Class PT' llJil. Book„^ u^y rfejS? •TNI *&">© IVJateria lVjeeJica, *?s ancjl 'Pharmacy. vj£ "TfTj. LYLE, A. U. M. D.fl ;'< Prot'tssot of Therapeutics and Materia Medica in Cliica- ;./tfi and Sanitai y S< :innati. Ohio. *. ana Prof. W. F. Pe- chuman, A. M., M. 1).,L L. I).: also (*. H. Mayliugn. M. D. Editor of "'Sanative Medicine.'* & .J. M. Massie, M. L>.. have each contributed valuable articles to this volume, while some have contributed some of their most valuable formula;. I also take pleasure in mentioning the fact that some of our eminent and reliable Pharmacists have willingly given a helping hand. Medical Literature is immense, and I do not forget to acknowledge that in these many years 1 have gained much information from an extensive reading of Medical .Jour- nals of all Schools or' Medicine: of Encyclopaedias and various Medical Volumes: of Dispensatories and other volumes of Materia Medica and Botany. In all the departments of this book 1 have aimed to give the latest, tie best and the most practical information. Herein I have mentioned many new agents, some of which are very valuable and some not so valuable. I have spent much time and money with these agents and have patient- ly watched their influence under various conditions. Some of these have not been equal to our anticipations, while others may now be considered among our best agents. Our ideas concerning some of our older agents have also changed, both with regard to their intrinsic worth and their relative application. In the future as we shall- know more of the knowable, we may think differently of some agents than what we now think. I claim infallibility for neither myself nor this Book. Careful investigation may cause us to change our opinions concerning the various influences of some of these agents, but the principles of Scientific Medication are the same yesterday, to-day and forever. No theory of Medicine can be Scientific which seeks to destroy or dethrone Vitality, hence Physio- Medical ism is the School of Scientific Medication: for Medicine is Scientific only as it seeks to sustain struggling Vitality. One thing I earnestly ask of the entire Profession. Carefully note your investigations and whatever in the line of Materia Medica you find new and practical report to me. And as I propose to add to this Book an annual appendix, should encouragement favor, I shall be pleased to publish briefly the results of these investigations there- in. In rending these pages the critic's eye of course will be present. Hut while we pass along the road from Jerusa- lem to Jericho allow not yourselves to represent either the priest, the levite or the robbers, but act the part of the Good Samaritan. Together we stand upon the same level, judged by the plummet of truth, and as we pass together along life's pathway we may by united effort bring forth the beautiful keystone for the triumphal arch of success. As a student of Vitality. I have solved a few problems: I have gathered a few facts from the great ocean of truth that lies before us. These I hand to you in the hope that thereby you shall be able to drink the more deeply from the great fountains of Medical truth. Proclaim the truth to others, that they in turn may do good to succeeding generations. "Lives of great men aU'remind you You may make your lives sublime. And in dying leave behind you, Footprints on the sands of Time." SALEM, OHIO. March 4th. 1897. PHYSIO-CD EDI O A L. THERAPEUTICS. '*» gWplie true physician is a wonderful being, whose call- rl%m^\ng is, second to none. He deals with human physi- , r ^ . leal and more or less moral defects. Indeed. J man's weal or woe to a great extent, is in his hands. If he ignorant, woe be to humanity. He cannot be too intelligent in his profession, lie musl be a continuous student, if he keeps abreast of the times. He must realize that there are others in the world- who know some things as well as he, that there is room for him to improve, and that there is some information vet for him to gain. Let him be assured that the r e is room for him at the top if he will but put forth the effort to attain it. Besides the knowledge of drugs, there are other things in which the physician must be proficient. He must be a thorough student of human nature and a thorough physi- ognomist. He must be wise in reading abnormal conditions, and be capable of reading character and of diagnosing on sight the conditions present in his patient. This will gain for him at once the patient's confidence and is extremely helpful in the physician's art. Beware of deceptions, for remember you are everybody's confidante. Be swift to hear everything: be quick to observe everything; but be slow to spe?k anything. Always tell the truth, but not always the whole truth. Do not make light of your patient's ailments, they believe they are sick, and that itself is a disease and needs your attention. Bookknowl- edge is good, but that gained at the bedside is frequently to be perfered, The results of a scientific experience are very valuable. The physician should have good common sense, good morals and a thorough medical and literary ed- ucation. Then too he should have a true love for his pro- 18 THERAPEUTICS. fession, and possess a magnetic affability. A little fun. a good joke, a pleasant anecdote, and a little laughter will often do your patient good. Never approach your patient with a long face. Be positively correct in your diagnosis, it is unpleasant to be compelled by force of consultation or otherwise to change your diagnosis of any case. Be scientific in the ap- plication of your remedies. "Be sure you are right then go ahead." Physiology is the science of life, its normal development and preservation. Health is physiology asan art,— a sound. unobstructed condition of the organism. Disease is defect- ion physiology, — an unsound and more or less obstructed condition of the whole organism or of some parts or part. Study well the manifestations of the vital force in health as well as in disease. Carefully differentiate these mani- festations, determine their signification and seek to restore to the normal condition. Let the manifestations of the vital force be > our guide in diagnosis, in prognesis and in the art of curing. Therapeutics relates to the discovery of remedies, the determining of their medical properties and of their ap] li- cation in restoring from diseased conditions to a state of health. Medical history is full of therapeutical schemes — some very foolish and some seemingly very wise. Some practical. some impracticable, and some a mass of arbitrary dictums. It is not then surprising that some are unreliable. This unreliability has given unrest to the medical mind, and given rise to the assertion that medicine is not a science. Some minds have built up and some have torn down. The dethroning of one opinion has give*" room for the enthron- ing of another. The present stands upon the ruins of the past; and man is still searching for truth. Ma iy medical systems have been founded upon imper- fect data, yet many have been their followers. All systems have had their gifted minds. But some rreconceived fad, some false premis or some pre-desired conclusion have 1 pre- vented these gifted minds from always reaching correct conclusions. Because we differ from others, we do not brand them ignorant, but rejoice in the fact that we live in an age of great research and of wonderful knowledge. We are pleas- ed to note the many intelligent persons who stand in the THERAPEUTICS. 19 lead of other schools of medicine. We simply say these men are more or less mistaken, and hope that the day will soon come when they too shall behold the beautiful light of truth and pronounce medicine not a mass of arbitrary dic- tums, but, in truth a science, Since Hippocrates, who has been called the father of medicine, of 400 B.C. many systems have arisen, among those that remain, the leading are the Regulars or Allopaths the Homeopaths, the Eclectic^ and the Physio-Medicalists The Regulars would have us cure a diseased action by in- ducing a different kind of action, though not necessarily diseased action. They claim that therapeutics is not a science, that it is uncertain and dependent upon the skill of the practitioner. Once they called disease an evil spirit and attempted cure by incantations. Then they thought that the fluids and solids of the body had changed, and that the fluids had left their proper places in the body, or had become disproportioned. Then came experimental therapeutics, statistical therapeutics and experiments on the loweranimals. All left them in more or less uncer- tainty, and hence to them medicine was necessarily some- what empirical. Galen was the man guilty of formulating the scheme of substituting an artificial diseased action for the dis- ease itself. Such always led to the reduction of vitality, landed the patient into more or less asthamia. resulted in protracting the period of illness and led to so many heart failures. These are the men who seek the protection of Uncle Sam to prevent others from practicing medicine who do not believe as they. Not unfrequently one extreme begets another. The Homeo- paths under Hahnemann arose and shouted '"Similia Simil- ibus Curantur''; — as medicines given to the healthy cause certain symptoms, they will cure disease showing similar or like symptoms. They would have you give arsenic or copper to cure diarrhoea, because such produce diarrhoea in the healthy. They would have you give strychnine for spasms beause it will produce spasms: or muriatic acid for hectic fever because it will produce similar results in the healthy. Why then not cure one drunk by inducing an- other drunk in the same person? The Eclectics elect from each school as their experience seems to indicate. They give medicine because its effect is opposite to or opposed to the diseased action. They hold 20 THERAPEUTICS. that remedies contain a force which set free in the body has the power to bring it back to that condition called nor- mal. They call disease an, excess, a defect or perversion. They say a medicine lessens an excess, restores a defect or changes a perversion to the normal standard. Physio-Medicalism is medication in harmony with true Physiology, recognizing in all conditions the indications of the vital force and hence abstaining from all poisonous medication, believing that whatever has for its tend- ency to kill cannot have for its tendency to cure- In Anatomy, Chemistry and the use of the surgical knife we hold a general agreement with other Schools of Medi- cine; but we differ more or less in Physiology, Therapeu- tics, Materia Medica, Medical Surgery and Practical Medi- cine. We teach Physiology as the basis of Medical Pract ice and demand that the laws of human life and functional activity must be thoroughly understood. The human body must be regarded as a highly endowed vital indepen- dence by virtue of an inherent vital and living plastic mat- ter, which is the sole causation of any function. By virtue of this vital force and living matter, the body is able to maintain its functional integrity against ordi- nary adverse influences. But when over-powered, function- al work becomes more or less disturbed. Then the resist- ive effort of vitality is manifested in repelling or elim- inating the producing cause To aid the vital force in these restorative efforts is the work of true medicine from the hand of a true physician. Toxics, irritants, or narcotics tend to destroy bioplasm, to weaken functional power and to foster chronic ailments in the body in place of the dis- ease they were intended to remove and hence are improper agents to be used as medicines. xVnything that can deprive the organs in part or wholly of their ability to act normally is a cause of disease. That inability is the disease: and the cure is the restoration of these organs and tissues to their normal condition. Much has been said of baccili, but these are usually harmless: the posionous element in which they thrive is the cause of further disease and is the con- tagium. It is apparent that the mass of medical men are thera- peutically at sea. In order that we may behold an appro- priate superstructure it must be built upon a true founda- tion. See with what avidity medical men have allowed themselves to run after therapeutical sensations. The THERAPEUTICS. 21 Brown-Sequard Elixir tor the rejuvenation of the race pro- duced a wild sensation; Koch's tuberculine was to be the eradication of consumption; and now antitoxine and se- rum theraphy are among the fading wonders. I grant honor to him who for the welfare of man becomes a patient investigator. But where is the trouble? Not in the intensity of the effort, but in the conclusions that are drawn from incomplete or incorrect premises. You need not search for gold in a dung hill; the proper place must be sought. Yellow glasses make all things look yellow: hence investigation must be conducted through the media of cor- rect premises, in order to reach correct conclusions. The physical basis of life is vital and not chemical. The conservation of the vital force is the pivotal point in thera- peutics. No agent harmful to the physiological unit of an. imal life, the proto - plasmic cell, must find a place in our Armamentorium Medicorum. Medicine must have a rational and scientific basis, a cor- rect anatomy and physiology. Physiological phenomena are dependent upon vital action. Chemical and other forces may and do act at times and under certain circumstances, within the organism, but their resulting phenomena do not constitute vitality. Before us are two existing facts, matter and force. Force is substantial, inherent with and inseparable from matter. Gravitation is the force one body has to attract another body in proportion to its size and density. The force of grav- itation is constant and the larger and denser the body the stronger the force, Then too, we have the force of electric it, v of magnetism, of heat, of light and of vitality. Eve^thing in the universe is in motion and governed by force of one kind or another, or by two or more forces combined. Heat is the great force in nature in opposition to gravity. Heat carries material things from the earth, can be seen, and is substantial. Heat is an attenuating foice and is the most important remedial agent in the whole Materia Medica. The properties of a medicine constitutes its force: and so of a food. The force of plant growth is absorption. The force of a substance gives character to that substance. The force of an agent when administered changes the condition of the man. Living matter is the seat of vital action, non-living mat- ter is the seat of chemical phenomena. When the vital force deserts living matter ,then chemical force decom- 22 THERAPEUTICS. poses and breaks it up into compounds. Matter assumes one of three forms; Matter about to become living, Matter actually living, or Matter that has lived. Such is the conversion ot pabulum into bioplasm and sub- sequently into formed material. The first stage of life in all forms of organism is bioplasm which is transparent, colorless, structureless and semi- fluid, exhibiting certain peculiar motions, changes of shape and dimensions as influenced by the vital force and sur- rounding circumstances. But the vital force dose not act thus on any other form of matter. Pabulum is fluid, but a reduction in volume takes place when converted into bio- plasm, and a still further reduction takes place in being converted into formed material, hence the necessity for the regular supply of proper pabulum. In condensation bioplasm is formed into cells or tissue elements. These cells unite in definite arrangement and form tissues, structures, organs and the living body. The motion observed in living matter is vital action and the result is function. There can be vital action and no function, because there is living matter, where there is no structure, without which there can be no function, and yet there is vital action. The ultimate intended result of all organism is the re- production of its kind, and the starting point is bioplasm. Food subtances are such as furnish proper pabulum for the sustenance and reproduction of bioplasm during nor- mal action. Remedies are substances whose constituents are es- pecially adapted to arouse and sustain extraordinary act- ions of bisplasm during disease. A poison is a substance having an inherent deleterious property, rendering it capable of destroying life in some degree by whatever avenue it is taken into the system. A substance ordinarily capable of destroying bioplasm can not be classed as a true remedy. Poisons produce disease: they are given for that purpose; hence their presence in the system is physiologically criminal. True medicine acts in harmony with the wants of the vital force in it's opposition to disease. The one legitimate object of medicine is the res- toration of the diseased body to a state of health. This is the line of action of the vital force and when nature calls for THERAPEUTICS. 23 help, true medication must answer that call by harmonious action. Vital action arouses all its energies to resist dis- ease and prevent death, thus frequently cures are effected without medicine. Blood, bone and muscle cannot be fur- ished by any chemical process; but by suitable pabulum for bioplasm which shall beome formed material and organic structures, Id the blood we find fluid plasma holding in solution nutrients for the white blood corpuscles which are semi-fluid, converting digested food substances into its own substance and finally into red blood corpuscles which carry oxygen throughout the entire body and maintain vitality. All things influence the organism either favorably orun- f a vorably, either increasing or diminishing the chances of life by the supply of proper or improper pabulum. These chances are also varied by external circumstances, changes of temperature, violence, habits and labor. In the work of restoration the attempt must be to re- store to some extent the opposite condition of that abnorm- ally existing. If the parts are congested apply heat and relieve the circulation. If the body is emaciated give proper food and sustain digestion. If there be too much relaxation stimulate to the relief of such abnormal relax- ation. If there be too much rigidity, relax to the relief of that rigidity. Diseased tissues are already weakened; and agents that carry the tissues from the normal will act as still farther causes of disease, because the diseased parts are more or less incapable of resistance. Narcotics benumb the body disable bioplasm, debilitate the heart, weaken the nerves and interfere with a speedy recovery. Narcotics may and do ease pain; but they debil- itate the vital force at the time she needs all her energies. Do you recognize an imperfect or perverted act of the vital force? Do not narcotize but determine the cause; as- certain the necessities cf the vital force and medicate ac- cordingly, with the utmost discrimination. Excitement is a function, excessive in action because of some injurious impression having been made, but that ex- citement is the grand medium for the removal of obstruc- tions, and for the maintainence of[normal action. So with fever and inflammation. They are but indications of na- ture for your guidance in order to proper medication. Na- ture throws her special energy where most needed, so 24 THERAPEUTICS. with a cough, it is a vital act for the purpose of removing some offending substances from the lungs, bronchi, or larynx. To narcotize the patient so that he cannot cough might leave nature helpless in the presence of dangerous substances she by that cough is trying to dislodge. It is better that functional disturbances exalt thesystem above normal, then that the whole system be so depressed that the circulation be below normal. Either condition would respectively express the resistive power of the vital force. Departure from the normal may be in extremely var- ied degrees, and remedial measures must be similarly varied. Different parts of the body may be in different-conditions at the same time; thebow T els may be tense and the skin lax: the head may be hot and brain hypersemic and the feet cold; the heart pulsations may be much above normal and yet the surface may not be hot, even warm; there may be a tense uterus while the limbs are cold and clammy. Some organs that are closely related may be either sim- ilarly or dissimilarly affected. Both liver and stomach may be relaxed, and yet we frequently find the stomach relaxed while the liver is tense and engorged. The uterus and urethra may both be influenced or the one only may suffer inflammation. The human system is a most wonderful commingling of tissues, structures and organs demanding most careful study of him who would be a physician, and yet in the art of curing disease we can but influence to contract and re- lax with varied degrees of rapidity and energy in imita- tion of nature's way of useing these structures in health. Remedies must be combined according to the structures to be impressed, and in strength or dose according to the remedial impressions desired. Make your compounds as sim- ple as possible. Do not think that because from 25 to 50 drugs are combined in a preparation that it is a panacea. Three principles of influence pervade the entire science of medicine Relax, Stimulate. Astringe- These three well applied are your passwords 10 the inner sanctum of success. The * hole person or some of his parts may be too rigid as we find in hysteria, convulsions, chordee, tet- anus, or stiff neck. Here our medication must be of a relaxing cbaiacter. But the whole person or some part may be too much relaxed as in anaemia, night sweats, paralysis, chorea apoplexy, epilepsy, nervous prostration, diarrhoea, or leu- corrhcea. Here there is a necessity for medication that will THERAPEUTICS. 25 be stimulating and sustaining to nerve sensibility. In the treatment of disease make your patient's food subservient to your medication. Have proper food, proper- ly prepared and regularly given. Then both food and med- icine will become instrumental under the vital force in the restorative act Some foods are stimulating in their nature as graham flour, beef, beets, cranberries, parsley. sour apples, pie plant. Some foods are astringent as boiled milk, thickened milk, fine flour, crab apples, arrow root. Some foods are relaxing to the system, as turnips, sweet apples, asparagus. Great care must be taken that the pat- ient be nor led too much. More food can be given than can be assimilated, or the wrong class of foods may be giv- en. An excess of either food or medicine, or the wrung kind of either food or merUcine though either in themselves may be innocent, may place tissues in such condition that for the time being they can be but imperfectly used by the vital force. What folly it would be to use lobelia in paralysis or apoplexy; or to use asclepias tuberosa in malig- nant diphtheria; or to use tannin in case of constipation. Each food or medicine holds a more or less fixed relation to the organism, and expends its influence on particular tissues or organs. Syr. juglans cinerea especially influences the lower bowel: leptandra virg. influences the liver tubu- li: ipomea jalapa influences the alvine mucous membrane: eupatorium purpureum influences the kidneys and asclep- ias tuberosa influences the skin. This will ordinarily be as true if these agents, two or more of them, be combined as when used separate. But how shall we form a correct estimate of an agent as to its remedial effects in order to our selection of a sanative remedial agent. No correct estimate can be formed usually unless there be numerous observations of the influer.ee of the agent by itself. The effect of large and small doses must be carefully observed as also the cumulative effect of continuous doses. The patient must be carefully watched to see if the vital force gives a favorable or unfavorable re- sponse. Can it be given persistently without any destruc- tive influence to bioplasm. Here the skillful use of the mi- croscope is very valuable. Then too we must take into consideration that chemical union may have much to do in forming innocent compounds out of otherwise deleterious substances. 2(1 THERAPEUTICS. Let us take a few examples of substances that are ordi- narily used as medicines. Strychnine acts quickly, within ten or fifteen minutes- The person first complains of stiffness about the neck and presents the aspects of terror. There is an impression of calamity or death. Soon the head is jerked back, the limbs extended, the back tetanic and the mouth drawn, in a few minutes these symptoms pass and there is relaxation, but on the slightest movements of the body these spasmodic efforts return, and usually continue tell the body siiccumbs in about a half hour. One forty-thousandth part of a grain of strychi ine will destroy living tissue. Such is its action in death toxic doses. We could not recommend this agent. Aconite and its alkaloid aconitine will prove fatal in 1-16 gr. dose. It produces a peculiar burning, tingling and numbness of the parts to which it is applied. Large doses pro- duce violent vomiting and more or less paralysis of motion and sensation, great depression of the heart and death from syncope. Intelligence remains until the last. This drug is not such as we could recommend. Belladonna and atropine dilate the pupils, and give a rapid pulse, a hot, dry, flushed skin, and an eruption sim- ilar to scarlatina, soreness of throat, difficulty of swallow- ing, intense thirst and a gay mirthful delirum. Neither could we recommend this agent. Chlorine 8f Bromine are powerful irritants. Inhaled fumes provokes spasms of the glottis and then induces in- flammation of the respiratory mucous membrane, which may prove fatal. These drugs we could not recommend. Mercury (Hydrargyrum) is given internally, chiefly for two purposes, to check inflammation and promote absorption and to antagonize syphilitic virus. In continued doses it produces salivation, first giving a metalic taste, then soreness of the gums, an undue flow of saliva and foetor of breath. Then come swelling of the tongue, ulceration of the mouth and disease of the jaw bones. The blood be- comes impoverished and the loss of flesh and feverishness ensues. Its action on the liver is uncertain. Inhalation of its fumes gives tremor of the nerves. Calomel (Hg. CI.), subchloride of mercury is one of the mildest forms of mercury. Et acts on the secretory or- gans and stimulates the Kver and intestinal glands to in- creased activity. Jalap is usually added as a purgative. THERAPEUTICS. 27 Calomel increases hepatic action and thence peristaltic acti6n, but it exhausts the liver by excessive stimulation and leaves it more or less congested which may lead to to chronic enlargement, tenderness, hardening, abscesses and cancer. Hence we could not make this agent a part of of our materia medica. Opium gives at first a feeling of exaltation. Then symptoms of cerebral congestion with face suffused or cy- anosed and pupils contracted with skin hot and dry. breath- thing slow, deep and finally stertorous. In approaching unconsciousness the person may be aroused by shouting in the ear and then will respire more rapidly. Then comes prostration, coma more or less profound, pupils become pin- points and then widely dilated toward the end of life. Res- piration now slows, the face becomes pallid and cyanosed and a heavy perspiration follows which is at first warm and then cold and clammy. The pulse increases and then feebles Mich is the action of opium in death-toxic doses. It carries every tissue into a dangerous state of insensibility, and hence cannot be considered a part of our materia medica. From these illustrations it is evident that poisons destroy bioplasm and carry the organs farther from the norma] standard, at least removes them more or less from under the control of the life power. Taken internally orapplied ex- ternally they produce disease and lengthen the period of sickness. We must confess that some poisons may be used for a time with seeming advantage. Calomel secures he- patic discharges and morphine usually secures sleep. There are times when such results are necessities. In fact many persons do take poisons and yet they live; and at times it would seem to be to some advantage in the restor- ation of certain faculties. How is it possible that we should destroy true life to save life and yet assist nature by the process of that destruction? It is claimed that if a new disease can be produced in the exact site of the one already existing, it may possibly supercede the latter, and if the new disease subside without injury, the patient may be cured. By other schools of medicine, poisons are given to produce disease, not accidentally nor incidental- ly but with the fullest intent. Some of these produce di- seased conditions which last through life, and the patients become miserable chronics. Frequently it is within the power of the organism to dispose of these poisons, but sometimes it results in death and then it is 28 THERAPEUTICS. termed heart-failure. A poison then lias some deleterious property which ren- ders it capable of destroying life by whatever avenue it is taken into the system, whether by application, inhalation or imbibition and whether they be in their nature corrosive, inflammatory or such as effect the ner/es of sensation and motion. I have given these few examples of agents that we do n( it- wish to recognize in our materia medica. in order that we may see their unnatural influences and sequela?, and realize that they do not harmonize with rital efforts. Too often patients are recovering from some sickness with aching bones, stiffened joints, trembling nerves., and ruined diges- tion, abscesses on the lower limbs, decayed teeth or some difficulty clinging to them the rest of their days as the re- sult of poisonous treatment. Many a case is prolonged into weeks and months which could have been cured by Physio- Medical treatment in a much shorter period and without leaving unpleasant sequelae. To be able to relieve pain is both excellent and necessary. To this end many drugs have been used as morphine, co- deine, chloral, aconite, belladonna, the bromides, phenace- tine, antikamnia &c. Morphine perphaps stands first and is used to an alarming extent. If the ordinary Allopath of to-day were debarred from using whiskey, morphine. & quinine he would be almost compelled to give up business. In health there is no pain. All is ease and comfort. When some of the structures are not attuned to the vital force, uneasiness ensues and pain results. The intensity of pain will depend much on the tissues affected and the severity of the cause. Pain is not the disease, but is a con- sequence of disease, of some injury received or of the ac- cumulation of more or less morbific materials. The pres- ence of dust in the eye may produce pain; the accumula- tion of faeces may produce enteralgia; and presence of gall stone in the gall duct, or the descent of a calculus into the urethra may produce pain in these localities. If any of these conditions were present and no pain resulted, it would most assuredly indicate that the parts were too near- ly dead to recognize the presence of obstructions or make any struggle in order to relief. Pain is the announcement of something wrong in the system; the relief of pain is to be sought in the removal of that which gave rise to it. Morphine usually relieves, THERAPEUTICS. 29 but it is at the expense of vitality. It relieves no obstruc- tions, re-establishes no suppressed functions, relieves ihe system of no offending substances, but usually leaves the nervous system much irritated and the whole system less able to eliminate the provoking cause, and less liable to recognize remedial measures Sensibility is benumbed and the causes of disease are left to care for themselves. Benumbed sensibility is not natural sleep and hence not as beneficial as natural sleep. In the latter the whole system is at rest: in the former the vital force is. so far as it is not benumbed, in a state of resistance. Physiologically an exalted sensibility is to be preferred See the wrecks nar- cotics leave; with muscles weak and motion irregular, with nerves in universal tremor and nutrition impaired; with the foundation of intelligence prostrated they resemble the inebriate, poor emaciated wrecks, mentally and physically. Insanity from this cause is least amenable to treatment. It is frequently urged that the size of the dose deter- mines whether the agent be a poison. But this is not poss- ible. Whether the dose be an innnitessimal one or one of al- lopathic proportions cannot change the real character of the agent. The results of either dose of the same strength of the agent will be proportionate to the size of the dose and of the ability of vitality to resist. Quantity can- not alter quality. The Homeopath understands this in the administering of his infinitissimal close. A small dose will excite less vital resistance and will be the more surely lodged in the system. But we hear it said that some poisons provide certain needed elements to the body. They seem to forget that dead matter and not living matter or the living man. is the proper domain of chemistry. Because a substance is found in the gastric juice after death is not always evidence that the substance was there during life in normal action. Blood and bone and mus- cle are manufactured by no chemical process, but under the influence of the vital force in the distributing of proper pabulum for the growth of bioplasm, and thence formed material. Man is a vital structure and not a chem- ical labratory. The Materia Medica of Physio-Medicalism is replete with agents that are perfectly safe and powerful in assist- ing the vital force in the work of restoration. They cure rapidly, effectually and without benumbing the system or 30 THERAPEUTICS. causing- disease. Such a system meets the approval of every man's common sense, stands the surest test of scien-. tine criticism and shows its superiority over all other sys- tems. Indeed we plead a grand reform in the theory and practice of medicine; a complete revolution in the art of healing, and demand that true medicine is a science and not a mass of arbitrary dictums. Physio-Medicalism demands the highest place in Medical Education, requir- ing exact observation of all physiological phenomena, for these are our accurate guide in all our efforts to cure. Frequently you will hear it said by physicians of other schools that your cases were not so ill as theirs. This is an unintentional compliment. It is good evidence that their use of poisons complicate disease and make their cases worse. We medicate in harmony with nature and our cases are soon cured. All drugs do not influence the same class of tissues: each agent has its favorite locality for its special influence and each has its own peculiar mode of action. Leptandra virg. influences the secretory tubuli of the liver, eupator- ium purpur. influences the kidneys: arctostaphylosuva ursi influences the urinary mucous membrane; solidago cana- densis stimulates and tones the alvine mucous membrane: cornus florida is an astringent to the mucous membrane: asclepias tuberosa influences the skin and capillary circu- lation, lobelia inflata relaxes muscular and nerve tissue; caulophyllum lends special influence to the uterine nerves, while scutelaria is a general stimulating nervine, Thus it is evident that the same remedy may be made to subserve a valuable purpose in more than one disease. The functions of organs and tissues are animal and veg- etative or organic. Animal functions comprise locomotion innervation and special sense. The organic comprise diges- tion, absorption, circulation, respiration, secretion, gener- ation, and the developement of heat, light and electricity. Medicine does not produce function; this is the work of the organism. Each medicine makes its own peculiar impres- sions by going the round of the circulation. Contact, pene- tration and absorption must take place prior to complete impression. Get your agents to the place where they are- most needed and by the shortest route possible. The nerve structures and ganglia convey remedial impressions, and by these and the circulation, the influence of some medicines is almost instantaneous. This is well exempli- THERAPEUTICS. 3] tied in the influence of the third preparation of lobelia, wherein is combined intense stimulation and relaxation. Symptoms are abnormal functions dependent upon certain diseased conditions. The symptom is the sequent rather than the diseased condition. The symptom is not the di- sease and is not the thing- to be medicated. As soon as the diseased condition is removed the symptom is not present. To medicate symptoms leads to narcotism and to specific remedies for special symptoms. Each abnormal condition usually manifests a plurality of symptoms. The relation and inter-relation of organs. tissues and structures necessarily leads to the involving of adjacent and related structures. Pain is not always manifested in the diseased part, but is sometimes felt at some distance from the part diseased. A pain or uneasiness felt under the left shoulder blade will frequently be the result of a chronically inflamed ovary. The same cause has frequently given rise to a pain down the inside of the thigh or at the knee. The patient is more or less congested and a diarrhoea following a period of constipation is the result. Your patient needs not to be narcotized to relieve that pain: equalize the circulation, relieve the congestion, and the pain ceases without the use of narcotics. Your patient has an aching back: it may he from some irritating cause in the kidneys, rectum, uterus or from one of several other causes. The cause must he sought and relieved. Your patient is nauseated or vomit- ing. It may be from some injury to the extremities, from some condition of the stomach, from pregnancy or from other causes. Ascertain the provoking cause and medi- cate accordingly, diagnose carefully the cause with the ut- most precision. It may be that your patient has a head- ache. Such might arise from one or other of a dozen causes. The ordinary headache powder may be far from relieving the cause of that headache. One thing is of especial importance: carefully differen- tiate between a normal vital effort, a vital effort resisting disease, and a vital effort under the influence of remedial measures. Carefully differentiate between the disease and the efforts of the vital force in resisting disease. Inflammation, fever and pain are not diseases, but physio- ogical manifestions of extraordinary bioplastic action. They are indications of the degree of vital action in the effort to overcome disease, whether it be for the removal of 32 THERAPEUTICS. obstructions, the replacing of destroyed cells, or other important aids to the restoring of a healthy condition. Dysentery and diarrhoea are occasionally vital efforts to wash away through the alvine canal some offending sub- stances. Cough it a vital effort to cast off some material obstruct- ing the bronchi or pulmonary tubuli. In all cases of either extra or depressed vital effort, care- fully diagnose what must be the conditions present that should cause the vital force to put forth such efforts for its relief. Such diagnosis will furnish you the indications for scientific medication. The heart as the center of the cir- culation feels to a greater or less degree all deleterious im- pressions; and the greatest care must be used in diagnos- ing the true cause of whatever trouble may be present. A stomach with fermented contents may make one feel as if there is heart trouble; and so may hysteria. The heart quickens its. pulsations according to the arterial tension present. It is a great mistake to give antipyrine and drugs of that class, attempting to reduce fever by depressing the heart's action, instead of furnishing those agents which will relieve arterial and capillary tension, and thus relieve the necessity for the condition of the heart. Such drugs as antipyrine suppress vital manifestations instead of re- moving the causes. You are but a clerk about the vital establishment whose duty it is to act in harmony with the head of the firm in all its restorative acts, and not to at- tempt to paralyse its efforts. It is usually true that an agent will similarly influence organs either similar in .structure or intimately related Asclepias tuberosa influences the serous membrane, as well as the mucous membrane and the skin. Aristolochia serpentaria influences the circulation, the skin and the kidneys. Zingiber influences the circula- tion and the skin. Lobelia influences the nervous and mus- cular tissue. "Many remedies influence more than one structure, some are quite general in their influence, and yet many confine their chief influence almost entirely to one structure. Many agents having a general influence over the struct- ures will expend their force either where most needed or in the directions whither they may be influenced oy other medicines. In labor, lobelia will influence the os uteri more than elsewhere; while in croup, hepatitis, pleuritis, THERAPEUTICS. 3J bronchitis and pneumonia, lobelia will chiefly influence the part that most needs to be relaxed. Lobelia combined with honey or sugar, which are expectorants, will most- ly influence the lungs and bronchi and is an expectorant. Lobelia with laxatives will assist in producing catharsis. In a sensitive and irritated condition of the stomach, lobelia given in small doses and at regular intervals will give gentle relaxation, ease and comfort. But should the stomach be already too relaxed instead of irritated, lobelia would be much out of place. According then to the con- ditions present and the mode of administering, lobelia will either arrest emesis or produce emesis; leptandra will either produce catharsis or check catharsis; capsicum will either produce diaphoresis or check diaphoresis. But these conditions are not diseases but efforts of vitality to free the system of offending substances. The conditions present and the necessities therefor govern the action of the medicine. In labor where the pains are inefficient, capsicum will lend its principal influence to the uterus and become a first class parturient. In conditions of extreme torpor of of the liver, skin or bowels the influence of capsicum will be felt as required in either direction. In case of menstrual suppression cimicifuga racemosa will chiefly influence the uterus; in case of nervous irri- tability it will influence the entire nervous system, assist- ing in the relief of the irritability present: and yet in rheumatism its influence will be mostly felt by the serous membrane the part then most needing relief. Some agents influence two or more organs or classes of tissue. Such agents may be made to act principally on either by properly combining with some agent which acts more especially on one of them. Apocynum androsaemi- folium combined with an excess of eupatorium purpureum both will thoroughly influence the kidneys and be excel- lent for dropsy. It will do likewise if combined with ser- pentaria in cold infusion only, with a much more stimulat- ing influence. Many agents that influence the generative organs as caulophyllum, convallaria. mitchella. viburnum prun. and trillium, when combined with some agent or agents in excess that especially influence the respiratory organs, both agents will combine their influence upon the lungs. Some agents may be made to influence one of several or- 34 THERAPEUTICS. gans by thus combining. Capsicum with hepatics acts on the liver; with cathartics influences the bovels; with medicines that influence the uterus it will extend its in- fluence in that direction; if the surface be congested cap- sicum with asclepias tub. will secure a good free perspira- tion; but if the skin be lax and the perspiration too free then capsicum either alone or in combination with some tonic will assist in stopping the excess. Uva ursi will assist in cystic catarrh or in vaginal leucorrhoea as may be needed or as influenced by other medicines. The same is true of convallaria multiflora. It tones the mucous membrane of the uterus or of the respiratory organs as required by the vital force or as influenced by other remedies. Hydras- tis is a very fine tonic to the stomach, but when combined with diuretics it will tone the renal organs: combined with cathartics it will tone the alvine canal; with hepatics it will tone the liver and portal circulation: and so when combined with agents that specially influence the genera- tive or the respiratory organs. In-some spasmodic conditions as asthma large quantities of lobelia may be given without producing emesis or even nausea. In case of gall stone large portions of saccharated podo- phyllin may be administered without nausea or excessive catharsis as it would do under other circumstances. Then too the mode of preparing a medicine and the mode of administering it have much to do with prod uee- ingthe desired influence. Saccharated podophyllin acts positively upon the gall ducts and gall cyst and tends to liquify the gall, but mm-saccharated podophyllin seems to have a more direct influence upon the bowels and produces catharsis. In hot infusion serpentaria influences diapho- resis, but cold preparations are diuretic. In hot infusion aralia hispidia influences the circulation and skin, but cold preparations are diuretic. In hot infus- ion anthemis nobilis influences the circulation, but cold preparations are tonic to the mucous membrane. The nearer the tissues are brought to the normal the greater will be the influence of the remedies used, for then the vital force makes the best use of these remedies. Hence the nearer the tissues assume their normal condition the less medicine will be necessary, and those medicines of less power will be preferred. If the skin be but slightly in- active it will take but little ascieplas tuberosa and zingiber THERAPEUTICS. 35 to arouse capillary circulation and will be better than ser- pentaria for that purpose. If the liver be but slightly torpid, taraxacum will suit better than poriophyllin If the kidneys be but slightly ailing eupatorium purpureum will will be better than juniper. The recognition of these facts will enable you to administer your remedies with greater accuracy, and with greater benefit to your patient. It is as important to know how and when to stop medication, as to know how to begin medication. Never use strong med- icines nor larger doses in the beginning of your treatment, if not adsoiutely essential. It is also well that we carefully observe that indirect functional results may be due to vital action. One part may be diseased through sympathy with other diseased parts. Seek first to relieve the part first diseased, and if the involvement of the second part be not of too long standing. it too will soon be relieved. Cathartics as such do not act on the skin: and yet free catharsis will frequently be followed by more or less per- spiration. In cases of congestion or inflammation such catharsis may very profitably be followed by a thorough course of diaphoretics. Not unfrequently free catharsis will relieve a headache, especially if it be from a foul stom- ach or torpid liver: but it should be followed by liver medicines rather than the use of quinine as is popularly practiced. Hyperaemic condition^, are best relieved by equalizing the circulation. Catharsis and diaphoresis and sometimes emesis are the great means to be used for this purpose. Medicines are specific to conditions and not to disease as such. Diseases are to be studied each as a combination or complication of conditions. Remedies must be selected and used with reference to their ability to restore the tis- sues to their normal condition: medication must change as the conditions change. Treat the conditions as they are and change as developments may demand. Relaxation, stimulation and astringency are your watch words. These must be varied or combined to suit the conditions present at the time of prescribing. In acute diseases the changes must be watched, for they will be more frequent than in chronic cases, where the changes are less abrupt and usual- ly require more stimulation. Some cases need relaxation only, some need relaxation and stimulation; some need a- stringency, some stimulation and astringency: some need 36 THERAPEUTICS. stimulation and some need stimulation and relaxation. Some agents are almost pure relaxants as asclepias tu- berosa. cypripediura pubescens and leptandra virginica. Some agents are pure stimulants as capsicum. Some agents are pure astringents as tannin, and some agents have these qualities combined in various degrees as myrica, cornus, and hamamelis. In selecting your agents as a rule use the depurative first to thoroughly cleanse the system. Then gently stim- ulate and tone as the case may demand. Relaxing agents expend their power more toward the surface, while the stimulating and astringent agents tend more toward the centres. T.eptandra virginica is an excellent hepatic favoring the secretion, of bile, but it is nearly always best to add some diffusive stimulant as zingiber, or some stimulating and toning agent as euonymous atropupureus or taraxacum densleonis. Even at times a little capsicum will assist. Capsicum is invaluable for its action on the heart and ar- teries, but in cases of nervous prostration its impressions are best diffused when combined with scutelaria. Relaxants are rendered more active by the addition of a diffusive stimuiant or a stimulant; as asclepias tuberosa and zingiber, or lobelia inflata and capsicum. In this last combination by the presence of the relaxant, the lobelia, the capsicum is rendered more diffusive: and its influence is felt more widely than had it been administe-ed by itself. Too much relaxation must be avoided, it may lead to ex- haustion. Hot water is a diaphoretic, hence the hot infusion of diffusive diaphoretics most readily secures diaphoresis. Cap- sicum is not a diaphoretic except in hot infusion: hot water gives it a diffusive tendency toward the surface from the heart. In the use of alterants it is best to give them by them- selves, using them in sufficent quantity to make a decided impression of whatever character is needed, Physics as a rule should be separate and should be given only as occaion demands and in quantity sufficient to pro- duce quick or tonic results as desired. Never allow the system to become accustomed to them. Instead thereof inculcate a positive habit of going to stool every morning immediately after the morning meal . Some medicines when rubbed upon the skin will exert THERAPEUTICS. 37 more or iess of their influence by being absorbed. Lobelia applied over the lungs is an admirable relaxant. Applied over an ulcer or a denuded surface will produce nausea. This would readily prove the principle of absorption. Lep- tandra, apocynum androssemifolium and capsicum ap- plied over the liver and gall cyst will powerfully influ these organs. This is just as true of poisons. Mercury applied to the surface will produce salivation. Atropine applied to the eye will widely dilate the pupil. Opium will contract the pupil to a mere pinpoint. Cocaine will benumb the surface to which it is applied. The influence of medicines by absorption is slower but more permanent. The same is true whether it be of the skin, the rectum or the vagina. Hypodermic injections produce more rapid effect. Phys- io-medicalists need not throw aside the hypodermic needle because it has been in bad company and been used to inject poisons. Many of our agents may be used hypodermically and with good success. Medicines in liquid form and especially in hot infusion act with greater rapidity than those in solid or pill form. Resonoids usually require sometime to thoroughly dissolve if taken in capsule or otherwise. Syrup forms are best for coughs. Give in small doses and frequently, and direct that no water be taken immediately thereafter. In acute febrile cases the hot infusitm surpasses all other-. They open the pores and keep them open, so that an amount of detritus escapes from the body which would otherwise do mischief. The surface is more easily cleans- ed, and the patient is kept far more comfortable. The temperature is more readily reduced and in accordance with correct physiology the patient is more readily cured. Make your preparations as pleasant as possible. Use lit- tle sugar except in cough syrups and liver medicines. Use as little medicine as you can. but as much as you must to make your medicines effective Do not weary the organs "by continuing any medicine too long. Be careful in your diag- nosis; nevei fall into a routine practice; make your prescrip- tions with precision and confidence; keeping ever before you the infallible standard of normal anatomy and physi- ology and carefully estimate the variations therefrom. At times the stomach may be in such a condition as to prevent the acting of some medicines in cold forms. Then 38 therapeutics: give hot water, hot infusions, an emetic, a physic, or all of them if needed. Poultices, fomentations and liniments are very valu- able aids in many conditions. In sprains, swellings, inflam- mations, congestions, abscesses or ulcers. Agents, relax- in _r. stimulating or astringent may be used as required by the conditions present. Rectal injections assist catharsis, relieve intestinal in- vagination, assist in emesis where you cannot give lobelia per orem. and in tetanus to secure thorough relaxation. Rectal injection is a valuable means of feeding and sus- taining the system when food cannot be retained by the stomach. Small closes of medicine frequently given will accumulate in force but each succeeding dose must be given before the former dose has expended its force within the system. Study well the temperament of your patient, the con- ditions of the structures affected, the age. the sex. the a- mount of vitality possessed by the patient, the locality and the general surroundings. Take all these things into con- sideration and then seek:— 1. To relieve the alvine canal and the secernents. 2. Equalize the circulation, relieving the surface and sustain the heart. 3. Sustain and tone the nervous system. Some one or other of the secernents may be too tense or may be too lax, in either case torpor will arise and inac- tivity of the organs will result in more or less toxaemia. -It may be from torpidness of the liver and result in cholaemia. or from torpidness of the kidneys and uraemia be the result. Indeed both may be present at the same time and great prostration be the result. In relieving the secernents. care must be taken to ascer- tain the condition of each class of tissue. Each must be relaxed or stimulated as required. But no organ must be overworked to accomodate the condition of torpor in some other organ. It is frequently true that the kidneys are overworked to accomodate the torpor of the liver, perhaps not intentionally, but nevertheless in reality. Frequently the kidneys are found carrying off material that should have been carried ( ff by the liver. Influence each >ecernent to a degree resembling the nor- mal action of that secernent. In overcoming const ipat ion use only such medication as will assist in producing normal THERAPEUTICS. 39 action of the bowels once daily. Such action will be tonic rather than forced action. Positively demand that the patient shall accomplish daily evacuation by persistent regularity of habit. For chronic cases where it will be necessary to medicate for sometime, it is best to make some slight change in medicine so that the system shall not weary of the medicine nor become accustomed to it. The system wearies of the long continued use even of the same diet. The quantity of food required differs very materially in different persons, but it should be proportion- ed to the general vigor and relative waste in each case. Some persons eat but little while others eat much and seem to be no better nourished. Some persons seem to use up all the nutriment taken into the system, while others lay up much adipose material. During sickness the for- mer class will require a more liberal diet than the latter class who can live long on the adipose material scattered throughout the body. Such persons will eat but little and yet seem to be well nourished. One trouble with such per- sons is that the secernents in fact all the organs are more or less prevented from doing their respective duties by be- ing clogged with a superabundance of this fatty material. Food substances contain starch, gluten and inorganic matter. A positive food can be converted into pabulum. Alimentation is the taking of food into the body, wheth- er it be per orem. per rectum or applied to the surface of the body. Nutrition includes all the processes by which the body is built up and sustained. The process of digestion consists in dissolving food substances so as to be readily taken up and filtered through the walls of the blood ves- sels. Reparation is the distribution of pabulum to the tis- sue elements and its being taken up by the living matter. Adipose tissue is composed of oil globules contained in dead cells. In inanition the cell of the globule is taken up by the tissue and used and the oil is eliminated by the se- baceous glands. It is this adipose tissue that gives rotund- ity to the frame and retains the animal heat. The body is made up of different systems as the osseous. the muscular, the nervous and the articular. The apparata are the circulatory, the digestive, the lach- rymal, the urinary and the reproductive. The accessories are the nervous and muscular tissue. The various tissues are bone, cartilage, fibrous, elastic, muscular, nervous, cellular and adipose. 40 THERAPEUTICS. Albumen, fibrin and earthy salts are the results of the death of living matter, and these can only become living matter by becoming suitable pabulum for other living matter. The nutritious fluids are blood, chyme, chyle and lymyli. The secretory fluids are saliva, gastric juice, bile, pan- creatic juice, intestinal fluids, lachrymal, mucous and serous fluids. The excretory products are sudoriferous and sebaceous perspiration and urine, carbonic acid gas from living air cells, billiary salts and lachrymal fluid. Secretion is the taking of a fluid into the circulation with out causing any special disturbance. An excretion is not de- signed for the circulation, and is hence cast off. The mouth, stomach and intestines constitute one continuous canal. That which influences the one either for good or for evil in any particular will more or less influence the entire tract. As all mucous tracts are external, food is not taken inside till it enters the circulation. The structural ar- rangement of all glands is the same whether secretory or ex- cretory. The glands are emptied by the action of invol- untary structures. Peyers patches are not glands as they have no ducts. They are poorly nourished and have but lit- l le circulation, and when this circulation is interrupted in the structures about them, their nourishment is cut off and results in sloughing as in typhoid fever, and may re- sult in perforation of the bowel, and peritonitis and death soon follows. The pancreas and liver are accessory to intestinal diges- tion. The gastric and peptic glands and juices are dissol- vents. The pancreatic juice emulsifies the fats The bile is not well emulsified fat. The gall cyst is its receptacle, and the solidifying of the gall forms gall stones much as the accumulation of solids in the bladder forms calculi. Starch is hydrated and then filtered into the blood. The intestinal juice converts the starch into sugar. The lymphatics are vessels situated in nearly all parts of the body and look knotted where the valves are located. Lymphoid bodies are capsules endowing parenchyma and celular tissue and in the channels of which are white blood corpusies. The liver is the largest gland in the body. By fissures this gland is divided into lobes and these again are divid- ed into lobules which are composed of hepatic cells fitting THERAPEUTICS. 41 closely together; polygonal in shape, one surface present- ing to the blood vessels, portal veins, hepatic arteries and veins. The billiary ducts are vessels between the hepatic cells having racemose glands on the outer surface which are secretory. The hepatic cells are excretory. The function of the liver is to furnish bile and perhaps to secrete sugar, fts physiological products are mainly secretory. There are secretory lobules and excretory tubuli and ducts, and a much larger venous than arterial circulation. Diag- nose carefully the condition of each class of tissues and medicate accordingly. Some remedies act mainly on the secreting side of the liver, while others influence chiefly the excreting department, while otheis influence both in varying degrees, and others chiefly influence the portal circulation. Whenever the secretory organs are affected the circulation soon shows the effect in itself, and other organs soon become affected. Torpor of the liver leads lo more or less disease throughout the body, and upon the re- lief of that torpor other abnormal conditions will begin to subside. Both the secreting and excreting functions of the liver must be carefully watched. The secreting function may be normal and yet there may be cholamna. The excreting function may be torpid and the bile though secreted in quantity sufficient, hardens in the gall cyst ana gall stones may be the result. The bile must now be quickly liquified or the most in- tense pain may result. In chola^mia as well as in uraemia, hot only is the circu- lation oppressed but the nervous system also deeply feels its influence. The liver is usually the most torpid organ of the body and usually requires more medication than any other organ. Even after it has assumed its nor- mal action it is frequently best to continue for a short time a sustaining or toning treatment. In the treatment of fever, whether of typhoid or mias- matic origin this is especially true: for it must be remem- bered that «i large amount of detritus and viri are elimi- nated through the liver and kidneys as w T ell as by way of the skin. Medicines chiefly influencing the alvine tract have been variously classed, but we shall here denominate them lax- atives, carthartics and intestinal tonics, according to the intensity of their ability to cleanse the intestines of their 42 THERAPEUTICS. contents and their ability to subsequently tone the mucous membrane. Laxatives exert but a gentle influence upon the intestinal mucous membrane and are the best when that membrane is in a tense condition. Cathartics are more powerful and are intended to thoroughly cleanse the alvine canal Intestinal tonics are intended to stimulate and tone the alvine mucous membrane to normal action. Those agents chiefly influencing the liver and assisting mainly in the secretion of bile are denominated hepatics; and those influencing the excretory function of the liver and gall cyst are denominated cholagogues. The bile excret- ed into the duodenum not only assists in the process of in- testinal digestion but also influences normal catharsis. An excess of bile excreted at any one time may produce free catharsis. Of those medicines that influence the alvine mucous membrane, some a~e intestinal tonics and do not particular- ly influence catharsis, as hydrastis, some preparations of ferrum, gentiana, rhamnus purshiana and others Other agents are tonic cathartics, influencing the peristal- tic action of the bowels, lead to catharsis and leave the bowels more toned for future action, as juglans cinerea. Still other agents are strictly cathartics and influence chiefly the cleansing of the bowels as ipomea jalapa, cas- ia angustifolia, rhamnus catharticus and others. There results at times from persistent constipation or from other causes a semi-paralysed condition of the lower bowel. In such cases some positive stimulant or diffusive stimulant is needed to be combined with tonic cathartics. One thing is positively essential; the exact condition of each tissue cr class of tissues must be careful]} diag- nosed, and the abnormal condition relieved. The liver may be too lax or too tense to normally secrete biie: the gall ducts may be closed by hardened bile, or the mu- cous membrane may be too dry, irritated or sensitive. Catharsis merely will not relieve the liver except what may be derived from the relaxation following catharsis: neither will catharsis merely relieve the gall cyst: the thoroughly relaxing influence of lobelia may so relax the gall ducts as to relieve them of gall stone and yet lobelia is neither a cathartic, hepatic, nor chologogue. Leptandra virgin ica influences chiefly in the secretion THERAPEUTICS. 43 of bile; podophyllin is a cholagogue: ju^lans cinerea is a tonic cathartic, while rhamnus catharticus is a cathartic. Many agents have two or more of these qualities. Eu- onymous atropupureus and taraxacum dens leonis are ton- ics influencing both sides of the liver, and the gastric and intestinal mucous membrane as well. If the gall ducts are occluded, to give leptandra virginica would be to add to the misery of your patient by further distending the gall cyst. If the gall ducts are free, but the liver fails to se- crete sufficient bile, then podophyllin would not be the agent to use: ieptandra with some diffusive stimulant would be preferable, or some tonic agent might be better still as enonymous. Dyspepsia is not cured by mere ca- tharsis, neither is chronic constipation. In dyspepsia, though the liver may be at fault, and there may be consti- pation, yet the mucus membrane itself is at fault. Diarrhoea as well as constipation may either of them be a result of a failure of the liver to secrete and excrete bile. Do not expect to cure persistent constipation by the con- tinued use of cathartics: these must be followed, when used, by a I vine tonics. Disease in one part of the al vine canal i- not unfre- quently felt throughout its extent. A sore throat may frequently be relieved by a good physic. In fact you need not ordinarily expect to cure throat diseases and torpid stomach troubles except by first thoroughly cleansing the intestinal tract, it may be by both emesis and catharsis. The same is true in the treatment of fevers, and indeed in the treatment of a majority of diseases: the alvine canal and its accessories demand first attention. Here again we have certain agents that will extend their influence as the system requires or as influenced by other medicines. Capsicum is not a cathartic, but may be macfe to lend its stimulating power to cathartics in cases of ex- treme intestinal torpor. Lobelia is not a cathartic, but may be made to lend its relaxing influence to cathartics in spasmodic conditions. Normal secretion and excretion of bile is usually suffi- cient to stimulate to ordinary intestinal evacuations. An excessive discharge may produce a temporary diarrhoea. Rectal irrjtctions may frequently be used to assist cathar- sis. These injections may be medicated and rendered stimulating or relaxing as desired. Zingiber is not a cathartic, but is a fine diffusive stimu- 44 THERAPEUTICS. lant to add to cathartics to prevent tenesmus and to ren- der them more stimulating, diffusive and toning. Zingiber may he added to hepatics and tonic hepatics for the same reason. Cathartics should only be occasionally administered; only when really demanded. Tonic cathartics are a better class of agents for persistent use, and these only as really demanded. When there is a weak stomach it is frequently best to administer the physic in broken doses. Excessive evacuations may lead to intestinal irritation. Aim to secure one free evacuation of the bowels each day. It is altogether probable that much of your practice will con- cern the digestive tract and hence it is well to be thor- oughly prepared to meet every possible issue that may arise. Diuretics induce a more or less increased flow of urine which may or may not include much of the solids. Some agents increase the flow of the watery portion only, while other agents induce a marked increase of solids. The fact that during diaphoresis the kidneys are less active is well worth noting when you have occasion to treat the opposite condition: in case of excessive or exhaustive renal discharges, diaphoresis to some degree should be in- duced. Resort may also be had to the vapor bath or to the hot water bath. During hot weather as a rule the flow of urine is less than in cold weather. So in case of general congestion, the kidneys are more or less burdened until the surface is relieved. During the relaxation which follows a paroxysm or a hysterical convulsion there will usually be a free flow of urine. The same will frequently be a result following some considerable fright or excitement, whether of sorrow or of joy. It is frequently true that too much medical attention is given to the kidneys. It is observed that they are not do- ing their duties properly, but we must not forget that when we search for a cause it will not always be found in the kidneys. The liver is frequently torpid and bile which should have been carried off by way of the gall cys f is eliminated by way of the kidneys. In such case the liver and not the kidneys is the organ to be medicated. As a rule the proper stimulation and relief of the liver is a great relief to the kidneys. Then too. constipation has much to do when there is already irritation of the urinary THERAPEUTICS. 45 tract, in increasing that irritation. Constipation will ren- der a case of gonorrhea or gleet much worse than it would be otherwise, Keep the bowels free and the liver active and urethral irritation will be much less. Urethral irri- tation, if continued long, may induce vaginal and possibly uterine irritation. The amount of excretion daily from the kidneys varies from 20 to 60 ounces. Its normal specific gravity is about 1020. but may range from 1010 to 1050. A specific gravity of 1030 or more indicates the presence of a superabundance of sugar, as in diabetes. A low specific gravity and dimin- ished quantity indicates albuminaria. A persistent foam in urine indicates the necessity for a careful investigation for the presence of either sugar or albumen. Highly col- ored urine indicates the presence of an excess of solids, at times amounting to a so-called brick-dust sediment. In such condition the urine is usually scanty. The reaction of normal urine when voided is acid, but after standing some time it becomes more or less alkaline. Relaxing nervines as nepeta cataria, cypripedium pubes- cens or lobelia inflata usually increase the flow of urine upon the general principle of relaxation. Those agents gently stimulating to the mucous membrane as uva ursi, hamamelis, hydrastis or altbea will usually increase the urinary flow. In cases of more or less paralysis of the urinary apparata a diffusive stimulant as zingiber or serpentaria should be added to diuretics, and at times even the more positive stimulant capsicum, in order to secure a free flow of urine. The female genito — urinary apparata are so situated and related that agents that influence the one will usually influence the other. There may be a persistent scantiness of urine which may lead to an accumulation of solids and thence to the forma- tion of calculi. Aralia hispidia, capsella bursa pastoris, agropyrum repens, mentha viridis, arctostaphylos uva ursi, eupatorium purpureum will each secure more or less freeness of urine and thus prevent the accumulation of solids. Juniperus communis, barosma betulina, sabal ser- rulata, piper cubeba are stimulating diuretics. Urinalysis is a valuable aid in diagnosing the exact con- dition of each class of tissue and the microscope is a valu- able assistant in determining the character of the solids evacuated. The diagnosis of disease by means of urinaly- 46 THERAPEUTICS. sis and microscopy is an attainment worthy your best ef- forts. Each disease presents some more or less distinct appearances in the urine. The liver, kidneys, and spleen are the cess pools of the body. It is-of the greatest importance that these be kept well cleansed and sufficiently active to prevent uryemic or cholasmic poisoning to the general system. Typhoid fever requires some stimulation for the kidneys and so does dropsy; but in neither case would over-stimulation be ap- propriate. In typhoid fever it wouid be very likely to lead to depression. In dropsy the mere elimination of water would not be a cure of the condition present. The diet may have much to do with troubles of the urinary tract, and frequently a change of the daily dietary will be all that is necessary, or at least with but little medicine. The circulation of the blood cannot be too carefully studied, and frequently demands the utmost care in medi- cation. With the h. j art as the centre, the capillaries at the extremes and the arteries and veins connecting these extremes, each demands proper medication for the condi- tion in which each may be found. The capillaries are the delicate vessels connecting the arterioles and venules and thus completing the circulation of the blood. Their walls are very thin and allow the exuding of the blood from the arterial to the venous system. The centre and propelling- power of the circulation is the heart; the arteries convey the blood from the heart and the veins bring it back again for purification. The normal heart pressure on the caplla- ries is about 48 pounds to the square in^h. The weight of blood compared to t'ue weight of the body is about V2\ per cent., giving an average of about 18 pounds. Amemia is a more or less bloodless condition, llypene- mia presents an abnormally increased supply of blood to a part. Congestion is an accumulation or overflow of blood in a part from mechanical obstruction, and precedes in- flammation. It is an indication of biopiastic failure to withstand unnatural surroundings. The vital force has been compelled to more or less yield to some temporarily superior obstructive influence. Inflammation is increased vital energy in a part, result- ing in more or less redness, swelling and pain. There is an increased nutritive activity usually according to the demand, and resulting in new formations. This in inflam- mation indicates the degree of vital resistance present, or THERAPEUTICS. 47 indicates the necessity therefor. The capillary walls be- ing distended, their walls are much thinner and possess greater transparency and hence show a brighter arterial redness in the parts. The swelling is caused by the more or less obstructed flow of blood through the parts, and the still further increased flow as a result of increased vital energy. The epidermis is composed of dead cells in a more or less mummified state. Some of these are constantly falling off. The surface of the body needs very especial attention from the physician. The skin has its circulation and its two sets of excretory glands — the sudoriferous and the se- baceous. A full, free and well proportioned circulation in all parts of the body is essential to health and pleasure. Aim at all times at the maintenance of such circulation. Let the extremities be warmed by it, and the brain and trunk not overcrowded. Relieve hyperemia and anaemia so that the blood makes its complete circulation in proper time, in proper quality and in proper quantity, and the equilib- rium is restored. Each disease makes itself felt on the circulation in one way or another. This is why we feel the pulse to discern its character, and thus to diagnose the degree of vital re- sistance, the character of that resistance and the general ability of the vital force to still further resist— whether sthenic or asthenic. Thus it will appear that the vascu- lar tissue may become too relaxed, too tense or more or less irritable. The pulse and the to- gue are the two great indexes to the abnormal conditions of the body. The former indicates the degree that the abnormal condition is. felt by the cir- culation, and the latter the degree that it is felt by the digestive organs. It is not unfrequently true that if the secernents are relieved, many other abnormal conditions will cease. The cleansing of the liver, gall cyst, stomach, bowels, kidneys and skin will secure normal action of the heart and of the arterial and venous circulation. Espe- cially do we find this to be true in the treatment of typhoid and other fevers. This is the way to reduce the tempera- ture physiologically. This leaves no depression of the heart, but seeks to establish an equilibrium of the circula- tion, a thing which antipyrine, oelladonna, aconite or veratrum cannot do. These last agents leave the system 48 THERAFKUIICS. •more depressed and less able to care for itself. Sucli dele- terious agents can but lead to more or less depression of the circulation and finally to heart failure. If the secernents are not first freed, the blood current becomes more clogged with impuritie«, and the vital effort is necessarily more intense in action, the blood vessels become more irritated from the presence of abnormal con- tents and thence become abnormally tense and narrowed and able to carry only a smaller amount of blood at each pulsation. The blood current must have normal volume and force that it may properly nourish the entire body, and- that it- may also be capable of eliminating detritus or any impurity of its contents. The secernents and the circulation may both be i n a tense condition, then such agents as lobelia, eupat >rium perfoli- atum, cypripedium or some agent of similar influence will be needed. They will give general relaxation. But if both the circulation and the secernents be relaxed, then capsicum with some stimulating hepatics will be required. But occasions will arise when the circulation and the secer- nents may not be both relaxed nor both suffering from tensity. When such is the case each class of tissue must be medicated as they severally require. This fact will also be observable. After the circulation and the secernents have been for some time abnormal the nervous system feels the effects, and this is perhaps no- where more apparent than in typhoid fever where the pointed, quivering tongue is soon shown. In such cases the medication of the nervo is system need only be such as is necessary to sustain. As a rule some relaxation is necessary in the treatment in the beginning, while stimulation will be needed to con- tinue throughout till each class of tissue shall have been toned to the performance of its respective duties. The capacity of the capillary system is several hundred times that of the arterial system and hence the capillary requirements cannot be too carefully watched. A free capillary system is a necessity to a free arterial and venous circulation, and is frequently a great relief to cardiac ex- citement. Cardiac stimulation must not be too strong: better give small doses and obtain an accumulative result. DifTusives largely influence the arterial circulation but extend toward the capillaries. THERAPEUTICS. 4;-) Asclepias tuberoaa, corallorrhiza odontorrbiza and sam- bucus canadensis in hot infusion are relaxing diaphoretics. Xantboxylum fraxineum. aristolchia serpentaria. zingi- ber officinalis, polygonum hydropiper and asarum caua- dense in bot infusion are stimulating diffusives or stimu- lating diapboretics. They especially influence the arterial and capillary systems. Capsicum is the grandest of all cardiac stimulants and cereus grandiflora the greatest of all heart tonics. If the capillaries are depressed as well as the heart, zin- giber will sustain the arterial and capillary circulatio ). while capsicum will sustain the heart and arterial circula- tion. If more powerful stimulating diffusives are needed than zingiber then use serpentaria or xanthoxylum. The portal circulation and indeed the whole venous sys- tem is best sustained by hydrastis canadensis. In acute cases less stimulation and more diffusives are needed. In chronic cases the stimulation will usually have to be increased, and tonics added. Hepatics, cathartics, stimulants and nervines will usu- ally be more effective if combined with some diffusive. and a less dose will be required. Local applications will be found very efficient in influ- encing the capillaries, the secernents and the peripheral nerves. A hyperaemic condition in many localities may be relieved by local relaxation and perhaps at times adding some stimulation. Lobelia is one of the very best agents to be used as a local application to a tense surface. It re- laxes the capillaries and relieves the pain that would oth- erwise exist because of their distended condition. In a majority of the operations of surgery there is no better application than lobelia. It relaxes the capillaries, relieves muscular tension and prevents hyperemia to a considerable extent. So in dislocations, swellings, sprains and bruises. In thoracic hyperaemic conditions there is perhaps nothing superior to lobelia as an application, lim- iting the stimulation to a minimum proportion. Of course if the parts are cold, pale or relaxed then local stimulation is required. Indeed local applications will be found beneficial to almost any part of the body, if the stimulation and relaxation be proportioned to the need of the respective parts, whether it be of the stomach, bow- els, liver, spleen, peritoneum, ovaries, uterus, brain, lungs or skin. Maintain the circulation by all possible means 50 THERAPEUTICS. and prevent stasis of the blood. In some low conditions even a frequent change of the patient's position will for a time prevent stasis, which otherwise may be productive of much evil. It must be remembered that all the parts of the vascu- lar system may not all be in the same condition at the same time; so that the same quality of treatment that would be appropriate for one part of the system might not be appropriate for another part of the system. It is not unfrequen«iy true that the capillaries may need relaxa- tion and the heart need some degree of stimulation, as in most cases of eruptive diseases. But there are circum- stances, many of them, when the body seems to have near- ly all the circulation and the extremities are cold. This is especially true in parturition, gastritis, hepatitis, cys- titis, pleuritis, &c. With capsicum and cereus grandiflora for the heart; with hydrastis and gentian for the venous circulation: with xanthoxylum, myrica and polygonum for the arterial circulation; with ferrum for the intestinal circulation: with serpentaria, zingiber and asarum as stimulating to the capillaries, and with asclepias tuberosa, corallorrhiza and sambucus as relaxing to the capillaries you are well prepared to maintain the equilibrium of the circulation if it can be maintained. As a rule medicines that influence the circulation, espe- cially that of the capillaries either by stimulation or by relaxation, more or less soothe the nervous system. This is especially true in diseases of an acute character. Other things besides medicine may influence the circulation. Mental confusion may bring a blush to the cheek. A hearty laugh or a vigorous exercise will give a better out- ward flow of blood, and so will a brisk rubbing of the sur- face. The application to the surface of an electric current will also induce a better superficial circulation. The pro- cess of mastication, digestion and reparation all influence the circulation more or less in those several directions. Fright or anger influence the circulation from the surface so that it will appear cold and pale. Shock of injury will lead to a somewhat similar result. Diseases of the nervous system, whether acute or chronic, also influence the circu- lation to a greater or less degree. Hut they are not always both influenced in the same direction. The one may re- quire stimulation and the other relaxation. The demand THERAPEUTICS. ">1 of each condition must be met as required. That class of agents which influence the circulation to- ward the surface are called diaphoretics. They are given in hot infusion and produce a warm perspiration. They may be either relaxing-, as asclepias tuberosa. or stimula- ting, as serpentaria. Diaphoiesis isoneof the most valuable means of ridding the system of a large amount of offensive material, and of very materially shortening the duration of acute diseases. They are very valuable in all the eruptive diseases, and are not less important in typhoid and other forms of fever. Diaphoretics primarily influence the surface but finally more or less influence the entire circulation. Capsicum primarily influences the heart but gradually proceeds to- ward the capillaries and especially so if a diffusive agent as zingiber is added. If the whole system be hot, the skin dry, the heart im- pulse large, full and frequent; then relaxation is needed and relaxing diaphoretics alone are best. But if this con- dition of the skin be present and the heart impulse weak and wiry, then more or less stimulation must be added. If the surface be congested diaphoretics of a more or less stimulating grade are required. But another class of superficial glands demand our atten- tion, the sebaceous or oil glands. These are especially deficient in action in scarlatina. The skin becomes in- tensely hot, dry and chaffy. Ordinary diaphoresis of tin- sudoriferous glands will not then suffice. The sebaceous glands must be stimulated to action. This is true to some extent in many eczemas. Such agents as arctium lappa semina. and helianthus annuus semina. and celastrus scandens cortex are among the best, and in order to accom- plish the best results they should be given in hot infusion Diaphoresis is one of the most valuable means of curing in a majority of cases. These millions of pores are the termini of a great human sewer system for the excretion of tissue detritus and various other injurious substances. If these remain closed the blood will soon be overwhelmed with deleterious accumulations, which will not only poison the circulation but may overwhelm the nervous system. In acute febrile, inflammatory or congested conditions there is nothing equal to diaphoresis, whether accomplished by the steam bath, hot air bath or by diaphoretics in hot infusion. The two former means are rendered more effect- 52 THERAPEUTICS. ive by the addition of the latter in conjunction therewith. It matters little where the trouble may be, if the general circulation is involved, more or less diaphoresis is neces- sary. Whether the lungs, plenra, peritoneum, stomach, bowels, spleen, kidneys, bladder, uterus, brain, meninges, serous, mucous or muscular tissue, diaphoresis is essential. Equalize the circulation, sustain a full, free, superficial flow of blood and thus prevent hyperemia in any locality. One of the best means for the relief of hemorrhage is the proper use of diffusive stimulants. I n acute dysentery and diarrhoea some degree of diapho- resis is frequently beneficial, and in dropsy and diabetes it is not unfrequently essential. It must not be forgotten that surrounding circum- stances, such as the proper warmth of the apartment, and the administering of the diaphoretic in hot infusion are points essential to be observed. Heat and hot water are themselves diaphoretics, but these are more fully discussed under the heading aqua. Heat, hot water, hot baths, hot broths and hot infusions are among our most powerful agents in this direction. Sleep under certain circumstances will lead to more or less profuse perspiration. This however must be carefully watched. Under certain circumstances such perspiration if too profuse may be very weakening. This result must be guarded against. But while avoiding this extreme con- tinue dhiphoresis long enough and free enough to accom- plish the required result. Alterants are ;igents such as act on the blood current, toning the serous membrane and cleansing the current of some variety of impurity contained therein. In the broad- est sense a large majority of our agents are alteratives, for they in some way tend to cleanse and tone the blood cur- rent. Indeed so do proper food, pure air, correct living and freedom from excesses in any direction. Impurities may gain access into the blood current from many sources. It maybe that the secernents are torpid and are not secreting or excreting in proper quantities. These secretions being retained in the system soon gain access to the blood current and some degree of septic influ- ence is the result. It may be that the skin is retaining impure materials and these instead of being cast off. are retained and conveyed by the venous current again into the blood and constantly make it more foul. It may be that THERAPEUTICS. 53 the lungs are being filled with impure air. or are supplied with an insufficiency of the same. In either ca-e the blood becomes more or less deoxygeni zed, and worse still it be- comes tilled with still greater impurities. It may be that the food has been improper in preparation, in quantity or in quality, and thus impr >per pabulum has been conveyed into the system. In order therefore that your alterative medicines may do the good intended to be accomplished, your patient must be supplied with proper food, proper air, proper clothing. proper exercise, and that he should have proper habits. and be given to no excesses. It will be your duty to see to those things and to administer your medicines so that the skin, stomach, bowels, mesenteries, kidneys and lungs are each doing their respective duties. Under these circum- stances you can cleanse the blood current and your altera- tive medicines will be efficient. Else they will be more or less a failure in spite of your best efforts. But remember that alteratives act slowly and promote a steady toning impression. It takes time for complete blood changes to occur. It sometimes takes months and even years to cleanse the blood current of some impurities. The quality of the whole blood current must be changed. and the secernents must be constantly toned to the ability of fully performing their respective duties. To say then that an agent is an alterative is very indefi- nite. We must know the process or channels by which it accomplishes the elimination of any impurities from the system. Elimination may be either by way of the liver and bowels, the kidneys or the skin. Alteratives may be relaxing, stimulating or toning. In chronic cases those of greater stimulating powers are needed than in acute case-. When eruptions of the skin are due to hepatic torpor, use such alteratives as have a de cided tendency to influence the liver both in its secreting and excreting functions. General torpor of the secretions is more or less productive of impurity of the blood. So is idleness, a sedentary habit and constipation. Physical activity in pure air and sustained by good food and pure water, and having good habits are the grand ac- cessories to good health and pure blood. To receive and to transmit impressions is pre-eminently the office of the nervous system. A leading manifestation of disease is pain, which is an exalted condition of the sen- 54 THERAPEUTICS. sory nerves arising from a greater or less degree of irrita- tion which has been caused by the introduction of some offending substance either locally or constitutionally. Pain is an evidence of the presence of some disease, injury or obstruction. Whenever and wherever there is loss of sensibility from any cause, such part or parts or the Avhole system is liable to suffer therefrom, because the vital force is not or cannot be aroused to its proper protection, nei- ther is there a proper supply of nutrition. Pain is not only an evidence of disease but is a means of arousing the vital force to some degree of activity for the removal of the cause. When the abnormal condition sub- sides the pain ceases. Do not be mistaken and demolish your friend for an enemy. Forget not that the abnormal reduction of sensibility is itself disease and is more or less disastrous to the system. Narcotics do not remove the conditions that cause suffering. Instead of narcotizing administer such agents as tend to remove the cause. The cause of pain is not always directly in nerve tissue. It is more frequently elsewhere, and the nervous system is then but the transmitting medium. Yet the long con- tinuance of such may become a source of nerve irritation. The pain is usually confined to the part or parts affected, but in time other parts suffer therefrom. Then too the pain is not always located at the point dis- eased. This is frequently true with ovarian and uterine pains. You cannot be too careful in the study and diagno- sis of transmitted pain. Many a time pain under the left shoulder blade, down the thigh or at the knee is from the ovary or ovaries. Many a time a headache i^ from consti- pation, hepatic torpor, improper mastication or imperfect digestion. Many a case of chronic sick-headache is cured by the use of a new set of teeth when the natural set had become decayed. Insanity is not unfrequently due to chronic torpid con- ditions of the secernents, first resulting in hypochondri- asis. Therefore carefully diagnose the cause of the symptom. Each disease and each injury in each different part give** its own peculiar suffering. If the pain proceeds from irri- tation then relaxing and soothing medication is needed as given by cypripedium, lobelia or ulmus. The pain due to hyperemia is very frequently relieved by external local applications of relaxing agents, and the THERAPEUTICS. ■)•) use internally of a hot infusion of diffusives and relaxants. The pain due to sprain is frequently relieved by the stimulating and relaxing influence of hot water continued for some hours and of the use internally of diffusives and relaxants. For the relief of the pain due to gangrene the strongest stimulants and antiseptics are necessary until the separa- tion of the parts dead and living is complete. Neuralgia is more or less an irritation of the nerve structures themselves, and yet this irritation not unfre- quently arises from some secernent or circulatory cause. In the treatment of such it is not only necessary to reliew the secernents and the circulation but also to sustain the nerves with agents of a more or less stimulating influence, as dioscorea villosa, caulophyllum thai actor ides, ferula foetida, sorbilin, salicine, scutelaria, or quinine. Restlessness is usually a result of long-continued irrita- tion of the nervous system leading to general weakness. Here you require a gently stimulating class of nerve ton- ics. Convulsion is a very much over-stimulated condition of the nervous system. In some children the cause of con- vulsion is the approach of some eruptive disease, the pres- ence of worms, teething or some stomach or bowel trouble. Convulsion may also be the result of cerebro-spinal disease, or of some injury; or it may arise from some weakness of the nerves as in hysteria. In all such cases more or less relaxation is need at first. In tetanus especially use the most powerful relaxants. Lobelia in large quantities will probably have to be used per rectum. But as the system becomes relaxed, more stimulating and toning nervines are required to sustain the system. The nerves and circulation frequently run side by side and reciprocate each other's action. Carefully diagnose which may be primarily at fault. Ascertain whether pain arises from acute irritation in any respect or from hyper- emia in any part. Investigate as to whether it be from congestion, suppuration or from gangrenous destruction. Ascertain whether the pain arises from some failure of the secernents, the circulation or the nervous system, or from two or more of them combined. Estimate carefully the degree of vitality present and the necessities in each direction. Then select your medicines 5t5 THERAPEUTICS. and combine them accordingly. In the treatment of some pain stimulating agents will be required, while other cases will require relaxation and still others astringency. In- flammatory effort will require relaxation; a depressed effort will require more or less stimulation: irritation re- quires demulcents and a very relaxed effort will require some degree of astringency and it may be of stimulation also. All pain therefore cannot be treated alike. While lobe- lia would be very suitable for the relief of arterial pressure in an inflammatory effort, it would be woire than nothing in the vital failure of gangrene where the most positive stim- ulation is needed. Cypripedium pubescens will relieve the pain due to some irritated condition of the nervous sys- tem, but in a depressed condition it would be a failure. Here more positive stimulating nervines as scutelaria. qui- nia or sorbilin are essential. Impacted faeces may be the cause of pain. Not nervines then, but the removal of the cause is the thing required. Caulophyllum, polygonum, ferula. Valeriana are both stimulating and relaxing in varying proportions. The third preparation of lobelia is the climax in this respect. Tonics are intended to give fuller vigor to the system and are more or less stimulating. An emetic, a bath, a cathartic or a diaphoretic is each a depurative measure, assisting in cleansing the system of whatever impurities may be present. Subsequently tonics are needed to slowly and permanently assist in giving greater firmness to the tissues. Tonics are especially used to restore general strength and vigor to the digestive apparatus, upon which depends the vigor of the entire sys- tem. Care must be taken not to use more stimulating agents than are necessary, nor should they be used in stronger or more frequent doses than required. Care must also be taken that the a 1 vine canal and its accessories are cleansed and active, for then a tonic will do most good. Without taking these precautions tonics will be of little value. Demulcents maybe applied as poultices. They may be. either relaxing or stimulating according to the agents selected or incorporated and according to the necessities requiring such. They should be kept warm. Poultices or fine powders may be used to absorb discharges from sores, the better to prepare the surface for further local treat- THERAPEUTICS. 57 merit. Demulcents given to the stomach soothe the mucous membrane and relieve irritation of the stomach and bow- els. Per vagi nam and per rectum they are very soothing to the mucous surfaces, and assist in relieving irritation. Demulcents may also be used as a vehicle for the convey- ing of more stimulating agents either into the stomach or rectum. Demulcents are also useful in the formation of pill mass in the manufacturing of pills. When required demulcents are excellent for the relief of bronchial and pulmonary irritai ion or inflammation. In such cases they are very important both applied externally as a poultice and taken internally either alone or in com- bination with other agents that influence the respiratory organs. Demulcents are also of great value in the covering of abraded surfaces, burns or scalds, especially when com- bined with some suitable oil. They prevent exposure to the air and pain ceases. Fruit acids are of great benefit in the treatment of bilious troubles and in convalescence therefrom. Avoid using them too frequently or too freely. A wash of vine- gar and water will be both pleasant and profitable at times in cleansing the tongue of foulness. Alkalies as soda, potassa, magnesia arid lime are at times needed to correct acidity of the stomach. Cautiously avoid giving more than enough to relieve the acidulated condition present. Sometimes sores having an ichorous discharge may be relieved by an alkaline wash applied as needed. Such wash may also be applied to the tongue to cleanse it of foulness. Escharotics are not strictly remedies, but as the surgi- cal knife, may be applied to the surface for the destruction of abnormal growths. Cautiously limit their use to the parts to be destroyed. 58 F>HVSIO - MEDICAL MATERIA MEDICA. \f he following- pages will be devoted to the consid- eration of such agents as we deem Physio-Med- VJ^JTp ical both oid and new. In presenting some new- agents it may be that we shall in future years change our views somewhat as we have concerning some of our older agents. We are in for advancement. We be- lieve in employing the very best agentsand the most effi- cient preparations the world can furnish. In this consideration of our materia medica I have ex- cluded to a great extent botanical description, and I have included but little concerning pharmacy, because an ex- cellent article has been furnished by Prof. J. M. Thurston. His pharmacy is peculiarly physio-medical, and such as we need, and I ask for this article the attention o! the profes- sion. Prior to introducing the first subject of materia niedica I have deemed it proper to give some instructions as to gathering your material. In each locality this will be valu- able concerning some agents. ROOTS. The roots of annual plants should be gathered just previous to flowering. Those of biennial plants should be gathered shortly after the leaves have fallen in the autumn of the first year. Those of perennials are the most active after the fall of the leaves and flowers in the autumn. BULBS. These should be gathered as soon as matured after the plant has lost its foliage. MATERIA MEDICA. . 59 STEMS. Herbaceous stems should be gathered after the foliage appears and before the blossoms have de /eloped. Ligneous stems should be gathered after the falling of the leaves. BARKS. These should be gathered in the spring before the flower- ing season or in the autumn after the foliage has gone. LEAVES. These should be gathered as soon as matured, in the time between the flowers and the maturing of the fruit. Biennials do not perfect their leaves during the first year. BERRIES, SUCCULENT FRUITS AND SEEDS. Should be gathered when ripe or nearly so. FLOWERS. These should be gathered when about to open from the bud. Sometimes the buds themselves are collected. Leaves, flowers and herbs should gathered in dry weather. Aromatic Plants are best after the flower buds are formed and ready to open. DRYING. Those agents which are to be dried, should be put into a room where they will be much in the shade. They should not be dried to quickly so as too dissipate any of their qualities, nor left long enough to mould. 60 RULES FOR PRONUNCIATION The following rules are applicable for the pronunciation of medical terms of latin origin. Of course there will be many exceptions which could not be considered here. 1. — Words of two syllables receive the accent on 'the pe- nultimate: as cortex, radix, vera, alnus, carum etc. 2. — Words of more than two syllables receive the accent on the penultimate, if the vowel be long;-: as palmatum, vulgaris, acetum, etc. 3. — If the penultimate vowel be short; then the antepe- nultimate receives the accent; as acidum, krameria, kal- mia, cataria etc. 4 — If the antepenultimate vowel is followed by a single consonant, that consonant usually receives the accent and the vowel preceeding is rendered short; as hepatica. nobi- lis, nepeta, etc, 5 — If the antepenultimate vowel be u it usually receives the accent instead of the consonant following; as punica. aluminum etc. Words derived from the G-reek language are pronounced according to the rules of pronunciation in that language. 61 ABIES BALSAMEA. Balsam Fir, Canada Balsam. The bark of this tree when punctured yields a thick and more or less transparent balsam, which is moderately stimulating to the mucous membrane throughout, espec- ially influencing that of the renal apparatus. It is quite persistent and in large doses nauseates. If the mucous membrane be irritated it is inappropriate but is best in relaxed and torpid cases, as in gleet, cystic and renal con- gestions, in bronchial and pulmonary congestions it is a stimulating expectorant, but its influence is best felt in this direction when combined with some agents which especially influence the respiratory organs. It gives very favorable results when combined with syrups for chronic coughs. F. E. Abies Bal. dr. ii Acetous Syr. Lobelia Sem. oz. iiss Mel q. s. oz. iv This may be used for colds, coughs, croup, asthma and bronchial catarrh. F. E. Abies Bal. dr. ii Glyceri n Mel aa. oz. ii This makes a good cough syrup. This balsam may also be incorporated with vaseline and used as an ointment for old sores and ulcers. Yolk of Egg Fresh Balsam Triturate thoroughly and apply. It may also be used as a plaster and applied to some weak or painful part, especially in the region of the kidneys. The baric is also used either in infusion or in fluid ex- tract for the same purpose as the gum which exudes there- from. ABIES CANADENSIS. Hemlock Spruce. (Pinus or Tsuga Canadensis. | The bark of this tree is used for tanning purposes. By incising the bark the tree yields a heavy black pitch or gum. The inner bark is a drying and gently stimulating astringent, useful in hemorrhages aud for diarrhoea. Lo- cally it may be used as an astringent wash wherever 62 ABIES EXCELSA. needed, as in cases- of sore mouth or other ulcerous parts. Its action is mostly local and is valuable in the treatment of rectal ulcers. It checks the excessive discharges and the ulcers heal under it. It is good also for buboes. Dr. C. B. Riggs advises the following for rectal supposi- tories for internal hemorrhoids: Grum Tragacanth Glycerine q. s. ad. to make a thick syrup. Powd. Pinus Can. 2 " Hydrastis Can. " Myrica Cer. " Boracic Acid Wheat Flour aa. 1 q. s. ad. to make the former stiff enough to form sup- positories the size desired. Sig. One suppository each night on retiring. This lias proven very successful, especially when the rectum is lax, and the tumors protrude. Rectal pain and tenesmus will be quickly relieved, and hemorrhoids soon cured and re- main so until the liver becomes torpid and the bowels constipated. The leaves ~re more stimulating and less astringent than the bark. In hot infusion it is diaphoretic and may- be used for the relief of colds and for dysmorrhoea; but it is not best to use this agent where the patient is inclined to constipation. They are valuable in hot fomentations for sprains, rheumatism, and inflammations. The oil of hemlock is obtained from the leaves and is far more stimulating. It is a useful addition to lini- ments, but is not used internally. The resin is sometimes incorporated with oils and formed into a plaster. ABIES EXCELSA. Norway Spruce. From the little drops on the bark we get our frankin- cense; and from incisions in the wood flows the pix bur- gundica. This incorporated with sweet oil forms an irritating plaster which may only occasionally be used. To irritate the surface is seldom the part of wisdom. ABRUS PRECATORIUS. Jeqiiirity. This is a stimulating and toning agent to the mucous ACACIA VERA. 63 membrane. It cleanses the parts and leaves them invig- orated. The seeds reduced to a powder and mixed with hydrozone is excellent in the treatment of uterine ulcer, abrasions, excoriations, polypoid excrescences, and in somewhat similar conditions of the rectum. It complete- ly exfoliates morbid tissue and leaves the parts underneath toned. It may be used in capsule, powder, suppository or cerate. The infusiou of the seeds is best in granular ophthalmia, in opacities of the cornea and in some varieties of cata- racts. Make the infusion of one drachm of the beans crushed to one pint of boiling water. Two or three drops put upon the inner canthus of the eye two or three times a day should be continued until complete exfoliation takes place. In diphtheria spray the throat with the ozonized jequir- ity and this will cause immediate exfoliation. For eczemas it may be used as a salve. ACACIA CATECHU. Catechu. This we obtain chiefly from the East and West Indies in the form of an extract which is a powerful astringent somewhat similar to tannin, and may be used for the same general purposes locally and internally. ACACIA VERA. Gum, Arabic. Arabia and Northern Africa, The gum exudes freely from the bark of the trunk and larger branches, soft and nearly fluid. Exposure hardens it. Acacia Vera is a pure mucilage, nutritious and demul- cient; and may be used to excellent advantage in all irri- tated conditions of the mucous membrane whether it be of the alvine canal, the bronchi or of the renal apparatus. Its chief influence is most felt where most needed or whether influenced by some other agent. It is quite serv- iceable in bronchial inflammation or irritation, in dysen- tery and diarrhoea. Gum Arabic oz. i Water, Vinegar, or Lemonade oz. vi Do not use enough to clog the system but merely to soothe as a mucilaginous drink. This gum plays an im- ()4 ACETUM. portant part in the manufacture of pills, troches and emulsions. ACETUM. Vinegar. The juices of various fruits after having undergone some degree of fermentation and having become sufficiently sour is called vinegar. The best vinegar is obtained from apples. Though there is a small proportion of acetic acid in vinegar, yet it is improper to manufacture vinegar from acetic acid and water. Acetum influences the mucous membrane chiefly, pro- moting the increase of saliva: and is an expectorant to the respiratory mucous membrane. Vinegar, sugar and water in appropriate combination form a pleasant acidulated drink when indicated in fevers to allay thirst and to promote a flow of saliva. Acetum in hot water is diaphoretic, and if inhaled when the head is somewhat covered is valuable for the relief of colds in the head and nasal passages, the throat and bron- chi. As a stimulating antiseptic it is valuable in various forms of sore throat, especially if combined with more stimulating and toning agents. It may be used as a gargle or be atomized into the throat in diphtheria, pharyngitis, laryngitis, aphonia or tonsilitis. A favorite home gargle is acetum, sodium chloride and capsicum in boiling water for various forms of mild sore throat. With verbascum thap- sus its influence is excellent as a fomentation for sprains and swellings. With lobelia it decreases its nausea, yet its influence is more permanent. Acetum with sanguinaria and lobelia may de adminis- tered with very favorable results in membranous croup in connection with gently stimulating diaphoresis. The acetous tincture of lobelia much less readily nauseates but is more persistent than the ordinary tincture. With capsicum the influence of both is intensified. Lo- cally acetum increases the power of any agent with which it is combined. If acetum is brought to the boiling point and poured over the crude ingredients as lobelia or sangui- naria the full strength of the agent will be more readily gained. In case of delirium tremens a wine glass of strong vine- gar will soon restore sense and locomotion. AGAVE AMERICANA. 