■ :^.^ ►''♦"'■ft ' ... ,1 ,i • v '.'r.v^ ftfty* ''■••'• "„ it ' y-v to; •/-■ • V'-fvJ;- AV;iT« :...•.•■/., 3,,-r 0>; it'/.i vi'Tir rt.3Ws:; l3>* K^v.A\^' K KW^V.'-..;} !& ffi' •*'S kV" #£& It",'/'"*-' r-w/v ->v •:•<:*•• ,'rr-.^' 3s 'i;.wi.,-' fe .^-.r-... -i.j'. Ijsr.ir;'- at ^featfSi^ r 30,3 •>&$ 9^ THE COMPLETE PHYSICIAN, SURGEON, AND ACCOUCHEUR --CONTAINING — THE SYMPTOMS, CAUSES, AND THE ALLOPATHIC, HOMCEOPATRIC, HYDROI'ATHIO AND ECLECTIC TREATMENTS OP ALL KNOWN DISEASES OF THE HUMAN BODY; POISONS AND THEIR ANTIDOTES; ACCIDENTS AND THEIR TREATMENT. BY HENRY WICAND, M. D. WITH NUMEROUS ENGRAVED ILLUSTRATIONS. Prove all things — hold"fast that which is good." — St. Paul, CO ? CINCINNATI: FOR SALE BY J. ii. PARKS, 133 JIAIN' STREET. ^•et' t?55 Entered according to Act of Congress, in the year 1855, BY HENRY WIGAND, In the Clerk's Office of the District Court of the United States for the Southern District of Ohio. Stereotyped by JOHN K. GERHARD, ' at the United Brethren Printing Establishment, Dayton. O. CONTENTS. CHAPTER I. Explanatory remarks to the practices of Allopathy, Homoeopathy, Hydropathy, Eclecticism and Surgery. Directions for the regi- men of the sick. Dietetics. - - - Page 7 CHAPTER II. General Diseases. ...... 33 CHAPTER III. Fevers. ----.... 7C CHAPTER IV. Nervous and mental diseases. - - - - IOC CHAPTER V. Diseases of the Skin. - - - - - 127 CHAPTER VI. Diseases of the Bones. ... . 184 CHAPTER VII. Diseases of the Joints. - - - - - 192 CHAPTER VIII. Diseases of the Head and Brain. - 204 CHAPTER IX. Diseases of the Eyes. ..... 229 CHAPTER X. Diseases of the Ears. ..... 269 CHAPTER XI. Diseases of the Nose. - - - - - - 277 CHAPTER XII. Diseases of the Face, Teeth and Buccal Cavity. - - 285 CHAPTER XIII. Diseases of the Throat and Fauces. .... 309 CHAPTER XIV. Diseases of the Stomach and Abdomen. - - . 320 CHAPTER XV. Diseases of the Urinary Organs. - - - - 419 CHAPTER XVI. Diseases of the Genital Organs. .... 449 3 CONTENTS. CHAPTER XVII. Diseases of the Respiratory Organs. - - - Page 503 CHAPTER XVIII. Diseases of the Blood-vessels. - - - - 571 CHAPTER XIX. Diseases of the Back. ..... 575 CHAPTER XX. Diseases of the Extremities. .... 585 CHAPTER XXI. Midwifery. ....... 595 CHAPTER XXII. Accidents and their treatment. Amputations, &c. - - 638 CHAPTER XXIII. Poisons and their Antidotes. .... 701 PREFACE. There are four medical systems, namely: Allopathy, Homoeopathy, Hydropathy, and Eclectisism (American Practice ), demanding, at the present time, the attention of the Student and Practitioner of Medicine. Each has its colleges, its books, its periodicals, its learned and un- learned advocates, its friends and foes; and each has sovereign remedies, and miraculous cures of which it can boast. To compare or set forth the merits or demerits of the theory and practice of these respective schools is not the present purpose of the author. The subject has, time and again, been ably discussed and he therefore leaves the decision in regard to the superiority of the one or the other system to the intelligent reader. The diagnosis, prognosis, and causes of disease, as given by " Mother " Allopathy, are admitted by all schools. There is a general agreement upon these points. The apple of discord seems to consist in the quality and quantity of remedial agents, a matter which, after all must be left to individual observation and experience. The progressive spirit of the present age, which seeks to condense and simplify the means of acquiring knowl- edge in all departments of science, has induced the author to give to the medical profession a work containing an impartial record of the treatment of disease as resorted to by each of the different schools. With regard to the sources from which these materials are gathered he can say, that the most valued and relia- ble works, of both english and german authors, have been carefullv consulted, 6 PREFACE. The plan of arrangement may appear rather novel, but it has, he thinks, the merit of being simple and conve- nient. With many imperfections of which he himself is con- scious, the author ventures to hope, that the Student and Practitioner will find in this work all the information which formerly could only be obtained by laborious search through ten or more volumnes, and by thus saving time, labor and expense, he has contributed to the advancement of a profession which holds in its hands the weal or woe of millions. The Author. CHAPTER I. EXPLANATORY REMARKS TO THE PRACTICE OF ALLO- PATHY. Allopathic remedies are divided into general and local, the former acting on the whole system, the latter on particular parts or organs. General remedies include: 1. Stimulants, exhibiting their influence chiefly upon the heart and arteries, as: Carbonas ammonise, oil of turpentine, phosphorus, alcohol, cloves, ginger, pepper, &e. 2. A'arcotics (Soporifics and Anodynes), which especially affect the cerebral functions, and are either stimulant or seda- tive, according as they increase or diminish action, as: Opium, garden lettuce, camphor, hops, henbane, conium maculatum, belladonna, stramonium, aconitum, digitalis, tobacco, nux vomica, rhus, spider's web, Prussia acid, &c. 3. Antispasmodics, which exert a peculiar influence ovet the nervous system, exhibited in the relaxation of spasm, the calming of nervous irritation, as: Assafcetida, galbanum, musk, ammonia, castor, Valeriana, garlic, skunk cabbage, sul- phuric ether, chloroform, oleum succini, &c. 4. Tonics, which exalt the energies of all parts of the frame. as : .Peruvian bark, snake root, columba, gentiana, quassia, cascarilla, wild cherry, chamomile, iron, copper, zinc, gold, arsenic, &c. 5. Astringents, which have the property of producing con- traction in the living tissues, with which they may come in contact, as: ^ortex querci, gallae, geranium maculatum, kino, catechu, sugar of lead, sulphas zinci, alum, lime water, sul- phuric acid, &c. LOCAL REMEDIES. 1. Emetics, which act on the stomach, producing vomitings as: Ipecacuanha, antimony, sulphate of zinc, lobelia, squill, sulphate of copper, &c. 7 8 INTRODUCTORY REMARKS. 2. Cathartics, which act on the bowels, producing a purga- tive effect, as: Jalap, rhubarb, senna leaves, gamboge, aloes, scammony, colocynth, elaterium, croton oil, castor oil, sulphur, magnesia, glauber's salts, epsom salts, cremor tartar, calomel, May apple, &c. 3. Antilithics (Lithon triptics), which prevent the formation of calculous matter, as: Carbonas sodae et potassae, magnesia, aqua calcis, mineral acids, carbonic acid, uvae ursi folia (bear- berry), &c. 4. Diaphoretics, which increase the cutaneous discharge, as: Antimonial preparations, Dover's powder, nitras potassae, pre- parations of ammonia, eupatorium perfoliatum (boneset,) asclepias tuberosa (pleurisy root, butter, fly weed), guajacum, daphne mezereum, sarsaparilla, sassafras, prickly ash, &c. 5. Expectorants, which augment the secretion from the pulmonary mucous membrane, or promote the discharge of the secreted matter, as: Senega, squill, garlic, arum tryphil- lum (Indian turnip), ammoniacum, assafoetida, camphora, balsamum tolutanium, balsamum peruvianum, carbonas pot- assae et sodse, liquorice, &c. G. Emmenagogues, which excite the menstrual secretion, as: Radix hellebori nigri, $abina, penny royal, rosmarinus offici- nalis, madder, senega, cantharides, aloes, borax, &c. 7. Sialagogues, which increase the flow of saliva, as: Mer- cury and its different preparations, &c. 8. Errhines, which increase the discharge from the mucous membrane of the nose, as: Tobacco, asarum europaeum, hele- nium autumnale, turpetheum minerale, &c.( 9. Rubefacients, which produce redness and inflammation of the skin, as: Mustard, cayenne pepper, garlic, turpentine, aqua ammoniae, camphor, tincture of cantharides, pix burgun- dica, &c. 10. Epispastics or Vesicatories, which produce a serous dis- charge beneath the cuticle, forming a blister, as: Cantharides, lytta vittala (potato fly), nitric acid, tartarized antimony, setons and issues. MODE 'OF ADMINISTERING MED1C1XE. 3 11. Escharot'ics or Caustics, which destroy the life of the part upon which they act, as: jiotassa fusa (common caustic), nitras argenti (lunar caustic), arsenici oxydum, alum, corro- sive sublimate, red precipitate, s-ulphate of copper, muriatic acid and nitric acid. 12. Abortiva, which increase the parturient action of the uterus, as: Ergot, borax, rue, &c. 13. Diuretics, which act on the kidneys, producing an in- creased-flew of urine, as: Digitalis purpurea, squill, colchicum autumnale, tobacco, cantharides, balsam copaibas, piper cu- beba, cahinca root, parsley, buchu leaves, dancus carota (wild carrot), winter-green, carbonate of potash, spirits of nitre, tinctura muriatis ferri, beer, creasote, turpentine, &c. 14. Anthelmintics, which have the power of destroying or dislodging and expelling wornis from the intestinal canal, as: Pink root, chenopodiurUjtowhage, male fern, seeds of artemi- gia, camphor, spirits of turpentine, stannum, mercury, &c. 15. Antacids, which obviate acidity in the alimentary canal (chemical action), as: Lapides calcariae, aqua calcis, magnesia, carbonas potassa? et sodae, &c. lb\ Demulcents, which obviate or lessen the effects of irri- tating matters, as: liquorice, slippery elm, gum arabic, flax seed, olive eil, arrow root, sago, seeds of the quince, gummi, tragacantha, 1 gr. 20 WINE MEASURE. Gallon, Pints. Fluid ounces , Fluid drachms. Minims. Cong. 1 8 128 1024 61440 0.1 16 128 7688 f. 3 1 8 480 f. 3 1 r^eo APPROXIMATE MEASUREMENT. A teacup is estimated to contain about four fluid ounces. A wineglass " " " two " " A table-spoon " " " half a fluid ounce. A tea-spoon " " " a fluid drachm. A fluid drachm " " " sixty drops A drop is equivalent to a minim. EXPLANATORY REMARKS TO THE PRACTICE OF HOMCE- OPATHY. Homoeopathy makes use of the same simple substances as the old school, procuring each medicine in all its purity, and administering it without any admixture, which might alter its proper virtues. For the preparation of Homoeopathic Medi- 12 INTRODUCTORY REMARKS, cines, two substances are used, viz: alcohol, or sptrits of wine, for the preparation of liquid or soluble substances; and sugar of milk for the preparation of dry substances. The tinctures are obtained in mingling with alcohol, the juice recently expressed from fresh plants, or, in infusing in this liquid the dry substances, the active principle of which, can be extracted in this way. The powders, on the other hand, are obtained by the trituration of the insoluble sub- stances, with a suitable quantity of sugar of milk. In the majority of cases, Homoeopathy considers primitive preparations too energetic to be administered such as they arc obtained. But, instead of seeking to diminish their energy by the means which the old school calls correctives, Homoeopa- thy endeavors to obtain this end by the simple attenuation of the primitive substance in the proportion of one or ten to one hundred. Thus she prepares out of each substance, a series of attenuations of which the following one contains ordinar- ily the one-hundreth, or sometimes the tenth part of the act- ive principle of the preceding one. The Homoeopathic physician dispenses his medicines with- out any other mixture than that of the least medicinal sub- stances, such as alcohol, pure watei, sugar of milk, and glob- ules composed of sugar and starch. The attenuations of each medicine being previously prepared, the patient receives of them the dose prescribed, either in form of solution with a convenient quantity of water, or in form of powder, mixed with a small quantity of sugar of milk, or, yet again, in forma of globtdes impregnated with the alcoholic attenuation of the medicine. CHOICE OF MEDICINES. The first and principal point in homoeopathic practice, is the possession of pure and genuine medicines, and next the choice of the proper remedy. The remedies should be select- ed strictly according to symptoms; i. e. the symptoms which the medicinal substance produces, when taken in large doses by an individual in health, should correspond as nearly aa bos£, 13 possible, with those which we perceive in the patient, according to the fundamental principle of Homoeopathy ulike cures like." When the symptoms are not characteristic or well marked, attention to the period of the day at which they occur; the side of the body which is affected; the disposition of the pa- tient, his pecaliar habits and likings, &c, are of material assistance. POTENCIES. The second point which merits attention, is the potency at which the proper remedy should be exhibited. In severe acute diseases, the best range is from the first to the third, sixth, and even twelfth potency, modifying the rule according to the remedy itself, the disease, and the particular suscepti- bility to medicinal influence of the patient. In chronic diseases, the majority of modern Homceopathists have decided in favor of the thirtieth, and even the two-hun- drcth and six-hundreth. In children and females, we find a marked receptivity to medicinal influence, a decided action and speedy reaction, con- sequently the higher potencies are most applicable in their diseases, and they rarely require so frequent a repetition. Medicaments, which in their crude state, possess little or no medicinal property, such as Lycopodium, Natrum muriati- eum, Calcarea, Sepia, Carbo veg, Silicea, &c, should gener- crally be used at the higher potencies. On the contrary, those which have a short-lived action, may be used in their original substance, for example, Moschus, Valerian, Asa- fcetida and Camphor, but in exceedingly small doses. DOSE. Tne third point requiring our attention, is the dose and its repetition. In the treatment of acute diseases we may employ one or two drops, or from two to twelve globules of the lower poten- cies, dissolved in half a wine glass full of soft water, adminis- 14 INTRODUCTORY REMARKS tering from a part of a tea-spoonful, up to a table-spoon ful—according to age and sex—per dose, every hour or every three or four hours, and as long as it does good. If no im- provement follow after the fourth dose, the next best reme- dy must be chosen. In the treatment of chronic maladies, from two to ten glob- ules of the proper remedy should be taken every night in a tea-spoonful of cold water, or dry upon the tongue at bed time, for a week, and then allow the remedy to act from four to eight days, and even upward, before repeating the remedy, or selecting another. But when the patient is extremely sus- ceptible to the action of medicine, only one or two doses, con- sisting of one or two globules, should be given, and the rem- edy allowed to act for the same period as above specified. Only one medicine should be prescribed at a time; but in some complicated cases, the alternate employment of two rem- dies (of one and the same family,) which are especially indi- cated, are of considerable advantage. The medicines should be taken fasting, and food or drink, as also excessive bodily or mental exertion abstained from for half an hour to an hour afterward. The Homoeopathic reme- dy should be kept in a clean, dry, dark place, free from odors. Every description of patent or domestic medicine is prohib-- ited, likewise coffee, tea, spices, spirits, indigestible substances, perfumery, and every thing containing camphor. In doubtful cases, where the symptoms have not been given, of the remedies recommended, the practitioner must be guided by Jahr's Symptomatology. EXPLANATORY REMARKS TO THE PRACTICE OF HYDRO- PATHY. The habits of civilized life cause deficient external circula- tion, capillary obstruction, and internal congestion or engorge- ment. To counteract this morbid condition a daily bath should be as regularly attended to as are the daily meals. The towel, sponge, or hand-bath, are for hygienic purposes, WATER-CURE PROCESSES. 15 and in ordinary cases the most useful. The best time for a general bath is on first rising from bed in the morning. In warm weather an additional evening ablution is refreshing and invigorating. The temperature of the water must be varied to suit dif- ferent circumstances of constitutional health and vigor. The general rule is, that cool or cold water, short of producing any chill, is the best. Persons of deficient blood and low vitality should use tepid water, and extremely feeble individ- uals should commence with warm water, gradually reducing the temperature as "reaction" improves. The cold bath may include all temperatures between 60° Fahr.; the cool from 60° to 72°; the tepid from 72° to 85°; the warm from 85° to 100°; and the hot above 100°. No person should bathe in cold water when the body is chilly from cold, nor when exhausted or over-fatigued from violent exercise, nor when, from any cause the, respiration is materially disturbed, nor soon after eating. Heat and per- spiration are no objections to going into, or using cold water, provided the body is not in a state of debility from over- exertion, and the breathing is easy and natural. WATER-CURE PROCESSES. 1. The wet sheet packing.— Spread on a matrass from three to five large comfortables, then a pair of flannel blankets, and lastly, the wet sheet lightly wrung out, so as not to drip. The patient lying down flat on the back is quickly enveloped in the sheet, followed by the blankets and comfortables, taking care to turn the clothing snugly and smoothly around the feet and neck. For delicate persons the sheet should at first be wrung out of tepid or even warm water. The average time for remaining packed is from thirty to sixty minutes. On coming out of the "pack," the plunge, douche, rubbing wet sheet, or towel washing may be employed. If the feet remain cold while in the pack, bottles of hot water should be 16 INTRODUCTORY REMARKS. placed to them. Headache is prevented by the application of cold wet cloths. When the object is to reduce fever or inflammation, the patient should be lightly covered, and the wet sheet frequently renewed. In chronic diseases, when the intention is to produce reaction and develop the external circulation, an additional quantity of bedding secures this object. As a cooling process, it may with safety be frequently repeated, until the force of the pulse and the preternatural heat are reduced to the normal standard. Much sweating is not usually to be desired. 2. The half Pack-Sheet.— This is the application of the wet sheet as above to the trunk of the body only. It is milder, yet less efficacious, than the full pack. It is only employed on feeble persons, who have not sufficient vitality for the whole sheet. 3. The Douche.—The stream should be directed to the back of the neck, along the spine, hips, and shoulders; in chronic swellings of the joints it may be directed to the affected parts; in cases of torpid bowels a moderate stream may be applied to the external abdominal muscles. No strong douche should ever be taken on the head, nor should it be long continued on any spot about the spine or back-bone. It is well adapted "*• to chronic enlargements of the viscera, tumors, swellings and stiffness of the joints; local attacks of gout and rheumatism, obstinate constipation, and many other disorders. Douches most generally in use are perpendicular streams from one to two inches in diameter. ,# The ascending douche is valuable in piles, prolapsus of the uterus, or bowels, constipation from debility, &c.—The stream may be half an inch to an inch. Warm water douches are of excellent effect in many cases of rigidity of the muscles, painful swellings, chronic inflam- mations of the joints, in neuralgic affections, in spasmodic and bilious colic, in retention of urine,amennorrhcea &c. A HEAD-BATH. WET-SHEET PACK. ** LEG-BATH. SITTING-BATH. WASHTUB-BATH. THE HALF-BATH DOUCHE-BATH. SHOWEB-BATH. ► * CATARACT-BATH. HOSE-BATH* RUBBING WET-SHEET i r PLUNGE-BATH, THE SHALLOW-BATH. 17 email stream should be long continued, followed by the cold dash for a moment. 4. The rubbing wet sheet.— The sheet is thrown suddenly around the patient's body, which it closely envelops from the neck to the feet, and the body is rubbed by the hands of the attendant outside the sheet; in ordinary cases five minutes are sufficient. It is succeeded by the dry rubbing sheet, or rubbing with dry towels. It is applicable in all cases wherein a strong diversion from the internal viscera, or the mucous membrane of the alimen- tary canal to the skin is required, as in the early stages of bowel complaints, colic, diarrhoea, dysentery, cholera, skin diseases, mental disorders, delirium tremens, epilepsy, night sweats, &c. 5. The Hip or Sitz-Bath. — Any common wash-tub will answer for its administration, though it is more convenient to have vessels made for the purpose, the bottom raised a few inches from the floor, the back side raised to rest against. The water should cover the hips and lower portion of the abdomen. It may be of any temperature from very warm to extreme cold, according to the case; and the time of applica- tion varies from five to thirty minutes. The best tonic effect of hip-baths is secured by having them of short duration — five to fifteen minutes — and frequently repeated. A blanket is usually thrown around the patient during this bath. The sitz-bath is invaluable in weakness, irregularity, ob- struction and torpor of the lower organs of the pelvis and abdomen; in acute inflammation of the liver, stomach, bowels, spleen and kidneys; weakness in the small of the back; &c. 6. The Shallow-Bath. — The common shallow-bath tub may be used, but a circular or oval tub, raised about twelve inches from the floor, is more convenient. The water should be from four to six inches deep, and generally tepid — 65° to 75° — seldom cold. During the bath the abdomen and lower part of the body should be well rubbed by the patient, or by an 18 INTRODUCTORY REMARKS. attendant, while the head is sprinkled, and the back and chest well rubbed. When there is no chilliness, a pail of cold water should be poured on the chest and shoulders to complete the process. This bath may be employed from one to thirty minutes, according to the strength of the patient. It is one of the leading baths in the treatment of mineral diseases, in sick headache, and rush of blood to the head; in apoplectic, epileptic, paralytic, hysterical, and cutaneous affec- tions; in sun-stroke, delirium tremens, &c. 7. The Half-Bath. — This is in effect intermediate between the shallow-bath and full-bath. It is to be regulated by the same rules as the shallow-bath. 8. The Plunge-Bath. — Immersing the whole body up to the neck quickly, when the patient has room and opportunity to exercise his limbs under water, is all that is essential to the full benefit of this process. The temperature of the plunge is usually from 35° to 65°, and the time for remaining in the bath varies from a very few seconds to two or three minutes, in chronic diseases; in high fever or general inflammation of the whole system, the patient may remain ten or fifteen minutes. It is generally preferred after the tweadiig process, and very frequently after the wet sheet Persons laboring under any organic affections, do not bear the plunge well. 9. The Foot-Bath. — Any vessel large enough to admit the feet, and water enough to cover them ankle deep, will answer. The time is usually from ten to fifteen minutes. Persons of feeble circulation should use shallow foot-baths for about five minutes, the water being not more than one or two inches deep. The feet should be kept in motion during the bath. As a derivative in affections of the head and chest, it is often used in connection with the sitz-bath, with which it may be advantageously alternated. The warm foot-bath is often valuable to relieve sudden attacks of headache, and soothe the nervous system when irritated. THE DRY PACK, OR SWEATING BATH. 19 10. The Head-Bath. — The common method of bathing the head in acute diseases is by folds of wet cloths, or a stream of water poured over the head. In chronic affections of the head, eyes and ears, the patient lies extended on a rug or matrass, the head resting in a shal- low basin or bowl, holding two or three inches of water, the shoulders being supported by a pillow. It may be adminis- tered from fifteen to thirty minutes. 11. The Shower-Bath.— It can be employed profitably only by those who have a good degree of vital heat. The shock should fall upon the neck, spine and shoulders. It may also be freely applied to the chest and abdomen. 12. The Cataract-Bath. — It may be employed for the same general purposes as the douche. It is a good substitute for the plunge, and for the wave-bath, in those who cannot bear the exertion required by the latter. 13. The Dry Pack, or Sweating-Bath. — Wrapping in the dry blanket is managed precisely as the wet-sheet packing, with the omission of the wet sheet. The flannel blanket comes in contact with the body, and a sufficient number of blankets. and comfortables is thrown around to retain the animal heat. A wet napkin should always be applied to the head, and the room should be well ventilated. The sweating process usually occupies two or three hours. One, two, or three tumblers of water are taken at intervals during the envelopment. The patient should never remain long envel- oped after sweating has become copious. On coming out of the sweating-blanket, some form of a cool or cold bath should be taken. The dry-blanket packing is very useful for those invalids who are too feeble to exercise sufficiently to overcome the chill produced by the wet-sheet pack; also for those who suffer occasionally severe chills, proceeding from enlarged liver or spleen. Besides the baths mentioned above, Hydropathists employ 20 INTRODUCTORY REMARKS. the Wave-Bath, the Vapor-Bath, the River-Bath, the Rain- Bath, Wet-Dress Bath, etc. 14. Fomentations.—Warm and hot fomentations are useful in a variety of morbid conditions. That temperature which feels the best, is the best.—Flannel should be used as foment- ing cloths, well covered with thick, dry flannel, or part of a light blanket. 15. Bandages.—A warming bandage, or compress, is simply one or more folds of linen cloth, wet in cold water, applied to the part affected, and covered with a dry cloth or other mate- rial, to retain the animal heat. A cooling bandage, or compress, is a similar wet application without the dry covering. 16. The Chest-Wrapper.— It may be made of crash towel- ing, and fitted, with arm-holes, loosely to the trunk of the body from the neck, nearly or quite down to the hips. The outside covering is a similar wrapper, made of the same ma- terial, or of flannel. The inner, or wet wrapper, is tied as tightly around the body as desired by tapes, which are attached to the bottom, top and middle. If the wet cloth over the spine produce any chilliness, a space of from four to six inches in the center of the back should be uncovered by the wet cloth. This wrapper is of benefit in all chronic diseases of the chest. 17. The Abdominal Wrapper.— Take three yards of com- mon crash towel cloth, one half of this is wet, and moderately wrung; the wet end is applied to the side of the abdomen, then the bandage is passed across the abdomen, and around the body, followed by the dry half. It may be kept in place by tapes or pins. It is serviceable in all acute and chronic diseases of the abdominal viscera. 18. Friction.— Hand-rubbing, towel-rubbing, rubbing the skin with a flesh-brush or horse-hair gloves, are among the accompaniments of the bathing process. Their object is to assist reaction and promote capillary circulation. DIAPHORETICS. 21 EXPLANATORY REMARKS TO THE ECLECTIC PRACTICE OF MEDICINE The Eclectic, or American system of medicine discards Bleeding and the use of mercurial remedies. Their Materia Medica embraces, principally, the so called physo-dynamic remedies, which are dependent for their action upon the natural vital force of the system, and not upon chemical or mechanical laws. These are divided into Evacuents and Non- Evacuents. The remedial action of Evacuents involves the removal of various offensive agents, or abnormal accumulations in the system. Among the evacuents are found the Emetics, Ca- thartics, Diaphoretics, Diuretics, Expectorants, Emmenagogues, Anthelmintics; also, Sialagogues and Errhines. 1. Emetics, are substances which evacuate the bowels, as Lobelia inflata, Ipecac, Euphorbia ipec. Euphorbia cor, &c. Topical emetics cause but little nausea or sickness, and pro- duce but little effect in the general spstem, other than that effected through their operation on the stomach. They are Mustard, Sanguinaria canadensis, Sodii chloridum, Eupatorium perfoliatum, Verbena hastata, Apocynum, etc. 2. Cathartics, a class of agents which, when given in proper doses, will excite purging. Esculent Laxatives (good for food), as Moma, Cassiae pulpa, tamarindi pulpa, Pruni pulpa, Sacharum, honey, etc. Bitter Laxatives: Menispernum canad, Triosteum perf, Apocynum andros, Amygdalis Pers, Berberis vulg, Asclepias tub. Convolvulus p., etc. Common Cathartics: Rheum, Oleum Ricini, Juglans cinn, etc. Antibilious Cathartics (Cholagogues): Podophyllum pelt, Sanguinaria, Leptandra, Apocynum andro, etc. Hydragogues (producing liquid evacuations): Senna, Pot- assae Bitartras, Magnesia sulphas, Jalapa, Podophyllum, &c. 3. Diaphoretics, a class of remedial agents which increase 22 INTRODUCTORY REMARKS. perspiration. Specific Diaphoretics: Asclepias tub, Ptero- spora Antro., Liquor Ammonia? acet, Ictodes foetida. Nauseating Diaphoretics: Lobelia inf., Eupatorium perfol. Ipecac, Euphorbia, Anthemis nob, Pulvis Sudorificus. Stimulating Diaphoretics: Capsicum, Zingiber, Piper, Myrrha, Xantoxylum, Cinnamonum, &c. 4. Diuretics, a class of remedies which, when taken into the system, produce an increased discharge of urine; aa Eupatorium purp, Juniperus comm. Copaiba, Galium, Leon- todon tarax, Terebinthiha, Sambucus,Apium petros. Aspara- gus off, Uva ursi, Potassse acetas, etc. 5. Expectorants, medicines promoting the discharge of mu- cus or other matter from the trachea and its branches. Nauseant Expectorants: Lobelia, Ipec, Sanguinaria; Stim- ulating Expectorants: Senega, Arum triph, Aslepias tub. Inula kel, Aralia racemosa, &c.; Antispasmodic Expectorants: Ictodas foetida, Assafcetida, Galbanum; Balsamic Expecto- rants : Tolutanum, Myroxylon, Benzoinum. 6. Emmenagogues, agents which possess the power to pro- mote Menstruation. Specific Emmenagogues: Botraphis rac, Actea, Polygonum Ilydropiper, &c. Relaxant Emmenagogues: Emetics, Vapor, baths, &c. 7. Anthelmintics, are remedies used to destroy intestinal worms. Specific Anthelmintics: Chenopodium anth. Oleum tereb., Spigelia, Felix mas,Lobelia card, Melia azed, Panicagran. Mechanical Anthelmintics: Mucuna, Cathartics. Prophylactic Anthelmintics: Liriodendron tulip, Populua tremula, Absinthium, Sabadilla, &c. 8. Sialagogues, agents used for the purpose of promoting the flow of saliva, as: Capsicum, Lobelia, Tobacum, Xan- thoxilum, &c. 9. Errhinex, remedies occasioning a flow of the natural secretion from the nose, as: Assarum Europ, Assarum Canad. NON-EVACUENTS. 1. Stimulants, substances which will promote action. NON-EVACUENTS. 23 Spicy Stimulants: Capsicum, Piper, Zingiber, Cinnamonum, Cardamomum, &c. Volatile Stimulants: Camphor, Terebinthina, Sassafras, Ros- marinus, Calamus, Origanum, Melissa, Salvia, Hyssopus, etc. Fragrant Volatile Stimulants: Fceniculum, Anisum, Carum, Cuminum, Coriandrum, etc. Gum Resinous Stimulants: Myrrha, Ammoniacum, Guaja- cutn, Assafcct, etc. Alcoholic and Ethereal Stimulants: Alcohol, Spiritus vini Galici, Vinum, JTCthor sulph, &c. 2. Tonics, medicinal substances which have the power to give strength and vigor to the system. Anti-intermittent Tonics: Cinchona, Cornus, Salix, etc.; Bitter Tonics: Populus, Hydrastis Canad, Gentiana, Frasera, Colomba, Serpentaria, etc; Aromatic Tonics: Cascarilla, Mag- nolia, Comptonia, Arantii cortex, Conella, Wintera, &c. 3. Astringents, a class of agents whose prominent effects upon the system are marked by a peculiar contraction of the muscular fibre. Simple Astringents: Geranium mac, Nymphaea odorata, Hamamelis, etc.; Bitter and Acrid Astringents: Myrica cer. Catechu, Kino, Quercus, Galla, Abies can, Geum, etc. 4. Antispasmodics, remedies calculated to assuage spasm, as: Lobelia, Ictodes foetida, Assaf, Moschus, Castoreum. 5. Anodi/ncs. remedies possessing the power to allay pain, as: Extractum Papaveris, Lactuca, Cyripedium, Valeriana, Asarum, etc. 6. Alteratives, remedies altering the condition of the sys- tem, as: Sarsaparilla and its different preparations, Stillingia, Guajacum, Celastrus, Iodinum, Alnus, Aralia, Sodii chlori- dum, etc. 7. Acids neutralize alkalies, and thus with them form salts. 8. Alkalies neutralize acids. In regard to doses, the preparation of medicines, etc., con- sult the Eclectic Dispensatory. 24 INTRODUCTORY REMARKS. SURGICAL APPLIANCES. INSTRUMENTS. The common pocket-case of instruments, with tooth for- ceps, ligatures, lint, adhesive plaster, sponge, bandages, male and female catheter, the stomach-pump, are all that emergen- cies demand to be kept always in readiness. Instruments needed for amputations, are the tourniquet, a large knife, saw and bone-forceps Issues. — They are best made with Caustic Potash. Take a stick of the pure potassa fosa, rolled in paper to protect the fingers; wet the end of it, and press gently with it on the point to be acted on. After the cuticle is thus destroyed, apply an elm poultice until the slough separates. The sore may be prevented from healing, either by binding several peas firmly on its surface, or by touching it occasionally with the Caustic. Issues should never be made over projecting points of bones, nor over the bellies of muscles; for they might de- generate into most obstinate sores. Setons are introduced by pinching up a fold of the skin, and pushing a needle through it, armed with a skein of silk or cotton, or a long flat piece of India rubber. As soon as one or two inches are brought through, the needle is cut off. A fresh portion of the thread is to be pulled through the wound every day, so as to keep up constant irritation and discharge. Cupping. — Sponge the skin well with hot water, and then try it with a warm towel. In the next place dip the torch in the spirit, set it on fire, introduce it for half a second into one of the glasses, and clap the latter on the skin. As soon as the skin has become red and swollen, charge the scarificator, detach the glass by insinuating the nail of the left forefinger under the edge, instantly discharge the scarificator on the swollen skin, and as quick as possible introduce the torch into the glass and apply it again. VENISECTION — BLEEDINQ. Ma VENISECTION — BLEEDING, Venaesection, at the bend of the arm, should always, if possible, be performed in the median cephalic vein. A ligature being placed a little above the elbow, (but not tight enough to stop the pulse at the wrist,) the operator takes the forearm in his hand, places his thumb on the vein a little below the intended puncture, and then pushes the lancet obliquely into the vein, and makes it cut its way directly outward. When sufficient blood has been taken, the ligature is removed, the thumb placed on or just below the aperture to check the bleeding, and the wound is closed with a bit of lint and plaster, and secured by a small compress, and figure of 8 bandage. Mustard plasters. — Use only the mustard of the strongest quality, and ground as fine as superfine flour. Wet it with cold water, or water not more than blood warm, and have it of such consistency that it will spread well without flour or meal. Applied in this state directly to the skin, it will take effect in one or two minutes, and cannot be borne longer than fifteen or twenty minutes. Vesicatory. — Before applying a fly-blister, the skin upon which it is to be laid, or the surface of the plaster should be moistened with vinegar or brandy. When the blister is drawn it must be opened and dressed with simple cerate spread on linen. To keep up the discharge from a blistered surface, an ointment made of a small portion of cantharides and lard Is one of the best applications. Savin ointment is also very good for this purpose. When a blister is in a state of painful irritation, sweet oil, or a soft bread and milk poultice, should be applied. Vesication may be produced by removing the Cantharides as soon as the skin is slightly reddened or inflamed, and ap- plying an emollient poultice over the part. This is a good mode of blistering, in infants, or where we wish to avoid much pain and irritation. m OTTKOIVUCTORY REMARKS Cantharides seldom produce complete vesication under eigli* ®r twelve hours. (See Poisons and tiseir Aistidotes.) SUTURES — DRESSINGS, When bleeding has been arrested from a woTtHfd, its edges are generally brought in contact,, in hopes that they will speedily unite. The interrupted suture is in s&ost frequeat use. It ia formed by passing a needle and thread through the skin and subcutaneous cellular texture from without inward on the one side, and from withia outward on the other,, at about the fourth of an inch distant from each margin, and fastening the end of the thread with sufficient tightness to prevent the; surfaces from separating. The stitches are proportioned in number to the extent of the wound; they are commonly placed about an iach fo&m each other; where the distance is greater the parts may be supported by a few strips of adhe- sive plaster, placed between each stitch; and over all it is usual to apply a few tarns of a roller. The threads are generally removed on the second day from their introduction. The knot should be seized with the dis- Becting forceps, gently turned aside, and the point of one blade of the surgical scissors insinuated under the thread, which should then be divided, and withdrawn through one of the apertures. 2. The twisted suture is often applied with great advantage, in instances when the parts require to be kept very steady, and in particular when some considerable stretching of the neighboring textures is necessary, as, for example, in the operation for hare-lip. This kind of suture is made by pass- ing a common sewinsg needle through the skin and-other textures, from one side of the wound to the other, and twisting a thread over each end of it, with such a degree of tightness as to keep the surfaces in contact. After the thread has been applied, the point of eao* needle should 1»> cut oil SUTURES — DRESSINGS. 27 with a pair of common pliers. The needles should be re- moved on the second or third day. The threads may be allowed to drop away of their own accord. After the removal of any kind of suture, it is a good prac- tice to reapply straps and bandages, so as to give support to the tender adhesions. Bandages. — Rollers may be made of good, smooth, un- bleached muslin from two to two and a half inches wide. The general rules in bandaging a limb are, to begin at the extremity and apply the bandage most tightly there, and more loosely by degrees as it ascends-^to make each succes- sive fold overlap about one-third of the preceding—to keep the bandage close to the limb, and unroll very little of it at a time — and to double it on itself on parts where it would not lie smoothly otherwise. Splints should be made of light, but tolerably stiff wood, such as the pine, cedar, bass wood, poplar, or by saturating woolen cloth with gum shellac. Some should be fitted for the forearm, some for the arm, others for the leg and thigh. They should be covered with cotton rolled on as a bandage, or fitted on with paste, or, what would be better, very soft buckskin or sheepskin. Anaesthetics are valuable acquisitions to the Surgeon as well as the patient. The best article for this purpose is Sulphuric Ether, purified by water, and taken into the lungs. Chloro- form is more effectual — producing, occasionally, death in a very short time — and should, therefore, be used with the greatest caution. The ether can be inhaled with comparative impunity. Moisten a piece of sponge large enough to cover the mouth and nostrils, so that no air can enter without being saturated with the vapor. It will seldom produce complete unconsciousness; patients know, but do not feel what is going on with them. In administering Chloroform or Ether the following rules phould be observed: The stomach should be empty; the patient in his ordinary quiet or composed state; that is, with- 28 INTRODUCTORY REMARKS. out rush of blood to the nead, or determination to the brain; the extremities must be warm, and a general glow upon the surface, etc. (See poisons.) Magnetism will produce in many cases the desired insensi- bility, and when the patient is susceptible, this process is always to be preferred. Congelation. — Frigorifie mixtures have been used as anaes- thetic agents with great success. A piece of ice dipped in salt, and applied to the part, produces congelation in about half a minute. Pieces of ice mixed with common salt and nitrate of ammonia, make a still stronger frigorifie. It should never be applied to a very large surface at once. Collodion. — This article is applied to small cuts and abra- sions for the protection of the surface. Adhesive Plaster.-—This is employed to retain divided parts in proximity; to afford mechanical support to relaxed and distended vessels, as varicose veins; to excite absorption by compression, as in indolent ulcers, and protect abraded sur- faces. In dressing wounds, it is applied in narrow .strips, with interspaces for the discharge of matter Surgeons Knot. — The first knot has two turns to prevent it from slipping while the second is being tied. The Tourniquet. — This instrument is a form of a ligature, and is calculated to compress large and deep seated arteries in amputations and other exigencies. The pad or compress is npplied directly upon the artery above the injury or opera- tion, and pressed upon the vessel until the pulsation of the artery beyond is suppressed by turning the screw. The Ligature. — Various kinds of strings or ligatures arc employed to arrest the bleeding from wounded or divided blood vessels, chuck the venous circulation so as to prevent the absorpfiou of poison, as in the case of bites of venomous animals, remove tumors, &c. Silk, linen, and animal mem- brane—cat-gut—are (he materials iu use. The latter is pref- erable, especially for tying bleeding arteries or veins, as loth THERAPEUTIC DIVISION OF DIET. 29 ends may be cut off close to the wound, and the rest left to decomposition and absorption. The Sponge. — For surgical purposes the finest and softest article is the best. Tents and Pledgets.— These are conical or cylindrical masses of charpie, or prepared lint—best made by scraping the fine nap from old linen — or sponge. They are employed to keep up a discharge from a fistulous or sinous ulcer, so as to secure granulation from the bottom of the sore; to introduce caustics and irritants; to absorb matter, etc. Tampons are large tents, for making pressure or applying distention to arrest hemorrhage. DIETARIES. The general errors in diet are, too great concentration, im- proper combination, excessive quantity, and imperfect quality of the alimentary materials. Each of these errors is equally important to guard against. The quantity of food for invalids varies with age, exercise, temperament, and pathological condition; a correct practice is to eat sufficient to satisfy all demands of actual hunger, but not to the extent of producing a sense of oppression in the brain and muscular system. Overloading the stomach pro- duces a feeling of weariness, fullness, oppression, and dullness in both body and mind. Some patients are insane on the subject of Diet. Their mind is continually directed to the stomach, and on the watch for some new or old feeling, or symptoms, to be mitigated, or aoo-ravated after every meal. Such persons better eat too much, than be always worrying for fear some error has been or will be committed. THERAPEUTIC DIVISION of DIET. 1. Full Mixed Diet. — Bread, mush, butter, cream, milk, potatoes, with some kind of fruit, for breakfast and supper; for dinner, bread, vegetables, fruits, plain pudding or pastry, 30 INTRODUCTORY REMARKS. with flesh, fish, fowl or eggs. This is calculated for persona in health, and for that class of invalids who have no special or disproportionate disease or derangement of the digestive organs. 2. Full Vegetable Diet.—Precisely the same as the preced- ing, omitting the flesh, fish, fowl, and eggs. This diet is to be preferred in all diseases attended with the inflammatory diathesis, or great irritability of nervous system; in gout and rheumatism, in pulmonary diseases, in scrofula, scurvy, neuralgia, and in nearly all of the ordinary female com- plaints. 3. Strict Diet.—Bread, mush, milk, sweet cream, patatoes, and good grapes or apples. This is adapted to nearly all chronic diseases, attended with weakness of the digestive organs, to liver complaint, and to a variety of nervous, rheu- matic, and neuralgic affections, which are connected with derangement of the biliary secretion; it is appropriate, too, in skin diseases, chronic catarrhal affections, bronchitis, laryn- gitis, and ulcerations of the throat. 4. Abstemious Diet.—This is the same as strict diet, with the exception that the quantity of food should be rather below the point of complete nutrition. It is the " Hunger cure." This is indispensable in glandular enlargements, fever and ague, dumb ague, enlarged livers and spleens, malignant tumors, ulcers, foul skin diseases, mucous dyspepsia, piles, and in nearly all forms of female complaints. 5. Dry Diet. — Crusts of bread, roast potatoes, Graham crackers, and uncooked apples make a good arrangement of dry diet. Many other selections can be made equally as good. Dyspeptics, who are troubled with excessive flatulency, acrid eructations, water brash, sick headache, etc., are benefitted by this diet. 6. Watery Diet.—Due proportions of milk, grapes, parsneps, and potatoes, are an example of a watery diet. It is adapted to gravel, calculous concretions, biliary obstructions attended with gall-stones, those forms of gout and rheumatism in which PARTICULAR DIETARY EOR DYSPEl'TlCfe . 31 chalky deposits as-e fermoHa atid a*wnd the joints, plethora, and may be resorted to in other cases when pure soft water can not be procured, 7. Fever Diet—The, best fever diet is starvation, until its- violence is abated. Isadian or wheat meal .gruel, toast-water, barley-water, ]esao?aade,«tc, are harmless, and often gratifying to the patieet.—-£Extr, From Traill Encyclopedia.] ALIMENT FOBIDDEN DURING SICKNESS. Old smoked salt meat, veal, geese, ducks, ike liver, heart, frumgs, or tripe of animals. Rancid butter, old strong claeese, lard, fU pork, turtles, terrapins. Fish without scales, as catfish, eels, and sakaioaa; lobsters. erabs, clams arad s®Taps prepared &&m them. Coffee and green tea. Food, prepared from bkx)d, a*td much animal fat. Veal cutlets; all kinds of sausages, particularly s«ck as are smoked. The flesh of all yo^ng ajtiitals. All soups highly seasoned, sauces, draw®-butter, pepper-pot. Oakas prepared with much fat or aromatics. All kinds of colored confectionary, pastry, honey. Pickles prepared with spices, or greeted with copper; cat- sup, celeTy, garlic, onions, pepper, mustard, nutmeg, ginger, vanilla, bitter abzioii&s, ckves, cinnamon, allspice, fennel or anis-sccd, sage, thyme, spiced chocolate. All kinds of distilled and fermented liquors; mineral-waters. PART I Off J L Alt DIETARY FOR. DYSPEPTICS. Breakfast. — Brown bread, apples, grapes, peaches, or pears, ©r other very ripe uncooked fruit, if sweet or s^b-acid. Drink water, or a very little milk. Dinner.—Baked or boiled ose&ly .patatoes, baked apples, or grapes, with brown bread. Desert.—Cold cracked wheat, mush or oat meal, or plain boiled rice, wii& a little sweetened milk, or brown sugar, for '>-> INTRODUCTORY RE3IARKS. seasoning; asparagus, or green peas, in their season. Drink a very little water. Supper.—Brown bread toasted, or Graham crackers, baked sweet apples. No drink, and the whole supper very lio-ht. Baked or boiled mealy potatoes may be substituted for the oread or crackers. CHAPTER II. GENERAL DISEASES. ABSCESSUS — AFOSTEMA - - A BSCESS. X collection of purulent matter formed or deposited in a cavity, or in the substance of an organ or part of the body. Acute abscesses are preceded by inflammation in the affected part, which is followed by suppuration. At the commence- ment of the suppurative process the pains become throbbing and the swelling increases. After the formation of matter, fluctuation of the part takes place, and if there is a large quantity of pus, chills or rigors supervene, succeeded by fever; the tumor becomes pointed, the skin near the centre of the swelling transparent, and ere long gives away and the contents are allowed to escape. Causes.—Fevers; inflammation; blows; unhealthy blood; foreign bodies introduced into the skin or flesh. Allopathic treatment is partly general, partly local. The patient should be purged; the diet should be low, and leeches should be applied to the part. When cold applications feel uncomfortable, they should be exchanged for warm fomenta- tions or poultices. Poultices are made of bread and water, or of oat-meal, boiled till it is soft; or linseed meal, to which are added—if much hardness exists in the abscess — honey, soap, yeast onions, arnica or chamomile flowers. A piece of soft lint or folded linen, dipped in warm water, and covered with oiled silk to prevent evaporation, is a good substitute for poultices in many cases. If an abscess points and becomes pyramidica] without enlarging, it may be left to burst of itself; but if it enlarges in breadth without tending to the surface, it should be opened by means of the lancet. 3 33 34 GENERAL DISEASES. Homoeopathic treatment.—Apply poultices and warm fomen- tations, and forward the suppurative process by the adminis- tration of Hepar sulph, half a grain several times a day. When there is much pain and extensive inflammation, before the formation of pus, the employment of Aconitum and Bella- donna, in alternation, is sometimes requisite. Mercurius and (farbo a, are useful when there is induration. Hydropathic treatment.—Wet Linen dressings are applied locally for cleansing, soothing and healing the parts. Low diet and general cleanliness must be observed. Eclectic treatment.—To reduce inflammation, bathe the general surface daily with an alkaline wash ; administer a ca- thartic (Syrup of Senna with equal portions of cream of tartar,) and mild Diuretics and Diaphoretics, as chamomile tea, but- terfly weed, skunk cabbage, etc. Local means recommended are: the local or general alcoholic vapor bath; cloths wrung out of warm alkaline solutions and laid on the painful part; hops or a combination of lobelia and eupatorium; roman wormwood bruised and covered with warm vinegar; sassafras, etc. When it is necessary to use the lancet, open freely, and make the incision parallel with the muscular fibres of the part. Chronic Abscess. — The symptoms of a chronic abscess are devoid of any apparent disorder until it forms an external swelling. It is free from pain, tenderness, and redness, unless far advanced or accidentally inflamed, and is generally deep seated, whilst the acute are mostly superficial. The secreted matter is thin and serous, and contains substances resembling curds. If the abscess is large, and the air is admitted into the eavity, inflammation takes place, and great constitutional dis- turbance ensues; the cavity, instead of healing up, goes on discharging, and hectic fever is produced. Causes. — Chronic disease of bone, or other source of slov irritation, in a weak and scrofulous habit. Allopathic treatment consists: in amending the general health by wholesome and sufficient food, pure air, cleanliness and freedom from avocations that fatigue the body or harass ASTHENIA NERVOSA — DEBILITY. 35 the mind; in procuring absorption of the matter by stimulants and counter irritants, as blisters, friction with Iodine Oint- ment, electric sparks, and cold affusion; in opening the ab- scess as soon as possible, if notwithstanding these efforts the tumor continues to enlarge, and if there is any incipient red- ness of the skin. In puncturing a large chronic abscess, a small puncture should be made at the most depending part of the tumor, and after the matter has been permitted to escape, the puncture should be carefully closed by lint and plaster, and the patient be kept at rest till it is healed. At the expiration of ten days, when it is nearly refilled, a second puncture should be made, and it should be healed again in like manner. To avoid the admission of air into the cavity of the abscess, immerse the part in which the abscess is situated, under water at the time it is punctured. Homoeopathic tr.—When the matter has been withdrawn, in the manner described above, a dose or two of Mercurius should be administered, followed by Hepar sulph., Silicea, and sometimes also by Calcarea and Phosphorus. — (See Scrofula; Maxillary Abscess; Mammary Abscess; Onyx; Empyema; Hip disease.) ANAESTHESIA—INSENSIBILITY—NUMBNESS. Loss of the feeling of the skin, either in single parts, or of the whole. It is often the consequence of an internal paralysis of the part, in which the sensitive portion of the nerve is affected. Sometimes it is a spasmodic affection of the cutaneous nerves; often it is local and confined to a small spot, which is numb. Therapeutics. — Anaesthesia produced by internal para- lytic affections, can be cured only by removing the cause. Numbness of small spots yields to friction and bathing. ASTHENIA NERVOSA—DEBILITY. After severe and tedious diseases, or from excesses in veuery, onanism and sexual indulgence in both sexes, or from 36 GENERAL DISEASES. loss of blood by too frequent venesections, or from chronic diarrhoea, gonorrhcea and fluor albus, heaviness in the limbs, lassitude, weakness, vertigo and want of appetite take place, the patient suffers from diarrhoea and sleeplessness; the skin becomes rough, shriveled, cold; the pulse is slow, weak; the eye is heavy and clouded; tongue furred, and, in* general, many symptoms of typhus are observed. Treatment — The principal object of cure is the removal of the causes of debility. Diet, cleanliness, and daily airing are the most efficacious remedies. Allopathic treatment. — Administer cooling, astringent, strengthening and nutritive remedies; quinine, columbo, iron, gelatin of Lichen island, cold baths, sea-bathing, strengthen- ing embrocations on the lower part of the spine. Homoeopathic treatment.— China, twice a day for several days, if debility arises from loss of humors or from exces- sive sexual indulgence; also Calcarea, Nux v., and Phos- phoric acid. If caused by masturbation : Nux v., Sulphur and Calcarea; if it is the result of violent acute diseases: China, Veratrum and Phosphoric ac.; if arising from the rapid growth of young persons: Phosphoric acid. Hydropathic treatment.—-Invigorate the system by cold bathing and exercise; soothe irritation of the nerves by the wet sheet; relieve the stomach and bowels by the wet band- age and clysters; and equalize the circulation by foot and sitz- baths. Water is used as the only drink, and Vegetables and cracked Wheat as the principal food. Eclectic treatment. — Administer small doses of iron and quinine; order a generous and nourishing diet; and employ all other means calculated to increase the quantity and quality of blood, and to invigorate the nervous system. ATROPHIA — EMACIATION. Deficient nutrition of the body; consumption exceeds sup- ply. It may take place by impeded admission of the nutritive CARCINOMA— CANCER—(SCIRRHUS.) 37 matter into the organism; by excessive loss of humors and vitality ; by chronic irritation and suppuration. In order to cure emaciation, wc must remove the general and local causes of the disease, prevent self-consumption, and restore the lost vitality by proper aliments, air, exercise, and medicinal agents. ATROPHIA LOCALIS EXTERNA. Emaciation of single parts, as of the arm, hand and foot, requires frequent friction and manipulations; showering with cold water; and electro and animal magnetism. Embrocations of spirits and balsams are also recommended. Atrophia ahdominalis, hepatica, mesen'erica infantum.—(See diseases of the abdomen.) Asphyxia, apparent death.—(See accidents.) Anhcemiu. Ana-mia. State of Bloodlessness.— (See Debility.) Blenorrhoea. — Mucous discharges.^-(Sec under different organs.) CACHEXIAE— CACHEXIES. A class of diseases which are caused by abnormal ehymifi- cation, as: Consumption, Marasmus, Scrofula, Cancer, etc.; (See under proper heads.) CARCINOMA — CANCER—( SCIRRHUS.) Many surgeons regard scirrhus and cancerous tumors as distinct diseases; others consider scirrhus the first stage of a cancer. All cancers in their incipient stages are hard, scirrhous, indurated tumors, and in their latter stage, open ulcers. Carcinoma. — Scirrhous tumors may remain for an indefi- nite period in a condition of stony hardness without evincing any tendency to cancerous ulceration, and therefore they are not proof of an approaching cancer. Symptoms. — After previous inflammation, generally of glandular parts, (the lips, breasts, testicles, uterus, parotid gland,) a hard knotty swelling is observed, subject, occa- sionally, to severe lancinating pains, which increase in seve- 38 (1ENKUAL DISEASES. rity and frequency, (occult cancers.) Then it slowly enlarges, portions of the tumor soften down, and ulceration commences. The ulcer enlarges in all directions, the discharge is thin and fetid, and there is constant burning pain. The surface be- neath the ulcer is lead coloured, and its edges are thick, jagged, and spongy. As the disease advances the patient becomes languid and emaciated, the countenance leaden and sallow, hectic fever is induced, which gradually exhausts the vital powers of the patient. The discharges are contagious. Scirrhus is rare under thirty. Causes.—Local irritation; peculiar morbid state of the con- stitution ; depression of mind and other circumstances that impair the powers of digestion and nutrition; blows; external injuries. Treatment Allopathic. — In the first stage, reduction of diet; application of leeches, cathartics; change of air; nar- cotics to allay pain, the iodides of potassium, and of iron, small doses of liquor arsenicalis, sarsaparilla, and any mild plaster, as a local application, should be employed. Issues made in the vicinity of the swelling have been found useful. In the ulcerated or cancerous stage (open cancer), the objects of local treatment are to allay pain, and to correct the discharges. To accomplish this, we may try in succession, poultices made of the pulps of carrots; or with the leaves of Belladonna, hyoscyamus or eonium; or with opium, or the extract of poppies; and ointments or lotions containing the same narcotics. Weak lotions of Chloride of lime and soda, or of the nitro-muriatic a,cid, will sometimes afford relief. Carbonic acid may be often advantageously applied by means of fermenting poultices. Early extirpation, if this can be done with safety, is recom- mended in all cases. Homeopathic treatment. — The principal remedies recom- mended by this school are: Arsenicum, Belladonna, Coniuui, Silicea and Sulphur. Hydropathic treatment. — Constitutional treatment consists CANCER—BLOODY FUNGUS. in bathing, exercise, cleanliness and vegetable diet. The hunger-cure is also recommended. The dripping sheet, and occasionally packing in the wet sheet to produce moderate sweating, are the principal means employed. The application of refrigerating mixtures, actually freezing the part occasion- ally, are thought by some the most promising topical appli- ances.—(See Scrofula.) Eclectic treatment. — The alterative syrup should be ta- ken three times a day in such doses as may be agreeable to the stomach. The Vapor-bath and Emetics are also recom- - mended. If the tumor is still in the scirrhous stage, the Iodine Ointment should be applied, with friction, to discus3 it. Should this treatment prove unsuccessful the pencil of potassa (caustic potash) must be applied so as completely to surround, as well as open the scirrhous mass. Let it pene- trate into the very centre from several different points. The elm poultice should then be applied immediately, and con- stantly continued. If the patient cannot bear so extensive an operation, the caustic can be applied, from day to day, to addi- tional parts, until all is effectually destroyed, taking care to keep up and excite inflammation. Every vestige of vitality in the morbid mass must be extinguished. Be sure to pene- trate with your pencil to the bottom of the tumor. In some eases it may be necessary to administer Chloroform or Ether. The poultice should be renewed every six hours. Allow no dis- charge to be re-absorbed into the system. Wash the sore freely with a solution of the mild caustic. The ucanccr-quacks" use arsenic as the principal corrosive to cat away the diseased structures; but death often results from the absorption of the poison. Vegetable powders, as blood-root and blue cohosh, have had a great reputation. CARCINOMA MEDULLARE--FUNGUS HJEMATODES--SOFT CAN- CER--BLOODY FUNGUS. It commences with a small, elastic, movable, and nearly insensible tumor, under the skin, the integument itself being unaffected. Sooner or later it becomes inflammatory, swells 40 GENERAL DISEASES. rapidly, the skin becomes discolored with purplish or red spots, and adheres firmly to the distended mass. Ulceration soon comes on; dark colored fungous growths sprout out irregularly; eventually the adjacent glands are affected, when the patient's health rapidly declines. Treatment. — When the lymphatic glands have become affected, the disease may be pronounced incurable. In its early stage, while the tumor is loose underneath the skin, and nearly free from active inflammation and tenderness on pres- * sure, it may be destroyed by caustic or removed with the knife. Hemorrhage may be restrained by a piece of lint. CARCINOMA ALVEOLARE. Gelatiniform cancers are extremely rare. Their structure is of greater size than that of other species of cancer. The cells vary from the size of a grain of sand to that of a pea; they are filled with a soft viscous jelly, and are of continual growth. CATACAUSIS — SPONTANEOUS COMBUSTION. General combustibility of the body, produced by the use of alcoholic drinks. In some cases the self-consuming flame has arisen without any obvious exciting cause; but in others, a fire, a lighted candle, the heat .of a stove, or an electric spark, has ignited the inebriate body. Water, instead of quench- ing the fire, seems rather to quicken it. The flame does not essentially injure the common furniture or bedding wilh which it comes in contact. CHLOROSIS--GREEN SICKNESS. Pale complexion and lips, preternatural appetite for chalk, lime, coal, tar, etc.; chilliness; mental and physical languor, debility and emaciation, palpitation of the heart, dyspeptic symptoms, suppression of menstruation; whites; cough with expectoration of blood and hurried respiration. Finally the patient becomes subject to trembling, fainting, dropsical affec- tions, and hectic fever closes the scene. The above symptoms vary, however, according to the char- acter of chlorosis, which is either Chlorosis atvnica, or Chlo- CHLOROSIS. 41 rosis erelhistica. The name is derived from the pale, livid, and greenish cast of the skin. Causes.—Absence of cruor and fibrin in the blood; onan- ism; obstruction of the first menstruation, sometimes owing to an imperforate hymen; repeated miscarriages; grief or fear; loss of blood. Treatment allopathic.—Increase the cruor and fibrin by iron, which may be used in all forms and preparations, but it operates most vigorously in substance: Take iron filings 10 grains; Rhubarb and Cinnamon each 2 grs.; White Sugar 20 grs.; mix; to be taken Morning and Evening. Animal food, mineral waters, pure air, and corporeal exercise are highly use- ful. If the disease is owing to a retention of the monthly period, remedies, appropriate to the various existing circum- stances, must be combined with the above. Retention of menses caused by an imperforate hymen, requires for its cure a transverse section of the membranous obstruction. Homoeopathic Remedies against chlorotic affections are: Pul- satilla, Sepia, and Sulphur. Also, Calcarea, Conium, Ferrum, Plumbum aceticum, Graphites, &c, which must be selected ac- cording to the peculiar symptoms present in the different cases. Hydropathy. — The general plan applicable to all forms of the disease except excessive menstruation is, a morning full- bath, as the plunge, dripping sheet, or towel wash; two or three hip-baths daily; one or two foot-baths; the abdominal bandage; frequent and varied out-door exercise, and a plain, solid, rather dry, and unstimulating dietary. The water should, in no case, be colder than will be followed by quick re- action, and a comfortable glow; and as a general rule, short baths frequently repeated, are more efficacious than long ones with greater intervals. Vaginal injections are useful in all cases attended with considerable relaxation, hemorrhage, or Jeucorrhcea; while in all other varieties, the horizontal douche or spray, applied to the hips, abdomen, and loins, is a valua- ble auxilliary. Brown bread, unfermented bread or cakes; cracked wheat 2b 42 GENERAL DISEASES. or rye meal mush, with a moderate allowance of the best vege- tables and good fruits, constitute the best dietetic plan. It were better to avoid animal food. Eclectic treatment.—The various forms of iron, quinine, cor- nine, and Hydrastin, in such proportion as agrees well with the condition of the system, avoiding such as produce irritation of the stomach, should be employed. The compound Syrup of Stillingia and Iodide of Potassium, and the alkaline-bath have been found beneficial. COLD OR CHILL, Although a very common affection has been in many cases the first cause of innumerable diseases. In most cases it affects the mucons membrane of the respiratory organs or nose, and therefore is called a cold on the lungs, or a cold in the head. The treatment immediately after taking cold Bhould have for its object the reproduction of the lost harmony caused by suppressed action of the skin—by a cutaneous spasm. In every case of this kind the patient should perspire. Allopathi/ recommends sweating by the administration of Diaphoretics, as hot whiskey-punch, chamomile-tea, elder- flower-tea, and steam-baths. Homoeopathy employs, in cases of cold where no decided consequences have yet manifested themselves, Aconite, or in the evening N-ux vom. The patient may also drink a large tumbler of cold water before going to bed, cover himself well and perspire. If children cannot be induced to drink water, let them drink milk and water, with much sngar, and very warm. Robust laboring men or women, who, after having overheated themselves, "catch cold," may take in the evening on going to bed, a glass of hot water and sngar, with which a small portion of brandy or rum is well mixed. If perspiration of the feet has been checked by taking cold or otherwise, put in a small tub some bran, heated in an oven, to the depth of three or four inches, place your feet upon it, and throw the remainder close about the legs, so as to cover them over the calves. Keep the feet in this bran-bath for CYANOSIS — BLUE DISEASE. 43 half an hour, and take a dose of Silicea evening and morn- ing. When a person, perspiring freely, is made wet by a shower of rain, and indisposition follows, give Rhus or Bryonia. Persons who, in winter, have become quite stiff with cold and wetj should take a cup of strong coffee, without milk. Hydropathic treatment. — Vapor-bath, drinking large quan- tities of warm or cold water, general ablutions, sleeping in wet clothing and well covered the whole night, spare diet and even total abstinence, are the principal means recommended. Eclectic treatment. — A tepid-bath, or a vapor-bath, aided by diaphoretics—warm diluent drinks — will generally be suffi- cient to restore the suppressed action of the skin. (See Ca- tarrh, Coryza, &c.) CORPULENCY — POL YS ARCIA — OBESITY. Excessive accumulation of fat in the whole system, especially around the heart, in the omentum and about the kidneys. Its effects are, disturbance of the whole economy, oppression of the circulation, obstruction of secretions and excretions, disposition to erysipelatous inflammations, abscesses, cachexy, and dropsy. Causes. — Immoderate use of nutritive food and want of exercise; a phlegmatic temperament; cessation of habitual hemorrhages, therefore occurring in woman after cessation of the menses; congenital disposition. Treatment—Scanty, watery, vegetable food; especially fruit; corporeal exercise; excitement of mental affections; promo- tion of all the secretions; bathing. Homaiopathists recommend according to symptoms Arseni- cum, Baryta carbo, calcarea, and sulphur. (See Pot or Fal- staff belly.) CYANOSIS — BLUE DISEASE. Livid, even dark blue color of the fingers, toes, face, some- times of the whole body; difficulty of breathing during exercise, palpitation of the heart, debility, deficient warmth, dullness of mind. 44 GENERAL DISEASES. Causes. — Unoxygenated condition of the blood; impedi- ment to the conversion of the venous blood into the arterial, caused by organic disorders of the heart; undeveloped lun^s tubercles in the lungs; scurvy; severe fevers; mineral medi- cines, nitrate of silver. Treatment — The blue disease is incurable; its subjects are feeble and short-lived; and all that can be done to prolong existence is found in plain, quiet, simple habits of life. Allopathists employ muriatic and sulphuric acids for oxy- dation and carbonization of the blood. Muriatic acid may also be used externally. (Two ounces of the acid to a bath.) If caused by diseases of the heart, small venesections, and the treatment of the diseases of the heart, are to be put in practice. Pure air, abounding in oxygen, must be inhaled. To remove cyanosis of the new-born, make the infant cry. Homoeopathic remedies; Digitalis and Lachesis. Hydropathic treatment. — In discoloration of the skin by drugs, a persevering employment of the wet sheet, with a course of plain vegetable diet and water drinking wiU do all that can be done. Other cases are incurable, yet diet, exer- cise and bathing may prolong life. Eclectic treatment of blue disease of infancy, consists in holding the child near the stove, or open fire, and rubbing its head and body gently with hot cloths. This should be perse- vered in, and at the same time keeping the child, when lying, constantly upon its right side. Dyscrasice. — Morbid state of the constitution. Faulty con- dition of the humors. (See Scrofula, Chlorosis, Cyanosis, Jaundice, Gout, &c. Exudationes Lymphaticce. — (See tumors.) Fistulce. — Pipe-like sores with a narrow orifice, and without disposition to heal. (See Fistula in ano.) G ANGRiEN A — GANGRENE — MORTIFICATION The death of any part of the body in consequence of dis- ease or injury. Inflamed parts assume a darker tint and become purple or GANGRENE. 45 blue; heat and pain diminish; serum exudes through the Bkin, and elevates the cuticle into blisters; the color becomes dirty brown, or black; the parts become soft, flaccid and cold, and emit a cadaverous odor; excessive thirst; cold sweat; tongue dry and black; pain ceases entirely; delirium; death. When its progress is arrested, a healthy circulation is re-estab- lished, and a bright red line, called the line of demarcation, separates the living parts from the dead. Separation of the mortified parts takes place by the formation of a chain of mi- nute ulcers, under the line of demarcation, which gradually unite and form a chink, this widens and deepens till the slough is entirely detached; and then a granulating and suppurating surface remains. Causes.—Congestion; deficient circulation; old age; poverty; starvation, hemorrhage, scurvy, use of diseased grain (ergot of rye ;) gun-shot wounds; compound fracture; long continued pressure; insufficient supply of arterial blood; impediment to the return of venous blood; injury of nerves. Treatment. — The principal objects of treatment are, to arrest the spreading of the disease, to uphold the strength of the patient, to assist nature in the separation of the mortified parts, and prevent the absorption of the poisonous matter into the organism. Allopathy. — Violent inflammation requires bleeding, purg- ing, leeches, fomentations and poultices. Care must be taken to reduce the strength as little as possible. Deficient vital power calls for wine and opium, quinine, charcoal-powders, beef-tea and arrow-root. If the powers of the system become languid, and there is no disposition to throw off the dead parts, the nitric-acid lotion on lint, under the poultice, should be applied. We may also apply the balsam of Peru, tincture of Myrrh, or poultice of yeast, carrots, or of stale beer grounds. Loose portions of slough must be cut away carefully. In mortification of a limb from severe compound fracture, amputation will be proper, when gangrene is rapidly extend- 46 GENERAL DISEASES. ing toward the trunk of the body, without hope of its cess*. tion. i :: Scarifications or incisions into the mortified parts are of great service. *-.u\ Homozopaihic remedies: Arsenicum, china, lachesis a'fid silicea. Humid gangrene: China, helleborus, squilla. Hot gangrene: Sabina, secale. Cold gangrene: Arsenicum, assaf, china, squilla, secale c. Eclectic practitioners use, externally, poultices made of marsh-mallow and milk; or of yeast and charcoal in connec- tion with a small portion of slippery elm and salt; the appli- cations to be frequently changed. Pyroligneous acid, used alone or in connection with the salt and charcoal, is an excel- lent application. The use of the Sulphate of Zinc is spoken of as efficacious, prompt, and unattended with any danger to the patient. GANGRJENA NOSOCOMIALS. Hospital gangrene commences with severe darting and sting- ing pains in a wound or an ulcerated surface; the edges of the wound become inflamed and gradually assume a bluish, then black color; the discharge of matter is first diminished, then becomes profuse, foetid and dirty yellowish. The sore enlarges in depth and breadth, assumes a circular form, and its surface is converted into an ash-colored or blackish slough. Occasionally hemorrhage takes place, hectic fever and hic- cough sets in, and an exhausting diarrhoea ends the severe sufferings of the patient. The disease is highly contagious. Causes.—Crowding together a large number of sick and wounded men in military or naval hospitals; inattention to cleanliness and to free ventilation. Treatment.—Remove the causes by scrupulous attention to cleanliness and ventilation. The walls should be daily white- washed, and the floors perpetually sprinkled with a solution of the Chlorides. Affected patients should be removed to the greatest possible distance from the others. WniTE GANGRENE OF TnE SKIN. 47 Destroy the diseased surfacfc by caustics in the following manner: Clean the sore, and absorb its moisture by lint or tow, If the sloughs are thick, remove them by forceps and scissors. The surrounding parts must then be defended with a thick layer of ointment; afterward a thick pledget of lint, which is imbued with concentrated nitric acid, is pressed steadily on every part of the diseased surface, till the latter is converted into a dry, firm and insensible mass. Cover the parts with cloths wet with cold water. Remove the eschar (the crust) in six- teen or twenty hours, and if the ulcer is healthy and the pa- tient free from pain, apply common dressings. Recurrence of pain requires again the application of the acid. Some sur- geons recommend the red hot iron and the liq. arsenicalis. 47 General treatment is tne same as stated under Gangrene. GANGR^ENA SENILIS. Gangrene of old people commences by a purple or black Bpot on one or several of the toes, the cuticle of the same is detached and the skin underneath is of a dark red color. Tho disease sometimes ends by shrinking and drying of the af- fected parts, which slowly slough away. In most cases, how- ever, the disease spreads, the pains increase, and the patients, generally old, and formerly dissipated persons, sink exhausted with pain and fover. A similar kind of gangrene sometimes attacks the skin of the leg. Treatment. — Keep the patient in bed, regulate his diet, allay pain by the proper internal remedies, and apply, exter- nally, soothing poultices. Amputation is inadmissible. Homoeopathic remedies employed, are: Secale and Conium- also, Arsenicum, China, Lachesis and Silicea. Eclectic tr.—A Solution of Sulphate of Zinc should be ap- plied to the ulcers, over which an elm poultice must be placed. Tonics, (Quinia, Hydrastin,) are recommended. WHITE GANGRENE OF THE SKIN. A circular portion of the skin, generally of the arm, be comes painful and suddenly mortifies; becoming hard, white, 48 GENERAL DISEASES. and dry, and showing the red streaks of the vessels with the blood dried in them. Cause is unknown. Treatment must depend on the circumstances of the case. HEMORRHAGIC — HEMORRHAGE. Escape of blood from its channels outwardly, or inwardly into cavities, or into the cellular tissue, which produces gene- ral and local derangement of health. Active hemorrhage consists in an escape of arterial blood from the capillaries, which are probably ruptured by the dis- tension caused by plethora or inflammation, by over-heating, by spirituous liquors, by spasms, dentition, worms, &c. It is accompanied by local heat, pain, and throbbing, and a febrile * state of the system. In passive hemorrhage the blood which escapes is venous, and the blood-globules pass through the parietcs of the capil- laries without rupture. Causes. — General and local weakness, putrid fevers, scor- butis, pressure. Treatment allopathic. — Active hemorrhage calls for a vene- section, perfect rest, vegetable diet and acid drinks; purga- tives, and cold, if it can be applied. Hemorrhage of a spasmodic, nervous character requires anti-spasmodics: Ipecac, Ilyoscyamus, Opium, Digitalis, and Hydrocyanic acid. Bleeding from organs above the diaphragm requires the Bitting posture; that from organs below the midriff, the hori- zontal posture. Should the above means not suffice, and the patient has small pulse, cold extremities, sparkling before the eyes, fits of fainting, buzzing at the ears, we must endeavor to suppress the bleeding by Styptics, Astringents applied internally and externally, Phosphoric and Sulphuric acid, Lead, Alum, &c; also by pressure with the finger, tourniquet, bandages, &c. In passive hemorrhage the chief remedies are, dilute Sul- phuric acid, sulphate of alumina, catechu, and ergot of rye. Homoeopathy employs in active hemorrhage: Aconite, bella- HYDROPHOBIA. 49 donna, crocus, ferrum, hyoscyamus, Pulsatilla. Passive hemor- rhage, of persons who have been weakened by depletions or loss of animal fluids, requires: China. Moreover: ferrum, ipecac, secale, and phosporic acid. Hydropathy uses: General and local baths, frequent drink- ing of cold water and small pieces of ice, wet compresses. (See hemorrhage of local organs.) HiEMORRHAPHYLIE— HEMORRHAGIC DIATHESIS. Peculiar constitutional defect, which consists, probably, in a want of contractibility of the arteries, and in a too watery state of the blood. The slightest wound causes uncontrolla- ble bleeding. Patients have a fair complexion, and almost transparent skin. Treatment. — General health must be improved by diet, ex- ercise, and residence in a mountainous country. (See Hem- orrhage. H/EMORRHAGIA TRAUMATICA—HEMORRHAGE FROM WOUNDS. (See under accidents, Wounds.) HYDROPHOBIA. A disease which is brought on by the bite of a rabid ani- mal (cat or dog). Sometimes it arises spontaneously, in the course of some other disease, which form is known under the term symptomatic hydrophobia. The first stage, that of incubation, varies from five weeks to three months, and even to twelve years. The first symptoms are usually, general uneasiness, anxiety and disturbed sleep; the eyes are glassy, inflamed, and sensi- tive to light; there are also ringing in the ears, giddiness, and paleness of countenance; frequent paroxysms of chilli- ness; oppressed respiration; and loss of appetite. In the second or convulsive stage, the wound, which may have been completely healed, begins to assume a somewhat inflamed ap- pearance, and a slight pain and heat, now and then attended with itching, is experienced in it, Tt now breaks out afresh. 5n GENERAL DISEASES. and an ulcer, with elevated margins of proud flesh, which secrete a dark colored and offensive discharge, is subsequently formed; and drawing, shooting pains from the lacerated part upward toward the throat, present themselves. 'fli,-e symp- toms increase daily; and the patient complains of a state of •■onfusion in the head, drowsiness and depression; is afflicted with sudden startings, sighing, spasms, and is fond of soli. tude; the pulse is small and intermittent; the breathing laborious; the skin cold and dry; then hiccough and palpita- tion come on; the eyes are wild, staring and glassy; the act of deglutition is impeded by a sense of pressure in the gullet, The sufferer remains affected in the above manner for a few days, after which the disease passes into the hydrophobic stage. The countenance now expresses indescribable alarm, anxiety, and suspicion ; it is utterly impossible to swallow the smallest drop of liquid, although he may, at the same time, suffer the most excessive thirst; even the sight of water, in fact any thing that reminds him of that fluid, produces anx- iety, convulsions, and even furious paroxysms of madness; he dreads even to swallow his own saliva, and is constantly spit- ting with vehement strainings; vomiting of bilious matter soon comes on, succeeded by fever, thirst, and fits of delirium, with disposition to bite and tear every thing within reach. Finally, the paroxysms come on more frequently, and more violently, and, in some instances, a fit of furious delirium closes the frightful scene; in others, the intellect seems un- affected to the last, and nature sinks exhausted after a severe attack of convulsions. It may be stated here, with confidence, that if no abrasion of surface exists, after being bitten by a rabid animal, there is not the slightest danger. Treatment allopathic — Preventive treatment consists in the destruction of the poison, and in avoiding its absorption into the system. Immediately after the bite of a suspected ani- mal, the whole wound should lie freelv cut out, then washc'l HYDROPHOBIA. 51 in salt, soap or lye-water, the blood pressed out and a cup applied to the same. Cauterizing the wound by nitric acid, oil of vitrol, or burning it with a red-hot iron and afterward applying a-fly-plaster, has been recommended by some au- thors. Internally give two grains of Calomel with one grain of Belladonna, every morning and evening until salivation takes place. In the third stage of the disease practitioners have resorted to bleeding, warm baths, mercurial ointment applied to the neck and other parts of the body, drinking of oil and vinegar, Extractum plumbi, and innumerable other remedies. It is conceded by this School that Hydrophobia is an incu- rable disease. A teacher in Croatien by the name of Lalich recommends the fresh root of Gentiana cruciata as a never- failing remedy; half an ounce to be taken early in the morn- ing for nine days in succession. Homoeopathic treatment.—A red-hot iron must be kept near the Wound, without burning the skin, three or four times every day, an hour each time, until shuddering appears. For this purpose one instrument should be kept ready in the fire all the time, so as never to allow the heat to lose its intensity. Oil and grease may be applied around the Wound; discharges from the same must be carefully removed. TIahneman recommends Belladonna,, a small dose every 3 ox 4 days, as the most certain preventive against Hydrophobia. Lachesis should be given as soon as convulsions set in, a dose every 2 or 3 hours. If this remedy exerts no perceptible influence, give again Belladonna, a few globules to be placed on the tongue at every threatening of a return of the con- vulsions. Cantharides (tincture) may be mentioned as another pre- ventive, one drop in a teaspoonful of water, every day until the effects of the medicine become troublesome. In some crises. Ilyoscyamus, Stramonium and Cantharides will be found indicated. The vapor-bath has proved a very efficient remedy. Use 52 GENERAL DISEASES. it several times soon after the bite, and again as soon as the least suspicious symptom makes its appearance. Hydropathic treatment. — Preventive treatment after the bite, is by excision of the part, if it can be done instantaneous- ly; the ligature ; cauterization; suction; and perhaps refrig- eration. The preferable process during the hydrophobic stage are, the douche and rubbing-sheet, followed by the wet-sheet pack when the temperature of the body is nearly at or above the normal standard, and by the dry-pack when the circula- tion is low, and there is an inclination to chilliness. These processes may be repeated and alternated as long as the spas- modic condition of the throat exists. The patient may swal- low or chew bits of ice to the extent of his inclination. Very cold compresses or powdered ice should also be applied to the thorax. Very cold water enemas should be tried. Eclectic physicians recommend, as highly successful treat- ment, the following: — Immediately after the accident, the wound is strongly cauterized with a strong solution of the Chloride of Zinc, then an Elm-poultice is applied to facilitate the suppuration, and the following prescription administered: take Aqua ammonia two drachms, tincture Scutellaria one ounce, Syrup Ginger two ounces, mix.; one drachm to be given every two hours until the parts that had been cau- terized slough out, with such changes of the quantity as the circumstances demand. The daily vapor-bath must be em- ployed, and the suppurative action of the wound continued, by the daily application of Sesquicarbonate of Potass a, for six weeks. The above prescription must be occasionally used during the six weeks of the suppurative process. The "red chick-weed" (anagalis arvensis) four ounces of the dried plant boiled in two quarts of beer, pressing out the liquid and straining it and adding two drachms of tincture of opium, has been successfully employed. The medicine should be taken in half gill doses every morning for three mornings. The wound should be bathed with the same liquid. HYDROPS — DROPSY. 53 If the symptoms are fully developed the whole of the pre- paration may be taken in one day. The treatment during the paroxysm is similar to that of tetanus. An active cathartic should be given every four to six days. HYDROPS — DROPSY. A morbid collection of watery fluid in a cavity or the cellu- lar substance. Symptoms.—Pale and sickly complexion ; general debility; secretion of urine diminished; impaired digestion; fever toward night. Causes.—Debility, produced by diseases which exhaust the vital powers; syphilis; scarlatina; bleeding; inflammation; spirit- uous liquors; suppression of natural secretions;cutaneous dis- eases; mechanical pressure; too watery blood. Treatment.—Remove the cause; effect the absorption of the morbid fluid, or its evacuation in the natural way; and if this cannot be done, recourse must be had to an operation.—(See: Hydrocephalus (head); Hydrothorax (chest); Ascites (abdo- men); Hydrocele (scrotum); Hydrometra (Uterus ;) Anasarca (skin.) Eclectic treatment.—After removing the cause we must en- deavor to procure the full and free action of the skin, kidneys and bowels. Among the Diuretics, a decoction of Sambucus canadensis, or white elder bark, in cider, will be found to produce the most sensible effect. It may be given in wine- glassful doses three times a day. Another remedy is a decoc- tion of Asclepias syriaca. In many cases a decoction of mul- lin leaves will be found to increase the urinary secretion The following formula has also been found an excellent diu- retic : take cream of tartar, half an ounce, Rock candy three ounces, mix: all to be taken at three doses. Other remedies reliable in the cure of dropsies are: Apocy- num caunabinum, or Indian hemp; digitalis, squills, tobacco, &c. In many cases Cathartics exercise an important influence, 54 GENERAL DISEASES. among which, a compound of apocynum and podophyllum in the form of a syrup, with the addition of a portion of best gin, has proved the most effective preparation. Dropsical affections connected with a highly deranged state of the stomach, will be often greatly benefitted by the opera- tion of an Emetic. Mild diaphoretics will do much toward a cure. Sponge, shower, or douche bathing should never be neglected. Counter irritation over the part affected, where the effusion is kept up by local irritation or chronic inflammation, will often strike an efficient blow at the cause of the difficulty. HYDRARGYROSIS—CACHEXIA MERCURIALIS. Diseases caused by the immoderate and injudicious use of the different mercurial preparations, as: Ulcers in the mouth and throat; eruption on the Genitals, or over the whole body, discharging a fetid liquid; pain in the bones with great lassi- tude; griping and purging; fever. Treatment.—(See: Ulcers (throat and mouth); Eczema mer- curiale (skin); Mercurial fever; Poisons. HEAT—OVERHEATING. Exposure to excessive heat will produce many different, and often very troublesome affections: headache with congestion, fever, vomiting, anguish, sleeplessness, loss of appetite, diar- rhoea, and even death. Treatment—Fatigue and exhaustion caused by over exer- tion in hot weather are generally relieved by taking a warm bath, or by putting the feet in warm water, in which a hand- full of salt or of ashes has been thrown. It is also well to take half a tea-spoonful of rum or brandy in a little water and sugar. A cup of green tea is beneficial in some cases. Per- sons who are easily exhausted in warm weather should drink coffee occasionally, abstain from meat and eat sparingly. (See: Sunstroke, headache, diarrhoea.) INFLAMMATIO--INFLAMMATION--PHLOGOSIS. Acute inflammation is a state of increased vascularity and sensibility; it is sudden in its origin and rapid in terminating; NER'N OL\S CONSU.MP'JTO.N. it is attended with fever, and the affected parts are red, hot, painful and sometimes swollen. Its duration is seven to four- teen days; it terminates in perfect resolution, which is accom- punied by general or local sweat, critical urine, hemorrhage, local secretions, as expectoration after inflammation of the lungs; or it glides into chronic inflammation, indurations, tubercles, suppuration, or mortilicatioii. It also gives rise to many after-maladies: exudation of humors in the neighbor- ing cavities, as hydrops cerebri, tic; adhesions after cere- bral and pulmonary inflammations; local weakness, and mor- bidly increased irritability. Causes.—-Increased action of the arterial and not equally increased action of the venous vessels; increased sensibility of the nerves; sanguineous congestion; high living; local weakness; mechanical irritation; wounds; concussions; poi- sons; morbid matter; overexertion; spasms; taking cold ; sup- pressed eruptions of the skin; gastric irritants. Chronic inflammation, is slow in its progress and lasts indefi- nitely. Causes are:--Acute inflammation, constitutional disorders, debility; congestion; morbific matters, and metastases. Treatment.—(See inflammations of the different organs.) MARASMUS JC\ i:NILJS — TABES SUVA, NERVOSA, HECTICA— NERVOUS CONSUMPTION. The patient is weak and listless, especially in the morning"; suffers from indigestion, want of appetite, satiety, pressure in the stomach and sleepiness after meals; Nausea and alterna- tion of diarrhoea and costiveness; hypochondriacal and hyster- ical complaints. The food passes undigested, the body ema- ciates, the patient becomes very irritable, his sleep is not re- freshing, and he has fever and partial sweats. This malady may last for a long while. It kills either by a total exhaustion, or by a transition into phthisis pulmonalis. Causes.—Nervous weakness, protracted acute diseases, ner- vous fevers, excesses in venery and masturbation; mental ane! physical over exertions; grief and sorrow; home-sickness: tog 5G GENERAL DISEASES. long continued lactation; frequent parturition; lcuconbu;., chronic diarrhoea, &,c. rrea/»ic»«.—Avoid all things which have a tendency to de- bilitate the mind or the body; abstain from sexual intercourse and guard against pollutions; attend also to the proper treat- ment of fluor albus (whites), of too profuse menstruation, and diarrhoea. The food must be easy of digestion and nourish- ing, as: asses and goat's milk, salep, arrow-root, cracked wheat, Iceland moss, snail-broth, oyster and turtle soup, fruit, small quantities of pure wine. Fresh air in the mountains, cleanli- ness and moderate exercise are of great importance. Allopathic treatment.—Tonics, as: valerian, columbo, pcru- vian bark, first in cold then in warm infusion; and mineral waters, llhubarb and aloes for cleansing and opening the bowels, aud simple baths of tepid water, or malt-baths are useful. Homoeopathic remedies indicated, according to symptoms and causes, are: Arsenic, belladonna, calcarea, china, ferrum, nux, silicea, sulphur, phosphor, veratrum— (See Atrophy, De- bility, Phthisis.) Hydropathic treatment.—All the resources of hygiene must be applied to the general invigoration of all the organic func- tions. The bathing appliances are few and simple. The drip- ping wet-sheet or towel wash, and the half or shallow-bath daily, followed by as much friction or rubbing over the dry- sheet as the patient can well bear, are the best water pro- cesses, and in most cases all that are necessary. The temper- ature should be as cold as consistent with prompt reaction, beginning with water of about 80°, and gradually reducing it. Dry diet is in most cases the most desirable. .MARASMUS SENILIS — CONSUMPTION IN OLD AGE. Gradual exhaustion of the vital powers; imperfect diges- tion; weakness of all the physical and mental functions; want of appetite; constipation, decrease of vital heat; emaciation; death. It is a natural and gradual transition into a new life PARASITES. 57 It is brought on, in many cases, prematurely by all kinds of excesses, and over exertions. Marasmus Infantum— Consumption of Infants-.—(See Atro- phia mesenterica infantum (diseases of the abdomen.) MELANOSIS—MELANOSE—BLACK CANCER. This disease consists in the formation, of a morbid product of secretion, of a dark color, more or less inspissated, and staining the organ affected. Symptoms.—The color varies from a dark yellow to brown-, approaching to complete black, which is the most common. The tubercles are pea-sized to walnut-sized, and scattered iis groups; they are sometimes situated upon the surface, but more generally below it; an irritative fever, mostly of the hec- tic form, attends, and the patient experiences great debility, Treatment.—The cure depends on restoring the normal con- dition of the secernent system, and this pre-supposes the em- ployment of all the means for invigorating the general system and purifying the circulating fluids, which have been detailed under scurvy, scrofula, and cancer. MYITIS—INFLAMMATION OF MUSCLES. Symptoms. — Several muscles swell, become hard and pain- ful, the skin covering them adheres closely to them, and their functions are impaired, most generally the muscles are in a state of contraction. In acute inflammation, fever is present. Treatment.—To prevent suppuration, leeches, or cold water- must be applied. After suppuration has taken place, poultices must be applied, a ad if ttecessaiy,. the abscess opened by means of the lancet. PARASITES. Parasites, newly generated organisms, to which not only worms, but also several organic diseases, as hydatides, en- cysted tumors, even scirrhus and cancer ase- to be counted, in- asmuch as they possess a peculiar life and vegetation. — (Sea Worms, hydatides, &c.) Polysarcia — (Sec Corpulency.) :»s U EN Kit A L DJSEA-SES. POLY 111 )'S[ A ERRIOSA--DRUN KENNESS. Insatiable thirst for spirituous liquors is the consequence of a bad habit, or of a morbid state -of the nervous system. It leads to dropsy, indigestion, suppurations, induration of the stomach, trembling of the hands, epilepsy, sterility, stu- pidity, spontaneous combustion, delirium tremens and insan- ity. Drunkards generally have inflamed eyes, copper-colored nose and face, and their perspiration has a spirituous odor, Treatment. — Gradual weaning off; substitution of another less injurious stimulus; rendering brandy and whisky dis- gusting by admixion of nauseating substances — (tartar emetic or sulphuric acid). » Chronic diarrhoea of drunkards requires, Succus citri, and oil of sweet almonds; phosphoric acid, opium, &c. Heart- burn will be relieved by pulv. aerophorus; gastric affections by manna, or common charcoal in lukewarm milk. Head- ache, nausea, vomiting, cough, and general indisposition after "a spree/' are alleviated by black coffee, salt meat, herrings, sardines, or by a spoonful of common salt in a glass of water. If children are made tipsy, or by accident swallow liquor, their heads and abdomen should be washed with cold water, and every quarter of an hour a tea-spoonful of hot water mast be given to them, a pint of which has been poured upon some bitter almonds. Intoxication, loss of consciousness, and other dangerous symptoms, are relieved by throwing cold water upon them by buckets full, or by applying a wet bandage around the abdomen. For vomiting and retching give hot black coffee. If it proceeds from drinking beer, give green tea and milk; if from wine, bitter almond or sugar; if from spirits, salt water or garlic. Homoeopathic remedies principally recommended are: Nux vomica, Arsenic, Opium, Carbo veg., and coffee. (See De- lirium tremens.) R APHANIA--ERGOTISMUS. An affection produced by eating poor grains, vitiated by UllKKMATlSM. 59 mildew, ergot of rye, or mixed with wild charlock, Belladon- na, &c. The patient is troubled with a sensation of crawling in the points of the fingers, which afterward spreads over the arm, and sometimes over the whole body, frequently causing spasms and convulsions. Treatment. — Contraction of the hands and feet is relieved by tying the extremities together. (See Poisons.) RIIEUMATISMUS — RHEUMATISM — RnEUMATALGIA— RHEU- MATIC FEVER. Pains, more or less severe, in a muscular, membranous, or aponeurotic part, with swelling and tenderness of the sur- rounding cellular tissue, increased heat and slight redness. Generally it bears a close relation to the atmospheric and barometrical condition; the least change of weather aggra- vates the evil. It is either confined to one spot (Rheumatis- mus fixus), or it wanders from one part to another (rheuma- tismus vagus). If accompanied with fever it is called acute or inflammatory rheumatism. The difference between rheu- matism and gout is, the first attacks, principally, the muscu- lar parts, and sets in after taking cold, while the latter affects only the joints, and is always connected with indigestion. In some cases Rheumatism assumes an arthritic form (rheu- matic gout). The effects of Rheumatism are: A serous exudation in the neighboring cellular tissue, indurations, stiff joints, partial paralysis, eruptions, salivation, nervous diseases, &c. Causes. — Suppression of sweat and insensible perspiration ; too light clothing, especially thin-soled shoes; damp dwellings; neglected cleanliness of the skin; ill ventilated rooms; hot drinks; indigestion; want of exercise. Therapeutics allopathic. — In acute Rheumatism restore the suppressed cutaneous function by giving, internally, infusions of florcs tilue (flowers of the linden tree), verbasci (mullin), sambuci (elder-flowers); nitre, preparations of antimony, camphor, Aconite, Guajacum and Sulphur. 60 GENERAL DISEASES. Externally apply flannel; wool; furs, especially that of the cat; embrocations of Sapo ammoniac; narcotic poultices; and fly-plasters, until they draw blisters. In true inflammatory rheumatism, with much heat and redness of the parts affected, leeches or cups are salutary. Nervous Rheumatism requires antispasmodics, even opium. If complicated with gastric or bilious derangement, Emetics and Purgatives are indicated. Chronic Rheumatism. — In obstinate cases of Rheumatism the following mixture has been found of great benefit: Take guajacum 2 ounces, tops of bitter-sweet \ ounce, spring water 2 pints; boil down to one and a half pint; add corrosive sublimate \ grain, syrup of mallows 2 ounces; take a cupful every two hours, so as to drink half in one day. Beside the above, we find recommended, tincture of guajacum; arnica; vinum colchici; and, as external applications: Mercurial oint- ment; Petroleum; Morphine; Aconite; Veratrin; tar-salve; de- coction of tobacco; used as luke-warm fomentation, scarifica- tion; electricity; galvanism; vapor baths; cold baths; shower baths and artificial ulcers. Homoeopathic treatment. — Against Acute Rheumatism: Aconite: shooting, tearing pains; high fever, thirst. Arnica: Violent pains in the affected part, with sensation as if resting upon something very hard. Belladonna: Stitching, burning pains with shining, wide- ly spreading redness, and congestion of blood to the head. Bryonia: Tearing pains in the affected part as often as it is moved, chilliness and shuddering, with bilious or gastric symptoms. Chamomilla: Drawing pains, with sensation of numbness or lameness in the affected part; fever with burning heat in the affected part; redness of one cheek; great restlessness. Colchicum: Tearing pain in the affected part through to the bone; tearing in warm weather; pains are intolerable in the evening; loss of appetite with loathing of the smell of food. RHEUMATfSM. 01 Mercurius: Pains, worse in cold and damp weather, in bed, or at night; oedema of the affected parts; copious sweat afford- ing no relief. Nux. Vomica: Tensive, jerking or pulling pains; numbness or lameness of the affected muscles; constipation. Pulsatilla: Pains which shift rapidly from one joint to the other; pains worse at night; relief by uncovering the part or in the open air. Rhus-tox: Tearing and burning pains or pain as if sprained, with sensation of lameness and creeping in the affected part; aggravation during rest and in bad weather; sensation as if the flesh was torn from the bones. Obstinate, chronic rheumatism: Hepar sulphuris and Lache- sis in alternation; Ignatia, Dulcamara, China, Causticum and Sulphur. Hydropathic treatment. — Local and general fever must be kept down by ablutions, the wet sheet and wet compresses.— In some cases where the joints are so tender that the least motion produces excruciating pain, a combination of relaxant and cooling processes will give prompt relief, as the warm fomentation, or warm douche, followed by the coldest wet- cloths or pounded ice. As the fever becomes reduced, less of the cooling measures are demanded. The bowels must be kept open by clysters of tepid water, and the stomach free from food. Chronic rheumatism requires the same general management as gout. Eclectic treatment. — The spirit vapor-bath should be used promptly, and the patient advised to inhale the vapor as it rises under the blanket, until free and copious perspiration is produced, and complete relaxation of the system has taken place. The covering may then be removed from the head of the patient, and, if the symptoms of relaxation and syncope pass off, without having to place him in a recumbent position, (be vapor-bath may be continued for half an hour longer. 02 GENEEAL DISEASES. This treatment should be repeated twice a day so long as the disease continues. From two to five days are sufficient for the removal of the disease. If there be much pain and irritability of the nervous sys- tem, it will be necessary to make use of anodynes and anti- periodics, as follows: Take Sulphate of Quinina, com. pow. Ipecac, and Opium, of each twenty grains; mix, and divide into five powders, one of which should be given every three to five hours, increasing or diminishing the dose according to the circumstances of the case. Gastric derangement, accompanied with hepatic torpor, re- quires small doses of Podophyllin, Leptandrin, and Caulo- phyllin. As local measures, use flannel bandages and dress the pa- tient with flannel. Should there be any symptoms of a metastasis to the heart or lungs, the feet and hands should be immersed in hot water, and vesication made over the parts originally affected, with aqua ammonia, turpentine, or Granville's lotion, with the free use of Quinine and diaphoretic powders. All exercise and exposure to sudden changes of the atmos- phere must be avoided. Some eclectic physicians recommend the following course of treatment in the acute form: Cups, with mustard or irrita- ting plasters to the spine over the points found involved; an emetic, if found necessary; colchicum and quinine, or other cathartics; mild diaphoretics; the application of cold wet towels to the parts affected, when swelling, heat, and redness exist. The pill of the juice of pokeberries, white pine pitch, each twenty grains, macrotyn ten gr. (formed into twenty pills, one of which may be given every four hours until the symptoms are relieved), together with volatile liniment applied, locally, are recommonded in the subordinate form. Chronic Rheumatism. Bandage the affected part with flan- S'WINE-E V iL — KI \< i rS -E VIL. *;.'» nel, and give tincture of Aster aestivus, in doses of one-half drachin every three or four hours,' ayd during the absence of constitutional symptoms, the part affected may be frequently bathed with the same tincture. The following is recommended as an alterative and stimu- lant: Take compound syrup Stillingia 2 ounces, Syrup of Ginger 4 ounces. Iodide of Potassa 2 drachms; mix; of this give a table-spoonful every three to five hours, unless it should produce nausea or pain in the head, when the quantity should be lessened. The shower-bath and alkaline wash should be used daily. SCROPHCLOSIS--SCROFULA--SWINE-EVIL—KING'S-EVIL. The scrofulous constitution manifests itself by the following characteristic signs: an unusually large head, a protuberant occiput, compressed temples, broad jaw-bones, fair and fine hair, relaxed, smooth and fair skin, full upper lip, blue eyes and large pupils, delicate complexion, lax and soft muscles, abdomen large and distended, irregular stools, irregular denti- tion, great sprightliness with feeble endurance. Symptoms of developed, confirmed Scrofula are: swellings and indurations of the glands of the neck, throat, armpits, groins, and in almost any glandular part of the body. The swellings differ in size, are first soft, painless, moveable, and continue in this state for years; or they grow larger, inflame, become painful, suppurate and form scrofulous ulcers. At the same time children suffer from catarrhal affections, chronic inflammation of the eyes, aphthae, tetter, styes on the eyelids, excoriations of the skin, indigestion, softness and weakness of the bones. When scrofula is of long duration and of a high degree, we have: painful enlargements of the bones (Spina ventosa), scrofulous cancer, tubercular consumption and dropsy. Causes.—General debility; badly prepared and assimilated lymph; scrofulous progenitors; syphilitic parents; bad nutri- tion in the first year of life from sickly mothers or nurses,; indigestible food; foul, moist and damp air; dark tenements; 61 GENERAL DISEASES, neglect of physical exercise in childhood; premature exertion of the mind; small-pox, measles, and scarlatina; poisonous drugs, especially Opium, Laudanum and Paregoric. Treatment.—The basis of a radical cure consists in improve- ment of the functions of digestion, chylification, and assimi- lation. The proper dietetic means to accomplish this are' healthy, nutritive aad easy digestible food, a combination of vegetable and simple animal food; all roots, acorn coffee, pure water, pure dry country air; ventilation of rooms, especially the bed-chamber; daily washing; sea-bathing; gymnastic ex- ercises; frequent change of linen and bed-cloths; matresses of hair, moss or straw; sea voyages. Allopathic remedies.—Mercury in combination with Sulphur or Antimony; infusion of Walnut-leaves; Carbo Animalis; one-tenth of a grain of Aurum Muriaticum, once a day; Ba- ryta Muriatica, half drachin, in one ounce of distilled water, ten to thirty drops three times a day; Sassafras- tea; lime wa- ter; a mild cathartic every eight to ten days; Cinchona for great debility; Spongia tosta. External applications should be made with gieat caution. Use, principally, a solution of half an ounce of chloride of lime in a pint of distilled water; mercurial and iodine ointment; sulphur-baths. Homoeopathic remedies.—At the commencement of the dis- ease, when children have great difficulty in learning to walk, give: Belladonna, calcarea, silicea and sulphur. In the second period, when the glands are affected; Sulphur and Calcarea; also, Baryta m., belladonna, dulcamara, hepar, lycopodium, mercury, nitric acid, silicea, and staphysagria, The cutaneous affections (eruptions, tetter, ulcers, &c.,j require: Aurum, baryta, calcarea, clematis, dulcamara, hepar, lycopodium, mercurius, rhus, silicea, sulphur, also ruta. Affections of the bones; Aurum, calcarea, lycopodium, mer- curius, phosphor, phosphor ac, silicea, and sulphur. Scrofulous enlargement of the abdomen of children : Sul- phur and calcarea; also: Arsenicum, baryta, and china. Hydropathic treatment—Abundance of fresh air and plenty SWINE-EVIL — KINGS-EVIL. 05 of clear sun-light. The food must be restricted to the best fruits, vegetables, and farinaceous preparations. For city children good country milk is essential. The distillery slop- milk is a fruitful source of scrofulous affections. Scrofulous patients should drink soft water freely, especially in the fore- part of the day. Generally one or two full-baths — tepid, cool, or cold—daily are sufficient. Wet compresses should be constantly applied to the tumors so long as they manifest pre- ternatural heat, redness, or pain; and the wet-sheet pack, fol- lowed by the dripping sheet or half-bath, should be employed daily whenever the whole body is feverish, and once or twice a week during the whole course of treatment; a moderate douche may be occasionally applied along the spine to advan- tage; and when the body evinces symptoms of general obstruc- tion, torpor and over-fullness, moderate sweating in the dry blanket will bo serviceable. Open sores should be covered with warm wet bandages to be worn by day and night. Eclectic treatment. — To remove scrofulous diseases, or cor- rect a constitutional predisposition, alteratives should be given, of which none is equal to the Stillingia sylvatica. It may be used as infusion, decoction or syrup, taken three or four times a day, as much as the stomach can bear. The saline and alkaline-baths should be used in alternation, one or the other every day. To discuss any hardened tumor or -enlarged glands before inflammation manifests itself, apply a poultice wet with the compound tincture of myrrh, or cloths wet with the same and covered with slippery elm. In threatening inflammation of the enlarged glands, make a poultice of the arum triphyllum, by mixing the dry powder in warm water, and apply, chang- ing it three times a day. * The fresh root finely grated is still better. If suppuration has already taken place, apply emol- lient poultices. The tumors should be opened as soon as any point becomes purple, re-applying the poultices so long as there is any inflammation. After this, wash out the abscess with vegetable caustic, or lye-water by means of a syringe. 66 GENERAL DISEASES. The different combinations of iron may be used freely. Allow the patient plenty of exercise and a generous meat diet. SYPHILIS —POX —CHANCRE—LUES VENEREA. This disease commences with one or several small pimples, or chancres, about the size of a pin's head, on some parts of the Genitals, which gradually fester, and finally terminate in spreading or deepening ulcers, filled with an exceedingly acrid and corroding matter. If this matter is allowed to be ab- sorbed, the glands of the groin swell into hard tumors, called buboes, and often ulcerate, Eventually the whole body be- comes contaminated with the virus absorbed from the chancres, and what are called constitutional or secondary symptoms ap- pear, as foul ulcers in the throat and palate, livid and copper- colored spots on the skin, or ulcerating scabs, inflamed eyes, pains, swellings, and caries of the bones (particularly of the nasal and frontal bones), Polypus, cancer, fleshy excrescenses, etc. Paralysis, spasms, hypochondry, hysteria, dropsy and consumption may be of a syphilitic nature and can only he cured by an anti-syphilitic treatment. It happens also at times, when syphilis lies dormant, exhibiting no sign of its existence, though it re-appears, after a time, with increased violence, or under entirely different forms (Syphilis larvata.) Syphilitic patients are generally low-spirited, their eyes are heavy, they lose flesh and suffer from rheumatic pains and sleepiness. Causes.—Infection is created by the communication and re- ception of the poison in the animal economy, which can only take place if there exists a susceptibility and through parte not covered with epidermis, as the genitals, anus, lips, fauces, nipples, eyes, nasal cavity and wounds. It has thus been caught by sucking the nipple of an infected wet nurse; by kissing; by drinking out of a cup that had previously been used by a syphilitic patient; by lying in a bed which had been occupied by a person laboring under the disease; by being shaved with an infected razor, or bled with an infected lancet. CHANCRE. 67 Excessive doses of mercury often produce symptoms like those of secondary syphilis. The disease has been known only since the year 1493, and is propagated from generation to generation. There exists no certain sign, by which we may judge that the system has been entirely freed from it. Therapeutics.—The cure of this most loathsome, painful and disgusting disease, is very difficult and tedious. The cure should have for its object the destruction of the poison, pre- vention of its regeneration, and the removal of its effects. Allopaihists, for attaining both ends, use caustics and the knife externally, and mercury internally, which, if properly administered, is considered a specific. It must be given in such doses as will secure such a degree of re-action as is requi- site for subdueing the virus. The sign of having accom- plished this end, is salivation. The treatment should be com- menced with very minute doses of mercury. In universal infection or secondary syphilis, the use of mer- curius solubilisllahnemanni, halfagrain a day is sufficient for a cure. At the same time a scanty, vegetable diet, avoiding acids, salt and spices must be adhered to. In obstinate cases the following formula will be found of benefit: take of corro- sive sublimate two grains, dissolve in distilled water; opium two grains; honey twenty grains, crumbs of bread as much as will make forty pills; half a grain to be taken every day for one or two months. Warm baths and drinking a decoction of Sarsaparilla assist the cure. Persons of a consumptive habitus should not use corrosive sublimate. Red precipitate, one-eighth of a grain twice a day, in the form of pills, is one of the most efficient preparations. When mercury has been sufficiently used and the evil will not yield, or a mercurial disease is created, it is best to discontinue its use, and give decoctions of guajac or sarsaparilla. Inveterate syphilis, deep seated, and of old date, requires the Bame treatment as secondary syphilis. 6*S 'lENERAL DISEASES. Homoeopathic Treatment.—Primary Syphilis requires Mer- curius vivus, in the sixth dilution, twelve globules night and morning, for five or six days, and, subsequently, if healthy granulations can be perceived, every second or third day. In torpid constitutions the first, second or third trituration of Mercurius vivus, or Merc, corrosivus, J to \ grain, daily, will be found requisite. Ulcers require sometimes the administra- tion of Arsenic and Nitric acid. When there is excessive pain, swelling and inflammation, and these symptoms do not yield to the employment of Mer- curius,— Sulphur and Aconitum, in alternation, every twelve hours, will give relief. In other cases, the exposure of the part to the vapor of hot water, together with spare diet and the reoumbent position, are sufficient to allay the excessive irritation. Great cleanliness is requisite in syphilitic sores. Cases treated by allopathic doses of Mercury, require Nitric acid or Hepar, one drop of the third dilution night and morn- ing, first daily, subseqnently every other day. Remedies employed against the ulcer with raised edges, are Acid, nitricum, Hepar s., Sulphur, Arsenicum, Silicea, Carbo veg„ and Mercurius. Hydropathic treatment.—The ulcer or chancre should be destroyed by fire or caustic as soon as it makes its appearance. Aqua fortis or lunar caustic may be employed for this purpose. When the ulcer has already spread over a large surface, or corroded deeply into the flesh, its virus may be destroyed by repeated applications of a strong solution of the caustic or diluted aqua fortis — one part to six of water. In all other respects both forms are to be treated as ordinary local inflam- mation. The sitz-bath should be frequently employed, of a temperature which produces a soothing effect. Eclectic treatment. — Chancres and syphilitic ulcers must be kept clean by washing them frequently with a solution of carbonate of potash. When poultices can be applied the fol- lowing should be used: Take equal parts of Thorough wort, narrow Dock root, Mandrake root, Bayberry and slippery Elm, \ TABES METALL1CA — MINER CONSUMPTION. 69 pulverize and form into a poultice by adding flour — if neces- sary. This should be laid over the ulcer and a new one ap- plied every morning, washing out the sore at the dressings with a solution of potash. When ulcers are indolent, it is a good plan to drop into them tincture of Myrrh. Confirmed Syphilis requires the following formula: Take Stillingia 12 ounces, Podophyllum 4 oz., Phytolacca 4 oz., Iris versicolor 4 oz., Alcohol 4 oz., White sugar 2 pounds. Bruise the first ingredients, macerate in Alcohol for ten days and strain, then add the sugar. It should be taken in doses sufficiently large to keep the bowels open. SYPHILIS NEONATORUM — SYPHILES OF INFANTS. Symptoms. — Ulcers and eruptions on different parts of the body, inflammation of the eyes, &c, which exist at the time of birth, or come on a few days afterward; the parents being evidently infected with Syphilis. Treatment is the same as described under Syphilis, but in the mildest form, and doses. Syphilitic ulcers in the mouth of the child may be moistened with a diluted solution of corrosive sublimate and lime-water (one-quarter of a grain of corrosive sublimate to three ounces of lime-water.) TABES METALLICA — MINER CONSUMPTION. Persons employed in mines and factories, where lead, arse- nic, mercury and copper vapors are developed, become trou- bled with a dry cough, colic, constipation, dryness in the mouth and excessive thirst. Gradually, vertigo, paralytic affections of the extremities, blindness and hectic fever set in and death ensues by exhaustion and Paralysis. Treatment.—Remove the sufferer from his general employ- ment, and administer the proper antidotes. (See Poisons.) CHAPTER 111. FEVERS. FEBR1S ACUTA — CONTINUED FEVER —SIMPLE EEVER, Accelerated pulse, dry skin, furred tongue, thirst, loss of appetite, pain in the back and limbs. In the severer form: Chilliness, followed by fever, hot and dry skin; flushed face; beating, throbbing pain in the head; general lassitude; rest- lessness; sometimes nausea and vomiting; entire loss of ap- petite; thirst; high colored urine; and quick and irritated pulse. Causes. — Cold, change of temperature, fatigue, exposure, loss of rest, derangement of stomach and bowels, and conta- gious influences. Treatment. — In simple fever very little medicine of any kind is needed. The best means by which to remove this disorder are: Rest, bodily as well as mentally; drinking of pure, soft water; barley-toast, or apple water; abstinence from food, especially animal food; cool and pure air; sufficient but light covering, no feather-beds; keeping the bowels free by an injection of tepid water given in the evening; and ab- lutions with cold or tepid water. (See Colds.) FEBRIS BILI08A—FEBRIS GASTRICA—REMITTENT FEVER- BILIOUS FEVER — GASTRIC FEVER. A form of fever in which the digestive organs are chiefly affected. The following are the principal symptoms: Chilli- ness, succeeded by heat and dryness of the skin; foul tongue, with a yellowish or brownish coat, aversion to food, nausea, vomiting, bitter, putrid, bad taste; fullness at the pit of the stomach; great lassitude;headache; quick irritated pulse; costiveness; offensive evacuations; dark colored urine; yel- low discoloration of the albuginea; thirst, but water tastes bad. 70 ■». **• REMITTENT. BILIOUS AND GASTRIC FEVERS, ?1 When bilious symptoms are predominant: Excessive thirst; desire for acid drinks; bitter taste; tongue coated with a yellow fur; vomiting of greenish, bilious matter; tenderness and slight pain in the hepatic region; yellowish color of the face; dark brown urine. Causes. — Morbid matter in the intestinal canal; undigest- ed food; overloading the stomach; indigestible aliments; sedentary life; melancholy; violent passion; corrupt dischar- ges from the fiver; bilious and mucous accumulations; taking cold; animal food during hot weather. Treatment allopathic. — In cases of gastric fever without accumulation of impurities, nentsal salts, as Cream of tartar or Glauber salts, should be administered in such doses as will not excite purging; should diarrhoea exist, sal ammoniacum will be preferable. If the patient exhibits signs of impurities in the stomach, an emetic (of tartar emetic two grains, pow- dered ipecac, one scruple, Oxymel of squills half an ounce, water two ounces, one table-spoonful every quarter of an hour until vomiting be produced) should be given. After the first effect of the emetic let half aa hour elapse, and then repeat the dose* if necessary, till the patient has thrown up three times. After each operation give a cup of chamomile tea. When there is spontaneous vomiting, it need only be aided by oxymel of squill and tea of chamomile. When the sensi- bility of the stomach and dispositions to diarrhoea is too great, let a mustard plaster on the gastric region, and a few drops -of laudanum internally, precede the emetic. If the bowels are constipated, the emetic must be preceded by an injection. In intestinal accumulations, indicated by pain in the back and loins, rumbling in the abdomen, and discharge of fetid winds, purgatives in divided doses are to be used, as: Epsom salts, or Epsom salts and senna leaves; Castor oil; Rhubarb; or Calomel, from five to fifteen grains, followed in six or eight hours by half an ounce or an ounce of magnesia. The con- tinuance and repetition of the Evacuents must depend upon the signs of impurities, and increase or decrease of the fever, T2 FEVERS. After the evacuation of the primae viae, Diaphoretics are recommended by some authors, among which the effervescing draught, properly prepared, is the most effective. But if it should occasion griping pains in the stomach and bowels, four or five drops of laudanum may be added to every other dose. In the advanced stages of the disease, Dover's powder, given in doses of ten grains, repeated every six or eight hours, is an excellent remedy. The external application of cold water is highly beneficial in the febrile exacerbations. When the disease is violent from the outset, and does not soon show a disposition to yield to the remedies employed, or when it assumes a dangerous aspect in its course, calomel, from half a grain, or even one-sixth of a grain, to two grains may be given every hour, two, or three hours, according to the susceptibility of the patient. Should the bowels be very irri- table, it will generally be advisable to combine the calomel with opium. The medicine should be given regularly through the day, but should be omitted during the night. As soon as any evidence of the effects of mercury upon the gums is afforded, it should be either diminished or suspended. Sulphate of Quinia should be had recourse to, when a par- oxysm of great virulence has occurred, from which the patient has been saved only by the most strenuous exertions, and there is every reason to fear that a similar one will prove fatal. From eighteen to twenty-four grains should be given during the remission, and if of a few hours duration only, the whole quantity must be taken in two or three doses. The remedy should be continued until two daily paroxysms have been prevented. Severe headache may be relieved by applying ice in blad- ders to the head, cups or leeches to the temples, or to the nape of the neck, and mustard to the feet. Restlessness, wakefulness, &c, may often be relieved by small doses of Hoffman's anodyne, camphor water, opium, in- fusion of valerian, Opium, Dover's powder, &c. REMITTENT, BILIOUS AND GASTRIC FEVERS. 7o Hiccough may be treated with camphor, valerian, chloro- form, and especially musk. Convulsions in children require the warm bath, garlic poul- tices to the feet, and brandy to the spine. The diet should consist of stewed fruit; drinks of lemon- ade, raspberry syrup in water, tartaric acid with sugar, &c. Homoeopathic remedies in gastric fever are: Pulsatilla, Nux v., Ipecac, Ant. cr., Bryonia, Chamomilla, China, Cocculus, Arsenicum, Veratrum and Coloeynth.; in bilious fever: Aco- nite, Mercury, Chamomilla, Nux v., China, Cocculus, Bella- donna, Arsenicum, Coloeynth. (Directions for the selection of these Remedies, see Dyspepsia, Hepatitis, and the Materia Mfedica.) Hydropathic treatment — Washing the whole body with cold or tepid water in the morning; a sitting bath, at 59°, of three-quarters of an hour duration before going to bed; a well-wrung bandage around the abdomen, to be repeated when it becomes dry; clysters, repeated seven or more times a day, if necessary; warm water emetics, if there is inclina- tion to vomit, constitute the special therapeutic measures. Obstinate diarrhoea can be arrested by clysters of cold water to which starch has been added. Very high fever requires the wet sheet, which should be repeated until perspiration is produced. Eclectic tr. — At the commencement of the febrile stage, an emetic should be given, followed by a Cathartic of the com- pound powder of Jalap, which, in ordinary cases, may be re- peated every other day. In cases where there is congestion of the portal circle, combinations of Podophyllin and Lep- tandrin, may be given in doses and at intervals suited to the urgency of the case. After the action of the cathartic has ceased, if there should still remain pain, fever, nausea, &c, sweating must be pro- duced, and maintained for a few hours by the spirit vapor- bath. If these symptoms, however, should not be pres- ent, antiperiodics should be given at once, and continued FEVERS. through the whole course of the disease. (See intermittent fever.) Hiccough may be relieved by aqua ammonia; headache by warm water and whisky externally; restlessness by the com- pound powder of Ipecac, and opium, sulphuric ether, or infu- sions of valerian, Skull cap or Black Cohosh. Diet should be light and fluid; the room well ventilated, and the linen often changed. Some.authors recommend the following plan of treatment: When first called to a case of bilious or remittent fever, you should bathe the surface frequently with weak lye and whis- ky, and give mild diaphoretics. When the time for a remis- sion approaches, whether there is much sensible decline of ?he fever or not, come in with the antiperiodic remedies. Take Qitinia and Iron, each three grains, mix and give in syrup or sweetened water, every two hours until five doses have been administered. Desist during the exacerbation, and commence again with the next remission, until six or eight powders have been taken. This course will most assuredly break up the periodical fever, and whatever local affections remain can be more easily treated. FEBRIS CATARRI-TALIS--CATARRHAL FEVER. Alternation of chills and heat, unusual languor, pains in the head, hoarseness and cough; or affections of the eyes, sneezing, running from the nose, loss of appetite, &c. (^ee ('olds, &c.) FEBRIS CONGEST1VA. Congestive fever is a species of typhus fever, all the symp- toms indicating a highly congested condition of all the vis- cera. The external heat of the body is diminished, there is a f-ense of weight and oppression in the chest, and the pulse is f-low and full. (See Typhus and intermittent fever.) Feb ns ephemera — Ephemeral fever. — One dav fever. (Set1 Fcbris acuta.) VELLOW FEVER — BLACK VOMIT. 75 FEBRIS FLAVA AMERICANORUM—'YELLOW FEVER — BLACK VOMIT. This disease commences with chilliness and horror, followed by high fever, strong throbbing of all the arteries of the body, and determination of blood to the head; laborious, hurried respiration; face flushed; eyes heavy and sensitive to light; tongue dry and parched; excessive thirst; yellow color of the skin; vomiting and purging, first of bilious, and subsequently of black fetid matter; great prostration; vio- lent fever; burning pain in the pit of the stomach; every thing taken into the stomach is rejected; severe darting pain in the head and back, extending down the thigh; spasms in the ab- domen and legs. In the second stage the vomiting becomes more violent; furious delirium sets in; tongue is covered with a thick, dark fur; there is hiccough, and the skin is soft and clammy. In the third stage the pulse sinks, the vomiting of matter, resembling coffee grounds, becomes incessant; breathing is .labored; the eyes hollow and sunk; there is twitching and starting; the hiccough is constant, and the limbs become deadly cold; hemorrhage takes place from different parts of the body, and death terminates the scene. The duration of the disease is from a few hours to three or four days, and originates in the coastward regions of the West Indies and the Southern States of North America. Causes. — Marsh-miasm; filthy streets in large cities and towns, containing putrescent matter, generated under a high range of temperature; damp, ill ventilated dwellings, deficient or unwholesome nutriment; &c. Treatment allopathic. — Like typhus, it is to be treated ac- cording to its different characters. Venesection is recom- mended by some, and condemned by others. Calomel, in large doses, constitutes the chief anchor. Cold affusions; small doses of croton oil; opiates; quinine and stimulants; warm baths have been employed with sue- 76 FEVER--. cess in the different stages, and according to the character of the disea^e. Homieopathic remedies. — Ipecac, Aconite, Belladonna, Lo- belia, Arsenicum, Veratrum, Nux v., Mercurius, and Canthar- ides. Select the drug cautiously, and give every two to four hours. Hydropathic tr. —Wet cloths and ice to the head, pouring head-bath, cold compress to the stomach, warm water emetic followed by sips of cold water, or bits of ice; warm water injections; footbaths, &c, constitute the principal remedial agents. Eclectic tr. — This disease should be treated like bilious fever. In the early stage of the disease an emetic of lobelia must be given, to be followed by an active Cathartic (compouud powder of Jalap); after the operation of the Cathartic, the compound powder of Ipecacuanha and Opium, combined with equal parts of Quinine, may be given, every hour or two, in three or four grain doses. The bowels must be kept open daily by small portions of Podophyllin and Leptandrin. In cases of iritability of the stomach, mustard must be applied over the epigrastric region, and cathartive injections, com- bined with lobelia or capsicum, given. The patient may also eat ice in proper quantities. The whole surface should be frequently bathed with a cold alkaline wash. FEBRIS INFLAMMATORY--SYNOCHA--INFLAMMATORY FEVER. This form of fever is rather peculiar to vigorous constitu- tions, and to persons of active, out-door habits of life. It may be distinguished by the following symptoms: Pulse full, hard, strong and quick, though never very frequent; tongue white with red edges; eyes reddish; constipation; respiration hurried in accordance with the pulse; urine scanty and high colored; temperature of the body uniformly high. Like all continued fevers, it is characterized by two exacerbations during the day; the severest toward evening. It runs its course with rapidity and regularity, rarely exceeding four- FEVER AND AGUE. 77 teen days. Crisis shows itself by sweat, urine or hemorrha- ges. Causes. — Local inflammation; wounds; taking cold; over heating; violent mental emotions; dry easterly winds. Treatment allopathic — Bleeding; Nitre; cooling purga- tives (sulphate of soda); calomel and nitre; cool air, and cool water. Homoeopathic tr. — Aconite is the most effectual remedy in inflammatory fevers, to be given every one, two or six hours, according to the severity of the case. In some cases Bella- donna, Bryonia and Cantharides are required. Hydropathic tr. — Reduce the heat and inflammation by ablutions, affusions, the wet sheet, cold bandages to the head, and drinking of cold water. The sheets and bandages must be repeated according to the degree of fever, every half hour to every hour. The bowels should be kept open by clysters. The nourishment should consist of stewed fruit and weak broth for seven days. Eclectic tr.—Reduce the temperature of the body, and keep the bowels open. FEBRIS INTERMITTENS--INTERMITTENT FEVER--FEVER AND AGUE. A chill followed by heat and terminating by perspiration constitutes a regular paroxysm of ague. The premonitory symptoms are languor, or general uneasi- ness, yawning, stretching, headache, stupor, pains in the limba and back, numbness in toes and fingers. During the cold stage the patient experiences, coldness of the extremities and along the back, general prostration of strength; blueness of the nails; insupportable coldness, ex- ternal and internal trembling, chattering of the teeth; labored and hurried respiration; livid cheeks and lips, scarcely percep- tible pulse. The duration of the cold stage is from one to four hours, when it gradually abates and runs into the hot stage without any marked interval. The hot stage presents all the symptoms of inflammatory fever, and lasts from four to 78 FEVERS. twelve hours, when it terminates in the sweating stage. In some cases perspiration is hardly perceptible. Fever and ague returns at definite, sometimes at indefinite periods, leaving an interval entirely free from fever with appa- rent good health. If it returns once in twenty-four hours it is termed quotidian (generally in the morning); once in forty- eight hours, tertian (midday); once in seventy-two hours, quartan (afternoon); the tertian form is the most common. This disease is mostly prevalent during autumn, re-appear- ing during the first warm days in spring, in nearly all cases where Quinine was taken in large doses. Enlarged livers and spleens, called ague-cakes, are very common sequelae of inter- mittents. "Chill and fever," and " dumb ague " are imper- fectly developed forms of intermittents. Death may ensue from collapse in the cold stage (sinking chills.) Causes.—Marsh miasmata, stagnant waters; new countries where decomposing vegetation abounds; obstructions of the abdominal viscera; taking cold; living near water; fish diet; drinking hard water; eating salt pork ; damp, low dwellings with sleeping apartments upon the first floor. Treatment allopathic. — In cases of ague accompanied with foul stomach, cathartics and emetics should be administered first, afterward two drachms of sal ammoniac daily, and, a few hours previous to the paroxysm, an emetic followed by chamomile-tea. Should this treatment prove unsuccessful, or other reasons exist for stopping it quickly, then quinine should be administered, one grain every two hours in the intervals of the paroxysm. ( Take Sulphate of Quinine twenty grs., extract of liquorice a sufficient quantity, and let twenty pills be made.) The last dose must be the strongest, and be given immediately before the paroxysm. If Quinine produces purging, add one drop of the tincture of opium to every other dose; in costive- ness, a few grains of Rhubarb; in pressure on the stomach, nausea or vomiting, cinnamon or a spoonful of wine must be admixed with every dose; in cramp-like affections, valerian,!, FEVER AND AGUE. It) This method is generally sufficient to arrest the fever after the first or second paroxysm. To prevent its .return we must give a small dose of Quinine during ihe apyivxial stages for eight or fourteen days. In some cases Quinine, apparently, has.no enect, and it is then necessary to add, to the last doi children* and nervous females #hi» i»ee$iei»e showld be givem in higher dilution. Arsenicum corresponds to a large nuriuibeT @£ symptoms. The f*ll©wi»g are the- principal.: Paroxysm- every other day; no distinct development of the chills or heat; they occur simultaneously or alternately; excessive prostration of strength; bruised feeling fa' the limbs; nausea aad v&auti&g of bile ;. burning fever with anguish, restlessness and terrible thirst mr •tensatioo of burning in the stomach or bowels; diarrhoea, no sweat, or very Mttle, sonae time after the heat. Two grains of the first trituration (10-100) should be given two hours after. and again: two hours before the paroxysm^ Between, the paroxysm give two doses of Nnx v. Ipecacuanha is an important yemedy in all Iatermittents,. which have previously beest treated,, aad maltreated with Qui- nine or Arsenicum. The folh>wi»g are the chasaeteristic- symptoms : nausea and vomiting, bad taste in the mouth, op- pression aad eosstsiction. of the ehest, loss of appetite, pros- tration of body and mind. C-ive as directed! undeu Avsenicum and Ciwh-stia^ Xux ■». is a remedy of gieai value in connexion -with, the others- aud for symptoms preceding the ague. It is- appro- priate in a sttate ©f csestipatioa, gastric or bilious symptoms,. numbness or a paralytic sensation, in the hands and feet, pairt in the right side and back, lknguos. Among a great many other remedies recommended in inter- mittent fever, are especially: Bone-set (Eapatorium perfolia- tum};. Natriam, mwiatacuimi, Casho veg., Yeratram, Tartar emetic, Pulsatilla and Cimex lectialaris. Some Physicians recommend giving the appropriate drug; in the higher potencies, immediaitely afte? i&e Paroxysm anoK repeat it every three or four hours during the intermission. Hydropathic treatment—The- bowels should be well cleansed with tepid injections, and when there is much nausea, os bit- IE VERS. ier taste in the mouth, a warm water en;otic is advisable. Discharges from the bowels should be kept up for several days. Shortly before the paroxysm sets in, the patient should place FEVER — PUERPERAL PERITONITIS. This form of fever takes place after delivery, and is caused by an inflammation of the Womb (metritis), or of the perito- neum (puerperal peritonitis). It may prevail epidemically, f nd even become contagious in houses where many lying-in* women are gathered together. The usual symptoms are; chills succeeded by fever ; headache ; violent pain in the abdo- men with much distention and great sensitiveness of the same; suppressed secretion of milk, and lochia, or profuse lochia with fetid odor ; nausea; diarrhoea ; thirst; low spirits ; quick pulse. It may last a number of days, or it may carry the patient off in the first twenty-four hours. Causes.—Protracted labor; instrumental delivery, improper food, stimulating drinks; cold; atmospheric contagion. Allopathic treatment.—During the first stage of the disease cooling laxatives and injections should be used; the child must be frequently applied to the breast, and when the lacteal secretion has been suppressed dry cups and poultices become necessary. In suppression of the lochia warm injections in the womb and application of leeches to the genitals; and in eases where much gastric derangement prevails, an emetic of ipecac, is indicated. In the inflammatory stage a venesec- 94 tfcVER.S. tion or eight to twelve clippings on the abdomen, cooling pur- gatives, embrocations of camphorated oil, and mercurial oint- ment, should be resorted to. In the nervous state valerian, musk, opium, peruvian bark, and camphor are the propei remedies. Gangrene of the Womb, indicated by putrid lochia, must be counteracted principally by injections of Arnica and Peruvian bark; excessive diarrhoea by alum and Ratanhia; vomiting by opium and Seidlitz powders; the white swelling of the thigh by emollient cataplasms and embrocations of mercurial ointment. Homoeopathic remedies: Aconite: excessive heat, hard and full pulse, headache, high fever. Bryonia: Fever with pain in the abdomen upon moving, disposition to perspiration, typhoid symptoms. Belladonna: suppressed secretion of milk, flushed face, headache, distented abdomen, burning sensation in the womb and vagina. Chamomilla: excessive tenderness of the abdomen, an- guish; severe attacks of sharp pain, painful sensation a3 if the parts were ulcerated. Nux v.: tenderness of the abdomen, constipation, suppres- sion of the lochia. Pulsatilla '. suppression of the milk and lochia, painful sen- sitiveness of the abdomen, rumbling in the bowels and diar- rhoea. If typhoid symptoms make their appearance: Bryonia, Ar- senicum, and Rhus tox. should be employed. The proper remedy must be repeated every one or two hours, until an improvement is manifest, when they may be given at longer intervals. The application of cloths dipped in hot water, wrung as dry as possible, and covered with silk oil-cloth proves of benefit by producing exhalations from the skin. Much comj pany ought to be avoided. Hydropathic tr.—Cold wet cloths to the abdomen; the pact or general ablution, warm foot-baths, cold applications to the S£IL£ SICKNESS, t)& head, and tepid injections. It is best to commence withwatoF a little tepid, gradually lowering the temperature. Eclectic tr. — The patient should be kept in bed and not allowed to change her position often, and not even the bed- clothes should be allowed to press upon- the abdomen. Not- withstanding constipation is a frequent accompaniment it is not proper to induce free catharsis. Apply warm fomentations over the stomach and bowels or cloths wrung out of a decoc- tion of bitter herbs, which should be as hot as the patient, can bear; these should be repeated as often as- they become cool, until the active symptoms have subsided To remove constipation, iujeetions of starch-water, with a small quantity of table salt and the anti-spasmodic tincture should be given. In violent pains, the Sudorific tincture may be added, FEBRIS R1IEUMATHA. Rheumatic fever. (See Rheumatism.; FEBRIS TRAUMATICA. This form of fever appears generally in- consequence of severe woundsv If slight, ao particular treatment is neces- sary ; if severe, the same treatment is required as in othej? inflammatory fevers-. Fever during dentition. (See Dentition-.) FEBKIS MERCURIALIS--MERCURIAL FEVER—.SALIVARY FEVER. Quick pulse; hot, dry skin; thisst;, headache; debility;. sleeplessness; dry, parched, foul mouth; red, swollen, spongy gums. It runs its course in a few days and terminates in Balivation, diarrhoea,, sweat or an eruption. Cause.—Injudicious administration of calomel, or blue- mass. (See Salivation, and Mercurial eruptions.) FEB-RIS VERMINOSA—WORM FEVER, See Helminthiasis (Worms.) MILK SICKNESS--TREMBtESr A miasmatic fever prevalent in many of our Western m> FEVER9. -States, and accompanied with excessive nausea, vomiting, debility, emaciation, chilliness, fever, headache. (See Pis- eases of the stomach and abdomen.) PESTIS BUBON1CA--BCBON-PLAGUE--PEST-PLAOL i.. This fatal disease is now limited chiefly to Fgypt, Syria, Greece and Europian Turkey; but by infection it can be spread every where. Infection takes place by contact, never by the atmosphere. The character of the Plague is that of a malig- nant exanthem; a typhus fever of the putrid form, attended with carbuncular and imperfectly suppurating tumors, some times running into deep gangrenous ulcers, the patient often feeling as if burning up with internal fire. Cause.—Filthiness; gross sensuality ; gross food; unventi- lated apartments; drunkenness; debauchery, etc. Treatment — Free ventilation; cleanliness; avoidance of filthy and crowded places; and among the many remedies recommended, rubbing the surface with ice has proved most successful. Mercury, Arsenicum, Peruvian bark; and in some cases bleeding has been employed. (See Typhus.) FEBRIS HECTICA—HECTIC FEVER. Consumptive fever originates in, and is always combined with internal or external suppuration. It commences slowly and insidiously, the patient complaining for some months only of lassitude after the least exertion, failure of appetite and emaciation; then chilliness followed by heat and prespiration, pale skin, hectic flush on the cheeks, quick and weak pulse; finally night and morning sweats, hot hands, fever worse after meals; difficult breathing, offensive diarrhoea, oedema of the lower extremities, and excessive debility. Therapeutics.—The treatment of this fever, which is only the symptom of some internal or external suppuration, Atro- phy, Phthisis, &c, must be directed to the cure of the original •disease. During the fever such mild remedies should be exhi- bited as will allay the heat and prevent night sweats. INFANTILE REMITTENT FEVER. 97 A decoction of amaranthus or crawly root has been em- ployed with benefit; likewise, the elixir of vitriol or diluted sulphuric acid, five to ten drops to be taken at bed time. Bathing the surface before bed time with hot whisky, and bathing the body with cold or tepid water at any time in the night when the sweats are profuse has afforded relief. INFANTILE REMITTENT FEVER. This is one of the most common fevers in children. It is generally accompanied with want of appetite, nausea, bad breath, furred tongue, vomiting, languor, thirst, restlessness, drowsiness or stupor, oppression of the chest, rattling in the throat, troublesome cough, starting during sleep; constipa- tion, or frequent desire to go to stool with but little effect, some times bloody discharges. The febrile symptoms never entire- ly subside. If the disease is not arrested, the little sufferer becomes emaciated, the vital powers give away, and he sinks exhausted. Causes.—Morbid irritability; inflammation, or even ulcera- tion in the mucous membrane of the stomach and bowels. Allopathic Treatment.—In case of constipation, an injec- tion should first be given, and afterward a mild Emetic, un- til three rejections have been effected, then again injections and a purgative. Afterward take tartrate of potassa half a drachm, fennel water one and a half ounce, syrup of manna and rhubarb each half an ounce ; mix, and give a tea-spoonful every two hours. Homoeopathic remedies.—Ipecac: dry heat, thirst, quick op- pressed breathing, foul tongue, nausea, vomiting, languor and indifference. Pulsatilla: fetid, bilious, or whitish motions, accompanied with griping, fever worse toward evening and during the night. Nux v.: Bowels confined, with frequent inclination to go to stool; tenesmus followed by scanty motions, mixed with mu- cus, or with a little blood ; tongue foul; nausea with disgust at food ; fever worse toward morning. 5 98 FEVERS. Chamomilla: bilious diarrhoea, and vomiting; yellow coated tongue', flushes of heat, head and skin hot, thirst, frequent and scanty evacuations, with tenesmus, or constipation. Arsenic, China, Antimony, Calcarea, Mercurius, Bryonia, and Lachesis may also be required in some cases. Hydropathic tr:—The wet pack several times a day, to keep down the fever; the wet girdle around the abdomen and stomach, warm water emetics, and cold or warm enemas, ac- cording to the state of the bowels, are the principal means employed. Eclectic tr. —At the commencement of the disease, a light emetic will be found advantageous. This should be followed by an active Purgative, as the compound powder of Jalap. After the bowels have been freely acted upon, should the fever continue, small doses of Leptandrin, with or without Podophyllin, or if there be gastric acidity, Leptandrin, com- bined with the compound powder of Rhubarb, or Syrup of Rubarb and Potassa, should be administered in doses sufficient to cause one evacuation daily. Gastric irritability may be overcome by mild mucilaginous draughts, as Marsh-mallows, to be aided by Sinapisms to the epigastric region and spinal column. Spasmodic action will usually yield to the tincture of lobelia and capsicum, aided by warm baths. As soon as the stomach can retain medicine, antiperiodics must be given continuously. Take powder of Ipecac, and Opium, half a scruple; Quinine, one scruple; mix, divide into ten powders, and, to a child two years old, give one powder every four or six hours. As soon as convalescence takes place the mild bitter tonics, as Hydrastin, Cornin, etc., must be given. Change of climate will effect an immediate, beneficial result, TYPHOID FEVER. Some writers regard this fever as a distinct disease. It is maintained that the follicles of the intestines inflame and ulcerate, and that the abdomen is the seat of the disease. This however, has not been clearly proved, and as the synip- TYPHOID FEVER. 99 toms are the same as those of Typhus in a modified form, the treatment must remain the same. Where there is reason to suspect the influence of marsh malaria, even though the periodic tendency were so obscure as to be scarcely recognized, the antiperiodic agents should be administered at once. (See bilious and intermittent fever.) CHAPTER IV. AFFECTIONS OF THE NERVOUS SYSTEM —INCLUDING MENTAL DISEASES. AGRYPNIA — SLEEPLESSNESS. Difficulty in obtaining or inability to sleep, without any apparent external or internal cause. Causes. — Severe study; intense attention to business; pro- tracted watching; eating near bed-time; use of coffee, tea, tobacco and ardent spirits; deeply seated nervous irritation, most frequently in the abdomen. In children, teething; acid- ity; worms, &c. Treatment allopathic. — Removal of the causes, especially the abdominal irritations; tepid foot baths before retiring; general baths (tepid), exercise in the open air; washing of the head with cold water; ventilation of the bed-room; avoid ing napping during the day, and abstaining from late suppers. Medicinal treatment; Extract of hyoscyamus, one to two grains, at bed-time, or applied to both temples; in debilitated old persons, a small glass of old malaga wine; in persons suffering from hemorrhoids, sour-krout with oil; in those afflicted with gout, a cup of black coffee in the evening; in hysterical females, an enema of chamomile; in women during confinement, the odor of milfoil (Achillea millefolium). Homoeopathic remedies:— Aconite: For sleeplessness caused by anxiety or alarming events. Belladonna: When the patient is sleepy, but unable to sleep, with great anguish and restlessness. Coffea: Sleeplessness caused by joy; or suitable for sleep- lessness of children, and for persons who have indulged in the excessive use of strong coffee ° loo CATALEPSIS — CATALEPSY. 101 Hyoscyamus: Sleeplessness from nervous excitement, espe- cially after violent diseases. Ignatia: Sleeplessness caused by grief, care, sadness, &c. Moschus: Sleeplessness of hysteric or hypochondriac indi- viduals. Nux v.: Sleeplessness caused by excessive thinking, read- ing, &c, or when caused by abuse of coffee. Opium: Sleeplessness from fear or fright; or when the patient is troubled with visions of ghosts; or suitable for old people. Pulsatilla: Suitable for individuals who have eaten too much supper; or when attended with congestion of blood to the head. For the sleeplessness of children: Aconite, belladonna, chamomilla, coffea, jalapa and rhubarb. Hydropathic tr.—A hip-bath or dripping sheet at bed-time, when the trouble arises from mental causes; and the warm foot-bath, abdominal girdle, active out-of-door exercise, and exercise in a cold room, while in a state of nudity; an air- bath, when the causes are corporeal. ASTHENIA —DEBILITY. (See General Diseases.) CATALEPSIS — CATALEPSY. Insensibility to external impressions; immovability, but no spasmodic stiffness of the muscles; body and soul continuing in the very situation in which the attack has befallen them; the mind persisting in the same series of thoughts, even words. Shortly before the paroxysm, patients complain of headache, loss of appetite, sleeplessness, melancholy, and their face has a suffering expression. During the same they have dreams and visions, and hear or see with the pit of the stomach or soles of the feet. Causes. — Annihilation of the direct influence of the spirit on the body; hysterics; masturbation; unsatisfied sexual de- sire; worms; cerebral susceptibility. Allopathic tr. — Zinc, valerian, cinchona, orange leaves in 102 MENTAL AND NERVOUS DISEASES. powder and infusion, cold baths, free air, corporal exercise, and magnetism constitute the principal agents for the removal of this affection. A small mirror held at the nose will condense any vapor from the lungs, and we can thereby distinguish catalepsy from death. Homoeopathic remedies. — Chamomile, ipecac, platina, stra- monium; also: belladonna, hyoscyamus, moschus and vera- trum. Hydropathic tr. — (See Ecstasy.) Eclectic treatment must be instituted according to the symp. toms present. If the disease be periodical in its attacks, Qui- nia and Iron must be given. CHOREA SANCTI VITI — ST. VITUs's DANCE. Children of from four to sixteen years of age, generally of the female sex, are attacked with involuntary motions of the different parts of the body, causing them to perform in many instances the strangest feats, as dancing for hours, or until falling down from fatigue; turning on one leg; leaps and jerks; running for hours irresistibly. Sometimes the in- voluntary motions seize only single parts, as the arm, the facial muscles, the tongue (producing stammering), or only one-half of the body is affected. The disease is either peri- odical or permanent, without loss of consciousness. Sleep alone procures rest. The bowels are, in most cases, constipa- ted, which symptom becomes aggravated as the disease ad- vances. Instances are on record of this disease having oc- curred epidemically and communicatively, especially in large assemblages. The disease is curable, though in some cases partial contortions of the facial muscles may remain. Causes. — Anormality of nervous life and its action; gas- tric impurities; worms; onanism; developing process of pu- berty; irregular menstruation; fright; repelled eruptions; lead; mercury. Treatment. — Abstinence from tea, coffee, warm bread, acids and greasy food; removal of worms and other remote causes. Allopathists recommend Zinc as the most efficacious reme- INFANTILE FITS. 'J 03 dy; next, valerian, copper, assafcetida, iron, tepid or culd river baths, shower-baths, sea-baths, sulphur-baths, Electro-mag- netism, and leeches on painful parts of the spinal column. Homoeopathic remedies:—Belladonna, causticum, cocculus, crocus, cuprum, ignatia, nux v., stramonium, .Zincum and Electricity. Hydropathic tr. — The great majority of cases will be found in connection with torpid liver, costive bowels, and obstructed skin; for which a thorough daily ablution, an injection every day, or every other day, and a diet of brown bread, wheaten grits, potatoes and fruit will be sufficient. Shower-baths are of benefit, if the patient has a good reaction after it; they should be commenced with tepid water. Eclectic tr. — Keep the bowels open by small doses of Lep- tandrin and Podophyllin, producing one alvine discharge daily, and bathe the surface daily with an alkaline wash, fol- lowed by considerable friction. The compound pills of Ma crotys, or of Valerian, compound tincture of cramp-bark, and Electro-magnetism have been used with benefit. Cgjia Somnolentum. — Deep, heavy sleep. The patient cannot at all be roused. Coma Vigil. — The patient awakes by the slightest noise and falls asleep again instantly. It indicates great affection of the brain, and is generally a sign of typhus or cerebral inflammation; the worst when it sets in immediately from the commencement of the fever. Narcotic poisons, apoplexy and worms may be, in some in- stances, the cause. Treatment must be instituted according to causes. llonioopathicremedies:—The principal indicated are: Bella- donna, Chamomile, Opium and Pulsatilla. CONVULSIONS--SPASMS--ECLAMPSIA—INFANTILE FITS. Alternate contractions and extensions of antagonistic mv. cular fibres, often attended with unconsciousness. Spasms aie generally preceded by restlessness, starts, cries, peevhsj.? 104 MENTAL AND NERVOUS DISEASE*. temper, with alternate paleness and redness of the face. They may last from several minutes to twenty-eight hours. Causes.— Acidity of the stomach, worms, constipation, ac- cumulation of wind, dentition, congestions, fright, sweet-cakes, candies, paregoric, &c. Treatment allopathic. — If caused by derangement of the digestive organs, cathartics, injections, magnesia, emetics when radicated, and valerian, are the best means to afford relief. If caused by dentition, congestion of the brain with redness of the face, heat of the head and a soporous state, the appli- cation of a few leeches on the temples and behind the cars is called for. In weakly nervous subjects, flores zinci, vale- rian, clysters and tepid baths are required—also Magnetism and Electricity. Homoeopathic tr. — Immerse the lower extremities, up to the knees, in warm water, from five to ten minutes, or until the paroxysm seems subdued, when the patient should be wrapped in a warm blanket. If the spasms return, repeat the immersion, at the same time pour a small stream of cold water on the crown of the head until animation becomes apparent. Injections of warm water or milk, or sweet oil and warm milk, or a composition of warm water, salt and molasses should be administered. Camphor water may be applied to the nostrils. The most important remedies, which should be selected with reference to the causes, are the following: Belladonna: Indicated for plethoric and corpulent child- ren ; starting while sleeping, pupils enlarged, smiles or laugh- ter during or before an attack. Recurrence of the spasm from the least touch. Chamomilla: For children of nervous temperament and extreme sensitiveness; drowsiness while awake, one cheek is red the other pale, jerks and convulsions of the arms and legs, with clenched hands, while the head is rolling from side to side. Ignatia: Hysterical alternations of vivacity and sadness; light slumber; suddenly flushed with burning heat; violent CRAMP. 