AN INDEX 
 
 DISEASES AND THEIR TREATMENT.
 
 L. & B. PUBLISH THE FOLLOWING 
 
 WORKS BY THE SAME AUTHOR. 
 
 THE PKACTICE OF MEDICINE. 
 
 Fourth American Edition. 8vo. Cloth, $6.00. Sheep, $7 00. 
 
 A PEACTICAL TKEATISE ON THE DISEASES OF INFANCY AND 
 
 CHILDHOOD. 
 
 Second American Edition. 8vo. Price $3.00. 
 
 A MEMOKANDA OF POISONS. 
 32mo., cloth. 50 cents. 
 
 THE SIGNS AND DISEASES OF PREGNANCY. 
 Preparing.
 
 AN 
 
 INDEX OF DISEASES 
 
 AND THEIR 
 
 TREATMENT. 
 
 THOMAS HAWKES TANNER, M.D., F.L.S., 
 
 MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, ETC. 
 
 PHILADELPHIA: 
 
 LI:N'DSAY & BLAKISTON'. 
 186 7.
 
 SHERMAN k CO., PRINTERS.
 
 m 
 
 100 
 I?fe7 
 
 PREFACE. 
 
 The present volume is intended to facilitate the daily work of 
 the busy practitioner; and especially to help him in successfully 
 managing such cases of disease as do not yield to treatment so 
 readily as might be desired. The student who wishes to learn the 
 nature of the tools with which he will have to work, and the best 
 mode of employing them, must seek for this information in other 
 treatises. But it is hoped that the actual laborer, who has em- 
 ployed his customary weapons and finds himself baffled, will re- 
 ceive useful suggestions from the following pages. 
 
 In constructing the various articles of which this Index is com- 
 posed, the Author has endeavored by giving a brief description of 
 each disease to make its diagnosis sure. With regard to the sec- 
 tions on Treatment, it is to be remembered that the numbers 
 appended to the drugs not only refer to the Formula?, but indicate 
 those remedies on which it is believed that reliance should be 
 chiefly placed. As a rule, however, most of the agents which 
 have been recommended by difterent authorities are mentioned ; 
 although where they are not deemed particularly useful either no 
 reference is given for the mode in which they are to be prescribed, 
 or they are placed in a separate paragraph. 
 
 It is only necessary to add that the Formulae have been reprinted 
 from the last edition of the Author's Practice of Medicine, with a
 
 vi PREFACE. 
 
 few alterations and additions. Each prescription has been written 
 in accordance with the rules and preparations of the British Phar- 
 macopoeia — a work which the practitioner will esteem the more 
 highly, the more attentively he studies its pages. 
 
 Henrietta Street, Cavendish Square, 
 1866.
 
 TABULAR SYNOPSIS. 
 
 ABSCESSES: 
 
 I. Abscess of Brain, p. 67. 
 II. Abscess of External Auditory Canal, p. 188. 
 
 III. Abscess of Tonsil, p. 257. 
 
 IV. Retro-Pharyngeal Abscess, p. 229. 
 V. Empj'ema, p. i05; 210. 
 
 VI. Abscess of Abdominal "Walls, p. 33. 
 VII. Hepatic Abscess, p. 137. 
 VIII. Perinephritic Abscess, p. 33; 203. 
 IX. Abscess around Cajcum, p. 55; 204. 
 
 X. Prostatic Abscesa, p. 218. 
 
 XI. Pelvic Abscess, p. 33 ; 201. 
 
 XII. Ovarian Abscess, p. 33; 192. 
 
 XIII. Abscess of Vaginal Labia, p. 273. 
 
 XIV. Lumbar, Psoas, and Iliac Abscess, p. 166. 
 XV. Mammary Abscess, p. 167. 
 
 XVI. Abscess of Bone, p. 187. 
 XVII. Boils, p. 50. Stves, p. 245, 
 XVIII. Carbuncle, p. 57". 
 XIX. Bubo, p. 54. 
 XX. Strumous Abscess, p. 236. 
 
 BLADDER DISEASES: 
 
 I. Vesical Irritability, p. 275. 
 II. Vesical Spasm, p. *276. 
 
 III. Vesical Paralysis, p. 276. 
 
 IV. Vesical Inflammation, 1. Acute Cystitis, p. 274. 
 
 2. Chronic Cystitis, p. 275. 
 V. Vesical Tumors, p. 276. 
 VI. Urinary Calculi, p. 263. 
 
 VII. Enuresis, p. 110. 
 
 BLOOD DISEASES: 
 I. Ana3mia, p. 88. 
 II. Chlorosis, p. 70. 
 
 III. Graves' Disease, p. 128. 
 
 IV. Leucocythemia, p. 165. 
 V. Hyperemia, p. 147. 
 
 VI. Ichorhajmia, or Pysemia. p. 149 ; 221. 
 VII. Piarhjemia, p. 208"'. 
 VIII. Acholia, p. 33. 
 IX. Glucohiemia, p. 91. 
 
 X. Urajmia, p. 263. 
 XL Ha^matozoa, p. 128. 
 XII. Thrombosis, p. 254. Embolism, p. 104, 
 
 XIII. Scurvy, p. 237. 
 
 XIV. Purpura, p. 221. 
 XV. Black Leg, p. 50. 
 
 XVI. Cellulitis Venenata, p. 64,
 
 Vlll 
 
 TABULAR SYNOPSIS. 
 
 BLOOD DISEASE S— (continued) : 
 
 XVII. Glanders, p. 124. 
 
 XVIII. Hydrophobia, p. 146. 
 
 XIX. Elephantiasis Graecorum, p. 103. 
 
 XX. Pellagra, p. 199. 
 
 BLOODVESSEL DISEASES: 
 I. Aortitis, p. 41. 
 11. Aortic Aneurism, p. 39. 
 
 III. Phlebitis, p. 205. 
 
 IV. Phlebolites, p. 205. 
 
 V. Phlegmasia Dolens, p. 205. 
 VI. Nffivus, p. 178. 
 
 BONE DISEASES: 
 I. Caries, p. 62. 
 II. Necrosis, p. 179. 
 
 III. Periostitis, p. 203. 
 
 IV. Osteitis, p. 187. 
 
 V. Osteomyelitis, p. 187. 
 VI. Osteomalacia, p. 187. 
 VII. Osteoid Cancer, p. 187. 
 VIII. Kickets, p. 232. 
 IX. Coccyodynia, p. 74. 
 X. Spina Bifida, p. 240. 
 
 BRAIN DISEASES: 
 
 I. Apoplexy, p. 43. Cerebral Hemorrhage, p. 44 ; 64. 
 II. Hydrocephalus, p. 145. Hydrocephaloid Disease, p. 145. 
 III. Coma, p. 75. 
 IV. Compression of Brain, p. 76. 
 V. Concussion of Brain, p. 76. 
 VI. Coup de Soleil, p. 84. 
 VII. Inflammation, 1. Simple Meningitis, p. 65. 
 
 2. Cerebritis, p. 65. 
 
 3. Acute Encephalitis, p. 65. 
 
 4. Chronic Encephalitis, p. 66. 
 
 5. Softening ; Induration ; Tumors, p. 67. 
 
 6. Tubercular Meningitis, p. 68. 
 
 7. Hypertrophy ; Atrophy, p. 69. 
 VIII. Alcoholism, 1. Delirium Tremens, p. 91. 
 
 2. Dipsomania, p. 95. 
 IX. Insanity, 1. Progressive Paralysis, p. 153. 
 
 2. Insanity with Epilepsy, p. 153. 
 
 3. Mania, p. 153. 
 
 4. Puerperal Mania, p. 219. 
 
 5. Monomania, p. 154. 
 
 6. Dementia, p. 154. 
 
 7. Idiocy, p. 154. 
 
 8. Cretinism, p. 85. 
 X. Headache, p. 131. 
 
 XL Vertigo, ji. 274. 
 XII. Paralysis, p. 193. 
 
 XIII. Epilepsy, p. 110. 
 
 XIV. Aphasia, p. 42. 
 XV. Convulsions, p. 80. 
 
 XVI. Amaurosis, p. 35. 
 
 Eclampsia Nutans, p. 102. 
 
 BREAST DISEASES: 
 
 I. Inflammation, 1. Acute Mammitis, p. 170. 
 
 2. Chronic Mammitis, p. 171.
 
 TABULAR SYNOPSIS. 
 
 IX 
 
 BKEAST DISEASE S— (continued) : 
 
 II. Tumors, 
 
 III. 
 
 IV. 
 
 V. 
 
 1. Lacteal, p. 168. 
 
 2. Fatty, p. 1G9. 
 
 3. Eiicliondroniatous and Fibroid, 
 
 4. Fibro-Plastic, p. 169. 
 6. Hydatid, p. 16'J. 
 
 6. Clironic Mammary, p. 169. 
 
 7. Mucous Cysts, p. 169. 
 
 8. Carcinoma, p. 170. 
 Mastodynia, p. 171. 
 Mammary Abscess, p. 167. 
 Mammary Hypertrophy, p. 168. 
 
 VI. Mammillary, or Nipple Diseases, p. 170. 
 VII. Agalactia, p. 35. 
 VIII. Galactorrhoea, p. 119. 
 
 p. 169. 
 
 CALCULOUS CONCRETIONS; 
 I. Rhinolithes, p. 231. 
 II. Phlebolites, p. 205. 
 
 III. Intestinal Concretions, p. 156. 
 
 IV. Gall Stones, p. 120. 
 
 V. Pancreatic Calculi, p. 193. 
 VI. Urinary Calculi, p, 263. 
 VII. Tophi or Chalk-Stones, p. 127. 
 VIII. Lacteal Calculus, p. 168, 
 
 CANCER (p. 56): 
 
 I. Varieties, . 1. Scirrhus, or Hard Cancer, p. 235. 
 
 2. Medullary, or Soft Cancer, p. 172. 
 
 3. Epithelial Cancer, p. 112. 
 
 II. Sub-Varieties, 1. Colloid, or Gum Cancer, p. 75. 
 
 2. Melanoid, or Black Cancer, p. 172. 
 
 3. Osteoid Cancer, p. 187. 
 
 4. Fungus Haematodes, p. 128. 
 
 5. Villous Cancer, p. 277. 
 
 III. Of Special Organs, 1. Cancer of Tongue, p. 256. 
 
 2. Cancer of Tonsil, p. 258. 
 
 3. Cancer of (Esophagus, p. 184. 
 
 4. Cancer of Stomach, p. 121. 
 
 5. Cancer of Duodenum, p. 97. 
 
 6. Cancer of Rectum, p. 222. 
 
 7. Cancer of Liver, p. 134. 
 
 8. Cancer of Kidney, p. 226. 
 
 9. Cancer of Pancreas, p. 193. 
 
 10. Cancer of Breast, p. 170. 
 
 11. Cancer of Vulva, p. 278. 
 
 12. Cancer of Uterus, p. 265. 
 
 13. Cancer of Penis, p. 201. 
 
 14. Cancer of Testicle, p. 251. 
 
 15. Chimney-Sweeper's Cancer, p. 69. 
 
 16. Cancer of Bladder, p. 277. 
 
 17. Pulmonary Cancer, p. 219. 
 
 18. Cardiac Cancer, p. 58. 
 
 19. Mediastinal Cancer, p. 157. 
 
 DEFORMITIES: 
 
 I. Spinal Curvature, p. 240. 
 
 II. Rickets, p. 232. 
 
 III. Spina Bifida, p. 240. 
 
 IV. Osteomalacia, p. 187. 
 V. Coccyodynia, p. 74. 
 
 VI. Wry-Neck, p. 282. 
 
 VII. Club Foot, p. 73.
 
 TABULAR SYNOPSIS. 
 
 DEFOE MITIE ^—{continued) : 
 
 VIII. Flat Foot, p. 117. 
 IX. Knock-Knees, p. 162. 
 
 X. Epispadias, p. 148. 
 XI. Hypospadias, p. 148. 
 XII. Cretinism, p. 85. 
 
 DEGENERATIONS OF TISSUE 
 
 I. Fatty Degeneration, p. 116. 
 
 II. Amyloid Degeneration, p. 37. 
 
 III. Mineral Degeneration, p. 174. 
 
 IV. Osteomalacia, p. 187. 
 V. Cardiac Atrophy, p. 58. 
 
 VI. Hepatic Degenerations, p. 135. 
 VII. Renal Degenerations, p. 226. 
 VIII. Arcus Senilis, p. 83. 
 IX. Cerebral Softening, p. 67. 
 
 DROPSY (p. 96) : 
 
 I. Ascites, p. 45. 
 II. (Edema, p. 184. 
 
 III. Anasarca, p. 38. 
 
 IV. Sclerema, p. 235. 
 
 V. Bright's Disease, p. 51 ; 226. 
 VI. Acute Desquamative Nephritis, p. 180. 
 VII. Hydrocephalus, p. 145. 
 VIII. Hydrothorax, p. 147 ; 210. ' 
 
 IX. Pneumothorax, with EflVision, p. 213. 
 
 X. Cardiac Dropsy, p. 60. 
 XI. Hydro-Pericardium, p. 146 ; 202. 
 XII. Beriberi, p. 49. 
 
 XIII. Hydrocele, p. 144. 
 
 XIV. Scrotal (Edema, p. 236. 
 XV. Hydronephrosis, p. 146. 
 
 XVI. Hydrorachis, p. 147 ; 240. 
 XVII. (Edema of Glottis, p. 164. 
 XVIII. Ovarian Dropsy, p. 191. 
 
 XIX. Dropsy of Fallopian Tube, p. 116. 
 
 EAR DISEASES: 
 
 I. Otitis, 1. Inflammation of External Meatus, p. 188. 
 
 2. Inflammation of Membrana Tympani, p. 180. 
 
 3. Inflammation of Tympanic Cavity, p. 189. 
 
 II. Diseases of Eustachian Tube, 1. Obstruction of Tube, p. 115. • 
 
 2. An Open Condition of Tube, p. 115. 
 
 III. Otalgia, or Earache, p. 188. 
 
 IV. Otorrhcea, p. 190. 
 V. Otorrhagia, p. 190. 
 
 VI. Deafness, 1. Rheumatism of Ear, p. 87. 
 
 2. (iout of Ear, p. 87. 
 
 3. Nervous Deafness, p. 87. 
 VII. Hajmatoma Auris, p. 113. 
 
 ENTOZOA (p. 107): 
 
 I. Trematoda, or Flukes, 1. Fasciola Hepatica, p. 107; 129. 
 
 2. Distoma Lanceolatiim, p. 107. 
 
 8. Distoma Ophthalmobium, p. 107. 
 
 4. Distoma Crassum, p. 107. 
 
 5. Distoma Heterophyes, p. 108. 
 
 6. Distoma Hitmatobium, p. 108; 128. 
 
 7. Tetrastoma Renale, p. 108. 
 
 8. Hexathyridium Pinguicola, p. 108. 
 
 9. Hexathyridium Venarum, p. 108 ; 128.
 
 TABULAR SYNOPSIS. XI 
 
 E N T Z O A.— {continued) : 
 
 II. Cestoda, or Tapeworms, 1. Tajnia Solium, p. 108; 158. 
 
 2. Tienia McdiocaiKsUata, p. 108; 158. 
 
 3. Tienia Marginala, p. 108. 
 
 4. Taenia Echinococus, p. 108; 136. 
 
 5. Bothriocephalus Latus, p. 108; 158. 
 
 III. Nematoda, or Round Worms, 1. AscarLs Lumbricoidos, p. 109; 158. 
 
 2. Ascaris Mvstax, p. 109. 
 
 3. Tricocephalus Dispiir, p. 109; 158. 
 
 4. Trichina Spiralis, p. 109; 270. 
 
 5. Strongylus Bronchialis, p. 109. 
 
 6. Eustrongylus Gigas, p. 109. 
 
 7. Sclerostuma Duodenale, p. 109; 158. 
 
 8. Oxyuris Vcrmicularis, p. 109 ; 158. 
 
 9. Dracunculus Medincnsis, p. 95; 109. 
 
 IV. Acanthotheca (not true Helminths), 1. Pentastoma Tienioides, p. 109. 
 
 2. Pentastoma Constrictum, p. 109. 
 V. Pseudelminths, 1. Dactylius Aculeatus, p. 109. 
 2. Spiroptera Hominis, p. 109. 
 8. Diplosoma Crenatum, p. 109. 
 4. Gordius Aquaticus, p. 109. 
 
 EPIPHYTES (p. 112): 
 
 I. In Cutaneous Diseases, 1. Microsporon Furfur, p. 112; 255. 
 
 2. Microsporon Mentagrophytes, p. 112; 255. 
 
 3. Microsporon Audouini, p. 112; 255. 
 
 4. Tricophyton Tonsurans, p. 112; 255. 
 
 5. Tricophyton Sporuloides, p. 112 ; 211. 
 
 6. Achorion Schonleinii, p. 112; 255. 
 II. In Stomach Diseases, 1. Sarcina Ventriculi, p. 112; 124. 
 
 2. Cryptococcus Cerevisiie, p. 112; 124. 
 
 III. In Aphtha, 1. Oidium Albicans, p. 43; 112. 
 
 2. Leptothrix Buccalis, p. 43; 112. 
 
 IV. In Fungus Foot of India. Chionyphe Carteri, p. 112; 176. 
 
 EPIZOA (p. 113): 
 
 I. On the Skin, 1. Pediculus, or Louse, p. 113; 206. 
 
 2. Pulex Irritans, or Flea, p. 113. 
 
 3. Chigoe, or Jigger, p. 113. 
 
 4. Ticks, or Ixodes, p. 113. 
 
 5. Argades, p 113. 
 
 6. Acanthia Lectularia, or Bug, p. 113. 
 
 7. Leptus Autumnalis, or Harvest Bug, p. 113. 
 II. In the Skin, 1. Acarus Scabiei, or Itch Insect, p. 113 ; 233. 
 
 2. Acarus FoUiculorum, or Pimple Mite, p. 113. ' 
 
 EYE DISEASES: 
 
 I. Diseases of Eyelids, 1. Ectropion, p. 103. 
 
 2. Entropion, p. 110. 
 
 3. Epiphora, p. 112. 
 
 4. Ophthalmia Tarsi, p. 186. 
 
 5. Ptosis, p. 219. 
 
 6. Trichiasis, p. 259. 
 II. Varieties of Sight, 1. Emmetropia, p. 104, 
 
 2. Myopia, p. 177. 
 
 3. Presbyopia, p. 217. 
 
 4. Asthenopia, p. 46. 
 
 5. Astigmatism, p. 48. 
 
 6. Color-Blindness, p. 75. 
 
 7. Hj'permetropia, p. 147. 
 
 8. Amblyopia, p. 36. 
 
 9. Diplopia, p. 36; 95. 
 
 10. Hemiopia, p. 36 ; 133. 
 
 11. Hemeralopia, p. 36; 132.
 
 xii TABULAR SYNOPSIS. 
 
 EYE DISEASE S— (continued) : 
 
 12. Nyctalopia, p. 36; 183. 
 
 13. Photophobia, p. 206. 
 III. Conjunctivitis, 1. Catarrhal Ophthalmia, p. 77. 
 
 2. Purulent Ophthalmia, p. 78. 
 
 3. Strumous Ophthalmia, p. 79. 
 
 4. Granular Conjunctiva, p. 79. 
 
 IV. Sclerotitis, 1. Kheumatic Ophthalmia, p. 235. 
 
 2. Catarrho-Kheumatic Ophthalmia, p. 236. 
 V. Corneitis, 1. Keratitis, p. 81. 
 
 2. Syphilitic Keratitis, p. 82. 
 
 3. Opacity of Cornea, p. 82. 
 
 4. Ulcers of Cornea, p. 82. 
 
 5. Conical Cornea, p. 82. 
 
 6. Arcus Senilis, p. 83. 
 VI. Diseases of Iris, 1. Iritis, p. 159. 
 
 2. Inflammation of Iris and Cornea, p. 161. 
 
 3. Mydriasis, p. 161. 
 
 4. Myosis, p. 161. 
 VII. Choroiditis, p. 73. 
 
 VIII. Retinitis, p. 228. 
 IX. Cataract, p. 63. 
 
 X. Muscse Volitantes, p. 175. 
 XI. Glaucoma, p. 124. 
 XII. Amaurosis, p. 35. 
 XIII. Exophthalmos, or Proptosis Oculi, p. 115; 128; 217. 
 
 FEMALE ORGANS OF GENERATION (Diseases of): 
 I. Vulval Pruritus, p. 279. 
 II. Vulval Tumors, 1. Encysted Tumors, p. 279. 
 
 2. Fibrous and Fatty Tumors, p. 280. 
 
 3. Warty Growths, p. 280. 
 
 4. Hypertrophy of Labia, p. 280. 
 
 5. Abscess of Labia, p. 280. 
 
 6. Pudendal Hsematocele, p. 280. 
 
 III. Inflammation of Vulva, 1. Simple Vulvitis, p. 280. 
 
 2. Gangrenous Vulvitis, p. 280. 
 
 3. Follicular Inflammation, p. 281. 
 
 4. Erythema, p. 281. 
 
 5. Infantile Leucorrhoea, p. 281. 
 
 IV. Vulval Corroding Ulcer, p. 278. 
 
 V. Vulval Cancer, p. 278. 
 VI. Clitoritis, p. 73. 
 
 VII. Vascular Tumor of Urethra, p. 273. 
 VIII. Vaginal Diseases, 1. Vaginal Occlusion, p. 271. 
 
 2. Vaginismus, p. 272. 
 
 3. Vaginitis, p. 272. 
 
 4. Vaginal Prolapsus, p. 271. 
 
 5. Vaginal Tumors, p. 272. 
 IX. Pelvic Cellulitis, p. 200. 
 
 X. Pelvic Haematocele, p. 201. 
 
 XI. Uterine Diseases, 1. Amenorrhooa. p. 36. 
 
 2. Lcucorrhwa, p. 165; 273. 
 
 3. Dysmenorrlicea, p. 99. 
 
 4. Menorrhagia, p. 173. 
 
 5. Uterine Hemorrhage, p. 268. 
 
 6. Endometritis, p. 106. 
 
 7. Metritis, p. 174. 
 
 8. Ulceration, p. 270. 
 
 9. Cancer, p. 2»)5. 
 
 XII. Uterine Tumors, 1. Fibroid Growths, p. 268. 
 
 2. Polypi, p. 269. 
 
 3. Cystic Growths, p. 269. 
 
 XIII. Uterine Displacements, 1. Prolapsus and Procidentia, p. 266. 
 
 2. Retroflexion and Anteflexion, p. 267. 
 
 3. Retroversion and Antcversion, p. 267. 
 
 4. Inversion, p. 268.
 
 TABULAR SYNOPSIS. 
 
 Xlll 
 
 FEMALE ORGANS OF G E N E R A T I O N— (conilmMerf) : 
 
 XIV. Diseases of Ovaries and Oviducts. 
 
 XV. Impotence and Sterility, p. 150. 
 XVI. Gonorrhcea, p. 126. Urethritis, p. 263. 
 XVII. Syphilis, p. 247. 
 
 1. Ovaritis, p. 192. 
 
 2. Ovarian Tumors, p. 191. 
 
 3. Displacements of Ovary, p. 191. 
 
 4. Dropsy of Fallopian Tube, p. 116. 
 
 FEVERS (p. 113; 116): 
 
 I. Continued Fevers, 1. Simple Continued Fever, p. 237. 
 
 2. Typhus, p. 262. 
 
 3. Typhoid Fever, p. 261. 
 
 4. Relapsing Fever, p. 22.5. 
 
 II. Intermittent Fevers, 1. Intermittent Fever, or Ague, p. 155. 
 2. Brass-Founder's Ague, p. 51. 
 
 III. Remittent Fevers, 1. Remittent Fever, p. 225. 
 
 2. Yellow Fever, p. 282. 
 
 IV. Eruptive Fevers, 1. Rubeola, p. 232. 
 
 2. Small-Pox, p. 238. 
 
 3. Cow-Pox, p. 84. 
 
 4. Chicken-Pox, p. 69. 
 
 5. Measles, p. 171. 
 
 6. Scarlet Fever, p. 233. 
 
 7. Dengue, p. 92. 
 
 8. Erysipelas, p. 42. 
 
 9. Miliaria, p. 174. 
 10. Plague, p. 209. 
 
 FORMULA (p. 285): 
 I. Aliments, p. 289. 
 II. Alteratives and Resolvents, p. 293. 
 
 III. Antacids, p. 301. 
 
 IV. Antiseptics, p. 301. 
 
 V. Antispasmodics, p. 304. 
 VI. Astringents, p. 305. 
 VII. Baths, p. 309. 
 VIII. Cathartics and Anthelmintics, p. 312. 
 IX. Caustics and Counter-irritants, p. 319. 
 
 X. Diaphoretics and Diuretics, p. 321. 
 XI. Emetics and Expectorants, p. 324, 
 XII. Gargles and Inhalations, p. 326. 
 
 XIII. Lotions, Liniments, Collyria, and Ointments, p. 329. 
 
 XIV. Narcotics and Sedatives, p. 335. 
 XV. Refrigerants and Salines, p. 342. 
 
 XVI. Stimulants, p. 343. 
 XVII. Tonics, p. 345. 
 XVIII. Uterine Therapeutics, p. 354. 
 XIX. Climates for Invalids, p. 358. 
 XX. Mineral Waters, p. 380. 
 
 FURUNCULAR INFLAMMATIONS; 
 
 I. Boils, p. 50. 
 II. Carbuncles, p. 57. 
 
 III. Malignant Vesicle, p. 167. 
 
 IV. Styes, p. 245. 
 
 GOUT AND RHEUMATISM; 
 
 I. Gout, p. 126. 
 II. Acute Rheumatism, p. 229. 
 Ill^'hronic Rheumatism, p. 230. 
 IV. Rheumatoid Arthritis, p. 231.
 
 XIV TABULAR SYNOPSIS. 
 
 GOUT AND 'RE.'EJJ M AT IS^H— {continued): 
 
 V. Lumbago, p. 166 ; 230. 
 VI. Pleurodynia, p. 211 ; 230. 
 YII. Sciatica, p. 182; 230; 235. 
 VIII. Rheumatic Ophthalmia, p. 235. 
 
 IX. Gouty and Eheumatic Deafness, p. 87. 
 
 HEMORRHAGE (p. 130) : 
 
 I. Hemorrhagic Diathesis, p. 130. 
 II. Epistaxis, p. 112. 
 
 III. Cerebral Apoplex}', p. 44. 
 
 IV. Cerebral Hemorrhage, p. 44 ; 64. 
 V. Cephalohfematoma, p. 64. 
 
 VI. Otorrhagia, p. 190. 
 VII. Hsematoma Auris, p. 128. 
 VIII. Spinal Hemorrhage, p. 242. 
 IX. Stomatorrhagia, p. 245. 
 
 X. Hemoptysis, p. 129. 
 XI. Pulmonary Apoplexy, p. 219. 
 XH. Hffimatemesis, p. 128, 129. 
 
 XIII. Mehena, p. 173. 
 
 XIV. Apoplexy of Liver, p. 135. 
 XV. Haematuria, p. 129. 
 
 XVI. Menorrhagia, p. 173. 
 XVII. Uterine Hemorrhage, p. 268. 
 XVIII. Pudendal Ha-matocele, p. 280. 
 XIX. Pelvic Hematocele, p. 201. 
 XX. Scrotal Hematocele, p. 144. 
 
 HEART DISEASES: 
 
 I. Pericarditis, p. 202. Hydropericardium, p. 146, 202. 
 II. Endocarditis, p. 105. 
 III. Myocarditis, p. 177. 
 IV. Valvular Diseases, p. 60. 
 
 V. Cardiac Hypertrophy, p. 59. 
 VI. Cardiac Dilatation, p. 59. 
 VII. Cardiac Atrophy, 1. Simple Atrophy, p. 58. 
 
 2. Fatty Degeneration, p. 58. 
 8. Fatty Growth, 58. 
 VIII. Cyanosis, p. 86. 
 
 IX. Cardiac Rupture, p. 60. 
 X. Angina Pectoris, p. 39. 
 XI. Cardiac Aneurism, p. 58. 
 XII. Cardiac Cancer, p. 58. 
 
 XIII. Cardiac Functional Derangement, p. 59. 
 
 XIV. Intra-Thoracic Tumors, p. 158. 
 
 HERNIA (p. 140) : 
 
 
 
 I. 
 
 General Varieties, 
 
 p. 141, 1 
 
 . Reducible. 
 
 
 
 2 
 
 1. Irreducible. 
 
 
 
 3 
 
 1. Incarcerated. 
 
 
 
 4 
 
 ;. Strangulated. 
 
 II. 
 
 Special Hernise, p. 
 
 141, 1. 
 
 Oblique Inguinal 
 
 
 
 2. 
 
 Direct Inguinal. 
 
 
 
 3. 
 
 Congenital. 
 
 
 
 4. 
 
 Femoral. 
 
 
 
 5. 
 
 Umbilical. 
 
 
 
 6. 
 
 Ventral. 
 
 
 
 7. 
 
 Obturator. 
 
 
 
 8. 
 
 Ischiatic. 
 
 
 
 9. 
 
 Perineal. 
 
 
 
 10. 
 
 Vaginal. 
 
 
 
 11. 
 
 Labial. 
 
 
 
 12. 
 
 Diaphragmatic.
 
 TABULAR SYNOPSIS. 
 
 XV 
 
 INFLAMMATION (p. 151) ; 
 
 I. Nervous System, 1. 
 
 3. 
 4. 
 
 IV. Organs of Digestion, 1. 
 2. 
 3. 
 4. 
 
 Cerebral Meningitis, p. 65. 
 Cerobritis, p. 65. 
 Encephalitis, p. 65. 
 S{)inal Meningitis, p. 242. 
 
 5. Cerebro-Spinal Meningitis, p. 243. 
 
 6. Myelitis, p. 176. 
 
 7. Neuritis, p. 182. 
 
 II. Organs of Kespiration, 1. Laryngitis, p. 163. 
 
 2. Tracheitis, or Croup, p. 85. 
 
 3. Bronchitis, p. 51. 
 
 4. Pleurisy, p. 210. 
 
 5. Pneumonia, p. 211. 
 
 6. Pleuro-Pneumonia, p. 211. 
 III. Organs of Circulation, 1. Pericarditis, p. 202. 
 
 2. Endocarditis, p. 10-5. 
 
 3. Myocarditis, p. 177. 
 
 4. Aortitis, p. 41. 
 
 5. Phlebitis, p. 205. 
 Glossitis, p. 2-55. 
 Stomatitis, p. 244. 
 Parotitis, p. 199. 
 Tonsillitis, p. 257. 
 
 5. Pharyngitis, p. 204. 
 
 6. OEsophagitis, p. 185. 
 
 7. Gastritis, p. 122. 
 
 8. Duodenitis, p. 97. 
 
 9. Enteritis, p. 107. 
 
 10. Typhilitis, or Cfficitis, p. 55. 
 
 11. Perityphlitis, p. 204. 
 
 12. Colitis (Dysentery), p. 98. 
 
 13. Kectitis, p. 225. 
 
 14. Hepatitis, p. 187. 
 
 15. Pancreatitis, p. 193. 
 
 16. Splenitis, p. 244. 
 V. Urinary Organs, 1. Nephritis, p. 179. 
 
 2. Acute Desquamative Nephritis, p. 180. 
 
 3. Chronic Desquamative Nephritis, p. 181. 
 
 4. Acute Cystitis, p. 274. 
 
 5. Chronic Cystitis, p. 275. 
 
 6. Urethritis, p. 263. 
 
 VI. Male Organs of Generation, 1. Balanitis, p. 48. 
 
 2. Prostatitis, p. 218. 
 
 3. Testitis, p. 251. 
 VII. Female Organs of Generation, 1. Vulvitis, p. 280. 
 
 2. Clitoritis, p. 73. 
 
 3. Vaginitis, p. 272. 
 
 4. Pelvic Cellulitis, p. 200, 
 6. Metritis, p. 174. 
 
 6. Endometritis, p. 106. 
 
 7. Ovaritis, p. 192. 
 VIII. Eye, 1. Conjunctivitis, p. 77. 
 
 2. Sclerotitis, p. 235. 
 
 3. Corneitis, p. 81. 
 
 4. Choroiditis, p. 73. 
 
 5. Iritis, p. 159. 
 
 6. Eetinitis, p. 228. 
 IX. Bone, 1. Periostitis, p. 203. 
 
 2. Osteitis, p. 187. 
 
 3. Osteomyelitis, p. 187. 
 X. Various Organs and Tissues, 1. 
 
 2. 
 3. 
 4. 
 5. 
 6. 
 7. 
 
 Mammitis, p. 170. 
 Otitis, p. 188. 
 Peritonitis, p. 203. 
 Myositis, p. 177. 
 Angeioleucitis, p. 38. 
 Adenitis, p. 34. 
 Housemaid's Knee, p. 144. 
 Cellulitis Venenata, p. 64.
 
 Xvi TABULAR SYNOPSIS. 
 
 INTESTINAL DISEASES: 
 
 I. Duodenal Disease, 1. Duodenitis, p. 97. 
 
 2. Duodehal Dyspepsia, p. 97. 
 
 3. Perforating Ulcer , p. 97. 
 
 4. Cancer, p. 97. 
 II. Enteritis, p. 107. 
 
 III. Ca>citis, p. 55. Perityphlitis, p. 204. 
 
 IV. Dysentery, p. 98. 
 
 V. Diarrhoea, p. 94. Melaena, p. 173. 
 VI. Cholera, p. 70. 
 VII. Flatulence, p. 117; 261. 
 VIII. Colic, 1. Simple Colic, p. 74. 
 
 2. Copper Colic, p. 75. 
 
 3. Lead Colic, p. 164. 
 IX. Constipation, p. 79. 
 
 X. Intestinal Obstruction, p. 156. 
 XI. Intussusception, p. 159. 
 XII. Intestinal Worms, p. 158. 
 
 XIII. Intestinal Perforation, p. 157. 
 
 XIV. Intestinal Concretions, p. 156. 
 
 XV. Diseases of Kectum, 1. Kectitis, p. 225. 
 
 2. Foreign Bodies in Eectum, p. 119. 
 
 3. Rectal Ulcers, p. 225. 
 
 4. Rectal Stricture, p. 225. 
 
 5. Rectal Prolapsus, p. 224. 
 
 6. Rectal Polypus, p. 224. 
 
 7. Pruritus Ani, p. 218. 
 
 8. Rectal Neuralgia, p. 223. 
 
 9. Fistula in Ano, p. 117. 
 
 10. Haemorrhoids, p. 130. 
 
 11. Cancer, p. 222. 
 XVI. Hernia, p. 140. 
 
 KIDNEY DISEASES: 
 
 I. Inflammation, 1. Nephritis, p. 179. 
 
 2. Acute Desquamative Nephritis, p. 180. 
 
 3. Chronic Desquamative Nephritis, p. 181. 
 II. Eenal Degeneration, 1. Fatty Degeneration, p. 226. 
 
 2. Amyloid Degeneration, p. 227. 
 
 3. Cystic Degeneration, p. 227! 
 
 III. Hydronephrosis, p. 146. 
 
 IV. Renal Cancer, p. 226. 
 V. Renal Tubercle, p. 228. 
 
 VI. Renal Parasites, p. 228. 
 VII. Diabetes Mellitus, p. 92. 
 VIII. Diuresis, p. 95. Polyuria, p. 217. 
 IX. Chylous Urine, p. 73. 
 X. Hsematuria, p. 129. 
 XI. Urinary Deposits, p. 263. 
 XII. Urinary Calculi, p. 263. 
 
 XIII. Enuresis, p. 110. 
 
 XIV. Urajmia, p. 263. 
 
 XV. Supra-Renal Capsular Diseases, p. 246. 
 
 LARYNGEAL AND TRACHEAL DISEASES: 
 
 I. Aphonia, p. 42. 
 II. Laryngitis, 1. Acute Laryngitis, p. 163. 
 
 2. (Edema of Glottis, p. 164. 
 
 3. Chronic Laryngitis, p. 164. 
 
 III. Laryngismus Stridulus, p. 163. 
 
 IV. Dysphonia Clericorum, p. 101. 
 V. Diphtheria, p. 93. 
 
 VI. Croup, p. 85. 
 VII. Foreign Bodies in Air-Passages, p. 118. 
 VIII. Haemoptysis, p. 129.
 
 TABULAR SYNOPSIS. XVll 
 
 LIVEE DISEASES: 
 
 .1. Hepatic Congestion, 1. Passive Congestion, p. 134. 
 
 2. Active Congestion, p. 134. 
 
 3. Apoplexy of Liver, p. 135. 
 II. Hepatic Hypertrophy, p. 136. 
 
 III. Inflammation, 1. Hepatitis, p. 137. 
 
 2. Cirrhosis, p. 138. 
 
 3. Syphilitic Hepatitis, p. 138. 
 
 4. Inflammation of Bloodvessels, p. 139. 
 
 5. Of Biliary Ducts and Gall-Bladder, p. 139. 
 IV. Hepatic Atrophy, 1. Acute or Yellow Atrophy, p. 133. 
 
 2. Chronic Atrophy, p. 133. 
 V. Hepatic Degeneration, 1. Fatty Degeneration, p. 135. 
 
 2. Amyloid Degeneration, p. 135. 
 8. Pigment Liver, p. 136. 
 VI. Hepatic Tumors, 1. Cystic, p. 136. 
 
 2. Cavernous, p. 136. 
 
 3. Tubercular, p. 136. 
 
 4. Hydatid, p. 136. 
 VII. Hepatic Cancer, p. 134. 
 
 VIII. Gail-Stones, p. 120. 
 IX. Jaundice, p. 161. 
 X. Acholia, p. 33. 
 
 LUNG DISEASES: 
 
 I. Catarrh, p. 63. Cough, p. 83. 
 II. Influenza, p. 152. 
 
 III. Bronchitis, 1. Acute Bronchitis, p. 51. 
 
 2. Chronic Bronchitis, p. 52. 
 
 3. Catarrhus Senilis, p. 52. 
 
 4. Plastic Bronchitis, p. 52. 
 
 5. Mechanical Bronchitis, p. 53. 
 
 6. Secondary Bronchitis, p. 53. 
 
 7. Hay-Asthma, p. 53. 
 
 IV. Hooping-Cough, p. 143. 
 V. Asthma, p. 46. 
 
 VI. Emphysema, 1. Vesicular, p. 105. 
 
 2. Interlobular, p. 105. 
 VII. Pulmonary Condensation, 1. From Various Causes, p. 220. 
 
 2. Pulmonary Apoplexy, p. 220. 
 
 3. Cirrhosis of Lung, p. 73 ; 220. 
 
 4. Acquired Pulmonary Collapse, p. 220. 
 
 5. Atelectasis, p. 48; 221. 
 VIII. Pleurisy, p. 210. Pleuro-Pneumonia, p. 211. 
 
 IX. Hydrothorax, p. 147 ; 210. 
 
 X. Pneumothorax, p. 213. 
 
 XI. Empyema, p. 105 ; 210. 
 
 XII. Pneumonia, p. 211. 
 
 XIII. Pulmonary Gangrene, p. 221. 
 
 XIV. Phthisis, p. 206: 
 
 XV. Pulmonary Cancer, p. 219. 
 XVI. Intra-Thoracic Tumors, p. 158. 
 XVII. Foreign Bodies in Air-passages, p. 118. 
 XVIII. Dyspnoea, p. 102; Orthopncea, p. 187. 
 XIX. Haemoptysis, p. 129. 
 
 LYMPHATIC DISEASES: 
 
 I. Angeioleucitis, p. 38. 
 
 II. Adenitis, p. 34 ; 54. 
 
 III. Cellulitis Venenata, p. 64. 
 
 IV. Tabes Mesenterica, p. 250.
 
 XVlll 
 
 TABULAR SYNOPSIS. 
 
 6. 
 
 7. 
 
 8. 
 
 II. Diseases of Testicle, 
 
 MALE ORGANS OF GENEEATION (Diseases of ) : 
 
 I. Diseases of Penis, 1. Balanitis, p. 48. 
 
 2. Hypospadias and Epispadias, p. 148. 
 
 3. Phimosis, p. 204. 
 
 4. Paraphimosis, p. 199. 
 
 5. Priapism, p. 217. 
 Prostatitis, p. 218. 
 Prostatic Enlargement, p. 217. 
 Cancer, p. 201. 
 
 1. Acute Testitis, p. 251. 
 
 2. Chronic Testitis, p. 252. 
 
 3. Abscess and Fungus, p. 252. 
 
 4. Scrofula, p. 253. 
 
 5. Neuralgia, p. 251. 
 
 6. Tumors, p. 251. 
 
 7. Varicocele, p. 273. 
 
 8. Hydrocele and Hematocele, p. 144. 
 
 III. Diseases of Scrotum, 1. Acute ffidema, p. 236. 
 
 2. Elephantiasis, p. 236. 
 
 3. Chimney-Sweeper's Cancer, p. 69. 
 
 IV. Impotence and Sterility, p. 150. 
 
 V. Gonorrhoea, p. 125. Urethritis, p. 263. 
 VI. Spermatorrhoea, p. 239. 
 VII. Syphilis, p. 247. Bubo, p. 54. 
 VIII. Syphilization, p. 249. 
 IX. Syphiliphobia, p. 247. 
 
 MELANOSIS: 
 
 I. True Melanosis, p. 172. 
 II. Spurious Melanosis, p. 173. 
 
 MISCELLANEA: 
 
 I. Expectation of Life, p. 115. 
 II. Death Causes, p. 87. 
 
 III. Weight of Body, p. 287. 
 
 IV. Temperature of Body, p. 250. 
 V. Spirometry, p. 243. 
 
 VI. Suspended Animation, p. 246. 
 VII. Bites of Venomous Keptiles, p. 50. 
 VIII. Bites of Rabid Animals, p. 49. 
 IX. Obesity, p. 183. 
 X. Dyspnoea, p. 102. Orthopncea, p. 187. 
 XL Sleeplessness, p. 237. 
 XII. Cough, p. 83. 
 
 XIII. Hiccough, p. 142. 
 
 XIV. Dysphagia, p. 101. 
 
 XV. Vomiting and Retching, p. 277. 
 XVI. Blows and Bruises, p. 50. 
 XVII. Burns and Scalds, p. 54. 
 XVIII. Anorexia, p. 39. 
 
 XIX. Headache, p. 131. Vertigo, p. 274. 
 
 MOUTH DISEASES: 
 
 I. Inflammation, &c., 1. Follicular Stomatitis, p. 244. 
 
 2. Ulcerative Stomatitis, p. 244. 
 
 3. Cancrum Oris, p. 245. 
 
 4. Stomatorrhagia, p. 245. 
 II. Toothache, p. 258. 
 
 III. Aphthaj of Mouth, p. 43. 
 
 IV. Parotitis, p. 199. 
 V. Tonsillitis, p. 2-57. 
 
 VI. Elongation of Uvula, p. 204,
 
 TABULAR SYNOPSIS. XIX 
 
 MUSCULAK DISEASES: 
 
 I. Myalgia, p. 175. 
 II. Pleurodynia, p. 211. 
 
 III. Myositis, p. 177. 
 
 IV. Phantom, or Muscular Tumors, p. 175. 
 V. Contusions of Abdominal Parietcs, p. 80. 
 
 VI. Abscess of Abdominal Parictes, p. 33. 
 VII. Lumbar, Psoas, and Iliac Abscess, p. 166. 
 
 NERVOUS DISEASES: 
 
 I. Hysteria, p. 148. Bed Case, p. 49. 
 II. Catalepsy, p. 62. Ecstasy, p. 102. 
 
 III. Chorea, p. 72. 
 
 IV. Tetanus, p. 253. Trismus Nascentium, p. 2G0. 
 V. Epilepsy, p. 110. Convulsions, p. 80. 
 
 VI. Sleeplessness, p. 237. 
 VII. Hypochondriasis, p. 147. Syphiliphobia, p. 247. 
 VIII. Inflammation, &c., 1. Neuritis, p. 182. 
 2. Neuroma, p. 183. 
 IX. Neuralgia, 1. Tic Douloureux, p. 181. 
 
 2. Hemierania, p. 132; 182. 
 
 3. Sciatica, p. 182 ; 235. 
 X. Hooping-Cough, p. 143. 
 
 XI. Asthma, p. 46. 
 XII. Laryngismus Stridulus, p. 163. 
 
 XIII. Nostalgia, p. 183. 
 
 XIV. Headache, p. 131. 
 
 NEURALGIA (p. 181): 
 
 I. Neuralgic Toothache, p. 258. * 
 
 II. Tic Douloureux, p. 181 ; 254. 
 
 III. Hemierania, p. 132 ; 182. 
 
 IV. Sciatica, p. 182; 23-5. 
 V. Mastodynia, p. 171. 
 
 VI. Intercostal Neuralgia, p. 155. , 
 
 VII. Neuralgic Dysraenorrhcea, p. 99. 
 VIII. Neuralgia of Testicle, p. 251. 
 IX. Neuralgia of Rectum, p. 223. 
 X. Spasm of Bladder, p. 276. 
 
 NOSE DISEASES: 
 I. Lipoma, p. 179. 
 
 II. Polypus, p. 179. 
 
 III. Oz»na, p. 192. 
 
 IV. Epistaxis, p. 112. 
 V. Rhinolithes, p. 231. 
 
 VI. Rhinorrhcea, p. 231. 
 
 PANCREATIC AND SPLENIC DISEASE: 
 I. Pancreatitis, p. 193. 
 
 II. Pancreatic Tumors, Cancer, &c., p. 193. 
 
 III. Pancreatic Calculi, p. 193. 
 
 IV. Splenitis, &c., p. 244. 
 
 V. Splenic Enlargement, p. 244. 
 
 PHARYNGEAL AND (ESOPHAGEAL DISEASES 
 
 I. Dysphagia, p. 101. 
 II. Pharyngitis, 1. Erysipelatous Inflammation, p. 204. 
 
 2. Syphilitic Ulceration, p. 204. 
 
 3. Elongation of Uvula, p. 204. 
 
 III. Retro-Pharyngeal Abscess, p. 229. 
 
 IV. CEsophagitis, p. 185.
 
 XX 
 
 TABULAR SYNOPSIS. 
 
 PHAKYNGEAL AND (ESOPHAGEAL BIS^E AS ES— (continued): 
 
 V. Oesophageal Cancer, p. 184. 
 VI. Esophageal Stricture, p. 184. 
 YII. (Esophagism, p. 185. 
 
 POISONS (p. 213): 
 
 I. Irritants, p. 213. 
 
 1. Acids and their Bases, Mineral Acids, Sulphuric, 
 
 Nitric. 
 
 Hydrochloric. 
 
 Mixed Acids. 
 Vegetable Acids, Acetic. 
 
 Tartaric. 
 
 Oxalic. 
 Phosphorus. 
 
 2. Alkalies and Alkaline Salts, Ammonia, Potash, Soda, and their carbonates. 
 
 Nitrate, Sulphate, and Bi tartrate of Potash. 
 Lime, Baryta and its salts. 
 
 Arsenic. 
 
 Mercury. 
 
 Lead. 
 
 Copper. 
 
 Antimonial compounds. 
 
 Zinc, Silver, Tin, Bismuth, Chi'ome, Iron. 
 Vegetable and Animal Irritants. 
 Irritant Gases. 
 
 8. Metallic Compounds, 
 
 II. Narcotics, p. 213. 
 
 1. Opium. 
 
 2. Hydrocyanic Acid. 
 
 3. Nitro-Benzole, Aniline. 
 
 4. Chloroform, ^ther, Amylene. 
 6. Alcohol. 
 
 6. Henbane, Lettuce-opium, Nightshade. 
 
 7. Narcotic Gases. 
 
 III. Narcotico-Irkitants, p. 213. 
 
 1. Nux vomica, Brucia, Strychnia. 
 
 2. Belladonna, Aconite, Stramonium, Colchicum, Hellebore. 
 
 3. Digitalis, Tobacco, Lobelia Inflata, Camphor. 
 
 4. Hemlock, Cocculus Indicus, Darnel-seeds. 
 
 5. Laburnum, Yew. 
 
 6. Ergot of Bye, Poisonous Eungi. 
 
 SKIN APPENDAGES (Diseases of ) ; 
 
 I. Alopecia, or Baldness, p. 35. 
 II. Trichiasis Ciliorum, p. 259. 
 
 III. Onyxis, p. 18(5. 
 
 IV. Onychia, p. 186. 
 
 V. Verrucas, or Warts, p. 274. 
 VI. Phthiriasis, or Lousiness, p. 206. 
 VII. Trichiniasis, p. 259. 
 VIII. Dracontiasis, p. 95. 
 IX. Mycetoma, p. 176. 
 
 SKIN DISEASES: 
 
 Order I. Exanthemata, 1. Erythema, p. 114. 
 lloseola, p. 232. 
 
 Order II. Vesiculas, 
 
 2. 
 
 3. Urticaria", p. 270. 
 
 1. Sudamina, p. 245. 
 
 2. Miliaria, p. 176. 
 
 8. Herpes, p. 142 ; 284. 
 4. Pemphigus, p. 201. 
 6. Kupia, p. 233.
 
 TABULAR SYNOPSIS. XXI 
 
 SKIN DISEASE S—{conti7iued) : 
 
 Order III. Pustulfc, 1. Ecthyma, p. 102. 
 2. Impetigo, p. 150. 
 Order IV. Parasitici, 1. Tinea Tonsurans, p. 254. 
 
 2. Tinea Favosa, p. 254. 
 
 3. Tinea Decalvans, p. 255. 
 
 4. Tinea Sycosis, p. 255. 
 
 5. Tinea Versicolor, p. 255, 
 
 6. Plica Polonica, p. 211. 
 
 7. Scabies, p. 233. 
 Order V. Papula3, 1. Strophulus, p. 245. 
 
 2. Lichen, p. 165. 
 
 3. Prurigo, p. 218. 
 Order VI. Squamae, 1. Lepra, p. 164. 
 
 2. Psoriasis, p. 219. 
 
 3. Pityriasis, p. 209. 
 
 4. Eczema, p. 103. 
 
 5. Ichthyosis, p. 149. 
 Order VII. Tubercula, 1. Barbadoes Leg, p. 48. 
 
 2. MoUuscum, p. 175. 
 
 3. Acne, p. 33. 
 
 4. Lupus, p. 167. 
 
 6. Framboesia, p. 119. 
 
 6. Keloid, p. 162. 
 
 7. Vitiligo, p. 277. 
 
 SPINAL COED DISEASES: 
 I. Epilepsy, p. 110. 
 II. Chorea, p. 72. 
 
 III. Inflammation, &c., 1. Spinal Meningitis, p. 242. 
 
 2. Cerebro-Spinal Meningitis, p. 243. 
 8. Myelitis, p. 176. 
 
 4. Spinal Hemorrhage, p. 242. 
 
 5. Tumors, p. 243. 
 
 6. Hydrorachis, p. 147 ; 240. 
 
 7. Concussion, p. 76. 
 
 8. Spinal Irritation, p. 242. 
 
 IV. Paralysis, 1. General Paralysis, p. 194. 
 
 2. Hemiplegia, p. 194. 
 
 3. Paraplegia, p. 195. 
 
 4. Local Paralysis, p. 195. 
 6. Keflex Paralysis, p. 225. 
 
 6. Progressive Locomotor Ataxy, p. 196. 
 
 7. Hysterical and Rheumatic Palsy, p. 197. 
 
 8. Progressive Muscular Atrophy, p. 197. 
 
 9. Mercurial Palsy, p. 198. 
 
 10. Lead Palsy, p. 198. 
 
 11. Paralysis Agitans, p. 199. 
 V. Catalepsy, p. 62. Ecstasy, p. 102. 
 
 VI. Tetanus, 1. Trismus, or Locked-jaw, p. 253. 
 
 2. Opisthotonos, p. 253. 
 
 3. Emprosthotonos, p. 253. 
 
 4. Pleurosthotonos, p. 253. 
 
 5. Trismus Nascentium, p. 260. 
 VII. Convulsions, p. 80. Eclampsia Nutans, p. 102. 
 
 VIII. Spina Bifida, p. 240. 
 
 STOMACH DISEASES: 
 
 I. Dyspepsia, 1. Simple Dyspepsia, p. 100. 
 
 2. Gastralgia, or Heartburn, p. 121. 
 
 3. Gastrodynia, or Stomach-cramp, p. 124. 
 
 4. Pyrosis, or Water-brash, p. 222. 
 6. Slow Digestion, p. 100. 
 
 6. Bulimic Dyspepsia, p. 54.
 
 Xxii TABULAR SYNOPSIS. 
 
 STOMACH DISEASE S—{co7itinued) : 
 
 II. Gastritis, 1. Acute Gastritis, p. 122. 
 
 2. Chronic Gastritis, p. 122. 
 
 3. Gastric Catarrh, p. 122. 
 
 4. Induration of Pylorus, p. 123. 
 
 5. Dihitation of Stomach, p. 123. 
 
 III. Gastric Ulcer, p. 121. 
 
 IV. Gastric Cancer, p. 121. 
 
 V. Gastro-cutaneous Eistula, p. 124. 
 VI. Gastro-colic Fistula, p. 124. 
 VII. Hsematemesis, p. 128. Vomiting and Retching, p. 277. 
 VIII. Melaena, p. 178. 
 
 THYEOID GLAND DISEASES: 
 I. Bronchocele, p. 53. 
 II. Cretinism, p. 85. 
 III. Exophthalmic Goitre, p. 53; 128. 
 
 TONGUE DISEASES: 
 
 I. Glossitis, p. 255. 
 II. Ulcers, p. 255. 
 
 III. Cancer, p. 256. 
 
 IV. Cracked Tongue, Tumors, &c., p. 256. 
 V. Aphthje, p. 43. 
 
 TOOTHACHE: 
 
 I. Caries, p. 258. 
 II. Inflammation of Pulp, p. 258. 
 
 III. Necrosis of Fangs, p. 258. 
 
 IV. Neuralgia, p. 258. 
 
 TUBERCULAR AND STRUMOUS DISEASES: 
 
 I. Tuberculosis, p. 260. Scrofula, p. 236. 
 II. Phthisis, p. 206. Phthisis Laryngea, p. 164. 
 
 III. Hydrocephalus, p. 145. 
 
 IV. Tabes Mesenterica, p. 2.50. 
 
 V. Tubercular Peritonitis, p. 203. 
 VI. Tubercular Meningitis, p. 68. 
 VII. Tuberculosis of Liver, p. 136. 
 VIII. Renal Tubercle, p. 228. 
 IX. Strumous Abscesses, p. 236. 
 
 X. Strumous Adenitis, p. 34 ; 236. 
 XI. Strumous Ulcers, p. 236. 
 XII. Strumous Ophthalmia, p. 79. 
 
 XIII. Scrofulous Testicle, p. 253. 
 
 XIV. Rickets, p. 232. 
 
 XV. Angular Curvature of Spine, p. 241. 
 
 TUMORS (Benign): 
 
 1. Polypi, 1. Nasal, p. 179. 
 
 2. Rectal, p. 224. 
 
 3. Vaginal, p. 272. 
 
 4. Uterine, p. 269. 
 II. Cerebral Tumors, p. 67, 
 
 III. Intra-Thoracic Tumors, p. 158. 
 
 IV. Spinal Cord Tumors, p. 243. 
 V. Hepatic Tumors, p. 136. 
 
 VI. Tumors of Testicles, p. 251. 
 VII. Mammary Tumors, p. 168. 
 VIII. Muscular, or Phantom Tumors, p. 175.
 
 TABULAR SYNOPSIS. XXlii 
 
 TUMOR S— (continued) : 
 
 IX. Renal Tumors, p. 146; 22G ; 228. 
 X. Vesioal Tumors, p. 276. 
 XI. Vulviil Tumors, p. 279. 
 XII. Vascular Tumors of Urethra, p. 273. 
 
 XIII. Vaginal Tumors, p. 272. 
 
 XIV. Ovarian Tumors, p. 191. 
 XV. Uterine Tumors, p. 268. 
 
 XVI. Hsemorrhoids, p. 130. 
 
 ULCERS: 
 
 I. Cancerous Ulceration, p. 56. 
 
 II. Rodent Ulcer, p. 232. 
 
 III. Scrofulous Ulcers, p. 236. 
 
 IV. Syphilitic Ulcers, p. 248. 
 V. Lupus, p. 167. 
 
 VI. Typhoid Ulcers, p. 261. 
 
 VII. Varioloid Ulcers, p. 238. 
 
 VIII. Dysenteric Ulcers, p. 98. 
 
 IX. Ulcers of Cornea, p. 82. 
 
 X. Ulcers of Tongue, p. 256. 
 
 XI. Gastric Ulcer, p. 121. 
 
 XII. Ulcers of Duodenum, p. 97. 
 
 XIII. Ulcers of Rectum, p. 225. 
 
 XIV. Vulval Corroding Ulcer, p. 278. 
 XV. Ulceration of Cervix Uteri, p. 270. 
 
 XVI. Chilblains, p. 69. 
 
 XVII. Chapped Hands, p. 69. 
 
 XVIII. Onychia, p. 186. 
 
 VENEREAL DISEASES (p. 274) : 
 I. Balanitis, p. 48. 
 II. Vulvitis, p. 280. 
 
 III. Gonorrhoea, 1. Gonorrhoea in Male, p. 125. 
 
 2. Chronic Gonorrhoea, or Gleet, p. 126. 
 
 3. Gonorrhoea in Female, p. 126. 
 
 IV. Syphilis, 1. Primary Syphilis, p. 248. 
 
 2. Constitutional Syphilis, p. 248. 
 8. Infantile Syphilis, p. 259. 
 V. Bubo, p. 54. 
 VI. Syphiliphobia, p. 247. 
 VII. Svphilization, p. 249. 
 VIII. Syphilitic Keratitis, p. 82. 
 IX. Syphilitic Iritis, p. 160. 
 
 X. Gonorrhoeal Ophthalmia, p. 78. 
 XI. Syphilitic Tumors of Brain, p. 67. 
 XII. Syphilitic Laryngitis, p. 163. 
 
 XIII. Syphilitic Bronchitis, p. 53. 
 
 XIV. Syphilitic Ulceration of Fauces, p. 204. 
 XV. Syphilitic Affections of Tongue, p. 256 ; 257. 
 
 XVI. Syphilitic Hepatitis, p. 138. 
 XVII. Syphilitic Sarcocele, p. 252. 
 XVIII. Syphilitic Ulceration of Labia Uteri, p. 270. 
 XIX. Syphilitic Lepra, p. 164. 
 XX. Syphilitic Rupia, p. 233.
 
 AN 
 
 INDEX OF DISEASES. 
 
 ABSCESS OF ABDOMINAL WALLS. — Im-oiu Ah.«Y,fo, (o lonn sm 
 :»l>sci'ss: Ahii,}ni,-ii, \]\c lirll\ .-- Mav rosult tVoin i-xtoiMial violoiu-i". fiirim- 
 cular intlamiiiation, niul orysipolas ; ov iVom ox ton si on of disoaso in (>llior 
 [tai'ls. Man\ oxaniplos ot' hillor: Inllaniniation and siippiii'alion of 
 voiMnilorni appendix ot' ctrciuu, (ho pus workino- its wa'y to siii-laoo sonu*- 
 wiiore about rii;lit iuii-uinal rooion. — Su}i]Mirat ivo intlainniati^ry action 
 apt to (H'cur in aroolar t issuo of polvis ; in oithor ovary, ospot'ially in 
 dolii'alo and strumous wonuMi; :il>si'i'ss at'torwarils points in ono of 
 i;roius, in hypoi^astrie roii'ion, or in vagina. ho\vol, «!i;c'. — Inllaniniation 
 and suppuration ot" adipose and ari'oiai' tissues around one of Uidiieys 
 (perineplu'itie abseoss) may occur tViun Mows or tiills ujion hack, or 
 trom dei'angenient of ijeneral lieaith. In favoralde cases, ahsi-ess ])oin(s 
 in oui" loin : occasionally, ])us Imrrows amongst dt)rsal niuscles, l>ein^ 
 ultimately discharn-ed into ui^Mcr, or into cavity ot" jteritoneum. — A cir- 
 cumscribed abscess may loiiu in pi'ritoneum, trom partial ov <;-enei'al 
 pei'itonit is : (he pus. contined by ailhesions, either approai'hes surface 
 at some ])art. of abdominal wail or bursts into sac of peritoneum, or into 
 bowel. iVc. — In all tbrms, when ahsi'css ])c)in(s, i(, is to hv caretuHy 
 opened. Strength to bo su])por(ed by ammonia and bark, oi- (piininc 
 and steel: animal food, nulk, cod-liver oil, n\alt licpiors. — See (\iiitusiot>ji 
 ol' AhiloDiiiuil Witlh ; Oi'iU-ifis : Pel ric (\l hi litis, ikv. 
 
 ACHOLIA. — From 'A, privative; x<'^V> ''''^'- '^.y»^>- Alh^ciiCi' 0/ />//«•. — 
 Arros( of (ho functions of the liver; so (hat matters from which bilo is 
 formed, accumnhUe in (he blood, producing (oxivsmia. — It arises in cer- 
 tain diseases of liver, such as acute atrophy, impermeability oi' tho 
 bile-ducts, cirrhosis, extensive cancer, fatty degeneration, i^c. 
 
 Symi'toms. — Abnormal states of nervous system. Kxci(ement. Noisy 
 delirium, (\)nvulsions. Typhoid pros(rati()n. (\>ma. llemoi-rhagc 
 from stomach and bowels. Kcchyn\oses. Jaundici^ (in a few instances). 
 
 Trkaiimknt. — Active purgatives. C'i-o(on oil, KiS, IDI. rodojihy llin, 
 D>0. lienzoii^ acid, 45). llydrot'ldora(e of ammt)nia, tiO. JNitro-hydro- 
 chloric acid, i>7S. — See Iltpatic Atrophy. 
 
 ACINESIA. — From W, ])i-iv. ; xi\^r}<n(;, motion. Synon. Immobilitas ; 
 Eriiiiiit. — Fai'alysis of juotion. — See Pdrah/sis. 
 
 ACNE. — l.'erha|)s a corru))tion of ^Axfuxi, pimples on the face at the 
 age of puberty, or from 'A, priv. and xviut, to itch, because there is an 
 
 3
 
 34 Addison's disease — adenitis. 
 
 absence of irritation, i^ynou. Gvtta JRosacea ; Copper Nose ; Stonepock. — 
 A chronic tubercular sliin affection; characterized by small isolated 
 pustules, with deep red bases. These pustules, after suppurating and 
 bursting, leave behind them minute and hard red tumors, the seat of 
 which appears to be the sebaceous follicles of skin. 
 
 Varieties. Three kinds, — acne simplex, acne indurata, and acne rosa- 
 cea : characteristic distinctions indicated by their names. Acne sim- 
 plex and acne indurata, most common about puberty; appear on fore- 
 head or sides of cheeks; are very protracted and frequently leave in- 
 delible cicatrices. Acne rosacea attacks the nose : often connected with 
 stomach or liver disease : mostly seen in persons of advanced years, 
 especially if they have been bons vivants, &c. 
 
 Treatment. Attention to digestive and uterine functions. Arsenic, 
 52. Creasote. Corrosive sublimate. Green iodide of mercury. Nitro- 
 hydrochloric acid. Solution of potash. Cod-liver oil. — Warm bathing. 
 Iodide of sulphur ointment. Calomel ointment. Red iodide of mercury 
 ointment. 
 
 ADDISON'S DISEASE. — Applied to a peculiar degeneration of the 
 gupra-renal capsules. According to Addison the prominent symptoms 
 were discoloration of the skin and incurable anaemia. It is now said 
 that the disease may exist without the skin becoming of a dingy or 
 fimoky hue. — See Supra-Renal Capsular Disease. 
 
 ADENITIS. — From Mo^^v, a gland ; terminal -itis. Synon. Phlegmasia 
 Glandulosa. — Inflammation of the lymphatic glands may accompany 
 disease of lymphatic vessels, or it occurs independently. Simple adenitis 
 common after eruptive fevers. Tubercular adenitis very frequently met 
 with in strumous subjects. 
 
 Symptoms. Acute form : Feeling of malaise: slight chills: sympto- 
 matic fever. One or more glands become swollen, hot, hard, tender, 
 painful. As tumefaction increases, skin over gland becomes red or livid. 
 If convoluted tubes get obstructed, surrounding tissues rendered oedem- 
 atous. Unless resolution occur, or acute stage subsides into chronic, 
 suppuration takes place : abscess forms in interior of gland, or in sur- 
 rounding areolar tissue. 
 
 Chronic variety : Induration with persistent enlargement. Pain and 
 heat slight. Skin retains its natural color. Areolar tissue unaftected, 
 so that gland remains movable. 
 
 Strumous adenitis: Usually chronic. Glands of neck, and those about 
 base and angle of lower jaw, more frequently affected than any others. 
 Subjects of this form are especially young children, though it is not a 
 rare affection of sti'umous adults. Rarely any premonitory symptoms: 
 first indication of the disease an indolent swelling of one or more 
 glands. If mischief increase, and especially if there be a tendency to 
 suppuration, system suffers considerably : the already weak patient 
 becomes irritable and restless, tongue gets furred, pulse quick and 
 feeble, bowels costive, appetite fails, urine scanty and loaded with urates. 
 Where general health is very bad, inflamed glands rapidly undergo dis- 
 organization ; surrounding areolar tissue and skin get involved; exten- 
 sive indolent ulcers result. When lymphatic glands of the mesentery 
 are affected with strumous inflammation, a special form of disease is set 
 up (Tabes Mesenterica). — For Syphilitic adenitis, see Bubo. Malignant 
 adenitis, see Cancer. 
 
 Treatment. Carbonate of ammonia, 301. Chlorate of potash, 61. 
 Ammonia and bark, 371. Quinine, 879. Quinine and steel, 380. Iodide 
 of ammonium and bark, 38. Phosi^hate of iron, 405. Cod-liver oil.
 
 AGALACTIA — AMAUROSIS. 35 
 
 Bromide of Mmnionium. Ilj'drochlorate of ammonia. Conium. Iodide 
 of iron. Coi-rosive sublimate. Eed iodide of mercur3\ Nourisliing 
 food : milk or cream. Sea air. Water dressing. Iodine liniment. Dilu- 
 ted red iodide of mercury ointment. Iodide of lead ointment. 
 
 AGALACTIA. — From 'A, priv. ; yd?.a, milk. Sj^non. Defectus Lactis ; 
 Oligogalactia. A diminution or complete absence of milk in nursing 
 women. May be caused by general weakness of constitution ; long- 
 continued mental anxiety ; exhausting disease; general plethora; acute 
 or chronic disease of breasts or nipples; torpor of the mammee; return 
 of menstruation while suckling; approach of change of life. 
 
 Treat^fent. Unless cured, infant must be weaned to prevent its 
 suffering from insufficient nourishment. See F. 427. 
 
 AGUE. — From the French Aigu, acute. See Intermitteyit Fever. 
 
 ALCOHOLISM. — Alcohol is a poison which especially affects the 
 nervous centres and liver. In a large dose it ma}" destroy life imme- 
 diately. ^eQ Delirixim Treviens ; Dipsomania; Poisons. 
 
 ALOPECIA. — From 'A^.w~r^^. a fox, — because this animal is said to be 
 liable to baldness. Synon. Capillorvm Defluvimn ; Lapsus Pilonim ; Bald- 
 ness; Cah'ities (Calvus, bald). — Loss of hair may be temporary or per- 
 manent. Senile calvities usually takes place gradually : hair first be- 
 comes thin on crown of head, or on temples and forehead. A con- 
 sequence of general loss of power: hair follicles participate in general 
 weakening of nutritive functions. As follicular apparatus gets de- 
 stroyed, the loss is generally irremediable. 
 
 In baldness occurring from debility, hemorrhages, fevers, tuberculosis, 
 syphilis, &c., the hair follicles remain entire, though inactive. Such 
 cases generally curable. 
 
 Treatment. Nourishing food. Quinine and steel, 380. Cod-liver 
 oil. Scalp to be well brushed : to be washed with cold water every 
 morning. Hairs which are withered and split to be cut off close to 
 scalp. Blisters. Ammonia and cantharides liniment, 287. Cantha- 
 rides, castor oil, balsam of tolu, &c., 287. Iodide of sulphur ointment, 
 310. Creasote and sulphur ointment, 311. Diluted iodine liniment. 
 Diluted liniment of cantharides. Solution of ammonia. Liniment of 
 turpentine and acetic acid. Balsam of Peru. Glj^cerine. Oil of rose- 
 mary (Oleum Eosmarini). Oil of marjoram (Oleum Origani). 
 
 AMAUROSIS. — From 'A/jLaupow, to obscure. Synon. Gutta serena. 
 Partial or complete loss of vision from disease of brain, optic nerve, or 
 retina. Reflex amaurosis due to remote causes, — irritation of teething, 
 intestinal worms, ovarian or uterine disease, pregnancy, &c. 
 
 Symptoms. Patient's gait and expression of countenance attract at- 
 tention. He walks with an air of uncertainty : his eyes, instead of being- 
 directed towards surrounding objects, have an unmeaning look — ap^^ear 
 to be staring at nothing. In incomplete amaurosis, movements of iris 
 sluggish and pupil dilated: in total blindness, pupil greatly dilated and 
 iris immovable. When both eyes are affected, they are often unnatu- 
 rally prominent and of an unhealthy color: sclerotica frequently of a 
 yellow hue, and covered with varicose vessels. Ophthalmoscope re- 
 veals either, — blood extravasations from retina or choroid ; or effusions 
 of serum between retina and choroid; or irregular patches of black 
 pigment scattered over retina, or yellowish spots (fatty degeneration); 
 or optic nerve enlarged and irregular in outline, or surrounded by dusky
 
 36 AMBLYOPIA AMENORRHCEA. 
 
 halo, or with a crescentic patch at margin, or of an extreme whiteness 
 (from degeneration) with chronic congestion of retina. 
 
 In commencement, failure of sight only experienced occasionally, as 
 after long-continued exertion of the eyes, reading by candlelight, &c. 
 Sometimes it begins with indistinct vision — cnnblyopia ; or objects appear 
 double — diplopia; or only one-half of an object may be seen — hemiopia. 
 At same time, frequently headache: ocular spectra become visible, 
 patient complaining of musca) volitantes. 
 
 Another form of partial blindness is that in which patient can only 
 see in broad daylight, being blind during remainder of twenty-four 
 hours. This complaint — heoieralopia — usually met with in those who 
 have been exposed to strong glaring light of tropics. In nyctalopia, 
 converse condition of hemeralopia, vision most acute during twilight. 
 
 Treatment. Difficult to lay down rules, since the causes are so va- 
 rious and opposite. In all instances, attention to general health. Each 
 case then to be studied in all its bearings, especially with reference to 
 the cause. When manifestly resulting from reflected irritation of worms, 
 decayed teeth, &c., treatment obvious. When from inflammation, — 
 strict quiet, warm baths, and low diet may be necessary: iodide of po- 
 tassium; aconite; arnica; calomel?; bloodletting. When from vascu- 
 lar exhaustion or nervous debility, — preparations of iron, bark, good 
 diet, sea air, and cold bathing. Strychnia, in some few examples, may 
 stimulate a torpid optic nerve itito action. Electricity acts in same 
 way. Counter-irritants behind ears, or to nape of neck, or to shaven 
 scalp. W^here there is degeneration of optic nerve all remedies useless. 
 
 AMBLYOPIA. — From ' J,a/?Au?, obtuse or dull ; m(/', the eye. Synon. 
 Diminished Acuteness of JRetitial Perception. Weakness of sight from 
 disease of brain, of optic nerve, or of retinal expansion of optic nerve. — 
 See Amaurosis. 
 
 AMENORRHCEA. — From 'A, priv. ; /7.r^v, a month; piw, to flow. — An 
 absence of the menstrual flow. Two varieties: 
 
 1. Retention of Menses. — The catamenia are secreted, but do not 
 escape externally. May arise from occlusion of vagina; from an im- 
 perforate OS uteri. Menses accumulate in uterine cavity, forming in 
 time an appreciable abdominal tumor. An outlet must be made for the 
 menstrual accumulation by very cautiously incising or puncturing ob- 
 structing membrane. If no spot or dimple, marking site where os uteri 
 should exist, can be found, it may be necessary to puncture uterus 
 through rectum. All such operations attended with danger. 
 
 2. Suppression of Menses. — Most common form of amenorrhoea. The 
 flux having been properly established, and having appeared regularly 
 for a longer or shorter time, becomes prematurely arrested. 
 
 May occur suddenly, while discharge is on, from mental shock, set- 
 ting in of acute disease, exposure to damp or cold. Takes place gradu- 
 ally; flow not returning at proper time, or becoming less and less for 
 several periods, and then entirely stopping. More constitutional dis- 
 turbance in abrupt than gradual suppression. Latter most to be feared, 
 as often indicative of more serious cause (severe ansemia, 2)hthisis, al- 
 buminuria, &c.). Care necessary not to overlook pregnancy. 
 
 Treatment. — If there be plethora : Nitric acid, taraxacum, and senna, 
 147. Aloes, senna, and suli)hate of magnesia, 150. Gamboge, aloes, 
 and blue pill, 174. Podophyllin and aloes, 422. Nitre, spirit of juniper, 
 and nitrous ether, 221. Iodide of potassium, 31. Aloes and savin pessary, 
 423. Enema of aloes. Bromide of potassium and cantharides, 422.
 
 AMNESIA — AMYLOID DEGENERATION. 37 
 
 Ergot of rye. Hot hip baths. Mustard pediliivia. Three or four 
 leeches, repeated at intervals to cervix uteri. Sinapisms to breasts. 
 Turkish baths. Simple diet. Avoidance of stimulants. If there be 
 ana'mia : Steel and aloes. 154, 393, 404. Steel and ammonia, 401. 
 Quinine and steel, 380. Steel and pepsine, 394. Spirit of juniper and 
 acid tartrate of potash, 219. Oil of juniper, 229. Iodide of iron, 32. 
 Iodide of iron and nux vomica, 421. Oil of rue and ergot of r3-e, 422. 
 Valerianate of steel, savin, and assafcetida, 421. Mustard pediluvia. 
 Galvanism. Nourishing food. Brandy; gin; wine. AVaters of Spa, 
 467. Ems, 486. Schwalbach, 488. Eger, 498. 
 
 AMNESIA. — From M, priv. ; ijyy,(nq^ remembrance. Synon. Ohlivio ; 
 Meiu()ri<t Dcleta. — Forgetfulness, or loss of memory. A prominent symp- 
 tom in certain cerebral diseases, ttc. 
 
 AMYLOID DEGENERATION.— From Awijhm. starch: JDegenero, to 
 degenerate. — The discover}' in the animal kingdom of starch, or of a 
 substance which possesses properties allied to those of amylaceous group 
 in vegetable world, is full of interest. For some years it has been 
 known that the liver, spleen, and kidneys, occasionally undei'go a de- 
 generation, which has been described as Lardaceous, Waxy, Cholesterine, 
 or Albuviinous Infiltration ; though until the researches of Virehow (1854 
 -1859), practitioners wei'e ignorant of the nature of this substance, as 
 well as of its exact seat. In the human body there are to be found 
 two allied, but not identical, substances: 
 
 (1) Bodies which, in their chemical properties, are analogous to real 
 vegetable starch, and in their form bear an extraordinaiy resemblance 
 to vegetable starch-granules, inasmuch as they constitute more or less 
 round or oval structures, formed by a succession of concentric layers. 
 To this class belong the little corpora amylacea of nervous system ; 
 laminated bodies found in prostate of every adult man, and which, 
 under certain circumstances, accumulate in large quantities, so as to 
 form prostatic concretions; and rare forms of a similar kind which 
 occur in certain conditions of lungs. 
 
 (2) In foregoing cases the starch-like matter lies between the elements 
 of the tissues. Very different are those cases where there is a degene- 
 ration of the tissues themselves, — where their component parts become 
 filled with a starch-like or amj'loid substance. The change begins in 
 the muscular fibre-cells of middle coat of small arteries : walls of ves- 
 sels get gradually thickened, while their calibre diminishes. Then the 
 morbid process involves surrounding anaemic parenchj'ma; extending 
 until the whole tissue in neighborhood of arteries is altered. Several 
 organs are generally invaded simultaneously, and rendered incapable 
 of performing their functions. Patients gradually assume a cachectic, 
 broken-down appearance; lose flesh and strength; dropsy often super- 
 venes; urine gets albuminous if kidneys be affected; diarrhoea sets in 
 when digestive tract is involved ; and in spite of remedies death soon 
 takes place. 
 
 When liver, spleen, or kidnej^s are organs affected, an unpractised 
 eye may fail to detect alteration in structure unless there be an extreme 
 amount of disease. When a liver is incised where amyloid degeneration 
 is far advanced, a feeling is communicated like that experienced on 
 passing a knife through wax : cut surface presents a semi-transparent 
 appearance. The gland is increased in size; has some resemblance to 
 a fatty liver, though its greater weight distinguishes it ; a sense on 
 handling is given like that received from a lump of wax; and if disease 
 be very extensive, no trace of normal structure can be distinguished,
 
 38 ANASARCA — ANGEIOLEUCITIS. 
 
 though in an earliei' stage the lobules are seen distinctly mapped out, 
 owing to the matter being deposited within the lobule and in and among 
 secreting cells. 
 
 Amyloid degeneration may exist alone, or in connection with tuber- 
 culosis, disease of bones, and syphilis. Thus, in phthisis, this form of 
 hepatic disease is probably more common than fatty liver; while 
 sometimes amyloid and fatty degeneration occur together. So fre- 
 quently has amyloid degeneration been found connected with caries or 
 necrosis, that it was thought the osseous disease exercised some deter- 
 mining influence on production of amyloid bodies. Multiplied researches 
 have proved, however, that amyloid degeneration is as frequently asso- 
 ciated with phthisis and sj'philis, as with bone disease. So it was con- 
 sidered that Bright's disease was often associated with amyloid degen- 
 eration, until the discover}' that the former was sometimes merely a 
 symptom of the latter aifecting kidneys. — See Hepatic Degenerations ; 
 Renal Degenerations, &c. 
 
 ANASARCA. — From 'Ava, through ; adp^, the flesh. Synon. Hydrops 
 Cellularis Totius Corporis; Hydrosarca ; General Dropsy. — The more or 
 less general accumulation of serum in the meshes of the areolar tissue 
 throughout the body. 
 
 Treatment. Compound Jalap powder. Compound scammonj- pow- 
 der. Elaterium, 157. Acid tartrate of potash, 228. Chimaphila umbel- 
 lata, 221. Digitalis and squills, 219. Oil or spirit of juniper, 229. Col- 
 chicum. Tartaratod iron. 
 
 Warm bath. Turkish Bath. Bloodletting. Dry cupjjing to loins. 
 Acupuncture. Issues. See CEdema; Dropsy. 
 
 ANMMIA. — From 'A. priv. ; ai/ia, blood. Synon. Exmnia ; Spanoiinia; 
 Hydra'iiiia ; Oligemia. Deficiency or poverty of blood. The red globules, 
 instead of existing in the proportion of 180 per 1000 parts of blood, as 
 in health, are reduced to 80, 60, or even less. The liquor sanguinis is 
 also poor in albumen, and ma}' contain an excess of salts. 
 
 Symptoms. A pale, waxy, blanched appearance of integuments and 
 mucous membranes. Feeble, rapid pulse. Anorexia. Aortic bellows- 
 sound. Bruit de diable in jugular veins. Enlargement of thyroid. 
 Proptosis oculi. Attacks of fainting. Palpitation and dyspnoea. 
 Oedema, and dropsical effusions into pleura, pericardium, or peritoneum. 
 Amenorrhea. Occasionally, latal syncope or coma. 
 
 Treatment. Iron, 380, 392, 393, 404, 412. Chemical food, 405. Bark, 
 371, 376. Binoxide of manganese. Aloetic aperients, with or without 
 steel, 148, 393, 404. Pepsine, 394, 420. Peroxide of hydrogen increases 
 the power of ferruginous tonics. Inhalation of oxygen. Alkaline hypo- 
 phosphites. Nourishing food: Milk; raw eggs; brandy and egg mix- 
 ture, 17; restorative soup, raw meat, 2; essence of beef, 3; malt flour, 
 &c., as in Liebig's food, 4; fish; poultry; roast beef and mutton ; bitter 
 ale; wine. Cod-liver oil. 389. Sea air. Mineral waters of Spa, 467. 
 Schwalbach, 488. Bruckenau, 493. Franzensbad, 498. See Chlorosis. 
 
 ANESTHESIA.— From M priv.; alffdrLo/jM, to feel. Synon. Anal- 
 gesia. — Paralysis of sensibility. — See Paralysis. 
 
 ANGEIOLEUCITIS. — From "Ayyslov, a vessel ; hoxth, white ; terminal 
 -itis. Synon. Lt/ntp/iangifis ; Tnjianimatio Vasorum Lynipliaticorum. In- 
 flammation of tiie lym])hatic vessels may result from external injury, 
 or from absorption of some morbid matter — as in dissection wounds, 
 unhealthy carbuncles, ko,. Lymphatic glands usually involved.
 
 ANGINA PECTORIS — AORTIC ANEURISM. 39 
 
 Symptoms. Formation of bris^lit red strenks; runnino; upwards from 
 wound in course of absorbents, to tlie jrlands in which the vessels merge. 
 Streaks, tender to touch; the seat of stinging pains; hard, like little 
 cords. G-lands in connection with affected vessels (piickly become in- 
 volved : get swollen and acutely painful. Whole limb rendered i)uffy 
 and tender. Great constitutional disturbance : chills or rigors ; nausea 
 and constipation, fever, restlessness, mental and bodily prostration. — 
 May end in resolution ; suppuration ; chronic induration; fatal exhaus- 
 tion, or ichorhffmia. Often complicated with erj^sipelas, or phlebitis. 
 
 Treatment. Sulphite of soda or magnesia, 48. Chlorate of potash, 
 61. Carbonate of ammonia, 361. Ammonia and bark, 371. Quinine, 
 379. Hydro(!hloric acid, 357. Purgative enemata, 188, 190. Essence 
 of beef, 3. Eestorative soup, 2. Eggs, cream, and extract of beef, 5. 
 Brandy and egg mixture, 17. Wine. Ice. Acid tartrate of potash 
 drink, 356. Hydrochloric acid and chlorate of potash drink, 358. — Fo- 
 mentations. Linseed poultices. Extract of belladonna and water dress- 
 ing. Bed to be placed in centre of well-ventilated room. Evacuation 
 of pus by free incisions. 
 
 ANGINA PECTORIS.— From "Ay/'^, to strangle : Pectus, the breast. 
 
 Synon. Orthopima Cardiaca ; Cardioneuralgia ; Suffocative Breast-pang. — 
 A disease in which severe pain is felt about the chest, with a sense of 
 strangulation and great anxiety. — Occurs most frequently in advanced 
 life. More common in men than women. Has been found associated 
 with fatty degeneration of heart ; but more usually in connection with 
 diseased coronary arteries. ^ 
 
 Symptoms. Paroxysms of intense pain about prrecordial region ; feel- 
 ing of suffocation ; fearful sense of impending death. Seizure rarely 
 lasts more than one or two minutes. May come on at any time : if pa- 
 tient be walking he is obliged to stop immediately. During attack, 
 pulse slow and feeble; breathing short and hurried; countenance pale 
 and anxious ; surface of body cold, perhaps covered with clammy SAveat; 
 consciousness unimpaired. As struggle passes off, patient regains his 
 usual health; often appears quite well. — If death do not occur in an 
 early seizure, it generally does so in some subsequent attack. 
 
 Treatment. During paroxysm : Brandy or wine. Ether, chloroform,, 
 and ammonia, 85. Hydrocyanic acid, soda, and morphia, 70. Bella- 
 donna. Camphor. Assafo^tida. Sinapisms. Turpentine stupes. Fric- 
 tion. Flying blisters. 
 
 During interval : Animal food ; milk or cream ; light wines. Ammonia 
 and bark, 371. Mineral acids and bark, 376. Quinine and steel, 380. 
 Quinine and belladonna, 383. Steel and pepsine, 394. Phosphate of 
 iron, 405. Zinc and nux vomica, 409. Valerianate of zinc and bella- 
 donna, 410. Sulphate of zinc and aconite, 413. Phosphate of zinc, 414. 
 Arsenic. Sulphur. Quinine. Belladonna plaster over pra'cordia. An 
 issue at nape of neck. Avoidance of stimulants, strong exercise, walk- 
 ing soon after meals, sexual intercourse, and mental excitement. 
 
 ANOREXIA.— From A, priv.; o/>£?:?, appetite. Synon. Inappetentia. — 
 Loss of appetite is a common symptom in most diseases. When present 
 without apparent cause, attempts must be made to give tone to digestive 
 organs. Mineral acids, pepsine, rhubarb, aloes, quinine, salicine, and! 
 bitter vegetable tinctures or infusions are the chief remedies. 
 
 AORTIC ANEURISM.— From \4oprrj, the great artery : 'Aveupwu), to 
 dilate. — Varieties : True aneurism, in which all the coats of artery dilate 
 and unite in forming walls of pouch ; false aneurism, in w^hich inner and
 
 40 AORTIC ANEURISM. 
 
 middle ai'terial tunics being ruptured, walls are formed by cellular coat 
 and contiguous parts ; and mixed or consecutive false aneurism, in which 
 the three coats having at first dilated, inner and middle ones subse- 
 quently rupture as distension increases. When the two inner tunics are 
 ruptured, and blood forces its way between them and outer coat by a 
 kind of false passage, so as to form a spreading diffused tumor, disease 
 known as a dissecting aneurism. Lastly, varicose aneurisms are those 
 where a communication has formed between aorta and either of the 
 vente cava^, or between aorta and one of auricles, or between this vessel 
 and right ventricle, or between aorta and pulmonary artery. 
 
 Aortic aneurism a disease of advanced life, rather than of youth : 
 often results from ossific or calcareous deposits, or from atheromatous 
 or fatty degeneration of coats of vessel, and consequently other vessels 
 are not uncommonly found affected at same time. When tumor is 
 small, its existence frequently goes undetected. Death generally results 
 from hemorrhage owing to rupture of sac; or sudden death may occur 
 "without any rupture (as from suffocation); or there may be gradual 
 sinking from exhaustion caused by long-continued suffering, or from 
 debility brought about b}^ repeated escape of small quantities of blood, 
 or from coexistent tubercular consumption. 
 
 1. Aneurism of Thoracic Aorta. — Chiefly met with in ascending por- 
 tion, or in transverse part of arch. 
 
 Symptoms. In early stage obscure, partly because they resemble 
 those caused by heart disease. When tumor is of some size, and has 
 been quickly developed, there is disturbed action of heart, with some 
 modification of radial pulse ; superficial veins of chest and neck are 
 turgid; one or both upper extremities oedematous; dulness on percus- 
 sion around portion of vessel from which aneurism springs; cough, 
 wheezing, dyspnoea, hjemoptysis, difficulty in swallowing, and jDain 
 about the chest and back. Latter most constant and severe when 
 erosion of bones of spine or sternum or ribs is going on. — Supposing 
 aneurismal tumor becomes very large and pulsating, and rises out of 
 chest, producing protrusion or absorption of sternum and ribs, then 
 the diagnosis is easy. When the sac presses upon trachea, there are 
 dyspnoea and cough; when on one or both recurrent laryngeal nerves, 
 aphonia with troublesome cough, severe paroxysms of laryngeal suffo- 
 cation, and pain coming on at intervals; w^hen on oesophagus, dysphagia 
 and symptoms of stricture; when on thoracic duct, inanition and en- 
 gorgement of absorbent vessels and glands. Where an aneurism of 
 ascending aorta is in immediate neighborhood of the heart, patient 
 suffers from angina pectoris ; probably to be referred to compression of 
 great plexuses of nerves ramifying on either side of ascending aorta, 
 and communicating freely with the cardiac ganglia and plexuses of the 
 ventricles (Dr. W. T. Gairdner). 
 
 Amongst other S3nnptoms, — conti-action or dilatation of pupil on 
 affected side; according as pressure is sufficient to paralyze, or only 
 irritate, branches of sympathetic nerve. — Sometimes a beilows-sound 
 <jan be detected. If the heart be compressed by tumor, so as to impede 
 normal action of valves, a sj'stolic or diastolic bruit will result. Pres- 
 sure on aorta, or on pulmonar}^ artery, may also produce a murmur. In 
 false aneurism there is generally a murmur both with entrance and exit 
 of blood into sac; or there may be one loud and prolonged and rasping 
 bruit, from passage of blood over roughened inner surface of vessel. In 
 true aneurism or mere dilatation of a part of the wall, murmurs seldom 
 audible. Nevertheless, a small but free opening from canal of artery 
 into aneurismal sac, and a roughened state of arterial tunics from
 
 AORTIC ANEURISM — AORTITIS. 41 
 
 degeneration or from atheromatous deposit, will give rise to a bruit. 
 In both foi-ms, when a murmur exists, a ijeculiar thrilling or purring 
 tremor will be felt over sternum. 
 
 Death may occur from ru])ture externally, or into pericardium, into 
 either pleural cavity, into trachea, or into a bronchial tube. Or patient 
 may die from exhaustion consequent on long-continued suffering. Or 
 there may be fatal destructive inflammation of lung, owing to compres- 
 sion of pulmonary vessels, or to pressure on pneumogastrie nerve. — Very 
 rarely, cure has resulted from solidification of fibrine. 
 
 Treatment. The same as for Aneurism of Abdominal Aorta. 
 
 2. Aneurism of Abdominal Aorta. — Often gives rise to acute pain in 
 lumbar region, shooting into either hj'pochondrium and downwards 
 into thighs and scrotum. Pain aggravated by constipation : often 
 relieved by l.ying on face. A tumor discovered by careful examination : 
 constant and powerful pulsation communicated to hand. A short, loud, 
 abrupt bellows-sound will be heard. 
 
 Treatment. General Rules : In aortic aneurism, all bodily and mental 
 excitement must be avoided. Pain, cough, dyspnoea, and other jjrom- 
 inent symptoms to be alleviated. Generous reparative diet to be 
 allowed: sheny, Bordeaux, Rhine, or Hungarian wines; brandy or 
 "whiskey and water ; avoidance of malt liquors. Attention to be paid to 
 digestive, secreting, and excreting functions. 
 
 Curative : Iodide of potassium, in lai'ge doses, 31. Acetate of lead, in 
 gradually increasing doses, ])erhap8 up to tw^enty grains dail.y; with 
 acetic acid. lodo-tannin. Tinctui'e of perchloride of iron, 101. Am- 
 moniated iron alum, 116. Locally: Ice. Electricity. Electro-puncture. 
 Belladonna plasters. Puncture with a small tx'oear and canula, and 
 introduction of fine iron wire through latter, so as to afford an exten- 
 sive surface on which fibrine may coagulate (Murchison and Moore). In 
 abdominal aortic aneurism, pressure with a tourniquet for several hours, 
 patient being kept under influence of chloroform (William Murray). 
 Valsalva's plan of frequent bleedings, while patient is kept on lowest 
 possible diet, not to be recommended. 
 
 Ptdliative : Opium. Morphia. Subcutaneous injection of morphia. 
 Belladonna. Digitalis. Indian hemp. Camphor. Assafoetida. Spirit 
 of ether or chloroform. Mercury, digitalis, and squills. Tracheotomy^, 
 if suffocation threaten. Small bleedings, where there is great pulmo- 
 nary congestion. 
 
 AORTITIS. — From 'Aapri], the great artery; tei-minal -2Y«s. Synon. 
 Inflainmatio Aorta'. — Acute inflammation of aorta a very rare affection. 
 Probably a blood disease : allied to rheumatism, like pericarditis and 
 endocarditis. 
 
 Symptoms. Very obscure. General uneasiness. Rigors followed by 
 fever. Orthopnoea, with frequent sense of suffocation. Pain and vio- 
 lent pulsation in vessel. Great palpitation. Sometimes, a loud S3'stolic 
 bruit. Pulse often unaffected. 
 
 Coats of aorta may undergo structural changes; either as result of 
 chronic inflammation, or of a simple degeneration of tissues. Mineral 
 or ossific, amyloid, and atheromatous or fatty degenei^ations, most fre- 
 quently met with in advanced life, although thej^may occur at an earlier 
 period. 
 
 Treat.ment. Iodide of potassium. Colchicum. Aconite. Opium. 
 Spirit of ether. Spirit of chloroform. Warm baths. Dry cupping over 
 sj)ine. Ice to spine. Blisters,
 
 42 APHASIA — APHONIA. 
 
 APHASIA. — From 'J, priv. ; <pd(n^, speech. — A loss of the cerehral 
 faculty of speech ; and (in most cases) of the power of expressing the 
 thoughts by writing and gestures. In other words, — a simultaneous loss, 
 in a greater or lesser degree, of the memory of words, the memory of 
 the acts b}^ means of which words are articulated, and of intelligence 
 (Trousseau). 
 
 Aphasia sometimes transitory, as occasionally during convalescence 
 from severe attack of fever, when it ma}' be owing to cerebral conges- 
 tion. It may be permanent, and due to softening of brain, or to cere- 
 bral hemorrhage. Some physiologists have tried to prove that the 
 faculty of expressing thought b}' speech is seated in the posterior por- 
 tion of the third frontal convolution of the brain, chiefly on the left side. 
 Clinical experience disproves this theory. Aphasia with hemiplegia, 
 especially of right side, is the most common form. In all cases there is 
 a tendency to apoplexy. 
 
 Symptoms. Sudden deprivation of powder of speech. Perhaps, in a 
 short time, one or two words can be uttered, which are then spoken in 
 reply to all kinds of questions. Face intelligent. Movements of lips 
 and tongue and lar^'nx healthy. There may be consciousness of what 
 is wished to be expressed, and jqX complete inabilit}" to express the 
 thoughts by speech, gesture, or even (frequently) by writing. Aphasic 
 patients know the use of objects (such as spoons, night-caps, pipes, &c.), 
 though they cannot name them. Moreover, they can often play cor- 
 rectly at cards, backgammon, dominoes, &c. They can perhaps read; 
 but if the}' understand what they peruse they forget directly, as they 
 will pore over the same page again and again. 
 
 The case related by Trousseau, of a Eussian gentleman, resident in 
 Paris, forms a good example of aphasia. Mr. T. spoke French like a 
 Parisian, yet after his attack was unable to speak a word of French. 
 \Yhen questioned, he smiled and said "f/a," a Eussian word meaning 
 yes. He was unable to construct even part of a sentence in his own 
 language. When shown a spoon he could make gestures showing its 
 use: and yet had forgotten its name in Eussian and French. Never- 
 theless, he could play at whist correctly, and noticed any errors of his 
 adversaries by making a gesture. In another example, a j'oung man 
 25 years old, was attacked with hemiplegia of right side and aphasia. 
 Some power of moving right leg, and then of arm, returned; but he 
 could only articulate two words, No and Mamma. " What's your name?" 
 — " Mamma." "What's your age?" — " Mamma, no." Yet he knew that 
 his reph' was incorrect. He had taught himself to wi'ite Avith his left 
 Ijand, as far as signing his name. He wrote this legibly. But on being- 
 told to say " Cxuenier," as he had written it, he made an eft'ort and said 
 '•Mamma." ''Say Henri," and he replied, "jSTo, mamma." On being- 
 told to write "mamma," he wrote '• Guenier." "Write no;" and he 
 again wrote " Guenier." 
 
 Treatment. In eases of aphasia without hemiplegia recovery may 
 occur spontaneously. Probaby any kind of treatment (by drugs, bleed- 
 ing, or blistering) is injurious. In aphasia with hemiplegia, medicine is 
 powerless to eff'ect a cure ; save in cases dependent on syphilis, when 
 iodide of potassium is the remed}'. 
 
 APHONIA. — From 'A. priv.; (pw^rj, the voice. — Loss of voice, from 
 organic or functional disease of vocal cords, varies in degree from a 
 slight impairment to complete dumbness. It is either temporary or 
 permanent. 
 
 Varieties. A])honia may be due either to functional disorder, or to 
 structural change.
 
 APHTHA OF MOUTH — APOPLEXY. 43 
 
 fl) Functional variety : Tlysterical aphonia t3'pical. Generally allied 
 with other symptoms indicative of its nature. In women, uterine 
 functions frequently disturbed : irritation of one or both ovaries often 
 present. Leucorrhoea: amenorrhoea, or sometimes menorrhagia. — Pa- 
 tient speaks in a whisper for days together. Then power returns, but 
 relapses are common. — Aphonia from fright occurs in men as well as 
 in women. — If functional aphonia be of long continuance, the vocal 
 cords will probabl}" become flaccid and powerless. An examination by 
 laryngoscope shows a paralytic condition of cords. Faradization very 
 useful. 
 
 (2) Organic form : Caused by inflammation, serous infiltration, ul- 
 ceration of mucous membrane about vocal cords; conditions detected 
 by larj-ngoscope. May also arise from pressure of morbid growths 
 in or near larynx: disease of brain, producing paralysis of muscles of 
 larynx, on normal action of which, the tension and position of vocal 
 cords depends. 
 
 Treatment. If functional : Quinine and steel, 380. Quinine and 
 nux vomica, 387. Compound iron mixture with aloes, 393. Phosphate 
 of iron, 405. Strychnia and steel, 408. Zinc and nux vomica, 409. 
 Valerianate of zinc, 410. Nourishing food. Galvanism. Spray of 
 astringent fluids, 262. Shower baths. Moral influence. 
 
 When organic: For cure of inflammation and ulceration about vocal 
 cords, sponging with solution of nitrate of silver (gr. 40 to fl. oz. j). 
 Spray of astringent fluids, 262. Scarification, in cedema of glottis. Re- 
 moval of polypi, or other growths, by wire ecraseur. Ferruginous tonics. 
 Cod-liver oil, &c. — For loss of the faculty of expressing the thoughts 
 by speech, see Aphasia. 
 
 APHTHA OF MOUTH.— From "Ar^zm, to fasten upon. Synon. Sto- 
 matitis Exudativa ; 2Iuguet; Thrush. — Aphtha? consist of small, round, 
 white, elevated specks or patches, scattered over tongue and lining 
 membrane of mouth, and sometimes extending down oesophagus. Forms 
 a special disorder in infanc}' — the thrush: in adult age, aphtha? often 
 produced in course of prostrating disease. — Two microscopical parasitic 
 plants — Leptothrix buccalis and Oidiurn albicans — developed in large quan- 
 tity, in and between epithelial cells of mucous membrane: filaments 
 and spores of these fungi render e]>ithelium friable, loose, and swollen. 
 
 Symptoms. Restlessness. Debility. Cough. Difficulty in swallow- 
 ing. Vomiting. Diarrhoea. Where aphthous spots are abundant they 
 may coalesce, forming a dirty diphtherial-looking membrane. 
 
 Treatment. Application of borax and gljx-erine, 250. Application 
 of sulphite of soda (gr. 60 to water fl. oz. j). Mild astringents. Bark 
 and port wine. Chemical food, 405. Cod-liver oil. Chlorate of pot- 
 ash. Pure milk. Liebig's food, 4. Restorative soup, 2. Beef tea. 
 
 APOPLEXY. — From 'J-o, by means of; -XrjfTffto, to strike, — because 
 those attacked fall down, as if from a blow. — A state of coma, occurring 
 suddenly from pressure on the brain, the compressing power having its 
 seat within the cranium. There is sudden loss of sensation, thought, 
 and power of voluntary motion; with more or less severe disturbance 
 of respiration and circulation. 
 
 Warnings. Apoplexj^ seldom occurs without some previous threaten- 
 ings, such as : Headache and giddiness, experienced particularly on 
 stooping; feeling of weight and fulness in head; noises in ears, tempo- 
 rary deafness ; transient blindness, or sometimes double vision ; repeated 
 e])istaxis; fits of nausea; occasional sense of numbness in limbs; loss 
 of memory; great mental depression; incoherent talking; drowsiness;
 
 44 APOPLEXY. 
 
 indistinctness of articulation ; and partial paralysis, affecting a limb, or 
 muscles of face, or eyelids. 
 
 Certain individuals predisposed : Those whose ancestors suffered from 
 it; men of a peculiar habit of body, of.sedentarj- habits, accustomed to 
 high living, with protuberant bellies, large heads, florid features, and 
 short thick necks ; and individuals advanced in life, beyond fifty. A 
 predisposition also engendered by disease of kidneys, heart, or cerebral 
 bloodvessels; by intemperance ; and by cessation of habitual dischai"ges. 
 
 Varieties. The comatose condition may cease in one of three ways: 
 It maj' gradually pass off, leaving patient well; or it may terminate in 
 incomplete recover^^, mind being impaired, and some parts of body 
 paralyzed; or it may end in death. In latter case, on examining the 
 brain, we find either no appearance whatever of disease, or extravasated 
 blood is discovered in ventricles, or pons Varolii, or to large amount in 
 centrum ovale majus, or in sac of arachnoid ; or there is copious effusion 
 of serum into ventricles or beneath arachnoid, with or without cerebral 
 softening. That which is fatal without leaving any traces is nervous or 
 simple apoplexy; the second, sanguineous apoplexy, or cerebral hemor- 
 rhage; the third, serous apoplex}'. Apoplex}^ niay also result from 
 embolism. During life it may be impossible to distinguish hy the symp- 
 toms these varieties. 
 
 Modes op Seizure. Commences in three different waj^s : In first, 
 patient falls down sudden!}^; deprived of sense and motion; lies like a 
 person in deep sleep. Face generalh^ flushed. Breathing stertorous. 
 Pulse full and not frequent, occasionally below natural standard. Some- 
 times convulsions; or rigiditj^ and contraction of muscles of limbs, 
 perhaps only on one side (Abercrombie). 
 
 In second form, coma not the first symptom. Complaint made of 
 sudden pain in head. Pallor, sickness, faintness. Sometimes vomiting. 
 Frequently, patient falls to ground in a state resembling syncope. Oc- 
 casionall}', instead of falling, the sudden pain is on!}' accompanied by 
 slight and ti*ansient loss of consciousness. After a few hours, headache 
 eontinuing, he becomes heavy and oppressed and forgetful: gradually 
 sinks into complete coma, from which recovery is rare. A large clot 
 usually found in brain. 
 
 Third variety begins by symptoms of cerebral hemorrhage. There 
 is an attack of paralysis of one side: sometimes deprivation of power 
 of speech, but no loss of consciousness. The paralysis may pass into 
 coma; or it mnj remain without further urgent sym]>toms; or it may 
 elowly go off and patient recover: or it may pass off and death occur 
 suddenly some hours or days subsequentl}', fi'om return of hemorrhage 
 (see Cerebral Hemorrhage). 
 
 Phenomena durinot Fit. Duration of apoplectic fit varies from two 
 or three hours to as many days. There is total unconsciousness. Pulse, 
 at first generally small, becomes full and strong, according as system 
 recovers from shock; it is usualh' slower than natural, sometimes in- 
 termitting. Respiration slow, embarrassed, often accompanied b}^ ster- 
 tor: frothy saliva about mouth. — In bad cases, body covered with cold 
 clammy sweat; face pale; eyes dull and glassy, with dilatation of one 
 or both pupils according as pressure is on one or both sides; teeth 
 firmly clenched, and all power of deglutition lost, or much impeded ; 
 stertorous breathing. Bowels torpid, or motions passed involuntarily. 
 Involuntary micturition ; or retention of urine, until bladder becomes 
 distended and overflows, causing urine to be constantly dribbling away. 
 When patient recovers incompletely, more or less paralysis of limbs 
 often remains. 
 
 Treatment, Prophylactic : Where predisposition is suspected, it is
 
 ASCITES. 45 
 
 necessary to warn patient against sti'ong l)odily exertion; venereal 
 excitement; stimulus and irritation of any approach to drunkenness; 
 heavy meals; violent mental emotion; exposure to extremes of tem- 
 perature ; constipation and straining at stool; long-continued stooping; 
 tight neckcloths ; and hot baths. Diet to be moderate. Bed-room to 
 be cool and well-ventilated: to sleep on a mattress, with head high. 
 Daily exercise in open air. Head to be washed in morning with cold 
 water. Where there is giddiness, or epistaxis, or headache, or throb- 
 bing of arteries of head, a few doses of an active purgative will be 
 useful : perhaps blisters or seton to na])e of neck. Leeches to sides of 
 anus, where the threatening seems due to the suppression of some ac- 
 customed discharge. Where there is anremia, bai'k, and mineral acids, 
 or small doses of steel; with good easily digested food, and plenty of 
 milk. Arsenious acid (gr. g'^j — j'^ twice daily) in combination with 
 licpior potassas has been recommended, on the supposition that it reduces 
 the excess of red globules in the blood. 
 
 Curative: The rule is, after an attack, "to obviate the tendency to 
 death." (Cullen.) If tendency be towards death by coma; if pulse be 
 full, hard, or thrilling ; if vessels of neck are congested ; if face be flushed 
 and turgid, — general bleeding, or cupping from nape of neck, may be 
 called for. Contrariwise, if patient be dying from s^-ncope, with a feeble 
 or almost imperceptible pulse, and a cold clammy skin, — then bleeding 
 will only insure a speedily fatal termination. Bleeding sometimes em- 
 ployed to prevent increase of extravasation ; but it is probable that this 
 remedy promotes further loss, as it induces greater thinness of blood 
 and diminishes power of coagulation. 
 
 Patient to be removed into a cool and well-ventilated room. Head 
 to be raised. All tight parts of dress to be loosened, especially cravat 
 and shirt collar. Cold to the head, by means of pounded ice in a blad- 
 der. If power of swallowing remain, calomel and jalap, followed by 
 common black draught, 140. Where deglutition is impossible, two or 
 three drops of croton oil on back part of tongue. Stimulating and pur- 
 gative enemata, 189, 190, 191. Pediluvia containing mustard. Blisters 
 to scalp, or nucha, seldom of benefit in any stage and never at early 
 period. Emetics only useful where attack is due to overloaded stomach. 
 
 In event of recovery : Great care needed to prevent a second fit. Strong- 
 medicines, great excitement, severe mental occupation to be avoided. 
 Simple, but nutritious diet : animal food : milk. Light French, German, 
 or Hungarian wines. 
 
 ASCITES. — From M^zo?, a wine-skin or leather bottle, — because of the 
 swollen condition of the belly. Sj'non. Hydrops Abdominis ; Hydroperi- 
 toneum ; Dropsy of the Peritoneum. — Consists of a tense swollen condition 
 of abdomen, owing to presence of a watery fluid in cavity of serous 
 lining. 
 
 May arise from, — chronic peritonitis; cirrhosis, cancer, obliteration of 
 portal vein, and amyloid degeneration of liver, causing obstruction to 
 free passage of blood through system of vena portse ; renal disease and 
 albuminuria; disease of heart or aorta; disease and enlargement of 
 spleen; malignant affections of omentum; and a few more simple dis- 
 orders, — congestion of kidneys, functional derangement of heart, an- 
 aemia. Cirrhosis of liver and renal disease, most common causes. 
 
 Symptoms. Characteristic appearance of patient. Upper part of body 
 wasted, features pinched, countenance very anxious: abdomen greatly 
 enlarged, integuments shining, superficial veins dilated. Fluctuation : 
 resonance on percussion. In advanced stage, dyspnoea : resjjiratory
 
 46 ASTHENOPIA — ASTHMA. 
 
 murmur cannot be heard as low down as in liealth : tubular breathing 
 in interscapular regions, especially towards left : apex of heart elevated, 
 and rather pressed to the left. Comnionl}" anasarca of lower extremi- 
 ties: more rarely, especially in renal dropsy, oedema of face and arms. 
 "Urine scanty, often loaded with urates : in ascites from cirrhosis it gen- 
 erally contains bilej in that from renal disease, albumen. Increasing 
 deterioration of general health. Weakness and emaciation. Loss of 
 appetite. Sleeplessness. Inability to lie down. Exhaustion: ending 
 fatallj' when the dropsy is due to organic disease. 
 
 Treatment. Compound powder of jalap. Acid tartrate of potash. 
 Pill of colocynth and hyosc^'amus. Elaterium, 157. Eesin of podophyl- 
 lum, 160. Croton oil, 168. Gamboge with aloes and blue pill, 174. Cal- 
 omel and jalap, 159. Acetate of potash, squills, and broom, 219. Solu- 
 tion of jDOtash, nitrous ether, and digitalis, 220. Spirit of juniper, nitrous 
 ether, and winter-green, 221. Digitalis and squills, with blue pill or 
 taraxacum, 219, 224. Urea. 225. ^Nitric acid, nitrous ether, and taraxa- 
 cum, 147. Acid tartrate of potash and buchu, 222. Nitrate of potash 
 and nitrous ether, 212. Conium, digitalis, and calomel. 230. Hydro- 
 chlorate of ammonia, 60. Iodide of potassium, 31. Iodide of iron, 82. 
 Corrosive sublimate, 27. Nitro-hydrochloric acid, 378. Colchicum, 46. 
 Tincture of pcrchloride of iron. Phosphate of iron, 405. Quinine and 
 steel, 380. Steel and ammonia, 401, 403. Warm baths. Tapor baths. 
 Turkish bath. Tapping. Acupuncture. Issues. 
 
 As a rule, in dropsy from renal disease, all preparations of mercury 
 are injurious, and diuretics must be emplo3-ed cautiously: baths espe- 
 cially useful. Mercurials pernicious where there is anaemia: compound 
 jalap powder, hot-air baths, and preparations of steel very valuable. — 
 See Dropsy. ' 
 
 ASTHENOPIA.— From "A, priv. ; ff^^voc, strength ; w^', the eye? Weak- 
 sighteduess, from fatigue of muscular system of accommodation. Synon. 
 Muscular Amaurosis. 
 
 Symptoms. The eyes appear normal. Inability to read or write for 
 any length of time : letters become indistinct, and words seem to run 
 into each other. The eyes ache or get ver}' tired. Muscje volitantes. 
 Headache. If unrelieved, the ej^es become useless for continued work. 
 
 Treatment. When dependent on hypermetropia. ma}' be cured by 
 proper use of convex glasses. If due to anaemia, — ferruginous tonics, 
 sea-air, good food, cold water douche, and spectacles of sufficient power. 
 Work to be interrupted every half-hour by rest, so long as fatigue is 
 induced. 
 
 ASTHMA. — From 'AtrO/jJXuj, to gasp for breath. Synon. Spasmi(S Bron- 
 chialis. — A nervous disease: phenomena dependent on tonic contraction 
 of circular muscular fibres of bronchial tubes. Paroxysms induced by 
 direct or reflex mechanism, i. e. — the stimulus to contraction may be 
 central, in medulla oblongata; or it will be in pulmonary or gastric 
 portion of pneumogastric, or in some other part of nervous system be- 
 sides the vagus, and being transmitted to medulla oblongata by inci- 
 dent, is thence reflected by motor filaments. 
 
 Symptoms. A fit of asthma is preceded either by headache and 
 sleepiness, or by various digestive or other disturbances, or it occurs 
 suddenl}' without warning. Patient awakes two or three hours after 
 midnight with sensation of suffocation or constriction about chest: 
 dyspnoea increases, until there is a most painful struggle for breath. 
 Various postures assumed to facilitate respiration. Chest gets dis- 
 tended to utmost limit : there is evidently some obstruction to entrance
 
 ASTHMA. 47 
 
 and exit of air. On auscultation, no respirator}' murmur audible; but 
 sibilant rhonchi, loud wheezings, or shrill whistlings are heard. Pulse 
 becomes small and feeble. Eyes staring. Countenance anxious. Lips 
 purple. Temperature of surface often falls to 82=' F.; but after a time 
 the fatigue causes the skin to be bathed in a hot sweat. After a longer 
 period, relief comes. Cough, with expectoration of little pellets of 
 mucus. Paroxysm ceases, and sufferer falls asleep. 
 
 J)uring interval between attacks, moderately good health enjoyed, 
 with quiet breathing. Most asthmatics thin and round shouldered: 
 countenance expressive of attacks of suffering; cheeks hollow ; voice 
 rather hoarse; slight cough. Interval varies in length from tw^enty- 
 four hours to twelve months. Attacks sometimes periodic. Asthma 
 very capricious: kept off by certain climates, but only experiment 
 can decide which air is suitable for each case. More common in men 
 than women. Often hereditary. In idiopathic or spasmodic asthma, 
 the disease is uncomplicated. In symptoniatic or organic asthma, the 
 suffering is complicated with, or symptomatic of, some disease of nerv- 
 ous system, of alimentary canal, of heart, of lungs, or even of skin. 
 
 Treatment. Dui'ing paroxysm : If stomach contain undigested food, 
 a stimulating emetic, 232. If rectum be loaded, an enema of castor oil 
 and assafoetida and rue, 189. Croton oil and turpentine enema, 191. 
 Great object is to relax bronchial spasm. A dose of iodide of potassium 
 (grs. 10), with ammonia or ether, and tincture of belladonna (min. xx 
 — xxx), often succeeds. Subcutaneous injection of atropine, 314. Opium 
 or morphia often injurious: if given, only a full dose will be of any, 
 avail, but the author's experience leads him to forbid it. A cup of 
 strong coffee. A glass of strong brandy or whiskey or rum punch. In- 
 halation of chloroform, or ether, of doubtful value : patient usually gets 
 relief while inhalation is continued, but wakes up as bad as before. 
 Iodoform, 338. Tobacco useful in some eases, especially in w'omen : 
 when it produces nausea and collapse, the attack often ceases. A pipe 
 of Latakia sufficient for those unaccustomed to smoking. Stramonium 
 cigars. Stramonium seeds smoked in a pipe. Datura Tatula cigars. 
 Cigares Anti-Asthmatiques de M. Joy. Stramonium with henbane, 323. 
 Conium with henbane, 335. JSitre-paper fumes. Turpentine stupes. 
 Hot-water stupes. Sinapisms. Hemlock poultice. 
 
 In interval: Improvement of general health by tonics; regular mode 
 of life ; use of cold shower or sponge bath. Eemoval of dj-spejisia. 
 Meals to be taken at such times that digestion may be completed be- 
 fore retiring to bed. Selection of a climate the opposite to that in 
 which attacks come on. 
 
 When mucous membrane about fauces is relaxed, — Tannin or catechu 
 lozenges. Atomized spray of astringent fluids, 202. Sponging with 
 solution of nitrate of silver. — If digestion be weak, — Nitro-hydrochloric 
 acid, 378. Pepsine, 420. Ammonia and bitters, 361. Quinine and 
 rhubarb, 385. Steel and citrate of potash, 403. — If periodic. Quinine. 
 Arsenic. — If cause be obscure, — Iodide of potassium with aconite, or with 
 ammonia and belladonna, 31. Inhalation of oxygen gas. Eespiration 
 of compressed air. 
 
 Remedies sometimes employed : Garlic (Allium sativum). Bulb of com- 
 mon onion (Allium cepa). Carbonate of ammonia. Ammoniacum mix- 
 ture. Compound squill pill. Assafoetida. Nitrate of silver. Arsenic. 
 Camphor. Musk. Galbanum. Ipecacuanha. Dilute hydrocyanic acid. 
 Indian hemp. Petroleum. Senega. Strychnia. Storax. Compound 
 tincture of benzoin. Sumbul. Oxide of zinc. Valerianate of zinc or 
 ammonia. Sulphate of zinc. Blisters to spine or nucha. Ointment of 
 tartarated antimony to chest walls. Issues. Galvanism.
 
 48 ASTIGMATISM — BARBADOES LEG. 
 
 ASTIGMATISM. — From 'J,priv.; ariyim^ a point, — signifying that rays 
 derived from one point, do not again unite into one point. — An ine- 
 quality in the refractive power of the several meridians of the eye. 
 The asymmetr}^ on which astigmatism depends is jjroper to all eyes. 
 Usualh' it exists in so slight a degree, that the acuteness of vision is 
 not essentially impaired by it (normal astigmatism). But exceptionally 
 it becomes considerable, and occasions an aberration of the rays of light, 
 which interferes with the sharj^ness of sight (Bonders). 
 
 ATELECTASIS.— From ' ATtXr^q, imperfect; exraff;?, dilatation.— A con- 
 genital non-expansion of air-cells of lungs. — See Pulmonary Condensa- 
 tion. 
 
 BALANITIS. — From BdXaw^, the glans penis; terminal -itis — from 
 " Itj/m, to impel, and signifj'ing inflammation when added to the Greek 
 name of an organ. Synon. External Clap ; Gonorrhoea Pra^putialis. — 
 Consists of inflammation, with redness and patches of excoriation, of 
 the glans penis and internal surface of the prepuce. Sometimes the 
 afl^ection is termed balanitis when only the glans is affected; balano- 
 posthitis {BoJm'mi^ -6<rO-ri. the skin covering the glans, terminal -itis). 
 being applied when the lining of the prepuce is also involved. This 
 refinement unnecessary: the two conditions are rarely seen apart. 
 
 Symptoms. Heat and itching about the glans. A niuco-])urulent 
 discharge. On denuding the glans, patches of redness and excoriation 
 perceived, perhaps with flakes of curd-like matter. If there be cedema 
 of foreskin, or the orifice of this covering be contracted, retraction may 
 be impossible — phimosis. Necessity of drawing back the foreskin, 
 there may be a chancre, or an abscess, or mortification may be threat- 
 ening. Sympathetic bubo may arise. Sometimes complicated Avith 
 gonorrhoea. Balanitis from inoculation with secondary syphilitic dis- 
 cbarge, may cause constitutional infection. 
 
 A similar disorder — vulvitis — occasionally met with in women, or 
 female children. 
 
 Treatment. Great cleanliness. Lightly touching of inflamed surface 
 with nitrate of silver. Astringent lotions, — alum, subacetate of lead, 
 siilphate of zinc, &c. Mere washing and drying of part, twice in 24 
 hours, with separation of glans from prejiuce by a thin laj^er of cotton- 
 wool. Circumcision. Slitting up of prepuce. Dilatation of preputial 
 opening with sponge tents. After retraction of foreskin it is again to 
 be drawn forwards, to avoid paraphimosis. 
 
 BAEBADOES LEG. — Synon. Elephantiasis Arabum ; Glandular Dis- 
 ease of Barbadoes ; Bucnomia Tropica. — Characterized by great swelling 
 and induration of true skin, or derma. Produces most marked deformity. 
 Sometimes subjacent areolar and adipose tissues are implicated. Most 
 frequently attacks lower extremities: swelling so great that limb be- 
 comes double its natural size. Hardness, severe pain, and thickening; 
 with an appearance resembling the leg of an elephar)t, whence the disease 
 has unfoi-tunately derived one of its names (EXicpa:;, the elephant). The 
 scrotum not an uncommon seat of it. Earely met with in Europe: 
 occurs principal!}^ in West Indies. Generally continues tor life; causes 
 alarming constitutional disturbance ; neither contagious nor hereditary- ; 
 attacks males and females, rich and poor, indiscriminately. When con- 
 fined to one foot and leg, amputation has been resorted to with advan- 
 tage. Ligature of main artery of limb. The success which has followed 
 removal of large scrotal tumors in India is very remarkable.
 
 BED CASE BITES OF RABID ANIMALS. 49 
 
 BED CASE. — A not uncommon form of hysteria. Subjects of it live 
 in bed; they are tranquil, cheerful, have good digestions, and like the 
 kind attentions of sympathizing friends. Often impressed with belief 
 that there is serious disease in spine, or in womb: there are certain 
 movements which they think cannot be made without "horrible" ])ain. 
 Menstruation frequently attended with suffering; leucorrhoea. — Amongst 
 examples of this pseudo-disease which have come under author's ob- 
 servation, the most marked was that of a single lady, thirty-four years 
 of age, who first consulted him in 1861. This patient had then been 
 confined to her room, and almost to bed, for ten years. Had been 
 treated for spinal disease; taken large quantities of medicine; leeches, 
 blisters, setons, &c., had been freely used. On examination every part 
 of her body was found health}^ with exception of uterus, which was 
 retroflexed. By replacing this, and by galvanism to long inactive 
 muscles, a cure was effected ; but great patience was needed to get her 
 from bed to sofa, from sofa to chair, from chair to crutches, and so on 
 until at the end of three months she could walk out in open air. Some 
 cases can be cured in a much shorter time. Each example varies in 
 regard to important mental peculiarities, and tact is needed to persuade 
 patient to get well. — See Hysteria. 
 
 BERIBERI. — From Beri the Singalese for weakness, by iteration 
 implying great weakness. Synon. Bad Sickness of Ceylon. — A form of 
 general dropsy almost unknown to pathologists in this country. It is 
 very fatal to European and native troops at Ceylon. 
 
 Symptoms. Increasing weakness. Marked anaemia. Anxiety. ISTumb- 
 ness of the surface. Stiffness and oedema of lower extremities. Dyspnoea. 
 Paralysis. Suppression of urine. Effusion of serum into pleurae and 
 pericardium. Exhaustion. Generally death. 
 
 Treatment. Elaterium. Calomel and squills. Squills and digitalis. 
 Treeak Farook, an electuary much esteemed in parts of India, the 
 ingredients of which are unknown, but which acts as an aperient and 
 mild diuretic when combined with rhubarb: the dose is from grs. 5 to 
 15. Oleum nigrum, regarded as a valuable prej^aration in India; hav- 
 ing stimulant and diaphoretic properties in doses of ten minims. Tonics. 
 Tincture of perchloride of iron. Effervescing draughts. Opium. Nux 
 Vomica. Spirit of nitrous ether. Nourishing diet. Wine. 
 
 Bleeding. Cupping over spine. Blisters. Friction, with stimulating 
 liniments. Galvanism. 
 
 BILIARY CALCULI.— From Bilis, bile : Calculus (dimin. of calx), a 
 small stone. — See (Tall-Stones. 
 
 BITES OF RABID ANIMALS.— The immediate treatment is as fol- 
 lows: The tissues around seat of injury are to be compressed by a 
 ligature or otherwise, to prevent absorption. Then the wounded part 
 is to be excised as soon as possible; taking care to remove every portion 
 touched by animal's teeth, and to obtain a clean raw surface. The 
 wound should next be thoroughly washed by a stream of water, long 
 poured over it; lunar caustic afterwards to be applied. Mr. Youatt 
 prefers nitrate of silver freely used, to every other caustic : he recom- 
 mends that after its application the wound be quickly healed. Some 
 authorities advise that the wound be kept open by irritating ointments. 
 Chloroform may be given to prevent pain of knife. Subsequently, 
 patient to be assured that all has been done to prevent any after mis- 
 chief. To afford him greater confidence, administer for some days the 
 sulphite of magnesia in bark, 48. — See Hydrophobia. 
 
 4
 
 50 BITES OF VENOMOUS REPTILES — BOILS. 
 
 BITES OF VENOMOUS REPTILES.— The poisonous reptiles provided 
 . with fangs are the ophidia or serpents. Chief foreign serpents : (1) 
 Cerastes or Horned Serpents, allied to vipers, and much to be dreaded. 
 (2) Crotali or Rattle Snakes, provided with long poison fangs, and a 
 reservoir of some size. In human subject, the poison is fatal in two or 
 three minutes. (3) Bothrops or Javelin Snakes, inhabitants of Martinique 
 and St. Lucia. The most formidable species is the yellow viper of Mar- 
 tinique. M. Guyon saw several soldiers perish from its bite. Death 
 may occur almost immediately, or in the course of twenty-four hours. 
 And (4) Naia, or Spectacled Serpents, or Hooded Snakes, which are met 
 with in Arabia and India. This group contains the coluber haje, the 
 true asp of the ancients: also the cobi-a di capello. 
 
 The only poisonous reptile indigenous to this country is the Common 
 Viper or Adder. It is found on the heaths and in the dry woods of all 
 parts of Great Britain. Poison apparatus consists of a gland placed by 
 side of head, a duct, and a fang or pointed curved tooth moulded in 
 form of a tube. The bite rarely proves fatal. The wounded part be- 
 comes the seat of severe pain; great swelling, redness, and lividity. 
 Faintness : rapidity and feebleness of pulse. Bilious vomitings. Dysp- 
 noea. Profuse cold sweats. Jaundice. Delirium, or convulsions. 
 
 Treatment. Locally : The wound to be immediately sucked freely 
 and perseveringly. If patient is too faint to do this for himself, a by- 
 stander can fearlessly help him : it is well known that these ])oisons 
 may be swallowed, or smeai'ed upon the lips and tongue (provided there 
 is no abrasion), with impunity. At same time a ligature is to be placed 
 around the limb, above the wound; or if this be impossible from its 
 situation, the textures around are to be compressed. Then, the bitten 
 part to be excised; or it may be destroyed by actual cautery, nitric 
 acid, strong liquor ammonia?, or nitrate of silver. 
 
 Constitutionally :, Remedies derived chiefly from class of diffusible 
 stimulants. No agent more generally recommended than ammonia. 
 Compound tincture of ammonia (Phar. Lond.), formerly known as eau 
 de luce, in half-drachm doses well diluted; or aromatic spirits of am- 
 monia, two drachms to an ounce-and-a-half of water. Supposing no 
 ammonia is at hand, brandy will prove an excellent substitute. Trans- 
 fusion of blood has been recommended. 
 
 SLACK LEG. — A form of purpura, which occurs amongst the lumber- 
 men on the Ottawa or Grand River of Canada. It is produced by the 
 use of pork packed in nitrate of potash. — See Purpura. 
 
 BLENNOREHAGIA. — From jSXiwa, mucus or slime ; pTjyvu/u, to burst 
 forth. A discharge from the mucous membrane of the urethra or va- 
 gina, usually contracted in sexual intercourse. — See Gonorrhoea. 
 
 BLENNOEEHCEA. — From i^Xiwa, mucus ; piw, to flow. — See Gonorrhoea, 
 
 Gleet. 
 
 BLOWS AND BEUISES. — Seldom necessary to do more than relieve 
 pain and prevent discoloration. To be accomplished by: Arnica lo- 
 tions, 275. Aconite lotions, 265. Spirit and ammonia lotions, 273. 
 Poultices of black bryony root (Bryonia nigra), used by pugilists. 
 Glycerine. Oil of turpentine. Expressed juice of leaves of Mikania 
 Guaco. Dilute solution of subacetate of lead. 
 
 BOILS. — A boil or furunculus (from Ferveo, to burn) is a circumscribed 
 hard tumor, small but very painful, produced by inflammation of the
 
 BRASS-FOUNDER S AGUE — BRONCHITIS. i9» 
 
 true skin and subjacent areolar tissue. Morbid process terminates in 
 suppuration and ulceration. 
 
 TreatmExNT. Poultices. Fomentations. Painting with iodine. Pe- 
 ruvian balsam ointment. Incisions? Jalap and senna, 150. Sulphate 
 of manganese, 172. Quinine, 879. Mineral acids and bark, 376. Liquor 
 arsenicaiis, 52. Yeast. Liquor potassaj. Tar, 36. Nourishing food. 
 Wine or beer. Change of air. 
 
 BRASS-FOUNDER'S AGUE.— A peculiar form of intermittent fever, 
 Avbicli atfeets brass-founders and other workmen exposed to the fumes 
 of deflagrating zinc. Observed in the Birmingham foundries, &c. 
 
 Symptoms. The paroxysms occur irregularly. Constriction or tight- 
 ness about chest. In the evening, shivering; an indistinct hot stage; 
 profuse sweating. 
 
 Treatment. Emetics and milk, as prophylactics. Avoidance of the 
 fumes of zinc. Tonics, quinine, &c. 
 
 BRIGHT'S DISEASE.— A term indiscriminately applied to all renal 
 diseases accompanied b}^ albuminuria and dropsy. If retained, it should 
 be limited to some particular form of kidney disease. There may be 
 considerable inconvenience, however, from introducing into medical 
 nomenclature such terms as Addison's, Eright's, and Graves' Disease. — 
 See Nephritis ; Renal Degenerations. 
 
 BRONCHITIS. — From Jipdyyoq, the windpipe; terminal -ito. Synon. 
 Pulmonary Catarrh. — Inflammation of mucous membrane of bronchial 
 tubes. May be acute or chronic ; affects one or both lungs throughout, 
 or only a portion of these organs — usually the upper lobes. Symj)toms 
 of hay-asthma often of a bronchial character. 
 
 1. Acute Bronchitis. — A dangerous disorder: inflammatory action 
 often spreads to vesicular texture of lungs. 
 
 Symptoms. Fever. A sense of tightness or constriction about chest. 
 Hurried respiration with wheezing. Cough. Expectoration of viscid 
 glairy mucus, and afterwards of purulent secretion. Frequent, and 
 often weak, pulse. Foul tongue. Headache and lassitude. Sickness. 
 Great anxiety. 
 
 Inflammation oi larger and medium-sized tubes, attended by less severe 
 symptoms and results than general and capillary bronchitis. Latter, rare 
 in adults; chiefly seen in very young and old. It is recognized by 
 tendency to cause asphyxia; paroxysms of dj^spnoea or orthopnoea; 
 congestion of surface; perpetual cough; general restlessness; increas- 
 ing prostration ; and, in fatal cases, somnolence, muttering delirium, and 
 coma. Sometimes, during progress of acute bronchitis, one or more 
 tubes become choked up with viscid phlegm; pulmonary collapse re- 
 sulting — a portion of lung being emptied of air. One frequent result 
 of collapse is vesicular emphysema ; so that loss of function in airless 
 part of lung is compensated for by increase of volume in non-obstructed 
 portion. 
 
 In early stage of bronchitis, auscultation often detects two dry 
 sounds — rhonchus and sibilus. Ehonchus belongs to larger bronchi : 
 sibilus bespeaks more danger, as denoting that smaller air-tubes and 
 vesicles are affected. After inflamed membrane has poured out fluid, 
 the dry are displaced by moist sounds — large and small crepitation. 
 Ehonchus and large crepitation are the dry and moist sounds of larger 
 air-passages: sibilus and small crepitation, of the smaller branches. 
 No marked alteration in resonance of chest to be detected : with ex-
 
 52 BRONCHITIS. 
 
 ception of increased resonance in emphysema, and dull percussion-note 
 in collapse. 
 
 Treatment. Confinement to bed. Temperature of room 65° to 70° 
 F. Air to be moistened by steam. Beef-tea; milk arrowroot or gruel; 
 tea with milk; soda water and milk. Mucilaginous drinks, 19. Sarsa- 
 parilla, squills, and barley water, 238. White-wine whey, 10. 
 