65 ACHILLEA MILLEFOLIUM. I 'arrow. This herb is a mild. slow, stimulating astringent tonic; influencing the mucous membrane of the alvine canal, and gives favorable results in chronic dysentery and chronic diarrhoea, it stimulates the appetite and tones the di- gestive organs. It is of much importance as a tonic to the general system. Combined with uterine tonics its influ- ence will be felt upon the generative organs and will be serviceable in lucorrhoea. gleet and vaginal laxity. In hot infusion it arouses the capillary circulation and is somewhat antiperiodic. and assists in the relief of hem- orrhages. In cold forms it is useful as a tonic in convalescence from fevers, from nervous prostration, in phthisis and night sweats. • ACORUS CALAMI'S. Calamus, Sweet Flag. The root when green is rather pungent but when dry is a pleasant, mild, aromatic stimulant. It is mildly warm- ing to the stomach and is frequently used to relieve the flatus and colic of children. It is best for this purpose combined with zingiber and dioscorea. and it may be used as a carminative vehicle for other drugs. ADIANTCM PEDATUM. Maiden-hair. This herb is a mild, pleasant, demulcent, stimulating astringent. It influences the mucous membrane through- out. In combination with agents that influence the bron- chi its action will be determined in that direction: as with aralia racemosa or Symphytum officinale. With hydrastis or gentian its influence will be most felt on the alvine canal. With uva ursi its influence will be felt by the kid- neys, the uterus, bladder and urethra, assisting much in the relief of cystic catarrh and scalding urine. AGAVE AMERICANA. American Agave- The juice of this plant forms a lather with water and has been sometimes u^ed as a substitute for soap, and forms a good cleansing application to the surface. Inter- na 11 v it influences the mucous membrane and is somewhat 66 AGRTMONIA EUPATORIA. laxative. It also influences the urinary and generative organs, increasing the flow in either direction as needed or as directed by other agents. AGAVE VIRGINICA. Rattlesnake Master. The root is a bitter, tonic carminative and is useful in flatulence and colic, and is recommended as an antidote for snake bites. AGRIMONIA EUPATORIA. Agrimony, The herb is a gently stimulating, aromatic astringent, acting mainly on the mucous membrane. In hot infusion it influences diaphoresis. Cold preparations influence the kidneys and other urinary apparata, imparting a gentle tonic influence, and will give favorable results in enuresis and relieve milky urine. With hepatics its chief influence is given to the intesti- nal mucous membrane in cases of dysentery and diarrhoea, acute or chronic. Dr. F. G. Hoener recommends it in hepatic abscess, mesenteritis, anaemia, atrophy of the liver, albumenaria, cirrhosis of the liver, marasmus, peri- tonitis, and stomatitis With uterine tonics its chief influence is given to tone the generative organs, slowly toning them and relieving laucorrhoea. With agents that influence the bronchi its influence will be expended in toning the mucous membrane in that local- ity, and is valuable in excessive expectoration. Dr. F. G. Hoener recommends the following in incipient consump- tion, colds and coughs: Elix. Agrimonia Eup. " Chrysanthemum Leucan. aa. oz. iss " Verbena Hast. oz. iiiss Sabbat i a Aug. " Veronica Off. " Verbascum Thap. aa. oz. ii " Helonias Dio. oz. iiss Syr. Marrubium Vulg. oz. iss M. S. A teaspoonful to a dessertspoonful every 2 or 3 hours. With more stimulating agents its influence when needed by the vital force will be exerted upon the pharynx and ALCOHOL. r>7 larynx. With ulmus or other mucilaginous wash it is good in ophthalmia. AGROPYRDM REPENS. Tri icuTYi, Couch Grass. (Triticum Repens.j The root is a pleasant diuretic, and is excellent for the relief of irritation of the bladder and urethra. It is valu- able in gonorrhoea in the inflammatory stage. It increases the flow and relieves the irritation. It is also valuable in cystic catarrh and renal congestions, fn dropsy it gives favorable results, also in nephritis, cystitis and urethritis it may be used to good advantage. ALCOHOL. By W. F. Pechuman, a. m. m. d. ll. d. Late Professor of Histology, Physiology and Pathology; Clinical Professor of Surgery at the Chicago Physio-Medical College and Secretary of its P'aculty. Member of the Medical and Surgical Staff of the R. R. Hospital and Militant Church Hospital, Chicago. Lecturer at St Paul's College. This is a subject on which much has been written, and yet there is room for much more to be said. We would like to go into a more lengthy article but time and space will not allow; so we will content ourselves with as short an article as possible, giving only enough to have our readers understand the main ideas and facts we wish to impress upon the minds of honest men and women, who read with an unprejudiced mind, to get a knowledge of truth wherever found. This subject is becoming more and more important to the the honest investigator. It is high time that the truth should be known, concerning this much argued question. Honest , conscientious, scientific experiments and invest- igation is the only way to find the right use and disuse for alcohol. This agent has become an important article of commerce. It is used as a medicine and as a food. It is much used in pharmacy and in the arts. There is hardly a country "on earth where alcohol is not known and used to a greater or less extent. It is shipped by tons to even barbarous nations. High taxes are paid 68 ALCOHOL. for license, to allow the sale of it. At present it is not only a question in the medical pro- fession, whether or not it is useful as a medicine, but it is seriously discussed from a legal and religious point of view. So if we come to think of it as it stands to-day, we find that it is one of the great questions to be scientifically sol- ved and understood. It is claimed by many that we cannot do without alcoln )1 as a medicine; by others that it is absolutely injurious in all conditions and under all circumstances, in quality as well as in quantity. That alcohol has ever saved a human life is a question, That it has destroyed the lives of thousands is no question at all. An old adage might well come in at this point: •'have a place for everything, and everything in its place.*' So we will try to find the right place for alcohol. The name alcohol is supposed to have its origin from the arabic language. The word is now used to designate a highly rectified spirit. History: — It is believed that alcohol was distilled from rice, many years before rice was introduced into Europe. We read of it being known in Bagdad in the ninth century. It is spoken of as known to the moors of Spain and by them the knowledge of its production and use was spread into Europe. It was known to the early Romans for Pliny wrote of "a strong kind of wine that was inflammable," which shows that a knowledge existed of distillation in the first century. A description was given in about 1280 by a western writer who wrote of a "burning water." But we find that it was used much earlier in the form of bter, by the ancients; whether they knew it by itself as al- cohol we cannot say. As early as 700 B. C. Archilocheus referred to nine of barley. The king of Egvpt. Osiris is credited by Diodorus Siculus, who wrote 630 B. C. with having introduced into that country, a fermented drink made of barley, as early as 1900 B. C. In 400 B. C. both iEschuylus and Sophocle speak of wine of hurley. In the writings of Julius Caesar we find mention of beer. in the year 50 B. C. Egypt is credited with the discovery of a fermented ALCOHOL. 09 drink- beer; yet it seems that for a Long time the manu- facturing of it ceased till it was reintroduced by the French army. The Germans introduced it to the Gauls. We also find drunkenness spoken of in such expressions as: — "staggered like a drunken man." as early as 1520 B. C. "He is a glutton and a drunkard" in 1451 B. C. "And he drank of the wine anl he was drunken'", about 2347 B. C. "Drinking himself drunk" in 930 B. C. "I am like a drunken man 1 ' 599 B. C. "These are not drunken" and "drink with the drunken" 33-54 A. I). Now then, if there was drunkenness at those times there must have been something that made them drunk; and as we have no evidence that they used other drugs that could produce drunkenness, we conclude that it was alcohol in some beverage that made them drunk. Paracelsus who lived from 1490 — 1541 introduced alcohol into medical use''. Paracelsus of old who wasted life in try- ing to discover its elixir, which after all turned out to be alcohol; and instead of being made immortal upon earth, he died drunk on the floor of a tavern." There is quite a large number of articles that have been classed under the generic term of alcohol. We have about twelve of the alcohol family The common or ordinary alcohol is the ethylic, sometimes known as spirit of wine and vinici alcohol. Absolute alcohol is pure alcohol entirely free from water. Alcohols are also known according to the number of hy- droxyl groups they contain. A group of alcohols may be given a* follows:— The Methylic, Ethylic, Propylic, But- ylic, Amylic, Caproic alcohol &c. Lime is generally used to make the absolute alcohol for commerce. The chemical formula for alcohol is (C2H5OH). It is a liquid that is very volatile; is entirely volatilized by heat: is colorless, inflammable, of a hot, pungent, burn- ing taste and a sweetish penetrating odor. Has great affinity for water, even abstracting water from the air if left in an open vessel. It boils at a temperature of 173.3 degrees F. It has never been frozen by any cold hitherto produced. At a temperature of 130 degrees alcohol becomes of an oily consistency; at 146 degrees it assumes the aspect of melted wax; and at 166 degrees it gets still thicker, but it does not congeal at the lowest attainable temperature. 70 ALCOHOL. Alcohol does not conduct electricity. The specific gravity of absolute or anhydrous alcohol at a temperature of 60 degrees Falir. is 0.820. We cannot get pure alcohol by the ordinary way of dis- tillation. The rectified alcohol or spirit of the United States pharmacopoeias is composed of 91 per cent, by weight of ethyl alcohol, and 9 per cent by weight of water. It is a powerful solvent for the alkaloids, resins, essen- tial oils, and many fats; also for gasses and minerals. It is very readily absorbed by all organic structures. It is a powerful antifermentative when stronger than 18 percent. It is also an antiseptic agent, in the way that it stops fer- mentation, absorbs fats, coagulates albuminous substances, in having an intense affinity for water, and its power for destroying all living micro-organisms: it is therefore also a preservative for animal tissues. We may take dilute alcohol and distill it with chloride of lime and obtain chloroform. It reacts upon acids in such a way that water is eliminated, 2nd ethers are pro- duced. Alcohol is in itself an anaesthetic It is alcohol in alcoholic beverages that intoxicates; even if the vapor of alcohol is inhaled, it will produce intoxication. The Source of Alcohol. — We produce alcohol from sugar, but many other articles can be changed into it by first converting them into sugar: such as the grains, fleshy roots, beets, potatoes. &c. . the fruits, and even woody fibres. The fermentation of sugar and other saccharine matter is the on'y source of alcohol. Sugar is the product of the vegetable kingdom. Some plants contain sugar while many more contain starch, which can be converted into sugar. Therefore those vegetables that contain the great- est amount of sugar or starch will yield the most alcohol. Alcohol is then a chemical product, produced by fermen- tation of vegetable tissue from degeneration: a breaking- down of organized matter: which is a backward process or a dissolving of matter into its primitive elements or atomic state, and then rearranging them into an entirely different compound or compounds. We have said that the chemical formula for alcohol is (C2H5OH): that of starch is (CViHioOsJn and of sugar is (C6H12O6). So w T e see that the same elements are found in the three entirely different compounds— starch, suuar and alcohol— which are carbon, hydrogen and oxygen: only ALCOHOL. 71 in different proportions. Yet starch is not sugar, nor is sugar alcohol. We do not find starch in the human body, only when it has been taken in as food. We believe that all chlorcphyll-containing plants, at some period of their existence, contain starch. Starch is the first organic substance produced by the vegetable king- dom from the mineral or inorganic matter. Animals cannot live on inorganic matter; such matter must first pass through the vegetable kingdom. Plants form starch from carbonic acid and water, which are taken out of the air and the soil. This process is ex- pressed by the following chemical formula: (6CO2 + 5H2C))u = (C6H I0 5 )n -f On. carbonic water starch oxygen acid In the hydrolytic action or change of starch into sugar we have: (C6Hio0 5 )n 4- H2O = Cell r2 ; ;e. starch water inverted sugar In producing common alcohol it is supposed that the cane-sugar first passes into grape-sugar; and in forming alcohol from cane-sugar, maltose and grape-sugar, carbonic acid gas is set free. C6H12O6 = 2C2H5HO + 20O 2 . grape-sugar alcohol carbonic acid gas It is claimed by some that alcohol is found in corn and in other grains: to substantiate their false theory that all things are poison, and that poisonous agents are medi- cines. They argue that we get alcohol from corn, there- fore it exists in corn; just as if alcohol was mixed with other ingredients in corn, and then all that would be nec- essary to get alcohol, is to extract it as you would acid from the lemon. But that is an erroneous idea, and it cannot be upheld by scientific investigation. Alcohol can no more be taken directly out of these bodies than vinegar out of the apple, prussic acid out of the peach, tartaric acid out of the grape, or a deadly poison out of an animal body; unless we first add heat and moisture to produce fermentation — a chemical change to disorganize the ele- mentary substances put together by vital force or life. Heat is the great disintegrative force; it separates the atomic structure, so that the atoms lose their affinity for each other and in that way the tissue is disintegrated— separated; and as these atoms now set free cannot exist in i 2 ALCOHOL. a tree state long, they unite with other atoms that are found in the disintegrated mass, and according to natural law form a new compound or compounds, entirety different from what existed at first. The Action of Alcohol — This is generally spoken of as the physiological action, but by the physiological action we understand it to ''pertain to or of the nature of physi- ology; of or pertaining to the functions of living organ- isms. Physiology treats of the vital phenomena manifest- ed by animals or plants: the science of organic functions." — Standard Dictionary. It then means, to act in harmony with life or with the vital phenomena, or the functions of living organs. Alcohol does not do this; it does not act in harmony with life, therefore its actions are not physiological. Pathology teaches of morbid disease conditions, their causes, symptoms and nature; alcohol causes morbid, dis- ease, or pathological conditions; therefore the proper term would then be, its pathological instead of its physiological action, Before we speak of the action of alcohol, let us first look at the human body as it is, from the microscopical, histo- logical and the chemical point of view. When we examine the human body we find that it is made up of bones, muscles, bloodvessels, lymphatics, nerves", etc. When we examine these tissues under the microscope, to study them histologically, we find that they are composed of many small particles, called cells. When we make closer observation we find that all living cells contain a nucleus, a central germinal spot, which is alive It is the matter, and the only matter through which life can manifest itself. This central germinal spot which is found in every living cell in every living tissue of the living body, is the matter that performs all the functions of that tissue. All organs of the bodV are made up of these cells, and the functions of all the organs — the brain, muscles, liver, stomach, etc — is f he result of the action of this living center of the cell that composes the organ. If we go still further into the mysterious work of nature, and examine one of these little cells, or the entire human body, chemically, we then find that it is composed of about fourteen elements, which are: Oxygen, hydrogen carbon, nitrogen, calcium, sodium, potassium, phosphorus, magne- ALCOHOL. 1'A sium, iron, sulphur, chlorine, fluorine, and silicon. These are not always the same but are constantly changed by new ones, taken from the food we eat. In the healthy normal body they are so combined that they are, as a whole, nonpoisonous; but when the body is dead and acted upon by decomposition, a deadly poison may be produced: as, for example, in dead bodies in the dissecting rooms. The central germinal spot or bioplasm in the cell i> of an albuminous consistency, resembliug the white of an egg. All food that nourishes the body is assimilated by the cells, and the living matter transforms such food into its own substance. In this way the body is built up and kept in repair. The waste material is thrown off from the cell in a molecular and atomic form. A good example of this living mutter, which we find in all living bodies, is found in the blood— the white blood- corpuscles or leucocytes. If we take one of these white blood-corpuscles — or any living matter wherever found— and place it under the microscope, we see that it is a color- less, semi-gelatinous mass, spherical in its natural state: but it can change itself into almost any shape, reaching out here and there, and moving from place to place. Un- der favorable conditions this bioplastic mass will divide and subdivide, so that a large number may be produced. It takes up pabulum and converts it into its own sub- stance, throwing out all foreign material that is not suit- able for its nourishment. It seems as if the human body has been looked upon as a chemical laboratory: medicines were given— and are only too often given yet- -without knowing anything about their true physiological or pathological action. The only true and scientific way to determine the action of any drug is on the bioplasm or living matter. To do this we should proceed as follows: First take a bioplastic body and place it under the microscope: let the fluid in which the bioplasm is immersed be of the right kind: also the temperature should be just right. Then take your agent to be tested; take for example capsicum, which is known to be the purest and most powerful stimulant in the materip medica. and place a small amount under the mi- croscope with a mass of living matter, and we can soon see it begin to act more freely: it will take up more pabulum, and divide and subdivide more readily. It has been stim- ulated to increased action. This can be kept up for some 74 ALCOHOL. time, and the experiment will always show the same re- sult. We next take lobelia inflata, a most powerful relaxant (and it is by some badly informed practitioners called poi- sonous) and put some of it with the living matter, in the same way as before, and we see that the active mass will begin to move very slowly, and then spread itself out so thin that it can hardly be seen for its transparency. Its movements become very slow and may cease altogether for a while; and now, while it is in this relaxed condition, should you add a little capsicum, or any other true stimu- lant, you would soon see it begin to resume its original shape and action. It would do so without the stimulant, but it would take longer. When hydrastis is used the living matter becomes more firm and yet it is very active under the tonic effect of this agent. When an astringent is used it will be seen to contract into a spherical mass and remain in that condition for a time, according to the character or strength of the agent used; but if the agent is sanative, the bioplast will in time resume its action as before. Some agents induce the living matter to throw out more material to form a cell wall. We now take a very weak solution of alcohol, and add it to this living particle of matter which has just preformed so wonderfully under our very eyes, and we see it change almost instantly according to the strength of the alcoholic solution into a spherical mass. So here we might conclude that alcohol is an astringent as the former agent was. We wait but there is no return to act- ivity, we add stimulants as in former cases but still no sign of action. We repeat our experiments over and over again but we get the same result, no activity, no life, but death. When a strong solution of alcohol is used the amoeba or or bioplast will remain almost in the shape it was in when the alcohol struck it, only a little smaller. When we exam- ine it closely we find that some have undergone a granular and others a fatty change. All our experiments with alcohol on living matter show that it so changes the bioplast ic matter that life cannot manifest itself through such matter. All vital phenomena cease, death is the result. So we declare alcohol to be an irritant not a stimulant in any sense of the word, no more than a whip is a stimulant to a hungry, tired and sick horse. Alcohol is a narcotic poison. ALCOHOL. 75 When the alcoholic preparation is very weak it only in- jures to a less extent, accordingly, but if even this small amount is kept up any length of time, the patholog- ical conditions that are set up will in time produce death. Therefore alcohol is injurious in quantity as well as in quality, under all conditions and under all circumstances The question is often asked. Why is it a man can drink much more of the alcoholics after he is used to them, than he could when he began? Our answer is nature has adapt- ed itself to suriounding circumstances. Send a small boy out. in the spring barefooted on a rough mad for miles, and he will come back with his feet bruised, torn and bleeding, but let t he boy go a short way every day with care, and in time he will be able to run over the roughest road without injuring his feet: here nature throws out more formed material to protect the living .particles within, a thick skin was toured, strong and tcugh. In the same way each bioplast is protected from the ravages of poison- ous drugs, alcohol, opium morphine, chloral. &c. &c. Nature throws out more formed material to make a strong- er and thicker cell wall, so as to protect the living centre within. The drunkard's fatty tissue is nothing but dead, waste material, caused by disease, not health; death, not life. After experimenting with alcohol we try other drugs that are known to be poisonous, and we always get the same result — death. It has been proved that one-seven- millionth of a grain of strychnia will kill bioplasm. There is a universal law in the physical world and that is, a poison will kill, no matter what the poison may be. Poison may whip up the system to action, it may bring out the latent force to activity, yet it can only do harm in the end. Why should such drugs be made use of. when nature has supplied, so abundantly, agents of life ? Agents that act physiologically, in harmony with nature, in har- mony with life. Alcohol can destroy a white blood-corpuscle in more than one way: First, because of its great affinity for water; second, on account of its power to coagulate albuminous substances: third, by its inherent power or property to destroy life. Now the question comes, what is a poison? Many of the old definitions given do not throw much light on the 76 ALCOHOL. subject. Some would have us believe that everything may be a poison. We will here quote from the Literary Digest on "What is a poison'?'' '"This question is propounded to the editor of The Nntlontil Druggist by a correspond- ent who criticises the definition of the word 'poison' as given by many of the dictionaries. Says this correspond- ent: 'Webster says a poison is any agent which, when introduced into the animal organism, is capable of pro- ducing a morbid, noxious, or deadly effect. Now, should there not be a limitation as regards quantity of the sub- stance ? Tt seems so to me; because there is scarcely a substance known which, if taken too freely, will not pio- duce morbid, noxious, and even deadly effects.' "To this query The Nat, Drug, replies editorially as fol- lows: 'Your criticism of the definition given by Webster is entirely justifiable. The definition of the word given in Dunglison's Medical Dictionary is almost identical with that of Webster, and so is that of Dr. Billings in his great Material Medical Dictionary. An English authority, whose name escapes us, defines a poison as "a drug that kills rapidly when administered in small quantity;' which, while it gives the element missing (the limitation referred to by the querist) is far more liable to criticism than those quoted. All poisons are by no means drugs, as witness the poison of typhus, of malaria, etc. [No poison should be used as a medicine.] A celebrated English toxicologist. recently deceased, we believe Dr. Melmott Tidey, defined a poison as "any substance which, otherwise than by the agency of heat or electricity, is capable of destroying life by chemical action or its physiological effects upon the system." This, too, is not entirely satisfactory, as admit- ted by the author, who confessed the difficulty of giving a true and comprehensive definition. If it were true, there is scarcely a substance in the whole armamentarium of medicine that would not fall under the term. "Nobody, for instance, thinks or speaks of quinine as a poison, and yet there are numerous instances recorded wherein it has caused death, to say nothing of the morbid and noxious effects of which' we have ample evidence every day. Glycerine, too, merely a feeble laxative when taken into the stomach through the mouth, when introduced into the animal organism by direct injection into the blood causes extreme nervous perturbation, and in the lower animals, death. ALCOHOL. 77 ••It would seem to us. therefore, that the following defi- nition would be more nearly correct and comprehensive: 'Any substance which, if introduced into a living organ- ism in small amount, or quantities beyond and over a certain definite limit, which latter is variable in each sub- stance and for each class of organism, is capable of destroy- ing life, either by chemical action or by its physiological effects.' Like Dr. Tidey, we believe that 'if a substance is a poison it is deadly: if it is not deadly it is not a poison." Substances which do not kill are merely noxious or hurt- ful." "Whatever tends to taint or destroy character or mis- lead.'*— B. Ogden Doremus' letter to the Standard Dic- tionary, January 22. 1896. What agent does more of this than alcohol'? The Standard Dictionary gives: "Any substance that when taken into the system acts in a noxious manner by means not median ical. tending to cause death or serious detriment to health." This does not give us any definite answer. Dunglison's Medical Dictionary gives the following •'All substances which, when introduced into the animal economy, either by cutaneous absorption, respiration, or the digestive canal, act in a noxious manner on the vital properties or the texture of organs.*' in Dutton's "Key to Medicine'' we find that "any sub- stance whose nature is injurious or destructive to health and phy&ical manifestations of life. Something that can- not be taken into the body without physical injury. Food tends to support physical life: poison tends to destroy it." Any substance that has a power or inherent property to so change matter that life cannot maintain itself through such matter. Any substance that has an inherent power or property to destroy bioplasm: or perhaps the best definition would be: Any substance that has the power or inherent property to kill: quantity does not change quality. Poisons kill. Then we learn that all poisons have a tendency to de- stroy life, and sanative medicines have a tendency to assist the vital phenomena — or life. It is a fact that all food made use of by the human body is taken up by the central germinal spot, the bioplasm of the cell; and likewise the medicine that influences the living matter to perform its functions normally and har- 78 ALCOHOL. moniously. All foods to a certain extent are medicine, and all true medicines are foods. No inorganic substance can become a part of the animal tissue, until it has first passed through the vegetable king- dom. If this is true — and all physiological research will substantiate this assertion — then a great many articles used by many, are not only unscientifically applied, but are detrimental to the human organism; such agents are mercury, arsenic, zinc, iron, etc. Those that are poison- ous kill; and those that are not poisonous, as iron, act as foreign substances, or irritants. All true medicines should be of a vegetable nature. Bi-carbonate of sodium will neutralize the acid condi- tions; sub-sulphate of iron will stop hemorrhage; these act locally, and should be given for that purpose, and as far as it goes, do well. But there are vegetable remedies that will do just as well, and better. The curative effect of all mineral waters is only local, a washing out of the various canals, as it were; and in that way may do some good, if they are free of noxious matter. Alcohol can be used as an antiseptic. It dissolves fatty matter, absorbs watery excretions, coagulates albuminous matter, and destroys all germs. On this account it can be used to good advantage to wash -the hands in before a surgical operation, and it is well adapted to immerse the instruments in before and during the operation. Old putrid sores are sometimes washed with alcohol be- fore applying the regular remedies. In fevers where the body is very dry and hot, alcohol is used to evaporate the heat and to dissolve the fatty waste material. It is often used in combination with chloroform and ether as an anaesthetic. While alcohol is used in the above mentioned circum- stances, yet we would not recommend it for such use. The hands harden when washed in alcohol. Hot water and soap is better. Your instruments immersed in hot water or some non-poisonous antiseptic, will produce better re- sults. Old sores are washed with alcohol, yet we have many superior articles, that will do better. Alcohol would ex- tract the water from the delicate blood-vessels, destroy healthy granulation, and do much harm generally. To wash the skin in fevers is not always best; it hardens and weakens th*» skin. It U no tonic to the skin, as is believed ALCOHOL. 79 by many. Warm water with sanative agents is best. We believe that alcohol destroys many of the medical properties in extracting them from plants: therefore alco- holic preparations cannot always be depended upon. Very often symptoms of depression, which are supposed to be caused by an innocent agent is caused by the alcohol in the medicine. Alcohol given internally will arouse to action many or- gans; but this action is of an irritating nature, and func- tion is performed normally. Its injurious effect begins .is it enters the mouth. The mucous membrane is loose, soft and far more delicate than the external integument. Much is absorbed by the numerous ues are not so created that every pleasant tasting substance will feed them. * * It is a deep-rooted belief that alcohol strength- ens the weary to new exertions and efforts. * * The error that alcohol strengthens the weary is most fatal in the class to which the largest part of the population belongs. Poor people whose income scarcely holds out for the supply of the barest necessities, are led by this mistaken notion to spend a very important part of their wages in drink, rather than in providing plentiful and nourishing food, which alone can lit them for hard work. * * It is the same with other poisons. The opium eater cannot work, or eat, or sleep on giving up his drug — he is "strengthened" by opium [so be thinks], but the man who is entirely fres from narcotics is the stronger, more capable man. Better than any scientific deductions, however, one learns the real uselessness — nay. the actual damage even— of moder- ate drinking, through the thousands of experiments made with the army, and which go to show, all of them, most 86 ALCOHOL. conclusively, that soldiers in peace and in war, in all cli- mates, in heat, rain and cold, best endure the hardships of their labor and discipline when all kinds of intoxicating drinks are withdrawn from their supplies. % * Alcohol strengthens no one. It only dulls or deadens the feeling of fatigue." Dr. Frank Hamilton speaks as follows: "It is greatly to be hoped that these experiments may not be repeated in the United States army. We have reached the firm conviction, through observation and experience, that the customary use of alcohol is under no circumstances neces- sary for healthy persons. We make no exception for cold, rain, heat, nor even for the habits of former drinkers, when once they have enlisted." Prof. Beale, of England, says: "Alcohol is not a food, but is absorbed as alcohol. It does not act as a food; it does not nourish tissue. * * It cuts short the life of rapid. y growing bioplasm, or causes it to live more slowly, and thus tends to cause a diseased texture in which vital changes are abnormally active, to return to its normal and much less active condition. It is easy to prove that by these measures many cells that were alive are killed, and that those that escape death live and grow more slowly than before." Prof. N. S. Davis, A. M., M. D., LL. D., of Chicago, says that alcohol "is not assimilated, but is thrown off un- changed. As it is not assimilated, it cannot be a food." Dr. James Ross was told by a medical man that he kept a prematurely born child alive for the first three weeks by feeding it with whisky toddy. Seven years later the child was a puny little idiot. In nearly every instance where alcohol is given it is given with some nourishing food, as milk, and it is this that keeps the patient alive, not the alcohol. The patient lives in spite of the alcohol. Sir Ashley Cooper, England, an undisputed authority in his day, denounced habitual beer-drinking as noxious to health. Referring to his experience in Guy's Hospiial, he declared "that the beer-drinkers from the London brew- eries, though presenting the appearance of the most rug- ged health, were the most incapable of all classes to resist disease; that trifling injuries among them were liable to lead to the most serious consequences; and so prone were they to succumb to disease that they would sometimes die ALCOHOL. 87 from gangrene in wounds as trifling as the scratch of a pin." Dr. John Higginbottom, F. R. S., after more than fifty years of practice, said: "Alcohol is neither food nor phys- ic." The eminent German chemist Baron Von Liebig says: "If a man drinks daily eight quarts of the best Bavarian beer, in the course of twelve months he will have taken into his system the nutritive constituents contained in a five-pound loaf of bread, or three pounds of beef"— 730 gal- lons— 23i barrels — nearly three tons in shape of beer against three to five pounds in ordinary foods. During that time he would pass through his system about one barrel of abso- lute alcohol; and this nourishment in shape of b»er would cost about $300.00. Is Alcohol a Stimulant ? t — Alcohol is not a stimulant but an irritant; a narcotic poison. The eminent Dr. Semnola. Professor in the College of Medicine at Naples, says: "I am of the opinion that alcohol is simply a toxicative, like many other antipyret- ics, as digitalis, phenic acid, etc., which poison the patient and those organs or tissues which are the necessary instru- ments of febrile manifestation. •' Dr. Reynolds: "It has been proved to be a true narcotic poison, of the same class as the so-called anaesthetics, chlo- roform, and sulphuric ether. * * Its influence is entirely in the direction of paralysis— suspension of nervous activ- ity— a source of deficient vital power." In Schmiedenberg's First Principles of Pharmacology, Leipsic, we read: "In general let it be understood that all the workings of alcohol in the system which usually are considered as excitement or stimulant, are only the indication of paralysis." Prof. Bunge: "The benumbing of all sense of fatigue or weariness belongs also among the tokens of paralysis so commonly attributed to stimulation." Prof. R. W. Wilcox, M. A., M. D., LL. D., in his Mate- ria Medica: "In many campaigns and Arctic expeditions it has been found that although at first the men, after taking alcohol, could do more work [so it would seem, in the stage of excitement], yet soon they felt so tired and exhausted, that on the whole they could do much more without than with the alcohol." Dr. Elislia Chenery, of Boston, author of a fine work— 88 ALCOHOL. "Alcohol Inside Out"— says: ''Though alcohol may excite for a while a portion of the mind, it is always the lower faculties; while the higher, such as the judgment and rea- son, are always lessened: so that by this abeyance of the higher powers, the wise and learned, though they cease not to speak when drunk, they babble as fools; and not in- frequently have decrees been issued and armies marched under the authority of this species of stupidity." Prof. K S. Davis, A. M., M. D., LL. D., of Chicago, says that alcohol "does not stimulate or strengthen, but de- presses and weakens." Alcohol is an irritant, a narcotic poison. Prof. William Hargreaves, M. D., of Philadelphia, in his tine paper on alcohol, says: "For alcohol, in all its forms, instead of nourishing, poisons; instead of stimulating, nar- cotizes and paralyzes; instead of increasing the vital forces, diminishes force, produces disease, and is an agent of de- generation and death." Dr. F. R. Lee, of England, says: "All poisons lessen vitality and deteriorate -the ultimate tissue in which force is reposited. Alcohol is an agent, the sole, perpetual and inevitable efforts of which are to avert blood development, to retain waste matter, to irritate mucous and other tis- sues, to thicken normal juices, to impede digestion, to lower animal heat, to deaden nervous sensibility, to kill molecular life, and to waste, through the excitement it creates in heart and head, the grand controlling forces of the nerves and brain." Reynolds says: "It has been proved to be a true narcotic poison. * * Its influence is entirely in the direction of paralysis— suspension of nervous activity— a source of deti- cient vital power." Sir William Gull, M. D., states that "the commonest thing in British society is that people are injured without being drunkards. "From my experience, alcohol is the most destructive agent that we are aware of." Dr. Desquin, of Antwerp, in a paper published in the Bulletin Generate de Therapeutlque for October 25th. 1875, said: "Two phases should be distinguished in the physiological action of alcohol and alcoholic drinks. The first is characterized -by excitations of all parts of the nervous system, ganglionary as well as cerebro-spinal; the second, by the depression of all the acts of organic and ani- mal life." ALCOHOL. 89 Dr. J. Mathews Duncan: -'That alcohol does not pro- duce equally palpable evidence of poisonous effects on all. argues no more against its poisonous nature than the dif- ferent effects of opium, arsenic, or lead on different per- sons." Dr. W. B. Richardson, F. R. S.: "The true character of alcohols is that they are agreeable temporary shrouds " Dr. N. S. Davis says: "Alcohol is a poison." Dr. Dunglison says: "That alcohol in large doses is such a poison admits of no question. All medical and medico- legal writers so classify it; and all practitioners become painfully familiar with the fact. * * It is in any form and dose noxious to the body." Prof "T. L. Mason says that "alcohol is a poison inhe- rently, absolutely, essentially; in a drop or in a gill, in a pint or in a gallon, in all quantities and in every quality, it is a poison. Its quantity does not alter its chemical constitution." Prof. Willard Parkes: "Alcohol has no place in the healthy system, but is an irritant poison, producing a dis- eased condition of the body, and mind." In Health.. —There is no human body so healthy or strong that it will not in time be ruined by the continual use of alcohol, even moderately. Some can stand more of the degenerating effect than others, just as many can with- stand cold, heat and rain better; yet all must in time be bent low by the depressing effects. In the United States Dispensatory we find the following: "As an article of daily use, alcoholic liquors produce the most deplorable consequences." Prof. E. A. Parkes, Netley, England: "Experience de- cidedly shows that the highest health, the greatest vigor and long life are quite compatible with entire abstinence from these liquors." Dr. W. Parker says: "Alcohol has no place in the healthy system." Dr. Hudson says: "By continuing our alcoholic stimu- lants [not stimulants] we retard the process, thus acting contrary to the indications of nature." Dr. George M. Beard, of New York, says of alcohol that it "in every way works more injury than benefit." Prof. Sydney Ringer, M. D., says: "There can be no doubt that healthy persons, capable of the fullest amount of mental and physical exertion without the stimulus of 90 ALCOHOL. alcohol, not only do not require it, but are far better with- out it." Alcohol Causes Diseases of a Great Variety. — James L. Perryman, A. M., M. D., of Illinois, says that "alcohol is no more the gift of a beneficent Creator than small-pox, yellow fever, diphtheria, measles, typhus, ty- phoid, leprosy, or any contagious or infectious disease. Alcohol passes through the animal economy unchanged, scorching, burning, disorganizing, paralyzing, and break- ing down sooner or later every tissue it comes in contact with." Prof. N. S. Davis says alcohol "disturbs physical proc- esses and lays the foundation of disease." Alcohol causes cirrhosis of the liver. Of twenty cases of this disease seen by Prof. Austin Flint, seventeen admit- ted intemperance, and another was not an abstainer. Of twenty-four cases caused by liquor, he found twenty-three drank spirits and one beer. Dr. Loomis, in his "Practice," states that "those who take alcohol before breakfast as well as through the day are almost certain to develop cirrhosis of the liver," Dr. H. F. Formad, of Philadelphia, found that of 250 bodies of chronic drinkers examined, 220 or 88 per cent, had fatty livers that were more or less enlarged. According to Dr. Edward Goodeve, "atrophy of the liver, which is so frequent in Europe, is to be ascribed chiefly to the use of alcoholic drinks among the people." Dr. S. J. Goodfellow, Physician to the Middlesex Hospi- tal, regards it an unquestionable fact, that alcoholic com- pounds are a very frequent cause of kidney disease and albuminous urine. Alcohol is Given in Consumption— Dr. Lebert, who has seen much practice in Germany, France and Switzerland, strongly condemns alcohol as a cause of consumption, and never intimates that it will help cure it. And no less an authority than Dr. Austie insists that no form of con- sumption is so utterly fatal as that arising from alcohol. This form is usually what physicians call the "fibroid" consumption, corresponding to cirrhosis in other parts. The Effect of Alcohol on the Heart —Prof. R. W. Wil- cox, M. A., M. D., LL. D., in his Materia Medica, says: "It has been repeatedly proved that these good results are but transitory. The heart, although at first stimulated [irri- tated], is m >:-j exhausted aftor t/ie stimulation has passed ALCOHOL. 91 off, than it was before. This is also true of all the or- gans." Dr. B. W. Richardson, of London, studied the heart with the aid of instruments of precision, showing that the heart beat was decidedly altered in persons much short of ine- briety. Total abstinence and time were both necessary to restore the heart to normal function again. Dr. Aitken asserts that ''alcohol acts specifically on the heart, and the powers of the heart are often permanently augmented, whilst the coats of the arteries, thickened, thinned or ulcerated, have their elasticity destroyed and thus the tendency to hemorrhage in the brain is increased."' Dr. Thomas Sewall, who has held many autopsies on the bodies of the intemperate, observes: ' I am inclined to think that the heart seldom escapes injury." Dr. Marvand of France, and Dr. Zimmerberg of Germa- ny, through their experiments made with the sphygmo- graph, or pulse-writer, have learned that "large doses in- crease at first and then diminish the heart's action; and very large doses depress from the first." Prof. Martin, of the John Hopkins University, one of the foremost experimenters in physiology in this country, aided by the fine instruments of precision of that highly endowed university, has made many experiments to dem- onstrate the action of alcohol on the heart, and has found by comparison that an ounce of whisky or brandy always lessens the force of that organ, though generally increas- ing its frequency. But frequency is often only the indica- tion of weakness, as is so often seen in disease and when the physical powers are going out in death. This weak- ness so clearly made out from an ounce of such spirits, becomes more and more decided as the dose is increased. This is an unequivocal demonstration which must be ac- cepted. Prof. A. B. Palmer, M. D., who was president of the medical department of the University of Michigan up to his death, made the following remarks in an address: "We thought, and we may sometimes still think, alcohol makes us witty. We know from observation it makes men silly. We thought it brightened the intellect and might make men wiser; we find that in the long run, at least, it dulls the intellect and makes men foolish. Wine has been called the 'milk of age,' and we thought it sup- ported advanced life; we know that the aged live longer 92 ALCOHOL. and retain their powers better without their use. Asa medicine, we thought it protected against epidemic dis- eases; we know now that it invites attacks. We thought it prevented and even cured consumption; we know it is the almost frequent cause of at least one form of that dis- ease. As our scientific knowledge of alcohol advances, our practice with it and our language respecting it should change. As to its physiological effects, we have certainly in many respects been mistaken in the past. We have said it excited the vaso-motor nerves of the surface and thus increased vascular action in the cutaneous circula- tion; we know now it depresses these nerves and causes passive dilatation of the surface vessels. We thought it increased animal heat; the thermometer shows it dimin- ishes it. We thought that, from more blood coming to the surface and sometimes causing a feeling of warmth, it would diminish the danger from exposure to cold; we find that, from less heat being produced in the centers, and more being lost from the surface by the increased blood in the superficial vessels, the danger of exposure to cold is greatly increased. We said tte alcohol taken was oxydized in the lungs, and that increased heat and other forms of force were thus produced; we find that it is not thus ox- ydized, and that under its influence heat and the other forms of force are lessened We thought it increased mus- cular strength, and it was taken to aid men in their work; we find that it diminishes muscular power, both for im- mediate action and with reference to endurance We said it was a direct heart excitor; we now know it is a direct heart depresser. We said, and nearly all the text-books still say, it is a cardiac stimulant; .we know from most conclusive experience it is a direct cardiac paralyzant." Alcohol in Cholera, Yellow Fever and all Intestinal Diseases. — Dr. Christison mentions a case where the whole lining coat of the stomach was in a gangrenous state, and the large and small intestines were red or inflamed their whole length. Dr. Jacobs confirms these observations. Remembering that fact and knowing that alcohol is one of the principal agents of many practitioners in the treat- ment of cholera, yellow fever and allied diseases, we will listen to those who have had much experience in this line; When cholera was prevailing in 1832, The London Morn- ing Herald put forth this announcement; "Intemper- ance is a e Ratification it never overlooks. Often hns it ALCOHOL. 93 passed harmless over wide population of temperate coun- try people, and poured down, as an overwhelming scourge, upon the drunkards of some distant town.'* The testimony of Dr. Mackintosh, of the extensive chol- era hospital in Edenbury, is this: "Drunkards were the persons generally attacked; and, above all, the first victims are the dissipated, particularly those addicted to the use of ardent spirits.'' Dr. Bronson, who has treated many cases of cholera in Montreal, said: "The disease has searched out the haunts of the drunkard, and has seldom left it without bearing away its victims: even moderate drinkers have been but little better off.'' Under the false theory that alcohol is a preventive of such diseases, and especially cholera, many persons resort- ed to their bottle; but, says Dr. Bronson, •they did it at their peril." It is a stated fact that out of one thousand deaths in the city of Montreal only two were members of temperance societies of any kind. '-During this same time there were 5,000 members of temperance societies in the city of Al- bany, N. Y., and Dr. Mussey testifies that only two of them fell by that disease." There were 204 cases in Park Hospital in New York, and Dr. Sewall, who came from Washington on a visit, made inquiry and reported that only six of them were tem- perance men, and they all recovered, while those who used alcoholic drinks all died. "(On account of this scourge the grog-shops were closed, as a nuisance to public health.)" In 1853 nine hundred persons died in Rotterdam of the disease, and only three were total abstainers. In Tifflis. in Asiatic Russia, a city of 20.000 inhabitants, Mr. Ruber reported that "every drunkard has fallen; all are dead; not one remains." What is true of cholera is also true of yellow fever. Dr. James Rush, who was a witness to a fearful outbreak of this plague in Philadelphia, said: — "Every species of inflammatory and putrid fever is rendered more frequent and dangerous by the use of spirituous liquors. This has been remarked in all the yellow fevers wmich have visited the United States. Hard drinkers seldom escape and rare- ly recover." Dr. G. Dowell of Texas, who lias had very large oppor- 94 ALCOHOL. tunities for observation, writes: — "All habitual drinkers died, none recoverd who were taken while drunk." In New Orleans 5000 died of the disease ere one sober man was touched.— "Alcohol inside out." The alcoholic liquors are taken to keep the cold out in winter and to keep the heat out in summer. They are taken for colds and when a man is out in the cold weather he takes it to prevent taking cold. When a man is nearly frozen to death, it is given to warm him up. When a per- son is overcome by heat or burning with a fever, it is given to revive him or to reduce the fever. With us on the Congo "says Henry M. Stanly" where men must work and bodly movement is compulsory, the very atmosphere seems to be fatally hostile to the physipue of men who pin their faith on whisky, gin and brandy. They invariably succumb. And again in the Journal of Balneology we read that Stanly Yery positively declares that Englishmen can keep their health under the Equator only on condition that they entirely relinquish alcohol even the use of light-wine or malt liquor is followed by the most unfavorable effects, and in course of a few months or a year the health is broken down and death or invalidism follows. Greely, the great Arctic explorer said that:— "Those who vsed alcoholic drinks could not stand the cold as well as those who used no alcoholic drinks of any kind, stood much more cold, hunger and hardships than those who did. The latter soon gave out, froze or died of exhaus- tion." Soldiers in peace and in war, in all climates, in heat, rain and cold, best endure the hardships of their labors and dis- cipline when all kinds of intoxicating drinks are with- drawn from their supplies. ** Eesults like these are also to be seen in the navy, as well as among merchantmen, thousands of which go to sea from America and England without a drop of spirits on board and it matters not whether in the tropic, temperate or friged zones.— Prof. Bunge. As the result of a great many observations taken in con- junction with Dr. Richards, every quarter of an hour, for several hours, on persons of all ages, we found that alcohol, brandy and wine, diminished temperature. ** These obser- vations have been confirmed by Prof. Bing of Boner, and Dr. Richardson, who asserts that all alcohols reduce the animal temperature. "— Ringer. ALCOHOL. 95 Dr. Davis:- "It diminishes nervous sensibility, reduces temperature, and retards molecular change." The general idea that mothers who nurse their children should use some alcoholic beverage is wrong; and very in- jurious to both mother and child. The milk of a drinking nurse is prejudicial to infants. The observing Scotch doctor Macnish, says:-Such children are almost always sickly; subject especially to derange- ments of the digestive organs and to convulsive affections.'' Dr. North has been obliged to discharge such nurses, transfering the children to the breast of abstaining women with immediate benefit. Prof. J. Redding, M. D. author of Physiology, it science and Philosophy," says;— "But worse than all else — yea a thousand fold more disastrous in its damnable influence, it even penetrates into the pregnant womb and there grasps the unborn babe in a vice-like grip, and sad to say may never let go either throughout time or endless eterni- ty." What Life Insurance Statistics show. President Green, of the Connecticut Mutual Life In- surance Company, says:— "The degree to which many dis- eases commonly referred to as malaria, overwork and other vague general scape goat causes, are actually grounded in what would almost invariably be called a temperate use of drink by persons of reputed temperate habits, would be in- credible to the mass of people unaccustomed to careful ob- servation and comparison of related cases". Mr. John Rutherford, some years ago, made the follow- ing statement: a certain assurance offlce with which he was connected, issued 30000 policies to moderate drinkers, and 10,000 to teetotalers, excluding all publicans, brewers, and free - drinkers, and the mortality of the two classes was kept separate. During the first thirty years the mortality of the teetotalers was 9 per cent less than that of the moderate drinkers, while for the last eight years it has been 25 per cent less. In 1886 the Total Abstinence Department of the Sceptre Life Association of England had at risk 3901 lives, of whom only 14 died, being less than four per 1000. During the last 21 years this association should have lost 361, but as a mat- ter of fact only 163 died, less than i the usual death rate where drinkers are insured. Dr. W. B. Carpenter says:— k 'The average mortality for 96 ALCOHOL. the whole population of England is twenty-three per thou- sand. Those insured in life insurance companies, eleven per thousand, those insured in Friendly Societies (Masonic. Odd Fellows, and others) ten per thousand; in the Rechab- ites, who are total obstainers, seven and one half pei thou- sand. The Pennsylvania Insurance Report of 1874 gives the following rate of death during the preceding year. Western Masonic, R. A., death per 1000. 14. Odd Fellows, " " " 6* United Brethren, (M.) " " " 8. Temperance Mutual, " " " 4. Alcohol as a medicine:— Dr. Davis, who has had many years of experience, gives his testimony as follows:- I have demonstrated by the last forty years of actual experience that no form ot -alcoholic drink, either fermented or distill- ed, is necessary or desirable for internal use, either in health or any of the varied forms of diseases: but that health can be better preserved, and disease be more success- fully treated, without the use of such drinks." The theory that alcohol is necessary in treatment of pneumonia has received a death blow from Dr. Bull of New York, who finds that in the New York Hospitals sixty-five per cent of the pneumonia patients die under alcohol treat- ment, while in London, at the Object Lesson Temperance Hospital, only five per cent die. S. Wilks, M, D., Physician to Guy's Hospital, London, says:- "To my mind, the most important question in ther- apeutics at the present day is the value of alcohol in dis- ease. If it be said that its frequent use is an evidence of its potency, this is the more sufficient reason why its ad- ministration should be watched with the extremest care. So wedded, however, are some to an idea of the absolute necessity of stimulants, that they have expressed almost incredility when they have heard it stated that fevers would terminate favorable without them. Young persons with typhus and typhoid do far better without them. ** It is also a fact that in bronchitis I have repeatedly seen improvement after stimulants [irritants] have been omit- ted; and, as regards heart disease, I am convinced that the amount of mischief done is immense. In the case of fevers and bronchitis, the weak pulse is often but an indi- cation of extreme capillary congestion, and a stimulus to the heart often aggravates the evil; and in the case of a ALCOHOL. 97 diseased and weak heart, where repose is indicated, a con- stant stimulation by alcohol [not stimulation but depres- sion, paralyzing, poisoning] adds immensely to the trouble. * * Do not then assume that alcohol is an equivalent to a tonic, and that it must, be necessarily administered because your patient i> weak. 1 1 may be that that very weakness is due to the long-continued pernicious effect of this same stimulant: indeed, as you have often heard me say in # the out-patient room, if a man comes into our pres- ence with a tottering gait, a bloated face, and his nervous energy all gone, you may be quite sure that he has been taking 'strengthening' things all his life." John Higginbottom, F. K. S.. F. R. C 8.: -'1 gave alco- hol in my practice for twenty years, and have now prac- ticed without it for thirty years or more. My experience is that acute disease is more readily cured without it. and chronic diseases made much more manageable. 1 have not found a single patient injured by its disuse, or a constitution requiring it: indeed, to find either, although I am in my 77th. year I would walk fifty miles to see such an unnatural phenomena." J. W. Beaumont, M. D., L. 11. C. P., Edenboro: "I have treated several thousands of cases off all kinds occurring in general practice without alcoholic liquors of ill kinds. The medicines take effect more potently, and answer their end better. Patients get well much sooner, and, as a nat- ural consequence, my bills are considerably less." Sir Henry Thompson regards it as ••a luxury, and not in any sense a medicine." Dr. Callenette, of the Isle of Guernsey, writes. "'For twenty-one years I have banished all intoxicants from my practice, and during that period 1 have made not fewer than 180,000 medical visits, and I hesitate not to say that the recoveries have been more numerous and more rapid than they were during the five years I followed the usual practice and administered brandy, wine and beer.'' Dr. Austie, of London, speaks of the alcoholic system of treatment, that ''it is a system fraught with danger of the gravest kind." Dr. B. W.Richardson [London Lancet 187H): "As a medicine it has no place." Dr. Henry Leftman condemns it on scientific grounds, and turning the tables on those who prescribe it makes them responsible for a lar«e proportion of the misery it 98 ALCOHOL. occasions and declares the time come when the profession should take a stand for abstinence. Years ago Dr. It. D. Mussey insisted that so long as alcohol retained a place among sick patients so long would there be drunkards. Dr. Davis: -'There is no disease that can not be better treated without than with it.'* Alcohol Causes Insanity. — Dr. Ogston teaches that "the nervous centres present the greatest amount Of mor^ bid change, the morbid appearance within the head ex- tending to over 92 per cent, of cases examined by him. Dr. Behics, a French physician, reporting on the phys- ical causes of insanity in that country, puts down 34 per cent, of 8,800 lunatics of alcoholic liquors; and no doubt but what the percentage is much higher. Dr, Romberg, of Berlin, having passed an army of 50,000 of his insane countrymen under his eyes, speaks thus: "The diseased condition of the blood and its vessels exerts an undoubted influence on the mind. The affections of the brain, such as vertigo, dizziness, fear, terror, etc., are caused in a great measure by the continued use of spiritu- ous liquors and other narcotics, that influence the blood- vessels of these parts. So, after a time the mind becomes clouded, and sopor-drowsiness, paralysis and death super- venes." Dr. D. H. Tuke, in "Manual of Psychological Medicine,*' states that "insanity produced by intemperance is unfa- vorable, and when it does not assume an incurable form, manifests a strong tendency to relapse after recovery." Dr, Harlow, of the Maine Insane Hospital, says: "It is quite a frequent occurrence to have patients brought in to us. between the ages of 50 and 70, who in early life were given to the use of alcoholic drinks, but had reformed and lived temperate lives ten* twenty or thirty years prior to the appearance of their malady, showing conclusively, to my mind, that the alcohol taken thus early left a damaged brain, doubly susceptible to mental derangement." Dr. Contesse, Superintendent of the Bicetre, near Paris* states "that over 25 per cent, of cases received are due to alcoholic drinks." Dr. Harlow: "The brain and nervous system of men. when acted upon for a considerable length of time by alco- holic drinks, by narcotics, as tobacco, opium, chloroform, chloral hydrate, or any of the nerve stimulants [nerve de- depressants], are pretty certain to give forth uncertain and ALCOHOL. 99 unreliable mental manifestations which soon ripen into unmistakable disease — insanity." Lord Shaftesberry. in his evidences before the Commit- tee on Lunatics, in 1859, expressed his opinion that fifty per cent, of the insane admitted into English asylums owed the cause of their mental state to intemperance, and quoted the authority of Esquirol in support of the state- ment. AVe now come to one of the most serious questions — that of heredity. The alcoholic liquors may dull the intellect— the face of a bright, intelligent young man may be disfigured, so that he will stagger along the street with blinded and bleared eyes, with red congested nose, bloated face; and long be- fore he enters the good years of old age, to go down as a miserable wreck, into ruin and disgrace, and end in a drunkard's grave, from whence there will be no return. All alcohol drinkers are walking advertisements for alco- hol, showing the way to misery, to degeneration and to death. The grog-shops may hang out bright glittering bottles, to waylay the virtuous and innocent passer-by, and even succeed to entice him through the doors that lead to eternal darkness, and keep him there— for "brigands, gangs of robbers, prostitutes, cannot dispense with alco- hol." It may be given to the father to so derange his rea- soning faculties that he will slay his whole family. It may be forced down the throats of helpless invalids, who cry for mercy and for health, but o-ly to be held down with that powerful arm of destruction, that will take the very food in their system and destroy it; that will depress, par- alyze, irritate, poison and destroy life. Yet all is not one- half so sad as to be born with the alcohol habit. What curse on earth can there be worse than to be born with the disease of alcoholism? No matter how good a man may be, how determined his intentions, he is bound to fall sometime. No matter how high an office in life he is hold- ing, he will fall in spite of all he can do. into the bot- tomless abyss of the "outcasts of society," and go friend- less, homeless and Godless into the dark avenues of death. This, above all. should make sane people think— to have mercy on the generations to come, if indeed they do not care for their own welfare. How few— even people who class themselves among the good on earth — will not turn 100 ALCOHOL. away from the voice of an honest teacher, whose heart is breaking within him to tell his fellow men of the dangers of alcohol poisoning. Much blame rests on them who would know truth only so far as not to interfere with their own selfishness. Then we would most earnestly appeal to the medical profession, who should be guardians of public health, to study this question more carefully, and we are sure, when the medical profession will come out right then the alco- holic liquor, with all its branches, will become less, year by year, till at last the thousands on earth can shout as with one mighty voice, "Hallelujah ! The agent that was the greatest curse to humanity with many of its branches is dead." Such a time will come when the doctors will tell the truth concerning alcohol. The term alcoholism was coined by Magnus Huss. All ancient authority who had any occasion to speak on the propensity for strong drink, whether they were philos- ophers or physicians, noted its transmissibility from parents to offspring. Dr. J. D. Steele, in his "Hygienic Physiology/' says: "The alcohol craving may be transmitted from father to son, and young persons often find themselves cursed with a terrible disease known as alcoholism." Gall, an authority of note, admits the transmissibility of the propensity for strong drink. Giron de Bonzareinque, in his book on Procreation, says that he knows of families where this morbid, unfortunate fondness for alcoholics was transmitted from generation to generation through the mothers. Thonreuf (thesis 1859), Conlesse (thesis 1882). also Marce, admitted fully the heredity of alcoholism. Lancereaux and Fournier suggest that the proneness in certain cases to alcoholic excess "is the result of an innate vitalized predisposition, and that habitual drunkenness is. in some eases, certainly the outgrowth of a morbid trans- mission." Tagnet ("Heredity in Alcoholism." Ann. Medic. Psycho . 1877, Vol. II. , p. 5) admits, "for alcoholism, as in all other diseases, is transmitted from the procreators." He dwells particularly upon the morbid manifestations produced by alcoholism of the procreators upon the constitutions of their progeny. Dr. Paul Sollier. resident physician in the Paris Hospi- ALCOHOL. 101 tal, tells us in his admirable article on "The Influence of Heredity on Alcoholism," that "We have found some very interesting inferences from the discussions of our present point in two recent theses by Grenier and by Legrain. Grenier, studying the progeny of alcohol ismics, shows by numerous instances that weak minded subjects are very much inclined to abuse of strong drink, and that from be- ing at first hereditary alcohol ism ies. they become inebri- ates by the same sequence as their procreators. We see alcoholics not only generating feeble offsprings, but im- planting in them also the taint of alcoholism. Hard drinkers procreate hard drinkers in a notable proportion of cases.'' Legrain (thesis 1886) says: "If t he re are any two propo- sitions that we have the right to formulate at the present day, the following 'are the two: 1.— Cerebral inferiority. the direct cause of excesses in strong drink, has its origin most frequently in heredity: that is, excessive drinkers are degenerates. 2. — Alcoholism is one of the most power- ful causes of mental degeneration: that is. the sons of inebriates are degenerates. The relations between alco- holism and mental degeneracy are comprised within this vicious circle, which is irrefutably traced out and confirmed by innumerable most eloquent medical observations.'* Further he says: "There are but few cases of degenerates in the careful study of which we may not discover, some- where, evidences of excessive addiction to strong drink. On the other hand, it is notorious that in the category of confirmed inebriates we find their progeny to include cases of idiocy, imbecility, weak-mindedness, and various neu- ropathies, of which the mo^t frequent is epilepsy.'' Dr. Crothers says: "In many cases alcoholism has a preliminary period, varying in duration, before the addic- tion to strong drink develops itself; and in some cases before the initiation by the first alcoholic indulgence. Alcoholism then makes itself known under shelter of the reparatory measure against the wear and waste of years, or after a nervous shock, or some sickness, entirely outside of all temptations and simply from the habitual use of stimulants. The patient commences to drink for relief to liis suffering; then he increases his potations; and finally he cannot do without them. Such a subject has started with latent alcoholism." Sollier shows that "in 141 cases the alcoholism was 102 ALCOHOL. linked with conditions of heredity, viz.. in 106 cases by heredity in similars and in 35 cases by heredity in dissimi- lars. * * If we analyze the cases of heredity in similars we find : Transmission to 2 generations. 93 cases. " 3 " 10 " . u 4 « 3 u In certain cases we have observed that alcoholism, after having been transmitted directly to two generations in one branch of the family, has been transmitted indirectly in skipping from the first to the third generation, tainting a member of another branch of the family. In one case the alcoholism, after being transmitted directly to the first two generations, was transmitted collaterally to the third and fourth generations, among which it was again transmitted directlv.'' According to Darwin (Zoonomia) alcoholism is transmit- ted through three generations, "after having gradually sunk in the scale of degeneration both physically and men- tally ." Morel, in his "Degenerations" (p. 114). gives the follow- ing: ••First generation--alcoholie excesses, depravity, moral turpitude, brutal instincts. "Second — habitual drunkenness, attacks of mania, gen- eral paralysis. "Third — hypochondriacal, thoughts of suicide, thoughts of homicide. "Fourth— undeveloped intelligence, stupidity, idiocy, and finally, probable extinction of the race." Dr. Tarquet says that "the children of drunkards are not all of necessity idiots, lunatics or epileptics, but there are few that present nothing abnormal: and in those of seeming freedom, the germ may be late in developing it- self." Fusch speaks of three young men whose father was a drunkard; two of them followed his example quite early, and the other one became a drunkard very suddenly at the age of thirty. The Herald of Health speaks of startling results of a study of the posterity in ten families of drinkers and ten families of non-drinkers: "The direct posterity of the ten families of drinkers included 57 children. Of these 25 died in the first weeks and months of their life, six were ALCOHOL. 103 idiots, in five children a striking backwardness of their longitudinal growth was observed, live were affected with epilepsy, live with inborn diseases - One boy was taken with cholera and became idiotic. '•Thus of 57 children of drinkers only ten. or 17.5 per cent., showed a normal constitution and development. The ten sober families had 61 children. Five only died in the first weeks, four were affected with curable disea^- of the nervous system, two only presented inborn defect--. The remaining fifty — 81.9 percent. — were normal in their constitution and development."* Rut alcoholic heredity carries with it more than the mere taking to the cup; it leads to suicide and to every namabie crime. Nowlm was a drunkard, a dipsomaniac. and is dead. His second son. aged seventeen, expiated on the gallows a horrid murder, while two younger sons have received sentences. Dupuy mentions four brothers, sons of inebriety, all of whom took their own lives. The following shocking facts are by Tarquet: "The head of the family was a drunkard and a debauchee. His wife, though remarkably sober herself, was t lie daughter of a drunkard and had two brothers, both drunkards. "These parents brought five children into the world, three sons and two daughters. The oldest was like his father, married and had three dissolute children. The second boy has been twice sent to the asylum for mania and homicidal impulses. The third was a debauchee, and died of consumption, of which there was none in the fam- ily, at the age of twenty-one. '•The oldest girl married, and is the mother of a licen- tious, drunken thief. The second girl, though married. lias lost all moral sense and decency, and is leading a most irregular life."— Alcohol Inside Out. Now for just one point more. After reading this article there may stili be some who will tell us that there are other physicians who administer alcoholic liquors, and that ••they know all about it." The time has not long passed when just as able and wise physicians used for med- icine, powder of viper's flesh and bones, volatile salts of earth worms, man's hair, powdered negro skull and dried human flesh, crab's eyes, hog and dog excrements dried and roasted — by such men that reason as all alcohol doc- tors do. We will show that the alcoholic liquors are bad. and are 104 ALCOHOL. dangerous in the treatment of disease, in another point of view. 1st. No one can tell just how much to give: just what is a small or a large dose in many cases. 2d. You can never tell just how much alcohol the liquor contains, or of what strength the alcohol is itself. 3d. You can never tell of what the liquor is made. It has been proved that the alcoholic compounds are not very often what they are represented to be. Dr. Messner said: "The lager beer sold in New York is not by any means a healthy drink." A malster confessed that if his customers knew what he really does they would all leave him. Another asserted that there is hardly an exception to some form of cheat. Take for example whisky and brandy, which are so much used for medicinal purposes. Some whisky was seized near Newton for examination, and in some way the recipe was obtained, which was as follows: 10 gallons of kerosene: 3 pounds of potash: 1 oz. of strychnine. Mix with soft water. If you want gin. add quan- tum sii/ffcit of oil of juniper. "The State Chemist of Ohio, in the course of two years, made about six hundred inspections, and found ninety per cent, spurious. "Two samples bought for the best, for medical purposes, were examined by him in the court room at Cincinnati, and the polished blade of a knife was placed in it for fif- teen minutes, when it changed the blade to the color of copper, and the liquor became black like ink. Nitric acid, sulphuric acid, prussic acid. Guiana pepper and fusel oil were among its ingredients. " That nearly all the alcoholic liquors are fraudulent con- coctions there is no doubt. United States Consul George Gifford at Bordeaux, wrote from La Rochelle in 1882: "All French brandy might, and perhaps ought to be, excluded from the United States on sanitary grounds. * * They are only counterfeit chemical compounds." It is a noted fact that much more "wine" is shipped from France than is grown there. So. much of their ,k wines" are fictitious compounds. It is so the world over. We cannot trust the manufacturers of AL.ETRT6. 105 these liquors, to risk the lives of the sick and dying by giving them as curative agents: say nothing about the deadly poison alcohol, there is enough noxious material in them to condemn them forever, in sickness or in health. In conclusion we will say that we have written this arti- cle with the view to bring out some more truth on this vital question, and not for any credit on our own part. To make our points as strong as possible, we have made many references to the experiences of noted men of science on this subject, so that we may convince our readers that we do not stand alone in condemning the alcoholic liquors, but that many of the world's greatest scholars concur with us in such condemnation. With this we close our arguments, hoping that many may hereby learn the true use. disuse and place of alcohol. ALETRIS FARINOSA. Star- Grass, Unicorn Root. The root of this plant is a gently stimulating and toning agent, chiefly influencing the female generative organs It is gently laxative to the bowels. In dysmenorrhea it stimulates and tones the uterus to normal action and thus frees the parts from pain. In menorrhagia it stimulates to the relief of the excessive flow. It is an excellent, per- haps the best, preventive of miscarriage, and may be given during any portion of the pregnant period or during the whole period of pregnancy; and is an excellent preparatory parturient. Many a case of impotency and barrenness has been relieved by its use continued for some weeks or months. Given during pregnancy in small doses two or three times a day gives relief to much of the dyspepsia of this period, and with mitchella is a superb female tonic. In amenorrhoea it stimulates to normal action. If anae- mia be present proper medication must be added. It is not best to use this agent with married ladies who are given to too frequent pregnancies. In such cases mitchella repens is to be preferred. F. E. Aletris Far. " Viburnum Op. •• Cauiophyllum Th. ; " Mitchella Rep. Syr. Simplex q. tia. dr. is.« dr. iii s. oz. iv 106 ALLIUM. F. E. Aletris Far. " Viburnum Op. " Caulophyllum Thai. '' Serenoa Serrulata aa. dr. iss " Mitchella Rep dr. iii Syr. Simplex q, s. oz. iv Either of these formulae makes a good female tonic. F. E. Aletris Far. " Viburnum Op. " Scutelaria Lat. " Dioscorea Vil. aa. dr. ii Syr. Simplex q. s. oz. iv This is a good nervine tonic in depressed and irritated conditions. F. E. Aletris Far. " Phytolacca Rad. aa. 1 " Arctium Sem. 2 This is a preparation used by Dr. J. E. Roop for ovarian irritation, ALISMA PLANTAGO. Plantain. (Plantago Major.) The fresh leaves bruised and applied to the surface are moderately stimulating as a poultice to bruises, sprains and swellings. When dry a hot infusion is diaphoretic and is soothing to the nerves. Cold preparations increase the flow of urine and allay irritation of the urethra. To the alvine mucous membrane it is stimulating, toning and demulcent. ALLIUM SATIVUM. Garlic ■ The bulbs are a diffusive stimulant to the mucous mem- brane throughout, and their influence will be most felt where most needed. In case of coughs and colds their in- fluence will be felt most upon the lungs and bronchi, for which they may be given internally and applied as a fo- mentation or poultice. They are stimulating to the alvine mucous membrane throughout, and are sometimes used to expel the stomach worm. The warm juice, may be dropped into the ear in case of otalgia and in dryness of the wax. The ordinary onion {Allium Cepa) is of less strength but may be used in the same manner and for the same purposes ALOE. 107 as the garlic buib. The onion poultice applied over the chest of children in case of cold, bronchitis or pneumonia is of much benefit. They also soothe the kidneys and increase the flow of urine. Expressed juice of Allium Sat. 1 part or of Allium Cepa 3 parts Acetum li parts Granulated Sugar enough to make into a good syrup is an excellent cough syrup for children's coughs. Allium Vineale or wild garlic seed tincture, says Dr. F. (t. Hoener, mixed with a little sweet oil and injected 5 or 10 drops into the ear passage will give instant relief in some cases of otalgia. ALXUS SERRULAT A. Tag or Small Alder. The bark is a mildly stimulating and gently astringing tonic alterative, influencing mainly the cutaneous and renal secretions, glands and lymphatics; and is therefore valuable in scrofula, glandular swellings, skin diseases and mercurial cachexia. It is also valuable in chronic diar- rhoea, sore mouth, sore throat, especially when arising from some impurity in the blood. In the treatment of dyspepsia it influences the flow of gastric juice and invigo- rates the appetite. Its action is excellent on the mucous membrane in catarrh of the stomach or bowels. Acting as it does on the circulation it Is valuable in rheumatism, and in the treatment of syphilis and in chronic and acute inflammation of the stomach and bowels and in cases of hemorrhages. It is a gentle stimulant of the kidneys and absorbents. ALOE SPIC ATA AND SOCATRINA. •Aloes. South Africa. The lefties furnish a juice which when expressed and evaporated gives the aloes of commerce. It is stimulating to the alvine mucous membrane, is somewhat hepatic and considerably cathartic. It is not suited to irritated or inflamea conditions of the mucous membrane, and may under other circumstances create more or less irritation of that membrane. Sympathet- ically it is stimulating to the vagina and uterus and may 108 ALTHiEA. promote menstruation. It is usually best to combine it with less irritating agents. It eradicates pin- worms when given in doses of 1 grain every three hours, for three ci four doses only. Aloes is very bitter and is usually best given in pill form. F. E. Aloes dr. ii " Taraxacum dr. vi Syr. Zingiber q. s. oz. iv This is a good hepatic and cathartic preparation. Aloes Myrrh Glycyrrhiza in equal parts is another preparation somewhat more ca- thartic. ALTHAEA OFFICINALIS. Marshmallow . The root contains much mucilage which is quite sooth- ing to the mucous membrane and skin, and is valuable in the treatment of irritated conditions especially in pharyn- gitis, laryngitis, bronchitis, pneumonia, dysentery, diar- rhoea, typhoid fever, diphtheria, gonorrhoea, cystitis, urethritis and nephritis. Its influence to soothe will be used by the vital force wherever needed, or where its influ- ence may be determined by other medication. With lobelia it forms a good wash and poultice in oph- thalmia. Althaea Off. oz. i Rubus Strigosus dr. iv Boil in li pints soft water down to 1 pint, and strain. Bathe the eyes 4 to 6 times a day for inflamed sore eyes. With raw linseed oil it forms a good covering for burns, scalds, and denuded surfaces. The mucilage is best pre- pared by boiling the root a short time. Dr. F. G. Hoener says it enriches watery milk of moth- ers nursing and makes it come more freely. ALTH^A ROSEA. Hollyhock. The roots ami flowers are demulcent and are frequently substituted for the althaea officinalis. They are soothing; to the mucous membrane and may be used for the same general purposes. It does not yield so much mucilage as AliTJMBN. 101» the officinalis, but its influence on the kidneys and urinary tract is more marked. Aqueous Hydrastis " Hamamelis Mucilage Althaea Off. or Rosea q. s. This is a good preparation for gonorrhoea. The Hydras- tis should be used in excess in the primary stage and the hamamelis should be in excess subsequently. With aralia rac. and prunus it forms a good cough syrup tor irritable coughs and colds. With celastrus scandens it gives favorable impressions in diabetes. A LUMEN. Alum. A103, 3S03+KO, S0 3 +24HO. The Sulphate of Aluimina and Potassa. Volcanic and rock alum are found in some parts of Italy nearly pure. It is purified by solution and chrystalization. It is a rather powerful astringent, but is somewhat irritating and stim- ulating. Many persons use it in croup but it is not the best agent that could be used. - Locally as a wash it quickly allays the irritation due to rhus fox. poisoning, especially if applied soon after con- tact. Keep the parts moist with a strong solution, ft also gives good results when applied to sore nipples: apply a strong solution and wash off before the child nurses. Burnt alum or alum deprived of its water by heat Is mildly escharotic. Mutton Tallow oz. xiv Cera Flava oz. ii Resina dr. i Pix Liquida oz. ii Carbolic Acid Crystals oz. ss Alumen Glycerine aa. oz. viii Dissolve the alumen in the glycerine and add to the former ingredients in a heated state and stir till cold. This forms an excellent ointment for application to piles, either externally or by capsule internally. If more relax- ation is needed add to the capsule some pul. lobelia seed. This ointment may also be used upon eczemas, tetter, and with a small portion of sulphur added is useful in scabies. Alumen Exsiccatum Yel Ustum Acidum Tannicum 110 AMPELOPSIS. in equal parts; apply twice a day to venereal warts. Talcum 5 A lumen 1 Use this for foot sweat. Alum en Chloride Sodii aa, one teaspoonful Aqua Fervens oz. xvi Use this as an injection for pin worms. AMARANTHUS HYPOCHONDRIASIS. Prince's Feather. The leaves are a stimulating - astringent to the mucous membrane but especially influencing the generative or- gans. It readily checks uterine hemorrhages, and gives favorable results in diarrhoea, dysentery and leucorrhoea. AMBROSIA ARTEMISI^FFOLIA. Bag-weed. This herb is a mild, stimulating, astringent tonic. A hot infusion relieves the circulation, giving a good out- ward flow of blood, and gives very favorable results in dysentery, diarrhoea and in feverish conditions where the bowels are too free, A strong infusion makes an excellent wash in case of relaxed vagina, prolapsus uteri and leucor- rhoea. It is the equal if not the superior of hamamelis virg. In case of weakened digestion with laxity of the bowels ambrosia is a good tonic to the mucous membrane throughout. Zingiber renders it of more importance to the circulation, and taraxacum or euonymous renders it of more importance to the hepatic apparatus and alvine canal in chronic dysentery and diarrhoea. It is claimed that during the season of the wafting on the breezes of the pollen of ambrosia that hay fever is more perplexing. The fresh juice of the ambrosia gives good results in cases of rhus poisoning. Dr. F. G. Hoener recommends the ambrosia as a good tonic, and for the removal of the after effects of quinine. AMPELOPSIS QUINQUEFOLIA. American Ivy. ( Vltis Quinquefolia. ) The bark of the root and vine and the twigs are mildly stimulating and toning, influencing mainly the mucous membrane and lymphatic structures, imparting tone and AMPHIACfiYRlS. Ill vigor and increasing the absorbing function of the vessels and hence is very valuable in scrofula, in enlargement of the spleen and lymphoid bodies. It greatly assists in both gastric and intestinal nutrition. It is valuable in enlarged mammae or testes, and gives strength and tone to the gen- erative organs. Ampelopsin Apocynin aa. grs. ii to iv This is very useful in case of congestive chill and en- larged spleen. Repeat as occasion demands, or give the apocynin alone. Inasmuch as it influences the mucous membrane it tones the bronchi and is a good addition to cough syrups where there is too free expectoration and especially for scrofulous cases. AMPHIACHYRIS DRACtJtfCULOIDES. Broom-weed. By J. M. Massie, M. IX. of Dallas, Texas, by whom it was introduced to the profession. The following is the botanical description furnished by Miss Ora Crawford, Dallas, Texas: Family— composite; genus— amphiachyris; species— dra- cunculoides. Plant from one to three feet high, pheogamous, exogen- ous, herbaceous; small yellow flowers, blooms in Autumn, grows in the waxy, heavy soil of Texas; root, primary tap. many rootlets, annual fibrous; stem, erect; herbaceous, smooth, naked 6 to 8 inches, then bears many branches. leaves, simple and bract like, sessile, linear, with strong mid rib; flowers, intermediate inflorescent in panicled raceme clusters, composite, irregular and unsymmetrical; involucre of two rows of needle shaped scales 7 to 11 in number, ray flowers number 7 to 10, are pistillate style^ twocteft, gamopetalous 3 petals included; imperfect calyx polysepalous, modified into a pappus of hairy bristles; head of velvety flowers '7 to 18, corrolla gamopetalous, 5 petals. •5 stamens; anthers syngenesious; pistil with style bearing one stigma, perfect involucre downy.— [Physio- Medical ^Journal*] The leaves, flowers and tender branches are used in medicine. They contain a somewhat volatile oil, and a resinous gum as well as extractive medicinal matters. It is difficult to grind on account of its gummy nature; and 112 AMPHYACHYRIS. an alcoholic strength of 50 per cent, is required to extract all its properties. It is a pleasant and decided diffusive stimulant to the intestinal, bronchial and circulatory nerves. It promptly soothes ail irritated mucous membranes, is carminative and stimulating to peristalsis which may lead to evacua- tions It is instantaneous in relaxed intestinal catarrh, and is a specific in cramp colic in doses of 15 gtta. to dr. i of the fluid extract from two to four hours A pleasant warmth follows its administration; more pronounced than that of the mint family. Its local effect is well observed in nasal catarrh, where ft stimulates the mucous membrane, relieves it of viscid secretions, leaves the surface clean aud permanently to' es the relaxed palatal muscles. A most valuable property is its influence upon the mucous membrane of the bronelii when taken per orem, for irritable coughs depending upon a relaxed state, where a prompt stimulating and soothing expectorant is desired. The amphyachyris promptly cleanses and tones the bronchial membrane. It is also a valuable locsl application to the vaginal membrane where it cleanses and tones and is one of our best agents for the treatment of a degenerate leucorrhoea. It influences the entire mucous membrane and may be made to give its especial influence to some part of the mu- cous membraue by being combined with other remedies having special local influences. This agent may be relied upon for its specific action described. It is excellent in bronchitis, bronchial asthma, broncho-pneumonia, and catarrh of all the mucous mem- branes. This is a new agent that fills a place in our mate- ria medica unoccupied by any other agent. It is a sanative agent perfectly harmless, and may be administered to pa- tients in all stages of vitality with perfect safety. Dr. F. O. Broady gives the following recipe for a Neutral- izing Cordial which he says is superior to all others: I. Amphyachyris Dra. oz. viii to iv Reum Pal. oz. viii Xanthoxyium Frax. Cort. oz. iv Pulverize the Rheum and grind the others for percola- tion. II. Prunus Virg. Cort. Chelone Glabra aa. oz. viii Hydrastis Can. oz. iv ANAESTHETICS. 113 Grind for percolation. Percolate I. with 50 per cent, alcohol q. s. ft. fl. ext. Percolate II. with glycerine oz. viii, water oz. xxi, T till two and one-half fluid lbs. have passed. Add sod. bicarb, oz. iii to percolate II., and saturate the latter, cold, with granulated sugar. Add percolate I.; add syr. simplex to make one gallon if necessary; finally add ess. mentha pip. dr. iv. Normal Tincture Amphiachyris Drac. ( Broom Weed ) standardized to represent 16 ounces per pint, as made by C. T. Bedford, is a good representative preparation of the a- gent, and contains all its valuable properties, and is in most cases the best and most convenient method of using it. Can be used i 1 ground and powdered form if preferred. This valuable agent was discovered and introduced by Dr. J. M. Massie, of Dallas, Texas. After a years' experience with itin bronchial, pneumonic and catarrhal troubles, and in la grippe, it has been found to fully justify the praise and recommendations be- stowed upon it by Dr. Massie. (See P. M. Journal and San- ative Medicine, December, 1894). Dr. P. Holt says the following formula is splendid for catarrh, the only objection to it being that it will stain the handkerchief, but not permanently: F. E. Amphiachyris Dra. oz. vi Tr. Myrrh et. " Mentha Piperita aa oz. iv Soda Bicarb, et. " Biboraset. Glycerine aa oz. vii Aqua qs gal. i Mix as follows: — use a large open vessel - a shallow pan. Dissolve the sodas in the water, then add the other agents which have been previously mixed. Filter through a close- ly woven cloth. When used as a douche or spray add an equal portion of water. Dr. P. Holt also recommends the following vaginal pow- der. Powd. Amphiachyris Dra. et. " AJumenCom. aa oz. viii " Boracic Acid oz. xvi " Tannic Acid oz. iv Mix. Sig. one teaspoonful to a pint of boiling water; steep 30 minutes, strain and inject to the vagina once or twice a 114 AMYGDALUS. day as indicated. This is valuable in all cases of leucor- rhoea, erosions and ulcerations of the os uteri. He says, we would not be without this preparation. The fact is, the longer we use amphiachyris, the better we like it and the more we use of it, we average a pound a day. The permanganate of potash and amphiachyris make a good wash for old sores. A combination of amphiachyris, sassafras and eucalyptus has been recommended for asthma. AMYGDALUS COMMUNIS DULCIS. Sweet Almonds- They are a nutrient aromatic demulcent. They may be eaten or emulsed and used to cover other remedies. They are somewhat diuretic, but chiefly lubricate and nourish the bowels in cases of debility. They yield an abundance of oil which may be used for the same general purposes. AMYGDALUS COMMUNIS AMARA. The bitter almond is more tonic that the sweet. AMYGDALUS PERSICA. Peach. This is an excellent fruit of tine flavor and taste and is quite nourishing in its ripe state and is somewhat laxative to the bowels. But the canned peach is a dangerous arti- cle of diet to the sick. The dried peach is far better. Soak it for twelve hours and then cook. This is best when the peach is out of season. The kernels or peach pets are a mildly stimulating tonic to the stomach; and if a diffusive be added its influence will be felt more generally throughout the alvine canal. If these be given in infusion care must be taken that fresh infusion be made every ten or twelve hours, and taken cold. This must be done in order to prevent the formation of hydrochloric acid. This same precaution should be observed in the use of the leaves, which are moderately stimulating, and demul- cent to the mucous membrane throughout the alvine canal, the kidneys, ureters, bladder and urethra, and may be used to good advantage in the treatment of catarrh of the alvine and urinary tracts, for the relief of irritated conditions, and for the cleansing from accumulated mucous. A hot infusion will influence the circulation toward the ANVESTHETU S. 115 surface and produce diaphoresis, except for which cause cold preparations are best. A diffusive renders them more active. The bark of the tree is also useful and is a strong- er tonic than the leaves. It is excellent in catarrhal indi- gestion. The fresh bark and leaves are much to be pre- ferred, but if carefully dried they will still be of some importance. The green leaves are excellent applied as a hot fomentation in cholera infantum. Inflammation of stomach, bowels or bladder. ANACYCLUS PYRETHRUM. Pellitory< The foot is quite stimulating to the mucous membrane and circulation. It creates a tingling sensation in the throat and excites a good free flo v of saliva. It is valu- able in chronic rheumatism and facial neuralgia. For semi-paralysis of the tongue and a relaxed palate, uvula or pharynx it may be used as a gargle very frequently. ANAESTHETICS AND ANAESTHESIA. By Prof. E. Anthony. M. I). Professor of Surgical Pathology Applied, in the Physio-Medical College of Indiana, Indianapolis To relieve suffering and prolong life is one of the first duties of man to his fellow man The office of the physi- cian and surgeon is among the most important in a phil- anthropic sense in whi'ui man can engage. As far back in antiquity as the scientific investigations have penetrated the chaos of thought, agents were discovered that would relieve pain and suffering, regardless of the causes that give rise to disease. The ancients were comparatively ig- norant of anatomy, physiology and pathology; consequent- ly could not explain the effects of their remedies, or give a solution of their mysterious action in relieving pain. Yet they were hailed with delight and accepted as gift's from the gods, and even at the present time, opium is consider- ed as the greatest boon that a beneficent Creator ever be- stowed on man. As the light of science has beat back the powers o! dark- ness, and the human body has been searched as by a light- ed candle, the deep recesses of this wonderful structure have been made to stand forth as in the brightest light; while the keen eye of perception and the intuitive powers of the 116 ANESTHETICS. mind of man has wrought out the philosophy of life, and is now able to explain the mode of operation by which the various functions of the body are performed. A deviation from this regular line of motion constitutes disease, and is considered pathological in contradistinction to the normal actions which are called physiological. Remedies have been discovered which will correct these deviations from the standard of health, and are not destructive in their tendencies, this being so, any one of these medicines that brings back the tissues to their natural state and allows the functions to go on regularly relieves all pain and suffer- ing, this is the highest point of attainment in the heal- ing art at the present time. This kind of application of remedies which restores health without impairing the integrity of the tissues or weakening the vital functions should and will releg- ate to oblivion all remedies that bring relief by destroying or paralyzing structures and sensibilities of the human frame: but this requires years of study, first of the bodily mysteries as they are revealed in the study of anatomy, physiology, therapeutics and materia-medica. Great as this task may be, it should be accomplished before the the physician should be allowed to take the responsibility of caring for the lives and health of men, and the physician who is thus not qualified to treat disease, and still resorts to destructive agencies and narcotics, should be discarded as a man unworthy the high calling in which he is engaged- The fact that he cannot do better than to administerthem should be taken as a confession of his ignorance, The century that is just closing has been marked by the greatest development of medical knowledge that has char- acterized any age, in all departments of the healing art. but especially in general medicine. The perfection that has been born of accumulated experience of all the ages past, laid the foundation for a system of -therapeutics, and the acquisition of a materia medica. that will enable any physician who will apply himself to the acquirement of such knowledge, to treat his patients and relieve them of their pain and suffering without the use of poisons. These latter, instead of prolonging life, leave dangerous effects on the constitution and tend to multiply suffering- in after years and shorten life rather than lengthen it. In the past centuries when little was known of the structure and uses of the different organs of the body, any AN^STHETK 8. 117 agents which relieve pain and suffering were hailed with unbounded enthusiasm: but experience in the use of them has shown that while they bring relief, they also are pro- ductive of very deleterious results not only to life, but to health in after years. This coupled with the fact that disease can be more successfully treated without, than with them, renders the physician inexcusable who goes on prescribing them because he is too ignorant to be able to do without them, and too indolent to learn better meth- ods. Surgeons of the past centuries were not so successful in discovering agents that would relieve pain while they made operations. It was not till near the close of the first half of this century that anaesthetics were discovered and used. Until that time surgery was regarded as an oppro- brium of the healing art. Few men had the courage to withstand the cries of their patients, and witness the writhing with agony from the effects of the knife or cau- tery. So terrible wa> the suffering that an eminent sur- geon of those days was wont to remark that it was not a question of whether they could withstand the suffering: but whether they could live without the operation. Ope- rations were undertaken only as a dernier ressort. and then generally too late The discovery of agents that would render the patient unconscious while the severest and most prolonged opera- tions were being made gave to surgery an impetus that has never been witnessed in any other of the sciences or arts. The darkest recesses of the body have been pene- trated by the surgeon's knife. The brain, the spinal cord, the lungs and contents of the abdominal and pelvic cavi- ties, and even the heart, have experienced the surgeon's touch, and life that receded apace has been wooed, so to speak, back to its wonted habitation. And yet we must remember, as remarked Samuel D. Gross, one of America's greatest Surgeons, that "immunity from suffering is pur- chased at the expense of vitality.' 1 It is a fact recognized bv mcst prudent surgeons that the poisonous influences of anaesthetics upon the system produce depression and weak- en vitality, and that many patients succumb to this cause and die. that would live if a painless operation could be made under the influence of agents that left no deleteri- ous results after them. Physio-Medicalists use anaesthet- ics in surgical operations because they know nothing 118 ANAESTHETICS. better to lessen the mental and physical impressions that necessarily attend all surgical procedures, and because it has been abundantly proven that the deleterious effects of the anaesthetic is far less than the shock of the operation would be without it; also that under its influence opera- tions can be made that no man would have the hardihood to undertake, and from which no living being could sur- vive. Nevertheless we approach this crisis with fear and trembling because we know that lives are lost by its use. It is the duty of the surgeon to surround his patient with all influences that can possibly add to his safety, and to arm himself with all the knowledge and appliances that can be commanded to combat the accidents that mometa- rily may arise. Having done this, he can only acknowledge his ignorance of a better and safer method, and hope that the time may come when methods will be discovered that combine relief from suffering and avoid deleterious results. This result has been accomplished in medicine: so may we hppe for it in surgery. CHLOROFORM. •"Discovery.— This agent was discovered by Mr. Samuel Guthrie, of Sackett's Harbor. N. Y., in 1831, and about the same time by Soubeiran in France and Liebig in Ger- many. " From that time to the present it has been ad- ministered internally as a remedy in asthma, spasmodic cough, scarlatina, atonic quinsy with favorable results. has been used in hysteria, cancer, neuralgia and painful gastric disturbances. It was first employed by inhalation in 1832 in a case of pulmonary disease, and was said to give relief from the difficult respiration. In 1847 its action on the lower ani- mals was tested by inhalation by M. Flou reus and Dr. Simpson, of Edinburgh, in surgery, as a substitute for ether. Physical Properties. — "Chloroform is a heavy, clear, odorless liquid, having a pleasant ethereal odor, a burning sweet taste and neutral reaction: specific gravity 1.485 to 1.490 at fifteen degrees C, fifty-eight F. It boils at 140 to 142 F."--?7. S. Dispensatory. If the greatest care is not exercised, it is likely to con- tain foreign elements, introduced during its manufacture? of these, water, alcohol and ether are most common. If pure, it will not have a density of less than 1.38 When impure, it will float on the surface of a mixture of concen- \ t ANAESTHETICS. 119 t rated sulphuric acid and water in equal parts, after it has cooled. Numerous tests are in use for impurities, but the most convenient is that of Mialhe. This consists in drop- ping a quantity of chloroform in distilled water. If pure, it will remain at the bottom of the glass, but if impure, it will either float on the top, or turn the water milky. The composition of chloroform is very unstable. It de- composes quickly in direct sunlight, or even diffused day- light. The presence of a very small quantity of water causes it to decompose, the resulting compounds being hydrochloric acid and phosgene gas. It is of the utmost importance for the safety of the patient that it should be pure and of a known strength. Squibb's chloroform and ether are now supposed to be the best; to be sure of this even, it should be obtained of the most reliable druggists, on whose knowledge and integrity implicit reliance can be placed. The local action of chloroform is that of an irritant. When applied to the skin and evaporation is prevented, vesication is produced. On the mucous membranes it exerts about the same effect as excessive heat, or acro- narcotic poisons. In a case of poisoning from an overdose reported by the U. S- Dispensatory, "Death took place in about thirty-four hours. The lining membrane of the lar- ynx and trachea was found inflamed, the bronchi were loaded with a dirty-gray purulent fluid, the lungs were in- flamed as in the first stages of pneumonia and the brain and its membranes congested.'* The smallest dose reported to have produced death was one teaspoonful, the subject a boy about eight years old. Larger doses may be taken and the person survive, but the irritant effect on the stomach leaves the organ weak for a long time, and in some instances they never recover. When an everdose is taken by accident or for suicidal pur- poses, they soon begin to feel its influences; if walking about, the first sensation is a dizziness, they stagger and fall semi-unconscious and soon fall into a state of coma, with stertorous breathing, dilated pupils, pulse imper- ceptible, cold skin, anaesthesia and sometimes convulsions. Occasionally there will be momentary flushing of the face and vomiting, but this does not retard the action of the poison. The temperature falls and respiration is slow and shallow. If called to a case of the above description, the breath will form a guide to the cause; if called after death 120 ANAESTHETICS. , and a post mortem is made soon, the poison will be found in the stomach; if called very late, say several days after death, only the corrosive action will be left, and the ab- sence of any other poison, together with any other circum- stances that point to chloroform as the agent, may lead to tolerable certainty as to the cause of death. Treatment. — As with any other acro-narcotic poison, the first thing should be to evacuate the stomach with a stomach pump if possible; if not, then by such agents as ipecacuanha, given in thirty grain doses with an infusion of aristolochia serpentaria. Large draughts of water, with salt or mustard, will also be effective in the absence of ipecac. After free emesis has been produced, if the patient can be induced to drink freely of a solution of bi- carbonate of soda or magnesia, they should be directed to do so. If the patient is stupid or comatose, -'flicking" with the end of a towel dipped in cold water may answer a good purpose. But far the best is an enema of half an ounce tincture of myrrha compound in half pint of warm water. At Ler recovery has progressed so far as to estab- lish the circulation and sensibilities, a cup of strong coffee is said to be good. The gastric disturbances that follow in such cases should be met with mild alkalies to keep the contents of the stomach as nearly neutral as possible, ex- cept during the period of digestion. Persistence in the above line of treatment will in time restore a natural state in most cases, but in bad cases and those who are debili- tated from other diseases, perfect health will never be restored. Chronic chloroform poisoning affords one instance of the many that attest to the incont Tollable infiue v ce of narco- mania. Its victims are mostly medical practitioners. The habit is solitary and usually periolical at first, but soon becomes constant. The most prominent symptoms are the gastric disturbances: the nervous symptoms are also prominent, especially during the intervals. Nervous depression soon manifests itself. Languor, tremors and loss of interest in everything, drowsiness and stupidity, a slow and weak circulation, coldness of the skin and great emaciation are usually present in the last stages, and death may take place at any moment from inefficiency of heart action. Alternating sensations of heat and cold are present, but the general temperature is lowered and at all times below the normal standard. This is caused by the ANESTHETICS. 