105 crying; tremor of the whole body; paroxysms occur at regu- lar intervals. China: For scrofulous children, who are subject to worms; spasms of the breast, rigid stiffness of the entire body. Arsenicum and Stannum are also indicated in some cases. Convulsions derived from repelled Scarlatina: Belladonna, Opium and Stramonium; repelled measles: Bryonia, Stramo- nium and Tartar emetic; Spasms caused by fright: Opium, Stramonium and Ignatia; by mechanical injuries: Arnica; by derangement of the stomach: Nux v., Pulsatilla, Coffea, Ipe- cac, Hydropathic tr. — Strip the patient of all clothing; give, according to circumstances, a warm or tepid bath; immerse the legs and feet in warm water, and, if there is much heat in the head, keep a piece of linen wet with cold water over the head and temples. Cold frictions upon the spine are useful in convulsions. Tepid injections must be given to move the bowels freely. Expose the patient to abundance of cold air. Eclectic tr. — If spasms are caused by the repulsion of some cutaneous eruption, Emetics (tincture of lobelia or blood- root), followed by diaphoretics and warm drinks, should be employed. If occasioned by indigestible food, empty the stomach by Emetics, followed by a small dose of Jalap. Dur- ing the convulsion, apply cloths dipped in hot water on the stomach and bowels, repeating their application every few minutes. Injections of castor oil, molasses and water, to which may be added compound tincture of lobelia and capsi- cum, should be freely administered. When dentition is the exciting cause, cut down to the tooth. When there is strong determination of blood to the brain, the feet should be immersed in warm water and affusions of moderately cool water used upon the head, shoulders and thorax. The compound tinc- ture of lobelia and capsicum, twenty drops every twenty min- utes, will be found one of the best agents for speedily allay- ing convulsive action. Cramp.— An involuntary contraction of one or more mus- 10G MENTAL AND NERVOUS DISEASES. cles, attended with a good deal of pain, leaving the affccicd part sore and lame. The stomach, neck, calves of the legs, and toes are the parts most frequently attacked. When the ttomach i.-j attacked, the breathing is short and distressing. Causes. — Muscular over-exertion; indolence; pregnancy; exposure to cold and wet (during swimming); flatulence of the stomach or bowels; acrid bile. Treatment. — Friction with the hand, wet in cold water; ex- tension of the muscles of the affected limb as powerfully as possible; compressing a roll of brimstone in the hand till it cracks. (See Colic, Cholera, and other diseases.) DELIRIUM TREMENS--DRUNKARDS DELIRIUM. The first symptoms of this malady are: Extreme irritability of temper, weakness of memory, increased muscular and cer- ebral activity, anxiety, and uncontrollable restlessness. After this, sleeplessness sets in, or sleep is disturbed by frightful dreams, visions and sounds. Fixed ideas then take possession of the patient's mind, such as the supposition that some one is bent upon killing him, &c, and he dreads being alone. The face is pale, countenance wild, speech often stuttering, the hands arc tremulous and muscular twitchings are often observable. Restlessness of mind and body increase, and finally delirium supervenes. Causes. — The habitual use of alcoholic beverages; in a few instances the disease has arisen from the use of opium, tobacco and tea. Allopathic tr. — In congestions of the head, local Antiphlo- gistics are indicated; if accompanied with inflammation of the lungs, venesections; if with gastric symptoms, Emetics: otherwise opium (increasing doses), and for the Sequelae, Phosphoric acid with opium should be administered. Homoeopathic tr. — In the first stage a dose of Nux v. every six hours. When the patient is affected with delirium or convulsions, Opium or Morphine in repeated doses. In some cases the alternate employment of Opium and Nux v., or the ECSTACY — TRANCE. 107 administering of Belladonna, Ilyoscyamus, Stramonium,Coffea and Camphor become necessary. Hydropathic tr. — When the patient is not ungovernable, the wet-sheet pack is the most soothing process which can be employed; in other cases the tepid shallow-bath, accompanied with active and persevering friction, must be relied upon. When the stomach is foul, a warm water emetic and a daily tepid injection are serviceable. Wet towels majT be applied to the chest, abdomen and thighs, and should be frequently renewed. Eclectic tr. — In the early stage of the disease, a cathartic should be administered and cold applications made to the head with warmth and friction to the feet. In order to quiet the nervous system, antispasmodics and sedatives must be given, among which most benefit will be derived from equal parts of tincture of valerian, tiueture of eastor, laudanum, and spirits of nitre, from one to two drachms of which may be given every hour until sleep is produced. When the attack commences with convulsions, give fifteen drops of the tincture of Gelseminum every fifteen minutes or half hour, until spasmodic action begins to subside. If pa- tients, after having slept, strongly crave liquors, it will be prudent to cautiously allow them the moderate use of some stimulant. Eclampsia. — (See Convulsions.) ECSTASY — TRANCE. Nervous derangement, in which the patient is absorbed in some object of the imagination; he seems at times out of the body, engrossed in some high object of contemplation; but is not wholly lost to external impressions, being able to read letters when placed upon his stomach or to the soles of his feet, and describe internal diseases and foretell future events. It attacks chiefly melancholic, hypochondriac, vision- ary, and abstracted persons. The fit varies from two or three hours to as many days, at the end of which the patient rouses as from sleep. 108 MENTAL AND NERVOUS DISEASES. Causes. — A morbid state of the liver; powerful mental ex- citement; long continued meditation on a particular subject; venereal excesses; self-pollution; prolonged suspense of mind. Treatment. — Out-door exercise; journeys; lively company; cheerful conversation; regular employment, with a daily bath and plain food. EPILEPSIA--EPILEPSY--FALLING SICKNESS. Convulsive motions with loss of consciousness. The most usual precursive symptom is the feeling of a cool breath or wind (aura epileptica), which commences at the point of a finger or a toe, rises upward, and, as soon as it reaches the brain, produces the fit. Sometimes the aura proceeds from an organ of the senses, and then exhibits itself as a foreign smell, taste, color, or double sight. But more generally the parox- ysm comes on suddenly; the patient is instantly deprived of all sense of perception and power of motion, and if standing, he falls, while the body is more or less convulsed; the coun- tenance is violently distorted; the tongue generally protrudes from the mouth, which discharges a frothy saliva; the teeth gnashing upon the tongue, often wound it severely; the hands are clenched; sometimes the urine, faeces and semen are dis- charged involuntarily. A profound lethargic sleep succeeds the severer attacks, from which the patient at length awakes, unconscious of having suffered pain. The attacks occur at indefinite times, sometimes every night. Persons have been epileptic for years, not knowing that they ever had a fit of the kind. Some authors assert that the pha- ses of the moon have influenced the disease. Causes. — Hereditary disposition; debility of the nervous system; onanism; fright and sudden emotions of the mind; repelled eruptions, and suppressed hemorrhages; obstructed menstruation; tape-worm; tobacco; internal tumors or col- lections of matter; external injuries, as depressed bones, &c. Allopathic treatment — Remove the remote cause, and ab- stain from all mental and excessive corporal exertions, stim- ulants, &c If the disease afterward does not cease, adminis- FALLING SICKNESS. 109 ter zincum, cuprum, valerian, cinchona; use cold affusions to the head and sea-baths. Zinc in large doses, and continued for a good while, is the most valuable of all. The patient may commence with taking one grain morning and evening, in- creasing the dose on every alternate day one-half grain, until nausea succeeds, when the dose is to be diminished. It can be taken in the form of pills by adding a sufficient quantity of liquorice. It should be taken at least fourteen days in every month, until the paroxysms cease. Electricity, Vale- rian, Stramonium, Belladonna and Hyoscyamus are also re- commended. The palliative treatment consists in preventing the fit by an Emetic, or by wearing a leather-band with a tourniquet on the hand or foot to prevent the aura from passing to the brain. During the fit remove all tight clothing, place the patient on a soft bed, sprinkle cold water over the face, and let his spasm work off. It is said that a black silk handker- chief thrown over the patient has arrested the fit. Homoeopathic tr. — The principal remedies used are: Bella- donna, Cuprum, Hyoscyamus, Ignatia, Nux v., Opium and Stramonium; which must be selected and administered accord- ing to causes and symptoms. Hydropathic tr. — During a fit cold water should be freely applied to the head, cold compresses to the stomach, and warm applications to the feet. In the intervals, the cure must be prosecuted by a careful attention to the general health. Brown bread, roasted potatoes, and baked or boiled apples should be prescribed as the leading articles of diet. Among the bathing processes, shallow-baths, sitz-baths, and foot-baths should take the lead. They should be of short duration, and frequently repeated to guard against determination to the brain. If the skin evinces considerable torpor, the patient should be tho- roughly rubbed in the dripping-sheet occasionally. Eclectic tr. — During a fit a piece of wood or other sub- stance should be interposed between the teeth to prevent the patient from biting the tongue. Cold water should be applied 11U MENIAL AND NEHVot f)l.-vF\M-:s. to the head, and hot water and friction to the extremities. Injections may be administered, consisting of the tincture of Castor, or Assafcetida, with a decoction of Scutellaria. In infants the warm-bath may prove beneficial. In cases at- tended with absence of respiration, Camphor may be applied with good effect to the nostrils, or an electro-magnetic current directed through the diaphragm. During the intervals the general health must be improved. Diet should consist of succulent vegetables, vegetable and animal albumen, and the fibrinous portion of animals. If the cause can be ascertained, as worms, uterine difficulties, etc., treat them accordingly. In those instances where the causes are obscure, the following plan of treatment is recom- mended : The bowels should be kept regular by small doses of Leptandrin and Podophyllin, and the following pills em- ployed during the intervals: take of Extract of Stramonium one grain, Valerian or Sulphate of Quinia four grains, hydro- alcoholic extract of Macrotys eight grains; mix, divide into eight pills, and give one, three or four times a day. The following liniment must be applied to the spine twice a day: Take oil of Stillingia one ounce, oil of Cajeput two ounces, oil of Lobelia two drachms, Alcohol three ounces; mix. It should be discontinued as soon as the patient com- plains of nausea, or an unpleasant acrid taste in the mouth. The doses should be proportioned according to the ages of children. Fi-s. — (See Convulsions.) HYPOCHONDRIASIS--LOW SPIRITS—SPLEEN. Inclination to solitude and sadness, mind constantly oc- cupied with imaginary diseases, singular fancies, anxiety, inclination to weep, disorders of the digestive system, dispo- sition to flatulency, pale watery urine. Patients are peevish, pleased and displeased with the veriest trifles, and are often unwilling either to live or die. It is not a fatal disease, but is very troublesome to the sufferer as well as to others. HYSTERICS. Ill Causes.—Morbid sensibility of the nervous system; espe- cially, of the digestive organs; excess in venery and onanism, immoderate exertion of body or mind; loss of blood; diarrhoea; suppressed hemorrhoids; gout; sedentary life; abdominal obstructions; disease of the liver; indigestion; coffee; tea;alcohol and tobacco. Allopathic Treatment.—In obstinate constipation, clysters, mineral waters, sulphur, aloes, assafcetida, mercury, are the principle remedies, in doses to produce one or two stools a day. Exercise on horse-back, soap and salt baths, and friction of the abdomen early in the morning, are of great benefit. When debility is the cause, we must endeavor to strengthen the patient by cold or tepid baths, sea-bathing, fasting and working, living in the country, traveling, &c. We may also prescribe an infusion of equal parts of valerian root, cloves, melissa, and green orange leaves, taken cold, morning and evening. Tea, coffee, warm beverages, onions, cabbage, and all excess in food must be avoided. Much flatulency re- quires valerian and fennel seed. Homoeopathic Remedies.—If caused by sexual excess, or loss of humors: calcarea, china, and nux v. ; in that which results from disorders in the abdominal functions, caused by excessive study and a sedentary life: nux v., sulphur, aurum, calcarea, natrum. (See Dyspepsia.) Hydropathic tr.—Spare vegetable diet, exercise, shower- baths, rubbing wet-sheet, foot-baths, enemata of tepid water, the wet bandage around the abdomen for months, are the principal means employed in the treatment of this disease. Eclectic tr.—(See Dyspepsia and Hysterics.) HYSTERIA--HYSTERICS. This nervous disease to which females are most liable, from their fourteenth to the thirty-fifth year, appears in paroxysms, and varies indefinitely as regards severity. The principal symptoms are: depression of spirits, anxiety, a sense of nausea or -icLness. flatulency., constipation, palpi- 11J MENTAL AND NERVOUS DISEASES. tation of the heart; pain in the left side, which seems to rise up to the throat, when it feels as if a ball were lodged there (globus hystericus;) alternate fits of laughing, crying, &c., without any assignable cause; sighing, fainting, even convulsions; coldness of the extremities; feeble pulse. The paroxysms are generally succeeded by pain in the head and back, and stiffness in the joints. In many instances the disease is imaginary. Causes.—Intense mental emotions; especially grief and anxiety; extreme nervous sensibility; suppression or derange- ment of the monthly periods; loss of blood; excessive sex- ual indulgence; tea; coffee; single life, etc. Treatment—During a paroxysm of hysteria, place the head over a basin, and pour water from a jug, over the head and chest till the patient becomes chilly and revives. During the intervals we must employ such treatment as will correct the condition on which the hysterical paroxysm depends. (See Indigestion, Amenorhcea. &e.) ILLUSION--HALLUCINATION — ALUS1A. In this affection the imagination overpowers the judge- ment. Morbid sentimentalism, manifested by every conceivable form of extravagant misjudgment, as rampant jesting, ecstasy, visions, belief in apparitions, or in some preter- natural endowments, etc. Causes.—Novel-reading, idleness, dyspepsia, etc. Treatment.—Regular and steady employment; reading useful and practical books; dieting. INCUBUS--NIGHTMARE. Feeling of a heavy pressure in the region of the stomach during the first hours of sleep, which impedes breathing and creates many images of fancy, as: flying men, dogs, bears, monsters, robbers, murderers, &c. The sufferer strives, often for a long time, in vain, to raise or move himself, or to cry for assistance, until he finally succeeds in uttering a cry of MADNESS. 113 anguish, by which he generally awakes, and the painful state terminates. Causes.—Cramp-like affection of the precordial nerves, originating in an overloaded stomach; accumulation of wind; rich and late suppers; congestions; lying on the back. Treatment.—Avoid and remove the causes. INJURIES OF THE NERVES. If a nerve is compressed, partly divided or wounded, par- oxysms of severe pain, shooting in the course of the nerves, violent spasms or palsy of the affected part, epilepsy, and other disorders occur. In complete division of a nerve, no serious inconvenience arises from it. Causes.—Blows; bruises; pressure upon nerves by the cicatrix of a stump after amputation, or by crutches upon the axillary nerves; venesection; &c. Treatment.—In case a nerve has been wounded and serious consequences follow, it should be freely divided. If neu- ralgia comes on in a stump while healing, it sometimes becomes necessary to open the wound afresh, and remove the cicatrix, or perform re-amputation. (See Neuralgia.) INSANITY--CRAZINESS—VESANIA--MADNESS. Mental derangement. Disturbance of the normal action of the mind. It is called madness (mania) when accompanied with rage, vigor, and fury; melancholy, with excessive gloom, sadness, mistrust, unsociability; idiocy, (imbecility) with entire loss or absence of the moral and Intellectual faculties ; frenzy, with fixed ideas, partial disturbance of the imagina- tion ; monomania, with derangement of the intellect on some one particular object. Insanity generally comes on gradually and in slight degrees. When the disease is periodical the diagnosis is very difficult. We must carefully distinguish a- mental disturb- ance, connected with fever, from insanity. Insanity is per- manent or periodical, and the cure is very difficult. It passes sometimes into other nervous maladies, as catalepsy, epilepsy, paralysis, &c. It may become epidemic or climatic, and 5e 114 MENTAL AND NERVOUS DISEASES. terminate fatally by apoplexy, consumption or dropsy. Causes.—Violent passions; fright; vexation; grief; envy; jealousy; anger; sorrow; masturbation; excess in venery; ambi- tion; unrequited love; disappointment; continued vexation; mental over-exertion; partial exertion of the mind; deep reflections upon mysterious religious subjects, scruples of conscience; fanaticism; obstructed menstruation; pregnancy; excessive heat; also: spirituous liquors, excessive use of opium, or mercury; mechanical injuries of the head, by a fall or a blow; metastases to the brain; suppressed hemorrhoids and cutaneous eruptions; atrophy of the brain; hydropic accu- mulation; or it may be hereditary. Among uncivilized nations it is an unknown disease. Allopathic treatment.—The first step is to remove the cause, and thereby restore the mental action to its normal state. In determination of blood to the brain, or in inflammations, local and general blood-letting is called for; in violent rage, purga- tives, tartar emetic, cold fomentations and affusions on the head are the proper remedies. Gastric accumulations, constipation, worms, flatulency, re- quire cream of tartar, helleborus niger, coloeynth and calomel. The most valuable remedies acting directly on the brain, and which have been found of much benefit, are: Digitalis in infusion and in large doses (thirty grains daily), belladonna, aqua laurocerasi, stramonium and camphor. In great excitement of the vascular system, digitalis with nitre (digitalis half a drachm, digest in as much spring-water for £ of an hour as will leave six ounces of clear liquor, add laurel water two drachms, nitre three drachms, a table-spoonful every two hours) cannot be too highly recommended. Small doses of tartar emetic should be given at intervals, and cold water applications made as the case may require. Opium is not appropriate in insanity causing constipation and congestion to the head. The proper psychical treatment must never be neglected and should be adapted to the peculiar symptoms of insanity MADNESS. 115 Obedience, even in trifles, must be strictly enforced. Exer* Mse in the free air, exact order, strict distribution of time$ agreeable impressions by music^ punishment and rewards) are curative means of vast importance. The attending phy- sician should inspire the patient with confidence; he should convince him that he is his friend. Finally, when all other means fail, the patient's thoughts must be directed to religion ; therefore, attendance at church, and conversation with a sensi- ble clergyman are advised. With raging individuals compulsory measures must be taken, of which the strait-jacket, and the darkness of a cushioned room are of great effect, thereby convincing the patient of hia impotency. Further, the proud must be humbled; the dejected raised; illusions of the imagination must be undeceived by entering into the hallucination of the patient and annihilating it by itself. Homoeopathic remedies. — In mania caused by depressing emotions: belladonna, hyoscyamus, nux v., and platina; if it be the result of excessive study: lachesis, platina, stramonium and nux v.; if caused by religious notions: lachesis, sulphur and veratrum; by sexual derangement in females: aconite, belladonna, platina, pulsatilla, stramonium and veratrum. Hydropathic treatment — The patient should be put upon a bland and simple diet, and a plan of derivative and soothing bathing. The tepid, shallow, hip and foot-baths are the lead- ing processes. Keep the feet warm, the head cool, and avoid all sudden shocks or strong impressions which would produce cerebral excitement. When the patient is manageable, the wetrsheet pack, followed by the dripping-sheet, is appropriate. Flesh, meat, coffee, tea, ardent spirits and tobacco must be strictly forbidden. Eclectic treatment.—Our intercourse with lunatics should be governed by the same laws that regulate our intercourse with society at large. In order to secure control over the insane as over the sane, we should present them with motives and ply them with solicitations. We should neither ridicule or 116 Mental and nervous diseases. laugh at their hallucinations. The insane companions of a patient should consist of those who were about his equals in society, in point of gentility and intelligence. It is of equal importance that his associates should not be afflicted with the same or analogous hallucinations. When the hallucination is such that it can be shown to be false or unfounded by a demonstration, or even true, apparently, and in such a man- ner as to be followed by relief, it may be attempted. ISCIIIAS — SCIATICA — COXALGIA. Rheumatism in the hip. A pain in the hip-joint, extremely Violent, extending upward to the back, or downward to the thigh, rendering pressure, walking, rising up or sitting down painful.—(See Rheumatism.) Melancholy.—(See Insanity^) Neuritis—Inflammation of a Nerve.—(See Ischias and Neu- ralgia.) NEURALGIA — NERVE-ACHE. The disease is recognized by acute, lancinating pains, along the course of one or more nervous branches of the organ or part affected, which recur in short paroxysms, with irregular intervals. Neuralgic pains, in almost all parts of the body, are, now a days, very common afflictions. Causes.—Dyspepsy; tea; coffee; alcohol; tobacco; excessive brain-labor; grief, fear; disappointment; colds; gout and rheu- matism; mechanical irritation by tumors, splinters of bone, wood, or a leaden bullet or shot. Treatment must be instituted according to the causes. Allopathists recommend: aqua laurocerasi, aconitin;hyoscy- amus, stramonium, belladonna (J to -| of a grain of the extract), douches, cold baths, and moxa; in periodical attacks, Peru- vian bark, quinine and iron, especially ferrum earbonicum, half a scruple twice a day; hot vapors, morphine and strych- nine used endermically. The bowels should be kept open by pills of Rhubarb and aloes. It is said that sea-sickness and journeying abroad will cure Neuralgia, entirely! Local means recommended are: Laudanum, opium and cam- NEURALGIA. 117 phor, tincture of Aconite, ointments made with the extracts of Stramonium and belladonna, a belladonna plaster, tobacco cataplasms, chloroform, ice, steaming with hot vapor, dry heat, blistering, magnetism, &c, Homoeopathic remedies.—Pains of irritable, nervous persons, require: Aconite, arsenic, chamomilla, china, coffea, ignatia, mercurius, Valeriana, veratrum; if affecting rheumatic indi- viduals, give: Aconite, arnica, bryonia, chamomilla, mercurius, nux v., pulsatilla, phosphor and rhus; if persons who have used much mercury: Arnica, carbo v., chamomilla, china, hepar, pulsatilla; if persons who have indulged in the exces- sive use of coffee: Chamomilla, coffea, ignatia and nux v.; if plethoric individuals: Aconite, belladonna, ferrum, hyoscy- amus, mercury, nux v., pulsatilla. — (See head-ache, tooth- ache, hack-ache, hip-ache, colic, etc.) Hydropathic treatment. — Obstructions of the bowels, skin, kidneys, and liver must be corrected. The local treatment should begin with gentle bathing in tepid or warm water, fol- lowed by moderate friction or hand rubbing. In some cases cold water is more agreeable and sedative than warm. Com- presses, half, hip, and foot-baths may be employed, followed by the half or full pack, dripping sheet, plunge, and douche, as the strength improves. Cases accompanied with rheumatic lameness and rigidity of the muscles require the warm douche, followed by the cold dash. Eclectic treatment.—The patient should be placed upon anti- periodics, among which the following are recommended: take Sulphate of Quinine, Prussiate of Iron, Hydrastin, equal quan- tities; mix, and give of this powder about four grains every four hours, in conjunction with the compound powder of Ipecac, and Opii, in the same doses, three or four times a day. Considerable advantage may be derived from the use of the compound Syrup of Stillingia and Iodide of Potassium in con- nection with the above means. The electro-magnetic battery applied to the affected nerve, and the local application of chloroform as well as the com- 118 MENTAL AND NERVOUS DISEASED pound cajuput mixture has been attended with the happiest results. In many cases the spirit vapor-bath and mild cathar- tics will be found beneficial. Belladonna, Arnica and Aconite have been recommended, and by the use of a saturated tinc- ture of the latter article, (in tbc proportion of one fluid drachm to eight ounces of water, a table-spoonful every hour) much good has been effected. Nervous consumption—Tabes nervosa. — (Sec Maiasmus ju- venilis.) NOSTALGIA—HOME-SICKNESS. Irresistible longing for home and friends. In long-lasting cases it will bring on indigestion and fatal nervous consump- tion. This disease is exceedingly rare in the United Slates! Treatment — The most effectual remedy is to return to home — "sweet home." In some cases minute doses of tartar emetic with camphor have proved serviceable Homoeopathic remedies.—-Capsicum, mercurius, phosphork acidum. PARALYSIS — PALSY — PARESIS. Abolition or diminution of the power of voluntary motion. It may affect all the muscles- of voluntary motion (general paralysis); or one half of the body, hemiplegia; when the two lower extremities are affected, it is called paraplegia] sometimes, only a single limb is paralyzed—local palsy; when sensation and mobility remain in some degree, paralysis is said to be partial. Generally the disease comes on gradually, an occasional sense of weakness, and troublesome but transient feelings of numbness, coldness, and slight convulsive twitchings being the leading admonitions. Palsied limbs shrink and become lifeless. Persons who work in quicksilver mines, at water- gilding, etc., are subject to local paralysis, called mercurial tremor; and an other variety, called lead, palsy, or dropped hand, attacks glaziers, plumbers, oil painters, enamel card' makers, etc. PALSY. 119 Causes. — Pressure upon the brain, spinal marrow, or any considerable nerve by congestion, metastases or abdominal irritations; enlarged or indurated liver or spleen; metallic fumes; tobacco and other narcotics; venereal excesses; divi- sion of a nerve; mechanical pressure caused by a ligature, tumor and induration; intense mental emotion, etc. Allopathic therapeutics. — Paralysis accompanied with or caused by congestion or inflammation, requires blood-letting, leeches, and anti-phlogistics. If mechanical pressure is the cause, it must be promptly removed; when it depends upon abdominal irritation, drastics are to be resorted to; when there exists metastasis, vesicatories and artificial ulcers are indi- cated; when debility is the cause, we must employ tonics and restorative remedies, as: all the ethers, nervines and balsams, valerian, camphor, moschus, serpentaria, wine, cinnamon, giv- ing them at short intervals. Externally the following means may be employed: friction and brushing of the paralysed parts; dry cupping; vesica- tories; mustard baths and mustard poultices; fomentations; ants-baths; mechanical shocks by riding in a carriage upon a rough road; shower-baths; placing the part in a fresh killed animal; woolen clothing, or wild-cat fur; warm-baths, steam and sweating-baths, malt-baths; electricity, galvanism, animal maonetism; psychical stimuli, as faith. &c. Homoeopathic remedies.—When paralysis occurs as a sequel of Rheumatism : Arnica, Ferrum, Ruta, Rhus ; in consequence of debility: china, ferrum, baryta; from a suppression of an eruption, or wonted discharge: sulphur and lachesis; from handling of white lead, or inhaling the fumes of lead: Opium and belladonna, or platina, alumina and nux v. In paralysis of the facial muscles: Belladonna, Graphites and Causticum; of the tongue: Belladonna, Opium, Hyoscyamus, Stramonium, Lachesis, Graphites; of the upper extremities: Belladonna, nux v., cocculus, lycopodium, opium, zincum, ruta; of the inferior extremities: cocculus, nux v., opium, stramonium, 120 MENTAL AND NERVOUS DISEASES. silicea and oleander. Electricity and Galvanism are likewise recommended. Hydropathic treatment. — For bathing purposes water should be employed as cold as can be borne without permanent dis- comfort. As a general rule, the baths should be of short dura- tion. In paralysis of one side, the ablution or dripping-sheet may be the most convenient general bath; the wet-sheet pack, followed by the plunge, is still better, when there is a good degree of remaining vitality. When the lower extremities are palsied, the shallow-bath is the best leading water process, and it may be aided by frequent hip and foot-baths. In all cases thorough friction by means of flannels, flesh brushes, hand rubbing, should follow the application of water. A moderate douche applied to the spine, and locally to the part affected is serviceable in most cases. Whenever the extremi- ties are paralyzed the wet compresses, well covered, should be constantly worn and frequently renewed. Cool injections are generally necessary daily. In paralysis of the urinary or- gans much drinking of water must be avoided. Eclectic tr. consists in improving the general health, and removing the causes of paralysis. Cups and scarification should be applied to the spine, followed by long and narrow irritating plasters directly over the spine where the cups were used. Small doses of Strychnine are also recommended. In this disease, among children, the stimulating liniment, men- tioned under Epilepsy, should be applied to the spine, and tonics given internally, with gentle stimulants, such as Myri- cin, Xanthoxylin, etc., and a nutritious and easily digested diet. Electric shocks are also beneficial. Prosopalgia. — (See Face.) Raphania.—An affection accompanied with spasm of the joints, trembling, etc., supposed to have been produced by eating the seeds of wild charlock. (See General Diseases.) Revery. — Absence of mind, mental abstraction, and brown study, are sometimes induced by bodily infirmity, but are more frequently the acquired habits, resulting from a loose, SYNCOPE — FAINTING. 121 irregular and superficial education. Intense study and over- whelming passion are not unfrequently causes of mental ab- straction. Sciatica. — ( Sec Coxalgia.) SOMNAMBULISM--SLEEP-WALKING. In the somnambulic state a patient can hear, speak, walk or perform other actions while asleep, but without being con- scious of them, and without remembering them when awake. It is the highest degree of dreaming. It mostly happens to sensitive children and youths, and wears away with advancing age. The full moon often exercises an influence on the pa- tients, thence they are called lunatics. Causes. — Too lively imagination during sleep; over-exer- tion of the mental powers before retiring. Other causes are the same as in Chorea. The same state may be excited by animal magnetism. Treatment — The best remedy to prevent the patient from walking while asleep, during night, is a tub, containing cold water and placed before the bed, into Avhich he is obliged to step when rising, and which awakens him. Abstaining from heavy suppers, intoxicating drinks, night-watching, close study, are important prophylactic remedies. The remedies recommended for the cure of Chorea and Catalepsy may be proper in some cases of Somnambulism. Sopor. — Deep sleep, with snoring and sighing; the patient cannot at all be roused. The highest degree of Sopor is ca- ms; milder degrees are coma and lethargy. It is generally an indicatian of great affection of the brain, hence a sign of typhus or cerebral inflammation; the worst when it sets in immediately from the commencement of the fever. (See Coma.) SYNCOPE — FAINTING. Loss of consciousness, sensation and motion; pulse and respiration diminished or annihilated. The forerunners of fainting are buzzing in the ears, sparkling before the eyes, 6 122 MENTAL AND NERVOCS DISEASES. and dimness of sight. Duration from a few minutes to several hours and days. Recovery is accompanied with a deep sigh. Causes. — Severe shocks; loss of blood; foul air; mental emotions; tight lacing; prolonged fasting; excessive fatigue; hysterics; worms; flatulency; passion; retrocession of cutane- ous eruptions; rapid evacuation of fluid accumulated in the cavities of the body; &e. Treatment. — Place the patient in a comfortable posture, admit fresh air into the room, remove tight clothes, especially corset-strings, and sprinkle a little water in the face. In the Banguineous syncope place the feet pendent, and raise the head and chest; warm foot and arm-baths, and cold applica- tions to the head and face, are of benefit. In hysterical per- sons the fumes of burning feathers, cut onion, vinegar or ammonium, held to the nose, are recommended. If all these means fail, the treatment of asphyxia must be resorted to. TETANUS. Painful, spasmodic contraction of many or all of the vol- untary muscles, with incurvation of the body, and difficulty of breathing. When the body is bent forward it is called emprosthotonos; when backward, epistholouos; when to one side, pleurosihotonos; when rigidly erect, erectus, &c. Teta- nus arising from a wound or other local injury, is said to be traumatic. Symptoms. — The extremities are firmly extended, the ab- dominal muscles contracted, the eyes fixed, the forehead drawn up into furrows, and the whole countenance is distorted; the skin is covered with a profuse perspiration. The symptoms are renewed by the least motion of the patient, or slightest touch of an attendant. Sometimes the tongue is darted spas- modically out of the mouth, and the teeth, spasmodically snapping upon it, lacerate it severely. In fatal cases, death is preceded by frothy or bloody mucus at the mouth, small pulse, and delirium. Causes. — Sudden exposure to cold when the body is over- heated: wounds, punctures, lacerations, or other lo.al brita- TETANUS. 123 tions of the nerves; the bad air of crowded hospitals; affec- tions of the spinal marrow7; violent passion; exposure to a very hot sun; strychnine, and intense galvanic excitement. The duration of fatal cases is from four to eight days. Favorable cases linger from one to ten weeks. Treatment allopathic —in. the treatment of tetanus it is necessary to discriminate carefully whether it is symptom- atical or idiopathic. In the first case the treatment is de- pendent upon the diseases of which it is a symptom. In inflammatory fevers, antiphlogistics and venesections; in gas- tric tetanus, Emetics, clysters of tobacco and Purgatives; in tetanus rheumaticus, Colchicum, Opium, Camphora, warm- baths; in putrid tetanus, musk and camphor, but no opium; in adynamic tetanus (caused by debility), musk, camphor, tincture of cantharides, opium, aqua laurocerasi, terebinthina; in metastases, regeneration of the suppressed disease. An immense amount of medicinal substances may be given with- out apparent harm. One case is on record of a lady who re- covered, in spite of her swallowing forty thousand drops of laudanum. Homoeopathic remedies.—In idiopathic tetanus Belladonna is the most important remedy. In some cases the alternate use of Belladonna and Lachesis, or Belladonna and Cicuta verosa, have been found necessary. In traumatic tetanus, Belladonna and Arnica have been principally employed. When patients cannot swallow, the proper remedy should be given in the form of an enema (a few drops of the tincture to an ounce of water). Hydropathic treatment must be directed to the removal of the primary disease; foreign bodies must be removed from the system, and suppressed diseases should be re-produced. During an exacerbation the shallow-bath, with prolonged and thorough wet-hand friction, must be persevered in for hours; cold affusions, and even the douche and cold plunging baths, may be employed, but the body must become thoroughly warm before we repeat any of these applications. Warming banda- 124 MENTAL AND NERVOUS DISEASES. ges to the parts affected with spasms must not be neglected. In mild cases the wet-sheet pack, the mild vapor-bath, the warm-bath, enemas, ice upon the spine by means of friction, have been found beneficial. Where an injury is the cause of tetanus, the wound must be kept moist with wet bandages, applied in the course of the nerve implicated. Eclectic tr.— Gelscminum tincture should be given, in doses of from fifteen to twenty-five drops, every fifteen to thirty minutes until the convulsions are arrested. To sustain the nervous system, and to prevent a recurrence after the exciting cause has been removed, Gelseminum and Quinine, in the proportion of three grains of the latter to fifteen drops of the tincture of the former, should be given three or four times a day. If there be any indication of the powers of the system giving way, it will be best to omit the Gelseminum and use the Quinine, Prussiate of iron and Hydrastin in as large doses as the circumstances will admit. In tetanus traumaticus, caused by wounds and especially by punctured wounds in the sole of the foot or the palm of the hand, the following treatment is generally pursued: Foreign bodies must be removed, the wound enlarged, and opiate oint- ment applied. Opium must then be administered by clysters, and rubbed on the spine and pit of the stomach; half a grain of it is to be taken internally, gradually increasing the dose to two grains. As soon as the spasm abates, the doses of opium must be decreased. If opium produces no effect, give Extract of Belladonna internally, and rub Ointment of Can- tharides on the back and chest. In desperate cases amputa- tion of the limb has been recommended. Eclectic treatment of tetanus traumaticus : Give large and repeated doses of the compound tincture of Lobelia (from half a drachm to one and two ounces) in warm water. If the patient cannot swallow, pour it in his mouth, and let it run be- tween the teeth. If no improvement follows, give the same medicine by the rectum, using a large syringe. The effect will be relaxation and prostration, with nausea and vomiting. TRISMUS NASCENTIUM. 125 After the first relief thus obtained, keep up nausea by smaller doses of the same remedy. Keep for twelve or twen- ty-four hours mustard to the spine. Caustic potash and emol- lient poultices should be applied to the wound for the purpose of exciting free suppuration. (See Wounds.) Trismus—Locked jaw. — Tetanus in which the effects are confined to the flexor muscles of the jaw or throat. In most cases the attack approaches in a gradual manner: a slight stiffness being at first experienced in the back part of the neck, together with an uneasy sensation at the root of the tongue, and a difficulty in swallowing; the respiration ia impeded, and a pain experienced in the pit of the stomach extending to the back, the countenance is pale, pulse small, bowels constipated; a stiffness also takes place in the lower jaw, which increases to such an extent that the smallest open- ing is unattainable. A termination is put to the sufferings generally about the fourth day in acute cases. Trismus nascentium. — Lock-jaw of children happens in the first days of life. The child cries, wants to suck, and ia not able; the milk is returned. The jaws are stiff and grad- ually close, the abdomen swells, the whole body becomes rigid, and death ensues by appoplexy. The disease is more common in warm climates and among the black race, than in the north and among whites. In some parts of the south one-half of the colored infants born, die of this disease, while scarcely a white child is attacked. Causes.—Vitiated milk; foul air; local irritation, especially from the navel string being too closely tied, accumulation of meconium; cold. Treatment allopathic—Remove the cause; then give an Emetic, and change the milk; employ, likewise, injections and warm baths; small doses of zinc, musk, and laudanum; and rub an ointment of oil of henbane, camphor, each half an ounce, and tincture of opium one drachm, into the jaws, spine and abdomen. Try also the ointment of cantharides on the back and chest, and injections with six drops of laudanum. 126 MENTAL AND NERVOUS DISEASES. Homoeopathic remedies.—Lachesis and Belladonna, if t^ta- nus is caused by a bad state of the milk. If cold has given rise to the disorder, Chamomilla, then Belladonna or Nux v.; when it can be traced to local irritation, Arnica internally and externally must be used. (See Tetanus.) TREMOR--NERVOUS SHAKES. Trembling may be local or general, of various degrees, from the lowest to the most violent; passing into convulsive, invol- untary motions of single limbs, as a continued striking with one arm or foot, so that the patients hit themselves. In some cases the shaking of the limbs or head appears similar to chorea. Causes. — Excessive use of brandy, beer, tea, coffee and tobacco; poisoning with mercury (shaking palsy), arsenic and lead. All persons exposed to mercurial vapors are liable to this disease. Treatment. — The causes require prompt removal; in other respects the treatment is the same as in all spasmodic affec- tions. Purely nervous species, having their seat in the spinal marrow, require Nux v., Zinc, Stramonium, Iron-baths, cold- baths, shower-baths, electricity with strong shocks, and leech- es to the spine, when there is sanguineous congestion. Trance. — (See Ecstasy.) Wounds of Nerves. — (See Injuries of the Nerves.) CHAPTER V. ■OUTA.VEOUS DISEASES. ACNE ROSEA--GCTTA ROSEA--GROG-BLOSSOMS—ITDER-BUDS. Purple, reddish-brown or copper-colored spots on the face, especially on the nose, somewhat elevated, imparting a sensa- tion of heat and slight burning. Causes. — Hard drinking; grease-eating; disordered biliary secretions; irregular menstruation; sexual excess. Treatment — The cure is difficult. It can only be accom- plished by removal of the causes, and by a sober and temperate life. Care must be taken not to use quickly repelling reme- dies, for they are apt to produce dangerous metastases. Allopathists employ the following wash: take of spring wa- ter one and a half pint, milk of sulphur five drachms, cam phor two drachms, mix, and moisten the eruption every night Homoeopathuis use in cases arising from drunkenness: Nux v.. Ledum, and Sulphur. If caused by sexual excess: Cal- carea, Phosphor Acid, and Sulphur. Other cases require-: Causticum, cicuta, ledum, lachesis, rhus and sepia. ANASARCA — DROPSY IN THE SKJ \ . Symptoms. — Cold and diffusive swelling or puffiness of the skin over the whole body, which pits beneath the pressure of the finger; around the feet and ankles the accumulation in- creases toward evening, and decreases during the night; urine i.- scanty and high colored. In some cases the skin is pain- fully distended, and assumes a shining appearance, which often becomes livid and discolored, and not unfroquently bursts in extreme cases. Causes. — Damp and ill-ventilated apartments, unwholesomo- food; intemperance; sedentary habits; repelled eruptions; ex- cessive loss of blood; suppressed evacuations and functional obstructions of the kidneys, skin, and lircr. 19- 128 CUTANEOUS DISEASES. Allopathic treatment — Anasarca of an acute character, caused by suppressed perspiration or cutaneous eruptions, calls for antiphlogistic treatment combined with diuretics and dia- phoretics, particularly Nitre with Digitalis, Squilla and Calo- mel. In dropsy of the lower limbs minute punctures above the knees have been made to draw away the water. Chronic Anasarca is owing to obstructions of the circulation of blond in the heart and the larger vessels. Mercury, digitalis, eme- tics, purgatives and diuretics are necessary to effect a cure. Homoeopathic treatment.—Principal remedies in the acute form: Helleborus, Bryonia, Phosphor, Arsenicum and Mercu- rius. The chronic form requires: Arsenicum, China, Colchi- cum, Mercurius and Sulphur. For Anasarca after Scarlatina, Measles, &c.: Helleborus and Arsenicum. When mortifica- tion threatens in consequence of this disease, Lachesis, Ar- senicum and Cinchona are given with good effect. Hydropathic treatment.—Restoration of the general health, and promotion of the tone and vigor of the system by cold baths followed by a good share of friction. The rubbing wet sheet, well wrung, and followed by a thorough rubbing over the dry sheet is a valuable remedy. Moderate showering and douching,—in case the patient is not too debilitated,—are also of great benefit. The diet must be of the dry and unconcen- trated kind, and water should be drank only to the extent demanded by actual thirst. Constipation, should be promptly relieved by tepid injections. The warm douche, or spray bath, followed by the cold dash or pail douche, is an excellent process when the swelling is tender and painful, and particu- larly serviceable if applied to the lower parts of the abdomen when the kidneys are torpid or obstructed, which is known by Bcanty or difficult urination. Eclectic treatment. — The spirit vapor-bath once or twice a day, according to the strength of the patient, until the accu- mulated fluid has disappeared. Internally cathartics should be given, among which the compound powder of Jalap and Senna with Cream of Tartar is the most valuable, in sufficient CARBUNCLE. 129 doses to produce an active hydragogue effect for two or three days, after which they should be employed in laxative doses. Or, the patient may be taking sufficient of the gin bit- ters to keep up a regular action of the bowels. If it is found not to act writh sufficient energy upon the urinary secretion, a decoction of peach and mullein leaves may be made, and taken in wineglass full doses three times in twenty-four hours. Ace- tate of Potassa and Iodide of Potassa may be given for the same purpose as before directed. When Anasarca follows an eruptive disease from a sudden cold, a thorough sweat should be produced by free draughts of decoctions of mullein leaves or parsley, aided by warm bricks wrapped in moist cloths. If these means are not suffi- cient the patient may take a wineglassfull, three or four times a day, of the cider and elder infusion, prepared by steeping half a pound of the fresh bark of common elder in two quarts of hard cider. Or the cream of tartar and rock candy may be given, while the most thorough course of general bathing should be instituted. After removal of the fluid the system must be invigorated by Quinine, Iron, Hydrastin, &c. Ban- dages should be applied tightly to the extremities, and kept moistened with cold water. CARBUNCULUS — CARBUNCLE--ANTHRAX--FURUNCULUS MA- LIGNANS—MALIGNANT BOIL. A livid, red swelling, attended with burning, smarting pain, followed by vesication, and readily running to gangrene; the ulceration appears in the forms of several fistulous open- ings, from which a thin, acrid, fetid fluid exudes. In the cen- tre of the tumor is a black core. It is most apt to form in the neck and between the shoulders. The disease is in many cases, attended by headache, thirst, foul tongue, languor, loathing of food, and sleeplessness. Causes. — Depraved or debilitated state of the constitution. Occurs, rarely, in any but aged persons Allopathic treatment.—Generous diet; wine; peruvian bark ; iron; opium; aromatic fomentations, to which may be added 130 CUTANEOUS DISEASES. camphor, arnica, and myrrh, are the principal remedies cm- ployed. When avcompaniod with vomiting, vertigo, fever, water. If the tip of the finger is long painful and tender without suppurating, it should be well penciled with lunar caustic. APover's powder at bed-time, with aperients in the morn- ing, are proper remedies. Homoeopathic remedies. — Mercurius, Hepar sulphuris. and Silicea, in repeated doses. The application of the north pole of the magnet, for a minute or two, to the finger, will often afford speedy relief. In malignant cases give Lachesis and Arsenicum. Hydropathic treatment. — On its first appearance the arm should be immersed in very cold water. This arm-bath should be prolonged and frequent. When discoloration of the skin indicates approaching suppuration, tepid, or even warm water to the inflamed part, with the cold elbow bath, will prove the most soothing treatment. Eclectic treatment. — Immerse the finger in weak lye, con- tained in a vessel which is placed upon a hot stove. Let the lye be heated gradually to as high a temperature as can possi- bly be borne, so that the part is quite "parboiled;" then take dry, pulverized clay one and a half ounce, camphor half an ounce, alcohol one pint, form into a paste, spread on a cloth, and apply it closely around the finger. It will need to be frequently wet with alcohol. Keep it on for several days. Steaming the hand over a decoction of wormwood, tansy, hops and dog fennel will relieve the intolerable pain. When diM-utient means fail, the caustic potash should be applied to that point where the swelling appears nearest the surface. Cauterize deeply, so as to kill the parts down to the suppurating tissue, and then apply a slippery elm poultice. In the course of twenty-four hours it will open of itself, fre- quently much sooner. If the pain continues after cauteriza- tion, the part should be immersed in warm water, or soap and water, and kept in until easy. ;>'.'If the pus be evidently near the surface, it would be proper i to. upon .with the lancet, GREASE-PON. 147 If fungus arise, it must be kept down with burnt alum, jowdered Sanguinaria, or the mild potash. The green salve is an excellent article to promote healthy action in the parts. The warm alkaline bath; an active cathartic of podophyllum and cream of tartar, and small doses of lobelia, will, in many cases, be of much service. GANGLIA — GANGLIONS. Encysted tumors, formed of a viscid, albuminous fluid, re- sembling the white of an egg, and varying in size from a pea to that of an egg. They are hard, globular, and without dis- coloration of the skin. They usually appear on the wrist, hand and top of the foot. Treatment. — Surgeons have resorted to compression, per- cussion, discutient applications, extirpation, and caustics. When the tumor is prominent and round, a simple incision will allow its contents to escape, and if dressed with a mode- rately tight compress, the wound will heal readily. Oblong and diffused ganglions may be punctured with a lancet, and the fluid pressed out. The use of irritants or caustics, to excite suppuration, is a method recommended by some authors. Gangrene white. — (See General Diseases.) GREASE-POX. It is asserted that the introduction in the human body of a portion of the sanious discharge from the heels of horses affected with the disease called grease, will cause the same effect as that from cow-pox. Dr. Jenner conceived the dis- ease of the horse to be the original one, and that the cow-pox in the cow is nothing more than a casual inocculation, pro- duced by the cow lying in a meadow, where the affected horse had been previously feeding. Blacksmiths and farriers who are infected by the grease, have been considered unsusceptible of variolous contagion. Gum Rash. — (See Strophulus.) Hands Chapped.— (See Rhagades.) Heat Eruption. — (See Eczema.) US ll'TANEOl S DISEASES. HERPES--TETTER--SALT RIIEUM. A chronic eruption of vesicles in small distinct clusters with a red margin. It is attended with itching or burning, and the vesicles concrete into scabs, and desquamate in the ctmrse of two or three weeks. It appears in one or several places, sometimes continuing to spread, even covering whole limbs. It presents several sub-varieties, as miliary, when the vesicles are millet-sized; corrosive, when the vesicles are hard and discharge an acrid, corroding fluid; shingles, when the vesicles spread in clusters around the body like a girdle; ring- worm, when the vesicles, which unite in small rings, are sur- rounded by larger concentric rings of different hues. The disease lasts for months and years, even through life. It is not infectious. Causes. — Peculiar corruption and abnormal condition of the skin; hereditary disposition; disease of the liver and acrimony of bile; scrofula; salted or fat food; lurking syphilis. Treatment. — Attend to the remote cause ; adopt a mild diet; avoid all kinds of heating food or drink, and live in a dry pure air. Allopathic remedies. — Dulcamara in decoction two to four drachms daily; crude antimony, one drachm daily with mag- nesia; artificial sulphur-water; corrosive sublimate in a de- coction of Sarsaparilla; graphites, one scruple daily; muriatic acid, ten to twenty-five drops, three times a day; baths, espe- cially of soap; etc. Local means employed in dry herpes are: fresh expressed nut oil; a solution of borax; lime-water; lime-ointment; weak sublimate water. To alleviate the itching or burning, spermaceti and almond oil, or cream, may be tried. In in- flammatory and painful herpes, the application of wet cloths, renewed often, are of benefit. Some of the worst suppura- ting herpes have been cured by frequent applications of fresh bruised leaves of beta alba or plantain. Tar, in the following form, has proved perfectly curative: One cup of tar, two yolks of eggs, and one cup of cream, mixed together and used twice a day. Lead should not be applied. SALT - RHEUM. 149 Homoeopathic remedies for dry, brany tetter are: Cicuta and Sulphur; also: Graphites, Kreosot, Mercurius and Thuya; for oozing, running tetters: Calcarea, clematis, coniuin, dulca- mara, graphites, mercurius and sepia; for burning and itching tetters: Arsenic, carbo veg., caustieum, fluor-ac, mercurius, rhus, staphysagria and sulphur; for herpes circinnatus (ring- worm): sepia and natrum m.; Jierpcs exedenss. lapsus (eating away flesh): Arsenicum, calcarea, graphites, lycopodium, sepia, staphysagria and sulphur. A decoction of Ruta graveolens (Garden Rue), applied ex- ternally, has proved of great benefit in dry tetter. Hydropathic treatment. — The pack, followed by the half- bath at 72°, with moderate friction, is one of the best leading processes. Any kind of washing, if sufficiently frequent, with a plain diet, will cure in due time. In all cases of irri- tation of the skin, unaccompanied with fever, tepid water is preferable to very cold for bathing purposes. It is also of importance to preserve a uniform temperature of body. When the itching or burning is unendurable, the full warm-bath may be occasionally employed. Wet compresses of soft linen, of such a degree of tempera- ture and moisture as is most agreeable to the patient's feel- ings, should be kept constantly applied to the affected parts. Eclectic treatment — Aperients should be occasionally ad- ministered, and an absence from all gross and indigestible food must be observed. A decoction of bitter-sweet (solanum dulcamara), taken in wine-glassful doses three times a day, has been employed with benefit. It may be prepared by making a quart of the de- coction from an ounce of the bark of the root. An ointment may also be prepared from the tincture of the same bark, and applied to the parts affected. In obstinate hereditary cases of long standing, good effects have been obtained by the employment of the syrup of stil- lingia and the Iodide of potassa. To allay the itching and smarting, emollient poultices; 150 CUTANEOUS DISEASES. water-dressings; alkaline washes; a solution of sulphate of dnc; equal parts of Iodine and Stramonium ointment; the recent juice of Bloodroot, etc., are recommended as external applications. Herpes Circinnatus (Ring-worm) ; Herpes Zoster (Shingles); Herpes Iris (Rainbow ring-worm). — (See Herpes or Tetter.) Hydrops Anasarca. — (See Anasarca.) Hives. — A species of chicken-pox. (See Chicken-pox and Orticaria.) HYPERAPniA. Great sensitiveness of the skin. Hypochondriac men and hysterical women, who are subject to acute and chronic erup- tions, suffer from pricking and itching of the skin. Treatment — A daily bath, and exercise in the open air. ICHTHYASIS — FISH-SKIN. A thick, indurated incrustation, of a dusky brown or yel- low color, sometimes covering the whole body, except the head and face, palms of the hand, and soles of the feet; and some- times the entire body, including the face and tongue. In some cases horn-like excrescenses sprout out of the incrusta- tions, and occasionally grow to the extent of several inches. Causes. — Morbid development of the cuticle; gross food; uncleanliness, kc. Treatment consists in purification of the system, and im- provement of the general health, by diet, exercise in the open air, and cleanliness. Mild oily substances, as Almond oil and Cacao butter, ap- plied externally to soften the horny skin; bran-baths, and minute doses of arsenicum have proved of benefit. Eclectics recommend the use of tar and pitch water and alkaline baths, &c. Icterus—Jaundice. — (See Diseases of the Stomach and Abdomen.) IMPETIGO. Humid or running tetter; yellow, itching, clustered pus- tules, terminating in a yellow, scaly crust. (See Herpes.) TOUCH-ME-NOT. 151 luduraiio tclec cellulosae.-—(See Erysipelas neonatorum.) Insects., bite of. — (See Poisons.) Intertrigo Infantum. — (See Exeoriationes.) IONTHUS--WHELK. This affection is a tubercular, unsuppurative tumor, gene- rally found upon the face. (See Acne.) ISC1IIDROSIS--ANIDROSIS. Suppression of the insensible perspiration of the skin. (See Colds.) Itching of the skin. — (See Prurigo.) Itch. — (See Psora.) Itch of Bricklayers and Grocers. — (See Eczema.) Lentigo. — (See Freckles, or Ephelides.) LEPRA — LEPROSY. Uneven, tumid, knotty skin, covered with thick, fetid crusts, and intermediate suppurating points; violent pricking and itching on different parts of the body. Its principal subvari- eties are the common or white leprosy, and the black leprosy, so called from the color of the scales which varies from a bright white to a dusky brown. Treatment — (Sec Herpes and Psoriasis.) LICHEN. Lichenous rash is characterized by a diffuse eruption of red pimples, with a troublesome and sometimes intolerable sense of itching or pricking. It gradually spreads over the neck, trunk and extremities. After ten to twenty-one days it becomes pale, the pustules change into crusts with redness of the skin underneath. Allopathic treatment.—-Emetics; mild cathartics; cooling, acid drinks; vegetable diet. Externally, applications of mild oily substances and fo- mentations of linseed and milk. Homoeopathic remedies. — Cocculus and dulcamara; also, ci- cuta, lycopodium and sulphur. (Sec Herpes.) LUPUS — NOLI-ME-TANGERE — THE WOLF--TOUCH-ME-NOT. A malignant disease, usually about the nose and mouth. 152 CUTANEOUS DISKASES. commencing as a small tumor, and progressing to a foul ulcer. Its first appearances are various, as a small dark sore, tuber- cle or vesicle; or a large, prominent wart. The lupus ulcer is known by a purple margin and depressed center, which ex- udes a tenacious pus, or an ichorus matter; the exposed sur- face has a fiery red appearance. When occurring near the eye, it will, if not arrested, destroy that organ, and may ex- tend to the brain. Treatment. — In the early stage, when the disease appears in the shape of warty excrescenses or tubercles, the knife or caustic may be employed indiscriminately. When it com- mences as a superficial red, angry sore, the mild caustic will be sufficient. When it has extended over a large surface, or penetrated deeply, the strong caustic must be freely applied. Homoeopathic remedies. — Lupus of the wing of the nose (herpes exedens), requires Staphysagria; also, arsenicuiu, calcarea, silicea, sulphur. MENTAGRA — SYCOSIS. A species of corroding Herpes. It is employed to denote round and irregular clusters of hard, red and painful little knots at the underlips and chin, or on the scalp, and on the bearded portion of the face. In the course of eight days they form into vesicles containing matter, which break and form in scurf, rendering shaving of the beard impossible. They are connected with unclcanliness, bad diet or drink, and may be cured by observing the laws of health. (See Herpes.) MILIARIA — MILIARY FEVER. A great number of very small, red, round pimples, resem- bling millet seed, on all parts of the body, especially on the chest; which are soon converted into white vesicles, and end in scurf. Lying-in women are peculiarly liable to this erup- tion. It also occurs at the turn of life. An eruption similar to that of miliary fever often appears in the course of other acute diseases, when the patients have been kept in hot, unventilated apartments. The eruption is T MEASLES. 153 preceded by febrile symptoms for five or six days; by profuse ■perspiration with a sour putrid odor; itching and burning of the skin; oppression of the chest, dry cough, stitches in the side, numbness and stiffness in the extremities, rheumatic pains in the limbs and teeth, low spirits, anxiety and restless- ness. Causes.-—Great weakness and colliquation of the cutaneous system; a rheumatic and catarrhal diathesis; too hot regimen ; lying on feather beds, and in ill ventilated rooms; hot teas, &c. Treatment. — Light covering, moderate temperature, pure air; cleansing of the primae viae; removal of feather-beds; tepid baths. Homoeopathic remedies.—Arsenicum, Ipecac, Bryonia; also, Aconite and Coffea. Hydropathic treatment — Hot or cold local applications, with frequent sponging of the whole surface, according to the de- gree of general heat. The bowels should be freely moved by tepid injections at the outset. WThen this fever has been pro- duced by the suppression of any customary discharge, warm hip and warm foot-baths are serviceable. Eclectic treatment — Wrhen it is idiopathic, very little treat- ment is required. An infusion of elder-flowers, maiden hair, &c., will be generally found sufficient, the bowels being kept regular. Recession of the eruption demands nauseants, dia- phoretics, and in some instances counter-irritation. MORBILLI —MEASLES. The mild form of this exanthem is called cowmen—-the vio- lent, malignant measles. The early symptoms resemble catarrh or influenza. On the third or fourth day the eruption appears, consisting of small red spots on the face, thence extending downward over the body. On the fifth or sixth day the bright red color changes to a brownish-hue, and in a day or two more disappears entirely with a mealy desquamation of the cuticle. The fever increases with the eruption, and is attended with cough, sore- ness of the chest, and oppressed respiration. 154 CUTANl'.oUS DISEASES. In the malignant form the eruption is paler and more irregular, often receding and re-appearing, and of a dark or livid hue. The febrile symptoms are more severe, the abdo- men is tender, the head is delirious or comatose, the lungs are inflamed, and diarrhoea and convulsions often occur. Putrid measles are accompanied with offensive discharges from the nose and throat. Measles are contagious, and affect the system only once. They have been inoculated, using the tears flowing during the efflorescent stage, or the blood from a morbillous spot. Causes.—A specific contagion. Therapeutics.—In a mild case of measles no medicinal treat- ment is necessary. Promote the proper development and evaporation of the virus through the skin, and prevent retro- cession and metastases by maintaining a uniform moderately warm regimen, and avoiding cold. Children should be con- fined to the bed for fourteen days from the commencement of the disease, and in winter for three weeks. Allopathic Treatment.—The cough, accompaning measles, is generally relieved by frequent drinking of water—gruel and barley-water, to which may be added oils and narcotics, (hyos- cyamus) if there exists great irritability. Gastric accumula- tion may be removed by emetics; inflammatory irritation by leeches. Measles of a nervous character require Arnica, cam- phor, serpentaria and senega. In metastases,calomel and vesi- catories answer best. The remaining cough requires a combination of sulphur with aqua laurocerasi and cicuta, Iceland moss jelly, &c. The eyelids, when inflamed, should be frequently moistened with a mucilage of sassafras pith. Homoeopathic remedies. — Aconite: Inflammatory fever, dry heat, redness of the eyes, headache with confusion and gid- diness. Pulsatilla: Catarrhal symptoms preceding and attending measles; cough with thick yellowish or white expectoration; gastric derangement; coryza. MEASLES. 155 Belladonna: Shooting pains in the throat when swallowing; dry spasmodic cough, worse at night; restlessness; severe inflammation of the eyes ; cerebral irritation. Bryonia: Eruption faiut, respiration oppressed, pain in the chest. Ipecacuanha: Oppression at the chest before the eruption is evolved; vomiting and diarrhoea; followed by Arsenicum, if no improvement takes place. Symptoms of cerebral disturbance require: Cuprum aceticum, Belladonna, Stramonium, Helleborus niger and Arsenicum. Pulmonic inflammation: Phosphor, Bryonia and Sulphur. Typhoid symptoms: Bryonia, Arsenicum and Phosphorus. Tenderness of the skin: Mercurius. Miliaria alba: Nux vomica. Burning itching rash: Arsenicum and Sulphur. Hydropathic treatment.—Nothing brings out the eruption so promptly and effectually as the wet-sheet pack, and at the same time moderates all the symptoms of violent disorder in the circulatory and nervous systems. When the eruption comes out full and free, occasional tepid ablutions are suffi- cient. When there is much soreness of the throat, several folds of wet linen, should be applied. Severe cough, pain in the chest, or inflammation of the lungs, requires the chest- wrapper, applied very wet, and well covered with dry flannel. Diarrhoea, when present, should be treated with cool injections. Eclectic treatment — In mild cases of the disease, gentle diaphoretics, such as chamomile, catnip, pennyroyal, thorough- wort, and alkaline washing of the skin to keep out the erup- tion, are sufficient. Should the eruption appear imperfectly, and there be much fever and other suffering, take equal parts of lobelia herb, thoroughwort, and seneca snake root, stir it into some hot water, and sweeten it; take in suitable doses. If the stomach is disordered administer an Emetic, and Ene- mas to relieve constipation. Purgatives should be avoided. Retrocession of the eruption requires: Wine, Capsicum, Porter with Quinine; nervous condition: Camphor and external friction. 156 CUTANEOUS DISEASES. MORPIONES — CRAB-LOUSE. Little insects, which are found chiefly about the groins, pubes and eye-brows of unhealthy persons, producing intolera- ble itching. Their removal is accomplished by embrocations of mercurial ointment, or by washing the parts with corrosive sublimate, (three grains dissolved in three ounces of Rose- water), three times a day. Cleanliness is a certain preventive. MORBUS MACULOSUS WERLHOFI--HJ3MORRIICEA PETECIIIA- LIS--LAND-SCURVY--PURPURA HEMORRHAGICA. Small or large, first red, then dark blue or black spots appearing spontaneously in a scorbutic looking skin. They do not change under pressure of the finger, and disappear without desquamation of the epidermis. The disease is accom- panied with bleeding of the gums, palate or nose and other hemorrhages; constipation; often bloody urine ; great prostra- tion ; no fever. The children in which this affection appeared were feeble and seemed starved and cadaverous. Post mortem examinations have exhibited petechial spots on the mucous lining of the stomach, intestines, surface of the heart, pericardium, pleura, bladder and kidneys. Causes. — Decomposition of the blood and weakness of the vascular system. Therapeutics. — Pure air, well ventilated apartments, fresh meat, green vegetables, horse-radish, mustard, &c, will aid in the cure of this disease. Allopathists recommend: Cinchona, Lemon-juice, Sulphuric and Phosphoric acid, Oak-bark, baths, and pure red wine. Homoeopathic remedies. — Bryonia, ledum, secale, rhus-tox., and sulphuric acid; also arsenicum and lachesis. Eclectic treatment—Tincture of muriate of iron well diluted with water should be administered internally, in doses suitable -to the age of the patient. The body may be bathed every day with a solution of salt in water, and the addition of cap- sicum, if more stimulant action is required. MOLE—NAEVUS MATERNUS. Brownish-red, violet spots, or wart-like elevations of various BULLAE. 157 sizes and figures, resembling strawberries, raspberries, mice, etc. They are often beset with hair aad last for life, Causes.—Mental affections of the mother during pregnancy. In some families they are hereditary. Treatment — Spongy, wart-like elevations may be removed by the ligature. In those called wine-stains, tatooing into the part a color corresponding to that of the skin has been successful. OEDEMA. A dropsical swelling of the feet, hands, scrotum and other parts, caused by an internal accumulation of water, or by colds, inflammations, rheumatism, local debility, abuse of Quinine and Arsenic, loss of blood, pregnancy, &c. Treatment. — Ascertain the cause and treat the disease accordingly. Allopathy employs in painful, hot oedema, leeches and cupping; in cold oedema: local vapor-baths, cush- ions of dry hops and absinth, linen rollers and scarification. Homoeopathic remedies. — Hot oedema: Aconite and Arse- nic. Cold oedema: China, Arsenic, and ferrum. Hydropathy recommends the cooling or warming bandages according to circumstances. Eclectic treatment—Irritating frictions, woolen garments, and warm covering. Panaritium. (See Felon.) PEMPHIGUS--VESICULAR OR BLADDERY FEVER--FEBRIS BULLOSA-—BULLAE. Yellowish and transparent vesicles, like those arising from a scald, with an inflamed base which feels itchy and prickly. Acute pemphigus is generally accompanied with fever which lasts several days; at the end of which the vesicles dry up or pass into ulceration. It resembles erysipelas bullosum. Du- ration from one to four weeks. Chronic pemphigus is unaccompanied with fever, and new blisters continue to form for months and even years. When the vesicles burst of themselves, they form incrustations of a pale, brown color. 158 CUTAN F.OUS DISEASES. Treatment allopathic—-When the blisters remain long, they ought to be cautiously opened by puncture, leaving the epi- dermis to protect the subjacent surface. Painful prickling and itching is to be relieved by fomentations of Rosewater and mucilage of Quince-seeds. Dover's powder may be adminis- tered internally. When they are of a gangrenous character, fomentations of Pcruvkn-bark, Lime-water, and Camphor will be useful. Chronic pemphigus caused by latent syphilis can only be removed by mercurial treatment, and Baths of Chloride of Lime (one ounce to a bath) and of Corrosive sublimate. Homoeopathic remedies. — Aconite, Cantharides, Rkus-tox., Dulcamara and Arsenicum. Hydropathic treatment. — Frequent sponging with tepid water, diet and improvement of the general health. Eclectic treatment.—Warm lye-bath with internal diapho- retics. Give enemas for constipation, and avoid cathartics. Dry powdered Elm-bark, flour, chalk, may be sprinkled upon the blebs. Pernioncs. (See chillblains.) PETECHIA. Spots of violet, brown, black, or of a red color and of differ- ent shapes, resembling flea-bites. They continue for an indefinite period, disappear without desquamation and occur mostly in typhus. Causes. — Extravasation of blood under the epidermis; de- bility; decomposition of the blood. (See Typhus and Mor- bus Maculosus Werlhofi.) PLEGMASIA ALBA DOLENS—MILK-LEG. White swelling of lying-in women. (See Diseases of Preg- nancy.) PHTHIRIASLS--LICE-DISEASE--CUTANEOUS VERMINATION. The whole surface of the patient is more or less covered with small bee which seem to emanate from the epidermis. Cause.-—T iicleanliness. ITCHING OF THE SKIN. 159 Treatment. — Soap-baths, change of linen, baths of corro- sive sublimate, and, in extreme cases, a solution of Arsenic applied externally, will, in most cases, disperse these trouble- some visitors. PITYRIASIS--DANDRUFF OR SCURF. Irregular patches of thin, bran-like scales, which repeatedly exfoliate and recur, without crusts or excoriations. (See Drandruff.) If this disease is distributed over the surface, the affected parts should be bathed with fresh olive oil, two or three times a day, to be followed by a warm alkaline-bath; avoiding all acids, fats, liquors, stimulants, and indigestible substances. PORRIGO — SCABBY SCALE — TINEA. An eruption of straw-colored pustules, concreting into yel- low or brownish crusts. Its subvarieties are the milky scall or crusta lactea, which chiefly affects infants at the breast; and the scalled head—tinea capitis—found mostly in young children, covering the head. (See crusta lactea and tinea capitis.) PRURIGO--PRURITUS--ITCHING OF THE SKIN. A nervous affection which sometimes assumes such a degree of violence as to allow no rest day and night. Causes.—Suppressed perspiration; suppressed menstruation; bilious and psoric acrimony; uncleanliness. Treatment allopathic. — Tepid or cold-baths, Russian steam- baths, cupping; a solution of borax or corrosive sublimate in rosewater used as a wash. Homoeopathic treatment. — Sulphur followed by Ignatia and Carbo veg.; also Pulsatilla, Mercurius, Nux V., and Arseni- cum have been found serviceable. When the itching is worse in particular places, and you cannot keep from scratching them until they bleed, rub these parts with fresh olive oil, so as to moisten the skin in the first place, and then dry it again by rubbing it slowly. Washing with brandy, or camphor and water is recommended. Hydropathic treatment.— Frequent ablutions; in severe cases the wet-sheet, lo'O CUTANEOUS DISEASES. Eclectic treatment—Apply locally sulphurous or alkaline lotions. Internally'inilk of sulphur in moderate doses, niglit and morning, for two or three weeks. Prickly heat.—(Sec Eczema.) Purpura hevmorrhagia. (See Morbus Maculosus Werlhofi ) PSORA — SCABIES--ITCH. An eruption of small, pointed vesicles, transparent at the summit, containing a watery fluid. They aj»pcar first between the fingers and on the hands (a characteristic symptom) and cause a violent itching, increased by the warmth of the lied and by rubbing. The eruption may spread over all the parts of the body, but confines itself most to the folds of the skin, and at the bend of the joints. Itch is contagious, unaccompanied with fever, and if left to itself may last for months, even years. There are several varieties of this disease, but it is difficult to distinguish their characteristic differences. Causes.—Peculiar contagion; uncleanliness; bad food or want of food; dampness and exposure to cold. The animal- cula (acarus scabei) discovered in pustules are not the cause, but the product of the itch. Therapeutics.—Suppression of the itch by external remedies is, and has been one of the most fruitful sources of dangerous and obstinate maladies known in the catalogue of medicine. Thus it can generate pulmonary consumption, dropsy, spasms, epilepsy, asthma, apoplexy, erysipelas, and innumerable chronic complaints. One remedy which is worthy of recom- mendation by all schools of medicine, is cleanliness of person and frequent change of linen, bedclothes and dress. Allopathic treatment.—During the first eight or fourteen days of the disease, when the contagion is still confined to the skin, sulphur-water, sulphur-ointment, or sulphur-soap (two parts of black-soap and one part of sulphur) rubbed in every eve- ning, and washed off with soap and water in the morning, for lour or five days, and, at the same time, one drachm of flores sulphuris taken daily, will remove it. The disagreeable odor DRY SCALL. I6l of the sulphur may be corrected by a few drops of the oil of bergamot to the ounce. Itch by infection in a healthy person requires the internal use of sulphur for several days, before an external application is safe. Washing the parts with a decoction of tobacco, and half a drachm of the decoction of sarsaparilla daily, internally, has proved serviceable. Homoeopathic treament.—At the commencement of the dis- ease, Sulphur, in a low trituration, may be administered night and morning for a week or ten days, but must be discontinued as soon as signs of improvement set in. In some cases the treatment is facilitated by the external application of tincture Sulphuris as a lotion. Kreosote largely diluted has been used externally with great benefit. Mercurius, Carbo v., Hepar, Graphites, Arsenicum, Rhus are indicated according to the symptoms of the case. Hydropathic treatment — Simple diet and cleanliness; thor- ough and frequent ablutions; perspiration in the wet sheet occasionally; well wrung bandages to those parts where the eruption is most evident, comprise the general remedial course. Eclectic treatment — Wash the entire surface of the body with a strong solution of soft soap, then place the patient in an alkaline-bath for fifteen minutes, containing a pound of Carbonate of Potash to twenty gallons of water, at a tempera- ture of 92°; the skin is then to be well dried, and the follow- ing ointment thoroughly rubbed in: Take Sulphur two ounces., Carbonate of Potash one ounce, lard eight ounces, mix. This treatment will effect a cure in three days. The compound ointment of Zinc externally, with internal use of Sulphur is generally sufficient to cure the most obsti- nate cases of itch. PSORIASIS—DRY SCALL. This disease consists in bright patches of continuous scabs, of' indeterminate outline, generally appearing in serpentine or tortuous stripes, and found chiefly on the back and face, but some times extending over the whole body. It is often 7g 162 CUTANEOUS DISEASES. attended with clefts or fissures in the skin, occurs at particular seasons of the year, and is considered contagious. (See Gro- cer's and Bricklayer's itch.) Treatment allopathic. — Simple, unstimulating diet, Diapho- retics, Sulphur-baths. In the inveterate form characterized by universal scaliness with a harsh, dry state of the skin and rhagades, a cure is difficult and tedious. Besides the above remedies, baths of wheaten bran, embrocations of Graphites with cacao-butter into the fissures, and, internally, Calomel and Ammonium Carbonicum are recommended. In obstinate chronic cases the preparations of arsenic are very efficacious. Fowler's solution, in the dose of from 3 to 5 drops three times a day, is generally employed, giving at the same time a pint of the decoction of dulcamara daily, and employ- ing warm mucilaginous baths. Homoeopathic remedies. — Psoriasis simplex requires: Lycopo- dium in repeated doses for four or eight weeks; and sometimes Bryonia and Rhus. In Psoriasis inveterata—besides the fore- going remedies—Sulphur, Sepia, Calcarea, Arsenicum, Gra- phites, Clematis, Oleander and Zincum, may be called for by the nature of the disease. Hydropathic treatment. — The long pack, from one to two hours — using two or three thicknesses of the wet-sheet, fol- lowed by a thorough rubbing with the dripping-sheet. Eclectic treatment.—The warm-baths must be used daily,and the following ointment applied locally: Take Benzoic acid two drachms, spirits of turpentine twenty grains, camphor ten grains, lard one ounce, mix; or, if symptoms of inflammation or irritation are present, the compound ointment of zinc will be found serviceable. The internal treatment should consist of alteratives and diu- retics, as the compound syrup of Yellow Dock and Iodide of Pot- assium,and the bowels kept regular, with a strict attention to diet. RHAGADES—CHAPS. The skin of the hands and feet becomes cracked at the 6CA&LET FEVER. 163 change of seasons, and is generally due to wet and cold, but also to general causes and dyscrasies. Allopathic treatment—Application of mild unctuous reme- dies, as almond soap, cacao-butter, deer's tallow and borax in combination with cosmetic washes. Homoeopathic treatment.—-Petroleum and Sulphur for rha- gades which manifests itself in winter; for that on the hands of those who work in water: Calcarea and Heparj or, Alum., Mercurius and Sarsaparilla. Hydropathic treatment. — Water-dressing; washing with cream or in tepid water with a handful of Indian meal or bran iu it. ROSEOLA —ROSE-RASH. A fed rash frequently met with upon the cheeks of children during dentition; in vaccination around the vesicle; in dyspep- sia and disorders of the blood, upon different parts of the body, Treatment.— Purify the blood, and all the secretions, by diet and cleanliness. Rubeola:, (See Measles.) RIIYPIA — RHUPIA — SORDID BLAIN. This eruption consists in broad, distinct vesicles, having a slightly inflamed base, and filled with a sanious fluid, which often produces gangrenous and offensive eschars. Treatment.—(See Herpes.) Salt Rheum. (See Tetter.) Scabies. (See Psora.) SCARLATINA — SCARLET FEVER. This eruption appears in three distinct forms: 1. Scarla- tina. 2. Scarlatina anginosa. 3. Scarlatina maligna. Simple scarlet fever.—Symptoms: fever with headache, deliri- um, quick pulse, photophobia, sore throat, restlessness, nausea or vomiting, thirst and general sickness. About the second or third day, large, scarlet, smooth spots appear on the face and neck, and in the throat, spreading gradually over whole limbs with a uniform redness, and terminating about the seventh day from the beginning of the fever. After this the cuticle peels off, 164 ulTANEots diseases, at which time the mucous membranes are more or less affected. The eyelids, edges of the tongue, nostrils and palate exhibit a bright red color, the tonsils are enlarged, and there is diffi- culty in swallowing. Angiii'ise Scarlet fever. — Dejection of niiad, pain in the head, soreness and stiffness of the muscles of the neck, hoarse- ness, difficulty of swallowing, hurried breathing interrupted by frequent sighing, breath hot, great heat of the surface, weak «md frequent pulse. On the third day;, the face, neck and breast appear redder than usual, or scarlet patches appear about the nose and mouth. The submaxillary glands are en- larged and painful, and specks and collections of thick mucus are observed about the mouth and throats In a few hours an intense redness prevails over the whole body, which is per- fectly smooth to the touch. On the fifth or sixth day the deep scarlet is succeeded by a brown color, and the skin peels off in small scales. The malignant form is known by the name of putrid sore throat. It is distinguished by intense inflammation of the throat at the outset, soon proceeding to deep ulceration and extensive sloughing. The salivary glands are enlarged, the eruption appears irregularly, often disappearing suddenly, and the general symptoms are indications of the putrid form of typhus fever. Scarlet fever may be distinguished from measles by its smooth surface, and by the absence of cough, sneezing and lachrymation. Scarlatina is contagious; it occurs but once in the same in- dividual, yet, like all other eruptions, may attack a person a second time. It is one of the most malignant and deceitful of all maladies. Death is most generally caused by inflammation of the brain, or angina. Causes. — An atmospheric contagion, which is afterward communicable from one person to another. Treatment allopathic—In mild cases, remaining in bed for SCARLET FEVER. 165 three weeks in order to prevent metastases, a solution of solu- ble tartar with small doses of antimonial wine to keep the bowels open, and lemonade or sugar water, will be all-suffi- cient. When the disease is more violent, and there is danger of approaching inflammation and corruption, it should be sub- dued as quickly as possible. Give chlorine water daily, two or three drachms for children, and the same number of ounces for adults, diluted in water and agreeably sweetened. Exter- nally use quick ablutions of cold water, which may be repeat- ed every two or three hours. Bleeding is improper. In youth- ful plethoric subjects, leeches may be applied. Sopor and delirium require cold fomentations to the head, and repeated affusions of the head with cold water. Angina calls for gargles of an infusion of elder-flowers, ciaiiows, capsicum, solutions of alum, nitre, &c, and flan- nel around the throat; when it is Intense, leeches and sinapisms must be applied. Gastric complications in the first stage require emetics and cathartics. During the period of desquamation, the patient must be confined to the bed and house for four weeks. Should symptoms of dropsy make their appearance, calo- mel (one, two or three grains, according to age)combined with jaSap and digitalis; Juniper-berry tea and warm baths are required to procure absorption and secretion. If there are symptoms of violent inflammation, recourse must be had to a venesection, nitre with cream of tartar, squilla, and other antiphlogistic means. Greasing the whole surface with a piece of fat bacon every morning and evening has been recommended. Diarrhoea and other affections which set in must be treated as if they were original. As a preventive, one grain of well-prepaTed extract of bel- ladonna, dissolved in half an ounce of cinnamon water, of which five drops may be given daily to children of five years 166 CUTANEOUS DISEASES. of age, increasing the dose one drop for every additional yeafy has been used with great success. Homoeopathic remedies.—Jn scarlatina, with a smooth, glos- sy surface, Belladonna is a specific remedy. Even in severer forms, with an ulcerated sore throat, delirium, inflaunuation of the air passages, Belladonna is a valuable remedy* Aconite is indicated when the following symptoms present themselves: Bilious vomiting, dry heat, congestion in the head, dry, painful cough, Arsenicum: Exhaustion and emaciation, burning heat, dis- torted features, restlessness and sleeplessness, gangrene of thet throat. Dropsical affections succeeding scarlet fever. Capsicum: Extreme redness of the face, alternating with paleness; slimy saliva in the mouth; violent sore throat; con- traction or spasm in the throat; accumulation* of tough mu- cus in the nose and throat. Mercurius: Inflammation and swelling of the tonsils,, saliva- tion, ulcers In the mouth. Muriatic acid: Malignant scarlet fever, irregular and faint efflorescence which changes to a dark red color, often inter- mixed with petechiae; ulcerations of the tonsils and adjoining parts with sloughs; fetid breath; acrid discharge from the nose, with soreness, chaps and blisters about the nose and lips. Phosphorus: Loss of speech and hearing, excessive falling off of the hair. In some instances, Ammonium c. has been administered with benefit. Angina (sore throat) requires: Belladonna, baryta c, and mercurius; putrid sore throat: Arsenic, lachesis and carbo v.; tenesmus and strangury, conium; pulmonary spasms, ipecac. and belladonna; sleeplessness, aconite or coffea; deep, heavy, comatous sleep, opium and belladonna; repercussion of the eruption, bryonia and phosphor; laryngitis, aconite, spongia and hepar; typhoid symptoms, ammonium c, arsenic, phos- phoric acid and secale; dropsical affections after scarlatina SCARLET FEVER. 167 helleborus, arsenic, bryonia and rhus; inflammation of and running from the ears, belladonna, hepar or pulsatilla; deaf- ness, belladonna, pulsatilla, dulcamara and sulphur; boils, arnica, followed by bryonia and sulphur; sore throat, nitrio acid and belladonna; parotitis, mercury, carbo v., calcarea c, and kali c; Scarlet rash, aconite, belladonna, dulcamara and sulphur. Hydropathic treatment. — The mild form requires occasional ablutions of tepid water, or the wet-sheet pack, if the fever is high, once or twice a day, with a free injection of warm water to clear the bowels. The anginose and malignant forms require careful manage- ment. Employ the wet sheet and ablutions as already stated. The feet must be kept warm, whenever the pack or any gene- ral bath is resorted to. In the anginose form, the swelling must be treated with the constant application of cold wet linen cloths, well but loosely covered. In the putrid form, the coldest water, or pounded ice, should be frequently applied around the neck, and sips of iced-watev, or bits of ice, occa- sionally taken into the mouth. Whenever diarrhoea attends, employ cold enema. Be careful and not disturb the stomach and bowels during the eruptive effort. If there is sickness or nausea, apply very cold compresses to the abdomen. Rest- lessness, anxiety, delirium, or headache may be best relieved by a hot foot-bath, with a cold compress to the head, or if the patient is able to sit up, a warm hip-bath. No slops or food should be given. In case of recession of the eruption, we must resort to cold affusion, to be continued a minute, or must plunge the patient three or four times into cold water. As soon as the skin is excited to action, affusion is not to be repeated until its bene- ficial influence has ceased, which will generally be in eight or twelve hours. In dropsical affections after scarlatina, the patient should sweat for an hour, once every day, and should remain in a state of gentle perspiration during the whole day. 168 CUTANEOUS DISEASES. Eclectic treatment. — A mild, vegetable emetic should be repeated daily, for three days. Purgation of any kind is in- jurious; simple enemas may be used to evacuate the bowels. After the action of the emetic, the body should be bathed with weak, warm lye-water, followed by the spirit vapor-bath, or better the free use of catnip, balm or sage tea. The lye- bath must be repeated often, especially in severe forms of the disease. In order to bring the deep-seated inflammation of the neck to the surface, camphorated soap-liniment should be applied three times a day, followed by a slippery elm. poultice. Afterward a diuretic, consisting of equal parts of the root of althea officinalis and apium petroselinum, may be drunk freely. In the malignant form of scarlatina, the treatment above named must be energetically persevered in. For ulcer- ation of the throat the following gargle may be employed several times a day: Take black pepper one drachm, salt one drachm, boiling decoction of hydrastis can. four fluid ounces; mix, and allow it to stand fifteen minutes; then add four fluid ounces of vinegar. With this the mouth and throat must be frequently washed with a swab, or gargled. When the low typhoid symptoms appear, stimulants and tonics must be resorted to, with generous, nourishing, and easily digested food. J Some eclectic practitioners recommend very highly the use of belladonna, administering the extract of the same every two hours, to a child eighteen months old, in ten drop doses of a solution of two grains to the ounce of water, of a good and tested article. In great debility an infusion of wild cherry bark, in wine-glassful doses three times a day, will be found val- uable. Shingles. — (See Herpes.) Steatoma. — (See Tumors.) STROPHULUS — RED-GUM — GUM-RASH — TOOTH-ERUPTION. This cutaneous disease, peculiar to infants, consists of pim- ples .on the face, neck, arms and loins, generally in clusters, TUMORS. 169 Burrounded with a reddish halo. Children who have this eruption are subject to scrofula in after years. Causes. — Teething, derangement of the digestive system; colds. Treatment.—Regulation of diet, equal temperature, clean- liness, and correction of the derangement of the digestive apparatus. Sweat morbid. — (See Ephidrosis.) Sycosis menfi. — (See Mentagra and Herpes.) Tinea capitis — Scald head. — (See Crusta lactea and Por- rigo. TUMORS. Every tumor is a morbid swelling or a new formation. The common caises are injuries, as pressure, blows, bruises; capil- lary obstruction induced by unhealthful food and drink, and neglect of cleanliness. In their incipient stages they can be removed by strong douches, cold compresses, and continued compression. Tu- mors are known as adipose, cellular, fibrous, cartilaginous, osseous, encysted, fungous, indurated, scrofulous, malignant, pulsating, vascular, etc., according to the structure affected, and the form, character and consistence of the swelling. Adipose, or fatty tumors, are collections of fatty matter en- closed in a cyst or sac of condensed cellular tissue, which renders them also encysted tumors. When filled with a suet- like matter, they are called steatomous; when containing a honey-like substance, melicerous; and when their contents nre a pap-like fluid, aetheromatus. They are softish, painless tumors of slow growth. Treatment. — They are easily removed by making a T inci- sion through the skin, and carefully dissecting around them to detach the cysts from the surrounding structures. They may also be removed by the "eight-tailed ligature," two needles being drawn through the under side of the tumor, touching each other at right angles, and each carrying a dou- ble ligature; the loops are then cut, and the ends tied in 170 CUTANEOUS DISEASES. four knots, by which the tumor is completely strangulated. These tumors do not re-appear after having been entirely re- moved. Fibrous tumors are composed of capsules of greater or less density, inclosing yellow or whitish substances, divided into lobes by cellular substance, their shape is irregular, and they have a doughy consistence. They are not painful, and arc easily removed by the ligature or knife, being almost always situated in accessible places. The fibrinous contents of these tumors adhere so loosely to their capsules that they can readi- ly be removed by the finger or forceps on making an incision through the skin. Cellular tumors are smooth, firm, and composed of com- pacted layers of areolar tissue, containing, in thin cells, albu- minous, fibrinous and sebaceous matter. They are never painful, except when inflamed. The cutaneous veins involved in the tumors may become varicose, and when abrasion occurs, sloughing and fungous growths are apt to follow. Excision with the knife is the best treatment; but when the sloughing takes place, the mild caustic is necessary; and the strong caustic when fungous appearances present. Vascular tumor, sometimes called Aneurism by anastomosis. It is a complete net-work of vessels. Some suppose it is caused by arteries opening into the cellular interstices, giving rise to corresponding veins. When this tumor forms just beneath the skin, it can be readily distinguished by the exter- ternal appearance; but when it occurs beneath the fascia?, the diagnosis is very obscure for a long time. Treatment — Wounds, or incisions into these tumors, are very troublesome, as it is almost impossible to arrest the hem- orrhage, they being generally situated about the eye, head or face. The proper plan of treatment contemplates the de- struction of the morbid congeries of blood vessels, in such a manner as to avoid hemorrhage. Repeatedly puncturing the part with hot needles, and the repeated applications of caus- tic, a small part of the surface only being touched at once, ULCERS. 171 with constant but moderate compression, have each succeeded in removing them. Tumors or* tendon and ligament. — (See Ganglia.) The character of the other varieties is sufficiently indicated by their names. Homoeopathic remedies. — Hard swellings require: Baryta, carbo a., carbo veg., conium, jod, kali c, or bryonia, chamo- milla and sulphur. Steatomota require: Baryta c; Ganglia: Arnica and Rhus. Cold swellings without inflammation: Belladonna, calcarea, dulcamara, mercurius and sulphur. ULCERA — ULCERS. Ulcer is a solution of continuity in any of the soft parts of the body, attended with a secretion of pus, or some kind of discharge. The functions of the diseased parts are more or less impaired, and the patient suffers from pain, restlessness and debility. As soon as the healing process commences, healthy granulations form, which present a florid color, and have a pointed shape. The matter secreted is altered to a thick, cream-like fluid (healthy pus), not adherent to the granulating surface. These granulations do not rise higher than the surrounding skin, and when they have risen to a level with it, they are converted into new skin. Causes. — Wounds; bruises; burns; abscess; bad condition of blood; unwholesome living. Therapeutics. — The only treatment required in healthy ul- cerations will be a little dry lint, or the water dressing. If the granulations are too luxuriant, they may be touched with lunar caustic, and dressed with dry lint; or the sore may be exposed to the air for several hours. When the ulcer presents a sharp, jagged and undermined appearance, with no distinct formation of* granulations, bleeding when dressed, and dis- charging a thin and acrid humor, the application of lint dipped in and kept constantly wet with cold water, is a highly useful form of dressing. If the granulating surface is very extensive, or if all the applications disagree with it, it will be 172 CUTANEOUS DISEASES. expedient to form a scab on its surface by sprinkling a little flour, calamine or chalk to absorb the pus. But the best plan is to pass a stick of lunar caustic over the surface of the sore. If pus afterward continues to be formed, a small hole should be made in the middle of the scab to let it out. Inflammatory ulcers. — When there is a high degree of heat in the affected part, it should be treated with water dressing, or poultices, leeches in the vicinity of the sore, keeping the patient at rest, and clearing his bowels every day. Irritable ulcer. — The granulations are spongy and morbidly sensitive; the affected parts are tender to the touch; extremely liable to bleed; the edges of the ulcer ragged and everted, and its color is dark or purplish. Treatment consists in the application of mild stimulants; weak lotions of nitric acid, of sulphate of zinc, sulphate of cop- per, lime-water, strong green tea and charcoal mixed with cream, moderate pressure with a smooth piece of sheet-lead, oint- ments of lead, weak mercurial ointment. Indolent ulcer,is characterized by deficiency of action and power. Its edges are inverted, rounded, thick and glossy; the granulations are of a dull, pale aspect, and insensible; the pus is thick, of a dark yellow color, and adheres to the bottom of the uicer. It is most frequently located on the lower extremities. Treatment. — Improvement of the general health by diet and bathing. Local applications should be lint, thoroughly soaked in the nitric acid lotion, covered with a warm soft poultice. These applications should be changed thrice a day, and continued till the discharge becomes healthy and granu- lations begin to arise. Afterward, strips of adhesive plaster should be applied two-thirds round the limb, from an inch be- low the ulcer to an inch above it, and in applying each strip the edges of the sore should be drawn together. Fistulous ulcers consist of a narrow channel (like a goose- quill), lined by a pale pseudo-mucous membrane, which may or may not lead to a suppurating cavity. They are produced ULCERS. 173 when abscesses are not thoroughly healed, or when there is some cause of irritation, as a ligature, or a piece of dead bone. Treatment.—-Remove any source of irritation, and prevent lodgment of matter. The next indication is to produce ad- hesive inflammation by stimulating injections, the caustic bougie, or a seton consisting of a few threads of silk, which may be passed through the fistula, and may be gradually di- minished as the passage contracts. If these means fail, the fistula should be slit up with a bistoury, and then a thin piece of lint be introduced, in order to prevent premature union of the cut edges. Varicose ulcers occur in consequence of a varicose state of the veins of the lower extremities, and are generally situated above the ankle and below the knee. They are indolent and painful. Treatment must be suited to the condition of the ulcer. Opening one of the enlarged vessels and abstracting a moder- ate quantity of blood will afford great relief. Support, by the roller, or a laced stocking, is necessary. When the veins are extremely distended and knotty, adhesive straps may be applied over and adjacent to the ulcer; and these may be cov- ered by the roller. Cauterization of each distended vessel with potassa fusa, one or two inches distant from the ulcer, so as to obliterate their cavities by adhesive inflammation, may be resorted to in bad cases with safety, and usually with success. Sloughing ulcers require applications of warm fomentations of poppy decoction; poultices of yeast or carrots; or the ni- tric acid lotion on lint, with a warm poultice over it. Phagedenic -ulcers.—An ulcer which spreads, and, as it were, eats away the flesh. The surface of the sore is irregular, the discharge, serous or bloody, and the pain extreme. Some cases are attended with fever and inflammation, the edges of the sore being red, swelled and painful, others with atony and debility, the margin being pale, or livid. 174 CUTANEOUS DISEASES. Causes. — Constitutional disorder; intemperance; abuse of mercury; measles; scarlatina; scrofula; syphilis. In its worst form it is called Sloughing Phagedoena, or Hos- pital Gangrene engendered by crowding together a large num- ber of sick and wounded men. Treatment consists in destroying the diseased surface and its secretions by caustics, and in improving the general health by diet, ventilation, and cleanliness. When it affects the mouth or genitals of children, constituting cancrum oris, noma, etc., the application of pyroligneous acid will be found most efficacious. Homoeopathic treatment of ulcers. — The most important remedies in the treatment of ulcers are: Arsenicum, Carbo v., Lachesis, Mercurius, Sulphur, Silicea, Sepia, and Lycopodium. In administering the remedies it is best to dissolve a drop or two of the tincture in a pint of soft pure water, to which a ta- ble-spoonful of spirits of wine has been added, a tablespoon- ful or tea-spoonful to be taken daily for eight days or longer. W7hen the ulcer is inflamed or very painful, a soothing effect is often derived from the application of linen dipped in warm water, or in weak tepid lye-water. When the ulcer presents a sharp, jagged appearance with no distinct formation of granulation, and bleeds on being dressed, the application of lint dipped in, and kept constantly wet with cold water is, as in all other ulcerations, a highly useful form of dressing. Varicose ulcers require: Arnica, Pulsatilla, Lachesis, Sul- phur and Silicea; inflamed: Aconite, Arsenicum, Mercury, Hepar, Silicea; gangrenous: Arsenic, Lachesis, Silicea, Cin- chona, Belladonna, and Conium; phagedenic; Arsenic, Silicea, Mezereum, Hepar, and Sulphur; fistulous: Sulphur, Silicea, Calcarea, Lycopodium, Pulsatilla, and Antimony; syphilitic: Mercury, and Nitric Acid; mercurial: Hepar, Nitric Acid, Aurum and Carbo v.; irritable, (painful, bleeding readily): Arsenic, Lycopodium, Hepar and Mercurius. The remedies administered internally may also be used in lotions externally. Hydropathic treatment. — The whole skin must have, at least, ULCERS. 175 one thorough daily ablution or .packing. Strict diet is also necessary. The locsl medication will vary according to the character of the ulcer. The healthy ulcer needs nothing more than a cool wet cloth. When the irritable ulcer is very painful, the limb or surrounding part may be ibmeuted with warm cloths until it becomes easy, and then done up with the ordinary water dressing. When exposure to the air aggra- vates the pain, the surface may be covered with flour. Eclectic treatment.—Healthy ulcers require nothing but the simple water dressing (cool or warm), or a carrot poultice. Irritable ulcers require a soothing treatment, warm poul- tices, fomentations of bitter herbs (those ox hops or poppy leaves) repeated two or three times a day. One of the best poultices is made of the roots of the common carrot, bruised and roasted,—or grated and wet in scalding water, and then allowed to cool. If these means fail, lint dipped in laudanum may be added, or the poultice m;iy be wet with a strong infu- sion of lobelia herb. Never compress this kind of ulcer, so long as it remains irritable. Gentle aperients, diaphoretics and the daily use of the alkaline bathing or sponging must be employed as circumstances require. Indolent ulcer,—To remove fungous or callous growth, apply the mild caustic, keeping it-to the part by means of a poul- tice. It should be washed off with a weak solution of saler- atus. If the parts around .the ulcer are hard, it may be well to cup and scarify them; hot fomentations will aid in this pro- v luxury in eating and drinking, especially by the immoderate use of wine and coffee; excess in venery; damp, cold atmos- phere, moist dwellings, laboring in water, colds and rheuma- tism ; suppressed habitual hemorrhages, as that of piles, and cessation of the monthly period; a hereditary disposition; frpp indulgence in animal food. Treatment.—Acute gout: considering this form of the disease as a crisis, all external as well as internal applications must bo hazardous, as they only disturb nature in her beneficial work- ings,—therefore, cold water, camphor, abstraction of blood, poultices, emetics and cathartics, wine of colchicum, etc., will either suppress the vital action (inflammation) in the affected part and cause retrocession to noble parts, or create local weakness, causing the arthritic matter to remain in the affected joint, and thus produce stiffness, anchylosis, and even sup- puration. Allopathic treatment.—In violent inflammation, and when the patient is very plethoric, the fever violent, the affected part very red and hot, nitre and sal ammoniac, along with tartar emetic, and a venesection, or local abstraction of blood is needed. In gastric complication cathartics and emetics, espe- cially when used previously to the paroxysm, are of benefit. In violent pains, without any great inflammation, extract of hyoscyamus diluted with water to the consistence of ointment, may be applied tepid to the surface; if this affords no relief, mix it with pure opium, or camphor, or take a dose of Dover's powder in the evening. When the fever ceases, but the pains and local affection continue, Guajacum should be administered in the following prescription: take of guajacum and gum arabic, each two drachms, distilled water six ounces, make an emulsion, and then add nitre one drachm, syrup one ounce, antimonial wine one drachm,—a table-spoonful every two to four hours. Chronic govt.—The treatment of this form of gout consists in dieting, or rather hungering, and in producing a crisis by .GOUT. 195 art, as nature effects in the acute form. In order to neu- tralize and destroy gouty matter, Guajacum should be admin- istered as directed above; also lime water, ammonium; sulphur and sulphuric baths; corrosive sublimate; sarsaparilla; colchi- cum; baths of ants, of salt, or mineral springs; pills combined of sulphur, iron and quassia, have prove efficient. Likewise: vesicatories applied near to the affected part; cupping; anti- monial and mercurial ointments; steam and Russian baths; oiled silk cloth; cat-skin; wool, etc. To prevent attacks of gout, avoid intemperate eating and drinking, and excess in venery; take strong exercise; live in a warm dry, airy house, and exchange a cold for a warm cli- mate; promote the secretion of the skin by cold or warm baths, (especially sea-baths), and keep the bowels open by enemas. Sulphur and Guajac in the following form: take of guajac half a drachm, milk of sulphur ten grains, golden sulphuret of antimony two grains, citron candy half a drachm; mix and divide in three powders; should be taken every month for four or six days, in such doses as will cause two stools a day. Homoeopathic remedies. — Antimonium crudum, when the attack commences with nausea and vomiting; when wdth much fever. Aconite; with shivering and creeping chills, Pulsatilla; when the pains are in the big toe, Pulsatilla and Arnica; when in the heel, Cannabis; when in the foot, knee and calf of the leg, Bryonia; when the entire foot is painful, Rhus tox.; wandering gout, Pulsatilla, Arnica, and Nux v.; for gouty nodes and lumps, Antim. c, Calcarea c, Graphites, Lycopo- dium, Phosphorus and Sepia; for gout caused by much expo- sure to water, Dulcamara; when it affects the stomach, Anti- mony and Nux v.; when it affects the heart, Aconite and Pulsatilla; the lungs, Aconite, Bryonia; the liver, Aconite, Nux v., Pulsatilla; the kidneys, Aconite, Arsenic, Belladonna, Cantharides; the bladder, Aconite, Cannabis, Cantharides. Select the remedy according to the peculiarity of the symp- toms. Hydropathic treatment.-—To mitigate the pain cold or 196 DISEASES OF THE JOINTS. very cold wet cloihs should be constantly applied to (ho affected parts until the pain subsides; or the feet and hands, when inflamed, may be held in cold water until the preter- natural heat is subdued. The general feverishness rcijuires the wet-sheet pack, followed by the shallow tepid bath. The diet should be of the "hunger-cure" kind. Some authors recommend the use of the warming bandages and tepid baths. All treatment must be discontinued as soon as critical per- spiration, or critical deposits in the urine appear. In cases where reaction is not sufficiently active, we must stimulate nature to greater activity by warming bandages and cold ablutions. In constipation a clyster should be used every day until the bowels become regular. Chronic cases require a daily pack for an hour, followed by a plunge, drip- ping sheet, or half-bath; a daily tepid shallow-bath for ten minutes, with the pail douche over the shoulders, a daily hip- bath at about 65° for fifteen minutes, and a dciily foot-bath at about the same temperature for ten minutes. Weakly persons should perspire only once every second or third day. In addition to all this, the douche may be applied to the affected part with as much force as can be borne without much pain, and moderately along the spine, two or three times a week. The patient should exercise as much as his strength will admit of, and drink all the water the stomach can endure without pain. The following plan is adapted to all ordinary cases: in summer, a plunge-bath on rising in the morning, followed by a long walk; at ten a. m., the pack and douche; at four or five p. m., half-bath and pail douche; at half-past eight p. m., sitz-bath; a foot-bath may be taken at either time a. m., five to six p. m., or evening. In winter, a pack and half-bath in the morning; douche at ten a. m.,; half-bath at four to five p. m.; sitz-bath in the evening; foot-baths as above. Eclectic treatment—During a paroxysm of gout, some relief may be obtained by placing the foot in an alkaline-bath, as hot as can be borne, and retaining it there for some ten or ARTHROCACE. 197 fifteen minutes, after which a fomentation of Stramonium leaves should be applied around the foot and painful joint; at the same time, powders of Sulphate of Quinine and Morphine may be given every half hour or hour, in doses of about half a "-rain or a grain of the former, and from one-eight to half a grain of the latter. Attacks can only be prevented by avoiding the exciting causes. The greatest benefit is sometimes afforded by a preparation composed of equal parts of the saturated tinctures of Mac- rotys-root and Colchicum-seed, which may be taken in half- drachm or drachm doses three or four times a day, and con- tinued for some time. The bowels should be kept regular, and the surface of the body should be frequently bathed with an alkaline solution. If torpidity of the liver is present, Podophyllin and Leptandrin may be used in small doses. When the gout attacks internal organs, the compound tincture of Virginia Snake-root must be given in half ounce, or ounce doses, to produce profuse perspiration; and at the same time, Sinapisms, must bo applied to the foot and leg originally attacked, at least as high up as to the knees—after which an active cathartic injection should be administered. Chronic arthritis, requires the same treatment as the acute form. No cure has ever been effected, save by a change of habits. Arthralgia—Pains in the Joints. (See Rheumatism, gout, neuralgia, etc.) ARTHROCACE. Inflammation of the terminal extremities of bones. The different parts which form a joint, as: the ligaments, synovial membrane, spongy ends of the bones, may become inflamed, and lay the foundation of white swelling, hydrops articuli, dislocations, and other diseases. According to the seat of inflammation it has received the following names: Spondylar- throcace, if the joints of the neck and spine are affected; Cleidarthrocace, if those of the clavicle; Omarthrocace, if 198 DISEASES OF THE JOINTS. those of the shoulder; Onconarthrocace, joints of the elbow; CJieirarthrocace, those of the hands; Dactylar throcuce, finger joints; Gonarthrocace, knee-joints; Padarthrocacc, foot-joints; Coxarthrocace, hip-joint. The treatment is the same as directed for Coxarthrocace. Homoeopathists recommend as successful remedies; Colo- eynth and Phosphor acidum. Bunion. (See Diseases of the extremities.) COXARUM MORBUS — HIP-JOINT DISEASE. This disease consists in an abscess originating from caries of the head of the os femoris; it generally occasions a luxation of the hip-joint, a permanent shortening of the limb. The symptoms come on insidiously. The first thing complained of is a slight pain in the knee. The limb will be found elong- ated, (caused by partial protrusion of the head of the femur out of the acetabulum), and the foot and knee are turned inward. At this period there is generally tenderness and pain in the groin, and in some cases may become very severe. Walking, stepping, or moving the foot, also pressure on the affected hip-joint increases the pain. In scrofulous caries of the bone, there is little or no pain. When suppuration commences it is indicated by shivering and shuddering, alter- nating with heat. The pus does not make its appearance, till the disease has committed great ravages. The ulceration almost invariably injures the joint, destroyiug the cartilages, if not the articulating surface of the ilium and femur. In most cases the head of the femur is thrown out, and dislocated backward on the dorsum of the ilium, where it may form a new joint, producing a short, deformed limb, though there has been no actual destruction of bone. Club-foot has, in several instances, been produced by this disease and removed by curing the hip. Causes.—Scrofulous or rheumatic metastases; external vio- lence; exposure to cold. Treatment allopathic-—Improvement of the general health; perfect rest enforced by a starched bandage, or by confining UlP-JulNT DISEASE., -■ " 19<) the patient to a fracture-bed; during the stage of shortening, extension of the limb by means of a weight attached to the thigh above the knee, by a cord which passes over a pulley at the end of the bed; cupping and leeches in the early stages; a warm bath daily; mercurial-ointment, rubbed morning and evening, on the hip:joint; calomel, half a grain to a grain, three tunes a day; intermediately a cooling purgative, so that a few fluid stools are evacuated daily. If no abatement of the disease takes place in eight days, a vesicatory to the Lip-joint, or an issue behind the great trochanter is to be applied. When ;in abscess forms, it should not be opened too soon. (See Abscess.) Homoeopathic remedies.—In the iir.-.t stage, liercurius. Bella- donna, Rhus and Coloeynth are the principal remedies. In the second stage Sulphur and Calcarea should be given in alternation morning and evening, for at least two or three weeks; followed by Ferrum and Kali c. in like manner. When ulceration has taken place, Calcarea c and Silicea should be given in alternation, twice or three time3 a day until removed. Magnesia carh, is indicated by pain in the hip and knee-joints, niglit sweats, or derangement of the digestive system. Jarring and motion of the affected limb should be avoided. Hydropathic treatment must be conducted on general prin- ciples, and should be of that kind which will give the most comfort. Alleviate pain by warming or cold bandages, and support the patient's strength by ablutions, pure air and diet. Eclectic treatment.—In the first stage apply the irritating plaster over the diseased hip (covering all that part of the spine which gives out nerves to the joint), to be continued so as to keep up a free purulent discharge for four to six weeks. The whole surface should be bathed once a day. A cathartie composed of equal parts of Powder of Senna and Cream of Tartar should be taken once a week. Some alterative, gene- rally the scrofulous syrup, is necessary throughout the treat- ment. If matter has formed, poultices and fomentations over the whole hip should be made use of, till there appears a 200 DT'!^s KS OF THE JOINTS. tendency to point at some particular place, at which a caustic issue should be opened to facilitate the exit of matter, as no good can result from retention of pus in the system. This ap- plication of caustic, however, is not necessary, if the matter seems rapidly approaching the surface; in this case apply emol- lients only. Wash out the abscess once or twice a day with in- jections of soap-suds, and encourage the discharge with slippery elm poultices. The irritating plaster should be kept on con- stantly until the abscess heals up, leaving a small space uncovered at the orifice of the sore. Gradually the strength of the wash for cleansing the abscess should be increased, by adding more and more of the mild caustic, in order to destroy and bring away all fungous flesh, or carious bone. Fistulous openings should be brought together, if they are connected, by the introduction of a liga- ture. To prevent mobility of the joint, and enable the patient, during the lengthy process of cure, to exercise in the open air, he should be supplied with crutches, and the limb should be dressed with gum-shellac, or other light splints. The shellao splint should extend from the middle of the thorax to the ankle, and attached all the way by rollers or bandages. Coxagra. (See Diseases of the Nerves.) HYDARTHRUS—HYDROPS ARTICULI—DROPSY OF THE JOINT- RHEUMATIC WHITE SWELLING. This disease consists in a distention of the synovial mem- brane and capsular ligament by serous effusion, which renders the limb lame and stiff, though not very painful except from ex- ercise. In some cases the whole limb may become dropsical. Causes.—Cold; suppressed perspiration; rheumatism; abuse of mercury. Allopathic treatment is the same as given under Chronic Rheumatism. Embrocations of volatile liniment, Terebinthina and tincture of Cantharides should be made, and the affected joint kept covered with an Ammoniac plaster. If pain and inflammation are present, the application of leeches becomes necessary. In cases of long standing a seton, or an issue, scrofula in a joint. 201 diuretics and purgatives, and the expulsive bandage will prove of benefit. Homoeopathic remedies principally indicated are: Bryonia, Mercurius, and Pulsatilla; lodium in scrofulous habits. When caused by abuse of Mercury: Hepar Sulph, and Sulphur; when caused by Quinine, or Sulphur: Pulsatilla should be administered. Enveloping the joint in a very thin roller of india rubber, to produce local perspiration is a valuable auxil- liary in this disease, and also in articular rheumatism. Hydropathic treatment. — The warm or cold douche, wet bandages, the pack-sheet, copious water drinking and frequent injections to keep the bowels free. Eclectic treatment — Alkaline bathing and friction of the whole surface of the body; a douche of cold or warm water directed upon the affected joint; fomentations of hops, tansy, or vinegar twice a day; the bandage rolled on with a considera- ble amount of compression from the great toe to above the affected part; stimulating liniment; cupping and scarification, are the principle measures recommended. The stiffness of the joints, following the disease, can be overcome by exercise, and the application of black walnut-oil. NODOSITY — NODES. Hard concretions or incrustations which form around rheu- matic and gouty joints; but especially around those of the fin- gers. The motion of the joints becomes impeded and some- times a degree of dislocation occurs. This disease is not attended with fever. It is peculiar to women about the period when the menses cease. Treatment is mainly constitutional. When the tumor be- comes projecting and pointed, the soft parts may be laid open, and the tumor removed with a saw, chisel, or trephine; when ulceration occurs, attended with callous edges or fun«oua excrescenses, these require cauterization. TUMOR ALBUS GENU — WHITE SWELLING--SCROFULOUS OR TRUE WHITE SWELLING — SCROFULA IN A JOINT. The swelling comes on very slowly, and is attended with 202 DISEASES OF THE JOINTS. little pain at first. Gradually the pain increasis till it becomes intense, especially at night, accompanied with a sen- sation of heat or burning in the part. The skin covering the joint appears whiter than natural, and gradually becomes tense, shining, and marked with varicose veins. In thig condition it may remain for years, but usually the swelling continues to increase until the soft parts become so hard as to appear like enlarged bone. As it progresses the tibia is thrown backward, the condyles of the femur project forward; the limb, both above and below the joint, emaciates, anchylosi3 takes place, and matter collects, and is discharged at various sinuous openings. Extensive caries of the bone often ensues, with hectic fever, night sweats, and general debility, soon terminating in death. Causes.—Repelled eruptions; scrofula; local injury; mercu- curial and antimonial medicines; etc. Allopathic treatment. — In the first stage of this disease we must have recourse to leeches, friction, cupping, cold water fomentations, and perfect rest of the affected limb. In the second stage embrocations with mercurial-ointment; compres- sion by strips of adhesive plaster, or the wearing of a gum elastic plaster, made by dissolving gummi elasticum in six to eight ounces of spirits of turpentine and spreading it upon leather. Washing the affected joint with Belladonna has in many instances proved efficient in the removal of severe pain. Scrofulous persons require Iodine, Terra ponderosa salita, and Codliver oil. Zinc ointment, kreosote and lye- baths are recommended as external remedies. Homoeopathic treatment. — Sulphur and Calcarea are the chief remedies; and in some cases: Iodine, Silicea, Lycopo- dium, Arsenic and Pulsatilla. In the event of suppuration, Mercurius, Silicea and Hepar. Hydropathic treatment.—When the joint is very painful, it should be bathed in warm water or fomented until it is relieved, and then dressed with several folds of wet cloth, except when the inflammation is acute, in which event, cold applications are WHITE SWELLING. 2(C> most appropriate, always regarding the sensation of the affected part. The cold pouring-bath, douche, or leg-bath, or even moderate congelation, may be employed with advantage, when they can be administered without pain. The limb should be kept as extended as possible, and as much compression em- ployed during the suppurative stage as can be borne without pain. The constitutional treatment consists in the employ- ment of the packing-sheet, and anti-scrofulous regimen. Eclectic treatment.—Remove the inflammation and swelling by cupping and scarifying the wdiole surface. After this apply the irritating plaster; and on removing the plaster, cup and scarify again, until free suppuration is excited. When this is brought about, still dress it twice a day with the plaster, to keep up the discharge. After each dressing, subject the limb to the bitter herb fomentations, by placing it over a vessel containing hops and tansy. If the re-application of the irritating plaster proves too painful, an emollient poultice may be used instead. After continuing this course for ten or twelve days, you may allow the sore produced by the plaster to heal. Then follow up with stimulating applications, and compression with the bandage, as strong as the patient can bear. (See Ulcers, Scrofula, Hydrops Articuli, Caries, etc.) White swelling. (See Hydarthrus and Tumor albus genu.) CHAPTER VIII. DISEASES OF THE HEAD AND SCALP. ALOPECIA--FALLING OFF OF THE HAIR. The causes of losing the hair, or of its becoming gray, are: Acute diseases, especially those which affect the head; ex- cesses in venery; grief and anxiety; chronic cutaneous dis- eases; syphilis, and old age. If baldness is hereditary, all treatment is useless. Treatment. — Frequent combing and brushing of the hair; washing it with soap water, or pure soft water, or with a de- coction of wheat bran, or burdock root; having it cut once a month when the moon is increasing; anointing it with a pom- ade of beef's marrow and oil of cedar; powdering with a mixture of culinary salt and hair powder; also, washing with a solution of blue vitriol. If caused by acute diseases or debility, the following pomade has been used with benefit: Mix extract of Peruvian bark two scruples, rose-oil three drops, bergamot-oil ten drops, lard one ounce. When it appears in early life, melt the marrow of beef- bones by the fire, put several drops of tincture of cantharides, laurel oil, or sweet almond oil into a saucer, and mix gradu- ally as much marrow with it as will fill the saucer, stirring and mixing it thoroughly; with this mixture rub the bald spots once every second evening. In cases where the hair is dry, or where there is much dandruff, a thin lye made of beech-wood is efficacious. Apply it to the head with a fine- tooth comb, or sponge, cleansing it afterward with cold soft water. When the hair splits, the ends should be cut every other day, and a little bear's grease used. Single bald spots must be shaved and rubbed every evening with sliced onion, or with a wash of brandy and onions. 204 PARALYSIS OF THE BRAIN. 205 Small doses of sulphur, taken internally, may prove benefi- cial. APOPLEXIA — APOPLEXY-—PARALYSIS OF THE BRAIN. Sudden or gradual loss of consciousness, sensation and mo- tion, with greater or less disturbance of the pulse and respi- ration. The indications of apoplexy are, continued inclina- tion to sleep; heavy, profound sleep; nausea with vertigo; hum- ming, singing in the head or ears; partial loss of memory; dim- ness of vision; flashes of fire or sparks before the eyes; hang- ing down of the lower lip and jaw; frequent chewing, with nothing in the mouth to chew; stammering; difficulty of deglu- tition; numbness or torpor in the extremities; easy distortion of the countenance; weak or unsteady mode of walking. Cause of apoplexy is a sudden stoppage of the cerebral ac- tion by congestion of the brain; metastases (shifting of ar- thritic or scarlatina matter to the brain); irritant matter in the digestive system (apoplexia biliosa); spasms of the brain in nervous individuals; exhaustion of vital power of the brain; great loss of blood; nervous fevers; excess in venery; narcotic poisons; concussion of the brain by blows. Apoplexia sanguinea s. plethorica, caused by congestion to the head, is characterized by blood-shot eyes; bluish redness of the face; full, hard pulse; oppressed and stertorous breath- ing; involuntary discharges of urine and fasces; frothing at the mouth; hanging down of eyelids and jaw. The paroxysm comes on without warning, or is preceded by fullness, weight, and a dull pain in the head, giddiness, drowsiness, — the patient suddenly falling to the ground, and seeming as if in a heavy sleep. Causes. — Plethora; pressure on the blood-vessels of the neck from tight cravats; swelling in the throat; diseases of the heart; over-eating; drunkenness; violent passions; hang- ing; inflammation of the brain; straining at stool; lifting heavy burdens; over-exercise in the hot sun; suppressed hemorrhages; excessive blowing of wind-instruments; in short, any thing that tends to over-heat or drive the blood to the head. 200 DISEASES OF THE HEAD AND SCALP. Preventive rules. — Lie with a high pillow; keep the feet warm; abstain from all spirituous liquors; avoid overloading the stomach; abstain from sexual intercourse; use light clothing; avoid costiveness, violent passions and late suppers. Treatment allopathic. — The patient should be placed in a cool room, his head must be elevated, tight clothing removed, and venesection in the arm (in suppressed hemorrhages, in the foot) must be immediately instituted. Let the blood flow until consciousness returns, and the pulse loses its fullness and hardness. If the pulse becomes small without alleviating the symptoms, local abstractions of blood by cupping or leech- es must be resorted to. If necessary, the venesection may be repeated after six or eight hours. In hemiplegia it must be made on the sound side. Clysters of three or four ounces of vinegar, salt, mustard, or four grains of tartar emetic; blisters behind the ears; mustard plaster on the calves of the legs and the arms; foot-baths with ashes and mustard; vesicatory on the neck; cooling purgatives of salts and sen- na; or croton oil, two drops, with castor oil; ice cold fomen- tations on the head, are remedial means which command the attention of the practitioner. Homoeopathic remedies.— Opium: If slow, stertorous breath- ing, red and bloated face, or of natural appearance; insensi- ble and dilated pupils; slow pulse. Belladonna: If face flushed; eyes injected; dilated, im- movable pupils; mouth drawn to one side; dull, heavy head- ache ; roaring in the ears. Nux vomica: If the attack has been caused by the intem- perate use of spirituous drinks; after a fit of passion; in bil- ious, sanguine or nervous individuals; stupor; difficult breath- ing; paralysis of the inferior extremities; twitching; occa- sional numbness of the limbs. Arnica: When caused by a blow. China &ni Cocculus: When caused by debilitating losses. Opium and Baryta muriaticum: When caused by old age. Opium and Coffea: When caused by excessive joy; Sulphur PARALYSIS OF THE BRAIN. 207 and Ipecac, by repelled eruption; Ignatia and Nux v., by anger or fright; Pulsatilla and Ipecac, by a full meal; by narcotic poisons, see poisons and their antidotes. The circulation in the feet and legs should be increased by frictions, or by warm foot-baths; the doors and windows thrown wide open; and all tight clothing removed. Hydropathic treatment. — Remove the patient to a cool, spa- cious, well ventilated apartment, loosen all the clothing about the chest, remove every thing from around the neck, and place him in a nearly upright posture; use vigorous friction with wet towels, wet hands or wet sheet; keep the head cool, and after a little abatement of the symptoms, water should be poured upon the head. If the fit continue the cold stream may be applied to the head for a quarter to half an hour, several times a day; the cold, wet girdle to the abdomen should succeed the hot fomentation, which may be resorted to every two or three hours, for ten or fifteen minutes each time. Vomiting must be encouraged by administering first tepid, and subsequently cold water. When the patient is restored, a daily envelopment in the wet sheet until he becomes warm, followed by a quick ablu- tion, may prove highly beneficial. Eclectic treatment. — Apply ligatures to all the extremities, so as to interrupt the venous circulation, which should be con- tinued till other measures can be resorted to. A cathartic should be next exhibited, consisting of the anti-bilious physic in drachm doses, with one grain of podophyllin and two grains of leptandrin. The three articles may be mixed, and taken in sweetened cold water, and repeated once in four hours, until the desired effects are produced. It may be assisted by an injection. If it should not operate, croton oil, in drop doses, made into a pill, with magnesia, must be given. Mean- time, the temples may be cupped and scarified, and mustard drafts may be applied to the back of the neck, upper part of the spine and to the bottoms of the feet. If, after these measures have been carried into execution, the 208 DISEASES OF THK HEAD AND SCALP. Bymptoms continue, effusion has probably taken place, and an issue may be applied to the back of the neck, while the pa- tient is put upon the use of the decoction of apocynum, given in sufficient doses to keep the bowels open. Apoplexia biliosa and gastrica, defined by eructations, dispo- sition to vomit, coated tongue, yellowishness of the white of the eyes; tenderness and distention of the epigastric region; an overloaded stomach or anger having preceded the attack. Allopathists recommend a vomit of tartar emetic, followed by injections and purgatives. A careful examination of the case should be made previous to the prescription of an emetic, whether congestions and a plethoric state do not exist. (See Apoplexia sanguinea.) APOPLEXIA NERVOSA — NERVOUS APOPLEXY. Asthenic nervous apoplexy is recognized by the absence of the above mentioned signs of sanguineous congestion. The patient looks pale (death-like) and is cool; pulse is feeble and easily compressible ; there is difficult deglutition, involuntary chewing, tremor of the lips, laborious respiration. The at- tack is generally preceded by exhausting diarrhoea, hemor- rhages and other debilitating causes. Allopathists recommend: Valerian, Castoreum, Opium, and particularly stimulant clysters of vinegar, tobacco, mustard, aromatic and tepid baths, sprinkling of the face with ice-cold water, inhalation of chloroform; vesicatories on the neck, and electro-magnetism. CEPHALHEMATOMA. Bloody tumors of the heads of new-born infants are gene- rally caused by the use of instruments during labor. Apply compresses wet with red wine, or arnica-water, and should these applications not be sufficient, remove the swell- ing by making an incision to evacuate the blood. FUNGOID TUMORS OF THE SCALP. They begin with small, hard, insensible tumors, feeling like shot. After months, or even a year, they will have attained the size of a musket ball. They continue growing and be- HEADACHE. 208 come tender to the touch and gradually painful. The hair over their surface falls off, and the substance of the tumor seems to he filled with pus; but if a lancet be thrust into it, only fresh blood will flow profusely. If the disease is not arrested, the tumor inflames and ulcerates, fungous growths sprout out, discharging a sanious fluid; the pains become se- vere, and constitutional disturbance takes place. Treatment. —'While the tumors are yet hard and insensible, discuss them by the application of the tincture of capsicum, in which as much of the sesqui-carbonate of potash has been dissolved as it will take up. This application should be re- peated three or four times a day to each tumor as warm as practicable. After inflammation has taken place, the only certain remedy is caustic potash. Apply this to the surface of each painful tumor, and let the pencil penetrate into the center of the substance. Then apply an elm poultice, wet in warm milk and water, until the cauterized portions slough out. Wash off the sores with strong soap-suds, and change the poultices three times a day. If the pains return, re-apply the caustic potash. If the sores become indolent, apply the sesqui-carbonate of potash in powder a few times, until a healthy appearance is assumed; then use simple dressings. Large bloody swellings on the scalp of grown up persons, caused by blows or falls, should be opened with the lancet, and the blood allowed to escape, after which compresses and a bandage must be applied. Sarcomatous growths. — (See Tumors.) CEPHALALGIA — HEADACHE. In a majority of cases this tormenting complaint is only a symptom of other diseases, as: Indigestion, fever, inflamed brain, congestion, catarrh, and mental emotions. It there- fore differs very much In its character and symptoms, and accordingly we have: Nervous headache, hemicrania, or meg- rim, which generally attacks nervous persons, and occupying only one side of the head; gastric, bilious and sick headache, caused by derangement of the digestive system, and coming 9i 210 DISEASES OF THE HEAD AND SCALP. on periodically; rheumatic, arthritic and syphilitic headache, caused by suppressed rheumatism, gout or syphilis; clavus hystericus when a small circumscribed spot is affected, like a nail driven in there; periodical or intermittent headache, com- in°- at regular intervals; sanguineous headache, caused by rush of blood to the head; catarrhal headache, caused by cold. Causes. — Coffee, tea, tobacco (nine-tenths of all headaches are caused by these poisonous substances); beer and ardent spirits; cold; suppressed eruptions; mental emotions; exces- sive study; over-exertion in hot weather; sleeping and living in close, ill-ventilated rooms; inflammation and congestion of the brain; gastric derangement; loss of sleep; foreign bod- ies, as worms, insects, larvae entering frontal sinuses; etc. Allopatliic treatment — Sanguineous headache calls for the application of leeches and warm foot-baths; bilious or sick headache for mild emetics, cathartics and mustard foot-baths; nervous headache for hyoscyamus, valerian, belladonna, aqua laurocerasi, cinchona, iron and sea-baths. If caused by in- sects or worms which have entered the frontal sinuses, warm vapors drawn into the nose, smoke of tobacco, snuff, in order to produce sneezing, must be employed. Arthritic, rheumatio and syphilitic headache requires repeated cupping in the neck, web of spiders, guajac, aconite, calomel, foot-baths of mus- tard, mustard meal in the stockings, etc. Homoeopathic treatment.—Headache caused by coffee calls for Nux v., chamomile, ignatia, or small doses of brandy; if caused by tea: Cinchona; nervous headache (neuralgia in the head): Nux v., pulsatilla, cocculus, ignatia, coffea, aconite, coloeynth, arsenic, etc.; sick headache: Ipecac, apis mellifi, belladonna, spigelia, sanguinaria, sepia, aconite; headache from over- heating: Aconite, belladonna and bryonia; from drinking ardent spirits: Nux v., arsenic, cocculus, lachesis; from losa of sleep: Nux v., cocculus and pulsatilla; from abuse of to- bacco: Nux v., pulsatilla, coffea; from excess of mental or bodily labor: Nux v.; from grief: Ignatia; from anger: Chamomile and Nux v.; from suppressed eruption: Sulphur iiiAijAciiE, 211 fend Antimonium cr,; from gastric derangement: Antimony^ bryonia, pulsatilla and nux v.; from cold in the head: Mer- cury, nux v., arsenic, aconite and chamomile; from conges- tion: Opium, belladonna, aconite, bryonia, mercury and puh satilla. For chronic headaches.: Sangiiinaria: Periodical pains, of if the headache begins in the morning and lasts till nighty with a fullness of the head as if it would split; shooting; beating pain more in the forehead, worse on the right sidet attended with chills, nausea, vomiting, inclination to lie down; symptoms aggravated by motion, and by walking of others in the room. Belladonna: Pains as if the head would split, or as if every thing would issue through the forehead, or one side; undula- tions in the head as of water; vertigo, red and bloated face, red eyes; sensitiveness to noise, light, shock or contact; pains worse on the right side; delirium. H*pia: Shooting, boring pain above the right eye, with nausea and vomiting; or throbbing pains in the temples, just above the brow; sensitive to the slightest touch; worse by moving the head, alleviated by keeping quiet and in a dark room with the eyes closed; sleep causes the pain to cease; the patient screams and is easily vexed. Aconite: Nervous headache on the left side, with great sen- sitiveness to all kinds of odor. Spigelia: Severe pains on the left side, insupportable beat- ing in the temples, increasing with the ascending of the Bun, or augmented by stooping and motion, in the open air, with the greatest sensibility to noise, and attended with a fetid odor from the mouth. Colocynthis: Most excruciating headache, furiously tearing on one side, aggravated by stooping or lying on the back; attack comes every afternoon .and evening, on the left side, with great restlessness, offensive discharges of urine, and perspiration smelling like urine. Nux v.: Pains commence early in the morning, and grow 212 DISEASES OF THE HEAD ANO SCAia' worse and worse until the patient is well nigh delirious, pains resembling the piercing of a nail, constipation, nausea, and sour Vomiting; worse when moving the eyes, when stooping and after meals; headache from coffee-drinking* Pulsatilla: Pains worse in the evening, jerking, shooting In the temples, or on one side of the head., giddiness, sickness of the stomach; buzzing and shooting in the ears; no appe- tite, no thirst, pale face, palpitation of the heart, worse when Bitting, better in the fresh air; relieved by ft tight bandage, Hydropathic treatment — The majority of cases can be re- lieved by putting the feet in warm water, and applying cold wet cloths to the head. The hot fomentation is often suffi- cient. When arising from suppressed menstruation, the warm hip-bath is advisable. When the cause is a sudden cold, the wet-sheet pack should be employed. If the stomach is exceedingly irritable, and troubled with obstinate nausea and vomiting, warm water drinking and the pouring head- bath constitute the most efficacious practice. When arising from the sudden abstraction of stimuli, as of wine, tea, coffee, tobacco, etc., the patient should keep very quiet for several days, and walk, sit, or lie down, as he finds most comfortable, and take frequent warm foot and cold head-baths. Eclectic treatment — (See Congestion, &c.) CONCUSSION OF THE BRAIN—COMMOTIO CEREBRI. An interruption of the functions of the brain, induced suddenly by mechanical injury (fall, blow), and not necessa- rily attended with organic lesion. When the concussion is severe, immediate deprivation of sense and power of motion, and death is the result; but when slight, a temporary stun- ning, with headache is produced, followed by increased action of the pulse, vertigo and sickness. In more severe cases the patient is rendered insensible, and incapable of movement; faeces and urine pass involuntarily, or there is costiveness and retention of urine; his limbs become cold, the pulse weak and slow, and the respiration laborious. As the patient be- gins to recover, the pulse and respiration improve, warmth CONCUSSION OF THE BRAIN. 213 and sensibility return, the contents of the stomach are ejected; still he continues in a dull, confused state, and inflammation of the brain gradually developes itself, which, if not arrested, will result in suppuration or effusion within the head. Allopathic treatment. — In slight cases the patient soon re- covers without any treatment. In severe cases: Stimulants, as warm wines, tea, water; frictions with warm flannel; olfac- tory applications, as ammonia, vinegar, etc.; for congestion and symptoms of apoplexy, blood-letting are the ordinary means. Should, afterward, symptoms of inflammation show themselves, the same treatment as recommended for inflamma- tion of the brain must be instituted. Bleeding should not be resorted to until reaction has taken place. Homoeopathic treatment.—— Arnica, a dose every hour, or oftener, internally, and the tincture of arnica diluted with water applied externally, are the principal means recommend- ed. For remaining headache, belladonna and aconite may be indicated. Hydropathic treatment.—Perfect quiet, and a careful atten- tion to keep up the general circulation and normal temperature, are the principal remedial resources. The extremities must be kept warm, cold cloths should be laid over the head, and, in prolonged cases the bowels may need evacuating by means of injections, and the urine may require to be drawn off by the catheter. Eclectic treatment.—Besides the common popular olfactory applications, stimulants should be applied to different parts of the body; several large dry cups, or common tumblers, along the course of the spine, and compound tincture of myrrh inter- nally. If these means are not sufficient, give stimulating in- jections, say the common emetic powder, or the compound tincture of lobelia. Bleeding is dangerous. Perfect restora- tion may not take place for several days. In all cases the greatest quietude should be observed. In retention of urine use the catheter; for constipation give mild cathartics. Ap- ply the irritating plaster to the nape of the neck, and to any 214 DISEASES OF THE HEAD AND SCALf, part where there may be irritation. In some cases small doses of leptandrin and podophyllin are of benefit. When there is tendency to inflammation of the brain, the feet and legs should be immersed to the knees in water, as hot as it can be borne, and kept there until relief is obtained; the head mean- while being subjected to cooling lotions, or a small stream of water. Compression of the brain often follows severe concussion* The symptoms are similar to those of apoplexy, aad are caused by extravasated blood arising from a wound, by fracture of the skull, or by suppuration upon or within the part. Treatment is the same as for apoplexy, the object being to avoid inflammation, and procure absorption of the blood. If the skull has been broken, or if a foreign body, such as a musket ball, is the cause of compression, the depressed por- tion of a bone must be raised by trepanning or trephining, (See illustration.) CONGESTION OF THE HEAD — CONGESTIONES AD CAPUT, Headache; uncommon drowsiness, which gradually changes into sopor, fullness of the vessels of the neck and head, the pulsations of which the patient experiences through the entire frame; giddiness; dimness of vision; buzzing in the ears; oppressed breathing; blindness when stooping; red looking tongue; constipation. Causes. — Sedentary life; intense mental applications; use of ardent spirits, coffee and tea; excesses in venery. Allopathic treatment — Venesections; cooling purgatives; foot and hand baths; clysters; applications of leeches and cupping; administration of mineral acids. Homoeopathic treatment. — Aconite, belladonna, nux v. and opium are the principal remedies employed. When caused by constipation: Nux v., aloes, bryonia and opium; by sup- pressed menstruation: Pulsatilla, sulphur and belladonna; by debilitating losses: China and ferrum; by violent anger: Chamomilla; by a fall or blow: Arnica. Consult also; Hy- oscyamus, veratrum, cocculus and mercurius. CRETINISMUS. 215 Hydropathic treatment — Scanty diet, warm foot-baths, cold applications to the head, rubbing wet-sheet, injections, and sitting-baths. See causes and avoid them. Eclectic treatment. — The treatment of acute cerebral conges- tion should be commenced with a free and repeated use of the warm bath, in connection with nauseants, as: Syrup of Squills and Syrup of Senega, each half an ounce, tincture of lobelia, two drachms; mix, and give from ten to twenty drops to a child one or two years old, which may be repeated suffi- ciently often to keep up the nausea and accompanying dia- phoresis. In order to allay irritation and produce a laxative effect, take podophyllin one grain, lupulin five grains, white sugar one scruple; mix, triturate thoroughly, and divide into twelve powders; of these one powder should be administered three times a day. If it should prove too active in its opera- tion, the intervals between the doses should be lengthened. The whole surface of the body must be bathed often with a weak alkaline wash. Cold or cool applications must be made to the head, and the feet kept warm by warm foot-baths, stim- ulating liniments, or mustard. In children, if the gums are swollen they must be cut. In some cases- the tincture of Aconite or Belladonna may be administered with benefit: Take tincture of Aconite (or Belladonna) eight drops, dis- tilled water three fluid ounces; mix; give a fluid drachm every three or four hours. The room of the patient should be kept darkened and perfectly quiet, and all diet of an irri- tating character must be avoided. The severer symptoms having abated, the same tonic and stimulating course may be pursued as recommended in treat- ing of encephalitis. CRETINISMUS. Cretinism is a sort of idiocy. Patients afflicted with this disease are mostly dwarfish in nature, with very large heads; wide vacant features and goggle eyes; incapable of articulate speech; some are blind and some deaf; intelligence is entirely obliterated; limbs arc short and crooked; muscles flabby, and 216 . DISEASES OF THE HEAD AND SrALT. bellies tumid. They are insensible to the decencies of nature, and obey, without shame, every animal impulse. The genital organs of male patients are eminently developed. This disease is generally accompanied with goitre, and prin- cipally found in the lower gorges and ravines of Switzerland, the houses being built under ledges of the rocks, and all of them very close, filthy, hot and miserable. In villages higher up no cretins are to be seen. Treatment — A cure is out of question, but much can be done to better their condition, by removing these unfortunate creatures to more cleanly and healthy habitations; by cleanli- ness, and by proper diet. ENCEPHALITIS — PHRENrTIS — BRAIN FEVER — MENINGITIS— INFLAMMATION OF THE BRAIN, AND ITS TISSUES. High fever; violent headache; redness of the face and eyes; congestion of blood to the head; intolerance of light and noise; coma or constant delirium; occasional attempts to grasp the head; pupils are first contracted, but as the disease ad- vances they become dilated; pulse is very variable, generally full; sometimes nausea and pain in the stomach and bowels; boring of the head against the pillow. The pain caused by inflammation of the tissues of the brain is more acute than that arising from inflammation of the substance of the same. The latter form is generally accompanied with paralysis. Causes. — Blows, falls, or other injuries of the head; ex- tremes of heat or cold; abuse of ardent spirits; repressed eruptions, as scarlatina, measles, &c.; contagious diseases; suppressed piles or menstruation; undue mental excitement; worms; excess in venery and onanism. Allopathic treatment. — This consists in the removal of the cerebral irritation; and to attain this end we must discrimi- nate its different character and causes. Should, after removal of the causes, genuine inflammation continue to exist, which is characterized by a strong, full pulse, sopor, reddened eyes, red face, pulsating arteries, heat of the head, and red urine; we must resort to general copious bleeding, then leeches on INFLAMMATION OF THE BRAIN, AND ITS TISSUES. 217 the neck, temples, or behind the ears; cupping on the neck; cold fomentations, or cold affusions on the shaved head; ice in a bladder on the head; sinapisms on the calves of the legs. Internally: Nitre, purgatives of calomel and jalap, and, if depletion fails to subvert the disease, calomel in one grain doses, every two hours. In the intervals of the above treat- ment, if the stomach is not nauseated, tartar emetic may be given, from ^ to L of a grain every two hours. In Encepalitis nervosa, opium, and tepid baths will be suffi- cient to remove the disease; in obstinate cases, musk and camphor; in great debility, cinchona and wine. The cure of Encephalitis gastrica-biliosa-verminosa, con- sists in cleansing the primae viae by emetics, purgatives and vermifuges. Homoeopathic treatment. — When the fever is high, pulse full, skin hot and dry, face flushed, severe pains in the head, give Aconite. When the heat of the head is great; face flushed and bloated; beating of the arteries of the head ;;nd neck; great sensitiveness to light and sound; wild expression ; raving; loss of consciousness; tendency to vomit, and invol- untary evacuations of faeces and urine, give Belladonna. When there is drowsiness, loss of consciousness, raving, with a desire to flee, Hyoscyamus. When there is lethargic sleep, with stertorous breathing; half-open eyes; complete apathy, Opium should be administered. Stramonium is indicated in cases strongly resembling the symptoms given under Bella- donna, and when there is a tendency to spasms. In cases where symptoms of paralysis of the brain are manifested, as: icy coldness of the extremities, or of the entire body; blue- ness of hands and feet; impeded respiration; small, weak pulse, Zincum is the proper remedy—first trituration, one grain every hour until improvement takes place. Cuprum accticum is called for in Encephalitis nervosa, when caused by repercussed cutaneous eruption, difficult teething, etc. When caused by a blow, Arnica and Aconite; by worms, Aconite, Belladonna, Cina. The above remedies must be 10 218 DISEASES OF THE HEAD AND SCALP. repeated every three to six hours. Applications of cold water or pounded ice to the head are of benefit, when there is great heat and no perspiration. Hydropathic treatment, — The patient may be enveloped in double or treble wet-sheets, while the head is cooled with pounded ice, cold cloths, or the pouring bath. If the feet are not hot like the rest of the body, they should be bathed in warm water. Constipation of the bowels requires copious tepid injections. If cold water feels disagreeable, when ap- plied to the head, tepid water must be used instead. Eclectic treatment.—Alkaline baths to the surface; bowels kept soluble, by means of small doses of Leptandrin and Po- dophyllin ; placing the patient in a warm bath until symptoms of syncope are induced; cups to the temples and nape of the neck; keeping the head cool by cloths saturated with a mix- ture of vinegar and warm water, and the feet warm; applica- tion of a corn-meal poultice, sprinkled with mustard or cayenne, to the abdomen, lower portion of the spine and in- ferior extremities, to a sufficient extent to produce redness without vesication; ligatures to the extremities. When the most urgent symptoms have abated, small doses of Quinine, combined with Hydrastin and Xanthoxylin, may be administered. ENCEPHALOMALACEA — SOFTENING OF THE BRAIN. Gradual loss of memory, and other intellectual faculties; vertigo with a deep-seated, violent pain in the head; impaired vision, speech and hearing; and paralytic affections of the extremities; sudden falling down; finally, death by nervous apoplexy. Cases of this disease are rare. Diagnosis and cure very difficult. Exostosis on the cranium — Bony tumor. — (See Diseases of the Bones.) FRACTURES OF THE SKULL. Such an injury cannot well take place without a certain amount of concussion, or symptoms of compression, and the HAIR AND ITS DISEASES- 219 same treatment must be instituted as recommended under those heads. When the skull is crushed, crepitus can be felt through the skin, and there are marks of violence on the surface. Considerable swelling may prevent a proper exami- nation until it has subsided. The skull-bone may be bent in without being fractured. The base of the skull may become fractured, when the top of the head is struck. When the temporal bone is broken in this way, blood will flow out of the ears. Symptoms of compression are not always an evi- dence of depressed bone, as they may result from extravasa- ted blood. Treatment. — To prevent the flow of too much blood to the head, apply ligatures around the arms and thighs. When faintness begins, loosen the ligatures a little. This operation is as effectual as venesection. If there be no symptom of compression, remove the hair for some distance round, then wash out with warm water, and bring the lips of the wound together with adhesive straps and bandages. Sutures should be avoided if possible. If symptoms of compression exist, and are not relieved by the proper treatment, it may be neces- sary to trephine, and elevate the depressed bone, or remove the extravated blood. Trephining is attended, even in the most skillful hands, with much danger. In using the instru- ment place it on such part of the head as will avoid the grooves for the middle meningeal arteries in the parietal and temporal bones, as well as the sutures, and have one edge of the trephine on the sound, and one on the fractured bone. (See illustrations.) GANGRENE OF THE BRAIN. This disease is the result of inflammation, and may take place in any part of the brain. It is marked by a livid ap- pearance and softening of the tissue, a fetid odor, and the presence of a greenish, very offensive liquid. HAIR AND ITS DISEASES. Mailed, plaited hair — Plica—Trichoma. — The hairs are inextricably entangled, and matted by the secretion of a glu- 220 DISEASES OF THE HEAD AND SCALP. tinous fluid from their roots. It arises from neglect of clean- liness, the use of fur-caps, and perhaps a peculiar condition of the water. It occurs only in Poland. It is contagious, and may be communicated by coition. Forky hair is a common affection, and depends upon the deficient nutrition of the roots of the hair, in consequence of which the ends become brittle and split. Cutting the hair, and stimulating the surface by combing, washing and fric- tions are useful. Gray hair is owing to a deficiency of coloring matter, or to a morbid condition of the nutriment the hair receives. Se- vere sickness, fright, grief, old age, will induce it. In some cases it is hereditary. Miseolored hair arises from a change in the coloring matter, fc supplied at the roots of the hair. Sensitive hair is dependent upon a morbid condition of the blood vessels and nerves of the scalp. Treatment. — Cutting the hair short, and frequently bathing the whole head in cold water, is the general restorative pro- cess in these deviations from health—some of which, however, are not curable. HYDROCEPHALUS ACUTUS — DROPSY OF THE BRAIN. This disease generally takes place in scrofulous children, who are born with large heads, and in whom the fontanels remain long unclosed. The precursors of this disease are, too large a forehead; prematurity of mind, stupidity, or dullness of the mental faculties; great drowsiness, or falling a sleep amid play; squinting; frequent knitting together of the brow; frequent falling down; want of strength in the feet; sudden starting in sleep ; lying on the belly and forehead during sleep; increased heat in the head. Signs of this form of disease are: rolling of the head on the pillow; vomiting; constipation; sopor and convulsions; moaning during sleep; a peculiar staring, and at the same time a squinting look of the eye ; falling of the head sideways, or forward; unequal pulse; one arm is kept almost constantly DROPSY OF THE BRAIN. 