 If there be constipation, castor oil ; or sulphate of magnesia and senna, 
 139. Saline draughts, 348. Ammonia and senega, 235. Carbonate of 
 ammonia, 361. Citrate of potash, ammonia, and aconite, 211. Dry 
 cupping, turpentine stupes, or sinapisms to walls of chest. Inhalation 
 of steam. 
 
 Remedies sometimes advised : Bleeding. Blisters. Friction with croton 
 oil, or tartarated antimony ointment. Emetics. Tartarated antimony. 
 Calomel. Colchicum. Hydrocyanic acid. Chlorate of potash. Laurel 
 water. Malt (Byne). Oxalic acid. Inhalation of chlorine. 
 
 2.' Chronic Bronchitis. — Very common in advanced life. 
 
 Symptoms. Slighter forms, indicated by habitual cough, shortness of 
 breath, copious expectoration: aggravated by exposure, to cold and 
 damp, bad living. Cases of " winter cough" in old people, mostly ex- 
 amples of bronchial inflammation of a low lingering form. — Impaired 
 resonance on percussion, especially low down posteriorly: on ausculta- 
 tion, feeble vesicular murmur, mingled with rhonchus and sibilus and 
 moist crepitation. — Dilatation of bronchi, with condensation of sur- 
 rounding lung tissue, occasionally results: sometimes, bronchorrhoea — 
 excessive and fetid muco-purulent secretion. — Seldom directly fatal : 
 may be indirect cause of death by leading to other diseases. 
 
 Treatment. Carbonate of ammonia, 361. Citrate of ammonia, 362. 
 Ammonia and senega, 235. Ammoniac mixture and opium, 237. Squills, 
 ammonia, and morphia, 239. Ipecacuan and Indian sarsaparilla, 241. 
 Nitrous ether, ipecacuan, and conium, 244. Squills and conium, 243. 
 Stramonium and dulcamara, 245. Sarsaparilla and squills, 238. Squills, 
 nitric acid, and bark, 236. Compound squill pill. Benzoate of ammonia. 
 Cod-liver oil. Wine. Nourishing food. Milk. 
 
 Locally : Inhalation of simple vapor. Turpentine or creasote inhala- 
 tions, 260. Inhalation of atomized fluids, 262. Counter-irritation to 
 thoracic walls by sinapisms ; turpentine stupes; stimulating liniments, 
 277, 278. Warm, pitch, galbanum, or chalybeate plasters. Respirator 
 to be worn. 
 
 Remedies sometimes recommended : Emetics of antimonial wine, or sul- 
 phate of zinc. Tartarated antimony. Compound tincture of benzoin. 
 Copaiba. Cubebs. Creasote. Guaiacum. Digitalis. Chlorate of pot- 
 ash. Storax. Suljjhur and acid tartrate of potash. Sumbul. Nitrate 
 of silver (locall}"). Balsam of Peru (locally). Blisters, ointment of tar- 
 tarated antimony, or croton oil (to chest walls). 
 
 3. Catarrhus Senilis. — A peculiar and severe form of chronic bn'on- 
 chitis, occurring in old people. Has been described as peripneumonia 
 notha, (bastard peripneumony); catarrhus senilis ; or subacute bronchitis. — 
 Consists of a subacute attack of general or capillary inflammation of 
 tubes. Symptoms of violent catarrh : more or less dyspnoea : excessive 
 secretion of opaque frothy mucus. Often much relieved by remedies 
 which produce copious expectoration. Sometimes causes fatal prostra- 
 tion : or patient dies from suffocation, unable to expel accumulated 
 mucus : or deficient oxygenation of blood leads to coma. 
 
 4. Plastic Bronchitis. — Eare form of bronchial disease. Characterized 
 by formation {UXuff/Tw, to form or figure, to make an image, &c.) of solid 
 or tubular concretions of exudation-matter within bronchi. 
 
 Symptoms. Expectoration of casts of tubes. Small fragments ex-
 
 BRONCHITIS. 53 
 
 polled easily. Expulsion of moulds of notable size preceded by dyspna'O ; 
 dry cough ; haemoptysis. Sometimes, excessive haemoptysis: tibi-iiious 
 concretions detached, but not easily expelled from tubes. Occasionally, 
 aneurismal or some other form of hemorrhage; casts consisting of de- 
 colorized coagulated blood. Cases of plastic bronchitis may last for 
 years, with occasional acute seizures. 
 
 Treatment. Remedies very ineffectual. Carbonate of ammonia, 
 361, 371. At time of hemorrhage, gallic acid, 1U3 : turpentine, 102: 
 iron-alum, 116: tannin and nitric acid, 99. Nourishing food. Sea air. 
 
 5. Mechanical Broncrdtis. — Due to inhalation of different particles 
 which irritate bronchi. For example, grinder's rot, or knife-grinder's 
 disease; carbonaceous bronchitis, or black phthisis, occurring in miners, 
 from inhalation of lamp-smoke and carbonic acid gas formed in pits; 
 and cotton pneumonia, or cotton phthisis, met with amongst operatives 
 in cotton mills. — Larch or Venice turpentine (Terebinthina laricea), in 
 doses of gr. 15 — 20 made into pills with liquorice powder, and tal^en 
 thrice daily, often serviceable. 
 
 6. Secondary Bronchitis. — Bronchitis occurring secondarily in blood- 
 diseases, often troublesome. Typhoid bronchitis, may greatly aggravate 
 danger in enteric fever. — Gouty ^ or rheumatic bronchitis, will require 
 colchicum and iodide of potassium. — Syphilitic bronchitis, occurs in sys- 
 tem poisoned to secondary or tertiary degree. Causes excessive muco- 
 purulent expectoration; night sweats; wasting; great debility. May 
 be cured by iodide of potassium, 31. Compound pill of calomel. Mer- 
 curial vapor bath, 131. Iodine inhalations, 259. Atomized iodine, or 
 corrosive sublimate, spra}"^, 262. 
 
 7. Hay-Asthma. — Synon. Hay- Fever ; Summer Catarrh. — May be de- 
 scribed as a severe catarrh, with asthmatic sj^mptoms superadded. 
 Probably due to inhalation of aroma of spring grass and hay. 
 
 Symptoms. Conjunctival, nasal, faucial, and bronchial mucous mem- 
 branes are each affected. Headache. Suffusion of ej^es. Sneezing. 
 Irritation of nose and fauces. Dry harassing cough. Paroxysmal 
 attacks of asthma. 
 
 Treatment. May be cut short by removal from cause ; residence at 
 sea-side especially. Susceptibility sometimes destroyed by quinine and 
 steel; arsenic; nux vomica. 
 
 During attack: Tincture of lobelia, 88. Ammonia and assafoetida, 86. 
 Valerian and assafoetida, 94. Ether and opium with camphor, 85. Bel- 
 ladonna and zinc, 410. Stramonium. Indian hemp. Coffee. Subcu- 
 taneous injections of atropine, 314. Creasote inhalations, 261. Pipe 
 of tobacco. 
 
 BRONCHOCELE. — From Bpoyyoq, the windpipe; zf;;.i;, a swelling. 
 Synon. Thyrocele ; Wen ; Goitre by the Swiss ; and in this country Derby- 
 shire Neck from its prevalence in some parts of Derbyshire. An enlarge- 
 ment of the thyroid gland. 
 
 Symptoms. The whole gland may be swollen, or only the centre, or 
 either side — especially the right. Sometimes no inconvenience beyond 
 the deformity. In other cases, throbbing of vessels, palpitation of heart, 
 mental depression, dyspe])sia, and other manifestations of attenuated 
 blood. Difficult respiration and deglutition from pressure of tumor. 
 Irregularity of uterine functions. Scanty menstruation. Profuse leu- 
 corrhoea. 
 
 A cystic form, in which cysts are developed in the gland. Their lining 
 membrane very vascular : brown-colored serous contents. 
 
 Exophthalmic goitre. Protrusion of eyeball (proptosis oculi); strong^ 
 pulsations in thyroid body; palpitation of heart, with a bruit.
 
 54 BUBO — BURNS AND SCALDS. 
 
 Treatment. Eemoval from infected loealit}^. Eegular establishment 
 of menstrual functions. Iodide of ammonium, 38. Iodide of potassium, 
 31. Cod-liver oil. Iodide of iron, 32. Quinine and iron, 380. Bromide 
 of iron. Steel and aloes, 393. Digitalis. Liquor potassae. Bromide of 
 potassium. Strychnia. Bromide of ammonium. Nourishing food. Cold 
 bathing. Sea air. 
 
 Locally : Comj^ound iodine ointment with cod-liver oil, 308. Diluted 
 iodine liniment. Ointment of iodide of ammonium. Ointment of iodide 
 of potassium. Ointment of red iodide of mercury, 302. Ice. Setons. 
 Ligature of thyroid arteries. Electro-puncture. Injection with solu- 
 tion of perchloride of iron, dangerous. Extirpation of the gland, unjus- 
 tifiable. See Graves' Disease. 
 
 BUBO. — From Bvu,3a)v, a tumor of the inguinal glands. Synon. Aden- 
 ophyma Inguinalis. Consists either of a simple or of a specilic inflam- 
 matory enlargement of a lymphatic vessel, or of one of the glands in 
 connection with such vessel. Term " bubo" especially applied to inflam- 
 mation of the inguinal glands. Superficial glands alone affected. 
 
 There are several varieties : 
 
 (1) Simple Sympathetic Bubo. — Whatever causes lymphatic irrita- 
 tion may give rise to simple inflammatory adenitis. Hence it may arise 
 from balanitis, gonorrhoea, excessive venery, <fec. The action may end 
 in resolution, or go on to suppuration. — Eequires rest. "Warm bathing. 
 Tonics. Cod-liver oil. Evacuation of pus. — See Adenitis. 
 
 (2) Primary Bubo. — Said to form from the direct absorption of syphi- 
 litic matter, without the occurrence of any chancre or sore. Very rare. 
 Described as bubon d'eniblee by the French. 
 
 (3) Amygdaloid Indolent Bubo. — Comes on simultaneously with 
 induration in eases of infecting chancre. Suppuration only occurs from 
 some accidental complication. Treatment the same as for constitutional 
 syphilis. 
 
 (4) Virulent or Inoculable Bubo. — Due to absorption of virus from 
 a soft or from a phagedenic chancre. Affected gland suppurates: walls 
 of resulting abscess form a syphilitic sore, the pus from which is inocu- 
 lable. — Eequires free incisions. Potassa fusa. Soothing dressings. Fre- 
 qnent syringing. Quinine and iron. Nourishing food. 
 
 BULIMIC DYSPEPSIA. — Bou, abbreviation of /3oDc, as an augmentative 
 particle; /lao?, hunger. — (jou/t/^o?, excessive hunger: zJyij, difficult; rtTrrw, 
 to digest. — In some cases of nervous gastric disturbance the appetite is 
 exaggerated : is scarcely appeased by food. Digestion takes place 
 easily and naturally; or is accompanied with acid eructations and p}-- 
 rosis. Stomach often dilated. 
 
 Symptoms. Desire for food returns immediately after a meal. Con- 
 stant hunger. Faintness and mental depression. Painful sense of 
 sinking about praecordia. 
 
 Treatment. Cod-liver oil, 389. Eaw minced meat, 2. Pepsine, 420. 
 
 BURNS AND SCALDS. — Synon. Ambustio (Ainburo, to burn around). 
 The danger varies according to the extent of surface injured, the de- 
 gree of tissue disorganization, the importance of the organ implicated, 
 and the age and constitution of patient. 
 
 Symptoms. Shock to S3^stem, sometimes so severe as to produce fatal 
 syncope. Pallor and coldness of surface and extremities; shiverings. 
 liapidit}^ and feebleness of pulse. Imperfect reaction and exhaustion; 
 or violent reaction with fever, and congestion or inflammation of lungs, 
 or brain, or bowels: or hectic fever from tedious cicatrization, exhaust-
 
 CiECITIS. 55 
 
 ing discliarges, &c. In few cases can the danger be said to be over until 
 after the hipse of nine days. Wliere recovery ensues, there is the fear 
 of deformity from contraction of cicatrices. 
 
 Treatment. To bring about reaction and relieve pain administer a 
 full (lose of opium, with mulled ]>ort wine or brandy and water: repeat 
 the dose if necessar}'. Chloroform inhalation, where pain is excessive: 
 the injured part to be dressed while patient is insensible. After reaction 
 is well established, a dose of castor oil or a purgative enema if there be 
 constipation. Simple salines, where internal organs are congested or 
 inflamed. Ice. Ammonia and bark, port wine or brandy, milk and 
 raw eggs, beef tea with pounded meat, cod-liver oil, where there is 
 depression. In all cases, perseverance with opium or chloroform to 
 remove pain and nervous irritability. 
 
 Locally : Chief object to prevent access of air to injured surface. Im- 
 mersion in cold Avater for many hours where only a portion of a limb is 
 burnt. Free application of lime liniment (Carron oil) on cotton-wool. 
 Cotton-wool alone, with gentle bandaging. Dusting with flour, rice 
 flour, prepared chalk, or equal ])arts of starch and carbonate of lead. 
 Crusts formed by the applications not to be removed until loosened by 
 discharges. Dressing with sulphur ointment, or turpentine ointment, 
 subacetate of lead ointment, carbonate of zinc in ointment or powder, 
 creasote, glj'cerine, sulphate of zinc lotion, solution of gum, collodion, 
 treacle, &c. 
 
 Patient to be kept in an easy position, between blankets, and on a 
 water bed if necessary. All vesicles to be pricked, so that tension may 
 be relieved by escape of contents; but the raised cuticle not to be dis- 
 placed. The prevention of deformity to be attempted by attention to 
 position, by movements of joints where practicable, and by lubricating 
 cicatrix freely with oil. 
 
 C^CITIS. — From Caucus, blind; terminal -itis. Synon. Typhlitis; 
 Tup/ilo-enteritis. — Inflammation of the caecum or its appendix. — May be 
 due to accumulation of hard fecal matter, skins or stones of fi-uit, biliary 
 and intestinal concretions, balls of lumbrici and oxyurides, &c. 
 
 Symptoms. In aaite form : Fever ; nausea; constipation. Fulness 
 and tenderness about right iliac region : pain, rendered exquisite by 
 pressure. Position on right side selected, with trunk somewhat bent, 
 and knees drawn up, to relax painful tissues. If peritoneal coat get 
 involved, appendix becomes inflamed ; followed by evidence of general 
 peritonitis. Areolar tissue round caecum may also become inflamed 
 (perityphlitis) : suppuration and abscess. 
 
 When inflammatoiy action begins in vermiform appendix from consti- 
 tutional causes, or escape into this part of morbid matter, symptoms are 
 ver}^ acute. Excruciating tormina; tj'mpanites; hiccup; violent sick- 
 ness. Obstruction of bowels. Great pain, extending to right ovarj- or 
 testicle, and shooting down inside of thigh. Gangrene and general 
 peritonitis may follow, and cause death. Or a portion of large intestine 
 and caecum with appendix may slough ofl:', be passed with stool, and yet 
 recovery ultimately ensue. In tuberculous typhlitis, ulceration occurs 
 more frequently in appendix than in esecum itself. 
 
 In chronic csecitis: S3'mptom8 come on slowly and insidiously. Fail- 
 ing health; weakness; loss of flesh. Colicky pains in right iliac region. 
 Flatulence; loss of appetite. Diarrhoea alternating with constipation. 
 If mucous coat ulcerates, — mucous discharges; attacks of hemorrhage. 
 When fatal, exhaustion generally the cause. Perforation rare. 
 
 Treatment. If acute : Opium. Opium and belladonna. 344. Olive 
 oil enemata, 188. Mucilaginous drinks, 19. Chlorate of potash drink.
 
 56 CANCER OR CARCINOMA. 
 
 360. Lemonade. Ice: iced water. Prolongedhot hip baths. Fomen- 
 tations. Linseed poultices. Most perfect quiet in bed. Milk diet. — If 
 symptoms of suppuration set in : Ammonia and bark, 371. Quinine and 
 ammonia, 386. Brandy and egg mixture, with opium, 318. Milk or 
 cream. Raw eggs. Essence of beef Port wine. 
 
 Chronic form. : Mineral acids with quinine, 379. Iodide of ammonium 
 and bark, 38. Cod-liver oil. Warm bathing. Application of belladonna, 
 265. Wet compress with belladonna, 297. Simple nourishing food. Sea air. 
 
 CANCER OR CARCINOMA.— From Kapxhoq, a crab. In the present 
 state of medical science a cancer may be described as a local manifesta- 
 tion of a specific disease of the blood, having incorporated in it peculiar 
 morbid materials which accumulate in the blood, and which its growth 
 may tend to increase. As it is of constitutional origin, so the removal 
 of the local manifestation does not effect a cure; but the cancer returns 
 either in the seat of original disease, or in some other parts. Moreover, 
 when the primary affection has existed for a variable period, secondary 
 deposits are very apt to be formed in the lymphatic glands, lungs, liver, 
 spleen, &c. This definition does not meet with universal acceptance; 
 since some authorities now assert that the disease is at first local, though 
 at an early period it becomes general. 
 
 There are three principal varieties, and five suhvarieties of malignant 
 disease: the latter probably mere modifications of the former. They 
 consist of: 
 
 Scirrhus, or Hard Cancer. 
 
 Medullary, or Soft Cancer. 
 
 Epitlielial Cancer. 
 
 Colloid, Gelatiniform, Alveolar, Cystic, or Gum Cancer. 
 
 Melanoid, or Black Cancer. 
 
 Osteoid Cancer. 
 
 Hsematoid Cancer, or Fungus Ilsematodes. 
 
 Villous Cancer. 
 
 Symptoms. A separable tumor, or an infiltration; which alters the 
 original texture of organ in which it is seated, invades surrounding 
 parts, extends to lymphatics, and involves system generally". Softening 
 and disintegration of the growth. Ulceration of skin or mucous mem- 
 brane. A foul, excavated, spreading ulcer. Sanious, foetid discharges. 
 Hemorrhages. Pi'ogressive debility and emaciation. Nausea and 
 vomiting. Diarrhoea. Complete prostration. Exhaustion. Death. 
 
 The cancerous cachexia: Dirty yellow hue of skin. Contracted fea- 
 tures. General wasting. Loss of strength and energy. Mental irri- 
 tability. 
 
 Cancerous growths abound in cell-formations and bloodvessels. 
 " Cancer-cells" have one or more nuclei of large size, and one or two 
 nucleoli. They bear a resemblance to secreting gland-cells. Degene- 
 ration of the cells. " Cancer-juice," — a viscid or creamy fluid. A basis 
 of fibrous tissue. Microscopical examination of tumors an aid to diag- 
 nosis. 
 
 Treatment. General indications : Maintain the constitutional powers 
 by tonics, nourishing food, pure air, warm clothing, removal of offensive 
 discharges, and mental occupation as long as possible. 
 
 Relief of Pain : Extract of opium, 343, 345. Opium with belladonna, 
 344. Liquid extract of opium. Mor])hia, 315. 329, 343. Conium, 336. 
 Henbane. Codeia. Indian hemp. 317, 337. Ether. Chloroform. Ex- 
 tract of hop. Subcutaneous injectiotis of morphia, 314. Aconite. Atro- 
 pine, 326. Iodoform, 338. Opiate enemata, 339. Opiate suppositories, 
 340.
 
 CANCRUM ORIS — CARBUNCLE. 0< 
 
 Trnprovement of the Blood: Liquid extract of yellow cinchona. Bark 
 and ammonia, 371. Bark and mineral acids, 376. Iodide of iron, 382, 
 391). Keduced iron, 394. Ammonio-citrate of iron, 401, 403. Phosphate 
 of iron, 405. Quinine and iron, 380. Lemon-juice and chiretta, 377. 
 Salicin, 388. Sarsaparilla. Sulphite of magnesia, 48. Chlorate of pot- 
 ash, 61. Cod-liver oil, 389. Pepsine. 420. 
 
 Animal food. Milk and cream. Paw eggs. Brandy. Wine. Beer. 
 Vichy or soda water. Wenham Lake ice. 
 
 Abatement of local growth and systemic contamination : Belladonna and 
 opium, 344. Quinine and belladonna, 383. Zinc and belladonna, 332. 
 
 Local Remedies: Belladonna, 265, 293. Opium and belladonna, 297. 
 Extract of poppies. Extract of conium. Iodoform. Carbonic acid gas. 
 Oxygen gas. Charcoal poultice. Yeast poultice. Hemlock ])onltice. 
 Chlorine poultice. Linseed poultice, with or without belladonna or 
 opium incorporated. Carrot poultice. Logwood, 82. Chlorate of potash 
 lotion. Iodide of potassium lotion. Citric acid lotion, 264. Friction 
 with solutions of iodide of lead, or iodide of potassium, or bromide of 
 potassium. Perchloride of iron. Cotton-M^ool. 
 
 Operative Treatment : Free excision. Union by first intention not 
 desii-able. Excision, followed immediately by sponging entire surface 
 of wound with solution of chloride of zinc (grs. 50 to fl. oz. j). Excision 
 followed by prolonged administration of belladonna, 383, 410. Ligature 
 of nutrient arteries. Electricity. Methodical compression. Congela- 
 tion. Actual cautery. Galvanic cautery. Friction and palpation. 
 
 Kemoval by caustics: Chloride of zinc, 197. Chloride of zinc and 
 puccoon. Chloride of bromium, 196. Dried sulphate of zinc. Super- 
 sulphate of zinc, 198. Arsenical paste, 199. Manganese cum potassa. 
 Strong mineral acids. Concentrated alkalies. Vienna paste, 204. 
 
 Remedies often tried and found valueless : Calomel. Corrosive sublimate. 
 Iodine. Iodide of potassium. Iodide of mercury. Iodide of lead. Bro- 
 mine. Bromide of potassium. Arsenic. Iodide of arsenic. Sanguinaria 
 Canadensis, or puccoon. Chloride of lime. Hydrocyanic acid. — Milk 
 diet. — Leeches. Venesection. Blisters. Syphilization. 
 
 CANCRUM ORIS.— Sloughing phagedena of the mouth. Occurs in 
 
 young children. — See Stomatitis. 
 
 CARBUNCLE.— Dimin. of Carbo, "a live coal." Synon. Anthrax 
 (from "AvOpa^, a coal). — Consists of severe inflammation of a circum- 
 scribed portion of skin and subjacent tissue, with infiltration of un- 
 healthy lymph. 
 
 Symptoms. Flattened circular swelling. Throbbing or dull aching 
 pain. Suppuration. Bloody purulent discharge. Slough of areolar tissue. 
 Vitiated state of the blood. Constitutional disturbance. Prostration. 
 Fear of pyemia. 
 
 Treatment. Poultices. Anodyne fomentations. Opium plaster. 
 Crucial incisions. Subcutaneous incisions. Potassa fusa, rubbed into 
 the centre until an eschar is formed, with avoidance of incisions and 
 poultices. Congelation. Acid nitrate of mercury. Nitrate of silver. 
 Turpentine ointment. Iodine, 205. Warm bathing to remove the dis- 
 charges. Cotton- wool. 
 
 Podophyllin, 160. Jalap and senna, 151. Colocynth and blue pill, 
 172. Saline aperients with eolchicum, 152. Castor oil. Chlorate of pot- 
 ash and steel, 4U2. Arsenic, 52. Tar capsules, 36. Mineral acids and 
 bark, 376. Ammonia and bark, 371. Quinine, 379. Opium. Moi-phia 
 and Indian hemp, 317. Nourishing food. Hassall's flour of meat. Milk. 
 Alcoholic stimulants.
 
 58 CARDIAC ANEURISM — CARDIAC CANCER. 
 
 CARDIAC ANEURISM. — From Kap8ia, the heart: "A'^eupwaj, to dilate. 
 — Two forms of aneurism of the heart: (1) The acute variety, depends 
 on a laceration of endocardium and muscular tissue, through which the 
 blood passes and makes a pouch. In this pouch fibrine is deposited, 
 while at its entrance is a fringed margin of endocardium with vegeta- 
 tions attached. (2) The chronic form, results from some inflammatory 
 condition of muscular fibre, or of endocardium. Walls of sac consist of 
 endocardial and pericardial membranes unbroken, while the muscular 
 fibre seems to be replaced b}' a fibroid tissue. — Either kind of aneurism 
 gives rise to obscure and uncertain sj'mptoms. Passage of blood into 
 sac may cause a murmur. Death usually occurs suddenl}' from rupture. 
 
 Aneurismai dilatation and rupture of coronary arteries not a frequent 
 event. No symptoms during life to allow of correct diagnosis. 
 
 CARDIAC ATROPHY. — From Kapdla, the heart: 'A, priv ; Tpi<paj, to 
 ' nourish. — Two foi'ms : (1) That in which the heart wastes and dwindles 
 in all its parts. (2) The texture of the muscular walls suffers a more 
 or less complete conversion into fat. 
 
 1. Simple Atrophy. — Occurs in connection with many exhausting dis- 
 eases, — cancer, tuberculosis, diabetes, &c. — The whole heart diminishes in 
 size: after death weight found reduced from 9 to 5 oz. Minute exam- 
 ination detects the muscular fibres pale and soft, but otherwise health3^ 
 The treatment must be that demanded by the constitutional state, of 
 which the atrophy is merely a symptom. 
 
 2- Fatty Degeneration of Heart. — Occurs alone; or in conjunction 
 with fatty disease of liver, kidneys, cornea, &c. Yalvular disease 
 rarely coexists; when it does, aortic more generally affected than 
 mitral valves. 
 
 Symptoms. Feeble action of heart : slow pulse, sometimes as low as 
 fifty or forty-five. General debility. Transient attacks of giddiness or 
 faintness. Nervous exhaustion, and loss of tone. Heart's sounds weak. 
 Attacks of dyspnoea. Many of the symptoms of angina pectoris. Per- 
 haps, an areas senilis. — Occurs more frequently in men than women. 
 Most common at advanced period of life. May cause sudden death, — 
 perhaps from rujiture. 
 
 Treatment. Nourishing animal food. Milk. Cream. Cod-liver oil. 
 Mineral acids. Mild preparations of steel. Attention to digestive organs. 
 Eesidence in pui-e air. Early hours. Gentle exercise. Avoidance of 
 excitement. Tepid salt-water sponge baths. 
 
 3. Fatty Growth. — That condition in which the fat normally depos- 
 ited upon the heart is increased on and amongst the muscular fibres to 
 a morbid extent. May occur alone; or in conjunction with general 
 obesity; or in association with fatty degeneration. 
 
 Symptoms. When existing alone the chief features are those of a 
 heart enlarged and impeded in the performance of its functions. Pulse 
 permanently quickened above normal standard, while its force is di- 
 minished. 
 
 Treatment. Animal food. Light French, German, or Hungarian 
 wines. Avoidance of sugar, vegetables, oily, and starchy substances. — 
 See Obesity. 
 
 CARDIAC CANCER. — From Kapdia, the heart. — Primary cancer of 
 heart exti'omely rare. This organ is secondai-ily involved more fre- 
 quently. Pight auricle most frequent seat: sometimes perforated by 
 the malignant growth. Disease occasionally extends along coats of 
 large veins. It may occur as an infiltration in muscular tissue, or as a 
 deposit in form of tumor.
 
 CARDIAC DILATATION CARDIAC HYPERTROPHY. 59 
 
 Cancer of pericardium almost invariably tlio result of secondary and 
 general dejiosits. Medullary more common than scirrhus. 
 
 CARDIAC DILATATION.— May occur under three forms : (1) Hyper- 
 trophy of heart with dilatation: known as active dilatation, when the 
 expansion predominates over the hypertrophy. (2) Simple dilatation, 
 wiiere thickness of walls is normal. (3) Passive ov attenuated dilatation, 
 the walls being thinned. Often combined with malnutrition of heart, 
 and fatty degeneration of muscular fibi"es. May arise fi"om exhausting 
 disease, endocarditis, or perhaps from pericardial adhesion. The chief 
 symptoms are, a small weak pulse; coldness of extremities; giddiness, 
 and deranged digestion. Attacks of fainting; paroxysms of asthma; 
 restless nights; palpitation; perhaps, anasarca followed by ascites. 
 Antispasmodics, ferruginous tonics, and agents to aid digestion are the 
 only remedies. Alum has been recommended. Digitalis may deserve 
 a cautious trial. 
 
 CARDIAC FUNCTIONAL DERANGEMENT.— From KapSh, the heart. 
 May closely simulate oi'gaiiic disease of heart. Occurs in cases of 
 hysteria, ovarian or uterine irritation, neuralgia, anaemia; not uncom- 
 mon in women at "change of life." May be due to nervous exhaustion 
 from over-study, anxiety, sexual excesses, &c. ; to gout, rheumatism, or 
 chronic liver disease; to use of tobacco or strong tea; to dyspepsia. 
 
 Symptoms. — There may be irregular pulse, palpitation, iluttering; 
 with a cardiac murmur and subcutaneous oedema in anaemic subjects. 
 Dull wearj'ing ache in prgecordial region : occasionally, lancinating 
 pains. Inability to lie on left side, owing to tenderness. Mental de- 
 pression. D3spepsia; flatulence and acid eructations. Globus hA'Ste- 
 ricus. Occasional attacks of giddiness, faintness. headache, noises in 
 ears, flushings of face, violent pulsations in aorta, &c. 
 
 Treatment. Allay symptoms while removing their source. Explain 
 cause of suffering to patient. Antispasmodics and sedatives to quiet 
 circulation, — Ether and ammonia, &c., 85. Assafoetida and ammonia, 
 86. Sumbul and ether, 95. Henbane, camphor, and hop, 325. Codeia 
 and assafoetida, 328. — Where there is any connection with rheumatism, 
 — Aconite and guaiacum, 330. Potash and ammonia, 67. — In gouty 
 subjects, — Potash and aloes, 71. Citrate of lithia, 64. Stramonium, 
 colchicum, and digitalis, 94. Colchicum, 46,351,352. Saline draughts, 
 348. — If there be constipation with unhealthy secretions, — Aloes and 
 jalap, 145. Rhubarb and gentian, 146. Phosphate of soda and aloes, 
 149. Pepsine and aloes, 155. — If there be dyspepsia, — Carbonate of 
 magnesia, 62. Ammonia and chiretta, 63. Potash and ammonia, 67. 
 Soda, morphia, and hvdrocyanic acid, 7U. Animonia in eftervescence, 
 362. Bismuth, 65. Nitro-hydrochloric acid, 378. Pepsine, 420.— If 
 there be nervous exhaustion or anajmia, — Citrate of steel and ammonia. 
 401, 403. Reduced iron and pepsine, 394. Phosphate of iron, 405. Steel 
 and aloes, 404. Quinine and iron, 380. 
 
 In all forms, — Attention to diet. Tobacco and tea to be forbidden. 
 Malt liquors usually disagree. Brandj^ and soda water. Light French, 
 German, or Hungarian wines. Exercise in pure air. Sea bathing. 
 
 CARDIAC HYPERTROPHY.— From KapSia, the heart: 'Trzsp, in ex- 
 cess; rpicfio, to nourish. Synon. Hypertrophia Cordis. — The heart is 
 I'oughiy said to be about the same size as the closed fist. Its average 
 weight in adult male is 9i oz. : in female 82-. After sixtieth year, the 
 weight is somewdiat greater, owing to the thickness of walls of left 
 ventricle bavin ff increased.
 
 60 CARDIAC RUPTUllE CARDIAC VALVULAR DISEASE. 
 
 The muscular walls of one or more cavities may become thickened 
 without any diminution in size of chamber, — simple, hypertrophy. Or, 
 the walls ma}' be thickened, and the chamber enlarged, — eccentric hyper- 
 trophy, or hypertrophy with dilatation. Or, the increase in thickness may 
 be accompanied with diminution of size of cavity, — concentric hyper- 
 trophy. Hypertrophy often beneficial : it counterbalances some impedi- 
 7nent to flow of blood through heart, or to free play of this organ. 
 Hypertrophy' of left ventricle with valvular disease, the most common 
 form of this affection. Simple hypei-trophy of left ventricle without 
 any obstruction to flow of blood is rare : sometimes found in cases of 
 chronic Bright's disease. Hypertrophy with dilatation of right ven- 
 tricle, generally due to some chronic disease of lungs obstructing cir- 
 culation. 
 
 Symptoms. Will depend on extent of hypertrophy. Frequently, 
 there are palpitations; dj'spnoea; difficult}^ in walking quickly ] unea- 
 siness and pain about cardiac region ; headache ; repeated attacks of 
 vertigo. Systolic sound heard less distinctly than in health. Extent 
 of pulsation and degree of impulse, increased. Murmurs in valvular 
 disease. 
 
 Treatment. Circulation to be jvcpt tranquil. If there be much de- 
 bility, — Quinine and steel, 380. Steel and pepsine, 394. Steel and am- 
 monia, 401. Phosphate of iron, 405. Bark and ammonia, 371. Mineral 
 acids and bark, 376. Nitro-hydrochloric acid and chiretta, 378. — If 
 heart's impulse be verj' great, — Aconite, 330. Digitalis, 334. — When 
 dyspnoea is urgent, — Ammonia and ether, 364. Indian hemp, aconite, 
 and ether, 342. Lobelia and ether, 322. 
 
 Remedies sometimes employed: Bromide of potassium. Iodide of potas- 
 sium. Hydrocyanic acid. Calomel. Acid tartrate of potash. Acetate 
 of lead. Henbane. Morphia. Digitaline. Camphor. Spirit of nitrous 
 ether. Hydrosulphuret of ammonia. Blisters. 
 
 CARDIAC RUPTURE. — From KapSia, the heart.— Eupture of the 
 heart may occur spontaneously from previous disease, or may be caused 
 by external violence. In former case, more frequent on left than right 
 side; in latter, the reverse. Laceration of walls of ventricles most 
 common. Eupture of valves or their tendons, generally the consequence 
 of prior attack of endocarditis: laceration of muscular wall frequently 
 symptomatic of fatty degeneration, or of rupture of aneurism in ven- 
 tricular wall. 
 
 When death does not result immediately, there is great orthopnoea; 
 intense prostration ; syncope ; convulsions. In laceration of valves, of 
 chordae tendinete, or of musculi papillares, — great oppression about prae- 
 cordia, with a loud endocardial bruit. If wound gets plugged with 
 coagula, patient may live for even some days. 
 
 CARDIAC VALVULAR DISEASE.— From Kap8ia, the heart. Most 
 of the alterations in internal lining membrane of heart result from in- 
 flammation, which gives rise to a deposit of Ij-mph upon or beneath the 
 serous membrane. The valves lose their delicacy and trans))arency : 
 become thick, puckered and adherent to each otlier. Independently of 
 inflammation, the valves get covered with warty vegetations or ex- 
 crescences; they may be converted into bone; or they become the seat 
 of atheromatous or other deposits. 
 
 Effects twofold : Either to contract and narrow the orifice and so 
 obstruct the passage of the blood — valvular obstruction ; or by thickening 
 and shortening the valves, to make the orifice more or less patent, and 
 hence permit of regurgitation of blood — valvular insufficiency, rcgurgi-
 
 CARDIAC VALVULAR DISEASE. 61 
 
 tani disease of valves, &c. There may be only valvular obstruction, or 
 valvular insufficiency; often these conditions coexist. 
 
 Symptoms. Difficulty of breathing, varying from slightest dyspnoea 
 to most severe orthopnoea: increased by exertion. Palpitation and 
 irregular action of heart, with sounds and murmurs discoverable by 
 auscultation. Alterations in pulse: soft and irregular in mitral disease, 
 hard and jerking but regular in aortic. Congestion of lungs ; bronchitis ; 
 pneumonia; pulmonary liemorrhage. Hemorrhages from nose, bronchi, 
 or stomach. Oedema of lower extremities, sometimes of arms and face ; 
 hydrothorax ; ascites. Dropsy more common in affections of right than 
 of left cavities. Headache, noises in ears, vertigo, syncope, cerebral 
 congestion, and cerebral hemorrhage : most urgent in aortic disease. 
 Broken rest, startings during sleep, frightful dreams. Enlargement of 
 liver and spleen. Disordered digestion. A peculiar appearance of coun- 
 tenance, — face puffed ; cheeks flushed and of purple hue ; lips congested ; 
 eyes bi'ight. 
 
 As disease becomes aggravated, patient gets weak and very nervous. 
 Suffers immediately from over-exertion, mentalemotion, improper food, 
 exposure to cold and wet. Subsequently, death : either suddenl}- from 
 syncope, or gradually from progress of secondary affections. 
 
 Physical signs : Either or both sounds of heart accompanied or sup- 
 planted by a bellows-murmur (bruit de soufflet). A murmur may be 
 harsh, or rough, or cooing, or whistling, or musical, — modifications of 
 but slight importance. Of whatever character, a murmur is caused 
 either "by obstructions to free flow of blood through heart and great 
 vessels, producing an organic murmur; or by an altered state of blood, 
 or a clot in one of heart's cavities, giving rise to an inorganic, or func- 
 tional, or hceinic murmur. 
 
 Lining membrane, valves, and orifices of left side of heart much more 
 frequently diseased than those of right: almost questionable whether 
 disease of tricuspid or pulmonary valves can be positively diagnosed. — 
 Signs of disease of aortic and mitral valves may be thus briefly tabulated 
 (Dr. Harvey) : 
 
 Bruit : If systolic, and loudest at 
 
 Base^KoKTic obstruction. 
 
 ^pex^MiTRAL insufficiency. 
 Bruit : If diastolic, and loudest at 
 
 Base=:AoRTiG insufficiency. 
 
 Apex=M.iTRAL obstruction. 
 Pulse : If regular. 
 
 Full, or strong. [-=Aortic disease. 
 
 Jerking, resilient. 
 Pulse : If irregular, 
 
 Intermittent, unequal, ^ ^Mitral disease. 
 
 Soft, small, weak, ) 
 
 Semilunar valves of pulmonary artery may be supposed to be diseased 
 when the bellows-murmur can be traced from middle of left edge of 
 sternum up towards left clavicle; and when this murmur cannot be 
 heard in subclavian or carotid arteries. Pulse remaining unaltered. — 
 Tricuspid valve, guarding right aurieulo-ventricular opening, seldom 
 found otherwise than healthy. When diseased, a murmur may be heard 
 over central and lower part of sternum, extending downwards to epi- 
 gastrium, and inaudible in aorta and its branches. There is also tur- 
 gescence, with pulsation of jugular veins at every ventricular systole. 
 Arterial pulse unaffected. 
 
 To determine systolic or diastolic character of a mui'mur, pulse at
 
 62 CARDIALGIA — CATALEPSY, 
 
 wrist should be carefully noted during auscultation : if systolic, the 
 bruit must be synchronous with pulse, and if most audible at apex, is 
 indicative of mitral disease ; if diastolic, not synchronous with pulse, 
 and most audible over centre of sternum and along course of aorta, it 
 denotes aortic disease. 
 
 Treatment. Three indications to be followed : (1) To abate inordi- 
 nate action by cautious use of sedatives. Digitalis. H^'drocyanic acid. 
 Aconite. Belladonna. Conium. Henbane. Hop. Opium, or morphia. 
 (2) To ward off or relieve results of cardiac disease, as pulmonary 
 congestion, pneumonia, hemoi'rhage, congestions of liver and kidneys, 
 dropsy, &c. A nutritious diet. Saline purgatives, Sulphate of soda, 
 144. Cream of tartar and buchu, 222. Cream of tartar and taraxa- 
 cum, 228. Diuretics. Squills and digitalis, 219, 224. Potash and digi- 
 talis, 220. Urea, 225. Elaterium, 157. Resin of podophyllum, 160. 
 Gamboge and blue pill, 174. Digitalis and calomel, 230. Small punc- 
 tures at various parts of anasarcous legs. (3) To impart strength and 
 tone to heart. Nourishing food. French, German, or Hungarian wines. 
 Warm clothing. Cod-liver oil. Ferruginous tonics, — Quinine and steel, 
 380. Steel and glycerine, 392. Steel and pepsine. 394. Saccharated car- 
 bonate of iron, 396. Steel and ammonia, 401. Phosphate of iron, 4(J5. 
 Tepid salt-water sponge baths, 127. 
 
 CARSIALGIA. — From Kap<iia, the heart; (iXyo-:, pain. Synon. Heart- 
 burn. — The uneasiness is popularly believed to be around the heart. — See 
 Gastralgia. 
 
 CAKIES. — From Caries, rottenness. Synon. Ulceration of Bone. — A 
 disease of bone, characterized by an unhealthy inflammation, softening, 
 and molecular disintegration ; accompanied by suppuration of surround- 
 ing soft tissues. Most frequently attacks the vertebrae, short bones, or 
 cancellated extremities of long bones (as tibia). Frequently due to 
 scrofula, syphilis, abuse of mercury. When caused by syphilitic taint, 
 or by combinations of syphilis with abuse of mercury, cranial bones 
 often affected. 
 
 Symptoms. Commonly' obscure at first ; apt to be attributed to rheu- 
 matism. Deep-seated pain. Redness and swelling of tissues over af- 
 fected part. Abscess, which on bursting discharges a fetid sanious pus 
 loaded with bony granules. On introducing a probe, it easily passes to 
 the bone and sinks into it. Fistulous openings. Constitutional dis- 
 turbance. 
 
 Treatment. Eradication of constitutional disorder. Tonics; nour- 
 ishing food; cod-liver oil; sea air. Iodide of potassium and bark, 31. 
 Iodide of iron, 32. Chemical food, 405. Locally: Great cleanliness. 
 Astringent lotions and injections. Other remedies failing, removal of 
 diseased portion of bone. Escharotics (potassa fusa, chloi'ide of zinc), 
 where use of knife is contraindicated. 
 
 CATALEPSY. — From A'araAa/z/Scfyw, to restrain, or hold firmly. Synon. 
 Hysteria ('ataleptica. — A sudden suppression of consciousness and voli- 
 tion ; patient remaining during attack in same position in which she 
 happens to be at commencement, or in which she may be placed during 
 its continuance. Seizure may last a few minutes, several hours, or one 
 or two days. Recovery occurs suddenly, as from a deep sleep, without 
 recollection of what has occurred. Nervous and hysterical women 
 suffer from these attacks more frequently than other persons. Danger 
 absent; very rarely the disease ends in apoplexj^ or insanity, possibly 
 when connected with chronic softening or with tumor of brain.
 
 CATARACT CATARRH. 63 
 
 Absence of mind a slight form of catalepsy. True mesmerism an- 
 other variety. The disease has sometimes been endemic. 
 For treatment see Hysteria. 
 
 CATARACT. — From KarappdfTfruj, to confound ; because the sense of 
 vision is confounded or obscured, if not destroyed (Mayne). — Consists 
 of an opacity of the crystalline lens, or of its capsule, or of both ; the 
 effect being to intercept the rays of light on their way to the retina. 
 Three forms usuall}^ recognized, according to situation of opacity, viz., 
 lenticular, capsular, and capsulo-lenticular. 
 
 Symptoms. Hard or lenticular cataract of old people, the most com- 
 mon form. Met with in men and women, between fifty and seventy 
 years of age. Causes objects to appear as if obscured by a thick cloud 
 or gauze : allows vision to be most clear when ])upil is dilated, as by use 
 of atropine or belladonna, or by light being dull and subdued. In ad- 
 vanced cases vision reduced simply to perception of light from dark- 
 ness. Commonly one eye first affected, and then the other. Move- 
 mejits of iris natural : when pupil is dilated by belladonna, cataractous 
 opacity can be distinctly seen with a convex glass of about one inch 
 focus. In commencing cataract, lenticular opacities not otherwise per- 
 ceptible may be seen with the ophthalmoscope as opaque stria», occupy- 
 ing either the anterior or posterior segment of the lens, and springing 
 from the centre of the crystalline, or converging towards tiie centre 
 from the circumference (Ernest Hart). 
 
 Soft or lenticular cataract of young people, may occur at any time of 
 life. Congenital cataract of this kind. Due to disintegration of whole 
 substance of lens, which becomes opaque and swollen. Symptoms 
 much the same as of hard kind, except perhaps that vision is more im- 
 perfect. There ajjpears to be some connection between diabetes and 
 soft cataract. 
 
 Capsular cataract may result from chronic inflammation. Opacity of 
 a dead white color; commonly affects part or whole of anterior wall 
 of capsule, or it may perhaps be confined to posterior portion. 
 
 Opacity of capsule always leads to opacity of lens, so that capsulo- 
 lenticular cataract is common. 
 
 Treatment. One of three operations: (1) Depression, displacement^ 
 or '■'•couching " a clumsy and generally inefficient proceeding by which 
 the lens is pushed from its natural j^osition, so as to allow rays of light 
 to pass through pupil to retina. (2) Solution, or absorption, in which 
 the body of lens is broken up, at several sittings, so that it may un- 
 dergo absorption. Only suitable for soft cataract. (3) Extraction, in 
 which opaque lens is removed entire through an incision in the cornea. 
 
 CATARRH. — From Ka-zappiu>, to flow down little by little. Inflamma- 
 tion of mucous membrane of some portion of air-passages. Known as 
 coryza, if it affect Schneiderian membrane of nose; gravedo, if frontal 
 sinuses suffer; bronchitis, when stress of disease falls on trachea and 
 bronchial tubes. — Catarrh, as affecting mucous lining of nose and throat, 
 one of the commonest of diseases. 
 
 Symptoms. Lassitude ; pains in limbs ; aching of back ; sense of tight- 
 ness across forehead; excessive discharge from nostrils; profuse lachry- 
 mation ; hoarseness; sore throat; furred tongue; more or less feverish- 
 ness; thirst; loss of appetite; quick pulse. An eruption of herpes ap- 
 pears upon lips; most frequently about angles or middle of lower lip. — • 
 At end of some forty-eight hours sj'mptoms begin to subside; or disease 
 passes into a more severe affection, — acute tonsillitis, bronchitis, pneu- 
 monia, &c.
 
 C-t CELLULITIS VENENATA CEREBRAL HEMORRHAGE. 
 
 Treatment. Warm bath. Foot bath. Turkish bath. Powder of 
 ipecacuan and opium. Warm clothing. An extra glass or two of wine. 
 White-wine whey at bedtime. 
 
 CELLULITIS VENENATA.— From Cellula, a little cell ; terminal -itis: 
 Venenum, poison or venom. Sj-non. Diffuse Cellular Inflammation. — Dif- 
 fused inflammation of the areolar tissue ; arising from one or more punc- 
 tures received in dissecting the dead bod}', or from bites of venomous 
 reptiles, &c. May occur without se))tic inoculation in unhealthy states 
 of system, from breathing vitiated air, &c. 
 
 Symptoms. Erysipelatous inflammation of areolar tissue and absorb- 
 ents. Skin secondarily involved. Redness and tenderness of lympha- 
 tics. Elgors. Pain. Offensive perspiration. Suppuration. Gangrene. 
 Delirium. Jaundice. Dyspnoea. Stupor. Fatal exhaustion. 
 
 Treatment. Withdrawal of poison by suction or cupping glass. Lig- 
 ature between wounded part and trunk. Caustic. Bark, 371, 376. 
 Quinine, 379, 386. Sulphite of magnesia, 48. Chlorate of potash, 61. 
 Tincture of perchloride of iron and glycerine, 392. Brandy and egg 
 mixture, 17. Fomentations. Poultices. Incisions. Leeches? — See 
 Ichorhcemia. 
 
 CEPHALALGIA.— From KtfaXij, the head ; a'A^^c, pain. Synon. CephaU 
 odijnia ; Dolor Capitis. — See Headache. 
 
 CEPHALOHiEMATOMA.— From Ks(pa?.rj, the head; al/mroj/m, a san- 
 guineous tumor. Synon. Cephalcematoma ; Ecchymoma Capitis Hecens 
 Natorum ; Thrombus Neonatorum. — A bloody tumor, developed immedi- 
 ately after birth, betAveen bones of skull and pericranium. It is proba- 
 bly caused by long-continued pressure upon foetal head during a difficult 
 labor. 
 
 Symptoms. Tumor varies in size from that of a hen's egg to that of 
 a large orange. Is generally formed on one or other of parietal bones: 
 on right more frequently than left; and occasionally on both — double 
 cephalohaematoma. Swelling soft, circumscribed, and fluctuating: its 
 base often becomes encircled by a hard ring, probably caused by occur- 
 rence of ossification in the plasma exudation which is poured out by 
 irritated pericranium. 
 
 Treatment. Generally best to leave the case alone : effusion becomes 
 absorbed in course of two or three weeks. In some instances, absorp- 
 tion may be hastened by use of evaporating lotions. Avoid the prac- 
 tice sometimes recommended of incising tumor, removing blood, and 
 applying compression. Should suppuration take place, the pus must be 
 evacuated, and case treated as a dangerous abscess. 
 
 A kind of false cephalohsematoma sometimes produced by effusion of 
 blood into areolar tissue between aponeurosis of scalp and pericranium. 
 It requires no treatment. 
 
 CEREBRAL HEMORRHAGE.— From Cerebrum, the brain: A'ljia, 
 blood; fjiyvoiii, to break out. — Not synonymous with apoplexy. There 
 may be symptoms of latter, but not necessarily. Pathognomonic fea- 
 ture, more or les^ paral^^sis on side of body opposite to that on M'hich 
 clot is formed. Intellect and senses may be unaffected. Patient may 
 fall down; but this results from the paralysis, not from the sudden abo- 
 lition of consciousness and sensibilitj^ as in apoplexy. In same way 
 there may be sudden loss of power in arm, or speech may be affected, 
 but without loss of consciousness. If hemorrhage continue, then S3'mp- 
 toms may graduall}' merge into complete apoplectic condition in course
 
 CEREBRAL INFLAMMATION. 65 
 
 of a few minutes or several hours. Many eases of cerebral licmorrliage 
 recover, provided recourse bo not had to active treatment. Patient i.s 
 not seen until after the ett'usion ; bloodletting and purgatives ])0\verles9 
 to remove clot, or to prevent further escape of blood. Rest in sitting 
 posture, with a nutritious but unstimulating diet, Avill ettect all that is 
 possible. 
 
 CEREBRAL INFLAMMATION.— The study of l)rain diseases hardly 
 sufficiently advanced to permit of a certain diagnosis between inflamma- 
 tion of substance of brain {cerebritis), and that of membranes {meningitis). 
 Distinction not of great importance. In only a few instances does men- 
 ingitis, or cerebritis, occur alone. In majority of cases the two affec- 
 tions are combined (encephalitis). 
 
 1. Simple Meningitis. — From Mv^viy^, a membrane; terminal -itis. Sy- 
 non. Encephalitis Membranosa. — Inflammation of arachnoid and jiia ma- 
 ter ma}^ arise without apparent cause ; or may be produced by a fall or 
 blow, by extension of disease from ear or nose, or by exposure to the 
 sun. May also arise from poison of syphilis or rheumatism : from de- 
 posit of tubercle (see Tubercular Meningitis). 
 
 vSymptoms. Fever. Acute pain in head. Irritability, with early and 
 violent delirium. Frequent flushings of face, followed by pallor. Rapid 
 pulse. Muscular twitchings. Prostration, and coma. 
 
 Inflammation of membra 7ies over convexity of brain: First, a rigor; or in 
 children, a convulsion. Then, skin gets hot and dry; pulse hard and 
 rapid ; bowels confined. Intense headache, increased by sound or move- 
 ment. Face alternately flushed and pallid ; conjunctiva? injected, eyes 
 suffused and staring. Noisy and violent delirium sets in early. Great 
 restlessness ; muscular twitchings ; strabismus. Vomiting. At end of 
 three or four days, fever lessens; pulse flags; tongue gets brown and 
 dry; excitement diminishes; delirium apt to pass into coma. In a few 
 days more, intense prostration. When disease ends favorably, improve- 
 ment very gradual: no critical sweat or diarrhoea. 
 
 Meningitis confined to base: Diagnosis very difficult. Sometimes, de- 
 lirium at commencement ; great fever; contracted jiupils; raving; fre- 
 quent pulse; clenching of teeth ; and retraction of head. Coma. Death, 
 as from apoplexy. In other cases, pain in temples; vomiting; consti- 
 pation; wry-neck; loss of appetite; a desire for repose. After a few 
 days, vacant look; dejection; intelligence clear ; pulse and skin natural. 
 Headache, unrelieved. Coma, ending in death. 
 
 Inflammation of dura mater: Frequently the result of violence: of dis- 
 ease of cranial bones, particularly of petrous portion of temporal or of 
 ethmoid. Chronic affections of ear and nose in children, regarded as 
 trifling, may end fatally by rapid extension of morbid action to dura 
 mater. 
 
 Treatment. See Acute Encephalitis. 
 
 2. Cerebritis. — From Cerebrum, the brain ; terminal -itis. Partial in- 
 flammation of brain substance without meningitis. Of rare occurrence. 
 
 Symptoms. Persistent, deep-seated pain in head ; general malaise 
 and vomiting; impairment of vision and hearing; confusion of ideas, 
 with failure of memory; convulsive paroxysms, ending in paralysis or 
 coma. Mental disturbance varies considerably according to part of 
 brain affected. After three or four days there may be a copious effusion 
 of serum : sj'mptoms of compression. Sometimes, inflammation ends 
 in abscess; suppuration occurring without exciting any suspicion. 
 
 TreaTxMent. See Acute Encephalitis. 
 
 3. Acute Encephalitis. — From ' Efy<.ifalo^^ that which is in the head; 
 
 5
 
 66 CEREBRAL INFLAMMATIOX. 
 
 terminal -itis. Synon. Jleningo-cerebritis ; Phrenitis. — The inflammation 
 gives rise to more or less complicated phenomena during life, according 
 to degree and extent to which brain and its membranes are involved. 
 After death, traces of its j^ower are found in form of meningeal conges- 
 tion, with effused lymph, or serum, or pus; appearances of vascularity, 
 varying from bloody points, or a scarlet tinge, to a dusky redness about 
 affected part of brain ; with occasionally softening, or suppuration of 
 cerebral substance. 
 
 Symptoms. Earliest indications, fever; nausea and vomiting; acute 
 headache; sharp and hard and irregular pulse; constipation; impa- 
 tience of light and sound ; watchfulness ; a look of oppression or sul- 
 lenness ; suffusion of eyes ; confusion of thought, or even delirium. 
 These symptoms most marked when meningitis predominates. After 
 from twelve hours to two days, second stage of the complaint sets. in — 
 period of collapse. State of stupor; articulation difficult or indistinct; 
 vision and hearing dull ; pupil — from having been contracted to a pin's 
 point — becomes dilated; perhaps squinting, and paralysis of muscles of 
 eyelids; frequent twitchings of muscles; ghastly countenance; sordes 
 on gums and teeth; cold sweats; relaxation of sphincters; convulsive 
 paroxj^sms, paralysis, and profound coma, which usually soon ends in 
 death. Occasionally the first symptom, a sudden attack of convul- 
 sion ; perhaps occuri-ing without previous illness, or preceded by head- 
 ache and slight complaints which have passed on unnoticed. Convul- 
 sion generally long and severe : may be followed immediately by coma, 
 which is soon fatal ; or it may i-ecur frequently at short intervals, and 
 pass into coma at end of twenty-four hours. When nausea and vomit- 
 ing are earliest symptoms, disease has probably had its origin in cerebral 
 pulp ; when attack begins with a convulsion, the inflammation has 
 started from arachnoid or pia mater ("Watson). 
 
 In all forms of this dangerous complaint, sj'mptoms variable. Caution 
 necessary against insidious character which many cases assume, and 
 deceitful appearances of amendment. Disease I'are. ^lay end fatally 
 in a few hours, or patient may struggle on for two or three weeks. 
 
 Treatment. Calomel and jalap, followed by sulphate of magnesia, 
 140. Jalap and senna, 151. Calomel and scammony, or jalap, 159. 
 Antimony and sulphate of magnesia, 152. Croton oil, 168. Castor oil 
 and turpentine enema, 190. " More recoveries from head-affections of 
 the most alarming aspect take place under the use of very strong purg- 
 ing than under any other mode of treatment" (Abercrombie). Iodide 
 of potassium (grs. .3 to 8 every four or six hours). Tincture of aconite. 
 Milk diet. Head to be shaved. Pounded ice in a bladder, to scalp ; or 
 cold evapoi-ating lotions. 273. Excess of temperature reduced, and ex- 
 citement calmed, by ])ouring cold water in a stream upon vertex of 
 head. It must be remembered that cold to head exercises a very de- 
 pressing influence : hence, case must be carefully watched. As soon as 
 extreme collapse sets in from exhaustion of nervous force, stimulants 
 will be needed. Ammonia. Spirit of ether. Brandy or wine. Strong 
 beef tea. Milk or cream. 
 
 Remedies sometimes employed : General and local bleeding. Drastic 
 purgatives, long continued. Antimonj'. Mercury. Digitalis. Opium 
 combined with antimony. Blisters, or ointment of tartarated antimony 
 to scalp, after shaving. Mustard pediluvia. 
 
 4. Chronic Encephalitis. — Ma}^ follow acute inflammation : more fre- 
 quently an iudt'])ciident primary disorder. 
 
 Symptoms. Of a subacute character. Very diversified : allied to 
 those which mark commencement of insanity. Great mental excite- 
 ment, or depression. Delusions. Hesitation in speaking, or slight
 
 CEREBRAL INFLAMMATION. 67 
 
 Rtammei'ing. Stiffness of some nuiseles. Slight lieadache. Loss of 
 appetite. Constipation. Irregularity of pulse. Subsequently, symp- 
 toms become more marked : memory fails, external senses get impaired, 
 paralysis, break up of general health. Disease may last for only a few 
 months, or for years. 
 
 Treatment. Attempts to combat symptoms as they arise. Hygienic 
 measures to improve general health. Attention to digestive and ute- 
 rine organs. Cod-liver oil. Small blisters behind ears, often repeated. 
 A seton in nucha. Sometimes inunction of shaved scalp with iodide of 
 potassium, or red iodide of mercury ointment. 
 
 5. Softening-, Induration, and Tumors of Brain. — General symptoms 
 of cerebral softening : More or less severe and persistent pain in head. 
 Sudden and short attacks of vertigo. Diminution of intellectual power, 
 embarrassment in answering questions, depression of spirits, tendency 
 to shed tears on any excitement. Prickings and twitchings in limbs, 
 perhaps pain or numbness. Tendency to sleep, especiall}" after meals. 
 More or less impairment of vision and hearing. In inflammatory soft- 
 ening, headache more acute than in other forms ; limbs become the seat 
 of painful cramps, stiffness, or contractions; paralj'sis with spasm not 
 uncommon; permanent contraction of flexor muscles of one or both 
 extremities; general sensibility more acute. In second stage of either 
 inflammatory or non-inflammatory form : Paralysis of a limb, or of one 
 half of body, coming on suddenly without loss of consciousness. Pa- 
 tient easily confused ; has a ditficulty in answering questions, and in 
 making himself understood. Feebleness; weak and intermitting pulse. 
 Vomiting and constipation. Difficulty in emptying bladder. Involun- 
 tary escape of stools. Eespiration labored; at last becomes stertorous. 
 Coma, ending in death. Disease most common after fiftieth year. 
 
 Acute Eamollissement (from RamoUir, to make soft), or red softening of 
 brain, one of the terminations of inflammation. Softening usually par- 
 tial ; affected portion reduced to consistence of cream. Symptoms, as 
 described in preceding paragraph. When resulting from acute inflam- 
 mation, parts which usually suffer are, corpus callosum, septum lucj- 
 dum, fornix, and cerebral substance, around ventricles. Softened struc- 
 ture sometimes infiltrated with pus ; occasionally purulent matter con- 
 tained in a well-defined cavity — abscess of the brain. 
 
 White softening occurs from conditions the opposite to those of in- 
 flammatory form. Met with in aged persons. Insufficient supply of 
 blood to brain ; owing to disease of cerebral arteries, or obstruction by 
 fibrinous masses. Probably leads to fatty degeneration of brain tissue. 
 Portions most frequently affected, gray matter of convolutions at base, 
 optic thalami, corpora striata. 
 
 Softening of cerebellum: Attended with fixed pain at back of head, 
 especially on diseased side. Occasionally, amaurosis; hemiplegia or 
 paraplegia; a tendency to walk backwards; tottering gait; vertigo; 
 semi-convulsive agitation of limbs; obtuse hearing; aphonia. No two 
 cases exactly alike. Abscess of cerebellum sometimes due to disease of 
 ear and mastoid cells. 
 
 Induration of brain : Termination of acute or chronic inflammation. 
 Indurated portion of small extent: presents appearance of wax, or 
 white of egg boiled hard. 
 
 Simple and malignant tumors^ deposits of tubercle, syphilitic gummatous 
 growths, and hydatids have been found in brain. Indications of such 
 very obscure. Most frequent symptoms, headache, sickness, giddiness, 
 mental depression with confusion, partial paralysis, epileptiform con- 
 vulsions.
 
 68 CEREBRAL INFLAMMATION. 
 
 6. Tubercular Meningitis. — Sj-non. Acute Hijdrocqjhalus ; Water Brain 
 Fever. Acute inflammation of brain not uncommon in children under 
 five years of age. The disease ma}" occur in those previously healthy, 
 when it is a form of simple encephalitis. Most frequently the children 
 are scrofulous; the inflammation being a result of tubercular deposit in 
 brain or membi*aues. It is then known as tubercular meningitis. For- 
 merly named acute hydrocephalus. 
 
 Symptoms. Various and uncertain. For convenience can be divided 
 into three stages. First or premonitory stage: Indications of malnutri- 
 tion. Signs of strumous diathesis. Short dry cough ; peevishness ; in- 
 tolerance of light and sound ; headache, giddiness, and other warnings 
 of cerebral congestion; fever, with exacerbations and remissions; ca- 
 pricious appetite; tongue furred, and breath offensive; sickness and 
 constipation. Child drowsy, yet restless ; moans or grinds his teeth ; 
 wakes in alarm and sci'eams; frequently becomes delirious. 
 
 After four or five days second stage reached. Child wishes to be left 
 quiet. Countenance alternately flushed and pale, expressive of suff'er- 
 ing ; eyes closed and eyebrows knit. If old enough to reply to ques- 
 tions, complaint made of headache and weariness and sleeplessness ; 
 frequent exclamations — '■ Oh my head." Pulse gets irregular; dimin- 
 ishes in frequency, perhaps falling from 120 to 80. Eemission of all 
 symptoms. Amendment of short duration. Stupor and heaviness come 
 on. Squinting. Child lies insensible, probably picking his nose and 
 lips with tremulous fingers. Convulsions; perhaps paralysis. Urine 
 and fffices passed unconsciously. 
 
 Transition to third stage, at end of a week or two, efl'ected gradually 
 by drowsiness passing into profound coma. Pulse gets very feeble, 
 extremities lose their warmth, cold clammy sweat breaks out. Par- 
 alysis, perhaps convulsions. Sometimes death does not occur for several 
 days. 
 
 Most diseases of the brain in children which interfere with cerebral 
 circulation, impede more or less the venous circulation in the eye. 
 Hence in tubercular meningitis characteristic appearances may be ob- 
 served at fundus of eyeball, by ophthalmoscope, before convulsive period 
 sets in. These are, (1) Pei-ipheral congestion of papilla, with spots of 
 congestion in retina and choroid. (2j Dilatation of retinal veins around 
 papilla. (3) Varicosity and flexuosity of these veins. (4) Thrombosis 
 of same. And (5) in some instances, serous infiltration with retinal 
 hemorrhages from rupture of veins (Bouchut). 
 
 Tubercular meningitis in adult usually preceded by history of pre- 
 vious lung affection. Amelioration of chest disease. Symptoms may 
 early assume an apoplectic or a convulsive form. More frequently they 
 come on gradually with vomiting, slight fever, acute pain in head; pa- 
 tient seems unable to collect his thoughts, is peevish and irritable, de- 
 sires only to be left quiet; there may be mutism and somnolence; 
 pulse irregular and feeble. In second stage, depression increases; 
 greater mental dulness or delirium; clonic or tonic sjDasms. In third 
 stage, sphincters relax; increasing stupor ; paralysis; death. 
 
 Treatment. Bowels to be cleared out by calomel and jalap. Iodide 
 of potassium, with small doses of tincture of aconite, according to age. 
 Cold evaporating lotions to head, 278. If child be teething, employ 
 gum lancet when gum is tender and hard and swollen. Where there is 
 depression of vital powers use stimulants — ammonia, ether, port wine. 
 If symptoms be subacute, h^pophosphite of lime or soda and bark. Cod- 
 liver oil. Sea air. Pui-e niillc. 
 
 7. Hypertrophy and Atrophy of Brain. — Hypertrophy of cerebral hemi- 
 S2)heres has occurred in children: more common between 2U and 30
 
 CHAPPED HANDS — CHIMNEY-SAVEEPER'S CANCER. 60 
 
 years of h^g. If skull increases as brain i^ets over-devclo])cd there may 
 be an absence of symptoms, until a sudden attack of convulsions ends 
 in death. When bony case does not enlarge, there are necessarily 
 indications of compression: mental disturbance, varying from slight 
 dulness of intellect to complete idiotcy. Headache; vertigo; loss of 
 muscular power or paralj'sis; unaltered or very slow pulse; severe 
 epileptic convulsions. Death in latter, or from subsequent coma. 
 
 Atrophy may vary from a complete absence of cerebral hemispheres 
 incompatible with extra-uterine life, to a simple incomplete develop- 
 ment of certain convolutions above ventricles. When atrophy affects 
 one side only, life may be uninterfered with for some time. 
 
 CHAPPED HANDS. — May be due to imperfect drying after washing; 
 to use of irritating substances, — common yellow soap, &e. ; to cold ; to 
 wearing coarse woollen gloves which fret the hand when moist from 
 jierspiration. 
 
 Treatment. Thorough drying after washing. Dusting with pow- 
 dered starch ; spermaceti; white bismuth ; oxide of zinc; carbonate of 
 zinc. Crlycerine soap. Pure honey soap. Glycerine and water — equal 
 parts. Collodium. Ointment of oxide of zinc. Ointment of carbonate 
 of lead. Ointment of subacetate of lead. Ointment of spermaceti. 
 Diluted citrine ointment, 305. Ointment of balsam of Peru and sper-' 
 maceti. 306. Lotion of nitrate of lead (gr. 10 to fl. oz. j). 
 
 CHICKEN-POX. — Synon. Varicella. — A trifling infectious complaint, 
 almost peculiar to infants and young children. Runs through all its 
 phases in six or eight days. Consists of an eruption of pimples, which 
 on second day become converted into transparent vesicles surrounded 
 by slight redness. Eash commences on shoulders and back, and after- 
 wards affects the scalp, but often sparges the face : about fourth day the 
 vesicles form small scabs, which rapidly desiccate. No constitutional 
 disturbance of importance : accompanying pyrexia slight. 
 
 Occurs but once to same person. Has a short incubation, probably 
 of four days. Requires no treatment beyond attention to bowels, and 
 restricted diet. Quinine, bark, steel wine, or cod-liver oil may be needed 
 during convalescence. 
 
 CHILBLAIN. — From the Saxon Cele, cold; blegen, a boil or ulcer; 
 /. c, a blain caused by chilliness or cold (Mayne). Synon. Pernio. — A 
 subacute inflammatory swelling, due to cold and the premature restora- 
 tion of the circulation by heat. 
 
 Symptoms. A feeble circulation, — cold feet and hands. In the first 
 stage, swelling and slight redness and pain or itching; in the second, 
 vesication ; in the third, ulceration or sloughing. Parts most exposed, 
 and where circulation is weakest, most prone to suffer. Occurs in 
 weakly constitutions, strumous children. 
 
 Treatment. Bark and port wine. Milk: nourishing food. Cod-liver 
 oil. Chemical food, 405. Fire in bed-room. Warm stockings and gloves. 
 Avoidance of tight shoes. Friction with compound camphor, arnica, 
 soap, opium, or turpentine liniment. Painting with tincture of iodine. 
 To relieve itching, lime liniment or glj^cerine. When vesication or 
 ulceration occurs, water dressing or poultices; collodium and castor oil 
 varnish, 285; resin or turpentine ointment. Diluted nitrate of mercury 
 ointment. Nitrate of silver. 
 
 CHIMNEY-SWEEPER'S CANCER.— A rather uncommon form of 
 epithelial cancer. Very rare in Scotland, France, &c. Produced by
 
 70 CHLOASMA — CHOLERA. 
 
 irritation of soot lodged in folds of scrotum, in individuals predisposed 
 to cancer. Sometimes hereditary. 
 
 Symptoms. Commence as a tubercle or wart. After a variable inter- 
 val, a fungous sore with ragged edges forms; which spreads and causes 
 great pain, and presents all the frightful characters of malignant ulcer- 
 ation. Superficial inguinal glands do not invariably become secondarily- 
 affected. General health breaks down. Death sometimes hastened by 
 hemorrhage. 
 
 Treatment. Destruction of the soot-wart by chloride of zinc, or 
 supersulphate of zinc, or chromic acid. Extirpation. When disease is 
 more advanced, excision may retard its progress; provided inguinal 
 glands have not become involved. Sooner or later there is sure to be 
 a return. — See Cancer. 
 
 CHLOASMA. — From Xlod'^u)^ to be of a greenish-yellow color. Synon. 
 Pityriasis Versicolor ; Macula Hepatica ; JAver Spot. — A parasitic cuta- 
 neous disease. — See Tinea. 
 
 CHLOROSIS. — Yvoiw XXwphq, green. Synon. Pallor Virginum ; Green 
 Sickness. — A peculiar form of anaemia, affecting young women about the 
 age of puberty The red blood corpuscles are pale, small, and diminished 
 in number. The serum is in excess. 
 
 Symptoms. Wax-like hue of countenance. Pallor of skin, Avhence 
 popular name of "green sickness." Deficient or depraved appetite. 
 Constipation. Abundant limpid urine. Weak quick pulse. Hysteria. 
 Pale scanty menstrual discharge. Leucorrhoea. Listlessness. Head- 
 ache. Palpitations. Backache. Cardiac and vascular murmurs. En- 
 largement of thyroid. Protrusion of ej^eballs. 
 
 Treatment. Good living. Pure air. Sea bathing. Chalybeates. 
 Aloetic aperients. — See Anaemia. 
 
 CHOL.XMIA. — From X^Ary, bile; al,a«, blood. The morbid state in 
 which bile exists in the blood, owing to its reabsorption after having 
 been formed by the liver. See Jaundice. 
 
 CHOLERA. — From AoAa?, the bowels, and piw^ to flow ; or, according 
 to some authors, from XoXij, bile, and piu)^ because the disease is said to 
 arise chiefly from a superabundance of acrid bile. Synon. Epidemic. 
 Malignant, Asiatic, or Algide (Algeo, to be cold) Cholera. — An epidemic 
 disease of such severity that it often proves fatal in a few hours ; at- 
 tended with prostration, coldness and lividity of surface, vomiting, 
 purging, suppression of urine, and cramps of muscles of abdomen and 
 extremities. Sometimes preceded by simple diarrhoea : more frequently 
 comes on suddenly Avithout warning. 
 
 Symptoms. Presents three stages : (1) Diarrhoea and vomiting, prob- 
 ably efforts of nature to expel morbid poison (cholerine) from the sys- 
 tem. (2) In addition, contracted pupil, spasms, cramps, coldness of 
 body, and intermitting pulse. (3) Supi^ression of urine : collapse. 
 
 In detail these symptoms ai-e: Copious vomiting, in most cases. 
 Purging, in most cases: stools consist of an abundance of water, a large 
 quantity of epithelium (imparting a rice-water appearance), a little al- 
 bumen, a trace of biliary matter, and a large amount of salts (especially 
 chloride of sodium). Severe cramps in lower extremities and abdo- 
 men, rendering muscles as hard as wood, or drawing them into knot- 
 like masses. Perhaps albuminuria, followed by suppression of urine. 
 Urgent thirst. Diminished circulation and impeded respiration: hence, 
 intense prostration, icy coldness of surlace and tongue and breath.
 
 CHOLERA. 71 
 
 Lividity or bluenoss of lips and skin generally. Unnatural and whis- 
 pering voice. Shrinking of whole body. Pinched features : muddy- 
 looking complexion : sinking of eye, with contracted and immobile 
 pupil, and flatteniiig of cornea: the whole so ])eculiar that the expres- 
 sion is s])oken of as the fades choleritica. Notwithstanding coldness of 
 surface, complaint is made of oppression ; patient often likes to lie un- 
 covered. There soon follows a gradual lessening of breathing; a thread- 
 like pulse; a clear intellect; and a complete arrest of circulation. — Pa- 
 tients who survive eighteen hours frequently show signs of amendment : 
 occasionally get well rapidly ; pulse rising, and rice-water evacuations 
 being replaced by stools containing bile. But often, iijiprovement only 
 transient: stools, though less frequent, are free from bile; suppression 
 of urine continues; and death is preceded by headache, drowsiness, 
 tonic or clonic spasms, vomiting, stertor, and coma. In more favorable 
 eases, a mild febrile exacerbation follows and subsides gradually in a 
 few days; or this consecutive fever is of a more severe type, and a low 
 typhoid condition follows. 
 
 According to Dr. Barraut, a contracted and immobile pupil precedes 
 all other phenomena : then, suppression of urine ; next an intermitting 
 pulse, followed by threadlike peculiarity. 
 
 Treatment. Prophylactic: Sanitary laws to be strictly obeyed. 
 Avoidance of all doubtful food and impure water ; of too long abstinence 
 from food; of purgative medicines; of over-fatigue; of intemperance, 
 uncleanliness, and of breathing vitiated air. An}'- tendency to diarrhoea 
 (as distinguished from premonitory diarrboea) to be checked by recum- 
 bent 250sition ; warm bath; sinapisms or linseed poultices to abdomen; 
 mucilaginous drinks; very plain food; and simple astringents, ether or 
 spirit of chloroform. 
 
 Curative: Only three points seem certain : The purging is not to be 
 checked ; opium is most injurious ; and the patient is to have cold water, 
 or soda water, and ice ad libitum. 
 
 Dr. William Stevens's plan was more successfully used than any other, 
 on a large scale, in the prison of Coldbath Fields, during 1832 : Patients 
 presenting premonitory sj'inptoms were removed into an observation 
 ward, where an even temperature was constantl}^ maintained. A Seid- 
 litz powder was immediately given ; if sinking were felt without purg- 
 iug, thi'ee or four teaspoonfuls of sulphate of magnesia were added to 
 powder. These agents acting freely, plenty of thin and well-salted 
 beef-tea was given : thirst was relieved with seltzer, soda, or pure water 
 without stint : if there were Q.nj pains a sinapism was applied over 
 gastric region. Most of the cases were thus cured. — If, however, cramps, 
 coldness, or sinking of pulse came on, the following was given about 
 every half-hour: Cliloride of sodium, gr. 20; carbonate of soda, gr. 30; 
 chlorate of potash, gr. 7; — dissolved in water. If much iri'itability of 
 stomach existed, a large sinapism was applied ; if much heat or burning 
 pain, an additional quantity of carbonate of soda was added to mix- 
 ture. — In cases in stage of collapse, a strong solution of same salts, dis- 
 solved in hot water (100° P.), was thrown into rectum, and repeated 
 every two or three hours. Sinapisms to stomach and between shoulders. 
 Frictions with warm towels. Air of ward kept perfectly pure. 
 
 Dr. A. C. Macleod, after twenty years of Indian practice, recom- 
 mends : Calomel, in ten-grain doses, everj^ half or even every quarter of 
 an hour. A large blister to loins. Diffusible stimulants, regulated by 
 state of pulse. Draughts of cold water ad libitum. Hot water bottles 
 to feet. Assiduous rubbing, by three or four attendants, of abdomen 
 and extremities with cajuput oil: while in intervals of friction, the ab- 
 domen is to be covered with spongio-piline sprinkled with the oil.
 
 72 CHOLESTER^MIA — CHOREA. 
 
 According'to the Cholera Eeport of the Eojal College of Physicians 
 (London, 1854), no appreciable effects followed the administration of 
 calomel, even after a large amount in small and frequently-repeated 
 doses had been administered. For the most part it was quickly evacu- 
 ated by vomiting or purging, or, if retained, was afterwards passed 
 from bowels unchanged. 
 
 All authorities agree that patient should be isolated as far as possible. 
 To be surrounded with pure air. To avoid all water drawn from a 
 well near any sewer. To have excretions received in a pan containing 
 some disinfectant fluid, and to be immediately thrown away. Great 
 caution with regard to diet during convalescence. Broths and farina- 
 ceous substances, without any solids whatever, until the biliary and 
 renal secretions have been fully re-established, and all symptoms have 
 vanished. 
 
 Remedies which have had strong advocates : Bleeding. Emetics. Purga- 
 tive enemata. Astringent, and opiate enemata. Injections of warm 
 water, or of saline solutions, into veins. Inhalation of oxygen gas. 
 Sulphur. Sulphuric acid. Nitric acid. Nitro-hydrochloric acid. Qui- 
 nine. Ipecacuanha. Indian hemp. Opium. Belladonna. Subcutaneous 
 injections of atropine. Brandy. Cajuput oil. Castor oil. Croton oil. 
 Creasote. Carbolic acid. Chloroform. Ether. Sugar. Acetate of lead. 
 Logwood- Nitrate of silver. Infusion of Mikania Guaco. Petroleum. 
 Phosphorus. SumbuL Turpentine. Inoculation with quassia. AYet- 
 eheet packing. Cold affusion. Hot air baths. Vapor baths. Hot water 
 baths. Mustard baths. Ice to spine. Galvanism. Actual cautery along 
 spinal column. Vesication with boiling water. Acupuncture of heart. 
 
 CHOLESTER-ffiMIA- — From XoXij, bile; (TT£peu^, solid; and alfj-a, blood. — 
 Blood-poisoning, owing to the non-elimination of cholesterine by the 
 liver. — See Acholia. 
 
 CHOEEA. — A'opeta, a dancing or jumping; from Xopbi;, a dance accom- 
 panied with singing. Synon. Choreu Sancti Viti; St. Vitus' s Dance. — A 
 disease characterized by irregular, tremulous, and often ludicrous ac- 
 tions of voluntary muscles, especially tliose of face and limbs; there 
 being incomplete subserviency of affected muscles to the will. Has been 
 called " insanity of the muscles." — Mostly attacks girls between sixth 
 and fifteenth years, though not uncommon in boys. 
 
 Symptoms. At commencement, slight clonic spasms of facial muscles. 
 By degrees almost all voluntary muscles affected. Child cannot keep 
 ■quiet, though movements are to some extent under control of will : 
 •constant restlessness of hands and arms, perhaps of legs, most marked 
 when patient sees she is watched. Features curiously twisted and con- 
 torted: vacancy of countenance. Articulation impeded. Temper irri- 
 table. Irregular appetite. Perhaps constipation. One-half of body 
 usually more affected than the other: disease may be confined entirely 
 to one side — hemiehorea. During sleep, irregular actions cease. 
 
 During progress, endocarditis or pericarditis ma}" supervene. An 
 anaemic mui-mur sometimes audible at base of heart. Or an organic 
 murmur at apex. Eheumatic fever may precede, accompany, or follow 
 chorea. Rarely terminates in epilepsy. 
 
 Treatment. Nourishing.food and general care will cure many cases. 
 Regulation of bowels, and of uterine functions if patient has reached 
 the age of puberty. Saccharated carbonate of iron, 396. Steel and am- 
 monia, 401. Steel and arsenic, 399. Quinine, steel, and arsenic, 381. 
 Steel and zinc, 414. Oxide of zinc, 415. Chemical food, 405. Hypo- 
 phosphite of soda or lime, with bark, 419. Cod-liver oil, 389. Nutri-
 
 CIIOUOIDITIS — CLUB-FOOT. 73 
 
 tiousdiet: milk. Cold shower bath. Sea bathing. Exercise in pure 
 air. Gymnastic exercises. Avoidance of mental excitement, long les- 
 sons, &c. 
 
 Remedies sometim.es recommended: Valerianate of ammonia. Iodine. 
 Calabar bean. Nitrate of silver. Sulphate of copper. Belladonna. 
 Atropine. Indian hemp. Stramonium. Strychnia. Turpentine. As- 
 safoetida. Salts of cerium. Inhalation of chloroform. Sulphur baths. 
 Clalvanisra. Blisters to spine. 
 
 CHOROIDITIS. — From X6f):ov, skin ; eldo-;, shape ; terminal -itis. — In- 
 flammation of the choroid, — the second, or vascular and pigmentar}^, 
 tunic of the eyeball. Rarely or never seen alone : inflammation rapidly 
 spreads to neighboring textures of eye, producing disorganization, &c. 
 
 Symptoms. Intolerance of light, lachrymation, dimness of vision, and 
 supra-orbital pain. Engorgement, more or less extensive, of conjuncti- 
 val vessels. Displacement of pupil. Thinning of sclerotic, so that cho- 
 I'oid is seen through it (staphyloma sclerotica?). Opacity of cornea. 
 Enlargement of globe : sometimes suppuration and formation of fungous 
 growths. 
 
 Treatment. Aperients. Calomel and opium. Arsenic. Warm baths 
 and fomentations. Blisters to nape of neck. Leeches. Tartar emetic 
 ointment to temples. 
 
 CHYLOUS URINE. — From XoXd<;, the nutritive juice formed by diges- 
 tion, — ch3de. Synon. Chyluria ; Galacturia ; Chylodiabetes ; Chylorrha'a 
 Urinalis. — The excretion of urine of a milky appearance from the pres- 
 ence of fatty matter in a molecular state. In addition, there is gener- 
 ally present one or more of following, — blood corpuscles, fibrine, albu- 
 men, and an imperfect albumen (albuminose?). The urine after stand- 
 ing a short time, and sometimes whilst in the bladder, coagulates into 
 a trembling mass resembling blancmange or common size. Mostly met 
 with in natives of East and West Indies, Mauritius, Brazil, &c. 
 
 Symptoms. Lassitude. Pains about loins and epigastrium. Mental 
 anxiety. Debility, and loss of flesh. Attacks intermit: urine health}^ 
 for months, and then chylous for months. 
 
 Treatment. Gallic acid (gr. 20 — 80 thrice daily). Decoction of man- 
 grove bark (Ehizophora racemosa). Tincture of perchloride of iron. 
 Quinine and steel. Ammonio-citrate of iron. Cod-liver oil. Opium. 
 Turkish baths. Salt water baths. Tight belt worn round loins. Change 
 of air, — a bracing temperate climate. Nourishing diet. 
 
 CIRRHOSIS OF LUNG.— From Ktppd<;, yellowish or tawny. — A con- 
 solidation or contraction of more or less of pulmonary tissue, accompa- 
 nied with dilatation of bronchi. — See Pulmonary Condensation. 
 
 CLITORITIS. — From Katjttjp, 7jpi><;, one who calls or invites; terminal 
 -itis. Sj'non. Inflammatio Penis Midiebris. — The clitoris occasionally at- 
 tacked with subacute inflammation; leading to great hypertrophy, or 
 to cystic degeneration. May also be excessivelj^ developed, from some 
 congenital malformation. Sometimes, the seat of cancerous infiltration. 
 Entire organ found diseased, or only its prepuce. 
 
 Clitoris occasionally becomes indurated, with or without enlargement. 
 Said to be due to self-abuse. The organ frequently amputated to cure 
 this practice, but with very doubtful benefit. 
 
 CLUB-FOOT.— Synon. Talipes; from Talipedo (talus and pedo), to 
 walk on the ankles. — A gradual change in the form and positions of the
 
 74 COCCYODYXIA COLIC. 
 
 tarsal bones, owing to undue action of certain muscles. May be con- 
 genital or acquired. One or both feet atfected. Four principal varie- 
 ties : 
 
 1. Talipes Equinus. — A rigid contraction of tendo-Achillis. so that 
 the heel cannot be brought to the ground, and the patient walks on the 
 metatarsal bones. Horse-heel sometimes occurs during first dentition. 
 When congenital — i.e. not caused by irritation of teething. Avorms. kc. — 
 a cure is generally effected by subcutaneous division of tendo-Achillis. 
 
 2. Talipes Yarus. — The heel is raised, inner edge of foot drawn 
 upwards, and outer edge rests on the ground. In extreme cases, patient 
 walks on dorsum of foqt and outer ankle. There is contraction of 
 muscles of calf and adductors of foot. The tendons of tibialis anticus 
 and posticus, as well as that of flexor longus digitorum, have to be 
 divided ; and subsequently the tendo-Achillis. 
 
 3. Talipes Yalgus. — The reverse of T. Yarus. Outer edge of foot 
 drawn upwards, so that patient rests on inside of instep and inner ankle. 
 Chiefly due to contraction of tendons of peronei muscles, which have 
 therefore to be cut. 
 
 4. Talipes Calcaneus. — Elevation of toes with a falling of heel, so 
 that patient walks on latter. Owing to paralysis of muscles of calf, 
 there is no counteraction to contraction of those of anterior tibio-fibular 
 region. Tendons of tibialis anticus, long extensors of toes, and j^eroneus 
 tertius may all need section before the foot can be brought to proper 
 position. 
 
 Mixed or compound varieties of foregoing not uncommon. Their na- 
 ture explained by the names : Talipes equino-varus, T. equixo-valgus, 
 
 T. CALCANEO-VALGUS. 
 
 The principle on which subcutaneous tenotomy is resorted to, is 
 simple. The cut surfaces of the tendons heal by connective tissue, which 
 lengthens the tendon and admits of considerable extension while re- 
 cent. — In some cases a cure can be obtained without operation : By 
 removal of sources of irritation ; fomentations and frictions of rigid 
 muscles; tonics, good food, sea-bathing, (tc. ; anti-rheumatic remedies; 
 and the proper application of wood or gutta percha splints, stiffened 
 boots. India rubber bands, bandages, and other mechanical appliances. 
 
 COCCYODYNIA. — From Koxxu^, the cuckoo, — because the coccyx is 
 said to resemble the beak of this bird; and odw^i, pain. Synon. Coccy- 
 algia; Coccygodynia. — Pain or tenderness about coccyx. After a fall or 
 blow, childbirth, violent horse exercise, &c., inflammation may be set 
 up in fibrous tissues around, and muscular attachments to, the coccyx. 
 
 Symptoms. Pain on sitting down or rising from chair, on walking, 
 on defecation, &c. Can only sit on one hip in many cases. Xi^j move- 
 ment which stretches coccygeal ligaments, or brings sacro-coccygeal 
 articulation into play, causes suffering: sometimes this is most severe. 
 Often aggravated h\ sexual intercourse, by menstrual flow. Tender- 
 ness on pressure. Occasionally an accompaniment of uterine or ovarian 
 disease, when it is sympathetic or neuralgic. Disease very chronic. 
 
 Treatment. Removal of any uterine or ovarian disease. Improve- 
 ment of general health. iJ^ervine tonics, — Quinine, iron, arsenic, zinc. 
 Warm hip baths. Leeches. Friction with ecjual parts of belladonna 
 and mercurial liniments. Subcutaneous injection of morphia, 314. Sub- 
 cutaneous division of muscles and ligaments and fascia? connected with 
 coccyx, so as to set the bone at rest. Complete removal of coccyx, or 
 a portion of it. 
 
 COLIC. — From Kwhr^, the large intestine. — Characterized by severe
 
 COLLOID CANCER — COMA. 75 
 
 twisting or griping pain in belly, especially about umbilicus, occurring 
 in paroxysms. Pain generally relieved by pressure: never aggravated 
 by it. Often, vomiting. Generally, constipation. An absence of in- 
 flammation and fever. While attack continues, pulse is lowered j sur- 
 face of body cold; countenance anxious. 
 
 Attacks of colic due to: (1) Indigestion, accompanied with flatulence. 
 Relieved by vomiting or purging, or eructation, or expulsion of wind 
 by anus. — See Flatulence. (2) The irritation of intestine by morbid 
 secretions, accumulation of fecal matter, &c. Cured by hot brandy and 
 water with spice : castor oil. (3) Fright, cold, h^-steria, gout : demand- 
 ing antispasmodics like ether, chloroform, belladonna, opium ; fomen- 
 tations; perhaps colchicum and opium. (4) Mineral poisons, such as 
 copper, lead, &c. — See Copper Colic; Lead Colic. 
 
 Colic not to be confounded with pain of gastrodynia or gastralgia, 
 enteritis and csecitis; peritonitis; perforation of bowel; strangulated 
 hernia, or ileus; passage of hepatic, or of renal, calculi; spasm of blad- 
 der ; uterine colic ; or with that produced by aneurismal or other tumors 
 of abdomen, disease of spine, &c. 
 
 COLLOID CANCER. — From K6X).a, glue. Synon. Alveolar Cancer 
 (Alveolus, a little trench) ; Cystic Cancer {Koanq, a bladder). — A variety 
 of cancer, consisting of a clear viscid substance, somewhat resembling 
 soft gelatine or gum. Most frequent primary seats — the stomach, in- 
 testinal canal, omentum, breast, and peritoneum; secondarily, it aff'ects 
 lymphatic glands, lungs, &c. A section of a colloid cancer presents to 
 naked eye a clear, soft, gelatinous mass, intersected and surrounded by 
 tough fibrous-looking tissue ; the intersections, when numerous, forming 
 small cj^sts or cavities filled with colloid matter. Such a cancer often 
 attains considerable size. — See Cancer. 
 
 COLOR-BLINDNESS. — Synon. Achromotopsia ; Acritochroviacy ; Chro- 
 inato Pseudopsis ; Daltonism. — The inability to discriminate between 
 certain colors is a defect which is quite compatible with perfect vision 
 in other respects. 
 
 Color-blindness may exist in three forms: (1) Inability to discern 
 any color, pi-operly so called, so that black and white — i. e.. light and 
 shade, are the only variations of tint perceived. (2) Inabilit}' to dis- 
 criminate between nicer shades of more composite colors, as browns, 
 graj'S, and neutral tints. (3) Inability to distinguish between primary 
 colors, red, blue, and j-ellow ; or between these and secondary and ter- 
 tiary colors, such as green, purple, orange, and brown (Dr. G. Wilson). 
 
 Defect upon which false perce^Jtion of colors is due, consists probably 
 of some peculiar organization of retina and that part of brain which is 
 essential to vision. Generally congenital: cases known where it has 
 been induced hj disease or injur}^. Quite incurable. Care should be 
 taken that railway servants are not afflicted with color-blindness, since 
 mistakes in nature of signals might lead to a serious accident. 
 
 COMA. — From A'«)/j.a, sound sleep. — A state of stujior Avith loss of con- 
 sciousness, from which patient is roused with difficulty. In cams (from 
 A'afMiq, heavy sleep) or intense coma, there is not only loss of perception 
 and volition, but usuall}' stertorous breathing, flaccid limbs, and dilated 
 pupils: patient cannot be roused. 
 
 In coma coming on without previous disease there may be a difficulty 
 in attributing it to the correct cause. Following table shows chief 
 points of distinction :
 
 COMPRESSION OF BRAIN — COXCUSSION OF BRAIN. 
 
 Pressure of Fradnred Bone or Apoplectic 
 
 Clot. 
 
 1. Patient cannot be roused. 
 
 2. Vomiting sometimes. 
 
 3. Snoring and difficult breathing. 
 
 4. Slow, irregular, intermitting pulse. 
 
 5. One or both pupils widely dilated, ac- 
 
 cording as pressure is unilateral or 
 bilateral. 
 
 6. Face pale. Cold clammy sweats. 
 
 Concussion. 
 
 1. Kecovery to a slight extent soon after 
 
 injury. 
 
 2. Vomiting in favorable cases. 
 
 3. Breathing easy. 
 
 4. Fluttering, or feeble pulse. 
 
 5. Pupils natural, but insensible to light. 
 
 6. Countenance but little changed. Body 
 cold and pale. 
 
 Poisoning hy Opium. 
 
 1. Can at first be roused by loud noises. 
 
 2. Vomiting sometimes, with slight eflbrts 
 
 at reaction. 
 
 3. Breathing slow and stertorous. 
 
 4. Weak and soft pulse. 
 
 5. Pupils usually much contracted, and 
 
 insensible to light. 
 
 6. Countenance livid. Clammy sweats. 
 
 Intoxication. 
 
 1. Can be momentarily roused. 
 
 2. Vomiting in early stage. 
 
 3. Stertor absent, or not loud. 
 
 4. Pulse quick. 
 
 5. Pupils contracted or dilated ; often 
 
 the latter. 
 
 6. General appearance characteristic. 
 
 Smell of alcohol in the breath. 
 
 Numerous cases of apoplex}^ occurring in the streets have been mis- 
 taken for examples of drunkenness. Practitioner cannot be too cautious 
 -in his diagnosis. — See Apoplexij ; Poisoning ; Alcoholism. 
 
 COMPRESSION OF BRAIN.— From Comprimo, to squeeze together.— 
 May he produced by extravasation of blood or serum ; fracture of skull, 
 with depression of lione ; bony excrescence ; some foreign body, — a bul- 
 let, portion of spike, &c. ; by abscess and tiimors of brain. Symptoms 
 are essentially those of apoplexy. 
 
 CONCUSSION OF BRAIN.— From Concutio, to shake.— Signalized by 
 fainting, sickness, stupor, insensibility, and loss of all muscular power, 
 succeeding immediately to some act of external violence. Patient may 
 rally quicklj-, or not for many hours ; or he may die suddenly, or at 
 end of some daj's. After death, no lesion may be detected ; or a lacera- 
 tion of some part of brain ; or a general softening of cerebral substance. 
 
 Symptoms. Vary according to degree of concussion. When shock 
 has been slight, state of unconsciousness soon recovered from : com- 
 plaint only made of confusion of ideas, faintness, sickness, chilliness, 
 drowsiness, ringing noises in ears. In more severe forms, insensibility 
 continues longer. Patient lies as if in deep sleep; pupils insensible to 
 stimulus of light ; surface pale and cold ; muscles flaccid ; pulse flutter- 
 ing or feeble; sphincters relaxed; breathing often scai'cely perceptible. 
 When, after variable interval, partial recovery ensues, there is confusion 
 of thought; inability to articulate distinctly; often, severe vomiting; 
 sometimes, paralysis of one or other extremity. In worst cases, indi- 
 vidual is felled to ground by the shock, and dies on the spot. 
 
 Whole nervous system now and then receives a jar by railway acci- 
 dents, without immediate symptoms being develojied. In course of a 
 few daj's there may be diminution of power of motion; one or more 
 fits of epilepsy; squinting, or impairment of sight; deafness, or trouble- 
 some noises in ears. These symptoms, after a variable duration, may 
 pass off: occasionall}' they are precursors of serious cerebral or spinal 
 disease. 
 
 Treatment. Patient to be watched carefully. Make sure that there
 
 CONCUSSION OF SPINAL CORD — CONJUNCTIVITIS. 77 
 
 is no fracture or dislocation. If, on recovery from shock, there be ex- 
 cessive reaction, cold to head. Two or three drops of croton oil on 
 tongue. Where no attempt to rally is made, a little wine or brandy 
 and water. Warmth to surface of body and extremities: blankets, 
 bottles of hot water, hot bricks, &c. In after-treatment, a mild un- 
 stimulating diet ; absolute rest from all mental occupation ; bodily repose 
 and quiet; gentle bitter aperients. 
 
 CONCUSSION OF SPINAL CORD.— From Concutio, to shake.— May 
 
 arise from any shock, — as fall, jump, severe blow, &c. 
 
 Symptoms. At first slight and obscure. Peculiar tingling (sense of 
 pins and needles) in extremities. Increasing weakness. Difficulty in 
 passing urine. Coldness and numbness of legs; gradually increasing 
 difficulty in walking. Perhaps, irremediable paraplegia. 
 
 Treatment. Cases become sei'ious from neglect. A cure usually to 
 be effected by perfect rest in bed until all symptoms have passed off. 
 Nourishing food. Attention to bowels and bladder. 
 
 CONJUNCTIVITIS.— From Conjunctiva (ConJKugo, to join together), 
 the membrane which lines the eyelids, and covers anterior surface of 
 eyeball; terminal -itis. Synon. Ophthalmia. — Inflammation of mucous 
 membrane of eye, a common affection. Some authors divide the oph- 
 thalmias into several classes : for practical purposes it suffices to remem- 
 ber the varieties to be presently mentioned. 
 
 During violent fits of coughing, vomiting, &c., blood sometimes 
 extravasated beneath conjunctiva, owing to rujJture of a small vessel. 
 Whether patch of ecchyiaosis be small, or so abundant as almost to con- 
 ceal sclerotic, absorption soon takes place. If patient be anxious for 
 some application, a piece of linen dipped in cold water containing a few 
 di'ops of tincture of arnica, may be laid over eye. 
 
 Effusion of serum into areolar tissue between conjunctiva and sclero- 
 tic is called chemosis. When oedema is abundant, conjunctiva becomes 
 quite elevated, so that cornea looks as if it were sunk in a deep depres- 
 sion. Swelling subsides as disease which causes pressure on conjunctival 
 veins disappears. 
 
 1. Catarrhal Ophthalmia. — A mild form of inflammation of the con- 
 junctiva and Meibomian follicles. Most common of all eye diseases: 
 caused by exposure to cold and wet, sudden changes of temperature, &c. 
 
 Symptoms. Slight pain, or sense of scalding. Stiffness and dryness: 
 a feeling of pricking or roughness about the eye, as if sand or broken 
 glass were under upper e3'elid. This sensation caused by rubbing of 
 sensitive eyelids over enlarged vessels of sclerotic conjunctiva. These 
 vessels seen to be of a bright scarlet, and irregularl}' arranged; diftei-- 
 ing from appearance of vessels in sclerotitis, in which the}' are of a pink 
 hue, disposed straight and regularly like radii in a circle. Natural 
 secretion from conjunctiva and Meibomian follicles increased in quan- 
 tity : often becomes ])uritorm. 
 
 Treatment. Yields readily to simple treatment : often terminates 
 favorably, without any remedies. At outset, if there be obstinate con- 
 stipation, calomel and jalap, 140, 159; or a dose or two of some milder 
 aperient, 141. If general health be bad, stimulants or tonics, with beer 
 or wine, and meat. Where there is plethora, continue purgatives for 
 two or three days, while diet is restricted. In troublesome cases, a 
 blister behind ear. Arsenic, 52. Iodide of potassium, 31. Affected 
 eye can be rested by wearing a shade; to be bathed several times in 
 day with warm water. Astringent applications rarely needed : occa- 
 sionally, a drop or tM'o of vinum opii, or of solution of niti'ate of silver
 
 78 CONJUNCTIVITIS. 
 
 (gr. 2 to fl. oz. j), may cut shoi't an attack. AVhen discharge is abun- 
 dant, edges of eyelids should be smeared with some sim])le ointment at 
 night, to prevent their adhering in the morning. 
 
 2. Purulent Ophthalmia. — Same disease as foregoing, onl}- much more 
 severe, and consequently more destructive. Three kinds: Purulent 
 ophthalmia of adults, or contagious ophthalmia, or Egyptian ophthal- 
 mia; gonorrhceal ophthalmia; and purulent ophthalmia of infants. 
 
 Symptoms. In purulent ophthalmia of adults, inflammation very intense, 
 runs a rapid course, attended with violent pain, and leads to formation 
 of large quantities of thick and yellow purulent matter. Eyelids swell 
 so that they cannot be separated sufficiently to expose cornea; chemosis; 
 discharge adheres to eyelashes in thick drops. Severe pain in eye and 
 forehead. Generally much constitutional disturbance, fever, prostra- 
 tion. Where disease does not yield, inflammation increases, attacks 
 cornea, and occasionally internal textures of eye ; extensive sloughing 
 takes place; and when sufferings terminate it is found that sight is 
 completely lost. — It is contagious, frequently epidemic, and common in 
 hot climates. Military life appears to predispose to it. Both eyes often 
 affected ; sometimes simultaneously. 
 
 Gonorrhosal ophthalmia differs from the preceding in a few points only. 
 Thus, it is the most severe; rarely limited to one eye, but one organ 
 usually attacked two or three days before the other ; caused by con- 
 tact of gonorrhoeal — or even leucorrhoeal — dischai"ge with conjunctiva. 
 Frequently ends in sloughing of cornea. 
 
 Purulent ophthalmia of infants, or ophthalmia neonatorum, generally 
 commences about third day after birth, with inflammation of that part 
 of conjunctiva lining palpebrfe. Edges of eyelids adhere ; on separating 
 them a drop of thick white fluid escapes. As inflammation extends to 
 conjunctiva covering eyeball, ej-elids swell; pui-ulent discharge in- 
 creases ; child becomes very feeble and restless and fretful. Disease 
 may remain in this state for eight or nine days; if not then relieved, 
 ulceration of cornea occurs, and very destructive consequences ensue. 
 Both eyes commonly suffer; either at same time, or within an interval 
 of a few days. Discharge contagious. 
 
 Treatment. — In purulent ophthalmia of adults and gonorrhoeal oph- 
 thalmia, no need for violent measures. Eesult to be dreaded is ulcera- 
 tion and sloughing; morbid processes which are more likely to be 
 encouraged by bleeding and antimony and mercury and starvation, 
 than ly any other agents. At commencement, when tongue is thickly 
 coated, an active purgative, 140, 151. If there be debility, — Ammonia 
 and bark, 371; quinine, 379; cod-liver oil. Animal food. Beer or wine. 
 To combat restlessness at night, — Henbane; camphorated tincture of 
 opium; ether; morphia and Indian hemp, 317. Locally: Injections of 
 solutions of alum (gr. 8 or 10 to w^ater fl. oz. j), under eyelids, every 
 hour; or solution of nitrate of silver (gr. 2 to fl. oz. j) may be employed, 
 in same way, about every eight hours. If there be ulceration of cornea, 
 it may sometimes be checked by early application of solid nitrate of 
 silver. Pain arising from application must be relieved by warm nar- 
 cotic fomentations, and opium. To prevent lids from adhering, smear 
 their edges at night with diluted citrine ointment, 305. 
 
 To cure purulent ophthalmia of infants, — Magnesia; castor oil; mer- 
 cury and chalk, 35. Small doses of ipecacuan and opium powder. Iodide 
 of potassium. f]xamination of mother's milk : if it be poor or deficient 
 in quantity, a health}- wet-nurse. Goat's or cow's milk. Liebig's food, 4. 
 Locally: Bathing of eye with tepid water: injections of a solution of 
 alnm (gr. 5 to water fl. oz. j) beneath lids, everj- six or eight hours. 
 Injections of sulphate of zinc (gr. 2 to fl. oz. jj in severe cases.
 
 CONSTIPATION. 79 
 
 3. Strumous Ophthalmia. — A disease of scrofLilous and other children, 
 occurring generally between time of weaning and ninth or tenth year. 
 
 Symptoms. — Slight conjunctival and sclerotic redness; with formation 
 of little phlyctenula3 or pustules, sometimes of ulcei'S, on cornea. Copious 
 h^chrj-mal secretion ; irritability of nasal and buccal mucous membranes. 
 Great intolerance of light (photojyhobia), with spasmodic contraction of 
 eyelids. Swelling of lips, eruptions behind ears, disordered intestinal 
 secretions. Both eyes usually affected. Hot tears flowing over cheek 
 often produce an eruption resembling crusta lactea. 
 
 Treatment. Good nourishing food. Milk. Beer. Warm clothing. 
 Pure air. Occasional doses of mild laxatives. Tonics, — Quinine, arsenic, 
 steel, &c. Cod-liver oil. Locally: Warm fomentations. Use of a green 
 shade : a green or blue veil. Drops of wine of opium. Sulphate of zinc 
 or alum (gr. 2 to fl. oz. j). Spermaceti ointment to edges of lids. Blis- 
 ters behind ears, or to nape of neck. Flying blisters to temples. 
 
 4. Granular Conjunctiva. — The conjunctiva, particularly palpebral 
 portion, is found red and uneven and granular. So-called '' granulations" 
 consist of inflamed mucous follicles and papilla) : when they cause much 
 irritation, opacity of cornea may result. 
 
 Treatment. Quinine. Arsenic and steel, 399. Good diet. Dabbing 
 granulations gently with undiluted liquor potassa;, previously everting 
 lids. Sulphate of copper. Nitrate of silver. Ointment of nitrate of 
 mercury. Sulphur ointment. 
 
 CONSTIPATION.— From Constipo, to crowd thickly together. Synon. 
 Obstipatio ; Alvus Adstricta ; Torpor Intestinorum. — May be an idiopathic 
 attection, or may arise during progress of any acute or chronic disease. 
 By habitual costiveness is meant, a prolonged departure from the stan- 
 dard natural to the individual. As a rule, most people have a dail}' 
 evacuation; but some only go to stool every second or third day. 
 
 Symptoms. Functions of stomach, liver, and pancreas imperfectly 
 performed. A sense of mental and bodily opjiression. Sallow and 
 pasty complexion. Dry skin. Scant}^ urine. JSo stools: or only scanty 
 motions, pale, clay-like, and very offensive. — In obstinate cases : A loss 
 of all power for exertion. Headache. Paljiitation. Neuralgia. Hyp- 
 ochondriasis. 
 
 Treatment. Temporary constipatmi : Sulphate of magnesia, manna, 
 and senna, 139. Sulphate and carbonate of magnesia, 141. Sulphate 
 of soda and taraxacum, 144. Aloes, senna, and jalap, 145. Eesin of 
 podophyllum, 160. Castor oil, 164. Calomel and jalap, 159. Ehubarb 
 and magnesia, 105. Croton oil, 168. Ehubarb and blue pill, 171. Gam- 
 boge, aloes, and blue pill, 174. Simple enemata, 188. Castor oil and 
 turpentine enema, 190. Ci'oton oil enema, 191. Purgative electuaries, 
 194. — Officinal purgatives : Confection of pepper. Confection of scam- 
 monj^. Confection of senna. Confection of sulphur. Compound decoction 
 of aloes. Decoction of tai-axacum. Elaterium. Enema of aloes. Enema 
 of sulphate of magnesia. Extract of Barbadoes aloes. Extract of Soco- 
 trine aloes. Compound extract of colocynth. Extract of jalap. Purified 
 ox bile. Calomel. Mercury and chalk. Blue pill. Infusion of rhubarb. 
 Infusion of senna. Eesin of jalap. Carbonate of magnesia. Sulphate 
 of magnesia. Scammony mixture. Croton oil. Castor oil. Pill of Bar- 
 badoes aloes. Pill of aloes and assafoetida. Pill of aloes and myrrh. Pill 
 of Socotrine aloes. Compound pill of gamboge. Compound pill of colo- 
 cynth. Pill of colocynth and hyoscyamus. Compound rhubarb pill. Eesin 
 of podophyllum. Tartrate of potash. Acid tartrate of potash. Compound 
 powder of jalap. Compound powder of rhubarb. Compound powder
 
 80 CONTUSIOXS OF ABDOMINAL WALLS — CONVULSIONS. 
 
 ofscammony. Tartrate of soda and potash. Phosphate of soda. Precip- 
 itated sulphur. Syrup of senna. Tincture of aloes. Tincture of jalap. 
 Tincture of rhuharb. Tincture of senna. Compound tincture of benzoin. 
 Wine of aloes. 
 
 Habitual Constipation: Olive oil. Almond oil. Castor oil, 164. Ehu- 
 barb and magnesia, 165. Syrup of senna. Sulphate of soda. 143, 144, 
 148. Pepsine and aloes, 155. Steel and aloes, 154, 404. Nitric acid, 
 senna, and taraxacum, 147. Sulphates of magnesia and iron. 166. Seid- 
 litz powders, 169. Puritied ox bile, 170. Crlycerine. Factitious Chel- 
 tenham waters, 180. Factitious Carlsbad waters, 182. Simple enemata, 
 188. Suppositories of soap, or cocoa butter. Quinine, 379. Quinine 
 and nux vomica, 387. Zinc and nux vomica, 409. vStrychnia and steel, 
 408. Sulphate of zinc, 177. Compound tincture of benzoin. Extract of 
 nux vomica, 175. Yalerianate of zinc and belladonna, 410. Tar pills, 
 36. Cod-liver oil. Pepsine, 420. Nitro-hydrochloric acid, 378. — Diet: 
 Wholesome and digestible food. Pipe fruits in morning. Figs or prunes 
 soaked in olive oil. Oatmeal porridge. Brown bread. Aerated bread. 
 Tobacco. Tumblerful of spring water at bedtime. — General rem edies : 
 Daily exercise. Avoidance of too much sleep. Sponge or shower baths. 
 Wet compress over abdomen. Friction of abdominal walls. Galvanism. 
 Gentle kneading of abdominal walls. Bowels to be solicited to act at a 
 regular hour daily. — See Intestinal Obstruction. 
 
 CONTUSIONS OF ABDOMINAL WALLS.— From Contundo, to bruise, 
 to crush to pieces. — ilay be produced by kicks, blows, a fall upon some 
 prominent object, or a squeeze between buffers of two railway carriages, 
 &c. Consequences often very serious. A blow sometimes causes death 
 immediately, owing to syncope from shock to solar plexus of sympa- 
 thetic. In other instances there may be laceration of some internal 
 structure, with hemorrhage: injured individual often dies, at end of a 
 few hours, from combined effects of shock and loss of blood. — Occasion- 
 ally, contusion causes rupture of an internal organ, with extravasation 
 of contents. There may be no external symptom of injury; and yet 
 tissues of gall-bladder, liver, spleen, stomach, intestinal canal, or preg- 
 nant uterus be torn through. Patient either dies shortU' from collapse, 
 or hemorrhage : surviving these dangers, from peritonitis after a longer 
 interval. Instances have occurred of laceration of liver or kidney, 
 where sufferers having srot over first effects of succeeding inflammation 
 have subsequently fallen victims to blood-poisoning from absorption of 
 extravasated fluids. Lastly, a contusion may only set up inflammatory 
 action in a limited portion of the abdominal wall, this action going on 
 to suppuration. — See Abscess of Abdominal Walls. 
 
 CONVULSIONS.— From Convello, to overthrow, to annihilate, &c. 
 Synon. Eclampsia ; Hyperspasmia ; Spasmus. — Convulsions consist of 
 violent and involuntary contractions of muscles of whole body; occur- 
 ring in paroxj'sms, and attended with unconsciousness. Sometimes, 
 contractions partial, of considerable duration, and attended with hard- 
 ness of affected muscles (tonic spasms, or spastic contractions^', e.g. com- 
 mon cramp and tetanus. Sometimes, quickly alternating contractions 
 and relaxations (clonic spasm); e.g. subsultus tendinum — a catching of 
 the tendons of hands and feet, as occurs in last stages of low fever. 
 
 Convulsions may be due to organic disease of nervous system, or to 
 an insufficient supply of health}^ blood to nervous centres; to irritation 
 about gums or alimentary canal (as in teething, indigestion, intestinal 
 worms, &c.); to renal disease and albuminuria (as in ura?mia and preg- 
 nancy); to a morbid state of the blood (as in hj'drophobia, eruptive
 
 COPPER COLIC — CORNEITIS. 81 
 
 fevers, whooping cough, &c.); as well as to strong and sudden mental 
 emotion. 
 
 Symptoms. There are premonitory symptoms, or an absence of any 
 warning. All the voluntary muscles attacked; or there may be only 
 spasms of features, one-half of body, or a single limb. During a general 
 paroxysm there is distortion of features, pallor or lividit}^ of face, star- 
 ing eyeballs, insensibilit}^ of pupils to light, grinding and gnashing of 
 teeth, protrusion of tongue, &c. Involuntary evacuations. Laborious 
 respiration. There will be only one attack, or several. Followed by a 
 tendency to sleep. Seldom a fatal result unless connected with severe 
 disease. 
 
 Treatment. General remedies: Patient's dress to be loosened, espe- 
 cially clothing about neck. To be placed so that he may breathe 
 pure and cold air. Cold to head if there be much heat and flushing. 
 Cold affusion to head, while body is in a warm bath. Sinapisms, or hot 
 bottles to extremities. Mustard footbaths. Purgative and antispas- 
 modic enemata, 190, 191. Croton oil, one or two drops on tongue. 
 Emetics of ipecacuanha, if patient can swallow and there be evidence 
 of gastric irritation, 2ol, 233. Blisters, dry cupping, to nape of neck. 
 Yenesection ? Leeches? Opium, where thei*e is no cerebral disease. 
 Hypodermic injection of morphia, 314. Belladonna and camphor, 326. 
 Ether. Chloroform in draughts, and by inhalation, 313. Sulphate of 
 aniline (gr. 1 twice or thrice daily). Benzoic acid, 49. Lemon-juice. 
 Vinegar. 
 
 Puerperal convulsions : Purgative and antispasmodic enemata. Inha- 
 lation of chloroform. Induction of labor, when patient is undelivered: 
 convulsions often cease as soon as liquor amnii is evacuated. When 
 convulsions occur during parturition, expedite delivery by forceps or 
 turning, patient being previously placed under influence of some anaes- 
 thetic. Venesection and leeches are worse than useless where there is 
 uremia or albuminuria. In convulsions after delivery, hypodermic in- 
 jection of morphia: chloroform, or ether, inhalation. Benzoic, or acetic 
 acid. 
 
 Infantile convulsions : Attention to diet. Cold to head, while body is 
 in a warm bath. One or two grains of calomel placed on tongue. Ipe- 
 cacuanha emetics, if stomach be loaded. Lancing gums, w^here they are 
 in fault. Magnesia or soda in dill water, if thei'e be acidity of secre- 
 tions. Calomel and scammouy, oil of turpentine, liquid extract of fern 
 root, santonin, decoction of pomegranate i*oot, if there be intestinal 
 worms. — See Chorea; Epilepsy ; Hysteria; Tetanus ; Urcemia, &e. 
 
 COPPER COLIC. — Paroxysmal twisting or griping pains in the belly, 
 due to chronic poisoning b}' cop])er. Aff^ects copper-plate printers. 
 
 Symptoms. Attacks of abdominal pain, coming on suddenlj^ : aggra- 
 vated by pressure. Nausea and vomiting. Constipation may be absent. 
 Peculiar sallow hue of complexion: countenance anxious: eyes sunken 
 and lips livid. A purple line around gums. 
 
 Treatment. Sulphate of magnesia and sulphuric acid, 142. Sulphate 
 of soda and sulphuric acid, 143. Castor oil, 164. Enemata of warm 
 water. Morphia, chloroform, and Indian hemp, 317. Ether and opium, 
 85. Iodide of potassium, 31. Hot baths. Sinapisms. Turpentine 
 stupes. Linseed poultices. — See Colic. 
 
 CORNEITIS. — From Cornea {Cornu^ a horn), the transparent and 
 nearly circular external tunic of the eyeball, forming the anterior sixth 
 of the globe ; terminal -itis. 
 
 1. Acute Inflammation. Corneitis, or preferably Keratitis (Kipaq, a 
 
 6
 
 82 CORNEITIS. 
 
 horn), renders the polished and transparent cornea hazy, dim, and 
 rough. May cause it to look like ground glass. 
 
 Symptoms. A ci'eseentic plexus of minute vessels can be seen passing 
 from edge of cornea. A zone of pink vessels in adjacent sclerotic. Ha- 
 ziness of cornea with opacity. Abundant secretion of tears. Intole- 
 rance of light. Strumous children and subjects under twenty years of 
 age most liable to it. One or both eyes may be aifected : sometimes 
 one eye attacked, just as the other is getting well. Morbid action may 
 last for months and leave cornea permanently cloudy. Occasionally 
 ends in suppuration, and pus gets infiltrated between fibres of the mem- 
 brane. Softening generally takes place posteriorly-: pus makes its way 
 into anterior chamber, to bottom of which it sinks; when it assumes 
 a crescentic foj-m — hyjjopyon. AVhen an opening occurs anterioi'ly, a 
 perforating ulcer of cornea is produced through which ii'is protrudes — 
 staphyloma iridis. 
 
 Treatment. Attention to biliary and intestinal secretions. Ehu- 
 barb and magnesia, mercury and chalk, calomel, or castor oil. Iodide 
 of potassium and bark, 31. Iodide of Iron, 32. Cod-liver oil. Chemical 
 food, 405. Quinine. Tincture of perchloride of iron. Nourishing diet 
 with milk. Small blisters to temples, or behind ears. Warm fomenta- 
 tion : steaming the eyes. Tincture of iodine to skin of lids. Avoidance 
 of irritating coUyria. 
 
 2. Syphilitic Keratitis. — Sometimes spoken of as "chronic interstitial 
 keratitis." The result of inherited constitutional syphilis. Affects chil- 
 dren and young persons, especially females. Is very chronic. 
 
 Symptoms. A diffused haziness beginning at centre of one cornea. 
 Tissue gets to I'esemble ground glass. No tendency to ulceration. 
 After a few weeks both corner become affected. Subjects of this dis- 
 ease have a coarse and flabby skin, pits and scars on face and forehead, 
 cicatrices of old fissures at angles of mouth, sunken bridge to nose, and 
 permanent teeth peculiar for smallness and bad color and vertically 
 notched edges (Hutchinson). 
 
 Treatment. Cautious use of mercury, avoiding salivation. Corro- 
 sive sublimate and compound infusion of gentian. Mercurial inunction 
 behind eai's. Iodide of potassium. Iodide of iron. Ferruginous tonics. 
 Liberal diet. Cod-liver oil. 
 
 3. Opacity of Cornea. — May result from inflammation, giving rise to 
 effusion of tibrine into substance of cornea, or between it and conjunc- 
 tiva; or it may be the consequence of a cicatrix following an ulcer. 
 
 "When opacity is cloudy and diffused, as from keratitis, appearance 
 called a nebula : a limited white patch, such as results from a cicatrix, 
 is known as albugo and leucoma. Employment of acetate of lead collyria, 
 when there has been an abrasion of cornea or conjunctiva, has led to 
 formation of a permanent white deposit. This may sometimes be gently 
 scraped away. 
 
 4. Ulcers of Cornea. — Occur in individuals of all ages where powers 
 of life have been lowered by illness, insufficient food, strumous disease, 
 &c. May lead to perfbi^ation of cornea with escape of aqueous humor, 
 obliteration of antei-ior chamber, and prolapsns iridis. To be cured by 
 attention to general health. When the ulcer is very indolent, local use 
 of nitrate of silver. Avoidance of irritating collyria. 
 
 6. Conical Cornea. — Synon. Keratoconus ; Staphyloma Oornexe Pellu- 
 cidiim. — A rare malformation. Cornea found exceedingly convex, giv- 
 ing a peculiar sparkling or brilliant appearance to eye. Both eyea 
 iisually affected, though often unequally. In consequence, an almost 
 total deprivation of vision. Causes of this deformity not known. In 
 the few cases which have been examined after death, apex of cornea
 
 CORYZA — COUGH. 83 
 
 has been found thinner than natural. — All kinds of treatment have 
 been fruitless. But patient's vision may sometimes be partly assisted 
 by a deeply concave glass; or by use of a black plate with a trans- 
 verse slit along its middle, fixed in spectacle-frame, with or without the 
 glass. 
 
 6. Arcus Senilis. — Synon. Leueoma Gerontotoxon ; Macula Cornece Ar- 
 cuata ; Fatty Degeneration of Peripheral Portion of Cornea. — A gradually 
 increasing opacity of circumference of cornea, owing to fatty degenera- 
 tion. Generally occurs in the aged. Indicative of fatty degeneration 
 of heart. 
 
 CORYZA. — From Kdpa, the head; C^w, to boil. Synon. Phinitis ; 
 Graved ; Stillicidium Narium ; Cold in the Head. — Catarrhal inflamma- 
 tion of Schneiderian membrane of nose. — Often quickly relieved by 
 full dose of opium. Iodine vapor, 259. — See Catarrh. 
 
 COUGH. — Synon. Tassis. — A sjnnptom of numerous and varied dis- 
 eases. Frequently an effort to expel irritating matters from bronchi 
 and air-cells. Sometimes an idiopathic affection. — See Asthma; Bron- 
 chitis; Cronp ; Hooping- Cough ; Laryngismus Stridulus; Laryngitis; 
 Phthisis-; Pleurisy ; Pneumonia, &c. 
 
 Treatment. General Remedies : Mucilage of gum Arabic. Mucilage 
 of tragacanth. Decoction of Iceland moss (Cetraria). Decoction of bar- 
 ley. Infusion of dulcamara. Infusion of linseed. Infusion of marsh 
 mallow. Liquorice jujubes (consisting of gum and sugar and gelatine). 
 Ammoniac mixture, 237. Balsam of Peru with mucilage. Syrup or 
 tincture of Tolu. Ammonia and senega, 235. Antimonial wine, 240. Ipe- 
 cacuan wine, 241. Powder of ipecacuan and opium. Tincture or syrup 
 of squills, 236, 247. Compound squill pills. Spirit of nitrous ether. Spirit 
 of ether. Spirit of chloroform. Eectitied pyroxylic spirit. Dilute hydro- 
 cyanic acid. Laurel water (Aqua laurocerasi, min. v to xxx). Morphia, 
 315, 317, 346, 347. Opium, 213, 316, 324, 338, 345. Camphorated tinc- 
 ture of opium, 235, 319. Sj-rup of poppies. Conium, 335. Henbane. 
 Stramonium, 323. Aconite, 330, 332. Belladonna, 326, 344. Indian to- 
 bacco, 88, 242. Almond oil. Cod-liver oil, 389. Inhalation of steam, tar 
 vapor, medicated vapors. Spray, or atomized fluids, of weak solutions of 
 tannic acid, perchloride of iron, sulphate of zinc, alum, opium, conium, 
 &c., 262. Locally to chest walls : Mustard poultice. Turpentine stupes. 
 Blisters. Opium, belladonna, ammoniac and mercury, chalybeate, gal- 
 banum, pitch, or warm plasters. Liniment of chloroform, or opium, or 
 belladonna, or iodine, properly diluted. Compound liniment of camphor. 
 Liniment of croton oil, 207. Ointment of tartarated antimony. Tartar 
 emetic embrocation, 206. 
 
 Cough from Intestinal L'ritation, d-c. : Lancing gums. Eemedies against 
 intestinal worms. Remedies against dyspepsia, gastric catarrh, consti- 
 pation, &c. 
 
 Cough from, Enlarged Tonsils, &c.: Astringent gargles, 248, 249, 252, 
 257. Quinine, 379, 386. Steel, 380, 392, 395, 403. Phosphate of iron, 405. 
 Iodide of iron, 382, 390. Iodide of ammonium. Phosjjbate of zinc, 414. 
 Cod-liver oil, 389. Application of nitrate of silver. Excision of tonsils. 
 Amputation of elongated uvula. Potassa fusa has been applied to en- 
 larged tonsils, but its use requires great caution. 
 
 Nervous and Hysterical Cough : Valerian, 87. Valerianate of quinine 
 or zinc, 93, 410, 411. Assafoetida, 89. Phosphate of zinc. Nux vomica. 
 Compound mixture of iron. Citrate of iron and quinia. (lalbanum ; 
 compound pill of assafoetida. Nitrate of silver to glottis. Attention to 
 uterine functions. Horse exercise. Seabathing. Shower baths. Nour- 
 ishintr food.
 
 84 COUP DE SOLEIL — COAV-POX. 
 
 COUP DE SOLEIL. — S^'-non. Sunstroke; Insolatio ; Heat Apoplexy; 
 Eretlilsnius Tropicus. — A disease allied to simple apoplexy. In perfect 
 form, only met with in the tropics. Often fatal to European soldier, 
 at seasons when heat is very oppressive. 
 
 Symptoms. . Generally, faintness; thirst; considerable heat and dry- 
 ness of skin ; great failure of nervous energy. Often, vertigo and a sense 
 of tightness across chest. Pulse sometimes quick and full, sometimes so 
 thin and feeble it can hardly be felt. As ease progresses, heart's action 
 becomes violent ; patient can scarcely be roused ; face gets pallid ; per- 
 haps an attack of vomiting ushers in deep coma. While comatose, 
 there is heat of skin; dyspnoea; contracted pupils, with congested con- 
 junctivse; action of heart intermittent. Just prior to death, dilatation 
 of pupils; gasping respiration; perhaps vomiting. 
 
 In some instances, symptoms very insidious. Mere listlessness and 
 stupidity; head is said to feel a little queer. Yet in twelve hours, 
 death. — Often, after exposure to sun, the individual has suddenly fallen 
 down insensible ; made one or two gasps; and died in state of sj-ncope. 
 
 If recovery take place, convalescence apt to be retarded by deranged 
 secretions, continued fever, some pulmonary" complication, partial par- 
 alysis, or great prostration. — Patient not free from immediate danger 
 until skin gets cool and moist. Many months after apparent cure, 
 symptoms of paralysis or of insanity may be developed : in an}^ case, 
 the individual is seldom the man he was prior to attack. 
 
 Treatment. Curative: Mortality very large where bloodletting has 
 been resorted to. Most reliable remedies, — Cold to the head, and stim- 
 ulants. A continuous stream of cold water to be poured over head and 
 neck and spine and chest, provided pulse be not ver}^ weak and skin 
 cold. Evaporating lotions to scalp. Blisters, or liniment of cantharides, 
 to nucha. Ammonia. Ether. Brandy. Tea, well sweetened. Ipecacu- 
 anha emetics, if stomach be loaded. Sinapisms or turpentine stupes to 
 extremities. Stimulant enemata. Ice to spine. Frictions of surface. 
 
 Prophylactic : When a march is undertaken in India during hot sea- 
 son, weak and sickly to be left behind. Costume to be suitable to early 
 morning hours before sunrise, as well as for scorching heat which fol- 
 lows. Flannel shirts, as safeguards against sudden chills: flannel belts 
 advantageous, save in hottest weather. Shirt collars to be open. Light 
 knapsacks, without cross-belts over chest. Troops to march easy : halts 
 when men are exhausted, with longer halt half-way, so that each man 
 may have coff'ee and biscuit. To arrive on new gi'ound about an hour 
 after sunrise. Camp to be formed on as high and open ground as possi- 
 ble. Men to have an ample supply of water. Rations of spirits to be 
 discontinued (Aitken). 
 
 COW-POX. — Synon. Vaccinia. — The comparative immunity against 
 small-pox, conferred by vaccination, was discovered by Jenner towards 
 close of eighteenth century. 
 
 When vaccination has been successfully performed on healthy child, 
 an elevation may be felt over puncture on second day, accompanied 
 bj' slight redness; on fifth, a distinct vesicle is formed, having an ele- 
 vated edge and depres.sed centre; on eighth, it is of a pearl color, and 
 is distended with a clear lymph. An inflamed areola now forms round 
 base of little tumor, and increases during two succeeding days ; about 
 eleventh day it fades ; and the vesicle, which has then burst and ac- 
 quired a brown color, gradually dries up, until by end of second w^eek 
 it has become converted into a hai'd and round scab. This falls off" 
 about twenty-first day; leaving a circular, depressed, striated cicatrix, 
 which is 2)ermanent in after-lfe. First vaccination affords protection
 
 CRETINISM — CROUP. 85 
 
 for ten years, perhaps for longer : a safe proceeding to revaceinate after 
 this lapse of time. 
 
 Four or five separate, good-sized vesicles should be pi-oduced. — When 
 variola occurs after vaccination, it is known as varioloid, or modified 
 small-pox. 
 
 CRETINISM. — Perhaps, according to Dr. Mayne, from Cretira, old 
 Italian for a poor creature. Synon. Idiotismns Endeinicus ; Fatuitas ; 
 Alpicolarum ; Micrencephcdon. — A form of idiocy accompanied by de- 
 formity of the bodily organs. Supposed by some autborities to have a 
 close but ill-understood connection with goitre. 
 
 Symptoms. Diminutive stature. Large bead, flattened at top, and 
 spread out laterally. Countenance vacant and devoid of intelligence. 
 Mouth gaping and slavering. Tongue protruding. Goitre. Disgust- 
 ing habits. Perhaps squinting, deaf-mutism, blindness. 
 
 Treatment. Pure mountain air. Plent}^ of exercise. Simple nour- 
 ishing food, with milk. Cod-liver oil. Carbonate of iron. Phosphate 
 of lime. Chemical food. Valerianate of zinc. Moral control. Judici- 
 ous mental training. 
 
 CROUP. — Synon. Tracheitis; Cynanche Traehealis; Angina Trachealis. 
 An inflammatory disease of mucous lining of trachea, or often of glottis 
 and larynx and trachea. Fever and inflammation accompanied b}' ex- 
 udation of false membranes on affected surfaces. — Most common during 
 second and third years of childhood. Often complicated with bron- 
 chitis or pneumonia. May end fatally from exhaustion, suftbcation, 
 convulsions, or thrombosis. Mortality very large. — See Death Causes. 
 
 Symptoms. In early stage, those of catarrh. Slight fever; cough; 
 hoarseness; drowsiness; suffusion of eyes, and running at nose. In 
 course of eighteen hours, wheezing respiration ; fits of hoarse coughing ; 
 occasional spasms of laryngeal muscles. Then, characteristic symptoms : 
 alteration in cough, which is attended with a peculiar ringing sound, 
 rendering it "brassy." Inspirations prolonged; accompanied with 
 crowing or piping noise. Eedness and swelling of tonsils and uvula, less 
 marked than in tonsillitis. Increased fever. Breathing becomes more 
 hurried and impeded. Cough frequent. Depression, with weakness and 
 irregularity of pulse. Thirst. Irritability and restlessness. Features 
 expressive of alarm and distress: patient grasps at his neck, or thrusts 
 his fingers into mouth, as if to remove cause of suffering. Nocturnal 
 exacerbations: remissions towards morning. — As disease subsides, cough 
 loses peculiar twang, becomes moist ; crowing inspirations lessen, or 
 cease. — \yhen tending to death, drowsiness gets extreme, though sleep 
 is uneasy; child starts, and wakes in terror. Breathing becomes gasp- 
 ing and interrupted: suftbcation seems imminent. Congestion of lungs. 
 Skin cold ; covered with clammy sweat. Perhaps death directly after 
 an inspiration : asphyxia, coma, convulsions, or fatal dyspnoea from 
 thrombosis. 
 
 Treatment. Under use of bleeding, tartarated antimony, and mer- 
 cmy, half the cases attacked die. For this cause alone, a difi'erent plan 
 ought to be tried. Blisters most injurious. 
 