121 contracting influence on the capillaries through the vaso- motor system. Through this state of the circulatory sys- tem, nausea, chills and pallor are present in nearly all cases. The habit is very seldom cured. Despite his own efforts and those of his friends, he continues his downward course until death relieves him of his suffering. There are no well-established pathological conditions except that there is a general failure of all the nutritive functions. Every tissue of the body, but especially the heart, is found in a soft and relaxed state, and reduced in size. No change of structure has been found to account for the symptoms that are seen in life, except that stated by Tillman, who says "Winogradow found granular degeneration of the ganglia of the heart, brain and spinal cord in both men and animals after death from chloroform." It was thought by Yon Lagenbech and Pirogoff that death may be caused by the presence of gas in the large venous trunks and in the right ventricle of the heart; but it has since been shown that this condition is not peculiar to persons who have died from chloroform, and in some cases at least is produced by decomposition after death. Not infre- quently the above changes in the tissues are present and may be assigned as the cause of death in those who have been addicted to its use for a long period of time. In sud- den death from chloroform, the blood is usually found dark-colored and uncoagulated, much as it is after death from the inhalation of carbonic acid gas, which no doubt is the cause of death in many cases; but microscopic exam- i nation shows no alteration i n the constituents. Chemical analysis, however, shows the blood overloaded with car- bonic acid and the products of waste from the tissues which could not be eliminated in consequence of the fail- ure of the respiratory process. ETHER. The ethers are a class of liquids discovered by chemists as early as the thirteenth century. The method of prepar- ing them was given by Valerius Cardus in 1540. They were known to Boyle and Newton, and were usually pre- pared by distilling alcohol with some acid. They receive various names according to the method of preparation: thus we have nitric ether, acetic ether, sulphuric ether, etc. Ether puris, or commercial ether, as it is commonly called, is sufficiently pure for all pharmaceutical and reme- 122 ANAESTHETICS. dial purposes; but for surgical purposes, the stronger sul- phuric ether, or ether fortior, prepared by Dr. Squibb, is perhaps the best that can be obtained at the present. Physical Properties. — "A thin diffusive and colorless liquid, possessing an aromatic odor, a burning and sweet- ish taste, leaving a slightly bitter sensation in the mouth. It is soluble in all proportions of alcohol, and the fixed volatile oils; also in benzoin, benzol and chloroform. It maybe dissolved in eight times its volume of water at fifteen degrees C. (59 F.) Ether is very inflammable: when its vapor is mixed with air and brought in contact with flame, it explodes with great violence. To preserve its purity, it should by kept in well-stoppered jpottles, or in soldered tin cans, and kept in a cool place out of the light and away from fire or flame. It is extremely volatile and evaporates rapidly when exposed to the air with the reduc- tion of the temperature. The simplest test of its purity consists in dropping a small portion on paper, and when it has evaporated it should leave no odor." ' Ether, as a medicine, is chiefly used for its anaesthetic properties, and may be used locally, or taken into the sys- tem by the stcmach When used locally, its evaporation should be prevented. When taken into the stomach, its first manifestation is that of a stimulant, which soon gives way to narcosis. It is used as a stimulant in cases of sud- den nervous depression, fainting from mental shock, hys- teria and all suspension of animation, in neuralgia and painful gastric disturbances; also in the nausea of flatulent and biliary colic. When ether is taken into the general system, it causes an increase in the force and frequency of the heart and . vaso-motor system: the pulse will be full and strong, the capillaries in the skin will be filled with blood, which gives a florid appearance resembling that of health. Given in larger doses, the skin will assume a dark livid color, show- ing that the respiratory center is being influenced by it; there will be anaesthesia, but not always loss of conscious- ness. This state will continue until death takes place, in some cases; while in others there will be paralysis of the vaso-motor system and collapse of the capillaries. In such cases the skin will become blanched, and cold perspiration stand upon the surface; but the heart will continue to act and the radial pulse can be felt beating several moments ANESTHETICS. 123 after respiration has ceased and life is extinct in all other j tarts of the body. The dose of ether taken internally is from fifty drops to one teaspoonful, to be repeated frequently when its full effects are desired. It may be dropped on the surface of cold water, or rubbed up with spermaceti, in the propor- tion of two grains for each fluid drachm of the ether. It can also be given in capsules, usually known as pearls of ether. Given in this way. the mouth and throat are not irritated, but the full irritating influence is soon felt on the stomach. It is said they can also be introduced into the bowel and vagina, but for what purpose is not stated. Gelatinized ether may be prepared by placing ether fortior and white of an egg in a bottle, stoppering the bottle tightly and shaking rapidly. Four parts of the egg and one of the ether are the usual- proportions used. This may be spread on linen and applied locally for the relief of pain. To prevent rapid evaporat ion, the parts should be covered with oiled silk. The French Codex gives directions for making a syrup of ether. They take 440 parts of sugar, 490 parts of distilled water, ,50 parts of alcohol 90 per cent.. pure ether 20 parts. If the above ingredients are repre- sented by grains in the same proportion, the whole of this might be taken at one dose. This is a very convenient method of administering ether for tape worm. This agent also enters into several anthelmintic compounds for the same purpose. The symptoms and treatment of r he acute ether poison- ing are about the same as those of chloroform poisoning. Chronic ether and chloroform poisoning, or narco-mania, is an abnormal and in many cases an irresistible desire for the influence of some narcotic, This appetite may be ac- quired by the constant use of some narcotic prescribed, possibly, as a medicine, until the will power is broken down by the overwhelming desire, or rather longing for its effect to quiet a feeling of unrest, that is many times worse than death itself: in fact, the monomaniacs will risk their lives and take the potion, well knowing that the sleep may be the last on earth. It may be hereditary, or may be acquired by the constant use of ether taken by persons desirous of concealing the fact that they are ad- dicted to the drink habit. Norman Kerr in the Twentieth Century Practice of Medicine tells of an epidemic of etherism that swept over 124 ANAESTHETICS. a large portion of Ireland and extended to London, some parts of Germany, France and even to New York, U. S. A. He says: "About 1838 a Catholic priest commenced a cru- sade against alcohol, and within three years had adminis- tered the teetotal pledge to millions of his countrymen.'* Following this tidal wave, equally as bad, if not worse, came the ether habit. 'A medical man gave a drachm of ether, which was not believed to be a violation of the pledge, to each one of a few of these abstainers. It was like applying a flame to highly coiubustible matter. In a short time it extended over an area of nearly 295 square miles with a population of more than 79,000 people. In one instance a village of 300 inhabitants had one shop to every 23 persons, for the sale of ether. The intoxicant was brought to the doors of the people by hawkers, was sold in sheebeens and groceries, being often exchanged in barter for eggs and other produce of the farmyard. This was suppressed by law, but the drink habit of Ireland is now, in proportion to the diminished population, nearly as great as ever. Fifty years of observation of these subjects confirms the above statement." I have known many per- sons to acquire the ether habit from taking the drug to disguise the use of spirituous liquors. I have also known others to acquire the habit from inhaling small quantities to relieve some transient neuralgia, or perhaps toothache. 1 once knew a physician who when called to attend an ob- stetric case, and while waiting for the tardy labor pains to become severe enough to require his assistance, would lie down, saturate a handkerchief with ether or chloroform, place it ovsr his face and go to sleep till aroused by the attendants and informed that his services were needed at the bedside. Of all the other anaesthetic agents used to produce anaesthesia in surgery, none, so far as the writer knows, are used as remedies and given internally. A brief account of these agents, showing their use by those who are the advocates of such remedies, was thought to be proper in the present connection, but it can be seen from the foregoing account of them that Physio-Medical- ists have no use for them as remedial agents. It will also appear from their use and action when inhaled, that the internal administration of them is attended with far more deleterious results than when they are inhaled under proper care. ANESTHETICS 125 ANAESTHETICS AS AN ADJUNCT TO MEDICINE The action of anaesthetics on the human body is peculiar when the vapor is inhaled. We have seen from the above that when applied direct to the tissues by actual contact, or by absorption from the stomach, it is an acro-narcotic producing actual destruction of tissue in a few minutes: but when applied to the mucous surfaces in the form of vapor, as by inhalation, its presence can be tolerated for hours, or even for days, without producing any serious re- sults. The same is true of its presence in the blood, and through this medium on the nervous system. The writer has witnessed its use in puerperal convulsions, where the patient remained unconscious several days, and ultimately recovered; and only recently a case occurred in Indianapolis where a patient- was under its influence thirty-six hours and that too under the most unfavorable circumstances. The case was one of typho-malarial fever on the twenty-first day of the attack. There had been a tendency to cardiac paralysis from the onset: for two weeks it was with the ut- most difficulty that the circulation could be kept up. The suffocation was so urgent that the room had to be kept open, and he was fanned constantly for two weeks. Dur- ing the third week the action of the heart improved, but he showed symptoms of disturbance of the brain. Delir- ium, sleeplessness and subsultus came on and gradually grew worse until on the twenty-first day. when at 3 o'clock P. M. he had the first convulsion, followed by another in thirty minutes. For twelve hours they increased in vio- lence until there was no complete intermission, and the remissions were only momentary. Physio-Medical reme- dies were used energetically by "Physio-Medicalism's Most Skillful Hand; but it seemed to avail nothing. Chloroform was given until the convulsive movement^ ceased and a quiet sleep came on; for a short time the spasm of the muscles ceased, but the sleep was broken by the convulsions, and again were checked by the chloro- form, and sleep was again obtained; thus sleep and convul- sions alternated for thirty-six hours. During this time the chloroform was not discontinued long enough to allow the system to be free from it, and when the last muscles ceased to contract and there was complete relaxation, life seemed almost extinct. He was watched with the most tender and skillful care for another twenty-four hours by the physicians, and the most careful and scientific medica- 126 ANAESTHETICS. tion was directed: at length life seemed to return to him and he rapidly recovered, and is now convalescent, October 20th, 1896. It will be natural for the reader to inquire what part the chloroform performed in the case, since other medicines were given with an unstinted hand. In answer to this anticipated question, will say that its ac- tion was net curative: it acted as an -adjunct, relieving violent convulsions and relaxing the spasms of the muscu- lar system, which were driving t';:e blood with such vio- lence into the brain, that no medication now known could counteract, and the congestion was momentarily increas- ing. It held the convulsive movements in abeyance and gave the medicines time and opportunity to remove the obstruction to a free circulation: and by so doing the cause was removed and the effect ceased. This use of chloro- form, as an adjunct to medicine, is the same as the lse of it by the surgeon to obviate the muscular contractions while he does his work. THE INHIBITORY ACTION OF ANAESTHETICS. It is an established fact chloroform exerts such an influ- ence on organic matter without producing any destructive changes. "If i\\\ aquatic plant be placed in a watery solu- tion of ether or chloroform, its absorption of carbonic anhydride and its exhalation of oxygen ceases. The plant does not die; it merely sleeps. The germination may also in a similar manner be arrested by surrounding it with an anesthetic atmosphere. Irritability of the protoplasm in the cells at the base of the pet ioles in the leaf of the sensi- tive plant is in like manner inhibited by anaesthetic vapors. A vigorous specimen of this specie- placed for half an hour under a bell glass, with a sponge saturated with ether, will no longer exhibit any irritability. Its healthy ap- pearance remains unchanged, but it no longer absorbs car- bonic anhydride, and its leaflets will not shrink when touched. Restoration of the plant to a pure atmosphere is soon followed by complete recovery of all its natural functions. The addition of ether to an infusion contain- ing yeast at once arrests the process of fermentation. On removal of the anesthetic by evaporation, or by filtration, the activity of the yeast fungus is renewed and fermenta- tion is again resumed." (See Anesthetics and Anaesthesia by Henry M. Lyman, International Surgery.) Anesthetics do not destroy living matter directly when taken by inhalation. Postmortem examinations have ANESTHETICS. 127 thus far shown no changes in the tissues of the bodies where anaesthetics given by inhalation have caused death. That anaesthetics do sometimes produce death is not de- nied; but when it does occur, it is by the inhibitory effect on the nerves controlling circulation or respiration, and not by any direct destruction of tissue, like other narcotics with which they have erroneously been classed. The action of chloroform and ether seem to be much the same in producing temporary relaxation of muscular spasm and loss of sensibility; but very unlike so far as their effect upon the general circulation is concerned. The former lessens the quantity qf blood circulating in the brain, while the latter increases the quantity. This property renders chloroform applicable where there is hyperaemia of the encephalon and in all cases of plethoric habit with- out any weakness of the heart. Ether is more applicable where there is anaemia of the brain, or weakness of the heart. ANAESTHESIA IN OBSTETRICS. Ether, chloroform and many other agents have been used in obstetric practice; but one after another has been aban- doned, until at the present, chloroform is the only one used. It is claimed for it that it is more effective and certain in in its action and causes less irritation than ether. It also counteracts the determination of blood to the head, a con- dition which is present in greater or less degree in all cases of childbirth. The use of chloroform as an adjunct to la- bor is popular with the profession and people, and it seems at times to be productive of the most gratifying results. The Physio-Medical physician, however, has but a limited use for it. Labor is a physiological process, but is attend- ed with more or less pain even in the most natural state. It is a matter of common observation that the nearer a labor approaches the normal, the less there is of pain and suffering and the better will be the recovery after confine- ment. In nearly all cases, the cause of laceration of the cervix and perineum is to be found in conditions that ante- date labor, and should be removed before the labor comes on; or if the physician is not consulted previous to the con- finement, as soon as called, he should make a thorough ex- amination and at once institute measures for restoring the parts to a normal state, and continue treatment after con- finement until health is restored. These means, properly 128 ANAESTHETICS. directed, will at the time of confinement usually place the patient in a normal state, and then the suffering will be at a minimum, the parts concerned will be in a favorable condition for recovery, by a recognition of those methods. If chloreform is administered without a recognition of these conditions, the patient is greatly benefitted in some cases; but a failure to recognize the abnormal conditions and remove them allows the patient to relapse into a bad state of health that may last for months or years. Added to this, the fact that it interferes with the natural process by producing relaxation of contracting muscles,- which are necessary for the expulsion of the child, under its influence labor is in at least half the cases retarded; there is no suf- ficient vital action to expel the child, when even a small part of the force is destroyed by the chloroform and conse- quently instrumental interference is rendered necessary. In the other class of cases, where the constution is vigor- ous, and the expulsive force is very great, the relaxation of a part of the muscles by chloroform seems, to facilitate the labor; but the same thing might be accomplished by other remedies just as well, and leave the patient in a more fa- vorable condition to recover. It is said that even small quantities given just as the pain begins will take off the sharp excruciating suffering, but this is only imaginary, is the time that the pain lasts is not sufficient to get any of the chloroform, at least, not enough to do any good; it is only a placebo. Its use is also recommended during the last expulsive pains. Anything short of insensibility at that moment will avail nothing; and to render a patient insensible at that time is to de- prive the case of one of the most important factors in the safe termination of labor, that is, the loss of the will power at the time when it is most needed. If the perineal struct- ures receive proper attention during the hours preceeding delivery, there will be no excessive pain at that moment and the risk of laceration will be greatly reduced. A proper study of the physiology, pathology and mechan- ism of labor will justify the conclusions: first, that chloro- form in obstetrics should be used only as in other surgical cases; second, that it may be used in some cases without in- jury, and with apparent benefit; third, that while this may be the case, it dose not justfy the general use of it in obstetrics by Physio-Medicalists, because they have other means far more efficient inasmuch as they operate in har- ANTFiEMIS. \'2\) mony with the physiological laws that govern the median ism of labor. ANEMONE PULSATILLA. • Pulsatilla, Pasqwe Flower. Europe. This species of the anemone has violet blossoms, having the outer surface hairy. This plant prefers a calcareous soil. The {terb is stimulating and relaxing, influencing the skin and mucous membrane. In large doses it may pro- duce nausea and vomiting. It is also quite cathartic and unless combined with zingiber or mentha it may produce considerable griping. In hot infusion it influences the circulation and relieves the skin and nervous system. Cold preparations will occa- sionally prove diuretic. It is a valuable agent in the treatment of skin diseases, in some stages of syphilis, ophthalmia, and eczema. It is also recommended in whooping cough and bronchitis espe- cially when there is some impurity of blood present. ANETHUM GRAVEOLENS. Dill. The seed is a warming, diffusive, stimulating, aromatic and carminative principally used in compounds to relieve the unpleasant taste of medicines. ANGELICA ATROPURPUREA. Angelica Seed. American. The seed of the American angelica are more diaphoretic than the German, but are used for the same general pur- poses. ' They are valuable in acute febrile cases and zy- motic diseases, coughs and colds They are antiperiodic. and in hot infusion are valuable in dysmenorrhoea and especially with nervous females. ANTHEM IS COTULA. Mayweed. The flowers and stems of this plant are diffusive stimu- lants to the circulation, tending the blood toward the sur- face. In hot infusion it is decidedly diaphoretic and somewhat emmenagogue. A hot fomentation of the green herb is excellent for sprains and inflamed extremities; for pelvic and abdom- 130 ANTHEMIS. inal peritonitis; for cystic, pelvic, abdominal or thoracic congestions and for local neuralgias. This herb is best adapted to torpid or congested condi- tions of the mucous membrane. ANTHEMIS NO HILTS. Chamomile, Roman. The flowers are more relaxing and less stimulating than the anthemis cotula. In hot infusion they induce diapho- resis and a good outward flow of blood. To the nervous system and the mucous membrane bhey are very soothing and have a decided influence upon the uterus, relieving congestion and promoting the menstrual flow. They are valuable in amenorrhea and dysmenorrhea when there is a scanty flow and nervous irritation. It is a good agent to be used for nervous and hysterical persons. Large and frequent doses may prove nauseating and result in emesis, but this will be no detriment in such cases, but rather an advantage. F. E. Anthemis Nob. Oaulophyllum Th. " Liriodendron Tul. Syr. Zingiberis q. s. Sig. Teaspoonfni four times daily as a tonic in dysmen- nrrhcea. A hot infusion is an excellent diaphoretic for the relief" of colds especially if zingiber be added, and will be found rery valuable in bilious fever. Cold preparations are quite tonic to f he stomach and uterus, giving tone and vigor to the stomach, increasing the appetite and improving digestion. It is best for this purpose combined with some diffusive stimulant or some mild hepatic. In convalescence from fevers chamomile is a tine tonic especially if combined with hydrastia sulphate. F. E. Anthemis Nob, dr. iv Liriodendron Tul. dr. iii k ' Scutelaria Lat. dr. i Hydrastia Sulp. gr. i Syr. Zingiberis q. s. oz. iv This is an excellent tonic in nervous prostration and iu hysteria. F. E. Scutelaria Lat. dr. ii •■ Liriodendron Tul. dr. iv- Hdyrastia Sulph. gr. i dr. iii dr. ii dr. iv oz. iv APIUM. 131 Ferri et Potassae Tart. grs. x . , jln fusion Anthem is Nob. oz. iv Mix. j When there is anv danger of hemorrhage or when the periodic flow is too free or too frequent this is not the best agent to be used. In sluggish cases some diffusive stimu- lant should be added. The inhaling of the acetous infusion of chamomile i& very beneficial in quinsy and colds in the head or nasal passages. A hot poultice of the same may be applied to the forehead or over the lungs, stomach or bowels for con- gestions in these legions. , With aralia rac. the influence of chamomile is valuable jji cough syrups where a soothing expectorant is needed. APIUM GRAVEOLENK. Velery. The seed is a moderately stimulating tonic nervine. It is useful in depression or ( prostration of the nervous sys- tem, wliether it be from general prostration, general de : bility or from overtaxing of the nerve centres by over brain work. It is best used with some toning hepatic as euonymous or taraxacum. With viburnum opulus it is good for pregnant females with a nervous temperament and a tendency to cramping. Aletris or helonias may be added if there is a tendency to miscarriage, , ; .. , The vegetable is a soothing nervine but is less stimulat- ing than the seed. In convalescence it is especially valu- able in the treatment of those of a nervous temperament. Apium Grav. et Kola Ac. et Cocoa in equal parts, or Apium Grav. et Kola Ac. et Cocoa et Viburnum Op. in equal parts are each good nervine tonics. McCoy, Howe Co., Indianapolis, Ind., prepare an elixir of celery and guarana in equal parts by direct percolation. Dr. N. D. Woodward recommends it as an agreeable and reliable nerve stimulant in nervous prostration and mi- graine. 132 APOCYNUM. APOCYNUM ANDROSJEMIFOLIUM. Bitter Root. The intense bitter taste of this root is difficult to be gotten rid of. It requires but little to produce a lasting nausea. It influences the mucous membrane, is quite stimulating to the gall ducts, influencing especially the excretion of bile. It influences the alvine mucous mem- brane as well as the gall ducts and in large doses will pro- duce watery discharges. Its best influence is shown in torpid rather than in sensitive conditions. In jaundice 2 to 5 drops every 2 or 3 hours will work well especially if combined with capsicum. Where the jaun- dice is from occlusion, podophyllin is to be preferred. Apocynin 1 Quinine 10 given one to three hours is excellent for chronic cases of ague. In ague-cake give apocynin 1 to li grs. every 2 hours. In combination with triticum, juniper, or eupatorium purpureum, it is a good diuretic and is one of the most serviceable articles to be used in dropsy, F. E. 5 to 8 gtta. every 2 to 4 hours. Apocynum maybe combined with lobelia in dry forms of catarrh, and used as an infusion to cleanse the parts. It is valuable in syphilis, scrofula and eczema where the hepatic apparata are sluggish. With or without hydrastis it may be used as a vermifuge, Apocynin is a good resonoid preparation. In small doses it is a tonic to the stomach, promotes digestion and influences the appetite. The taste of apocynum may be moderately well covered when needed by comp. syr. rhei et potas. Tr. Capsicum et. F. E. Leptandra et. F. E. Apocynum, in equal parts applied over the liver is excellent in cases of congestion: or the powders may be used in the form of a liver pad, and occasionally moistened with tr. capsicum, or with the fld. exts. combined, and worn in cases of extreme torpor. Apocynin Leptandrin a a gr. } Podophyllin gr. i Ampelopsin AQUA. 133 Oil Capsicum aa gr. 1-1<> This makes an excellent pill. APOCYNUM CANNABINUM. ( 'a nadian Hemp . The roots are a stimulating alterant, quite cathartic and largely influencing the glandular system. Apocynum And. et Apocynum Can. in equal parts in Syr. Zingiberis is good tor dropsy. In large doses it produces emesis, which is followed by a free diaphoresis, especially if given in hot infusion. Cold preparations produce free diuresis. It hastens disintegration of the nitrogenous elements of the body and eliminates solids freely through the kidneys. It is of value in" atonic dyspepsia, in scrofula, rheumatism, phthisis, sluggish condition of the kidneys and a clogged conditions of the lacteal vessels. It is excellent for the destruction of the ascaris vermicul- aris. In hot infusion it is diaphoretic and expectorant and hence good in rheumatism and acute febrile disorders with clogged secernents. AQUA-WATER, H^ (). By Prof. E. G. Anthony, M. 1>. Professor of Didactic and Clinical Ophthalmology, Otology and Rhinology in the Physio-Medical College of Indiana, Indianapolis. A study of the physiological uses of water in the human organism, will show it to be one of the absolute necessities for life. For the purpose of slaking thirst, the lower animals use nothing else, and even man, in his primitive state de- sired no other drink. But, in our modern life, as a result of what might be termed moral retrogression, a large share of the populace indulge too freely in drinks, of which, water, of necessity, is the staple ingredient. Among drink- ers of beer and other alcoholic liquors, some bloated men will swallow many pounds of liquid daily. This greatly distends the vascular system, weakens the walls of the blood-vessels and keeps the tissues constantly distended with fluid. These weakening influences in connection with the still more deleterious effects of the alcohol on the assimilative and disassimilative processes, renders such in- 134 AQUA. di victuals very prone to attacks of congestion of any of the vital organs upon the slightest provocation. A lack of water in ; the dry seasons leads to the genera- tion' and accumulation of impurities, of various kinds. Cook- ing-is interfered with, dirt and filth collect abo jt the home, streets are not washed and sewers not flushed. By virtue, of the decomposition of such offending material, noxious gasses and specific poisons are formed which contaminate the very air itself. Hence the state of health of the people inhabiting such an unfortunate district, is greatly lowered. And in most instances, if conditions are properly investi- gated, it will be> found that the direct cause of this lower- ed state of health of the community at lar£e, is the 'srnalT amount of rainfall and the bad quality of drinking Water: instead of the "'high temperature'' as is sometimes sup^ posed - DRINKING WATliR. The supply of drinking water may be obtained either from rain • 'which the clouds do drop and distill upon man abundantly," or from springs, wells, rivers and lakes. The quality of drinking water depends to a great extent upon the amount of oxygen it contains. And the amount of this element found in water is dependent upon the good quality of the air. After distillation water is almost free from air. It is tasteless and very unpalatable. When taken into the stomach an unpleasant sense of heaviness is experienced. These disagreeable properties will be found to have disappeared after aeration. This ma^'be accom- plished by shaking or spraying the distilled article in air. allowing it to absorb oxygen. '" ' In hot weather,, ice water is more frequently the cause of stomach and bowel troubles than the heat. This is due partly to the fact that in the process of freezing, the air is expelled, and thus the product is unwholesome. Some germs which are found in water survive after having been subjected to a freezing temperature and are a great source of danger. And it may even be suggested that the vessels in which water is frozen in the manufacture of artificial ice. are not always thoroughly cleansed and freed from impurities even though the water be previously distilled. ' PHARMApOPOESE. , ,, , ,In the preparation of medicines, water is a valuable menstruum. It is principally used in preparing decoctions. AQUA. 135 infusions and syrups. It is also used extensively as a dilu- ent and solvent in the manufacture of tinctures and fluid extracts. The vast majority of Physio-Medical remedies possess a combination of properties, some of which alcohol will extract while others can only be dissolved and held in solution by water, So to have a preparation that will'rep- resent all the properties of such drugs, these menstrua must be combined in various proportions. For all ordinary purposes in pharmacy, common drinking water will answer. But since such water generally con- tains a greater or less amount of organic matter and calci- um compounds, causing precipitates and holding in abey- ance the dissolvent properties, it is better in many instances to use aqua that has been subjected to a process of purifi- cation. Of the various processes distillation is undoubtedly the best. However, it has been suggested that in this plan, foul gasses and even bacteria maybe carried over in the attempt at vaporization and condensation, but this is exceedingly doubtful. It is always well to test distilled water by adding to three or four drachms a small amount of nitrate of silver. If it turns turbid or milky, it has become charged with impurities. Pure distilled water should always be used in preparing lotions for the eye. Especially should this be the case in solutions of nitrate of silver, cocaine, atropine, homatropine and various other drugs which are to be applied to the del- icate tissues of the organ of vision. It should always be kept tightly corked, for it is easily contaminated by mix- ing with impure air. Next to distillation comes boiling. It is said that this process kills most fungus spores, precipitates lime products. gets rid of iron in part and very markedly lessens the amount of organic matter. An absence of these elements increases the solvent power of the article. Hence it is better adapted for use in pharmacy. In surgical opera- tions and the dressing of wounds, by being boiled several times, water can be successfully sterilized and its use is quite safe. Filtration through sand and animal charcoal is another method quite satisfactory for removing organic and min- eral matter, especially if such material is not held in solu- tion. In case sand is used it should not be too fine, and 136 AQUA. should be cleansed often, for the particles soon become en- crusted with the impurities. A good charcoal filter is one of the best means for the purification of water by the removal of both organic and mineral suspended matters. But the water must not be kept in contact with the charcoal any longer than is abso- lutely necessary for it to filter through. If allowed to remain in contact too long it will again take up the matter which has already been deposited. While this method makes water quite pure, yet it cannot be depended upon, for if allowed to stand any Jength of time, evidence of its containing low forms of organic life will begin to show. MINERAL WATERS. In filtering through the earth, water becomes loaded with the mineral salts and gases which are peculiar to the soil through which it passes. When impregnated with these salts and gases to such a degree as to be unfit for the ordinary uses in life, it is spoken of as mineral water. Aqua mineralis derived from springs may be hot or cold, and in making use of it, there is no doubt but that the temperature of the article has much to do with the good effect. The deeper the source of the water the higher its temperature. It has been estimated that for every sixty feet in depth, there is an increase in temperature of one degree F. So, if this be true, the springs of Arkansas and other localities well known, must derive their water from a great depth. Furthermore, mineral waters may be either natural or artificial. The former are preferable, and to get the best results the user must drink and bathe in them at their source, since imported waters, drank and used at home, will not have the same effect. The chemist can imitate some of the waters quite well. But in no instance can the same effect be obtained from artificial, as from natural mineral waters. Mineral water baths act very similarly to ordinary water baths, although much of the good results depends upon the temperature of the water. It is true also that the stimulating effect on the skin is enhanced by the mineral salts which are held in solution. When given internally, mineral water often acts as a diuretic, diaphoretic and sometimes purgative. Torpid livers are stimulated to increased activity and rheumatism and gout are frequently relieved. In reality, these waters. AQUA. 137 of which there are several varieties, may be considered medicinal. Some physicians are in the habit of prescrib- ing them for a remedial effect, while others discard them altogether as medicament. The classification of mineral waters is difficult. The different salts and gases are so intermingled, that the vari- et ies are exceedingly numerous. But for the sake of brev- ity, they may be grouped into four classes, as follows: ] . ) Gaseous or carbonated. 2.) Chalybeate — containing iron. (3.) Saline— containing salt. (4.) Sulphurous— containing sulphur. Gaseous or Carbonated water is strongly impregnated with carbonic acid gas. This gives to the water a ;, live." sparkling effect, and by chemical action helps to hold in solution other elements, chief among which are carbonates of iron, calcium and magnesia. Carbonated mineral waters are often applicable in chron- ic cases of gastritis where there is considerable irritability of the stomach. Their influence is modified by the salts which they contain, but they are generally soothing and grateful to the stomach. Kidney secretion is often stimu- lated and constipation due to defective peristaltic action is many times relieved, since the carbonic acid water aug- ments peristaltic movement. Chalybeate water is generally impregnated with carbon- ate of iron. This is held in solution by the carbonic acid gas which the water contains. Iron mineral water has an astringent taste and although when taken from the spring it is perfectly clear, if exposed to the air any length of time, the iron precipitates and is deposited on the sides of the vessel. Carbonate of iron is a Physio-Medical remedy and a strong tonic. Hence chalybeate waters are applicable in all cases where a tonic effect is desired. In atony of the stomach, menstrual derangements and many nervous con- ditions a beneficial influence may be secured. Saline waters, for the most part, contain chloride of sodium. Magnesia and iron are found in some of them. They are principally used in stomach troubles. Cases of intestinal catarrh often derive benefit from their use. They are generally recommended in diseases of the ali- mentary canal and even hemorrhoids are sometimes relieved. 138 AQUA. Sulphur water contains sulphuretted hydrogen together with saline matter. This makes it quite applicable in all chronic affections of the mucous membrane of the digest- ive tract. Many diseases of the skin are relieved under the influence of sulphur mineral water. Especially is this the case when sulphur baths are applied. Speaking in general terms, the use of mineral waters of various kinds, in properly selected cases, is often followed by good results. At any rate they may be considered an auxiliary to medical treatment. But in no case should they be used indiscriminately, for each kind of water has its peculiar properties, and like any sanative remedy has its indications for each use and must be prescribed in ac- cordance with those indications. BATHING. For simple ablutionary purposes, water devoid of mineral matter is best. The good effect of the bath depends upon the thoroughness of skin cleansing. The body must be soaped and thoroughly washed. And since the mineral matter in water interferes with the soaping process, it is better to use rain water or other water that has been boiled. Subsequent rubbing with a rough towel removes the epidermic scales, opens the ducts of the sweat glands. induces perspiration, brings a glow to the surface, tills the vessels of the skin with blood, renders the integument soft and pliable and enables the individual to experience a feel- ing of comfort throughout his general economy. The remedial effect of water when applied to the surface of the body, depends (1) upon its temperature and (2) upon the vital powers of the individual. Erich must be carefully considered and one adapted to the other. We often hear the cold plunge, the cold sponge and the cold shower baths condemned. The bad results which are sometimes ob- tained come from a misapplication of the bath. Every bath, no matter what its temperature may be, has its in- dications for use and its field of application. And if not selected in accordance with these indications, taking into consideration the vital resistive powers of the patient, harm will of necessity be the consequence. The temperature of the ordinary water bath will vary from 32 to 112 degrees F. , or even higher. So according to the sensations of the bather, baths are classified between these two extremes as follows: (a.) Cold bath 32 to 60 degrees F. AQUA. 139 ! (b.) Cool bath 60 to 75 degrees F. (c.) Hot bath 98 to 112 degrees F. (d.) Warm bath 92 to 98 degrees V. (e. r ) Tepid bath 75 to 92 degrees F. It must be remembered, however, that the bather is not capable of judging as to the temperature of the water. Water, the temperature of which is pleasant and agreeable to the extremities, will feel cold when applied to the abdo- men and other parts, where the temperature of the body, is higher. If the body be allowed to remain in the bath un- til an equilibriurn is effected* between the temperature of , the skin and that of the water, the. coolness is no longer experienced. This being a fact, in regulating the tem- perature of the different baths it is better to depend upon the thermometer. THE pOLD BATH. , ; 32, to 60 degrees F. 1 On suddenly immersi'ng' the body' in cold water, the • bather experiences. some very unpleasant sensations. The water being so much colder thati the ; body absorbs heat very rapidly. This abstraction of heat is perceived by the peripheral fibrillar of the sensory nerves of "the skin as a shock. The impression is conveyed to the centre, where it Ss reflected to the vaso-motor constrictors of the tegument Vary structure. This transient influence causes a contrac- tion of the skip and its vascular structures, effecting an unequal distribution of blood throughout the general vas- cular system. ' '(. - By virtue of these facts the derma appears contracted; shriveled and pale. As" a natural consequence the bather reels as though all the blood had been forcibly driven to the internal organs, particularly the 1 viscera of the thoracic cavity. There is su'dden and spasmodic gasping for breath. The respirations 1 are increased' In frequency and the individual feels like 1 he would certainly suffocate". 1 'Pulse small, hard and not easily compressed. Muscles and tissues in general seem drawn together, rigid and tense. '•* 'After the body has remained in the water a few minutes a change takes place. The bather feels like new life had gained possession of his tissues: A sense of nimbleness is experienced. ^ Pie rhovtes with the greatest ease aud enjoys in the highest degree the feeling of flexibility. • The skin is now full of blood. There is a glow. Reac- tion has taken place, and there is a determination of blood 140 AQUA. to the surface, relieving ihe pressure on the internal or- gans. Pulse full and strong. He can breathe deep and his respirations are regular. In short, he enjoys a great sense of* comfort, ease and juvenility. At this moment, when reaction is established, he must leave the water and rub the surface thoroughly with a crash towel to assist Nature in her efforts to throw the blood to the surface. Upon the completeness of reaction depends the good effect of the bath. If the bather remains in the water very long after reaction, he again becomes cold and is seized with cramps. When this condition obtains harm always results from the bath. A vigorous constitution is the essential requisite to a beneficial effect of the cold bath. If the individual has strong vital powers, the bath will give increased tone, strength, flexibility and firmness to the vascular struct- ures, skin and nervous system, enabling him to endure vicissitudes of temperature without so markedly disturb- ing the equilibrium of the circulation. And thus he can withstand a greater amount of exposure with less danger of taking cold. Tt is a principle in physiology that "the growth of a part from undue exercise of its functions is always, in itself, a healthy process." While the force of the heart's action alone is sufficient to propel the blood the rounds of the circulation, there are other forces which act as helps. The arteries perform their part of this function. For this pur- pose they are provided with an elastic and muscular coat. The former is predominant in the larger arteries but grad- ually diminishes in thickness as the vessels get smaller, until finally the muscular coat is thickest and most devel oped. These two coats are the ones by which the arteries are enabled to influence the onward flow of the life sus- taining fluid and at the same time assist in keeping up the blood pressure. Aside from this, their elasticity allows them to receh T e more than an average amount of blood, either from an increased quantity, or from an unequal dis- tribution. The first effect of a contracted surface from the applica- tion of cold, is a determination of blood to the heart and larger vessels. This sudden accumulation of blood gives the heart more work than it can perform for the time be- ing. There is also a greater dilatation of the vessels than they are accustomed to in the "performance of their ordi- AQUA. ' J41 nary function. Hence the heart s action is feeble. In two or three minutes, nature supplies the heart and arteries with energy necessary to perform their extra amount of work, and soon the peripheral vessels are filled, equilibrium is established and reaction is complete. The performance of this- increased function— which is physiological— is what leads to the development of a strong heart, strong blood-vessels and increased tone of adjacent tiSvSues, which also exert an influence on the onward flow of blood. Thus the circulatory apparatus is strengthened and better adapted for its function. The circulation is more active and the tissues in general more hardened and more capable of resisting the influence of sudden changes in temperature. Although the cold bath does not recei /e much favor from Physio-Medicalists, there are individuals whom it will benefit. In its recommendation it is well to observe the following conditions: (1.) Where there is disease of the heart or large blood- vessels, or exhaustion from any cause, or disease of any organ or organs causing the walls of the blood-vessels therein to be thinned and weakened and unable to with- stand increased blood pressure, the bath will prove injuri- ous. (2.) Where there is an absence of these conditions and a strong nervous system, with vital powers capable of react- ing quickly and thoroughly, the bath may be recom- mended. (3.) In the beginning the water should be tepid and its temperature gradually lowered at each bathing until the cold bath is reached. (4.) The stimulating effect is greatest and reaction comes up best when the bath is taken quickly. The longer the bather is in the water the slower and weaker is the reaction which follows. (5.) A warm diffusively stimulating tea should be given before entering and after leaving the bath. THE COOL BATH. t>0 to 75 degrees F. The cool bath has a much wider field of application than the cold bath. Its physiological action is much the same, except as to the degree of shock and intensity of reaction, which are much less. This makes baths between the above temperatures applicable in cases where the vital 142 AQUA. powers are weak.. Old people and children ma^ take them, • The cooi bath answers a good. purpose in disease, for if due care , be . exercised the degree of impressicn induced will not be too great for the, patient's vital resistive pow- ers. An£ it is altogether iprobable that, ifi the truth were, known, the good., results which have been reported as due to the action of the cold, bath, were, in; reality, a',conse T quence of a.coojl .bath,; since many times' the temperature of the water is judged by the patient's sensations, in the absence of a thermometer. In recommending the cool bath to individual* suffering from disease, the tempera- ture of the room in. which tlie bath is taken must be prop- erly regulated. Subsequent rubbing of the surface must be practiced until reaction comes up thoroughly, for in this as in the cold, bath, the good effect, is in direct ratio to the completeness of reaction. }n cases where complete reaction is not established, particularly ,if the. bath is fol- lowed by chilliness, tired feeling and loss of appetite, its use should either be discontinued or the temperature of the water raised. .. , This bath is- not applicable in all cases. But when it does prove beneficial, rheumatic and neuralgic pains are often greatly relieved. Some nervous troubles like hys- teria and spasmodic croup will quickly yield upon the application pf a cool bath followed by brisk, rubbing with a' crash towel, In some cases of rickets, if due care be exercised, good will result. It has a tonic effect upon the skin and the tissues become firmer. But in all such cases.. the condition of the bath room as regards temperature and ventilation, as well as subsequent rubbing of the skin to aid, reaction, must be carefully looked after. THE HOT BATH. : 98 to 112 deg. F. 5 The effect of this bath is therapeutically opposite to that of the cold bath. Yet they both bring about the same result,, which is increased capillary circulation of the skin. One is the extreme of the other. Both have a field of usefulness, the former being applicable in those people who have enough reserve force to allow the performance of increased function, the latter where there is a delicate constitution, lowered vitality, poor circulation, and bad resistive powers, engendering an inability to overcome influences demanding strong reaction. While the hot bath is one extreme, it invites blood to the tegumentary vascu- kQVA. 143 lar structures, thereby relieving internal pressure without calling into requisition the vital powers. In the first stages of pneumonia, when congestion and engorgement are marked but as yet no actual inflammatory lesion, the hot bath, by inviting a flow of blood to the ves- sels of the derma, lessens the amount of that fluid at the diseased point in the thoracic viscus. This does much toward aborting the attack, or at least greatly modifying its severity. Likewise, in an acute inflammatory condition of any of the internal organs, its use is not contra-indicated although care must be exercised lest the patient take cold. An external application of hot water brings the blood to the surface. The skin becomes red and has a puffy appear- ance. The conjunctiva is hyperaemic and there is a ten- dency to lachrymation. The derma of the face is turgid. Increased heart action causes the pulse to be full and fre- quent. The temporal arteries throb and the bather com- plains of a heaviness in the head with confusion of thought. Breathing is somewhat difficult and there is a feeling of oppression in the chest. Soon a profuse sweat begins, much to the relief of those unpleasant feelings. At this moment it is best for the bather to leave the water and take a cool or tepid shower followed by brisk rubbing. If he remains in the bath too long he has a subsequent feeling of fatigue and loss of en- ergy. The pulse continues rapid, he feels weak and the extremities are swollen. In some cases, however, this de- gree of relaxation is desired, especially when the muscular system is to be relaxed in cases of dislocation, rupture and many other conditions. In these cases the hot water may be applied to a circumscribed portion of the body by satu- rating cloths and applying to the part. In cases of keratitis, iritis and many other acute inflam- mations of the eye or its appendages, the local application of hot water does much to relieve the pain and suffering. After bathing in hot water the skin is much relaxed and in a very delicate and susceptible condition. To avoid a state of extreme contraction of the vessels of the skin, en- dangering violent congestion of the internal organs, the bather must be placed in a warm room or in bed to favor perspiration. THE WARM BATH. 92 to 98 deg. F. The warm bath has a most soothing effect. There is no 144 AQUA. shock, no extreme redness of the skin and no hyperaemia of the conjunctiva. The face is only slightly flushed and the respirations are normal. Pulse a little quickened but full and strong. This the bath for the feeble; the ablutionary wave for the convalescent. Instead of securing its results by calling into action nature's dormant powers, it assists lowered vi- tality and deficient nerve force in soliciting a. full and free Circulation to the skin. The cuticular layers absorbing the liquid are soltened and subsequent rubbing removes the loose ones, opens the ducts of the glands, induces perspi- ration and imparts renewed vigor and increased tone to the integumentum and underlying tissues. Irritability of the nervous system is relieved and neuralgic and muscular pains are allayed. So that, aftera long and tiresome jour- ney, the weary traveler secures from the warm bath a tran- quilizing effect to his living economy. It will be found that the warm bath is much more useful in disease than the cold bath. Those old rheumatic cases in which there is inflammatory thickening of the ligaments and other structures of the joints, will derive much benefit. In cases of paralysis of syphilitic origin where the cause is removable the warm bath is a valuable accessory to treat- ment. In the very first stages, Bright's disease will yield more readily to the influence of medicines if the skin be stimulated to a better performance of its function. In many forms of skin disease the continuous warm bath is made use of and recommended by Hebra of Vienna a prominent writer on skin disease. The vessel in which the bath is given is so arranged that the water flows constantly and is kept at a certain tempeiature. At first the patient is kept in the bath only two or three hours. The time is gradually lengthened until he is made to remain under water several days. He can eat, sleep and drink while in the water and the processes of nutrition, secretion, excre- tion and respiration are carried on normally. In psoriasis the continuous bath softens the scales and keeps the part cleansed. Burns are treated with the great- est success. The water keeps the air from the burned sur- face and cleanses the part so that resoiution is soon com- plete. While this bath cannot be well used except in hos- pitals, and but few if any Physio-Medicalists have used it. good results can no doubt be obtained in properly selected cases. AQUA. 145 THE TEPID BATH. 75 to 92 deg. F. Water, between these temperatures, has no special reme- dial effect when applied to the surface of the body. It is used more for cleansing purposes. And since the oily filth can not be remo\ed from the derma without the use of soap, soft water is preferable. There are people who go months and even years, without having" their bodies subjected to the cleansing influence of water. Yet these undeserving creatures pass through life seemingly healthy and robust. In most such cases however the individual indulges in such physical procedures as ex- cite free perspiration and thus the sudoriferous glands are continuously flushed. Were it not for this fact, these anti- ablutionists would certainly suffer the dire consequences of surface suffocation. It is necessary to take a good cleansing hath oftener in Summer than in Winter. During the hot months the sweat glands are constantly at work. The watery portion of the cutaneous excret ion evaporates leaving the solid con- stituents and sebaceous matter in contact with the skin. This, together with the dried epithelial scales forms a uni- form coating over the entire surface of the integumentum. The mouths of the gland ducts are clogged and this pro- duct undergoes decomposition. Thus very offensive odors are exhaled. The bath should be taken often enough to prevent the collection of such foul material and the skin should be thorougly rubbed afterwards to stimulate cap- illary circulation. THE SPONGE BATH. One of the simplest aud at the same time most effective methods of applying water to the surface of the body is by the use of the wet sponge. One part should be bathed at a time and thoroughly rubbed and dried, then another un- til every part of the body has been bathed. The water may be used at any temperature that the condition of the the patient and the state of vital resistive powers seem to indicate The cool sponge bath upon arising in the morning, is a luxury which but few of us enjoy. Yet it is a process which is cleansing, stimulating, bracing and if not carried to excess, conducive to health. While at first the cool wa- ter may feel unpleasant, in a short time it becomes more agreeable. And if followed by brisk rubbing, a warm glow 146 AQUA. o'erspreads the surface and a thrill of vigor permeates his entire organism. The warm sponge bath is especially applicable in febricula, typhoid fever, pneumonia, and acute inflammatory condi- tions of any internal organs attended by an elevation of temperature. The temperature of thewater is below that of the body and yet it does not produce shock when applied, but absorbs or becomes charged with heat from the body. Thus by the sponging process, radiation of heat is favored and the temperature of the patient can be reduced several degrees, great care must be exercised in fever cases to sponge and dry one part of the body at a time. And this must be done under cover to prevent taken cold. THE SITZ BATH. In taking this bath the patient sits down in a vessel of suitable size and depth. Enough warm or hot water is then poured- into the vessel to come well up on the hips. Hot water must be added every few minutes to maintain proper temperature. The patient may remain in the bath from twenty to thirty minutes. This process of local bathing is very relaxing to the pelvic organs and has a tendency to attract blood to their vessels. It may be used to advantage in cases where the menses are checked from cold. In all such however, diffusively stimulating emmenagogues which have a tendency to aid in bringing on tardy menses must be administered internally. If persistently applied in connection with internal relax- ation and stimulation, in cases of renal colic, being care- ful to have the vessel deep enough to allow the water to come well up on the back, its relaxing influence will do much to lessen the tension and allow the offending materi- al to pass into the bladder, much to the relief of the pat- ient's suffering and physicians anxiety. In acute inflammations of the kidney and bladder as well as neuralgic affections of the uterus and ovaries, its sooth ing effect will be greatly appreciated. THE FOOT BATH. This bath is very frequently made use of for the relief of pain and suffering due to severe congestion and inflamma- tion of internal organs attended by febrile movement. It should always be used as hot as the patient can bear it and Hie water should be heavily charged with a powerful and AQUA. 14. persistent stimulant. Mustard or an infusion of capsicum is generally used. The vessel in which the bath is given should be deep enough to allow the hot water to come well up to the knees and the feet should remain in the bath until the capilla- ries of the skin are full of blood and the surface of the feet and legs intensely red. This lessens the blood pressure at the diseased point and makes the bath of special benefit in all acute inflammations of the lungs, liver and bowels. The sharp cutting- pain due to acute inflammation of the membrana tympani and purulent accumulation> in the cavity of the tympanum, is often greatly relieved. In the first stages of meningitis, this bath together with the internal administration of diffusively stimulating remedies which have a tendency to strongly favor an outward circu- lation, will do much to abort t lie attack, or at. least lessen the danger of subsequent serious results. THE SHOWER BATH. The apparatus necessary for the bath consists essentially of a funnel-shaped cup the large end of which is covered with a perforated sheet of tin or other metal. The small end is attached to a common pipe to which two other pipes are attached. One of these serves for the passage of hot. arid the other for cold water. Properly arranged stop- cocks allow a mixture of the hot and cold aqua and thus any temperature can be used from hot to cold. In passing- through the perforated sheet, the flow of water is broken up into small streams. The advantage of this bath is that there is a constant change of water. The bath may begin with tepid water and gradually increase to hot. After the effect of the hot bath has been secured, the water may be gradually cooled until finally a shower of cold water may be passed over the body. This closes the ducts of the sweat glands and brings up reaction. Then there is no danger of the bather taking cold upon leaving the bath. THE PACK BATH. Packing the patient with a wet sheet is a method of ap- plying water quite different from those which have been considered. The water may be either cold or warm. But since the temperature of the water and that of the skin quickly approximate, it is better to begin with warm water. Oil-cloth is placed on the mattress to keep it dry. The patient is stripped naked and wrapped in a sheet which has 148 AQUA. been dipped in warm or hot water. If it is the wish to en- courage perspiration, a blanket may be applied also. Great care is required in giving a cold pack for there is danger of doing jbhe patient considerable injury. Even a warm pack requires close attention. When properly given a warm pack is a valuable help in the treatment of malar- ial fever. The patient has a chill. After the chill comes the fever. The tongue is dry and the pulse quickened. He is in no condition to stand a shock. So, we place him in a warm pack having the temperature of the water about 98 deg. F. Slight diffusive stimulation or in some cases near- ly pure relaxation are given internally. Bottles of hot water are placed to the feet and sides. The bath may be continued until free perspiration is secured. Then the temperature begins to drop and the patient may be re- moved from" the pack and rubbed briskly. As long as the fever remains high the pack may be continued. Prof. Davidson, one of the ablest men, most successful practition- ers and deepest thinkers ever known to Physio-Medicalism, once said that he had continued the pack in these cases two or three hours with the happiest results. If the patient is a child, a partial pack may be applied over the organ or part affected. It acts well in cases of pneumonia, dysentery and derangements of the bowels. In cases of erysipelas the warm pack answers a good purpose. In applying the pack bath to patients suffering from chronic troubles it must be applied quite hot to arouse them thoroughly. But it must be remembered that a per- son in a hot pack is very easily scalded. The water must not be too hot. If an emetic has been given, the patient should not take a bath that day. He must wait until he has thoroughly recovered 1 rom the effects of the emetic. It is always well to stimulate patients before they enter and during the time they are in the pack. And subsequent friction until the surface is dry must always be practiced. THE MOTST VAPOR BATH. 90 to 150 deg. F. For its hygienic effect, vapor bathing has been practiced from time immemorial. Hippocrates recommended simple watery vapor. The ancient Romans used it extensively. But their use of it was more for enjoyment and a prevent- ive influence than any therapeutic effect. In the United States, Physio-Medical physicians have AQUA. U9 been given the credit of first using- the vapor bath for ther- apeutical purposes. And although in liis effort in this direction Samuel Thompson was classed as an empiric, the best writers of to-day must acknowledge that as a sudatory process it is far superior to any yet known. The placing of the body in a medium in which there is suspended watery vapor, is called a moist vapor bath. Di- rectly opposite to this is the dry vapor bath in which the medium consists of heated air. The temperature of a steam bath will vary from 90 de- grees to 150 degrees F. When the entire body, with the exception of the head, is surrounded by steam having a temperature above that of the body, a portion of the water is taken up by the absorbents of the skin. Indeed, in the very beginning of a vapor bath the absorbents are often so active that they will take up the greater part of the water. After the blood-vessels and absorbents are full, and tin- steam has lost some of its caloric by c< ntact with the body which has a lower temperature than that of the vapor, large drops will trickle down the skin. When the head is surrounded by vapor and the latter inhaled, there is great augmentation of fluid absorption and at the same time increased stimulating effect. The vascular system is filled with water. The heart's action is increased and the pulse' full. There is corresponding increased fullness of the. cerebral vessels. This extra quan- tity of fluid in the cranial cavity has its effect on the ence- phalic function, hence there is a feeling of drowsiness and indisposition. In due time, profuse sweating begins. The delicate ves- sels of the skin are filled with blood. At the same time the absorbent vessels are filled with water. By virtue of these two conditions the integument has a swollen, plump appearance immediately after the bath. The patient may remain in the steam from ten minutes to two hours, owing to his temperament, habits and sensi- tiveness. Therapeutically speaking, as soon as perspira- tion is thoroughly established, the full effect of the bath has been secured. If continued too long, drowsiness and other unpleasant symptoms supervene and prostration is the sequence. And in some cases, if the steam is applied still longer, the blood becomes heated to such a degree that the results may be quite disastrous. The simplest way to give a vapor bath, especially in 150 AQUA. certain acute eases where it is necessary to give it at the patient's home, is to seat him in a chair, nude. A blanket is thrown around him. pinned sufficiently tight around the neck and allowed to reach the floor to prevent any draught from striking him. The feet are placed in hot water to keep them .warm. Under the chair sits an alco- hol lamp and over the flame rests a small basin or cup filled with water. During the time he is in the bath, warm diffusively stimulating drinks should be adminis- tered to favor an outward circulation and call into action the sweat glands. Although very simple and seemingly rude, when better apparatus cannot be made use of. the good effect of a moist vapor bath may be secured in this way. In chronic cases where the patient can come to the office more expensive apparatus may be used. A box large enough to allow the patient to enter, should be secured. This box may be made of hard wood nicely finished. A stool which can be raised or lowered must be placed in the box. The lid of the box is made in two sections. A circu- • lar opening is cut through these sections, allowing haJf to be removed from each section. This opening should be sufficiently large to receive the patient's neck. Thus the attendant may enclose the patient's entire body in the box with the exception of his head. The steam may be generated either in the box or out of it. If generated in the box an alcohol lamp should be placed under the stool, and the basin containing the water suspended over this. If formed outside of the box the water- may be heated in a closed boiler and the steam conveyed to a point beneath" the stool by means of a pipe. The interior of the box may be lined with zinc. An opening at some point in the bottom will allow the escape of water. A shower bath may be attached in such a way that when the steaming process has been completed, the lid of the box may be removed and a shower bath given. This should be given with warm water and its tempera- ture gradually lowered until the cool bath is reached. A fan attached to the box and operated by means of a crank is a valuable accessory. Or, in cities where an elec- tric current may be made use of, an electric fan is more convenient. The patient's head can then be kept cool while his body is subjected to the influence of the steam. The best time to give a vapor bath to get the most ben- AQT7A. 151 eficial effect, is when the stomach is empty. For this rea- son in some cases it is well to give an emetic previously. It is good practice also to cleanse the lower bowel by enema to preven T the absorption of any offending material. In many forms of disease, restoration of suppressed per- spiration is the desideratum, and this is one of the first effects of the vapor bath. To assist in accomplishidg the object, warm diffusively stimulating diaphoretics, such as zingiber tea. or an infusion of myrica comp., or sierra sal- via in hot lemonade, should be given at the time. The next effect of the vapor bath is a softening of dried epithe- lial scales, together with relaxation of the skin. After being exposed to such high temperature the skin is open and very susceptible to influences. This calls for a cool shower which will close the pores. Subsequent rubbing aids in bringing up reaction, and places the skin in such a condition as will prevent the taking of cold. THE DRY VAPOR HATH OR HOT ATK BATH. 100 to 120 deg. F. The dry vapor bath, or Turkish bath. excite> profuse sweating, without necessitating an exposure of the body to the influence of moisture. And although its considera- tion has no direct connection with water, it may be well to give the hot air bath brief mention. To give a thorough Turkish bath, three rooms arc neces- sary. One serves for a dressing room. Another having a higher temperature is used for a cooling room, while the third, having a temperature of from 100 degrees to 120 de- grees F., is the bath room proper. In this room is a mar- ble slab on which the bather reclines. The attendant rubs him thoroughly during the time he is in the hot room. After perspiring freely for a short time, he is washed with warm water and soap and then rubbed with a crash towel. To prevent taking cold, he remains in the cooling room from thirty to sixty minutes. The Turkish bath arouses the sudorific glands power- fully and fills the tegnmentary vascular structures with blood. Hut since this bath is not always available, a pa- tient may be sweated just as effectively by means of hot air. at the office. The same box in which the moist vapor bath is given, may be used for a dry vapor bath. The alco- hol lamp should be much larger and several wicks are necessary. A thermometer may be placed in the box and when the temperature is raised to 100 degrees F. the pa. 152 AQUA. tient should enter. In some cases the temperature may be raised as high as 120 degrees F. But in no instance should the patient be allowed to remain in such hot air without having his head kept cool by fanning. Sulphur fumes add very much to the good effect of a hot air bath. These fumes may be applied by placing over the flame of the lamp, in a metallic cup, about two drachms of sulphur. If not heated above 232 degrees F. the sulphur passes into a vapor. But if heated above this point, and a current of air strikes the sulphur, it burns and sulphurous gas is formed which is very irritating. Care must be exer- cised not to have the temperature of the cup in which the sulphur is burned too high. After the patient has been in the bath a few minutes, his face becomes flushed and the conjuctiva hyperaemic. Soon slight perspiration appears on the body and in a short time it becomes profuse. In most cases the respirations are increased and the pulse quickened and full. It is very necessary tc be careful, especially with weakly persons, for there is much excitement of the cerebral cir- culation, often dizziness and sometimes syncope. If the patient be allowed to remain in the bath until these symp- toms appear, there is a subsequent feeling of exhaustion which neutralizes to a certain degree the good effects of the bath. After remaining in the sulphurous vapor fifteen or twenty minutes, the lamp should be removed from the box and a shower bath applied, beginning with warm water and gradually lowering its temperature to that of a cool shower. Then rub the patient thoroughly with a crash towel. The dry vapor bath with sulphur fumes is one of the best baths that can be made use of in chronic cases. Long- standing intersticial hepatitis, chronic bronchitis, gastric difficulties and rheumatism will be greatly relieved. In fact this bath is applicable in almost any chronic case where there is not too much prostration. Many forms of skin disease are improved and diseased conditions of the mucous membranes at any point will yield to the influence of medicinal treatment more readilv, if this bath be ap- plied. It has one marked advantage over the moist vapor bath in that there is little or no danger of the individual, taking cold upon leaving the bath, even in damp cold weather. I have known weakly people to leave the bath A KALI A. 153 at once and drive several hours, cold, windy weather days, and not take cold. This may be due to an astringent which is deposited upon the skin, closing the pores; for if the attendant rub the bather's skin with his hands, it feels as though li is integument were bathed in alum water. In the preparation of this article the writer has availed himself of many excellent works, chief among which may be mentioned, Ravogli on The Hy- giene of the Skin; Parkes' Practical Hygiene byNotter; Wilson's Hanc 1 book ot Hygiene; Kirk's Manual of Phy-iology ; Carpenter's Human P. ys ology; Bell on Baths; Phillips' Materia Medica and Therapeutics others. and- ysi- and A KALI A H1SPIDA. Dwarf Elder. The bark of the roots and stems are mildly stimulating and tonic diuretic. In hot infusion it influences the blood toward the surface, but cold preparations influence the kidneys and procure a good flow of urine, and yet leaves the parts toned. To the stomach they are a warming, pleasant, bitter tonic. For its tonic diuretic properties it is excellent in dropsy, renal torpor, renal congestions; and where there is scanty and scalding urine with aching of back or bladder. With females, while it is valuable for its action on the renal tract it also influences the uterus, relieving uterine torpor and assisting in the promotion of the periodic flow. F. E. Aralia Hisp. dr. ii '• Taraxacum Dens Le. dr. iv " Mitchella Rep. dr. iii Syr. Zingiberis q. s. oz. iv Sig. Teaspoonful three or four times a day as a female diuretic tonic. F. E. Aralia Hisp. et " Capsella Bur. Pas. aa. oz. ss Potassa Citralis dr. ss Syr. Zingiberis ad. oz. iv Mix. Sig. Teaspoonful every three hours for cystic congestion. ARALIA NUDICAULIS. * Imevican Savsaparilla. Tl:e root is a pleasant and gently stimulating diuretic, influencing all the mucous membrane, but especially that of the renal organs. In hot infusion it influences the cir- 154 ARALIA. culation toward the surface very favorably and may be used for the relief of colds whether of the bead, lungs, stomach, bowels or uterus. It is stimulating and soothing to the mucous membrane. F. E. Aralia Nud. dr. ii " Celastrus Scan. dr. ii ik Taraxacum dr. iv " Menispermum C. dr. i Syr. Zingiberis q. s. oz. iv This is a valuable alterative. A KALI A RACEMOSA. Spikenard ■ This root is mildly stimulating, demulcent, warming, sustaining andtoning to the mucous membrane especially that of the respiratory organs. In hot infusion the circu- lation and skin feel its influence. It allays irritation of the respiratory mucous membrane. and is a soothing expectorant. It is of much value in allaying spasmodic cough and in the relief of inflammations and congestions of the thoracic organs, whether they be bronchial, pleuritic or pulmonary. It is valuable in tin' treatment of the irritation subsequent to eruptive diseases. It soothes the mucous membrane throughout the stomach bowels and bladder also. Inhaling of a vapor or spray of aralia is valuable and pleasant in irritated conditions of the lungs. Aralia Eac. 2 Symphytum Off. Mitchella Rep. Eupatorium Purp. m. 1 forms a valuable tonic for ladies having a weak and irri- tated mucous membrane, whether alvine. renal, respira- tory or uterine. F. E. Aralia Rac. et " Inula Hel. et " Symphytum Off. et '• Marrabium Vulg. aa. dr. i " Sanguinaria Can. gtta. xv " Primus Yirg. dr. ii " Glycyrrhiza Glab. dr. ss Syr. Simp. q. s. oz. vi This is an admirable tonic cough syrup for chronic cases with more or less debility. If needed it can be made more ARALIA. relaxing by the addition of f. E. Lobel i;i F. E . Aralia Rac. Lycopus Virg. dr. dr vi iv ' Polemoninni V, ep. dr. ii Inf. Syr. Zing. q. s. oz. viii Sig Half to one teaspoonf il as required. F. E. Aralia Rac. et Symphytum Off aa. dr. iss " Inula Hel. et Sanguinaria Can. aa. dr. i Lobelia Infl. et " Cephaslis Ipecac. aa. dr. ss Tr. Capsicum gtta. v Syr. Primus Virg. q. s. oz. iv This is a stimulating coug i syrup. F. E. Aralia Rac. et " Symphytum (Iff. a a. dr. ii Syr. Prunus Virg. <|. s. oz. iv Add to this F. E. Lobelia Inf. or Sanguinaria, o to suit the case, F. E. Aralia Rac. dr. iii F. E. Symphytum Off. e t " Caulophyllum aa. dr. i Syr. Prunus Virg. q. s. oz. iv Aralia Rac. 8 Symphytum Off. 4 Viburnum Opu. 2 Inula Hel. 1 Mitchella 3 Prunus 10 This forms a good female tonic and cough syrup bined. F, E. Aralia Rac. dr. iii ! " Eupatorium Perf. dr. ii " Lippia Mexicana dr. ii se of this compound, and in diphtheria and many other acute cases where the bowels are constipated this is my first dose. I have treated successfully many a case of typhoid fever with no other hepatic than this compound in small doses every 3 hours. It stimulates and cleanses the alvine mu- cous membrane. In jaundice where the overflow is not from gall stone it gives good success. In all eruptive diseases you will find a less virulent course and a more favorable termination by the use of a good dose of this compound in the beginning. In the treatment of chronic constipation there are few compounds that will do their work more completely and of which the system will become less weary. At first give dose sufficient to procure a complete evacuation, then give smaller doses and gradually decrease the frequency and quantity. And during the time of this temporary treat- ment strive to educate the system to habitual regularity. n In the treatment of remittents and intermittents this compound is very important: regulate the doses as required to keep the alvine canal free, but not too free. Many a case may be aborted by the use of this compound, taken in time. Cassia is an excellent antiperiodic. Many a time a good size dose of antibilious physic will anticipate and prevent a chill and frequently will do it more permanently than quinine. It will certainly prevent the necessity for giving so much quinine as would otherwise be required. In giving large doses of this compound let the patient re- cline for an hour. This will usually prevent nausea and vomiting which may otherwise occur. It may be given in capsule or in fluid extract form, but neither are so ^ood. 184 CAULOPHYLLUM. A dose of the compound should usually be given after the use of anthelmintics. Small doses given every three hours will soon relieve hemorrhoids and frequently prevent their recurrence. In case of constipation either acute or chronic this com- pound may be given in suitable doses to infants. Dr. C. B. Riggs' antibilious compound is as follows: Powd. Senna Jalap aa. oz. i Ginger Mandrake aa. oz. ss Sanguinaria oz. i Mix. Sig. No. 1 capsule two or three times daily. This is a splendid cathartic and strongly influences the liver. It will be found useful especially in sluggish cases. CASTA NEA DEN TAT A. Chestnut. (Castanea Vesca.) The leaves are a mild, stimulating, astringent tonic. This is a home remedy for whooping-cough, but is not so successful alone as in combination with the acetous syrup of lobelia. CASTELA NICHOLSON1. Chaparro Ainargoso. This is a thorny shrub indiginous to Texas and Mexico. The bark of the stem is an intensely bitter stimula* ing and astringent tonic, antiperiodic and antiseptic. By the people among whom it grows it is considered a specific in the treatment of acute and chronic dysentery and diarrhoea, and of remitting fever. Let an infusion be given plentifully and it seems never to fail. It influences the mucous membrane, improves digestion, tones the alvine mucous membrane, soothes and tones the nerves, relieves insomnia and builds up the general system. CAULOPHYLLUM TH AL1CTROIDES. Blue Cohosh. The root is a gently diffusive, relaxing and stimulating nervine and excellent antispasmodic especially in uterine irritations. Its principal influence is expended upon the generative system and tne sympathetic nervous system connected therewith, soothing each and imparting tone and vigor. CEANOTHUS. 185 Tn amenorrhoea its influence is felt favorably, increasing the periodic flow. The addition of leonurus gives a more stimulating compound. In dysmenorrhea it is an excel- lent antispasmodic. In vaginitis its influence is good both per oram and per vaginam. In urethritis whether of the male or of the female, it prevents too frequent urinat- ing and soothes irritation. In the irritation of the nerves that frequently occurs during parturition and for false pains and the restlessness during pregnancy and for after-pains caulophyllum is superior. In acute rheumatism it gives ease, and it is valuable as an antispismolic for whooping-cough and asthmatic and catarrhal coughs. It may be added to aralia racemosa and prunus virgin i- ana or other agents used in cough syrups. In hysteria it allays nervous irritation but frequently needs such an addition as »cutelaria to furnish greater tonicity. It may be used in puerperal convulsions, as an antispas- modic and to assist in relieving the flow which is usually suspended at that time. Dioscorea VII. 3 Caulophyllum Thai. 2 Scutelaria 1 may be used in cases of chorea, after-pains, nervousness during parturition, and with a little lobelia inflata it is excellent for rigidity of the os uteri. Caulophyllnm may be added in the treatment of an irri- tated stomach, and to the third preparation of lobelia for sick-headache. Dr. F. G. Hoener recommends that the leaves be com- bined with asarum canadense and says that then it is a specific for whooping-cough. F. E. Caulophyllum Thai. Tr. Lobelia Inf. aa. dr. ii Syr. Zingiber q. s. oz. iv Use half a teaspoonful every two to four hours for bron- chial catarrh. The fluid extract quite fully represents the drug. CEANOTHUS AMEKICANUS. .New Jersey Tea. The root and 1<«r the vomiting incident to pregnancy: Cornus Ser. Viburnum Prunif. aa. equal parts. GOTO AND PARA-COTO BARK. These are two distinct barks brought from Bolivia under the name of coto-bark. They are now distinguished as above. In physical appearance these two barks are strik- ingly different, but their therapeutical properties are very similar. The bark is a gently stimulating, tonic astringent. lt> influence is especially felt by the alvine mucous mem- brane, and is very useful in dysentery, diarrhoea and chol- era infantum. In hot infusion of ziugiber it is excellent in the exhaustive discharges of cholera morbus and to quiet the pain incident thereto. With xanthoxylum, cap- sicum and hydrastis it will be found very valuable in cholera. Goto tones the digestive tract and is especially valuable in all lax conditions of the mucous membrane. It influ- ences a good flow of blood toward the surface. It is very successful in the treatment of sore and spongy gums, toothache, sore mouth, sweating of the feet and the night sweats incident to phthisis It may be used locally upon ulcers and old sores, and is valuable to be used as an injection to the vagina in case of excessive discharges whether lucorrhoeal or from ulcer- ation. In nasal, gastric, intestinal and bronchial catarrh it will 212 CUCURBITA. be found very valuable in cases where the discharges are in excess. In typhoid fever and in the excessive discharges from the bowels in phthisis this is a superior agent. F. E. Para-Coto Cort. Tr. Cardamon Comp. aa. dr. i Acacia Mucilage dr. iii Syi. Simp. dr. ii Aqua q. s. oz. iv Sig. Teaspoonf j! or more as needed to arrest diarrhoea. CROTON EL UTERI A. Cascarilla. Bahama Islands. The bark is a pleasant, mild, aromatic, stimulating tonic, chiefly influencing the mucous membrane. In hot infusion it is diaphoretic, soothes the nerves, gently quiets the whole system and gives a good flow of blood toward the surface. In convalescence it is gently sustaining and if needed may be combined with stronger tonics, or combined with some diffusive, as required. If combined with aralia racemosa or some other agent influencing the respiratory organs it lends its influence in that direction. It is a good tonic addition to some cough syrups, especially when the expectoration is already too free. It will be found valuable in phthisis for such condi- tion. In combination with uterine and vaginal tonics it is useful in the treatment of leucorrhcea, prolapsus aud vagi- nal weakness. CUCURBTPA CITRULLUS. Water-melon. (Citrullus Vulgaris.} The seed and husk are a moderately relaxing and stim- ulating diuretic. It influences the mucous membrane throughout, but especially that of the kidneys, promptly increasing the flow of urine. In nephritis, cystitis and urethritis it is one of the best agents. It relieves scalding urine and soothes the entire urethra. Its influence may be partially felt on other parts of the mucous membrane when properly combined with other agents. An infusion of the seed gives best results when freely drank. CUNTLA. 213 CUCURBIT A PEPO. Pumpkin. The seed without the husk is bruised in a mortar or ground and then emulsed in water. This is oily and sweet and influences the raucous membrane throughout, but especially that of the kidneys, bladder and urethra, and promptly relieves scalding urine. It is a pleasant anthelmintic for the expulsion of the tape worm. Emulse two ounces of the peeled seed in water and drink early each morning for three mornings, eating but little during these three days, and follow their use with a full dose of antibilious physic. The oil maybe used for the same purpose in doses of from 20 to 60 drops. CI NILA MARIANA. Dittany. This plant is a pleasant diffusive aromatic stimulant. In hot infusion it is diaphoretic and gives a good out- ward circulation. In recent colds, in tardy exanthems, headache, hysteria, cramping, gastralgia. enteralgia, re- mitting and continued fevers and in tardy menstruation caused by congestion. In all such it stimulates the capil- laries, relieves nervous irritability and sustains the circu- lation. It stimulates the mucous membrane, relieves flatulence and assists digestion. Cunila Mar. Cypripedium Pub. aa. equal parts makes a good relaxing nervine for irritated conditions. Cunila Mar. Caulophyllum Thai. Dioscorea Yil. aa. equal parts makes a good antispasmodic preparation for dysmenor- rhoea. Cunila Mar. Scutelaria Lat. aa. equal parts makes a stimulating nervine. The leaves yield an oil which is a carminative essence. CURCUMA LONGA. Tumeric. The root is a diffusive stimulating aromatic tonic to the alvine mucous membrane. Its chief use is as an adju- 214 CYPERUS. vant for the administering of bitter tonics and cathartics CUSPARIA TRIFOLIATA. Angustura. (Galipea Cusparia.) South America. The bark is a mild, diffusive, stimulating, tonic nervine. It relieves the heart by promoting an outward circula- tion. It influences the alvine mucous membrane and large doses are cathartic. It more or less influences all the secernents, and is valuable in the treatment of intermit- tents, remittents and typhoid. It cleanses and tones the gastric and intestinal mucous membrane and is very serviceable in convalescence from typhoid and other fevers, in gastric, intestinal, cystic, nasal or vaginal catarrh. It is an agent that may be in- fluenced in different directions by being combined with different agents, and yet it maintains its general character of influence. It is positive in its infusion and is a valuable agent used in the relations mentioned. CYDONIUM VULGARIS. Quince. The seed and covering yield a mucilage very soothing to the mucous membrane and to the surface as well. It is excellent in cases of irritation or inflammation of the kid- neys, bowels, bladder or urethra. To the stomach it is a very grateful bitter tonic, more pleasant than most demul- cents. Hydrastis Aq. Dis. 6 Hamamelis Aq. Dis. 4 Cydonium Mucilage 22 This forms a good injection for gonorrhoea. The mucilage is an excellent wash for ophthalmia. Dr. F. Gr. Hoener says that quince leaves either as a local steam bath or taken in hot infusion per oram in four cases out of five will prove emmenagogue in cases of tem- porary suppression. CYNOGLOSSUM OFFICINALE. Hound s Tongue. Dr. F. G. Hoener says, this has given good effects in bronchitis, dentition and coughs and colds of infants. CYPERUS ARTICULATUS. Anti- emetic Root, Adrue.* Tropical. The root possesses an aroma scmewhat resembling that of calamus. It is a gently stimulating, warming, and dif- CYPRIPEDIUM. 21") fusive agent, soothing to the mucous membrane. In Ja- maica a strong infusion has been used successfully to stop the black vomit incident to yellow fever. It may also be used in the vomiting incident to cholera infantum, cholera morbus, atonic dyspepsia, and the vomiting incident to pregnancy. It is a pleasant aromatic and creates a feeling of warmth and comfort in the stomach. It is a tine tonic to the gastric and alvine mucous membrane. In hot infusion it influences the circulation toward the surface and soothes the nervous system. The mucilage is an excellent wash in ophthalmia. CYPRIPEDIUM PUBESCENS, Lady's Slipper. The root is almost if not quite a pure relaxing nervine. It is less positive and less stimulating than lobelia. It is antispasmodic by inducing nerve relaxation, and thus free- ing the nerves from irritability and excitement. In typhoid fever it decidedly influences the brain and relieves delirium to a great extent. The more your pa- tients can naturally sleep and the less the brain is allowed to be irritated the better. Of course cypripedium in typhoid fever is not best alone. More or less capsicum or other stimulant is necessary. Cypripedium Pub. Lobelia Inn. aa. equal parts is excellent in many cases of insanity where there is much restlessness and inability to sleep. Business men who are overworked or worried and unable to sleep can take with much benefit smail and frequent doses of cypripedium with excellent quieting effect. If it is to be used on the surface, capsicum should be added; and in depressed cases it is best to add a small por- t ion of capsicum for internal use. Cypripedium Pub. Lobelia Infl. aa. 5 Capsicum 1 Make into a pill with extract of eupatorium perfoli- atum. These may be used in febrile delirium, insanity, dysmen- orrhoea and uteriue irritation. Cypripedium Pub. 2 Cimicifuga Rac. Zingiber Off. aa. 1 216 CYPRIPEDIUM. Give an infusion of this for dysmenorrhoea. In cases of insomnia give an injection of eypripedium or of eypripedium and lobelia at night on ^retiring. Do not give enough to nauseate but simply to quiet. This process may also be used in nymphomania and used on retiring to prevent seminal emissions. Cypripedium Pub. 6 Lobelia Inn. 5 Eupatorium Perfol. 2 This make s an excellent suppository to be used for irri- tation of the nervous system, or the ingredients may be used in infusion per oram, in hysteria, chorea, nervous headache, neuralgia, nervous irritability, nervous debility when from irritability, dysmenorrhoea and epilepsy. For delirium or insanity from nerve irritation there is nothing better to relax them. Give such doses as are re- quired to produce the desired result As the case pro- gresses other nervines may be added to sustain the nerves after the stage of excitement has passed. If cypripedium be given in hot infusion, especially if some zingiber be added, a warm and gentle perspiration results. Its relaxing effect upon the nerves is felt by the circulation, and the secernents are also relaxed and re- lieved. The kidneys and bowels are also relieved. Indeed the whole system is left in better shape for future activity. In dysmenorrhoea ascertain if the patient has been given to too free discharges or as is usual to too scanty dis- charges. If the latter use in hot infusion the following: Cypripedium Pub. Anthemis Nob. aa. 4 Caulophyllum Thai. ' Leonurus Card, aa. 2 Zingiber 1 In parturition cypripedium relieves the rigid os uteri and the nervous irritation that is frequently present. Of course this does not apply to cold, slow cases that need some degree of stimulation. Cypripedium Pub. 3 Dioscorea Vil. 2 Zingiber I gives very favorable results in colic and after-pains, but in cases of post-partem hemorrhage omit the zingiber and add either trillium or capsicum or viburnum prunifolium as required. CYSTISTTS. 217 The above preparation may also be used in rheumatism, but must be combined with some degree of stimulation. In a dry and irritable form of catarrh cypripedium is useful to cleanse and to relieve irritation. In the convulsions of hysteria use a large injection of Cypripedium Pub. Lobelia Infl. aa. equal parts and if needed give a second smaller injection. Cypripedium is not a diaphoretic, but in cases where there is feverishness with irritation of the nervous system some diaphoretic agent as zingiber or serpentaria should be added. Cypripedium is not a tonic, and yet after the system has been brought well under its influence, the entire system is relieved and toned. In the presence of putrescence this agent has but little value unless combined with very positive stimulation. In such cases it is simply of value to relieve irritation of the nervous system. Cypripedium Pub. 2 Scutelaria 1 is an excellent combination for a ease of irritable nervous depression. In nervous headache this will give good re- sults. If the stomach is involved it may be used by enema.. F. E. Cypripedium Pub. dr. iv •' Scutelaria Lat. '■ Nepeta Oat. ." Dioscorea Vil. aa. dr. i Syr. Zingiber q. s. oz. iv This is a soothing nervine for child or adult for cranial or abdominal pain Cypripedium is one of our best agents when properly used. CYSTISUS SCOPARIUS. Broom Tops, Scotch Broom. Europe. The young shoots are a stimulating and relaxing diu- retic, securing a free flow of urine. With hepatics and tonics this is of much value in drop- sy. It gives good results. Cystisus Scop. Euonymous Atr. aa. 3 Zingiber. 1 This is a successful combination for dropsy. 218 T>ENTARIA. Dr. F. G. Hoener recommends the following for general dropsy: Elix. Cystisus Scop. " Celastrus Scan. aa. oz. iss " Agrimonia Eup. oz. i M. S. One tea^poonful every two hours. DAUCUS C A ROTA. Carrot. This vegetable is of some importance as a medicine. Finely grated it is a stimulating application for sores, ul- cers, abscesses, carbuncles, and scrofulous and cancerous sores. It cleanses the surface and siimulates to sound granulation, after which other applications will make more favorable impression. The seed are a pleasant, mild, diffusive, aromatic, stim- ulating diuretic. It increases the watery discharge and with hepatics wil^ be found valuable in some forms of dropsy. Dr. F. G. Hoener recommends the following for severe cases of general dropsy. To be used in conjunction with steam baths. Elix. Daucus Carota Sem. " Polytrichum Juniperinum aa. oz. iss " Cucurbita Citrullus oz. i .M S. One tablespoonful every hour. DELPHINIUM CONSOLIDA. Larkspur. This plant is a moderately stimulating diuretic and is somewhat emmenagogue. It influences the alvine mucous membrane and in large doses may produce emesis and ca- tharsis. Dr. F. G. Hoener says an infusion washed over a child's head, a few times will destroy insects. DENTARIA DIPHYLLA. Pepperwort. This root is a pleasant, diffusive, stimulating, tonic nervine. It influences the sympathetic and the peripheral nerves. In hot infusion it influences a good outward flow of blood and stimulates the capillaries. It is valuable in dysmen- orrhoea, colic, hysteria and general nervous weakness. It warms the surface and tones the nerves. DICENTKA. 219 DTCENTRA CANADENSIS. Turkey Com. The root tubers are a positive systemic, stimulating alterant which influences the stomach and mucous mem- brane throughout, the secretory organs and the skin. It is stimulating to the salivary glands, warming to the stomach and invigorating to the whole circulation. In hot infusion it influences both the sudoriferous and the sebaceous glands. It is one of the best of stimulating alteratives. In fact all the excretive avenues of the body are more or less emptied of injurious and impure contents and all the secernents are rendered more active. It is just the agent for torpid, sluggish or depressed conditions. It is especially valuable in secondary syphilis, scrofula, chron- ic eruptive troubles and chronic rheumatism. In all such conditions it is one of the most valuable of stimulating alterants. F. E. Di centra Can. dr. iv " Arctium Lap. Sem. " Taraxacum Den. L. " Xanthoxylum Frax. Syr. Simplex ( F. E. Dicentra Can. Iris Versicolor Euonymous At. Celastrus Scan. Xanthoxylum F. Syr. Simplex < aa. dr. ii gtta. xx q. s. oz. iv dr. iv dr. ss dr. iii dr. ii gtt i. XX [. s. oz. iv F. E. Dicentra Can. 4i Alnus Ser. ; ' Meni-spermum Can. •' Arctium Lappa Sem. aa. dr. ii Syr. Zingiberis q. s. oz. iv F. E. Dicentra Can. dr. iv " Iris Vers. •' Jeffersonia Diph. aa. dr. ii ; ' Xanthoxylum Frax. gtta. xx Syr. Simplex q. s. oz. iv These 'are all good stimulating alterant preparations suitable for the treatment of secondary syphilis, scrofula and chronic eczema. 220 DIETETICS. F. E. Dicentra Can. dr. iii " Taraxacum Dens. L. dr. iii " Xanthoxylum Frax. gtta. xx Inspissated Juice Phytolacca Bac q. s. oz. iv This is a good preparation for syphilitic rheumatism. F. E. Dicentra Can. " Rumex Cris. aa. dr. ii " Arctium Sem. dr. iv " Zingiber q. s. oz. iv This is a good preparation for scaly eruptions, secondary syphilis and scrofula. DIERVILLA TRTFIDA. Gravel-weed- The bark is mildly stimulating to the mucous mem- brane, the skin and the kidneys. It is useful in the treat- ment of gonorrhoea, gleet, scrofula and skin troubles. It is best administered in an infusion of zingiber. The leaves are a mild stimulating diuretic. DIETETICS. Digestion, assimilation and disassimilation are purely vital acts. In no sense are they chemical. Chemistry is essentially integrative, but digestion is disintegrative through heat force. There is perhaps no subject of more importance for us to consider than that of food. It is that upon which we live and when properly selected, properly digested, properly assimilated and properly disassimilated adds length to our days and obtains for us much bodily and social pleasure. There is scarcely a subject of more importance to the physician or to the nurse. What shall be our food ? How shall it be prepared and given to meet the requirements of the patient ? It is often of principal importance that the physician give proper instructions to the nurse upon these questions. Sometimes it is of as much importance as med- ical discrimination. An error in lood may prove as disas- trous as an error in the administering of medicine, and may prove fatal to the patient of the otherwise most skill- ful physician. Especially is this true in typhoid fever. Of all things, proper feeding is of principal importance with the infant, and more especially in the summer season when there is so great tendency to cholera infantum. The great mass of cases of cholera infantum and summer dys- DIETETICS. 221 pepsia come from administering improper food and from improper feeding. Nature has provided us with many foods; the industri- ous housewife and nurse have provided us with many more: and wherein these sources lack, the inventive genius of the pharmacist has come to our aid with a variety of pre- pared foods. Many a person has been rendered dyspeptic more or less through life by the way that person was fed during infancy and childhood, or if we may be permitted to go one step further back and say, by the way that person's mother lived and ate when he was en utero. To-day as a rule we are a race with rotten teeth, partly because our mothers lived on food that did not provide material out of which nature could manufacture tooth material, and partly because of our improper feeding dur- ing infancy and childhood, and partly because of the amount of destructive calomel and other poisons taken into the system that have been destructive to bioplasm and impoverishing to the blood current. Sugars, candies, pies and cakes are not the proper mate- rials out of which to manufacture children, whether it be pre-natal or subsequently. Proper feeding may do much for those children whose misfortune it has been to have one or both parents con- sumptive. Let the consumptive pregnant be properly fed and it may perhaps be a means of saving the child. Let every pregnant be instructed as to how she may escape the greater or less unpleasantness of the pregnant state, and that she is now manufacturing a human being, and that that being's future earthly happiness depends upon two things: the manner in which she lives, acts and feeds herself during this allotted time: and the manner in which she takes care of the child after birth, as to its feed- ing, clothing and association. During this allotted period her mental, physical and moral powers should be used for the development of that new being. Many a noble, patri- otic and positive man came from humble parentage, be- cause these elements were pre-natally established by a true mother. The question has been asked, how shall we pre- vent our jails and penitentiaries being filled with crimi- nals. One answer is evident. "Stop breeding them." This is theoretical but not practical. Health is thoroughly and practically the antithesis of 222 DIETETICS. disease of every form and of every degree. The blood cur- rent is the citadel of life and of the great power of vital resistance and for bodily cleansing through its capillaries. Nutrition is life itself and is the result of alimentation, digestion, absorption, secretion and circulation. In pro- portion as any of these functions fail, nutrition becomes impaired. In the blood current we find the elements of nutrition necessary for the support of life, both the nitro- genous and the carbonaceous elements; the nitrogenous necessary for the supply of muscular force and the carbon- aceous for the supply of animal heat. Proper food must be supplied in proper proportions of these elements. If there be an inherited tendency to mal-nutrition, the blood is more likely to become contaminated and a weak- ened digestion established. The continuance of acute and chronic ailments furnishes a similar result. A deficient, excessive or improper supply of food will produce indiges- tion. So will the habitual use of alcoholics, opiates or tobacco. Food is either inorganic or organic. The inorganic con- sists of water and various saline elements. The organic- are either nitrogenous or non-nitrogenous; and the non- nitrogenous are either hydro-carbons or carbo-hydrates. The nitrogenous contribute to growth and nutrition and furnish the active agents of -the secretions. The hydro- carbons or fats are for the production of heat force. These are the basis of adipose tissue and are essential more or less to tissue development. Carbo-hydrates as starch and sugar assist in the formation of fats and are force produc- ing. Thus there is constantly developing new cellular growth, and new formed material is added to the body. Of some persons the nitrogenous element of food may be deficient, and even if the carbonaceous be abundant, debil- ity ensues. He may seem well and have sufficient fat about his person, but he will lack resistive ability. He is not muscular and has not the power of endurance. His development is chiefly adipose. But suppose the carbonaceous element is wanting while the nitrogenous is sufficiently prominent. The heat giv- ing element is deficient and he is chilly and soon becomes emaciated In some way to such a person fats must be supplied, whether per oram, per rectum or as a rubifacient. It must not be forgotten that a proper amount of exer- cise is absolutely essential in order to a proper assimilation DIETETICS. 223 of nitrogenous food. Else it will not contribute to muscu- lar vigor so fully. The indolent person consumes more food, as a rule, than the man who toils hard from mornine till night. The excess of the nitrogenous is eliminated by way of the bowels and kidneys and the excess of the carbonaceous forms adipose tissue, an excess of which is likely to pro- duce more or less debility which may lead to some disease or at least degeneracy of tissue. Deficient or improper nutrition may render the system more liable to contagious maladies. It leads to degener- acy of tissue. Again let the general system be blockaded, the stomach foul, the liver torpid and bowels constipated, and such a one is a tit subject to contract almost any contagious dis- ease. Such a one has prepared a nest that germs love to revel in Micro-organisms of one variety or of another are more or less everywhere, in some things we eat, in some water we drink and in some air we breathe. When these find a proper soil in which to propagate within the system they multiply with wonderful rapidity. For the time being such conditions of indigestion more or less control the system and the degree of resistive vitality is lowered. Defective, improper or perverted nutrition here plays the disastrous part. Whether the defective nutrition be inherited or arising from some acute or chronic disease, such failure of assimi- lation results in an impoverished condition of the blood current which thus becomes more or less loaded with im- purities. Carefully diagnose wherein the blood current is deficient or abnormal; ascertain the needed elements and adminis- ter the proper food and medicine to meet the requirements of the case. But do not forget that man is vital and the supply should be such as the vital force can cheerfully recognize. Supply those materials in that form in which they will most readily be assimilate! Some propose to give the fresh blood itself, others prefer it in some manu- factured form. I belie » r e I have seen some cases where such have furnished good results. All the digestive fluids are alkaline except the gastric juice. The final mixture results in a neutral compound, else the blood plasma being slightly alkaline, an acid com- ing into contact therewith would derange the blood and 224 DIETETICS. render it incapable to properly nourishing the body. Moleschott gives the following as an estimate for aver- age daily alimentation: Albuminous matter oz. 4.587 Fatty matter ' k 2.964 Carbo-hydrates " 14.250 Salts " 1.058 oz. 22.859 Add to this the water in this food " 22.859 oz. 45.718 Then add to this the extra water drank. . '■ 45.718 oz. 91.436 This will be about the average amount of solid and liq- uid consumed daily by an adult in health. Of course this amount will differ in different persons, of different ages, under different circumstances and in different climates. Some nations are largely vegetarians. It has been said that the Brahmans lived entirely upon roots and vegeta- bles and that their longevity was very great. Some nations use chiefly the cereals, while others use largely of meats. Within the tropics man's living is mainly vegeta- ble, but in the arctic regions it is chiefly oleaginous; while in the temperate zones these two extremes are more or less combined. The laboring man requires more food and different food from that required by persons of sedentary habits. Many athletes while in training confine themselves to some form of prepared beet But under normal conditions some sub- stantial foods varied are best for the ordinary person in ordinary employment. In the reduction of fatty tissue the diet must be cut down to some prepared food, and that must be given only in such quantities as to relieve the system of hunger and to maintain the general vigor. The corpulent should avoid fat meats, butter, cream, sugar, sweetmeats, pastry and starches. The better foods for such persons are lean meats, eggs, green vegetables, fruits and these in very lim- ited quantities. In the treatment of acute diseases frequently it is almost impossible to do otherwise than to seek some carefully pre- pared food. A good cook is a queen in the sick-room, in DIETETICS. 225 fact almost anywhere. But in the sick-room you do not always find a good cook. Sometimes your cook is worse than no cook at all. Then prepared foods are a necessity, indeed then they are a boon to the sick, and a relief to the physician. Physical exercise by the healthy must be proportioned to the quantity eaten, and vice versa. The sick who are not exercising at all must eat but little — iust enough to maintain the general system, and to prevent debility. Else the case may be prolonged and debility increased by the system being unable to dispose of the quantity of food supplied. It is then more a burden to vitality than a ben- efit, In chronic cases many times it has been found necessary to put the patient upon some prepared food before you can see any important change in his condition toward improve- ment. In anasmia, chlorosis and consumption, prepared foods are very essential. An irritable or very debilitated condition of the stomach not unfrequently renders rectal alimentation a necessity. In this way fatty, albuminous and mucilaginous matters may be introduced into the system and some of it taken up into the circulation. Milk, beef, starch, etc.. may be thus used. The following makes a very nutritious injection for rec- tal alimentation: Beef finely cut and blood warm oz. xxxii Water oz. xvi Hydochloric Acid gtta. xx v Pepsin dr. ss Keep this mixture at a temperature of 100 degrees F. Shake it occasionally and when disintegrated strain and add half a teaspoonful bicarbonate soda to neutralize the acid. Or the following may be used. Beat one egg well and add four tablespoonsful of beef essence. Always, if they will, let the bowels move first before giving rectal nourishment. Milk porridge by the using of graham flour may also be used in this way. Eggs and miik contain the elements of normal food per- haps more fully than any other edibles, whether animal or vegetable. The constituents of milk are usually stated about as follows: 226 DIETETICS. Water 88 per cent. Oleaginous matter 3 " " Cream and butter. Nitrogenous matter 4 " " Cheese and albumen. Hydro-carbons 4i " " Sugar. Salinp mattprs * " " \ Phosphate of lime, valine matters 1 j chloride of sodiuril! &c . Man survives longest and develops best physically and intellectually upon a mixed diet. Of the foods taken from the animal and vegetable king, doms, that taken from the animal kingdom is as a rule the more easily appropriated by man's vital organism and more fully satisfies hunger at the time of participation and for a longer period of duration than do those foods taken from the vegetable kingdom. If we compare the nitrogenous elements in bread with that in milk, eight ounces of bread would be equal to a pint of milk, but the carbonaceous element in the bread exceeds that in the milk. Wheat is an excellent article of diet, but fine flour is constipating. Potatoes have about eighteen per cent, of starch and two per cent, of albumen. The sweet potato has about ten per cent, of sugar and about tlie same pro- portion of starch. Fruits contain more or less sugar. In milk, eggs, and meat the albumenoids predominate. But- ter contains mostly fats. The starches should not be omitted from our food. They have done much toward the eradication of scurvy at sea. Good cooking is an important factor, but to eat slowly to solicit the aid of all the saliva possible, and to rest for a short time after each meal are quite important. The American people are always in a hurry. This renders them nervous and any abuse tells more quickly on them than on those of easier habits. The Romans usually ate but twice a day. The English and the Germans eat from three to five times a day. The following animal foods are considered to be easy to digest: Raw eggs beaten to a froth, eggs soft boiled, beef tea free from fat, fresh milk, boiled mutton, boiled veni- son, boiled white part of the chicken, boiled rabbit, boiled fresh fish if not fat, etc. The following vegetable products are considered easy of digestion: Stale bread, graham bread, rice well boiled r tapioca, sago, corn starch, oatmeal porridge long boiled, dry toast, graham mush, cracked wheat, cauliflower. DIETETICS. 