221 in motion; deep sopor; paralysis of the limbs; apoplectic death. Dissection shows accumulation of blood in the cerebral vessels, and serous effusion in the cavities of the brain and spinal marrow. Causes.—Congenital and scrofulous disposition; congestion to the brain; wine, opiates and spiced diet; difficult dentition; inflammation of the brain; a blow or fall on the head; sup- pressed scald head or otorrhcea. Treatment allopathic.—In acute hydrocephalus a congestive state of the brain is generally present, and therefore requires the application of leeches behind the ears and temples; calomel half a grain to one grain, according to age, every two or three hours,—with injections of vinegar and water to produce three or four discharges from the bowels. If calomel is insufficient, Jalap must be added. Magnesia saturated with lemon juice often succeeds in quieting the irritable stomach. The hair must be shaved off, and cold fomentations, or bladders filled with ice applied to the head; small doses of digitalis may be given, and sinapisms applied to the soles of the feet; in infants, the feet are to be enveloped in a cloth wet with a decoction of mustard. Should the sopor, redness of the face and heat of the fore- head continue, then the leeches must be repeated every two hours, and affusions of the head with cold water resorted to, until the child manifests a return of sensation by crying. In obstinate sopor, a vesicatory applied to the neck is of efficacy. To prevent a return of the disease the best preventative is, cold washing and affusions of the head every morning and evening; a daily motion of the bowels; country air; cleanli- ness; abstinence from all exertion of the mental faculties. A seton, or an issue in the neck or arm has, it is said, been serviceable in preventing attacks of this disease. Homoeopathic treatment. — During the inflammatory stage, Aconite and Belladonna are the appropriate remedies. (See Encephalitis.) Bryonia should be given in the second stage, when signs 222 DISEASES OF THE HEAD AND SCALP. of effusion are manifest, as: dark redness of the face; eyes convulsed; sudden starts with cries; or constant inclination to sleep; tongue coated with a dark, yellowish fur; respiration difficult and hurried; constant chewing; passage of urine difficult. Helleborus: face pale and swollen, constant rolling of the head from side to side, convulsions. Mercurius, Tartar emetic, and Digitalis are frequently indicated. Give the remedy indi- cated every three to four hours; as the patient improves extend the time to six or eight hours. Hydropathic treatment—The treatment of Hydrocephalus unless commenced in the early stage, proves, generally, unsuc- cessful. The treatment should be derivative—half, hip, and foot-baths, and the wet girdle to the abdomen. The pouring head-bath is advisable in the chronic variety. The external form has in some instances been relieved by evacuating tho water with a lancet, couching-needle, or trochar. Eclectic treatment.—Acute hydrocephalus: Alkaline-bath to the surface; bowels kept soluble; diaphoresis maintained by means of the spirit vapor-bath; compound tincture of Virginia Snake-root, and warm effusions of Spearmint, Crawly-root; local application to the head of cooling lotion, tepid or cool, as indicated by the effects, and in some instances warm fomen- tations of Hops, or Stramonium leaves applied to the whole head. (See Encephalitis.) Chronic hydrocephalus.—The following preparation has been found the best: Compound Syrup of Stillingia, four fluid ounces; Iodide of Potassa, half a drachm; mix, and give twenty drops, three or four times a day, in a table-spoonful of water, to a child five years old, or in proportion to age. All sources of mental irritation, or gastric derangement, must be carefully guarded against. Compression of the head has been recommended, but in no case has it proved successful, HYPERTROPHIA CEREBRALIS. In this disease the actual cerebral substance is abnor- mally enlarged. In some cases it has existed without causing UlNGWuRM OF THE SCALP. >Slo serious detriment to the general health. In other cases, the intellectual powers are prematurely developed; the patient suffers from severe periodical headache, and increased heat of the head; vomiting, debility and torpor; partial paralysis. Treatment, — Proper vegetable diet: ybs.tine.nce from all stimulating drinks and meats; cleanliness; sleeping in an erect posture; and keeping the bowels open. Insolatio—Sunstroke. (See Accidents.J LICE — I !i: AD-LICE. Lice in the hair of the head can be removed by daily comb- ing and washing of the head, cutting the hair short, and appli- cations of red precipitate ointment. Mania. — (See Ves.-inhe.) Meningitis. — (See Encephalitis.) plica polonica, — (See Hair.) TINEA CAPITIS — SCALD-HEAD — RINGWORM Gl' THE SCALP. Little ulcers in the hairy parts of the head, which secrete a viscous fetid matter, itch violently, and form scabs. The disease commonly attacks children from the age of two years to the period of puberty; it appears on the scalp, neck, trunk and extremities. The mild form is called scald-head; the malignant form tinea. Causes. — The disease is contagious. It may be produced by a comb or hair-brush which has been used by one having the affection, or by sleeping on the same pillow. The primary causes are: neglect of cleanliness; terofula; unhealthy food; suppressed perspiration; swelling and disease of the roots of the hair. Treatment—Cleanliness of the head ; frequent combing and cutting the hair; washing of the head with tepid soap-water; anointing the hard scabs with sweet cream, butter, or oil; in obstinate cases, cabbage leaves applied triple three times a day. Allopathists recommend internally: Rhubarb and Magnesia, Sassafras-tea, and once every eight days a cathartic of calomel and jalap. Great caution must be observed in using external roborants, especially lead-salves, zinc, etc: which are apt 4o 224 DISEASES OF THE HEAD AND SCALP. cause dangerous metastases to the brain and the organs of the senses. In tinea it is necessary to remove the diseased roots of the hair, by the application of small strips of pitch plaster, (resin mixed with a little flour), which, when taken off, draws with it the roots of the hair; or by carbonate of potassa or soda. In very obstinate cases take one tea-spoonful of mer- cury, dissolve in muriatic acid, and mix with a like quantity of butter, anoint the affected part with it every day, uutil the whole is entirely cleansed. Tar ointment; sulphur ointment; citrin ointment, cod-liver oil, internally and externally; con- centrated acetic acid (applied for a few minutes by means of a sponge, tied to the end of a stick ) are recommended. Homoeopathic remedies are. — Arsenicum, Calcarea, Rhus, Staphysagria, Silicea, and Sulphur, also: Hepar-s., Baryta, Graphites, Lycopodium, and Oleander. Arsenicum: when there is much burning of the affected part when touched; Sulphur, Calcarea and Silicea when the child is scrofulous; Rhus tox, and Staphysagria when the dis- charges are offensive, attended by violent itching, and occuring periodically. Give the proper remedy once or twice a day, for six or seven days, then omit medicine four or five days, and afterward give the next remedy indicated in the same manner. Hydropathic treatment.—Cleanliness; simple diet; exercise in the open air; washing of the head with tepid water twice a day; covering the affected parts with a well wrung bandage; daily ablutions; occasionally a wet sheet pack. Eclectic treatment.—Shave the head as closely as possible, and then apply an elm poultice over the whole scalp, until the soreness and irritation are removed; then wash the head twice a day with strong soap-suds. Once a day wash the head with the tincture of Phyl. Decandi. This plan of treatment should be continued for three or four weeks, but, if it should not prove sufficient, the following ointment may be adopted: Take: liquid pitch, two ounces; Capsicum, thirty grains; TUBERCLES OF THE BRAIN. 225 Sulphate of Zinc, one grain; Creosote, twenty drops; mix in a mortar and apply to the scalp night and morning. If the patient experiences much pain from the application it should not be applied so frequently. Tar ointment and application of the tincture of Sanguinaria and Lobelia equal parts, after each washing, is recommended. If the above treatment should not be sufficient to remove the disease, the irritating plaster should be applied over the whole scalp until free vesication is produced. This will soon be attended with copious, purulent discharges, which should be kept up for ten or twelve days. When the parts become very much inflamed, the slippery elm poultice may be applied until it subsides. The alkaline-bath should be used every day during the treat- ment. The bowels should be kept open and the compound syrup of Stillingia in alterative doses, administered three times a day. Trichiasis. — (See Hair morbid.) TUBERCLES OF THE BRAIN. The first stage of this disease is characterized by a dull pressure upon one part of the head, which gradually increases to a more or less severe periodical pain, accompanied with vertigo. This stage may continue for months—even years; or it may terminate fatally in eight or twelve days. In the latter ease the pains become very severe, the patient being unable to sleep during night. In the second stage the patient has periodical epileptic attacks (aura epileptica is absent), during which the headache always increases in severity, fol- lowed by sopor and drowsiness. The pains are generally confined to one side — the opposite side of that part of the brain which is the seat of the tubercles. Finally, partial paralysis takes place, generally of the opposite organs, the pressure upon the brain and burning pains continuing upon the same part of the head. Causes.—Suppressed gonorrhcea, itch, or menstruation. Treatment promises very little. Foot-baths, proper diet, avoiding mental exertions and mental excitement. Moxa and mild cathartics may be tried. 226 DISEASES OF THE HEAD AND SCALP. VERTIGO — GIDDINESS. All objects, even the patient's own body, appear to him a8 turning round; when the case is severe his sight is obscured and consciousness suspended. In advanced age it is the fore- runner of apoplexy. Causes. — Gastric impurities; worms; flatulency; plethora; congestion of the head; nervous debility; excessive use of tobacco, or ardent spirits; riding in a carriage; suppressed erup- tions ; dried up ulcers. Treatment allopathic — Cold affusions, cold bathing of the head; mustard foot-bath; frequent cupping in the neck; wash- ing the temples, forehead, behind the ears and neck with spirits; issues on the neck, or on the arm; internally, vale- rian and mustard. The following powder has been found a spe- cific: take of resin of guajacum half a drachm, cream of tartar one drachm, white sugar half a drachm, mix; half in the morning, the rest in the evening, to be taken for several days. Homoeopathic treatment, — Aconite and Belladonna, when caused by fullness of habit and congestion, worse on rising from a recumbent posture or on stooping; Nux vomica when caused by disordered stomach with constipation and headache; Antimonium crudum when caused by over-loading the stomach, accompanied with nausea; Pulsatilla when there is confusion of the head, roaring in the ears, worse when stooping or sit- ting, palpitation of the heart; Opium confusion of ideas, hum- ming in the ears, clouded vision on sitting up in bed, vertigo from fright. When caused by riding in a carriage: Cocculus and Petro- leum; by intoxicating drinks: Nux vomica; by debility,China and Ferrum. During a violent attack repeat the proper remedy every fifteen minutes until relief is obtained. To prevent another attack repeat the remedy once a day. Hydropathic treatment, — The rubbing wet sheet, the tepid shallow-bath with much friction, clysters, affusion of cold VESANL/E. 227 water upon the head, tepid foot-baths, diet and exercise con- stitute the principal means of cure. Eclectic treatment.—(See Congestion and other causes.) Vesania\ — Mania, insanity, melancholy, etc. (See under Nervous Diseases.) Ulcers of the brain, abscesses, tumors, atrophy, are diseases of the substance of the brain, but they are generally so obscure that no distinctions can be made, until a post mortem exami- nation reveals the fact. CHAPTER IX. DISEASES OF THE EYES. Abscess. — (See Hypopyon, Inflammation, Lachrymal Ca- runcle, etc.) Albugo.—(See Maculae corneae.) AMAUROSIS — NERVOUS BLINDNESS. Impairment or loss of vision from paralysis of the optic nervous apparatus, without obscuration of the humors, or membranes of the eye. Concomitant symptoms and forebodings are: tension, fixed- ness, and dryness of the eye, with dryness of the nose; impaired vision, double vision, confusion and distortion of objects; or great sensitiveness to light, sparks and flames pass before the eye; eyes and nose moist; eyelids bloated, pupil contracted, the patient sees, or imagines to see blue and yellow spots, or specks. The disease is often accompanied with headache, vertigo, tendency to coma, sleeplessness, etc. It may appear suddenly or gradually. Both eyes generally become affected. Causes.—Over-exertion of the sense of vision; protracting and exhausting disease; suppressed cutaneous eruption ; sup- pressed hemorrhages or mucous discharges; excessive hemor- rhage; excess in venery; abuse of the lancet and calomel; epileptic convulsions; narcotics; injuries of the head; thicken- ing and ossification of the retina. The cure of this disease is generally difficult, and in most cases, impossible. Amaurosis which appears suddenly is more easily cured than that which has come on gradually; Allopathic treatment. — Amaurosis from congestion of the optic nervous apparatus, if early seen, requires,—first, the general antiphlogistic plan of treatment as described under inflammation of the eye, and afterward the tonic and altera- 228 NERVOUS BLINDNESS. 229 tive, together with counter-irritation. When caused by exhaus- tion of the optic nervous apparatus, the plan of treatment fitted for these cases is the tonic and alterative (see ophthalmic inflammations), with counter-irritation. In this form of amau- rosis strychnia and veratria, endermically applied, (by sprink- ling it daily on the raw surface, left by a blister, on the temple, or over the eyebrows, to the quantity of one-eigth or one-half grain at first), have been much recommended; likewise: Gal- vanism and Electricity, Pulsatilla, Arnica and Belladonna. Amaurosis resulting from pressure on some part of the optic nervous apparatus, by tumors, extravasation of blood, collec- tion of fluids, &c, is removable by an operation, if the cause of pressure is seated in the orbit, or in the eye; in other cases the treatment adopted must be regulated according as the gene- ral symptoms agree with one or other of the preceding forms, consisting in the one case, of blood-letting and rnercurializa- tion, in the other of tonics, alteratives, and counter-irritation. When depending upon some irritatiug substance in the stomach or bowels, the irritating cause should be removed by an emetic or cathartic. Perfect repose of the eye is necessary. Homoeopathic treatment.—In incipient amaurosis the follow- ing remedies are indicated: Acidum Sulphuricum, Aurum, Ambra, Cannabis, Drosera, Helleborus, Plumbum ac, Rhus and Sulphur. In scrofulous persons : Calcarea, Kali, Silicea and Sulphur. When it comes on suddenly: Nux v., Rhus t., Veratrum. When attended with swelling of the lower lid, Lachrymation, &c, Digitalis. For mere weakness of sight caused by over-exertion of the eyes: Ruta, externally and internally. When caused by plethora or congestion: Bella- donna and Hyoscyamus; by lifting, straining, etc.: Rhus tox.; by a fall or a blow, Arnica; during pregnancy: Bella- donna, Nux and Pulsatilla; night blindness: Belladonna; blindness during day, the patient seeing best in the dark: Sul- phur and. Silicea; when caused by sexual abuse: Phosphor, Staphysagria and Sepia. 230 DISEASES OP THE EYES'. Hydropathic treatment. — Confirmed amaurosis is incurable. In the incipient stage the simple and single indication is, to invigorate the whole system. The rubbing and wet-sheet, the pack followed by the shallow-bath, or plunge, sitz, and foot- baths, with occasional douches, should be adopted discrimi- natingly to the particular condition of each case. In no dis- ease is strict temperance in eating and drinking more indis- pensable. Eclectic treatment.—Bathing the whole surface in weak lye twice a day, followed by brisk frictions with a harsh towel; daily foot-baths; keeping the head cool; irritating plaster to the neck and spine; pouring a small stream of water on the temples from a considerable height; shocks of electricity; external application of a dilution of the tincture of capsicum. AMBLYOPIA — INCOMPLETE AMAUROSIS. In amblyopy there is constantly present an indistinctness of sight extending to all objects large and small, distant and near. The patient's field of vision is obscured as if a gauze or cloud were interposed between him and the object looked at. Treatment.—(See Amaurosis.) ANKYLOBLEPHARON. Cohesion of the eyelids to each other at their borders. The adhesion is either through the medium of a false membrane, or without any intervening substance; and the borders of the eyelids are united in part only, or in their whole extent. Congenital ankyloblepharon is generally total, and often co-exists with imperfect development of the eyeball; if ac- quired, it is generally the consequence of excoriations by burns or escharotics, in which case it is often complicated with adhesion of the lids to the eyeballs. To determine whether the case is complicated with adhe- sion of the eyelid to the eye-ball, the united eyelids are to be pinched up into a fold, and the patient desired to move the eyeball about, and to make efforts as if to open and shut the eye. During this, the attention of the surgeon is to be WEAK-SIGHTEDNESSS. 231 directed to the eyeball, to discover whether it moves freely behind the eyelids. Treatment — The operation for partial anchyloblepharon is performed by passing a director behind the part where the borders of the eyelids adhere, whilst an assistant stretches the upper eyelid upward, and the lower downward, and separating them with a scalpel, taking care, in the case of immediate union, not to cut the oroper substance of the tarsus either of the one or other eyelid. In the case of total anchyloblepha- ron, if there is an opening at the inner angle, a director or probe is to be passed through it behind the united eyelids, and their separation effected in a manner similar to that just indicated. If, however, there is no opening, the united eye- lids are to be pinched up into a vertical fold and drawn from the eyeball, and the united edges separated at the part. Through the opening thus made, the director is passed, and run along, first to the inner and then to the outer angle, and the adhering parts separated in each direction. To prevent re-union, the eyelids should be frequently drawn from each other after the operation, and the raw borders smeared with tutty ointment, until cicatrization takes place. Union of the skin and conjunctiva at the external angle may be promoted by means of a suture. ASTHENOPY — WEAK-SIGHTEDNESS. An incapacity to exercise vision on near objects, as in reading, sewing and the like, for any length of time. The objects are at first seen distinctly, but the eyes soon become tired and painful, the vision growing confused. Causes. — Over-exertion of the eyes, as in students, artists, clerks, engravers, watchmakers, tailors, seamstresses, etc., with want of sleep, want of exercise in the open air, etc. The com- plaint sometimes occurs as a sequela of inflammation of the eyes. Treatment. — Removal of causes; rest to the eyes; the oc- casional application to them of the cold douche, good diet, country air, sea-bathing, constitute the leading part of the treatment of this disease. (See Amaurosis.) 232 DISEASES OF THE EYES. ATROPHY OF THE EYEBALL. This disease is the result of chronic inflammation, and presents itself in various degrees, from that in wdiich it has lost merely its natural plumpness and feels soft to the touch, to that in which it has become so flaccid and shrunk, that its prominence is gone, and the eyelids are fallen in. The prognosis, as regards vision, is unfavorable. BLEPHARITIS ERYSIPELATOSA. Erysipelatous inflammation of the eyelids generally occurs on one eye only, occasionally on both. Pale, yellowish red, transparent glossy swelling, commencing on the inner edges of the eyelids. The pain is not severe, rather burning and tense; the mucous secretions of the eyes and nose are in- creased; there is some fever; and, after the inflammation, scaling off of the epidermis. Allopathic treatment. — At the commencement of the dis- ease, an emetic, or antiphlogistic cathartic is generally suf- ficient to remove this affection. In the second stage dia- phoretics should be prescribed internally, and dry aromatic applications, as chamomile and elder-flowers, externally. Homoeopathic treatment. — During the inflammatory stage, Aconite, a dose every four to six hours; afterward Hepar sul- phuris, or sulphur, twice a day, will be sufficient to remove the disease. BLEPHARITIS SCROPHULOSA — SCROFULOUS INFLAMMATION OF THE EYELIDS. The margins of the eyelids, are swelled, red, sometimes ex- coriated, and the lids more or less closed; there is photopho- bia, and increased secretion of tears; itching at the borders and angles of the eyelids; in an advanced stage the eyelids become thickened at their borders, the eyelashes are found Bcanty, and closely surrounded at their roots by the crusts covering the ulcers. Causes. — The disease is generally a sequela of some oph- thalmia, or it arises from the spread of some cutaneous erup- tion to the borders of the eyelids; scrofula. PARALYSIS OF THE EYELIDS, 23S Treatment allopathic. — The general treatment must be the same as directed under scrofulous ophthalmia. Local treat- ment consists in the removal of the incrustations from the borders of the eyelids, and plucking out those eyelashes which are loose; the use of the bichloride of mercury eye- water (take: bichloride of mercury one grain, Hydrochlocate of ammonia six grains, rosewrater eight ounces) three times a day; and the application of the weak precipitate salve to the borders of the eyelids at bed-time. If, however, there are much tenderness and irritability, the only local application, at first, should be tepid water to bathe the eyes, and some mild ointment applied to the edges of the eyelids. (See Ophthalmia Scrophulosa.) Blear eyes. — (See Lippitudo.) BLEPHARO - BLENNORRHEA 1DIOPATHICA. A morbid secretion of mucus from the eyelids. Eyelids are painful, red, swollen, and discharge a tenacious matter like mucus, which impairs the vision and causes them to stick together in the morning. There is fever towards evening, with aggravation of all symptoms. Treatment. — This disease is generally preceded by inflam- mation, which must be treated like inflammation of the eye- lids; after which Goulard's eye-water has been used with benefit. BLEPHARO-OPHTHALMITIS—INFLAMMATION OF THE EYELIDS. The eyelids are more or less swollen, red, hot, tense, very sensitive to pressure, and difficult to move; slight fever; first diminished, afterward increased secretion of mucus. Treatment.—Inflammation must be removed by local and general antiphlogistic remedies. (See Ophthalmia.) BLEPHARO-PLEGIA — PARALYSIS OF THE EYELIDS. The patient is unable to raise the upper eyelid, which is somewhat swollen; the vision is impaired (generally sees double); and there exists a sensation of coldness in the supra- orbital region of the affected side, and confusion in the head. Treatment. — If the disease is a purely local affection, fre- 10k 234 DISEASES OF THE EVES. quent washing of the lids, the wet compress, the warm douche on the back part of the ears and neck, have been found useful. BLEPHARO-EMPHYSEMA. Air in the cellular tissue of the eyelids. A tense, elastic swelling, which yields a crepitous sound under pressure. Causes. — Violent cough, emetics, &c. Treatment. — Bathe the eye frequently with fresh spring water, or apply dry aromatic herbs. BLEPIIARO-PTOSIS PARALYTICA — PTOSIS. Hanging down of the upper eyelid over the eye, in conse- quence of paralysis of its levator muscle, permitting the unrestrained action of the orbicularis palpebrarum. The patient can thus open his eye only by raising the eyelid with his finger. Causes. — Paralysis of the nerve of the third pair; injury of the levator palpebral muscle; extension aud relaxation of the skin, or of the whole substance of the eyelid; congenital ptosis. Treatment. — Organic Ptosis can only be remedied by one or the other of the operations described for ectropium. Par- alytic Ptosis requires the application of a strip of plaster, or some such contrivance, to retain the upper eyelid, on one side, open, in order that the person may see to move about. Ptosis from extension and relaxation of the skin can be reme- died by the excision of an elliptical piece of skin as directed for entropium. BLEPHARO-SPASMS--SPASM OR CRAMP OF THE EYELIDS. Sudden and involuntary, or periodical contractions of both eyelids. During such an attack the eyeballs recede into the sockets, the external surface of the eyelids is shriveled, and the muscles of the face are distorted. Voluntary opening of the lids is impossible. Treatment. — During the attack warm water applications, poultices, arnica and chamomile decoctions are advisable. For a radical cure, Belhjdunna, Hyoscyamus, Stramonium, SOFT CANCER, 23S and bathing the eye frequently with cold water, are the prin- cipal means recommended. (See Nictitation.) Blows on eye; Burns of cornea and eyelids. — (See Injuries.) CALCULUS. Lachrymal calculous concretions deposited from the tears have been met with, lodged in the sinuses of the oculo-palpe- bral space of the conjunctiva, in other cases in the derivative lachrymal passages. Meibomian calculus. — Small calcareous concretions some- times form,apparently,in the Meibomian glands, and are seen shining through the palpebral conjunctiva on everting the eyelid. Sometimes they project on the surface of the con- junctiva, acting thus as a cause of irritation to the eye. The removal of such a calculus becomes necessaiy. It is affected by dividing the conjunctiva over it, and turning it out with a cataract needle or the like. CALLOSITY OF THE EYELIDS. A hard, tuberculated, warty-like degeneration of the whole thickness of the eyelid, ending in ulceration, and occurring principally in old people. If not irritated, it may remain Stationary. Sometimes, however, it causes so much irritation to the eye that an operation becomes necessary, which con- sists simply in the amputation of the diseased part. CANCER OF THE EYELIDS — CARCINOMA PALPEBRARUM. Lancinating, severe pains in the affected eyelids; indura- tion of the same, with a violet, dirty color of the conjunctiva. If the disease progresses, ulceration takes place, with the discharge of a bloody, dirty, offensive, watery substance. Treatment. — The only effectual treatment is removal of the affected parts with the knife, together with a portion of the healthy structure immediately around. (See Cancer.) CANCER OF THE EYEBALL—SOFT CANCER — FUNGUS HiEMA- TODES. In the first stage there is seen through the pupil, under certain lights, a whitish-yellow or redish-yellow reflection from the bottom of the eye, somewhat resembling that in the 236 Diseases of the eyes, eyes of the cat. The vision of the eye may be lost from the first, or it may be still partially retained. There is, in gene- ral, no pain, unless there be attendant inflammation. In the second stage the morbid growth begins to increase and is seen, through the now much dilated pupil, to be more or less distinctly lobulated, and to have blood-vessels ramify. ing on its surface. The eyeball gradually becomes more and more enlarged and misshapen from distention. In this state the eyeball protrudes from the orbit, and is ready to burst' the eyelids are swollen, and the patient suffers from severe pains in the eye and head, which are more severe during the night. In the third stage the cornea bursts, and a fungous growth sprouts up, discharging a fetid, bloody, yellowish fluid. Profuse hemorrhage will occur from the slightest touch, or even spontaneously from ulceration. The other eye frequently becomes affected. Under the bleeding, sloughing, ulceration, discharge and constitutional disturbance, the patient sinks rapidly, and dies from exhaustion, or from the brain being involved in the disease. The prognosis is, in the last degree, unfavorable. Treatment — In the early stages the occasional application of leeches, with careful regulation of the bowels, diet and regimen. Extirpation of the eyeball has been generally unsuccessful. In the advanced stages, anodynes are required, both internally and externally. The application of caustic (sesqui-carbonate of potash) and elm poultices are recommended as directed for other cancers. As a palliative use the following: Take of morphium three grains, oil of Hyoscyamus one drachm, make a liniment, and apply externally around the affected eye. CARBUNCLE. This disease sometimes occurs in the eyelids, especially the upper. Treatment is the same as when it occurs on other parts of the body, viz: Opium to relieve suffering, wine and nourishing CATARACT. 237 diet, and a free crucial incision into the swelling, followed by the application of emollient poultices, until the slough sepa- rates, when granulation and cicatrization are to be promoted in the usual manner. Malignant pustule, which is a gangrenous inflammation of the skin and cellular tissue, most frequently produced by contagion from oxen, horses, &c, sometimes affects the eye- lids. Treatment. — Destroy the infected part by caustic. In other respects the treatment is the same as in Carbuncle. CATARACT. This disease consists in a greater or less opacity of the crystaline body, whereby the rays of light are intercepted on their way to the retina, and vision thus impaired or reduced to a mere perception of light and shade. In the commence- ment of the complaint, all objects appear enveloped in a mist, dirty and dusty; the flame of the candle seems surrounded by a glory. As the opacity increases, the sight becomes less perfect, until it is entirely lost. It is to be distinguished from amaurosis by the fact that the opacity in cataract is immediately behind the pupil; in amaurosis it lies deep in the eye, and the sensibility of the iris and retina are affected; — from opaeity of the cornea, by the latter retaining the same compass, whether the pupil contracts or dilates, and may clearly be seen behind it, if looking side-ways at the eye. Cataracts are divided, in respect to the seat of the opacity, into: Cataract lenticularis, where the crystalline lens is af- fected; Cataract capsularis, where the capsule is affected; Cataract morgagnia, where the morgagnian fluid is affected; Cataract universalis, where all the above parts are affected; Cataract dura, when the lens is indurated, chiefly met with in old people; the color is brownish, red or yellowish; Cataract mollis, when the lens is soft, and presents a white, ash-colored appearance; Cataract lactea, when the lens is changed into a milky substance, white and glossy, and uniform in color; 238 DISEASES OF THE EVES. Cataract puriformis, where, in consequence of inflammation^ the lens has become changed into a purulent substance. Causes. — Deep seated inflammation; mechanical violence; exposure of the eye to intensely bright light; hereditary dis- position; scrofula; syphilis; old age; wrant of nutrition; intemperance; congestions to the head; metastasis of gout; suppression of natural secretions; ophthalmia. Treatment — Three kinds of operation have been adopted: Depression, or proper, "couching," is performed by introduc- ing the couching-needle through the sclerotic coat, about two lines from the outer edge of the cornea, and a little below the horizontal axis of the eye, for the purpose of avoiding the long ciliary artery. Carry the point on in a slightly back- ward direction, so as not to touch the iris. When, on looking through the pupil, you can see the point of the needle in front of the lens, proceed to detach the capsule from the lens; then push it down out of sight, leaving the lens clear. If the lens itself, or the posterior capsule, still appear opaque, move an edge of the needle round its margin, so as to separate the lens from the tunica hyoloidea, and then placing its flat surface on the top of the lens, push it down, below the pupil, and a little backward, so that it may enter the vitreous humor. If it does not move readily, the needle may be thrust into it to pull it down. Hold it there for a few minutes, and then gently raise the needle a little. If the lens follows, press it down, and hold it down again for a longer time. Repeat the process until it no longer returns. The eye is to be closed and kept constantly wet with cold water, the patient being kept quiet, and in a dark room, for from two to six weeks. The operation of extraction is performed by passing a cornea knife, with the edge downward, into the transparent cornea, a little within its outer margin, and above its center, straight across, parallel to the iris, thus dividing one-half of the cir- cumference of the tunic, and making an opening sufficiently large to permit the escape of the lens. The instant the knife is removed the lids are closed. After a brief interval th" *"' conjunctivitis. , 239 is again opened, the pointed end of the needle inserted, and the capsule freely lacerated with it. Very slight pressure may then be applied to the eyeball, if the lens do not spon- taneously pass through the opening. The cornea is then ad- justed. Should the iris have slipped through the wound into the cornea, the protrusion must be pressed back, or the eye exposed to a strong light to cause the pupil to contract and draw it back. In operation for absorption, the couching needle is intro- duced in the same manner and place as for depression. The capsule and lens is then broken up into small fragments, which gradually dissolve in the aqueous humor. After these operations both eyes are to be kept closed, and the eye is to be, from time to time, carefully cleansed with tepid water and a soft linen rag. The eye is not to be opened until the fourth or fifth day, but that things are going on well may be inferred if there is no pain, and the upper eyelid neither red nor swollen. (See Illustrations.) Homoeopathists employ, for the cure of cataract, the follow- ing remedies: Causticum, Sulphur, Phosphorus, Calcarea and Conium mac.; the proper remedy to be given once a day, for one or two weeks. cat's eye. This term has been applied to cases of amaurosis, in which there is a reflection from the bottom of the eye similar to that in the cat. Chalazion. — ( See Tumors.) chemosis. Tumefaction of the eyelids. An affection in which the conjunctiva is elevated above the transparent cornea. (See Conjunctivitis and Ophthalmia.) CHOROIDITIS. Inflammation of the choroid seldom appears alone, but gene- rally accompanies ophthalmitis. CONJUNCTIVITIS. Inflammation of the conjunctiva is a usual accompaniement 240 DISEASES OF THE EYES. of ophthalmia, but occurs also itself. The principal symptoms are: redness of the conjunctiva; bloodvessels injected and enlarged; the cornea turpid and opaque; pain and aversion to light; sometimes loss of vision, and spots and ulcers after the inflammation has ceased. Treatment.—(See Ophthalmia.) Double vision.—(See Pseudopia.) Dropsy of the eye.—See Hydrophthalmia. ECCHYMOSIS conjunctivae. Bloody swelling of the conjunctiva is generally caused by mechanical injury, or accidental rupture of a bloodvessel. Treatment—If caused by mechanical injury, make applica- tion of wet compresses, or apply a solution of Arnica tincture. In other cases a wash of borax, half a drachm, and rosewater, one ounce; or red precipitate salve will hasten the absorp- tion. ECCHYMOSIS PALPEBRARUM—BLACK EYE. A red, afterward blueish swelling of the eyelids caused by effusion of blood into the subcutaneous cellular tissue. Treatment.—See Ecchymosis conjunctivae. A cataplasm of the grated roots of convallaria, or "Solomon's seal," is a pop- ular and efficient remedy. ENOANTHIS INFLAMMATORY. Inflammation of the caruncula lachrymalis. A soft, painful, light colored swelling at the inner canthus. By a spasmodic contraction of the puncta lachrymalia the eye is kept con- stantly suffused with tears. Causes.—Cold; foreign bodies; loose eyelashes, etc. Treatment. — All causes of irritation being removed, the inflammation will subside under the use of fomentations with tepid water, rest to the eye, attention to diet, and a little laxative medicine. If not, a leech or two to the skin at the inner angle will prove beneficial. In chronic inflammation, a weak solution of Sulphate of Zinc may be employed. FISTULA LACHRYMALI8. OPERATION FOR STRABISMUS EYE-FORCEPS AND CURVED SCISSORS. FINE EYE HOOKS — DIRECTOR OR CURETTO — TUBE AND STYLE. WIRE-SPRING SPECULUM. <*» -^C^rrmm couching needle, (see cataract.) OPERATION FOR CATARACT. CORNEA-KNIFE—USED IN THE OPERATION FOR CATARACT. POSTERIOR CAPSULAR CATARACT. HARD LENTICULAR CATARACT. FISTULA LACHRYMALIS, (IN- SERTING THE STYLE OR TUBE.) COUCHING, (SEE CATARACT.) SOFT LENTICULAR CATARACT. INVERSION OF THE EYELIDS. 241 ENCANTHIS FUNGOSA. A substantial enlargement, or out-growth of the caruncula lachrymalis. It is soft, easily bleeding, light red, or, of a livid hue. Treatment. — Local abstraction of blood, applications of Goulard's water and anodyne tincture to the diseased mass; also cauterization and excision. Eclectic treatment— Protect the eye by a slippery elm poul- tice, wet with vinegar, then apply freely the pencil of potassa fusa to the cancerous growth, and keep it there for several minutes, so as at once, to disorganize nearly the whole of it. Dress with the slippery elm, to be removed every three or four hours. The sore should further be washed in a strong solu- tion of the milder caustic, and the same article sprinkled occasionally on the face of the slippery elm poultice. After the sloughing of the first eschar, retouch remaining portions of the diseased mass with the stronger caustic, until the whole face of the sore assumes a healthy aspect, then dress as before stated. Excision is performed with the curved scissors, the eyelids being properly secured by an assistant, and the surgeon seizing the tumor by means of the hooked forceps. One-half, or even two-thirds of it,—may be excised. ENTROPIUM — INVERSION OF THE EYELIDS. The free margin of the eyelid with the eyelashes is turned in against the eyeball, which they keep in a state of great irri- tation by the friction they exert upon it. Causes. — Chronic inflammation, injuries; diseased state of the meibomian glands; relaxation of the integuments of the eyelid, and spasmodic contraction of the orbicularis palpebra- rum muscle; contracted and deformed state of the tarsal car- tilage. Treatment.—This consists in the excision, or the destruction by caustic of a portion of the relaxed integuments; or, the subcutaneous section of the orbicularis palpebrarum muscle. Cauterization is not admissible in cases where the skin is 11 242 DISEASES OF THE EVE- very abundant. The escharotic most commonly used for this purpose is concentrated sulphuric acid. By means of a pencil of wood, the acid is to be rubbed over an oval portion of the integuments of a length corresponding to the inversion, and about one-quarter of an inch broad in the middle. Alter a few minutes the eyelid is to be dried with a bit of lint, and the application of the acid repeated; and this again and again, until a sufficient contraction of the skin is produced to bring the eyelid into its proper position. When entropium results from a contracted and deformed state of the tarsal cartilage, an incision must be made through the whole thickness of the lid, and a piece of the skin of the lid excised. The lid is then kept in the everted position by fixing on the cheek the end of the thread forming the suture. ECTROPIUM — EVERSION OF THE EYELIDS. By eversion, the eyelid is necessarily drawn away from the eyelid, its conjunctival surface turned out. The eyeball, being thus deprived of the protection of the eyelid, is exposed to constant irritation, by which a chronic conjunctivitis is kept up. Causes,—generally^ are long continued inflammation of the eyelids, and scrofula. Treatment.—Ectropium from excoriation and contraction of the skin of the eyelid, together with a thickened state of the conjunctiva, requires the repeated application to its surface of the lunar caustic pencil. After the application of the caustic, the part is to be wiped with a bit of lint and then pencilled with sweet oil. The cauterization may be repeated in the course of three or four days. Should this prove insufficient, recourse must be had to the excision of an elliptical shaped piece of the thickened con- junctiva, parallel to the ciliary margin of the eyelid. After cauterization or excision of the conjunctiva, it is well to keep the lid in its proper place by means of strips of plaster, a compress and bandage. When there is evident transverse elongation of the tarsus, the excision of a wedge-shaped piece from the whole substance FISTULA OF THE CORNEA. 243 of the eyelid, will be necessary to restore the eyelid to its natural position. Ectropium, from contraction of the skin in consequence of bad cicatrices, requires extirpation of the cicatrix, or the divi- sion of the contracted skin; and, if the gap left by reinstal- ment of the eyelid in its natural position is very considerable, transplantation of a flap of skin from the temple or cheek. The shortening of the outer fold of the lid can often be effected by cauterizing the lid on the outside; the lengthening of the inner fold by simply incising the mucous membrane. Homoeopathic remedies recommended are: Belladonna, Hepar s., Calcarea, Sulphur, Phosphor, and Causticum. EPIPHORA--WEEPING OR WATERY EYE. Frequent and involuntary flow of tears, producing soreness of the cheeks. This irritation may be owing to inflammation, to the action of chemical or mechanical agents, cold winds, acrid vapours, inverted eyelashes, _&c. Treatment.—Remove the cause, and wash the eye frequently with tepid water. Euphrasia internally and externally is also recommended. FARSIGHTEDNESS With this state of vision the person can see objects dis- tinctly only when they are at a considerable distance from the eye; in reading for example he holds the book at arm's length. Prevention and treatment.—Avoid over-exertion of the eyes, and use convex-glasses. Convex-glasses diminish the diver- gence of the rays of light before they enter the eye, so that they may be more speedily brought to a focus, than they would otherwise have been, in consequence of the diminished refrac- tive power of the eye. FISTULA OF THE CORNEA. A penetrating wound of the cornea, close to its margin, sometimes closes by the conjunctiva alone healing over it, while the proper substance of the cornea remain disunited. The consequence is the aqueous humor elevates the conjunctiva in the form of a vesicle. 214 DECEASES OF TH" EYES. Treatment—After snipping off the elevated conjunctiva the orifice in the proper substance of the cornea, leading into the anterior-chamber, is to be touched freely with the lunar caustic pencil. FISTULA LACHRYMALIS — LACHRYMAL FISTULA. An obstruction in the nasal duct, causing constant accumula- tion and consequent overflow of tears. In some cases the swelling occasions inflammation and ulceration, with an open- ing for the tears on the face, instead of into the nose. Treatment—If inflammation is the cause of the disease it should be promptly removed by cold water applications, poul- tices, leeches, bitter herb fomentations, &c. Should this treat- ment not suffice, washing the surface with the tincture of Capsicum, or introducing sesqui-carbonate of potash within the nose, aud to the mouth of the duct by means of a camol'a hair brush, especially when the obstruction consists in a mor- bid thickening of the Schneiderian membrane, or in incipient polypus, will be found of benefit. In true fistula inject the lachrymal sac with a solution of mild caustic, and distend it by means of violin strings armed with the caustic, or mercurial ointment. If the caustic applications are insufficient, the operation must be performed. A sharp, pointing knife is used to cut, and force an opening into the lachrymal sac. A probe is then introduced into the duct, and made to pass into the nose; after which insert a tent of cat-gut, or some other substance. This should be removed daily, and the parts freely syringed out, till all irritation and soreness have subsided, when the tent may be withdrawn, and the external orifice allowed to heal. Some surgeons introduce a silver or golden tube, or probe, about an inch long, with a round, black head, which allows the tears to flow through the duct by its side and into the nose. It is generally worn for life; it should be changed often. (See Illustrations.) Homoeopathic remedies. — Euphrasia, Silicea, Calcarea, He- par s.. Petroleum and Causticum have been found useful. HEMORRHAGE. 215 Give the proper remedy every other day for a fortnight; the next in order for the same length of time. Foreign substances in the eye.—(See Splinters.) GLAUCOMA — GLAUCOSIS. A greenish or gray opacity of the vitreous humor of the eye, with a more or less loss of vision; a name formerly given to cataract. This complaint frequently succeeds ophthalmia, and generally appears in one eye only. In an advanced stage its cure is impossible. (See Cataract and opacities of the Cornea.) H^EMOPHTHALMUS. Effusion of blood, within the eye is not unfrequently met with as a result of blows and other injuries of the eye. (See Echymosis.) HEMERALOPIA--NIGHT BLINDNESS. Indistinct vision, recurring regularly at night, is sometimes met with as a congenital and habitual infirmity; most fre- quently it is met with as an occasional complaint, especially in warm countries and warm latitudes at sea. Causes. — Fatigue and exposure to the strong light of the sun; gastric derangement; lunar influence. Treatment. — Remove the causes and if afterward the com- plaint has not of itself gone off, a succession of blisters to the temple has been found a most efficacious remedy; also cup- ping and leeches. Homoeopathists employ: Belladonna, Veratrum and Hyos- cyamus. The eyes should be occasionally bathed with cold water. HEMIOPIA. A defect of vision, in which only half of the object is seen. Treatment.—As hemiopy depends simply on fatigue, or gas- tric derangement, the treatment should be regulated accord- ingly. hemorrhage from the eye is generally caused by severe inflammation, or wounds of this organ, and must be treated accordingly. 246 DISEASES OF THE EVES. HORDEOLUM — STYE — BARLEY-CORN. A small, inflamed tumor on the eyelid. It is a miniature boil, and is of quite frequent occurrence in a scrofulous habit. If not interfered with it may eventually be absorbed, or changed into a hard, indolent tumor called grando. Causes.—Scrofulous constitution; derangement of the stom- ach. Treatment.—At the very commencement, the progress of the disease may sometimes be arrested by an emetic, followed by a laxative, and cold applications to the eye, or by touching the inflammatory swelling with caustic. When it is soft, and has matter already formed, puncture and let it out. If it degene- rates into a Grando, or indurated stye, apply tincture of myrrh, or slightly touch the tumor with the pencil of caustic potash; after which it will come off in the poultice. Homoeopathists employ the following remedies: Aconite, Belladonna and Pulsatilla, when the tumor is exceedingly painful and pulsating; Sulphur, when there is much itching of the eyelids ; Sulphur and Silicea, when ulceration has com- menced, and the patient is of a scrofulous habit; Staphysagria) when it degenerates into a hard tumor. HYDATID. Three cases are on record in which a living hydatid, floating free in the aqueous humor was observed. In one case the hydatid was extracted alive. HYDROPHTHALMIA--DROPSY OF THE EYE. A gradual enlargement of the globe of the eye caused by an accumulation of a watery fluid. As this accumulation in- creases, the membranes become very tense, and the eyeball protrudes from the socket; the pains become excessive; head- ache also sets in, and the sight is considerably affected; the iris looks as if deeper seated than natural, is darker colored, immoveable, and appears floating and tremulous. The eyeball feels hard and the patients are short-sighted. If the morbid fluid is not absorbed or evacuated, inflammation sets in and terminates in suppuration, thus destroying the eye. HVPOPI'UN. 245 Causes.— Cachectic state of the constitution; iujuries. Treatment.—If the disease is of an inflammatory character, leeches around the eyes and cooling purgatives to be repeated once a week, are indicated. Diuretics and the alkaline-bath, with frictions, to bear upon the drainage from the surface, should be used at the same time. Gentle compression of the eyeball, friction with mercurial or iodine ointment round the eye, blisters on the neck, or behind the ears, change of air, tonics &c, may be tried. If the accumulation of water goes on in spite of these measures, tapping of the eye must be re- sorted to. In dropsy of the aqueous chambers (anterior Hy- drophthalmia) introduce the point of a lancet, or better, a couching-needle into the anterior chamber, through the cornea; in posterior hydrophthalmia into the posterior chamber, behind the junction of the cornea with the sclerotic coat, as is directed for cataract. HYPOLYMPII A-— L VMP1I-EY F. Effusion of a lymphy fluid into the chambers of the aqueous humor of the eye. We perceive in the back chamber of the eye a grayish substance, interwoven with small vessels. The pupil is immovable, and, in some eases, covered with a fine delicate net. Treatment. — Increase and excite the function of resorption by counter-irritation, or alterative remedies. Unguentuni neapoh, with opium rubbed into the eyebrows, has proved of benefit. HYPOPYON. This name has been given to a collection of pus, or puri- form matter occupying the bottom of the anterior chamber. It is, generally:, the consequence of various forms of ophthal- mic inflammation. Treatment. — The inflammation, which is still going on, should be subdued as quickly as possible, and then the accu- mulated matter will, in general, soon disappear. When the accumulation of water is considerable, it may be advisable to have recourse to paracentesis cornese. The operation should. 248 DISEASES OF THE EYES. in this case, consist in the removal of a section of the lower part of the cornea, with a cataract knife, to the extent of one-fourth of its circumference. Intolerance of light. — (See Photophobia.) IRITIS-—IRID1TIS. Inflammation of the iris is accompanied with great sensi- bility of the eye, intolerance of light, lancinating pain from the eyebrow to the orbit, and darting through the ball. There is no redness, or change in the outer coat of the eye. It terminates frequently in adhesion, and in some cases lymph is thrown out, occasioning obstruction of sight. Causes. — Syphilis; wounds; bruises; strong light; over-exer- tion of the eyes; abuse of mercury; scrofula; gout; rheu- matism. Treatmant — Bleeding; two grains of calomel with one- quarter of a grain of opium every six to eight hours, with nitre and barley-water in the intervals. Two or three drops of a solution of the extract of belladonna may be introduced between the eyelids, or the eyebrow is to be constantly kept smeared with belladonna. In severe pains around and over the orbit of the eye at night, take ten grains of mercurial ointment, mix intimately with two grains of powdered opium, and rub it well into the temple, a little while before the noc- turnal pain is accustomed to recur. When the inflammation begins to yield, counter-irritation, repeated occasionally, will promote the cure. Homoeopathic remedies. — Iritis arthritica requires: Coccu- lus, Staphysagria, Conium, Lycopodium, Calcarea, Nux v., Bryonia and Spigelia. Iritis mercurialis: Hepar s., Acidum nitricum, Lachesis. (See Rheumatic Ophthalmia.) Iris, protrusion of the — Procidentia iridis.—Pro- trusion of the iris through a wound or ulcer in the cornea and its coverings. It is accompanied with severe p.; in, and intolerance of light; and the pupil assumes an oval shape. Treatment — If caused by a wound, attempt to return the LEUC0MA. 249 iris. If caused by an ulcer, cure the ulcer by applications of mild caustics, followed by emollients. The'application of the caustic should be made with great care in order to prevent doing harm to sound parts. Apply a crust of slippery elm wet with vinegar, making a hole over the ulcer, or over the point to be cauterized. KERATITIS — CORNEITIS. Acute inflammation of the cornea is very seldom found as a distinct species of disease, but generally accompanied with inflammation of the conjunctiva. (See Ophthalmia.) LAGOPHTIIALMOS--RABBIT'S EYE. The patient cannot close the eyelids, and sleeps with the lids open. The disease is the result of too short eyelids, or is caused by muscular contraction or palsy; and curable by corresponding means. Mechanical expansion of the lids by means of straps of adhesive plaster; antispasmodic ointments; formation of arti- ficial lids, are indicated. Leucoma. — (See Maculae Corneae.) LIPPITUDO--BLEAR-EYE. A chronic catarrhal inflammation of the eyelids. Eyelids are red and swollen, motion and light are painful, tears hot, and there is a discharge of purulent mucus, which causes glueing together of the eyelids during the night, and forma- tion of yellowish scabs. Treatment.— Lead, and mercurial collyria, are recommended. Homoeopathic remedies. — Aconite, Euphrasia, Mercurius, Rhus and Spigelia, Luscitas. — (See Strabismus.) MACULE CORNER — OPACITY OF THE CORNEA—ALBUGO — NE U V LA--LEUCOMA. Ppots or films on the cornea. This disease is generally the result of acute ophthalmia of the conjunctiva, leaving a pre- ternatural deposit between that membrane and the cornea, occasioning difficulty of vision. The opacity may cover the whole of the cornea, or appear in distinct specks, which are 250 DISEASES OF THE EYES. furnished with separate vessels. All specks on the cornea are, more or less, of a whitish color, and, according to the different degrees of whiteness, are called Albugo, Lcuco- ma, &c. Treatment allopathic, — Application of astringent and stim- ulating washes, compound tincture of myrrh (Gum myrrh ten ounces, Capsicum eight ounces, Alcohol one gallon); mild caustic solutions, zincum sulphuricum, borax, alum, sugar of lead, tin filings, common table salt, mercurial ointment, ex- tractum cicutae; loaf sugar blown into the eye through a quill, or laid on dry; honey ayplied directly to the eye as it can be borne; showering the temples; alteratives and counter- irritants, are the principal means employed for the removal of this disease. Homoeopathic remedies. — Belladonna, Euphrasia, Sulphur, Calcarea, Silicea, Hepar s. and Pulsatilla, externally and internally. The remedy indicated to be given twice a day for eight days. MYDRIASIS. An unnatural dilated state of the pupil. The iris is im- moveable and nearly invisible, the margin of the pupil irreg- ular, vision impaired, other parts of the eye weak and torpid. That a case is one of simple mydriasis, and not a symptom of amaurosis, is ascertained by requesting the patient to look through an aperture, of the ordinary size of the pupil, in a card blackened on the surface next the eye, when he will be able to see objects quite distinctly. Vision is also improved by convex glasses, and is better in dull light. Treatment. — Simple uncomplicated mydriasis is sometimes removed by irritating applications to the conjunctiva, as: Sulphuric ether, tincture of Cantharides, oil of Camphor, Turpentine and Electricity. MYOSIS. Unnatural contraction of the pupil. It does not disturb vision much, except in weak light, and does not usually come under the notice of the practitioner. ACUTE INFLAMMATION OF THE EYES. 251 MYOPIA — SHORT-SIGHTEDNESS. This is that state of vision in which the person can see objects distinctly only when they are at a very short distance from the eyes; a distance of nine inches or less, and consists in a too great thickness, density or convexity of the lenses or humors of the eyes, whereby the rays of light are brought to a focus before they reach the retina. Causes.^Ophthalmia; typhus; loss of fluids; over-doses of mercury; scrofula; onanism; &c. In many cases it is con- genital. Treatment — Remove the causes, improve the general health, and use concave glasses. Concave glasses help the vision of short-sighted persons for distant objects, by increasing the divergence of the rays of light before they enter the eye, so that they are less speedily brought to foci than they would otherwise have been, in consequence of the increased reactive power of the media of the eye, or that they may be brought to foci at a greater distance behind the lens, in order to cor- respond with the greater distance of the retina behind the lens. Homaopathists employ: Pulsatilla and Sulphur, when the sequel of Ophthalmia; Acidum phosphoricum, when resulting from Typhus or from loss of fluid; Nitric acid, Sulphur and Carbo v., when attributable to the effects of Mercury. In some cases Conium and Petroleum are indicated. Near-sightedness. — (See Myopia.) Night-blindness. — (See Hemeralopia.) ONYX--UNGUIS. A small collection of pus in the anterior chamber of the aqueous humors. Some denote by this term a small abscess between the layers of the cornea. (See Hypopyon.) OPHTHALMIA — ACUTE INFLAMMATION OF THE EYES. Superficial, bright, scarlet redness, pain and heat of the eye; uneasy sensation, itching or scratching in the eye; sensibility to the action of light; dryness, or increased secretion of tears, or mucus; in some cases headache and fever. In severe cases the entire eyeball is affected (ophthal- 252 DISEASES OF THE EYES. mitis); or the sclerotic coat (Sclerotitis), in which latter case the redness presents a pink or slight violet appearance, and pain more severe and aggravated toward night. Common Ophthalmia consists, generally, in simple inflammation of the membrana conjunctiva (Conjunctivitis), or catarrhal ophthal- mia (cold in the eye) which is frequently characterized by a sticking together of the eyelashes and lids. This inflamma- tion usually terminates in resolution. In some cases the con- junctiva becomes thickened, or the disease may even spread in the suppurative stage to the extent of separating the cornea from its attachments. Causes. — Congestion, catarrh, rheumatism; exposure to extreme light, the strong heat of a fire; external injuries and cold. Allopathic treatment. — In slight cases no remedies of an active kind are ever necessary. The patient should avoid ex- posure to draughts of air, and to cold and moisture. A cathartic of calomel and jalap should be given. If the inflammation is very severe, venesections, leeches, calomel three grains every six hours, and cool fomentations of weak acetate of lead, or sulphur of zinc water, should be employed. Some writers recommend nitrate of silver in distilled water in the proportion of four grains to the ounce, a drop to bo ap- plied to the membrane once or twice in the course of the day, by placing the drop in the hollow formed at the internal angle of the eye. Moderate perspiration should be encour- aged by Dover's powder, warm foot-baths and warm drinks. To obviate the gumming together of the eyelids, the tarsal edges of the eyelids should be smeared at bed-time with any mild ointment, the spermaceti ointment, or a bit of lard. Dry inflammation generally bears Collyria or eyewashes better; the moist, oily salves, among which that of red precipitate deserves the preference. Homoeopathic remedies. — Aconite: Considerable inflamma- tion of the eye, attended with high fever. Belladonna: Redness of the eye; burning dryness; intol- OPHTHALMIA. 253 erance of light; lacerating pain; pain deep in the orbits; dimness and cloudiness of vision toward evening; objects iq.-pear double; severe headache; dry, spasmodic cough, ag- gravated toward night. Nux vomica: Burning, pressive pains; a feeling as of sand in the eye, with stiffness, smarting, tickling and itching; the eye bloodshot, with adhesion of the eyelids; affection worse toward morning. Cinchona: Motion of the eye painful, with a sensation as of sand in the eye, aggravated toward evening; headache arising from suppression of the nasal secretion. Arsenicum: Severe, burning pain; specks and ulcers on the cornea. Euphrasia: Affection of the eyelids; swelling of the lids; pressure and smarting in the eyes; profuse and acrid flow of tears; secretion of mucus; pustules on the cornea; intole- rance of light; profuse, fluent, nasal discharge; violent head- ache ; aggravation toward evening. Ignatia: Flow of tears; intolerance of light; little or no redness of the eyeball. Pulsatilla: Burning and smarting in the eye, as if from sand under the lids; redness of the eyes and eyelids; copious secretion of mucus; disordered stomach; lachrymation; pho- tophobia; aggravation toward evening; disposition to weep. Mercurius sol: Iritis; pains and pressure as if from sand, especially on reading and when at rest in bed; itching in the eyes; injection of the veins; burning, acrid tears; photopho- bia; pustules and scabs round the eyes and at the margins of the eyelids; cloudiness of sight; pustules and ulcers on the cornea. Spigelia: Sharp, penetrating pains, extending into the head; periodical pains; sensation of enlargement of the eye. Sulphur: Inflammation of the eyes of all kinds; pressure, burning, smarting, as if from sand; specks, vesicles or ulcers on the cornea; copious lachrymation and excessive photopho- bia; dryness of the eyes. 254 DISEASES OF THE EVES. Arnica: Internally and externally, if inflammation is the result of mechanical injury. The proper remedy should be repeated every two to six hours. Dry cups to the temples are often of great benefit. Ophthalmia with cedematous swelling requires: Rhus and Clematis; and when a burning pain is the prominent symp- tom: Arsenicum, Capsicum and Carbo veg. Chronic cases require principally Hepar s. c.; also: Graph- ites, Calcarea, Petroleum, Perrum and Nitric acid. Hydropathic treatment. — Keep the eye at rest and shaded from strong light, but not confined from the air by close bandaging. Apply linen cloths wet in water, of such tem- perature as most agreeable to the feelings; until the tempera- ture becomes natural, and the redness disappears. Wet the head often in cold water. If there are irregular chills and heat, employ the wet-sheet pack once or twice daily for an hour, followed by the cold ablution. Move the bowels freely with tepid water injections. If the feet are cold, use warm foot-baths. Holding, and opening and shutting the eyes in tepid or warm water four or five times a day, during five or more minutes, is highly useful. The face, throat and neck should be frequently washed with cold water; the skin be kept in a clean and active state, and the patient eat nothing stronger than water-gruel, until the violence of the disease has very materially abated. The more chronic the disease, the less cold the water should be. Eclectic treatment. — In slight inflammation of the eyes, very little treatment is required. Cold water applications during the day, with a slippery elm poultice at night, will be all-sufficient. In more severe cases one of the most soothing applications is a poultice of the leaves of Scrofularia rnary- landica. (Wet and wash the green leaves in warm water and apply to the eye.) In obstinate cases, an infusion of Hydras- tus canadensis with the addition of Borax (two drachms to the pint) may be made use of with good effect. General OPHTHALMIA ERYSIPELATOSA 255 treatment, however, is considered of more importance than local means. The patient's feet should be immersed in warm water, and while in that situation, his whole body should be subjected to the alkaline wash, which wash is made by pour- in^ scalding water on wood-ashes, and using it cold or warm, according to the reactive powers of the patient. This bath is to be followed up with the alcoholic vapor-bath, during which the patient should drink some diaphoretic tea. As soon as he perspires freely give him cold water, and have the same applied to the eyes. Emetics of lobelia, and cathartics of cream of tartar and jalap, may also be beneficial in cases accompanied with gastric derangement. If the disease passes into chronic ophthalmia, stimulating applications must be made, as diluted tincture of capsicum; an irritating plaster applied to the neck till it produces sup- puration. Should this not succeed, apply the fly-blister, in which case the surface should be moistened with sweet oil to prevent absorption. As soon as the cuticle is removed, apply the irritating plaster. For weakness of the eyes and photophobia remaining after inflammations, combine with the stimulants the tincture of galls, the extract of oak-bark or a strong decoction af rose- mary. Should the eye get worse instead of better, discontinue this treatment, and resume cooling and soothing measures. OPHTHALMIA ERYSIPELATOSA. The conjunctiva is always more or less affected in erysipelas of the eyelids; there is an uneasy sensation of pressure and tension about the eye when it is moved, with itching and smarting pain, and some impatience of light. Causes.—Exposure to wet and cold; injuries, &c. Treatment allopathic. — Three grains of mercurial chalk, with watery extract of aloes, and extract of hyoscyamus, of each one grain at bed-time, followed by a purgative draught in the morning; and as a collyrium, the solution of the bichlo- ride of mercury, with vinum opii, will in general suffice to check the disease. 256 DISEASES OF THE EYES. Instead of a lotion, some prefer*dry warmth, by means of medicated bags hung over the eye. (See Ophthalmia.) OPHTHALMIA GONORRIIOICA. This ophthalmia resembles very much the severest form of Egyptian ophthalmia, and is caused or accompanied by clap or gonorrhoea. Treatment.—Besides bleeding and leeches, minute doses of a mercurial preparation internally, and red precipitate ointment externally. (See Egytian Ophthalmia). Homoeopathic remedies.—Mercurial preparations are the specific; mercurius sol. and sublimate deserve the perference to be administered at short intervals in a low trituration, Nitric acid, Hepar s., and Sulphur may be indicated, at the close of the treatment. OPHTHALMIA NEONATORUM. Ophthalmia of new born infants appears as very trifling at first and yields readily to proper treatment, but is the most dangerous of inflammations of the eye when it finds its way into foundling hospitals, or into the cottages of the poor. The inflammation usually comes on between the first and tenth day after the birth of the child. The general symptoms are: intolerance of light, glueing together of the eyelids, spasmodic closing of the eyelids, reddening of the border of the upper eyelid; cedematous swelling of both eyelids; increase of flow of tears; discharge of pus at the inner angle of the eye. In this way, first one eye, and, in a day or two, the other becomes affected. That first affected generally suffers most in the course of the disease. The swelling and redness increases, the conjunctiva of the upper lid rises in blisters, and forms a dark red lump, which sometimes hangs down to the nose, laying the foundation for eversion of the eyelids. Mucus and pus, often mixed with blood, flow from the fiery eyelids, and occasion swelling and soreness of the cheeks and other parts. Should the inflammation attack the conjunctiva of the eyeball, the heat, swelling and pain will increase and generally ter- minate in colliquation and blindness. As long as the OPHTHALMIA NEONATORUM 257 cornea remains brilliant and uninjured the child1 s eye ia Bafe. The discharge from the infant's eye is highly conta- gious. •Causes.—Leucorrhcea or gonorrhcea of the mother, the chil- dren being exposed to these morbid secretions as they are brought into the world; strong light; irritants, such as soap or spirits used in washing the infant; contagion. Treatment.—In severe cases apply a leech upon the centre of the tumid upper lid; open the bowels by a little castor-oil, and apply to the inflamed part a lotion, made by dissolving two grains of acetate of lead in an ounce of water. In less severe cases keep the bowels open with Magnesia; apply a little lard along the edges of the lids to prevent them from sticking together, and inject into the eye a solution of alum (four grains to one ounce ©f water.) In some eases nitrate of silver (one to four grains in an ounce of water) may be substituted with advantage. A strong infusion of common tea introduced between the lids is an excellent application. Small blisters behind the ear and red precipitate ointment have been employed in severe cases. Whenever the eyelids become everted, they should be imme- diately restored to their proper position, which is done by seizing the eyelid between the finger and thumb, drawing it a little from the eyeball, and then turning it down. Homoeopathic treatment — Keep the infant in a dark and well ventilated room; wash the mucous secretions carefully and frequently with a soft sponge wet with tepid water, taking care not to touch the eyeball. Give Aconite three or four times a day, until the inflamma- tion has been subdued, and an increase in the secretion of mucus takes place. Then according to circumstances give Chamomilla, Nux v., Bryonia, Belladonna, Pulsatilla, &c. Chamomilla and Calcarea are the most valuable remedies. In the second stage use externally and internally Euphrasia, and next Borax and Pulsatilla, Rhus t., Calcarea and Sulphur. If caused by Leucorrhcea or Syphilis: Mercurius sol., and llL 258 DISEASES OF THE EYES. Nitric acid are indicated. The best treatment is to give seve- ral doses of Aconite and then proceed to low triturations of Mercury and Sulphur. Hydropathic treatment is the same as in the case of the adult, substituting the warm or tepid bath for the pack. Eclectic treatment—Applications of the tincture of Myrrh every six to eight hours. In severe eases a cloth wet with the tincture should be laid over the affected eye, and although these applications may increase the pain for a few minutes, it soon relieves the suffering. Reapply the tincture three times a day for two days, and once on each of the two following days. The lye-bath is always of great value. OPHTHALMIA PURULENTA Inflammation of the eyes with discharge of pus. There are three varieties: purulent, or contagious ophthalmia of adults; (Egyptian Ophthalmia.) 2, gonorrhceal ophthalmia; and 3, purulent ophthalmia of new born children. Of the two latter we have already given symptoms and treatment. The symptoms of the first and second degrees of Egyptian ophthalmia do not essentially differ, from those of the milder and severe forms of catarrhal ophthalmia, except in the gran- ular state of tho conjunctiva, which presents itself in Egyptian Ophthalmia from the first, and remains to the last. In the third degree a copious discharge of thick, yellow matter flows from between the swollen lids, and excoriates the cheek; the conjunctiva protrudes; the upper lid is hard, swollen and stiff (chemosis); and there is sometimes pulsation, throbbing, peri- odical pain, in which case the sclerotica and cornea are affected, the latter generally giving away. Egyptian Ophthalmia gene- rally affects both eyes; on the other hand gonorrhceal ophthal- mia is mostly limited to one eye. This disease affected severely the English and French armies in Egypt, and has since raged in the armies of almost all the states of Europe. Treatment — In the first degree, leeches around the eye; opening medicine; lotions of tepid water; penciling the palpe- OPHTHALMIA SCROPMULOSA. 259 bral conjunctiva once a day with the nitrate of silver drops, of with the red precipitate ointment. In the severer degree of the disease, if the patient possess sufficient strength, venesection, followed at bed-time with Dover's powder ten to twenty grains, and calomel three grains, and a black draught the next morning. The eye must be bathed and cleansed frequently with tepid water, or the tepid solution of alum, or of bichloride of mercury. A solution of alum (8 or 10 grains to the ounce of distilled water) to be injected under the lids every quarter of an hour; or nitrate of Silver (3 or 4 grains to the ounce) to be "applied three times a day have been employed with benefit. It is useful, after employing the nitrate of Silver for a few days, to change it from the alum, or vice versa. Eclectic treatment.—The tincture of Myrrh should be applied as recommended for Ophthalmia neonatorum, combined with gome astringent, such as the Geranium maculatum, or strong infusion of Sumach-berries; but it requires to be continued for several weeks after the more prominent symptoms have subsided. OPHTHALMIA SCROPHULOSA. Scrofulous or strumous inflammation of the eyes, occurs gene- rally in children of a scrofulous habit, and is mostly prevalent from the time of weaning to about the age of eight. The leading symptoms are slight redness; great intolerance of light; pustules and specks on the surface of the conjunctiva; eyelids spasmodically closed; child's brow knit and contracted; dis- charge of scalding tears when opening the eyes, which exco- riate the surrounding parts. One eye is generally worse than the other. When little or no redness exists and great intoler- ance of light, it has been called Photophobia scrophulosa. Treatment allopathic.—Correction of the unnatural condi- tion of the whole system, and especially of the digestive or- gans. Clear the bowels occasionally by a mercurial purge, aud regulate them at other times by Rhubarb, Senna, or Cas- tor oil. Recovery will be promoted by nourishing plain food; 260 DISEASES OF THE EVJsSi change of air; exercise; daily ablutions, and respiration of a pure mountainous atmosphere. Preparations of iron or tho dilute mineral acids should be administered. The best remedy, however, is sulphate of quinine, a grain to be given three times a day, dissolved in water with a drop of dilute Sulphuric acid and syrup of orange peel. The application of a few leeches around the eye; counter-irritation by blisters behind the ears; belladonna lotion to the eye itself; steaming the eyes with the vapor of hot water impregnated with belladonna, are servicea- ble means. When the acute symptoms have been overcome, recourse may be had to the application of nitrate of Silver drops to the eye once a day. The eyes may be protected by a large shade like a bonnet front. In tedious cases the vinum opii, the solution of lunar caus- tic, and the red precipitate ointment—if not employed too long, will be found beneficial. An infusion or decoction of walnut leaves has been successfully used. Ulceration going on in the cornea may be checked by touching its surface once in two or three days with a pencil of lunar caustic. The crusts on the surrounding parts are to be removed by a poultice, and bathing the parts with a lotion made by mixing the oxide of Zinc with water, (a drachm to four ounces of rosewater); which will speedily dry up the discharge and re- move the disfiguring crusts. Homoeopathic remedies.—Besides the remedies already men- tioned under Ophthalmia, the following will be found indi- cated: Arsenicum, Conium, Hepar, Sulphur, Calcarea, Dulca- mara, Ferrum, Graphites, Sepia, Petroleum and Phosphor,—a dose every three to four days. (See Scrofula and Ophthalmia.) OPHTHALMIA RHEUMATICA--ARTHRITICA. This affection occurs in persons who are subject to Rheu- matism or Gout, and consists in inflammation of the Sclerotica. The principal symptoms are: eyelids slightly reddened, swol- len, exuding an acrid secretion; photophobia; dull, dirty appearance of the Sclerotica; pain in the eye when exposed to PANNUS. 261 light; repeated attacks cause effusion of lymph, contraction of the pupil and impaired vision. Causes are the same as those of Gout and Rheumatism. Treatment allopathic.—Moderate topical bleedings, counter- irritation; improvement of general health; change of air; regulation of the bowels, and employment of those remedies mentioned already under Ophthalmia. Oil of turpentine in drachm doses three times a day has been recommended; also Colchicum and the solution of hydriodate of potash. Homoeopathic remedies. — Aconite, Belladonna, Spigelia, Rhus, Coloeynth and other remedies recommended for Rheu- matism. Ohthalmia hemorrhoidals; Ophthalmia menstru- alis; Ophthalmia herpetica; Ophthalmia morbillosa; Ophthalmia syphilitica, psorica, scorbutica, senilis. The treatment of these species of inflammation of the eyes requires the removal of the cause, indicated by their names, and the employment of the remedies mentioned under Oph- thalmia. ophthalmia tarsi. Inflammation of the margins of the eyelids, or meibomian glands, causing intolerable itching, and glueing together of the lids. The eyelashes not unfrequently drop off, leaving the edges of the lids smooth, glossy and red, and causing a great disfigurement of the countenance. Treatment.—(See Ophthalmia.) To prevent the "glueing up" of the eyelids during sleep, apply a little lard oil to the edges of the lids. In chronic affections the application of mild caustics, and the tincture of Capsicum will become necessary. Ophthalmia blenorrhoea.—(See purulent ophthalmia.) PANNUS. Vascular cornea, in which its mucous covering is so loosened and thickened as to present the appearance of a dense pellicle. Symptoms.—Eyeball dark red, appearing like a piece of dark red cloth; intolerance of light; impaired vision; small 262 diseases of the eyes. fleshy pimples upon the conjunctiva; increased flow of teare^ and discharge of mucus; pupil and iris become invisible. Treatment — The source of irritation being removed, the vascularity of the cornea sometimes subsides of itself, or with the assistance of local applications, such as the strong red precipitate or nitrate of silver ointment, counter-irritation and tonics, or good diet, and change of air. PEDICULI CILIORUM. Lice of the eyelashes are removed by cleanliness, and the application of red precipitate ointment. PHOTOPHOBIA. Intolerance of light is a very frequent symptom in the Oph- thalmias; but that in which it occurs in the highest degree is the scrophulous ophthalmia of children. Treatment consists in the removal of the original dis- ease. Belladonna, Valeriana, eye-baths, eye-douche and foot-baths are highly useful. Pladarotes.—(See Trachoma.) Presbyopia.—(See Farsightedness.) PSEUDOPIA. A delusion of the sense of vision; seeing something where there is no object, or wrongly perceiving what is visible; or seeing flocks and sparks (seotomia); seeing colors and various apparitions; seeing half; seeing double (diplopia). This illu- sion of the senses may increase into an exhibition of real images and apparitions, and originates in an altered tone of the nerves, either of the external or the internal sense brought on by local or sympathetic irritation. The sympathetic is most frequently abdominal and therefore occurs often to hypo- chondrial and hysterical persons. Persons suffering under an accumulation of wind will suddenly become affected with half- sight, they see all objects only half; as soon as they discharge flatus, they can see them whole again. Other causes are congestions, metastases, or nervousness, and the treatment must be adopted accordingly. STAPHYLOMA CORNER. 263 Prurigo palpebrarum.—Itching of the eyelids. (See Oph- thalmia, tarsi). PTERYGIUM — WEB. A thickened state of the conjunctiva, so called from its triangular shape. It appears generally as a small reddish tumor at the inner corner of the eye, and spreads from the caruncula lachrymalis toward the cornea. Its growth is rapid when irritated or inflamed. The subjects of it are generally old persons, and laborers whose work exposed them to the entrance of mortar and stone dust into the eye. Treatment—Pterygium may sometimes be removed by fre- quently touching it with the nitrate of silver solution or with vinum opii. Powdered caustic may be applied with a camel's hair pencil in the morning, and a few drops of the tincture of myrrh and capsicum in the evening. If these means do not succeed, raise the tumor with forceps, cut between the diseased growth and the membrane beneath with a fine scalpel, and finish the operation with curved scis- sors, or the scissors and forceps alone may be used for the whole operation. (See Encanthis). RETINITIS — INFLAMMATION OF THE RETINA. Sensation of fullness, stitches, or painful pressure in the interior of the orbit, Photophobia, Pseudopia, difficulty of motion of the contracted pupil, and a slight redness in the white of the eye. Treatment. — Besides the general antiphlogistic treatment, Belladonna and Hyoscyamus are very useful. (See Amaurosis) Spasms of the eyelids.—(See Blepharo-spasms). STAPHYLOMA CORNEiE. (A swelling like a grape).—A disease of the substance of the cornea, resulting in thickening and opacity of its layers, and a considerable protrusion of its anterior surface In ad- vanced stages of the disease, the before enlarged cornea ia sometimes absorbed, when both the anterior and posterior chambers of the eye seem to be filled with matter. 264 DISEASES OF THE EYES. Treatment is seldom of any avail. The inflammation should be reduced; and in some cases puncturing of the eye and let- ting out the humors will be necessary to relieve pain, which however should be avoided if possible. The alkaline-bath, tincture of capsicum to the eye, applica- tion of powdered caustic may, in some cases, relieve pain and swelling without destroying the sight. SPLINTERS AND OTHER FOREIGN SUBSTANCES IN THE EYE. The removal of foreign substances from beneath the lids, or within the coats of the ball is in some cases accomplished by a thorough washing of the parts; in others it will be neces- sary to use manual means. If the substance is under the lower lid, this should be brought down, till it can be removed with a piece of moistened paper or fine linen. If under the upper lid this should be held back by the elevator or specu- lum, or everted over a pencil or other convenient article, when the offending substance should be wiped away by a camel's hair pencil or moistened sponge. When small sharp sub- stances stick in the eye, they should be pressed out with the edge of the cataract needle. Grains of powder or specks of metal,— (pieces of percussion caps excepted),—sticking deep in the eye are better left where they are, as dissecting them out is very dangerous. The inflammation must be promptly kept down. When lime or mortar gets in the eyes, wash with diluted vinegar or lemon juice. STRABISMUS — SQUINTING. An affection of the eye, or more properly speaking of the muscles of -the eye, whereby it is turned obliquely from the axis of vision. The eyes do not act in harmony, and the per- son seems to be looking two ways at once. If both eyes have changed their natural axes, the patient appears to be looking away from the object before him. Such states of the eye may be temporary or permanent. In the former case there is a spasmodic contraction of some of the muscles of the globe, occurring in connection with cerebral affections of children, or are caused by intestinal irritation from worms. In such SQUINTING. 205 cases a dark shade should be worn over the affected eye with a small opening for light in the centre. The confirmed or permanent squinting is caused by a relaxa- tion of the muscles not acting, which is thus allowed to be- come a permanent shortening. The deficiency of power is generally in the rectus externus, the internal rectus drawing the eyeball toward the nose. Causes.—It may be congenital or caused by bad habits; by fevers, worms, constipation, excessive study, &c. Treatment.—The operation (Strabotomy) consists in divid- ing the shortened or permanently contracted muscles. Cut through the conjunctiva, pass a small blunt hook under the muscle in order to draw it out somewhat, and then divide it with the scissors, from below upward, near its in- sertion. (See Illustrations.) If, after this is done, the eye does not admit of being freely moved, an exploration of the bottom of the wound is to be made with the hook, in order that if this be owing to any bands of cellular tissue remaining uncut, they may be raised and divided. The weak eye should be strengthened by use, covering the sound one from time to time. The following plan of exercis- ing the eye is recommended: close the sound eye and look at some particular object with the weak one ; then open the sound eye, upon this, the squinting one will immediately diverge; but by perseverance the patient may educate it till he can keep it parallel with the other. Homoeopathic remedies.—Belladonna, Ilyoscyamus and Alum in congenital cases, or when it depends upon a congested state of the brain. Cina, Belladonna and Hyoscyamus, when depending upon verminous irritation of the stomach and bowels. Nux v., Rhus t, Veratrum and Spigelia, when it Qjpcurs sud- denly from paralysis of the muscles of the eye. In chronic cases give the proper remedies twice a week; in recent, symptomatic cases every three or four hours. 266 DISEASES OF THE EYES. SYMPBLEPHARON. This is adhesion of the conjunctival surface of one or both eyelids to that of the eyeball. It is usually the consequence of injury of the conjunctiva from the action of caustics intro- duced into the eye. Treatment.—The morbid adhesion may be readily separated by the knife, but re-establishment of the adhesion is as prone to take place as in anchyloblepharon. TRACHOMA — PL AD AROTES — GRAN UL AR EYELID — GRANULAR CONJUNCTIVA. Roughness under the eyelids. A sensation of roughness and dryness under the eyelids; the conjunctiva slightly red, minute protuberances on the same; photophobia, and a dis- charge of dirty mucus from the eye. Treatment. — Improvement of the general health. The local treatment should consist of the application of a leech to the eyelids to relieve congestion; counter-irritation, kept up by repeated blisters to the nape of the neck; scarification of the affected conjunctiva, and, immediately thereafter, the ap- plication of red precipitate salve. The sulphate of copper and nitrate of silver, when judiciously applied, are useful local ap- plications. Trichiasis is a growing in of eyelashes against the eyeball, the border of the eyelid remaining in its proper position, which circumstance constitutes the distinction between tri- chiasis and entropium. Causes. — Inflammation of the borders of the eyelids, which are attended by abscesses and ulcers at the roots of the eve- lashes. Treatment. — Evulsion of the misdirected eyelashes; exci- sion or cauterization of the skin of the eyelid, as in entro- pium; extirpation of the roots of the eyelashes. TWITCHING OF EYELIDS — NICTITATION. When the eye has been frequently exposed to dust, or pun- gent gases, vapors, or by intemperate use of tobacco and ardent spirits, a morbid sensibility is created, producing an WARTS ON THE EYELIDS. 267 irregular, convulsive and unsightly winking. It has been overcome by removal of the causes, by a powerful exertion of the will, and by employing only one eye at a time. Fre- quent cold bathing, followed by gentle manipulation, seems well adapted to restore the natural tone. TYLOSIS. A swollen, knotty and callous state of the eyelids, in which their margin often loses altogether its natural form and ap- pearance. Treatment. — Cicuta externally is recommended for this disease. Ulcers of the cornea occur as the consequence of me- chanical injury, ophthalmia, or strong irritating substances introduced in the eye. Frequently there is severe pain caused by the rough and projecting edges of the ulcer, and the sur- face is covered with a brownish pus. Treatment.—Fix the ball of the eye by means of the spec- ulum, and touch the sore twice a day with powdered caustic by means of a camel's hair pencil, the slippery elm poultice being applied in the intervals. The surface of the eye should be washed off at each dressing with warm milk and water. As soon as the ulcer has a healthy appearance, diminish the strength of the caustic, and wash out the eye occasionally with cold water. (See Ophthalmia, Maculae corneae.) Homoeopathic remedies.—Nitric acid, Arsenicum, Euphra- sia, Sulphur, Lachesis, Calcarea, Belladonna, Mercury, Hepar, Silicea and Natrum muriaticum. WOUNDS — BURST EYE. From severe blows the eye is sometimes burst. Do not attempt to touch it, as vision may be irremediably damaged by touching it with the finger. Place the patient in bed, darken the room, and treat the subsequent inflammation with cool compresses. WARTS ON THE EYELIDS. Remove them by ligature, or snip them off with the scis- sors, and then touch the root with strong acetic acid or lunar 268 DISEASES OF THE EYES. caustic. If they have a broad base, their removal may be effected by the caustics alone. XEROMA — XEROPHTHALMOS — DRYNESS OF THE EYE. Sensation of coldness and heaviness in the orbit of the eye; in the eye itself a disagreeable dryness; enlargement or contraction of the pupil; difficult motion of the iris. Treatment. — If caused by torpidity of the lachrymal gland, local stimulants are indicated. If by obstruction of the lachrymal ducts, fomentations of Chamomile, Sambucus, &c, and cacao-butter rubbed into the affected parts, will generally afford relief. CHAPTER X. DISEASES OF THE EARS. DYSECOIA — COPHOSIS--DEAFNESS. The causes of impaired hearing are; Organic disorders, as closure of the Eustachian tube at both extremities, or destruc- tion of the same by ulceration; sanguineous congestion; local debility; abdominal obstructions; local over-irritation by too strong a sound, as explosion of cannons; hardened wax; ex- crescences; concretions; accumulation of mucus arising from catarrh; enlargement of the tonsils; sudden fright, or violent mental emotions; scrofula; typhus; eruptive diseases; over- doses of Mercury and Quinine. Treatment. — Remedies ought to be selected according to the causes of the complaint. In accumulation and thicken- ing of ear-wax, the ear should be cleansed and syringed with warm milk, and the wax removed. In sanguineous conges- tions, local abstractions of blood, cupping on the neck, and foot-baths with mustard must be employed. In catarrho- rheumatic affections, cantharides-ointment behind the flap of the ear, guajac combined with calomel, and sulphuret of an- timony have been used with success. Stimulating the mucous membrane of the nose by Pulvis errhinus has proved of benefit . In metastases, as the syphilitic, the proper specifics are to be used. Local means, as injections, vapors and ether- eal oils, should be used with the greatest caution. Injections into the Eustachean tube may become very useful, when ob- struction exists in it, which may be suspected when the patient cannot hear better with his open mouth. Ossification or in- duration of the tympanum requires perforation. Electricity is of great efficacy. As a means of relief, the use of acoustic tubes is advised, 269 270 DISEASES OF THE EARS. Homoeopathic remedies. — For congestive deafness: Bella- donna, Hyoscyamus, Sulphur, Silicea, Mercurius, Graphites and Phosphor. Nervous deafness: Causticum, Petroleum, Phosphor and Phosphoric acid. Catarrhal or rheumatic deafness: Mercurius, Pulsatilla, Arsenicum, Belladonna, Le- dum. Deafness from repercussion of eruptions: Sulphur, Antimony, Causticum and Graphites. As a sequel of measles: Pulsatilla and Carbo veg. When it results from scarlet fever: Belladonna and Hepar; when from small pox: Mercurius and Sulphur. Deafness from abuse of mercury: Nitric ac, Sta- physagria, Assafcetida, Aurum, Hepar and Petroleum; from abuse of Quinine: Carbo veg., Pulsatilla, Sulphur and Cal- carea; from hypertrophy or enlargement of the tonsils: Nitric acid, Aurum, Mercurius, Iodine, Staphysagria; as a sequel of typhoid fevers: Phosphor, Phosphor acid and Arnica; when caused by suppressed discharge from the nose or ears: Hepar, Lachesis, Ledum; also: Belladonna, Mercurius and Pulsatilla. Hydropathic treatment. — Deafness from colds requires per- severing tepid injections, with due attention to the general health; from excrescenses: extirpation of the fungous growths, after which both tepid and cold injections should be employed for a considerable length of time. Deafness from caries: the inflammatory stage should be treated by the means previously recommended, and, as the healing process goes on, the passage should be prevented from closing by caustic or metallic tubes. Deafness from an altered membrane tympani: Derivative hip and half-baths for thirty or forty minutes; tepid or cold injec- tions; artificial perforation, &c. Deafness from diseases of the Eustachian tube requires the same general and local treatment as previously mentioned. Deafness from extrava- sation, by external injuries, violent sneezing, or severe con- striction of the neck: Cold compresses, gargles, injections, and any other baths demanded by the state of the general system. Nervous deafness, or impaired hearing, unconnected with inflammatory phenomena, or structural changes, requires Buch treatment as will improve the general health and remove OTALGIA. 271 existing causes. Dumb deafness, paralytic deafness, and senile deafness, are difficult to cure. Eclectic treatment. — (See causes and their treatment.) HERPES--TETTER. Eruptions or humors which appear on or behind the ears are various, and require general treatment. Scrofulous children are often troubled with a soreness or rawness behind the ears, which should be cleansed once or twice a day with warm water and milk without soap, afterward dried (mopped) with a soft linen cloth, and powdered with fine pulverized wheaten starch, the seed of Lycopodium, or powdered slippery elm. No feather pillows must be used, and taking cold carefully prevented. Homoeopathic remedies. — Graphites, Calcarea, Mercurius and Sulphur. (See Herpes.) Humming in the ears. — Buzzing. (See Otitis and Deaf- ness. OTALGIA. Earache is a very painful and sometimes tedious complaint. It is more common among children than adults, and may lead to caries of the petrous portion of the temporal bone, and to inflammation of the brain. It is often accompanied with difficulty of hearing, singing and buzzing in the ears, convul- sions, &c. Children suffering from earache scream, and roll their heads, and put the hands to the ears. Causes. — Taking cold; neuralgia; rheumatism; drinking strong coffee; suppression of discharges from the ears; for- eign substances; insects in the ears; inflammation. Allopathic treatment.—Remove foreign substances; if caused by cold, the whole head should be bathed with warm water, followed by frictions with hot flannel; elder-flowers, or the herb of hyoscyamus boiled, or steeped in milk, and applied to the painful ear; warm water vapors, also tinctures of opium and myrrh, externally applied, have been used with benefit Homoeopathic treatment — Externally use heated flannels, or bags filled with heated bran, ashes or salt; a sponge dipped 272 DISEASES,OF THE EARS. in warm water; a thread dipped in sulphur and placed around the ear. Internally give: Pulsatilla, Chamomilla and Mercu- rius; also, Nux v., Spigelia, Dulcamara and Belladonna. For painfulness in the ear, which remains after severe Otalgia, give Sulphur and Calcarea in alternation. Hydropathic treatment. — Fasting a day or two, syringing the ear with warm water, and a few tepid foot-baths, will soon remove the worst attacks. A warm or vapor-bath, or a wet- sheet packing, will often remove the trouble ot once. If the stomach is foul, warm water emetics, and warm water injec- tions are advisable. Eclectic treatment. — (See Otitis.) OTITIS — INFLAMMATION OF THE MUCOUS MEMBRANE OF THE EAR. Violent, beating, burning, often insupportable pain deep in the ear, with heat, and even external sensibility of the meatus auditorius; febrile irritation, sometimes redness and swelling in and outside of the ear; headache; in severe cases delirium and even inflammation of the brain, and convulsions in chil- dren. If complete resolution does not succeed, suppuration or otorrhoea ensues. Causes. — Colds; rheumatism; foreign substances and in- sects; severe otalgia. Allopathic treatment. — Leeches on the ears; in plethorio persons general bleeding; cooling laxatives; cataplasms boiled in milk; removal of insects or other foreign substances; foot- baths with mustard. In severe cases Calomel with extractum Hyoscyami; oil of Chamomile with Laudanum dropped in the ear; warm vapors. In case an abscess should form, apply a poultice of linseed, and inject a decoction of the same article. Homoeopathic remedies. — The principal remedy is Pulsatilla. If the fever is very high and the head affected, give Aconite and Belladonna. Coffea will relieve great sensitiveness and restlessness. - Mercurius and hepar are indicated if an abscess is about to form. RUNNING OF THE EAR. 273 Hydropathic treatment. — Fasting until the inflammatory stage subsides; constant application of several folds of cold wet-cloths to the part; occasionally syringing the ear with cool water; one or two general baths daily; pouring cold water over the sides and back of the head several times a day, and several minutes at a time, until the preternatural heat is sub- dued. The wet sheet and tepid injections must be freely used. Eclectic treatment.—Remove the causes. If resulting from cold, a thorough sweat, and steaming the parts with a decoc- tion of hops, will usually give relief. In other cases apply sinapisms of garlics, bruised, to the feet and behind the ears; put a cup under the ear, and a roasted onion into and upon the ear; give an infusion of saffron to equalize the circulation, and a drop of a mixture, composed of two to four drops of oil of sweet almonds, and one of laudanum, warmed, may be allowed to fall into the affected ear, or may be pressed gently into the ear on some lint. Tobacco smoke blown into the ear affords prompt relief. The bowels should be kept open by mild laxatives (Seidlitz powders.) OTORRHCEA — RUNNING OF THE EAR. A discharge of serous, mucous, sometimes purulent matter, which is either inodorous, or of an offensive, putrid odor. If of long standing it may be followed by weakness of hear- ing and organic disorders. It is most common among delicate and scrofulous children. Causes. — Scrofula; psoric or syphilitic metastases; caries; inflammation of the ear; catarrh; scarlet fever; measles; small pox. Allopathic treatment. — Luke-warm milk, or weak soap wa- ter may be used for cleansing the ear; vesicatories should be applied behind the ears; and purgatives occasionally admin- istered. Zinc, vitriol, lead and mercury should never be used to suppress the discharge. In deafness occasioned by sup- pressed discharge of the ear, apply half of a small loaf of bread fresh from the oven, and moistened with warm vinegar8 to the ear. 274 DISEASES OF THE EARS. Homoeopathic remedies. — Pulsatilla and sulphur, if it suc- ceeds measles; Belladonna, Mercurius and Henar, if after scarlet fever; Mercury, Lachesis, Sulphur and Calcarea, if after small pox; after inflammation of the ear, Pulsatilla, Mercury and Sulphur. Sudden suppression of the discharge requires Pulsatilla, Mercury and Belladonna. A weak solution of Borax or Potash, a tea-spoonful of which may be poured into the ear every day until improve- ment takes place, has been recommended. Hydropathic treatment — The general health must be at- tended to. The rubbing wet-sheet, with frequent hip and foot-baths, as derivatives, make a good bathing arrangement. If the skin is obstructed or bilious, the pack-sheet should be occasionally resorted to. After the general health has been substantially improved, warm, then tepid, and then cool in- jections, should be thrown into the ear, and if there is more or less deafness, this should be persevered in for weeks and months, if necessary. Eclectic treatment. — The parts should be kept clean, by syringing out the canal of the ear with castile soap and wa- ter, an infusion of hydrastis canadensis, with a little myrrh, or a solution of chloride of Sodium; after which, to prevent any mischief from an extension of the disease, the ear should be syringed with a weak solution of sulphate of Zinc, or ses- qui-carbonate of Potash. Sometimes it is necessary to open the ear with the speculum, and touch the ulcer with nitrate of silver. In scrofulous persons the alterative syrup should be given. PARACUSIS. Buzzing, humming, singing of the ears; hearing of unusual foreign sounds and voices, is in many cases a very trouble- Bome complaint, bringing the patient almost to desperation. Causes. — The disease is generally an accompaniement of Otorrhoea and Otalgia, and will disappear with them. In other cases it is caused by congestion to the head from catch- ing cold or other diseases. FOREIGN SUBSTANCES IN THE EAR. 275 Allopathic treatment. — Daily embrocations withUnguentum epipasticum behind the ears, repeated cupping on the neck, foot-baths of mustard, laxatives; oil of hyoscyamus dropped into the ear, will generally afford relief. Homoeopathic remedies. — Pulsatilla, Nux v., Mercurius, Chamomilla; China and Carbo veg. in persons who have taken much Calomel or Quinine. Cold foot and sitting-baths have been employed with benefit. POLYPUS OF THE EAR. These excrescenses appear frequently after long continued running of the ear, or after mechanical injuries by ear-pricks, &c. They are not painful, but discharge an offensive mucus and bleed easily. Treatment — Keep the ear clean by frequent injections of milk and water. They can be removed by a pair of fine curved scissors, or a curved, double-edged knife, having a blunt and rounded extremity, or a pair of delicate forceps, with sharp points, or with a ligature passed around them, and occasionally tightened until they are cut off. Polypus may also be destroyed by touching it twice a day with a mild solu- tion of caustic, the employment of which demands great care, to prevent the sound parts from being cauterized also. Boring, or perforating the ear for ear-rings. To perform this operation a small punch, similar to that employed by shoemakers for cutting string-holes, or a trocar and canula, or a good sized darning-needle may be used. Place a piece of soft wood or cork at one side of the part to be perfora- ted, while from the opposite side it is forced rapidly through the flesh. To prevent the wound from healing and closing, introduce a waxed thread, which should be moved from day to day. In about two weeks the wound becomes healed, and the ring may be introduced. FOREIGN SUBSTANCES IN THE EAR. Insects should be well deluged with olive oil and honey, and then carefully taken out. If a bean or any other sub- stance gets into the ear, bend tho point of a large, stout sew- 276 DISEASES OF THE EARS. ing needle a little, so as] to form a hook, then dip it in some oily substance or honey, enter the ear with it cautiously, and extract the substance slowly. After the operation, drop a few drops of tincture of Arnica, in solution, into the ear. In some cases foreign substances have remained in the ear for a long period, and are so surrounded by fungous growths as only to be detected by the most critical examination with the speculum, forceps or probe. Water thrown forcibly against the tympanum by means of a small syringe, has proved an excellent means to expel foreign substances (peas) where all other means failed. CHAPTER XL DISEASES OF THE NOSE. ANOSMIA — LOSS OF SMELL — MORBID SMELL. Acrid, obtuse, and absence of smell are usually among the symptoms of fevers and local affections. With some, an ex- treme and painful keenness or total deprivation of the sense exists from birth. A temporary loss of smell may result from a cold; and a permanent deprivation of the sense is often produced by snuff, tobacco, dust, cigar smoke, &e. In some cases it is a symptom of spasm and paralysis. Treatment — The head-bath and the frequent sniffing of cold water up the nostrils, with a rigidly simple diet, consti- tute the special therapeutic measures. CANCER IN THE NOSE. This disease occurs mostly in old persons. It is known by lancinating pains and other symptoms peculiar to cancer. Treatment. — (See Cancer). Caries in the nose.—(See Caries under diseases of the bones). CORYZA—COLD IN THE HEAD — CATARRH. This is an affection of the mucous membrane of the nasal cavities (cold in the head); or in the cavities of the frontal bones (catarrh in the head), manifesting itself by sneezing, obstruction or running of the nose, with excoriations, head- ache, feverishness and affections of the eyes. Causes. — Taking cold; sudden changes of temperature; leaving off an habitual warm piece of dress. Treatment allopathic—Restore the cutaneous action by vapor-baths, tea made of elder—or chamomile flowers, warm clothing, &c. Homoeopathic treatment. — Give Nux v., and Mercurius in alternation, every four to six hours until improving. 277 278 DISEASES OF THE NOSE. In some cases Arsenicum, Lycopodium, Lachesis, Chamo- milla and Pulsatilla are required. Suppression of cold in the head requires: Aconite, if fever and headache ensues, followed by Pulsatilla and China; if Asthma follows, give Ipecacuanha and Bryonia, or Arsenicum and Sulphur. Hydropathic treatment — The acute form requires a few packs to reduce the general feverishness; abstemious diet; and a moderately warm room of uniform temperature. Eclectic treatment.—Reduce the quantity of food, keep the feet warm, cleanse the surface by a tepid or vapor-bath, or by washing with weak lye-water, and drink a warm infusion of sage or catnep; bathe the feet in warm water, rendered stimu- lating by the addition of salt, ashes, mustard, or capsicum, then, after being dried with a warm cloth, put a hot and mois- tened brick to them, cover warmly, drink warm lemonade and perspire. Constipation should be removed by enemas. In severe cases small doses of Ipecacuanha and Opium, with a free use of warm drinks will be found useful. For severe headache inhale the vapor of vinegar, and apply poultices of mustard to the feet. Excoriation of the nostrils and lips re- quires the application of a little suet, or spermaceti cerate. EPISTAXIS. Bleeding at the nose is one of the most common hemorrhages, and is often accompanied with headache, vertigo, redness of the eyes, and fullness and heat in the nostrils. Causes.—Congestion of the head; sanguineous dissolution in low typhoid fevers; mechanical injuries; mental emotions; suppressed menses, or piles; worms; polypus, and other dis- eases of the nose. Treatment.—In most cases it is a relief, or benefit to the system, and no treatment whatever is necessary. Sudden suppression has caused blindness, deafness and cerebral inflam- mation. When the loss of blood however has become enor- mous, and when there is palor in the face, vertigo, small inter- mittent pulse and fits of fainting, or in cases where the bleed- EPISTAXIS. 279 in0, is a consequence of debility and of a putrid dissolution of the blood, suppression of the hemorrhage becomes neces- sary. Allopathy recommends: applications of cold water to the forehead and bridge of the nose; cold water, vinegar or a solu- tion of alum, drawn into the nose; injections of Sulphate of Iron; foot and head-baths; pledgets of lint moistened with alum or Creosote water; plugging the nose; cold lotions on the Genital organs; chewing of a piece of blotting paper; slipping a cold key down a child's neck; raising one or both arms above the head, and holding them for some time in that posi- tion; cream of tartar dissolved in a large quantity of water and taken internally; in a spasmodic state small doses of Ipe- cacuanha and Opium. A radical cure of often returning Epistaxis caused by de- bility, requires Cinchona, Iron and Sulphuric acid. Homoeopathic treatment. — Externally cold water or ice on the root of the nose; lint pressed tightly under the upper lip; hand and foot-baths. If it is necessary to plug the posterior outlets from the nose, pass threads up the nostrils and bring- ing them out at the mouth, secure pieces of sponge, or small rolls of lint to the ends; after this the thread should be drawn back, and tied sufficiently tight, so as to bring the plugs firmly against the orifices. Internal remedies recommended are: China, Ferrum, Cina, Mercurius, Arnica, Aconite, Belladonna, Bryonia. Hydropathic treatment. — A cold stream or iced water may be applied to the back of the neck, and cold or tepid water frequently sniffed up the nostrils, at the same time the head Bhould be freely exposed to the cold air, and the bleeding part be kept entirely uncovered. If there is much febrile excitement the sitz-bath, shallow- bath, pail douche, plunge, &c, are appropriate measures, and will produce constriction of the bleeding vessels. We will also find of benefit: Plugging the nostril with a piece of sponge, lint, or soft rag formed into a cylindrical shape, and moistened 280 DISEASES OF THE NOSE. with cold water; winding a piece of moistened lint round a probe, so as to form a cylindrical tube, passing this along the floor for its whole length, then carefully withdrawing the instrument, and allowing the lint to remain for three or four days. Eclectic treatment.—Place the patient in a sitting posture, apply cold water, snow, &c, to the nostril, and to the back of the neck; and let him take a mustard foot-bath. A mix- ture of equal parts of Alum, Gum arabic, and Geranium may be passed into the nostril upon a piece of moistened lint or cotton, and retained there for sometime. Dried beef, grated fine and the nostril filled with it has proved very service- able, also pressure on the outside of the nose over the artery. Another plan, is to introduce with a probe a portion of the intestine of swine (properly prepared and closed at one end) deeply into the nostril, then to inject some water forcibly, or inflate it by blowing into it through a goose quill, and tie the other extremity of the tube. Erysipelas in the nose.—(See Erysipelas). Eruptions on the nose are generally of an herpetic or tettery character, and require the same treatment as given under the different species of tetter. Homoeopathists recommend particularly: Rhus t., Antimony, Causticum and Nitric acid. Itching of the nose is in most cases a symptom of irrita- tion in the stomach and bowels, of worms, swelling of the glands of the abdomen and inflammation of the bowels. Lupus—Noli me tangere.—(See Diseases of the skin.) OZ^ENA An ulcer, situated in the nose, discharging a foetid purulent matter, and sometimes, accompanied with caries of the bone. In its early stage it is termed catarrh, when more advanced it is called cancer of the nostril or throat. Causes.—Scrofula or Syphilis. Treatment allopathic. — Anti-Scrofulous or Anti-Syphilitic remedies should be employed: also injections of Kali hydro- POLYPUS IN THE NOSE, 281 jodieum in the nose; purgatives of Calomel and Jalap; to remove the offensive smell resort must be had to injections of Creosote or a solution of Chloride of Calcium. Scratching of the nose must be avoided and occasionally, a decoction of cicuta injected. Homoeopathic remedies.—In the first stage: Belladonna, Pul- satilla, Sulphur, Calcarea, Mercury, Auruni; in the second stage with discharge of pus: Teucrium marum verum, followed, if necessary, by Sulphur, Silicea, Nitric acid, Phosphor, Co- nium, or Potassiae bich.; in Syphilitic Ozcena, Mercurius forms the principal remedy. (See Caries). Hydropathic treatment.—(See Catarrh). Eclectic treatment—(See Caries, Scrofula, and Syphilis), POLYPUS IN THE NOSE. These tumors are of two kinds; the soft or compressible. and the hard or cartilagious. They often come on as a mere swollen and thickened state of the mucous membrane, with many of the symptoms of a common cold. This swelling ap- pears to change its seat from one part to another, or even from one nostril to the other. In other cases its existence may be detected, when it is not larger than a pin's head. The first symptoms are unusual sneezing, especially when the patient changes his position; there is a sense of full- ness and dull pain in the head; the eyes become suffused with tears; the sense of smell is generally lost; that of hearing may be subsequently injured; the teeth are sometimes crowded out, and the voice assumes the nasal sound. Before a storm and during wet weather, it is much more swollen than at ordi- nary times, and when a change to dry weather occurs, it shrinks in size. After enlarging the parasyte may project through the nostrils, or backward into the throat, occasioning difficulty of swallowing and of respiration. If the disease is not arrested, caries of the bone takes place. Allopathic treatment, — When polypi assume such a size as to cause difficulty in respiration and deglutition, they should be removed by operation. The blades of the forceps must be 12m 282 DISEASES of the nose. passed into the nostril, one on each side of the growth, when they should be closed over its roots, and then withdrawn by a twisting, pulling motion, so as to seperate the disease from the mucous membrane above. When the tumor is of considerable size a ligature may be most advisable; this being drawn tightly round the root of the mass will cause its strangulation when it will seperate in the form of a slough. Cat-gut, or silver wire may be used for a ligature. Homoeopathists assert that Polypus can be cured without an operation, by administering the following remedies: Staphy- sagria, Phosphorus, Teucrum, Calcarea, Silicea, and Sepia, each remedy to be given for three weeks, a dose every other day, discontinuing for five days before the next remedy is commenced. Hydropathic treatment—In the early stage frequent sniffing of the coldest water will often arrest the tumor. When it be- comes troublesome from bulk, extirpation is necessary. The hard polypus cannot always be removed by a surgical opera- tion without endangering the life of the patient. Eclectic treatment.—In the first stage a simple application of the powdered Sanguinaria canadensis is often sufficient. After a few days, if this has no effect, try Podophyllum pelta- tum. If after five days you perceive no improvement, substi- tute the sesqui-carbonate of potash in powder, till you have disorganized the accessible part of the tumor; and then resume the former powders. If any of these applications, which should be repeated two or three times a day, are operating properly, the polypus will turn black, and begin to slough off. This degree of success will indicate the continuance of the same measure until the whole is removed. If the mild caustic is not strong enough to disorganize the tumor, take hold of the polypus with sharp pointed forceps, and crush it in various directions, tearing away any parts that can be detached. After this operation re-apply mild eaustics to the lacerated mass in the shape of a strong wash once a day. The caustic should be applied by means of a SNIFFLES. 283 camel hair pencil. A daily alkaline bath and proper diet is of much importance. To prevent a return, which amounts to a certainty in most cases after a mechanical removal of this parasyte, Harlem oil and oil of Cedar in combination ought to be applied to the restored surface for months. SWELLING OF THE NOSE—-INFLAMMATION OF THE NOSE. If caused by external injuries applications of cold water, and a lotion of the tincture of Arnica will in most cases suf- fice to remove it. Other causes are Scrofula, bites of Insects, use of ardent Spirits, Erysipelas, and Congestion. SNEEZING. Clonus sternutatio. Sneezing is a convulsive motion of the respiratory muscles, by which air is drawn violently and sud- denly through the nostrils, producing a sonorous expiration. It indicates an irritation of the nose (catarrh and measles); or of the lungs, therefore it is present in pneumonia at the com- mencement of suppuration; or of the abdomen (worms). In most cases it is caused by dust, vapors, gases, &c. Treatment.—When the sneezing is excessive, and the Schnei- derian membrane is morbidly sensible, or stung with some irritant material, it may be relieved by sniffing tepid or cold water frequently, taking care to draw the fluid into the nostrils by means of a moderate but prolonged inspiration; or by throwing it up gently with a syringe; or forcing up pellets of lint, moistened with opium, dissolved in warm water. Compression of the root of the nose; pressure upon the upper incisors with the fingers; also pressing the thumb against the hard palate has been found successful in relieving violent sneezing. SNIFFLES. Infants are often attacked with a kind of catarrh, or obstruc- tion of the nose, which prevents them from breathing whilst they are sucking. It is in most cases caused by cold. Allopathists recommend gruel with sugar candy, light elder tea, and a mild emetic, if there is much phlegm on the lungs. 284 iiisEASES OF THE Nosh Homoeopathists give Nux vomica and Sambucus in alterna-' tion morning and evening. FOREIGN SUBSTANCES IN THE NOSE. Children are apt to introduce in the nostrils, beans, peas, beads, cherry-stones and such like objects, which require re- moval. Treatment. — Hard sneezing by thickling the nose with a feather, or blowing the nose, may suffice in some cases to re- move the foreign substance. In others it is necessary to push a flexible catheter up into the posterior nares by the finger and out at the nose; or extraction must be made by means of a small hook; or the foreign body can be pushed back so as to fall into the mouth. Throwing a full jet of water up the unobstructed nostril, with a four ounce syringe has proved successful, the water gushing out the other one, bringing along with it the foreign substance. 2i6~ CHAPTER XII. DISEASES OF THE FACE AND BUCCAL CAVITY. APHTHA—STOMATITIS VESICULAR — THRUSH. This disease consists of small, usually roundish, white ulcers, or patches, scattered over the surface of the tongue, and the lining membrane of the cavity of the niouth and fauces, extending sometimes from the mouth to the stomach, and even intestinal canal. They terminate in curd-like sloughs, leaving behind them a reddish, raw-looking surface, or in some cases an ash-colored spot. They cause painful degluti- tion, cough, fever, nausea, spasm in the stomach, vomiting, diarrhoea, even dysentery, enteritis, &c. Children are most subject to this disease during lactation, and it is then called Thrush. Aphthae in adults are symptoms of debility. Causes. — Improper diet; milk of a bad quality, from an unhealthy or intemperate nurse; derangement of the stom- ach ; gastric impurities; suppressed cutaneous eruptions; corruption of the humors in putrid fevers and in the last stage of consumption; constitutional taint. Treatment allopathic — Cleanliness, pure air and proper diet; mild purgatives and emetics; repeated gargling of the mouth with a mixture of borax (one drachm) and syrup of blackberries (two ounces), or with a decoction of quince-seeds. In acidity of the stomach antacids (pulvis sodae cum hydrar- gyro) from three to five grains daily, should be administered. When they are very painful, mucilaginous decoction of marsh- mallow roots or mallow-flowers may be used as a gargle; in a putrid disposition Peruvian bark and alum. In very obsti- nate chronic cases, Sulphate of Zinc may be used as a wash. In gangrenous aphtha? or noma the application of pyrolig- neous acid and honey has proved most efficacious. 285 286 DISEASES OF THE FACE AND BUCCAL CAVITY Homoeopathic remedies. — Borax, Mercurius, Nux v., Sul- phur and Sulphuric acid. Each remedy should be given twice a day for several days, until an improvement is percep- tible. When there is much acidity, vomiting, &c, Nux v. and Pulsatilla are useful. In very bad cases, when the aphthae assume a livid or violet appearance, with diarrhoea and excessive weakness, Arsenicum, followed by Nitric acid, is highly beneficial. Mouth and tongue should be washed with borax and sugar, dissolved in water, after which the mouth should be well cleansed with another clean cloth, dipped in cold water. Hydropathic treatment, — As a wash, pure, soft water should be used. In some cases soothing fluids, as: Flaxseed tea, in- fusion of slippery elm bark, white of an egg mixed with wa- ter, may be used with benefit. The strictest cleanliness and attention to the general health must be carefully observed. Pure air, exercise, diet, clysters, ablutions, wet packs are the most appropriate means to improve the general health. Eclectic treatment. — The whole surface should be bathed with a warm weak alkaline wash, once or twice a day; the accumulations in the bowels must be removed by a gentle purgative (neutralizing physic); during the inflammatory stage compound capsicum liniment should be applied under the jaw; and for a mouth wash, a decoction of Hydrastis can- adensis may be used several times a day, or Borax may be added to the decoction with advantage. Too much "swab- bing" is injurious. Small doses of pure salad oil have been administered when the irritation has extended to the stomach. Diarrhoea requires infusion of Blackberry root, Dewberry root, &c, or the syrup of Rhubarb and Potash, and injections of Starch-water. In canker of the mouth an excellent remedy is a gargle of common salt, pepper and vinegar; likewise an infusion of polygonum punctatum. Sore mouth of nursing women requires the same treatment CANCER OF THE TONGUE. 287 as directed for Aphthse. The only remedy for a severe case of this disorder is to wean the child. Aphthae gangrasnosa, Aphtha; neonatorum and Aphthae phthis- icorum, — ( See Aphthae.) Bleeding from mouth. — (See Hemorrhages.) CANCER OF THE LIP. This disease appears first as a mere fissure or cracked lip, healing in summer and reappearing in winter, or it shows itself from the beginning in the form of a small tumor, look- ing like a small shot, increasing in size, becoming painful and gradually passing into a foul, painful ulcer, with hardened base and ragged surface. A third form under which it may make its appearance is that of a scaly scab, or little ulcer. Cause.—In most cases, irritation of smoking. Treatment.— Extirpation or caustic applications will suc- ceed while the disease is confined to the lip. The extirpation must be made by a V incision — taking care to include the whole of it—and uniting the wound afterward like that made in the operation for hare-lip. CANCER OF THE TONGUE. It consists of a foul, excavated ulcer, with extremely hard- ened base, prominent edges, burning and lancinating pain, and is preceded by nodular, scirrhous enlargement. It is often caused by over-doses of mercury. Treatment. — The whole surface of the ulcer should be cov- ered once or twice a day with a dry caustic powder (mild al- kaline carbonate) and a pledget of cotton or lint so as to fill up the fissures and absorb all fluids as fast as they are dis- charged. This should be removed every four hours, washed each time with soap and water, and a fresh one applied. In a few days all the discolored part will disappear. The raw and healthy surface should be treated in the same manner, though with less caustic. If the hard and callous edges do not yield to the mild alkaline caustic, the caustic potash must be used. In applying the latter, have the neighboring parts well shielded and the whole 288 DISEASES OF THE FACE AND BUCCAL CAVITY. mouth filled with cotton. Sulphate of Zinc has been applied with good effect. Great care must be taken not to swallow the slightest portion. In some cases excision is necessary. CANCRUM ORIS--CANKER--SCURVY IN THE MOUTH — STOM- ATITIS PUSTULAR — ULCERATIVE INFLAMMATION OF THE MOUTH. This disease consists in inflammation and ulceration of the inside of the mouth, and is usually attended with gastric de- rangement, debility, loss of appetite, fever, copious flow of saliva and a fetid breath, redness and sensitiveness of the gums, which swell, become spongy, and retract from the teeth; presently small ulcers of a grayish color, and surrounded by an inflamed border, appear on the gums, spreading to the lips, tongue, palate and inside of the cheeks. Sometimes the glands of the throat and niouth swell, and participate in the inflammation, secreting large quanti- ties of a putrid, acrid saliva. It occurs most frequently among children, and is epidemical. Causes. — Catarrhal or gastric derangement; want of pure air, cleanliness and proper food; debility caused by diseases, which weaken the powers of life, as: whooping-cough, mea- sles, scarlatina, &c. Treatment allopathic-—Prompt administration of an emetic, which alone often removes the whole evil; afterward laxatives and acids. Locally, gargling and swabbing with a solution of chloride of lime in water; or a solution of nitrate of silver, alum, or sulphate of copper. As a purgative, rhubarb and magnesia, with a grain of calomel, should be administered daily. Homoeopathic treatment. — Mercury is the most useful rem- edy in this disease (but not in those cases which have been produced by over-doses of Mercury). It should be given in a low potency two or three times a day for several days. Then, if no improvement is perceptible, select, according to symp- toms, one of the following remedies: Capsicum, Arsenicum, Borax, Carbo veg. and Nitric acid. DIFFICULT TEETHING. 289 The mouth should be frequently washed with cold water. Lemon-juice and sage-tea as local applications, or rinsing the mouth with brandy, have been found of service. Hydropathic treatment. — The wet-pack, tepid shallow-bath, and frequent washings of the mouth with cold water, are the appropriate remedies. Eclectic treatment. — Administer a mild aperient of Rhubarb and Magnesia, together with four grains of chlorate of Pot- ash dissolved in water sweetened with syrup, which last dose should be repeated every four hours. The mouth should be washed with a weak solution of chloride of Soda. Some writers recommend the local application of strong Nitric or Hydrochloric acid, sulphate of Zinc, &c. (See Aphthse.) Caries of the jaw.—(See Diseases of the Bones.) Crusta lactea and other eruptions.—(See diseases of the Skin.) DENTITIO DIFFICILIS--DIFFICULT TEETHING. Teething is not naturally a process of disease, but in so- called civilized communities we find children suffer severely from it, and in many cases life is destroyed by it. The most common symptoms are: Swollen purple red gums, hot mouth, the child cries and frets, it drivels at the mouth, aud carries everything to its mouth to bite on; frequently there is diar- rhoea, sometimes fever, eruptions; heat of the head, vomiting, coughing, difficulty of breathing; difficulty in sucking, eos'tivc- ness, spasms, inflammation of the brain and of the lungs; &c. Course of teething. — We have in the human subject two sets of teeth: the milk or temporary teeth, twenty in number, and which appear from the sixth to the twenty-fourth month; and the permanent teeth, thirty-two in number, appearing from the sixth to the fourteenth year. Wisdom teeth appear from the twentieth to the fiftieth year. Causes of difficult dentition. — Too large a number of teeth cutting at once; complication of other diseases; scrofulous or rachitic constitution. The eye-teeth give most trouble, on account of their peculiar form. 13 290 DISEASES OF THE FACE AND BUCCAL CAVITY. Allopathic treatment. — The cutting tooth cannot be done away with; therefore, nothing can be done but appease the effects of the irritation. Gentle laxatives (Rhubarb and Magnesia) and injection should be used to keep the bowels open. In congestions of the head one or two leeches should be applied behind the ears, cold to the head, and draughts of horse-radish, sour dough and vinegar to the calves of the legs. In nervous irritation and spasms, flores zinci, valerian, musk, tepid lye-baths, vesicatories and antispasmodic injec- tions must be resorted to. Diarrhoea is a favorable symptom and should not be checked, unless it becomes too profuse and debilitating; then, administer rice water, gum arabie water, almonds milk, rhubarb with chalk, or calomel, one-tenth to one-half a grain per day. In violent vomiting give small doses of subcarbonate of potash with lemon acid. In an ex- treme case, when the point of the teeth is retained by a ten- der skin, cutting of the gum may be resorted to. Locally means may be used which soften and wear away the gums, as chewing marsh-mallow, biting an ivory ring, &c. Homoeopathic treatment. — For high fever and restlessness give Aconite; for restlessness, convulsive jerkings, starting during sleep, congestion to the head, give Chamomilla and Belladonna; for nervousness and sleeplessness without fever, Coffea; for dry cough, with signs of worms, Cina; excessive diarrhoea, with green watery discharges: Chamomilla, Mercu- rius and Cuprum; diarrhoea of a whitish, slimy color, and curdled: Coffea, Ipecac, and Calcarea c; for great cerebral sensibility, with spasmodic clenching of the spoon or cup with the gums \«hen drinking: Cuprum aceticum; for incipient paralysis of the brain, with sopor, half closed eyes, loss of consciousness, moaning, insensible pupil, icy coldness of the body, bluish color of the skin, give Zincum, half a grain every two hours until the temperature of the skin increases and consciousness returns. Sometimes this latter remedy has to be given in alternation with Belladonna. If the teeth are tardy in breaking through, give a dose of FETOR OBIS. 291 Calcarea every evening for a week; obstinate constipation requires injections of tepid water and a dose of Nux v., Bry- onia or Opium, morning and evening. Hydropathic treatment. — Restlessness and sleeplessness re- quire tepid baths; in high fever the wet-sheet is indicated; congestion to the head must be removed by cold bandages to the head and tepid foot-baths, constipation by injections of tepid water, excessive diarrhoea of a white color by injections of cold water; great irritation and heat in the gums can be allayed by the frequent introduction of a clean piece of linen with wet cold water into the mouth. Eclectic treatment.—-(See Diarrhoea, Constipation, Conges- tion, &c.) Erysipelas in the face. — (See Diseases of the Skin.) EPULIS. A tumor formed by an hypertrophy of the gum without any apparent alteration in its structure. It generally com- mences between two teeth, which it gradually separates, then loosens, and finally displaces, and may spread so as to involve several of them. The tumor is indolent, painless and of slow growth. Treatment. — The tooth on either side must be extracted, and the tumor entirely cut out. Face-ache. — (See Prosopalgia. FETOR ORIS. Foul breath arises from carious teeth, from chronic ulcera- tion of the tonsils, a diseased state of the jaw bone, chewing and smoking of tobacco, onions and cabbage taken into the stomach, which find their way through the circulation to the lungs where they are thrown off. Treatment. — Remove and avoid the cause; observe cleanli- ness, simple diet, gargle and cleanse the mouth every day with charcoal and soft water. Chewing of a piece of orris-root will sweeten the breath. Homoeopathic remedies. — Arnica and Nux v., when the of- fensive smell manifests itself only in the morning; Chamo- 292 DISEASES OF THE FACE AND BUCCAL CAVITY. milla or Nux v., when perceived after a meal; Pulsatilla, when in the evening or at night; Aurum, Carbo veg., Lache- sis and Arnica, when from abuse of mercury; Arnica, Mer- cury, Nitric acid and Nux v., for putrid smell from the mouth. FLUXION IN THE CHEEK. Swelling of the cheek is generally caused by toothache and disappears with the removal of the cause. Treatment. — A bread and milk poultice; a little bag with warm ashes, hops or chamomile flowers is often of benefit. (See Toothache.) GLOSSITIS—INFLAMMATION OF THE TONGUE. Swelling, redness and heat in the tongue; great difficulty of swallowing, danger of suffocation from excessive swelling; sometimes filling the whole cavity of the mouth. Unless resolution takes place it may terminate in induration suppuration or gangrene. Causes..—Local injuries; acrid substances; burns and scalds; points of decayed teeth; rheumatism; catarrh; general strumous habit. Treatment allopathic — General and local abstraction of blood; in great swelling longitudinal incisions into the tongue, which quickly cause a subsidence of the swelling and removal of the danger; locally, cold water or applications of fresh almond oil. Chronic glossitis requires local abstractions of blood by leeches, fomentations of an infusion of Belladonna; and embrocations of mercurial ointment. Homoeopathic treatment. — If the tongue has been injured give Arnica, rinsing the mouth with a solution of ten drops of the tincture to a tea-spoonful of water ever three to four hours. If injured by burning or scalding, use the tincture of Urtica urens, in a similar manner. Real inflammation with high fever requires Aconite, a dose every hour, or every two hours, in alternation with Apis mellifica until better. For great swelling and heat of the tongue and surrounding parts, with pain, congestion to the head, dryness of the mouth, &c, HYPERTROPHY OF THE TONGUE. 293 use Belladonna and Mercurius, a dose every three to four hours. Hydropathic treatment. — In violent inflammation keep a cloth wrung out of cold water in the mouth, gargle mouth aud throat frequently with water, and quench the general fever by ablutions and the wet sheet. Eclectic treatment. — Cupping, poultices, and purgatives. Gums.—Ulceration, abscesses and fistulae, inflammation and bleeding of the Gums.—See Scurvy, Stomacace, &c. GUM BOIL — ALVEOLAR ABSCESS — PARULIS. A small abscess commencing in the socket of a tooth, and bursting through the gum, or sometimes through the cheek. It is usually caused by the irritation of a decayed tooth. Treatment. — Leeches and fomentations,— removal of the tooth, and a puncture as soon as matter can be detected. Hare-lip. — (See Labium leporinium). HEMORRHAGE FROM THE MOUTH, TEETH OR GUMS. All the parts of the mouth are subject to spontaneous bleeding. Causes.—Scurvy, anomalous piles, malignant fever, wounds, dividing the frenum linguae for tongue tie, extraction of teeth. Treatment. — Local applications of sage, vinegar, mineral acids, alum; treatment of piles or scurvy. Troublesome hemorrhage following the extraction of teeth requires applica- tion of common salt, or cold water to the bleeding surface. If these means do not prove sufficient, fill the alveoli with super- fine powder of slippery elm. The flesh side of oak tanned Bole leather, grated off finely, and wet with the tincture of Kino or galls, and crowded into the cavity has been used with success. Homoeopathic treatment — Buccal hemorrhage requires ac- cording to causes: Arnica, Belladonna, China, Ferrum, Kre- osote. Herpes.—Tetter on the face, (See Diseases of the Skin). HYPERTROPHY OF THE TONGUE. Slow enlargement of the tongue without pain, tenderness or 294 DISEASES OF THE FACE AND BUCCAL CAVITY. structural disease, causing it to protrude permanently from the mouth. Treatment.—In some cases a superfluous portion is removed by passing a double ligature through it, tying half each way. In other cases a portion has been cut out in the shape of a V, and the remaining parts healed. Inflammation of the tongue.—(See Glossitis). LABIUM LEPORINUM--HARE-LIP. This congenital mal-formation consists in a fissure or fissures of the upper lip. The division sometimes extends back through the palate-bone, as well as the soft palate. Treatment. — Can only be remedied by an operation. If the patient is young, a cloth should be wrapped round the chest, so as to confine the arms; a pillow case answers the purpose well, as the legs can thus be secured by slipping the patient into it; then the child should be held by an assistant, with its head resting between the surgeons knees. The surgeon rais- ing the edges of the fissure with his fingers or forceps places a flat piece of wood between the lip and gum. If the lip is found adherent to the gum, it will require to be cut loose. Sponging with cold water will be sufficient to staunch the bleeding. The edges of the fissure are to be pared off from both sides upon the wood with a scalpel or bistoury, so as to leave the sides straight, in the shape of a letter V. When all bleeding has ceased bring the fresh surfaces together. Be sure that you have the margins even at the lip, and then pass a thin sewing needle through and across the direction of the fissure near its lower extremity. Make it penetrate deep enough to be quite near the inner surface of the lip where it crosses the fissure. This will keep the inner edges near together, while the outer and all between must be secured by a ligature (twisted suture) over the head and point of the needle in the form of a figure 8. A common waxed thread will be a suitable material, and should be drawn tight enough to bring the wounded edges together. After the margin is thus secured, introduce two other needles, deep enough to nearly .STOMATITIS MERCURIAL. 295 reach the mucous lining of the lip, and apply ligatures as before. Break off the points of the needles with forceps, then cover the parts with lint and a bandage to retain it, both being kept constantly wet with cold water. After four or six days the needles can be removed and adhesive straps or the collo- dion substituted. Before attempting to pull them out, take hold of them with the forceps, and turn them three or four times round. If any thing adheres at the margin of the hole, carefully scrape it off, and see that the surfaces of the needles are smooth. To prevent rusting, a little sweet oil is applied to them before entering, and every time before the bandage is renewed. The patient should be confined to a room for several days, and avoid laughing, crying, talking, &c. For security's sake a long strip of adhesive plaster may be placed over the li]» reaching from ear to ear,—first pressing the cheeks forward. In double hare-lip, operate on both fissures at the same time. If the teeth project so as to lie in the way, and cannot be pressed back, they must be extracted. (See Illustrations). LIPS CRACKED. Fissure of the lip is sometimes the coiumencement of cancer of the lip. In common cases apply Almond-soap, Cacao- butter and especially deer-fat. Lockjaw.—(See Tetanus). Mentagra. — Eruption on the lip and chin. (See disease^ of the skin). MERCURIAL SORE MOUTH—MERCURIAL APHTIUE — STOMAT- ITIS MERCURIAL. Inflammation and sloughiaag of the mouth by large doses of Mercury is characterized by a very disagreeable odor from the mouth; the patient has a coppery, metallic taste; the ulcers are of a round form and yellowish color, bleed readily and change in quick succession from one place to another in the cavity of the mouth; the gums become inflamed, painful and sore with stiffness in the jaws; the tongue is covered with a brownish, or yellowish fur, and so swollen as to fill the buc- 296 DISEASES OF THE FACE AND BUCCAL CAVITY. eal cavity; often salivation and general emaciation takes place. Weeks and months may elapse after the administration of mercury before the effect on the salivary glands and mouth shows itself. Even mercurial ointment rubbed upon a part distant from the mouth has several months afterward caused salivation and ulceration in the mouth. This disease is always of serious and lasting injury to the system. Treatment allopathic. — Diet and cleanliness, tepid baths, small doses of Hepar sulphuris and Purgatives. The mouth must be kept clean and gargles of mucilaginous decoctions of mallow flowers, or marsh mallow root may be prescribed; in a putrid disposition Peruvian bark and Alum are indi- cated. Homoeopathic treatment. — Hepar sulphuris and Nitric acid, and in some cases Carbo v. and Sulphur will be found the most suitable remedies. The proper remedy should be given twice a day for six or seven days, and the mouth kept clean by gargling with slippery elm water, or honey and water. Hydropathic treatment — A thorough purifying treatment; the daily wet sheet or dry pack, followed by an ablution of tepid or cold water according to the strength of the patient; appropriate diet; pure air; and occasional fasting constitute the principal means of removing the effects of mercurial poi- soning. Eclectic treatment.—Employ the same means as recommended for Cancrum oris. NOMA — "WATER-CANKER. This disease generally occurs in infants and young children. The application of pyroligneous acid has proved most effi- cacious. (See gangrenous Aphthae). Odontitis vera.—Inflammation of the teeth. Sharp, throb- bing pains in one tooth with dark red swelling of the gum and pain when touched. Treatment.—One or two leeches applied to the painful part will in most cases relieve the pain. 'ODONTALGIA, 297 ODONTALGIA. Toothache generally arises from an inflammation of the nerve within the tooth, from an inflammation of the perios- teum of the fangs, er from an inflammation of the socket. Remote causes are: colds, rheumatism, congestion, carious teeth, pregnancy, general nervousness, drinking of coffee, using tobacco, eating pastry, &c Prevention. — Abstain from tea, coffee, spices, tobacco, and rich food; avoid the extremes of heat and cold drinks; keep the teeth clean with a soft brush dipped in eold water or in fine pulverized charcoal and water-; if tartar adheres to the teeth have it carefully scraped off, and if any decay is visible consult a skillful Dentist. Remove all bits of meat or other food from between the teeth after each meal. Treatment allopathic. — Removal of the carious tooth, ple- thora, nervousness and rheumatism. Palliative cure consists in the application of leeches on the gum; fly-blister or horse-radish on the arm or neck; spirits of camphor with opium on the painful cheek; a pill of hyos- cyamus, alum, belladonna, or opium laid into the aching tooth; a few drops of tincture cantharidis on the gum, or with acidum pyrolignosum upon cotton put into the painful tooth; a mouth- bath of a decoction of elder flowers and hyoscyamus; but the most efficient remedy is to wet the tooth with tincture of Para- cresses, chloroform or sulphuric ether. Homoeopathic treatment—The principal remedies are: Cof- fea, Chamomilla, Aconite, Belladonna, Mercurius, Nux v., and Pulsatilla; also: Arsenicum, Sulphur, Asa foetida, Tartar emetic, Rhododendron chrysanthum. If no proper remedy can be found, introduce a little cotton moistened with one drop of the tincture of Aconite into the hollow tooth, or in some cases, Belladonna. This frequently affords instantaneous relief. Toothache from cold: Aconite, belladonna, and ehamo- tuilla; from abuse of mercury: Carbo v., and nitric acid; from Bmoking: Bryonia, china, spigelia; from abuse of coffee: 298 DISEASES OF THE FACE AND BUCCAL CAVITY. Chamomilla, ignatia, nux v.; nervous toothache requires: Aconite, belladonna, chamomilla, coffea, hyoscyamus, nux v., spigelia and electro-magnetism; pains in hollow teeth: Anti- monium, mezereum, staphysagria, mercurius, &c; pain extend- ing to the eyes: Chamomilla, clematis, pulsatilla and spigelia. Hydropathic treatment. — Holding tepid water in the mouth until it gets warm when it must be changed; rubbing the face, cheeks, neck, and parts behind the ears with the hands dipped frequently in very cold water; rubbing the gums with a wet finger until they bleed; a general bath and cold shallow foot- baths; tepid water in the mouth and cold outside; fasting twenty-four hours and sleeping in a wet sheet are the principal means recommended. Eclectic treatment. — If the pain arises from Neuralgia and the teeth are sound, apply mustard to the back of the head and neck, continuing it as long as the patient can endure it; cup and scarify the same surface; apply large dry cups below and behind the mastoid processes; make applications of extract of tobacco in solution, as thick as thin molasses, along the painful jawT. Rheumatic toothache, or that which results from cold, and in which the pain affects the whole face more or less, Emetics are very valuable; also Diaphoretics and the alcoholic vapor- bath. Decayed teeth should be taken out. In some cases oil of cloves, cinnamon and Creosote have been applied with some benefit. A compound of equal parts of pulverized camphor and opium, made into a thick paste, by wetting them with oil of turpentine, and the cavities of the decayed teeth filled with it, will in most cases give immediate relief. PARALYSIS OF THE FACE. The muscles of the face have lost their power to act and be moved by the will. The face is thrown to one side, causing the well side to appear shorter and narrower than the paralyzed side. The eye on the sound side is firmly shut, while that on FACE-ACHE, 299 the other side is partially closed or wide open; if the patient attempts to spit, the saliva shoots off in a side way direction out of the sound side; if he tries to blow out a light the same phe- nomena is observed; if he speaks, laughs, cries, sneezes or coughs, the sound side is thrown into contortions, while the paralyzed side remains the same. Causes. — Attacks of apoplexy ; loss of fluids ; suppression of an eruption; pressure of tumors under the ear, wounds and surgical operations. Treatment.—Remove the causes; improve the general health; apply galvanism or electricity. (See: Diseases of the nervous System). Paralysis of the tongue. — This disease is generally a symp- tom of apoplexy and must be treated accordingly. Paralysis of the jaw (hanging jaw) is likewise a symptom of apoplexy. It must be distinguished from dislocation of the jaw. PALATE DEFICIENT — FISSURE OF THE PALATE, Has been successfully remedied in some instances by a sort of internal rhinoplastic operation. In this operation the new roof is brought from the walls of the mouth, or inside of the cheeks, and secured by a sufficient number of interrupted sutures. This operation is only necessary where so great a portion of the soft palate is wanting, as to make it impossible to approximate the edges by simple ligatures. PROSOPALGIA — TIC DOLOREUX—NEURALGIA OF THE FACE — FACE-ACHE. Excruciating pain in the face, especially under the eye, and sometimes before the ear, from whence it shoots over the entire half of the face, and frequently into the orbit and cranium. In the highest degree the pains resemble electric shocks and create spasmodic distortions of the face. The paroxysms continue for several days, or weeks in succession. This dis- ease is one of the most obstinate, and is in some cases incu- rable. Causes.—Congestion; decayed teeth; abdominal obstructions; 300 DISEASES of TIlK FACE AND BUCCAL CAYITV. colds; abuse of mercury and opium; abuse of coffee, tea and tobacco; Rheumatism and Gout. Treatment allopathic. — The remote causes, congestions and abdominal obstructions) should be remedied. If afterward the pain still continues resort to lotions and fomentations of aqua laurocerasi, tinctura Stramonii, Morphine and Veratrin; to applications of opiate plasters, ice, frequent cupping on the neck; douches of cold water by means of a small clyster pipe, linen compresses dipped in hot water, setons and moxa, elec- tricity, magnetism and chloroform. The division of the nerve is an unsafe remedy. Internally give Aconite and Guajac, Belladanna, carbo animalis, extractum hyoscyami, Guajac and asa foetida, natrum arsenici, opium, small doses of Strychnine and sublimate. (See Neuralgia). Homoeopathic treatment — During a severe attack of neu- ralgia in the face, give the tincture of Aconite, three drops to half a tea-spoonful of water, a tea-spoonful every fifteen to twenty minutes, and apply the same remedy externally. Spigelia is one of the principal remedies in all cases when the pain is excessive, appearing at a certain time of the day and of a tearing, burning character; affecting mostly the cheek-bones and aggravated by touch or motion, with shining swelling of the diseased part. Belladonna: pain under the right eye; twitchings of the eyelids; rigidity of the nape of the neck; spasmodic jerkings of the facial muscles and distortion of the mouth; heat and redness of the face. Colocynthis: tearing and shooting pains on the left side of the face, aggravated by the slightest touch. Platina: feeling of coldness and torpor in the affected side of the face; sensation of creeping or crawling. Arsenicum: burning, pricking, periodical pains; great an- guish; excessive prostration. See also: China, Mezereum, Asa foetida, Mercurius, Nux v., Chamomilla, Thuya and Hepar. Hydropathic treatment—Fasting; application of ice and ice PTYALISMUS. 301 cold water to the painful part; the hot douche by means of a small syringe; hot iron or hot coals held near the part as long as the patient can bear it; steaming the part with a hot brick or stone, with a wet cloth wrapped about it; covering the part with oiled silk and cotton or wool, application of little bags filled with warm ashes or salt; Russian bath; wet pack; sea-bathing; sea-sickness. Eclectic Treatment—The bowels should be kept open, and if the face-ache is caused by cold the occasional use of the spirit-vapor bath will be found beneficial. The electro- magnetic battery, rubefacients and the local application of chloroform as well as the compound cajuput mixture have been employed with the happiest results. The saturated tincture of aconite, in the proportion of one fluid drachm to eight ounces of water, of which a tablespoonful was given every hour, has afforded great relief. The patient at the same time should be placed upon the use of anti-periodics, among which the following is preferred: take of Sulphate of Quinia, Prussiate of Iron and Hydras- tin, equal parts, mix and give four grains every four hours in conjunction with the compound powder of Ipecac, and Opium, given in the same doses three times a day. PTYALISMUS—SALIVATION—DRIVELING--SLAVERING. Immoderate secretion or discharge of saliva (spittle) with heat, dryness, swelling and pain of the gums, of the inner sur- face of the cheeks and of the mouth generally. The patient complains of difficulty of swallowing and difficulty in open- ing the jaws; a coppery metalic taste in the mouth; swelling of the tonsils; fetid odor of the breath; and elongation, looseness and soreness of the teeth. At length the parts that are most affected begin to ulcerate, the ulcers presenting a fungous appearance and blood issuing from them. Causes.—Teething; cold; scarlet fever; measles; abuse of mercury; idiocy; scurvy; obstruction in the abdominal viscera. Sometimes it appears as a critical discharge, and is then very beneficial. 302 DISEASES OF THE FACE AND BUCCAL CAVITY*. Treatment allopathic.—Use mild mouth-washes, made of A decoction of the roots or leaves of marshmallow. In obstin- ate cases, washes and gargles of sulphate of copper, tincture of myrrh, alum, pyroligneous acid, and chlor-water, may be required. Tepid baths, sulphur, and repeated purging are also recommended. If caused by abdominal obstructions or scurvy, employ the means recommended for those diseases. Homoeopathic Treatment.—If caused by abuse of mercury, give: Hepar s., Lachesis, Belladonna, Nitric acid, and Sul- phur in alternation every six to twelve hours, until an im- provement is perceptible. If cold is the cause, give: Mercury, a dose every six hours, until four are taken; and if not better after twenty-four hours, give the above named remedies in the same manner. Hydropathic Treatment—If caused by abuse of Mercury which renders the body over-sensitive to the impression of wet and cold, caution should be used in the application of cold water. Each case should be managed according to symptoms and on general principles. Exercise in the open air, diet of the mildest kind, occasional fasting, and a daily ablution are some of the best means of gradually restoring the system,—if that is possible—to a natural action. Driv- eling or Slavering generally cures itself. Eclectic Treatment.—(See Stomatitis mercurial.) RANULA--FROG-TONGUE. Swelling under the tongue, caused by obstruction of one or more of the salivary ducts. The fluid secreted by the sub- maxillary or sublingual glands accumulates at the point of obstruction, forming a tumor which becomes inflamed or pain- ful. Causes.—Cold, inflammation, and other irritations. Allopathic treatment. — Snipp out a small piece of the sac, and rub the interior with lunar caustic; or pass a small seton through the sac. Homoeopathic treatment. — If caused by cold or inflamma- tion, Mercurius, Calcarea and Thuya are chiefly emploved. SCURVY. 303 If the tumor has burst and left an obstinate ulcer behind, Mercurius, Calcarea and Silicea are the appropriate remedies. Eclectic treatment, — Cut through the surface with the points of sharp scissors, and take out a small portion of the sub- Btance; then wash out the cavity with soap-suds, clean cold water or a solution of super-carbonate of potash* Scirrhous indurations. — (See Cancer.) SCORBUTUS — SCURVY. Excessive debility; pale and bloated countenance; shiver- ings; nausea and vomiting; swelling of the gums, which be- come livid, spongy and bleed easily; fetid breath; difficult respiration; cedematous swelling of the inferior extremities; livid spots on the skin, or foul ulcers; offensive urine and extremely fetid stools; sometimes obstinate costiveness; he- morrhages, from the nose, teeth, tongue, and the urinary organs; violent pains in the bones; increase of debility; gan- grene without previous inflammation, detaching, sometimes, entire parts from the body; general dissolution. In petechial scurvy, which is apt to follow nervous and typhoid fevers, there are small eruptions like flea-bites upon the breast, arms and legs. In land-scurvy the eruption is larger than the former va- riety, and often occurs in stripes over the thighs, arms and trunk, with hemorrhages and great debility. Sea-scurvy is most destructive. Causes.—Decomposition or dissolution of blood, caused by intemperance, want of exercise, anxiety of mind; impure air; uncleanliness and unwholesome food; salt meat; exposure to cold and moisture; &c. It chiefly affects sailors and soldiers, who are deprived of fresh provisions and an adequate quantity of ascescent food, and are exposed to cold and fatigue. There exists also a congenital dispositio scorbuticae. Prevention. — It is prevented on board of vessels by clean- liness, ventilation, exercise and exhilaration of the crew, and by sour-krout, citrons and beer. Treatment allopathic — Enliven and oxidate the blood by 304 DISEASES OF THE *'ACE AND BUCCAL CAVITY. country air, fresh water and fresh vegetables. Lemon juice, six to twelve ounces taken daily, and also externally applied to the ulcers, is one of the most efficacious remedies. In land-scurvy, yeast has proved of excellent service, from four to twelve ounces to be taken daily, and also applied to the ulcers. -.. Carrot pulp, frequently renewed, is useful to heal the scor- butic ulcers. Herba sabinae, used in fomentations and baths, has specific effects, even for curing caries. In great debility give cinchona and the mineral acids; in a disposition to hemorrhage, alum; for violent pains in the bones, poultices with linseed and Sabina-herb; against the ulcers in the mouth, gargling the mouth with chlorine water, decoction of Peruvian bark, calamus with alum. Homoeopathic treatment. — Wholesome diet, fresh vegetables and those fruits which furnish citric acid, especially lemon. Sour-krout, cider, spruce-beer, and also vinegar, are recom- mended. Mercury—if this has not been already used to excess— should be given every six hours until six doses are taken for the following symptoms: Red, spongy, ulcerated and easily bleeding gums with burning pains at night; looseness of the teeth; aphthae or thrush; fetid smell of the mouth and ulcers; profuse discharge of saliva; fetid urine; depression of body and mind. Carbo veg.: In persons who have taken much mercury, or when there are burning ulcers in the mouth, which bleed and discharge fetid matter. Arsenicum: In severe forms of the disease; painful, livid, dark ulcers; blueish, cold and dry skin; extreme anguish and restlessness. Staphysagria: Principally indicated in hemorrhage from the gums. Hydropathic treatment — The tepid half-bath, and dripping- sheet, or towel-wash, are the preferable water appliances; and when the disposition to hemorrhage is great, cold water enema TARTAR UPON THE TEETH. 305 should be occasionally employed. Moderate use of acids while at sea is of benefit. Eclectic treatment, — The patient should be placed upon a fresh vegetable diet, especially of acid fruits, oranges, lemons, limes, sour-krout, and similar articles. As a local application nothing equals the strong decoction of Hydrastis canadensis, very frequently applied to the parts, and, at the same time, taken internally several times a day. STAMMERING--STUTTERING. Defects of speech. A nervous affection of the organs of speech. If it appears in consequence of spasms or paralytic strokes, see their respective chapters. In other cases the patient must endeavor to acquire control of his speech by reading aloud, articulating properly, intonating every word and beating time with the fingers. Patience, kindness and perseverance is necessary to remove stammering in children. Tea, coffee and spices are injurious. Surgical operations have thus far proved unsuccessful. Deep, full and prolonged inspirations and expirations, dur- ing which the patient may to advantage count one, two, three, four, etc., taking pains to open wide the mouth, and speak loud and plain each monosyllable he attempts to utter, are highly serviceable. STOMATITIS EXSUDATIVA—THRUSH. Inflammation of the mucous membrane of the mouth, at- tended with the exudation of lymph on its surface, generally affects infants and nursing women (nursing sore mouth.) (See Aphthae.) Stomatorrhagia. — (See Hemorrhage from the mouth.) Stomacace. — (See Canker.) Swelling of the lips and face. — (See Erysipelas, Fluxion in the cheek, Toothache, &c.) TARTAR UPON THE TEETH. The teeth are incrusted with a hard, whitish substance, which is destructive to the gums and leads to early decay of the teeth. iov 306 DISEASES OF THE FACE AND BUCCAL CAVITY. Causes. — Drinking hard, limy water, and neglecting tho proper cleansing of the teeth. Treatment. — Remove the accumulated tartar, and afterward clean the teeth daily with a wet soft brush dipped into finely pulverized charcoal, or into sugar of milk. TEETH CROWDED. The irritation of the gums, caused by the teeth crowding too closely together, will often produce inflammation and ul- ceration, and if the latter be round the posterior teeth, it not unfrequently produces inflammation of the tonsils, and pha- rynx. Treatment, — Extract a tooth from the crowded space. Toothache. — (See Odontalgia.) Thrush.