 Confinement to bed. Flannel clothing. Temperature of room 70° 
 F. ; air to be moistened with steam. Continuous fomentations to throat : 
 sponges dipped in water as hot as can be borne. Emetic of ipecacuan, 231. 
 Calomel as a purgative, or castor oil, if there be constipation. Lessen 
 excessive heat of skin by warm bath, 137. If skin be drj-, wrap patient 
 in a blanket wrung out of warm water, and cover all with two or three 
 diy blankets, 136. Painting of throat with belladonna, — diluted ex- 
 tract, liniment, or tincture — if distress arise chiefly from spasmodic 
 contractions of laryngeal muscles. Iodide of potassium with assafoetida
 
 86 CYANOSIS — DEAFNESS. 
 
 and senega, 81. Ammonia and senega, 235. Inhalation of spray of hot 
 saccharated solution of lime, 262. Inhalation of oxygen gas. Beef tea. 
 Lime-water and milk. Cream. Wine, or brand3\ — Tracheotomy, if 
 predominant symptoms are those of asphyxia : inhalation of chloroform, 
 80 that operation may be performed deliberately and cautiously. Atter 
 operation, trust to warm moist air, nourishment, and stimulants : aban- 
 don medicines. 
 
 Remedies often recommended : Leeches. Bleeding. Purging. Blisters. 
 Tartarated antimony. Calomel. Mercurial inunction. Digitalis. Hy- 
 drocyanic acid. vSquills. Yeratrum viride. Sanguinaria Canadensis. 
 Quinine. Sulphate of copper. Sulphurated potash. Nitrate of silver, 
 locally. Glycerine, locally. Tincture of iodine, painted over outside of 
 neck. 
 
 CYANOSIS. — From /iwavoc, blue; k5(toc, disease. Synon. Hamiatocy- 
 anosis ; Morbus Cceraleus; Blue Disease. — A condition characterized by 
 a blue or purplish discoloration of skin ; arising generally in connection 
 with some deficiency in construction of the heart. 
 
 Chief mnlformations : Permanence of foramen ovale, allowing a pas- 
 sage of blood between the auricles. Abnormal apertures in some part 
 of sejitum of auricles or ventricles. Origin of aorta and pulmonary 
 arteiy from a single ventricle. Transposition of origins of large vessels 
 from heart; aorta arising from right, and pulmonary artery from left, 
 ventricle. An extreme contraction of pulmonary artery. Continued 
 patescence of ductus arteriosus, jDermitting a mixture of bloods of aorta 
 and pulmonary artery. 
 
 Symptoms. Discoloration of skin. Coldness of body: temperature 
 of mouth sometimes reduced to 77° F. Palpitation. Fits of dyspnoea. 
 vSyncope on excitement. Tips of fingers and toes become bulbous: nails 
 incurvated. Generative organs often imperfectly developed. Conges- 
 tion of internal organs, and dropsical effusions. — Infants affected, gen- 
 erally die very early: occasionally, life prolonged to adult age. Males 
 more prone to cyanosis than females. Under exceptional circumstances 
 it may not come on until somewhat late in life. 
 
 Treatment. Must be simplj- palliative. Nourishing food. Occa- 
 sionally, mild tonics. Warm clothing. Avoidance of fatigue, or mental 
 excitement. Residence in pure mild air. 
 
 CYNANCHE LARYNGEA.— From /lucyv, a dog; «>/«», to strangle,— 
 because dogs were sii]»]>osed to be especially liable to sore throat: Adpuyq, 
 the windpipe. Synon. Angina Laryngea ; Inflammation of the Larynx. — 
 See Laryngitis. 
 
 CYNANCHE PAROTIDEA.— From Kuwv, a dog; «V;^a>, to strangle: 
 Udpa, ne'dv; oS?, the ear. Sj-non. Parotitis Contagiosa ; Angina Externa ; 
 Mnmjys ; Branks ; hiflammatio7i of the Parotid Gland. — See Parotitis. 
 
 CYNANCHE TONSILLARIS.— From Kbojv, a dog; ^yxio, to strangle: 
 TonsiUa, the tonsil. S^-non. Amygdalitis ; Angina Tonsillaris; Liflam- 
 matory Sore Throat; Quinsy. — See Tonsillitis. 
 
 CYNANCHE TRACHEALIS.— From A'uw,, a dog; cly/ju, to strangle: 
 TracJiea, the windpipe. Synon. Suffocatio Stridxila ; Angina Membrana- 
 cea ; Laryngotracheitis ; Mising of the Lights ; Inflammation of the Trachea. 
 — See Croup. 
 
 DEAFNESS. — Synon. Cophosis ; Surditas ; Hardness of Hearing — May 
 be the result of rheumatism, gout, or some diminution of nervous force. — 
 See also, O^orr/tci'rt ; Otitis; Eustachian tube.
 
 DEATH CAUSES. 87 
 
 1. Rheumatism of Ear. — Most frequently occurs after subsidence of 
 rheumatic inflammation of joints. 
 
 Symptoms. Tenderness of scalp, temple, mastoid process, jaw, and 
 teeth on affected side. Distressing tinnitus. Nightly exacerbations, 
 with acid perspirations. An acute attack may prove most destructive 
 by producing periosteal inflammation and caries Sometimes obstinate 
 otorrhoea results: may lead to exfoliation of a portion of bone. 
 
 Treatment. Alkaline salts. Iodide of potassium. Opium. Hot 
 bathing. Fomentations. When great tenderness exists over mastoid 
 process, much relief may be given by an incision over this part down 
 to the bone, so as to free tense inflamed periosteum. 
 
 2. Gout of Ear. — A common cause of deafness. Ear seldom attacked 
 until small joints have been frequently invaded. Deafness generally 
 preceded by severe headaches. 
 
 Symptoms. Gout affecting eocternal ear often sets in soon after mid- 
 night. Tearing or twisting pain ; burning heat ; beating noises or sing- 
 ing in ear; swelling with redness. — Minute articulations of bones in the 
 middle ear may sufter. Pain very acute. Sometimes loss of conscious- 
 ness, delirium, or convulsions. Concretions and deposits of urate of 
 soda found after death (Harvey). 
 
 Treatment. Same as for gout in other parts of body. Purging with 
 neutral salts. Alkalies. Colchicum. Fomentations. When apparently 
 due to metastasis, mustard pediluvia, or other local stimulants, to recall 
 disease to less important joints. 
 
 3. Nervous Deafness. — Somewhat analogous to amaui-osis. More or 
 less deafness owing to some lesion of nervous system; whether the mis- 
 chief have its seat in nervous tissue expanded in labyrinth, at origin or 
 in course of seventh pair, or 'in brain itself. — In some cases no relief can 
 be given; as in senile deafness, arising from insensibility of nervous 
 tissue due to old age. Ear-trumpets. Marshall's Double Reflecting 
 Ear-trumpets possess great advantages as regards the ease and distinct- 
 ness with which they convey sounds of voice, without any necessity for 
 speaker doing more than articulate clearly. Singing noises and deaf- 
 ness sometimes due to decayed teeth. 
 
 DEATH CAUSES. — Life can only be maintained by the circulation of 
 arterial blood. If no blood circulates through arteries, or only venous 
 blood, the result is death. When no blood circuhites, death due to syn- 
 cope (luyxoTTTuj, to be affected with sudden prostration of strength), which 
 is of two kinds: (1) Death by ancemia ('J, priv. ; aifj-a, blood), in which 
 there is a want of due suj)ply of blood to heart; as in fatal hemorrhage. 
 (2) Death by asthenia ('J, priv.; ffdivu^, strength), where there is a failure 
 in contractile power of heart; as in apoplexy, action of certain poisons, 
 &c. — Sometimes life fails p art h' from anaemia and partly from asthenia; 
 as in cases of starvation, phthisis, dysentery, &c. 
 
 If venous blood circulate through arteries, death happens in one of 
 two ways: (1) Jiy ajiJicea ('A, priv.; micu, to breathe), asphyxia, or suffo- 
 cation, where access of air to lungs is stopped; as in drowning, strangu- 
 lation, many laryngeal and lung diseases, tetanus, section of phrenic 
 and intercostal nerves, &c. (2) By coma (Kw/ia, deep sleep), in which 
 muscular movements required for respiration cease owing to insensi- 
 bilit}' produced by cerebral disease. — In apncea there ai^e successively 
 impeded respii'ation, circulation of venous blood, and insensibility. In 
 coma the order is reversed, — insensibilit}^ cessation of thoracic move- 
 ments, and stoppage of chemical functions of lungs. 
 
 The following table shows the Causes of Death in England for the 
 four years 186U-1863, as well as the classification ado^ited by the Regis- 
 trar-General :
 
 88 
 
 DEATH CAUSES. 
 
 
 1860 
 
 1861 
 
 1862 
 
 1863 
 
 Estimated Population of England in 
 middle of the Years, .... 
 
 
 
 
 
 19,902,713 
 
 20,119,314 
 
 20,336,467 
 
 20,554,137 
 
 CO 
 
 DISEASES. 
 
 1860 
 
 1861 
 
 1862 
 
 1863 
 
 
 ALL CAUSES, 
 
 422,721 
 
 435,114 
 
 436,566 
 
 473,837 
 
 (Classes.) 
 
 
 
 
 
 I. 
 
 ZYMOTIC DISEASES, . . 
 
 75,849 
 
 87,986 
 
 91,539 
 
 119,731 
 
 11. 
 
 co:nstitutional " . . 
 
 82,088 
 
 84,987 
 
 83,024 
 
 84,393 
 
 111. 
 
 LOCAL " . . 
 
 171,037 
 
 167,454 
 
 170,651 
 
 174,6(i3 
 
 IV. 
 
 DEVELOPMENTAL" . . 
 
 70,311 
 
 71,948 
 
 68,842 
 
 71,467 
 
 V. 
 
 VIOLENT DEATHS, . . . 
 SuBDEN Deaths, Cause un- 
 
 14,775 
 
 14,985 
 
 14,944 
 
 15,680 
 
 I. 
 
 ascertained, 
 
 2,894 
 
 2,697 
 
 2,778 
 
 3,008 
 
 (Orders.) 
 
 
 
 
 
 
 1. Miasmatic Diseases, . . 
 
 71,304 
 
 83,324 
 
 86,881 
 
 114,538 
 
 
 2. Enthetic 
 
 1,252 
 
 1,355 
 
 1,449 
 
 1,578 
 
 
 3. DiETIC, 
 
 2,206 
 
 2,095 
 
 2,149 
 
 2.456 
 
 II. 
 
 4. Parasitic, 
 
 1. Diathetic, 
 
 1,087 
 
 1,212 
 
 1,060 
 
 1,159 
 
 16,404 
 
 16,233 
 
 16,412 
 
 16,651 
 
 III. 
 
 2. Tubercular, 
 
 Diseases of — 
 
 65,684 
 
 68,754 
 
 66,612 
 
 67,742 
 
 
 
 
 
 
 1. Nervous System, . . . 
 
 55,577 
 
 55,625 
 
 55,692 
 
 57,428 
 
 
 2. Organs of Circulation, 
 
 18,758 
 
 18,076 
 
 18,709 
 
 19,505 
 
 
 3. Eespiratory Organs, 
 
 68,408 
 
 64,310 
 
 67,565 
 
 67,280 
 
 
 4. Digestive Organs, . . 
 
 19,718 
 
 20,327 
 
 19,421 
 
 20,516 
 
 
 5. Urinary Organs, . . . 
 
 4,990 
 
 5,222 
 
 5,328 
 
 5,578 
 
 
 6. Organs of Generation, 
 
 1,118 
 
 1,129 
 
 1,227 
 
 1,219 
 
 
 7. Organs of Locomotion, . 
 
 1,466 
 
 1,624 
 
 1,588 
 
 1,765 
 
 IV. 
 
 8. Integumentary System, 
 1. Dev. Diseases of Chil- 
 
 1,002 
 
 1,141 
 
 1,121 
 
 1,312 
 
 
 
 
 
 
 dren, .... 
 
 12,706 
 
 13,116 
 
 12,787 
 
 13,498 
 
 
 2. " Adults, .... 
 
 2,233 
 
 2,168 
 
 2,198 
 
 2,508 
 
 
 3. " Old People, . . 
 
 28,442 
 
 27,373 
 
 26,780 
 
 27,268 
 
 
 4. Dis. OF Nutrition, . . . 
 1. Accident or Negligence, 
 
 26,930 
 
 29,291 
 
 27,077 
 
 28,193 
 
 12,991 
 
 13,187 
 
 13,055 
 
 13,772 
 
 
 2. Battle, 
 
 * 
 
 * 
 
 * 
 
 * 
 
 
 3. Homicide, 
 
 377 
 
 320 
 
 418 
 
 399 
 
 
 4. Suicide, 
 
 1,365 
 
 1,347 
 
 1,317 
 
 1,319 
 
 
 5. Execution, 
 
 10 
 
 11 
 
 17 
 
 21 
 
 V. 
 
 Other Violent Deaths not 
 
 
 
 
 
 I. 
 
 CLASSED, 
 
 32 
 
 120 
 
 137 
 
 169 
 
 Order 1. 
 
 
 
 
 
 
 1. Small-pox, 
 
 2,749 
 
 1,320 
 
 1,628 
 
 5,964 
 
 
 2. Measles, 
 
 9,557 
 
 9,055 
 
 9,800 
 
 11,349 
 
 
 3. Scarlatina, 
 
 9,681 
 
 9,077 
 
 14,834 
 
 30,475 
 
 
 4. Diphtheria, 
 
 5,212 
 
 4,517 
 
 4,903 
 
 6,507 
 
 
 6. Quinsy, 
 
 319 
 
 342 
 
 323 
 
 334 
 
 
 6. Croup, 
 
 4,380 
 
 4,397 
 
 5,667 
 
 6,957 
 
 
 7. Whooping-cough, . . . 
 
 8,555 
 
 12,309 
 
 12,272 
 
 11,275 
 
 
 8. Typhus (and infantile fever). 
 
 13,012 
 
 15,440 
 
 18,721 
 
 18,017
 
 DEATH CAUSES. 
 
 89 
 
 05 
 
 CS 
 
 
 
 DISEASES. 
 
 18G0 
 
 1861 
 
 1862 
 
 1863 
 
 I. 
 
 Order 1 — continued. 
 
 
 
 
 
 
 9. Erysipelas, 
 
 1,06.5 
 
 1,542 
 
 1,.523 
 
 1,920 
 
 
 10. Mcti-ia, . 
 
 
 
 
 
 
 
 987 
 
 886 
 
 940 
 
 1,155 
 
 
 11. CiirbuMcle, 
 
 
 
 
 
 
 
 247 
 
 193 
 
 206 
 
 237 
 
 
 12. Influenza, 
 
 
 
 
 
 
 
 1,130 
 
 746 
 
 915 
 
 919 
 
 
 18. Dysentery, 
 
 
 
 
 
 
 
 1,156 
 
 1,416 
 
 1,044 
 
 1,051 
 
 
 14. Diarrhcea, 
 
 
 
 
 
 
 
 9,702 
 
 18,746 
 
 11,112 
 
 14,943 
 
 
 15. Cholera, . 
 
 
 
 
 
 
 
 327 
 
 837 
 
 511 
 
 807 
 
 
 16. As^ue, . . 
 
 
 
 
 
 
 
 203 
 
 149 
 
 150 
 
 141 
 
 
 17. Remittent Fever, 
 
 
 
 
 
 314 
 
 254 
 
 284 
 
 198 
 
 
 18. Kheumatism, . 
 
 
 
 
 
 1,998 
 
 1,982 
 
 1,943 
 
 2,175 
 
 
 19. Other Zymotic Diseases, 
 
 
 110 
 
 116 
 
 105 
 
 114 
 
 Order 2. 
 
 
 
 
 
 
 1. Syphilis, 
 
 1.067 
 
 1,177 
 
 1,245 
 
 1,386 
 
 
 2. Stricture of Urethra, . . . 
 
 178 
 
 168 
 
 199 
 
 183 
 
 
 3. Hydrophobia, 
 
 3 
 
 4 
 
 1 
 
 4 
 
 
 4. Glanders, 
 
 Order 3. 
 
 4 
 
 6 
 
 4 
 
 5 
 
 
 
 
 
 
 1. Privation, 
 
 68 
 
 63 
 
 73 
 
 54 
 
 
 2. Want of Breast-milk, . . 
 
 1,002 
 
 970 
 
 1,006 
 
 1,158 
 
 
 3. Purpura and Scurvy, . 
 
 361 
 
 405 
 
 353 
 
 409 
 
 
 . . , , , f rt Delirium Trem., 
 4- ^^^"^^°1' 16 Intemperance,. 
 
 Order 4. 
 
 457 
 
 415 
 
 471 
 
 471 
 
 
 318 
 
 242 
 
 246 
 
 364 
 
 
 
 
 
 
 1. Thrush, 
 
 920 
 
 1,055 
 
 904 
 
 961 
 
 II. 
 
 2. Worms, &c., 
 
 Order 1. 
 
 167 
 
 157 
 
 156 
 
 198 
 
 
 
 
 
 
 1. Gout, . 
 
 268 
 
 247 
 
 284 
 
 248 
 
 
 2. Dropsy, 
 
 7,823 
 
 7,301 
 
 7,247 
 
 7,414 
 
 
 3. Cancer, 
 
 6,827 
 
 7,276 
 
 7,396 
 
 7,479 
 
 
 4. Noma, 
 
 122 
 
 174 
 
 197 
 
 180 
 
 
 5. Mortification, 
 
 Order 2. 
 
 1,364 
 
 1,235 
 
 1,288 
 
 1,330 
 
 
 
 
 
 
 1. Scrofula, 
 
 2,995 
 
 3,457 
 
 3,416 
 
 3,277 
 
 
 2. Tabes Mesenterica, . . . 
 
 4,982 
 
 5,692 
 
 5,203 
 
 5,877 
 
 
 3. Phthisis, 
 
 50,149 
 
 51,931 
 
 50,962 
 
 51,072 
 
 III. 
 
 4. Hydrocephalus, 
 
 Order 1. 
 
 7,229 
 
 7,674 
 
 7,031 
 
 7,516 
 
 
 
 
 
 
 1. Cephalitis, 
 
 3,518 
 
 3,426 
 
 3,580 
 
 3,869 
 
 
 2. Apoplexy, 
 
 9,181 
 
 8,795 
 
 9,136 
 
 9,721 
 
 
 3. Paralysis, 
 
 9,752 
 
 9,812 
 
 9,733 
 
 9,762 
 
 
 4. Insanity, 
 
 536 
 
 529 
 
 535 
 
 555 
 
 
 5. Chorea 
 
 66 
 
 71 
 
 52 
 
 63 
 
 
 6. Epilepsy, 
 
 2,454 
 
 2,464 
 
 2,443 
 
 2,574 
 
 
 7. Convulsions, 
 
 25,205 
 
 25,423 
 
 25,286 
 
 26,008 
 
 
 8. Brahi Disease, Jfc, .... 
 Order 2. 
 
 4,865 
 
 5,105 
 
 4,927 
 
 4,876 
 
 
 
 
 
 
 1. Pericarditis, 
 
 575 
 
 541 
 
 559 
 
 597 
 
 
 2. Aneurism, 
 
 368 
 
 387 
 
 373 
 
 418 
 
 
 3. Heart Disease, <J-c., . , . . 
 Order 3. 
 
 17,815 
 
 17,148 
 
 G 
 
 17,777 
 
 18,490 
 
 
 
 
 
 
 1. Laryn2;itis, 
 
 1,166 
 
 1,253 
 
 1,478 
 
 1,561 
 
 
 2. Bronchitis, 
 
 32,347 
 
 30,986 
 
 32,526 
 
 32,025 
 
 
 3. Pleurisy, 
 
 882 
 
 781 
 
 833 
 
 907 
 
 
 4. Pneumonia, 
 
 
 
 
 
 
 
 25,264 
 
 22,914 
 
 23,713 
 
 24,181
 
 90 
 
 DEATH CAUSES. 
 
 
 DISEASES. 
 
 1860 
 
 1861 
 
 1862 
 
 1863 
 
 III. 
 
 Order 3 — continued. 
 
 
 
 
 
 
 5. Asthma, 
 
 4,325 
 
 3,892 
 
 4,087 
 
 3,699 
 
 
 6. Lung Disease, ^c, .... 
 Order 4. 
 
 4,424 
 
 4,484 
 
 4,928 
 
 4,907 
 
 
 
 
 
 
 1. Gastritis, 
 
 704 
 
 809 
 
 765 
 
 838 
 
 
 2. Enteritis, 
 
 3,154 
 
 3,333 
 
 2,911 
 
 3,234 
 
 
 3. Peritonitis, 
 
 1,151 
 
 1,563 
 
 1,488 
 
 1,637 
 
 
 4. Ascites 
 
 750 
 
 728 
 
 745 
 
 735 
 
 
 5. Ulceration of Intestine, . 
 
 847 
 
 856 
 
 870 
 
 858 
 
 
 6 Hernia, 
 
 817 
 
 852 
 
 827 
 
 848 
 
 
 7. Ileus, 
 
 1,170 
 
 1,199 
 
 1,091 
 
 1,166 
 
 
 8. Intussusception, .... 
 
 245 
 
 276 
 
 280 
 
 246 
 
 
 9. Stricture of Intestine, . . 
 
 301 
 
 272 
 
 257 
 
 288 
 
 
 10. Fistula, 
 
 115 
 
 115 
 
 109 
 
 89 
 
 
 11. Stomach Disease, ^-c, 
 
 2,866 
 
 2,786 
 
 2,730 
 
 2, SCO 
 
 
 12. Pancreas Disease, ^c, . . 
 
 12 
 
 18 
 
 16 
 
 12 
 
 
 13. Hepatitis, 
 
 1,329 
 
 1,386 
 
 1,262 
 
 1,4U2 
 
 
 14. Jaundice, 
 
 1,262 
 
 1,344 
 
 1,292 
 
 1,426 
 
 
 15. Liver Disease, i^c, . . . 
 
 4,531 
 
 4,704 
 
 4,680 
 
 4,853 
 
 
 16. Spleen Disease, ^-c, . . . 
 Order 5. 
 
 64 
 
 86 
 
 98 
 
 84 
 
 
 
 
 
 
 1. Nephritis, 
 
 245 
 
 306 
 
 273 
 
 385 
 
 
 2. Ischuria, 
 
 96 
 
 102 
 
 104 
 
 143 
 
 
 3. Nephria, 
 
 1,390 
 
 1,448 
 
 1,541 
 
 1,700 
 
 
 4. Diabetes, 
 
 536 
 
 637 
 
 574 
 
 551 
 
 
 5. Stone 
 
 179 
 
 168 
 
 196 
 
 172 
 
 
 6. Cvstitis 
 
 299 
 
 343 
 
 342 
 
 340 
 
 
 7. Kidney Disease, ^-c. , . . . 
 
 2,245 
 
 2.318 
 
 2,298 
 
 2,337 
 
 
 
 
 
 1. Ovarian Dropsv, .... 
 
 244 
 
 235 
 
 280 
 
 255 
 
 
 2. Uterus, ^-c, Disease, . . . 
 Order 7. 
 
 874 
 
 894 
 
 947 
 
 964 
 
 
 
 
 
 
 1. Arthritis, 
 
 68 
 
 79 
 
 70 
 
 73 
 
 
 2. Joint Disease, S^-c, . . . . 
 Order 8. 
 
 1,398 
 
 1,545 
 
 1,518 
 
 1,692 
 
 
 
 
 
 
 1. Phlcs;mon, 
 
 413 
 
 454 
 
 409 
 
 530 
 
 
 2. Ulcer 
 
 332 
 
 401 
 
 387 
 
 435 
 
 IV. 
 
 3. Skin Disease, cf-r., . • . . 
 Order 1, 
 
 257 
 
 286 
 
 325 
 
 347 
 
 
 
 
 
 
 1. Premature Birth, .... 
 
 7,642 
 
 7,610 
 
 7,706 
 
 8,121 
 
 
 2. Cvanosis 
 
 398 
 
 420 
 
 4.59 
 
 456 
 
 
 3. Spina Bifida, . . 
 
 350 
 
 394 
 
 386 
 
 402 
 
 
 4. Other Malformations, . . 
 
 420 
 
 441 
 
 424 
 
 403 
 
 
 5. Teething, 
 
 Order 2. 
 
 3,896 
 
 4,251 
 
 3,812 
 
 4,116 
 
 
 
 
 
 
 1. Paramenia, 
 
 47 
 
 59 
 
 61 
 
 75 
 
 
 2. Childbirth {see Metria), . . 
 Order 3. 
 
 2,186 
 
 2,109 
 
 2,137 
 
 2,433 
 
 
 
 
 
 
 1. Old Age, ....... 
 
 Order 4. 
 
 28,442 
 
 27,373 
 
 26,780 
 
 27,268 
 
 
 
 
 
 V. 
 
 1. Atrophy and Debility, . . 
 Order 1. 
 
 26,930 
 
 29,291 
 
 27,077 
 
 28,193 
 
 
 
 
 
 
 (Accident or Negligence.) 
 
 
 
 
 
 
 1. Fractures and Contusions, . 
 
 5,417 
 
 5,589 
 
 5,397 
 
 5,852 
 
 
 
 103 
 
 120 
 
 111 
 
 108 ;
 
 DELIRIUM TREMENS. 
 
 91 
 
 C3 
 5 
 
 DISEASES. 
 
 1860 
 
 1861 
 
 1862 
 
 1863 
 
 V. 
 
 Order 1 — continued. 
 
 3. Cut, Stab, 
 
 4. Burns and Scalds, .... 
 
 5. Poison, 
 
 6. Drowning, 
 
 7. Sufl'ocation, 
 
 8. Otherwise, 
 
 Order 3. 
 
 (Homicide.) 
 1. Murder and Manslaughter, . 
 
 Order 4. 
 
 (SOICIDE.) 
 
 1. Gunshot Wounds, .... 
 
 2. Cut, Stab, 
 
 3. Poison, 
 
 4. Drowning, 
 
 5. Hanging, 
 
 6. Otherwise, 
 
 Order 5. 
 
 (Execution.) 
 
 1. Hanging, 
 
 Other Violent Deaths (not 
 classed), 
 
 Sudden and other Deaths (Cause 
 unascertained), 
 
 81 
 3,166 
 
 240 
 2,264 
 1,061 
 
 6-59 
 
 41 
 3,053 
 
 258 
 2,351 
 1,014 
 
 761 
 
 54 
 
 2,767 
 
 262 
 
 2,463 
 
 1,219 
 
 782 
 
 82 
 2,766 
 277 
 2,488 
 1,147 
 1,052 
 
 377 
 
 320 
 
 418 
 
 399 
 
 59 
 276 
 156 
 219 
 569 
 
 86 
 
 59 
 257 
 122 
 225 
 592 
 
 92 
 
 54 
 215 
 128 
 204 
 611 
 105 
 
 56 
 257 
 121 
 245 
 562 
 
 78 
 
 10 
 
 11 
 
 17 
 
 21 
 
 32 
 
 120 
 
 137 
 
 169 
 
 8,661 
 
 7,754 
 
 7,566 
 
 7,963 
 
 DELIRIUM TREMENS. — From Deliro, to be crazy : Tremo, to tremble. 
 Syiion. Delirium Ehriositaiis ; Mania a Potu ; Delirium Vigilans. — An 
 acute attack of poisoning by alcoholic drinks. Delirium characterized 
 by hallucinations, fear, trembling of muscles of extremities, weakness, 
 and watchfulness. Natural tendency of the disorder to terminate in a 
 critical sleep, at end of from forty-eight to seventy-two hours from com- 
 mencement of delirium. 
 
 Symptoms. Sleeplessness. Loss of appetite. Xausea. Constipation. 
 A busy, but not violent, delirium : aggravated towards night. Constant 
 talking or muttering. Tremulous motions of hands: constant twitch- 
 ing ot^ facial muscles. Hallucinations of sight and hearing. A dread 
 or suspicion of every one: a belief that strangers are under the bed, or 
 listening at door Mental with bodil}^ prostration. A generally excited 
 and eager manner. In severe cases, an increase in sulphates and urea, 
 with diminution of phosphates, in urine. Varies thus from phrenitis, 
 in which phosphates are in excess. 
 
 1\\ favorable cases, critical sleep, lasting f-welve or more hours; from 
 which patient wakes cured, though weak, lu fatal examples, watchful- 
 ness continues; muttering delirium, subsultus tendinum, and exhaus- 
 tion ; great prostration, coma or convulsions or fatal syncope. Death 
 usually between third and seventh daj^s. 
 
 Treatment. Critical sleep to be brought about as soon as possible. 
 Ice to cool irritable stomach. Salines, 348, 349, 350. Milk, raw eggs, 
 beef tea. Brand}- and egg mixture, 17. Ammonia and bitters, 361, 
 371. Ether, brandy, and bark, 367. Sumbul and hop, 369. Morphia, 
 chloroform, and Indian hemp, 317. Subcutaneous injection of morphia,
 
 92 DENGUE — DIABETES MELLITUS. 
 
 314. Tincture of digitalis, in half ounce doses, once or twice repeated. 
 Patient to be restrained by one or two good attendants. Apartment to 
 be kept quiet and dark. All soui-ces of mental irritation to be removed. 
 Cold atfiifsion, or cold shower bath, sometimes very useful. 
 
 Avoidance of over-stimulation, and excessive doses of opium. Use of 
 strait-waistcoat very rarely advisable, as it increases irritation. — See 
 Dipsomania. 
 
 DENGUE. — Synon. Scarlatina Bheumatica; Ervptive Epidemic Fever ; 
 Eruptive Rheumatic Fever ; Dandy Fever ; Break-hone Fever. — In certain 
 parts of East Indies, Southern States of America, as well as in Phila- 
 delphia and New York, a peculiar infectious fever sometimes prevails, 
 in which an eruption like that of scarlatina is combined with severe 
 rheumatic pains in limbs and joints. Sometimes, throat is implicated; 
 occasionally, testicles enlarge ; often, lymphatic glands of neck and 
 groin swell. Pains about shoulders and arms, loins and hips, thighs and 
 legs; great soreness of muscles and bones; headache and flusiiing of 
 face; rapid pulse and coated tongue ; nausea and vomiting; prostration. 
 The disease generally lasts about eiglit days. Demands the use of 
 antacid aperients, saHnes, colchicum with opium, and bark or quinine. 
 
 DIABETES MELLITUS.— From Ain, through; /SatVw, to move: MiXi, 
 honey. Synon. Melituria; Paruria Mellita ; Glucosuria ; Glucolumrua ; 
 Saccharine Diabetes. — A complicated chronic disease, due to inefficient 
 performance of some important function. Characterized by secretion 
 of a large quantity of urine containing glucose or grape sugar. 
 
 Symptoms. Come on insidious!}'. Malaise: sense of feverishness. 
 Excretion of large quantities of ui'ine, having a faint ajiple-like odor, 
 and a high sp. grav. 1035 — 1050. Dryness and harshness of skin. Con- 
 stipation : hard dry fseces. Constant thirst. Failure of general health : 
 muscular weakness; loss of sexual power. Pain about loins. Coldness 
 of extremities, with sense of burning in hands and feet. Increasing de- 
 bility, diminution in weight, shrinking of frame, oedema of legs, and 
 sometimes albuminuria. Chloroform-like smell of breath. Sponginess 
 of gums, with decay of teeth. Mental depression and irritability. Con- 
 stant sense of sinking at stomach, with voracious appetite. Tendency 
 to double cataract: to boils. — Often becomes associated with phthisis 
 after a time. In confirmed cases, death from some intercurrent low 
 form of inflammation — bronchitis, pleurisy, pneumonia, or peritonitis; 
 from gangrene of legs; phthisis; or from gradual exhaustion. 
 
 Sugar to be detected in urine by fungus, potash, copper, or fermenta- 
 tion tests. 
 
 Treatment. Diet: To be nutritious, yet free from saccharine and 
 am^-laceous materials. Meat, ])Oultry, game, ham or bacon, white fish, 
 eggs. Milk, or preferably cream. Neufchatel, Stilton, or cream cheese. 
 Butter. Greens, green leaves of lettuce, spinach, watercresses. Bran 
 loaf, 9. Almond rusks and biscuits. Gluten bread. Stale, well-fer- 
 mented bread thoroughly toasted. Spring water, iced M-ater, soda 
 water, Vichy water. Tea sweetened with glj^cerine. Weak beef tea, 
 mutton broth. Dry sherry: Bordeaux wine: dry Hungarian wines: 
 Burgundy: weak brandy and water: whiskey and Avater. — Forbid: 
 Sugar, Pastry. Fruit. Confectionery. Potatoes. Carrots. Parsnips. 
 Beetroot. Turnips. Eadishes. Maccaroni. Eice, sago, tapioca, arrow- 
 root. Liver. Oysters, lobsters, crabs, mussels. Beer; raw spirits; 
 liqueurs. Coffee. 
 
 Drugs: Opium (gr. I — 1, thrice daily). Opium, ipecacuan. and nitre, 
 324. Citrate of ammonia or potash, Avith steel, 4U3. Eeduced iron.
 
 DIARRHCEA DIPHTHERIA. 93 
 
 aloes, and nux vomica, 404. Strychnia. Quinine and opium, Ci'cusote, 
 41. Cod-liver oil; or suet boiled in milk. Pepsine, 420. Castor oil: 
 Seidlitz powders: Compound powder of rhubarb and magnesia: Aperi- 
 ent enemata. 
 
 General remedies: Warm clothing: flannel or chamois leather next 
 the skin of trunk and extremities. Hot water or vapor baths. Turkish 
 bath, 130. Mineral springs of Vichy, 479. Carlsbad, 496. 
 
 Remedies which have been employed: Carbonate of soda. Acetate of 
 potash. Tartrate of potash and soda. Carbonate of ammonia. Alum. 
 Lime-water. Yeast. Large quantities of sugar. Potato bread. Iodine. 
 Nitric acid. Phosphoric acid. Sulphur. Tui-peutine. Permanganate 
 of potash. Inhalation of oxygen gas. 
 
 DIARRHCEA. — From Acappiuj, to flow through. Synon. Coprorrhoea ; 
 Cafarrhus Intestinalis ; Summer or Bilious Diarrhoea; English Cholera; 
 Purging. — A relaxed state of bowels, i.e. the frequent evacuation of 
 loose or liquid stools, w'ithout any coexistent inflammation of intestines. 
 
 Symptoms. Purging. Nausea. Furred tongue. Foul breath. Flatu- 
 lence and griping pains. Acid eructations. Tenesmus. Stools un- 
 healthy: consist either of liquid fa3ces, or a watery feculent mucus, or 
 thin frothy serum, or of pale j-east-like matter. In severe summer or 
 English cholera, evacuations often consist chiefly of bile: violent ab- 
 dominal pains, cramps in legs, chilliness, and depression. 
 
 Treatment. Expulsion of offending matter from intestinal canal : Cas- 
 tor oil, 164. Castor oil and opium, 114, 164. Tincture of rhubarb. 
 Compound powder of rhubarb. Blue pill and rhubarb, 171. Warm 
 water enema. Calomel. 
 
 Subsequently, or at first when cause has been removed by spontaneous purg- 
 ing : Ether and opium, 85. Chloroform, morphia, and Indian hemp, 
 317. Chalk mixture, with catechu and opium, 97. Rhatany, 96. Ma- 
 tico and rhatany, 1U5. Aromatic sulphuric acid and opium, lOJ. Liquid 
 extract of bael, 58, 97. Kino and logwood, 108. Compound powder of 
 catechu. Aromatic powder of chalk and opium. Powder of kino and 
 opium. Powxler of ipecacuan and opium. White bismuth, 65, 112. As- 
 tringent enemata, 113. Enema of opium. Morphia suppository. Vege- 
 table charcoal, 98. — Careful diet: Mucilay;inous drinks. Mucilaire of 
 gum Ai'abic. Tapioca, sago, or milk arrowroot. Saccharated solution 
 of lime and milk, 14. Custard or rice puddings. White fish. Pepsine, 
 420. Port wine. Brandy and cold water. Ice. — Linseed poultices. 
 Turpentine stupes. Wearing a flannel round abdomen. Avoidance of 
 damp and cold. 
 
 Remedies sometimes used : Niti-ate of silvei-. Chloride of silver. Sul- 
 phate of copper. Ammonio-sulphate of copper. Tannate of bismuth. 
 Alum. Cinnamon. Oxide of zinc. Iron-alum. Tincture of perchloride 
 of iron. Acetate of lead. Ergot of rye. Dilute sulphuric acid. Blis- 
 ters. Ice to sjjine, &c. 
 
 DIPHTHERIA. — From At(pdipa, a skin or membrane. Synon. Angina 
 Midigna; Cynanche Membranacea ; Putrid Sore Throat; Malignant Quinsy. 
 — An epidemic and contagious sore throat of great severity, due to tox- 
 aemia; being attended with much prostration, and characterized by ex- 
 udation of false membranes on tonsils and adjacent structures. — When 
 followed by recovery, it often leaves an altered state of voice, jjartial 
 paralysis of muscles of deglutition, weakness of upper extremities, im- 
 paired vision, and other secondary nerve affections. — Children more 
 obnoxious to this specific blood-disease than adults. Most common
 
 94 DIPHTHERIA. 
 
 amongst poor, or such as reside in damp situations and badly drained 
 houses. 
 
 Symptoms. Commence gradually; feelings of depression and muscu- 
 lar debility, headache, nausea, slight diarrhoea, chilliness, drowsiness, 
 and sense of stiffness about neck. Then, tonsils get inflamed and swol- 
 len : tenderness of glands about angles of lower jaw. Inflammatory 
 action spreads to velum, uvula, posterior part of pharynx. Perhaps 
 difficult deglutition. If resolution do not occur, characteristic feature 
 becomes manifested, — effusion of a plastic fibrinous material. This may 
 first appear in nasal fossse, or on soft palate, on one tonsil, or on back 
 of pharynx. Exudation looks like ash-colored specks; which, enhu-ging 
 and coalescing, form large patches resembling damp dirty wash-leather. 
 As disease spreads, false membrane increases in thickness and extent: 
 firmly attached to mucous membrane beneath: if forcibly removed, a 
 new patch soon forms : spreads to cheek and gums, oesophagus, or 
 through glottis into larynx and trachea. AVhen membrane begins to 
 separate and decompose, horribly fetid breath : when thrown oft', there 
 may be left ulceration, sloughing, or gangrene; or tissues gradually as- 
 sume a healthy appearance. True diphtheritic membranes sometimes 
 form on abraded cutaneous surface, conjunctiva, mucous coat of vagina 
 or rectum, &c. 
 
 Constitutional symptoms perhaps slight at first. Soon, prostration 
 and restlessness. Only moderate fever. Pulse increases in rapidity. 
 Saliva often dribbles away. Breath fetid. Disinclination for exertion 
 or food. Dj^sphagia often absent. Attacks of hemorrhage occasionall}', 
 from nose, fauces, or bronchi. Purpura. Albuminuria. — Death from 
 exhaustion, hemorrhage, ichorha^mia, uraemia, gangrene, or asphj'xia, — 
 consciousness remaining till close. Sometimes, fatal event due to throm- 
 bosis. — In event of recovery, convalescence tardy. Anaemia. Secondary 
 nerve affections : paralysis, neuralgia, defective vision. 
 
 Treatment. No specific known. By remedies of a supporting na- 
 ture, patient may be often guided through the great danger, which is 
 present in every case. 
 
 Locally: External applications — leeches, blisters, poultices, fomenta- 
 tions — to throat, useless or injurious. At commencement, inhalation of 
 acid vapor — three ounces of vinegar to pint of boiling water. When 
 pellicle has formed, — spray of hot atomized lime-water, 262. Painting, 
 with tincture of perchloride of iron and glycerine; turpentine; strong 
 solution of nitrate of silver; solution of chlorinated soda. Hydrochloric 
 acid gargle, 2.A9>. Borax gargle, 250. Chlorinated soda gargle, 254. 
 Creasote gargle, 255. Gargle of hot saccharated solution of lime. Avoid- 
 ance of solid nitrate of silver, nitric acid, hydrochloric acid, and other 
 caustics. Tearing away of exudation, injurious. 
 
 General remedies : In early stage, emetic of ipecacuan and ammonia, 
 233. Cream of tartar drink, 356. Chlorate of potash drink, 360. If 
 there be depression, hemorrhage, or albuminuria, commence with tinc- 
 ture of perchloride of iron, 392. Quinine and iron, 380. If thrombosis 
 be feared, ammonia and bark. 371. Chlorate of potash, 61. Iodide of 
 potassium, 31. Sulphite of soda, or magnesia, 48. Opium. Essence of 
 beef, 3. Eggs, cream, and beef tea, 5. Lime-water and milk, 14. Brandy 
 and eggs, 17. Brandy. Port wine. Champagne. Milk, or cream. Ice, 
 to suck veiy freely. 
 
 Patient to be kept in bed, from commencement ; flannel clothing often 
 advantageous. Air of room to be pure and warm (70° F.); to be kept 
 moist by evaporation of boiling water. Sinapisms to epigastrium, if 
 there be sickness. Simple enemata, or castor oil, if there be constipa- 
 tion. Linseed poultices to loins, or hot fomentations, if suj)pression of
 
 DIPLOPIA — DRACONTIASIS. 95 
 
 urine come on. Cliloroform inhalation, where attacks of dj'spnoea are 
 paroxysmah Tracheotomy or laryngotomy, when exudation obstructs 
 larynx. When swallowing is prevented, nutrient enemata, 21, 22, 23. — 
 Directly convalescence is firmly established : Sea air. Very generous diet. 
 Cod-liver oil. Quinine and steel. Strychnia, or nux vomica. Faradiza- 
 tion. 
 
 DIPLOPIA. — From JotAooc, double; oTtTo/mt, to see. Synon. Ambiopia ; 
 D/ttopsia; Double Vision. — Arises from some derangement in the visual 
 axes, or some irregularity in density or curvature of dioptric media, or 
 some disease of retina or optic nerve. — See Amaurosis. 
 
 DIPSOMANIA. — From dc-^a, thii-st ; fxavta, madness. — An intense crav- 
 ing for intoxicating liquors; attended with a protracted state of general 
 depression and restlessness. An unphilosophical and dangerous view to 
 regard a dipsomaniac as an irresponsible being. Hard drinking a de- 
 grading vice: difficult to discontinue, the more it is indulged in. 
 
 Excessive use of alcoholic stimuli leads to : Induration of portions of 
 nervous centres. Congestions of respiratory organs. Amyloid and 
 fatty degeneration of liver. Chronic inflammation and thickening of 
 walls of stomach. Disease of substance of heart, and of kidneys. Cir- 
 rhosis, or gin drinker's liver. Drops}^. Tuberculosis. 
 
 Treatment. Total abstinence from intoxicating drinks. Henbane, 
 hop, or small doses of opium, to avoid sleepless nights. Bark and min- 
 eral acids, 376. Quinine, 379. Quinine and nux vomica, 387. Phos- 
 phate of iron, 405. Phosphate of zinc, 414. Oxide of zinc, 415. Hypo- 
 pliosphite of soda or lime, 419. Pepsine, 420. Nourishing food. Milk. 
 Fruit syrups in soda water. In almost hopeless cases it may be justi- 
 fiable to substitute opium for alcohol. Opium-eating much less injurious 
 than alcohol to general health; while the subject of it is not an intoler- 
 able nuisance like the drunkard. — See Delirium Tremens. 
 
 DIURESIS. — From Aca, through; oufjicu, to pass urine. Synon. Dia- 
 betes Itisipidus. — A condition in which an excessive quantity of pale 
 limpid urine is secreted, free from sugar or other abnormal ingredient. 
 
 Symptoms. Insatiable thirst (polydipsia), with excretion of large 
 quantities of urine. AVatery constituents of latter alone increased; 
 total amount of urinary solids not greater than in health : in exceptional 
 eases, however, the solids, and particuUirly the urea, have been above 
 the average (polyuria). General health usually sufters : annoying thirst 
 and frequent micturition cause bad nights. Sometimes, dro])sy sets in. 
 
 If there be an excess of urine over amount of liquid taken, one of 
 three explanations must be adopted : (1) Either the body becomes 
 poorer in water, and so loses weight. (2) Or, water is absorbed by skin 
 and lungs. (3) Or, water is formed in system by direct union of its 
 elements — oxygen and hydrogen (Parkes). 
 
 Treatment. Tincture of perchloride of iron, 101. Phosphoric acid 
 and nux vomica, 376. Iron alum, 116. Gallic acid, 103. Opium. Warm 
 baths. Cod-liver oil. Enforced abstinence from fluids useless. 
 
 Remedies sometimes employed : Ergot of r^^e. Mineral acids. Tannic 
 acid. Oxide of zinc. Iodide of potassium. Green iodide of mercury. 
 Valerian. Assafoetida. Camjihor. Nitrate of potash. 
 
 DRACONTIASIS. — From Apd/.iuv, a serpent. Sj^non. Malus Dracuncu- 
 Ins; Helminthoncus Medinensis. — A helminthic disease, produced in the 
 human body by the Guinea-worm. — Dracunculus Medinensis, Filaria 
 medinensis, or Guinea-worm, has a slender cylindrical body, sometin\es
 
 96 DROPSY. 
 
 nearly as thick as a crow-quill, and from one to twelve feet in length. 
 Endemic in some parts of Asia and Africa, especially in marshy districts : 
 individuals returning from these countries occasionally bring tliis nema- 
 tode helminth with tliem. — Common seat of the Guinea-worm, in human 
 body, is the sulicutaneous areolar tissue of feet and legs. 
 
 Symptoms. May be absent for some months: then a feeling of irrita- 
 tion in aifected part, when a cord-like ridge ma}' be felt. Constitutional 
 disturbance; fever, headache, nausea, colic, debility. A kind of boil 
 forms: sometimes pustule breaks, and head of worm protrudes. 
 
 Treatment. Curative: When head protrudes, a thread to be placed 
 round it and rolled on a piece of stick or bougie; day by day drawing 
 worm out, and winding it round the stick until extraction is complete. 
 When worm does not protrude, it may be exposed by incision ; parasite 
 being removed in a loop, or a wedge of wood being inserted around 
 which it is to be wound Avithout fracture. 
 
 Prophylactic : Feet to be well-protected, when travelling in districts 
 where Guinea-worm is found. Thorough drying of feet after bathing, 
 or wading through marshy districts. Avoidance of 13'ing on the ground 
 with any part of body exposed to the soil. 
 
 DROPSY. — Formerly correctly called hydropsy, from "TSwp, water, and 
 ©%/'£?•, an appearance. An accumulation of watery or serous liquid in 
 some one or more of the natural serous cavities of the body, or in the 
 meshes of the areolar tissue, or in both, often occurring independently 
 of inflammation. 
 
 A result of over-distension of the veins and their capillaries, and hence 
 may arise from many different conditions. The most common are : Pres- 
 sure of tumors, enlarged glands, gravid uterus, &c., on veins. Structural 
 disease of liver, impeding return of blood through the portal system of 
 veins. Valvular disease of the heart. Retarded circulation, with in- 
 ci'eased fulness of veins, in pulmonary emj^hysema, bronchitis, &c. 
 Chronic inflammatory hyperaemia, as is seen in strumous ascites, hy- 
 drocele, &c. Blood poisoning, — as in acute renal dropsy, where the 
 kidneys become congested and inflamed, the circulation through their 
 capillaries is impeded, and urea is retained in the blood. And anaemic 
 or watery blood. — See Anasarca; Ascites; Hydrocephalus ; Hydrothorax ; 
 Hydropericardium ; Hydrocele, &c. 
 
 Treatment. Purgatives. Diuretics. Diaphoretics. Emetics. Al- 
 teratives. Tonics. Tapping. Incisions or acupunctures. Issues. 
 
 Purgatives: Calomel, 159. Jalap, 140, 159. (Jompound jalap powder. 
 Compound scammony powder. Compound pill of gamboge. Elaterium, 
 157. Croton oil, 168. Black hellebore. Tobacco. Oil of turpentine, 
 190. Acid tartrate of potash, 228. Rhubarb. Colocynth. Resin of 
 podophjdlum. 
 
 Diuretics : Acetate of potash, 219. Digitalis, 219. Squills, 219. Ni- 
 trate of potash, 212. Buchu, 222. Senega, 214. Compound spirit of 
 horseradish. Spirit of nitrous ether. Tincture of cantharides. Oil or 
 spirit of juniper, 229. Infusion of uva ursi. Liquor potassas. Fomen- 
 tations to loins. Cupping or leeches to loins. Dry cupping over the 
 kidneys. 
 
 Diaphoretics: Tartarated antimony, 210, 213. Antimonial powder. 
 Opium. Powder of ipecacuan and opium. Elder-flower water. Guai- 
 acum, 43. Hot-water baths, 119. Hot-air or vapor baths, 130. Wet- 
 sheet packing, 136. 
 
 Emetics: Ipecacuanha, 231, 233. Sulphate of zinc, 232. Mustard. 
 
 Alteratives: Corrosive sublimate, 27. Compound pill of calomel. Mer-
 
 DROWNING — DUODENAL DISEASES. 97 
 
 cury and chalk. Blue pill. Colchicum, 46. Liquor arsenicalis, 52. 
 Chlorate of potash, 61. Iodide of potassium, 31. 
 
 Tonics: Nitric acid, 147. Nitro-liydrochloric acid, 378. Tincture of 
 perehloride of iron. Citrate of iron and ammonia. Citrate of iron and 
 quinia. Iodide of iron, 32. Tartarated iron. Cod-liver oil. 
 
 DROWNING. — For the restoration of the asphyxiated from submer- 
 sion, see Suspended Animation. 
 
 DUODENAL DISEASES.— From Duodeni, twelve; because this portion 
 of bowel was said by the ancients to be as long as the breadth of twelve 
 fingers. — Great difficulty in diagnosing diseased conditions of duodenum 
 from those of small intestines generally. 
 
 1. Duodenitis. — Synon. Dodecadactylitis. — Acute inflammation seldom 
 limited to duodenum: generally complicated with similar disease in 
 stomach, jejunum, or ileum; or with inflammation of gall-bladder, or 
 under surface of liver, accompanied by jaundice. 
 
 Symptoms. Probably pain about epigastric and right hypochondriac 
 regions; perhaps onl}' becoming severe about three hours after taking 
 food. Thirst. Unaltered or even increased appetite. Nausea and vom- 
 iting. Diarrhoea, with unnatural and offensive stools. Weakness, men- 
 tal anxiety, and loss of flesh. — When complicated with inflammation of 
 the biliary apparatus, or when due to the irritation set up by a gall- 
 stone (which may cause inflammation, ulceration, and perforation of the 
 walls of the gall-bladder and intestines, so as to allow of its escape into 
 the duodenum), there will be jaundice with the usual results. If there 
 be also pancreatic disease the liquid stools will contain fatty matters. 
 
 Treatment. Castor oil, or calomel as an aperient. Opium. Solution 
 of acetate of ammonia. Mucilaginous drinks. Milk diet. Linseed 
 poultices. Poppy-head fomentations. 
 
 2. Duodenal Dyspepsia. — Either the result of chronic or subacute in- 
 flammation, or simply of impaired function. 
 
 Symptoms. Pain about duodenum some three hours after food has 
 been taken. Nausea. Attacks of faintness. Occasionally, jaundice ; es- 
 pecially when the disease is caused by abuse of alcoholic drinks. Well- 
 marked tenderness about right hypochondrium ; partlj' owing to in- 
 flamed condition of intestine, and partly to sympathetic irritation about 
 liver. 
 
 Treatment. Mercury and chalk. Mercury and chalk with opium, 
 34. Rhubarb and blue pill, 171. Nitric acid, senna, and taraxacum, 
 147. Nitro-hydrochloric acid, 378. Quinine and rhubarb, 178, 370, 385. 
 Ipecacuan, rhubarb, and oxide of silver, 179. Ammonia and ox bile, 
 170. Ammonia and chiretta, 63. — See Dyspepsia. 
 
 3. Perforating Ulcer of Duodenum. — Presents, in a mitigated form, 
 many of the symptoms of ulcer of stomach. There may be diarrhoea 
 with bloody stools; nausea and vomiting; great prostration, &c. Fatal 
 perforation sometimes occurs- suddenly where premonitory symptoms 
 have been mild. A sloughing ulcer is perhaps liable to form in upper 
 part of duodenum within a few days of a severe burn. — See Gastric 
 Ulcer. 
 
 4. Cancer of Duodenum. — As a primary aflPection very rare. Not un- 
 frequentl}^ the duodenum is secondarily involved in progress of hepatic 
 cancer, and in malignant disease of pancreas or neighboring lymphatic 
 glands. Colloid form most common. When the diseased mass presses 
 on the ductus communis there will be jaundice. — Death may occur from
 
 98 DYSENTERY. 
 
 inanition, or from peritonitis the result of perforation, or from obstruc- 
 tion of the bowel. — See Gastric Cancer. 
 
 DYSENTERY. — From Auq, difficulty or badness; k'vTspov, intestine. 
 Synon. Colitis; Colorectitis ; Bloody Fhix. — A specific inflammation and 
 ulceration of mucous lining (occasionally also of other tissues) of the 
 colon, especially perhaps of lower part of this gut and rectum ; attended 
 with febrile disturbance, severe griping pains, mucous and bloody stools, 
 and great prostration. Has been improperly termed colitis (^Colon, the 
 large gut; terminal -itis); cases occurring where ulceration does not 
 stop at ilio-cfecal valve, but extends several inches up small intestines. 
 
 Severe dysentery rare in this country. Sometimes breaks out in un- 
 healthy localities. In tropics often veiy fatal. — Has been ascribed to 
 wet and cold, contagion, malaria, polluted water, intemperance, depri- 
 vation of fresh fruit and vegetables, bad or insufficient or salt food, in- 
 sufficient clothing, &c. 
 
 Symptoms. Acute form : Uneasiness and pain in abdomen of a griping 
 character (tormina, from Torqueo, to torture), with frequent inclination 
 to go to stool. As ulceration commences, desire to empty bowel be- 
 comes more frequent, and is followed by shorter interval of ease. Evacu- 
 ations scanty, thin, mucous, blood}^; mixed with small hard lumps of 
 faeces (scybala, from l7(.o,3aXov, excrement). The scanty stools produce 
 great distress; griping, and straining without any evacuation (tenesmus, 
 from Tsivu}, to strain); peculiarly fetid and dark-colored motions, mixed 
 with blood and purulent matter and shreds of lymph ; and frequent mic- 
 turition. Urine high-colored; gives rise to scalding. Sometimes con- 
 stant desire to micturate, only a few drops coming away at a time 
 (strangury, from Izpay^, a drop; ovpov, urine). Great constitutional dis- 
 turbance and prostration. 
 
 May end in perforation of bowel and fatal peritonitis : in rupture and 
 fecal abscess : in ichorhremia and secondary abscesses : in fatal exhaus- 
 tion. After healing of ulcerations in favorable cases there may be 
 troublesome constipation from contraction of cicatrices. 
 
 Chronic variety : Most intractable. Often causes atrophy of mucous 
 membrane with degeneration of intestinal glands: or imperfectly cica- 
 trized ulcers remain in tissues of caecum, colon, or rectum. Most cases 
 recover. Sometimes, however, patient gradually wastes : skin gets di'y 
 and scaly: improvement one day with relapse the next: discharges of 
 fecal matter, mixed with thin pus and blood, most offensive : the ex- 
 haustion, pains, tenesmus, &c., render death welcome. 
 
 Treatment. Acute: Pei'fect rest in bed, in well-ventilated room. 
 Demulcent drinks. Ice. Farinaceous food : milk or cream : thin broths. 
 Warm bath. Fomentations: linseed poultices: wet compress. A few 
 doses of castor oil (164) if there be lodgment of scj^bala. Ipecacuanha 
 often most valuable, given thus: Interdict use of fluids for three hours: 
 apply a large hot linseed poultice, containing two or three tablespoon- 
 fuls of mustard, over epigastrium : a full dose of opium in form of enema 
 or suppository : thirty or forty minutes subsequently give from thirty 
 to sixty grains of ipecacuan powder in form of bolus, in mucilaginous 
 drauglit, or wrapped up in wafer-paper; repeating dose, if neeessarj^, at 
 end of six or twelve or twenty-four hours. Subsequently: Opiate sup- 
 positories or enemata, 339, 340. If there be weakness and anaemia, sal- 
 icine; quinine; bark and ether; cascarilla; or some mild preparation 
 of steel. If stools continue numerous and frothy and bloody, bismuth; 
 gallic acid; kino; logwood; sulphate of copper. In scorbutic cases, 
 lemon or orange juice. Generous diet; milk or cream, raw eggs, strong 
 broths, ripe grapes, perhaps stimulants. Restorative soup, 2.
 
 DYSMENORRHCEA. 99 
 
 Remedies sometimes em-ployed : Bloodletting. Leeches to anus. Emetics. 
 Calomel. Compound powder of jaliip. Sulphur. Acid tartrate of pot- 
 ash. Nitrate of silver. Tartaric acid. American hellebore (Veratrum 
 viride). Belladonna. Hydrocyanic acid. Narcotine. Infusion of lin- 
 seed. Mucilage of tragacanth. Tobacco fomentations. Turpentine 
 stupes. 
 
 Chronic or subacute : Residence in a mild, dry, equable climate. Sea 
 voyage. Warm clothing. Constant use of flannel roller round belly. 
 Plain animal food : milk or cream : raw eggs. Grapes : oranges. Mor- 
 phia. Chloroform, morphia, and Indian hemp, 317. Liquid extract of 
 bael, 58, 97. Sumbul and ether, 95. Pill of lead and opium (officinal). 
 Sulphate of copper and opium, 106. Nitrate of silver and opium, 107. 
 Kino and logwood, 108. Matico and rhatany, 105. Gallic acid, 103. 
 Alum and sulphuric acid, 115. Tannic acid lozenges. White bismuth, 
 65, 112. Vegetable charcoal, 98. Iron alum, 116. Tincture of perchlo- 
 ride of iron. Reduced iron. Nitro-hydrochloric acid, 378. Pepsine, 
 420. Cod-liver oil. Qui4une, rhubarb, and hop, 370. 
 
 DYSMENORRHCEA.— From Au<;, difficulty ; /j.rjv, a month ; ^ioj, to flow. 
 Synon. Paramenia Difflcilis ; Menstrua Dolorosa ; Amenorrhoea Partialis ; 
 Laborious or Difficult Menstruation. — Three distinct varieties : 
 
 1. Neuralgic Dysmenorrhcea. — Afflicts nervous women, in delicate 
 health, about time of puberty: or may come on after some years of 
 painless menstruation, especially in those who have never been preg- 
 nant. 
 
 Symptoms. Malaise, headache, with pain about sacrum and lower 
 part of abdomen for a few da3^s prior to period. Soi'eness of inner and 
 upj)er part of thighs. Bearing-down, with sense of pelvic Aveight. If 
 discharge comes on freely, relief experienced. Commonly, flow is 
 scanty — slight gushes: suffering becomes acute. Pain lessens and re- 
 turns. Hysteria. Flatulence and constipation. Pain probably in 
 ovaries, rather than in uterus. No swelling or heat of parts. 
 
 Treatment. — During paroxysm : Hot hip bath for thirty or forty-five 
 minutes. Bath, with extract of poppies and carbonate of soda (an ounce 
 of each). Pessary of oxide of zinc and belladonna, or of iodoform, 423. 
 Indian hemp, aconite, ether, and juniper, 342. Morphia, chloroform, 
 and Indian hemp, 317. Opium and henbane, with hot gin and water, 
 343. Hypodermic injection of morphia, 314. Linseed, or hemlock, 
 poultice to abdomen and vulva. 
 
 During interval: Quinine and mineral acid, 379. Bark, phosphoric 
 acid, and aconite, 376. Salicin, 388. Hypophosphite of soda and sum- 
 bul, 419. Cod-liver oil, 389. Compound rhubarb pill. Effervescing 
 citrate of magnesia. Taraxacum juice. Pepsine, 420. Iodide of lead 
 and belladonna pessaries, 423. Chamomile tea. Nourishing food : sub- 
 stitution of milk or cocoa for tea and coffee. Wine ; weak brandy and 
 water; bitter ale. Avoidance of sexual intercourse. Warm sea baths. 
 
 2. Congestive Dysmenorrhcea. — Synon. Membranous Dysynenorrhoea. — 
 Generally occurs at later period of life than neuralgic form. 
 
 Symptoms. Suffering begins four or five days before each period. 
 Backache; weariness and i-estlessness; sense of pelvic weight ; irrita- 
 bility of bladder. Hemorrhoids; frequent flushings ; throbbing uterine 
 pain. Discharge comes on gradually : scanty at commencement; relief 
 follows abundant flow. Clots, and shreds or flakes of membrane ex- 
 pelled: sometimes, pear-shaped casts of uterine cavity, formed of epi- 
 thelial lining of uterus, analogous to decidua. Uterus found congested,
 
 100 DYSPEPSIA. 
 
 lips oedematous, on examination; sometimes displaced : ovaries tender. 
 Swelling and tenderness of breasts. 
 
 Treatment. During paroxysm : Same as for neuralgic form. Three 
 or four leeches to labia uteri. Scarification of labia. 
 
 During interval: Mercury and conium, or iodide of lead and bella- 
 donna, pessaries, 423. Corrosive sublimate, 27. Iodide of potassium, 31. 
 Bromide of potassium, 42. Mercurial vapor baths, 131. Colchicum. 46. 
 Cod-liver oil. Plain living: absence of stimulants. Avoidance of sexual 
 intercourse. Moderate exercise in open air. Sea air. 
 
 3. Mechanical Dysmenorrhcea. — That form in wnich there is stricture 
 of internal or external os uteri; or a narrowing of entire canal of cer- 
 vix; or some uterine tumor; or uterine displacement — retroflexion or 
 antiflexion. Ensuing remarks apply only to the variety due to stric- 
 ture of internal or external os, or to narrowing of entire cervical canal; 
 conditions causing sterility as well as dysmenorrhcea. 
 
 Symptoms. Indicative of obstruction to escape of menstrual fluid. A 
 scanty flow : discharge escapes in gushes ; each gush attended by pain. 
 Backache. Irritability of bladder. Congestion and tenderness of ova- 
 ries. Examination reveals a very small os uteri ; or an orifice of normal 
 size, stricture being detected by uterine sound at internal os. Some- 
 times, OS uteri only slightly smaller than natural ; but under influence 
 of menstrual molimen spasmodic contraction occurs, with all the suffer- 
 ing of organic stricture. 
 
 Treatment. Incision of uterine canal with hysterotome (Routh's or 
 Simpson's); followed by plugging with oiled lint, or introduction of a 
 spring-stem pessary (Green halgh's). Dilatation by sea- tangle or sponge- 
 tents, less likely than incision to effect permanent cure; and more 
 apt to be followed by pelvic cellulitis, metritis, or ovaritis. Dilatation 
 by bougies, useless. 
 
 DYSPEPSIA. — From Jt»c, difficult ; r^Trrto, to digest. Synon. Apepsia; 
 Digestio Difficilis; Concoctio Tarda; Indigestion. — Anything which inter- 
 feres with the healthy action of stomach and intestines may give rise 
 to indigestion. 
 
 Symptoms. Variable in nature and severity. Loss of appetite. Pain, 
 weight, and fulness at ejDigastrium, especially after eating. Flatulence. 
 Nausea and vomiting. Costiveness alternating with diarrhoea. Furred 
 tongue and foul breath. Palpitation. Headache. Pains in loins and 
 limbs. Heartburn. Cramp in stomach. Water-brash. Hypochondriasis. 
 
 In slow digestion from scanty secretion of gastric juice, — a feeling of 
 fulness and distension in left hypochondrium, and at pit of stomach, 
 after food. Flatulence; sour eructations; constipation; coated tongue; 
 palpitation and irregular action of heart; headache and mental depres- 
 sion, &c. 
 
 Treatment. General Directions: Digestion to be improved by means 
 which invigorate system generally: Rest and early hours. Relaxation 
 from severe studies, or from harassing cares and anxieties of business. 
 One day's holiday in every seven. Change of air: sea-bathing. Cold 
 or tepid sponging. Wet compress over stomach, 136. Horse exercise: 
 brisk walking. Disuse of tobaccco. Alcoholic stimulants in great 
 moderation. 
 
 Regulation of Diet: Plain food in small quantities. Gruel; sago; ar- 
 rowroot. Weak tea with milk. Milk and water. Lime-water and 
 milk. Stale, or unfermented, or aerated bread. White fish. — especially- 
 sole, whiting, brill, turbot. Poultry; sweetbread; tripe; mutton; ven- 
 ison; pheasant; hare. Dry sherry: dry Ruster, Ofner Auslese, Carlo- 
 witz, Szamarodnya Muscat, or other white Hungarian wines. Weak
 
 DYSPHAGIA — DYSPHONIA CLERICORUM. 101 
 
 cold brandy and water. Simple aerated water: soda water. Coffee, 
 without chicory, but not after dinner. — Avoidance of: Vegetables, save 
 cauliflower, asparagus, vegetable marrow: of raw fruit, — save grapes 
 and oranges: of pastry, cheese, beer, port wine, and undiluted spirits: 
 of rapid mastication and huny at meal times. 
 
 Drugs: Pep8ine,420. Pepsine and aloes, 155. Pepsine and steel, 394. 
 Rhubarb. Ipecacuanha and rhubarb, 179. Quinine and rhubarb, 178. 
 Rhubarb and blue pill, 171. Rhubarb and magnesia, 165. Ammonia 
 and rhubarb, 161. Purified ox bile, 170. Nux vomica, 175. Steel and 
 hydrochloric acid, 397. Steel and citrate of potash, 403. Quinine, rhu- 
 barb, and hop, 370. Carbonate of ammonia, 361. Nitro-hydi-ochloric 
 acid, 378. Salicin, 388. Nitrate of silver. Oxide of silver. White 
 bismuth. Bicarbonate of potash. Ipecacuanha. Blue pill. Mercury 
 and chalk. Taraxacum. Nitric acid. Saccharated solution of lime. 
 Wood charcoal. Oxalate of cerium. Hydrocyanic acid. Lactic acid. 
 Tannic acid. Gentian. Quassia. Hop. Kino. Serpentary. Chiretta. 
 Cascarilla. Calumba. Compound tincture of cardamoms. — See Gas- 
 tralgia; Gastrodynia ; Pyrosis. 
 
 DYSPHAGIA. — From Jt^c, difficulty; ^aj'w, to eat. Synon. Deghititio 
 Impcdlta; Difficulty of Deglutition. — Difficulty in swallowing is a promi- 
 nent symptom in disease of pharynx and oesophagus, — as inflammation, 
 ulceration, stricture, spasmodic contraction, polypus, or cancer. It may 
 also arise from glossitis, acute or chronic tonsillitis, diphtheria, croup. 
 From erysipelatous or other inflammation of areolar tissue of neck. 
 Retro-pharyngeal abscess. Glosso-laryngeal paralysis ; paralysis of 
 muscles of degkitition ; progressive paralysis of insane ; progressive mus- 
 cular atrophy ; paralysis agitans. Tetanus. Myelitis. Malignant, syphi- 
 litic, and tubercular ulcerations about epiglottis. Syphilitic ulceration 
 of velum and fauces. The pressure of aneui'ismal or other tumors. 
 Spasm of pharynx and oesophagus, as in hj-drophobia. Inflammation, 
 ulceration, or oedema of larynx. And rarely, from disease of laryngeal 
 cartilages. 
 
 DYSPHONIA CLERICORUM.— From Ju?, difficulty or pain ; ^wi/vy, the 
 voice: Clericus, a clergyman. Synon. Follicular disease of Pharyngo- 
 laryngeal membrane. — Frequently, a nervous complaint; unattended in 
 early stage by any organic lesion, but consisting of hypersesthesia or 
 irritability of investing membrane of fauces. Subsequently, congestion 
 or inflammation or relaxation of mucous membrane ; enlargement of 
 tonsils; elongation of uvula ; irritation, inflammation, morbid deposit, 
 and ulceration of mucous follicles about isthmus fauciura. — Clergymen, 
 barristers, public sjDeakers, actors, singers, &c., most liable to this dis- 
 ease. 
 
 Symptoms. Uneasy sensations in upper part of throat, with frequent 
 inclination to swallow, as if there were something in oesophagus. Cough- 
 ing, hawking, and spitting of phlegm. Uneasiness or pain about larynx. 
 Diminution in power of voice: hoarseness, especially towards evening; 
 sometimes aphonia. Unhealthy granular appearance of fauces. Mucous 
 follicles seem to be filled with yellowish matter. A viscid muco-purulent 
 secretion adhering to palate and velum. 
 
 Treatment. Early stage: Quinine and iron, 380. Steel and pepsine, 
 394. Quinine and nux vomica, 387. Phosphate of iron, 405 Iron alum, 
 116. Cold shower baths, or sea-bathing. Rest of voice. Temporary 
 change of scene and occupation. 
 
 Confirmed stage: Iodide of potassium, 31. Iodide of iron, 32, 390. 
 Iodide of ammonium, 38. Bromide of ammonium, 37. Corrosive sub-
 
 102 DYSPN(EA — ECTHYMA. 
 
 limate, 27. Phosphate of zinc, 414. Stiyohnia and steel, 408 Steel 
 and chlorate of potash, 402. Quinine, steel, and arsenic, 381. Phos- 
 phoric acid, mix vomica, and bark, 376. Cod-liver oil. 389. Nourishing 
 food. Sea air. Undercliff, 434. Torquay, 436. Pau, 443. Malaga, 
 445. Algiei's. 451. 
 
 Local applications : Inhalation of atomized alterative or astringent 
 fluids, 262. Sponging diseased parts, including interior of larynx, with 
 solution of nitrate of silver (gr. 40 — 60 of crystals to fl. oz. j). Outside 
 of throat to be protected: beard to be worn. Excision of tonsils, if 
 they be affected with chronic enlargement and induration. 
 
 DYSPN(EA.— From Auq, difficulty; --Au,^ to breathe. Synon. Pseudo- 
 Asthma; Bespiratio Dijficilis ; Short Breath. — Difficulty of breathing a 
 prominent symptom in many acute diseases. May be due to poisoned 
 or impoverished state of blood ; dropsy; hysteria; paralysis of muscles 
 of respiration ; obstruction of air-tube by pressure of aneurismal and 
 other tumors, foreign bodies, false membranes, oedema of glottis; asthma; 
 laryngismus stridulus ; disease of lungs; or to disease of heart. 
 
 ECLAMPSIA NUTANS.— From 'ExXd^r.io, to emit brilliant light ; Nuto, 
 to nod. Sj'non. Salaam Convulsions of Infancy. — A rare disease of in- 
 fants: attended with a frequent bowing of the head. Probably a form 
 of epilepsy. Sometimes leads to impairment of intellect. 
 
 Symptoms. A peculiar, involuntarj , rapid bowing forward of the 
 head, and occasionally of the body. Bowings rejjeated in rapid succes- 
 sion : attacks come on in paroxysms several times in day. Most severe 
 seizures usually occur in morning, on awaking from night's rest. After 
 a time, — cerebral sj'mptoms; convulsions; pure epilepsy; hemiplegia 
 or paraplegia; general wasting; in favorable cases, symptoms remit at 
 end of some months ; bodily health com2)letely restored in two or three 
 years. 
 
 Treatment. Intestinal secretions to be kept healthy by mild altera- 
 tives, — mercury and chalk, rhubarb and soda, syrup of senna. Tonics, 
 bark and ammonia ; quinine ; phosphate of iron and lime, &c., 405. Cod- 
 liver oil, 389. Nourishing food. "Warm clothing. Sea air. Tepid salt 
 water baths. As palliatives. — chloroform inhalation : small doses of 
 hydrocyanic acid. Opium aggravates the attacks. 
 
 ECSTASY. — "Ev-azaaii;^ a deep trance ; from 'E^iarr^tJ.'., to put a person 
 out of his natural state. Synon. Catalepsia Spuria ; Trance. — A con- 
 dition analogous to the cataleptic. Patient insensible to all external 
 impressions; absorbed in contemplation of some imaginary object. 
 Eyes immovably fixed : impassioned sentences, fervent prayers, psalms 
 and hymns are recited with great expression. Religious fanatics, by en- 
 couraging some predominant idea, fall into a state resembling incipient 
 stage of monomania. " Gift of unknown tongues" mo.stly manifested by 
 nervous w^omen in a morbid condition. Faith, imagination, enthusiasm, 
 and especially an irresistible propensity to imitation, will explain the 
 origin of tarantism, dancing mania, convulsionaires of St. Medard, &c. 
 — For treatment, see Hysteria. 
 
 ECTHYMA. — From 'ExOuu), to break out in eruptions. Synon. Furun- 
 cull Atonici ; Dartre Crustacee ; Phlyzacia ; Papulous Scall. — Anon-con- 
 tagious inflammation of the skin; characterized by large, round, promi- 
 nent pustules, occurring upon any part of the body. Pustules usually- 
 distinct ; seated upon a hard inflamed base ; terminate in thick dark- 
 colored scabs, which leave superficial ulcers followed by cicatrices. —
 
 ECTROPION — ELEPHANTIASIS GR^CORUM. 103 
 
 May be acute, and preceded by lancinating pains with fever: more com- 
 monly chronic, and due to bad living, &c. Often met with on scalp of 
 badly nourished infants. In ecthyma cachecticum, ulcers assume an un- 
 healthy appearance : general health much deterioi'ated. 
 
 Treatment. Internally: Mineral acids and bark, 376. Nitro-hydro- 
 chloric acid, 378. Quinine and steel, 380. Quinine, steel, and arsenic, 
 381. Steel and aloes, 154. Steel and sulphate of magnesia, 1G6. Iodide 
 of potassium. Opium. Henbane. Cod-liver oil. Nourishing food. — 
 Locally : Warm or tepid baths. Gelatine baths, 132. Water dressing, 
 dilute solution of subacetate of lead, oxide of zinc ointment, or sub- 
 acetate of lead ointment to the scabs or ulcers. 
 
 ECTROPION, — From "ExTpinw, to turn from. Synon. Blepharotosls ; 
 Divaricatlo Palpebrarum. — Eversion of the eyelid may be due to long- 
 continued conjunctivitis, or to the contraction of one or more cicatrices 
 on the cheek, or to dropping of lower lid from paralysis. More com- 
 mon with lower than upper lid. 
 
 ECZEMA. — From 'ExUcu, to break forth in pustules. Synon. Running 
 Scall ; Humid Tetter. — A very common non-contagious skin disease. 
 Usually classified with vesicular diseases : more correctly belongs either 
 to exanthematous or to pustular orders (Milton). A portion of skin 
 becomes red, inflamed, and stiff; cuticle desquamates ; a discharge of 
 serum takes place from follicles and sebaceous ducts of skin ; and super- 
 ficial moist excoriations, or patches of ulceration, covered with scabs or 
 crusts, result. General health depressed: loss of appetite, irritability, 
 restlessness. The disease may be acute or chronic. 
 
 Treatment. Internally: Effervescing citrate of magnesia, 169. Rhu- 
 barb and magnesia, 165. Ehubarb and blue pill, with henbane, 171. 
 Steel and sulphate of soda, 180, 181. Quinine and steel, 380. Phosphate 
 of iron, 405. Steel wine. Pill of carbonate of iron. Arsenic, 52. Qui- 
 nine, steel, and arsenic, 381. Steel and arsenic, 399. Cod-liver oil, 389. 
 Cod-liver oil chocolate. Corrosive sublimate, 27. Bed iodide of mer- 
 cury, 54. Red iodide of mercury and arsenic, 55. Opium. Henbane. 
 Indiam hemp. — Animal food : milk or cream : malt liquors, sherry, 
 claret, &c. Exercise in pure air. 
 
 Locally : Warm baths. Conium and starch bath, 122. Thin gruel, 
 barley water, or simple water dressing. Subacetate of lead and gly- 
 cerine lotion, 264. Glycerine and water (equal parts). Carbonate of 
 soda and gl3'cerine lotion, 268. Lime liniment. Saturation of scabs 
 with washed lard or olive oil, and removal by linseed poultices. Oxide 
 of zinc ointment. Diluted nitrate of mercury ointment, 305. Creasote 
 and red oxide of mercury ointment, 301. lu eczema capitis, the hair to 
 be cut off close to scalp. 
 
 ELEPHANTIASIS GR^CORTJM. — From 'EXiipa-,, the elephant,— 
 owing to the terrible nature of the disease, and its causing the skin to 
 resemble that of the elephant. Synon. Elephantiasis Anoisthetica ; Lazari 
 Malum; True Lepro.<iy. — A terrible and dangerous constitutional or 
 blood disease; gradually becoming more and more rare. It is endemic: 
 affects the poor and badly nourished in preference to the well-fed : non- 
 contagious, hereditary, and generally incurable. 
 
 Characterized by patches of a purple color; which are succeeded by 
 elevated tumors, irregular in shape and size, soft and smooth and insen- 
 sible to touch, and which generally become the seat of unhealthy ulcera- 
 tion. Not met with in temperate climates ; there is found to be a pre- 
 disposition to it towards the polar regions on the one hand, and the
 
 104 EMBOLISM — EMPHYSEMA. 
 
 tropics on the other. Males suffer more than females. Designated by 
 the Jews tsaraiith. 
 
 Elephantiasis Grseeorum appears to be endemic in Lisbon. The first 
 indication of it, as observed there, is a discoloration in patches, of skin 
 of face; an elongation and thickening of lobes of ear; and a spreading 
 out of alae of nose. Face gets beset with tubercles; features become 
 puffed out and traversed by deep lines; lips thicken; whiskers and 
 eyebrows and eyelashes fall off. Gradually tubercles extend over the 
 limbs; sensibility of mind and body becomes greatly blunted, until 
 there is mere animal life. After some years tubercles ulcerate; there 
 is ozffina; fingers and toes become gangrenous; body exhales a loath- 
 some fetor. Death occurs from exhaustion, diarrhoea, or erysipelas. 
 
 Treatment. Arsenic. Nitro-hydrochloric acid. Nitric acid. Iodide 
 of potassium. Iodide of iron. Bromide of potassium. Powdered bark 
 of root of Mudar (Calotropis Gigantea; Asclepias Gigantea). Bevilac- 
 qua (Asiatic Pennywort; Ilydrocotyle Asiatica) internally, and locally 
 to ulcerations. Phosphorus. Cod-liver oil. Sudorific drinks. Turkish 
 baths. Sulphur baths. Sea-water baths. Sea air. Nourishing food : 
 avoidance of salt meats. The Jews of Morocco are said to employ, as 
 a prophylactic remedy, brandy distilled from raisins, pears, figs, and 
 dates. 
 
 EMBOLISM. — From "EnSohx;, a plug. — A term used to designate a 
 fibrinous concretion detached and transported from the interior of the 
 heart or of some vessel, and carried onwai'ds by the blood until the 
 calibre of the vessel becomes too small to allow of further progress. 
 The migratory substance is called an embolus. 
 
 Symptoms. They depend upon the organ in which the embolus is ar- 
 rested. Thus, the debris of a clot in a peripheral vein may be stopped 
 in capillaries of liver, or may pass through these vessels, and then be- 
 come arrested in more minute capillaries of lungs. A large clot fixed 
 in pulmonary artery will induce immediate asphyxia; or if able to pass 
 on into lung, may be the cause of gangrene. So also, obstruction of the 
 chief vessel of a limb will induce mortification. Softening of brain may 
 result from plugging of one of the branches of internal carotid, or of 
 one of the arteries in fissure of Sylvius. 
 
 Treatment. See Thrombosis. 
 
 EMMETROPIA. — From Enfierpoq, in regular measure; w^, the eye. 
 Synon. Normal-sightedness. — Emmetropia, or normal vision, exists when 
 a well-defined but inverted image of an object, at an ordinarily visible 
 distance, is formed upon the compound structure known as the retina. 
 The local change here excited must be convej^ed to the fibres of the 
 optic nerve, communicated to the brain, and again projected outwards 
 in an inverted direction. Through this double inversion the projected 
 image corresponds to the object; and men say that they see the object, 
 although only the projected retinal image stands, as it were, before 
 their ej^es (Donders). The emmetropic eye can distinguish the pres- 
 ence of an object the 600th of an inch in size at a distance of six inches. 
 Can read Snellen's types at indicated distances. 
 
 The power of vision often injured by use of single eyeglasses. Light 
 blue spectacles — "conservative spectacles" — do harm, the retina being 
 benefited by the stimulus of white light. It would be as wise to employ 
 " conservative" crutches to spare the muscles. 
 
 EMPHYSEMA. — From "EiKfuirdw, to inflate. Sj^non. Pneumatosis Pul- 
 monum ; Pneumectasis. — Two varieties: One consisting of enlargement
 
 EMPYEMA — ENDOCARDITIS. 105 
 
 of air-cells, atrophy of their walls, and obliteration of their vessels (vesic- 
 ular or pulmonary emphysema). The other due to infiltration of air into 
 interlobular areolar tissue, or into subpleural areolar tissues (interlobu- 
 lar em]ih3'sema). Both forms produce habitual shortness of breath ; 
 occasional paroxysms of asthma ; and such distress, that sutferer is unfit 
 for any active occupation. They often lead to disease of right cavities 
 of heart, with venous congestion and di'opsy. 
 
 1. Vesicular Emphysema. — May affect one lung or both, or a part of 
 each — especially anterior edges and apices. 
 
 Symptoms. Dj-spnaa, increased on any exertion. Feeble cough. Ex- 
 pectoration of frothy sputa. Dusky appearance of countenance. Weak- 
 ness of voice. Stooping gait. Loss of flesh and strength. Lowered 
 temperature of body. Constipation. Weak and slow pulse. Attacks 
 of asthma. On percussion, — unnatural clearness and resonance. On 
 auscultation, — ver}- indistinct vesicular murmur. Occasionally, a moist 
 rale, like subcrepitant rattle of bronchitis. Heart's sounds feeble : often 
 cardiac displacement. Diseased side of thorax unduly prominent and 
 rounded. 
 
 Treatment. Invigorating diet, with attention to digestive organs. 
 Eest. Warm clothing. Carbonate of ammonia, 361, 371. Ammonia 
 and ether, 85, 364. Lobelia and ether, 88. Sumbul and hop, 869. Qui- 
 nine. 379. Quinine and steel, 380. Steel and pepsine, 394. Cod-liver 
 oil, 389. Steel and cocoa-nut oil, 391. Phosphate of iron, 405. Stra- 
 monium smoking. Easpail's camphor cigarettes. Use of respirator. 
 Warm climate. 
 
 2. Interlobular Emphysema. — Generally due to sudden rupture of air- 
 cells b}^ violent strain. Very rarely as.sociated with vesicular emphy- 
 sema. Can only be relieved by antispasmodics. When extensive may 
 at once prove fatal. / 
 
 EMPYEMA.— From '^i-, within; -^;«y, pus. Synon. Pyothora.r; Hydro- 
 thorax Purulentiis. — The formation and accumulation of pus in the cavity 
 of the pleura. Some physicians speak of true and false empyema: the 
 first form being that in which pus is secreted by pleura in consequence 
 of inflammation; the second, that in which pus finds its way into thor- 
 acic cavity from rupture of an abscess of lung. — See Pleurisy. 
 
 ENDOCARDITIS. — From "fvcJov, within; xapdia, the heart; terminal 
 -itis. Synon. Internal Carditis. — Inflammation of the transparent and 
 glistening serous membrane which lines the interior of the heart, and 
 which by its reduplications assists to form the valves. — Endocarditis 
 usually associated with acute rheumatism. Endopericarditis more com- 
 mon than simple endocarditis. 
 
 Symptoms. In severe forms, a sense of oppression and uneasiness at 
 prtecordial region. Fever. Small and feeble and intermittent pulse. 
 Patient prefers to lie on his back ; is restless and anxious. Cold sweats. 
 Oppressive dyspnoea. Jactitation. Syncope. — When morbid action is 
 of limited extent, or of subacute character, symptoms milder and more 
 obscure. During rheumatic fever, it sometimes occurs without being 
 recognized; though its power is manifested by the structural changes 
 which remain after apparent recovery. — Endocarditis of left, more com- 
 mon than of right side of heart. That portion of membrane covering 
 valves and lining orifices most frequently attacked. Seldom directly 
 fatal : remote effects most to be dreaded. 
 
 Physical signs : Palpation may detect a vibratory thrill. Doubtful if 
 there is ever increased dulness on percussion, owing to tumefaction of
 
 106 ENDOMETRITIS. 
 
 heart's walls. A soft bellows-murmur detected by auscultation. If 
 murmur be systolic, most distinct at base and along course of aorta, and 
 accompanied with small pulse, it is significant of aortic obstruction ; if 
 systolic, most distinct at apex, and Math irregular pulse, it is due to 
 mitral regurgitant disease. A diastolic murmur, most distinct from centre 
 of sternum upwards towards the base, with a jerking pulse, indicates 
 aortic regurgitation ; while a diastolic murmur, most distinct from fourth 
 left intercostal space downwards towards apex, with an irregular small 
 pulse, results from mitral obstruction. Pulmonary systolic and diastolic 
 murmurs, infinitely rare. 
 
 Ternwiations : Permanent valvular disease, with implication of heart's 
 substance, and all their combined consequences. Systemic loss of tonej 
 impoverishment of blood ; obstruction to circulation ; drops}'. Perhaps, 
 8udden death. — See Embolism. 
 
 Treatment. Perfect rest of body and mind. Sulphate of magnesia, 
 or sulphate of soda, if there be constipation, 141, 144, 150, 152. Car- 
 bonate of ammonia, 361, 362. Aromatic spirit of ammonia, 349. Bicar- 
 bonate of potash drink, 355. Linseed poultices over cardiac region. 
 Light diet. 
 
 Remedies sometimes employed : Tartarated antimony. Calomel. Mer- 
 curial inunction. Digitalis. Opium. Colchicum. Bloodletting. Leeches. 
 Blisters. 
 
 ENDOMETRITIS.— From "E^8m, within; /^.ij^a, the womb; terminal 
 -itis. Synon. Uterine Leucorrhcea ; Uterine Catarrh. — Catari'hal or croupy 
 inflammation of mucous membrane lining uterine cavity. 
 
 Symptoms. Acute variety : Dry hot skin; general irritability ; sallow 
 complexion ; loss of appetite. Pain about lower part of abdomen : 
 sacrum, groins, inside of thighs. Sense of heat and fulness about pelvis, 
 bearing-down. Frequent micturition : urine loaded with urates or uric 
 acid. Tenesmus and diarrhoea; subsequenth' constipation. Ha>mor- 
 rhoids. Tendei'ness of ovaries and uterus on pressure. Thick and 
 tenacious discharge, after two or three da^^s: subsequently, muco-puru- 
 lent secretion tinged with blood, imparting a greenish-yellow or yellow- 
 ish-red stain to body linen. 
 
 Chronic form : Euns a tedious course. Obstinate dyspepsia; flatu- 
 lence; constipation; mental depression. Wearj'ing pains about sacrum, 
 groins, &c. Discharge of abundant glairy mucus, resembling white of 
 egg or mucilage. Increasing debility. Hysteincal or convulsive affec- 
 tions, severe nausea, tympanites, tenderness of breasts, and menor- 
 rhagia, if lining of fundus be involved. 
 
 Treatment. Acute variety: Eest in bed. Diet offish, milk, tea, mu- 
 cilaginous drinks. Castor oil. Calomel and compound jalap powder, 
 159. Podoph^ilin, 160. Warm hip baths. \Yarm water vaginal in- 
 jections. Mercury and belladonna pessary, 423. Linseed poultices to 
 lower part of abdomen and vulva. Four or six leeches to lips of uterus. 
 Avoidance of sexual intercourse. 
 
 Chronic form : Corrosive sublimate, 27. Green iodide of mercury, 53. 
 Eed iodide of mercury, 54. Donovan's triple solution, 51. Iodide of 
 potassium, 31. Mercury, or iodide of lead, and belladonna pessaries, 
 423. Pepsine, 420. Cod-liver oil. Leeches to labia uteri, or scarifica- 
 tions, only if there be congestion and no tendency to menorrhagia. 
 Division of os uteri with hysterotome, if there be constriction. Appli- 
 cation of solid nitrate of silver up cervical canal, or astringent uterine 
 pessaries (424), in endometritis limited to cervix. Injection of tincture 
 of iodine, but only after dilatation of os uteri by sponge-tents. — Animal 
 food, milk, raw eggs. Avoidance of malt liquors. Gentle exercise in
 
 ENDOSTEITIS — ENTOZOA. 107 
 
 open air. — Subsequently, — Mineral acids with bark, 376. Quinine, 379. 
 
 Nitro-hydroehloric acid, 378. Steel and pepsine, 31)4. Phos|)hate of 
 
 iron, 405. Mineral waters of Spa, 467. Honiburg, 491. Carlsbad, 496. 
 Marienbad, 497. Kissingen, 493. 
 
 ENDOSTEITIS. — From "D^Sov, within : oariov, a bone; terminal -itis. — 
 Inflammation of medullary membrane lining central canal of long bones, 
 as well as cells of flat and irregular bones. — See Osteomyelitis. 
 
 ENTERITIS. — From "B,zepi>v, an intestine ; terminal -itis. Synon. 
 Intestinorum Inflammatio ; Ileocolitis; Enterophlogosis. — Inflammation of 
 the small intestines varies much in severity. Eesults sometimes very 
 slight. There are no signs by which the morbid action can be positively 
 diagnosed as existing only in duodenum, or in jejunum, or in ileum. 
 All the coats of the bowel ma}- be involved, or only the mucous lining. 
 
 Symptoms. Rigors; hot skin; thirst; hard and frequent pulse. Ab- 
 dominal pain, especially around umbilicus; increased by pressure. 
 Nausea and vomiting. Position on the back assumed, so as to relax 
 abdominal parietes. Great restlessness; high fever; prostration; anxiety 
 of countenance; obstinate constipation; delirium. Wiry and almost 
 imperceptible pulse. Vomited matters highly offensive : sometimes ster- 
 coraceous. 
 
 Treatment. Perfect quiet in bed. Opium and belladonna, 344. 
 Enemata of warm water, to empty lower part of intestines. Ice or 
 cold water. Aconite. Calomel. Demulcent drinks. Broth; beef tea; 
 farinaceous substances; milk. Hot linseed poultices. Fomentations. 
 Application of belladonna and opium, 297. Turpentine stupes. Sina- 
 pisms. Blisters. — Wliere there is a disposition to collapse: Ammonia and 
 ether, 364. Brandy and egg mixture, with opium, 318. Bi-andy and 
 ether, 367. — During convalescence : Ammonia and bark, 371. Cod-liver 
 oil. Steel and cocoa-nut oil, 391. Steel and glycerine, 392. Phosphate 
 of iron, 405. Simple animal food; milk; raw eggs. 
 
 ENTOZOA. — From ' Evroq, within; C"'"^', an animal. — The parasitic 
 animals which infest the human body are very numerous. Helmin- 
 thologists are well acquainted with upwards of thirty perfectly distinct 
 forms. The following are those of importance : 
 
 (1) Fasciola Hepatica. — Synon. Distoma liepaticum; Liverfluke. — 
 Of the order Trematoda, or flukes. Common in all varieties of grazing 
 cattle, producing the Rot. It has been found in the human gall-bladder, 
 &c. Usually rather less than an inch in length, and rather more than 
 half an inch in breadth ; bod}^ flat, covered with minute spines, of an 
 oval form, and capable of contraction like that of a leech : has an ot*al 
 and a ventral sucker: androgynous, the orifices of the male and female 
 organs being placed side by side near the ventral sucker : oviparous. 
 Bile forms its nourishment. 
 
 (2) Distoma Lanceolatum. — Synon. Fasciola lanceolata. — This hel- 
 minth belonging to the order Trematoda, is smaller than the preceding, 
 and less common. Bod}" flat, smooth, and of a lanceolate form : androg- 
 ynous: circular oral and ventral suckers. Most frequently found in 
 liver of ox : only three cases recorded of its occurrence in human sub- 
 ject (Cobbold). 
 
 (3) Distoma Ophthalmobium. — Synon. Distoma oculi-hn7nani. — Of the 
 order Trematoda. Four specimens have been found in the eye of an 
 infant with congenital cataract (Gescheidt). Body very minute, and of 
 a lanceolate oval form : two circular suckers. 
 
 (4j Distoma Crassum. — Synon. Distoma Buskii. — Of the order Tre-
 
 108 ENTOZOA. 
 
 matoda. Body varies in length from an inch and a half to three 
 inches: about half an inch in breadth. In 1843, fourteen of these flukes 
 were found in duodenum of a Lascar who died in the Dreadnought 
 Hospital ship (Busk). 
 
 (5) DiSTOMA Heterophyes. — A very small trematode helminth, 
 scarcely one line in length. Found on two occasions in small intestines 
 of boys (Bilharz). 
 
 (6) DisTOMA HAEMATOBIUM. — Synon. Cryna'cophorus hcematohivs ; The- 
 cosoma hcemntohhim ; Bilharzia hcematobia. — A cylindrical trematode 
 worm, nearly half an inch in length. Males and females distinct: 
 former the largest, and having on under surface of abdomen a longitu- 
 dinal groove (gynfficophoric canal), in which the slender female is 
 lodged during copulation. — See Hcematozoa. 
 
 (7) Tetrastoma Eenale. — Has an oval flattened body, about five lines 
 long, and provided with four suckers. Said to be found in the tubuli 
 uriniferi. Very little knoMn about it. 
 
 (8) Hexathyridium Pinguicola. — Synon. Lingxiatula pinguicola ; 
 Polystoma pinguicola. — A flat trematode. about eight lines in length. 
 Been found in a small tumor of ovary (Treutler). 
 
 (9) Hexathyridium Yenarum. — Synon. Polystoma venarnm; Lingua- 
 tula I'enarum. — vSee Ho'matozoa. 
 
 (10) T^NiA Solium. — Synon. Tcenia communis, &c. — A large cestode 
 helminth, which in its sexually-mature or strobile condition may meas- 
 ure from twenty to thirty feet in length ; breadth, at widest part, 
 nearly half an inch. Head (scolex) small and flattened, provided with 
 a projecting papilla, armed with a double circle of hooks, and with four 
 suckers: the neck long and narrow, continued into imperfect segments 
 (sexually immature), which gradually merge into distinct segments 
 (proglottides or sexually-mature joints). The generative apparatus con- 
 sists of a ramified canal or ovarium containing the ova, and of a minute 
 spermatic duct, both occupying the centre of each proglottis. Impreg- 
 nation occurs by contact of one proglottis with another. The cysti- 
 eercus cellulosae, or pork measle, is the larva or scolex of this tape- 
 worm. — See Intestinal Wor7ns. 
 
 (11) T^NiA Mediocanellata. — A cestode worm, attaining a greater 
 length, and having larger segments than the preceding. Head fur- 
 nished with large sucking discs, but destitute of a rostellura and hook- 
 apparatus. The "measles" or cj-sticerci "udiich produce this helminth 
 are found in the muscles of cattle. This bookless tapeworm is as com- 
 mon in this country as the Taenia solium, for which it is often mistaken 
 (Cobbold). — See Intestinal Wonns. 
 
 (12) T^NiA Marginata. — Synon. Tcenia ex cysticercotenuicolli ; Taenia 
 tenuicolUs ; Tcenia globosa. — Intests man only in the immature or cj^sti- 
 cercal condition, the full-grown tapeworm (strobila) being found in dog 
 and wolf (Cobbold). The larva (Cysticercus tenuicolUs) only been 
 found once or twice in human body. 
 
 (13) Taenia Echinococcus. — A very small cestode helminth, infesting 
 only the dog and wolf Often met with in its larval condition in man, 
 forming the well-known hydatids (echinococci, or acephalocysts). 
 Hydatids are found in the following organs, enumerated according to 
 their frequency : Liver; subperitoneal areolar tissue ; omentum ; female 
 breast; muscles of heart; brain; spleen; kidneys; lungs; bones, espe- 
 cially shaft of tibia. — See Hepatic Tumors. 
 
 (14) BoTHRiocEPHALus Latus. — The largest cestode helminth ever 
 met with in human subject; sometimes attaining a length of more 
 than twenty-five feet, and a breadth of nearly an inch (CoblDold). This 
 broad tapeworm is almost peculiar to the inhabitants of Switzerland,
 
 EXTOZOA. 109 
 
 E-ussia, and Poland. Each joint or segment possesses its own ovary 
 and male organs. 
 
 (15) AscARis LuMBRicoiDES. — Sjnon. Lumbricus teres homhiis. — A 
 nematode helminth, in size and appearance like the common earth 
 worm. Males about six inches long: females, double this length. — See 
 Intestinal Woryns. 
 
 (16) AscARis Mystax. — A nematode worm, especially characterized 
 by the presence of alaform appendages, one being placed on each side 
 of the head. The male acquires a length of two inches and a half: 
 female, twice as long. Very common in the cat. In a few instances it 
 has been found in human intestine (Cobbold). 
 
 (17) Tricocephalus Dispar. — Synon. Trichuris; Ascaris trichmra. — 
 The long thread-worm is a small nematode helminth, usually found in 
 caecum and large intestines. Male measuring about eighteen lines in 
 length, female reaching two inches. — See Intestinal Worms. 
 
 (18) Trichina Spiralis. — See Trichiniasis. 
 
 (19) Strongylus Bronchialis. — Synon. Filaria hronchialis ; Filaria 
 lymphatica. — A nematode helminth ; the male measuring al)Out seven 
 lines, the female about an inch. Has been found in the human bron- 
 chial glands. 
 
 (20) EusTRONGYLUs GiGAS. — Sj'uon. Strongylus gigas ; Strongylus re- 
 nalis. — A nematode helminth; the male attaining a length often to 
 twelve inches, and the female reaching to three feet. Not very un- 
 common in the kidneys and ovarian passages of animals, especially wea- 
 sels. Eare in man. Gives rise to symptoms like those of renal abscess 
 or renal calculi. 
 
 (21) ScLEROSTOMA DuoDENALE. — A Small nematode worm ; the males 
 measure one-third of an inch in length, the females being rather longer. 
 Very common in Egypt, its presence in the small intestines of the na- 
 tives giving rise to severe anaemia. 
 
 (22) OxYURis Vermicularis. — Synon. Ascaris vermicularis. — This 
 nematode helminth is the smallest of the intestinal worms. Male 
 about three lines in length ; female slightly longer. — See Intestinal 
 Worms. 
 
 (23) Dracunculus Medinensis. — Synon. Filaria Medinensis ; Guinea- 
 icorm. — See Dracontiasis. 
 
 (24) Pentastoma T^enioides. — One of the family of Acaridae. No 
 structural connection with true helminths. Adult body, lancet-shaped ; 
 flattened at ventral surface; marked transversely by some ninety rings; 
 four feet or limbs; head, truncated; general surface smooth, but in 
 larval condition {Pentastoma denticulatum) furnished with many rows of 
 sharp spines. Length of female, three to four inches; of male, eight to 
 ten lines. Oviparous, with a subsequent metamorphosis. In sexually 
 mature state, infests nostrils and frontal sinuses of dog and wolf; in 
 pupa and larva state found in human abdominal and thoracic cavities, 
 though it has not been met with in this country. Does not give rise to 
 any functional derangements (Cobbold). 
 
 (25) Pentastoma Constrictum. — About half an inch in length, and 
 one line in breadth. Difters from larva of Pentastoma taenioides in not 
 having spines. The cephalo-thorax has four foot claws; the elongated 
 abdomen is marked with twenty-three rings. Has been found in the 
 livers of negroes at Cairo (Cobbold). 
 
 (2G) Pseudelminths. — The following so-called worms are not human 
 parasites. They have probably been introduced into the excrements 
 or into the viscera for the purpose of deception. They are, — Dactylius 
 aculeatus; Spiroptera ho minis ; Diplosoma crenatum ; Gordius aquaticus,
 
 110 ENTROPION — EPILEPSY. 
 
 or common hairworm of ditches, about a foot long, extremely slender, 
 and which coils itself into knots (Cobbold). 
 See Eritozoa in the Tabular Synopsis. 
 
 ENTROPION. — From 'jEv, in ; rpiTttu, to turn. Sjmon. Inversio Palpe- 
 brarum ; Blepharelosis. — An inversion of the margins of the eyelids. 
 May result from a cicatrix in conjunctiva, neglected purulent ophthal- 
 mia, &c. Removal of the eyelashes will give at least temporary relief. 
 Collodion to outside of lid: alum coagulum, 289. 
 
 ENURESIS. — From 'Evoupiw, to urine in bed. Synon. Hyperuresis ; 
 Incontinence of Urine. — May be associated with tendency to renal dis- 
 ease; disposition to gravel; excess of uric acid in urine; stone in blad- 
 der; loss of tone, or tumors, of walls of bladder; irritation of thread- 
 worms in rectum ; haemorrhoids and prolapsus ani ; long and contracted 
 foreskin; stricture of urethra; enlarged prostate; vascular tumors of 
 female ui^ethra; ovarian or uterine diseases and displacements; par- 
 alysis from spinal disease; nervous debility ; hysteria; dyspepsia, &c. 
 
 Enuresis very common in young children. Its occurrence favored b}^ 
 free use of fluids during after part of day ; by exposure to cold in night ; 
 by lying on back, — a posture unfavorable to retention of urine, espe- 
 cially when natural sensibility of mucous membrane of neck of bladder 
 is increased. 
 
 Can usually be cured by making child almost abstain from fluids for 
 three or four hours before going to bed : waking him to empty bladder 
 twice or thrice during night : tying a cotton reel over spinal column, so 
 that when he turns round upon his back he may be awoke : giving 
 strength and tone to system, by administration of the tincture of per- 
 ehloride of iron, phosphate of iron, cantharides and steel, benzoic acid, 
 phosphate of zinc and belladonna, cod-liver oil, &c. Circumcision will 
 be required, if there be a long prepuce with a very small oritice. In in- 
 veterate cases, application of succession of small blisters over sacrum. 
 Where bladder is very irritable, belladonna' plaster over loins and sac- 
 rum: or friction with diluted belladonna liniment. Where walls of 
 bladder are weak, nux vomica; ergot of rye; galvanism to lower part 
 of abdomen and spine. 
 
 EPILEPSY. — From " Endaii^avm, to attack unexpectedly. Synon. 
 Morbus ComlfiaUs; Falling Sickness. — A disease presenting these promi- 
 nent symptoms : Sudden loss of consciousness and sensibility, with tonic 
 convulsions lasting a few seconds, and followed by clonic spasms of 
 voluntary muscles. Cessation of tit succeeded by exhaustion and coma. 
 Attack recurs at intervals. — Hereditary taint, and marriages of con- 
 sanguinity, are j^redisposing causes. 
 
 Warnings. Premonitory symjitoms of an approaching seizure often 
 not experienced. They differ in duration and character. Sometimes 
 too short to allow sufferer to dismount from horseback, or remove away 
 from fire, or lie down : sometimes many minutes or hours between their 
 occurrence and tit. Spectral illusions, headache, giddiness (epileptic 
 vertigo), confusion of thought, sense of fear, and that peculiar sensation 
 — the aura epileptica — constitute most frequent premonitory symptoms. 
 Epileptic aura differently compai*ed to a stream of cold water, a current 
 of cold or warm air, sense of tingling, creeping of insects; the feeling 
 beginning at extremitj^ of a limb, and gradually ascending along skin 
 towards head. As soon as the aura stops, the paroxysm occurs. 
 
 Symptoms. Cadaverous pallor of countenance, with utterance of a 
 shriek or scream; immediately after which patient falls to the ground,
 
 EPILEPSY. Ill 
 
 and frequently on bis face, senseless and violently convulsed. Severe 
 burns, fraetui^es, dislocations, &c., may be produced. Convulsive move- 
 ments continue violent: usually more marked on one side of body tban 
 on tbe other. Gnashing of teeth. Foaming at mouth; protrusion of 
 tongue, which is often severely bitten. Eyes partly open and suffused : 
 eyeballs rolling, and pupils insensible to light. Skin cold and clammy. 
 Perhaps involuntar}' micturition and defecation : vomiting. Breathing 
 laborious, seems about to be suspended; when the limbs ai'e stretched 
 out, a deep sigh is drawn, and attack goes oif. Patient left insensible 
 and as in a sound sleep, with stertorous breathing; from which he re- 
 covers with feeling of stupor and exhaustion and headache, but without 
 any knowledge of what he has gone through. Some hours subsequently, 
 small ecchymoses, like fleabites, often to be detected about forehead 
 and throat and chest. 
 
 Average duration of fit from two to three minutes. Occasionally said 
 to last some hours : appearance of this due to rapid succession of seiz- 
 ures. — the status epllqjticus. Fit may be very slight {petit mal), or very 
 severe {grand or ha.ut mal of the French). Former often only consists 
 of giddiness, loss of consciousness, convulsions, and stupor, and is all 
 over in less than a minute. Seizures recur at very variable intervals: 
 often happen in the night, and for a time without being suspected b}' 
 patient or friends. Repetition of attacks impairs memory : may pro- 
 duce cerebral hemorrhage, temporary or permanent paralysis, or de- 
 mentia and idiocy. 
 
 In feigned epilepsy, the impostor does not fall violently, but throws 
 himself down deliberately in such a way as to avoid injury. Eyes are 
 closed ; pupils contract to stimulus of light; tongue is not bitten; face 
 is red instead of deadly pale, while skin is hot from necessary exertion ; 
 neither urine nor fteces are voided. Proposing to apply actual cauterj-, 
 or to shave the head, often effects a speedy cure. Blowing snuff up the 
 nostril changes the fit into one of sneezing. 
 
 Treatment. During fit : Patient to be laid on a large bed, or on 
 floor. Air to be freely admitted around him. Head to be raised, and 
 all tight parts of dress loosened. A piece of cork or soft w^ood to be in- 
 troduced between teeth for protection of tongue. Cold affusion to head 
 sometimes useful Avhere countenance is turgid. Use of snuff, so as to 
 induce sneezing. — Where fit is preceded by epileptic aura, application 
 of ligature just above region from which sensation starts, may prevent 
 attack. 
 
 During interval : Improvement of general health necessary. Bromide 
 of potassium, continued for a long time, 42. Belladonna, or Atropia, 
 326. Hj^podermic injection of atropine, 314. Quinine, 379, 386. Salts 
 of iron, 380, 390, 394, 405. Salts of zinc, 410, 413, 414. Hypophosphite 
 of soda or lime, 419. Cod-liver oil. Henbane, hop, or Indian hemp, if 
 there be sleeplessness. Nutritious diet : milk, raw eggs, animal food, 
 wine or beer. Cold shower bath. Tepid salt-water sponge bath. Chap- 
 man's ice bags to spine. Removal of stumps or decayed teeth : or of 
 any other source of irritation, as worms, &c. 
 
 Remedies sometimes recommended : A long-continued course of corrosive 
 sublimate. Iodide of potassium. Turpentine. Camphor. Valerian, 
 Assafoetida. Opium. Digitalis. Chloroform. Naphtha. Cajuput oil. 
 Nitrate of silver. Ammonio-sulphate of copper. Sulphate of copper. 
 Ai'senic. Juice of cotyledon umbilicus. Expressed juice of galium al- 
 bum. Galvanism. Stramonium. Sumbul. Oxalate of cerium. Strych- 
 nia in small tonic doses. Inhalation of oxygen. Tracheotomy. Caus- 
 tics to larynx. Moxa, or actual cautery, to nape of neck, or to part 
 whence aura starts. Setons or issues high up in neck. Repeated blis-
 
 112 EPIPHORA — EPITHELIAL CANCER. 
 
 ters over upper cervical vertebrae. Excision of clitoris. Extirpation of 
 testicles. 
 
 EPIPHOEA. — From "E-i<fipo, to convey to. Synon. Lachrymatio ; 
 Weeping. — A superabundant secretion of tears, so tliat tbey run over 
 the cheek. Common in strumous children. May be due to foreign 
 bodies. To be distinguished from stillicidiwn lachrymarum owing to 
 closure of puncta lachr3-malia, or to obstruction of nasal duct. 
 
 EPIPHYTES. — From ' E-\, upon; <fo-i'^, a plant. Synon. Plnjfopara- 
 sites. — Microscopic vegetable growths, belonging to the class Fungi 
 Cryptogamia. They are found on the skin and raucous membranes, in 
 the stomach, &c. 
 
 The chief vegetable parasites are: (1) 3Iicrosporon furfur, found in 
 Tinea versicolor or chloasma. (2) Microsporon mentdgrop/hytes, in Tinea 
 sycosis. (3) Tricophyton tonsurans, in ringworm. (4) Achorion Schon- 
 leinii, in Tinea favosa or honeycomb ringworm. (5) Microsporon Audou- 
 ini, in Tinea decalvans. (6) Tricophyton sporuloides, in Plica Polonica. 
 (7) Oidium albicans, in aphthae. (8) Sarcina ventriculi, in some stomach 
 diseases. (9) Crypjtococcus Cerevisioi or yeast plant, in the Htomaeh. And 
 (10) Mycetoma or Chionyphe Carteri, in Fungus foot of India. — See Tinea ; 
 Fungus Foot of India. 
 
 EPISTAXIS. — From 'Entara^w, to drop upon. Synon. Hcemorrhagia 
 Nariiun; Rkinorrhagia ; Bleeding at the ISJose. — Bleeding from the nose is 
 very common in early life, without doing anj^ harm. But it frequently 
 gives rise to anxiety when it occurs in advanced life. If there be ten- 
 denc}^ to apoplexy, or if patient be afflicted with heart-disease, the loss 
 will perhaps prove beneficial. This is not the case when the bleeding 
 sets in during progress of disorders which injure quality of blood ; as in 
 renal and hepatic diseases, fever, scurv}'. purpura, &c. Exhausting epis- 
 taxis may be immediate cause of death m leucocythemia, when ap- 
 proaching a fatal termination. 
 
 Treatment. Patient to be seated upright. Collars and neckhand- 
 kerchiefs to be removed. Holding one or both arms above the head. 
 Cold to neck and back, or over nose and forehead External compres- 
 sion of nostril with finger. Swabbing nostril with perchloride of iron. 
 Snuffing of alum, powdered matico leaf, tannin, powdered gum. Injec- 
 tions of alum, or iron-alum, or tincture of perchloride of iron in water. 
 Plugging nostril with cotton-wool saturated with an astringent. Styp- 
 tic rods of tannin, 424. Plugging posterior nares. 
 
 Calomel. Corrosive sublimate, 27. Gallic acid, 103, 104. Ammonio- 
 sulphate of iron, 116. Ergot of rye. Mineral acids with bark, 376. 
 Tincture of perchloride of iron, 101. Turpentine, 102. Digitalis. Mild 
 laxatives, 142, 143. Nitric acid and tai^axacum, 147. Nourishing diet, 
 potatoes ; watercresses ; orange or lemon juice. 
 
 EPITHELIAL CANCER.— From "E-ki, upon ; and dr^krj, the nipple. 
 Properly, therefore, the ej^idermis of the nipple; but now used gen- 
 erally for the layers of cells forming the cuticle. Synon. Fpithelioma ; 
 Cancroid of the Skin. — By some pathologists regarded not as a form of 
 cancer, but as a disease sui generis, consisting of an infiltration of cells 
 of scaly epithelium. Hence its synonj'ms. Eesembles cancer inasmuch 
 as it returns after excision, is prone to incurable ulceration, affects the 
 i3'mphatics seated near it, and destroys the patient. Peculiar in being- 
 little liable to multiplication in internal organs, and in being, apparently, 
 produced by local causes. — See Cancer.
 
 EPIZOA ERYSIPELAS. 
 
 11-- 
 
 EPIZOA. — From 'isTrl, upon ; and Joiw, an animal. Synon. Ectopara- 
 sites. — Animal parasites which live upon, or in the structure of, the skin. 
 
 The epizoa living on the skin are: (1) The Louse or PefJiculus. (2) 
 Common Flea or Pulex irritans. (3) Chigoe or Jigger^ found in Guiana 
 and Brazil. (4) Ticks or Ixodes, which particularly attach themselves 
 to oxen, sheep, dogs, wolves, and occasionally to the human body. (5) 
 Argades, which are allied to the Ticks, and are met with in parts of 
 Persia. (6) Common Bed- Bug or Acanthia lectularia. And (7) the Har- 
 vest-Bug or Leptus autumnaUs. — vSee Phthiriasis, and F. 429. 
 
 The epizoa found in the skin are : (1) The Itch insect, or Acarus scahiei, 
 or Sarcoptes hominis. — See Scabies. And (2) Demodex foUiculorum 
 (Owen), or Acarus foUiculorum (Simon), or Pi.jnple mite, which is chiefly 
 found in the ducts of the sebaceous glands of the altx? of the nose. 
 
 EQUINIA. — From Equns, a horse. A severe inflammatory disease^ 
 due to inoculation with morbid fluids generated in the horse, ass, and 
 mule. — See Glanders. 
 
 ERUPTIVE FEVERS. — Continued fevers, Avith an eruption super- 
 added. — See Small-pox ; Coic-pox ; Chicken-pox; Measles; Scarlet fever ;. 
 Rubeola; Plague; and Erysipelas. 
 
 The principal diseases of this class have these common characters-: 
 A variable amount of time elapses between reception of poison and set- 
 ting in of symptoms, called the j^eriod of incubation; the}^ are accom- 
 panied by fever, which runs a defined course; are attended by an erup- 
 tion, which goes through a regular series of changes; for the most part 
 aff'ect every individual once, and once only, during life; and the}" arise 
 from specific contagion. Of all eruptive fevers, scarlatina is probably 
 that which most frequently occurs a second time. 
 
 The following table shows the period of incubation, together with 
 date of eruption, and time of its disappearance, in the three chief erup- 
 tive fevei's : 
 
 Disease. 
 
 Period of Incuba- 
 tion. 
 
 Eruption appears. 
 
 Eruption fades. 
 
 Measles, . . . 
 Scarlet fever, . 
 
 Small-pox, . . 
 
 10 to 14 days. 
 4 to 6 days. 
 
 12 days. 
 
 On 4th day of fever. 
 On 2d day of fever. 
 
 On 2d day of fever. 
 
 On 7th day of fever. 
 
 On .5th day of fever. 
 
 ( Scabs form on 9th or 
 \ 10th dav of fever, and 
 ( fall ofl" about 14th. 
 
 ERYSIPELAS. — From 'jE'/oww, to draw; r.ika^, near, — expressive of the 
 tendency of the disease to spread. According to German lexicographers, 
 from 'Epuffpo':, red ; Tze?.k(i<;, livid, — livid redness. Synon. Saint Anthony's 
 Fire, the Hose. — A diffused, spreading, inflammator}- affection of the skin, 
 and very commonly of the subcutaneous areolar tissue. There are the 
 general phenomena of fever; while the affected part becomes of a deep 
 red color, hot, painful, and swollen. — It is a miasmatic disorder, due tO' 
 absorption of a specific poison. The miasm most readily generated by 
 the assembling together, in one ward, of patients with unhealthy dis- 
 charges or secretions. Epidemic, and contagious. 
 
 No portion of the surface exempt from attacks. Integuments of face 
 and head most commonly the sents o? idiopathic erysipelas, — that which 
 arises from internal causes ; while traumatic erysipelas, — that following 
 
 8
 
 114 ERYTHEMA — EUSTACHIAN TUBE DISEASES. 
 
 wounds, — commences at seat of injury. In simple erysipelas, inflamma- 
 tion superficial ; in phlegmonous form, subcutaneous areolar tissue in- 
 volved. 
 
 Symptoms. A period of incubation, varying from three to seven days. 
 Chilliness, rigors, sore throat, fevei*. and constitutional disturbance. 
 Urine sometimes albuminous; chlorides diminished. Cerebral disturb- 
 ance, delirium. Nausea, vomiting, diarrhoea. Swelling of the part : if 
 of face, all traces of natural features quite lost. 
 
 Death may occur fi'om extension of inflammation to brain or its mem- 
 branes. Chink of glottis sometimes becomes closed from serous ettusion. 
 Failure of vital powers. Erysipelas occurring in cases of diabetes, or 
 es])ecially of renal disease with albuminuria, are almost always fatal. 
 Mortality in England averages about 20i»0 annually. Poison of ery- 
 sipelas will give rise to puerperal fever in lying-in women. 
 
 Treatment. Confinement to bed in a well-ventilated room. Light 
 diet. Cooling drinks. — Castor oil. Aloes, senna, and magnesia, 150. 
 Ehubarb and blue pill, 171. Compound rhubarb powder, 165. Carbonate 
 of ammonia, o61, 371. Tincture of perchloride of iron, 392. Chlorate 
 of potash, 61. Quinine. Turpentine. Colchicum. Port wine. Ale or 
 stout. Brandy. Brandy and egg mixture, 17. 
 
 Locally: Fomentations. Poultices. Inunction with lard. Dusting 
 with flour ; finely-ground rice powder. Collodion. Boundary lines to 
 be drawn on sound skin with nitrate of silver or tincture of iodine. 
 Incisions to evacuate pus, or to relieve great tension. 
 
 Infantile erysipelas : Vigorous wet-nurse. Good milk. Beef tea. 
 "White wine whey. Wine and water. Bark. 
 
 ERYTHEMA. — From 'Epudaivio, to redden or cause blushing. Synon, 
 Injiainmatory Blush; Efflorescence Cutanee. — A non-contagious aflFection 
 of the skin. One of the Exanthemata. Characterized by slight super- 
 ficial red patches, irregularly circumscribed, of variable form and 
 extent. Most frequently seen on face, chest, and extremities. 
 
 Varieties. Erythema fugax, of a fleeting nature, and generallj'due to 
 some derangement of alimentarj' canal. Erythema intertrigo, sometimes 
 produced by friction between folds of skin, where secretions are not 
 removed b}^ washing. Erythema pernio, the technical name of that 
 peculiar inflammation of skin constituting an unbroken chilblain. 
 Erythema circinatum, in which the round red jjatches are sliglitly raised, 
 and ring-shaped. Not of uncommon occurrence in acute rheumatism. 
 Erythema Ixve, which is developed on lower extremities when they 
 become anasarcous. Erythema nodosum, in which the eruption is con- 
 fined to fore part of leg, taking the form of one or more oval raised 
 patches, resembling nodes. 
 
 Treatment. Effervescing citrate of magnesia. Compound rhubarb 
 powder. Pill of aloes and myrrh, Colchicum. Quinine. Compound 
 tincture of bark. Mineral acids. Steel wine. Ammonio-citrate of 
 iron. Pill of carbonate of iron. Subacetate of lead lotions. Glycerine 
 lotions. Veratria ointment, if there be pain. Warm water or vapor 
 baths. Warm fomentations. Elevation of limb. Puncture of anasarcous 
 limb. Light diet. Cooling drinks, — lemonade. 
 
 EUSTACHIAN TUBE DISEASES.— This tube (first described by 
 Eustachius). by which the tympanum communicates with the pharynx, is 
 about two inches long. Composed partl}^ of bone, parti}' of fibro-carti- 
 laginous tissue. It affords aa entrance for air into tympanum and an 
 .exit for mucus.
 
 EXOPHTHALMIC GOITRE — EXPECTATION OF LIFE. 115 
 
 1. Obstruction of Tube. — Permanent obstruction produces exhaustion 
 of air in tympanic cavity: consequently a pressure inwards of niem- 
 brani tym])ani, a forcing together of chain of bones, pressure on 
 contents of labyrinth, and deafness. Conditions giving rise to obstruc- 
 tions are; Thickening of mucous membrane of laucial ori^ce, such as 
 often coexists with chronic enlargement of tonsils; a collection of viscid 
 mucus, or stricture of middle pai"t of tube; and thickening of mucous 
 membrane, stricture of bony walls, or dejjosit of fibrine at tympanic 
 opening. 
 
 Symptoms. The entrance of air into tympanum, during act of degluti- 
 tion, can be distinctly heard by the Otoscope, — an elastic tube, eighteen 
 inches long, having its ends tipped with ivory. One end being inserted 
 into ear of patient, and the other into that of the surgeon, the patient 
 is directed to swallow saliva with mouth and nose closed. If tube be 
 pervious, at the moment the patient has a sensation of fulness in the 
 ear, practitioner will detect a faint crackling sound, produced by slight 
 movement of membrani tympani. Where mucous membrane of the 
 tympanum is thickened, a gentle flapping sound will be heard instead 
 of faint crackling. If the otoscope tail to reveal any sound during 
 deglutition, if no sound be heard when a forcible attempt at expiration 
 is made with mouth and nose tightly closed, and if no other cause can 
 be found for dulness of hearing, then it may presumed that the tube is 
 obstructed (Toj'nbee). 
 
 Treatment. Attention to general health. Nourishing diet; warm 
 clothing; exercise in open air; sea bathing. Cod-liver oil, 389. Iodide 
 of iron, 82. Iodide of potassium and bark, 31. Corrosive sublimate in 
 bark, 27. If tonsils be enlarged, or faucial mucous membrane swollen, 
 application of solid nitrate of silver: swabbing with tincture of iodine. 
 Excision of tonsils. Introduction of Eustachian catheter. Puncture of 
 membrani tympani in irremediable obstruction. 
 
 2, An Open Condition of Tube. — The normal condition of this canal is 
 that of closure by apposition of its walls. It acts like a valve, which is 
 opened by muscles of palate and pharynx during deglutition. When 
 permanently open, — complaint made of buzzing and other noises in ear. 
 Uneasiness about throat. Occurs during attacks of catarrh ; in irritable 
 conditions of throat. Cure results as cause subsides. 
 
 » 
 EXOPHTHALMIC GOITRE.— From '£|, out ; dwdaXijM, the eye. Pro- 
 trusion of the ej'eball (proptosis oculi), accompanied with goitre. — See 
 Bronchocele ; Graves' Disease. 
 
 EXOPHTHALMOS.— From '£?, out; oipeaXiidq, the eye. Synon. Pro- 
 cidentia Bulbi Oculi; Ophthalmocele ; Protopsis Oculi; Goggle-eyed. — A 
 protrusion of the eyeball, so that the lids cannot cover it. Met with in 
 some forms of anajmia. — See Graves' Disease; Ancemia. 
 
 EXPECTATION OF LIFE.— By this term is meant,— the mean num- 
 ber of years which, at any given age, the members of a community, 
 taken one with another, may expect to live. An easy rule has been 
 established for determining this value: The expectation of life is equal 
 to two-thirds of the difterence between the age of the individual and 
 eighty. Thus, a man is 20 years old ; 60 is the difference between 
 this age and 80 ; two-thirds of 60 are 40, and this is the sum of his 
 Expectation. By the same rule, a man of 60 will have a lien on life for 
 nearly 14 years; a child of 5 for 50 years (Willich). The results thus 
 obtained correspond very closely with those to be deduced from Dr.
 
 116 FALLOPIAN TUBE DROPSY — FEVERS. 
 
 Farr's English Life Table, which was constructed with great care from 
 an immense mass of records. 
 
 FALLOPIAN TUBE DROPSY.— An uncommon aifection. Fimbriated 
 extremity of tube together with uterine orifice, get completely obliter- 
 ated in consequence of chronic inflammation; the portion of canal be- 
 tween the openings becoming the seat of an accumulation of pus or 
 serous fluid. As many as twenty-three pints of fluid have been found, 
 under these circumstances. Only one method of giving relief, — punc- 
 ture of cyst with a minute trocar and canuJa through roof of vagina. 
 
 FARCINOMA OR FARCY. — From Farcio, to stufl' or cram. — A severe 
 contagious disease ; accompanied with a pustular eruption or small 
 tumors (Farcy-buds) which soon suppurate, and malignant fever. Arises 
 from inoculation with morbid matter generated in the horse, ass, or 
 mule. — See Glanders. 
 
 FATTY DEGENERATION. — The designation o? fatty degeneration, or 
 fatty metamorphosis, is given to a certain class of cases which during life 
 are marked by anaemia with great prostration ; and which, after death, 
 are found to be distinguished by the more or less pertect transformation 
 into fat of various important textures, but especially of muscular fibres 
 of the heart. 
 
 There is no connection between the tendency to form ftit around 
 organs, or the production of obesity, and the change of tissues into fat. 
 In foi'mer case there is a condition which may prove preservative, if 
 confined within due limits. In latter, is to be recognized a process of 
 decay and death, the result of some defect in nutritive functions. 
 
 Amongst the causes of this retrograde metamorphosis are old age, 
 intemperance, inactivity, and cessation of function. Heart, lungs, brain, 
 liver, kidneys, uterus, and arteries may sufter from it. Atheroma of ar- 
 terial walls is a form of fatty degeneration ; and arcus senilis is caused 
 by same change occurring in cornea. When important organs are in- 
 volved, it may lead to gradual, or sudden death: in latter case, owing 
 to rupture of oi-gans. — See Cardiac Atrophy ; Fatty Degeneration of Kid- 
 ney ; Hepatic Degeneration. 
 
 FEBRICULA. — Dim. Febris, a fever. Sj'non. Ephemeral Fever. — A 
 mild form of fever. — See Simple Continued Fever. 
 
 FEVERS. — From Ferveo, to burn. Synon. Febris; Pyrexia. — Fever 
 may be defined thus: After a preliminary stage of languor, weakness, 
 defective appetite, and some degree of chilliness or shivering, there is 
 preteriMitural heat of body, increased waste of tissue, acceleration of 
 pulse, great muscular debility, and disturbance of most of the functions. 
 This morbid state accompanies many diseases as one of their phenomena 
 — symptomatic fever; but under certain circumstances we meet with id- 
 iopathic fevers, which are probably independent of any local lesion. 
 
 Much has been written on the classification of fevers. In order to be 
 as clear as possible, the dift'erent varieties ma}' be arranged on the fol- 
 lowing plan : 
 
 I. Continued Fever. 
 
 1. Simj/le Fever, or Febricula. 
 
 2. Typhus Fever. 
 
 3. Typhoid, Enteric, or Pythogenic Fever. 
 
 4. Relapsing, or Famine Fever.
 
 FISTULA IN ANO — FLATULENCE. 117 
 
 II. Intermittent Fever, or Ague. 
 
 III. Eemittent P'ever. 
 
 1. Simple Remittent Fever. 
 
 2. Yellow Fever. 
 
 IV. Eruptive Fevers. 
 
 1. Small-pox, or Variola. 
 
 2. Cow-pox, or Vaccina. 
 
 3. Chicken-pox, or Varicella. 
 
 4. Measles, or Morbilli. 
 
 5. Scarlet Fever, or Scarlatina. 
 
 6. Erysipelas. 
 
 7. Plague. 
 
 For further information concerning any particular fever, reference 
 must be made to the disease as it is arranged in alphabetical order. 
 
 FISTULA IN ANO. — From Fistula, a pipe or reed ; Anus, the funda- 
 ment. — A fistulous passage by side of rectum, the result of abscess. — 
 Two forms of anal fistula?: (1) Complete, in which a probe can be intro- 
 duced from external orifice upwards into the bowel. (2) Blind external 
 fistula, where mucous coat of rectum is not perforated. 
 
 Symptoms. External aperture, in either kind, often small and diflS- 
 cult to find: generally, near the anus, but perhaps one or two inches 
 distant; may be concealed in a furrow, or will be found in centre of a 
 button-like eminence. Complete fistula most annoying: flatus, intes- 
 tinal mucus, and fluid fseces pass along its tract, causing irritation, and 
 painful spasmodic contractions of sphincter. — Fistula often coexists 
 with phthisis: probably due to tubercular inflammation of portion of 
 rectum, followed by ulceration and perforation. 
 
 Treatment. Exceptional cases may be cured by attention to gen- 
 eral health; frequent bathing of part with tepid or cold water; and 
 daily injection along sinus of iodine lotion, or sulphate of zinc lotion, 
 &c., 264, 269. (renel-ally it is necessary to divide the tissues which in- 
 tervene between the external and internal opening, including fibres of 
 sphincter ani ; first clearing out the bowels with aperients. It has 
 been recommended to effect division by a ligature, to be tightened 
 daily until parts are cut through ; but it is much better to use the 
 knife, pushing it through the mucous membrane of the bowel if thefe 
 be no internal opening. Operation not forbidden b}- presence of tuber- 
 cles in lungs, unless the deposit be abundant or case otherwise far ad- 
 vanced. 
 
 FLAT FOOT. — Synon. Spurious Valgus; Splay Foot.— A. sinking of 
 the tarsal arch, from relaxation of the supporting ligaments. Walk- 
 ing is rendered awkward, slow, and somewhat painful. In confirmed 
 cases, lameness and deformity. Occasionally associated with talipes 
 valgus (see Club foot). May arise from constitutional debilit}^ Avith too 
 much standing. Often to be remedied, in slight cases, by friction, 
 bandaging, and improvement of general health. The sole of boot ought 
 to be considerably thicker on inner than outer side. An apparatus to 
 support ankle and invert foot. 
 
 FLATULENCE. — From Flo, to blow up. Synon. Tympanites; Meteor- 
 ism; Drum Belly; Wind Dropsy. — An accumulation of gas in the intes- 
 tines occurs as an idiopathic disorder, or it may be symptomatic of some 
 other aifection. The gas is generally derived from the decomposition
 
 118 FOREIGN BODIES IN AIR-PASSAGES. 
 
 of imperfectly digested food ; or it may probably be a secretion from 
 the gastric or intestinal raucous membrane ; or it will be merely air that 
 has been swallowed. In the eructation or belching due to dyspepsia, 
 the gas has the offensive odor of sulphuretted hydrogen. 
 
 (1) Idiopathic form : The flatus usually most abundant a few hours 
 after food: little or no derangement of general health. Nervous and 
 hysterical women especially liable to it. Often produced by green vege- 
 tables, ])ea soup, tea, or any food which quickly undergoes fermenta- 
 tion. — To be cured by : Avoidance of vegetables, soup, beer, tea. Creasote, 
 41. Vegetable charcoal, 98. Mineral acids with nux vomica, 376. Qui- 
 nine and nux vomica, 387. Strychnia and steel, 408. Steel and pep- 
 sine, 394. Pepsine, 420. In tympanites from intestinal atony and weak- 
 ness of abdominal muscles, electricity very useful. — To give immediate 
 relief when distress from ffatulence is urgent : Carbonate of magnesia, 
 opium, and ether, 62. Ether and tincture of castor, 85. Ammonia and 
 chloroform, 86. Dill water. Caraway water. Assafoetida. Cinnamon. 
 Spirit of nitrous ether. Cajuput oil. Spirit of nutmeg. Spirit of ju- 
 niper. Compound tincture of cardamoms. Ammoniated tincture of 
 valerian. Tincture of ginger. Hot brandy and water with spice. Pep- 
 permint lozenges. Castor oil and rue enema, 189. Castor oil and tur- 
 jientine enema, 190. Turpentine stupes. Sinapisms. Linseed poultices. 
 