227 asparagus, some preparations of beans, baked apples, strawberries, whortleberries, grapes without seeds or skins, oranges, etc. The child should not be nursed longer than from eight to ten months, and during this time the nursing mother should be well and properly fed. Her daily diet should be- about as follows: Meats oz. J 44 Fats, butter and sugar oz. 13 Farinaceous foods and vegetables oz. 20 Salt, etc. oz. i Aqueous fluids G pints. If it agrees with the mother, cow's milk may be used, or a prepared milk if preferred. The milk as it flows from the mother's breast into the infant's mouth may be said to be still alive and it quickly becomes living blood in the infant's circulation. For the first six months the infant usually requires nothing else. By this period of nursing the uterus is better relieved, be- comes more contracted, ovulation is usually though not always longer deferred, and the whole pelvic viscera is better prepared for the future. But if the mother be suffering from any specific or other blood or lung trouble, or from general debility, the child should not nurse the mother at all. If she be otherwise healthy but does not herself furnish enough nurse for the child, a suitable substitute should be chosen for that part she is unable to furnish. One thing must never be forgotteu. The child must not be nursed while the mother is overheated. Many a case of cholera infantum has been induced by inattention to this, and such cases are usually very intractable. Cow's milk is richer in all its essential constituents than woman's milk, and goat's milk is richer still than cow's milk. Each of these if used as a substitute for mother's milk must be toned down with water more or less accord- ing to the age of the child. Allow the milk after being poured into a vessel to stand for an hour or more, then take of the upper half for the infant's food. If the infant be quite young add as much water as milk. As the child grows older the quantity of water may be slightly de- creased. Then too the child should be fed with as much regularity as possible. At the conclusion of parturition the child should not 228 DIETETICS- ordinarily be separated from the mother until the pulse in the umbilical cord has ceased to beat. Many a child has been robbed of some vitality that it might have had, had it not been cut off too soon from the source of its foetal nutrition. It has been said that those children born in Winter and Spring have the greatest vitality. During the first days of the infant's life it seems to lose weight some little, at least it does not perceptibly gain in weight. In proportion to weight the infant takes four times as much food as the adult. Ordinarily if it be overfed of proper food it will vomit the superabundance. The dan- ger is when it is fed an excess of improper food. At first the babe should nurse, if awake, every two hours during the day and once or twice during the night. At each nursing during the first day the babe will take about from one to two drams. This quantity will be increased on the second day to five or six drams, and on the third day to an ounce at each nursing. By the fourth day this quantity will be increased to two ounces and thenceforward for perhaps three or four weeks it will range from two to three ounces, and this quantity will be taken from six to ten times in twenty-four hours. During the second month the child will take about four ounces and by the fourth month it will be increased to five or six ounces, but the frequency of nursing will now be reduced to from four to six times in twenty-four hours. Children require less variety of food and more in quan- tity than do older persons. Meat then once a day is enough. Milk, bread and butter are the requisite diet, with vegetables and fruits. Neglect not one thing. Instruct them positively to cultivate the habit of obtaining one good free passage from the bowels regularly every morning. From two to five years of age about twelve hours sleep are required. At seven or eight years of age the child's appetite is capricious and does not appreciate so much a plain diet, but care more for fruits and confections, much of which is more or less injurious. Rachitis is the result of improper feeding and of the use of improper food. Food or drinks much above 98 degrees F. retard diges- tion. Meats usually should be warm because digested DIETE1TCS. 229 largely by the gastric juice. Farinaceous foods should be well boiled and then cooled. Foods at a high temperature are injurious to the teeth. Use sufficient water but not too much. Do not over-cook food, a too concentrated food is liable to produce indigestion. The nitrogenous element is essential for the day laborer, but for mental work an easy soluble mixed died is essen- tial. Never overload the stomach. Than to do this you will find it preferable to arise from the table slightly hun- gry. Rest half an hour before meals, eat slow and enjoy pleasant conversation, then rest for a half hour subse- quently. Never partake of a meal when you are over- excited, angry or overheated; indigestion will be the result. In sickness avoid such articles as will in any way in- crease the severity of the conditions present. If possible cause your foods to be curative as well as your medicines. In old age there is less growth and hence a less demand for food. In hysteria, hypochondriasis and insanity correct feed- ing is very important. And daily exercise and temperate habits are no less so. In febrile and acute inflammatory troubles, especially where there is a failure of digestive power, care must be taken not to administer too much food, and that proper food be administered regularly and in proper quantity. Beef-tea, mutton, veal or chicken broth, barley water, rice mucilage, fruit jellies, lemons and oranges are good, and in convalescence a raw egg in milk or wine, stale, bread, fish and game. In typhoid fever the stomach and bowels must scarcely be looked upon as digestive organs, but better as recepta- cles for food that has been more or less pre-digested. Thus absorption will quickly take place. In typhoid fever the stomach and the upper half of the smaller bowels are least affected, and from these portions most of the absorption of food takes place. In catarrhal conditions more or less of this power of absorption is lost. Fatty substances are rejected because principally absorbed by the lacteals. Boiled water improves digestion and prevents emacia- tion if systematically given. Raw white of egg and pepsin dissolved in cold water is very acceptable, being wholly digested and absorbed from the stomach. Raw milk is not the thing to be used in typhoid fever: 230 DIETETICS. boiled milk is better, but even then it can only act as a salt and water, as neither the fat nor the casein can be fully absorbed. Hence if milk is given it is best in some pre-digested form. Junket or milk digested with rennet will give good results. In acute rheumatism and acute gout avoid nitrogenous foods. Albuminous foods contain nitrogen and are not to be used in rheumatism. The use of an excess of meats gives an excess of uric acid in the blood. A vegetable diet and alkaline waters are then to be preferred. In the treatment of gravel restrict to about the same diet as in rheumatism. In Bright's disease, atrophied liver and all the other degenerative diseases alcohol is very injurious, tending to greater arterial tension. Pre-digested milk and stale bread are best. Use mostly a vegetable diet and in cases of threatened urasmia add some little fats and carbo- hydrates may be added. Throw as little burden on the kidneys as possible. A weak and slow digestion demands great care of food and feeding. In cases where there is a deficiency of nerve power debar food for about from seven to nine hours be- tween meals. In other words, such should eat only when they must eat and not because it is meal time. Two meals are better in such cases than three meals. Mutton, chick- en, venison, lamb and beef are digestible in the order here given. Oatmeal gruel, chicken broth, meat jelly, meat soups supply the nitrogenous. In dyspepsia reduce the amount of food and the kinds of food to that which will be best suited to the particular case. Give the stomach but little to do, and yet sustain the general system. Avoid that which seems to hurt and use in great moderation that which agrees. In some cases it is best to give only one kind of food at a meal. Say partake of one meal in the day of vegetables, one of meats and one of bread. The starches are dissolved by the alka- line saliva, and meats are dissolved by the acid of the gas- tric juice. In diabetes melitis there is a want of assimilative power over the saccharine and starch elements, therefore avoid adding these as food. Animal food increases the acidity of the urine, and vegetable food decreases it. Hence care- fully examine the urine and feed the patient accordingly. In dysentery and diarrhoea use boiled milk, thickened DIETETICS. 231 milk, fish, fresh game, boiled eggs, boiled meat, boiled rice, boiled barley, toast, crackers. Avoid salted or dried meats and vegetables. Use but little fluid. Add a few drops of gentian in a glass of water and give a teaspoonful every three hours. Scurvy has usually been the result of an improper diet, dry food, and improper water. Vegetables, fruits gener- al lv and lime-juice are best here. In habitual constipation prescribe graham cracker, or bread without fluid, oatmeal, corn meal, barley meal, or fruits. Such coarse foods irritate the mucous membrane sufficiently to start secretion and muscular contraction. The treatment of consumption is largely dietetic. Con- sumptive mothers should not be allowed to nurse children. The greatest care must be taken to use nothing that will spoil the appetite. Watch the assimilative process and make everything tend to improve the appetite. I now take pleasure in introducing some digestive prepa- ration* from some of our most reliable Manufacturing Chemists. These preparations are especially valuable in wasting diseases and where there are digestive failures. PROTONUCLEIN. Manufactured by Reed and Cam rick. New York. Protonuciein is derived from all the available lymphoid structures of healthy bullocks and pigs. The brain sub- stance, salivary, thyroid, thymus, gastric and intestinal glands, pancreas and spleen are used. Thecellulary active constituents are separated by a mechanical process, which does not alter the form in which they exist in the living glands. Metchinkoff. who discovered the nature and func- tion of the leucocyte, stated that in his opinion ''the secret of health will have been discovered when science learns how to increase the number of white corpuscles at will." Protonuciein produces leucocytosis as soon as taken into the organism, and in this way becomes ' nature's tissue b rilder and antitoxic principle. Protonuciein is indicated in all forms of wasting diseases and asthenic conditions. It rapidly restores the vitality of all the tissues by stimulating and supporting assimi- lative nutrition. It is also indicated in all diseases due to toxic germs, and in the treatment of neoplasms, ulcers and all surface lesions, malignant or otherwise: also as prophy- :P 232 DIETETICS. lactic in exposure to contagion or infection. Protonuclein is prepared in three forms, Tablets and Powder, prepared especially for internal use, and Proto- nuclein Special for local applications and for hypodermic use. Nutrition is the important factor both in growth and in the prevention of disease. There is no doubt that the leucocytes of the blood have much to do with nutrition, and by properly sustaining their number and vitality, physiological conditions are restored. Protonuclein may be administered in doses of one to three tablets, or three to nine grains of the powder, every three or four hours. It is valuable in bronchitis, tonsil itis, laryngitis, pneumonia, diphtheria, typhoid fever, ovarian troubles, abscesses, anaemia, Bright's disease, cancer, neu- rasthenia, phthisis, etc. PEPTENZYME. This is a perfect digestant, a prompt and efficient physi- ological remedy for dyspepsia, vomiting, cholera infantum, malnutrition in its various forms. It contains all the ferments furnished by nature for the digestion af all kinds of food. The best results are obtained by administering it about twenty minutes before and immediately after meals. CAKNRICK'S SOLUBLE FOOD. We have used this food for years, and know it to be excellent for children, a preventive of cholera infantum or a cure for it. It will not fail you. Ansemiol is made by H. K. Wampole & Co., U is a distinctive preparation of beef containing haemoglobin and albumin, highly nutritious, restorative and tonic. It contains all the nutritious albuminous constituents of meat tissue unaltered. The bright red arterial color of the preparation is due to haemoglobin, the natural proteid of iron contained in blood and meat, which has been proven by clinical tests to be more readily and completely absorbed than any other form of iron known. This is one of the best, it not the best preparation on the market. It is easily di- gested and absorbed without forming hard faeces, and hence is especially valuable in typhoid fever, chronic diarrhoea, gastric catarrh, sickness of pregnancy, phthisis, anaemia and chlorosis. DIETETICS. 233 H. K. Wampole&Co.'s Liquid Wheat is an excellent prep- aration. Each teaspoonful represents one ounce of the whole wheat grain in perfect solution and i grain of pen- sin containing ov-r seven per cent, of the nutrient vital- ized hypophosphites and oleo-nitrogenous hypoptu sptiftes obtained solely from wheat, principally from the germ and cortical portion. It is rich in gluten and albumen and con- tains over four per cent, oil of wheat, and the wheat starch is converted into maltose, a direct force and fat producer. It is an ideal nutrient for anaemic cases, a fat and flesh producing food. It contains all the elements of nutiition easily assimilat- ed without digestive effort. It is a brain and nerve food, valuable in nervous prost ration and debility, fatigue of body and mind, lassitude, insomniaand for anaemic pregnants. It enriches the milk of the nursing mother and assists the babe in cholera infantum. Why is it that we have but few children over eight years old who have perfect teeth? There has been something wronji in the material out of which they were made and grew. Liquid wheat is a palatable and nourishing food, it gives to the system those valuable organic and vitalized phos- phatic elements so deficient in the food which children and the sick will ordinarily eat. McCoy, Howe Co.. Indianapolis, manufacture liquid acid phosphates, a brain and nerve food for mental exhaustion, insomnia and melancholia. Pepsin is the active digesting principle of gastric juice, mostly obtained from the stomach of the hog. This is much stronger than that obtained from the stomach of the calf, but calf pepsin is best for children. It is best triturated on sugar, and in conjunction with tonic medi- cines. It is best dissolved in a little lemon juice, vinegar or glycerine. Dr. G. H. Mayhugh uses the following: Pepsin C. P. grs. ii Pancreatine C. P. gr. i Diastasi gr. i Lactic Acid gr. 1-16 Hydrastin gr. 1-16 M. Trit. Make into one tablet. Sig. One to three tablets after meals. 2S4 DIETETICS. Sacch. Pepsin , gr. i Charcoal grs. ii Soda Bicarb. grs. ii This forms an absorbent for dyspeptics troubled with fermentation. Sacch. Pepsin 3 Sub. Nit. Bismuth 2 may be used in summer complaint of children. Lactopeptine is pepsin and lactic acid with sugar of milk. Ingluvin from the ventriculus callosus gallinaceous is a superior digestant, and is much used for the vomiting of pregnancy and with good success. Pancreatine is a similar preparation to pepsin only pre- pared from the pancreas instead of the stomach. It is fre- quently combined with pepsin and gives excellent result*. Many of the malt preparations also serve an excellent purpose. I conclude this article by appending some excellent dishes for the sick and the convalescent. Beef Tea. Take one pound or more of lean beef, cut into small pieces, add salt and put into a self-sealing glass jar. Cover tight and put the jar upon a thin piece of wood in a kettle of cold water filled as high as the beef in the jar. Boil from two to four hours, adding water to keep it as high as at first. This prepares an excellent essence. Mutton Broth. Take one pound of lean mutton, cut small; one quart of cold water; one tablespoonful of rice or barley soaked in a little warm water; four tablespoonsful of milk, salt and pepper to suit. A little parsley finely cut may be added. Boil the meat covered and unsalted in the water until it falls to pieces. Strain it out", and add the barley or rice. Simmer a half hour and stir in the seasoning and milk. Then simmer five minutes. Some crackers may be added if desirable. Chicken Broth. Make the same as the above. Chicken Jelly. Take half a raw chicken, pound with a mallet and add DIETETICS. 235 water to cover. Heat in a covered vessel for about two hours, until the liquid is reduced one-half. Press through a colander, salt to taste and then simmer five minutes. Keep on ice and use on stale bread. Chicken Panada. Boil a chicken, take the breast and pound it fine. Sea- son with salt, nutmeg and lemon-peel, and boil gently until a little thickened but so that it can be drank.. Calf's Foot Jelly. Take one pair of calf's feet and put into a gallon of wa- ter. Boil down half, skim, strain and cool. Take the fat off the top. Then warm and add sugar, the juice of three lemons, one pint of wine, the whites of seven eggs. Boil half an hour, strain and cool. Milk Gruel. Take one pint scalding milk, two tablespoonsful of tine oatmeal, one pint of boiling water. Cook until done. Milk Porridge. Soak two teacupfuls of oatmeal in water over night. In the morning strain and boil the water half an hour, add two cupsful of milk and a little salt and boil well. Eat warm. Sweeten a little if desired Thickened Milk. Mix well a little milk, a little flour and a little salt. Add a quart of boiling milk. Stir well and bring to a boil. Serve alone or with dry toast. If it is to be used during a case of diarrhoea, scorch the flour before mixing with the milk. Rice Milk. Boil the rice in a water bath till it swells and softens. Add some milk, sugar and nutmeg and if desirable add a little well dissolved flour or beaten egg. Egg and Milk. Take the white of 'an egg and milk. Beat the white of the egg to a froth and stir quickly into a glass of milk. 236 DIETETICS. Egg Cream. Beat a raw egg to a stiff froth, and add a tablespoon ful of white sugar and two tablespoonsful of blackberry wine and half a glass of cream. Beat all well together. Wine Whey. Sweeten one pint of milk to taste and when boiling throw in two glasses of sherry wine. When the curd forms strain the whey through a muslin cloth into glasses. Lemon Whey. Take the juice of two lemons or twice as much vinegar to a quart of milk heated till the curd is well formed. Then strain. This whey is a pleasant and nourishing food. A little powdered cinnamon and sugar makes an excellent drink to be given during the treatment of dysentery and diarrhoea. Egg Wine. Break a fresh egg into a glass, beat until very light, sweeten and add a tablespoonful of wine and beat again. Egg-JVog. To the yolk of an egg add a tablespoonful of sugar, the i of a pint of new milk, and two tablespoonsful of sherry wine. Beat the white of the egg separately and stir into the mixture. Egg and Water. Stir the white of an egg into water as warm as it can be without coagulating. This is excellent for infants or adults where there is a disordered digestion. Egg Gruel. Beat the yolk of one egg with one tablespoonful of sugar. Pour on one teacup of boiling water. Beat the white of the egg to a froth and add. Take while warm. Soft Boiled Eggs. Put the eggs into a pan of boiling water and put on the stove where they will not boil and keep them there for several minutes. Such eggs will be much like jelly, soft and very digestible. DIETETIC S. 237 Oatmeal Gruel. Soak a handful of oatmeal over night in water. In the morning pour off the water and add a pint of fresh water. Stir well, add salt and boil an hour and a half. Or cook two tablespoonsful of oatmeal in a quart of water at least two hours by simmering (^om-Meal Gruel. Thoroughly mix one tablespoonful of fine corn-meal in water. Add a little salt and a pint of boiling water and boil half an hour. Add a little more water as it boils down. Frequently stir and add a tablespoonful of cream. Arrow-Root Broth. Put a little lemon-juice, sugar, nutmeg and salt in half a pint of water. Dissolve a tablespoonful of arrow- root in a little water and add. Then boil five minutes and take warm. Arrow-Root Jelly. In one pint of water boil a little cinnamon or lemon-peel, and add two tablespoonsful of arrow-root dissolved in a little water. Boil ten minutes, strain, salt and add sugar, wine and nutmeg. Barley Water. Cook the barley five or ten minutes, strain and add two quarts of boiling water. Boil to one quart and flavor with lemon-juice. More water may be added if desired. Or, Soak 1 pt. of barley in lukewarm water a few minutes and drain off. Add three quarts of cold water and cook slowly till soft. Skim occasionally and when cold flavor with jelly or lemonade. Cracker Panada. Split half a dozen crackers and pile in a bowl in layers with a little salt and sugar. Cover with boiling water and set on the back part of the stove for an hour. Then add sugar to suit the taste. Bread Panada. Into a little water add some wine, sugar, nutmeg and lemon-peel. The moment it comes to a boil stir in a few 238 DIETETICS. crumbs of stale bread. Boil about five minutes. Soft Toast. Toast well some thin slices of bread. Put them upon a warm plate and pour a little boiling water over it, cover quickly with another plate of the same size and drain off the water. Then remove the upper plate and butter the toast. Put now into the oven for one minute and then take out and cover again with the plate and serve at once. Toast Water. Toast stale bread brown, but do not allow it to burn. Break into a bowl and pour on boiling water. Then al- low to cool . Lemonade. Slice two or three lemons into one quart of cold water. Add four tablespoonsf ul of granulated sugar. This should be used occasionally at dinner during the summer season, also in some cases of rheumatism, in malarial and typhoid fevers and in convalescence therefrom. A hot lemonade may prove diaphoretic in cases of colds. Cracked Wheat. Put a teacupful of cracked wheat and a little salt into a quart of hot water. Boil slowly for one hour. Then add sugar and cream. Onion Soup. Slice sufficient onions, fry brown in a little butter and fine flour. Pour into a saucepan and add q. s. milk, three parts milk and water one part. Season to suit the taste and add one grated potato. Then cook some ten minutes aild add some sweet cream. Roasted or Baked Potato. Wash well and bake with skins on till well done. Rice and Apple. Cook apples to a pulp and sweeten. Boil the rice in milk till tender and mix the two. Appleade. Cut two large apples in slices and pour on one pint DIETETICS. 239 of boiling water; strain, sweeten and cool before drinking. Apple Water. Roast two large, tart apples until soft. Put into a pitcher, and add a pint of cold water, and stand in a cool lace for an hour. Roasted Apples. Take large, tart apples, wipe clean, extract the core and put into a pan. Then partly fill with sugar the opening out of which the core was taken and bake for one hour. Dried Fruit Water. Several of the dried fruits, as apples, peaches, apricots, etc., may be washed, and then stand in water over night. Then stew. The water will be found quite pleasant and nutritious. Jelly Waters- A little jelly may be added to some water. It is a good appetizing drink. Such jellies as currant, cherry, plum, elderberry, grape or apple may be profitably used in this way. DIOSCOREA VILLOSA. Wild Yam. The root is a gently stimulating and relaxing, antispas- modic nervine. It is quite positive in character and its action is peculiar to itself. In bilious colic it is a superior agent, also in cholera morbus, flatulence, and in almost any painful condition. In neuralgia of almost any part of the body it affords won- derful relief. In facial neuralgia it affords quick relief and that relief is quite permanent. In nervous rheuma- tism it soothes, relaxes and tones. Dioscorine Salicylate Sodium aa. equal parts , Or Dioscorine Sorbili n aa. equal parts. Either of these preparations gives admirable results in rheumatic pains. For uterine pains but few things equal it and for after- 240 DIOSCOREA. pains it is surpassed by no other agent. For uterine neu- ralgia use the following: F. E. Dioscorea Vil. " Valeriana Off. aa. dr. vi " Cimicifuga Rac. t; Xanthoxylum Frax. aa. dr. ii Ess. Anise q. s. Syr. Simplex q. s. oz. viii For nervousness, restlessness and pains incident to preg- nancy there is nothing equal to dioscorea. It may be given throughout the whole period of pregnancy with the very best of results. It gives ease and comfort and quiets nau- sea. Especially to nervous females it is quite relieving in the preliminary stage of parturiency. It quiets the nerves and enables the patient to do more vigorous labor. It is also a superior preventive of miscarriage. Dioscorea Vil. 4 Zingiber Off. 1 The diffusiveness of the zingiber added to the antispas- modic influence of the dioscorea, especially if given in hot infusion, gives admirable results in dysmenorrhoea, relieves the uterine hyperaemia and produces a good outward flow of blood, both to the surface and also locally as a menstru- al flow. Dioscorine is a good preparation of this agent. For quicker results this may be used in hot infusion of zingi- ber or even alone in hot water. The fluid extract is a good preparation but it is very lia- ble to gelatinize. F. E. Dioscorea dr. i to ii " Zingiber gtta. v to x Comp. Syr. Rhei et Potas. q. s. oz. iv Sig. Half teaspoon t'ul as needed for the colic of children. It is a good remedy. F. E. Dioscorea Vil. - 3 " Viburnum Op. 1 " Mitchella Rep. 4 This is a splendid female tonic for crampings, pains and nervousness. F. E. Dioscorea Vil. •' Mitchella Rep. " Aletris Far. aa. 2 " Viburnum Prunif. I This is an excellent preparation for the preventing of DISINFECTANTS. 241 miscarriage and the relief of the pain premonitory thereto. DIOSPYROS VIRGINIAN A. Persimmon. The bark is a bitter, stimulating and astringent, nervine tonic. Small portions are a good appetizer and a sustaining nervine. It is a pleasant tonic for convalescence, espe- cially when thsre is a tendency to too much freeness of the bowels. In chronic diarrhoea its nervine tonic influ- ence is very favorable. It possesses not only the necessary ^stringency, but has the influence of a permanent tonic. In phthisis where there is a general laxity of the system, more or less diarrhoea, too free expectoration, night sweats and poor appetite this is just the agent. Of course the continued use of this agent must depend, like that of* other agents — upon the necessity therefor. DISINFECTION AND DISINFECTANTS. The Latin conttigiuin indicates that material in which resides the infective power of certain diseases. This pow- er of contagiousness pertains to quite a number of diseases and is not alone confined to man. Domestic animals and even the vegetable kingdom are each more or less subjects of special contagious diseases. These latter phases of con- tagion we shall not here discuss, nevertheless they are interesting to us in many ways. The word contagion {contlngo) implies the existence in some way of material contact. Whenever this material, whatever it may be, finds admission to the system and finds therein suitable substance adapted to its growth, it grows, and multiplies as rapidly as the conditions will .per- mit. Why not then assume that contagui are material in some way endowed with life ? Whether this be true of all or not, it certainly is true of some at least. Some parasitic diseases spread by direct contagion or ordinary contact; as by the acari in scabies, and by the spores of the microphyte in tinea capitis. Trichiniasis is produced by the eating of raw or imper- fectly cooked pork affected with trichinae. Thus the para- site eggs or larvae still living are introduced into the sys- tem. Those persons given to the eating of raw beef occasion- ally suffer from attacks of taenia. 242 DISINFECTANTS. In all cases of contagion the severity of the disease con. tracted is largely due to the clogged condition of the person's system and to the ability of his vitality to resist such incursion. Each contagium propagates itself in its own form and never in any other form. As in small-pox. measles, scarla- tina, whooping-cough, typhoid fever, typhus fever, yellow fever, cholera, mumps, syphilis, gonorrhoea, venereal soft- chancre, chicken-pox, diphtheria, erysipelas, hospital gan- grene, purulent and other ophthalmia, puerperal fever, phagedaenia, tuberculosis, cancer and hydrophobia. Tuberculosis and some other forms of disease are occa- sionally derived from milk taken from diseased animals. Some contagia show a particular affinity for some organs or parts, though the whole system may become affected by it; as small-pox for the face, mumps for the parotid glands, syphilis and gonorrhoea for the genitals, and typhoid fever for the bowels. Different persons and different families show different susceptibility for contagion and in fact for all diseases. Some are more susceptible than others and some have more vitality to resist disease or to endure its influence. Then too there is in some persons and in some families an inherited tendency to consumption, cancer or some other form of disease. In all these contagia we find a more or less definite course of duration. It is also true of some contagia that those who once suf- fer with it have immunity from it for the future; as scar- latina; while in other diseases having been once affected gives a liability to a second or further attacks. We also find that a contagion may be worse in some com- munities than in other communities; that it may be of a more malignant type some years than other years. In the passage of contagia various media may be instru- mental, as bedding, towels, dirty hands, unclean instru- ments, cooking or other utensils, foul or deficient water supply, cohabitation, house drains, contaminated food or the atmosphere. The disengagement of infectious products from the body of the sick and the establishing of communication with a diseased body bringing its products into relation to the healthy person is pathalogically the one influential factor. The air seems to purify space from the presence of some DISINFECTANTS. 243 cootagia. and in other cases the air seems to be the means by which contagion is spread, as in la grippe. Tuberculosis is conveyable to the foetus by cohabitation and so are alcoholism, syphilis and other forms of disease that have become thoroughly septic to the blood of a pro- genitor. Much trouble may be caused by continually inhaling in a close room the breath of a consumptive, a typhoid or a diphtheritic case. Ventilate thoroughly but cautiously. In treating cancerous, syphilitic or other sores possess- ing some degree of malignancy great care should be taken that your own hands are free from any denuded surfaces, else inoculation to some extent may take place. But the broken skin or the denuded mucous membrane are not always necessary to transmitting, as in cases of ophthalmia from one eye to another on the same or on dif- ferent persons. And also in the transmitting of gonor- rhoea and syphilis. In all such the mucous membrane being very thin, and the discharges in either case being very irritating, the mucous membrane soon becomes irri- tated and absorbs the virus. In vaccination the surface is denuded and the virus is absorbed; and if the vaccine be pure bovine vaccine virus the inoculated disease will be much lighter than the dis- ease itself. But vaccination from virus taken from other persons has many a time inoculated some disease worse than small-pox. Periods of incubation differ in different diseases. In hydrophobia it is usually one or more months. In syphilis it is from two to five weeks, and nearly three months elapse before the appearance of the roseola. In small-pox the incubative period is about ten or twelve days and the erup- tion appears some two or three days later. Measles and scarlatina have about the same length of incubative peri- od, some nine or ten days; but while the eruption does not appear in measles until the fourth day, that of scarlatina appears on the second day of the fever stage. During epidemics usually but one contagious disease prevails and nearly every other disease will be found to partake more or less of the characteristics of that conta- gion. This is especially true of la grippe. Sporadic cases if not properly cared for may lead to epi- demics, and these epidemics may be local or extend over one or more nations. 244 DISINFECTANTS. In order to establish the proper means for preventing the spread of contagious diseases we must consider the means by which they are spread, whether it be the air. the drinking water, the food, the surroundings, or whether it be transferred direct from one person to another. The following will do much toward checking the spread of contagion: 1. Isolation of the sick. 2. The use of more or less continuous disinfection dur- ing the continuance cf the diseased condition. 3. Maintain cleanliness of the person and the apart- ment Maintain a proper temperature and give good ventilation. 4. The physician should make his visits short, and the nurses should be careful not to mingle with the rest of the family. 5. Food and medicine should not be long exposed to the air of the room; they will absorb contagious effluvia. 6. Oiling of the surface of the body in scarlatina wiil be of great benefit to prevent the scales from being carried by the air. In small-pox it will prevent pitting. 7. Thoroughly disinfecting the room and the entire house and all things that had any relation to the room or the patient, when the patient shall have been ready to leave the room. 8. In venereal troubles positive abstinence must be maintained. Disinfectants are agents employed in preventing the spread of contagion. The *-fficiency of any disinfectant is due to its power to destroy or at least to render inert whatever specific poison or disease germs may be exerting an influence in each par- ticular case. Deodorizers act by oxidizing or otherwise changing the chemical constitution of volatile substances disseminated in the air. Such also prevent noxious exhalations from organic substances. Hence deodorizers may be disinfect- ants in certain diseases, but all deodorizers are not neces- sarily disinfectants. A free atmosphere, pue water, dry earth, heat and cold are very powerful disinfecting media. Artificial disinfectants are either vaporizable and cleanse the air, or are chemical agents for rendering inert all in- fectious discharges. DISINFECTANTS. 215 The use of sulphurous anhydride gas obtained by burn- ing sulphur is unequalled as a means of purifying the air and of thorough disinfection- Disinfectants may be classified as solid, liquid and guseous. To the solid belong dry earth, quicklime, charcoal, cal- cium, magnesium carbonate, a mixture of lime and coal tar, etc. To the liquid belong solutions of potassium permanga- nate, zinc chloride and lead nitrate. To the yaseous belong ozone, chlorine, iodine, bromine: nitrous, sulphurous and hydrochloric acids; carbolic acid, tar fumes, acetic acid, ammonia. Deodorizers do not always disinfect. They may absorb offensive gasses and liquids, as when water absorbs hydro- gen sulphuret or the earth absorbs foul drainage, but heat may drive the hydrogen compound again into the air. Rain may wash impurities into open wells, or wells may be so nearly dry as to become more or less putrid. The boiling of water is one of the best means of purify- ing it. Instead of throwing disinfectants into manure heaps. pile them so that they will quickly heat, and they will soon be disinfected. Heat is one of the most powerful of disinfectants. This is true whether it be dry or moist heat. An intermitting high temperature is best. It need not exceed 220 degrees F. for one hour. Clothing may be baked thus or they may be boiled in water with some soda; or any of the following may be added: Either commercial chloride of lime, 2 ounces to the gallon of water, or 1 ounce of sulphate of zinc, or half an ounce ol chloride of zinc, or a five percent, carbolic solution may be used. Sulphate of Zinc oz. iv Salt oz. ii Water 1 gal. This also may be used to disinfect clothing, it must be used boiling hot. Sulphur dioocide in aqueous solution contains sulphu- rous acid. It is one of the most powerful of disinfectants. It destroys sulphuretted hydrogen and combines with am- monia. As to its disinfective power there is no question. Its suffocative odor is the chief objection to its nse. The 246 DISINFECTANTS. solution can be made by deoxidizing hot concentrated sul- phuric acid with copper turnings or charcoal. Sulphur dioxide should not be used in conjunction with either chlorine or permanganate of potash for they mutu- ally destroy each other. The room to be thoroughly disinfected should be kept saturated with the gas for not less than an hour. For general disinfecting purposes the sulphur may be burned in small quantities every six to nine hours during the continuance of a contagious disease. It is especially valuable in diphtheria, scarlatina and small-pox. In thor- oughly disinfecting a room one pound of sulphur should be used for each 1,000 cubic feet. One pound when burned it has been estimated produces 11.7 cubic feet of sulphur di- oxide gas. Chlorine is most easily obtained from chloride of lime by adding either hydrochloric or sulphurous acid; or some crystals of potassium chlorate may be placed into a wide- mouth bottle containing dilute hydrochloric acid. This allows the gradual discharge of euchlorine or protoxide of chlorine, which is more agreeable and more effective than chlorine. Chlorine is soluble in water to the extent of 2-k volumes in one, and this solution will be found valuable for disinfecting purposes. As a deodorizer enough euchlo- rine may be expelled from moist chloride of lime by the carbonic acid of the air for most purposes. The chloride of lime or bleaching powder gives off chlo- rine easily. It forms a cheap and valuable disinfecting powder. Quicklime does well as a disinfecting whitewash and for drains. Carbolic acid solution 5 per cent, is a good disinfectant. The chief objection to it is its odor. Ozone is a powerful agent. It oxidizes organic matter and so destroys odors and organic germs. It is produced by half immersing a stick of phosphorus in tepid water, or by gradually mixing two parts of permanganate of potas- sium with three parts of strong sulphuric acid. Permanganate of potassium is non-poisonous and is a good deodorizer. It is odorless and its aqueous solution )oses its color as it becomes exhausted. It should be dis- solved in water and used in plates or other large open sur- faces. It is an absorbent of gasses as well as a deodorant. If DISINFECTANTS. 247 oxidizes and destroys contagia and putrid matters, but its best use is as a deodorant. Charcoal is a powerful absorbent of passes and is valu- able for drains, water closets, etc. Broino-chloralum is a non-poisonous compound, a dis- infectant and deodorizer of some merit. Smoke from burning wood, paper or green coffee forms good deodorizers. The last mentioned is especially valu- able during the continuance of small-pox. The hyposulphite and sulphite of soda arrest putres- cence and can be used internally if desired. Sulphate of copper or blue vitriol dissolved in water is a good, cheap disinfectant for vaults, drains, privies and bed- vessels. Pul. Copperas 1 Fresh Pul. Charcoal 2 Or Copperas I lb. Water 1 gal. Either of these is cheap and leliable. Dissolve nitrate of lead dr. i in boiling water pt. i Add to this Salt dr. ii in a bucket of water. This gives chloride of lead, which is excellent for the foetor of gangrene and small-pox. It sweetens the air im- mediately. DOREMA AMMONIACUM. Gum Annnoriiacufn. Persia. The juice is gathered from incisions in the bark and when this becomes dry it assumes the form of a gum-resin. It is a diffusive of moderately stimulating and relaxing power, influencing the mucous membrane, and in hot infu- sion it influences the skin and general circulation. The odor is rather disagreeable and the taste is rather bitter and nauseating. In large doses it is cathartic. By the combining of particular agents it may be made to be diaphoretic, expectorant, diuretic or emmenagogue. DORSTENIA CONTRAYERVA. Contrayerva . The root is a diffusive, stimulating, mucilaginous tonic. 248 ECHINACEA. In hot infusion it sustains the capillary circulation and promotes diaphoresis and thence soothes the nervous sys- tem. In scarlatina, measles, small-pox and other exanthemata it arouses the circulation and hastens the eruption. It is also valuable in typhoid and other fevers as a stimulating: diaphoretic. In local and general congestions it relieves the surface by relieving the capillary circulation, if gWen in hot infu- sion. In cold infusion it influences the alvine mucous mem- brane and the kidneys. DROSERA ROTUNDIFOL1A. Sundew, Youthwort. Eastern and Southern V . S. This plant grows in marshy places and peat bogs, and is covered with a chaff-like coat. Its flowers are white. It is considerably valued in pertussis, where from 2 to 4 drops may be given every 3 or 4 hours. It is also recom- mended in asthma, chronic bronchitis, dry hacking coughs, nervous or sympathetic coughs arising from pulmonary, cardiac or gastric disease. It is also spoken of in gastric troubles where there is flatulence, catarrhal or ulcerous conditions. ECHINACEA ANGUSTIFOLIA. Echinacea, Black Samson, Western U. S. This is a perennial herb with thick black roots and pun- gent taste. The root is a stimulating, antiseptic alterative, some- what like xanthoxylum. In puerperal septicaemia give half to one teaspoonful every four hours, or a half teaspoonful from two to four hours. F. E. Echinacea Aug. dr. ii Ess. Pepsin oz. ii Grive a teaspoonful every four hours in cases of pelvic abscess. Echinacea and lycopodium make a very good application for carbuncles and boils. Then give F. E. Echinacea Ang. Syr. Simpl. aa. equal parts. M. Sig. One dram three to six times a day. ELECTRO - THERAPEUTICS. 24U This may be alternated with Lyc( »podium gtta v Peroxide Hydrogen dr. ss 11 times daily. Apply a poultice of flaxseed, lobelia, ulmus and capsicum wet with echinacea twice a day for four days. Put a nap- kin ring around the carbuncle and pour in a dram of per- oxide hydrogen and let it foam for a few minutes twice a day. In consumption give of echinacea 10 to 15 drops three times a day, and also the peroxide of hydrogen in dose of half to one dram three times a day. Lycopus virg. may be added five or six times a day in doses of ten drops. For black tongue use F. E. Echinacea Ang. dr. i or more Aqua Dis. q. s. oz. iv Sig. One dram may be given every three hours for low septic conditions. In case of scorpion sting apply fid. ext. echinacea ang every 10 or 15 minutes and give per oram also F. E. Echinacea Ang. gtta xx Aqua oz. iv M. S. Teaspoonful every 15 or 20 minutes till the pa- tient rests. Or the fresh root may be scraped and given the person bitten. It then induces an excessive flow of saliva and perspiration. ELECTRO-THERAPEUTICS. By A. A. StoneBurner. M. D„ M. S. E., Professor of Electro-Therapeutics in Chicago Physio-Medical College and Proprietor of the Electro-Therapeutical Institute of Chicago. To wade into the general scope of Electro-Therapeutics would require more space than we are allotted in this vol- ume, and we shall endeavor to be as concise as possible, trusting our efforts will be appreciated by our many Physio-Medical friends. Electro- Physiology is that science pertaining to the ac- tion of electricity on the human body, animals and plants. Electricity as a factor in medicine is measurable with the milhamperemeter. It is portable as in case of the secondary battery, and many of its various phenomena on the human body are manifest. With the use of electricity in medical science as a reme- dial agent it has been found necessary to employ currents 250 ELECTRO - THERAPEUTICS. of different qualities; electrodes or conductors of varied styles and various applications are made. Each individual case requires specific treatment. Now in order to utilize this agent with success, we should know something of its physiological action, that we may apply it to every individual case requiring electrical treat- ment scientifically. The advancement made in Electro-Physiology has been very slow, but much credit is due Baird and Rockwell for the noble fight made by them against the old country granny, the egotistical professor of medicine, the ignora- mus, and the practitioner who used it simply for a fake. They have placed Electro-Physiology on a scientific basis where it should have been many years ago, and too much cannot be said in praise for their noble efforts in their be- half, for the noble sacrifices made by them in their efforts to advance medical electricity. While we have some practitioners using electricity in their practice with something like success, without know- ing anything about its physiological effect, yet it is not the way to apply it. We should know beyond a question of doubt where to apply the current, in what direction it should flow, and what quality should be used. The electro-therapeutist should know every action that should manifest itself in its application on the human body; at least he should know its action on the brain, spinal cord, sympathetic system, nerves of motion and of common and special sense; also of the conductivity of the body, besides electro-physics. When we become masters of these points, electro-diagnosis is made easy, and the interpretations of the various complicated ailments readily understood and treated scientifically with proper appara- tus. When we become master of electro-physiology, we are then electro-therapeutist in a strict sense of the word. When we put a drug into a human being's stomach, chemical action takes place, after which we have a physio- logical effect; this effect may be on one particular organ or part, and when this takes place, it is due to the inhe- rent affinity for such organ or part. So can electricity be localized, and with greater certainty; its action can be recorded with some hopes of accuracy, while with drugs when internally administered, its action is always clouded with uncertainty. Matteucci discovered that muscles would with the ELECTRO - THERAPEUTICS. 25] interrupted galvanic current become affected, but DuBois- Reymond more fully investigated these effects, and he has accomplished a great deal in his investigations. It was proven that all the animals, both warm and cold blooded, contain animal electricity, toads, salamanders, fresh water crabs, addlers, lizards, glow-worms, and tor- toises, as well as rabbits, rats, sparrows, etc. Animal elec- tricity, like mechanical, is due to action, a. id we find when a chemical decomposition or chemical change takes place, electricity is always produced. This electricity is found in the muscles, nerves, brain, kidneys, liver, lungs, testi- cles, spleen, etc, Matteucci and DuBois-Reymond'are the founders of elect rology. Electricity in mankind, while the cutaneous currents in the human being have certain laws made concerning the direction in which this current flows, we sometimes find the reverse condition exists. Dr. C. B. Radcliff says that during sleep the sheaths of fibres, of nerves and muscles are charged with electricity the same as a Leyden jar. This change is brought about by the development of electricity, either positive or negative through oxidation, or some form of chemical action on the outside of the sheaths of fibres, through the di-electric sheath, and have opposite condition as in the Leyden jar, which would be in a static condition. The nerve-current and muscle-current are purely incidental phenomena, result- ing from applying the electrodes to points of unequal elec- tric tension or potentiality. That the passage of a nerve or muscle from a state of rest to that of action is accompanied by a discharge similar to that of a torpedo. The argu- ments in favor of this view are, that the anatomical and physiological apparatus of the torpedo closely resembles the muscular apparatus of all anjmals; that the nerve- current nearly disappears from the nerve, and the muscle- current from the muscle, when nerve and muscle pass from rest into action, and, finally, that the phenomena of induced or secondary contraction cannot otherwise be ex- plained. The discharge takes place between the sheaths of fibres, which are very elastic, and are capable of being elongated during rest by mutual attraction of the opposite electricities with which they are charged. When a nerve or muscle passes from action to rest, it re- sumes its condition of charge. Elongation therefore is the result of charge and contraction of discharge. This 25: ELECTRO - THERAPEUTICS. point is illustrated by the following experiment: A nar- row band of rubber is covered on both surfaces very near the edge with gold-leaf, so that it can be charged or dis- charged with electricity, similar to the Leyden jar. By a simple arrangement of a grooved wheel, and an apparatus that multiplies and records the movements, it can be shown that when the band is charged by a few turns of africtional orstatic machine, it elongates, and when discharged it con- tracts. It is believed that the muscle behaves in precisely this manner. If the nerves are not affected in the same way, it is because their fibres are not sufficiently elastic. The acceptance of this view explains many interesting facts in pathology. It explains the fact that diseases that are accompanied by a deficiency in the nerve currents, as neuralgia, spinal irritation, hysteria, tetanus, epilepsy, usually manifest themselves by morbid activity, by in- creased and unnatural movements of muscles and ner/es. This theory of current production in the human body may be correct, but the theory of destruction of a cell structure or chemical decomposition looks more reason- able, for we find in chemistry that when a chemical change takes place a current of electricity is generated. We find electricity prevailing in all the organs of the body and are in opposite electrified state. We find the hand is negative to the elbow, and the palm of the hand is negative to the back. The foot is negative to the chest, and the sole of the foot is negative to the back. The elbow is slightly positive to the chest, and the hand is sometimes negative to the foot, and sometimes the reverse. Apparatus for Studying Animal Electricity, as Recommended by DuBois-Reymond- A delicate galvanometer or milliamperemeter register- ing only a few milliamperes in its full circle, in order to detect the most feeble current present. Two cushions, as they are called, made of layers of blotting paper soaked in a solution of sulphate of zinc, are laid in the edge of each vessel, with their ends in the liquid. The whole is en- closed in a moist chamber in order to protect the tissue. Professor Trowbridge, in the description of his experi- ments, says that he is satisfied that the deflection pro- duced by DuBois-Reymond is mainly due to the soaked cushions used by him, and in his experiment with natural and artificial muscle, says that he is convinced that when ELECTRO - THERAPEUTICS. 253 there is an absence of saline solution, no deflection takes place, and when present a perceptible deflection is mani- fest. He therefore comes to the conclusion that there is no. such thing as muscular current, properly speaking. In all these experiments made by different authorities, we should expect different results would be obtained when different methods are used, whereas if they were continued to the end, they would all arrive at the same conclusion. Lt is natural therefore to rind sodium chloride in the blood, hence the saline solution, and according to Trowbridge's theory and DuBois-Reymond's electricity should be present in all parts of the body, and no doubt of it electricity pre- vails in all animal life. It is more perceptible in the mus- cles, on account of there being the best conducting path in them. Irritability or electrotonus is a condition of altered func- tional activity. The electrotonic state is produced by the passage through a nerve of a constant polarizing current. The passage of the constant current produces a change in the electromotive force of that part of the nerve traver. sed by the current. This alteration in muscular excit- ability may consist in either an increased or a decreased functional activity. The decreased functional activity oc" curs in the neighborhood of the anode or positive elec- trode, and is called electrotonic state. The increased func- tional activity occurs in the neighborhood of the cathode or negMlive electrode, and is called catelectrotonic state. The altered activity affects not only the intra polar parts of the nerve, or that part between the electrodes, but also the extra polar portions, or the remainder of the nerve. The electrotonic state is characterized by two varieties. Those in which the electromotive force is decreased, and those in which this force is increased. These conditions are called positive and negative phases. A decrease in the electromotive force of a nerve affected by sending a current through the nerve in opposite direc- tion to the nerve current is called negative phase, and by sending it through the nerve in the same direction it is called positive phase. Anelectrotonic zone, and catelectrotonic zone, are terms used for that region surrounding the electrode. Positive and negative regions. The electrotonic condition not only remains while the current continues, but a considerable time afterwards, or 254 ELECTRO - THERAPEUTICS. it remains in a charged condition after the current (-east's. Dead nerves, or nerves that have lost their irritability, electrotonus effects con not be accomplished. In a comparative illustration, the disturbance that takes place in a magnet are similar to the action of the nerve. DuBois-Eeymond says that the nerve is always in the condition of a closed circuit, since electric currents are pro- duced by the connecting layers surrounding the molecules with their molecules; and secondly, that current obtained from an animal as indicated by the galvanometer is only a small portion of the entire current that it contains. While it is true that contraction is not so marked at midway as at the anelectrotonic or catelectrotonic zones, yet there certainly cannot be any neutral point. This chemical or mechanical stimulation of the nerve must be proportionate throughout its entire length, according to the amount of current traversing it. We must remember that in the electrical zone region the current is confined to the surface at conducting terminal, and after penetrat- ing the body it diverges and again contracts to suit con- ductor at the terminal. The portion of a nerve near the positive pole has its conductibility diminished, while that portion of a nerve near the negative pole has its conducti- bility increased. Some authorities claim that we have a neutral point in the contraction of a nerve by electricity: they say that the anelectrotonus meets catelectrotonus at about midway, and at this point there is no irritability, and this is called neutral point, or intra-polar region. While a nerve when acted upon by the electric current is in a polarized condi- tion, it does not necessarily follow that it is exactly like a magnet, having a neutral or dead point at the intra polar region, for we notice when a death occurs caused by the electric fluid, we find a uniform condition between the terminals, that is, when the stroke is distinctly marked. We have deaths from the physiological shock, sometimes its action on the repository centres, or on the nerves and muscles, etc., but when we have a distinct rupture of the body by it, we do not find any neutral points. While it is true we have positive and negative terminals, and at lithe anelectrotonus zone we find oxygen gas and at the catelectrotonus zone we find hydrogen, we would also find if we had some means of making the examination correctly that when electrolytic action takes place, that ELECTRO - THERAPEUTICS. 255 the hydrogen while accumulating at the negative pole, has a flow extending to the anelectrotonus zone, we would also find the oxygen extending to the catelectrotonus zone. This does not prove that we have a neutral point. Now while we are satisfied that at midway of intra-polar region we have less irritability, this is due no doubt to it being The highest point of diverging. The nerve when in a catelectrotonus condition is greatly modified by the breaking of the current, its irritability is diminished thereby. This is called negative modification. At the positive pole an increase of irritability is manifest. and is called positive modification. The restoration of irritability is accomplished with a suitable farad ic current, and when we find patients whose condition is such that they cannot take the faradic cur- rent, or no faradic current is at hand that would have the desired effect, then the interrupted galvanic will often restore irritability, even when the faradic sometimes fails. When the muscles are affected, a faradic coil should be used of coarse wire and to have a slow vibrator, so as to allow saturation to be completed before the current is broken. If the sympathetic are affected, a finer wire and a finer interrupter should be used in order to produce the best results. Many experiments have been tried for the restoration of the muscle and nerve irritability, but noth- ing is so effectual as the properly applied and correct faradic current. The theory of analectrotonus and catelectrotonus is, when a current from a battery of voltaic cells is passed through the nerve, the irritability diminishes at the ane- lectrotonus zone region and increases at the catelectroto- nus zone region. This may be explained by the physical effects of the current in the tissue. We have seen in elec- trolysis that acids go to the positive or anelectrotonus zone, and the alkalies to the negative or catelectrotonus zone. It is a well known fact in physiology that acids diminish nerve irritability while alkalies increase it. In Coyn's experiments of Paris on the ulner nerve, Pflu- yer's Laws and the action of electricity were proven, which are as follows: The nerve is excited by the appearance of catelectrotonus and disappears on anelectrotonus. Coyn has shown in his experiment that after closing the circuit, the irritability is increased near the negative pole: that is, this condition 256 ELECTRO - THEK'APEUTICS. increases as the current r ins up to a certain point; that on breaking the current the negative modifications or corir ditions of diminished irritability appears for a moment and then disappears near the positive pole; on the other hand the irritability is diminished at and after closing the cir~ cuit. On breaking the circuit there is an increase of irritability or positive modification, which appears to be greater when the current has been allowed to run a long time. Action of Electricity in Brain and Spinal Cord. It has been shown by Fritsch and Hitzig that in the cerebral convolutions there are centres for the production of voluntary muscular movements in various parts of the body. These investigators took off the upper part of a dog's skull, and by means of a weak galvanic current, ex- cited the exposed brain, locating the current in small por- tions. They found that when certain definite portions of the anterior convolutions were excited, movements were caused in certain groups of muscles on the opposite side of the body. Continuing their researches, they showed that there are definite nerve centres for the nerves that preside over the muscles of the neck, the foot, and the face, for the extensor and adductor muscles of the forearm, and for the flexor and rotator muscles of the arm. , Ferrier, of King's College, London, performed similar experiments. He studied the cerebrum, the cerebellum, the corpora, etc. Electrization of the optic thalami pro- duced no result; of the corpora striata caused the limbs to be flexed; of the anterior tubercles of the corpora quad- rigemina caused dilatation of the pupils and apisthotonus; while electrization of the posterior tubercles caused the animal to make all sorts of noises. Dr. Beard has carefully studied the action of electricity on the cerebellum in dogs, rabbits, cats, and pigeons, and he has come to the conclusion that the surface of the brain was electrically excitable; that the theory advanced by Dupuy and others, that the excitation was due to the dif- fusion of currents to the central ganglia, was not tenable. In the external application of galvanism to the brain, it is somewhat different. If we should place an electrode to the forehead and the other on the back part or occiput and use from ten to twenty milliamperes, the sensation would not be as marked as five milliamperes from temple ELECTRO -THERAPEUTICS. 257 to temple, when the sensation would be That of vertigo. Hitzig says when the current passes from forehead to occiput, the right and left lobes of the brain and all that pertains to them are equally or symmetrically influenced, and little if any dizziness is perceived: but when applied to the temples, dizziness is at once produced if the current be sufficiently strong. It will be readily perceived the dissimilarity in the region of the zones, one hemisphere being in anelectrotonus condition and the other catelectro- tonus, or diminished irritability on one side and increased irritability on the other. And we must have falsification of the muscular sense. Hitzig indicates several degrees of galvanic dizziness: 1. A mere sense of fullness in the head is caused by a mild current when broken, but not usually when the cur- rent is running, nor so marked when closed; certain tem- peraments however experience this feeling, not only when the current is broken, but also when it is running. 2. Apparent movements. These are produced by stron- ger currents; objects when the current is passing appear to go from positive to negative pole, arid when the circuit is broken, the movement is in opposite direction. 3. Staggering is produced by still stronger currents. Luschka says there are anatomical reasons for supposing that the 'brain can be more easily affected in the mastoid and occipital regions than in the anterior portions. A large vein connects the transverse sinus with the posterior auricular veins, and with the posterior meningeal artery into the skull through the mastoid foramen. In the oc- cipital region a vein connects the transverse sinus with the venacervicalis profunda through the posterior condy- loid foramen. If an electrode is placed upon either end of the spinal cord, contraction of the muscles of the trunk and the ex- tremities follows. If one electrode is placed upon the cen- tre of the spine and the other on the lower extremity of the cord, only the muscles of the lower limbs will be con- tracted: and if the upper half of the spinal cord be elec trized, the muscles of the arms only will be affected. When we break the circle of a galvanic current, the spi- nal cord being part of it, the contraction of the muscles in the body manifests its presence; but if this current be not so broken, no contractions are observed and a paralyzing effect takes its place. The cord remains insensible to any 258 ELECTRO - THERAPEUTICS. stimulus that may be applied to it as long as the current is passing, but at its cessation mechanical irritation will give rise to the usual tetanic convulsions. This diminution of excitability is confined to the spinal cord. The long continuation of galvanic treatment of about twenty milli- amperes on the spinal cord is liable to produce paralysis. Centrum cilio spinale, as designated by Budge and Wal- ler, a ganglion near the fifth lumbar vertebra, which, on being electrized in animals produces contraction of the rectum and bladder. And when we electrize the spinal cord at the sixth dorsal vertebra in the human body, exci- tation is transmitted to the cervical sympathetic nerve, and thence to the iris, producing dilatation of the pupil. The Action of Electricity On the Shin. In the application of electricity to The human body, it is done by the way of electrodes on the skin or epidermis mostly, and when it is so done it requires a large electrode externally and a much smaller one internally. The reason for this is due to the high resistance of the external coat- ing of the body. This resistance of the skin is subjected to marked difference in some individuals and different in each individual, according to their condition in life. While this resistance is great, it can be materially re- duced in two ways; one is by washing the skin with luke- warm vinegar, and the second way is to increase the size of the electrode. So in the application of electricity, either galvanic or farad ic, to the human body, we must take into considera- tion the resistance interposed, the individual's suscepti- bility to the electrical stimulus, etc. We find young and old are more susceptible than middle aged persons. Brain working classes more so than labor- ing or uneducated classes. Women more so than men. Hence, the difficulty of electrical formula. The application of electricity, galvanic or faradic. to the cervical sympathetic may cause in one individual symp- toms of cerebral congestion, and in another cerebral anae- mia, so each individual case must be carefully diagnosed before application is made, then carefully watched. The action of static electricity when applied to the skin has a pricking sensation, and has a tendency of making the skin red. If the patient be placed upon an insulated stool or platform, and is charged with static electricity. ELECTRO -THERAPEUTICS. 259 and a negative conductor be placed near the surface of the skin, a small Jump will be produced by the jumping shock, which resembles that of a mosquito bite. This would soon disappear by a little friction, but it is a very unpleas- ant sensation. The action of the faradic current on the skin is some- what similar, but more pleasant than that of the static current. On account of the resistance of the skin a moist electrode is preferable for most work, but when faradiza- tion of the skin is desirable, then a dry electrode should be used, or the hand of the operator. The action of the dry electrode is, that the high resistance of the skin is main- tained, the electricity fails to penetrate the deeper tissues, unless the current be very strong. The calibre of the blood-vessels is narrowed through its action on the vaso-motor nerves. They first have anaemia and then hy- peremia. Hyperemia will not be noticeable for several minutes, but it will make its appearance soon, according to the strength of coil and the size of wire and interrup- tion made. The fine wire coil with a high tension interruption has a more marked effect on the sensory nerves than the mus- cular or intermediate coils. And the negative pole has a more marked effect on the sensory nerves than the posi- tive. The forehead and the region of the scapula and tibia are very sensitive to faradization. Electricity pene- trates the skin through the sudoriferous and sebaceous glands, and the smaller these apertures are, the greater the resistance. The action of the galvanic current on the skin differs from that of the faradic and static currents very materi- ally. When a few cells are applied, no sensation is mani- fest, but when about twenty or thirty milliamperes are applied it is noticeable, and the sensation is like that of a mustard plaster. When a moist electrode is placed upon the skin aud a cur- rent of galvanic electricity of about twenty milliamperes is passed, through it, there appear small pale vesicles at the negative pole that are transparent and are not raised much above the surface. These are produced by the alka- lies and hydrogen gas, and as the current continues, the epidermis becomes brown, and the serum comes to the surface and assists in producing these ugly electrical sores. 260 ELECTRO - THERAPEUTICS. Electrical .Action of the Sympathetic and Pneu- mogastric. The action of electricity on the sympathetic and pneumo- gastric region should be used with care or intelligence, on account of its action on all of the ganglia of the body, for none of the ganglia can escape its influence, when applied internally or externally. We should know beyond a ques- tion if the case in hand is one for electrical treatment or not, and if we should use galvanic or faradic currents. If galvanic, how strong and how shall we apply the electrodes. and in what direction should the current flow, and if faradic, what kind of faradic, etc. These are essential points when the electrical treatment is to be used near the pneumogastric. When we make an external application, the effect is not so marked as when we apply direct to the nerves them- selves on account of its absorption by surrounding con- ductors, but as external application is the practical way of applying electricity to the pneumogastric region, we should only consider this one. If a current of sufficient power was conveyed so as to saturate the surrounding con- ductor, then the same effects would be obtained on these nerves as if a direct contact was made by the electrode, but this is not possible with the galvanic current, on ac- count of the resistance of the skin. When we place cne electrode on the nape of the neck, and the other at the anterior of the sterno-cleido-mastoid muscle, the current will diverge from a direct path, but it will traverse the sympathetic and pneumogastric. While the surrounding tissue is almost as good a conductor as the nerves are, yet we will have a distinct action when a current of electricity is applied by this method, on both pneumogastric and sympathetic nerves, and it is impossi- ble to act on one without affecting the other. The anatomical relation existing between these two great nerves is such that, no matter where we place the electrodes, one or the other will be affected, which will be carried to the base of the brain, where the pneumogastric. the phrenic and other nerves centre, hence through the other nerve to the electrode. In Baird and Rockwell's experiments on these nerves, they were laid bare and isolated, the cervical ganglia of the sympathetic receiving the most attention, and distinct ELECTRO -THERAPEUTICS 2*jl action on one could not be obtained without affecting the other. M. M. Arloing and Tripier have shown that sectioti of the pneumogastric below the medulla so far modifies its contraction that the action of the heart is not arrested, or but for a short time, with the farad ic current when applied to the distant end of a cut pneumogastric. Also weak faradic currents affect the heart's action; by the contraction of a nerve the free flow is checked, elevating the blood pressure in the arteries. They also found that the right pneumogastric has a more powerful influence over the heart than the left. Faradization of the peripheral end of the divided pneumo- gastric causes arrest of the action of the heart, sudden irregularities of its rythm, with slightly reduced pressure. They also found that the left pneumogastric has a more powerful influence over respiration than uhe right. Masoin found that the movements of the Lieart were stopped by galvanization of the left pneumogastric. It was possible to restore heart action by mechanical move- ment, such as striking the heart with the fingers, but after the movements were stopped by galvanization of the right pneumogastric. it was not possible to restore them in that way. I have observed that when an electrode is placed upon the nape of the neck and another nndrrthe feet, and a strong faradic current is used, with sensitive patients a severe attack of coughing is produced, and lasts while the current is flowing. Also, I have observed with external applications the fol- lowing results; one of the electrodes being placed in the mastoid fossa, and the other over the seventh cervical ver- tebra, and the current used was from one to ten milliam- peres from one to ten minutes duration: A young lady whom I was treating for facial acne by central galvanization, was frequently pnt right to sleep within one minute after application, and she would awake but slowly as if from a sound sleep, and in a number of cases this drowsiness was manifest when the electrodes were so applied. I find the following laws in reference to the action of electricity on the retinal circulation through the neck are correct: 1. Gal /anizati on or faradization of the region of the 262 ELECTRO - THERAPEUTICS. cervical sympathetic has a marked temporary influence over the retinal circulation. It may cause contraction of the arteries or dilatation of the veins. 2. The faradic current produces precisely the same ef- fects on the retinal circulation as the galvanic, only more slowly. The physiological difference between the currents in this respect is therefore a difference of degree and not of kind. 3. Mild currents of short duration caused contraction of the blood-vessels of the retina, while strong currents and long applications caused dilatation. Much seemed to depend upon the temperament and condition of the indi- vidual. What would cause contraction in one would cause dilatation in another. These varying effects correspond with clinical experience. In conclusion we would say that it is a difficult matter to localize a current of electricity from external applica- tion without affecting the sympathetic or pneumogastric by external application near the medulla oblongata. The Nerves of Special Sense. Optic Nerve.— The galvanic electrodes when placed up- on the temples cause both light flashes and a perception of color. The faradic current has very little effect on the retina. A coil of very fine wire as made by some of the best makers has a decided action on the retina. Auditory Nerves. — The action of a faradic current when the electrode is applied to the ear, or in the vicinity of the ear, causes a ringing or rumbling noise, according to the method of application, which no doubt is due to the contraction of the muscles and the disturbance of susurri. The galvanic current acts on the auditory by certain fixed laws, and various sounds are produced. A distinct accented sound, a sound that gradually fades away, a whistling sound, a ringing sound, a hissing sound, and many more different sounds are produced. These sounds vary according to the individual and strength of current. With the healthy ear, the anelec- trotonus effect is always the same. • All these various sounds, no doubt, are due to the audi- tory nerve. Olfactory Nerve. — When a galvanic current is applied to this nerve or to the Schneidorian membrane, an odor ELECTKO -THERAPEUTICS. 263 resembling sulphuretted hydrogen is produced. This is no doubt due to the liberation of ozone. Gustatory Nerve — The action of two dissimilar metals producing a sensation when in contact with the tongue was discovered by M, Sulzer in J754. This taste was simi- lar to the vitriol of iron. If we placed zinc on top of the tongue and silver underneath, an acid taste would be ex- perienced under the zinc plate, and a slight alkaline taste under the silver plate. This action of the gustatory nerve varies with different individuals but the majority say it is a copper taste. It is not necessary to send the galvanic current through the tongue or through the chorda tympani nerve, or even through the face. An electrode placed upon the neck or any part of the spine will produce this effect, This coppery taste is due no doubt to electrolytic action, the acids and alkalies forming at their respective poles. Voluntary and Involuntary Muscles.— In the excitation of the involuntary muscles by faradism, the contraetibil- ity continues during its entire application, while with the continuous galvanic current the muscles relax after the first shock, and again contract upon breaking the circuit. If we should pass the current through the intestines, stomach, oesophagus, etc., which are composed of involun- tary muscular fibr^, excitation does not take place until the parts become, saturated or charged, in which case exci- tation continues after cessation of the current. Stomach. — In electrization of the stomach with the interrupted galvanic or muscular faradic current, a short- ening of the transverse and longitudinal fibres in the direction from the cardiac to the pyloric orifice takes place. In the treatment of paralysis of the oesophagus associated with a sort of atony of the stomach, we have frequently had occasion to observe the readiness with which this phenomenon took place. In the shortening of these fibres, close adhesion with the serous coat is prevented. It also prevents and will assist in the destruction of the solid adhesion of any of the four layers of the stomach; areolar, mucous, muscular or serous. Bladder.— When electricity is applied to the bladder when partially filled, a painful sensation is manifest, caused by the contraction of the whole bladder. Intestines. — In the contraction of the intestines by elec- 264 ELECTRO - THERAPEUTICS. tricity, strong currents are generally used, on account of the tardiness of the intestine contraction, and when the passage of the current ceases, relaxation takes place slowly. The duodenum responds most readily, almost instantly, and the lower bowel is a little less responsive. Uterus. — The contraction of this organ is similar to that of the bladder. Gall Bladder. — The contractions are similar to those of the bladder. Heart. — The direct electrization of the tissues of the heart is somewhat different from that of the aorta and its direct branches. We can apply a much stronger current to the heart before cessation is accomplished than when the aorta is contracted. It is also possible to restore the heart's action by a weak current momentarily applied, and again stopped by a strong current of long duration. The liver and lungs are very little affected, so far as the contractibility is concerned. A congested liver may be restored by a continuous treatment of a muscular farad- ic current daily at a fifteen minute seance. Its Action On the Blood. The action of the galvanic current on the blood is a sub- ject that has received considerable attention from Baird and Eockwell, Rollet, Neuman, Parsons, Hutchinson, Hayes, and others. While the conclusions arrived at by these several inves- tigators are not in unison, they are nearly so. While the blood corpuscles are variable in size, they are fairly uniform in appearance, and the average length would be about 1-2400 of an inch. If it would be possible to pack together 8,126,464 they would occupy space the size of a pin head. (This is for human blood). Dr. R. K. Browne has calculated that these corpuscles move 400 times their own length in a second of time. If we should take a weak solution of blood and put. it into a test tube over heated mercury, it reduces itself to a state of oxida- tion of venous cruorine and a spectroscope would show that it was purple cruorine, but if we should add one drop of distilled water, the color of the cruorine will be restored to its scarlet state. In the higher animals we find the composition of the blood is very complex. We find water, albumen, fibrin, and coloring matter, also several fatty substances, such as cholesterine, cerebrine and some salts, ELECTRO - THERAPEUTICS 2(i0 chloride of sodium, sulphate of potash, carbonates of soda, lime, and magnesia, and' no doubt there are many more substances that we do not know are contained in the blood. We have in the globules 79 per cent, water, 19 per cent, albumen, and one of salts. Now when a galvanic current of electricity is applied, and it be strong enough to produce electrolytic action, we have chemical decomposition. If its strength were about twenty milliamperes this would be sufficient to coagulate albumen. Now the presumable phenomena that take place in the blood would be as follows: In the decomposition of the blood, water is paramount to all the rest of its composition as previously shown, two gasses are given off, the lighter is carried to the negative pole, and the oxygen accumulates at the positive pole. In this decomposition the electrolyte is broken into atoms or groups called ions, which are of two kinds, electro-positive or cathions. and electro-negative ions, or anions. The decomposition that takes place is greater at the positive than at the negative electrode, and we would naturally infer that the anelectrotonus zone being gradu- ally dried up, a clot formation would take place without the assistance of any other agent, but the oxygen that is liberated performs an important part. Acids are formed and they gradually disappear, leaving a charged mass, which would adhere very closely to the electrode. Where these acids are lormed, coagulation takes place with the albumen, while at the catelectrotonus zone we find very little coagulation has taken place, but what there is, are yellowish, light and bulky. If a large clot is desired to obstruct the passage within a blood-vessel, about forty milliamperes is preferable. The following rules in regard to electro-coagulability of the blood: 1. At both galvanic terminals, clot formation takes plnce. 2. At the positive terminal v is the hard black clot, and at the negative it is light, soft and bulky. 3. When the galvanic terminals are located within a blood-vessel, and when in close proximity, the coagulation is most satisfactory, the duration is very short compared with the time of a separation. 4. In blood electro-coagulation, the larger the volume of current, the quicker coagulation takes place. 266 ELECTRO - THERAPEUTICS. Ihe Human Body as a Conductor. The composition of the human body is such that it is a better conductor than water, but is variable in different, parts of the body, on account of different quantity of saline constituents. Proportionately, adults have about 80 per cent, of water, children under one year about 85 per cent. The blood has about 78 per cent., gray matter of the brain 85 per cent., white matter of the brain 75 percent.; the spinal cord, gray 72 and white 67 per cent.; muscle 82 and nerve 77 per cent. These figures are variable in different individuals. The water in the tissue is very uniform. The bones, like the skin, are a very poor conductor, and when the epider- mis is in a dry state, little or no current will pass it, but when moistened it will conduct fairly well. We would call the attention of the medical student to the complex condition of affairs, which we will rind on studying the dosage of electricity. In drugs, the physician has only to know the absolute strength of the extract or tincture he is using; but in electricity we must take into account volume, pressure, or current strength, in relation to the work to be performed. These conditions are ex- plained by the following expressions, which we call electr.- cal units: The volt, ampere, ohm, coulomb and watt. We have about forty electrical unit phrases, but the above are about all that are necessary for our purpose. Hitherto the student has found difficulty in studying these terms, as in the various text-books on the subject, the meaning of the authors has been obscured by abstruse mathemati- cal problems. Physicists, like lawyers, seem to try to promulgate laws that are incomprehensible. In as concise a manner as possible, we will endeavor to translate these specific terms and render the explanation easy of compre- hension. A thorough understanding of the effects of electricity on the body is as necessary as the study of general materia- medica, and in order to become familiar with the subject, the student must thoroughly understand the symbols, words, and phrases used in expressing the condition of the current. Electricity is analogous to other manifestations of force, and is capable of being generated, measured, and put to work or utilized, similar to steam power. In the first ELECTRO - THERAPEUTICS. 267 place we must consider force as unliberated pressure, or energy of suspended action, ready for motion and easily changeable into energy of action. Engineers express the amount of energy of suspended action that can be gene- rated in a given boiler, by saying it represents ,; so many pounds pressure."' and in fact we habitually compare pres- sure and weight. Thus we say the thermal unit can per- form 500 foot-pounds of work, which means that the potential so situated as to be easily changeable into kinetic energy would equal 500 foot-pounds. In a similar manner another arbitrary work-unit is established, to which we give the name of horse-power. We can and must therefore fix upon a unit to express electrical energy, and the term volt-coulomb has been adopted, which corresponds to the caloric (or any other) arbitrary unit. The electrical units are all based upon the C. G. S. sys- tem, or centimetres, grammes and seconds, adopted in September. 1881, at the Paris Electrical Congress. Volt, or Cult of Force — To explain the meaning of volt let us perform the following experiment: Take a standard voltaic cell and an unknown cell. Couple the zincs of each cell together, and attach the copper of nega- tive elements to a galvanometer. Now as a result we will have the galvanometer or needle deflected or remaining at rest. Should we find the needle remaining quiescent, then we have a condition of equilibrium, the electro- motive force of each cell being identical; but should the needle be moved, then there is a difference in the strength of the current from the different cells. Should we make a battery on the same plan as the Daniel cell, and of the same materials, but only as large as a thimble, and connect it with an ordinary sized one, we will find no deflection of the needle. This shows that the larger cell has no more pressure than the smaller one, which is. as far as pressure is concerned, an equivalent of the larger We therefore say it has the same voltage. In order to measure the pressure or the voltage definite- ly, we must use a comparative test of some kind It is to be understood therefore that when two bodies having dif- ferent electrical potentials are connected by a conductor, the quantity of electricity present must occupy a certain time in passing from one to the other, hence if there be a certain difference of poteutial. we have a difference in the 268 ELECTRO - THERAPEUTICS. transfer of a given quantity of electricity as regards time or duration of flow. Jf we should take a voltaic cell and connect the termi- nals to a galvanometer, we would find the current flowing from the negative element to the positive, through the circuit. Should we place a magnetic needle near the con- ducting wire, it would be deflected. Now should we add another cell to be connected up in series, that is, carbon of one cell to zinc of the other, we would have double the previous force, but not double the deflection of the needle The reason for this is that, while we have increased the pressure or E. M. P., we have also increased the resistance, which has destroyed the volume equivalent to one cell's production, but the E. M. F. is never destroyed. Now these cells being connected with a galvanometer and add 2,000 ohms resistance when we find a certain de- flection, and on taking one cell away the deflection is reduced. Should we take 1,000 ohms from the circuit, we have then' half of the previous resistance, and we get a corresponding increase in the needle's deflection. From this we infer that the current that is passing is inversely proportional to the resistance. This is called strength of current. We now take a standard cell and connect it with the instrument having a thousand ohm's resistance, when wj will get a deflection that we take note of, and we can then calebrate the unknown cell accordingly. The volt is being considered the unit of potential, the electro-motive force and means energy. The Daniell's standard cell is usually used for comparison, the electro- motive force being 1.079 volts or E. M. F. The second unit we will consider is the coulomb or unit of quantity, or the ampere measure. For example, it would require a quantity of galvanic electricity equal to two coulombs to supply a current of two amperes for one second, or a five ampere current will give twenty-five cou- lombs in five seconds. Each coulomb of electricity liber- ates 0.1176 C. C. of hydrogen, and 0.0568 C. C. of oxygen or a total of 0.1764 C. C. of mixed gasses. It also requires 95,000 coulombs of electricity to decompose nine quarts of water. We think these experiments explain the coulomb distinctly, but rather than be obscure in any way, we will explain farther. The coulomb was first used to measure f Fictional electricity, and it was fomd very useful, because ELECTRO - THERAPEUTICS 2 watts. Joule — The unit of electric energy. The volt-coulomb, the amount of electrical work required to raise the poten- tial of one coulomb of electricity one volt. The joule may be regarded as a unit of energy or work in general, apart from electrical work or energy. The British Association proposed to call one joule the work- done by one watt in one second of time. Recapitulation. — The several units in themselves do not signify anything, but collectively they mean a ''watt.'" a "watt" being the unit of work done, or "watts" as the case may be. The strength of current is "ampere" and the symbol is S. The electro-motive force or potential is "volt" and the symbol is E. The quantity is "coulomb'" with the symbol Q. The resistance is "ohm." having R for a symbol, and capacity is the farad with the symbol C. These units look much brighter now than when we first started, but we will endeavor to make them still a little clearer. Potential is, as we have seen, a possibility, and when it is an accomplished fact we call it voltage or electro-motive force or volt-coulombs. Now to give the student a better idea of these terms, we will use the following illustrations; they are not correct, but they are as near so as any illustration can be. First, you must look upon the word volt as indicating pound pressure: the ampere as a volume of water in a tube 274 ELECTRO - THERAPEUTICS. on a level, with the pound pressure back of it; the cou- lomb as the area of pipe in which the fluid flows; the ohm as the length of pipe or resistance. Now we have one volt or pound pressure in the water column, or ampere of cur- rent passing through one ohm of pipe, at the rate of one coulomb or amount in one second. If we should take ten Daniell's cells, the energy of which is one volt per cell, the total number of cells would then be equivalent to ten volts. Now we connect these cells in series, the internal resistance we say is two ohms per cell or twenty ohms in all; then we have twenty ohm6 placed in the circuit which would represent forty ohms in all for the current to pass through, and we would find a current of 0.25 amperes. This is expressed in Ohm's law as follows: E=10 (volts) R=40 (ohms) E 10 and— =—=0.25 amperes. K 40 Should we reduce the resistance say 20 ohms we would have the following: E=10 (volts) R=20 (ohms) E 10 and — =—=0.5 amperes. a 20 This shows that we have a much stronger current than before. If we should take four voltaic cells having an electro-motive force of four volts with internal and exter- nal resistance of 40 ohms, we would have 0.1 ampere. With a few more words on the practical use of positive and negative poles, we have finished. All acutely inflammatory aflections are elect] ically posi- tive in excesfe, having too i much vital action, being over- charged with electro-vital fluid, while all paralytic dis- eases are those of sluggish character are electrically nega- tive, having too little vital action.. When we wish to repress or repel inflammation, which is electrically positive in excess, we put the positive pole to it or as near to it as possible, by applying this positive cur- rent to a diseased part, we drive away the condition by the repelling influence of the positive battery current, while the negative pole is upon some more healthy portion of the ELECTRO -THERAPEUTICS. 27 f> body; also, we And spinal Irritation and at the same time a stomach afflicted with chronic dyspepsia, accompanied with constipation of the bowels. We place the positive pole at the spinal nerves, because we know that from its irritation that there is an excess of electro-vital fluid in the part making it improperly positive, and with the neg- ative electrode we will at the same time treat over the stomach, bowels, and liver, because we know from the in- action of the organs that there is a lack of the vital force there, and that consequently they are too negative. Now if we find inflammation or enlargement of the spleen as is commonly the case with chills and fever, we place the positive pole upon the spleen and the negative pole upon the liver. The positive repels the excess of electro-vitality away from the positive spleen, and so reduces the improper ex- citement there, while at the same time it rushes by at- traction to the negative liver under the negative pole or electrode and makes that more positive and so more active. In this way we change the polarization of the parts, and in so doing remove the sustaining cause of the disease. Thus you see we may treat different functions of the body with correspondingly excellent results. Of course, as soon as the object in view is attained, we change the location of the electrodes, as long continued actions of the current would not be desirable in the same direction and location. Again, in treating a case of enteritis(inflammationof the intestines) we would place the positive current over the bowels and the negative over the lumbar region. Mechanical Effect of Each Pole. The mechanical effect of the negative pole or negative current on that part of the body under the negative elec- trode is to relax, expand. When, therefore, we wish to re- lax a muscle that is unnaturally contracted by rheuma- tism or otherwise, we must bring it under the negative electrode. If we desire to contract ligaments or muscles that are abnormally relaxed (not atrophied) as in prolapsus uteri, we mu-t subject them to the positive current or bring them under the positive electrodes. Parts that are unnaturally contracted are electrically negative in excess, and need to be made positive. Parts that are unnaturally relaxed are too positive and should be made more negative. We make a part more positive by applying to it the weg- 27H ELECTRO - THERAPEUTICS. ative pole and more negative by applying the positive. Parts spasmodically contracted are acute and positive. Those permanently contracted are chronic and negative. Inflammatory affections should be treated by a downward current in most cases. In treating a paralyzed organ, the current should be run through a healthy part to it, with negative electrode over the affected part. Acute diseases are to be regarded as electrically positive, and chronic affections as negative. Alkaline affections, those causing excessive alkaline se- cretions are electrically positive, and acid or acidulous states are negative. Recent wounds, contusions, and burns are positive. Old ulcers and irritations are gen- erally negative. With a few brief quotations from celebrated writers on therapeutic electricity, who testify to its value as a reme- dial agent, we will conclude: •'Electricity," says Matteucei. "is the only irritant which can excite at one time, sensation, and at another, contraction, according to the direction in which it trav- erses a ner/e. " Dr. Phillips remarks that in cases "where there is a fail- ure in the secreting power of the liver, or a defective ac- tion of the gall tubes, I have repeatedly seen from galvan- ism the same effect on the biliary system which arises from calomel; a copious bilious discharge from the bowels, coming on a few hours after the employment of galvanism.'" • Says Golding Bird, "It is the only direct emmenagogue which the experience of our profession has furnished. I do not think I have ever ever known it to fail to excite menstruation, where the uterus was capable of performing this office." "The beneficial effects of galvanism," says Sturgeon, "in asthma and bilious complaints, have several times come under my notice." ''Mr. Cole, house-surgeon to the Worcester Infirmary," according to the Dublin Medical Journal, "informed Dr. Phillips that no other means employed there have been equally efficacious in relieving asthma, as galvanism." The same paper observes that "Dr. Marcus repo its sev- eral instances of the successful application of galvanism in the great hospital of Bamberg. One was a case of paralysis of the arm, in which a complete cure ,was ef- fected. Another was one of violent headache after are- ELECTKO -THEKA F El TIC S. 2i i mit tent fever, which could not be subdued by any medical treatment." "The same reason" says Smee, "for which electricity is valuable in amenorrhoea, might lead us to expect that it- would tend to nctify the state of barrenness in the female; for. by causing it to act directly upon the uterus, it is cal- culated to increase the supply of blood, and thus remedy the deficit.'' I might here remark that I have been suc- cessful in curing several cases of barrenness, of many years standing, by the application of electricity. "One of the most important and curious of the physio- logical properties of the galvanic influence," says M. Don- avan, "is its power over the peristaltic motion of the in- testinal canal, and the consequent evacuation of the fasces. The power over the peristaltic motion, denied by Volta> was, I believe, first observed by Grapeugiesser; but the re- sulting effects were discovered by M. Le Roy d'Eliolle." "Costiveness in the bowels. '* says Sturgeon, "however obstinately it may resist the usual remedies, very soon yields to the galvanic treatment: and by a similar process, constipations generally may be readily vanquished." "In diseases of the eye" says Dona van. "the application of galvanism has been of the greatest service; there are many cases of cure on record." The experience of runny others might be added, equally commendatory of tne therapeutic power of electricity; but as our object in making these quotations is merely to show what many eminent physicians of the old school, across the Atlantic think of it. these are sufficient. PHYSIOLOGICAL ELECTRO-THERAPEUTICS. The Physio -Medical Idea of Medical Electricity. By J. M. Thurston, M. I).. Professor of Applied Physiological Anatomy of the Nervous System and Electro-Therapeutics in the Physio-Medical College of Indiana. Indianap olis. It is an historical fact not at all flattering to the Med- ical Profession in general, that the large volume of our Therapeutic agents were discovered and used by the non- professional laity; so also we have the singular historic fact that the fathers of Medical Electricity were non- medical men. For instance: Michael Farady was an English chemist; A. Volta was an Italian physicist; 278 ELECTRO - THERAPEUTICS. Charles Augusta Coulomb was a French philosopher; An- dris M. Ampere was a French physicist: Georg Simon Ohm was a German physicist. And so cf our own Benja- min Franklin, and our up-to-date Edison and Tesla. Most fortunate for science and far more fortunate for humani- ty's weal, there were no "State Boards of Health" in those days to throttle progress in medical science, else Benjamin Franklin could never have used statical electricity Thera- peutically. And indeed the early history and development of Medical Electricity owes not its origin to what is to-day styled the "Regular" medical profession. The fact is, that like the most of the so-called new Materia Medica of this school of medicine which have been regularized by a singular process of piracy upon the Materia Medica of the New Schools, and likewise Electro-Therapeutics, has re- ceived its baptism into Kegularism only within the last two decades. By this we do not wish to be understood as refusing full credit to our Regular brethren for the many good things they have developed in the way of Electro- Therapeutics, but we do mean to here enter our protest against their appropriation of the valuable fundamental truths of Electro-Therapeutics, which cost I he pioneers of medical reform so many years of patient perseverance and untiring experimental work, without giving them the least credit for iheir life work, but on the contrary boast- ing that they have rescued Medical Electricity from the hands of ignorant empirics and charlatans. The question which the Physio-Medical school of medi- cine must first answer before recommending the use of electricity therapeutically is, what is the inherent ten- dency of electricity upon the living matter of the tissue elements of the organism; in other words, is its influence sanitive, in harmony with the physiological actions in the human body? If we seek an answer to this question in the literature of the "Regular School" of medicine, as Physio-Medicalists, we will be compelled to answer this question in the negative. When the attention of the so-called Regular School of medicine was directed per force to the ''irregular" medical electricians, because of their enviable reputation for cur- ing diseases wholly beyond the control of the "Regular" methods of treatment, and when it became apparent that they must adopt this wonderfully successful remedy, or go to the wall for want of business, thev found themselves in ELECT KG -THERAPEUTICS, 279 a dilemma; for the medical electricity of the "'Irregulars" would not fit the central idea of alos pathos, that is, they could not use the "Irregulars' " electrical currents with the idea of making disease to cure disease, because they were not "strong'' enough. So that they must either abandon their cherished philosophy of •eontraria contra- rius curunter," or else they must adapt electricity to the disease-producing therapy. The latter they had little dif- ficulty in achieving, so that their medical philosophy was really in no danger. For electricity is the most versatile and eccentric force of the universe; and we now know- that its influence upon the living organism can be made as various and opposite in nature as there are means and methods of varying its force or voltage, its quantity and intensity — amperage, and its modification by magnetism, etc. In other words, that we can produce every effect upon the living fcissu? from that of a gentle stimulating and tonic influence upon the whole great process of gen- eral nutrition, to that of complete disintegration, as by nitric acid or caustic potassa electrolysis. So that it was »nly necessary in order to adapt electricity to their idea of therapeutics to administer it in heroic doses; and thus we find their whole system of Electro-Therapeutics is based upon the fact of electrolysis. Dr. George Apostcli, one of the early baptizeis.of electricity into -'Regular" medicine, used immense electrodes of potters' clay to diffuse the force of the current, so as not to burn a hole straight through the patient, or produce electrolysis of the tissue from one pole to the other, and then would turn on 250 milliaraperes, believing that he actually produced electro- lysis of fibroid tumors of the uterus. We have said the whole theory of "Regular'* Electro- Therapeutics is based upon the fact of electrolysis. Let us examine their literature upon the subject and see if we are misstating their position. On page 108 of "Electricity .in Diseases of Women and Obstetrics," by Benjamin H. Martin, M. D., "Professor of Gynecology Post-Graduate Medical School of Chicago, attending surgeon Women's Hospital of Chicago. Gynecologist to Charity aud Post- Graduate Hospitals, member of the Chicago Gynecological Society, etc., etc.," says, "Electrolysis is the power pos- sessed by the voltaic current of chemically decomposing a compound body into its constituent elements. An elec- trolyte is that body or substance which is capable of being 280 ELECTRO - THERAPEUTICS. dissolved into its several elements by means of the electric current. The ions are the product of electrolysis or the constituent parts into which an electrolyte has been di- vided by the current of electricity. When the two elec- trodes from a galvanic battery are plunged into a solution containing electrolyte to be decomposed, definite propor- tions of the ions are attracted by the positive pole, while the remainder are attracted by the negative pole. Those which are deposited or attracted by the positive pole or anode are called anions, while those which are deposited or attracted by the negative pole or cathode are called catJiions. " After thus explaining what electrolysis really is, on page 110, he says, "That electrolysis does occur, how- ever, in living tissues, we have obtained proof. When it is remembered that from one-half to two-thirds in bulk of the human tissue of the body is water, we can, at least, readily understand why electrolysis should occur under proper influences. While the galvanic current, passed through a soft living tissue, has not an uninterrupted fluid medium, it has practically a fluid medium divided into in- numerable compartments, each one separated from the other by a thin wall of solid. During the passage of the current, each of these particles of solids, acts as a positive electrode on the fluid between it and the solid particle in front of it. Each molecule of fluid in a conducting solid, therefore, in the line of a galvanic current, may become electrolyzed." And on page 111, he says, k 'Now, are we not in a position to explain how tissue-change, or absorp- tion even, may be promoted by these two factors alone, when applied to living normal tissues ? A galvanic cur- rent of moderate or decided strength is made to traverse a portion of living tissues and the most susceptible mole- cules in the course of the current become broken into their original elements. (1.) These liberated elements imme- diately make a similar or different combination with neighboring elements of opposite electrical tendencies, making thereby new compounds which act as foreign par- ticles; as foreign particles, they are promptly removed by the nearest absorbent. (2.) Other elements, as they be- come free from their original molecules, make combina- tions with elements which are already leaving the tissues through one of their innumerable minute vascular or ab- sorbent canals. (3.) Many in the form of gas. pour into the atmosphere beneath and surrounding the electrodes. ELECTRO - THERAPEUTICS. 