— (See Aphtha1.) TONGUE-TIE. A child is said to be "tongue-tied" when the membrane which holds the tongue down to the lower part of the mouth (frenum linguae) is too short, or extends to the tip of the tongue, fixing it firmly to the floor of the mouth. It prevents the child from sucking well, and in later years from speaking distinctly. Treatment — When the malformation is so complete as to prevent the child from sucking, about one-eighth of an inch of the anterior portion of the membrane should be cut with a pair of sharp scissors. The points of the scissors should be directed downward, as near the floor of the mouth as possible, so as to be sure to avoid cutting the lingual artery. Operate when the child is asleep, holding the tongue up a little with the fore-finger of one hand. Tumor of the gums. — (See Epulis and Gum-boil. Ulcers of the mouth. — (See Canker of the mouth, and Aphthae.) ULCERATION OF THE ANTRUM — MAXILLARY ABSCESS. Severe pain in the face beneath the prominence of the ma- lar bone, which continues in spite of all remedies used exter- nally and internally for its relief; with fever, headache and LANCING OF THE GUMS. 307 costiveness. The neighboring teeth are sympathetically af- fected, and often extracted without mitigating the pain. In some cases there is a discharge of offensive matter from the nose. The face in some instances swells and becomes disfig- ured, and the walls of the antrum may be visibly extended by the accumulation of pus. The disease may exist for months and years, and pass for mere "toothache," without the sufferer being aware of its nature. Causes. — Irritation of the lining membrane of the cavity by decaying teeth; ulcers on the roots of the teeth; common cold. Treatment. — If there are any decayed teeth extract them; allay inflammation to prevent suppuration, and keep the bow- els open by clysters and other means. When suppuration has already commenced, or has continued for some time, extract the second or third molar tooth, and if the alveolus does not communicate with the antrum by a sufficiently large opening, drill a hole about the size of an ordinary goose-quill, then inject into the cavity some anodyne preparation (opium and capsicum), which generally will allay the pain. If the in- flammation does not subside, inject a solution of mild caustic once or twice a day, alternating it with a strong decoction of oak-bark and the compound tincture of myrrh. To correct the fetor, inject diluted pyroligneous acid once or twice a day. (See Caries and Necrosis.) WOUNDS OF THE TONGUE. If attended by serious hemorrhage from the lingual artery, which cannot be arrested by the ordinary means, one or more ligatures should be introduced with curved needles so as to include and constrict the bleeding parts; or a hot iron may be applied to the bleeding orifice through a metallic tube. LANCING OF THE GUMS. If at any time during dentition a child is feverish and rest- less, and there are any symptoms of disorder in the head or chest, the gums should be examined, and if any part appears red and swollen, a free incision should be made with a gum 308 DISEASES OF THE FACE AND BUCCAL CAVITY. lancet quite down to the tooth. The edge of the lancet should be turned outward, so as to avoid the sacs of the permanent teeth. FILLING TEETH. When a tooth commences decaying, the decayed portion should be removed by proper instruments, and the cavity be filled up with gold. This operation should be performed with care. If the decay has advanced so far as to lay open the central cavity of the tooth, or if the introduction of an in- strument Causes the peculiar pain arising from pressure on the nervous membrane, such a proceeding might cause ex- cruciating agony, and induce suppuration in the centre of the tooth and in the socket. Under these circumstances, the in- dications are to remove the diseased part of the tooth, and to protect it from the irritation of contact with food and saliva and to diminish its sensibility. For these purposes the best plan is, to fill the cavity with a composition of powdered chalk, with a very little tannin, mixed into a paste with a solution of mastic in alcohol; or frequently to introduce a drop of some narcotic or stimulating solution. By these means the tooth may very probably be brought into a state to bear stopping with gold. The patient should avoid exposure to cold — or drinking very hot, or cold, or sweet, or acid fluids—and should be careful not to induce feverishness by any errors in diet. DISEASES OF THE THROAT AND NECK. ANGINA VERA—INFLAMMATION OF THE THROAT—QUINSY— TONSLLLITIS. Inflammation and swelling of the mucous membrane of the fauces and tonsils, accompanied with chilliness, huskiness of the voice, and impaired functions of swallowing, respiration and speech. In some cases the uvula and adjacent parts are implicated and become so much swollen and inflamed that the patient cannot swallow at all. In malignant, or ulcerated sore throat, the attending fever is typhoid, the fauces exhibit a crimson flush; the tongue, tonsils and other parts are covered with ulcerations and with a tenacious slime, and spreading sloughs, of an ash or whitish hue. The face is generally flushed and swollen. Inflammation of the throat terminates either in resolution, or passes into suppuration or induration. In some instances mortification takes place, or even death by suffocation. Causes. — Taking cold; influence of cold and east winds in the open mouth; hot, ill-ventilated rooms; too warm covering on the neck; &c. Treatment allopathic. — Local bleeding by leeches or by cups on the neck, gargles of the common elder tea with vinegar and honey; or of an infusion of sage sweetened with honey of roses; a mixture of black-berry syrup two ounces, and oxymel (honey and vinegar) one ounce, a tea-spoonful of it to be taken frequently; or borax (half a drachm), and mulberry syrup (two ounces), to be taken in the same manner, have been employed with much benefit. Wrap the throat thickly in flannel, embrocated with volatile lin- 309 310 DISEASES OF THE THROAT AND NLVK. iment. In dangerous cases scarification by means of the Pharyngotoinus should be resorted to, by which the most imminent danger of life may be removed. If an abscess forms warm linseed poultices must be applied until it breaks. Opening of the abscess may be facilitated by irritatino- the pharynx with a feather dipped in oxymel of squill. Homoeopathic remedies principally indicated are, Aconite Belladonna and Mercurius; and in some cases: Chamomilla Lachesis, Nux v„ Pulsatilla and Ignatia. Gargling with warm water and milk, and the inhalation of the vapor from boiling water will often afford considerable relief. Hydropathic treatment, — The wet compress, consisting of several folds of linen wet in cold water, must be promptly applied around the throat, and frequently renewed. The whole body must be well rubbed in the dripping sheet, and then wrapped in the dry blanket, so as to produce moderate perspiration; or the general fever may be treated with the wet-sheet pack. In the malignant form small draughts of iced water should be frequently taken, and the coldest water, or pounded ice, applied to the throat whenever the morbid heat is trouble- some. Eclectic treatment.—Some mild evacuant, as the compound powder of Rhubarb, should be administered, followed by a warm, stimulating foot-bath, and the surface must be bathed with a weak, warm, alkaline solution, as often as the severity of the disease may require. The throat and neck should be bathed several times a day with some stimulating liniment, after which a piece of flannel should be bandaged around the throat, and in severe cases a fomentation of hops and mullen leaves. Cups to the side of the throat, followed by poultices of roasted onions, is a valuable application. A solution of Alum, or Borax in honey and vinegar may be used as a gar- gle a number of times through the day. Should the child be too young to gargle, this must be applied on a piece of linen ULCERATED AND PUTRID SORE THROAT. 311 rag to the inflamed parts. In obstinate cases, a solution of the nitrate of silver, five or ten grains to an ounce of water, may be applied two or four times a day. At any time, when the secretions about the fauces become very abundant, inter- fering with respiration, the compound tincture of lobelia may be given in sufficient quantities to produce emesis. For restlessness a dose of the diaphoretic powder may be given every evening before going to bed. ANGINA CHRONICA. Frequent attacks of inflammation of the throat, or sore throat upon the slightest occasion. It generally follows acute inflammation of the throat, and the symptoms are nearly the same. Causes. — Local weakness; scrofulous, syphilitic, or rheu- matic metastases; hemorrhoidal congestion and other abdomi- nal accumulations. Treatment allopathic — Gargling with alum water mixed with some agreeable syrup; daily cold washing of the throat; wearing a neck-cloth of silk or flannel on the bare skin; cure of scrofula, rheumatism or syphilis. Cutting out of the ton- sils is generally a dangerous operation, as frequently, the lungs become affected, and the patient dies of consumption. Homoeopathic remedies. — Belladonna, Lachesis, Calcarea, Sulphur, Hepar sulphur, and Mercurius. Hydropathic and Eclectic treatments. — (See Angina vera.) ANGINA GANGRENOSA — MALIGNANT QUINSY — ULCERATED' AND PUTRID SORE THROAT. This disease generally appears as a sequel of scarlet fever, and prevails epidemically. The symptoms in the first stage are shivering, dryness and burning in the throat; uvula and pharynx, blueish or violet-colored; dryness of the point and edges of the tongue; inflamed nostrils; restlessness; great debility; quick, irritated pulse. In the second stage we have increase of fever and restlessness; offensive breath; swelling of the glands of the neck; difficulty of swallowing and breath- ing; shining, glossy appearance of the skin on the neck and 312 DISEASES OF THE NECK AND THROAT. face; acrid discharge from the nostrils causing excoriation of the nose and lips ; palate and tonsils covered with numer- ous ulcers which are coated with grayish yellow crusts dis- charging a very acrid, offensive ichor; diarrhoea ; discharge of large pieces of a membranous like mass; symptoms of croup; rattling respiration; sunken countenance; sopor • symptoms of suffocation; death on the fourth or sixth day. Treatment allopathic.—Utmost cleanliness; free ventilation; frequent drinking of and gargling with ice water; little bags of ice put into the mouth; vapors of vinegar mixed with myrrh; gargling with chlor-water; emetics; mineral acids; diaphoretics. Homoeopathic Remedies. — Belladonna, Mercurius, Nitric acid, Lachesis, Arsenicum. (See Angina vera.) Angina Membranacea.—(See Croup.) Angina Pharyngea.—Inflammation of the pharynx, with swelling of the same and difficulty of swallowing. (See Quinsy.) Angina Rheumatica.—White-swelling of the tonsils or uvula, with little pain; slight fever; stiffness of the-neck and rheumatic pains in the same. (See Quinsy and Rheu- matism.) Angina Syphilitica.—Redness of the throat with burn- ing pains; small whitish pustules in the mouth and throat which break and form into ulcers, discharging a fetid, ichor- ous pus. (See Syphilis.) Angina Biliosa.—Quinsy with symptoms of a gastric bilious fever. (See Quinsy and. Bilious Fever.) Angina Tonsillaris and Uvularis.—(See Quinsy.) CHOKING AT THE GULLET—FOREIGN SUBSTANCES IN THE GULLET. If a large piece of meat, apple, pieces of fish-bone, pins and the like get lodged in the gullet, seat the patient, throw the head far back, and open the mouth widely, then pass your finger and thumb down the throat, regardless of the gagging DYSPHAGIA. 313 or efforts to vomit, and extract the offending substance. In some cases we can succeed better by the use of a teaspoon, spoon-handle, or curved forceps. If it has passed below reach in this way, it may be pushed into the stomach with a probang, a piece of whalebone, having a rounded end, and covered with silk; or withdrawn by means of an air-pump. Should the probang pass by the substance without moving it up or down, then attach firmly to the end a piece of very fine sponge perfectly dry, lubricating its surface with oil or soap. It must not be so large as to produce suffocation by pressure on the trachea. Pass this down to the substance and press gently upon it. If it moves continue the pressure until it enters the stomach, but if the instrument with the sponge passes by the substance, push it on a few inches further and let it remain for several minutes ; it will thus, by absorbing fluid, become swollen, so as to fill up the oesopha- gus, and when withdrawn, bring up the substance before it. If it be some substance which would not be digested, or too large to pass through the pylorus and be discharged from the bowels, every effort must be made to bring it up by vomiting. A fish-hook with a line attached, lodged low down in the oesophagus, was drawn out by drilling a hole through a bullet and letting it down the throat over the line; when coming in contact with the hook the latter was disengaged by the weight of the ball, and the point then turning up against the bullet was prevented from catching hold again. DYSPHAGIA. Difficulty of swallowing without pain and without signs of inflammation. Causes.—Debility of the muscles of deglutition; spasms, (globus hystericus)■$ paralysis, after apoplexy and hemiple- gia; scrophulous, syphilitic and arthritic metastases ; mechan- ical impediments, as swellings and indurations of the glands in scrofulous persons, polypus, &c. Treatment allopathic.—Spasmodic dysphagia, requires ex- ternal fomentations of hyoscyamus, cicuta and opium; 31 I DISEASES OF THE NECK AND THROAT. internally, belladonna, extract of hyoscyamus, opium and aqua laurocerasi may be given, and sinapisms and vesicatories applied to the throat. Oleum cajeputi on sugar is particu- larly efficacious in spasms of the gullet and stomach. In atonic and paralytic dysphagia we must employ electricity, vesicatories, and spirituous fomentations. In metastatic dys- phagia: foot-baths of mustard, sulphur-baths, vesicatories, res- toration of suppressed discharges and eruptions; when caused by scrofulous swelling of the glands, the best remedies are: Spongia tosta, iodine, barytes, mercury, internally and exter- nally. In incurable dysphagia life may be prolonged by the intro- duction of bougies, and injections of milk. Homoeopathic remedies.—Spasmodic constriction of the gul- let: Belladonna, Lachesis, Stramonium, and Veratrum. (See causes and their treatment.) GOITRE — STRUMA —DERBYSHIRE NECK—BRONCHO-CELE. This tumor is a preternatural enlargement or hypertrophy of the thyroid gland. In its early stage it is soft and elastic; fautas it advances in size it becomes firmer, and spreads toward the spides of the neck, attaining sometimes an enormous mag- nrrade. Respiration is often somewhat difficult, caused by pressure upon the larynx. It is very prevalent in the valleys of Switzerland, and in other low, moist, marshy situations; and affects principally young females. Causes.—Scrofula; damp, moist countries; drinking water containing gypsum, lime, sulphur, &c. Treatment allopathic.—Removal from valleys into a level or mountainous country, drinking of rain water; burned sponge externally and internally, Bromine, Hydriodic ointment; roasted salt in a little bag, worn upon the swelling have proved efficacious. In persons that have weak lungs great caution must be used in the application of external remedies. If goitre is of scrophulous origin, anfi-scrophulous remedies must be .prescribed. t / a INDURATION AND ENLARGEMENT OF THE TONSILS. 315 Homoeopathic treatment.—Take a dose of Spongia, low tritu- ration, every day, and wash with a solution of the tincture of Spongia, or apply an ointment of Spongia. Should this treat- ment not disperse the swelling within a month or two, admin- ister anti-scrophulous remedies, as: Calcarea, Sulphur, Conium, Natrum m., Lycopodium, Iodine and Carbo veg. Hydropathic treatment.— Friction with the hand wet in cold water; stimulating compress; douches to the spine and to tli3 tumor itself as the patient can conveniently bear; occasional packings in the wet sheet; hip and foot-baths, plain, abstemi- ous diet; drop-bath, followed by the wet compress. Eclectic treatment.—Give a brisk purgative, composed of Po- dophyllum one part, and cream of tartar two parts, enough to operate freely. The podophyllum may be used in half grain doses, with half a drachm of cream of tartar given every two hours until there have been from six to ten evacuations. This cathartic treatment should be repeated once a week. Bathe the whole surface in weak lye at night, and with cold water in the morning. Apply a strong stimulating liniment, with as much compression as can be born to the tumor. At each dressing let the tumor be showered with a small stream of cold water poured from a height, and the surface rubbed dry, using brisk frictions with the hand of another person; oil of turpentine, which has been saturated with gum of camphor, is an excellent liniment. Tonics may be used, and, if the patient is scrofulous, the scrofulous syrup. If no recovery takes place under this treatment, the irritating plaster must be applied. It should be kept on and dressed in a proper manner for five or six weeks with as much compression as the patient can bear; and when removed, and the surface healed, the showering, with the liniments should again be resorted to. Inflammation of the throat—(See Angina). INDURATION AND ENLARGEMENT OF THE TONSILS. This disease occurs after repeated attacks of acute Angina, especially in scrofulous persons. Voice is changed, degluti- tion obstructed, respiration difficult and noisy, especially dur- 316 DISEASES OF THE NECK AND THROAT. ing sleep, and occasionally there is partial deafness resulting from obstruction of the Eustachian tubes. Treatment consists in the improvement of the general health, and in the administration of such remedies as have been recom- mended for Angina. Excision and removal of the enlarged tonsils is considered dangerous to the future health of the patient, predisposing to pulmonary consumption. MTJMPS—ANGINA PAROTIDEA—INFLAMMATION OF THE PARO- TID GLAND — PAROTITIS. A painful, unsuppurative swelling of one or both parotid glands; it is contagious, and often epidemic; it is often accom- panied with swelling of the testes in males, and of the breasts in females; occurs but once in the same individual, and ap- pears often as a sequela of typhus, of measles and scarlatina. The tumor increases till the fourth day, and often involves the maxillary glands in the inflammation. Allopathic treatment.—Diaphoretic drinks, keeping warm; cathartics, dry fomentations; embrocations of mercurial oint- ment. In severe forms, calomel, leeches and emetics. Homoeopathic treatment. — Mercurius is considered the spe- cific remedy, but if the patient has taken Mercury in large doses already, Carbo vegetabilis should be administered. If metastasis to the brain has taken place, and the swelling disap- pears suddenly, we should have immediate recourse to Bella- donna, Hyoscyamus, or Cuprum aceticum. If the swelling presents an erysipelatous appearance Belladonna is indicated, or Rhus and Bryonia. If it occurs as a sequela of typhus: Belladonna, Sulphur and Calcarea; of measles: Arnica, Bryo- nia and Rhus; of scarlatina: Hepar, Dulcamara, Baryta, Rhus and Arsenicum. Hydropathic treatment. — Abstemious diet, the wet sheet whenever the whole surface is affected with feverish heat, and the application of a wet linen cloth, covered with a dry one, to the inflamed part, whenever this is very hot or painful, constitute the remedial plan. Whenever metastasis occurs OESOPHAGITIS — INFAMMATION OF THE GULLET. 317 to the testes or breasts, the full warm-bath should be em- ployed, succeeded by wet compresses to the affected part, well covered. Eclectic treatment. — Abstemious diet; avoidance of cold by exposure to wet, or sudden changes of temperature; seidlitz powders should the bowels be constipated; externally a piece of soft flannel. In metastasis to the testicles, the patient should be confined to his bed in a horizontal position, the testes enveloped in an elm poultice, and supported by a sus- pensory bandage—the poultice must be changed two or three times a day. In order to recall the inflammation to the paro- tid glands a sinapism or blister should be applied over the gland, and then compound powder of Ipecacuanha and Opium administered internally. In cases where the brain, or some other vital organ, becomes affected, they must be treated like severe inflammation of such organs. OESOPHAGITIS — INFLAMMATION OF THE GULLET. A fixed pain of a burning, smarting character, either high or low in the gullet, which is increased during the act of swal- lowing. If the inflammation is severe, swallowing is impossi- ble and food is thrown up, when reaching the inflamed spot, by contraction of the oesophagus. In some cases the patient complains of pain in the back, and under the sternum, and stiffness of the neck. We often find oesophagitis complicated with inflammation of the Nervus vagus, and have, then, all symptoms of Hydrophobia spuria. Causes. — Swallowing of very hot food or drink; irritation caused by swallowing foreign substances; tumors in the neigh- borhood of the oesophagus; Angina, &c. Treatment. — If the inflammation is caused by swallowing hot food or drink, give mucilaginous drinks, milk, almond- milk, slippery elm water. If accompanied with much fever and the patient is plethoric, apply leeches along the tube. If complicated with inflammation of the nervous vagus very little hope of saving the patient can be entertained. Vesica- 318 DISEASES OF THE NECK AND THROAT. tories along the oesophagus, or perhaps division of the nervo might prove of benefit. Homoeopathic remedies.—Belladonna, Hyoscyamus, Arseni- cum, Mercurius, Arnica and Carbo veg. (See Angina). Paralysis of the gullet. — (See Dysphagia). Pharyngitis.—Inflammation of the pharynx. (See An- gina) Putrid, sore thoat.—See Angina gangrenosa. Quinsy.—(See Angina vera). RHEUMATISMUS COLLI--RHEUMATISM OF THE NECK. Periodical, wandering pains in the muscles of the one or other side of the neck, rendering the moving of the head or neck painful and difficult. In some cases the neighboring mucous membrane becomes affected and we have Angina rhcu- matica, or it affects the muscles of the lower jaw and trismus rheumaticus takes place. (See Rheumatism). Spasms in the throat.—(See Dysphagia). Sore throat—(See Angina). SWELLING AND ELONGATION OF THE PALATE — FALLING OF THE PALATE — INFLAMMATION OF THE UVULA — ANGINA UVULARIS. Inflammation and swelling of the Uvula accompanied with painful and difficult swallowing, and a tickling and irritating cough. Causes. — Cold and Indigestion. Treatment is the same as that of Angina. If the swelling threatens suffocation, longitudinal incisions are the safest and quickest means for relief. Chronic elongation of the uvula re- quires in many cases excission or abscission, an operation easily performed with an instrument constructed for that purpose. WOUNDS OF THE THROAT—CUTTING OF THE THROAT. Most cases of serious wounds in the throat occur in persons attempting suicide with a razor, or other sharp weapon, and death generally takes place, if any of the larger vessels are wounded. Treatment. — Cleanse the wound with a sponge and warm ULCERS IN THE THROAT. 319 water, and then apply, if necessary, the ligature to veins as well as arteries; next bring the edges together, and retain them by stitches, taking care to keep the patient's head for- ward, so as to cause the surfaces to approximate. The patient should not be allowed to talk. Eating and drinking have often to be restricted. WRY NECK—TORTICOLLIS. An involuntary and fixed inclination of the head toward one of the shoulders. Causes. — Atony of the muscles on the yielding side; scalds and burns; strain; carrying heavyweights upon the head; cold; spasmodic muscular contraction. Treatment. — First attempt to invigorate the debilitated muscles by friction with the hand wet with cold water, local wet bandages and electro-magnetism. If all medicinal and mechanical means fail, the contracting muscular tendon or fascia should be divided by the subcutaneous section. The snapping back of the musele will tell when it has been com- pletely severed. Ulcers in the throat.—(See Angina.) CHAPTER XIV. DISEASES OF THE ABDOMINAL VISCERA, Abscess of the liver.—(See Phthisis hepatica and In- flammation of the liver. ACIDITY OF THE STOMACH — SOUR STOMACH. Sour eructations and sour breath; sometimes a canine ap- petite; nausea and vomiting of food and watery fluid; colic; &c. Vegetables and milk disagree; meat agrees well. Chil- dren, especially infants, are troubled with this affection, which is a consequence of overloading the stomach, and insufficient bile. Treatment allopathic. — Neutralize tho acids by absorb- ents; such as magnesia, saleratus, lime-water and milk of sulphur. To prevent the generation of acidity, the patient must take muscular exercise; eat little, and strengthen the digestive organs. (See Indigestion.) Homoeopathic remedies. — Ipecac, Pulsatilla, Bryonia, Nux v., Chamomilla, Sulphur and Calcarea. (See Indigestion.) ADIPOSIS--POLYSARCIA--POT, OR FALSTAFF BELLY. Abnormal secretion and excessive accumulation of fat in the abdomen (omentum). Its effects are: obstruction of ex- cretion and secretion, oppression of circulation, congestion, dropsy. Causes. — Immoderate use of animal food, beer, and ar- dent spirits; want of exercise; phlegmatic temperament; lax fibre; cessation of habitual hemorrhages; congenital disposi- tion. Treatment. — Scanty, watery food; vegetable, instead of meat diet; strong, corporeal exercise, excitement of mental affections; riding on horse-back; little sleep; fasting; drink- in tr of water instead of beer, whisky; &c. 320 GASTRIC AND BILIOUS APOPLEXY. 321 Hoinceopathists recommend; Celecynth, Calcarea and Sul- phur. Ague-cake.—( See Splenitis,) ANOREXIA. Absence of appetite is most frequently a symptom of another disease, as fevers, gastric impurities, hypochondria, hysteria, &c, and must be treated accordingly. In many cases it is a symptom of dyspepsia, and usually attributable to irregular eating; imperfect mastication of food; abuse of tonics and other medicines; sedentary habits; neglect of cleanliness, ventilation and exercise in the open air; indulgence in fermented liquors, or in tea or coffee; sleeping after din- ner; late and heavy suppers; drinking copiously during meals, &c. Treatment — Avoid the causes above mentioned; rise early, take exercise in the open air, pay attention to diet, abstain from rich and highly seasoned food., sleep in a well ventilated room, and drink a tumbler-fill of fresh, soft water before reti- ring, and early in the morning, If caused by gastric impurities, cathartics and emetics should be administered; if it originates in debility and want of sen- sibility of the stomach, stimulants, as bitters, aromatics and salts are required. Homceopathic treatment — A proper remedy to restore the natural tone of the stomach will be found among the follow- ing: Nux v., Chamomilla, Pulsatilla, China, Ipecac, Ant. c, Bryonia, Arnica,. Hepar, Sulphur and Calcarea. (See Dys- pepsia.) APOPLEXIA GASTRICA — GASTRIC AND BILIOUS APOPLEXY. Eructations, disposition to vomit, coated tongue, a wry face, the white of the eyes yellowish, and distended epigastric re- gion. Causes. — An overloaded stomach, anger, mental excite- ment, bilious epidemy. Treatment—When congestions and a plethoric state do toot coexist, which is frequently the case, a vomit of tartar 322 DISEASES OF THE ABDOMINAL VISCEBA. emetic, and irritative injections, must be administered. (See Apoplexy.) ARTRESIA ANI — IMPERFORATE ANUS. Children sometimes are born without an opening in the rectum, the integuments being closed over the rectum, which can be frequently observed swelling beneath. Treatment-*— If the end of the intestine can be felt pro- truding when the child cries, a crucial incision may be made into it without delay; if it cannot be felt,it may be left a day or two, so that it may become distended with meconium, and then a cautious incision should be made with a double-edged bistoury in the direction of the curve of the sacrum. If it succeed in reaching the bowel, the aperture should be kept open by tents. But if this operation should fail in reaching the bowel, or if the rectum appear to be altogether deficient, the only re- source is the formation of an artificial anus; although it ap- pears more humane to let the child die quietly. ASCITES — DROPSY OF THE ABDOMEN. Tense swelling of the abdomen, with dullness of sound on percussion; gravitation of the swelling to the side toward which the patient inclines; sense of fluctuation will be felt on placing one hand on one side of *the abdomen, and strik- ing the opposite side sharply with the other; more or less difficulty of breathing, with incapability of resting in the recumbent posture; emaciation of those parts of the body, which are not puffed up by serous infiltration; urine scanty and dark brown; stool also scanty and dry; dryness of the skin, tongue and mouth. In inflammatory ascites the patient experiences pain in the abdomen, increased by pressure, and accompanied with fever and vomiting. In hydrops saccatus the tumefaction is unequal in the be- ginning; is, however, more equally distributed, as the disease advances, urine more profuse and less dark. In torpid, atonic ascites, the abdomen enlarges gradually and steadily; the patient suffers from impaired digestion; and the lips, DROPSY OF THE ABDOMEN. 323 tongue, gums and lining membrane of the mouth are of a pale color. In nearly all advanced forms of ascites, the feet, scrotum or labia vulva? swell; a dry cough sets in, and, toward the end, there is lingering fever. Death ensues by suffocation; or by the fever assuming a putrid character, and gangrene taking place in some abdominal viscus. Causes.—Repelled eruptions, or exanthema by mercurial ointments, lead-water, or by taking cold; suppressed men- struation, and gout; obstructions and other diseases of the abdominal viscera, especially of the liver; badly treated in- termittent fevers, by large doses of Quinia and Arsenicum; abuse of spirituous liquors; mechanical lesions by blows, or falls on the abdomen. Treatment allopathic. — In the acute form with febrile symp- toms, a full pulse, and signs of local inflammation, we must resort to moderate abstractions of blood, with lance or leeches; to nitre, castor oil and calomel with digitalis. In the atonic form recourse must be had to the strengthening method; cinchona, quassia, &c Specific dyscrasies require specific remedies, as mercury in the syphilitic, sulphur in the psoric In suppressed perspiration of the feet, old ulcers and hemor- rhages, the original complaint must be reproduced. The direct treatment, which is the evacuation of the water, consists in exciting the lymphatic system by emetics, mercu- rials, digitalis, guajacum, compression of the abdomen by means of a bandage, producing resorption, or promoting the diuresion by radix squillae (take powder of squills and digi- talis, each 20 grains, Cinnamon 1J drachms, extract of elecam- pane as much as is sufficient, let 60 pills be made, give two or three, three times a day, increasing to six). Besides the foregoing, the following formula has been proved of benefit: Take oil of juniper half drachm, tincture of digitalis one drachm, nitrous ether two drs., thirty to sixty drops three times a day. Cold water, mixed with a little Catawba wine, may be used as a drink. Externally we may apply spirits of 321 DISFASES OF THE ABDOMINAL 'VISCERA, turpentine with vinegar of squills, and lukewarm mercurial ointment. Of great effect is a combination of diuretics with purga- tives: Gamboge, squills, digitalis, golden sulphuret of anti- mony, and extract of pimpinella, equal parts; let pills of two grains be made, taking one every two or three hours, gradu- ally increasing the number until an effect is produced. In some cases tapping (paracentesis abdominis) has pro- longed the patient's life; it is performed as follows: Place the patient in a chair, pass a sheet, folded about half a yard wide, around the abdomen, let it cross behind his back, and put the ends in the hands of two assistants, who must be di- rected to draw so as to tighten it as you desire, while the fluid escapes. Have a hole in the bandage through which to ope- rate. Make a cut, one-half or three-fourths of an inch in length, with a sharp lancet or bistoury, through the integu- ments, along the linea alba, two or three inches below the umbilicus; then introduce a diamond pointed trochar, covered with a canula, and pass it on into the cavity, withdraw the trochar, leaving the canula in the orifice to conduct off the fluid. The fluid is received into a proper vessel, while the assistants are directed to draw gradually upon the bandage so as to keep a firm pressure upon the abdomen as the fluid escapes. Taking off too suddenly the pressure upon the ab- dominal vessels may cause fainting or bursting of blood ves- sels. The fluid being drawn off, the patient is put to bed in a horizontal position; the wound closed with an adhesive plaster, and a bandage applied around the abdomen. If fainting occurs during the flow of the fluid, stop the flow, and wait a day or two, before evacuating the remaining portion. Homoeopathic remedies.—Aconitum must be administered in the first instance when there is any excessive degree of arterial excitement. Helleborus: Febrile symptoms, with great debility and a tendency to torpor, or lethargy; urine scanty or suppressed; stools loose and gelatinous; pains in the extremities. DECAY OF CHILDREN. 325 Arsenicum: Extreme debility; organic affections of some important viscus; when the disease has been brought on by the depressing effects of other maladies, by indulgence in spirituous liquors, oppression of the chest on assuming the re- cumbent posture; dry, harsh skin, of an earthy hue ; excessive thirst; pains in the back and limbs; coldness of the extremities. Cinchona and Mercurius in chronic dropsy, arising from or- ganic disease of the liver or spleen; short and distressing cough. Cantharides: Hydrops connected with Strangury; tenesmus and pain in the limbs. In Ascites consecutive, on Scarlatina, Measles, &c, Helle- borus, Ars., Rhus., Belladonna, Sulphur and Digitalis are the most valuable remedies. Chronic Ascites requires: Kali c, Conium, Sulphur, Iodine, Lycopodium, and Oleum therb. (See Hydrops and Anasarca.) Hydropathic treatment. — Improve the general health, for which purpose the packing, douche and foot-baths are neces- sary. The abdominal bandage well covered and renewed five or six times a day, and free use of injections constitute the most important means in the treatment of this form of dropsy. Eclectic treatment.—In the early stage of this disease the use of a broad bandage, applied as tightly as the patient can bear without inconvenience, will frequently effect a cure. In desperate cases it is necessary to resort to the operation of paracentesis abdominis. The irritating plaster nearly over the entire abdomen, by which is kept up a free discharge will be found a most important adjuvant. The general treatment recommended under dropsy, must be prescribed in ascites. ASTHMA ABDOMINALIS. This disease originates from causes which impede the free motion of the diaphragm, as: flatulency, indigestion, constipa- tion, enlargement of the liver and spleen, &c Treatment consists in the removal of the causes. (See Asthma.) ATROPHIA MESENTERIC A INFANTUM — DECAY OF CHILDREN. Distended, hard abdomen, frequently with hard knots, and 326 DISEASES OF THE ABDOMINAL VISC'fiftA. total emaciation of the extremitiea; insatiable appetite; cos- tiveness alternately with diarrhoea; pain in the bowels; old wrinkled, disfigured countenance; skin dry and inactive; de- bility, and depressed spirits. Causes.—-Impeded passage of the chyle into the blood by obstruction in the mesenteric glands. Remote causes: un- healthy milk, heavy pastry, potatoes, over-feeding, neglect of cleanliness, ill-ventilated rooms, tight lacing, opiates, spirituous liquors, intermittent and gastric fevers, worms, &c This disease becomes fatal, if neglected, by total induration, chronic inflammation and gradual suppuration of the mesen- teric glands. Treatment. — Remove the causes; change the food; use tepid malt-baths; change the linen every day; in the more advanced stage of the disease prescribe egg-water, acorn-coffee (a true specific for discussing the hard, distended belly), a dry dwel- ling, and residence in pure, salubrious air. Allopathists recommend: Magnesia; rhubarb with calomel; extract of dandelion one drachm, peruvian bark, twenty grs., acetate of potassa, half drachm, fennel water and rhubarb, each one ounce, mix, and give a tea-spoonful four times a day; externally, inunctions of mercurial or iodine ointment. If chronic inflammation exists cups or leeches will produce a salutary effect. Homoeopathic remedies. — Calcarea c, third trituration, two doses every other day, morning and evening, for the space of four or six weeks, with single intermediate doses of Sulphur, is one of the most efficacious remedies. In some cases the following remedies will be found indi- cated: Arsenicum, Cina, Baryta and Belladonna. Hydropathic treatment. — The dripping wet sheet or towel wash, and the half or shallow bath daily, followed by as much rubbing, over the dry sheet, as the patient can well bear. The water should be of a comfortable temperature. Water- drinking, diet, and exercise in the open air are also necessary. (See Scrofula). BLENNORRHEA 1NTESTINORLM. 327 BLENNORRHEA RECTI—WHITE FLUX—MUCOUS HEMORRHOIDS. Immediately after eating, evacuations from the intestinal canal of a white color, resembling milk or chyle, sometimes mixed with blood or excrements, and followed by tenesmus. The stools are in many case3 preceded by colic and burning pain in the rectum. The patients suffer from dyspepsia, be- come emaciated, and die from exhaustion. Causes.—Hemorrhoidal congestion, metastases, atony of the intestinal canal. Treatment allopathic—Cure of the hemorrhoidal disease; removal of obstructions of the liver and other abdominal viscera; the use of bitter tonics, as columbo and quasia, nourishing diet, starch-water injections. Homoeopathic remedies.—Helleborus: stools consist of mucus, generally in solid pieces and without any faeces. Colchicum.—Stools of mucus, preceded by severe griping. In some cases one of the following remedies will be found indicated: Cina, Mercurius, Capsicum, Pulsatilla, Nux v., Carbo v., and Sulphur. Hydropathic treatment.—Cover the whole abdomen with the wet compress, which should be often changed; give, occasion- ally, injections of cold water (sometimes very cold water has a more soothing effect upon the griping and tenesmus); use hip-baths and washings of the whole surface. BLENNORRHEA INTESTINORUM. Stools are intermixed with mucus, or are formed exclusively of masses of thick tenacious mucus; alternation of constipation and diarrhoea; when the bowels are relaxed, the evacuations consist of large quantities of watery, or bilious-looking mucus, passed in rapid succession and preceded by griping pains; the patients also complain of a constrictive sensation in the abdo- men, accompanied with flatulent distension. Allopathic treatment—First, Narcotics, later, Tonics; light diet, exercise in the open air, mineral waters, and stimulating injections. Homoeopathic treatment.—When diarrhoea is present, Pulsa- 328 DISEASES OF THE ABDOMINAL VISCERA. tilla, Rheum, Arsenicum, Phosphorus, Mercurius, Cinchona or Ferrum will be found the most appropriate. When tho motions are coated or mixed with considerable quantities of mucus and constipated, Nux v., Sulphur, Sepia, Stannum, Alumina, and Lachesis are the most suitable. BLENNORRHEA VENTRICULI — GASTRAHAXIA P1TU1TOSA. Derangement of the mucous membrane of the stomach Loss of appetite, absence of thirst, distressing fullness or weight in the stomach after meals, nausea and even vomiting, Pyrosis, furred or white and thickly coated tongue and fauces; insipid, clammy, nauseating, sweetish taste; accumulation of fluid or tenacious mucus in the mouth; constipation or slimy stools; pale, cloudy and slimy urine; disturbed sleep, pale coun- tenance; cold extremities, coldness in the epigastrium, debility. Causes. — Indigestible food; much acid food; sour wine; sour apple-sauce; sedentary habits; worms; damp, ill-venti- lated dwellings; loss of blood; excess in the use of ardent spirits; depressing passions; changeable, damp state of the atmosphere. Treatment allopathic.—Regulation of the diet; food should consist principally of simple lean meats and roots; hunger- cure; exercise in the open air; alkaline-baths; avoiding colds; a little wine in water; Magnesia; Kali c.; Radix squillae; Tar- tar emetic and Ipecac, in small doses; mineral acids, as the muriatic and phosphoric acid; mild cathartics; after removal of the acidity and mucus, tonics should be given, as acorn- coffee, malt-baths, iron, &c Homoeopathic treatment — Ipecacuanha is one of the most important remedies in the early stage of the disease, to be given in repeated doses and for four or six days; after which another remedy must be selected in accordance with the re- maining symptoms; against these we shall find Nux v., Tart. em., Arsenic, Pulsatilla, Squilla, Gratiola and Stannum the most appropriate. Hydropathic treatment — Hip-baths, towel-baths; wet com- press, diet, exercise, tepid injections, warm water-vomit. . «. I, J J GALLSTONES. 320 Bleeding from the bowels. — (See Proctorrhcea.) Bulimia. — (See Voracitas.) CALCULUS BILIARUS — GALL-STONES — CALCULUS FELLENS. A concretion of bile. Violent pains in the hepatic and epigastric region extending to the back, with nausea and vomiting, followed by a yellow color of the skin, lasting for several days, after which gallstones — i. e. resinous, earthy, combustible masses — are found discharged in the stool. The pains occurr in paroxysm with intervals of comparative ease. Causes. — Stagnation in the liver; increased secretion of bile in the liver; much heavy, fat, animal food; sedentary life; tight lacing; grief and sorrow; eating during suppressed anger, &c. Treatment allopathic. — Vegetable diet; much drinking of fresh, soft water; exercise in the open air; the different pre- parations of soda; soap-pills with bitter extracts (soap half an ounce, gum ammoniac and extract of absinth, each two ounces; mix, make pills of two grains, take ten three times a day.) In great inclination to vomit carbonate of soda and tartaric acid is of benefit; of similar effect is bi-carbonate of soda, one drachm dissolved in a bottle of water, also Seidlitz powders. During a paroxysm of pain employ warm sitz- baths, mustard plasters, oily injections, opiates, hyoscyamus, ether or chloroform, sometimes ice, cupping, &c. J Homoeopathic remedies. — Belladonna, Calcarea, Hepar, La- chesis, Lycopodium, Silicea and Sulphur. Hydropathic treatment. — Warm sitz-baths, hot fomentations, copious warm water drinking to facilitate the passage of the stone and mitigate the pain. Eclectic treatment — The spasmodic action of the duct should be relieved by giving full doses—say two drachms—■ of the common sudorific tincture, repeated every hour and a half if relief is not immediately obtained. The application of a sinapism extending over the stomach and liver, followed with hot hop fomentations will be likely to afford relief. A cathartic, consisting of the common anti-bilious physic with 330 DISEASES OF THE ABDOMINAL V1SCEKA. cream of tartar, should be administered. If the stomach is irritable, small doses — say a tea-spoonful at a time — of a decoction of the compound neutralizing physic should be given, and repeated every hour till the stomach is quieted, and then it may be given in larger doses till it operates on the bowels. The infusion of lobelia and boneset, adminis- tered until full and free vomiting is procured, will remove morbid accumulations, and produce a relaxing influence upon the whole system. To prevent the formation of gallstones, the compound neu- tralizing cordial, with the addition of an equal part of wild cherry bark, should be given. CARDIALGIA — GASTRO-DYNIA — SPASM OR CRAMP OF THE STOMACH. Spasmodic or gnawing pains at the epigastrium, extending to the chest and back, attended with nausea or vomiting, faintness and coldness of the extremities. The patient is sometimes relieved by emission of ascending flatus, or by a discharge of a quantity of limpid fluid. The pains vary in intensity, and are sometimes periodical, sometimes constant. When it occurs in women after the cessation of the menses, it is apt to be accompanied with vomiting of blood. Causes. — Abnormal state of the nerves of the stomach, accompanied by diseases of the liver, spleen or pancreas, or even by cancer of the stomach; improper articles of food, as new bread, cheese, salads, nuts, sweet-meats, cherries, roasted chesnuts, tea, coffee, spirituous liquors; worms; exposure to damp or cold air, rheumatism of the stomach; hysteria; chronic inflammation; congestion; cessation of the monthly period. Treatment allopathic. — If the spasm proceed from offending matters in the stomach, especially from undigested food, these should be evacuated by an emetic of Ipecac, which should be followed by a a mild cathartic. Peppermint water is also recommended. In rheumatic cardialgia: Infusion of elder-flowers, chamo- mile, Dover's powder; externally, burgundy pitch plaster, 14o CRAMP OF THE STOMACH. 331 flannel, mustard plasters with vinegar, or vesicatories, should be employed. If the pain is caused by sanguineous congestion and chronic inflammation, local abstractions of blood will give relief. If the spasm be caused or accompanied by flatus, the aro- matics may be freely used, as the essence of peppermint, spear- mint, or pennyroyal, ginger tea, compound spirit of laven- der, tincture of cardamom, oil of turpentine, &c. In nervous spasm of the stomach: Belladonna, Hoffman's anodyne, musk, and especially subnitrate of bismuth tritura- ted with sugar, two grains three times a day. In obstinate cases the following mixture will be found of great efficacy: Take flowers of bismuth two grains, extract of henbane one grain, magnesia ten grains, oil of cajeput one drop, white sugar twenty grains; mix, and make a powder. Obstinate spasm has also yielded immediately to the revulsion produced by a large cupping-glass applied to the epigastrium. In chronic spasm of the stomach, douches of cold water are recommended. Homoeopathic remedies. — Nux v. is, in a large number of cases, the most appropriate remedy, and particularly in cases where this affection can be attributed to the long-continued use of strong coffee, or an excessive indulgence in strong liquors, with constipation, pressure, squeezing or spasm in the stomach, sensation as if the clothes were too tight at the waist. Increase of symptoms after meals, or after partaking of coffee, and early in the morning. Carbo veg. andTineture sulphuris will be found to answer if Nux v. should afford only temporary relief. Chamomilla: Pressure as if from a stone in the pit of the stomach, painful pressure at the precordial region, as if the heart would be crushed, with flatulent distention; mitigation on partaking of coffee. Belladonna: Pain of so violent a nature as to deprive the patient of consciousness; pains relieved on bending backward and holding in the breath. 332 DISEASES OF THE ABDOMINAL VISCERA. Pulsatilla: Pains aggravated by movement, and particu- larly by making a false step, with vomiting, diarrhoea, &c suppressed menstruation, hysteria. Other remedies sometimes indicated are, Ignatin, China Cocculus, Staphysagria, Platina, Bryonia, Arnica, Bhmuth, &c. Hydropathic treatment. — If caused by indigestible food a warm water emetic and tepid water injections; woolen cloths wrung out of warm water and applied to the abdomen, and sometimes the wet-sheet must be resorted to. Warm bricks wrapped in a wet cloth and applied to the stomach afford, in cases where cold is the principal cause, immediate relief; also little bags with warm ashes, warm salt, &c The feet should be kept warm. (See Indigestion and Colic) CHOLERA MORBUS. Sudden feeling of nausea and griping, followed by purging and vomiting; in severe cases accompanied with coldness of the body, particularly the extremities, excessive thirst, hur- ried breathing, a feeling of cramp in the legs or in the arms with spasmodic contractions of the abdominal muscles, shrink- ing of the features, and a hollow expression of the eyes, pulse weak, evacuations thin, watery and fetid, or bilious; sometimes dark, bilious vomiting and tenesmus. Causes. — Unripe fruits, crude vegetables, cold drinks when overheated, indigestible food; wet feet; suppressed perspira- tion from sudden exposure to cold; worms, &c Allopathic treatment. — Dry cupping on the epigastric re- gion; warm baths; mucilaginous beverages, such as water- gruel, gum water, wreak chicken broth; a sinapism of pure mustard mixed with water, to be applied over the epigastrium; a pill containing the sixth of a grain of calomel, and from the sixth to the twelfth of a grain of opium to be given every hour, according to the urgency of symptoms; carbonic acid water, in small draughts of about two fluid ounces, frequently repeated, to quiet irritation of the stomach; in severe cases from twelve to twenty-five drops of laudanum, repeated at longer or shorter intervals until the violence of the svmp- CHOLERA MORBUS. 333 toms abates. In desperate cases recourse must be had to a blister over the epigastrium and injections of laudanum, with thin starch or mucilage. Small doses of Hyoscyamus or Ipecac have been employed with benefit; also ice-pills moistened with two drops of the tincture of opium; or old malaga wine. Homoeopathic treatment.— Chamomilla: Acute, colic-like pains, heavy pressure in the region of the navel, with exces- sive anguish; bilious diarrhoea, cramps in the calves of the legs, sometimes vomiting of acid matter. Ipecacuanha: Vomiting; weakness; coldness in the face and limbs; shivering in the abdomen; slight cramps in the calves of the legs, and in the fingers and toes. Veratrum album: Violent vomiting with severe diarrhoea, excessive weakness, and cramps in the calves of the legs; sunken countenance with expression of suffering and intense anguish; coldness of the breath; excruciating pain in the region of the navel. Arsenicum: Rapid prostration of strength, insatiable thirst; excessive anxiety and restlessness; burning sensation in the region of the stomach; discharges from the bowels, especially after drinking; violent and painful vomiting; tongue and lips dry, cracked, blueish or black; small, weak, intermittent pulse; clammy perspiration. The dose of these remedies should be repeated at times varying from half an hour to two hours, according to the severity of symptoms. (See, also, Cinchona and Pulsatilla.) Hydropathic treatment. — Copious warm water injections, and free warm water drinking, to cleanse the whole alimentary canal. After the employment of the cleansing processes, frequent sips of cold water should be taken, and moderate cool injections employed after each evacuations. The cold compress should be applied to the abdomen, and frequently changed. When the griping is extreme, the hot hip-bath should be resorted to, and the cold hip-bath when there is much heat and tenderness of the abdomen. In some cases the wet-sheet pack is very grateful and efficacious. 334 DISEASKS OF THE ABDOMINAL ViSCF.RA. Eclectic treatment. — If the patient is nauseated and in the first stage of the disease, the natural efforts of the system should be aided by drinking plentifully of warm water, or a decoction of boneset. In cases where a speedy effect is desi- rable, an infusion of lobelia and eupatorium is desirable. Af- ter the emetic is administered, or in case it is not thought necessary, a large sinapism should be immediately applied over the stomach, while tea-spoonful doses of the compound neutralizing physic should be given every half hour, until the vomiting is checked; and the patient must be kept quiet, and resist the inclination to vomit. If cases occur in which the very thought of medicine is repulsive, very small doses of Morphine will be found to answer an excellent purpose in quieting the nausea, and also in restraining the bowels. One-twentieth of a grain may be given every half hour for three or four times. In many cases tea-spoonful doses of strong, clear coffee, repeated every few minutes, have been found of benefit. When diarrhoea continues after the irritation of the stomach has been relieved, the neutralizing medicine should be con- tinued in the dose from half a fluid ounce to an ounce to an adult, and repeated every two hours. If, however, the diar- rhoea should persist, without much evidence of local irritation, the tincture catechu and paregoric in equal parts, adminis- tered in tea-spoonful doses after each evacuation, have been found to answer an excellent purpose. CHOLERA ASIATICA--EPIDEMIC, MALIGNANT, ASIATIC CHOLERA. First stage. Weight or oppression at the praoeordiae, slight nausea, flatulency, rumbling in the bowels, debility, slight diarrhoea. Second stage. Stools have the appearance of very thin gruel, or rice water (characteristic of the true Asiatic cholera); sometimes they are watery with small flakes of curdy-looking matter intermixed, at other times they present an appearance of water in which fresh beef had been macerated; '-port wine ASIATIC CHOLERA. 33.") stools;" irresistible desire to go to stool; stools are very copious or scanty; violent vomiting of a foamy, turbid liquid; intense thirst; restlessness; anxiety; burning heat in the region of the stomach; pain and a feeling of contraction in the intes- tines; respiration'is natural, or hurried and oppressed; breath is cool; tongue cold and slightly coated; face cold; the color of the hands and feet becomes changed, nails assume a blue appearance, and often the wTiole surface of the body assumes a blueish hue; the eyes are sunken, and surrounded by a dark circle; the features are sharp; the expression of the countenance wild and confused; voice hoarse, whispering or nearly suppressed; cramps in the fingers, toes, muscles of the extremities and abdomen; shriveled hands and feet; the pulse thready or wholly imperceptible; secretions of bile; saliva and urine are suppressed; the functions of the brain continue to be carried on even after the body seems to be dead. Patients generally dread hot applications, and express a desire of being put in a cold bath, or a wet sheet. A large proportion of patients die in this stage. Third stage. When the cholera abates, it passes into a typhus fever, or dysentery, which often terminates fatally. For a long time after an attack of cholera, there remains nervous debility, and weakness of the digestive organs. In dry cholera (cholera sicca), where no discharge from the stomach and bowels takes place, the decomposition of the blood is so great and rapid, that the cramps follow immedi- ately before the serum has time to escape. Causes.—This disease had its origin in the East Indies, and the cause probably is a peculiar miasmatic state of the atmos- phere, producing an intensely irritated or inflammatory state of the mucous membrane of the stomach and bowels. Prevention. — Do not give away to fear and despair; keep body and mind active; observe regularity in all actions; eat sufficient but not to overload your stomach; use no unripe fruit or raw vegetables, make no sudden changes in your diet 336 DISEASES OF THE ABDOMINAL VISCERA. or mode of living; keep up a healthy action of the skin by daily bathing; avoid taking cold; keep the feet warm; avoid over-exertions of body or mind, late hours, grief, an- ger, fear and sexual excesses; "love thy neighbor as thyself." A flannel bandage covering stomach and bowels is recom- mended. Allopathic treatment. — The most important indication of treatment is to arrest the alvine evacuations. Among the numerous remedies recommended, those best calculated to arrest the discharges are opium and calomel, in small and fre- quently repeated doses, combined, when the discharges are copious, with acetate of lead, and in addition, if this should prove insufficient, with tannic acid, kino, catechu, or the ex- tract of rhatany. In relation to the combination and exact dose of the above remedies, the practitioner must be guided by peculiar circumstances. Cold carbonic acid water may be allowed as a drink to relieve the burning thirst and vomiting. At the same time a sinapism of pure mustard should be ap- plied over the epigastrium, and an enema be given of from forty to sixty drops of laudanum, with mucilage or thin starch. The best mode of effecting a centrifugal excitement is by moderate frictions over the surface, either by the hand alone, or with flannel, coarse towels, or a flesh-brush. Leeching of the epigastrium is indicated in the earlier stages, when there is tenderness with burning pain in the stomach. Prostration must be obviated by tincture of camphora, aromatic spirit of ammonia, and the ethereal preparations. Should the stomach be loaded with undigested food during the forming stage the treatment may be commenced with a gentle emetic of Ipecacuanha. To allay violent vomiting, allow cold water, ice pills, cold beer, soda water, &c Cold applications to the abdomen and even cold affusions have been recommended to restore the action of the skin. In the stage of collapse, sinapisms may be applied to the abdomen and extremities, and cayenne pepper and brandy, oil ASIATIC CHOLERA. 337 of turpentine, tincture of camphora, liniment of ammonia over the surface of the body; frictions with ice or iced water. Chloroform, used by inhalation, tincture of camphor, char- coal, solution of chlorine, strychnia, and galvanism have had more or less credit with the public. Homoeopathic treatment.—When premonitory symptoms of cholera exhibit themselves, its complete development is fre- quently prevented by the administration of the saturated solu- tion of camphor. Give one or two drops every five minutes, in a tea-spoonful of cold water, or on a lump of sugar, until a cessation or amelioration of the symptoms takes place; when the intervals between the doses may be lengthened to from two to six hours. (See also remedies mentioned under Chol- era Morbus.) When cholera sets in, in all its frightful forms (second stage), Veratrum in solution should be administered immediately, a dessert or tea-spoonful every fifteen minutes to one hour, according to the severity of symptoms. If the cramps change to spasms and convulsions Cuprum must be had recourse to, in the manner prescribed for Veratrum, and if symptoms do not abate, Veratrum and Cuprum may be administered in alternation. Arsenicum should be selected in preference to Veratrum, when an intense burning sensation is experienced in the stomach and bowels, with extreme restlessness, great thirst, prostration of strength. Coffea has proved of great benefit for sleeplessness, restless- ness, &c, after vomiting and purging had somewhat abated. In the third or collapse stage Carbo vegetabilis may be given with advantage, in a state of almost complete Asphyxia. In some cases the following remedies may be found indi- cated: Phosphor, Tartar emetic, tobacco, Prussic acid, Secale cornutum, Cantharis, Mercurius, &c Diarrhoea prevailing during the prevalence of cholera will yield to China, Phosph. acid and Chamomilla. Typhus fever, Congestion of the Brain, &c, following chol- era, see under their proper heads. ■ 15 33S DISEASES OK THE ABDOMINAL VISCERA. Prophylactics: When the first symptoms of cholera make their appearance the patient should lie down quietly, cover himself up to the chin wTell and abundantly, and bottles of hot water must be applied to his feet and body; noise, contradic- tion and excitement should be carefully avoided. Injections of iced water are sometimes serviceable in reliev- ing the colic and cramps in the intestines. Cold water or small pieces of ice may be taken internally. Veratrum and Cuprum are recommended as Prophylaxes, to be taken in alternation night and morning every third day. Sulphur is also recommended for prevention of cholera, to be taken twice a week shortly before going to bed. Hydropathic treatment — In the first stage of the disease, when there is much nausea and retching, a warm water emetic should be administered, followed by sips of cold water. After- ward we must employ frequent injections of tepid water; frequent but moderate draughts of cold water, or bits of ice; the cold compress to the abdomen well covered with dry, soft flannel. Before the patient sinks into collapse the dripping wet sheet, followed by the dry sheet, and bath, accompanied with active and persevering frictions, should be used; the wet sheet pack as well as the cool hip-bath works admirably in the early stages. In the collapse stage the surface should be well rubbed with a cold wet towel, succeeded by active friction with dry, soft flannel, or the dry hand; frequent injections of cold water must also be employed. Eclectic treatment,—When called upon to treat a patient in the early stage of the disease, he should be placed in a recum- bent position, and the compound pills of camphor be adminis- tered. They are made as follows: Take Camphor, Opium, Kino, of each thirty-five grains; Capsicum five grains, con- serve of Roses as much as is sufficient, mix, divide into thirty pills, and give one after each discharge from the bowels. A large sinapism over the wdiole abdomen has been applied with advantage. Should there be an overloaded condition of the SIM M LR COM PL AIN T. 339 alimentary canal, the fluid extract of Rhubarb and Potassa three parts, with saturated tincture of Prickly-ash berries one part, may be administered in table-spoonful doses every hour, and continued until the bowels are properly evacuated, after which the above astringents may be given. In the second stage the compound mixture of camphor may be used with excellent effect; it is prepared as follows: Take Camphor-water, Peppermint-water, Spearmint-water, each one fluid ounce, Paregoric, two fluid drachms, mix ; give a table- spoonful every twenty minutes, and continue until the nausea ceases. To remove the cramps, hot bricks or bottles of hot water should be kept applied to the feet, legs, and arms, and cloths wet with water as hot as can be borne, must be applied over the abdomen, and changed every few minutes. Sometimes advantage will ensue from stimulant applications along the whole length of the spine. Cramps of the muscles of the limbs may be evercome by bathing with the cajeput mixture, either alone or in combination with chloroform, and applying friction at the same time. In the stage of collapse, in addition to the above, the patient should be enveloped in blankets, wet with water as hot as can be borne, which should be renewed every ten or twenty minutes; and stimulants may likewise be given, as the saturated tincture of Prickly-ash berries, &c. CHOLERA INFANTUM — CHOLERA OF YOUNG CHILDREN — SUM- MER COMPLAINT. Violent vomiting, first of food, afterward of sour liquid; diarrhoea generally at the same time; restlessness; retching on the least movement, or after drinking water; thirst; very weak eyes, sunken and half open ; pulse feeble. Treatment.—Keep the children cool, and take them into the fresh air. They are also benefited by driving into the coun- try with them late in the afternoon, and returning before dark. A sail on the water in very warm weather is also ser- viceable. Never take them out in the middle of the day, and 340 DISEASES OF THE ABDOMINAL VISCERA. give no tea, coffee, unripe fruit, or pie made of it; if the child be still on the breast, the mother should live on animal food, potatoes, and other vegetables of the most unirritating kind. Smoked herring, or ice-cream are relished by the pa- tient, and generally are of benefit. Treatment.—(See Cholera morbus.) Eclectic treatment—The agent principally employed is the Syrup of Rhubarb and Potassa, which removes nausea and vomiting, when present, acts mildly upon the stomach and bowels, and restores the evacuations to a healthy condition. If febrile symptoms are present, the whole surface of the body and limbs should be sponged two or three times daily with a weak alkaline solution, rendered stimulant by the addition of a small quantity of whisky or alcohol; and in obstinate cases, attended with high fever, the compound tincture of Virginia Snakeroot may be added to the above syrup, in the proportion of one part of the tincture to four of the syrup. Where the discharges are frequent and attended with pain, employ the following injection: Take ulmus fulva, cortex Prunus virginiana, half an ounce each, water a pint; mix, let it stand two or three hours, and it is ready for use. The quantity to be used as an injection must vary from one to two drachms. Where vomiting is obstinate and frequent, a mus- tard poultice, applied over the epigastric region will be found useful. If the patient at any time becomes prostrated, stimu- lants must be administered, as diluted Brandy, Wine-whey, Aromatic spirits of Ammonia. After the febrile form of the disease has been removed, should diarrhoea remain, astringents, with tonics must be given; as: take Hydrastin, S. Quinia, of each two grains; Geranniin, sixteen grains, mix, divide into sixteen powders, of which one must be given every hour or two, according to the urgency of the case. In biliary derangement Leptandrin will exert a beneficial influence. The diet of the children should be light, as boiled milk, with colic. 3-41 powdered cinnamon added, or milk thickened with wheat or rice flour. CHOLERINE. Diarrhoea, occurring during the prevalence of cholera, with- out any of the more severe symptoms of that disease, gene- rally caused by fear, grief, &c (See Cholera and Diarrhoea.) COLICA—ENTERALGIA — COLIC. Griping, tearing, cutting, burning, gnawing, or shooting pains in the bowels, chiefly confined to the region of the navel, sometimes attended with painful distention of the abdomen, spasmodic contraction, cold sweat, vomiting, diarrhoea or cos- tiveness. The pains being generally relieved by pressure distinguish it from inflammation. Causes.—Acid, unripe fruits, and indigestible substances; cold from wet feet, drinking ice water when heated, gastric impurities, worms, constipation, &c. Treatment allopathic. — When the pains are moderate, and dependent upon flatulence or mere exposure to cold, relief will be obtained: by hot infusion of ginger, cloves or calamus; from fifteen to thirty drops of the essence of peppermint, or spearm- mint, dropped on sugar, or diffused in sweetened water; or one to two table-spoonfuls of the camphorated tincture of opium; soaking the feet in hot water; sulphuric ether and musk in severe cases. A fluid ounce of castor oil with twenty-five or thirty drops of laudanum, given in peppermint water, will often meet all the indications. If the patient be affected with nausea or retching, vomiting should be promptly induced, either by copious draughts of warm water or warm chamo- mile-tea, or by a dose of ipecacuanha. If indigested food is the cause of the spasm, and castor oil does not act speedily, recourse may be had to sulphate of magnesia; infusion of senna with epsom salt, manna, and fennel-seed, or ginger; or, in very obstinate cases to croton °il,of which from half a drop to two drops may be given, and repeated at short intervals until it operates. In some very bad cases, enemata constitute our chief reliance, for which 342 DISEASES OF THL ABDOMINAL VISCERA. purpose we may employ olive oil, lard, molasses and common salt, of each a table-spoonful, mixed with a pint of warm water; or castor oil, infusion of senna, jalap, &c. In cases of ileus, where danger is imminent, the tobacco enema should be' employed, a drachm of the narcotic to be infused in a pint of hot water, giving half the quantity, and repeating the operation with the other half at the end of half an hour or an hour. Cold water douche; warm bath; cupping, leeches. and blisters are recommended; likewise, poultices of hops and vinegar, a spoonful of linseed oil, spermaceti, half an ounce dissolved in warm water, &c In bilious colic, with congestion or even inflammation of the liver, we must resort to bleeding; cupping; emetics; opium and calomel, followed by castor oil, magnesia or senna with salts; external applications as heretofore stated. In hemmorrhoidal colic, Sulphur is the principal remedy. Colica nervosa, spasmodica, hysterica, call for oily emul- sions with hyoscyamus, sulphate of zinc, chamomile, musk, asa foetida; externally, poultices to which laudanum may be added. Colica melallica—(colica pictonum—lead colic).—Generally caused by metallic poisoning, as Arsenic, Mercury, lead, &c, and is distinguished by obstinate constipation, paralysis of the extremities, vomiting of blood, vertigo, convulsions, delirium, violent thirst, leaden color of the face, dryness of the skin, emaciation, &c The treatment should consist in opening the bowels by cas- tor oil, rhubarb, nux vomica, aloes or sulphur; afterward opium and calomel, or alum must be given, the latter in the quan- tity of three or four drachms in twenty-four hours. A com- bination of alum and opium, given in the dose of twenty grains of the former and one grain of the latter every three hours, has had the happiest effect. Chloroform administered internally in thirty drop doses, and also in enemata, and ap- plied externally to the abdomen, is recommended. Colica calculosa (nephritica), is caused by gall-stones in the COLIC. :u3 kidneys. The best remedy is a warm sitz-bath. (See Gall- stones, and stone in the kideeys.) Homoeopathic treatment. — When caused by inflammation: Nux v,, Belladonna, Lachesis and 3Iercurius. When flatu- lency is the cause: Nux v., Pulsatilla, China, Chamomilla, Cocculus, and Colecynthls. When the attack proceeds from a spasmodic contraction (Ileus): Opium and Plumbum. In hemorrhoidal colic: Nux v., Pulsatilla, Lachesis, Codoc., Carbo v., Sulphur. For colic arising from worms: Cina, Cicuta, Spigelia, Mercurius. For spasmodic colic: Bell., Hyoscy., Cocculus, Coloc, Chamomile, Nux v., Pulsatilla. For colic caused by indigestible food: Puis., Ant. cr., Nux v., Bellad. When caused by a fit of passion, or indignation; Chamomilla and Coloeynth. When a blow or strain has given rise to the attack: Arnica, Bryonia, Rhus. Against lead-colic: Opium, Belladonna and sometimes Alumina or Platina. Colic of infants: Chamomilla and Rheum. Colic arising from a chill: Nux v., Chamomile, Merc, Coloc; for that from oold, damp weather, Pulsatilla; and that from a thorough wetting, Rhus. Bilious colic requires: Chamomilla, Coloeynth, and Sulphur. In hysterical colic: Ignatia, Cocc, Moschus, Nux v., Puis.., Stramonium, Belladonna. Menstrual colic: Cocculus, Nux v., Bell, Pulsatilla, Coffea. (See DysmenorrhceaA The most important of the foregoing remedies in the treat- ment of colic are: Nux v., Pulsatilla, Chamomilla, Belladonna, Cocculus, and Colocynthis. Hydropathic treatment. — Copious warm water injections to free the alimentary canal; frequent hip or half baths with thorough frictions of the abdomen and back, cither hot or cold, according to circumstances, to quiet pain and overcome whatever inflammatory condition may exist. Fixed pain with feverishness of the whole body requires cold water, when, however, the body is inclined to torpor and coldness, hot water is indicated. In mild cases, the hot fomentation, followed by the cold compress, will remove all symptoms ef pain. 344 DISEASES OF THE ABDOMINAL VISCERA. * In painter's colic and colica ileus it is sometimes necessary to remove the hardened faeces with the handle of a spoon. Repeated injections to soften the hard fajces, and the warm stream douche, followed by the cold dash, are excellent reme- dies. Painter's colic demands also the wet sheet pack, cold or warm, followed by the dripping wet-sheet, or towel-wash, and this by the dry sheet, and dry hand rubbing. Flatulent colic requires, besides the hot fomentations and injections, the warm douche to the abdomen, followed by the dash of a pail of cold water to the belly and legs. Total abstinence, warm water emetic, and a free injection are the principal means employed in colic caused by derange- ment of the stomach. Eclectic treatment. — If acidity attend the disease, with a tendency to constipation, magnesia will be indicated. In children sweet oil, by the tea-spoonful, three or four times a day, proves a valuable remedy. Colic produced by cold or wet requires a foot-bath, and at the same time warm fomen- tations with a flannel cloth with frictions with a warm hand to the abdomen. Warm mint-teas are also of benefit. In lead-colic give stimulating enemas until free and copious evacuations of the bowels are produced; afterward use the warm-bath or vapor-bath, then rub the patient until he is perfectly dry, and place him in bed. If the pains should continue, apply hot bitter-herb fomentations over the whole abdomen; apply bottles of warm water to his feet, and give internally from one to three drachms of the compound tinc- ture of Capsicum and Lobelia. The white liquid Physic in table-spoonful doses every few hours, until a full and free action of the bowels is produced, has been employed with apparent benefit. >■■ When the sufferings are very severe, a preparation of mor- phine and assa foetida is recommended. Use Podophyllin and Leptandrin daily, until catharsis is produced. Bilious colic has been successfully treated by a remedy, OYNSTlPATIoN 34£ called dioscorea villosa, or yam. About an ounce of the root is made into a decoction in a pint of water, and half of this quantity is given at a dose. If this remedy is not at hand, give assa foetida, with the Sudorific tincture, in drachm doses, and repeated once in two hours, till the patient is relieved; or, if the stomach is irrita- ble the preparation may be administered in the form of eneH|a, and a pill of assa foetida and gum opium given in doses of two grains each, and repeated every two hours. In severe cases, chloroform may be administered. Wind colic.—Wlren the bowels are loaded with acrid accu- mulations the anti-bilious physic will afford relief. Where the symptoms are urgent a cathartic injection may be resorted to to which may be added the infusion of assa foetida, castor oil, spirits of turpentine and molasses. If, however, the pain is intolerable the sudorific tincture, fifteen or twenty drops for a child fifteen months old, repeated once in two hours, may be given; or you may administer tea-spoonful doses of equal parts of tinct. opium, tinct. camphor, and essence of peppermint. COLONITITIS — INFLAMMATION OF THE COLON. Violent pains with swelling along the course of the colon, increased during an evacuation; copious, frequent evacua- tions, often mixed with blood and accompanied by tenesmus. (See Enteritis.) CONGESTION OF BLOOD TO THE ABDOMEN. Disagreeable sensation of weight, heat and burning, with hardness and tension in the lower parts of the abdomen. Causes. — Plethora; want of exercise; high living; debility; humors; &c Treatment. — Meagre diet, diminution of sleep, drinking of water, daily bathing, strong exercise, a cool regimen, wear- ing the wet bandage on the abdomen. (See Piles.) Homoeopathic remedies.—Nux v., and Sulphur; sometimes Carbo v., and Arsenicum. CONSTIPATION—COSTIVENESS—OBSTRUCTIO ALVI. This complaint is generally sympathetic with some other 346 DISEASES OF THE ABDOMINAL VISCERA. derangement of the organism, and must be treated accord- ingly. To some men it is natural to have a stool only every two or three days, and without annoyance; however, a person in perfect health should have one evacuation every day. If constipation continues for too long a time, the feces harden, accumulate, and distend the colon, create abdominal obstruc- tions, loss of appetite, congestion to the head and chest, and many sympathetic disturbances. Causes.—Insufficient drink; hard, heavy dry food; continual sitting; fermented liquors; coffee; neglecting to go to.stool; lacing of the abdomen; deficient bile; continued use of pur- gatives, &c Treatment — Going to stool regularly every morning, is probably of more importance in the treatment of constipation, than all medicines. The patient must also drink a larger quantity of soft water, and live on vegetables, and juicy fruits, as apples, peaches, prunes, &c; take active exercise, and make frictions on the abdomen. Allopathists recommend remedies which will regulate the secretion of bile, as Rheum, Aloes, Senna leaves, &c A com- bination of aloes and iron filings, equal parts, made into pills of one grain each, one taken at bed-time, is highly recom- mended. The most innocent and surest remedy, but, which loses its power by habit, is senna in pills (take Powder of Senna, two drs., Extract of Dandelion a sufficiency, make into sixty pills, take five to ten a day). In the utmost inactivity of the intestinal canal, and when other means are inefficacious, ex- tract um colocynthis, one grain for a dose has proved infallible. Laxatives should always be taken on an empty stomach. In many cases an injection of tepid soap-water, or small doses (half grain) of Nux vomica, or Podophyllin, prove sufficient to relieve the bowels. Homoeopathic treatment.—Opium, in recent cases, with want of power to relieve the bowels, and a feeling of constriction in ano; sense of weight and pulsation in the abdomen, deter- mination of blood to the head. MARRIKEA. 347 Nux v>, constipation resulting from indigestible food, coffee, tobacco, and spirituous liquors with determination of blood to the head, headache, feeling of oppression; frequent ineffectual efforts to relieve the bowels. Plumbum mctallicum: Obstinate constipation with inef- fectual efforts, evacuation of hard, bullet-shaped faeces. Sulphur: Habitual costiveness, with hemorrhoids, inclina- tion to go to stool without result. Besides the above remedies the following will be found indicated in some cases: Natr. m., Calcarea, Pulsatilla, Silicea, Lachesis, Platina and Lycopodium. Constipation from exposure to the vapor of lead: Opium, Platina and Alumina. Hydropathic treatment is the same as mentioned under Dys- pepsy. Eclectic treatment — Injections are more applicable in acci- dental cases of constipation than medicine, but when these means fail, it will then be proper to administer some mild purgative, as Olive Oil, Castor Oil, the compound tincture of Jalap, or Syrup of Elderberries. The Graham bran-bread, and mush are highly serviceable. DIARRIIffiA--LOOSENESS OF THE BOWELS. Fluid discharges from the intestines in increased quantity. Causes.—Increase of the peristaltic action of the intestinal canal produced by acid, or rich indigestible food, a check of perspiration, sudden changes of temperature, prolonged use of strong Purgatives, worms, mental excitement, coffee; dental irritation, inflammation, debility, peculiar state of the atmos- phere. In many cases diarrhoea is a salutary crisis, and should not be checked, unless the evacuations become very watery, and the patient experiences great prostration after stool. Diarrhoea aestiva. — Summer diarrhoea, occurs epidemically during the prolonged heat of the months of July and August, and is accompanied with more or less griping pains. Cause.—Increased acrimony and quantity of bile, by the heat of the season. 348 DISEASES OF TnE ABDOMINAL YlSCEftA. Teatment — Strict observance of diet, avoiding all acid green fruit, beer, vegetables, &c; living on water gruel, rice- water, chicken or veal. Rhubarb in three or four grain doses, formed into pills with liquorice, one every three or four hours is the most efficacious remedy. When there are symptoms of gastric impurities, administer first an Emetic of Ipecac, then give Rheum as above directed. Should the diarrhoea be very watery and accompanied wdth violent griping pains, we must prescribe castor oil internally and in injections; from five to ten drops of laudanum, or a fluid drachm of camphorated tincture of Opium, to be repeated if necessary. Poultices may also prove of benefit. Bilious diarrhoea, accompanied with pain in the front part of the head, coated tongue, bitter taste, nausea, sensation of fullness in the epigastric region, griping and rumbling in the bowels, tenesmus with discharge of burning, greenish evacua- tions, and slight fever. This diarrhoea is generally beneficial and should not be violently suppressed. The patient must avoid taking cold, remain quiet, and eat very little, or what is better, no food at all. When there is much nausea, give an Emetic of Ipecacuanha, afterward Rheum, in small doses. Some physicians recommend small doses of calomel and opium, about the sixth of a grain of the former, to the twelfth of a grain of the latter, every hour or two. Diarrhoea catarrhalis, rheumatica, owing to taking cold, requires flannel around the abdomen, lying in bed, perspira- tion and abstinence from food. Take mucilaginous drinks, and if there is at the same time gastric complication, give an Emetic Should the diarrhoea still continue, take Rhubarb, two grains, Ipecac, a quarter grain, prepared chalk, ten grains, make a powder, divide into eight doses, and give one every half an hour, or hour, according to the severity of symptoms. Extract of cascarilla one drachm, peppermint and chamomile water, each two ounces, mucilage of gum Arabic half an ounce, a table-spoonful every two hours, will stop diarrhoea without detriment. Nutmeg and Opium have also proved very effica- DlARRHtiSA. 349 ciotts, the latter, however, should always be given in combi- nation with evacuants. Diarrhoea chronica.—Chronic or continual looseness of tho bowels, alternating with costiveness is generally caused by a local debility with increased irritability, and requires Tonics, as Columbo, one scruple of the powder three or four times a day; cascarilla; acorn-coffee; claret, aromatized with orange peel; flannel around the abdomen; baths; douche on the abdo- men; a little spice-bag worn on the abdomen, and filled with cloves, cinnamon, ginger, nutmeg and pepper, moistened morn- ing and evening with cold rum. Nux vomica three grs., with nutmeg four grains, two or three times a day; tincture of mace half an ounce, and laudanum half a drachm, thirty drop3 three or four times a day. Very obstinate cases have been perfectly cured by milk diet and cold food, the patient being allowed nothing but milk, color"meat and white bread. Diarrhoea colliquativa, caused by debility, generally accom- panies consumption and other chronic diseases, and must be treated accordingly. Starch injections with opium are recom- mended. Diarrhoea of infants requires magnesia with rhubarb, or take of prepared chalk half a drachm, Fennel water and Syrup of Rhubarb, each one ounce, a tea-spoonful every hour. For violent belly-ache, give an injection of Chamomile-tea with gruel and a tea-spoonful of oil. In diarrhoea caused by cold, give elder-tea, and a warm bath with Chamomile. Diarrhoea puruknta. — A discharge of pus, hectic fever, tenderness on pressure of the abdomen, indicating suppuration in the intestinal canal, requires the use of milk, whey, butter- milk, snail-broth, milk with an addition of lime water, myrrh, copaiva balsam, injections of milk with myrrh and a little laudanum. Diarrhoea of scrofulous children.—Give acorn-coffee, extract of cascarilla, nutritious jellies, and malt-baths. Homoeopathic treatment.—Diarrhoea biliosa: Pulsatilla, Nux v., Bryonia, Chamomilla, Ipecac, Ant. cr. 350 DISEASES OF THE ABDOMINAL VISCERA, Mucous diarrhoea.—Puis., Colocynthis, Mercurius. Diarrhoea catarrhalis.—(From a chill) Chamomilla, Dulca- mara, Bryo., Merc, Veratrum. Diarrhoea from cold drinks, ice, dec—Arsenic, Bry., Puis., Nux moschata; from eating fruit, or after the use of acids: Arsenic, Lachesis and Pulsatilla; after partaking of milk: Bryonia, Sulphur and Sepia; when arising from indulgence in intoxicating liquors: Nux vomica and Carbo v.; from rich and indigestible food, pastry, &c: Pulsatilla. Against diarrhoea which occurs as a sequela of Measles, Scarlet Fever. Small- Pox, &c: Arsenic, Mercurius, Pulsatilla, Sulphur and Phos- phor acid. Against diarrhoea in scrofulous persons: Calcarea, Sulphur, Silicea, Lycopodium,, Dulcamara, and Sepia; in con- sumptive persons: Ferrum, China, Phosph, Calcarea; in de- bilitated constitutions: Secale c, China.,.Ferrum, Phosphor, Phos. ac, and Nux moschata. Diarrhoea accompanied by Colic: Chamomilla, Arsenic, Merc, Pulsatilla, Rheum; by tenesmus: Merc, Hepar, Rhus. Rheum, Nux v.; with vomiting: Arsenic, Ipecacuanha, Vera- trum; with prostration: Arsenic, Veratrum, China and Ipe- cac; without pain: Ferrum, and sometimes China, Secale, Cinnamon; from abuse of calomel, Hepar; from abuse of mag- nesia : Pulsatilla and Rheum ; from abuse of tobacco: Chamo- milla and Pulsatilla; from abuse of Rhubarb: Chamomilla, Merc, Pulsatilla ; Bloody stools: Arsenic, Cantharides, China, Ipecac, Merc, Nux v., Puis., Rhus, Sepia and Sulphur; pu- trid: Arsenic, Carbo v., China, Nux m., Nux v., Sulphur; flocculent: Arsenic, Ipecac, Veratrum; gray, ash-colored: Digitalis, Merc, Phos. acid; green: Chamomilla, Merc,Puis., Phosphor and Sulphur; black: Ars., Camphor, China, Ipecac, Squills and Veratrum; white: China, Phos. ac, Sulphur; in- voluntary: Arnica, Bellad., China, Hyoscy., Opium, Phosph., Phpsph. acid, Rhus, Secale, Veratrum. Hydropathic treatment — Common diarrhoea requires no medication; fasting, and one or two copious injections of tepid water. All other forms must be treated on general pr'»>- DIARRHCEA. 351 ciples; the local irritation may be relieved by sitz-baths, cold injections, cold compresses, hot fomentations, &c (See Dys- pepsy.) Eclectic treatment. — In the early part of the attack, the syrup of Ehubarb and Potassa will be found sufficient to check the discharges; it may be given every hour, in doses suitable to the age, and continued until it exerts laxative effects, when the intervals between the doses should be lengthened. We must also employ a warm alkaline bath, two or three times a day. If nausea or vomiting are present, a few drops of Pare- goric may be added to the syrup, and a mustard plaster applied oyer the epigastrium. When tenesmus is present, a few drops of the compound tincture of Virginia Snake root, in one or two tea-spoonfuls of cold water, injected into the rectum, immediately after each alvine evacuation, and retained there as long as possible, will speedily remove this disagreeable symptom. If there is much fever, with pain in the stomach or bowels, the compound tincture of Virginia Snake root, in proper doses, may be administered every hour or two, with the appli- cation of warm fomentations to the bowels. In chronic diarrhoea, the following has proved successful: Take syrup of Rhubarb and Potassa, four ounces, Hydrastin, twelve grains, mix; of this a tea-spoonful may be given to a child five years old, or proportionate to its age. If the dis- charges are frequent, twenty grains of Geraniin may be added to the above compound. In mucous diarrhoea, as well as in the chylous, alterative doses of Podophyllin and Leptandrin combined, or of Lep- tandrin and Geraniin, are required. In lienteric diarrhoea, after the employment of the means heretofore named, a combination of Quinia, Hydrastin and Geraniin (equal parts), or an infusion of Blackberry root may be used. All candies, preserves, and knick-nacks must be prohibited. Dirt-eating—African cachexia.—(See Malacia.) 352 DISEASES OF THE ABDOMINAL VISCERA. DUODENITIS. An inflammatory state of the mucous membrane of the duodenum, at the point where the bile enters this portion of the intestinal tract. Sickening, sinking, gnawing sensation just below the pit of the stomach, with tenderness to external pressure, often so great as to make the weight of the bed- clothes painful. Causes* — Accumulation of acrid and irritating bile. Treatment is the same as mentioned under Dyspepsia. DYSENTERIA--DYSENTERY. Constant urgency to evacuate the bowels, tenesmus, violent pains in the abdomen, tenderness of abdomen, fever especially toward evening, and stools of mucus or blood, or both, but no faeces in the stools. The disease is generally preceded by bilious diarrhoea (Dysenteria biliosa), or other symptoms of deranged digestion. When there are small mucous evacuations, the disease is called white dysentery; if mixed with blood, red dysentery (bloody flux). If not checked in time the disease may terminate in ulcera- tion or gangrene, or the patient may sink from exhaustion. Sudden cessation of all pain, offensive evacuations and cold- ness of the extremities are signs of gangrenous mortification. (Putrid dysentery.) The evacuations becoming feculent is a sign of improvement. Causes. — Inflammatory affection of the mucous coat of the large intestines, produced by suppressed action of the skin in warm weather, with increase of quantity and acrimony of bile; dietetic errors; low or marshy situations; local irrita- tions, such as worms, scybola; suppression of hemorrhoids; in children, difficult dentition. Treatment allopathic — When the patient is plethoric, the abdomen distended and painful to the touch, the pulse full and hard, recourse must be had to a small venesection, and application of leeches to the abdomen. After the pulse has been reduced, an emulsion consisting of mucilage of gum DYSENTERY. 353 Arabic one ounce, spring water seven ounces, laudanum six- teen drops, syrup of mallows one ounce, a table-spoonful every two hours, should be administered. When the dysen- tery is of a bilious-rheumatic character, with indications of gastric impurities, an emetic of ipecac, should be adminis- tered, then a laxative mixture of manna and tamarind, or castor oil. If no improvement follows, we must give the above emulsion, or small doses of Dover's powder, and at the same time administer pearl-barley, water-gruel, gum-water as a beverage. Embrocations of antispasmodic ointment with opium to the abdomen may be employed with benefit. In rheumatic dysentery, without gastric or inflammatory symptoms, we prescribe the above mucilaginous emulsion, or small doses of Dover's powder, and externally warm baths and a vesicatory to the abdomen. In nervous, adynamic dysentery we employ the foregoing remedies and valerian, moschus, two grains in a decoction of pine-sprouts; arnica, wine, and aromatic baths. In putrid dysentery: Arnica-root, one scruple of the pow- der every two hours; Sulphuric acid; Nux vomica, one-six- teenth of a grain pro dosi; fresh charcoal and red wine. In epidemic dysentery a decoction of pine-sprouts, and Vitrum ceratum antimonii, in half or one grain doses, are highly recommended. In obstinate cases of dysentery, powdered Nux vomica, a grain every four hours; Sulphur; Calomel; and especially corrosive sublimate, one-eighth of a grain to four ounces of water with three ounces-of mucilage of gum Arabic and twelve drops of laudanum, a table-spoonful every two hours; which may also be given in injections with one-sixteenth of a grain of corrosive sublimate. Salep-mucilage is of great benefit when a feeling of great rawness in the abdomen exists, caused by the loss of the mucous membrane. Persons subject to dysentery must wear a flannel vest around the abdomen. Good, ripe fruit is not injurious. Homoeopathic treatment. — The principal remedies in in- l.-ip 354 DISEASES OF THE ABDOMINAL VISCERA. flammatory dysentery are: Aconite, Nux v., Bellad., Mer- curius. In rheumatic catarrhal dysentery: Aconite, Chamomilla, Rhus and Pulsatilla. In bilious dysentery: Aconite, Merc corros., Coloeynth, Colchicum and Pulsatilla. Putrid dysentery: Arsenic, Nux v., Carbo v., Petroleum, Kreosot, Sulphuric or Nitric acid. Among the above remedies, the most important are: Ipecac, Coloeynth and Mercurius corrosivus; also: Chamomilla, Aco- nite and Pulsatilla; and in some cases: Bryonia, Rhus, Arsenicum, Nux v., Carbo v., Cantharides, Colchicum and Sulphur. In suppressed dysentery the following remedies will be found useful: Aconite, against inflammatory symptoms; Cup- rum acetieum, when spasms or cold sweats predominate; Bel- ladonna, against inflammatory colic; Coloeynth, violent colic and distention of the abdomen; Veratrum album, coldness of the body and extremities and retching; Carbo v., cold breath and scarcely perceptible pulse. Warm water clysters are use- ful. If typhoid symptoms are present, see typhoid fever. In this affection flannel should be worn outside the linen, and strict abstinence from all solid food must be observed. Hydropathic treatment. — General fever requires the wet- sheet pack or half-bath. The abdomen should be kept con- stantly covered with the wet compress, which must be very often changed, until the pain, heat and tension subside. In the early stage give two copious tepid injections to clear the alimentary canal, after which moderate cool injections are to be employed occasionally. Regulate the temperature of the water according to the patient's feelings. Hip-baths of a low temperature, once in from three to six hours, may be em- ployed with benefit. Moderate draughts of soft water should be frequently administered. Entire abstinence from food is necessary, until the fever and local inflammation havj abated. DYSPEPSIA. 355 Eclectic treatment. — The first prescription should be as fol- lows: Take Podophyllin six grains, Leptandrin four grains, Lactin half a drachm; mix, and divide into four powders, one to be given every three hours, until free catharsis is produced. After the third or fourth dose the patient will experience for a time unpleasant symptoms, as nausea and vomiting, griping pains in the abdomen, cold sweat, and copious discharges. Those symptoms need create no alarm. In case of much prostration the patient must be supported with brandy-sling. After the cessation of tenesmus and the dysenteric discharges, it will be necessary to maintain, for a few days, a hepatic and cutaneous influence, by administering the following: Take Sulph. Quinia eight grains, Sulph. Morphine half a grain, Ipecac, two grains; mix, and divide into eight powders; one powder to be administered every two or three hours, gradually lengthening the intervals between the doses, and continuing their use for two or three days. In obstinate cases it will be necessary to administer injections, composed as follows: Take Infus. Hydrastis Can. (cold) one ounce, tinct. Opii ten to twenty grains; mix; one to be given immediately after each discharge. An infusion of raspberry leaves, or of oak bark, may likewise be employed. *■ Some practitioners continue the administration of the Podophyllin and Leptandrin, in minute doses, triturated with lactin, and with excellent results. Oat-meal made into a cake with water, then baked and finally browned, similar to coffee, and made into coffee, will be found nourishing, and soothing to the stomach and bowels. It must be given in little spoonful doses, without milk or sugar. In patients of weak constitution, the dose of the cathartic powders may be diminished. A wet sheet applied round the body is recommended. DVSPEPSIA — DYSPEPSY — INDIGESTION — WEAK STOMACH. Absence of appetite, or weak, irregular, depraved appetite; pressure and tenderness in the epigastrium after eating, eruc- tations with taste of the aliments; flatulency; heartburn; 356 DISEASES OF THE ABDOMINAL VISCERA. nausea; irregular bowels; a feeling of languor which is re* lieved by taking food; drowsiness; aversion to exercise of body or mind; ill humor; occasional palpitation of the heart; furred tongue, and irregular pulse. Causes. — Irregular or bad diet; gluttony; warm beverages; rich and indigestible food and stimulating soups; hot bread and biscuit; imperfect mastication of food; tea and coffee; tobacco; ardent spirits; sedentary life; great mental exertion; sorrow; immoderate sexual intercourse; keeping late hours; large doses of Calomel, and the so called Tonics (Bitters). Treatment allopathic-—Weakness of the stomach caused by gastric impurities, bile, or morbid metastases, as the rheu- matic, arthritic, psoric, &c, requires cathartics, emetics, and the treatment of Rheumatism, Psora, &c But when the dis- ease originates in mere weakness of the stomach, we may use the following compound of Tonics: Take of quassia and tri- folium each six drachms, root of Zedoary and Galanga each two drachms; Gentian and Orange bark each half an ounce; Peruvian bark two ounces, iron filings six drachms, Catawba wine eight pints; digest in a warm place, take a wine-glassful three times a day. The following remedies bMye been used with more or less benefit: Mineral water, a glassful every morning fasting; six to nine corns of white pepper, swallowed every morning fast- ing; columbo; hops; valerian; ether, beer, and aloes; old wine; wild cherry bark; a current of electricity or galvan- ism made to pass through the stomach. Externally, wearing a little bag filled with spices, repeatedly moistened with French brandy, on the pit of the stomach; stomach-plasters; bathing the epigastric region, and cold douches on the same. To maintain regular alvine evacuations, if this cannot be accomplished by means of diet (bran bread, or bread made from unbolted flour), we must resort to Rhubarb or Aloes, the latter only when there is no tendency to piles or uterine irri- tation. Rhubarb may be chewed, or reduced to powder and taken with grated nutmeg. When these medicines lose their ■* DYSPEPSIA. 357 effect by repetition, they may be mixed with one-sixth of a drop of croton oil. Magnesia should be employed when there is acidity of the stomach. Mild laxative enemata or suppositories are sometimes usefully substituted for cathar- tics by the mouth. The best of all tonics in this disease is exercise in the open air. The patient must also abstain from all warm beverages, much milk, flatulent vegetables, grease, cheese, cakes, spirits, and above all avoid overloading the stomach. Roast meat is an excellent remedy. Homoeopathic treatment. — The principal remedies are: Nux v., Pulsatilla, Bryonia, Chamomilla; also: Ipecac, Hepar, Sulphur, and Acidum sulphuricum. Avoid every quantity and quality of food which seems to disagree. (See Flatulency, Cardialgia, &c.) Hydropathic treatment.—A nervous, feeble patient must take moderate water-treatment, gentle exercise, sailing and riding, and sleep all that he is inclined to; while the torpid, quiet, but more enduring person should rise early, walk much, and practice gymnastics for amusement, or perform some light kind of manual mechanical labor. The diet should be plain and simple. The bowels should be kept regular by injections and by going to stool at a regular hour every morning. Cool or cold injections should be employed every morning, soon after rising, except when affected with colic or griping. The sitz-bath may be resorted to two or three times a day for ten or fifteen minutes, the temperature as cold as the patient can bear without producing a permanent chill, or a feeling of weakness and stiffness. The crash towel bandage is of great importance. It should be worn around the whole abdomen, t. e. when it can be worn thus without producing irritation or chilliness of the back, otherwise it should only extend across the abdomen. Cold feet require foot-baths. A good combination of daily baths for full treatment in an ordinary case, would be the following: Tepid half-bath for five minutes, and pail-douche; wet-sheet pack, followed by 358 DISEASES OF THE ABDOMINAL VISCERA. moderate douche, plunge, or dripping-sheet; sitz-bath at 60°, ten minutes, followed after an hour's interval by a foot-bath at 72°, five minutes; the first to be taken on rising, the sec- ond from ten to eleven A. M., the third at four to five P. M., and again in the evening. The wet girdle should be wet and re-applied after each bath, and again at bed-time. It is advi- sable to omit the wet bandage occasionally for a few days, and then resume it again. Kneading, pounding, rubbing of the lower part and external muscles of the abdomen is, in many cases, of benefit. A trotting horse affords good exercise, also climbing mountains, and walking rather fast over an uneven surface. Eclectic treatment. — In cases of dyspepsia it is far better to remove constipation by soap suppositories, than by any inter- nal administration of medicine Medicines only palliate or remove a symptom of this disease; a radical cure can only be effected by a proper attention to diet, rest, ventilation and temperature. In order to give tone to the digestive organs, and sustain a proper degree of activity in the alimentary canal, the Restora- tive Gin Bitters (Bone's Bitters) should be prescribed in doses varied to suit the age, constitution and condition of the patient. If the patient has a tendency to diarrhoea and acidity, the compound neutralizing medicine should be administered, com- bined with the bark of wild cherry. Dysphagia —Difficulty of swallowing. —(See Diseases of the Throat.) D ENLARGEMENT OF THE SPLEEN — AGUE-CAKES. An indurated tumor in the left hypochondrium, verging toward the spine; symptoms of general ill-health; nervous de- bility; dry skin, pale lips; features have a dark, bilious hue; appetite is generally good, but the patient looses flesh and muscular strength, and is morose and desponding. Causes.—Obstinate intermittent, or remittent fevers; scrofu- lous constitutions; constitutions debilitated by intemperance; INFLAMMATION 01' 'IIIM BOWELS. 350 marshy situations and stagnant waters, suppressed menstrua- tion; abuse of quinia. Treatment. — The principal remedy in allopathic practice is Peruvian bark, or Sulphate Quinia. (See Splenitis.) ENLARGEMENT OF THE MESENTERY. This affection is generally known by an indurated and irregular mass of tumors below the stomach, yielding to the pressure of the hand; the countenance is pale and bloated; the appetite is irregular often voracious, and general emacia- tion attends. The enlargement of the mesentery may be in the form of tubercles, hydatids, scirrhous induration; fleshy, adipose or calculous deposits, or several of these; morbid alter- ation of structure may be co-existent. (See Atrophia me- seraica.) Enlargement of tJie intestines.—(See induratio intestinorum.) ENLARGEMENT OF THE OMENTUM. The tumor is indurated and diffused, extending frequently over the entire abdomen; it is accompanied with general ema- ciation and difficulty of breathing. Turgescence of the omen- tal portion of the peritoneum, is usually of a complicated cha- racter—indurated, scirrhous, cartilaginous, and tuberculated; in some instances the structure acquires a stony hardness. Treatment is the same as recommended for enlargement of the liver and mesentery. Complicated, visceral enlargement — Conjoint existence of several of the diseases already considered. It is denoted by a hard, elevated and distended abdomen, resembling that of pregnancy; the belly is more or less knotty and unequal; the respiration is but slightly disturbed, and there is usually pain. thirst, nausea and vomiting. A diseased liver is commonly the starting point of these structural monstrosities. (See enlargement of the liver and other organs.) ENTERITIS SEROSA — INFLAMMATON OF THE SEROUS COAT OF THE BOWELS. Intense pain, generally in one spot of the abdomen, and especially in the region of the navel, increased by the slightest 330 DISEASES OF THE ABDOMINAL VISCERA. pressure (even of the bed-clothes), and by movement, with tightness, heat and tympanitic distension of the abdo- men; violent thirst with aggravation of suffering from cold drinks; obstinate constipation, vomiting of slime and bile and even of excrements (Ileus miserere); sobbing; anxiety; small contracted pulse; inflammatory fever; obstruction of urine, &c In the chronic form of the disease (inflammation of the mucous coat of the bowels), the pain is only slightly felt, and consists of a diffused soreness over the abdomen, which is commonly increased by pressure, and aggravated by cold drinks and indigestible food; there is redness at the tip and margin of the tongue, loss of appetite, indigestion, nausea and vomiting; thirst; diarrhoeic stools mixed with blood; fever and extreme languor. Unless inflammation is subdued, the disease may terminate in induration of the intestines, laying the foundation of chronic constipation, dropsy, suppuration or gangrene. In some cases the inflammation is owing to hernia incarcerata. Causes. — Cold in the feet and abdomen; suppressed dis- charges; drastic purgatives; worms; difficult parturition; long retained hardened faeces; indigestible or highly stimulating food; prolonged use of acids, ardent spirits; mechanical inju- ries; &c Treatment allopathic. — General and local abstractions of blood; fresh linseed oil given by spoonfuls; butter-milk; externally: anti-spasmodic and mercurial ointments; cups; linseed poultices; bruised garlic; a vesicatory on the abdo- men, and oily mucilaginous injections every six hours. No purgatives should be administered as long as the inflammation continues; the removal of the inflammation opens the bowels. If costiveness and vomiting continues after inflammation has subsided, three grains of the watery extract of opium should be administered with an oily emulsion, and at the same time opiate injections should be given, after which castor oil, a table-spoonful every two hours, may be resorted to. When INFLAMMATION OF THE BOWELS. 361 constipation still continues we must have recourse to injec- tions of vinegar or cold water, and cold fomentations on the abdomen. If the skin is hot and dry, and the febrile action considera- ble, the neutral mixture may be employed. Dover's powder should be given at night, so as to procure rest. Calomel or blue mass should be added, in small doses, when there is deficiency or derangement of the hepatic func- tion. Great care is requisite in relation to diet. Total ab- stinence is best- In chronic enteritis the most important part of the treat- ment is the regulation of the diet. (See Gastritis.) Homoeopathic treatment,—The inflammatory symptoms should be subdued with Aconite; after which Arsenicum and Vera- trum should be administered. When the derangement arises from spasmodic congestion, or strangulation of the intestines (Ileum miserere) Opium and Plumbum should be had recourse to; but when it is connected with inflammatory action, or has resulted therefrom, Aconite and Sulphur are more appro- priate. In the chronic form one or more of the following remedies must be selected to complete the cure: Mercurius, Belladonna, Nux v.; also: Nitric acid, Coloeynth, Bryonia, Chamomilla, Pulsatilla, China, Opium, Cantharis, Colchicum, Rhus, Phos- phor, Sulphur and Silicea. (See Gastritis.) Hydropathic treatment. — After the heat and tenderness of the abdomen has been reduced by external applications of cold water, recourse must be had to copious tepid injections, if there exists constipation of the bowels; in diarrhoea, the warm sitz-bath and cool injections must be employed. (See Gastritis.) Eclectic treatment, — Fomentations and sinapisms over the abdomen; counter-irritation to the extremities, and in obsti- nate cases to the spinal column; alkaline-bath, in some cases tne vapor-bath; and emollient and mucilaginous drinks, with taicturc of Aconite or Belladonna. (See Gastritis.) 362 DISEASES OF THE ABDOMINAL VISCJERA. ENTERO-PHTIIISIS—PHTHISIS INTESTINALIS--CONSUMPTION OP THE BOWELS--DYSPEPTIC CONSUMPTION. Emaciated patients, suffering from colliquative sweats and hectic fever, experience periodical pains in different parts of the abdomen, especially during the night, which are aggra- vated by pressure. Characteristic symptoms are: frequent stools, which first appear only during the night, later during day time also, containing an offensive, sometimes bloody pus. Causes.—This disease generally shows itself after tedious dysentery, typhus abdominalis, small pox, scrofulosis, Ac, and in many cases accompanies pulmonary consumption. Treatment allopathic—The treatment is analogous with the cure of the diseases of which Entero-phthisis appears as a symptom. At the commencement a few leeches may be ap- plied to the painful parts; and narcotic cataplasms and baths employed. The great irritation of the bowels must be allayed by narcotics. Torpid fever requires Peruvian bark, wine, mineral acids, and nourishing diet. Clysters of tepid water with some oily substance, and internally small doses of lead with opium, have been prescribed with benefit, Homoeopathic remedies. — Arsenicum, Calcarea, Hepar, La- chesis, Merc, Silicea and Sulphur. Hydropathic treatment, — Tepid sitz-baths and hip-baths; wet compress, well covered with flannel to the abdomen, and tepid injections. Entero-stenose.—(See Ileus.) Enteralgia.—(See Colic) FLATULENCIA — FLATULENCY. Excessive generation of air in the stomach and intestinal canal, manifesting itself by tension and swelling of the epigas- trium, rumbling in the bowels, and frequent discharges of wind. This accumulation of air in the digestive organs creates manifold complaints, as difficulty of breathing, confu- sion of the head, mental anguish, illusions of the senses and visions, pain in the abdomen and sides, palpitation of the heart, globus hystericus, tympanitis, hyst-erv. hypoehnndry. A<. AlSSCEbS IN ANO. 363 Causes. — Weakness of digestion; errors in diet; flatulent food, cabbage, turnips; fermenting beverages; mental affec- tions; taking cold in the abdomen or feet. Treatment allopathic—-Avoid taking cold and abstain from warm drinks, soups, cabbage, &c The removal of the accu- mulated flatus is effected by taking a little anis seed—or pep- permint-tea; or a small quantity of pulverized charcoal in a little french brandy; a few drops of sulphuric ether upon a lump of sugar; valerian-tea; oil of spearmint; ginger; cara- way; fennel seed; cloves; &c Externally, we apply warm cloths or stones ; use frictions with a combination of four drops of chamomile oil dissolved in half a drachm of sulphuric ether; or dry hand frictions, and give injections of pepper- mint, caraway, and chamomile flowers. Persons subject to flatulency should take a cup of cumin-tea every morning fasting. A radical cure requires: cold, dry regimen ; cold roast meat, ice cream, ice pills, malaga wine; cold lotions and douches to the abdomen; injections of cold water and strong out-door exercise. Homoeopathic remedies. — Pulsatilla, Carbo v., China, Asa f., Nux v., and Sulphur. If arising from the use of flatulent food: China; after using pork or fat: China, Colchicum, Pul- satilla; if after taking a drink: Nux v. (See Dyspepsy and Wind Colic) Fissures of the anus, are ulcerous grooves in the rectum ex- tending upward from the orifice. The edges of the crack or fissure become thickened and hardened, and constantly exude a sanious fluid. They should be removed by caustic as in the case of fistula, the patient kept quiet, the warm relaxing baths employed, and the general regimen strictly attended to. FISTULA ANI — ABSCESS IN ANO. An abscess about the rectum, opening either within or without the anus, or both. The disease is generally connected with piles, and is accompanied wdth costiveness. In some 364 DISEASES OF THE ABDOMINAL VISCERA. cases the first marked symptom consists in a hard swelling of a part of the buttocks in the vicinity of the anus, which soon becomes red in the centre, accompanied by symptoms of fever. In other instances the suppurative process is ushered in by an attack of widely ramified erysipelatous inflammation. On some occasions the affection commences with somewhat of the appearance of a carbuncle; in others as a hardening of the cutaneous surface near the anus, exempt from pain and discoloration. The formation of matter is preceded by a shivering fit. The abscess may point in the buttock, either remote from the anus or in its immediate vicinity; or in the perineum. When there is only an external opening, it is called a blind external fistula; when both an external and internal, complete fistula; and when merely an internal aperture, a blind internal fistula. In a majority of cases several distinct openings are, internally, connected with a fistulous pipe. When a fistula in ano, or sinus by the side of the rectum, is fairly established, the patient experiences pain in expelling the faeces, has frequently strangury, prolapsus ani, tenesmus, hemorrhoids, diarrhoea, or costiveness; there is a discharge of thin yellowish pus, mixed with faeces, from the anus, or from a small fistulous opening in its immediate vi- cinity, and the surrounding parts are generally red and hard. Causes. — Laxity of the cellular tissue; functional derange- ment of the rectum; external injuries, and foreign substances lodged in the rectum; habitual costiveness; inattention to the calls of nature for evacuation; erysipelatous inflammation about the anus; long neglected piles. Treatment allopathic. — When a painful abscess appears in the neighborhood of the rectum, several leeches and poultices should be applied to the affected parts. An opening (inci- sion) should be made with a lancet at an earlier period than is generally deemed necessary in many other parts, after which a bandage and poultices should be again applied, thus bringing about a cure and preventing the formation of a fis- tula. Should a fistula, notwithstanding, appear, we must ABSCESS IN ANO. 365 have recourse to injections, which will create inflammation, as decoctions of oak, creosote, &c Surgeons recommend the following operation, which, however, has proved only in very few cases of decided benefit: The patient should lean over the margin of a bed, table, or back of a stout chair, and the surgeon should seat himself sufficiently low to get a clear view of the perineum; he should then introduce the end of a probe-pointed bistoury through the external opening, and push it slowly along the sinus, until it reaches its upper ex- tremity; then the point of the forefinger of the left hand, smeared with oil, should be passed into the anus, and if the instrument has not yet penetrated the gut, he should cause it to do so, either through the opening in this situation,— sup- posing that one is present—or he should thrust it through, partly by pushing with his right hand, and partly by scratch- ing with the nail of the left over the point of the blade, and as soon as this is accomplished the bistoury and finger must be drawn downward so that all the textures between the sinus and the rectum are divided, and thus the two are, as it were, thrown into one chasm. If the opening of the skin has been some way from the anus, the sphincter muscle must be divi- ded in the incision. A slip of lint, moistened with oil, should then be passed to the bottom of the wound, and the patient kept in bed until the cavity heals by granulation. If the bleeding is more copious than desirable, the wound should be firmly stuffed with lint, and a pad should be retained over it. This operation should never be undertaken in patients whose lungs are diseased. The disease often returns after the opera- tion. Homoeopathic treatment. — In the early stage of abscess about the anus, and when there are febrile symptoms present, a few doses of Aconite should be administered. If there is much erysipelatous inflammation, Belladonna and Rhus may be prescribed. A simple poultice may then be applied, and the suppurative process forwarded by repeated doses of Silicea (third trituration) or of Hepar and Silicea in alternation. In 366 DISEASES OF THE ABDOMINAL VISCERA. some cases it is necessary to open the abscess with the lancet. If the skin presents a livid appearance, and the fistula commences with the features of a carbuncle, Lachesis and Silicea must be administered in alternation. After the burst- ing of the abscess and the discharge of its contents, the union of the sides of the cavity may be left to nature. When true fistula has resulted, a dose or two of Mercurius may be given, and then Silicea and Sulphur to forward granulation, or Pul- satilla, Sulphur and Calcarea. In some cases Phosphor and Hepar are required. Hydropathic treatment — In order to subdue the inflamma- tion, and overcome the irritable condition of the ulcer, fre- quent warm hip-baths with the wet compress must be em- ployed. In complete fistula the treatment recommended by the Eclectic school is advised as the most proper and suc- cessful. Eclectic treatment. — In the incipient stage, when an abscess has formed near the anus, but no fistulous pipes are yet de- veloped, recourse must be had to fomentations and emollient poultices, with diaphoretics and cathartics. If there is evident fluctuation near a convenient part of the surface, open freely with caustic potash. When all the pus has escaped, heal up as soon as proper, taking care not to allow the surface to heal before the abscess fills up. The abscess must be cleansed daily with soap-suds, and if it manifests the least disposition to become indolent, stronger alkaline lotions (weak solutions of vegetable caustic) must be resorted to. Steady compres- sion is also beneficial, whenever it is practicable. In true fistula the general health must always be regarded; the alkaline-bath should be used daily and the bowels be kept open. The local treatment consists in substituting the ligature and the caustic for the knife and the scarificator. Pass the threaded probe from the external to the internal orifice, the string being brought down by the finger intro- duced in the rectum. The two ends of the ligature are to be fcLLX. 367 tied as firmly as the patient can bear, and afterward drawn a little together every day. Before tying let the ends of the string pass through a large vial-cork, separating three-fourths of an inch where they emerge, and passing over a little wooden roller fitted to radial grooves cut on the end of the cork. These notches will hold the stick after turning or twisting to tighten the string. While the ligature is on, every sinus should be thoroughly injected two or three times a day with the alkaline lotion. The caustic must also be inserted by means of pledgets of lint to act upon and dissolve the callous or cartilaginous growths. The part should be frequently bathed or fomented with warm water when painful, and slip- pery elm poultices applied; or several folds of wet cloths, covered with dry, kept constantly applied, being retained in place by a "T"' bandage. 'When branching sinuses lead into or from the main one, they should be enlarged by the armed tents, which are made of hemp-cord, well charged with the caustic A blind internal fistula .should be opened with a pointed probe or the caustic, at the point nearest the external surface. thus eojiverting it into a complete fistula to be treated as above. The blind external fistula can often be cured by the armed tent alone; but if this fail the threaded probe can be passed through the bottom of the sinus into the rectum and the ligature applied. The elm poultice should be kept over the affected parts by a "T" bandage during the whole of the caustic treatment. It will usually take from three to six months to cure bad cases of this affection. FLUXUS COELIACUS--FLUOR ALBUS INTEST1NI RECTI. White, milk, or chyle-like evacuations from the intestinal canal, sometimes permanent, at other times intermittent, and often accompanied with tenesmus. In some cases the dis- charges are mixed with faeces or blood, and are fetid. In the first stage of the disease the patients have a good appetite, later they suffer from dyspepsia, emaciation and hectic fever- Causes. — Atony of the intestinal canal; hemorrhoidal 3J8 DISEASES OF THE ABDOMINAL VISCERA. congestion; metastases; obstruction of the liver; &c (Sec Diarrhoea.) Fiuxus hepaticus.—Watery and mucous stools (ten to twelve a day) resembling bloody water, without tenesmus and colicky pains, and with or without faeces. It lasts for years. Finally, emaciation, debility and hectic fever end the patient's life. Causes. — Exhalation of serum into the small intestines; hemorrhoidal diseases; obstruction of the liver and abdominal viscera; atony of the intestines; softening, dissolution or ulceration of the liver. Treatment. — It is a rare disease, and its cure consists in the removal of the causes. Flux bloody. — (See Dysentery.) Gcillstones. — (See Calculi Biliosa.) GASTRITIS. Inflammation of the mucous membrane of the stomach, frequently involving the submucous tissue, and sometimes the muscular coat. Burning, pricking, or shooting pain in the gastric region, increased by pressure, inspiration, or the passage of food and drink; swelling, heat and tension over the whole stomachic region, sometimes with pulsation; fever, thirst; nausea and vomiting, increased or brought on by the smallest quantity of food or drink; sometimes with hydrophobic symptoms; cold extremities; constipation or diarrhoea; sunken features; anxiety, restlessness, and prostration of strength; tongue red at the tip and round the edges; spasms; convulsions, fainting, even tetanus; pulse small. Death may ensue from gangrene, in which case the pains suddenly cease; or from paralysis of the nervous system. Often it passes into chronic inflamma- tion, scirrhus, or ulceration of the stomach. Chronic Gastritis is a congestive state of the stomach, and must be treated as such. Causes. — Partaking of cold drinks or iced water when heated or during hot weather; admission of poisonous or foreign substances into the stomach; external injuries; ardent '", xst surra. 36S spirits; suddenly checked diarrhoea; abuse of emeties, and suppressed menstruation or piles. Allopathic treatment. — General and local abstractions of blood by the lancet and leeches; cupping; embrocations with mercurial ointment, oil of Hyoscyamus, cold and even ice; internally, mucilaginous remedies, as the following compound: Take sweet oil of almonds one ounoe, spring water eight ounces, mucilage of gum Arabic, extract of Hyoscyamus six grains, syrup half an ounoe, a -table-spoonful every hour. Milk with water, butter-milk, ice, iced lemonade, or carbonic acid water may sometimes be favorably substituted for pure water. Obstinate vomiting often yields to enemata of lauda- num with a solution of starch or flaxseed tea. La desperate cases, when the symptoms indicate gangrene, the mostefficienst remedy is oil of turpentine with laudanum, given frequently in small doses. Constipation requires oily injections. Nervous affections should be subdued by Belladonna six to eight grains, aqua laurocerasi, small doses of Prussic acid in a mucilaginous vehicle, tepid baths, and poultices -to the ahdome-n. In Gastritis owing to poisoning with corrosive substances (Arsenic, corrosive sublimate, &c), see Poisons and their An- tidotes. In metastatic Gastritis mustard poultices, or fly-plasters applied to the region of the stomach are generally all-sufficient. If ulceration takes place, the patient is lost. Venesection is safe in this disease, so long as the pulse rises and becomes more developed under the lancet. In chronic Gastritis the patient must be subject to strict dietetic regulations, which are often all that is necessary. No precise rule can be laid down for all circumstances, except that in every case the food allowed should be of the kind most easily digested. ( See Dyspepsia.) Homoeopathic remedies. — Aconite, Belladonna, Ipecac, Nux v.. Ant. cr., Pulsatilla, Bryonia, Cantharis, Hyoscyamus, Ar- senicum, .&c 370 DISEASES OF THE ABDOMINAL VISCERA. Chronic Gastritis requires: Natr. m., Lachesis, Nux v., Sulphur and Carbo veg. (See Cardialgia, Dyspepsia.) Hydropathic treatment.—Apply wet cloths freely to the whole abdomen, of a temperature most agreeable and sooth- ing to the patient. Small quantities of ice or iced water may be frequently taken. Water of a moderate temperature may be allowed, as much as the patient wishes. Tepid injections to relieve costiveness; cold injections if there is diarrhoea. When the fever is high and general, the wet-sheet envelop- ment should be employed two or three times a day. Eclectic treatment.—In all eases of gastric inflammation apply fomentations over the epigastric region, as hot as the patient can bear, which should be often changed, not allowing them to become cool. The feet and legs must be frequently bathed in hot water, and sinapisms placed on the soles, and even around the ankles. Perspiration must be induced by the use of the spirit vapor-bath or injection of the compound tincture of Virginia Snake root, one to three drachms of which may be placed in about half a gill of warm starch water, and injected at one time into the rectum. To overcome the tendency to vomit, by reducing the inflammation, we should employ an infusion of peach-leaves and elm-bark, which may be given in tea-spoonful doses every fifteen min- utes, with one drop of the tincture of Aconitum added to it; and as soon as the more active symptoms become lessened, the Aconitum may be omitted. Constipation must be overcome by purgative injections. As soon as the patient becomes able to retain any thing upon the stomach, the compound powder of Ipecac, and Opium in very small doses, combined with half to a grain of Hydrastin, may be given at intervals of two or three hours, still continuing the peach-leave infusion. Barley-water, rice-water, or toast-water may be allowed, as soon as the patient can retain any food. In chronic gastritis the diet must be especially attended to; the surface of the body should be bathed daily with a weak SOFTENING OF THE STOMACH. 371 alkaline-solution; an irritating plaster may also, if the case proves obstinate, be applied over the region of the stomach. If the inflammation be purely of a chronic character, a nutri- tious diet will be required, as animal jellies, oysters, poultry, venison, tender beef, steaks, birds, or other meats easy of digestion. Particular craving of the patient should be grati- fied. Internally we may use the following combination of reme- dies: Take Hydrastin, Cornin, Myricin, of each ten grains; mix; divide into ten powders, one of which may be given every four hours. For the constipation injections must be used. (See Dyspepsia.) Gastro-ataxia. — (See Blenorrhcea ventriculi.) Gastro-dynia. — ( See Cardialgia.) GASTRO-MALACIA — SOFTENING OF THE STOMACH. A disease occurring in infants. In the first stage there are pains in the bowels, with drawing up of the extremities; vomiting of milk or food, which has a sour or putrid odor; hacking cough; fretfulness; bloatedness of the epigastric region; from eight to ten stools per day, resembling chopped eggs, sometimes streaked with blood and fetid; pale counte- nance; blue rings around the eyes, cold extremities, dry skin, emaciation, fever toward evening. In the second stage we have sunken eyes, cold extremities, sopor, hiccough, involun- tary evacuations, spasms, death, generally on the fifth or ninth day. By dissection the mucous membrane is found soft, trans- parent, and the stomach sometimes perforated. Causes. — Indigestible food; hot food; sore mouth; atmos- pheric influences; dentition; scrofula, &c The disease is often mistaken for Atrophy, Hydrocephalus, &c Allopathic treatment. — Leeches to the region of the stom- ach; embrocations of mercurial ointment with oleum hyos- cyami; tepid baths with bran; in copious diarrhoea, injections with opium and small doses internally; strict diet, nothing but water-gruel. When the vomiting ceases but the diarrhoea 372 DISEASES OF THE ABDOMINAL VISCERA. continues, acetate of iron, with ;i little opium, should bo administered. During convalescence continue bran-baths, and prescribe acorn and china-coffee. Homoeopathic treatment — Removal of the cause, and ac- cording to symptoms one of the following remedies may be selected: Arsenicum, Ipecac, Calcarea, Chamomilla, Nux v., Bryonia and Pulsatilla. (See Gastritis and Cholera infantum.) Hydropathic treatment. — Wet compress to the abdomen, foot and hand-baths, injections of tepid or cold water, tepid hip baths, frequent draughts of cold or iced water. GASTROSIS--GASTRIC IMPURITIES. When the impurities are in the stomach, we find the tongue white, yellow, or brown-coated; want of appetite, pressure, tension and painful sensation in the stomach, eructations, nausea or vomiting, headache, lassitude, &c When the intestinal canal is the seat of tho impurities, the symptoms are colic, pains in the back, fetid flatus, sometimes diarrhoea, rumbling in the abdomen, bloatediiess of the abdo- men ; lassitude, &c These symptoms are generally combined with fever (see gastric fever) or without it (Gastrosis chronica). The chief kinds of gastric impurities are bile, phlegm, acidity, infarcts, accumulated or formed in the intestinal canal. Causes. — Imperfect digestion; indigestible food; disordered secretions of the digestive organs; mental affections; taking cold; suppressed cutaneous function; atmospheric and cli- matic influences, especially moist or changeable weather. Treatment — Remove and avoid the causes. Evacuate the offensive matter by cathartics, emetics, injections, &c (See diarrhoea, vomiting, gastric fever, dyspepsy, &c) H^EMATEMESIS--VOMITUS CRUENTUS--VOMITING OF BLOOD. Sometimes of a dark color (venous), and sometimes of a bright red; it is occasionally mixed with bile, food, &c Premonitory symptoms are: Weight, pressure, fullness or spasm in the hypochondrial or hypogastric region; griping Vomiting of blood. 373 hnd colic; burning heat in the region of the stomach; anxiety on partaking of food or drink, or on pressure upon the stom- ach; saltish taste in the mouth; loss of appetite and nausea; giddiness; syncope; cold perspiration; sometimes an inter- mittent pulse is perceptible at the pit of the stomach. Causes. — Bursting of some of the vessels of the stomach; sudden suppression of any sanguineous discharge, as piles, menstruation, &c, and the conseqent determination of blood to the stomach; cancer of the stomach; worms; splenitis; congestion; internal injury from swallowing sharp substances; poisons; contusions; emetics; putrid dissolution of the blood. Treatment allopathic, — The bleeding should not be sup- pressed suddenly by astringents. Give mucilaginous bevera- ges, gum Arabic with tartaric acid; make fomentations of vinegar on the epigastric region; give tepid oily injections; foot-baths, mustard plasters on the calves of the legs, warm poultices on the abdomen; small pieces of ice taken internally, and ice applied externally; in more advanced stages a warm- bath; small doses of acetate of lead combined with a little opi- um, in some cases alum, kino, oil of turpentine, kreosote; lime- water to allay the irritability of the stomach. In suppressed hemorrhoidal or menstrual flux, apply leeches to the anus or vagina; in symptoms of an inflammatory state make a vene- section in the foot; in a spasmodic state ipecacuanha, one-eighth of a grain every quarter of an hour; in violent spasm opium and musk. If the vomiting of blood should not abate after the em- ployment of these means, alum-whey is the best remedy. Solid food should be avoided for several days. Homoeopathic treatment. — The treatment and removal of the causes of vomiting of blood should be attended to first; strict diet should be observed; no solid food must be partaken of; all drinks should be cold; if any nourishment is needed, preparations of milk and broth may be allowed; absolute rest of body and mind is essentially requisite. During the hemorrhage the application of dry cupping-glasses to the 374 DISEASES OF THE ABDOMINAL VISCERA, abdomen and under the ribs, or of a cloth wrung out of cold water, to the lower region of the stomach will prove of benefit Among the remedies one of the following will be found indicated: Aconite, Arnica, Arsenic, Belladonna, Ipecac Nux v., Pulsatilla and Sulphur. Hydropathic treatment. — Sips of cold water, or even bits of ice, may be occasionally swallowed (some Hpdropathists think this injudicious), while the coldest compresses are ap- plied over the stomach and abdomen. Cold hip-baths are also recommended. Eclectic treatment. — In the uncomplicated condition of this species of hemorrhage, Geranium, added to the compound powder of Ipecac and Opium, may be given with advantage, and sinapisms over the epigastric region will often afford rapid relief. In cases attended with constipation enema must be used. Small doses of acetate of Morphine (£ of a grain), and an infusion of peach-leaves and raspberry-leaves may be given. HiEMORRHOIDES — PILES. Small, fleshy tubercles of a brownish, or pale red color, either situated within the anus, or descending from the rec- tum. They frequently appear and disappear very rapidly, and often contain a cavity filled with blood. The swellings gradually enlarge into caruncular excrescenses of various shapes and forms, from pea-sized to fig-sized, and are fre- quently so painful as to prevent either sitting or walking. At the same time patients suffer from pain in the back and abdomen, and from itching, pricking, tickling, burning at the rectum; constipation and not unfrequently derangement of the urinary organs. Hard, florid swellings without discharge and intolerably sore to the touch are called blind piles. When the hemorr- hoidal vessels, which form or support the growing tumors are so distended as to burst and bleed freely, it is denominated bleeding piles. When white mucus is discharged, it is called white piles; and PILES. 375 when warty excrescenses spread about the perinasum, or within the verge of the anus, it is called caruncular piles. Causes.—The proximate cause is congestion of blood in the abdomen, plenitude of blood in the portal system, nervoua congestion. The remote causes are: debilitation of the abdominal organs by frequent purging (especially by aloes); abuse of warm drinks (tea and coffee); immoderate sexual intercourse; heat- ing food and drink (spices, wine and spirituous liquors) ; much concentrated food; habitual costiveness; obstruction of the liver; pregnancy; sedentary life; continued sitting posture; suppression of long continued discharges; severe exertion on horseback; constitutional taint. Prophylactic treatment — Strong or heating driuks, such as wines, coffee, tea, and stimulating, concentrated, or highly Beasoned food, should be strictly avoided. Unbolted and unconcentrated forms of farinaceous food are the most recom- mendable. The use of soft chairs or soft cushions, and tho sitting posture should be avoided; and much active exercise taken. Pickled, unripe capsicum pepper, as an article of diet with the dinner, is highly recommended. Allopathic treatment.—After a careful removal of all causes which tend to create Hemorrhoids, we must remove the hemorrhoidal disposition, which end can be attained by travel- ing, or an active country life continued for six months. The bowels should be kept open by mild resolvents, especially cream of tartar and sulphur (take of cream of tartar one ounce, flowers of sulphur half an ounce, mix, take a tea-spoonful once or twice a day to produce one or two loose stools). Senna and Sulphur, Castor Oil, and the laxative mineral waters, and the Cheltenham salt, may be advantageously given. Aloes should be avoided. A tea made of millefolium, and one cup drank morning and evening for years is an excellent remedy in ohronic piles. One of the most efficacious means of cure is the injection daily, after the bowels have been evacuated, of half a pint or more of cold water into the rectum. Spong- 376 DISEASES OF THE ABDOMINAL VISCERA. ing the anus with cold water every morning and evening will also be found useful. Should the tumors be inflamed and painful, rest in a horizontal posture, with lotions of cold water, er lead water; and, when the pain is very severe, liniments, ointments, or cataplasms, containing opium, hyoscyamus, bella- donna, or stramonium, or decoction of poppy heads, or hops, should be employed. In an extreme case, fomentations with sugar of lead half a drachm, oil of hyoscyamus half an ounce, may be made, but should not be long continued. Some prac- titioners recommend apple-pulp steeped in red wine. If the internal piles have protruded, and do not return of themselves, and cannot be returned by the patient, the practi- tioner must endeavor to reduce them by placing the patient on his hands and knees, anointing the parts well with unctuous matter, then making gentle and uniform pressure so as to force out the blood, and, lastly, introducing by his hands the dimin- ished tumor within the sphincter. If unsuccessful, apply cold water to the part in order to produce contraction, or let out the blood by means of needles, or a lancet, and then restore the piles. When the hemorrhage is so copious as to endanger life, the patient should lie on his back, cold water should be injected into the rectum, and applied externally, and nitre with antim onials, or the acetate of lead given by the mouth. If these measures fail, a solution of alum or a strong vegetable astrin- gent infusion, or the two combined, may be used in the form of enema. Extirpation of the tumors by the knife or ligature is only admissible, when the disease is purely local. Should the suppression of piles have occasioned any serious injury to the health, endeavors should be made to restore the hemorrhoidal flux by aloetic purgatives, irritating injections, foot-baths, and the use of the warm hip-bath. Homoeopathic remedies. — Aconite is a useful remedy in allaying pain when considerable inflammation exist. Nux vomica: an excellent remedy in individuals, who lead a PILES. 377 sedentary life, or who indulge in the use of coffee, or stimu- lating liquids. Hemorrhoids attended with shooting, itching, or burning pain; colic; shooting, or jerking pains in the loins, rendering it difficult to rise or walk in an erect position; con- stipation aud difficult urination. Sulphur, may follow the administration of Nux vomica in chronic cases. Arsenicum: Hemorrhoids accompanied by burning and shooting pains. Platina: Scanty and difficult evacuation, succeeded by gene- ral shuddering and a feeling of weakness in the abdomen. Antimonium crudum: Discbarge of mucus and blood at every Btool, followed by severe colic, and burning at the anus, par- ticularly at night. In some cases Pulsatilla, Lycopodium, Belladonna, Ignatia, and Coloeynth may be found useful. When the discharge of blood from piles amounts to hemorr- hage, Aconite, Ipecac, and Belladonna should be employed. Hemorrhoids with mucous discharges, require: Mercurius, Helleborus, Colchicum and Spigelia. Hydropathic treatment.—When the tumors are inflamed and painful, frequent sitz-baths of a low temperature 60° to 50°, with often repeated injections of a small quantity of cold water, should be employed, until relief is obtained; after which four to six ounces of very cold water should be throwrn into the rectum every morning previous to the expected action of the bowels. When the bowel protrudes, the patient should keep the horizontal position, and apply the coldest wet cloths to the fundament. In frequent dysenteric discharges, the wet sheet pack, two or three times a day, and the wet abdo- minal bandage frequently changed must be employed. Hard, warty excrescenses around the anus must be removed by the ligature or knife, or clipped off with a pair of scissors. Eclectic treatment—When there is much inflammation of the tumors and the anus, the bowels should be evacuated, by giving small doses of podophyllin (one-eighth to one-quarter of 16q 373 DISEASES OF THE ABDOMINAL \ 1SCERA. a grain) every two hours until four doses are taken, followed up with from half a drachin to one drachin of aromatic castor oil. If the inflammation and pain are severe the local applica- tion of tobacco, moistened in warm water, will have a good effect. A salve made of the extracts of Stramonium and tobacco, each one drachm, and tannin, five grains, and applied three or four times a day, should be constantly used. Cold wate* is generally a good palliative. The patient should take regularly half a grain of podophyllin every night. In cases of long standing, and when the tumors wear a malignant appearance, a ligature should be applied round the tumor, passing it through a cork, as recommended in the case of fistula in ano, and tightening it every day, till the strangulent tumors slough off. The patient, meantime, should constantly keep On a slippery elm poultice. After the tumors have come away, the salve recommended above may be applied. In those cases which present a soft, elastic, and dark colored swelling, in which there is severe throbbing and painful un- easiness, prompt relief may be obtained by puncturing the tu- mor. This measure should be followed by warm fomentations. In many cases a warm starch injection will afford prompt relief, especially if followed by a soft poultice of roasted onions, applied as warm as can be borne with comfort, imme- diately upon the swelling. For bleeding piles, such of the foregoing treatment as the circumstances of the case may indicate, should be employed, and in addition thereto, a strong decoction of oak bark should be used as an injection and the bowel freely bathed with it two or three times a day. If the case is attended with much pain, the tumors and adjacent parts should be bathed freely and frequently, with a liniment composed of linseed oil four parts, and oil of origanum one part. Heart-burn.—(See Pyrosis.) HELMINTHIASIS--WORMS. The thread—anal—or maw-worm (Ascaris vermicularis), and the long, round worm (lumbricus). WORMS. 379 When the alimentary tube becomes irritated by worms, the principal symptoms which are developed thereby, are the fol- lowing; pallor and sickly appearance of the countenance, and sometimes flushing; livid circles round the eyes, dilated pupils; headache; disturbed dreams; sleep broken off by fright; screaming fits; convulsions; feverishness; thirst; bad taste in the mouth, offensive breath; difficult breathing; itching of the nostrils; boring of the nose; tickling cough; pains in the stomach; nausea; voracious appetite; emaciation; tenesmus; itching at the anus toward night; irritability of temper ; grind- in«- of teeth; chorea; epilepsy; inflammation of the bowels. The alimentary canal may be infested with worms without any indication of their existence, save their occasional evacua- tion at stool. Causes. — Weakness of digestion; accumulation of mucus; dritikino- of stagnant or marshy waters; eating decayed or infected fruits and vegetables, much pastry, warm bread, &c; ill-ventilated, damp habitations; want of cleanliness; inhaling of animalculas, and their eggs floating in the atmosphere; &c Allopathic treatment.—The principal remedy to appease the worms, and to soothe the spasms and pains created by them, is sweet milk, used as a beverage, and as injections, and fomen- tations on the abdomen. Next to it of importance, are oily emulsions, mercurial water (take of quicksilver, one pound, water four pints, boil in an earthen vessel, stirring often with a wooden spatula for a few hours) as a drink and in clysters; flores Zinci; and extract of Hyoscyamus. In obstinate cases, emetics, asa foetida and Valeriana. For the expulsion of worms, which should be done during the decline of the moon,—the worms being weaker and less capable of sucking at that time—we must employ the follow- ing remedies: For ascarides (thread — or mawr-worms), injec- tions of a decoction of tobacco, oil, culinary salt, mercurial water; and internally pills of quassia and tansy (take of ex- tract of tansy, and quassia each two drs., oil of tansy, ten l'-"ps, mix, make pills of two grains, take five, morning and 380 DISEASES OF THE ABDOMINAL VISCERA. evening) for several weeks. We find also recommended the following substances for enemata:) decoction of rue or worm- wood, vinegar, chloride of soda, infusion of quassia, cold wa- ter, &c For lumbrici (long round worms) mix one and a half ounce of santonicum seed, or chenopodium (worm seed) with honey, and give a tea-spoonful every morning, fasting, for a fort- night during the decline of the moon, to be followed after- ward by a purgative of jalap and calomel. The pulp of car- rots mixed with sugar, and taken, fasting, is an excellent remedy; also the following: take of pink root, two drachms, let it be boiled in one pint of water and strained, a cup full three times a day; or, take of wormseed three drachms, boil in eight ounces of water down to four, let it be strained, and give a tea-spoonful every two hours. Externally, employ embrocations of oil of tansy or petro- leum, on the abdomen, and cataplasms of tansy and absinth. A little culinary salt occasionally, and a good deal of exercise should be taken. Homoeopathic treatment. — Against Ascarides (maw-worms) the most appropriate remedies are: Aconitum, Mercury, Nux v., Cina, Ferrum and Sulphur. Against lumbrici (long round worms): Cina, Nux v., Belladonna, Mercurius, Spigelia, &c. In chronic cases we should have recourse to Sulphur, Calca- rea and Silicea, each remedy to be given for a fortnight, one or two doses every two or three days, which treatment will restore the mucous membrane to a healthy state. An interval of from six to ten days must be allowed to elapse between the different remedies. When excessive irritation is present, we may give a drop of the tincture of Urtica urens, on a piece of loaf-sugar every night and morning, for several successive days. We may also administer an enema of a desert-spoonful of salt to a pint of water, of which a tea-cupful may be in- jected. In diarrhoea a mixture of vinegar and water may be used. Cina: Colic; frequent boring at the nose, fretfulness,fever- WORMS. 381 ishncss; restlessness; desire for things which are rejected when offered; paleness of face, with livid circles around the eyes; craving for food; heat and hardness in the abdomen with discharge of worms; constipation or diarrhoea; starting and talking during sleep; heaviness of the limbs; changing of color of the face; tongue coated; vomiting; itching in the anus; involuntary micturition; turbid urine. Spigelia: Colic, voracity, diarrhoea, nausea in the morning, accompanied by a sensation as if something were ascending from the stomach into the throat; palpitation and anxiety. Mercurius: Diarrhoea; distension of the abdomen; hardness in the umbilical region with increased secretion of saliva. Diet: Fruit and vegetables must be prohibited, as also milk, pastry and sweet meats. The food ought to consist chiefly of roast or boiled beef, or mutton, and sometimes chicken. Children should not be allowed to eat raw herbs, roots. &c Hydropathic treatment.—The same medication recommended for the restoration of the vigorous action of the digestive sys- tem under dyspepsia is suitable here. To dislodge worms from their slimy beds, we must resort occasionally to copious injections of cold water. The best vermifuge are the crusts of good, sweet, wheat meal bread, and good, ripe apples. Dry, toasted, brown bread and cracked wheat may be used moder- ately by way of variety. Sweet cakes must be forbidden. Eclectic treatment — Pink root is, perhaps, the principal remedy relied upon for the removal of worms. It is usually combined with Senna, or with the compound powder of Jalap, in the proportion of from five to ten grains of the powdered Pinkroot, to the same quantity of the cathartic, which may be given in molasses, or infusion, and repeated two or three times a day, to a child three years old, for several successive days. A very excellent vermifuge is made as follows: Take of castor oil one ounce, oil of wormseed one drachm, oil of anise balf an ounce, tinct. of myrrh half a drachm, spirits of tur- pentine ten grains, croton oil one drop, mix. To a child three years old. a half tea-spoonful may be given every two 'iV&Z DISKVSFS OF THE ABDOMINAL VISCERA. hours, for ten or twelve hours, or until active purgation has been produced. Another vermifuge, which has been used effectually, is: take oil of wrormwood, oil of tansy, each one ounce; spirits of turpentine one and a half ounce, castor oil, two ounces, mix. The dose for a child three or four years old, is a tea- spoonful every hour until it operates. For the removal of the thread-worm, in addition to the above internal remedies, infusions, or decoctions of bitter sub- stances must be injected into the rectum, as of Aloes, Bitter- root, salt and water, soap-suds, &c, or an enema of Spirits of turpentine, one drachm, in one gill of milk. Irritation amounting to dysentery requires an injection of slippery elm and laudanum. To restore the impaired condition of the intestines to one of strength and health, the following preparation is employed: Take Hydrastis canadensis, Columbo, Chamomile flowers, Prickly Ash berries, Sassafras bark, of each two ounces, mix. Upon these articles, coarsely bruised, pour one pint of boiling water, let them stand until cold, then add one pint of Sherry or Port wine, and sweeten with loaf sugar. The dose to a child one year old, is a tea-spoonful three times a day. HEPATITIS--INFLAMMATION OF THE LIVER. When inflammation occurs on the outer surface of the liver, there is pain in the right side under the short ribs, in- creased by a full inspiration, by pressure, and by lying on the right side; sensation of numbness or tingling in the arm of the same side; a short, dry cough, and the symptoms of inflammatory fever; bowels constipated, and of an unnatural color. When the seat of the inflammation is on the inner side of the liver, the pain is much less, but the whole biliary system is more affected. The eyes and countenance become yellow, the urine is orange-colored, and the evacuation of a whitish or gray color. We also find bitter taste in the mouth, accompa- nied with vomiting. The patient can only lie on the right side. INFLAMMATION OF THE LIVER. 383 In both forms the right hypochondrium is bloated, hot, and painful on pressure. Inflammation of the liver, if not properly treated, assumes the chronic form, or ends in suppuration (hepatic consump- tion) externally or internally; in indurations; in gangrene, or in the formation of adhesions. Causes. — Gallstones; violent anger in persons using fer- mented liquors; strong emetics; concussions of the brain; external injuries; excessive heat; meat-diet and much grease in hot weather. Allopathic treatment — General abstractions of blood in small quantities; leeches to the region of the liver and rec- tum; acid laxatives, as tamarinds, whey prepared with cremor tartaris, injections. If these remedies do not suffice, from five to fifteen grains of calomel should be given, and followed in a short time by the infusion of senna with salts. One to three grains of calomel may afterward be given at bed-time, and followed in the morning by a saline aperient. It will often be found advantageous, when the first violence of the inflammatory excitement has been subdued, to combine with the calomel at night a grain of opium. If the skin be hot and dry, and the stomach not irritable, tartar emetic in solu- tion may be given in small doses, at short intervals; alone, or combined with nitre. In the early stages fomentations or poultices may be ap- plied to the side, and later large blisters. A critical sweat should be supported by Dover's powder. The external use of mercurial ointment is recommended, when the stomach and bowels do not bear the mercurial treat- ment well. Homoeopathic remedies. — Aconite, in the commencement of the attack, when there is violent inflammatory fever. Belladonna: Oppressive pain in the region of the liver, producing a sensation of tension, difficult respiration; con- gestion of blood to the head and giddiness: great thirst; sleep- lessness. 3S4 DISEASES OF THL' ABDOMINAL VISCERA. Bryonia: Shooting pains with tension and burning, increased by touch and movement, violent oppression of the chest; anxious respiration; bitter taste; tongue coated yellow, con- stipation. Mercurius.: Fullness and swelling in the region of the liver with pricking; oppressive pains; bitter taste in the mouth; want of appetite, thirst; sweating, without relief; yellow color of the skin and eyes; also in advanced stages of the disease, when there is induration of the liver, or formation of matter. Chamomilla: In slight cases. Nix vomica: Shooting, pulsative pains, accompanied with excessive tenderness at the region of the liver to the touch; pressure and fullness under the ribs, with shortness of breath and constipation; also in enlargement, induration, and chronic inflammation of the liver. In some cases, Lachesis, Arsenic, Sulphur, Phosphor and Pulsatilla may be consulted. Hydropathic treatment. — In general febrile symptoms the wet-sheet must be employed, and repeated according to the degree of superficial heat. Afterward apply the wet girdle around the upper part of the abdomen, cover with a dry cloth, and renew five or six times a day. The bowels should be thoroughly cleansed with warm w7ater enemata. The warm sitz and foot-bath may also prove serviceable. Eclectic treatment — Commence the treatment by the use of the spirit vapor-bath, and administer during the period of perspiration a cathartic, for which the compound powder of Jalap may be used at first, and subsequently followed by laxative doses of Podophyllin and Leptandrin. After the operation of the cathartic a large mustard plaster should be placed over the region of the liver, to be removed only when its full rubefacient effect has been obtained, and then the parts are to be covered by fomentations of bitter herbs as hot as can be borne, which should be changed often. Emetics composed of lobelia and blood root are also recommended. LIVER COMPLAINT. 385 For the purpose of allaying pain, the compound powder of Ipecac, and Opium may be given in four or five grain doses every four hours; and toward the termination of the disease should there be any prostration of strength, or evidences of suppuration, Sulphate of Quinia should be combined with it in quantities of half a grain or one grain to each dose. HEPATITIS CHRONICA--LIVER COMPLAINT. This disease is distinguished from acnte hepatitis by the absence of general fever. In addition to the symptoms which attend the acute variety, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh and loses strength; pain in the right shoulder, or between the shoulder-blades; darting fugitive pains through the chest; occasionally there is a dry, hacking couo-h with expectoration of a tenacious mucus, sometimes like coal dust, especially in the morning ; in some cases perceptible enlarge- ment of the liver, continuous or returning periodically, with a number of dyspeptic symptoms; high colored urine; yellow tinge of the skin and eyes; costiveness; clay-colored stools; the patient is torpid, inactive, tired of life; pulse slow and full. Allopathic treatment — A moderate mercurial course, sus- tained for a considerable time. The blue pill is the most suitable in this case. It should be given in small doses, re- peated several times a day, and combined with Bhubarb or Aloes, or both, if the bowels are constipated; should they be too loose, with opium or small doses of Dover's powder; and fhould the digestion be feeble, with extract of gentian or quassia, or small doses of sulphate of quinia. Sometimes it is better, especially when the stomach and bowels are very irritable, to depend upon mercurial frictions; or a mercurial plaster should be worn constantly on the side. Muriate of ammonia, nitro-muriatic acid, taraxicum, &c, have been employed with more or less benefit. Diet should be nutritious and easily digestible; an alkaline- bath should be taken daily; and a change of climate (some 38G DISEASES OF THE ABDOMINAL VISCLKA. mountainous region) recommended. Some practitioners ad- vise the constant wearing of a soap or galbanum-plaster. Homoeopathic remedies.---Nnx vomica. Bryonia, Arsenicum, Sulphur, Carduus marianus. Hydropathic treatment. — Besides the treatment recom- mended under dyspepsy. warm water emeties are serviceable to deterge the biliary ducts, whenever nausea, bitterness in the mouth, and an unusual sense of fullness in the right side indicate obstruction; and if the bowels are costive, tepid injections should be freely employed. Eclectic treatment. — Application of an irritating plaster over the region of the liver; internally the following com- pound : Take compound syrup of Stillingia four ounces, iodide of Potassium one drachm, tincture of Aconite two drachms; mix; a tea-spoonful three times a day in a wine-glass of water. to be continued for some time. The bowels should be acted upon once or twice daily by a mixture composed of one part of Podophyllin, and four of Leptandrin, to be given three times a day to cause the desired effect. The patient should take moderate exercise and avoid alco- holic stimulants, tea, coffee, and fats. HERN [A--RUPTURE, Protrusion of some portion of the small intestines, or some part of the arch of the colon (enterocele); or of the omen- tum (epiplocele); or of both (entero-epiplocele), from the cavity of the abdomen, in the form of a tumor, found to be suspended in a peculiar sac, which is a fold of the peritoneum carried on before the bowel and still enclosing it. It appears most frequently at, or near the navel (umbilical hernia), and at the groin (inguinal hernia). Of the latter there are several varieties to be distinguished: 1, incomplete inguinal hernia, when the intestine is arrested in the canal, after having passed through the internal abdominal ring; 2, complete inguinal hernia, when it passes through the canal and emerges at the external abdominal ring; scrotal hernia, when the intestine passes nn descending into the scrotum; a pro- RUPTURE. trusion through the same point in women, appearing in the labia pudendi, is called vulvar, pudendal, or labial hernia. Hernia escaping through the crural canal is called femoral; through the opening, which gives passage to the infra-pubia vessels, infra-pubian; through the sacro-ischiatic notch, ischiatic hernia; &c. Hernia is termed reducible, when it can at any time be readily returned into the abdomen, and when in an unreduced state it is productive of no pain or hindrance to the performance of the intestinal functions; irreducible, or incarcerated when it cannot be replaced, in consequence of its bulk, or from the contraction of adhesions; and strangulated, when the protruding parts are not incapable of being returned, but are moreover affected with constric- tion, pain and inflammation, attended with nausea, retching or vomiting, tension of the abdomen, obstruction of the bow- els, quick, hard pulse and more or less fever. If the return of the intestine be not effected under such a state of matters, the vomiting is exchanged for hiccough, with bilious eructa- tions; the patient suddenly becomes relieved from pain, the pulse is low, feeble and intermitting, the eyes dim and glassy, the skin cold and moist, the hernial swelling disappears, and the integuments over the part often change to a livid hue; gangrene is established, and death soon terminates the scene. The nature of the contents of the hernial tumor is gene- rally known by the following distinctions: If the hernial tumor contains omentum only, it is insensible and inelastic, of an uneven and flabby texture, feeling to the touch like dough; receives no impulse from coughing; is more compres- sible, and recedes very gradually; its reduction being unat- tended by any gurgling noise. If the case be an enterocele (formed of intestine), the swelling is smooth, elastic, rendered tense by coughing, or by holding the breath; is in general very easily returnable, and usually attended with a gurgling noise, when ascending. An entero-epiplocele has the characteristic marks of both, but less distinct than either of the preceding cases. One '388 DISEASES OF THE ABDOMINAL VISCERA. part is elastic and sensitive, while another has the peculiar doughy insensibility. Either of the cases is liable to become strangulated, i. c. to have the orifice through which it passed contracted upon it, so as to prevent its return and obstruct its circulation. (See Illustrations.) Causes. — Unusual largeness of the natural openings of the abdomen; general debility; costiveness and neglect to goto stool regularly; straining at stool; blows, falls, violent bodily exertions; wounds; pregnancy; hard riding on horse-back; severe coughing; etc. When it results from extreme corpo- real exertion, it appears very suddenly, and as the opening, through which the bowel protrudes is generally small in such instances, there is much danger of strangulation. When rupture ensues in consequence of predisposition, its formation is very gradual, and in most cases reducible. Treatment. — In all recent cases, if inflammation has not yet taken place, we should endeavor to replace the protruded parts within their natural cavity, and maintain them there by a truss, or other suitable contrivance. To perform this opera- tion with facility, place the patient in a horizontal posture on the sound side, with the hips elevated, the chest inclined forward, the thigh of the affected side fixed upon the abdo- men, and drawn toward the other—all of which is intended to relax the muscles and integuments at and around the pro- trusion. The sac is then to be gently grasped, and moderately elevated and compressed with one hand, while the forefinger of the other hand presses as much of the tumor as possible up to and within the point of protrusion; the returned por- tion is to be retained while the middle finger pushes up another portion, when the forefinger may be again employed for still another portion; the middle finger holding the part it has brought up, or the ring-finger may be used, while the others are both occupied in holding the advantage gained. In this way the whole tumor is to be removed. In the external in- guinal hernia the pressure must be directed upward and out- ward along the course of the spermatic cord; in femoral HERNIA, ("RUPTURE.) HERNIA, (RUPTURE.) SMALL DIRECTOR, USED IN THE OPERATION FOR HERNIA. PROBE-POINTED BISTOURY, USED IN THE OPERATION FOR HERNIA. • \ RUPTLRE. 