 (2) Symptomatic flattdence : An accompaniment of indigestion ; inflam- 
 matory disorders of stomach or bowels; organic diseases of liver; peri- 
 tonitis; typhoid fever; uterine or ovarian irritation ; gout, &c. — Remedies: 
 Of a variable nature, according to the cause. Enemata of turpentine 
 and rue, 189, 190. If quantity of air be excessive, its escape may be 
 aided by passage of stomach-pump tube for several inches up rectum. 
 
 FOREIGN BODIES IN AIR-PASSAGES.— Foreign matters may pass 
 into larj-nx, ti-achea, or bronchi of children, — very rarely of adults. 
 They may enter air-passages from within the body : Worms have passed 
 upwards from stomach, b}' oesophagus, into larynx. Tubercular deposit, 
 or pus, now and tiien makes a way by the neck. Retropharyngeal 
 abscess sometimes bursts into larynx or trachea. In attempting to 
 repress vomiting, matters from the stomach have entered the larynx. 
 Portions of necrosed bone occasionally work a passage into bronchi or 
 trachea. — Those bodies which are accidentally introduced from \cithout 
 are often remarkable for their size, considering the smallness of the 
 chink of glottis. The most common are portions of toys, seeds or beans, 
 fruit stones, buttons, pins, coins, beads, marbles, pebbles, nails, fish- 
 bones, masses of meat, sugar-plums, &c. Animal and vegetable sub- 
 stances imbibe moisture and swell : sometimes they disintegrate and are 
 expelled piecemeal. 
 
 Symptoms. The entrance of a foreign solid body from without usually 
 occurs during a sudden and strong inspiration : it at once causes violent 
 spasmodic cough, dj'spnoea, a sense of impending suffocation, perhaps 
 immediate death. In a few minutes, symptoms lessen in severity : cough 
 and dyspnoea return at intervals. If the body remain in larynx, there 
 will be harassing and suffocative cough : loss of voice, or inability to 
 speak above a whisper : probably pain in swallowing: tenderness: noisy 
 hissing respiration, Avith more or less dyspnoea. If it descend into 
 trachea it is seldom stationary : can sometimes be felt by application of 
 hand externally to rise and fall : the change in position gives rise to 
 severe spasmodic attacks of dyspnoea : sometimes a flapping or valve- 
 like sound, owing to foreign body being forced against rima glottidis in 
 expiration. The substance often passes on into one of the bronchial 
 tubes, — most frequently the right, being directed to this by the bron-
 
 FOREIGN BODIES IN RECTUM — GALACTORRHEA. 119 
 
 cliial septum. Auscultation and percussion will then show that air does 
 not enter the obstructed lung at all, or only incompletely: diminution 
 or loss of resonance and of respiratory murmur. The fear of bronchitis 
 and pneumonia to be remembered. 
 
 When fluids enter the larynx the}" induce a sense of choking, with 
 convulsive and suffocative cough, which usually suffices to expel them: 
 if very abundant they may cause sudden death. 
 
 Treatment. If the body be at entrance of larynx, or between the 
 vocal cords, it may perhaps be seen by laryngoscope and seized with 
 polypus forceps. This failing, child should be placed with head down- 
 wards, and slapped smartly and quickly on the back. Emetics and 
 sternutatories can be tried : they are generally useless. 
 
 When the body remains in larynx, laryngotomy should be performed 
 as early as possible: when it has descended lower, and ]ierhaps always 
 in young children, trachea ought to be opened. The substance may be 
 ejected through glottis, or through artificial opening, directly the latter 
 is made: should this not take place, patient's body must be inverted, 
 and a few smart taps made to dislodge the substance. Inversion rarely 
 followed by bad consequences, because patient will breathe through 
 artificial opening: hence the coin, bean, or whatever it may be, will not 
 give rise to that severe spasm of the glottis on touching it, which it 
 would otherwise do. Perhaps this spasm of glottis might be overcome 
 by inhalation of chloroform, without opening trachea. If tried, the 
 surgeon should be prepared to perform tracheotomy immediately, in 
 case of necessity. — Where extraneous body resists all efforts to remove 
 it, the wound in the trachea should be kept open to favor expulsion 
 subsequently. When operation is successful, incision should be imme- 
 diately closed by strips of plaster or by sutures.. 
 
 FOREIGN BODIES IN RECTUM.— May consist of: (1) Substances 
 which have been swallowed ; such as stones of fruit, fish-bones, coins, &c. 
 (2) Concretions formed in intestines, having a gall-stone or some mass 
 of indigestible matter as a nucleus. (3) Articles forced through anus; 
 as pieces of wood, syringe-pipes, gallipots, bottles, ferrules, &c. 
 
 In attempting removal of substance, force to be avoided. If sphinc- 
 ter be contracted, relaxation should be procured by lubricating with 
 iodoform (one part to four of lard). Chloroform seldom necessary. In- 
 durated faices to be extracted with a lithotomy scoop or handle of spoon. 
 
 FRAMBffiSIA. — From Framboise, a raspberry. Synon. Anihracia Bu- 
 bula ; Lepra Fungifera; Pian ; Yaws. — A tubercular skin disease, said 
 to be common in Africa, parts of America, and West Indies. Without 
 precursory symptoms, portions of skin about face, scalp, axillae, or gen- 
 ital organs are found covered with small dusky-red spots; which gradu- 
 ally become converted into larger tubercles, isolated at summits but 
 collected together at bases, and resembling raspberries or mulberries in 
 color and form. Tubercles generally hard, covered with dry scales, 
 sometimes inflamed If inflammation spreads, ulceration sets in ; a j^el- 
 low sanious discharge resulting, which forms scabs. Disease continues 
 for years, or even for life. 
 
 GALACTORRH(EA. — From r«Aa, milk ; pim, to flow. Synon. Galac- 
 topleurosis; Superabundant Secretion cjf Milk. — An excessive secretion of 
 milk in nursing women. Owing to this excess, the milk continually 
 oozes away: several pints may thus escape in course of twenty-four 
 hours, keeping patient's clothing wet, and weakening her system. Hence
 
 120 GALL-STONES. 
 
 result, ana?mia; hysteria; dyspepsia; low spirits; and even phthisis or 
 dropsy. Milk always found poor in quality, after a time. 
 
 Treatment. Infjint to be weaned. Compression of breasts, by strap- 
 ping with belladonna plaster. Belladonna, iodide of potassium, eolchi- 
 cum, camphor, &c., 427. Nourishing food. Removal of uterine or 
 ovarian disease. Iodide of lead and belladonna pessaries, 423. 
 
 GALL-STONES. — Synon. Chololithus ; Biliary Calculi. — More fre- 
 quently formed in gall-bladder, than in substance of liver — in branches 
 of hepatic duct. Solitar}" calculi when found in gall-bladder are globular 
 or oval or pear-shaped : associated stones usually have numerous polished 
 facets, the result of pressure and mutual attrition. Gall-stones formed 
 in branches of hepatic duct are small, rough or tuberculated, and of a 
 dark color — like black pepper-corns. Gritty sand-like deposits (biliary 
 gravel) are met with in excretory passages of liver ; consisting of minute 
 calculi, or of a powder made up of cholesterine and cholochrome. — 
 Ingredients of gall-stones, — Cholesterine; cholochrome or coloring mat- 
 ter; earthy and alkaline salts — phosphate and carbonate of lime and 
 magnesia; together with biliary and fatty acids. 
 
 Symptoms. Small calculi in branches of hepatic duct may give rise 
 to dull pains about liver, perhaps shooting to shoulder; to symptoms of 
 intermittent fever ; gastric disturbance with nausea. As they usually 
 only cause temporary obstruction to flow of a small quantity of bile, 
 there is no jaundice. 
 
 Hepatic duct rarely blocked-up b}^ a concretion. When it is, symp- 
 toms consist of intermittent pains; bilious vomitings; jaundice; and 
 enlargement of liver owMng to escape of bile from all the ducts being 
 prevented. Fatal rupture of duct has occurred. 
 
 Calculi may be present in gall-bladder without producing morbid 
 derangements. Earely, they set up catarrhal or plastic inflammation; 
 with ])ains about epigastrium, right shoulder, and hip. Loss of appe- 
 tite; indigestion; constipation. Ulceration and perforation have oc- 
 curi-ed. 
 
 When calculi of any size leave the bladder and enter cystic duct, they 
 cause well-marked symptoms — hepatic, or biliary, or gall-stone colic. Ex- 
 cruciating pain. Great tenderness of right hypochondriac and epigastric 
 regions. Nausea and vomiting. Constipation and flatulence. Perhaps 
 rigors. Slow pulse. — If stone recede into bladder, symptoms cease : if 
 it remain impacted, dropsy of gall-bladder may result, and perhaps 
 ulceration or gangrene of duct: if it be forced onwards into common 
 duct, there is a sense of partial relief: though pain returns as duodenal 
 orifice is reached. If common duct be long occluded, jaundice must 
 ensue, as there is no outlet for the bile. Where obstruction is perma- 
 nent, jaundice increases; liver progressively enlarges; gall-bladder gets 
 much distended. Ultimately, death occurs; unless the stone be forced 
 into bowel, or unless it induces adhesive inflammation and gets into 
 intestines or through abdominal walls, after ulcei-ation and perforation 
 have taken place. In event of passing into intestines, care must be 
 taken that it escapes peranum; otherwise it may form a nucleus for 
 a concretion, and ^jroduce complete obstruction at the end of a few 
 months. 
 
 Treatment. Jlelief of biliary colic: Hot water, or vapor, or air bath. 
 Fomentations with decoction of poppy-heads and chamomile flowers. 
 Linseed poultices. Poultices, with application of belladonna and opium, 
 297. — Morphia, chloroform, and Indian hemp, 317. Subcutaneous injec- 
 tion of morphia, 314. Opium and belladonna, 340, 344. Opiate ene- 
 mata, 339. Inhalation of chloroform, or ether, or of a combination of
 
 GASTRALGIA — GASTRIC ULCER. 121 
 
 both. Ice. Copious draughts of hot water containing bicarbonate of 
 soda. 
 
 Expulsion of calcuhis and prevention of further formations : Castor oil. 
 Seidlitz powders, 169. Phosphate of soda and aloes, 149. Sulphate and 
 phosphate of soda, 148. Pill of colocynth and hyoscyamus. Carlsbad 
 waters, 496. Vichy, 479. Eins, 486." Eger, 498. Eegulation of diet. 
 Bloodletting and emetics to be avoided. Mixtures of ether and turpen- 
 tine to dissolve calculi, useless. 
 
 GASTRALGIA.— From rmrrip, the stomach ; alyn-, pain. Synon. 
 Dyspepsodynia; Cardialgia ; Heartburn. — An unpleasant burning sensa- 
 tion in the stomach and gullet, coming on in paroxysms. A common 
 symptom in indigestion. 
 
 Treatment. White bismuth, 65. Carbonate of magnesia, 62. Solu- 
 tion of potash, 69, 73. Bicarbonate of soda. Carbonate of ammonia. 
 Saccharated solution of lime, 14. Lemon-juice. Niti-ic acid. Dilute 
 nitro-hydrochloric acid, 378. Hydrocyanic acid, 86, 377. Phosphoric 
 acid. Ammonio-citrate of iron, 401, 403. Pepsine, 420. — See Byspejma. 
 
 GASTRIC CANCER. — From raffzijp, the stomach. — Generally primary. 
 May be of scirrhous, medullary, or colloid variety. Most frequent 
 seats, — pyloric aperture ; cardiac orifice j space along lesser curvature. 
 More common in men than women; rare before fortieth j^ear. Few 
 cases survive beyond two years from commencement of symptoms. 
 
 Symptoms. Pain in epigastrium, of a burning, lancinating, or gnawing 
 character; increased by food and pressure. Retraction of abdominal 
 wall. Eructations of fetid air. Nausea: frequent vomiting of ingesta 
 and glairy mucus, of bloudy sanious fluid, of dark grumous matter 
 having an appearance of coflPee-grounds. Constipation. Debility. 
 Emaciation, which becomes extreme. Pulsating tumor, when mass lies 
 over aorta : or a firm painful tumor in some part of epigastric, umbilical, 
 or hypochondriac region. Cancerous cachexia. — Perforation ma}- occur, 
 witli escape of contents of stomach into peritoneum. Or perforation, 
 with communication between stomach and outside of abdomen ; between 
 stomach and colon ; between stomach and duodenum ; or between 
 stomach and pleural cavities, lungs, or pericardium. 
 
 Treatment. Opium and belladonna, 344. Subcutaneous injection of 
 morphia, 314. Opiate suppositories, 341. Iodoform, 338. Bismuth and 
 soda, 65. Vegetable charcoal. Hydrochlorate of ammonia (gr. 15 every 
 two hours), to relieve nausea and pain. Inhalation of small quantities 
 of chloroform or ether, 313. Cod-liver oil. — Locally: Wet compress. 
 Belladonna and opium, 297. Linseed poultices. Hemlock poultices. 
 Fomentations. Ointment of aconitia, cautiously. Ointment of atropia. — 
 Diet: Milk; cream; asses' milk. Raw eggs. Essence of beef, 3. 
 Nutrient enemata, 21, 22, 23. 
 
 GASTRIC ULCER. — From /a-rrr;/), the stomach. Sj-non. Simple, 
 Chronic, or Perforating Ulcer of Stomach. — More frequentl}- in women 
 than in men, and in poor than rich. Very x-are before puberty. The 
 ulcer is round or oval; seldom smaller than a fourpenny piece, or larger 
 than a crown piece ; and mostly seated on posterior surface, lesser curv- 
 ature, or pyloric pouch. — May be fatal by hemorrhage, perforation, or 
 exhaustion. 
 
 Symptoms. Liable to some variety. Pain in epigastrium, and over 
 lower dorsal vertebrte : increased by food. Violent aortic pulsations. 
 Eructations of sour fluid : nausea and vomiting. Loss of flesh. Amen-
 
 122 GASTRITIS. 
 
 orrhoea in yonnpj women, particularly if there be hemorrhage. In fiwor- 
 able cases pains diminish as ulcer gradually heals: complete recoveiy. 
 
 Where perforation happens : Violent pain, spreading from epigastrium 
 all over belly. Tympanites. Great anxiety. Eaj)idly increasing pros- 
 tration. Painless collapse in a few hours; death. 
 
 Treatment. Extract of opium (gr. 1 every six or eight hours). 
 Opium and belladonna, 344. lienbane and Indian hemp, 337. Subcuta- 
 neous injection of morphia, 314. Bismuth and soda, 65. Bismuth and 
 kino, 112. Powder of kino and opium. Nitrate of silver. Oxide of 
 silver. Oxalate of cerium. Bicarbonate of potash, ammonia, and aco- 
 nite, 67. Bromide of ammonium, 37. Iodide of jjotassium. Citrate of 
 ammonia and hydrocyanic acid, 362. Steel and ammonia, 401. Steel 
 and citrate of potash, 403. Iron alum, 116. Castor oil. Simple ene- 
 mata, 188. — Locally: Hot linseed poultices. Fomentations. Turpen- 
 tine stupes. Sinapisms. Ice in a bladder. — Great care as regards diet : 
 Only small quantities of food at a time. Gruel, or arrowroot, with milk. 
 Saccharated solution of lime and milk, 14 Iced milk. Wenham Lake 
 ice. In severe cases, complete rest of stomach: nutrient enemata, 21, 
 23. Subsequently, — White tish. Light puddings. Poultry. Weak 
 brandy and water. Avoidance of: Sugar. Beer. Wine. Coffee. All 
 indigestible foods. — Great caution during convalescence. 
 
 GASTRITIS. — From Faffzy-^p, the stomach ; terminal -itis. — Several 
 im))oi-tant affections of the stomach, more or less closely connected with 
 intlamniation, are included under this head. 
 
 1. Acute Gastritis. — Synon. Ivflammatio Ventricidi. — Acute inflamma- 
 tion of mucous membrane of stomach seldom or never arises idiopath- 
 ically. A frequent result of poisoning by mineral acids, caustic alkalies, 
 arsenic, &c. Sometimes produced by swallowing boiling water, exces- 
 sive doses of antimony, or use of mustard emetics. 
 
 Symptoms. In gastritis due to an irritant poison, — increasing burning 
 pain in epigastrium, aggravated by pressure. Distressing nausea; 
 violent retchings. Accelerated pulse and bi'eathing. Great thirst; 
 desire for cold drinks, which are vomited immediately. Constipation. 
 Scanty and high-colored urine. Extreme prostration sets in quickly. 
 Commonly death from exhaustion. — In exceptional cases, earl}- symp- 
 toms very slight. Disease may not be suspected until a few hours 
 before death. 
 
 Treatment. Purgative enemata, 1S8. Nutrient enemata, 21, 22, 23. 
 Free sucking of ice. Opium and belladonna, 344. Opiate suppositories, 
 340. Subcutaneous iiijection of morphia, 314. Linseed poultices. 
 Poppy-head fomentations. Mucilaginous drinks; iced milk. — Avoid- 
 ance of : Emetics. Stomach pump. 
 
 During convalescence : Great care as to diet. Small quantities at short 
 intervals, of farinaceous substances and broths. Milk: cream. Eaw 
 eggs. Ice. 
 
 2. Chronic Gastritis. — A comparatively mild disorder, unless of long 
 duration. May produce thickening and induration of coats of stomach, 
 narrowing of p3'lorus, or ulceration perhaps going on to perforation. 
 
 Symptoms. Anorexia. Tenderness at epigastrium and sternum. 
 Pain and sickness after meals. Slowness of digestion. Gastrodynia. 
 Pyrosis. Disordered bowels. 
 
 Treatment. Low diet. Iced water, or ice. Eemoval of cause. — See 
 Dysfepsia. 
 
 3. Gastric Catarrh. — Catarrhal affections of stomach when slight
 
 GASTRITIS. 123 
 
 usually spoken of as " bilious attacks." — SymjAoms are those of indiges- 
 tion : furred tongue, oppression at epigastrium, vomiting of bile, giddi- 
 ness, "sick headache." — Rernedij-s consists of rhubarb, ipecacuanha, 
 mercury and chalk, Seidlitz powders. Meagre diet. Soda water. Ice. 
 
 Chronic catarrh or mucous flux may succeed a bilious attack, or arise 
 independently. Often coexists with chronic bronchitis, hooping-cough, 
 plithisis, and pulmonary emphysema. There is congestion of capillary 
 gastric vessels, with excessive secretion of glairy mucus. — Symptoms are 
 those of indigestion. Often a craving for food; only a small quantity 
 can be taken without sense of oppression, vomiting, &c. — Remedies are 
 such as restrain secretion of mucus and restore tone of stomach. Sul- 
 phite of soda, 48. Bismuth, 65, 112. Kino and logwood, 108. Iron 
 alum, 116. Tannin lozenges. Aromatic sulphuric acid Calomel (gr. 5), 
 if there be constipation. Milk and saccharated solution of lime, 14. 
 Arrowroot. Gruel. Bread and milk. White fish. Poultry. Sherry and 
 water. Soda water. 
 
 Severe examples of gastric catarrh sometimes spoken of as " gastric 
 fevers." — Chief symptoyns are heat of skin; quick and full pulse; vomit- 
 ing, with epigastric pain; scanty urine loaded with lithates. Super- 
 ficial ulceration of mucous coat may result. — Remedies are rest, low diet, 
 demulcent drinks, mild aperients, effervescing salines. An emetic of 
 ipecacuanha at commencement. Hot fomentations. Poultices. Tur- 
 pentine stupes. 
 
 4. Induration of Pylorus. — Synon. Fibroid Infiltration of Pylorus; 
 Plastic Li nit is ; Cirrhotic Inflammation. — Consists of an abnormal devel- 
 opment of fibrous tissue in submucous areolar membrane about pyloric 
 portion of stomach. As a consequence there is stricture, perhaps with 
 dilatation of stomach and hypertrophy of muscular coat. 
 
 Symptoms. Eesemble those produced by cancer, save that they ex- 
 tend over a longer space of time. Emaciation and progressive debility. 
 Pyrosis. Sickness. Constipation. Mental depression. Appetite may 
 be ravenous : a large meal causes great suffering, as food tries to pass 
 through pylorus. Vomited matters may look like yeast, and contain 
 sarcinse or torulee: often consist only of partially digested food. In- 
 durated p3dorus can be felt, like a tumor, through abdominal walls. 
 Aortic pulsation. Disturbed sleep. Prostration. Death from inani- 
 tion ; though by strict attention to diet, life may be prolonged for some 
 years. 
 
 Treatment. Iodide of potassium. Iodide of ammonium. Hydro- 
 chlorate of ammonia. Liquor calcii chloridi (Phar. Dub.). Opium. 
 Belladonna. Belladonna plaster. Wet compress. Cod-liver oil. Liquid 
 food, — milk, cream, raw eggs, soups, wine. Nutrient enemata. AVarm 
 clothing. 
 
 5. Dilatation of Stomach.— Generally due to some affection of pylorus 
 causing contraction, so that food is impeded from passing into duode- 
 num. Dilatation goes on slowly and steadily, until stomach comes to 
 occupy a large portion of abdominal cavity. 
 
 Symptoms. Stomach-cramp, heai-tburn, water-brash, flatulence, con- 
 stipation, and sometimes attacks of vomiting. Appetite may be vora- 
 cious. Where there is vomiting, ejected matters are large in quantity, 
 intensely acid, often resemble yeast : microscopically examined, vSarcinse 
 ventriculi are found, and sometimes the j^east fungus — Torulse cerevisia^. 
 These vegetable organisms probably result from long detention of food 
 in stomach. 
 
 Treatment. Eegulation of diet: unfermented or aerkted bread. 
 Food not to be too limited, where appetite is large. The author has
 
 124 GASTRO-COLIC FISTULA — GLAUCOMA. 
 
 known suicide committed from not allowing sufficient food to relieve 
 tlie hunger. — Formation of parasites to be checked by sulphite of soda, 
 48. Sulphite of potash. Hyposulphite of soda. — For relief of other 
 8y mptoms J Bee Gastralgia ; Gastrodynia ; Pyrosis; Dysjyepsia. 
 
 GASTRO-COLIC FISTULA.— A communication between the stomach 
 and colon takes place with greater frequency, than between stomach 
 and duodenum. More commonly due to cancerous than simple ulcera- 
 tion. Stomach and colon not always closely adherent : a cavity may 
 intervene, as if a mass of cancer or tubercle had connected the two 
 viscera, and been gradually hollowed out. — The symptoms are chiefly 
 fecal vomiting, and expulsion of undigested food with the stools. 
 
 GASTRO- CUTANEOUS FISTULA.— A communication between the 
 stomach and outside of abdomen. May result from suppuration in ab- 
 dominal wall; wounds; from long-continued pressure, voluntaril}' pro- 
 duced by hysterical women ; or from simple or malignant perforating 
 ulcer of stomach, this^viscus first contracting adhesions with perito- 
 neum. In either case, it is almost impossible to close the opening. A 
 plug must be worn to prevent escape of contents of stomach. 
 
 GASTRODYNIA. — From FafTTr^p, the stomach; odu'^r^, anguish or pain. 
 Svnon. Spd sinus Ventriculi ; Stomachalgia ; Cramp in the Stomach. — May 
 occur in connection with organic disease of stomach, or from simple in- 
 digestion. 
 
 Treatment. White bismuth. Oxide of silver. Oxalate of cerium. 
 Morphia. Hydrocyanic acid. Wood charcoal. Creasote. Sinapisms. 
 Linseed poultices. Wet compress. — See Dyspepsia ; Pyrosis. 
 
 GENERAL PARESIS. — From Ildpem^, want of strength, from -rafiir^nt, 
 to relax. Synon. Progressive Paralysis of the Insane. — See Insanitij. 
 
 GLANDERS. — Synon. Equinia ; Farcinoma ; Farcy. — A malignant 
 febrile and contagious disease: due to a specific poison received from a 
 glandered horse, ass. or mule. Glanders and farcy are essentially iden- 
 tical, both having their origin in the same poison. But when the effects 
 of the morbid agent ai-e especially manifested in the nasal cavities, the 
 disease is known as glanders; while, when the lymphatic system suffers, 
 it is Qtd\e& farcy. 
 
 Treatment. Prophylactic : Cauterization of inoculated tissue. Sul- 
 phite of soda or magnesia, 48. 
 
 Curative: Sulphurous acid. Sulphite of soda or magnesia, 48. Iodide 
 of potassium, grs. 10 to 15 thrice daily. Bark. Quinine. Arsenic. 
 Strychnia. Carbonate of ammonia. Disinfectant washes to nostrils 
 and ulcers. Creasote injections. Vapor baths. Stimulants. !Nourish- 
 ing food. Pure air. Abscesses to be opened. 
 
 GLAUCOMA. — From rXau/.6^, sky-blue. — A term formerly applied to 
 opacity of the lens. Now used arbitrarily to denote a form of blindness 
 attended with disorganization of the various tissues of the eyeball. The 
 symptoms are the result of excessive intraocular pressure, this being 
 due to an increase in quantity and firmness of the vitreous humor 
 (Hulke). Glaucoma peculiar to middle life and old age : its occurrence 
 sometimes foreshadowed by quickly increasing presbyopia. 
 
 Symptoms. The disease may be acute; when the glaucomatous 
 changes take place rapidly, and quickly end in loss of vision. Attack 
 perhaps commences suddenly during night, with severe throbbing pain
 
 GLOSSITIS — GONORRHCEA. 125 
 
 in one eye and temple. Pain continues ; on following morning, scle- 
 rotic found discolored and congested. Iris becomes of a dusk}- hue, and 
 motionless: cornea gets dim: pupil widely dilated, and sometimes of an 
 irregular oval shape : eyeball felt to be unnaturally hard. Sometimes 
 complaint made of bright flashes of light darting before the eye. Occa- 
 sionally there is slight temporary improvement, though blindness 
 subsequently results. Both eyes affected; disease usually commences 
 in one a few days befoi'C the other. 
 
 I?i c/«'on«c glaucoma same symptoms; but they come on insidiously, 
 with much less pain. Morbid changes spread over many months. 
 Their sequence seems to be as follows: First, in retina and choroid; 
 going on, perhaps, to serous effusion between these two coats, which 
 causes a bulging forwards of lens and iris, by pressing from behind upon 
 vitreous body. Then, congestion and inflammation of iris and cornea. 
 Last of all, opacity of lens, as a consequence of its deranged nutrition 
 (Dixon). 
 
 Opthalmoscope usually shows extravasations of blood in retina and 
 choroid; serous effusion between retina and choroid, retina appearing 
 as if raised into folds ; small clots in vitreous humor; and an excava- 
 tion of optic nerve entrance, with pulsation of arteria centralis retin®. 
 
 Treatment. Bleeding, blistering, and mercury have invariably done 
 great harm. All that the physician can do is to improve the general 
 health. Whether the surgeon can best reduce the excessive tension of 
 the eyeball in acute cases, by iridectomy, or simply by evacuating the 
 aqueous humor, is a disputed point. 
 
 GLOSSITIS. — From Flwnffa, the tongue, terminal -His. Synon. Inflam- 
 matio Linguce; Inflammation of the Tongue. — See Tongue Diseases. 
 
 GLUCOHjEMIA. — From n.uxu<;^ sweet; ai/m, blood. Sweet blood. — 
 
 See Diabetes Mellitus. 
 
 GLUCOSURIA. — From D.uxhq, sweet; uupov, the urine. Sweet urine. 
 
 See Diabetes Mellitus. 
 
 GOITRE. — Perhaps from Guttu?', the throat. See Broitchocele. 
 
 GONORRH(EA. — From Avtj, semen ; piio^ to flow. Improperly used 
 to signify an inflammation more or less acute of one or more portions 
 of the genito-urinaiy passages, accompanied with a muco-purulent dis- 
 charge. Synon. The Clap. 
 
 1. Gonorrhoea in Male. — Inflammation of the mucous membrane of 
 the urethra, — generally of the anterior portion. It is attended with 
 the flow of a contagious purulent or muco-purulent fluid. 
 
 Symptoms. About third day from exposure to contagion, heat and 
 itching of glans penis. Fulness and redness of urethral orifice. Milky 
 purulent discharge, which becomes muco-purulent. Scalding. Pain in 
 groins, irritability of bladder, weight and dragging pain about testicles. 
 
 Complications: Painful erections or chordee. Balanitis. Hemorrhage 
 from urethra. Eetention of urine. Abscess. Prostatitis. Cystitis. 
 Orchitis. Gonorrhoeal ophthalmia. Gonorrhoeal rheumatism. 
 
 Treatment. Balsam of copaiba and cubeb pepper: very inefficient, 
 nauseous, apt to derange stomach and to produce skin eruptions. Mer- 
 cur}^, turpentine, creasote, nitrate of potash, ergot of rye, &c., worse than 
 useless. Oil of yellow sandalwood (Sirium myrtifolium) and Gurjun 
 balsam or wood oil (product of the Dipterocarpus turbinatus) have been 
 recommended.
 
 126 GOUT. 
 
 Abortive trenfment: In early stages always very dangerous. It consists 
 of injections of nitrate of silver (grs. 5 — 10 to fl. oz.), active purgatives, 
 perfect rest, abstinence from stimulating food and drinks, and hot 
 bathing ; followed by mild injections of subacetate of lead, and gentle 
 aperients. 
 
 In ordinary cases : Mild aperients. Moderate rest. Diet free from 
 salt meats, pastry, cheese, coffee, wine, beer, and spirits. Injections 
 — from 1 to 3 grs. to the fl. oz — of alum, acetate of lead, sulphate of 
 zinc, chloride of zinc, acetate of zinc, nitrate of silver, sulphate of 
 copper, or sulphate of iron. Testicles to be supported by a suspensory 
 bandage. 
 
 Astringent sticks or suppositories made with cocoa butter and alum 
 or sulphate of zinc or tannic acid, so as to be introduced into urethra. 
 Strips of lint or linen moistened with an astringent solution, passed 
 down urethra for two inches. Cauterization of urethra with nitrate of 
 silver. Copaiba mixed with urine as an injection? Copaiba enemata 
 and suppositories? 
 
 For relief of scalding: Warm baths. Liquor potassse in camphor 
 water. Opium. Drinking freelj^ of tea witii milk, or of plain water. 
 Demulcent drinks useless, except as vehicles for water. 
 
 For relief of chordee : Camphor (grs. 5) and belladonna (gr. 2) in a 
 pill at bedtime. Spirit of camphor in drachm doses. Sleeping on a 
 mattress, without much covering; towel with a knot over spine, or a 
 cotton reel, to prevent lying on the back. 
 
 For retention of urine: Warm bath and opiate suppository, before re- 
 sorting to catheter. 
 
 For hemorrhage from urethra: Application of ice. Pressure by intro- 
 duction of a large bougie. Pressure externally, by pad and bandage. 
 
 2. Chronic Gonorrhoea or Gleet. — Transparent mucous discharge. No 
 scalding nor pain. Frequent calls to pass urine, when the prostate or 
 the neck of the bladder is irritable. Pain in pei-ineum. 
 
 Treatment. Temperate mode of living. Attention to digestive or- 
 gans. If there be an organic or permanent stricture, employ dilatation, 
 Ibrcible rupture or incision. 
 
 Where patches of the urethra are contracted and over sensitive, use 
 bougies smeai*ed with some astringent ointment. Solid nitrate of silver, 
 by means of Lallemand's porte caustique. Astringent injections. Sus- 
 pensory bandage for testicles. 
 
 If there be irritation about prostate or neck of bladder, avoid bougies 
 and injections. Employ hot baths, warm bathing of penis and peri- 
 neum, opiate suppositories, and application of extract of belladonna to 
 perineum. Infusions of uva ursi, pareira, or bucco. Iodide of potassium, 
 '6\. Painting under surface of urethra and perineum with tincture of 
 iodine. Application of a blister to penis for one or two hours. 
 
 Where there is constitutional debility, — Phosphoric acid and bark, 
 376. Gallic acid, 103. Iron-alum, 116. Steel and cantharides, 4U0. Nux 
 vomica. Cod-liver oil. Sea bathing. Nourishing diet. 
 
 3. Gonorrhoea in Female. — Consists of acute or chronic inflammation 
 of urethra, vulva, vagina, or canal of cervix uteri. Not to be distin- 
 guished from inflammations due to other causes than impure sexual in- 
 tercourse. 
 
 Treatment. Hot hip baths. Yaginal injections of warm water. Mild 
 aperients. Rest. Low diet. Astringent injections, 425. Medicated 
 pessaries, 423. Solid nitrate of silver. 
 
 GOUT. — From the Fr. Goutte, a drop ; because it was thought- to be 
 produced by a humor which fell goutte d goutte into the joints. — May be
 
 GRAVEDO. 127 
 
 defined as a specific inflammation, having a constitutional origin, and 
 being much favored by hereditary taint. It is accompanied by great 
 pain and swelling of the affec^ted joint, fever with general disturbance, 
 and especially by some disorder of the digestive organs. The disease 
 has a tendency to recur again and again, after variable intervals. 
 
 Symptoms. The acute attack may be preceded by warnings, — heart- 
 burn, flatulence, dull pain in left side of chest, irregularity of heart's 
 action, dry skin, urticaria, and urine loaded with urates. It may come 
 on suddenly in the night, with, — acute pain in great toe, heel, or instep; 
 a rigor followed by heat ; tenderness and swelling of affected part ; fever, 
 irritability, and restlessness; constipation with furred tongue; and urine 
 loaded with urates, phosphates, or containing albumen. The attack 
 passes off: an interval elapses, of length proportionate to the care 
 taken; and then another attack follows. Toplii or chalk-stones form 
 round the joints, consisting chiefly of urate of soda; small deposits on 
 auricle of ear. 
 
 Complications : In reti-ocedent gout metastasis occurs from the joint 
 to some internal organ, — to the stomach, heart, membranes of the brain. 
 Often caused by application of cold to gouty limb. 
 
 Gouty diathesis without local manifestations, causing neuralgia, dys- 
 pepsia, palpitation, syncope, congestion of liver, urticaria, piles, pains 
 about the head, toothache, tonsillitis, &c. 
 
 Treatment. Acute Stage: Bleeding to four or six ounces, where the 
 constitution is sound, to relieve overloaded heart and congested vessels. 
 Mild laxatives containing aloes, senna, rhubarb, jalap, &c., 144, 145, 146, 
 148, 149, 151. Calomel, colchicum, aloes, and ipecacuanha pill, 46. Ace- 
 tate, citrate, or bicarbonate of potash. Emetics. Opium. Hot-air or 
 vapor bath. Colchicum, — in Vichy water, or with sedatives and alka- 
 lies, or iodide of potassium, 31, 46, 212, 351, 352. Hellebore and colchi- 
 cum, 163. Carbonate of ammonia. Liquor potassae. Liquor sodse. Sul- 
 phur. — Locally : Cotton-wool and oiled silk. Anodyne lotions, 265, 281, 
 297. One or two leeches. Poultices, with extract of belladonna or 
 opiuni. Ointment of veratria. Small blisters, in chronic cases. — Diet: 
 Milk. Arrowroot. Tapioca. Tea. Diluents. Soda water. Vichy 
 water. Avoid animal food too soon. 
 
 Chronic stage : Maintain proper action of bowels and skin. Colchicum. 
 Alkalies. Iodide of potassium, truaiacum. Extract of the physalis 
 alkekengi. Quassia. Calumba. Bark. Mild ferruginous tonics, 394, 
 402, 403. Arsenic, with colchicum or iodide of potassium or steel, 52, 
 399. Phosphate of soda. Avoid opening chalk-stones Friction with 
 liniments of iodide of potassium or iodide of ammonium, 280. Regulate 
 diet : Animal food in small quantity ; white fish ; milk and eggs. Avoid- 
 ance of malt liquors, port, and sherry; sugar to be used sparingly. 
 
 In irregular or misplaced attacks: Salines and colchicum. Ether. Am- 
 monia. Chloroform. Brandy. Mustard pediluvia. Warmth to the 
 joints. Sinapisms. Turpentine stupes. 
 
 To prevent repetition of attack : Well-regulated diet. Food from which 
 healthy chyle can be extracted. Claret. Hock. Hungarian wines 
 (Other or Carlowitz). Brandy and water. Soda water. Vichy water. 
 Infusion of leaves of common ash. Mild aperients. Carbonate or cit- 
 rate of lithia, 64. Moderate mental and bodily exertion. Avoidance of 
 too great sexual indulgence. Hot-air or water baths. A visit to Bath, 
 46); Buxton, 464; Cheltenham, 461 ; Harrogate. 46i) ; or Leamington, 
 463. Wiesbaden, 489. Vichy, 479. Carlsbad, 496! Aix-la-Chapelle;483. 
 
 GRAVEDO. — From Gravis^ heavy. Catarrhal inflammation of mem- 
 brane lining frontal sinuses. — See Catarrh.
 
 128 graves' disease — h^matozoa. 
 
 GRAVES' DISEASE. — This name has been given to a singulai- com- 
 bination of three symptoms, — palpitation, protrusion of eyeballs, and 
 enlargement of thyroid gland. More common in females than males: 
 there is often some obscure connection between it and disturbance of 
 the uterine functions. Generally believed that a neurosis of the cervi- 
 cal sympathetic nerve is the cause of the affection. The cases run a 
 chronic course. The remedies to be resorted to will depend on the con- 
 dition of the system ; — i. e., whether there is any syphilitic taint, or 
 tuberculosis, or simply a state of an»mia. 
 
 H.ffiIIIATEMESIS. — From Al/ia, blood ; iiJ-ico, to vomit. Synon. Gas- 
 trorr/uKjiit ; ILvmorrhcea Ventrlculi ; Vomiting of Blood. — Hemorrhage 
 from the stomach may be either acute or chronic; latter most danger- 
 ous, as indicative of some disease of abdominal viscera. 
 
 Symptoms. Blood vomited in considerable quantities. Blood not 
 frothy: of a dark color. Blood mixed with food. Melsena very com- 
 mon. Gastric or duodenal symptoms. Perhaps, simple or malignant 
 ulcer; cirrhosis of liver; aneurism of one of the branches of abdominal 
 aorta; vicarious menstruation ; scurvy. 
 
 Treatment. In acute form : Abstinence from food. Perfect rest in 
 horizontal posture. Cold to the epigastrium, 118. Ice or cold acidulous 
 drinks. Gallic acid, 103. Turpentine, 102. Sulphuric acid and opium, 
 100. Tincture of perchloride of iron, 101. Lead and acetic acid, 117. 
 Alum and sulphuric acid, 116. Ipecacuanha. Enemata of beef tea and 
 brandy, 21, 23. 
 
 In chronic form : Mineral acids with bark, 376. Quinine and iron, 380. 
 Ammonio-sulphate of iron, 116. Cream; raw eggs; essence of beef. 
 Cod-liver oil. — See Mctmoptysis. 
 
 H^MATOID CANCER. — From Alaa, blood; terminal -ides. Synon. 
 Fungus Hecmatudes. — This disease is probably a soft medullary or other 
 cancer, the substance of wiiich has become more or less infiltrated with 
 blood. When it protrudes through the skin it forms a large vascular 
 mass, somewhat resembling a clot of blood. — See Cancer. 
 
 H.ffiMATOMA AURIS. — From J f/iar^w, to convert into blood; Auris, 
 the ear. — A sanguineous tumor about outer surface of auricle of ear. 
 Often symmetrical. Especially affects insane. The explanation of its 
 occurrence is: (1) The states of the circulation, nutrition, and develop- 
 ment of tissues which make up the ear-lobule, and cover the helix, very 
 commonly coincide with similar conditions of the encephalic tissues. 
 (2) Development of cartilages of external ear, and their several parts, 
 is in relation with encephalic and cranial development of individual 
 (Lay cock). — See Insanity. 
 
 H.ffiMATOZOA. — From Al/m, blood ; ^ojov, an animal. — The following 
 entozoa have been found in human blood : 
 
 (1) Distoma ILematobium. — An entozoon with a flat elongated body 
 and a cylindrical tail : inhabits the vena portse, and the veins of the 
 mesentery, liver, bladder, and intestines. It is very common in Egypt, 
 and especially infests the bodies of those who drink the unfiltered waters 
 of the Nile, &c. It is probably the cause of a peculiar form of ha^ma- 
 turia somewhat prevalent in Southern Africa and in the Mauritius. — 
 Chief remedies: Calomel. Turpentine. The efticacy of either very 
 doubtful. 
 
 (2) Hexathyridium Venarum. — About three lines in length. Has 
 been found in venous blood, and in sputa of patients with haemoptysis.
 
 HiEMATURIA — HEMOPTYSIS. 129 
 
 (3) Fasciola Hepatica. — Has been discovered in the vena portffi. 
 This fluke and the Distoma lanceolatum are often found in the gall-duets 
 and bladder of the sheep, producing the distemper or Eot. — See Eiitozoa. 
 
 HJEMATURIA. — From Aliia, blood; o5/5ov, urine. Synon. Hcvmuresis ; 
 Sanguis in Urina ; Bloody Urine. — Hemorrhage from the mucous mem- 
 brane of the urinary passages, — the kidnej^s, bladder, or urethra. 
 
 Symptoms. Urine smoky, or of a black hue, or of a port-wine tint. 
 Albumen present. When from kidney, the blood equally diffused 
 through the urine. When from bladder or urethra, blood comes away 
 after passing clear urine. Blood-casts of renal tubes? Cancer cells.? 
 Eenal calculi ? 
 
 Endemic haematuria of Egypt, Southern Africa, and Mauritius due to 
 the Distoma hajmatobium. — See Hcematozoa. 
 
 Treatment. In malignant disease or calculus: Gallic acid, 103. Tinc- 
 ture of perchloride of iron, 101. Sulphuric acid and opium, 100. Infu- 
 sion of matico. Euspini's styptic. Turpentine. Creasote. Krameria. 
 Ergot of rj^e. Opium. Rest in recumbent posture. Sinapisms. Turpen- 
 tine stupes. Application of ice to loins. 
 
 In renal disease, or some morbid poison in the blood : Hot air baths. 
 Warm water baths. Compound jalap powder. Ferruginous tonics, — 
 especially tincture of perchloride of iron, a'nd iron alum. 
 
 From disease of urethra: Aj>plication of ice. Use of a large bougie 
 for some hours. 
 
 Vesical hemorrhage : Injections of alum or tannin, grs. 30 to water fl. 
 oz. X. Ice to pubes. Ammonio-sulphate of iron, 116. 
 
 H^MOGASTRIC FEVER.— From Alfia, blood; y^ffrrip, the stomach. 
 Synon. Febris Flara ; Festilentia Hcemagastrica; Festis Infertropica ; Ty- 
 phus Icterodes; Synochus Icterodes; Malignant Pestilential Fever. — See 
 Yellow Fever. 
 
 HEMOPTYSIS.— From A^im, blood; xruw, to spit. Synon. Emoptoe ; 
 Sputum Sanguinis; Hiemorrhagia Pulmonis; Pneumorrhagia. — The escape 
 of blood through the mouth — from larynx, trachea, bronchial tubes, or 
 air-cells of lungs. Of little consequence, comparatively, when due to 
 some accidental and transitory cause. An important indication of bron- 
 chial, pulmonary, cardiac, or aortic disease when of frequent recurrence, 
 at variable intervals. 
 
 Symptoms. Blood coughed up in mouthfuls. Blood frothy, and of a 
 florid red color. Blood mingled with sputa. Absence of mela?na. Bron- 
 chial or pulmonary symptoms. Tubercular deposit? Aortic aneurism? 
 
 Distinction between haBmoptysis and hffimatemesis: 
 
 In hcemoptysis : In hannatemesis : 
 
 Dyspnoea ; pain or heat in chest. Nausea ; epigastric tension. 
 
 Blood coughed up in mouthfuls. Blood vomited profusely. 
 
 Blood frothy. Blood not frothy. 
 
 Blood of a florid red color. Blood dark colored. 
 
 Blood mingled with sputa. Blood mixed with food. 
 
 Absence of melsena. Melsena very common. 
 
 Bronchial or pulmonary symptoms. Gastric or duodenal symptoms. 
 
 Treatment. Strict mental and bodily repose. Rest in bed. Head 
 and shoulders to be elevated. Unstimulating diet. Ice and cold drinks. 
 Blisters. Turpentine stupes. Sinapisms. Dry cupping. Ice to chest. 
 
 (jrallic acid, 1U3. Mineral acids, 99. lUO, 115. Acetic acid. Ammonio- 
 sulphate of iron, 116. Acetate of lead and opium, 117. Creasote. Com- 
 
 9
 
 130 HEMORRHAGE — HEMORRHOIDS. 
 
 men salt? Ergot of lye. Turpentine, 102. Alnm. Infusion of matieo. 
 Hydrocyanic acid. Morphia. Emetics of ipecacuan. Antimonj- ? Digi- 
 talis? Leeches? Venesection? A ligature round the limbs. Inhalation 
 of atomized fluids, medicated with tannic acid, alum, perchloride of 
 iron, or turpentine, 262. 
 
 H.ffiMORRHAGE. — Synon. Sanguifliixus ; ITcemorrhoea ; Loss of Blood; 
 Rupture of a Bloodvessel. — The escape of blood from the vessels in which 
 it is naturally contained constitutes haemorrhage {Jicemorrhagia, from 
 A\iJ.a, blood ; prjvuiu. to break out). 
 
 Varieties. The chief subdivisions are these: (1) Traumatic when a 
 vessel has been directl}^ divided, and spontaueovs when the bleeding has 
 resulted fi-om some constitutional cause. (2) Symptomatic when clearly 
 a result of some disease, as tubercle, cancer, &c., and idiopathic or essen- 
 tial, when no such connection has been perceptible. Or, (3) active hemor- 
 rhage when congestion or inflammation has preceded the flow, and 
 passive when there have previously existed signs of debility, with pov- 
 erty of blood. Moreover, hemorrhages have been termed constitutional 
 when they occur at intervals, and seem to be of service to general 
 health, as in the bleeding from piles in plethoric people: vicarious when 
 su])plenu'ntal of some other hemorrhage, as where a woman has peri- 
 odical bleeding from nose in place of usual catamenial discharge: and 
 sometimes spoken of as critical when they occur during progress of 
 some disease, and produce marked good or bad effects. 
 
 The. seat of the hemorrhage is likely to vary with the patient's age. 
 Bleeding from the nose is most common in youth : from the lungs and 
 bronclii, stomach, urinary passages, and uterus in adults: and from the 
 cerebral vessels and rectum in old age. 
 
 Treatment. Cool apartment. Eepose. Freedom from excitement. 
 Simple and unstimuhiting diet. Position such as to prevent afliux of 
 blood to bleeding organ. Application of cold. Turpentine stupes. Blis- 
 ters. Ligatures. 
 
 Ice. Gallic acid. Tannin. Mineral acids. Ammonio-sulphate of 
 iron. Tincture of perchloride of iron. Creasote. Ipecacuanha. Ace- 
 tate of lead. Ruspini's styptic. Oil of turpentine. Nitrate of silver. 
 Oxide of silver. Alum. Kino. Matieo. Ehatany. Corrosive sub- 
 limate. Calomel. Ergot of rye. Opium. Venesection. Digitalis. 
 Aperients. Transfusion. — ^qq Apoplexy ; Epistaxis; Hcematemesis ; Hcem- 
 aturia. ; Hcemoptysis ; Menorrhagia; Melcena; Otorrhagia; Stomatorrha- 
 gia. 
 
 HEMORRHAGIC DIATHESIS.— May be hereditary, or will perhaps 
 
 be induced by insutiicient food. 
 
 Symptoms. Ecchj'moses. Dropsy. Painful swellings round joints. 
 Bleeding from umbilicus a few days after birth; from nose or gums in 
 youth ; from urinary passages or rectum in after-life. Fatal loss of blood 
 after leech-bite, extraction of a tooth, rupture of hymen. &c. 
 
 Treatment. Avoidance of surgical operations. Caution after acci- 
 dents. Nourishing food. — See Haemorrhage. 
 
 H-ffiMORRHOIDS.— From Al/ia, blood ; pico. to flow. Synon. Proctal- 
 gia Ha'Tiiorrhoidalis; Piles. — Small tumors situated within or at verge 
 of anus. Two varieties : (1) ixferna/, or those outside sphincter muscle. 
 (2) Internal, or such as are within sphincter. Often, the two kinds 
 coexist. 
 
 1. External Haemorrhoids. — Consist either of a knot of varicose veins,
 
 HEADACHE. 131 
 
 or of one or more cutaneous excrescences. In first case, the veins may- 
 contain fluid blood: more frequentl}^ their contents have coagulated, 
 forming one or several tense and purple swellings. The excrescences 
 consist chiefly of hypertrophied skin and areolar tissue. 
 
 Symptoms. When indolent, only troubleson)e from their bulk. If 
 they become congested or inflamed, considerable pain arises; with heat 
 and throbbing, tenesmus, backache, irritability of bladder, perhaps re- 
 tention of urine, and uterine irritation in women. 
 
 Treatment. Daily action of bowels to be procured. Confection ot 
 pepper. Confection of senna. Confection of sulphur. Compound elec- 
 tuaries, 194. Simple enemata, 188. Sulphur and magnesia, 153. Pep- 
 sine and extract of aloes, 155. (Jastor oil. Mercury and chalk. Taraxa- 
 cum. Pullna water. Anus to be sponged with cold water after every 
 stool. Sponging parts round anus, when relaxed, with lotions of alum 
 or tannic acid. Ointment of galls. Ointment of galls and opium. — 
 Plain nourishing food; free from highly seasoned dishes, coffee, and 
 alcoholic stimulants. — Hot bathing and poultices, where there is inflam- 
 mation. — Incision, with evacuation of contained clot, when tumor is 
 swollen and tender. — Excision of growths with curved scissors. 
 
 2. Internal Haemorrhoids. — May be simple or multiple. Of three kinds : 
 (1) S]>ongy vascular growths, having a red granular appearance, and 
 soft elastic texture like that of erectile tissue. (2) Made up of lower 
 branches of the plexus of hgemorrhoidal veins. Branches dilated : often 
 plugged with coagula. (3) Pendulous tumors, composed of fibro-areolar 
 tissue. 
 
 Symptoms. The piles only protrude during defecation at first. After- 
 wards, as sphincter gets dilated by their jjressure, and relaxed by 
 attacks of hemorrhage, they are constantly down save when patient 
 is in recumbent posture. Loss of blood, from a mere tinging of fffices 
 to escape of many ounces. Uneasiness about rectum : tenesmus. Irri- 
 tability of bladder, and of uterus in women. Muco-purulent discharge. 
 Loss of flesh. Anjemia. Sallowness of complexion. Derangement of 
 functions of liver, stomach, and bowels, &c. 
 
 Treatment. Daily action of bowels to be insured by remedies re- 
 commended for external piles. Improvement of general health. Atten- 
 tion to functions of liver, digestive organs, &e. Nitro-hydrochloric acid. 
 (Quinine. Arsenic. Sulphur. Cold water enemata. Enemata of solu- 
 tions of gallic acid, alum, ammonio-iron alum, or of tincture of per- 
 chloride of iron to check hemorrhage. When protruded piles cannot 
 be replaced, it may be necessary to reduce their size by applying ice, 
 or by puncturing, before making further attempts. If, from constric- 
 tion of sphincter, protruded piles have become strangulated and more 
 or less gangrenous, they must be poulticed, and pain relieved by opiates, 
 till they slough oft'. 
 
 Radical cures: By cauterization with nitric acid. Simple excision 
 dangerous, owing to probability of hemorrhage. Excision with ecraseur. 
 Use of clamp and excision ; appljang actual cautery, or nitric acid, 
 before removing clamp. Operation by ligature the safest and most to 
 be recommended. 
 
 HEADACHE. — Synon. Cephalalgia, iroxn KsipaXri, the head; a'A^o?, pain. 
 — Of common occurrence during progi'css of most acute and many 
 chronic diseases. Affects adults more than young or old ; inhabitants 
 of towns more than country folk: nervous and delicate more than 
 robust : higher classes of society more than lower. 
 
 Varieties. Pour principal forms may be noticed : (1) Organic head-
 
 132 HEMERALOPIA — HEMICRANIA. 
 
 ache, due to disease of bvain or membranoe, and especially of such in 
 early stage. Accompanied by vertigo; sometimes by vomiting, confu- 
 sion of mind, noises in ears. Pain, sliarp or dull or lancinating or throb- 
 bing : more severe in disease of meninges than of brain substance. When 
 due to inflammation, pain intense, increased by warmth or noise or 
 movements, and lessened b}'" elevating head. — In valvular disease of 
 heart, the interrupted supply of blood to nervous system causes head- 
 ache. 
 
 (2) Plethoric headache, dependent on congestion of cerebral vessels. 
 Sense of pulsation in ears : giddiness on stooping. Constipation. Those 
 who live too freely, take but little exercise, rise late in morning, &c., 
 are subject to it. It may arise from sudden suppression of accustomed 
 discharge, as of catamenia. 
 
 (3) Bilious headache, temporary or constant. When temporary, pro- 
 duced by some error of diet, any excess in food or wine. Most severe 
 in morning, after restless night. Passes away with cause. Constant 
 sick headache occurs in persons with w^eak stomachs, and in the gouty. 
 Stomach and duodenum out of order: tongue coated, breath offensive, 
 flatulence, low s]»irits, nausea. Hepatic functions ill-performed; stools 
 clay-colored. Urine scanty and high-colored. 
 
 (4) Nervovs headache, often owing to debilit}' and exhaustion. Poverty 
 of blood from renal disease, hemorrhage, &c., may induce it. Irritation 
 of decayed teeth, or off'ensive stumps, a frequent cause. — In hemicrania, 
 or brow-agne, symptoms are intermittent, recurring with regularity of 
 an ague fit. — The megrims is a form which aff'ects delicate women, espe- 
 cially if exhausted by over-lactation. — When hysterical young women 
 suffer from nervous headache it is often confined to a single spot, resem- 
 bles the pain of driving a nail into the part, and is known as clavus hys- 
 tericus. 
 
 Treatment. The indications are to relieve congestion of head and 
 dyspeptic symptoms, while tone is given to general system. Diet to be 
 regulated: often beneficial to discontinue tea and coff'ee. Milk taken at 
 night may be injurious. Tobacco in all forms to be forbidden. In 
 organic headaches, attention to be paid chiefly to cerebral mischief. 
 
 Sulphate of soda and taraxacum, 144. Aloes, gentian, and liquor 
 potassa>, 148. Pej)sine and aloes, 155. Ehubarb and magnesia, 165. 
 Rhubarb and blue ])ill, 171. Nux vomica and rhubarb, 175. Colchicum, 
 46. Phosphate of iron, 4U5. Effervescing citrate of magnesia. Hydro- 
 chlorate of ammonia, 60. Aconite. Camphor. Nitro-hydrochloric acid, 
 378. Where there is albuminuria, iron alum, 116: tincture of per- 
 chloride of iron and hydrochloric acid, 101. Quinine or arsenic in hemi- 
 crania, 52, 379, 381. Zinc or steel in hysterical forms, 394, 403, 410, 414. 
 Stramonium. Shower baths. Mustard pediluvia. Holding arms high 
 above the head sometimes palliative, owing to effect on cerebral circu- 
 lation. Compression of temporal arteries with pads and a bandage 
 round forehead. Cold lotions, sponge dipped in cold water, eau de 
 Cologne, ifcc, to forehead and crown. Dry cupping, or blisters, or sina- 
 pisms, or setons, to nape of neck. Extraction of bad teeth. Change of 
 air. 
 
 HEMERALOPIA. — From "Hfiipa, daylight; oTZToimi, to see. Synon. 
 Visus Diurnus ; Dysojria Tenebrarum ; Day-vision. — That condition in 
 which vision is only distinct during daylight — See Amaurosis. 
 
 HEMICRANIA.— From "H/icffo^, half; xpau{ov, the skull. Synon. Hem- 
 icephahva ; Neuralgia Cerebral is ; Megrims. — Headache affecting one side 
 of brow and forehead. — See Neuralgia ; Headache.
 
 HEMIOPIA — HEPATIC ATROPHY. 133 
 
 HEMIOPIA. — From "Hfj.c(Tu<;, half; cu</', the eye. Synou. Visus Dimid- 
 iatus; Amaurosis Dimidiata. — That form of faulty vision in which only 
 half an object is seen. — See Amaurosis. 
 
 HEMIPLEGIA. — From "Hiuau^, half; TzXrjrrffu), to strike. Synon. Sem- 
 ipJcgia ; Semisideratio. — Paralysis limited to one side of the body. See 
 Paralysis. 
 
 HEPATIC ATROPHY.— From 'Hxarixdq, affecting the liver: 'J, priv.; 
 Tpi<poj, to strengthen or support. The secretion of bile may be sus- 
 pended owing to acute atrophy; as well as from cirrhosis, extensive 
 cancer, &c. — See Acholia. 
 
 1. Acute Atrophy of Liver. — Synon. Yelloto Atrophy of Liver; Acute 
 Wasting of Liver; Softening of Liver; Lif used Hepatitis ; Fatal Jaun- 
 dice. — A most remarkable disease ; consisting as a rule, of a rapid and 
 complete destruction of hepatic cells through every part of the gland. 
 Women more obnoxious to this rare affection than men; pregnancy 
 seems to predispose to it. Among other alleged exciting caugesai'e, — 
 grief or anxiety, sudden alarm, fits of passion; venereal excesses, syph- 
 ilis, excessive use of mercury; drunkenness and dissolute habits; 
 poisons of malaria and typhus. Many points of resemblance between 
 acute atrophy and yellow fever. 
 
 Symptoms. Preliminary stage : Headache, loss of appetite, thirst, 
 drowsiness, mental and bodily depression, irregularity of bowels, ten- 
 derness of abdomen. Then conjunctivae become yellow : skin gets 
 slightly jaundiced. These precursory symptoms may last from a few 
 days to three or four weeks; or may be altogether absent. 
 
 Confirmed stage : Jaundice; perhaps with petechia and large ecehy- 
 moses. Yomiting; at first of mucus, afterwards of matter like coffee- 
 grounds (altered blood). Irritability, great despondenc}^ ; soon followed 
 by wandering merging into noisy delirium and convulsions, stupor and 
 deep coma. — Tongue and teeth coated with black sordes. Pains about 
 epigastric and right hypochondriac regions. Diminution of hepatic 
 dulness: increased area of splenic dulness. Obstinate constipation: 
 purgatives bring away hard clay-colored stools; at later period, evacu- 
 ations black from presence of blood. Difficult micturition ; urine 
 loaded with bile pigment, perhaps albuminous, and containing tyrosine 
 and leucine. — Increase of jaundice. Bedsores, if life be prolonged 
 beyond eight or nine days. Hemorrhages from nose, stomach, bowels, 
 bronchi, <fec. 
 
 Death usually occurs within a week from commencement of confirmed 
 stage: sometimes within eighteen or twenty-four hours. 
 
 Treatment. Empirical and probably- useless. Usual remedies : 
 Drastic purgatives; then mineral acids, with dift'iisible stimulants as 
 prostration increases. Large doses of quinine and mineral acids. Ice. 
 Cold drinks. 
 
 2. Chronic Atrophy of Liver. — This disease is in no way connected 
 with acute atropli}^ It results from all those conditions which tend to 
 arrest the capillary circulation through the gland, and hence to lessen 
 its nutrition. 
 
 Symptoms. Developed slowl}^ and insidiously. Imperfect digestion: 
 flatulence, diarrhoea alternating with constipation, pale-colored stools. 
 Dry sallow skin. Loss of flesh and strength. Ana?mia : persistent 
 wasting: perhaps dropsy : finally, there may be fatal exhaustion. 
 
 Treatment. Light nourishing food : avoidance of rich dishes, sugar, 
 fermented drinks, coffee. Warm clothing;. Over-fatigue to be guarded
 
 134 HEPATIC CALCULI — HEPATIC CONGESTION. 
 
 against. — Pepsine, 420. Purified ox bile with ammonia, 170. Quinine 
 and ipecacuanha, 44, 384. Quinine and rhubarb, 385. Bark and min- 
 eral acids, 376. Harrogate waters, 466. Spa, 467. Kissingen, 493. 
 Marienbad, 497. — If dropsy sets in: Squills, digitalis, and broom, 219. 
 Bnchii and acid tartrate of potash, 222. Nitre, juniper, and ether, 221. 
 Tapping, to afford temporary relief. 
 
 HEPATIC CALCULI. — From 'Hrarud^, affecting the liver; Calculus 
 (dimin. of calx), a small stone, — See Gall-stones. 
 
 HEPATIC CANCER. — From "HTzaTcxdc;, affecting the liver. — Every 
 variety of cancer has been met with in the liver. Medullary more 
 common than scirrhus. 
 
 Symptoms. In addition to general inrlications of malignant disease: 
 Enlargement of gland : loss of regular form : detection of uneven bulg- 
 ing prominences. Nodulous masses often give rise to partial peritonitis. 
 Daily increasing loss of flesh and strength. Diffused abdominal pain 
 and tenderness. Indigestion. Irritability and mental depression. 
 Jaundice occurs more frequently than ascites: occasionally both 
 present. Formation of gall-stones not uncommonly adds materially to 
 the suffering. 
 
 Duration, except in scirrhus, short. Life seldom prolonged for two 
 years, sometimes only for six months, from onset of symptoms. 
 
 Treatment. Opium. Belladonna. Conium. Ammonia and bark. 
 Mineral or vegetable acids. Light nourishing diet.— See Cancer. 
 
 HEPATIC CONGESTION. — From'//^ar«oc, affecting the liver. Synon. 
 Hypera'.mia of the Liver ; Congestion of the Liver. — Two varieties to be 
 described : 
 
 1. Passive, Congestion. — Simplest form. Results from some obstruction 
 to circulation through hepatic and portal veins. Occurs in valvular affec- 
 tions of heart; in morbid states of lungs impeding passage of blood 
 through pulmonary artery; in diseases which diminish capacity of 
 thoracic cavity ; temporarily, from violent exercise, &c. Leads to 
 diminished excretion of bile : ducts become gorged with bile — biliary 
 congestion. 
 
 Symptoms. Sense of constriction and weight in rigbt hypochondrium. 
 Often, slight jaundice, nausea, dyspepsia : urine scanty, high-colored, 
 perhaps contains bile-pigment, with traces of albumen : constipation 
 and haemorrhoids. Area of hepatic dulness found to be increased on 
 percussion. Symptoms of cardiac or pulmonary disease, &c. 
 
 Treatment. Sulphate and carbonate of magnesia, 141. Sulphate of 
 soda and sulphuric acid, 143. Aloes, senna, and sulphate of magnesia, 
 150. Antimony and magnesia, 152. Nitric acid, senna, and taraxacum, 
 147. Ammonia and rhubarb, 161. Sulphates of magnesia and iron, 
 166. Leeches to anus. Harrogate waters, 466. Carlsbad, 496. Kis- 
 singen, 493. Marienbad, 497. Simple diet. Avoidance of stimulants. 
 
 2. Active Congestion. — Capillaries of hepatic artery chiefly affected. 
 Produced by morbid matters in blood ; suppression of habitual dis- 
 charges, i. e. hfemorrhoidal, catamenial, &c. ; long residence in hot cli- 
 mates; deranged nervous influence; atony of bloodvessels from disease 
 of coats; excessive eating and drinking, alcohol, &c. ; sedentary habits. 
 
 Symptoms. Fulness and sense of tightness about right hypochondrium. 
 Slight enlargement of gland. Pains about right shouldei-. Headache; 
 loss of appetite; mental depression; nausea; irregularity of bowels, 
 bilious stools, &c. These symptoms soon pass off, unless the congestion
 
 HEPATIC DEGENERATIONS. 135 
 
 be kept up by non-removal of the cause; in which ease structural dis- 
 ease may ultimately result, with jaundice, perhaps suppurative fever, 
 perhaps di'opsy, &c. 
 
 Treatment. Removal of cause. Horse exercise, walking, &c. Simple 
 diet: white fish, fresh vegetables, rice, weak tea, &c. Aloes, gentian, 
 and solution of potash, 148. Sulphate of soda and taraxacum, 144. 
 Aloes, senna, and jalap, 145. Eesin of podophyllum. Sulphate of man- 
 ganese, 172. Nitro-hydrocbloric acid, 378. 
 
 3. Apoplexy of Liver. — Extravasated masses of blood sometimes found 
 in hepatic tissue, or beneath the capsule. Results of great congestion 
 induced by morbid changes in the blood. Occur in scurvy, purpura, 
 ichorhffim'ia, and especially in malarious fevers of tropical climates. 
 Extravasations often numerous: vary in size from a pea to a hen's egg: 
 or blood may be infiltrated through parenchyma, converting the tissue 
 into a pulpy mass. 
 
 HEPATIC DEGENERATIONS.— From 'H-arcxd^, affecting the liver: 
 Degenero, to degenerate. — Three varieties: 
 
 1. Fatty Degeneration of Liver. Synon. Hepar Adiposum ; Fatty Liver. 
 — A great increase in the quantity of oil naturally contained in the 
 hepatic cells; so that, on minute examination, the latter are found 
 gorged with oil-globules, diminishing the normal granular matter, and 
 quite obscuring the nucleolated nuclei. 
 
 Of frequent occurrence in phthisis, and in flitty degeneration of other 
 important organs. May affect those who live too freely, who lead 
 indolent lives. Has been observed in constitutional syphilis ; as well as 
 after death from ichorhfemia, typhus, small-pox, erysipelas, &c. 
 
 Symptoms. If cells be excessively loaded, they may impede capillary 
 circulation, and obstruct excretion of bile. Gastric catarrh, dyspepsia, 
 constipation alternating with diarrhcea, pasty-looking complexion, 
 anffimia, hemorrhoids, &c., may be present. Possibly, ascites ; complete 
 acholia; or fatal exhaustion. 
 
 Treatment. Regulation of diet : plainly cooked animal food, fresh 
 ripe fruits. Avoidance of alcohol, sugar, amylaceous matters, and fat. 
 Daily exercise. Sulphate of soda and taraxacum, 144. Alkaline ape- 
 rients, 148. Rhubarb and magnesia, 165. Hydrochlorate of ammonia, 
 60. Iodide of potassium, 31. Harrogate waters, 466. Carlsbad, 496. 
 Kissingen, 498. Selters, 487. 
 
 2. Amyloid Degeneration.— From Amylum, starch. Synon. Waxy, 
 Albuminous, Lardaceous, or Scrofulous Liver. May coexist Avith fatty 
 liver, cirrhotic induration, syphilitic cicatrices and gummatous nodules, 
 or be alone present. The glandular structure is gradually converted 
 into a dense material: hence, destruction of hepatic cells with abolition 
 of their functions. After death, liver found increased in weight and 
 size : may average 8 or 9 lbs. avoir, instead of 3 or 4 lbs. Substance 
 tough, resembling yellow wax : cut surface presents only faint traces of 
 lobules. 
 
 Chief predisposing causes, — Caries and necrosis in strumous subjects ; 
 constitutional syphilis; tubercular disease of lungs and intestines; and 
 perhaps intermittent fever. 
 
 Symptoms. Enlargement of liver. Sense of fulness in right hypo- 
 chondrium. Enlargement of spleen. Loss of appetite. Dyspepsia : 
 flatulence, attacks of diarrhoea with pale stools, nausea. Albuminuria, 
 from coexistence of same disease in kidneys. Very rarely, acute pain; 
 jaundice; ascites. Disease slowly but steadily advances to fatal ter- 
 mination.
 
 136 HEPATIC HYPERTROPHY — HEPATIC TUMORS. 
 
 Treatment. TJnsatisfactoiy. Attempts to be made to relieve the 
 cause, and prominent symptoms. Iodide of potassium. Iodide of iron. 
 Ferruginous tonics. Warm or tepid sea-water baths. Digestible food. 
 — See Amyloid Degeneration. 
 
 3. Pigment Liver. — Synon. Melancemic Liver. — After death from severe 
 intermittent, remittent, or continued fevers, the liver is sometimes found 
 to present a blackish or chocolate color. This is due to accumulation 
 of pigment matter in vascular apparatus of the gland (Frerichs). The 
 loading of the hepatic capillar'ies with this melanotic matter, leads to 
 their destruction, and consequent atrophy of the gland. The resulting 
 gastric catarrh, diarrhoea, iand severe cerebral symptoms or ascites, are 
 incurable. 
 
 HEPATIC HYPERTROPHY.— From 'HTza-cxd-, affecting the liver: 
 'T-rsft, in excess; rpifiu^ to nourish. — Hyperti'ophy of liver characterized 
 by an increase in the secreting cells, causing general enlargement of 
 the gland. Hepatic cells may be increased in size, or multiplied in 
 number. 
 
 Arises from long-continued congestion, such as occurs in residents of 
 tropical climates or of malarious districts. Sometimes found in leucocy- 
 themia, phthisis, dysenleiy, saccharine diabetes, &c. Partial h^-per- 
 trophy may be of a compensatory nature; i. e., a portion of gland 
 having been rendered useless by disease, the healthy part has its cells 
 enlarged so as to prevent systemic derangement. 
 
 HEPATIC TUMORS.— From 'Hizarub^, affecting the liver: Tumor 
 (tumeo), a tumor. — The most significant new formations having their 
 seat in the liver are the hydatid tumors and cancerous infiltrations (see 
 Hepatic Cancer). There are, however, two or three other growths 
 which may be met with. 
 
 1. Cystic Tumors. — Enc3-sted knotty tumors, containing a cheese like 
 substance, are found in the glandular substance, varying in size from 
 that of a large pea to a small potato. They have their origin in in- 
 flammation of mucous lining of hepatic ducts. Steatomatous contents 
 composed of irregular granules, free oil globules, and occasionally plates 
 of cholesterine. 
 
 Simple serous cysts, with clear watery contents, are sometimes scat- 
 tered through the liver. Seldom larger than small beans. 
 
 Sacculated cysts, containing a glairy fluid, may be met with. Very 
 rarely, the liver has been crowded with such cavities. 
 
 2. Cavernous Tumors. — Common]}^ found on the upper surface of the 
 gland, especially in bodies of aged persons. They are developed in the 
 hj'pertrophied connective tissue. On the surface, the}^ look like dark 
 blue-colored spaces, varying in size from that of a pea to a fowl's egg: 
 on cutting into them, a tissue is found resembling that of the corpora 
 cavernosa of penis, containing dark blood. 
 
 3. Tuberculosis. — Tubercular deposits very rare in liver: probably 
 never occur primarily, but always in connection with far advanced 
 tuberculosis of other organs — especially of abdominal viscera. Deposit 
 takes place over all parts of the gland, in shape of semi-transparent 
 miliary granules, or as yellow adipose de2)0sits. Patient usually suc- 
 cumbs to constitutional affection before stage of softening sets in. 
 
 4. Hydatid Tumors. — From 'T3aTi<;, a vesicle. Synon. Echinococci of 
 the Liver. — Hydatid tumors occur in the liver more frequently than in
 
 HEPATITIS. 137 
 
 other organs. They are occasionally met with, however, in subperito- 
 neal areolar tissue, spleen, omentum, muscles of heart, brain, kidneys, 
 lungs, ovaries, and bones — particularly the tibia. 
 
 Tliese growths consist of a sac formed by condensation of surround- 
 ing tissue, lined by a thin bladder or c_yst, and filled with a limpid salt 
 fluid; floating in which are usually found numerous small bladders, 
 which contain the entozoon known as the echinococcus ('E/Jvo:;, a hedge- 
 hog, and xoy-xog, a beny). Hence, the term "echinococcus cysts" is 
 sometimes used synonymously with "hydatids." The echinococci are 
 immature tapeworms — the scolices or embryos of the Taenia echinococ- 
 cus which infests the dog and wolf 
 
 Symptoms. A hydatid tumor in the liver grows slowly. Ma}* give 
 rise to little inconvenience beyond a sensation of weight. When large 
 it is easily detected : volume of liver increased. Occasionally, fluctua- 
 tion : in exceptional cases, a peculiar vibrator}- sound — hydatid fremitus. 
 If the cyst inflame, violent pains: sometimes compression of portal 
 vein or vena cava, causing ascites and oedema of legs. — Cyst may burst 
 into peritoneum, causing fatal peritonitis: or into base of lung, hydatids 
 and puriform matter being expectorated; or into hepatic duct, whence 
 contents maj^ pass through common duct into duodenum. More for- 
 tunately- it sometimes bursts directly into intestines, or through ab- 
 dominal wall. May also undergo spontaneous cure, without rupture; 
 by secretion of thick putty-like matter within the sac. 
 
 Treatment. Iodide of potassium, 31. Calomel. Common salt. Sul- 
 phur baths. Electricity. Eemoval of fluid contents by tapping. Injec- 
 tion of solution of iodine, or diluted alcohol, after tapping. Insertion 
 of drainage-tube after tapping. Careful incision, provided cyst be ad- 
 herent to integuments. 
 
 HEPATITIS. — From "H-ap, the liver; terminal -itis. Inflammation 
 of the liver lias to be considered under five heads: (1) Hepatitis, or in- 
 flammation of peritoneal investment, or of substance of the gland, or of 
 both combined. (2) Cirrhosis, or that slow form of inflammatory ac- 
 tion which affects the areolar or connective tissue. (3) Syphilitic 
 hepatitis. (4) Inflammation of the bloodvessels. (5) Inflammation of 
 biliar}- ducts and gall-bladders. 
 
 1. Hepatitis. — Synon. Suppurative Injiammation of Liver. — Occasion- 
 ally, only the coats of liver and Glisson's capsule become inflamed (Peri- 
 Hepatitis). More commonl}^, substance of gland attacked. The morbid 
 action mtiy be diffused over wdiole organ (Hepatitis diffusa parenchyma- 
 tosa) ; an5 it may lead to softening and acute atrophy, or to induration. 
 Generally, inflammation more circumscribed (Hepatitis vera circum- 
 scripta, suppuratoria) ; and then aljscess is a frequent result. 
 
 Symptoms. Tenderness over gland: most marked if peintoneal in- 
 vestment be affected. High fever, sometimes assuming a low form. 
 Fulness of right hypochondrium : increased dulness on percussion. 
 Pain increased by pressure, cough, deep inspirations; inability to lie 
 on left side. Yellow tinge of conjunctiva; rarely jaundice. Dyspnoea, 
 cough, vomiting, headache, hiccup. Pains in right clavicle and shoul- 
 der: probably, when left lobe of liver suffers, pains in left shoulder. 
 
 Formation of abscess signalized by chills, or distinct rigors. Hectic 
 fever. G-astric disturbance. Pain and great tenderness. Tension of 
 abdominal muscles on pal2)ation. Feeling of weight about liver. Ema- 
 ciation. Prostration. Diarrhoea or dj-senterj". 
 
 Treatment. Sulphate of soda and taraxacum, 14-4. Aloes, gentian, 
 and potash, 148. Small doses of blue pill and ipecacuanha. Acid tar-
 
 138 HEPATITIS. 
 
 trate of potash. Salines, 848. Opium. Opium and ipecacuanha, 324. 
 Opium and belladonna, 344. Ipecacuanha, morphia, and astringents 
 where there is dysentery. Fomentations. Compress with dilute nitro- 
 hydrochloric acid and water. — Restricted diet. Indian sarsaparilla and 
 harley water drink, 20. Acid tartrate of potash drink, 356. Complete 
 rest in bed. 
 
 If svppuration occur: Bark and ammonia, 371. Mineral acids and 
 bark, 376. Nitro-hydrochloric acid, 378. Quinine, 379. Quinine and 
 steel, 380. Opium. "Wine. Nourishing food. — If surface of abscess have 
 become adherent to abdominal parietes, puncture with trocar and can- 
 ula, after exploratory punctui*e with grooved needle. Some authorities 
 prefer allowing abscess to burst spontaneously. 
 
 Remedies sometimes employed : Tartarated antimony. Calomel. Iodide 
 of potassium. Colchieum. Digitalis. Bloodletting. Leeches. Blis- 
 ters. Issues. 
 
 2. Cirrhosis. — From A't/>/5o<r, yellowish : because on slicing the liver it 
 presents the grayish-yellow color of impure beeswax. Synon. Intersti- 
 tial Hepatitis; Granular Induration of Lirer ; Hob-nailed Liver; Gin- 
 drinker's Liver. — Chronic inflammation and hypertrophy of areolar tis- 
 sue pervading and covering liver. The gland becomes abnormally firm, 
 and subsequently contracted ; the contraction of thickened connective 
 tissue causing the capsule to be drawn in, so that the surface of the 
 liver has a " hob-nailed" appearance. As it is a common result of spirit- 
 drinking, it is sometimes known as Gin-drinker's liver. 
 
 Symptoms. Few and obscure until effused fibrine begins to interfere 
 with flow of portal blood, and secretion and escape of bile. Slight en- 
 largement of gland : as fibrous tissue contracts and lobules atrophy, the 
 gland diminishes in size. Hypertroph}^ of spleen. Pain in right h^-po- 
 chondi'ium : indigestion, flatulence, constipation: occasional feverish- 
 ness: drj- and rough skin : unhealthy sallow look. After an interval, — 
 debilit}" with loss of flesh. An increasing contraction of eff'used Ij-mph 
 obstructs portal circulation, — ascites. Jaundice. Dilatation of veins in 
 abdominal walls. Hemorrhage into stomach and intestines. Rarely, 
 an attack of hemorrhage has constituted one of earliest symptoms, and 
 caused death before disease has been suspected. Increase of dropsical 
 efl'usion. Death from exhaustion; or from some intercurrent attack of 
 pneumonia, peritonitis, jaundice and toxaemia, or diarrhoea. 
 
 Treatment. At commejicement : Disuse of all alcoholic drinks, coffee, 
 curr}", and highly seasoned dishes. Plain animal food. Sulphate of 
 magne.sia, 141. Sulphate of soda, 143. Resin of podophyllum. 160. Acid 
 tartrate of potash and taraxacum, 194. Factitious Carlsl)fd waters, 
 181. Watersof Carlsbad, 496. Marienbad, 497. Kreuznach,484. Iodide 
 of potassium, 31. Quinine and iodide of iron, 382. 
 
 When degeneration of hepatic cells has far advanced : Nitro-hydrochloric 
 acid, 378. Pepsine and nux vomica, 420. Rhubarb and bitters, 370. 
 Inunction of hepatic region with compound iodine ointment: red iodide 
 of mercury ointment. 
 
 For checking hemorrhage : Gallic acid, 103. Turpentine, 50, 102. Cin- 
 namon and nitric acid, 104. Aromatic sulphuric acid and opium, 100. 
 Cold drinks: ice. Bladder of ice over abdomen. 
 
 For ascites: Squills, digitalis, and juice or decoction of broom, 219. 
 Buchu and cream of tartar, 222. Nitre, juniper, and nitrous ether, 221. 
 Solution of potash and digitalis. 220. Benzoate of ammonia, 215. Ela- 
 terium. 157. Calomel and jalap, 159. Morphia, chloroform, and Indian 
 hemp, 317. Tapping. Nourishing food: milk, raw eggs, stimulants. 
 
 3. Syphilitic Hepatitis. — Generally accompanied with other tertiary
 
 HEPATITIS. 139 
 
 symptoms of venereal infection. Three varieties : (1) Simple interstitial 
 hepatitis and pei'i-hepatitis. (2) Hepatitis gummosa; in which wliite 
 depressions, like cicatrices, are found to contain yellowish nodules of a 
 rounded form and dried appearance, varying in size from a linseed to a 
 hcan. And (3) as waxy, amyloid, or lardaceous degeneration. — All 
 three forms may coexist, or either may be present independently of the 
 others (Frerichs). 
 
 Symptoms. Those produced by first and second varieties seldom very 
 sti-iking: while one portion of gland becomes unfit for its functions, the 
 cells of healthy part get hypertrophied. Syphilitic cachexia. Enlarge- 
 ment of spleen. Sometimes albuminuria. 
 
 T[iEATMENT. lodidc of potassium, 31. Corrosive sublimate, 27. Green 
 iodide of mercury, 53. Red iodide of mercury, 54. JMercui-ial va])or 
 bath, 131. Nourishing food. Rest from mental and bodily labor: coun- 
 try air. Where there is renal disease, — iodide of iron, 32. — See Hepatic 
 Degenerations. 
 
 4. Diseases of Bloodvessels. — Hepatic artery and its branches may be 
 involved in liver disease. — in cirrhosis, cancer, tubercle, &c. ; or canal 
 of artery may become obstructed; or there may be atheroma of the 
 coats, or aneurismal dilatation. 
 
 Portal vein may have its channel obstructed by coagnla. — Sometimes 
 ru))tured, from fiatty degeneration of coats. — Inflammation, ulceration, 
 or suppuration of viscera in which the roots of this vein have their 
 oi'igin, may produce suppurative disease of vein itself Chief featui-es 
 of suppurative portal phlebitis are headache, violent fever, great pros- 
 tration, rigors, profuse sweating, pains in epigastrium or right h3"po- 
 cliondrium, bilious diarrhoea, jaundice, enlargement of liver and spleen ; 
 followed frequently by symptoms of peritonitis, occasionally by metas- 
 tatic purulent deposits in liver or lungs or joints; and terminating in 
 fi\tal exhaustion or coma. Remedies of little avail : quinine and opium 
 to subdue rigors and pain. Milk and raw eggs. Solution of beef, 2. 
 Demulcent drinks, 19. 
 
 Hepatic veins usually found enlarged after death from valvular disease 
 of heart. — Rarely the seat of adhesive inflammation. — Su])purative he- 
 patic phlebitis more common, as a consequence of abscess ot liver. Blood- 
 poisoning generally ensues. 
 
 5. Inflammation of Biliary Passages. — The biliary ducts and gall-blad- 
 der may be attacked b}- different forms of inflammation : (1) Catarrhal 
 inflammation, in which secretion of mucus is increased and soon be- 
 comes viscid or muco-purulent. Sometimes the cystic or common duct 
 becomes temporarily obstructed by a firm plug of mucus. The morbid 
 action generally has its origin in catai'rh of stomach and duodenum. 
 (2) In exudative or plastic inflammation there is either a firm fibrinous 
 or a croupal product. This forms casts of the tubes, blocking them up 
 and leading to dilatation. ^3) Suppurative inflammation leads to forma- 
 tion of pus and a thick kind of mucus tinged with bile. Ulceratiou 
 may occur: ulceration of gall-bladder often found, together with gall- 
 stones : may be induced by decomposing bile, where there are no calculi. 
 
 Symptoms. Verj^ variable in severity. Cxall-bladder, cystic and 
 common ducts more obnoxious to inflammation than hepatic ducts, 
 because the former are more likely to be irritated by gall-stones and 
 unhealthy bile. — In catarrhal inflammation, there is slight tendei-ness, 
 tightness about epigastric and right hypochondriac regions, nausea, 
 mild fever, and constipation. Jaundice, if viscid mucus choke up many 
 of the ducts; ending with salutary diarrhoea as pent-up bile finds its 
 way into duodenum. Undue retention of bile in gall-bladder, from any
 
 140 HERNIA. 
 
 cause, may lead to decomposition : hence irritation and inflammation, 
 perhaps ending in suppuration and ulceration and even perforation. 
 
 Dilatation of biliary passages may occur, from their origin in plexiform 
 network in which hepatic cells lie, to termination of common excre- 
 tory duct of liver or gall-bladder in duodenum. Generally, expansion 
 only partial. In any case, it may arise from habitual accumulation of 
 inspissated bile; compression of ducts by tumors or bj- disease of the 
 parench^^ma ; inflammatory swelling of mucous lining diminishing 
 calibre of tubes, and so leading to retention of their secretions as well 
 as of bile; and from obstruction by calculi, catarrhal or croupy exuda- 
 tions, &c. Owing to obstruction of duodenal orifice, the ductus com- 
 munis choledochus has become as large as small intestine. When the 
 gall-bladder cannot get rid of its contents in consequence of occlusion of 
 cystic duet, the residuary bile may be absorbed ; but if lining membrane 
 continue to secrete mucus, dropsy of cyst must result. If obstructing 
 substance act like a valve, permitting ingress of bile but preventing 
 egress, a large pear-shaped or globular tumor may form, containing 
 some pints of fluid. Rupture of bladder has been pi'evented by 
 tapping: can be safely performed provided there are adhesions to 
 abdominal wall. 
 
 Treatment. Active remedies have probably only an injurious efl'ect. 
 Recovery may be aided by a restricted diet ; warm baths ; simi)le a]^eri- 
 ents if there be constipation; astringents if there be undue diarrhcea. 
 Fomentations and sedatives to relieve pain: simple diluents or salines 
 for fever and thirst: digestible restorative food, with ammonia and 
 bark, if there be exhaustion. 
 
 Where catarrhal inflammation becomes chronic, and customary dis- 
 charge of bile does not occur, — Nitro-hydrochloric acid, 378. Benzoic 
 acid. 49. Benzoate of ammonia, 215. Hydrochlorate of ammonia, 60. 
 AVaters of Carlsbad, 496. Marienbad, 497. Sellers, 489. Ivissingen, 
 498. 
 
 Remedies sometimes employed: Leeches to anus: to hepatic region. 
 Blisters. Issues* Calomel. Blue pill. Taraxacum. Resin of podo- 
 phyllum. Tartarated antimony. Iodine. Iodide of potassium. Iodide 
 of zinc. Xitrie acid. Purified ox bile. Chlorine baths. Nitro-hj'dro- 
 chloric acid baths. Turkish baths. 
 
 HERNIA. — From "Epvo-, a branch or sprout; because in this affection 
 the whole or part of an organ shoots out from its natural position. 
 Synon. Rupture. — A tumor formed by the protrusion of more or less of 
 a viscus from its normal site. Thus, there may be hernia of the brain, 
 cornea, mucus lining of windpipe through rings of trachea, lung, liver, 
 spleen, bladder, uterus, ovaries, omentum, and intestine. When, how- 
 ever, the term '• hernia" stands alone it signifies a protrusion of omen- 
 tum or intestine through some abnormal opening in abdominal walls; 
 in which sense it is here considered. The viscera most liable to protru- 
 sion are, — small intestines, omentum, and arch of colon. The most 
 frequent sites are those points where muscular and tendinous structures 
 ar<« weakened to allow of exit of spermatic cord in male and round liga- 
 ment in female, or of large vessels to lower extremity, — inguinal 
 and crural canals. 
 
 A hernia is composed of a Sac and its Contents. The sac consists of a 
 parietal layer of peritoneum : is always present save in hernia? follow- 
 ing penetrating wounds, in some cases of congenital umbilical hernia, 
 and in cases where viscus protruded is only partially covered by peri- 
 toneum (as the Cfficum) ; and it has a neck which is often the seat of 
 constriction in strangulated hernia,', and a body which is usually pyi"i-
 
 HERNIA. 141 
 
 form or globular. When the sac only contains intestine, the rupture is 
 termed an Enterocele; when only omentum, an Epiplocele; when both, 
 an E7itero-epiploeele. 
 
 A hernia is at first Reducible, — the contents of the sac can generally 
 be pushed back into abdominal cavity, though the sac itself i-apidly 
 becomes adherent to areolar tissue. After reduction, protrusion is to 
 be restrained by a projier truss, — a pad kept over the seat of protrusion 
 by a steel spring round the body. Amongst the best trusses are those 
 of Mr. John Wood; contrived so as to exert flat and level pressure at 
 sides of hernial opening instead of in the axis. Most other instruments 
 have convex pads which exert pressure chiefly on centre of hernial aper- 
 ture, and must therefore increase its size. Bigg's convolute spring truss 
 sometimes very useful in oblique inguinal rupture. A radical cui-e may 
 be desirable : operations for eft'ecting this, either aim at invaginating the 
 skin and superficial fascia and sac, so as to plug the 0])ening through 
 which the hernia passes (Wiitzer's) ; or, after invaginating sac and 
 fascia, the sides of the aperture are brought together by sul)Cutaneous 
 stitches, and held so until sufficient adhesive inflammation has been set 
 \\\) (John Wood's). 
 
 Irreducible hernia, — protrusion generally large, of long standing, and 
 often consisting of thickened omentum and of intestine and mesentery. 
 If left alone, there is a tendency to gradual increase: to prevent this, 
 if hernia be not too large, it may be supported and protected by a truss 
 with a large concave pad; if of great size, a suspensory bandage ought 
 to be Avorn. Inflammation, simulating strangulation, sometimes occurs 
 in these hernia): the treatment must consist in use of opium, fomenta- 
 tions, and perfect rest. 
 
 Incarcerated hernia is an irreducil)le hernia which has become tempo- 
 rarily obstructed, from accumulated flatus or some undigested matters 
 in an angle of the gut. The constipation is to be removed by purgative 
 enemata, 189, 191 : ice may be a])plied : the taxis to be used to empty 
 incarcerated gut of its contents. 
 
 Stra/ajidated hernia is that form in which the portion of protruded 
 omentum or intestine is so tightly constricted that it cannot be re- 
 duced : consequently the passage of fJBCes is arrested, and gangrene 
 soon occurs if relief be not aftbrded. The symptoms are those of 
 obstruction of the bowels. The treatment consists in recourse to the 
 taxis, — the attem|)t to return the protrusion by manipulation, without 
 undue force. This may be assisted bj^ placing the patient in a hot 
 bath ; by inducing anaesthesia with chloroform ; by a full dose of opium : 
 by application of bladder of ice; or by invei'ting the patient, so tiiat 
 the gut niay be emptied of its fluid contents. Some practitioners relax 
 the muscular contraction by bleeding,. nauseating doses of antimony 
 or tobacco, large enemata to empty the lower bowel, &c. If the symp- 
 toms continue after reduction, they may be due to, — the hernia having 
 been pushed back en masse, sac and all; or there may have been a 
 double strangulation, the taxis having failed to relieve the stricture 
 within the sac: or the constriction may have been so great that gan- 
 grene has been set up. But the taxis failing to effect reduction, one of 
 two operations becomes necessary without delay: — an incision is made 
 over the neck of the tumor, the sac exposed and opened, and the stric- 
 ture divided from within; or the sac is to be left entire, the stricture 
 being divided outside. 
 
 The special hernife are: (1) Oblique inguinal hernia, in which the 
 protrusion originates at internal abdominal ring, traverses entire length 
 of inguinal canal, and usually passes out at external ring. — (^2) Direct 
 inguinal herrda passes through a triangular space on inner side of epi-
 
 142 HERPES — HICCOUGH. 
 
 gastric vessels, bursting through or pushing before it the conjoined 
 tendon of internal oblique and transversalis muscles, and presenting at 
 external ring gradually makes its way into scrotum or labium. — (3) 
 Congenital henna descends inside the tunica vaginalis, which forms its 
 sac. Always oblique, following the course of si^ei-matic cord. The 
 tendency to the protrusion is congenital, but the actual hernia may not 
 occur for some years after birth. — (4) Femoral or crural hernia is that 
 wljich escapes under Poupart's ligament through the crural ring, and 
 enters the sheath of the vessels internal to tlie femoral vein. After 
 passing through the saphenic opening of the fascia lata it turns up over 
 the falciform process, instead of descending on the thigh. — (5) Umbilical 
 hernia protrudes through the umbilical aperture. Not uncommon in 
 infants, and in women who have borne many children. — (6) Ventral 
 herntce are such as protrude through any part of the abdominal parietes, 
 except the inguinal or femoral or umbilical apertures. Most frequent 
 through the linea alba, linege semilunares, &c. — (7) Obturator hernia 
 passes through the opening in obturator ligament which gives exit to 
 the artery and nerve. Very rare, and very difficult to diagnose during 
 life. — (8) Ischiatic hernia escapes through the sciatic notch. — (9) Peri- 
 neal hernia descends between rectum and bladder, forming a pi'otru- 
 yion in perineum. — (10) Vaginal hernia gives rise to a tumor which 
 jjrotrudes through the posterior or upper wall of vagina. — (11) Labial 
 hernia presents a tumor in one of the labia and along the side of vagina. 
 -^(12) Diaphragmatic hernia results from a wound or from congenital 
 detieiency of a portion of the diaphragm. The stomach or transverse 
 colon, with a large portion of omentum, may escape through sucii an 
 opening and form a large tumor in thoracic cavity. 
 
 HERPES. — From "Ep-oj, to creep. Synon. Tetter. — A transient non- 
 contagious skin disease, consisting of clusters of vesicles upon inflamed 
 patches erf irregular size and form. Eruption runs a definite course ; 
 with one exception, rarely continues for more than three or four days; 
 is not usually severe; and leaves no scar. 
 
 Varieties. Herpes labiaiis, often forms on upper lip during a cold. — 
 Herpes preputialis, occurs on foreskin: vesicles run into each other, pro- 
 ducing an excoriation covered with a scab. — Herpes zoster, zona, or 
 shingles, sometimes very troublesome: frequentl}- attended with sevei-e 
 stinging pain. Inflamed patches with their clustered vesicles, arranged 
 in ibrm of a band, encircling half the circumference of the body. May 
 resist treatment for a few weeks. 
 
 Treatment. Attention to bowels. Regulation of diet. Vesicles 
 may be pricked, and sponged with warm water or dilute solution of 
 subacetate of lead. Oxide of»zinc, or subacetate of lead ointment. 
 Painting with belladonna or aconite liniment, where there is pain. In 
 obstinate forms, quinine and arsenic, 52. 
 
 HICCOUGH. — Synon. Singultus; Hiccup. — A short convulsive and 
 nt)isy insjjiration, followed immediately by expiration. It is due to the 
 sudden and involuntary and momentary contraction of the diaphragm, 
 with a simultaneous narrowing of the glottis. Frequently a warning 
 of great danger in severe diseases: often a symptom of irritation or 
 inflammation of the digestive organs: occasionally a jDroduct of hys- 
 teria: sometimes a mild idiopathic atfection. Most common during 
 infancy and old age. The convulsive inspirations produce pain about 
 the prajcordia. Paroxysms of hiccough recurring at short intervals, 
 and continuing for some days, are occasionally the cause of great 
 exhaustion.
 
 HOOPING-COUGH. 143 
 
 Treatment. Idiopathic : In inild cases hiccoui^h may pcrliaps be 
 checked by taking a set of deep inspirations and then holding the 
 breath as long as possible, so as to keep the diaphragm contracted. A 
 belt firmly apjjlied round epigastrium. Use of sternutatories to pro- 
 voke prolonged sneezing. — In severe forms, — Ammonia. Musk. Pep- 
 permint. Camphor. Ether. Mulled Port wine, or hot brandy and 
 water with spice. Chloroform on sugar. Aconite. Belladonna. In- 
 halation of chloroform or ether. Opium. Henbane. Hydrocyanic acid. 
 Ice, or iced water. Blisters; sinapisms; turpentine stupes; dry cup- 
 ping; wet compress; belladonna, aconite, chloi-oform, or opium lini- 
 ment; either agent to be applied to back and sides, in neighborhood of 
 attachments of diaphragm. — Dyspeptic: Emetics. Mild warm ape- 
 rients, or enemata of castor oil, &c. Draughts of ammonia, bicarbonate 
 of potash, and peppermint water. White bismuth. Ci-easote. Ipecac- 
 uanha. Sinai)isms. — Hysterical: Assafoetida. SumbuL Musk. Vale- 
 rianate of ammonia, quinine, iron, or zinc. Ferruginous tonics. Shower 
 baths. Galvanism. — Intermittent: Quinine. Arsenic. — Infantile: Dill 
 water (aqua anethi). A few drops of brandy in hot sugared water. 
 Warm bath. Attention to quantity and quality of milk or other food. 
 
 HOOPING-COUGH. — Synon. Pertussis; Tiissis Convulsiva; Broncho- 
 cepluditis; Chincough. — An infectious disease, especially of childhood; 
 rarely occurring more than once in same individual. Attended with 
 slight fever and vomiting; and accompanied at first by catarrh, and 
 subsequently by a peculiar cough which occurs in paroxysms at uncer- 
 tain intervals. — Duration, from two or three weeks to as many months. — 
 Probably due to some poison affecting pneumogastric nei-ve. Some- 
 times epidemic. 
 
 Symptoms. After a latent period of perhaps six days, a simple febrile 
 stage of eight or ten or twenty days' duration : sometimes accompanied, 
 but usually followed, b}^ violent paroxysms of coughing. Hestlessness 
 from corj'za, heat of skin, oppression of chest. As fever remits, the 
 cough assumes its peculiar shrill sound or hoop. Child soon learns when 
 each paroxysm is commencing, and is frightened. Series of coughs or 
 expiratory efforts very powerful : suffocation seems about to set in, when 
 relief is afforded by a long-protracted inspiratory act, the rush of air 
 through glottis causing characteristic crowing or hooping. Directly 
 after fit, patient regains courage; soon appears wadl. If paroxysm end 
 in vomiting, there is a craving for food immediately afterwards. There 
 may be two or three pai'ox^'sms in a day, or as many in an hour. 
 
 Complications: May coexist with measles, small-pox, &e. With bron- 
 chitis, pneumonia, disordered bowels, sonie head attection. — Perhaps the 
 urine occasionally contains sugar — pertussal glucosuria. — When cough 
 is very severe it is sometimes accompanied with hemorrhage from nose 
 or mouth ; or from ears, with laceration of membrane of tympanum. 
 Ecchymosis of conjunctivse, common. — May prove fatal by causing 
 pneumonia. Convulsions. Hydrocephalus. More frequently, by catar- 
 rhal inflammation of bronchi, with collapse of a portion of the lung. 
 
 Treatment. Mild cases: Warm clothing : flannel or chamois leather 
 jackets next the skin. Light nourishing food. Mucilaginous drinks. 
 Confinement indoors. Friction of spine, night and morning, with bel- 
 ladonna and soap liniment, 281. 
 
 3Iore severe forms: Ipecacuan, as an emetic, if bronchi are loaded with 
 mucus, 231. Ammonia, ipecacuan, and senega, 235. Sulphate of zinc 
 and belladonna, 92. Ammonia, ether, belladonna, and hydrocyanic acid, 
 86. Bromide of ammonium, 37. Spirit of chloroform. Hydroc^-anic 
 acid. jS^itric acid, 91. Tincture of aconite (min. j — iij). Opium, 338.
 
 144 housemaid's knee — hydrocele and hematocele. 
 
 Hj'drochlorate of ammonia. Attention to bowels. Belladonna liniment 
 to spine, 281. Confinement to one room: temperature 68° F. Flannel 
 clothing. Nutritious but easily digested food : milk, cream, fish, eggs. — 
 When chronic : Saccharated carbonate of iron. Cod-liver oil. Eemoval 
 to sea-side. 
 
 Remedies sometimes recommended: Tartarated antimony. Ipecacuan. 
 Alum. Arsenic. Assafoetida. Camphor. CoflPee. Colchicum. Peroxide 
 of hydrogen. Musk. Lobelia inflata. Saccharated carbonate of iron. 
 Quinine. Oxide of zinc. Sulphur. Sponging fauces and glottis with 
 solution of nitrate of silver (gr. 20 to the fi. oz.). Leeches to spine. 
 Sinapisms to spine. Tartarated antimony ointment. Cold shower bath, 
 in chi'onic stage. 
 
 HOUSEMAID'S KNEE.— Enlargement of bursa over patella, the re- 
 sult of pressure and inflammation from kneeling. If the inflammation 
 be acute, — Leeches, poultices, evaporating lotions, and rest w411 be 
 needed. In chronic cases, — Iodine liniment, blisters, ammoniac and 
 mercury plaster, diluted red iodide of mercury ointment, &c. Wire 
 setons. Tapping with trocar, followed by seton : the wires or threads 
 to be left in until free suppuration has been set up. If there be slough- 
 ing, a free incision must be made through anterior part of bursa. 
 
 HYDREMIA.— From "TSwp, water; ai;ia, blood. Watery blood.— See 
 Ancemia. 
 
 HYDROCELE AND HEMATOCELE.— Hydrocele (from "ncop, water ; 
 x7jV.7j, a tumor) consists of an accumulation of serum in the tunica vagi- 
 nalis, or in the cord. Hiiematocele (^Al;j.a, blood; xrj^.jj') is an extravasa- 
 tion of blood into tunica vaginalis. 
 
 1. Hydrocele of Tunica Vaginalis. — Synon. Hydrops Scroti ; Hydrorchis. 
 — May result from injuries, testitis, and many causes. 
 
 Symptoms. The scrotum gradually gets distended with serum, ujitil 
 it forms a smooth and pear-shaped and fluctuating and traiisiucent 
 swelling. The testicle may be felt near the lovver and back part: the 
 spermatic cord to be distinguished free at neck of tumor. The fluid 
 consists of pale yellow serum : average quantity ten or twelve ounces. — 
 In congenital hydrocoiQ the communication between the tunica vaginalis 
 and peritoneal cavity has not been obliterated. Apt to be complicated 
 with congenital hernia. — In encysted hydrocele thei'e are one or more 
 cysts tilled with serum, connected with the testis or epididymis. 
 
 Treatment. Palliative: Withdrawal of fluid by trocar. Punctures 
 wiih a grooved needle: fluid escapes from tunica vaginalis into scrotal 
 areolar tissue, whence it is absorbed. Painting with iodine. Friction 
 with diluted red iodide of mercury ointment. Radical cure: Tapping, 
 with injection of tincture of iodine (fl. drm. j to water iij), allowing the 
 injection to remain. A moderate amount of inflammation is set up. 
 which does not subside for two or three days. This plan failing, a seton 
 may be j)assed through the sac, — two or three threads, or a tine iron 
 wire. — In congenital hydrocele a truss to be worn, so as by pressure to 
 close vaginal process. Iodine to scrotum. Punctures with giooved 
 needle. Irritating injections inappropriate. — In encysted form, recourse 
 is to be had to tapping with or without injection ; or to seton. 
 
 2. Hydrocele of Cord. — Serum accumulates in areolar tissue of cord: 
 not Common. In some cases, the fluid is formed in a distinct cyst; 
 which may either be a new formation, or a portion of unobliterated
 
 HYDROCEPHALOID DISEASE — HYDROCEPHALUS. 145 
 
 vaginal process of peritoneum. Where interference is needed, the best 
 remedies are iodine to surface of enlargement. Acupuncture. 
 
 3. Haematocele. — Synon. A Blood Tumor. — May be due to injury; 
 sometimes arises spontaneously. The tunica vaginalis gets distended 
 with blood : perhaps to such an extent as to compress the testicle and 
 produce atrophy. Eest, pressure, and cold lotions sometimes effect a 
 cure. If there be much inflammation it may be necessary to turn out 
 the clot by a free incision, and leave the cavity to granulate. 
 
 HYDROCEPHALOID DISEASE. — From "mvp, water; ysfaXij, the 
 head ; terminal -ides. Synon. Spurious Hydrocephalus. — The early ap- 
 pearances somewhat resemble those due to dropsy of the brain. A 
 fatal error to mistake spurious for i*eal hydrocephalus. 
 
 Symptoms. Weakly children the subjects of this affection. Heavi- 
 ness of head. Drowsiness. Great languor. Unhealthy stools. Alarm 
 at strangers and slight noises. Freaks of temjjer. Irregular breath- 
 ing. Coolness of skin. Surface of fontanelle depressed, instead of raised 
 as in dropsy. 
 
 Treatment. Pure milk. Strong beef tea, or finely pounded meat. 
 Eaw meat, 2. Port wine. Bark. Steel ; especially chemical food, 405. 
 Strict avoidance of active purgatives, diuretics, and poor diet. 
 
 HYDROCEPHALUS. — From "Tdiop, water; xefaXij, the head. Synon. 
 Hydrocranium ; Hydrops Capitis; Water on the Head; Dropsy of the 
 Brain. — Met with in children of various ages, as result of many circum- 
 stances. Often congenital, and associated with some cerebral malfor- 
 mation. Sometimes the precursor, sometimes result, of tubercular 
 meningitis : in this case, often spoken of as acute hydrocephalus. AVhen 
 congenital, or when arising slowly from constitutional causes, it is 
 termed chronic hydrocephalus. 
 
 Head attains a great size: the unossified sutures yield readil}" to 
 pressure of fluid. One side may be larger than the other. Bones thin 
 and transparent : meninges thickened. Serum often contained in lateral 
 ventricles, which are perhaps expanded into one large cavity: occa- 
 sionally collected in sac of arachnoid, compressing brain. Quantity of 
 fluid varies from two or three ounces to as many pints. Essentiall}' a 
 disease of childhood, yet occasionally adults are aftected. 
 
 Symptoms. Grenerally commence before infant is six months old : 
 may exist from birth. Child takes food eagerly, but does not thrive: 
 after a few weeks, extreme wasting. Appearance remarkable: ema- 
 ciated body, small face, with a large globular cranium. Head droops 
 helplessly on one side. Intelligence usually enfeebled. Irritability and 
 peevishness; morbid susceptibility to noise and light; liability to epi- 
 leptic convulsions; great muscular weakness. EoUing movement of 
 eyeball: perhaps strabismus, or amaurosis. Headache; nausea; con- 
 stipation, with dark-colored offensive stools. Grinding of teeth. Screams 
 on awaking. 
 
 In second stage, moi"e stupor; pallor; slow^ pulse; dilatation or con- 
 traction of pupils ; picking of nose and lips. In favorable cases, lethargy 
 and pallid hue and irritability gradually subside. Desire for food. In- 
 crease of muscular power. Diminution of emaciation. In unfavorable 
 examples, excessive prostration and rapidity of pulse. Paralysis. Coma 
 or convulsions ending in death. 
 
 Treatment. Prophylactic: Infiints with tendency to hydrocephalus 
 to be reared so as to strengthen constitution as much as possible. Nour- 
 ishing food : plenty of good milk. Salt water baths : friction of skin. 
 
 10
 
 146 HYDRONEPHROSIS — HYDROPHOBIA. 
 
 Residence in pure air: sea side. Cod-liver oil. Only the most gentle 
 attempts at education. — Curative: Rhubarb and magnesia. Syrup of 
 senna. Castor oil. Mercur}^ and chalk. Plain but nourishing food : 
 pure milk. Cod-liver oil. Glycerine. Iodide of potassium. Iodide of 
 iron. Quinine. Bark and hypophosphite of lime or soda. Chlorate of 
 potash. Sea air. 
 
 Compression of head and tapping have been strongly advocated. 
 Compression best effected by bandaging, or bj^ application of strips of 
 soap plaster over whole of cranium, so as to make equal pressure on 
 every part. Where thei-e are no symptoms of active cerebral disease, 
 pressure will probably do good. — Puncture is performed with a small 
 trocar and canula at coronal suture, about an inch and a half from an- 
 terior fontanelle, so as to avoid longitudinal sinus. The fluid is to be 
 evacuated slowly; as much as will flow may be allowed to come away; 
 and gentle pressure must be kept up both during its escape and aflei-- 
 wards for some weeks. Only to be had recourse to when other means 
 have failed. Has proved successful in very young children. 
 
 Remedies sometiynes used : Active purgatives. Leeches. Blisters. Calo- 
 mel. Corrosive sublimate. Mercurial inunction. Crude mercury, with 
 manna and squills. Tartarated antimony. Iodine. Colchicum. Digit- 
 alis. Liquor potassas. Acetate of potash and squills. Cold attusion. 
 Issue in neck, or on each shoulder. 
 
 HYDRONEPHROSIS.— From "r5a>/>, water; v£^/)o?, the kidney. Synon. 
 Mydrorenal Distension; Dropsy of the Kidney. — May result from obstruc- 
 tion of ureter by calculi, tubercular or malignant deposit, pressure of 
 tumors, &c. Kidney ultimately converted into a large pouch. Occa- 
 sionally associated with suppuration of lining jnembrane of pelvis and 
 calyces. 
 
 Symptoms. Sometimes altogether absent; especially if distension be 
 not very great, and other kidney remain healthy. Hydronephrotic 
 tumor found in loin, reaching forwards in abdomen ; may be very large, 
 with undulating feel and fluctuation, and tender to touch. Urine often 
 natui-al in quantity: contains pus if there be associated pyelitis. Sup- 
 pression of urine and uraemia where both glands are affected. Attacks 
 of nephritic colic where there is a calculus. 
 
 Treatment. Rest. Diluents, to prevent concentration of urine. 
 'Gentle and oft-repeated manipulation, if there be an absence of tender- 
 ness, so as to force onwards obstructing body. Tapping. 
 
 HYDRO-PERICARDIUM. — From "Ydwp, water; nepcxdpScov, the peri- 
 (Cardium. Synon. Hydropericarditis ; Hydrops Pericardii; Ilyd.rocardia ; 
 Dropsy of the Periqardium. — See Pericarditis. 
 
 HYDROPHOBIA.— From "r^w/), water; <po6iw, to dread. Synon. Phobo- 
 dypson; Rabies; Canine Madness. — A disease caused by inoculation with 
 the saliva of a rabid animal. Period of incubation varies from thirty 
 .days to many months. Death often occurs before the end of fourth day 
 from commencement of symptoms. 
 
 Symptoms. Cramps of muscles of pharjnix and thorax. Spasmodic 
 action of diaphragm. Great dread of fluids. Recurrence of paroxA^sms 
 of phrenzy on attempting to drink, or on exposure to a current of air. 
 A flow of viscid saliva (" hydrophobic slaver"). Restlessness. Anxiety. 
 Delirium. Exhaustion. 
 
 Treatment. Prophylactic: Suction of wound. Excision of bite. Ex- 
 posure of wound to stream of water. Nitrate of silver. Caustic potash. 
 Actual cautery.
 
 HYDRORACHIS — HYPOCHONDRIASIS. 147 
 
 Curative: Chloroform. Belladonna. Subcutaneous injections of liquor. 
 Atropia?. Hydrocyanic acid. Indian hemp. Wourali. Ice. Opium. 
 Curara. Sulphite or hyposulphite of soda or magnesia. Vinegar. Va- 
 por baths. Iodide of potassium. Laying open cicatrix, and inducing 
 suppuration. Division of nerves leading to wound. Application of ice 
 to spine. Transfusion of blood. Copious eneniata of plain water. 
 
 Remedies which have been eynployed : Venesection to syncope. Cupping 
 at nape of neck. Morphia injections into veins. Vaccination. Strychnia. 
 Galvanism. Arsenic. Iron. Turpentine. Tobacco. Calomel. Injec- 
 tions of warm water into veins. 
 
 HYDRORACHIS. — From "Tdojp, water; /i«/£T, the spine. Synon. 
 HydrorThachia Myelochysis ; Hydrocele Spinalis; Dropsy of the Spine. — 
 The serous effusion is either within the spinal canal, or in a sac — spina 
 bifida. 
 
 Usually congenital. When fluid has been present for some time, the 
 pressure produces atrophy of cord. — See Spina Bifida. 
 
 HYDROTHORAX. — From "Tdiop, water; Owpa^, the chest. Synon. 
 
 Hydrops Thoracis; Pleurorrhcea Serosa ; Dropsy of the Chest. — An effusion 
 of serum, or of serum mixed with blood, into the cavity of the pleura. 
 A result of inflammation. — See Pleurisy. 
 
 HYPER.ffiMIA. — From 'T-kp, in excess ; mpa, blood. Synon. Plethora ; 
 Polyceinia. — An excess of blood ; or, a superabundance of red corpuscles, 
 producing superfluous richness, without any increase of the other com- 
 ponents. 
 
 Symptoms. Lassitude. Indolence. Desire for sleep. Snoring and 
 dreaming. Vertigo. Hemorrhage. Distended capillaries. Full, strong, 
 resistent pulse. Turgidity of veins. 
 
 Treatment. Restricted diet: non-nutritious substances. Active 
 exercise. Saline purgatives, 165, 167, 169. Bromide of ammonium, 87. 
 Liquor potassfe, 73. Liquor arsenicalis. Mercury. Tartar emetic. 
 Bloodletting. Issues. Mineral waters of Cheltenham, 461. Vichy, 479. 
 Friedrichshall, 495. 
 
 Abstinence from. : Beer; wine; spirits; sugar; milk; fatty matters. 
 Lessened amount of sleep. 
 
 HYPERMETROPIA. — From 'Tr^kp, in excess ; fj.hpnv, measure ; and co(/>, 
 the eye. S3'non. Over-sight. — That condition in which the refractive 
 power of the eye is too low, or the optic axis (antero-posterior axis) too 
 short. Consequently when the eye is in a state of rest, parallel rays 
 are not united upon the retina, but behind it, and only convergent rays 
 are brought to a focus upon the latter (Soelberg Wells). 
 
 Symptoms. A sense of heat and fulness about the eyes on reading: 
 the print appears indistinct, and the words seem to run into each other. 
 Distant objects not seen clearly. Eyes look smaller and flatter than in 
 health. Dull frontal headache. 
 
 Hypermetropia is one of the causes of asthenopia, as well as of con- 
 vergent strabismus. Sometimes associated with presbj^opia. 
 
 Treatmei<jt. Carefully-selected convex spectacles. Glasses increasing 
 in power will have to be gradually used until the hypermeti'opia is com- 
 pletely neutralized. 
 
 HYPOCHONDRIASIS. — From "Y-KoxovSpiaxo^^ affected in the viscera 
 under the false ribs, — because such affection was regarded as the cause 
 of melancholy. Synon, Hallucinatio Hypochondriaca ; Anathymiasis j
 
 148 HYPOSPADIAS AND EPISPADIAS — HYSTERIA. 
 
 Spleen; Vapors ; English Malady ; Low Spirits. — May be said to consist 
 prominently of an exaggerated egoism. 
 
 Symptoms. Frequently functional derangement, occasionally .struc- 
 tural disease, of certain organs, especially of those connected with func- 
 tions of nutrition and generation. Hypochondriacs writhe under des- 
 potism of imaginar}' evils. They fullil their duties naturally, at least 
 for a time, but art; morbidly sensitive of opinions and actions of others. 
 Constantly dwelling on their miserable condition. Dread of internal 
 disease, impotence, insanity, death. Want of resolution. Languid cir- 
 culation. Decayed teeth. To same extent that hysteria is peculiar to 
 female, is hypochondriasis to male sex. 
 
 Treatment. Purgatives injurious as a rule. Action of bowels to be 
 maintained by exercise and proper diet. Narcotics and sedatives in- 
 crease the mischief, and check secretions. If there be anamia, quinine 
 and steel, 379. Strychnia, or nux vomica, 387, 407, 408. Phosphate of 
 zinc and bark, 414. Hypophosphite of soda, or lime, 419. Phosphate 
 of iron, 405. Nitro-hydrochloric acid. 378. Sulphate of manganese. 
 Cod-liver oil. Assafcetida. Musk. Sumbul. Shower bath. Sea-bathing. 
 Turkish bath. Nourishing food. Exercise in open air. Physical train- 
 ing. Gymnastics. 
 
 HYPOSPADIAS AND EPISPADIAS. — Hypospadias QY-b, under; 
 ff-rKw, to draw from ) is a congenital malformation, in which the urethra 
 opens on under surface of penis instead of at extremity of the glans. — 
 Epispadias ('£'-'£, upon; and'^u)) is that condition in which urethra ter- 
 minates on dorsum of penis. Either state, when extensive, ma_y call 
 for an attempt at cure by a plastic operation. Actual cautery some- 
 times succeeds: galvanic cautery wire. 
 
 HYSTERIA. — From 'Yfrripa, the womb ; owing to its supposed origin 
 in this organ. Synon. Hysteropathia ; Asthma Uteri; Vapores Uterini; 
 Passio Hysterica; Hysterics. — A nervous disorder which occurs in par- 
 oxysms, or simulates other diseases. Attacks accompanied with an 
 abundant secretion of urine of low specific gravity-: frequently with a 
 sense as of a ball rising in the throat (globus hystericus). Occasionally 
 convulsions. Women from the age of puberty to the decline of men- 
 struation most liable to it; though occasionally men are the subjects 
 of it. 
 
 Symptoms. Those characterizing hysteric paroxysm or fit are : Con- 
 vulsive movements of trunk and limbs; beating of breasts with hands 
 clenched, or tearing of hair or clothes; shrieks and screams, violent 
 agitation ; globus hystericus, or feeling of sufibcation ; attack ending 
 with convulsive outbreaks of crying or laughter, and sometimes with 
 hiccough. Occasionally, patient falls to ground insensible and ex- 
 hausted : soon recovering, tired and crying. Perhaps urine is discharged 
 involuntarily during the excitement. 
 
 Hysterical paraplegia, or hemiplegia, sometimes occurs. There may 
 be hyperaesthesia, or increased sensibility of various tissues, perhaps 
 leading to erroneous susjjicions of pleurisy, spinal disease, metritis, or 
 ovaritis. The opposite condition — anjcsthesia, or loss of sensibility — not 
 uncommon ; sometimes lasting for many months, affecting left side more 
 than right, and being so deep that pins and needles may be thrust into 
 substance of affected muscles without causing pain. Appetite for food 
 increased, or diminished, or depraved so that most extraordinary sub- 
 stances ai*e eaten. 
 
 Hysteria simulates almost all diseases. The favorite are : Suppi'es- 
 sion of urine, stone in bladder, pleurisy, consumption, complete loss of
 
 ICHORH^MIA — ICTERUS. 149 
 
 voice, paral^ysis, epilepsy, and affections of spine or joints. Ilj'sterical 
 cough, hiccough, or vomiting may prove very obstinate. Peculiar ex- 
 pression of countenance: fulness of upper lip, drooping of upper eye- 
 lids. Questions answered abruptly. Pains increased b}'^ pretended 
 pressure. Catamenia often irregular: more or less profuse leucorrhoea. 
 — Sufferings not alwa3'8 feigned. Perhaps generally, patient believes 
 she is grievously affected. Even where pins are thrust under skin, 
 stones placed in vagina, or food refused unless it can be obtained sur- 
 reptitiously, the patient is diseased. She resorts to these practices to 
 increase sympathy of friends. 
 
 Treatment, ijuring paroxysm : Loosen dress. Prevent self-injury. 
 Surround body with cool air. Ammonia to nostrils. If it can be swal- 
 lowed, a draught containing a drachm of ammoniated tincture of vale- 
 rian. If apparent insensibility continues, cold water douche over head 
 and face. 
 
 In other forms, or during intervals between fits : Aloetic aperients, 156, 
 39.3, 404. Quinine and steel, 380. Steel and glycerine, 392. Strychnia 
 and steel, 408. Zinc and iiux vomica, 409. Valerianate of zinc, or am- 
 monia, or steel, or quinine, 410. Phosphate of iron, 405. Hypojihos- 
 phite of soda, 419. Bromide of potassium, 42. Cod-liver oil. Ammo- 
 niated tincture of valerian and bark. Compound pill of assafoetida. 
 Nourishing food. Exercise in open air. Mental occupation. Shower 
 baths. Sea bathing. Galvanism. Attention to uterine functions; 
 checking catamenia if too abundant, promoting them if too scanty. — 
 
 See Bed Case. 
 
 ■* 
 
 ICHORH^MIA. — From '//<«/), pus ; at/jia, blood. Synon. Septicceinia ; 
 Pijcemia ; Pyohcemia. — A morbid condition of the blood, caused by the 
 introduction of ichorous or putrid matters. 
 
 Symptoms. Shivering. Sweating. Eapid pulse. Epileptiform seizures. 
 Sweet hay-like odor of^ the breath. Diarrhoea. D3'sentery. Pleurisy. 
 Pericarditis. Peritonitis. Erysipelas. Boils. Secondary abscesses. 
 Rapid wasting. Feebleness. Death from prostration. In chronic cases 
 the symptoms come on much more gradually, and are less intense. 
 
 Treatment. Calomel? Aperients. Vapor bath. Wet-sheet pack- 
 ing, 130. Acid sponging, 138. Perfect ventilation of sick-room. Beer. 
 Wine. Brand}-. Beef solution, 2. Essence of beef, 3. Bark and am- 
 monia, 371. Quinine, 379, 386. Sulphurous acid. Sulphite of mag- 
 nesia, 48. Mineral acids, 376, 377. Opium. Cold drinks. Wenham 
 Lake ice. Fomentations. Poultices. Incisions. Leeches? Bleeding? 
 
 ICHTHYOSIS. — From '//^/yc, a fish. Synon. Xeroderma Ichthyoides; 
 Fishskin Disease. — A very rare, non-contagious, squamous skin disease. 
 Characterized by development, on one or more parts of body, of thick 
 and hard and dry imbricated scales of dirty gray color. Unattended by 
 beat or pain or ilching. The scales or shagreen-like flakes give rise to 
 most unsightly appearance. 
 
 Treatment. Internally: Arsenic, 52. Donovan's triple solution, 51, 
 Red iodide of mercury and arsenic, 55. Cod-liver oil. Corrosive sub- 
 limate. Solution of potash in sarsaparilla. 
 
 Locally : Warm baths. Alkaline baths. Vapor baths. Creasote 
 lotions. Glycerine. Cod-liver oil. Neat's foot oil. Friction with 
 olive oil. 
 
 ICTERUS. — From "Ixrepo^, a yellow bird (probably the Loriot) ; be- 
 cause the color of the plumage resembles that of the skin in jaundice.
 
 150 IMPETIGO — IMPOTENCE AND STERILITY. 
 
 Synon. Morbus Arcuatus ; Morbus Begins ^ Cholcemia ; Fellis Superfusio. — 
 See Jaundice. 
 
 IMPETIGO — From Jmpefo, to attack; terminal -?"^o. Synon. Psydra- 
 cia ; (■rusted or Bunning Scall ; Pushdar or Humid Tetter. — A severe, 
 sometimes eonta<ii;ioiis, inflammation of the skin ; characterized by an 
 eruption of small hemispheroidal, or flattened pustules, most frequently 
 grouped in clusters, and forming thick yellowish scabs or incrustations. 
 From beneath incrustations a discharge flows: crusts get thicker and 
 larger, and fall off, leaving raw surfaces. 
 
 Varieties. Impetigo figurata occurs generally on face, especially the 
 cheeks. Attended with constitutional disturbance, and swelling of lym- 
 phatic glands. Pustules arranged in round or oval groups: as they 
 burst and form scabs, heat and itching become intolerable. In chil- 
 dren, impetiginous eruption sometimes covers head or face like a mask, 
 and is called crusta lactea : sometimes due to pediculi. Impetigo sparsa 
 characterized by scattered pustules ; perhaps irregularly distributed 
 over a limb, or even entire body. 
 
 Treatment. Internally : Quinine, 379. Quinine and steel, 380. Arse- 
 nic, 52, 3«1. Eed iodide of mercury and arsenic, 55. Cod-liver oil. 
 Steel and aloes, 154. Steel and sulphate of magnesia, 166. Potash and 
 lime-water, 73. Iodide of potassium. Colehicum. Plain nourishing 
 food. 
 
 Locally : Yapor or warm water baths. Conium and starch bath, 122. 
 Hj-drocyanic acid lotion, 263. Subacetate of lead and glycerine lotion, 
 264. Creasote lotion, 270. Oxide of zinc ointment. Use of linen 
 dipped in melted suet. Lime liniment. Creasote and red oxide of mer- 
 cury ointment, 301. Diluted citrine ointment, 305. Nitrate of silver. 
 Iodine. Borax. Sulphur. Hairs to be cut close to scalp, if head or 
 beard be attacked. Early puncture of pustules. 
 
 IMPOTENCE AND STERILITY. — The term Impotence (from 7n,neg.; 
 possum, to be able) n)ay be applied to every morbid state, in either sex, 
 which prevents the seminal fluid of the male coming into contact with 
 the female ovule. — On the other hand. Sterility (from lTclpo<;, barren) is 
 that condition in which either no spermatozoa or ovules are secreted, 
 or their vitality is immediately destroyed. 
 
 1. Impotence in Man. — The act of copulation may be rendered impos- 
 sible by many causes: By absence, or want of development, or malfor- 
 mation, or mutilation of penis. — By mental influences, — violent emotion, 
 passion, over-excited desire, want of confldence, anxiety, grief, disgust: 
 this form most curable, by tact and skill on part of physician (see 
 Montaigne's Essays, Book I^chap. xx). — By fevers and other severe dis- 
 eases, sexual organs remaining feeble after general health is restored : 
 curable by ferruginous tonics, nux vomica, sumbul, cantharides, Indian 
 hemp, hypophosphite of lime or soda, sea bathing, nourishing food, and 
 stimulating liniments or gentle galvanism to spine. — By injuries to back 
 part of head, — from falls, blows, railwaj^ accidents, &c. ; there being 
 generally incurable loss of power and wasting of testes and penis. — By 
 injuries and diseases of spinal cord ; which remove the power to copu- 
 late, though desire remains and semen may be secreted. — By excessive 
 use of tobacco, which impairs digestion and weakens nervous and mus- 
 cular systems: opium-eating injurious in same way. — By abuse of sexual 
 functions removing the power of erection, — onanism, excessive inter- 
 course (see Spermatorrhoea). — Impediments to escape of semen; such as 
 stricture of urethra, in which ejaculated fluid regurgitates into bladder. —
 
 INDIGESTION — INFLAMMATION. 151 
 
 Abnormal openings in urethra (hypospadias and epispadias), bo that the 
 semen is not ejaculated into vagina. — By excessive obesity; large scrotal 
 herniffi. 
 
 2. Impotence in Woman. — May be due to : Firm adhesions of labia 
 pudendi — Excessively developed and persistent hymen. — Absence, mal- 
 formation, or an impervious condition of vagina (see Vaginal Occhision). — 
 Obliteration of this canal through inflammation. — A double vagina im- 
 pedes but does not prevent copulation. — Super.sensitiveness, with spas- 
 modic closure of vagina (see Vaginismus). — Tumors of vagina, or uterine 
 tumors which have passed into vaginal canal. — Elongation of cervix 
 uteri. Engorgement, or induration, of labia uteri. Obliteration, ob- 
 struction, or great narrowing of os uteri or cervical canal: closure of 
 uterine cavity by tumors, cancer, ka. — Malpositions of uterus, — acute 
 retroflexion and anteflexion. — Inflammatory affections of uterus. — Oc- 
 clusion of Fallopian tubes: disease of their fimbriated extremities. — 
 Irremediable procidentia of uterus. — Large vesico-vaginal, or recto- 
 vaginal fistulas, or complete rupture of perineum, allowing impro])er 
 escape of seminal fluid. — Uterine cancer, even when vagina is involved, 
 impedes but does not prevent intercourse and fecundation. 
 
 3. Sterility in Man. — Arises from : Certain diseases, as tuberculosis, 
 diabetes, albuminuria, some forms of obstinate dyspepsia: in advanced 
 stages, secretion of seminal fluid usually stopped. — Some cerebral de- 
 fect, owing to which the functions of testicles have never been called 
 into play. — Diseases of testicles, — tumors, cancer, repeated attacks of 
 inflammation, and varicocele; though as only one gland is usually 
 affected, these conditions rarely produce sterility. — Malposition of testes, 
 these organs being retained in abdominal cavity ; cojjulation being fea- 
 sible with these cryptorchics, but the semen ejaculated being destitute 
 of spermatozoa. — Obstructions in the excretory ducts of testicle; such 
 as temporary or permanent obstruction after epididymitis, power of 
 copulating remaining but ejaculated fluid being destitute of sperma- 
 tozoa. — Obliteration of ejaculatory canals from abscesses near prostate, 
 leading to atrophy of testes. — Abuse of tobacco and opium and alco- 
 holic drinks, as well as a syjjhilitic taint, may destroy vitality of sper- 
 matozoa. 
 
 4. Sterility in Woman. — Arises from : Amenorrhoea. — Exhaustion or 
 excessive general weakness. — Too frequent or imperfect sexual excite- 
 ment. — Indifference to sexual act, or a restraint of the orgasm ? — Ab- 
 sence, arrest of development, or disease of ovaries; only a relative, not 
 absolute cause, as both glands are seldom diseased at same time. — Leu- 
 corrhoea, especially where the discharge is abundant and acrid; by caus- 
 ing destruction of the spermatozoa before they reach an ovule. — Syph- 
 ilitic taint occasionally destroys vitality of ovules. 
 
 For the treatment of impotence and sterility refer to the different dis- 
 eases of the sexual organs under their appropriate heads. 
 
 INDIGESTION. — From In, neg; digero, to concoct or digest. — See 
 Dyspepsia. 
 
 INFLAMMATION. — From In/lammo, to burn. Synon. Phlogosis ; 
 Phlegmasia ; Myperhmmatosis ; Hyperendosmose. — Sometimes a destruc- 
 tive, sometimes a formative process; consisting essentially of local 
 congestion and stagnation (stasis) of blood, with exudation of liquor 
 sanguinis. 
 
 Symptoms. Pain. Swelling. Heat. Redness. Blood when drawn 
 becomes buffed and cupped. Diminution of red corpuscles, and increase
 
 152 INFLUENZA INSANITY. 
 
 of fibrine: perhaps an increase of colorless corpuscles. Eise in tempera- 
 ture of the blood. Symptomatic fever. Depression. Eigors. Frequency 
 of pulse. Headache. Thirst. Loss of appetite. Furred tongue. 
 Diminution of chlorides in the urine. Increased excretion of urea. 
 Sweating. Hectic fever. Hemorrhage. Adbesive inflammation. 
 Suppuration. Ulceration. Sloughing. Gangrene. Excessive wasting. 
 Prostration. 
 
 Treatment. Generally: Withdrawal of cause. Eepose. Well- 
 ventihited sick-room. Light diet. Ice and cold drinks. Tea. Milk. 
 Belladonna. Henbane. Aconite. Opium. Salines, 348, 349, 351, &c. 
 Aperients. Acid tartrate of potash. Citrate of potash. Colchicum. 
 Carbonate of ammonia. Wine or brandy. 
 
 Locally: Fomentations. Poultices. Water dressing. Ice. Evapo- 
 rating lotions. Baths. Sinapisms. Turjientine stupes. 
 
 Antiphlogistic remedies: Bleeding. Leeches. Cujoping. Emetics. 
 Drastic purgatives. Antimony. Mercury. Digitalis. Veratrum viride. 
 Blistei'S. Setons. Issues. Low diet. 
 
 INFLUENZA. — From the Italian, Influenza ; because the phenomena 
 were thought to be due to the influence of the stars. Synon. Rheuma 
 Epideniicum ; Defluxio CatarrhaUs; Epidemic Catarrhal Fever ; La Grippe 
 (in France). — An epidemic disorder attended with great depression, 
 chilliness, running from ej'es and nose, frontal headache, cough, rest- 
 lessness, and fever. — Probably' due to some peculiar condition or con- 
 tamination of atmosphere. 
 
 Symptoms. Shivering or sense of chilliness down the back, followed 
 by heat and dryness of skin. Urgent frontal headache ; aching pains 
 about eyes. Corj'za and sneezing. Tenderness of fauces. Hoarseness. 
 Harassing cough, and shortness of breath. Pains in back and limbs. 
 Perverted taste, with disordered stomach. In addition, all the signs of 
 nervous and muscular prostration. Occasionally, acute bronchitis, or 
 pneumonia. Euns its course in less than a week : often ends in 
 diarrhoea, or diuresis, or profuse sweating. 
 