281 (4.) Others attack the electrodes and a re disposed of in the form of deposits on their surfaces. (5.) The current by its cataphoric action, produces an engorgement of the tissues at the negative end of the circuit. The absorbents in that portion of the tissues will promptly make an effort to establish an equilibrium, and by a direct action of endosmosis, they are filled and the excess is carried away in their currents. "' On pages 121-2 Dr. Martin gives a con- cise summary of their whole philosophy of Electro-Thera- peutics, as follows: "1. Electrolysis in living tissues, is in direct proportion to the strength of the current and direct proportion to its density. ■'2. Electrolysis may occur at any or all the points in the line of the tissue current, as well as at the external poles. "'3. Electrical osmosis, or the cataphoric act ion of the galvanic current, causes a direct transference of the fluids of the body through the tissues t in a direction from the positive to the negative pole. '•4. The products of interstitial electrolysis of living tissues, are removed by the absorbents of the tissue in which the action occurs. "5. When a portion of living tissue becomes over- charged with fluids from the effect of electrical osmosis, it is unloaded by the absorbents of the part acted upon. "6. The polar effect of an electrode upon the living tis- sue with a concentrated electrode, varies with the polarity as well as the strength of the current. "7. The cathode acts locally like the varying effects of an alkali of different strengths, from (a) a slight burning with accompanying redness of the parts; with a mild cur- rent, (b) a more decided burning sensation with a local destruction of the superficial tissue, leaving a white scar: with a medium current, to (c) a severe burning pain accom- panied with an active and deep destruction of tissues, a perceptible gathering of fluid products, and an active escape of gasses through the fluids, with a strong concen- trated current. "8. The anode acts locally like the varying effects of a deep penetrating acid of different degrees of concentration, from (a) a slight feeling of discomfort with a local redness of the tissues; with a mild current, with (b) a decided feeling of. discomfort, a tendency to numbness, and a superficial 282 ELECTRO - THERAPEUTICS. hardening of the portion of tissue in contact with the elec- trode; with a medium current, to (c) a severe local pain accompanied with numbness, and an effect of coagulation and hardening of the tissues for some considerable distance around the electrode, with a strong concentrated current.'' In the paper on treatment of stricture, in the Interna- tional System of Electro-Therapeutics, Robert Newman, M. D., gives a thorough exposition of this philosophy of Medical Electricity, from which we quote at some length, as we do not want to misrepresent the status of their fun- damental theory of electrical action. ''Electrolysis is the decomposition of a compound body by electricity— a chemical decomposition. The body to be decomposed must possess certain elements to be an electro- lyte, and, as a compound body, must contain water and salt. A simple element cannot be further subdivided, and, therefore, cannot be an electrolyte. Tissues of the human body have all the properties of an electrolyte, and there- fore electrolysis can be applied there, and electrolysis as a chemical action is an indisputed fact. "Nicholson and Carlisle discovered this process of elec- trical decomposition in 1800, and successfully electrolyzed water into oxygen and hydrogen; therefore the theory is not new, and the explanation can be found in any text- book on elementary physics and chemistry. In combina- tion with this chemical action is the cataphoric, which by some authors is considered an important factor of electro- lysis. The explanation lies in the direction of the cur- rent interpolar, between the elements from zinc to carbou, or the current from electro- negative to the electro-posi- tive. In the external current between anode and cathode the direction of the current is positive, and the particles of the fluid gather at the electro-negative pole, which is the cathode. The galvanic current only produces the de- sired result."— M.—l, International Therapeutics. "Meat Test— The poles of the battery, in the shape of two needles (platinum are best) are inserted in a piece of fresh raw meat. After electrolytic action has been allowed to take place for a while, t'.:e differ- ence in pole action can readily be seen. The positive pole almost destroys it; at the negative pole the color is nearly white, and bubbles of hydrogen appear. In electrolysis the action of the poles is very different, each having its own function. The positive pole attracts ELECTRO - THERAPEUTICS. 283 the acids and the oxygen from the tissues and coagulates the blood. The negative pole attracts the alkalies, hydro- gen and the base of the. salt, dissolves blood (but forms a plug from froth of the hydrogen), coagulates albumen, and causes absorption. The positive pole acts like an acid and burns Jike fire, which is not only exceedingly painful. but may leave a hard, resilient cicatrix. The negative pole acts more like a caustic alkali, which should not hurt so severely during the application, and leaves, if carried to excess, a cicatrix which is soft and not retractile. Thus it is evident that, for the immediate destruction of tumors and for the treatment of strictures, the negative poie should be selected. Electrolysis requires the presence of water, and that is present in every tissue of the human body. It is vitally important to distinguish the poles, and, as we cannot trust to the marks of the instrument- maker, we must always ascertain which is the positive and which is the negative pole. The positive pole is noiseless, the litmus-paper applied to it shows an acid reaction, and the needle adheres firmly to its surroundings in the meat: the- needle of the negative pole sticks loosely in the meat, can easily be removed, and during electrolysis a hissing sound proceeds from it. A piece of fresh meat still con- tains enough water to become an electrolyte, while the living body, in which the circulation is active, is better: a dried up piece of meat is not an electrolyte. The author has made practical experiments on dogs, on pieces of meat, and pathological specimens, particularly with carcinoma. From among them the following are mentioned: (a) Into a piece of fresh raw pork two large platinum needles were inserted, at a distance of three inches apart. The current of thirty-five cells from a galvanic battery was allowed to pass for fifteen minutes, after which the meat between and around the needies was thoroughly changed into a soft pulp. A weaker current caused changes proportion- ately: the current of five cells produced distinct effects in five seconds, twenty cells in one second, (b) Into a piece of meat, containing a bone in the centre, the needles are inserted at a distance of two and a-half inches from each other. One large platinum needle was tlien connected with the positive pole, while with the negative pole two small steel needles were connected. These needles were inserted close to the bone, and one direct into the bone cells. The negative current of thirty-five cells in fifteen 284 ELECTRO - THERAPEUTICS. minutes produced changes in the entire tissue, so that the bone around one negative needle was entirely destroyed." —Ibid. M.— 2 and 3. Here then is the philosophy of electrical action upon the living tissues of the human organism, based upon the electro-chemical phenomena which take place in water in fresh meat, and in short, all organic or inorganic sub, stances, when a current of sufficient electro-motive force and intensity is sent through them to disintegrate their molecular integrity; in other words, to wholly destroy the organic conditions of an organic body, and break up present molecular relations in an inorganic body, when in either case chemical laws instantly go to work to construct new atomic relations; and the new product is builded on chemical laws wholly, whether the electrolysis occurred in an organic or inorganic body. Why did not these experimenters complete their experi- ments, and subject the whole human body to the same proportion of current that it takes to decompose water, and a piece of fresh meat? The recent claims of D'Arsonval, who announces that electricity does not electrocute the criminal, throw a ludi- crous halo around our friends, to say the least; he says the criminal is not killed, but his physiological functions are inhibited— simply the functions of the body are brought to a standstill by the powerful action of electricity upon the nerves, the criminal being in a trance — electric trance, as it were, and death really occurs, he says, from the sur- geon's knife at the autorsy ! This is certainly a startling announcement to the advocates of electrolysis, as well as to the humane society: for if electricity does, as so posi- tively averred by our above quoted eminent authors, pro- duce electrolysis throughout the whole interpolar region, certainly no power could resuscitate the criminal, and if electrocution only inhibits the functional activity of the body, it is in order for the advocates of the "Therapeutic" electrolysis theory to arise and explain the explanation as to why the whole patient does not become raw meat under a "'medical" electric current which produces chemical de- composition. Then, if D'Arsonval is correct, the theory of therapeutic electrolysis is disproved without further argument, and if he should be wrong, then the very fact of patients surviving the therapeutic electric currents is ELECTRO - THERAPEUTICS. 285 proof in itself that electrolysis cannot occur. There is no attempt to explain— in fact there can be no possible expla- nation—why electrolysis, if it occurs in the living tissues in th interpolar region, should be in any way different from the electrolytic phenomena that occur in the ele- ments of the battery cell, in fresh meat, in salt water, or in any other substance, whether it is organic or inorganic: the fact is, that if electrolysis occurs in t he application of electricity to the living tissues of the body it simply means disintegration (destruction) of the organic continuity, and reconstruction of molecular conditions by the chemical changes and interchanges which instantly ensue, which new molecular constitution must necessarily be inorganic. The very fact then that patients not only live under the application of medical electricity, eveu by the advocates of the electrolysis theory, but actually improve, and their ailments disappear, is proof positive that this theory i> false, and elect rolysfs cannot occur in therapeutic electric- ity. This is one of the many singular instances of the inutility of theory, when not in accord with practical re- sults- Here is an agent producing valuable results in many cases, applied upon a false and harmful dogma. Certainly if such good results so often follow the applica- tion of this agent upon such a false idea, how much more good can be accomplished with it if used in accordance with the true philosophy of its physiological action and in harmony with the normal functional activities of the body. Physio-Medical philosophv rejects this idea of electroly- sis as the fundamental basis of Electro-Therapeutics. That electrolysis can be produced upon the living tissues of the body it does not deny, indeed it is willing to make use of electrolysis to get rid of superfluous offending tissues or new growths, but it admits electrolysis as it admits the surgeon's knife, as a last resort, and as an acknowledge- ment of final failure to redeem and restore the organic integrity of tissues, by most thorough sanative thera- peutic means. We accept electricity as a Physio-Medical agent becnuse its current force for all necessary practical medical uses is perfectly sanative, and in line with the vital endeavors to restore and maintain the physiological equilibrium. All who use electricity to any extent in the cure of diseases, regardless of school or theoretical belief as to its action, must admit that under its influence in proper current, intelligently applied in accordance with 286 ELECTRO - THERAPEUTICS. the conditions, that nutrition is promoted; that the circu- lation, local or general, is increased; that the functions of assimilation and dissimilation are rendered more active; that nerve energy is increased and equalized; and that the patient experiences a strengthening and invigorating effect from its application. Upon these results we establish the Physio-Medical philosophy of Electro-Therapeutics. The term "catalysis" was used by the old electricians— who are now called empirics — on the above idea with the enu- merated beneficial results which have been so frequently observed and lauded by all alike, regardless of school, or theory, since its discovery. This term, as well as these facts which are incontrovertible, it is now sought by the advocates of the new Electro-Therapeutics to relegate to the realms of empiricism and obsolescence. Static electricity was the first form of electricity discov- ered, and the only kind used for medical purposes for a great many years. Any one at all acquainted with its nature knows that it is impossible to produce electrolysis with static elecricity. This form is in fact nascent elec- tricity, yet it is not the result of chemical action. Great- confusion has arisen from the close resemblance of elec- trical and chemical forces and phenomena; the fact is that writers upon the subject seem to make no distinction be- tween chemical action and electrical force, notwithstand- ing the fact that a correct understanding of the same constitutes the basis of all correct Electro-Therapeutic investigation. In the galvanic battery we have first the chemical action of the fluid upon the metal (zinc), its chemical molecular disintegration, and the liberation of atoms which instantly seek new combinations. Asa re- sult of this general breaking up of the old, and formatiou of new atomic relations, as far as affinities permit, there are atoms, or, perhaps, atomic constituencies, combined into kinetic energy, constituting the subtile ethereal force which we call electricity; which now seeking a level of potentiality, readily traverses any conducting media from one element of the battery out through all intermediate or interposed substances forming a circuit as it returns to the other element of the battery, which is of less potenti- ality, thus constituting the electric current. Thus while chemical action creates the conditions from which arises electrical force, we must not confuse the conditions with the result itself, for the chemical action and the electrical ELECTRO - THERAPEUTICS 2*7 force are certainly two entirely different things. As proof of this, in statical or mechanical electricity we have no chemical action or disintegration from which the electri- cal force is generated; here the electrical force is obtained simply by agitation of the atmosphere from which it is liberated, and seeking the balance of potential as before. is taken up by the proper conducting media and consti- tutes the static electrical current. Therefore this the- ory of chemico-electro-therapeutics, which is assumed, perhaps, in order to harmonize electricity with the mod- ern ehemico-therapeiitics, is as fallacious as the idea of electrolysis. A few experiments with the electrical current under proper conditions will demonstrate our theory of physio- logical electro-therapeutics. With the life-slide, place un- der the microscope an amoeba; attach about No. 30 wire electrodes, bringing the poles a little distance at opposite points from the amoeba, and turn on with a good current controller first an exceedingly mild galvanic current. Af- ter a few seconds the amoeba will exhibit more activity, it will move with greater vigor and seemingly increase in bulk Now increase the current slowly and very gradu- ally; the amoeba exhibits correspondingly increased activ- ity, but when the current has reached a certain degree of strength, il exhibits symptoms of exhaustion, and finally assumes a spherical form, all motion ceases, and it is ap- parently dead: but with a very mild faradic secondary current from coarse wire it can be resuscitated; if, how- ever, the galvanic current is continued five minutes longer after assuming the spherical form, it remains motionless despite all efforts to resuscitate it, and i n the course of twenty minutes to an hour disintegration has taken place: it is reduced by chemical action back into the simpler ele- ments, and as an amoeba is gone forever. If the faradic current, exceedingly mild, is used instead of the galvanic, and not increased, the amoeba will live and seemingly do well under it for an almost indefinite time; but if this current is increased gradually as with the gal- vanic current, the same result occurs, though not nearly so soon. The same phenomena exactly will be observed in experiments with the white blood-corpuscles. Now. cer- tainly, electrolysis has not occurred in the amoeba or white blood-corpuscles when they can be resuscitated with the mild faradic current, and chemical disintegration and de- 288 ELECTRO - THERAPEUTICS. composition does not occur until a considerable period after all life manifestations have ceased. Then what does kill the amoeba and the white blood-corpuscles ? Exactly the same thing that would cause the death of the complex organism of the human body under proportionately the same force. It is essential that we bear in mind the pro- portionate relation between micro-organism and the vol ume of electric current. We have a being so minute that it must be increased in volume several hundred times to come within the region of our optical power, consequently electro-motive force and current quantity must be propor- tionately diminished, Now apply the same proportion to the whole human organism, or in other words, take the same amount of current strength that would kill an amoe- ba or white blood-corpuscle and multiply it by the number of living bioplasts in the human organism, and we would have enough electrical force to kill a billion men! And yet they undertake to base Electro-Therapeutic hypothesis upon such data, The fact is that the most harmless and beneficial substance used by man would, if applied in the same ratio, become a huge sum of evil. Let us undertake to use bread for instance in the same proportion as the electric current required to kill the amoeba and the white blood-corpuscles, and we would be crushed under the weight of billions of loaves, much less attempting to eat them. Adjust the web of a frog's foot under the microscope with a magnifying power of 900 or 1,000 diameters, and arrange the poles of the battery under a current con- troller, turn on— what is best for this experiment— the faradic current coarse secondary coil with rapid interrup- tions, bring on the current exceedingly mild at first, gently increasing it to the current strength that would be barely perceptible through the little finger. Watch carefully the change that takes place. The accompanying- cut, which is partly diagramatic, gives only a faint illus- tration of what can be seen under proper conditions after the current has been applied for from twenty to thirty minutes. The first thing to be seen is an increase in the circulation as evidenced by the rapid movement of the blood-corpuscles. There will be an increase in the number of red blood-corpuscles seen in the vessels near the positive pole, which will finally extend toward the negative till it covers nearly half of that polar region.- Now after start- ELECTRO -THERAPEUTICS. 589 ing the current again, with a camel's hair brush apply to the surface both above and beneath, close to the positi ve pole, a very small quantity of staining fluid, analine blue, for instance; after the current is continued for perhaps five or ten minutes, the white blood-corpuscles and the extravascular interspaces (areolae) will be seen to become filled with the coloring matter; and gradually the stain- ing will move like a cloud through the areolar interspaces toward the negative pole, and remain collected in a dense cloud about this region. Now reverse the poles, and after the current has continued fo: from ten to twenty minutes the whole process is reversed; the vessels at the other pole. now negative, become richer in blood-corpuscles, and grad- THE WEB OF A FROG'S FOOT UNDER THE FARADIC CURRENT AS SEEN UNDER THE MICROSCOPE, plus 1,000. Partly diagramatic; that is, the electrodes P and N of course were not in the microscopic field; and the fibrous net work F is introduced to show the form and limits of the extravascular space-, A. 290 ELECTRO - THERAPEUTICS. ually the cloud of color traverses to the negative pole again. There is nothing resembling electrolysis in this phenomenon; the current is a faradic secondary, with which it is impossible to produce electrolysis in any sub- stance, and there is no disintegration of tissue elements or tissues; on the contrary there is every evidence of in- creased vital activity, and all the conditions favorable to the great physiological process of nutrition and growth. The lesson we learn from these experiments with the amoeba and white blood-corpuscles, and the webb of the frog's foot, is one of vast importance. Not least of which is, that electricity applied in accordance with the physio- logical demands of deranged tissue conditions, and per- verted functional actions, it exerts a mild stimulating, toning effect upon the living matter of the tissue elements, and from the initial increase and strmgth of vital actions arises a general equilibrium of nervous action and circula- tory volume and strength, favoring all the important steps of assimilation, reparation, and disassimilation. Upon these facts as observed by the application of elec- tricity and the web of the frog's foot under the microscope, and which can be further extended by experimenting with the mesentery of a young mouse, the cornea of a frog, and patches of epithelium scraped from the tongue, etc., sub- jected to the same electrical current under the microscope, we base our philosophy of Physio-Medical Electro-Thera- peutics. As a basis, then, of our theory of Electro-Therapeutics, and for the want of a better term, we have coined the word "Electr osmosis." By this term we mean the sana- tive influence of properly applied electrical currents, of mild and harmless strength and volume, that shall act in the line of the resistive and reconstructive efforts of the Vital Force. In fact the term is synonymous with that of "catalysis" as used by the older electricians. The contenders for therapeutic electrolysis are compelled to admit all these facts as to the increase of all the nutri- tive functions, the general invigorating, tonic, and stimu- lating effect of electricity upon the system; but they allude to it in a vague way, exactly as they admit the "vital force" in the living organism whose actions "are sometimes constructive, sometimes destructive;" but when pressed as to what is really meant by the term "vital force," no definite answer is elicited. It seems then that ELECTRO -THERAPEUTICS. 291 the term electrolysis being more in harmony with the idea of induced diseased conditions to remedy existing patholog- ical states, it is desirable to do away with all ideas of san- ative influences of mild electrical therapeutical currents. "We are aware that tissue changes are produced, that nutrition is promoted, that obscure nervous tendencies ai> j transformed by the mildest application of the faradic. stat- ic or galvanic form of electricity. * * * These effects of the current, then, including the refreshing and invigora- ting effect often experienced from the application of the above forms of electricity, which cannot be the effects of electrolysis, but which may be due to the mechanical ef- fects of the current, which, like massage or other form of mechanical treatment, favors tissue changes, are included under the convenient name catalysis, a term which it is to be hoped may rapidly become obsolete, with many other terms connected with empiricism.'' — Electricity, Diseases of Women avid Obstetrics. F. H. Martin, M. D. And why, forsooth, should this and other terms of •'em- piricism" become obsolete, if they express exactly what takes place under "the mildest application of the faradic. static, or galvanic form of electricity?" In the absence of any reason given by the above, or all other authors of that school, are we not justified in presuming that the term catalysis and all that it implies being directly opposed to the fundamental basis of the medical philosophy of l 'contraria contrarius cnranterC and "dlos pathos" it is desirable to get rid of it and base Electro-Therapeutics u'ou electrolysis, which means electro-chemical disinte- gration of the living tissues— destruction of diseased tissue elements in the hope that in the reconstructive efforts of the vital force the diseased conditions may be eradicated ? We are justified further in this conclusion from the fact that hundreds of terms far more empirical are still re- tained and continually used. For instance, the terms inflammation, artery, diaphragm, Bright's disease, have all arisen from the most empirical and erroneous ideas of anatomy and pathology; they are meaningless and arbi- trary in the light of advanced sciences, yet are continually used in ail their original glory of "empiricism;" whether thus kept in use purposely or not, they are certainly in accord with the traditions of the "Regular" medicine -as expressed in its present medical philosophy. 292 ELECTRO - THERAPEUTICS. Physio-Medical .Electrical Dosage. Then as we have already seen, from the Physio-Medical standpoint the current quantity, intensity, and work, are all-important, and summed into one word mean dosage. And our dosage means mild sanative currents as applied to the organism to correct departures from normal physio- logical functional actions. In other words, we seek and use those electrical currents that act in harmony with the vital force in maintaining the vital integrity of living matter and tissue elements, purposeful and harmonious functional activities, the constructive and sanative efforts of the vital force generally — Sanative Electro- Therapeu- tics. Our dosage being mild and sanative, it follows that our most valuable current quality is the induced; the faradie apparatus and farad ism being the basis of Physio-Medical electricity. Not that the galvanic does not afford us valu- able sanative work in proper dosage, but the faradie sec- ondary is the most valuable. The Faradie Current- It is not necessary here to describe minutely the faradie apparatus, much less attempt to refer to the numerous faradie machines on the market. We therefore content ourselves with briefly classifying the current qualities and the Electro-Therapeutic effects of each. From the faradie apparatus, as generally constructed, we get three qualities of current, each of which may be varied and multiplied by special construction of the appa- ratus. These, mentioned in proper sequence of their oc- currence, are: — 1st. Primary faradie. 2d. Induced, or secondary faradie. 3d. Electro-magnetic. Primary F. 2^ '4 in the core called magnetism and it becomes a magnet. This fact is taken advantage of to mechanically interrupt The current— break it up into'exceetlingly short waves. A little metal hammer on a spring or flexible post is placed in front close to the end of the core, so that when it be- comes magnetized this hammer or "rheotome" is attracted to it and drawn away from a screw point in an adjacent stationary post which is bringing the current to the coil. This movement of the rheotome breaks the current, when the core is instantly demagnetized, releasing the rheotome. which flies back, receiving the current, again magnetizing the core, which attracts the rheotome to again break the current and demagnetize the core, and thus the current is more or less rapidly interrupted according to the rapid- ity of the vibrations of the rheotome. The wire of the primary coil is quite coarse, which offers less resistance and affords a greater volume of current. Therefore we have two essential qualities of current, viz.: high volume and low tension. To these may be added a third quality, that of rapidity of interruptions. Therapeutically we get from the primary faradic current muscular stimulation, by the large volume, low tension and slow interruptions. Va so -motor stimulation, by the large volume, very rapidly interrupted, giving a great- er intensity. Secondary Faradic or Induced Current. — This is our most valuable current, especially as afforded by the recent improvements in faradic machines. We have a variety of current qualities, which in their sequence may be classi- fied as follows: Large volume [voltage) and high potency. This is ob- tained from a coarse secondary cv.il of moderate length, whose potency may be varied by the character of the inter- ruptions, as follows: Slow interruptions, stimulates mus- cular tonicity, voluntary and involuntary: increases local nutrition by increasing the circulation- -vaso-motor stimu- lation. Rapid interruptions,, vigorous muscular stimula- tion, and increased nervous circulation. Smaller volume (amperage) a tid higher tension (poten- cy). This is obtained by a secondary coil of fine wire (No. 20) and considerable length (1.500 feet. This may be varied by the character of the interruptions as follows: Slow inter- ruptiotts, stimulates deep muscles, and increases vaso- 294 ELECTRO - THERAPEUTICS. motor action. Moderately applied tor thirty to forty min- utes with 600 or 800 interruptions per minute, it leaves a general pleasantly stimulated sensation, and an invigor- ating effect. Rapid interrupt Ions, from 1,000 to 1,500 per minute. This current will exert a still more soothing influence upon the nervous system if applied generally, say at the back of the neck and to the feet; at the same time it increases the vaso-motor functions generally, so that after thirty or forty minutes or an hour's sitting the pa- tient is in a general warm perspiration, and no matter where or how many aches and pains, acute or chronic, he is in a most agreeable state of perfect ease and quietude; if he has lost sleep from pain he will go to sleep under the treatment, and awake at the end of it with a feeling of deep rest and refreshment. Very rapid interruptions, 3,000 to 5,000 per minute, increases the above effects, and is best in cases of extreme nervousness, with acute pain and tenderness locally. Very small volume {amperage) and exceedingly high tension. This most valuable current is obtained with a very fine wire (36 or 40) and 2,500 to 3,000 feet long, and is usually used with very rapid interruptions, 3,000 to 5,000 per minute. It is the nervine current. Used with the positive pole at the back of the neck and the negative at the feet, with a sitting of forty to sixty minutes, it most effectually relieves all nerve tension, pains, aches, and general muscular soreness. Applied locally it relieves local congestions, engorge- ments, tenderness, and irritation. In ovarian irritation, congestions acute or chronic, hypertrophies, or other en- largements of uterus and appendage; chronic enlargements of the liver, spleen and kidneys; congestion, pain and ten- derness of the stomach and bowels. Electro- Magnetic Current.— When the soft iron core in the primary coil of the farad ic apparatus is unmagnet- i zed by the sudden stoppage of the current through the primary wire as the rheotome strikes it, breaking the con- nection between it and the screw post, as in f he ordinary arrangement of the machine, the static magnetic force instantly pours out of it in every direction, as light, or heat-rays would emanate from a radiant or a heated body; and obeying the physical law of electricity, it seeks a me- dia of less potential, which would be the wire coils. Now it is natural to suppose that in seeking its potential leve] ELECTRO -THERAPEUTICS. 295 the magnetic current would lodge in the secondary coil-, because they are of much lower potential than the pri- mary wire; second, because the initial force of the escaping magnetic volume is the greatest at the start and this would project at least its main volume through the pri- mary coil out to the secondary wires, to which it is drawn by the additional force of potential attraction. This would add to the secondary faradic currents, already described, more or less magnetic current, making it an electro-magnetic current. With our present means of investigation it is impossible to determine the proportion of these two forces— electric and magnetic— in this combi- nation, much less to determine which is the greater or less factor in the therapeutic effects of this current. Magnetic-electric machines have been variously devised, affording a current in which the magnetic largely predom- inates; but so far they have not yielded therapeutic advantages over the faradic currents, and consequently have not come into general use. The Galvanic Current. This is simply the constant stream directly from the batteries or cells through switches, current controller, milliamperemeter, and any other essential media consti- tuting the board of galvanic apparatus, and the interposed media as the patient. From this current we get the larg- est current force, amperage, from a medical standpoint at least, and therefore it should be used moderately. The most useful form of galvanic current is the inter- rupted. It is found that by mechanically breaking the current flow into exceedingly short waves or rapid inter- ruptions a very large amperage or current quantity can be used without producing electrolysis of the tissues; indeed the application soothes irritation, relieves pain, the structures being in a state resembling anaesthesia for some little time after the current is discontinued. The best, cheapest, and simplest galvanic interrupter is a small electric motor: the toy motors which range in price from $1.50 to $5.00 are quite sufficient. The little metal pulley-wheel is divided into about three or four equal segments insulated from each other by filing broad grooves and fitting in them segments of wood or other non-conducting material. The motor is run with about three small cells which can be thrown on in succession by 296 ELECTRO - THERAPEUTICS. a selector or double switch. The first cell runs the motor at a moderate speed; by adding to it the second it runs at a rapid speed; and adding the third, exceedingly rapid revolutions are attained. It is now only necessary to bring the galvanic current to the pulley by spring bearings so that one bears against the end of the metal pulley, and the other bears on the segmented surface of it, sliding alternately over a wooden and a metal segment, thus breaking and making the current with proportionate rapidity to the revolutions of the pulley. The galvanic current thus interrupted is better than the constant current for fibrous and fibroid tumors; for cysts of very fluid contents, such as ovarian cysts; and for pleural and abdominal effusions, etc. For vascular tumors and cheesey cysts the constant cur- rent should be used. No Heroic Dosage. In all currents, but especially the galvanic constant, mild amperage should be used; the current strength need never exceed fifteen or twenty milliamperes. It is just as grave a mistake to believe that heroic electric dosage is necessary, even in the removal by absorption of fibrous tumors, as to administer heroic therapeutic remedies and dosage, such as strychnia, aconite, dynamite, etc. For we insist, as has been amply proved herein from the best au- thority, viz., its own advocates, that electrolysis never occurs in the interpolar region; and these growths are re- moved by the physiological process of absorption, which is simply increased to its highest activity by the sanative stimulating influence of the electric current upon the liv- ing matter of tissue elements. Let us here impress upon the Physio-Medical beginner in the use of electricity, that a good knowledge of physiol- ogy, the Physio-Medical philosophy of Electro-Therapeu- tics, and a little patience and perseverance will accomplish far greater curative results with mild and persistent cur- rents of electricity, than by the painful and dangerous heroic dosage. The author has followed the simple rule for twenty-live years of using no current of electricity stronger than the patient can agreeably bear. Our milliamperemeter im- practical dosage is the patient. Briefly stated our method is as a rule, mild currents, stationary large electrodes, and ELECTRO - THERAPEUTICS. 297 long sittings, from 30 minutes to one hour. Seated in an easy upholstered chair wired for the purpose, we place our re-enforcement pads, (see Max Wocher & Son's catalogue. Cincinnati, Ohio,) upon the patient at the required points, hand them some interesting literature to entertain them- selves with, turn on the current with a Massey controller till the patient says, '-That's about right," and then go about our business, probably attending to five or six other office patients in the mean time. To the honest critic who believes the above method old- fashioned, '-empirical,'' and -'too weak" to accompli>h anything, we have only to say that, although we never take ''certificates," we can furnish ample proof of the re- moval of an ovarian cyst, large as the gravid uterus at full term, by the faradic secondary current, an hour's sitting every third day for three months. The removal of numer- ous fibrous and fibroids, from the size of a hulled walnut to a cocoanut, with the faradic secondary, and also the galvanic, of not over ten milliamperes, rapidly interrupted. Surgical Electricity. As already stated we use electrical currents to the extern of producing electrolysis, only as we use the scalpel— after all sanative resistive and constructive vital efforts, aided by sanative therapeutic means, have failed, and it becomes necessary to remove an obstructive perverted growth. In such cases, where inconveniently situated, and there is danger of excessive hemorrhage with the knife, electroly- sis becomes a valuable surgical means. Deep electrolysis of dense growths, deep or superficial, is accomplished by introducing silver or platinum needles, and using the con- stant galvanic current of sufficient amperage to cause dis- integration or electrolytic action upon the fluids of the areolar interspaces, extra-vascular spaces, and living matter of the tissue elements at each polar (not interpolar) region. Electro-cautery is produced by passing the constant galvanic current through variously-shaped platinum cau- tery-knives, which are constructed so as to form a circuit of sufficient intensity to bring the knife to a white heat. With our modern aseptic surgical technique, and our means of controlling hemorrhage with compression forceps and the Esmarch bandage, surgical electricity can never attain a very prominent position. However for facial blemishes electrolysis has a field that 298 EMBELIA. is fast bringing it into prominence. Warty growths, moles, nevi, etc., and superfluous hairs, can be removed by the constant galvanic current. But here, as in the gener- al use of electricity, much harm has been done by heroic dosage amounting to actual cautery, producing a wound exceedingly hard to heal and leaving a cicatrix much more unsightly than the original blemish. Mild current with low tension, which effects electrolysis of the fluid plasma and living matter, and not actual cautery, though the treatment requires a little more time and patience, will accomplish the work more effectually and leave no cic- atrix, ELETTAEIA REPENS. Cardamon. Malabar. The seeds are a stimulating, aromatic, warming carmi- native. They are chiefly used as a vehicle for cathartics to prevent griping and nausea; and with bitter tonics, es- pecially with quinia sulph, gentiana and apocynum an- drosem. It partially covers the bitter taste. Cardamon Seed Caraway Seed aa. oz. 1 Cinnamon Bark oz. 2 Raisins, Seedless grs. 8 Or Cardamon Seed Cassia Cin. aa. oz. 2f Caraway Seed oz. H Either formula makes one pint of fluid compound carda- mon. Either forms a good vehicle for bitter medicines. EMBELIA RIBES. Babarang. India, Malaga. China. This climber is native to the forests of Bengal. Its seed is similar in appearance to pimento seed and is slightly aromatic. It is a pleasant, mild, stimulating, astringent, alterative tonic, influencing the mucous and serous membranes. It is considered a specific in the treat- ment for the expulsion of tape worm. A teaspoonf ul twice a day followed by a cathartic is sufficient for a child while a dessertspoonful is required for an adult. It usually expells the worm dead. In small doses it improves digestion, relieves flatulence, tones the stomach, soothes and stimulates the nerves, and EPIG^EA. 299 soothes and tones the serous membrane. Its alterative quality is best realized when combined with some such agent as iris versicolor. With salicylate sodium it gives good results in rheuma- tism and dyspepsia. EPHEDRA ANTLSYPHILITICA. Brigham Weed. Western U. S. This herb grows in Arizona and the surrounding States. It is a mild but positive stimulating alterative, slightly astringent. By the people among whom it grows it is recognized as a very efficient agent in the treatment of gonorrhoea, syph- ilis and various eczemas. It is certainly an admirable alterant. It soothes, stimulates and tones the general sys- tem, but its depurative properties are aided by combining with such agents as syr. juglans or iris versicolor. It is also valuable in scrofulous diarrhoea and the diar rhoea sometimes incident to phthisis and in cholera in- fantum in scrofulous, syphilitic and rickety children. It eliminates impurities, cleanses the blood current, and tones the mucous membrane. EPIGJEA REPENS. Gravel Plant. The leaves are a mild stimulating and astringing diu- retic. In sluggish renal action they stimulate, sooth and tone the kidneys and promote diuresis. They relieve the ach- ing back and stimulate the prostate gland. This agent is of much value in gonorrhoea and cystic catarrh. F. E. Epigsea Rep. 3 '• Mitchella Rep. 2 Fid. Hydrastis Can. 1 This is a good remedy for gonorrhoea. F. E. Epigsea Rep. dr. iv " Celastrus Scan. dr. i " Mitchella Rep. dr. ii ; ' Althsea Ros. dr. ii Syr. Simplex q. s. oz. iv This is a valuable prescription for spermatorrhoea and all irritable troubles of the urinary apparata. 300 ERECHTHITES. F. E. Epigsea Rep. dr. iv " Liriodendron Tul. dr. ii " Eupatorium Purpu. dr. ii Hydrastia Sulph. gr. i Ferri et Pot. Tart. grs. iii Syr. Zingiber q. s. oz. iv This is a good tonic for prolapsus uteri, chronic cystitis and general pelvic weakness. Epigaea Rep. 4 Amygdalus Pers. Fol. 6 Cypripedium Pub. 2 Zingiber i This in cold infusion is a good preparation to be used for weakness of the bladder, and for gleet. EPILOBIUM ANGUSTIFOLIUM. Willow-herb. (Epiiobium Spicatum.) The root is a pleasant astringent tonic, chiefly influenc- ing the mucous membrane and useful in cases of dysentery, diarrhoea and cholera infantum. The leaves are more diuretic and influence the entire pelvic viscera. They are useful in chronic cystitis, cystic catarrh, leucorrhoea, gonorrhoea, vaginal weakness, and uterine hemorrhages. In severe cases it may have to be combined with more positive agents. EPIPHEGUS VIRGINIANA. Beech-drop. This plant is a stimulating astringent. When applied to the surface of foul and indolent ulcers and gangrenous sores it arouses and cleanses the surface ready for the application of an appropriate dressing. Internally or ex- ternally it may be used for the relief of hemorrhages. ERECHTHITES HIERACTFOLIA. Fireweed. The leaves and flowers are a mild bitter, stimulating, astringent tonic. Its chief influence is expended upon the mucous membrane and are best in relaxed and sluggish conditions, as in chronic diarrhoea. In combination with uva ursi it is valuable in cystic catarrh. Combined with agents that chiefly influence the genera- ERIGERON. 301 tive organs it is useful in vaginal weakness and in prolap- sus uteri. It is also of service in hemorrhages of the lungs and of the bowels, as "well as in menorrhagia and in post-partem hemorrhage. Incorporated into an ointment it is a good application for old sores, for hemorrhoids and for rectal ulcers. The oil of fireweed more or less diluted with olive oil forms an excellent application for hemorrhoids. ERIGEROX CAXADENSE. Canada Fleabane. This herb is a diffusive, aromatic, stimulating, astrin- gent. It is best administered in small and frequent doses. In hot infusion it influences the circulation toward the surface and is of advantage in hyperagmic conditions. In diarrhoea, dysentery and cholera infantum it is a superior remedy. Repeat small doses as the conditions require. it is quite effective for the relief of hemorrhages, whether from the lungs, nose, uterus or bowels. Dr. F. G. Hoener recommends an infusion to be used as an injection in cases of gonorrhoea. The oil of erigeron is very diffusive and has almost en- tirely superceded the use of the herb for hemorrhages. A good fresh article is a success; age impairs the quality of both the herb and the oil. Give one to four drops on sugar and follow with a little hot water. This is the ordi- nary dose of the oil, but do not depend too much upon this agent unless you know the quality of the oil you are using. You can better depend on capsicum and lobelia or on cap- sicum alone. The following is a good preparation to be used in such cases: Oil Capsicum •• Erigeron aa. 1 Sugar or Lactin 10 Triturate thoroughly and administer from one to three grains every ten minutes for two or three doses and then lengthen the time as the conditions require. If it be post- partem hemorrhage give only as required or you may check the flow so completely as to give trouble i n the opposite direction. For metrorrhagia Dr. G. H. Mayhugh advises the fol- lowing - : 302 RIODICTYON. Oil Cinnamon '• Erigeron aa. gtt. 5 to 10 M. Sig. Give in hot water every five or ten minutes till the flow is checked, then give every half hour till relief is had. In cases of anal fistula apply erigeron throughout its entire length. It will cure it. In cases of rectal ulcer, it will arouse the parts, but it will cure the ulcer. ERIGERON PHILADELPHICUM. Philadelphia Fleabane. This plant is a stimulating diuretic. Dr. F. G. Hoener says: This agent, combined with some good alterant preparation, will cure those afflicted with syphilitic ulcers on the lungs. ERIGERON STRIGOSUM. This is another species of the fleabane. The leaves and flowers in medical properties much resemble the erigeron philadelphicum. They are valuable, says Dr. F. G. Hoener, for cuughs, colds, sores in the mouth or on the tongue or tonsils. It may also be used as a gargle for the throat, and as a wash for foul ulcers, sores and old wounds. It may also be used as an injection for gonorrhoea i n severe caseN. and gleet. ERIODICTYON GLUTINOSTJM. Yerba Santa. Northern California. This is of thorough balsamic properties and quite stimu- lating to the bronchi, trachea and larynx. It is a superior agent to be used in cases of chronic congestions and slug- gish conditions, chronic laryngitis, aphonia, paralysis of the vocal chords and chronic bronchitis. In inflamed and irritated conditions it is best combined with more relaxing agents. It is a good agent to add to cough syrups when there is a dry, hacking cough, a constant desire to clear the throat, with sputa scanty and dry. It almost completely disguises the bitter taste of quinine and an aromatic syrup is an excellent vehicle for the ad- ministering of quinine in the proportion of about 8 to 1. ERYTHROXYLON. 303 ERYNGIUM YACCJEFOLIUM. Water Eryngo, (E. Aquaticum.) Button SnaJce Hoot. The roots are a moderately diffusive stimulant, some- what relaxing. It influences the mucous membrane, the circulation and the secernents. In hot infusion it promotes diaphoresis, and increase expectoration. Large doses prove emetic and cathartic. It is useful in the exanthems to bring out the eruptions, as in cases of small-pox, scarlatina and measles. It is claimed that it will eliminate the viri of snakes. For this purpose it should be used internally and applied externally. It influences the kidneys, the bladder and the urethra in the relief of chronic congestions and gleet. Combined with epigsea repens it is a superior tonic diuretic, useful in dropsy and nephritis. It also lessens erections and pre- vents seminal emissions. It lessens urethral, vaginal or rectal irritation and is valuable for diarrhoea, leucorrhcea. and hemorrhoids. It makes a good addition to some alterative medicines for the elimination of impurities from the circulation, as in scrofula and syphilis. ERYTHRONIUM AMERICANUM. Adder 's-tongue. The leaves ami roots lose much of their power by dry- ing. In the green or recently dried state it is a moderate stimulating antiseptic and astringent. Dr. F. G. Hoener recommends this agent in ha?mateme- sis and hamialtirrhcea and says that it is a very cooling antiseptic. ERYTHROXYLON COCA. Cuca, Coca South America. The leaves of this plant somewhat resemble the leaves of the tea plant. The leaves are dried in the sun and are much used by the inhabitants of Peru, Ecuador, Columbia and Rio Negro, in which countries it grows wild, and it is also much cultivated and used in Bolivia. The Peruvian Indians use from one to three ounces a 304 EUCALYPTUS. day and seem to be well sustained by its use. When used in moderate quantities it increases nerve energy, re- moves drowsiness, gives an indisposition to sleep, much as tea or coffee. It enli\ens the spirits and enables the Indi- ans to bear cold, wet, bodily exertion, and even the want of food for whole days with apparent ease. But they will eat freely in the evening. But they find it necessary to use in conjunction therewith some alkali, as ashes or lime. When well dried they have an agreeable odor and in infusion have a peculiar taste somewhat bitter and astrin- gent. Cocaine C16H19NO4 or C17H21NO4 is the alkaloid. It in- duces a series of symptoms affecting the nervous, respira- tory, circulatory, vasomotor and glandular systems. Cocaine is a local anaesthetic. Cocaine Hydro-chlorate. — This salt of cocaine usually comes in the form of crystals. Useful in ophthalmology, especially the large crystals. H grs. bo 1 dr. dis. water equals a 2 per cent, solution. Add 2i grs. for a 4 per cent, solution, and double this for an 8 per cent, solution. These solutions should always be properly prepared. The following is recommended as a dental sedative: Hyd. Cocaine gtta xx Oil Cloves Chloroform aa. dr. i Alcohol Oz. i Diy the gum and apply a few drops around an aching tooth. Squeeze the gum between the finger and thumb for a few seconds. This will paralyze the gum. Then extract the tooth immediately. It may also be injected into the gum. Coca Cordial or F. E. may be used. Coca. — The leaves in a remarkable degree possess the power of sustaining the vital powers, under conditions of extraordinary fatigue and privation. Useful in nervous exhaustion, sleeplessness, mental depression, and in reliev- ing the opium habit. EUCALYPTUS GLOBULUS. Eucalyptus. This is an evergreen which grows vigorously in Australia and California. The leaves contain numerous pellucid glands filled with an essential oil which is quite diffusive, having a strong, penetrating, disagreeable odor. This EUCALYPTUS. 30i odor assists respiration and neutralizes marshy miasms. The tree is of very rapid growth and has been very fre- quently planted for thea latter purpose. The bark, flowers and fruit are covered with glands containing the oil, which is denominated eucalyptol. This is an antiseptic in fevers and catarrhal affections, in odontalgia, in gonor- rhoea and gleet, in gastric ulceration and in diphtheria. Dr. J. E. Raop uses locally the following for endo- metri- tis: Eucalyptol Fid. Hydrastis aa. 1 Glycerin 2 For nasal catarrh use with the nasal douche or atomizer two to four times a day. Eucalyptol Sodae Bicarb. aa. dr. i Glycerin oz. i Aqua oz. xvi This may also be used as a wash to cleanse offensive dis- charges from sores. In hot infusion the leaves form a fine febrifuge and anti- periodic. They contain a resin which is precipitated when water is added. The infusion is quite stimulating to the throat and fauces and is serviceable in membranous croup. F. E. Baptisia Tine. dr. i " Eucalyptus Gl. dr. iss Aqua q. s. oz. iv Gargle with this every hour and swallow a half teaspoon- ful for sore throat. F. E. Eucalyptus oz. i Aqua q. s, oz. iv This is a good antiseptic gargle for diphtheria and scar- latina, or Eucalyptol gtta xv may be added to half a glass of water and used for the same purpose. For membranous croup use F. E. Eucalyptus oz. i Syr. Simplex oz. iii Ten drops or more of the fluid extract or of the oil four times a day will be found serviceable in dropsy. Dr. Hunter recommends the following in teaspoonful doses every two or three hours for a dry, tickling cough and in bronchitis: 306 EUGENIA. Elixir Eucalyptus F. E. Grindelia Robusta (soluble) "' Cypripedium Pub. aa. oz. ss Syr. Simplex q. s. oz. iv Tr. eucalyptus gtta. xx to xxx used three times "a day is a specific for cystitis. Eucalyptus, benzoate soda, boracic acid, yerba santa. yerba reuma, vaseline. Apply locally for nasal catarrh. The following forms a good local anaesthetic: Cocaine, hydronaphthol. eucalyptus, mentha arvensis, baptisia. gaultheria, thyme, benzO-boracic acid. Euthymol (eucalyptus and thymol antiseptic), a liquid preparation of wide utility. It is neither poisonous, irri- tant nor escharotic and is perfectly safe in any form of ad- ministration, whether internal or external. It possesses an agreeable odor and may be used instead of iodoform and carbolic acid. It equals either as an antiseptic and does not possess their objectionable characteristics. Each fluid ounce contains: Oil Eucalyptus 3-8 M. " Gaultheria 9-32 " F. E. Baptisia Tinctoria 1 1-4 •• Boracic Acid 10 15-16 grs. Menthol 5-64 " Thymol 15-32 " This article should not be exposed to the cold. It should be used as a spray or internally in doses of a fluid dram three or four times a day. EUGENIA CHEQUEN. Chekan. (Myrtus Chekan) Chili. The letives are slightly stimulating, astringing and ton- ing to the mucous membrane especially of the respiratory organs. It contains a good percentage of volatile oil. Chekan is tonic, expectorant, diuretic, and antiseptic. It is chiefly valued in purulent bronchial inflammation, bronchial and Cystic catarrh, emphysema, winter-cough, phthisis where the expectoration is too free, catarrhal conditions where the expectoration is difficult of removal and pneumonia. Through its toning power it decreases purulent expec- toration. EUGENIA. 307 It also influences the serous membrane and is valuable in the treatment of rheumatism. EUGENIA JAMBOLANA. Jambul, Java Plum. East Indies. This is a tree of some considerable size, yielding- an abundant crop of a pleasant and a much esteemed sub- acid fruit. In the East Indian peninsula it is abundant in both the wild and the cultivated states. The fresh bark and the leaves yield a juice that is valued in the treatment of acute and chronic diarrhoea both of children and of adults. The use of the root and of the seed give similar favor- able results. The bark and especially the seeds seem to have the pro- perty of arresting - the excessive formation of sugar in cases of diabetes mellitis. The physicians of India claim that not only does it cure diabetes, but that it enables the patient to continue to eat anything without augmentation of sugar in the urine. It arrests emaciation, assists in the general improve- ment of nutrition, giving natural sleep and a less ten- dency to micturation. It diminishes the density and quantity of urine and relieves the intolerable thirst of which those patients suffer. It influences intestinal digestion and thus prevents ex- cessive saceharitication. It influences the vaso-motor cen- ters and is hence useful in cases of diabetes of nervous ori- gin. Large doses may produce nausea in some patients. In order to better prevent the tendency to glycosuria the diet should be watched and restricted to skimmed milk, gluten bread and meat. The powdered extract may be given in dose of 5 grs. 3 times a day, or 5 to 8 grains of the powdered seeds may be given, or 6 to 8 drops of the fluid extract. These doses may be much increased if desired. It is usually best to begin with small does, say 5 drops of the fluid extract one hour after each meal ana this dose increased one drop per dose per day or given as required. EUGENIA PIMENTA. Allspice. (Pimenta Officinalis.) The berry is a mild diffusive, stimulating, astringent aromatic. 308 ETJONYMOTJS. It is chiefly used as a vehicle for cathartics and bitter tonics. In cholera infantum it is used to good advantage, re- lieves colic incident to cold and in hot infusion gives a good outward circulation and relieves irritation of the nervous system. EUONYMOUS ATKOPURPUBETJS. Wahoo. The bark of the root is stronger than that of the trunk and twigs but all are used. It is a reliable, gently stimulat- ing, bitter tonic hepatic. It is antiperiodic and laxative, and in large doses cathartic. It will abort mild cases of ague. It may cause nausea but does not usually cause emesis. It is positive in its action on the liver both assecretor of bile and as an excretant of the same from the gall cyst. Its tonic influence is extended throughout the mucous membrane. As a tonic hepatic it is a superior agent. Its mildness and yet positiveness are properties in such degree as, possessed by but few agents. It improves appetite and gastric digestion and slowly but persistently relieves cholasmic poisoning. Its qualities in billiousness and jaundice are not surpassed by scarcely any agent. In hy- pochondriasis it exerts a gentle depurating influence and gives relief to the nervous system. This depurative power makes it a good antiperiodic, persist ingly relieving hepatic torpor. It is one of those agents that may be used for a long time without wearying the system by its use. Large doses will prove cathartic, but for this purpose \t is best combined with syrup juglans. For chronic coughs where there is hepatic torpor it may be added to cough syrups with excellent results. It may be added to alteratives especially in torpid con- ditions of the digestive tract. In dyspepsia it is a tonic to the gastric membrane, but should be given in small quantities and in frequent doses. In dropsy it is best combined with apocynum androsaem- rfolium or with some diuretic as iriticum. In rheumatism with suitable agents it is a favorite. But it must be remembered that the excellency of this agent lies in its gentle persistency and not in its excessive action. F. E. Euonymous Atrop. oz. i Syr. Juglans Cin. q. s. oz. iv EUPATORIUM. 309 Sig. Teaspoonful morning and evening or evening only for the relief or habitual constipation. F. E. Euonymous At. dr. v " Leptandra Virg. dr. ii Podophyllin grs. iii Syr. Zingiberis q. s. oz. iv This is a stimulating hepatic and may be used in tea- poonful doses once to three times a day. EUPATORIUM ALTERNIFOL1UM. False Boneset. This plant grows on dry hillsides. The leaves are lighter colored than the true boneset, but the flowers are very similar. The leaves have the same shape, but are loose around the stem, and gummy to the touch. Dr. F. G. Hoener says he has employed this for many years with good success in typhoid and typhus fevers especially where there was much tympanitis, also in ty- phoid pneumonia and meningitis. He recommends the following for typhoid fever, to be taken in dessertspoonful doses every two or three hours. Elix. Eupatorium Alter. oz. ii 11 Betonica Lane. " Chionanthus Virg. aa oz. i If desirable the eupatorium perfoliatum may be used in- stead of the alternifolium. EUPATORIUM AROMATICUM. White Snake-root. (E. Agertoides). The roots are a pleasant stimulating and relaxing dif- fusive. In hot infusion it influences a good flow of blood toward the surface, soothes the nervous system and increases ex- pectoration It relieves the heart and brain from the pressure due to congestion by promoting and outward cir- culation and securing of an abundantwarm perspiration, in ague, congestive chills and billious fever it sustains the circulation, relieves restlessness and headache. In the treatment of eruptive diseases it is valuable in assisting in bringing out the eruption. It is also useful in typhoid fever, pneumonia, bronchitis and pleuritis. Its being antispasmodic renders it useful in hysteria, dysuienorrhoea and in tardy parturition. Cold preparations give a warm- ing feeling in the stomach, promote appetite,, influence 310 JSTTPATORIUM. the salivary flow and materially increase the renal flow. Combined with eupatorium purpureum it is a valuable diuretic. The stimulancy possessed by this agent makes it adapted to languid conditions of the mucous membrane. EUPATORIUM PERFOLIATUM. Boneset. This herb in bloom is positively relaxing to the mucous membrane throughout, slightly stimulating, toning and antispasmodic. It is best when it first blooms. It is slow in its action but almost certain to relieve the liver. It is a favorite remedy for the prevention of fever. In large doses it is gently cathartic and gently tones the bowels throughout. Boil the herb down to a solid extract, and this makes an excellent pill for indigestion. Night sweats yieid to this better than to almost anything else even in phthisis. The relaxing properties are to some extent dissipated by the heat and the stimulancy, antispasmodic and tonic proper- ties are left. I have frequently stopped night sweats in three or four days and in some cases in less time. And they are not likely to return. Give a pill from 1 to 3 hours. For chronic ague it cannot be excelled, but it is good for all fevers. Other medicines may be incorporated into this extract if needed when it is being formed into pills. Eupatorin moderately represents this agent and the fluid extract is good also. Whenever needed a large injection of this agent in in- fusion may be used to cleanse the bowel. It does well. In hot infusion in large doses it is nause-ating and may be emetic. Small doses continued at short intervals prove diaphoretic. I have no doubt that the persistent use of this agent has prevented many a case of typhoid and of remitting fevers, and if not entirely prevented, it has made them very much lighter than they would otherwise have been. Dr. F. G. Hoener recommends the following for enteric fever: Elix. Eupatorium Perfol. Jeffersonia Diph. ;i Xanthoxylum Frax. " Helonias aa. oz. i M. S. One teaspodnful in as much sweetened water every hour or two according to the conditions present. ETTPATOBIUM. 311 In hot infusion it is good for a cold especially when the tongue is foul and the liver torpid. Eupatorium promotes the secretion of bile by the liver also its excretion by the gall cyst. This makes it valuable in many liver complaints, especially in general biliousness. In habitual constipation it is best when incorporated with more or less of syr. juglans cinerea as required. In skin diseases of hepatic origin it is of much impor- tance if persisted in. Eupatorium Perfol. 5 Zingiber Off. 1 gives a preparation for infusion far more diffusive and bet- ter in some cases of considerable torpor. F. E. Eupatorium Perfol. oz. i Syr. Zingiber q. s. oz. iv may be used for the same purpose. As a rule this agent is not best when the bowels are too free, except when such is the result of torpor of the liver. In such cases the last mentioned lormula will be prefer- able. This agent is also valuable in some forms of jaundice, both acute and chronic. F. E. Eupatorium Perf. oz. i 11 Zingiber gtta x Syr. Juglans Cin. q. s. oz. iv This is a reliable preparation for persistent constipa- tion. It is rather pleasant and may be continued as long as needed. The fluid extract may be added to cough syrups when a more free expectoration is needed. In colds, bronchitis and pneumonia, especially if the patient be inclined to biliousness and constipation, a large injection may be given to free the lower bowels. Then give hot infusion per oram till free emesis takes place. Relaxation of the mucous membrane generally will follow with good results. Subsequently smaller doses may be continued and the mucous membrane will become toned thereby. The pro- ducing of a free outward circulation relieves the hyper- ami ic condition. If used in the eruptive fevers more stimulation is neces- sary. Eupatorium perfoliatum is valuable in the treat- ment of rheumatism especially of the gouty and bilious classes. In the former it cleanses and tones the gastric 312 JSTJPATOHIDM. membrane and in the latter it relieves the liver and gall- cyst. When you have an irritable condition of the stomach and nervous system with biliousness and constipation, small enemas of this agent may be used with much profit to the stomach and nerves. In whatever manner this agent is given it influences an outward circulation, soothes the mucous membrane and relieves nervous irritation. Dr. F. Gr. Hoener recommends the following for cerebro- spinal meningitis: • Elix. Eupatorium Perfol. oz. iii " Verbena Urtic. oz. iss " Cypripedium " Cimicifuga Rac. " Leptandra Virg. aa. oz. i " Xanthoxylum Frax. oz. ss M. S. One dessertspoonful every two hours. Give a hot sponge bath, and if the bowels are constipated use ene* mata. The Doctor also says, In the last epidemic (1891) of la grippe, influenza, catarrhal fever or epidemic catarrh as you please to call it, I cured over seven hundred cases with the use of the following prescription: Elix. Eupatorium Perfol. " Eupatorium Alternif. aa. oz. iiss " Agrimonia Eup. " Verbena Hast, or " Betonica Lane. " Leptandra Virg. oz. i M. S. One dessert or tablespoonful every two or three hours according to the case. I did not lose a case by heart failure as others claimed in their practice with the use of their agents. EUPATORIUM PURPUREUM. Queen of the Meadow. The root is a relaxing and very mildly stimulating diu- retic. It chiefly influences the urinary and genital organs. It relaxes, gently stimulates and tones the pelvic viscera and influences the sympathetic nervous system. In the suppression of the menses it is splendid and always safe. It needs to be given in large quantities, but always leaves atoned condition. It is valuable in uterine and vaginal irritation. It is very soothing to the kidneys and gently EUPHRASIA. 313 toning by the relief of irritation and increasing the flow of urine. In these respects it is one of the most reliable agents. It tones the urinary mucous membrane and en- ables by the process of relaxation and some stimulation to cast off sediments that may have accumulated upon its • surface. Thus it is that after taking some large doses of this agent that the urine will be found full of deposit of one kind or of another. In typhoid fever it needs to be combined with more stimulating agents, as juniper or barosma. When needed it is an excellent addition to alterative compounds. In spermatorrhoea, irritable prostatic trou- bles, painful or scalding micturition, gonorrhoea, urethral irritation, aching back, and general pelvic weakness it is one of the best agents. It may be thoroughly relied upon. Eupatorium Purpur. 3 Epigaea Rep. 2 Mitchella liep. 1 This makes a good compound for such pelvic troubles. With helonias or aletris it is excellent in barrenness. These three agents are among the most powerful in that direction. They positively tone the uterus and ovaries, and neither of them should be used much by ladies who are given to frequent conceptions. EUPHORBIA HETERODOXA. Alveloz. The milk juice of this plant applied in cancroid ulcera- tion promptly destroys the affected tissues layer by layer. It produces profuse suppuration and some degree of irrita- tion and dermatitis with but little pain. It acts as an irritant and escharotic and results in the destruction of morbid tissue, which is replaced by healthy granulation. It is of importance in cancroid and syphilitic ulcers, lupus of the nose, epithelioma of the lip, ulcerated epithelioma of the nose, malignant ulceration of the os uteri. In cases that have become thoroughly constitutional there is no cure, but this agent will even then make life somewhat more endurable. EUPHRASIA OFFICINALIS. Eye-bright. The letives are a mild, stimulating, astringent tonic, influencing chiefly the mucous membrane, and useful H14 FAGTJS wherever there is too free discharge, whether it be of the bladder, urethra, bowels, or bronchi. In cholera infantum when there is an excessive greenish mucous discharge, in leucorrhoea, gonorrhoea, cystic catarrh, and catarrhal oph- thalmia this agent may be used with profit. In cases of congestions and inflammations of the eyes, especially of any torpid grade, it is valuable as an eye- wash. In nasal catarrh when the discharge is too free it may be used with the douche or atomizer and is a good cleans- ing remedy. It is an astringent but is not drying and hence is more toning to the membrane. FABIANA IMBRICATA. Pichi. South America. The leaves of this plant are a relaxing and stimulating tonic diuretic. I have never used this but in one case of cystic conges- tion and then with excellent results. The case was one of much severity. The local spasms were terrible. I had usually relieved such by the use of eucalyptus, but this was in the night and I had no eucalyptus. I had an ounce of fabiana and believed here was a case for a fair trial. 1 used it in small doses every five or ten minutes. It was uot long till the patient quieted down, and began to pass urine in small quantities and was soon relieved of both the pain and the congestion. I administered the F. E. of the age? it in some hot infu- sion of zingiber. I have no doubt it is also valuable in cystic catarrh. It is^oothing and cleansing to the urinary mucous membrane. FAGUS FERRUGINA. Beech. The leaves are a relaxing, demulcent, slightly stimu- lating and toning diuretic. They influence the mucous membrane and especially that of the kidneys. They are useful in cystic catarrh, cystitis, nephritis, urethritis, scalding urine. It relaxes, soothes, gently stimulates and gently increases the quantity of urine. A hot fomentation of this agent is valuable to be used over the bowels, lungs, stomach or bladder in cases o^in- FERULA. Mia flammation and also to be applied over painful swellings. Dr. F. G. Hoener says Fagus Ferrugina Cort. Rhus Glabra Bac. aa. in equal parts is a good recipe for diabetes. FERULA FCETIDA. Asafcebida. The roots yield a thick, milky juice of a peculiar foetid odor. When d n ied this gum-resin is a penetrating diffu- sive, stimulating and relaxing, antispasmodic nervine. It is best given in pills or capsules, but nothing will dis- guise it fully. Though a nervine, its influence is extended to the circu- lation and to the mucous membrane. It is an excellent antispasmodic and it is a pity that its odor cannot be disguised so that it can be administered in some unobjectionable form. In nervous irritability, in hysteria, in hypochondria, in convulsions, in meningitis, in double vision, in spermatorrhoea, in restlessness, in insomnia and in dysmenorrhoea it is one of our very useful agents. For colds it is a good remedy, and in bronchial troubles it is a good expectorant. It is a good remedy to be used for nervous females with scanty or tardy menstruation. It gradually increases the flow. It may be dissolved and used per enema and thus influ- ence the bowels and the pelvic nerves. If it be retained its influence will extend through the entire system. Give it in the evening and allow it to remain all night. By morning the nerves will be thoroughly quieted. This is an excellent way to treat the hysterical and those habitu- ally nervous. The whole system will thus slowly feel its effects and be calmed and toned thereby. Triturate one- half to one dram in four ounces of tepid water for enemata. Even the odor is soothing and stimulating to the nervous system. These little asafoetida and camphor bags that many times we find put on children's necks and hung next to their bodies, though we smile at it, I have no doubt they have a soothing and stimulating effect on those wear- ing them, especially so if it be hung over the child's stom- ach in a thin cloth. Even though the odor is unpleasant it is not so unpleas- ant to the stomach. In fact though some ladies become 31t) FERRUM. nettled because it is prescribed for them, many others soon become accustomed to it and do not dislike it. It may be administered in some wine one-half ounce to eight ounces and triturated thoroughly. A syrup may be formed by thoroughly triturating one ounce of the gum in boiling water and then adding two pounds of sugar, and enough water to fill one pint. Asafoetida oz. i Valerian dr. ii Capsicum grs. x This is a good antispasmodic and may be made into pill form or used in the form of syrup. It will be found useful in congestion of the brain, inflammation of the brain, meningitis and the double vision at times incident there- to. It is a superior remedy in such cases. FERULA SUMBUL. Mush root. Central and Northeastern Asia. The root has a strong, pleasant, musky odor. It has a faintly sweetish taste which soon becomes a slightly bit- terish aromatic. It is a rather positive stimulating and relaxing antispasmodic. It arrests spasms and relieves and tones the muscles. Ferula Sumbul Piper Meth. Rhamus Pursh. aa. equal parts. This is rather effective in the treatment of epilepsy and hysteria. Sumbul hardens the muscular fibres of the arteries and stimulates and soothes the blood current. With lobelia it is valuable in the treatment of asthma, and with aralia rac. it will be found useful in bronchitis. This agent will also be found useful in gastralgia, ente- ralgia, and dysmenorrhea. FERRUM. Iron. Some preparations of iron are harmless, some are not so harmless and some are very injurious. Chalybeate waters are chiefly valued because of the iron and sulphur ingredients they contain. These waters largely influence the kidneys and tend to cleanse both the urinary and the intestinal tracts, and leave these parts more or less toned. FERRUM. 317 The chief value of sanative iron preparations is that they are stimulating to intestinal digestion. Some of them more than others, some of them influencing in one way and some in another. Beware of compounding the iron preparations with veg- etable astringents. Such will give you inky results. Detannated prunus may be combined with iron. All the iron preparations are used for one or other grade of gastric or intestinal indigestion, and the accompanying anaemia. Ferri et Potassce Tartras is soluble in water and is laxative to the bowels, usually coloring dark the stools. It is an excellent preparation for anaemia and intestinal indi- gestion, especially when there is a tendency to constipa- tion. Ferri et Pot. Tart. grs. x Hydra st ia Sulp. gr. i F. E. Zingiber gtta iii Aqua q. s. oz. iv Sig. Teaspoonful before meals, between meals and before retiring. Ferri et Potassce Citras is more soluble in water than the above but may be used for the same purposes. The slight acidulation in this preparation may be more suit- able to some stomachs. Either of these preparations makes a good tonic for depressed conditions. Ferri Carbonas Prceclpitcms is a stimulating astrin- gent useful in more or less debilitated conditions compli- cated with dysentery or diarrhoea in either acute or chronic form. It is useful in gastric and intestinal dys- pepsia, cholera infantum, chronic dysentery and chronic diarrhoea. Precip. Carb. Ferri dr. ss Tr. Kino oz. iv F. E. Zingiber gtta. v Comp. Syr. Rhei et Pot. q. s. oz. viii This is an excellent compound for the conditions above named. Ferri Carbonas Saccharatus is a grayish brown prepa- ration which may be used in two to four grain capsules three times a day for the same purposes as the last men- tioned. Ferri Pulvls is a gray powder, one of the best of the powdered forms. It may be given one to two grains with 318 FERRUM. each meal. This is also denominated hydrogen iron. It is quite stimulating and is best for debilitated conditions. Ferri Oocidum Hydratum is frequently used as an an- tidote in cases of arsenic poisoning. MunseVs Solution of Iron (Perchloride of Iron) is a fluid preparation of iron of the strongest styptic powers for the arrest of hemorrhages. Thiana is a good preparation of ferrum manufactured by the Yale Chemiral Co., Atlanta, Ga., and for sale by C. T. Bedford of Indianapolis, Indiana. Thiana 3 Hydrastia Sulph. 1 Given in capsules is a good aid in the treatment of in- digestion, coiic pains, diarrhoea, flatulence, and insomnia. Dlalyzed Iron is the result of dialysis. A \essel con- taining the required salts of iron is closed by a membrane of parchment and placed in a vessel of distilled water with the orifice downward. Part of the liquid in the upturned vessel passes through the membrane and mingles with the distilled water. The separation will be complete. The acids will be transmitted to the water and leave the oxide of iron in the dialyzer. In this way dialyzed iron is ob- tained. It is very soluble in water devoid of styptic prop- erties, almost tasteless and readily made into a syrup. Chloro-Ferrine is made by McCoy, Howe Co., Indiauap- olis, Ind., for the treatment of diphtheria and acute dis- eases of the throat. It is a combination of chlorine, ferric iron, chlorates, etc., in conjunction with an agreeable menstruum, valuable for diphtheria, follicular tonsilitis, thrush, ulceration of the mouth or tonsils, syphilitic ulcer- ation, chronic pharyngitis, enlargement of the tonsils and ordinary sore throat. It is used internally, locally or both as conditions indi- cate. It is best undiluted. The dose for an adult inter- nally is one teaspoonful every three or four hours. In diphtheria the parts should also be frequently atomized, or the patient may swallow some after each local treat- ment. FGENICULUM CAPILLACEUM. Fennel Seed. Europe. The seed are a relaxing and stimulating, aromatic, diffu- sive carminative. They are chiefly used as a vehicle for the administering of bitter tonic< and cathartics. FHASEKA. 319 The oil may be used for the same general purposes. Foeniculum Cap. 1 Sweet Orange Peel £ Carbonate Magnesia 3 Sugar 2 Triturate thoroughly and give In hot water to increase the lacteal fluid. Foeniculum Cap. 1 Parsley Root * Licorice root £ Carbonate Magnesia 3 Sugar 2 This is another formula used for the same purpose. FRAG ARIA VESCA. Strawberry. The leaves are a pleasant, mild, astringent tonic to the mucous membrane. In diarrhoea and dysentery it is sooth- ing, toning and strengthening but not drying. It is an excellent remedy for children's diarrhoea and intestinal debility. If given in hot infusion they influence the cir- culation toward the surface and soothe and quiet the nerves. The berries are a pleasant vegetable acid for convales- cence when an acid is proper. An excellent syrup is made by expressing a pint of juice and adding a pound of granu- lated sugar. This may be used as an acid vehicle in bitter medicines and the juice unsweetened makes a nice acidu- lated drink in convalescence from fevers. The berry itself is nut admissible until seeded. FRASERA CAROLIXENSIS. American, Coluni bo. The root is a reliable mild, stimulating and slightly astringent tonic. It is moderately bitter but not unpleas- antly so. Its chief influence is expended upon the alvine mucous membrane as a tonic. Its best use is for that class of persons who have a weak digestion and are more or less subject to an extra freeness of the bowels. It is an excel- lent tonic in typhoid fever and hastens convalescence, but other agents had better be used when there is a tendency to constipation. If diarrhoea be troublesome throughout the course of typhoid, frasera will give good results. In gastric ulceration this agent will usually be well 320 FRAXINUS. received. In gastric catarrh you will find frasera one of your most valuable and most reliable agents. It improves the appetite and assists digestion. In combination with uterine and vaginal tonics it ex- tends its influence in that direction and becomes a very excellent addition in cases of uterine and vaginal ulcera- tion, prolapsus uteri and vaginal weakness. This agent may be used with excellent effect with chil- dren having a weak digestion and a chronic diarrhoea. It is also a good wash for aphthous sore mouth. An infusion forms an excellent vaginal wash for a weak vagina, prolapsus uteri and leucorrhoea. The fluid extract of this agent may be used for ail the purposes of the agent. Frasera Car. Leonurus Card. Anthemis Nob. Cypripedium Pub. aa. 4 Citrus Auran. Cort. 1 This forms an agreeable nervine tonic forchlorotic ladies. Frasera Car. 4 Aletris 3 Hydra&tis Can. Citrus Auran Cort. aa. 1 This forms an excellent tonic for weakly ladies with a tendency to miscarriage, and for those having a poor diges- tion, a degenerate leucorrhoea, general pelvic weakness and more or less menorrhagia: FRAXINUS AMERICANA. White Ash. The bark of the root and the inner bark of the trunk yields a mild, persistent, stimulating tonic alterant influ- encing chiefly the digestive apparata. The mucous mem- brane and secernents all feel its effects. It influences the liver both in the secretion of bile and in its excretion from the gall cyst It also influences the peristaltic action of the bowels in defecation. It increases the flow of urine and cleanses and bones the urinary tract. In chronic jaundice and chronic biliousness, chronic hepatic congestions and general hepatic torpor and skin eruptions arising therefrom, With diuretics and hepatics it is valuable in dropsy. It is a slow, steady, cleansing and toning agent to the whole system. Its steady, persistent toning influence makes TRAXINUS. 321 this agent very valuable in its influence on the kidneys. The nervous system also feels its influence and it is of much importance in the treatment of insanity. It depu- rates the whole system and tones and strengthens the nerves, sympathetic, cerebral and spinal. In hysteria, hypochondria, cholaemia and uraemia there are but few medicines that will do better work. Fraxinus Am. <> Aralia His. 3 Gentiana Lut. 2 Taraxacum D. L. -1 Xanthoxylum Frax. Cort 1 This forms a preparation excellent in chronic bilious- ness, jaundice, habitual constipation, hypochondria, anae- mia, chlorosis, insanity. It forms a good addition to cough syrups for chronic coughs when there are bilious conditions to be met, FRAXINUS SAMBUCIFOLIA. Black Ash. This bark is about the same as the americana and may be used for the same general purposes. It is said by some to have a slight degree of astringency. Fraxinus Sam. Cort. Ashes 2 Acacia Vera Valeriana Off. aa. 1 Make into pills to be used night and morning for sleep- lessness. An infusion is said to be good for the expelling of pin worms. FRAXINUS ORNUS. Flowering Ash, Manna Tree. This tree yields a light yellowish, sweetish exudation from its stems. When treated with alcohol it is white, sweet, odorless and soluble in hot water. The manna is a mild laxative, one of the most pleasant agents to be used for the relief of constipation, especially of children. For adults it is best used as a vehicle for some bitter remedy. When an infant which nurses the bottle is chronically constipated, manna may be dissolved and added to the milk. 322 » GALIUM. FUCUS VESICULOSUS. Bladder- wrack- This plant has a reputation as an ant if at, claiming- that it diminishes the fat without in any respect injuring the health. It influences the mucous membrane, the serous membrane and the lymphatics. It is a gently stim- ulating and toning alterant. It is one of those slow, per- sistent agents that require time to accomplish the desired results. It is stimulating to the absorbents and especially influences the fatty globules. Its best action is observed in individuals having a cold, torpid, clammy skin and loose flabby rolls of fat. It is an agent that gives better results in cases of morbid obesity than in those cases of a healthy character. When using it as an antifat it is best to exclude farinaceous foods and beer and prescribe an active life. It is best to begin with small doses and grad- ually increase to larger doses. Soon the urine becomes more abundant and the stomach is invigorated by its use. By its influence on the serous membrane it is valuable in cases of gout, rheumatism and dropsy especially for those of plethoric habit. It may be used in form of pill, fluid extract or infusion. This agent seems to influence the starches and prevents their being formed into fats. Where there is a tendency to constipation in eases of obesity the following will be found best adapted: ' Fueus Ves. Juniperus Fructu. Juglans Cin. aa. in equal parts in infusion. UALBANUM OFFICINALE. Ga Ibatbum . Pers i a . The gum has a disagreeable, foetid odor, an acrid, pun- gent and unpleasant taste. It may be dissolved by tritu- ration in water or vinegar, it much resembles asafoetida. Its use is almost entirely superceded by that agent. GALIUM APARINE. Cleavers. This herb is a soothing, relaxing, diffusive diuretic It materially increases the urine and relieves irritation. It is # valuable in scalding urine, and irritable bladder and urethra: in the inflammatory stage of gonorrhoea it re- GARCINIA. 323 lieves the irritation and soothes the nervous system. In hot infusion this is a diaphoretic and may be used to good advantage in fevers where there is a necessity to favor a good free outward circulation and it relieves the nervous system. An inspissated juice of the fresh herb is a valuable agent in acute gonorrhoea given every 3 hours. GALIUM VERUM. Yellow Ladies 7 Bed-straw. Europe. The flowers have an agreeable odor, and are antispas- modic. They are useful in nervous affections. The herb is inodorous and a mild, bitGer, stimulating astringent, influencing the mucous membrane and the nervous system. The bruised plant has been used to color cheese yellow. The roots dye red. It is a valuable tonic in dyspepsia, and is an emmena- gogue of some importance. For this last named purpose it is best used in hot infusion, when it is also valuable for dysmenorrhosa. GARCINIA MANGOS I ANA. Mangosteert. Ind in, Malay. This is a very handsome tree growing from twenty to thirty feet high. It has beautiful dark green foliage. It bears a finely flavored and most palatable fruit about the size of an apple. Near the equat >r it, fruits twice a year. The bn,rk is a stimulating, antiseptic, astringent tonic to the mucous membrane, but does not seem to produce constipation. It can be used as a valuable aid in acute inflammation, typhoid fever, cholera infantum and diar- rhoea. In cases of uterine inflammation, and ulceration of the cervix, paint the cervix with the full strength of the fluid extract, or make an infusion to be used by injection. This will overcome very obstinate cases. It lessens catamenial pain, cures leucorrhoea and dimin- ishes the menstrual flow. In nasal catarrh spray the mucous surfaces thoroughly. It will be very beneficial in the more moist forms. It may be employed in the treatment of hemorrhages from either uterus, bowels, or luugs. and it also lesseus muco-purulent discharges from either of these sources. In light forms of diphtheria the fluid extract in full strength may be sprayed into the throat, or it may be di- 324 GAULTHEKIA. luted as required for inflamed or irritated conditious of the pharynx. It forms a good antiseptic wash for ulcers. It cleanses and tones the surface. It will also give good results in dermatisis. The leaves find flowers form a good wash for sore gums and sore mouth. F. E. Garcinia Mang. 1 Aqua 5 to 10 M. S. One teaspoonful every one to three hours. In small doses this is easily taken and causes no gastric disturbance. Its action is rapid and positive. In cases of uterine hemorrhage, whether from threatened or actual miscarriage, from the presence of uterine tumors or during the menopause, this may be considered a specific. Jt is also very valuable in the treatment of dysentery and diarrhoea, acute or chronic, and especially where there is indigestion and more or less debility. GARRY A FREMONTII. California Fever Bush. California. This is an ornamental evergreen shrub growing from live to ten feet high. The leaves excite a profuse saliva, give a sense of gastric and intestinal warmth and impart a persistent bitter taste closely resembling that of cin- chona. It is a gently stimulating tonic and antiperiodic. It stimulates the circulation and especially so when used in hot infusion. In large doses it creates a cerebral fullness and tinnitus auriam somewhat similar to those symptoms when induced by quinine. It leaves no other unpleasant after-effects. In dysentery and diarrhoea where these conditions show some signs of malaria this agent will give good results. In hot infusion it will abort many a case of malarial fever, and cases of chronic ague soon yield to it. G A ULTI-IERI A PROCUMBENS. Winter green . The le4ives and the oil therefrom area very diffusive, relaxing and stimulating diuretic, carminative and anti- septic. It will relieve flatulence, colic, and assist digestion and diuresis. GAULTHERIA. 325 This agent is chiefly used as a vehicle for alteratives and other compounds. Its taste and odor are both usually agreeable to patients. Ol. Gaultheria " Sassafras aa. oz. i " Eucalyptus " Lavender aa. oz. ss Thymol dr. i Carb. Magnesia oz. ii Mix the oils, add the thymol, shake the preparation to dissolve. Pulverize the magnesia and add the oils by thorough trituration. Then take Alcohol oz.xvi Aqua oz. xLviii Sodium Salicylate dr. iii Shake these last till dissolved and add the former ingre- dients as above combined. This is an excellent formula for the making of listen ne. It is an antiseptic wash for wounds, abscesses, and for the maintenance of surgical cleanliness. In chronic conjunctivitis evert the lids and paint the conjunctival surfaces with pure listen ne or diluted as the case may require. There are many formula? for the making of listerine. One combines thymus, eucalyptus, baptisia, gaultheria. mentha arvensis and benzo-boracic acid. Another formula combines Hydrastis, Phytolacca, salicylic acid, boracic acid, mentha arvensis, thymus and hamamelis. The Lambert Pharmaceutical Co., of St. Louis, have gained a national reputation from the value of their LAMBERT'S LISTERINE Is a non-toxic, non-irritating and non- escharotic antisep- tic, composed of ozoniferous essences, vegetable antiseptics and benzo-boracic acid; sufficiently powerful tomakesurgic ally clean— aseptic— all parts of the human body. Listerine at 60 degs. Farhenheit is a clear amber-color liquid, but as the temperature is reduced it becomes opaque; this characteristic of Listerine is caused by the partial con- gelation of its essential constituents; its brilliancy is re- sumed at 60 degrees. It is of a slightly acid reaction, a powerful, fragrant aromatic odor and pungent taste, both 329 GAUI/THEKIA. of which are agreeable: its specific gravity is lighter thaD water, with which it mixes in any proportion without pre- cipitation or separation of its constituents; this genial com- patibility extends to most of the standard remedies of the Materia Medica. The boracic acid constituent is beauti- fully exhibited in the atom i/at ion of Listeriue. Listerine is a most powerful non-toxic antiseptic; it pos- sesses quali ties that are more pronounced in preventing fer- mentation than in destroying the prod nets thereof, its germ- icidal value equaling but & five per cent, solution of carbolic acid, although its non-toxic effect, enabling its continued administration or application, renders it of extremely great- er yalue than any dilution o! the corrosive and poisonous agents for the destruction of micro-organisms. Asadressing for wounds, whether accidental or operative, and later in the suppurative stage. Listerine in various de- grees of dilution proves thoroughly trustworthy: for treat- ing catarrhal conditions of every locality, Listerine has proven peculiarly acceptable because of its non-poison- ous effect, its efficacy as an alterative-antiseptic, and for its detergent, antiphlogistic properties, as weil as for the cooling and refreshing effect which its use imparts to the tissues. Listerine is well adapted for use. in the throat or nasal cavities, especially by atomizing or spraying, and for puru- lent otitis, it is probably unrivaled. Applied to ulcerous or mucous patches, and in contag- ious catarrhal affections, Listerine alone or as an adjuvant is a boon to the afflicted because of its freedom from, and power to disguise, objectionable odors. Listerine is valuable in skin diseases, as urticaria, eczema, pruritus; in eruptive fevers, etc.. and in cases where the skin is excoriated or effected with vesicles, pustules or crusts Internally, in certain forms of fermentative dyspepsia, Listerine— a true antiferment- -is very valuable, and equal- ly so in summer diarrhoeas of infants and children. In typhoid fever Listerine is extensively prescribed, a- greeably diluted, both for its antiseptic effect and to im- prove the condition of the stomach for the reception of nourishment. Lirterine by inhalation and by internal ad- ministration is a valued means of attaining antiseptic in- fluence in the treatment of phthisis, not only in the later stages during the production and absorption of pus, but also in the earlier process of infection. GENTIAN A. .527 GENTIANA LUTEA. Gentian. Europe. The root is an intense and permanent bitter, stimula- lating tonic. Though intensely bitter, when given in small doses it is usually well received by the stomach, and it promotes appetite and digestion, stimulates the circula- tion, thoroughly tones the digestive organs, and is espe- cially valuable in languid conditions and in that of general debility. It is one of the most serviceable of tonics, influ- encing the secernents as well as the mucous membrane. Its action on the liver is that of a cholagogue rather than to influence in the secreting of bile. It influences the portal circulation somewhat similar to Hydrastis. It gives good service in biliousness and jaundice. Its tonic pow- ers make it also a good vermifuge, and enable it to slowly promote peristaltic action. It is also somewhat antiperi- odic. The sensitive stomach will receive it only in minute doses without producing a persistent nausea. In general use it is best combined with milder agents. Gentiana Lut. 1 Orange Peel Coriander Seed aa. 2 This in infusion forms a good, stimulating and pleasant tonic. V. E. Gentiana Lut. 4 '• Citrus Aur. Cort. 1 • 4 Cardamon Sem. 1 his is also a good tonic. Gentiana Lut. 4 Cinchona Call. 8 Citrus Vulg. Cort. 2 Canella Alba ] This forms a valuable tonic for languid conditions. F. E. Gentiana Lut. dr. i Syr. Zingiber q. s. oz. iv This is an excellent tonic for a weak stomach and a poor digestion, taken just before meals. GENTIANA OCHROLEUCA. American Gentian. The root of this agent possesses somewhat similar prop- erties to those of the European variety, but is usually 328 GERANIUM. better received by the stomach. It is a positive, bitter, stimulating tonic. It influences the gastric and intestinal mucous membrane and the liver and gall cyst. As a gen- eral tonic, especially if combined with alterants, it exerts a good influence upon the glandular system. Where there is a poor appetite, a weakened digestion and hepatic debil- ity or jaundice and biliousness, its tonic power is quite valuable. In very debilitated forms of dropsy but few tonics can be used to better advantage and it is one of the most valuable agents to be added to alterant compounds. F, E. Gentiana Och. dr. i ' ; Euonymous Atr. dr. ii Eupatorium Perf. dr. iv Syr. Zingiber q. s. oz. iv This is a good hepatic tonic for agues. F\ E. Gentiana Och. dr. i Capsicum gr. i Comp. Syr. Rhei et Pot. oz. i This will break a chill. Gentian, salicine and capsicum will do the same thing. F. E. Gentiana Och. dr. ii Citrus Yulg. Coriandrum Sat. aa. grs. xxx This made into a syrup is a pleasant tonic. McCoy, Howe Co., Indianapolis, Ind., make a prepara- tion of which each fluid dram represents, . Gentian Wahoo aa. grs. ii Tr. Iron Chloride gtta. v Dr. N. D. Woodward uses this and speaks liig-hly of its efficiency and palatableness, its permanence and its elegant appearance. GERANIUM MACTJLATUM. Cranesbill. The root is a pleasant, positive, tonic astringent. It is only moderately drying, but is persistent and effective. It is one of our most excellent astringent agents. Its chief influence is expended upon the alvine mucous membrane throughout. It is applicable in the treatment of sore mouth or gums, mercurial salivation, spongy gums, ca- tarrhal ophthalmia, leucorrhcea, gleet, dysentery, diarrhoea. It is a good local and constitutional styptic for hemor- rhage from the nose, lungs, stomach, bowels, or uterus. GERMICIDES. 329 The fluid extract is a good application to the uvula in case of elongation. Apply frequently. In typhoid fever in case of excessive discharges, whether fcecal or sanious, this agent is one of the most valuable. The addition of a little capsicum will at times be valuable- Diluted with water or combined with comp. syr. rhei et pot. this agent is one of the most valuable in the treat- ment of severe cases of cholera infantum. Geraniin represents this agent quite well, but is less stimulating and more astringent than the herb itself or its fluid extract. GERMS AND GERMICIDES. By Albert W. Kelley, A. M.. Ph. D., M. D., Professor of Bacteriology, Microscopy and Histology in Chicago Physio- Medical College. In no department of medicine has there been greater advancement than in aetiology. But this knowledge of the cause of disease is of comparatively recent origin; in fact, it is largely the work of the present generation. The vague notions and theories advanced by former phy- sicians ascribing all disease to impurity of the blood, epidemics, and discrasia of chemical composition, while not without some valid ground, were at best vague and unsatisfactory. With the advent of the microscope, which was invented about the latter part of the sixteenth century, was ush- ered in a new epoch in this department of medieine. Soon after the introduction of tfee microscope, minute organ- isms, which before were unknown, were 'found in decom- posing organic substances. Various conjectures and theo- ries were advanced as to the nature and office of these minute organisms. As early as 1645 Kircher suggested that diseases might be due to similar organisms: but owing to lack of facilities with which to prove his theory, but little, if any, attention was paid to his teaching. About 1710 Anthony Van Leu- wenhoeck, of Holland, had so improved his microscope that he was enabled to demonstrate the fact that large numbers of micro-organisms existed in normal saliva, in fsecal mat- ter and in vegetable infusions. He carried his observa- tions to that extent that he described and attempted to give a classification of some of the more marked varieties. 330 GERMICIDES. But it remained for Mueller, of Copenhagen, to give us the first description and classification of bacteria that was in any degree correct. However, it was not until some years later that authentic evidence was obtained connect- ing germs with disease, when Davanes and Rayer dem- onstrated the presence of rod-shaped bacteria in the blood of animals suffering with splenic fever. However but little attention was paid to the discovery until Pasteur and others working along the same line published the results of their research, which went far to prove the etio- logical nature of micro-organisms. The researches of Robert Koch upon the history of the bacteria or bacilli of splenic fever have removed all doubts of their etiological signification. In 1883 Koch startled the medical world by the announcement that consumption was a germ disease and dependent upon the presence, in the affected tissues, of an organism which he named "bac- illus tuberculosis." This statement met with strong opposition, both among physicians and the laity; but Koch «o fortified his state- ments, both by experimental and clinical evidences, that it may now be regarded as fully demonstrated. Two years later(in 1885)Koch showed that Asiatic cholera is due to the presence of bacterial organisms — the "cnmma bacillus " Schutz and Loeffer discovered the bacillus of glanders in 1882; Eberth the bacillus which is now generally accepted as the cause of typhoid fever, in 1880; Fehleisen the micro- coccus of erysipelas, in 1883; Neissen the micrococcus of gonorrhoea, in 1879. Obermeier announced the discovery of the spirillum of relapsing fever as early as 1868. In 1881 Laveran discovered the micro-organisms of malaria — ma- laria Plasmodia. These minute organisms are found in the blood of persons suffering from malaria, and have lately been carefully observed, and according to concurrent testimony they do not belong to bacteria, being really of animal origin, among the protozoa. Pneumonia may also be included with the germ diseases, since the demonstra- tion of Sternberg, Nova and Frankel of the constant pres- ence of the micrococcus Pasteurii in the sputa in that disease. The careful observation and exhaustive experi- mental research made by those mentioned, as well as that of many others who have devoted years to the development of this department of science, have established the germ theory of disease upon a firm foundation. A large number GERMICIDES. 331 Of diseases are undoubtedly of parasitic origin. Almost daily new facts are discovered which substantiate the germ theory of disease, and as far as the theory is applica- ble, it eliminates the factor of ''accident" from the con- sideration of aetiology, and disease is assigned a legitimate place in the curriculum of nature. According to the commonly accepted definition, disease is a disturbance of the normal and functional activities of some one or different parts of the organism; the reaction to an unaccustomed influence. According to the germ theory the foreign influence producing functional disturb- ance is, in many cases, due to the presence of foreign microscopic organisms in the interior of the body, and the number of diseases revealed by the germ theory is con- stants growing more numerous. Especially is this true of that class of diseases generally acknowledged to be contagious. By contagion we mean the transmission of disease from one individual to another, either by direct contact, or indirect, as through air, water, clothing, etc. No sharp distinction can be drawn between contagion and infection. Although various attempts have been made to do so, none of the propositions are beyond criti- cism. The two classes of disease seem to overlap each other, so that no real division occurs. Infectious disease depends upon a specific agent, as does the contagious; and there is valid ground for the belief that all contagious and infectious diseases depend upon some constant and specific element in each individual dis- ease; this agent in a great majority of cases remains unchanged. However there appears to be an occasional exception; thus the streptococcus pyogenes of Rosenbach and the streptococcus erysipelutis of Fehleisen, are to all appearance identical, and both are presumed to be the cause of puerper.U fever, erysipelas and suppuration. These apparent exceptions will probably disappear when a more definite knowledge of these particular organisms has been obtained. While no well defined distinction can be drawn between the germs of contagion and those of infection, experience goes to prove that certain germs whose habitat by nature or adaptation is in the human body, and the spores of which can pass from one person to another, where they develop and produce disease. 332 GERMICIDES. Another class of germs, those of infection, differ from those of contagion in this, that they have one stage of development in the human body and another in some other media. Thus they cannot reproduce the disease until after they have passed through their second stage of develop- ment. This second stage may be in the soil, water or elsewhere. When they have passed through this secondary stage the spores are again ready for the production of dis- ease in man. In this way a whole section of country may become in- fected, and persons attacked by the disease who have not been exposed to the sick, or even near them. Such diseases as typhoid, cholera and yellow fever afford good examples of this cla>s of diseases. The theory of infection has not been satisfactorily dem- onstrated with each specific germ, but general experience affords adequate proof of the correctness of the theory. We find in the life history of several of the parasitic fungi producing disease in plants, an exact parallel. The com- mon puccinia gramitiis, producing the disease known as rust, which appears upon wheat and oats, affords a good example of this cycle of life. The spores found upon the growing grain do not again grow upon the wheat, but grow luxuriantly upon the leaves of certain netted-vernel leaved plants; and the spores formed upon these plants will grow upon wheat or oats, etc., where they produce the disease of rust and thus complete the cycle of life of the fungus. While the germ theory affords the best and most satis- factory explanation of such facts as are known about infection and contagion, it does not necessarily follow that it satisfactorily explains every occurrence in the dissem- ination of disease; and it is highly probable that future development will throw new light upon many of these much disputed questions. Experience has demonstrated that of the large number of distinctive species of bacteria, only a few species are known to be pathogenic: so while the earth, air and water everywhere may be filled with teeming myriads of the minute organisms, only a comparatively few kinds are known to take part in the production of diseases. The mere presence of bacteria is not, in itself, a suffi- cient cause of disease; but that there are certain kinds of bacteria that uniformly induce disease, when they are GERMICIDES. 333 inoculated in or gain entrance to the body, is also well known, as well as the fact that certain poisons known as ptomains originate in connection with the disease-produc- ing germs. These poisons are the product of the micro-organisms, produced in connection by the functional activity of the organism in its process of digestion, growth and excretion. in the same way that alcohol is produced by yeast plant in its remoleculization of sugar. The ptomains produced by pathegenic germs have been separated from the germs, and when so separated produce the same effect, that of direct poisoning similar to that induced by the poisons from the higher plants. Different species of bacteria produce different poisons— poisons that produce different physiological effects upon the human body. The effects are constant for a given germ, thus furnishing the definite physiological characteristics where, by the germ may be identified. On the other hand we are thus enabled to diagnose the disease from the germ. It is now quite generally understood that disease is induced not so much by the mere presence of micro-organ- isms in the body as by their poisonous products, which are formed through changes wrought in the molecular forms of matter. Bacteria being organic bodies, must of necessity possess the same nutritive functions common to all living bodies, whether plant or animal; viz., digestion, absorption, assim- ilation, and the formation and excretion of waste products: these are necessary to the life and growth of the organism. The process of digestion in bacteria, as in other organ- isms, is accomplished through the agency of soluble fer- ments, which are elaborated by the organism. In the higher forms of plant and animal life the digestive fluids are produced by specialized cells and found in special organs. In animals it is in the stomach and intestinal tract, where it comes in contact with the food. In the lower forms of life, as in protozoa and protophyte, no specialized organs are found, parts of the simple cell doing the work of the stomach, while other parts of the same cell act in some other capacity at the same time. All digestive ferments are the direct products of the activity of cell life, whether this digestive fluid be found in the amoeba, monad, or in the peptic glands of the higher animals. The function of the ferments, primarily, is that 334 GERMICIDES. of digestion, which consists quite largely in the rernolecu- lization of certain food substances and the formation of new compounds. In the simple celled plants this process is manifest to a most marked degree, and as all forms of life are supported by the continued absorption of new matter, the old mate- rial must be eliminated, which, in case of the micro-organ- isms is cast out into the surrounding media, from whence they obtain their supply of food, so that it is difficult to determine the exact source of some of the bacterial prod- ucts, whether they are products of digestion or elimina- tion. Excretions are classified into two groups: those that contain much oxygen, and compounds containing but a small amount. Thus, in animal excretions, carbon diox- ide, rich in oxygen; urea, poor in oxygen but rich in nitro- gen. In plants we find the same carbonic acid, and in addition, some free oxygen; and corresponding to urea, we find the alkaloids and organic acids, all poor in oxygen. All this goes to show the uniformity of plan in vital processes, whether manifest by the higher or lower forms ol life. The fact that all bacteria are not pathogenic shows conclusively that all do not produce the same pto- maines, either by the action of their soluble ferments or excretions. Nor is their presence in the body in any way detrimental to health; it is claimed that a large propor- tion of the non-pathogenic germs are absolutely essential to the well being of* all the higher forms of life, mankind included. While on the other hand the well-known deadly effects of pathogenic germs lead us to enquire how we can best destroy them, or, at least, avoid them. The development of bacteria, even under the most favor- able conditions, cannot continue indefinitely, bacteria can only grow as long as the favorable conditions continue. When the soil becomes exhausted their food supply is cut off. But starvation is not the only cause of their death, or in many instances bacteria die before the supply of food is exhausted. Death of the bacteria is brought about by the accumulation of bacterial products, poisonous to their producers. The vinous yeast plant affords a familiar example of the effects of the bacterial products. When the amount of alcohol reaches a certain per centage of the solution all fermentation ceases, although there may still be a large GERMICIDES. 