389 hernia it is to be directed first downward and then backward; in umbilical and ventral hernia the pressure is to be made directly backward. Violence must never be used, nor the parts handled so roughly as to occasion much pain. In some cases active inflammation, extreme distention of the protruded intestine, great pain and tenderness and severe constriction around the neck of the sac, may interfere with the operation of taxis, or defeat its successful result; we must then in the first named complication have recourse to cold water, or ice; and when the part is irritable and tender, the full warm-bath or local fomentations, or both, must be em- ployed, after which the taxis is to be tried again. In extreme cases, when the strangulation with inflammation has existed for twelve or fifteen hours, and reduction seems impossible, we must have recourse to the operation for strangulated her- nia; although with this extreme measure the chances are three to one against the patient. Another recource in bad cases is the dry cupping. A large cup, or any convenient vessel, in which a piece of burning cotton is placed to exhaust the air, may be applied to the abdomen, covering the umbilical region; the suction thus established will pull upon the protruded intestine, while we may be pushing from without. Holding the patient's heels up, and head down, and jouncing him in that condition, has succeeded in reducing a rupture. Allopathists recommend in such cases a purge, and after- ward a clyster, then antispasmodics by the mouth and per annum; opium being administered in either way, and to- bacco in the form of clysters and smoke. A relaxing effect may be further produced by the warm-bath. Frequently cold is put upon the tumor by means of ether or ice, and occasion- ally warmth is applied. If the patient is young and robust, and the strangulation very recent, leeches are placed upon the swelling, and blood is abstracted by the lancet. The taxis often succeeds after one or more of such measures have been adopted. 390 DISEASES OF THE ABDOMINAL VISCERA. Homoeopaihists recommend highly the internal use of Aco- nite and Nux vomica, as being remedies vhich exercise a specific influence upon strangulated hernia, relieving strangu- lation, pain and tenderness, and thus rendering reduction by taxis easy. Aconite should be administered, a dose every half an hour, or one hour, when there is inflammation of the affected parts, with excessive sensibility to the touch, bitter bilious vomit- ing, &c Nux vomica is to be preferred when the tumor is not so painful, the vomiting less severe, but the respiration oppressed and laborious, and the strangulation has arisen from errors in diet, from exposure to cold, or from a violent fit of pas- sion. If no change results in about two hours after the second dose has been given, Opium should be prescribed and re- peated every quarter of an hour until four doses are taken, after which Plumbum may be given, if no change for the better becomes perceptible. In some cases Acidum sulphuricum and Lycopodium havo been found of benefit. Lachesis, Arsenicum and Bhus are recommended" when symptoms of gangrene appear. Eclectic relaxing measures consist in an emetic of blood- root, lobelia, skunk cabbage root and cider vinegar; warm enemas of the same articles, combined with the infusion of senna; constant fomentations of the herbs of lobelia and stramonium, and the root of Elecampane over the tumor. Directions how to operate in Hernia,—The instruments neces- sary are a scalpel, a director, and a curved probe-pointed bis- toury. Place the patient on his back with the knees and shoul- ders slightly elevated, then make an incision through the skin, three or four inches in length, along the course of the tumor, cutting through the successive layers, or coverings, by picking up a small bit at a time with the forceps and cutting through it under th^ir points, until an opening into the sac, which can be Btri'LitE. ;;:.»j distinguished by its blueish appearance, is made. The sac- is then opened in the same manner, and the small director insert- ed and an opening made large enough to admit a finger. The forefinger of the left hand is next introduced and passed up to the neck of the sac to find the stricture, which may be at the ex- ternal or internal ring, or at both places. The stricture should be sufficiently dilated to permit the finger to enter the abdomen, which may be done by the probe pointed bistoury; the blade is passed up flatwise, along the finger, pushed on through the stricture. Its edge is then turned upward, cutting no more than is necessary to admit the finger. The cut must always be made directly upward, parallel to the linea alba, to avoid the epigastric artery. After the stricture is thus relieved, the parts must be examined, and, if firm adhesions have taken place, or fatty deposits accumulated largely, no attempt at reduction must be made, but the wound allowed to heal. If, unfortunately, the intestine is wounded during the operation, there is no better course of procedure than leaving the aperture at the mouth of the sac, and retaining it there by means of a stitch through the bowel and the latter part; care being taken to keep the orifice in such a position that the contents of the gut will have free egress through the wound without passing into the peritoneal cavity of the abdo- men. (See Illustrations.) In femoral or crural hernia, the sac is usually very small, and embraces the bowel very tightly, hence it must be opened with caution. When mortification has taken place, the only chance is by an artificial anus. Radical cure of hernia has been noticed to take place, when by the pressure of a truss adhesive inflammation had been excited in the parieties of the canal between the abdominal rings, or in the femoral sheath, the passage becoming thus closed against all future danger. Acting on this hint, some surgeons have applied as strong pressure as the paiient could bear, by means of a truss with a large and hard pad, so applied 392 DISEASES OF THE ABDOMINAL VISCERA. as to compress the whole canal or sheath, through which the viscera had passed. Others have succeeded by adding to the mechanical-pressure treatment, that of vital irritation, by applying upon the previous shaved part an irritating plaster, (compounded of blood root, mandrake, wake-robbin, poke root, tar, and rosin), over which the truss is worn, the pad of which is nearly as large as the plaster. The truss is removed daily, and the plaster repeated, during which the patient must keep perfectly still. Should the pain and irritation become intoler- able, the plaster is to be omitted for a few days, a slippery elm poultice taking its place. After a purulent discharge from the surface covered by the plaster has been excited, suppura- tion should be kept up from four to six weeks. UMBILICAL AND VENTRAL HERNIA. Umbilical hernia generally occurs in infants, and sometimes in parturient females. Treatment.—The protruded portion of the bowel can gene- rally be reduced very easily by the hand, after placing the patient on the back, with the shoulders moderately elevated, and the thighs flexed upon the abdomen. To effect a radical cure, take a circular piece of the thick, spongy portion of sole-leather and of the proper size to cover the opening and extend about two inches all around it. Excavate the fleshy side of the leather, so as to make it regularly concave, the center of the depression being about half an inch below the plane of the circumference. Place the patient in the position for reduction, and bring the parieties of the hole in the mus- cles in contact, so as completely to close the orifice by pres- sing from the sides, while the muscles are in this relaxed con- dition. The edges being thus kept in contact, apply, directly over the point of protrusion, a layer of raw cotton or lint, wet in a strong decoction of white oak-bark. This applica- tion should be large and thick enough to fill the excavated surface in the leather, without causing any pressure. Apply your leather pad over it and secure it by a bandage passed round the body, sufficiently tight to compress the muscles, ■STRICTURE OF THE RECTUS! 393 and keep in contact the parieties of the aperture. It is best to fasten the pad to the bandage before it is applied. This should be kept on six or eight -days without being removed, unless it produces too much irritation. It should be wet once or twice a day with the oak decoction, by applying it upon the surface and allowing it to soak through the pad and cotton. One or two weeks will often suffice to produce adhe- sion in an infant, while an adult may require the treatment for one or two months. While removing the dressings the patient must keep perfectly quiet, and the walls of the abdo- men firmly held by an assistant, so that no" motion be allowed to interupt the adhesive process. IIYPERTROPHIA SPHINCTERIS AN I — STRICTURE OE THE RECTUM. The patient suffers from tenesmus, obstinate constipation with discharge of watery excrements, aud experiences after every evacuation violent spasmodic contractions in the anus. On examination of the parts the introduced finger meets obstructions, the sphincters closing spasmodically around the same. The sitting posture becomes very difficult. This painful and tedious disease is generally accompanied with derangements of the urinary organs, and congestion of blood to the head. Causes.—Thickening of the rectum; formation of a small callous ring around the bowel; sedentary life; neglecting the calls of nature; hemorrhoidal constitution; large sphincters, &c. Obstructions sometimes may occur in consequence of an enlarged prostrate gland. Treatment—To relieve the inflammatory irritation we must apply leeches to the anus, use tepid sitz-baths, and make em- brocations ef Marsh-mallow ointment, or salve of the white of an egg, or extract of Hyoscyamus and Belladonna. The patient should remain in a horizontal posture, and not sit aiuch; observe a light diet, as fruits, soups, broths, &c In case this treatment proves ineffectual, the passage must be enlarged by a bougie. The bougie should consist of * 394 DISEASES OF THE ABDOMINAL VISCERA. piece of ordinary cane-wood, covered with silk, of a conical shape, about three inches in length; the smaller end just large enough to pass the stricture, and the other end about two inches in diameter. Lubricate this dilator with olive oil, then insert it past the strait, and fasten it by a "T" bandage, made of gum elastic, requiring the patient to keep it on as long as he can bear it. In some cases it is necessary to apply salve of opium to the bougie. The bowels must be kept regular throughout the treatment. In some instances the thickened parts are hard and callous, and will not yield to mechanical pressure, we must then have recourse to sesqui-carbonate of potash. A strong solution should be used as a lotion once or twice a day; and the lower part of the rectum well loaded with tents, in which the dry powder is involved. The destruction of callosity by the sup- purative process must be kept up by repetitions of the caustics, until it is entirely destroyed. At every dressing the rectum should be thoroughly washed out with warm water injections. Some surgeons recommend superficial incision in the sphinc- ter immediately behind the os sacrum. An incision through the whole of it would cause incontinentia alvi. Homoeopathic treatment. — In ordinary cases of spasmodic stricture, the following remedies will be found at once gentle and efficacious: Nux v., Opium, Lachesis, Plumbum c, Sepia, Natrum m., Staphysagria, Calcarea, Coloeynth, &c. In advanced cases of stricture with ulceration of the mucous membrane, and the formation of abscesses, a cure may be attainable through the instrumentality of Silicea, Phosphorus, Sulphur, Calcarea, Lycopodium, Mercurius, or Hepar. The introduction of a portion of a mould candle, for the purpose of dilating the anus, is recommended; likewise that of an elastic gum catheter through the stricture, for the pur- pose of throwing up an injection of tepid soap-water, and then tepid water with a couple of table-spoonfuls of sweet oil, in order to empty the bowel of its contents. Hydrops ascites.—(See Ascites.) JALNDICE. 395 Hunger voracious. — (See Voracitas.) Inflammation of the stomach. — (See Gastritis.) Inflammation of the bowels. — See Enteritis.) INTESTINAL CONCRETIONS. Intestinal calculus is composed of earthy and sandy mat- ters, such as are found in the bladder, of various sizes, from a pea to a hen's egg. Causes.—The long continued use of chalk, magnesia, carbo- nate of iron, &c Another kind of intestinal concretion is the scyphalum, con- sisting of indurated mucus, or oily matter, mixed with hard- ened faeces. The discharges are usually in the form of hard, roundish balls, from the size of a pea to that of a walnut. Cause. — Constipation. These affections are generally characterized by pain or uneasiness at a particular point in the abdomen, and occasion- ally a hard, lumpy tumor may be felt on pressure by the finger. Treatment consists in the removal of the morbid accumula- tions by warm water injections, cathartics, and a plain uncon- stipating, farinaceous diet. Invermination. — (See Helminthiasis.) ICTERUS — JAUNDICE. Yellow color, appearing first in the white part of the eyes, then extending over the whole surface of the body; hard whitish faeces; orange colored urine, nausea; deficient appe- tite, flatulency, and sometimes pain and pressure in the region of the liver and stomach ; drowsiness; languor; &c In severe cases the perspiration will color the linen yellow. The first Bign of improvement is re-appearance of color in the stools. Causes. — Existence of bile in the blood and lymph; affec- tions of the liver; sedentary life; indigestion; mental emotions; taking cold; emetics; purgatives; internal obstructions, such as gallstones, or even worms, obstructing the biliary duct. Treatment.—Bestoration of the unhealthy function of the liver, and of the free discharge of bile into the duodenum; 396 DISEASES OF THE ABDOMINAL ViSCKRA light diet, as roast apples, cracked wheat, stewed lettuce, broth, &c; avoiding eggs, butter, meat, milk, and liquors. In ordinary cases an Emetic is to be given, then aloes, or rhubarb, one grain three or four times a day; cream of tartar water, tamarind whey; a dose of calomel followed by castor oil; from half a grain to three grains of calomel, or one or two blue pills, may be given every night, or every other night, and followed in the morning by two drachms or half an ounce of sulphate of magnesia, or bitartrate of potassa, to produce a slight stimulation of the liver, and a gentle action of the bowels. The fresh expressed juice of Chelidonium, a tea-spoonful two or three times a day; electricity applied to the torpid viscus; cider and lemonade; change of air; mineral waters, &c, have been employed with more or less benefit. Worms, gallstones, &c, require mercurial embrocations on the hepatic region. Homoeopathic remedies.—Mercurius vivus and China are two of the principal remedies. Chamomilla and Nux v. are indi- cated for jaundice caused by a fit of passion, sedentary habits, over study. Aconite is necessary if jaundice is accompanied by inflam- mation of the liver. In chronic affections: Lachesis, Hepar, and Sulphur have been found successful. Hydropathic treatment.—-Wet sheet pack; rubbing wet sheet; shallow-baths; clysters and the hunger-cure. Eclectic treatment —A pill of equal parts of podophyllin and the extract of dandelion, every two hours until a cathartic effect is produced. In derangement of the stomach an emetic of lobelia may be necessary. The use of diaphoretics, aided by the vapor-bath will be required to remove the bilious mat- ter from the system. The raw yolk of an egg, taken on an empty stomach has been used with benefit. A decoction of wild cherry bark and sanguinaria, a table- spoonful two or three times a day is recommended. MISERERE. 397 ICTERUS NIGER —BLACK JAUNDICE. In the severest kind of jaundice the color becomes dark brown or blackish, caused by incurable disorganizations of the liver, or irremovable gallstones. It rarely admits of a cure, and generally passes into dropsy. ICTERUS INFANTUM, Jaundice of children arises from the administration of cathartics immediately after birth; exposure to cold; retention of meconium in the intestines and of bile in the liver. Allopathists recommend Bhubarb; Homceopathists, Chamo- milla and Mercurius; Hydropathists the wet sheet pack. ILEUS--ENTOSTENOSIS--MISERERE. A species of colic This disease generally commences with occasional attacks of colic after eating food which is apt to produce constipation. The symptoms accompanying this dis- order are: painful retraction, or drawing in of the navel and spasms of the abdominal muscles; obstinate constipation, first with vomiting of food and drink, then of bile and gastric juices, finally of excrements; the abdomen is hot, painful and distended, and the least pressure is intolerable; pulse is small and contracted. In these cases inflammation is present. Ex- amination of the abdomen in a horizontal posture with the feet drawn up, generally gives us a more or less hard, circum- scribed swelling at the region where the small intestines pass into the colon. The inflammation has passed into gangrene, when the pain suddenly abates, followed by copious fetid stools; the abdomen becomes soft and shrinks, the extremities cold, and the pulse intermittent. In such cases death is unavoidable, though the patient generally feels happy, and thinks himself better. Causes. — An interruption to the passage of the contents of the intestinal canal, which may arise from indurated excre- ments in the colon and rectum; from stones, kernels of fruit, and worms; from volvulus; imperforatio ani, or from incarcera- ted hernia, indurations and tumors; also from inflammation, irri- tation and spasms, and torpor and atony of the intestinal canal. 398 DISEASES OF THE ABDOMINAL VISCERA. Treatment. — Examine first whether the patient has a rup- ture, or inflammation of the bowels, which if present, must be removed in order to cure Ileus. If neither is the case, or Ileus continues after the inflam- mation has been subdued, we must use such means as are likely to remove the obstructing contents, for which purpose linseed oil, one table-spoonful every two hours, has been recom- mended. Should this prove insufficient, we must have recourse to the following compound; take epsom salt, manna and tama- rinds, each one ounce, boil in twelve ounces of water to eight, at the end of the boiling add Senna leaves two drachms; to the strained liquor add extract of hyoscyamus eight grains, poppy-syrup one ounce,—give two table-spoonfuls every hour. If this also has no effect give a table-spoonful of castor oil every hour, and half a drop of croton oil on sugar, or in the form of pills; also aloes and jalap. In order to allay violent vomiting, small doses of champagne wine, and seidlitz powders with tinctura thebaica, should be administered. In a spasmodic state an infusion of tobacco; or better, injections, first of sulphate of magnesia, infusion of senna or castor oil; then of two or three ounces of vinegar with four grains of tartar emetic; the most effectual is half an ounce of an infusion of tobacco. The ascending douche of warm water into the rectum, nar- cotic poultices, sinapisms, warm half baths, dry euppingr em- brocations of croton oil, and cold applications, or ice on the abdomen are of efficacy. "Venesection, and in extreme cases, half a pound of Quick- silver swallowed at once with a spoonful of oil have been recommended. Homoeopathic treatment — When the disease, characterized by vomiting of faecal matter and urine, is caused by spasmodic strangulation, or intussusception of the intestines, the medi- cines which claim a preference are opium, plumbum, thuja; also: cocculus, nux v., sulphur, &c INDIGESTION. 399 If caused by inflammation, or by some internal swelling, give Bryonia, Aconite and Sulphur. Hydropathic treatment. — In this form of colic, the faeces may be so hardened, as to require the handle of a spoon, or some similar contrivance, to remove them from the rectum. For these reasons, as large a quantity of water as the bowrel can well receive should be injected, and the process frequently repeated. The warm stream douohe followed by the cold dash is excellent as a local application. Eclectic treatment.—In obstruction of the bowels dependent on intro-susception, the indication is not so much to procure an operation of the bowels, as to relax the spasm and to relieve the invaginated condition. This indication will be fulfilled by the use of large quantities of anti-spasmodic and cathartic lavements, thrown far up the bowels with the force pump and tube, and by the internal administration of mild, anodyne anti-spasmodics and aperients, together with applications of fomentations to the abdomen, or the use of a large cup over the seat of the obstruction. The injection should be com- posed of a solution of ten grains of the extract of hyoscyamus, an infusion of a drachm of assa fcetida, and a gill of castor oil, in a sufficient quantity of warm water to fill the bowel as full as it will hold. It should be repeated if it comes away. In cases attended with severe suffering the diaphoretic pow- der in ten grain doses should be given every two hours, till the object is attained. INDIGESTION. Gormandizers, who frequently overload the stomach, will find relief by taking the digestive powder, consisting of equal parts of magnesia, sulphate of potassa, rhubarb, and syrup of mint, a tea-spoonful for a dose. Homoeopathists recommend a cup of black coffee, Pulsatilla and Nux v. (See Dyspepsy.) Infarclus. — (See Oastrosis and intestinal concretions.) 400 DISEASES OF THE ABDOMINAL VlM'ERA. INDURATION OF THE STOMACH—SCIRRHUS VENTRICIJLI—CAN- CER OF THE STOMACH. A pressing, gnawing, burning pain in the region of the stomach, increased by external pressure, and after eating. This sensation of gnawing pain gradually extends to the abdo- men ; there is heaviness in the stomach with loss of appetite, hardness in the pit of the stomach, difficulty of swallowing, hiccough, nausea, vomiting;1 constipation, flatulency, offensive fetor of breath; the pains increase, the vomiting becomes more frequent; emaciation takes place, and the disease gene- rally terminates in dropsy. Causes. — Inflammation of the stomach; depressing pas- sions; strong and frequent emetics; large doses of narcotic medicines; gross, high seasoned food; spirituous liquors; scro- fula; hemorrhoidal metastases. Treatment allopathic.—Remove the causes; abstain from all fermented liquors, from indigestible and aoid food and drink. Milk diet is advisable When accompanied with chronic inflammation, leeches should be applied once a week until all pain is relieved. Recourse must also be had to tepid hip- baths, to plasters and salves with Iodine, Mercury, Belladonna, Cicuta and Opium. Internally: mercurial remedies, Hydro- cyanic acid, Aqua laurocerasi, Kali hydrojodicum, and extract of Belladonna. To allay violent vomiting we must give small doses of cham- pagne, and apply Moxa on the epigastrium, or resort to Carbo- nate of potassa in lemon juice. Costiveness requires injection*. Homoeopathic remedies. — Arsenicum, Baryta c, Conium, Lycopodium, Nux v., Phosphor, and Veratrum. Hydropathic treatment. — All measures which conduce to general invigoration of the system, as out-door exercise, one or two general baths daily; the dripping sheet, half bath, wet sheet pack to produce moderate sweating, wet compresses of as cold a temperature as can be borne without increased pain. The "hunger-cure" is recommended as an indispensable auxiliary. INFLAMMATION OF THE SPLEEN. 401 OALLOSITAS INTESTINORUM — INDURATION OR HARDNESS OF THE BOWELS. This disease generally results from ill treated inflammation of the bowels. The swelling may be round or elongated, hard, or circumscribed; but is moveable by pressure made with both hands; the action of the bowels is irregular; there is usually vomiting, and more or less fever and emaciation. In some cases the induration is confined to the coats of the intes- tines, and in others adhesions unite the intestines to the walls of the abdomen, and to each other. Treatment — (See Induration of the Stomach.) Induratio hepatis—Induration of the liver. — (See enlarge- ment of liver.) Jaundice. — (See Icterus.) Lead colic — (See colic and poisons.) LIENITIS — SPLENITIS — INFLAMMATION OF THE SPLEEN. Sharp, pressing, or shooting, pulsating pains in the left side under the ribs, aggravated by external pressure and movement, with a high degree of fever, general debility, pale- ness of the complexion, nausea, loss of appetite, sour taste, obstinate constipation, evacuation of hard, dark faeces, bleed- ing from the left nostril, headache, sometimes cough, vertigo and even syncope, dark, red urine, in some cases enlargement and tumefaction, and in very severe cases vomiting of blood. In chronic inflammation of the spleen the patients have a peculiar, yellowish, greenish complexion, are low-spirited, hypochondriac, siek of life, and inclined to commit suicide. The extremities and skin are cold. The local affections are the same as in the acute form only in a milder degree. Causes. — Marsh-miasm; want of exercise; or proper nutri- ment; long continued mental disquietude; &c Treatment allopathic — Acute splenitis requires the same treatment as hepatitis, as venesection, leeches to the painful parts, narcotic fomentations, purgatives and proper diet. The chronic form requires leeches, and internally cremor tartari, kalium bromatum, iodine and salt water baths, much 17r 402 DISEASES OF TUC ABDOMINAL VISCERA. exercise in the open air. Sulphate of quinia is highly useful. In all cases the food should be of easy digestion. (See Ihs- pepsia.) Homoeopathic remedies principally indicated, are China and Arsenicum. In cases accompanied with much fever, Aconite should be administered first. When the disease has beeu caused by abuse of Quinia, benefit will often be derived from the employment of Arsenic, Carbo v., Pulsatilla and Veratrum, Chronic enlargement and induration of the spleen (ague- cakes) require: Sulphur, Calcarea c, Baryta c, Lycopodium, Carbo v., Plumbum, Ferrum, &c Hydropathic treatment, — Apply the wet girdle around the upper part of the abdomen, over the seat of the principal pain; keep the bowels open with warm water enemata, and subdue the general fever by the wet sheet. In chronic enlargement of the spleen (ague-cake) the douche should be frequently applied to the spine and left hypoehondrium, with as much force as the patient can bear; and in all other respects the same treatment pursued as recom- mended for enlarged liver. Eclectic treatment. — Acute and chronic splenitis are to be treated in all respects the same as acute and chronic hepatitis. LIENTERIA--LIENTERY. Evacuations of the aliments in an undigested state, generally accompanied with insatiable hunger, sometimes with vomiting, prostration, emaciation, pale countenance, lingering fever. Causes.—Morbid irritability of the stomach; gastric impuri- ties ; organic disorder of the stomach; gluttony; sour wines; raw fermentive vegetables; too rapid eating, abuse of purgatives. Treatment allopathic. — Small doses of opium, columbo, quassia, aloes, extract of hops; diet: salep, rice-water, broth, astringent red wines with nutmeg; acorn-coffee; bitter beer, lime water, quinces, &c (See diarrhoea.) Homoeopathic treatment.—Cinchona and Ferrum are the most useful remedies. (See Diarrhoea.) Liver complaint — (See chronic hepatitis.) t 1 DEPRAVED APPETITE. 403 LIVER ENLARGED. General derangement of health; symptoms of indigestion; pale, yellow countenance, irregular often whitish evacuations, a hard tumor in the right hypochondrium, often extending to the pit of the stomach. In dropsical persons the swelling is sometimes enormous. (See chronic hepatitis.) Hydropathists recommend the hunger-cure; a moderate douche, frequently applied over the back; the wet sheet pack; abdominal compress; and when the bowels are habitually con- stipated, the warm stream douche to the whole abdomen, fol- lowed by the cold dash. MALACIA--PICA--DEPRAVED APPETITE. Appetite for unusual, indigestible things, as clay, chalk, coal, lime, salt, dirt, tar, &c In some cases it is a salutary instinct in diseases, as the desire for acids in putrid maladies; for earthy substances" in acidity of the stomach; &c In other cases it is merely a morbid symptom, as in chlorosis, hysteria, melancholy, pregnancy, worms, &e. Treatment consists in the removal of the original disease. Dirt-eating, called African Cachexy, prevails among the colored population of hot climates, and appears to belong to the colored race exclusively. It has often been witnessed at large plantations in Louisiana, and in most cases terminated fatally. The patient experiences an irresistible craving for substances of an indigestible and disgusting character. There is more or less uneasiness in the stomach; dyspnoea on the slightest exertion; great debility, despondency, and desire to be alone. The black color of the surface becomes of a brownish green, or olive hue. When the patient becomes dropsical, dissolution is near. Primary symptoms of dirt-eating, are the peculiarly white and pallid appearance of the palms of the hands, and soles of the feet, bleached and bloodless aspect of the inside of the lips, the gums, the tongue, and the mouth generally. Causes. — Severity of treatment by their masters and over- seers, causing depressing emotions, and a sense of degrada- 404 DISEASES OF THE ABDOMINAL VISCERA. tion; improper and insufficient food (rice and molasses, and molasses and rice); damp and unhealthy dwellings; damp, malarious climate; over-work. Treatment consists in the removal of the causes, then pro- moting the strength, and exciting new impressions so as to break in upon their despondency. In order to prevent the patient from eating dirt, a close wire-mask should be placed over his face. MARASMUS--EMACIATION. A wasting of the body, without any particular local affec- tion. (See Atrophy.) MELjENA — MORBUS NIOER—BLACK DISEASE. Evacuation of black, tar-like, or brown, grayish matter. This disease is generally preceded by want of appetite, pres- sure in the pit of the stomach, sometimes violent pains in the stomach, abdomen and back; melancholic and hypochondri- acal complaints; pale, yellow complexion; flatulency; consti- pation of the bowels; intermittent pulse. All of a sudden, and sometimes without any cause, a violent vomiting of black, tar-like matter sets in, and the same kind is evacuated from the intestinal canal. The pulse is very feeble; there are painful sensations in the abdomen, often with the most violent spasms, anxiety, a constant inclination to stool, cold extremities, cold sweats, fits of fainting. This state may continue for days, weeks, and months, discontinuing a few days, and returning with greater severity and more pro- fuse evacuations of the same tar-like substances. It is always a dangerous disease, and tabes or hydrops is a common se- quel. Causes. — Engorged state of all the vessels of the stomach, intestinal canal, and mesentery; over-filling of all these ves- sels with old stagnant blood; sedentary life; long continued sitting posture; sorrow and grief; heavy, heating food; ardent spirits; suppression of piles, or menses. Treatment allopathic. — Tamarind-whey; tartaric acid; mu- cilaginous drinks; narcotic fomentations with vinegar; tepid INFLAMMATION OF THE PANCREAS. 405 aromatic baths, malt-baths, hand and foot-baths. To allay the pains, and remove the great irritation, we must resort to extractum hyoscyami and belladonna. In dangerous cases cold application to the abdomen, sulphuric acid, alum, and injec- tions of salt water. Homoeopathic remedies. — Arsenicum, China, Veratrum, or else Ipecac, Nux v., Belladonna. (See Black-vomit.) MILK-SICKNESS. In many of our western States a disease prevails, called milk-sickness, trembles, or sick stomach, and is caused by eat- ing the flesh, using the butter, or drinking the milk of animals, that are infected with miasmatic fever, or that are in the habit of drinking, during the dry and hot season, standing water, impregnated with decayed vegetable substances. The patient complains of a burning sensation in the epigastrium, followed by vomiting with insatiable thirst. The bowels are constipa- ted; the pulse irregular; epigastrium tender to the touch; body hot; extremities cold; breath has a peculiar acid odor, which fills the whole room. This disease often proves fatal. Treatment — I have employed, in many cases which came under my treatment in Western Ohio, small doses of Arseni- cum and Nux vomica in alternation, one-tenth of a grain from three to four times in twentv-four hours, and always with most astonishing success. Eclectic treatment. — The neutralizing physic, a spoonful given every time the patient complains of the burning sensa- tion, has proved of benefit. OMENTITIS--INFLAMMATION OF THE OMENTUM. Symptoms and treatment are the same as in Peritonitis. The pains are more confined to the epigastric region, and accompanied with vomiting. Obstructio alvi. — (See Constipation.) PANCREATITIS — INFLAMMATION OF THE PANCREAS. Deep seated, dull pain in the region between the pit of the stomach and navel, which are increased by pressure; violent 406 DISEASES OF THli ABDOMINAL VlbCER\. vomiting, frequent loose, whitish evacuations from the bowels, and acid taste of the saliva. This disease appears generally in the chronic form. Treatment is the same as in Peritonitis. PERITONITIS--INFLAMMATION OF THE PERITONEC.M. Peritonitis muscularis has its seat in the abdominal muscles; Peritonitis inembranacea in the lining serous membrane of the abdomen. Symptoms.—Painful tension and tumefaction of the abdo- men, with a sensibility to the touch even more acute than in Enteritis, so much so that the patient cannot bear the pressure even of a sheet upon the abdomen; frequently constipation, ischuria, vomiting, &c. If not cured by resolution, it runs into indurations or suppurations, and the latter may form an external abscess. Causes. — External injury; parturition; taking cold in the abdomen, and metastases. Treatment allopathic—In plethoric patients venesection; leeches to the painful parts; mercurial embrocations; fomen- tations; tepid baths. In rheumatic Peritonitis, with violent pains, apply externally volatile liniment, and give internally Calomel, Oleum Ricini, Pulvis Doveri, and Ammonium Acet- icum. Homoeopathic treatment —Three or four doses of Aconite should be given in the first place to allay the fever and inflam- mation. When caused by external injury the tincture of Arnica, in a diluted state, should be applied externally. After inflammation has been subdued, we may find benefit from the employment of Nux vomica, Mercurius, Bryonia, and sometimes Arsenicum. (See Enteritis and Gastritis.) Peritonitis,puerperalis. — (See Febris puerperalis.) PHTHISIS HEPATICA--LIVER CONSUMPTION. After previous inflammation of the liver the symptoms of inflammation continue, with pain and pressure on the hepatic region, spreading to the right arm or leg; inability to lie on the left side; yellowish colored countenance, vomiting and HEMORRHAGE FROM THE BOWELS. 407 other disorders of the stomach; constipation of the bowels alternating with diarrhoea, and red, turbid urine. Causes. — Suppuration, either in consequence of inflamma- tion, or of a metastasis of morbific matters; or a shifting of pus from other parts. Treatment allopathic.—If chronic hepatitis continues we should have recourse to mercurial embrocation, emollient narcotic cataplasms, and the internal use of mild cathartics. If an abscess forms externally, we must open, and dress it with simple salves. Should the abscess open internally, we must treat the disease like Phthisis pulmonalis, remove the pus by oily mucilaginous remedies, and keep up the strength of the patient by tonics, especially Peruvian bark and Alcor- noque. Change of climate is of great benefit. Homoeopathic remedies. — Lycopodium, Kali c, Sulphur, Silicea, Hepar. Phthisis meseraica. — (See Atrophia meseraica infantum.) PROCTITIS — INFLAMMATION OF THE RECTUM. Violent burning pain in the anus, with constant small evac- uations (often twenty-four in a day) of bloody purulent mucus, and severe tenesmus. Causes. — Taking cold by sitting upon cold stones or damp ground; mechanical injuries; hemorrhoidal constitution. Treatment allopathic — Leeches to the anus, embrocations withUnguentum althaee andOleum hyoscyami, or tincture of opium; tepid sitz-baths, and simple, vegetable diet. Homoeopathic remedies. — Aconite, Nux v., and Mercurius. PROCTALGIA. Pain in or about the anus, without inflammation, experi- enced or aggravated during and after the expulsion of faeces, frequently attended with hemorrhage. Causes.—Exposure to cold; piles; prurigo; scirrhus; small ulcer. Treatment consists in the removal of the causes. PROCTORRHCEA— HEMORRHAGE FROM THE BOWELS. Bleeding from the bowels is. in most cases, a symptom of 408 DISEASES OF THE ABDOMINAL VISCERA. piles. In some cases, however, it is caused by Ascarides, also by debility of the rectum. Treatment — Tepid injections of vinegar and water, foot- baths, keeping quiet and in bed, and observing a simple diet, are generally sufficient to arrest this hemorrhage when ap- pearing without any particular cause. (See Piles.) PROLAPSUS ANI — PROTRUSION OF THE INTESTINE. Protrusion of a portion of the mucous membrane of the lower intestine is of much more frequent occurrence in child- ren than in adults, and takes place principally during strain- ing when at stool or when urinating. Causes. — Ascarides; frequent purgatives, and continued costiveness; tenesmus; affections of the bladder. Treatment. — If the bowel does not return of itself, the protruded portion should be reduced by gentle pressure with the thumb, or thumb and fore-finger, which have been previ- ously dipped in oil. The sooner this is done the better. In order to perform the operation properly, the child should be laid across the lap with its head a little lower than its hips. When the reduction cannot be accomplished, a tepid sitz- bath, and an injection of tepid water, or an injection of cold water, with a few drops of acetate of silver and lead, with five drops of the tincture of opium, will be found of great service. To effect a permanent cure the child must be put on simple fruit diet, take a daily bath, and exercise in the open air. Homoeopathists recommend: Nux v., Ignatia, Merc, and Sulphur. Eclectic treatment. — Return the prolapsed bowel by slight, uniform, and constant pressure with a soft, folded linen rag, wet in warm water. If this method should fail, press up be- fore the finger, a soft, oiled rag, and, after waiting a few mo- ments for the sphincter muscles to contract, you will be able to withdraw the finger without the bowel following—when the rag can be readily removed. The patient should guard against straining when at stool, RHEUMATISMUS INTESTINALE AND ABDOMINALIS. 409 and defecation should be performed in as nearly an erect pos- ture as possible. The bowrel should be freely bathed, if it comes down, with a strong decoction of oak bark, and be fol- lowed with a compress wet in the same, and retained there with the 'T'' bandage. PULSATIO ABDOMINALIS. Pulsation in the abdomen generally happens in hypochon- driac and hysterical persons, and is caused by aneurismatic extension, often, merely by local spasm. (See Hypocondry, Hysteria, and Palpitation of the heart.) PYROSIS—HEART-BURN--BLACK-WrATER--WATER-BRASH. Painful or uneasy sensation of heat and burning about the pit of the stomach, extending upward. It is accompanied with anxiety, nausea, sometimes rising, or vomiting of limpid fluid, and is worse after taking fat food. Causes. — Acidity in the stomach; fat aliments; drunken- ness; indigestion; &c Treatment allopathic. —Avoid all strong drinks; to procure immediate relief use a tea-spoonful of magnesia; ammonium carbonicum, three grains in an ounce of aromatic water; one or two bitter almonds; a small glass of peppermint liquor; several drops of the liquid ammonia; charcoal powder; chew- ing of ginger-root. To effect a radical cure the same treat- ment will be required as recomended for G-astrosis, Dyspepsia and Flatulence. Homoeopathic remedies. — Nux v., Pulsatilla and Sulphuric acid. Redostenose.— (See Hypertrophy ani.) RHEUMATISMUS INTESTINALE AND ABDOMINALIS. Sharp, tearing pains in the abdominal muscles, aggravated by movement, by rising from a recumbent posture, by bend- ing forward during evacuations from the bowels and bladder. In most cases the patient has fever, and the disease is often mistaken for Enteritis. Long continuing abdominal rheuma- tism may cause Peritonitis. 410 DISEASES OF THE ABDOMINAL VISCERA. Treatment is the same as recommended for Rheumatism general. Rupture. — (Sec Hernia.) Scrofula intestinalis. — (See Scrofula and Atrophia me- seraica.) Scirrhus ventriculi. — (See Induration of the stomach.) SEA-SICKNESS—-VOMITUS MARIN US. Deadly nausea with vomiting, sometimes purging, excessive debility, and feeling of fainting. Cause. — Rocking motion of the ship. Treatment allopathic.—Staying on the deck; horizontal position; water with cremor tartari; small doses of Sulphuric acid or Sulphuric ether; keeping the eyes closed generally prevent severe attacks. Vomiting is made easy by taking a tea-spoonful of Olive, or Almond oil. The following plaster has been found of much benefit: Take compound galbanum plaster one ounce, camphor, carbonate of ammonia, opium, each half a drachm; oil of cajeput, peppermint, each twenty drops; knead together; spread on leather, of the size of a hand, and apply to the epigastric region. The food should be easily digestible, and moderately taken, flaw salt oysters arc acceptable to the stomach. Homoeopathic remedies. — Nux v. and Arsenicum alternate- ly every hour, at the commencement of the voyage, or oftener, should a degree of nausea have already come on. As soon as decided improvement is experienced the remedies must be discontinued, or taken at longer intervals. Cocculus: Giddiness, sensation of emptiness in the head, nausea, inclination to vomit, aggravated by standing erect. (May be repeated every hour.) Tabacum: Excessive giddiness, attended with deadly nausea, paleness of the face, sickness of the stomach renewed by movement, and relieved by exposure to fresh air. Petroleum has been recommended as a specific. As soon aa nausea and swimming in the head set in. the patient takes six HICCUP 411 pellets upon the tongue, which in most cases will be found sufficient to remove all sickness. Ipecac, and Thrideon are also recommended. Hydropathic treatment. — Select a position and berth in the middle of the vessel.-where the motion is less felt; diet some days before embarking; and never go on board the ship in a state of excitement and fatigue. During the voyage keep busy, go aloft, and stir about actively. Sailors recommend girding the loins, and taking a good draught of salt-water. A sea-sick person should manage to keep himself occupied as much as possible. Drink water freely from the first when you are sea-sick; it will make the vomiting easier. The wet girdle, tightly applied, is an excellent remedy in this affection. The health of almost all persons is improved by sea-sickness, which seems to be tho result of entire abstinence from food. SINGULTUS--HICCOUGH--HICCUP. A convulsive catch of the respiratory muscles with sonorous inspiration, iterated at short intervals. The spasmodic action is made by the diaphragm and external abdominal muscles. Causes. — Bile in the stomach; acidity; flatulence; indi- gestible food; an overloaded stomach; external pressure; narcotics: taking cold; intoxicating drinks. In fever it is a fatal symptom. Treatment allopathic. — Make a very full inspiration, and then hold the breath as long as possible; a draught of cold water will sometimes give relief; slow drinking, or, still better, a piece of sugar melted in the mouth, removes it quickly. When it is nervous or spasmodic, we should employ musk, or a combination of chloroform with camphor; hyoscyamus, sharp vinegar and sulphuric acid; opiate embrocations; dry cups over the stomach; a warm bath. Hiccough of women during confinement is generally re- lieved by Extract valerian., or Extr. belladonna; also by sompression of the abdomen. Inflammatory symptoms require leeches. To prevent the 412 DISEASES OF THE ABDOMINAL VISCERA. return of the paroxysm, sulphate of quinia is the most effec- tual remedy in the regularly intermittent cases. (See Causes.) Homoeopathic remedies.—Aconite, Belladonna, Hyoscyamus, Nux m., Nux v., Pulsatilla, Stramonium. Hydropathic treatment.-—A draught of cold water, holding the breath, the foot-bath, cold compresses to the stomach. Splenitis. — ( See Lienitis.) Stricture of the rectum. — (See Rectostenose.) Summer complaiut. — (See Cholera infantum.) TAENIA — TAPE-WORM. There are two varieties of tape-worm — the solitary tape- worm (Taenia solium) composed of long, slender articulations, which has been known to exceed thirty feet in length; and the broad tape-worm (Taenia osculis superficialibus), which varies from three to ten feet, seldom comes away entire, but in joints which are considerable broader, and thicker, than those of the variety first mentioned. Besides the general symptoms of worms, the patient expe- riences the sensation of a lump in the left or right side, with a wave-like motion, and a feeling of sucking in the abdomen; he also speaks of a sensation as if something was ascending from the left side up to the throat and falling back again. When the stomach is empty there is vertigo, nausea, crawling and numbness in the fingers and toes. After taking a little brandy, or a bitter essence, all the abdominal difficulties sud- denly cease. Treatment. — In order to ascertain the existence of the tape-worm, when it is not positively known, give resina gua- jaci, with bitter almond water daily, when pieces of the worm will be discharged by stool. Being certain of the existence of tape-worm, we should first try a gentle mode of dislodging it, viz: Glauber's salts and Sedlitz salt taken every morning; and, several times du- ring the day, pewter filings, three or four drachms a day, mixed in conserves of roses; garlic stewed in milk, taken every morning fasting; also the bark of the pomegranate root, one TAPE-WORM. 413 and a half ounce boiled in twelve ounces of water to eight, two table-spoonfuls every half an hour in the morning fasting. The forcible mode is to drive it down to the lower part of the intestinal canal by remedies offensive to the animal, of which the root of the genuine male fern is the most efficacious, and then to enforce its discharge by drastic purgatives. Oil of turpentine from half a fluid ounce to two fluid ounces, followed by a full dose of castor oil, if it does not purge in the course of two or three hours; or the two oils conjointly (half a fluid ounce of the oil of turpentine mixed with an ounce of castor oil, and the dose repeated in a few hours if it should fail to operate) have been successfully employed. In obstinate eases the powdered seed of Indian caustic barley, ten grains taken every morning mixed in honey, is a very efficient remedy. Spasms must be prevented by assa fcetida and hyoscyamus. After the above remedies have been given the patient must live, for a few days, on herring, sardines, and similar aliments. For supper he must take a little panada. Before retiring he should take one drachm of the male fern root in powder; or the following morning first a glass of water; then the follow- ing compound: Six grains of gamboge, one grain of calomel, ten grains of magnesia, and one grain of extract of hyoscya- mus ; half an hour afterward he must swallow half an ounce of castor oil and receive an injection of milk, and the abdo- men be embrocated with Petroleum. If the worm is not dis- charged two hours afterward, the above remedies must be repeated once more. When the worm hangs out of the rec- tum, wind it around a little piece of wood, in order not to break it, and to prevent it from returning; the patient must sit over a vessel filled with warm milk, and the worm is to be gradually extracted by winding it up. As soon as the pointed end or head is evacuated, the whole is expelled. Homoeopathic remedies. — Felix mas. (male fern) is recom- mended as a specific, a few drops of the tincture several times a day; or a saturated decoction, half an ounce, every day 414 DISEASES OF THE ABDOMINAL VISCERA. after dinner. The following remedies are in some cases em- ployed with benefit: Sulphur, Calcarea, Mercurius, Fragaria vesca., Terebinthina, Petroleum, Stannum, &c Eclectic treatment. — A decoction made of an ounce of the pomegranate bark to a pint of water should be administered for a few days, followed with about an ounce of spirits of turpentine and the same quantity of salad oil. The eelebrated pumpkin-seed cure is the following: Procure sufficient seed of the pumpkin to make two ounces after re- moving the outside shell of the seed; put them in a mortar and add half a pint of water; pound them well up, and make a liquid orgeat of them, which strain through a cloth. Prink this mixture in the morning on a fasting stomach. If it does not operate in the course of an hour and a half, take one ounce of castor oil. Drink all the time as much fresh cool water as the stomach can contain. The stomach may be rubbed with ether, and an injection of about sixty drops ta- ken. Should the first application of the remedy not answer, repeat it the next morning, and there is no doubt the com- plaint will be removed. (See Helminthiasis.) TENESMUS — FORCED STRAINING TO STOOL. Generally a symptom of dysentery, or piles, and must be treated accordingly. THIRST MORBID--POLYDIPSIA. Insatiable thirst, arises either from internal heat, thence a symptom of fever; or from increase of watery evacuations, present in diarrhoea; &c. It can also be produced by nervous diseases, obstructions of the liver, and salty or fat food. The treatment must comply with the various causes. TUBERCLES OF THE LIVER. In the first stage the patient experiences the symptoms of common dyspepsia, pressure and distention in the epigastric region, with constipation, and hard and dark faeces; from time to time sensation of pressure in the right hypochondrium with darting pains, extending upward; the skin assumes an ash-like color, and the face becomes bloated; pain and pres- WlNO-LK-ul'&V. 415 sure below the false ribs of the right side increase; enlarge- ment of the liver takes place, aad little painful knots (tuber- cles) are clearly felt. The dyspeptic symptoms continue, and constipation increases from day to day. When the tubercles form on the inner part of the liver, the disease is accompa- nied with jaundice. The prognosis is generally unfavorable; especially if the tubercles form in the inner part of the liver. Treatment — (See Chronic hepatitis. Enlargement of the liver, &c) XDSSIS ABDOMINALIS—*STOMACM-Ll\ ER-WORM-ABDOMINAL COUCH. In this cough the respiration is free, the patient can walk. run, speak, take a deep breath without coughing or panting. Cough is worse after meals, and there is generally imperfect digestion. In order to cure the cough we must remove the disease, 01 derangement of the abdominal organs. Millefcil-tea is highly recommended. ( See Worms, Dys- pepsia, Ac.) TYMPANITIS —INFLATION — WIND-DROPSY. Elastic swelling of the abdomen, which on percussion gives a hollow sound, like a drum. These symptoms and the ab- sence of fluctuation distinguish it from dropsy. In tympanitis intestinalis, when the air is accumulated in the intestines, the distention is unequal; in tympanitis abdo- minalis, when the air is accumulated in the abdominal cavity, the abdomen is. equally elastic .and distended. The patient has rumbling in the intestines, but no discharge of flatus, respiration is difficult, the abdomen is painful, extremities cold, and the bowels irregular. Inflammation may set in. or a rupture may take place. Causes of intestinal tympanitis.—Overloading of the stomach with peas, beans, cabbage, milk, beer, &c; also an accumula- tion of gastric and bilious matter, and such as are apt to pass into putrid fermentation; taking cold.; debility of the intesti- 41t> DISEASES OF THE ABDOMINAL VISCERA. nal canal; inflammation and gangrene; indurations, ulcers; wounds in the abdomen. Causes of abdominal tympanitis.— Escape of air from the intestines into the abdominal cavity, which may happen when they are pierced by ulcers and wrounds; putrid dissolution; kc. Treatment allopathic.—When there are inflammatory symp- toms present, we must have recourse to abstractions of blood. In the absence of the same we must administer pills of assa foetida and rhubarb; columbo and oleum cajeputi; externally embrocations of oil of mint, and camphor oil with laudanum; dry cups; injections of cumin with assa foetida, chamomile, or oil of turpentine. When the patient has eaten fermentable vegetables, we may resort to magnesia and aqua calcis with rhubarb; in putrid fermentations, acids, and ice internally and externally; dropping of Naphta on the abdomen. When the stomach is overloaded, Emetics are required. In desperate cases we should draw off the air by means of a syringe and a long flexible tube; wear a tight girdle around the abdomen, and even puncture the part, which is most dis- tended, with a needle or a trocar. Homoeopathic remedies. — Cinchona, Colchicum, Pulsatilla, Carbo v., Asa foetida. Hydropathic treatment — Copious cold injections by means of a pump; the spray bath, and the ascending douche. Typhus abdominalis.—(See Malignant typhus; putrid fever.) VOLVULUS — INTUSSUSCEPTIO. A disease produced by the passing of one intestine into another. (See Ileus.) Vomiting of blood.—(See Hasmatemesis.) VOMITUS — VOMITING. When vomiting becomes a chronic derangement it claims our greatest attention. When it always follows a meal, we may suspect an organic disorder of the stomach. When it is accompanied with violent pains in the stomach and abdomen, and the patient turns yellow, gallstones; or, when accompanied with pains in the region of the kidneys, gravel are supposed "V ORACIOL S APPL 1'lTE 411? to exist. When it attacks children with drowsiness, squinting, costiveness, and the head being affected, it is a sign of water on the brain. When children vomit in the morning and have a voracious appetite, it points to worms. Obstinate vomiting of children, with thirst, diarrhoea, distended praecordia,-dis- figured countenance, cold cess of hands and feet, and emacia- tion. Gastro-malacia (softening cf the stomach) is threatened. Causes.—Convulsive contraction of the stomach; great irri- tability and debility of the stomach; morbid, indigestive mat- ter, as bile, mucus, worms, acid substances; organic disorders, as cancers, ulcers, polypus, indurations and metastases; swel- ling and induration of the liver, spleen, pancreas, and kid- neys; stones and gravel; cerebral affections; pregnancy; con- cussion of the brain by falls or blows; mental excitement; hoop- ing-cough; riding in a carriage, or on a vessel; smoking; etc Treatment — Investigate the different remote causes, and remove them. When no material cause can be ascertained, or when it continues after their removal, take carbonate of potassa two drachms, fresh lemon juice, as much as will satu- rate the potassa, distilled or pure rain water three ounces, raspberry syrup one ounce; Mix, and give two table-spoon- fuls every two hours. Externally apply cloths wet with the tincture of opium; mustard-poultices; especially dry cups, which is one of the most efficient means. Small pieces of ice, or ice cream, and injections have proved useful. Homoeopathic treatment—Vomiting without any particular cause, requires Antimonium or., when the tongue is coated white or yellow; Ipecac, when the tongue is clean; Arseni- cum and Veratrum, when there is great debility, coldness of the extremities, thirst" &c; Cocculus, vomiting with dizziness. Animal magnetism has been used with good effect. VORACITAS — VORACIOUS APPETITE. Excessive appetite is in most cases a symptom of dyspepsia or worms, and must be treated according to causes. Water-brash. — (See Pyrosis.) 418 DISEASES OF THE ABDOMINAL VISCERA. Weakness of the stomach. — (See Indigestions.) Worms. — (See Helminthiasis.) WOUNDS OF THE ABDOMEN. When the intestines are wounded the patient is affected with nausea and vomiting of bloody matter, faecal matter and fetid wind pass out of the wound, and there is often griping pain about the praecordia. When a portion of the intestine protrudes, it must, after freeing it carefully from foreign par- ticles, be replaced as soon as possible; if this is not done within forty-eight hours, adhesions may form and render it impossible. When the protruded bowel is distended with gases or faeces, by which its return is hindered, these may be pressed forward into a portion of intestine within the abdominal cavity; or, if this measure fails, the wound must be dilated. Be careful to replace intestine before omentum. These wounds, when large, may require the suture ; a fine needle and thread only should be used. For several days after severe injuries of the bowels, which are always dangerous, the patient should keep quiet, eat little or nothing, and the bowels be moved, when necessary, by warm injections. Keep the wound open, and dress with simple salve to protect it from the air. At each dressing, press upon the wound a little, to force out the mat- ter. After the second day the external wound may be allowed to heal. CHAPTER XV DISEASES OF THE URINARY ORGANS, Abscess urinary.—-(See Fistula.) CALCULUS URINARIUS — LITHIASIS RENUM ET VESICAE URI- NARIA — GRAVEL. Stone or gravel in the kidneys is attended with a fixed, or periodically returning pain in the loins, shooting downward toward the thighs, which are affected with numbness. The pain often alternates with a sense of weight, and is increased by exercise. The urine deposits a sandy sediment of a white or red color. The passage of a large gravel or sandy particle through the ureters is accompanied by an agonizing pain, spreading over the whole abdomen; nausea, vomiting, crying, fainting, and generally retraction and inflammation of the testes. The pulse is not affected—a distinguishing symptom from inflammation of the kidneys and bladder. If the calculus is stopped in the ureter, heat, thirst and fever come on, and the retained urine being thrown back in the blood, occasions suppuration, intermitting pulse, coma, convulsions, and even death. Stone in the bladder produces a constant urgency of making water, accompanied with difficulty and pain of discharging it; itching and tickling in the orifice of the urethra ; sudden stop- page of the stream before urination is completed; which some- times can be renewed by a change of posture; strangury; dysury; slimy sediment in the urine, frequently mixed with gravel or little stones, sometimes with blood, especially after horse-back riding, or any hard jolting exercise ; sensation of weight deep in the pelvis, aggravated by standing and walking. On sounding the bladder the instrument meets with a sonorous resistance. When the stone becomes large there is a dull 419 420 AFFECTIONS OF THE I I'.l.NARV ORGANS, pain about the neck of the bladder, and the rectum is affected with a troublesome tenesmus. The disease terminates in disorganizations, thickening and suppuration of the bladder, lingering fever, consumption, and death by emaciation. Causes.—Hard water; free use of salt, alkalies, especially saleratus; sour wine, fermented liquors; vinegar; much animal food ; presence of a foreign body; constitutional or congenital debility of the kidneys and bladder; arthritic metastases; mechanical pressure on the kidneys. Treatment allopathic — Palliative treatment—when symp- toms of inflammation are present — consists in the application of leeches to the painful parts, venesection, poultices of lin- seed and hyoscyamus; internally, cooling purgatives, oil, and Extract of Hyoscyamus. In the absence of all inflammatory symptoms, we must employ: tepid half-baths; decoction of linseed as a beverage; oily emulsions with opium; club-moss seed made into an emul- sion; embrocations of volatile liniment, of camphor with laudanum; oily injections of half a drachm of hyoscyamus herb or opium. Some cases require the daily use of opium, or inhalation of chloroform. The radical cure consists in restoring a healthy action of the kidneys, preventing the formation of new calculus, and in dissolving or neutralizing those already existing. A remedy answering both indications, is soda, or alkali in general. Soda-water dissolved in carbonic acid water (common soda- water); Kali causticum purum (ten drops twice a day in broth); soap, or lime water, taken by the pint daily; Magnesia carbonica, half a drachm three times a day. Some vegetables have also proved useful, as: radishes, strawberries, red bilberries, honey, quince-seeds, juniper-berries, and bear-berry leaves half a drachm three or four times a day. The last remedy possesses also the advantage of allaying pain. If all these means prove abortive, recourse must be had to the operation of lithotrity, or lithotomy, that of cutting out the stone. The latter opera- GRAVEL. -121 tion should never be performed when suppuration in the blad* der or kidneys is manifest, nor when gravel is simultaneously present. Lithotrity or Lithontripsy consists in crushing the stone in the bladder with an instrument called the lithontriptor. This operation can only be performed in adults, and the stone must be soft and small. Previous to the operation the urethra must be diluted by bougies until the lithontriptor will pass. The patient is then placed on a table covered with quilts; the hips are elevated, and the bladder if not already full of urine is to be nearly filled with tepid water injected through a catheter. The instrument is then oiled, warmed and passed into the bladder, while closed as a common bougie. When it comes into contact with the stone, the moveable half is pushed in, by which the blades are opened at the several joints; it is then rotated from side to side, tightened occasionally so as to grasp the stone; when fixed between the blades, which fact is known by the inability to draw the sliding part back—the arms of the screw are turned gradually, by which the slide is withdrawn and the blades brought slowly and with great force together. After the stone has given away and the instrument closed, it is to be re-opened and managed in the same way for any large fragments which remain. After the crushing process is com- pleted, the lithontriptor is withdrawn, the patient turned face downward, and directed to urinate as rapidly as possible ; after which the bladder may be repeatedly injected, and the pow- dered stone washed out. (See Illustrations.) A free use of diuretics, such as an infusion of Juniper- berries and Althaea officinalis will aid in a free urination. Lithotomy, or the operation of cutting into the bladder in order to extract a stone. The lateral operation is now almost universally preferred. The patient should diet and be kept quiet for a week or more before the operation. The bowels having been evacuated and the bladder being nearly full of fluid the patient is ready for the operation. Place him upon his back, on a table covered with a mattrass. Flex the thighs 422 AFFECTIONS OF THE URINARY O ROAN'S. on the abdomen, and the legs on the thighs, separate the knees, and make him grasp the soles of his feet with his hands, then fasten the feet and hands together by bandages, first put round the wrists by a noose. Now give him the ether or cloroform until he is insensible to pain. It is better also at this stage to apply a bandage around each arm and thigh, to stop the return of the venous blood as far as practi- cable, so that a large amount of blood will, for the time, be retained in the limbs, and thus lessen the hemorrhage during the operation. Having thus prepared his patient the surgeon introduces the staff; an assistant on each side holds the thighs apart, and another holds the patient's head and shoulders firmly; a third holds the scrotum to one side, and supports the staff perpen- dicularly drawing it up firmly against the pubes. A finger should then be introduced into the rectum to ascertain whether it is empty, and to stimulate it to contraction. The perineum must be previously shaved clean. The knife used has the posterior two-thirds of the edge blunt. This enters the peri- neum about midway between the scrotum and anus, on the left side of the raphe, and is brought downward and outward, dividing only the skin and superficial fasciae to about midway between the anus and the tuberosity of the ischium. The section is then deepened by the finger, for the purpose of secu- rity to the rectum and to blood vessels. Muscles also should be separated rather than torn. If any portions of the levator ani resist the finger they must be divided by the knife. The point of the knife is slipped along the nail of the finger, and guided by it, is entered, the back still directed upward, into the groove. The finger all along is placed so as to depress and protect as much as possible the coats of the rectum, and the same knife pushed forward, is made to divide the deep fascia, the muscular fibres within its layers, and to perforate the urethra about two lines in front of the prostate, then it must be pushed into the bladder, slitting up the urethra and notching the margin of the prostate within its course. The. GRAVEL. 423 knife being withdrawn, the left forefinger is gently insinuated into the bladder, dilating the parts as it enters; then, the assistant having removed the staff, the forceps are cautiously introduced over the finger into the bladder; the finger being gradually withdrawn as the instrument enters. At this mo- ment the blades should be opened and the stone caught, as it is brought within their jaws by the gush of urine that escapes. If the stone is not immediately clutched, the point of the forceps should be advanced and depressed to the part where it is most likely to be found. The object being seized, it is extracted by slow, cautious, undulating movements, taking care that no part of the bladder is included. The forceps should be held with the convexity of one blade upward and the other downward; and the endeavor should be to make the parts gradually yield and dilate, not to tear them. The general maxims to be borne in mind during the per- formance of this operation are: to make a free external inci- sion, and to bring it low enough down, so that the urine may subsequently escape freely without infiltrating the cellular tissue; not to cut too high up. or to open the urethra too much in front, for fear of wounding the bulb or its artery ; not to wound the rectum, or pubic artery, by carrying the incision too much inward or outward; and above all not to cut com- pletely through the prostate, otherwise the urine will find a ready passage into the loose cellular tissue of the pelvis and the patient will almost surely die. The incision into the pros- tate should not be of greater extent than six or seven lines; its direction downward and outward like the rest of the wound. After treatment. When every fragment of the stone ha3 been removed, and the bladder has been syringed with warm water, the patient should be put to bed. The patient should lie on his back with his shoulders elevated; a napkin should be applied to the perineum to soak up the urine, and the bed be protected by oil cloth. It is a good plan to introduce a large gum elastic canula through the wound into the bladder for it to flow through. If not, the surgeon should introduce 424 AFFECTIONS OF THE URINARY" UHLANS. his fingers, after a few hours, to clear the wound of coagula. Pain must be allayed by anodynes — the bowels be kept open without purging—the wound be kept perfectly clean and then, in favorable cases, the urine begins to flow by the urethra in about one week, and the wound heals completely in four or five. Among the casualties which make this operation often fatal, may be enumerated the shock itself; hemorrhage during the operation; and hectic from the Inflammation and copious sup- puration of the wound. Homoeopathic treatment — The chief remedies for stone in the bladder are: Cannabis,Sarsaparilla andUva. For stone or gravel in the kidneys: Lycopodium and Sarsap- arilla. Hydropathic treatment—To alleviate the suffering, the warm hip-bath, and, in extreme cases, the full warm or hot-bath is necessary; and if the pain continues, the wet sheet pack, of two or three thicknesses, will be the best sedative. To free the system from all impurities, the diet must be strictly vegetable; the drink nothing but soft water; and fre- quent packing, and rubbing wet sheets, with such additional appliances as the general health may demand. Eclectic treatment. — When there is uric acid in the deposit of urine, we must endeavor to change the secretion by increas- ing the quantity and quality of the urine, so as to make it soluble; for this the alkalies may be used freely. The Iodide of Potassium, the Bicarbonate of Soda, or the Bicarbonate of Potassa should be used and continued in moderate doses until the desired effect is produced. This class of agents increases the quantity of urine. In connection with these the various mucilages, such as Slippery-elm, Gum-arabic, Flaxseed, Uva ursi, Althea offici- nalis, etc., are used. In order to prevent a recurrence of this disease, the patient should use freely the different combinations of Iron, Iodide of Potassium, and compound syrup of Stillingia; with the alka- CONDYLOMATA. 425 line and vapor-bath, alternately each day; and should be strictly confined to meat diet. If the phosphatic variety be present, and complicated with dyspepsia, as we usually find it, we would treat that complica- tion as heretofore recommended under its proper head, making use, at the same time, of the same treatment referred to for uric acid, with the exception of the Bicarbonate of Soda, or Potassium. A similar treatment is recommended in the oxalic form. The pure wine or juice of the Catawba grape, and also pickled grapes have been used with benefit in arresting this disease. Operation of Lithotomy. — (See allopathic treatment.) CATARRHUS VESICAE--CATARRH OF THE BLADDER--CHRONIC INFLAMMATION OF THE BLADDER. Discharge of mucus with the urine, accompanied with pain in the small of the back, spasmodic contractions of the blad- der, constant inclination to urinate, difficulty of passing the urine. The penis is generally cold. When the discharge is very gelatinous and very copious the disease may become in- jurious to health and life, and may pass into Phthisis vesicalis. Causes. — Local irritation of the bladder by gravel; stone; inflammation; iuduration; debility of the organs; immoderate use of diuretic drinks and medicines; metastases; hemorrhoi- dal congestion ; venereal excesses; worms; etc Treatment allopathic. — For the treatment we have carefully to examine the causes. Uva ursi, lime-water and phosphoric acid have generally proved salutary. In some instances the use of the catheter becomes necessary. Wine and all other fermented liquors must be strictly for- bidden. Homoeopathic remedies. — Dulcamara, Pulsatilla and Sul- phur. (See Cystitis and Dysuria.) CONDYLOMATA. Wart-like, fleshy, sometimes bleeding or suppurating 426 AFFECTIONS OF THE URINARY ORGANS. excrescenses, which appear about the genital organs, or anus. The form resembles figs, mulberries, cauli-flowers, &c In some cases they have growrn into monstrous masses of several pounds weight, which break and form into secondary syphi- litic ulcers. Causes. — The general cause is Syphilis. Pressure aud con- tusion may produce the disease. Therapeutics. — The treatment should be the same as for Syphilis. If they remain obstinate for a long time, external application of Kreosote, Pyroligneous acid, tincture of Thuya occ, Arsenic, red precipitate and Sabina, should be made Ex- cision, cauterization, and the ligature may likewise be resort- ed to. Homoeopathic treatment.- - Staphysagria N., a dose repeated every five days, removed the disease in the course of two weeks. (See Syphilis.) CONTRACTION OF THE URETHRA--STRICTURE OF THE URE- THRA--SPASMS OF THE URETHRA. The first sign of organic stricture of the urethra is the retention of a few drops of urine after micturition; these drops are afterward involuntarily emitted. The next derangement observed is frequent inclination to void water. As the obstruction increases, the urine cannot be passed without pain and effort, and the stream becomes forked, spiral, or scattered; finally it passes only in drops, and is sometimes mixed with purulent matter, evincing ulcer- ation in the urethra or bladder. The patient moreover com- plains about the glans penis, and in the loins, and has often severe paroxysms of intermittent fever. When extensive ulceration takes place, rigors and hectic fever are the precursors of a fatal termination. Spasmodic stricture is knowm by the sudden stoppage of the stream, after it has reached the irritable spot; there is also a desire to urinate frequently and hurriedly. Causes. — Diminution or alteration of the tube, depending SPASM& uF THE URETHRA. 427 upon a thickening of parts of the canal, the result of inflam- matory action ; exposure to cold; stone in the bladder; pas- sage of gravel; violent exercise; excess in venery; high living; fly-plasters; gonorrhoea; injuries by catheters; as- tringent and irritating applications to check gleety discharges. Treatment allopathic — The first measure is to relieve the bladder. When the stoppage occasions a tense, round, painful dis- tention above the pubes, the catheter must be employed. Spasmodic stricture requires the use of Opium, Semen Ly- copodii internally and externally, in fomentations, injections and lotions. To perform a radical cure we must introduce a Bmall wax candle, covered with extract of Belladonna or oil of Hyoscyamus. In permanent stricture caused by mechanical obstruction, thickening and induration, the urethra must be dilated by means of gum elastic or gutta percha bougies, commencing with very small ones, and substituting larger ones as soon as the parts admit of a change. Each should be kept in for a day or two, and worn as much of tho time as possible. The most certain mode of destroying strictures is the ap- plication of caustic directly to the constricted part. The most convenient mode of doing this is by means of Lalle- mand's port-caustique. Some nitrate of silver is melted into the groove at the end of the moveable rod, and scraped down smooth and round like the rest of its surface, so that it can be drawn back into the sheath. When the latter is inserted up nearly to the strictured point, the armed rod is pushed out, turned two or three times round, and sheathed again. Another mode is to inject a solution of the seBqui-carbonate of potash, two or three times a day, by means of a syringe, through a catheter. The solution should be weak at first, and gradually increased in strength. This will produce con- siderable irritation of the urethra, and a discharge resembling gonorrhcea. This artificial discharge may be kept up until the proper change is produced in the urethra. In order to 428 AFFECTIONS OF THE URINARY" ORGANS. ascertain whether the stricture is removed, discontinue the caustic for a few days, using instead a solution of Hydrastus, in which Borax is dissolved, or a simple injection of Slippery Elm-water. Then introduce a bougie, and if any symptoms of stricture be still found, renew the caustic injection. Homoeopathic treatment. — In the incipient stage of stric- ture of the urethra, a cure may often be effected by the following medicines: Cannabis, Petroselinum, Cantharides, Camphora, Mercurius, Aconitum and Sulphur. If the symptoms are exacerbated by exposure to cold, Dul- camara may be prescribed with advantage. In some instances, with induration and more or less contraction and thickening of the urethra, Clematis, Digitalis, Petroleum, Sulphur, Ni- tric acid, Silicea, Calcarea and Lycopodium will prove service- able. Where the medical treatment no longer offers any reasona- ble prospect of success, and the stricture is so complete as entirely to arrest the introduction of the bougie, a surgical operation becomes necessary, which consists in the perforation of the stricture with a stilet; or the plan of cutting down to the stricture, and then cutting through the diseased part of the tube, must be resorted to. Hydropathists recommend the above operations, and advise to keep down the irritation, and maintain constant relaxation by frequent warm hip-baths, or fomentations. The bowels should be kept free by simple diet, and with tepid injections when necessary. (See Ischuria, Gonorrhcea, &c) CYSTITIS--INFLAMMATION OF THE BLADDER. General fever, burning pain, swelling, tension in the region of the bladder; pain increased by pressure above the pubea, or in the Perineum; vomiting; tenesmus; frequent micturi- tion, with great difficulty in discharging the urine; heat and smarting in the urethra; great general irritation, restlessness and anxiety. Causes.. — Gravel; stone; long retention of urine; mal- treated Gonorrhcea; long continued use of fly-plasters, or INFLAMMATION OF THE BLADDER. 429 Cantharides internally; ardent spirits; pregnancy; suppressed menstruation; external injuries; &c Treatment allopathic. — The inflammation and consequent contraction of the urethra should be removed by local and general blood-letting, calomel, opium, tepid-baths, emollient injections, embrocations and cataplasms. In entire retention of urine a flexible catheter should be carefully introduced, and left in as long as circumstances require. If the inflam- mation is not properly removed, the disease will pass into suppuration, abscess, and finally urinary fistulas in the Peri- neum, scrotum, or rectum; indurations; gangrene. Homoeopathic treatment — When a considerable degree of inflammatory fever is present, Aconitum should be adminis- tered in repeated doses, followed by Cantharides, which is the leading remedy, particularly when the urine passes off in drops, or is tinged with blood; or when micturition is exceed- ingly painful, with burning pain in the urethra. Nux vomica: When the affection results from indulgence in spirituous liquors; from suppressed hemorrhoids, or from dyspeptic derangements. Pulsatilla: When arising from suppressed menstruation, or in individuals of phlegmatic temperament. Hyoscyamus: When the disease is more of a spasmodic character. Camphor: Must be resorted to in cases which have arisen from the application of Cantharides (fly-blister). Digitalis, Arsenicum, Carbo veg., Helleborus, Capsicum and Veratrum may be found of service in some eases. Hydropathic treatment— The warm hip-bath for half an hour, or until relief is experienced, succeeded by the cold compress, which should be worn constantly, and very fre- quently renewed, occasionally alternating with the warm hip- bath. General fever should be subdued with the wet-sheet pack, followed by the dripping-sheet, or tepid half-bath. The vomiting may be relieved by warm water drinking, followed oy sips of cold water. Tenesmus requires copious injections 430 AFFECTIONS OF THE URINARY' ORGANS, of warm water, followed, after the bowels have acted freely, by the injection of as much cold water as the bowels c;m conveniently receive. The warm foot-bath is useful, when there is coldness of the extremities. Eclectic treatment. — In most cases the stomach and bowels should be evacuated first, by administering the anti-bilious physic combined with cream of tartar. Hot fomentations of bitter herbs should then be applied over the hypogastrium, and the perineum. A better measure is to seat the patient over a tub containing a hot decoction of bitter herbs, un- til a free perspiration is produced. Applications of cups to the lower part of the bowels, followed by hot fomentations, are also of benefit. A large poultice of onions or hops should afterward be applied. At the same time the diaphoretic pow- der, or a tea of the althea officinalis, should be freely used. DIABETES--WATER-FLUX--IMMODERATE SECRETION OF URINE. When the urine contains a large proportion of Sacharine matter, it is called Diabetes mellitus; and when the usualuri- nary taste alone is perceived, Diabetes insipidus. Most cases are attended with some of the following symp- toms: Insatiable thirst, and voracious appetite; dry skin; great lassitude; easy perspiration; deranged digestion; pain in the back and loins, with a sense of distressing weakness in the same; the voided urine exceeds in quantity that of the fluid and aliment introduced; rapid emaciation of the whole body; complete prostration; hectic fever; weak and quick pulse; laborious breathing; dropsical infiltration in the lower extremities. Causes. — Impaired function of the kidneys; suppression of the cutaneous secretion ; debility of the kidneys and spinal marrow; excessive venery; prolonged abuse of diuretics and aperients; excessive blood-letting; dyspepsia; asthma; hyste- ria; suppression of piles; local irritants, as stone and gravel. Treatment allopathic. — If the disease be owing to long checked perspiration, the function of the skin must be restored IMMODERATE SECRETION OF URINE. 131 by diaphoretics, especially by Camphor andHydrosulphuret of ammonia, two grains daily; hot-baths; Bussian-baths; fric- tions. If the disease is due to gastric accumulations, worms, &c, Emetics and worm remedies must be administered; if nervous debility is the cause, assa foetida, belladonna and cuprum am- monicum are advised; if gravel or stone, lime-water, magnesia and alkalies must be prescribed. Should these means not suf- fice, we must have recourse to Peruvian bark, iron, artificial ulcers, opium in increasing doses with lime-water; small doses of the tincture of cantharides (one drop every three to four hours); warm baths and a dose of Dover's powder after the bath; likewise Kreosote from ten to twenty drops a day. The use of fresh ox-gall has proved efficacious. Diet should con- gist principally of animal food. Vegetables, fruits, and all fermented liquors should be strictly avoided. Homoeopathic treatment. — The medicines chiefly recom- mended in Diabetes mellitus are: Acidum phosphoricum, Mercurius solubilis, Sulphur, Natrum muriaticum, Veratrum, Kali c, and Acidum muriaticum. When Diabetes is symptomatic of dyspepsia, asthma, hys- teria, &c, see the remedies which have been enumerated under these different heads. Hydropathic treatment. — When the skin is cold, pale, and bloodless, the tepid dripping-sheet, followed by the dry-pack, bo as to produce moderate perspiration, and the half or shal- low-bath, followed by the dry rubbing-sheet, with thorough frictions of the whole surface, are the leading measures of treatment. Water may be drunk to the extent of thirst, and the diet should be farinaceous and dry, as wheat=meal biscuits, brown bread, roasted potatoes, Graham crackers, &c Eclectic treatment. — In Diabetes mellitus permanent cures have been effected in several cases by the following method: Podophyllin and Leptandrin, to be given in doses sufficient to arouse the hepatic functions, without active catharsis being *t tho snnie time induced. Subsequently to this, diaphoretics 432 AFFECTIONS OF THE URINARY ORGANS. and tonics to be given, as the compound powder of Ipecac and Opium, with Hydrastin and Prussiate of iron, and an irritating plaster over the region of the kidneys, which course is to be pursued until the excessive discharge of urine has abated. In connection with this, the spirit vapor-bath must be employed at least twice a week, and the body should often be thoroughly rubbed _all over the surface. When the dis- charge of urine has lessened, the above means may be omitted, with the exception of the spirit vapor-bath, and the compound syrup of Stillingia with Iodide of Potassum in the usual doses, which should be continued until the cure is permanent. The diet of the patient should be exclusively of an animal character. Diabetes insipidus may be cured by the means advised for Diabetes mellitus. It has frequently yielded to diaphoresis alone. DYSURIA — STRANGURIA. Difficulty in discharging the urine. Dysuria: frequent inclination to urinate; smarting pain, heat and difficulty in voiding the water, and a sense of full- ness in the bladder. Stranguria: painful and uneasy urgings, the urine passing off only in drops or in minute quantities. Causes.—Inflammation of the urethra, arising from gleet or acrid injections; inflammation of the kidneys or bladder; spasms in the neck of the bladder; enlargement of the hemorr- hoidal veins; a collection of hardened faeces in the rectum; excess in drinking intoxicating beverages; tumors or other diseases of the prostate glands; the suppression of an erup- tion, or of some habitual discharge; the prolonged application of cold; abuse of cantharides, externally or internally; the lodgement of particles of gravel at the neck of the bladder or in the urethra; paralysis of the bladder; &c. Therapeutics.—As this disease is almost always symptomatic, the treatment must be directed against the primary affection. Treatment allopathic. — In ordinary cases one drachm of STRANGURIA. 433 Semen lycopodii, made into an emulsion with mucilage of gum-arabic and syrup, is a very salutary remedy. In Stran- gury an injection of from forty to sixty drops of laudanum in a wine-glassful of mucilage will afford relief, if not at first, at least upon being repeated. Warm baths and camphor water are also recommended. Mechanical obstruction is to be treated by bougies and injections. (See Ischury.) Homoeopathic remedies. — Aconitum: Frequent inclination to make water, with great pain and difficulty in voiding it, the discharge being passed in drops and presenting a dark, red, muddy appearance. Pulsatilla: Sense of fullness in the hypogastric region, with a cutting, boring or aching pain. Belladonna and Hepar: Darting pain, extending from the lumbar region to the bladder with agitation and colic. Mercurius: Urgent calls to make water, the urine passing in a very small stream, is acrid, dark colored, soon becomes cloudy, and exhales an offensive odor. Petroselinum: Dysuria with an incessant inclination to make water. Cantharides: Difficult urination, the urine passing only in single drops, attended with severe burning in the region of the bladder and urethra. When abuse of Cantharides or other poisons is the cause, Spirits of camphora will prove the most serviceable remedy. Warm fomentations and injections of tepid water sometimes give considerable relief. Salt should be taken in great moderation, and acids alto- gether eschewed. The diet must be sparing, and consist prin- cipally of gruel. Exposure to currents of air must be avoided, by those who are subject to urinary complaints. (See causes and their proper remedies.) Hydropathic treatment—Copious, water drinking, and warm nip-baths; in severe cases the full warm-bath may be necessary. Eclectic treatment. — Diuretic drops: Take sweet Spirits of Nitre and Oil of Sweet Almonds, of each two ounces; Balsam 19 434 AFFECTIONS OF THE URINARY ORGANS. Copaiba and Alcohol, of each one ounce; oil of Juniper, Oil of Spearmint, and Oil of Turpentine, of each, one-half ounce. Dose from one to two fluid drachms, or tea-spoonfuls. (See Enuresis.) ENURESIS — INCONTINENCE OF URINE. Frequent or perpetual discharge, with difficulty of retaining the urine. Causes.—Belaxation, or a paralytic affection of the bladder; worms; the presence of gravel; acrid quality of the urine; debility of the sphincter of the bladder; superabundant secre- tion; hot drinks; diuretic drinks; intoxicating liquors; &c Treatment allopathic—Bemove the causes of local irrita- tion, as, worms, gravel, and gastric accumulation. Enuresis caused by debility of the bladder requires: cold douches, elec- tricity, cantharides, and -astringents applied internally and externally. In incurable cases a urinal or a compressor should be worn. Nightly enuresis of children is most frequently only a bad habit. They should abstain from tea and other drinks in the evening, and must be awakened several times during the night to make water. A mild chastisement in the morning proves often of great benefit. (See Worms.) Homoeopathic remedies. — Enuresis caused by a too free use of spirituous liquors: Nux v., Opium, Lachesis, Sulphur and Calcarea. By paralysis of the vesica: Cicuta and Electro-magnetism, cold bathing, &c. Spasmodic enuresis requires: Camphora, Belladonna, Hyoscyamus, Ignatia, Nux v., Pulsatilla, Conium, Cina and Bhus. If caused by inflammation about the neck of the bladder and urethra: Aconite and Cantharides should be chiefly em- ployed. By gravel: Calcarea, Nux v., Cannabis, Ura, Phos- phorus or Petroleum. By acrid or highly acidulated urine: Mercurius, Hepar, Kreosotum, Laurocerasus, Arsenicum, Gra- phites, Iodine, Veratrum. Also drinking freely of cold water, barley-water, or linseed-tea. INCONTINENCE OF URINE. 435 Nocturnal Enuresis: Belladonna, when the complaint pro- ceeds from cerebral irritation; Kreosotum, wdien the emission only takes place during sleep; Cina, when the existence of Worms in the alimentary canal appears to be the irritating cause. In other instances, Silicea, Pulsatilla, Sepia and Sul- phur may be indicated. Hydropathic treatment.—The causes should be removed and the same plan of treatment pursued as recommended for Diabetes. Eclectic treatment.—The bowels should be kept in a soluble condition by mild laxatives; an irritating plaster should be applied to the sacrum, and the spinal column should be touched with cold water, twice a day. Internally, the follow- ing mixture is recommended: Take Compound Syrup Stil- lingia four ounces, Iodide of Potassium one drachm, tincture Cantharides one ounce. Mix one drachm in about a wine- glassful of water, three times a day, until it produces the spe- cific effect of the Iodide upon the head, and also, Strangury. Cases in children and adults arising from a debility of the urinary organ the isinglass mixture has proved effectual: Take of isinglass two drachms; boil it in one pint of water until it is dissolved; then strain, and add one pint of sweet milk, put it again over the fire, and let it just boil up; then sweeten it with loaf-sugar, and grate nutmeg upon it. Dose: For an adult, a tumblerful three times a day. In some cases the following diuretic compound will be found of efficacy: take Pulvis Eupatorium Purpureum, Aralia Hispida, Althaea officinalis, Epigma Bepeus, one ounce of each. Steep the compound in four pints of water for about four hours, then add four pints of good Holland Gin, heat it until it boils, and when cold sweeten with honey. This compound will also be found useful in all urinary diffi- culties, as suppression, heat, high color, difficulty in urinating, gravel, &c Dose : In severe cases a wineglassful every hour until relief is obtained, after which, and, also, in mild cases, i wineglassful three or four times a day. 436 AFFECTIONS OF THE URINARY ORGANS. FISTULA IN PERIN.EO — FISTULA URINARIA — URINARY AB- SCESS AND FISTULA. Fistula? in Perinaeo are ulcerated openings in the Perinaeum, generally the result of a stricture in the urethra. The urethra becomes ulcerated immediately behind the seat of the obstruc- tion, and the urine escapes into the membrane; the injected parts swell and inflame; suppuration speedily supervenes; the abscess bursts, and the fistulous opening, forming an outlet for the urine, is produced. In some cases no urine is dis- charged from the aperture until two or three days are elapsed, but in others, it flows from the first, intermixed with fetid pus. The secretion of pus then diminishes, and the urine passes out of the new channel in large quantities. Several external openings are occasionally formed. Fistulse of a similar nature to the foregoing, may be produced in the groin, scrotum, and even at the base of the penis near the pubis; and in some rare cases they form a communication between the rectum and the part of the urethra behind the obstruction. Treatment. — The abscess which forms the swelling in the Perinaeum should be opened early; and the strictures which cause the fistula must be removed, in the manner recommended under contraction and stricture of the Urethra; when these are removed, the urine resumes its natural course, and the fistulous aperture closes. If no stricture exists, or after its removal, a gutta percha catheter should be introduced into the bladder and worn con- stantly. The hard callous edges of the ulcer are then to be disorganized by the repeated application of the mild caustic, or the pure potash, if necessary. Before applying the caustic, the parts should be soothed with warm fomentations and if the Urethra is too irritable for the constant employment of the catheter, the patient should keep on his back while it is with- drawn, taking care to haye the instrument introduced before he rises, so that the bladder may be emptied without allowing any urine to come in contact with the ulcerated parts. Homoeopathic treatment. — Besides the foregoing surgical BLOODY URINE. 437 treatment Homoeopathists recommend: Silicea, Sulphur, and Calcarea, and in some cases Mercurius, Arsenicum, Lachesia or Cantharides, in order to effect the healing of the fistulous ulcer. If the introduction of a gum catheter is impracticable from the stricture remaining entire, a staff may be passed down the urethra as far as the stricture, the canal laid open, a ca- theter conveyed into the bladder, and kept there until cicatri- zation is accomplished. Gravel, — (See Calculus.) HEMATURIA--BLOODY URINE. The hemorrhage is from the bladder, urethra, or kidneys, and the symptoms differ accordingly. The blood is sometimes intermixed with urine. When the blood proceeds from the kidneys, the urine first expelled looks muddy and high colored, is usually very copious, and attended with acute pain in the back, anxiety, numbness in the thighs, drawing up of the testes, constipation and other abdominal derangements. When from the urethra, the symptoms are nearly the same as the foregoing, with the exception of the pains extending from the lumbar region along the course of the urethra down into the pelvis, with strangury, and sometimes nausea, and vomiting. In hemorrhage coming from the bladder, we commonly meet with spasm, dysury, occasionally severe burning and other pains in the perinaeum, penis, and anus during and subsequent to the act of micturition. In severe cases we find syncope, cold sweats, chills and debility. Causes.—Falls; bruises; blows; violent exertion; hard riding; the lodgement of a small stone in the kidney or urethra; inflam- mation of the kidneys; irregular menstruation; suppressed piles; excessive indulgence in spirituous drinks; tea; frequent use of asparagus; excess in venery; frequent external or inter- nal employment of cantharides. Treatment allopathic — The cure consists in the removal of toe causes, and in allaying the irritability of the kidneys and 438 AFFECTIONS OF THE URINARY ORGANS. other urinary organs. In violent hemorrhage we must apply bold compresses to the lumbar region, and administer inter- nally, astringent remedies, as: Kino, Batanhia, Alum-whey, preparations of Iron, and oily emulsions; also Cannabis and Secale cornutum. In ordinary cases local abstractions of blood, warm baths and clysters. After maltreatment with Spanish flies: Camphor in an oily emulsion should be administered. If it is owing to Calculus, see its treatment. If stoppage of the urinary discharge takes place, caused by coagulated blood in the urethra, injections, bougies, and cathe- terism are required. In all kinds of Haematuria a table-spoonful of poppy—or almond oil, taken morning and evening has proved beneficial. Homoeopathic treatment. — When the disorder has resulted from external violence: Arnica, internally and externally, and Aconitum will be found advantageous; when it has originated in the employment of Spanish fly, a drop or two of Spirits of Camphor must be given and repeated every two or three hours until relief is obtained. In all other cases, where we are uncertain as to the exciting cause, we will find Cantharides, administered in small doses, the most important remedy, and in some instances Pulsatilla, Clematis, Mercurius, Cannabis, Sabina, or Uva ursi. Water or barley-water should, in most cases, be drunk in considerable quantities. Hydropathic treatment. — Contraction should be excited in the bleeding vessels by applying locally the coldest water, giving cold injections and cold hip-baths. If there is feverish heat, or inflammatory excitement, the whole body must be promptly cooled with the dripping sheet or ablution. Eclectic treatment — When uncomplicated, haematuria is to be treated similar to the other hemorrhages, by astringents, rest, abstinence, and cooling mucilaginous drinks, with other auxiliary means, as indicated by the symptoms. When it M RETENTION OF URINE. 439 of a passive character, the oil of Turpentine may be used with benefit. Infusions of Lycopus virginicus, Geranium maculatum, Althaea officinalis, Flaxseed or Uva ursi and the Peach-leaf decoction may be used alternately, in obstinate cases. If the patient is suffering from pain, a cup or two may be applied to the seat of the difficulty, and followed by hot fomentations of hops, and the internal use of one-eighth of a grain of morphine. HiEMORRHOIDES VESICAE—PILES OF THE BLADDER AND URETHRA. Blind piles generally create difficulty in making water, stran- gury, ischury, vesical spasms, inflammation, induration and suppuration of the bladder. In bleeding piles haematuria occurs. Treatment — (See Hemorrhoids and Haematuria.) HYPOSPADIAS — EPISPADIAS. Openings of the urethra in the upper or under surface of the Penis. The appearance in most cases is as if the lower part of the urethra were split up and down. Treatment.—The parts may be pared or cauterized and made to adhere. ISCHURIA — RETENTION OF URINE. Distension of the bladder, forming a perceptible swelling in the hypogastric region; tenderness and tumefaction of the entire abdomen, fever, frequent and ineffectual inclination to pass water, accompanied by intense pain. Ischury, whew it continues for any length of time, is always a dangerous affection. Causes.—Inflammation or stricture of the urethra; sup- pressed piles, spasm of the neck of the bladder; inflammation or paralysis of the bladder; excessive use of spirituous liquors; pressure of the rectum from indurated faeces, or of the uterus, tumors, &c, on the neck of the bladder; gravel; swelling or ulcer of the prostate gland. Treatment allopathic — Ischuria accompanied with inflam- matory symptoms requires: local and general blood-letting, 440 AFFECTIONS OF THE URINARY ORGANS. clysters, anodyne poultices to the abdomen; embrocations of mercurial ointment with camphor and oil of hyoscyamus; internally nitrate of potassa with calomel. In spasmodic retention of urine we employ narcotics, espe- cially opium and extract of hyoscyamus, and injections of oil with laudanum. Paralytic ischuria, the introduction of the catheter, appli- cations of Peruvian bark, Therebinthina, Arnica to the spine, and electricity to the bladder become necessary. Homoeopathic treatment — Bemedies best adapted to over- come all ordinary cases of Ischury are, according to symptoms and causes: Aconitum, Camphora, Cantharides, Sulphur, Cal- carea c, Nux v., Carbo v., and Arsenicum. In many instances we must also have recourse to the intro- duction of the catheter, to the application of hot or cold fomen- tation to the pubic region, tepid injections and the hip-bath. In retention of urine from hernia of the bladder, the urine should be taken away by means of the catheter, the protruded bladder reduced, and a truss applied. Hydropathic treatment — A hot hip-bath, or hot fomenta- tions to the abdomen, followed by a dash of cold water, will, in most cases, give relief; if they fail, the catheter must be promptly employed. Eclectic treatment.—To restore the functions of the kidneys and the consequent secretion of urine, the patient must be placed in a bath as warm as can be borne, in which he should remain until approaching syncope; he should likewise be made to drink freely of an infusion of equal parts of Queen of the Meadow root, Marsh-mallow root, and Peach leaves, or an infusion of Uva ursi and Spirits of Nitre; and this drink should be continued for several days after the return of the urinary discharge. Should constipation be present, the com- pound powder of Jalap may be given. Spirits of turpentine given in twenty drop doses, three times a day and cantharides in thirty drop doses, is recommended. To prevent the return of the attack, an irritating plaster INFLAMMATION OF THE KIDNEYS. 441 should be applied intermittingly over the region of the kid- neys, and the following pill given internally: Take Eupur- purin, two scruples; Xanthoxylin, one scruple; Strychnia, one grain; mix; divide into twenty pills, giving one at a time, three or four times a day. When the disease is owing to a disorganized condition of the kidneys, palliative measures are all that can be of service. Inflammation of the bladder. — (See Cystitis.) Lithiasis. — (See Calculus.) MORBUS BRIGHTII — BRIGHT's DISEASE — GRANULAR KIDNEY —DEGENERATION OF THE KIDNEYS. The patient is dropsical, evacuates an albuminous urine, which coagulates when exposed to heat, and suffers from fever, and from pains in the renal region, and Haematuria. The disease is seldom cured, when fully developed. Treatment — Cupping, afterward small vesicatories, or Issues over the seat of the disease have been recommended. The skin should be kept active by frequent baths and frictions. The patient should partake freely of horseradish, and the bowels must be kept free by injections, and by administering, inter- nally, Pills made of Croton-oil.—A pill composed of the alco- holic extract of Sambucus, extract of Taraxicum, and the Leptandrin powder, two administered three times a day, has proved of benefit. NEPHRITIS — INFLAMMATION OF THE KIDNEYS. General fever, pain in the region of the kidneys, extending to the groin and along the urethra to the neck of the bladder; the pain is deep seated and increased by the erect posture, by coughing, sneezing, pressure, and by straightening the leg of the affected side. There is, also, Strangury; Ischury; hot and high colored bloody urine; drawing up, swelling, and pain of the testis on the affected side; numbness and spasms, of the foot on the same side; nausea, vomiting, colic and tenesmus; costiveness; tympanitis of the abdomen; depres- sion of spirits. Causes.—Excessive use of stimulants; falls or strains; ex- 442 AFFECTIONS OF THE URINARY ORGANS. ternal injuries; abuse of Diuretics, and Cantharides; stone or gravel; hard water; suppressed hemorrhoids, or menstrua- tion; long lying on the back. Treatment allopathic. — Venesection, leeches, narcotic fo- mentations ; lukewarm baths, oily remedies and mucilaginous drinks; mild laxatives of manna and tamarinds; cataplasms, frequent clysters. Violent vomiting requires Opium in emul- sions; abuse of Spanish-flies, Camphor; obstinate cases, Cal- omel and Opium (three to four grains of Calomel and one of Opium every two hours until relief is obtained). The use of Blister-plasters and Nitre must be avoided. When gravel is the cause of inflammation, mineral waters containing Carbonic acid gas should be administered. In chronic cases cups, decoction of uva ursi, oil of turpentine and copaiba, pure air and flannel next the skin are recommended. Homoeopathic remedies. — Aconite: Should be administered in repeated doses in the inflammatory stage of this disease. Cantharides: Urine passes off in drops, or is tinged with blood; micturition is exceedingly painful, with burning in the urethra; shooting, cutting and tearing pains in the loins and region of the kidneys; complete strangury. Cannabis: Obtuse aching or pressive pain; or a sensation as if from excoriation, extending from the region of the kid- neys down toward the groin; painful and difficult urination. Nux v., Pulsatilla, Belladonna, Colchicum, Arnica and Camphora will be found useful in some cases. When an abscess forms or suppuration commences, which stage is characterized by cessation of the acute pain; sensa- tion of throbbing and a feeling of weight in the region of the kidneys, alternate chills and flushes of heat and copious perspiration, we must administer Hepar, Mercurius, Arseni- cum, Silicea, Sarsaparilla, and Kali nitricum. When the disease arises from the pressure of calculi in the kidneys, the use of Nociatiana rustica has been found a useful palliative; also: Lycopodium, Sarsaparilla, Cannabis, Meze- reum and Belladonna are of benefit. KlDNEY-CONSUMPTION. 443 Hydropathic treatment. — When the fever is not violent, the warm hip-bath will alleviate the pain; if the heat of the sur- face is great, cooling wet-packs and the cold hip-bath will produce the greatest relief. One or the other must be fre- quently employed with general and topical treatment, usually employed in inflammatory diseases. Eclectic treatment. — During the whole course of the disease the surface of the body must be bathed frequently with an alkaline wash, the bowels be kept open, and the compound tincture of Virginia snake-root should be given to allay pain, soothe nervous irritability, and keep up a tendency to the surface. Cups, followed by an onion poultice, will prove of benefit. Diet used should be: Cold water, gum Arabic water, flax- seed tea, chicken or mutton broth, barley water. In long standing and obstinate cases an irritating plaster should be applied to the lumbar region. Nephralgia—Pain in the Kidneys. — (See Calculus and Nephritis.) PARALYSIS VESICAE URINARIA. Paralytic affections of the bladder are recognized by the absence of pain and the facility of introducing the catheter; also by the circumstance of urine being discharged by exter- nal pressure to the bladder. Causes.—Old age; long retention of urine; apoplexy; abuse of diuretics; inflammation and irritation of the blad- der. Treatment—The urine should be evacuated by the catheter once in twelve hours, and the bladder invigorated by cold lotions and douche, electricity, injections of cold water, and vesicatories. Homoeopathic remedies. — Arsenicum, Cina, Dulcamara and Hyoscyamus. PHTHISIS RENALIS — KIDNEY-CONSUMPTION. Emaciation; pain and pressure in the renal region, increased by lying on the back; drawings in the leg and lower foot of 444 AFFECTIONS OF THE URINARY ORGANS. the side affected; discharges of pus with the urine; diarrhoea; lingering fever. Causes. — Inflammation of the kidneys; shifting of pus from other parts to the kidneys; &c Treatment, — Existing inflammation should be properly re- moved. The ulceration must be arrested, which can be best accomplished by the internal use of China and Uva ursi. When the matter appears on the surface, which can be recognized by swelling and fluctuation, the abscess should be opened. The patient must use light nourishing food and avoid all stimulants. Homoeopathic remedies. — Mercurius, Hepar, Silicea, Cal- carea, Arsenic and Sulphur. PHTHISIS VESICALIS. Consumption of the bladder consists in discharge of matter and bloody mucus from the bladder, accompanied with evacu- ation of offensive urine, strangury, pain in the bladder, hectic fever, emaciation. Treatment, — (See Phthisis renalis.) POLYPUS VESICALIS--POLYPUS OF THE BLADDER. (Compare polypus of the nostrils and vagina.) Homoeopathic remedies. — Calcarea and Staphysagria. Retention of Urine. — (See Ischuria.) Strangury.— Difficulty of voiding the urine. (See Dysuria.) Strictura urethrae. — (See Contraction.) Stone in the kidneys or bladder. — (See Calculus.) Spasms of the tirethra. — (See Strictures.) Thickening of the bladder. — (See Catarrhus vesicae, and Cystitis.) Ulcera urethrce. — Ulcers in the Urethra. (See Gonorrhcea, Urethritis, &c,) Urethritis. — (See Gonorrhoea.) Urine.—Difficulty in passing. (See Dysuria and Stran- gury.) URINARY DIARRHOEA— UNASSIMILATED URINE. Impregnation of the urine with various alimentary and SUPPRESSION OF URINE. 445 medicinal articles, which have found their way into the kid- neys and bladder unchanged. In some cases of impaired digestion, the urine is impregnated with a matter resembling chyle. This affection is but an effort of nature to rid the body of "unnecessaries." Treatment.—Diet, cleanliness, and abstinence from such food, drink, and medicinal substances as nature cannot make use of. URINE, DESTITUTION OF—SUPPRESSION OF URINE. No secretion of urine by the kidneys, without sensation of fullness, or uneasiness in the bladder, and no desire to urin- ate. The introduction of the catheter confirms the want of Becretion. Nausea, constipation, and a sense of sinking ac- company this disorder. In some cases vomiting, pain in the back, hiccough, headache and restlessness are present. Some- times sweating supervenes, and the perspiration has been found to exhale a strong, urinous odor. The disease gener- ally proves fatal in a very few days. Causes.—Loss of secreting power of the kidneys; gouty habit; suppression of an eruption, of piles; &c Fat, corpu- lent persons are subjects of this complaint. Allopathic treatment.—Arnica ; cinchona ; stimulant diu- retics, as juniper, turpentine, cantharides, &c Cold affusions to the region of the kidneys; electricity; vesicatories, and moxas to the lower part of the spine. Homoeopathic treatment—Bemedies, which have been em- ployed with success, are: Aconite, Camphor, Cantharides, Nux v., Pulsatilla, Belladonna, Opium, &c. When exposure to wet and cold has produced the complaint, Dulcamara will prove of service. Hydropathic treatment.—To relieve the blood of its urinous accumulations, the wet-sheet pack and dripping-sheet should be employed, while the action of the kidneys should be exci- ted by the alternate hot and cold hip and foot-baths; or per- haps, the warm douche, followed by the cold, to the loins and 446 AFFECTIONS OF THE URINARY ORGANS. abdomen. The bowels should be moved by copious injections. (See Ischury.) Eclectic treatment.—If inflammation of the kidneys is the producing influence the case should be treated as for that disease. But if the case is dependent upon mere atony of the renal glands, the cider and elder preparations, with cream of tartar and rock candy, a decoction of mullen leaves, water- melon seed tea, an infusion of parsley or pumpkin seeds (an ounce to a quart of water) may be taken in wine-glassful doses three times a day. UROPLANIA — ERRATIC URINE. An affection in which a urinous fluid is secreted from vari- ous parts of the body, as: stomach, bowels, skin, ears, eyes, nostrils, breasts, navel, and at ulcerous surfaces and openings. Causes.—Atony of the kidneys. Treatment — (See Suppression of Urine.) URODIALYSIS — ACRID URINE. In Urodialysis infantum the discharge of urine is very diffi- cult and painful. The few drops evacuated are of a red color, and tinge the linen red. The little patients scream and are in great agony when urinating; vomit, and suffer from cos- tiveness. A short time after these symptoms first manifest themselves, the surface becomes raw and sore in different pla- ces, and the affected parts become moist, are of a brown color, they spread, and have a urinous odor. Urodialysis senilis affects persons of old age. The first symptoms are acidity, flatulency, loss of appetite, diminished secretion of urine, burning when urinating, sleeplessness, tearing pain along the crural nerves. Afterward the patients experience a burning and itching all over, especially during the night (Prurigo senilis), little, itching swellings appear in different parts of the surface (Epinyctis), which gradually form into painful ulcers, occupying, principally, the front part of the legs, and secreting a corrosive liquid of a disagreeable urinous odor. Toward evening patients suffer from violent Asthma (Asthma urinosum.) VARIETIES OP URINE. 447 In some cases this disease is accompanied with scirrhous affections in the face and inflammation of the eyes. Treatment. — Diet, cleanliness, keeping the bowels free, are the principal means recommended; also: Diuretics and Dia- phoretics. URETHRA-IMPERFORATE. When this is a congenital malformation, a round trochar is to be inserted, followed by a canula, and then by a catheter, and this is retained until the orifice heals. VARIETIES OF URINE. Healthy urine is straw=colored of a specific but not fetid odor, and remains clear. In summer it is less copious and darker colored than in winter. Sedentary life increases the quantity and the paleness. In old persons it is diminished, darker, and fetid. Females have paler urine, and more sediment in it. Much drinking increases the quantity and paleness of urine. Rhubarb makes it light yellow; Asparagus, fetid. Urine, which is to be used for examination, must have been voided six hours after meals; it then must be left untroubled for two hours in a cool temperature, and be not brought quickly from a cold into a warm place, or the reverse. Red urine is, with quick pulse, a sign of fever, internal heat and inflammation. Muddy, thick urine, with much sediment, and bloody (Urina turbida) indicates a colliquative state of the blood inclined to dissolution. Thick, black urine (urina nigra) is a sign of a high degree of putridity, and inflammation terminating in gangrene. Greasy urine indicates a high degree of hectic dissolution. Saffron colored urine (Crocea) is a sign of bile in the blood. Urine containing matter is a sign of internal suppuration. Critical sediment in Urine falls down soon after urination, is white or grayish, light, and about one-fourth to one-sixth of the whole. 448 AFFECTIONS OP THE URINARY ORGANS. Red, bile-colored sediment indicates intermittent fever, or a rheumatic character of the disease. Thick, dark-colored urine, with a white, chalky sediment, indicates urinary calculus, or an arthritic character. Dark, black sediment indicates a putrid disease. Milky urine is a sign of worms. Changeable urine in fevers indicates a nervous character Suppression of perspiration renders the urine watery and in- creased in quantity. Slimy urine indicates blenorrhcea vesica?, or calculus vesicae Bloody urine, a bleeding from the kidneys or bladder. Excessive quantity and aqueous quality of urine, indicates Diabetes. Painful, difficult, impeded evacuation of urine, indicates spasm, inflammation, local disease; involuntary passage, paral- ysis, or very dangerous fevers. CHAPTEB XVI. DISEASES OF THE GENITAL ORGANS. ADHESION OF THE LABIA PUDENDUM. This affection should be removed by gradual distention, or by the knife. AMENORRHEA — SUPPRESSION OF THE MENSES. The monthly period not appearing at the regular time, or being suddenly stopped during its course, is generally attend- ed with headache, difficult breathing, and palpitation; with cedematous swelling of the feet and ankles; with dyspeptic symptoms, and a longing for innutrient and injurious sub- stances. In some cases there is a troublesome cough, with Bymptoms of general decline. Causes. — Exposure to cold; getting the feet wet; over- heating; powerful mental emotions; organic diseases; imper- forate hymen. Treatment allopathic — When sudden stoppage of menstru- ation takes place, the patient should take a warm hip-bath, and swallow some warm drinks. When attended with violent abdominal pains and inflammatory symptoms, we must make first a venesection, or apply leeches to the genital organs; afterward resort to narcotic cataplasms to the lower part of the abdomen, foot and steam-baths, and emollient injections into vagina. Should these means prove unsuccessful, admin- ister borax, pulvis aerophorus. When all signs point to a spasmodic state, foot and steam- baths, cataplasms, injections, and internally pulvis aerophorus along with extract, hyoscyami and crocus, or extract, taxi, one grain as a dose, also castoreum and chamomile tea are service- able. 19t 449 450 DISEASES OF THE GENITAL ORGANS. If this be too weak, add a few drops of laudanum; the same also to the injection. In morbid retention of the menses,—when pregnancy is not suspected, and when it is not the consequence of peculiar organization,—caused by debility, blood-letting, hard labor, severe diseases, fluor albus, means should be adopted to strengthen the patient by generous diet and moderate use of wine, with gentle exercise, and remove the causes. Should this treatment not suffice, recourse must be had to prepara- tions of iron and aloes, one grain of aloes and from five to ten grains of iron, may be given in the pilular form three times a day for months; also to ergot, iodine, electricity, dry cupping, leeches, injections of aloes; also the ammoniated tincture of guajac, in the use of a fluid drachm three times a day. The following formula is highly recommended to pro- duce from within a stronger rush of blood to the uterus: Take of Chamomile, Melissa, Crisp mint, each two drachms; Savin, one drachm; mixed, and infused in two cups of boiling water; half to be taken morning and evening. Homoeopathic treatment. — When suppression takes place from the sudden effects of a chill, Pulsatilla will be found the most important remedy; and in some cases, Nux moshata, Dulcamara, Sepia or Sulphur. When sudden fright has giv- en rise to the affection, Aconitum should be immediately ad- ministered, followed by Lycopodium, Opium, or Veratrum. if only partial relief is obtained from the employment of the first remedy. In chronic cases occurring in weak or debilitated individu- als, the following remedies are useful: Sepia, Sulphur, Natrum m., Conium, Arsenicum, China, Graphites, lodium. In plethoric persons, Aconitum, Belladonna, Sulphur, Bry- onia, Nux v., Sabina, Opium, Platina, will be found the most serviceable. When there is not a complete suppression, Graphites, Kali, Conium, Phosphorus, Pulsatilla, Sulphur, Lycopodium, Veratrum, or Zincum, are the most important remedies. SUPPRESSION OF THE MENSES. 451 Hydropathic treatment.—Sudden suppression of the dis- charge during the period of menstruation must be overcomo by the envelopment in the blanket, by the application of warming bandages to the abdomen and back, followed by ablu- tion and foot-baths. One envelopment, and two or three foot- baths daily, will generally suffice. If mental emotion, or exposure to cold be the cause of the irregularity, the wet sheet must be brought into application once daily, the patient remaining in the envelopment until perspiration ensues. In addition to the moderately cold ablu- tion, which must follow the wet envelopment, the patients must take two sitting baths at 59° Fahrenheit, remaining one-fourth of an hour in each bath; and wear wet bandages around the body. In cases of debility and languor, the patient must take a general ablution daily, drink soft water freely, exercise in the open air, and employ all other means recommended for the improvement of the general health. To bring on menstrual secretion, two sitting-baths at 68° Fahrenheit must be taken daily, remaining half an hour, in each bath. During the period of menstruation, the sitting- bath must be discontinued. Eclectic treatment. — When the patient is plethoric, a deple- tive treatment will be required, as: purgatives, diuretics, and diaphoretics, which should be continued both during the cata- rnenial effort and the intervals. After proper depletion by these means, the patient should be placed upon the use of Macrotin, Caulophyllin, Senecin, &c, for the purpose of acting more especially upon the reproductive organs, and imparting to them tone and energy. Debilitated patients require Tonics and Stimulants. Qui- nine and Iron, some one of the various preparations of Iron, the compound wine of Comfrey, &c, may be used in connec- tion with the agents above named. The diet, in this latter case, should be nutritious and generous. Anaphrodisia—Incapability of sexual intercourse.—(See Im- potentia. 452 DISEASES OF THE GENITAL ORGANS. ATROPHIA GENITALIUM Atrophia of the genital organs of men is known by the small size of the penis, and small, hard or soft testicles; abdomen and pelvis large; delicate skin; a feminine voice; absence of a beard, and hairs on the Genitals; small vasa spermatica, and watery semen. Strong development of the masticating appa- ratus; mental powers undeveloped. The feet are in most cases swollen, with ulcers on the ex- tremities. This disease is generally found in Asia, produced, perhaps, by the peculiar climate, much riding on horse-back, and the use of horse-milk. Treatment.—The people in Asia use for the treatment of the leprous ulceration, external applications of Arsenicum with fat and black pepper. ATROPHIA GENITALIUM ACQUISITUM — ACQUIRED ATROPHY OF THE GENITAL ORGANS. The Genitals of patients are fully developed; gradually the testes, one after the other, loose all sensibility, become hard and decrease in bulk to the size of a bean or pea; the penis looses all power of erection; there is no desire for sexual intercourse; no emission of semen; the extremities are weak; loss of hair and emaciation takes place; the voice and mental power become weak, and the patients are childish. Causes—Excessive coitus ; gleet; abuse of brandy made of dates in West Asia ; Scrofula. Treatment.—Embrocations of phosphor-liniment; spiritusser- pilli; Eau de cologne; iron baths; internally, vanille and tinc- ture of cantharides; proper diet may, perhaps, prove serviceable. ATROPHIA GENITALIS FCEMINAE— ATROPHIA OF THE GENITAL ORGANS OF WOMEN. The genital organs, uterus and breasts, either remain unde- veloped, or after being developed, gradually decrease in size, and their functions cease. The latter variety is generally caused by excessive coitus, frequent conceptions, hemorrhage, hard work and poverty. BUBONES. 453 Treatment should consist in the employment of such means, as will strengthen and improve the general health, and prevent pulmonary consumption. BALANITIS. Inflammation of the mucous membrane of the glans penis, and inner layer of the prepuce. This disease generally occurs simultaneously with inflam- mation of the Urethra after impure connexion, and requires the same treatment as Urethritis, and Gonorrhoea. In some instances it arises from mechanical injury, or from poisonous plants; in others, it is of a syphilitic or sycosic origin. (See Gonorrhoea.) Balanorrhoea. — (See Gonorrhoea.) Barrenness.—(See Sterility.) BUBONES. Buboes are glandular swellings in the groin, sometimes in the axilla, and generally appear in consequence of Syph- ilis. But there are, also, Buboes which appear sooner or later after coition, and after getting the feet wet without any other symptom of venereal infection. Treatment allopathic — The same remedies should be em- ployed, which are recommended for Gonorrhoea and other venereal diseases. Externally fomentations of tepid lead water should be employed. If they continue after the inflam- mation has been removed, the internal use of Mercury must be resorted to. If they appear as a symptom of primary infection without clap or chancre, the immediate internal use of Mercury must be prescribed. Homoeopathic remedies. — Mercurius sol: should be given in the third trituration, half a grain night and morning, when the swellings are neither inflamed nor particularly painful, until signs of improvement make their appearance. Belladonna: Swellings large and painful, accompanied by intense inflammation, red hue extending over a considerable 454 DISEASES OF THE GF.NtTAL ORGANS. #• surface, the redness disappearing on pressure, but returning immediately after the finger is removed. Silicea and Hepar should be administered when suppuration threatens, or when it is already established. Staphysagria: When the mouth and gums are much in- flamed or ulcerated, and in obstinate cases of this kind, Carbo v., Sulphur, and Nitric acid will prove useful. In some cases it is necessary to open the swelling by the lancet, afterward the treatment must be conducted according to the character and appearance of the ulcer. (See Ulcers.) Sympathetic buboes require: Belladonna, Hepar, Silicea and Sulphur; Scrofulous buboes: Mercurius, Dulcamara, Bella- donna, Silicea, and Sulphur. Also: Iodine, Nitric acid, Au- rum, Arsenic, Carbo v., and Staphysagria. (See Syphilis and Gonorrhcea.) CANCER OF THE WOMB—SCIRRHUS AND CARCINOMA UTERI. Darting, twinging pains in the uterus, coming on and going off suddenly; bearing down, with pain in the back, and in the inside of the thighs; shooting through the region of the pelvis; leucorrhcea, monthly discharges are sometimes excessive, at other times very scanty and accompanied with violent pains. Dangerous hemorrhage often takes place in an advanced state of the disease. On examination the neck of the womb will be found hard and rough, painful to pressure, and in many cases enlarged. As soon as ulceration occurs, there is a sanious, bloody, or mixed and highly offensive discharge. Allopathic treatment. — (See Scirrhus.) Homoeopathic remedies. — Belladonna, Arsenicum, Staphy- sagria, Thuya, Carbo v., Clematis, Conium, Silicea. Eclectic treatment. — The constitutional treatment consists in taking a daily alkaline bath, keeping the bowels regular, and taking the alterative syrup. Local treatment must be commenced with tepid water injec- tions in the womb by means of a silver catheter. These injec- tions should be continued, until they occasion pain no longer, CANCER OF THE BREAST. 455 then use weak soap suds, increasing its strength as the patient can bear. In a few days a little mild caustic may be added, increasing the quantity until a saturated solution can be used. If the caustic should produce great irritation at any time durino- the treatment, injections of slippery elm mucilage should be substituted, and warm applications applied over tho pubic region. The injections must be repeated once, or, better, twice a day. The powdered caustic may also be applied, two or three times a day, to the neck of the womb, by placing a piece of black salve or wax on the end of the finger, with a cup like depression in it, filled with the powder. As soon as a more healthy condition of the cervix has thus been brought about, a strong decoction of the Epiphegus Vir- "inianus should be injected into the vagina and womb once a day,—the caustic solution being used at some other part of the day. Bad cases require ten or twelve months of treatment in order to produce a radical cure. CANCER OF THE BREAST. Scirrhus of the breast commences as a hard, circumscribed, moveable swelling in some part of the breast, attended with an itchy feeling. After a few weeks, or months, it becomes affected with paroxysms of violent, lancinating pain, which are apt to occur about the period of menstruation. Not unfre- quently a little bloody fluid is discharged from the nipple. The diseased breast is often smaller than the sound one; the nipple is generally drawn in, and the skin around is prickered like a cicatrix. The tumor ere long becomes more elevated, and feels knotty to the finger; at length it ulcerates, and forma a cancer, discharging first an ichorous fluid and later an offen- sive and fetid matter. Id some cases the patient sinks from the cancer affecting vital organs, even before the stage of ulceration. In others, life may be protracted ten, twenty, and even thirty years. Causes. — Most cases of cancer of the breast are caused by 456 DISEASES OF THE GENITAL ORGANS. ill-timed and improper lancing of mammary abscesses, espe- cially where the ineission is made across the course of the lactiferous ducts. Treatment allopathic, — The local and general treatment must be conducted on the principles laid down in the section of scirrhus generally. Extirpation is the only remedy, and is thus performed: The patient being placed in a convenient position, an assistant takes the arm of the affected side and holds it out, so as to put the pectoralis on the stretch. A semi-eliptical incision is then made, below the nipple, along the lower border of the pectoralis major, and another on the upper and inner side of the nipple, so as to include that part between them; next the lower and outer part of the gland, quite down to the pectoralis, must be dissected out, and then, cutting from below upward, the remainder is separated. When the mass is removed, its surface and the wound should be well examined, to ascertain that no part of the gland, or any hard- ened or discolored portion of cellular tissue or muscular fibre, is left behind. Arteries are then to be tied, and the patient put to bed, — and when all oozing has ceased, a few strips of adhesive plaster may be applied. The topical use of chloride of Bromine, it is said, has proved highly successful. The formula of the paste used, is the following: chloride of Bromine, three parts; chloride of Zinc, two parts; chloride of Antimony, one part; chloride of gold, one part; powder of liquorice sufficient to make a paste. Imbricated pieces of lint are spread with the paste, and left on twenty-four hours. The surrounding parts are protected by an ointment composed of one drachm of Chloro- form to an ounce of Axonge (lard). When the pledgets aro taken off, a line of demarcation is observed, which separates the altered from the healthy tissue. Bread poultices are then applied, or else lettuce leaves, or basilicon ointment, which should be changed every three hours, until the eschar ia thrown off, which event takes place from the eighth to the fifteenth day. CANCER OF THE TESTICLE. 457 Homoeopathic remedies.—The principal remedies for indura- tion and lumps of the breasts are: Carbo an., Conium, and Silicea. Cancer of the mammae requires: Arsenicum, Clema- tis, and Silicea. (See Cancer, Scirrhus, &c) CANCER OF THE PENIS. This disease generally begins either on the glands or on the prepuce, and occurs to elderly persons who have had Phy- mosis. It appears in the form of a small tumor, resembling a wart; its base is generally broader than its surface, and looks much more like a continuation of the substance of the gland. Finally, ulceration takes place, and fungous growths are thrown out as in other cases, and the matter discharged becomes fetid and bloody. It gradually destroys the whole organ, contaminating the glands in the groin. Treatment allopathic. — The parts must be amputated before the glands are affected. The surgeon stretches it out with one hand, and cuts it off with one sweep of a bistoury; bleed- ing vessels are then to be tied, and cold to be applied, and after three or four days a piece of bougie is to be introduced into the orifice of the urethra, and to be retained there during the cicatrization. Eclectic treatment. — Eclectics do not consider it necessary to have recourse to the knife. If there be much pain, inflam- mation and swelling, apply fomentations and emollients before caustics. Sulphate of Zinc is recommended as a very successful appli- cation in this disease. The affected parts should be filled and covered with the Sulphate of Zinc; the dressing kept on for five or six hours, on the first day, and a shorter period for several days in succession, although producing the most excru- ciating pain. (See Treatment of Cancer under General Dis- eases.) CANCER OF THE TESTICLE. At first the testicle swells and becomes very hard and heavy; there is no pain — merely a slight aching in the loins by its wtiirht. After a time it enlarges rapidly and feels soft; the 20 458 DISEASES OF THE GENITAL OUHANS. cord swells; there are occasional darting pains, a fungus pro- trudes, which easily bleeds, the lumbar glands become aflocted, and cachexia and death soon follow. The distinguishing features of the case are its opacify and weight. '"' Treatment.—Castration should be performed before the cord is affected, which is done in the following manner: The scrotum having been shave'd the surgeon grasps it from behind, and putting the skin upon the stretch, makes an inci- sion from the external abdominal ring to the bottom of the scrotum. If the skin is adherent to the testicle, hard, or otherwise in a diseased condition, two elliptical incisions may be made, so as to remove all the morbid part. The cord is next to be dissected-tout, and the artery separated from the other parts and tied. The cremaster muscle and vas deferens should be separated from the artery nearly up to the abdom- inal ring, in order that their contractions may not carry the artery beyond your reach. The whole cord can then be cut off below the tie, aud the testicle and all its covering beneath the Scrotum dissected out. The wound must not be closed until all hemorrhage has ceased. It should be closely watched for the first twenty-four hours, as there is great liability to secondary hemorrhage. In dressing the external wound, two or three sutures should be applied with adhesive straps be- tween them to keep the lips in contact. Chimney-sweeper's cancer is a foul, ragged ulcer of the scrotum, with the skin hardened, and tuberculated round. It commences as a small wart, and is caused by the irritation of soot. The remedy consists in extirpation of the ulcer, and of the diseased skin around it. Chancre.—An ulcer which arises from the direct applica- tion of the syphilitic poison. (See Syphilis.) Change of life— Critical age. — (See Menoposia.) Clap.—(See Gonorrhcea.) Condylomata. — A wart-like excrescence, which appears about the anus and pudendum. (See Urinary organs.) FALLING OF THE WOMB. 459 Consumption of the uterus. — (See Metro-phthisis.) DISPLACEMENT OF THE WOMB. Prolapsus of the uterus or falling of the womb, is attended with a heavy, disagreeable, or painful dropping down sensa- tion at the lower part of the abdomen; aching or weakness about the small of the back, and, when severe, great difficulty in walking or inability.to walk ; feeling about the rectum as if something should be allowed to pass the bowels; discharges from the vagina of a purulent character, sometimes tinged with blood; nervous and hysterical complaints. All the symptoms are aggravated by the erect position, and subside after lying down. In some cases the falling down of the womb or vagina drags -along the bladder with it, constituting complicated prolapsus. Causes. — Belaxed condition of the system, induced by idle- ness and high living; getting up too soon after confinement; leucorrhcca; falls; lifting heavy weights ; severe puking; tight lacing; heavy skirts; long continued coughs; abortion; mis- menstruation ; etc Treatment is chiefly mechanical. Pessaries, trusses, braces, and supporters of all sorts and shapes have been contrived for this purpose. Means to improve the general health should be employed, and the above enumerated causes strictly avoided. When retention of urine follows the falling down, or partial descent of the womb, the female should lie on her back, press the uterus into the pelvis, and urinate in that position. Homeeopatiric treatment — The principal remedies employed in this disease, are: Belladonna, Calcarea carb., Nux v., and Sepia. Take a dose of the most appropriate remedy every night for a week ; then suspend all medicine for a week, and if the symptoms have not abated, take the next best in the same manner. The patient should pay strict attention to diet. Hydropathic treatment—Simple and abstemious diet; brown 460 DISEASES OF THE GENITAL ORGANS. bread, baked apples, boiled potatoes, and soft water; a daily tepid dripping sheet or half-bath, with one or two tepid hip- baths ; a foot-bath in the evening, with two or three vaginal injections daily, of as cold water as can be borne without dis- quiet. The patient should exercise according to ability. The uterus should be restored to its natural position by mechanical means. When the vagina is extremely relaxed, the womb will have to be supported with a piece of soft sponge inclosed in a delicate capsule of India rubber, until the requisite mus- cular contraction can be induced. Inversio uteri. — Inversion of the womb is that state of the uterus in which it is turned, wholly or partially, inside outward. It may be mistaken for polypus uteri, prolapsus uteri, or prolapsus vaginae. This disease is rare, but if it takes place the promptest attention is demanded. Acute inversion is generally accompanied with hemorrhage, with a sudden exhaustion or sinking, deadly pale countenance, weak voice, fluttering pulse, retention of urine, nausea and vomiting, restlessness, agitation, death. Chronic and incomplete inversion is characterized by irreg- ular hemorrhages, and a constant and profuse mucous dis- charge during the interval; every month the surface is cov- ered with red drops, which are in fact the menses; sensation of weight in the Pelvis, and dragging from the loins; syn- cope, hectic fever, and dropsical affections. Pressure being made on the abdomen, we do not feel the contracted uterus. Terminations. — The patient may die from exhaustion; dis- tention and inflammation of the bladder may take place; the inverted uterus may be strangulated, and be separated by sloughing or gangrene. Causes. — Violence used in extracting the placenta; adhe- sion of the placenta; polypus; tumors; quick labors, espe- cially if the patient be delivered standing. Treatment. — Instant reduction of the displaced organ. The protruded organ should be grasped firmly, and passed in RETROVERSIO UTERI. 461 through the vaginal orifice, followed by the hand (previously well oiled), which, when in the vagina, should be closed and formed into a cone, and made mainly to press upon the fundus uteri. No effect will be produced upon the inversion until the vagina shall have been put upon the stretch; but then, after some time, it will be found to recede, and on being still further pressed, it suddenly starts from the hand (like a bot- tle of India rubber when turned inside out), and the womb is restored to its natural condition. The hand, now in the cavity of the uterus, is not to be withdrawn, but expelled by the uterine contraction. If the placenta remains attached to the womb at tne period of inversion, it should be carefully removed before the at- tempt of reduction is made, in order to lessen the bulk of the uterus. The bladder and rectum should be emptied previous to re- turning the uterus, unless we are present at the moment the accident occurs. If the parts are swollen much, fomentations should be made before attempting the reduction. After the reduction the patient should remain in the hori- zontal position with the head low, the pelvis elevated, and the knees bent. In irreducible inversion, and when life is in danger, extir- pation may become necessary. This operation consists in applying a ligature of silk, fishing line, or silk wire, around the tumor at its highest part, and gradually tightening it, as the patient may be able to bear it, until the tumor is entirely separated. Retroversio uteri.—A morbid inclination of the womb backward. The disease is attended with difficulty in expel- ing the faeces and urine, caused by the pressure of the dis- placed organ on the rectum and bladder. The womb often becomes congested, inflamed and enlarged, and every attempt at walking is painful and exhausting. There is also tenderness and tension of the whole abdomen. 462 diseases of the genital organs. Causes are the same as those of Prolapsus uteri. Treatment. — After having restored the womb to its natural position, the same treatment is required as recommended under Prolapsus. Discharges from the infantile vagina. — (See Leucorrhcea.) Dropsy of the scrotum. — (See Hydrocele.) DYSMENORRHEA--DIFFICULT MENSTRUATION--MENSTRUAL COLIC. This form of abnormal menstruation is accompanied with excruciating pains, and frequently with an expulsion of frag- ments of a membranous concretion, like that of croup. In some- instances this membranous concretion is thrown off from the entire surface of the uterus at once, in the shape of a small bag filled with a fluid, which has been mistaken for an early abortion. Causes. — Cold; sudden shocks; mental emotions; &c Treatment allopathic. — To relieve the pain during an at- tack, we must employ Opium, Hyoscyamus, Conium, &c, which may be given alone, or in combination with Camphor. Small doses of acetate of Ammonia, or ergot of Bye, have also been employed with great success. In order to prevent the return of the disease the patient must take during the intervals nourishing diet, vaginal injec- tions of tepid or cold water, and plenty of exercise in the open air. Some preparation of iron may also be given. A blister to the sacrum, or a caustic issue has been recommended by some physicians. Several days before the appearance of the next period, the patient should use warm vaginal injections, and a hip-bath every night. Inflammatory Dysmenorrhoea, occurring in females of a full habit, and caused by congestion of the womb, is generally accompanied with headache, pain in the back, aching of the limbs, weariness, intolerance of light, flushing face, full, quick pulse, swelling and pain of the breasts. Treatment. — Venesection; leeches; cupping the loins; MENSTRUAL COLIC. 463 leeches and scarification to the cervix uteri, Ac. We must at the same time recommend much walking in the open air, diet, aloetic purgatives, and abstraction of blood by cupping before the regular attack comes on. Mechanical Dysmenorrhea, caused by a stricture in some part of the canal of the cervix, must be treated by tho re- peated introduction of bougies, increasing in size until the obstacle be overcome. No force must be used. Homoeopathic treatment.—In the so called infllfeimatory Dysmenorrhoea, we will find the following remedies useful. Aconite, Belladonna, Calcarea, Nux vomica, and Veratrum. In neuralgic Dysmenorrhoea: Assa foetida, Chamomilla, Cocculus, Coffea, Moschus, Nux v., Pulsatilla, and Veratrum. Against uterine spasms: Cocculus, Pulsatilla, Ignatia, Pla- tina, Cuprum are appropriate remedies. Two doses of Calcarea. given after the period, and again three or four days before, on two successive evenings, has been found a most efficacious remedy. Hydropathic treatment. — The treatment for a radical cure of this deranged function is the same as for Amenorrhooa. To alleviate the severe pains during the Period we mutt employ the warm foot-bath, warm sitz-bath, hot fomentations to the abdomen, the full warm-bath or even hot-bath, followed by the dry-pack, according to the severity of the pains. In some cases the pain is agonizing for two or three days, and the only endurable condition for the patient is to remain dry packed, or closely covered up in bed, so as to keep the body warm and perspirable, until the secretion takes place. Drinking warm water freely often proves of benefit. Eclectic treatment. — To relieve suffering at the monthly period, the patient should use a warm foot-bath, or, if conve- nient, a general bath, after which fomentations should be ap- plied upon the abdomen, over the region of the womb, as hot as can be borne; and internally, the compound tincture of Virginia snake-root should be given in doses of from one to two fluid drachms, every hour or two hours. Small doses of 464 DISEASES OF THE GENITAL ORGANS. some nauseant, as Ipecac, Lobelia, &c, may be given to maintain a degree of nausea and relaxation. To restore the uterus to its normal condition, the compound Pill of Black Cohosh may be given in doses of one or two pills, three times a day, and its use continued during the catamenial intervals, in connection with the use of the com- pound Wine of Comfrey. In severe forms of the disease, the compound syrup of Stillingia with Iodide of Potassium, may be beneficially substituted for the above medicated wine. In some cases of the neuralgic form, much benefit has been derived from the use of Quinia and Prussiate of iron. EMANSIO MENSIUM. When retention of the first menses should produce any symptoms of morbid action in the system, we will find them generally those of Chlorosis. (See Chlorosis,) Eruption on the genital organs. — (See Prurigo, and Syphi- litic affections.) Erysipelas on the scrotum. — (See Orchitis.) Exoneurosis — Nocturnal pollution. — (See Onania and Pol- lutio.) EXCRESCENCE OF THE GENITAL ORGANS. A vascular excrescence, varying in size from that of a large pin's head to that of a horse-bean, is liable to grow from the female urethra. It causes great distress through its exquisite sensibility. Treatment — It should be cut off, and the Potassa fosa be applied, to prevent its reproduction. But immediately after the caustic, a sponge dipped in diluted vinegar should be applied, in order to prevent injury to the surrounding sound parts, and if it is necessary to introduce the caustic within the urethra, it must be by means of a tube which has an aperture in it, corresponding to the diseased surface. FISTULA. Vesico-vaginal fistula. — Perforation of the coats of the vagina anteriorly, producing a communication between the bladder and the vagina. The patients generally suffer RECTO-VAGINAL fistula. 465 inexpressible distress, constant escape of fetid urine, causing excoriation of the vagina, external parts and (thighs. The borders of the wound become thick and callous, and the case generally remains stationary during the patient's life. Causes.—Sloughing of the parts after a tedious labor; wounds; attempts to procure abortion; long retention of a pessary in the vagina; corroding ulcers; cancer of the uterus; mal-adroit use of instruments. Treatment — In all cases a careful examination should be made, by passing a catheter into the bladder, and a finger into the vagina; then placing the points of both in opposi- tion, the whole posterior surface of the bladder should be passed over and carefully examined. At some one point, the finger and catheter will come in contact, the catheter may then be passed into the vagina, and the extent of the damaae ascertained. As soon as it is discovered, the patient should be made to lie on her face, a catheter should be constantly worn in the urethra, and an oiled sponge in the vagina. The bowels should be kept moderately loose. After some weeks, it will be expedient to pare the edges of the fissure, and unite them by suture, by means of Mr. Beaumont's instrument; or, if this fails, to touch them frequently with nitrate of silver. To perform these operations the vagina must be dilated with a speculum. If these means fail, plugging the vagina with an India rubber bottle, having upon one side of it a small piece of sponge, to be applied to the fistulous opening, appears to be the best means of preventing the constant drib- bling of urine. Recto-vaginal fistula. — Perforation of the coats of the vagina posteriorly, producing a communication between the vagina and rectum. Causes are the same as in vesico-vaginal fistula. Treatment. — Many of these cases are cured spontaneously. To prevent the passage of fasces through the vagina a sponge should be worn in it constantly. If after a time the aperture does not close, it must be treated like the foregoing case. 466 DISEASES OF THE GENITAL ORGANS. Homoeopathic remedies recommended in urinary fistula are: Arsenic, Caloarea, Carbo-an., Silicea and Sulphur. Fluor albus. — (See Leucorrhcea.) GONORRHEA — CLAP — URETHRITIS. Inflammation of the mucous membrane of the urethra, attended with a discharge of puriform matter, commonly com- mences a week or ten days, sometimes two or three weeks, after impure connexion. It varies in severity according to the extent and intensity of the inflammation. The first symptoms of clap are: a sense of itching at tho orifice of the urethra, frequent inclination to make water, and some uneasiness on passing the urine. In a short time the orifice of the urethra becomes red and swollen, urination be- comes more and more painful, sometimes even ischury takes place, and a small quantity of watery discharge is observed, which gradually becomes more copious and thick, white or yellowish. During the night the patient suffers from involun- tary and painful erections, and symptoms of fever. This stage continues for eight or ten days, but is sometimes pro- longed to three weeks, if the patient commits errors in diet, exposes himself to cold, to the excitement of sexual inter- course, or indulges in the use of ardent spirits. The disease disappears in four or six weeks; or the acute symptoms disappear, but a discharge of puriform fluid con- tinues for a considerable period, the affection assuming the form of chronic inflammation. The existence of a pale green, or colorless discharge from the urethra after an attack of acute inflammation, is called Gleet. In severe cases small indurations in the urethra, stricture of the urethra, abscess and fistula, thickening of the bladder, disease of the prostate and kidneys are the consequence of tha affection. In women the symptoms are not so distressing as in men. The discharge takes place from the secreting surface of the URETHRITIS. 467 labia, nymphee and clitoris, as well as from the meatus uri- narius and vagina. Treatment allopathic. — During the first, or inflammatory stage, complete rest, abstainence from stimulants and animal food; drinking of flax-seed-tea; hemp emulsion with small doses of nitre; bathing the penis in warm water; frequent ablution with tepid water; wearing a supporter, and in violent pains the application of leeches. In painful erections blood must be abstracted, and opium used internally and externally. Inflammation and swelling of the prepuce before the glands, is to be removed by abstractions of blood, opium, fomentations of lead-water, decoction of hyoscyamus, and injections be- tween the prepuce and glands. If chancres are present, the use of mercury is required. Should the pains and other symptoms of Gonorrhoea not abate after a fortnight, a moderate internal use of mercury is advisable. An injection of Nitrate of Silver (one scruple to an ounce of water) at the very onset of the disease, when the patient is otherwise in good health, and his occupation does not ex- pose him to much bodily fatigue, has, in some cases, effected a speedy cure. In the second stage, or discharges of mucus without pain (Gleet)'the following remedies are proper; Copaiva balsam, twenty-five to thirty drops three times a day, taken on sugar, or in pills; cubebae, root of juniper, one ounce a day; one drachm of chloride of lime mixed in an ounce and a half of aqua laurocerasi, thirty drops taken every day; injections first of lime-water, then a weak solution of corrosive sublimate, one grain to two ounces of water, or of vitriol, zinc, copper, and nitrate of silver. Myrrh with sugar of lead, or cold topi- cal-baths may also be applied. Homoeopathic treatment. — The disease has been arrested at its outset, by the alternate employment of Aconite and Can- nabis, at intervals of six to twelve, or twenty-four hours. So soon as the discharge begins, Copaiba should be adminis- 468 DISEASES OF THE GENITAL ORGANS. tered, but should there be a constant inclination to pass water, the tincture of Petroselinum may be prescribed in preference to Copaiba. Cannabis is preferable, when the inflammation runs high, and the pain and difficulty in passing water are more intense. A drop of the first dilution may be taken every six to eight hours. Mercurius sol, is the most important remedy in gonorrhoea with swelling of the prepuce, and at the commencement of the second stage, when there remains a muco-purulent discharge, of a white or greenish yellow color, and some degree of pain in passing the last drops of water; or when there is swelling and induration of the lymphatic glands of the penis. Sulphur is required when the discharge has been serous, Painless Gonorrhoea requires Mercurius, Sulphur or Silicea. A few globules night and morning for four successive days. In severe forms of the disease the employment of Aconite, Cannabis and Cantharides is especially called for. Nitric acid and Thuja are also mentioned as useful remedies in Gleet. Tussilago petasites (species of colts foot) in the dose of two tea-spoonfuls of the expressed juice of the plant, or of water containing the plant in a macerated condition, has recently been recommended as a most efficacious remedy in recent as well as chronic Gonorrhcea. If aggravation follows the first or second dose of the medicine, it must be given in a weaker form. Hydropathic treatment.—During the inflammatory stage the cooling wet compress (or warm applications), upon the part af- fected, and the sitting-bath two or three times a day are recom- mended. The general treatment is the same as for Syphilis. In Gleet the system must be purified and invigorated by bathing, diet, &c, and the penis is to be kept constantly swathed in wet cloths. The patient must be restricted to a scanty, vegetable diet, and drink water and milk only; and must sleep on a hair matress under light covering. URETHRITIS. 469 Swelling of the penis should be allayed by warming band- ages, and moderately cold baths. Swelling of the prepuce and scrotum requires copious perspiration. Eclectic treatment.—Prescribe first an Emeto-cathartic com- posed of Senna Syrup, Cream of Tartar and Podophyllin, equal parts, half a drachm to be taken every two hours, until eight or ten discharges have been produced. Afterward give Diuretics; as, a strong infusion of burdock and mullein, or the Althaea officinalis, to be continued for the second twenty-four hours, during which time the patient should also take the diuretic drops, to which ought to be added one-fourth the quantity of the tincture of Cubebs (one drachm of the mix- ture every two hours). The saturated solution of borax, with the addition of sale- ratus, in the portion of two drachms to the pint, may be in- jected into the urethra by means of a catheter, every six hours. Two or three days of such treatment will be sufficient to check the violence of nearly every case. The alkaline-bath must be used night and morning. The bowels should be kept open by small doses of Podophyllin and Apocynum. As a simple course of treatment the following is recom- mended: The patient after bathing thoroughly in Alkali, and drinking copiously of some demulcent diuretics, is given a five grain pill, composed of equal parts of Podophyllin, Iris vehi- cular, and Cubebs, moistened with the balsam of Copaiba. This pill is repeated every four hours, or often enough to pro- duce from five to eight evacuations from the bowels daily. This, in the course of a few hours after the first .operation from the bowels, entirely eradicated the disease. The same injections are used as before directed. Another remedy: Take equal parts of the tops of the female and male hemp while in blossom; bruise them in a mortar and express the juice, adding an equal portion of alcohol. Give from one to three drops every two or three hours. In Gleet, injections of the tincture of Myrrh and Catechu, are recommended. Pyroligneous acid, in a diluted state, ar- 470 DISEASES OF THE GENITAL ORGANK rests in many instances the discharge after two or three injec- tions. HEMATOCELE, A tumor of the scrotum consisting of a collection of blood in the tunica vaginalis. It is distinguished from Hydrocele by its greater solidity and weight, and being neither transpar- ent nor fluctuating. The external parts are generally black. Causes. — Blows and other injuries of the scrotum or sper- matic cord; wounding of some large vessel in operating for Hy- drocele. Treatment — Inflammation present should be reduced by giving mild cathartics, and applying cloths wrung out of wrarm vinegar and salt. Some surgeons recommend cold lotions and abstractions of blood. If the quantity of blood extravasated is large, a puncture should be made, and a poultice be applied for the blood to ooze into gradually. The scrotum should be suspended and gentle compression applied. Homoeopathic treatment,—Haematocele resulting from con- tusion, or any other mechanical injury, requires the external and internal use of Arnica. In some cases, Pulsatilla, Zinc, or Bhus are the appropriate remedies. Hydropathic treatment — Occasional sitz-baths, and the use of a suspensory bandage. HERNIA SCROTALIS — OSCHEOCELE. Scrotal hernia exists when the omentum or intestine, or both descend into the scrotum. (See Ingunial Hernia.) Vaginal Hernia.