 Treatment. Eest in bed for first three days, in properly ventilated 
 room. Barley water. Cold infusion of linseed, lemonade, soda water, 
 raspberry vinegar, &.C. Tea and milk. Mutton or chicken broths. In 
 mild cases, drugs unnecessary. — If catarrhal symptoms are urgent : Ipecac- 
 uanha and conium. Henbane. Ethereal tincture of lobelia. Powder 
 of ipecacuan and opium (gr. 10 at night). Indian sarsaparilla with infu- 
 sion of linseed, 243. Spirit of nitrous ether with cam})horated tincture 
 of opium, 348. Inhalation of simple vapors. Iodine, lime-water, bella- 
 donna, or conium spray, 262. Sinapisms to chest. Vapor, or hot air, 
 bath. — When prostration is a prominent symptom : Ammonia and bark, 
 371. Extract of beef, L AVine, or brandy. Brand}- and egg mixture, 
 17. — During convalescence : Bark and phosphoric acid, 370. Quinine and 
 iron, 880. Cod-liver oil. Nourishing diet : substitution of milk for tea 
 and coff'ee. A few days' holiday in the country. 
 
 INSANITY. — From In, neg. j sanus, reasonable. Synon. Mental 
 Alienatiuu ; Unsound Mind; Deranged, Intellect; Madness. — No useful 
 definition of insanity can be given. Speaking roughl}^, it may be said, — 
 That it is a general term used to ex])ress the mental condition opj)osed 
 to sanity ; sanity being that state of mind which enables a man to dis- 
 charge his duties to his God, his neighbor, and himself 
 
 Warnings. Indications of impending cerebral mischief often to be 
 detected by physicians some months before they attract notice of 
 patient or his i'riends. Cerebral att'ections not developed suddenly ;
 
 INSANITY. 153 
 
 often rendered incurable by neglect of treatment in earlj^ stages. 
 Threatenings "which should excite alarm are: Headache, severe and 
 frequent; attacks of giddiness and mental confusion; paroxysms of 
 irritability, and loss of temper without sutficient cause; iiia])titude for 
 usual occupations; weariness of life ; sleeplessness or lethargy ; loss of 
 memory; some marked deviation from usual line of conduct; sanguin- 
 eous tumors about external ear; defective articulation; dimness of 
 sight; flightiness of manner; sufferer feels that he is not quite right, 
 but does not like to consult a physician. He shuns his old friends; is 
 tortured with blasphemous or obscene thoughts; has frightful dreams; 
 frequently sutfers from dyspepsia. 
 
 Complications. Mental diseases often accompanied with symptoms 
 of a variety of bodily disorders. Of all forms of insanity those compli- 
 cated with general paralj^sis, or with epilepsy, are the most terrible. 
 
 Insanity with general paralysis : An affection sui generis. Sometimes 
 spoken of as "general paralysis;" "general paresis;" or, more appro- 
 priately^, as " progressive paral3'sis of the insane." — Paralytic lunatics 
 seldom live more than from one to three years. — The paralysis may 
 come on in any vari'ety of mental disease, increasing as power of mind 
 diminishes. The tirst indication is usually an impediment to movements 
 of tongue: convulsive trembling of lips: articulation muffled and 
 imperfect. As this impediment increases, there come on tottering, 
 uncei'tain, and vacillating movements in walking: sometimes, impair- 
 ment of locomotion precedes other symptoms. Handwriting gets 
 changed. A heavy vacant look. Intelligence and judgment greatly 
 lessened. Fits of irritability, hallucinations, and illusions. Loss of 
 memory. Debasement of moral character. Pulse gets frequent and 
 feeble. Tongue on being protruded curves tremulously from side to 
 side. Pupils often of unusual size, and their mobility lessened. Excre- 
 tions escape involuntarily, either from want of attention, or from paraly- 
 sis of sphincters. Ilemiplegic seizures, attended^vith convulsions orcoma, 
 not uncommon; though they generally pass otf after use of stimulating 
 enemata, and removal of any collection of hardened faeces. As disease 
 progresses, patients become unable to articulate a single word; they 
 continually grind their teeth; their weakness such that the}- cannot 
 walk or stand; all traces of intelligence get abolished; they remain 
 motionless and insensible, their torpid existence being reduced to a kind 
 of slow death. — All that can be done with remedies is to give sleep, 
 relieve painful symptoms, and support strength. Henbane, in twenty- 
 grain doses, may be useful. Nourishing diet. "Warmth. Cleanliness. 
 Attention to bowels and bladder. 
 
 Insanity with Epilepsy: Always incurable. Conduct of insane epilep- 
 tics most ferocious; homicidal or suicidal. Filthy and disgusting in 
 their habits. Eesidence in a well-ordered asylum does much to induce 
 a certain amount of mental tranquillity. Good diet, and daily exercise, 
 contribute to physical improvement. Bromide of potassium is said to 
 reduce the frequency of the fits, and to soothe nervous irritability. If 
 early death do not result, disease usually subsides into incurable de- 
 mentia. 
 
 Varieties. Differences between various forms of insanity always 
 imperfectly marked. Descriptions in books extraordinarily distinct, 
 compared with medley of sj'mjjtoms in real cases. Various forms fre- 
 quentlj^ run into each other. 
 
 (1) Mania (Mai^o/iat, to rage), or leaving madness: Characterized by 
 general delirium. Reasoning faculty, if not lost, is disturbed and con- 
 fused. Ideas abundant, erroneous, absurd, wandering. Manners, vio- 
 lent, excited, mischievous.
 
 154 INSANITY. 
 
 Earely comes on suddenl}-, though it does so more frequent!}' than 
 other varieties. Premonitorj' s^'mptoms : Neglect of famil}' and busi- 
 ness. Distrust of relatives. Causeless attacks of anger and despon- 
 dency. Insomnia. — Disease sets in with general delirium, and extreme 
 fur}'. Tendency to suicide. Shouting, howling, laughing, reciting. &.C., 
 for hours together: angry, furious, destructive, ceaseless movements. 
 Weakness, exhaustion, emaciation. Want of sleep. Aversion to food. 
 Incontinence of urine. — Eecovery preceded by sleep, desire for food, 
 with a gradual cessation of agitation and delirium. 
 
 (2) Monomania (^Movoq, alone; iLahoiiai. to be furious. — irrationality on 
 one subject only), or -partial insanity: That form in which the under- 
 standing is deranged to a certain degree, or is under the influence of 
 some one particular delusion. Mind, vigorous: ideas few, erroneous, 
 fixed, not under control. Manners, in accordance with predominant 
 idea. A false principle seized upon, which is pursued logically, and 
 from which legitimate consequences are deduced. Thus, a monomaniac 
 insists that his body is made of glass; and impressed with this idea he 
 takes care to avoid rough handling, lest he should be broken. Or, in 
 belief that he is a divine instrument of vengeance, he may commit mur- 
 der. Aside from his partial delirium, he will reason and act like other 
 men ; so that the insanity is often difficult of detection. 
 
 There are particular forms of monomania : Melancholia (^MiXa^, black; 
 •/(i/'Ti, bile), or lypemania (ilu/nj, sadness; ixa'Aa), is characterized by fear, 
 moroseness, and great despondency: an unwillingness to move, talk, or 
 take food, &c. — In autophomania (AtJTo^ouoq, a self-murderer), there is a 
 desire for suicide; to effect which, melancholies will take most extra- 
 ordinary steps. — In androphomania CAvip, a man ; ^ovbow, to kill), there 
 is an uncontrollable tendency to murder. — Pyromania {llvp, fire), is 
 marked by a propensity to set buildings on fire. — An irresistible desire 
 to steal is known as kleptomania (A/.i--aj, to steal). — In erotomania 
 CEfiwq, love), amatory delusions rule, just as religious delusions pre- 
 dominate in theomania (6'£()?, God), or religious melancholy. Erotomania 
 may be an excessive degree of a chaste and honorable affection; or it 
 may be combined with iiymjjhomania (i\'o/i<frj, the nympha) in women, 
 or with satyriasis (^Id-upoq, a satyr) in men. In all forms of erotomania 
 there is great mental and bodily depression ; women suffer most fre- 
 quently, especially the single; and the phenomena are often connected 
 with some disease of sexual organs. 
 
 (3) Dementia (De, priv. ; 7nens. the mind), or incoherence: That condi- 
 tion in Avhich weakness of intellect, induced by accident or age, is the 
 prominent feature. Mind, altogether feeble; ideas confused, vague, 
 wandering; memory much impaired. Patients ignorant of time, place, 
 quantity, property. &c.; forget immediately what they have just seen 
 or heard. Manners undecided, childish, and silly. The demented have 
 neither affections nor aversions, nor care for anything. Paroxyms of 
 restlessness and excitement. Little or no control over bladder and 
 rectum. In last stage, complete paralysi.s. 
 
 (4) Idiocy (Idiota, a simpleton) : Characterized by partial or com- 
 plete absence of intellect, owing to congenital imperfection of brain. 
 Mind, not developed : ideas, simple or few. Manners foolish; transient 
 gusts of passion. Countenance vacant. Sanguineous tumors about ex- 
 ternal ear. Articulation and gait often imperfect. Occasionally the 
 idiot is a blind deaf-mute. 
 
 Treatment. Prophylactic : Eest of mind, or change of occupation : 
 proper amount of sleep. Attention to functions of sexual system, skin, 
 liver, kidneys, alimentary canal. Removal of any bodily disorder. — 
 Henbane. Stramonium. Indian hemj). Digitalis. Morphia, or opium.
 
 INTERCOSTAL NEURALGIA — INTERMITTENT FEVER OR AGUE. 155 
 
 Chloroform. Quinine and steel. Syrup of phosphate of iron. Phosphate 
 of zinc Bark. Cod-liver oil. Nourishing food : milk: stimulants with 
 discretion. Change of air and scene. 
 
 Curative: All antiphlogistic remedies badly borne. Eemoval of other 
 disorders, — skin diseases, uterine disturbances, syphilitic taints, gastric 
 and intestinal disturbances, &c. Then, in ordinary forms of insanity, 
 a nutritious diet; warm clothing; outdoor occupations and amuse- 
 ments ; cheerful recreation. Sleep at night to be procured by sedatives. 
 Healthy evacuations to be obtained from bowels by vegetable altera- 
 tives, and mild aperients. General strength to be improved by tonics. 
 All bad habits, as onanisn^, to be prevented. Gentle and slow attempts 
 to revive affections, and strengthen bewildered intellect. Baths often 
 useful, — douche, shower, warm, or Turkish. Where food is refused, aiiy 
 derangement of stomach or bowels to be removed, and healthy evacua- 
 tions procured : this failing, forced alimentation, with stomach pump, 
 will be required. All harshness and mechanical restraint to be avoided. 
 Unfortunate patient's confidence to be obtained; every promise that is 
 made must be kept ; as much indulgence as possible to be allowed. 
 
 Restraint in a well-managed asylum, often necessary to enable treat- 
 ment to be effectually carried out : imperatively called for, when patient 
 has suicidal or homicidal tendencies. 
 
 INTERCOSTAL NEURALGIA.— Neuralgia {Nehpov, a nerve; akyo':^ 
 pain) may affect the intercostal, as it does the other nerves of body. 
 Chlorotic and hysterical women most liable to it. Sometimes occurs 
 in Bright's disease, phthisis, &c. Must not be confounded with neuritis, 
 or with pleurisy. 
 
 Symptoms. Pain of a dull and continued aching character, or sharp 
 and paroxysmal. Sometimes lasts for weeks. Most frequently located 
 in sixth, seventh, eighth, or ninth nerves of left side. Follows course 
 of nerves (anterior primary branches of dorsal), extending from ante- 
 rior part of thoracic wall directly backwards to vertebi'se. One or two 
 painful spots sometimes detected on pressure. Occasionally, cutaneous 
 hypersesthesia of whole mammar}' or infra-matumar}'' region. Debilit3\ 
 No febrile symptoms. In women, catamenia may be irregular; leucor- 
 rhoea. 
 
 Treatment. Quinine and aconite, 379. Quinine and steel, 380. 
 Steel and arsenic, 399. Cod-liver oil. Belladonna and aconite lini- 
 ment, 281. Strips of belladonna plaster completel}' round thorax. 
 Flannel bandage. Subcutaneous injection of morphia or atropine, if 
 there are one or more sensitive spots, 314. Nourishing food. Malt 
 liquors or wine. 
 
 INTERMITTENT FEVER OR AGUE.— From Intermitto, to give over 
 for a time. Synon. Periodic Fever. Sometimes termed Paludal fever, 
 from Palus, a fen or marsh. — See Ague. — A disease chiefly due to 
 marshy miasms, in which febrile phenomena occur in paroxysms, are 
 ushered in by rigors, and end in a critical sweat. During the remis- 
 sion there is good health ; but at end of a definite interval the phe- 
 nomena are repeated, and this happens again and again until a cure is 
 effected. 
 
 Three species of intermittent fever or ague, viz., Quotidian, Tertian, 
 and Quartan. Tertian most common in this country; quotidian in 
 India. When the paroxysm occurs at same hour every day, it is called 
 quotidian ague ; when every other day, tertian, though secundan would 
 be more appropriate; and when absent for two whole days, and then 
 recurrent, quartan. In first species the interval is twenty-four hours;
 
 156 INTESTINAL CONCRETIONS — INTESTINAL OBSTRUCTION. 
 
 in second, fort3'-eight; in third, seventy-two. The time between com- 
 mencement of one parox3'sm and beginning of next is termed the in- 
 terval; that between termination of one paroxysm and commencement 
 of next, the intermission. In quotidians the paroxysm occurs, for most 
 part, in morning; in tertians, at noon ; in quartans, in afternoon. The 
 tirst is most common in spring; the second, in spring and autumn ; the 
 third, in autumn. 
 
 Symptoms. An ague fit is composed of three stages, — the cold, hot, 
 and sweating. The first has a duration varying from 30 minutes to 3 
 or 4 hours : the second rarely lasts less than 3 or more than 12 hours: 
 while the third continues a few hours, and ends in complete relief. 
 Patient comparatively well dui'ing interval. — Enlargement of spleen, a 
 frequent result — ague cake. Disturbance of liver and digestive organs. 
 Chronic desquamative nephritis sometimes a consequence of repeated 
 attacks. 
 
 Treatment. General rules : Removal from malarious district. Nour- 
 ishing diet with stimulants. Aperients, or emetics, if bowels or stomach 
 be loaded. Bicarbonate of soda or potash, with a few drops of tincture 
 of belladonna, if bladder be irritable. 
 
 In cold stage: Warm diluent drinks, as weak tea, Avhite wine whey, 
 or negus. External warmth by blankets, hot bottles to feet, hot air 
 baths. 
 
 In hot .stage : Cooling drinks. Sponging with tepid or cold water. 
 Light coverings. In sweating stage : Diluents freely. Eepose. 
 
 Curative remedies : Quinine; 2 or 3 grains to be given every six or 
 eight hours during the intermission, in acid infusion of roses. In Indian 
 intermittents, 10 or 20 or 30 grains of quinine during sweating stage. 
 Subcutaneous injection of quinine, 379. Arsenic, 52. Salicin. Sulphate 
 of bebei'ia. 
 
 To reduce the spleen : Quinine and iron, 380. Bromide of potassium, 
 42. Cod-liver oil. Friction with ointment of red iodide of mercury 
 diluted with an equal quantity of lard Iodide of potassium ointment. 
 Compound ointment of iodine. 
 
 INTESTINAL CONCRETIONS.— Synon. Alvine Calculi; Intestinal 
 Calculi. — Calculous conci'ctions ver}' rare in human intestines, compared 
 with their frequency in large ruminating animals. In man, they are 
 more common in ca?cum and colon, than in other portions of alimentary 
 canal. Bezoars consist chiefly of imperfectly crystallized earthy salts 
 and indigestible fibrous matters, arranged in concentric layers round a 
 nucleus — a gall-stone or an}- foreign bod}'. Other concretions may con- 
 sist solel}' of hardened faeces, with the phosphates of lime and magnesia ; 
 or of chalk or carbonate of magnesia, where these substances have been 
 largely taken; or of hair, cotton, or paper when a depraved appetite 
 has led to the consumption of either; or of gall-stones with layers of 
 inspissated mucus and ftecal matter. Either kind may gradually in- 
 crease in size, until there is complete obstruction of the gut. In for- 
 tunate cases, concretions have been expelled by vomiting or passed at 
 stool. When situated in the rectum, they can be removed by the scoop. 
 If one or more can be felt through the abdominal parietes, producing 
 obstruction, an incision into intestine has been recommended, all other 
 plans failing. 
 
 INTESTINAL OBSTRUCTION.— Synon. Ileus (from EtXim, to twist or 
 
 contract); lleac Passion; Colique de Jlisericorde ; Volvulus {Volvo, to 
 turn or roll itself round about).
 
 INTESTINAL PERFORATION. 157 
 
 Causes. Excluding examples of inguinal and femoral and umbilical 
 hernia, the causes are : 
 
 (1) Intermural, or those originating in and implicating mucous and 
 muscular coats of intestinal walls : 
 
 a. Cancerous stricture, most common in sigmoid flexure of 
 
 colon and in rectum. 
 
 b. Non-cancerous stricture, comprising — 
 
 1. Contractions of cicatrices followino; ulceration. 
 
 2. Contractions of walls of intestine from inflammation, 
 
 non-cancerous deposit, or injury. 
 
 c. Intussusception : ileum and caecum most commonly jjro- 
 
 truded into colon. 
 
 d. Intussusception associated with polypi. 
 
 (2) Extramural, or those causes acting from without, or affecting the 
 serous covering : 
 
 a. Bands and adhesions from effusion of lymph, 
 
 b. Twists or displacements. 
 
 c. Diverticula. 
 
 d. External tumors or abscesses. 
 
 e. Mesocolic and mesenteric hernia. 
 
 /. Diaphragmatic and foramen of Winslow hernia. 
 
 g. Omental hernia. 
 
 h. Obturator and ischiatic and perineal hernia. 
 
 (3) Intramural, or obstructions produced by lodgment of foreign sub- 
 stances. 
 
 a. Foreign bodies, hardened faeces, concretions having for 
 nuclei gall-stones, &c. 
 
 Symptoms. Constant vomiting: at first of mucus and contents of 
 stomach, but in a few days of fjecal matter (stercoraceous vomiting). 
 Pain, often very severe. Tympanites, with violent borborygmi, unless 
 occlusion be high up. Hiccough, especially in strangulation of upper 
 part of small intestines. Mental depression. Pathognomonic symptom 
 — constipation. Palpation often detects increased fulness just above 
 obstruction : more marked diminution of resonance at this point than 
 elsewhere. Early prostration. Acute peritonitis commonly occurs in 
 a few days. Gangrene most frequent in intussusception and obturator 
 hernia. The lower the obstruction, the less urgent the vomitir)g, and 
 the longer the time before it commences. The higher the obstruction, 
 the greater the diminution in the quantity of urine. 
 
 Treatment. When diagnosis is doubtful : Castor oil. Castor oil and 
 turpentine enema, 190. Croton oil enema, 191. 
 
 Directly it is certain a mechanical obstruction exists: Purgatives injui'i- 
 ous. Extract of opium (gr. I every four, six, or eight hours). Opium 
 and belladonna, 344. Subcutaneous injection of atropine, 314. — Fomen- 
 tations. Linseed poultices, with application of belladonna and opium, 
 297. — Food and fluids in very small quantity. Ice. Frozen milk. Lime- 
 water and milk, 14. Tea and cream. Brandy and water. Essence of 
 beef, 3. Eggs, cream, and extract of beef, 5. Brandy and egg mixture, 
 17. — Hot baths. Euemata of large quantities of fluid, with manipulation 
 of intestines by pressure on them through abdominal walls. Gas- 
 trotomy. 
 
 INTESTINAL PERFORATION.— The intestine may be perforated 
 owing to: (1) Disease in coats of bowel, — as in typhoid fever, inflam- 
 mation of csecum, dysentery', cancer of stomach or intestines, &c. (2)
 
 158 INTESTINAL WORMS INTRA-THORACIC TUMORS. 
 
 From extension of ulceration in disease of adjacent organs, — as in hy- 
 datids and abscess of liver, calculi in gall-bladder, ovarian tumors, 
 extra-uterine pregnancy, ovarian abscess, pelvic cellulitis, cancer of 
 uterus or vagina, and suppuration in abdominal parietes. 
 
 INTESTINAL WORMS.— Seven principal entozoa (^Evrbz, within; 
 ifa)((i/, ail animal) may be found inhabiting intestinal canal : Tricocephalus 
 di.spar, or long thread-worm ; Ascaris luiabricoides, or large round-worm ; 
 Oxyarls vermlcularis, or small thread-worm; Sderostoma duodenale, un- 
 known in this country; Taenia solium, or common tape-worm; Tamia 
 wiediocanellata, or bookless tape-worm ; and Bothriocephalus latiis, or 
 broad tape-worm, almost peculiar to inhabitants of Switzerland, Eussia, 
 and Poland. 
 
 Symptoms. Colicky pains and swelling of abdomen. Picking of nose. 
 Itching of rectum and fundament. Foulness of bi'eath. Irregularity 
 of bowels. Grinding of teeth at night. Frequent feeling of malaise. 
 Voracious or impaired appetite. Only conclusive sign, — passage of 
 worms, or of joints of them, in stools. — From reflex irritation, ejiileptic 
 attacks or chorea may occur. 
 
 Treatment. For round and tape-worms: Liquid extract of fern root, 
 187. Santonin, 185. Oil of turpentine, 183. Kousso, 184. Kamela, 182. 
 Calomel, with scammony or jalap, 159. Garlic (Allium sativum). Oil 
 of rue. Assatoetida. Oxide of silver. Spigelia. Decoction of pome- 
 granate root. Veratria. Chloride of tin. Sulphur. Gamboge. Croton 
 oil. Cowhage (Mucuna pruriens). Common salt. 
 
 Fur thread-worms: Enemata of cold water; lime-Avater; infusion of 
 quassia; steel and quassia, 192; common salt, 188: spirit of ether (min. 
 XV to each ounce of water); olive oil. Calomel with scammony, or 
 jalap, 159. Santonin, 185. 
 
 To prevent recurrence: Avoidance of raw and underdone animal food, 
 especially pork ; as well as of imjjerfectly washed raw vegetables. Steel 
 and sulphate of soda, 180. Quinine, rhubarb, and hop, 370. Infusions 
 of chamomile, chiretta, quassia, or rhubarb. Quinine and steel, 380. 
 Steel, glycerine, and quassia, 392. Compound iron mixture and aloes, 
 393. Extract of nux vomica, 175. Phosphate of iron, 405. Steel, 
 hydrochloric acid and quassia, 397. Ammonia iron-alum, IIG. Glycerine. 
 Cod-liver oil. Extract of wormwood (Artemesia absinthium). Oil of 
 stinkweed (Chenopodium anthelniinticum). — See Entozoa. 
 
 INTRA-THORACIC TUMORS.— May be aneurismal ; or composed of 
 cancer, simple exudation matter, fibrous tissue, or of fatty or steatoma- 
 tous matter. Discarding aneurisms, these tumors have their origin in 
 the glandular structures, and are developed in the mediastina. 
 
 Symptoms. Chiefly due to pressure exerted oti heart or lungs, or on 
 the nerves and vessels. Hence, tumor often considei*able before it in- 
 terferes with circulation or respiration. 
 
 General symptoms : More or less pain ; restlessness ; cough ; dyspnoea, 
 or even orthopnoea; frothy or viscid expectoration; palpitation; hoarse- 
 ness; frequently dysphagia; sometimes hemoptysis. Pleuris}-, bron- 
 chitis, pneumonia, laryngitis, or tracheitis may arise from constant irri- 
 tation. Pulmonary collapse may be caused by pressure. Bulging, or 
 even pei'foration, of ribs and sternum. Di-splacement of heart. Im- 
 pediment to circulation through aorta, or through superior or inferior 
 vena cava Dulness on percussion more marked as growth protrudes 
 into anterior mediastinum. Auscultatory signs vary according to nature 
 of secondary complications. 
 
 In primary cancer involving root of lung, inflammatory condensation
 
 INTUSSUSCEPTION — IRITIS. 159 
 
 , of pulmonary tissue, with disorganization and abscess, may result early. 
 These changes probably due to tumor involving and destroying all or a 
 greater part of pulmonary nerves as they pass oif from root of lung. 
 
 Death takes place slowly in mediastinal tumor generally. The pain, 
 want of sleep, loss of appetite, dyspnoea, &c., weaken patient. Anaemia, 
 followed by anasarca, sets in. Sometimes sudden death from hemor- 
 rhage, thrombosis, or spasm of glottis. 
 
 Treatment. All that can be done is to palliate symptoms. Tem- 
 porary relief may be given by, — Diuretics and aperients. Antispas- 
 modics, — Ether, chloroform, belladonna, aconite, stramonium, opium, 
 &e. Iodide of potassium, 31. Iodide of ammonium, 38. Chlorate of 
 potash, 61. Dry cupping. Inunction with red iodide of mercury oint- 
 ment, 302. Iodine and cod-liver oil ointment, 308. Iodide of cadmium 
 ointment, 311. Yenesection to six or eight ounces, if symptoms of pul- 
 monary or cardiac congestion predominate. 
 
 INTUSSUSCEPTION.— From Intus, within ; suscipio, to carry. Synon. 
 Invagination i^In, witlii)i; vagina, a sheath). — That condition in which 
 one part of the bowel is drawn into another portion, just as the finger 
 of a glove is pulled within itself Owing to the congestion, effusion, 
 and inflammation which result, the canal of the bowel gets more or less 
 obstructed. 
 
 The intussusception maybe single or multiple: the traction is usually 
 from above downwards: in about half the cases, ileum and cfficum pro- 
 truded into colon : most common in young children and aged persons. 
 
 Sy.mptoms. The chief are sudden violent pain; sickness; obstinate 
 constipation; discharges of blood and mucus peranum. Spontaneous 
 reduction may take place. In less fortunate cases, inflammation of peri- 
 toneal coats of involved portion usually sets in between third and 
 seventh days ; opposed surfaces becoming adherent. Inflammatory ac- 
 tion may end in gangrene; several inches of included sjihacelated bowel 
 coming away by stool, and leaving canal of gut free. 
 
 Treatment. See Intestinal Obstruction. 
 
 IRITIS. — From '^fptt;, the rainbow, — any object supposed to resemble 
 a rainbow; terminal -itis. Synon. Jriditis ; Inflanimatio Iridis. — Sus- 
 pended (like a curtain with a circular aperture in its centre) between 
 the cornea and crystalline lens, and bathed on both sides by aqueous 
 humor, the iris serves to regulate amount of light admitted to retina. 
 By it, the cavity containing aqueous humor is divided into an anterior 
 and a posterior chamber. — Iris composed of delicate bundles of fibrous 
 tissue, of circular and radiating involuntary muscular fibres, and of 
 pigment cells. Sometimes, absent; or only present in a rudimentary 
 form, a condition known as Irideremia. — In Albinism the iris is of a rose 
 color, while pupils present a deep red appearance owing to absence of 
 opaque pigment (uvea). — In Coloboma the two halves of the iris have 
 failed to unite, in consequence of arrest of development, so that jmpil 
 has an elongated form. 
 
 1. Acute Inflammation. — -The iris is seldom alone attacked ; sclerotic 
 and deep-seated textures of eye generally also involved. Hence, ob- 
 jections have been raised to use of term Iritis: its employment "has 
 the effect of dii*ecting the practitioner's attention to the iris, which 
 bears a great deal of inflammation without destruction to the organ, 
 and withdrawing it from the retina, which bears very little without 
 permanent injury to vision." (Jacob.) 
 
 Symptoms. In first stage, ii-is presents a confused appearance, owing
 
 160 IRITIS. 
 
 to its fibrous texture becoming indistinct : loses its contractile power, 
 and undergoes a change in color. Sclerotic becomes extra-vascular. In 
 next stage, fibrine effused on surface of iris, and in anterior chamber. If 
 inflammation proceed, pupil may get closed, or its margin become ad- 
 herent to capsule of lens; or cornea may be rendered opaque; or per- 
 manent opacity of lens or its capsule may result. 
 
 The important symptoms may be thus enumerated : (1) Zonular 
 sclerotitis; fine hair-like vessels, running in radii towards edge of 
 cornea. (2) Discoloration of iris. If naturally blue, it becomes green- 
 ish ; if dark colored, reddish. This the result of increased vascularity, 
 or of eff'usion of lymph into its substance, or on its posterior surface. 
 (3) Contraction, irregularity^, and immobility of pupil. (4) Etfusion of 
 coagulable lymph into pupil and posterior chamber, and occasionally 
 into anterior chamber. (5) Adhesions of iris, and especially of pupil- 
 lary edge, to capsule of lens; in some rare cases, to cornea. (6) Tuber- 
 cles, pustules, or small abscesses of iris. (7) Dimness of sight, and 
 sometimes total blindness. (8) Pain in eye, and nocturnal circumor- 
 bital pain. (Mackenzie.) 
 
 Not to be supposed that in every case all the foregoing symptoms will 
 be met with : rather a certain number of them will be found, sufficient 
 to render diagnosis certain. Constitutional disturbance well marked, 
 though not generally severe. 
 
 If inflammation be not checked, it creeps on, involves choroid coat 
 and retina, and, spoiling delicate texture of latter, completely destroys 
 sight forever. When one eye has been permanently injured from any 
 cause, sympathetic subacute inflammation is not unfrequently set up in 
 the sound organ at the end of some months, or even in the course of a 
 few days, which may go on to produce complete destruction. To 
 prevent this it is often necessary to remove the eye which was first 
 damaged. 
 
 The chief causes are: Exposure to cold and wet, giving rise to rheu- 
 matic or idiopathic iritis; syphilis, causing syphilitic iritis; injuries 
 and wounds producing traumatic iritis; and certain conditions of the 
 constitution, especially the scrofulous, rheumatic, and gouty. 
 
 Iritis arising as a secondary eftect of syphilis, is perhaps the most 
 common. May occur at all ages. Usually attended with other eftects 
 of constitutional syphilis — copper-colored eruptions, nodes, pains in 
 bones especially severe at night, and ulceration of thrOat. At first, 
 redness is less severe than in rheumatic form; there is seldom any 
 haziness of cornea, as in rheumatic iritis; iris often assumes a rusty 
 color, especially near pupillary edge; pu])il is apt to be displaced, and 
 to be drawn upwards towards the root of the nose. 
 
 Treatment. Mercury, bleeding, and belladonna are the supports on 
 which practitioner has been taught to rely. That the first tAVO agents 
 may be advantageously dispensed with is pi'oved by rejiorts of sixty- 
 four cases; all of which were cured by sustaining general health, re- 
 lieving jjain with narcotics, and keeping pupil dilated by belladonna 
 (Dr. W. H. Williams). 
 
 The object must be to check flow of blood towards the part ; to arrest 
 eff'usion of fibrine; and to procure absorption of that poured out To 
 gain these ends, patient to be kej^t quiet, preferably in darkened room, 
 and with eye protected from light. Sedative foinentations, if the eye 
 is morbidly sensitive; bowels to be kept regular by mercurial purga- 
 tives, or enemata; opium to be given to relieve pain: diet to be plain 
 but nourishing, and free from stimulants. Iodide of potassium (81) 
 often of great value, especially in rheumatic and strumous iritis: in 
 that dependent upon syphilis, mercurj^ (25, 34, 131) sometimes more
 
 JAUNDICE. 161 
 
 useful, though not to salivation. — If there he depression, — Ammonia and 
 bark, 371: quinine, 379; salicin and sarsaparilla, 388. — When circumor- 
 bital pain is intense, — relief may be alforded by mixing three grains of 
 powdered opium with ten of mercurial ointment, and well rubbing the 
 compound into the temple. — The pupil to be kept Jildted (in order to pre- 
 vent iris from forming adhesions with capsule of crystalline lens) by 
 belladonna; or more conveniently by solution of atropine, 288; or by 
 discs of gelatine atropine paper. No astringent or other collyria should 
 be employed. 
 
 Other remedies recommended: Turpentine; colchicum ; cod-liver oil; 
 santonin ; henbane. Stramonium (locally, as a substitute for bella- 
 donna.) 
 
 2. Inflammation of Iris and Cornea. — It was erroneouslv believed 
 until recently that a serous memhraiie or capsule covered the posterior 
 surface of cornea, both surfaces of iris, and front of capsule of lens. 
 Hence, the present disease was su])po8ed to consist of inflammation of 
 this membrane, and was named " aquo-capsulitis." 
 
 Symptoms. They run a chronic course. There is chiefly, — intole- 
 rance of light; vascularity of sclerotic; haziness of cornea; and slight 
 change in color of iris. General health alwaj's bad. The disease very 
 obstinate in delicate children. Probably always the result of inherited 
 syphilis. 
 
 Treatment. Mild alteratives ; tonics; good diet. Tincture of iodine 
 carefully applied to skin of ej^elids often relieves intolerance of light. 
 
 3. Mydriasis. — From Muddut, to be damp ; because the disease was 
 supposed to be occasioned by redundancy of humors. — From pai'alysis 
 of third nerve or motor oculi, long continued use of belladonna, and 
 other causes — the iris sometimes loses its power, so that pupil remains 
 dilated. This condition must not be confounded with immobilit}' of 
 pupil owing to disease of retina, from which it may be distinguished 
 by a simple experiment practised hy ophthalmic surgeons. The patient 
 is directed to supply the want of a contracted iris by looking through 
 a large pin-hole in a card held close to the eye. If case be one of 
 mydriasis, he will see perfectly; whereas, if retina be diseased, the 
 aperture will be nearly or quite useless. — The remedies for mydriasis 
 consist of tonics which act specially upon the nervous sj^stem, — Zinc, 
 414, 416 ; nux vomica, 387, 409. Phosphate of iron, 405. Strj'chnia and 
 steel, 408. Ergot of rye. A succession of blisters to the temple. Con- 
 cave glasses often serviceable. Tlie local employment of the Calabar 
 bean might be useful where the disease has been caused by belladonna. 
 
 4. Myosis. — From Mbo), to contract. An unduly contracted state of 
 the pupil. — There is obscurity of vision, especially in a weak light. The 
 remedies are rest, with tonics to improve the general health. The use 
 of belladonna has been condemned. 
 
 JAUNDICE. — Probably from the Fi-ench Jaunir, to become yellow. 
 Synon. Icterus. — A prominent sj-mptom of many varied morbid processes. 
 Like albuminuria, glucosuria, &c., a symbol of changes going on in the 
 economy, rather than a specific disease. 
 
 All forms can be included under one of two divisions: (1) Those due 
 to suppression of biliary functions, in which the coloring matter of biie 
 and cholesterine accumulate in the blood. (2) Those arising from re- 
 absorption of bile properly formed, the flow of which into duodenum is 
 impeded. After jaundice from obstruction has existed some time, sup- 
 pression likewise occurs; owing to backward pressure exerted on hepatic 
 
 11
 
 162 KELOID — KNOCK-KNEES 
 
 parenchj^ma by over-distended bile-tubes impeding capillary circulation 
 through the gland. 
 
 Symptoms. Yellowness of conjunctivre and skin. Saffron hlie, or 
 brownish-black tinge, of urine; according to amount of bile-pigment 
 present. White color, or light clay appearance, of faeces. Itching of 
 skin. Perhaps, exhaustion; drowsiness, giddiness, and peevishness; 
 bitter taste ; slow pulse; dyspepsia, especially for fatty food. Exception- 
 ally, corne^e, or aqueous and vitreous humors have become jaundiced; 
 making all objects appear of yellow hue. 
 
 If disorder be of long-continuance, there may be marked stupor, 
 delirium, and other indications of cerebral derangement. Weakness 
 and emaciation from malnutrition. Tendency to hemorrhage — bleed- 
 ing from gums, purpura, etc. — Where there is obstruction from a gall- 
 stone, most severe suffering results; vomiting and hiccup; perhaps 
 fatal exhaustion. 
 
 In jaundice from srippressio7i urine only contains those biliary ingre- 
 dients which exist preformed in the blood. In that from obstruction, 
 besides these, there are materials (bile-acids) generated in liver itself; 
 which have been reabsorbed into circulation from overcharged gall- 
 bladder and ducts. To distinguish between these, add gently to about 
 two fluid drachms of urine half a drachm of strong sulphuric acid, and 
 a piece of loaf sugar as large as a j^ea. If at line of contact of the two 
 liquids a purple or scarlet color is pi'oduced, it shows that acids of bile 
 are present, — jaundice therefore due to obstruction : if merely a brown- 
 ing of the sugar takes place, there are probably no bile-acids, and the case 
 is one of suppi*ession. (Harley). 
 
 Treatment. From suppression : Sulphate of soda and taraxacum, 144. 
 Nitric acid, senna, and taraxacum, 147, 227. Eesin of podophyllum, 30, 
 160. Benzoic acid, 479. Colchicum, 46. ISTitro-hydrochloric acid, 378. 
 Hydi'ochlorate of ammonia, 60. Acid tartrate of potash drink, 356. 
 Sulphate of manganese, 172. 
 
 From obstruction : Compound decoction of aloes. Pill of Barbadoes 
 aloes. Sulphate and carbonate of magnesia, 141. Squills, digitalis and 
 broom, 219. In long-continued obstruction, capsules of pig's bile, 170. — 
 See Gall-Stones. 
 
 KELOID. — Perhaps from KrjXr,. a tumor; el(5o?, like. Described by 
 Alibert, as Kelis. Cheloidea, or Cancroide; owing to its presenting a 
 flatfish raised patch of integument, resembling the shell of a tortoise 
 (^XiXu<;, a tortoise, terminal -ides.) — Consists of flat tender excrescences 
 or cuticular folds; one or more inches in diameter; 7-aised a few lines 
 above level of skin ; having irregular forms Avith slight depressions in 
 their centres; and covered with wa'inkled eijidermis. Sometimes, ex- 
 crescence resembles a cicatrix left by a burn. There may be only one 
 tumor, or several. Disease developed slowl}' ; rarely ends in ulceration ; 
 sometimes disappears spontaneously, merely leaving a cicatrix; is 
 usually found on chest between the manimre; and is verj^ uncommon. 
 
 Treatment. Arsenic, 52. Donovan's triple solution, 51. Iodide of 
 potassium. Cod-liver oil. Eemoval by knife, or caustics, injurious. 
 Pressure, useless. 
 
 KNOCK-KNEES. — Synon. Genua Valga. — A relaxation of internal 
 lateral ligaments of knee-joints, allowing femur and tibia to become sep- 
 arated, so that an angular obliquity of the bones results. — May come on 
 in delicate and strumous children when the}- begin to walk. Not 
 uncommon in porters who carry heavy weights on the head. When
 
 LARYNGISMUS STRIDULUS — LARYNGITIS. 163 
 
 treatment is called for may be remedied by an articulated apparatus 
 extending from pelvis to beel. Improvement of general health. 
 
 LARYNGISMUS STRIDULUS.— From Aapv'rfi%u>, to vociferate with 
 
 all liis might: Htridco. to make a hissing noise. Synon. Apncea Infan- 
 tum; Jjaryngospasmus ; Infantile Laryngismus ; Thymic Asthma; Spuri- 
 ous or Cerebral Croup ; Child-crowing. — A spasmodic disease occurring in 
 infants, chiefly during dentition. It consists of a temporary, partial, or 
 complete closure of rima glottidis ; by which entrance of air into lungs 
 is impeded or stopped. 
 
 Symptoms. Interruption of breathing. Eigidity of fingers and toes, — 
 carpo-pedal spasm. Child suddenly seized with dyspnoea : it struggles 
 and kicks, is unable to inspire, and seems about to be suffocated. 
 Presently, spasm ceases ; air drawn through chink of glottis with a 
 shrill whistling or crowing sound. Paroxysms may return in a few 
 hours or days. 
 
 Treatment. During paroxysm: Hot water to lower parts of body, 
 with cold affusion to head and face. Slapping of chest and nates, 
 sharply. Exposure of face and chest to current of cold air. Gentle in- 
 halation of chloroform. Vapor of ether or ammonia to nostrils. Arti- 
 ficial respiration, drawing tongue well forwards. As a last resource, 
 tracheotomy. — During interval: Mild purgatives. Anthelmintics, if 
 necessary. Antispasmodic tonics : Zinc and belladonna. 92. Assa- 
 foetida. Hydrocyanic acid. Valerianate of iron. Quinine. Cod-liver oiL 
 Especially change of air. Cold sea- water sponge baths. Simple diet, 
 with milk. Lancing of gums, if they be tender and swollen. 
 
 LARYNGITIS. — From Adpuy^, the windpipe; terminal -itis. — Acute 
 inflammation of the larynx is a rare disease; it is generally fatal. 
 CEdema of glottis may occur from other causes than acute inflammation. 
 Larynx also liable to chronic inflammation, ulceration, polypi, kc. 
 
 1. Acute Laryngitis. — Synon. Inflammatio Laryngis; Cynanche Laryn- 
 gea ; Angina Laryngea. — Almost peculiar to adults. Generally arises 
 from cold and wet in unhealthy constitutions. Ocasionally caused by 
 syphilis. Inflammation often of limited exteut : the great danger due 
 to its situation. 
 
 Symptoms. Come on insidiously. At end of some hours, — fever; 
 redness of fauces; pain referred to pomum Adami ; difficulty of breath- 
 ing and swallowing ; considerable anxiety; hoarseness or even com- 
 plete loss of voice. Spasmodic exacerbations : paroxysms of threatened 
 suffocation. Long inspirations: peculiar wheezing sound, as if air were 
 drawn through a narrow tube. Perhaps, harsh and brassy cough. 
 Dysphagia: liquids swallowed Avith more difficulty than solids. Face 
 gets flushed; eyes protruded; pulse hard; great general distress. 
 Larynx and trachea move rapidly upwards and downwards: all 
 the muscles of respiration brought into strong action, so that chest 
 heaves violentl}?". Patient gasps for breath : tries perhaps to get to 
 open window. He soon sinks into a drowsy and delirious state; and 
 speedily dies suffocated, from obstruction of chink of rima glottidis. 
 
 Treatment. Eest and quiet : forbid talking. Air of room to be kept 
 moist: temperature 70° F. Turpentine, or hot water, stupes to neck. 
 Extract of belladonna to neck, with linseed poultices. Inhalation of 
 steam of boiling water; or of vapor medicated with hydrocyanic acid 
 or a little chloroform, 261. Inhalation of spray medicated Avith stramo- 
 nium, belladonna, conium, or iodine, 262. A respirator to be Avorn dur- 
 ing intervals betAveen inhalations. Directh' there are indications that
 
 164: LEAD COLIC — LEPRA. 
 
 the blood is not thoroughly oxygenated, — tracheotomy. Milk, or cream. 
 Raw eggs. Beef tea. Wine or brandy. 
 
 Bleeding, blistering, calomel, tartarated antimony, — positively inju- 
 rious. If disease be due to constitutional syphilis, — free mercurial 
 inunction 5 mercurial vapor baths, 131. 
 
 2. (Edema of Glottis. — Synon. (Edematous Laryvgitis; Hydrops Glot- 
 tidis; Submucous Ldryngitis. — May be caused b}' larj-ngitis ; boiling water, 
 or corrosive poisons taken accidentally into mouth; poison of erysip- 
 elas. Sometimes simulated by d^'spnoea of general anasarca, renal dis- 
 ease, &c. Hence a laryngoscopic examination should often be made to 
 remove all doubt. To favor subsidence of tumefaction sponge epiglottis 
 and cavity of larynx with solution of nitrate of silver (gr. 60 of crystals 
 to one ounce of distilled water). Scarifications of oedematous swelling 
 may be successfully made b}^ aid of laryngoscope. These plans failing, 
 — laryngotomy or tracheotomj'. 
 
 3. Chronic Laryngitis, &c. — Chronic inflammation and ulceration not 
 uneouiuiun in pulniunar}' consumption : a species of tuberculosis known 
 as phthisis laryngea, — Membrane lining laryngeal cartilages often be- 
 comes thickened and ulcerated in constitutional syphilis. — Polj'pi and 
 warty tumors arise from different parts of larj^nx : cause great impedi- 
 ment to entrance and exit of air. May be removed by aid of laryngo- 
 scope with a small wire ecraseur. — Epithelial cancer occasionally seated 
 about vocal cords. — See Foreign Bodies in Air-passages. 
 
 LEAD COLIC. — S3'non. Painter's Colic; Saturnine Colic; Morbus 3Ie- 
 taliicus ; Colica Bachialgia ; Dry Gripes or Bellyache; Colica Pictonum^ 
 from its former frequenc}' among the Pictoiies or inhabitants of Poictou. 
 — Attacks of colic, vomiting, and constipation from the jDresence of lead 
 in the s^'stem. Often followed by paralysis. 
 
 Symptoms. In addition to those of ordinary colic, an intense grind- 
 ing or twisting sensation round navel: retraction of abdominal integu- 
 ments towai'ds spine : pain in back. A blue or slate-gray line round 
 edges of gums. 
 
 House painters suflFer most frequently: often have manj^ attacks be- 
 fore muscles of arms become affected with paralysis, causing drop-wrist. 
 Sleeping in a recently painted room, drinking fluids which have been 
 kept in leaden vessels, taking snuff adulterated with lead, &c., are not 
 uncommon causes. 
 
 Treatment. During attack: Calomel and jalap, with sulphate of 
 magnesia, 140. Sulphate of magnesia and sulphuric acid, 1-42. Sulphate 
 of soda and sulphuric acid. 143. Castor oil, 1()4. Croton oil, 168. Ene- 
 mata of warm water. Hot baths. 0})ium and chloroform, 316. Morphia 
 and ether, 315. Morphia, chloroform, and Indian hemp, 317. Opium 
 and belladonna, 344. Faradization: perhaps Avhile patient is under 
 influence of chloroform. Farinaceous food. — Subsequently, to eliminate 
 poison: Iodide of potassium, 31. Sulphur baths, 125. Sulphate and car- 
 bonate of magnesia, 141. Colchicum,46. — Prophylactic : Sulphuric acid 
 drink. Attention to functions of skin and bowels. Avoidance of abuse 
 •of alcoholic drinks. — See Colic; Paralysis (section 9). 
 
 XEPRA. — From /l^-/5a, a scal^'state of the skin. Synon. Common Dry 
 Tetter; IJurojiean Leprosy; Alphos ; Psoriasis. — The most obstinate and 
 ti'oublesome of all curable cutaneous diseases. A non-contagious squa- 
 mous eruption ; consisting of red and scaly circular patches, of various 
 dimensions, scattered over different parts of body. Most frequently 
 found in the neighborhood of the joints, especially near the knee and
 
 LEUCOCYTHEMIA LICHEN. 165 
 
 elbow. By degrees, pateheH increase in size and number, and extend 
 along extremities to trunk. 
 
 Varieties. When the patches are of moderate size, round and red- 
 dish, and covered with, tliin white scales, affection known as lepra 
 vulgaris: when eruption is smaller and whiter than the foregoing, and 
 of long standing, disease termed lepra alphoides : when it is copper- 
 colored, result of syphilis, syphilifie lepra. 
 
 Treatment. Locally: Warm baths. Alkaline baths, 121. Tar oint- 
 ment (unguentum picis liquidffi, Phar. Lond. 1851). 
 
 Internally : Aloes, gentian, and potash, 148. Pepsine and aloes, 155. 
 Nitric acid, senna, and taraxacum, I-IT. Ammonia and rhubarb, IGl. 
 Arsenic, 52. Donovan's triple solution, 51. Sarsaparilla and corrosive 
 sublimate, 27. Infusion of dulcamara. Tar capsules, 36. Tincture of 
 cantharides. 226. Cod-liver oil. Sulphur. Colchicum. Iodide of potas- 
 sium, HI. Eed iodide of mercury, 54. Ked iodide of mercury and ar- 
 senic, 55. Harrogate waters, 466. Purton spa, 462. Bareges, 470. Simple 
 nourishing food: avoidance of stimulants. 
 
 LEUCOCYTHEMIA.— From Aeuxdq, white; xurac;, a cell; and al/m, 
 blood. i6ynon. Leucocytosis ; Leucaemia; White Cell Blood. — A morbid 
 state of the blood, in which the white corpuscles are greatly increased 
 in numbei", while the red cells are much diminished. Connected with 
 hypertrophy of one or more of the lymphatic glands, or of the spleen. 
 
 Symptoms. Anajmic pallor. Emaciation and debility. Abdominal 
 swelling. Disordered respiration. Loss of appetite. Mental depres- 
 sion. Diarrhoea. Nausea. Hemorrhage from nose, lungs, or stomach. 
 Jaundice. Anasai'ca. Ascites. Prostration, ending in death. 
 
 Treatment. Bark, 22, 376. Iron, 21, 392, 394, 405. Quinine, 379, 
 380. Carbonate of ammonia. Cod-liver oil, 389. Gallic acid, 103. 
 Alkaline hypophosphites, 419. Iodide of potassium. Chloride of potas- 
 sium. Nourishing food. Pepsine, 420. Stimulants. Sea air. Chalyb- 
 eate mineral waters. 
 
 LEUCODERMA. — From Asuxd:;, white ; diprm, the skin. Synon. Leii- 
 eopathia; Chloasma Album; Alphosis ; Achroma. — A rare condition; in 
 which the skin is rendered white in various sized patches, from loss of 
 cutaneous pigment. Occurs especially in negroes, — " the piebald negro." 
 General health not affected. 
 
 LEUCORRHCEA.— From Asuxo^, white; ^'a>, to flow. Synon. Menstrua 
 Alba; Fluor Aluliebris ; Catarrhus Genitalium; The Whites. — A mucous 
 discharge from the lining membrane of the uterine cavity, or of the 
 vaginal canal. Hence, there may be uterine or vaginal leucorrhoea. — 
 See Endometritis ; Vaginitis. 
 
 LICHEN. — From Aeiyr,'^, moss. Synon. Papxdce Siccoi ; Licheniasis 
 Adultorwm; Lichenovs Bash. — An obstinate and annoying papular affec- 
 tion of the skin. Recognized by the minute, hard, red elevations which 
 it presents, and which are either distinct or ari-anged in clusters; by 
 the tingling and irritation; and by the slight desquamation which fol- 
 lows. 
 
 Varieties. (1) Lichen simplex: Eruption of red inflamed papuhie, on 
 face or arms, extending to trunk and legs. Slight fever; itching or 
 tingling; eruption fades in about a week, when desquamation takes 
 place. Disease apt to return every spring or summer in irritable con- 
 stitutions. Sometimes mistaken for measles or scarlet fever. — (2) Lichen 
 pilaris, or hair lichen: a modification of preceding; papula? appear only
 
 166 LIP^MIA — LUMBAR, PSOAS, AND ILIAC ABSCESS. 
 
 at roots of hairs. Often due to stomach derangement, especially that 
 from abuse of alcoholic drinks. — (3) Lichen circumscriptus, or clustered 
 lichen: jjatches of papulae, with well-defined margins and an irregularly 
 circular form. — (4) Lichen agrius, or wild lichen: most severe form; 
 ushered in by fever. Papulae much inflamed ; developed on an erj'them- 
 atous surface, which appeal's hot and painfully distended. In a short 
 time, inflammation diminishes: papulae become covered with furfuraeeous 
 desquamation ; or their points are scratched off, surrounding skin be- 
 comes fissured into deep painful cracks, and sero-purulent fluid exudes, 
 forming thin scaly crusts. Itching, tingling, and smarting intense; 
 fever, nausea, headache, rigors, and other s^^mptoms of constitutional 
 disturbance. In mild cases, symptoms may subside and eruption die 
 away in fourteen days : in severe varieties, disease frequently prolonged 
 for months. — (5) Lichen lividus: distinguished by livid hue of papulae, 
 which chiefly form on limbs, and are not accompanied b}^ fever. — (6) 
 Lichen tropicus, or prickly heat : peculiar to tropical climates. Appears 
 to be partly due to exposure during heat of day, before system has be- 
 come acclimatized. — (7) Lichen urticatus, or nettle lichen : peculiar, inas- 
 much as its commencement is marked by occurrence of wheals, like 
 those produced by bites of bugs or gnats. "Wheals subside and leave 
 papulae, which are sometimes obstinate ; both wheals and jiapula) accom- 
 panied with itching, pricking, and tingling. 
 
 Treatment. Fo?' all forms except Ath and 5th : Only simple i-emedies 
 required. Tepid baths : mild laxatives : acidulous drinks : an unstimu- 
 lating diet. Irritation to be relieved by acetate of lead and hydrocyanic 
 acid lotions, 263 : or by equal parts of subacetate of lead and oxide of 
 zinc ointments : or by glycerine and water, equal portions : or by cor- 
 rosive sublimate lotion, 271 : or b}' collodium, 285. 
 
 Lichen Agrius: Steel and aloes. 154. Steel and sulphate of magnesia, 
 166. Pepsine and aloes, 155. JSTitric acid and bark, 376. Arsenic, 52. 
 Corrosive sublimate, 27. Turkish bath, 130. Mercurial vapor bath, 131. 
 Sulphur baths, 125. Cod-liver oil. Iodine. Iodide of jiotassium. Col- 
 chicum. Pepsine. 
 
 Lichen Lividus: Quinine and mineral acids, 379. Quinine and steel, 
 380. Phosphate of iron, 405. Tincture of perchloride of iron and gly- 
 cerine, 392. Cod-liver oil. Generous diet : milk: malt liquors>or wine. 
 
 LIPJEMIA. — From ih'-a, fat; aqm, blood. Fatty blood. — See Piar- 
 hccniia. 
 
 LOCKED-JAW. — Synon. Trismus, from Tpt'Cw, to gnash with the teeth. 
 
 — See Tetanus. 
 
 LUMBAGO. — From Lumbus, the loins. Synon. Bheumatismus Dor- 
 
 salis ; liachirrheuma. — See Chronic Rheumatism. 
 
 LUMBAR, PSOAS, AND ILIAC ABSCESS. — Chronic collections of 
 pus in these situations generally due to caries of bodies of dorsal ver- 
 tebrae. More seldom, are caused by general debility without spinal dis- 
 ease. Occur especially in strumous subjects. 
 
 Symptoms. Quantity of pus usually large. When it points in the 
 loins, generally on one side of spine, it is known as lumbar abscess. 
 "When in the groin, below Poupart's ligament, having travelled along 
 the course of one or both psoae muscles, it is termed psoas abscess. 
 When above Poupart's ligament, it is called iliac abscess. In excep- 
 tional cases, the abscess has burst into peritoneum, large intestines, or 
 pleura. "V^ery rarely the pus has been absorbed.
 
 LUPUS — MAMMARY ABSCESS. 167 
 
 Treatment. When a permanent cure cannot be hoped for, it is un- 
 wise to interfere unless there be pain or much inconvenience. If diag- 
 nosis of spinal disease be uncertain, or if there be ranch pain or hectic 
 fever, or if the abscess appear lilvely to burst, its contents may be let 
 out by a valvular incision and the opening closed. Puncture with trocar 
 and canula sometimes advised. In all cases, improvement of general 
 health necessary. Bark. Ferruginous tonics. Good diet. Cod-liver 
 oil. Sea air. 
 
 LUPUS. — From Lupus, a wolf, — owing to its destructive character. 
 Synon. Ulcus Tuberculosum; Noli me Tangere. — A destructive skin dis- 
 ease; commencing in the form of one or more indolent, soft, dull-red 
 tubercles, which become covered with scabs, have a tendency to heal 
 spontaneously, and always leave a scar. Most common on the face: 
 occurs in the young or middle-aged: and is more often met with in 
 women than men. 
 
 Varieties. Two forms, — Lupus non-exedens, and Lupus exedens. In 
 the first, little or no ulceration, yet the tubercles leave deep cicatrized 
 pits behind them; while when it spreads rapidly and superficially, the 
 skin is left crossed by white sear-like ridges and bands. The second, 
 very destructive; attacks the nose more frequently than any other 
 region of body. Extent of parts which it destroys varies; sometimes 
 the whole nose being eaten away, sometimes only the point. — Both 
 varieties maybe present in same case: disease on alse nasi consisting of 
 lupus exedens, while that on face is of non-exedens form. Moreovei-, 
 whether ulceration be present or not, the disease is essentially the same. 
 
 Treatment. Litertially : (Inin'me, 379. Quinine and steel, 380. Qui- 
 nine, steel, and arsenic, 381. Arsenic, 52. Cod-liver oil, 389. Iodide 
 of iron and cod-liver oil, 390. Phosphate of iron, 405. Opium. Nour- 
 ishing food. Exercise in pure air. 
 
 Jjocally : Free destruction of entire tubercle or ulcer by some poten- 
 tial caustic; repeating application until a healthy surface results. Chlo- 
 ride of zinc, rubbed in, or applied in paste, 197. Potassa fusa. Arsenic 
 and calomel powder, 203. Acid solution of nitrate of mercury, 195. 
 Pure carbolic acid. Chromic acid, 196. 
 
 MALACOSTEON.— From MaXay.oq, soft; dffriov, a bone. Synon. Mol- 
 litles O.'isiuiii. — See Osteomalacia. 
 
 MALIGNANT VESICLE. — Synon. Charhon. — A furunculoid disease 
 conveyed from cattle to man by inoculation. 
 
 Symptoms. A pimple or vesicle, which usually forms on a surface 
 habitually exposed. Swelling and discoloration. Severe carbuncular 
 inflammation: enormous swelling: brawny hardness : loss of vitality : 
 blackness. Fetid breath. Embarrassed respiration. Great prostra- 
 tion. Death with symptoms of general blood poisoning. 
 
 Treatment. Early incisions. Extirpation. Scarifications, with ap- 
 plication of caustics. Potassa fusa. Acid solution of nitrate of mer- 
 cuiy. Actual cautery. 
 
 Sulphite of soda or magnesia, 48. Bark. Quinine. Opium. Tar 
 capsules, 36. Essence of beef, 2, 3. Cream or milk. Haw eggs. Alco- 
 holic stimulants. Current of pure air over bed. 
 
 MAMMARY ABSCESS.— Synon. Mastodynia Apostematosa ; Milk Ab- 
 scess ; Abscess of the Breast. — May be acute or chronic : the former a re- 
 sult of active inflammation. Forms either in substance of gland, or 
 between gland and skin, or between gland and chest walls.
 
 168 MAMMARY HYPERTROPHY — MAMMARY TUMORS. 
 
 Symptoms. Acute: Occurrence of rigors during progress of inflam- 
 mation. Engorgement of breast. Deep-seated or diffused burning 
 pains: thi'obbing, and sense of heavy weight. Formation of a painful 
 point. Fhictuation. Symptoms, general and local, most severe in intra- 
 glandular abscess. 
 
 Chronic : Most important, because the lump or knot in breast is apt to 
 be mistaken for a malignant tumor. Matter forms very slowl}^ : may 
 be result of scrofula or derangement of general health, without any in- 
 flammatory symptoms. Occurs in puerperal and in sterile Avomen. 
 First indications, are hardness of gland and soreness about nipple. An 
 imperfectly circumscribed and uneven tumor can be detected: fluctua- 
 tion indistinct, often difficult to appreciate, owing to thickness of plastic 
 effusion round the jnirulent collection. Nipple ma}^ be retracted. Ad- 
 hesion occurs between tumor and skin. 
 
 Treatment. Tonics and stimulants. Nourishing food : malt liquors. 
 Introduction of grooved needle, if diagnosis be doubtful. Free punc- 
 ture at most depending point. Drainage tube. Poultices. Pressure 
 with long strips of sti-apping. Care necessary to prevent sinuses from 
 burrowing. If they form, pressure or stimulating injections can be 
 tried ; or setons should be passed through them. Attention to digestive 
 and uterine organs. 
 
 MAMMARY HYPEETROPHY.— Enormous hypertrophy of one or 
 both breasts may occur in single and married women. Usually one 
 gland first begins to enlarge, and slowl}^ increases in size. At the end 
 of a year or more, opjiosite mamma gets affected. No inflammatory 
 s5'mptom8, induration, or pain. Enlai'gement becomes burdensome, and 
 unsightly. Affected gland may project firmly from thorax ; or it may 
 hang flabby and loose — pendulous breast. In many cases, the uterine 
 functions are imperfectl}^ performed. General health usually impaired. 
 Occasionally, perhaps, the result of masturbation. The worst case 
 which the author has seen, w^as attributed to imperfect sexual inter- 
 course : both breasts were affected, reaching to the umbilicus. 
 
 Treatment. Very unsatisfjictory. Improvement of general health. 
 Attention to uterine functions. Pressure with strips of ammoniac and 
 mercur}^, or mercurial, or litharge, or belladonna plaster; or by spring 
 pads, or Dr. Arnott's air cushion. Where patient is pregnant, a hope 
 of cure may be entertained when lactation is set up. Various prepara- 
 tions of iodine have been largely tried : seldom with any benefit. The 
 clitoris has been excised. In very severe cases, one or both breasts 
 have been amputated. 
 
 MAMMARY TUMORS.— The female breast may be the seat of several 
 varieties of tumor. Some are simple; and with one or two exceptions, 
 are composed of elements more or less resembling those entering into 
 the structure of the normal gland. Others are malignant ; and are 
 formed of elements foreign to the healthy organism. 
 
 1. Lacteal Tumor. — From Lac, milk. Synon. Galactocele (Fr/Ja, milk ; 
 xyj/.Tj, a tumor); Lactocele ; Milk Tumor. — A distension of one or more 
 lacteal tubes, owing to occlusion of the oi'ifices; or a rupture of a milk 
 duct, with escape of contents into surrounding connective tissue. 
 Occurs during lactation. 
 
 Symptoms. A cystic growth, varying in size from that of a walnut 
 to that of an orange, can be felt; which when recent is elastic and fluc- 
 tuating. As the serous portion of the milk gets absorbed, the tumor 
 becomes firmer and feels almost solid. Absence of pain. General
 
 MAMMARY TUMORS. 169 
 
 lienlth unaffected. Enlargement commonly discovered by accident : 
 patient alarmed, fearing cancer. Very rarely the earthy salts of the 
 milk form a small concretion, — lacteal calculus. 
 
 Treatment. Free puncture, keeping the wound pervious until all 
 discharge ceases. Sometimes a cure cannot be effected until gland 
 tissue becomes inactive, — until infant is weaned. If slight inflamma- 
 tion and suppuration follow the puncture, tbere will be no need for 
 anxiety : a cure will occur as in abscess. 
 
 2. Fatty Tumor. — Masses of fat may be developed within the breast, 
 or in front or behind it. They give rise to an appearance of mammary 
 hypertroph}^. Such tumors grow slowly, sometimes attain a weight of 
 several pounds, and are only inconvenient from their bulk. 
 
 3. Enchondromatous and Osteoid Growths. — Cartilaginous and bony 
 tumors have been found in the breast on a very few occasions. 
 
 4. Fibro-Plastic Growths. — Synon. Recurrent Fibrous Tumor. — O^very 
 rare occurrence. The tumor may attain a large size : the integuments 
 ulcerate, giving exit to a fungating mass which often bleeds readily. 
 The lymphatics are not involved. Cleneral health good. After removal 
 there is great probability of a recurrence of the disease, — perhaps on 
 five or six or more occasions. 
 
 5. Hydatid Cysts. — Cysts containing entozoa have been found in the 
 breast. Echinococci to be detected on a minute examination of the 
 fluid contents of the sacs. Sometimes curable by puncture of parent 
 C3^st, and compression ; or by withdrawal of parent cyst through a free 
 incision. Occasionally extirpation must be resorted to. 
 
 6. Chronic Mammary Tumor. — Synon. Adenoid Tumor; Adenocele 
 CAdr^v^a gland; xrj atj. ii tumor); Pajicreatic Sarcoma; Partial Hypertro- 
 phy; Mammary Glandidar Tumor; Hydatid Disease of Breast; Sero- 
 cystic Sarcoma. — A tumor of the breast, which generally commences in 
 healthy women between the time of puberty and the thirtieth year: 
 single, more liable than married women. Growth slow : an enormous 
 size may ultimately be obtained. Sometimes remains stationary for a 
 long time, and then rapidly increases in bulk ; sometimes gradually 
 diminishes, perhaps owing to absorption of fluid contents of cysts. 
 Never disappears entirely. May be due to mechanical injury. One 
 variety of mammary tumor is dense, compact, lobulated, and provided 
 with a fibrous capsule : ducts and sinuses are developed through the 
 new growth. In another form, there are cj^sts with growths attached 
 to their walls, and floating in fluid. In a third group, dilated ducts 
 get converted into cysts, with gi'owths of gland tissues springing from 
 their sides. 
 
 Symptoms. The tumor begins as a small, movable, nodulated groAvth : 
 it appears isolated from gland tissue ; is not painful ; does not involve 
 skin ; no enlargement of axillary glands. As the foreign body grows, 
 the true breast may atrophy. Eate of growth very variable. When 
 large, the integuments may ulcerate; occasionally tumor protrudes 
 through ulceration as a fungating mass. 
 
 Treatment. Eemedies to induce absorption only injure the general 
 health. When the growth is increasing, excision should be resorted to. 
 Heeurrence is rare. 
 
 7. Mucous Cysts. — Consist of diluted and expanded gland ducts filled 
 with mucus and epithelium. There may be one or several cysts, in one 
 or l)oth breasts. The growths seldom attain a greater size than that of 
 a filbert. Most common after childbearing period is over. A cure can
 
 170 MAMMILLARY DISEASES^MAMMITIS. 
 
 often be effected by puncture and pressure. This fiiiling, and irritation 
 arising, the breast will have to be amputated. '' 
 
 8. Malig-nant Tumors. — Cancer of the breast may be of the nature of 
 scirrhous, medullar}', or colloid : the first by far the most common. 
 Alwaj-^s primary. Only one mamma generally affected. Frequently 
 developed between the ages of forty and fifty. The tendency of the 
 disease is to increase, to ulcerate, to cause great pain, to affect the 
 lymphatics and glands, to diminish health and flesh and strength, to set 
 up the cancerous cachexia, to lead to secondary deposits in distant 
 organs, and to destroy life in less than four years from commencement. 
 
 The male breast occasionally becomes the seat of malignant disease. 
 — See Cancer. 
 
 MAMMILLARY DISEASES. — The nipple, or mammilla (dim. of 
 Maiiiiiio. the breast), may he tlie seat of certain morbid processes. 
 
 The chief are: Chronic eczema and psoriasis. There are excoriations 
 covered with rather thick crusts. Aggi*avated by pressure against 
 stays. May usually be cured by lime liniment, zinc ointment, or lotions 
 of sulphate of zinc. In obstinate cases, arsenic, 52. 
 
 Inflammation of ni])ple very common at commencement of lactation. 
 Exquisitely painful ulcers or abrasions form, — " fissures," " chaps," or 
 " cracks." The acute suffering sometimes impairs general health ; 
 there is constant dread, mental depression, loss of appetite, restless 
 nights. The disease may often be prevented by bathing nipple night 
 and morning, during last few weeks of pregnane}^, WMth astringents, — 
 Port wine, brandy, or saccharated lime-water. Numerous curative 
 measures recommended ; the most efficient being, — CoUodium, 285. 
 Solid nitrate of silver, but it causes great pain on first application. 
 Lead or zinc lotions, 264. Balsam of Peru and spermaceti ointments, 
 806. Cxlycerine. or almond oil. Lime liniment. Borax and glycerine 
 lotion, 268. Dusting with powdered spermaceti, or oxide of zinc, tied 
 up in a muslin bag. Nipple to be well dried after nursing: child not to 
 be allowed to lie with it in the mouth, after a proper meal. Nipple- 
 shields, of glass or boxwood or vulcanized India rubber, to afford pro- 
 tection during suckling. Mucous membrane of infiant's mouth to be 
 examined, so that any aphthous or other morbid state may be rectified. 
 Other means failing, infant to be nursed only from sound breast. 
 
 Malignant disease ma}' attack either the male or female nipple. Early 
 extirpation is the only remedy. 
 
 MAMMITIS. — From Mamma, the breast; terminal -itis. Synon. 
 Mazoitis ; Mastitis; Tnflammatio Mammoi. — Inflammation of the breast 
 may be acute or chronic. Generally occurs during lactation : from 
 cold; irritation of sore nipple; external injury j too poor a diet; in- 
 attention to suckling at pi-opcr intervals; general debility; or sym- 
 pathy with gastric, intestinal, hepatic, uterine, ovarian, or renal irrita- 
 tion. 
 
 Symptoais. When acute: Considerable pain, swelling, induration. 
 Shivering, fever, quick pulse, loaded tongue, delirium. Secretion of 
 milk soon checked. Suppuration commonly results. 
 
 In c/;ro?u'c form: Comes on insidiously. Enlargement of gland and 
 induration : the hardness much less than in scirrhus. Often ends in 
 suppuration. May follow acute inflammation ; or ma}' arise in women 
 of strumous constitution quite independently of childhearing. 
 
 Treatment. Acnte: Antiphlogistic remedies not advisable; though 
 rapid cures are said to have been effected by saline purgatives, antimo-
 
 MASTODYNIA MEASLES. 171 
 
 iiials ami leeches. Mild aperients. Iodide of potassium, 31. Aconite 
 and 0])ium, 332. Fomentations. Hemlock poultices. Linseed poulti- 
 ces, with application of extract of belladonna. Three or tour leeches, 
 where there is great congestion and the powers of life are not enfeebled. 
 The breast to be supported. Arm to be kept quiet, by a sling or ban- 
 daging to the side. Infant to be weaned at commencement. If milk 
 accumulates and causes painful distension, it must be drawn otf with 
 breast-pump. Incision, as soon as there is fluctuation. Tonics, and 
 good nourishing food. — See Mammary Abscess. 
 
 (7A/-o/i<c; Ammonia and bark, 371. Quinine and mineral acids, 371. 
 Cod-liver oil. Nourishing food. Support and pressure by strips of 
 strapping, belladonna plaster, or bandage. Abscess to be opened at 
 most depending point. 
 
 MASTODYNIA. — From Matrrd-:, the breast; ddu'^vj, pain. Synon. Mazo- 
 dynia ; JLtstalgia ; Neuralgia of Mamma. — The female breast is not un- 
 frequentiy the seat of distressing pains, without an}' structural disease 
 of the gland. 
 
 Symptoms. Occasionally there is slight heat and more or less swelling 
 of affected breast. Sometimes the lobules feel rather firmer than is 
 natural. More commonly the gland is healthy to the touch. The pain 
 may be of a weaiying, aching character : it maybe very acute, liable to 
 exacerbations, and perhaps periodic, — like neuralgia elsewhere. Yery 
 frequently due to some ovarian or uterine irritation. In many women 
 the breasts are irritable at the commencement of each menstrual period. 
 General health seldom good. Nervous temperament. Loss of appetite, 
 constipation, restless nights, anxiety. 
 
 Treatment. Cure of the disorder on which the pain depends. 
 Eemoval of any ovarian or uterine irritation. Attention to diet, exer- 
 cise, clothing. 
 
 Quinine, 379, 411. Ammonia and bark, 371, 372. Aconite, 330, 374. 
 Quinine and belladonna. 383. Cod-liver oil. Pepsine, 420, Castor oil. 
 Iodide of lead and belladonna in vaginal pessaries, 423. Friction of 
 breasts with belladonna liniments, 265, 281. Support by strapping or 
 bandage, if breast is pendulous. The breast has been amputated; the 
 pain returning in cicatrix, or in opposite gland. 
 
 Young infants, and boys or girls about the time of puberty, are 
 liable to enlargement and tenderness of breasts. Sometimes there is 
 secretion of milk. The disorder subsides spontaneously, provided irri- 
 tation is not kept up by application of iodine and similar drugs. The 
 author has more than once seen abscess in breast of infant, from the 
 nurse using friction with oil " to rub the milk away." 
 
 MEASLES. — From the Saxon MesaU, or 2IyseJ, leprous : Meazel, a 
 leper or diseased person. Synon. Morbilli ; Rubeola. — A continued 
 infectious fever, preceded by catarrh, accompanied by a crimson rash, 
 and often attended or followed by inflammation of the mucous mem- 
 brane of the oi'gans of respiration. Some authors divide measles into 
 two grades, — the morbilli mitiores, and morbilli graviores ; but the latter 
 only differs from the former in its greater severity, and in the fact that 
 the eruption assumes a dark purple color. 
 
 Symptoms. After a period of incubation var3'ing from 10 to 15 days, 
 there are lassitude, shivering, pj-rexia, and catarrh ; the conjunctivae, 
 Schneiderian membrane, and mucous membrane of the fauces, larynx, 
 trachea, and bronchi being much affected. Swelling of eyelids, with 
 eyes suffused and watery, and intolerant of light ; sneezing ; dry cough, 
 hoarseness, and severe dyspnoea; drowsiness; great heat of skin;
 
 172 MEDULLARY CANCER MELANOSIS. 
 
 tOijother with frequent and hard pulse. The eruption comes out on 
 fourth day of fever and fades on seventh : it consists of dots which 
 coalesce into small blotches, raised above the skin, and often of a horse- 
 shoe shape. Fever does not abate on appearance of eruption. Pulmo- 
 nsivy complications are to be feared, especially in winter and spring 
 months. Occasionally, life endangered by the occurrence of larj-ngitis, 
 cancrum oris, severe otitis, epistaxis, acute tuberculosis, or acute des- 
 quamative nephritis. 
 
 Treatment. Confinement to bed in a moderately warm room. Pedi- 
 luvia. Milk diet ; acid or mucilaginous drinks. Castor oil. Ehubarl) and 
 magnesia. Cream of tartar. Solution of acetate of ammonia. Etfei'- 
 vescing saline mixtures. Spirit of nitrous ether. Carbonate of ammo- 
 nia. Alcoholic stimulants if there be depression. Ipecacuanha and 
 morj^hia, if cough be troublesome. Colchicum. Sponging with vinegar 
 and water. Inunction with oil or lard. — Bark; quinine; steel; cod- 
 liver oil; and nourishing food during convalescence. 
 
 MEDULLARY CANCER.— From Medulla, pith or marrow. Synon. 
 Enci'i>holoid Cancer. — ' Kyy.itfaXu':, the brain. — These cancers are of two 
 kinds — soft and tirm ; the former most frequent. In either condition 
 they are found as separable tumors, or as infiltrations. As separable 
 tumors, when occurring in testicle, breast, eye, intermuscular and other 
 spaces in limbs; as infiltrations, when occupying the substance of uterus, 
 alimentarjT^ canal, serous membranes, and hones. In either form their 
 course towards a fatal career is ra])id : average duration of life, from 
 patient's first observation of disease, little more than two years. — See 
 Cancer. 
 
 MELANOID CANCER.— From .IMaww, to grow black. Synon. Car- 
 cinoma Mehinoti.cinn ; Fungus Jlelanodes; Black Cancer. — Consists gen- 
 erally of medullary cancer modified by the superaddition of black 
 pigment. Scirrhus sometimes becomes associated with melanosis, and 
 more rarely epithelioma does so. — See Cancer. 
 
 MELANOSIS. — From MiXaq, black; v6(r(><;, disease. Synon. Nigritudo ; 
 Black Tubercle. — A rare disorder, characterized by the deposition in 
 various tissues of the body, of a black or dark-brown substance. 
 
 Melanotic formations may take place in various parts of body, 
 iTiay present much variety of form, and may owe their production to 
 difltei-ent agents. They are divided into two great groups (Carswell) : 
 (1) True Melanosis, of which there is only one kind. (2) Si^urious 
 Melanosis, of which there are three kinds — a, that arising from the in- 
 troduction of carbonaceous matter ; b, from the action of chemical agents 
 on the blood ; and c, from the stagnation of the blood. 
 
 1. True Melanosis. — Has its seat most commonly in connective and 
 adipose tissues ; but it is also found, though rarely, in mucous and serous 
 membranes, in tendons and cartilages, as well as in osseous system — 
 particularly bones of cranium, ribs, and steimum. The organs it most 
 commonly affects are liver, lungs, spleen, pancreas, Ijniiphatic glands, 
 brain, eye, kidneys, testes, uterus, ovaries, rectum, and mamma\ It is 
 sometimes found associated with various forms of cancer; and it has 
 been met with in the false membranes formed on serous surfaces 
 (Andral). Melanotic disease has a great tendency to extend to differ- 
 ent parts of the body through the lymphatic system. 
 
 Sympto.ms. In subcutaneous melanosis the tumors or nodules remove 
 all difficulty as to diagnosis. — When internal organs are alone affected,
 
 MELiENA — MENORRHAGIA. 173 
 
 the symptoms are obscure. Gradual sinking of the vital energies. A 
 cachectic habit of bod}'. Dusk}' or ash-colored countenance. Emacia- 
 tion. Dropsy. Night-sweats. Gradual exhaustion. 
 
 It is still a matter of uncertainty whether true nutlanosis is simjil}* 
 medullar}' cancer modified by the formation of black pigment in its 
 elemental structures. 
 
 Treatment. The symptoms to be combated as they arise. Chola- 
 gogue purgatives. Bark and mineral acids. Ferruginous tonics. Nour- 
 ishing diet. Sea air. 
 
 2. Spurious Melanosis. — (1) From Introduction of Carbonaceous Matter. 
 — The lungs — it occurs only in these organs — present a black carbona- 
 ceous color; bronchial glands bhudiened ; pulmonary tissue indurated 
 and friable, infiltrated with black serum, and often broken down into 
 irregular cavities. The discoloration has its origin in inhalation of 
 carbonaceous products of ordinaiy combustion. Is chiefly found in 
 lungs of those who have worked in coal mines. 
 
 (2) From Action of Chemical Agents on the Blood. — In digestion of coats 
 of stomach by gastric juice after death, and in poisoning by acids, the 
 blood contained in gastric capillaries, as well as that extravasated, will 
 generally present a blackish tint. Inhalation of sulphuretted hydrogen 
 gas will also darken the blood in the intestinal capillaries. 
 
 (3) From Stagnation of Blood. — Retarded or impeded circulation may 
 produce black discoloration of the blood. When blood ceases to circu- 
 late in capillaries of an organ it coagulates, the serum and salts become 
 absorbed, and a black substance remains. This probably consists of 
 fibrine and htematin. Occurs in the digestive and respiratory organs. 
 
 MEL-ffiNA. — From JA^/a?, black. Synon. Dysenteria Splenica ; Fluxiis 
 Splenicu.i ; Dejectiones Nigral. — When the intestinal evacuations contain 
 blood, whether this comes from vessels of stomach or only from those 
 of intestines, there is said to be mehena. The evacuations are often black, 
 and sometimes resemble tar; but this dark appearance is by no means 
 constant, and does not occur if the blood comes away too quickly to be 
 acted upon b}' intestinal juices. Cirrhosis of liver, or any disease which 
 produces obstruction of portal sj'stem, necessarily gives rise to conges- 
 tion of gastric and intestinal veins; a condition otten terminating in 
 extravasation of large quantities of blood that are thus expelled. 
 Amongst other less common causes are enteritis, dj'sentery, intussus- 
 ception, simple and carcinomatous ulcerations, aneurismal and other 
 tumors, &c. Not to be confounded with bleeding from rectum, owing 
 to the presence of a polypus or of haemorrhoids. 
 
 Treatment. When there is gastric disease, see Hamatemesis. In 
 other forms: Calomel and jalap, 140. Podophyllin, 1(30. Turpentine, 
 102. Gallic acid, 10.3. Mineral acids and bitters, 378. 
 
 MELITUEIA. — From Mlh, honey ; oupnv, urine. Sweet urine. — See 
 
 Diabetes MeUitus. 
 
 MENORRHAGIA. — From J/^ive?, the menses ; nywiu, to burst out. 
 Synon. Paramenia Profusa ; 2£ensirua Superflua ; Menorrhoea ; Profuse 
 Menstruation. — An abnormal increase of the catamenia. 
 
 Causes. May arise from diseases producing anaemia : Tuberculosis; 
 Bright's disease; affections of spleen; undue lactation. Also from: 
 Excitement at monthly period. Excessive sexual intercourse. Metritis 
 and ovaritis. Relaxation of uterine tissue. Uterine and ovarian 
 tumors, &c.
 
 174 METRITIS MINERAL DEGENERATION. 
 
 Treatment. Gallic acid; cinnamon; sulphuric acid; — either i-emedy 
 alone or in combination, 103, 104. Nitric acid. Solution of corrosive 
 sublimate, 27. Ergot of rj-e. Ammonio-sulphate of iron, 116. Tur- 
 pentine. Opium. Indian hemp. Ipecacuan. Savin. Acetate of lead. 
 Oxide of silver. Arsenic. Infusion of digitalis. 
 
 Local remedies : Ice over pubes. Introduction of ice into vagina. 
 Vaginal injections of tannic acid or of matico. Astringent vaginal pes- 
 saries, 423. Galvanism. Plugging os uteri with sponge, 426. Plugging 
 vagina with cotton-wool. Styptic rod of tannin, 424. Cold water 
 eneniata. — See Uterine Hemorrhage. 
 
 METRITIS. — From M-qzpa, the womb; terminal -«Yi'.s. Synon. Fehris 
 Uterina ; Hysteritis ; Inflammatio Uteri. — Inflammation of the substance 
 of the unimpregnated uterus a rare disease. Muscular tissue of the 
 bod}' may be alone affected, or that of cervix, or that of whole organ 
 will be involved. 
 
 Symptoms. Acute metritis may set in suddenly Avith rigors followed 
 by fever. More commonly, comes on gradually. Sense of fulness, 
 weight, and heat about pelvis. Throbbing, with tenderness, about 
 pubes, and groins and perineum. Irritability of bladder. Nausea and 
 vomiting. Diarrhoea with tenesmus. After first day, acute paroxysms 
 of uterine pain. A mucous, sometimes sanguineous, discharge. Suffer- 
 ing relieved by recumbent posture. — Acute symptoms subside in about 
 seven days. Eesolution often occurs. But occasionally, one or more 
 abscesses form in uterine parenchyma; or subacute inflammation fol- 
 lows, pelvic areolar tissue getting involved; or fatal gangrene sets in; 
 or it leaves hypertrophy of uterus, induration of labia, abrasions, and 
 leucorrhoea. 
 
 Treatment. Acute stage: Complete re2:»ose. Simple diet; cooling 
 drinks; iced water. Hot hip baths. Leeches to labia uteri. Opium 
 and belladonna pessaries, 423. Ice; sinapisms to epigastrium; a few 
 drops of chloroform on f?iigar, — for relief of gastric irritability. Mucous 
 diarrhoea to be checked by opiate enema or suppositorj', 339, 340. 
 
 Subacute stage : Iodide of potassium and aconite, 31. Corrosive sub- 
 limate, 27. Mercur}^, or iodide of lead, pessaries, 423. Potassa fusa to 
 indurated labia. Nourishing food. Warm hip baths. Moderate exer- 
 cise in pure air. 
 
 MILIARIA. — From Milium, millet. Synon. Miliary Fever ; Miliaria 
 Swhitoria ; Exanthema Miliaria; Millet-Seed Rash. — A vesicular erup- 
 tion; vesicles the size of millet-seeds, containing a slightly opaque fluid, 
 and surrounded by a narrow red margin. Occurs during progress of 
 diseases attended with offensive sweating, — rheumatic fever, &c. Mil- 
 iary eruptions have occasionally been epidemic (miliary fever) : at- 
 tended with much danger. — See Sudamina. 
 
 MINERAL DEGENERATION.— Every texture in the body is proba- 
 bly liable to mineral or earthy degeneration. Occurs most frequently 
 in the coats of arteries and in cartilages. Tubercular and cancerous 
 growths sometimes undergo this change, and so may fibroid tumors of 
 uterus. 
 
 (1) It is important to distinguish between ossification and calcifica- 
 tion. Ossijication docs sometimes take place, with formation of dense 
 or compact, and spongy or cancellated tissue, and occasionally even of 
 periosteum. 
 
 (2) In calcification or petrifaction there is a deposit of the salts of lime 
 in the intercellular substance. The coats of large arteries are often
 
 MOLLITIES OSSIUM — MYALGIA. 175 
 
 found brittle from this cause. Sometimes plates of mineral matter are 
 discovered embedded in the middle coat of the vessels, renderinu; them 
 hard riu-id tubes. So the gall-bladder, pericardium, &c., have been 
 found converted into calcareous shells. 
 
 MOLLITIES OBSIUK.— From Mollis, soft; Os, a bone. A morbidly 
 flexible condition of the bones, owing to an insuflficienc}" of phosphate 
 of lime. — See Osteomalacia. 
 
 MOLLTJSCUM. — From Molluscum, a fungus that grows on the maple 
 tree. Synon. Ochthiasis ; Acne Molluscoide. — A rare cutaneous disease : 
 of the order Tubercula. Consists of small tumors; varying in size from 
 that of a pea to that of a pigeon's egg, occasionally of a brown color, 
 sometimes growing from a broad base, and sometimes from a narrow 
 peduncle. Two forms, one contagious, the other not. Contagious mol- 
 luscum very rare, severe, and chronic. Non-contagious molluscum is 
 less severe; does not produce so much irritation as opposite kind ; after 
 a time the tumors neither grow nor alter, but remain stationary for life. 
 A cure can only be effected by snipping off the tumors, or by incising 
 them and apjjlying nitrate of silver. 
 
 MOEBILLI. — The dim. of Morbus, a disease; M6p(K fiwv, the fate of 
 life, i. e., death. — See Measles. 
 
 MUSC-ffl VOLITANTES.— From Musca, a fly; Volito, to fly about. 
 Synon. Flocci Volitantes. — Little specks, or floating black spots, which 
 fly over the field of vision. Due to minute floating bodies, pi'obably 
 near the retina. Their presence generally gives rise to very unneces- 
 sary alarm. Quite compatible with lasting good sight. 
 
 MUSCITLAR TUMOR. — Synon. Phantom Tumor. — From some pecu- 
 liar action of diaphragm and other abdominal muscles, an appearance 
 results exactly resembling that caused by a large foreign body. Some- 
 times simulates pregnancy, — Spurious pregnancy ; Gr'ossesse simulee par 
 illusion pure of French authors. Has been mistaken for ovarian tumor. 
 — An erroneous sensation of a small tumor often communicated to the 
 hand by irregular contractions of recti muscles, in sensitive subjects. 
 
 Symptoms. Abdominal cavity appears to be entirely or partially 
 filled by a foreign body, or by pregnant uterus. Swelling may be firm 
 and unyielding; or it changes its position from day to day; or aj^pears 
 movable, and as if attached by a pedicle. Sometimes, tenderness on 
 pressure. Borborygmi on auscultation. Resonance on percussion, un- 
 less there be much fat. Arching forwards of lower dorsal and upper 
 lumbar vertebraj. Swelling occasionally melts away under influence 
 of prolonged manipulation : always dispersed on placing patient under 
 full influence of chloroform. 
 
 General health usually bad. Anaemia. Hysteria. Irregulai'ity of 
 uterine functions. Dyspepsia. Ovarian iwitation : uterine disease. 
 
 Treatment. Improvement of general health. Cure of uterine or 
 ovarian disease. — Bark and mineral acids, 376. Quinine, .379. Quinine 
 and steel, 380. Quinine and nux vomica, 387. Steel and aloes, 393, 
 404. Strychnia and steel, 408. Zinc and nux vomica, 409. Valerianate 
 of zinc, 410. Hypophosphite of soda, 419. Cod-liver oil. Nourishing 
 diet. — Galvanism. Sea bathing. Shampooing. Support by abdominal 
 belt or bandage. 
 
 MYALGIA. — From Muq, a muscle ; aX^'iw, to suffer pain. — Stiffness,
 
 176 MYCETOMA — MYELITIS. 
 
 cramp, soreness, or pain, in the voluntary muscles or their tendinous 
 pi'olongations. Arises from fatigue. — Muscles of trunk more commonly 
 attacked than those of extremities; of abdominal walls, than of thoracic; 
 and of legs, than of arms. Tendinous parts more frequently the seat 
 of pain than the fleshy ; the portions of tendons usuallj' aifected being 
 the spot where they are inserted into bone, or where the tendinous joins 
 the muscular fibre (Inman). 
 
 Myalgia common during progress of scurvy, tuberculosis, cancer, 
 chlorosis, leucocythemia, chronic dysentery or diarrhosa, prolonged lac- 
 tation, exhausting uterine disease, &c. Also during convalescence from 
 hemorrhage, severe inflammation, parturition, continued fevers, &c. 
 
 Symptoms. Pain: severe in proportion to the general debility: aggra- 
 vated by an}' movement which calls affected muscle into play: seldom 
 conjplained of in the morning after a good night's rest, but soon follow- 
 ing upon a few hours' exertion, and gradually increasing towards night. 
 General health more or less depressed. Skin cool. Pulse natural, or 
 feeble and somewhat quickened. Appetite good. Tongue clean. — In 
 exceptional cases, — fever; night sweats; loss of appetite; impaired 
 digestion; constipation; a disinclination for work of any kind; severe 
 mental depression. 
 
 Treatment. Quinine, 379. Quinine and steel, 380. Cod-liver oil, 
 389. Steel and cocoa-nut oil, 391. Steel and glycerine, 392. Steel and 
 pepsine, 394. Phosphate of iron, 405. Hypophospliite of soda and 
 bark, 419. Morphia, chloroform, and Indian hemp, 317. Subcutaneous 
 injection of morphia, or chloroform, 314. Ether spray. Linseed poul- 
 tices, with belladonna and opium, 297. Friction with belladonna lini- 
 ment, 281. Partial rest of affected muscle to be insured by bandage; 
 strips of belladonna or opium plaster. Galvanism. Shampooing. — 
 Animal food: milk, or cream: raw eggs: wine, or malt liquors, or 
 whiskey, brandy, &c. 
 
 MYCETOMA. — From Muxrjc;, rjroi;, the mushroom. Synon. Fungus Foot 
 of India. — A destructive parasitic disease. The mucedinous fungus 
 {Chionyphe Carferi) eats its way into the metatarsal and tarsal bones, 
 and ultimately into lower extremities of tibia and fibula. Numerous 
 fistulous channels result, becoming filled with rounded black masses of 
 fungus. Observed onl}- in natives of India, who go about with naked 
 feet. Sporules of the fungus get introduced beneath the cuticle, through 
 some scratch or abrasion. Amputation seems to be the only remedy of 
 any use. 
 
 MYELITIS. — From MueXbq., marrow; terminal -itis. Synon. Spinodor- 
 sltis ; Machialgitis ; Inficwimatio Medullm Spinalis. — Inflainraation of the 
 substance of the spinal cord is a rare disease. Sometimes coexists with 
 pneumonia, gastro-enteritis, and continued fever. May be excited by 
 cold, damp, wounds, contusions, &c. Often ends in softening, or sup- 
 puration. 
 
 Symptoms. Not very uniform. If cranial portion of cord be affected : 
 Deep-seated headache; convulsive movements of head and face; inar- 
 ticulate speech ; trismus ; difficult deglutition ; impeded spasmodic 
 breathing; irregular action of heart; hemiplegia, or other form of 
 paralysis. If about to prove fatal in acute stage, great prostration; in- 
 creased dyspno3a; involuntary escape of excretions. When whole thick- 
 ness of cord above origin of phrenic nerves is attacked, death occurs 
 rapidly from cessation of respiratory movements. — Inflammation of 
 cervical portion: Difficult deglutition; impossibilit}^ of raising or sup- 
 porting head; acute pain in back of neck; urgent dyspnoea; sense of
 
 MYOCARDITIS — MYOSITIS. 177 
 
 pricking aiul formication in arms and bands; ])aralysis of upper ex- 
 tremities. — Of dorsal region: Pain over affected part; numljness or 
 pricking sensations in fingers and toes ; convulsive movements of ti-unk; 
 paralysis of arms and lower extremities; dyspnoea; great palpitation. — 
 Of lumbar portion : Marked paralysis of lower extremities at early 
 period; abdominal pain, with sensation as of a cord tied tightly round 
 body ; convulsions ; retention, followed by incontinence of urine, owing 
 to paralysis of bladder; involuntary stools, from paralysis of sphinc- 
 ter ani. 
 
 Pain in affected part of cord less severe than in meningitis: increased 
 by application of heat (as of hot sponge), and by pressure. Bed-sores 
 very apt to form. 
 
 Treatment. Calomel and jalap, 140, 159. Jalap and senna, 151. 
 Castor oil and turpentine enema, 190. Corrosive sublimate and sai-sa- 
 parilla, 27. Iodide of potassium, 31. Great care necessary to keep 
 patient dry and clean. Bladder to be emptied by catheter, unless urine 
 be passed freely. Bed-sores to be prevented by amadou plaster, water- 
 bed, &e. 
 
 MYOCARDITIS. — From J/tJ-, a muscle; y.ap8ia, the heart; terminal 
 -itis. Synon. Carditis. — Inflammation of muscular substance of heart. 
 
 Seldom occurs as a distinct affection : generally combined with peri- 
 carditis, or endocarditis, or both. Walls of left ventricle suffer more 
 frequently than other parts. — Eesults, — induration of muscular struc- 
 ture from deposit of lymph; formation of abscesses; aneurismal dila- 
 tation of walls of heart; softening of heart, and possibly, rupture. 
 
 MYOPIA. — From Mom, to contract; w^^, the eye. Sjnion. Hypome- 
 tropia; Short-sightedness ; Near-sightedness.— \^ hew the distance at which 
 ordinary type can be easily read is less than twelve inches, the vision 
 is said to be mj'opic. Near objects are seen distinctly. Myopia most 
 frequently arises from too great a convexity of the cornea, or of the 
 crystalline lens, or both. May be owing to a lengthening of the eye- 
 ball: to an undue density of any or of all the refractive media. The 
 rays of light from objects at the usual distance are brought to a focus 
 before they j-each the retina, instead of being concentrated upon it. 
 Sometimes associated with strabismus. Myopia rarel}^ decreases as age 
 advances, though popularly believed to do so. It is often hereditar}'. 
 
 In many cases of short-sightedness the iris is either preternaturally 
 contracted, or it possesses unusual irritability. This occurs especially 
 in individuals of a very nervous temperament. Exposure to bright 
 light aggravates this condition. Snow-blindness chieflj^ due to it ; con- 
 sisting, in a great measure, of excessive contraction of pupil. 
 
 Treatment. Avoidance of overwork, examination of minute ob- 
 jects, &c., especially by gaslight. — Well-adjusted double concave glasses 
 or spectacles: single eye-glasses are bad. The greater the degree of 
 short-sightedness, the greater must be the concavity of the glassed. The 
 glasses had better be worn only when required. Heat and congestion 
 about the eyes to be relieved by the eye douche. Where the iris is 
 unusually irritable belladonna gives relief Where there is disease of 
 choroid, a prolonged course of corrosive sublimate in small doses. 
 
 MYOSITIS. — From J/uc, a muscle; terminal -itis. Synon. Myitis; 
 Sarcitis; Infiammatio Musculorum. — Inflammation of muscular fibre is a 
 rare affection. May occur from injury, over-exertion, disease of adjoin- 
 ing textures, &c. 
 
 Symptoms. Pain : greatly aggravated by any movement of affected 
 
 12
 
 178 N^vus. 
 
 mnscle. Heat and swelling; the latter often distinct, simulating a 
 tumor. Symptomatic fever. May terminate in induration; or soften- 
 ing; or suppuration ; or even gangrene. 
 
 Treatment. Hot fomentations. Best. Opium. Nourishing food, 
 in proportion to the failure of general strength. 
 
 NiEVUS. — As if Gitccmis, from yvAu), whence yiyvvj, to be born ; because 
 the blemish is congenital. Synon. Na'vus Matermts ; Mother's Mark; 
 Erectile or Vascular Tumor; Aneurism by Anastomosis — A growth formed 
 by enlarged and dilated arteries, veins, or capillary vessels. 
 
 Symptoms. Arterial navi more commonly begin in youth than in- 
 fancy. The diseased vessels become enlarged and elongated and tor- 
 tuous; forming a tumor of irregular sha])e, which is spongy and com- 
 pressible and pulsating. A loud superficial bruit is audible. — Venous 
 nsBvi give rise to irregular tumors of a jjurple color ; which feel doughy, 
 and are diminished in size by pressure. They may be as small as a nut, 
 or as large as an orange. — Capillary nsevi most common. Usually con- 
 genital. Commence as vivid red or purplish spots, which gradually 
 spread. May affect the skin and subcutaneous areolar tissue of any 
 part: more commonly met with on scalp or face or neck, than on back 
 or buttocks or organs of generation. — Nffivi of a mixed character not 
 rare. 
 
 Treatment. When small, producing no disfigurement, and not in- 
 creasing in size they are best left alone. Occasionally, spontaneous cure 
 occurs. Interference being necessary attempts must be made, — to ex- 
 cite adhesive inflammation so as to coagulate the blood and obliterate 
 the vessels; or to destroy the growth by caustics; or to effect removal 
 by knife or ligature. 
 
 (1) To excite adhesive inflammation : Vaccination, making several punc- 
 tures at circumference of spot and one or two on surface, so as to pro- 
 duce a confluent vesicle. Compression; by a piece of sheet-lead and 
 bandage, or painting with collodium, or by the finger applied for some 
 hours. Frictions with compound iodine, or croton oil, or red iodide of 
 mercury, or tartarated antimony ointments. Congelation. Dotting the 
 surface with a small and pointed actual cauf ery. Setons ; passing several 
 threads with a common sewing-needle in all directions across the tumor, 
 and leaving them until suppuration is excited. Breaking up substance 
 of growth, subcutaneouslj", by a common dissecting needle. Injection 
 of a few drops of tincture of perchloride of iron with a sharp-pointed 
 syringe. — Passing a needle under the growth, when small, and twisting 
 a thread around it so as to cause considerable pressure, and allowing it 
 to remain for forty-eight hours (Fergusson). — Introduction of two 
 needles, at right angles to each other, under the mass, and winding of 
 a ligature round the whole. Immediate withdrawal of needles; ligature 
 to be untied in four hours. A scab forms, which drops off in ten or 
 fourteen days; no suppuration nor open sore. Without destroying the 
 nffivus, sufficient obstruction is caused to allow the blood in the tissue 
 to get consolidated (Cooper Forster). 
 
 (2) Destruction by caustics: Nitric acid, or acid solution of nitrate of 
 mercury, repeated once or oftener. Potassa fusa. Acetic acid. Super- 
 sulphate of zinc, 198. Actual cautery; free application, so as to insure 
 complete destruction. 
 
 (3) Removal by knife or ligature: Use of knife very rarely advisable: 
 if employed, the incisions must be made wide of the disease, or hemor- 
 rhage will be great. — Ligature, safe and convenient : may be used in 
 many ways. Amongst other plans, the ligatures may be passed subcu- 
 ';aneously around the nsevus, and tightened so as to strangulate it,
 
 NASAL LIPOMA — NEPHRITIS. 179 
 
 without involving the skin. Or a needle carrying a douhle thi-cad can 
 he passed through the centre of the base of the growth, and the liga- 
 tures tied round each hemispherical division, first making an incision 
 or groove through the skin in which the ligatures may lie. In either 
 case, the ligatures may have to be tightened in four or five days. As 
 gi-anulations form,"any tendency to nrovus growth Ynust be checked by 
 application of nitric acid. — In naevi within the orbit, or in other inac- 
 cessible parts, it has been found necessary to tie the nutrient vessel : 
 ligature of the common carotid has been resoi-ted to under such cir- 
 cumstances. 
 
 NASAL LIPOMA.— From Aimx;, fat. — Hypertrophy of skin and sub- 
 cutaneous tissue of apex and ala3 of nose. Most common in men, who 
 are advanced in years and have lived very freely. When the growth is 
 considerable, a cure can only be effected by paring off the redundant 
 tissue. In other cases, increase in size may be prevented by careful 
 diet ; avoidance of intoxicating drinks ; frequent nse of astringents 
 washes. 
 
 NASAL POLYPUS. — From TJoru^, many; noh^, a foot. A tumor so 
 named because it was suj^posed to have numerous attachments or feet. 
 Nasal polypi are of three kinds: Mucous, or gelatinous; fibrous; and 
 medullary. 
 
 Symptoms. A sense of stuffiness in one or both nostrils. Frequent 
 desire to blow the nose, with no relief on doing so. Increased mucous 
 discharge. Attacks of bleeding — epistaxis. Imj^airment of smell and 
 taste. When uninterfered with, displacement of septum of nose; deaf- 
 ness from pressure on Eustachian tube; indistinctness of articulation; 
 deformity of cheek, from expansion of bones; obstruction to tears; and 
 even fatal cerebral pressure. These tumors verj'^ apt to return again 
 and again after removal. 
 
 Treatment. Eemoval by strong, toothed, slightly curved forceps, 
 applied to neck of growth, so as to twist it off. 
 
 NECROSIS. — From NsxpdcD, to produce mortification or decay. Synon. 
 Osteonecrosis ; Osteogangra'tia. — Mortification or death of a bone, or por- 
 tion of a bone. The term usually restricted to one form; in which part 
 of the shaft of a cylindrical bone dies, and is inclosed in a case of new 
 bone. Exfoliation signifies necrosis of a thin superficial layer, which is 
 not incased in any shell of new bone (Druitt). 
 
 Frequently attacks the tibia in children: the phalanges, from whit- 
 low: the skull and clavicle, from sj'philis. May arise from mechanical 
 injury, or from inflammation however set up. A peculiar fbrm of ne- 
 crosis of the lower jaw occurs amongst the makers of lueifer matches,, 
 being produced by the fumes of phosphorus. 
 
 Symptoms. Indications of acute osteitis. Suppuration, with forma- 
 tions of sinuses, or cloacae; through which, on passing a probe, the bare 
 dead bone (the sequestrum) can be touched. Abundant fetid discharge. 
 Inflammatory fever. Separation of sequestrum from the living bone 
 after a variable interval. Disease very chronic. 
 
 Treatment. Incision and removal of sequestrum as soon as it is 
 detached, and when it can only act as an irritating foreign body. 
 
 NEPHRITIS.— From Nefpdc;, the kidney; terminal -<Y<s.— Under this 
 head may be arranged for convenience: Inflammation of the substance 
 of the kidney; acute desquamative nephritis; chronic desquamative 
 nephritis.
 
 180 NEPHRITIS. 
 
 1. Nephritis. — Sjnon. Nephrophlegmone ; Inflammatio Renum; Inflam- 
 mation of Substance of Kidney. — Comparativelj- a rare disease. May , 
 arise without appreciable exciting cause, especiallj^ in strumous sub- 
 jects; from exposure to cold and damp; gravel and calculi; mechanical 
 injuries; poor living combined with intemperance; abuse of diuretics; 
 use of cantharides, oil of turpentine, Arc. Morbid action either ends in 
 resolution ; or it goes on to su])puration, variable sized abscesses re- 
 sulting, which sometimes destroy entire gland. — When disease is con- 
 fined to mucous lining of pelvis and infundibula, it is known as pyelitis. 
 
 Symptoms. Severe pains in loins, increased by pressure or exercise: 
 pain often extending along ureter to neck of bladder, groin, scrotum, 
 or testicle. Numbness of thigh : retraction of testicle. Much constitu- 
 tional disturbance: shivering, fever, nausea and vomiting, hard and fre- 
 quent and full pulse, constipation, tj-mpanites. Frequent and urgent 
 desire to empty bladder: urine high-colored, often contains renal casts 
 with blood and pus corpuscles. Sometimes, suppression of urine; with 
 urtemia, convulsions, and coma. When recovery follows, foundation for 
 future renal disease often laid. 
 
 Where one or more abscesses form, thej^ perhaps lead to ulceration, 
 perforation of capsule, renal fistulse, and establishment of a purulent 
 discharge. Sometimes, fatal hectic fever. In more favorable cases, pus 
 passes away by natural passages and is found in the urine. — Eenal ab- 
 scess may also be a secondar}' affection : due to irritation of a calculus, 
 obstructive diseases of urinar}' passages, &c. 
 
 Treatment. Hot hip baths. Vajjor, or hot air baths. Fomenta- 
 tions. Mild aperients. Diaphoretics, especially such as contain opium 
 if there be no ura?mic symptoms. Rest in bed, preferably between 
 blankets. Low diet; with tea, milk, ice, and simple diluents. Sinapisms 
 to epigastrium if there be sickness. — Stimulants, tonics, and support as 
 soon as prostration sets in, or there are indications of suppuration. — 
 See Urcemia. 
 
 2. Acute Desquamative Nephritis. — Sj-non. Acute Diffuse Nephritis; 
 Acute Albuminous Nephritis; Acute Bright' s Disease ; Acute Inflammatory 
 Dropsy. — Has its origin in many causes, — intemperance, starvation, 
 exposure to wet and cold, but especially scarlet fever. — Consists essen- 
 tially of disease of epithelial cells lining convoluted uriniferous tubes; 
 induced by their having to eliminate from the blood some matter not 
 naturally excreted by kidneys. Functions of cells being modified, they 
 ^become atrophied and disintegrated : from their rapid desquamation 
 they check secretion by mechanically obstructing the tubes. Circula- 
 tion through vessels of Malpighian tuft becomes impeded : hence effu- 
 sion of serum and fibrine into cavities of tubes. The serum exuded from 
 congested Malpighian ca])illaries mingles with the urine, rendering it 
 .albuminous: the fibrinous material solidifies, entangles the cast-off celli^, 
 ;and escaping Avith urine is detected as epitlielial tube-casts. If walls of 
 .an}' vessels give way, blood corpuscles will also be found entangled in 
 ithe casts; and urine will present a dark-colored sediment. 
 
 Occasionally there is general dropsy and albuminuria without des- 
 'quamation of renal epithelium — non-desquamative disease of kidney. 
 Often attended with prominent symptoms of blood-poisoning; owing 
 to some failure and imperfection in effort to eliminate morbid material 
 .from sj'stem (George Johnson). 
 
 Sy.mptoms. Chilliness, rigors: soon followed by feverish reaction, 
 'headache, thirst, restlessness, pain and tenderness about loins, vomiting. 
 Dro])S3-: face first becomes puffy, then general oedema and effusion of 
 serum into one or more of serous cavities. Frequent micturition: urine
 
 NEURALGIA. 181 
 
 scanty, of a dark smoky color, higlily all)Uininous, abundance of epithe- 
 lial casts and cells, &c. — Earliest signs of amendment, — disappeai-ance 
 or lessening of dropsy; increase in quantity of urine; steady diminu- 
 tion of albumen. In unfavorable cases, — supjjression of urine; ura'mia. 
 
 Treatment. At onnet : Confinement to bed; preferably between 
 blankets. Low diet: free allowance of milk, tea, cold water, barley 
 water, lemonade, ice. Hot water batlis. Blanket-baths, 136. Hot air, 
 or vapor baths. Dry cupping to loins. Linseed poultices to loins. 
 Compound jalap powder. Sulphate and carbonate of magnesia, 14L 
 Sulphate of magnesia and antimonial wine, 152. Eesin of podoplnllum, 
 160. Elaterium, 157. Solution of acetate of ammonia. Citrate of 
 potash. Nitrate of potash and nitrous ether, 212. — At end of a few daya : 
 Tincture of perchloride of iron, 392, 897. Phosphate of iron, 405. 
 Iron-aiuMi, 116. Quinine. Animal food; milk; raw eggs. Bordeaux 
 or Hungarian wines. Warm clothing : flannel next the skin. Avoid- 
 ance of spirits and beer: of exposure to cold and damp. — For unemic 
 poison. — See Urcemia. 
 
 Remedies occasionally employed : Bloodletting. Capping. Leeches. 
 Blisters. Tartarated antimony. Colchicum. Digitalis and broom. 
 Digitalis and acid tartrate of potash. Chloroform. 
 
 3. Chronic Desquamative Nephritis. — Synon. Chronic Diffuse Nephritis ; 
 Chronic Bri(jht's Disease; Gouty Kidney. — Characterized b}' long-con- 
 tinued shedding of renal epithelium, which appeal's in urine in a more 
 or less disintegrated state. The tubes lose their epithelial lining, and 
 become atrophied or filled with new material; or sometimes get dilated 
 into cysts. Kidney becomes granular and contracted. Urine albu- 
 minous: of a low density: contains granular epithelial casts. — Cc>mes 
 on insidiously. May result from acute desquamative nephritis: more 
 frequently due to chronic gout, or some allied disorder. 
 
 Symptoms. Eun their course slowly. Health gradually fails. Debil- 
 ity and loss of flesh. Produces great changes in the blood. Anasarca; 
 dropsy of one or more serous cavities. Inflammation of serous mem- 
 branes. Hypertrophy of heart : perhaps valvular disease. Structural 
 changes in, or great functional disturbance of, nervous centres. 
 
 Treatment. Removal of prominent symptoms. Simple nourishing 
 food. Attention to functions of skin. Cure of any gouty afl'ection. 
 Improvement of blood by ferruginous tonics. Sea air. 
 
 NEURALGIA. — From Nsopav, a nerve ; aXyo^, suffering. Synon. 
 Neurodynia ; Nervous Pang. — Violent pain in the trunk or branch of a 
 nerve, occurring in paroxysms, perhaps at nearly equidistant intervals. 
 May attack nerves of head, trunk, or extremities: subcutaneous nerves 
 of these regions suffer most frequently. 
 
 Varieties. When the pain aft'ects branches of fifth pair of nerves, 
 — neuralgia faciei, or tic douloureux: certain nerves about head, — herni- 
 crania ; sciatic nerve, — sciatica. Some authorities regard angina pectoris 
 as neuralgia of cardiac nerves : gastrodynia, as a similar disease of 
 nerves of stomach. 
 
 (1) Tic Douloureux: May affect either of three branches of fifth 
 pair of nerves. Where pain depends upon morbid condition of first or 
 ophthalmic branch, the frontal i-amification of it — supra-orbital nerve — 
 is most frequently attacked: suftering i*eferred chiefly to forehead. 
 Supposing second or superior maxillary branch is seat of complaint, 
 infra-orbital nerve most commonly aftected : s^-mptoms consist of excru- 
 ciating pain shooting over cheek, lower eyelids, alffi of nose, and upper 
 lij). Tic douloureux of third or inferior maxillary branch is generally
 
 182 NEURITIS. 
 
 confined to inferior dental nerve, especially to portion which emerges 
 from mental foramen and extends to lower lip; pain referred to lower 
 lip, alveolar process, teeth, chin, and side of tongue. 
 
 AVliichever ner%'^e suffers, the torture is equally confined to one-half 
 of face. Eight infra-orbital nerve most frequent seat. Attack comes 
 on suddenly, patient at once putting up hand to press the seat of suffer- 
 ing: it greatly increases in severity, gets lancinating and burning, and 
 then ceases in coiirse of a few seconds. Attacks perhaps preceded by 
 derangement of digestive organs; by dyspnoea; by slight rigors, fol- 
 lowed by heat. Sometimes absent for weeks, and then almost constant 
 paroxysms for many days. — May be due to dyspepsia ; anaemia ; renal 
 disease; disease of facial bones; organic disease of brain; disease of 
 teeth or gums; poison of malaria, &c. 
 
 (2) Hemicrania : Headache affecting one side of brow and forehead. 
 Often accompanied with sickness. Sometimes periodical. Has been called 
 Sun-pain, as at times it only continues so long as sun is above hoi'izon. 
 
 (3) Sciatica: Acute pain following course of great sciatic nerve. 
 Extends from sciatic notch down })OSterior surface of thigh to popliteal 
 space, and often along nerves of leg to foot. May be due to pressure of 
 intestinal accumulations, of simple or malignant uterine tumors. Other 
 causes, — inflammation, rheumatism, gouty or syphilitic taint, malaria, 
 over- fatigue, exjiosure to cold and wet. 
 
 Treatment. Eemoval of cause. Improvement of health. Purga- 
 tives, only if actuall}' required. General remedies: Nourishing diet: 
 regulated amount of bitter ale, stout, or other alcoholic stimulants: 
 raw eggs : milk, in place of tea and coffee. AVarm clothing : flannel next 
 the skin or chamois leather jackets and drawers. Warm, tepid, or cold 
 salt water baths. Turkish bath. Friction of skin. 
 
 Drugs: Aloes, gentian, and liquor potassie, 148. Sulphate, or phos- 
 phate, of soda, 148, 149. Pepsine and aloes. 155. Croton oil (in sciatica 
 from fecal accumulation), 168, 191. Quinine, 379. Quinine, steel, and 
 arsenic, 381. Cod-liver oil, 389 Iodide of iron and cod-liver oil, 390. 
 Steel and pepsine, 394. Steel and arsenic, 399. Phosphate of iron, 4U5. 
 Strjx'hnia and steel, 4U8. Valerianate of zinc, quinine, steel, or ammonia, 
 4lU. Sulphate of zinc, 413. Ilypophosphite of soda or lime, 419. 
 lodideof potassium. 31. Gnaiacum and aconite, 48, 380. Colchicum, 40. 
 Turpentine, 50. Hydrocblorate of ammonia, 60. Opium, 340, 345. 
 Morphia, &c., 317. Hj-podermic injections of morphia, or atropine, or 
 aconitine, 314. Chloroform inhalation, 313. Stramonium, 323. Bella- 
 donna, or atropia, 826. Digitalis, 834. Conium. Galbanum. Glonoin. 
 Oxygen inhalation. Salicin. Sabadilla. Sulphate of beberia. Arnica. 
 Musk. 
 
 Topical expedients: Division of affected nerve. Eemoval of tumors 
 and foreign bodies. Extraction of decayed teeth. Application of iodine. 
 Blisters, dusting raw surface Avith morphia. Spray of pure ether. 
 Aconitine, 296. Yeratria, 304. Belladonna, Avith opium or mercury, 
 297, 298. Chloroform, belladonna, and aconite, 281, 282. Belladonna 
 and glycerine, 265. Hypodermic injections of morphia, &c., 314. Cyan- 
 ide of potassium. Hot douches of medicated water. Continuous gal- 
 vanic current. Acupuncture. Dry cupping. 
 
 NEURITIS. — From Nsdpnv, a nerve; terminal -itis. Synon. Neuro- 
 phlogo-sis ; Xeurophlegmone. — Inflammation of a nerve is a rare disease. 
 Usually due to a bruise or wound, or to inclusion of some nervous 
 branch in a ligature when taking up an artery. May perhaps arise 
 spontaneously in gouty or rheumatic subjects. 
 
 Symptoms. Severe and continuous pain along trunk of nerve and its
 
 NEUROMA — OBESITY. 183 
 
 ramifications. Fever. Eestlessness, especially at night. In chronic 
 form, symptoms of neui'ulgia. 
 
 Treatment. Iodide of potassium. Aconite. Colchicum. Local use 
 of belladonna. Hypodermic injection, in neighborhood of pain, of 
 morphia or aconite, 814. Fomentations. Water-dressing. Eest of 
 atf'ected part. 
 
 NEUROMA. — From jXedpov, a nerve. — A solid or cystic tumor con- 
 nected w ilh a nerve. Solid growths are of a fibrous nature, consisting 
 of dense plastic matter, implicating neurilemma and nerve-fibres. Oc- 
 casionally, nerve-fibres merely spread over tumor, without being in- 
 volved in its texture. 
 
 Neuromatous tumors may form spontaneously. Single, more y)uinfiil 
 than multiple, growths. May result from a wound or other injury: 
 occasionally produced on ends of nerves after amputation. 
 
 Symptoms. Neuromatous growths vary in size from a barlej'corn to 
 a melon. Occur most frequently on spinal nerves : branches of gan- 
 glionic system very rarely affected. Growth steady but slow. Of an 
 oval or oblong form; long axis corresponding with direction of nerve 
 to which there is attachment. Darting pains: much increased by 
 moving tumor in direction of nerve. — In traumatic neuroma, growth 
 single: source of paroxysmal pains, like shocks of galvani.sm. 
 
 Treatment. Excision otters the only hope of cure. Tumor to be 
 carefully dissected out, if possible. When complete excision is adopted, 
 the ends of divided nerve to be brought into apposition by sutures : by 
 maintaining continuity thei-e is no loss of power in parts supplied by 
 the nerve. 
 
 NOSTALGIA. — From Noarico, to return ; «A^o?, suffering. Synon. Nos- 
 tomania ; Homesickness. — The ungratiried desire to return home may 
 give rise to symptoms of melancholia. Great bodily and mental depres- 
 sion. Loss of appetite. Inability to procure sound sleep. In some cases 
 there has been a gradual wasting, delirium, and fatal prostration. When 
 other diseases supervene on nostalgia, the danger of the former is 
 greatlj^ increased. Kind treatment, amusement, outdoor exercise, 
 nourishing food, remedies to induce sleep, and attention to the secre- 
 tions may afford relief for a time. A temporary return home often 
 suffices to effect a cure. 
 
 NYCTALOPIA. — From Auf, evening; omopm, to see. — That condition 
 in which vision is most powerful during twilight. The opposite state 
 to hemeralopia. — See Amaurosis. 
 
 OBESITY. — From Obesns, flit or gross. Synon. Pohjsarcia ; Polysar- 
 cosis. — The over-accumulation of fat under the integuments and around 
 some of the viscera constitutes obesity. Not to be confounded with 
 fatty degeneration of tissues. The term corpulency to be retained for 
 those cases where the amount of fat does not constitute a disease. 
 
 Symptoms. Impeded play of various important organs. Diminution 
 of bodily and mental activit}^. Disturbances of organs of respiration, 
 circulation, and digestion. Panting on slight exertion. Blood compara- 
 tively deficient in quantity or quality. Weakness of muscles. Counte- 
 nance bloated and sallow. Liability to gouty and neui-algic affections. 
 Obesity not conducive to longevity. Sudden death not uncommon. 
 
 Partial obesit}^ — e.g., fatty tumors, fatty accumulation around heart, 
 fatty omentum or "pot-belly." 
 
 Causes. Hereditary tendency. Over-feeding. Consumj)tiou of large
 
 184 (EDEMA — (ESOPHAGEAL STRICTURE. 
 
 quantities of fluid. Indolence, and too much sleep. Excessive use of 
 fatty, farinaceous, vegetable, and saccharine foods. Fat is formed in 
 the body from food containing it ; also from chemical transformation of 
 starch and sugar. 
 
 Treatment. Rational treatment: Diet of meat, white fish, green 
 vegetables, biscuit or dry toast, tea, claret, sheny. Avoidance, more or 
 less complete, of bread, butter, milk, sugar, beer, potatoes, beans, and 
 soup. Bromide of ammonium, 37. Carbonate of ammonia. Magnesia. 
 Colchicum. Exercise. Seven hours for sleep. 
 
 Diminution of weight not to exceed one pound a week. General 
 health, state of appetite, and condition of bowels to be watched. 
 
 Remedies formerly employed: Bleeding from the arm, or jugular vein. 
 Dry cupping. Prolonged blistering. Vegetable diet with vinegar. 
 Acids, except the nitric and phosphoric. Turkish baths. Hot baths. 
 Salt water baths. Baths of Aix, Spa, Forges, Eouen, and Acqui. Occa- 
 sional starvation. Guaiacum and sassafras. Scarifications. Grief and 
 anxiety to be induced. Purgatives. Diuretics. Preparations of iodine 
 and bromine. Liquor potassa?. Fueus vesiculosus. Emetics. Digitalis. 
 Tobacco. Soap. Salt. Mercury. Inhalation of oxygen gas. 
 
 (EDEMA. — From Oidicj^ to swell. Synon. Hydroeedema ; Hydroncus. — 
 Dropsy of the subcutaneous areolar tissue of any one region. 
 
 Treatment. Elaterium, 157. Acid tartrate of potash, 228. Com- 
 pound jalap powder. Compound scammony powder. Acetate of potash. 
 Digitalis and squills, 219. Gin. Acupuncture. — See Anasarca; Drojjsy. 
 
 (ESOPHAGEAL CANCER.— From Oi<To<fdYo-, the swallow. Synon. 
 Cancer of the Gullet. — May occur through whole length and circumfer- 
 ence of tube, or be very limited. Of scirrhous, medullary, or epithelial 
 variety : latter most common. Generally fatal within a year from com- 
 mencement. 
 
 Symptoms. Soreness of throat. Difficulty in swallowing. Occasion- 
 ally, cutting pain in ears. Frequent, sometimes constant, sickness. 
 Decided obstruction : after a time, not a particle of food reaches stomach. 
 Formation of a pouch above constriction, in which food lodges. Burning 
 pain in canal, back, or between shoulders. Cough, or hiccough. Hemor- 
 rhage. Wasting. Debility. Cancerous cachexia. 
 
 Treatment. Opium, or morphia, 315, 317. Opium by rectum, 339, 
 340. Subcutaneous injection of morphia, 314. Nutrient enemata, 21, 
 23, 23. Sometimes, a large gum elastic catheter (No. 14) may be passed 
 through contracted (^esophagus and left in : so that cream, solution of 
 raw beef, wine and opium may be injected through it every four or six 
 hours. Ice, to relieve thirst. Iced milk. 
 
 (ESOPHAGEAL STRICTURE.— From Olffofdyoq, the swalloAV.— Stric- 
 ture of the gullet may be organic or functional (spasmodic): 
 
 1. Organic Stricture. — Generally the result of an attempt to swallow 
 some corrosive ])oi80n. 
 
 Symptoms, At first, vomiting. Pain about oesophagus, perhaps dart- 
 ing through to between shoulders. An apparent cure, after rest and 
 simple diet and demulcent drinks. — At end of some nine or twelve 
 months, great dysphagia: emaciation from inability, which has been 
 gradually increasing for several weeks, to take solid food. — A gum elastic 
 catheter can generally be introduced; through which solution of raw 
 beef, cream, and port wine can bo injected into stomach. By gradual 
 use of larger and larger tube, stricture appears to be cured. Patient is
 
 (ESOPHAGISM — (ESOPHAGITIS. 185 
 
 perhaps removed from observation. But in a few months, all the s3-mp- 
 toms return: the wastiiiij^ and anaemia become extreme: no instrument 
 can be passed down oesophagus: and death occurs from starvation ia 
 spite of nutrient enemata. 
 
 Treatment. The only remedj' of any avail, consists of dilatation by- 
 frequent use of bougies for many months. At first, a gum elastic cathe- 
 ter can be constantly worn. Subsequently, a bougie ought to be intro- 
 duced at least twice a week. — In hopeless cases, it may be justifiable to 
 make an incision through abdominal parietes into stomach ; forming an 
 opening sufficiently large to allow of daily introduction of food. Gastrot- 
 omy can be performed with knife: or, perhaps better, by exciting 
 iuflianimation, adhesion, and ulceration with potassa fusa. 
 
 2. Spasmodic Stricture. — S^-non. GiJsophagospasmiis ; Tenesmus Gulce; 
 Dy.^p/uKjia Spasinodica. — Like the urethra and bronchial tubes, the 
 a?sophagus may be affected with spasmodic contraction. Young hys- 
 terical women subject to it. 
 
 Symptoms. Difficulty in swallowing. Sense of fulness and choking 
 under influence of an excitement. Languor. Ansemia, &c. Spasmodic 
 cannot be confounded with permanent stricture, because dysphagia is 
 only temporary: a bougie passes with little or no difficulty: symptoms 
 aggravated when patient's attention is directed to them. 
 
 Treatment. Ammonia and assafoetida, 86. Ether and chloroform, 
 85. Assafoetida and chiretta, 89. Valerianate of quinine, 414. Vale- 
 rianate of zinc, 410. Phosphate of zinc, 414. Strj'chnia and steel, 408. 
 Compound iron mixture and aloes, 393. Cod-liver oil. Galvanism. Cold 
 shower bath. Nourishing food. Cure of any general or uterine disor- 
 der which ma}' be present. 
 
 t 
 
 (ESOPHAGISM. — From O'^ixpriyix;^ the swallow. — A nervous disorder, 
 in which the symptoms are allied to those produced by spasmodic stric- 
 ture. 
 
 Symptoms. An individual fixncies he has swallowed a pin, or fish 
 bone, or other hard substance, and that it can be felt sticking in the 
 gullet. Irritation increases as the delusion is nourished. There is diffi- 
 culty in swallowing owing to spasmodic or irregular action of the su])e- 
 rior, middle, or inferior constrictor muscle. Even the medical man may be 
 misled by trusting to patient's symptoms; or by feeling, with finger in 
 throat, upper edge of cornu of os hyoides, and mistaking it for a foreign 
 body. 
 
 Treatment. A careful examination with finger, bougie, or laryn- 
 goscoj^ic mirror fails to detect any substance. Galvanism. Quinine, 
 379. Valerianate of zinc, 410. 
 
 OESOPHAGITIS. — From Olfrocpdyot;^ the swallow (jnw, to carry ; wdyw, to 
 
 eat); terminal -itis. ii>y won. Angina (Esophagcea ; Dysphagia Injiamma- 
 toria ; Inflanimatio Gula^. — Inflammation of the oesophagus very rarely 
 a primary- disease. Generally a result of strumous diathesis; of one of 
 eruptive fevers; of abuse of alcoholic drinks, or irritating drugs; of use 
 of acrid poisons, &c. — Characterized by dj'sphagia ; symptomatic fever ; 
 burning pains shooting from throat to between shoulders; fits of cough- 
 ing, hiccough ; constipation, &c. vSuppuration, ulceration, or gangrene 
 may result. — Remedies consist of mucilaginous drinks; milk or cream; 
 aperient enemata ; hot fomentations to throat ; and perfect quiet, even 
 talking being forbidden. 
 
 Simple idceration of oesophagus is attended with difficult}' in swallow- 
 ing ; sometimes so great that deglutition is impossible. Pain at epigas-
 
 186 OLIGEMIA OPHTHALMIA TARSI. 
 
 trinm, or top of sternum, or between shoulders. Nausea ; anxiety ; 
 emaciation and debility. Ulceration may extend into trachea, pleura, 
 bronchial tube, pericardium, or aorta. — Chief remedies : — Sponging with 
 solution of nitrate of silver (gv. 20 to fl. oz. j). Atomized astringent 
 fluids, 262. Bark. Steel. Quinine. Cod-liver oil. Iodide of ammo- 
 nium. Iodide of potassium. Nourishing food. Sea air. Where death 
 is approaching from starvation, the formation of agastric fistula should 
 be attempted. 
 
 OLIGJEMIA. — From ^O/.iyoq. thin; a\:m, blood. Synon. Oligohcemia ; 
 Hypcemia; Hypohoemia. — Deficiency of blood. — See Ancemia. 
 
 ONYCHIA. — From "Ow?, a nail. Synon. Paronychia; Onychitis; 
 Onychia JIaligna. — An inflammation of the matrix of the nail. May 
 arise from mechanical injury; or from depraved state of constitution. 
 
 Symptoms. Pain and swelling at root of nail, and about surrounding 
 textures. Exudation of sanious discharge on pressure of nail. Xail 
 gets raised, and finally detached, exposing a foul ulcer. Ulcer becomes 
 glazed and irritable : perhaps extends in all directions. Occasionally, 
 necrosis of distal phalanx. 
 
 Treatment. Eemoval of nail. Ulcer to be dressed with zinc lotion, 
 264. Nitrate of silver. Local fumigation with calomel. Arsenic, 
 chlorate of potash, and bark, 402. Quinine and steel, 380. Cod-liver 
 oil. Nourishing food. — In syphilitic onychia, — Red iodide of mercury, 
 54. Mercurial vapor bath, 131. Solution of corrosive sublimate, 27. 
 Iodide of potassium, 31. 
 
 ONYXIS. — From "Ovu|, a nail or hoof. Synon, Aduncatio Unguium ; 
 In-groaing of the Nail. — Inflammation and ulceration of side of toe, 
 owing to margin of nail being pressed into the flesh. Ulcer gets cov- 
 ered with flabby and sensitive granulations. Causes great sufi'ering, 
 especially during walking. 
 
 ' Treatment. Removal of pressure of boot. Nails to be ordinaril}- 
 cut off' square, instead of down inner and outer sides. Scraping side of 
 nail very thin, soaking in hot water, and introduction of pellet of cotton- 
 wool so as to separate nail from ulcer. Removal of off'ending half of nail : 
 anai'sthesia. or ether spray. Subsequent dressing with zinc lotion, 264. 
 Excision of bulbiform enlargement close to edge of nail, leaving a 
 sloping surface with the nail overhanging raw surface. 
 
 OPHTHALMIA. — From "OipOakiibq, the eye. — A general term for in- 
 flauunalion of the eye. — See Conjunctivitis ; Sclerotitis^ &e. 
 
 OPHTHALMIA TARSI.— From l)<p0aAfid^. the eye ; Tapffd:;. a hurdle. 
 Synon. BIcjj/iiirnji/it/ialmia ; Blepharotitis ; Adenophthalmia. — Inflamma- 
 tion of the palpel)ral conjunctiva and edge of eyelids; with formation 
 of minute pustules at roots of eyelashes, the discharge from which pro- 
 duces small crusts matting the hairs together. When attended with 
 much irritation it is sometimes termed Tinea ciliaris, or tinea pjalpebra- 
 rurn, or psorophthabnia. 
 
 Sympto:ms. When acute, considerable pain and soreness. Usually 
 chronic: Itching; destruction of tissues wliich secrete the hairs; a 
 blending of the skin and conjunctiva into a red shining cicatrix. Ob- 
 literation of puncta, causing stillicidinm lachrymarum. — See Epiphora. 
 
 Treatment. Internally: Improvement of general health. Tonics. 
 Alteratives. Arsenic and steel. Cod-liver oil. Animal food: milk. 
 Change of air. — Locally : Great cleanliness to prevent accumulation of
 
 ORCHITIS — OSTEOMYELITIS. 187 
 
 crusts. Eyelashes to be cut off close. Ointments, pro])e?-ly (liiiited, of 
 nitrate of mercur}^, red oxide of mercury, or of oxide of zinc. Diluted 
 solution of subacetate of lead. In obliteration of the lower puiictuni, 
 the whole course of the canaliculus to be slit up to the caruncle, so as 
 to lay open the canal and extend its orifice backwards to the point 
 where the tears accumulate (Bowman). 
 
 OECHITIS. — From 'VV/y;;^;?, a testicle; terminal -itis. Sj'non. Hernia 
 Huinoralis. — Inflammation of the testicle. — See Testitis. 
 
 ORTHOPNEA. — From 'OpOo-, erect; -v/co, to breathe. — Excessive 
 difficulty of brcuthins^, so that the sufferer has to maintain erect posi- 
 tion. Often present in asthma, bronchitis, pneumonia, drops}-, valvuhtr 
 affections of the heart, paralytic diseases, &c. 
 