335 amount of sugar in the solution, the effect of the alcohol is to check further growth of the bacteria or to destroy them. In most spore producing plants resting spores are produced about the time that fermentation ceases. These resting spores retain their vitality for some considerable time so that the race does not die out for some time after- parent cells are dead. In a media in which bacteria have ceased to multiply it is impossible to rear a second colony of the same kind. The nutritive solution seems to possess immunity against a second injection. The cause of this phenomena has been made the subject of special study in the hope of throwing some light on the pathology of infectious diseases Many of this class of diseases due to the presence of micro-organisms have a self-limited duration similar to that observed in bacterial culture, and one attack of such disease gives the body an immunity against subsequent attacks. On this subject nothing satisfactory has been learned. There is no proof that the limited duration of infectious diseases depends upon either the exhaustion of certain nutritive substances in the animal body or upon the accumulation of poisonous bacterial products. Even if this should be the case in reference 10 the limitation of the acute infectious diseases it certainly could have no direct connection with the im- munity against subsequent attacks. The growth of germs upon dead matter such as are pro- vided for artificial culture cannot be compared directly with their growth and development in living bodies. In the latter the germs must compete with living cells, and are subiected to conditions not found in artifical cultures. Any attempt to account for the phenomena of immunity cannot be based exclusively upon a chemical basis but must also take in consideration the properties of living bodies and the functional activities of living cells. Chemical influences wiiich interfere with bacterial life may relate to either the absence of the necessary nutri- tive elements or to the presence of injurious agents. • Substances which kill bacteria are known as germicides or disinfectants. While the term "anti-septic'' as com- monly used, does not necessarily imply the power to de- stroy bacteria. Any agent which has the power to arrest the growth of germs and renders them inactive for a peri- od may be termed antiseptic, or any substance which de- 336 GERMICIDES. stroys or neutralizes the poisonous products of bacteria so that it cannot be absorbed into the system is properly termed antiseptic. The researches of Koch and Wernich have overthrown many of our preconceived notions in reference to the effi- ciency of various disinfectants and antiseptics. It has been shown that it is by no means an easy task to destroy germs, while their spores seem to defy most of our so-called antiseptics. Then it is evident that we should depend upon disinfect- ants rather than antiseptics. The latter are good, but not so reliable. Of the long list of antiseptics and germicides, which have within the past few years been highly recommended by physicians and surgeons, but comparatively few haw retained the confidence and proved reliable in practice. While this failure may appear to be due to the lack of germicidal power of the agent, it should be borne in mind that we cannot expect every germicide to serve the same purpose under all conditions, and the choice of the agent to be used must, the same as of other remedies, be gov- erned by existing conditions; for conditions and environ- ments may vary, even more than the agents themselves. Since all disinfectants are necessarily antiseptic, they may be so classed. The following substances are antisep- tic, but in the strength given cannot be considered reliable as disinfectants under all circumstances. Pyrogallic Acid, - 1: 100 Boric Acid, - - 1: 600 Salicylic Acid, - 1: 600 Camphor, - - - 1: 400 Iodine, - - - 1:2000 Picric Acid, - - 1:3000 Sulphate of Iron, - 1: 300 Bromine, - - - 1:4000 Kreolin, - - 1: 100 Sodium Carbonate, 1: 200 Sulphate of Copper, 1: 400 Nitric Acid, - - 1: 400 Alcohol, - 30 to 95 per ct. Peroxide of Hydrogen, 5 " The agents named in the above list may be used with satisfactory results in surgical and obstetrical practice as antiseptics, but it should be borne in mind that the great Thymol, 1:75000 Bichloride of Mercu ry, 1 :40000 Oil of Mustard, 1:30000 Permanganate of Pc - tassium, - - 1: 3000 Carbolic Acid, - 1: 600 Quinine, 1: 1000 Benzoic Acid, - 1: 1000 Sulphuric Acid, - 1: 1000 Oil of Cinnamon, 1: 1000 Hydrastis, 1 : 500 M yrrh, 1: 1000 Eucalyptol, 1: 2000 GERMICIDES. 337 danger in treating cases of this nature comes from carry- ing the germs to them in the instruments and hands of the operator. In order to avoid contamination from this source the most thorough measures of disinfection are necessary. For this purpose it is well to use some of the stronger chemical disinfectants, and where practical heat may be used in order that aseptic conditions may be se- cured. In all surgical and obstetrical cases the use of antisep tics is of secondary importance to that of disinfectants. Nothing short of absolute cleanliness can secure the de- sired aseptic condition. In considering the properties of the various germicides and antiseptics, we find that some are valued solely for their germicidal properties. To this class belong bichlo- ride of mercury, carbolic acid, thymol and some of the stronger acids. Bichloride of mercury proves to be one of the most effi- cient germicides known. No other ngent so readily destroys both germs and spores, its action being instanta- neous even in very dilute solutions, one part to five thou- sand: provided, of course, there are no chemicals present, with which it unites and. thus renders it inert. When albumen is present in the solution, the bichloride is de- composed and rendered inactive as a germicide. It is also found that a watery solution of bichloride when allowed to stand for a long time precipitates its mercury salts and becomes inert. This may be prevented by the addition of a small amount of sodium chloride. Some surgeons recommend the addition of a mild organic acid— one that is unduly irritating. The following pre- scription has given satisfactory results, when used in surgical cases: Hydrarg. Chlorid. Corros. gr. xv Acid Tartaric gr. x vel dr. i Aquae Dist. pts. ii Bichloride solutions are used in strength of 1:1000 to 1:5000 in treatment of ordinary wounds. The objections frequently urged against the use of bi- chloride of mercury and other chemical germicides, on the ground of their toxic effect upon the human system, are not without valid reasons; but as before stated, we should be governed in our choice entirely by the nature of the individual case, and the special work to be accomplished. 338 GERMICIDES. In surgical work, where the object is thorough disinfec- tion of the operator's hands, instruments, and the surface of the body to be operated on, we should not hesitate to use some of the stronger germicides, thymol, bichloride, etc.; or if superficial wounds are to be cleansed and rendered asep- tic, this class of agents may be used with good results. However, after thorough disinfection we may with great advantage use the milder antiseptics, which are less irri- tating to raw surfaces, and are of such nature as to favor the healing process. Under all circumstances, where deep sinuses or mem- branous cavities are to be irrigated, avoid the use of those germicides that are readily absorbed by the tissues, such as bichloride, carbolic acid and arsenious acid. When agents of this class are used in deep fissures or in periton- ial cavities, toxic symptoms are of frequent occurrence. We would call attention to the use of iodoform, which has little if any germicidal action, yet it occupies a most important place among antiseptics. While iodoform exerts but little influence directly upon the germs, its virtue as an antiseptic lies in its peculiar power of rendering inert the bacterial ptomaines. It decomposes in the presence of germs, and while in a nascent state its elements change ptomaines into innocuous compounds, thus preventing absorption of the poisons by the system, and the forma- tion of pathogenic pus in wounds. Iodoform is ( f little, if any, importance in aseptic wounds; its greatest value is in suppurating wounds, where it can be applied directly to the diseased parts. The fact that it does not possess germicidal properties makes it necessary to sterilize it before using, or it may be the means of infection in an otherwise aseptic wound. A large list of purely sanative non-poisonous antisept ics could be mentioned. To this class belongs hydrogen per- oxide, much valued as a disinfectant for suppurating wounds, ulcerated sore throat and diphtheria, but owing to the frequent presence of higher acids is somewhat irri- tating, it is an excellent cleansing agent to be followed by the milder antiseptics. Hydrogen peroxide may be used in 5 per cent solution up to full strength, according to the requirements of the case. Boric acid is one of the most important sterilizing agents known fpr mucous surfaces. When used in a saturated GETJM. 339 aqueous solution it is an excellent disinfectant, and an antiseptic in weaker solutions. The diluted tincture of myrrh aside from its valuable antiseptic properties acts as a mild stimulant to the cir- culation and may be used with confidence. Its heal inl- and cleansing qualities are especially manifest in treat- ment of ulcerated sore throat and nasal cavities. For this purpose the pure tincture may be diluted one-half and used as a gargle. In obstetrical and surgical operations it is one of the most desirable antiseptics. Hydrastis possesses but little power as a germicide but like idoform is one of the most potent agents in its action upon bacterial products. Experience has demonstrated its value not only as an antiseptic but in its benign influence upon mucous membranes. It is one of the best remedial measures that we have for the treatment of choleraic diarrhoea, especially by electrolysis or slow irrigation of the colon and small intestines by way of the rectum. The following prescription may be used for this purpose Sterile infusion of Chammomile Flowers 1000 Standard Aqueous Solution Hydrastis 50 Gum Arabic 15 Hydrastis like myrrh manifests a tonic influence, and wherever membranes or tissues in wounds or cavities manifest a lowered tone or degenerate condition this agent is indicated. Hydrastis also exerts a very decided anti- malarial influence showing that when taken into the blood it antagonizes the germicidal ptomaines. It is also of special value in some forms of chronic dyspepsia where it exerts its peculiar antiseptic properties as well as its in- fluence upon the mucous membranes of the stomach. Hydrastis has long been recognized as an antiseptic and healing agent in the treatment of uterine catarrh, diseases of the bladder and as an injection for gonorrhoea. GEUM RIVALE AND VIRGINIARUM. Water Averts, Averts. The root is a pleasant, mild, soothing, tonic astringent. It is not drying but soothing to the mucous membrane. It is useful in mild acute and chronic cases of diarrhoea and dysentery. In leucorrhcea and gleet it may be used with good effect both locally and constitutionally. It may be used for light hemorrhages from any source. Locally it is a good wash for some irritated forms of sore mouth. 340 GLYCiSMNA. This article is not best where there is a tendency to con- stipation without it be combined with some such agent as syr. juglans. Constipation is irritating and diarrhoea is weakening. Avoid both extremes and seek to induce daily regularity. If there be a tendency to diarrhoea use tonic- astringents. Such may prevent debilitated conditions. Geum displays its influence to best advantage as a tonic- astringent. It is one of the best agents to be used in cases of cholera infantum. It improves digestion and assists assimilation. The fluid extract is a good preparation, or the powdered root may be boiled in milk. GILLENIA TRIPOLI ATA AND STIPULACEA. Indian Physic. The root is relaxing and stimulating chiefly to the alvine mucous membrane. Given in small doses in hot infusion it gives an outward flow of blood. If this be continued long or it be given in large doses emesis may be the result. This will also help to equalize the circulation. Cold preparations chiefly influence the alvine canal and produce catharsis. This agent is of value in colds, in the incipient stage of eruptive diseases where a good circulation is needed, and not unfrequently catharsis. Such a course is not unfre- quently essential in the beginning of the treatment of inflammatory rheumatism. It may also prove valuable in dropsy. ULECHOMA HEDERACEA. Ground Ivy. The herb gives a disagreeable odor, and possesses a bit- terish aromatic taste. It is a gently stimulating tonic to the mucous membrane, influencing especially that of the kidneys and of the respiratory tubuli. It will be found of use in cases of chronic bronchitis and phthisis where ex- pectoration is too free. GLYCERIN A. This is an odorless and colorless fluid obtained from various oils and fats. It has a sweetish taste, remains fluid and can be mixed with water in any desired propor- tions. Applied to the skin it softens it, but it gives a stinging sensation lasting a few seconds. This however GLYCERIN A. 341 can be avoided if it be previously mixed with a little water. Glycerin is an antiseptic, a solvent and a preservative nearly equal to alcohol. For solvent purposes it maybe diluted with alcohol to any desired extent. It may be used to partially cover bitter and stimulating medicines, and is frequently used to cover cod liver oil in the forming of an emulsion. As a solvent more or less diluted with water, it extracts the qualities of drugs and partially covers the excess of bitterness and stimulancy which the same drugs would have, had the menstruum been alcohol. As a wash in eczemas either alone or in combination it is good. Tr. Iodine 2 Glycerin 1 To one ounce of this mixture add half an ounce of hypo- sulphite of soda and apply for barber's itch. Or the fol- lowing may be used for the same trouble after shaving close: Prepared Chalk 10 Coal Tar 1 to 4 Glycerin 5 Simple Cerate 60 Or instead of the glycerin and simple cerate, add 20 parts of linseed oil. Ol. Rosas Glycerina Spiritus Myristicae OL Cajuputi Apply at night to chapped hands, or the following may be used for the same purpose; Glycerin Tr. Benzoin Aqua Rosas Aqua Camphorae M. Apply at night. Or use the following; Spermaceti Ol. Almonds Glycerin White Wax Melt together and stir till cold. gtt a. xv oz. i oz. iii gtta. xx ds, or tfc oz. as dr ss oz. iiiss oz. iv oz. ss oz. ii oz. i dr. i 342 GLYCJSIUNA. Glycerin oz. i Tr. Myrrh dr, ii Hydrastia Phos. grs. iii Rose Water q. s. oz. iv In bad cases of sore mouth apply every three hours. Glycerin oz. iv Alum oz. iv Mutton Tallow Beeswax aa. oz. ii Best Pine Tar oz. i Carbolic Acid dr. ii Dissolve and then stir till cold. It is excellent for piles. As a diluted wash for the head it is cleansing to the sur- face and nutrient to the hair follicles. Glycerin oz. iii Tr. Capsicum dr. i F. E. Quercus Alba dr. iv Ess. Bergamot dr. i This is a, pleasant and effective tonic to the hair follicles after fevers or subsequent to cases of syphilis or wherever there is danger of the hair falling off. Alcohol oz. i Glycerin oz. ii Tr. Capsicum dr. ii F. E. Verbascnmi oz. iii Ess. Bergamot dr. ii Rose Water oz. i This is also an excellent hair invigorator. But we do not guarantee either of these recipes to cause bald . heads to be covered with a luxuriant growth of hair. Soften clean glue oz. xiv in coJd water oz. xxviii. Make the solution complete in a water bath. Then add oz. ii glycerin. Apply with a camel's hair brush over burns. Some glycerin diluted may be added to poultices to keep them moist especially during the night. F. E. Lobelia Infl. Glycerin aa. equal parts is a good preparation for the moistening of the wax of the ear and for the relief of partial deafness due to this cause. It is also a soothing and relaxing preparation for caked or inflamed breast. Glycerin when added to cough syrups promotes expecto- GL.YCYRRHIZA. 343 ration, and when added to cathartics increases their laxa- tive power. Aqua 32 Glycerin 5 Citric Acid, Lemon Juice or Acetuni 1 This is a pleasant and most admirable beverage for the troublesome thirst of diabetes. Glycozone manufactured by Charles Marcharul, of New York, is the chemical result ol submitting pure glycerin to fifteen times its own volume of ozone under certain conditions. This is a good preparation for the prevention of gastric and intestinal fermentation. It heals the gastric mem- brane, relieves heartburn and gives favorable results in dyspepsia, gastritis and gastric ulcer. After sores have been cleansed by hydrozone or listerine or some other preparation, apply glycozoue; it is an excel- lent fluid dressing. GLYCYRRHIZA GLABRA, Licorice. Southern Europe. The root is a gently relaxing and stimulating, soothing demulcent, influencing chiefly the mucous membrane antf especially that of the bronchi. It soothes and relieves conditions attributable to colds. It is an excellent adju- vant for bitter medicines; eveu the taste of quinine and gentian is somewhat disguised by its use. Pills are fre- quently coated with it and bitter powders are frequently incorporated into it. If the extract be dissolved and incorporated with lactiu or starch and then dried and pulverized, it becomes a splendid vehicle with which to triturate quinine and many other bitter resinoids and stimulants. This is especially excellent where it can be incorporated with medicines that influence the bronchi. The fluid extract is also used as a vehicle. F. E. Glycyrrhiza " Lobelia Inf. a a- dr. ii " Aralia Rac. dr. i " Sanguinaria Can. gtta. xv Ess. Anise dr. ss Syr. Prunus q. s. oz. Iv H44 GNAPHALIUM. This for a dry tickling cough is excellent, and so it, the following: F. E. Eupatorium Perfol. " Glycyrrhiza Glab. aa. dr. ii Lobelia InfL m dr. i '■ Zingiber gtta. v Syr. Pruhus V. q. s. oz. iv GNAPHALIUM POLYCEPHALIUM. Life Everlasting. The herb is a mild diffusive, relaxant and stimulant to the muons membrane. It is slightly demulcent and is soothing to the mucous membrane in whatever part its action is most needed, or as directed by other medicines. Locally it is a good cleansing wash for either a sore mouth or a foul and irritable vagina. In the treatment of cystic catarrh it influences the cystic membrane to tfhrow off a large amount of mucous. Ln bronchial catarrh it allays irritation and relieves the mucous membrane of its extra accumulation. The smoke of this herb as well as an infusion of the plant yields good results in asthma. Give the infusion a^nd between the doses allow the patient to inhale the smoke. The latter influence is exerted directly by inhala- tion and the former is directed by the vital force a* a neces- sity for bronchial relief. In colds in which there is more or less bronchial conges- tion, a hot infusion of the following is excellent: Asclepias Tub. 4 Zingiber 1 Gnaphalium 2 Gnaphalium in hot infusion is mildly diaphoretic: zingi- ber gives it power in diaphoresis. In gastric catarrh it loosens the mucous discharge, but usually needs some tonic to follow. Dr. F. G. Hoener recommends this agent in pleuro- pneumonia, angina, croupy cough, atelectasis pulmonum. bronchiectasis, bronchial catarrh, capillary bronchitis, laryngitis, mumps. This agent is rendered still more important when com- bined with verbascum. GUA1ACTJM. 345 GOODYERA PUBESCENS. Spotted or White Plantain. Dr. F. G. Hoener recommends this agent as excellent for scrofula and chronic diarrhoea. GOSSYPIUM HERBACEUM. Cotton Root. The root is a relaxing and stimulating emmenagogue. In small doses it is antispasmodic and is valuable in dys- menorrhoea where there is usually scantiness of menstrual Mow It is a very improper agent for the use of the pregnant* It may provoke uterine irritation. It will increase labor pains and their intensity, hence it is not a proper agent to be used during parturition, especially if the lady be of a hemorrhagic diathesis. In acting as it does on the uterus it also influences diu- resis. Cotton seed oil has become quite an industry. It may lie used as a substitute for the same general purposes a^ linseed oil. It may be combined with ulmus as a dressing for burns and irritated sores. GUAIACUM OFFICINALE. Lignum V'itoz. .Jamaica. St. Domingo The wood comes to us in the form of chips. The centre wood yields a supply of gum-resin which is its active prin- ciple. Guaiaci resin i is a positive stimulating alterative to the general system. The digestive organs all feel its influence and so do the urinary and genital organs. It stimulates the circulation and induces a good capillary flow. It is best suited to languid and depressed conditions of the mucous membrane, and a clogged condition of the secernents, as in secondary syphilis, mercurial cachexia and venereal rheumatism. For such purposes however it is best administered with alterants. For arousing the circulation it is best administered in hot infusion when its influence is felt by the capillary circulation. AsclepiasTub. 4 Zingiber 1 Guaiacum 3 346 HAGUSNIA. This acts quite fully on the circulation and may be used in syphilitic fever and acute rheumatism. Cold forms are usually best for chronic diseases. Guaiacum is not suited to irritated or sensitive condi- tions. It is too stimulating for such. The resin may be triturated on lactin or sugar and given dry or in capsule. But the resin does not readily combine with other remedies. The chips are best for the forma- tion of compounds. Guaiacum Chips Smilax Off. aa. 2 Ruraex Crisp. Arctium Sem. Taraxacum D. L. aa. 3 This is an excellent alterative. Guaiacum Chips Cimicifuga Rac. Phytolacca Bac. aa. 4 . Xanthoxylum Cort. 1 Aqua q. s. Raise to the boiling point and allow to stand two hours and add- sugar q, s. Give three to six times a day for rheumatism. Gum Guaiacum oz, i " Myrrh " Camphor Oil Capsicum aa. oz. ss Alcohol oz. xxxii This forms a pain-killer of some importance, Guaiacum Resin Sugar aa. oz. ss Gum Acacia dr. ii Triturate well in one pint of cinnamon water. This forms a good emulsion of this agent. HAGE^IA ABYSSIN1CA. Kousso. Abyssinia, The flowers are an anthelmintic and are used to expel the tape worm. It excites a heat, nausea and sometimes vomiting and thirst. It may be given in powder, infusion or fluid extract after fasti Hg a day. Four hours after giv- ing the dose of kousso give a good large dose of antibilious physic. It usually expels the worm. Occasionally the dose may have to be repeated. HAMAMELIS. .'H7 HAMAMELIS VIRGINICA. Witch Hazel. The leases and twigs are a pleasant, reliable, mild, soothing, diffusive, stimulating, astringent tonic. It chiefly influences the mucous membrane. Locally it is much used in gonorrhoea, and in gleet. The aqueous or distilled extract has become a favorite for this purpose. It is colorless and when used with colorless hy- drastis it makes an excellent injection to soothe the ure- thra. In the treatment of this disease it gives good re- sults and no urethral contractions follow its use. In leu- corrhoea it stimulates, astringes and tones the uterus and vagina. In dysentery and diarrhoea it may be used alone or in conjunction with ulmus or other remedies. It is a mild remedy for light cases of hemorrhages, rec- tal, cystic or uterine. In catarrh of whatever part of the mucous membrane it may be, it is a good remedy. When needed for vaginal <»; nasal catarrh it may be used locally. In nasal catarrh it may be used with the nasal douche or be incorporated with vase- line and applied with a camel's hair brush. In vaginal ca- tarrh it may be used by injection, suppository, gelatin cap- sule, tablet, or upon a pledget of cotton. Thus applied it is an excellent remedy for prolapsus uteri. As a rectal injection it gives favorable results in prolap- sus ani and in rectal hemorrhages. In purulent ophthalmia it forms a good wash, and also for sore gums or sore mouth. With a small portion of capsicum it is excellent in cases of menorrhagia. Though this agent is an astringent it is not drying but leaves the surface soothed and toned. It influences the nerves in the same manner. A strong infusion forms a good wash for scaly and other skin diseases. When there is a tendency to hemorrhage it will give re- lief of after-pains. Aqueous Hydrastis dr. iii " Hamamelis dr. ii frequent than normal. The limbs remain in the same po- sition in which they maybe placed, but do not resist a change of position, tendon reflexes are absent and complete anaesthesia of the surface of the body obtains. Deep mus- cular sense and vision are partly active. Communicated positions of the limbs produce corresponding ideas in the brain. This state of catalepsy terminates by either a return to normal or by a change into the state of lethargy. The principal points in this state are, anaesthesia of skin and mucous membranes, increase of irritability of the mo- tor nerves, and, as a rule, non-susceptibility to suggestion. The eyes are closed, or half open, the body is relaxed, mobile, and respiration quickened, tendon reflexes are increased, and muscular contraction often remains until released by excitation of antagonistic muscles. By opening the eyes of the lethargic he is transferred into catalepsy; by closing the eyes of the cataleptic he is taken into lethargy. And a curious proof of the independence of the separate halves of the brain is found in the fact that the opening or closing of one eye in the cataleptic or lethargic state, as the case may be, will cause a change to occur in one-half of the body in accordance with the rule above stated. In the third, or somnambulistic state there is anaesthe- sia of skin and mucous membranes, and also, insensi- bility to pain; the senses are enormously quickened, and the same is true of the mental faculties. It is on persons in this state that suggestion works such wonders. By the term suggestion we understand that action by means of which the operator gains control over the subject ope- rated upon by means of some suggested action or idea. To illustrate: A man whose arm is to be amputated is put into the somnambulistic stage of hypnosis, and it is svg- 3H0 HYPNOTISM. gested to him that he have no pain. The operation is done without pain— suggestion has done its perfect work. One operator suggested to his lying-in patient that she have no pain: she received it as a suggestion that she have no contractions, and labor ceased till the suggestion was changed. Its Practical Application. — That the influence of mind over mind, and that of mind over matter (the body), has in it a great potentiality for good to the physician and sur- geon is being realized more and more. Hypnotism is being- divested of the mysteries that once surrounded it, and in which the ,# /V*i£/*-curists" and so-called "Christian-scien- tists" seek yet to envelop it: its application is being rationally and rapidly systematized, and we have now the science of Suggestive Therapeutics. In surgery and obstetrics hypnotism has great utility, depending upon the anaesthesia it induces. As early as 1829, Cloquet amputated a woman's breast without pain by its aid. In 1845, Loysel, of Cherebourg, made a pain- less amputation of the leg. Velpeau, Broca, and other French surgeons have made extensive use of hypnosis as an anodyne in their work. From 1850 to 1860, six hundred surgicai operations were done in the hospital at Calcutta, in which this agent was the only anaesthetic used. Braid, in England, used it in the same way. Its use is not so convenient as is the use of chloroform or ether, too much time being required to bring most patients under its influ- ence; hence, in this commercial age, where time has such a monetary value, this fact militates against hypnotic anaesthesia. It is infinitely more safe than either chloro- form or ether, a fact greatly in its favor. It has been used less frequently in obstetrics than in surgery, but it certainly has a wide field for its application in the former. In mental and nervous disease hypnotism has a more extensive therapeutic range. Indeed, here it seems to find its special" application. True, many cases of mental de- rangement are no doubt secondary to some functional, physical disease, the cure of the latter restoring the mind to its normal again. But we are persuaded that many cases of mental aberration are simply pathological states due to the existence of some abnormal, secondary ego, some perverse consciousness obstinately cherishing its narrow idea, which, with the normal, supreme ego in full ILEX. 361 control, would be out of the field of thought and contem- plation, but which, in the abnormal state of things, has assumed supreme command of the mind, and inhibits the normal flow of life. Current literature is rich in its record of cures by hypnotic suggestion. The best plan seems to be to make but one suggestion at a time, thus attacking each hallucination singly, and thereby avoiding confusion. The suggestions are to be given loudly, definitely and precisely. Assurance is thus given that a certain voice, vision or fixed idea will soon vanish, and lo, it is gone ! The range of hypnotic cure among the insane is. unhap- pily, limited, for not all are susceptible to hypnosis: what per cent, we cannot ascertain. Genuine epilepsy seem> in bear the same relation to this agent; yet hysterical paral- ysis, convulsions, etc.. come readily under its therapeutic influence, while writer's cram]), chorea and tonic spasms are most readily relieved. Lieboult has cured a number of obstinate rases of enure- sis by hypnotism. Insomnia is said to be very easily cured by this means. Hypnosis has cured many cases of alcohol- ism. So we see that bodily suffering and bodily disease can be relieved by hypnosis. And not only this, but the psychical life of man seems equally open to its benign influence, so That bad habits can be overcome and depraved character improved. Hypnotism is undoubtedly a potent therapeutic force and deserves careful consideration and investigation at our hands. HYSSOPUS OFFICINALIS Hyssop, This plant is a mild, diffusive, stimulating and relax- ing aromatic. In hot infusion it influences the circulation giving a good outward flow of blood, It is useful for the re- lief of colds, coughs and bronchial congestions. Inhala- tion of the steam is a pleasant relief in cases of coryza. ILEX AQUIFOLIUM AND OPACA 'Holly. The leaves are a mildly stimulating and relaxing dia- phoretic especially when yiven in hot infusion, and are ser- 362 INULA. viceable in the treatment of colds, feverishness, conges- tions and inflammations. ILEX PARAGUAYENSIS. Paraguay Tea. Central South America. The leaves and twigs are a soothing, gently stimulat- antispasmodic nervine. The tree is about the size of an orange tree or a little larger and its leaves remain green throughout the year. It is a favorite beverage among the people of Chili, Bolivia, Peru and Southern Brazil. From some of these nations it is a large and valuable export. An effort has been made to cultivate this tree but not with great success. It is more productive in its wild state. It has a pleasant aroma due to the presence of a volatile oil. It is best in hot infusion, and as a beverage it is su- perior to Chinese tea. It is more diuretic than coffee and fully as stimulating as tea, but is more soothing and quiet- ing to the nerves than either of them. It allays thirst, re- lieves hunger, promotes digestion, and stimulates the ner- vous system producing refreshing sleep. A hot infusion may be used in feverish conditions, in the eruptive fevers, in pleurisy and in insomnia and gen- eral nervousness. IMPATIENS PALLIDA. Wild Celandine. This herb is a stimulating and relaxing alterative influ- encing the mucous membrane and the secernents through- out. It is of some service in jaundice, dropsy, some forms of indigestion, hemorrhoids, tetter, ringworm and other eczema. The fresh herb bruised and applied to the surface is said to be a cure for rattlesnake bite. INULA HELENIUM. -Elecampane. The root is a gently stimulating tonic to the mucous membrane. It is a warming, strengthening, cleansing and toning agent to the gastric, alvine and pulmonary mucous membrane, and is very serviceable in catarrhal conditions of the bronchi, and catarrhal dyspepsia. It is better suit- ed to chronic than acute cases. It is an excellent addition to cough syrups. iris. 363 In hot infusion its stimulating power gives a good out- ward circulation. Elix. inula Hel. oz. i Verbascum Thap. " Polygala Senega aa. oz. iss Tr. Lobelia oz i Dr. F. (r. Hoener says administer this every 15 or 20 minutes till relieved, in cases of pseudo-membranous croup. [POMEA JALAPA. ,/alap- Tbe root is a stimulating cathartic in ordinary doses in from three to six hours. Large doses produce more or less griping and watery stools. In combination with zingiber the griping may to a great extent be prevented. In com- bination with zingiber and senna it forms a good antibil- ious physic. F. E. Ipomea Jal. dr. iii Cassia Acut. dr. iv Syr. Zingiber. q. s. oz. iv M.S. Teaspoonf ul or less at night To overcome consti- pation. IRIS VERSICOLOR. Blue Flag. The root is a positive alterative. Its influence extends to the whole glandular system and the lymphatics. In hot infusion it stimulates a good free outward circu- lation. Cold preparations unite freely influence the liver, gall ducts and bowels. Large doses are unite cathartic, and arc somewhat nauseating. Its influence is best as an alterant and when combined with other alterants. It is a most desirable agent in secondary syphilis, scrof- ula, skin diseases, mercurial cachexia, dropsy, chronic rheumatism and chronic liver troubles. Its best influence is seen in chronic, torpid conditions. The fluid extract may be used for all the general pur- poses of the root. It gives good results in chronic constipation, and it is said to give good results in goitre. 3()4 JATROPHA. F. E. Taraxacum D. L. dr. iii " Eryngium Yuc. dr. iv " Iris Vers. dr. ii Syr. Zingiber. q. s. oz. iv M. S. Teaspocmful three to five times daily for dropsy. F. E, Iris Vers. " Smilax Off. " Rumex Crisp. " -Arctium Sern. aa. dr. ii " Xanthox. Carol. gtta xx Syr. Simplex q. s. oz. iv This forms a good alterant for glandular and skin troubles. This is an excellent addition to liver medicines, espe- cially when there is more or less impurity of blood and a sluggishness of the circulation. It is valuable in rheumatism from specific cause. When there are irritable conditions this is not the agent to be used. F. E. Iris Versi. dr. vi u Hydrastis Cau. dr. iv " Chelone Glab. dr. v " Xanthoxylum Frax. dr. ii Syr. Simplex ad. oz. xvi This has been successful in uterine fibroids. Irisln is the resinoid and does quite well. It stimulates the lymphatics, absorbents, skin and kidneys. It is a powerful hepatic and stimulating alterant in the treat- ment of scrofula, syphilis, gonorrhoea, dropsy, rheumatism, glandular swellings, eruptions of the skin, affections of the liver and spleen, and wherever there is a low condition of the excretives. JATROPHA MACRORHIZA. Jicama. Southern States and Northern Mexico. This plant grows to be about a foot high, and has a short, thick, tuberous root, which is a pleasant, compara- tively tasteless cathartic. In large doses it may prove drastic and emetic, especially so if the green root be used. These symptoms may be to some extent prevented by the addition of zingiber or mentha piperita. It is both hep- atic and cholagogue and need only be used in small doses. It operates in from three to five hours according to the JUGLANS. 365 JEFFERSONIA D1PHYLLA. Twin Leaf. The root is a rather pungent, bitter, stimulating and relaxing alterant. It influences the mucous membrane and in hot infusion it indues a good outward circulation and relieves the secernents and the glandular system in general. It is quite stimulating and relieves a torpid condition of the mucous membra ne, and is sui'able to catarrhal condi- tions. With agents that influence the bronchi it stimulates to expectoration. With agents that influence the uterine discharge it increases the monthly. Its action may thus be also guided toward the kidneys. It is a very valuable alterant to be used in the treatment of rheumatism. Or. F. G. Hoener says that he has suc- cessfully used it for twenty-five years in cases of rheumat- ic fever, acute rheumatism, cerebral and chronic rheuma- tism. It is also valuable in mercurial rheumatism, mercurial cachexia and atonic amenorrhcea, and it may be added to cough syrups when the treatment is for scrofulous or con- sumptive cases. F. E. Jeffersonia Diph. ' ; Mitch el la Rep. aa. dr. iii 44 Liriodendron Tul. ''' Taraxacum D. L. aa. dr. ii Syr. Zingiber. q. s. oz. iv This is an excellent alterant where a female tonic is also indicated. F. E. Jeffersonia Diph. " Di centra Ex. " Phytolacca Bac. " Euonymous At. aa. dr. ii Syr. Zingiber. q. s. oz. iv This is an excellent stimulating alterant. An infusion of jeffersonia is a good wash for sore mouth and as a wash for the treatment of indolent ulcers. JUGLANS CINEREA. Butternut, White Walnut. The inner bark of the root is more active than that of the trunk, but both are used. It yields its properties to 360 JUGLANS. boiling water except' its astringency, which property is yielded when alcohol is the menstruum used instead of boiling water. Juglans is an active stimulating hepatic and cathartic. It relieves the portal system, disgorges the liver and cleanses the bowels. For catharsis it usually takes from four to eight hours according to the dose given. Juglans cinerea tones the entire alvine mucous mem- brane, but especially that of the lower bowels, influencing peristalsis. The alcoholic fluid extract may profitably be used in diarrhoea and dysentery. It cleanses the surface and leaves the parts toned and astringed. The aqueous extract being free from this astringency may be used to relieve chronic constipation. It is in this sphere one of the most valuable preparations. In relieving the portal circulation it also relieves hemorrhoids and rectal hemor rhages. In dysentery in small doses it cleanses the bowels, re- lieves the portal circulation, and tones the mucous mem- brane. New Milk qrt. i Good Vinegar tablespoonsful 2 to 4 Let it come to a boil. Don't let them eat anything elst. This makes a vinegar whey and add juglans and zingiber to suit in cases of diarrhoea. F. E. collinsonia can. may be added to syr. juglans in the treatment of hemorrhoids and is very valuable in the treatment of rectal hemorrhages. Solid Extract Juglans Cin. grs. iii Capsicum Powd. gr. ss may be given at bed-time for chronic diarrhoea; or give h. E. Juglans Cin. dr. ii " Cornus Flor. dr. iv Tr. Myrrh dr. i Syr, Zingiber. q. s. oz. iv M. S. Teaspoonful at bed-time. To prepare the syrup of juglans gather your bark from the fifth to the twentieth of April in this climate. It is then strongest. Crush or chop fine. Then boil till quite strong and pour off and cover a second and third time to completely exhaust the strength of the drug. Then boil all together and evaporate to three-fourths of equality of one pint per pound of bark. Then for each twelve ounces add alcohol two ounces and sugar four ounces. A small JUGLANS. mi proportion of the fluid extract of zingiber may be added now or when prescribed. The Syrup Juglans Cin. as kept in stock by Dr. C. T. Bed- ford, made from fresh selected bark and gathered in proper season, according to the formula and practical experience of Prof, G. N. Davidson is the best and most effectual form in which this valuable agent can be given, combining as it does, all the desirable qualities, viz: Reliability, Cheap- ness and Pleasant Taste. For which it has become favorably known throughout the United States from the Atlantic to the Pacific, from the Lake to the the Gulf. This preparation is made as above noted by one of the most reliable of pharmacists, and in itself is susceptible of a very wide range of application. In small and lrequent doses it may even be used in ty- phoid fever. It is well adapted to the treatment of skin eruptions. It is a tonic to both mucous membrane and dermoid tissue and slightly increases the action of the kidneys. It is one of the most valuable agents in the whole materia medica. It relieves the liver, proves gently cathartic and leaves the bowels soluble and toned. These are qualities that can be accorded to but few agents. By the use of this agent the fieces become more or less darkened. The fluid extract alcoholic may be used in combination with comp. syr. rhei et potassse in the treatment of diar- rhoea and dysentery in either adults or children. Ess. Mentha Pip. gtta. ii F. E. Hydrastis Can. dr. i Bicarb. Potas. dr. ss Syr. Juglans q. s. oz. iv This is an alkaline, tonic, hepatic and cathartic valuable in chronic constipation and other atonic conditions of the alvine mucous membrane when there is a tendency to gas- tric acidulation. .Juglans cinerea is a most excellent alterative. The oil may be used as an application to irritable sores. It is best triturated with glycerine or vaseline. JUGLANS NIGRA. Black- Walnut. The leaves are a gently stimulating tonic to the mucous 368 JUNIPER. membrane, especially of the generative organs. They also form an excellent fomentation for applying to inflamed and congested surfaces, frozen limbs, or congested lungs. The bark is used very successfully in catarrh, leucor- rhoea, prolapsus uteri, relaxed vagina, etc. The fluid extract may be incorporated with vaseline and used with a brush or atomizer in case of nasal catarrh. A salve made of walnut hulls boiled in cosmoline is ;i favorite application in cases of eczema rubrum. The oil is excellent in cases of purulent ophthalmia acute and chronic. It cures quite rapidly and scarcely ever disappoints. It is one of the best agents for applica- tion to children who become excoriated from urine. If you get a»ll the black out of the hull of the walnut and use for this purpose it is good. It will smart the eyes but little, and may be used for the same general purposes as the oil. JUNIPERUS COMMUNIS. efun iper. Theberries are a stimulating diuretic, suitable to tor- pid conditions of the renal apparata. It increases the flow of urine and somewhat influences the uterine function in sluggish conditions. In typhoid fever, dropsy, cystic ca- tarrh, renal congestions, but it is not best in irritated conditions except in combination with eupatorium purpu- reum in excess. The oil very much resembles the berries in properties and may be used for the same general purposes. With vaseline or glycerine it forms a good wash for irritated surfaces. The fluid extract is a good preparation. F. E. Juniperus Com. " Eupatorium Furpur. aa. oz. ss Syr. Zingiber. oz. i This forms an excellent diuretic. JUNIPERUS SARINA. Savine. The twigs and leaves are a powerful stimulating diu- retic and emmenagogue. The pregnant should not use this agent at all. It is too irritating for internal use, but the oil may be incorporated with other ingredients and used upon the surface where a powerful stimulant is re- KRAMERIA. 36ft quired. When used by itself upon the surface of those who are thin skinned it will blister. JUNIPERUS VIRGINIANA. Bed Cedar. The leives contain an essential oil which is obtained by distillation. It forms an excellent application for sprains and bruises, painful and swollen joints. Internally, tritu- rated on lactin, it is a stimulating diuretic. KALMIA LATIFOLIA. Mountain Laurel. The leaves are a mild stimulating and relaxing alterant especially influencing the glandular system. F. E. Kalmia Lat. " Euonymous Atr. aa. dr iii " Dicentra Ex. dr. i " Menispermum Can. dr. ii " Xanthoxylum Carol. gtta. xv Syr. Simplex q. s. oz. iv M. S. Teaspoonful three or four times a day for skin diseases, secondary syphilis, scrofula and glandular swell- ings. An infusion of kalmia may be used for rheumatism or other conditions indicating irritation of the serous mem- brane. The fluid extract is a good preparation and may be used Whenever the agent is needed. KRAMERIA IXINA. Rhatany. The bark contains a large proportion of tannic acid. The root is a mild, pleasant, soothing, stimulating and diffusive, astringent tonic. Though stimulating it is not irritating to the mucous membrane. It is somewhat dry- ing but not intensely so. In the treatment of leucorrhoea, prolapsus uteri and vaginal relaxation it is a valuable wash. It is of much service applied to bleeding surfaces, and internally it is valuable for the relief of hemorrhage, whether it be of the gastric, intestinal, uterine or respira- tory organs. Locally it is an excellent application for spongy gums, mercurial sore mouth, it is also of excellent service in the treatment of diarrhoea and in dysentery acute or TJO LARIX. chronic, and in typhoid fever it is frequently of service. LACTUCA SATIVA. Garden Lettuce. This plant is a soothing nervine, whether used as an edible or in the form of an inspissated juice. It is also soothing to the mucous membrane of the gastric and alvine banal. It is pleasant in an irritated or ulcerated stomach and is useful in an irritable dyspepsia. It is very soothing and quieting to an irritated condition of the nervous system. Insp. lactuca may be combined with scutelaria and lupu- lin and used with good results, or the following may be used as a nervine of much value: Insp. Lactuca F. E. Humulus aa. 2| " Scutelaria •' Cypripedium aa. 5i LAM1LTM ALBUM. Blind Nettle. Europe, Asia. North Africa. The flowers are a powerful haemostatic. It is of espe- cial importance in the treatment of bronchial hemorrhage, in the coughing of blood, in uterine hemorrhage and in dysentery. In metrorrhagia the fluid extract of the blossoms may be combined with some aromatic syrup and given every half hour until the hemorrhage ceases. It may then be given every four hours or as required. LARTX AMERICANA. Tajnarac. The bark is a mild, stimulating and relaxing alterant, influencing chiefly the skin ;md secernents. It is best in acute and inflammatory forms of blood and skin diseases. It is not suitable for the treatment of depressed cases. except in combination with more stimulating agents, as iris, dicentra or smilax. F. E. Larix Am. dr. iii •' Iris Vers. Dicentra Ex. " Smilax Sar. aa. dr. ii Xanthoxylum Car. gtta. xv Syr. Simplex q. s oz. iv LAUKUS. 371 M. S. Teaspoon ful from three to six times a day. This is a valuable alterant. LAURUS CAMPHORA. Camphor. The camphor evergreen is native to Japan and South- eastern Asia. The leaves, stems and trunk yield a so-called guni which is put through a principle of purification. It is very volatile arid will evaporate if exposed to the air. To obtain it in tine powder it must be triturated on mag- nesia, lactin or sugar, fcamphor is not really a gum; but a concrete oil rriore or less solidified. It has a penetrating fragrance and a bitter, pungent taste. Camphor is antispasmodic and rather soothing to the uervous system. Aqua camphora is made by either of the following form- ulas: Camphor dr. ii Alcohol gtta. xl Carbonate Magnesia dr. iv Aqua pts. ii Or Camphor dr. ss Alcohol dr. vi Shake these till dissolved, and add by trituration, subse- quently filter: Carb. Magnesia dr. iss Aqua dr. xxvi One or two grains of camphor will relieve after-pains, or better; the water of champhor may be given. Yet it is not the best thing to be given. Locally it allays muscular soreness. OL Olivae 4 Laurus Canipli. dissolved 1 Dr Laurus Camph. oz. i iss Oil Lavender dr. i Alcohol 45 p. c. oz. xvii Either of the above formula; is a good application for bruises, sprains or sore muscles. The following is a soothing liniment: Laurus Camph. oz. i Oil Rosemary " Origanum aa. dr; i 2 LATJKUS. Alcohol Pt. \ Castile Soap oz. iii Or Laurus Cam ph. oz. iiiss Oil Sassafras ;i Cedar Tr. Guaiacum aa. oz. i " Capsicum oz. ii Alcohol pts. iv Or Sp to. Camphor oz. ii " Origanum " Sassafras aa. dr. ii " Turpentine oz. ss Or Spts. Camphor oz. ii Tr. Capsicum oz. i " Guaiacum oz. ss Alcohol oz. iii Or Spts. Camphor dr. iv " Ammonia Oil Sassafras Turpentine aa. dr. ii Oil Cloves dr. i Apply the following for winter eczema: Gum Camphor Oil Origanum Oil Cloves aa. equal parts in vaseline. To assist in stopping the flow of milk apply to the breasts a few times, Gum Camphor oz. ss Turpentine oz. iii The ordinary spirits of camphor is made of gum camphor one ounce to eight ounces of 45 p. c. alcohol. Camphor, sugar and acacia in equal parts is camphor powder. Camphor ice is made as follows: Camphor oz. ii Almond Oil oz. xvi Dissolve these and melt together Spermaceti White Wax aa. dr. i While cooling add LAVENDULA. 373 Oil Rosemary dr. i Rose Water oz. xvi This is an excellent application. Camphor inhaled through the nostrils soothes and stim- ulates the brain and relieves oppression. Dr. C. B. Riggs recommends the following for toothache: Tr. Camphor Gum dr. vi Oil Sassafras dr. li M. Sig. Bathe the gums frequently and fill the decayed tooth with a pledget of cotton saturated with the above compound. When this fails to relieve the aching allow the dentist to extract the tooth or if possible till it. The tincture of camphor should be a saturated tincture with absolute alcohol. Spts. Camphor 1 Aqua Ammonia 2 Kerosene Oil 4 This will be found valuable for sprains. LAVENDULA VERA. Lavender. The flowers are a relaxing and stimulatiug, soothing nervine. It is an antispasmodic and useful in nervous restlessness and the irritation or depression therefrom. It also forms a good adjuvant for the administering of other agents. The oil may be used for the same geueral purposes, and is best used when triturated on lactin or magnesia. Lavendiila Vera oz. iss Cinnamonum Cas. Zingiber. Off. Leonurus Card. Pimpinella Anisum aa. oz. ss This forms an excellent compound for faintcess, palpita- tion, shock, fright, colic or hysteria. It is best adminis- tered in hot water. Oil Lavender * ; Lemon aa. dr. vi " Rosemary dr. ii " Cinnamon gtta. xx Alcohol 98 per cent. qrts. ii This is a good cologne for the sick room. 4 LEONURUS, Oil Lavender M. 245 " Rosemary Cassia Cin. M. «1 oz, n Cloves oz! i Nutmeg Red Saunders aa. oz, i f)r Oil Lavender Nutmeg Cinnamon a a. grs. 300 Oil Rosemary M. 20 Red Sandal grs. 600 Either of these form ulae make good adjuvants for the Hd ministering of bitter medicines. LEONURUS CARDIACA. .Motherwort. • This fierb is a pleasant, reliable, diffusive, stimulating and relaxing, antispasmodic nervine. It influences the mucous membrane, especially that of the pelvic organs. A hot infusion promotes a good outward circulation, in- creases the menstrual flow. It is useful in amenorrhoea and in dysmenorrhea when congestion is present, and in hysteria and palpitation when the patient is more or less ehlorotic. Leon tin dr. ii Elixir Wahoo Syr. Pepsin aa. oz. ii M. S. One teaspoonfui after, eating and one he fore retiring for amenorrhoea. A cold infusion is a gojd tonic, improving the appetite, assisting digestion, and is somewhat a tonic diuretic. This is not a proper agent for the pregnant to use, nor for those given to too free menstruation In case of after- pains when the lochia is quite scanty this agent may be used to advantage. In anaemic and chlorotic nervousness, palpitation, rest- lessness and insomnia it is one of those mild agents that may be used to great advantage as well as for the relief of the aching back and pelvis in case of tardy menstruation, F. E. Leonurus Card. " Dioscorea Vil. aa. dr. iii " Caulophyllum Thai. dr. ii Syr. ZJngiberis q. s. o», iv LJfiPTANDRA 375 This is a good diffusive antispasmodic in cases of dys- menorrhea. V. E. Leonurus Card. " Senecio Aur. " Mitchella Rep. aa. dr. iii Syr. Zingiberis q. s. oz. iv This is a good nervine tonic for the chlorotic. F. E. Leonurus Card. " Arctium Lap. Sem. aa. dr. iii Xanthoxylum Frax^ dr. ss Menispermum Can. dr. ii Syr. Simp. q. s. oz. iv This may be used by the chlorotic who have some scrof- ulous or other impurity of the blood current. F. E. Leonurus Card. dr. iii Ferri et Pot. Tart, grs. x Hydrastia Sulph. gr. ss F. E. Taraxacum D. L. dr. iv Syr. Zingiberis q. s. oz. iv This may be used where there is more or less failure of gastric and intestinal digestion. In cases of nervous pros- tration scutelaria may be added in small quantities. LEPTANDRA VIHGIN1CA. Culver's Boot. (Veronica Virginiea. The root is a mild, slow but persistent relaxing hepatic. It is very slightly stimulating. Its chief influence is ex- erted upon the liver tubuli rather than upon the gall cyst. It assists in the secretion rather than in the excretion of bile. In fact it seems to exert but little influence in the latter direction without being combined with some suit- able agent. Whenever mild, persistent, relaxing hepatic influence is needed this agent is reliable and may be used both internally and externally. But when used externally it should be combined with an equal portion of capsicum. Thus combined it may be made into an excellent liver pad. Leptandra, apocynum and. and capsicum in equal parts forms a good liver pad. This should be occasionally moist- ened with the fluid extracts or tinctures of the same. Leptandra is quite nauseating tu some stomachs in some conditions. In such cases the pad or the application of the fluid extracts is an excellent substitute. In ai^ute febrile cjnditions it is best to combine leptan- dra with m >re stimulating agents, and in jaundice this 37 6 LEPTANDRA must always be the case, especially if the gall be somewhat solidified. Preparations of the green root are more cathar- tic than those of the dry root. As a rule leptandra is not a cathartic, yet its relaxing influence is felt upon the whole alvine nricous membrane and through this relaxation of the alvine membrane it dislodges viscid mucous and occa- sional doses are valued for this cleansing cause in cases of diarrhoea and dysentery. When used as a physic large doses must be given. In cholera infantum small doses given once or twice a day will cleanse the alvine canal of viscid mucous and assist in the proper secretion of bile, and indirectly by its relaxing influence may also relieve the gall cyst, and thus create a healthy flow of bile, and a healthy condition of the alvine mucous membrane. In nearly all febrile conditions it is needed, though it is usually best when combined with some diffusive or chola- gogue. If it is to be used alone it is best in acute rather than in chronic cases, when it is a necessity that it be combined with more stimulating agents. In chronic constipation in cases of hepatic failure lep- tandra may be used, but is best with agents more stimu- lating and those more cholagogue. Leptandrin dr. ss Oil Capsicum gtta. x Lactin dr. ii Trit. Mnke into twenty-rive powders. This is a valu- able hepatic, Leptandrin Podophyllin aa. gr. i Capsicum Apocynin aa, gr. ss This may be taken in capsule once or twice a day in cases of torpor or congestion o! the liver. In typhoid fever more or less capsicum is needed in small and frequent doses with all hepatics. Leptandra in combination with some alterants will be found valuable in the treatment of skin eruptions. F. E. Leptandra Virg. dr. vi " Hydrastis Can. dr. ss " Gkmtiana Och. gtta, xv Syr. Zingrberis q. s. oz. iv This is a good tonic hepatic. LIATRIS. 377 F. E. Leptandra Virg. dr. vi " Apocynum And. dr. ss Syr. Zingiberis oz. iv This will influence both sides of the liver about equally. F. E. Leptandra Virg. dr. vi " Podophyllin gr. ii Syr. Zingiberis q. s. oz. iv This will favorably influence both secreting and excret- ing functions of the liver. F. E. Leptandra Virg. dr. iii Euonymous Atr. dr. ii '• Taraxacum D. L. dr. iv Syr. Zingiberis q. s. oz. iv This is a gentle hepatic tonic and forms an excellent base which may be influenced by various other agents. Leptandrin grs. 1 1-4 Juglandin Euonymin aa. gr. 3-4 Apocynin Sodae Bicarb. aa gr. 1-16 Ol. lies. Capsici gtta. 1-40 Ol. Mentha Pip. gtta. 1-20 This forms the famous Stimson Physio-Medical Pill, hepatic and cathartic. Lepta»drin gr. 1 Podophyllin gr. i Irisin gr. i This forms a good cholagogue, hepatic and alterant. LIATRIS ODORATTSSIMA. Deer Tongue. This is a stimulating, astringent tonic, influencing chiefly the mucous membrane. It is valuable in the check- ing of rectal hemorrhages and in dysentery and diarrhoea. In hot infusion it influences the circulation. Its hepatic action is also well marked. Dr. F. G. Hoener recommends the use of this agent in cases of abscesses of the liver and in miliary consumption. LIATRIS SPICATA. Button Snake-root. The root is an aromatic, diffusive, stimulating and relax- ing diuretic, increasing the flow of urine and relieving irritation. .'U» LINUM. In hot infusion it influences the circulation, gives a good outward flow of blood, soothes the peripheral nerves and the uterus, and is somewhat diaphoretic. Jt is a good antispasmodic and may be used to relieve colic, after-pains and dysmenorrhea, especially where there is a deficient flow. In hot infusion it is valuable in the fever stage of erup- tive diseases. It is quite diffusive and maintains a good capillary circulation. Used locally and internally it is recommended for the elimination of snake virus, and also for weak sores and chancres. In cases of renal debility or renal and cystic congestion it gives favorable results. LINDERA BENZOIN. Spice-bush. The bark and berries are a mild diffusive, relaxing and stimulating diaphoretic. In hot infusion it may be used for the relief of colds and in the eruptive diseases. In re- lieving the circulation it also soothes and gently stimu- lates'the nervous sysiem and is valuable in the acute stage of rheumatism, gonorrhoea and syphilis. LINUM USITATISSIMUM. Flax. The seed are an excellent soothing demulcent, stimu- lating and toning agent to the mucous membrane of the alvine, respiratory and urinary tracts and is valuable for the relief of irritated and inflamed conditions. When needed for the respiratory tract, it relieves irrita- tion and promotes expectoration. In hot infusion it may be used for the relief of recent colds and coughs. For such conditions it is best made in syrup form. When needed for the alvine tract it may be used cold. Ln dysentery, diarrhoea and cholera infantum it soothes, heals and tones. When requirer 1 for the urinary tract it soothes and re- lieves irritation, but its influence will be more marked when combined with more positive diuretics. After the oil has to a great extent been pressed out of the ground seed what is left is denominated oil meal. This is frequently used as a poultice. In bronchitis and pneumonia it forms an excellent poultice for the lungs. LJPPIA, 37f> It may be frequently moistened with lobelia, verbascum and capsicum combined as desired. For boils and abscesses it is best combined with ulmus, The raw oilis valuable for many purposes, internally in sufficient doses it will prove cathartic. Combined with pulverized ulmus it is a most valuable preparation for the covering of burns. I have always had the very best of results witlj its use. Never allow the surr face to become uncovered untill thoroughly healed. It will do its work without leaving any marks, no difference how deep the wound, wipe off any puss that may be present and remove dead flesh and then cover again with this prepara- tion. The results of gunpowder accidents I have frequent- ly removed with the same. Of course nervines, cathartics, hepatics or alteratives may be added as needed by the con- stitution. An excellent flaxseed tea is made as follows:— Flax seed Rock Candy aa oz. viii To which add three lemons pared and sliced. Then add fwo quarts of boiling water, and cool and strain. Dr. C. B. Riggs recommends the following ( (German Liniment ) for burns. Linseed Oil (raw) Turpentine aa oz. xvi Sulphuric Acid C. P. oz. i Mix the oil and the turpentine thoroughly. Put this mixture into an earthen crock and add the sulphuric acid very slowly, a few drops at a time, then allow to stand twenty - four hours until all the precipitate has formed and pour off and retain the supernatant fluid only. Keep the burned surface wet with this liniment. The surface may be covered with gauze or cheese cloth and thus kept saturated. This forms an antiseptic covering to exclude the air. If desirable some agreeable perfume may be added. The Doctor says, this is the best thing for burns that he has ever used, and that he has had remark- able results with it. having healed some very extensive burns without ulceration or scar. He gives credit to Dr. P. Holt for this formula. L1PPIA MEXICANA. (Lippia Dulcis.) Cuba, Central America, Columbia. Tli is is a creeping shrub covered with minute glandular ■IS® LIRIODENDRON. hairs. It blossoms from November till March. The leaves and stalks are gathered during the flowering season or shortly after. It has an agreeable sweetish taste and is slightly demulcent. It is a pleasant, prompt, stim- ulating and relaxing, demulcent alterant. It influences the respiratory mucous membrane and is a valuable expec- torant. Large doses may be followed by nausea and vom- iting. Care must be taken to have a fresh article. It contains a volatile oil called lippiol, the absence of which renders the agent more or less inert. Much heat must not be used in the extracting~Of its virtues. % The aqueous extract is devoid of astriugency. In hot infusion it relieves colds, loosens catarrhal secre- tions, increases expectoration and relieves soreness of the throat and is excellent in the treatment of la grippe. It quickly allays an irritating cough, and is very useful in acute and chronic bronchitis, catarrhal fever, catarrhal phthisis and night sweats. It tones the respiratory mu- cous membrane and cleanses it of excessive mucous. LIQUIDAMBER STYRACIFLUA. Sweet Gum. From incisions made in thp bark of this Southern tree flows a nearly transparent aromatic balsam. Its volatile oil is more or less evaporated upon drying. This resinous yumis warming and moderately stimulating and relaxing. Combined with olive oil or vaseline it forms an ointment for ringworm, scald head, tetter and other irritations of the skin. It rarely fails to cure scabies and is a valuable application for old sores, hemorrhoids and ulcers. Inter- nally it may be used in gleet and other excessive discharges. The bark is a mildly stimulating agent and may be used freely in gonorrhoea, cystic catarrh, dysentery and diarrhoea. LIRIODENDRON TULIPIFERA. Tulip-Tree. The inner bark of the trunk and roots is a mild, bitter, aromatic, relaxing and very gently stimulating alterant and nervine. ■ The green bark is much more positive than the dry. This, agent influences the mucous membrane, the secern- ents, the nervous system and the generative organs. It LIRIODENDRON. H81 improves the appetite, assists digestion and is somewhat laxative to the bowels. In convalescence it is a mild nervine tonic and is grate- ful to the stomach. It is especially soothing and toning to the generative organs and is a valuable agent to be used in the treatment of nervous irritability, hysteria and the irritations some- times incident to pregnancy. In influencing the generative system it also influences the urinary membrane and very gently increases the flow of urine. In combination with such agents as aralia racemosa. Symphytum or prunus it influences the respiratory organs and to cough syrups it adds an excellent nervine influence. F. E. Liriodendron Tulip. " Aralia Rac. • k Symphytum Off. '.' Inula Hel. aa. dr. i Syr. Prunus q. s. oz. iv This is a good cough syrup. F. E. Liriodendron Tul. dr. vii •' Hydrastis Can. dr. ss Syr. Aurantium Cort. q. s. oz. iv This is a good nervine tonic. F. E.' Liriodendron T. dr. iii Caulophyllum Th. . " Leonurus Card. Viburnum Op. a a. dr. i " Sencio Au. dr. ii Syr. Zingiberis q. s. oz. iv This is useful in dysmenorrhcea. F. E. Liriodendron Tul. oz. ss Valeriana Off. Caulophyllum Th. aa. dr. i Xanthoxylum gtta. x Tr. Anisum dr. i This forms a good nervine tonic, and so i> the following: F. E. Liriodendron dr. iv Convallaria Mult. Euonymous xVt. a a. dr, ii Hydrastis Can. •• Scutelaria Lat. aa. dr. ss Syr. Aurantium Cort. oz. i •' Zingiberis oz. iv 382 LOBELIA. LOBELIA INFLATA. Lobelia. The herb and seed are relaxant with a moderate degree of diffusive stimulation. More especially in the seed we find an extractive and a volatile oil . It is best gathered when about half ripe, but you will find trie plant good at any time of its growth. Much heat will injure it. To prepare an infusion use a sufficient quantity of boiling water and allow it to stand covered. The seed will not readily yield their properties Unless well crushed. To extract the inspissated juice it must be gathered green and tieavily pressed. When the herb is put up to dry it should be placed upon its root end so as to prevent losing the seed out of the cap- sules. When once thoroughly dry it should be packed in a close box; or the better way is to make a fluid extract of the fresh herb For ordinary use this is strong enough, Lobelia is a relaxant to the mucous, serous, nervous and muscular structures. It influences the glandular system, the fauces and the respiratory tubuli. It increases the flow of saliva; relaxes, cleanses and tones the mucous membrane throughout. To the fauces it is acrid and to the gastric membrane it is nauseating. If small doses be given at regular intervals it will bring the whole body under its influence, add a condition known as *'the alarm" produced. Its influence then is complete on the capilla- ries, the nerve peripheries, the general circulation, and the muscular and glandular systems. In certain acute conditions it relieves the tension of the circulation, estab- lishes the functions of the skin, relaxes the secernents, and relieves the liver, kidneys and bowels. Lobelia is one of the greatest equalizers of the circula- tion and gives a full outward flow of blood. Its influence reaches every organ and almost if not quite every tissue of the body, and hence wherever a relaxing influence is needed it will be felt. Medically therefore its range is wide, especially in acute troubles. In influencing the cir- culation it also influences the nerves, sympathetic, central and spinal. The muscles thoroughly feel its relaxing power and it becomes one of the best aids in surgery requiring 1 relaxa- tion, especially in dislocations* LOBELIA. 383 Lobelia is abused by Physio-Medicalists more by leaving it out of their prescriptions than in any other way. It is of great service in croup, pneumonia, bronchitis, pleuritis, hepatitis, peritonitis, nephritis, phrenitis, otitis, ophthalmia, rheumatism, and in nearly all the forms of fever. In many cases it is best to add some asclepias and zingiber. Such a combination will give quick relief in pulmonary congestions. Given in hot infusion it clears out the lungs wonderfully. Very weak persons can take emetics when they are needed; even an occasional emetic maybe given to con- sumptives. Emesis is also valuable in puerperal fever to certain conditions, (rive to cleanse and stop, and repeat only as required. Pound the green herb to a pulp and press out the juice into a shallow p -rcelain vessel and allow to evaporate in the sun to a thick paste and bottle for use. I have heard this plaster recommended as a cure for cancer, but it makes an excellent plaster for swollen joints, sprains. abscesses boils, etc. In the beginning of typhoid fever an emetic will prove serviceable in cleansing the system and equalizing the cir- culation. If necessary you can give the stimulating agents by the stomach and the lobelia by enema. In typhoid cases it takes but iittle to produce emesis. In the tardy appearance of the eruption in the eruptive diseases an emetic serves a good purpose. It equalizes the circulation, opens the pores and gives free vent for the eruption, usually all that there is in the system, and such cases will make good recovery. You will find some jaundiced cases that can retain noth- ing on the stomach. Give them an enem i of lobelia and the stomach will soon be emptied of an amount of viscid bile and soon be quieted. An emetic has frequently proven valuable in cases of hepatic congestion. In membranous croup an enema at* lobelia to move the bowels and produce relaxation will be of value. Give a strong tea of lobelia per enema and follow with a strong infusion per orani. P^ollow with some diffusive stimulants and relief will be experienced. The enema may also be used in order to produce emesis in enses of malarial fever if required. 384 LOBELIA. In dislocations give small doses regularly and frequently and apply also locally, and it will be of great \alue in re- laxing the parts so that the dislocation may be the more readily and easily reduced. Locally lobelia is of great value applied to abscesses or erysipelas. Hydrastis may be added as needed. The oil of lobelia has less of the stimulating property and is not so likely to produce emesis. To prepare this oil cover the seed with 98 per cent, alcohol, shake this tinct- ure occasionally, and after being well saturated four or five days, then percolate thoroughly, adding alcohol till the strength is exhausted. Evaporate on a water bath and you have the oil. Then water can be added to the percolator and a strong preparation results, to which some glycerin may be added. This will be an excellent addition to cough syrups. The oil is best for asthma, combined as follows. It sel- dom fails in hay asthma: Oil Lobelia Infl. Cincho— Quinine aa. oz. i Sugar (granulated) oz. ii Dr. G. H. Mayhugh gives the following for asthma: Oil Lobelia Cinchonidia aa. dr. i. Sacch. Lactin oz. ii M. Trit. Sig. Five to ten grains everyone to three hours, until relief is had. Then give four times a day til! cured. Dr. F. G. Hoener gives the following for asthma: Syr. Scillse Tr. Lobelia F. E. Hepatica Tril. Syr. Bidens Bip. aa. equal parts. M. S. Take one dessertspoonful every hour or every two hours till relieved. Oil Lobelia " Zingiber. aa. gtta. iii Caulophyllin Cimicifugio aa. grs. iss Trit. on lactin. For hysterical cough give three doses fifteen minutes apart. Lobelia Infl. oz. ii Nepeta Cat. oz. i LOBELIA. 385 Sanguinaria Can. dr. ii Xanthoxylum Frax. Bac. dr. i Add one-half pint saturated tincture of cypripedium. Steep in one and a-half pints of water for three hours. Then strain, press and add two pounds of sugar. This is a serviceable cough syrup for the scrofulous and anaemic. F. E. Lobelia Infl. dr. ii " Cypripedium Pub. dr. iv Tr. Capsicum dr. ss Syr. Simplex q. s oz. vi M. S. Terspoonful every half hour in the treatment of puerperal convulsions. In giving lobelia there will be less relaxation if capsicum or hydrastis be added. In the treatment of congestions some diffusive stimula- tion should b3 added. In cases of gastric irritation give minute doses at regu- lar intervals. This will allay irritation, prevent emesis, arrest spasmodic conditions and allay sympathetic vomit- ing, In spasmodic and membranous croup, whooping cough, asthma, occlusion of the gall ducts, strangulated hernia, rigid os uteri, hour-glass contractions and tetanus, lobelia has no equal. Emesis is a powerful arrestor of hemorrhages, whether from lungs, uterus or bowels. It casts out impurities and equalizes the circulation. Lobelia is best suited where and when arterial action is strong and when given in asthenic and more or less putres- cent conditions, its continuance usually should be brief, only sufficient to cleanse and then use a more stimulating treatment. Small doses given at regular intervals and continued for some time will bring on that state known as the alarm, in which condition we examine our patient and find him with a good, full, soft, steady pulse; breathing full and gentle; the secretions of the skin increased; the secern- ents are all relaxed, and the whole system is in a state of relaxation and rest. The patient rallies from such a con- dition in an hour or so. Usually this time is shortened if some stimulation is given or applied As a result of such condition the skin will be relaxed, there will be a free dis- charge of urine, of bile and of faeces. The nerves are quieted, the mucous membrane is freed of much mucous, <86 L0BKL1A. and in every way the whole system and all of its sever.il parts are more completely under the control of the vital force than they had previously been. In cases of convulsions, lobelia should be combined with caulophyllum. In tetanus it is best administered by enemata. Give in large doses a. id give until relaxation occurs, then sustain by appropriate stimulation. In cases of hemorrhage after emesis follow with astrin- gents. With ulmus it is valuable in ophthalmia as awash or poultice. In surgery it has n > equal where relaxation is needed. It quiets the nerves and prevents the vital force from put- ting forth as much inflammatory effort, Small enemas may be used to prevent seminal discharges and nocturnal erections. Lobelia is not best jn nervous prostration, paralysis, gangrene or shock. Lobelia Inf. 2 Symplocarpus Sanguinaria aa. 1 This may be prepared into a syrup for croup, asthma and nervous coughs. Lobelia Infl. Capsicum aa. dr. iv Cypripedium dr. ii Comp. Tr. Myrrh et Cap. (No. (5) oz. viii This is Dr. Samuel Thompson's Third Preparation of Lobelia. It is a most valuable preparation. In sluggish cases it arouses the system to dislodge semi-putrescent material, and quickly stimulates and equalizes the circula- tion. It is a most valuable preparation for sick-head- ache, some forms of dyspepsia and in the incipiency of some forms of apoplexy. Tincture Lobelia Comp., third preparation, the Physio- Medicalist's sheet anchor, when life hangs in the balance, where effects are required on short notice, the tincture lo- belia comp. can be relied upon when made by C, T. Bedford who uses only the best material in its manufacture. The Oil of Lobelia kept in stock by C. T. Bedford is extra fine being made by the formula peculiar to G. N. Davidson. Third Lobelia - '1 r. Lobelia lull LOBELIA. 387 F. E. Scutelaria Lat. " Valeriana aa. equal parts. M.- S. Three-fourths teaspoonful in warm water every five minutes in a strong infusion of cimicifuga. Use this in ( ases of rattlesnake bite. Pui. Lobelia Seed dr. ii Cider Vinegar pt. i The vinegar may be added cold and tinctured for a week, or the vinegar may be raised to the boiling point and added, when it is immediately ready for use. This is one of the best preparations for croup, whooping cough and asthma. This preparation is best administered in the form of acetous syrup, which is pleasant and very efficient. To make the syrup fill the bottle two-thirds full of the tincture and add sugar to fill the bottle. Shake until'dis- solvecl. Or half the quantity of sugar may be replaced by an equal bulk of honey. The oil is best administered by being triturated with l(i times its own weight of sugar or lactin. or the two may be combined in equal parts. Dr. C. B. Riggs recommends the following compound :*-grain Lobelia pill: Powd. Lobelia Intl. Seed grs. iss " Cypnpedium Pub. gr. i " Capsicum gr. ss Extract Boneset q. s. ad. pill. Sig. One pill every one to four hours, as *he conditions demand. The Doctor says, This is a most excellent prepa- ration where profound relaxation is desired without eme- sis. It is excellent in peritonitis, lung and bronchial troubles, especially for bronchial cough and painful condi- tions' in any part of the body. Lobelia seed and tannin in equal parts in vaseline makes an excellent suppository or maybe introduced in rectal capsules for hemorrhoids. Triturate enough lobelia inflata in bicarbonate soda to form a thin paste and this rubbed well into a sore made by a rusty nail or into other inflamed or poisoned sores has been very successful in the hand's of Dr. C. R. Phillips. At first put on a paste of this and then keep the surface moist with lobelia tincture. You will be surprised to see how quickly it will cause pain to cease and cure the wound. 388 LYCOPODIUM. Dr. F. O. Broady recommends the following hair tonic: F. E. Lobelia Seed (made by cold process) dr. vi " Bayberry Bark " " " " dr. ii Strong Tinct. Capsicum dr. ii Glycerin oz. i Rose Water q. s. oz. vi M. Sig. Apply every morning after having first washed the scalp with a good tar soap. A small quantity well rubbed in is sufficient at each application. I have twice restored my own dying and falling hair with six ounces of this. LYCOPERSICUM ESCULENTUM. Tomato. (Solanum Lycopersicum.) The fruit is a stimulating and soothing tonic alterant to the mucous membrane especially of the mouth, stomach and alvine canal. The fluid extract acts on the mucous lining of the mouth and other cavities and is excellent in nurse's sore mouth, canker and ulcerated sore mouth. The dose of the fluid extract is from 30 to 60 drops. The fluid extract should be made without heat from the ripe tomatoes. Its alterative influence is felt by the lym- phatics when they are swollen and hard and when scrofula is present. It assists in the relief of dyspepsia, constipa- tion, catarrh, hemorrhoids, leucorrhoea, spongy gums, de- caying teeth. The tomato is a germicide and a cleanser of the mucous membrane, and may be a means of preventing typhoid fever and diarrhoea. I have noticed one thing peculiar with the use of the tomato by those who have recently used some form of mer- cury. There may follow some semblance to salivation, but usually a little hydrastia phosphate and glycerin will quickly relieve this. LYCOPODIUM CLAVATUM. Club-Moss. Switzerland, Germany. The capsules of this moss contain a fine powder called lycopodium which consists of the seeds or spores of the plant. It is exceedingly tine, very light and of a delicate yellow color, tasteless and inodorous. This powder is a fine absorbent application to excoriated surfaces. It is an excellent baby powder for the prevent- LYCOPUS. 389 ing or cure of chafing. It may also be used for the cover- ing of burns. LYCOPODIUM COMPLANATUM. Ground Pine. Dr. F. G. Hoener says that with this he has cured some very severe cases of erysipelas. He gives it internally and applies it as a wash locally. LYCOPUS EUROP^US. Bitter Archangel, Bitter Bugle Weed. This is an extremely bitter, stimulating nervine. The herb is a powerful antiperiodic and seems to influence the secernents more and the brain centres less than does qui- nine. If it could be properly covered by some vehicle it would be a more valuable agent than quinine. Small quantities maybe used in large quantities of water as a tonic appetizer. LYCOPUS VIRGIN ICUS. Bugle Weed. The herb is an aromatic, soothing, stimulating, astrin- gent tonic, influencing the mucous membrane. It is valu- able in dysentery, diarrhoea, cholera infantum, in typhoid fever, in hemorrhages of the lungs, gums, bowels, kidneys, uterus. In hot infusion it influences the capillaries, soothes arterial excitement, strengthens the venous circulation, relieves gastric, alvine and urethral irritation, equalizes the circulation and soothes the nerves. In combination with inula, Symphytum or prunus it forms a good tonic cough syrup where expectoration is quite free.. Cold preparations influence the kidneys and give valu- able assistance in enuresis, cystisis. nephritis and sperma- torrhoea. F. E. Convallaria M. dr. iv " Lycopus Virg. " Liriodendron aa. dr. ii Syr. Aurantium Cort. q. s. oz. iv M. S. Teaspoonful three times a day for the relief of ovaritis. An injection of lycopus into a fistula is a valuable apj li- ■"■890 MAGNESIA. cation. It may also be diluted and used in cases of ure- thral ulceration. Lycopus is valuable both locally and constitutionally in hemorrhages. MAGNESIA. This name is derived from the name of the district of country where it was originally obtained. It is one of the primitive alkaline earths, an oxide of magnesia. May ties ice Sulphas (sulphate of magnesia, epsom salts) is a mild, pleasant saline cathartic, usually operating in four or tive hours. It may be repeated as needed. If given in some lemon syrup it forms an effervescent drink. Magnesice Carbtnaa (catenate of magnesia) is an ant-acid and is used much for the relief of heartburn, sour stomach and nausea, especially during the period of preg- nancy. It also assists in keeping the bowels free during this period. This also effervesces when mixed with some acid. Magnesia is frequently used to absorb essential oils by trituration and rendering them capable of suspension in water, or making the oil more palatable by administer- ing in dry form. It may also be used as an absorbent or to apply to the surface to keep it from chafing, or as a baby powder. It is also used in the manufacture of tablets, pills and troches. Magnesia Usta (calcined or burnt magnesia) is obtained by heating the carbonate and driving off the carbonic acid gas. This combines with acids without effervescence. With this exception it is almost identical in practice with the carbonate. Liquor Mngnesice (it vat is (solution of citrate of mag- nesia) is an ant-acid, a liquid preparation, a pleasant, effer- vescing cathartic. Milk of Magnesia (Mg.H 2 2 ) is an excellent ant-acid, and may be used wherever the use of magnesia is implied. MAGNOLIA ACUMINATA. Cucumber Tree. MAGNOLIA GLAUCA. Sweet Bay Tree. . MAGNOLIA TKIPETALA. Umbrella Tree'. ' The bark of the" root and trunk of all these species is a MAHRUBIUM. 391 mild aromatic, diffusive, stimulating tonic, influencing the mucous membrane of the alvine and renal tracts. It increases the flow of urine and is a gentle laxative to the bowels. In convalescence it is a gentle tonic, improving diges- tion, and is of value in convalescence from fevers and rheumatism. It is useful in gonorrhoeal or other urethral irritation. It is quite soothing to the nervous system and is very sustaining. MALLOTUS PH1LIPPINENSIS. Kawvala. India. This is an evergreen tree of tropical India. The glands and hair of the capsules come to us in the form of a deep red powder, having but. little taste, and insoluble in water. The berries are gathered and rubbed together so a- to divest them of this powder, which is a pleasant anthel- mintic. With occasional failures this brings away the taenia solium. It causes no colic and needs to be followed by no physic as do other anthelmintics. It is itself rather a brisk physic' if given in large doses. It may be given alone or in combination with male fern or kousso in equal parts. An ounce or more of the powder may be given in capsules, in fluid extract or in infusion. MALVA SYLVEsTRIS AND ROTUNDIFOLIA. High Mallows, Low Mallows. These plants are demulcent tonics to the mucous mem- brane throughout. It relieves irritation, whether of kidneys, bowels, bladder, or stomach. It is of much importance in dysentery, diarrhoea, nephritis, cystitis and urethritis. It may be used externally and internally. In poultice it is excellent upon inflamed surfaces, and with such agents as aralia, comfrey or inula it gives valuable assistance to the lungs, over which it may also be applied ;;s a poultice. MARRUBIUM VULGARE. Horehourid. This heib is a gently diffusive, stimulating tonic to the respiratory organs. In hot infusion it is somewhat diapho- retic, promotes a good outw T ard flow of the circulation and M92 mel. relieves hyperaemic conditions of the lungs, congestions and hoarseness. In combination with leonurus it relieves the menstrual flow. Its best influence upon the lungs is in combination with aralia, inula and prunus. Marrubium decreases the mucous discharge and gives good results in wet catarrh and where expectoration is too free. MEDEOLA V1RGINICA. Cucumber Root, Indian Cucumber. The root is a soothing, gently stimulating diuretic. It increases the urinary flow, cleanses the mucous membrane and soothes and tones the urinary passages. It is service- able in congestions of the urinary tract and in gonorrhoea. Dr. F. G. Hoener recommends the following as a specific in some severe cases of gonorrhoea: Medeoia Virg. Agrimonia Eup. Plantago Major aa. equal parts. MEL. Honey. This is the liquid prepared by the apis mellifica f rom the juice of certain flowers. The best is made from white clover. It is stimulating to the mucous membrane, laxative to the bowels, and an expectorant to the bronchi. With sage and boracic acid it forms a good wash for sore mouth, and it is a good addition to cough syrups. Tr. Lobelia oz. xvi Oil Anise " Sassafras aa. gtta. xv Honey oz xii This fo T ms a good cough syrup, excellent for croup. Honey exerts a peculiar influence over some forms of ulcers, especially that produced by the removal of cancers. Here it is one of the best dressings. Spread pure honey all over the sore. It heals quick and does well. It does well as a dressing after cleansing the surface on any ulcer. Cleanse with hydro/.one and cover with honey. Pul. Hydrastis 1 Mel 2 MENTSPERMTJM. 39 1 Mix and spread on muslin and lay on the lids in chronic ophthalmia. MELALEUCA CAJUPUTI Cajuput. The oil obtained fro n the leaves is quite pungent and stimulating. Triturated on sugar it is a powerful and permanent stimulant, quite healing to the stomach, and influences the circulation toward the surface. Its best use is on ths surface, where it is intensely stim- ulating aud may be used alone or in combination with other stimulating or relaxing medicines as the case may require. Its use will be beneficial in toothache. MELISSA OFFICINALIS. Lemon Balm. This herb forms a pleasant beverage for convalescence. It is a strong and soothing, toning nervine. In hot infusion it is somewhat diaphoretic and may be used for the removal of colds, and for the restoration of the menstrual flow stopped by recent cold. MENISPERMUM CA'NADENSE. Fellow Parilla. The root is a slow, bitter, diffusive, permanent, stimu- lating alterative. It slowly but positively influences the secernents and the skin, and in diseases influencing such it is exceedingly valuable as an alterant. It tones the mucous membrane throughout, assists gas- tric and intestinal digestion, and slowly relieves the liver and gall ducts. Controlled by agents that have especial influence upon the respiratory passages it is very valuable in phthisis, in chronic bronchitis, and scrofulous conditions. In the treatment of fevers in strumous persons this agent is one of the best in combination with other suitable agents. In biliousness, atonic dyspepsia, glandular swellings, scrofulous and mercurial rheumatism, secondary syphilis and indolent ulcers, in combination with such agents as rumex, fraxinus, celastrus, arctium or Phytolacca valuable compounds may be formed. 394 MENTHA. F. E. Menispermum Can. " Arctium Lap. " Taraxacum D. L. aa. equal parts. This is a good hepatic alterant. F. E. Menispermum Can. dr. iii u Fraxinus Am. dr. iv " Celastrus Scan. dr iii Syr. Zingiberis q. s. oz. iv This is a good alterant for skin disease.-. MENTHA ARVENSIS. Japanese Peppermint. Japan and China. It is from this plant that we get that useful camphora- ceous substance denominated menthol, which as an anti- septic is about equal to thymol. In China and Japan it is considered a specific for head- ache and is recommended for sciatica and neuralgia. Menthol camphor pui into a carious tooth relieves tooth- ache usually at once. This comes in crystals deposited from the oil on exposure to cold. It is the camphor of peppermint oil. It is only partially soluble in water but melts at 100 degrees F. and soon volatilizes without decomposition. It will evaporate and disappear at the ordinary temperature of living rooms. It is a camphor and not an oil at such temperature. Its smell is less pungent than that of peppermint but it has a sharper taste. On the skin it produces a sensation of cold, and yet the temperature may be exalted slightly. Menthol and iodoform or iodide of potassium combined equally in vaseline may be used for ringworm or tinea cap- itis. Menthol may be applied to the head in cases of neuralgia and inhaled for coryza, or combined with albolen it may be atomized. It may be used in this way. also in bronchitis; whooping cough, nasal catarrh or asthma. It is a germicide and antiseptic and is valuable in the treatment of la grippe. It has been said that 1 to 33000 prevents the development of anthrax bacilli and 1 to 2000 destroys the cholera bacilli. A 20 per cent, solution may be used for pruritus ani or pruritus vulva. It may be used for the same purposes when combined with olive oil or vaseline MENTHA.* 395 Menthol grs. xxx Ess. Rosemary or Com p. Spts. Lavender Alcohol 45 per cent. aa. dr. ii This may be applied to carious teeth. Menthol dr. v Spts. Camphor Alcohol aa. oz. i This is usually successful in neuralgia, colic and in- flamed conditions. Menthol is useful in erysipelas. It circumscribes the eruption, allays pain and itching and lessens its duration. Menthol Alcohol aa. oz. i Oil Cinnamon gtta. xxx is successful in facial and intercostal neuralgia. Menthol may be triturated on sugar or lactin and giv- en in small doses for the vomiting of pregnancy. It may also be combined with syrup and given in small quantities internally for the same purpose, or it may be inhaled. Menthol may be dissolved in olive or cotton seed oil and used over burns. Combined with sodium salicylate and iodide potassium it will be found useful in rheumatism. Sprayed into the throat it relieves hoarseness, clears the voice and assists in the treatment of laryngitis. Menthol is altogether preferable to the ordinary smell- ing salts. Menthol must be tightly corked to prevent rapid vola- tilization. Menthol is claimed to be of much value in sunstroke. Th it menthol is a good antiseptic preparation of thymol and menthol. It is useful where either of its components is useful. MENTHA PIPERITA. This herb is a diffusive, aromatic, stimulating and relax- ing antispasmodic nervine and carminative. It is sooth- ing to the stomach and allays vomiting. Tr. Comp. Myrrh and Capsicum 3 Ol. Mentha Pip. 1 This will arrest chills in the milder forms of ague even after the person has begun to feel chilly. Give small doses every five minutes in some hot water. This preparation well diluted may also be used for gastralgia and shock. •J96 MENTHA. F. E. Cypripedium Pub. " Dioscorea Vil. aa. 20 Ess. Mentha Pip. ] Syr. Zingiber. q. s. This may be used for colic for babies or adults, also for flatulence, gastralgia, enteralgia, cholera morbus, cholera infantum and chronic diarrhoea. A drop or two of the essence may be added to cathartics and bitter tonics; with the former it prevents griping and nausea and with the latter it partially covers their bitter- ness. The oil is more positively stimulating and warming but is less relaxing and diffusive than the herb. Oil Peppermint " Anise " Cajuput " Cloves aa. oz. i Alcohol oz. iv This is a stimulating preparation for either internal u^e or for external application. Dr. F. G. Hoener recommends the following for delirium tremens: Elix. Mentha Pip. oz. i " Trichostema Dichota oz. ii Tr. Ferri dr. iv Elix. Hydrastis Oil Bergamot aa. dr. ii M. S. One tablespoonful four or five times a day. Give hot water or milk to drink. MENTHA VIRIDIS. /Spearmint. This herb is a soothing, aromatic, diffusive, relaxing and stimulating diuretic and nervine. It induces free discharges of the watery portion of the urine, relieves flat- ulence and soothes the nervous system A weak infusion readily allays nausea and vomiting, the vomiting of pregnancy, and is quieting to the stomach after free emesis. Mentha Vir. 3 Zingiber I forms a good preparation for colic, flatulence and some cases of hysteria. The oil may be used for the same purposes of the herb. MICROSCOPY. 397 Tt may be triturated on sugar or lactin for internal use. Oil Mentha Y. " Rosemary aa. 1 Tr. Lobelia 10 This makes a good application for various aches and pains. Oil Mentha Pip. " Mentha Yir. aa. equal parts in Vaseline forms an excellent application to the nostrils by pencil- brush or by atomization. This protects the mucous mem- brane, especially when about to be exposed to the cold air. It is very valuable in cases of catarrh. It protects the surface, soothes and heals. It is also excellent in hay asthma. MENYANTHES TRIFOLIATA. Buckbean. The root is a mild, stimulating tonic, influencing the secernents and glandular system. Large doses are somewhat nauseating but are thoroughly hepatic and cholagogue. It also increases the flow of urine. In its way it is valuable as an antiperiodic and an alter- ant. It cleanses the secernents and relieves the glandular system generally. It will be found useful in scrofula or where there is any impurity in the blood current. It is also quite useful in dropsy, where hepatic, alterative, diu- retic and tonic influences are needed to be thoroughly felt. MICROSCOPY. By F. O. Broady. M. D., Late Professor of Histology and Pathology in Chicago Physio-Medical College. Only a few hints can here be given on the subject of Microscopy. The student is referred for further necessary information to the many excellent manuals published in America and England. Chief among these may be said to be Dr. Carpenter on "The Microscope and its Revelations" (cost $6.00); Lionel S. Beale's "How to Work with the Mi- croscope" ($7.50); Prof. D. J. Hamilton's "Text Book of Pathology," 2 vols. ($12 50); Stirling's "Histology" ($3.00), a work on common objects, will no doubt be interesting, and M. C. Cooke on "Ponds and Ditches" (85 cts.) may be 398 MICROSCOPY. recommended. With the works of Stirling, Beale, Hamil- ton and Cooke the foundation for a good microscopical library has been laid, and with this beginning the charm of the microscope and its beautiful, useful and wonderful revelations will never lose its force with the student. The microscope is simply an aid to the eye, and being a very delicate aid it is subject to unusual fallacies. A good instrument should therefore be chosen at first, so that this outlay of money may not be wasted, but be made the foun- dation of a complete outfit. Some of the principal makers of good microscopes are Zeiss and Leitz of Germany, Beck and Watson of England. and Bausch & Lomb of America. A good second-hand stand by Mr. Bullock, of Chicago, is equal with the best. but Mr. Buliock is now dead. In general, we may say that the microscopes made by Zeiss and Leitz are carefully made but none of them are specially arranged for tilting the instrument. This compels most of the work to be done with the instrument standing straight up, and is very tiring to the investigator as well as causing dimness of vision from retinal congestion. This is a serious fault with all "continental model" microscopes. Among Eng- lish makers Watson, of London, is coming to the front: his beautiful exhibit at the Columbian Exposition attracted great attention. A satisfactory high-class stand (the in- strument without lenses) would be Watson's* -'Edinburgh Student's" microscope, tripod foot, model "H," cost with case $51.00 in England; with 1 inch and l-(i inch objective, two eye pieces, Abbe substage illuminator with iris dia- phragm, the cost is $75.00 in England— roughly counting the pounds at 85.00 and the shillings at 25 cents. In gen- eral, it may be said that the custom house tariff is at present 40 per cent, on these instruments, and the express- age from London to Chicago is $10.00 for 200 pounds. The services of a custom house broker are needed to get the goods out of the custom house and shipped to other points; his charge will be $5.00. A shipment from England is practical where two or more buyers join in one shipment. A corresponding American outfit would be Bausch & Lomb's (Rochester, N. Y.) "Universal Microscope, J," two eye pieces, 3-4 inch and 1-5 inch objectives, Abbe con- denser, with case, costs $85.00. To either stand a 1-12 inch *W. Watson & Sons, 313 High Holborn, W. C, London, England. MICROSCOPY. 399 oil immersion lens should be added for advanced work: this is the standard lens for bacteriological work. An ex- cellent lens is sold by Watson for $25.00 in London and a good one by Bauson & Lomb for $44.00. A "nose piece" is next needed to hold the objectives so that a change can be instantaneously made from one power to another. It should be ordered with the stand in order that it may be truly centered to that particular instrument. A double nose piece will do (American cost $5.00; English $.175). The following list comprises the principal accessories which would make an excellent microscopical outfit with what has already been mentioned: Beale's Camera Lucida (English cost $1.50) for drawing objects and for measure- ments; dissecting microscope for minute dissections, with objectives 1 inch, £ inch, i inch (American cost $10.00; English $8.75); stage micrometer, metric system (Ameri- can $2.00; English $1.25), for measuring size of objects; Rousselet's Live Box (American $2.50; English $2.00) for studying live animalcule; Cathcart's Ulicrotome, the best of the cheap kind and very useful. Watson sells it for $5.25 and it can be ^ed both for ether freezing or imbed- ding. Baiisch & Lomb charge $19.00 for practically the same instrument. The knife is extra, and Cole's costs $1.12 in England and $3.25 in America. Next comes a turn table (American $2.50; English $1.07) for making mount- ings; dissecting case of instruments (American $3.50; Eng- lish $2.07): injecting syringe for prepa-ing specimens by Beale's method (American $10.00; English, one pipe less. $3.12); glass shade for protecting the microscope from dust and a great convenience, $5.00 with base. This and the following articles can be bought in America to greater ad- vantage: The smalle-t size hand lamp, to be fitted with ground blue'glass chimney for evening work; 4-riug retort stand ($1.00); spirit lamp (35 cents): water bath (50 cents); sand bath (50 cents); wash bottle; pipettes; cover glass forceps (50 cents); bell glass (50 cents), for covering work from dust; brass table for heating slides, with suitable lamp (31.80; a dozen or more each of assorted ebonite and block tin cells (20 cents a dozeiij; thin cover glasses; ground glass slides; watch glasses; a few staining fluids, as Beal's carmine, eosine, hoematoxylin (each 20 cents;; Bell's cem- ent; Canada balsam; Price's glycerine; two capped bottles (30 cents each) for balsam and glycerine: and Pilisbury's cabinet ($3.25) to preserve your specimens. A plain but 400 MICROSCOPY. steady table is also needed. If shipment is made from England it would be very satisfactory to include some of Watson's excellent mounted specimens of human tissue at 25 cents apiece, admitted free of duty. A good microscope should be steady on its foot; the "field" (that is the surface of the picture presented to view) should be of good size — apparently 2± inches in di- ameter is good; there should be no rings of color around the outer edge of the field if the lens is good; the field should not seem to move or be unsteady as the tube is raised and lowered; and the fine and coarse adjustments should work perfectly smoothly from one end to the other. Great stress is laid by all teachers of microscopy on the need of the student drawing all that he observes. It is really of the greatest help as it trains the eye to observe closely; it assists in differentiating structures, and the accumulated drawings form a valuable source of reference. It is strongly urged that the student draw what he sees In the preparation of the tissues for microscopical exam- ination, but especially in preparing tissues for preserva tion in cabinets, two somewhat divergent methods are used by microscopists. One class— and they are in the majority — use many different kinds of hardening or soften- ing methods before they color and mount the tissue for preservation. The standard hardening chemicals are chromic, picric, osmic, nitric and formic acids and alcohol; other acids are used for softening. As the hardening power depends upon the power to coagulate albumen and render it opaque, we should also study how to render the tissue transparent after having cut it into thin slices — for which purpose the hardening was done — but no attention is paid to this important step in popular histology. The other method of preparing 'tissues is by injecting the capillaries with a red and the veins with a blue transparent solution, next doing a-; little hardening as possible but depending largely upon skill in fine dissec- tions (here the dissecting microscope is necessary), and lastly mounting (preserving) the tissue in heavy (Price's) glycerine. Beale, in his excellent work, fully explains this method, and as he at all times endeavors to alter the tis- sues as little as possible the student will do well to master Prof. Beale's technique. It is reasonable to expect greater discoveries in the histology of thp future from the delicate methods of Prof. Beale than from the harsh methods of MICROSCOPY. 401 other popular authors, by whom tissues are even boiled before being mounted. The beginner who, for the first time, attempts to look through a microscope, may find some assistance in the fol- lowing instructions: Put the instrument on a steady table by a north window — never in direct sunlight. Tilt the stand to an angle suitable to the eye of the observer when comfortably seated. Use either nose piece, but at first put into the tube the low power objective (1 inch). Ex- clude all light from beiow by a slip of paper and put a dry, small piece of bread crumb in the Rousselet's Live Box. Hack the tube down till the object is in focus. Nothing but an opaque mass is seen, but here and there a glimpse of more or less transparent pieces appears. Let one or more of the transparent pieces be in the field and remove the 1-inch objective, replace it by thei-inch, and remove the paper which excluded the light from below. Be sure to get a beam of light from the concave mirror to pass through the opening in the stage before focusing. Still but a glimpse of something beyond is seen. Next, raise the tube and remove the live box. On the finger carry a drop or so of water and carefully apply to the pieces of crumb. Let them soak a few seconds and gently still more separate the pieces by means of a needle mounted in any wooden holder the size and shape of a slim lead-pencil. Needles are useful in microscopy; the slightly curved, spear pointed surgical needle mounted in a wooden handle makes an excellent knife for fine dissections. Next, gently press down the cover to the live box, place on the stage, and focus the tube. We now notice that a number of small, oval, circular, angular, and perfectly transparent particles are seen for the first time. Each transparent particle ha& a sharp and dark outline and the starch gran- ules are now differentiated. Notice that not until exam- ined in water did the starch granules yield any result; while looked at in air only opaque masses were seen. Hence we get a hint, how the medium may be suitable or not. In the same way examine in air and in water the thinnest shavings of lead-pencil wood, a thread or two of cotton, of wool, of linen, of silk, a small pinch of flour, ordinary starch, pepper, capsicum, powdered mustard, taking care to let the harder objects soak an hour or so in water so that they are well penetrated with the fluid. Next examine moist tea leaves, very thin sections of pota- 402 MICROSCOPY. to, skin of orange or lemon, cabbage and other vegetables, taking care that in all cases the section is small and thin enough. A razor can be used for this. The beginner will also be greatly interested in examining various specimens of jam and preserved fruits. As these have been long soaked in syrup they have become exceedingly transpar- ent so that the spiral vessels, woody and cellular tissues can be seen without any trouble. Small insects, the pro- boscis of the mosquito, the flea, lobelia seed, lycopodium. the dust of the wings of moths and butterflies, the scum and ooze of ponds, and many other minute growths yield a rich field for the beginner. An intimate knowledge of the microscopical appearance of what goes to making up common household dust, mould and debris, is necessary at the very beginning of histolog- ical investigation, in order that the observer may not mistake a thread of cotton or wool for elastic tissue of the lungs in tuberculosis, a fibril of linen for shreds of urethral membrane in gonorrhoea, or the sugar mold for tubular casts in nephritis. Also be sure to learn to recognize air bubbles in all kinds of media, as water, oil and gum; oil globules in water and in tissue; and the ''Brownian' movements that all finely divided particles, the size of ordinary bacteria or less, show and which may easily bv mistaken for life movements. : The beginner will also find that the following precau- tions will be of advantage in order to save and develop his powers as an observer: Do not work too long at a time, especially with high powers (1-6 inch objective and higher): do not have the object illuminated more intensely than is necessary to see it clearly. Be sure to cultivate the habit of keeping both eyes open even though observing with but one, and change from one eye to the other quite frequently to avoid strain. At first work for half an hour only at a stretch, and if this does not tire too much the length of time for observation maybe gradually increased; two or three hours a day is the normal length of time for the ordinary observer. If care is exercised a weak eye may be strengthened and made as serviceable as any. A good microscope with a sufficient, supply of accessories is a practical help to the busy practitioner; to the scholar and investigator it is a charming companion and helpful friend. He is dull of wit whose pulses are not stirred at seeing the brilliant, scintillating movements of his own MITCrfELLA. 4C3 white blood-corpuscles with the 1-12 inch lens, or the beat- ing heart of some transparent animalcule with the 1-6 inch. A large field of usefulness and discovery in diagno- sis and therapeutics as well as in physiology lies before the medical microscopist. But the Physio-Medical inves- tigator will find that the artificial and violent methods of Allopathy have even invaded microscopy and histology so that it will be necessary for a member of the only scien- tific medical school to select from the mass of tissue destroying Allopathic technique that which is of service, and on that build a method of his own. Prof. Beale will probably be of more service than any other popular in- structor, but as, histology has advanced somewhat (though not as fundamentally as many would make us believe) since he wrote, there is something to learn from other authors and more to be developed by Physio-medical investigators. Let such enter the field with full assurance of rich intel lectual reward for even the smallest efforts made. Remarks.— rAn article on Microscopy may seem out of place in the midst of a Materia Medica, but I think it is very appropriate. The time has come when microscopy should be esteemed as one means of determining in some respects the therapeutical value of the agents we use and especially of the new ones we seek to choose. It will assist much in determining whether the agent be sanative or poisonous, and be a means of purifying our Materia Medica as well as of guiding in the selection of new agents. I hope to enlist the efforts of some willing and efficient microscopists who will from time to time report the results of their careful investigations of the various influences of different agents upon. bioplasm as actually observed in the field of the microscope. Prof. Broady's article is a very suitable introduction. MITCHELLA REPENS. Squaw- Vine. This herb is a moderately stimulating tonic nervine.' Its range of influence is. wide and at is one of pur most uselul agents. The stomach, bowels, kidneys, uterus, nervous system and circulation all feel its iNfluence. ■ It is valued in all kinds of female weakness, but may be used by males wherever their troubles, are similar. In fact, wherever a good tonic is required, not too stimulat- 404 MITCHELLA ing but permanent, mitchella is in place. Jt would be rather difficult to misapply mitchella. It tones the stomach and bowels, relieves the aching back and stops uterine crampings during gestation. In nervous feebleness, irritability or prostration, wheth- er in males or in females, it is of superior value. It is a most important agent in spermatorrhoea, hysteria, and hypochondria. In leucorrhoea, prolapsus uteri, dysmenor- rhoea and all other female weaknesses it is so highly valued as to be denominated a female tonic. It relieves many au unpleasantness arising during the period of gestation. It may be taken more or less during this whole period with much benefit to the w'.:ole pelvic organism and the lady better prepared for parturition. There are few if any agents better adapted to the requirements of this period than mitchella. Mitchella Rep. 9 1-7 or 8 Viburnum Op. 2 Chamaslirium Lut. Caulophyllum Th. aa. 2 2-7 or 2 Each forms an excellent female conic which will not dis- appoint you whichever formula you may adopt. Syrup Mitchella Comp. as made by C. T. Bedford under his improved process of manufacture, gives a syrup which represents the medicinal agents better than any other we know of. Extract Mitchella gr. i Caulophyllin gr. i Helonin Viburnin aa. gr. i Form this into a tablet or put into a capsule and use one or two after each meal and before retiring. If there be any scrofulous or spermatic troubles add menispermum or celastrus as required, or use for sperma- torrhoea the following: Comp. Syr. Mitchella qz. x (or F. E. Chamaslirium Lut. oz. i) F. E. Celastrus Scan. " Uva Ursi a a. dr. iss " Epigasa Rep. dr. iii In liiiT? trouble; where there is an excessive expectora- tion the tonic influence of mitchella is very favorably felt. • MOBUS. 405 MITELLA CORDIFOLIA. Bishop's Cap. Dr. F. (t. Hoener recommends this agent in the treat- ment of gravel, gonorrhoea and suppressed urine. MOMORDICA BALSAMINA. Bal sain Apple. Tropical. This is a Southern annual climbing plant. The fruit is flattened* and narrowed at both ends and orange colored. In the Southern States it is a household remedy for colic pains, cold on the lungs, stomach or bowels. In large doses it is emetic. The ordinary dose of fluid extract is one-half to one fluid dnim, repeated as needed. Where its influence is needed for the relief of congestions it should be given in hot water. The fruit crushed or made into an infusion makes a good covering for burns, bruises, cuts, boils, chilblains and hemorrhoids. MOXARDA FISTULOSA. Wild Bergamot. Dr. F. G. Hoener recommends this agent for spasmodic colics, especially when fever is present, and for the head- aches caused by malarial fever. MONARDA PUNCTATA. Horsemint. This is a mild, diffusive, stimulating and relaxing anti- spasmodic nervine and carminative. In hot infusion it influences a good outward circulation and is a diaphoretic, and is useful in the treatment of colds, catarrhal fever and the eruptive fevers. It is sooth- ing to the nervous system and somewhat influences the secernents. It is warming to the stomach, checks nocturnal emis- sions, relieves the vomiting of cholera infantum and chol- era morbus. The oil is quite fragrant and makes a good addition to liniments when a stimulating, soothing nervine is needed. MORUS ALBA. RUBRA AND NIGRA. Mulberry . The fruit is refreshing and laxative. Its juice is a 406 MYRICA. pleasant and grateful drink to convalescents from fever. The bark of the roots is a mildly stimulating and ton- ing diuretic, and is very serviceable in nephritis and albu- minaria. It also influences the liver and the alvine canal and is serviceable in jaundice, enteritis and dropsy from hepatrc torpor. It tones the stomach, improves digestion, relieves sore mouth and assists in the removal of liver spots upon the face. .