—The tumor projects into, and blocks up the vagina. Labial or pudendal Hernia descends between the va- gina and ramus of the ischium, and forms a tumor in one of the labia. It is to be distinguished from inguinal hernia by the absence of swelling at the abdominal rings. The treatment of the two last named Hernia consists in replacement by pressure with the fingers, and keeping them up by pads made to bear against the Perinaeum, and by hollow caoutchouc pessaries worn in the vagina. (See Hernia.) CYSTIC DISEASE. 471 HERPES TREPUTIALIS. An eruption of vesicles on the Penis, especially at the pre- puce. The disease commences with a sensation of heat and itching in the said parts, followed by small patches of a vivid red color, and the size of a split pea, on each of which five or six small globular vesicles arise, containing a serous and trans- parent fluid. On the third or fourth day the fluid grows tur- bid, and is converted into pus. The vesicles then burst, and the discharged fluid dries, and forms email, thin, scaly incrus- tations. In some cases the vesicles do not break, but form into minute dry scabs. Herpes preputialis is distinguished from venereal ulcers by the absence of the raised, or of the indurated edges, and cf the small, gray colored secretion, covering the base of the venereal sores. Causes.—Friction of the clothes during prolonged exercise; contact of the deranged vaginal secretions; repeated syphi- litic attacks; abuse of mercury; derangement of the digestive organs; neglect of cleanliness. Treatment.—In most cases, the disease, if left to itself, heals in a fortnight or sooner. The parts should be protected from friction, and when the inner surface of the prepuce forms the seat of the disease, the vesicles or excoriations ought to be protected by the introduction of a small portion of lint be- tween the glands penis and the prepuce. Cold water may be freely employed. The patient should use simple food and drink, and his bowels kept free. Homoeopathic remedies.—For spots on the prepuce: Aurum, hepar, nitric acid, phosphor acid. HYDATIDS — MOLES--CYSTIC DISEASE. Hydatids of the testicle is a rare disease and occurs almost ex- clusively to adults. The testicle swells exceedingly, and its in- terior is filled with a number of cysts containing a watery fluid. This affection is incurable, but not malignant. When the part becomes of unsightly magnitude it must be removed. (See Hydrocele.) 472 DISEASES OF THE GENITAL ORGAN8. ■1 HYDROCELE — DROPSY OF THE TESTICLE. A collection of serum in the tunica vaginalis (a serous membrane enclosing the testicle). It forms a pear-shaped swelling, smooth on the surface, fluctuating if pressed, free from pain and tenderness, and caus- ing merely a little uneasiness by its weight. The swelling begins at the lower portion of the scrotum, gradually extend' ing upward toward the abdominal ring. On placing a lighted candle on one side of the scrotum, the light can be discerned through it. The disease is often accompanied with ascites, or dropsical diseases in other parts. Causes. — Inflammation of the testis; strains of the loins and belly; &c Treatment. — Palliative treatment consists in the evacuation of the serum by a puncture with a common lancet or trocar. Another method consists in making a number of punctures with a large needle, so that the fluid may escape from the tunica vaginalis into the cellular tissue of the scrotum. The radical cure is performed by injecting stimulating fluids, or by introducing setons into the tunica vaginalis. This cure is inadmissible, if the testicle is diseased, or if Hydrocele ia completed with irreducible hernia, or if the tunica vaginalis preserves its communication with the abdomen. Operation. — The surgeon grasps the tumor behind, and introduces a trocar and canula into the sac, pointing the in- strument upward, so that it may not wound the testicle. He next withdraws the trocar, at the same time pushing the can- ula well into the sac, so that none of the fluid, which is to be injected, may pass into the cellular tissue of the scrotum. When all the serum has escaped, he injects from two to four ounces of some stimulating fluid through the canula, by means of an elastic bottle fitted with a stop-cock. Equal parts of port wine and water, or zinc lotion, are commonly used. Some surgeons recommend common lime-water and tincture of Iodine. When the fluid has remained from three HYDROCELE. 473 to five minutes, according to the degree of pain, which it causes, it is suffered to flow out, and the canula is withdrawn. Some degree of inflammation follows, and more effusion into the sac; but the latter generally disappears in a fortnight or three weeks. If the cure is not perfect, the operation may be re- peated after a few weeks. (See Illustrations.) Encysted hydrocele.—A serous cyst, containing clear water, and developed on or near the testis, generally situated between the tunica vaginalis and epididymis. If they become of inconvenient bulk, they may be punc- tured with a curved needle to let the fluid escape. In some cases it is necessary to pass a common silk ligature through the sac with a curved needle and return it, till it has caused Borne inflammation. Hydrocele of the spermatic cord may consist either of an encysted tumor of an oblong shape between the abdom- inal ring and testis,—the latter always can be felt below or behind it, — or of a collection of serum in the cellular tissue of the cord. The latter forms a tumor along the course of the cord, is soft and colorless, diminishes on pressure, but Bpeedily resumes its usual size. The needle must be employed, if the swelling becomes troublesome from the bulk. Homoeopathic treatment.—When the whole system partici- pates in the disorder, it will frequently yield to the employ- ment of Helleborus, Arsenicum, or China. When contusion has given rise to the affection, Arnica and Conium should be employed internally and externally. Mercurius, Digitalis, Silicea, Graphites and Sulphur have been employed in several cases with success. When the tumor has become a painful annoyance to the patient, the accumulated fluid may be evacuated by the means of a trocar, after which operation the parts may be dressed with lint dipped into eold water, or into arnica and water. Hydropathic treatment. — In recent cases very cold sitz- baths, and the ascending douche, each repeated several times yftn * 474 DISEASES OF THE' GENITAL ORGANS. a day; refrigerating local applications of iced water, or pounded ice, in connection with the general treatment recom- mended for dropsy, will often effect a cure When the case has been of long standing, the operation will be necessary. Eclectic treatment — In recent cases, and in young persons, a cure may sometimes be effected by active hydragogue ca- thartics, diaphoretics, and diuretics. Absorption may be aided by suspending the scrotum in a bag and "T" bandage, and by stimulating applications to the surface. A solution of muriate of ammonia and vinegar, or the compound tincture of myrrh, diluted with an equal quantity of the decoction of marsh-rosemary, applied once a day, is recommended for this purpose. Pressure can be best applied by fixing round the part, pre- viously covered with a layer of raw cotton, moistened with the stimulating lotion, an India rubber bag. The bag should be so small as to require considerable distention to get it on. It may be better to have it previously distended to the requi- site size by two or three coils of watch-spring, which can be drawn out when it is on, and by placing an elastic opening at the mouth, which may be conveniently pulled out at any time, when it is required to repeat the cotton. A radical cure has been effected in several severe cases. The operation for the purpose of removing the fluid is the same as stated under allopathic treatment. HYDROPS UTERI--HYDROMETRA--DROPSY OF THE WOMB. Heavy, circumscribed tumor, or protuberance in the hypo- gastric region, attended with obscure fluctuation, and progres- sively enlarging; the mouth of the uterus is thin and yielding; vagina cold; cessation of the menstruation; leucorrhcea; and the complaint is unattended with pregnancy or Ischury. The patients have a pale, leuco -phlegmatic countenance, cold extremities, oedema of the feet and external labia, dimin- ished secretion of urine. In Hvdrometra attended with pregnancy, the uterus reaches HYDROPS OVARII. 475 in the second or third month the same size as in common pregnancy at the end of the ninth month; the mouth of the womb is thin; the motions of the child are felt very little or not at all, and during the third month of pregnancy dis- charges of water take place through the vagina, which return periodically in most cases. Causes. — Accumulation of fluid in the cellular tissue of the womb; cluster of Hydatids, originating between its tunics; structural affection; frequent conceptions, and frequent abor- tions, accompanied with hemorrhages. Treatment. — When the mouth of the womb is closed, and the patient is not pregnant, the water may be evacuated—not at once but by degrees — by the introduction of a canula. Secale cornutum, or Cinnamonum, have been recommended to produce contraction of the uterus. Mild diuretics may prove serviceable. Hydrometra with Pregnancy requires mild diaphoretic and diuretic remedies. The water should not be evacuated until after the birth of the child. The general treatment is the same as in Hydrops. HYDROPS OVARII. Dropsy of the ovary is always of the encysted character, and the cysts are generally combined with enlargement of the ovary itself, which becomes converted into a hard, whitish, cartilaginous mass. The tumor commences on one or both sides of the iliac region, and gradually spreads over the abdo- men; its surface is unequal, and its fluctuation is obscure and feeble, and in some cases entirely imperceptible. The patient suffers from a sensation of numbness of the thigh of the affected side, from Globus hystericus, nausea and vomiting, inclination to void urine, constipation, flatulency, and the symptoms of Hydrops in general. Causes. — Frequent child-birth; irritation of the sexual desires without conception; sexual intercourse during the monthly period. Treatment — The remedies generally employed in the treat- 476 DISEASES OF THE GENITAL ORGANS. ment of dropsical affections seem to be of very little efficacy in Hydrops ovarii; yet the patient may enjoy comfortable health for an indefinite period without any treatment. All that can be done is to endeavor to afford as much palliative relief as circumstances will admit. When the increase of swelling begins to affect the general health, tapping may be resorted to. The extirpation of the cyst, or of the tumor, by the operation called Paracentesis abdominis, generally proves fatal. Homoeopathic remedies recommended are: Dulcamara aud Sabina. HYPERTROPHIA OVARII. Induration and enlargement of the ovary. — The symptoms of this disease are similar to those of dropsy of this organ, and is distinguished from the latter by the absence of fluctu- ation and other characteristic symptoms of Hydrops, and on tapping no water is discharged. Causes.—Frequent coition without conception. Treatment.—When the disease is accompanied with inflam- matory symptoms, and the swelling is painful, recourse must be had to local abstractions of blood. In plethoric persons a venesection becomes necessary. The bowels should be kept open, and the patient be put on the most simple diet. Em- brocations of Hydrojodin Cali, or Iodate of Mercury, and internally the tincture of Iodine should be employed. If all these means prove ineffectual, extirpation remains the only remedy. Homoeopathic remedies.—Conium, Lachesis and Platina. HYPERTROPHIA UTERI. Sensation of pressure and heaviness in the pelvis; enlarge- ment of the abdomen; the swelling changing according to the position of the patient; slimy secretions from the vagina; dislocation of the os uteri; pressure upon the bladder, caus- ing difficulty in voiding urine; derangement of the digestive organs; flatulency; costiveness; gradual cessation of the menstruation; emaciation of other organs, • • IMPOTENCE. 477 Causes. — Sudden suppression of the monthly period; sup- pression of chronic Blenorrhoea; frequent coitus without conception. Treatment.—A radical cure is impossible, unless the uterus could be removed by extirpation. Palliative treatment consist in avoiding all irritations of the womb by coitus, by emmenagogues, as secale cor., &c; by keeping the bowels and bladder open; and by ordinary, simple diet, HYMEN IMPERFORATE. Sometimes this membrane completely obstructs the vagina, and causes the menstrual fluid to accumulate and distend the uterus. This impediment is removed by a crucial incision, after which all the black fluid should be immediately sponged out with warm water, otherwise it might putrify, and cause typhoid fever. Hysteria. — (See Nerves.) IMPOTENTIA — IMPOTENCE. Inability of the male to fecundate, which may consist in an entire want of erection, or in a too quick, or total want of emission of semen in coition. Three things are necessary to render coition fecund: the semen must be possessed of an enlivening power; it must reach the womb; and both parties must experience a certain degree of excitement and pleasure during coition. Causes.—Diseases of the genital organs; too watery semen; deficient or bad food; corporeal and mental over-exertions; sorrow and grief; excesses in venery and onanism; physical or moral dislike; unequal temper and irritability. Treatment. — General and local invigoration by cinchona; columbo, generous old wine; spices, especially vanilla; sea- baths; cinnamon water; douche to the lower part of the spine and perinaeum; washing the genitals with a decoction of mustard; electricity; half grain doses of Phosphor dis- solved in Sulphuric ether; nutritious regimen; eggs; strong 478 DISEASES OF THE GEN'ITAL ORGANS. broths; animal food, oysters, snails, chocolate, salep; exercise in the open air; avoiding all mental and physical over-exer- tions. Homoeopathic remedies. — Baryta c, Calcarea, Cannabis, Co- nium, Lycopodium, Moschus, Muriatic acid, Natrum m., and Sulphur. (See Onanism.) INDURATIO TESTICULI — SARCOCELE — INDURATION OF THK TESTICLES. In the mild form the tumor is smooth, and pressure produ- ces imly little pain. There is slight aching in the loins by its weight. If the disease is not arrested, it acquires a more serious character, by becoming unequal and knotty; the gland, after awhile, enlarges rapidly, and feels soft; the cord swells; there are occasional darting, lancinating pains; a fungus protrudes; the lumbar glands become affected; and cachexia and death soon follow. Scrofulous induration of the testicle is less hard, and less painful in Scirrhus. Venereal swelling of the testis and cord comes generally very gradually, and is caused by badly treated Syphilis. Causes. — Inflammation of the testis; Scrofula and Syphilis; mechanical injuries. Treatment — Simple induration of the testis, caused by in- flammation, requires repeated applications of leeches, poulti- ces, mercurial ointment and rest of the affected organs. Syphilitic and scrofulous indurations, the anti-syphilitic and anti-scrofulous treatment, In Scirrhus testis the best remedy is castration before the cord is affected. (See Cancer and Inflammation of the Tes- ticle.) Homaopathic treatment. — In the mild form resolution may be effected by means of the following remedies: Aurum, Cle- matis, Lycopodium, Agnus Castus, Graphites, Bhododendron and Sulphur. When the Scrotum presents a livid color, Lachesis will be found useful. INFLAMMATION OF THE TESTIS. 479 Malignant tumors may in some instances be arrested by Arsenic, Clematis, Arauea diadema, Carbo v., or Thuya; but in the majority of such cases extirpation is the only resource. Eclectic treatment. — Have the part constantly supported in a sac and kept up by the "T" bandage around the loins. Apply fomentations and stimulating and astringent washes. Much exercise should be avoided, the bowels kept regular and the skin in a state of healthful activitj\ The camphorated plaster applied to the scrotum, in connection with compression and suspension, will frequently exert a favorable influence, As a general rule, castration is the only radical remedy. (See Inflammation of the Testicle.) INFLAMMATION OF THE LABIA MAJORA AND VAGINA. Painful, burning, red, hard, dry and very sensitive swelling of the labia pudendi. It chiefly occurs in newly married females after the rupture of the hymen, and especially when the orifice of the urethra is of small size. Difficult and tedi- ous labors also form a not unfrequent source of the inflamma- tion. Allopathic treatment. — Leeches, poultices, and fomenta- tions. Homoeopathic treatment. — When arising from difficult labor, or after rupture of the hymen, speedy relief will be afforded by the application of a lotion of Arnica tincture. In neglected cases Aconite, Arnica and Mercurius may be of service. Inflammation terminating in ulceration requires Arsenicum and Sulphur. (See Inflammation of the Testis.) INFLAMMATION OF THE TESTIS — ORCHITIS —HERNIA HUMOR- ALIS. Diminished discharges from the urethra, aching pain in the testis and cord, extending up to the loins, followed by great swelling, excruciating tenderness, fever and vomiting. The epididymis (small oblong body which lie3 above the testis) is the part chiefly affected. The swelling depends upon an effusion of lymph and serum into the tunica vagi- nalis. 480 DISEASES OF THE GENITAL ORGANS. Causes. — Local violence; gonorrhoea; violent exercise; use of fermented liquors during the treatment of clap; &c Treatment. — Bleeding, if the habit is very plethoric; the application of leeches; purgatives, followed by the exhibition of tartar emetic in doses of quarter of a grain, so as to keep down the pulse; and of mercury and opium, so as barely to affect the gums; cold lotions or warm fomentations; a sus- pensory bandage to support the affected part. In order to remove the hardness and swelling remaining after the attack, compression should be made by encircling the affected testicle — after separating it from its fellow—with strips of adhesive plaster, which are to be applied regularly, and as tightly as the patient can bear; the first strip being applied round the spermatic cord, immediately above the tes- ticle, and the others downward in succession, slightly over- lapping each other. Homoeopathic treatment—If the fever runs high a few doses of Aconite must be administered first. Pulsatilla is one of the most efficacious remedies, when irri- tation of the urethra, and especially suppressed Gonorrhcea, has given rise to the affection. In some cases, Clematis and Sulphur are preferable to Pul- satilla. When the swelling has resulted from external injury: Ar- nica, externally and internally, succeeded by Pulsatilla or Conium, generally affords relief. Indurations remaining, require Aurum, Clematis and Sul- phur; also: Mercurius, Graphites, Staphysagria or Zincum. Hydropathic treatment. — Constant application of water, either by compresses or the hip-bath, of such temperature as is most soothing to the pain; and the wet-sheet pack, or tepid full-bath, according to the degree of general heat. Eclectic treatment. — Fomentations of the parts with bitter herbs and vinegar, or Lobelia herb with a small portion of Stramonium. An active cathartic and enemas must be ad- ministered, and if there is much nausea an emetic should be RUPTURE OF THE WOMB AND VAGINA. 481 given (a tea-spoonful of the common emetic tincture as a dose), keeping up nausea for several hours, then vomitino- freely. Sweating should be kept up by drinking a tea of hops. An alcoholic sweat has been found to exert a favora- ble influence, if there is much constitutional suffering. When ulceration has commenced, castration of the affected part should be performed. SCROFULOUS INFLAMMATION OF THE TESTICLE commences with a deposit of tubercle in some part of the testis or epi- didymis, either in or between the tubuli. A nodular swelling appears externally, attended with very little pain or tender- ness, which after a time inflames and bursts, giving exit to the fungous protrusion mentioned under abscess of the testis. Treatment is the same as for Scrofula in general. In some cases castration becomes necessary. Inversion of the uterus. — (See Displacement.) LACERATION OF THE WOMB AND VAGINA — RUPTURE OF THE WOMB AND VAGINA. This fatal accident may occur at the time of parturition, during gestation, and at a more advanced period of life. Sudden, acute and intolerable pain like a cramp; a sense of some part bursting or tearing; the suspension of the labor- pains; hemorrhage from the vagina; vomiting; pale and ghastly countenance; cold, clammy sweat; feeble, fluttering pulse. Causes. — Extra-uterine pregnancy; any violent accident, such as a fall or a blow; inflammation; softening and abscess of the womb; narrowing of the upper outlet during labor; violence in turning the child; rigidity or imperforation of the mouth of the womb; old age; Ac Treatment. — In ruptures occurring during gestation and before labor has commenced, immediate delivery must be at- tempted, if the os uteri is dilated. The mode of delivery will depend upon circumstances of the case. In cases where delivery is impossible, it is advised to perform the Caesarian section, and extract the child through the abdominal parietes. 482 DISEASES OF THE OEXITAL ORGANS. Inflammation setting in, requires the same treatment aa recommended undo,* Metritis. LASCTYIOUSNESSS—INORDINATE LUST. Ungovernable sexual passion in tho male is termed Saty- riasis; and a similar propensity in the female, Nymphomania. The latter is generally accompanied with violent burning, itching pain on the clitoris and bladder, strangury, ischury, discharge of mucus, fits of fainting, and hysterical spasms. Causes.—Too frequent gratification of sexual desire; clap; overheated imagination directed to voluptuousness; irritation of the Genitals without gratification; idle, luxurious mode of living; worms; plethora and indurations of the abdominal organs; Pessaries; &c Treatment.—Fasting, labor, and cleanliness; vegetable diet; cold lotions to the Genitals, and cold baths; Camphor inter- nally and externally; lead externally. In the highest degree of Nymphomania, Morphine, embrocations of Saffron, and oil of Hyoscyamus with Camphor; and when it is incurable by the usual means, cauterizing the clitoris and nymphae with lunar caustic; or extirpation of the clitoris is the only radical remedy. Injections of cold water into the vagina and rectum; embro- cations of mercurial-ointment or lead-water, also, Baryta niuri- atica have been employed with success. Homoeopathic remedies.—Satyriasis: Cantharides, mercurius, natrum m., nux v., sulphur. Nymphomania: Hyoscyamus, phosphor, stramonium, vera- trum. Hydropathic treatment. — General cold baths; copious water drinking; active exercise or occupations, warm relaxing hip- baths, and a simple vegetable diet. LEUCORRHCEA — FLUOR ALBUS — WHITES. A discharge of thin, limpid fluid; or a thick, tenacious, ropy mucus of a yellowish-white, or greenish, sometimes brownish color, from the vagina. It is usually accompanied with weakness or pain in the back, difficulty in making water. WHITES. 483 and some degree of spinal irritation. In cases of long stand- in°- the discharge is acrid and offensive, attended with a sense of heat, itching, or smarting. The whites of advanced life appear soon after the cessation of the menses; the discharge is thin, acrid, fetid and excoria- ting, and is sometimes combined with incipient cancer, or polypus. Young female children are sometimes subject to mucous or purulent discharges from the parts at the entrance of the vagina, which may also be excoriated. Causes. — Inflammatory irritation of the vaginal mucous membrane; local irritation and local weakness; mismen- struation; pessaries; repelled eruptions; sexual excitement; frequent coition; uncleanliness; sedentary life; drinking of tea; damp dwellings; colds; masturbation; unsatisfied sexual instinct; rocking in chairs; metastases of all kinds; worms; polypus, or scirrhus of the womb, &c Treatment allopathic. — Warm clothing and strong exercise in the open air; removal of abdominal obstructions; shunning of sexual excitement; abstaining from all stimulants, as coffee, tea, spices and fermented liquors; strengthening visceral remedies, especially Bhubarb in small doses; aloes; bitter ex- tract, guajac with calomel and sulphurate of antimony. When the discharge continues after the causes have been removed, and the disease is merely owing to a local weakness, we may prescribe balsam of copaiva, thirty drops three times a day on sugar; rhubarb one grain, morning and evening; prepared oyster-shells; peruvian bark; sulphate of iron; ex- ternal ablutions of cold water and tepid baths. In very obsti- nate cases injections of lime wrater, decoction of slippery elm bark, calomel; after these sulphate of zinc, corrosive subli- mate in solution; finally oak-bark, alum, sulphate of iron, and nitrate of silver. Sea-bathing has proved a specific in many cases. Homoeopathic remedies. — Calcarea, mercurius, pulsatilla, sepia, sulphur. 484 DISEASES OF THE GENITAL ORGANS. Bloody mucus.—Baryta, calcarea, kreosote, nitric acid, sepia, and sulphuric acid. Bluish mucus.—Ambra. Brown: Amm. m., cocculus, nitric acid. Thick.—Arsenic, borax, conium, magn. m., natrum m., pul- satilla, sepia. Thin, watery.—Alum, amm., carbo an., carbo veg., graphites; magn. m., pulsatilla, silicea, Sulphur. Burning leucorrhoea,— Alum, amm., calcarea, carbo an., co- nium, kreosote, pulsatilla, sulphur acid. Leucorrhoea with yellow complexion. — China, ferrum, natr. m., sepia; with pale face: Arsenicum, graphites, kreosote, pul- satilla, sepia. Hydropathic treatment — Hip-baths, and vaginal injections are among the leading measures, regulating the temperature of the water by the condition of the patient. Baths should be commenced with water 80 or 90°, gradually reducing the temperature to 60° or 50°. The vaginal syringe in severe cases should be employed three or four times a day. When the discharge is blood-colored, very cold water should be thrown up the vagina, and cold, wet cloths laid over the abdo- men. Eclectic treatment. — In simple cases, rest, abstinence from intercourse, and vaginal injection, composed of an infusion of Alum, Hydrastin, and Tannin, one drachm of each, water one pint, are recommended. Of the infusion, one or two fluid ounces may be injected into the vagina, and repeated three times a day. If there is much inflammation, and attended with a green, purulent discharge, in addition to the above, the use of the cold hip-baths twice a day, is advised, with tonics and astrin- gents internally, as infusion of Hydrastin, or Nacrotys, carbo- nate of Iron, Quinine, Cornin, Tannin, Geranin, etc. In those cases where the leucorrhoea is dependent upon a prolapsus of the uterus, this organ must be first permanently re- duced to its proper position before the leucorrhoea can be cured SELF-POLLUTION. 485 MANIA PUERPERALIS — CHILD-BED INSANITY. This disease generally commences with a peculiar restless- ness, fear of death, sleeplessness, talkativeness, &c On the tenth or fourteenth day after confinement a great change in the patient's countenance is observed, her eye is unnaturally bright, she scolds, becomes furious, endeavors to injure her genital organs, and looses all feeling of shame. xAt the same time she suffers from costiveness, and, if the disease had its origin in the suppression of lochial discharges, from fever, congestion, and inflammatory irritation of the brain, the dis- ease generally lasts three or more weeks, and disappears under critical sweats. Unfavorable cases terminate in consumption, dropsy, or insanity. Causes.—In most cases suppression of the lochial discharges; mental excitement during lying in, &c Treatment. — The bowels should be kept open, and warm baths with cold showering administered. Homoeopathic remedies.—Aconite, Belladonna, Platina, Pul- satilla, Stramonium and Veratrum. (See Lochial Discharges.) MASTURBATIO — ONANIA—ONANISM—MASTURBATION—SELF- POLLUTION. Repeated practice of this vice creates diseases, which pro- bably never can be eradicated from the system, and prevents the development of body and soul. The most common results are debility of the nervous system, insanity, catalepsy, epi- lepsy, apoplexy, weak and dim eyes, stupidity, sickness of life, suicide. Treatment. — Abandon at once and forever, self-pollution; denounce lascivious books, pictures, and conversation; sleep on a hard matress and use light covering; arise early; work hard; use cold ablutions; and abstain from rich and highly Beasoned food. Homoeopathic remedies.—Disposition to onanism: Calcarea, Nux v., Sulphur; or, China, Cocculus, Mercurius, Natrum m., and Phosphor. For the consequence of the vice: China, Nux v., Phos. ac, or 486 DISEASES OF THE GENITAL ORGANS. Staphysagria. Slow chronic ailments require: Calcarea, Nu* v., and Sulphur at long intervals. (See Satyriasis, Nympho- mania, and Spermatorrhoea.) MENOPOSIA--CRITICAL AGE OF WOMEN —CHANGE OF LIFE- CESSATION OF MENSTRUATION. It generally takes place between the fortieth and fiftieth year of age; and either ceases all at once, which is always hazardous; or it decreases gradually, failing once or twice, then reappearing again. In some females the menses termi- nate with considerable hemorrhage. Momentary flushes with sweats, cold and chills, cutaneous eruptions, congestions and hysterical affections, symptoms of spurious pregnancy, dropsy, glandular tumors generally accom- pany this change of life. Allopathic treatment — Congestions require a venesection every six or twelve months; cream of tartar one tea-spoonful in a glass of sweetened water; a mild purgative of Glauber's salt every two or three weeks; vegetable diet, and exercise in the open air. Homoeopathic treatment,—Lachesis is generally found a spe- cific for all affections arising from the cessation of menstrua- tion. In some cases, Cocculus, Conium, Pulsatilla and Sepia will be found of benefit. (See Amenorrhcea.) Menstruation difficult and painful; too profuse, too scanty, &c. (See Dysmenorrhoea, &c) METRALGIA— HYSTERALGIA. Painful affection of the Womb. (See Dysmenorrhoea, Af- ter-pains, Hysteria, Metritis.) Homoeopathic remedies.—Cocculus, Conium, Ignatia, Magn., and Electricity. METRITIS—HYSTERITIS — INFLAMMATION OF THE WOMB. Continuous, burning, pricking, or shooting pain in the hypo- gastric region, accompanied by a sensation of weight; in some cases the pain occupies a small extent of surface, in others even the entire abdomen. Subsequently the abdomen becomes tumefied, sensible to the touch and hot; the utero-vaginal INFLAMMATION OF THE WOMB. 487 secretions are suppressed, sometimes also the evacuations of fgeces and urine. The tongue is dry and furred, and the pulse hioh; there is pain in urinating, heat and pain in the vagina, and pain on touching the mouth of the womb. In lying in women the secretion of milk is arrested. Causes.—Severe, unnatural labor; maltreatment; protracted labors; retention of the placenta; suppressed menstruation or lochia; mental emotions; cold; external injuries; ill applied pessaries; sudden suppression of hemorrhages by cold, &c The disease may terminate in resolution; in abscess; in softening; in gangrene. Treatment.—Venesection, followed by leeches, poultices, and fomentations. The bowels should be kept free by enemata of castor oil and turpentine. Opium and Calomel have proved of benefit. In chronic cases a succession of blisters must be resorted to. Homoeopathic remedies chiefly employed are: Aconitum, Belladonna, Arnica, Nux v., Mercury, Chamomilla and Coffea. Of these Aconite, Belladonna, Arnica will be found of most importance in all cases. Hydropathic treatment. — A warm hip-bath should be first employed for half an hour, until sensible relief is experienced. This should be succeeded by the cold compress, which should be worn constantly, and very frequently renewed, occasionally alternating Avith the warm hip-bath. Violent fever must be subdued by the wet-sheet pack, followed by the dripping sheet. Eclectic treatment. — The vapor-bath, warm foot-bath, and warm fomentations over the region of the womb; stimulating enemas, until a laxative condition of the bowels is produced, after which the bowels should be kept in a relaxed condition by the use of compound powder of Jalap. If there be much febrile action or nervous irritability present, the compound powder of Ipecac, in five grain doses should be given, and repeated sufficiently often to allay these conditions and favor diaphoresis. If there be a retention, or even scanty and high-colored urine, use the decoction of Althea officinalis and! 488 DISEASES OF THE GENITAL ORGANS. and Ulmus fulvis, of which the patient should drink freely. If there be much gastric derangement sinapisms should bo applied over the stomach, and the tepid hip-bath used twice ;i day. If warm applications are disagreeable, the use of cold water is advised. If ulceration should occur, the sesqui. carb. Potassa, 3jj dissolved in four ounces of water, should be injected or thrown upon the ulcerated surface every day, increasing or diminish- ing the strength of the preparation according to circumstances, In chronic Metritis, accompanied with retention of the men- strual discharge the use of Macrotin is advised; thi3 should be given in doses from three to four grains three times a day increasing or diminishing the dose so as to produce its specific constitutional effect, which consists of aching in the joints, dull, full heaviness of the head, accompanied with more or less dizziness. This treatment should be continued, in con- nection with the warm hip-bath, until the suspended function of the womb is restored. METRO-MALACIA — SOFTENING OF THE WOMB—PUTREFACTION OF THE WOMB. This rather uncommon disease, in most instances, takes place after child-birth. Most of the patients complain of great debility during pregnancy, have very little appetite, periodical pains and colic in the abdomen, cachectic color of the face, sadness, melancholy; presentiment of a dangerous ehild-birth; sometimes miscarriage; the afterbirth, and um- bilical cord are softened; liquor amnii is dark colored; infants are small and emaciated. The disease frequently causes rupture of the womb; after the birth of the child no contraction of the uterus takes place ; after pains are wanting; lochia are black, bloody, fetid, color- ing instruments and the nails of the finger black for considera- ble time; the breasts are filled with watery milk, which soon disappears again. In some cases, however, the secretion of milk as well as lactation have been normal. In some cases a periodical appearance of dark spots has been * FLOODING. 483 noticed on the surface; other cases have been accompanied with an intermittent nervous fever. This disease generally terminates in 'death on the third, seventh, or eleventh day after child-birth. Causes probably are: -chronic inflammation of the womb; Scrofula; profuse menstruation ; Metrorrhagia. Treatment. — Vegetable diet; cooling drinks; fresh, soft sprint water; injections of wine and water into the womb. Internally, Arsenicum, or Secale cornutum, in small doses may prove of benefit. METRORRHAGIA — MENORRHAGIA — UTERINE HEMORRHAGE — FLOODING. Bleeding from the womb at other times than those of Tegu- lar menstruation. It is generally accompanied with weak pulse, cold extremities, general prostration, melancholy, palpi- tation of the heart, hysterical affections, oedema of the feet, Causes— Weakness of the uterus; sedentary life; high living: increased sensibility of the uterine system; morbidly increased Bexual instinct; frequent coition; masturbation; frequent child- beds; polypus; Ac Treatment allopathic. — The palliative treatment during a dangerous hemorrhage, calls for alum, ten grains in powder, or in sweetened water, every two hours; tincture of cinnamon, thirty or forty drops at a dose; cold fomentations on the uterine region and genitals; cold injections, also injections of red wine, or alum; dossils wet with alum inserted; liga- ture around the thighs; extreme quietude and horizontal position. Radical cure consists in avoiding all debilitating causes and observing a cold diet. When caused by weakness of the uterus, frequent parturition, or sedentary life, recourse must be had to peruvian bark, cinnamon-tea (one drachm of cinna- mon to two cups of water) drunk daily; sulphuric acid; alum whey; tannin; Kino; sulphate of iron, in one grain doses; when increased sensibility exists, small doses of Ipecac; in plethoric subjects a venesection, tartaric acid, cooling purga- 490 DISEASES OF THE GENITAL ORGANS. tives and mineral acids. When caused by polypus an opera- tion is called for. Homoeopathic remedies.—For active hemorrhage, in plethoric persons, give: Aconite, belladonna, bryonia, calcarea, chamo- milla, ferrum, nux v., platina, sabina, sulphur. Passive hemorrhage in debilitated, cachectic subjects: china, crocus, pulsatilla, secale, sepia, and sulphur. Hemorrhage at the critical age, requires: Pulsatilla, or bella- donna and lachesis. Kreosotum has been successfully employed in hemorrhages with dark red, excessive discharges, frequently in large clots, and very offensive; burning, corroding pain. Hydropathic treatment—Keeping quiet; temperate and cold injections, '-md cold hip-baths; chilling the abdomen and thighs with cold wet towels; drinking of cold water frequently. Hemorrhage during pregnancy requires rest, cold bandages to the addomen, placing the soles of the feet in cold water, at 41° to 44° of Fahrenheit; and if all these means fail, pouring cold water from a height of several feet on the abdomen. Eclectic treatment.—The patient should be kept in a recum- bent position; if constipation exists, it must be obviated by laxative enema; if there be hepatic torpor, Leptandrin may be given. A large mustard plaster should be applied to the spine be- tween the hips, and if the hemorrhage is associated with pain a powder of one-eighth of a grain of Morphine and two grains of Capsicum should be given every hour and a half, until relieved. Applications of cold water or vinegar may be made over the abdomen and genital organs in connection with warm or cold astringent vaginal injections, together with astringents administered internally. (Astringents are considered useless by some authors.) Should much nervous irritability be present, the compound powder of Ipecac, and Opium will be found serviceable, and in some cases Camphor, Valerian, Asa foetida, &c. In dangerous cases the outlet should be firmly plugged ) NOMA. 491 up with a sponge, or with a wad of folded linen dipped in cold water. This should not be allowed to remain more than twenty-four hours. Internally, a decoction in a quart of water of Macrotys rac,Trillium p., Fol rubus strigosa (half an ounce of each), and Sanguinaria (two drachms), sweetened, a table- spoonful every half hour, has manifested an almost immediate influence in checking the excessive discharges. Passive hemorrhage requires: sea-air, a mild but nutritious diet, consisting of animal food and milk, or malt liquor. Where there is coldness of surface, especially of the extremi- ties, friction with the flesh-brush, or horse hair gloves, the wearing of flannel, and worsted stockings are indicated. The salt hip-bath, the local salt shower-bath, applied night and morning, by a common garden watering pot, over the hypo- gastric and lumbar regions, are often advantageous. (See accidental and unavoidable hemorrhage under diseases of preg- nancy and child-birth.) Menostasia. — (See Amenorrhcea.) METRO-PHTHISIS — CONSUMPTION OF THE WOMB. Sensation of pressing, tearing pains, deep in the pelvis; vagina painful to the touch; discharges of fetid, bloody, sanous fluid; menses appear regularly but the blood is offensive, and of an unnatural color; finally hectic fever sets in, followed by death. (See Metro-malacia.) NEURALGIA OF THE TESTIS AND CORD. Paroxysms of excruciating pain, which leave the parts tender and highly swollen. Extreme sensitiveness of the testis, so that it cannot bear the slightest touch, is a disorder met with in ner- vous, hypochondrical subjects, and generally caused by a diseas- ed condition of the urethra, or excessive spermatic discharges. The treatment must be that of Neuralgia generally; a few leeches, the application of intense cold, electro-magnetism, fomentations, poultices of hops and vinegar, aconite, bella- donna, &c. NOMA. A Phagedenic affection (ulcers eating away the flesh) of; 492 DISEASES OF THE GENITAL ORGANS the labia pudendi of young female children, resembling can-- crum oris. After two or three days of low fever, the little patient is observed to suffer considerably whilst making water, and on examination, the labia present a livid erysipelatous redness and vesications, that are rapidly followed by ulcers. This disease is very frequently fatal, and is often mistaken for ve- nereal disease. The treatment is the same as recommended for cancrum oris. Nymphomania. — ( See lasciviousness.) C3DEMA OF THE SCROTUM. The loose cellular tissue of this part is exceedingly liable to serous infiltration from inflammation or dropsy. (See In- flammation of the testis.) Onania. — (See Masturbation.) Orchitis.— (See Inflammation of the testis.) OVARITIS — OOPHARITIS — INFLAMMATION OF THE OVARIES. Pain in the left or right ovarian region, sometimes of a severe shooting, pulsating character, aggravated by external pressure, with a circumscribed swelling of that region. By a careful examination per vaginam et rectum, we detect a small, hard, circumscribed swelling. Frequently patients complain of a constant itching in the internal organs of generation; also headache, constipation, diminished secretion of urine, fever, nervousness, &c Ovaritis is chiefly encountered in the chronic form; coming on gradually and insidiously, and often occurring in associa- tion with a species of nymphomania. Causes. — Inflammation of the ovaria is more particularly liable to occur a short time after delivery; in other cases it is the consequence of venereal excesses; coitus without satis- faction; onanism; over-indulgence in spirituous liquors; ex- ternal injuries. Treatment, — Application of leeches, cooling purgatives, calomel, and embrocations of volatile liniment and mercurial ointment. phimosis. 493 Homoeopathic remedies. — Aconitum, when attended with high fevor and shooting pain. Bryonia: Pain in the affected part, increased by movement. Rhus: "When rest is produc- tive of aggravation. Arsenicum or Coloeynth: Violent pains, with continual shifting of the feet. Nux. v.: When the dis- ease has arisen from the habitual use of of spirituous liquors. Lachesis, Staphysagria, Mercurius and Hepar, when there is reason to apprehend that the inflammation has terminated in suppuration. Hydropathic treatment.-----Wet compresses to the painful parts; tepid hip-baths, and tepid injections. Ovarian induration and ulceration is generally the consequence of neglected Ovaritis. Palliative relief is usually all that can be afforded. Homoeopathists assert that they have accomplished a cure by the administration of Lachesis, followed by Platina. OVARIO-PHTHISIS. Ulceration of the ovaries with hectic fever, emaciation, Ac, generally the consequence of chronic inflammation. Treatment. — Opening of the swelling through the vagina or rectum, followed by poultices to the affected parts. PHIMOSIS. Signifies that contracted state of the extremity of the pre- puce which prevents its being retracted, so as to expose the glans penis. Besides the obstruction which it occasions to the functions of the organ, it renders the patient liable to gleet, balanitis and cancer. Causes. — Inflammation and swelling, or thickening of the prepuce; friction and other mechanical injuries; syphilis; chemical, poisonous substances; congenital affection. Treatment. — Against congenital Phimosis division or cir- cumcision is generally employed. A director should be intro- duced about half an inch between the glans and prepuce, and a curved, narrow-pointed bistoury be passed along its groove, by which the prepuce should be slit up. Then four or five sutures should be passed through the margin of the 494 DISEASES OF THE GENITAL ORGANS. incision, so as to draw together the edge of the skin and that of the mucous lining of the prepuce, that they may unite by adhesion. In inflammatory Phimosis inflammation must first be re- moved by abstractions of blood, and then opium must be ap- plied internally and externally, connected with emollient fomentations of lead-water and decoction of hyoscyamus, and injections between the prepuce and glans, and local baths in order to wash out the matter, which may have gathered there. The greatest attention is needed, since suppuration, gangrene and loss of the glans are very apt to follow. When caused by poisonous substances, camphor is probably the best antidote. Homoeopathic remedies. — Arnica, internally and externally, if friction, or any other mechanical injury has given rise to it. In other cases, arising from a similar cause, Calendula officinalis, Bhus, or Pulsatilla may be required. If from Syphilis, Mercurius, Acid nitr., and Thuya. When it pro- ceeds from uncleanliness, Aconite and Mercurius must be prescribed. Tepid water should, at the same time, be injected between the prepuce and glans by means of a small syringe. In congenital Phimosis circumcision and division of the prepuce. Para-phimosis is that state of the prepuce in which it is drawn over the glans, and is incapable of being again brought forward. In adults the prepuce often becomes inflamed and ulcerated, and the glans penis destroyed by mortification. Treatment. — In recent cases, the reduction is often effected by compressing the glans, and simultaneously drawing the prepuce forward. When requisite, the process may be facili- tated by previously immersing the penis in cold water, or ap- plying it to the part. In some cases warm fomentations are useful. If this fails, the constricting part of the prepuce must be divided with a curved pointed bistoury. PHYSOMETRA — WIND-DROPSY OF THE WOMB — UTERINE TYMPANITIS. When the uterus is inflated with air, there is light, tense, POLYPUS UTERI. 495 circumscribed intumescence in the lower part of the abdomen, obscurely sonorous, and accompanied with occasional dis- charges of wind through the mouth of the womb, and pains like wind-colic Causes. — Foreign or decaying substances in the womb; softening of the womb; hysteria; &c Treatment. — Bemoval of the accumulated air by means of catheter, and slight compression of the hypogastric region; external applications of Oleum Sabinae, copious cold injec- tions by means of the pump and vaginal syringe; the spray- bath, and the ascending douche. Homoeopathic remedies. — Perhaps, China, Carbo v., Sepia, Secale and Platina. Pollutio. — ( See Spermatorrhoea.) POLYPUS UTERI. A pear-shaped tumor covered by mucous membrane, and attached by a narrow neck to some part of the uterus. The disease is accompanied with bearing down pains, menorrhagia, and after a time fetid discharges. On examination an insen- sible tumor is found partially or entirely protruding through the os uteri. Inversion, or prolapsus of the womb must not be mistaken for it. Treatment. — A ligature should be twisted lightly round its neck, but not too near the womb, by means of the double canula, and tightened from time to time until the tumor comes away, which will usually be in five or six days. Frequently the application of powdered caustic, by means of pieces of sponge, with threads attached to withdraw them, will be sufficient to destroy them, in combination with me- ohanical force, as: squeezing, twisting, crushing, and tearing away such parts as may be conveniently detached. Some surgeons recommend the destruction of the polypus by a solution of caustic-potash, introduced through a silver catheter. Homoeopathic remedies. — Staphysagria and Calcarea. 496 DISEASES OF THE GENITAL ORGANS. PRIAPISMUS. Permanent, painless rigidity and erection of the penis with- out concupiscence. Causes. — Gonorrhoea; inflammation of the urethra; stones in the bladder; poisoning by Spanish flies. Treatment consists in the removal of the causes. PROSTATITIS--ACUTE INFLAMMATION OF THE PROSTATE GLAND. Great weight, pain, throbbing at the neck of the bladder; tenderness of the perinseum; the gland feels swollen and tender on examination by the rectum; frequent, violent, and exceedingly painful efforts to make water. It is generally the consequence of acute Gonorrhoea. Treatment — Best in bed ; cupping or leeches to the peri- nseum; hip-baths and enemata of starch and laudanum every night. The introduction of the catheter must be avoided, if possible. Abscess of the Prostate may be suspected, if rigors and obscure swelling in the perinaeum follow the symptoms of acute inflammation. The swelling should at once be punctured with a bistoury. If the abscess should burst into the urethra, the catheter should be used every time the patient passes urine, in order to prevent it from entering and irritating the cyst. Chronic Enlargement of the Prostate Gland is extremely frequent in advanced life, and seems to depend on the decay of age rather than on any disease. It generally commences about the time that the hair turns gray, and when earthy specks begin to be deposited in the coats of the arte- ries. The gland increases from two to fourteen times its nat- ural bulk, and becomes hardened. It produces frequent in- clination to urinate, and slight difficulty in doing so; sense of weight in the perinseum, and tenesmus, and prevents the bladder from being completely evacuated, and the urine is in consequence rendered constantly turbid. Total retention of urine is liable to occur, if the swelling is aggravated by any excesses to which the patient is addicted. Finally the obsta- RHEUMATISM OF THE WOMB. 497 cle continues to increase, the bladder ia constantly distended, the urine perpetually dribbles away; abscess in the gland sometimes takes place; the kidneys become disorganized, strength is exhausted, and he dies. Causes.—-Calculous concretions; venereal affections; repel- led gonorrhceal discharge. Treatment. — The catheter should be introduced two or three times a day, so that the bladder may be completely emptied. The catheter should be long, and have its point well turned up. A silver one is the best. The finger should be introduced into the rectum to guide it. If the bladder has been long distended, aud the kidneys have become organically diseased, the urine should be drawn off in small quantities at a time, as the sudden withdrawal of all the urine will be followed by sinking, &c Hydropathic treatment. — Frequent hip-baths, the ascend- ing douche, and a daily ablution. When produced by sup- pressed clap, warm hip and foot-baths must be employed until the discharge reappears, after which the cold treatment may be employed. PRURIGO SCROTALIS, AND PUDENDI AND VULVAE. Irritation or violent itching of the scrotum, pudendum and private parts of females, which in some cases has been so vio- lent as to cause emaciation and even death. Causes. — Nervousness; suppressed perspiration; psoric acri- mony; disturbances of menstruation; and hemorrhoidal con- gestion; uncleanliness; ascarides creeping into the vulva. Treatment. — Washing the genital organs with soap water, composed of genuine cocoa-oil, soap, and a weak solution of corrosive sublimate in rosewater. Homoeopathic remedies. — Prurigo scroti: Sulphur, Acidum nitricum, Dulcamara and Bhododendron. Prurigo pudendi: Sulphur, Sepia, Conium, Calcarea, and Natrum muriaticum. Psoriasis prosputii. — (See Herpes prseprotialis.) Prolapsus uteri. — (See displacement.) Putrefaction of the uterus. — (See metro malacia.) 21v 498 DISEASES OF THE GENITAL ORGANS. Retroversion of the womb. —(Ave displacement.) RHEUMATISMUS UTERI--RHEUMATISM OF THE WOMI5. Drawing, tearing pains in the pelvis, following the course of the ligamenta rotunda, and extending in some cases to the muscles of the thigh and abdomen. There are also periodi- cal hemorrhages, especially during a paroxysm of violent pains. The disease is sometimes accompanied with fever. Mineral acids and cold applications increase the sufferings. Causes. — Taking cold during menstruation. Therapeutics. — Warm fomentations to the hypogastric re- gion ; warm sitz-baths, diaphoretic remedies, Dover's powder, mustard poultices, a hot brick wrapped in a wet cloth and applied to the painful part, internally Chamomile and Aco- nite. Flannel bandages must be worn after the pains are relieved to prevent a return of the disease. (See Rheuma- tism.) Rupture of the Yivmb. — (See laceration.) Satyriasis. —(See lasciviousness.) SARCOCELE. A fleshy tumor of the testicle. The most common form ii a simple enlargement, depending upon chronic orchitis. When the enlarged gland resists the ordinary means for its reduction, the safest remedy is castration. (See Orchitis.) SPERMATORRHOEA--SEMINAL FLUX —INVOLUNTARY EMIS- SION OF SEMEN. This debilitating disease, when the emissions are frequent, is generally accompanied with the following symptoms: a kind of feverishness; irregular, unrefreshing sleep; dreams of sexual intercourse; nervous headache; fixed dull pain in the back of the head; spinal debility; despondency; bash- fulness; forgetful n ess ; incapacity for concentrated attention; hypochondria; awful forebodings; partial insanity; disposi- tion to seclude themselves from society; (especially in young females ;) catalepsy ; epilepsy ; frequent inclination to empty the bladder; &c Causes. — Ascarides;piles, irritation or chronic inflammation INVOLUNTARY EMISSION OF SEMEN. 499 of the prostate gland, excess in sexual indulgence ; idleness ; libidinous ideas; much animal diet; self-pollution; coffee; tea : spirituous liquors ; internal chronic irritability. Treatment. — Besides the means and remedies recommended under masturbation and lasciviousnesss, the patient should avoid lying on the back, should denounce all lascivious books, pictures and conversation; keep body and mind busy in useful occupations, adopt a plain vegetable and fruit diet; take daily a general ablution, and a moderately cool hip- bath, injections of borax and salaeratus into the urethra; make irritating applications to the perinaeum, camphorated plaster to the spine and perinaeum, even cauterization of the urethra. Simple pressure has been found an efficient remedy. A pad is applied around the base of the penis so as to bear upon the seminal ducts with a silver yoke, encircling and removing all the pressure from the private parts, and secured by a gum elastic strap, passing over the bodyT, before and behind, and over each shoulder, and buckled in front, to be worn during the hours of sleep. A more simple instrument than the one described has been lately invented, and can be had in most Drug-Stores. If Spermatorrhoea is caused by ascarides, piles, &c, these diseases must be removed by the proper remedies. Homoeopathic remedies. — For excessive nocturnal emissions, give China, Phosphoric acid, Selena, and Sulphur. If caused by onanism or sexual abuse : China,. Phosphor and Sulphur; or Nux v., Pulsatilla, and Sepia. For discharge of prostatic juice: Calcarea, Hepar, Phosphor acid. Sepia and Sulphur. Hydropathists and Eclectics recommend sleeping on a hard bed, eating light suppers, and sleeping on the side. By sleeping on the back, blood, by its own gravity, accu- mulates in the cerebellum, which excites, not only the amatory organ, but those which co-operate with it. Spermatocele, — (See Varicocele.) ^ 500 DISEASES OF THE GENITAL ORGANS. STERILITAS-—STERILITY--BARRENNESS. A sufficient degree of vitality, excitability, irritability, and productivity of the female organs of generation is requisite for procreation. Besides the inefficiency of one or more pre- requisites causing sterility, there are the following: Mechani- cal obstructions, as callosities and a spasmodic contraction of the vagina; disorders of menstruation; profuse menstruation causing imperceptible abortions every four weeks; whites; concretions in the uterus; cold temperament; want of nourish- ment; grief; frequent coition; too ardent temperament; great excitement during coition; forced coition; organic disorders of the uterus, as polypus, Scirrhosities, &c Treatment. — Bemoval of the remote causes; change of cli- mate,—women wrho are barren in the north become mothers in the south; arousing the specific sexual action in the womb by iron and baths, coition should be performed in the morning immediately after menstruation has terminated; change of position during coition, &c (See Impotence.) SPASMS OF THE VAGINA, Take place suddenly during parturition; the vagina becomes dry, and its muscles contract, so that the already advanced parts of the child are retained in the canal; the patients be- come excited, nervous, and often general spasms -take place. Treatment—Bepeated injections into the vagina and rectum of Valeriana; narcotic cataplasms; tepid hip-baths, and embro- cations of opiate ointment into the perinaeum and the orifice of the vagina. In obstinate cases anti-spasmodics, as: Hyos- cyamus, Belladonna or Opium must be given internally. Syphilis. — (See General Diseases.) Testicle swelled. — (See Orchitis.) TESTIS, ABSCESS OF. Abscess of the testis is in most cases the result of chronio, or scrofulous inflammation, very rarely of the acute. A punc- ture should be made as soon as fluctuation is clearly felt, and the skin is adherent. When an aperture is formed, part of the tubular texture of the gland is apt to protrude in the form CIRCOCELE. 501 of a pink, fungous, irregular mass, called fungus or hernia testis. This should be returned to its place by pressure with strips of plaster; and stimulating applications (lunar caustic) should be used to excite granulations. TESTIS, ATROPHY OF. Atrophy of the testicle may be a result of excessive venereal indulgence, or of inflammation; the part becoming filled with lymph, which first annihilates the tubular structure, and then is itself absorbed. The gland dwindles to the size of a pea. There is no cure. ULCUS MENSTRUALE--MENSTRUAL ULCER. This name is given to ulcers occuring in chlorotie young women, and exuding a bloody fluid at the time of their monthly discharge, if that be absent. Treatment. — Monthly discharge must be restored, and the ulcer be treated on general principles. (See Ulcers.) VARICOCELE--CIRCOCELE. Varicose enlargement of the spermatic veins, usually com- mences close to the testis, and extends upward to the abdominal ring. The swelling is knotty and unequal, bearing some resemblance to coiled up earth worms; it is sensitive to the touch, creates a feeling of weight in the scrotum, neuralgic pains in the loins, and often a degree of numbness in the thigh. The erect posture and exercise produce aggravation of symptoms. The left cord is more liable to this state than the right. It is distinguished from hernia, as follows: after placing the patient in the horizontal posture, proceed to reduce the swel- ling by compression of the scrotum, then press the fingers against the upper part of the abdominal ring, and request the patient to get on his legs; if it be a varicocele, the swelling- will reappear with increased size, from the obstruction which is afforded to the return of blood into the abdomen by the pressure; but, if a hernia, the recurrence of the tumor cannot take place as long as the pressure at the ring is continued. Causes.—Blows upon the groin : violent pressure of a hernial 502 DISEASES OF THE GENITAL ORGANS, truss over the spermatic cord; tumors resting on, and inter- rupting the circulation of the vena cava infcrioris; excess in coition, Ac. Treatment allopathic. — In ordinary cases sufficient relief may be obtained by keeping the bowels open; by frequently washing the scrotum with cold water or astringent lotions- and supporting it with a suspensory sling made of open silk net, and fastened up with two tapes, which are to be fastened round the abdomen, and tied in front; but it should have no tapes passing between the legs. In obstinate cases the opera- tion of cutting away a good piece of the loose relaxed skin is proposed. The patient being placed in the recumbent posi- tion, the relaxed scrotum is drawn between the fingers; the testis is to be raised to the ring by an assistant, and then the portion of scrotum is to be removed by the knife. Arteries must be tied, and cold applied to check the bleeding; and then the lower flap of the scrotum must be brought upward and forward; and a suspensory bag should be applied to press the testis upward, and glue the scrotum to its surface. Appli- cation of moderate pressure to the dilated veins at the exter- nal abdominal ring, by means of Evan's lever truss is the most promising method. Homoeopathic remedies. — Pulsatilla, Lachesis and Arnica; also, Arsenic, Carbo veg., Nux v., and Sulphur. Removal of the varicose veins is recommended. Hydropathic treatment.—Careful regard to hygienic habits; occasional sitz-baths, or the ascending douche, with the use of a suspensory bandage. Eclectic treatment. — Stimulants and pressure, in connection with creating inflammation by an irritating plaster. Whites. — (See Leucorrhoea.) CHAPTER XVII. DISEASES OF THE CHEST AND WINDPIPE. arscess of the lungs. — (See Phthisis and Pneumonia.) Aneurism, thoracic. — (See Diseases of the Bloodvessels.) ANGINA PECTORIS—ASTHMA CARDIACUM--STENOCARDIA—NEU- RALGIA OF THE HEART. During motions of the body, sudden violent oppression at the chest, about the lower part of the sternum, a little toward the left side, with or without pain; feeling of constriction and suffocation; palpitation of the heart; anxiety; cloudiness of the head; vertigo; fainting; painful drawing and numbness in one arm; irregularity of the pulse. Horizontal position re- lieves the severity of symptoms, which is a peculiar feature of Asthma cardiacum. (In Asthma pulmonale the forward bent position relieves.) In severe forms of the disease, the cardiac region is found somewhat swollen. Causes.—Organic disease of the heart or of the great vessels as: enlargement, ossification of the valves, polypus, &c; violent exertions of the body; mechanical lesion; metastases, espe- cially the arthritic; plethora; intemperance. In the more advanced stage the paroxysms come on even in bed, and dur- ing slumber. Treatment allopathic. — In the interval the patient should cultivate calmness of mind; avoid all vigorous muscular effort; attend carefully to his general health; take exercise on horse- back, or in a carriage; avoid all stimulants; travel in foreign lands; Ac. During the paroxysm the patient should be kept at rest. If plethoric, diminish the action of the heart by small vene* sections, leeches on the cardiac region, and the use of nitre, 503 504 DISEASES OF THE CHEST AND WINDPIPE. digitalis and aqua laurocerasi; also by cold ablutions and a compress wet with cold water to the region of the heart. To relieve the pain, give a large dose of laudanum, or mor- phine, and repeat the dose, if the first should not prove suc- cessful. When there is a gouty or rheumatic taint, the ammo- niated tincture of guaiac, or the wine of colchicum are indi- cated. An overloaded stomach requires vomiting produced by ipecacuanha, aided by warm water, or infusion of chamomile. Inhalation of chloroform; external applications of mustard; blisters; setons, &c", are recommended. Homoeopathic remedies. — Aconitum, Arsenicum album and Digitalis. v In some cases, Ipecac, Veratrum, Asa fcetida, and Acidum \ydrocyanicum have been found beneficial. hydropathic treatment.—The rubbing wet sheet, or washings and frictions with wet towels wrung out of cold water, two, three or more times in succession, or until the excitement and difficulty of breathing ceases. Wet towels to the chest, and the wet jacket are also useful. Eclectic treatment — During the paroxysm, administer the compound tincture of Lobelia and Capsicum, in table-spoonful doses, which must be repeated every ten or fifteen minutes, until relief has been afforded. If the paroxysm is not com- pletely relieved by this, an Emetic should be given as soon aa the patient can swallow, for which the common Emetic Pow- der will be found the most useful. When the paroxysms are severe, and there is coldness of the surface, external stimu- lants, as Ammonia, or Granville's lotion, must be applied, especially over the epigastrium and along the spine, with warmth and friction to the extremities. Angina membranacea. — (See Croup.) APHONIA--LOSS OF VOICE--SUPPRESSION OF VOICE. The entire loss of voice, or hoarseness, and roughness of the voice is in most instances a symptom of catarrh; or it arises from a scrofulous affection of the tracheal glands; or from syphilitic metastasis; again in other cases it accom- APOPLEXY OF THE LUNGS. 505 panies measles, croup, influenza. Not unfrequently it is the first symptom of phthisis trachealis. In some cases it is caused by a morbid affection of the nerves pertaining to that organ. Periodical Dumbness is always a spasmodic affection ; if we find it in children we may suspect worms; in grown persons Hystery, Catalepsy, or Insanity. (See Stammering.) Treatment — Catarrhal hoarseness or loss of voice requires such remedies, as will correct the discharges of the mucous membrane, and aid the expectoration of the accumulated tena- cious mucous and slime. Drinking of cold water; smoking of tobacco in the morning; Antimony and Sulphur; oxymel of Squills; gargling of the throat with a solution of alum; Bteam-baths, croton oil externally; chlorine diluted with water, and Pulvis spongiae ustae, are the principal remedies recom- mended in allopathic practice. The patient must abstain from coffee, tea, spices, ardent spirits, pork, cheese, nuts, Ac Homoeopathic remedies. — In common hoarseness or loss of voice caused by cold: Nux v., Mercurius, Belladonna, Chamo- mile and Pulsatilla. In chronic cases: Phosphor, Carbo v., Causticum, Sulphur, and Hepar sulphuris. Hydropathic treatment—In recent cases gargling with cold or tepid water; wet bandage, well covered with flannel around the throat during the night; steam-bath; in some cases a pack. In chronic cases the treatment must be instituted according to the causes. Eclectic treatment,—If the affection result from a suppressed action of the skin: a tepid bath, or a vapor bath, aided by dia- phoretic and anti-spasmodic agents; foot-baths; warm diluent drinks, and in severe cases Emetics and Expectorants. APOPLEXIA PULMONALIS—APOPLEXY OF THE LUNGS. Great oppression of breathing, increased by talking or mov- ing; sense of impending suffocation; sensation as if warm water had been poured suddenly into the chest, after which coughing ensues, with expectoration of sweetish tasting blood. 1 ^'0 ILemoptysis and Apoplexia.) 506 DISEASES OF THE CHEST AM) WINDPIPE. ASTHMA--TISSIC. Difficulty of breathing, recurring in paroxysms, without fever, and attended with cough, dry or loose, constriction in the chest, and wheezing. Paroxysms appear generally toward evening, or during the night between the hours of ten and two; and are in some cases preceded by indigestion, loss of appetite, headache, lan- guor, drowsiness, Ac During a severe attack the patient feels worse in a recumbent posture; is anxious to get to an open window, feels as if he would suffocate, and can be heard wheez- ing and gasping; inspiration is more difficult and painful than expiration, and there is a constant attempt to force something out of the air passages, which impedes the breathing. In some cases the lungs appear to shrink a good deal, the chest becomes contracted, and the epigastrium hollow, showing an unusual elevation of the diaphragm. Expectoration consists of a thin, soap-like mucus. We distinguish asthma from organic diseases of the 1iiii<;h and the heart by the periodical appearance of the symptoms of the former. The proximate cause is a constriction of the minute bron- chial tubes, and the myriads of air cells in the lungs, llemoto causes are: taking cold; flatulency; spasms or cramps in the chest; exposure to copper, arsenic, sulphur and iodine vapors; inhalation of stone and mill dust; hysteria; fit of passion; fright; repercussion of an eruption, or the suppression of an habitual discharge; suppressed catarrh, Ac Treatment allopathic-—Bemoval from damp, low countries to a high and mountainous one; confinement to the house during wet weather; keeping saucers filled with Sulphuric acid, or Hepar sulphur in the room; internally: Gummi ammo- niacum; Gummi benzce in combination with squills; Sulphur auratum; tartar emetic; digitalis; vinum antimoniatum; exter- nally : Sinapisms, vesicatories, plaster of Pix burgundica, warm foot-baths of mustard; flannel next to the skin; also: inhaling of tar-gas; or ehlor-gas: smoking of Stramonium leaves. ASTHMA. 507 The patient should be careful not to eat too much, and only light food. Treatment homoeopathic.—Ipecacuanha: suffocating sensation of constriction in the windpipe; wheezing and mucous rattling in the chest; cough; paleness and coldness of the face. Arsenicum: great exhaustion, and anguish, as if at the point of death, with cold perspiration; aggravation of symptoms by walking up a hill, ascending stairs, laughing and other exer- tions, and during damp weather; burning heat in the chest. Nux v.: Spasmodic constriction in the lower part of the chest, short dry cough; better when lying on the back. Pulsatilla: Choking as from the vapors of Sulphur; parox- ysm of suffocation with deadly anguish; palpitation of the heart; worse at night and when lying horizontally; better in the open air. Tartar emetic: Asthma in old persons and children; anxious oppression arising from an excessive secretion of mucus in the bronchii; choking and retching with rattling in the chest. Other remedies occasionally indicated, are: Aconite, Bella- donna, Phosphor, Bryonia, China, Moschus, Ammonium c, and Stannum. In acute Asthma the dose may be repeated at intervals of from half an hour to two hours. When the medicine first prescribed affords no relief after four repetitions, another must be selected. Hydropathic treatment — Dripping sheet five minutes, fol- lowed by the douche three minutes, on rising; at ten to eleven, a. m., wet sheet pack forty-five to sixty minutes, followed by a shallow-bath at 72°, ten minutes ; at four p. m. sitz-bath at G5°, fifteen to twenty minutes; keep the bowels free by tepid injections; let the patient drink six or eight tumblers of soft water during the forepart of the day. Hunger-cure is recomr mended. During the paroxysm: hot fomentations to the chest and abdomen; drinking of warm water; the tepid half, or hip-bath. Eclectic treatment — During the paroxysm of Asthma the 508 DISEASES OF THE CHEST AND WINDPIPE. following liniment exerts almost a specific influence over the spasm: Take oil of Stillingia, 3j ; oil of Lobelia, 3jj ; Alcohol. f, giij ; mix. The throat, neck, chest, and spine, must be bathed with this, three or four times a day. Internally, the following may be used: Take syrup of Ipecac, Syrup of Senega, Syrup of Squills, each one ounce, Tincture Lobelia half an ounce; mix. Of this give about a fluid drachm every fifteen minutes, until nausea is produced. Some authors recom- mend an infusion of lobelia and boneset, two table-spoonfuls every fifteen minutes till free vomiting takes place, followed by a cup of clear coffee. Restlessness requires a tea-spoonful of sulphuric ether and red drops. Bemove gastric, hepatic, or other derangements. Asthma ardominale. — Its causes are indigestion, flatu- lency, acidity, costiveness and affections of the liver. Allopathists give: Emetics, purgatives, cummin, pepper- mint, injections, Hoffman's anodyne liquor and mineral water. Asthma nervosum, and hystericum,. Principal remedy: Asa- foetida. Asthma metastaticum, requires for its cure the same treat- ment as the disease, of which it is metastasis. Artificial ulcers on the arms and legs are employed by Allopath- ists. Asthma mucosum, distinguished by constant accumulation of mucus, and mucous cough. (See Asthma and Phthisis pituitosa.) Asthma mechanicum, is caused by poisonous vapors, mill and stone dust, accumulation of water in the chest, ossification of the ligaments of the ribs, hump-backs, &c Principal treatment consists in the removal of the causes. Homoeopathists recommend for asthma caused by vapors of Sulphur, Pulsatilla; if caused by vapors of Arsenic or Cop- per, Ipecac, Hepar and Mercury; by dust from stone or flour, Calcarea, Silicea, Sulphur. Asthmaplethoricum. (See congestion of the chest.) CHOKING fits of children. 509 ASTHMA OF MILLAR & WIG AND — SPASMODIC CROUP — CHOKING FITS OF CHILDREN. A spasmodic contraction of the top of the Windpipe. Sud- den attack of short breath, usually at night; gasping, whist- ling respiration; great anxiety; barking cough; little or no fever; face purple; sometimes spasmodic contraction of tho toes, and clenching of the thumbs. Paroxysm ceases after six or eight hours. The child feels well during the day; in the next night the same symptoms return with greater vio- lence; again cease and so on. Death often ensues by suffoca- tion during an attack. It may be confounded with croup. The discriminating signs are: In asthma there is a remission, even intermission of the dyspnoea, in croup it continues; in asthma there is no fever, in croup inflammatory fever; in asth- ma pale, in croup red urine. Causes. — Taking cold, damp air, and moist dwelling. Treatment Allopathic. — Commence with an Emetic; then give Asafcetida in the following manner : Take Asafoetida 2 drachms; Spirit of Mindererus 3 drs.; Mucilage of Gum Ara- bic, as much as will make an emulsion with three ounces of Melissa water; a teaspoonful every hour. We may also em- ploy mustard plaster, or a vesicatory on the chest; musk in large doses, in the form of powder with sugar and magnesia, or in solution with chamomile; antispasmodic injections of asa f., one half to one grain with the yellow of an egg and an in- fusion of chamomile. In desperate cases the chest, cardiac re- gion, and extremities should be rubbed with fine brushes; with diluted spirits of muriate of ammonia, chlorine water, &c Air should be blown into the mouth; and even after life seems departed, we should persevere with the above means to call it back. Cases are on record of children dying with this disease being buried alive. Homoeopathic remedies: Aconite, Ipecac, Arsenic, Sambu- cus, Moschus or Pulsatilla; the proper remedy to be repeated every one or two hours according to the symptoms. If this disease attacks children violently and suddenly, in 510 DISEASES OF THE CHEST AND WINDPIPE. sleep, Sambucus has been found the most effective remedy. Hydropathic treatment, — Apply several folds of wet cloths, well covered with dry one3 to the throat; give a tepid bath, followed by the dry pack, or by putting the patient in bed, well covered, so as to promote perspiration; give also a warm water emetic, and tepid injections, to keep the bowels open. Asthma senile.—Difficulty of breathing in old persons, caused by ossification of the costal cartilages, or by weakness created by old age. When ossification of the cartilages is the cause, nothing can be done but palliatives administered. Smoking of Belladonna, or Stramonium, and the inhalation of tar or turpentine is recommended. Homoeopathists recommend: Aurum, Conium, lachesis and opium. Asthma strumosum. — This species of asthma is caused by swelling of the thyroid gland. The same treatment is re- quired as recommended for Goitre. Acetate of soda, half a drachm, dissolved in water and taken daily, has, in several cases, effected a perfect cure. Asthma thymicum. — Children when awaking in the morning, or after excitement and anger have attacks of short, whistling, imperfect inspiration, sometimes a complete cessa- tion of respiration; spasmodic motions of the limbs, cold ex- tremities, red, livid face. These symptoms last for some min- utes, and then pass off, leaving the patient weak, but other- wise perfectly well. Cause. — This disease generally attacks children, from after the first days of birth to the second year, and is caused by a too large and firm Thymus gland, connected with great irrita- bility and sensibility of the pectoral nerves. Treatment. — A cure can only take place by a gradual dim- inution of the Thymus gland, which is the work of nature. Warm baths during a paroxysm; application of flannel wrung out of tepid water to the chest; small doses of sul- phate of Zinc or Musk. V BRONCHITIS. 511 Spongia tosta, lodium, or Bromium, in small doses, are, probably, the proper remedies to aid nature in the diminution of the swollen, enlarged gland. Bleeding from the Lungs. (See Haemoptisis.) BRONCHITIS. An inflammatory affection of the mucous membrane of the bronchial tubes. Acute Bronchitis. — Chilliness succeeded by fever; hoarseness; difficulty of respiration; frequent, distressing dry cough, subsequently with copious expectoration; labori- ous respiration attended with a feeling of constriction and op- pression of the chest; a peculiar pain^inder the manubrium sterni; the patient cannot expand the chest without inconve- nience; foul tongue; loss of appetite; loud wheezing; pale lips; anxious countenance When the disease takes an unfavorable turn, the difficulty of breathing increases, a state of excessive debility supervenes. the face becomes livid, the body covered with a cold and clam- my sweat; the mucus accumulates in the bronchial tubes, and the cough is insufficient for its ejection; cerebral symptoms declare themselves, and the patient is carried off in a state of asphyxia. In many cases of acute Bronchitis—mostly in children — no particular pain, heat of the skin, or fever may exist, and no attention is paid to the wheezing and oppression atthe chest, until suddenly suffocation threatens, when it is gen- erally beyond control. The frequency of this disease in infancy and early life deserves particular notice. It is often accompa- nied with sore throat, painful cough and mistaken for croup. The exacerbation of suffering at night is a very remarkable symptom of this complaint. Causes.—Colds; exposure to sudden changes of tempera- ture ; insufficient clothing. It is, also, of frequent occur- rence as a concomitant of scarlet fever, measles, small pox, whooping cough, Ac Treatment allopathic — Twelve to twenty leeches to the larynx and along the trachea; in plethoric persons venesection; 51li DISEASES OF THE CHEST AND WINDPIPE. embrocations of mercurial ointment, and oil of Hyoscyamus. Internally gum arabic water; or sweet almond oil (a teaspoon- ful every half hour) with aqua laurocerasi; spare diet; confine- ment to house; moist and warm air. Vesicatories and inha- lation of medical vapors must be avoided. Homoeopathic remedies: Aconitum: hot. dry skin, with strong, hard and accelerated pulse; obstructed respiration. Bryonia: laborious, rapid breathing, with constant inclina- tion to take a deep respiration; dry cough, attended with a burning pain, from the throat to the middle of the Sternum; cough with expectoration of mucus streaked with blood; dryness of the mouth and lips; thirst; complication with pleurisy. Spongia: hollow, dry cough, day and night; cough with scanty, ropy expectoration; laborious respiration; heat in the chest; hoarseness; inclination to throw back the head, which diminishes the difficulty of breathing. In some cases the following remedies will be indicated: Hepar, Belladonna, Nux v., Lachesis, Phosphorus, Pulsatilla, Mercurius, Ipecac, Tartar em., and Arsenicum. Hydropathic treatment. — Spare diet; hunger-cure; vapor bath, followed by a general ablution; wet bandages on the chest day and night; general ablutions to cool the surface; frequent rubbing of the chest and throat with the cold wet hand until it is completely red. Eclectic treatment — Stimulant applications should be ap- plied to the surface as near the inflamed parts as possible, as upon the back between the shoulders, upon the breast, upon the arms, to the feet and ankles. Diaphoretics should not be neglected. When an equalization of the circulation has been affected, the function of the skin should be rendered particu- larly efficient, in order that the disease may be removed by de- puration. A Seidlitz powder or mild pills may be given. A syrup prepared from a decoction of Eupatorium perfolia- tum and Sanguinaria canadensis, in drachm doses several BRONCHITIS. 513 times a day, adding a small portion of paregoric at night, on going to bed; or as a substitute, the common sudorific tinc- ture or red drops, in -proper doses mixed with salad oil and loaf sugar, will afford in most cases, prompt relief. In Bronchitis with fever of a distinct periodical character, there should be given three grains each of quinine and prus- siate of iron every two hours until the next exacerbation oc- curs, when it should be suspended. A difficult and obstinate cough has often been removed by the syrup of balsam of tolu and senega, from one half to a drachm, with ^ of a grain of morphine to each dose, repeated three or four times a day. Bronchitis chronica. — Chronic Bronchitis differs from acute Bronchitis chiefly in the greater mildness and longer duration of its symptoms, continuing from several weeks or months to many years. The disease is worse during winter and inclement weather; distressing cough with expectoration of greenish or yellowish matter; difficulty of breathing after slight corporeal exertion. In severe forms of the disease, we have hectic fever, emaciation, nocturnal sweats, and, occasion- ally, attacks of diarrhoea, and the disease is often mistaken for tubercular consumption. In chronic Bronchitis the re- sonance of the chest is little, if at all, diminished. Causes. It may be the result of acute Bronchitis, or it may arise as a gradual inflammation of the mucous membrane of the bronchial tubes; or proceed from the irritation of dust, from over exertion of the Bronchia, from congestion, after eruptive fevers, Ac. Treatment, — Local bleeding, by cups or leeches; expecto- rants, such as tartar emetic in aqueous solution, ipecacuanha wine or syrup, tincture of sanguinaria and lobelia, and wine of colchicum; of which a dose should be given four or six times a day, and so regulated as to be kept just within the nauseating point. If there is no active inflammation the above expectorants may be conjoined with syrup of squill or syrup of seneka. A decoction of seneka and liquorice root, 514 DISEASES OF THE CHEST AND WINDPIPE. with tartar emetic is recommended as a very efficacious com- bination. Becourse may also be had to the balsams of Tolu and Peru, the compound tincture of benzoin, and to copaiba. When there is tightness of the chest, and want of bronchial secretion, hyoscyamus, conium, stramonium, belladonna, or hydrocianic acid; also camphor water may sometimes be use- fully added to the other ingredients. Black snake-root and sulphur have been used with advantage. Should febrile action supervene upon chronic Bronchitis, it may be relieved by a saline aperient, the neutral mixture, and tartar emetic in small doses. External irritation should be sustained by blisters to the chest, pustulation by tartar emetic or croton oil, setons or issues be- tween the shoulders, plaster of Burgundy pitch, friction, Ac. Inhalations of the vapors of tar; of the air of pine forests; of an ethereal solution of tolu; of the vapor of iodine by means of an inhaler, are recommended. The system should be invigorated by an infusion of wild cherry bark, long and freely used; or by a decoction of Ice- land moss; porter; tannic acid, in doses from one to three grains, twice a day; sea voyages; change of climate; &c Homoeopathic treatment. — The remedies found most useful in cases of this nature are: Sulphur, Calcarea, Carbo v., Pul- satilla, Hepar, Phos., Stannum, Sepia, Lycopodium, Kali c; Natrum m., Lachesis. Causticum, Arsenicum, Silicea, Acidum nitricum, &c. Hydropathic treatment. — Commence with the sponge or towel bath, or rubbing sheet, accompanied with friction. Af- ter a few days the chest wrapper should be applied, and half- hip and foot baths employed as frequently and as cold as the patient can bear without prolonged chilliness. Too great a shock, or too cold an impression should be avoided. When the general heat of the surface is above the natural standard, the pack should be resorted to daily, or tri-weekly. Eclectic treatment—We should aim to establish a general centrifugal action, and a strong depurating one on the part of CONTRACTION OF THE HEART. 515 the skin, kidneys and liver, particularly the kidneys. The compound tincture of Benzoes, balsam Copaiba are highly recommended. In cases of much anaemia, it will be judicious to administer iron separately, or in combination with the bal- sams. To allay cough employ the same remedies recommend- ed under acute Bronchitis. The bowels should be kept free by Rhei and Bicarbonate of Potassa, and when necessary, an emetic of infusion of Lo- belia and Eupatorium administered. Bronchitis maligna acuta, ( See Catarrhus suffocatious.) CARDITIS. Inflammation of the substance of the heart, distinct from Pericarditis, or inflammation of the serous membrane covering the heart, is a rare disease, and, in all probability, is incurable. CARDIO-STENOSE--CONTRACTION OF THE HEART AND ITS LARGE VESSELS. Paroxysms of Apncea during the night; when ascending stairs; accompanying exertions — even speaking; constant sensation of oppression in the region of the heart; pale, liv- id lips and tongue; cough dry or with expectoration of blood; sudden cessation of respiration and feeling of suffocation; horizontal posture very uncomfortable; face livid; eyes pro- trude; pulse weak and intermittent; extremities cold. As the seat of the disease is in the left or right heart, so Apncea is more or less severe. Worse if the right arterial heart is affected. Auscultation shows an unnatural contraction of the heart, accompanied with a grating sound, as if the blood met obstruction during its passage through the large vessels. The disease lasts for years and causes Dropsy, Hydrothorax, and Hydrops pericardii. Causes.—Dissection has shown an abnormal condition, gen- erally ossification, of the valves, by which the free passage of the blood was interrupted. In other cases deposits of ar- thritic or syphilitic matter have been found in the valves. Treatment—A radical cure is seldom possible. If caused by syphilitic or arthritic metastasis, it calls for the cure of 516 DISEASES OF THE CHEST AND WINDPIPE. Syphilis or Arthritis. Patients should abstain from spirits ous liquors, spices, coffee, tea, and should avoid physical and mental exertions. During a paroxysm, small venesections, sinapisms, warm hand and foot baths; and internally anti-spasinodic remedies, as Valeriana and Ether have been found efficacious. Dilatation or enlargement of the capacity of one or more of the heart's cavities, is characterized by palpitation and dyspnoea on any sudden emotion, diminished impulse, increased and more extensive sound, and soft, feeble, undulating pulse. Treatment.—Strengthen the heart and improve the blood by tonics, as the chalybeates, vegetable bitters, mineral acids, animal food, porter or ale in moderate quantities. To diminish the frequency of the heart's contractions, hy-- drocyanic acid, in the shape of wild cherry-bark tea may be given freely. Nervous disorders require asafoetida, valerian, camphor water, Hoffman's anodyne; &c Narcotics (Salts of Morphia) are also useful. In the latter stage of dilatation the efforts of the practi- tioner should be directed to palliation exclusively. Atrophy of the heart; Softening of the heart; Induration of the heart; rupture of the heart; polypous concretions of the heart; malformation of the heart; are organic diseases of this organ occasionally met. They are generally incurable. Valves of the heart.—Diseases of the valves of the heart are indicated by bellows or rasp sounds, heard most dis- tinctly over the situation of the diseased valve, occasionally accompanied by a purring tremor or vibration; palpitations and dyspnoea aggravated by exercise or by mental emotions; weak, small, sometimes intermittent pulse; swelling of the feet toward evening, discoloration of the face and extremities; extension of oedema to the legs. This disease is rarely curable. OATARRHUS SUFFOCATIVUS—APOPLEXIA PULMONUM—PARAL- YSIS OF THE LUNGS — BRONCHITIS ACUTA MALIGNA. Sudden attacks of dyspnoea, with a copious and early secre- CATARRH OR COMMON COLD. 517 tion of mucus, and consequent wheezing respiration; the pa- tient speaks with difficulty, is often unable to lie down, gasps for breath, and coughs violently and incessantly to free the lungs from the matter which threatens to overwhelm them; the face is pale, the lips are purple, the extremities cool, and the circulation very feeble. The disease is very dangerous. Causes. — Paralysis of the pectoral nerves; accumulation of mucus in asthma mucosum, sanguineous extravasation; effu- sion of matter; Ac Treatment consists in freeing the lungs from the accumula- tion by emetics, and in rousing them to action by arm baths, mustard plasters, or a vesicatory to the chest. Venesection, and immediately afterwards two to four grains of Tart, stibiat. in order to produce a free evacuation; Digitalis 5 — 6 gr. with 6 oz. Colatur with Oxym. squillit. and Vin. stibiat. in a mu- cilaginous vehicle* CATARRHUS SIMPLEX — CATARRH OR COMMON COLD. Slight fever, impaired appetite, languor, sneezing, pains in the back, head and extremities; chills or shiverings, cough, hoarseness; slight wheezing and difficulty of breathing. Causes. — Mild degree of inflammation of the lining mem- brane of the nostrils and windpipe, induced by sudden changes of temperature, or too chilly atmosphere, with insuf- ficient clothing. Treatment.—Bathe the feet and legs in warm water, go to bed, and encourage a gentle sweat by drinking warm gruel, or some simple warm tea; abstain from all food; "starve the cold." Sometimes by drinking one or two glasses of cold wa- ter on going to bed will relieve a cold. Hydropathists recommend the wet sheet pack and tepid water injections. Should these means prove insufficient, see treatment of cold in the head, hoarseness, influenza, bronchi- tis, cough, &c Homoeopathic remedies: Aconite, Bryonia, Nux v., Chamo- milla, Belladonna, Dulcamara, Mercurius, Ipecac, and Arse- nicum. 518 DISEASES OF THE CHEST AND WINDPIPE. Persons who are troubled with extreme susceptibility to cold, should rub the throat, chest, and indeed the whole body every morning with a wet towel, until a glow of heat is pro- duced; they should also go out every day, but avoid all ex- tremes either of heat or cold. Catarrhus epidemicus. (See Influenza.) Choking fits of children. (See Asthma Millari.) CONGESTIO AD PECTUS — CONGESTION OF BLOOD TO THE CHEST. Accumulation of blood in the vessels of the chest, sensation of great fulness, throbbing, weight or pressure in the chest and palpitation of the heart, attended with anxiety, short sighing respiration, and dyspnoea, aggravated by talking, ascending a flight of stairs, Ac. Causes. — Phthisical taint; exposure to extremes of heat or cold; stimulants, such as liquors, wine, beer, coffee, tea; the abuse of narcotic drugs; violent exercise; over-exertion in speaking or singing; sudden check of perspiration; cold or damp feet; sedentary habits ; suppression of the menstrual or hemorrhoidal discharges; repressed cutaneous eruption. Treatment — Cure of plethora by meagre diet, diminution of sleep, drinking of fresh soft water, exercise in the open air and a cool regimen. If there exist a syphilitic, psoric, or arthritic cause we should employ such remedies as will re- move the maladies. When it is the consequence of debility or nervousness, strengthening, antispasmodic remedies are serviceable. During a severe paroxysm recourse must be had to small venesections, cooling, antiphlogistic purgatives, foot and hand baths, clysters, &c. In mild attacks we should em- ploy local abstraction of blood by leeches; Digitalis; Miner- al acids, especialiy Ferrum carbonicum and Seneka. Homoeopathic treatment. — The symptoms of one or the other of the following remedies will be found corresponding with those of the disease; Aconitum, Nux v., Belladonna, Bryo- nia, Aurum foliatum, Mercurius, Pulsatilla, Phosphor, Spongia, Cinchona and Sulphur. croup. 519 Hydropathic treatment — Frequent ablutions of the chest with cold water; exclusive use of water as a beverage; walk- ing in the open air, on rising ground if possible, which may be daily increased; three or four tumblers of water during the day, always before, never after the exercise; a wet bandage applied to the chest during the night; foot and sitting baths. If congestions appear as a sequel of itch and other skin dis- eases, we must wrap the patient daily in the wet sheet to pro- duce perspiration, and re-establish the eruption. This envel- opment must be followed by a bath, by friction, and by the use of copious potations. Contusion of the chest, (See Contusio.) CROUP — ANGINA MEMBRANACEA — CYNANCHE LARYNGEA. Short, difficult and hoarse respiration, &c, accompanied by a shrill, whistling, squeaking, harsh, rattling, or metallic sound, with cough resembling the crowing of a young cock; fever, thirst; the patient throws the head back; in some cases comatose state of the brain. When any matter comes up in coughing, it has a stringy appearance, resembling portions of a membrane. Real croup is always preceded by catarrhal symptoms; is always attended by fever, and usually, a very violent one; urine is red, feverish, inflammatory; children are mostly at- tacked during the forepart of the night after a sound sleep. Severe paroxysms are followed by a profuse, clammy perspi- ration especially of the head and face; breathing during inspi- ration is difficult and audible; the child makes attempts to stretch the throat and extend it upward; the features become almost purple from the sense of suffocation; the voice sinks to a whisper; the eye has a glassy appearance; death ensues by apoplexy or suffocation. The intermission of the disease on the second day should not deceive us. Causes.—Inflammation of the lining membrane of the wind- pipe, causing the secretion of a thick substance, about the consistency of the white of an egg when boiled, which adheres 520 DISEASES OF THE CHEST AND WINDPIPE. to the interior of the windpipe, and is called " false mem- brane." Remote causes are: constitutional taint; exposure to cold and damp, dry, cold weather with sharp northern winds, cold air blowing into the open mouth, too heating nutritious diet, too much animal food, hot drinks as coffee and tea. Croup particularly effects early childhood, and is often confounded with croupy cough, and asthma of miliar. Treatment allopathic—As soon as the characteristic symp- toms of this disease appear, administer an Emetic, consisting of one grain of Tartar emetic, twenty grains of Ipecac, Oxy- mel of Squills and Syrup, each half an ounce, and an ounce of water, to be mixed and a tea-spoonful administered every fifteen minutes until vomiting has taken place; then give an injection of tepid bran water with a table-spoonful of vinegar, in order to effect a proper discharge from the intestines; let the child inhale warm vapors of elder flowers steeped in water, or the vapors created by pouring hot water upon hepar sul- phuris (sulphuret of lime). If no improvement should follow, apply leeches to tho throat, from one to four according to the age of the child, and give half a grain to two grains of calomel. Should the pa- tient be no better within twenty-four hours, give sulphurate of copper, a most efficacious remedy for removing the spas- modic state. It may be triturated with sugar, and one to four grains may be given, enough to create vomiting, after which one-fourth of a grain should be administered every two hours. When the suffocation fit returns, resort again to the former dose, which creates vomiting, and hare mercurial ointment rubbed on the neck, and vesicatories or sinapisms on the throat. In case the patient is unable to swallow, vomiting must be excited by tickling the pharynx and inside of the mouth with the finger wet with oxymel of squills. In order to prevent a return of the violent spasmodic symptoms the patient should be kept moderately under the influence of Ipecac, Antimony or Seneka, or combinations of them. In desperate cases fomen- fZLrU:^,^ ^f ^ Ck*-*~fr *1~ ouUU &^w'4a.t*<^i £-" & fn+~- ^ *£" At'**-**** "W rvkA>- Q**^-*j& t?l tM. aWr A*a>j^- vv« v^ j^al^vW* CROUP. 521 tations made from the leaves of tobacco, and applied upon the throat; cold lotions to the head, and affusions, have proved useful. In cases of severe spasm tobacco externally, and lobelia with decoction or syrup of seneka internally is recom- mended. Homoeopathic remedies. — Aconite, is called for during the inflammatory period, when attended with great burning heat, thirst, short dry cough and laborious breathing. Put three drops of the third dilution (or twenty globules) in half a tea- cup of water, and give a tea-spoonful every half hour to two or three hours, according to the violence of fever, until four or six tea-spoonfuls are taken. When the febrile symptoms are partially subdued by Aconi- tum, give Hepar sulphuris and Spongia for the following symptoms: moist skin, dry harsh cough with hoarse voice, croup cough with mucous rattling in the respiratory organs, laborious respiration, and restlessness. Prepare each remedy like Acouite, in seperate cups, and give in alternation a tea- spoonful every half hour until the child is better, then give the medicine only every three or four hours. Should the previous remedy fail to relieve the patient, or when they are merely productive of temporary benefit and the breathing is very labored and difficult, with a constant rattling in the throat or breast, and drowsiness, (threatening paralysis) give Tartar emetic Prepare one grain of the first trituration, or twelve to twenty globules, in half a teacup of water, and give a tea-spoonful every half hour for two hours, until four or six are taken, or until nausea ensues. After- ward we may again fall back upon Hepar and Spongia — if the symptoms indicate these remedies. Lachesis: Short dry cough with hoarseness; great sensi- tiveness of the larynx to the touch, the slightest pressure affecting almost to suffocation, rigidity of frame. Prepare and give as directed above. Besides the above remedies the following have been found useful: Cuprum, Phosphorus, Iodine, Opium, and Camphora, 22w "rl'l DISEASES OF THE CHEST AND WINDPIPE. Hepar and Phosphorus are recommended to eradicate a susceptibility to this affection. Hydropathic treatment.—Wash and rub the chest and throat with the hand wet in cold water and envelope the throat in several folds of very cold, wet clothes which should be frequent- ly changed, until the perspiration becomes free. If the fever is very high, effusions, or the wet sheet pack occasionally renewed, is indicated; in cases not accompanied with high fever, the whole body should be bathed in tepid water (70°) and then packed in the dry blanket until the heat returns, or perspiration is excited. Keep the bowels open, and the ex- tremities warm. When the breathing is very difficult and painful, and the patient makes unavailing efforts to expector- ate, warm water should be drank, and the throat tickled with the finger or a feather, so as to provoke vomiting. In severe cases, the child should be placed in a tub, and a pail of cold water, (59 or G0°) should be poured quickly from the head along the spine, after which, envelope the child in blankets, and repeat the operation whenever it gets worse. In the third or fourth stage of the disease, all treatment commonly fails. Eclectic treatment. — To relax the constricted or spasmed organs, an emetic should be promptly administered, which should be as promptly repeated, as often as the peculiar croupy inspiration occurs; and the most efficacious articles that can be used for this purpose, are the compound tincture of Lobe- lia, or the Acetous Emetic Tincture. After having produced free cmesis, either of these tinctures must be continued in doses sufficient to produce expectoration, and even nausea. Hot water should be applied to the throat constantly, and the skin should be thoroughly cleansed by the warm lye-wash. To strengthen the debilitated organs, Cayenne or Mustard poultices to the neck are recommended, also, one drop of the oil of Stillingia, placed upon the patient's tongue has rendered immediate relief, and ultimately by its repetition cured cases of this disease, which had resisted all previous treatment. It CYANOSIS PULMONAL1S. 523 has also been found beneficial when applied externally, in the form of a liniment: Take oil of Stillingia, 3j; oil of Lo- belia, 31J, Alcohol, 3jjj- Mix. Bathe with this the throat, neck, and chest three or four times a day; and after each application, a fomentation should be applied, composed of two parts of Hops, one part of Lobelia, with equal parts of vine- gar and water; boil together and apply the herbs. The child should be kept warmly clothed, and the diet should be light until convalescence. In the more grave cases, (the pseudo-membranous form of croup), the application of the cups, with scarification on the sides of the trachea or immediately over it, repeating it once or twice, will be found to give permanent relief. After this operation a soft onion poultice (roast the onions in the fire and mash soft) should be applied as warm as the patient can bear once every hour to two hours. A tea-spoonful or less of the syrup of Sanguinaria should be given every hour. Vomiting must be avoided. (See Laryngitis.) Consumption. — ( See Phthisis.) CYANOSIS PULMONALIS. A species of blue disease, Plethora venosa. Pressure, heavi- ness and oppression in the chest; difficult, short, hoarse breath- ing; respiration carried on by the abdominal muscles and dia- phragm ; expectoration of transparent or purulent mucus, mixed with dark blood; livid color of the cheeks, lips and inner walls of the mouth ; worse during movement; extremi- ties are cold; the skin dry, stool sluggish; diminished secre- tion of red urine, which is of a dark red color; excessive debility; paroxysm of suffocation, caused by the slightest exertion. Causes.—This disease is generally a sequel of inflammation of the lungs caused by menstrual congestion. Treatment. — Best, avoiding all exertions, even speaking; vegetable diet; water the only drink; increase of the action of the skin by bathing and friction; keeping the bowels free; stimulating foot and hand-baths. (See Congestion.) 524 DISEASES OF THE CHEST AND WINDPIPE. COUGH — TUSSIS. Forced and audible expectoration without fever. In many cases it is a precursor of phthisis, and, too often neglected; in others, it is a symptom of acute diseases, — such as fever, pneumonia. and is either dry or accompanied with expectoration. Causes.—-Irritation of the air passages or lungs from dis- eases of these organs; convulsive contraction of lungs and res- piratory organs; elongation of the uvula; metastases; cold; derangement of other important viscera. Treatment, allopathic—Cough caused by cold requires reme- dies which will increase the cutaneous action and thus restore the lost equilibrium. The following mixture has proved an excellent curative in the treatment of catarrhal cough: Take of extract of blessed thistle (centaurea benedicta) one drachm, bittersweet twenty grains, fennel water one ounce, laurel water one drachm. Mix. Of this take sixty drops four times a day. Obstinate cough requires flannel next to the skin, stipites dulcamara?, and a vesicatory on the upper arm. When Dul- camara is not sufficient use the following combination of reme- dies: Take of Iceland Moss, and twigs of Bittersweet, each half an ounce, boil in fourteen ounces of water down to eight, let it be strained, and then add aromatic spirit of Ammonia sixty drops, and syrup of Liquorice one ounce. Mix. Take two table-spoonfuls four times a day. Gastric and abdominal cough, has the following characteristic signs: the respiration is free, the patient can walk, speak, run, take a deep breath without coughing or panting; cough is worse after eating, and there is imperfect digestion. Treatment consists in the administration of Emetics and Purgatives, especially Manna and Folia sennae. Millefoil-tea is also useful. It should be taken morning and evening. (See Worms, Hypochondriasis, Ac) Nervous cough.—Diminished by running, speaking, motion, even overheating; excited by mental emotion. Patients are of a nervous habit. Treatment—Open air; exercise on horse-back; tepid or COUGH. 525 cold baths; asses milk; Hyoscyamus, Opium, Ipecac, and Valeriana. Spasmodic cough with gagging, which attacks hard drinkers during the morning, is relieved by abstaining from spirituous liquors, and using Quassia, Belladonna and Aqua laurocerasi. Homoeopathic treatment — The remedies mostly indicated when the cough is dry and caused by a common cold, with pains in the head and limbs, chilliness, &c, are: Aconite, Chamomile, Bryonia, Bhus t., Belladonna, Hyoscyamus, Capsi- cum, Ignatia, Nux v., Hepar, Phosphorus, Spongia. When the cough is loose: Ipecac, Pulsatilla, Dulcamara, Tart, em., Mercury, Stannum, Calcarea, Bryonia. Nervous and spasmodic cough: Bellad., Hyoscyamus, Ipe- cac, Drosera, Cina, Hepar, Carbo v., Lachesis. If accompanied by vomiting or retching: Ipecac, Tart, em., Pulsatilla, Mercury, Sepia, Bryonia. If by fits of suffocation: Ipecac, Tart, em., Drosera, He- par, Lachesis, Arsenicum, Chamomile, Opium. (See Bron- chitis, Worms, Dyspepsia, and teething, which are often the cause of coughs. Symptomatic detail. — Aconite: violent cough with feverish heat, oppression in the chest, &c Belladonna: Short, dry, barking, (spasmodic, nervous, catarrhal) cough at night in bed; tickling in the pit of the throat; pains in the abdomen, hoarseness, headache, Ac. Chamomile: Dry cough from tickling in the throat, worse during the night; coughs in children with hoarseness, fretful- ness, fever toward evening, pain in the bowels, diarrhoea. Nux vomica: Dry, hoarse, fatiguing cough, aggravated in the morning, better during night, expectoration of a little mucus detached with great difficulty; cough is excited by a scraping in the throat; pain as if from a blow or bruise in the epigastrium and hypochondria. Bryonia: Dry cough excited by irritation in the throat, after partaking of food or drink, with prickings in the chest, headache; loose cough with yellowish expectoration. 52(1 DISEASES OF THE CITEST AND WINDPIPE. Rhus t.: Short, dry cough, worse toward evening and before midnight, excited by tickling in the chest; bitter taste in the mouth. Ipecacuanha: Nervous spasmodic cough with nausea, retch- ing and vomiting; dry cough; severe shaking; spasmodic cough with difficulty of breathing. Cough in children with feeling of suffocation from the accumulation of mucus. Dulcamara: Moist or loose cough, caused by cold with copious secretion of mucus, hoarseness, Ac Pulsatilla: Severe shaking, catarrhal or nervous cou"h, worse toward evening, at night, and when in a recumbent pos- ture; sensation of suffocation, as if from the vapor of sul- phur; first dry, then followed by copious expectoration ; nausea and vomiting. Mercurius: Catarrhal cough with hoarseness, or watery coryza, or accompanied by diarrhoea; increased by talking, and worse during the night. Arsenicum: Dry cough, chiefly in the evening after lying down, often with difficulty of respiration and fear of suffoca- tion, as if arising from inhaling the vapor of sulphur; excited by drinking or by ascending stairs, or as soon as coming in the open air, then acrid discharges from the nose; sneezing; periodic dry cough; dryness and burning in the larynx; tena- cious mucus in the throat and chest. Hepar sulphuris: Dry hoarse cough, excited on any part of the body being exposed, or becoming cold from the bed clothes slipping off. Phosphorus: Dry cough excited by a tickling irritation in the throat or chest; pains in the chest as if from excoriation. Lachesis: Short, dry, suffocating cough; dryness and tick- ling in the larynx; cough excited by the slightest pressure on the exterior of the throat; cough always after sleeping. Stannum: Loose cough with copious sputa of a sweetish or saltish taste; sorenesss of the chest; feeling of weakness; sinking, emptiness in the chest. Calcarea: A dry or loose cough, with expectoration of INFLAMMATION OF THE DIAPHRAGM. 527 offensive, thick, yellow mucus; aggravated at night, tickling in the throat, or sensation as of a feather being down in the throat. Take of the proper remedy a dose every two to twelve hours, until four are taken; then wait from four to twelve hours, and if not better select the next best remedy. Hydropathic treatment,-—Drink freely of cold water; wash twice a day, and let each ablution be followed by thorough friction, or active exercise. When fever is present, the pack prolonged sufficient to produce moderate perspiration may be necessary, and when there is soreness or pain in any part of the chest, the chest-wrapper should be applied. Eclectic treatment. — Nervous cough: Asa foetida will give almost immediate relief, but it will not effect a cure. The following compound will be found of benefit: Take Podophyl- lin, gr.j., Cyanuret of iron grs. five, S. Morphia half a gr., white sugar, one drachm; Mix; Divide into twelve powders; give one powder three times a day, to a child three years of age, or in proportion. In connection with this take Iodate of Potassium, three grains, Tincture of Belladonna twenty drops, distilled water six ounces. Mix, and give a table- spoonful every half hour. A strong infusion of Peach leaves, or Wild Cherry bark, may be used as a drink. In common cough use a syrup prepared from a decoction of Eupatorium perfoliatum and Sanguinaria canadensis, and at night on going to bed a small portion of paregoric; or as a substitute the common sudorific tincture or red drops in appro- priate doses, mixed with salad oil and loaf sugar. When derangement of the stomach is present, an emetic should be employed. (See Bronchitis.) DIAPHRAGMITIS — INFLAMMATION OF THE DIAPHRAGM OR MIDRIFF. Violent pain, spreading from the lower ribs to the spine, Rnd accompanied with intense fever, aggravated by inspiration, moving or stretching the body, alleviated when sitting up 528 DISEASES OF THE CHEST AND WINDPIPE. with the body inclined forward. The upper part of the abdo- men is hot and very sensitive to the touch. There is often low, muttering delirium from the irritation which is commu- nicated to the phrenic nerve. Respiration is always impeded, and a dry, distressing cough is commonly present. In many cases we have also hiccup, vomiting, restlessness, spasmodic twitchings, and retractions of the angles of the mouth. This disease generally appears in combination with inflam- mation of the pleura or peritoneum, and is often mistaken for pleurisy. Causes. — (See Pleurisy and Pneumonia.) Treatment allopathic, — Venesection, leeches, and cupping, are the principal remedies; frequent injections are also useful. Against hiccup narcotic poultices, mustard poultices, aqua lau- rocerasi, musk and hyoscyamus are the best. (See Pneumonia.) Homoeopathic remedies. — Aconite and Bryonia; sometimes Chamomilla and Nux vomica. Hydropathic treatment. — Wrap the patient in a damp, well wrung sheet; apply a wet bandage to his chest and abdomen, put him into bed with his head raised, and give him water not too cold to drink. Change the sheet and bandages as often as the general heat demands, until perspiration takes place. Keep the patient in the envelopment as long as perspiration continues to afford relief; afterwards an ablution with tepid water must be performed. Bowels should be kept open by clysters. DYSPNOEA. Permanent difficulty of breathing, with a sense of weight in the chest. Like cough, dyspnoea is in most cases a symp- tom of other diseases of the chest. Causes.—Irritating dust, or pulverulent particles to which stone-hewers, glass-cutters, china manufacturers, workers upon metals, millers, starch-makers, horn and pearl workers, weav- ers, wool-carders, cotton-spinners, feather-dressers, Ac, are subject; the vapor of mineral acids, narcotic vapors, various WIND-DROPSY OF THE LUNGS. 529 structural derangements, as corpulency or obesity, hydatids, tumors, indurations, adhesions, emphysema, &c, &c Treatment consists in the removal of the causes. When caused by poisonous vapors the proper antidotes should be ad- ministered. EPILEPSIA THORACICA--CHEST EPILEPSY. The seat of the epileptic irritation is in the nervus pneu- mo-gastricus. Symptoms of the first period: a feeling of ex- cessive oppression or suffocation, mostly towards evening or during the night, without pain in the chest. This feeling of contraction originates in the processus ensiformis, spreading gradually over the whole chest, very often attended with a peculiar feeling of coldness (sensation as from blowing, aura epileptica). The attack lasts | to J of an hour, and termi- nates with a spasmodic cough. Paroxysms are more frequent during winter than in summer. Second period. The patients awake out of a sound sleep, scream several times, and fall into convulsions, which are often so severe as to throw them out of the bed. On the next morn- ing the patient generally suffers from great debility, but is entirely unconscious of what has happened. This disease generally affects only the male sex and in the prime of life. Causes. — Psora, or suppressed itch and cold. Therapeutics. — Administration of such remedies and em- ployment of such means as will restore and radically cure the itch. Sulphur and steam baths are considered specifics. Hand and foot baths arc recommended, if suppressed perspira- tion is the cause. When after the reproduction and cure of the itch, the epi- leptic attacks should not cease, we must resort to the reme- dies recommended for Epilepsy in another place. EMPHYSEMA PULMONUM — INFLATION — WrIND-DROPSY OP THE LUNGS. Penetration of air into the spongy substance of the lungs, causing difficulty of breathing and pain in the chest, worse 530 DISEASES ol-' THE CM F.ST AND \V i N hlMl'E. when ascending stairs, towards evening, and when lying in a horizontal posture. Respiration is performed by the abdomi- nal muscles and the diaphragm. These paroxysms are mostly accompanied with dry cough or palpitation of the heart, or a cough with frequent and frothy expectoration. The affected side is swollen, and when pressure is applied with the fingers a peculiar crackling is produced. Auscultation over the af- fected part gives the crepitating Rattle, and Percussion, a drum-like sound. Causes. — Wounds, ulceration of the lungs, Ac. Emphysema, in itself, cannot be considered a serious condi- tion, unless it 'is connected with dangerous injuries of the chest. (Traumatica Emphysema.) Treatment.—-Hand-friction, careful pressure, in some cases leeches and vesicatories. Internally Ipecacuanha and Sene- ka. In extensive diffusion of air immediately under the skin, punctures with a lancet have been advised, though this need seldom be resorted to. The air wdll ultimately, in three to eight days, entirely disappear. EMPYEMA. A collection of matter in the cavity of the pleura. En- largement of the side affected; a dry tickling cough; laborious breathing, which is easiest in the erect posture; fixed pain in the chest, with difficulty in lying on the sound side. Causes. — Inflammation of the lungs, or of the membranes, resulting in suppuration. Treatment. — The operation of paracentesis thoracis has been performed by Surgeons, which, however, in most cases, has proved unsuccessful. An incision is made, with the bis- toury, an inch and a half long through the integuments of the upper edge of the sixth rib, a little behind its middle, and carefully separate the intercostal muscles, passing the point of the bistoury on through the pleura costalis; then introduce the canula, through which the puss may pass off. Care must be taken that air does not pass in through the tube; to pre- vent which, the patient may incline, after the introduction of SPITTING OF BLOOD. 531 the canula in the affected side; or a valvular instrument may be used. The wound should be closed before all the morbid fluid is discharged. GANGR-ffiNA PULMONUM--MORTIFICATION OF THE LUNGS. Sharp pain with a sense of weight and burning upon one side of the chest; hurried respiration; in the beginning dry cough, afterward cough with expectoration, or vomiting of a brownish, watery, offensive liquid. The breath of the pa- tient is intolerably offensive, the face pale, with livid circles around the eyes; excessive debility; pulse weak and quick; surface dry and hot, extremities cold, tongue dry, great thirst, the face covered with cold, clammy perspiration, delirium, hic- cup, death. Percussion gives a dull sound. Auscultation shows a want of vesicular Respiration. This disease generally attacks dissipated young men, mostly at the latter part of Autumn and early part of Spring, during wet and cold weather. Sometimes it is preceded by symp- toms of Pneumonia, which, however, soon disappear, leaving a dry, hacking cough. Therapeutics.-—Radical cure is hardly possible. Probable remedies indicated are: China, Arsenicum, decoction of Marsh-wallow; Phosphoric acid, in sugar-water; inhalation of chlorine; cloths wet in cold water upon the chest. GALACTORRHEA—MILK FLUX. Morbid flow of milk. Involuntary emission of milk from. the breasts of women during or after nursing. The breasts are generally distended; secretion of urine is diminished; surface dry; costiveness; emaciation; finally symptoms of tubercles of the lungs and Phthisis pulmonale. Therapeutics. — Poultices of bran, linseed, or cicuta; foot- baths. Camphor or carrot herb to the chest and in the axil- lae; alkaline baths; injections to keep the bowels free. Homoeopathic remedies. —Calcarea, Phosphor, and Rhus tox. HEMOPTYSIS —HiEMORRHAGIA PULMONUM —BLEEDING FROM THE LUNGS — SPITTING OF BLOOD. Expectoration of blood by coughing, in greater or less 532 DISEASES OF THE CHEST AND WINDPIPE. quantities, presenting itself without any marked pains or dif- ficulty of breathing; or preceded by dry, hacking cough, op- pression, tightness at the chest, shivering, coldness of the ex- tremities, high pulse, Ac. Blood coming from the chest is warm, tastes sweet, and there is generally a burning and pain- ful sensation in the thorax". When Haemoptysis occurs in a robust and healthy person it is not very dangerous, but when it attacks slender and deli- cate persons, it is more serious. When the patient has had a succession of severe attacks, and the blood is discharged in a large quantity, the case may be considered dangerous. Causes. — Congestion of the lungs, rupture of a blood-ves- sel in the tubercular cavity of the lungs (Phthisis pulmonalis), overheating the body by immoderate exertion; blowing wind- instruments; contusion of the chest or back; falls; colds or coughs; breathing of poisonous vapors; pneumonia; phthisis; suppressed menstruation, Hemorrhoids, or other discharges; scurvy, repercussed cutaneous eruptions. Treatment allopathic. — Absolute rest of body and mind; sitting upright; removal of tight dress; abstaining from speaking; cool air and cool drinks; injections in order to pro- duce a free evacuation from the bowels; a venesection if pa- tients are plethoric; a teaspoonful of pulverized common salt, taken dry into the mouth, and swallowed gradually by drink- ing a little water with it, and repeated every half an hour, as circumstances may require. When haemoptysis is caused by congestion, suppressed hemorrhages, &c, and attacks persons of a full plethoric habit, Nitre with Cream of tartar and dig- italis (Nitre three drachms, Cream of tartar two drs., water six ounces, extract of digitalis one to two grs., syrup of Mal- lows one and a half ounce, a teaspoonful every half hour to two hours); or nitre with cream of tartar in powder mixed in a mucilaginous vehicle, should be given internally. We may also order foot-baths, cool lotions to the chest, injections, and leeches to the spot of suppression. In persons of weak constitution we should prescribe Ipecac, in small doses, tar- SPITTING OF BLOOD. 533 taric acid with hyoscyamus, and mustard poultices to the chest. Ligatures to the limbs near the body; Ergot of rye, ten grains every two hours; oil of turpentine, ten drops every hour or two; alum, tannic and gallic acids, geranium, &c, have been occasionally employed with benefit. (See Hemorrhage.) Homoeopathic remedies. — Pulsatilla, in cases of females, arising from suppression of the monthly discharge, or of a hemorrhoidal flux. Bryonia. — Expectoration of blood excited by a tickling cough; oppression at the chest, with frequent necessity to take a deep inspiration. Nux vomica. — When the disease owes its origin to a sup- pression of piles, a fit of passion, or exposure to cold. Arnica. — In cases arising from external injuries and over- exertion. In severe cases attended with danger: Aconitum, Sulphuric acid, Ipecac, Arsenicum, Opium, Cinchona and Kreosote are the most useful. Aconitum and Phosphorus are the chief remedies in hem- orrhages from the lungs, during the course of Consumption. Give the proper remedy in solution a teaspoonful every ten minutes, to two or six hours, according to the severity of the case. Hydropathic treatment. — The coldest water, or pounded ice may be applied over the stomach and chest, and sips of cold water, or even bits of ice may be occasionally swallowed. If there is feverish heat, the whole body must be promptly cool- ed with the dripping sheet, or ablution. When the extremi- ties are cold, they should be rubbed thoroughly with cold wet cloths, and then with dry flannels. Eclectic treatment.—The greatest benefit has been derived from the following preparation: Take Lycopus virginicus half an ounce, boiling water half a pint, mix, infuse for fif- teen or twenty minutes, and when cold, about two fluid ounces may be given two or three times a day; and if the hemorrhage 534 DISEASES OF THE CHEST AND WINDPIPE. be very copious it should be given every fifteen or twenty minutes and continued until it is arrested. Likewise from a decoction of trillium pendulum and macrotys racemosa. After the hemorrhage is arrested, to prevent a return of the attack, the following tonic compound will prove beneficial: Take Pulv. Ilydrastus canadensis, Pulv. Prinos verticellatus, of each one ounce; mix. One fourth of this is to be added to one pint af boiling water and when cold, the infusion is to be taken in the course of twenty-four hours, and thus repeat- ed daily. If cough be present, and proves very troublesome, it mnst be allayed by expectorants, for so long as this exists the hem- orrhage will continue. Cases attended with febrile symptoms require foot-baths and diaphoretics (spirit vapor bath.) Patients of full habits should take a Seidlitz powder every two hours until a free op- eration is produced. Hoarseness. (See Aphonia and Cold.) WHOOPING COUGH — TUSSIS CONVULSIVA — KIN COUGH — PER- TUSSIS. Paroxysms of violent and convulsive cough, interrupted by long whistling inspirations, or by a loud, shrill whoop, termi- nated by the expectoration or vomiting of a quantity of mucus, after which the attack ceases for a time. In severe cases tho features swell and become livid ; blood escapes from the nose and mouth, and even from the ears. The least excitement brings on the paroxysms, and they are generally more fre- quent at night. This is peculiarly a disease of childhood, and attacks only once during life. The duration is five, eight, twelve or more weeks. Causes. — Peculiar nervous irritation (of the nervous phre- nicus and vagus) produced by a contagion in the atmosphere, and propagated from individual to individual. In some cases it assumes an inflammatory character. Treatment allopathic. — The first stage is of catarrhal cha- WHOOPING COUGH. 535 racter and requires cooling purgatives (castor oil, magnesia, or sulphate of magnesia) and afterwards small doses of Ipe- cac, or antimonial wine, at short intervals. Should fever be present it will be best to administer a full purgative dose of calomel; three or four grains to a child two or three years old, to be followed by castor oil, if it should not operate freely. This cathartic may be repeated in a few7 days, if the febrile symptoms do not abate. In the second stage, the cough assuming a spasmodic character. Hyoscyamus, Belladonna, or Asa fostida are required. The following prescription has in many cases proved very effectual: Take Belladonna root one grain, white sugar one drachm, mix, and divide it into eight equal parts. Of this give a powder morning and evening. Asa foetida has been given in emulsion, in the dose of one or two grains, to a child two years old, repeated three or four times a day. Garlic, strong coffee, and musk have had more or less reputation in this complaint; also: ointments of Can- tharides, or Tartar emetic on the pit of the stomach or sides; Dover's powder in the evening; honey and water as a drink,&c In the third stage, characterized by weakness, quinine, half grain twice a day. Chronic cough and excessive debility require: tepid malt- baths, acorn-coffee, and Iceland moss. Homoeopathic remedies. — In the first or catarrhal stage of the cough, the most appropriate remedies are to be found amongst those which have been pointed out for common cough. Second, or convulsive stage: Veratrum album: Child is reduced in strength and emacia- ted; suffers from cold sweats, with excessive thirst, involun- tary emission of urine, vomiting. Drosera: Violent paroxysms of cough in rapid succession, fever, vomiting of food, or stringy mucus; bleeding from nose and mouth. Cuprum aceticum: Convulsions with loss of consciousness after each paroxysm; rattling of mucus in the chest and wheezing; bleeding from nose and mouth. 536 DISEASES OF THE CHEST AND WINDPIPE Arnica: Considerable hemorrhage from the mouth; each paroxysm is succeded by crying. Conium: Paroxysms occur particularly at night, followed by vomiting, Belladonna, Mercurius and Cina will be found indicated in some cases. Diet must be light and of easy digestion. Hydropathic treatment is the same as in common cough. In severe paroxysms we must add warm water emetics, tepid half baths and foot-baths. Eclectic treatment. — The first stage must be treated upon the principles indicated under the head of Catarrh. In the second stage the compound tincture of Lobelia will be found the most effectual agent. After the inflammatory symptoms have subsided, some of the specific remedies, so named, may be given. Take: Carbonate of Potassa, one scruple; pulv. Cochineal, half a scruple; white sugar, one drachm, distilled water, four ounces. Mix. Of this, a table-spoonful may be given three or four times a day to a child one year old. Alum, likewise, affords prompt relief: Take Alum twenty- five grains, Syrup of Ginger two drachms, water three ounces, mix. Of this, an ordinary sized tea-spoonful may be given every six hours to a child a year old. Belladonna is highly recommended in the following formula: take: Alcoholic ext. belladonna, one scruple, water half an ounce, Bet. spt. one drachm. Mix, commence in doses of twenty drops to a child two years old, and if at the expiration of three hours its specific action, (enlargement of the pupils or flush on the skin) is not manifest, it should be repeated, adding five drops more, and so on repeating and increasing five drops at the expiration of every period of three hours. The dose on the next day should be the same. The time re- quired for the medicine to be continued before the disease is broken up varies from three to four days. In troublesome cough following whooping cough, from fif- teen to thirty drops of the red drops, with a tea-spoonful of salad oil rubbed up with loaf sugar may be given. DROPSY OF THE CHEST. 53? In very violent paroxysms the application of compresses dipped in cold water to the sternum, or a piece of ice wrapped in linen and suddenly applied to the epigastrium, have proved very beneficial. HYDROPS PERICARDII--DROPSY OF THE PERICARDIUM. Palpitation of the heart, extending through the whole ex- tent of the chest, intermitting pulse, fainting fits, extreme anxiety. .(See Hydrothorax.) HYDRO-THORAX — DROPSY OP THE CHEST. Sensation of uneasiness at the inferior portion of the ster- num, with difficult breathing, which is increased by any exer tion, but especially whenever the recumbent posture is assumed; short dry cough; spasmodic pains between the shoulders- swelling of the hands, feet, and sometimes around the eyes; fluctuation of fluid on particular movements of the body; per- cussion gives a dull sound; and the respiratory murmur h» very obscure; in some cases enlargement of one or both sides of the -chest. As the disease advances we have: increase of dyspnoea, particularly at night, which creates a dread of suffo- cation ; irresistible impulse to rise and rush to the window fox fresh air ; palpitation; extremities become more swollen; numb- ness in one or both arms; impossibility to lie down, none but a Bitting or standing posture can afford any relief; cheeks and lips are pale; urine is diminished; pulse intermittent; death takes place by suffocation, exhaustion, or apoplexy. The collection of fluid may take place in both sides of the chest, or in one only, in the cellular texture of the lungs as well as in the sacs of the pleura. A cure is rarely possible. Causes.—Organic lesions of the lungs, heart and the great vessels; pneumonia; tubercles of the lungs; metastases; sup- pressed ulcers on the feet; induration or scirrhus of the liver:, chronic asthma; intemperate use of spirituous liquors; ascites; over exertion. Treatment allopathic. — The remedies recommended for As- cites are generally indicated in this disease. In plethoric patients and acute cases of Hydrothorax small 538 DISEASES OF THE CHEST AND WINDPIPE. venesections are of benefit; at the same time, mercurial oint- ment with black henbane oil should be used externally. During the first three or four days small doses of Calomel and Digitalis, and on the fourth day, a purgative of Salt and Senna leaves. In chronic hydrothorax the causes should be removed first, afterward Diuretics, Digitalis, Squills, or Bryonia, are effica- cious. Nitre one scruple, along with sulph. aurat. antimonii, one grain three times a day ; artificial ulcers on the arms and on the chest; foot-baths of mustard; mustard plasters on the calves of the legs; scarifications of the legs — when swollen and during the first period of the disease — have proved highly useful; also Naphtha in alleviating the paroxysms of suffoca- tion during the niglit. When fluctuation between the ribs is clearly discriminated, paracentesis thoracis (operation of making an opening into the thorax with a trocar) may be resorted to. For much nervous excitement give aqua lauro- cerasi with extract of Hyoscyamus and Opium. Homoeopathic remedies. — Aconitum, Arsenicum, Carbo v., Helleborus, China, Lycopodium, Colchicum, Digitalis, Spige- lia, Dulcamara, &c Digitalis in decoction, and Asparagus are highly recom- mended. Hydropathic treatment. — But very little benefit can be ex- pected from water treatment. Eclectic treatment is instituted by the rules laid down in the treatment of general dropsy. HYPERTROPHIA CORDIS. Morbid thickening, or increase in volume of the muscular Bubstance of the heart. In simple hypertrophy of the right heart: Dyspnoea, throb- bing under the sternum toward the processus ensiformis; vibra- tions of the external jugular veins, especially the right one; pulse not very strong. When the left heart is affected the pulsations of the heart are natural between, the third and sixth rib, but the pulse is HYPERTROPHIA UAMM&. 539 Very full and strong. We find also numbness of the left arm and fainting fits. Hypertrophy with enlargement of one or more of the heart's cavities is characterized by palpitation almost perceptible in nearly all parts of the chest, dyspnoea, dry cough, or cough with bloody expectoration, asthmatic complaints and other symptoms peculiar to diseases of the heart; enlargement of the left side of the chest; pulse soft, quick and undulating. Causes.—Over exertions of the lungs, intense mental excite- ment; Rheumatism, Arthritis. Treatment allopathic.—Great rest of body and mind; avoid- ing all passions and sexual intercourse; vegetable diet; very small quantity of food at a time ; pure soft water; sugar water; whey-milk; acids ; regulation of the secretions of the kidneys and bowels. Medicines recommended are: Nitrum, Digitalis, Cream of Tartar, Aqua laurocerasi, small sinapisms, hand and foot-baths with mustard, and in violent oppression at the chest, small venesections. The remedies must be frequently changed. Homoeopathic remedies. — Arsenicum, Spigelia, Digitalis, Rhus t., Phosphorus, Prunus spin., Iodine, Veratrum. HYPERTROPHIA MAMMAE. Swelling and induration of the female breasts (and some- times rthose.of the males) creating difficulty in walking. The right breast is more liable to become affected than the left. Patients have no menstruation. Size of the breast increases at the time when the monthly period should make its appear- ance. (Often ten to twelve pounds). Perspiration of the skin has a peculiar odor, similar to that of women during confinement. Causes. — The disease makes its appearance mostly during the development of the female genital system. All activity seems to concentrate in the breasts, and the disease is gene- rally accompanied with sterility. Treatment allopathic — A suspensorium should be applied, and Iodine, Spongia usta, Kali hydrojodinicum used inter- 540 DISEASES OF THE CHEST AND WINDPIPE. nally and externally. In some cases extirpation become* necessary. INFLAMMATION OF THE BRONCHIAL GLANDS. Sense of oppression in the middle of the sternum, dyspnoea, especially towards evening; in severe cases swelling of the sternum and the neighboring parts; cough without, or with expectoration of tenacious slime, or a dark substance, or sandy particles. Causes.—Scrofula; milbcoal - or stone dust. Treatment, — Removal of the causes, leeches, spongia tosta and Iodine internally and externally. Inflammation of the heart.—(See Carditis.) Inflammation of the lungs. — (See Pneumonia). INFLUENZA--EPIDEMIC CATARRH — GRIPPE. During fall and winter a great many individuals are sud- denly attacked with catarrhal affections, accompanied by ex- treme oppression and prostration of strength, sleepiness, chilli- ness, rheumatic pains in the back and limbs; intense frontal headache, affecting the whole head, giddiness, earache, red- ness of the eyes with sensibility to light; violent sneezing, coryza, or obstruction of the nose; dry shaking cough; dry- ness of the throat, fever, loss of appetite, nausea, soreness of the throat, hoarseness, and in some cases Dyspnoea, swelling of the glands, slight twitchings of the muscles, and offensive sweats. Causes.—Peculiar contagion; sudden change of tempera- ture; usually epidemic, like Asiatic Cholera. Allopathic treatment depends upon the character of the epi- demy, and is in most cases analagous with that of common catarrh. Troublesome nervous cough, remaining after influ- enza, yields to the use of Narcotics, particularly Hyoscyamus, Hydrocyanic acid, and Zincum. Blennorrhoea of the lungs requires: Iceland Moss. Pills of Sulphas ferri, Opium, Kino, and Musk. Homoeopathic remedies. — Camphora: One or two drops of weak spirits of Camphor, when taken at the commencement INFLAMMATION OF THE LARYNX. 541 of the attack, and even in a more advanced stage of the affec- tion, with asthmatic breathing, accumulation of mucus in the bronchia and cold dry skin, Will frequently check the further progress of this disease. Otherwise the same remedies mentioned under simple Ca- tarrh, as: Aconite, Mercurius, Arsenicum, Phosphorus, Pul- satilla, Ipecac, and Belladonna will be found efficacious. Opium has cured a distressing, dry cough, with difficulty in expectorating the sputum which has been detached. (See Catarrh and cough) Hydropathic treatment—Tepid ablutions frequently repeated, and followed by the dry blanket envelop when the body feels chilly after the bath; the chest-wrapper, when the lungs are affected, and warm hip and foot-baths when the abdominal viscera are disturbed. Water clysters and warm water emetics are necessary in some cases. LARYNGITIS — INFLAMMATION OF THE LINING MEMBRANE OF THE LARYNX. Inflammatory fever; voice hoarse and indistinct; sharp burn- ing pain in the larynx; laborious breathing with a painful Bense of constriction in the throat; extreme sensitiveness of the larynx to the touch; constant hawking to clear the air passages; swallowing is productive of the most distressing spasms, which threaten death from suffocation; frequent pulse, considerable thirst, tongue furred. If the disease advances the face becomes swollen and livid; the eyes protrude as in threatened strangulation, and the pa- tient dies by asphyxia. The disease is distinguished from croup by the existence of a constant and voluntary hawking, rather than an involun- tary cough; and from Quinsy by the absence of any considera- ble swelling of the tonsils. Causes.—Sudden changes of temperature, combined with a strong draught; scarlet fever; measles; whooping cough; scro- phulous or syphilitic Dyscrasia. Allopathic treatment — (See Bronchitis and Croup.) For 542 DISEASES OF THE CHEST AND WINDPIPE, remaining hoarseness Sulphur water with milk has proved of benefit. Homoeopathic treatment. — The remedies recommended for Croup are equally efficacious here. In some cases of less for- midable nature '. Chamomilla, Mercurius and Drosera. Hydropathic treatment — Ice water gargles in conjunction with cold, wet cloths to the throat, and the general tepid-bath or wet-sheet. If there is danger of suffocation the patient should be put into a full hot bath for ten or fifteen minutes; if this is impracticable, the hot fomentations to the abdomen should be resorted to occasionally. Eclectic treatment. — Commence with a mild emetic, as the compound tincture of lobelia; after which some slightly stimu- lating liniment should be applied to the neck and throat, two or three times a day, followed by the application of cloths wet with warm water, or a warm fomentation of Hops and Mullen leaves, around the throat. The feet and legs should be placed in a vessel of warm lye-water for ten or fifteen minutes, which may be repeated daily. Expectorants must be administered, such as the compound tincture of lobelia, in small doses, repeated several times a day; or: Take syrup of Squills, syrup of Senega, of each one ounce, Camphorated tinct. of Opium, 3ij, tine of Lobelia, one drachm. Mix. Of this, ten or fifteen drops may be given to a child five years of age, and repeated three or four times a day. The warm vapor of vine- gar should be inhaled several times a day. The bowels should be kept open by laxatives, and mustard plasters to the feet should not be omitted. In the case of adults, gargles are recommended composed of an infusion of equal parts of Hydrastis canadensis, Myri- ca cerifera, and common salt, to half a pint of which may be added a drachm of black pepper, and two ounces of vinegar. The severe cough left after the severe inflammatory symptoms have subsided, requires the following compound: Take satu- rated solution of alum, Syrup of Balsam Tolu, each two ounces, camphorated tincture of opium, one ounoe. Mia INFLAMMATION OF THE PERICARDIUM. 543 An adult may take a tablcspoonful of this compound several times a day. Chronic laryngitis. (See Phthisis laryngea.) Laryngitis gonorrhoica. (See Gonorrhoea.) Laryngitis hysterica. ( See Hystery and Laryngitis.) Laryngitis strumosa. (See Struma and Laryngitis LARYNGO-STENOSE. Contraction or diminution of the Larynx (inside) by a hard and callous state of the lining membrane of the same. Hoarseness, a peculiar fistulating voice, breathing like that of air passing through an extremely small aperture; painful- ness of the larynx when pressure with the finger is made, difficulty of breathing; patients have a constant "hunger for more air"; inspiration long; respiration short; unusual feel- ing of debility; emaciation; difficulty of swallowing; weak pulse. In the last stage the epiglottis is unable to close the larynx, and consequently food passes into the trachea, pro- ducing cough, and a return of food through the nostrils. Cough resembles croup. The disease is often mistaken for chronic laryngitis, asthma, diseases of the heart, and croup. Causes. — Syphilis, Gonorrhcea, Ac Treatment can, in most cases, be only palliative. Vesica- tories; sinapisms; hand and foot-baths with mustard; fric- tion of the extremities ; tracheotomy; rest of body and mind; simple, warm aliments; abstaining from speaking; Ac Milk metastasis—Suppressed secretion of milk. (See diseas- es of midwifery. (Edemapulmonum. (See Hydrops pulmonum.) Orthopnoea. — Difficulty of breathing when in the erect po- sition. (See Dyspnoea.) PERICARDITIS — INFLAMMATION OF THE PERICARDIUM. Inflammation of the membrane surrounding the heart. Sharp, burning pain in the region of the heart, radiating to- wards the left arm-pit, and sometimes extending downward to the elbow or wrist; pain is increased by pressing upward against the diaphragm, and by lying on either side; inflam- 544 DISEASES OF THE CHEST AND WINDPIPE. matory Fever, with hard, full, regular pulse, or small, rapid, in- termitting pulse; laborious, difficult breathing, especially on moving; a feeling of contraction and oppression in the pre- cordial region; frequent sweats, often alternated with dry ami hot skin; palpitation of the heart; numbness of the left arm; countenance is pale and marked with great anxiety; extremi- ties are occasionally found infiltrated; sighing; sobbing, swooning and hiccup; sometimes delirium and convulsions. Horizontal posture is the most comfortable. Auscultation gives us increased or more abrupt impulse of the heart, and friction sounds, resembling the rustling of silk or the creak- ing of a new saddle; and percussion an unusual, dull sound. Causes. — Plethora; derangement in the digestive organs; rheumatic or arthritic metastases; grief; anxiety; exposure to cold. Treatment allopathic—'The same treatment is to be follow- ed as in inflammation of the lungs. Frequent and free ven- esections; application of twenty to thirty leeches to the re- gion of the heart; embrocations of mercurial ointment; pur- gatives; Calomel and Digitalis. Colchicum will be found use- ful, when the disease is of a rheumatic origin. Perfect rest of body and mind are of the utmost importance; all unneces- sary persons should be excluded from the apartment. Should the disease assume a chronic form, it will be necessary to sus- tain a slight mercurial impression; to keep up a constant suc- cession of blisters over the heart; to apply occasionally, in case of pain, a few cups or leeches between the shoulders; and when the effusion is copious, to employ the diuretics, es- pecially squill, digitalis and bitartrate of potassa. Homoeopathic remedies.—Aconite and Belladonna in alter- nation to subdue inflammatory symptoms. Cannabis. Tumultuous action of the heart with oppressive anxiety, and a feeling of constriction in the precordial region; Bryonia, sharp, pricking pains in the region of the heart, in- creased by taking a full inspiration and by movement; Spige- lia, severe lancinations in the cardiac region, pain as if the PALPITATION OF THE HEART. 545 heart were violently compressed or squeezed, distressing op- pression at the chest, especially when moving, or even whilst speaking. Arsenicum, Veratrum, and Carbo v., will be found indicated in some cases. Hydropathic treatment is precisely the same as for inflam- mation of the lungs. Eclectic treatment. — Use the spirit vapor bath, or the com- pound tincture of Virginia Snake-root sufficiently to cause profuse perspiration, which should be maintained for several hours; after which the compound powder of Ipecac and Opi- um may be given in doses of four or five grains, every two or three hours, for the purpose of keeping up considerable moist- ure upon the skin, and to allay pain. The bowels should be evacuated by the compound powder of Jalap to which ten or twelve grains of Bitartrate of Potassa may be added. After- ward it will be necessary to obtain one or two evacuations daily. The patient should drink freely of diuretic infusions; one composed of equal parts of Asclepias tuberosa and Al- thaea officinalis will be found very beneficial. Should the pain be very severe, sinapisms may be applied over the affected part, and afterward hot emollient poultices. The surface should be bathed once or twice daily, with a warm alkaline solution. In the chronic form of pericarditis, the bowels should be kept open by laxative doses of Podophyllin and Leptandrin: and the compound syrup of Stillingia with Iodide of Potassium must be given to promote absorption. Pertussis. (See Whooping cough.) Paralysis of the lungs. (See Catarrhus suffocativus.) PALPITATIO CORDIS — PALPITATION OF THE HEART — FLUT- TERING OF THE HEART. Irregular, forced beatings (motion) of the heart, or of single vessels. In some instances, the palpitation becomes visible and audible; and in severe cases it becomes dyspnoea, and fainting often takes place. Causes. — Hypochondria; Hysterics; abdominal irritations; 23x 54n DISEASES OF THE CHEST AND WINDPIPE. flatulency; obstructions; mental excitement; distension of abdominal viscera; worms; hemorrhoidal congestions; pleth- ora; metastases of arthritic and psoric matters; diseases of the heart. Therapeutics. — Search for the disease of which palpitation of the heart is a symptom. The remote causes must be treated. If it be idiopathic (a primary disease) we must resort to external applications of cold wet cloths, or even ice for a quarter or half an hour, cold ablutions, riding on horseback, low diet, keeping the feet warm, abstaining from coffee, tea, tobacco, and spirituous liquors. In allopathic practice wo find the following compound highly recommended: Take Ex- tract of Digitalis, henbane, powder of digitalis, of each equal parts, mix, and make pills of one grain. Take one, morning and evening. In the paroxysms, relief will often be afforded by asafcetida, musk, valerian, the ammoniacal and ethereal preparations, camphor, strong tea, Hoffman's anodyne, Ac. None of these remedies, however, should be employed when the palpitation is dependent upon plethora. Homoeopathic remedies. — If caused by fright, Opium or cof- fea; by sudden joy, coffea; by fear or anguish, Veratrum; by disappointment, Aconite, Chamomilla, Ignatia, Nux v.; by congestion of blood, Aconite, bell, coffea, ferrum, lachesis, auruni, phosphor, opium, sulphur; by loss of blood, or other debilitating causes: China, phos. ac, nux v., veratrum. In nervous persons, hysterical females: Asa f, Moschus, Cof- fea, Pulsatilla, Cocculus, Nux v., Lachesis. After suppression of an eruption, Arsenicum, Lachesis and Sulphur. Chronic palpitation : Puis., Ars., Lachesis, Aconite, Sulphur, Phosph., Aurum. Take a dose of the proper remedy from one to twelve hours until r dieved. H/Jrovrithie treatment consists in the removal of the causes. PHTHISIS FLORIDA--QUICK CONSUMPTION. The different stages of this form of consumption arc short- CONSUMPTION OF THE LARYNX AND TRACHEA. 547 cr. and it terminates fatally in less time than Phthisis pul- monalis. Symptoms and treatment are the same. PHTHISIS LARYNGEA AND TRACHEALIS--CONSUMPTION OF THE LARYNX AND TRACHEA. Feeling of soreness, or heat, or burning like a coal, or con- traction and pricking in the trachea; sometimes there is only a sensation of external pressure on the windpipe; pain and difficulty in swallowing if the ulcer is next to the oesophagus; speaking, laughing, every exertion of the throat creates cough; hoarseness; aphonia; frequent attacks of severe cough with scanty, and occasionally dark colored, gray, or bloody expectoration; thick coat upon the root of the tongue, mostly on the side where the ulceration is going on; feeling of suffocation; quick pulse; hectic fever; colliquative sweats; sometimes diarrhoea; dark urine with peculiar oily drops. In some instances part of the oesophagus has been destroy- ed by ulceration, and a communication been thus established between it and the trachea, allowing liquid food to enter the trachea, creating cough, and coughing up of the swallowed substances. Causes. — Chronic inflammation, and, finally, ulceration of thelarynx; neglected catarrh; scrophulous, syphilitic, or rheu- matic metastases; healing of ulcers on the loWer extremities; immoderate efforts in singing, speaking or crying. Treatment allopathic—When Scrofula forms the founda- tion of the disease, we must have recourse to Iodine, embroca- tions of mercurial ointment and local abstractions of blood. Laryngo-Phthisis rheumatica requires external irritation of the skin, and vesicatories in the neighborhood of the diseased parts. General treatment consists in the administration of Hepar sulphuris, two grains three times a day, formed into pills with liquorice; dulcamara in decoction; drinking of sulphur water and milk; inhalation of water-vapors impregnated with de- coction of Sambucus, cicuta, hyoscyamus, myrrh, boiled tar, Iodine and Bromine. Vapors ought never to aggravate the 548 DISEASES OF THE CHEST AND WINDPIPE. symptoms, if so, they should be inhaled through the nose; they should also differ according to the cause of the affection. In the first stage the sperm of herring, taken fasting, has proved very useful, (probably on account of its minute quan- tity of Iodine). Cod-liver oil is a most valuable remedy in this disease. Nitrate of silver applied directly to the laryngeal mucous membrane, has been used with the best results. For this purpose a solution of the crystalized nitrate is employed, of the strength of from two to four scruples of the salt to a flu- id ounce of distilled water, and applied by means of a piece of curved whalebone, with a sponge attached to the end of it. Before attempting to penetrate the glottis, the membrane should be accustomed to the irritant impression by applying the solution daily, for several days, to the parts immediate- ly about the opening. When the sensibility of the lips of the glottis is thus somewhat blunted, the sponge saturated with the solution, should be passed through the rima glotti- dis into the cavity of the larynx. The patient, upon opening his mouth, should take a full inspiration, and then breathe gently out, at the moment in which the sponge is introduced. This is carried over the top of the epiglottis, along the poste- rior surface of this cartilage, and then suddenly pressed down- ward and forward through the aperture. A momentary spasm of the glottis takes place, by which the sponge is compressed, and the fluid forced out of it. The application should be made every other day for the first two weeks, after which it may be repeated two or three times a week, until a cure is ef- fected. The patient should avoid speaking, and all other exertions of the throat, breathe a moist, temperate air, and partake of simple but nourishing food. Homoeopathic remedies. — Hepar., Lachesis, Phosphorus, Carbo v., Acid, nitr., Calcarea, Arsenicum, Spongia. Sanguinaria Canad., proved of singular efficacy in a case with the following symptoms: Sensation of swelling, and PULMONARY CONSUMPTION. 549 pain, as if arising from excoriation in the larynx during empty deglutition; expectoration of whitish, saline tasting mu- cus; hectic fever. Argentum fol., has proved efficacious in affections of the larynx occurring in public speakers, with a sensation as if a foreign substance were sticking in the forepart of the larynx, with frequent inclination to cough, but no abatement of the irritation in the larynx after coughing. The patient should adhere to dietetic rules, avoid exposure, and enter into very little conversation. Hydropathic treatment — Plain and abstemious course of diet, coarse bread, wheaten grits, good fruits, mild vegetables, entirely abandoning all animal food, except milk. Very lit- tle should be eaten as the oppressed lungs require all the room and all the quiet possible. As consumptives are ex- tremely sensitive to cold, avoid all baths which occasion much of a shock to the system. Feel your way! In the first stage of consumption, when the superficial heat is not materially deficient, nor the hands and feet inclined to much coldness, the cold wet sheet pack for an hour, followed by the tepid, shallow bath for five minutes, the half bath at 72° five to ten minutes, and the hip bath at 65° fifteen minutes, with the constant employment of the chest-wrapper constitutes a plan of bathing adapted to the majority of cases. The walking foot-bath has been found of service. Chills can be mitigated by the dry pack. Night sweats may be palliated by sponging the surface with tepid water, or by the rubbing wet-sheet at bed-time. When ulceration exists, one sponge-bath or towel-washing, and one sitz-bath every day, with the employment of the chest- wrapper, or abdominal girdle, according to symptoms, will an- swer all remedial purposes. Eclectic treatment. (See Laryngitis and Phthisis.) PHTHISIS PULMONALIS--PULMONARY CONSUMPTION In the first period (incipient consumption) we have: short and tickling cough, increased by strong exercise, laughing, 550 DISEASES OF THE CHEST AND WINDPIPE. speaking, either dry or accompanied by the expectoration of a frothy mucus; flying stitches in the chest; shortness of breath, at first experienced only during exertion, but subse- quently comes on after every fit of coughing, or on lying on the one or the other side; pulse normal yet accelerated by the least motion; symptoms of gastric and hepatic derangement with redness of the tongue. Second Period. Chilliness and emaciation; dejection and excessive languor, sometimes a feeling of soreness behind the sternum, or under the clavicles, particularly after coughing or after any fatigue; fever of an intermittent character, which declares itself most in the afternoon and forepart of the night, with a circumscribed red patch on each cheek (hectic fever); pulse full, hard and accelerated; heat in the palms of tho hands and soles of the feet; exhausting night sweats; appe- tite good; the dark red or grayish indurations are converted into crude, yellow tubercles, the respiration becomes more dif- ficult; emaciation and debility go on increasing; the cough is more severe and troublesome, and expectoration becomes more free and copious, is purulent, often tinged with blood; irregu- lar chills and fever; countenance wears a dejected expression, and the color of the cheek, when free of fever, is faded. In the third or suppurative stage the tubercles become soft and are expectorated at first in the form of curd, cheese-like, or small stony particles, and subsequently mixed up with mu- cus, pus, blood, and even fleshy substances; appetite remains good; in the female menstruation ceases; attacks of colliqua- tive diarrhoea; aphtha?; hoarseness; the patient becomes re- duced to a skeleton; extremities swell; the eyes have a lustre rarely met with in other maladies; urine turpid, or clear with greasy drops on the surface; pulse frequent and feeble; state of mind is serene and hopeful, almost to the end. In some cases a day or two before death, delirium takes place, and con- tinues until life is extinct. Auscultation and percussion are of no value in the early stages of this disease, except tho indurations accumulate iu IT LMONAP,Y CONS!'V, ITI ON. 551 clusters, which on percussion, will give us a dull sound most- ly at the clavicle and subclavicular region (generally on the left side); the breath sound, during expiration, will be unu- sually audible, and the voice will transmit a diffused resonance, or preternatural clearness. During the suppurative stage a clicking or bubbling sound will be heard, either under one of the clavicles, or above the spine of one of the scapulae. As the evacuation of the softened matter of the vomica progresses a continued gurgling (cavernous rhoncus) will then be heard. Phthisis pulmonalis can exist without cough, without ex- pectoration, and without pain on expanding the chest. The formation of an abscess in the lungs is known by a dry cough which returns fitfully; fixed, circumscribed pain in the chest, which is sometimes throbbing; great difficulty in lying on one side. The cough at length terminates in a sud- den and copious expectoration of purulent matter, which sometimes threatens suffocation. When the collection of matter is considerable, the patient experiences severe rigors, or chills, and high fever. After the discharge of matter re- lief is sometimes experienced for a long time, until a new ab- scess forms. Signs characteristic of consumptive persons are: careless- ness in regard to health, feeling of unconcern about sickness, inclination to seek for the disease in the abdomen, increase of hope with increase of danger. Constitutional, hereditary consumption is very seldom cur- able. When the expectoration consists of viscid mucus, the dis- ease is phthisis pituitosa; when of pus or matter phthisis pur - ulenta. Causes. — The proximate cause of consumption is a disor- dered state of the lungs which disables them for the perform- ance of their function— preparing and animating the blood. The remote causes are: a phthisical constitution and struct- ure, marked by a flat, narrow chest, shoulder blades protruding 552 DISEASES OF THE CHEST AND WINDPIPE. like wings, peculiar irritability of the lungs and of the vascu- lar system; quick growth; tight clothing; corrupt, moist, con- fined, animalized air; confined, luxurious,gluttonous, dissipated life ; immoderate dancing, singing, running; ardent spirits; hot slops; immoderate coition; frequent pregnances and too long nursing ; frequent and long continued catarrh; scrofulous dis- position; suppressed itch; malformations; curvature of the spine and deformities of the chest; pneumonia; haemop- tysis; wounds and contusions of the chest; metastases to the lungs; &c A high degree of phthisis ulcerosa generates an infectious matter, which may communicate the disease to persons pre- disposed to it. Butchers and tanners are seldom, if ever subject to con- sumption; in tailors, shoemakers, cabinet makers especially millers, bakers, cotton spinners and masons the disease is more apt to develop itself on account of their inhaling impure air. We seldom find consumption prevailing in salt-works, and in countries where the air is impregnated with chlorine-vapors. On the south coast of France with its natural salt-works, con- sumption is an unknown disease. Persons with goitre never can have Phthisis as long as the glandular swelling remains. Prophylactic treatment — Avoid every thing that can tend to an increase of sanguineous congestion in the lungs; strengthen them, and protect them against all injurious influ- ences. This end is attained by avoiding all violent, over- heating exercise, dancing, running, fighting, great effort in singing and speaking, spirituous beverages, tobacco, coffee, tea, much animal food, sexual intercourse, mental excitement; enjoyment of pure, mild air, living in the country on milk, vegetable diet, wearing flannel next to the skin, moderate exercise on horse-back, &c One of the principal preven- tives, and remedies to restore due vigor to the solids, and a healthy state to the circulating fluid, is exercise in the open air, for months and even for years. It should at first be moder- PULMONARY CONSUMPTION. 