 OSTEITIS. — From 'Offzkov, a bone; terminal -itis. Synon. Ostitis. — 
 Inflammation of bone arises from same causes as periostitis. Where 
 the latter is of long duration, the former arises. 
 
 Symptoms. Great tenderness. Deep-seated pain, aggravated at night ; 
 influenced also by weather. Enlargement of affected bone. 
 
 Treatment. See Periostitis. — Where suppuration occurs, and the 
 medullary canal and cancellous structure get filled with pus, tonics and 
 free su])]»ly of nourishment required. Amputation sometimes necessaiy. 
 See Osteomyelitis. — In circumscribed abscesses of cancellated structure 
 of either extremity of tibia, trephining the bone must be resorted to, so 
 as to let out the pus. 
 
 OSTEOID CANCER. — From Wffziov, a bone. — These cancers usuallj^ 
 grow fi-nm some bone, and especially from the lower part of femur. 
 Their general history corresponds to that of the scirrhous and medullary 
 varieties. The}' are as malignant and as quickly fatal as the medullar}', 
 and they give rise to secondary deposits in areolar tissue/» lymphatics, 
 lunirs, &c. — See Cancer. 
 
 'b^i 
 
 OSTEOMALACIA. — From ^Ouriov, a bone; iJ.a)My.u<;, soft. Synon. 2fol- 
 lities 0-<sii(m; Malacosteon ; Rachitis Adultonim ; Softening of the Bones. 
 The characteristic feature of this disease, as of rickets, is a deficiency 
 of phosphate of lime; so that the bones become soft and unnaturally 
 flexible. The affection is constitutional : the whole skeleton is usually 
 affected, producing distressing and remarkable deformity. Women be- 
 yond the age of forty are most obnoxious to it : the pelvis often first 
 attacked in childbearing women. Large quantities of earthy salts are 
 passed in the urine. The general health becomes hopelessly impaired: 
 gradual loss of flesh and strength. Severe and intractable pains of a 
 rheumatic character: spontaneous fractures. Sooner or later, in spite 
 of tonics and opiates and nourishing food, death. 
 
 OSTEOMYELITIS.— From VVr^«i/, a bone; iwikoq, marrow; terminal 
 -itis. Synon. Medullitis ; Endosteitis. — Inflammation of the medullary 
 membrane lining the central canals of long bones, as well as the cells 
 of the flat and irregular bones; which delicate vascular membrane se- 
 cretes the medulla, and is continued into the cells of the cancelli and 
 the Haversian canals. 
 
 Generally the result of injury: a frequent cause of death after am- 
 putation and other operations on bone. The symptoms ai'e usually ob- 
 scure, being masked by accompanying inflammation and su])pui"ation 
 of soft parts. It causes the periosteum to recede or separate from sur-
 
 188 OTALGIA — OTITIS. 
 
 face of the bone. But little modified by medicines : amputation of limb, 
 or of remainder of limb, often necessary, — See Osteitis. 
 
 OTALGIA. — From Oo^, the ear; aXyo^, pain. Synon. Otodyne ; Ear- 
 ache. — May be symptomatic of inflammation of ear, or of presence of for- 
 eign bodies in external meatus, or of tonsillitis, or of disorder of primae 
 viffi, or of rheumatism of the head, kc; or it may be idiopathic, — true 
 neuralgia of auditory nerves. In latter case, suffering most severe on 
 invasion ; unlike the pain in otitis, it does not increase in severity, is 
 unattended by fever, and often disappears suddenly. Nervous otalgia 
 may be connected with imperfect performance of functions of stomach 
 or liver; or may arise from uterine derangement; or may occur in eai"ly 
 stage of utero-gestation ; or may be due to a carious tooth; or perhaps 
 alternates with sciatica, tic douloureux, &c. Sometimes pain very severe ; 
 it frequently shoots through nervous filaments distributed over same 
 side of face and head, causing much siiftering and restlessness. 
 
 Treatment. When symptomatic, attention to be directed to primary 
 disease. When idiopathic, — mild purgatives; quinine; opium; Indian 
 hemp. Application of a small blister behind affected ear; local use of 
 chloroform vapor, aconite liniment, cotton-wool saturated with lauda- 
 num, steam of decoction of poppy-heads, linseed poultices, the boiled 
 bulb of common onion or of garlic. Carious teeth to be extracted or 
 stopped. 
 
 Noises in the ears (tinnitus aurium), deafness, confusion in the head, 
 &c., may arise from accumulation of cerumen in external meatus. The 
 wax to be removed by thoroughly syringing with warm water; or with 
 solution of carbonate of potash (gr. 10 to fl. oz j). Avoid mistaking 
 deafness and singing in the ears, owing to the pressure of a mass of hard 
 wax on the membi'ane of the tympanum, for symptoms of incipient 
 cerebral disease. 
 
 OTITIS.— From Oo:;, the ear ; terminal -iti,s. vS3'non. Injlammatio Auris; 
 Inflammation of the Ear. — Various parts of the organ of hearing may be 
 attacked : 
 
 1. Inflammation of External Meatus. — Synon. External Otitis; Otitis 
 Catarrhalis. — The sensitive dermis of the canal may become inflamed 
 from introduction of irritating matters, an accumulation of bard wax, 
 blows on side of head, cold, gouty state of system, impoverished blood, etc. 
 
 Symptoms. Dull aching pain, increased on moving jaw. Vascularity 
 and tumefaction, the latter sometimes closing canal and causing tem- 
 porary deafness. Swelling of cervical glands on affected side. In a 
 day or two, a copious secretion of mucus, — often very thin and abun- 
 dant. In chronic cases, persistent otorrhoea: the dermis remains more 
 or less tumid; epithelium thrown off in scales which accumulate and 
 obstruct canal; diminished powder of hearing; great itching; and gen- 
 eral de])ression. 
 
 A small circumscribed abscess in the meatus will cause acute throb- 
 bing pain ; narrowing of aperture of canal; dulness of hearing. Often 
 occurs where there is a tendency to boils or styes. 
 
 Treatment. The general health to be improved. Nourishing food, 
 witii ])lenty of milk, when digestion is good. Quinine. Iron. Chlorate 
 of ]jotasb. Colchicum? Cod-liver oil. Sea air. — Locally: Fomenta- 
 tions and poultices ; tVequent bathing to remove the irritating discharge. 
 If much pain and swelling, a couple of leeches to margin of meatus will 
 relieve congestion. When inflammatory symptoms terminate in chronic 
 irritation, the collection of epidermis must be removed hj syringing
 
 OTITIS. 189 
 
 with warm water; mild asti'iiigent injections generally useful ; glyce- 
 rine, or olive oil. Sometimes the cure is hastened by application of 
 
 small Misters over mastoid process. 
 
 2. Inflammation of Membrana Tympani. — S^-non. Mi/n'ngifis. — May be 
 acute or chronic. The consequence of cold; of irritating matters; of 
 gouty, tubercular, or syphilitic taints; of the extension of disease from 
 walls of meatus. 
 
 Symptoms. Pain, itching, slight deafness. A sense of discomfort on 
 affected side of head. On examination with speculum, the membrana 
 seen to be opaque, and traversed by distended vessels. Ulceration may 
 take place, and even lead to perforation. Another result to be feared 
 is permanent relaxation of the membrane ; which loses its natural de- 
 gree of resiliency, becomes flaccid, and falls in towards the promontor3\ 
 A third consequence is thickening and hypertrophy of the fibrous 
 lamina?. 
 
 Treatment. When due to gouty, strumous, or syphilitic taints, the 
 appropriate remedies for these conditions are needed. In other re- 
 spects, the treatment is the same as tor inflammation of external meatus. 
 Where there is perforation, the artificial membrana tympani, — a thin 
 circular plate of gutta percha with a silver wire handle; or a layer of 
 moistened cotton-wool with a thread attached to it. 
 
 3. Inflammation of Tympanic Cavity. — Sjmon. Tnttrnal Otitis. — A severe 
 disease. Eendered more serious by usually being combined with inflam- 
 mation of the internal coat of the membrana t3Miipani. 
 
 May arise from cold, the poison of rheumatism or gout, scarlet fever, 
 and tlie strumous constitution. Not uncommon in 3'outh : many cases 
 of children's earache, causing miserable nights, really due to it. 
 
 Symptoms. Uneasiness in ear on blowing nose or on swallowing: in 
 a short time the discomfort becomes continuous. There ma}' be violent 
 headache; followed by intense and sharp and gradually increasing pain 
 in ear, with loud or beating noises. Then, a sense of bursting or disten- 
 sion in ear: more or less deafness. Eyes become injected ; countenance 
 anxious; skin hot; pulse frequent; functions of kidneys and bowels 
 disordered. Delirium often present; or, in children, convuhions. Al- 
 wa3's great depression: foreboding of some heavy calamity. Facial 
 paralysis (caused by inflammation extending to bony canal in which 
 portio dura passes round t^'mpanum) imxy occur: power regained as 
 morbid action subsides. Termination in one of three ways: either by 
 resolution ; b}' suppuration, the pent-up pus bursting through membrana 
 tympani, and so discharging itself; or by inflammatc^r}' ])rocess spread- 
 ing through mastoid cells internall}', or by bon}' meatus to periosteum 
 covering mastoid process externally. 
 
 In external otitis, perforation of membrana tympani may take place 
 owing to extension of ulceration from without inwards. In present 
 case, the reverse happens ; morbid action progresses from within out- 
 wards. This latter the most frequent cause of formation of an orifice; 
 fortunatel}' the opening generally closes spontaneously in the course of 
 a week or two. 
 
 Treatment. To be conducted with caution. Bowels should be mod- 
 erately acted upon; action of skin promoted; patient kept in bed in a 
 quiet room. 
 
 Salines, ;-')48. Eefrigerating drinks, 355, 356. Chlorate of potash, 
 360. Where there are manifestations of rheumatism or gout, iodide of 
 potassium and colchicum, 31. Opium or morphia, 315, 317. Aconite, 
 330,331. — Locally: Vapor of boiling water. Fomentations with poppy- 
 heads, chamomile flowers. Linseed, onion, or garlic j^oultices. Small
 
 190 OTORRHCEA — OTORRHAGIA. 
 
 blisters to mastoid process. When abnormal aperture in membrana 
 tympani fails to close, attempts to be made to induce cicatrization by 
 occasional use of nitrate of silver. This failing, and opening being of 
 such a size as to cause deafness, application of ai'titicial membrane, after 
 producing healthy state of lining tissues of tympanum by mild astrin- 
 gent lotions and gentle syringing. 
 
 OTORRH(EA.— From 0Z-, cbrdq, the ear; /5i(v, to flow. Synon. Otir- 
 r/iiea; Bleniiotorrhoea ; Catarrh of the Ear. — A purulent or muco-purulent 
 discharge from the ear. A symptom of certain diseases of the ear; as 
 of catarrhal inflammation, pol^'pus, granulations on the surface of the 
 membrana tympani, &c. Occui-s very frequently, without any appre- 
 ciable cause, in j^oung children about the time of dentition ; or on the 
 subsidence of any of the exanthemata, especially in strumous subjects. 
 In adults it occasionally seems to be due to a depressed condition of 
 system. The secretion is generally ofl'ensive and irritating; when it has 
 existed for any length of time, it is often tinged with blood. 
 
 Symptoms. Commonly the discharge ceases in a short period. Occa- 
 sionally it becomes chronic, and when this happens it may continue for 
 years; desti'oying in the course of time the membrana tympani, the 
 ossicula auditus, and producing caries of the bony walls of the meatus 
 and tympanum. The disease may even extend to the cells of the mas- 
 toid process of the temporal bone ; or in the opposite direction along 
 the petrous portion of the same bone, until the brain and its membranes 
 become involved in the unhealthy action. This event indicated by 
 rigors, fever, and marked cerebral symptoms: ultimately convulsions, 
 coma, and death. Cases of phlebitis, with pleurisy and pneumonia, 
 have also resulted from caries of the mastoid cells. 
 
 Treatment. Syringing gently with warm soap and water; then 
 careful examination of meatus auditorius externus with ear speculum. 
 If no cause (as polypus, &e.) be found, attention to general health. 
 Nourishing diet, — animal food, milk, &c. Quinine and steel, 380. Steel 
 and ]>epsine, 394. Phosphate of iron, 405. Mineral acids and bark, 376. 
 Iodide of iron. 32, 882. Iodide of potassium and guaiacum or sarsa- 
 parilla, 31. Cod-liver oil. — Locally: Frequent syringing with warm 
 water. Injections of alum, zinc, sulphate of cadmium, or tannin, of 
 san\e strength as collyria, 291. Glycerine. Olive oil. Painting walls 
 of canal with solution of nitrate of silver — gr. 6 to fl. oz. j. Equal parts 
 of balsam of Peru and ox gall daily dropped into ear. Ointment of 
 carbolic acid — gr. 10 to lard oz. j. Solution of chlorinated soda — min. 
 XXX to fl. oz. j. 
 
 OTORRHAGIA. — From 05?, wrdc;, the ear; pvjy^u/u, to burst out. — Hem- 
 orrhage from the ears arises from different causes: (1) Fracture of 
 base of skull, by which a communication is established between sinuses 
 of dura mater and middle ear. The membi'ana tympani being ru])tured, 
 blood escapes externally. If both petrous bones be injured, hemorrhage 
 from both ears. Occurrence of bleeding, on one or both sides, generally 
 regarded as of unfavorable import. — (2) Wounds and ulcerations of audi- 
 tory canal ; whether produced by earpicks or other instruments, insects, 
 foreign bodies voluntarily introduced, or old hardened ceruminous con- 
 cretions. To be stop])ed by extraction of foreign body. — (3) Granula- 
 tions, polypi, and abscesses of auditory canal. To be cured by removal of 
 polypus, use of nitrate of silver to granulations, or incision into ab- 
 scess. — (4) Caries and necrosis of petrous portion of temporal bone, with de- 
 struction of membra 7m tympani. If walls of carotid canal be involved, a 
 spiculum of bone will possibly wound inter)ial carotid artery, and cause
 
 OVARIAN DISPLACEMENTS OVARIAN TUMOR. 191 
 
 fatal loss of blood. Ligature of common carotid may have to l)e re- 
 sorted to. — (5) Rupture of membrana tympani ; which may occur dni-ing 
 ascent of high mountains, or in descent of low valleys, or in going to 
 any great depth in a diving-bell, &c. ; during violent sneezing or vomit- 
 ing; or during paroxysms of whoo])ing-cough or asthma. The air is 
 violently forced through Eustachian tube into tympanum, the delicate 
 meml)rane of which gives way where it is least cai)able of oifei-ing re- 
 sistance — near insertion of handle of malleus. The blee<iing to be 
 checked by swal)bing meatus with styi)tics. Subsequently, an artificial 
 tympanum may be needed to relieve deafness. — And (6) It may be a vi- 
 carious hemorrhage, — i.e., it may perha])S replace menstruation, or long- 
 continued bleeding from piles or old ulcers. 
 
 OVARIAN DISPLACEMENTS. — One or both ovaries are occasionally 
 forced out of position by some uterine or other tumor; or an ovary may 
 escape from pelvis, forming a true hernia of this gland. Displacements 
 of first class, usually aggravate the s^nnptoms of the disease causing 
 them: suffering often ceases, if tumor increase in size and pass upwards 
 out of pelvic cavity. Those of second class may be congenital, or may 
 happen accidentally after puberty. Occasionall}^, the ovary forms the 
 contents of an inguinal, crural, or umbilical hernia. 
 
 OVARIAN TUMOR. — From Ovarium ("Qdpcov, a small egg, dimin. of 
 wo:'), the ovary: Tumor {Tumeo, to be swollen), a tumor. Synon. Ova- 
 rian Dropsy ; Cystic Disease of Ovary. — Consists of a conversion of the 
 ovary, or parts of it, into cysts. Three varieties of cysts: Simple or 
 unilocular: compound, multilocular, or proliferous; and dermoid cysts, 
 the lining membrane of which has the power of 23roducing hair, teeth, 
 sebaceous matter, &c. 
 
 Symptoms. Very slight in early stage: disease generally escapes 
 detection until abdomen begins to be enlai"ged. In exceptional cases, 
 tumor while in pelvic cavity causes irritation of rectum and bladder: 
 sense of weight and oppression : pain and numbness down thigh of 
 affected side. Backache. Menstruation usually regular, perhaps 
 abundant. 
 
 In more advanced stage, great pain and tenderness: distension of ab- 
 domen. Disordered menstruation, perhaps suppression. Loss of flesh. 
 Constipation. Indigestion. Frequent micturition : urine often scanty. 
 Loss of appetite. Eestless nights. Dyspnea. Diminution of strength. 
 Abdomen found enlarged: fluctuation var3'ing in distinctness according 
 to number of cj^sts, their distension, and capacit3\ Dulness on percus- 
 sion. Tumor may cause ascites. (Edema of thighs and legs. — At 
 length suft'ering greatly augmented. Patient's movements impeded 
 from bulk of tumor. Miserable nights: attacks of dyspnoea necessitate 
 sitting up in chair. Considerable cedema. Sometimes, suppression of 
 urine : ursemic poisoning. Fatal prostration. 
 
 Treatment. Abdominal tapping, followed by well-adapted pressure, 
 and administration of iodide of potassium, 3L Tapping, with intro- 
 duction ofdraiiuige tube, so as continually to withdraw fluid as it is re- 
 secreted. Tapping, followed b}^ prolonged adniinistration of chlorate 
 of potash in full doses. Tapping, with injection of iodine. Tapping, 
 with application of ligature around pedicle. Tapping tln-ough vagina. 
 Abdominal section, — ovariotomy. 
 
 Drugs to produce absorption, worse than useless. Application of 
 blisters, leeches, iodine ointment, mercurial ointment, stimulating lini- 
 ments, electricity, &c., to be avoided.
 
 192 OVARITIS — OZ^NA. 
 
 OVARITIS. — From Ovarium {'Qdpwv, a small egg, dimin. of mh')^ the 
 ovarj; terminal -iY?'5. Synon. Oophoritis; Odritis ; Injiammatio Ovarii. — 
 Infiunimation of the ovarj'^ occurs under tvv^o forms, — the acute, and 
 subacute or chronic. 
 
 1. Acute Ovaritis. — May arise from violence, use of strong caustics to 
 labia uteri, dilatation of os with sponge-tents, sudden sup})ression of 
 menses from shock, gonorrhoea, &c. Left ovary more frequently attacked 
 than right: double ovaritis rare. 
 
 Symptoms. Pain of variable amount: sometimes most intense, caus- 
 ing paroxysms like labor-pains; more frequently of a dull aching char- 
 acter, with occasional sharp lancinating attacks. Tenderness about 
 lower part of abdomen : of groin and inner part of thigh corresponding 
 to affected gland. If morbid action continue, peritoneum gets involved. 
 Bladder becomes irritable: urine scant}-, high-colored, and scalding. 
 Tenesmus. Passage of hardened faeces causes much suffering by pres- 
 sure on ovary. Fever; ra])id pulse; nausea; restlessness; disgust for 
 food. On examination, the swollen and exquisitely sensitive ovary 
 easily detected. — If suppuration occur, there will be rigors; quick and 
 fcel)le pulse; glazed red tongue; excessive sickness; sense of weight 
 and throbbing about pelvis. Abscess may burst in peritoneum, setting 
 up severe peritonitis: more favorably, into rectum or vagina. Sucb 
 cases sometimes very tedious: opening closes, but pus accumulates 
 again and again. 
 
 Treatment. Hot hip baths, night and morning Pessaries of opium 
 and belladonna, 423. Fomentations: hemlock poultices: linseed poul- 
 tices, — to vulva, hypogastric, and inguinal regions. Iodide of potassium, 
 31. Guaiacum and aconite, 43. Oj)ium and belladonna, 344. Eectum 
 to be emptied by enemata of olive oil, 188. Leeches to labia uteri, if 
 attack be due to sudden suppression of menses. If an abscess point in 
 vagina, it may be cautiously opened with a trocar or bistoury. 
 
 2. Chronic Ovaritis. — A common disease during period of sexual 
 vigor. Euns a tedious course. May be set up by excessive sexual 
 intercourse; unskilful use of uterine sound, or caustics; rheumatic and 
 syphilitic taints, &c. 
 
 Symptoms. Dull and continuous aching in ovarian and sacral regions. 
 Tenderness of upper j^art of one or both thighs. Scant}' and dithcult 
 menstruation. Pain on sexual intercourse. Irritability of stomach ; 
 nausea, indigestion, constipation, flatulence. Fits of hysteria. Irrita- 
 bility of bladder. Tumefaction and tenderness of one or both breasts. — 
 Attacks of nymphomania, or even some forms of chronic insanitj", may 
 arise from subacute ovaritis. Inflamed gland found swollen and sensi- 
 tive, on making a vaginal examination. 
 
 Treatment. Iodide of potassium, 31. Bromide of ammonium, 37. 
 Guaiacum and aconite, 43. Hydrochlorate of ammonia, 60. Cod-liver 
 oil, 389. Pepsine, 420. Ammonia and bark, 371. Quinine and bella- 
 donna, 383. Iodide of iron and cod-liver oil, 390. Iodide of lead and 
 belladonna pessaries, 423. Belladonna plaster to sacrum. Wai-m hip 
 baths. Warm clothing: flannel drawers. Animal food, milk, raw eggs. 
 Gentle walking exercise. 
 
 Avoidance of: Blisters. Leeches. Calomel. Antimony. Strong pur- 
 gatives. Sexual intercourse. 
 
 OZiENA. — From "^^ij, a stench. Synon. Coryza Virulenta ; Pyorrhoea 
 JVasalis; liliinitis Ulcerosa. — Chronic inflammation of the nostrils. Due 
 to long-continued attacks of catarrh, especially in gouty or strumous sub-
 
 PANCREATIC DISEASE — PARALYSIS. 193 
 
 jects ; syphilitic taint; abscess of septum ; chronic ulceration; polypi; 
 necrosed bone; or foreign bodies in nasal cavities. 
 
 Symptoms. — Appearance, perhaps, of common cold. Uneasiness and 
 ''stuffiness" of nose. Swelling of pituitary membrane. Headache. 
 Profuse, fetid, muco-purulent discharge ; sometimes tinged with blood. 
 Formation of flakes of fibrine or hardened mucus; which if allowed to 
 remain in nose, decompose, and give out a most disgusting odor. Septum 
 of nose often eaten through, leaving a small round hole. Caries or 
 necrosis of spongy bones, especially in s^^philitic cases. 
 
 Treatment. General remedies : Quinine and iron, 380. IS'itro-hj-dro- 
 chloric acid, 378. Arsenic and bark, &c., 52. Steel with arsenic, 381, 
 399. Cod-liver oil. Chlorate of potash and steel, 402. Iodide of iron 
 and cod-liver oil, 390. Iodide of potassium, 31. Corrosive sublimate, 
 27. Eed iodide of mercury, 54, 55. Green iodide of mercury, 53. Mer- 
 curial vapor baths, 131. Sea air. Nourishing food. Warm clothing. 
 
 Locally : Frequent and thorough syringing with warm water. Injec- 
 tions of alum; or zinc; or jjcrmanganate of potash, 78. Inhalation of 
 steam medicated with iodine, 259; or creasote, 260; or turpentine, 260. 
 Iodine vapor, 259. Nitrate of mercury ointment, 305. Iodide of lead 
 ointment, 293. Pulverized medicated fluids, 262. Snuff's of chlorate of 
 potash and sugar (gr. 30 and oz. ^) ; or of red oxide of mercury and 
 sugar (gr. 5 and oz. J) ; or of white bismuth. 
 
 PANCREATIC DISEASE.— Disease of pancreas (from /7«v, all; xpiac, 
 flesh) of comparatively rare occurrence. When affected, it is mostly 
 impossible to diagnose exact nature of morbid state. 
 
 Diseases which may occur are : Congestion, hypertTdphy, inflamma- 
 tion, suppuration, induration, serous softening. Atrophy; fatty degen- 
 eration. Simple C3'stic tumors; hydatid tumors. Scirrhous or medul- 
 lary cancer. Calculous concretions, composed of carbonate and phos- 
 phate of lime cemented by animal matter, are not uncommonly found 
 in pancreatic duct or its branches : of a white color, varying from size 
 of a pea to that of a walnut, and existing singly or to the number of flf- 
 teen or twenty. 
 
 Symptoms. Most jiancreatic disorders attended by enlargement and 
 tenderness of gland. Epigastric tenderness ; fulness or hardness ; sense 
 of heat and constriction. Nausea and vomiting; salivation ; loss of ap- 
 petite; inodorous eructations. Fatty stools. Mental depression. De- 
 bility, with emaciation. If common choledic duct be pressed upon by 
 pancreatic tumor, or if it be involved in structural disease of gland, 
 there will be persistent jaundice. 
 
 Treatment. Alleviation of prominent symptoms. Pancreatic emul- 
 sion. In obstinate sicknesitf, — nutrient enemata. Ice. Seton in abdomi- 
 nal wall over seat of gland. Eepeated small blisters. 
 
 PARALYSIS. — From flapakuo), to relax — to aff'ect with paralysis. 
 Synou. Paresis; Palsy. — A total or partial loss of sensibilit}^ or motion, 
 or of both, in one or more parts of body. Two great classes of par- 
 alytic aff'ections : (1) Perfect paralysis, in which both motion and sensi- 
 bility are affected. (2) Imperfect, in which onlj" one or the other is lost 
 or diminished. Divided into acinesia ('J, priv. ; xv^-qa'.:;, motion), paralysis 
 of motion ; and ancesthesia CA, priv.; alaOdvoixm, to feel), paralysis of sen- 
 sibility. — Again, palsy may be general, when it affects whole body; 
 or partial when confined to one portion, — hemiplegia or paraplegia. 
 Term local palsy used, when only a small portion of body is affected; 
 as face, a limb, one foot. In reflex paralysis (Keflecto, to turn back) the 
 irritation extends from perij^hery to centre : diseases of urinary organs, 
 
 13
 
 194 PARALYSIS. 
 
 uterus, and intestines most common causes of this foi-m. A peculiar dis- 
 ease known as wasting palsy, prominent symptom of which is a degenera- 
 tion and wasting of the muscles. 
 
 Palsy may he due to disease of brain arising from apoplexy', abscess, 
 softening, induration, tubercular or cancerous tumors, renal disease, 
 epilepsy, chorea, or poison of syphilis; to disease of spinal cord, as in- 
 flammation, atrophy, solution of continuity, &c. ; to diseases of invest- 
 ing parts of brain or cord, acting by pressure ; to lesion or compres- 
 sion of a nerve, by which its conducting power is impaired; to some 
 affection of the muscle itself, as is possibly seen in wasting palsy; to 
 hysteria, or to rheumatism; and to influence of such poisons as lead, 
 mercuiy, &c. 
 
 1. General Paralysis. — Complete loss of sensation and motion of whole 
 system cannot take place without immediate death. Term "general 
 paral3'si8" usually applied to palsy affecting the four extremities, whe- 
 ther any other parts of body are affected or not. Must not be con- 
 founded with progressive paralysis of insane: see Insanity. 
 
 A case has been related in which power of motion in every part of 
 body was lost, save in muscular apparatus of tongue, and of organs of 
 deglutition and respiration. Sensibility also wholly destroyed except 
 in a small patch on right cheek, by tracing letters on which the patient 
 could be communicated with (Defei*mon). 
 
 2. Hemiplegia. — From "///^j^y?, half ; 7:).rjaff(o. to strike. Synon. Hemi- 
 plegia. — Paralysis of one side, almost invariably involving both upper 
 and lower extremity. Most common form of palsy. Usually spoken 
 of as ''a paralytic stroke." Left more frequently affected than right 
 side. If onl}- one extremity suffer, it is generally the arm. Yery rarely, 
 upper limb of one side and lower of opposite are paralyzed, — transverse 
 or crossed palsy. 
 
 Symptoms. Facial nerve or poi'tio dura of seventh pair seldom in- 
 volved. Fifth nerve aftected ; so that palsied cheek drops loosely, 
 while mouth is drawn upwards to sound side by non-counteraction of 
 paralyzed muscles. Tongue implicated ; when protruded, point turned 
 to diseased side, owing to vigorous action of healthy muscles pushing 
 sound half further out than the other. Articulation imperfect owing 
 to palsy of ninth and fifth nerves. If third nerve be involved, — drop- 
 ping of upper eyelid, dilated pupil, divergent squint. — Often anesthesia. 
 Mental faculties frequently damaged. Tendenc}' to shed tears. For- 
 getfulness and misi)lacement of words. In red softening of bi"ain, 
 muscles of one of atfected limbs often rigid and contracted. — In hope- 
 less cases, limbs waste: muscles atrophy, owing to diminution of nu- 
 trition. Prognosis unfavorable if there be flexion of fingers into palms 
 of hands. In favorable instances, symptoms of amendment first observed 
 in leg. Where the arm regains power before the leg, prognosis un- 
 favorable. 
 
 Treatment. Depletion injurious. Cathartics sometimes useful at 
 first: Scammony and jalap; calomel; crotonoil; stimulating purgative 
 enemata. Efficacy doubtful of blisters to scalp or nucha, or of setons. 
 
 When muscles of palsied limb are perfectly flaccid, the lesion is prob- 
 abl}" owing to white softening from defective nutrition. Hence, wine 
 and nourishment to be given; cod-liver oil; ammonia and bark; am- 
 moniocitrate of iron ; h3'pophospiiite of soda or lime. — When muscles are 
 contracted or resist movement, the lesion of an irritative kind ; perhaps 
 an ajjoplectic clot which has lacerated nerve fibres. In such, mild pur- 
 gatives; blisters; sulphur baths; iodide of potassium. — In reflex hemi- 
 plegia, removal of the cause.
 
 PARALYSIS. 195 
 
 In chronic forms: Small doses of strycliniji, wlici'c there is no active 
 disease of brain. Mild foi'riiginous tonics : phosjiliate of ii'on ; aninionio- 
 citrate of ii'on. Cod-liver oil. Animal food; milk. Frictions of limbs 
 and spine with flesh-brush; liniments of turpentine, cantharides, am- 
 monia, kv. P^lectricity and galvanism, when paralysis remains without 
 muscular rigidity. 
 
 3. Paraplegia. — From Haf^a-Xri^ia, partial paralysis, — TzapaTzXTjatrto, to 
 strike badly. S^^non. Rachioplegia ; Myelopnralyais ; Paralysis Spinalis. 
 — Palsy of the lower half of body. Two varieties: (1) that due to dis- 
 ease of spinal cord or membranes. (2) Reflex paraplegia, that caused 
 by excitation which has reached the cord from a sensitive nerve. There 
 is probabl}" an insufficient amount of blood in cord. 
 
 Symptoms. Begin slowly and insidiously. Weakness and numbness 
 and tingling of feet and legs. AYeakness increases, until there is com- 
 plete loss of sensibility and motion in lower extremities. Paralj'sis of 
 bladder and sphincter ani. Decomposition of urine in bladder. Invol- 
 untary movements and spasms of legs often very distressing. Reflex 
 movements excited more easily in paraplegia than in hemiplegia. 
 Marked deterioration of general health. 
 
 Treatment. An important distinction to be drawn between cases 
 where there is congestion or inflammation of spinal cord or membranes, 
 and the opposite condition. 
 
 (1) Where amount of blood is increased, as in chronic local myelitis, 
 there ai'e symptoms of irritation of motor nerve-fibres, — as convulsions, 
 cramps, twitchings, priapism; with indications of irritation of sensitive 
 nerve-fibres, — as itcliing, pricking pains, abnormal sensations of cold or 
 heat, &c. ; and also signals of irritation of vaso-motor or nutritive nerve- 
 fibres, as wasting of muscles, bed-sores, alkaline urine, &c. Pain corres- 
 ponding to upper limit of inflammation. Tenderness on pressure. Ap- 
 plication of a hot sponge causes sense of heat in all parts above inflam- 
 mation, with burning sensation at upper limit. Application of a piece 
 of ice over vertebrae gives rise to sense of cold everywhere except at 
 level of inflammation, w^here feeling of heat is experienced. In treating 
 these cases, quantity of blood sent to cord is to be diminished. Ergot 
 of rye, in five or six grain doses, twice daily. Belladonna. Belladonna 
 plaster over spine. Iodide of potassium, in conjunction with belladonna. 
 Cod-liver oil. Henbane, conium, or Indian hemp to relieve restlessness. 
 Avoidance of opium, as it causes congestion of cord. Nutritious diet: 
 wine or beer, milk. Nutrition of limbs to be maintained by shampooing, 
 stimulating liniments: at a subsequent period by very gentle galvanic 
 current. 
 
 (2) In paraplegia due to diminished nutrition of cord, as that caused 
 by white softening and reflex palsy, food and remedies needed to im- 
 prove quality of blood, and cause an increased quantity to be sent to 
 cord. Strychnia, gr. ^'^ dail}^. Opium. Quinine and iron. Nitrate of 
 silver and hypophosphite of soda, 419, deserving of trial. Cod-liver oil. 
 Sulphur baths. Very nourishing food. Patient to lie on his back, with 
 head and shoulders and lower extremities raised, so that blood may 
 gravitate to coi'd. 
 
 A controlling power can be exercised by means of heat and cold ap- 
 plied to different parts of back, over the circulation in brain and spinal 
 cord and ganglia of symj^athetic, and through agency of these nervous 
 centres in every other organ. In this way, reflex excitability, or excito- 
 motor power of cord, and contractile force of arteries in all parts of body 
 can be modified. To lessen the excito-motor power, ice is apjjlied in an 
 India-rubber bag about two inches wide, over that part of spine on
 
 196 PARALYSIS. 
 
 which it is wished to act. On same principle, vitality of cord increased 
 by using hot water and ice alternately, each in an India-rubber bag if 
 energetic action be requii-ed : w^here less vigorous efforts are called for, 
 ice or iced water only emplo^'ed, resorting to application several times 
 a day, for a short time on each occasion, with long intervals between 
 (John Chapman). 
 
 In reflex paralysis, while relieving loss of power on preceding prin- 
 ciples, the external cause must be removed. Thus, the practitioner 
 should expel intestinal worms; laiice gums; relieve irritability of uri- 
 nary and sexual systems; cure skin diseases, &c. 
 
 4. Local Paralysis. — Many varieties of local palsy. Only necessary to 
 mention one,— Paralysis of face. Eesults from pressure on, or injury to, 
 portio dura or facial portion of seventh pair of nerves ; a nerve rarely 
 affected by disease of brain. Exposure to cold, and debility, most fre- 
 quent causes of facial palsy. May also be due to irritation of decaj-ed 
 teeth. In children, otitis leading to caries of peti-ous portion of tem- 
 poral bone may produce the disease. It will last from a few days to 
 several weeks. Usually free from danger. 
 
 Symptoms. Appearance remarkable, as only one-half of face is usu- 
 ally palsied. Features on affected side blank, unmeaning, void of all 
 expression. Orbicularis palpebrarum muscle powerless, so that eyelids 
 cannot be closed. Inabilit}' to frown or blow; nostril does not dilate; 
 cheek hangs loose; angle of mouth droops. — Fifth i)air of nerves unaf- 
 fected; so that muscles of mastication act properly. No loss of sensi- 
 bility. — In facial parah^sis due to cerebral hemorrhage the symptoms 
 are less marked, though of same character as foregoing. 
 
 Paralysis of portio dura on both sides, a rare affection. When it 
 occurs there is no distortion of features owing to symmetrical nature of 
 disease. On close examination, however, nostrils are found motionless; 
 cheeks fiat and relaxed; inability to close eyes completely; defective 
 articulation with regard to sounds formed by lips, but unimpaired lingual 
 articulation. 
 
 Treatment. Mild antacid aperients. Iodide of potassium. Bi-omide 
 of potassium. Nourishing food. Warm bathing. Friction with sham- 
 pooing. Galvanism. 
 
 5. Progressive Locomotor Ataxy. — From 'A, neg.; rdffaw, to put in 
 order. Syuon. Tdhes Dorsal is ; Wasting of posterior columns of Spinal 
 Cord. — A peculiar form of paraplegia produced by sexual excesses, ex- 
 posure to cold and damp, rheumatism, gout, &c. Most common in males 
 about middle period of life. In well-marked cases it has been shown 
 that atroplij^ and disintegration of nerve-fibres of posterior columns of 
 spinal cord has taken place, with formation of amyloid corpuscles and 
 hypertrophy of connective tissue. Lesions not always confined to pos- 
 terior columns of cord. Often also a certain gray degeneration of cere- 
 bral nerves, of spinal nerves, and various lesions of gray substance of 
 cord (Lockhart Clarke). 
 
 Symptoms. The pathognomonic symptom is a diminution or total 
 absence of power of co-ordinating movements; so that patient has dif- 
 ficulty in walking, loses his balance, and has an uncertain and tottering 
 gait. Distinct fi-om ordinary paraplegia, in which there is impairment 
 or loss of voluntary motion. 
 
 Intellect and memory unaffected. Occasionally more or less paralysis 
 of second, third, fifth, sixth, seventh, and some poi-tions of eighth cere- 
 bral nerves. T^arely deafness: difficulty in swallowing: strabismus: 
 double vision. A sensation as of strings tied round abdomen now and 
 then com])lainL'd of. Jrlheumatic pains: sharp pains over limited spots.
 
 PARALYSIS. 197 
 
 No tenderness on examination of spine. "Pins and needles," with 
 numbness in lower extremities; a feeling of insecurity in walking, so 
 that the legs have to be watched to prevent staggering, while they are 
 thrown forwards spasmodically and tlien planted forcibly on the ground. 
 Ultimately, loss of sensation in lower limbs; complete amaurosis; in- 
 creasing weakness, so that patient cannot leave his bed. Progress of 
 disease slow : perfect recovery very rare. Occasionally death occurs 
 from intercurrent affections, as bronchitis, pneumonia, erysipelas, &c. 
 
 Treatment. A nourishing diet: animal food; raw eggs; rum and 
 milk ; milk cocoa in place of tea and cottee. Nitrate of silver, 59. Phos- 
 phate of iron, 405. Iodide of iron, 32, 390. Quinine and iron, 380. 
 Bark and phosphoric acid. 376. Aloes and pepsine, 155. Aloes and 
 reduced iron, 404. Ilypophosphite of soda or lime, 419. Belladonna. 
 Indian hemp. Cod-liver oil. Sulphur baths, 125. Continuous galvanic 
 current to lower part of spine. Mineral waters, in early stage, of Ba- 
 reges, 470; of Marienbad, 497; of Wiesbaden, 489. 
 
 JRemedies often recommended : Iodide of potassium. Ergot of rye. Ar- 
 senic. Bromide of potassium. Nux vomica and strychnia. Opium. 
 Turpentine. Faradization. Actual cautery, moxa, blisters, and leeches 
 to spine. 
 
 6. Hysterical and Rheumatic Paralysis. — In hysterical palsy there is 
 neither disease of nervous centres nor of motor nerves. Occurs in hys- 
 terical women: produced by fright, over-excitement, ovarian irritation, 
 &c. Muscles of lower extremities may be affected (hysterical para- 
 plegia); or muscles of arm and leg on same side (hysterical hemiplegia) ; 
 or only one or two particular muscles. Generall}", other symptoms of 
 hysteria present. May be cured by remedies which improve general 
 health. Ferruginous tonics. Antispasmodics. Galvanism. 
 
 In rheumatic palsy muscles of lower extremities often attacked : or 
 extensor muscles of forearm, or deltoid and trapezius rendering it diffi- 
 cult to raise arm. May come on suddenly or gradually. To be cured 
 b}' galvanism, shampooing, iodide of j)otassium, cod-liver oil. 
 
 7. Progressive Muscular Atrophy. — From M, priv. ; rpi^w, to noui-ish. 
 Synon. Wasting Palsy ; Creeping Palsy ; Idiopathic Degeneration of Vol- 
 untary Muscles; Atrophie Musculaire avec Transformation Graisseuse. — 
 Paralj'sis from a granular and fatty degeneration of muscular fibre, 
 owing to some error of nutrition. Patches of granular degeneration 
 have sometimes been found in those parts of gra}' substance of spinal 
 cord whence nerves pass off to affected muscles. Also, amyloid cor- 
 puscles round central canal of cord. Nerve-cells shrunken and atro- 
 phied. Difficult to say whether spinal cord lesion is primary or sec- 
 ondarj'. The former is rendered more probable than was formerly 
 believed, by researches of Lockhart Clarke. 
 
 Symptoms. The pathognomonic feature is a degeneration, and con- 
 sequent loss of volume and power, of voluntary muscles; without dimi- 
 nution of intelligence or sensibility. May affect upper or lower limbs, 
 or voluntary muscles of whole bod}''. 
 
 Fibrillary tremors or convulsive quiverings of some of the fasciculi 
 which form the muscle; produced by irritation of skin; patient uncon- 
 scious of their occurrence. Unwonted lassitude of limbs, slowlj' ]')ro- 
 gressing to marked weakness. A withered look, owing to muscular 
 wasting. Occasionally, neuralgic or rheumatic pains. Great sensitive- 
 ness to cold. Intellectual powers undisturbed. General health moder- 
 ately good. — As disease progresses, total deprivation of motion in 
 affected limbs. Patient often has to be fed and carried about like a 
 child. Power of deglutition, and articulation may be lost. Fatal as-
 
 198 PARALYSIS. 
 
 phyxia a common termination, — for, as a consequence of catarrh, bron- 
 chitis, &c., mucus accumulates in air-tubes: owing to diaphragm and 
 intercostal muscles being involved, no etforts at expectoration can be 
 made. Occasionally, apncea from paralysis of respiratory muscles. 
 
 Duration of disease varies from a few months to some years. Com- 
 plete recovery rare : progress of disease sometimes suspended, especially 
 when muscles of trunk are not involved. General muscular atrophy 
 spares neither children, adults, nor aged people : partial form most com- 
 mon between thirtieth and fiftieth 3'ear. Males suffer more than fe- 
 males. Exposure to wet and cold, or hard work, often assigned as 
 causes. May follow fever, sun-stroke, falls and blows, &c. It is hered- 
 itary. 
 
 Treatment. Attention to digestive organs. Hypophosphite of soda 
 or lime, 419. Nitrate of silvei-, 59. Frictions of affected muscles. Sul- 
 phur baths, 125. Galvanism to wasting muscles. Localized Faradiza- 
 tion (electricity of induced or secondary current in helix round magnet, 
 discovered b}' Faraday); not giving more than one or two minutes to 
 each muscle, lest it get fatigued, and not prolonging each sitting for 
 more than ten or fifteen minutes. 
 
 Bemedies ichicli have generally failed: Strychnia and nux vomica. 
 Mercury. Iodide of yjotassium. Tonics. Cod-liver oil. Setons, issues, 
 or blisters over vertebral column. Cold baths during active stage. 
 
 8. Mercurial Palsy. — Synon. Mercurial Tremor. — A convulsive agita- 
 tion of voluntary muscles, increased when volition is bi-ought to bear 
 upon them. In advanced stages, articulation and mastication and loco- 
 motion performed with difficulty. Sometimes delirium, or even acute 
 mania. Use of hands almost entirely lost. Epilepsy. Great weakness. 
 Eestlessness at nights. Skin acquires a dirty brown hue. Soreness of 
 gums. Teeth turn black, decay. — The sufferers are workmen exposed 
 to fumes of mercur}-. — gilders of buttons, glass-platers, barometer 
 makers, &c. Chemists working with mercuric methide ought to take 
 special precautions to avoid the deadly influence of this very poisonous 
 compound. 
 
 Treatment. Withdrawal entirely from injurious atmosphere. Iodide 
 of potassium, 31. Nourishing food. Cod-liver oil. Warm baths. Sul- 
 phur baths, 125. Galvanism. Sea air. 
 
 9. Lead Palsy. — Synon. Paralysis katurnina ; Metallic Palsy ; Painter's 
 Palsy. — Often follows or accompanies lead colic, though it may exist in- 
 dependently. Operatives in lead-works and mines suft'er much from 
 saturnine emanations. Work-rooms where manufacture of white lead 
 is completed have their atmosphere loaded with minute particles of lead 
 compounds; so that workers in them get "leaded," — become victims of 
 paralysis, colic, gout, sleeplessness, neuralgia, spasms of respiratory 
 muscles, debility and pallor and emaciation, &c. Plumbers, painters, 
 color-grinders, type-founders, &c., also suffer much. 
 
 Symptoms. Poison of lead exerts a peculiar noxious influence over 
 nerves of forearm and hand ; in consequence of which, extensor mus- 
 cles of hands and fingers get paralyzed, and hands hang down by their 
 own weight when arms are stretched out, — the wrists drop. Inferior 
 extremities rarely aftected. Frequent attacks of lead colic. Saturnine 
 taste and odor in breath. Formation of a blue or i)urplish line round 
 edges of gums, just where they join the teeth, a charaeteritstic feature. — 
 Death may occur when system has long been exposed to influence of 
 lead; especially if health be also injured by intemperance, or by fre- 
 quent attacks of gout. 
 
 Treatment. Curative: Iodide of potassium, 81. Galvanism. Sul-
 
 PARAPHIMOSIS PELLAGRA. 199 
 
 phur baths, 125. — Prophylactic: All workers in lead should drink sul- 
 phuric acid lemonade daily. To avoid intoxicating drinks. Functions 
 of skin to ho promoted by cleanliness. 
 
 10. Paralysis Agitans. — Synon. Paralysis Tremula; Tremor; Shaking 
 Palsy. — Characterized by an involuntar}- tT'cmulous aji^itation of mus- 
 cles; commencing in hands and arms, or in head, and gradually extend- 
 ing over whole body. Diminished muscular power. A propensity to 
 bend the trunk forwards, and to pass from a walking to a gentle run- 
 ning pace. Senses and intellect uninjured. Disease progresses slowly. 
 When far advanced, agitation may be so violent as to prevent sleep. 
 Deglutition and mastication performed with difficulty. Inclination of 
 body forwards, with bending of chin or sternum. Involuntar}- escape 
 of fffices and urine. Slight delirium and fatal coma. 
 
 Treatment. Few remedies of much use. The effects may be tried 
 of pure air, nourishing food, baths, ferruginous tonics, cod-liver oil, and 
 occasional opiates. Benefit may perhaps be obtained from employment 
 of continuous galvanic current, such as can be derived from a Pulver- 
 macher's chain-battery of 120 links. 
 
 PARAPHIMOSIS.— From Ilapa, beyond; fi/idoj, to bind tight. Synon. 
 Phi/iwsis Circitmligata. — That condition in which a tight prepuce having 
 been drawn back over the glans penis, the latter becomes constricted 
 and swollen, so that the prepuce cannot be replaced. 
 
 Symptoms. Gx-eat swelling of areolar tissue behind constriction. 
 Mucous membrane of withdrawn prepuce forms a thick and brawny 
 girdle. Congestion of glans penis. Pain, inflammation, anxiety, &c. 
 
 Treatment. Reduction : Parts to be well oiled : glans to be com- 
 pressed and gentl}^ pushed backwards with right hand, while the pre- 
 puce is di-awn steadily forwards with the left. Compression of glans 
 sometimes effected by encircling it with a narrow strip of adhesive 
 plaster; or by a loop of tape; or by spoon-bladed forceps. Application 
 of ice, or stream of cold water, before trj-ing reduction, sometimes 
 useful. All fiiiling, a notch or slight division of tight preputial collar 
 with probe-pointed bistoury. 
 
 Permanent Cure : To prevent a recurrence, circumcision may be ad- 
 vantageously practised. — See Phimosis. 
 
 PARAPLEGIA. — From Uapardrj^ia, partial paralysis; Tapar.lri<T(7w, to 
 strike badl}'. Synon. Bachiojxiralysis ; Myeloparalysis ; Paralysis Spi- 
 nalls. — Paralysis confined to inferior half of body. — See Paralysis. 
 
 PARASITIC ANIMALS AND PLANTS.— From Ilapamrico, to flatter 
 another and live at his expense. — See Eatozoa ; JEpizoa ; Epiphytes. 
 
 PAROTITIS. — From //«/>«, near; ouc, the ear; terminal -/f/s. Synon. 
 Cynanche Parotidea ; Mumps. — A specific and contagious inflammation 
 of salivary glands, and of parotid gland especially. 
 
 Symptoms. Chilliness. Slight fever. Pains in limbs. Tumefaction 
 and soreness in one or both parotid regions. Disease reaches its height 
 in four days; then declines. Yery rarely runs on to suppuration. Oc- 
 casionally, during or after decline, testicles or mammas become painful 
 and swollen. 
 
 Treatment. Mild diet. Cold acidulated drinks. Ice. Gentle laxa- 
 tives. Solution of acetate of ammonia, 349. Carbonate of ammonia. 
 361. Hot fomentations. Linseed poultices. 
 
 PELLAGRA. — From Pellis^ skin ; wyreo, to be sick, — unhealthy skin.
 
 200 PELVIC CELLULITIS. 
 
 Synon. Mania Pellagria ; Mai de Sole; Elephantiasis Italica; Scurvy of the 
 Alps. — A severe constitutional or blood disease attended with an altered 
 state of skin. The eruption merely symptomatic of the vitiated state 
 of system. — Cause not clearly made out. Mostly ascribed to peasants 
 living chiefly on maize, — nine-tenths of their food consisting of this 
 substance made into polenta with coarse bread, &c. Objections to this 
 theory : In Naples, Sardinia, some parts of Switzerland, &c., where 
 maize is extensively used, pellagra is unknown or is very rare. Landouzy 
 found thirteen individuals aff"ected with pellagra in a small town of 
 Aragon, where no maize is eaten. Probably disease due to insufficient 
 nourishment, and the use of dry farinaceous food without sufficient 
 fatty matter. 
 
 Usually ends in mania, imbecility, and slow death. Softening of pe- 
 ripher}" of brain has been often met with in autopsies : softening of part 
 of spinal cord almost always. — A common disease in Lombardo-Venetian 
 country. In 1831, official returns showed that amongst the Milanese 
 alone 20,000 individuals were suffering from pellagra. Women more 
 liable than men. 
 
 Symptoms. The pellagrosi the most afflicted of individuals. Disease 
 begins insidiously at commencement of warm spring weather, with a 
 shining red spot suddenly arising on back of hand or some part of body. 
 This spot elevates skin, and produces numerous small tubercles. Epi- 
 dermis dries and cracks, f{\lls off; but shining redness underneath con- 
 tinues. At end of summer, ei'uption generally disappears; suspended 
 till following spring, when it reajipears. This first stage may go on 
 thus for seven or eight years. — The second stage is characterized by the 
 disease setting in with greater constitutional disturbance, general de- 
 bility, disturbance of nervous system (despondenc}', cramp, spasm). 
 Convulsions severe : when paroxysm ends, patient becomes a pre}' to 
 melancholy of a religious character with suicidal tendency. At end of 
 autumn there is a remission, but less marked than before. The next 
 year, symptoms greatly aggravated. Skin all over bod}', gets dry, 
 rough, and shrivelled: great debility; diarrhoea: breath and sweat 
 most offensive: great flow of saliva. Pain in head, vertigo, delirium; 
 dyspnoea; cramps; bilious vomiting; low fever; dropsy; epilepsy; 
 and, surviving these, mania, or fatuity. Disease may not prove fatal 
 for five, ten, or even fifteen years. Its popular name — mallattia di 
 miseria — sufficient!}^ justified. 
 
 Treatment. In early stage: Removal to healthy locality. Good 
 nourishing food, with milk, fatty matters, &c. — When fairly established : 
 All treatment useless, beyond attempts at relieving the most prominent 
 symptoms. 
 
 PELVIC CELLULITIS.— From Pelvis {T1e)Mz or nw.a), a bowl: Cellnla 
 (dimin. of cella), a little cell ; terminal -itis. — Inflammation of the cellular 
 or areolar tissue of pelvis. — Occurs mostly in connection with abortion, 
 or lingering labor at full term. Also as a consequence of external vio- 
 lence, uterine disease, or some strumous state of constitution. 
 
 Sy.mptoms. May come on insidiously. More commonly, — Constitu- 
 tional disturbance. Fever, headache, restlessness. Local pain and 
 throbbing and tenderness. Aching pains in limbs. Difficult micturi- 
 tion. Tenesmus. Nausea and vomiting. Painful swelling, somewhat 
 appreciable at lower part of abdomen: always detected by vaginal ex- 
 amination. 
 
 If morbid action go on to suppuration — Increased severity of general 
 symptoms. Eigors. Severe throbbing and tenderness. Neuralgic 
 pains down thighs. Fluctuation. Pus may be discharged into upper
 
 PELVIC IL'EMATOCELE — PENIS CANCER. 201 
 
 part of vagina or bladder, or colon, or rectum : rarel}^ into peritoneum, 
 causing severe peritonitis: or it will burrow and make its escape exter- 
 nally. Troublesome sinuses sometimes produced. Pus formed again 
 and again for months. 
 
 Treatment. Castor oil, ]G4. Ehubarb and magnesia, 1G5. Citrate 
 of ammonia or potash, 362. Morphia, chloroform, and Indian hemp, 317. 
 0])iate enemata, 339. Opium and belladonna suppositories, 340. Mercu- 
 ruil and belladonna pessaries, 423. Ammonia and bark, 371. Quinine 
 and mineral acids, 379. Hot hip baths. Fomentations. Linseed poul- 
 tices. Hot water vaginal injections. Milk, raw eggs, beef tea, arrow- 
 root, tea: animal food as soon as it can be digested. Wenliam Lake 
 ice. Sinapisms to epigastrium, if there be sickness. Abscess may 
 sometimes be opened with advantage. 
 
 PELVIC HEMATOCELE. — From Pelvis, a basin; Alfm, blood ; zij'Atj, a 
 swelling. Synon. Retro-uterine Hcematocele ; Peri-uterine Hcematocele. — 
 An effusion of blood into peritoneal ])ouch between uterus and rectum, or 
 into subperitoneal tissue behind and around the uterus. 
 
 Symptoms. Vary according to amount of loss. If excessive, — Nerv- 
 ous shock. Exhaustion from internal hemorrhage. Acute pain in 
 lower part of abdomen. Chilliness qr shivering; coldness of extremi- 
 ties. Vomiting. Increased feebleness of circulation. Ghastly expres- 
 sion of countenance. Death may occur in a few hours. 
 
 Where loss is great but not excessive, — Violent abdominal pain. 
 Sickness. Chilliness, followed by fever. Anxietj" of countenance : 
 pinching and pallor of face. Difficult micturition, with frequent desire 
 to empty bladder. Irritability of rectum. Perhaps, sudden cessation of 
 catamenia if flow be on at the time. Pelvic tumor : appreciable through 
 abdominal and vaginal walls. 
 
 In a third class of cases, symptoms of same character but less acute 
 than foregoing. Pelvic tumor : only appreciable by vaginal examina- 
 tion. F'ear of peritonitis : of hemorrhage returning after an interval. 
 Absorption may be hoped for. 
 
 Treatment. In acute cases : Brandy. Wine. Opium in large doses. 
 Sinapisms to extremities. Bladders of ice to lower part of abdomen and 
 vulva. 
 
 Where loss is moderate: Perfect repose in recumbent posture. Opium 
 in sufficient doses to relieve pain and prevent faintness. Gallic and 
 aromatic sulphuric acids, 103. Alum and sulphuric acid, 115. Ice. Sin- 
 apisms to epigastrium. Cold applications to vulva. Catheterism. Punc- 
 ture of prominent part of tumor with trocar? Rest and care at two or 
 three succeeding catamenial periods. 
 
 PEMPHIGUS.— From /7.V.^;|, a bubble or blister. Synon. Febris Bul- 
 losa; Bladdery Fever ; Weiterblehs. — A non contagious skin disease. Char- 
 acterized by large round or oval vesicles, or bullae (Bulla, a bubble of 
 water), two or three inches in diameter, which appear on one or more 
 regions. Each bleb filled with alkaline serum; which soon loses its 
 transparency, becoming acid and puriform. Slight fever, &c. 
 
 Pompholyx (/7o//^oq a blister) is merely a variety of pemphigus. 
 
 Treatment. Ammonia and bark, 371. Nitro-hydrochloric acid, 378. 
 Quinine and steel, 380. Cod-liver oil. Effervescing citrate of magnesia, 
 IGC. Arsenic, quinine, and steel, 381. Chlorate of potash. Iodide of 
 potassium. Vesicle to be punetui-ed : cuticle not to be removed. 
 
 PENIS CANCER. — Carcinonia of the male organ is generally of the 
 epithelial kind. Commences as a warty or cauliflower-looking growth
 
 202 PERFORATION OF STOMACH PERICARDITIS. 
 
 on inner surface of prepuce : followed by unhealth}^ and very destructive 
 ulceration. Lymphatics on dorsum of penis, and the glands in the 
 groin gradually get involved. Sanious discharges. Retention of urine. 
 Cancerous cachexia. Painful death. — The disease may result from irri- 
 tation of retained secretions of corona glandis in phimosis, where there 
 is predisposition to cancer. — Early and complete amputation offers the 
 only hope of cure. The author has had a case under treatment, where 
 the penis was amputated for relief of disease of a "cancerous nature" 
 by ]\Ir. Clement of Shrewsbury in the year 1847; the patient having 
 died (June, 18G6), from cancer of the face and left tonsil, after enjoying 
 good health for nearly seventeen years. 
 
 PERFORATION OF STOMACH.— In cancerous as well as in simple 
 ulceration of stomach perforation may occur, with escape of contents 
 into peritoneum. Where this viscus has contracted adhesions, a com- 
 munication may fortunately only form between stomach and outside of 
 abdomen ; or between stomach and colon or duodenum ; or even between 
 stomach and pleural cavities, lungs, or pericardium. — See Gastric Ulcer; 
 Gastric Cancer; Gastro- Cutaneous Fistula; Gastro- Colic Fistula. 
 
 PERICARDITIS.— From rhfu, about; xap>Jia, the heart; terminal -itis. 
 Synon. Exocarditis ; Inflammation of the Pericardium. — Inflammation of 
 the external fibro-serous covering of heart. May be regarded as a local 
 manifestation of constitutional disease. Occurs most frequently in con- 
 nection with acute rheumatism, Bright's disease, ichorha^mia, and scurvy. 
 
 Symptoms. Sometimes so slight that disease is not suspected. When 
 there is only a slight exudation of fibrine, or when effused serum has 
 been rapidly absorbed and adhesions early affected, there may be only 
 a feeling of fever and oppression. If effusion be copious (hydro-peri- 
 cardium) so as to press on heart and embarrass its movements, or when 
 there is coexistent myocarditis, sjnnptoms much more decided. High 
 fever, as ascertained by thermometer; pain in cardiac region, darting 
 through to left scapula, upwards to left clavicle and shoulder, and down 
 arm; tumultuous action of heart ; irregularity of pulse; dyspnoea; in- 
 ability to lie on left side; anxiety of countenance ; noises in ears, giddi- 
 ness, epistaxis, &c. As disease advances, — Extreme debility, cough, 
 suffocative paroxj^sms, tendency to s^-ncope, oedema of face and extremi- 
 ties. Great restlessness, distortion of features, tetanic spasms, delirium. 
 
 Physical signs : (1) Sensations of friction communicated to hand. (2) 
 Friction sounds; an alternate rubbing, or to-and-fro sound. (3) Exten- 
 sion of dulness over heart, owing to serous effusion. (4) Friction-sounds 
 attended with, or preceded by, valvular murmurs. (5) Signs of eccen- 
 tric pressure analogous to those of empyema. (6) Signs of excitement 
 of heart. (7) Signs of weakness or paralysis of heart. 
 
 Treatment. Perfect quiet in bed. Temperature of room 65° to 70° 
 F. Neutral salts, if there be constipation, 141, 144, 150, 152. Opium, 
 in full doses. Opium and belladonna, 344. Bicarbonate of potash (gr. 
 30 every two or three hours). Bicarbonate of potash drink, 355. Cream 
 of tartar drink, 356. Chlorate of i)otash drink, 360. Poppy-head fomen- 
 tations. Large linseed poultices. Belladonna and opium, over cardiac 
 region, 297. Vapor baths. — Light diet, — gruel, arrowroot, milk, mutton 
 broth. As soon as strength fails, — Soup, essence of beef, raw eggs, wine. 
 
 When effusion is abundant: Iodide of potassiuin, 31. Red iodide of 
 mercury, 54. A succession of blisters. As a forlorn hope, tapijing of 
 pericardium. 
 
 Rem^edies sometimes used : Mercuiy. Tartarated antimony. Digitalis. 
 Drastic purgatives. Bleeding. Leeches. Blisters.
 
 PERINEPIIRITIC ABSoEao — PERITONITIS. 203 
 
 PERINEPHRITIC ABSCESS. — From Hep), around; >e<ppd^, the kid- 
 iiov. — Alist'css of the areohir tissue surrouuding the kidney. — See Abscess 
 of Abdominal Walls. 
 
 PERIOSTITIS. — From Pcriostevm (Hep), round about; orrzim, a bone); 
 tei'iniiial -itis. Synon. Iiifiammatio Pen'ostei. — Inflammation of the peri- 
 osteum may result from injury, sj-philitic taint, i-heumatism, abuse of 
 mercury, and from atmospheric exposure acting upon broken-down 
 constitutions. 
 
 Symptoms. Pain, generally aggravated at night; veiy acute if sub- 
 jacent bone be involved. Tenderness. Thickening of inflamed part 
 from deposit of plastic matter, forming a tense elongated swelling, — a 
 7iode. Constitutional disturbance; varying from slight impairment of 
 health to acute inflammatory fever. Eestless nights. Mental depres- 
 sion. Eigors indicate suppuration. 
 
 Treatment. Calomel and opium. Corrosive sublimate. Eed iodide 
 of mercury. Iodide of potassium, 31. Syrup of iodide of iron. Mor- 
 phia and Indian hemp, 317. Cod-liver oil. — Locally : Leeches, rest, and 
 hot fomentations (in acute cases). Iodine liniment. Blisters. Friction 
 with equal parts of belladonna and mercurj'^ liniments. Subcutaneous 
 incisions through the membrane down to the bone, to relieve periosteal 
 tension when excessive, or to prevent sujipuration when imminent. 
 Early incision, through skin and periosteum, when there is pus beneath 
 the membrane. 
 
 PERITONITIS. — From Uspirsi'Mo, to stretch all over; terminal -itis. 
 Synon. Injlammailo Peritonei. — Inflammation of the serous membrane 
 lining abdominal and pelvic cavities, and investing the viscera. May 
 be acute or chronic : 
 
 1. Acute Peritonitis. — Acute inflammation of peritoneum a serious dis- 
 ease. Accompanied with pain and SM^elling of abdomen, and severe 
 symptomatic fever. 
 
 Symptoms. Pain, gradually extending over whole abdomen. Some- 
 times, chilliness and rigors. High fever. Exquisite tenderness of ab- 
 domen ; increased by slightest pressure, and by an}' movement calling 
 abdominal muscles into action. Patient lies on the back, with knees 
 bent and legs drawn up. Abdomen tense, hot, and often tympanitic. 
 Constipation; nausea and vomiting; dry bui*ning skin; rapid feeble 
 pulse ; hurried respirations ; often, hiccough ; and tongue thickly furred. 
 Countenance expressive of anxiety and suffering. After a time, belly 
 ceases to be tympanitic but remains enlarged from cftusion of serum. 
 When disease is about to end fatally, abdomen usually gets much dis- 
 tended ; pulse thread}^ and very quick ; face assumes a ghastly expres- 
 sion ; cold clammy sweats ; and death takes place from exhaustion 
 within eight or ten days of onset. 
 
 Treatment. Opium, 344. Opiate suppositories, 340. Opium and 
 aconite, 332. Opium and belladonna, 344. Poppy-head fomentations. 
 Belladonna and opium, with fomentation flannels. Hemlock poultice. 
 Linseed poultice. Turpentine stupes. Leeches. Enemata of warm 
 soapy water, if there be fecal accumulation in colon or rectum. 
 
 Diet: At Jfirst to be restricted to milk and water, tea, arrowroot, beef 
 tea, ice, iced water, barley-water. Lime-water and milk, 14. When 
 exhaustion sets in, brandy; aron*iatic spirits of ammonia; spirit of 
 ether; brandy and egg mixture, 17. Essence of beef, 3. — Most perfect 
 quiet. Air of sick-room to be warm but pure. A cradle over abdomen 
 to support bed-clothes. Good nursing.
 
 204 PERITYPHLITIS PHIMOSIS. 
 
 Remedies sometimes employed: Bloodletting. Blisters. Calomel and 
 opium. Tartarated antimony. Tobacco enemata. American hellebore. 
 Antiphlogistic regimen. 
 
 2. Chronic Peritonitis. — Sometimes the sequel of an acute attack : 
 more frequently an independent affection. May be due to presence of 
 tubercles on peritoneum, — Tubercular peritonitis. 
 
 Symptoms. Somewhat obscure. Abdominal pain slight. Attacks of 
 colic : perhaps fever with obstinate diarrhoea. Tenderness and swelling 
 of abdomen. Nausea. Anamia and wasting. Abdominal enlargement 
 from effusion. When with tubercular peritonitis there is disease of 
 mesenteric glands, phthisis, &c.; the case rapidly runs on to fatal ter- 
 mination. 
 
 Treatment. Attention to bowels. Mild but nutritious diet : milk or 
 cream; cocoa; raw eggs; solution of raw meat, 2. Cod-liver oil. Iodide 
 of iron. Quinine or bark. Chemical food, 405. Ilypophosphite of lime, 
 or soda, and sumbul, 419. Pepsine, 420. Diluted iodine liniment to 
 abdominal wall. Iodine and cod-liver oil ointment, 308. Iodide of cad- 
 mium ointment, 312. Blisters. Sea air. 
 
 PERITYPHLITIS.— From mp\, around; to^Ao?, blind ; terminal -zYw. 
 Inflammation of the areolar tissue connecting the cacum with the psoas 
 and iliac muscles. 
 
 Symptoms. Severe pains shooting from right iliac region. Diarrhoea 
 and tenesmus. Nausea. Mental depression. Fever. — Parts around 
 seat of inflammation become swollen. Frequently suppuration. When 
 abscess opens into cavity of cajcum, recovery often follows. 
 
 Treatment. See Ccecitis. 
 
 PERTUSSIS. — From Per, very ; fws5;'.s, a cough. Synon. Tussis Con- 
 vulsiva ; Whooping-cough ; Chincough, &c. — See Hooping-cough. 
 
 PHARYNGITIS.— From i>'ipoY^, the gullet; terminal -itis. Synon. 
 Cynanche Pharyngea. — Inflammation of the pharj-nx not as common a 
 disease as might be expected. 
 
 Occasionally, especially in hospitals and workhouses, walls of pharj-nx 
 are affected with diffused erysipelatous inflam7nation. Attended with low 
 difficulty in swallowing, rapidly increasing prostration. Morbid action 
 may run on to sloughing. Death from exhaustion not uncommon. 
 The remedies are, — Ammonia and bark, 371. Chlorate of potash and 
 steel, 402. Quinine, 379. Ether and brandy, 367. Wine or brandy. 
 Haw eggs. Eestorative soup, 2. Thorough ventilation of sick-room. 
 
 Syphilitic ulceration of velum and fauces may, after healing, produce 
 narroM'ing and contraction of upper part of throat so as to impede deg- 
 lutition and obstruct respiration. Incising edges of contracted open- 
 ing sometimes useful. In severe cases, tracheotom}*. The tracheal tube 
 has been worn with comfort for 3'ear8. 
 
 Elongation of uvula may result from chronic inflammation, or from a 
 generally relaxed state of fauces. By irritating pharynx and epiglottis 
 the hypertrophied uvula produces a troublesome tickling cough, with 
 occasional inclination to vomit. Astringent gargles, application of 
 nitrate of silver, nourishing food, and ferruginous tonics failing to cure, 
 two-thirds of the organ had better be snipped off. — See Retro-Pharyngeal 
 Abscess. 
 
 PHIMOSIS. — From ^t/j6a,, to bind tight. Synon. Ligatura Glandis ; 
 Strictura Pra'putii. — A preternatural constriction of the foreskin, pre-
 
 PHLEBITIS — PHLEGMASIA DOLENS. 205 
 
 vcntini!; its being drawn back over the glans penis. May be congenital 
 or acquired. 
 
 Symi'toms. Iu children, a long and contracted foreskin often gives 
 rise to symptoms resembling those of stricture, or of stone in the blad- 
 der. Irritation, from inability to wash away secretions of corona glandis. 
 Ju adult.s, it may result from the inflammation of a gonorrhoea, or of a 
 chancre. Swelling, from inflammation of areolar tissue. Ii-ritation, 
 from accumulation of discharges; which may produce balanitis, and in 
 after life epithelial cancer, — if there be any jiredisposition. 
 
 Treatment. Palliative: Warm bathing. Fomentations and poultices. 
 Tobacco or belladonna lotions. Injection of astringent lotions under 
 prepuce. Stretching with bougies ; with blades of dressing forceps. — 
 Radical cure: Circumcision. Slitting up of prepuce on dorsal aspect as 
 far as the corona; and stitching of edges of mucous lining to skin. 
 Water dressing after either operation. — See Paraphimosis. 
 
 PHLEBITIS. — From (Pklip, ^X£,3o^, a vein; terminal -itis. Synon. In- 
 flanunatio Venarum. — Inflammation of the veins depends upon, or is 
 accompanied by, a morbid state of the blood. The history of phlebitis 
 is that of the coagula (thrombi) formed within the afll'ected veins, and 
 of the metamorphoses through w^iich these coagula ]jass (Virchow). 
 
 Symptoms. Pain, increased on pressure; swelling, stiffness, and red- 
 ness in course of vessel, generally spreading upwards towards heart. 
 When suppuration results, rigors and flying pains in various parts of 
 body. Constitutional disturbance always great. The result of admix- 
 ture of pus or other morbid fluids with blood is to cause the latter to 
 coagulate : in this way a vein sometimes becomes filled with a coagulum ; 
 if morbid matter is of such a nature that it ought to be eliminated, the 
 areolar tissue around inflames, suppuration and abscess follow^ coats of 
 vein ulcerate, and contained clot is discliai'ged by means of the abscess. 
 On the contrary, if poison does not produce coagulation, it mixes with 
 the blood, atfects entire system, and is subsequently deposited in distant 
 parts — lungs, liver, spleen, eye, joints, areolar tissue, &c. 
 
 Treatment. Ammonia and bark, 371. Chlorate of potash, 61. Sul- 
 phite of soda or magnesia, 48. Quinine, 379. Brandy and egg mixture 
 with opium, 318. Opium, or opium and belladonna, 344. Morphia, 
 chloroform, and Indian hemp, 317. Essence of beef, 2. Eggs, cream, 
 and extract of beef, 5. Lime-water and milk, 14. Port wine or brandy. 
 — Perfect repose. Fomentations. Linseed i:)oultices. Hemlock poul- 
 tices. 
 
 PHLEBOLITES.— From ^;iv'', a vein; XiOn^, a stone. Synon. Vein 
 Stones. — Small calculi, from size of millet seeds to that of peas, occa- 
 sionally found in the veins. Frequently, produce no obstruction : they 
 lie in dilatations. Chiefly composed of phosphate of lime, carbonate of 
 lime, and animal matter. Probabl}' formed by calcareous deposits from 
 the blood, having a small clot as a nucleus. 
 
 PHLEGMASIA DOLENS.— From ^Uy<u, to burn : doleo, to be in pain. 
 Synon. Phlegmasia Alba JJolens ; (Edema Lactexun ; Crural Phlebitis ; Ob- 
 structive Phlebitis; White Leg ; Milk Leg; White Swelling of Lying-in 
 Women. — A brawny, non-oedematous, painful swelling of one or both 
 low^er extremities, attended with prostration. Probably depends on 
 spontaneous coagulation of blood within internal or external iliac and 
 femoral veins: coagulation due to some poisonous or acrimonious fluid 
 entering the veins, or merel}' to cachectic state of sj'stem. Most prob- 
 ably, lymphatics also involved: they become obstructed. — Not uncom-
 
 206 PHOTOPHOBIA — PHTHISIS. 
 
 mon after pai'turition, especially in women weakened by flooding, &c. 
 Frequently occui's towards termination of uterine cancer. — Left leg 
 more often attacked than right. 
 
 Symptoms. Commence in from one to five weeks after labor. Fever; 
 headaclie; thirst; nausea; pain. Sometimes, chills, or rigors. Swell- 
 ing and loss of motor power in affected extremity. Limb unnaturally 
 hot; tender; non-ffidematous, but swollen perhaps to twice its natural 
 size; of pale white color, tense and elastic ; having a glazed or shining 
 appearance. — After subsidence of acute symptoms, limb often remains 
 enlarged for many weeks. 
 
 Treatment. Acute stage: Ammonia in effervescence, 362. Carbonate 
 of ammonia, 36L Chlorate of potash, 61. Sulphite of soda or magnesia, 
 48. Hydrochloric acid. Opium. Aconite. Iodide of potassium. Qui- 
 nine. Simple diet. Diluents. — Perfect rest. Fomentations. — Chronic 
 stage: Iodide of iron, 32. Iodide of potassium and bark, 31. Ammonia 
 and bai"k, 371. Phosphate of iron, 405. Nourishing food : milk, wine, 
 and malt liquors. — Bandaging. Friction with stimulating liniments. 
 Cold water douche. Flying blisters. 
 
 Remedies sometimes employed : Venesection. Leeches. Blisters. Evap- 
 orating lotions. Mercurial ointment. Calomel. Blue pill. Digitalis. 
 Creasote. Antiphlogistic regimen. 
 
 PHOTOPHOBIA.— From ^w-^ light; (po6iM, to dread. Synon. PJmiopho- 
 bia ; Aversion to Light. — Intolerance of light is a painful symptom in 
 many diseases of the eye, — e. g., strumous ophthalmia, sclerotitis, &c. It 
 may often be relieved by protecting the eye with a large green shade 
 or veil, or by spectacles with glasses of a neutral tint. By darkening 
 the room, with careful avoidance of subsequent sudden admission of 
 light. Hot fomentations; or the steam of hot water, medicated with 
 extract of belladonna or extract of poppies. Hemlock poultices over 
 eye. Exposure of the eye to the vapor of twenty or thirty drops of 
 chloroform placed in the warm hand. Small blisters behind the ear, or 
 on temple. Painting skin of upper eyelid with tincture of iodine. 
 
 The constitutional remedies will be those required by the disease of 
 which the photophobia is only one of the results. 
 
 PHRENITIS. — From ^piiv, the mind; terminal -itis. Synon. Cepha- 
 litis; Ccrebritis ; Brain Fever. — See Cerebral Inflammation. 
 
 PHTHIRIASIS. — From 0Oslp, a louse. Synon. Morbus Fedicularis; 
 Fhtlieiriasis ; Fediculatio ; Lousiness. — Human body may be infested 
 with three kinds of lice : Fediculus corporis vel vestimentorum ; Fediculus 
 ca2)itis or head louse, and Fediculus pubis or crab louse. All are oviparous, 
 the eggs being known as nits : sexes distinct : young are hatched in five 
 or six days, and in eighteen days are capable of reproduction. 
 
 Treatment. Free washing with yellow or soft soap and hot water. 
 Sulphur bath, 125. Mercurial vapor bath, 131. Mercurial ointment. 
 Dusting with calomel. Corrosive sublimate lotion (gr. 2 to fl. oz. j). 
 Sulphur ointment. Cocculus ointment. Infusion of tobacco. Nits to 
 be combed awa}^, after washing the hairs with vinegar or spirits of wine. 
 
 PHTHISIS. — From <pO{(o, to waste away. — Synon. Tabes Fulmonum ; 
 Tubercular Fhthisis ; Fulmonary Consumption ; Decline. — Phthisis may be 
 inherited or acquired. Left lung suffers most frequently. Apices and 
 posterior parts of upper lobes most frequent seats of deposit at first. 
 No period of life exempt from this scourge. — See Tuberculosis.
 
 PHTHISIS. 207 
 
 1. Acute Phthisis. — This form very rare. Commences suddenly witli • 
 shivering, fever, rapid pulse, pain, cough, dyspnoea. .Shortly afterwards, 
 hectic fever, profuse sweating, diarrhoea. Eapid degeneration of lung 
 substance, cavities quickly forming. Increasing emaciation. Death 
 from exhaustion, perhaps in from three to twelve -weeks of commence- 
 ment of disease. — Tubercle generally spread all through lungs: deposit 
 oiten begins in middle and lovver lobes. 
 
 2. Chronic Phthisis. — The variety ordinarily met with. The tubercle 
 ma}' be confined to one or both lungs; or it may be deposited also in 
 mesenteric glands, tissues of intestinal walls, kidneys, liver, nervous 
 centres, &c. 
 
 Symptoms. Gradually increasing cough, haemoptysis, debility, expec- 
 toration, loss of appetite and dislike to fatty food, dyspepsia, accelerated 
 pulse, pyrexia, slight dj^spnoea, loss of flesh, sweating, diarrhea. "Weak- 
 ness of voice, or hoarseness. A festooned appearance at reflected edge 
 of gums. So long as tubercle is being deposited the temperature of the 
 bod}' is raised, so that it may reach to 105° F. Dull aching pain under 
 clavicles or scapulae. Sometimes, fistula in ano one of earliest symptoms. 
 
 Haemoptysis most frequent in early stage : it is very rarely fatal. 
 Aphtha^ about niouth and fauces. Mucous membranes of bronchi, lar- 
 ynx, and phar3'nx apt to get affected with low form of inflammation: 
 tubercle sometimes deposited in submucous tissue of these organs. Dis- 
 turbance of uterine functions in women: cessation of catamenia. Con- 
 gestion and tenderness of liver. Incurvation of finger nails : clubbed 
 appearance of ends of fingers. The debility and emaciation become 
 more and more marked. Profuse night sweats. Diarrhoea : either due 
 to disordered secretions, or to ulcerations about ileum and colon. Urine 
 sometimes contains albumen, or sugar. Tenderness and oedema of ex- 
 tremities. Mental faculties usually remain clear until death. 
 
 Physical signs: At first, if tubercular deposit be considerable, flatten- 
 ing of infra- and supra-clavicular regions. Defective expansion of u))))er 
 and front part of affected side. Dulness on percussion. Harsh or tubu- 
 lar inspiration. Act of expiration prolonged. Bronchial respiration 
 and bronchophony. A systolic bruit under one or both clavicles. — In 
 second stage, more marked depression of infra- and supra-clavicular 
 regions. Deficiency of chest n^iovement. Decided dulness on percus- 
 sion, unless amount of tubercle be small and surrounded b}- emphyse- 
 matous lung. Large crepitation. Puerile breathing in sound lung. — 
 In third stage, great depression below clavicle. Flattening of whole of 
 aftected side. Eetraction of intercostal spaces. Heart's impulse seen 
 and felt at higher point than normally. Dulness on percussion, owing 
 to solidity of layer of lung forming wall of cavit}'. Gurgling. Cavern- 
 ous i-espiration, if cavity be empty or nearly so; amphoric resonance 
 and pectoriloquy, if it be also large. 
 
 For diminution of Vital capacity, see Spirometry. — For extent of Loss 
 of weight, see Weight of Body. 
 
 Treatment. General rules : Improvement of general nutrition. At- 
 tention to quantity and quality of food. Eesidence in a healthy climate : 
 not necessarily a warm one. Exercise in open air, preferabfy without 
 fatigue, — by driving, sailing, &c. Insuring purity of air in apartments 
 occupied. Warm clothing: flannel or chamois leather next the skin. 
 Daily tepid sponging, preferably with saltwater: friction with coarse 
 towels, flesh-brush. Sti*ength on no account to be lowered : exacerba- 
 tions of fever to be treated by simple salines, omitting tonics for a 
 couple of days or so. In early stage, any complication (such as fistula 
 in ano) may be cured by operation.
 
 208 PIARH^MIA. 
 
 Diet: Most nutritions. Animal food, so long as it can be digested. 
 Pepsine, 420. Milk; cream; raw eggs. Iceland moss and quinine jelly, 
 13. Milk, flour, and steel, 16. Saccbarated solution of lime with milk, 
 where there is acidity of stomach. Rum and milk. Brandy. Port 
 wine or sherry. Burgundy. Champagne. Hungarian wines (Ofner 
 Auslese, Szamarodnya Muscat, Carlowitz, &c.). Stout; bitter ale; Scotch 
 ale; Guinness' stout. Too long an interval not to elapse between meals. 
 
 Change of air and scene: Very valuable in early stages. Patients re- 
 quiring a relaxing or sedative atmosphere in this country may be sent 
 to Torquay, 486. Undercliff of Isle of Wight, 434. Sandgate, 431. 
 Hastings, 432. Penzance, 437. — Where a more bracing air is suitable, 
 Bi-ighton, 432. Southport, 439. Queenstown, 440. Western coast of 
 Scotland, 431. — If a more complete change than this country affords be 
 Avished for, Mentone, 443. Cannes, 443. Ajaccio, 444. Malta, 449. 
 Malaga, 445. Algiers, 451. Madeira, 452. — Colony of Natal, 453. Can- 
 ada, 454. — When a sea voyage is indicated, Australia or New Zealand, 
 457. 
 
 Drugs : Cod-liver oil, 389. Ozonized cod-liver oil. Cod-liver oil and 
 bark enemata, 22. Inunction with oil, 283, Steel and cocoanut oil, 391. 
 Steel and glycerine, 392. Hypophosphite of soda or lime, 419. Bark 
 in full doses. Various preparations of iron, 38U, 394, 397, 401, 403, 405, 
 &c. Iodide of iron. Quinine. Liquor potassa?. Carbonate of am- 
 monia. — If there he haemoptysis : Iron alum, 116. Gallic acid, 103. Tan- 
 nin and nitric acid, 99. Oil of turpentine, 102. Lead and acetic acid, 
 117. — To relieve cough: Opium or morphia, 315, 316, 317, 346, 347, &c. 
 Decoction of Iceland moss. Demulcent drinks, 19. — If heart's action be 
 irritable: Hydrocyanic acid. Digitalis. — To check night-sweats : Oxide 
 of zinc. 111. Gallic acid. Mineral acids with bark. Sponging body 
 with very hot water. — To check diarrhoea: Ehatany, 96. Catechu, 97. 
 Vegetable charcoal, 98. Matico and rhatany, 105. Sulphate of copper 
 and opium, 106. Nitrate of silver and opium, 107. Kino and logwood, 
 108. White bismuth, 112. Astringent enemata, 113. — To check expecto- 
 ration, and lessen laryngeal irritation: Turpentine inhalations, 260. Hy- 
 drocyanic acid inhalations, 261. Inhalation of spray medicated with 
 tannic acid, turpentine, steel, &c., 262. Sponging epiglottis, pharynx, 
 and even interior of larjaax with solution of nitrate of silver. 
 
 Local applications to chest ivalls : Iodine liniment. Dry cupping. 
 Croton oil liniment, 303. Succession of small blisters. Blisters, kept 
 open by savine ointment or by Albespeyre's plaster, 208. Issues, or 
 setons, below clavicle. Frequent sinapisms. Turpentine stupes. Fric- 
 tion with salt water; cod-liver oil, 283; salad oil; belladonna and aconite 
 liniment, 281. 
 
 Remedies which have been recommended: Pancreatine and pancreatic 
 emulsion. Naphtha. Malt (Byne). Bromide of Iron. Peroxide of 
 hydrogen. Acetic acid. Actea racemosa. Hydrosulphuret of ammonia. 
 Iodide of ammonium. Glycerine. Common salt. Sulphur. Codeia. 
 Digitaline. Phosphorus. Carbonate of lead. Sanguinaria Canadensis. 
 Arsenic. Oxalic acid. Phosphate of lime. Tartarated antimony. 
 Mercury and chalk. Colchicum. Excreta of reptiles. Daily emetics. 
 Frequent small bleedings. Inhalations of naphtha; chlorine; carbonic 
 acid; oxygen gas; iodine; tar vapor. Arsenical cigars. Stramonium 
 cigars. Turkish baths. Laying open cavity by incision through inter- 
 costal space, and treating it as a chronic abscess. 
 
 PIARH.^MIA. — From IIJap,fixt; al/ia, blood. Synon. Lipa'viia ; Pi- 
 oxcemia. — Milkincss of the serum or fatty blood is met with under cer-
 
 PIOX^MIA — PLETHORA OR FULNESS OF RLOOD. 209 
 
 tain circumstances in disease. Its physical causes are two — viz., free 
 fat, and molecular albumen. 
 
 (1) PiarluTmia a physiological result of digestion, pregnanc3% lactation, 
 and hibernation. During digestion, lactescence of serum begins about 
 two hours after ingestion of aliment, and continues for two or three 
 hours. The serum is turbid, opalescent, and semi-opaque ; a condition 
 only transitory, and due to absorption of fatty matters of food, formed 
 into an emulsion by pancreatic juice, and absorbed as such in duodenum. 
 Examined microscopically, the serum is found to contain a large number 
 of fat globules and of molecular granules of albumen. The passage of 
 chyle into the blood renders the serum turbid; this turbidity lasting 
 until insoluble fatty matters — oleine, stearine, and margarine — enter 
 into combination with free soda of blood, and become converted into 
 oleic, stearic, and margaric acids. 
 
 (2) Lactescent serum a pathological result of disease. The cases in 
 which its occurrence has been noted are diabetes, chronic alcoholism, 
 dropsy, jaundice, nephritis, hepatitis, pneumonia, and especially Bright's 
 disease. 
 
 PIOXiEMIA.— From /7cwv, fat; al/za, blood.— Fatty blood.— See Pi 
 
 hcemia. 
 
 lar- 
 
 PITYRIASIS. — From Uiropov, bran. Synon. Herpes Fvrfuraceus ; 
 Branny Tetter ; Dandriff ; Dandruff. — A chronic, non-contagious, squa- 
 mous inflammation of the skin; attended with slight redness and much 
 irritation. Characterized by production of minute white scales, or scurf, 
 in great quantity. May attack any region : scalp and parts covered 
 with hair most common seats of it — pityriasis capitis. Desquamation 
 takes place copiously and incessantly, often for months. When occur- 
 ring in red and rough patches, it is known as pityriasis rubra. 
 
 Treatment. Locally : Warm baths. Conium and starch baths, 122. 
 Borax baths, 129. Gelatine baths, 122. Lotion of glycerine and water, 
 equal parts. Glycerine and lime-water, 286. Lime liniment. Borax 
 and glycerine, 268. Morphia and solution of potash, 266. Nitrate of 
 mercury ointment, 305. Calomel ointment. 
 
 Internally : Arsenic, 52. Cod-liver oil. Corrosive sublimate. Col- 
 chicum. 
 
 PLAGUE. — From Plaga (j^hyrj) a blow or wound. Synon. The Black 
 Death; Pestilential Fever; Levant Plague; Septic or Glandular Pesti- 
 lence. — A continued contagious fever, bearing a striking resemblance to 
 typhus. 
 
 Symptoms. A period of incubation, varying from a few hours to three 
 weeks. Petechiae. Buboes, from eflPect of poison on the cervical, axil- 
 lary', inguinal, and mesenteric glands. Carbuncles. Fever. Diarrhoea. 
 Vomiting. Great congestion and softening of heart, liver, and spleen. 
 Intense prostration. Suppression of urine. Attacks of hemorrhage. 
 Convulsions, coma, or fatal exhaustion. 
 
 Treatment. Emetics. Mild aperients. Diaphoretics. Salines. Min- 
 eral acids. Disinfectants. Cold affusion. — Friction of body with oil, as 
 a preventive measure. Avoidance of contact. 
 
 PLETHORA OR FULNESS OF BLOOD.— Synon. Polycemia ; Hcema- 
 toplethora ; Mypero'mia. — Partial plethora, or a local congestion or de- 
 termination of blood, is the superabundance of this fluid in one or more 
 particular organs or tissues. — See Hypercemia. 
 
 14
 
 210 PLEURISY. 
 
 PLEURISY. — From Uktupa, the side; the pleurae being the serous 
 membranes which invest the lungs and inner surface of thoracic walls. 
 Synon. Pleuritis ; Inflammatio Pleurce ; Morbus Lateralis. — Inflammation 
 of the pleura runs an acute or chronic course. One side only may be 
 aifected, or both — bilateral pleurisy. 
 
 Symptoms. Chilliness, or slight rigors. Fever. An acute lancinat- 
 ing pain in the side, called a "stitch ;" situated commonly below nipple, 
 over antero-lateral attachment of diaphragm. Pain aggravated by ex- 
 pansion of lung in inspiration, coughing, lying on affected side, and by 
 pressure. A short harsh cough. Hot and dry skin : temperature of 
 body varies from 101° to 105° F. Flushed cheeks. Hard and quick 
 pulse. Slightly increased frequency of respirations. Anxiety and rest- 
 lessness. Scanty and high-colored urine. — Physical signs: At first a 
 friction sound ; caused by the dry and inflamed pulmonary and costal 
 surfaces of the pleura rubbing against each other. This rubbing may 
 be felt by hand. It soon ceases : as the inflammation is resolved, and 
 the two surfaces become moist and smooth ; or tlie surfaces get adherent, 
 the exuded lymph forming a pseudo-areoiar tissue; or the surfaces be- 
 come separated by effusion of serum, a kind of dropsy resulting, known 
 as hydrothorax. Quantity of effusion varies from a few ounces to several 
 pints : when excessive it compresses yielding lung, suspends its func- 
 tions, displaces heart, and somewhat distends thoracic parietes. 
 
 When pleurisy ends in suppuration, and pus accumulates in cavity of 
 chest, the condition is known as empyema. The pus sometimes forms a 
 bulging tumor in an intercostal space, with appi"eciable fluctuation. 
 Occasionally, ulceration of costal pleura follows, extends through 
 muscles, and forms an external aperture (a parietal fistula) through 
 which pus is discharged. Or, pulmonary pleura may be perforated, an 
 opening form into air-tubes (a bronchial fistula), and pus be expec- 
 torated. 
 
 Whether matter eft'used be serum, or serum mixed with blood, or pus, 
 there will be dulness on percussion. Auscultation detects a diminished 
 respiratory murmur. If lung be compressed, so that air only enters 
 bronchial tubes, no vesicular murmur at all will be heard ; but instead 
 bronchial respiration and bronchial voice or bronchophony. Perhaps also, 
 mgojjhony. When compression is complete, so that air cannot even enter 
 bronchi, no sound will be audible. On healthy side, respiration puerile. 
 Patient cannot lie on sound side, because movements of health}' lung 
 become impeded by superimposed weight of dropsical pleura. Affected 
 side enlarged: intercostal muscles, inactive: spaces, obliterated or even 
 bulging ; fulness of infra-clavicular region ; shoulder depressed. Pleu- 
 ritic effusion occurs most frequently on left side — When absorption of 
 effusion occurs, and owing to adhesions the lung cannot expand, there 
 will be a shrinking inwards of affected side. 
 
 In latent pleurisy, there may be neither pain, cough, or dyspnoea. Yet 
 effusion may occur until one half of chest is found full of fluid. 
 
 Treatment. Perfect rest in bed. Avoidance of talking or of full 
 inspirations, so as to prevent undue friction between inflamed surfaces. 
 A tine flannel bandage around chest lessens the movements of ribs. 
 Large hot and moist linseed poultices, covered with extract of poppies. 
 Poppy-head fomentations. Sinapisms. Turpentine stupes. Cupping 
 to three or four ounces, often relieves severe pain more quickly than 
 other measures. Aperients, if there be constipation. Subcutaneous 
 injection of morphia, 314. Opium. Aconite. Citrate of potash and 
 ammonia, 211. Ether and ammonia, 212. Diet of gruel, milk, arrow- 
 root, tea, and broths. Soda water. Lemonade. Cream of tartar 
 drink, 356. Indian sarsaparilla and barley water. 20. — Tonics and good
 
 PLEURODYNIA PNEUMONIA. 211 
 
 food, durino; convalescence. — Quinine, nourishing soups, and wine if 
 patient be aged, or when symptoms assume a typhoid character. 
 
 To promote absorption, of effused fluids: Moderate diet, free from stimu- 
 lants. Sinapisms to diseased side. Flying blisters, frequently repeated. 
 F'riction with ointment of red iodide of mercury. Iodide of potassium, 
 31. Squills, digitalis, and blue pill, 128. Iodide of iron. Cod-liver oil. — 
 Tapping the thorax, after failure of foregoing remedies. In empyema, 
 tapping with use of drainage tube. 
 
 Remedies sometimes employed : Calomel, or blue pill. Tartarated anti- 
 mony. Colchicum. Hydrochlorate of ammonia. Hydrocyanic acid. 
 American hellebore (Veratrum viride). Digitalis. General bleeding. 
 Leeches. Blisters. 
 
 PLEURODYNIA.— From Hkiopa, the side ; 6i%vrj, pain. Synon. Pleu- 
 ralgia; Pleurodyne; Rheumatism of Walls of Chest; False Pleurisy; 
 Stitch in the Side. — Chiefly of importance, because the pain, which is 
 often severe, ma}^ be wrongly attributed to pleurisy or pericarditis, or 
 even to peritonitis. 
 
 Symptoms. General health impaired. Loss of appetite. Low spirits. 
 Urine loaded with urates or phosphates. In exceptional cases, rheu- 
 matism of joints. Acute pain, often coming on suddenl}^ frequently 
 referred to infra-mammary region: increased by a deep inspiration, or 
 by any movement which stretches the muscles. In nineteen cases out 
 of twenty, muscular and. fibrous textures of left side of chest alone 
 affected. 
 
 Treatment. Ammonia, aconite, and bark, 371. Iodide of potas- 
 sium, 31. Subcutaneous injection of morphia or chloroform, 314. 
 Cod-liver oil. Warm baths. Turkish baths, 130. Sulphur baths, 125. 
 Belladonna and opium liniment, 281. Veratria ointment, 30-4. Hot 
 linseed poultices. Sinapisms. Animal food : milk. Steel, milk, and 
 flour, 16. Light wines. Brandy and soda water. 
 
 Cupping, leeching, blistering, and purging will only I'ender the dis- 
 order more intractable. 
 
 PLEURO-PNEUMONIA. — Synon. Pleuro-peripnevmonia. — Inflamma- 
 tion, attacking simultaneously the pleura and lung. — Pneumonia may 
 happen without pleurisy. But when the pleura is involved in the 
 inflammation, the pneumonia forming the chief affection, the double 
 disease is known as pleuro-pneumonia. If the pleurisy predominate, it 
 is sometimes ca.\\ed pneumo-pleuritis. — See Pneumonia. 
 
 PLICA POLONICA.— From Plico, to twine together. Synon. Tricho- 
 sis Plica; Trichoma; Polish Ringworm. — A disease of the hair, probably 
 allied to common ringworm of this country. Endemic in Poland, and 
 some parts of Russia and Tartary. Characteinzed by tenderness and 
 inflammation of scalp; hairs become swollen and imj^erfectl}' formed ; 
 hair-follicles secrete a large quantity of viscid reddish-colored fluid, 
 which glues the hairs together, and unites them into tufts or felt-like 
 masses. Two cryptogamic plants — the Tricoph^'ton tonsurans and 
 Tricophyton sporuloides — have been detected by a minute examination. 
 Sometimes, matted hairs loaded with pediculi. Disease not confined to 
 scalp, but may involve hairs on any part of integument. Odor from 
 affected parts said to be most disgusting. 
 
 Treatment. See Tinea. 
 
 PNEUMONIA. — From Uvsuiiovia, a disease of the lungs. Synon. Pul- 
 monitis ; Inflammatio Pulmonum ; Peripneumony. — Acute inflammation
 
 212 PNEUMONIA. 
 
 of the substance of the lungs. Eight lung suffers twice as often as left. 
 Lower lobes more frequently attacked than upper. Average duration 
 of uncomplicated cases about fourteen days. 
 
 Symptoms. Disease ushered in with restlessness and general febrile 
 disturbance. At end of one to three days, rigors; followed by nausea, 
 cough, expectoration of viscid and rust-colored sputa, pain in side, dis- 
 tressed breathing, a pulse reaching to 140 or even 160 beats in minute, 
 temperature of body raised perhaps to 105° F., thirst, loss of apj)etite, 
 prostration, headache, and perhaps transient delirium. 
 
 Each case may be said to consist of three stages : (1) That of en- 
 gorgement or splenization, in which substance of affected part gets loaded 
 with blood or bloody serum. On auscultation, minute crepitation, or 
 crepitant rhonchus, is heard; at first, mingled with vesicular murmur. 
 Percussion, at commencement, affords natural resonance, which gradu- 
 ally becomes obscured. — (2) If the inflammation proceed, it passes into 
 stage of red hepatization ; in which spongy character of lung is quite 
 lost, and it becomes hard and solid. JSTeither minute crepitation nor 
 vesicular murmur can now be heard: bronchophony often present, with 
 bronchial respiration. Dulnees on percussion. — (3) When disease still 
 advances, there is reached the stage of gray hepatization, or purulent in- 
 filtration; consisting of diffused suppuration of pulmonary tissue, parts 
 of lung remaining dense and impermeable. Often, no true suppuration: 
 appearance of such simulated by liquefied exudation matter. When 
 portion of lung breaks down and pus is expectorated, large gurgling 
 crepitation will be heard. — If inflammation subside before reaching 
 stage of purulent infiltration, as it often does, the hepatized state ma}' 
 remain permanent or gradually cease. In latter case, air begins to re- 
 enter affected part of lung; as evidenced by return of minute crepita- 
 tion, mingled with and then superseded by healthy vesicular murmur. 
 
 For first day or two of pneumonia a normal amount of chlorides will 
 be found in the urine; the quantity diminishing as inflammation ad- 
 vances, until they have disappeared by time hepatization is complete. 
 As latter recedes, tbe chlorides reappear. A deficiency of chloride of 
 sodium in urine not peculiar to pneumonia. — Occasionally, in depressed 
 constitutions, pneumonia ends in diffused, or in circumscribed, gangrene. 
 
 Chronic pneumonia may occur as sequel of acute disease; giving rise 
 to persistent consolidation of a portion of pulmonary tissue. May be 
 mistaken for solidification due to tubercle. It causes weakness, emacia- 
 tion, cough, attacks of feverishness, loss of appetite, and sense of op- 
 pression about chest. 
 
 Treatment. Acute form: Perfect rest in bed. Temperature of sick- 
 room not to fall below 65° F. Air to be kept moist by steam. A dose 
 of castor oil, if there be constipation. Solution of acetate of ammonia, 
 211. vSmall doses of opium, if there be pain or restlessness. Vapor of 
 chloroform, to relieve cough and dyspnoea. Carbonate of ammonia, if 
 there be much debility, 212. Large linseed poultices, or poppy-head 
 fomentations, to aftected side of chest. Turpentine stupes. Light diet, 
 with plenty of cold water. Strong beef tea, wine or brandy, milk or 
 cream, as soon as there are indications of exhaustion. During convales- 
 cence: Milk, raw eggs, wine, animal food. Ammonia and bark, 371. 
 Quinine and steel, 380. Cod-liver oil. 
 
 Chronic pneumonia : Iodide of potassium and bark, 31. Iodide of iron, 
 32. Ilydrochlorate of ammonia. Cod-liver oil. Nourishing food. 
 Turpentine stupes. Iodine liniment. 
 
 Remedies sometimes employed : Tartarated antimony. Calomel. Vera- 
 trumviride. Bloodletting. Leeches. Blisters. Antiphlogistic regimen.
 
 PNEUMOTHORAX — POISONS. 213 
 
 PNEUMOTHORAX.— From IhEwim, air; 8mpa^, the chest. 83-11011. 
 Piieumafothorax ; Emj)hysema Pectoris; Aerothorax. — A collection of air 
 ill the pleura. When, as generally happens, there is liquid with the air, 
 the disease is called Pneumothorax ivith Effusion. — May arise from injury 
 b^" jagged ends of a broken rib: from an external penetrating wound: 
 from ulceration owing to extension of a tubercular cavity. — Physical 
 signs: Great resonance on percussion; with indistinctness of respiratory 
 murmur on auscultation. Amphoric resonance. Metallic tinkling, on 
 practising succussion, in pneumothorax with effusion. — In some rare in- 
 stances, the dyspnoea has been so urgent that the air has had to be 
 evacuated by puncturing pleural cavity with a grooved needle. 
 
 POISONS. — Consist of any matters which, when absorbed into the 
 blood, are capable of destroying life. "Deadly poisons" are such sub- 
 stances as rapidl3^ prove fotal in small doses. The term '" destructive 
 thing" is applied to any mechanical ii-ritant, — such as jiins, needles, par- 
 ticles of iron or glass, sponge, &c. 
 
 Poisons are arranged according to their action into three classes, — 
 Irritants, Narcotics, and Narcotico-lrritants. Another division is into 
 Irritants and I^eurotics ; the latter consisting of Narcotics or Cerebral 
 poisons, and Nai'cotico-Irritants or Spinal and Cerebro-spinal poisons 
 (Taylor). — See Poisons, in Tabular Synopsis. 
 
 Symptoms. Irritants: Give rise to pain in stomach and bowels, sick- 
 ness, purging with tenesmus. Evacuations often tinged with blood : 
 pulse feeble and irregular: skin cold. Many irritants corrode the tie- 
 sues with which they come in contact; hence the}- produce severe burn- 
 ing sensations in mouth, oesophagus, and stomach. The degree of 
 chemical action produced will vary in proportion to amount of water 
 with which noxious agent has been diluted. They cause death by in- 
 ducing collapse, or convulsions; or by exciting severe inflammation ; or, 
 after a variable interval, by leading to stricture of oesophagus. Diseases 
 which most resemble action of irritants are, — Malignant cholera, severe 
 diarrhoea, colic, gastritis, enteritis, rupture of stomach or intestines, 
 trichiniasis, and obstruction of bowels. 
 
 Narcotics : Act on brain and spinal cord, inducing headache, drowsi- 
 ness, giddiness, stupor, and insensibility. Frequently there are convul- 
 sions; sometimes paralysis. Very seldom vomiting or diarrhoea. The 
 symptoms of apoplexy, epilepsy, and uramia, bear a resemblance to 
 those caused by poisons of this class. With regard to one intensely 
 powerful agent (nitro-benzole) the sj^mptoms may not come on for a 
 few hours, unless several drops have been taken. In the latter ease, 
 there is rapid coma and death. 
 
 Narcotico-lrritants : Produce great thirst, pain in throat and stomach, 
 vomiting and purging, delirium with spectral illusions, and rarely con- 
 vulsions. Sometimes tetanus, sometimes coma or sjnicope. Diseases 
 of brain and spinal cord often very insidious in their progress: hence 
 they give rise to symptoms which maj' be improperl}- attributed to 
 poisoning. The history, mode of attack, &c., should serve to prevent 
 error. 
 
 Treatment. The object of practitioner maj'^ be comprised under 
 three heads: (1) To promote discharge of poison from, system. When the 
 poison has been introduced into stomach, recourse to be had to stomach- 
 pump or to emetics. The stomach-pump is the best instrument for 
 emptying the stomach, washing it out, and administering the antidote. 
 Its emploj'ment not advisable in poisoning by corrosives, as it might 
 cause laceration of tissues, or even perforation of oesophagus or stomach. 
 When used, less fluid should be withdrawn than is pumped into stomach.
 
 214 POISONS. 
 
 If stomach-pump cannot be employed, emetics must be trusted to, unless 
 the poison has itself produced sufficient vomiting. Sulphate of zinc, 
 rapid in action and but slightly depressing in its effects, 232. Mustard 
 useful, 232. In poisoning by opium and other narcotics, when other 
 emetics fail, sulphate of copper often acts well, 232. Ipecacuanha use- 
 ful, especially for children, 231. A warm and stimulating emetic can 
 be made with ipecacuanha and ammonia, 283. Vomiting may also be 
 excited by tickling the fauces: by free administration of hot water, or 
 of hot greasy water. 
 
 When poison has been administered by rectum, or when it is thought 
 to have passed from stomach into bowels, enemata are necessary. Salt 
 and water, oil and barley water, soap and water, 188. Castor oil and 
 turpentine, 190. Croton oil, 191. 
 
 When poison has been applied through wound in skin, absoqjtion to 
 be prevented. Ligature between trunk and wounded part, as near 
 latter as possible. Removal of deletei-ious substance by suction ; use of 
 cupping-glasses. Stream of cold water, long-continued. 
 
 (2) To counteract operation of poison by antidotes. No universal anti- 
 dote known : hence treatment varies with nature of substance taken. 
 An antidote should possess these properties : It ought to allow of being 
 given in large doses without danger; it should act upon the poison, 
 whether liquid or solid, at a temperature equal to or below that of body; 
 its action should be quick; it should be capable of combining with the 
 poison, though shielded by gastric juice, mucus, bile, or other substances 
 contained in stomach ; and it should deprive the poison of its deleteri- 
 ous properties (Orlila). Antidotes operate by forming harmless chemi- 
 cal combinations, or by producing insoluble compounds: they thus de- 
 stroy the poison, or prevent its absorption. Purified animal charcoal 
 has been recommended. It seems to have the power of combining in 
 the stomach with poisonous principles of animal and vegetable sub- 
 stances, so as to produce innoxious substances: when given in large 
 quantities it will absorb some mineral substances (especially arsenic) 
 and render them inert: about half an ounce of charcoal is required to 
 each grain of morphia, strychnia, or any other alkaloid; but much less 
 for the drugs from which they are obtained, a scruple of mix vomica, 
 for example, not requiring more than half an ounce of charcoal: and, 
 lastly, this antidote has no injurious action on the body (Garrod). 
 
 In poisoning by Mineral Acids, the remedies are, — Carbonate of soda, 
 calcined magnesia, or carbonate of magnesia, freely in milk or any mu- 
 cilaginous fluid. In absence of these, whiting, soap and water, plaster 
 of the walls. Olive oil, linseed tea, gruel, milk, barley water. If breath- 
 ing be impeded by injury to larynx,' tracheotomy. Subsequently, reme- 
 dies against gastritis. External parts when injured, to be bathed with 
 soap and water, olive oil, lime liniment. 
 
 Vegetable Acids: Stomach-pump or emetics. Draughts containing 
 magnesia, chalk, or whiting: mucilaginous or demulcent drinks. Alka- 
 lies"(soda, potash, or their carbonates) form salts with oxalic acid, which 
 are as injurious as the acid itself 
 
 Phospfiorus : Vomiting to be encouraged by large draughts of muci- 
 laginous or albuminous drinks. Full doses of magnesia. Oil to bo 
 avoided, as it is a solvent of this substance. 
 
 Iodine: Vomiting to be encouraged. Free administration of amyla- 
 ceous fluids, as gruel, arrowroot, starch. Ijatter to be continued as long 
 as blue iodide of starch is vomited. 
 
 Ammonia, Potash, Soda, and their Carbonates: Vinegar aiul water to 
 neutralize poison. Acidulated barley-water, orange-juice. The use of
 
 POISONS. 215 
 
 oil has been recommended, with object of converting the alkali into 
 a soap. 
 
 Nitrate, Sulphate, and Acid Tartrate of Potash : No antidotes known. 
 Vomiting to be produced. Demulcent drinks. 
 
 Baryta, and its Salts: Sulphate of soda, or sulphate of magnesia, or 
 some earthy sulphate, so as to convert the poison into an inert and in- 
 soluble sulphate of baryta. Emetics or stomach-pump. 
 
 Arsenic: Stomach-pump. Emetics. Vomiting to be kept up by 
 albuminous or mucilaginous diluents. Raw eggs in milk. Eggs, milk, 
 and lime-water. Equal parts of oil and lime-water. Castor oil (fl. oz. ij) 
 to carry off any portion which has passed into intestines. Animal char- 
 coal. Calcined magnesia. Hydrated sesquioxide of iron has been un- 
 deservedl}^ praised: if given, large doses necessary (a tablespoonful, 
 frequently repeated). Subsequent depression of nervous power to be 
 combated by stimulants and opium. For any inflammatory action, 
 opium or conium or henbane. 
 
 Corrosive Sublimate: Vomiting to be encouraged. Best antidotes, al- 
 bumen and gluten of wheat: White and yolk of several raw eggs; flour, 
 made into a paste with milk or water. Subsequently, demulcent drinks 
 and milk and Wenham Lake ice. Gargles of alum and myrrh, 252; 
 tannin, 251; borax, 250; chlorinated soda, 254. Opiates. Chlorate of 
 potash, 61. Iodide of potassium, 31. 
 
 Salts of Lead: Soluble alkaline or earthy sulphates, as the sulphates 
 of soda or magnesia. Milk, or milk and raw eggs. Emetics, or stomach- 
 pump. Croton-oil enema, 191. In chronic lead poisoning : Croton oil, 
 168. Castor oil and opium, 164. Sulphate of magnesia with sulphuric 
 acid, 142. Enemata of hot water. Hot sulphur baths, 125. Opium, 
 316, 317, 339, &c. Iodide of potassium, 31. 
 
 Salts of Copper: Vomiting to be encouraged by warm water. Albu- 
 men, the only effectual antidote. Hence several raw eggs are to be 
 given, followed by milk or mucilaginous drinks. 
 
 Tartarated Antimony (Tartar Emetic): Vomiting to be encouraged by 
 milk ; warm greasy water. As tannate of antimony is inert, tea to be 
 given; decoction of oak bark; gallic or tannic acid. Tinctui^e of galls. 
 Cinchona bai'k in tincture or powder. 
 
 Chloride of Antimony (Butter of antimony) : Magnesia in milk. Tea; 
 decoction of oak bark ; gallic acid. 
 
 Sulphate of Zinc: Vomiting to be encouraged by milk or albuininous 
 fluids. Remedies containing tannin, as for antimony. 
 
 Chloride of Zinc: Emetics and albuminous drinks, followed by prepa- 
 rations of tannin. 
 
 Nitrate of Silver : Common salt. Emetics, if vomiting be absent. 
 
 Bismuth : No antidote known. Vomiting to be promoted. Emollient 
 drinks. 
 
 Chrome : Emetics. Magnesia or chalk. 
 
 Sulphate of Iron (Green Vitriol) : Magnesia and diluents. 
 
 Vegetable and Animal Irritants : Vomiting to be excited or encouraged. 
 Purgatives. Linseed tea, gum water, gruel. Warm baths. Opiates. 
 Emollient enemata. In poisoning by cantharides, oil to be avoided, as 
 it is a solvent of the active principle (cantharidine). 
 
 Irritant Gases: Removal of patient to pure air. Artificial respiration 
 (see Suspended Animation). Cautious inhalation of ammonia, ether, or 
 steam. 
 
 Opium: Stomach-pump. Emetics of sulphate of zinc, 232: sulphate 
 of copper, 232 : of a tablespoonful of mustard in water. Where there ia 
 inability of swallowing, emetics to be administered as enemata. Patient 
 to be prevented from sleeping by dashing cold water over head and.
 
 216 POLY^MIA POLYDIPSIA. 
 
 chest; walking him up and down in open air between attendants; elec- 
 tro-magnetic shocks to spine ; flagellation to legs with a wet towel ; ad- 
 ministration of strong coffee. Alcoholic stimulants. Artificial respira- 
 tion. Belladonna, in from thirty to sixty minim doses of the tincture 
 every hour, as an antidote. 
 
 Hydrocyanic Acid (Prussic Acid): No antidote to be relied on. Chlo- 
 rine and mixed oxides of iron been recommended : if they were at hand 
 their efficacy would be doubtful. Animation to be restored by cold 
 affusion; stimulating frictions to chest and abdomen ; ammonia to nos- 
 trils. Artificial respiration. After recovery from immediate effects, 
 vomiting to be produced. Strong coffee. Brandy. 
 
 Nitro-Benzole (Essence of Mirbane, Artificial Oil of Bitter Almonds): 
 Strong coffee. Brandy. Ammonia. Turpentine enemata. Cold affu- 
 sion. Galvanism. Artificial respiration. — The same treatment is neces- 
 sary in poisoning by Aniline. No antidotes are known ; but it might 
 be advisable to try the effects of animal charcoal, if the case were seen 
 early. 
 
 Chloroform and Ether : Stomach-pump if these poisons have been swal- 
 lowed. Where symptoms follow inhalation, — Exposure of patient to 
 current of pure air. Cold affusion. Galvanism. Artificial respiration, 
 313. 
 
 Alcohol : Stomach-pump. Cold affusion. Solution of acetate of am- 
 monia properl}' diluted. Warmth to be promoted. Sinapisms to ex- 
 tremities and cardiac region. 
 
 Henbane, Lettuce- Opium, and Nightshade: Emetics. Full doses of cas- 
 tor oil. 
 
 Narcotic Gases : See Suspended Animation. 
 
 Nux Vomica, Strychnia, and Brucia : Emetics. Stomach-pump. Pur- 
 gative enemata. Olive oil. Animal charcoal. Warmth and sweating 
 to be induced. Perfect quiet. Chloroform to diminish tetanic spasms. 
 
 Belladonna : Emetics. Castor oil. Animal charcoal. 
 
 Aconite: Emetics. Castor oil. Animal charcoal. Strong coffee. Am- 
 monia or brandy. Limbs to be rubbed with hot towels. Artificial res- 
 piration. 
 
 Digitalis: Emetics. Castor oil. Infusions containing tannin, as tea, 
 decoction of oak bark, tincture of galls. Tannic acid in water. Strong 
 coffee or brandy. 
 
 (3) To remedy effects produced and obviate tendency to death. Frequently 
 too long an interval has elapsed between exhibition of poison, and the 
 time when emetics or antidotes can be of use. If absorption have taken 
 place, the symptoms must be palliated. In poisoning by depressing 
 agents and nai'cotics, or such as destroy neiwous fox"ce, lowering agents 
 to be avoided; whilst stimulants and cold affusion and galvanism are 
 resorted to. When breathing and circulation seem about to cease, arti- 
 ficial respiration may preserve life till the poison is eliminated. To pro- 
 mote elimination, the excreting functions are to be excited. Thus, in 
 poisoning by arsenic, the employment of diuretics has been proposed, 
 because it has been found that this poison is eventually carried off in 
 large quantities by the urine. 
 
 FOLY^MIA. — From lloXhq, much; al/xa, blood. — Abundance of blood. 
 — See Hyperoemia. 
 
 POLYDIPSIA.— From noXh^, much ; <5j^'^, thirst. Synon. Sitis Mor- 
 hosa ; Excessive Thirst. — A symptom in many diseases, — fever, inflam- 
 mation, cholera, diabetes mellitus, diuresis, &c.
 
 POLYPUS — PROSTATIC ENLARGEMENT. 217 
 
 POLYPUS. — From //oAu<r, many; tto^c, a foot. — A tumor so-named 
 because it was supposed to have numerous attachments or feet. — See 
 Nasal Polypus ; Otorrhagia (for polypus of ear) ; Uterine Tvmors ; Rectal 
 Polypus. 
 
 POLYSARCIA. — From IJaXhi;, much ; ffdp^, flesh. Synon. Carnositas; 
 
 Corpuleniia ; Steatites. Excessive corpulency. — See Obesity. 
 
 POLYURIA. — From //oAu?, much ; urea. Synon. Azoturia. — A condi- 
 tion in which a hirgcr quantity of urine than natural is secreted, con- 
 taining an absolute and relative increase of urea. — See Diuresis. 
 
 PRESBYOPIA. — From Hpi(Tj3u7, an old man; w<J', the eye. Synon. 
 Presbytia; Visus Senilis; Long-sight. — An alteration in the refractive 
 powers of the eyes, producing presbyopia, or long-sightedness, is one of 
 the earliest indications of the commencement of old age. Seldom begins 
 before the forty-fifth year. 
 
 Symptoms. The range of accommodation is diminished; vision is 
 imperfect for near objects; distant ones are seen clearly. Often ac- 
 companied by weakness of sight (amblj^opia). Rapid increase of pres- 
 byopia is a precursor of glaucoma. 
 
 Treatment. Convex glasses directly vision fails for ordinar}^ work : 
 to be so worn that they can be seen over at pleasure for distant objects. 
 If there be anaemia, quinine and ferruginous tonics. Cold water douche 
 to eyes. 
 
 PRIAPISM. — Priapismus, from IJpiano^, the virile member; terminal 
 -i(Tlxo<;. Synon. Tentigo Penis; Horn Colic. — Constant and distressing 
 erection of penis. May arise from: (1) Injury or disease of spine, as 
 fracture of lower dorsal or upper lumbar vertebrae. Disease of brain. 
 (2) The rupture of some vessel, with extravasation of blood into corpora 
 cavernosa. (3) Subacute inflammation, with eff'usion of lymph into 
 corpora cavernosa. (4) Vesicular and nervous excitement, owing to 
 excessive venery. 
 
 Priapism may sometimes be relieved by: Bi-omide of potassium, 42. 
 Iodide of potassium, 31. Henbane, camphor, and hop, 325. Camphor 
 and belladonna, 326. Belladonna suppositories, with opium if there be 
 pain, 340. Iodoform suppositories, 338. Aconite or belladonna lotions, 
 265. Cold lotions, 273. Arnica lotions, 275. 
 
 PROCTALGIA. — From llpwxrdt;, the rump or anus ; aXyoq, pain. Synon. 
 Proctagra; Proctodynia; Dolor Ani. Pain about the anus: due to 
 neuralgia, or to organic disease. — See Rectal Neuralgia. 
 
 PROCTITIS. — From /7/>tt;zTo?, the rump or anus; terminal -?Y«s. In- 
 flammation of the rectum and anus. — See Rectitis. 
 
 PROPTOSIS OCULI. — From UpoTzii^Tco, to fall forward : Oculus, the 
 eye. A protrusion of the eyeball, so that the lids cannot cover it. Met 
 with in peculiar forms of anemia. — See Graves' Disease. 
 
 PROSTATIC ENLARGEMENT. — Hj^pertrophy may result from 
 chronic prostatitis, or in advanced life independent of any inflammatory 
 action. Produces displacement or compression of urethra, so that mic- 
 turition is rendered slow and difficult. The whole gland may enlarge 
 equally, or only the central portion. In hypertrophy due to inflamma- 
 tion, a cure may sometimes be eftected by a course of mercury. In
 
 218 PROSTATITIS — PRURITUS ANI. 
 
 senile form, only palliatives are useful: Acids, buchu^ steel, opiates, 
 aperients, careful diet, avoidance of cold, &c. Care must be taken that 
 the bladder is completely emptied, or chronic cystitis will be set up. 
 Partial or complete retention of urine requires the employment of a 
 long catheter with a large curve. 
 
 Very rarely the prostate becomes the seat of cancer, — especially the 
 medullary form. 
 
 PROSTATITIS.— From Prostata, the prostate gl&nd—Prosto, to stand 
 in front, this gland being anterior to the bladder ; terminal -itis. Synon. 
 Infiammatio Prostatoi. — Inflammation of the prostate may occur in 
 course of gonorrhoea, from violence, use of strong injections to urethra, 
 exposure to wet in unhealthy constitutions, excessive venery, diseases 
 of rectum, and irritation of cantharides. 
 
 Symptoms. Pain and tenderness about perineum, with sense of heat. 
 Frequent painful micturition. Pain during defecation. Feeling of 
 weight about perineum and rectum. Great suffering if a catheter be 
 passed. Aggravation of suffering, rigors, fever, difficulty of micturition, 
 &c., w^hen the morbid action progresses to abscess. 
 
 Treatment. Perfect rest in bed. Hot hip baths. Fomentations. 
 Poultices. Free use of belladonna to perineum. Opiate suppositories 
 or enemata, 339. 340. Simple nourishment, without stimulants. Col- 
 ehieum, 46. Iodide of potassium. 31. Bromide of potassium, 42. Ily- 
 drochlorate of ammonia, 60. Oi)ium, 324, 339, 340, 345. Aconite, 330, 
 331. Belladonna, 326, 344. 
 
 In abscess : Incision through perineum directly there is fluctuation. 
 Ammonia and bark. Nourishing food; raw eggs, cream, essence of 
 beef, &c. Wine, if there be much depression. 
 
 PRURIGO. — From Prurio, to itch ; terminal -igo. — A chronic non- 
 contagious cutaneous disease, characterized by an eruption of small 
 papulas or pimples. Causes intense discomfort. The term Prurigo 
 should not be used as the synonjnn of Pruritus or Itching. 
 
 Varieties. Prurigo mitis, the mildest form. — Prurigo formicans, the 
 itching being combined with a sensation like the creeping of ants or 
 stinging of insects. — Prurigo senilis, which occurs in old age, and may 
 last for the remainder of patient's life. — Irritation from prurigo not to 
 be confounded with that caused by lice. These insects often j^resent in 
 old age, where there is a want of cleanliness. 
 
 Treatment. Internally : Aloes, gentian, and potash, 148. Sulphate 
 of soda and sulphur, 148. Sulphur and magnesia, 153. Khubarb and 
 magnesia, 165. Pepsine and aloes, 155. Sarsaparilla and iodide of iron, 
 32. Tar capsules, 36. Arsenic, 52. Steel and ai'senic, 399. Bark and 
 mineral acids, 376. Nitro-hydrochloric acid, 378. Quinine, 379. Nour- 
 ishing food, avoiding stimulants. Acidulous drinks. 
 
 Locally: Alkaline baths, 121. Sulphur baths, 125. Conium baths, 
 122. Creasote baths, 123. Applicationsof vinegar, lime-water, tobacco- 
 water, solution of corrosive sublimate, solution of creasote, solution of 
 bydrochlorate of ammonia, lotions with prussic acid and glycerine. 
 Ointments of aconitine, tar, nitrate of mercui-y, sulphur, &e. Sponging 
 with apple vinegar, and then smearing with diluted nitrate of mercury 
 ointment. 
 
 PRURITUS ANI.— From Prurio, to itch; Anus, the fundament.^ 
 A very troublesome itching of anus not uncommon in cases of haemor- 
 rhoids, dyspepsia, intestinal worms. Old people often complain of it;
 
 PSORIASIS — PULMONARY CANCER. 219 
 
 as do women towards tlie end of pregnancy, and such as have uterine 
 disease, or such as have recently got over the change of life. 
 
 Symptoms. Severe itching of fundament: increased by heat, rich 
 living, &c. Often prevents sleep. The friction resorted to causes the 
 surrounding tissues to become thickened and furrowed. Care necessary 
 lest irritation be due to pediculi. 
 
 Treatment. Internally: Pjlectuary of senna and taraxacum, 194. 
 Confection of pepper, or sulphur. JJhubarb and blue pill, 171. Simple 
 enemata, 188. Arsenic with bitter infusions, 52. Iodide of iron and 
 sarsaparilla, 132. Tar pills or cai)sules, 36. 
 
 Locally: Tobacco-water, 2G5. Corrosive sublimate and prussic acid 
 lotion, 2G3. Borax, morphia, and glycerine, 268. Lint dipped in tinc- 
 ture of opium. Lemon-juice. Vinegar. Olive oil. Calomel and bella- 
 donna ointment, 299. Diluted citrine ointment, 305. Fuller's earth 
 (chiefly a compound of silica, alumina, oxide of iron, and magnesia). 
 Glycerine. Nitrate of silver. Leeches. 
 
 General remedies: Cold bathing or sponging. Daily exercise in open 
 air. A diet free fi'om alcohol, coffee, and seasoned dishes. Cool bed- 
 room : to sleep on a hard mattress, without too heavy clothing. 
 
 PSORIASIS. — From '/"«>/>«, tetter. Synon. Psora Leprosa ; Diffused 
 Dry Tetter ; Lepra Diffusa. — A variety of lepra, the eruption being dif- 
 fused over the whole body. — See Lepra. 
 
 PTOSIS. — From Utom, to fall. Synon. Ptosis Palpebrce; Blepharopto- 
 sis ; Prolapsus Palpebrce. — An inability to lift the upper eyelid from palsy 
 of the third nerve. May be due to cerebral disease, to congestion of 
 brain, to simple debility. When there is organic disease, it may be 
 accompanied by amaurosis. 
 
 PUERPERAL MANIA. — From Puerpera {Puer and pario), a woman 
 in childbed : Mav^o/mc, to rage. — A peculiar form of insanity occurring 
 to women soon after delivery. 
 
 Symptoms. Commence with restlessness, insomnia, severe pain in 
 head, diminution of secretion of milk. Sometimes, skin hot and dry: 
 pulse full and thick: tongue thickly furred. Often, great debility: 
 perhaps prostration from flooding, lingering labor, or some morbid 
 poison in system. Delirium frequently violent. Great general irrita- 
 bility. Tendency to suicide, or child-murder. 
 
 Treatment. Indications are, first to arouse and support powers of 
 patient: second, to alla}^ irritability of brain and nervous system. (1) 
 , Brandy and egg mixture, 17. Ammonia and bark, 371. Quinine and 
 phosphoric acid, 379. Cod-liver oil, 389. Pounded beef in broth. Wine. 
 Beer. Milk. (2) Extract of stramonium, 323. Extract of opium, 343. 
 Morphia and Indian hemp, 317. Subcutaneous injections of morphia, 
 314. Chloroform inhalation, 313. — Patient to be controlled by a trained 
 nurse. Separation from family and friends, unless symptoms quickly 
 3^ield to remedies. 
 
 PULMONARY APOPLEXY.— From Pulmo, the lungs.— The effusion 
 of blood into the air-cells of the lungs, and its coagulation there. It 
 may be circumscribed, the eft'usion varying in size from a pea to an 
 orange; or it may be diffused through the broken-down pulmonary 
 tissues. Arises from disease of heart, lung tissue, bloodvessels, or 
 anaemia. 
 
 PULMONARY CANCER. — Most commonly of encephaloid character.
 
 220 PULMONAKY CONDENSATION. 
 
 May occur as a primary or secondary infiltration, or as a primary or 
 secondary nodular deposit. Generally associated with mediastinal 
 cancer. See Intrathoracic Tumors. 
 
 Symptoms. When occviYrxng^ primarily ; Flattening of affected side, 
 impairment of respiratory movements, dulness on percussion. Pain, 
 emaciation, night sweats, d3^spnoea, failure of powers of life, purulent 
 expectoration, &c. Right lung most frequently affected. Often, chronic 
 bronchitis as a complication. 
 
 In secondary cancer, symptoms very obscure. Frequently, dj^spnoea 
 the chief indication of pulmonary mischief Both lungs usually 
 affected. 
 
 Primary cancer oi pleura very rare. Usually the disease is associated 
 with cancer of lung, pericardium, mediastinum, &c. Deposit found as 
 small spots, or hard layers, or in form of tumors which sometimes 
 become pediculated. May be attended with effusion of serum, or pus, 
 or blood. Symjitoms sometimes simulate those of phthisis. 
 
 Treatment. Attempts must be made to relieve symptoms as they 
 arise. Strength to be supported by nourishing food ; cod-liver oil ; 
 stimulants. If there be much suffering, morphia with chloroform and 
 Indian hemp, 317. Opiate enemata, 339. Opiate suppositories, 340. 
 Subcutaneous injections of morphia, 314. 
 
 PULMONARY CONDENSATION.— Consolidation of the vesicular 
 tissue of the lung may arise from several causes. Thus, it may result 
 from pneumonia, phthisis, cancerous deposit. From pressure exerted 
 on lung, b}^ fluid poured out in pleurisy ; by extravasated blood, as in 
 pulmonary apoplexy ; by enlarged bronchial lymphatic glands, which are 
 arranged along sides of air-tubes; b}^ aneurismal or other intrathoracic 
 tumors. A small tube, or even a main bronchus, may thus become so 
 obstructed that air cannot pass; and as a consequence there results 
 collapse of that portion of lung to which the compressed bronchus 
 leads. 
 
 In cirrliosis of the lung, the vesicular structure contains no air, and is 
 infiltrated by a tough fibrous and grajash material. Perhaps there 
 may be numerous small cavities filled with yellowish viscid mucus; the 
 cavities consisting of dilated bronchial tubes. If entire lung be affected 
 there will be dulness on percussion ; exjjansion movement scarcely per- 
 ceptible; no vesicular murmur ; but perhaps loud gurgling rhonchi on 
 forced inspiration. 
 
 Another important form of pulmonary condensation is due to collapse 
 of the air-cells from the plugging up of a bronchial tube. This condition 
 sometimes described as disseminated lobidar pneumonia, marginal pneu- 
 monia, carnification, or pulmonary collapse. It may be acquired or con- 
 genital : 
 
 In acquired pulmonary collapse, the margin of lung, or an irregular 
 portion of one lobe, or an entire lobe, or the whole of the organ may be 
 involved. Obstruction owing to increase in secretion of mucous lining 
 of tubes, with inability to cough it up. Hence, not uncommon during 
 course of bronchitis or hooping-cough in feeble subjects. Or, secretion 
 natural in quantit}^, but unduly viscid; while from debility or old age 
 it is expelled so imperfectly that an accumulation takes place in central 
 or some other part of lung, and acts like a plug. Plwsical signs, — dul- 
 ness on percussion, with an absence of res})iratory murmur over affected 
 parts: unless morbid condition has been of some duration, when these 
 signs may be masked by occurrence of a kind of compensating emphy- 
 sematous distension of those portions of lung anterior to obstruction. —
 
 PULMONARY GANGRENE — PYEMIA OR PYOII^EMIA. 221 
 
 Stimulants, tonics, and restorative food are the only remedies of any 
 value. 
 
 Congenital non-expansion of air-cells met with in weakly infants. Known 
 as Atelectasis, from 'Jr^Ajj^, imperfect; ^/.raffi-, expansion. An infant so 
 affected looks as if about to die. Often jaundiced : cry consists of a 
 weak whim])er : inability to suck: drowsiness and exhaustion: surface 
 cold and slightly livid : chest but partially dilated by imperfect respira- 
 tory movements. The solidity will perhaps lessen as strength is gained, 
 and good health be ultimately attained ; or death may occur from ex- 
 haustion, with convulsions. To obviate latter, child to be wrapped in 
 cotton-wool, and kept in warm room ; hot bath once or twice in twenty- 
 four hours; friction of chest with cod-liver oil and soap liniment; ad- 
 ministration of milk, port wine, a few drops of tincture of bark, and 
 solution of raw beef every two hours. 
 
 PULMONARY GANGRENE.— Gangrene of the lung is an occasional 
 termination of pneumonia in enfeebled constitutions, -with a depraved 
 state of blood. Very rarely occurs independentl}'" of pneumonia, from 
 some impediment to pulmonary circulation. May be met with in chil- 
 dren as an accompaniment of cancrum oris. The gangrene may be dif- 
 fused or circumscribed. 
 