« - < ' MUSA SAPIENTUM. Banana. The fruit is a pleasant and nourishing food. The root of the banana has given in the hands of some others good results in goitre. I shall report further in some cases now under treatment. It is worth a trial; Dose a teaspbonful of the fluid extract three or four times a, day. i MYRICA CERIFERA. Bay berry. The bark is a positive, diffusive, stimulating, astringent alterative. Itarouses the circulation, stimulates nil the organs, and brings into greater activity all the secernents. It is one of the best agents to be used in the treatment of scrofula and tuberculosis. It more or less prevents the. deposit of tubercle. Though astringent it is more solidi- fying than drying. In scrofulous diarrhoea and chronic cholera infantum and goitre it is one of the best agents. Give in large or small doses as required and persist in its use. Its influence on the uterus is very postive. In prolapsus uteri it is splendid, and in parturition it cannot well be excelled. It induces better contractions and when given near the end of the cofinement it will anticipate flooding, and should there be excessive lochia it will assist in stop ping the excess. Its influence is also good in excessive menstruation or hemorrhages from other parts of the body and in female weakness. In hot infusion it gradually arouses the circulation and favors an outward flow of blood. A good free perspiration will follow, which will be more abundant if zingiber be added. It will then be found good in the removal of colds and be serviceable in some acute fevers. With some persons large doses will induce nausea and MYKICA. 407 vomiting. In connection with lobelia it is frequently used in producing emesis, which will be very valuable in the treatment of the conditions found in mercurial cachexia, scrofula and secondary syphilis. It is an excellent means of ridding the system of impurities. For emetic purposes it should be given in hot infusion. In medical history the name of Dr. Samuel Thomson and his composition, his No. 6 and his third preparation of lobelia are forever united. His composition is a power- ful stimulating astringent preparation of great value in prostrated cases. The following were its components: Pul. Myrica Cer. 16 " Abies Can. " Zingiber. Off. aa. 8 •• Capsicum " Cloves aa. 1 Composition, the old reliable compound as recommended by Dr. Samuel Thomson and always used in the crude form i. e. powdered state, has been changed by C. T. Bedford in- to a reliable fid. ext. which can be quickly converted into an infusion by adding gtts. q. s. to hot water to meet the requirements. In many cases it is given in capsule and the hot water drank soon after, thus getting rid of the burning and disagreeable taste. Dr. S. E. Carey "s formula was as follows: Pul. Myrica Cer. 32 " Zingiber. Off. " Asclep'ias Tub. aa 16 11 Hydrastis 2 " Capsicum 1 Still another formula has been added: Pul. Myrica Cer. " Zingiber. Off. " Asclepias Tub. aa. 32 " Xanthoxylum Frax. 8 " Capsicum , 1 Each of these formulae in hot infusion are stimulating diaphoretics and may be selected as the conditions require. F. E. Myrica Cer. " Populus Bal. aa. dr. iv Tr. Amygdalus Per. Pets dr. i Syr. Simplex q. s. oz. iv This is somewhat similar to Dr. Samuel Thomson's No. "> and is a valuable soothing, astringent tonic. 408 NEPETA. Myricin grs. v Oil Xanthoxylum gtta. iii Hydrastia Phos. grs. v This may be triturated on lactin or given in water oz. iv and used three or four times a day for chronic diarrhoea. Myrica, hemlock and gum myrrh may be used in infu- sion by injection for hemorrhoids. Locally myrica is a good wash for aphthous sore mouth, spongy gums, and upon old and obstinate sores. Bayberry wax or tallow as it is called is prepared from the berries and is used occasionally in ointments, for ring- worm, tetter and other sores. MYRISTICA FRAGRANS. Mace, Nutmeg. Java. West Indies. This is a mild aromatic, diffusive stimulant, chiefly used as a vehicle for other agents. NECTANDRA RODICI. Bebeeru South America. The bark is a stimulating tonic influencing the gastric and intestinal mucous membrane. In hot infusion it stimulates the circulation toward the surface and soothes and strengthens the nerves. It is also somewhat antiperiodic. It may be used to much advan- tage in the treatment of atonic dyspepsia, general debility, hysteria, neuralgia, ague and fevers. NEPETA OATAR1A. Catnip. This herb is an aromatic, relaxing, slightly stimulating, diffusive, diaphoretic and antispasmodic nervine. Though considered a very simple agent it is none the less important in children's colic, restlessness, nervous irrita- bility and fevers. In hot infusion it influences 'he circulation, soothes the nervous system and relieves irritation, and under proper conditions it increases both menstrual and renal flows. The addition of zingiber increases diaphoresis and intensi- ties all of the influences of nepeta. Nepeta 5 Mitchella 1 NYMPxi^EA. 409 will be found an excellent tonic in some forms of hys- teria. Nepeta 10 Dioscorea 1 forms a compound of superior merit for children's colic. The inspissated juice of the green herb obtained by pres- sure and evaporated with but little heat forms an excellent antispasmodic for children's convulsions, hysterical con- vulsions, restlessness o.nd insomnia from irritation of the nervous system. This process may be continued to the formation of a solid extract and given in the form of pills. Inspis. ISepeta dr. vi Ess. Anise dr. ss F. E. Valerian dr. ii Syr. Zingiber. q. s. oz. iv This is suitable for either adults or children as an anti- spasmodic and for nervine purposes. A strong infusion made of four pounds of the herb re- duced to fourteen ounces, and two ounces of alcohol added, makes a very serviceable fluid extract. Locally a hot fomentation may be applied to any inflamed parts, over stomach, abdomen, chest or limbs where relaxa- tion is needed. Over the chest it is excellent for the relief of colds. There is nothing better for the relief of invagination of the bowels than a strong infusion of nepeta. Use two or three gallons or as much as is needed till relief is accom- plished. , NEPETA GLECHOMA. Ground Ivy. This herb is a mildly stimulating, tonic expectorant, chiefly influencing the respiratory organs. The secernents all more or less feel its influence and this fact renders this agent of much value as an addition to cough syrups, espe- cially with persons who are inclined to be bilious. In hot infusion it influences the circulation toward the surface and soothes and sustains the nervous system. NYMPHJSA ODORATA AND ADVENA. White and Yellow Pond Lily. (Castalia Odorata.) The roots of these two species differ but little medically, though the white is mostly used. The root is a demulcent and a mild toning astringent. It influences the mucous 410 OLEUM. membrane throughout, toning but not drying. It materi- ally lessens mucous discharges and is useful in diarrhoea, dysentery and cystic catarrh. Locally for leucorrhoea it has few superiors, as also for prolapsus uteri, ulceration of the cervix, relaxed vagina. It forms a good wash for purulent ophthalmia. This is not the best agent to be used when there is a tendency to constipation. It forms a yood wash for aphthous sore mouth and for scrofulous sores. In cases of chafing and excoriations it may be used as a dusting powder. CENOTHERA BIENNIS. Tree Primrose, Evening Primrose. The leaves thoroughly influence the mucous membrane throughout and the nervous system. It is a soothing and moderately stimulating agent relieving irritable conditions wherever needed by the vital force. In irritable forms of dyspepsia, irritation of the urethra, the bladder or the bronchi wherever it is needed or wherever influenced by other medicines, its force will be felt for good It assists in relieving asthma spasmodic dyspnoea, spas- modic coughs and croupal coughs. It assists in relieving sensitive conditions. It lessens gastric irritation and flat- ulence, improves theappetite, relieves nausea and vomiting and the nausea of pregnancy. It cleanses and heals and will be found useful in typhoid fever and catarrhal dyspepsia. It may be used in doses of 20 to 50 gtta. 3 to 5 times a day, it also assists in the relief of hay asthma, angina, hysteria and whooping cough, epilepsy, spinal irritation and neurasthenia. OLEUM EULACHON. Cod Liver Oil may soon be dethroned from its wonder- fully lauded position by eulachon oil obtained from the candle fish — thaleichthys paciflcus, which abounds in the rivers of British Columbia. This oil is said to be equally as efficacious in promoting nutrition in scrofulous and tu- berculous subject. Its flavor is less diagreeable than that of cod liver oil and may be administerd in the same dose, and under similar conditions. It seems to furnish equally as good results. OLEUM. 411 OLEUM MORRHU^E. Cod Liver Oil. 1 This oil is obtained from the fresh liver of the codfish. The pure oil may be given to infants, they do not seem to object to either its taste or smell as do adults. I have driven it to many infants and where they are not gone too far with gastric and intestinal indigestion they have done well, and from puny infants they have grown to be healthy and fat. • Adults have more acute taste and smeli and the oil must usualiy be fixed up in some way that there as usually more of other things to form an emulsion than there is present of the oil. With some persons a clove chewed before tak- ing the dose is sufficient to disguise the dose. Some take it in a little wine and some in malt extract. As a rule it is very questionable as to whether much bene- fit is derived from the use of cod liver oil. I believe proper foods are to be preferred. OLEUM OLIV^E. Olive Oil. ' This oil is nutritious, laxative and cholagogue. It has been successfully used for relief from gall stones. It- increases the fluidity of bile and assists in the excretion of the same. i Olive oil is a superior agent to be used in all forms of poisoning from acids, in fact it comes the nearest to being an antidote for all forms of poisoning. It forms a valuable enema whether it is intended for rectal nutrition or as a rectal laxative. In cases where the stomach will not retain food, olive oil. I beef extracts and milk may be used by enemata The oil may also serve as a lubricant to the stomach and bowels in cases of mal-nutrition. As a cathartic for both infant and adult it is more pleasant than oleum ricini, gives less griping and is more nutritious but is a less active cathartic. - i i ■: OLEUM RICINL Castor Oil. The seeds yield a fixed oil of rather an unpleasant taste and smell and gives a stickiness in the mouth. It is cathar- tic in from four to five hours. It thoroughly cleanses" the 412 OLEUM. bowels without giving watery discharges. After cathar- sis the bowels are toned and are left somewhat constipat- ed. In large doses it gripes, but this may usually be avoid- ed by the addition of a drop or two of the essence of mentha piperita. It is quite serviceable in acute and chronic dysentery and diarrhoea and in cholera infantum. It leaves the bowels soothed and toned. Its taste may be somewhat covered by milk, essence of peppermint, the yolk of an egg, sugar, ulmus or acacia. Ol. Ricini oz. i Tr. Cardamon comp. dr. iv Ol. Gaultheria gtta. iv Pul. Acacia " Sacch. Alba aa dr. ii Aqua Cinnamon q. s. oz. iv This forms an emulsion which disguises the taste of the oil. The following will also disguise it. Pul. Acacia dr. iss Ol. Ricini oz. iss " Cinnamon gtt. v Vinum dr. vi Lacto-peptine dr. i Syr. Zingiber q. s. oz. iv In cases of dysentery or diarrhoea the following may be given in doses of a teaspoonful after each stool or every three hours. Ol. Ricini oz. i " Anise dr. i •' Cloves gtta. iii Leptandrin grs. xx Syr. Simplex q. s. oz. ii OLEUM ROS^E. Oil of Hoses. This is prepared from several different species growing in Egypt, Persia, India and Asia Minor. It is obtained by pressure or by distillation. Ol. Rosas gtta, xx Carbonate Magnesia dr. i Aqua Distillata oz. viii Triturate and add water sufficient to make half a gal- lon or more according to the strength required. This is pleasant for the sick room. OSMORRHIZA. 41-'} ONOSMODIUM VIRGOIANUM. Gravel Weed. The root is a demulcent, stimulating diuretic. It soothes the mucous membrane but especially influences the renal department, increasing the flow of urine and toning the organs. It is best in torpid and sluggish condi- tions where the membrane is more or less clogged with mucous. It cleanses, soothes and tones. ORIGANUM YULCtARE. Wi I d Major a m. This plant yields an essential oil powerfully stimulating, a useful addition to liniments. Pare your corn close and apply two drops of oil origanum. Oil Origanum 2 " Cedar 1 Xeat's boot Oil 4 This is a soothing and stimulating liniment. ojrthosiphon staminet>. Java Tea. India. Java. Australia. This is a perennial plant one to three feet high with leu res two to four inches long. They are prepared and come to the market somewhat like other tea. This seems to render the agent more .aromatic, and less astringent than are the ordinary leaves. It contains a small percent- age of glucoside and the alcoholic extract yields some tannin, but the aqueous extract yields none. The leaves are a mild, stimulating and relaxing diuretic. A strong infusion acts on the kidneys and bladder, cleanses the mucous membrane, assists in the relief and prevention of gravel, increases the quantity of urine and gives good results in chronic cystitis and ascites. OSMORRHIZA LOXGISTYLIS. Sweet Cicilij. The root has a sweetish taste. It is a mild stimulating and relaxing antispasmodic, influencing the mucous mem- brane and is valuable in cough syrups as an expectorant. It influences the gastric and intestinal mucous mem- brane and relieves flatulence, especially if combined with a small portion of zingiber. (I 414 p^o^ia. , OSTRYA VIRGINICA. Iron Wood. \ The heart-wood is red and yields a mild, bitter, stimu- lating, astringent, tonic alterative, chiefly influencing the mucous membrane and the nerves. It soothes, stimulates and tones and is useful in acute and chronic diarrhoea, either per oram or by injection. \ Per vaginam it is a good wash for leucorrhoea and female weakness generally. Per oram it prevents miscarriage. It is quite stimulating to the brain and nerves and is serviceable in some forms of. neuralgia. It is a line anti- periodic and excellent in agues, more permanent than quinine. , It is best combined with some diffusive stimulant, when it will the better influence the circulation and. relieve con- gestive chills. -Boil two quarts of the chips thoroughly to make one pint of infusion. u ../.„, OXALIS ACETOSELLA- Wood Sorrel. ^ .....,,.. i This plant is quite stimulating and somewhat astrin- gent. ' > . ;• By powerful pressure and subsequent exposure to the air a strong extract isitnade from the application of which as a plaster wonderful successes are reported in the cure of cancers. The addition of a. small portion, of pulverized uimus makes such plaster, more soothing and enables the patient to keep the plaster on the cancer a much longer time. ■ i . i Combined with five times its own bulk. of .vaseline it- forms a good salve for application to old sores, especially those of scrofulous origin. It cleanses and heals. OXYCOCCUS MACROCARPUS. American Cranberry. s i ,The berries form an excellent poultice very valuable in the treatment of erysipelas, or apply the raw juice. < The juice of the cooked fruit is a good acidulated drink where such is required in convalescence. P^ONIA OFFICINALIS. Peony. , ,. ■ The root is a mild relaxing and stimulating antispan- PAULINIA. 415 mudic nervine. In hot infusion it may be used for colic, flatus and convulsions of children. Zingiber adds much to its diffusiveness. PANAX QUINQUEFOLIUM. Ginseng. The root is a mild, aromatic, diffusive, relaxing, tonic nervine. It soothes and strengthens a weak and irritated stom- ach, relieves general nervousness, insomnia, light cases of neuralgia, hyperesthesia and irritable conditions gener- ally. With aralia and prunus it assists in nervous pulmonary troubles. PANAX SCFIINSENG Chinese Gentian. The root is a diffusive, stimulating tonic to the digest- ive organs. It relieves pyrosis and flatus, and assists di- gestion and assimilation. It does good service in wasting diseases, as chlorosis, consumption, etc PARTHENIUM INTEGR I FOLIUM Cutting Almond. The root is a relaxing and slightly stimulating diuretic. It increases the flow of urine and soothes the entire renal apparata. It relieves the aching back, scalding urine and the irritation of gonorrhoea, nephritis, cystitis and urethritis. PASSIFLORA INCARNATA. Passion Flower. This is a reliable relaxing and somewhat stimulating antispasmodic nervine. It relieves excitement of the nervous system, and is of much benefit in spasmodic and neuralgic diseases, insomnia, the delirium of typhoid, the convulsions of children, chorea, dysmenorrhoea, epilepsy, hysteria, la grippe. It also relieves irritation of the brain centres and quiets the general nervous system. PAULINIA SORBILIS. Guarana. Brazil. This is a woody climber, bearing a fruit about the size 416 PAUL1NIA. of a large grape and is nearly tilled with one or more nuts about the size of hazel nuts. In the Amazon valley it grows wild, but in the Madiera district it is cultivated and presents somewhat the appearance of a \ineyard. They ripen in December and open. The nuts are then gathered, roasted, shelled, ground, and enough water added to allow it kneaded into doughy rolls about a foot long in which state it comes into market. Guaranin is the alkaloid, a stimulating tonic nervine for sick-headache where the stomach is not much involved. We are indebted to Mr. K. M. Turner, of the Yale Chem- ical Co., of Atlanta, Ga., for the most valuable preparation of this agent which he has denominated SOEBILIN. This is the alkaloid guaranin chemically combined in certain proportions with pure bicarbonate of soda. It is a gently stimulating, soothing and toning nervine. This is an admirable preparation, an innocent reliever of pain. In facial, intestinal and cranial neuralgia it is a superior relief. Also in gastralgia, enteralgia and ovarian and uterine pains. It assists much in sciatica, rheumatism and insomnia. It sustains the heart and in angina gives quick relief. It soothes and tones the sympathetic and sensory nerves, and in sick-headache if the stomach is not too much at fault there is nothing better. In such cases it may be combined with a drop or so of Lobelia >d. Prep. Five to ten or more grains of this agent may be used as required. Dr. John Cooper says: "I have given Sorbilin of the Yale Chemical Co. a very thorough clinical test in typhoid, malarial, irritative and other fevers, also headaches of various kinds, and must say that its effects are very rapid and satisfactory, reducing temperature and relieving head- ache quickly without any profuse sweating or cardiac de- pression so common with the coal tar preparations. "Knowing it to be perfectly harmless I do not hesitate to use it in doses from 10 to 30 grs. every 2 or { hours, for any length of time. "I treated seventy cases of typhoid fever during two months and have used a pound of sorbilin. "I usually give the doses in the afternoon at one, four and seven o'clock in typhoid fever, with the very best results." PETROLATUM. 417 Sorbilin may be combined with salicylate of sodium in the treatment of rheumatism and be used in fluid extract of celery seed when needed. PERSEA GRATISSIMA. Alligator Pear. Mexico, West Indies. This is a tree of moderate size, having leaves four to seven inches long, and its fruit in the shape of a pear, pulpy and having one seed. The seeds are a warming, stimulating agent, chiefly val- ued as an application for intercostal neuralgia, also in rheumatism, sciatica and ovarian pain. PETROLATUM. Petroleum. This is a bland, neutral, protecting dressing. Cosmoline or vaseline (unguentum petrolii) is obtained from residuum and reduced oils; benzine, naphtha, illumi- nating and paraffine oils having been removed by distilla- tion by the vacuum process. With iodide potas. it forms an ointment for glandular swellings. Abolene is a hydro-carbon oil from a new and peculiar kind of petroleum. It is colorless, odorless, tasteless and is not affected by exposure to the air or strong acids. It is a good application for laryngeal and catarrhal affections. McCoy, Howe Co. manufacture Emulsion Petroleum with hypophosphites. Each fluid dram contains: Purified Petroleum (medicinal) m. xx Hypophosphite Calcium grs. ii Hypophosphite Sodium grs. ii Hypophosphite Potassium gr. i This is a fine permanent emulsion prepared from 0. P. salts and trituration accomplished by special machinery. It is used with marked benefit in consumption, bronchitis, pneumonia, general debility and all wasting diseases. It may be mixed with wine, milk or water as preferred. PEUMUS BOLDUS. Boldo. Chili. Boldo is an evergreen and fragrant tree. Its whitish fruit is aromatic, sweet and is eaten in its native country. Its hard round seeds are sometimes used in making the beads of rosaries. The bark gives a dye material for tan- ning. The leaves are a soothing, diffusive, stimulating tonic 418 PHYTOLACCA. to the mucous membrane. It is also antiseptic and valu- able in atonic dyspepsia, hepatic torpor, biliousness and hepatic congestion. Its influence is also extended to the urinary organs and is useful in cystic catarrh, Menor- rhagia and nocturnal erections. It improves the appetite, stimulates digestion and tones the general system. PHORADENDRON FLAVESCENS. Mistletoe. This grows upon a variety of trees and shrubs but seems to prefer oaks and cottonwood. Its appearance is rather peculiar, having greenish yellow, woody, brittle stems. It branches freely and soon forms a dense mass. The leaves are fleshy, of color and brittleness similar to that of the stems. The leaves vary much in size. The flowers are very minute and the fruit is a small whitish berry, very viscid. The leaven are a stimulating and relaxing antispasmodic nervine. It seems -to give its especial influence where it is most needed by the vital force. During parturition when the pains are light, it produces prompt uterine con- tractions and well anticipates hemorrhage. Besides being an oxytocic it is also valuable in all uter- ine hemorrhages, and assists much in the expulsion of the placenta when retained after an abortion or miscarriage. As an antispasmodic it will be found useful in the relief of the extra effort put forth in asthma, epilepsy and other spasmodic conditions. PHYTOLACCA DECANDRA. Poke. The berries are a relaxing and stimulating alterant, in- fluencing the mucous, serous and glandular structures. Cook the berries till they burst and pour off the juice without straining. Then cover the berries again with water and cook thoroughly. Now strain off all the juice and boil it down to the consistency of a thick syrup and add the flrst juice poured off. Bottle for use. It can also be made into a jelly or into a tincture with 30 p. c. alcohol. Either is excellent for rheumatism. It soothes the serous membraue, relieves the glandular sys- tem, solidities the muscles and throws off the excessive amount of internal blubber as a result of fatty degenera- tion. PHYTOLACCA. 419 In the treatment of scrofula it relieves the glandular system of its impurities and cleanses the blood current. It increases the flow of saliva, of urine, of perspiration, ana frees the alvine canal. Like most alteratives it is slow but persistent, and some time must be given to participate in the full benefits of this agent. In the early spring the young leaves are frequently used as a popular dish of greens. At their maturity the leaves and stalk have much of the same properties as the root and berries. The root in its green state is quite acrid and is quite irritating to the mucous membrane, frequently causing a persistent vomiting. A similar result will follow if the green root be bruised and placed upon the surface of an excoriated or ulcerated part. The green root taken in small and frequent doses will frequently relieve rheumatism. The better way to use this agent is to cut the green root- tine and cover with boiling water and allow to boil two or three minutes. This preparation may be given in doses of a teaspoonful to a tablespoonful. with but little if any nausea experienced. Two ounces of alcohol to the pint may be added to keep this preparation The dried roi)t is but of little value. This agent is a good alterant and if applied externally and taken internally for some time it will relieve many a bony and cartilaginous swelling. I believe it will avert white swelling, but I have not proved it. It relieves neuralgia, sciatica and lumbago. I combine at times the berry juice and this preparation of the root in equal quantities with good results in inflam- mation or ulceration of the alimentary canal and rheuma- tism. In case of threatened mammary abscess this preparation of the root may be used internally and locally in hot fomen- tation or poultice. Treat orchitis and ovaritis in the same- way, and so with scrofulous abscess, surface inflammation and inflammatory rheumatism, give large doses and fre- quently to control at once, else it lingers. Phytolacca influ- ences all the deep structures when inflamed and all the serous structures. It is a good poultice in case of felon. The roasted root makes a splendid poultice for inflamed 420 PICR^NA. surfaces. It quickly reduces inflammation and decreases excessive suppuration. The cooking largely dissipates the naseating tendency so that much more of it can be given than of the green root. But only cook two or three minutes, it is then a better nervine, alterative and laxative. Phytolacca may be combined with many of the altera- tives with much profit. Take Phytolacca roots (green), verbascum thapsus and trifolium pratense in equal parts, cover with boiling water and simmer two or three minutes, than poor off and cover with water, which simmer to one half the quantity, add the two products and simmer to 14 oz. to 1 lb. of the crude, add oz. 4 of sugar to each pint, one dr. of salicylic acid and one ounce of alcohol. Use this for cancer, ophthalmia, scrofula, consumption, rheumatism and overheat. F. E. Phytolacca Bac. dr. v '• Verbena dr. iss " Xanthox. Frax. gtta. xv Salicylate Sodium dr. i Syr. Zingiber v q. s. oz. iv M. S. Teaspoonful every 3 hours for rheumatism. Bruise the green root and apply to a bunion. Dr. F. Gr. Hoener uses the following for acute and chron- ic rheumatism. Succus Phytolacca Bac. oz. i Elix. Betonica Lane. " Cimicifuga aa oz. iss PICRiENA EXCELSA. Quassia. Jamaica. The wood and bark are an intensely bitter, stimulating tonic, influencing chiefly the digestive organs. In lan- guid conditions and in convalescence it improves the ap- petite and assists digestion. Very small doses only are re- quired. The quassia cup is made out of this wood, and water kept in it for a short time will taste quite bitter, and this water drank before meals is an appetizer and di- gest ant. Cardamon Seed oz. ss Cinnamon . Picraana Raisins aa. dr. vi This forms a good tonic preparation. PIPER. 421 PICRAMNIA . Honduras Bark. (Cascara Aniarga) Mexico, Honduras. The bark is a stimulating- alterative of especial value in secondary syphilis, syphilitic tubercules, chronic eczemas, summy tumors, gonorrhoea! rheumatism, chronic nephri- tis, chronic nasal catarrh. Prohibit the use of alcoholics, tobacco and sexual ex- cesses. This agent seems to eliminate the specific virus by way of the skin and kidneys. It improves the appetite and assists digestion. From 30 to 50 drops may be taken of the fluid extract three times daily. Berberis aquifolium and xanthoxyium may be added. PIMPINELLA ANISUM. Anise Seed. The oil from the seed is a pleasant, sweet, aromatic, relaxing and stimulating nervine and carminative. It is mostly used as an adjuvant for the administering of cathar- tics, bitter and nauseating medicines. The oil may be triturated with sugar or magnesia and may then be used in powdered form or combined with water. PIPER CUBEBA. Cubebs. East Indies. The berries are a prompt, diffusive, stimulating diuret- ic, influencing the mucous membrane but chiefly that of the urinary organs. In hot infusion it influences the circulation. Their use is not best in acute inflammatory conditions, but in chronic conditions, as gleet and cystic catarrh. This agent is sometimes combined with copaiba for cys- tic and nephritic congestions, and chronic inflammatory conditions. The oil may be used in doses of three to ten drops on sugar, acacia or magnesia. PIPER NIGRUM. Black Pepper. East Indies. This is principally used for seasoning food. In hot in- fusion it stimulates the circulation and tends the flow toward the surface. The oil may be used triturated on sugar or lactin. 422 PODOPHYLLUM. Piper ine is a resinoid used for the same general pur- poses as the oil. PLANTAGO COKDATA. Water Plantain. The roof is a mild, soothing, relaxing and stimulating antispasmodic nervine. It is useful in irritable forms of nervous troubles, hysteria, children's convulsions and spi- nal irritation. It is gently soothing to the stomach espe- cially of the pregnant. In hot fomentation it is a valuable application to swellings, sprains and bruises. PLANTAGO MAJOR. Plantain. The roots and leaves are a mild, diffusive, stimulating and relaxing alterant, influencing the entire mucous mem- brane, but especially that of the urinary tract. The glandular system is thoroughly influenced and it is valu- able in cases of scrofula, struma and some eczemas. It mildly increases the quantity of urine, relieves its scald- ing, the aching back, cystic catarrh, acute and chronic gonorrhoea, and internal and external scrofulous swellings. A fomentation or wash of the plant is useful for sprains, erysipelas, ophthalmia and other surface irritations. PLANTAGO VIRGINICA. The properties of this plant are very similar to those of the cordata. PODOPHYLLUM PELTATUM. Mandrake. The root when fresh is quite acrid, nauseating and dras- tic. The dry root produces much less irritation. It influ- ences the salivary glands, mucous membrane, gall ducts, liver and kidneys, it is decidedly a cholagogue, and a cathartic in from six to ten hours. Large doses leave an uneasy sensation in the lower bowels which soon influences the entire pelvic organism. J t is not a proper agent to use much or frequently with the pregnant. The crude material and the fluid extract have given way to the resinoid podophylUn, which is now most used. This is a prompt cholagogue and is a most valuable agent in liquefying the gall in the relief of gall stone, for which purpose it is best triturated with sugar one lo fifty or POLYGALA. 423 given in syr. zingiberis, or the ingredients may be given in capsules. Give large doses every few minutes. It will not nauseate nor produce catharsis until the parts become eased and the gall liquefied. The vital force uses it where it is most needed. Occasional doses must be given to maintain a liquid condition. If this agent is to be used as a cathartic add a little zin- giber but use no sugar. Other agents will give better results if the mucous membrane is irritated. Podophyllin in small doses is useful in jaundice. There is one trouble with the use of this agent. After yrtu have used it for some time, milder agents seem to have but little effect. POLEMONIUM REPTANS. Greek Valerian, Abscess-Root. The root is a diffusive, stimulating and relaxing diapho- retic, antiseptic, nervine and alterant. In hot infusion it influences the circulation and gives a prompt flow of blood toward the surface. Thus it also relieves the nerves and the mucoid membrane. It is use- ful in recent colds, pleuritis. tardy exanthems, typhoid restlessness, nervous prostration, dysmenorrhoea, lingering parturition, whooping cough and phthisis. It acts prominently on the lungs, the stomach and gland- ular system. If you can obtain the green herb bruise it and obtain the strength by hot water and evaporation. Add two ounces of alcohol to the pint to keep it. It is said to re- lieve of snake virus. F. E. Araiia Rac. dr. vi F. E. Lycopus dr. iv " Lycopus V. dr. iv Tr. Cimicifuga '• Polemonium R. dr. ii il Lobelia Syr. Prunus q. s. oz. viii F. E. Polemonium aa. dr. ii Syr. Prunus q. s. oz. viii These are both valuable cough syrups. POL YG ALA SENEGA. Senega . The root is a positive, scimulating alterant, somewhat irritating to the fauces and salivary glands. It is quite general in its influence. In large doses it is emetic. To the respiratory mucous membrane it is a stimulating ex- 424 POLYGONUM. pectorant, especially if combined with more relaxing and demulcent agents, as aralia and glycyrrhiza. In hot infusion it stimulates to a good capillary flow and leads to diaphoresis. It is useful in tardy eruptions, espe- cially of variola, relieves the nerves and circulation and brings the rash out in good shape. In many cases so much stimulation may not be required. Cold preparations are diuretic and are useful in torpid conditions of the urinary membrane. It is also useful in amenorrhoea, chronic rheumatism, snake virus, mercurial cachexia, secondary syphilis and some eczemas. POLYGONUM AVICULARE. Knot Grass, Goose Grass. This herb is a mild, diffusive, stimulating and relaxing, antispasmodic nervine. In hot infusion it influences the circulation and is dia- phoretic, quite stimulating to the capillaries and increns- ing the periodic flow, especially if a little zingiber be added. Cold preparations are diuretic and relieve the aching back and bladder. For irritable coughs it is a good addition to aralia, inula and prunus. POLYGONUM PERSICAR1A. Heart's Ease. In hot infusion this herb is a diffusive, stimulating dia- phoretic, and useful in coughs, colds, glandular swellings and fevers. POLYGONUM FUNCTATUM. Water- Pepper, Smart Weed. (P. Hydropiper.) (P. Bistortaof Europe.) This herb when green is acrid, but is less so when dried. It is a stimulating and relaxing diaphoretic and nervine. In hot infusion it is freely diaphoretic, quite stimulating to the circulation and soothing to the nervous system and is slightly emmenagogue. Cold preparations are diuretic. In hot infusion it is valuable in recent colds, bronchial and pulmonary congestions, especially if combined with asclepias and zingiber. POLYMNIA. 425 Syr. Polygonum oz. ii Syr. Polygonum oz. i " Polemonium oz. i " Polemonium oz. iss " Aralia Rac. dr. iii " Prunus oz. ii " Hydrastis dr. v ; ' Aralia Rac. oz. iss Either of these combinations forms a good cough syrup for bronchitis and phthisis, F. E Polygonum Punc. dr. ii " Caulophyllum Thai. " Glycyrrhiza Glab. " Polemonium Rep. aa. dr. i Syr. Prunus Virg. q. s. oz. iv This may be used for old spasmodic coughs. In amenorrhoea and dysmenorrhea when arising from congestion, this is one of our best agents. In parturition when the pains are slow, the contractions feeble and the patient fatigued, it stimulates to better contractions and more effectual labor. In the treatment of swellings, inflammations and con- gestions, when the green material can be applied in hot fomentation it is one of the very best for peritonitis, pleu- ritis, hepatitis, cystitis; also for gastric, hepatic, splenic, intestinal, pulmonary, cystic and nephritic congestions. For swellings of the limbs and joints verbascum maybe added in hot acetum. Age soon renders this agent inert. With solidago it is valuable in diphtheria, aphonia, pharyngitis and tonsilitis. Polygonum combined with alterants makes them of greater value by adding diffusive stimulation and increased arterial force. An infusion of the fresh herb may be used as a wash for foul ulcers and gangrenous sores. The fluid extract may be used for all purposes of the herb when the fresh material cannot be obtained. POLYMNIA UVEDALIA/ Bears foot. This is a coarse looking plant from four to ten feet high, growing in moist fertile grounds in the Eastern and South- ern States. The leaves are a foot or more in length, and about the same in their greatest width. The root is a stimulating, tonic alterant to the secern- ents. mucous and serous membranes and glandular system. 426 populus. It cleanses the mucous surface and increases nutritive activity. It is valuable in enlarged spleen, rheumatism, scrofula, enlarged and tender liver, sore throat, sore chest, inflamed breasts. F. E. Polymnia Uv. oz. i Adeps oz ii This forms an excellent ointment which when applied over enlarged or sore parts greatly assists the internal use of the agent, as in rheumatism, spinal irritation, glandular enlargement, ague cake, inflamed breasts, etc. POLYPODIUM VULGARE. Polypody. The root is a soothing, demulcent stimulant, influencing the mucous membrane of the alvine canal and respiratory organs. To the bowels it is laxative and to the bronchi it is an expectorant. POLYTRICHUM JUNIPERUM. Hair- Cap Moss. This plant is a pleasant, prompt, relaxing diuretic, and serviceable in dropsy and the suppression of urine in either infant or adult. It very materially increases the urinary flow. POPULUS BALSAMIFERA. Balsam Poplar, Balm of Gilead. (P. Candicans.} Gather these buds in the spring before they become ex- panded. They are a balsamic stimulant influencing the circulation and the mucous membrane throughout. The buds yield an exudation which water dissolves only in part. They may be tinctured in alcohol, which is then evaporated and the residuum triturated on sugar. This is quite stimulating in old coughs and is valuable for debili- tated cases. It gives best service with more relaxing agents. For the kidneys and bladder it should be used only in cases needing much stimulation. It> is best with relaxing diuretics. It influences the circulation, but with some diffusive will do it much better. It assists in chronic rheumatism, sciatica and lumbago, but will be better if combined with Phytolacca and sodium salicylate. POPULUS. 427 Pinus Canaden. Prunus Virgin. aa. 5i Populus Balsam. Aralia Rac. aa. 8 Sanguinaria Can. 6 Sassafras 4 This is a good cough compound. POPULUS TREMULOIDES. White Poplar. The buds gathered in winter are very strongly medici- nal. The inner bark and buds are a stimulating tonic alterant. Its influence is quite general. It promotes appetite and assists digestion when used in lax conditions, and general weakness and depression. In chronic diarrhoea, chronic dysentery, cholera infan- tum, it is a tonic, not an astringent. It tones the mucous membrane, relieves indigestion and is somewhat anthelmintic. The kidneys and bladder also feel its power. It gradu- ally increases the urine and relieves the aching back. If more or less controlled by uva ursi, it will give good results in cystic and renal catarrh and congestions. It is also of use in uterine, vaginal and anal weakness, both as a wash and for internal use. It is also a valuable wash for eczemas, purulent ophthal- mia, chronic gonorrhoea and syphilitic sores. Dr. F. (t. Hoener recommends the following for cholera morbus: Elix. Populus Trem. oz. ii " Ambrosia Artem. " ' Monarda Punc. aa. oz. i Dessertspoonful every 15 or 20 minutes. Populus Trem. Myrica Cer. aa. oz. ss Aqua oz. xvi Inject for anal prolapsus. Populus Trem. Berberis Vulg. Chelone Glab. aa. equal parts forms what is known as Dr. Samuel Thomson's spiced hitters, or No. 5. It is a fine tonic hepatic. 428 POTASSIUM. Dr. Bedford's formula for Spice Bitters differs material- ly from the old formula, making it much more pleasant and palatable. It can be had in powder or fluid extract, the latter being easy of administration: the former may be used in capsule or in hot water as needed, this makes it de- sirable and at the same time economical. F. E. Populus Trem. dr. iiss " Yerbascum Thap. dr. iv " Polygonum Pun. dr. iss Syr. Zingiberis q. s. oz. iv This may be given three to six times a day for chronic diarrhoea. F. E. Populus Trem. dr. ii " Berberis Aqui. dr. i 11 Hydrastis Can. dr. ss " Aletris Far. dr. i " Taraxacum D. L. dr, iv " Xanthoxylum Frax. gtta. x Syr. Simplicis q. s. oz. iv This forms a good tonic alterant for debilitated cases, especially suited to females. PORTULACA OLERACEA. Garden Purslane. This is an annual succulent plant of our gardens. It is a gentle, soothing, stimulant to the mucous mem- brane of the alvine and urinary departments. It soothes cleanses and tones and is a quite useful infusion. Dr, F. G. Hoener uses the following for cholera infan- tum: Elix. Portulaca Olerac. oz. ii " Monarda Punct. " Comptonia Asplen. aa. oz. i M. S. A half to a whole teaspoon ful every one or two hours till improvement. POTASSIUM. Potassce Carbonas Purus is prepared from the lye of wood ashes. It is a strong alkali. Potassce Bicarbonas is the result of the absorption of an additional equivalent of carbonic acid gas. This is an acceptable alkali frequently used in various ways and preparations. Potassa Caustlca is also prepared from the carbonate POTASSIUM. 42fl and is the escharotic, lunar caustic. In the process of ob- taining this precipitate we obtain Liquor Pofassce, which is sometimes used in the mixing of resins or gums with fluid extracts. Potassa Caustica cum Calce (Caustic Paste) is made by thoroughly triturating caustic potash and unslacked lime. This is a somewhat milder escharotic. Potassae Chloras is a popular gargle for sore throat, but I believe there are many things better. Potassae Bitartras, (Cream of Tartar) is occasionally used as a morning drink for constipation and as an ad- dition to physics. Potassae Bisulphas, applied locally and given inter- nally has been successful in some cases of goitre and sever- al cases of pruritus* Potassil Sulphur etum. Sulphuret Potas. oz. ss Oil Rosemary dr. i Aqua oz. vi or more. Makes a good wash for scabies, pruritus and other itching eczemas. Potassii lodidum, is a tonic alterant influencing the mucous and serous membranes and glandular system. Iodide Potas, dr. iv Tr. Cimicifuga Tr. Gentian Comp. aa ( z. ii This used 3 to b times a day will give good results in rheumatism. Iodide Potassium will assist much in the treatment of pneumonia. Locally this agent is valuable for the removal of warts, goitre and eczemas. Iodide Potas. dr. iv Pix Liquida dr. i Sulphur dr. iii Vaseline oz. iv This is one of the best preparations for tinea capitis. Iodide Potas. dr. i Aqua oz. ii A teaspoonful of this may be used 3 or 4 times a day for specific ulceration, scrofula or ophthalmia. Iodide Potas. dr. i Tr. Lavender Comp. dr. iv 430 POTENTILLA F. E. Serpentaria, dr. ii. Syr. Zingiber, q. s. oz. vi A teaspoonful every 3 or 4 hours will soon relieve the headache which follows or accompanies puerperal fever. Iodide Potas, oz. ss Aqua oz. viii A teaspoonful may be given three times a day in bad cases of nasal catarrh. McCoy, Howe Co. make a syrup of double strength 2 per ent hydriodic acid. They claim for it exceptional keepi ng qualities, and absolute purity of ingredients, being kept for months without change. Potassae Per many anas, is an excellent deodorizer for the sick room, an absorbent of foul gasses and a destroyer of contagia. Potassae Permanganas, Manganesii Oxidum, Acidum Oxalicum, aa. equal parts. Do not triturate all these together for an explosion may take place. But combine first the oxalic acid and the manganese and then add the permanganate of potassium. Two teaspoonsful of this powder in a dish occasionally di- luted with water will be sufficient to thoroughly disinfect a sick room and destroy most atmospheric contagia. potentilla canadensis. Cinque foil, Five-Finger Herb. This herb is a mild, stimulating, astringent tonic, chief- ly influencing the mucous membrane, and very service- able in diarrhoea and dysentery of both children and adults. It is rather pleasant to the stomach and frequently allays nausea and vomiting, and is quite soothing to the nerves. Locally it is a good wash to either the mouth, the vagina or the rectum, in case of either ulceration or irritation. It is splendid as a wash for cold sore eyes. POTENTILLA tormentilla. Torwventilla. The roots are a mild, stimulating astringent, chiefly in- tiuencing the alvine mucous membrane and is serviceable m the ordinary forms of diarrheal and mild hemorrhages- PRUNUS. 4.31 PRINOS VERTICILLATOS. Black Alder. (Ilex Verticillatos;. This bark is a mild, stimulating, tonic alterative, in- fluencing chiefly the alvine mucous membrane and the secernents. It is a mild laxative to the bowels and a gen- tle hepatic and cholagogue. It is of service in biliousness, jaundice, atonic dyspepsia and dropsy arising from secer- nent failure. The berries are more cathartic and less hepatic. PRUNELLA VULGARIS. Heal All . This herb is a mild stimulating astringent influencing the mucous membrane, throughout. To the throat it may be used as a gargle. It is soothing and toning to the urin- ary organs and will be of service in diabetes. It is a good addition to cough syrups, is serviceable in chronic bron- chitis and phthisis where the expectoration is too free. PRUNUS DOMESTICA. Prune. France. This fruit is a pleasant nutritious laxative, and may be used in the relief of the habit of constipation, but if used too freely it may occasion flatulence. PRUNUS INSTIT1A RUBRUM. Wild Red Plum. The bark of the root is a relaxing and somewhat stimu- lating agent influencing the mucous membrane especially of the respiratory organs. A syrup made from an infusion is an excellent agent for asthma. PRUNUS VIRGINIANA. Wild Cherry. (P. Serotina.) The bark of the root is the best but the bark of the trunk is as frequently used. This is a mild, soothing, stimulating, astringent tonic to the mucous membrane especially of the respiratory organs and of the alvine canal. To the former it is a valuable tonic expectorant and to the latter it is a most excellent tonic, very mildly astrin- gent if the alcoholic extract be used. Its tonic influence is felt by the liver and gall ducts and it is serviceable in the jaundice of children. For this pur- 432 PRUNUS. pose use an aqueous extract, made by putting cold water on the finely-cut fresh bark and frequently shaking for a few hours. Make it frequently fresh and use it very free- ly. It is successful. Boiling dissipates the soothing property, but makes a ti excellent preparation for chronic diarrhoea. The fresh bark is much to be preferred. Grind or pound up line the fresh bark and put into a self-sealing jar; pour boiling hot syrup over it and seal it up. Let it stand a few days and then pour it off. You have then the nicest syrup of primus that can be made. Or it may be made in this way: Take prunus 6 ounces, steep in one pint of hot water three hours. Then strain and add It pounds of granulated sugar and two ounces of glycerine. Prunus improves the appetite, enlivens the digestion and tones the whole system. It is one of those agents whose influence may be directed to either the digestive or the respiratory organs, according to the agents with which it is combined, or the necessities of vitality in the individ- ual case. It quiets nervous irritability and relieves arterial excite, ment. In chronic gastritis, weak digestion, typhoid fev»r, chol- era infantum, diarrhoea, convalescence, and in diseases of the respiratory organs this agent cannot be too highly praised. In acute and irritable coughs it is a tonic expec- torant of the highest value. In moist catarrh a fine powder may be used as a snuff or the infusion may be atomized. Thus inhaled it will be of much benefit also to the lungs As a wash in ophthalmia it soothes, cleanses and tones weak, irritated and inflamed conditions, whether it be from simple, scrofulous or specific cause. It is one of the best washes for a weak or inflamed vagi- na and for the relief of a mild leucorrhoea. F. E. Prunus Virg. 11 Cornus Flor. aa. dr. iv " Myrica Cer. dr. ii " Xanthoxylum Frax. gtta. xv Syr. Zingiberis q. s. oz. vi Teaspoonful four times a day for chronic diarrhoea. Prunus, glyoyrrhiza, yerba santa and solidago in equal parts form an admirable troche for weak throat. PTEROCARPTJS. 433 Detannated prunus may be consistently mixed with iron preparations. PTELEA TRIFOLIATA. Wafer Ash. The bark of the roots is a mild stimulating tonic, influ- encing chiefly the mucous membrane, alvine and respira- tory. In hot infusion it moderately influences the circulation. Large and frequent doses are rather irritating to the stomach. Small doses are suited to gastric and alvine tor- por, as in diarrhoea, cholera infantum, gastric and intesti- nal catarrh. Also in bronchial catarrh it may be added to cough syrups with a good stimulating result. Ftelein is the oleo-resin which, triturated on sugar, may be used for the same general purposes as other prepara- tions of this agent. Ptelea-Pepsin (10 to 30] is a good compound for languid conditions of the gastric and intestinal mucous membrane, as in cholera infantum. PTEROCARPUS MARSUPIUM. Kino. East and West Indies. This gum obtained by incisions in the bark of the tree is a positive astringent gently stimulating, soothing and toning rather than drying. Its influence upon the alvine mucous membrane makes it an excellent agent in all forms of diarrhoea and dysentery, whether of infant or adult and whether acute or chronic. It is one of the best applications for lucorrhoea, a weak vagina and prolapsus uteri. In hemorrhages, whether from the lungs, stomach or bowels, it renders good service used both locally and con- stitutionally. The fluid extract will frequently stop the toothache. Cold water is very slow in dissolving kino. Hot water is much better. For immediate use I like this much bet- ter than the tincture or fluid extract, which so frequently gelatinizes and loses its astringency. I have used it a few times successfully in oedema glottidis. PTEROCARPUS SANTILANUS. lied Saunders. India, Ceylon This wood has but little >mell or taste It imparts its. 434 PYROLA. color to alcohol but not to water, being a resinous princi- ple, soluble in hot water and in alcohol, and but slightly soluble in the fixed oils with the exception of oil lavender and oil rosemary. Its chief use is that of coloring aiedi- cines, especially liniments, to make them more showy rather than adding any quality. PUNICA GRANATUM. Pomegranate. Asia, Africa, West ^Indies. The bark of the root is an anthelmintic for the expulsion of the round, pin and tape worms. A strong infusion may be used for all these purposes. Large doses may nauseate hence it should be used in small and frequent doses Of course in case of tape worm the patient should fast as long as he conveniently can prior to taking this dose, and it should be followed by a full dose of antibilious physic. If unsuccessful repeat in a few days. The flowers and rind of the fruit are quite astringent and are valuable in diarrhoea and in the night sweats of phthisis. PYCNANTHEMUM INCANUM. Wild Basil. This herb is an aromatic, diffusive, relaxing and stimu- lating antispasmodic nervine. In hot infusion it influences the circulation and is useful for colds, catarrhal fever, the exanthems, malarial fever, infantile convulsions It will be rendered more diffusive by the addition of a little zin- giber. PYCNANTHEMUM MONTA^TM. Mountain Mint. This species may lie used for the same general purposes. PYROLA ROTUNDIFOLIA. False Wintergreen. The leaves are a mild, diffusive, stimulating, astringent tonic influencing the mucous membrane throughout. With agents that especially influence the bronchi it Ls an expectorant. With those that influence particularly the uterus and vagina it stimulates and tones. In enuresis it gives favorable results, and also in diabe- QUlSRCUS. 435 tes. It decreases the irritation of the membrane and the amount of the urine. In chronic diarrhoea it tones and astringes the alvine mucous membrane. It is a good wash for cleansing foul ulcers and a good gargle for sore throat. PYRUS MALUS. Apple Tree. The bark of this tree cooked in lard forms an excellent application for burns and scalds It quickly relieves and heals. QUERCUS ALBA. White Oak. The inner bark of all the oaks yield a large proportion of tannin, and are largely used in the process of tanning leather. It is a stimulating tonic astringent and a power- ful arrestor of hemorrhages whether external or internal. Locally it may be applied to sores, bruises, tetter, ring- worm, scaly eruptions and to prevent the falling out of the hair. It forms a good astringent wash for prolapsus uteri, pro- lapsus ani or relaxed vagina, spongy or bleeding gums, and for hardening them when false teeth are to be used. It is a good gargle for some forms of sore throat, ulcerated or inflamed, and in light cases of diphtheria. Per rectum it may be used for hemorrhoids, fissures and prolapsus ani. Locally it is a good wash for sweaty and tender feet. Internally it may be used for diarrhoea, acute or chronic. Zingiber, xanthoxylum or capsicum make it more stimu- lating and diffusive. For night sweats it may be used either locally or consti- tutionally or both. F. E. Quercus Al. 10 Tr. Capsicum I Glycerin 20 This Is for either external or internal use. The acorns are a mild, stimulating, tonic alterative. QUERCUS LUSITANICA. Nut- Galls. The excrescences upon the young branches formed by 436 QUJSRCUS. the puncture of a fly and immediately thereafter the de- posit of an egg. The egg hatches, the fly grows and finally escapes. These excrescences are denominated nut-galls and from them is obtained Acidum Tannicum, a pure astringent without the stimulation. It is a very light powder readily dissolving in water. Tannin may be used upon a bleeding surface or used internally for hemorrhages and for diarrhoea. Tannin and powdered lobelia seed in vaseline forms a good ointment for hemorrhoids, or the powders may be enclosed and inserted in gelatine capsules for rectal itch- ing and painful hemorrhoids. The tannin itself may be used in case of prolapsus ani. Tannic Acid enters into the Pile Suppositories made by C. T. Bedford which a great many of the profession have found very effective in the treatment of rectal troubles. Tannin and quinine in equal parts in syrup of zingiber forms a good preparation for cholera infantum when the discharge is watery and the patient weak. Tannin has been successfully used to remove tattoo marks. Cover the parts with a saturated solution of tan- nin and pick into the skin. Then rub with lunar caustic and allow to turn black. Now wash off the excess. It will pain for some two or three days. In fourteen to eighteen days the scab peels off and leaves a pink surface which dis- appears in a month or two. Papoid is said to do this as well as tannin, and milk- weed may be used for the same purpose. In this way many birth marks may be removed, and many may be removed by the use of a sun glass. Burn the surface and heal the wound. Dissolve tannin in 45 p. c. alcohol and add lint to form a covering for raw and bleeding surfaces. It excludes the air and prevents hemorrhage. Tannin dr. ii Glycerine oz. i Apply during the ninth month of pregnancy to toughen the nipples, and in cases of sore nipples. Tannin grs. xv Sulphur Lactate dr. ss Petrolatum dr. v This is a good application for barber's itch. QUERCUS. 437 Tannin Pul. Acacia Vera aa. dr. iss Tr. Arnica Flowers dr. iiss Paint the surface with this every five minutes until thick and hard. It will usually abort a boil. Tannin grs. x Sulph. Quinia grs. v Aqua oz. ii Wash the lids with a little of this in purulent ophthal- mia. Acidmn Gallicum is chiefly made from nut-galls and is a pure astringent. It is a good preparatioo for internal use as it does not act so fully on the mucous membrane and produce so much constipation. It is valuable for gas- tric, respiratory, cystic or uterine hemorrhages. QUERCUS RUBRA. Red Oak. The bark of this variety may be used for the same gen- eral purposes as that of the other varieties. In cancer, as an escharotic use concentrated potash made from the ashes of red oak bark. Apply until the cancer is removed, and then overspread the surface with pure honey. QUERCUS TINCTORIA. Black Oak. The bark of this variety is more bitter and mere stimu- lating than that of the alba, and is more suitable for very torpid conditions. It exerts about the same astringency as the alba and is a better application for old sores, tetter, ringworm and some eczemas. An infusion is the usual method of administering. Py-oak tannin or blue methyline is a successful applica- tion for old ulcers. RANUNCULUS BULBOSUS. Butter Cup. This plant has a solid, fleshy, turnip shaped root. Its flowers appear in May and June in the shape of small cups of a yellow color. The green root is quite acrid and stimulating when ap- plied to the surface. An ointment made by simmering the root in lard is useful as an application to glandular swellings and scrofulous sores-. 438 RHEUM. RHAMOTS CATHARTICA. Buckthorn. The berries furnish a juice which is quite a stimulating cathartic, and in large doses produces nausea, griping and watery stools. But most of these symptoms by being ad- ministered in syr. zingiberis are prevented. RHAMNUS FRANGULA. Buckthorn. This is the European variety. It is a mild, stimulating laxative and cholagogue It leaves a moderate tonic im- pression. In large doses it is fairly cathartic. For more tonic purposes combine it with euonymous, when it will be valued for habitual constipation arising from indiges- tion. RHAMNU8 PURSHIANA. Cascara Sagruda. California. The barkisa very bitter tonic, a slow, mild, stimulating hepatic. Its influence is chiefly expended upon the stom- ach, liver, gall ducts and bowels. It is of value in chronic constipation, torpor of the stomach and liver and chronic dyspepsia. It influences peristaltic action but is more tonic than cathartic. F. E. Rhamnus Pursh, oz. i Syr. Juglans (in. q. s. oz. iv This is an admirable hepatic and alvine tonic to be given morning and evening or at night only to overcome constipation. RHEUM OFFICINALE. Rhubarb. . ^R- Palmatum.) Turkey, India. The root is a mild, stimulating tonic to the alvine mu- cous membrane, the liver and gall ducts. In large doses it is cathartic, but its tonic influence borders on astrin- gency, and hence some slight constipation may follow its use. It is therefore not the agent to assist in overcoming chronic constipation, but its tonic hepatic influence is valuable in the treatment of diarrhoea, dysentery and cholera infantum. Heat somewhat increases its astrin- gency. In such cases it is therefore best boiled or roasted. Calcined radix rhei is prepared by burning the root in an iron vessel till easily puherized. Give doses of 3 to 5 grs.. RHEUM. 439 or use one dram to a half teacup of boiling water. Give ateaspoonful as required from fifteen minutes to three hours for cholera infantum, or use rheum, prunus and mentha piperita in equal parts, with one-fourth part bi- carbonate soda. Triturate well and add a heaping tea- spoonful to a half cup of boiling water. Give one or two teaspoonsful after each operation of the bowels. Rheum cleanses the mucous membrane of viscid mucous, and while large doses prove cathartic, small and frequent doses are wmic hepatic. The addition of some alkaline preparation, as bicarbonate soda, bicarbonate potassa or bitartrate potassa, relieves acidity and increases its cathartic power. Comp. Syr. Rhei et Potassa? is a valuable compound for the making of which many diiferent formulae are used. Rheum oz. viii Rheum Cassia Cin. oz. iv Potas. Bicarb. aa oz. ii Potas. Bicarb. oz. i Hydrastis oz. i Hydrastis oz. iv Oil Cinnamon M. 20 Oil Peppermint M. 30 Oil Peppermint M. 20 Dr. Bedford has put upon the market a Syr. Rhei et Po- tassa Comp, composed of the purest Turkey rhubarb inade- P. M. formula, but double strength, as suggested by Prof. Geo. Hasty. It is a very reliable neutralizing mixture and an efficient syrup. He also manufactures a neutralizing mixture according to Prof. Anthony's suggestion of the same agents minus the syrup. In many cases where children are suffering from cholera infantum the syrup is objectionable on account of its fermentative tendency and here the neutralizing mix- ture acts grandly. Rheum oz. xvi Bicarb. Potas. oz. vi Add these to one gallon of strong green peppermint infu- sion and sweeten to suit. Zingiber and hydrastis may be added if desired. Rheum, hydrastis, cinnamon and bicarbonate of potassa in equal parts, with one-fifth part pancreatine, may be formed into tablets of convenient size and be used for some forms of indigestion; or rheum and calcined magne- sia in equal parts with a half part of zingiber may be used for the same purpose. 440 ItHTJS. Pul. Rheum grs. iii Leptandrin grs. ii Hydrastia Sulphate gr. 1-10 This may be formed into a pill or used in a capsule. Each pint of the Comp. Tincture represents Rheum oz. xvi Cardamon Seed Saffron Coriander Seed aa. oz. ii Each pint of Rheum, Aromatic, represents Rheum oz. x Cinnamon Cloves aa. oz. ii Nutmeg oz. i Each pint of Rheum, Sweet, represents Rheum oz. 6| Glycyrrhiza Anise aa. oz. 2t Cardamon oz. i RHUS AROMATICA. Fragrant, Svmach. (R. Canadensis.) This bush is of straggling growth three to seven feet high. It has a sweetish and rather pleasant perfume, especially if the leaves be crushed. The flowers are pale yellow; the fruit is globular, clothed with acid, crimson hairs. The bark of fche root is a stimulating, astringent tonic, influencing the mucous membrane and especially that of the urinary and alvine departments. This is a valuable remedy in the treatment of enuresis. Fifteen drops of the fluid extract may be given two to five times a day. In diabetes 30 or 40 drops may be given as required. F. E. Rhus Arom. dr. iii F. E. Rhus Arom. Elix. Aromat. oz. iss " Celastrus Scan. aa. oz. i Aq. Cinnamon q.s. ad. oz. iii Syr. Simplex q. s. oz. iv These formulae may be used in enuresis, diabetes or Bright's disease; or use F. E. Rhus Arom. Glycerin Syr. Simpl. Aqua As a tonic astringent it is of much importance in diar- oz. ss oz. ii dr. SS' Q- s. oz. iv is of much i in iportance RHUS. 441 rboea, dysentery and cholera infantum; also in hemor- rhages from any organ or part. It is a very serviceable agent during the menopause with those of hemorrhagic diathesis. RHUS GLABRA. Sumach. The leaves, berries and bark are all more or less posi- tive astringents. The leaves are the least astringent, but are valuable in dysentery and hemorrhages of lungs or uterus. The bark is more stimulating, astringing and toning, and is valuable for leucorrhoea, inflammation of the blad- der, and for rectal troubles, chronic diarrhoea and rectal hemorrhages. A hot infusion gives a somewhat fuller out- ward circulation. It is a good wash for aphthous sore mouth and spongy gums. Dr. F. G. Hoener has with this agent cured several cases of prolapsus ani, and several cases of prolapsus uteri that had by others been pronounced incurable. The berries are a pleasant acid astringent. Fill a vessel full of berries, cover with boiling water and steep a half- hour. Then strain and sweeten to suit the taste. This is a good beverage to allay irritation of the bladder and in the treatment of diabetes and for the relief of bloody urine. Combined with pineapple syrup it is an expectorant, and is also useful in diphtheria. It may be atomized or gar- gled. Dr. F. G. Hoener uses the following gargle for sore throat and diphtheria: Aci. Rhus Glabra Bac. oz. iv Elix. Phytolacca Rad. Syr. Pineapple aa. oz. i M. S. Spray the throat as often as necessary, and use internally the following: Elix. Betonica Lane. " Eupatorium Perf. aa. oz. iss Tr. Capsicum dr. ii Syr. Simplex dr. vi M. S. One teaspoonful or more hourly, and if thirsty drink hot lemonade between times. 442 RUBUS. RIBES NIGRUM. Black Currant. The fruit is a pleasant, nutritious, mildly stimulating astringent useful in diarrhoea. The root in hot infusion is a stimulating diaphoretic. RIBES EUBKUM. Red Currant. This fruit forms an acidulated drink admirable in con- valescence, especially from fevers. It is an appetizer and assists digestion. The root is a stimulating diaphoretic when used in hot infusion, and is very valuable says Dr. Bryson when the eruption of measles is very tardy. An infusion of the leaves and branches produces nearly as good results as a stimulating diaphoretic. ROSMARINUS OFFICINALIS. Rosemary. The leaves are a diffusive stimulant and relaxant. In hot infusion they influence the circulation toward the surface and produce diaphoresis and soothe the nerves. It is chiefly used as a vehicle. RUBUS CANADENSIS. Dewberry. RUBUS VILLOSUS. Blackberry. The roots of these two varieties are much alike medi- cally. They are a positive astringent tonic, influencing chiefly the alvine mucous membrane, giving good results in acute and chronic dysentery and diarrhoea, prolapsus ani and rectal hemorrhages. Locally it is a good wash for aphthous sore mouth and bleeding or spongy gums, and to the vagina in leucorrhoea, prolapsus uteri and lax vagina. The berries are a pleasant and nutritious fruit, soothing to weak and irritable stomachs, and useful in diarrhoea and cholera infantum. For this purpose remove the seeds and prepare a cordial as follows: Juice of Bei Ties oz. ii Allspice Zingiber. Cinnamon aa. dr. ii Cloves grs. iii RUMEX. 443 Blackberry Juice qrt. i Sugar lb. i Nutmeg Cinnamon aa. oz. ss Cloves Allspice aa. dr. ii In either formula bring the berries to the boiling point. Tie the spices in a piece of muslin and put into the berry juice; simmer one hour, covered. Press out the spices and add li lbs. granulated sugar. RUBUS STRIGOSUS. Red Raspberry . The leaves are a mild, pleasant, soothing, diffusive, stimulating, astringent tonic. It allays nausea, sustains the nerves, and tones the mucous membrane. It is effect- ive in acute and chronic dysentery and diarrhoea. It is also of much service in urethral irritation. It soothes the kidneys and urinary ducts. When needed it also sustains the uterus and stops hemorrhage. In ophthalmia it is a tirst-class wash. In leucorrhoea, gonorrhoea, dysentery and diarrhoea it is a good injection. No. 6 gtta. x Infusion Rubus Strig. oz. iv will be found useful in diabetes. The expressed juice of the fruit is very nourishing in convalescence and for weak stomachs. RUDBECKIA LANCINATA. Thimble Weed- The flowers arid leaves are a- moderately bitter, diffu- sive, balsamic, alterative tonic. It tones the kidneys, increases the flow of urine, is useful in renal congestions, catarrhal cystitis and in the beginning of Bright's disease. It also soothes andtones the digestive and the generative organs, and in hot infusion it influences the circulation and soothes the nervous system. It is an excellent addition to alteratives Dr. F. G. Hoener combines it with tri folium pra tense flowers in the treatment of gastric cancer. RUMEX ACETOSELLUS. Sheep Sorrel. This herb is a positive stimulant which may be made 444 SABBATIA. into a soft extract for application to indolent ulcers and cancers. KUMEX CRISPUS. Yellow Dock. The root is aamild, slow, stimulating, tonic alterative. It influences the mucous membrane, the skin and the secernents generally. It is of much importance in all forms of scrofula, skin diseases, syphilis, ophthalmia and glandular troubles. It is somewhat laxative to the bowels, is both hepatic and cholagogue and assists in the process of assimilation. The fresh roots of rumex digested in fresh cream or lard and then strained is useful for swellings, irritations, scrof- ulous sores, scaldhead, eczema, tetter and itch. Rumex 160 F. E. Rumex dr. iv Celastrus " Celastrus Ampelopsis •' Ampelopsis Euonymous aa. 80 " Euonymous aa. dr. ii Oil Anise " Syr.Zingiber. q.s. oz. iv " Sassafras aa. 1 Rosewater 5 Either of these are good alteratives. SABBATIA ANNULARIS. American Century. This herb is a positive, diffusive, stimulating tonic to the heart, stomach, liver, generative organs and nervous system. In hot infusion it promotes the menses and influ- ences a good outward circulation. Cold preparations increase the appetite, assist digestion and assimilation in languid conditions, chronic dyspepsia and general debility. It is a good hepatic, maintains the portal circulation, but is best combined with more positive agents. It is a good antiperiodic, and an efficient nervine tonic in nervous prostration, hysteria and general debility, the night sweats of phthisis, in chronic dysentery and diar- rhoea, and in convalescence from fevers. Its tonic power over the stomach makes it a good vermi- fuge. SABBATIA ELLIOTTII, Quinine- Flower. S. E. United States. The root is a stimulating, tonic nervine, antiperiodic Salix. 445 and anthelmintic. It may be used instead of quinine as an antiperiodic. A hot infusion used freely does well, but where large doses are given patients experience tinnitus aurium similar to that arising from quinine. SABAL SERRULATA. Saw Palmetto. (Serenoa Serrulata.) The berries are a mild, stimulating, tonic alterant, in- fluencing the mucous membrane throughout but especially that of the urinary tract. It is a valuable agent in the relief of renal and cystic catarrh, prostatitis, sexual impo- tency, masturbation, irritation or inflammation of the renal mucous membrane and painful micturation. H. K. Wampole&Oo's preparation of Raw Palmetto Wine is palatable and efficient. Each teaspoon ful representing 30 grs. of the fresh saw palmetto berries. Securing the fresh berries in proper season and by special manipulation, they have prepared a wine, representing fifty per cent, of the fresh berries. An excellent expectorant, it soothes the mucous mem- brane in coryza, acute and chronic laryngitis and bronchitis. It increases appetite and digestion, and imparts tone and vigor to the organs of nutrition. It is soothing and toning to the urinary and reproductive organs in cystitis, urethritis, pyelitis and sexual neuras- thenia. It is valuable in enuresis, in impotence, masturbation and sexual execesses. Sabal Ser. 20 Carum Petrosel. 3 Cola Acum. 6 Santalum Album. 4 Aromatics q. s. This is a good tonic diuretic. SACCHARUM LaCTLS. Sugar of Milk, Lactin. Lactin forms only about 5 per cent, of milk. It is fre- quently used in which to triturate oils and bitter medi- cines. SALIX ALBA. White Willow. The bark is an intensely, bitter, stimulating, tonic ner- 446 salix. vine, slightly astringent. As an antiperiodic it probably stands near to quinine, and is much less exciting to the nerve centres. It is useful in general debility, chronic diarrhoea, chron- ic dysentery, convalesence from fevers, and in hot infusion stimulates the circulation. An infusion made of the tags is excellent for salt rheum and running sores. Salacin is an excellent tonic, nervine and antiperiodic. It relieves neuralgia and tones in convalesence. A small portion of capsicum may be added when desired. It may be used for after pains and rheumatism. Salacin grs. x Xanthoxylin grs. v Lactin grs. xl Make into five powders and use every four hours for rheumatism. Acidum Salicylicum is derived from salicin by fusion with potas. hydrate or from gaultheria by saponification with potas, hydrate solution, but mostly treating sodium phenol or carbonate with carbon dioxide gas. It is odorless, slightly astringent and somewhat irrita- ting to the fauces and increases the saliva. It has but little influence on digestion more than to control fermen- tation but is quite stimulating to the nerve centers. A solution of this agent applied once or twice to ring- worm usually cures it, and gives good results when applied to soft chancre and syphilitic condylomata, and with lard or glycerine it forms a good ointment, 10 grains to one ounce. Acidum Salicylicum 32 Cimicifugin 10 Potassii Iodidum 9 Xanthoxylin 2 Triturate on Lactin. This is a valuable prescription for rheumatism, gout or lumbago. Sodli Salicylas. To 100 parts salicylic acid with water to form a paste, add 104 parts carbonate of sodium. Car- bonic acid gas will be evolved and the salicylate of sodium remain. It acts nearly the same as the acid but is not irritating, is more soluble and is more rapidly absorbed. SALIX. 44: Sod. Salicy. dr. i Potas. lod. dr. ss F. E. Xanthox. gtta xv Comp. Gentian %. s. oz. iv M. S. i to 1 teaspoonful in water every three hours for rheumatism. Sod. Salicy. may be used in some water in doses of 2 to 10 grains every 2 hours for rheumatism. McCoy, Howe Co., Indianapolis, manufacture Boro-Sali- cylicum a seventy-five per cent, solution, a powerful anti- septic, germicide and prophylactic, adapted to the use of surgeons, gynecologists, dentists, and the general prac- titioner. It is non-toxic, non-irritant, non-corroding, non-escha- rotic. It is mild, yet powerful. Each fluid ounce repre- sents the antiseptic power of one hundred grains of boric acid and one hundred grains of salicylic acid combined with glycerine in a permanent and soluble form. It is antiseptic and antizymotic. adapted to internal or local use, to create and maintain asepsis, and may be used as a spray, by atomization, irrigation or simple application, and causes rapid, healthy granulation and with but little suppuration. Locally, use i to £ strength: per vaginam ± strength; or internally 5 to 20 drops in water three or more times daily. In chronic cystitis and chronic urethritis it is a valuable local application. SALIX ERfOCEPHALA. Swamp Willow. - The leaves in hot infusion give good results in entero- colitis. SALIX NIGRA. Black Willow, The bark of the roots is a positive, bitter, tonic nervine- It seems to direct its chief influence to the generative organs, where it allays irritation and restores vigor to the entire sexual tract. Taken before retiring it quiets the nerves and prevents lascivious dreams and nocturnal emis- sions. Dr. G. H. Mayhugh recommends the following for sperm- atorrhoea: 448 SAMBUCUS. F. E. Salix Nigra " Celastrus Scan. aa. oz. ii Syr. Simplex oz. iv M. Sig. One or two teaspoonsful in water four times a day. The aments are a stimulating, astringent tonic especi- ally influencing the genito-uri nary organs of both sexes. It is of importance in nymphomania, onanism,. seminal incontinence, ovaritis, cystitis, prostatitis, spermatorrhoea and nocturnal emissions. It relieves irritation, soothes the nerves and tones the organs. SALIX PURPUREA. Rose Willow. The bark of the roots has about the same properties as nigra, SALVIA OFFICINALIS. Sage. The leaves are a pleasant, mild, diffusive, stimulating tonic, slightly astringent. In hot infusion it is gently diaphoretic and quite soothing to the nerves. It cleanses and tones the mucous membrane and may be profitably used in throat troubles from colds and in respiratory, stomach or bowel troubles from the same cause. Cold preparations are diuretic and excellent in night sweats, and are sometimes used for the removal of the stomach worm. Infusion of Sage oz. ii Powd. Borax dr. i Honey to sweeten. Apply to mouth ulcers SAMBUCUS CANADENSIS. Elder. The flowers are a mild, diffusive, relaxing diaphoretic and alterant. When given in hot infusion it is excellent for the removal of colds and feverish conditions therefrom, also in measles and chicken-pox. It influences the glandu- lar system and is an excellent addition to some alterative compounds. Its relaxing influence is felt by all the secero- ents. It is a gentle laxative for children and is very soothing to the nerves. They form a fine soothing poultice to any inflamed part. Cold preparations are diuretic. SANGUINARIA. 449 The bark is a .stimulating cathartic. It thoroughly arouses the alvine mucous membrane and is excellent for the cleansing and toning of that membrane in cases of gastric and intestinal ulceration and in catarrhal condi- tions. It is a good gastric tonic and anthelmintic. An infusion is a good wash for the cleansing of sores. Boil the green bark till the fluid is a soft extract. Then combine with vaseline and you have an excellent salve for old sores, eczema rubrum, etc. The fruit is nutritive and medicinal. It influences all the secernents and is mildly laxative. It may be made into a wine or jelly and partaken with profit in convales- cence. SANGUINARIA CANADENSIS. Blood-Boot. The fresh root is a very harsh, positive stimulant to the mucous membrane; the dry root is much less so. It influ- ences the mucous membrane, the secernents and the glandular system. Large doses are quite nauseating. As an alterant it is excellent in glandular troubles, scrofula and skin diseases. It is useful in diphtheria internally and externally, and in the cleansing of old sores in prepa- ration for a healing dressing. It is one of the best additions to cough syrups; it cleanses the mucous membrane, induces expectoration and relieves irritation of the bronchi. With acetous syrup of lobelia, or the 3rd. prep, of lobelia, it is unexcelled in the treatment of membranous croup. The combination must be proportioned to the age of the child and the severity of the case Give every few minutes until the child vomits and expels the membrane. Then give small doses at longer intervals to prevent a recurrence. In asthma sanguinaria is a valuable addition to lobelia, and in whooping cough a small portion with the acetous syrup of lobelia is a success. Give enough and give frequently enough to compel the spasmodic efforts to cease. In sluggish cases it is a good emmenagogue. An infusion of only moderate strength may be used as an injection in case of leucorrhcea but not where the vagi- na is irritated. Sanguinaria may be combined with hepatics in torpid catarrhal conditions of the alvine membrane. Toning agents will thfen be more effective. 450 SARBACENIA. The acetous tincture is made by heating acetum oz. xvi to the boiling point and adding to oz. iv of powd. sangui- naria, Combined with glycerin the infusion or fluid extract will invigorate the hair follicles and prevent the falling out of the hair, whether as a result of fever or other causes; but it will not make hair grow on bald heads. Applied to the skin when inflamed by poisonous contact it will promptly relieve the itching and burning. Sanguinaria and lobelia may be used in equal parts in cases of pruritus. The nitrate of sanguinaria is an escharotic. Prof. E. G. Anthony makes a pencil of the acetous tr. sanguinaria with starch and tragacanth for application to granular eye lids. SANICULA MARILANDICA. S article. The root is a mild, aromatic, diffusive, stimulating and relaxing agent. Hot infusions are moderately diaphoretic and nervine and may be used for colds with feverish ness, whether of the head or the respiratory organs; also in the fever stage of the eruptive diseases, especially in measles. SANTALUM ALBUM. Sandal Wood, Yellow or White Saunders. India, Ceylon. This evergreen glabrous tree grows 20 to 30 feet high and 8 to 3 feet in circumference, having a brownish bark. The wood chips yield an oil. Either is a mild, aromat- ic, astringent tonic. In pharmacy it is sometimes used to color liquids, especially liniments. It is frequently used as a substitute for copaiba in gonorrhoea, gleet, or other urethral irritations. SARRACENIA PURPUREA. Pitcher Plant. The root is a mild relaxing and stimulating diaphoretic. When given in hot infusion it is very valuable in measles, scarlatina, small-pox, chicken-pox and other contagious eruptive diseases. Dr. F. G. Hoener recommends the following for such conditions: SCKOFHULAKIA. 451 Sarracenia Purp. Sambucus Can. Eupatorium Pert", aa. equal parts. SASSAFRAS OFFICINALE. Sassafras. (S. Variifolium.j The inner bark of the trunk and root is a pleasant, aro- matic, warming, stimulating alterathe. The wood and bark are frequently used as a pleasant alterant beverage, a popular drink in Spring when the bark has its greatest strength. It influences the glandular system, and is valu- able in cases of varicose ulcers and those of a scrofulous nature. Give an infusion and poultice the sore with sassa- fras and ulmus. A poultice is also valuable for bruises, congested swellings, and chronic abscesses. In hot infusion it is diaphoretic, nervine and emmena- gogue. The oil is used for scabies and other contagious erup- tions. It is a good stimulating and relaxing nervine for bruises, sprains, congestions, inflammations, rheumatism and neuralgic swellings. Oil Sassafras 1 Oil Sassafras F. E. Lobelia " Cinnamon " Cypripedium aa. 4 " Cloves in equal parts. The former is a stimulating and relaxing liniment and the latter a stimulating liniment. Oil Sassafras gtta. i Ha in Water dr. i forms an application for ulceration of the cornea. The pith in the young shoots in cool water forms a mu- cilaginous wash of excellent service in acute and chronic ophthalmia. It soothes and heals. Gather the pith in spring and allow to dry. SATUREIA HORTENSIS. Summer Savory. This herb in hot infusion is a mild, aromatic, stimulat- ing diaphoretic useful in colds, feverishness, and for the relief of the menses when stopped by cold. SCROPHULARIA NODOSA. Carpenter 's Square . The leaves are a mild, relaxing and gently stimulating 452 SCUTlSLARIA. alterative, influencing the secernents and useful in scrof- ula and skin diseases. It tones the pelvic viscera, increases the quantity of urine, and soothes and strengthens the generative organs. SCUTELARIA LATERIFLORA. Scullcap. This herb is a positive, diffusive, permanent, stimulat- ing nervine. It is bitter but not nauseating. Its chief influence is spent upon the nervous system. It is an excellent agent in nervous prostration. In its way it is fully as stimulat- ing as quinia, but its influence is more general than that of quinine. Its stimulation extends to the brain, spinal cord and sympathetic system. To all it extends its tonic influence, which is quite permanent. With lobelia and. capsicum, cypripedium and capsicum, or with caulophyllum alone it is an excellent antispas- modic, which may be used in such conditions as chorea, epilepsy, hysteria, puerperal convulsions and other spas- modic conditions of infant or adult. I think such combi- nations would give favorable results in hydrophobia, and I know that such will with delirium tremens and morphia mania. It may not cure bad cases of epilepsy but it will help such conditions, especially with alkaline and hepatir, preparations. Have such patients abstain from sweets, fats and starches to a great extent. In the delirium of typhoid and in nervous dyspepsia it is an excellent agent. In cases of insanity, after getting your patient well under the influence of lobelia and cypridedium put them on scutelaria. It is also useful in hysteria, hj-pochondria, general ner- vousness, insomnia, convalescence from fevers, cranial neuralgia, uterine neuralgia, general female weakness. A hot infusion renders it more diffusive than is the fluid extract, except it be used in hot water. Scutelarin is a moderate representative. SEMPERV1VUM TECTORUM. House Leek- The leaves by pressure yield a juice that makes a good dr. iv F. I G. Senecio dr. ii " Caulophyllum aa dr. iv Syr. Zingiber. q. s. <>z. iv SIERRA. 453 application in acute ophthalmia and for all raw open sores of recent production, and surface swellings. Internally it is a moderate diuretic. SENECIO AUREUS. Life- Root. This herb is a slow, stimulating and relaxing agent, in- fluencing the nervous system and the generative organs. It gently promotes menstruation, relieves some forms of clysmenorrhcea, the aching back and some forms of hys- teria, and tones the generative organs of both sexes. With sanguinaria it is a positive emmenagogue. Senecio Viburnum Op. Caulophyllum Euonymous a a. dr. i Syr. Zingiberis q. s. oz. iv These are good compounds for dysmenorrhoea. With aralia and prunus it influences the bronchi and may be added to the cough syrups of the chlorotic. It is soothing, cleansing and strengthening to the lungs. McCoy, Howe Co. prepare Caulo-Senecio, a fine antispas- modic and nervine. Each fluid ounce represents: Black Haw Cramp Bark aa. grs. xlv Wild Yam grs. xxx Blue Cohosh Life-Root aa. grs. xv It is very effective in amenorrhoea and dysmenorrhoea, cramps, colics, cholera morbus, convulsions, hysteria, etc. SENECIO OBOVATUS. Squaw Weed. This is a mild, stimulating alterative. Dr. F. G. Hoener uses this agent in the treatment of tetter, eczema and chronic skin diseases generally. SIERRA SALVIA. Mountain Sage, Sage-Brush, . (Artemisia Frigida. ) Western U. S, This herb is a bitter aromatic, diffusive, stimulating diaphoretic, and is also anti periodic, alterant and ner- vine. Large doses nauseate and may produce vomiting. In hot infusion it influences the circulation, inducing a 454 SIM ABA. good outward flow of blood and free diaphoresis. It stim- ulates the entire peripheral circulation and sustains the heart and arteries. It quite thoroughly influences all the secernents and the mucous membrane, the liver, the gall ducts, the kidneys and the bowels. It gives excellent results in mountain fever, spinal irritation, meningitis: intermittent, remittent, congestive and rheumatic fevers: pleuritis, pneumonitis, sciatica, la grippe, scarlatina and the other exanthemata. Also in muco-purulent leucor- rhoea, in phthisis, and in amenorrhoea and dysmenorrhea when the results of congestion. SILPHIUM LACINIATUM. Rosin Weed. The leaves contain a resinous material, a rather bitter stimulant to the mucous membrane. It lessens expecto- ration, and lessens the alvine discharges in dysentery and diarrhoea. SILPHIUM PERFOLIATUM. Cup Plant. The root and leaves are a diffusive stimulant, influenc- ing the liver, gall ducts and spleen, and is laxative to the bowels. In hot infusion it is a gentle diaphoretic and useful in cases of biliousness, colds, remittent and catarrhal fevers. It is said also to be an antiperiodic. SIM ABA CEDRON. Cedron Seed. New Grenada. This tree grows to the height of about 15 feet. The stem when about twelve feet ends in a terminal panicle of flowers covered externally with brownish hairs. It then sends forth side branches which do the same. The fruit is about the size of a large peach and covered with short hairs. Each fruit contains one seed having two halves. The seed is a stimulating and relaxing antispasmodic nervine. By those among whom the tree grows, it is suc- cessfully u&ed in the cure of rattlesnake bite and that of other poisonous reptiles and insects, also in the cure of hydrophobia. It is used internally and applied to the surface of the wound, and in hydrophobia it is also used hypodermically. SMILAX. 455 Internally from 5 to 30 grains may be used every 3 to 6 hours. Large closes produce in some persons some griping sensations in the bowels. This agent is also used in spasms, for toothache and as an antiperiodic in agues. As an antiperiodic give two to four grains three to six times during the cold stage. SINAPIS ALBA AND NIGRA. Mustard. The seed is quite pungent to the taste and smell, stimu- lating and acrid. It is preparer 1 lor table use and in Spring the young leaves are eaten as greens. The powdered seed will blister the surface if left on long enough, and if used persistently with food it will irritate the stomach. It is doubtful whether we can advise the use of an agent that will so quickly destroy a healthy surface. If used to destroy some portion of skin necessary to be destroyed its blistering use would be legitimate. This agent should be used only to stimulate the surface, never allowing it to blister except as above stated. It is sometimes used internally as a quick emetic in cases of poisoning, but I prefer capsicum, lobelia and bicarbon- ate of soda for this purpose, but I would give the mustard if nothing better was at hand, a teaspoonful or less in four ounces of water. It may be used to stimulate over the surface of a con- gested organ, or over the seat of acute pain, but remove before blistering even if it is reapplied. If some flour and the white of an egg be added it will usually not blister. Sinapis is sometimes added to a foot bath to stimulate the extremities. SMILAX CANELL.E FOLIA. Bamboo-Brier Boot. (S. Pseudo-China). S. E. United States. The root is a stimulating tonic alterative of consider- able value in primary and secondary syphilis, rheumatism, scrofula and eczema. An infusion may be used freely. SMILAX OFFICINALIS. Sarsaparilla. Honduras, Jamaica. The root is a mild, pleasant, relaxing and stimulating alterative- In hot infusion it gives an outward oircula- 456 SODIUM tion of the blood. It is a very mild agent and deserving praise chiefly when combined with other alterants. In this way it is of service in scrofula, syphilis and skin diseases. F. E. Smilax Off. " Articum Lap. 14 Phytolacca Had. aa dr. iii " Xanthoxylum gtta. xv Iodi. Potas. dr. i This is valuable for syphilis especially if gummata be present. Sarsaparilla 320 Sarsaparilla 800 Rumex 160 Guaiacum Menispermum 80 Iris aa 80 Oil Sassafras 1 Stillingia 240 Oil Anise 1 These are good alteratives. SODIUM. This is the base for a number of alkaline preparations. It is a soft silvery white metal. The hydrate of soda (caustic soda) and quicklime in equal parts form a powder to apply to chancres and warts. Sodii Chloridum (salt) is a stimulating antiseptic use- ful in gastric and pulmonary hemorrhages, as a saturated solution inject to relieve pin worms; as a stimulating in* jection to relieve the bowels; as an application to sprains, bruises, and (envelop the joint in a hot compress of salt water every 3 or 4 hours), in rheumatism and neuralgia; as a wash for weak sore eyes; for cleansing the mucous mem- brane in nasal catarrh; and for making a salt water bath. Sodce Carbonas, (Carbonate of Soda) is as strong alkali used for cleansing and disinfecting. A solution forms a good wash for scaly skin. Sodae Bicarbonas, (Bicarbonate of Soda.) Baking Soda is a valuable act-acid, and may be used in cases of poison- ing by mineral acids. It is also valuable as a vaginal in- jection in cases of sterility where such arises from an acid leucorrhoea. This agent is an abortive in tonsilitis if giv- en in the early stage. Give 30 or 40 grains internally and frequently apply to the tonsil by means of a blow-pipe. Listerine oz. i Bicarb. Soda Biborate Soda aa grs. xxx SODIUM. 457 Aqua q. s. oz. iv Atomize this in case of catarrh to cleanse the nostrils. Sodce SalpfUs (Sulphite of Soda) is a good wash for aphthous sore mouth, one dram to an ounce of water. It clears up the trouble in a hurry. In typhoid and other fevers and torpid conditions of the alvine mucous mem- brane, small doses in solution may be given 3 or 4 times in 24 hours it will readily cleanse the tongue and alvine mu- cous membrane throughout. Sulphite Soda 1 Salicylate Lithia 20 Cimicifuga Rac. 30 Cascara Sagrada 30 This combination is suitable for rheumatism. Sodce Hi/pts ul phis (Hyposulphite of Soda) is very use- ful in arresting gastric fermentions, 2 or 3 grains to the ounce of water may be used. A stronger solution is a good wash for sore mouth, and a saturated solution is a good application for ringworm, pruritus and tetter. Sodae Bi boras (Borax) has two equivalents of boracic acid and one of soda and is soluble in ten or twelve parts of water. It is a good alkaline wash for the babe's sore mouth. Salvia, prunus, myrica. kino, rhus glabra or hy- drastis may be added. Borax is also a good wash for oph- thalmia, granular lids, for cleaning the scalp, tender sur- faces and in scaly eruptions. Borax dr. i Glycerin dr. iv Phos. Hyd. grs. iv Rose Water oz. iii ss Use for mouth ulcers. Borax dr. iv Carbolic Acid dr. i Tannin dr. ii Glycerin oz. ii Alcohol oz. iii Rose Water oz, V Apply for the removal of pimples and blackheads. Boracic Acid consists of one equivalent of boron and three of oxygen. A solution of 4 to 10 grains to the ounce of water relieves the burning sensation of gonorrhoea. In resilient stricture and painful cystitis an injection to the bladder of a solution of 8 grains to the ounce of water gives almost instant relief and abates micturition. Wherever 458 SOLIDAGO. used it diminishes muco purulent discharges, whether it be to the vagina for leucorrhoea, to the ear for otorrhoea, or to the eye in conjunctivitis, gonorrhceal ophthalmia, granulated eyelids, catarrhal ophthalmia, corneal conges- tions, or ulcerated tarsi. Boracic acid two drams to one pint of water makes a good eye wash. Boracic acid ten grains to simple cerate one dram forms a useful ointment. Boracic Acid Tannin aa. grs. x Glycerin , dr. ii Aqua Hosae dr. vi Use a few drops in the eyes every three hours for con- junctivitis. Boracic acid and acetanilid form a wash for cleansing sores and wounds. Boracic acid and the aqueous extract of hamamelis in water form a good wash for ophthalmia. SOLANUM CAROLINEJSTSE. Horse Nettle, Bull Nettle. (Succus Solanii.) S. E. United States. This is the fresh juice of the fruit concentrated by exposure to currents of air at a low temperature and pre- served by the addition of sotne alcohol This is the process adopted by McCoy, Howe Co., of Indianapolis. They pre- pare it double strength. It is recommended largely in the treatment of epilepsy. If we shall rely upon reports it is very successful. Begin with small doses; increase their size and continue long enough to perfect a cure. SOLIDAGO CANADENSIS. Golden-rod. There are several varieties of this plant, but that bear- ing a plume- like flower is preferred. The leaves and flowers are a stimulating and slightly astringent tonic antiseptic to the mucous membrane. It is a sanative germicide, and is valuable in the presence of putrescence, as in diphtheria, scarlatina, tonsilitis, phar- yngitis or laryngitis. It maybe boiled down and made iuto a confection or troche with sugar, suitable for sore throat of almost any kind, for children or for adults. SOLIDAGO. 459 Sol id ago Can. 4 Hydrastis Can. Myrrha aa. 2 Chloride of Sodium Capsicum aa. I This may be made into an acetous infusion for gargling, or for atomizing the throat; or the vinegar may be omitted and the infusion swallowed. In diphtheria and scarlatina there is nothing better. In scarlatina arctium seed should be added. In tonsilitis solidago may be used alone. Sol id ago 20 Lobelia " Xanthoxylum aa. 1 This also may be used for diphtheria and scarlatina, in light form. The Fid. Ext. of Solidago Comp. according to the formula of Prof. G-. N. Davidson, made by C. T. Bedford is a very excellent combination of agents in the treatment of diph- theria and all forms of ulceration of the throat and mucous surfaces Here you have the tonic and antiperiodic action of the eucalyptus, the fine stimulation of the xanthoxylum, the relaxation of the lobelia with the slight escharotic action of the solidago made from the green herb. This comp. proved very effective in the hands of the late Prof. Davidson. In catarrh and especially in la grippe, solidago is very valuable. It cures quick and completely. I have had more complete eradication of la grippe from the use of sol- idago, either alone in hot infusion, or in combination with other suitable agents, than with anything else. In typhoid fever it stimulates and cleanses the alvine mucous membrane very successfully. In phthisis pulmonalis and bronchial catarrh it is of much value, especially when added to other agents influ- encing the respiratory organs. Boiled down to a thin paste and added to vaseline, an excellent salve is formed. SOLIDAGO VIECtAUREA. (Virga Latifolia. | The lefives are a stimulating astringent and diuretic. It is valuable in dropsy. When given in hot infusion, very freely, it increases freely the flow of urine. 460 STATICE. SPIGELIA MARILANDICA. Pink Hoot. The root is a domestic anthelmintic. It is usually com- bined with senna. Large doses produce dizziness, but no such symptoms attend the ordinary dose. Dr. F. G. Hoener recommends the following as an anthel- mintic: Syr. Spigelia Mar. " Chenopodium Antu. aa. oz. ii " Cassia Acut. oz. i M. S. A teaspoonful or more four times a day for a few days. SPIR.EA OPULIFOLIA. Mine Barks- The leaves are a mild, stimulating, astringent tonic. SPIRAEA TOMENTOSA. Hardhack. The roots and leaves are a mild, stimulating astringent, useful in diarrhoea. STAPHYLEA TRI FOLIA. Bladder JV'ut. The bark is a mild, soothing, stimulant and relaxant to the mucous membrane. In hot infusion it influences the circulation and soothes the nervous system. In case of gastric, alvine, urinary and generative irritation it soothes and gently stimulates. STATICE BRAZILIENSIS. Baycvru. Brazil, Paraguay. The f oot internally is of a reddish brown color, having a thick bark and its pith fully one-fourth of its diameter. The natives use this for all kinds of scrofulous enlarge- ments and glandular swellings. It is a stimulating, as- tringent alterant. It is used locally as a wash, inhaled and given by way of the stomach. It is used as a gargle in some forms of sore throat. STATICE CAROLINIANA. Marsh- Rosemary : The root is a positive astringent, useful in acute and STILLINGIA. 461 chronic diarrhoea and that resulting in typhoid fever. It is also valuable in hemorrhages from whatever locality, and whether internal or superficial. It is useful as a wash for sore mouth and spongy-gums. STIGMATA MAYDIS. Com Silk. This should be gathered immediately after its pollen has been shed. It is a demulcent, tonic diuretic. It increases the flow of urine, soothes the kidneys and bladder, and relieves the urine of that strong odor of ammonia which is sometimes present. It cleanses the cystic membrane in the relief of cystic catarrh, and of other morbid deposits showing its influence as an antiseptic. It assists in free- ing the circulation of urea and is valuable in the treat- ment of renal and cystic inflammation. Dr. C. B. Riggs recommends the following for cystitis: F. E. Stigmata Mayd. oz. iss " Uva Ursi oz. ss Sodium Salicylate (Wintergreen) grs. lx M. S. Teaspoonful every one, two or three hours. This gives relief within a few hours and will give any physician a reputation in this class of cases. The Doctor says this has never failed him. STILLINGIA SYLVATICA. StilliTbgia. The root is a positive stimulating alterative. Large closes are cathartic and emetic and subsequently leave in the stomach and bowels a burning sensation. It stimulates the alvine mucous membrane and the glandular system, and is valuable in the treatment of sec- ondary syphilis, eczemas, ulcers and scrofula. It is best adapted to chronic cases and in combination with other agents less stimulating. F. E. Stillingia Syl. F. E. Stillingia Syl. " Dicentra Ex. •' Sarsaparilla Off. " Iris Ver. " Arctium Sem. " Chimaphilla U. aa. dr. ii " Chimaphilla i; Xanthoxylum C. gtta. xv " Rumex Cr. aa dr. ii Syr. Simplex q. s. oz. iv " • Xanthox. Car. gtta. x Syr. Simplex q. s. oz. iv 462 SULPHUR. Stillingia Syl. 5 F. E. Stillingia oz. iii Dicentra Ex. 3 " Sanguinaria dr. iv Chimaphilla U. 2 " Iris Versicolor dr. iss Xanthoxylum Bac. 1| Iodide Potas. dr. iii Coriander Sem. H Syr. Simplex q. s. oz. xvi Iris Yers. Sambucus Flowers aa. 1 These are all good alterative preparations more or less stimulating. Oil Stillingia " Lobelia aa. dr. ii " Cajaput il Euc*alyptol aa. dr. iii Alcohol oz. iii This is a good liniment for sore throat and wherever needed. STYLOSANTHES ELATIOR, Afterbirth Weed. This herb is a soothing, stimulating, tonic nervine espe- cially influencing the pelvic orgauism. It relieves the irritation and pains frequently present during the preg- nant period, prevents miscarriage and quiets the false pains so frequently perplexing just prior to parturition. It i3 a splendid preparatory to the parturient act, and nicely anticipates a long and tedious labor. Of the fluid extract 10 or more drops may be given three times a day for a month prior to confinement. STYRAX BENZOIN. Benzoin. East Indies. This fragrant balsam exudes through incisions made in the bark. This dries to a state of brittleness. An alco- holic tincture is made which may be combined with cough syrups in the treatment of old coughs. In hot water it is quite fragrant and being inhaled will add to its power as a tonic expectorant. Benzoic acid is quite irritating. STYRAX OFFICINALE. Storax. Southern Europe. This balsam is a stimulating expectorant. SULPHUR. Sulphur Sublimat tint is very valuable in the treatment SUKGICAL ANESTHETICS. 463 of diph'heria. After cleansing the throat by the process of gargling or atomizing then use a blowpipe and leave the throat well covered with sulphur. It gives excellent results. Sulphur burnt in a sick room or through a house is one of the best of disinfectants. Sulphur may be taken internally but it should be re- membered by those who wear jewelry next to the flesh that after taking sulphur a few days the skin will tarnish jewelry. Its chief action is on the circulation and the skin. Externally and internally it is used as a cure for itch. Triturate sulphur 1, with lard 2 and apply, but sulphuret of potassium is better for this purpose. Sulphur dr. vi Unslacked Lime dr. iii Aqua oz. xvi Boil the compound till almost a red color. This is the bisulphuret of calcium. A few applications of this will usually cure itch. SURGICAL ANAESTHETICS. BY E. ANTHONY, M. D. Professor ofa Surgical Pathology applied, in the Physio-Medical College of Indiana, Indianapolis. Relative Value of Each —Immediately upon the dis- covery of ether by Dr. Morton of Boston its use became general throughout the civilized world. Dr. Simpson's discovery of chloroform during the following year robbed Morton, at least for a time, of a portion of his laurels. The influence wielded by Simpson and his friends on the coniinent, gave chloroform a much greater impetus than ether; but it was soon found that more patients died from the use of the former that from the latter; and this fact caused a reaction, which turned the tide of sentiment in favor of ether. Notwithstanding this chloroform is ex- tensively used by some European nations, especially the Germans. The general effect of these two agents is much the same; but each finds its applicability in the peculiar conditions found in individual cases. Ether is a cardiac stimulant, increasing the force and frequency of the heart, filling up the capillaries and distending the vessels of the brain. This property of ether renders it in- applicable in persons of a plethoric habit Also in hy- 164 SURGICAL ANAESTHETICS. pertrophy with irritability of the heart, caused by aoritic stenosis. Its stimulating properties render its use in irri- table states of the nasal passages and bronchial tubes very unpleasant, and contra-indicates its use in all well devel- oped cases of bronchitis and organic disease of the lungs. Epileptics are not good subjects for taking ether by inha- lation, the increase in the cerebral circulation is liable to bring on the convulsions and such patients sometimes die from this cause. Owing to its liability to cause vomiting it is not highly esteemed in abdominal surgery. Its stimu- lating effect on the capillaries also favors hemorrhage, the same objection applies to its use in operations about the nose and mouth and in cataract. Its inflammability ren- ders it very dangerous where artificial light has to be em - ployed. Its volatility and bulk contra-indicates its use in armies that are changing places, owing to its inconvenience of transportation. Its odor is very objectionable to many patients, the impression it makes on the nervous system lasts sometimes for several months. The one redeeming feature is its safety as claimed by its friends, the number of deaths from its use in surgery being less than from the use of chloroform, which, according to statistics, causes one death in ten thousand, while that of ether one in twenty-six thousand. However the mortality from either may not be correct, because the number of these is not known, that may have died from the careless- ness or ignorance of the administrators. Even in many well regulated hospitals the administration of the anaes- thetic is trusted to inexperienced and careless internes. It is also a part of human nature, from which none of us is exempt, to allow ourselves to become careless. After hav- ing administered the agents, perhaps one thousand times without a fatal result, but owing to some little omission a patient may suddenly and unexpectedly die. The life is gone and cannot be recalled. In this, more than in other cases, "vigilance is the price of safety." This applies more directly to chloroform than ether, as the former is more certain and potent in action. This may in part ex- plain its greater fatality. The same may be said of its almost universal use by country practitioners, who use it indiscriminately and who are many times compelled to trust its use in the hands of inexperienced men. It is a fact peculiar but nevertheless true that the larger number of patients die when the anaesthetic is given when trivial SURGICAL ANESTHETICS. 4f)S operations are to be made, such as amputation of a toe or finger, the removal of small tumors and other like trivial proceedures. The explanation of this is, first; experienced men, only, make severe operations; they are aware of the danger, not only of the operation, but of the anaesthetic, and take every precaution to guard the patient against all danger; and when the time comes to make the operation there are no mistakes made. On the other side the operation is triv- ial, seemingly free from danger, and the operator takes the same view of the anaesthetic; therefore little or no precaution is taken. He seems to forget that the anaes- thetic is just as dangerous when administered for trivial operations as for severe ones. The following is an analysis of 21 and 2/6 cases of chloro- form and ether respectively, as taken from the reports at Xetley Hospital for the year 1875, and shows the relative time required to bring the patients under the influence. The shortest time for chloroform, two minutes and thirty seconds; ether, three minutes and thirty seconds. Long- est time for chloroform, fourteen minutes and thirty sec- onds; ether, twenty-four minutes. Average time for chlo- roform, six minutes and twenty-four seconds: ether, eight minutes and ten seconds. Average time under its influ- ence—chloroform, twelve minutes and forty-eight seconds; ether, nineteen minutes and six seconds. Smallest quan- tity used in any one case-chloroform, one dram; ether, two ounces and four drams. Largest quantity used— chlo- roform, eight drams; ether, nine ounces. Average quan- tity used in any case— chloroform, three drams and nine minims; ether, five ounces and one dram. From chloro- form vomiting occurred in two cases during or after the use of the drug. From ether vomiting occurred in eleven cases after the use of the drug. Excitement occurred in ten cases during or after the administration of chloroform. During or after the administration of ether there was marked excitement in seven cases. It will be seen from the above analysis that chloroform brings about anaesthesia quicker than ether; that ether holds its influence longer than chloroform; that vomiting- is more frequent from ether than chloroform: that it takes four to eight times more ether than chloroform to produce the specific effect. The temperature of the room has much to do with the 466 SURGICAL ANESTHETICS. administration of either, as the following table compiled by Mr. Snow will show. One hundred cubic inches of air was saturated with ether and chloroform in the following quantities: One hundred cubic inches of air at 44 degrees would contain 27 cubic inches of ether vapor 54 " " " 24.3 tl " " 64 " '■' " 43 3 " 74 '« " " 53.6 " 84 " " " 66.6 •' " One hundred cubic inches of air at 50 degrees would contain 9 cubic inches chloroform vapor CO " " " 14 70 - ; " i4 24 SU " " " 36 DO '" " " 55 " The object of exhibiting the above table is to show that the temperature of the atmosphere in the operating room lias much to do with the time required to bring the pa- tient under its influence, as the atmosphere will absorb only a given amount at a certain temperature. A knowl- edge of this is necessary, because if the temperature is low it will take too long to get the patient ready for the ope- ration; on the contrary if the temperature is high the patient may get a fatal quantity. The above is a fair representation of the opinions of those who prefer ether in surgery. A brief statement of the representative men who are not sanguine of the safety of ether, might serve to put the young practitioner on bis guard, as some writers leave the impression that ether is almost absolutely safe. The fohowing is extracted from the pen of Joseph Lister. Esq.: At the International Congress at Brussels M. Per- riu said: "The fact of death resulting from ether cannot be contested, and accidents, whatever may be said, resem- ble those from chloroform. Like chloroform, ether exposes to sudden accidents, impossible to foresee, dependent on accidental syncope." M. Forget said that "to deny that every anaesthetic causes sudden death is to refuse to receive evidence.' Kappeler, in summing up the evidence fur- nished by his table of ether-deaths, says: "From the foregoing facts, however, it by no means appears that ether-death in man t* essentially different from chloroform- death, nor that death under the inhalation of ether iu SURGICAL ANAESTHETICS. 