553 ate, not longer continued nor more severe than the patient cau well bear, and gradually and perseveringly increased, as the increasing strength may permit. By clothing himself warmly, and carefully protecting himself from the wet, the patient may venture out at all seasons and in almost any weather. The best mode of taking exercise, upon the whole, for consumptive patients, is on horse-back. An infant should never be allowed to derive its nourish- ment from the breast of a consumptive or scrofulous nurse. Allopathic treatment. — First stage: of the medicines used in Phthisis no one has hitherto proved so efficient as cod-liver oil. Given at the first appearance of the symptoms it will often set them aside altogether, and is capable of effecting permanent cures in many instances. Its observable effects are usually to improve the digestion, and render the patient fatter and stronger, to diminish the frequency of the pulse and check the sweats at night, to relieve the cough, and, in fine, greatly to ameliorate all the general symptoms. Unhappily, however, after a period of very flattering amendment, per- haps for months, perhaps for a year or more, the symptoms return, and the patient often sinks at last. Yet it is not always so. Cod-liver oil does not act as a specific, but it invigorates digestion, improves the character of the blood, and by a peculiar power modifies the nutritive process, so as to obviate, in a greater or less degree, the tendency to tho deposition of tuberculous matter. It, therefore, should be looked on only as one of the means of confirming the gene- ral health. But great care must be taken to guard against the error of relying on this alone, to the neglect of various other methods of invigorating the system, already referred to. A table-spoonful of the oil should be given three times a day, and the remedy persevered for many months, nay, even for years, should it continue to agree with the patient. Should inflammation of the lungs take place, it should be treated by measures least calculated to exhaust still further the failing powers of the system. Blood should be taken less 554 DISEASES OF THE CHEST AND WINDPIPE. freely than in the same affection under any other circum- stances. The patient should be kept quiet for several days, and observe a cooling diet. We may also resort, if necessary, to nitre, aqua laurocerasi and digitalis. If there is any tendency to pulmonary inflammation small venesections every four or six weeks are recommended by some practitioners (condemned by others) to prevent the increase of tubercles and their tran- sition into suppuration; at the same time whey, and milk diet, particularly asses milk, juice of cucumbers, &c If the patient has a disposition to atonic pituitous phthisis (weakness of the lungs with expectoration of mucus), the con- tinued use of a jelly of Iceland Moss, made in water or milk, is the principal remedy. At the same time the patient must Bhun warm air, confinement, warm drinks, and sleeping in warm, close rooms. Biding on horse-back, daily exercise of the lungs by reading aloud, ascending hills, washing the chest with water, and drinking of cold water have a wonderful effect. In catarrhal, or rheumatic metastasis, dulcamara is a spe- cific; which may be combined with Iceland Moss, and a vesica- tory entertained for a long time on the chest; and in an inflam- matory disposition, leeches and venesection. Other metastases, as: the arthritic, psoric, scrofulous, &c, should be treated in the same manner, always paying due regard to other specific character; (in the psoric a combination with sulphur; in the scrofulous, with baryta muriatica). In nervous incipient phthisis prescribe : milk diet, country life, daily tepid baths, riding on horse-back, asses milk; in very debilitated nervous persons cold infusion of peruvian bark, salep, arrow-root, broth of snails; oysters; in frequent nervous cough, small doses of Hyoscyamus and even Opium, The patient should in all cases endeavor to prevent coughing as much as he possibly can. The good effect which this exer- cise of will-power has produced in many cases, is miraculous. Should the disease, notwithstanding the above prophylactic treatment, develop itself, we must subdue symptoms of inflam- CONFIRMED PHTHISIS. 555 mation by small venesections, leeches and diet. In mere con- gestions of the chest we find tepid foot-baths with mustard; wet cold cloths to the chest, and internally Nitre with Digi- talis of great benefit. Confirmed Phthisis.—When ulceration takes place and the patient expectorates sweetish, or saltish tasting matter, which sinks in water, we must order milk and whey diet; a table- spoonful of prepared barley boiled in a few cups of milk; Iceland Moss, two or three ounces daily, boiled in milk and sweetened; salep-water; oat-water (one hand full of oats, boiled three times in a quart of water, and poured off, then again boiled until the grains burst, then percolate it and mix it with two tea-spoonfuls of milk, and a tea-spoonful of honey); broth of snails and oysters. These remedies will make up the loss of power and humors, and also, serve to heal the ulcer. Healing of the pulmonary ulcer is accomplished partly by the means just stated, and partly by remedies which exert a direct influence on the lungs. The most valuable, when consump- tion is of a phlogistic (inflammatory) character are; Seltzer water, mixed with milk or whey; lime water with milk; chlo- rate of lime (one-half drachm daily, dissolved in water; juice of cucumbers (two ounces four times a day) ; Dulcamara, and Mineral acids,—if, on the other hand, we have a case of nervous Phthisis, recourse must be had principally to Myrrh (half a drachm of Myrrh mixed with one ounce of white sugar, a tea-spoonful several times a day); other reme- dies, such as Copaiva, and Peru-balsam, Kreosote, Arnica, have been used,—but with doubtful success. Inhalation of Conium and Kreosote, Chlorine, Hydrocy- anic vapors, Sec, are recommended. To promote expectora- tion, when arrested by great tenacity in the mucus, the pa- tient must inhale warm emollient (softening) vapors, and take internally antimonial wine; oxymel of squill with marsh-mal- low syrup; Sulphur auratum; and Kermes. If the obstruc- tion is caused by cold, water gruel with liquorice, dulcamara, and vesicatories on the chest. 556 DISEASES OF THE CHEST AND WINDPIPE. Extreme oppression and anxiety without phlogistic symptoms, require: cold, or warm wet cloths to the chest; foot and hand- baths with mustard, laxatives, Lobelia, extract of Stramonium, compound spirit of sulphuric ether, &c (See Dyspnoea.) Hemorrhage is generally checked by the administration of common salt, and mineral acids. (See Haemoptysis.) Excessive night sweats will be relieved by light covering, fre- quent airing of the bed clothes, washing the surface with warm almond oil, or any other fatty substance; drinking of sage-tea, equal temperature of the bed-room; aromatic sul- phuric acid (five to fifteen drops in a wine-glassful of cold water.) Diarrhoea requires: Tepid baths, opium, opium salve rubbed into the abdomen, Dover's powder, sugar of lead, lime water, opium in clysters with milk, charcoal, a mixture of decoction haematoxyli and aqua calcis, &c All fermentable and acid food must be avoided. Aphthae. — (Sore mouth): A gargle of pulverized borax with honey, or with mulberry syrup; or a wash of Sulphate of Zinc with syrup of Mallows. Decubitus—Bedsores. — Patients must pass several hours out of bed; lie on a smooth hair matress and buck-skin, covered with fine and smooth sheets. Embrocations of deer- fat in those parts which suffer most, and washing with Arnica tincture. (See Decubitus.) Dropsical affections.—Embrocations of turpentine salve, and the fresh juice of squills in the region of the kidneys. Great debility of the last stage requires: Carbonate of Am- monia, wine-whey, milk-punch, and egg with wine. Homoeopathic treatment—In the first or inflammatory stage, when the tubercles are in a crude or inflamed state, the reme- dies indicated are chiefly: Aconite, Bryonia, Bellad., Lachesis, Hepar, Spongia, Phosphorus, Dulcamara, Pulsatilla, Arseni- cum, Nux v., Hyoscyamus, Silicea, Calcarea, Carbo v., Aci- dum nitricum, and Sulphur. These must be selected accord- ing to the aggravate symptoms under treatment. (See Cough, Pleurisy, Pneumonia, and Haemoptysis). PULMONARY CONSUMPTION. 557 In the second stage, with more free, copious and sometimes purulent expectoration, the most important remedies are: Nitric acid, Silicea, Kali c, Calcarea, Sulphur, Natrum m., Mercurius, Lachesis, Phosphorus, Lycopodium, Carbo v., Sam- bucus, Hepar s., Spongia, Ferrum, Cinchona, Conium, Zincum, lodium, &c In the third or ulcerative stage: the same remedies as the foregoing, together with Guajacum, Sepia, Stannum, Phos- phoric acid, Staphysagria and Sanguinaria c. Diarrhoea of consumptives: China, Ferrum, Arsenicum, Phosphorus, Acidum phosph., and Sepia. Colliquative sweats: Sambucus, Stannum, China, Phosphorus, Arsenicum, &c Pituitous Phthisis, or blennorrhcea of the lungs : Stannum, Dulcamara, Pulsatilla, Sulphur, Sepia, Calcarea, Lycopodium, Silicea, Arsenicum, Copaiva, &c Hydropathic treatment.—Out-door exercise, walking, riding, sailing, as much as the strength of the patient will allow; gymnastic exercise in expanding the chest, as striking the elbows or backs of the hands together behind the back, making gentle circular motions with the hands while both arms are extended laterally from the body; taking slow, deep full inspi- rations holding the breath as long as convenient when the lungs are inflated, and then expiring very slowly; gentle exer- cise with (not too heavy) dumb-bells. In all exercises care must be taken not too greatly to disturb the breathing or accelerate the pulse. Removal to a warmer climate is con- sidered unnecessary. A residence inland, and a voyage at sea are both preferable to a residence on the sea-shore. High mountainous regions are preferable to low lands, for consump- tives. Diet should be more watery, plain and innutritious than even in dyspepsia. Abandon all animal food, save milk. Use coarse bread, wheaten grits, mild vegetables and good fruits, and only very small quantities of them. Frequent drinking of small quantities of soft water is advisable. (See Phthisis laryngea. 558 DISEASES OF THE CHEST AND WINDPIPE. Eclectic treatment. — In the treatment of this disease, little else can be done than to make use of means which will enrich the fibrinous portions of the blood, strengthen the nervous and muscular systems of the patient, and relieve troublesome and dangerous symptoms as they appear. For the accomplishment of the first indication, give iron in its various forms. Advantage has been derived from the Prussiate of Iron, combined with Sulphate of Quinia and Ilyoscyamus. Equal parts of common salt and the precipitated carbonate of Iron, combined together, and administered in such quantities as the stomach will bear, to the extent of two or three drachms a day, have apparently aided in effecting a permanent cure. Vegetable alterative tonics, as various combinations of Stil- lingia sylvatica, Rumex crispus, Solanum Dulcamara, Inula helenium, Prunus virginiana, etc., in the form of syrup or decoction, with some alcoholic liquid added, have produced beneficial results. If the cough is not connected with any elongation of the palate, demulcent, mucilaginous draughts may be drunk, either with or without narcotics, as each particular case may require. A syrup of Helianthus has been used with marked effect. In severe cases of haemoptysis Geranin, in doses of ten grains every half hour, exerted a beneficial influence; oil of turpentine has also been recommended. Emetics of an infusion of boneset-tea and lobelia, when the state of the stomach requires them, are recommended by some authors. In cases in which the cough is so troublesome as to greatly disturb the patient's rest, the following prescription will usu- ally afford the requisite relief: Take Tinct. Lobelia, Tinct. Camphoret Opii, of each one ounce; Ox. Scilla? two ounces; distilled water seven ounces; mix; of this two table-spoonfuls may be given on going to bed. The syrup of Sanguinaria and Paregoric (equal parts,) taken in the same dose, may answer as well. For pain over the largest part of the chest, five drops of the PLEURISY. 559 oil of tar, three times a day, taken on a lump of sugar, and the free use of a decoction of the white pine bark to the ex- tent of a pint or more per day, deserve recommendation. In the early stage of consumption beneficial effects have been witnessed from the persevering use of a pure article of cod liver oil. It should be continued for months. In diarrhoea use a powder composed of two drachms of My- ricin and one of Gerauin. Dyspnoea requires the inhalation of vapor of vinegar, or vinegar in which Lobelia or Stramonium has been tinctured. Emetics, Cathartics, Diaphoretics, &c, must positively be prohibited. PLEURITIS — PLEURISY--INFLAMMATION OF THE PLEURA. Severe cutting, sharp pain in the side, confined to one cir- cumscribed spot, interfering with breathing, and acutely in- creased by taking a deep inspiration, when speaking or by coughing; difficult and anxious respiration, but not so op- pressed as in Pneumonia; quick, full pulse, or small, weak and frequent; hot skin; short dry cough; parched tongue; high colored urine; sometimes cough with blood streaked sputa. If effusion or secretion of lymph follows, and is very con- siderable, enlargement of the affected side takes place. Per- cussion of the painful part gives a dull sound. In chronic pleuritis we have no fever, and the pain is less severe. Causes.-— Extreme vicissitudes of temperature; unequal ex- posure of the body; cold or wet feet; exposure to cold when the body is in a state of exhaustion. Allopathic treatment. — If pleurisy is accompanied with inflammatory fever repeated venesections become necessary; in other cases local abstractions of blood will suffice. At the same time we must apply cataplasms, warm milk in bladders. blisters, &c The bowels should be thoroughly evacuated by sulphate of magnesia, the infusion of senna with salts, or calomel fol- lowed by an active cathartic Subsequently, it will generally 560 DISEASES OF THE CHEST AND WINDPIPE. be sufficient to keep them open once daily by enemata, or castor oil. If the pain should be sufficient to prevent sleep, Opium and Ipecacuanha in the dose of a grain each, combined with two grains of Calomel, may be given at bed time. Dur- ing the day small doses of Tartar emetic may be given every two or three hours, with the neutral mixture, when the skin is hot and dry. If the effusion be considerable, it will be proper to employ Mercury, which should be given in moderate doses, and at short intervals, until the gums are touched, when it should be suspended. Seneka is useful, when catarrhal symptoms co-exist with those of pleurisy. Nitre freely given in a large proportion of water, will produce absorption of the liquid. Repeated blistering is also, here, a most valuable remedy. In bilious pleurisy, purging with Calomel, and an early recourse to the mercurial impression are usually indicated; and as in the case of the same variety of pneumonia, Quinia should be used freely when the disease assumes an inter- mittent form. Diet should be very low. Chronic pleurisy requires repeated blisters; issues or setons; combinations of calomel, squill, and digitalis; ointment of iodine or mercury; opium; nutritious diet. (See Pneumonia.) Homoeopathic remedies. — Aconitum: Inflammatory fever; a dose every two hours for eight or twelve hours, until a favorable impression is produced. Bryonia: Acute, shooting pains in the chest, increased during inspiration or on movement; dry cough; oppressed and anxious respiration; yellow coated, dry tongue, bitter taste, nausea; occasionally vomiting of mucus; constipation; head- ache ; cough on lying on the side, &c. A dose every three to six hours. Sulphur: After Aconite and Bryonia. Slight fever, effu- sion of Lymph. These three are the most important remedies, and are fre- quently found sufficient to effect a speedy cure. PLEURISY. 561 In a few cases we may be obliged to have recourse to: Bella- donna, Mercurius, Arnica, Arsenicum, Hepar s., Phosphor, Carbo v., China, ke, (See Peumonia.) Hydropathic treatment. — Use the wet sheet to allay general febrile symptoms, and repeat it according to the degree of superficial heat. Local pain, cough, and difficulty in breath- ing require the chest-wrapper, which should be constantly worn, covered with a dry cloth, and renewed five or six times a day. The tepid sitz-bath, or the shallow tepid bath once in twenty-four hours is of benefit. Use tepid injections to keep the bowels free Warm water drinking will give speedy relief, when the expectoration is painfully scanty. Eclectic treatment.—Produce copious perspiration by means of the spirit vapor-bath, if the strength of the patient will admit. If, however, this can not be done, the compound tinc- ture of Virginia snake root is given in two or three drachm doses, and repeated at short intervals, until the patient per- spires freely, when instant relief is afforded. In bilious pleurisy an emetic should be administered, fol- lowed by an active cathartic, as soon as the patient can breath: with but little pain. Covering the whole of the affected chest with a fomentation of bitter-herbs, as hot as can be borne, and which should be renewed every five minutes, has in many instances given relief in a short time. In difficult cases we must resort to the use of the hot foot- bath, cupping, and counter-irritation, over the chest and be- tween the shoulders by means of sinapisms, with draughts of a warm infusion of the roots of Asclepias tuberosa and Althaea officinalis and the compound powder of Ipecacuanha and Opium. Febrile symptoms of a periodic character require anti-periodics (Quinine and Iron). Chronic pleurisy. — Make an application of the compound Tar plaster over the affected side, the use of which must be continued until a free discharge of purulent matter takes place; after which remove the plaster and dress the ulcerated 562 DISEASES OF THE CHEST AND WINDPIPE. surface with the compound lead-ointment, continuing its use, until the irritability of the part subsides, and the soreness of the ulcer is somewhat removed. This process must be repeated until the pain is completely dissipated. As an alterative we may employ the compound syrup of Stillingia and the Iodide of Potassium, in the proportion of one drachm of the salt to six fluid ounces of the syrup, in doses of a fluid drachm every three or four hours. For the dry cough which usually accompanies this form of pleurisy, nauseant expectorants (tincture of Lobelia, Senega, Squills and Paregoric equal parts of each) may be given. PLEURODYNIA — SPURIOUS PLEURISY. A rheumatic affection of the intercostal muscles, charac- terized by severe, acute and generally shifting pain in the side upon taking a full breath, or coughing, by soreness of the intercostal spaces by pressure, and by the general absence of fever. There exists in most cases an inability to lie on the side affected. Causes. — Violent exertions, as running, jumping, lifting; flatulency; hysteria; hypochondria. The chronic form is caused by plethora, transferred gout or rheumatism; chronic inflammation of the liver or spleen, tight lacing, leaning against a hard desk, &c. Treatment allopathic.—A vesicatory on the painful part; covering it with flannel; internally Tartar emetic in small doses, and a diaphoretic regimen. In plethoric persons leeches should be applied. Homoeopathic treatment. — The principal remedy is Arnica; then Bryonia, Nux v., Pulsatilla, Ranunculus bulb., and Saba- dilla. Hydropathic treatment.—Apply a tight bandage, the hot fomentation, or the warm douche. In the chronic form the wet girdle, applied to the painful part and covered with flan- nel, is of benefit. (See Rheumatism and Pleurisy.) PLEURO-PNEUMONIA. In this disease there is a combination of the peculiar gene* INFLAMMATION OF THE LUNGS. 563 ral symptoms of pneumonia and pleurisy, of which the viscid and rusty expectoration is most characteristic of the former, and the sharp stitch in the side of the latter. Treatment* — (See Pleurisy and Pneumonia.) PNEUMONIA VERA — PULMONITIS — INFLAMMATION OF THE LUNGS. Rigor followed by heat; dyspnoea; respiration short and hurried; cough short, continuous and distressing; dry at the commencement, afterward attended with scanty expectoration of viscid, tenacious, lumpy mucus, generally of a brick red, or rusty hue. The cough is invariably excited or aggravated by every deep inspiration, or on speaking; the speech is inter- rupted, or there is a pause after every articulation; the respi- ration is abdominal; more tightness than pain in the chest; pulse full and strong at the commencement, afterward hard and wiry; the tongue parched and dark colored; sometimes this disease is accompanied with typhoid symptoms; the patient is inclined to lie upon his back. If inflammation is not checked, suppuration takes place. The mucus becomes converted into a brown, serous fluid; Blight shiverings take place, and the sense of tightness abates; the patient is enabled to lie on the side which was affected without much inconvenience; the face is patched with red and sometimes livid spots; the vessels of the neck are swollen and turgid; pulse weak and thready; extreme debility; death by obstruction of the circulation in the lungs. Auscultation gives, during the first stage, the crepitous rale; during the second (or that of the hepatization) the bronchial or tubular respiration is perceptible; and in the third, suppu- rative stage, a gurgling mucous rale is occasionally substituted for the latter. Percussion gives a dull sound of the affected lung. In severe cases pneumonia is often found combined with pleurisy, or still more frequently with Bronchitis. When pneumonia terminates by resolution, we have free and abundant expectoration of thick matter, often streaked 564 DISEASES OF THE CHEST AND WlNDPlPfi. with blood; or a profuse general sweat; diarrhoea; a profusd discharge of urine with sediment; or an attack of nose bleeding. Causes. — Great pressure of the atmosphere; north-east winds; severe cold and dry weather; low degree of electricity; over exertion of the lungs; suppressed hemorrhages; taking cold; concussion; acrid or poisonous inhalations; etc Treatment allopathic — In persons with vigorous constitu- tions, venesections in the arm of the affected side by a large opening, until the hard, full pulse becomes softer and smaller, or the soft becomes fuller and larger, and the oppression abates. If the pulse becomes remittent or irregular, the vein must be closed. No disease bears the loss of blood better than well developed pneumonia. The first venesection should be most copious to annihilate the inflammatory process at once. From sixteen to thirty ounces may be taken at the first opera- tion. Should the symptoms have in no degree abated, we may bleed again at an interval of from twelve to twenty-four hours. The occurrence of nausea or faintness, while the pa- tient is bled in the sitting posture, should be a signal to stop the discharge. After the first bleeding, the bowels should be thoroughly evacuated by an active cathartic, as calomel and jalap, or an infusion of Senna with Epsom salt. The bowels having been evacuated recourse should be had to tartar emetic, which is the specific remedy in this disease, together with ni- tre, (take of tart. em. three grains, nitre two drachms, water four ounces, syrup of Mallows and liquorice, each one ounce, two table-spoonsful every two hours); and on the fifth or sixth day a vesicatory may be applied to the chest. There are cases where bleeding is necessary and salutary even in the third or fourth week. When pain and oppression increase, without fullness and hardness of pulse also increasing, ten or twelve leeches ought to be applied to the most painful and oppressed part. If af- ter this the same symptoms continue, take of calomel six grs., opium two grs., white sugar two drs., mix, and divide into six PNEUMONIA VENOSA. 565 equal powders, one to be given every two hours. Expectora- tion must be supported by lukewarm beverages, as decoction of barley, gruel, salep, rice ; rad. althaeae; warm sugar water, etc When the expectoration is very difficult, warm vapors of elder flowers must be inhaled. The syrups of squill and seneka combined with a little tartar emetic have been employ- ed with advantage. Should the strength fail in the advanced stages, it will often be found useful to employ carbonate of ammonia, in two, five, or ten grain doses, at intervals of two hours. Wine-whey and syrup of quinia may be added. Gan- grenous symptoms may be met with chloride of lime and opi- um, quinia, and the mineral acids. Chloroform by inhalation has been employed by a physician in Germany as the main remedy, with remarkable success. About sixty drops were placed on compressed cotton, and the vapor allowed to enter the lungs, for ten or fifteen minutes; and the dose was repeated every two, three or four hours. It was not permitted to produce unconsciousness. There was a gradual amendment of the symptoms, which ended in recovery on the twelfth day. Pneumonia biliosa—bilious pneumonia.—Pneumonia complicated with derangement of the stomach and liver, ac- companied with bitter taste, yellow coated tongue, yellow col- or of the skin, nausea, headache, &c. In this variety the treatment should be commenced with an emetic, followed by a cathartic Afterward loss of blood may be resorted to, if called for by the symptoms. Whenever there exists decided remission, recourse should be had to Quinia, twelve to eighteen grains to be given between the par- oxysms. Should the disease be intermittent, the propriety of employing this remedy is still more obvious. In other respects the treatment may be conducted as in ordinary pneumonia. Pneumonia venosa.—Violent oppression with feeling as from inhalation of vapors of Sulphur; short, anxious respira- tion, sometimes with sharp, wandering pains in one or the other side. Cough comes in paroxysms, is dry or accompanied 566 diseases op the chest and windpipe. with expectoration of bloody mucus; intense heat as from an internal fire, with a pale face, headache, and no signs of con- gestion ; irregular, quick pulse. The disease is more of a nervous than inflammatory char- acter; attacks, generally, plethoric individuals, and often pre- vails epidemically during a wet cold winter. Treatment, — Sinapisms, cut into small strips and placed along the nervus pneumo-gastricus to the middle of the sternum, have generally an excellent effect. Internally we must employ Seneka and Calomel, (four to five grains Seneka, with half a grain of Calomel) and tepid, slimy drinks. TYPHOID PNEUMONIA. If the disease is seen in its earliest stages, commence the treatment with an Emetic of ipecac, or sanguinaria, and follow this with a purgative dose of calomel, or of calomel and rhubarb. Afterward, the patient should be put immedi- ately upon the use of opium and ipecacuanha, with calomel, a dose of which containing half a grain of each of the first two ingredients, and one or two grains of the third, should be given every three or four hours; and persevered in until the gums become affected. When debility is considerable, wine and sulphate of quinia are the standard remedies. Oil of turpen- tine, when there is considerable bloody discharge from the lungs. Musk, dry cupping, and blistering are also recom- mended. Bleeding is not well borne in this variety of the disease. Chronic pneumonia requires a steady course of the mercn- rial pill; iodide of potassium; Squill and Seneka; hyoscya- mus and morphine. Homoeopathic treatment. — The most important remedies in pneumonia are: Aconitum, Belladonna, Bryonia and Phos- phorus. Aconitum and Belladonna may be given in rapid alterna- tion, during the first or congestive stage, with severe in- flammatory fever, difficulty of breathing, sputa tinged with blood, cheeks flushed, lips and tongue dry, the skin hot and PNEUMONIA. 567 the thirst incessant. A dose every half an hour to four hours. Bryonia. — Cough with expectoration of tenacious mucus, of a brick dust color, oppression at the chest, acute or rheu- matic pains in the pleura, with increase of pain on movement; foul tongue, constipation; a dose every two to eight hours ac- cording to the severity of the case. Phosphorus. — This remedy has been employed with success, even when hepatization has taken place. A dose every four hours, lengthening the intervals as soon as the patient is im- proving. Tartarus emeticus—Is highly recommended in promoting resolution after hepatization has taken place. Oppression at the chest, laborious respiration, no expectoration, or expecto- ration of mucus chiefly during the night; or mucus rattling in the chest, with temporary relief after expectorating the sputa detached by the cough. A dose three times a day. In some cases it is given in alternation with Phosphor with advan- tage. Sulphur deserves a preference to Tart, em., when Pneumo- nia occurs in scrofulous habits, and when Phosphor and Tart. em., have effected only a temporary improvement. Other remedies, as Mercury, China, Rhus t., Squilla, Hepar may be useful in some cases. In obstinate or chronic cases, with weak and thread-like pulse, and clammy sweats, Lachesis and Lycopodium have been found useful. In the third or suppurative stage, Sulphur, Lycopodium and Kali c, with Mercurius, Hepar and China, form the prin- cipal remedies. Desperate cases, which threaten gangrene of the lungs, with foetid breath and sputa, require Lachesis, sometimes in alternation with Arsenicum and China. Pneumonic states, originating from tubercles in the lunga require: Mercurius, Iodine, Sulphur, Spongia and Oleum je- coris aselli. In pneumonia of old persons, Arsenicum is the principal 568 DISEASES OF THE CHEST AND WINDPIPE. remedy; in that arising from repercussed eruptions, Arseni- cum and Sulphur. Typhoid symptoms and delirium tremens accompanying in- flammation of the lungs, and in various forms of the so- called nervous pneumony, we find indicated Opium, Nux vomica, Hyoscyamus, Lachesis, Conium, Cocculus and Stra- monium. In insufficient crisis, which takes place in consequence of bleedings, China, Camphor, Oleum tereb., and Moschus are often beneficial. Diet. Almost total abstinence during the inflammatory period, and even during convalescence must be observed. The drinks may consist of water, toast-water, whey, rice or barley water, sweetened with a little sugar. Hydropathic treatment is the same as mentioned under pleurisy. Eclectic treatment.— At the commencemeut of this disease, give an Emetic, as the compound powder of Lobelia, to an adult, or the compound tincture of Lobelia to a child, and as soon as possible after emesis has ceased, follow it with the spirit vapor-bath, if the circumstances of the patient will per- mit. If the pain be very severe after this course has been pursued, fomentations of bitter herbs must be placed over the chest, as hot as can be borne; and internally administer nau- seant expectorants, as a combination of Senega, Squills and Lobelia, in tincture, of each, equal parts, which must be ad- ministered in sufficient doses to keep up nausea and free ex- pectoration. In some instances where the pulse keeps full, and there is no cessation of pain, with a dry skin, the com- pound tincture of Virginia Snake-root may be added to the above, or it may be given in connection with the compound powder of Ipecac and Opium; and large cups applied over the seat of the disease every day until the active symptoms subside. Ligatures may likewise be placed around the ex- tremities, as heretofore recommended in other forms of dis- ease, thereby retarding a too free return of the venous blood RHEUMATISM OF THE HEART. 569 into the trunk, and consequently diminishing the pain and active condition of the inflammation. The surface of the body should be often bathed with a weak alkaline solution. The bowels should be kept in an open condition by small doses of Leptandrin and Podophyllin. Mucilaginous drinks must be used freely, as an infusion of Elm-bark, Flax-seed, or Marsh-Mallow-root; and during the inflammatory stage, Sweet Spirits of Nitre may be occasionally added to the draught. Great debility requires wine-whey, Quinia, cold infusion of Virginia Snake-root, and even milk punch. Troublesome and irritating cough following this disease can be readily relieved by the occasional administration of £ of a grain of morphine in a teaspoonful of the Sanguinaria Syrup, prepared from an infusion of Sanguinaria (1 drachm) and boneset (^ ounce) to a pint of water. Pneumonia traumatica. (See: Wounds of the Chest and Pneumonia.) RHEUMATISMUS CORDIS — RHEUMATISM OF THE HEART. The patients experience, during the movement of the left upper arm, tearing pains in the external muscles of the chest, with a sensation of weight, oppression, and apnoe in the left side of the chest; palpitation of the heart; occasional stitches through the heart; pulse small, contracted, and does not har- monize with the action of the heart; chest can be expanded without any difficulty. If improperly treated it is apt to run into rheumatic inflammation of the heart. Causes. — Attacks young people during the period of pu- berty; metastases; &c. Treatment allopathic. •— A vesicatory on the left side to be kept in suppuration for some time. Internally Digitalis with Dover's powder; Sulphur-baths; vegetable diet. Homoeopathic remedies.—Aconite, Arnica, Belladonna, Bryonia, Pulsatilla, Spigelia, Colchicum, and Nux v. (See Rheumatism.) \ 24y 570 DISEASES OF THE CHEST AND WINDPIPE. TUBERCLES OF THE UNiiS. Patients complain from time to time of pain in the chest The pain is not severe, and not constant, and has its seat gen- erally under the clavicle. Sometimes tearing pains extending from the pectoral muscles towards the upper arm, and a sensa- tion of numbness and heaviness in the latter. Cough toward evening and in the morning, and sometimes before midnight, dry in the evening, and accompanied with expectoration in the morning. During the summer these symptoms disappear more or less, and reappear when the cold weather sets in. Percussion gives a dull sound between the clavicle and scapula, which is confined to a place not larger than the size of half a dollar. Patients lose flesh, although they have a good appetite. The calves of the legs, the middle finger, and the cheeks emaciate first. (See Phthisis.) Tracheitis. — Inflammation of the lining membrane of the trachea. (See Laryngitis.) CHAPTER XVIII. DISEASES OF THE BLOOD VESSELS. ANEURYSMA--ANEURISM. An aneurismal tumor is a preternatural dilation of the coats of au artery forming a pulsating swelling, which eventually ruptures and destroys the patient by hemorrhage. True aneurism consists of a sac formed by one or more of the arterial coats; false aneurism occurs after a puncture of an artery, and consists of an accumulation of the lymph by which the wound united; diffused aneurism, when there is no sac, the artery continuing to pour out its blood into the cellu- lar tissue. Aneurism when externa,!, is known by a pulsating tumor, which beats synchronous with the artery where it occurs; it may be diminished by pressing on the affected artery above the tumor. Internal aneurisms, or aneurisms which occur in the heart or large vessels of the chest and abdomen, can be discovered by the unnatural pulsation felt in the part. Aneurism may become its own cure by coagulation of the blood; or by pressure of the effused blood upon the vessel. Causes.—Injuries; blows; falls; violent exertions; mental excitement; concentrated, greasy food. Treatment—In the early stage application of pressure along the course of the artery, that feeds the aneurism, which should bear most on two points and above the aneurismal sac. The compression should be made gradually, in order to induce ooagulation. In some cases, however, the ligature is the only resource, which should be applied at some convenient point between the affected part and the source of circulation. In varicose aneurism, it is necessary to ligate both above and below the sac. 571 572 DISEASES OF THE BLOOD VESSELS. Homoeopathic remedies so far as known: Carbo veg., La- chesis and Lycopodium; also: Guajac, Pulsatilla and Sulphur. Eclectic treatment. — In the early stage compression is the best remedial resource. In other states the ligature is neces- sary. The artery should be tied with a single ligature above the tumor. After dissecting down to the vessel affected, the blunt end of an aneurism needle should be worked around the vessel to separate it from its accompanying vein or nerve. After the obliteration of the cavity of the diseased vessel, the anastomosing vessel in its vicinity will enlarge to maintain tho necessary circulation. The diet must be simple, bland and opening; and all violent exercises of body or mind strictly avoided. Aneurism of the Aorta. — Loud whizzing or rushing at the superior extremity of the sternum, perceived on the applica- tion of the hand to that region; rattling in the throat; oppres- sion at the chest; dissimilarity of the pulse at the wrist; dull sound, and perceptible impulse under the sternum, or below the right clavicle, when the tumor is" large. The general symptoms differ according to the situation, size and shape of the aneurism. If it presses on the gullet, it will cause impeded deglution and sometimes a constantly clucking noise. It may press on the spine, and cause severe dorsal pains. Treatment.—Venesection, digitalis, narcotics, diet, and rest. The disease is seldom curable. Varicose aneurism results from puncturing an artery through a vein, as in the operation of bleeding, permanently connect- ing it with the vein. If the disease is not very troublesome, it should not be meddled with; otherwise the vessel must be tied above and below the injury. ARTERITIS — INFLAMMATION OF AN ARTERY. The arteries are seldom separately inflamed, except from wounds. Inflammation from the application of a big ligature, may extend to the heart itself. Gangrene of the affected ves- sel is an occasional result. varicose veins. 573 Treatment is like that in other inflammatory diseases. Nawus.—Dilatation of small arteries. (See Diseases of the Skin.) PHLEBITIS. Inflammation of a vein is more common than arteritis, both as a spontaneous disease and after mechanical injuries. In the latter case the termination is often in adhesion. The affected vessel may be traced as a thick hard cord, and is very sensitive to pressure. (See Varices.) Diffuse plebitis is a very serious disease. The great danger is from discharge of pus into the current of the circulation, giving rise to extreme depression, restlessness, hectic fever, &c, with secondary inflammations in other parts. In local phlebitis apply wet cloths to the inflamed part, and subdue the general fever. (See Fevers.) Plethora.—(See Corpulency.) VARIX — VARICES — VARICOSE VEINS. Swelled veins are knotty, elongated thickenings and dilata- tions of these vessels. They are most frequently formed in the lower extremities, the great saphenal vein, and its branches, being the affected vessels; the spermatic and hemorrhoidal veins are also very liable to become varicose. In many cases the valves of the veins are destroyed; the affected vessels are liable to inflammation; and the lower limb particularly, is dis- posed to ulceration; bleeds easily, and heals with great diffi- culty. Debilitated females suffer from this disease during preg- nancy, arising from obstructed circulation caused by the pres- sure of the graved uterus upon the blood vessels. Treatment. — Considerable alleviation can be obtained by constant bathing with water, diluted alcohol, water and vine- gar, or wine; by cooling wet bandages; by compression with the roller or the common bandage from the foot upward to the hip, and by preserving a recumbent posture. Costiveness must be removed by clysters. Juniper-berry-tea has been recommended internally. 574 DISEASES OF THE BLOOD VKSSKI.S. In hemorrhage one should place a finger upon the bleeding spot, and, after the hemorrhage is somewhat checked, a small pad of lint should be bound upon the bleeding orifice. In violent hemorrhages the application of the ligature to the bleeding vein becomes necessary, which however, should be avoided if possible. A plan for obliterating the vessels by the combined action of caustic and compression has been succesful in many cases. It consists in the application of caustic to one or two very small portions of the distended veins at a time, so as to pro- duce ulceration and ultimate adhesion; the parts being, mean- while, dressed with adhesive plaster, or the wet roller. As soon as one dilatation or knob is obliterated, the caustic may be applied to another, and so on. Homoeopathic remedies.—Pulsatilla, Lachesis and Arnica; also Nux v., and Lycopodium. If the bandage or laced stocking is used, it should be applied in the morning, when the veins are least distended, begining at the toes and progressing upward. Wounds of the Pans.—-(See Varicous Ulcers.) CHAPTER XIX. DISEASES OF THE BACK AND LOINS. ABSCESSUS LUMBARIS —LUMBAR ABSCESS — PSOAS ABSCESS. This is one of the most fatal diseases. Symptoms. — Dull, heavy aching in the lumbar region; pains shooting down the spine and thighs, and a lameness in one or both lower limbs with difficulty of standing erect; drawing up of the testicle of the side affected; fatigue by ex- ercise. At length the pain becomes throbbing, chills and night sweats occur, the breath becomes fetid and foul, a fluc- tuating enlargement appears along the Psoas muscle, and the apex of the tumor presents itself immediately below the groin. In the recumbent posture the swelling recedes, while standing up it becomes more tense and firm, when coughing it enlarges; which peculiarities constitute the diagnosis from hernia. Causes. — Scrofula; inflammation; caries of the spine. Treatment. — As soon as the tumor is discovered, puncture it and let out the matter. When the pus lies very deep, an opening may be made to it with caustic potash, after which the slippery elm poultice should be constantly used. In dress- ing not let the air enter the wound, as it may produce excessive inflammation. A compress should be kept upon the part, bearing as much as possible from above downward. When the flow of matter has ceased the opening should be closed, and if matter again accumulates re-open it. Injections of the tincture of Myrrh through a common catheter are recommend- ed. The external orifice should be kept open until the ab- icess heals up internally. The constitutional treatrrent consists in the improvement of the general health by diet, daily bathing, regulation of ■ >i j 576 DISEASES OF THE BACK AND LOINS. evacuations of the bowels, and administration of antiscrofu- lous remedies. (See Scrofula and Abscess.) Apoplexia spinalis. (See Apoplexy.) Consumption of the back. (See Sabes dorsalis.) DISTORTION OF THE SPINE — SPINAL CURVATURES. The spine is subject to a variety of curvatures. They may result from organic affections — caries or injuries — of the vertebral column, or from osseous malformation, as in rickets and scrofula; but the majority owe their existence to muscular debility. In organic derangements, the distortion is from within out- ward, forming a sharp projection of the bones, called angular curvature, in contradistinction to muscular distortion, which is usually termed the lateral curvature, and this may be right or left, as the muscles on the right or left side of the body are more debilitated from ordinary bodily positions, &c The muscles of the back are more or less emaciated, the soreness or tenderness upon pressure may be constant or occasional, severe or slight, or entirely absent. Paralysis of the lower extremities is a common symptom of the true or organic spi- nal disease. Causes.—Muscular debility from want of exercise, hot drinks, close rooms and sedentary habits; derangement of the uterine system; sympathetic affection from indigestion, mor- bid condition of the liver, kidneys, &c. Treatment. — Remove all artificial support; exercise in the open air, take moderately such gymnastics as call the debili- tated muscles into action ; lie on a hair mattrass or straw bed; dress comfortably, not fashionably; eat plain food, and drink cold, soft water; keep the bowels regular by tepid injections; invigorate and restore the general health by rational means. Medicinal treatment. (See Rickets and Scrofula.) Hydropathic treatment. — The dripping sheet, followed by active and prolonged rubbing with the dry hand, or the tepid bath followed by the pail douche and succeeded by hand fric- SPINAL DROPSY. 577 tion. When both are impracticable, the towel wash may be substituted. The douche of moderate force to the whole sur- face of the back, once or twice daily, from two to five minutes; as well as the hip bath, and manipulations and shampooing of the whole back have proved highly servicable. Eclectic treatment. — The irritating plaster should be ap- plied, and a free purulent discharge kept up for months, only removing the plaster occasionally, for a day or two, and apply- ing an Elm poultice when the sore becomes too irritable. Af- ter using the irritating plaster for a few weeks, direct attempts may be made to rectify the deformity. Stays may then be put on, and so fixed as to exert a slight force tending to straight- en the spine. The force applied should give no pain or un- easiness. Continue the plaster with the machinery. Fracture of the Spine. — (See accidents.) HYDRO-RACHITIS — SPINAL DROPSY—SPINA BIFIDA. Sensation of heaviness in the lower extremities with difficult movement of the same during walking; a feeling of numb- ness and impossibility of ascending steps; sensation of cold- ness in the lower part of the spine; gradual development of a small, elastic, tender tumor, and total paralysis and insensi- bility of the lower extremities. Later, paralytic affections of the bladder and intestinal canal take place. According to the increased accumulation of water and its ascension in the spi- nal column, we have also an increase of paralytic affections, difficulty of breathing, &c, and finally effusion of water in the brain. Paralytic affections are aggravated when the patient occu- pies a horizontal posture, diminished when sitting up. Causes.—Scrofula) organic derangement; excessive coi- tion; mechanical pressure upon the spinal column. Treatment allopathic — This disease is considered incurable. Cautious acupuncture, repeated from time to time, combined with compression may be tried; also Unguentum Juniperi, or mercurial ointment. Hydropathists recommend a linen compress and bandage, 25 578 DISEASES OF THE BACK AND LOINS. applied moderately tight, and so adjusted as to press the tu- mor to a level with the surface. If inflammation exists the cold water dressing must be added. Eclectic treatment — The tumor should never be opened un- der any circumstances. The early application of a strong de- coction of white oak bark for four or five hours, by means of cloths wet in the decoction, first warm and afterward gradual- ly colder, has proved of benefit. As soon as the inflamma- tion has subsided, which generally occurs at the end of twenty - four hours, a compress of raw cotton, wet in the same decoc- tion, and a bandage moderately tight so as to press the tumor down to a level with the surface should be applied. Before inflammation comes on, all applications should be cold. LUMBAGO RHEUMATICA—RHEUMATISM OF THE BACK. Violent pains in the small of the back, either periodical or permanent, frequently accompanied with fever, and an imagin- ary feeling of stiffness. In some cases the patient is suddenly seized with a violent, sharp pain, which pins him in a fixed attitude, from which he cannot stir without suffering extreme torture, and so confines him for many days. In cases of chronic pain, and when scrofulous or syphilitic causes are present, caries of the vertebrce may gradually arise, and thereby engender a lumbar abscess, which breaks at the groins or legr Causes. — Taking cold; congestion of blood, which may pass into inflammation ; abuse of Mercury; excess in venery. Allopathic treatment. — Leeches to the painful parts; vene- sections in plethoric persons; cooling laxatives; lukewarm baths, especially steam baths; equal temperature; mild dia- phoretic drinks; volatile salves; electricity; sulphur. Homoeopathic remedies.—Aconite, Bryonia, Nux vomica, Rhus t., Belladonna, Pulsatilla, Mercury. Hydropathic treatment — Hot fomentations to the affected parts, followed by the cold covered compress; or the warm douche followed by the cold, regulating the temperature and force of the stream by the reactive powers of the patient. INFLAMMATION OF THE PSOAS MUSCLE. 579 Eclectic treatment. (See Bheumatism.) Marasmus dorsalis. (See Tabes dorsalis.) MYELITIS VERA—ACUTE INFLAMMATION OF THE SPINAL CORD AND ITS MEMBRANES. Symptoms. — Pain, more or less severe, in some part of the spine, either permanent, or of an intermittent character, ag- gravated by the slightest movement, and by the slightest touch; sharp pain in the epigastrium, increased on pressure; palpitation of the heart, with oppressive respiration. The symptoms vary according to the locality of the affection. When the dorsal or lumbar regions are affected, the inferior extremities are convulsed or paralyzed; in inflammation of the membranes of the cord, (meningitis spinosa,) the spasms are frequently general, accompanied with constipation. In inflammation of the substance of the cord, the sensibility is usually lessened and diarrhoea accompanies it. Causes. — Exposure to cold and damp; sanguineous conges- tion; external injuries. Allopathic treatment.— Leeches and cupping; warm mercu- rial embrocations; calomel; purgatives and vesicatories. Homoeopathic treatment. — Aconite in repeated doses, in all cases where the fever is intense; afterward Belladonna, Dul- camara, Arsenicum, Digitalis, Pulsatilla, Bryonia, Nux v., Cocculus, Rhus, Ignatia, Opium, Veratrum — as the symptoms may require. Hyoscyamus, Stramonium, Bryonia, Zincum are useful in warding off paralysis of the brain. Hydropathic treatment—Subdue the general fever by ablu- tions and the wet sheet, and apply the cold compress to the affected part. NOTALGIA—PAINS IN THE LOINS. These pains are generally symptoms of another disease, and the treatment must be directed against the latter. (See also Lumbago, Neuralgia, &c) PSOITIS — INFLAMMATION OF THE PSOAS MUSCLE. Pain in the renal region, hip, and down the leg; the limb 580 DISEASES OF THE BACK AND LOINS. can neither be stretched, or drawn upward without pain; in walking there is a hobbling in the gait, with the body inclined forward; turning in bed or lifting any weight increases the pain. Occasionally we find some degree of external swelling. Discriminative signs of inflammation of the kidneys, are; the absence of urinary difficulty, and costiveness. Psoitis is generally chronic, and more painful than danger- ous. It becomes dangerous when an abscess is formed, and the matter discharges itself into the cavity of the abdomen, but more frequently the abscess opens in the groins, anus, perinaeum or thighs. Causes. — Over exertion in lifting and carrying; blows and falls on the back, or the testes ; rheumatism. Allopathic treatment.-—Leeches, lukewarm-baths; vesicato- ries; Mercury externally and internally; and fomentations with salt-water are principally used in the treatment of this disease. Homoeopathic remedies. — Aconite, Bryonia, Nux v., Pulsa- tilla, Rhus, Staphysagria. (See Rheumatism and Psoas Ab- scess. ) Rheumatism in the back. — (See Lumbago.) Sciatica. — Hip-Gout, Neuralgia of the sciatic nerve. (See Ischias.) SPINAL IRRITATION. There are numerous instances, in which the spinal marrow affords evidence of a diseased condition, and thus enables us to refer various morbid phenomena existing elsewhere, with great confidence, to their true origin. The evidence of func- tional spinal disorder is that afforded by tenderness upon pres- sure on the spinous processes, when there is no reason to sus- pect the existence of inflammation. The symptoms are immensely diversified. They vary with the portion of the spine affected; those parts especially show- ing signs of disorder, which receive nerves directly or indi- rectly from the vicinity of the tender vertebrae. Beginning with the digestive function, we havedifficultdeglutition, stric- SPINAL IRRITATION. 581 ture of the oesophagus, spasm of the stomach, morbid appe- tite, nausea and vomiting, symptoms of dyspepsia. The respiratory organs are also liable to be attacked. The voice is altered; violent cough, spasm of the glottis, difficulty of breathing, &c Palpitations of the heart are very frequent. Deranged hepatic secretion, urinary and genital disorders are not un- common. Neuralgic pains, cramps, St. Vitus dance, convulsive move- ments, and paralytic symptoms may be added to the list. Causes.—The disease occurs most frequent in women, and especially during the menstrual period, or between the ages of fourteen and forty-five. Changes of the weather, and mental disturbance appears to be capable of inducing it. It resembles inflammation of the spinal cord, and is distinguished by the absenee of fever. Treatment allopathic. — The application of a few cups or leeches directly to the tender spot, or its immediate vicinity, will often afford complete relief. This remedy may be repeated again and again. After sufficient depletion in this way, a blister may be created over the tender vertebrae, and renewed as it heals. In obstinate cases pustulation with tartar emetic, may be resorted to. Mustard and issues are also recommended. Cold ablutions and warm baths have proved of benefit. Homoeopathic remedies.—Aconitum, Belladonna, Dulcamara, Arsenicum, Digitalis, Pulsatilla, Bryonia, Nux v., Cocculus, Rhus, Ignatia, Opium, Veratrum—according to the portion of the cord which is affected. Eclectic treatment.—Free bathing and friction, and such exercise as the condition of the patient will justify; cupping; applications of the compound tar or irritating plaster to the spine. In any cases presenting periodical qualities, the free use of quinine and iron for a few days, followed by the gin bitters is recommended. When the spinal disease is connected with an impoverished state of the blood, the muriated tincture of 582 DISEASES OF THE BACK AND LOINS. iron may be given. Dry cups may be freely used. More lasting benefit will be realized from a discharge kept up by the use of the tar or irritating plaster, applied in strips three inches wide and four inches long, to the affected parts of the spine. TABES DORSALIS--DORSAL CONSUMPTION. Consumption of the back. Symptoms. — Emaciation, weakness and finally paralysis of the lower, and sometimes of the upper extremities; a feeling of heat or cold, crawling like ants, and in some cases, violent pain in the lower part of the spine. The first symptom of the disease is a wavering, tottering gait, with great debility, which continues in some cases ten, or more years. Generally, however, the disease continues to spread, and with it the para- lytic affections, and emaciation of the spinal column. Most patients have great sexual desire, and a sensation like that of pouring hot water down the spinal column. Death ensues by paralysis of the brain, heart, or lungs; or by total emaciation and exhaustion. Causes. — Exhaustion of the lower part of the spinal mar- row, created by excess in venery and masturbation; conges- tion; chronic inflammation; rheumatic and arthritic metas- tases, with loss of semen. Treatment allopathic.—Remove the causes and invigorate and strengthen the general health and the affected part of the spinal column. Severe cases are incurable. Female nurses should not be employed in waiting on male patients; they should lie upon a mattrass in a cool and pure atmosphere; and the genital organs should be frequently washed with cold water and vinegar. Internally we must administer Camphor with Nitrum and Opium (Cali nitrici one grain, Camphor two grains, Opium half a grain, white sugar one scruple, mix, and take before going to bed); andiron. Externally, embroca- tions of Phosphor liniment, and Phosphor with Naphtha; douche upon the spinal column; bathing in water containing iron, etc. The patient should exercise in the open air daily, TUBERCLES OF THE SPINK. 583 abstain from coffee, tea. and spices, and his diet should con- sist of oyster soup, light meats, fruits, cracked wheat, and good vegetables. Exposure to the heat of the sun is injurious. : Homoeopathic remedies.—When the complaint is not too far advanced, benefit may be derived from: Calcarea, Cocculus Nux v., and Sulj)hur. Phosphoric acid, Causticum. China and Staphysagria naay prove useful in some cases. For Atrophy with paralysis of the lowrer extremities: Nux v., Sulphur, Nux v., Causticum, Nux v., Carbo veg., Cocculus, Phosphor, Rhus tox; to be given in this order and at long intervals (a dose every two or three weeks). Hydropathic treatment. — A general course of treatment to invigorate and rebuild the system of the patient should be pursued. Diet, exercise; keeping the bowels regular by clys- ters; washing the organs of generation and the back frequently with cold water; sitting-baths of short duration, and applica- tions of wet bandages to the perinaeum, which must be fre- quently changed. During the night the patient must wear a wet bandage down the spine, and wash the genital organs with cold water whenever he is troubled with erections. River and wave-baths are an admirable remedy. A mild douche may also be directed to the spine. TUBERCLES OF THE SPINE. In the first stage the patient has symptoms of circumscribed inflammation, wdth a feeling of pressure in the parts affected, he complains of sharp, burning pain, extending from the spine along the course of one or the other nerve, without signs of any inflammation or dislocation in the vertebrae. The pains increase in severity, and twitchings take place in those muscles which receive their nerves from the parts diseased, Twitchings are like electric shoeks. In the second and third stage the parts affected with twitching become paralyzed, hec- tic fever sets in, and pains continue until death relieves the patient from sufferings. Causes. — The disease has been principally observed k 584 DISEASES OF THE BACK AND LOINS. females of an advanced age, and in most cases was accompa- nied with derangement of the Uterine system or preceded by nervous rheumatism. Treatment — Very little can be done with medicine. Such remedies should be administered as will alleviate the sufferings of the patient. CHAPTER XX. DISEASES OF THE EXTREMITIES. ANKLES, WEAKNESS OF. The ankles of children often become weakened and de- formed. In some cases the inner ankle almost touches the ground, and the patient walks only with a great deal of lame- ness and pain. Causes. — Weakness and relaxation of the bones and liga- ments; scrofula; allowing the child to walk too soon; &c Treatment.—The various means of improving the general health should be resorted to; excessive exercise must be avoided, and the ankles and feet washed and showered with cold water. Mechanical aid can be afforded by a well applied bandage; wearing a boot that fits pretty tightly about the ankle; or having a piece of steel or whalebone fastened to the sole, and passing perpendicularly upward to the middle of the inner side of the leg. If scrofula is the cause anti-scrofulous remedies should be administered. (See Scrofula.) Bunion. — Inflammation and swelling of the bursa mucosa (small sacs situated about the joints) at the inside of the ball of the great toe. It often produces distortion of the big toe, and is accompanied with tenderness and pain. Causes. — Tight shoes or boots; weak flattened state of tho foot. Treatment — Wearing of proper shoes, so arranged as not to press on the tender part. A mercurial plaster on soft leather often gives great comfort. If the inflammation is severe it must be treated by rest, leeches and poultices in order to avoid suppuration. For fistula following these inflam- 586 DISEASES OV THE EXTREMITIES. mations a weak solution of Kreosote is recommended as an ex- ternal application. Homoeopathic treatment. — A dose of Silicea administered daily, or at intervals of four days in susceptible habits. Hydropathic treatment—Warm foot-baths, when the part is very tender and irritable; at other times frequent cold-baths; and when a horny substance like a corn appears externally the application of Caustic. CLUB-FOOT — TALIPES. There are four varieties: 1, talipes varus, the foot is turned inward, the patient walking on the outside of it, the heel being elevated; 2, talipes equinas, the heel is more or less elevated, the patient walking on the ball of the foot or on the toes, and pressing equally on all the toes, or principally on the side of the little, or that of the great toe; 3, talipes vulgus, the foot is turned out, so that the patient walks on the inner sur- face, the external edge being raised from the ground, and the sole standing outward; 4, talipes calcaneus, the toes and foot are elevated to an acute angle with the leg, the heel resting on the ground. (See Illustrations.) Causes.—The first variety is produced by a contraction of the muscles of the calf of the leg and the adductors of the foot; the second variety is usually owing to a contraction of the gastrocnemii muscles alone, but sometimes the flexors of the toes are also contracted; the third variety is caused by the contraction of the adductor muscles, and also those of the calf of the leg; and the fourth variety is owing to the con- traction of the tibialis anticus and the extensor muscles. These deformities are usually congenital, but may result from accident. Treatment. — The majority of cases can be remedied by a proper mechanical apparatus, if it is applied early—say before three years of age. This consists essentially of a stiff shoe or sole, fixed to an upright shaft to which springs are so attached as to make gentle but constant extension against the contracted muscles. BANDAGE IN OLD SORE LEGS. TALIPES EQULNUS, CLUB-FOOT. ■**=«TT11fI NARROW BLADED KNIFE—USED IN THE OPERATION FOR CLUB-FOOT. t V. CORNS. 587 When machinery fails, or is not applicable, the operation of tenotomy—a division of the contracted tendon or ten- dons—is the only chance. A division of the tendo Achillis is sufficient in a majority of cases of the first variety. The patient is placed on a bed upon his face, or he may sit in a chair with his foot elevated. The skin of the ankle is drawn tense so that it will cover the wound when it contracts, and a long, narrow bladed knife is passed through the skin flat- wise between the tendon and the bone, near the anterior sur- face of the tendon, one or two inches above the internal mal- leolus, and carried through to the skin on the opposite side; the edge is then turned upon the tendon, and, while an assis- tant bends the foot so as to put the tendon firmly on the stretch, this is eut through, when it will separate with a crack- ing noise. The space between the divided ends of the tendon will be filled up with coagulated lymph, which eventually becomes firm and serves as a tendon. After the operation the limb should be kept in an easy posi- tion for three or four days, and then placed in a suitable ma- chine to keep up extension and fix it in its proper situation. The posterior tibial muscle can be most readily divided about two inches behind and above the internal malleolus; ca*e must he taken not to carry the incision too deeply, else the posterior tibial artery and nerve might be wounded. The tendon of the anterior tibial muscle must be cut where it passes over the ankle joint. The flexor of the great toe is most conveniently divided on the sole of the foot. It may be seen and felt projecting like a strong cord. Chilblains. — (See Diseases of Skin.) CLAVI — CORNS. Growths of thick cuticle on the toes, produced by irritation of the skin, situated over some projecting joint of bone. They are divided into the hard and the soft corn. The soft cerns are generally situated between the toes. 588 DISEASES OF THE EXTREMITIES. When the corn is completely formed it has a membrana situated between it and the true skin, so that it can be taken off without injuring that surface. Causes. — Tight boots or shoes; constitutional taint. Treatment. — Have the boots properly adapted to the shape and size of the foot; bathe the feet frequently in warm water and cover the corns constantly with a plaster composed of equal parts of soap-plaster and oil, spread on kid-leather; or, if they are very tender, with a bit of linen thickly spread with spermaceti ointment. The growth of cuticle must be fre- quently removed with a blunt knife. Sometimes it is useful to put a sole of felt into the shoe with a hole in it to receive the corn. If the cuticle is excessively hard, its exfoliation may be hastened by rubbing it with nitrate of silver, or lini- ment of ammonia, or by touching it with a hair pencil dipped in strong nitric acid. For the soft corns between the toes the nitrate of silver is the best application. Homoeopathic treatment — Antimonium crudum, externally as well as internally, is recommeded as the most effectual remedy. Bathing the feet in warm water, then paring down the corn carefully and afterward applying a weak Arnica lotion, has afforded great alleviation of suffering in many cases. Hydropathic treatment—-Soak the feet in warm water, shave off the horny substance and then touch them with the nitro- muriatic acid. Eclectic treatment — Soak the corn in warm water two or three times a day until all inflammation is removed, then shave off all the horny substance that can be easily removed, and apply to the centre of the corn a small drop of the nitro-mu- riatic acid by means of wood, tapered away to a point as fine as that of a darning needle. The process may be repeated several times if necessary, taking care that the acid does not come in contact with the surrounding parts. To prevent this the surface all around should be covered with finely pulverized saleratus, chalk or carbonate of magnesia, either of which inverted toe-nail. 589 will neutralize the acid. After this the common black salve may be applied, which with a loose shoe, or boot, will be all- sufficient. CRAMP IN THE CALVES OF THE LEGS, THE SOLES OF THE FEET AND OTHER PARTS. Allopathic treatment — Bleeding, laudanum and friction. Homoeopathic treatment. — Press the part firmly against the bedstead or the wall, or press and squeeze it with the hands. Veratrum, a dose taken for several days is recommended aa a preventive followed by Sulphur and Coloeynth. Nux v., Rhus, Calcarea, Argilla, Sepia, Lycopodium and Nitric acid are in some cases required. Hydropathic treatment — Rub the limbs with a cold wet cloth, followed by dry friction. Frozen feet — (See Chilblains.) Gonitis, Inflammation of the Knee. — (See Joints.) Gout in the feet — Podagra — (See Diseases of the Joints.) house-maid's knee. Acute inflammation of the bursa, that intervenes between the patella and skin, common to female servants who are kneeling much upon hard, damp stones. It causes great pain, swelling and fever. The swelling is superficial, and in front of the patella, which is obscured by it; whereas in inflamma- tion of the synovial membrane of the knee, the patella is thrown forward, and the swelling is most prominent at the sides. Treatment. — Rest, fomentations, leeches, and regulation of the bowels. If the pain and swelling are not relieved, it must be punctured and treated as an acute abscess. Limping. (See Coxar throcace.) Malformations of the toes require such operations as the case may indicate. Supernumerary toes may be easily removed if annoying to the possessor. OjJdema of the feet. (See diseases of the skin.) ONYXIS—INVERTED TOE-NAIL. Growth of the nail into the flesh. The nail, from some 590 DISEASES OF THE EXTREMITIES. accidental bruise, or the wearing of a tight boot or shoe, cur4s down at the sides and becomes embedded in the flesh, causing inflammation, suppuration, and frequently large fungottB growths shoot out which are extremely painful and tender to the touch. Treatment allopathic — Soften the nail by soaking in warm water, then shave it as thin as possible with a knife or file or bit of glass, and allay the irritation and pain by keeping the foot at rest a day or two, and applying leeches and poultices. If the case is obstinate, the edge of the nail must be removed by cutting through it with a pen-knife, and then turning it back. Homoeopathic treatment. —Soak the feet in warm water, and, afterward, endeavor to introduce, with a dull pen-knife, a lit- tle lint moistened with Arnica between the nail and the skin. When there is proud flesh, strew some finely powdered loaf- sugar on it twice a day, and use the foot as little as possible. The nail should be scraped in the middle with a sharp knife every day until it is as thin as possible. By these means the sides will heal much quicker, and the nail is more easily bent out, so as to introduce the lint between the skin and the nail. When the edges of the nail are rough, scrape them smooth, but do not cut them. To cure this evil effectually, cut the centre of the nail out, gradually, as far as possible, and leave the sides as they are. The nail will in consequence grow more in the centre and less on the sides. Hydropathic treatment — The foot must be frequently soak- ed in warm water, until the soreness is so far abated that it can be handled without pain; then with a probe press pledgets of lint, as firmly as can be borne, under the most detached point of the toe-nail, pressing them also between the nail and projecting portions of the flesh as far as possible. Cover these with the wet compress, and apply a moderately tight bandage over the whole, frequently wetting the whole with warm, tepid or cool water. The tents are to be pressed fur- ther add further under the nail from time to time,; and the SWEATING FEET. 591 foot should be soaked and dressed once or twice daily. When portions of the nail become free they may be cut off, and mild caustic may be employed to remove the fungous or indurated growths. Eclectic treatment. — When the toe is in an inflamed and painful condition, have the part immersed in warm, weak lye for one to two hours each day,, and in the intervals cover it with a large elm poultice, kept warm. When all inflamma- tion and soreness have subsided, each time after the part has been in the lye, press under the nail with a probe, at the most detached point, pledgets of lint or cotton. Also press the pledgets down at the sides, between the nail and flesh which has risen up and projected over the nail, and fill it up so high that a bandage will press a little on the tents. Cover this with a plaster of the black salve, or some simple cerate, to shield the parts from the air and apply a bandage over the whole. It should be immersed in the lye and dressed twice a day. If there be any fungus or induration of the parts, the mild caustic powder may be applied. P^EDARTHROCACE. A scrofulous affection of one of the phalanges of the fin- gers. The skin of the affected part becomes red or blueish, which color changes after several weeks into a dark brown, finally it breaks and forms an ulcer with callous edges, caus- ing caries of the diseased phalanx and hectic fever. In the latter stage of the disease the pains are very severe. Treatment.—In the first stage leeches and poultices. Af- ter ulceration has taken place, it will be necessary to touch the edges with Caustic, wash with a weak solution of Kali, and dress with Unguentum basilicon. Homoeopathic remedies.—'In the first stage, coloeynth and phos. ac; in the second stage, arsenicum, lachesis, hepar, mercurius and silicea. ( See Ulcers.) Paralysis of the lower extremities. (See Paralysis.) SWEATING FEET. Some individuals are much troubled with a disagreeable, 592 DISEASES of the EXTREMITIES. clammy sweating of the feet to such an extent as to render it necessary to change the stockings several times daily. The offensive odor which is exhaled at the same time, is a source of extreme annoyance to others. Cleanliness is often insufficient to remedy the evil. Pow- erful astringent washes as alum, &c, will suppress the sweat- ing, but bring on blindness, * deafness, asthma, phthisis and many other chronic diseases. Washing and bathing the feet with a decoction of Chamo- mile and Sage is recommended. In order to smother the bad odor the parts may be washed with chlorine water. Homoeopathists recommend Silicea and Rhus as remedies which have frequently brought about a radical cure. A dose of Rhus tox. should be taken every three to four days for two or three weeks. If no improvement result, Silicea may be had recourse to in the same manner. After Silicea, Rhus may again be used if required. Toe-nail inverted. (See Onyxis.) TWITCHING. Jerking of the muscles of the feet in nervous persons of otherwise fair health, generally depend upon some obstruc- tion of the skin or bowels, drinking of coffee or tea, and the use of tobacco. ULCERS IN THE LEGS — FEVER SORES—OLD SORE LEGS. Chronic ulcers on the legs, frequently the consequence of intemperate habits, are often from an inch to an inch and a half deep, accompanied with burning pains especially dur- ing the night, and lameness. The affected limb is hardened and swollen, of a dark color, and where the cuticle scales off it leaves a shining, purple surface, which becomes white on pressure with the finger. The character of the sore may be irritable or indolent, or of a mixed character. Children of liquor-drinking parents are often subject to these sores. Treatment—If the ulcers are of the indolent character, with hard, callous edges, and pus adhering to the bottom, they should be completely covered with the mild ( powdered ) caus- WOUNDS. 593 tic, and then a slippery elm poultice put on. This dressing Bhould be renewed every twelve hours. In the course of for- ty-eight hours the pus will easily wash off, and the sore pre- sent a healthy appearance. When the ulcers are painful they are to be soothed with warm fomentations; when hot and inflammatory, the cold douche should be applied to the limb daily. The most important measure is the roller bandage, which must be applied twice a day, and with great care, smoothly and firmly, from the foot up to the knee or thigh. The band- age should be thoroughly wetted with cold water after it is applied. Wet cloths should always be placed over the band- age when there is active inflammatory excitement. The water, in whatever manner applied should not occasion any sensation of chilliness. The whole surface should be thoroughly washed every day, the stomach kept unburdened and well cleansed. Obstinate cases have often been treated successfully by wash- ing the ulcers with a strong solution of salaeratus, or white oak bark. The bandage should be worn for twelve months. Oily substances should not be applied. In some cases of chronic ulcers of the leg, the following formula has been found of much benefit: Take prepared chalk, four pounds; lard, one pound; olive oil, three ounces. Having heated the oil and lard, add gradually, the chalk, fine- ly powdered. The ointment and a bandage being once appliedj it is left until the cicatrix forms and becomes firm. (See Ulcers.) Varix— Varices or Varicose veins. Varicose ulcers. (See diseases of blood-vessels.) White swelling. (See diseases of the joints.) WOUNDS. The femoral artery has occasionally to be tied for wounds or disease. It is most conveniently found for ligating just above the point crossed by the sartorius. In cutting, avoid veins and enlarged glands, and, after introducing your liga- ture by pressing the needle from the inside outward, close to 25z 594 DISEASES OF THE EXTREMITIES. the coat of the artery so as to separate it from the great vein and saphenic nerve, ascertain whether there are any branches from above that would render the operation useless, and if not, tighten and tie. The anterior tibial artery is only to be reached in the up- per part of the leg, by a long and deep incision down to the interosseous ligament. The posterior tibial artery can be easily secured in the lower part-of the leg, just behind the in- ternal malleolus, or for some distance higher up along the in- ner side of the tendo Achillis; but in the upper part, with much difficulty, so that it is best to go up to the femoral arte- ry at once. OHAPTEK XXI. MIDWIFERY. ABORTION— MISCARRIAGE. Expulsion of the foetus before the sixth month, preceded by uneasiness and weariness, with aching or pain in the back, followed after a few days, or hours, by slight discharge of mu- cus, or blood from the vagina and bearing down pains; these are at first felt in the back, extending around the loins to the abdomen and down the thighs, recurring at regular intervals, and increasing in strength and frequency, until the foetus is expelled. The disease cannot be considered dangerous unless accom- panied by great hemorrhage. Causes. — General or local debility, so called inward weak- ness; bodily shocks or injuries, overlifting, false steps, severe coughing, running up hill; luxurious mode of life; powerful cathartics; leucorrhoea; excessive sexual indulgence; diseases of the rectum and bladder; sudden anger, joy, sorrow, good or bad news suddenly told; hemorrhage from the womb; neg- lecting to take air and exercise. Treatment allopathic. — When the pains are trifling, dis- charges slight, abortion may be prevented by the following means. The patient should repose on a hard bed, lightly cov- ered with clothes, in a cool room, and be kept perfectly quiet, mentally and bodily. All causes of irritation must be re moved, and all stimulants avoided. The uterine action may be suspended by opium or some of its preparations in full doses. An enema of cold water, and cold water to the private parts will be useful. If our attempt to arrest miscarriage fails, the pains increase and expel the 595 596 MIDWIFERY. whole ovum, or the foetus will be detached alone and the se- cundines afterward. If the latter are not expelled, we must endeavor to reach them with the fingers and gradually with- draw them. Cases complicated with flooding require the same treatment, especially the plug, as stated under hemorrhage from the Uterus. If the uterine action ceases during the flooding and the ovum is not expelled, Borax and Ergot should be administered, or the foetus removed with the hand. The after treatment of patients who have miscarried is the same as after regular confinement. When the habit of miscarrying has been acquired, the pa- tient should abstain from sexual intercourse during gestation and avoid all the causes of abortion enumerated above. Homoeopathic treatment. — Sabina should be given in cases where there is evident disposition to miscarriage—a dose every four to eight days, until the period of danger be past; it is also of benefit after miscarriage has taken place, and when there is profuse, bright colored hemorrhage; sinking or faint- ness in the abdomen; frequent desire to relieve the bowels; diarrhoea, nausea and vomiting; chilliness and fever. Secale is recommended when abortion has occurred more than once; a dose should be given every fourteen days, com- mencing immediately after the cessation of the monthly pe- riod at which miscarriage usually occurs. This remedy is also useful in weak or exhausted persons and in those cases of hemorrhage in which the discharge consists of dark, liquid blood, and is followed by considerable debility, and in cases of inevitable miscariage, attended with feeble expulsive efforts. Hydropathic treatment. — The patient should recline in an easy posture, and be placed on a cool and rather hard bed or mattrass; the wet bandage be applied around the abdomen and changed several times a day, also two or three vaginal in- jections of cold water employed daily. When the flooding is excessive, and in cases of internal hemorrhage, denoted by AFTERBIRTH, RETENTION OF. 597 headache, great lassitude, shiverings, the patient becoming pale, exhausted and faint, a silk handkerchief, wet in the coldest water, or enclosing a cylindrical piece of ice or snow, may be introduced into the vagina as far as convenient; it may remain for six or eight hours, and then be introduced again if necessary. Enemata of the coldest water are valua- ble in severe cases. Faintness, which takes place after severe flooding, favors the formation of a clot and need create no alarm. Abscess of the breast, or " broken breast" is the result of inflammation of the breast. (See Inflammation of the mammary glands.) Accidental hemorrhage. — (See Hemorrhage.) AFTERBIRTH, RETENTION OF. Cases of retained placenta are those in which the womb does not, after a due interval of rest (an hour or two hours) expel the placenta, Causes. — Inactivity of the uterus; irregular contraction of the womb; morbid adhesion between the uterus and placenta. Treatment. — When caused by inactivity of the womb, and if there be great hemorrhage, the placenta (after-birth) must be instantly removed—either by traction by the cord, or by the introduction of the hand, except in cases where the pa- tient has fainted from excessive loss of blood. If there is no hemorrhage we may excite contractions of the uterus by fric- tion and pressure upon the abdomen, and then draw by the cord steadily and firmly. Small doses of ergot of rye will in some cases bring on uterine contractions, and it has been administered with benefit. If it fail we must extract the placenta by the hand. Great care must be taken not to injure the surface of the womb, and to remove the whole after- birth. When retention is caused by irregular contraction ("hour glass contraction," &c.,) steady and firm traction should be made by the cord in the axis of the brim, and maintained for 598 MIDWU'LRV. sometime without relaxation. If it fail the placenta must be extracted by introducing th» hand carefully and gently. Morbid adhesion of the placenta to the uterus requires ex- traction by the hand, but no violence should be used in endeavoring to detach it; it is better to peel off the placenta all around up to the adhesion, and then to separate the loose part from the adherent portion, close round the adhesion, leav- ing the latter in the uterus to soften and come away with the lochia. Homoeopathic remedies, recommended to bring on contrac- tion of the womb, are: Belladonna, Pulsatilla, Secale cornu- tum, and gentle, rational mechanical means. Hydropathic treatment.—The hand dipped in cold water and applied to the lower part of the abdomen, or the sudden appli- cation of a cold wet cloth to the abdomen will often bring on contractions of the womb and expel the placenta. AFTER-PAINS. Contraction of the uterus subsequent to delivery. These pains generally commence half an hour after delivery, and cease in thirty or forty hours. This operation is, within cer- tain limits, salutary; at the same time when they occur in an aggravated form, and are unduly protracted, as frequently is the case in nervous females, they tend to deprive the patient of her rest, and ought under such circumstances to be subdued as speedily as possible. With the first child they are seldom experienced. Cecuses. — Exalted nervous sensibility in general, and par- ticularly of the uterine system; foreign substances (clots of blood) in the womb; suppressed lochia; &c. Treatment allopathic—Cinnamon-tea; embrocations of vola- tile liniment; removal of foreign substances by the hand; Dover's powder; Asa foetida with laudanum; injections of weak Chamomile-tea with herba hyoscyami; cooling beverages; application of bags filled with dry herbs to the uterine region. Homoeopathic treatment—Arnica, internally and externally APPARENT DEATH OF INFANTS. 599 as a lotion employed after delivery, is generally sufficient to prevent the excessive development of these pains. Chamomilla, in highly excitable and sensitive patients. Also: Nux v., Coffea, Pulsatilla, Secale cornutum, and Cu- prum metallicum. Hydropathic treatment. — Cold wet towels, often changed, upon the abdomen, thighs and genitals; tepid vaginal injec- tions if there is not too much soreness, and in extreme cases wet hand frh ' ^i the shallow bath. Aphthoe. — Nursing sore mouth. (See Diseases of the Mouth.) ASPHYXIA NEONATORUM — STILL-BORN — APPARENT DEATH OF INFANTS. Suspension of the functions of vitality, respiration, circula- tion and motion (death). Causes.—Defective nutrition; natural debility; difficult par- turition; injuries from the forceps ; pressure of the umbilical cord round the neck; tying the navel string too tightly and too soon after birth; accumulation of mucus in the throat; too sudden an alteration of temperature; &c. Treatment. — If no efforts at inspiration take place, and if there is no pulsation in the cord, the navel string should be tied and divided, and the child plunged into a warm bath; if this fail, cold affusions must be tried; most effectual is light and rapid friction of the body and extremities with warm flannel, with or without stimulants. Tickling the nose or fauces with a feather; electricity and stimulating enemata have been successfully employed. Infla- tion, gently and slowly, may be tried by means of a proper tube introduced into the larynx. In cases where the pulsations of the funis are perceptible, the cord must not be divided until respiration has been estab- lished ; therefore, placing the infant in such a position that there shall be no impediment to the circulation through the cord, we must adopt some of the plans already mentioned for its restoration. If these means fail we may try the effect of 600 MIDWIFERY. loss of blood by cutting cross the cord and allowing a dessert or table-spoonful of blood to escape before applying the liga- ture. When the child is threatened with, or attacked by apoplexy from prolonged labor, the heart's action being labored, the pulsation in the cord feeble and suppressed, the surface blue, the face livid and, in some cases, the form of the head changed, the cord should be divided, and half an ounce to an ounce of blood allowed to escape, after which we r£ .lady "*».d the face paler, the pulse quicker and an effort made to respire; the cord may then be tied. If respiration does not take place, cold sprinkling, warm baths, friction or inflation may be tried. Homoeopathic treatment.— Tartar emetic, a grain in eight ounces of water, a few drops into the mouth of the child every quarter of an hour. Opium: If, after half an hour no change for the better takes place, and the face is livid and blueish, a few globules in a wine glass full of water, and put a few drops into the mouth of the child every ten minutes until some effect is produced. Cinchona: If the face be pale during the affection. Wrap the child's body and limbs in warm flannel or linen, and apply cold water, or cold spirits to its breast with the palm of the hand; should this not succeed, place your mouth over the child's mouth, and gently blow so as to inflate the lungs, closing the child's nostrils at the same time between your thumb and finger, to keep the air from passing out through its nose. If pulsations be felt in the cord and the beating of the child's heart be perceptible, have a little patience and all will be well. Hydropathic treatment. — Dash a little cold water on the chest, abdomen and spine of the child, and resort to artificial respiration. Broken breast—(See inflammation of the mammary glands.) CONCEPTION, THEORY OF. The researches of naturalists and physiologists during tha CONCEPTION, THEORY OF. 601 last hundred years, together with extensive observations and experiments which have recently been made, in relation to the reproductive function, have established a fact of immense importance to physiological improvement and human happi- ness. It has been demonstrated that procreation in the human animal is effected — as in all mammifers, as well as with birds and reptiles — by the development of germs, ovules, or eggs in the female, and their fecundation by the male. These ovules are formed in the ovaries, and are passed to the uterus, and thence expelled independently of fecundation or sexual intercourse. During each menstrual period an ova is trans- mitted to the uterus, where it remains several days, varying in time usually from one to two weeks, though, in a majority of cases, it is passed off between seven and twelve days. But if, before its expulsion, it becomes impregnated by sexual con- nection, it remains and becomes the embryon of the future being. Now, a knowledge of this hrw of conception places the existence of offspring, and the future population of the earth, entirely within the control of the will, reason, judg- ment, instead of leaving them, as heretofore, at the mercy of blind impulse or merciless passion. Many reasons will occur to any reflecting mind why, in certain places and under certain circumstances, a less numerous but better quality of infantile population is desirable. There are also thousands of married persons in the world, whose circumstances of extreme indi- gence render many children a source of regret to the parents and misery to the offspring; and, again, there are thousands of infirm, crippled, deformed, imbecile, or incurably diseased persons, living in the matrimonial relation, who are capable of propagating an inferior race, but who ought not to be curs- ing and cursed with offspring at all; and, lastly, under the forcing, stimulating, disorderly physiological habits of the vast majority of civilized people, there is a tendency to numerical increase, with corresponding imperfection of offspring. Against nil these accidents and incidents, a knowledge of the origin of life affords us the remedy. And who shall say that a knowl- 26 602 MIDWIFERY. edge of the origin of life is not as legitimately to be sought and understood as a knowledge of the growth, development, educa- tion, and preservation of it? It is true, that in some few in- stances, the ova is expelled in two or three days after the cessation of menstruation; and in some rare cases it does not pass off until after the twelfth day; but these are only excep- tions to a general rule; and as impregnation can only occur, as a general rule, between the commencement of the men- strual excitement and twelve days after its cessation, those who would not propagate have only to abstain from sexual connection during this period. I am aware that some may object, as others have objected, to enlightening the general mind on this matter; that many persons, dreading the cares, expenses, trials, etc., of a family, will abuse the privilege it confers, and refuse to bear their share of the burdens of fur- nishing the world with inhabitants, and the state with taxable citizens and numbers for the census. .But I have no sympathy with the advocate for ignorance in relation to this or any other physiological law ordained for man's government. If God has made the law, it is mans privilege to learn it, and his duty to obey it; and, further, if there are such persons in existence, as the objection supposes, they are themselves the strongest argument I can adduce in favor of my position. They should never be parents. (Trail's Encyclopedia.) CONVULSIONS. Hysteric convulsions are generally confined to the early months of gestation, and are preceded by a tightness about the throat, by sobbing or repeated attempts at swallowing; the patient then becomes motionless or may roll about from side to side; the face is pale, limpid urine is discharged, and after this state has continued for a longer or a shorter time, the sobbing becomes more violent, or the patient screams and sheds tears, and the fit thus terminates. Causes.—Want of sleep; excessive fatigue; disordered diges- tion. Treatment allopathic.—Cold water dashed in the face: vola- CONVULSIONS. 603 tile alkali held to the nostrils, and, internally, valerian or asa foetida with ammonia. Stomach must be attended to. Tonics and aperient medicine may be given if necessary. Epileptic convulsions. — (See Epilepsy.) Convulsions during labor, generallytake place at the com- mencement of a labor pain; the uterine contractions however do not appear to be impeded by the fits; the labor generally runs a natural course in the usual time, and is seldom fatal to the infant. After the convulsions have ceased, and the labor is over, there is a great tendency to abdominal inflammation. Patients sometimes become temporarily deranged after the convulsions have ceased. Convulsions generally occur from two to four hours after delivery, and are usually attributable to some injury received by the brain or nervous system during labor. Treatment allopathic,—Taking away blood from the arm or temporal artery largely and in a full stream; the nape of the neck may be cupped and leeches applied. A purgative of Calomel and Jalap should next be administered, the head Bhaved and cold lotion or ice applied. After the lapse of sometime the head and nape of the neck may be covered with blistering plaster, and mustard applied to the feet and calves of the legs. No interference with the progress of parturition should be attempted, except that, when the head has descended into the pelvis so as to be within reach of the forceps and there is sufficient space, it will be proper to apply that instrument. Apoplectic convulsions, are preceded by pain and throbbing in the head for some days previously, and accompanied by flushed face, full pulse, entire insensibilty. stertorous respira- tion, injected eyes and headache. Causes. — Stress upon the cerebral vessels during the labor pains; anxiety of mind; &c Allopathic treatment — The same as mentioned under pre- vious convulsions. Homoeopathic treatment. — The principal remedies against spasmodic pains, convulsions and cramps are: ' 604 MIDWIFERY. Chamomilla, Belladonna, Hyoscyamus, Stramonium, Igna- tia, Cocculus, Acidum hydrocyanicum, Platina and Cina;—the one or other of which should be selected as indicated by symp- toms. A calm and decided air of the physician attending nervous hysterical women during parturition is probably the best pre- ventive of convulsions. Hydropathic treatment.—Cramps can be removed by rubbing the lower limbs with a cold wet cloth, followed by dry fric- tions. The treatment of convulsions consists in avoiding the causes, and the employment of such means as are recom- mended under convulsions. (See Nervous Diseases.) Cerebral congestion. — (See Diseases of the head.) CONTUSION OF THE VULVA. This lesion is ordinarily removed without the aid of art; however, a tea-spoonful of the tincture of Arnica in a pint of water used for bathing the private parts, will greatly facili- tate its cure. Consumptive mothers should wean their children imme- diately, if the disease has received a certain development. CYANOSIS — BLUE DISEASE OF INFANTS. Children remain blue, because the ductus arteriosus con- tinues open, and the veinous blood is not consequently forced to pass through the lungs and be there changed into arterial blood. Treatment—To make the infant cry has been recommended as a probable means to cause the adhesion of the foramen ovale. Homoeopathists recommend Calcarea, Digitalis and Sulphur at long intervals. (See Cyanosis.) Coryza.—Stoppage of the nose of infants prevents respira- tion in suckling. Oil the nose, and let the patient inhale the vapors of milk and water, or those of boiling potatoes. Homoeopathists recommend Nux v., and Sambucus nig.; sometimes Chamomilla and Dulcamara. Crying, continual, of infants is generally caused by pain in EPHEMEREAL fever. 605 the ears, abdomen, head or urinary organs, and must be treated accordingly. When caused merely by nervousness Coffea or Chamomilla in homoeopathic doses has proved efficacious. DEATH OF THE FffiTUS, The diagnosis of a dead foetus is very difficult. The prin- cipal symptoms are sudden cessation of the motions of the child (in the sixth month of pregnancy or afterward); loss of the tense and rounded form of the abdomen; the uterine tumor feeling weighty and rolling loosely in the lower belly; the breasts, which had been tense firm and glandular, subside and become flaccid. Besides these symptoms, the patients ex- perience in some instances repeated rigors; the appetite ia bad; the countenance sunk; a dark areola around the eyes; the breath foetid. After the foetus has been dead sometime, the bones of the skull overlap more and feel loose within the scalp; the scalp also feels emphysematous, crepitating under the touch, and a portion of the cuticle will peel off; the pulsa- tion at the greater fontanelle is absent. deformities of infants—monstrosities. These are the effect of a deviation in the action of the vital forces in the formation of the organs. Remedies recommend- ed for Scrofula will be found of great benefit in restoring the vital force to its normal state. Diarrhoea in pregnant women should not be neglected, because it easily produces abortion. Repose and light food should be recommended, and such remedies employed as are indicated. (See diseases of the abdomen.) EPHELIS. Pregnant women have often the face covered with yellow, dirty spots. Homoeopathists employ Sepia, Sulphur, and Lycopodium. (See diseases of the skin.) EPHEMEREAL FEVER. This is a short attack of fever to which sensitive females are liable during the early part of their convalescence. 606 MIDWIFERY. The attack commences by general uneasiness, palpitation and shivering, with headache, pain in the back and limbs; soreness of the skin, thirst and quick pulse, succeeded by a well marked hot stage, with flushed face, throbbing in the temples, pain in the breasts, soreness of the abdomen, &c. The tongue is coated and the bowels confined. During the paroxysm the secretion of milk and the lochia are diminished or suspended, but they return after the paroxysm. In some cases, the patient is delirious. If neglected it may assume the form of an intermittent or continued fever. It is distin- guished from puerperal fever by the absence of marked ab- dominal tenderness, and the cessation of the paroxysm after some hours. Causes. — Impression of cold, perhaps on rising from bed, or changing the room; indigestion; fatigue; mental agita- tion want of rest. Treatment. — During the cold stage hot bottles and warm bed clothes may be applied. During the hot stage a com- fortable quantity of clothing must be continued, and dia- phoretics given so as to favor perspiration; and during the sweating stage we must guard against cold, and diminish the clothing very gradually. (See fevers.) FAINTING. Syncope during pregnancy is generally the result of a sed- entary life, debility, loss of blood, want of good nourishing food, plethora, tight dressing, &c Avoid the causes, and in fainting during labor, we should give a little broth, or a spoonful of old wine. (See Syncope.) False conception, (See mole.) FALSE PAINS. Sudden pains like those of labor, during the last month, especially at the end of the seventh, or a week before term. We recognize by the touch alone that they are not real, for the neck of the uterus remains absolutely unaffected and soft during their presence. HEMORRHAGE. 607 Homoeopathists reooiuuiend a dose of Nux v. or Pulsatilla, which generally suffices to relieve the patient from these suffer- ings. FISSURES IN THE SKIN OF THE ABDOMEN. The enormous extension that the volume of the womb, to- ward the seventh month, produces in the integuments, causes a species of laceration in the skin, into which there pass par- ticles of blood making little bluish linear marks over the whole surface of the abdomen and anterior parts of the thighs which remain during life. Treatment.—Compression of the abdomen during the first months of pregnancy; light frictions with the tincture of Ar- nica diluted with sweet oil of almonds, is the best means of preventing and of dissipating these wounds. Flooding sometimes, though rarely, occurs several hours after delivery. The most dangerous flooding may take place, and the blood accumulate in the cavity of the uterus without flowing from the vulva, in consequence of the presence of a clot or a por- tion of the placenta, which plugs up the mouth. (See Hemorrhage.) HEMORRHAGE. During the last month of gestation, at the commencement of labor, two forms of hemorrhage are liable to occur; one is called accidental because it arises from an accidental and par- tial separation of the placenta, while occupying its usual situ- ation; the other is termed unavoidable, because the placenta is placed over the os uteri and unavoidably separated, as the dilatation progresses. In the first variety the discharge occurs only between the pains; whereas, in the second variety, it is increased during (hepains, yet continues also during their intervals. The causes of accidental hemorrhage are: blows, falls, fa- tigue, over-exertion, violent straining at stool, lifting heavy weights, general plethora, &c; those of unavoidable hemorr- hage is evidently the separation of the placenta from the 608 MIDWIFERY. cervix uteri, and the exposure of the mouths of the torn ves- sels; and this separation is increased by the uterine contrac- tions, dilating the os uteri. Treatment—When the hemorrhage occurs before expulsive contraction takes place in the uterus, the ordinary means to correct it should be resorted to, as the horizontal posture, a cool room, hard bed, cold water drinking, aud cold enemata, to which may be added, in severe cases, the tampon of two silk handkerchiefs. When the full term of gestation has arrived, and actual la- bor pains have commenced, the operation of turning should be resorted to as soon as the mouth of the womb is sufficiently dila- ted, provided the hemorrhage continues dangerously alarming. Homoeopathists recommend Arnica and Pulsatilla diluted in water, a teaspoonful every five to ten minutes, according to the greater or less gravity of the hemorrhage; and if the life of the mother is threatened to proceed to artificial delivery by turning or the forceps. (See Menorrhagia.) HEMORRHOIDS AND VARICES. After the fifth month of pregnancy, the volume and the weight of the uterus incommodes the circulation in the ischi- atic and portal veins; the veinous branches which convey the blood in these trunks become stopped up; their coats are con- siderably dilated and form bluish tumors on the margin of the anus, called hemorrhoids, or under the skin of the lower limbs, called varices. ( See the same diseases in another place.) HICCOUGH OF INFANTS. The child should be warmed against the breast of the nurse, and take sweetened water by drops. INFLAMMATION OF THE BREAST. Inflammation of the mammary glands is accompanied with redness, swelling, pain, and induration ending in suppuration or in the formation of obstinate nodosities. By too harsh a treatment of this disease the foundation of cancer has been laid in many instances. INFLAMMATION OF THB BREASTS. 60-9 Causes. — Disturbance or sudden suppression of lacteal se- cretion by fright, passion, cold, &c; sudden cessation of suck- ling, occasioned by the death of the infant, or other reasons. Treatment allopathic.—Warm, cooling poultices; embroca- tions and applications of spermaceti and almond oil; frequent sucking and pumping out of the milk; warm fomentations and low diet. Diachylon Plaster, or a Cranberry poultice has been used with much success. Ulceration must be treated ac- cording to general principles. Homoeopathic treatment, — Bryonia, when the breasts are hard and tumefied, and the secretion of milk is suppressed. Belladonna: when the inflammation is intense, and when there is erysipelatous appearance of the skin. Mercurius solubilis: when induration still continues after the administration of Belladonna. In more severe cases Phosphor, Phosphoric acid, Hepar sulphuris, and Silicea should be resorted to when suppuration has already commenced. Hydropathic treatment—During the inflammatory stage apply cold wet cloths, well covered with dry ones and renew them often. Milk may be drawn off with a breast-pump, or by the mouth. Eclectic treatment. — In the first stage when inflammation is confined to a small compass and before the chill, add to fine- ly pulverized Gum Camphor, a little lard, just enough to make it adhere, spread this on a linen or cotton cloth, and ap- ply to the breast. Apply also to the tumor, if still circum- scribed, finely pulverized common salt, wet with oil of turpen- tine, and the camphor plaster over it, and the rest of the breast. This salt application will produce severe smarting so that the patient may not be able to endure it; in such a case it must be removed and the camphor applied over the tumor as well as the other parts. A lotion composed of vinegar saturated with salt, to which capsicum enough is added to make it stim- ulating, has been found, in many cases, to relieve the pain in a few minutes, and when persevered with for five or six hours, 610 MIDWIFERY. to entirely remove the disease. It should be applied as hot as it can be borne, by flannel cloths, wrung out and frequently changed. In the more advanced stage the breast should be anointed with the camphorated lard, and this covered with a poultice made of the green or finely pulverized dry leaves of lobelia, wet in hot vinegar and water, and applied blood warm. But all these means may fail to afford any relief, and in such cases it is advised to apply poultice of wheat bran, wet with human urine. It should be applied tepid and changed once in five or six hours. Besides these local measures, we should have recourse to an Emetic, followed by a brisk Cathartic, and the alcoholic vapor bath. If called too late to prevent the formation of an abscess, we must apply an Elm poultice, wet with urine, or flax-seed wet with scalding milk and applied quite warm. In all cases that will admit of delay, it is best to allow the matter to come so near the surface that nothing but the skin will intervene, and then open. In puncturing, have the edge of the lancet look toward the point of the nipple. By this means you will avoid severing any of the ducts. After the escape of the pus dress the part with the elm poultice as long as there is much discharge, and when it diminishes with simple cerate. Ischuria. — Women in the state of pregnancy often have difficulty in passing urine; there is frequent desire and great pain when urinating. (See diseases of the urinary organs.) Incontinence of urine, is generally caused by a prolonged or violent pressure of the head of the child upon the urethra and neck of the bladder, during its sojourn in the pelvis, and even during its passage, producing paralysis of the neck of the bladder, and rendering it incapable of retaining the urine. Treatment. — The tincture of Arnica as a lotion externally and small doses internally has proved of excellent effect. (See Enuresis.) TREATMENT DURInO and after labor. 611 LABOR-—TREATMENT DURING AND AFTER LABOR. Refinements of civilization, and the detestable physical education we give to our daughters have rendered foreign aid necessary in many cases of parturition. In order that the expulsion of the foetus should take place Without accident, it is necessary, the fruit having arrived at maturity: 1st, that the mouth of the womb dilate sufficiently to allow a passage to its contents; 2d, that the contraction of the muscular fibres of the body of the uterus, aided by those of the diaphragm and the muscles of the abdomen, are strong enough to expel it: 3d, that the parts through which the foe- tus passes have the necessary dimensions; and ith, that the size of the foetus be in proportion to the capacity of the pas- sage which it is to traverse, and present to that passage the parts of its body which offer diameters in accordance with it. The first decisive indication of approaching labor is a slight discharge of mucus, more or less tinged with blood, called "labor-show," and which serves to lubricate and prepare the parts for the requisite distention. Wandering pains about the back, around the abdomen, and down the thighs, gradual- ly becoming fixed and regular, with intervals of perfect ease, denote the preparation going on in the uterine region. In the first stage of labor, the pains are called cutting or grinding pains; they are of an acute character, and are occasioned by the stretching of the fibres of the os uteri. They are gene- rally difficult to bear, and the patient gives utterance to groans and loud outcries, she is irritable and restless, and at the time the head passes through the os uteri, severe rigors occur, and in some cases nausea and even vomiting ensues, probably from sympathy with the uterus. When the mouth of the womb is pretty well dilated, the discharge from the vagina becomes sanguineous, the liquor amni escapes (water breaks),and the head passes through the mouth of the womb. Here the second stage commences. The pains now become more frequent and longer, the pa- tient holds her breath, and seizing hold of something with 612 MIBWIFERY. her hands to aid the expulsive efforts of the Uterus. These are the bearing down pains. Vomiting frequently occurs dur- ing this stage, being the result of pressure, and if tho second stage is prolonged, the patient often feels heavy and sleepy; which under ordinary circumstances need excite no uneasi- ness. Spasms and cramps occurring during the advancement of the head through the pelvis may be partially relieved by friction. At the period of labor when the head is distending the perineum, and dilating the external orifice, both the suffering and the exertion reach their maximum point. The pains oft- en succeed each other so quickly, that a new one commences before the former has quite terminated (double pains). The head is then expelled and soon afterward the body of the child. There is, generally, a short interval after the head is born, before the pain expels the body. If the interval is prolonged to the manifest risk of the child, the nurse should be directed to use frictions over the womb, and if this fail in exciting it to action, she must make firm pressure upon the uterus, while the accoucheur takes hold of the child's head and inserts a finger into the axilla, and quietly extracts the body, When the child is born, any mucus that may have accu- mulated in its mouth or nostrils must be removed; if the cord is twisted round the neck it should be drawn down carefully and sliped (the loop) over the head or shoulders; if the face and head is covered with a so-called "cap" it should be bro- ken with the finger nails and removed. If the child be healthy it will cry as soon as it is born, and when respiration is established the cord may be tied about two inches from the navel and again a few inches farther on, and then cut through between the two ligatures with a pair of scissors. It should then be rolled in warm flannel and removed. The body of almost every new-born- infant is covered more or less with a white tenacious matter. The best method of removing it is by rubbing the covered parts of the body freely with lard until the two substances become completely incorporated, TREATMENT DURING AND AFTER LABOR. 6l3 when they are easily removed by a piece of flannel used as a wash-rag, after which a little fine soap may be used to wash off the grease. After the child has been carefully washed, which should be well done the first time, its skin should be rendered perfectly dry with a fine napkin. The end of the cord should always be examined before the child is dressed and if any oozing has occurred an additional ligature must be applied near to the umbilicus. The navel should then be dressed by folding a piece of linen or muslin until it is about six inches long and tnree wide, consisting of four or six thicknesses, in which a hole is to be cut and the cord pased through. The cord is then to have another strip of linen or muslin wrapped round it, as you would wrap up a Bore finger. The end of the cord now wrapped, is to be laid up toward the child's breast, the lower end of the first men- tioned piece is to be folded over it, and the whole secured by the belly band, which should be made of a strip of flannel, without either heming or lining. This fragment of the funis gradually dries up, withers and generally falls off on the sixth or eighth day. After the birth of the child the mother experiences some moments of perfect calm, afterward pains are felt in the lower part of the abdomen and in the back; they are frequently repeated, and if, after a time, we introduce the finger following the cord, we feel the soft mass of the placenta (afterbirth) in the excavation of the pelvis; it may then be extracted without any difficulty by making slight traction upon the cord; if we feel any resistance we must await its expulsion by the succes- sive contraction of the uterus. (See retention of the after- birth.) After expulsion of the placenta the wet and soiled clothing Bhould be removed from the bed as soon as convenient, the night dress drawn down, and the patient allowed to rest as long as she feels so inclined. Soon afterward a warm napkin, or a cloth wrung out of a tepid lotion of the tincture of Arnica should be applied to the 614 MIDWIFERY. private parts and changed at short intervals during the day* This will afford relief from the smarting pain consequent upon the passage of the child. Flowing, or the bloody discharges which take place after delivery from the open mouths of the vessels of the womb are called lochia. The red color leaves about the tenth day, and a yellowish discharge follows for a few days, which is often succeeded by a whitish or mucous discharge. (Sec lochia.) Milk generally makes its appearance on the third day, some- times earlier and sometimes later. After the lapse of ten or twelve hours, or sooner, the child may be put to the breast, by which the secretion and escape of the milk will be facilitated and a good nipple formed. When a substitute for the mother's milk becomes necessary, take fresh milk from one cow, add one-third warm water, sweeten it with loaf sugar, and give to the child a few tea-spoonfuls at a time, as often as may bo necessary. Every infant should have a tea-spoonful of soft cold water given to it every day, if the water agrees with it. For the first four or five days after delivery a woman should remain quiet, keep her mind free from excitement, and live on simple food. The room should be well aired every day and too bright light avoided. The patient must also avoid going up or down stairs during the first four weeks after confine- ment. Matteis belonging to the management of Natural Labor.—In the management of natural labor, there is but very little for the accoucheur to do, and very little needed except patience and gentleness. All the surgical appliances needed are an elastic-gum catheter, a few strong pins, a pair of scissors, and some ligatures of twine or tape. When summoned to a pa- tient he should make a careful examination of the bodily functions generally, and institute a more minute investigation into the state of the uterine system, as to the presence of real pains; their frequency, force and regularity; the character of the out-ery; the quantity and quality of vaginal dischai-<"c~<- TREATMENT DURING AND AFTER LABOR. 615 &c. He must then seek for more special information by means of a vaginal examination, which will give him a knowledge of the presentation and position of the child. In making examinations, the patient should lie upon her left side, with the hips near to the edge of the bed and the knees drawn up toward the abdomen. The forefinger of the right hand (or two forefingers), having been well oiled or soaped, should be passed along the perineum, and into the vaginal orifice; it is then to be directed upward and backward, until the mouth of the womb or the presenting part be found. If the mem- branes be entire, an experienced finger will in most cases detect the presentation; if they have given away this will be much more easy and certain; and if it be the head a hard, round substance will arrest the further progress of the finger. Suppose that the patient is really in labor, that the head presents, it is not necessary during the first stage, that the accoucheur should stay in the room with the patient, nor is it necessary, that the patient should lay in bed the whole time, she may walk about, or rest on the sofa; she should be kept tranquil and cheerful without making any false promises. Among the matters which should be in readiness, are two or three short pieces of twine for tying the navel string, a pair of scissors, some strong pins, a binder, and a flannel cloth, in which to wrap the child. The bed should be made by placing a skin of leather, or a square of oiled silk over the mattress to protect it at that part of the bed which will be occupied by the patient's hips; over this is placed the under blanket and sheet and upon these, two or three sheets folded square, on which the patient is to be placed. The sheets will absorb most of the discharges, and can afterward be removed without disturbing the patient, leav- ing dry bed-linen underneath. The skin or oiled silk is allowed to remain for some time longer. The position for delivering varies in different countries and is not of much consequence. The patient's night dress should be drawn up underneath her, beyond the hips, to escape soiling; and she 616 MIDWIFERY. may be allowed to grasp a sheet fastened to a bed post, or the hand of an attendant. It is entirely unnecessary to have the patient surrounded by half a dozen female-helpers, each one having something to say and some particular pushing, pulling, holding, or lifting duty to perform in the premises. Two attendants are all sufficient. The only food or drink allowed during labor should be an occasional swallow of water or gruel. Endeavors to hasten the labor, by manual dilatation of the niouth of the womb or passages, is an abominable custom. Supporting the perineum during the passage of the head is recommended by most authors ; at the same time hundreds of mothers are delivered daily without this artificial support, and without sustaining the least injury. Nature has con- structed the parts on correct principles, and we, therefore, think this practice of supporting the perineum is, not merely useless, but injurious. "Meddlesome midwifery is bad." The employment of Ergot and other "forcing medicines;'1 of Chloroform, Ether, or any other unnatural agent, has always injurious effects on the mother or child, and should be discountenanced by every rational physician. The majority of accidents and diseases which follow ordi- nary labors are artificially produced, the result of meddlesome doctoring or bad nursing. LABOB ABNORMAL — UNNATURAL LABOR. Tedious labor, or delay in the first stage of labor involves very little, if any danger, no matter how tedious it may be. Its principal causes are insufficient action of the uterus; undi- latable os uteri; excess of liquor amnii; toughness of the mem- branes; premature escape of the liquor amnii; obliquity of the uterus, the head of the child not applied in a right direction to the brim. Treatment—None of these cases are of such a kind as to prevent the completion of labor by the natural powers; all interference is, therefore, unnecessary. Patience and cheer- *■ UNNATURAL LABOR. 617 fulness of the patient are the wisest means of bringing labor to a successful termination. Powerless labor. — Feeble and inefficient, or totally sup- pressed pains (bearing down pains) in the second stage of labor, sometimes accompanied with one or the other of the following symptoms: shivering resembling a slight convulsion, vomiting, restlessness, fever, fearfulness and despondency; tenderness of the abdomen; cold clammy sweats; delirium;&c Causes.—Inefficient or powerless condition of the uterus, the result of a weak constitution; mental-emotion; disease of the uterus, as rheumatism, tumors, &c Treatment. — If we are certain that the natural efforts will not terminate the labor, and the condition of the mother demands assistance, or, if the child is dead, we must resort to artificial delivery by the aid of forceps, the vectis (tractor), or the crotchet (hook). In all cases where there is sufficient space between the frontal head and pelvis, and the child is alive, a trial with the forceps should be made before using the crotchet; however, if the state of the mother preclude all con- sideration for the child, or if it be dead, then the perforator or crotchet may be used. The treatment of the mother after instrumental delivery is the same as after natural labor. Homoeopathic treatment.—If during the second stage—after breaking of the water—the pains become weaker and less fre- quent, a single dose of Pulsatilla (high dilution) should be administered, which, at the end of ten minutes causes the pains to return. If, however, the woman is very feeble with a disposition to cramps in the legs and feet, Secale cornutum (30th) in a glass of water, a tea-spoonful every half hour should be given until the pains are developed. If the pains stop suddenly without a known cause, with heaviness in the head, drowsiness, numbness and trembling of the limbs, we may give Opium (6th) in water by tea- spoonfuls every half hour until the cessation of the symptoms and return of the pains. 26A2 618 MIDWIFKKY. Pains rendered inefficacious by the too great nervous sensi- bility of the patient, require a dose of Coffea, or Aconite. If accompanied by a continual need of going to stool, or by tenesmus of the bladder, Nux vomica should be given. Great nervous agitation, with fears, tears, and despair, re- quires a dose of Chamomilla or Belladonna. (See Fainting and Hemorrhage.) OBSTRUCTED LABOR. The progress of labor is impeded by some mechanical ob- struction in the passages, causing delay in the second stage and symptoms of powerless labor. Causes.—Minute or imperforate mouth of the womb; cancer of the womb; congenital or accidental contraction of the vagina or of the vulva ; narrow and undilatable vagina; tumors (polypus) in the pelvis; diseased ovary; vaginal cystocele ( hernia formed by the protrusion of the bladder); calculus in the bladder; collection of faeces in the rectum; swelling of the soft parts; imperforate hymen; rigidity of the perineum; pro- lapsus of the umbilical cord; deformity of the pelvis. Treatment.—In no case need we interfere, when the obsta- cle can be overcome by the natural powers, within a reasona- ble time. The less serious the mode of interference the bet- ter ; so that, if the natural powers are insufficient, we should endeavor to push the obstacle out of the way; to remove it; or to puncture it. In some cases, besides removing the cause of delay, it is necessary to employ extracting force; and, in such cases, the less violent the operation the better. In deformity of the pelvis when the disproportion is so marked, that it is evident the child cannot pass without assist- ance, we must have recourse — according to the cause — to the forceps, craneotomy or cessarian operation. (See Cancer, Polypus and other Causes.) OBSTACLES TO DELIVERY OFFERED BY THE CHILD. The difficulty in mal-position and mal-presentation of the child is a purely mechanical one; but if it be not removed after a certain time, the constitution becomes involved. OBSTRUCTED LABOl?. 619 When during sufficiently severe and frequent pains, the membranous sac is not regularly formed, it may be presumed that the position of the child is unfavorable, or that the cord is either too short, or is wound round the neck; and it is then necessary to make an examination of the position of the child. In all presentations of the head, and of the feet, knees and breech of the foetus, delivery will take place through the force of nature alone — consequently all idea of manual or instru- mental interference must be abandoned. Face presentations, the face being placed across the upper outlet, and the head put backward, retard the second stage, but not to such an extent as to give rise to unfavorable symp- toms. The sufferings are more severe and prolonged. The child when born is a frightful object, but the injuries speedily pass away, and in a day or two the face assumes its ordinary aspect. The presentation of the face is discovered by the bridge of the nose, it being prominent, firm, and unlike any part of the breech, for which it otherwise might be mistaken. Treatment. — Assistance, merely on account of the mal-posi- tion, is unnecessary. Accidental complications, however, may occur, which make a mild form of assistance necessary. The child's face may be fomented with a decoction of Chamomile or Arnica flowers; or occasionally bathed with a lotion of the tincture of Arnica. Breech-presentations, can be recognized by the softness of the breech, the anus, os coccygis, the scrotum or vulva, and the cleft between the buttocks. Treatment. — No interference whatever is required, until the breech shall have been expelled through the external parts. The child should be carefully supported without of- fering any impediment to changes of position, and when the umbilicus appears at the external orifice, the cord should be drawn down a little and removed as much as possible out of the way of pressure. If tho uterine power should fail (as in powerless labor) or 620 MIDWlFERi. any circumstances demand speedy delivery before the breech is expelled, one or two fingers should be passed into the groin and assistance gently and steadily afforded during a pain. After the breech is born, we may extract by grasp- ing the body of the child, covered with a napkin, the extracting force always to be made in the axis of the brim or outlet. Presentation of the inferior extremities.—Presentation of one or both of the knees or feet—the former being always converted into footling cases as the labor advances. Treatment. — See Breech-presentations. Presentation of the superior extremities. — In almost all cases of the kind it is the shoulder which primarily presents, and afterward the arm prolapses; occasionally, however, we find the hand, at the beginning of the labor, at the os uteri, and more rarely the elbow. Labor with this mal-presentation is extremely dangerous to the mother and child. The os uteri is very little dilated and suffers comparatively very little pressure during each pain; the bag of the membranes protruding is of a conical or elon- gated form and evidently not covering the head; the hand may also be felt protruding through the undilated mouth of the womb. Causes.—Irregular early contractions of the womb; irreg- ular distention by an unusual quantity of liquor amnii; ob- liquity; &c Treatment. — Should the mal-presentation have been detect- ed before the rupture of the membranes and before the mouth of the womb is fully dilated, we may wait for a time to allow of as complete dilatation as possible, nor is there any risk, so long as the membranes are entire. But if they have given way, and if the os uteri be fully dilated, we must proceed im- mediately to deliver by turning by the feet. The protruded hand or arm will be our guide in this operation; and it ia better not to attempt to put it back, much less to separate it. The hand is to be passed over the front of the child, as it is OBSTRUCTED LABOR. tf2l generally in front that we meet with the feet. Should these measures fail, and version be impracticable, wre must open the chest of the child and eviscerate; after which it may be ex- tracted by the crotchet. In a very few eases spontaneous ex- pulsion by evolution has taken place. It is often difficult to reach the feet, and this part of the operation should be slowly and quietly performed, resting oc- casionally. Having found one or both inferior extremities, we must bring them with a waving motion slowly into the pelvis. The turning of the child is accomplished during an interval of pain; the feet being brought over the front of the child, and not over the back, which would risk dislocation of the spine. The extraction of the child is to be accomplished gradually during a pain. The after treatment is the same as in natural labor. Compound presentations. — 1. The hand or arm may present with the head, adding to its size, and, if the pelvis be small, prohibiting its entrance into the passage. At an early stage a cautious attempt should be made to re- place the arm above the head, so as to allow it to descend, but, we must be very careful neither to draw down the hand nor to displace the head. If the arm cannot be replaced and longer delay should ex- cite unfavorable symptoms, we must first see if the forceps are applicable, or version, and as a last resort, if all others fail, we must lessen the head. 2. The feet and hands may present, or one of each, and in these cases it not unfrequently happens that the cord pro- lapses. In such cases one or other extremity must descend, making it an arm or footling case. There can be no doubt of the propriety of drawing down the foot or feet into the pelvis so as to preclude the possibili- ty of the arm descending, and when this is done, the case is one of footling presentation, and to be managed accordingly. Prolapse of the cord increases the danger to the child, and 622 MIDW1FF.RY. may require us to hasten the labor (according to the rules laid down). Other obstacles to delivery offered by the child are: Hydro- cephalus, ascites, and monstrosities, rendering the child dispro- portionate to the passages. Whenever the monstrosity adds so much to the bulk of the child as to render the delivery impracticable by the natural powers, we must lessen the bulk by perforation and extraction by the crotchet. PLURAL BIRTHS. A woman may conceive of two fine children. The mode of transmission of each may be perfectly natural, or they may come under some of the orders of unnatural labor, requiring the management suitable for such cases. It is better to leave the placenta of the first child until after the birth of the second, as its removal might excite uncontrollable flooding. PROLAPSE OF THE UMBILICAL CORD. ■ This accident, occurring either at the commencement or during the course of labor, has no influence whatsoever upon the progress of the labor, but a very serious one upon the life of the child. There are but few cases in which the child escapes safely when the labor is left to the natural powers. Treatment.—Various modes of management have been pro- posed. We are advised to push the cord upward beyond the brim of the pelvis, and there to retain it with'one or two fingers, until the upper outlet be filled by the ascending head. Others recommend turning, or the use of the forceps. Should the cord exhibit marks of putrefaction, or be without pulsa- tion, it will be useless to interfere, because hopeless, as regards the life of the infant, and the labor may be allowed to termi- nate naturally. Shortness of the Umbilical Cord — is in most cases, recognized by the slowness with which the head advances during the uterine contraction, the prompt retraction as soon as the impulsive effort is past, the sudden suspension of con- RUPTURE OF THE PERINEUM. 623 traction at the instant when it should apparently attain its highest degree, and a sensation of drawing in the abdomen during the pains, as if something were being torn away, with anxiety, &c Homoeopathists assert that a dose of Pulsatilla (30th dilu- tion) will accelerate labor sufficiently to prevent all accident for the child as well as to the mother. Only a few cases are on record of cords so short as to require division, before the child could be delivered. LACERATION OF THE PERINEUM—RUPTURE OF THE PERINEUM. When the accident is of slight extent, it may not interfere with the comfort of the patient; but if it extend to the anus the patient will feel a want of support at the lower outlet, and a sense of " falling through." If the recto-vaginal septum be torn, the faeces pass through the vagina involuntarily, and the condition of the patient will be very pitiable. The offen- sive smell attending this disease renders the patient an object of disgust to herself and her friends. Causes. — Deviation from the ordinary mechanism of partu- rition; mal-conformation of the passages, or soft parts; mal- presentation; mis-management during labor. Treatment. — Slight cases will heal without any assistance, observing cleanliness, and keeping the patient in one position eo as to preserve the edges of the wound in contact. In severer cases a degree of compression has been recom- mended, also the application of strips of adhesive plaster, sutures, &c; but in very few cases have these different modes of treatment proved successful. A more efficacious treatment is the following: soon after the rupture has taken place the patient should be cleansed and put to bed; the parts should then be washed with water in which is some of the tincture of Arnica; afterward, the edges of the wound must be brought together and covered with a thick and large compress of lint saturated with pure tincture of Arnica. The union of the edges must be maintained by thick compresses, wet with the Arnica lotion; over these 624 MIDWIFERY. should be crossed two bandages, which, starting from, and securely attached to a large body bandage, firmly enclosing the pelvis, descend behind and under the two thighs, tending to bring them together, and crossing opposite the perineum, remount and are attached to the body bandage, each in front of the opposite groin. The woman should be kept motionless on the side which is most agreeable to her. During the first days we should renew the dressing very frequently to facilitate the flowing of the lochia; the following days it will suffice to renew them every time the woman is obliged to urinate. This dressing, and these precautions should be continued for six weeks, that the cicatrix may have time to consolidate. The woman should be kept upon a strict diet, and drink as little as possible, to avoid the frequent occa- sion of renewing the dressing after urinating or going to stool. LACTATION — SECRETION OF MILK. Twenty-four hours after labor the woman experiences prick- lings in the breasts, which swell and harden accompanied by a general febrile disturbance, called milk fever. In severe cases of the fever the patient suffers from head- ache, pains in the back, chills alternating with heat, suppres- sion of the lochia, &c Six or twelve hours after the com- mencement of the fever, profuse perspiration commences, the breasts begin to relax, milk flows spontaneously and every thing returns to its normal state. Treatment. — If the suffering is not too violent, it is better to give no medicine, and to content ones-self by administering simple and tepid drinks, according to the desire of the patient, She should be kept moderately covered, avoiding currents of air and the fatigue of importunate visits. The child must be placed at the breasts as soon as the mother feels the milk flowing into them. If the vascular action be excessive it must be moderated by anti-phlogistic remedies, especially by tepid ablutions. Excessive flow of milk.—(See Galactorrhcea.) LOCHIA. 625 LOCHIA. Uterine discharges which take place after delivery. Dimi- nution or suppression of the lochia generally occurs in conse- quence of a sudden, mental affection, a cold, or other hy- gienic influence suddenly impressing the woman and causing a spasmodic contraction of the orifices of the vessels on the internal surface of the uterus. Obstructions of the mouth of the womb by a clot often obstructs, or restrains altogether the discharges. Treatment — If no morbid symptoms develop themselves after suppression has taken place, it is best to leave it to nature. If it causes fever, pain, etc., we must have recourse to foot- baths, applications of poultices to the lower part of the abdo- men, mild laxatives, and anti-phlogistic treatment. (See Me- tritis and Puerperal Peritonitis.) Homoeopathic treatment.—Aconite, if the suppression of the lochia is caused by a chill accompanied by fever-heat in the face, pain in the abdomen, congestion, etc. Chamomilla: Suppression of the lochia accompanied by diarrhoea with colic, nervous pains in the head, teeth, etc. Colocynthis: Violent colic, or tympanitis and diarrhoea. Belladonna or Hyoscyamus for violent pains in the head, redness of the face, delirium. In some cases the employment of Coffea, Nux v., Dulca- mara, Bryonia and Pulsatilla will be found necessary. If we apprehend an inflammation of the viscera of the abdo- men we should have recourse to Aconite or Belladonna. Hydropathic treatment. — In suppression of the lochia by taking cold or by excitement, followed by distress or swelling in the abdomen, or pain in the head, sense of coldness, etc, we must occasionally employ the warm hip-bath, or hot fomen- tations until the action is re-established. ■\ Augmentation or increase of 4h.e lochial discharge is often c'aused by the abuse ^f warm drinks, spirituous drinks, coffee, chamomile, catnip, or other teas, mental excitement, a chill, 27 626 MIDWIFERY. imprudence in rising or walking too soon, too great heat of the chamber or of the covering of the bed, coitus, etc. Treatment — Remove the causes, and afterward, if no im- provement takes place, recourse must be had to remedies recommended for Metrorrhagia (hemorrhage from the uterus). Lochia of a very offensive odor may arise from the decompo- sition of a small portion of the placenta or membranes which were left in the uterus or vagina, or from the putrefaction of coagula. Treatment—Syringe the vagina two or three times a day with warm milk and water, or a very weak solution of chlo- ride of Zinc. LONGINGS. Desire of pregnant females for improper food, or hurtful substances as: lime, plaster, brandy, charcoal, salt, vinegar, etc (See Malacia, under Diseases of the Stomach and Abdo- men.) LUMBAGO — BACKACHE. Pregnant women are very subject to pains in the back, caused by the backward direction given to the body, the effort made to support the weight of the abdomen, and main- tain the equilibrium. (See Lumbago under Diseases of the Back.) MARKS. The different blemishes which appear on the periphery of the body of the new-born, are the products of a defect of the organic tissues of the skin, and ordinarily of the excessive development of the capillary vessels. MILIARIA. An eruption of minute transparent vesicles of women in child-bed is the effect of excessive perspiration, uncleanliness, and ill-ventilation. This indisposition generally disappears of itself in a day or two. Milk fever. — (See Lactation.) Milkleg. — (See Phlegmasia dolens.) *s NTPPLES, AFFECTIONS OF. 627 MOLE. False conception is the result of a degeneration of the ovum, either by the premature death of the embryo, or by a mon- strous development of the placenta. The mole cannot be recognized by any characteristic sign before its expulsion. We must await its maturity, or until nature herself expels it, which takes place with pains similar to those of ordinary labor. The expulsion of the mole is ordinarily followed by a serious hemorrhage, and requires the treatment recommended for Metrorrhagia. NIPPLES, AFFECTIONS OF. When the nipples are deficient or mal-formed, we must endeavor to draw them out by the breast pump. The nipples of women in their first pregnancy should be washed from time to time in brandy to harden the skin, in order that it may not be too easily broken by the efforts of suc- tion. Excoriated nipples covered with cracks, which render suck- ling very painful, should be covered with cloths wrung out of lotions of a weak tincture of Arnica each time after giving the child the breast, which commonly cures it in a few days. We find also recommended: french brandy, cacao-butter, cacao-butter with Zinc; lime ointment consisting of equal parts of lime water and poppy oil; powder of gum-arabic and flores cassiae spread on the part. When we apply the one or other remedy to the nipples they should be washed with tepid water before giving them to the child. Homoeopathic remedies principally recommended are: Sul- phur, Graphites, Calcarea and Lycopodium. Hydropathic treatment — External applications of Cream, olive oil, or simple cerate with the occasional application of cold, wet cloths, when the nipples are hot or painful, and occa- sional fomentations when they are cracked and sore. Nursing sore mouth. — (See Aphthae.) Obstacles opposed to labor. —(See Labor unnatural.) 628 MIDWIFERY. ODONTALGIA. Many women are tormented with toothache during preg- nancy, sometimes from the time of conception, at other times later; this pain continues to the last with or without caries of one or more teeth. These odontalgiae should be treated like ordinary toothache. Homoeopathists recommend principally Coffea and Staphy- sagria. OPPRESSION. In the first month of pregnancy, the pressure of the fundus of the uterus upon the parts contained under the diaphragm, incommode considerably the action of the stomach; digestion proceeds with difficulty; immediately after meals the woman is troubled with a flow of blood to the head, the face becomes red with anxiety and a feeling of suffocation. Treatment. — Abstain from animal food, coffee and tea. (See Dyspnoea and Dyspepsy.) PAINS IN THE BREASTS. The fluxion which takes place toward the breasts, to pre- pare the mammary glands for the secretion of milk, excites always more or less pain in these parts. Very acute pains are generally caused by compression of the breasts with corsets. Treatment.—Cooling or warming external applications—ac- cording to the symptoms—will generally afford relief. (See Inflammation of the breasts.) Palpitation of the heart. — (See Diseases of the Chest.) PHLEGMASIA ALBA DOLENS — PUERPERAL SWELLED LEG — MILK-LEG — WHITE-LEG. This disease consists in a swelling of one or both legs, shortly after delivery. In a majority of cases the attack com- mences with pain in the groin of one side, accompanied with fever, and followed by a swelling, which extends down the thigh and leg to the foot, and, in a day or two the whole limb is double its natural size, hot, smooth, exquisitely tender, and moved with great difficulty. The fever usually begins to MILK-LEG. 629 decline in two or three weeks, but in some cases runs for six or eight weeks, causing great emaciation. A disease very like the one before us, has sometimes affected the male sex. The characteristic marks of the disease arc the time of its occurrence; the pain down the thigh and leg; the painful, hard, cord-like femoral vein. Causes.—Inflammation of the veins of the pelvis and of the inferior extremity; inflammation and suppuration of the uterus, of the peritoneum, or of the ovaries; cold upon the limbs too soon after labor. Treatment allopathic.—Leeches, in numbers proportioned to the severity of the attack, should be applied along the course of the femoral vein, to the groins, or to the calf of the leg, and a poultice applied when they fall off. If decided relief be not obtained, they may be repeated in similar numbers, once, twice, or thrice. If diarrhoea be not present saline purgatives may be given. Blisters, turpentine fomentations and opiates are recommended. The diet should be bland, and chiefly farinaceous. Gentle support may be afforded to the limb by a light flan- nel bandage, and slightly stimulating friction employed. When the acute stage has been terminated, bark, or quinine and sulphuric acid will be found serviceable; a moderate por- tion of malt-liquor, or wine may be allowed; and after some time,air and slight exercise, with sea-bathing will restore the patient to perfect health. Homoeopathic treatment. — When Phlegmasia alba dolens is the effect of suppurations occurring in the pelvis and re-absorbed by the veins of the extremities, the physician should direct all his attention to this cause and combat it by the means indicated in the articles Metritis and Peri- tonitis. The medicines principally indicated for common phleg- masia are: Arnica: If during labor the head had remained long in the 630 MIDWIFERY. pelvis, and if at the same time, the tensive pains in the hips and thighs indicate a development of phlebitis. Bryonia: Drawings in the hips and the extremities; lami- nation from the hips to the feet, sometimes with general perspi- ration and impossibility of supporting the touch and move- ment; dragging like those preceding the appearance of the menses, &c Belladonna: Pains, as if bruised, in the inferior extremity with tearing pains in the joints, weight in the thighs; drawings in the left thigh, pressure in the right; lancinationsas with a knife, &c Pulsatilla: has a special action in phlebitis, and particu- larly when it is accompanied with a suppression of the lochia. Iu some cases it will be necessary to have recourse to: Aconite, Rhus, Nux vom., Chamomilla, and Sulphur. Hydropathic treatment. — Cold wet cloths, according to the local heat, and cold or tepid sponging or washing of the whole body, according to the general heat. Eclectic treatment—In the early stages of this disease mild cathartics may be given, after which the bowels should be kept regular daily. The affected limb should be exposed to a vapor-bath until perspiration has been induced, after which a poultice of bran and hops must be applied, and the whole limb enveloped in it. This should be continued, alternating the use of the vapor-bath and poultices until the inflammation has subsided. Internally, the compound tincture of Virginia Snake-root, or compound powder of Ipecac, and Opium, should be given in sufficient doses to keep up moisture of the skin, as well as to relieve pain which is present. In very obstinate cases the use of nauseants and relaxants will be found advan- tageous. The patient should be kept in a recumbent position, and allowed a light diet; and after the inflammation has been reduced, if any oedema remains, the limb should be bandaged, but not too tightly, and cooling diuretics given. STITCHES AND PAIN IN THE ABDOMEN. 631 In chronic cases to favor absorption, the compound syrup of Stillingia with Iodide of Potassium should be given. Puerperal Peritonitis — Puerperal fever.—(See Febris Puer- peralis. ) PUERPERAL MANIA. Temporary delirium, or mania after parturition may attack the patient a few days after delivery, and more frequently before the lacteal secretion is fully established, although cases occur at a later period, and even appear to be the result of weaning. Females of a nervous temperament seem peculiarly obnoxious to it. Causes.—Suppression of the lochia, metastasis of the milk; local irritation of the breasts or other parts; irritation and loss of blood combined; disturbance of the vascular system, occasioned by delivery; effects of suckling; violent shock of the nervous system at the time of labor; mental emotion; indigestion, etc. The insane phenomena do not differ from insanity generally, but, alarming as these cases appear, they generally recover under judicious treatment. Treatment.—The utmost quiet will be necessary. The diet should be bland and nutritive. There is more to be gained by the appearance of yielding to the wishes or whims of the patient than by resisting them. The bowels should be kept open by the proper remedies and enemata. (See Insanity.) Rupture of the Perineum. — (See Laceration.) Spasms of the vagina during Parturition. — (See Diseases of the Genital Organs.) STITCHES AND PAIN IN THE ABDOMEN. Toward the fourth month, or later, women often experience a stitch under the false ribs or in the sides. The pains generally disappear of themselves. A small dose of Nux v. or Pulsatilla often proves of benefit in tedious cases. Stoppage of the nose of infants. — (See Ooryza.) Suckling. — (See Lactation.) Toothache. — (See Odontalgia.) Varices— Varicose veins.—(See Diseases of the Extremities.) 632 MIDWIFERY. (I VOMITING. Pregnant women are more or less troubled with this indis- position during the first months of pregnancy. Treatment — Small doses of Nux v., or Ipecacuanha gene- rally take away all these discomforts. The patient should at the same time observe a severe alimentary regimen. Weaning becomes necessary to mothers, by a new preg- nancy ; the presence of the menses, with a diminution of milk; a state of exhaustion manifested by distressing pains in the stomach, especially while the child nurses; consumption; faintings; etc On the part of the child, nature teaches that it should have the breast, until by the growth of the teeth it is in a condi- tion to take other nourishment; hence if the nurse is in good health, it would be preferable to delay the weaning until after the appearance of ihe first canine teeth. The first appearance of the teeth, about the seventh month, seems to indicate that as the natural period for commencing the employment of solid food. The food should be un- concentrated and unobstructing, as well as simple and un- complicated, as: brown bread soaked in milk; cracked wheat; roasted, baked, stewed or boiled apples; hominy; boiled rice; etc. Improper diet has a vast deal to do with making children cross, fretful, and ugly-tempered, as well as dull, sickly and stupid. After being weaned, the usual time of which is at the end of nine or twelve months, the child should be trained to regu- larity in the habit of eating; never allowed to eat between meals, nor after supper. The practice of feeding children with poison-colored candies, sweet cakes, etc., simply to keep them quiet, is deserving of severe reprobation; it is adding fuel to the flames; for you will find such children "criped," crying, and yelling a good portion of the time, — except when their kind mothers have put them to sleep by administering a tea-spoonful of Paregoric or Laudanum—the most dangerous OBSTETRIC OPERATIONS. 633 of all poisons for infantile age, laying the foundation for innu- merable nervous diseases. When a nurse has decided to wean, she should prepare for it by gradually giving the breast at longer intervals, and diminishing the quantity of her food; after pursuing this course for several days, she should cease entirely to give the breast and keep her bed for a day or two, upon a very light diet, with watery tepid drinks; and if she still feels, in spite of these precautions, the milk flowing into her breasts, she should take a small dose of Pulsatilla, every morning for eiaht days, and cover the breasts lightly with a muslin hand- kerchief. OBSTETRIC OPERATIONS. - Induction of premature labor. — This operation is of great value for the purpose of saving the life of the infant, of its mother, or of both. It is available in the following cases: 1. When the diameters of the upper outlet of the pelvis are too much reduced by distortion to permit the passage of a foetus at the full term, and yet not so much diminished as to prohibit the passage of a foetus at an earlier but still "via- ble" age. 2. When a narrowing of the transverse diameter of the lower outlet offers a fixed impediment to parturition. 3. When tumours of the pelvis offer an impediment to the delivery of a child at term. 4. When the uterus is the seat of fibrous tumours. 5. When dangerous diseases are caused by or connected with pregnancy. Mode of operating. — Several methods of exciting uterine contractions have been adopted and recommended. 1. Abdominal frictions and manipulations, with warm baths, &c 2. Separating the membranes for two or three inches around the mouth of the womb. 3. Rupture of the membranes either directly or obliquely, by means of a female catheter, or a piece of wire. 634 MIDWIFERY. 4. Dilatation of the os uteri, by means of a piece of sponge placed within it, and maintained there by a plug in the vagina. 5. Ergot of Rye and Extract of Belladonna. The second, third and fourth methods are the most suc- cessful. An interval, varying from twenty four to ninety-six hours, generally elapses after the operation, before uterine action commences, which it does sometimes by shivering and fever- ishness. The patient will require the same management as after or- dinary labor. Version or turning. — This term is applied in midwifery to that manual operation by which one presentation is substituted for another, less favorable; and to the rectification of certain malpositions. The object of the operation is: 1. To place the head in a more favorable relation to the pelvis, or to substitute the head for some other presentation. 2. To substitute the inferior extremities for some other less favorable presentation. 3. To hasten the termination of labor, in consequence of complications, as convulsions, flooding, prolapse of the funis, &c Method of operating. — The most common mode of version in malpresentation is turning by the feet, or podalic version. The rectum and bladder having been previously emptied, the patient is to be placed in the position most convenient for the operator; the hand we chose to operate with is to be well oiled or soaped, and then insinuated through the os externum edgeways. This should be done during an interval of pain. When the greater part of the hand is in the vagina, it will be necessary to change its direction from that of the axis of the lower outlet to that of the upper outlet. Through the os uteri (and membranes if entire) the hand is to be insinuated very gradually, in a conical form, and during the interval of the pains; holding still, but not losing ground, when the pain OBSTETRIC OPERATIONS. 635 comes on. No attempt should be made to put back the hand or arm when they present. They will be our guide and are no impediment of any consequence in the operation. Having ascertained all about the position of the child's body, the hand is to be passed over the front of the child, where we gener- ally meet the feet. This part of the operation should be slowly and gently performed, resting occasionally, and keeping the hand quite still and flat upon the body of the child during a pain. Having found the feet, they must be held firmly in the hand and brought with a waving motion, slowly into the pelvis. The turning of the child is accomplished during an inter- val of pain, the feet being brought over the front of the child, and not over the back, and as the feet are drawn down, the presenting hand or arm will ascend. The extraction of the child is to be accomplished gradually during a pain, and in drawing downward we should be care- ful not to place the foetus in a wrong position in reference to the pelvis. The patient requires absolute quiet and rest after the ope- ration. The lever, or vectis, is not frequently employed in midwifery. Its use is to correct malpositions, or aid the natural motions of the head at the brim or in the cavity of the pelvis. This instrument ought to be excluded from midwifery prac- tice altogether. The forceps. — The invention and employment of this in- strument is the greatest improvement that has ever been made in midwifery. The object of the operation with the forceps is: 1. To facilitate delivery, when its progress is arrested by certain malpositions of the head at the brim, or in the cavity of the pelvis. 2. To supply the want of uterine action, or to render it ef- fective for the expulsion of the child. 3. To save the mother from the evil consequences of a la- bor too prolonged. 636 MIDWIFERY. 4. To save the life of the child, or at least afford it a chance of escape from certain destruction. The forceps possess a twofold power: that of grasping and compressing the head of the child, and that of acting as a lever or extractor. In no case is the forceps to be applied, until we are perfect- ly satisfied that the obstacle cannot be overcome by the natu- ral powers with safety to the mother and child. Their employment should be limited to cases in which ute- rine contractions fail, from absolute exhaustion of the patient; in cases of convulsions, hemorrhage or rupture of the uterus, demanding an immediate conclusion of the labor, in order to save the life of the patient; and in cases of breech-presenta- tion, when the head is retained a long time, from incompress- ibility of the base of the skull. • Method of operating. — The patient is to be placed on her left side, or on her back, close to the edge of the bed; the forceps, warmed and oiled, are to be within reach, and the op- erator should introduce two or three fingers of his left hand, or his whole hand, during an interval of pain, along the head of the child, within the os uteri, for the purpose of protect- ing it, and guiding the blade of the forceps. The upper or anterior blade is then to be passed along the inside of the fingers, or hand, in the axis of the upper outlet, until it glides over the part of the head to which we wish to apply it. It is then to be retained by an assistant, and the hand with- drawn ; the right hand is next to be introduced on the oppo- site side, and the second blade passed carefully up, and ap- plied to the head. If the blades will not lock, one must be withdrawn and reintroduced. ■ In a natural presentation and situation, one blade of the instrument will be placed over the forehead, the other over the occiput. Great care must be taken that the soft parts, or hair, are not included in the lock. The extracting force should be employed gradually, steadily, OBSTETRIC OPERATIONS. 