 Symptoms. Great and increasing debility. Loss of flesh. Hectic 
 fever. Night-sweats. Weakness and rapidity of pulse. Anxiety of 
 countenance. Cough. Expectoration of frothy greenish-tinted sputa, 
 which have a most offensive odor. Offensive putrid breath. In diffused 
 gangrene, patient soon sinks from exhaustion. In the circumscribed 
 form the symptoms come on more gradually, beginning with indications 
 of pulmonary congestion. After a time there may be a little improve- 
 ment; which slowly increases, and patient recovers. — In both forms, 
 the physical signs are those of pulmonary condensation ; with, subse- 
 quently, those caused by destruction of tissue and the formation of a 
 cavity. 
 
 Treatment. Ammonia and bark, 371. Bark and uitro-hydrochloric 
 acid. Tincture of perchloride of iron. Quinine with a mineral acid, 379. 
 Solution of chlorinated soda, 76. Opium. Compound tincture of ben- 
 zoin. Sulphite of magnesia, 48. Chlorate of potash. Inhalation of tur- 
 pentine vapor, 260. Inhalation of atomized solutions of turpentine, steel, 
 iodine, or sulphate of zinc, 262. Inhalation of diluted oxygen gas. Cod- 
 liver oil. Animal food. Good soups. Milk, cream, and raw eggs. Stout, 
 or ale. Port wine, or bi'andy. 
 
 PURPURA. — From llofj<pijpa, a purple dye. Synon. Malignant Petech- 
 ial Fever ; Ha^morrhcea Petechialis. — A morbid condition of the blood 
 and capillary vessels; leading to disintegration of the red corpuscles, 
 with diffusion of their contents. 
 
 Symptoms. Languor and debility. Sallow or dusky complexion. 
 Epistaxis. Pains about epigastrium. Craving for food. Palpitation. 
 Giddiness. Constipation. Sanguineous effusions into different tissues. 
 Small hemorrhagic spots or petechia. Large patches, — vibices or ec- 
 chj-moses. Enlargement and softening of the spleen. 
 
 Treatment. Animal food. Fresh fruit or vegetables. Milk. Wine 
 or beer. Aloes. Senna. Castor oil. Bai'k and mineral acids, 376. 
 Nitro-hydrochloric acid, 378. Quinine, 379. Arsenic, 381. Iron, 397, 
 399. 'Vinegar. Nitrate of potash ? Oil of turpentine, 50. Gallic acid, 
 103, Citric acid. Lemon-juice. 
 
 PYJEMIA OR PYOH^MIA.— From TWov, pus; al/^a, blood.— Blood-
 
 222 PYELITIS — RECTAL CANCER. 
 
 poisoning, owing to absorption of ichorous or putrid matters. — See Ich- 
 or hcemia. 
 
 PYELITIS. — From flueXoq, a trough; terminal -itis. — Inflam.mation of 
 mucous membrane lining pelvis and infundibula of kidney. — See Neph- 
 ritis. 
 
 PYREXIA. — From Uop, fire ; eyio, to bold. — The febrile state, or an 
 attack of fever. — See Fevers. 
 
 PYROSIS. — From Hupou), to set on fire. Synon. Ardor Stomachi; 
 Water-I/rash. — A form of indigestion in which there is frequent eructa- 
 tion of a thin, watery, and acid or tasteless fluid. More common in 
 women than men. Not infrequent in advanced life. Often exists in 
 connection with some derangement of nervous or uterine system; or 
 with organic disease of stomach, panci'eas, or liver. 
 
 Symptoms. Pain at pit of stomach, followed by eructation of watery 
 and insipid or acid fluid. Sometimes nausea and vomiting; heartburn. 
 Often associated with other symptoms of indigestion. 
 
 Treatment. White bismuth. Solution of ammonio-citrate of bis- 
 muth (Schacht's). Bismuth lozenges (officinal). Bismuth, with mag- 
 nesia or soda, 65, 112. Saccharated solution of lime and milk, 14. So- 
 lution of potash and lime-water, 73. Ammonia in eifervescence, with 
 hydroC3'anic acid, 362. Carbonate of magnesia. Opium. Henbane. 
 Hop. Kino. Powder of kino and opium. Compound powder of rhu- 
 barb. Aromatic sulphuric acid. Nux vomica. Alum. Nitrate of silver. 
 Oxide of silver. Oxalate of cerium. Compound tincture of benzoin. 
 Gallic acid. Tannin lozenges (officinal). Iron alum. 
 
 For diet, &c., see Dyspepsia. 
 
 PYTHOGENIC FEVER.— Looking to the origin of the typhoid poison, 
 the appelhition o^ Pythogenic Fever has been suggested, — TMOityv^r^z-, from 
 TtbOwv {-(jfloiiai, to putrefy), and yzwdut, to engender. Literally, " born of 
 putridity" (Murchison). Synon. Enteric or Typhoid Fever. — See Typhoid 
 Fever. 
 
 RABIES. — From Rahio, to rSi\Q. Synon. Morbus Hydrophohus ; Ra- 
 bies Canina ; Water-Fright. Canine madness. — See Hydrophobia. 
 
 RACHITIS. — From ^Pdyiq, the spine; terminal -itis; so named be- 
 cause of the opinion that the spinal cord is in fault. Synon. Rhachitis; 
 Osteomalacia Infantum; Innutritio Ossium. — See Rickets. 
 
 RECTAL CANCER. — May be of scirrhous, medullary, or colloid form. 
 Epithelial cancer sometimes attacks anus, and may extend some dis- 
 tance up the rectum. 
 
 Symptoms. Not we,ll marked at first: but little suff'ering until diffi- 
 culty in defecation arises. When practitioner is consulted, coats of 
 bowel generally found extensively infiltrated with cancer, producing 
 considerable contraction. Severe lancinating pains. Frequent attacks 
 of hemorrhage. Ofl'ensive muco-purulent discharges. Debilit}', ending 
 in complete prostration. Loss of flesh. Cancerous cachexia, &c. Ul- 
 ceration into bladder or urethra in men : frequently, into vagina in 
 women. Death from exhaustion. 
 
 Treatment. Opium, 343. Opium and belladonna, 344. Opiate sup- 
 positories, 340. Subcutaneous injections of morphia or atropine, 314. 
 Morphia, chloi'ofbrm, and Indian hemp, 317. Iodoform pills or supposi-
 
 RECTAL NEURALOIA — RECTAL TROLAPSUS, 223 
 
 toricR, 338. Nourisliing food: milk, cream, raw ei!;^8. Brandy: wine. 
 Formation of artificial anus in left loin : so as to jjrolong life for a few 
 months, and render it more endurable. In epithelial cancer, — excision, 
 cutting wide of affected tissue, and immediateh'^ afterwards touching all 
 parts of raw surface with chloride of zinc. — See Cancer. 
 
 RECTAL NEURALGIA.— Synon. Proctalgia.— }il ay persist for many 
 weeks, without altogether subsiding for a day. Pain aggravated by 
 passage of stools. Tenesmus. Pain ma}' be confined to a single spot. — 
 To be cured by nourishing food. Pepsine, 420. Simple enemata, 188. 
 Suppositories of opium and belladonna, 340. Quinine. Zinc. Steel. 
 Cod-liver oil. — See Neuralgia. 
 
 An irritable sphincter muscle causes pain in defecation. On introduc- 
 ing finger, the muscle grips it very tightly. Mild laxatives. Bougies. 
 Belladonna ointment. Improvement of general health. 
 
 RECTAL POLYPUS.— From /Zr^Au?, numerous; ;r«u?, the foot,— because 
 these tumors were supposed to be attached by many roots. — More 
 common in children than adults. The pedunculated growth arises from 
 the mucous membi'ane; and it may bo soft or follicular, or firm and 
 fibrous. — A villous tumor, resembling that sometimes found in urinary 
 bladder, occasionally grows with a broad base from mucous membrane 
 of rectum. 
 
 Symptoms. Uneasiness about fundament. Frequent desire to go to 
 stool. Mucous discharges tinged with blood. In villous growths, per- 
 haps abundant hemorrhage. A polypoid tumor usually descends when- 
 ever the bowels act. 
 
 Treatment. Application of a ligature, and immediate removal of 
 tumor below it with scissors. If there be no fear of bleeding, excision 
 only. 
 
 RECTAL PROLAPSUS.— From Prolabor, to glide forward. Synon. 
 Prolapsus Ani ; Proctocele ; Ectopia Ani ; Falling of the Fundament. — 
 There may be protrusion only of mucous lining of rectum, or all the 
 coats of the bowel will be found prolapsed. Caused by want of tone in 
 sphincter ani, constipation, straining at stool, prolonged diarrhoea, irri- 
 tation of worms, disease of urinary organs, stone in bladder, &c. 
 
 Symptoms. At first, protrusion only occurs when bowels act. After 
 a time, descent follows any exertion, as standing, coughing, &c. Onl}^ 
 a fold of raucous membrane comes down, or inverted bowel is forced out 
 to extent of five or six inches. When prolapsus is almost constant, in- 
 testinal mucous membrane becomes indurated, perhaps ulcerated : 
 sphincter ani found much relaxed. Discharge of mucus tinged with 
 blood. A general sense of weight and distress about the body, with 
 severe pain on going to stool. 
 
 Treatment. Eeplacement usually effected without difficulty. Some- 
 times, especially in children, bowel descends immediately after reduc- 
 tion : to be prevented by applying a pad of lint, and drawing buttocks 
 firmly together with a broad strip of adhesive plaster. Advantageous 
 to make children pass their motions in a recumbent posture, so as to 
 prevent violent straining. General health to be imj^roved : bark, qui- 
 nine, glycerine, steel, cod-liver oil. Constipation to be prevented: ta- 
 raxacum, carbonate of magnesia, cream of tartar, or mercury and chalk. 
 After each evacuation, bowel to be replaced: anus to be sponged with 
 cold water. Astringent enemata of alum and decoction of oak-bark; or 
 of tincture of perchloride of iron and water; or of infusions of matico 
 or rhatany. Suj^positories of tannic acid and cocoa butter.
 
 224 RECTAL STRICTURE— RECTAL ULCERS. 
 
 Medical treatment failing : Eectal supporters worn for some time. 
 Production of superficial sloughs by application to mucous membrane 
 of nitrate of silver, nitric acid, solution of perchloride of iron, potassa 
 fusa, or actual cautery. Acid solution of nitrate of mercury objection- 
 able : it may cause salivation. Excision of two or three folds of mu- 
 cous membrane and skin at margin of anus. Several small folds of 
 mucous membrane, at different parts of prolapsed bowel, to be taken up 
 w^ith forceps and then tightly ligatured : ligatures to be cut off short, 
 intestine returned, a dose of opium administered, and patient to be kept 
 in bed until ligatures come away. 
 
 RECTAL STRICTURE. — Synon. Rectostenosis ; Proctostenosis; Strictura 
 Ani. — Stricture of rectum may be limited to a ring of condensed tissue, — 
 the annular form ; or it may be confined to one side of bowel, as when 
 it follows cicatrization of ulcers; or almost the whole gut may be nar- 
 rowed and indurated. To be distinguished from constriction due to 
 cancer, or to pressure of tumors ; as well as from simple spasmodic con- 
 traction produced by irritable ulcer, &c. 
 
 Symptoms. Constipation; small stools; great diflSculty in voiding 
 solid motions. Straining and bearing-down efforts. Flatulence. Pain 
 in loins and sacrum. Mucous discharges, sometimes stained with blood. 
 Depression of general health : low spirits. If ulceration follow, burn- 
 ing pains; tenderness about sacrum and fundament; discharges of blood 
 and pus; considerable constitutional disturbance. 
 
 Treatment. Dilatation by bougies : an instrument to be passed oc- 
 casionally for some months after apparent cure. SjDonge tents, 426. 
 Slight notching of annular stricture with j^robe-pointed bistoury, and 
 plugging with oiled lint; subsequently, use of bougies. Suppositories of 
 opium and belladonna, 340. Aperient electuaries, 194. Simple enemata, 
 especially of olive oil, 188. Nourishing food. Glycerine. Cod-liver oil. 
 
 RECTAL ULCERS. — (1) Irritable ulcer of rectum, or fissure of anus. An 
 aj)parently slight affection, but one which causes great suffering. Ulcer 
 generally superficial ; nbout one-eighth of an inch broad and one-third of 
 an inch long; seated immediately within anus, and generally towards 
 the coccyx. Most common in women ; sometimes produces ovarian pain, 
 irritability of bladder, and great pain during sexual intercourse. Pas- 
 sage of stools irritates' the sore; producing spasm of sphincter ani, and 
 acute burning pain which lasts some hours. — To make a thorough ex- 
 amination, chloroform sometimes needed. — To heal the ulcer, constipa- 
 tion to be prevented by mild aperients. Castor oil. Electuary of senna 
 and taraxacum, 194. Dinner pill of pepsine and watery extract of aloes, 
 155. Cod-liver oil. Nourishing food, free from stimulants. Locall}', — 
 Mercurial ointment and belladonna, made into a solid stick with cocoa 
 butter, 424. Ointment of nitrate of mercury, 305. Calomel and bella- 
 donna ointment, 299. Nitrate of silver to be avoided. A longitudinal 
 incision through centre of ulcer and superficial fibres of sphincter ani : 
 one or two grains of opium immediately afterwards, so as to confine the 
 bowels for two or three days. If an external pile be present near fissure, 
 it should be snipped off. 
 
 (2) Chronic ulceration, with thickening of coats of rectum. May arise as 
 one of secondary effects of syphilis. May also be due to deposit of 
 tubercle; to cancer; or only to a depressed state of general health. 
 Cause to be removed. Opiate and belladonna suppositories, 340. Sub- 
 sequent contraction to be prevented by bougies. 
 
 (3) Rodent ulcer. This intractable disease is met with at margin of 
 anus, the sore gradually creeping up rectum. Requires, — Comjilete
 
 RECTITIS REMITTENT FEVER. 225 
 
 excision. Destruction with potential cauHtics, — chloride of zinc, 197. 
 Steel with arsenic, 381, 399. Cod-liver oil. Sulphate of zinc ointment, 
 294. iSubcutaneous injections of atropine, or morphia, 314. 
 
 RECTITIS. — From Jiectus, straight; terminal -itis. — because this por- 
 tion (»f the gut was supposed to be straight. Synon. Proctitis; Architis. — 
 InHaniination of the rectum and anus. A rare disease, now that drastic 
 purgatives and alcoholic drinks are less abused than formerly. May be 
 produced by external violence, or introduction of some foreign body 
 into gut. 
 
 Symptoms. Sense of intense heat around anus. Severe pain shooting 
 up sacrum and back. Spasmodic contraction and excessive sensitiveness 
 of sphincter ani. Tenesmus, with passage of dark-colored gelatinous 
 mucus. Irritability of bladder. Constitutional disturbance. 
 
 Treatment. Rest in bed. Milk and farinaceous diet. Sedative 
 enemata,339. Opiate suppositories, 340. Ipecacuanha. Saline draughts, 
 348. Hot hip baths. Linseed poultices. 
 
 REFLEX PARALYSIS.— From Reflecto, to turn back. That form of 
 palsy in M'hich the ii*ritation is reflected from periphery to centre. Dis- 
 eases of uterus, urinary organs, and intestines, common causes of this 
 form. To be remedied by cure of cause, provided irritation has not 
 existed long enough to induce organic disease in spinal cord, — See 
 Paralysis. 
 
 RELAPSING OR FAMINE FEVER.— The name of relapsing or recur- 
 rent fever has been bestowed upon this infectious disease, because at a 
 certain period of tlie convalescence there is a relapse of all symptoms. 
 Epidemics of it have been recognized, during seasons of famine and 
 destitution, since 1739; and have been described under various names. — 
 Five-day fever ^ Seven-day fever, Bilious remitteyit fever, Mild yellow fever, 
 Synocha, and Irish famine fever. 
 
 Symptoms. There may be a latent period of three or four days, or 
 not. — Rigors, frontal headache, muscular pains; followed by fever, rapid 
 pulse, thirst, pain at epigastrium, and vomiting. Sometimes great de- 
 sire for food. True petechiae and purpuric spots perhaps appear, but no 
 characteristic eruption. Prostration. On tifth or seventh day great 
 amendment. Patient progresses steadily towards convalescence ; when 
 about fourteenth day from commencement of symptoms, there is a re- 
 lapse. On third or fourth day afterwards, there is again improvement, 
 and gradual restoration. — Seldom fatal: mortality about one in forty. 
 
 Treatment. Gentle aperients. Refrigerating drinks. P^arinaceous 
 diet. Perfect repose. Quinine. Opium, VVine. Tea and coffee. Spong- 
 ing body with tepid water, or vinegar and water, 138. If there be jaun- 
 dice, nitro-hydrochloric acid, 378. Nitrate of potash. Dry cupping to 
 nape of neck. No remedy prevents the relapse, 
 
 REMITTENT FEVER.— From Pemitfo, to abate. Synon. Febris Pe- 
 mittens. — The cause of this disease being the same as that of ague, it 
 might be described as miasmatic ov paludal remittent fever. 
 
 Remittent fever varies much in severity according to nature of climate 
 in which the poison is generated. Autumnal remittents of England and 
 France, comparatively mild: endemic remittents of tropical climates 
 often very severe and fatal. The locality where the fever prevails seems 
 often to impress some peculiarity upon it, especially as regards the na- 
 ture of the complications which arise : hence remittent fever has been 
 described under the names of Walcheren fever, Mediterranean fever, Jungle 
 
 15
 
 226 RENAL CANCER RENAL DEGENERATIONS. 
 
 or Hill fever of East Indies, Bengal fever, Bilious remittent of West Indies, 
 Sierra Leone fever, African fever, &c. 
 
 Symptoms. The symptoms bear a resemblance to those of intermittent, 
 fever except that there is no cessation of the fever, but simply an abate- 
 ment or diminution. Length of remission varies from 6 to 12 hours; 
 at the end of which time the feverish excitement increases, the exacer- 
 bation being often preceded by chilliness and rigors. 
 
 Eemissions usually occur in the morning: the principal exacerbation 
 is generally towards the evening. The disease may run on for some 14 
 or 15 days, and end in an attack of sweating ; or it may merge into low 
 fever. In England, in 1861, the deaths from it were 254; and as 99 of 
 these were in children under 5 years age, it is probable that the first 
 number indicates a larger mortality than reall}" existed. Infantile re- 
 mittent is a form of typhoid fever. 
 
 Treatment. Principles to be followed, the same as in ague. At- 
 tempts to be made to shorten the exacerbation, and to lengthen the 
 remission.— Saline and effervescing draughts, 348, 349, 354. Cold drinks, 
 — water; lemonade; ice; cold tea; cream of tartar, 356, 360. Aperients, 
 139, 140, 144. Emetics of ipecacuan, if there be nausea without vomit- 
 ing, 231. Sinapisms to epigastrium, if there be troublesome vomiting. 
 Tepid sponging, 138. Cold affusion, 134. Wet-sheet packing, 136. Sim- 
 ple diet. Avoidance of stimulants. 
 
 Directly remission takes place, from 1 to 6 grains of quinine to be 
 given every six hours : omitting it as the hot stage sets in. At next 
 remission, to be commenced again. 
 
 Salicin. Sulphate of beberia. Warburg's tincture. Cold affusion; 
 blisters to nape of neck, if stupor set in. If there be jaundice, turpen- 
 tine stupes or sinapisms to epigastrira. Nourishing broths; raw eggs; 
 and stimulants when depression follows. Avoidance of mercury and 
 bloodletting at any stage. 
 
 RENAL CANCER. — The rarest form of kidney disease : most com- 
 }non during first years of childhood and in old age. Enccphaloid cancer 
 much more frequent than scirrhus. When the disease is primary only 
 one gland is usuall}^ attacked : if secondary, the reverse. Cancerous 
 degeneration usually commences in cortical substance, and thence ex- 
 tends to medullary cones as well as to pelvis and ureters. 
 
 In primary cancer, the renal tumor frequently attains an enormous 
 size: fills abdominal cavity, so that it has been mistaken for ovarian 
 tumor. In secondary form, kidneys enlarge to smaller extent: often 
 feel nodulated on surface. 
 
 Chief symptoms, — Enlargement of affected gland. Ilsematuria ; more 
 blood escaping than in cases of calculus. Pain in loins. Sickness. Ema- 
 ciation. Anasarca: perhaps ascites. Fatal exhaustion. 
 
 Medical skill can only relieve the prominent symptoms. If passage 
 of urine be obstructed by blood-clots, catheter must be used. 
 
 RENAL DEGENERATIONS.— From Ben, a kidney: Degenero, to de- 
 generate. — Three ditfei'eiit varieties of kidney disease included under 
 this head : Fatty, Amyloid, and Cystic Degeneration. 
 
 1. Fatty Degeneration. — Synon. Grannlar JDegeneration of Kidney; 
 BrighVs Disease. — Ma}- be the result of acute desquamative nephritis ; 
 of strumous diathesis; bad living, intemperance, constant exposure to 
 wet and cold, &c. 
 
 Symptoms. Gradually increasing debility; frequent and irritable 
 pulse; striking pallor — perhaps combined with puffiness — of face and
 
 RENAL UEGExXEKATIONS. 227 
 
 skin generally; frequent mielurition, patient liaving to rise once or 
 of'tener in night to pass water; dysjiepsia, with attacks of obstinate 
 vomiting. A tendency to grave inHanitnations of serous membranes — • 
 pericarditis, peritonitis, meningitis, pleurisy; also to amaunjsis, some* 
 times attacking both e3'es, and perliaps due to fatty degeneration of 
 retina. Anasarca of limbs, with dropsy of diiferent cavities; in rare 
 cases (unless there be coexistent heart disease) anlema of lungs, set- 
 ting in suddenly, and rapidly producing serious dyspnoea. Ultimately, 
 convulsions, due to effects of retained urea upon nervous system ; coma, 
 soon ending in death. 
 
 Characteristic appearances of urine: Scanty secretion, highly albu- 
 minous, of low specific gravity. In early^ stages, generally free from 
 sediment; examined by microscope, neither renal epithelium, nor casts 
 of tubes found. After a variable interval, while general characters of 
 urine remain unaltered, there appears a light cloudy sediment; contain- 
 ing small waxy casts, in which are entangled one or more globular or 
 oval cells inclosing numbers of oil-globules. Several cells completely 
 filled with oil, presenting appearance of dark opaque masses. Usually, 
 the casts have adhering to their surface man}^ small oil-globules, which 
 have escaped from ruptured cells; while numerous cells containing oil, 
 together with detached oil-globules, are scattered over field of micro- 
 scope. 
 
 When the urine is of natural color, highly albuminous, and presents 
 a large number of oily casts and cells, prognosis most unfavorable. 
 These appearances indicate as serious and intractable a malady as tuber- 
 cular disease of lung (George Johnson). 
 
 Treatment. Palliation of symptoms. Regulation of diet : absti- 
 nence from intoxicating drinks, starch, sugar. Sea air. Occasional 
 purgatives, — Compound jalap powder; elaterium, &c. Bark or quinine. 
 Mineral acids. Ferruginous tonics. Opium may be needed if there be 
 great irritability and restlessness : it must be prescribed with great cau- 
 tion. Hot water or vapor baths. Puncture of anasarcous extremities. 
 — See Nephritis; Urauiua; Fatty Degeneration. 
 
 2. Amyloid Degeneration. — Synon. Waxy.ov Amyloid form, of BrighVs 
 Disease. — Waxy, lardaceous, or amyloid degeneration of kidney prob- 
 ably never exists alone. It renders kidney inefficient as an excreting 
 organ, and ultimately useless. Has often some connection with scrofula, 
 syphilis, oi-disease of bones. 
 
 Symptoms. Loss of strength, coming on gradually. Lassitude* 
 Thirst. Excessive secretion of urine : patient has to rise two or three 
 times during night to micturate. (Edema of feet and ankles. Enlarge- 
 ment of liver and spleen. Urine albuminous, of low specific gravity, 
 pale in color, of acid reaction : under quarter of an inch object-glass 
 delicate and transparent and waxy or hyaline tube-casts are seen, which 
 are formed by the coagulation of an exudation from bloodvessels into 
 tubules denuded of epithelium. Progress of case slow. Sooner or later, 
 anaemia; diminution in quantity of urine, with increase of albumen. 
 Diarrhoea, if intestinal mucous membrane become affected with waxy 
 degeneration. Ascites, or general dropsy. Death from effusion into 
 pleurai or pericardium; from bronchitis, or phthisis; from exhaustion;- 
 or from convulsions and coma due to urtemic toxfemia. 
 
 Treatment. Good may be effected in early stage b}' sea air; nour- 
 ishing food ; ferruginous tonics. If there be any syphilitic taint, — Iodide 
 of potassium, 3L Iodide of iron, 32, 890. Subsequently, relief of 
 prominent symptoms. — See Urcemia. 
 
 3. Cystic Degeneration. — Four forms of cystic disease may affect the
 
 228 RENAL PARASITES — RETINITIS. 
 
 kidney: (1) Small scattered cysts, few in number, are often present on 
 surface of kidneys, or in cortical substance, without interfering with 
 functions of these glands. Very rarely such a cyst attains a great size, 
 contains some pints of fluid, and forms an aj^preciable abdominal tumor. 
 — (2) Cysts, varying in size from a pin's point to a hazel-nut, are not 
 uncommonly developed in kidneys aft'ected with chronic desquamative 
 neyjliritis. Result of obstruction of uriniferous tubes by exudation. — 
 (3) Congenital cystic degeneration, may be complete or incomplete. 
 Infants sometimes born with large irregular-shaped kidneys made up 
 entirely of cysts, M'ithout any trace of secreting tissue. Usually com- 
 bined with other malformations. — (4) General cystic degeneration may 
 occur gradually in adults, OAving to expansion of portions of uriniferous 
 tubes, with obstruction and atrophy of intervening sections. Symp- 
 toms come on ver}^ gradually, not very marked: perhaps frequent 
 attacks of hsematuria, albuminuria, pains about loins. Occasionally en- 
 largement of kidne3's, so as to produce distinct tumors. Death from 
 some complication, or ultimately from urasmia. 
 
 RENAL PARASITES.— Four varieties of Entozoa may infest the 
 kidneys: (1) Hydatids, containing echinococei. Very much more rare 
 than in the liver. Sometimes, renal hydatid cysts discharged with 
 urine : perhaps with symptoms like those produced by passage of a 
 calculus. Recovery may follow : or cysts may be discharged at inter- 
 vals for years: or death occurs from rupture of parent cyst into parts 
 around kidney, or from its exciting inflammation and suppuration. 
 Opium, iodide of potassium, and warm baths are remedies to be tried. 
 If cyst attain a large size, puncture with a fine trocar may be justifi- 
 able. — (2) Distomaha3matobium : cause of endemic hematuria of Egypt, 
 &c. See Hcematosoa. — (3) Tetrastoma renale : said to infest uriniferous 
 tubes, but no instance of its occurrence known in this countr}'. — (4) 
 Strongjdus gigas : very rare. One specimen in JVLuseum of Royal Col- 
 lege of Surgeons. — See Entozoa. 
 
 RENAL TUBERCLE.— Synon. Tuberculous Pyelitis. — Much more com- 
 monly a secondary than primary affection. In former case, seldom de- 
 tected till after death : both glands involved. In latter, disease extends 
 from kidney to ureter and bladder. Ijarge tubercular cavities pro- 
 duced, Avith destruction of renal tissue. Urine contains pus, blood, and 
 tubercular debris if ureter be unobstructed. One or both kidneys may 
 be affected. Symptoms, those of tuberculosis; with burning pains in 
 loins, purulent and bloody urine, and rapid emaciation. Perhaps, renal 
 tumor; owing to confluence of tubercular deposits, or to gradual dis- 
 tension of pelvis by retained urine and pus. Death occurs from ex- 
 haustion in course of eighteen months; from progress of similar disease 
 in other organs, or from uraemia, or ichorhaimia. 
 
 RETINITIS. — From Rete^ a net or web ; terminal -itis. Synon. Tn- 
 fiainmatio Retinae. — Inflammation of the delicate nervous membrane 
 called the retina occurs as a sympathetic aftection in the course of other 
 ophthalmia?. As a simple idiopathic inflammation it is exceedingly rare. 
 
 Symptoms. Acute deep-seated pain in ejeball, extending to temples 
 and forehead; great intolerance of light; dimiimtion or loss of })ower 
 of vision; frequent sensation of flashes of light. Pupil found con- 
 tracted; iris loses its brilliancy and becomes motionless; vascularity of 
 the sclerotic. Constitutional disturbance severe. High fever and de- 
 lirium often present. — When acute symptoms have subsided, the oph- 
 thalmoscope shows vessels of retina congested and varicose; transpar-
 
 RETKO-PIIARYNGEAL ABSCESS — RHEUMATISM. 229 
 
 ency of retina impaired; while extravasations of V)loo(l may often be 
 seen, owin<j; to rupture of one or more vessels. In untavorable cases, 
 masses of black ])igment are visible on choroid and retina: these tissues 
 gradually get atrophied: total blindness results. 
 
 Generally caused by exposure to vivid light — large fires, furnaces, 
 &c. Ileflected light very injurious to retina; hence jiernicious effects 
 of glare from snow, or from burning sands of tropical climates. 
 
 Trkatmknt. Perfect rest in a darkened room. Applications of cold 
 lotions or of hot fomentations, according to the patient's feelings. Mild 
 purgatives. Sedatives to relieve pain. Simple diet. 
 
 RETRO-PHARYNGEAL ABSCESS.— From Retro, backwards ; (Pdjwy^^ 
 the ])harynx; Abscedo, to foi-m an abscess. — Result of acute or chronic 
 inflammation of loose areolar tissue between posterior wall of pharynx 
 and muscles on anterior part of spine. Often connected with strumous 
 diathesis. Perhaps may occur in association with syphilitic taint. 
 More common in children than adults. 
 
 Symptoms. Derangement of cerebral, respiratory, and circulatory 
 systems. Fever, nausea, restlessness, soreness of throat. Difficulty in 
 swallowing and breathing. A fixed and retracted state of head: 
 rigidity of muscles at back of neck. More or less locked state of jaws : 
 painful and difficult and drawling articulation. As painful deglutition 
 increases, solids are refused ; liquids regurgitate through nose. Spas- 
 modic efforts at swallowing, as if there was food in gullet. — On 
 examining fauces, a firm and projecting tumor is felt just beyond base 
 of tongue. — Death has occurred from convulsions ; from coma ; from 
 tumor pressing pharynx forwai'ds on epiglottis and rima glottidis, 
 causing suffocation ; from abscess suddenly bursting, with inspiration 
 of pus into trachea. 
 
 Treatment. Puncture with a bistoury : head to be pressed forwards 
 directly opening is made so as to facilitate escape of pus by mouth. 
 Ammonia and bark, 371. Syi'np of phosphate of iron, 405. Quinine, 
 379. Cod-liver oil. Nom-ishing food. Malt liquors: wine. 
 
 RHEUMATISM. — ' Peurj.aTt<T/j.d^, a flux or looseness; /^su/iart^o/xai, to be 
 affected with looseness — from peufj.a, a humor floating in the body causing 
 disease. There are two forms of rheumatism, the acute and chronic ; 
 
 1. Acute Rheumatism. — Synon. Rheumatic Fever; Synocha Rheumatica ; 
 JIa'nioarfhritis. — A formidable disease, owing to the suffering it causes, 
 the intensity of the fever, and the damage it so frequently inflicts upon 
 the heart. — A superabundance of lactic acid in the system is the sup- 
 posed cause. The suggestion probably true, that ordinaril}^ the starch 
 of the food is first converted into lactic acid ; this then combines with 
 oxygen to form carbonic acid and w^ater, which is excreted by the 
 lungs; but under conditions unfavorable to this oxidation the Jactio 
 acid accumulates in the system (Headland). 
 
 Symptoms. Restlessness and fever, stiffness and aching pain in limbs, 
 following exposure to cold and damp. Pain quickly increases ; swelling 
 and tenderness of one or more large joints: high fever and constitu- 
 tional disturbance. Patient soon rendered a pitiable spectacle of help- 
 less suflFering. He dare not move; pain in joints so agonizing, that 
 weight of bed-clothes cannot be borne ; skin' bathed in sweat, of a disa- 
 greeable acid or sour odor; pulse, full, bounding, and quick; usually 
 constipation, sometimes diarrhoea; tongue moist, but thickly furred;; 
 and urine high-colored, acid, scanty, loaded with urates. Relapses very 
 common.
 
 230 RHEUMATISM. 
 
 Complications: A tendency to metastasis, the inflammation suddenly- 
 leaving one part and reappearing in another. Most serious change, 
 when the pericardium or endocardium becomes aifected. Sometimes 
 complicated with bronchitis, pleuris}^, pneumonia, or inflammation of 
 brain and its membranes. Disorganization of one or more of the 
 aftected joints rarely occurs. 
 
 When uncomplicated, average duration from twelve or sixteen to 
 thirty days. If fatal, this result usually due to the cardiac affection. 
 
 Treatment. Venesection been recommended, but loss of blood is 
 badly borne. Saline purgatives, 140, 141, 152, 155, 165, 169. Calomel 
 and jalap. Opiates, in doses sufficient to relieve the pain. Powder of 
 ipecacuan and opium, 213. Quinine. Quinine and iodide of potassium. 
 American hellebore. Guaiacum. Liquor potassae. Sulphur. Nitrate 
 of potash, sometimes to extent of 480 grains in 24 hours. Lemon-juice. 
 Free blistering, excluding all drugs and other applications. 
 
 Most reliable remedies: Opium. Large doses of the alkalies and their 
 salts, as from 20 to 60 grains of bicarbonate of potash or soda, in an 
 etlervescing draught, every thi"ee or four hours. Colchicum, if urine 
 continue loaded with lithates. Iodide of potassium, if disease remain 
 stationar}' in one or two joints. Hot air or vapor baths, if perspiration 
 be scanty. During convalescence: Ammonia and bark, 371. Quinine 
 and iodide of iron, 382. Mild preparations of steel, 390, 391, 394, 401, 
 403, 404. Cod-liver oil, 389. 
 
 Diet: At first low; slops and arrowroot. Beef tea; milk and lime- 
 water, 14; eggs, cream, and beef extract, 5; sherry and soda water. 
 Light puddings; vegetables; white fish. Mutton, poultry, and beef not 
 to be allowed too soon. Malt liquors, port wine, and sugar to be avoided. 
 
 Local remedies: To lie between blankets in preference to sheets. 
 Wrajiping aff'ected joints in cotton-wool and oiled silk. Hot alkaline 
 fomentations. Hemlock poultices. Small blisters at a late stage. Iodine 
 paint, 205. If the heart be irritable, large hot linseed-meal poultices. 
 If there be effusion into pericardium, large blisters over cardiac region. 
 Turpentine stupes. 
 
 2. Chronic Rheumatism. — Synon. Rheumatismus Non-febrilis ; Rheumat- 
 algia ; ArthroJynia. — Sometimes a sequel of rheumatic fever, but gen- 
 erally a separate constitutional affection. Very common in old age. 
 The fibrous textures around the joints, or the fibrous envelopes of the 
 nerves, or the aponeurotic sheaths of the muscles, or the fasciie and 
 tendons, or the peiiosteum are the parts which suffer. 
 
 Varieties: Gonorrhoeal rheumatism. Lumbago. Sciatica. Stiff or 
 wry neck. Pleurodynia. 
 
 Treatment. Attention to the general health, and to the organs of 
 digestion. Sedatives to procure sleep. — Iodide of potassium, with tinc- 
 ture of serpentary or bark, 31. Liquor potassai. Ammoniated tincture 
 of guaiac, 43. Cod-liver oil, 389. Quinine, with or without belladonna, 
 45, 386. Iodide of iron, 32. Ammonia and bark, 68, 371. Oil of tur- 
 pentine, 50. Colchicum, 46. Sarsaparilla, 26. Corrosive sublimate, 27. 
 Eed iodide of mercury, 54. Arsenic^ 52. Aconite, 330, 331. Sulphur, 
 43, 148. Hydrochlorate of ammonia, 60. Tincture of actea racemosa, 
 320. Arnica. Morphia, chloroform, and Indian hemp, 317. Opium and 
 i{)Ocaciianha, 324. Subcutaneous injection of morphia, 314. 
 
 Sidphurous waters of Hurrogate, 466. Sea air, and warm salt water 
 baths. Alkaline waters of Vichy, 479. Antacid springs of Carlsbad, 
 496. Hot air or vapor baths. Alkaline baths. Sulphur baths. — Vent- 
 nor, 434; Hastings, 432; Eome, 447 ; and Nice, 443, are good winter 
 residences for habitual sufferers.
 
 RHEUMATOID ARTHRITIS — RIIINORRHCEA. 231 
 
 Locally: Blisters, 208. Iodine paint, 205. Belladonna and aconite 
 liniment, 281. Chloroform and opium liniment, 282. Veratria oint- 
 ment, 304. Powdered sulphur. Plasters of belladonna or opium. Acu- 
 puncture. Ironing the part, a piece of brown paper being placed be- 
 tween the skin and hot iron. Moxas. Application of a bladder of ice 
 for a \'ii\v minutes. Flannel next the skin. 
 
 RHEUMATOID ARTHRITIS.— From 'Ftutm, a humor floating in the 
 body causing disease; eldoz^ appearance; apOpm^ a joint, terminal -iti^. 
 Sjnon. Rlu'Kniatic Gout; Chronic Rheumnilc Arthritis; Nodosity of the 
 Joints. — A chronic inflammatory affection of the joints, not unlike gout 
 in a few of its characters, somewhat resembling rheumatism in other 
 points, but differing essentiall}^ from both. 
 
 Symptoms. Pain, swelling, and stiffness of affected joints. In acute . 
 cases, disease comes on abruptly with fever and general disturbance; 
 but usually the affection is chronic, commencing with languor, restless- 
 ness, loss of appetite, and vitiated secretions. The joints become stiff 
 and painful ; effusion into the synovial membranes causes them to ap- 
 pear swollen and distended ; and if hip, knee, or ankle be the parts 
 affected, there is lameness. Fluctuation can sometimes be detected ; or, 
 a distinct kind of crepitus may be felt. A peculiar crackling of the 
 joints on movement is appreciable to the patient. If the disease be of 
 long continuance a degree of rigidity may occur from thickening of the 
 articular textures, equal to that produced by bony anchylosis; or the 
 joint may become quite disorganized from a gradual wasting of the car- 
 tilages. In addition, the articulations become deformed; there ai'c 
 painful spasms in the muscles of the limbs, mental depression, general 
 lassitude, dyspepsia with acidity of stomach, rest at night disturbed, 
 every change in the weather felt, while owing to the languid circulation 
 the patient suffers much from cold. The complaint always lasts for 
 several months, — sometimes for years. 
 
 Treatment. General health to be improved. Uterine functions to 
 be regulated. Generous diet, with animal food. Claret, sherry, brandy^ 
 whiskey, bitter ale. Warm clothing. Carriage exercise. Sugar, pastry, 
 pickles, and cheese to be forbidden. 
 
 Sulphate and carbonate of magnesia, 141. Confection of sulphur. 
 Sulphate of soda, 148, 153. Cod-liver oil. Arsenic with quinine, iodide 
 of potassium, steel, taraxacum, and colchicum, 31, 32, 46, 52, 381. 
 Either of foregoing drags separately, especially arsenic. Lemon-juice.. 
 Mineral acids, 376, 378. Guaiacum, 43. Bark and serpentary, 375, 
 Opium. Indian hemp. Aconite. Chloroform. Tincture of arnica. 
 Leeches. Blisters. Mercurial or iodine plasters. Sulphur, and flannel 
 bandages. Aconite lotions. Friction, or shampooing. 
 
 Sulphur or alkaline baths, 121, 125. Arsenical baths, 128. Vapor or 
 hot air baths. Harrogate waters, 4G6. Buxton, 464. Bath, 460. Spa, 
 467. Sehwalbach, 488. Aix-la-Chapelle, 483. Wiesbaden, 489. Wild- 
 bad, or Baden-Baden, 492. Carlsbad, 496. Vichy, 479. 
 
 RHINOLITHES. — From 'Ph, the nose; /.idoq, a stone. — Concretions 
 of phosphate and carbonate of lime, magnesia, and mucus, which occa- 
 sionally form in one of the nasal cavities. Nucleus may consist of a 
 shell, piece of pencil, bean, or an}' foreign hod}'. Easily detected by 
 sounding with a probe. Removal with forceps. — See Ozcena. 
 
 RHINORRHCEA. — From 'Ph, the nose; piw. to flow. Synon. Bhino- 
 blennorrhoea ; Nasal Gleet. — Chronic inflammation of the nostrils, pro- 
 ducinir a constant discharire of mucus. — See Oza'na.
 
 232 RICKETS RUBEOLA. 
 
 RICKETS. — Synon. Rachitis; Osteomalacia Infantum. — A disease pe- 
 culiar to childhood, as osteomalacia is to adults. Usually appears to 
 commence about the fifteenth or eighteenth month after birth, when 
 tlie child begins to walk. The bones as they grow remain soft and 
 flexible: they bend under weight of body. The osseous tissue looks 
 natural in structure, but is insufficiently impregnated with earthy salts. 
 Strumous children of the poor mostly suffer. 
 
 Symptoms. Physiognomy peculiar. Growth stunted. Head usually 
 large; forehead prominent; fontanelles close slowly. Tonsils often en- 
 larged. Chest narrow, with prominent sternum — pigeon-breasted. Spinal 
 curvature. Pelvic deformity, so that in after life parturition would be 
 attended with great difficulty. Curvature of the limbs, especially of 
 lower extremities (bandied legs). The deformed bones become firm 
 after puberty. 
 
 Treatment. Attention to general habits, exercise, and clothing. 
 Animal food : milk : raw eggs. Phosphate of lime. Phosphate of iron. 
 Chemical food, 405. Cod-liver oil. Tannic acid. Carrageen, or Irish 
 moss. Light supports for spine, or lower limbs. Bathing with salt 
 water. Friction. Sea air. 
 
 RODENT ULCER.— From Rodo, to gnaw. Synon. Lupoid Ulcer; 
 Ciincroid ; Peculiar Ulcer of Eyelids.— Commences as a hard, irritable, 
 and painful tubercle. Ulceration; the ulcer having hard margins, a 
 dry glossy surface, and tubercles in or adjoining it. Tendency to spread 
 slowly in every direction, completely destroying all adjacent textures — 
 as muscle, bone, eye, &c. Most frequently situated on eyelids; next, on 
 nose or cheeks; sometimes seen on scalp, vulva. Lymphatic glands 
 not affected. General health often remarkably good, even when the 
 ulceration has produced frightful disfigurement. Occurs equallj' in both 
 sexes, after middle period of life, ^o affinity between rodent ulcer and 
 lupus: former, more allied to cancer; latter, a skin disease. 
 
 Treatment. A cure can be effected by thorough extirpation with 
 knife or caustics, — chloride of zinc, potassa fusa, nitric acid: in either 
 operation, anaesthesia should generally be employed. Opium. Cod- 
 liver oil. Nourishing food. 
 
 ROSEOLA. — Dimin. of Rosa, a rose. Synon. Rose Rash; False Measles; 
 Epidemic Roseola. — A non-contagious inflammatory affection of the skin. 
 One of the Exanthemata. Characterized either by transient patches of 
 redness, of small size and irregular form, distributed over more or less 
 of surface of body; or by formation of numerous, small, separate, rose- 
 colored spots. Accompanied by slight fever. Occasionally prevails as 
 an epidemic. Duration from one to seven days. 
 
 Roseola sometimes simulates measles, sometimes scarlatina. No 
 coryza. Soreness and redness of fauces, with gastric distui'bance, often 
 present. — Roseola a?stiva affects adults, especially women, in the sum- 
 mer. May arise in children from dentition. Eruption often preceded 
 by chills and smart fever. 
 
 Treatment. Citrate of magnesia. Sulphate of magnesia Avith acid 
 infusion of roses. 142. Compound rhubarb ])owder. Solution of acetate 
 of ammonia with spirit of nitrous ether, 348. Aromatic sulpluiric acid 
 and compound tincture of gentian. Nitric acid. Quinine. Plain diet. 
 Lemonade. AVarm baths. Sponging with vinegar and water. During 
 teething, lancing of gums may be required. 
 
 RUBEOLA. — From 7?M6eo, to blush. Synon. Rotheln ; Scarlatina Mar-
 
 RUI'IA SCARLET FEVEU. 233 
 
 hiUosn; A Hybrid of Measles and Scarlatina. — A compound of measles 
 and scarlet fever. 
 
 For treatment, sec Scarlet Fever. Maintain functions of skin. Col- 
 chicum has been especially recommended. 
 
 RUPIA.— From 'Putto^, filth; owing to the foulness of the affected 
 parts. Synon. Ulcus Atonicum ; Ecpfilysis Rhypia. — A non-contagious 
 skin disease. May be regarded as a modification of pemphigus occur- 
 ring in debilitated constitutions, and especially in systems contaminated 
 with poison of syphilis. Characterized by eruption of flattened vesicles 
 or bullae; containing at first serous fluid, which soon becomes purulent 
 or sanguinolent, and then concretes or dries into dark and black and 
 rough scabs. Margins of surrounding skin inflame; serum continues 
 to be poured out; incrustation increases in circumference and thickness 
 until it somewhat resembles the shell of a limpet. As crusts fall off 
 they leave circular ulcers, which often only cicatrize after lapse of man}' 
 weeks. Loins and lower extremities most frequently affected. Dura- 
 tion varies from two or three weeks to several months. Seldom any 
 danger, unless a great deficiency of vital power be present. 
 
 Varieties. Three forms usually described. When crusts are thin, 
 and ulcers beneath them superficial. — rupia simplex. If crust be large, 
 constituting marked feature of case, — rupia prominens. Where ulcera- 
 tion is extensive and deep and spreading, — rupia escharotica. 
 
 Treatment. Nitric acid and bark, 376. Quinine and mineral acids, 
 379. Quinine and steel, 380. Cod-liver oil. Phosphate of iron, 405. 
 Bullae to be punctured. Grenerous diet: milk; wine or malt liquors. 
 Warm baths. Change of air. — In syphilitic form: Iodide of potassium 
 and bark, 31. Iodide of iron, 32. Corrosive sublimate, 27. Eed iodide 
 of mercury, 54. Mercurial vapor baths, 131. 
 
 SAINT ANTHONY'S FIRE.— The popular name for Erysipelas. St. 
 Anthony of Padua, was supposed to work miraculous cures of this dis- 
 ease. — See Erysipelas. 
 
 SCABIES. — From Scabo, to scratch. Synon. Psora; Itch; Scotch 
 Fiddle. — A contagious, troublesome skin disease, attended with great 
 itching: irritation increased by warmth. Commences as a papular, 
 vesicular, or pustular eruption : vesicles or pustules ruptured by scratch- 
 ing, causing excoriations. Most common about flexures of joints, espe- 
 ciall}' on hands. 
 
 Due to an animal parasite, — the Acarus Scabiei, or Sarcoptes Hominis. 
 Female larger than male : after impregnation she burrows beneath 
 epidermis, forming furrows or cuniculi, in which her eggs are usually 
 deposited. Males wander over surface of epidermis. 
 
 Treatment. Thorough washing with warm water and soft soap. 
 Sulphur ointment. Sulphur baths, 125. Sulphur soap. Lotions con- 
 taining creasote, carbonic acid, corrosive sublimate, or tobacco. — Con- 
 taminated clothes to be fumigated Avith sulphurous acid gas; or by 
 exposure to a temperature of 180° F. ; or by thorough sprinkling with 
 powdered sulphur. 
 
 SCARLET FEVER. — This disease, known also as Scarlatina — from 
 the Italian Scarlatto, scarlet — is an infectious fever, characterized by 
 scarlet efflorescence of skin, and mucous membrane of fauces and ton- 
 sils; the eflflorescence commencing about second day of fever, and de- 
 clining about fifth. Often accompanied by inflammation of throat, and 
 sometimes of submaxillary glands. liike measles, essentially a disease
 
 234 SCARLET FEVER. 
 
 of childhood; but more to be dreaded. As a rule, scarlet fever occurs 
 on!}' once: in the event of a second attack there is often no rash, little 
 or no throat affection, and the disorder runs a favorable course. 
 
 Three forms: Scarlatina simplex, in which skin is most affected ; scar- 
 latina anginosa, in which both skin and throat are severely implicated; 
 and scarlatina maligna., in which all the force of the poison seems to be 
 expended upon the throat. 
 
 Symptoms. In scarlatina simplex, after a latent period of from four to 
 six days, there is fever, lassitude, and headache. On second day, erup- 
 tion appears in form of nuniberless minute dots, of a bright scarlet hue. 
 This terminates by desquamation of the cuticle: wliich begins about 
 the end of fifth day. While the rash has been appearing, the raucous 
 membrane of mouth, fauces, and tonsils has also been affected. Tongue 
 covered with a thick white fur, through which red elongated papilla) pro- 
 ject : as the fur clears off, the organ presents a strawberry appearance. 
 
 In scarlatina anginosa, more violent symptoms. Greater fever, deli- 
 rium, prostration. The fauces, palate, uvula, and tonsils get swollen, 
 and covered with an exudation of coagulable lymph. .The eruption is 
 delayed to third or fourth day, and comes out in scattered patches. 
 With its fading on fifth or sixth day, the fever and inflammation of 
 throat begin to abate. Severe inflammation of the serous and mucous 
 membranes to be feared. 
 
 In scarlatina maligna, the fever assumes a malignant or t3^phoid char- 
 acter. Great cerebral disturbance. Urgent prostration. Low mut- 
 tering delirium. Dark incrustations of coagulable lymph, over uvula, 
 tonsils, &c. Cervical glands involved. The rash comes out late, disap- 
 pears in a few^ hours, and is renewed several times. Often a fatal ter- 
 mination on third or fourth day. 
 
 In all forms the urine to be examined daily; as to quantity, reaction, 
 and freedom from albumen. Two great sources of danger: suppres- 
 sion of urine with uraemia, and formation of fibrinous clots in right 
 cavities of heart. 
 
 Sequela?: Ulceration and enlargement of tonsils. Strumous ulcers. 
 Ophthalmia. Scrofulous enlargements of cervical glands. Abscesses in 
 the ears. Diseases of the scalp. Acute rheumatism. Cardiac inflam- 
 mation. Scarlatinal vaginitis. Anasarca, dropsy of the serous cavities, 
 and acute desquamative nephritis with albuminuria : to be feared as 
 much in mild, as in severe cases. Uraemia. 
 
 Treatment. No prophylactic remedy known. Acetic acid, bella- 
 donna, and inunction with oil or lard useless. — The simpAe form only re- 
 quires confinement to the bed-room; a warm bath or two; proper cloth- 
 ing ; spare diet; and attention to the bowels. Care to be taken lest 
 the escape of the poison by the skin be checked, and thrown back upon 
 the kidneys. Carbonate of ammonia, 361. Acetic acid ; or a drink of 
 vinegar and water. Sponging of skin with vinegar and water, 138. 
 Daily inunction of entire surface with hot lard. 
 
 Scarlatina Anginosa : Emetics of ipecacuanha at onset. Saline effer- 
 vescing draughts. Carbonate of ammonia, 3G1, 364, 371. Cold or tepid 
 sponging with vinegar and water. Cold affusion, 134. Inunction with 
 lard. Scalp to be shaved and cold lotions apj>lied, if there be much de- 
 lirium. Good beef tea. Nourishing soups. Milk: cream. Raw eggs. 
 Port wine. 
 
 Malignant Scarlet Fever: Demands stimulants from commencement. 
 Carbonate of ammonia. Bark. Port \yine. Brand3\ Quinine. Chlorine, 
 77. Hydrochloric acid and ether, 365. Ice. Acid drinks ; or chlorate 
 of potash drink, oGO. Cold affusion, 134. Astringent gargles, 249, 252,
 
 SCIATICA — SCLEROTITIS. 235 
 
 254. Nitrate of silver to throat. Essence of beef, 3. Restorative soup, 
 2. Cream. Eaw eggs. Brandy and egg mixture, 17. 
 
 When Dropsy supervenes : Compound jalap powder. Elaterium. Tinc- 
 ture of perchloride of iron. Ammonio-citrate of iron. Quinine. Min- 
 eral acids. Warm baths. Hot air or vapor baths. Nourishing food. 
 
 SCIATICA. — From '[(T^iov, the hip. Synon. Neuralgia Ischiadica ; 
 Ischial iji a; Coxalgia. — Acute pain in sciatic nerve. — See Neuralgia; 
 Rheumatism. 
 
 SCIRRHUS, OR HARD CANCER.— From Ixif^i^o^^, indurat(!d. Synon. 
 Scirrhoma; Carcinoma Fibrosiim ; Fibrous Cancer. The most frequent 
 variety of cancer. Seen occasionally in stomach, upper part of rectum, 
 and elsewhere; but most frequently by far in the female breast. Aver- 
 age duration of life, after jjatient's first observatjon of the disease, 48 
 months. — See Cancer. 
 
 SCLEREMA. — From I/.hipb':, hard or stiff. Synon. Algide (Edema 
 (from Algeo, to be cold ; and oiditu, to swell). — A peculiar disease of new- 
 born infants, not uncommon in France but rarely met with in this 
 country. Consists of partial or universal induration of subcutaneous 
 areolar tissue, with serous effusion. 
 
 Symptoms. Somewhat resemble those of ordinary anasarca. Ob- 
 struction to circulation, — probably caused by deficient expansion of 
 extensive portions of lungs (atelectasis). Usually occurs within ten 
 days of birth ; mostly in feeble or premature children. The skin as- 
 sumes a dry, stift', waxy, yellowish appearance; it gradually gets dis- 
 tended and unyielding, so that the infant is said to be skin-bound. 
 Temperature of body gets reduced. Infant appears prostrated, un- 
 healthy, perhaps jaundiced, and as if dying from exhaustion. Indica- 
 tions of distress, restlessness, whining cries, refusal of food, fieeble pulse, 
 laborious respiration. Gastric and intestinal disturbance ajit to set 
 in. Death often occurs from asph^'xia, within a week from commence- 
 ment of attack. 
 
 Treatment. Warm baths. Friction with warm flannels. Body to 
 be enveloped in cotton-wool. Port wine with a few drops of tincture 
 of bark. Ether. Acupuncture. Solution of raw beef in distilled water, 
 2. If child cannot suck, mother's milk to be drawn ott' in a spoon and 
 given frequently. Goat's milk. Cream. 
 
 SCLEROTITIS. — From Sclerotica, the firm fibrous tissue of the eye- 
 ball ; terminal -itis. — Inflammation of the sclerotic coat of the eye. 
 Two varieties : 
 
 1. Rheumatic Ophthalmia. — Synon. Ophthalmia Arthritica, — Acute in- 
 flammation of the sclerotic excited by cold, or by the poison of rheu- 
 matism, or by gonorrhoea. 
 
 Symptoms. Pale pink redness of the eye; the turgid vessels being 
 arranged in a radiated or zonular form, and being evidently beneath 
 the conjunctiva. Severe aching pain round the orbit, in the eyebrow, 
 and over the temple, always most severe at night. Occasionally, intol- 
 erance of light. Dimness of vision, from haziness of the cornea and 
 contraction of pupil. Fever and constitutional disturbance. 
 
 Treatment. Attention to diet; avoiding port wine, beer, and sugar. 
 Bark and iodide of ])otassium, 81. Iodide of iron and cod-liver oil, o'JO. 
 Colchicum, 46. Morphia. Henbane. Calomel and opium. Alkaline 
 purgatives, 141, 148. Warm baths. Blisters behind the ears or to nape
 
 236 SCROFULA SCROTAL CEDEMA. 
 
 of neck. Friction of forehead with belladonna lininient, or with chloro- 
 form liniment. Application of muslin bags filled with chamomile 
 flowers, and dipped in a hot and strong decoction of poppy-heads. 
 Eye-sliades. Spectacles with glasses of a neutral tint. Collyria of 
 little use. 
 
 2. Catarrho-Rheumatic Ophthalmia. — Not an uncommon affection : 
 characterized by a combination of the symptoms of conjunctivitis and 
 sclerotitis. 
 
 Symptoms. A feeling as of sand between the ball and lids. Circum- 
 orbital pain. Scarlet redness of eye, chemosis, intolerance of light, 
 epiphora, &c. If unchecked ma}' lead to ulceration of cornea, onj'x, 
 suppuration in anterior chamber, efiFusion of 13'mph into pupil. General 
 health usually bad. 
 
 Treatment. Iodide of potassium and bark, 31. Opium. Nourishing 
 diet; milk. Cod-liver oil. Warm fomentations. Sedative collyria. 
 Chamomile bags dipped in decoction of poppy-heads. 
 
 SCROFULA. — From Scrofa, a sow; because swine were supposed to 
 suffer fi-om this disease. Synon. Scrophida; Tabes Glandularis ; Struma; 
 Kin<fs Evil. — See Tuberculosis. 
 
 1. Scrofulous or Strumous Abscesses. — Often commence insidiously in 
 areolar tissue. Sometimes become indolent. Suppurate imperfectly. 
 In other cases they burrow deeply, and in all directions. Long sinuses, 
 from which exudes a thin sanious ]>us. Occasional extension to the 
 bone, — necrosis resulting. General health much depressed. Only to be 
 cured by a very nourishing diet ; bark ; iron ; cod-liver oil; and sea air. 
 Iodine and its compounds regarded as anti-strumous remedies. "Chem- 
 ical Food," i. e., the phosphates of lime, iron, soda, and potassa, in syrup, 
 405. Anthracite has been recommended. 
 
 2. Scrofulous Ulcers. — An indication of the weak cachectic condition 
 of the strumous system. Most commonly situated about neck, shoul- 
 ders, arms, or hips. Extensive tracts of skin destroyed by their gradual 
 extension. Efforts at repair slow and imperfect. Granulations absent, 
 or exuberant and flabby: subjacent tissue boggy, and readily broken 
 down by finger or probe. General health bad from the beginning, with 
 daily deterioration. Cicatrization sometimes procured after destruction 
 of the unhealthy tissue with strong caustics : nitric acid, or potassa fusa. 
 Ordinary astringent lotions useless. Constitutional treatment most es- 
 sential. Occasionally strumous ulcerations and lupus coexist. 
 
 3. Inflammation and Suppuration of Lymphatic Glands. — One of the 
 most frequent results of the strumous habit. Glands of neck most liable. 
 Extensive tracts of skin and areolar tissue sometimes destroyed. When 
 pus has formed, early evacuation by knife or potassa fusa required. The 
 resulting cicatrix becomes a great disfigurement. Constitutional reme- 
 dies. — See Adenitis. 
 
 SCROTAL ELEPHANTIASIS.— Enormous hypertrophy of the scro- 
 tum. In many cases the tumor has reached below the knees. Very 
 rare in temperate climates. There is no cure but by removal. — See Bai'- 
 
 badoes Leg. 
 
 SCROTAL (EDEMA.— The areolar tissue of scrotum may rapidly be- 
 come intiltruted with serum as a result of erysipelas. Great constitu- 
 tional disturbance: fatal sinking sometimes occurs early. Sloughing 
 apt to take place. Tonics and stimulants must be freely employed.
 
 SCURVY — SLEEPLESSNESS. 237 
 
 Scrotum to be well supported by 8iiuill pillows. Fomentations. — See 
 Erysiiielas. 
 
 Simple oedema of scrotum is usually an accompaniment of general 
 anasarca. If it cause distress, relief may be given by acujjuncture. 
 
 SCURVY. — Synon. Scorbutus; Land Scurvy ; Sea Scurvy. — A complex 
 morbid state, caused b}' long-continued privation of fresh succulent 
 vegetables or fruits, or their preserved juices. 
 
 Symptoms. Sallow dusky hue of countenance, and of skin generally. 
 Swollen, spongy, pallid or livid gums. Fetid breath. Debilit}'. Ilem- 
 eralopia. Deafness. Dyspnoea. Sloughing of gums. Loosening of the 
 teeth. Hemorrhage from gums, nose, mouth, stomach, intestines. Ex- 
 tensive ecchymoses. Swelling and stiffness of legs. Want of energy: 
 despondency. Diarrhoea. Dysentery. Dropsy-. Exhaustion. Throm- 
 bosis. 
 
 Treatment. Lemon or lime juice. Oranges. Salads. Watercresses. 
 Potatoes. Pickles. Broccoli. Cabbage. Vinegar. Horseradish. 
 Wood sorrel. Common sorrel. Milk. Wine or beer. Spruce beer, 7. 
 Fresh meat and fish. Raw meat. Fresh blood. Citric acid. Iron, 
 Catechu. Gallic acid. Tannic acid lozenges. Tartrate, chlorate, ni- 
 trate, or phosphate of potash. Opium. Pure air. The recumbent 
 posture. 
 
 SEPTICJEMIA. — From I-q-nu), to putrefy; aqm, blood. Sj^non. Sep- 
 toiima ; Putrid Infection. — Contamination of the blood with putrefying 
 matters — See Ichorhoimia. 
 
 SIMPLE CONTINUED FEVER.— Synon. FehrlcuJa ; Ephemera (when 
 only lasting a day). — A mild disease, having a variable duration of from 
 one to ten days. 
 
 Symptoms. Patient suddenly seized with lassitude, nausea, anorexia, 
 chilliness, and pains in back and limbs. After a few hours, — heat of 
 skin, rapid pulse, headache, thirst, constipation, and scanty ui-ine. Per- 
 haps slight delirium. Symptoms aggravated at night. About fourth 
 day, or later, a remission ; critical sweating, or diarrhoea. Convales- 
 cence often somewhat slow. 
 
 Treatment. The indications are: (1) To moderate, when necessary, 
 the violence of artei'ial excitement by saline laxatives, rest in bed, and 
 low diet. (2) To support the powers of the system, as soon as they 
 begin to flag. (8) To obviate local inflammations and congestions. 
 And (4) to relieve any urgent symptoms if they arise. 
 
 SINGULTUS. — From Singultus, a sobbing. Synon. Spasmolygmus ; 
 
 Hiccup. — See Hiccough. 
 
 SLEEPLESSNESS. — Sjmon. Insomnia (from In, priv. ; somnus, sleep); 
 Pervigilium (from Pervigilo, to watch or be awake all night). 
 
 Often a premonitory symptom of insanity. Commonly present in 
 mania, aggravating the symptoms. Desire for sleep often banished in 
 the insane: sometimes they are afraid to sleep because of frightful 
 dreams and visions. Sleep prevented by exciting passions ; mental 
 anxiety; many acute diseases; dyspepsia; diseases ot heart and large 
 vessels; pregnancy; jaundice, though sometimes where blood is much 
 poisoned there is a tendency to excessive drowsiness. Medicinal doses 
 of strychnia, or nux vomica, will often cause bad nights. 
 
 Tre.\tment. Daily exercise in open air. A digestible diet, such as 
 will not favor production of acidity or flatulence. Avoidance of tea
 
 238 SMALL-POX. 
 
 and coffee in after-part of day. Dinner at one or two o'clock in the 
 afternoon, with light su2:)per at night. Bed-room to be quiet, well- 
 ventilated, warm. Bed to consist of mattress, without too many heavy 
 blankets. Some nervous subjects can only sleep with head quite low, 
 and lying on face with arms folded underneath. 
 
 When there is debility, a tumblerful of port-wine negus, or mulled 
 claret, or white-wine whey the last thing at night. A pipe of mild 
 tobacco often unobjectionable. — Where skin gets hot and dry, a 
 tumblerful of cold water or soda water on going to bed. Eapid 
 sponging of body with tepid water. Warm foot-bath. A hot-water 
 bottle in bed draws the blood from brain to extremities. Wet compress 
 over the eyes. 
 
 Removal of any physical cause for wakefulness. Aperignts if there 
 be constipation. Alteratives and laxatives if stools be unhealthy. 
 Bismuth, or soda, if there be heartburn or acidity. A rag dipped in 
 cold water, or a tight band round forehead, if there be headache. In 
 some acute diseases, a bladder containing ice, to head. 
 
 Henbane, 325, 337. Stramonium and henbane, 323. Hop, &c., 325. 
 Indian hemp and henbane, 337. Morphia, chloroform, and Indian hemp, 
 317. Opiate enemata or sujjpositories, 339, 340. Hypodermic injection 
 of morphia, 814. Codeia. Musk, with or without assafcetida, in hypo- 
 chondriasis. When insomnia is due to nervous irritability, bromide of 
 potassium, 42. Mesmerism. Hyjinotism. 
 
 SMALL-POX. — S3mon. Variola. — A continued infectious fever, at- 
 tended with an eruption. Due to absorption of a specific poison. The 
 disease would probabl}' become extinct, were vaccination universally 
 and efficiently performed. 
 
 Symptoms. This disease goes through four stages, — that of incuba- 
 tion, primary fever, eruption, and secondary fever. 
 
 The period of latency or incubation lasts twelve days. Then there 
 is lassitude, headache, fever, vomiting, and well-marked muscular pains 
 in back. These symptoms succeeded at end of 48 hours by eruption of 
 small red pimples, which in course of a week inflame and suppurate. 
 In many instances accompanied by a similar affection of mucous mem- 
 brane of nose and mouth ; generally by soreness in throat; in some, by 
 swelling and inflammation of subjacent areolar tissue; occasionally by 
 marked irritation of nervous system. When vomiting and pain of 
 back are violent, they are generally precursors of a severe attack. 
 
 Peculiar eruption of pimples or papula; begins to show itself on com- 
 mencement of third day of fever, appearing in following order; First 
 on face, neck, and wrists ; secondly on trunk ; and lastly on lower ex- 
 tremities. The papula; then gradually ripen into pustules, suppuration 
 being complete by ninth day; at which time pustules break, and crusts 
 or scabs form. In four or five days more, these scabs are falling off. 
 
 The severity of the disease bears a direct relation to quantity of 
 eruption. When pustules are few, they remain distinct, and separate 
 from each other; when very numerous, they run together, coalesce, and 
 lose their regularly circumscribed circular fornix Hence a division of 
 small-])ox into — variola discreta, and variola C07\fluenB. Former seldom 
 attended with danger; latter never free from it. Eruption on face niay 
 be confluent, while it is scanty elsewhere; still the disease is of confluent 
 kind. Sometimes, pustules so numerous that they touch each other, but 
 do not coalesce ; disease then said to be of cohering or sem.iconfl.utnt 
 form. If, in confluent cases, symptoms of malignancy and puti-es- 
 ceiicy are added, the disease becomes malignant small-pox, a most for- 
 midable affection.
 
 SPANiEMIA — SPERMATORRirCEA. 230 
 
 The greatest ditlereiiee between distinct and continent forms is in l!io 
 secondary fever ; slightly marked in first, intense and perilous in second. 
 Sets in usually about eleventh day of the disease, or eighth of eruption, 
 and occasionally at once proves fatal; the system being overwhelmed 
 by virulence of the poison. During its course, troublesome comijlica- 
 tions may arise, — as erysipelas, swelling of glands in groin and axilla, 
 ]>hlebitis, ichorhajmia, glossitis, pleurisy, pneumonia, ulceration through 
 cornea, suppuration of ear, conjunctivitis, &c. 
 
 No contagion so ])Owerful or certain as that of small-pox ; infection 
 lasts from end of latent period until every crust has fallen olf and skin 
 cicatrized. One attack exhausts susceptibility of system to future influ- 
 ence of the poison, as a rule. Variola occurring in ])ersons unprotected 
 by inoculation or vaccination is fatal on average to one in evei'y three. 
 When variolous matter is introduced into skin — inoculated small-pox — 
 disease is in all respects of a mild nature. Practice of inoculation, now 
 illegal. 
 
 Treatment. In simple cases, the less drugs are used the better. 
 Patient to be kept quiet in bed; in a well-ventilated room, free from 
 carpets, curtains, &c. Some disinfectant to be employed, — iodine very 
 good, 81. Diet, — arrowroot, gruel, weak beef tea, tea with milk, ripe 
 fruits. Lemonade; barley water; plain water; raspberry vinegar 
 and water; soda Avater; ice. Tepid sponging. Change of linen once 
 a day. Mild saline laxatives, 139, 141, 155, 169. Opium or henbane, 
 315, 318, 325, 340: provided there be no fear of mucus accumulating in 
 the bronchi and threatening suflfbcation. Sarracenia purpurea, useless. 
 Good broths, wine, ether, bark, &c., when maturation of pustules pro- 
 ceeds tardily. Complications to be palliated : antiphlogistic remedies 
 injurious. 
 
 In secondary fever: Mild laxatives, if necessary: Effervescent citrate 
 of magnesia; compound rhubarb powder. Astringents if there be 
 diarrhoea. Sedatives, once or twice daily, if there be restlessness. 
 Nourishing food : pounded meat in beef tea, good soup, milk or cream, 
 raw eggs. Alcoholic stimulants, in proportion to the depression. — If 
 any boils or abscesses form, early incision. 
 
 For sloughy and gangrenous sores: Quinine, 379. Bark and nitric acid, 
 376. Ale, wine, or brandy. Milk: pounded beef. Water bed. 
 
 To prevent pitting : Olive oil. Glycei'ine and rose-water (equal parts). 
 Lime liniment. Nitrate of silver. Puncturing the pustules. Collodion. 
 Gutta pereha and collodion. Mercurial ointment. Tincture of iodine. 
 Sul])hur. Linseed or yeast poultices. Water dressing. Oxide of zinc 
 ointment. 
 
 SPANJEMIA. — From Ir.a'^q. thin or poor; al/jta, blood. Thin or poor 
 blood: A diminution in the quantity of red corpuscles. — See Anaemia. 
 
 SPERMATORRH(EA.— From JTr.V", seed; piu>, to flow. Synon. 
 Spermorrhcea ; Gonorrhoea Vera; Profluviuni Seminis ; Pollution. — A 
 deranged state of mental and bodily health, due to the too frequent 
 escape of seminal fluid. Masturbation the most common cause. 
 
 Symptoms. There may be only a repeated escape of seminal fluid; 
 or this may be associated with morbid changes in vesicular seminales, 
 ejaculator^* ducts, bulbous portion of urethra, and prostate gland. Urine 
 sometimes rendered slightly albuminous by seminal fluid. 
 
 General weakness: nervous irritability, with a dreamy absent kind 
 of manner. Flatulence and constipation. Dulness of sight and perhaps 
 of hearing. Weakness of memorj-. Attacks of palpitation, giddiness, 
 headache, neuralgia. In extreme cases, final result may be epilepsy, 
 phthisis, impotence, insanity.
 
 240 SPINA BIFIDA SPINAL CURVATURE. 
 
 Treatment. General rules: Moderate mental and bodily work. 
 Cheerful society. Not more than eight hours for sleep, on a mattress, 
 without too much clothing. Obscene works of quack doctors and sham 
 museums, to be shunned like virulent poisons. Avoidance of heavy 
 meals, alcoholic drinks, and tobacco: substitution of milk for tea and 
 coffee. If emissions take place when patient lies on his back, a cotton- 
 reel to be tied over middle of spine at night. Salt water sponge baths, 
 tepid or cold, with friction of skin. Careful ablution of glans penis to 
 remove irritating secretions of sebaceous follicles. Support of testicles 
 by suspensory bandage. 
 
 Drugs : Phosphoric acid, nux vomica, and bark, 376. Sulphate of 
 zinc and nux vomica, 409. Phosphate of zinc. Quinine and iron, 380 : 
 best avoided in single men, as all ferruginous tonics produce congestion 
 of sexual organs Cod-liver oil. Bromide of potassium. Camphor, co- 
 nium, and belladonna, 326. Digitalis. Ergot of rye. Cubebs. — Re- 
 moval, when present, of oxyurides from rectum ; or of excessive acidity 
 of urine. 
 
 Local treatment : Only required in exceptional cases. Introduction of 
 metallic sound into bladder, once or twice a week. Nitrate of silver to 
 prostatic portion of urethra, — Lallemand's porte caustique. Circumci- 
 sion. Galvanism. 
 
 SPINA BIFIDA. — Synon. Hydrorachitis, from "T8(op, water, and pciyt,;^ 
 the spine ; Hydrorachis Congenita ; Cleft Spine. — A congenital deficiency of 
 the posterior laminsB and spinous process of one or more vertebraj ; 
 owing to which there is undue distension of membranes of cord with 
 cerebro-spinal fluid. May exist in cervical, doi'sal, lumbar, or sacral 
 region : most common in lumbar. 
 
 Symptoms. A tumor is formed, varying in size fi"om a walnut to a 
 child's head. There is fluctuation: swelling most tense when child is 
 held upright: swelling semi-transparent: skin may be unaffected, or 
 congested and blue. Prognosis unfavorable, if complicated with hydro- 
 cephalus; if there be paralysis of bladder or rectum and lower extremi- 
 ties; if the tumor threaten to burst by increasing in size. When only 
 two or three upper lumbar vertebrae are aftected, the spinal cord seldom 
 deviates from its course, and only the posterior spinal nerves have any 
 connection with the sac. If tumor occupy part of lumbar and part of 
 sacral region, the cord itself and its nerves will almost always be found 
 in close contact with the sac. The disease is not necessarily fjxtal. 
 
 Treatment. If general health be good, and tumor small, interference 
 will be unnecessary, beyond protecting the growth bj- a piece of leather 
 or gutta percha moulded to the part. Where there is slow enlargement 
 pressure may be tried by an air pad, or by painting with coUodium. 
 Where growth is rapid, and there is a fear of skin giving wa}^, tapping 
 with a small trocar may defer a fatal result: after emptying the sac, 
 pressure to be a2)plied. Iodine injections have succeeded twice at least: 
 their employment fraught with danger. In another case, a cure was 
 effected by application of a clamp to the broad base, the instrument be- 
 ing gradually tightened until the tumor sloughed off. 
 
 SPINAL CURVATURE. — The causes of spinal curvature are : Peculiar 
 
 avocations, causing the muscles on one side to become unduly developed 
 and powerful: e. g., habitual use of right arm in blacksmiths. Constant 
 assumption of an unnatural attitude: e. g., nurses carrying children 
 always on one arm ; repeatedh' standing on right leg with left knee 
 somewhat bent. General weakness, producing a relaxed and flabby 
 state of all the tissues; or a deficiency of earthy matters in the osseous
 
 SPINAL CURVATURE. 2-11 
 
 system, so that there results a, loss of equilibrium between the resist- 
 ance of spinal column and weight of u])|)ci' part of body: e. g., curva- 
 ture from rickets, and destruction of the bodies of the vertebra) by 
 caries. — There are three principal varieties : Lateral Curvature, the con- 
 vexity being to either side, but usually to the right. Posterior curva- 
 ture^ or excurvation. And anterior curvature, or incurvation. 
 
 1. Lateral Curvature. — The most common form. Appears chiefly in 
 young women between the ages of ten and eighteen ; who are said to 
 outgrow their strength, i e., the wants of the S3'Stem are insufficiently sup- 
 plied owing to imperfect assimilation of food, too little outdoor exercise, 
 and inattention to position while standing or walking. 
 
 Symptoms. One shoulder observed to be higher than the other : or 
 a growing out of one scapula. While one shoulder is high, the other is 
 unduly depressed. So one hip projects, while the opposite curves in- 
 wards. On examination the vertebi*al column is found to be curved: 
 in double lateral curvature it is twisted like the italic/. As the tlioi-acic 
 and abdominal cavities are more or less deformed, the pla}' and tree 
 movements of the viscera get impeded. If there be difficulty in taking 
 full inspirations, dj'spnoea will be present. The action of the muscles of 
 trunk is impaired. General health suffers. Pain, from pressure exei-ted 
 on the nerves. In curvature from rickets there is also distortion of the 
 limbs: patient's aspect rickety. 
 
 Treatment. Maintenance of general health at highest point of 
 efficiency. Animal food: milk; raw eggs. Cod-liver oil. Sea air. and 
 baths. Quinine and ii'on, 380, 382. Phosphate of iron ; chemical food, 
 405. Strengthening of muscles and ligaments which act on vertebi-a), 
 by frictions, palpation, shampooing. Carefully devised gymnastic ex- 
 ercises. Removal from spinal column, by proper apparatus, of such 
 weights or forces as tend to keejD the various segments of spine in an 
 unnatural relation to one another. 
 
 2. Posterior Curvature. — Chiefly affects the cervical and dorsal re- 
 gions. May be caused in infancy by the frequent practice of raising the 
 child by placing the hands under the armpits, and so compressing the 
 ribs and forcing back the sternum and spine. The muscles and liga- 
 ments which keep the column erect, become relaxed. In rare cases, 
 there is disease of bodies of vertebra). 
 
 3. Anterior Curvature. — Synon. Angular Curvature; Pott's Curvature. — 
 The most uncommon variety. Generall}" associated with some consti- 
 tutional affection (scrofula); producing caries or ulcerative destruction 
 of bodi(^s of vertebrn3, or interstitial softening and absorption of cal- 
 careous elements of osseous texture. As many as tive or six vertebi"», 
 with the intervertebral substances, may be affected. More frequent 
 about mid-dorsal region than elsewhere. 
 
 Symptoms. General indications of scrofula. "Weakness, coldness, and 
 numbness of legs. Twitchings and spasms of legs. Subsequently pa- 
 ralysis of bladder, rectum, and lower extremities. Tenderness or dull 
 aching pains, in back. Tightness of chest, with more or less dyspnoea. 
 Occasionally, formation of strumous abscesses. Exhaustion and hectic. 
 Under favorable circumstances, disease gets arrested; bones collapse, 
 anchjdosis occurs, and pus becomes absorbed; patient recovering, but 
 with incurable deformity. Sometimes sudden death; owing to diseased 
 bodies of vertebrae giving way and crushing spinal cord, or from occur- 
 rence of dislocation of odontoid process of axis in consequence of ulcer- 
 ation and destruction of its ligament. 
 
 16
 
 242 SPINAL HEMORRHAGE — SPINAL MENINGITIS. 
 
 Treatment. Perfect rest in horizontal position is indispensable. Use 
 of a reclining couch, so shaped as to keep the trunk perfectly quiet. A 
 stitf bandage, or pair of stays, extending from occiput to hips, to insure 
 rest. Any active attempts to remove deformity will altogether prevent 
 a cure of the disease. Pain to be relieved by belladonna or opium 
 plasters : issues, setons, blisters, or leeches worse than unnecessary. 
 Abscesses to be opened when they point. Improvement of general 
 health, by good diet, cod-liver oil, phosphate of lime, bark, or steel. 
 During convalescence, mechanical support to the trunk judiciously ap- 
 plied. 
 
 SPINAL HEMORRHAGE.— Synon. Myelorrhagia; Myelapoplexia ; 
 Apoplexia Myelitica ; Apoplexy of the Cord; Paralysis from Effusion of 
 Blood into Spinal Canal or into Substance of Cord. — More rare than cere- 
 bi'al hemorrhage. Arises from injury; acute inflammation of cord or 
 membranes; fatty degeneration of coats of vessels ; caries and other 
 disease of vertebras. — Blood poured out external to dura mater; or be- 
 tween membranes ; or into gray portion of cord. Death may happen 
 at once; or after a variable interval from chronic softening of nervous 
 substance. 
 
 Symptoms. Yixry according to seat of ruptured vessels. Blood effused 
 between the membranes, gi-avitates to lowest part of spinal canal : hence, 
 paralysis which gradually extends upwards. Acute and sudden pain in 
 back, sometimes in head. Often, severe convulsions. Difficult breathing 
 when there is pressure on upper part of cord. Heart's action depressed. 
 Surface pale and cold. Consciousness unimpaired. — Effusion into sub- 
 stance of cord produces sudden paralysis in all parts supplied with 
 nerves below its seat : where hemorrhage is very slight, loss of power 
 occurs slowly after lapse of some hours. 
 
 Treatment. Further effusion to be checked by perfect repose: appli- 
 cation of ice along spinal column. Aconite, to moderate heart's action 
 if it be excited. 
 
 SPINAL IRRITATION. — Synon. Rhachialgia ; Neuralgia Spinalis; 
 Notalgia. — Probably no disease exists deserving this name. The symp- 
 toms mostly observed in women : pains about mamma?, thorax, abdo- 
 men, or uterus. Tenderness on pressure over spinous processes of cer- 
 tain vertebrae. The suffering due to a combination of myalgia and 
 hysteria, with constitutional weakness. This opinion confirmed by 
 curative influence of belladonna plasters; nourishing food; cod-liver oil; 
 bark or steel ; sea air ; and moderate exercise. 
 
 SPINAL MENINGITIS.— From Spina, the backbone; Mfivty^, a mem- 
 brane; terminal -«Yis. — Synon. Perimyelitis; Myelomeningitis; Acute Pa- 
 ralysis from Inflammation of Membranes of Spinal Cord. — Acute inflam- 
 mation of membranes of cord not a common disease. It terminates in 
 resolution, effusion of serum, softening of cord, or suppuration. When 
 acute, may be associated with disease of cerebellum or of cerebral mem- 
 branes ; when chronic, mostly connected with caries of vertebrae. Me- 
 chanical injuries, and exposure to wet and cold in rheumatic subjects, 
 the most frequent causes. 
 
 Symptoms. High fever and sleeplessness. Acute burning pains along 
 spine, extending into limbs; greatly aggravated by motion and pres- 
 sure; often simulating rheumatism. Eigidity, or tetanic contraction of 
 muscles of neck and back. Feebleness of limbs, perhaps to extent of 
 paralysis of lower extremities: loss of power extends upwards as 
 effused serum increases in quantity. Suffocating sensations : feeling of
 
 SPINAL TUMORS — SPIROMETRY. 243 
 
 constriction in neck, back, and abdomen. Eetention of urine. Priapism. 
 Obstinate constipation, sometimes succeeded by diarrhoea. Great pros- 
 tration, if morbid action proceed: sometimes, feverish delirium and 
 coma. 
 
 Cerebro-S'pinal meningitis occasionally occurs as an epidemic : inmates 
 of workliouses, soldiers in over-crowded barracks, liable to it. 
 
 Treatment. Iodide of potassium and aconite, 31. Corrosive subli- 
 mate and sarsaparilla, 27. Eed iodide of mercury, 54. Aconite and 
 guaiacum, 330. Stramonium. Henbane. Belladonna. Castor^ oil. 
 Calomel and jalap — Locally : Lint, saturated with belladonna or aconite 
 liniment, and oiled silk. Linseed poultices. Fomentations with poppy- 
 heads and chamomile flowers. Ice? Blisters. Tartarated antimony 
 ointment. Painting of spine with diluted iodine liniment. Leeches. 
 
 To prevent the spread of epidemic cerebro-spinal meningitis, removal 
 from unhealthy locality is necessary. 
 
 SPINAL TUMORS. — Paralysis may arise from long-continued pres- 
 sure of tumors on the cord, producing partial atrophy. Morbid growths 
 consist of tubercle, cancer, bone, or hydatid cysts. Exostosis of odon- 
 toid process of second cervical vertebra, an occasional cause. Some- 
 times, tumor has its origin in syphilitic disease of vertebra;. 
 
 Symptom-s. Come on slowly. Paralysis often not manifested until 
 great pressure is exerted. Paralysis of motion always precedes that of 
 sensation. Pain over seat of growth. Cramps, and convulsive move- 
 ments of extremities. Systemic disease where tumor is of a tubercular, 
 cancerous, or syphilitic nature. 
 
 Treatment. Iodide of potassium. Iodide of ammonium. Red iodide 
 of mercury. Corrosive sublimate. Syrup of iodide of iron. Cod-liver 
 oil. Nourishing food : milk. Counter-irritants to painful parts of spine, 
 occasionally useful. 
 
 SPIROMETRY. — From Spiro, to breathe; fierpico, to measure. The 
 mode of measuring the quantity of air which the lungs can contain. 
 
 Spirometers, or Spiroscopes, or Pneumometers, are instruments for 
 measuring the volume of air expired from the lungs. This volume is 
 diminished in each stage of phthisis. Quantity of air expired after 
 most complete inspiration is the vital volume or vital capacity. The 
 vital capacity always increases with stature ; also slightly affected by 
 weight, but not sufficiently to interfere with correctness of following 
 table, which shows the capacity in health and in the three stages of 
 phthisis : 
 
 Height. 
 
 Ft. 
 
 in. 
 
 Ft. 
 
 in 
 
 5 
 
 
 
 to 5 
 
 1 
 
 5 
 
 1 
 
 " 5 
 
 2 
 
 6 
 
 2 
 
 " 5 
 
 3 
 
 6 
 
 3 
 
 " 5 
 
 4 
 
 5 
 
 4 
 
 " 5 
 
 5 
 
 5 
 
 5 
 
 " 5 
 
 6 
 
 5 
 
 6 
 
 " 5 
 
 7 
 
 5 
 
 7 
 
 " 5 
 
 8 
 
 6 
 
 8 
 
 " 5 
 
 9 
 
 5 
 
 9 
 
 " 5 
 
 10 
 
 5 
 
 10 
 
 " 5 
 
 11 
 
 5 
 
 11 
 
 " 6 
 
 
 
 Capacity in 
 Health. 
 
 Cub. in. 
 . 174 . . 
 
 Capac 
 
 Ist Stage. 
 
 Cub. in. 
 
 . . 117 . . 
 
 ity in Phthisis Pu, 
 
 2d Stage. 
 
 Cub. in. 
 
 . . 99 . . 
 
 Imonalis. 
 
 3(1 Stfige. 
 Cub. in. 
 
 . . 82 
 
 . 182 . . 
 
 . . 122 . . 
 
 . . 102 . . 
 
 . . 86 
 
 . 190 . . 
 
 . . 127 . . 
 
 . . 108 . . 
 
 . . 89 
 
 . 198 . . 
 
 . . 133 . . 
 
 . . 113 . . 
 
 . . 93 
 
 . 206 . . 
 
 . . 138 . . 
 
 . . 117 . . 
 
 . . 97 
 
 . 214 . . 
 
 . . 143 . . 
 
 . . 122 . . 
 
 . . 100 
 
 . 222 . . 
 
 . . 149 . . 
 
 . . 127 . . 
 
 . . 104 
 
 . 280 . . 
 
 . . 154 . . 
 
 . . 131 . . 
 
 . . 108 
 
 . 238 . . 
 
 . . 159 . . 
 
 . . 136 . . 
 
 . . 112 
 
 . 246 . . 
 
 . . 165 . . 
 
 . . 140 . . 
 
 . . 116 
 
 . 254 . . 
 
 . . 170 . . 
 
 . . 145 . . 
 
 . . 119 
 
 . 262 . . 
 
 . . 176 . . 
 
 . . 149 . . 
 
 . . 123 
 
 This table reads : A man whose height is between 5 ft. 7 in. and 5 ft. 
 8 in. should breathe in health 230 cubic inches: in first stage of con-
 
 244 SPLENIC DISEASE — STOMATITIS. 
 
 sumption this is reduced to 154 ; in second, to 131 ; in third, to 108 
 cubic inches. 
 
 To test the vital capacity the patient loosens his vest, stands per- 
 fectly' erect, takes as deep an inspiration as possible, and places mouth- 
 piece of spirometer between his lips. The observer having opened the 
 tap, ]'»ationt empties his lungs, steadily making deepest possible expira- 
 tion ; at termination of which the operator turns off the tap, thus con- 
 fining the air in receiver. Tiie receiver is then to be lightly depressed 
 until the surfaces of spirit in bent tube on outside of insti'ument are 
 on a level with each other, when the vital capacity may be read off 
 from scale. 
 
 SPLENIC DISEASE.— The spleen, like other glands, is liable to, — 
 Congestion, inflammation, softening, abscess, gangrene ; tubercular and 
 malignant disease; fibrinous deposits — remains probably of extrava- 
 sated blood; serous and hydatid cj'Sts ; and simple enlargement. — 
 More common among residents of tropical and marshy than of tem- 
 perate climates. 
 
 Enlargement of Spleen ("Ague-cake") generally results from repeated 
 attacks of intermittent fever. Sufferers from it have a peculiar sallow 
 and unhealthy aspect; anaemic appearance of gums and buccal mucous 
 membrane; tendency to hemorrhage; dyspepsia; debility and loss of 
 flesh. Wlien result of ague, — aperients; bark or quinine ; arsenic. In 
 other forms, — steel; bromide of potassium. Friction with diluted oint- 
 ment of red iodide of mercury. Good nourishing food. Residence in a 
 dry and bracing locality. Avoidance of mercury and depletion. Iodine, 
 iodide of lead, nitric acid, ergot of rye, have been emplo3'ed. Rusot 
 (an extract prepared by natives of India from the Berberis Lj'cium 
 and Berberis Aristata) has been strongly recommended. Extirpation 
 of the spleen (Splenectomy) has been resorted to. 
 
 STOMATITIS. — From lT6>ia, a mouth ;. terminal -His. Inflammation 
 of the mouth. — A common disease of young children. It may occur in 
 three forms, — i.e., according as chief seat of morbid action is in mucous 
 follicles of mouth, substance of gum, or in tissues of cheek. 
 
 1. Follicular Stomatitis. — Inflammation of mucous follicles of mouth 
 may be idiopathic, or a sequela of one of the eruptive fevers. 
 
 SvMPTOMS. Difticulty of sucking. Abundant flow of saliva. Sub- 
 maxillary glands tumid and tender. Restlessness, with fever. Loss of 
 appetite. i)iarrhoea with offensive motions. Small vesicles on inside 
 of mouth, on tongue and fauces: vesicles burst and form ulcers, which 
 are covei-ed with dirty white or yellowish sloughs. 
 
 Treatment. Application, with a camel's-hair pencil, of borax and 
 glycerine, 250. Mild tonics. Carbonate of magnesia. Chlorate of pot- 
 ash. Attention to the milk supplied to child. Beef tea. 
 
 2. Ulcerative Stomatitis. — Synon. Noma, from Niiim, to con-ode. — 
 Ulceration of the gums, sometimes destroying these parts and denuding 
 the teetii. Occurs mostly in badly nourished children. May be er- 
 roneously atti'ibuted to use of mercury. 
 
 SvMPT(tMS. Heat of mouth. Salivation. Offensive breath. Swelling 
 of upper lip : enlargement and tenderness of subn\axillary glands. Gums 
 get swollen, red or violet colored, and covered with a layer of pulpy 
 grayish matter. If disease proceed, gums become destroyed by the ul- 
 cei'ation : teeth are exposed and loosened. Inside of cheeks may be in- 
 volved: irregular sloughing ulcerations. 
 
 TreaTiMENT. Chlorate of potash : gr. 5 may be given every four
 
 STOMATORRHAGIA — SUDAMINA. 245 
 
 hours in sweet tea to an infant one year old. Subsequently, bark in 
 wine. Cod-liver oil. Pure milk; that of the ass, goat, or cow. .Solu- 
 tion of raw meat, 2. Beef tea, 6. 
 
 3. Gangrenous Stomatitis. — Synon. Cancrum Oris; Sloxighing Phage- 
 dirna of Movth. — A formidable disease. Occurs in weakly children, be- 
 tween second and fifth year. 
 
 Symptoms. Debility. A hard indolent swelling on one check. On 
 examining mouth, a whitish or ash-colored eschar is seen in centre of 
 cheek: slough increases until it si:)reads over whole of inside of cheek, 
 lips, and gums. Saliva copious : horribly fetid. Great constitutional dis- 
 tiirl)ance. Pulmonary complications apt to occur. Frequently, death. — 
 Often attributed to use of mercury: ma}' occur where none has been 
 given. 
 
 TKEATArENT. Application of nitrate of silver, sometimes of strong 
 nitric acid to slough. Frequent syringing of mouth with warm water: 
 with sohition of permanganate of potash. 78: with chlorinated soda 
 gargle, 254. Chlorate of i)ota8h in bai'k. Wine, or brand}'. Eaw meat, 
 2. Milk: cream. 
 
 STOMATORRHAGIA.— From Izotm, a mouth ; piiyvutu, to break out. 
 
 Synon. Stomatorrha'a ; Jlcemorrhagia Oris; Buccal Heworrhage. — Dis- 
 charges of blood from mouth and throat seldom give trouble, except 
 when they occur during last stages of scurvy or purpura, or after ex- 
 cessive use of mercury. In some instances, small veins about mouth 
 and pharynx become varicose; should their walls rupture, severe or 
 fatal bleeding may result. Ulcers about tongue seldom bleed much. 
 Gangrenous glossitis has ended fatally with hemorrhage. 
 
 Treatment. Ice. Cold astringent washes. — See Hemorrhage. 
 
 STROPHULUS.— Synon. Li cheniasis Strophulus; Tooth-rash; Bed Gum 
 Bash. — A papular skin disease, peculiar to infants and young children. 
 Characterized by an eruption of minute, hard, sometimes slightly red, 
 and clustered or scattered, pimples. May appear upon a part, or ex- 
 tend over whole sui'face of body. Irritation slight. 
 
 Varieties. Several described, according as j^apulse ai'e large or small, 
 scattered or grouped. But whether papules are scattered, with red dots 
 interspersed among them, as in strophulus intertinctus ; or white and 
 large, often resembling flea-bites, as in strophidus candid us ; or forming 
 circular patches, which come out successively in ditferent parts of body, 
 as in strophulus volaticus.^ — is of little moment. Practically, all forms 
 due to stomach or intestinal derangement; the consequence of imj)roper 
 feeding, or of irritation about gums from dentition. 
 
 Treatment. Careful diet. Avoidance of acid milk Mild antacid 
 aperients. Weak glycerine lotions. Lancing gums, in strophulus con- 
 nected with ditficult dentition. 
 
 STYES. — A stye or hordeolum (from Hordeum, barley) is merely a 
 small boil, of the size and firmness of a barleycorn, situated at the edge 
 of the eyelid. — See Boils. 
 
 SUDAMINA. — From Sudo, to sweat. Synon. Hydroata ; Papido' Su- 
 dorales; Sweat Vesicles. — Consist of crops of small transparent vesicles, 
 which come out in many diseases attended with sweating. The skin 
 looks as if dotted with small colorless glass beads. Most common on 
 front of neck and chest. No treatment required. — See Miliaria.
 
 246 SUPRA-RENAL CAPSULAR DISEASE — SUSPENDED ANIMATION. 
 
 SUPRA-RENAL CAPSULAR DISEASE.— Synon. Iforbus Addisonii; 
 Supra-renal Melasma. — An excessive degree of anaemia, supposed to be 
 due to disease of the supra-renal capsules. 
 
 Symptoms. Commence very gradually : failing health and debility. 
 Languor; loss of appetite; feeble pulse; irritability of stomach; pro- 
 gressive emaciation. Perhaps vomiting and gastric irritation ; indica- 
 tions of disturbed cerebral circulation. A gradual discoloration of skin ; 
 most marked about face, neck, arms, circumference of navel; gradually 
 becoming of a dingy or smoky hue. This discoloration now said (con- 
 trary to Addison's original views) not to be a necessary element : ap- 
 pears only when case has been of long duration, and perhaps not then. — 
 After an average duration of eighteen months, death from extreme 
 anaemia and exhaustion. 
 
 Treatment. Relief of prominent symptoms. Ferruginous tonics, 
 with good nourishing food, are useful for a time. 
 
 SUSPENDED ANIMATION.— Synon. Asphyxia; Apnxa ; Apnceas- 
 phyxla. — May result from syncope; strangulation, and obstruction of 
 larynx by foreign bodies; inhalation of chloroform, carbonic acid, or 
 other poisonous gases; nai'cotic poison ; a stroke of lightning ; and 
 drowning. In all forms, treatment resolves itself into allowing free in- 
 gress of pure air to lungs; and then inducing warmth and circulation. 
 
 Appearances which indicate death : Complete cessation of breathing 
 and heart's action; eyelids half closed, and pupils dilated; jaws clenched; 
 tongue appearing between teeth, with frothy mucus about mouth and 
 nostrils; lingers semi-contracted; with increasing coldness and pallor 
 of surface. 
 
 1. Drowning, or Suffocation. — The following rules for treatment are 
 essentially those drawn up by Dr. H. R. Silvester, and circulated by the 
 Royal Humane Society: 
 
 Rule 1. — To maintain a Free Entrance of Air into the Windpipe. — 
 Cleanse the mouth and nostrils : open the mouth : draw forward pa- 
 tient's tongue, and keep it forward ; an elastic band over the tongue, 
 and under the chin will answer this purpose. Remove all tight cloth- 
 ing from about neck and chest. Make sure that no foreign body is 
 lodged in pharjmx, larynx, or oesophagus. 
 
 Rule 2. — To adjust the Patient's Position. — Place the patient on his 
 back on a flat surface, inclined a little from the feet upwards ; raise and 
 support the head and shoulders on a small firm cushion or folded article 
 of dress placed under the shoulder-blades. Supposing that natural res- 
 piration has ceased, proceed — 
 
 Rule 3. — To imitate the Movements of Breathing. — GrasiD patient's arms 
 just above the elbows, and draw the arms gently and steadily upwards, 
 until they meet above the head (this is for the purpose of drawing air 
 into the lungs) ; and keep the arms in that position for two seconds. 
 Then turn down patient's arms, and press them gently and firmly for 
 two seconds against sides of chest (this is with the object of pressing 
 air out of the lungs. Pressure on the breast-bone will aid this). 
 
 Repeat these measures alternately, deliberately, and perseveringly, 
 fifteen times in a minute, until a spontaneous effort to respire is per- 
 ceived ; immediately upon which cease to imitate the movements of 
 breathing, and proceed to iiiduce circulation and warmth. 
 
 Should a warm bath be procurable, the body may be placed in it up 
 to the neck, continuing to imitate movements of breathing. Raise the 
 body in twenty seconds in a sitting position, and dash cold water against
 
 SYPHILIPHOBIA — SYPHILIS. 247 
 
 chest and face, and pass ammonia under nose. Patient should not be 
 kept in warm bath longer than five or six minutes. 
 
 Rule 4. — To excite Inspiration. — During employment of above method 
 excite nostrils with snuff or smelling-salts, or tickle throat with a fea- 
 ther. Rub chest and face briskly ; dash cold and hot water alternately 
 on them. 
 
 Rule 5. — To induce Circulation and Warmth. — Wrap patient in dry 
 blaidvcts, and commence rubbing limbs upwards, firmly and energetically. 
 Friction must be continued under blankets or over dry clothing. 
 
 Promote warmth of body by a])plication of hot flannels, bottles or 
 bladders of hot water, heated bricks, &c., to pit of stomach, ai-mpits, be- 
 tween thighs, and to soles of feet. Warm clothing may generally be 
 obtained from bystanders. 
 
 On restoration of life, when power of swallowing has returned, a tea- 
 spoonful of warm water, small quantities of wine, warm brandy and 
 water, or coffee, should be given. Patient should be kept in bed ; dis- 
 position to sleep encouraged. During reaction, large mustard plasters 
 to chest and below shoulders will greatly relieve distressed breathing. 
 
 2. Intense Cold. — Acts chiefly on nervous system. There is giddi- 
 ness; inability to see ; weakness and rigidity of limbs ; almost imper- 
 ceptible respiration and pulse; tendency to profound sleep; and coma. 
 — Attempt restoration of circulation and sensibility by rubbing body 
 with snow or ice or cold water. Friction with flannel long-continued. 
 Yery gradual application of warmth. A stimulating enema, — unless 
 warm milk, or coffee, or beef tea, or wine can be swallowed. 
 
 3. Syncope. — From Iu)'/.67ztu), to be affected with sudden prostration. 
 Synon. Swooning; Fainting. — Remedies for fainting are: Recumbent 
 position with head low. Cold air. Cold water dashed over head and 
 chest. Friction or sinapisms over heart's I'egion. Small quantities of 
 ammonia or brandy. Galvanism to rouse heart's action. — In apparently 
 hopeless cases of syncopic from hemorrhage, a full dose of opium in 
 brandy. Transfusion. 
 
 4. Intoxication, or Narcotic Poisons. — Treatment of: Patient to be 
 
 placed on his side, with head slightly raised. Cold affusion. Heat to 
 extremities. Stimulating embrocations to chest. Use of stomach-pump, 
 as emetics and tickling of fauces seldom act where insensibility is great. 
 Artificial respiration. Galvanism. Strong tea or coffee. Solution of 
 acetate of ammonia. 
 
 SYPHILIPHOBIA.— From Syphilis; and <po§iu,, to dread. Synon. 
 Sijphiloinania ; Noddle Pox. — A morbid or hypochondriacal fear of 
 syphilis, producing imaginary symptoms of the disease. 
 
 Symptoms. Allied to those presented in fictitious cases of sperma- 
 torrhoea or impotence. Great mental suffering. Impairment of general 
 health. Urgent desire for anti-syphilitic drugs. 
 
 Treatment. Some preparation of zinc with strychnia or nux vomica, 
 407, 411. Iron, 380, 387, 408. Mineral acids, 376. Ilypophosphite of 
 soda and bark, 419. Cod-liver oil Good diet. Cold or tepid baths. 
 Sea air. 
 
 SYPHILIS. — Several derivations have been given of this word; but 
 according to Dr. Mayne none seem better than that of Blancardus, — 
 2'yK, together; <pdi<u, to love. Synon. Lues Venerea; Venereal Disease; 
 Fox.
 
 248 SYPHILIS. 
 
 1. Primary Syphilis. — Occurs as a specific ulcer or chancre, the nicer 
 ap|)earinu; on the part to which the virus has been directly applied. 
 There are four distinct varieties of sores: 
 
 (1) Indurated, Hunterian, Infecting, or True Chancre. — It is 
 accompanied by the adhesive inflammation, and gives rise to a specific 
 chronic enlargement of the inguinal glands. It is followed by consti- 
 tutional s^'mptoms. A period of incubation, varying from ten days to 
 six or seven weeks, elapses from the time of inoculation to the appear- 
 ance of the induration. The sores are characterized by their margins 
 and bases being indurated from the effusion of lymph; while the secre- 
 tion from them is scanty, and formed of serum, Ij-mph globules, and 
 epithelial debris. This secretion is not inoculable upon the infected 
 party. A mercurial course, similar to that required in constitutional 
 sypliilis, is necessary. — See Syphilization. 
 
 (2) SiMPLK, Soft, Non-indurated Chancre. — Accompanied by sup- 
 purative inflammation. It is a local disease, not followed by secondary 
 symptoms. There are one or more sores, with Avell-defined edges, 
 looking as if portions of healthy tissue had been punched out. The 
 secretion abundant and purulent; auto-inoculable. If seen within five 
 days from inoculation, effective cauterization will destroy the sore and 
 virus. Best caustics, — nitric acid, acid solution of nitrate of mercury, 
 potassa fusa. In other cases astringent lotions. Ferruginous tonics. 
 Nourishing food. 
 
 (3) Phagedenic Chancre. — Accompanied by ulcerative inflamma- 
 tion. The ulcer is small, irritable, ragged, secreting unhealthy pus. 
 The sore has a tendency to spread irregularly. A suppurating bubo 
 forms, Avhich yields inoculable pus. It is not followed by constitutional 
 S3'philis, and does not usually require specific remedies. Fomentations 
 and ]30ultices, or soothing lotions. Bark and nitric acid. Ferruginous 
 tonics. Iodide of potassium and sarsaparilla. Nourishing diet, fi'ee 
 from stimulants. 
 
 (4) Sloughing Chancre, or Gangrenous Phagedena. — Accompa- 
 nied by mortification. It does not aflTect the inguinal glands, is not 
 followed by constitutional infection, and requires only local treatment. 
 Sometimes the disease so severe, that the prepuce and a portion of the 
 glaiis may be destroyed. In enfeebled prostitutes the Avhole of the 
 labia and nj^mphfe may slough away. Fomentations and poultices. 
 Opium. Nourishing food. Stimulants. Confinement to bed. 
 
 2. Constitutional Syphilis. — Result of indurated or infecting chancre. 
 Many cases of chronic ill-health are due to it; while it is often the 
 cause of obscure diseases of the vital organs, affections of the bones, 
 reltel lions ulcers of the cutaneous or mucous surfaces, troublesome skin 
 diseases, impotence or sterility, abortion, and the death of the foetus in 
 utero. 
 
 Symptoms. In the beginning there is general disturbance of the 
 sj'stem. Then fever, mental dejjression, lassitude, pains in the limbs, 
 and a sallow hue of skin. Shortly, unmistakable evidence afforded by 
 the ])roduction of certain copper-colored cutaneous diseases; ulcers on 
 the skin; warts, and condylomata or mucous tubercles; tumors of the 
 skin and subcutaneous areolar tissue; alopecia or baldness, and loss of 
 the eyebrows and eyelashes; syphilitic iritis; discoloration and crumb- 
 ling of nails, or inflammation and ulceration about their roots; superfi- 
 cial ulcerations on the tongue, lips, and pillars of the fauces; ulceration 
 of the larynx ; diseases of the periosteum and bones ; pain about middle 
 of sternum ; and in a few instances, and as late tertiary symptoms, 
 by sei'piginous ulceration of the skin, as well as by diseases of the 
 brain, spinal cord, lungs, heart, liver, &c.
 
 SYPHILIZATION. 249 
 
 Treatment. Diet liglit and nutritious; fish, moat, milk, cream, i*aw 
 Cfijgs ; claret or sherry and water. Warm clothing, flannel, and avoid- 
 ance of cold and damp. Warm water or vapor baths. Blue pill. 
 Calomel. Compound calomel pill. Mercury and chalk. Inunction 
 with mercurial ointment ; sixty or more grains every night. Mercurial 
 vapor baths, 131. Solution of corrosive sublimate, given for many 
 weeks, 27. Green iodide of mercury, 58. Eed iodide of mercur}-, 
 54. Donovan's solution, 51. Iodide of potassium, 31. Iodide of 
 sodium, 39. Iodide of iron, 32. Opium. Cod-liver oil. — "-Derivative" 
 treatment as practised by Dr. Ujort : Application to different parts of body, 
 beginning between the scapuhe, of stibiatc plasters (made with one 
 part of powdered tartarated antimony and three of adhesive plaster, 
 melted together), the size of a visiting card. As soon as good pustules 
 are produced, poultices. At same time, caustics to mucous tubercles, 
 ulcers on fauces, &c. — The ^^ Zittmann" eliminative plan consists of rest 
 in bed in a warm room: a very moderate diet without stimulants: 
 a purgative every second day : and the production of sweating by 
 copious draughts of compound decoction of sarsaparilla. Subsequently 
 a course of tonics or of alkaline waters. — See Syphilization. 
 
 3. Infantile Syphilis. — May be hereditary or acquired. Infant usually 
 born healthj'-looking : but sometimes with its skin of a dull color, and 
 its features contracted — like a little old man. 
 
 Symptoms. Generally, within the month, symptoms of coryza set in j 
 cough, difficulty in sucking, dryness of the lips and mouth, the 
 "snuffles." Voice shrill and coarse. Superficial ulcerations about 
 mouth and throat. Parts around the mouth, nosti'ils, buttocks, arms, 
 and flexures of joints become copper-colored, fissured, and excoriated. 
 Child wastes and gets very weak. Amyloid disease of liver. Indui-ated 
 nodules in lungs. Syphilitic iritis. Chronic interstitial keratitis. Deaf- 
 ness. — In children with inherited syphilis: A peculiar physiognomy. 
 Tendency to chi'onic interstitial keratitis. Notching of central upper 
 incisors of permanent teeth (Hutchinson). 
 
 Treat.ment. Mercurial inunction. Mercury and chalk. Iodide of 
 potassium. Chlorate of potash. A healthy wet-nurse? Feeding by 
 hand, — goats', asses', or cows' milk — See Syphilization. 
 
 SYPHILIZATION. — A term applied by Auzias Turenne to the condi- 
 tion produced by successive inoculations with syphilitic poison ; in 
 which each succeeding chancre becomes less and less, until a time 
 arrives when no ulcer can be produced by insertion of venereal virus. 
 Hence the inference has been drawn that, by prolonged inoculation, a 
 constitutional state is induced in which the system is no longer capable 
 of being affected b}' syphilis. 
 
 To obtain pei'fect syphilization or immunity, an individual must un- 
 dergo constitutional syphilis: he must be forced rapidly through this state 
 by repeated inoculations, so that his organization may not be injured. 
 Sperino inoculates for from six to ton chancres at each sitting; and allows 
 three or four days to elapse between each operation. By continued 
 inoculation the ulcers become less and less until no effect is produced ; 
 but the individual is still susceptible, though in a less degree, to another 
 kind of matter, again to a third, and so on until at last no effect is pro- 
 duced by any syphilitic poison. The general health instead of suffering, 
 improves during process of inoculation. Time required to produce 
 immunity varies: in one case it was obtained after 71 chancres; in 
 most instances upwards of 3j0 were produced, treatment lasting for 
 nine or twelve or twenty months and more. It may be practised at
 
 260 TABES DORS'ALIS TEMPERATURE OF BODY. 
 
 any age. To obtain a complete cure when patient has previously 
 been mercurialized, the use of iodine has often to be combined with 
 syphilization. Dr. Boeck asserted in 1858, in consequence of results 
 he had obtained from 83'philization alone in those who had not been 
 previously mercurialized, that in no disease has the ■practitioner a more 
 certain method of cure. Disadvantages of the method, — its offensive 
 nature, and the length of time necessary for effectually carrying it out j 
 on the other hand, the immunity produced is thought to last for life. 
 
 TABES DOESALIS. — From Tabeo, to waste away; dorsum, the back. 
 Synon. PlUhisis Uorsalis ; Myelophthisis. — A state of atrophy of poste- 
 rior columns of spinal cord producing palsy. — See Paralysis. 
 
 TABES MESENTERIC A.— From Tabeo, to melt away; Meav.ripw^, the 
 membrane which connects the intestines together, — p.iffo':, 'ivztpov. Synon. 
 Phthisis Mesaraica ; Scrofula Mesenterica; Mesenteric Disease; Abdominal 
 Phthisis. — A tubercular degeneration of the mesenteric glands. Tuber- 
 cle effused into the glands, destroying their structure, and obstructing 
 the passage of chyle through the convoluted lacteals traversing them. 
 Particularly affects infants and young children. Often combined with 
 tubercular peritonitis. 
 
 Symptoms. More or less constant pain in bowels : sometimes severe, 
 causing legs to be drawn up towards belly. Deep red color of lips : 
 angles of mouth covered with small ulcers, or lips fissured. Irregular 
 action of bowels: motions generally frequent, watery, unhealthy, and 
 fetid. Abdomen swollen and tense : wasting of other parts of body 
 until extreme emaciation ensues. Great pallor : general debility, weak- 
 ness rapidly increasing. Recovery occasionally takes place, if disease 
 be checked before functions of glands are much impeded. Symptoms 
 of pulmonar}' consumption, or of tuberculization of bronchial glands, 
 or of tubercular meningitis may supervene. 
 
 Treatment. Phosphate of iron (" Chemical Food"), 405. Hypo- 
 phosphite of soda or lime, 419. Ammonia and bark. Cod-liver oil, 389. 
 Steel wine. Tincture of perchloride of iron. Ammonio-citrate of iron. 
 Iodide of iron. Quinine. Iodide of ammonium. Iodide of potassium. 
 Solution of chlorinated soda. Peroxide of hydrogen in weak solution. 
 Glycerine. Taraxacum, bicarbonate of potash, and sarsaparilla. Mer- 
 cury and chalk, with soda and magnesia, 34. Mercury and chalk, with 
 powder of ipecacuan and opium. Aromatic powder of chalk and opium. 
 Bismuth. Logwood. Catechu and chalk mixture. — Mild nourishing 
 food. Asses' or goats' milk. Milk and soda water. Milk and lime- 
 water. Cream. Paw eggs. Carrageen or Irish moss. Eaw minced 
 beef, 2. — Friction of abdomen with soap or opiate liniments. Linseed 
 poultices. Wet compress. Warm, or tepid, salt water baths. Iron, or 
 oak bark, baths, 126. Warm clothing. Flannel bandage round abdo- 
 men, night and da3^ Well-ventilated sleeping-room. Sea air, — Mar- 
 gate, Broadstairs, Folkestone, 431; Scarborough, 439; Brighton, Hast- 
 ings, 432 ; Ventnor, 434. 
 
 TEMPERATURE OF BODY.— The normal temperature at unexposed 
 parts of surface is 98.4° Fahr. A persistent rise above 99.5°, and a con- 
 tinued depression below 97.3°, are indicative of disease. The increase 
 above 99° is the best index of amount of fever present. 
 
 Observations should be taken at least every morning and evening, 
 alwaj'S at the same hour, throughout the whole illness. Pulse and res- 
 pirations to be noted at same time. The bulb of thermometer to be ap- 
 plied to armpit, groin, or belly : to be kej^t in close contact with skin :
 
 TESTICULAR NEURALGIA TEPTITIS. 251 
 
 to remain in situ for at least three minutes. Were it not for obvious 
 objections, the rectum would be the best situation. A very sensitive 
 curved thermometer, and a straight self-registering instrument, can be 
 obtained in a convenient case from Mr. L. Casella, 23 Hatton Garden, 
 London. 
 
 There is a continuous elevation of temperature in all cases of pro- 
 gressive tubercxdosis from the beginning; the temperature becoming 
 normal when the disease becomes arrested. — A continued elevation 
 occurs in all acute inflammatory diseases. In rheumatism : empyema : sup- 
 puration : continued and eruptive fevers, &c. During paroxysms of ague, 
 from commencement of the rigor to the termination of the sweating 
 stage. — A persistent temperature of 105° is indicative of danger, or of 
 a tendency to some important complication, m pneumonia, typhoid fever, 
 typhus, small-pox, measles, scarlet fever, erysipelas, acute rheumatism, and 
 ichorhcemia. In any case, a rise above 106° very unfiavorable : above 
 110°, disease in all probability will be fatal. In typhoid fever, a sudden 
 fall below normal heat has indicated the occurrence of hemorrhage from 
 ulcerated Peyer's patches, manj'' hours before blood has appeared in the 
 stools. — During convalescence from acute disease, a sudden rise in temper- 
 ature may be the first indication of a relapse : an abnormal fall (as to 
 95°) shows a tendency to collapse and indicates the need of hot appli- 
 cations, stimulants, warm soups, &c. 
 
 TESTICULAR NEURALGIA.— There may be merely increased sen- 
 sibility of the testicle, — irritable testis. Or the pain will be most distress- 
 ing, assuming the character of true neuralgia. No swelling or increase 
 of heat: but only intolerance of least pressure, and retraction of gland 
 close to the groin during the paroxysms. Either irritable testicle or 
 neuralgia may arise from onanism, or excessive intercourse; disease at 
 prostatic part of urethra; as a sequel of testitis; from gout; dyspepsia, 
 with very acid urine; a calculus in kidney or ureter; varicocele, &c. 
 The remedies are: Belladonna, aconite, and opium locally applied: cold 
 lotions, or even ice bag: subcutaneous injections of morphia into scrotum. 
 Quinine; iron; arsenic; valerianate of ammonia or zinc. When pain 
 has been very acute, patients have demanded castration : compliance 
 with such a wish, perfectl}' unjustifiable, save in very exceptional in- 
 stances. Were castration resorted to, the pain would return in the cord, 
 unless due to actual disease of the gland. 
 
 TESTICULAR TUMORS.— The testicle may be the seat of a fibrous 
 transformation. Of fibro-plastic or myeloid growths; or of enchondro- 
 matous (cartilaginous) tumors. Non-malignant c^'Sts of different kinds 
 may form, by dilatation of the seminiferous tubules {hydatid disease of 
 Sir Astley Cooper; cystic sarcoma of recent writers). Very rarely, ma- 
 lignant cystic disease has occurred. Scirrhous is less frequent than me- 
 dullary cancer. Young children are occasionally affected with scirrhus, 
 more often with encephaloid. Extirpation is the only remedy in all 
 cases, where treatment is really necessary. In cystic sarcoma, a per- 
 fect cure may be hoped for by removal : in cases of carcinoma a recur- 
 rence is very much to be feared. 
 
 TESTITIS. — From Testis, a witness, — because the testicle is a proof 
 of virility ; terminal -itis. — Inflammation of the testicle may be acute or 
 chronic ; or it may be specific, — syphilitic, or tubercular. 
 
 1. Acute Testitis. — Synon. Hernia Humoralis ; Orchitis; Orchiocele; 
 Swelled Testicle. — Generally due to extension of gonorrhoeal inflamraa-
 
 252 TESTITIS. 
 
 ttion from urethra; such inflammation havinj>; been often aggravated by 
 •strong injections, use of alcoholic drinks, active exercise, neglecting to 
 •M'ear a suspensory bandage, &c. The central portion or body of the 
 gland may be affected; or the epididymis and tunica vaginalis may be 
 attacked (epididymitis); or all these parts may suffer. 
 
 Symptoms. Pain and feeling of weight in cord and testicle. Uneasi- 
 'jiess about the loin, groin, and upper part of thigh. Frequent micturi- 
 tion. Diminution of urethral discharge. Swelling of testicle, from eifn- 
 sion of serum and lymph into tunica vaginalis : scrotum firm and tense: 
 .swelling of cord. Great tenderness; pressure aggravates thcjniin. Feb- 
 xi\e disturbance: nausea and vomiting: constipation. Abscess rarely 
 forms. Very seldom the inflammation has ended in gangrene. 
 
 Treatment. Prior to setting in of swelling the disease may perhaps 
 be checked by antimonial emetics, 231. Alkaline aperients, — Sulphate 
 of soda and taraxacum, 144. Sulphate and carbonate of magnesia with 
 colchicum, 141. Iodide of potassium, 31. Aconite, 330, 331. Opium, in 
 doses sufficient to relieve pain. Eest in bed : scrotum to be supported 
 by small pillows. Hot fomentations, with ap])lication of extracts of bel- 
 ladonna and poppies, 297. Pressure by means of strajiping, or of strips 
 of mercurial plaster, methodically applied: seldom to be used till to- 
 wards the end of acute stage. 
 
 Puncture with a thin sharp knife into body of testis, so that by di- 
 vision of tunica albuginea the pressure on lobules and convoluted tubes 
 may be removed: the incision allows a quantit}^ of serum and a few 
 drachms of blood to escape: there is immediate i-elief, the process sel- 
 dom requiring repetition (Henry Smith). Puncture of the testicle, fol- 
 lowed as soon as bleeding has ceased by tight comiircssion with strap- 
 ping: administration of one grain of opium (Spencer Watson). 
 
 2. Chronic Testitis. — Synon. Sarcocele, from -r/^'l, flesh; xrjh, a swell- 
 ing. — Is either the sequel of an acute attack; or the inflammation may 
 be subacute or chronic from commencement. May be due to stricture 
 of urethra; to gleet; or to a sj-phiiitic taint. 
 
 Symptoms. Morbid action usually begins in cpidid3-mis, and extends 
 to bod}' of testicle. There is swelling, hardness, and tenderness on pres- 
 sure : a sense of weight. Sometimes, cfl'usion of serum into tunica vagi- 
 nalis — hydro-sarcocele. When due to constitutional syphilis (syphilitic 
 sarcocele) there are other manifestations of this state: pustular or scaly 
 skin eruptions, rheumatic pains with nocturnal exacerbations, ulcers 
 about tongue or throat, derangement of general health, and sometimes 
 iritis. 
 
 Treatment. Removal of cause : examination of urethra for stricture, 
 &c. Avoidance of active exercise. Use of suspensoi-y bandage. Pres- 
 sure, firmly and evenly applied, by encircling the gland with strips of 
 strapping or of mercurial plaster. Iodine liniment diluted. Red iodide 
 of mercury ointment diluted, 3(12. Iodide of potassium, 31. Mercurial 
 vapor baths, 131. Red iodide of mercury, 54. Corrosive sublimate with 
 sarsaparilla, 27. 
 
 3. Abscess and Fungus of Testicle. — May result from acute or chronic 
 inflammation. When fluctuation can be detected, and the skin is ad- 
 herent, a puncture should be made; pressure being ap])lied after evacu- 
 ation of the pus. 
 
 Sometimes, when matter forms, the tunica albuginea gets perforated; 
 the integument thins and gives way; and through the opening a j)ro- 
 trusion of flbro-plastic matter with some of the tubular structure takes 
 place. There is but little pain. The fungus slowly increases; unless it 
 has been returned and kept in place by strapping, after separating by
 
 TETANUS. 253.' 
 
 dissection the thickened inte<^ument adherent to the maririns of the 
 woiinil, and tlien carefiUly britii^ini!; tiie edges togetlier. Where the pro- 
 truded part has become disorganized, it must be sliced otf, — a jiroceed- 
 ing equivalent to partial castration. 
 
 4. Scrofulous Testicle. — Slow and anbacute inflammation, with deposit 
 of tubercular matter between the tubuli seminiferi, or into the epididy- 
 mis. 
 
 Symptoms. Formation gradually of a nodular swelling, without pain. 
 Tumor seldom attains much size. Softening and suppuration ; the swell- 
 ing bursts, pus and tubercular matter coming away; sinuses form, and 
 communicate with similar enlargements. The sores may put on a healthy 
 character, or there may be a protrusion of tubular structure, — fungus of* 
 testicle. Tubercular (lisease of lungs often also jiresent. 
 
 TaEATME.NT. Nourishing food : .stimulants, milk, cream, raw eggs, 
 beef solution, 2. Sea air. Cod-liver oil. Ammonia and bark. TIj'po- 
 phosphites of soda or lime, anil bark, 419. After evacuation of pus, 
 pressure by strapping. Lotions of sulphate of zinc, 264; or iodine, 260. 
 Where constitutional disturbance is great, removal of source of irritation' 
 b^'' castration may be required. 
 
 TETANUS. — From 'AcVw, to bend or strain. Synon. Rigor Nervorum; 
 Spasm with Rigidity. — A disease, the chief feature of which is long-con- 
 tinued contraction or spasm of a certain number of the voluntary mus- 
 cles. Rigidity of muscles continuous, and hence spoken of as tonic 
 spasm or i<pastic contraction ; in contradistinction to clonic spasms of con- 
 vulsions, where there are alternate contractions and relaxations. — '■ 
 Cases oi" idiopathic, move hopeful than of ^yaumn^ic, tetanus. Symptoms 
 very similar to those produced by poisonous dose of strychnia. 
 
 Symptoms. Usually siU in suddenly : muscles of jaws and throat first 
 affected. Patient complains that he has taken cold, and as if he had 
 got a sore throat and stiff neck; but stiffness and uneasiness soon in- 
 crease, and extend to the root of the tongue causing difficulty in swal- 
 lowing. Temporal and masseter muscles gradually get involved ; lock- 
 jaw or trismus {T/j{'^(o, to gna^h with the teeth) occurs. VYlien disease 
 proceeds, remaining muscles of face, trunk and extremities become im- 
 plicated. Spasms never entirely cease, except in son\o cases during 
 sleep: aggravated every quarter of an hour or so, increased cramp last- 
 ing for a few minutes and then partially subsiding. — Where strong 
 muscle-) of back are most affected, they bend body into shape of an 
 arch, so that ]iaticnt rests upon head and heels, a condition known as 
 opisthotonos ('0-c/tO:, backwai-ds; r ztxu, to band). — When body is bent 
 forwards by strong contraction of the mviscles of neck and abdomen, 
 affection termed emprosthotonos (^Efj-potrOzv, forwards, and T-i>iij). — If 
 muscles are affected laterally, so tl.at body is curved sideways, the dis- 
 ease has been designated pleurosthotonos {^llhupoOtv, from the side, and 
 Tct'vw), or tetanus lateralis 
 
 Frightful suffering caused by tetanic spasms. Face pale; brows con- 
 tracted; skin covering forehead corrugated; eyes fi.xed and prominent 
 — sometimes suffused with tears; nostrils dilated; corners of mouth 
 drawn back, teeth exposed, and features fixed in a grin — risus sardon- 
 icus. Respirations performed with difficulty and anguish; severe pain 
 at sternum; great thirst, but agony increased by attempts at deglu- 
 tition; pulse feeble and frequent; skin covered with pei-spiration ; pa- 
 tient cannot sleep, or if he dozes it is only for a few minutes ai a time. 
 With all this suffering, iiUellect remains clear and unaffected. Death 
 usually occurs between third and fifth days; partly from suffocation, 
 partly from exhaustion.
 
 264 THROMBOSIS — TINEA. 
 
 Treatment. Empirical and often useless. Full doses of calomel and 
 jalap, until bowels are freely acted on. Inhalation of chloroform, more 
 or less insensibility being kept up for many hours. Belladonna locally, 
 and internally. Quinine in full doses, with or without belladonna. Sub- 
 cutaneous injections of liquor atropiae, 314. Subcutaneous injections of 
 solution of active principle of woorara — the alkaloid curarina. Nicotine 
 (one or two drops for a dose). Powder of Old Calabar bean (one grain 
 to six for a dose). Aconite. Conium. Sulphite of soda or magnesia, 
 if disease be thought due to absorption of morbid matters, 48. Pro- 
 longed application of ice to spine. 
 
 Opium objectionable: produces a state of congestion and polar excite- 
 ment of spinal cord. Bloodletting; blisters; cold, hot, and vapor 
 baths; mercui-y ; antimony; colchicum ; large doses of assafcetida; tur- 
 pentine; digitalis; glonoin ; musk; iron; hydrocyanic acid; Indian 
 hemp, — all have been fruitlessly employed. — See Trismus Nascentium. 
 
 THROMBOSIS. — By this term (from BposiSo':, a clot of blood) is gen- 
 erally understood the partial or complete closure of a vessel, by a mor- 
 bid product developed at the site of the obstruction. The coagulum, 
 which is usually fibrinous, is known as autochthonous clot or throvibus. 
 
 Thrombi mostly met with in diseases attended with exhaustion. 
 Particularly in croup, diphtheria, scarlatina, endocarditis, pneumonia, 
 phthisis, typhus, purpura, erysipelas, hemorrhage, &c. Their formation 
 favored by condition of blood during pregnancy and puerperal state. 
 
 Treatment. Variable according to the symptoms. Indications gen- 
 erally are to support the vital powers and allay irritability. Brandy. 
 Eum. Essence of beef, 2, 3. Milk. Brandy and eggs, 17. Ammonia, 
 361, 371. Ether, 367. Quinine, 379. Bark. Opium, 316, 318, 340. 
 Sulphite of magnesia, 48. Pure air. Perfect rest. 
 
 THRUSH. — A disease of the mouth occurring in infants. Synon, 
 Aphtha lufantmn ; Fehris Aphthosa ; Vesicular Gingivaruvi; Milk Thrush. 
 — See Aphtha; of Mouth. 
 
 TIC DOULOUREUX. — Severe attacks of neuralgic pain in nerves of 
 face. Infra-orbital branches of fifth pair, most frequent seat. Synon. 
 Neuralgia Faciei ; Painful Tic. — See Neuralgia. 
 
 TINEA. — From Tinea, any gnawing or destructive worm. — Applied 
 generally to those cutaneous diseases which are due to presence of epi- 
 phytes or parasitic plants. All are contagious. Five varieties : 
 
 1. Tinea Tonsurans. — From Tonde.o, to shave, — because of the brittle- 
 ness of the affected hairs. Synon. Porrigo Scutulata; Scalled Head; 
 Herpes Tonsurans; Herpes Circinatus ; Trichosis Furfuracea ; Bingworm. 
 A chronic contagious disease, known by decolorization and brittleness 
 of affected hairs, scaly eruption, and roundness of diseased patches. 
 Most common on the scalp. The parasite is the Tricophyton Tonsurans; 
 the sporules and mycelium of which intiltrate the texture of each hair, 
 while they also spread among the epithelial scales. 
 
 Treatment. See Tinea Sycosis. 
 
 2. Tinea Favosa. — From J^a ?;?/.«, a honeycomb. Synon. Favus ; Tinea 
 Lupinosa ; Porrigo Favosa; Honeycomb Jlingworm. — Very rare. Most 
 commonly affects the scalp, in form of small cup-shaped, dry, yellow 
 crusts; each crust containing a hair in its centre,and resembling a piece 
 of honeycomb. Attended with severe itching; hairs become brittle 
 and fall out; crusts have a mouldy offensive odor and are often sur-
 
 TONGUE DISEASES. 255 
 
 rounded with lice. The cryptogamic parasitic cause is the Achorion 
 Schonleinii. 
 Treatment. See Tinea Sycosis. 
 
 3. Tinea Decalvans. — From Becalvo, to make bald. Sjnon. Porrigo 
 Decalvans; Alopecia Circumscripta ; Alopecia Areata. — The hair falls off 
 one or more circular or oval spots; leaving perfectly smooth bald 
 patches. The parasitic fungus is the Microsporon Audouini. 
 
 Treatment. See Tinea Sycosis. 
 
 4. Tinea Sycosis. — From luxo/mi, to become like a fig. Synon. Roseola 
 Ficosa ; Sycosis; Mentagra ; Ghinwhelk; Barber's Itch. — Characterized by 
 inflammation of the hair follicles; causing successive eruptions of small 
 acuminated pustules, which have been said to have a granulated ap- 
 pearance resemblance the substance of a fig. Occurs most frequently 
 on chin, and other parts co^^ered by the beard. The parasite is the 
 Mici'osporon Mentagrophytes. 
 
 Treatment. Attention to, cleanliness. Eemoval of hairs with scis- 
 sors, or extraction by forceps — epilation. Separation of all scabs or 
 incrustations by poultices and simple ointments or oil. Improvement 
 of general health by generous diet; cod-liver oil; bark, quinine, steel. 
 Destruction of parasitic plant by sulphurous acid lotion, 27:^; creasote 
 or carbolic acid, 270; corrosive sublimate, 271; a mixture of equal parts 
 of calomel, creasote, and sulphur ointment; diluted citrine ointment, 
 305; ammoniated mercury and sulphur ointment, 300; or iodide of sul- 
 phur ointment, 310. In ringworm especially, painting with strong acetic 
 acid ; or glacial acetic acid, washing the part directly afterwards. In 
 tinea decalvans, frequent painting with liniment of cantharides. 
 
 5. Tinea Versicolor. — From Versicolor {verso and color), that changes 
 its color. Synon. Chloasma; Pityriasis Versicolor; Macula Hepatica ; 
 Liver Spot. — Makes its appearance generally on front of chest or abdo- 
 men, in form of yellowish patches covered with small branny scales. 
 Caused by a cryptogamic plant, — the Microsporon Furfur. 
 
 Treatment. Sulphurous acid lotion, 272. Corrosive sublimate lini- 
 ment, 271. Thorough cleanliness. Flannel vests to be soaked in boil- 
 ing water. In obstinate cases, — arsenic, 52. 
 