467 man always commences by disturbance of respiration, and in every case proceeds from the respiratory organs, as experimental physiologists maintain to be the case with animals." We are forced, then, by clinical evidence, to reject the statement of text-books that ether "never suddenly para- lyzes the heart,'' as well as the latest doctrine that ether always gives warning by the pulse, it becoming "weak and slow, not suddenly but gradually.'' Nor will the doctrine of Schiff, based wholly upon experiments with animals, that death under ether always begins with the respiratory function, bear examination by the light of clinical experi- ence: while his corollary that the surgeon is always respon- sible for the death of a patient under ether, is unsound, as it is sure to work, if adopted, most serious injury and great injustice to whoever may be so unfortunate as to have an accident with this anaesthetic. The second important fact in regard to ether, is that the dangerous symptoms or death may supervene at some considerable time after the administration has terminated, just as they do after chlo- roform. Whether the fatal event can justly be attributed to ether in such cases as those reported by M. Richet, where a suffocative catarrh began soon after the inhala- tion, and caused death some days afterwards, remains yet to be determined. There are cases fully detailed, however, exactly resembling those occurring after chloroform, and in regard to which there can be no question. The writer is cognizant of a number of such cases, in which the patient was rescued by vigorous measures, and which have never been published. It is probable that these late appearing accidents are more frequent with ether than with chloro- form, from the larger quantity required, its greater solu- bility in the blood serum, and the slower rate cf its excre- tion. With present knowledge they are the most inexplic- able facts connected with anaesthesia. The physiological action of ether, although in general resembling that of chloroform, differs in some points so much as to demand consideration, as in its mode of caus- ing death the effect of ether upon the blood-pressure is far from showing in man that entire want of influence which it exhibits in animals, neither does it in man show that in- variable and unexceptionable depression of pressure which is characteristic of chloroform. With chloroform, marked depression of the sphygmographic curve is always pro- 468 SURGICAL, ANAESTHETICS. duced in man while with ether a considerable proportion of cases show no change. Thus, Kappeler gives ten trac- ings, in three of which there was but slight, if any, change from the normal — an occurrence not presented once in twenty-five observations- with chloroform; but in seven of the ten cases ''the curve of deep ether-narcosis differed not at all from that of chloroform-narcosis." Deep flush- ing of the face occurs under the administation of ether. A profuse salivation is a very unpleasant feature, causing cough, efforts at swallowing, and choking sensations. The pupils are not generally so closely contracted as under chloroform, and may remain unchanged. The respiratory action very rarely goes on undisturbed with ether as it often does with chloroform; cough, hawking, catching of the breath are almost always present, and marked irregu- larity is the general rule. In the length and severity of the stage of excitement there is the greatest contrast be- tween the two agents. With ether irregular muscular action is extreme, and marked rigidity of the extremities, which may extend to the whole body; there are violent ef- forts to escape from the inhalation, prompted by the dis- tressing sense of suffocation; and, more generally than with chloroform, there are struggles with the arms and legs, attempts to rise from the table, and even get out of the room. The stage of relaxation and complete anaes- thesia having been attained, it is maintained with diffi- culty; the patient readily relapses into a condition of excited intoxication, in which it is impossible for the operator to proceed. Finally, the return to conciousness is marked with more unpleasant symptoms than that from chloro- form. A state of excitement like partial intoxication, and various hysterical symptoms are apt to make their ap- pearance, while the smell and taste of the ether may dis- gust the patient for hours if not days. The question as to which anaesthetic causes vomiting most frequently afterwards, long undecided, may be said to be settled in favor of the ether by the experience of O'Keith of Edinburgh, whose brilliant success with an operation alter which vomiting is especially deleterous is well, known. There is no question, however, that this unpleasant effect of .ether, as well as the stage of excite- ment, may be very much and very favorably modified by circumstances fully under control. The quality of the ether should be assured. The mode of administration is SURGICAL ANAESTHETICS. 469 very important. When the patient is brought promptly under the influence without saturating the tissues throughout the body, the stage of excitement is less marked, the subsequent vomiting more frequently absent or milder, and recovery from the anaesthetic state is more rapid and less unpleasant. The relaxation of the vaso-constrictors and consequent accumulation of blood in the arterioles and capillaries of the system generally, renders the use of ether inadmissible in all cases of disease in any of the vital organs where there is dilatation of the blood-vessels and consequent con- gestion; but especially it is said to be fatal when albumen is present in the urine. The kidneys therefore should be carefully examined lor all organic diseases, and the urine should be tested, not only for albumen, but for all abnormal conditions; and if even slightly diseased, chloroform should be given instead of ether. An impartial study of the above facts will show- that there has been but one allegation against chloroform: viz.. that it su Idenly and without warning causes death, and that in consequence of this disability the rate of mor- tality is much larger than that of ether: that it does its work so insidiously that the patient is dead before it is known that there is danger. The same may be said of ether, although not to the same extent. By reference to the preceding pages the reader will doubtless see that there is danger to life from the use of any anaesthetic, however carefully administered by even the most skillful hands. To the writer this subject has been one of deepest inter- est. The works of all the best writers and thinkers and most practical surgeons of the present and past, as well as the faculty of the Physio-Medical College of Indiana, have been consulted and valuable suggestions received from all. The writer has added to this twenty-five years of close personal observation of the use of anaesthetics, by the most skillful experts in this line, when given by them in the cases upon whom operations were to be made. These cases furnish most convincing proof that although there was not one death in them all, yet in several instances a fatal termination was only averted by the most timely and skillful treatment. The same experience also furnishes proofs that ether and chloroform are both effective anaes- thetics; that they both produce death in a greater or less 470 SURGICAL ANAESTHETICS. number of cases; that the cause of death may be the same, but that their mode of action may be entirely different. Ether relaxes the vaso-constrictors and allows the blood to accumulate in the arterioles and capillaries, thus causing the blood to be retained in the body longer than natural. This sluggish state of the circulation hinders the normal interchange, in the lungs, of morbific material for oxygen, and the blood assumes a venous appearance. Death may now occur in either of two ways: first, by this dark and impure blood, which is loaded with material which has been rendered useless in the tissues, and which becomes injurious when retained too long in the system, also absence of oxygen and nutritive material in the blood that circulates in the nerve centres which control the action of the heart. Deprive these centres of their proper stimulus and they cease to influence the heart action, and the organ ceases to move. A second mode of death may be caused by this same kind of impure blood passing through the heart. The proper stimulus to heart action when applied di ect to the heart is a proper quantity and quality of blood; without this the heart action becomes feeble and may cease eniirely. Plethoric people have dilated vessels, most frequently in the brain and its mem- branes. To administer an agent that has the property to dilate these vessels still farther is bad practice, and may result in death by one or the other mode as above de- scribed. The same may prove true if the lungs or kidneys are already in a state of engorgement. Chloroform con- tracts the vaso-dilators, narrows the calibre of the arteri- oles and capillaries and force-: the blood internally upon the large arteries and heart. This contractile power may be sufficient to bring on a tonic spasm, which forces so much blood into the heart that it \< unable to keep up its movements. It cea-es to act suddenly and death is the result. Thi^ philosophy, if correct furnishes a separate field for each remedy Should this be true, and the proper anaes- thetic employed, the death rate from anaesthetics might be reduced to a very meagre per cent.; then if the other avoidable accidental causes be prevented, d.eath would be the exception and success the rule. This style of argu. ment wouid seem to make the ana^stheric responsible for every death: and so it would be if the judgment was infal- lible and the accidents all avoidable. Such is not the case, SURGICAL ANAESTHETICS. 471 however. It is not possible for the surgeon or the anaes- thetist to judge correctly as to the kind of anaesthetic suitable to each case, neither are the accidents entirely unavoidable. A proper knowledge of the properties of the agent used, a prevention of all the preventable causes, a judicial regulation of the quantity, and a proper attention to all other circumstances is all that can be expected. If the surgeon and anaesthetist realize the great responsibil- ity of their position when they are trusted with a human life, they will be inexcusable if they neglect to prepare themselves, and fail to take advantage of every measure to prevent any accident. It has been a question raised by able men on both sides, whether the use of chloroform has increased or diminished the mortality. It was found that the mortality in some hospitals was greater after the introduction of anaesthet- ics than before. A solution was found in the history of the cases. When the properties of ether and chloroform were published, they became the object of great abuse. The fear of suffering pain being removed, encouraged pa- tients to desire operations that were entirely improper at that time. Surgeons also became bold in their conception of what might be done, and undertook operations for which they were not well qualified. This tilled the hospi- tals to overflowing. More patients were crowded into the wards than they were adequate to contain. Aseptic sur- gery was then only a dream; antiseptsis was thought little of. Sanitary science was not born. It was not a wonder that patients died— not because of the anaesthetic, but because of the inexperience of the surgeons in making operations of so severe a character, and with such bad san- itary surroundings. Then too the use of the agents was not so well understood; surgeons had to learn much of their potency, and the accidents bo which patients were liable. Mark the wonderful success in brain surgery, in abdominal and pelvic operations, and then ask where is the surgeon that would have the temerity to undertake these operations without an anaesthetic; and where is the patient that would brave the knife and submit to any such operations? And even in general surgery, the writhings and cries of the patients were more than humanity could withstand, and few men were willing to undertake to ope- rate under such circumstances. Then for a patient to be conscious and witness the keen, scathing, lancinating pain 472 SURGICAL ANESTHETICS. of the glittering knife and endure the terrible grating of the saw, or the seething, crisping and scorching effect of the cautery, would be more than ordinary human minds can endure. It is doubtless true that a few patients have succumbed to the influence of the anaesthetic and the ope- ration, but they were patients that could have survived but a short time at the longest. Contrast these with those cases where patients have remained for hours under the influence of an anaesthetic to enable the surgeon to maktt long and tedious dissections; which once accomplished, a human being was saved from impending death. Much of success depends on care in the administration of the agent. In the hands of skillful men the death rate has fallen very low. Prof. Samuel D. Gross gave chloroform in four thousand cases without a single death. Of five thousand cases anaesthetized by Prof. Syme there was not even a serious occurrence. Prof. Nussbaum never lost a patient in ten thousand cases. Here are eighteen thousand cases anaesthetized without one death. It has been said that Simpson lost only one case in all his large experience. It is but due to those illustrious men to say that this success was the result of their skill and <-are. They took every precaution, and saw that nothing was left undone that might add to the safety of their patients. In view of the fact that anaesthetics were suddenly and universally adopted by ail practitioners, who. especially outside the hospitals and large cities, were without experience in their use, and with limited means for meeting accidents, the death rate is exceedingly low. I)r Gross says: 'I ascribe my own good luck in the use of chloroform to the extraor- dinary care with which it has been administered in my practice, and to the puritv of the article selected." The Advantages of CMoroform and Ether. — Anges- thetics not only prevent pain and suffering, but place the patient in a passive state while the surgeon makes his operation, or pursues his other manual processes as delib- erately as if he were operating on the dead body. By its use all the cavities of the body can be explored. Under its influence the anus, rectum, vagina, uterus, urethra and bladder may be painlessly explored. The contents of the abdomen can be more certu inly examined while the abdominal muscles are relaxed under its influence. Deep sinuses leading to abscess cavities and diseased bones, can SURGICAL ANESTHETICS. 473 be readily examined by the probe, or other explorative measures. The exact condition of fractured bones and dislocated joints can be ascertained and the surgeon will be inexcusable if he neglects so important a means of diagno- sis in all cases of doubtful character. Delicate operations upon the generative organs of female children and young misses without them being conscious of it, and thus save them the mortification of a personal knowledge of all the procedures. Parity of the Air.— The presence of a normal propor- tion of all the elements of the air, as well as its freedom from foreign substances, has much to do with the success or failure of anaesthetics. No excess of carbonic acid gas and other deleterious agents, when present at a time when the proportion of oxygen that should enter the lungs at each inspiration is about to be lessened by the addition of the anaesthetic vapor. An average sized man will give off about six-tenths of a cubic foot of carbon dioxide and from one to one and a-half ounces of water, which is charged with the products of wear of the body. These exhalations are exceedingly offensive to the olfactories and also depress the vital activities of the patient, who al- ready has a surplus of such agents consequent upon the use of the anaesthetic. Particular attention should always be given to selecting a room of proper size, also to the methods of ventilation Parks and DeChamnout give ".(i per 1000 volumes of total carbonic acid gas in the air as the limit of impurity allowable. Of this about .2 is derived from respiration and the remainder is the normal quantity present in the atmosphere. In order to maintain the air at this stand- ard, an ordinary man requires to be supplied with three thousand cubic feet per hour." This is the minimum quantity, and it is unwise to accept this if more can be obtained. From four to five thousand feet should be secured if possible. Arrangements for this amount to be changed at least four times per hour should be made. This is the maximum number of times that the air can be changed without creating undesirable currents in the room. To secure this amount of air. the room should be eighteen by twenty feet, with the ceiling twelve feet high, which is about the maximum size of rooms in private dwellings. This space, however, may be increased to twice this size by opening the doors to adjoining rooms. 474 SURGICAL ANAESTHETICS. Attention to ventilation must also be given. So many factors enter into this subject that it is difficult to give any definite rules. First, the height of the column of air —or rather the height of the room; second, the difference between the temperature in the room and that on the out- side; third, the rate of velocity of the wind; and fourth, position of the inlet and outlet. If the inlet is on the side from which the wind is blowing it will enter the room more rapidly than if placed on the opposite side. The heating appliances have much to do with the ventilation. Grates are the best ventilators; then come consecutively stoves, heated air from furnaces, and last and poorest, steam heat. All these circumstances must enter into account when arranging the ventilation of a room for anaesthesia. A basis from which calculation may be made is as follows: Take an opening of twenty-four square inches for each indi\idual, or six inches by four; if there are six persons to be in the room, then there should be six such openings. These would aggregate one hundred and twenty-four square inches, which would not give an equal temperature in the room. In private practice the open- ings or inlets can be arranged by letting the top sash down, and the exact amount estimated in inches or square feet. The windows have the advantage of being lowered or raised according as the amount of fresh air'is needed. The operating table should be placed in the room so that a current of cool air can be let in on the patient at any mo- ment should there be any signs of asphyxia. This can be done by placing the patient near a window that can be hoisted at a moment's warning. Are Chloroform and Ether Poisons?— In the classifi- cation of material substances in relation to the human body, there has been great diversity of opinion. In ac- cordance with their inherent properties substances may be arranged in three general classes. First, such agents as are entirely harmless in their action upon the living ele- ments of the body. To the second class belong such agents as water, heat, electricity, a proper proportion of oxygen and nitrogen in the atmosphere, and I may venture to say ether and chloroform, as well as others possessing similar properties that may be found hereafter. These agents have a_double action. The human system is so consti- tuted that a certain degree or amount of them is absolute- ly necessary to health, and life itself may be dependent SURGICAL ANAESTHETICS. 475 upon their presence; and yet in quantities greater than is necessary to health they become detrimental in their ac- tion, and in still greater degrees or quantities, destructive to life. A third class of agents to which the term is ap- plicable, are always, under all circumstances, and in any quantity destructive to the living elements of the body. They produce somatic death by destroying such a propor- tion of the bioplasm as to interfere with, and even cause the vital functions, (circulations and respirations) to cease. The exact sphere and application of this word "poi&on ? ' has been a matter of dispute among medical men. It has been contended that there is poison in all sub- stances. A better knowledge of chemical laws, however, has shown that while the elements necessary for the for- mation of poisons may be found in almost any article of diet, as well as the human body itself; the organic struc- ture must be broken up and the atoms allowed to arrange themselves in new and different proportions to form new compounds. Thus, sodium and chlorine may be united in such atomic relations that sodium chloride (common salt) is formed. This new substance possesses entirely different physical properties and exerts a different influence on the body. The two elements before their combination are destructive agents, while the compound resulting from their union is not only harmless in iLs action upon the body; but actually is conducive to the highest degree of health. The most wholesome foods may be partially de- composed either before or after they enter the stomach and the resulting compounds be virulent poisons, capable of impairing health and destroying life. A mixture of the proper proportion of oxygen and nitrogen is essential to health. Any deviation from this gives to the mixture new properties which are injurious. In like manner the vapor of chloroform possesses properties differing from those of the liquid. Persons may be kept under its influ- ence for hours and if no operation or other procedure is undertaken that will shock the system, or disturb the cir- culation, the patient will awake as if from a natural sleep, and feel as well as usual. If the vapor of chloroform is destructive to the elementary substances of the body, the person would surely awake with some feeling of malaise. Various other forces or influences to which the human body is subject, may be deleterious, or beneficial according to circumstances. Light is essential to health and possi- 476 SURGICAL ANAESTHETICS. bly to life at times. The force of gravity holds all matter in proper relation, and all the movements of matter in the universe are divided so that harmony prevails. When the equilibrium of this force is disturbed by bodies being thrown out of their relation to the earth which causes them to be unsupported, they fall to the ground. If a man falls from a building which is fifty feet high and is killed, it cannot be said that he died from the effects of poison. j^If an engine runs over, crushes the limbs of a man it cannot be said that the engine is a poisonous agent. The word must have some definite application, and must have some special sphere of action. The following defini- tions are perhaps the most concise, and more nearly ex- press the true relation of that class of agents that are tru- ly poisonous. This is from Quain's Dictionary of Medicine: "There is no legal definition of the word poison, and the definitions usually proposed are apt to include too much or too little. Generally a poison may be defined as a substance having an inherent deleterious property which renders it capable of destroying life by whatever avenue it is taken into the system " The leading thoughts in this definition are two only; first, the 'inherent deleterious property,'' and sec- ond, that the poison must enter the system. There are only two avenues proper by whiah the poison can enter the circulation, and reach its ultimate destination; viz., ab- sorption from the pulmonary, alimentary, or the cutaneous surfaces. Nearly but not quite all the poisons are taken into the stomach in such quantities as will produce death if absorbed. The second avenue is byJesion of tissue, as by snake bite, stings of insects, or by bringing the virus in contact with an abraded surface. Corrosive substances, such as mineral acids and other chemical agents, unless they possess some element that is capable of being ab- sorbed, cannot be classed as poisonous. The following definition proposed by Prof. George Hasty, is perhaps the most appropriate that has been given: "Poi- sons are substances having inherent properties of such a character that when^brought into contact with the living matter of the human body, destroy, or tend to destroy the same." The distinctive point in this is, that the poison must be brought in "contact with the living matter." This should be a final test of a poison; viz., that it destroys the living matter. This definition might be more explicit SURGICAL ANESTHETICS. 4 m by adding that it destroys, or tends to destroy, in infini- tesimal quantities. With these agents quantity does not alter quality. This word "poison" has been used in the language of all nations from the earliest dawn of letters. The idea that there is a class of agents that uniformly possesses the power to kill when taken into the body was entertained by several of the sacred writers in a metaphor- ical sense. The Greeks made use of several words denotive of the poisonous action of some drugs and always in con- nection with the idea of taking them into the body. Thus they use the word (IiapixaxoKoaia (Pharmakoposia), the drinking of a medicine, potion, or of a poison; Qapixaxoizoren (Pharmakopoteo), to drink a medicinal potion or a poison. In the Latin language is found Potio, a drink, a draught, a potion: from Potare, to drink: Potion, a drink, a draught, especially a liquid medicine. The French use Empoisoner: the Spanish Pongonar, from the Latin Potionare, to give to drink. The following is from '-The Century Dictionary:" "Any substance which introduced into the living organism directly, tends to destroy the life or impair the health of the organism." The above is sufficient to show that all nations recognize a poison as a substance possessing inhe- rent properties capable of destroying living matter when introduced into the body. Do chloroform and ether belong to this class ? Do they uniformly kill or tend to kill when introduced into the living organism, and is it brought in contact with the living matter? The answer to this question is probably- one of the most difficult connected with the subject under consideration. That patients die while under its influence is unquestioned: but has it an inherent property to kill or tend to kill regardless of all circumstances? Common experience and clinical observa- tion has long since settled beyond a doubt the poisonous character of many substances: but it has only been within the last fifteen years that the power to kill living matter possessed by the agents has been demonstrated by subject- ing living matter (bioplasm) to their action- The micro- scope has shown that infinitesimal quantities destroy leucocytes. Ether and chloroform hav# not been tested in this way, but there is other evidence which points strongly to the conclusion that they are not poisonous. The prop- erties of opium and its alkaloids have been known to the profession for over two thousand years. Its power to 478 SURGICAL ANESTHETICS. relieve pain has been recognized and tested in all its phases, and while a small dose can be given and stupor produced, yet when well marked the patient shows delete- rious results. Complete insensibility cannot be produced without giving enough to cause death. Its effect has been tried in surgical operations and failed. In cases of death from what is called an overdose there will be found a fluid state of the blood, the brain is crowded with dark blood, on the surface there will be ecchymosis produced by effu- sion; when the brain is cut there will be bloody points on the curt surface. In a ca»e of death from cyanide of potas- sium bloody points were observed in the brain and spinal marrow. In a case of death from the essential oil of bitter almonds there was general effusion of blood on the brain. In death'from alcohol the stomach has been found intense- ly congested, the mucous membrane presenting in some cases a bright red in others a dark brown color. In death from an overdose of nicotine there was effusion of dark colored blood in the course of the veins of the neck. The membranes of the brain were tilled with dark colored blood. In cases of death from strychnia there is a fluid state of the blood and congestion of the brain and upper part of the spinal cord. In a case of death from canium maculatum (hemlock) the lungs were gorged with dark fluid blood, and there were numerous bloody points. The above are extracts from Taylor's "Medical Jurispru- dence." By reference to "The United States Dispensato- ry, " "The National Dispensatory" and Shoemaker's "Materia Medica," it will be seen that there is nothing that contradicts Taylor's statements. He describes these cases as individual cases upon whom he made autopsies and saw for himself. He also describes graphically the symptoms present in cases of death from the vapor of chlo- roform, but says nothing about the appearances after death Is it likely that a man in his high position would so minutely describe the post mortem appearances in all other cases and neglect to do so in this one instance? If he made the examination and found lesions would he not have* reported them the same as others? May the same not be said of such works as named above, if they had found lesions as in death from other poisons? So far as I know only two observers have found real lesions of tissue after death from chloroform. Tillman quotes Winogradow as saying "that he found granular degeneration of the SURGICAL ANAESTHETICS. 479 cells of the brain, spinal cord and ganglia of the heart, both in men and animals." The following is from "Reese on Toxicology," page 361: 4 In death from inhalation (of chloroform) there is very often no lesion discoverable. At times there will be found a considerable congestion of the lungs and bronchial tubes and likewise of the vessels of the brain, together with a dark and fluid condition of the blood." First as to the statement of Winogradow, it is too gen- eral to go iuto an accurate clinical report. He should have named the specific cases in which he found those postmortem appearances, and stated all the circumstances connected with the administration of the agent, whether the subjects were in good health, etc. He should also have stated the precise points where he found the lesion, as it is not probable that the whole or even a considerable part of any of the organs named were thus destroyed. Until some such accurate report shall be made it cannot be con- clusively stated that the anaesthetic vapor caused death in that way. The second author, Reese, makes the same mistake by not being specific in his descriptions. He also admits that "very often no lesion is discoverable." If lesion is absent in some and present in others, then there must have been some different conditions which he should have discovered and described. That difference might have caused the lesions. The latest work that the writer has consulted is '"Chap- man on Toxicology," 18^5. Referring to the cause of death from chloroform vapor he says: "The postmortem appear- ances presented in cases of chloroform poisoning are those of death by asphyxia." (Page 229.) The following is from "Garretson's Oral Surgery" (page 436): •'Etherization ex- hibits to us the entire mechanism of asphyxia: we mean the successive deaths of the various nervous centres. It isolates, just as mechanical experiments do, the intellect- ual powers, the co-ordination of movements, sensibility, motility, life." "The autopsy in case of death from chloroform generally reveals little that is characteristic, and often gives no sat- isfactory explanation of the cause of death. Not infre- quently the above mentioned pathological changes in the organs are present and are more or less correctly consid- ered to be responsible for the accident- The blood is 480 SURGICAL ANAESTHETICS. ordinarily uncoagulated and dark colored, but microscopic or chemical examination of it has hitherto given no satis- factory explanation for death. It is worth noting, how- ever, that as a result of the disturbance of respiration, the blood is over-loaded with carbonic acid." (See "Principles of Surgery and Surgical Pathology,*' Tillman, page 31. ) The changes referred to above are "Fatty degeneration- of the muscles of the heart, valvular lesions and degenera- tion of the walls of the vessels. The autopsies of the victims of anaesthesi a present nothing positive or charac- teristic. In such cases death is the consequence of dis- turbance of the nervous apparatus concerned in the act either of respiration or circulation. The changes which have produced the result are intra-molecular and are con- sequently beyond the reach of our senses " ("International Surgery," Vol. 1, page 424.) By the same author (page 411): "Keeping in mind the fact that the effect of anaes- thetic substances is temporary, it seems more probable that they operate by inhibition of those chemical processes which are associated with the liberation and diffusion of motion throughout the system. Among the protoplasmic- molecules the substance acts the part of a screen, like a cloud between the sun and the earth; hindering the ener- gies of one from acting upon the susceptible matter of the other." Anaesthetics are never given to human beings while in health. There is in all cases some lesion of tissue or other abnormal state for which an operation is to be made. These deviations from health may have caused the changes of tissue that they found after death. As above shown by eminent writers the only conditions uniformly found alter death were those resembling as- phyxia. It only then remains to learn what is asphyxia. The following from Webster: "Apparent death or sus- pended animation particularly from suffocation or drown- ing or the inhalation of irrepressible gases, recently applied also to the collapse state of cholera with want of pulse." Foster's Dictionary: "As now used a state of suspended animation caused by impeded respiration, as by strangulation, smothering, submersion or the inhalation of an irrepressible gas." The above quotations are from men of ability and authority. The definitions are from the pen of the best philologists of the age, and seem to make it clear that death from anaesthetics is caused by asphyxia. In order to determine the difference between SURGICAL ANAESTHETICS. 481 death by asphyxia and that produced by other causes, it will be necessary to point out the changes that take place in the tissues of the body. What takes place in asphyxia ? Oxygen is admitted to be indispensable to life by all physiologists. As above shown, strangulation, smother- ing, submersion or the inhalation of irrepressible gases, prevent the ingress of air and consequently oxygen being one of its constituents, is excluded. The point is made equally clear that the products of wear are, to a. large ex- tent, eliminated from the system through the air as it passes in and out of the lungs, and life cannot be main- tained more than five minutes after these interchanges are completely arrested. The proper .stimulant to the heart's action is the presence of a proper quantity of blood as well as a natural quality can only be supplied by the processes of respiration and circulation. These two functions are dependent on a natural condition of the nerves controlling these functions. The changes in the blood are absence of oxygen and the presence in an excessive quantity of the products of wear. The carbon compounds are largely eliminated by the lungs. When this with the other ele- ments which should also be eliminated are retained and accumulate in an unnatural quantity and retained longer than natural, chemical changes take place in the presence of the blood and carbonic acid gas is evolved. This ac- counts for the presence of gas in the blood that has been found by some authors and thought to be the cause of death; but this has been disproved by other writers who have found gas in the blood when death had taken place from other well known causes. According to the definitions of poisons and other quota- tions as given above, anaesthetics (chloroform and ether) do not belong in the category of poisons, since it has been shown that a poison possesses inherent properties capable of destroying or tending to destroy life by producing de- struction of tissues or living matter of the body. The inherent properties are as inseparable from these sub- stances as the attractive properties of the magnet, and cannot be changed without destruction of the form of matter in which it resides. So long as there is a molecule or an atom unchanged in its structure and relations the inherent property is present; and this property is exerted in proportion to its volume or magnitude. It follows from this that a poison when once in the system is as uncon- 482 SURGICAL ANAESTHETICS. trollable as the cannon ball as it escapes from the mouth of the cannon and speeds on its way, producing destruc- tion wherever it comes in contact with other matter. This marks the line indelibly between poisons an'cl that large class of agents whose effect on matter depends on quantity, or are of such a nature that their effect may be prevented, or so modified as to render them capable of ac- complishing great good when the law governing them is obeyed, or equally as destructive when the laws are disre- garded. Heat, light, electricity, and chemical affluity have long been known to possess such properties; chloro- form and ether belong to the same class, but have not been so recognized. How Do Chloroform and Ether Act ?— Rest is an in- herent necessity. This proposition is stamped upon all nature. The Creator of the universe, after laboring six days rested upon the seventh, and left the inexorable law stamped upon every molecule of living matter. This means a cessation from action and a period of time when the proper avenues of communication with all external objects is for the time severed. The vegetable world has its period of budding, growing, blooming, and maturing of its fruit, then comes a period of repose. Whether this tendency to repose is inherent or determined by surround- ing conditions is not certain; perhaps both are contributing factors. That surrounding conditions do modify the peri- od of repose is abundantly established by gardeners and horticulturists. The gardener can take the seed that matures in early summer, plant it and bring two crops the same season, or he may keep the seed for years by supply- ing proper surrounding conditions The horticulturist can convert a biennial into an annual shrub and an annual into an evergreen by supplying necessary conditions to lengthen or shorten this period of repo-e. A\\ animal life has its period of rest during which the sensibilities are arrested and motion ceases. It has been thought that the heart never rests; but works on physi- ology show that it has its period of repose and recupera- tion. "Taking a cardiac cycle as a unit and seventy-two as the average number of cardiac evolutions per minute, each evolution may be considered to occupy five-sixths of a second, or about eight-tenths, which may be approxi- mated distributed in the following wav: SURGICAL ANESTHETICS. 488 Auricular systole, about .1 plus auricular diastole .7=.8 Ventricular systole about .3 plus ventricular diastole .5=. 8 Period of joint auricular and ventricular diastole. 4 plus period of systole of auricles and ventricles .4=. 8 If the speed of the heart be quickened, the time occu- pied by each cardiac revolution is of course diminished, but the diminution affects only the diastole and pause. The systole of the ventricles occupies very much the same time, whatever the pulse rate." ("Kirke's Physiology, page 186.) By the above we see that the systole and dia- stole are equal and that the heart rests during the period of diastole, thus proving that the heart rests one-half of the time. A materia medica that is perfect in all its departments must have remedies that will imitate in their action every function of the body. This has to a great extent been supplied. Cathartics imitate the natural movements of the bowels; diuretics increase the secretion of urine; and stimulants promote Lhe circulation. Rest is one of the natural functions of the body and sleep promotes rest. In this condition the sensibilities are suspended to a large degree, but not entirely, as powerful impressions will arouse the body to activity. There are conditions of the body and states of the mind in which the sensibilities are so completely held in abeyance that surgical operations can be made without causing any sensation of pain, and that too without drugs. From an early date there have been persons who have been so constituted that their co- ordinating aud connecting powers have been susceptible of certain influences. They may remain clear in their intellectual functions and yet their sentient apparatus be so changed in its relation as to enable them to look calmly on an operation upon their bodies and not experience a sense of pain. In others the intelligence is so disturbed that they are wholly unconscious. This condition has been brought about by certain influences bearing on a sus- ceptible mind. It was this influence that Mesmer exerted on his subjects, and it is the same influence that people call hypnotism at the present time. Chloroform has the same property. In "Therapeutics, its Principles and Practice," by H. C Wood (page 140), is the following : "Dr. Coleman ('Sansom Chloroform.' page 55, Philadelphia, 1866) states that he has extracted his own teeth without pain; and Dr. Snow 484 SURGICAL ANESTHETICS. relates the anecdote of a child who played with his toys during the operation of lithotomy." The writer had occasion to remove the left half of the inferior maxillary bone for sarcoma in which the horizon- tal portion from the symphysia to the junction with the ascending ramus was affected: but from that point to the articulation of the bone it was sound. It was thought best to remove the entire piece at the articulation. Prof. C. T. Bedford administered the chloroform and the disar- ticulation was begun. Ii was soon found that the anaes- thetic was not acting well; symptoms of disturbance of the heart action as well as respiration were observed, and inhalation was discontinued; but the operator continued his work. It was Prof. Bedford's intention to resume the inhalation as soon as it seemed advisable; but the patient soon awoke and did not complain of pain. The further use of chloroform was not required. The operation was completed, the patient all the time talking, but did not complain of any pain until the stitches were being placed, when he said he felt the needle passing through the skin, but said the pain was not great. The writer was also present where a surgeon was operat- ing for lacerated os uteri. The dissections were completed and the sutures inserted after the patient became con- scious and began talking. No more of the anaesthetic was given (which was the usual A. C. E. mixture) and the ope- ration completed without pain. The following case recorded in the "Journal of a Natu- ralist" affords a remarkable instance of this general fact. The correctness of the statement having been called in question, it was fully confirmed by Mr. Richard Smith, the late Senior Surgeon of the Bristol Infirmary, under whose care the sufferer had been. "A traveling man, one winter's evening, laid himself down upon the platform of a lime-kiln, placing his feet, probably benumbed with cold, upon the heap of stones, newly put on to burn through the night. Sleep overcame him in this situation; the fire gradually rising and increasing, until it ignited the stones upon which his feet were placed. Lulled by the warmth, the man slept on; the tire increased until it burned one foot (which probably was extended over a vent-hole) and part of the leg above the ankle entirely off; consuming that part so effectually that a cinder-like fragment was alone remaining— and still the wretch slept on'.— and in SURGICAL ANAESTHETICS. 485 this state was found by the kiln-man in the morning. In- sensible to any pain, and ignorant of his misfortune, he attempted to rise and pursue his journey; but missing his shoe, requested to have it found; and when he was raised, putting his burnt limb to the ground to support his body, the extremity of his leg-bone— the tibia— crumbled into fragments, having been calcined into lime. Still he ex- pressed no sense of pain, and probably experienced none: from the gradual operation of the fire, and his own torpid- ity during the hours his foot was consuming. This poor drover survived his misfortunes in the hospital about a fortnight; but the fire having extended to other parts of his body, recovery was hopeless.'' ("Carpenter's Human Philosophy, " page 549.) In the case of insidious shock the body may be horribly mutilated, either by mechanical injuries or by burns or scalds, and the patient will be conscious and suffer no pain while life lasts. These cases are related to show that the sentient part of the nervous system may be so influenced by circumstances that exert no evil influences on the living matter of the centres of circulation and respiration, and yet the func- tion of this part of the nervous system will be entirely abated for the time being. An instance has been cited where chloroform vapor ar- rested fermentation without destroying the vitality of the ferment or disarranging the organic matter; as evidenced by its resumption of activity as soon as the anaesthetic is removed. The sensitive plant was also anaesthetized and awoke and resumed active growth as soon as pure air was substituted. In the same manner the human body can be subjected to the action of those agents and in a very short time awake and resume all the functions as regularly as before. Just what action they exert or what changes are effected it is at present impossible to tell. Henry M. Ly- man, A. M., M. D., as above quoted from the "Interna- tional Surgery," says: "Among the protoplasmic mole- cules, the substance acts the part of a screen, like a cloud between the sun and the earth, hindering the energies of one from acting upon the susceptible matter of the other.'" In experimenting with numerous substances upon living matter, Prof. Jacob Redding found that there are agents which when brought in contact with living matter, would cause it to relax, spread out and remain motionless as long 486 SURGICAL ANAESTHETICS. as the drug continued in contact with it; but eventually it would resume activities. Another class of agents would cause the bioplast to assume the sperical form; these bio- plasts would never resume work, and after some hours would disintegrate and disappear from the field of the microscope. Might not this work the changes that take place in relaxation and paralysis ? It might be urged against this theory that small doses of any narcotic may exert its legitimate effects and then the patient recover, as it is well known that patients re- cover from the effects of small doses of many poisons, just as they do from small doses of chloroform vapor; and also die from large doses of either. It has been very forcibly shown above that the vapor of chloroform or ether does not destroy living matter, but that poisons positively do. The difference in the mode of death is the only point that is of sufficient importance to discuss. Water is not consid- ered a poison by any one, and yet if its laws are transcend- ed death follows as certainly and promptly as it does from any poison. The body may be immersed in water for an indefinite time, provided the mouth and nose are not sub- merged; but let these points be covered, the water enters the lungs, excludes the air and respiration ceases. This is purely a mechanical interference with a vital function and one that is preventable. Water is perfectly harmless and conducive to health as long as its laws are obeyed. So we think with the anaesthetics; they are safe while they are kept in their proper sphere of action. Life then depends on the skill and knowledge ol the anaesthetist and on the agent used. The only question then is, how near can these laws be obeyed ? Occasionally it will be impossible to foresee and provide against acci- dental violations of these laws, just as it is in all mechan- ical pursuits. Sometimes a death will occur and no one could avoid it; but we. believe if those laws were better known and greater care exercised, there would be very few deaths— very many less than at this time. This we think cannot be said of any poisonous agent. Whenever any poisonous agent is introduced into the body and comes in contact with the living matter, no amount of skill can prevent its legitimate effect. It either kills or tends to kill, in proportion to the number of molecules of the po - son present to those of the living matter. This mav be illustrated by using sir William Thomson's SURGICAL ANAESTHETICS. 487 hypothesis. He has reached a quassi-definite conclusion •is follows: ' If a drop of water were magnified, to the size of the earth, the molecules or granules would each occupy spaces greater than those filled by small shot and smaller than those occupied by cricket balls " We cannot even in our imagination enumerate the molecules that, according To this hypothesis, would be found in the blood of a man. Let us suppose now that one grain of morphia could be compressed into a bulk the size of one drop of water and compute the proportion that would ; exist between the morphia and the whole amount of blood in the body. It would not seem possible for this amount of morphia to be brought in contact with any large proportion of the blood; but it would kill all the molecules that it could reach, and if it reached a sufficient number so that the debras should be so great that its presence would obstruct the circula- tion of the blood, death would follow; or if a few molecules should reach the vital spot in the medula oblongata and destroy the centres for circulation and respiration, only a fe^v molecules would be necessary to produce death. This is the reason why a very small amount of some poisons will kill one patient, and will fail, apparently, to injure some other. Although the injury is not apparent at the time, yet it is a destruction of some of the physical organization, and a diminution of the vital properties of the body. This calls for the expenditure of some vital effort that lessens the resistive and recuperative powers, and in the end shortens life, or cripples usefulness, just in the same way that a man spends his fortune before he dies. " If he has ten thousand dollars and should live ten years. The first year he draws out fifteen hundred dollars and hopes the other eight thousand and five hundred dol- lars will bring him interest enough to keep up his deposits to the original amount; as a fact it will not do it. At the end of the first year, if the interest is six per cent., he will have as a principal $9010.00; at the end of the second year his principal would be $7960.60; at the end of the eighth year he would have in bank $201.50. Thus it is with the man who habitually or even occasionally takes poison in small doses. He does not die after the first, second or even the one hundredth dose; but slowly and impercepti- bly, like the man drawing his money from the bank, he is exhausting his reserve powers, and when in old age he is attacked with sickness, he finds his reserve exhausted 488 SURGICAL ANESTHETICS. and he must die several years before his allotted time. The critic will ask: "Chloroform and ether not being poisons, how do they kill ?" The answer is, by inhibition. The anaesthetic restrains bioplasm in the cells in the medula oblong ita, acting the same as it does on the proto- plasm in the cells of the sensitive plant at the base of the petioles. It is a law of the animal economy, especially of man, that if circulation and respiration are prevented for the space of five minutes, death follows as a result. If the anaesthetic reaches the vital spot in the medula oblongata and thus inhibits circulation for the time above men- tioned, the man dies by asphyxia. Accidents attending the use of anaesthetics. One of the most common accidents to which patients are exposed is obstruction to respiration caused by the tongue falling back over the glottis They are exposed to this on account of the position on the back. When the tongue and fauces are relaxed, the force of gravity carries the base of the organ directly over the glottis. The air ceases to enter the lungs, the heaving of the chest deceives the anaesthet- ist, and the continuation of the pulsation at the wrist con- firms the deception. Suddenly the pulse stops, and when death occurs it is attributed to paralysis of the heart. It was the custom of Mr. Syme to disregard the pulse in order that more attention could be directed to the respiration. Mr. Lister also agrees with Mr. Syme and states that the respiration is of more importance than the heart-action. This may be true, but it is the experience of the writer that it is safer to entrust the respiration and circulation to c ne man and leave the anaethetist to his duties, having only a casual oversight of these vital functions. The premonitory symptoms of this accident are stertor- ous breathing and vascular disturbances. The former may be caused either by relaxation or spasm of the muscles of the fauces. This latter condition is described by Erich- sen more fully than by any other author, as far as my knowledge extends. He says on the authority of Mr. Lis- ter, that the spasm is at the upper opening of the larynx. The folds of mucus membrane, above the apices of the ary- tenoid cartilages are carried forward till they are in contact with the base of the epiglottis which remains erect, and unchanged in position. The laryngeal stridor that charac- terizes this condition, is of a peculiar character: and re- quires to be heard only once to be recognized ever after. SURGICAL ANAESTHETICS. 489 There is a peculiar effort to breathe and the muscles of the neck and larynx are in a state of rigidity. The respiratory effort is convulsive and the sound is stridulous. This con- trasts sharply with the slow, heavy breathing and dull, low pitched stertor of the premonitory stage that preceeds the closure of the glottis in the first condition mentioned. These two conditions are dangerous in the extreme sense of the word. It shows that the vital spot in the medula is being approached. An instant more and the patient may cease to breathe and death takes place either by syncope or asphyxia. It is not possible to tell in every case which may be the urgent condition. The anaesthetic must be re- moved from the face at once: all operative proceed ures ■should cease, and the patient be allowed to inhale fresh air. If death by syncope threatens the patient, lowering of the head will favor the return of the blood to the brain. The mouth should be pressed open and the tongue seized with a pair of forceps and drawn well forward. If there is spasm of the laryngeal muscles, respiration will be estab- lished by reflex action. If respiration is hindered by the tongue falling back, the patient will breathe as soon as there is a free entrance and exit for the air. Should the case be one of asphyxia, and life seems extinct, there may still be hope of recovery. The respiration often stops sev- eral minutes before the heart ceases to act. Artificial res- piration should be instituted: before leaving this part of the subject, I wish to call attention to the manner of draw- ing the tongue forward. It is necessary to do this, and at the same time see that the larynx and fauces are free. To this end it is well for the anaesthetist, who is supposed to be standing at the patient's head, to grasp the jaws with both his hands and carry them forward, being careful to keep the head in line with the body. This insures a free entrance and exit for air. Artificial respiration is often performed in an irregular and bunglesome manner. It is not uncommon to see some one give the patient a punch in the stomach, and I think 1 have seen very unpleasant results from this rude hand- ling. The patient is likely to be very sore for several days. and sometimes will suffer acute pain in the epigastric region, accompanied with nausea and vomiting. It is very dangerous to handle patients roughly. The utmost care should be taken in all manipulations lest a sudden move- ment should stop the heart action and cause death. 490 SURGICAL ANAESTHETICS. To produce insensibility from the use of ether, it is often necessary to exclude nearly if not all the air. Under such circumstances the patient may die from asphyxia, but the heart continues to beat for a short time after all motion of the chest ceases. This is caused by the devitalized blood filling the capillaries of the lungs, thus excluding whatever small amount of oxygen may have entered with the ether. This condition may first be noticed by a change in the color of the face, especially the lips, which will be livid. Shallow respiration will also mark the on- set. Small flickering pulse and dilated pupils, accompa- nied with convulsive movements of the muscles and dis- tended veins in the neck, may also be present as immediate forerunners of the fatal result. The same treatment as instituted for the foregoing accidents will be proper. Dashing cold water in the face, or pouring it from a height on the chest or abdomen has been found of benefit. Forci- bly dilating the spinster muscle with a Pratt's speculum has been attended with good results. Inserting ice in the rectum has been recommended and favorably spoken of, Persons having fatty degeneration of the heart, or a gen- erally soft and flabby muscular system, with a feeble action of the heart and dilatation of the ventricles, are likely to die suddenly if chloroform is used. Ether is safer in such cases than chloroform. It has been shown that nearly one-half the deaths from ether and chloroform have taken place before full anaes- thesia has been produced. Some anaesthetists have taken extreme ground on the subject of rapidly or slowly bringing patients under its influence. Those on the side of rapidly giving full quanti- ties at once, instruct the patient to take full and rapid breaths. In this case the blood becomes over-charged with the anaesthetic and is carried to the lungs in large quantities, and goes directly to the left side of the heart; a powerful local impression is made on the ganglia of the heart; a portion of this blood goes surcharged to the brain and there makes another powerful impression almost be- fore the general system feels it at all. Under these circum- stances the heart may cease to act, or acts feebly; the color of the face becomes pale; the pupils dilate; the respiration is convulsive; and life, if it does not become extinct, is only saved by the most timely and energetic action. If ether is given, the heart beats violently at first, the SURGICAL ANAESTHETICS. 491 blood fills the capillaries of the skin and gives it a dusky or purple hue. The brain is crowded with this dark blood. the vessels are engorged, unconsciousness supervenes and death by coma may take place in from two to ten days. A great amount has been written by some surgeons about death taking place by reflex action in the early stages of anaesthesia. It is difficult for me to understand how an impression of a so-called paralyzing character could make such a profound impression on a distant organ as to cause it to cease to act. I believe that most, if not all the deaths reported to have been caused by reflex action, were in fact caused by suddenly overwhelming the heart as above described. The same accident may occur where from some cause the anaesthetic has been removed. The air in the lungs being charged with it already, to resume the anaesthetic in full draughts may over-charge the blood and stop respiration or circulation as above mentioned. Antesthetic Compounds.— The dangers attending the use of the agents when given singly have induced surgeons to try various methods of compounding them, hoping to modify their deleterious action without impairing their desirable qualities. This effort has met with some opposi- tion. Mr. Snow discards their use and says that a combi- nation of their objectionable qualities is obtained without a full influence of the beneficial. However, the use of any combination has never supplanted either of the great anaesthetics. A compound is like any similar substance — it may possess some properties of each of the elements entering into its composition, but those properties are as inflexible as those of the elementary substances. Its range of influence may be different, but just as limited. The only scientific rule for forming compounds is the therapeu- tic indications that call for the use of properties which cannot be found in any elementary substance. These de- mands are so varied that any compound may contain med- icines whose properties are not needed in the case at hand. It is bad practice to allow any agent to go into a compound whose action is not needed. If it is a poison, it will cer- tainly prove destructive; if it is not poisonous, it is an embarrassment to a system to eliminate it, as it attempts to, or does cast it out. Each compound represents one or many properties, in the same sense as does any single remedy which possesses inherent properties. The mixture which has been most thoroughly tested is 492 SURGICAL ANAESTHETICS. that consisting of three parts of ether and one of chloro- form, known as the "Vienna mixture'' and which is said to have been given in Vienna alone eight hundred times without a fatal accident. Bilroth adds to this now, one part absolute alcohol. Next to this is the alcohol-chloroform-ether mixture- - one part alcohol, two parts chloroform, and three parts ether, by measure. These mixtures were especially recom- mended by the "Chloroform Committee" as being as effect- ive as pure chloroform, and a safer agent when deep and prolonged anaesthesia is to be produced. Although this or any other mixture has been used by only a few surgeons, it is highly recommended by them, and is considered safer and just as effectual as either of the other agents when they are used alone. The action of anaesthetics is said to have been modified by the use of morphine, The usual method is to give from one-sixth to one-third of a grain at least twenty minutes before commencing the inhalation of chloroform. It is claimed that it lessens the stage of excitement and reduces the amount of chloroform to one-half the usual amount required. The vomiting is less frequent and the patient falls into a quiet sleep. However highly it may be recom- mended by a few surgeons, it has not been generally accepted by the profession. Tillman recommends it very highly for operations on the face, mouth, pharynx and nose, as the patient retains sufficient intelligence and power to control the muscles of the throat, thus enabling him to keep the blood cleared from the respiratory pas- sages. But he adds: "As objections to the combined morphine-chloroform narcosis, both Kacher and I have noticed that the morphine sleep following the operation has a bad influence upon breathing, and permits the inha- lation of foreign matter with a resulting aspiration-phe- nomena." The authors say that injections of chloral hydrate may be resorted to; that they have a close resem- blance to the morphine-chloroform narcosis. In "Moulin 's Surgery," by Hamilton, may be found the following: "An injection of morphia before the chloroform is given ena- bles anaesthesia to be produced much more rapidly and without struggling, but it very greatly increases the dan- ger of syncope." Keen, in his "American Text-Book of Surgery," says: "It has been suggested that hypodermic injection of one-sixth of a grain of morphia and one- SURGICAL ANESTHETICS. 493 hundred-and-twentieth of a grain of sulphate of atropia given before the inhalation has commenced, acts benefi- cially:" but he does not say that he has used it himself. Hi* statement of the fact would imply that he has not used it. With the testimony of its friends as to its doubt- ful efficacy, Physio-Medicalists will have no use for the agent. With the stimulants which are at the command of every Physio-Medicalist, reaction from the shock of the operation can be established, and with the nervines and relaxants in the stage of febrile movement, the patient's suffering will be assuaged and sleep procured without any of the risks that accompany the use of the morphia. In cases where from some cause the stomach is full of food or other accumulations when anaesthesia is begun, the presence of such material interferes with the free movement of the heart and respiration, and may result seriously if not disastrously. In the act of vomiting, some of the matter may fall into the larynx and cause fatal asphyxia. To avoid any accident from this cause, when the patient is about to vomit, he should be gently turned on the side, being supported by the hands in such a way that there will be free exit for the contents of the stom- ach. Should there be signs of asphyxia, the mouth should be forced open and the ringers carried boldly back of the fauces, for the purpose of exploring the parts, especially the rima glotidis, to see that nothing is resting upon it. If the substance is small, it will probably pass into the trachea. In this ca*e artificial respiration should be main- tained. Failing in this, the trachea maybe opened and respiration kept up in that way. Other substances may fall into the larynx. Artificial teeth, tobacco, and some- times the cork that has been used to keep the mouth open. Corks, or other small substances used for this purpose, should have a cord attached to them. Sudden death has frequently occurred when patients (either adults or chil- dren! have been struggling violently against the use of the anaesthetic. If the!y are conscious, the spasmodic res- piration may carry a large quantity of the vapor into the lungs as stated above: or if semi-unconscious, the air in the lungs being already well charged with the vapor, a deep inspiration such as occurs at times when the lungs are suddenly filled by one deep and prolonged effort, may carry sufficient vapor into the air cells to cause sudden death. The greatest care should be exercised at this time. 494 SUKGICAL ANESTHETICS. in order to prevent a sudden ingress of vapor. Vomiting frequently follows the use of the anaesthetic, and may be produced by three separate conditions, all of which are directly attributable to disturbances of the circulation caused by the shock of the operation. The reaction from the vascular disturbances in the abdominal viscera, caused by injury or operations, is attended with nausea and vom- iting, which can be promptly relieved by establishing a free and- full circulation in all parts of the body. In. a second class of cases, the vomiting is caused by an over- distension of the vessels of the brain. This makes pressure on the control centres which, under certain circumstances, influence the centres for vomiting. Vomiting may also be caused by enaemia of the brain, as this condition may be brought about by the use of chloroform, while the former condition is due to the action of ether. In either case there is vomiting, but it may be from opposite conditions. In the first case, the usual treatment employed by Physio-Medicalists in shock of injury will be proper. In the second and third classes, absolute quiet and rest must be maintained. The patient's room must be darkened and all visitors excluded, allowing no one in the room but the attendants. If the pulse is feeble and soft, and the tem- perature low, bottles of warm water should be placed at the feet, knees, and along the spine, when it can be done. Weak mustard plasters over the epigastrium and warm applications to the abdomen will often give relief. Hot water by the stomach, in teaspoonful doses, repeated every ten or fifteen minutes, often gives relief from the nausea and adds heat to the body. If the temporal arteries are full and strong, or the head hot, indicating hyperemia of the brain, bathing the head in three parts warm water and one part alcohol, and dampening the hair with the same. Leaving the head uncovered favors evaporation, and thus tends to reduce the temperature and restore tone to the venous system. Give but little food and medicine by the stomach; medicate and nourish by the rectum, should be the rule, to which there may be exceptions. If medicines are used by the stomach, they should be very mild. After hot water has been used a few hours, if the vomiting is not made worse by it, equal parts of hot milk and water may be allowed, in teaspoonful doses. If the stomach seems hot and there is great thirst, one teaspoon- ful of calcined magnesia in one-fourth of a glass of cold SURGICAL ANAESTHETICS. 495 water and given in teaspoonful doses every half hour, does well. Ten grains of oil of lobelia (prepared by trituration with sugar) may be given once every hour if there is a febrile movement. A weak infusion of mentha vir. or mentha pip. may also prove beneficiai; but there is noth- ing more deleterious than the use of active drugs given in large doses. Vomiting in the early stage of anaesthesia is caused by a profound influence being made on the nerve centres before the anaesthetic has had time to reach the more remote parts of the system. This need not cause alarm if the stomach is empty. As soon as the vomiting ceases, the agent can be cautiously applied again without any risk. In elderly people and epileptics, there may arise some cerebral disturbance, which can be treated on gen- eral principles as the same condition, when it arises in other cases. Hypostatic pneumonia may occur in old people several days after; but it is caused by the inability of the structures to rid themselves of the accumulated blood consequent upon the shock produced by the opera- tion, rather than the effect of the anaesthetic. The same condition may arise in any case whose vital structures are weakened. Fatal syncope may occur when a patient sud- denly rises from the table. No patient should be allowed to rise for at least one hour after consciousness has been restored. They should not be left alone— -not even for a moment. Austie tells of a case, in his own experience, that rose suddenly, while the attention of the nurse was called to something else, and fell back dead. Complete Anaesthesia — How to Detect It. — Different writers have mentioned and relied on different symptoms. One surgeon depends on what may be. called the arm test. In this 'test hold up the patient's forearm, and when it falls powerless by the side, the patient is thought to be completely anaesthetized. This test is not reliable, as a patient's mind may be obscured before anaesthesia is established. In such cases they are not sufficiently under the influence to be insensible to pain. Another surgeon tells us to separate the eyelids and if the pupil is contracted, and insensible to light, and touch- ing the eyeball with a probe gives no response, then the patient is ready for the knife. Dr. Snow, as quoted by Garretson, first called attention to the condition of th^ eyelashes, which he claims will be the last sensation to 496 SURGICAL ANAESTHETICS. yield, and when they can be touched without giving evi- dence of sensation, any operation can be made without evidence of consciousness. Dr. G-arretson says that he has relied on this test for years, and it has never disappointed him. He says just after unconsciousness is induced, if the eyelashes are touched with a probe they close very strongly, especially in females. If the chloroform is con- tinued the lids gradually lose their sensibility until they fail to respond to any impression. Pricking the skin with a sharp instrument is sometimes resorted to, but this will fail as sensibility yields first in the anterior part of the' body. Operations on the genital organs, rectum, fingers and toes require deep anaesthesia. Plastic operations in which a large amount of the integu- ment is involved, necessitating the insertion of numerous stitches, require more of the anaesthesia than where the dissections are made on the deeper structures. From personal observation the writer is convinced that each of the above symptoms is of value; but that the anaes thetist should take all the symptoms into account when making a judgment. The general condition of the patient should be considered. The circulation, respiration and condition of the pulse have much to do with the state of anaesthesia. The muscular sense is as reliable as any other single symptom. When a patient is completely anaesthet- ized it has lost all its tonicity and feels like a dead muscle. If the student will learn the sensation imparted to his hand when feeling the muscles of a cadaver, he will have no difficulty in detecting complete anaesthesia. Again there is something indescribable about a patient under these circumstances which intuitively tells him that the patient is ready for the operation. All the above signs should be given full credit where there is an imperative reason for determining When a patient is anaesthetized. Incomplete Ancesthesia.— The writer, in common with other members of the profession, has entertained the opin- ion that it is safer for the patient if he is not profoundly under the influence of the anaesthetic. Especially is this the case when there exists heart disease. Patients par- tially anaesthetized will writhe, moan and in various ways express signs of pain; but when consciousness returns, they have no knowledge of it. This has been thought to be a safe stage in which to operate. There is, however, a difference of opinion on this point. Many surgeons of SURGICAL ANESTHETICS -'97 experience advise against the practice. Physio-Medical- ists have been very successful. As far as I know, there has never been a death in their hands under these circum- stances; yet it is well to give heed to the experiences of others. Mr. Lister relates a case of death that he wit- nessed. "The patient whs a man above the middle period of life. He was afflicted with cancer of the penis. Con- sidering the momentary nature of the operation, chloro- form was purposely not given to ihe full extent. The surgeon now placing his Angers on the pulse and finding the pulse was good, at once made the amputation almost instantaneous. I observed," says Lister, "that the pas- sage of the knife through the member was accompanied by a start of, the patient's body. The bandage applied on the organ to restrain hemorrhage was removed, but no blood flowed from the arteries: he was dead." Lister's opinion was that he died from the shock operating on a weak he'art, and thinks that if the chloroform had been pushed to the full extent, he would not have died. It is probable that it is safer to give the anaesthetic to the de- gree that was mentioned in a former place, and which so closely resembles natural sleep. It is bad practice to allow a patient to fluctuate so much as is often seen. Patients who are half conscious and struggling against the pains inflicted by the surgeon's knife, and the next moment snoring in the depths of profound anaesthesia, are likely to have a slow and tedious awakening, together with troublesome vomiting or other unpleasant complications. Narcomania,— Persons addicted to the use of morphia, chloral, cocaine or alcohol, are bad subjects for anaesthesia. Their systems are so inured to influences that so closely resemble anaesthesia, that they require more than the others who are not habitual users of those drugs. Their vital capacities being weakened, they are unable to rally from its influence. ; Inhalers.— One of the chief differences between ether and chloroform consists entirely in the quantity used. In ether the question is. how nearly can the air be exclu- ded ?— while in the other, how little chloroform can be admitted and yet get its full influence? In the latter case no instrument is absolutely necessary. In fact a handker- chief is claimed to be the best and safest. Garretson uses a sponge. He first wets it in water and squeezes the water out. Upon this he drops a few drops of chloroform at first, 498 SURGICAL ANAESTHETICS. and in a few minutes be increases it till full anaesthesia is produced. He regards most kinds of apparatus as entitled to no better name than "life traps." The following is a quotation from Mr. Erichsen (Vol. 1, page 52): "The following is the way in which chloroform may be most safely given on lint or a handkerchief with- out apparatus of any kind: On a piece of folded lint about three inches square, and about three doubles, a dram of chloroform is poured; and the lint then held about three inches from the patient's nose, so as to admit a free admixture of air with the first few inhalations of the vapor. After the lapse of about one-half minute the lint is brought nearer the patient's nose, to within one inch, but never allowed to touch." Keen uses a handkerchiel. Moulin uses a piece of lint and a drop-bottle. He folds the lint upon itself two or three times and then drops a few drops of chloroform on it, and then turns the lint over so that the moistened surface is next to the mouth. Dr. H. C. Wood read a paper at the Berlin Congress in 1890 in which he called attention to the superiority of "forced artificial respiration." He stated that he had repeatedly resuscitated dogs that seemed to be dead. All the apparatus that Dr. Wood recommends is a face mask, a bellows, and a foot of India rubber tubing. Before ap- plying the face mask a thread should be passed through the tongue, and the organ well drawn out and held in place so that the epiglottis is held up. If the lungs do not expand, an intubation tube should be inserted. He recommends that two sizes be on hand. The lungs should be thoroughly but slowly expanded by each stroke of the bellows, care being taken that too much force is not used, as the air cells might be ruptured. It is essential that the lungs be freed from the residual air as quickly as pos- sible and thus relieve the blood of the chloroform. This apparatus or any other that is complicated will be all right for hospitals or any one who chooses to use it. but in the absence of it, artificial respiration thoroughly performed will accomplish the same result with less risk. Of course it matters not what means is adopted. The operator should see that the throat and larynx are free. To accom- plish this the tongue should always be drawn forward. It" any apparatus is used, those above mentioned or Esmarch's are the best, and in fact the only ones the writer would-rec- ummead. Ether should always be administered with an SURGICAL ANAESTHETICS 499 inhaler. The Allis or Esmarch's for ether are the best. The number of inhalers now on the market is very large, and each has its admirers; but we think that these two above named are the least complicated, and therefore less liable to get out of order. In the absence of any instrument, a very good one can be made by folding a piece of heavy paper in the form of a cone, cutting the large end to fit the irregularity of the face; and then place a napkin, sponge, piece of lint or ab- sorbent cotton in it and secure it with pins. Drop the ether on the under side of this substance and bring it near the face, but not to touch, for the first few minutes. After the patient has inhaled it lightly for a few minutes, the quantity of ether may be increased, and the apparatus brought down close to the face. The air may be nearly, but not entirely excluded. Any signs of asphyxia or fail- ure of the circulation as manifested by the respiration, pulse or color, should at once be considered a reason for removing the inhaler until the circulation or respiration is completely restored. After a patient is fully under either anaesthetic, the agent should not be continuously held over the nose. Opportunity should be afforded for a breath of fresh air every few minutes. It requires more ether to keep the patient constantly at the right stage of anaesthesia than chloroform. Constant watchfulness is necessary as the operation proceeds and the room gets warmer. Anaesthetics During Shock.— This subject has been under consideration by many eminent surgeons ever since their (anaesthetics) use in surgery; some recommending their use, others condemning them. Those who recom- mend their use claim that they act as a stimulant and favor reaction. Those who oppose their use. do so on the supposition that they are narcotic poisons, and have a tendency to add to the shock rather than to act as a stim- ulant. The unsettled state of this point should cause Physio-Medicalists to investigate for themselves. This question, if settled at all, must be done by studying the cause of pain as well as its influence on the organism. •Pain the monitor and rest the cure," says Heaton, ••should be recognized by all." Physio-Medicalists have always considered pain as a friendly monitor, and valued it as an element in diagnosis. They have considered it an evidence of vital activity, which is no doubt correct; but 500 SURGICAL ANESTHETICS. does it not also produce debility? And does it not often add to the gravity of the case? An answer to these ques- tions, either in the negative or affirmative, will probably determine the advisability of using or not using anaesthet- ics in shock of injury. Starting with the proposition, as we have, that anaes- thetics are non-poisonous, and if properly administered never produce death or destruction of living matter, our first inquiry should be, does pain of itself ever produce prostration or hinder reaction ? For myself, it has been a matter of common experience that small operations, every- thing else being equal, cause more shock than major ope-' rations do with the use of anaesthetics. Some months ago Prof. Haggard had occasion to remove some small cancer tumors from the region where he had previously removed a cancerous mammary gland. Cocaine was injected and two removed without any suffering or apparent prostra- tion. A third one was likewise treated with cocaine, but owing to the density of the cicatricial tissue the anaes- thetic did not reach every part of the structure. While making the last half of the dissection, the lady complained severely. Her pulse failed and the surface became livid. Respiration was shallow, and she was on the point of a collapse when the work was completed, which had not lasted to exceed three minutes. Only a few weeks ago the writer had occasion to inject the hernial rings of a large and well formed healthy man. The operation was followed by severe and prolonged shock. In about ten days after this, it was found necessary to repeat the injection, and the patient asked for chloroform, stating that the operation was too painful. This was not advisable on account of the risk of vomiting, which would have defeated the design of the operation. Cocaine was injected by Prof. Haggard. The injection was made equally as thorough as the former one. but was not fol- lowed by any severe shock. This point, we believe, will not be controverted by any, as this is one of the principal reasons why all surgeons use anaesthetics, and forms a basis for the use of anaesthetics in ^hock of injury. Agents that will prevent shock while an injury is being inflicted, ought to be capable of relieving it. at least to some extent, after it is inflicted. But does pain of itself ever produce debility? And can it alone he the cause of death? I answer this in the affirmative, and ask the critic what SURGICAL ANESTHETICS 501 comparison there is between the extent of lesion in the case of neuralgia and a cerebral hemorrhage; or between the pain of angina pectoris and a penetrating gunshot injury of the lung, when the lesion of tissue is taken into account ? One of the severest kinds of shock is that pro- duced by gunshot injury of the knee, or a crushing of the bones and joints in railroad accidents. It is very difficult and sometimes impossible to establish reaction. The shock is far worse than that from any other injury, not- withstanding the lesion of tissue may be far greater. Is •it not possible that pain is the greatest source of shock in these cases'? If so, and chloroform, not being poison, is administered, is it not possible that the patient can rally sooner when not suffering such severe pain, especially if Physio-Medical remedies are given ? Two forms of shock should be recognized. One in which the damage is instantaneous, but the effect ceases as sud- denly, leaving nothing but the vascular disturbance and loss of equilibrium of nervous action. In these cases prompt Physio-Medical treatment will soon restore them to a normal state. The second class of cases are such as produce all the above changes in the tissues, and in addi- tion the injured ne'ves keep up a constant influence on the nerve centres, and retard reaction To avoid this influence bee >mes at once the important thing to do. Can this be done without the use of some agent that will pre- vent these injured structures from transmitting their deleterious influence to the nerve centres'? It is plain to me that ordinary Physio-Medical remedies will not do this. They are all-powerful to restore circulation and nervous action, but they have no power to control common sensa- tion. The Physio-Medical materia medica is replete, as I can testify, with remedies to relieve all the ills of life; even common sensation may be restored to a normal stand- ard far enough to restore a normal action; but they will not entirely inhibit the nerves of common sensation when there is a cause like such injuries as these named above. To expect trhis of our common relaxants, stimulants and nervines is as unreasonable as to expect that the same agents can amputate a limb. All medical men recognize tins common law; viz., that remedies can modify functions, but cannot perform me- chanical acts, such as setting bones and dislocated joints; and so it is with the transmission of sensation to the 502 SURGICAL ANESTHETICS. centres, while the cause of the irritation continues to make its impression on the nerve centres. In chloroform, it is believed there are properties that will do this without in the least impairing the integrity of the tissues, pro- vided its laws can be obeyed. I am aware of the delicate ground I occupy as a Physio-Medicalist. Only the desire to avail ourselves of every agent for the relief of human suffering that will accomplish that purpose without leav- ing deleterious conditions on the organism, prompts this suggestion. To the intelligent, thinking and unpreju- diced mind are these thoughts dedicated, with a hope that our cause (which is of the people), if not benefited, will at least receive no injury therefrom. Why the circulatory and respiratory centers are the last to be influenced in general ancesthesia. As I have stood by the side of patients who were being anaesthetized and have observed the phenomena, I have asked myself the question why is it that every part of the body except the the circulation and respiration is rendered as insensitive and motionless as if dead; and yet the heart and lungs per- form their part as regularly and harmoniously as if in a profound sleep? I have wondered if it is an extraordinary property which anaesthetics possess that accomplishes this or is it due to some peculiar structure of the nervous or vascular system'r 1 soon satisfied myself that it could not be due to the anaesthetics, and turned to anatomy- and physiology for the explanation. A general survey of the anatomy of the central nervous system and the distribution of the sympathetic ganglia and nerves together with the influence they exert, each upon the other, will furnish a key to this mysterious condition. The cerebrum may be regarded as a hollow sphere, having an internal and an external surface. The latter of these is all that portion that presents itself to the eye upon a sup" erficial examination. In order to increase the surface it is every where thrown into folds or convolutions which are covered in their entirety by gray matter. This matter is largely made of cells held together by a net work called neu- roglia which serves as a cement to fix these cells; greater firmness is also given to this structure by a rich net work of blood-vessels which break up into a capillary system that abundantly supplies the cells among which they ram- ify. This network receives its blood from the vessels in the pia mater. This membrane is very vascular and SURGICAL ANAESTHETICS GO.'J receives its supply of blood from the cerebral arteries, and are branches of the circle of Willis which lies in immedi- ate contact with the base of the brain, and is supplied with blood directly from the heart through the two. verte- bral arteries and the internal carotids. This arrangement is perhaps the most elaborate- provision for the supply of blood to an organ that is found in the human body. The internal surface, or hollow inside the brain communicates with the external surface by the foramen of Magendi. This expansion is called the general ventricular cavity, and is divided into five compartments like the rooms in a house. Beginning with the entrance is the fourth ventri- cle or first room. It N situated on the first floor. The third ventricle corresponds to a room on the second floor and is a narrow, irregularly constructed space situated between the corpora striata in front and the thalami optici behind. Situated above this cavity and communicating with it by the foramina of Munroe are the two lateral ven- tricles, each extending into a corresponding hemisphere. They are separated from each other like two rooms having a double wall between them. Between these two walls is a space known as the fifth ventricle. Ranney not inaptly compares the cavities to rooms in the attic of a two-story house. This cavity is supposed to be a continuation of tiie central canal in the spinal cord, only being contracted at some points and expanded at others. This arrangement affords a considerable surface over which the gray matter is extended. This surface is also convoluted, the two principal convolutions being the thalamus opticus and cor- pus striatum, one for each lateral hemisphere. The blood supply for this internal surface of the cerebrum is abun- dant in proportion to the extent of tissue supplied, and comes more directly from the large trunks at the base of the brain. They may be divided into six groups or sets; two sets are called medial, one anterior and one posterior. The anterior are given off from the anterior cerebrals and anterior communicating artery. They supply the anterior extremity of each caudate nucleus. The posterior medial groups are branches of the posterior cerebral arteries and arise from them near their origin from the basilar. These arteries enter the ventricular cavity through the pasterior perforated space. They supply the internal parts of the optici thalmi and ramify on the walls of the third ventri- cle. The antero-lateral group take their origin from the 504 SUROICAL AN.E ST rl ETICS. middle cerebral near its origin. They enter the ventricle through the anterior perforate space, and supply • 'the whole of the caudate nucleus except its head. The len* tricular nucleus, internal capsule and part of the optic thalamus are also supplied by these branches. The posteri- or lateral arises from the posterior cerebral artery, and supplies the posterior part of the optici thalami. The pos- terior cerebral also give branches to the crus and corpora quadrigemina. It will thus be seen that the two surfaces of the cerebrum are well supplied with blood that is sent direct from. the heart. , The blood supply of the spinal cord is equally abundant. The arterial pressure, however, owing to the more indirect manner in which it receives its blood, is not quite as great as that of the brain. The blood) reaches the cord through t,he vertebrals, intercostals and lumbar arteries. From the first (the vertebrals) the anterior spinal artery takes its origin by two branches, one from each. From the sec- ond, viz., intercostals and lumbar arteries, the blood reaches the cord by a branch which enters the spinal canal through each intervertebral foramen and passes along the nerve root to the pia mater in which they ramify. From these sources the vessels of the cord receive their blood. These vessels have a peculiar and elaborate arrangement for reaching every part of- the cord. The anterior spinal artery. as before stated, arises by two branches, one from each vertebral which nnite near the junction of, the me- dulla and pons. It extends the entire length of the cord, and receives, as it passes down the cord, reinforcements from each artery that enters the canal through the inter- vertebral formina. These vessels join the anterior spinal nearly at right angles in the upper part of the. cord, but more obliquely as the lower termination is reached. The anterior spinal artery in its co'irse gives off from two hun- dred and fifty to three hundred brandies, which pass along the anterior median fissure to the gray commissure. Each of these branches divides into a right and left branch to supply the Jateral. half of the gray matter. These again, divide into an. anterior and posterior branch. Vertically each of the primary, brandies gives off, two branches, one to the branch above and one to the branch next below; so there is formed a second spinal artery within the cord — the anastamotic artery; from this artery a capillary net- SURGICAL ANAESTHETICS. 505 work supplies the tubular gray matter. The arteries from the external surface penetrate the substance of the cord. They supply all the white substance and there is a branch that enters through the posterior external column to the posterior horn. This is the posterior cornual artery. Just on the inner side of the posterior root a small artery enters the cord and supplies the root and head of the posterior cornu. A number of small arteries enter with the anterior root. From the pi i mater innumerable branches called radicular branches penetrate and supply the white matter. A posterior medial artery extends along the posterior me- dian septum, supplying the columns of Gall on each side. Another artery situated in the septum between the col- umns of Gall and Burdoch supplies each of these columns as they lie in contact with each other. These two arteries like the anterior medial extends the whole length of the cord. Thus it may be seen that the cord is richly supplied with blood from the internal as well as the external sur- face. The blood supply of the medulla and pons is derived from the basilar, vertebral and anterior spinal arteries as these arteries lie in contact .with their anterior (under surface). They are divided into two sets, median and radicular. The former of these is a series of branches given off at right angles from the vertebrals, basilar and anterior spinal arteries. They penetrate the substance of the pons and medulla, passing in direct lines through the substance of the medulla to reach the nerve nuclei on the floor of the fourth ventricle, and supply these nerve nuclei with the greater portion of their. blood. The radicular arteries pass around and on the surface of the medulla to the roots of the nerves as they emerge from the substance of the cord. Here they divide into two branches and one goes to the nerve nuclei. The other follows the course of the nerve trunk. By a comparison of the anatomical structure of the cere- brum, spinal cord and medulla, it will be seen that the latter is very scantily supplied with blood as compared with the two former, as it only receives blood from the one source: and that this small supply has to penetrate the solid structure of the medulla or pass in a tortuous manner around half its circumference to reach the nuclei that preside over the two vital functions: viz., circulation and respiration. It has been shown that the brain has 506 SURGICAL ANAESTHETICS, two surfaces, and that the spinal cord is a cylinder with a canal extending in the centre its entire length; that they both receive blood from the internal as well as the external surfaces. As the spinal cord approaches the upper termi- nation of its course, the central canal is pushed backward by the addition of new matter added for the purpose of supplying new centres with nuclei. At the commence- ment of the medulla the posterior portion of the cord seems as if it had been split and its substance pushed lat- erally so that the central canal is exposed and expands into a lozenge-shaped surface— the floor of the fourth ven- tricle. Here nestled together are f( und the nuclei of the most important cranial nerves. In the centre of this little group will be seen the nuclei from which spring the pneu- mogastric nerves, the other centres clustering around them as if to protect them from external influences. Let us now trace the blood that reaches the nuclei of the pneumogastric nerves. The anterior spinal artery is formed by the union of two branches, one from each of the vertebral arteries. They leave the vertebral trunks at right angles, pass to the surface of the medulla, and then describe a gentle curve downward along the anterior medi- an surface. From this downward trunk the median arte- ries pass at right angles. This brings the anterior spinal artery parallel with the vertebrals, and the blood flows in opposite directions; viz., upward in the vertebrals and downward in the spinal artery. From this reversed cur- rent the blood in the anterior spinal enters the median artery at right angles to the former. The median arteries penetrate the entire thickness of the medulla — one-half inch. These arterial twigs break up into a capillary net- work, as they arrive at the floor of the fourth ventricle, and supply the nuclei. These are all typical end arteries; i. e., they do not communicate with other arteries. From this brief description of the circulation of the blood, in the various nerve centres, as compared with that of the bulb, it may be seen that neither the pressure nor the sup- ply is equal to that of those centres. So much for the structure of the cerebro-spinal axis; but this is not suffi- cient for our purpose. The sympathetic or ganglionic system is also an import- ant factor in the circulation of the blood and its structure must receive a passing notice.. Anatomically it is divided SURGICAL ANAESTHETICS. 507 into ganglia and nerves. The principal ganglia form a complete circle consisting of two chains connected by the ganglion of Ribes situated on the anterior communicating artery. The lower extremities of these t^o chains are united by the ganglion impar, which is placed on the ante- rior surface of the coccyx. These ganglia are divided into pairs except the ganglion impar; this is single. The pairs are named from the region which they occupy. There are four cephalics all connected with the branches of the fifth nerve; three cervical situated in the cervical region: twelve in the dorsal; four in the lumbar; five in the sacral and one (single) in the coccygeal region. These are pri- mary branches and communicate with each other by a superior and inferior branch. They also communicate with the spinal cord by sending branches of communica- tion, one from each ganglion composed of gray matter and receiving one branch of white matter from each spinal nerve. Hence the ganglia are composed of gray and white matter (spinal and sympathetic). The primary branches of distribution in the cervical region are three in number; viz., superior, middle and inferior cardiac. They arise from the superior, middle and inferior cardiac ganglia. The branches in the tho- racic region are also three in number; great splanchnic, lesser splanchnic and renal splanchnic; all these penetrate the diaphragm. The first joins the solar plexus, the sec- ond the cceliac plexus and the third unites with the renal plexus. In the lumbar region the primary branches of distribution terminate in plexuses corresponding in name to the organ supplied by them; the same is true of those in the pelvic region. Another set of primary branches of distribution are sent to all the blood-vessels of the body and entwine themselves around the arteries in form of plexuses, from which the arterial coats are supplied. The secondary branches of distribution in the thoracic region take their origin from the cardiac plexus and are distributed to the heart. The secondary branches of distribution in the abdominal cav- ity take their origin from the epigastric or solar plexus and semiluna ganglia, and are distributed through the medium of other smaller plexuses to all the viscera of the abdominal cavity. There is, therefore, a complete inter- communication between the cerebro-spinal and the gangli- onic nervous system. Every organ, and every tissue of an 508 SURGICAL ANAESTHETICS. organ, feels the influence of each alternately. Another branch (vaso-motor) takes its origin from the floor of the fourth ventricle, between the calamus scripterius and corpora quadrigemina. These vaso-motor fibres pass down in the substance of the spinal cord. A branch passes out of the spinal column with each anterior root of a spinal nerve, and thence passes to all parts of the body that pos- sess arteries and capillaries. They maintain the tone of the vascular system, and are also called vaso-constrictors. The tenth nerves (pneumogastric) take their origin from two nuclei in the lower half of the floor of the fourth ven- tricle. They are intimately associated in their origin with the spinal accessory nerves, from which they derive their motor fibres. They also send to and receive fibres from the glosso-pharyngeals and hypoglossals, and have many connections with different branches of the sympathetic. In their range of influence they are the widest; and in their extent of anatomical connections they are the most vital as well as the most important nerves in the human body. Through their connections with the other nerves named above, they influence deglutition, phonation, respi- ration, circulation and digestion. They are also the inhib- itory nerves of the heart. This double strictural arrangement of the nervous sys- tem has its analogue in the muscular system. Every mus- cle of the body has its antagonistic muscle; thus we have them classed into flexors and extensors, abductors and adductors, rotators and supinators, expirators and respi- rators, and constrictors and dilators. These two last sets are those whose actions are concerned in respiration and are principally connected in anaesthesia. When chloroform vapor is inhaled, as has been hereto- fore described, it is brought into direct contact with the lungs and heart, and were it not for a peculiar arrange- ment of the muscles and nerves of these structures, those organs would cease to act, and death would supervene before the anaesthetic could reach any other of the nerve centres; because it has been found by experimental phys- iologists that the heart action will cease when a current of chloroform vapor is directed upon it. The same is true of the lungs— respiration ceases. The lungs are in one sense passive. Inspiration and expiration are carried on by muscles that move the chest, alternately enlarging and diminishing the cavity, in this way producing a tendency SURGICAL ANAESTHETICS. 509 to create a vacuum. The air rushes in and out and pre- vents this tendency to a vacuum. The nerves controlling this action have their centres in the floor of the fourth ventricle and near the origin of the pneumogastric nerves. Through the influence of this respiratory centre the lungs are kept moving, although they themselves may be bathed in the vapor of the anaesthetic. The same is true of the heart, which, although it is automatic to a limited degree, is under control of the cardiac centres in the medulla. The heart and lungs are kept moving to a limited degree by these centres. But by a law of limitation this influence cannot continue beyond a certain degree. This is why anaesthetics should not be pushed too rapidly at the commencement as hereto- fore stated. This danger-point being passed, the vapcr is carried by the blood to every part of the body in propor- tion to the amount of blood circulating in each organ or tissue. The cerebrum being better supplied with blood feels the influence first, and intellection, sensation and voluntary motion are first obliterated. Operations are sometimes made during this stage. The patient struggles and moans as it suffering the severest pain, and yet after recovery he has no recollection of anything that passed. This is inconvenient for the surgeon, as the struggling interferes with the work and might cause the operator to make an unfortunate stroke of his knife. It is also dan- gerous to the patient. The struggling might cause an arrest of the heart action. The second stage comes when the cerebellum, crura cere- bri, pons varolii and spinal cord are anaesthetized. All motion and sensation through reflex action cease. (See previous pages.) The third stage is characterized by snoring or stertorous breathing, with congestion of the capillaries or the oppo- posite— anaemia, or bloodlessness. In some cases, instead of the snore, the respiration becomes deep and labored. In either case the patient is asphyxiated and in a danger- ous condition. This is an indication that the medulla is being influenced. This condition is produced by an overdose of the anaes- t he tic, which should be discontinued at once, and the patient allowed to breathe fresh air. Patients should never be brought to this condition, and a skillful anaesthet- ist will not allow a patient to pass beyond the second stage. •UO SURGICAL ANAESTHETICS. The vaso-motor (constrictor) nerves control all the organs of the body except those immediately connected with the heart and lungs— respiratory and cardiac constrictors. As above stated, the nerves arise from the floor of the fourth ventricle and the point extending above this to the corpora quadrigemina, This is the controlling centre. All the other ganglia connected with this centre are dependent centres. In anaesthesia by ether the constrictor muscles, which are controlled by the dependent centres, are relaxed and complete insensibility is produced and can be main- tained indefinitely without the independent centre being reached. The effect of this dilatation of the capillaries and other blood-vessels is to allow the blood to accumulate in the lungs and brain, and the patient may die from con- gestion (coma) of the brain or asphyxia, when too much ether is inhaled in proportion to the air. This explana- tion also shows why persons with pulmonary disease or hyperaemia of the brain should not use ether vapor as an anaesthetic. Chloroform relaxes the vaso-dilators and allows the vaso- constrictors to narrow the capillaries and other vessels, and force the blood upon the heart so rapidly that the right auricle is distended and the action of the organ is arrested in diastole. This constricting force also drives the blood from the brain and lungs, and patients may die because of the deficient supply of blood, which fails to keep up vital action. Now for the final answer to the question— Why is the medulla the last centre to be influenced ? When patients die as the result of any of the conditions above pointed out, they do so by the anaesthetic inhibiting the vital cen- tres; and this is done either by anaemia in chloroform, anaesthesia or hyperaemia or congestion when ether is used. The medulla oblongata and pons varolii are exempt from these disturbances by reason of the peculiar arrange- ment of the blood supply, as it has been shown that there is a far greater amount of blood sent to the other centres than to this vital spot. So great is this difference in the supply, that every other part of the body can receive enough to render it entirely insensible without the me- dulla feeling its influence. Therefore the blood must be surcharged with the anaesthetic in an unwarranted man- ner before this centre is reached and life is cut off. SURGICAL ANESTHETICS. 511 A Thorough Qualification Needed.— It is feared that there is not sufficient importance attached to the acquire, merit of a complete knowledge of the properties of anaes- thetics, also to the danger to life if not properly used. It is an indisputable fact that the death rate is very low. One death in five thousand from the use of chloroform, and possibly one in twenty-five thousand from the use of ether does not seem alarming, and yet it is not known in what given case it will prove fatal. In the Net ley Hospi- tal there were twenty-five thousand administrations, and twelve deaths in ten years' use of it; while in the next ten there were over three hundred deaths. It has been shown that death usually occurs suddenly and without warning. In three instances within the past fifteen years there have been four such deaths in this state, three of which were in this city. It must be a terrible feeling for an operator to find that while he is busily engaged with his work his patient has passed beyond the point of needing his services, and what must be the chagrin of the anaesthetist to know that the life of his patient has been extinguished, perhaps by his negligence. It is true that occasionally a patient may die notwithstanding every precaution has been taken to guard against it. It is the duty of every person who assumes this great responsibility to know that nothing has been left undone to insure safety. I fear that there is not sufficient attention given to this subject while at college. Some students get the impres- sion that they may never be called upon to administer these agents: while others, seeing so many cases anaesthe- tized and that they all come out, will conclude that not very much knowledge is required beyond what they term the use of good judgment. This is a very serious mistake. a knowledge of which may come to the student when he has to regret that a life is lpst and that he is responsible. With this conviction on his mind the conscientious stu- dent will avail himself of every opportunity to acquire a complete knowledge of this subject, by attendance at every clinic at the hospitals as well as at the college, and close attention to didactic lectures. I have often been astonished at the indifference manifested by students to this subject while patients were being anaesthetized. The attentive student will watch with interest every move- ment of the anaesthetist as well as the patient, and observe 512 SURGICAL ANESTHETICS. carefully all the phenomena, and from his text-books learn the import of each. Thus armed with all the knowledge it is possible to acquire, every graduate ought to be qualified to adminis- ter these agents. Assuming that he has done all this, and has mastered all the facts in relation to the more common accidents to which patients are exposed, we will suppose that he is now the actor, not the spectator as before. The operation is to'be one of