637 at intervals, resembling the labor pains, and in the direction of the axis of the pelvis. The subsequent management is the same as after ordinary delivery with increased caution, however, and daily attention to the state of the vagina. Craniotomy. — This operation consists in opening of the head of the child, and evacuating the contents of the cranium, when there is too great disproportion between the size of the foetal head and the pelvis to permit the passage of the former, as in the case of deformed pelvis or dropsy of the head; also, when the child has been dead for some time without the labor progressing; also, when from disease or accident the head has been separated from the body; and, finally, when the passage is obstructed by immoveable tumors. The instruments invented for this operation are: the perfo- rator, employed to open the cranium; the crotchet, or cranial hood, to extract the foetus. The principal point of skill consists in keeping the point of the instrument exactly in position during the operation, and avoiding injury to the surrounding parts. "When the os uteri is well dilated, the fingers may be employed as tractors more advantageously than any other instrument. Embryotomy is a modification of craniotomy; it consists in dissecting the trunk and limbs, and bringing away the foetus in fragments, in those cases of cross presentations of the trunk or superior extremities, in which the body is immoveably fixed in the cavity of the pelvis, and in cases of deformities or monstrosities of the foetus. Hysterotomy, or the Caesarean section consists in making an inci- sion through the abdominal walls and the uterus, removing the foetus and placenta, and dressing the external wound by sutures and adhesive plaster. This operation is only justifiable when distortion or obstructions render all other methods unavailable. Symphyseotomy, or a division of the bones at the symphisis pubis was proposed as a substitute for the Caesarean operation, but soon fell into disrepute. CHAPTER XXII. ACCIDENTS. ASPHYXIA — APPARENT DEATH. From Drowning. The drowned person should be undressed, the mouth and throat cleansed, the upper part of the body and head be bent forward for half a minute that the water may run out, the whole surface wiped dry, then wrapped in warm blank- ets, and conveyed in a recumbent posture on the back, with the head and breast raised, to a warm, dry, ventilated room. In summer place the patient, wrapped in a blanket, in the sun with his face turned toward it, the head slightly covered. The surface should be thoroughly and perseveringly rubbed by the warm dry hands of robust healthy men, or with warm cloths, and bottles of warm water, or hot bricks wrapped in wet cloths, or bags of warm sand or ashes, are to be applied to the stomach, feet and sides. Warmth furnished by the contact of a living person, and thus caloric retained by pro- per bed-clothing is still better. At the same time injections should be given, and the lungs inflated by repeatedly forcing into the patient's mouth—the nostrils meanwhile being held close—a full expiration of air from the lips of an attend- ant, or by means of a tube, alternating the expiration with moderate but firm pressure on the external abdominal mus- cles. Bleeding is folly. Persons after having been under the water half a day have been restored to life by continued and unwearied exertion. Apparent death from choking, hanging; suffocation by pres- sure and burthens. — Remove all tight clothing, place the patient in an easy position, the head and neck rather high, the neck being quite easy; then commence rubbing gently, 638 APPARENT DEATH FROM A FALL OR BLOW. 639 but steadily with warm cloths; put hot stones wrapped in cloths to the feet, between the thighs, to the neck, the sides and under the shoulders. Allopathists recommend venesection to relieve the sur- charged lungs and heart. Homoeopathists recommend Opium and bitter Almonds to be given in small doses in the mouth and in injections. Elec- tro-magnetism has been found a valuable auxiliary in the treatment of the different forms of Asphyxia ; a current passed from the epigastrium to the back part of the head, has restored sensibility and vital action, when life was supposed to have become extinct. Apparent death from freezing. — In some cases animation was restored even when it had ceased for several days. Move the patient carefully from the open air under cover in a cold room or barn, where there is not the least draught; cover him entirely with several inches of snow, face and all, leaving merely the mouth and the nostrils free. Place them so that the melted snow may run off easily and be replaced by fresh. When there is no snow put the patient in ice water; when ice attaches itself to the body or clothes remove it. In this man- ner thaw the body until every part becomes perfectly pliable, then undress and remove the clothes by degrees. As the limbs become soft and pliable, rub them with snow and continue it until they become red. Place the patient on a dry bed and rub him with cold flannel cloths; give an injection of Camphor and water every quarter of an hour. If symp- toms of returning animation take place, administer small injections of lukewarm coffee, and as soon as he can swallow give him a tea-spoonful of coffee occasionally. No external heat should be applied. The patient must recover his na- tural warmth in the bed. If the patient craves wine or brandy give him a little. Persons recovered from freezing must avoid the heat of the stove and of the fire for a long time, as it might occasion diseases of the bones. Apparent death from a fall or blow. —Allopathists recom- 640 ACCIDENTS. mend venesection; Homoeopathists Arnica iuternally and ex- ternally. Apparent death from hunger.—Give repeatedly small injec- tions of warm milk. When the patient begins to breathe give milk drop by drop, afterward a tea-spoonful at a time, and gradually more. When he begins to ask for food give him some spoonfuls of toast and water, and then some clear broth, after this a few drops of wine. The patient may eat often, but only little at a time. Eating too much and too quickly endangers life. Apparent death from lightning.—Place the patient in newly dug earth, and cover him with it, so that only his face is free. The position should be half sitting, half lying with the face turned toward the sun. As soon as the eyes begin to move shade the face. When respiration is fully established uncover the chest, and bring him into a light sunny room. Dashing cold water freely over the breast, face, and even the whole body, and the prolonged pouring bath to the head have proved successful means to restore animation. Besides the above means Allopathists recommend bleeding and opium; and Homoeopathists Nux vomica internally, in clysters, and in solution rubbed on the neck. Apparent death from noxious vapors, deleterious gases, nar- cotic or metalic fumes, etc.—Expose the patient freely to the open air, dash cold water in the face, and pour it over the body; use active friction, and inflation of the lungs. Asphyxia neonatorum—Apparent death of infants. — (See pregnancy and child birth.) Apparent death from sun-stroke.—A common effect of ex- posing the head, during hot weather to the direct rays of the sun, is a sudden inflammation of the brain or its membranes. If the individual thus exposed is struck down suddenly, he should be moved carefully to a place that is cool, and yet not too cold, the body should then be rubbed with the hands wet in cold water. Cold water should also be poured upon the head, but not too suddenly at first, and tepid injections given. BURNS AND SCALDS. 641 Homoeopathists recommend, in affections of the head caused by exposure to the sun, Aconite and Belladonna. BURNS AND SCALDS--AMBI'STIONES. They are divided into three kinds: those which excite an inflammation of the skin; those which injure the vitality of the cutis, inducing suppuration of the derma! surface; and those in which the vitality of the integuments is so seriously affected that sloughing ensues. Treatment. — If the clothes are on fire no time should be lost in putting out the flames. Take blankets, comforters, sheets, or tear up the carpet and envelop the patient. In slight burns the injured part should be held for several min- utes to the fire. The principal object to be kept in view, in the treatment of severe burns, is, to protect the injured part from the atmos- pheric air, and from any other irritation and pressure. The affected part may be dressed with heated alcohol, or oil of turpentine, taking care to keep the surface continually moist, and well protected from the external air. Raw cotton to the part is frequently found very efficacious; having pre- viously punctured any blister that may have arisen and bathed the sore with tepid water; cover it with cotton or wadding, in three layers; when suppuration sets in, remove the upper layer only, and substitute fresh. Saturating raw cotton with Rum and Orleans molasses and applying it to burns is exten- sively used in the South. Thick, warm soap-paste, and Kreosote water have been like wise recommended. Some physicians apply cold water and wet cloths until the irritability and pain is removed, then cover the part with a mixture of olive oil, flax-seed oil and lime- water— equal parts. This is left on six hours, and maybe continued until the parts are restored. Care must be taken at the dressings, not to expose the sores too long to the air. The finely pulverized slippery elm, made into a poultice, with either cold or warm water is one of the most soothing applications. It may be kept on for a long time, being re-wet 27b3 642 ACCIDENTS. when required, or thickened by more of the powder being added. Wheu not too wet, it will absorb any fluid that may be dis- charged. After acute symptoms have subsided, the black salve or simple cerate, will shield the part from air, and be sufficient in all ordinary cases. If fungus appear, the powdered San- guinaria, sprinkled over it, will commonly keep it down and change the process into healthy granulations. If there be much hardness of the parts, take the leaves of the common mullen, moisten them with warm vinegar, and after allowing them to cool, apply them in the form of a poultice. Contractions of muscles and tendons must be guarded against by applying suitable splints, flexing or extending, as the case may require. The contracted tendons can be divided when necessary, though in most cases it will be only found necessary to dissect away the adhesions. BRUISES. Nothing will cure a bruise so soon as the application of linen, dipped in cold water, and applied to the part affected, and diet. If a limb is crushed it should be straightened with a piece of paste-board, so as to be in a natural position. In case of a bad bruise, injuring a part of a bone, such as the shinbone, dip a piece of linen in water, in which several drops of Comfrey tincture have been diluted, and apply it fre- quently to the injured part. If the injury is not very bad, but the part is painful when pressed upon, looking red, and the redness spreading, give Ruta (Rue) internally, and apply it externally. CHILBLAIN — PERNIO. Inflammation of the extreme parts of the body from expos- ure to cold. (See diseases of the skin.) Choking at the windpipe. (See throat.) Concussion and compression. (See diseases of the head.) Combustion spontaneous. (See General diseases.) DISLOCATIONS. 643 DISLOCATIONES — LUXATIONES. Simple dislocation, a displacement of one bone from its natural articulation with another. Compound, dislocation, a displacement of one bone from its natural articulation with another, when accompanied with ex- ternal laceration or fracture. Partial dislocation when the bone is moved out of position in its socket, or on its articular surface, without being thrown completely out or off. Reduction. — Term employed for readjustment of the bones. Extension, the force applied by the surgeon on the luxated part. Counter extension, the force employed to fix the body in po- sition, which may be by machinery, or the hands of assist- ants. Symptoms. — Change in the external form of the joint; an alteration in the length and position of the limb; the patient may have the power of moving the limb immediately after the accident. When considerable swelling has taken place it is difficult to distinguish between a dislocation and a fracture near the joint. In fracture the mobility of a part is increased; in dislocation it is diminished. A broken bone is shortened, a dislocated one is not. In fracture there is crepitus or a grating sound of the ends of the bone upon each other when moved; in dis- location no such symptom is observed. Dislocation is not apt to occur in grown persons, while fractures near the joints are more apt to happen in the young. When muscles are ruptured, there is great effusion and inflammation in the part. Severe pain may be occasioned by pressure of bone on sen- sitive parts. Paralysis by pressure on a nerve is unfrequent. Treatment — The sooner the difficulty is remedied, the easier for the operator, and the less painful and the better for the patient. The contraction of the muscles increases with the length of time the part has been displaced. When luxation has existed for several weeks, adhesions 644 ACCIDENTS. are apt to occur, forming a new joint or an anchylosis; and rendering reduction impossible. Strong muscular contraction requires in addition to extension and counter-extension warm water applications to the affected muscles; the general warm bath or vapor bath, and principally Nauseants, as: small doses of tartar emetic or lobelia, or drinking plentifully of warm water. The extending force should always begin gently, and be gradually increased, while the counter extension should be fixed and uniform. The limb should be slightly flexed, so as to favor relaxation. The patient's mind should be diverted from the injury or operation, especially at the moment when extension has been carried to a sufficient ex- tent. To gain this object surgeons have resorted to the smashing of a window; communicating tidings of some awful accident; &c When the bone returns to its socket, a "snap" can be heard and generally felt. A general plan by which many dislocations can be replaced even by persons entirely unacquainted with anatomy, consists in -drawing the limb out of place as much as possible, and then while the patient's mind is diverted to something else, making a sudden rotary motion, during which the bone gene- rally slips into its place. After the dislocation has been re- duced, the limb should be kept in its original position by bandages, and in some cases splints also. The bandages over the joint should be kept constantly wet with cold water, and the patient should be kept quiet, and live on simple, unstim- ulating food. In compound dislocations we must first arrest hemorrhage and remove all foreign substances from the wound, after that the "bone should be restored to its natural place, and the wound closed as soon as possible. The wounds should be healed by the first intention. Sutures should never be used. The limb should then be placed in an easy position and moderate compression applied by the Gum Shellac splint, leaving an open space at the wound and fixing it on by a roller. The wound itself must be kept constantly covered with lint over DISLOCATION OF THE JAW. G45 which are laid cloths wet in cold water. If the bone be in- jured broken portions in the wound must be scrupulously re- moved. Poultices should be avoided as they tend to promote suppuration, however, when severe inflammation has set in and suppuration is inevitable, recourse must be had to the same. If Abscesses form they should be opened as speedily as possible. DISLOCATION OF THE JAW. This accident may be caused by a blow on the chin, when the mouth is wide open, or by yawning or gaping, by which the articular con- dyles are drawn over the transverse root of the zygomatic process. (Fig. 1.) It may affect one or both sides. The mouth is fixedly 61-6 ACCIDENTS. the hands and fingers on the sides and under the surface of the jaw; then press downward with the thumbs, and forward and upward with the hands; the thumbs must be removed as the joint slips in its place. After reduction it is best to confine the chin for a week or two by a four-tailed bandage. DISLOCATION OF THE CLAVICLE OR COLLAR-BONE. Displacement of the collar-bone may take place at its ster- nal or scapular extremity. In the former case it is pushed pIG- 3# forward or backward, (Fig. 3.) \ ward. In thin persons the nature Vtof the injury is obvious at a *-* glance; but with very fleshy pcr- ;iil!^ sons the diagnosis is sometimes .- j~ difficult. Moving the shoulder however, occasions great pain; *"~ and it is with difficulty that the patient can move it at all. Treatment of clavicula-ster- nal dislocation. — By pulling the shoulder backward and slightly outward, the collar-bone is drawn down to a level with the breast-bone, when the head will readily fall into its proper place. When the scapular end is dislocated, the shoulder on the injured side is depressed as compared with the other and also drawn inward toward the sternum. In reducing it, the surgeon standing behind the patient, places his knee between the shoulders, and draws them both backward, until the clavicle sinks into its place. The clavicle-bandage is afterward applied, and is the same as for fracture of the clavicle. " DISLOCATION OF THE SHOULDER-JOINT. In dislocation downward, or into the axilla, which is the most common, the head of the bone rests on the axillary plex- us of nerves, between the sub-scapularis muscle and the ribs. (Fig. 4.) The head of the bone is readily found in the axilla; there is a tumor-like projection in the arm-pit, and a correspond- DISLOCATION OF THE SHOULDER-JOINT. 647 ing hollow below the acromion process; the shoulder seems flattened; the elbow sticks out Fig. 4. from the side; the attempt to raise the limb causes great pain and numbness, the patient in- clines to separate his arm from the body, and support it with the other hand. When the ac- cident has existed for a consid- erable time, an effusion of lymph into the joint may occa- sion a grating sound on moving the arm. In the dislocation forward, the head of the humerus can be clearly felt, and generally seen upon the pectoral muscle below the clavicle. (Fig. 5.) Tho arm is shortened — the elbow projects backward; the acromion process seems pointed, and beneath it is a considerable hol- low. There is great difficulty in moving the arm in any di- rection. Fig. 5. Fig. 6. In the dislocation bad-ward, the head of the bone may be 648 ACCIDENTS. felt on the dorsum scapulae; (Fig. 6.) and the elbow projects forwards. Treatment of the downward form of dislocation (into the arm-pit). — The patient is placed in a recumbent position, and the surgeon, sitting before him puts his j'unshod" heel on the head of the bone in the axilla, and presses it upward, while he pulls steadily and firmly on the arm, by means of a towel fastened round the elbow, (Fig. 7.) until the head of the Fig. 7. bone slips into the glenoid cavity. If greater force is required than one person can exert, he may be assisted by others pulling behind him by means of additional straps placed upon the arm. If this plan fails, the patient is seated in a chair, and counter extending bandages are so applied as to let the arn» pass through them. (Fig.8.) For the extended bandage,a wet- ted roller, placed round the arm above the elbow, with straps or slips of cloth attached, will answer. The arm is then raised so that the elbow is a little above the horizontal line with the shoulder, and while in this position, two or more assistants make gradual and steady extension upon it, an equal amount of force being employed in producing counter extension at the same time. After the strain upon the musclesl has been *'> DISLOCATION OF THE SHOULDER-JOINT. Fig. 8. continued for some time, the surgeon, resting his foot on the chair, pushes his knee into the axilla, and presses up the head of the bone while he presses down on the acromion with one hand making also a slight rotation upon the arm. Another method by which a majority of recent dislocations can be easily replaced, is the following: Place the patient in a chair, extend the luxated arm as far as possible from the side, then, with the knee in the axilla—the foot being sup- ported on the chair, and the heel raised so as to press the knee upward—grasp the humerus above the elbow with the hand, pressing down upon the shoulder at the same time. The pully and counter extending bandage may also be ap- plied if necessary. (See fig. 9.) In the forward luxation, the extension is to be made ob- liquely downward and slightly backward. When the head of the bone is observed to move, the surgeon should place his knee or heel against it, and press it backward into its cavity. The dislocation backward may be easily reduced by fixing 28 650 ACCIDENTS. Fig. 9 the shoulder and making gradual extension directly outward, the head of the bone being thus moved slowly forward into the glenoid cavity. This dislocation has been replaced by merely raising the arm, and turning the hand to the back of the head.;* After reduction a pad should be placed in the axilla, and the arm and shoulder supported for some days with a figure of'8'bandage, a few turns of which should confine the arm to the trunk. The arm should be carried in a sling, and all motion of the joint avoided. dislocation of the elbow. Presents five varieties. I. Both bones of the forearm may be pushed backward. Symptoms: The elbow is bent at the right angle, and is im- moveable; the posterior projection is very prominent, and a deep hollow may be felt on each side of it; the condyles ap- pear like hard tumors in front. (Fig. 10.) Treatment. — Place the knee on the inner side of the elbow, DISLOCATION OF THE ELBOW. 651 Fig 10. pressing chiefly on the displaced bones, so as to keep them from bearing on the end of the humerus, and to bring the coronoid process out of the posterior fossa, so that it can pass over the condyles (Fig. 11), while the arm is bent slowly Fig. 11. and steadily with considerable force. II. Both bones of the forearm may be pushed to one side. In the outward dislocation (Fig. 12), the coronoid process is Fig. 12. throw behind the external condyle, and the head of the radius can be plainly felt on the outer side of the joint. Inward dislocation (Fig. 13) is known by a great projec- 652 ACCIDENTS. Fig. 13. tion of the outer condyle, in addition to the symptoms of the first variety. Treatment — Reduction may be accomplished by bending the arm over the surgeon's knee, as in the preceding case; less pressure, however, is usually required, as the bones do not require the same separation from the humerus. III. Dislocation of the ulna backward. Symptoms: The olecranon can be easily felt behind the humerus; the arm can not be straightened nor can it be flexed to more,than a right angle; the forearm and hand are also twisted inward. Treatment—Reduction by the foregoing plan. The bend- ing of the arm is the principal part of the operation, the fixed radius acting like a lever to push the humerus back into its place on the ulna. IV. Dislocation of the radius forward. Symptoms: The forearm is more or less bent, and in bending it more, the head of the radius can be felt to strike against the front of the humerus (Fig. 14). The hand is in a state of pronation. Fig. 14. Treatment. — Take the patient's hand, as in shaking hands, and make steady extension, while the other hand is pressed DISLOCATION OF THE WRIST. 653 strongly on the ulnar side of the head of the radius, pushing it outward and upward. The arm must be slightly bent during the operation. V. Dislocation of the radius backward. Symptoms : The head of the bone can be felt behind the outer condyle (Fig. 15). Fig. 15 Treatment. — Reduce by simply bending the arm, which should be kept bent for three weeks. DISLOCATION OF THE WRIST. When both bones are displaced forward, their projection is seen and felt under the carpus. This accident is caused by falling on the palm of the hand. When both bones are dis- placed backward they project over the carpus; the carpal Fig. 16. bones are thrown forward and upward under the flexor ten- dons, in front of the forearm. (Fig. 16.) When the radius alone is displaced, the external or thumb side of the hand is backward, and the opposite side is inward or forward, the extremity of the radius may also be seen to form a prominence in front of the wrist. When the ulna alone is detached, the connecting ligament is necessarily ruptured; the hand is twisted, the bone projects 654 ACCIDENTS. at its back, from which place it may be easily pressed down; but when the pressure is removed, the deformity will reappear. Treatment. — Reduction is accomplished by the application of extending and counter-extending force. Compresses should be placed upon the wrist, and secured by a roller which should inclose the limb from the tips of the fingers to the elbow; after which a splint should be added, and the forearm sus- pended in a sling. The splints should be well padded, extend along the forearm in a line with the back of the hand, and be well secured with a roller. CARPAL AND METACARPAL DISLOCATION. Displacements of the bones of the wrist are extremely rare. When they do occur the hand is to be extended, and the bone pressed down in its place, and then secured by a proper com- press and bandage. dislocation of fingers and toes. (fig. 17 & 18.) Fig. 17. Place your thumb at one of the divided extremities and the finger at the other, then make extension, while the other is moderately flexed (Fig. 19.) In long standing cases it is Fig. 18. necessary to keep up extension for a considerable length of time ; by the use of a piece of tape, fixed to the finger by what is called the " clove-hitch." (Fig. 20.) DISLOCATION OF THE IllP-iulNT. 655 Fig. 1!>. Reduction of the thumb is more difficult. It should be well covered with wet tape before the clove-hitch tape is applied. DISLOCATION OF THE RIBS. The costal cartilages may be torn from the extremity of the ribs, or from the sternum; — and the posterior extremity of the ribs may be dislocated from the spine by falls on the back. Treatment is the same as prescribed for fracture. DISLOCATION OF THE HIP-JOINT. 1, Dislocation upward on the dorsum of the ilium is the most frequent (Fig. 21). The limb is shortened; the foot is Fig. 20. turned inward (Fig. 22) ; the knee closely approximates, yet does not touch that of the other leg; the limb can be bent slightly across the other, but cannot be moved outward; the round head can be felt moving upon the ilium. Treatment — As the muscles concerned in the articulation are large and their resistance power- ful, it is always prudent to relax the whole muscular system by a hot bath, or by envelop- ing the patient in the warm wet sheet-paek, placing hot bottles to his feet and sides, and' covering him well with bedding. While in the pack or bath, the patient should drink abundantly of warm water, and after being sufficiently relaxed for the operation, he should be kept well covered in flannel blankets to retain the heat and moisture, and prolong the 656 ACCIDENTS. FlG. 21. relaxation. Some surgeons re- commend moderate bleeding, and the exhibition of half a grain of tartar emetic every ten minutes, the latter continued till the pa- tient feels nauseated and power- less. He should then be placed on his back on a table; a strong towel should be passed round the upper part of the thigh, so as to bear firmly against the perinseuni, at the inside of the dislocated limb, and fastened to some un- yielding point. A wet bandage, of eight or ten turns is applied around the limb, above the knee, and to this the extending straps are attached, which last are to be fixed to the wall or some other firm object. Then extension is to be made in such a direc- tion as to draw the thigh across the opposite, a little above the knee. The force is to be steadily increased as long as the patient can well bear it; then held stationary for a few Fig. 22. moments until he ceases to complain, then again increased, and so continued until the head of the bone reaches the edge of the socket, when the surgeon rotates the limb a little, or lifts the upper part of it, until the head of the bone returns DISLOCATION OF THE HIP-JOINT. 657 Fig. 23. to the acetabulum. The snapping noise is not always heard when the head of the femur slips into its socket. (Fig. 23.) A different and more easy plan is the following: place the patient on his back, without fastenings of any kind, the leg flexed on the thigh, and then strongly adduct- ed—carried inward; in this con- dition the adduction is continued by flexing the thigh on the pelvis until the knee is as high as the umbilicus. 2. Dislocation backward, in which the head of the femur is thrown in- to the sciatic notch. (Fig. 24.) Fig. 24, The limb is shortened, the toes rest on the ball of the great toe of the other foot; the knee is slightly flexed and ad- vanced forward; the foot and knee are turned inward (Fig. 25); the head of the femur can scarcely be felt, and the tro- chanter will be found further back than natural. 658 ACCIDENTS. Fig. 25. F™- 2«- Treatment.— The patient is placed on his sound side on a board or table with the affected thigh drawn over the middle of the other. Extension and counter extension are made in the same way as in the first variety with the addition of a strap around the upper part of the thigh, which is car- ried over the shoulders of an assistant, to raise the head of the bone at the commencement of the operation, out of the notch, or impart a lifting direction to the extending force. (Fig. 26.) The Surgeon may also press the trochanter forward with his hand. 3. Dislocation downward.—The head of the femur is thrown into the thyroid foramen or on the obturator externus. (Fig. 27) The limb is lengthened one or two inches; it is drawn dislocation of $he hip-joint. 659 Fra. 27. Fig. 28. away from the other, the toes point downward and directly forward, because the psoas muscle is on the stretch. (Fig. 28.) Treatment —-The patient is placed on the back, the thigh separated; a folded cloth is placed over the perinaeum, so that when the ends are drawn upon, the force will bear against the inner and back surface of the bone. Another strong band is passed transversely around the pelvis, above the acetabuluuij the front end passing over the former strap, so as to give to it a more upward direction. The force is then applied as in the former case, and as the head of the bone begins to rise, the surgeon passes his hand under the opposite leg, and seiz- ing the ankle of the affected one, brings it gently but firmly toward the other. (Fig. 29.) Another plan is to lay the patient on the bed, with one of the bed posts between his thighs, and close up to the perinaeum. Then the foot may be carried inward across the medium line; so that the bed post acting as a fulcrum, may throw the 660 ACCIDENTS. head of the femur outward. But the foot must not be ratW, Fig. 29. otherwise the head of the fe- mur may slip around under the acetabulum into the sciatic notch. 4. Luxation upward and Fig. 30. forward (on the pubes.) (Fig. 30.) The limb is shortened; it is drawn away from the other and the foot points directly Fig. 31. DISLOCATION OF THE HIP-JOINT. 66l Outward. (Fig.31.) The head of the bone is at once discov- ered in front a little above the level of Poupart's ligament, which circumstance distinguishes the case from a fracture of the neck of the femur. Treatment — The patient is to be laid on the sound side; extension should be made in direction backward as well as downward; and, after it has been continued a little time, the head of the femur should be raised over the pubis, and edge of the acetabulum. (Fig 32.) Fig. 33. 662 ACCIDENTS. DISLOCATION OP THE KNEE-JOINT. The outward dislocation (Fig. 33) of the patella is more fre- quent than the inward; but in either case the knee is par- tially flexed and the joint immoveable; the patient also com- plains of a sickening pain in it. The upward displacement of the patella, which is attended with rupture of the liga- ment is perfectly obvious to the sight. In the forward dislocation of the tibia, (Fig. 34), the head of the bone is seen and felt above the front of the condyles, these being perceived in the popliteal space. There is also numbness of the foot from pressure on the nerves and popliteal artery. In the backward luxation of the tibia, (Fig. 35), the limb Fig. 35. is sensibly bent, and somewhat shortened, the condyles project, and the flexure of the limb is backward instead of forward, the foot being drawn forward. In the lateral displacements one condyle" of the femur rests on the head of the tibia, where the other condyle belongs, the dis- placed one projecting externally or inter- nally. (Fig. 36-37.) Treatment—-To reduce the outward disloca- tion of the patella the patient is placed in a recumbent posture, the limb raised by the heel, to relax the extensor muscles, and then the displaced bone is pressed down to its place, the force being applied to the edge most distant from the joint. The upward dislocation of the patella is easily reduced, but with difficulty kept in its place, on account of the rupture of the ligament. The roller skillfully applied from the toes to the groin, will generally answer; and this may be assisted by a straight splint fastened under the whole length of the leg. Displacements of the tibia must be rectified by simple ex- tension, fixing the pelvis, and placing a bandage round the ankles,—and the knee be kept at rest. dislocation of the ankle. 663 Fig. 36. Fig. 37. DISLOCATION OF THE ANKLE. In the inward dislocation, which is the most common, the Fig. 39. Fig. 38. 664 ACCIDENTS. foot is turned out, and a tumor is formed by the internal mal- leolus pressing strongly against the skin, which seems ready to burst, (Fig. 38); the joint, however, is still moveable. A depression may generally be felt about three inches above the ankle, in which case the fibula is fractured (Fig. 39). The outward dislocation is known by a corresponding de- formity on the other side. In the forward dislocation (Fig. 40), the foot is shortened, Fig. 40. the heel elongated, and the toes point downward. The backward dislocation, which rarely occurs, is man- ifest to the sight. Treatment. — The manner of reduction is essentially the same in all cases. An assistant holding the foot by the heel and toes, flexes the leg to a right angle with the thigh, aud while the thigh is held fast by another assis- tant, just above the knee, makes extension at the an- kle, the surgeon at the same time pushing the end of the tibia in its place. Splints and bandages are necessary, and wet cloths must be frequently applied, as there is usually considerable inflammation. DISLOCATION OF THE FOOT. When the tarsal or metatarsal bones are displaced, the nature of the injury is obvious. Reduction is effected by extending the foot and pressing upon the displaced bone at the same time. Compresses and bandages are necessary. Dislocation of toes. —(See dislocation of fingers). FRACTURES OF THE CRANIUM. 665 FRACTURES. A fracture is called transverse when the bone is broken directly across; longitudinal when it is split lengthwise; oblique when broken in other directions: simj>le when not accompa- nied with an external wound; compound when the soft parts are so lacerated that the fractured bones protrude; complicated when occurring in connection with a dislocated joint; comminu- ted when the fractured bone is divided into several fragments. FRACTURES OF TnE CRANIUM. Any of the bones of the skull may be cracked in a straight line through one or both plates; or crushed, the fracture ex- tending in different directions from a central point. The skull bone may also be bent without being fractured. In the case of fracture, a crepitus can be felt through the skin; there are more or less marks of violence on the surface; and if any portion of bone is driven in upon the brain, symptoms of compression, as: laborious breathing, dilated pupils, slow and regular pulse, loss of motor power and of sensibility, involun- tary discharge of faeces, retention of urine, &c, will be pre- sent. These same symptoms, however, may exist without any depression, resulting from extravasated blood. In some cases symptoms of both concussion and compression may appear together. A severe blow or fall on the head, may occasion fracture of the skull at some other point than that where the foreign force was received. When the temporal bone is broken in this way, blood will flow out of the ears. Symptoms of concus- sion will be present for a short time in nearly all cases of frac- ture as well as after blows on the head when the bone is not injured. Treatment. — If there be no symptoms of compression dress as in any other case—first remove the hair, then wash out with warm water, and bring the lips together with adhesive straps and bandages. Sutures should be avoided, if possible. Treatment of compression and concussion, see diseases of the head. 28c4 066 ACCIDENTS. Should the symptoms of compression continue after the inflammation has subsided, the depressed bone must be eleva- ted by trephining (a dangerous operation, even in the most skillful hands). Proceed as follows: remove a sufficient por- tion of the scalp, by cutting a flap in the shape of the letter D, raising the circular side. Loose pieces of bone should then be removed with forceps. The pericranium is next to be separated from the surface of the bone, to which the instru- ment is to be applied. The instrument should be placed on such a part of the head as will, if possible, avoid the grooves for the meningeal arteries in the parietal and temporal bones, as well as the sutures, and one edge of the trephine must be placed on the sound and one on the fractured bone. Then press gently and saw through, steadily turning the instrument backward and forward, but stopping- and removing it fre- quently to cleanse the teeth with a brush, and to examine the groove,—which must at the same time be well cleansed from the saw-dust and blood, by means of a wetted sponge. As soon as the groove is deep enough to steady the instrument, withdraw the centre-pin. When you get nearly through the bone, examine the fissure with the point of the probe, a strip of quill, or any other convenient article very frequently, so as to make sure of not cutting through the dura matter. As soon as any point of the saw is through the bone, introduce the small end of the elevator, and endeavor gently to raise the whole. If it should still be very firm, introduce the tre- phine again and saw a little more, taking care not to let the teeth touch at the point or segment which is already cut through. After having removed the extravasated blood or pus, or elevated any depressed portion of the skull, — by "prying" with the elevator as a lever against the opposite firm edge as a fulcrum — replace the scalp and secure it by a compress of lint or cotton. The part must be kept wet with cold water. FRACTURES OF THE NOSE. The nature of these accidents is apparent from the resulting FRACTURES OF THE LOWER JAW. 667 deformity. They can be adjusted by pushing out the depressed bone by a silver catheter or some similar instrument, intro- duced within the nostril, while the fingers support them on the out side. The surface should be covered with cloths wet in cold water, to keep down inflammation and swelling. There is danger in these fractures of inflammation extend- ing from the ethmoid bone to the dura water, and the most Berious effects may ensue. FRACTURES OF THE LOWER JAW. This accident commonly occurs at the middle of the chin (Fig. 40), although it may take place in aq& part. The crepitus and pain felt on Fig. 40. moving the bone will deter- mine the exact locality of the fracture; a depression may also be felt at the place. Treatment. — The adjust- ment is effected by elevat- ing or depressing until all the teeth are arranged pro- perly with respect to each other and to those of the upper jaw. Should one of the condyles be displaced at the same time, it must be reduced previously to setting the broken bone. The jaw must be secured; the mouth being kept shut by means of a strip of adhesive plaster, (or collodion plaster or gum shellac cloth) two and a half inches wide extending from ear to ear over the chin. The plaster should be spread on fine leather, as calf- skin; and over this a bandage of strong muslin, two yards long and two and a half inches wide, split from each end to within six inches of the middle, is to be applied. A hole is made in the centre for the chin; the two lower ends are brought up over the top of the head and the two upper ends are carried horizontally round- the back of the neck; several turns with each pair are then made over and around the head, where they are fastened at their ends, and ,also, at each crossing (Fig. 41). 668 ACCIDENTS. In the absence of adhesive plaster the compress and roller Will answer all purposes. Fig. 41. The compress under each ramus is held by an assistant until fastened by the first turns of the roller, which is an inch and a half in width and four or five yards long; the first vertical turns are repeated over each other several times, followed by the horizontal ones above the ear over the occiput and forehead, and, lastly, several turns below the ear and lip. FRACTURE OF THE CLAVICLE. 669 Pins or stiches are applied wherever the roller crosses or changes direction. If no teeth are wanting in the forepart of the mouth, and there is not sufficient space between them, one or two will have to be extracted previously to closing the mouth in order that there may be a space through which the patient, by means of a tube, may take drink and food in the liquid form. FRACTURES OF THE SCAPULA. (SHOULDER-BLADE.) The body of this bone may be broken across by great violence. The symptoms are great pain in moving the shoulder and crepitus. Treatment—A roller must be passed round the trunk, and a few turns be made round the humerus, so as to fix the arm to the side and prevent all motion. Low diet, and keeping the surface wet and cool will be required to avert inflamma- tion of the chest. Fractures of the neck of the scapula are distin- guished by the following symptoms: the shoulder appears sunk and the arm lengthened; the acromion is unusually prominent; the head of the humerus can be felt in the axilla as in dislocations; and on placing one hand on the acromion and moving the shoulder, crepitus may be detected. Treatment. — The shoulder must be replaced and held in opposition by the same sling, bandage, and pad, that are used for fracture of the clavicle. Union may occur in seven Fracture of the acromion is known by a flattening of the shoulder, because the fractured portion is drawn down by the deltoid; and, on pressing the arm upward, a crepitus is felt. Treatment — Press the head of the humerus up —by which the fragment is carried to its place, and secure it by the clavi- cle bandage, omitting the pads or compresses under the arm; otherwise the broken part will be pushed outward too much. FRACTURE OF THE CLAVICLE (COLLAR-BONE), Is most frequently situated at the middle of the bone 670 ACCIDENTS. (Fig. 43 and (Fig. 42), and it is generally caused by falls on the arm or shoulder; sometimes, however, by direct violence. Symp>toms.—Inability to lift Fig. 42. the affected arm, and support- ing it at the elbow; the shoul- der sinks downward, forward and onward; crepitus occurs on moving the shoulder; by passing the finger along the edge of the bone the fracture tSess^ is readily detected. Treatment.—Place the knee between the shoulders, draw them both back until the parts of the broken bone come into their proper position, and while the shoulders are kept back, and the arms down by the hands of assistants, the "figure of 8" bandage 44), or the clavicle bandage is applied. The cure will be completed in four or five weeks. Some little irregularity is apt to re- main. FRACTURE OF THE STERNUM. The breast bone is never bro- ken, except by great force di- rectly applied. Symptoms.—Depression of the injured point; pain a«d crepitus attending the movements of the thorax in respiration. Treatment.—Apply the roller around the chest in such a man- ner as to stop all motion ; the respiration being carried on wholly by the abdominal muscles. FRACTURE OF THE RIBS, May take place at their vertebral or sternal extremity, and is FRACTURES OF THE SPINE. 671 commonly caused by direct violence, such as blows, kc. Symptoms.—Fixed lanci- nating pain, aggravated by inspiration, coughing or any other motion. A depression and crepitus may be detect- ed by passing the finger along the rib. Emphysema, a swelling caused by the presence of air in the cellu- lar tissue, is an occasional complication of this frac- ture, caused by perforation of both pleurae, and escape of air from the lung into the cavity of the pleura. Treatment.—A broad rol- ler, applied around the chest Fig. 44, ^^ so firmly as to prevent all motion of the intercostal muscles, will in most cases be sufficient. When a rib projects, the com- press must be applied, and tapes, carried over the shoulder and fastened to the roller near the spine and sternum, are neces- sary to prevent it from slipping down. In complicated frac- tures stiff adhesive plaster, or even gum-shellac cloth or wetted paste-board, fitted to the part are useful additions. Preceding the operation of pressing the bones or cartilages down to their proper position, the patient should in all cases be directed to take a rather deep inspiration, and also to hold his breath as long as possible during the adjustment, FRACTURES OF THE SPINE. The transverse processes of the vertebrae may be broken off without serious inconvenience, and may be treated like frac- tured ribs. When the body or articulating surface is frac- tured, the injury is irremediable. Fractures about the fourth rertebne of the neck cause instant death; above the lumbar 672 ACCIDENTS. vertebrae, they are fatal in a few days. Paralysis affects all the parts whose nerves are derived from the spinal cord below the point of injury. FRACTURES OF THE PELVIS. These are only produced by extreme violence, of a crushing kind. They are always dangerous. The patient should be placed in an easy horizontal position, and handled as little as possible. Crepitus can be felt by placing the hand on the crest of the ilium, while motion is made at the spine or lower extremities. A roller around the pelvis, with a strap under the nates, and attached to a pully over the bed, so that the pelvis can be raised without effort on the part of the patient, constitute the principal surgery. FRACTURE OF THE HUMERUS. Fracture of the shaft (as in fig. 46) will be known at a Fig. 46. glance by the limb being bent, shortened, and help- less, and by the crepitus being felt when it is handled. Treatment. — The fracture may be reduced by drawing the elbow downward, whilst the shoulder is steadied. Then the whole limb from the hand up- ward, is to be evenly, but rather loosely bandaged; next two or four splints about a quarter of an inch in thickness, are then placed at convenient distances, so as nearly to inclose the arm; the roll- er is then continued down over the splints and back and forward until the splints are properly se- cured ; the forearm and hand are lastly to be sus- pended in a sling from the neck; but the elbow must not be raised up; other wise the fracture will be liable to be misplaced. Fracture of the neck of the humerus (Fig. 47 ) is caused by great direct violence, and is at- tended with much swelling. It seldom occurs ex- cept in old persons. By rotating the arm below the elbow a crepitus will be felt. The roundness of the shoulder is not diminished as in dislocation. fracture of THE HUMERUS. 673 Treatment. — A wedge-shaped pad in the ax- illa; the shellac or paste-board splint applied on the outside and over the top of the shoulder, and the whole fastened by the clavicle bandage. Fractures near the condyles (Fig. 48) are often mistaken for dislocation of the fore- arm. When the fracture is above the condyles, the arm will be shortened; and in all cases the grating of the broken pieces can be felt; the motions of the elbow are but little impeded in fracture, which is not the case in dislocation. Treatment. — In fracture of the lower extrem- ity of the humerus, the fore and upper arm should be bandaged, and a piece of pasteboard, gummed sheeting, or leather softened in water, should be cut to a right angle, like the letter L, so as to fit the elbow when bent, and should be applied on the inner aud outer sides, and be retained by another bandage. Beside this an an- gular splint may be employed, which should Fig. 48. Fig. 47. reach nearly from the shoulder to the wrist, one being applied on the front and the other on the back of the arm. Passive motion should be commenced in a fortnight or three weeks. Some degree of deformity will always exist after these injuries. 674 ACCIDENTS. FRACTURES OF THE FORE-ARM. Fracture of the olecranon may be caused by a direct force, or by violent action of the triceps muscle. The patient can bend the arm easily but cannot straighten Fig. 49. it. (Fig. 4!).) There is also great pain at the point of injury. Treatment. — The in- flammation must be first subdued; then the arm is to be bandaged, rather tightly, from the ends of the fingers to the elbow; the broken end of the bone is next to be brought to its place and included in the turns of the roller which should be con- tinued half way up the arm; the roller is then turned back and passed about the elbow joint about a dozen times in the form of the "figure 8;" afterward it is continued upward in- cluding the whole arm. Lastly a strong splint is to be placed in front of the joint over the bandage to prevent flexion. The coronoid process is sometimes fractured, attended neces- sarily with a backward luxation. It impedes the bending of the elbow. Its adjustment only requires the flexure of the forearm, and its retention in that position by proper bandages and splints. Fracture of the shafts of the radius and ulna, together or singly, are known by the ordinary signs of fracture, especially by the crepitus felt on fixing the upper end, and rotating or moving the other. Treatment. — In fracture of both bones (Fig. 50) the most important point in the treatment, is, to keep the bones apart. After adjusting the bones, by making the necessary extension at the wrist, the arm should be bent at a right angle, with the thumb midway between pronation and supination; the loose roller is to be applied, and this, followed by two splints one on the inside and the other opposite, which should be con- FRACTURES OF THE FORE-ARM. 675 vex on the side next the arm, and well padded with cotton; Fig. 50. the splints are, lastly, to be secured by a roller extending from the hand to the elbow. Fig. 51. When the radius alone is fractured (Fig 51) the hand may hang loose, and thus exert some degree of extending force on the bone. Fig. 52. When the ulna alone is broken (Fig. 52) the hand and forearm should be kept in the same line and the splint and bandage should extend to the ends of the fingers. The splints should in all these cases be worn ten or twelve days; but the compress and bandage should be continued a week or two longer. Fig. 53. 676 ACCIDENTS. Fractures of the lower extremity of the radius (Fig. 53) must be treated as the other fractures of the forearm, but care must be taken to apply pads and compresses in such a manner as to keep the two bones apart and the fractured portions to- gether at the same time. Many months may elapse before the use of the wrist and fingers is restored. FRACTURES OF THE WRIST, HAND, AND FINGERS. These accidents require a broad splint fitted to the front of the wrist and hand, with the ends slit for the fingers, the parts being well padded to secure equal pressure, and the splints fastened by the roller. Splints may also be adjusted to the sides and back of the fingers. A single finger bone may be fixed with four small splints secured by tape. FRACTURES OF THE THIGH. Fracture of the neck of the femur may occur either within the capsular ligament, (Fig 53 &,) or external to it. Symptoms. —After a blow or fall, the patient finds him- self unable to stand, and complains of great pain, in- creased by motion, and principally seated at the in- ner and upper part of the thigh. The leg is from half an inch to two inches short- er than the other; the foot is turned outward; the heel rests in the interval be- tween the ankle and tendo- achillis of the other leg (Fig. 54); crepitus maybe detected if the hand be placed on the trochanter whilst the limb is draivn to its proper length and rotated; the limb may generally be freely moved although with great pain. Sometimes, however, the shorten- ing of the limb does not occur until several hours after the FRACTURES OF THE THIGH. 677 accident, and in some rare cases it is said the foot turns in in- stead of being everted. Treatment. — The patient should be kept in bed for a fortnight, till pain and ten- derness abate; with one pillow under the whole length of the limb, and another rolled up and placed under the knee. Then he may get up and sit in a high chair, and shortly begin to crawl about with crutches; and in time he will regain a tolerable use of the limb, especially if not very corpulent. Fracture external to the capsular liga- J ment resembles the last in many general features. The pain and swelling are greater—often extreme; the limb is not materially shortened or everted, and crep- itus is more easily felt. Treatment — The bones should be kept in approximation, by pressing the tro- chanter toward the acetabulum and pre- serve the length of the limb. The foot andimkieof the injured side should be firmly bound with aroller to the foot and ankle of the other leg, and thus the uninjured side will serve as a splint to that which is fractured, giving it a continued support, and keeping it extended to the proper length. A broad leathern strap should also be buckled around the pelvis, including the trochanter major, to press the fractured portions of the bone firmly together; and the best position of the limb is to keep it in a straight line with the body. The best and most simple apparatus, to retain the broken surfaces in apposition for a time sufficient to admit of union is the long straight splint. This is a simple wooden board, not so thick as to feel cumbrous, and not so thin as to be pli- able or easily broken; of a hand's breadth for an adult but narrower and slighter for a young person. It should reach 678 ACCIDENTS. from opposite the nipple to four or five inches below the foot. At its upper end it has two holes, and at its lower end two deep notches; with a hollow for the outer ankle. The splint well padded is applied to the outside of the extended limb, the ankles being protected by proper adjustment of the pads. Before applying the splint the limb must be bandaged from the foot to the hip and the same roller — after the application of the splint — must be repeatedly passed round the instep and ankle, and through the notches, so as to secure the foot, and must then be carried up the leg. A broad band, like a riding belt, is fastened round the pelvis, so as to bind the splint to the trunk, and thereby keep the broken surfaces of the bone in contact. A large handkerchief Fig. 55. or shawl is brought under the perineum, and its ends secured through the openings at the top of the board; and lastly, a few turns of broad bandage are to be passed round the trunk (Fig. 55). The bandages will require to be reapplied once or twice during the cure; and the perineal band should be tightened frequently. The apparatus is retained for six or eight weeks. After its removal great care must be taken at first in moving the limb and putting weight upon it; it should be accustomed to its former function very gradually. The double inclined concave splint (Fig. 56) with a foot-board added has been highly recommended. Oblique fracture through the great trocan- ter. — The limb is everted, but very little shortened; and the shaft of the bone can be felt widely separated from the trochanter. This fracture unites readily by bone; and the treatment required consists in extension of the limb, and a circular girt with a pad FRACTURES OF THE CONDYLES. 679 to support the upper extremity of the shaft and keep the broken surfaces in apposition. Fracture of the shaft of the femur. — The most important point in the treatment of these fractures is to prevent the shortening of the limb. The patient is placed in a sit- ting position, by which the psoas and iliac muscles are relaxed, and the ends of the bone approximated. Extension is then made until the two limbs correspond; the roller is next applied, from the toes to the hip; three splints are then placed over the first band- age; one in front from the patella to the pelvis; one from the external condyle to the trochanter major; and one from the internalj condyle to the perineum. Some recommend a fourth splint of stout gum-shellac cloth to be applied on the interior surface, from the tuberosity of the ischium to the hollow of the knee, wide enough to cover one-third of the thigh and perfectly adapted to the surface. All the splints are to be firmly fastened with a roller, when the limb should be placed on the inclined splint, or sup- ported by some similar apparatus. Three separate rollers are commonly employed; applied about the knee as to admit of its being bent. The patient should not lie down for ten or twelve days, as that posture is exceedingly liable to displace the broken bones. If both thighs are broken, the patient should be placed on his back, with four splints to each thigh, and his knees drawn up. and supported by pillows. Fractures of the condyles. — The limb is to be straightened so that the head of the tibia will press upon the condyles, and secured with rollers and splints. 680 ACCIDENTS. FRACTURE OF THE PATELLA. This bone is generally broken transversely; the upper frag- ment is drawn up by the rectus femoris; the patient is unable to straighten the knee; and the separation of the fractured parts can be readily seen and felt. (Fig. 57.) Fig. 57. Treatment — The limb must be laid straight, with a well padded splint behind the thigh and leg, in order to keep the knee quite motionless; and the patient's body should be raised to a half sitting posture, in order to relax the rectus muscle. Pain and swelling must !be removed before the employ- ment of any apparatus to keep the broken surfaces in contact. The divided parts may be brought together by straps buckled around the limb above and below them, and drawn together by other straps attached to them, which pull the circular ones up and down until coaptation is complete. When fractured longitudinally, the leg is to be extended, the parts brought together, and secured by bandage, compresses, and paste-board splints. A new apparatus see Fig. 58. Fig. 58. FRACTURES OF THE TIBIA AND FIBULA. These accidents are readily detected by the deformity, pain, crepitus, etc. FRACTURES OF THE ANKLES. 681 Treatment — When the head of the tibia is fractured, the management is the same as for fractured condyles of the femur. What is commonly termed "broken leg" is a fracture of one or both bones between the knee and ankle. Tho double inclined-splint apparatus, or some similar contrivance is here necessary. The application of the roller (Fig. 59)- Fig. 59. which is the first part of the dressing, need not begin at the toes, as in the case of ulcers, nor be as firmly bound. This bandage is applied before the bones are fully adjusted, and not so tight as to prevent further extension. In all fractures the great toe is to be kept in a line with the inner edge of the patella. In oblique fractures, after the provisional application of the roller, the limb should be placed on the inclined splints, and extended until the two limbs compare exactly; the foot is then to be fixed to the foot-board by straps that will not stretch; and, after the adjustment of the bones is completed, two or three splints are to be applied and bound with a roller, which is also to extend around the inclined or supporting splints. FRACTURES OF THE ANKLES. By twisting the foot outward, the fibula is sometimes bro- ken about three inches above the ankle, accompanied with partial or complete dislocation of the ankle. The internal malleolus, by projecting, forms a tumor, and when the foot is moved, crepitus can be felt just above the external malleolus. (See Dislocations.) The tibia is sometimes fractured near its lower end; it may be transverse, extending through the fibula; but is generally 682 ACCIDENTS. oblique, with the internal malleolus also broken (Fig. 60), The foot is turned inward, and the crepitus is Fig. 60. felt on the inside. Treatment—In the first variety the disloca- tion must be reduced before the fracture is adjusted. The fractured parts are to be kept in place by one splint at the back of the leg, another along the fibula, the foot-board, and the usual bandages. In the second variety a splint is to be ap- plied on the side of the tibia. Fractures of the foot will often be attended with so much other mischief as ren- ders amputation expedient. The cold water dressings and bandages must be employed; and the fractured bones kept in their places by paste-board or shellac splints, compresses, and bandages applied to meet the indications of each case. GLASS SWALLOWFD. Persons who have swallowed pieces of glass, which are apt to produce hemorhage of the oesophagus, or of the stomach, should use softened bread, oil, mush of corn-meal, &c. Flu- oric acid may likewise prove of benefit. HEMORRHAGIC TRAUMATICA — HEMORRHAGE FROM WOUNDS —LOCAL BLEEDING. If an artery is wounded, the flow of blood is profuse, of a florid color, and ejected in repeated jets, corresponding to each beat of the pulse. Partial division of an artery is more dangerous than complete division, because contraction and re- traction are prevented. Treatment.— Stop the flow of blood, until measures can be adopted for arresting it permanently, by pressing the finger or fingers, or a cork, or a pad made for the purpose firmly upon the orifice of the bleeding vessel; or by grasping it between the finger and thumb, if the wound is large and open; or by Local bleeding. 683 pressing the trunk of the artery above against the bone; or *>y applying a tourniquet; (Fig. 61); or by twisting a hand- kerchief tightly around Fig. 61. the limb. If this method will not suc- ceed, examine the wound, and endeavor to find -the bleeding vessel. Having dis- covered it, draw it up with the point of a tenaculum (a little hook), or the forceps and paBS a strong I thread of silk around the part below the in- strument. One end of the ligature should be cut off and the other made to hang out of the wound. It will come away in from five to twenty-one days. When an artery is completely divided, it is necessary to tie both orifices. A wounded artery must be tied at the wounded part, and not in the trunk above. The ligature should never be applied to an artery immediately below a branch. In desperate cases, where the bleeding orifice is deeply seated and cannot be found, it is necessary to pass a curved needle and ligature through a considerable thickness of flesh and tie it up altogether. The bleeding of small vessels is often arrested by a pinch with the forceps; or by torsion, which is performed by draw- ing out and fixing the vessel with a pair of forceps, a quarter of an inch from the end, and then twisting the end round and round, until it will not untwist itself. When the bleeding is from the hand or forearm, the pres- 684 ACCIDENT'S. sure should be made by means of a tourniquet, handkerchief, or fingers above the middle of the arm ( brachial artery ); and if from the legs or feetj the femoral artery (midway of the thigh) should be compressed. When the bleeding occurs high up on the arm press your thumb, or the handle of si door-key, around which four folds of muslin have been wrap- ped, firmly into the neck, behind the middle of the collar- bone until a ligature or other means cau be employed to ar- rest the bleeding more effectually. In hemorrhage from the thigh — if a tourniquet or handkerchief cannot be applied — pressure' must be made immediately below the crease of the groin. Hemorrhage from wounds of arteries of the neck, chest and abdomen are very dangerous, still life may be saved by pinging up the wound — if possible—with lint or rags, and by applying pressure. When the bleeding vessels are very numerous and small, cold and wet compresses should be applied to the wound, and cold water poured upon -the parts at a little distance from the wound. The external application of turpentine, creasote, nitrate of silver, tincture of Arnica, collodion, or a saturated solution of alum are recommended. The patient should observe low diet and a recumbent pos- ture in a cool place. The hemorrhage from wounded veins is not in general dan- gerous. It may in ordinary cases be restrained by pressure and a raised position. In difficult cases it will be necessary to apply a ligature, (which, however, should always be avoid- ed, if possible,) or to keep up unremitting pressure on the bleeding point with the finger. LEECH-BITES. The bites of leeches sometimes bleed too much; children have thus bled to death in the night. The wounds can be closed by putting in a couple of stitches, or the bleeding may be stopped by pressing the finger upon the wound for a consid- SPRAINS. 685 erable time, and applying some gardener's or shoemaker's wax. Others recommend the application of small pieces of linen dipped in common glue; also the application of caustic, col- lodion, pulverized gypsum, alum, &c. MIS-STEPS AND OVER-LIFTING. Pains caused thereby have been removed by administering Rhus and Bryonia in homoeopathic doses. Rupture. ( See Hernia.) RUPTURES OF TENDONS AND MUSCLES. This accident happens more frequently to the large tendon back of the ankle—tendo Achillis as it is called. It occa- sionally happens to man of mature years during dancing. Suddenly they suppose that some one has inflicted a blow on the leg from behind. Their dancing is arrested, and the foot cannot be extended. Treatment — Put the patient to bed, lay his leg outside With his knee much bent, and the toes much pointed, in which position the torn ends of the tendons are brought as nearly together as possible. Put on a piece of board well padded about three fingers wide, and extending from below the knee- cap beyond the toes upon the front of the leg. It must be confined above and below by a few turns of a short roller, and the leg kept in this posture for about a fortnight to give time for the production of the new substance by which the tendon is to be repaired. Another mode is to bend the leg upon the thigh, and fasten it with the toes upward. SPRAINS. A limb is sprained, when, after a fall or other violence, it pains severely, cannot be moved without pain, swells and turns red. They are most common in the ankle and wrist. Treatment — Apply cold water, or Arnica and water until the violence of the pain abates, and then wrap the part in wet compresses until all inflammatory excitement is passed. In some cases warm fomentations give more relief than cold. The affected limb should be kept at rest. 686 ACCIDENTS, SWALLOWING HOT LIQUIDS. The best remedy is to swallow cold water and keep down tho" general fever. Swallowing pieces of money, button, shells, nuts,etc—The article swallowed generally finds its way out of the system without any trouble. OVER-EXERTION, After immoderate exertion, great relief will be felt from taking a warm bath for half an hour. If the limbs are Very painful, rub them, while in the bath, with spirits of soap. OVERHEATING, If much fatigued, take a cup of weak green-tea. If a per- son is easily exhausted in warm weather, let him drink coffee occasionally; or a little brandy or rum, or fiery wine, and refrain from drinking cold water for half an hour afterwards. WOUNDS. Wounds are of different kinds ; they are called incised, punc- tured, lacerated or contused. Incised wounds are those made with clean cutting instru- ments ; they generally bleed more at first than the other kinds of wounds. Treatment.—Arrest hemorrhage by means of the tourniquet (Fig. 61), by compression, by the ligature, by a raised posi- tion, or by the application of cold. If an artery has been wounded, the ligature must be applied. (See Haemorrhagia traumatica.) Remove foreign bodies immediately with for- ceps or with the fingers, and Wash the wound clean with tepid water. All clots of blood must, likewise, be removed. Next bring the sides of the wound into apposition. The edges must be made meet as nicely as they can without undue straining, and must be retained by cross strips of adhesive or isinglass plaster or collodion, A light compress and bandage may be applied to keep on the dressings. In some cases it is requisite to have recourse to sutures in order to hold the edges of the wound securely in contact. The less stitches are used the better; the needle should be well oiled before using it; Wounds. 687 each stitch is tied by itself, and may be taken out in from two to three days, by carefully clipping the thread at one side, and pulling gently at the knot. (See Sutures.) Punctured wounds; caused by pointed instruments are esteemed the most dangerous of all wounds, on account of the great depth to which they frequently penetrate, implicating blood vessels, nerves, viscera and other deep seated parts of importance. They are often attended with lock-jaw. Treatment. — In some cases dilation of the wound is neces- sary to convert them into simple incision, and thus avert the deep seated suppuration. To avoid this severe measure, an endeavor should be made to avoid inflammation by constant application of tepid water, low diet and rest. In some cases leeches are necessary. If, notwithstanding, suppuration should take place, the case must be treated in the same manner as deep seated abscess. Lacerated wounds; are those in which the muscular fibres have been torn asunder with some violence ; the edges being jagged and unequal. They are commonly attended with little or no bleeding, and rarely heal without suppurating. Treatment is the same as in other wounds. Gun-shot wounds includes all the injuries caused by the discharge of fire-arms. When a ball has penetrated an ordi- nary fleshy part, there is seen a hole, rather smaller than itself, with its edge livid and inverted. These wounds are generally attended with considerable constitutional disturb- ance, but very little pain and hemorrhage at the moment of infliction. A ball often escapes by the very hole at which it entered. If the ball or any other foreign body remain lodged, the inflammation and constitutional disturbance will be °severe, and the resulting suppuration more profuse and exhausting. If the ball be small and polished, and if it press against no nerves, vessels, or other sensitive parts, it may remain for years without creating any disturbance, especially if the force with which it was propelled was not very great. TVea^.-After the ordinary hemorrhage is arrested, and 688 ACCIDENTS. the wound properly cleansed, apply a piece of lint, which should be secured by two or three strips of plaster and covered with a wet bandage. Tremor and mental confusion may be allayed by a spoonful of wine or spirits. These dressings need not be removed for the first three days, and should be kept moist with water. During the inflammatory stage noth- ing is necessary but the water-dressing, — and sometimes leeches. If the foreign body is found lying under the skin, it should be immediately removed by an incision. If the ball has lodged in the substance of a bone, it should be removed by a chisel or trephine. In some cases amputation is neces- sary, which should be performed not too soon nor too late after the accident. Homoeopathic treatment consists more or less in the use of the same means above recommended. Arnica tincture and Aqua ealendulae, or tincture of calen- dula officinalis have been applied externally with great success. Arnica and Aconite are, also, given internally to prevent inflammation and pain. If the joints, synovial membranes, or tendons are injured Rhus and Silicea are of utility. Gan- grenous affections require Lachesis and Arsenicum, and in suppuration Mercurius, Hepar and Silicea must be adminis- tered. Hydropathic treatment—Application of a wet cloth of one, two or more thicknesses to the wound at a temperature most agreeable to the feelings of the patient, which should be changed or rewet from time to time as the case may require. A better mode of applying the water is the following: lay the affected limb upon a pillow or cushion, with a piece of oil- cloth over it, arranged in such a way as to conduct the water off into a basin. A bucket of water is then suspended over the bed, or set upon a table near the patient, and by means of a tube with a stop-cork, or some other contrivance, con- stant dropping of water upon the affected part, which is cov ered with a soft linen cloth, is kept up. The water can be kept at a certain temperature by means of a spirit lamp under AMPUTATIONS. 689 the bucket. If there is no uncomfortable heat in the wounded part, the wet compress should be covered with flannel. Use no air tight coverings. Poisoned, wounds. — (See Poisons.) AMPUTATIONS. Severe wounds, injuries, tumors, ulcers, etc., of the superior and inferior extremities, render it necessary in many instances to resort to amputation, in order to save the patient's life. Amputation of the arm.—This, like other amputations, may be performed in two ways — either by the circular inci- s(on—that is, by cutting round the limb from without toward the bone; or by the flap operation — that is, by transfixing the limb, and then cutting outward. The latter is applicable to a greater number of places. The usual instruments employed, in addition to the pocket- case, are, the tourniquet, large knife, saw, and bone forceps; ligatures, sponges, and curved needles threaded should be close at hand on a tray. The patient is seated in a chair, or placed on a bed or table; the pad of the tourniquet is fixed on the artery at a conve- nient distance above the place of operation. (See Haemor- rhagia traumatica.) In the circular operation (Fig. 62) upon the arm, one assis- Fig. 62. 29d5 6;m ACCIDENTS. tant supports the forearm, and another grasps the arm above with both hands, and pulls back the integument as much as possible. The surgeon passes his hand under the arm, bring- ing the knife completely over it on his own side, with the point downward, and makes the first incision by drawing the blade backward from hilt to point, cutting through the skin and superficial fascia, entirely round the limb. The skin is then loosened from the muscles beneath, by separating the areolar tissue with a scalpel or bistoury; the skin is next retracted further up, and then another incision made as high up as the skin will allow, dividing all the flesh down to the bone. The muscles are next separated from the bone an inch or two with the point of a knife or scalpel, and a strip of muslin, a yard long and three inches wide, made into a "two tailed retractor" by slitting it to its middle, applied, the broader end being placed on the under side, the two tails passing upon each side of the naked bone, and crossing them at the top; by this the flesh is pulled upward as far as possible, and held by an assistant. The periosteum is then separated from the bone by a circular cut, and then the bone is sawed off, the splints, if any remain, being smoothed off by the bone-forceps, or nippers. The retractor is then removed, and the brachial artery tied. If the artery is not readily found, the tourni- quet is loosened, when a jet of blood discovers it. All other arteries which bleed on loosening the tourniquet, are to be taken up and tied. Haemorrhage from large veins is to be restrained by elevating the stump, and making compression for a short time with the finger. If however, nothing else will do, they must be tied. Any obstinate oozing from small ves- sels, should be restrained by sponging with cold water, or perhaps by a touch with nitrate of silver. When the bleed- ing has ceased, the stump is to be washed clean and dressed by bringing the edges of the flesh together in an exact hori- zontal line across the middle of the stump, and there fastened, by strips of adhesive plaster, three-fourths of an inch wide and eight or ten inches in length, placing the first over the AMPUTATIONS. 691 center of the seam, and the others laterally at about a quarter of an inch distance. Other straps may be laid obliquely over these, and narrow straps in any direction necessary to secure every part of the wound firmly; and a strap around the whole arm to secure all the others is also advisable. The sturip is then covered with lint, retained by a light, easy bandage; and the dressings are to be kept constantly wet with cold water, if there is the least tendency to inflammation. One end of the ligature must be left long enough to hang out between the straps. The dressing does not usually require moving under several days; and when they are removed or readjusted, the parts must be carefully supported by an assis- tant ; the ligature must be taken away whenever it can be done by gentle pulling; but its removal should not be attempted within one week. When it is necessary to amputate the arm high up, the sub- clavian artery should be compressed where it passes over the first rib, by the thumb of an assistant. In the flap operation for the forearm (Fig. 63), the pos- Fig. 63. 692 ACCIDENTS. the point pushed on close over both bones, taking care that it does not pass between them; when the blade passes over the ulna, the hand is to be rotated a little outward, to bring its point further down under that bone; the incision is then Dursued downward and outward, so that the edge of the knife Fig. 64. may emerge at about an inch and a half below, and at equal distance from the points of entrance and emergence. The external flap is then raised a little, the knife entered at the former point, pushed through close in front of the bones, and brought obliquely downward, thus making a second flap to correspond with the first. The remainder of the operation and the dressings are similar to those of the former operation. Flap operation of arm see (Fig. 64.) Amputation of the wrist.— Circular.— The skin being pulled back, a circular incision is made a little below the level of the line that separates the forearm from the palm of the hand (Fig. 65). The external lateral ligament is then cut through, and the knife carried across the joint, to divide the AMPUTATION of the fingers. Fig. 65. 693 remaining attachments. This operation is scarcely to be pre- ferred to amputation of the forearm low down. Amputation of the fingers, though occasionally desira- ble at either joint (Fig. 66), is most frequently performed at Fig. 66. the base — the phalangeo-metaearpal articulation. (Fig 67.) Fig. 67. An incision is made .__upon the knuckle in an elliptical form around the finger, ex- tending down upon the palmar surface of the finger about an 694 ACCIDENTS. inch, to make a flap large enough to cover the joint; after which the tendons and ligaments are cut through, and the joint dislocated by carrying the knife through it. be done by carrying a bistoury through the soft parts between the metacarpal bone and that of the forefinger upward, until it is arrested by the trapezium; then through the joint, and lastly, by cutting downward and forming a flap of the fleshy substance constituting the ball of the thumb ( Fig 69). To AMPUTATION OF THE THIGH. 095 arrest the hemorrhage, it will be necessary to take up one or more small arteries. Secure the flap in place by adhesive Fig. 69. straps, apply your lint and bandage, and support the hand in a sling. AMPUTATION OF THE THIGH. Is performed after the same manner in which the arm is amputated. Flap operation. The femoral artery being com- pressed, the surgeon grasps the flesh on the anterior surface of the limb with his left hand, and lifts it from the bone; then passes his knife horizontally through it — carries the Fig. 7<). 696 ACCIDENTS. limb as low as possible; then makes it cut its way upward and forward, so as to make the anterior flap. In amputating the right leg, the knife should be passed in behind the saphe- na vein. It is again entered on the inner side a little below the top of the first incision, passed behind the bone, brought out at the wound on the outside, and directed so as to make a posterior flap in the direction of the dotted line (Fig. 70). This should be a very little longer than the anterior, because the flexor muscles retract more than the extensors, which are adherent to the bone. Both flaps are now drawn back; the knife is swept round the bone to divide any remaining mus- cular fibres, and the bone is sawn through (Fig. 71). The Fig. 72. AMPUTATIONS OF THE FOOT. 697 after treatment is the same as for amputation of the arm. The stump should be supported on a pillow covered with oil cloth. AMPUTATION OF THE LEG. The flap operation is the best for this situation (Fig. 72). The steps to be taken are precisely similar to those in ampu- tating the forearm. AMPUTATIONS OF THE FOOT. Amputation of all the metatarsal bones together, requires a semicircular incision across the instep, with the convexity forward, beginning at a point in front of the articulation of the metatarsal bone of the great toe with the internal cunei- form, and terminating on the outside, at the tuberosity of the metatarsal bone of the little toe. This incision should pass boldly down to the bones at once; tendons or other textures left undivided should next be cut and an assistant should draw the flap upward; the operator should then forcibly de- press the extremity of the foot with his left hand, and pass the knife into the line of articulations. The fibrous textures being all divided the incisions should be so conducted in the sole as to form a flap between the tarsus and roots of the toes, the knife being kept close to the under surface of the metatarsal bones as it is carried toward the surgeon. This long flap, with the short one above, will form an excellent -overing to the ends of the bones (Fig. 73). All the arte- pIG 73 ries being tied, the wound is adjusted and dressed in the usual manner. The bleeding during these pro- ceedings on the toes and foot can be efficiently ar- rested by an as- sistant compress- 30 698 ACCIDENTS. ing the tibial arteries at the ankle, or a tourniquet may be put on at the knee. Amputation of all the toes (Phalangeo — metatarsal ampu- tation) from their junction with the foot is the most common. A transverse incision is made across the dorsal surface of the metatarsal bones, and the tendons and lateral ligaments of each joint are divided separately in succession. The first pha- langeal bones are then dislocated upwards, and the knife pass- ed beneath their metatarsal extremities, cutting out flaps from their inferior surfaces sufficient to cover the ends of the metatarsal bones. It is better, however, to divide the bone than disarticulate,—taking precaution, by means of the bone forceps, not to leave sharp or prominent edges to the bones. This direction applies particularly to the great and little toes, as they both aid very much in walking. Amputation of separate toes at any of their joints is per- formed in precisely the same manner as amputation of the fin- gers. AMPUTATION AT THE HIP-JOINT. The femoral artery being compressed, the knife is passed completely through the limb on the inner side of the joint and carried forward and inward so as to form a flap of the abductor muscles; then cut into the joint, aud Fig. 74. sever the liga- • « AMPUTATION AT THE SHOULDER. G99 AMPUTATION AT THE SHOULDER. The patient having been placed on a firm table, with the shoulder elevated, and projecting beyond its edge, and the sub- clavian artery being compressed, the surgeon enters a long straight knife at the anterior margin of the deltoid muscle, an inch below the acromion. From this point he thrusts it through the muscle, across the outside of the joint, and brings out the knife, at the posterior margin of the axilla. (Fig. 75.) If the left side is operated on, the knife must be entered at the posterior margin of the axilla, and be brought out at the anterior margin of the deltoid muscle. Then, by cutting downward and outward, the external flap is made. The origins of the biceps and triceps, and insertions of the infra and supra spiratus are next cut through, and the joint is laid open. Finally, the blade of the knife, being placed on the inner side of the head of the bone, must be made to cut the inner flap. In the pIG 75^ last movements of the knife, the axillary ar- tery must be divided, and to restrain hemor- rhage an assistant, at this period of the ope- ration should grasp the soft parts in the axilla. As soon as the arm is de- tached, a ligature should be placed on the main vessel, the subscapular, and any other artery which may continue to bleed. The edges of the wound should then be brought into contact and secured by adhesive straps. 700 ACCIDENTS. STUMPS, AFFECTIONS OF. Secondary hemorrhage may occur under the same circum- stances as after other wounds, and requires no observations distinct from those already made. See Wounds and Haemorrhagia traumatica.) Erysipelas and phlebitis have also been treated of in an- other chapter; one of them may be supposed to be coming on if the patient, a few days after amputation, is seized with a violent shivering. It sometimes happens that the flesh shrinks away from the end of the bone, which becomes white and dry, and finally exfoliates. The application of the nitric acid lotion is recom- mended. Protrusion of the bone is a very awkward circumstance. The cause of the conical stump, so called, is generally a want of skin and muscle sufficient to cover the end of the bone. Sometimes, however, it arises from spasmodic retrac- tion of the muscles — especially if they have not been proper- ly supported by bandages during the cure. The remedy is simple; the bone must be shortened. Areuralgia of the stump is another very untoward event. It arises from adhesion of the extremities of the nerves (which after amputation always swell and become bulbous) to the cicatrix; or from some irritation in their course, or from disease in the spinal cord at their origin. Treatment depends upon the causes. If the pain and ten- derness are referred to one or two nerves only, their bulbous extremities should be cut down upon and removed. If the whole surface of the stump is implicated, or if the bone pro- trudes, a second amputation should be resorted to. Other forms require the same treatment as recommended for Neuralgia in another chapter. CHAPTER XXIII. POISONS AND THEIR ANTIDOTES. POISONING--TOXICATION. In all cases where poisons have been swallowed two things are required: 1, removal of the poison by exciting vomiting with copious administration of warm water, irritating the fauces by means of a feather; placing on the tongue a pinch of snuff, salt or mustard; emetic or injections of tobacco Bmoke; also, by the use of the stomach-pump. 2,xVdministra- tion of the proper antidotes. If we are unable to ascertain what kind of poison has been swallowed, we should first administer the white of an egg; and if there should be stupe- faction, coffee without milk. Acids.—The nitric (aqua fortis), sulphuric (oil of vitriol) muriatic (spirits of salt), phosphoric, hydrochloric, oxalic and acetic (vinegar) acids, whether taken internally or applied externally produce redness, inflammation, vesication and ulcer- ation. When swallowed a burning sensation in the throat, excru- ciating pain in the stomach, and gaseous eructations are usu- ally the immediate effects; the inside of the mouth looks scalded; breath soon becomes offensive ; what is vomited tastes sour, ferments, and blue litmus paper dipped into it turns red. All the symptoms are most severe when the poison acts upon an empty stomach. Antidotes.—Tepid soapsuds; magnesia, a spoonful dissolved in a cup of water, after every fit of vomiting; chalk, or common plaster powdered and mixed with water; potash or soda, as much as will lie upon the end of a knife, dissolved in water, taking a table-spoonful as long as the vomiting continues. 701 702 POISONS AND THEIR ANTIDOTES. When strong acids have got in the eye, oil of almonds, or fresh unsalted butter is best. For an external scald, or burn with strong acids, lime water is good, or a salve made of lime water and weet oil. Prussic or Mineral acids.—Antidotes: Smelling of cam- phor; spirits of hartshorn; or vinegar; drinking plenty of black coffee; injections of black coffee. Alkalies.—Alkaline poisons are: caustic potash; saleratus; quick lime; salt of tartar; pot or pearl ashes; soda ; ammoniac; carbonate of ammonia, or smelling salts; and spirits of am- monia, or hartshorn. Symptoms are similar to those produced by the strong acids. There is however, no fermentation in what is vomited and no sour smell; lithmus paper which has been turned red becomes blue again. Antidotes. — Vinegar and water in large quantities, warm, if at hand, a wine glass full every five minutes ; lemon juice, or any of the stronger acids largely diluted; sour milk; olive or almond oil; mucilaginous drinks and injections. Emetics are dangerous. Vomiting should be excited by these drinks and by tickling the throat. The resulting inflammation is to be treated like inflamma- tion resulting from other causes. Alum.—Taken in large doses internally it corrugates the fibres, diminishes the secretions, creates dryness and thirst, griping and purging. Treatment, — Give soap-suds or sugar water until vomiting ensues; or use the stomach-pump. Alcohol—Strong Spirits of Wine—Strong Liquor. This is a narcotic and produces, taken in large doses, vio- lent irritation and inflammation in the stomach and bowels, followed by stupor, delirium, prostration, &c. Treatment — Use the stomach-pump or warm water emetic, or both; and give milk and mucilaginous drinks. If not suffi- cient give a drop of corrosive spirit of sal ammoniac in a glass of sugar water, a tea-spoonful at a time, Throw also watej saltpetre and sal ammoniac. 703 on the head; and place wet towels on the region of the stomach; afterwards give coffee without milk. Barytks — Barium.—A peculiar kind of heavy white earth, sometimes sold as ratsbane. The effects produced on the human system are similar to those of Arsenic. In poisoning with Barytes mucilaginous drinks and oil should be administered until some sulphate of Soda (Grlauber salt) can be procured, which should be dissolved in vinegar and then diluted. Let the patient at the same time smell of camphor and sweet spirits of nitre. Liver of sulphur—Hepar sulphuris.—In over doses it corrodes the stomach and depresses the powers of the ner- vous system. Give water with .some vinegar or lemon juice, oily and glutinous drinks and injections. If much drinking and tick- ling of the throat does not produce vomiting, give a weak solution of tartar emetic. Iodine.—In large doses causes burning pain in the stomach, exhausting diarrhoea with a rapid emaciation and extreme prostration. Give starch stirred in water or paste made of it; wheat flour, and, afterwards, thin mucilaginous drinks. Phosphorus. — In large doses produces violent irritation of the stomach, the kidneys and of the genital system. Give mucilaginous drinks and excite vomiting as quickly as possible; if unsuccessful administer tobacco or mustard, afterwards coffee without milk. Some hours after the ad- ministration of coffee a spoonful of magnesia has fre- quently a good effect. Smelling of camphor may, also, give relief. Saltpetre and Sal ammoniac. — If given too freely and in an over dose, it causes heat and pain in the stomach, vomiting and purging of blood, great prostration, convul- sions and even death. Give tepid water, melted butter mixed with water, until the patient vomits copiously, then plenty of mucilaginous drink. 704 POISONS ANO THEIR ANTIDOTES. vitriol— White, green and blue. — Give sugar and warm water, or the white of eggs dissolved in cold water, until the patient has vomited several times; afterwards give gruel. metallic poisons. Arsenic.—The arsenical preparations from which poisoning occasionally results are the protoxide, or fly-powder; arsenious acids or white Arsenic commonly called Ratsbane; arsenite of copper or mineral green; arsenite of potass as in Fowler's solution; arsenin-setted hydrogen gas, which is evolved in various chemical operations, &c. Arsenic is also contained in fever-drops, salves and plasters for cancers, and numerous secret remedies, particularly in those for horses and cattle. Symptoms. — Inflammation and irritation of the whole alimentary canal; a burning pain in the throat and stomach, extending gradually over the whole abdomen, with nausea, faintness and extreme prostration, excessive thirst; face cold and pale ; expression of great torture and anxiety; suppressed urine and fasces; hoarseness and difficulty of speech; exces- sive depression; cramps of the legs and arms; sometimes con- vulsions, paralysis and insensibility or delirium; scanty offen- sive bloody stools; death. When it has been taken medi- cinally in small doses for sometime, it produces a peculiar puffi- ness of the whole face (oedema arsenicalis), with redness of the eyes, nausea, purgings and sinking of strength. Treatment — The stomach pump should always be resorted to at once, if possible. If it is not at hand administer soap- suds; water with white of eggs; sugar water; milk, As soon as the patient has vomited repeat the remedy. Copious vomit- ing to bring up every thing is very necessary. The best anti- dote is the liquid acetate of iron, at first a table spoonful every ten to fifteen minutes. Fresh blood of pigeons, fowls, calves, etc., has been highly recommended; two spoonfuls of blood to each grain of arsenic. Let the patient drink it slowly to prevent coagulation, and retain it on the stomach as long as possible. Sulphur has also been recommended as an Antidote. TARTAR EMETIC. 705 The liquid which hatters use for the manufacture of fine hats contains arsenic and the wearing of the same causes fre- quently sore eyes and eruptions on the forehead. Washing the parts with lime water has proved of benefit. Corrosive sublimate; Red Precipitate; Vermillion. Symptoms.—Violent pain in the stomach and bowels, thirst. vomiting, diarrhoea, heat and fever. Treatment, — Give white of eggs beaten up with water or milk, alternately with sugar water. Starch from wheat flour dissolved or boiled in water; and flour-paste are recommended as Antidotes. When paints, ointments, kc. which contain some form of Mercury are accidentally swallowed, the patient should drink copiously of warm milk made into a very thin batter with wheaten flour, and if the accident is soon discovered, the stomach-pump should be employed. Drug symptoms of Mercury.—(See Mercurial Sore Mouth, etc. Copper-—Cuprum. — The preparations in common use are mineral green, blue vitriol (sulphate of copper); verdigris (carbonate of copper ) ; artificial verdigris. The salts of cop- per are employed in the manufacture of culinary vessels and to color candies, sweet-meats, and preserves, from which fre- quent poisonings have resulted. Symptoms.—In small doses: cramps, paralysis, discoloration of the skin, slow fever, wasting of the body, chronic inflam- mation of the stomach and lungs, metallic taste, nausea, bloody stools or constipation. In large doses: difficult breathing, dryness in the oesopha- gus, affections of the brain, pain in the epigastric region, with the usual symptoms of gastric-enteric inflammation; exces- sive debility; apoplexy, or gradual and slow sinking. Treatment. — After vomiting give the white of eggs; sugar with or without water; milk and wheaten flour; Hepar sul- phuris with milk and the white of egg. Tartar emetic—Antimony — Antimonial wine,—This deadly drug is a common ingredient in candies, lozenges 706 poisons and their antidotes. cough mixtures, drops and syrups; also contained in Jame's powder and Plummer's pills. Death often results from an over dose of Tartar emetic. Symptoms. — Small doses produce debility, difficult breath- ing and nausea; large doses: pain in the epigastrium, cold- ness, vomiting, purging, relaxation, depression, sometimes convulsions and death. Applied to the skin it produces an eruption of painful pustules, resembling small pox. Treatment. — Produce vomiting by drinking warm water freely; afterwards give coffee without milk in large quantities; a decoction of gall nuts or oak bark, or the peel of pomegra- nates; sugar water with half a grain of opium, and mucilagi- nous drinks. Small doses of Ipecac, for nausea and other symptoms, and Opium for convulsions. Lead — Plumbum. — Sugar of Lead; Litharge (protoxide of lead); red lead (red oxide); white lead (carbonate of lead?); Gotdard's extract. Milk, molasses and even water may acquire a poisonous property by standing in leaden vessels. Red earthen ware ought never to be used for cooking on account of its lead- glazing. Symptoms. — Small doses produce constipation and check the secretions generally. Large doses reduce the pulse, diminish the temperature of the body, produce dryness of the throat and mouth, and general emaciation. The extreme effects are lead-colic, inflammation of the bowels, and a nar- row leaden-blue line bordering the edges of the gums. Treatment. — The warm water emetic must be given in the first instance, and the stomach-pump employed if practicable. Next give Sulphurate of Iron; Epsom Salts, a table-spoonful dissolved in a pint of warm water, and drank often and abundantly, in proportion to the quantity of poison; Glau- ber salts (sulphate of soda); white of eggs; soap; milk. After the salts or soap, give mucilaginous drinks and in- jections. METALLIC POISONS. 707 Nitrate of* Silver—Lunar caustic—Lapis infer- NALIS — ARGENTUM NITRlCUM — SILVER—CHLORIDE, Ox- LDE, AND CYANIDE OF SlLVER. Symptoms. — Applied to the skin, hair or nails it stains them black; to an ulcerous surface it produces a white film, and to a mucous membrane, smarting pain and inflammation Which lasts several hours. Taken into the stomach it pro- duces heart-burn, nausea and vomiting, and sometimes inflam- mation and mortification. Its absorption into the system pro- ' duces a slate-color of the skin which results from a chemical combination of the salt with the organic tissues. Treatment — Give a solution of common table salt, a cup every five minutes, afterwards mucilaginous and oily drinks. A solution of salt may be applied in external poisoning. Tin—Stannum„—Chlorides of tin are used in color-making and dyeing, and the oxyde forms a part of the putty powder for glass staining and silver-plating. Poisoning by tin occurs very often from sour victuals being left in tin vessels. Things that are sour should never be allowed to cool or remain in tin or metal vessels, noT should silver or tin spoons be left in victuals. The symptoms are similar to those in cases of poisoning by Bismuth. treatment—Give white of eggs, sugar and milk. Chronic affections of tin require small doses of Pulsatilla. Gold—Aurum.— Pulvis auri—Fulminating gold (Aurate of ammonia.) — The morbific and medicinal effects of the dif- ferent preparations of gold are similar to those of the mercu- rials. Antidotes are albumen, flour and milk. Iron — Ferrum.— Iron filings; Black oxide; Red oxide; «fcc—Small doses constringe and harden the fibres, constipate the bowels, and blacken the stools, and even reduce and hard- en the liver and spleen. Like nitrate of silver, they form compounds with the organic tissues; they increase the fre- quency and force of the pulse, augment the temperature of ■ 708 POISONS AND THEIR ANTIDOTES, the body, and heighten the color of the cheeks, followed, ere long, by sinking and depression. Sulphate and chlorate of iron, in large quantities produce great heat, weight, pain and uneasiness in the stomach, and nausea, vomiting, and some- times purging and hemorrhage. Treatment. — Warm water vomits and employment of tha stomach pump. Antidotes for the muriated tincture of iron are the alkalies, as: chalk, magnesia, &c. Zinc — ZlNCUM. — Flowers of Zinc; Butter of Zinc; Sul- phate of Zinc (white vitriol).—The symptoms and treatment are the same as in copper poisoning. Bromine — Brominum.— Symptoms and treatment see Io- dine. Chrome—Chromium. — The chromate of potass and some other salts of this metal are extensively employed ia dyeing. When taken into the stomach they produce vomiting, griping and purging; debility and paralysis. Treatment — See Lead poisoning. VEGETABLE POISONS. Camphor.—In cases of poisoning with Camphor, give Coffee, without milk, till it brings on vomiting, and if all the symptoms do not disappear, Opium, a small dose every hour until they cease. Ergot—Secale cornutum—: Blighted corn.— Thick, black grains, in Indian corn, rice, wheat, rye, &c. The ill effects can be counteracted by the common black nightshade, bruised in cold water and then hot water poured on it. Inhale the vapor or use as a Wash. Mushrooms, poisonous.—The fly agaric, pepper agaric, deadly agaric, bulbous agaric, and champignon are the kinds of mushrooms from which poisoning most frequently results. None should be eaten from which a milky juice exudes, and none that are old, or dissolve readily. Taste them raw and if they have anything acrid or disagreeable either in taste or smell, do not use them. Several hours after poisonous mushrooms have been taken OPIUM. 709 they produce nausea, heat and pain in the stomach and bow- els, thirst, vomiting, griping and purging; hiccough; agita- tion; coldness of the limbs; numbness; small pulse; inco- herent talk and convulsions; stupor, delirium, cold sweats and death. Treatment — Promote vomiting and let the patient drink much cold water, as cold as it can be had; from time to time give finely powdered charcoal, made into a sort of paste with sweet oil. Poisonous juices. — External injuries from plants which exude a pungent, milky juice, are cured by Washing with soap- water and afterwards with brandy. If some of the juice has got into the eye apply the oil of almonds, unsalted butter or milk; if it has got into the stom- ach use soap-suds, milk, &c. Acids and Emetics are injurious. Should the above treatment afford no relief, let the patient smell of spirits of Ammonia. The remaining symptoms are mitigated by wine or coffee. The stomach pump and copious tepid injections may be employed with benefit. Allopathists recommend an Emetic of Sulphas vitrioli (six to ten grains) afterwards mild purgatives of oil and salts, and strong black coffee. After vomiting, 10 drops of liquid Ammonia, diluted with water are given. Opium; Laudanum; Morphine; Seeds of poppy; De- coction OF POPPY HEADS; PAREGORIC; BLACK DROP ; GOD- FREY'S cordial; Wine of Opium. Symptoms. Opium and its different preparations in large doses produce in some cases first great excitement; afterwards torpor; apoplexy; paralysis; cessation of respiration and circulation of blood; suffocation, death. In other cases loss of memory, stupidity; tremor; paralysis of single or several limbs. Treatment — Induce vomiting by administering large doses of strong black coffee alternately with vinegar largely diluted 710 poisons and their antidotes. with water, and tickle the throat with a feather. A tea made" of oats a teaspoonful taken frequently, also Camphor with lemon juice have been highly recommended. Externally ice should be applied to the head, and the ex- tremities washed with vinegar. The patient should be placed in the open air, and, in plethoric patients, venesection has been recommended. If the patient lies insensible, beat him hard on the back and fundament until consciousness is re- stored. Small doses of Ipecac, have been found efficacious in the treatment of remaining symptoms. Pink Root — Spigelia.—This medicinal substance is fre- quently given for worms. In large doses it produces palpita- tion of the heart, pain in the region of the heart, giddiness, nausea, arrest of breathing, &c. Treatment. — Give Coffee, without milk. Rhus radicus (Poison vine.) Pioson ivy. Rhus toxi- codendron (Poison oak). Rhus glabrum (Smooth Su- mach—Pennsylvania Sumach.) Rhus vernix (Swamp Sumach.) Poison vine is apt to cause a complaint similar to Erysipe- las. The exhalations of the plant are especially poisonous in the heat of the sun and generally produce burning, inflamma- tion, swelling and vesicles of the skin. Taken internally, it creates pain in the stomach, nausea, convulsions, increased urination, itching of the skin, vertigo, paralysis and swelling. Treatment of external poisoning. — Wash carefully with soap and water; rubbing with wheaten bran; dusting with hair powder. The patient should abstain from everything that is heating and stimulating. Small doses of Belladonna and Bryonia have also been used with some success. Allopathists recommend embrocations of white precipitate salve and internally Tartar emetic and Sugar water. Internal poisoning requires milk and oil. HELLEBORUS, 711 Belladonna—Deadly night-shade.— Symptoms.—Ver- tigo; convulsions, stupor, coma and delirium. Treatment—After vomiting, administer vinegar, externally and internally; and apply the cold pouring bath to the head, Aconitum — Wolfsbane or Monkshood.—Convulsions, partial paralysis, vertigo, often blindness, fainting, &c. Treatment.—Produce vomiting by a warm water Emetic and afterward administer vinegar and water internally and externally. In some cases strong coffee without milk is ben- eficial and the cold pouring bath applied to the head. Capsicum. (Spanish pepper.) Treatment. See Mushrooms. Cicuta—Water hemlock.— Symptoms and treatment see Belladonna, Cocculi indici — Indian Cockel.— Coma, violent head- ache, dryness in the pharynx, colic, spasmodic affections and loss of consciousness. Treatment — Emetics, Vinegar and Camphor. Colocynthis — Wild Cucumber. — Violent pains in the bowels, bloody discharges from the bowels, with inflammation, even gangrene of the intestinal canal. Treatment.—Decoction of Salep; almond oil; and other demulcents. Digitalis.— Symptoms and treatment see Aconitum. Euphorbium — Spurge.— Vomiting, purging, colic, in- flammation of the stomach and bowels. Treatment.— Milk; soap-water; decoction of linseed and other slimy remedies. Helleborus niger — Christmas-rose. — Symptoms: Numbness of the tongue, salivation, sensation of sufiocation in the nose, cutting in the stomach and bowels, vomiting, purg- ing, anxiety, headache, stiffness in the neck, delirium, spasms, hemorrhage. Treatment—A solution of potash, two drachms in a pound of water, with the white of eggs; strong black coffee, and later Almond-milk with Camphor. 712 POISONS AND THEIR ANTIDOTES. Honey prepared by bees living on poisonous flowers, often causes pains in the bowels and stomach, spasms, vertigo, &c. Treatment.— Frequent drinking of vinegar and water, after- wards a warm water emetic; smelling of camphor and rubbing with it; warm tea or coffee. Hyoscyamus. See Belladonna. Lolium temulentum.—Symptoms are those of narcotic poisons. Treatment — Emetics; later, vinegar with water; washing of the limbs with vinegar, cold applications to the head, and mucilaginous drinks. Mezereum. See Helleborus. Nicotiana—Tobacco.—Nausea, vomiting, frequent urin- ation, anxiety, vertigo, coma, fainting, even death by general paralysis. Treatment. See Belladonua. Nux Vomica—Strychnine.—Symptoms: Vertigo, coma, enlargement of the pupil of the eye, dancing before the eyes, crawling sensation along the spine; painful twitchings in the extremities, general debility; numbness of the limbs, death by paralysis. Treatment.— Emetics; injections to relieve the bowels; small doses of Opium; decoction of China; cold douches to the head while sitting in a warm bath; stomach pump; &c. Sabina (Savin).-—Antidotes: Oily mucilaginous drinks, sugar-water and Camphor. Stramonium ( G-ymson weed, Thorn-apple, Stink-weed). Treatment. See Belladonna. Sausage-poison.— The poison of fat generated in smoked sausages, badly smoked meat, blood-pudding, liver-pudding, half-putrified meat, bacon, hams, meat of sick animals,— par- ticularly if with eruptions, or disease of the bowels, is very injurious, and produces heart-burning, nausea, a sensation of dryness in the throat, extending to the mouth, the nose, ears, and even the eyes, and, after some days, cracking of the skin on the eye-lids, the sides of the nose and the points of tha CANTHARIDES. 713 fingers. The voice becomes hoarse; hunger and thirst, are very great, but the patient can hardly swallow anything. At the same time the abdomen is tight with much constipation and pain, eyes are very weak, and the knees and feet become stiff. The patient generally dies in a few days. Treatment.— Drink tepid water to produce vomiting, and, after the stomach has discharged its contents, give weak, di- luted vinegar internally, and use it as a gargle and general wash. Lemon juice is still better. When the patient is get- ting tired of the acid, give from time to time some sugar. Occasionally give a cup of coffee or strong black tea. We may also administer slimy injections with a little acid. Some Physicians recommend strong emetics of Ipecac, and cathartics of Glauber salts in water with olive oil and the white of eggs. At the same time Sulphur-baths, and inter- nally, five to ten grains of Kali sulphuratum in two pounds of water, drank when in the bath, will aid in the cure. Calcarea usta — Unslaked lime.— Antidotes: Lemon juice diluted with water; vinegar with honey and water; mu- cilaginous oily remedies. animal poisons. Hair of Caterpillars is apt to cause violent inflammation. Apply cloths which have been moistened with camphor. Shellfish, such as clams, muscles, and cockles are some- times poisonous, and produce vomiting, and other troublesome complaints. Encourage the vomiting; give charcoal with sugar and water, or, in molasses ; let the patient smell camphor and af- terwards drink coffee without milk. Poisonous fish.-—Give finely powdered charcoal with brandy ; afterwards, if not relieved, coffee without milk : then sugar-water, and, if necessary, give weak vinegar internally, and use externally. Toads Frogs, Lizards.—When the poison has got in the eye, rub in the saliva of a healthy person. In other cases use char- coal with milk or sweet oil, and let the patient smell camphor. 306e 714 POlbONS AND THEIR ANTIDOTE.-. Cantharides — Spanish flies and plaster made thereof,— Antidotes: Camphor, opium, and mild oily sub- stances; white of eggs, gruel, kc. The poison which is developed in fat, or cheese or old ham can be easily known by rubbing it on blue litmus paper, when, if the poison is present, the paper will turn red or red- dish. ( See Sausage.) Glanders in horses.— Anything soiled by horses which have the glanders, should be cleansed with chloride of lime, and exposed to sun and air for a long time. Flesh of cattle which had the disease of spleen is poison. Everything which has been in contact with such animals should be buried, or be purified with chloride of lime in water. When persons have been infected with the disease of the spleen, they feel first melancholy, weak and chilly; red spots, black in the centre show themselves on different parts of the body; they soon become bluish tumors, and terminate in in- flammatory gangrenous ulcers. The only remedy is quietness and strict diet; drinking much cold water, and the shower bath, followed by friction with dry coarse towels. POISONING BY EXTERNAL INJURIES. Stings of Spiders. — Smell camphor and wash with cold water. Holding the affected part near a hot fire, or a lighted cigar is recommended. Stings of bees or wasps.— Moisten the bites with saliva, and pass your finger-nail over them to extract the sting and the poison; then put on black garden mould, renewing it when- ever the pain increases; or rub it with honey, or scraped chalk. A raw onion cut in two, and a section of it applied to the affected part generally relieves all pain in a few minutes. The onion is to be changed every fifteen to twenty minutes. When a bee has stung the eye or mouth, apply honey and smell camphor. Aqua ammoniae, common salt and plantain leaf have been recommended. . -^tsar bites of snakes. 715 Musquitos may be, driven away by the smoke of brown sugar, strewed upon live coals or red hot iron, after some time let the smoke pass out and close the doors and windows. The bites of musquitos are healed by the application of lemon juice. Olive oil is also recommended. Bites of Snakes. — (Moccasin, copper-head, and rattle snakes.) All poisonous snakes have in their upper jaw two long large teeth. All serpents having two rows of teeth are not poisonous, and rubbing salt or gun powder in the wound is sufficient. If the serpent is venomous, tie, two or three inches above the wound, a ribbon, strap, rope, or the like, tightly around the limb and leave it as long as the pa- tient can bear it. Then bring a red hot iron, a coal or a lighted cigar as near the wound as possible. Change them frequently; do not blow the coal, and continue the heat until the patient begins to shudder and stretch. Remove the appli- cation when symptoms of poison return. If you have fat at hand, smear it around the wound three or four inches and when absorbed renew it. Whatever oozes from the wound must be carefully wiped away. Give inwardly some salt water, or as much salt or gun pow- der as will lie on the end of a knife, or a little garlic. If bad symptoms appear notwithstanding, give a teaspoon- ful or tablespoonful of wine or brandy, every -two or three minutes until they disappear again. If the spot turns blue, or spotted, or swells, make a poultice of ash-root and put it round the limb; give also an infusion of it to drink. Senega- root is also recommended. The poison may be sucked out. Immediately after the wound has been sucked, rub into it fine salt, or gun powder, chewing tobacco, wood-ashes, or whatever of this kind is at hand. Let the patient keep perfectly quiet. Another and successful mode of treatment is to make the patient drink freely of a strong decoction in milk of plantain andhoarhound, and apply a poultice of the same articles to the wound. Bites of mad dogs. —(See Hydrophobia.) 716 POISONS and THEIR ANTIDOTES. Wounds which have become poisonous in consequence of decayed animal matter or pus having got into them, require small doses of Arsenicum. Bites of Scorpion are relieved by the application of a little olive oil in which a Scorpion is kept. Poisonous gases. Gases contained in deep privies, old wells, caves, cellars, vaults, lime-furnaces and in places deprived of a current of fresh air, will — if inhaled — cause nausea, nervousness, diffi- culty of breathing, languor, coldness, convulsions and appa- rent death. Such places should not be entered without pro- per caution and previously purifying the air by lighted straw or gun powder. Persons exposing themselves should provide themselves with chloride of lime; some of it diluted with water will destroy the fetid gas. The bad smell is removed by throwing in a few shovels of quick lime. Treatment — ( See Asphyxia.) Dry Rot in Buildings.—The effect produced by dry rot in old buildings is similar to that produced by coal fire, only it operates less suddenly. The best remedy is to quit such houses. ADULTERATION OF FOOD AND DRINK. Bread.—Adulteration of bread by a large admixture of potash occasions dyspepsia and consumption.. In order Xo detect the potash, pour hot water over the bread till it is quite covered, and let it get cold; then put a strip of litmus paper into it, which has previously been drawn through weak vinegar, and reddened thereby. If it turns blue again, there is much potash in it. Adulteration of bread by Magnesia is injurious to people of weak stomachs. It generally is more or less bitter in its taste. By burning a pound of such bread to ashes you will find the Magnesia. By Alum.—Mixtures of flour and alum, or alum and salt, are intended to make white bread of inferior or spoiled flour. To detect this adulteration soak the bread in water, knead it KITCHEN UTENSILS. 717 till it dissolves, adding enough water to make it thin, let it remain over night, then strain it, boil it down and let it stand; the crystals of alum will adhere and you can taste it. By Copper. — This is the worst of all adulterations. It makes the bread uncommonly white, fine, large and heavy. When such bread is burned, the flame now and then burns green. To detect the copper soak some pounds of it in water, and add enough to cover the whole completely, let it get sour and stand until it becomes clear. If you suspend a rod of polished iron in it and this turns ever so little red, you may be sure that the bread is poisonous. Butter. — Adulteration of butter is accomplished by mix- ing it with sand, chalk or dye stuffs. Melt it in hot water and the foreign substance will be precipitated. Rancid butter is poisonous and should be thrown away. If it must be used let it be well washed in boiling, and then in cold water. Beer is frequently adulterated by mixing it with Nux vomica, Cocculus Indicus, Bitter-roots and Herbs, and Alum and Vitriol. — (See Bread.) Brandy, often contains an admixture of lead. Flour is adulterated with sand, plaster, etc. Burn some of the flour to ashes and you will find the white grains. Fruits.—Nuts become injurious when old and rancid, and occasion cough or diarrhoea. Raisins, figs and prunes, if they are covered with a white dust resembling sugar (in some instances it may be sugar) ought to be carefully washed first in cold and then in hot water. Gall of every animal is poison. Kitchen Utensils. — Earthen ware is often glazed with poisonous substances. Nothing acid should stand or be pre- pared in such vessels. Copper vessels ought never to be used for any thing that is sour; they should always be kept clean and polished, and whatever is cooked therein should be taken out immediately; 71S poisons and their antidotes. for while it is cooling it will be most likely to imbibe the poison. Tinned Utensils. — If during the process of cooking you suffer the tin to melt off, or the bottom of the vessel is scraped by the stirring of its contents with a spoon slow and tedious diseases will be produced thereby. Milk of diseased cows, or of those fed continually with dis- tiller's slops, is highly injurious to the health of the consumer. Paints — consist of metallic substances in a state of solu- tion which renders them so noxious. Salt — Kitchen-salt. — When salt, exposed to the air easily becomes moist, it is bad; and when an ounce of fine salt does not perfectly dissolve in four ounces of cold rain water, it contains plaster of paris and is injurious. Vegetables.—Poisonous, insects often infest vegetables, especially cabbage, or leave their slime upon them, which ren- ders them very injurious. Vinegar is often adulterated with Sulphuric acid, and adul- terated wine. Such vinegar will burn on the lips and have an acid taste in the mouth. It can be ascertained still more positively by dropping a solution of Potash into the vinegar, until litmus paper dipt in it no longer turns red. Pure vine- gar will then have lost its sharpness altogether, and only taste like salt or lye, while a fabricated article will remain of a sharp and acrid taste. Water—Poisonous Water.—Springs which are avoided by cattle and have a reddish or brownish sediment are inju- rious. Water from rivers, on which a little higher up there are manufactories; or water containing sulphurous or salty particles, and stagnant water from ponds or pools, ought not to be used. It commonly contains putrid particles and eggs of insects scarcely visible, which occasions tedious fevers and other diseases. When no other water can be had improve it by throwing into it powdered charcoal, shaking it well and straining it through a double linen or cotton cloth. chloroform and ether. 719 Bad wells ought to be well cleansed and covered. Pipes of copper, lead or zinc, used to convey water render it injurious, and you should always let as much water run out as may have stood in the pipes. Wine.—Wines may be adulterated with harmless or noxious substances; by water; by sugar; by brandy; by coloring mat- ter ; by lime or chalk ; by sulphur or brimstone ; by alum; by lead ; by corrosive sublimate ; by arsenic. Sweet oil is often adulterated with lead or copper. Dissolve liver of sulphur in water, and mix the oil with an equal portion of such solution ; if it turns brown or black upon being shaken, it is poisonous. Washes and Cosmetics, contain poison, and should never be used. True cosmetics are: fresh air and pure soft water. Chloroform and Ether,—When during the inhalation of these anaesthetic agents the face of the patient becomes suddenly turgid, cold water should be applied to the forehead and temples, suffering the patient to breath ammonia or con- centrated vinegar, allowing at the same time plenty of fresh air, and directing them to take full and rapid inspirations. Should the breathing become stertorous or distressed, desist from its use, until the natural breathing.is restored. A loud out cry, a distressing groan or other manifestations of pain, invariably pass off and need create no alarm. INDEX. Page. Abortion,....................595 Abortiva,.................... 9 Abscess,.................... 33 Absceesus lumbaris...........575 " alveolaris...........293 Abscess of the brain...........227 " " lungs..........503 " '•' liver...........306 " " eye............363 " maxillary.............406 Absence of mind..............120 Accidents....................638 Acidity .....................320 Acids........................23 Acne rosacea.................127 Adhesive plaster.............. 28 Adiposis.....................320 Afterbirth, retention of........597 Afterpains...................598 Agrypnia....................100 Ague........................ 77 Ague-cake...............358,402 Albino skin................. .182 Allopathy.................... 7 Alkalies..................... 23 Alopecia....................204 Alteratives................... 23 Amaurosis...................228 Amenorrhoea.................449 Amplyubia...................230 Amputaiion..................689 Anaemia..................... 37 Anaesthesia.................. 35 Anaesthetics.................. 27 Anasarca....................127 Ankyloblepharon.............230 Anchylosis...................192 Aneurism....................571 Angina......................309 " cardiacum..............503 " pectoris................503 " gangrenosa............311 " membranacea..........519 Ankle, weakness of...........585 Anodynes.................... 23 Anorexia..................... 321 Page. Anosmia.....................277 Anti-acids.................... 9 Anthrax.....................129 Anthelmintics...............22, 9 Anti-spasmodics.............23, 7 Anti-lithics................. 8 Anus, fissure of...............363 Anus, imperforate.............322 Antrum, ulceration of..........306 Aphonia.....................504 Aphthse......................285 Apoplexy....................205 " gastric & bilious......326 " of the lungs..........505 Anostema....................33 Apothecary weight............ 11 Apparent death...............638 Appetite, depraved............403 " voracious.............417 " absence of............321 Arteritis................-.....572 Arthritis.....................193 Arthrocace...................197 Artresia ani..................322 Arsenic......................"^4 Ascarides....................&7& Ascites...................• • -322 Asphyxia....................G38 " neonatorum ........599 Athemia nervosa..............35 Asthenopv...................231 Asthma.."---................506 " abdominalis......... .325 " thymicum.............510 Astringents.................23, 7 Atrophia.....................36 " gerutalium............452 " of the eyeball..........232 " mesenterica infantum . .325 " of the brain...........227 Backache....................626 Balanitis.....................453 Baldness.....................204 Bandages.................... 27 Barrenness...................500 Baths........................ 15 INDEX. 721 Page B*d sores____............___133 Beer, adulterated.............717 Bees, stings of................714 Births, plural................622 Black disease................404 Black cancer................. 57 Black eye....................240 Black vomit.................. 75 Bladder, inflamed............428 Blear eye....................249 Bleeding.................25, 683 Bleeding at the nose..........278 Bleeding from mouth..........293 " from lungs..........531 Blenorrhoea ventriculi.........328 " intestinorum. ,.....327 recti........_____327 Blepharitis scrophulosa.....„. .232 " erysipelatosa.......232 Blepharo-blenorrhcea..........233 " emphysema........234 " spasms.....>,.....234 Blindness, night..............245 Blindness, nervous.....;......223 Blue disease................. 43 " of infants.........604 Boil.........................144 Boil, malignant...............129 Bowels, hardness of...........401 Bowels, inflamed.............359 Brain fever...................216 Brain, tubercles of the.........225 " congestion of the........214 " inflammation of the......216 " dropsy of the............220 " hypertrophy of the.......222 " softness of the...........218 Brandy, adulterated..........702 Bread, adulterated............716 Breasts, inflammation of.......608 Breast, broken................597 Breasts, pain in the...........628 Breath, foul..................291 Bright's disease..............441 Bricklayer's itch..............151 Bronchitis...................511 Bronchocele..................314 Bruises......................642 Buboes......................453 Bulimia.....................417 Bullae.......................157 Bunion.......................585 Burns..............'.........£41 Butter, adulterated............~17 31 Page. Buzzing of the ears...........274 Cachexia;..................37, 54 Cesarean section.............637 Calculus of the eye........___235 " urinarius............ .419 " biliosus..............329 Callosity of the eyelids.......235 Cancer...................... 37 Cancer, soft................. 39 " black.................57 " of the nose.............277 " of the bone............187 " of the eye.............235 " of the tongue..........287 " lip..............287 " " testicle..........457 " " womb...........454 " ■" breast...........455 " " penis............457 " " stomach.........400 Cancrum oris........,.......288 Canker......................288 Carbuncle....................129 " on eyelids ».........236 Carcinoma.................... 37 medullare..........39 " alveolare........... 40 Cardialgia...................330 Carditis.....................515 Cardiostenose................515 Caries.......................184 Caro fungosa.................130 Cat's eye....................239 Catacausis................... 40 Catalepsy................... .101 Cataract.....................237 Catarrh......................277 " on the hand...........145 of the bladder.......... 425 " epidemic..............540 Catarrhus suffocativus.........516 " simplex............517 Cathartics..................21, 8 Cartel-pillar's poison..........713 Caustics.................... 9 Cephalalgia..................209 Cephalematoma..............208 Chancre.....................458 Change of life......>.'.........486 Chapped hands......'.........162 Chemosis.....................239 Cheek swollen................292 Chicken pox.................176 Child-bod fever............... 93 INDEX. Child-birth...................611 Chilblain....................131 Chirargra....................193 Chloroform...............27,719 Chlorosis....................,40 Choking at the gullet.........312 Choking fits of children.......509 Cholera, Asiatic..............334 '• infantum.............339 morbus...............332 Cholerine.....................341 Chorea......................102 Choroiditis...................239 Circocele....................501 Clap........................466 Clavi........................587 Clubfoot.....................586 Cold.....................42,517 " in the head..............277 Colic...........•............341 " bilious.................342 " lead...................342 " flatulent...............342 " menstrual...............462 Collodion..................... 28 Colonitis.....................345 Coma somnolcntum...........103 " vigil...................103 Combustion spontaneous...... 40 Comedones...................132 Compression of the brain.......214 Conception, theory of..........600 " prevention of........ 600 false................627 Concussion of the brain........212 Condylomata............425, 458 Congelation.................. 28 Congestion of the chest........518 of the head..........214 " " abdomen......345 Conjunctivitis............... .239 Constipation.................345 Consumption, nervous.........55 " of miners......... 69 dorsal............582 " of the kidneys.....443 " " bladder......444 " " womb.......491 " pulmonary........549 " quick............546 " of old age......... 56 " of the liver........406 " " larynx.......547 " bowels......362 " of mothers........604 Contusion of the vulva.........6U4 Convulsions..................103 " during labor........002 Cophosis.....................269 Corns.......................587 Corpulency.................43 Coryza......................277 " of infants..............604 Costiveness..................345 Cough.......................524 Cowpox......................176 Coxalgia................... -116 Coxarum morbus.............193 Cramp......................105 " of the stomach,..........330 " in the calves of the legs... 589 Craniotomy..................637 Crap-louse...................158 Craziness....................113 Cretinism....................215 Croup........................519 " false...................509 Crusta lactea.................132 Crying of infants..............604 Cupping..................... 24 Cyanosis....................43 " of infants.............604 " pulmonalis............523 Cvnanche laryngea............519 CvM.it.is.....*.................428 Dandruff.....................133 Deafness.....................269 Death, apparent..............638 of foetus.......605 " " of infants......599 " " from hunger ... 640 from a fall.....639 " " from lightning.640 « " from gases.....640 Debility..................... 35 Decay of children..............325 Decline......................325 Decubitus....................133 Deformities of infants.........605 Delirium tremens.............106 Dentition difficult............289 Diabetes.....................430 Diaphoretics................21, 8_ Diaphragmitis............... .52< Diarrhoea....................347 Diet..................•......29 Diet for dyspeptics............31 Dirt-eating..................351 Dislocations..................643 Diuretic*...................22, '.' INDEX. 723 Page. Douche bath................. 16 Doses....................... 9 Dressings.................... 26 Dropsy...................... 53 " of abdomen.............322 " in the skin.............127 " spinal..................577 " of the brain.............220 " of the eye...............246 " " scrotum...........472 " " womb.............474 Dropsy of the chest.......---537 " ovarian..............475 of the testicle.........472 Drowning...............• • • -^38 Drunkenness................. 58 Duodenitis..........-.-..-......351 Dyscrasie .,................. 44 Dysecoia.............••......269 Dysentery ..................352 Dysmenorrhoea...............462 Dysphagia...................313 Dyspepsia..................3o5 Dyspnoea...................528 Dvsuria.....................432 Earache.....................271 Ear, foreign substances in the. .275 " boring of the............275 " running of the...........2/3 Echymosis...................136 " palpebrarum........240 " conjunctive.........240 Eclecticism.................7, 21 Eclampsia...................103 Ecstasy......................i07 Ecthyma....................136 Ectropium...................242 Eczema......................134 Elephantiasis................ 136 Elephant's skin..............136 Emaciation.................. 36 Embryotomy............■ • • •-|637 Emetics.................... oo Emmenagogues............... 22 Emphysema..................137 pulmonum........^9 Empyema. .530 Encanthis fungosa........---241 " infiammatoria.......240 Encephalitis.................216 Endocarditis..................515 Enlargement of omentum......359 " mesentery.....359 " spleen........358 Page. Enteritis.....................359 Enteralgia...................341 Entero-phthisis...............362 Entropium...................241 Enuresis....................434 Ephelides...............137,605 Ephidrosis...................138 Epilepsy....................108 Epilepsia thoracica...........529 Epiphora....................243 Epispadias...................439 Epistaxis....................278 Epulis......................291 Ergotismus.................. 58 Errhines,...................22,8 Eruptions of children.........168 '' genital organs.......497 Erysipelas..................139 " of children.........142 Essern.......................143 Ether.................,,.27,719 Excrescence of the genitals.....464 Exfoliation............>..,.. .186 Exostosis................— .186 Expectorants...............22, 8 Eye, burst...................267 " watery..................243 » dry.....................268 " splinters in..............264 " black...................240 Eyelid, granular..............266 " inversion.............241 " eversion.............242 Face ache....................299 Face, paralysis of the .........298 Fainting.....................121 Falling sickness..............108 False conception..............627 Farsightedness...............243 Febris acuta.................. 70 " bullosa................. 157 " flava Americanorum ..... 75 *' lactea.................. 85 « lenta................... 92 " traumatica.............. 95 Feet sweating................591 Felon.......................145 Fetor oris.^..................291 Fever, bilious................ 70 Fever, camp................. 91 " catarrhal............... 74 " congestive intermittent... 84 " consumptive............ 96 " ephemereal.......-..... 74 72-f INDEX. Page. Fever, gastric................ 70 " hectic.................. 96 " infantile remittent........97 " inflammatory........... 76 " intermittent............ 77 " jail................... 91 " lingering............... 92 " malignant.............. 92 " mercurial............... 95 " mucous................. 85* " nervous................. 86 " puerperal............... 93 " putrid.................. 92 " remittent................ 70 " salivary................ 95 " scarlet..................163 " simple................. 70 " ship................... 91 " slow................... 86 '< spotted................. 91 " typhoid................ 98 " yellow.................. 75 Fever and ague............... 77 Fever-sores..................592 Fish, poisonous...............713 Fish-skin....................150 Fissures, abdomen............607 " anus.................363 Fistule......................44 Fistula cornea................244 " lachrymalis-............244 " in perineo.............436 " urinaria...............436 " vesico-vaginal..........464 " recto-vaginal...........465 " ani....................363 Fits................. .......103 Flatulency.....,.............362 Flesh, proud.................130 Flooding.................... 489 Flour, adulterated............717 Fluor albus..................482 Flux, bloody.................352 " white..................327 Fluxus hepaticus.............368 " cceliacus..............367 Forceps, obstetric.............635 Fractures....................665 of the skull..........218 Fragility of the bones.........187 Freckles.....................137 Freezing.....................639 Frog-tongue.................302 Frostbite....................131 Page. Fruits, poisonous.............717 Fungus, bloody............... 39 Furunculus..................144 " malignant..........129 Galactorrhcea.................531 Gallstones...................:<29 Ganglia......................147 Gangrena pulmonum..........531 Gangrene....................44 '' nosocomialis......... 46 of the brain..........219 Gases, poisonous..............716 Gastric fever................. 70 Gastric impurities............372 Gastritis.....................368 Gastroataxia..................328 Gastromalacia................371 Gastrosis.....................372 Giddiness........___...____225 Glass, swallowed.............682 Glaucoma....................245 Gleet........................466 Globus hystericus.............Ill Glossitis......................292 Goitre.......................314 Gonorrhoea...................466 Gout........................193 Gravel.......................419 Grease pox........ ..........147 Green sickness...............40 Grippe......................540 Grog blossoms................127 Gum-boil....................293 Gum-rash....................168 Gums, lancing of the..........307 Gutta rosea.................127 Hematuria...................437 Hematocele...................470 Hematemesis................372 Hemophthalmos..............245 Hemoptysis.................531 Hemorraphylia............... 49 Hemorrhagia................48 " traumatica......683 Hemorrhoea petechialis........156 Hair and its diseases..........219 Hair, falling off..............204 Hallucination................112 Hanging.....................638 Harelip......................294 Headache...................209 Heart, diseases of.............515 Heart-burn...................409 Heat, effects of............... 54 INDEX 725 Page. Beat eruption................134 Hectic fever. ,n.............. 96 Helminthiasis................378 fiemicrania ..............___209 Hemiralopia...............*. .245 Hemiopia.................. . 245 Hemiplegia..................118 Hemorrhage.,vu............. 48 of eye ...-....-......245 " from womb........489 " accidental ....*....607 " unavoidable ....... 607 " from wounds....... 682 " from mouth........293 " from bowels....»., .407 Hemorrhoids.................374 of the bladder......$08 Hepatitis ......v............ .382 Hernia..................»• • -386 Hernia humoralis.............479 " umbilical. . ... i....... • .392 Hernia, scrotal ...........'. —470 " labial.................470 Herpes......v.....-. i.,.. v.... 148 of theear............•••271 Herpes preputialis.............471 Hiccough....................411 of infants............608 Hipjoint disease............. -193 Hives.......................176 Hoarseness....,.....»i%..... .504 Homesickness................ 118 Homoeopathy .,............... 11 Hooping-cough...............534 Hordeolum,........».»»......246 Hospital gangrene............ 46 Housemaid's kaee............589 Humming in the ears.....,.. • .274 Hunchback, see Rickets. Hunger voracious.........---417 Hydarthms..................200 Hydatids.....................471 Hydrargyria .............. .. 135 Hydrargyrosis................ 54 Hydrocele................... 47 Z Hydrocephalus . ......■•......220 Hydrometra............. * •---474 Hydropathy........•.•*•--- ^ Hydrophobia---.........----49 Hydrophthalmia ....... ^.....246 Hydrops.....................53 " articuli...............200 " ovari................• 475 Hydrorhachitis ...............577 Page. Hydrothorax.................537 Hymen, imperforate...........477 Hypertrophy cordis...........538 " mamme..........539 " v sphincter ani......393 " ' of the tongue......293 " ovarii............475 " uteri.............475 "' oerebralis.........222 Hyperaphia .............. 150 HypOlympha................ .247 Hypopyon....................247 Hypospodias..........;.......439 Hypochondriasis ... ......... 110 Hysterics....................111 Icterus......................395 " infantum ..............397 " niger................-.397 Icthyosis.................... 150 Idiocv...,..,,...............H3 Ileus'........................397 Illusion......................112 Impetigo....................150 Impotence...................477 Incubus........... •..........112 Indigestion............. .399, 355 Induration of testicle..........478 Induratio tele cellulose.......142 Inflammation................ 54 Inflammation of the arteries... .572 " bones .... .,188 " brain ......216 " bladder---42* bowels.....359 " diaphragm.. 527 ears........,272 *« eyes....—251 eyelids.....232 gullet......317 heart.......515 " kidneys___441 " larynx.....541 labia.......479 « lungs......563 ■" liver.......382 ■« mouth......288 « muscles .... 57 « nose........283 « ■omentum ...405 « ovaries.....492 « peritoneum .406 «« psoas muscle 579 « pericardium 543 " pleura.....559 726 1NT)EX\ Page. Inflammation of the pandreas___405 rectum.....407 " spleen......401 " spinal cord. 579 " stomach.... 368 throat......309 tongue.....292 testes.......479 " uvula(palate)318 " vagina ....,479 " veins.......573 " womb..... .486 Influenza............,.......540 Insanity.....................113 " childbed___.........485 Insensibility.................35 Intermittent fever.....«....... 77 Intertrigo....................144 Intestinal concretion......;... 395 Intolerance of light............262 Inversion of the womb........ .460 Iodine.......................703 Ionthus ................,...J51 Iris, protrusion of the ......., .248 Iritis........................248 Ischias......................116 Ischidrosis...................157 Ischuria.....................439 Issues.......................24 Itch.........................160 Itching of the skin............159 anus s. piles and worms. Jaundice....................395 of children..........397 black.............397 Joints, inflammation of........197 Joints, pain in...............193 Kidneys, pain in.............443 " granulated...........441 Kin cough...................534 Kine pock....................176 King's evil...................63 Kitchen utensils..............717 Labia, adhesion of the.........449 Labium leporinum............296 Labour, abnormal............. 616 " management of........611 " obstructed............618 " powerless.............617 " unnatural.............616 Labor-pains, false.............606 Lactation....................624 Lagophthalmos...............249 Laryngitis...................541 pAGft. Ldryiigo-stenosc..............543 Lasciviousness.....:.........482 Lead colic'............t.. *... .349 Lead palsy..'..........t......118 Leech-bites..................684 Lentigo.....................137 Leprosy......................151 Lethargy, see sopor. Leucoma....................249 Leucorrhoea ..................482 Lice-malady........*........158 Lice of the head.....<........223 " eyelashes..........262 Lichen.......................151 Lienitis.....................401 Lienteria.....................402 Ligatures....................28 Lightning, struck by..........640 Limping.....................116 Lippitudo....................249 Lips, cracked...............295 Lithiasis...........,. <.......419 Liver-complaint............385 Liver, enlarged...............403 Liver, consumption of.........406 Liver-grown, see colds. Liver, pains in. See Hepatitis. Lochia, suppression of........625 Lockjaw.....................125 " of children...........125 Logophthalmos.........*.-... .249 Longings...................626 Looseness of bowels...........347 Low-spirits..................110 Lues venerea................. 66 Lumbago ...............578, 626 Lungs, diseases of............503 Lupus.......................151 Luxations---...........---643 Lymph-eye................... 247 Macule corneae...............249 Madness.....................113 Magnetism...................28 Malacia.....................403 Mania.......................113 Mania a potu.................106 Mania puerperalis........631,485 Marasmus...................55 Marks.......................626 Masturbation.................485 Maw-worms-..................378 Measles.....................153 Melena......................404 Melancholy, see low spirits. INDEJt. 727 Page. Melanosis.................... 57 Meningitis...................216 Menoposia...........» ......486 Menorrhagia...........,.....489 Menostasia, see amenorrhcea. Menses, suppression of....... .449 " retention of...........464 Menstruation, difficult.........462 Mentagra....................152 Mercurial cachexia............ 54 Mercurial sore mouth...»......295 Mercurial eruption............135 Metralgia....................486 Metritis.....................486 Melro-malacia................ 438 Metrorrhagia.................489 Midwifery...........i.......595 Milaria..................152,626 Milk, poisonous............. .718 Milk-crust...................132 Milk-fever................85, 624 Milk-leg.....................628 Milk, secretion of.............624 Milk-sickness.............95, 405 Miscarriage..................595 Miserere.................... .397 Mis-steps.......<............685 Mole........................156 Moles.......................627 Mollities ossium..............187 Monstrosities.................605 Morbilli.....................153 Morbus Brightii............. .441 Morbus maculosus Werlhofi---156 Mortification................. 44 " of bones.........187 " of lungs.........531 Mouth, diseases of............285 Mouth, sore..................286 Mumps.....................316 Mushrooms...................708 Musquitos...................715 Mustard plaster...............25 Mydriasis.................«• .250 Myelitis.....................579 Myitis...................... 57 Myopia......................251 Myosis.................• • • • -250 Nevi........................156 Narcotics.................... 7 Nausea......................416 Navus maternus..............156 Nearsightedness...........• • .251 Necrosis.....................187 Page. Nephralgia...........»......443 Nephritis....................441 Nervous shakes...............126 Nerves, injuries of............113 Nettle-rash..................176 Neuralgia...................116 Neuralgia of the face..........299 of the heart.........503 of the testes.........491 Night-mare..................112 Night-sweat »,,..............138 Night blindness..............245 Nipples, affections of the......627 Nitric acid.................. .701 Nodosity...................261 Noli me tangere..............151 Noma..........,........296,491 Nose, itching of the........... 280 Nose, bleeding of the.........278 Nostalgia....................118 Notalgia.....................579 Numbness................... 35 Nursing sore mouth...........627 Nymphomania...............482 Obesity......................43 Odontalgia...................297 Odontitis....................296 Oedema.....................157 Oesophagitis.................317 Onania......................485 Onyx...................589,251 Operations, obstetrical.........633 Ophthalmia..................251 Ophthalmia tarsi............261 " rheumatica.......260 " scrofulosa.........259 " purulenta.........258 Oppression during pregnancy .. 628 Orchitis.....................479 Orthopnoea...................516 Ostitis.......................188 Osteo sarcoma................187 Otalgia......................271 Otitis......................272 Otorrhcea....................273 Ovaritis.....................492 Ovary, enlargement of.........476 Overexertion.................686 Overheating..............54, 686 Ozoena......................280 Pack........................ 15 Pedarthrocace...............591 Pains, false, see Midwifery. Pains in loins................579 728 INDEX Page. Pains in breasts..............628 Paints.......................718 Painter's colic, see leadcolic. Palate, deficient......;.......299 " falling of the..., .......318 Palpitation of heart..;........545 Palsy..........,............118 Panaritium..................145 Pannus................ .... .261 Paracusis ,...................274 Paralysis....................118 Paralysis of the eyelids........233 " brain..........205 " " lungs.........516 " " bladder .......443 Paraplegia...................118 Paraphimosis................ .494 Parasytes.................... 57 Paresis......................118 Parotitis.....................316 Parulis...........,..........293 Pemphigus...................157 Pericarditis.................. 543 Perineum, laceration of the.....623 Periostitis...................189 Peritonitis...................406 Perniones....................131 Pertussis.................... 534 Pestis bubonica............... 96 Petechia;.................. . .158 Phimosis.....................493 Phlebitis........... ........573 Phlegmasia alba dolens........628 Phlogosis.................... 54 Photophobia..................262 Phthiriasis...................158 Phthisis renalis ..............443 Phthisis pulmonalis...........549 laryngea,.............547 " florida...............546 " hepatica.............406 Physometra..................494 Piles.... -..................374 Piles of the bladder...........439 Pityriasis....................133 Plague....................... 96 Plaster irritating.............. 175 Plethora, see Congestion. Pleurisy.....................559 " spurious..............562 Pleurodynia.................562 Pneumonia.................. 563 " typhoid...........566 bilious............565 Pagjl, Podagra.....................193 Poisons......................701 " animal...............713 ,c vegetable.............708 metalic...............704 " acids.................701 Polydipsia...................414 " ebriosa............. 58 Polypus of the nose...........281 "" ear............275 " womb.........495 Polysarcia ..................320 Porrigo___........___......159 Pot-belly---................320 Pox.........................66 Presbyopia..................243 Prickly heat..................134 Priapismus..................496 Proctalgia....................407 Proctitis.....................407 Proctorrhcea..................407 Prolapsus ani................ .408 " of the womb,........459 Prolapse of umbilical cord......622 Prosopalgia....................299 Prostatitis...................496 Prostate gland, enlargement of. .496 " abscess ........496 Proud flesh..................130 Prurigo..................... 159 " scrotalis..............497 " vulva....,...........497 Pseudopia........,.......262 Psoas-abscess.............___575 Psoitis........... ,v.........579 Psora.......................160 Psoriasis.....................161 Pterygium...................263 Ptosis.......................234 Ptyalismus.................301 Pulsation, abdominal.........409 Purpura.....................158 Putrefaction of the womb ......488 Putrid sore throat............. 311 Pyrosis............,..........409 Quinsy---...........<......309 Quinsy, malignant............311 Rabbit's eye.................249 Rachitis.....................189 Ranula......................302 Raphania.................... 58 Rash, see diseases of Skin. Rectostenose.................409 Retention of urine........... .439 INDEX. 729 Page. Retro version of womb.........461 Revery.......................120 Rhagades....................162 Rheumatalgia................59 Rheumatism................. 59 Rheumatic white swelling.....200 Rheumatism of the neck.......318 " back.......578 " heart.......569 " " womb......498 Rheumatismus, abdominal.....409 Rhupia......................163 Rickets......................189 Ringworm.................. 150 Ringworm of the scalp........223 Rollers...................... 27 Roseola......................163 Roserash....................163 Rot, dry, in buildings.........716 Rubefacients................. 8 Rubeola.....................163 Runround...................145 Running of the ear............273 Rupture.....................386 Rupture of tendons............6b5 Rupture of the womb..........481 Salivation...................301 Salt, adulterated..............718 Salt-rheum...................148 Sarcocele................478,498 Sausage, poisonous...........712 Scabies......................160 Scalds.......................641 Scaldhead....................223 Scarlatina...................163 Scarlet fever..................163 Sciatica......................116 Scirrhus..................... 37 Scorbutus....................303 Scorpion, bite of..............716 Scrophulosis................. 63 Scrophula................... 63 Scrotum, swelling of.........492 Scurvy......................303 Scurvy, land..................156 Sea-sickness.................410 Seat worms..................378 Semen, emission of............498 Setons.....................24 Shingles..................- • -150 Short-sightedness.............251 Sialagogues..................22 Singultus....................411 Sinking chills................ 84 Page. Slavering....................301 Sleep, deep...................121 Sleep-walking................121 Sleeplessness.................100 Small-pox...................177 Smell, loss of................277 Snakes, bites of..............715 Sneezing....................283 Sniffles ....................233 Softening of bone.............107 Softening of the brain.........218 " " stomach......371 Somnambulism...............121 Sopor........................121 Sore mouth, mercurial.........295 Sore throat...................309 Sour stomach................320 Spasms......................103 Spasms of the eyelids.........234 " urethra.........426 " " vagina..........500 Spermatorrhoea...............498 Spiders, stings of.............714 Spina ventosa................187 Spina bifida.................577 Spinal curvature..............576 Spinal irritation..............580 Spirits, low..................HO Spitting blood................582 Spleen......................H° Splenitis....................401 Splints.......................27 Sprains......................Doa Squinting........;........• • • -264 Stammering..................305 Staphyloma cornee.. ". .......263 Steatoma.....................169 Sterility.....................500 Stiff joint....................192 Stiff neck....................318 Stillborn....................599 Stimulants.................22, 7 Stomacace, see Canker. Stomach, weak...............355 Stomach-cough...............415 Stomach, induration of........400 Stomatitis...................285 Stomatitis, mercurial..........295 Stomatitis, pustular...........288 Stone in the kidneys..........419 Strabismus...................264 Strangury.....-.,............432 Strictura urethre.............***> Stricture of the rectum.........393 730 INDEX. Page, Strophulus...................168 Struma......................314 Stumps, affections of..........700 Stuttering...................305 Stye.........................246 Suckling, see Lactation. Summer-complaint............339 Sun-stroke....................640 Surgeon's knot............... 28 Sutures...................... 26 Swallowing of hot liquids.....686 " foreign substances 686 Swallowing, difficulty.........313 Sweat, morbid................138 Sweating feet................591 Swelling, air.................137 Swelling of the scalp..........209 Sycosis......................152 Symphyseotomy..............637 Syncope.....................121 Synocha..................... 76 Syphilis..................... 66 Syphilis of infants............ 69 Tabes metallica............... 69 Tabes sicca.................. 55 Tabes dorsalis................582 Tenia.......................412 Talipes......................586 Tapeworm....................412 Tartar emetic, poison..........705 Tartar upon the teeth.........305 Teeth, crowded...............306 " decaved................185 " filling of the............308 Teething, difficulty...........289 Tenesmus....................414 Tents....................... 29 Testis, atrophy of.............501 " abscess of.............500 swelled...............478 Tetanus......................122 Tetanus traumaticus..........124 Tetter...................148,271 Thirst, morbid...............414 Throat, sore...............311 " wounds of............318 " foreign substances.....312 Thrush.......................285 Ticdoloreux.................299 Tinea capitis..................223 Tissic.......................506 Toe-nail, inverted............589 Tongue-tie...................306 Tongue, wounded.............307 Page. Tongue, enlarged..............293 Tonics.....................23, 7 Tonsils, enlargement of.......315 Toothache...................297 " during pregnancy ... 628 Torticollis...................319 Tourniquet.................... 28 Touch-me-not.................151 Tracheitis....................570 Trachoma...................266 Trance.......................107 Trembles.................95, 405 Trembling of the feet..........592 Tremor........................126 Trismus......................125 Trismus nascentium...........125 Tubercles of the spine..........583 " " lungs ........570 " liver...........414 " " brain..........225 Tumors......................169 " ofthescalp............208 Tumor albus genu..............200 Turning (child-birth)............634 Tussis.......................524 Twitching of eyelids..........266 Tylosis.......................267 Tympanitis........~.........415 " of the womb.......494 Typhoidfever................ 98 Typhus......................86 " putridus.............. 91 " abdominalis............91 Ulcers.......................171 " of the legs..............592 Umbilical cord, shortness of.... 622 Urethra, imperforate..........447 Urethritis....................466 Urine, incontinence of.....434, 610 Urine, varieties of.............447 Urine, acrid..................446 " erratic..................446 " suppression of...........445 " retention of.............439 " bloody..................437 Urinary diarrhoea.............444 Urodralysis..................446 Uroplania....................446 Urticaria....................176 Vaccination..................176 Varicella.....................176 Varicocele....................501 Varicose veins................573 Variola......................177 INDEX. 731 Page. Varioloides"..................181 Varix.......................573 Vegetables, poisonous.........718 Venesection.................. 25 Venereal disease, see Syphilis. Verruce.....................182 Vertigo......................226 Vesania......................113 Vesicatory..................25, 8 Vinegar, adulterated..........718 Vitriol......................704 Voice, loss of.................504 Volvulus....................416 Vomiting....................416 of blood..............372 " during pregnancy.....632 Warts.......................182 " on the eyelids...........267 Water, poisonous ............718 Water, canker................296 Water-brash..................409 Weaksightedness ... .........231 Weaning....................632 Web........................263 Webbed fingers...............183 Wen........................183 Page.. Wet-sheet pack............... 15 Wetting the bed..............434 Whelk......................151 Whites......................482 White leg....................628 White swelling...............201 White rheumatic swelling.....200 Whitlow.....................145 Whooping cough..............534 Wind dropsy.................415 Wine, adulterated.............719 Wolf........................151 Womb, rupture of.............481 falling of.............459 " displacement of........459 " softening of...........488 Worms......................378 Wounds.....................686 of throat..............318 " of abdomen...........418 " of extremities.........593 Wryneck....................319 Xeroma.....................268 Yellow fever................. 75 Zona........................183 Zoster.......................183 ! FORCEPS USED IN THE OPERATION FOR STONE. .LITHONTRIPTOR, (SEE STONE OR GRAVEL.) VIALCORK, USED IN THE TREATMENT OF FISTULA. HOLDING AND USING THE SCALPEL WHEN DISSECTING. HARE-LIP (LABIUM LE- PORINUM.) TWISTED SUTURE, (SEK HARELIP.) DOUBLE CANULA—USED IN THE REMOVAL OP POLYPUS. INSTRUMENT ESED IN THE EXCISION OP ENLARGED TONSILS AND UVULA LALLEMAND S PORTE-CAUSTIQUE. * CURVED NEEDLE — USED IN THE OPERATION FOR FISSURE OF THE PALATE. HOLDING AND USING THE SCALPEL WHEN DISSECTING. NLM010016794