 TONGUE DISEASES.— The tongue is exposed to many sources of dis- 
 ease and injur3\ A highly sensitive organ : hence, slight diseases of its 
 mucous membrane, or of its muscular fibres, are commonly very painful. 
 
 1. Glossitis. — From nai<T(Ta, the tongue; terminal -«Y;'.s. Synon. Angina 
 Lingiudis; Inflammatio Linguce. — Inflammation of the tongue a rare 
 aff'ection, now that mercury is seldom used so as to induce salivation. 
 Generally an accompaniment of other diseases, rather than an idiopathic 
 aff'ection. 
 
 Symptoms. Fever. Constitutional disturbance. Debility. Anxiety. 
 Pain, heat, and salivation. Color deepened. Swelling sometimes so 
 great that cavity of mouth cannot contain the organ, and it projects 
 beyond the teeth. Swelling may set in rapidly : often produces urgent 
 dyspnoea. Sometimes ends in suppuration. 
 
 Treatment. Castor oil, 164. Castor oil and turpentine enema, 190» 
 Croton oil enema, 191. Chlorate of potash, 61. Application of ice. 
 Pencilling with nitrate of silver. Free incisions along upper surface 
 to relieve congestion, or evacuate pus. Tracheotomy, if suffocation 
 threaten. 
 
 2. Ulcers of Tongue. — Several varieties : most forms very painful and 
 difficult to heal.
 
 256 TONGUE DISEASES. 
 
 (1) ^yhole of upper part of tongue sometimes superficially ulcerated. 
 Eaw surface very tender. Severe, long-continued disorders of digestive 
 organs are chief source of this form. May occur in any disease attended 
 with great exhaustion. To be relieved by gargles of borax, 250. Nour- 
 ishing food, such as can be digested. Tonics and stimulants. Pepsine, 
 42Q. — (2) Ulcers the result of simple inflammation are usually small, 
 superficial, without definite shape, very sensitive. Seated about tip, or 
 near fi-a3num, rather than at sides. Mild diet. Simple aperients, 146, 155, 
 161, 169. Compound powtler of rhubarb. Borax gargles, 250. Appli- 
 cation of sulphate of copper. Extraction of carious stumps. Removal 
 of tartar from teeth. — (3) Ulcers from ptyalism easily distinguished by 
 accompanying affections of gums, and fetor of breath. Most readily 
 healed by chlorate of potash, 01. Sulphate of magnesia, 141. Sulphate 
 of soda, 144, 148. Chlorinated soda gargle, 254. Alum and myrrh 
 gargle, 252. Tannin gargle, 251. — (4) Superficial syphilitic ulcers gen- 
 erally attended with similar disease of lips, or other secondary symp- 
 toms. Appear at sides of tongue: very sore and intractable. Mercurial 
 vapor bath, 131. Mercurial inunction. Green iodide of mercury and 
 conium, 53. Chlorate of potash, 61. Iodide of potassium, 31. Appli- 
 cation of nitrate of silver, or sulphate of copper. — (5) Deep syphilitic 
 ulcers generally commence as inelastic indurations, which slough in 
 centre. Sores become deep and excavated : edges ragged and sloughy, 
 or thickened and hard. Most common on upper and back part of 
 tongue- Generally accompanied by other tertiary symptoms. Iodide 
 of potassium, 31. Corrosive sublimate gargle, 25!3. Nitric acid gargle. — 
 (6^ R'.Ma,§,t*iing forms of ulc3ration are either strumous, tuberculous, or 
 eancero'its. Occur with other symptoms of these diseases. Require the 
 treatment necessary for constitutional state. Cod-liver oil generally 
 useful. 
 
 3. Cancer of Tongue. — May be of Epithelial form: or a firm Scirrhous 
 tumor: or Medullary. Of whichever kind, there is a tendency to speedy 
 ulceration. A foul sloughy sore forms, with ragged everted edges and 
 an indurated base. 
 
 Symptoms. Severe pain. Profuse salivation. Cancerous cachexia. — 
 Difiicult articulation and deglutition. Attacks of hemorrhage. Great 
 swelling of whole organ. Sometimes sloughing. Cancerous deposits 
 in sublingual and submaxillary glands: in surrounding tissues. Mouth 
 may get almost filled with an extensive ulcerated fungus, threatening 
 sutt'ocation. Disease runs a rapid course. Death, generally from ex- 
 Ihaustion. 
 
 Treatment. Morphia, 315, 843. Opium and belladonna, 344. Sub- 
 cutaneous injection of morphia, atropine, or aconitine, 314. Gargle of 
 citric acid (gr. 10 to fl. oz. j). Milk; cream; raw eggs. Essence of 
 beef, 3. — To check hemorrhage, application of powdered matico leaf; 
 ice; lemon-juice; saturated solution of perchloride of iron — Removal 
 of tongue, by knife, ligature, or ecraseur. To diminish sensibility and 
 salivation, division of gustatory nerve. Division of nerve, with liga- 
 ture of corresponding lingual artery. 
 
 4. Cracked Tongue, Tumors, &c. — (1) Cracked fow^r/e very troublesome. 
 The cleCts or fissui-es form an irregular series of grooves: they may bo 
 .a couple of lines in depth. Render eating and speaking painful. 
 Where this condition cannot be accounted for by an}' specific state of 
 system, or by any derangement of alimentary organs, it may often be 
 •cured l)y application of l)orax and glycerine, 268. Iodide of potassium, 
 with steel or sarsaparilla, 31, 32. — (2) Surface of tongue occasionally 
 presents patckea of b(ddne.s^, i.e., one or more smooth, oval, gloss}' patches.
 
 TONSILLITIS. 257 
 
 No ulceration or fissure. Often coexists with psoriasis palniaris: 
 may be indicative of a syphilitic taint. Corrosive sublimate. 27. ]{ed 
 iodide of mei'cury, 54. Donovan's triple solution, 51. — (3) Warts and 
 condylomata not uncommon diseases of mucous covering of tongue. 
 The former requires excision: the latter, anti-syphilitic remedies. — 
 Papillary patches consist of large, tough, brawny, coai-sely jjapillary, and 
 perhaps fissured spots of thickened mucous and submncoiis tissue. 
 They cause an unpleasant feeling; thickness of speech ; and have been 
 mistaken for cancer. Iodide of potassium, 31. Conium, SHG. — (4) 
 Hypertrophy, a rare affection of tongue. Sometimes congenital. En- 
 largement generally becomes so great that mouth is too small ; conse- 
 quently a large portion of the organ is constantly protruded. In some 
 instances, j)rolapsed part has reached below the chin. Removal may be 
 accomplished by knife, ligature, or ecraseur. — (5) When frajnum lingua? 
 is shorter than usual, the individual is said to be tongue-tied. If move- 
 ments of tongue be interfered with, the frsenum is to be divided; the 
 points of scissors being directed downwards to avoid ranine arteries. — 
 (6) Encysted or fatty tumors form in tongue, or beneath it. Maj' require 
 extirpation. — Firm tumors, made up of fibrous and areolar tissue, some- 
 times grow from tongue. When pedieulated they may be snip])ed off: 
 if an}- artery be felt in stalk, ecraseur to be used. — (7) Eanula (from 
 Sana, a frog; because the voice is said to be croaking like a frog's) is a 
 semi-transparent fluctuating swelling, perhaps as large as a walnut, 
 situated under the tongue. It consists of a dilatation of Wharton's 
 duct of submaxillary gland. A seton should be passed through cyst; 
 or a portion of anterior wall excised. 
 
 TONSILLITIS.— From Tonsilla, the tonsil; terminal -iti's. Synon. 
 Cynanche Tonsillaris; Arnygdaiitis ; Injlammatio Tonsillarum ; Quinsy; 
 Inflammatory Sore Throat. — Inflammation of one or both tonsils, with 
 fever. 
 
 1. Acute Tonsillitis. — Generally caused by cold and some peculiar 
 condition of sj'stem. Liability to the inflammation increased, durino- 
 youth, by repetitions of attacks. 
 
 Symptoms. Chilliness or rigors. Smart fever. Redness and swelling 
 of fauces and tonsils. Pain and difficulty of deglutition. Return of 
 liquids through nostrils, on attempting to swallow. Pain along course 
 of Eustachian tube. — May end in resolution in about four days; often 
 goes on to suppuration. 
 
 TreaTiMENT. Rhubarb and magnesia, 165. Citrate of magnesia, 169. 
 Solution of acetate, or citrate, of ammonia, 348, 349, 362. Carbonate 
 of ammonia, 361, 364. Ammonia and bark, 371. Quinine and nitric 
 acid, 379. Guaiacum. Inhalation of steam of poppy-water. Opiate 
 gargles, 253. Linseed or hemlock poultices. Belladonna and opium to 
 outside of throat, 297. — If an abscess form, it is to be opened cautiously 
 with a sharp-pointed bistour}^, the cutting edge being directed towards 
 mesial line of body : in event of hemorrhage, a strong solution of per- 
 chloride of lime to be freely ap]>lied. 
 
 2. Chronic Enlargement and Induration. — May result from acute ton- 
 sillitis, or may come on gradually in strumous children and wx^akly 
 young women. Enlargement often so great that fauces appear to be 
 almost blocked up by meeting of the glands. Thickness of speech. 
 More or less deafness. Difficulty in swallowing. Impediment to full 
 and deep inspirations. — Iodide of ammonium, 38. Cod-liver oil. These 
 remedies failing, — portions of the glands to be excised. Sometimes, 
 
 17
 
 258 TOOTHACHE. 
 
 entire gland can be shelled out with finger. Applications of nitrate of 
 silver, iodine, or potassa fusa have been recommended. 
 
 Cancer of tonsil may occur as a secondary affection. As a primary 
 disease it is almost unknown. AVhere suffocation threatens, the promi- 
 nent part of the gland should be excised if the whole cannot be shelled 
 out. 
 
 TOOTHACHE. — Synon. Odontalgia; Odontodynia; Dentium Dolor; 
 Gomphiasis. — Teeth '^ divided into incisors, canines, biscuspids or pre- 
 molars, and molars. A representation of the number of different kinds 
 of teeth in both jaws by means of symbols, constitutes a " dental form- 
 ula." Number and nature of permanent teeth of man are thus expressed 
 in convenient signs (Owen) : 
 
 . 2—2 1—1 2—2 3—3 „„ 
 
 t. ; c. ; p. : m. =J2. 
 
 2—2 1 — 1 2—2 3—3 
 
 The formula for deciduous, temporary, or milk teeth is 
 
 2 2 1 1 2 2 
 
 d i. ; d c. . ; d m. 1^=20. 
 
 2—2 1—1 2-2 
 
 1. Toothache from Caries. — Synon. Odontalgia Cariosa ; Dental Gan- 
 grene. — Softening and decay of dentine, causing great pain when central 
 cavity of tooth is reached. May be due to original malformation of 
 enamel and bone, to pregnancy, to use of mercury, to depi-aved secre- 
 tions with dyspepsia, &c. 
 
 Treatment. Eemoval by scraping of decayed portion, and then 
 stopping with gold, gutta percha, or amalgam of silver and mercury. 
 Temporary stoppings with cotton-wool dipped in mastic varnish; cotton- 
 wool with creasote, &c. Extraction. Troublesome hemorrhage after 
 extraction may set in : Remove clot from cavity, and sponge the latter 
 dry with lint pushed into it; then plug with cotton-wool soaked in a 
 saturated solution of perchloride of iron, or of tannic acid, orof matico; 
 and finally add a small compress of lint so as to keep up pressure when 
 the jaws are closed. In caries of deciduous teeth extraction unneces- 
 sary, unless there be pain or frequent gum-boils. 
 
 2. Toothache from Inflammation of Pulp — Synon. Odontitis; Odonto- 
 phlegmone. — When the pulp has been bared, inflammation may be set up 
 by irritation of food, cold, hot or cold fluids, &c. 
 
 Treatment. Aperients, 141, 144, 148, 153. Washing mouth with 
 strong solution of bicarbonate of soda in hot water. Stopping tooth 
 with cotton-wool saturated with creasote, or chloroform, or oil of cloves, 
 or tincture of aconite, or cajuput oil, or camphor in turpentine, or tannic 
 acid in ether. A leech to gum. Chewing horseradish or ginger. Chew- 
 ing pellitory (pyrethrum). Ginger poultice to face. Extraction. Drill- 
 ing into pnl]i-cavity (rhizodontrypy) after sto2)ping. 
 
 3. Toothache from Necrosis of Fangs. — The crown and cervix may be 
 healthy, and yet the fangs necrosed. The fangs of stumps get attected 
 in .><ame Avay. Abscess foi-ms again and again. Instead of necrosis 
 there may be thickening of fang from bony deposit. Even exjjosure of 
 .a fang from recession of the gum causes often severe pain. 
 
 Treatment. Exti'action. Sensibility of a bared fang may be per- 
 manently relieved by painting with carbolic acid, or niti*ate of silver. 
 
 4. Toothache from Neuralgia. — Synon. Odontalgia Nervosa; Neuralgia 
 Dentalis. — Not uncommon in early months of pregnancy : in cases of 
 disordered health, &c. Rheumatic toothache of same kind.
 
 TORTICOLLIS TRICIIINIASIS. 259 
 
 Treatment. Antacid aperients. Quinine. Animoniated tincture of 
 valerian and bark. Ammonia and sunibul. Colchicum. Aconite. Iodide 
 of potassium. A leech to tender gum, or scarification. Eemoval of 
 accumulated tartar (salivary salts — chiefly phosphate of lime). 
 
 TORTICOLLIS.— From Torqneo, to turn aside; collnm, the neck. 
 Synon. CoUum Obstipum; Cephaloloxia ; Rheumatismus Cervicis ; Stiff- 
 JVeck. — See Wry-neck. 
 
 TOXEMIA. — From To^uov, a poison ; a£,aa, blood. Synon. Toxico- 
 hcemia ; Toxiccemia. — A contaminated state of blood, from absorption of 
 some deleterious matter, — as syphilitic virus, poison of small-pox, ty- 
 phus, &c. 
 
 TRACHEITIS.— From Trachea, the wind-pipe; terminal -His. Inflam- 
 mation of the trachea. — See Croup. 
 
 TRICHIASIS. — From 0p\^, rpr/uc;, the. hair. Synon. Morbus Pilaris ; 
 Trichiasis CUiorum; Trichosis ; Trichia. — An irregular direction%f one 
 or more of the eyelashes. The cilia present their points towai'ds the 
 globe of the eye, producing chronic inflammation of the conjunctiva. 
 
 Treatment. Misdirected hairs to be drawn out singly, with broad- 
 pointed and well-gi-ooved forceps. Hair follicle to be destroyed by ni- 
 trate of silver; frequent dabbing with spirits of wine. 
 
 TRICHINIASIS. — From BplS, rpi'/o:;, a hair, — owing to the hair-like 
 form of the entozoon producing this disease. Synon. Trichina Disease; 
 Trichinosis; Flesh-Worm Disease. — A peculiar febrile helminthic affec- 
 tion, attended with sjnnptoms somewhat resembling those of typhoid 
 fever. — Trichinje may exist free in muscular tissue, or in more or less 
 calcified cysts about ^\-^ of an inch long and jJ^ of an inch broad. 
 Young trichina, extracted from cyst, is disposed in two or two and a 
 half coils : straightened out, it measures 3L of an inch in length, and 
 7^1^(5 of an inch in diameter. Fully developed and sexually-mature 
 male trichina measures j'g of an inch : female, | of an inch. 
 
 Symptoms. Vary in severity according as few or many worms have 
 been swallowed, as well as in proportion to number of the progen}"^ and 
 extent of their migrations. Usually, loss of appetite, general malaise; 
 followed by nausea, prostration, diarrhoea, and painful stiffness with- 
 swelling of muscles of arms and legs. Pain due to immigration of 
 young trichiufe into the muscles. High fever: oedematous swelling 
 about face and eyelids. Frequent pulse. Copious offensive sweats. 
 Diminished secretion of urine: excess of urates and uric acid, but never 
 any albumen or sugar. Stiffness of limbs increases : muscles become 
 painful, tender to touch, and greatly swollen. Movements of intercostal 
 muscles in respiration attended with pain, preventing sleep. Hiccup, 
 if diaphragm be invaded. Hoarseness and loss of voice, where laryn- 
 geal muscles get inhabited. — When a large quantity of trichinous meat 
 has been eaten, patient may lie almost paralyzed in state of great ex- 
 haustion. Facial oedema continues a week or ten days: its disappear- 
 ance followed by swelling of feet and legs and trunk. — About com- 
 mencement of fourth week, patient's condition very unfavorable. Pulse 
 and respirations frequent: tongue dry and red : pain severe: sweating 
 profuse: mouth can scai'cely be opened: no sleep can be obtained: pra?- 
 cordial anxiety and delirium : death preceded b}^ profound exhaustion. 
 Complications sometimes prove fatal earlier, — pneumonia, pleurisy, 
 peritonitis, dropsy, diarrhoea, &c. In favorable cases, symptoms gradu-
 
 260 TRISMUS NASCENTIUM — TUBEHCULOSIS. 
 
 ally abate; return of appetite and power of digestion, dimiBUtion of 
 muscular pain and swelling, lessening of anaemia: parasites have be- 
 come encysted in the muscles. 
 
 Treatment. Very unsatisfactory. In earliest stage, emetics and 
 purgatives. Calomel and jalap, 140. Calomel, as a purgative, in 20 gr. 
 doses. Prussic acid, or laurel water. Quinine. Picrate of potash? 
 Benzole? Oil of turpentine ? Santonin? Tannin? Salts of copper? 
 For relief of sleeplessness and sweating, wet-sheet packing, 1H6. Opium 
 and digitalis, injurious. — Perfect quiet. Broths, gruel, milk, ice, soda 
 water, brandy and egg mixture (17), restorative soup (2). Subse- 
 quently, during convalescence, large quantities of nourishing food, wine, 
 &c. Ferruginous tonics. 
 
 TRISMUS NASCENTIUM.— From 7>j'>, to gnash with the teeth: 
 Nascor, to be born. Popularly known as Nine-day fits. — A peculiar foi-m 
 of Tetanus, which occurs in infants about second week after birth, and 
 is ver}^ fatal. Pare in this country. Eighty years ago, w^hen Dublin 
 Lying-in Hospital was badly ventilated, it proved one of the most prom- 
 inent causes of infantile mortality in that Institution. Still common 
 in West Indies, where it sometimes seems to rage as an epidemic. 
 
 When prevalent, great care necessary to guard new-born child from 
 cold or foul air, inij^roper feeding, imperfect cleansing, or from reten- 
 tion of meconium. Remains of umbilical cord to be properly managed, 
 and not left to charge of an ignorant nurse. In dividing funis at birth, 
 not more than two inches to be left attached to umbilicus. As curative 
 remedies, warm baths, purgatives, and friction of spine with belladonna 
 are the only measures likely to be serviceable. 
 
 TUBERCULOSIS. — From Tuberculum, dim. of Tvher, a knob or ex- 
 crescence. — The term tuberculosis designates an idiopathic blood dis- 
 ease, which manifests itself by producing conditions commonly known 
 as scrofula, pulmonary consumption, tubercular hydrocejjhalus, tuber- 
 cular peritonitis, and tabes mesenterica. Precise nature of change in 
 blood, unknown; probably the aqueous part is increased in proportion 
 to the solids, while the red corpuscles are especially diminished. 
 
 Tubercle, or tuberculous matter, is the specific product of this disease. 
 It is deposited in a fluid state from the capillaries, just as lymph is; the 
 deposit coagulating, and forming a foreign body. Hence it exists in 
 insoluble masses, or is infiltrated into the tissues of many different 
 organs; being most frequently found in the lungs, constituting pulmo- 
 nary tuberculosis, or tubercular disease of the lungs, or phthisis, or con- 
 sumption — these terms being synonymous. 
 
 Symptoms. Dyspepsia, with difficulty in assimilating sugar and fat. 
 Acid eructations, heartburn, flatulence. Paleness and sense of coldness 
 of the body, although the thermometer shows an elevation of tempera- 
 ture. Tumidity of the abdomen. Intellectual system well developed. 
 Sanguine temperament. Pufflness of the face, with swelling of lips and 
 nostrils. Purulent discharges from the ear. Vesicular eruptions about 
 the head. Enlargement of tonsils, and glands of the neck. Disagree- 
 able exhalations from skin, especially from feet and axillae. Feebleness 
 with rapidity of pulse. General debility. Progressive loss of weight. 
 Susce|)tibility to attacks of simple fever. Signs of disease in the organ 
 invaded. 
 
 May set in at any period of life. Liability to it greatest between 
 three and fifteen, and between eighteen and forty. 
 
 Its development favored by all conditions which render the blood
 
 TYMPANITES — TYPHOID FEVER. 2i')l 
 
 unhealthy. Malformations of chest. Defective structure of lungs. Dis- 
 eased nutrition. Sexual excesses. 
 
 Treatment. To prevent its transmission : Well-assorted marriages to 
 be obtained; great care to be taken of maternal health during preg- 
 nancy- ; attention to infant's food and clothing, as well as to the air it 
 breathes. A strumous mother not to be allowed to suckle her child. 
 Avoidance of ill-ventilated, badly drained, or damp houses. 
 
 Curative treatment: Ini])rovoment of the faulty nuti-ition. The forma- 
 tion of healthy blood to be promoted. Special attention to diet, dress, 
 exercise, repose, sexual intercourse, air to be breathed, functions of skin, 
 and powers of the digestive organs. — See Hydrocephalus; Phthisis; 
 Tahes Mesenterica, &c. 
 
 TYMPANITES. — From Ti/mpanum, a tambourine or drum ; because 
 the belly, if struck, sounds like a drum when the bowels are distended 
 with air. SjMion. Pneumatosis Abdominis; Aerosis ; Meteorism ; Wind 
 Dropsy. — See Flatulence. 
 
 TYPHLITIS.— From TucpX^>-, blind; terminal -«Y«5. Synon. Tuphloen- 
 teritis. Inflammation of the Caecum. — See Ccecitis. 
 
 TYPHOID FEVER. — From Tu<po<;, stupor; eWr^c, appearance. Literally, 
 "like Typhus." — Formerly described as Abdominal Typhus; Febris 
 Patrida ; Gastro-biliovs Fever ; Febris Gastrica; Febris Mesenterica Ma- 
 ligna; and Night-soil Fever. In the present day, its synonyms are, — 
 Enteric Fever ; Pythogenic Fever; and Typhia. — May be defined as an 
 endemic, slightly infectious, contagious fever ; most prevalent in autumn : 
 generated by putrefying animal matter. Effluvia from drains, or con- 
 tamination of drinking water by decomposing sewage making its way 
 into the wells, are frequent sources of this disorder. — Attacks rich and 
 poor indiscriminately ; but is particularly a disease of early 3'outh and 
 adolescence. — It frequently has a duration of 30 days. In many cases 
 it terminates on 21st or 28th day; and occasionally is followed by a 
 relapse. 
 
 Symptoms. Sometimes a period of incubation, vaiying from 10 to 14 
 days: in other cases, the symptoms come on immediately after expo- 
 sure to the poison. The disorder sets in slowly and insidiously, with 
 languor. In a day or two, there are chills, headache, thirst, pains in 
 limbs, weakness, with a tendency to diarrhciea and sickness. Restless- 
 ness ; face languid and pale, or marked with a circumscribed flush on 
 each cheek; urine diminished in quantity, urea increased, chlorides ab- 
 sent; pulse rises to 120 or higher; breath offensive, often ammoniacal; 
 tongue dry and brown, or red and glazed. — At commencement of second 
 week, or a day or two earlier, the typhoid rash appears; rose-colored 
 dots on chest or abdomen; few in number; circular; disappearing on 
 pressure ; and fading away, to be replaced by a fresh crop. In 10 or 
 12 per cent, no rash. — After the middle of the second week, — somno- 
 lence, delirium, tinnitus aurium or deafness, prostration, bed-sores, &c. 
 Tympanites; gurgling in right iliac fossa on pressure; diarrhoea. At- 
 tacks of hemorrhage from the ulcei-ated patches in the ileum and ca-cum. 
 Stools alkaline and of a putrid character. Perforation of the bowel, 
 with fatal peritonitis, to be feared. Congestion of kidneys. Cerebral 
 or pulmonary complications. 
 
 Mortalit}^ about 1 in 5 or 6. More fatal to the rich than the poor. 
 Death usually due to exhaustion, ura?mia, peritonitis, pneumonia, or 
 erysipelas. Two lesions invariably present, — alterations in the agmin-
 
 262 TYPHUS FEVER. 
 
 ated inlands or Payer's patches, and in the corresponding glands of the 
 mesentery. Frequently, the patches have undergone ulceration. 
 
 Treatment. Prophylactic: Good drainage. Xo old cesspool to be 
 opened in an inhabited house. Patient's excreta to be passed into a 
 bed-pan containing Condy's fluid, 74. 
 
 Curative: In most respects the same as for typhus. There are two 
 or three exceptional points : Avoidance of aperients. Astringents with 
 opium to relieve intestinal irritation and diai'rhcea, 96, 97, 100, 105, 106, 
 107, or 113. Cold over the abdomen when there is intestinal hemor- 
 rhage ; gallic acid, 103. 
 
 Great care during convalescence, lest the cicatrizing ulcers in the 
 ileum be irritated. Quinine. Liquid extract of yellow cinchona. Com- 
 pound tincture of cinchona. Eeturn to a generous diet to be very 
 gradual : no solid food until all symptoms have vanished. 
 
 TYPHUS FEVER. — From To(poq, smoke ; an expression employed by 
 Hippocrates to denote a lethargic disease, in which the patient is sud- 
 denly deprived of his senses, as if thunderstruck. — Prior to 1759, typhus 
 was known as Putrid, Pestilential, Malignant, Jail, Ship, or Hospital Fe- 
 ver. — May be defined as, — a contagious infectious fever. Often prevails 
 epidemically during seasons of general scarcity. The accompaniment 
 of destitution. Generated in over-crowded and ill-ventilated dwellings. 
 Duration from 1-1 to 21 days. 
 
 vSymptoms. a period of incubation varying from 1 or 2 to 12 days. 
 Then, dry and heated skin; heavy dull look; thirst; constipation; 
 stupor, prostration, &c. Towards evening, irritability and restlessness; 
 sleepless nights. The typhus rash rarely appears before 7th day ; con- 
 sists of irregular spots, of a dusky or mulberry hue, disappearing on 
 pressure, and feeling as if raised above the skin ; remains permanent 
 until end of fever; may be accompanied by, or become converted into 
 petechiae ; sometimes altogether absent. 
 
 During first week, deafness or noises in the ears; injected conjunc- 
 tivaB ; often constipation, never diarrhoea; brown dry tongue. Wake- 
 fulness ; or patient sleeps, and afterwards believes he has not done so. 
 Urine diminished in quantity; urea increased; chlorides absent, or 
 nearly so; sometimes albuminuria; occasionally complete suppression, 
 with urfemia. In second week, — Great prostration. Muscular twitch- 
 ing. Delirium. The danger may be increased by the supervention of 
 acute bronchitis, pleurisy or pneumonia. Approach of convalescence 
 gradual; usually begins on 18th or 14th day. Sometimes a critical 
 sleep, or sweat, or attack of diarrhoea, or greatly increased flow of urine. 
 
 When fatal, death usually occurs between 12th or 20th days. Mortal- 
 ity about 1 in every 5 attacked. The greater the age, the greater the 
 danger. 
 
 Treatment. Projihylactic : The poor to be supplied with wholesome 
 food, and properly ventilated dwellings. Over-crowding to be pre- 
 vented in sleeping-rooms, and lodging-houses. Every common lodging- 
 house, hospital, workhouse, &c., to be thoroughly cleansed and lime- 
 washed, once a year or oftencr. — Clothes and bedding of typhus patients 
 to be disinfected, 74, 75. The patient to be kept scrupulously clean. 
 Not to be taken to the hospital in an omnibus, or street cab. No room 
 where a case has been to be reinhabited until purified with chlorine gas, 
 whitewashed or repapered, and had the fresh wind blowing through its 
 open doors and windows for many days. 
 
 • Curative: Patient to be in a well-ventilated apartment; free from 
 bed and window-curtains, carpets, superfluous furniture; window to be 
 open at the top. A disinfectant to be used; chloride of lime, 75;
 
 UREMIA — URINARY CALCULI. 263 
 
 chloride of zinc, 79; iodine, 81. A fire to bo kept up in the room. A 
 form of quarantine to be maintained strictly. 
 
 Avoidance of active remedies, at first especially, No specific known 
 for cutting short the disease; quinine fails, and is often injurious. An 
 emetic of one ounce of ipecacuan wine, if case be seen very early. A 
 purgative, — from 30 to 60 grains of compound rhubarb powder. One 
 of the mineral acids, freely diluted, as a daily drink, 357, 358, 359 ; they 
 are valuable as alteratives, if the blood contain an excess of ammonia. 
 Cold or tepid sponging. Cold lotions to hea<l. Cold affusion, when 
 there is a tendency to coma. Warm bath, prolonged for 30 or 45 min- 
 utes, if there be great irritability. Milk diet; farinaceous food; thin 
 broths, well salted; tea and coffee. 
 
 When the powers of life begin to fail, stimulants. Wine ; gin ; brandy; 
 brandy and egg mixture, 17. Strong beef or chicken tea. Administra- 
 tion of the nourishment frequentl}^: every 30, 45, or 60 minutes. Al- 
 cohol to be used carefully when urine is scanty or albuminous. Opium 
 to relieve restlessness. Patient to be kept strictly in recumbent pos- 
 ture. Water-bed. Catheter, if urine be retained. 
 
 During convalescence: Mineral acids and bark, 376. Quinine and 
 steel, 380. A gradual return to solid food. Country air. 
 
 URJEMIA. — From Urea; aqm, blood. — Toxaemia from accumulation 
 of urea in the blood, owing to its non-elimination by the kidneys. 
 
 SymptoiMS. Disturbed action of either or both of the great nervous 
 centres. Convulsions. Coma. Albuminuria. Suppression of urine. 
 
 Treatment. Hot air or vapor bath. Blanket bath, 136. Wet 
 sheet packing, 136. Acid sponging, 138. Saline aperients, 152. Jalap 
 and senna, 145, 151. Elaterium, 157. Podophyllin, 160. Croton oil, 
 168, 191. Castor oil and turpentine enemata, 190. Benzoic acid, 49. 
 Lemon-juice. Yinegar. Steel. Arsenic. Chloroform vapor, 313. Stim- 
 ulants. Tea. Venesection? Cupping over loins. Dry cupping to 
 nape of neck and loins. Ice to the head. 
 
 URETHRITIS.— From Urethra (Odpiw, to urine) ; terminal -itis. In- 
 flammation of the urethra may be acute or chronic, may arise in male 
 or female, and may occur independently of gonorrhcea or syphilis. 
 
 Symptoms. Sense of heat along urethra. More or less pain on uri- 
 nating. Muco-purulent discharge. Irritability of bladder. Urine may 
 contain an excess of uric acid; sometimes, blood, pus, or ropy mucus. 
 Lips of urethral orifice swollen. Constitutional disturbance. May cause 
 retention of urine from spasmodic stricture. 
 
 Treatment. Hot hip baths. Fomentations and rest in bed, in acute 
 cases. Unstiniulating diet. Demulcent drinks. Opium. Belladonna. 
 Copaiba. When chronic, astringent injections. 
 
 URINARY CALCULI.— From Urina, iirme: Calculus (d'lmm. of Cfi]x), 
 a small stone. S3'non. Urolithi. — These concretions are found in kid- 
 neys, bladder, or follicles of prostate gland. Yery rarely, one or more 
 urinaiy salts become deposited in ureters, or in urethra : usually, calculi 
 found in these situations have travelled there from kidneys or bladder. 
 Calculous disease much more common in men than women. 
 
 Chief Yarieties. Uric acid ; L^rate of Ammonia ; Fusible calculus. — 
 Phosphate of Lime, with Phosphate of Magnesia and Ammonia ; Mul- 
 berry calculus, — Oxalate of Lime; Carbonate of Lime; and, very un- 
 common forms, Cystic and Xanthic Oxides. Pseudo-calculi of tibrine 
 or blood-coagula, or of urostealith (a resinous or fatty substance), are 
 exceedingly rare.
 
 264 URINARY CALCULI. 
 
 Calculi consist of only one substance, or of alternate layers of two or 
 more salts — as of uric acid and oxalate of lime, &c. 
 
 Urinary concretions vary much in size. Occasionally, resemble grains 
 of sand so small as to pass with urine. Particles of gravel thus voided 
 may be made up of aggregated crystals of urinary salts, — microscopic 
 calculi. In other instances, calculi are as large as a small orange. When 
 a stone has formed in pelvis of kidney, it may, while of moderate size, 
 enter ureter and gradually be forced onwards towards bladder. The 
 suffering which takes place during transit verj^ great; popularly known 
 as "a fit of the gravel." As soon as calculus reaches bladder, all pain 
 is over for a time. 
 
 Symptoms of Calculus Retained in Kidney. Almost constant back- 
 ache. Bloody urine, especially after exertion. Reflex irritation of dis- 
 tant organs. Nervous irritability. Subsequently, impaired health : loss 
 of flesh and strength. Foreign body gradually encroaches on true renal 
 tissue : either converts the gland into a large cyst, or sets up suppurative 
 inflammation. When large calculi are present in both kidneys, case 
 ends in ura^mic toxsemia. 
 
 Symptoms op Stone in Bladder. Severe attacks of pain in bladder 
 and perineum: always brought on, or aggravated, by exercise. Fre- 
 quent micturition, sometimes incontinence of urine: with a feeling that 
 bladder is not thoroughly emptied by the act of urinating. Urine often 
 thick with ropy mucus: sometimes contains pus, or blood. Act of mic- 
 turition often suddenl}^ stopped by stone being forced against neck of 
 bladder : on making any movement, flow of urine returns. Tenesmus : 
 prolapsus of rectum. Stone discovered by use of sound. 
 
 Treatment OP Renal Calculus. Plain diet; nourishing food, milk, 
 cream, raw eggs. Weak brandy or Avhiskey and water. Free amount 
 of aqueous drinks. Cod-liver oil. Belladonna plasters to loins. Warm 
 clothing: flannel or chamois leather jackets. — For checking hemorrh(xge : 
 Gallic acid, 103. Tincture of perchloride of iron, 101, 392. Iron alum, 
 116. Pill of lead and opium.— In uric acid diathesis: Vegetable diet: 
 white fish. Avoidance of alcoholic drinks. Free use of simple diluents. 
 Yichy or Carlsbad waters. Acetate of potash. Bicarbonate of potash. 
 Solution of potash. Citrate of potash. — In phosphatic diathesis: Animal 
 food. Wine; diluted spirits. Bark. Quinine. Phosphoric acid. Nitro- 
 hydroehloric acid. Steel. Opium. — In oxaluria : Avoidance of garden 
 rhubarb, sorrel salad, and sugar. Nitro-hj-drochloric acid. Tepid or 
 cold bathing. Friction of skin. Warm clothing. Sea air. Attention 
 to digestive organs. — To relieve ■pain of any form of calculus passing down 
 ureter: Hot bath. Chloroform or ether, inhalation of. Opium, in full 
 doses. Belladonna. Barley-water, or any emollient diluent, with spirit 
 of nitrous ether. 
 
 Treatment of Vesical Calculus in Males. Opium and belladonna 
 to allay pain. If stone be small, patient to allow urine to accumulate 
 and then to discharge it forcibly in hot bath. Introduction of silver 
 catheter with an ojien end, and washing out of bladder with warm 
 water. Lithotrity. Lithotomy. Attempts at solution of calculus 
 (Litholysis) by alkaline and saline mixtures in the case of uric acid 
 calculi, and by acid solutions for oxalate of lime and phosphatic calculi, 
 have hitherto failed. Injecting solvents into bladder has not succeeded. 
 Electi-icity has been employed foi- disintegrating calculi, but with very 
 doubtful results. That success will ultimately follow attempts at litho- 
 lysis can hardly be doubted. 
 
 Treatment op Vesical Calculus in Females. Four methods for 
 removal of stone: (1) Lithotrity: by far the best plan, as a general 
 rule. (2) Dilatation of urethra by sponge tents, or a three-bladed ex-
 
 URINARY DEPOSITS — UTERINE CANCER. 265 
 
 panding dilator, or by India-rubber bags which can be inflated after 
 introduction. Patient to be under influence of chloroform. Apt to be 
 followed by permanent incontinence of urine. (3) Incision of external 
 urethral orifice, with stretching of canal by three-bladed dilator. May 
 produce incurable incontinence. (4) Vaginal lithotomy: edges of in- 
 cision into bladder being brought together by silver wire sutures, as in 
 operation for vesico-vaginal fistula. 
 
 URINARY DEPOSITS. — Two varieties, — Inorganic and Organic. (1) 
 Inon/ii/u'r Deposits : Uric, or lithic acid ; amorphous or mixed urates, con- 
 sisting of uric acid combined with several bases — ammonia, soda, pot- 
 ash, lime ; urate of soda; urate of ammonia ; hippuric acid ; oxalate of 
 lime; carbonate of lime; amorphous phos])hate of lime, or bone-earth; 
 crystallized phosphate of lime, or stellar phosphate; phosphate of am- 
 monia and magnesia, or triple phosphate; cystine, or cystic oxide; 
 xanthine, or xanthic oxide; leucine and tyrosine. 
 
 (2) Organic Deposits: Epithelium from pelvis of kidney, ureter, blad- 
 der, urethra, and vagina; epithelium from uriniferoiis tubes, with casts 
 of the tubes (as found associated with albuminuria), such casts or moulds 
 of urinifierous tubes being composed of epithelial cells imbedded in coagu- 
 lable matter, or of an opaque granular matter, or of transparent waxy 
 matter, or of waxy material studded with minute fatty particles, or of 
 blood discs, or of pus corpuscles; molecular fatty matter, as in chyluus 
 urine; oil globules, free, or inclosed in cells, or adherent to casts; pus; 
 blood; cancerous and tubercular matter; spermatozoa; and minute 
 confervoid parasitic vegetations, — sarcinge, yeast or sugar fungus (Torula 
 cerevisiae), mould fungus (Penicilium glaucum), and vibriones. 
 
 Soluble substances found in morbid urine: Urea, in abnormal quantity; 
 albumen ; sugar ; biliary coloring matter ; and biliary acids. 
 
 UTERINE CANCER. — From "Ytrripa, tbe womb: Cancer (xipy.v^ix;, a 
 crab) a kind of ulcer. Synon. Metro-carcinoma; Carcinoma Uteri. — Can- 
 cer of the womb most frequently met with under form of medullary ul- 
 ceration of lips or vaginal portion of cervix. Very rarely, infiltration 
 commences in mucous or muscular coat of body or fundus of womb. — 
 Medullary cancer most common variety. Scirrhus seldom observed. 
 Cauliflower excrescence, or epithelioma, not often met with. Uterine 
 cancer most frequent after the 40th year. 
 
 Symptoms. Abundant watery discharge, of a dirty pale-gi-een color, 
 always offensive. Sudden attacks of hemorrhage. Distressing pain; at 
 first most severe at night, afterwards always present. Nausea and 
 vomiting; flatulence; irregular action of bowels; loathing for food. 
 Painful mental depression. Daily increasing debility, and vvaste of 
 tissues. Dingy sallow hue of countenance, and pinched anxious ex- 
 pression — cancerous facies. — Uterus found immovably fixed in pelvic 
 cavity. Labia uteri indurated and nodulated at first: subsequently, 
 excavated by an ulcer of a loose spongy character, seated on a hard- 
 ened base, and sun-ounded by indurated tissue. Vagina soon gets in- 
 volved : communications form between vagina and bladder, or vagina 
 and rectum. Death, in course of second year from commencement of 
 symptoms, from exhaustion. 
 
 Treatment. General remedies: Ammonia and bark, 371. Mineral 
 acids and bark, 376. Citric acid and bark. Phosphoric acid and qui- 
 nine, 379. Quinine and belladonna, 383. Zinc and conium, 413. Cod- 
 liver oil, 389. Nutritious diet: milk and cream, raw eggs, animal food. 
 Light s])arkling wines; sherry; brand3\ Malt liquors usually increase 
 dy spejisia. Avoidance of sexual intercourse. — When stornach is irritable :
 
 266 UTERINE DISPLACEMENTS. 
 
 Pepsine, 420. Nitro-hj'drochloric and dilute hydrocyanic acids, 378. 
 Ammonia and ether, 364. Bismuth, 112. Ice. Cream of tartar drink, 
 356. Chlorate of potash drink, where there is soreness of mouth, 360. 
 Castor oil. Confection of senna with taraxacum, 194. Simple enemata, 
 188. Belladonna liniment to epigasti'ium. Sinapisms. Hemlock poul- 
 tices. — For relief of pain : Henbane, camphor, and hop, 325. Opium and 
 henbane, 343. Morphia, chloroform, and Indian hemp, 317. Subcu- 
 taneous injection of morphia, 314. Opiate enemala, or suppositories, 
 339, 840. Oxide of zinc and belladonna pessaries, 423. Use of a frigo- 
 ritic mixture of ice and salt to uterus, by a gutta percha speculum. In- 
 jection of carbonic acid gas : of chloroform vapor. Belladonna liniments 
 or phisters to sacrum. Hemlock poultices to pubes and vulva. — For 
 control of hemorrhage : Gallic and aromatic sulphuric acids, 103. Cinna- 
 mon, 104. Iron alum, IIG. Lead and opium, with acetic acid, 117. 
 Turpentine. Digitalis. Application of cold to vulva. Insertion of plug 
 of wool, saturated with sohition of perchloride of iron, into ulceration. 
 Injection of solutions of alum and tannic acid, or of infusion of matico. 
 Tannic acid pessaries, 423. Plugging with cotton-wool. — For removal of 
 offensive odor in discharges : Cleanliness. Injections of solutions of chlo- 
 rinated soda or lime; of creasote and water (fl. drm. j. to fl. oz. xx); of 
 solution of permanganate of potash and water (fi. drs. iv to fl. oz. xx) ; 
 of chloride of zinc and water (gr. 20 to fl. oz. xx). Pessary of logwood 
 and cocoa butter (gr. 30 of each). Iodoform pessaries, 423. Padding 
 vulva w'ith muslin bags of vegetable charcoal. 
 
 Operations by knife, ecraseur, and ligature, useless. Employment of 
 powerful escharotics rarely to be recommended. The treatment of cau- 
 liflower excrescence, in early stage, perhaps an exception to two fore- 
 going rules. 
 
 UTERINE DISPLACEMENTS.— The uterus may be displaced in sev- 
 eral ways, giving rise to much discomfort. 
 
 1. Prolapsus and Procidentia. — Terms employed to designate a descent 
 of the womb as it exists in two diff'erent grades. By " Prolapsus" (Pro- 
 labor, to glide forward) is meant that condition in which uterus falls be- 
 low its natural level in pelvic cavity. By " Procidentia" (Procido, to 
 fall down) is signified the protrusion of uterus beyond vulva. Causes 
 of both conditions the same. Suffering varies chiefly in degree. 
 
 Symptoms. Sense of fulness or pelvic weight. Bearing-down pains. 
 Backache. Leucorrhoea. No impediment to menstruation ; nor to con- 
 ception, as uterus is generally easily replaced Avhen patient is in bed. 
 Irritation of bladder and rectum. In prolapsus, uterus found depressed, 
 perhaps resting on upper floor of perineum. In procidentia, a round or 
 pear-shaped tumor, with os uteri visible at its centre, seen projecting 
 beyond vulva. Labia uteri often excoriated. Vaginal walls may be 
 dry and harsh and cracked ; perhaps, ulcerated. 
 
 Treatment. General rules : Artificial suppoi-t to be afforded to super- 
 incumbent abdominal viscera. Tone to be given to round and broad 
 ligaments of uterus, to relaxed vaginal walls, to perineum. Removal of 
 complications, — uterine congestion or hypertrophy, cough, constipa- 
 tion, &c. 
 
 To effect reposition in procidentia : Patient to be placed on left side, 
 with knees well flexed : greased uterus to be gently pushed up. Woman 
 may rest on hands and knees, with head lower than pelvis, so as to re- 
 move superincumbent weight of intestines: womb to be then replaced. 
 Uterus to be firmly encircled with strips of plaster for forty-eight hours, 
 and patient kept quiet in bed: circumference of tumor being thus re-
 
 UTERINE DISPLACEMENTS. 267 
 
 (luced, reposition uHunlly effected with case after removal of plaster. 
 All plans failing, uterus has been removed by ligature applied around 
 the neck of tumor formed by it. 
 
 To support abdominnl viscera : An abdominal belt of common jean. A 
 pelvic belt, with a firm perineal band and pad, — a modification of the 
 T-bandage. Hull's '' Utcro-abdominal Supporter." Bigg's abdominal 
 ])late, fixed by steel bauds somewhat like a truss. 
 
 To give tone to tissues: Phosphoric or nitric acid, nux vomica, and 
 bark. .376. Tincture of perchloride of iron, 380, 392, 397. Quinine and 
 nux vomica, 387. Strychnia and steel, 408. Astringent vaginal injec- 
 tions, 425. Astringent pessaries, 423. Nitrate of silver to vaginal 
 walls. Cold salt water hip baths. Nourishing diet. 
 
 To support uterus: Oval or globular boxwood, vulcanized India-rubber, 
 vulcanite, tin, plated or gilt metal, or gum elastic pessaries. Eing pes- 
 saries. Hodge's lever pessaries. Pessary of watch-spring, covered 
 with thread and solution of gutta-percha. Zwauke's pessary. Eemoval 
 by dissection of one or more longitudinal strips of vaginal mucous mem- 
 brane, bringing edges of wound together with wire sutures. Paring the 
 sides and posterior wall of lower part of vagina, and keeping raw sur- 
 faces in contact by quill-suture, so as partly to close vulval opening. 
 
 2. Retroflexion and Anteflexion. — Eetroflexion (Reti-o, backwards; 
 Jlecto, to bend) consists of a bending backwards of uterus, at part where 
 the neck joins the body; so that fundus is found between cervix and 
 rectum, os uteri being in normal position. Uterus becomes shaped 
 like a retort. — In anteflexion {Ante, forwards; flecto), fnndns rests on 
 bladder. 
 
 Symptoms. Almost absent when displacement is slight, uterine struc- 
 tures flabb}^ and pelvic cavity more than ordinarily capacious. Con- 
 siderable suffering where angle of flexion is acute, uterine ligaments 
 unduly stretched, circulation through uterus impeded, and fundus im- 
 movabl}^ pressed on rectum or bladder. 
 
 Dull wearying backache. Tenderness about groins and inside of 
 thighs. Sense of fulness in rectum or bladder. Pain from sexual in- 
 tercourse : fecundation prevented. Dysmenorrhoea. Nausea, loss of 
 appetite, mental depression. Hysteria. Displacement recognized with 
 certainty by use of uterine sound. 
 
 Treatment. Eeplacement by pushing fundus upwards, with or with- 
 out assistance of uterine sound. Use of intra-uterine stem. Pessaries 
 of belladonna and iodide of lead or mercurial ointment, 423. Dilata- 
 tion of uterine cavity and cervix with sponge or sea-tangle tents (426), 
 allowing uterus afterwards to contract in normal position upon a metal- 
 lic stem. Horseshoe-shaped vaginal pessaries. Division of os and 
 cervix with hysterotome, so as to remove contraction of muscular tissue 
 at point of flexion. 
 
 3. Retroversion and Anteversion. — In retroversion (Betro, backwards ; 
 verto, to turn), uterus lies almost transversely in uterine cavity; with 
 fundus towards hollow of sacrum, and os uteri under pubic arch. The 
 opposite condition, anteversion {Ante, forwards ; verto) is characterized 
 by fundus lying towards bladder, and os uteri in cavity of sacrum. 
 
 Symptoms. Backache, bearing down. Leucorrhoea. Menstruation 
 not interfered Avith : impregnation not absolutely prevented. In retro- 
 version, pressure of labia uteri on urethra may cause retention of urine, 
 — a common result in pregnancy. 
 
 Treatment. Occasional replacement. Quinine, steel, and nux 
 vomica, 380. Mineral acids with strychnia, 378. Nourishing food. In- 
 jections of alum and sulphate of zinc, 425. Tannin pessaries, 423. Cold
 
 268 UTERINE HEMORRHAGE UTERINE TUMOR. 
 
 sea-water baths. Avoidance of over-exertion, straining at stool, &c. 
 In displacement during pregnancy, reposition best eifected with patient 
 resting on hands and knees: chloroform maj^ be required. Use of 
 catheter. 
 
 4. Inversion of Uterus. — From In, in; verto, to turn. Synon. Tnversio 
 Uteri. — The uterus is literally turned inside out. Fundus descends 
 through OS uteri; mucous lining of cavity of womb becoming the ex- 
 ternal covering of tumor, which projects into vagina and generally 
 through vulva. Usually happens directly after labor; but has followed 
 the expulsion of a polypus. 
 
 Symptoms. Severe nervous shock. Great depression and faintncss. 
 Bearing-down pain. Nausea and vomiting. Perhaps, hemorrhage. 
 Sometimes death from shock, especially if the labor has been difficult. 
 Where the accident has not been detected at time of occurrence, pa- 
 tients have gone on for months, or even years, sutfering from bad 
 health, anaemia, repeated attacks of hemorrhage, sacral and pelvic 
 pains, &e. 
 
 Treatment. When occurring directly after labor, placenta to be 
 peeled off if it remain attached. Uterus to be firmly grasped, and 
 steady pressure made in upward direction so as to reduce that portion' 
 first which has last descended : patient may be under influence of chlo- 
 roform. — In chronic cases, attempts at replacement may have to be 
 gently pei'severed with even for an hour or rather longer. Occasion- 
 ally, the attempt has had to be repeated for many days in succession; 
 pressure having been kept up during the intervals by a well-adapted 
 air pessary. All plans failing, uterus has been removed by ligature. 
 
 UTERINE HEMORRHAGE.— Synon. Ha-morrhagia Uteri; Metrorrha- 
 gia; Flooding. — Arises chiefly from: Cancer of uterus. Fibroid tumors 
 or polypi. Endometritis. Inflammatory diseases of the cervix. Con- 
 gestion of the ovaries. Moles. 
 
 Often the precursor of abortion. In latter months of pregnancy, in- 
 dicative of separation of the placenta; or of placenta praivia. 
 
 Treatment. See Menorrhagia. 
 
 UTERINE TUMOR. — Synon. JTysteroncus ; Metroncus ; Hysterophyma ; 
 MetropJtyma ; Tumor Uteri. — Of all organic diseases of uterus first mani- 
 festing themselves during period of sexual vigor, non-malignant tumors 
 are the most common. 
 
 1. Fibroid Tumors. — Consist of outgrowths of uterine tissue. Are 
 single or multiple. Sometimes attain an enormous size. May be de- 
 velo])ed in an}^ part of uterus. Classified as subperitoneal or surface 
 tumors, when just beneath peritoneum; interstitial or intra-mural 
 tumors, when imbedded in uterine walls; and submucous or intra- 
 uterine tumors, when pressed into cavity of wotnb. 
 
 Symptoms. Often neither important nor well marked. When of 
 sufficient size to encroach on pelvic viscera, or to be detected thr-ough 
 abdominal wall, symptoms more prominent. Menstrual irregularities, — 
 frequently monorrhagia. Dull, aching, throbbing pains. Sense of 
 weight and bearing-down. Cramp or numbness in one or both thighs. 
 Difficulty in voiding or in retaining urine. Constipation : hsemorrlioids. 
 Enlargement and tenderness of breasts. Attacks of severe hemorrhage 
 in intra-uterine growths : occasionally, expulsive pains. Tumor detected 
 on careful abdominal manipulation, and vaginal examination. 
 
 Treatment. In a large number of cases, the less fibroid tumors are 
 interfered with the better. Great danger from attempting radical cure
 
 UTERINE ULCERATION. 269 
 
 by enucleation, gouging growth and scooping away portions, or by 
 abdominal section. — Remedies recommended to produce absorption: Mer- 
 cur}'; iodine; iodide of potassium; solution of potash. Bromide of 
 potassium, 42. Bromide of ammonium, 37. Chlori|[^ of calcium. So. — 
 For control of hemorrhage: Corrosive sublimate, 27. Gallic acid, 103. 
 Oxide of silver and Indian hemp, 47. Iron alum, 116. Incision of os 
 and cervix utei-i. Incision into exposed part of tumor, where it can be 
 easily reached from vagina. — For relief of pressure on pelvic viscera: 
 Gentle elevation of tumor into false j)elvis. Iodide of lead and bella- 
 donna pessaries, 423. — For cure of siiffering due to congestion or oedema of 
 growth: Bromide of potassium, 42. Kreuznach waters, 484. 
 
 2. Polypus of Uterus. — From TloVuq, many; ttou?, a foot: 'T<T-ipa, the 
 womb. Synon. Metropolypus ; Bysteropolypus ; Polypus of the Womb. — 
 A tumor attached to inner surface of uterus by a pedicle or neck. May 
 occupy uterine cavity or be in vagina and merely attached to uterus by 
 pedicle. Three varieties: Fibroid, mucous or gelatinous, and placental. 
 
 SyiMptoms. Profuse menstruation. Irregular attacks of uterine 
 hemorrhage, — often amounting to flooding. Profuse leucorrhoeal dis- 
 charge. Irritation of pelvic viscera from pressure. Spasmodic attacks 
 of pain. Debility and loss of flesh, in proportion to amount of dis- 
 charges. Tumor found on making vaginal examination : if it be in 
 uterine cavit}", easily detected after dilating os by sponge-tents. 
 
 Treatment. If tn vagina: Tumor to be removed b}- dividing pedicle 
 with scissors or wire-rope ecraseur. — If in utero : Os uteri to be fully 
 dilated with sea-tangle or sponge-tents (426), and tumor subsequently 
 removed by division of pedicle with wire-rope ecraseur. Sometimes, 
 can be taken away by torsion, when pedicle is slender. 
 
 3. Cysts of Uterus. — Unilocular cysts, or closed sacs, filled with 
 mucus or serum, are occasionally developed in substance of uterus, or 
 just beneath internal mucous lining, or under external serous covering. 
 Sometimes, one part of uterus invaded by cystic growth, while another 
 is the seat of an ordinary fibroid tumor. These cysts only give rise to 
 inconvenience when they attain such a size as to admit of their detec- 
 tion. If within reach, they may be punctured : if pediculated and 
 pressing into uterine cavity, they can be twisted off after dilating the 
 OS uteri with sponge-tents. 
 
 UTERINE ULCERATION.— From 'Yaripa. the womb ; Vlcero, to cause 
 to ulcerate. Synon. Mysterelcosis ; Uteri Exulceratio. — As a frequent 
 result of congestion and inflammation of lower part of uterus, various 
 forms of ulceration are found about the cervix: 
 
 1. Simple Abrasion. — S3'non. Excoriation ., or Erosion, of Labia Uteri. — 
 Epitheliuiu removed from a part of one or both lips; exposed villi with 
 tlieir looped capillaries conveying a '• velvety" feel to the touch. Extent 
 of abrasion easily ascertained with speculum. 
 
 Symptoms. Leucorrha-al discharge. Pelvic and sacral pains. Ovarian 
 iri'itation. Indigestion : flatulence, with irregular action of bowels. 
 Irregular menstruation. Depression of general health. 
 
 Treatment. Locally: Alum or zinc injections, 425. Te])id or warm 
 salt water hip baths. Iodide of lead and belladonna, or acetate of lead 
 and opium pessaries, 428. Application of solid nitrate of silver. L^ndi- 
 luted solution of subacetate of lead. Glycerine. Collodium. 2^<5. Mer- 
 curial ointment. Acid solution of nitrate of mercury. Potassa fusa. 
 Scarification of labia, or application of three or four leeches where 
 there is congestion.
 
 270 URTICARIA. 
 
 Generally : Animal food : milk. Claret, sherry, champagne, or brandy 
 
 *and water, — in place of malt liquors. Nitro-hydroehloric acid, 378. 
 
 Salicin, 388. Quinine, 379. Pepsine, 420. Rhubarb and ipecacuanha, 
 
 179. Oxide of sil^Pr, 47. Arsenic and bark, 52. Iodide of potassium, 
 
 31. Cod-liver oil. Moderate exercise in open air. 
 
 2. Ulceration of Labia Uteri. — Uterine lips not only more or less 
 dejDrived of dense epithelium, but the villi with their vascular loops 
 destroyed in patches. Sometimes, proper tissue of uterus involved. 
 
 Symptoms. Thick muco-purulent discharge. Pelvic pains. Back- 
 ache. Menorrhagia. Anaemia: headache, neui'algia, dirty sallow hue 
 of skin, irregular action of bowels, loss of appetite, &c. Debility : 
 mental depression. Pains increased by walking or sitting upright. 
 Reflex irritation of breasts, bladder, and rectum. 
 
 Treatment. Same as for simple abrasion. Warm water or stringent 
 injections night and morning. Tonics. Nourishing food : stimulants. 
 Relief to reflex irritation by iodide of lead and belladonna j^essaries, 
 423. Avoidance of sexual intercourse. 
 
 3. Syphilitic Affections. — Primary syphilitic sores very rare. Chancre 
 may be situated on labia, within canal of cervix, or on outside and 
 upjjer part of cervix. — Secondary syphilitic affections of uterus not un- 
 common. Chief symptoms, — Hypertro])hy and induration of vaginal 
 portion of cervix. Abundant muco-purulent discharge from uterus and 
 vagina. Patches of abrasion, or of ulceration on labia uteri. Menstrual 
 irregularities, — often menorrhagia. Evidence of disease in distant 
 parts, loss of hair, sore throat, cutaneous eruptions, nodes, &c. Treat- 
 ment the same as for syphilis generally. 
 
 4. Rodent Ulcer. — Synon. Corroding Ulcer. — A severe disease, which 
 has been confounded with epithelial cancer. Very rare befoi'e age of 
 thirty; usually commences about "change of life." 
 
 Symptoms. Ulceration begins gradually and extends slowly. As it 
 eats away aff'ected tissue, complaint made of pelvic heat and discom- 
 fort; thin serous discharge, occasionally streaked with blood. Debility, 
 pallor, indigestion. Subsequently, — burning pains; attacks of hemor- 
 rhage. On examination, an irregularly-sha})ed ulcer found, with ragged 
 or indurated edges : sore excavated, presenting a dry and glossy or a 
 pulpy surface. Uterus not fixed, as in cancer. Sometimes, whole of 
 cervix destroyed. Disease eats its way into body of uterus; so that 
 entire muscular structure gets destroj^ed, unless death first occur from 
 hemorrhage or peritonitis or exhaustion. 
 
 Treatment. Excision, if disease be limited to cervix : otherwise, 
 actual cautery, or potential caustics. Sedative vaginal injections, 425. 
 Opium and belladonna pessaries, 423. Arsenic, 52. Cod-liver oil. Tonics. 
 Narcotics. Nourishing food. 
 
 URTICARIA. — From Urtica, a nettle. S^^non. Purpura Urticata ; Ex- 
 anthema Urtiaituin; jVettle-Pash. — A non-contagious aftcction of the skin. 
 One of the Exanthemata. Characterized by formation of ])r()mincnt 
 patches or wheals (pomphi), which often apjiear and disappear sud- 
 denly: accompanied by heat, burning with tingling, and great itching. 
 'Sometimes, constitutional disturbance: fever, coated tongue, unhealthy 
 secretions. A chronic intermittent variety (Urticaria Evanida of Wil- 
 lan), often very troublesome, lasting for months. 
 
 Urticaria generally due to derangement of digestive organs, caused 
 by use of shell-fish, mushrooms, cucumbers, nuts, bitter almonds. Hen- 
 bane, turpentine, nux vomica, and balsam of copaiba may induce it.
 
 VACCINIA VAGINAL PROLAPSUS. 271 
 
 Sometimes connected with rheumatism or gout, uterine irritation, den- 
 tition, &c. 
 
 Treatment. Sulphate of magnesia in acid infusion of roses, 142. 
 Ehubarb and magnesia, 165. Khubarb and blue pill, 171. Ammonia 
 and chiretta, 63. Bismuth, 65. Potash and ammonia, 67. Ammonia 
 in effervescence, 362. Nitro-hj-drochloric acid, 378. Steel and ammonia, 
 401. Steel and citrate of potash, 403. Pe])sine, 420. Iodide of potas- 
 sium and colchicum (in chronic form). Quinine, 379. Arsenic, 52. 
 Sponging with vinegar and water: equal parts of tincture of ai-nica, 
 glycerine, and rose-water: equal parts of solution of sul)acetate of lead, 
 laurel water, glycerine, and elder-flower water: solution of cori-osive 
 sublimate (gr. 5 to fl. oz. viij). Warm or tej)id baths. Plain diet. Active 
 exercise. 
 
 VACCINIA. — From Vacca, a cow. Synon. Variola Vaccina; Exan- 
 thema Anticariolosum; Vacciola ; Inoculated Cow-Pox. — A disease pro- 
 duced by inoculation with the virus of cow-pox, such disease aflfVjrding 
 protection against the contagion of small-pox. Included by Willan in 
 the Vesicular order of skin diseases. — See Cow-Pox. 
 
 VAGINAL OCCLUSION.— From Vagina, a sheath or scabbard.— In- 
 dependently of cases where, from arrest of development, vagina is en- 
 tirely absent, or is considerably malformed, examples of occlusion can 
 be arranged under one of three heads : 
 
 (1) Those where there is a morbidly tough and persistent hymen. If 
 the membrane cannot be ruptured with finger, it must be divided; re- 
 union being prevented by use of oiled lint. (2) Where the hymen is 
 hypertrophied and imperforate, so as completely to close vaginal canal 
 from urethra to fourchette, preventing escape of menstrual fluid. A 
 longitudinal or crucial incision to be made through obstructing mem- 
 brane. Under such conditions, operation attended with considerable 
 danger : fatal peritonitis, endometritis, or pyaemia not uncommon. And 
 (3) cases of imperforate vagina; whether due to congenital adhesions 
 between opposite walls, to stricture in consequence of inflammation, or 
 to cicatrices consequent on injury. A careful dissection often required 
 to make canal patulous. 
 
 VAGINAL PROLAPSUS.— From Vagina, a sheath : Prolabor, to fall, 
 or slip out. Synon. H yder opt osis Vagina'. ; Colpoptosis ; Elytroptosis. — A 
 descent, more or less complete, of the vagina. 
 
 Sy.mptoms. Protrusion of the vagina usually accompanied by pro- 
 lapsus uteri, though it may occur alone. If entire circumference of 
 vaginal mucous membrane be prolapsed, a projecting tumor is found at 
 vulva. Surface may be inflamed and excoriated. Bladder rendered 
 irntable : often, emptied with difficulty. 
 
 Cases of partial more common than of complete prolapsus. When 
 anterior wall is alone affected, posterior wall of bladder is drawn down — 
 Vaginal cy&tocele. The posterior Wall of vagina and anterior wall of 
 rectum may be protruded — Vaginal rectocele. In the one case, urine is 
 apt to accumulate in pouch formed by bladder; in the other, a pocket 
 forms, in which hard fecal masses ai'e retained, causing constipation and 
 sense of weight. 
 
 Treatment. 6^eA?em%.- Nourishing food. Eest. Avoidance of strain- 
 ing, and of lifting heavy weights. Quinine, steel, and strychnia, 380. 
 Phosphoric acid, nux vomica, and bark, 876. Phosphate of zinc and 
 steel, or bark, 414. Sulphate of zinc and nux vomica. 409. Colocynth, 
 or aloes, and nux vomica, 175. Olive oil enemata, 188. Castor oil and
 
 272 VAGINAL TUMORS VAGINITIS. 
 
 turpentine enemata, 190. — Locally: Cold salt water hip baths. Alum 
 and zinc injections, 425. Tannin and catechu pessaries, 423. Boxwood, 
 or India-rubber pessaries. Diminution of vaginal capacity, by dissecting 
 off one or more strips of mucous membrane, and bringing edges to- 
 gether with interrupted suture. 
 
 VAGINAL TUMORS.— These growths may consist of: 
 
 PoU/j/us of vfKjina. Very rare. Produces leueorrhoea, bearing-down, 
 irritability of bladder, &c. May be cured by excision. If any vessel be 
 felt pulsating in pedicle, a ligature should be applied, and tumor snipped 
 off just below it. 
 
 Fibrous tumors. Sometimes found imbedded in submucous tissue of 
 vaginal wall. Seldom troublesome: may perhaps cause hemorrhage. 
 Cxrowth can be shelled out with fingers or handle of scalpel, after divi- 
 sion of mucous membrane covering it. 
 
 Mucous follicular cysts. May be superficial ; formed by dilated follicle, 
 excretory orifice of which has closed. Deep-seated cysts produced by 
 accumulation of contents of interstitial or closed follicles. Either form 
 to be cured by puncture, and application of nitrate of silver to inner 
 walls. 
 
 VAGINISMUS. — From Vagina, a sheath; terminal -ismns. — An in- 
 voluntaiy spasmodic closure ot the sphincter muscle of the vagina, with 
 such excessive supersensitiveness of the surrounding tissues as to form 
 a complete barrier to coition (Marion Sims). 
 
 May exist as a simple or complicated state. In first case, no local 
 structural change. Excessive tenderness of vaginal orifice, and of 
 hymen or its remains. Slightest touch causes great agony. In second 
 form, in addition to supersensitiveness, inflammation of follicles about 
 vulva; or fissure of fourchette ; or hypersesthesia of entire vaginal mu- 
 cous lining; or some uterine displacement; or a contracted state of os 
 uteri and cervical canal. In either form, essential remedy consists in 
 removal of hymen, incision of vaginal orifice, and subsequent dilatation 
 with graduated bougies. 
 
 VAGINITIS. — From Vagina, a nhGnth; terminal -^Yit'.s. Inflammation 
 of the vagina may be acute or chronic : 
 
 1. Acute Vaginitis. — Synon. Elytritis ; Colpitis. — Not very common. 
 Morl)id action not always limited to mucous membrane: tissues beneath 
 sometimes involved, causing distressing suffering. Arises from violence ; 
 pressure of foetal head in lingering labor; want of cleanliness with de- 
 pression of vital powers, etc. 
 
 Symptoms. Pain and sense of heat in vagina. Itching about vulva. 
 Irritability of bladder. At first, mucous inembrane dry and swollen : 
 secretion of mucus checked. Then, creamy mucus, or muco-purulent 
 matter, or pus is poured out : pain diminishes. Backache; pains about 
 hips and upper part of thighs ; sense of weight or bearing-dovvn ; smart- 
 ing and tenderness. Disease runs its course in seven or eight days, or 
 subsides into chronic form. — If submucous tissues be involved, there 
 may be rigors, fever, headache, rapid pulse, severe throbbing pains. 
 Suppuration : abscess bursts into vagina, or pus bui'rows making its way 
 to perineum or sides of labia. 
 
 Treatment. Hot hip baths. Vaginal injections of warm water. 
 Pessaries of oxide of zinc and belladonna, or of acetate of lead and 
 opium, 423. Confinement to bed or sofa. Castor oil. Cubebs. Fish 
 diet: eggs, milk, tea, demulcent drinks. — If supj>uration occur: Am-
 
 VARICELLA — VASCULAR TUMORS OF URETHRAL ORIFICE. 273 
 
 mouia and bark, 371. Quinine Avith mineral acids, 379. Opium or 
 morphia, 343. Opium and belladonna, 344. Fomentations or linseed 
 poultices to vulva. Abscesses to bo ojjened if they point. 
 
 2. Chronic Vaginitis. — Synon. Catarrhus Genitalivm ; Bleniwrrhoea 
 Genitallum ; The Whites; Vaginal Leiicorrhoea {AzuyMq^ Avhite; pioj^ to 
 flow). — One of the most common diseases to which women (particularly 
 the married) are liable. 
 
 Symptoms. Constant or frequent leucorrh(x?al discharge — "the 
 whites." Backache; sense of weariness after sligbt exertion. Loss of 
 ap])etite; indigestion; flatulence and constipation. Mental depression. 
 — Exfoliation of epithelial covering of mucous membrane may occur: 
 comes away in flakes, or in masses forming complete casts of vagina. 
 
 Treatment. Mineral acids and bark, 376. Nitro-hydrochloric acid, 
 378. Mineral acids and quinine, 379. Quinine and steel, 380. Phos- 
 phate of iron, 405. Gallic acid. Colchicum. Cod-liver oil. Pepsine. — 
 Cold salt water hip baths. Astringent injections, 425. Tannic acid, or 
 sulphate of zinc, or acetate of lead pessaries, 423. Brushing vaginal 
 walls with solution of nitrate of silver, or solution of carbolic acid in 
 glycerine (gr. 10 to fl. oz. j). 
 
 VARICELLA. — The dim. of Variola ( Varius, spotted). Synon. Var- 
 iola. Spuria; FseudovarioUv. — The mildest of the eruptive fevers. Often 
 classed with the Vesicular skin diseases. — See Chicken-pox. 
 
 VARICOCELE. — From Varix, a dilated vein ; xrp.-q, a tumor. Synon. 
 Oscheocele Varicosa ; Spermatocele; Oii'socele (i'rom Juptrd':, a. yarix; xv^Xtj). 
 — A varicose condition of the veins of the spei-matic cord may arise 
 from any cause which retards upward flow of blood, — as tumors, 
 trusses, constipation, corpulence, frequent straining in erect posture, 
 &c. Spermatic veins on left side most frequently afl^ected, owing to 
 their greater length, and greater liability to pressure from a distended 
 colon. 
 
 Symptoms. Swelling; pyriform with base on testis. Veins can be 
 rolled under fingers, like worms in a bag. Weight, and aching about 
 groin and loin. Uneasiness or pain about scrotum. Neuralgia of test-, 
 icle, sometimes atrophy. Mental depression. 
 
 Treatment. Palliative: A regular action of bowels to be insured by 
 attention to diet, mild apei'ients. Improvement of general health; 
 mineral acids, nux vomica, &c. Bathing scrotum with salt water night 
 and morning. Firm support with a suspensory bandage. Invagination 
 of loose skin of scrotum through a padded steel ring. Radical cure : 
 Obliteration of the veins. To be accomplished either by a spring truss, 
 or by passing ligatures of silver or iron wire subcutaneously, so as only 
 to divide the veins, or by passing a hare-lip pin underneath the veins, 
 and then twisting a figure of 8 suture over it. !None of these proceed- 
 ings free from risk. 
 
 VARIOLA. — From Frtrfws, spotted. Synon. Testis Variolosa. — Avery 
 contagious eruptive fever; the frequency and severity of which have 
 been greatly diminished by the discover}^ of vaccination. Included by 
 Willan in the Pustular order of skin diseases. — See Small-pox. 
 
 VASCULAR TUMORS OF URETHRAL ORIFICE.— Synon. Urethral 
 Hoimorrhoids. — Not uncommon in females : very rarely vascular tumors 
 have been found at orifice of male urethra. 
 
 In women, external orifice of meatus urinarius is the most frequent 
 
 18
 
 274 VENEREAL DISEASE — VESICAL INFLAMMATION. 
 
 Beat of vascular tumor. Excrescence varies in size from that of a pin's 
 head to that of a date-stone. Exquisitely eensitive, often causing ii-ri- 
 tability of bladder with pain on passing water. To be cured by excision 
 and subsequent application of actual cautery to submucous base. Or a 
 ligature may he applied, passing a tenaculum through base and tying 
 tightly round it. Chloroform usually necessary for either operation. 
 Patient to be in position for lithotomy. Acid solution of nitrate of mer- 
 cury, or potassa fusa, sometimes employed. Nitrate of silver worse 
 than useless. 
 
 VENEREAL DISEASE.— From Venus, the Goddess of Love. A term 
 generally apj)lied to those disorders which result from impure connec- 
 tion. — See Gonorrhoea; Syphilis, &c. 
 
 VERRUCffi. — From Verriica, a wart. Synon. Ecthyma Verruca; 
 Vegetations; Warts. — Consist of collections of hj^pertrophied cutaneous 
 papillse; each j)apilla being separate and merely covered with thin 
 cuticle, or a bundle of papillfe being bound together by an excess of dry 
 and hard scaly epithelium. 
 
 Treatment. Excision. Nitrate of silver. Glacial acetic acid. Acid 
 solution of nitrate of mercury. Creasote. Carbolic acid. Savin. Chromic 
 acid, 196. Tincture of jDerchloride of iron. 
 
 VERTIGO. — From Verio, to turn round. Synon. Circnmgyratio ; Gid- 
 diness ; Swimming of the Head. — A transitory sense of giddiness, of whirl- 
 ing round, or of falling. Surrounding objects appear to be in motion : 
 sufferer loses his balance for a moment or two, and is in danger of fall- 
 ing unless he can grasp some object. Usually followed by headache : 
 occasionally, by nausea. 
 
 Often a symptom of incipient disease of brain. Sometimes betokens 
 general weakness ; or a poison in blood, as opium or tobacco or alcohol ; 
 or some cardiac, hepatic, renal, gastric, or intestinal affection. Any 
 disturbance of cerebral circulation will induce giddiness. In mild form 
 of epilepsy, giddiness and a tit of absence (epileptic vertigo) are promi- 
 nent symptoms. Swimming in head, a forerunner of apoplexy and pa- 
 ralj^sis. Paroxysmal attacks not uncommon in the aged, either witliout 
 ..obvious cause, or from disease of coats of cerebral arteries, or from pas- 
 isive venous congestion. 
 
 Tonic and antispasmodic remedies more frequently called for than 
 those of a lowering nature. Chalybeates when there is anannia. Pur- 
 gatives, spare diet, blisters behind ears, outdoor exercise if there be evi- 
 •dence of active arterial congestion. Small doses of corrosive sublimate 
 .in simple vertigo of old people. 
 
 VESICAL INFLAMMATION.— From Vesiea, the urinary bladder: 
 
 Tntiiimnio,{o'u\i\iimii. Synon. Cystitis; Cystophlogia ; Tnflanimatio Vesicae. 
 — Intiammation of the bladder may be acute or chronic: 
 
 1. Acute Cystitis. — From Ku^Tce;, a bladder; terminal -itis. A severe 
 disease wliicli may arise idio])athically ; or may supervene on chronic 
 intiammation. irritation of a calculus, external injuiy, disease of pelvic 
 viscera, &c. Mucous lining of neck and bas-fond of bladder more fre- 
 .quently attacked than all tlie coats. 
 
 Symptoms. Shivering. Pain over bladder. Heat of urethra: con- 
 stant desire to pass urine, which comes away in small quantities. High 
 fever. Nausea. Constitutional disturbance : mental depression. Blad- 
 der can perhaps be felt as a small rounded tender tumor. Severe pain,
 
 VESICAL IRRITABILITY. 27o 
 
 extending to perineum and down thighs: increased by abdominal pres- 
 sure, rectal or vaginal examination. Tenesmus. — Unless resolution 
 occur, — unbearable ])ain. Constant calls to micturate: urine expelled 
 ill drops, or retention. Urine becomes fetid and alkaline: contains 
 shreds offibrine entangling pus and blood cor])uscles. Great prosti'ution. 
 Cold clammy sweats. Low muttering cb'lii'ium. Fatal exhaustion. 
 
 Trkatment. Opium. 0})iuni and belladonna, 344. Aconite. Hot 
 hip baths. Fomentations. Linseed or hemlock poultices. Castor oil. 
 Mucilaginous fluids. Catheterism. Wine, bi'and}', cream, raw eggs, 
 essence of beef, etc., as soon as indications of exhaustion couimence. 
 
 2. Chronic Cystitis. — Sjnion. Cystirrhcea ; Cystorrhosa ; Blennorrhoea 
 ZJrinitlls; Tenesmus Vesicce Mucosus ; Catarrhus Vesica;. — This form of 
 inflammation common. Sometimes follows an acute attack : more fre- 
 quently due to gout, retention of decomposing urine, irritation of urine 
 charged with saline diuretics, foreign substances in bladder, or to ex- 
 tension of inflammation from rectum or uterus, &c. 
 
 Symptoms. Often slight. Feeling of indisposition. Increased sensi- 
 bility of bladder walls. Frequent micturition. Urine scant}^ with 
 perhaps a small quantity of mucus or pus : sometimes loaded with viscid 
 ropy mucus. 
 
 Treatment. Catheterism, unless bladder can be thoroughly emptied 
 at will. Washing out bladder with warm water; or with solutions of 
 henbane, opium, or some astringent. Opium and belladonna sup- 
 pository, 340. Oxide of zinc and belladonna vaginal pessaries, 423. 
 Belladonna plaster to sacrum. Benzoate of ammonia, 40. Infusion of 
 bearberry (infusum uva? ursi). Infusion of buchu. Decoction ofpareii-a. 
 Decoction of couch-grass. Cubebs, in small doses. Demulcent di'inks; 
 barley-water, infusion of linseed, &c. Animal food: milk or cream : raw 
 eggs. Alcoholic stimulants. 
 
 VESICAL IRRITABILITY. — From Teska, the urinary bladder. 
 fijuoii. Ijiijtatirittid l\'sk'a' ; Cysterethismns. — Irritability of the bladder 
 is said to exist when there is an unnaturally frequent desire to pass 
 urine. Ma}^ arise from organic disease of kidneys, bladder, prostate 
 gland, or urethra; vascular tumor of female urethra; pi'cssure of en- 
 larged or displaced uterus; irritation of haemorrhoids, or intestinal 
 worms; presence of a tumor or calculus in bladder; or simply from 
 some functional derangement of kidneys, bladder, stomach, or nervous 
 system. 
 
 Symptoms. Desire to micturate comes on suddenly and frequently : 
 urine may have to be passed every fifteen or thirty minutes. Inability 
 to resist desire : if attempted, uneasiness or aching pain. Total amount 
 of urine seldom increased in quantity. Bladder diminishes in size. 
 General health suffers from the annoying irritation. 
 
 Urine always to be examined. If preternaturally acid or alkaline; if 
 loaded with urates, phosphates, or oxalates; or if it contain pus, albu- 
 men, sugar, or any other morbid material, — disease must be traced to 
 its origin. 
 
 Treatment. Dilute nitro-h^Hlrochloric acid, belladonna, and pareii-a, 
 378. Solution of potash and buchu, 69. Ferruginous tonics. Decoction 
 of couch-grass or triticum repens (oz. 1 of underground stem to water 
 fl. oz. xx). Opiate or belladonna suppositories, 340. Oxide of zinc and 
 belladonna pessaries (for women), 423. Tincture of cantharides. Tinc- 
 ture of benzoin. Infusion of bearberry. Colchicum. Cod-liver oil. — 
 Warm or tepid salt-water baths. Local application of carbonic acid 
 gas. Avoidance of stimulants. Substitution of cocoa for tea and coffee. 
 Mucilaginous diluents. — See Enuresis.
 
 276 VESICAL PAKALYSIS — VESICAL TUMORS. 
 
 VESICAL PARALYSIS.— From Vesica, the urinary bladder: Tlapalmo^ 
 to affect with paralj'sis. Synon. Cy stop araly sis ; Cystoplegia; Acystin- 
 ervia. — The muscular coat of bladder may become paralyzed from some 
 influence confined to this viscus; disease of nervous centres, inducing 
 simultaneous loss of power in other organs; or from constitutional de- 
 bility. 
 
 Symptoms. Unlike the rectum, the bladder retains its contents when 
 paralyzed. When distension becomes great, urine dribbles away by 
 urethra : hence, incontinence of urine often an indication of retention. 
 Urine loaded with mucus : alkaline: offensive ammoniacal odor. Pain 
 at neck of bladder: as distension gets great, the walls lose their sensi- 
 bility. Severe constitutional disturbance. Frequently, death from coma 
 or exhaustion. 
 
 Treatment. Use of catheter: bladder to be slowly but thoroughly 
 emptied. Tejjid or cold water injections. Ergot of rye. Strychnia or 
 nux vomica. Ai-nica. Aloetic purgatives. Hip baths. Galvanism, 
 cold douche, or blisters to lower part of spine. 
 
 When disease of nervous centres exists, symptoms can only be re- 
 lieved as they arise. — See Enuresis. 
 
 VESICAL SPASM.— From Fes? ea, the urinary bladder. Synon. Cysto- 
 spasmus ; Ischuria iSpasmodica. — Spasmodic attacks of pain in bladder. 
 May arise from vesical calculus or tumor ; diseases of rectum and uterus ; 
 abscess of kidney; ulceration or other organic disease of bladder, pros- 
 tate gland, &c.; abnormally acid urine; excessive venery; hysteria; or 
 from use of irritating diuretics — cantharides, oil of juniper, savin. 
 
 Symptoms. Severe pain at lower part of abdomen, extending to 
 urethra. Involuntary micturition : sometimes retention of urine with 
 urgent desire to micturate. Tenesmus. — When of long continuance, 
 death has resulted with symptoms of suppression of urine. 
 
 Treatment. Relief of spasm : Hot baths. Hemlock poultice. Poppy- 
 head fomentations. Linseed poultice with camphor to perineum. 
 Opium and belladonna suppository, 340. Ether and opium draughts, 
 85. Mucilaginous drinks. 
 
 JRetnoval of cause : Colchicum. Quinine. Citrate of jDotash. Regula- 
 tion of diet: avoidance of stimulants, tea, and coffee. Warm clothing. 
 Avoidance of violent exercise : sexual intercourse. Appropriate reme- 
 dies for renal abscess, calculi, &c. 
 
 VESICAL TUMORS.— From Vesica, the urinary bladder.— The growths 
 which may be developed on the walls of the bladder are: Warty or 
 polypoid fibrous bodies; villous or vascular growths; and malignant 
 tumors. 
 
 Symptoms. Whatever the nature of the tumor, the symptoms resemble 
 those caused b}^ a calculus. Frequent micturition. A painful sense of 
 inability to empty bladder. Urine may be bloody, or purulent, or am- 
 moniacal and loaded with mucus. 
 
 Malignant more common than innocent growths. Medullary cancer, 
 or epithelioma, more frequent than scirrhus. Cancerous deposit gener- 
 ally primary ; but may result from extension of disease from rectum, 
 pi'ostate, uterus, or vagina. Suffering very great. Ui'ine bloody: per- 
 haps cancer-cells may be found. 
 
 Treatment. Relief of prominent symptoms. Narcotics, to ease jjain. 
 Asti-ingents, to check hemorrhage. Nutritious food. 
 
 Polypoid, fibrous, and pendulous villous growths, have been removed 
 by ligature from female bladder, owing to ease with which urethra can 
 be dilated.
 
 VILLOUS CANCER — VOMITING AND RETCHING. 277 
 
 VILLOUS CANCER.— From Villus, shaggy hair.— A variety of medul- 
 lary and perhaps of epithelial cancer, occurring most frequently on mu- 
 cous mcmhraue of urinary bladder. The histories coincide with those 
 of medullary cancers. — See Cancer. 
 
 VITILIGO. — From Vitulus, a calf; terminal -igo. A rare disease, said 
 to produce a glistening veal-like appearance of skin. — Two varieties: 
 Vltilujoidea plana and V. tuberosa, which may occur separately or com- 
 bined. In former, irregular yellow patches are observed, slightlv ele- 
 vated and hard; in latter, isolated or confluent tubercles, ranging' from 
 the size of a pin's head to that of a large pea. Possibly there may be 
 some connection between this skin disease and derangement of the liver. 
 
 Yitiligo sometimes confused by authors with lepral alj)hoides, or with 
 lupus non-exedens. Other writers seem to regard the appearances as 
 merely due to a diminution of pigment, without any change of texture; 
 making it of same nature as leucoderma. Xo remedy for it at present 
 known. 
 
 VOMITING AND RETCHING.— Synon. Emesis; Sickness of the Stom- 
 ach; Spewing. — Vomiting (ti-om Fowio) is due to forcible and repeated 
 contractions of the stomach, with relaxation of the cardiac sphincter, so 
 that the gastric contents are expelled upwards. In retching there are 
 fruitless attempts to empty the stomach, the cardiac sphincter being 
 contracted; or the stomach is empty. 
 
 Sickness arises in many diseases: i. e., cerebral, pulmonary, renal, bil- 
 iary, gastric, intestinal, or uterine and ovarian disorders. It may be 
 due to symj)athetic ii'ritation of pregnancy. To ingestion of poisonous 
 or irritating substances : drunkenness. To blood-poisoning, as in ichor- 
 hffiinia ; continued and eruptive fevers. Or it may occur as an idiopathic 
 aftection, — no other morbid state being discoverable. 
 
 Symptoms. Vary with the cause. Some prominent distinctions are 
 shown in following table : 
 
 Gastric or Hepatic Vomiting. Cerebral or Sympathetic Vomiting. 
 
 1. Nausea relieved, at all events, tern- 1. Little or no nausea. Ketching con- 
 porarily, by the discharge of the stom- tinues, often in spite of stomacli being 
 ach's contents. empty. Directly any fluid or solid is 
 
 taiven, it is rejected. 
 
 2. Vomit consists of partially digested 2. Vomit consists of unaltered food. Of 
 food, biliary matters, and offensive secre- frothy mucus. Never pus or blood, 
 tions. Sometimes acid water; pus; blood. Sometimes a tinge of bile. 
 
 3. Loss of appetite, or even a disgust 3. Appetite remains. Frequently a de- 
 for food. sire for food immediately after vomiting. 
 
 4. Tongue coated; breath foul; con- 4. Tongue clean; breath pure; conjunc- 
 junctivie often yellowish; headache sec- ti vie colorless, or only injected; headache 
 ondary in point of time. primary. 
 
 5. Griping abdominal pain ; fetid eruc- 5. No eructations of foul air. Gener- 
 tations ; diarrhoea; unhealthy watery ally, obstinate constipation; or stools 
 stools. solid and healthy. 
 
 6. Retching; increased salivation; more 6. Stomach emptied without effort; no 
 or less abdominal tenderness ; faintness or increase of saliva; no abdominal tender- 
 exhaustion, ness ; little or no fatigue or faintness after 
 
 vomiting. 
 
 Treatment. General remedies: Attention to diet: bland simple nour- 
 ishment, in small quantities at a time. Aperient enemata, 188, 189, 190. 
 Calomel in purgative doses (grs. 5 to 10). Calomel, blue pill, or mer- 
 cury with chalk, as alteratives. Taraxacum, 227, 228. Seidlitz powders, 
 169. Podophj'Uum, 160. Carbonate of magnesia. Tartaric or citric 
 acid. White bismuth, 65. Charcoal biscuits. Cotfee. Carbonic acid. 
 Citrate of ammonia, potash, or soda in effervescence, 348, 362, 403. Di-
 
 278 VULVAL CANCER — VULVAL CORRODING ULCER. 
 
 lute hyclrocj'anic acid, 70, 86, 377. Laurel leaf water (aqua laurocerasi, 
 min. X to xxx). Dilute nitro-hydrochloric acid, 378. Creasote, 41, 90. 
 Carbolic acid. Eectified pyroxylic spirit (spiritus pyroxylicus rectifi- 
 catus, min. v to xl). Carbonate of ammonia. Aromatic spirit of am- 
 monia. Infusion or tincture of calumba. Cinnamon. Spirit of chloro- 
 form. Three or four drops of chloroform on a lump of sugar. Spirit 
 of ether. Nitrate of silver. Sulphate of copper. Oxide of silver, 47. 
 Salicin, 388. Sulphite of soda, 48. Opium. Belladonna. Pepsiue, 420. 
 Ice. 
 
 Locally : Sinapisms over epia'astrium. Blisters. Seton. Issues. Hem- 
 lock poultices. Linseed poultices. Wet compress, 136. Belladonna, 
 opium, warm galbanum. pitch, or chalybeate plaster. Extracts of bel- 
 ladonna and poppies, 297. Dr^" cupping. Leeches. 
 
 ISympaihetic vomiting, in pregnancy, vterine or ovarian disease, rf-c. : Ice 
 to suck freely. Soda water. Champagne; sparkling Hock or Moselle. 
 Pepsine, 420. Tincture of iodine in small doses. Strong cotfee before 
 rising in the morning. Infusion of cloves. Lemon-juice. Oxalate of 
 cerium (gr. 1 to 2 in a pill). Rectified pyroxylic spirit. "VYhite bis- 
 muth. Effervescing draughts with calumba, cascarilla, &c. Setons, is- 
 sues, sinapisms, stimulating liniments, turpentine stupes, or repeated 
 flying blisters to epigastrium. Leeches to os uteri, if there be conges- 
 tion : nitrate of silver, if there be excoriation or ulceration. Yaginal 
 pessaries of iodide of lead and belladonna, 423. In \qyj severe cases, 
 the induction of premature labor. 
 
 Hysterical vomiting: Sumbul, 369. Nux vomica, or strychnia, 387, 
 407, 408. Assafoetida, 89, 190. Yalerian, 87, 303, 411. Shower baths. 
 Dry cupping over stomach and margins of lower ribs. 
 
 Sea-sickness: Eecumbent posture. Ammonia. Brandy. Whiskey. 
 Chloroform by inhalation, or a few drops on sugar. A tight belt round 
 the body. Chapman's ice bags to spine. 
 
 See Gastritis; Gastric Ulcer; Gastric Cancer; CJiolera ; Hcematemesis ; 
 Obstruction of Boicels, &c. 
 
 VULVAL CANCER. — From Vulva, a covering. — or perhaps as if 
 Valvce, folding doors. — Any part of external genitals, or of vaginal 
 walls, may become the seat of malignant disease. Occurs primarily, or 
 secondarily. Epithelial cancer more common than other forms. Eelief 
 may be given by excision, where disease is confined to external labia. — 
 See Cancer. 
 
 VULVAL CORRODING ULCER.— Synon. Vulval Esthiomenos QEaOim, 
 to corroile or eat away). — An inveterate and progressive ulceration of 
 external genitals. Probably of same nature as Rodent ulcer. 
 
 Symptoms. An intractable ulceration, which commences on some 
 part of external genitals, and gradually creeps over vulvo-anal region : 
 surrounding structures have a tendency to become hypertrophied. As 
 ulcer heals in one direction, it extends in another: process of repair ac- 
 companied by formation of a firm burn-like cicatrix, which has a ten- 
 dency to cause contraction of vaginal or anal orifice. Suftering very 
 slight for several months: until vaginal orifice becomes fissured by it, 
 or mouth of urethra gets involved, there is no pain during sexual inter- 
 course or micturition. For a long time, general health not affected; 
 menstruation occurs regularl}''; neither loss of strength nor flesh. But 
 unless a cure be eftected, profuse discharge ultimately proves very weak- 
 ening; appetite fails; dyspepsia; attacks of colliquative diarrhoea; 
 sometimes, hemorrhage. 
 
 Death seldom occurs until after lapse of eight or ten years. May be
 
 VULVAL PKURITUS — VULVAL TUMORS. 279 
 
 due to peritonitis; erysipelas; stricture of rectum; hemorrhage; or 
 fatal exhaustion. 
 
 Treatment. Thorough excision; with extirpation of any tubercular 
 excrescences, if present. Use of tents or bougies, as parts heal, to pre- 
 vent undue contraction of vaginal and anal orifices. Efficacy of poten- 
 tial caustics very doubtful. Nourishing food. Cod-liver oil. Daily hip 
 baths. Anodyne lotions. 
 
 If there be any suspicion of syphilitic taint, — Iodide of potassium, 31. 
 Green iodide of mercury, 53. Hed iodide of mercury, 54. Donovan's 
 triple solution, 51. Mercurial vapor bath, 131. 
 
 VULVAL PRURITUS ,— From Vulva, a covering: Pn.irio, to itch.— 
 Irritation of the vulva may be simply a local affection ; or a symptom 
 of some disease, — excoriatiou of labia uteri, onset of carcinoma, &c. 
 Not uncommon in advanced life : sometimes troublesome during preg- 
 nancy. 
 
 Symptoms. Itching, tingling, formication, or smarting about vulva: 
 increased by stimulants and warmth. The scratching resorted to, pro- 
 duces irritating excoriations and scabs about vaginal labia, perineum, 
 vestibule, and mons Veneris. The constant annoyance causes general 
 irritability, restlessness at night, loss of a])petite, &c. 
 
 Pruritus not to be confounded with irritation from prurigo, presence 
 of lice, follicular vaginitis, eczema, or from crops of small boils. 
 
 Treatment. Generally: Sulphate of soda and sulphur, 148. Sulphur 
 and magnesia, 153. Compound powder of rhubarb. Ehubarb and blue 
 pill, 171. Steel and sulphate of soda, 180, 181. Pepsine, 420. Nitro- 
 hydrochloric acid, 378. Phosphoi-ic acid and nux vomica, 376. Quinine, 
 379. Quinine and belladonna, 45. Tar capsules, 36. Arsenic, 52. Cor- 
 rosive sublimate, 27. Colchicum, 46. Copaiba. Camphor. Tincture 
 of Indian hemp. — Plain animal food, milk, eggs ; avoidance of alcohol, 
 tea, coffee. 
 
 Locally : Tobacco lotion, 265. Lotion of acetate of lead and prussic 
 acid, 263. Lotion of morphia and solution of potash, 266. Lotion of 
 borax, morphia, and glj'cerine, 268. Painting vulva with mixture of 
 equal parts of belladonna and aconite and chloroform liniments. Cod- 
 liver oil. Olive oil. Nitrate of silver. Lime liniment. Glj'cerine and 
 rose-water (one part to eight). Calomel ointment. Equal parts of red 
 oxide of mercury ointment and cod-liver oil. Carbonate of lead oint- 
 ment. Hi]) baths. Vaginal injections of plain water; or of solution of 
 lead and poppies, 425. 
 
 If there be excoriatiou of labia uteri it must be healed. In carcinoma, 
 relief may be given to irritation by pessai'ies containing oxide of zinc 
 and belladonna, 423. 
 
 VULVAL TUMORS. — Prom Vulva, a covering, — or pei'haps as if 
 Valvoi, folding doors. — Several varieties of morbid growths are met 
 with about the vaginal labia: 
 
 1. Encysted Tumors. — Have their origin in connective tissue of vag- 
 inal labia; or in one of lobules of vulvo-vaginal gland; or in entire 
 gland. The tumor feels firm but elastic. 
 
 Symptoms. When about size of walnut, discomfort on walking. Pain 
 after intercourse. Irritability of bladder. Tenderness about time of 
 catamenial periods. Inflammation and suppuration of cyst walls may 
 occur, converting tumor into an encysted abscess. 
 
 Treatment. — Simple incision, seldom followed b}' permanent cure. 
 Excision of portion of cyst wall. Evacuation of contents, afterwards
 
 280 VULVITIS. 
 
 rubbing cyst walls with nitrate of silver, or iodine liniment. Introduc- 
 tion of seton through entire swelling. Cj'st to be dissected out. Sen- 
 sibility to be removed by ether spray (Eichardson). 
 
 2. Fibrous Tumors, &c. — Occasionally developed in one of the labia 
 majora ; more rarely about perineum. They vary in size from that of 
 a hazel-nut to that of an orange. 
 
 Fatty tumors sometimes met with in same situations. May become 
 pediculated. 
 
 The only remedy for either form of growth is excision. Sensibility 
 to be removed by ether spray. 
 
 3. Warty Growths. — Usually scattered about labia, nymphae, vestibule, 
 perineum, and around anus: sometimes appear in large clusters. They 
 give rise to irritation, and oifensive moisture. 
 
 Eemoval with scissors necessary. Sensibilit}' to be destroA^ed with 
 ether spray. Hemorrhage, if any, requires application of solution of 
 j^erchloride of iron. Escharotics painful and inefficient. 
 
 4. Hypertrophy of Labia. — May occur to an enormous extent : some- 
 times constitutes a form of elephantiasis. Enlargement often due to 
 syphilitic taint. 
 
 Treatment. Eed iodide of mercury, 54. Mercurial vapor bath, 131. 
 Iodide of potassium. 31. Iodide of iron, 32. Excision seldom success- 
 ful without constitutional treatment. 
 
 5. Abscess of Labia. — May arise from a blow, forcible sexual inter- 
 course, irritation of gonorrhoeal or acrid leucorrhoeal discharges, &c. 
 Produces throbbing pain, heat and swelling, constitutional disturbance. 
 
 A free incision will be needed. Eest. Ammonia and bark, 371. Cod- 
 liver oil. Animal food. 
 
 6. Pudendal Hsematocele. — Synon. Labial Thrombus; Sanguineous 
 Tumor of Vulva. — Extravasation of blood into areolar tissue of one of 
 the labia majora, nymph®, or vaginal walls may occur from injury: 
 from rupture of a vessel during parturition. 
 
 Symptoms. Considerable elastic swelling. Pain. Tumor sometimes 
 bursts: if small, clot msiy be absorbed. 
 
 Treatment. — Puncture ; followed by application of pads and a T- 
 bandage to prevent further hemorrhage. Latter may also be prevented 
 by lint saturated with solution of perchloride of iron. 
 
 VULVITIS. — From Vulva, a covering; terminal -itis. Synon. In- 
 flammatio Vulvae. — Several forms of troublesome inflammation may 
 attack the vulva : 
 
 1. Simple Vulvitis. — Not very uncommon from want of cleanliness, 
 excessive intercourse, venereal taint, or irritation of adjoining struc- 
 tures, — rectum or uterus. 
 
 Symptoms. Pain and tenderness. ' Swelling. Mucous discharge. 
 Heat or scalding during micturition. Aching about loins, groins, and 
 thighs. Constitutional disturbance. 
 
 Treatment. Seidlitz powders. Effervescing citrate of magnesia. 
 Cold hip baths. Alum or lead lotions. Avoidance of stimulants. 
 
 2. Gangrenous Vulvitis. — Has on a few occasions prevailed as an epi- 
 demic amongst lying-in women. 
 
 Symptoms. Commence three or four days after delivery with vomit- 
 ing and diarrhoea, or fever and abdominal pains, or with slight hemor- 
 rhage. Prostration, anxiet}^. (Edematous redness of vulva. Disease 
 progressing, pultaceous plates form on interior of vulva, somewhat like
 
 VULVITIS. 281 
 
 diphtheritic membranes. Separation of phates does not occur iintil end 
 of first or second week : small suppurating wounds left. Disease may 
 extend to uterus, causing gangrene. Peritonitis. 
 
 Treatment. Mineral acids and bark, 876. Quinine, 379. Quinine and 
 steel, 380. Opium. Cod-liver oil. Essence of beef. Milk, cream, raw 
 eggs. Brandy or port wine. Locally : Fomentations. Yeast poultices. 
 Application of strong hydrochloric acid. 
 
 3. Follicular Inflammation of Vulva. — Synon. Follicular Vaginitis. — 
 An accunuilation of sebaceous matter, or an inflammation of the seba- 
 ceous follicles scattered over mucous membrane of vulva. Both sides 
 of vaginal entrance usually affected; with tissues within nymphse and 
 at base of clitoris. — Very intractable. Most common during pregnancy 
 and about change of life. 
 
 Symptoms. Parts found moi-e or less inflamed : studded with numer- 
 ous raised vascular points, sometimes having specks of ulceration on 
 summits. Soon, the points coalesce, forming a strip of highly injected 
 mucous membrane : subsequently vascularity disappears, tissues looking 
 as if covered with white paint (Oldham). Disturbance of general health. 
 Constriction of sphincter vagina? muscle. Leucorrhoea: irritation and 
 smarting of genitals. Sexual intercourse very painful. Pains in back 
 and thighs. 
 
 Treatment. Locally: Avoidance ofcaustics and astringents. Morphia 
 and hydrocyanic acid lotion, 26G. Tobacco lotion, 265. Glycerine and 
 lime-water, 286. Lime liniment. Iodide of lead and belladonna oint- 
 ment, 293. Aconitine and calomel ointment, 296. Hydrocj^anic acid 
 and atropia ointment, 306. Hemlock poultices. Warm hip baths, con- 
 taining extract of poppies and soda. 
 
 Generally: Plain nourishing food. Avoidance of seasoned dishes: 
 tea, coffee, wine, and beer. Milk. Brandy and soda water. Arsenic 
 and bark, 52. Mineral acids and bark, 376. Xitro-hydrochloric acid, 
 378. Quinine with aconite, 379. Corrosive sublimate and sarsaparilla, 
 27. Cod-liver oil. Change of air. 
 
 4. Pudendal Erythema. — Generally from want of cleanliness, or from 
 excessive exhalation of moisture in stout middle-aged women, the sur- 
 faces of the labia and perineum and upper part of inside of thighs be- 
 come the seat of an erythematous eruption. Parts of a bright red color : 
 sensation of heat and great discomfort. Severe forms may end in ery- 
 sipelas. 
 
 Treatment. Non-stimulating diet. Eemoval of any derangement of 
 general health. Great attention to cleanliness-. Bathing Avith dilute 
 solution of subacetate of lead. Dusting with oxide of zinc, or powdered 
 spermaceti. Fuller's earth, a common domestic remedy. 
 
 5. Infantile Leucorrhoea. — An irritation or subacute inflammation of 
 mucous glands of vulva, producing a muco-purulent or purulent dis- 
 charge. — May occur from irritation of worms or teething : sometimes 
 as a complication during progress of one of eruptive fevers. 
 
 Symptoms. Derangement of general health : children often strumous, 
 badly fed, &c. There may be only a mucous discharge, with irritation 
 of surrounding parts: if disease extend up vagina, j^rofuse purulent dis- 
 charge, heat and pain during micturition, excoriation of surrounding 
 parts, perhaps aphthous ulceration. Caution necessary, lest disease be 
 wrongly attributed to gonorrheal infection, or to violence in attempt- 
 ing a rape. — Fatal sloughing, or gangrenous ulceration of vulva, very 
 rare. — In diphtheritic vulvitis, tough false membranes formed on inner 
 surface of labia. Effects of diphtheritic poison very seldom confined to
 
 282 WASTING PALSY — YELLOW FEVER. 
 
 vulva. — Scarlatinal vaginitis, attended with exfoliation of patches of 
 epithelium. 
 
 Treatment. Plain nourishing food : milk. Bai'k. Quinine and steel. 
 Cod-liver oil. Glycerine. Chemical food, 405. Chlorate of potash. 
 Warm hip baths. Fomentations. Alum or subacetate of lead lotions. 
 Sea bathing. 
 
 WASTING PALSY. — A degeneration of the voluntary muscles, pro- 
 ducing complete loss of power. — See Paralysis. 
 
 WEIGHT OF BODY.— The following table shows the normal weight 
 in })roportion to height. Loss of weight an early symptom in phthisis. 
 A slow and gradual fall, more serious than a rapid and iiTegular diminu- 
 tion : a steady loss always precedes tuberculosis (I)r. Hutchinson) : 
 
 
 
 
 
 Weight increased I 
 
 Exact Stature. 
 
 Mean Weight. 
 
 7 per cent. 
 
 Ft.' in. 
 
 St. 
 
 lbs. 
 
 lbs. 
 
 St. lbs. lbs. 
 
 5 1... 
 
 . . . 8 
 
 8 or 
 
 120 . . . 
 
 . . . 9 2 or 128 
 
 5 2... 
 
 . . . 9 
 
 " 
 
 126 . . . 
 
 ...99" 135 
 
 5 3... 
 
 . . . 9 
 
 7 " 
 
 133 . . . 
 
 ... 10 2 " 142 
 
 5 4... 
 
 . . . 9 
 
 13 " 
 
 139 . . . 
 
 . . . 10 9 " 149 
 
 5 5... 
 
 . . . 10 
 
 2 " 
 
 142 . . . 
 
 , . . 10 12 " 152 
 
 5 6... 
 
 . . . 10 
 
 5 " 
 
 145 . . . 
 
 . . .11 1 " 155 
 
 5 7... 
 
 . . . 10 
 
 8 " 
 
 148 . . . 
 
 . . .11 4 " 158 
 
 5 8. . . 
 
 . . . 11 
 
 1 " 
 
 155 . . . 
 
 . . . 11 12 " 166 
 
 5 9... 
 
 . . . 11 
 
 8 " 
 
 162 . . . 
 
 . . .12 5 " 173 
 
 5 10 . . . 
 
 . , . 12 
 
 1 " 
 
 169 . . . 
 
 ... 12 13 " 181 
 
 5 11 . . . 
 
 . . . 12 
 
 6 " 
 
 174 . . . 
 
 ... 13 4 " 186 
 
 6 0... 
 
 . . . 12 
 
 10 " 
 
 178 . . . 
 
 . . .18 8 " 190 
 
 This reads: A man of 5 ft. 8 in. should weigh, in his clothes, 11 st. 
 1 lb. or 155 lb. (14 lb.== 1 stone); he may exceed this by 7 per cent., 
 and so attain 11 st. 12 lb., or 166 lb., without affecting his vital capacity ; 
 beyond this amount his respiration becomes diminished. According to 
 M. Quetelet the average weight of the clothes at different ages is one- 
 eighteenth of the total weight of male body, and one-twenty-fourth of 
 that of female. 
 
 WRY-NECK. — Synon. Torticollis. — A distortion, in which the head is 
 drawn down to one side (often the right), and the face directed to the 
 opposite. Due to contraction of one sterno-mastoid muscle. Paralysis 
 of one muscle, allows the other to overpower its fellow. Inflammation, 
 or rheumatic spasm of one muscle ma}" cause it to conti'act unduly. 
 Sometimes the affection is owing to lateral curvature of spine ; to caines 
 of cervical vertebric; to tumors and enlargement of cervical- glands on 
 one side; or to contraction of cicatrix left by a burn or ulcer. 
 
 Treatment. Injiammatory or rheumatic variety: Eest. Fomentations 
 or hot bathing. Turkish bath. Ammonia and bark. Aconite or bel- 
 ladonna. Iodide of potassium with tincture of aotea racemosa. Fer- 
 manentform: Apparatus to produce and maintain extension. Division 
 of cicatrix, if present. Subcutaneous division of sternal or clavicular 
 attachments of muscle, or of both. — Paralytic variety: Friction, blisters, 
 irritating liniments, or galvanism to palsied muscle. Tenotomy on 
 sound side sometimes recommended. Improvement of general health. 
 
 YELLOW FEVER. — Synon. Pestilentia Hamiagastrica; Bulani Fever ; 
 3! a I de Siam; TyjiliHS Icterodes; Bilious Remitting Yelloio Fever; Black 
 Vomit ; Yelloio Jack. — An acute and very dangerous fever; accom])anied 
 with jaundice, severe headache, and vomiting of black matter. Almost
 
 YELLOW FEVER. 283 
 
 limited to warm climates. Not of nnfrequent occurrence in sea-port 
 towns of tiie West Indies, Africa, southern parts of Spain. May occur 
 sporadically or epidemically. Probably infectious. Male sex much 
 more obnoxious to the morbid poison than the female. 
 
 Symptoms. Often commence suddenly with languor, loss of appetite, 
 giddiness, headache, mental depression. Sometimes begin with cold-* 
 ness of the surface, or distinct rigors; followed by fever which con- 
 tinues for a few houi'S. In a third class of cases, there is prostration 
 from the first, without febrile reaction ; stupor, coma, and convulsions 
 soon following. When there is decided fever, it generally becomes 
 aggravated towards night: pulse gets quick, skin hot and dry, eyes 
 congested and painful, face flushed. Distressing headache; perhaps 
 confined to one temple. Pains in back and limbs; in large joints. Irri- 
 tability of stomach; tenderness on pressure; sense of tightness about 
 pnccordia; nausea, followed after a few hours by constant vomiting 
 and retching. Thirst, with desire for cold drinks. Urine diminished 
 in quantity; of a dark-red color. Constipation; stools free from bile. 
 Distressing restlessness; mental anxiety; sleeplessness; perhaps, active 
 delirium. — At the end of second or third day, sevci'ity of symptoms 
 greatly diminishes : patient feels much relieved : face gets slightly jaun- 
 diced : skin becomes moist, and there are copious bilious stools. In 
 favorable cases, convalescence firmly established. More frequently, 
 improvement of short duration. After some twenty-four hours, epigas- 
 tric tenderness is aggravated : jaundice increases and spreads over 
 body : tendency to stupor : pulse becomes feeble, irregular, and slow — 
 perhaps as low as thirty beats in the minute : tongue gets foul and dry: 
 respiration embarrassed : hiccough, thirst, nausea, vomiting, &c., are 
 constant. Unless symptoms remit, grumous blood is vomited — black 
 vomit: urine is suppi-essed or simply retained : skin becomes of a dark- 
 brown hue: dark-colored blood effused in patches under skin, or exudes 
 from nose, gums, anus, vagina, &c. : most offensive tarry-looking stools. 
 There are now all the features of a most malignant fever: almost im- 
 perceptible pulse; slow or stertorous breathing; involuntary evacua- 
 tions ; difficulty of deglutition and articulation ; suppressed or bloody 
 ui'ine ; with formation of buboes or patches of gangrene. Death takes 
 place, preceded by coma or convulsions; or patient retains consciousness 
 to the close. 
 
 Usual duration from three to nine days. Mortality about one in 
 three. Death from over])Owering effect of poison on the system, ex- 
 haustion, uraemia, or apoplexy. 
 
 Treatment. Prophylactic: Eemoval of all nuisances : thorough ven- 
 tilation and fumigation of narrow courts, cellars, docks, holds of ships, 
 t\:c. Cleanliness on board ship : pumping out of foul bilge-water. — In- 
 dividuals exposed to risk, to live on plain nourishing food, avoiding the 
 abuse of alcoholic drinks and sexual excesses : to have a due amount of 
 sleep: to promote healthy action of skin, kidneys, intestinal canal: to 
 have Avarm clothing: not to venture out early in the morning with the 
 stomach empty. The special efficacy of strong coffee, quinine, and 
 inunction with lard or oil, doubtful. 
 
 Curative: From the commencement until convalescence is firmly es- 
 tablished the recumbent posture to be strictly maintained : bed to be 
 placed in centre of well-ventilated room: great attention to be paid to 
 cleanliness. The indications presented by the urgent sj^mptoms to bo 
 observed. The disease cannot be cured, but the patient may be guided 
 through it. Simple diet, — Arrowroot, barley-water, ice and iced water, 
 tea, lemonade, broth, champagne, spruce, seltzer water, brandy and
 
 284 ZONA. 
 
 water. Podophyllum. Sulphate of mag-nesia and senna. Calomel with 
 quinine, or jalap. Quinine. Bark. Sulphate of beheria. Tincture of 
 perehloride of iron. Nitro-hydrochloric acid. Morphia, in a small dose. 
 Turpentine. Creasote. Liquor potassffi. 
 
 Blisters or sinapisms to nucha. Cold to the head. Compression of 
 the temporal arteries, for relief of cephalalgia. Prolonged use of warm 
 bath, or of wet sheet. Sinapisms or tuqjentiue stupes to epigastrium. 
 Venesection : if at all, only in early stage. 
 
 Avoidance of ammonia ; the blood often strongly ammoniacal. Alco- 
 holic stimulants to be used cautiously, when kidneys are much congested. 
 
 ZONA. — From Zotia, a belt. Synon. Herpes Zoster; Shingles. — That 
 form of herpes in which the vesicles, with their inflamed patches, are 
 arranged in the form of a band encircling half the circumference of the 
 body. — See Herpes.
 
 APPENDIX OF FORMULAE.
 
 APPENDIX OF FORMULAE. 
 
 In prescribing a medicine, attention must be paid to the following points: Age, 
 Sex, Temperament, Habit, Condition of System, Climate, and Season of tlie Year. 
 The operation of most drugs is materially influenced by the form in which the medi- 
 cine is given, the purity of the preparation, tlie time of day at which the dose is taken, 
 and the condition of the stomach as regards the presence or absence of food. The 
 succeeding formula are for Adults, unless the contrary is stated. The doses may, 
 except in the case of mercurials and narcotics, be reduced by attention to this table : 
 
 For an adult, suppose the dose to be .... 1 or gr. 60. 
 
 Under 1 year, will require only l-12th or gr. 5. 
 
 " 2 years, " l-8th or gr. 7^. 
 
 " 3 " <' 1-nth or gr. 10. 
 
 " 4 " " l-4th or gr. 15. 
 
 " 7 " " l-;]d or gr. 20. 
 
 " 14 " " 1-half or gr. 30. 
 
 " 20 " " 2-3ds or gr. 40. 
 
 Above 21, the full dose. 
 
 " 65, the dose must be diminished in the inverse gradation of the above. 
 
 Children bear as large doses of mercui'y as adults; but they are much more sus- 
 ce]itible to the influence of opiates. Consequently, opium must be given in very 
 minute doses to them. Females, also, from their jiiore delicate organization and 
 greater sensitiveness, require smaller quantities of powerful medicines than males. 
 This is particularly the case during the periods of menstruation, pregnancy, and lac- 
 tation. 
 
 The skill of the physician is shown by the administration of the proper remedy, in 
 the proper quantity, at the proper time. A druggist's apprentice can tell" what agents 
 will purge, vomit, or sweat; but a man must be practically conversant with disease 
 to be able rightly to apply his therapeutical resources to the exigencies of any partic- 
 ular case. Instead of introducing medicines into the system by the stomach, it is 
 often more advisable to do so by the rectum, or by the skin, or by the lungs, or by 
 injection into the areolar tissue. Absorption takes place from the rectum as sj)eedily 
 and surely as from the stomach ; and hence purgatives, emetics, narcotics, tonics, and 
 nutrients may be admirably administered as enemata. The skin offers a mechanical 
 impediment to absorption ; but still poultices and fomentations, plasters, liniments 
 and ointments, and medicated vapor or water baths are all valuable remedies. If the 
 cuticle be removed by a blister, and the medicine applied to the denuded dermis in its 
 pure state, or incorporated with lard or mucilage, its action will be rajiid. The sys- 
 tem is quickly and thorouglily affected by tlu; inhalation of medicatt'd vapors, or of 
 substances reduced to an impalpable powder. Subcutaneous injections must be em- 
 ployed with great caution ; since by this plan none of the medicine is lost, neither is 
 it altered or diluted by the contents of the stomach, «s happens when drugs are taken 
 by the mouth. — In only exceptional cases can there be any advantage in procuring 
 absorption through the conjunctiva, the nasal or pituitary membrane, or the mucous 
 coat of the vagina; but in these exceptional cases the benefit is often very great. — 
 Injection into the veins is too dangerous to allow of its being practised except as a 
 last resource in grave diseases, — such as epidemic cholera, «&c. 
 
 The practitioner will do well to bear in mind the following rules: 1. When a dis- 
 ease is progressing favorably towards reco\ery, it is unwise to interfere with the 
 efforts of Nature by the administration of drugs. The end and aim of treatment is 
 not only to restore health, but to do so safely, speedily, and pleasantly. — 2. Where 
 drugs are needed, and there is a choice of remedies, emphjy that one which will be 
 the least distressing at the time, and subsequently the least injurious to the constitu-
 
 288 APPENDIX OF FORMULA. 
 
 tion. — 3. Put the medicine in that form in which it can be most easily taken. "When 
 possible — especially with children — cover the disagreeable taste of the draught by 
 syrups, &c. — 4. If there be an idiosyncrasy with respect to any special medicine^ — 
 such as mercury, opium, turpentine, &c. — avoid administering it. That a peculiarity 
 of constitution, causing an extreme susceptibility to the influence of certain drugs, 
 food, and odors sometimes exists, cannot be disputed. It is as certain that it can sel- 
 dom be safely combated. — 5. Attend to the condition under which the patient will be 
 at the period of the medicine's action; e.g., it will be worse than useless to give a 
 sudorific to an individual obliged to be in the open air soon after taking it. — 6. Be 
 careful that the various agents in the prescription are not incompatible with each 
 other, unless it be desired to form some new or particular compound. Chemical 
 incompatibility, however, is by no means synonymous with therapeutic inertness ; for 
 experience tells us that certain unchemical compounds — bichloride of mercury and 
 tincture of bark, gallic acid and tincture of opium, calomel and Dover's powder, &c., 
 are all valuable preparations in curing diseases. — 7. Remember that if a disease be 
 incurable, it may still admit of great alleviation. Hence it is cruel to give up any 
 case ; although, at the same time, the patient is not to be deceived by false promises. — 
 8. Never order, or sanction the use of, a quack medicine; i.e., one, the composition 
 of which is kept a secret. — 9. Bearing in mind the weakness of human nature, and 
 the prejudices and superstitions which are current, it is not only necessary to give 
 good advice, but pains must be taken so to impress the patient and attendants that the 
 necessary treatment may be thoroughly carried out. /fope and confidence are no mean 
 remedial agents ; and in many chronic diseases at least, the individual who has faith 
 will recover more speedily, ceteris paribus, than he who is shy of belief. — 10. Simply 
 to prescribe drugs, without regulating the diet and general management of the pa- 
 tient, is to omit a most important duty. In acute diseases plain directions must be 
 given as to the ventilation and warmth of the sick-room, the amount of light, the 
 position of the bed (not to be placed in a corner), the degree of quiet to be maintained, 
 the cleanliness of the sufferer, and the nature and quantity and times for administra- 
 tion of food. In cases of long illness, when the patient can be moved without risk, 
 it is often desirable to have two beds in the room, — one to be occupied during the 
 day, the other at night. Every precaution must be taken to prevent the spread of 
 infectious disorders. And, in all instances, the evacuations ought to be passed in a bed- 
 jian or night-stool containing some disinfectant fluid. — 11. While it is allowed that 
 the folftwing formulae may often be employed unaltered with great advantage, j-et it 
 is not supposed that they will usually be prescribed with servile exactness ; for it must 
 never be forgotten that all medicines of any power have to be adapted to the require- 
 ments of the special case under treatment. It has been quaintly but truly observed, 
 that a bundle of ready-made receipts in the hands of the routine practitioner, is but a 
 well-equipped quiver on the back of an unskilful archer. — And 12. In watching the 
 restoration of a sick man to health, do not attribute the improvement too confidently 
 to the action of the medicine prescribed ; for it may not have been taken, or it may 
 not have been absorbed, or its properties may have been destroyed by adulteration, 
 or it may have even proved injurious — recovery occurring in spite of it. 
 
 The succeeding formulas liave been written in accordance with the rules, prepara- 
 tions, &c., of the British Pharmacopoeia. For the sake of convenience they are 
 arranged in twenty classes. — See For-mulce in Tabular Synopsis.
 
 ALIMENTS. 289 
 
 I. ALIMENTS. 
 
 Formula 1. Extract of Beef. 
 
 ' Take one pound of rumpstoak, mince it like sausage-meat, and mix it with one 
 pint of cold water. Place; it in a pot at the side of the fire, to heat very slowly. It 
 may stand two or three lunirs before il is allowed to simmer, and then let it l)oil gently 
 for fifteen minutes. Skim and serve. The addition of a small tablespoonful of cream 
 to a teacupful of tiiis beef tea renders it rielier but more; nourishing. Sometimes it 
 is preferred when thickened with a little flour or arrowroot. 
 
 2. Restorative Soup for Invalids. 
 
 Take 1 lb. of newly killed beef or fowl, chop it fine, add eight fluid ounces of soft 
 or distilled water, four or six drops of pure hydrochloric acid, M) to WO grs. of common 
 salt, and stir well together. After three hours the whole is to be thrown on a conical 
 hair sieve, and the fluid allowed to pass through with slight pressure. On the flesh 
 residue in the sieve pour slowly two ounces of distilled water, and let it run through 
 wliile squeez;ing the meat. There will be thus obtained about ten fluid ounces of cold 
 juice (cold extract of flesh), of a red color, and possessing a jjleasant taste of soup; 
 of which a wineglassful may be taken at pleasure. It must not be warmed (at least, 
 not to a greater extent than can be ettected by partially filling a bottle with it, and 
 standing this in hot water); since it is rendei'cd mudd}' by heat or by alcohol, and 
 deposits a tliick coagulum of albumen with the coloring matter of blood. — If, from 
 any special circumstance (such as a free secretion of gastric juice) it is deemed unde- 
 sirable to administer an acid, the soup may be well prepared by merely soaking the 
 minced meat in plain distilled water. — Children will frequently take the raw meat 
 simply minced, when they are sufl'ering from great debility. One teaspoonful of such 
 meat may be given every three or four hours. 
 
 This modification of Liebig's formula is very valuable in cases of continued fever, 
 in dysentery, and indeed in all diseases attended with great prostration and weakness 
 of the digestive organs. When the flavor is thought disagreeable, it may be concealed 
 by the addition of spice, or of a wineglassful of claret to each teacupful of soup. 
 
 3. Essence of Beef 
 
 Take one pound of gravy-beef, free from skin and fat, chop it up as fine as mince- 
 meat, and pound it in a mortar with two tablespoonfuls of soft water. Then put it 
 into a covered earthen jar with a little salt, cementing the edges of the cover with 
 pudding paste. Place the jar in an oven, or tie it tightly in a cloth and plunge it into 
 a j)ot of boiling water for three hours. Strain ott" (through a coarse sieve, so as to allow 
 the smaller particles of meat to pass) the liquid essence, which will amount to about 
 two ounces in quantity. Give two or more teaspoonfuls frequently. 
 
 In great debility, diphtheria, exhaustion from hemorrhage, &c. 
 
 4. Liebig's Food for Infants and Invalids. 
 
 Half an ounce of wheaten flour (that called "seconds" is the most suitable), an 
 equal quantity of malt flour, 7| grains of bicarbonate of potash, and an ounce of 
 water, are to bo well mixed. Add five ounces of cow's milk, and \nit the whole on a 
 gentle fire. When the mixture begins to thicken it is to be removed from the fire, 
 stirred for five minutes, heated and stirred again till it becomes quite fluid, and finally 
 made to boil. After separating the bran by passing the mixture through a sieve, it 
 is ready for use. 
 
 To save the trouble of weighing, it may be remembered that a tablespoonful 
 (heaped up) of wheaten flour weighs nearly half an ounce, and a heaped dessertspoon- 
 ful of malt flour is equal to the same. This soup is as sweet as milk ; and after boiling, 
 may be kept for 24 hours without undergoing any change. — This is an excelbnit food 
 for infants who cannot be suckled. It is slightly ajierient ; so that children under 
 one year of age can seldom take more than two meals of it in the day. Where there 
 is a tendency to diarrhoea, twenty grains of prepared chalk may be substituted for 
 the potash. The proportion of blood-forming and heat-producing elements is the 
 same as in women's milk (1 : 3.8); while the quantity of alkali is equivalent to that 
 in human milk. 
 
 The solid parts of this food are sold, ready mixed in packets, b}' Mr. Hooper, of 
 Pall-mall East and Grosvenor Street, Mr. Cooper, of 26 Oxford Street, as well as by 
 many other chemists. 
 
 19
 
 290 APPENDIX OF FORMULA. 
 
 5. Eggs, Creavi, and Extract of Beef. 
 
 Wash two ounces of the best pearl sago until the water poured from it is clear. 
 Then stew the sago in half a pint of water until it is quite tender and very thick : 
 mix with it half a pint of good boiling cream and the yolks of four fresh eggs, and 
 mingle the whole carefully with one quart of good beef tea, which should be boiling. 
 Serve. 
 
 This nourishing broth is very useful in many cases of lingering convalescence after 
 acute disease. 
 
 6. Mutton or Veal Broth— Beef Tea. 
 
 Take of mutton or veal or beef one pound and a half, cold water one quart, a little 
 salt, and rice two ounces. Simmer for four hours, boil for a few minutes, strain and 
 serve. Another excellent plan for making beef tea is as follows : Take one pound of 
 beef minced very fine, and put it into a common earthenware teapot with a pint and 
 a half of cold water. Stand the pot on the hob, so that it may simmer for at least 
 three hours. About three-quarters of a pint of good beef tea will be thus obtained. 
 
 Beef tea as ordinarily made, and preserved meat-juice of all kinds, are palatable 
 but not very nutritive drinks. A pint of fine beef tea contains scarcely a quarter of 
 an ounce of anything but water. Nevertheless, if these fluids are of small value a8 
 mere nutrients, perhaps the osmazome and salts they contain may possess the property 
 (like tea and coffee) of diminishing the waste of the tissues. It has been proved that 
 dogs die slowly if fed on bread and gelatine alone ; but when greatly reduced by this 
 diet they soon regain flesh and strength if two ounces of meat-tea be daily added to it. 
 
 Oruel and beef tea is nourishing. It is made thus : Take two tablespoonfuls of oat- 
 meal with three of cold, water, and mix them thoroughly. Then add a pint of strong 
 boiling beef tea (or of milk); boil for five minutes, stirring well to prevent the oat- 
 meal from burning ; and strain through a hair sieve. 
 
 An excellent simple restorative during convalescence from acute disease before 
 solid food can be taken. 
 
 7. Spruce Beer. 
 
 The essence of spruce is prepared by boiling down to concentration the young 
 branches of the Black Spruce Fir (Abies Nigra). Take of this essence half a pint; 
 bruised pimento and ginger, of each four ounces ; water three gallons. Boil for five 
 or ten minutes ; then strain, and add eleven gallons of warm water, a pint of yeast, 
 and six pints of molasses. Mix, and allow the mixture to ferment for twenty-four 
 hours. 
 
 It is an admirable antiscorbutic, and is an agreeable and wholesome drink in warm 
 weather. This drink was found very eflScacious by Captain Cook. Dr. Robert Barnes 
 suggests that it should be used in the Merchant Service instead of rum, which has 
 no antiscorbutic virtue. 
 
 8. Tapioca and Cod-Liver. 
 
 Boil a quarter of a pound of tapioca till tender, in two quarts of water ; drain it in 
 a cullender, then put it back in the pan ; season with a little salt and pepper, add half 
 a pint of milk, and put over one pound of fresh cod liver cut in eight pieces. Set the 
 pan near the fire to simmer slowly for half an hour, or a little more, till the liver is 
 quite cooked. Press on it with a spoon, so as to get as much oil into the tapioca as 
 possible. After taking away the liver, mix the tapioca. If too thick, add a little 
 milk, then boil it a few minutes ; stir round, add a little salt and pepper, and serve. 
 — Alexis Soter. 
 
 Tapioca thus cooked is nourishing and easily digested. 
 
 9. The Bran Loaf. 
 
 The formula used by Mr. Camplin, in Diabetes^ is as follows : Take a sufficient 
 quantity (say two or three quarts) of wheat bran, boil it in two successive waters for 
 ten minutes, each time straining it through a sieve, then wash it well with cold water 
 (on the sieve), until the water runs ofl" perfectly clear; squeeze the bran in a cloth as 
 dry as possible, then spread it thinly on a dish, and place it in a slow oven — if put in 
 at night let it remain until the morning, when, if perfectly dry and crisp, it will be 
 fit for grinding. The bran thus prepared must be ground in a fine mill, and sifted 
 through a wire sieve of sufficient fineness to require the use of a brush to pass it
 
 ALIMENTS. 291 
 
 through: that which does not pass at first ought to be ground and sifted again, until 
 the whole is soft and fine. 
 
 Take of this bran-powder three ounces troy, three fresh eggs, one ounce and a half 
 of butter, and rather less than half a pint of milk ; mix the eggs with part of the 
 milk, and warm the butter with the other portion ; then stir the whole well together, 
 adding a little nutmeg and ginger, or any other agreeable spice. Immediately before 
 jiutting into the oven, stir in first thirty-five grains of sesquicarbonate of soda, and 
 then tliree drachms of dilute hydrochloric acid. The loaf thus prepared should be 
 baked in a basin (previously well buttered) for about an hour or rather morg. 
 
 Biscuits may be prepared as above, omitting the soda and hydrochloric acid, and 
 part of the milk, and making them of proper consistence for moulding into shape. 
 
 If properly baked, the loaves or biscuits will keep several days, but should always 
 be preserved in a dry place, and not be prepared in too large quantities at a time. 
 
 10. White Wine Whey, 
 
 To half a pint of boiling milk, add one or two wineglassfuls of sherry or Madeira. 
 The curd is to be separated by straining through a fine sieve or piece of muslin. 
 Sweeten the whey with refined sugar. 
 
 11. Caudle. 
 
 Beat up one egg with a wineglassful of sherry, and add it to half a pint of fine hot 
 gruel. Flavor with sugar, nutmeg, and lemon-peel. 
 In insomnia with debility. 
 
 Beat up two tablespoonfuls of cream in a pint of thin cold gruel. Add to this one 
 tablespoonful of curacoa or noyeau, and a wineglassful of sherry. Flavor with sugar- 
 candy, and let half a tumblerful be taken, cold, at intervals. 
 
 12. Ferruginous Chocolate. 
 
 Spanish chocolate 16 oz. ; carbonate of iron half an ounce. Divide into one-ounce 
 cakes. One to be dissolved in half a pint of hot milk, and taken night and morning. 
 In anemia, amenorrhcea, &c. 
 
 13. Iceland Moss and Quinine Jelly. 
 
 Take of Iceland moss (Cetraria), and Irish Moss (Chondrus crispus, Carragheen), 
 each one ounce. Boil slowly for three-quarters of an hour in a pint and a half of 
 milk, strain through muslin, and add three ounces of white sugar dissolved in one 
 ounce of the compound tincture of quinia (equal to eight grains of the salt). A 
 dessertspoonful to be taken frequently in the course of the day. 
 
 In phthisis, tabes mesenterica, &c. 
 
 14. Lime-water and Milk. 
 
 R. Liquoris Calcis Saccharati, fl. drs. j — iv ; Lactis, ad fl. oz. 4. Mix. 
 
 This compound will sometimes be retained when all other food is ejected. As a 
 variety, milk and soda-water, in equal proportions, may also be ordered. (See F. 73.) 
 
 It may be well to remember that the addition of grs. 15 of Bicarbonate of Soda 
 to the quart of milk not only prevents it from turning sour, but renders it more di- 
 gestible. 
 
 15. Artificial Ass's and Goat's Milk. 
 
 Take half an ounce of gelatine, and dissolve it in half a pint of hot barley water. 
 Then add an ounce of refined sugar, and pour into the mixture a pint of good new 
 cow's milk. 
 
 Chop an ounce of suet very fine, tie it lightly in a muslin bag, and boil it slowly 
 in a quart of new milk. Sweeten with white sugar, or a glass of an\' liqueur. 
 
 An excellent aliment in some cases of tabes mesenterica, &c., where the unpleasant 
 odor of goat's milk prevents it being taken.
 
 292 APPENDIX OF FORMULAE. 
 
 16. Milk, Flour, and Steel. 
 
 Beat up carefully one tablespoonful of flour, one raw egg, and about twenty grains 
 of the saccharated carbonate of iron, with half a pint of new milk : flavor with nut- 
 meg and white sugar. To be taken for lunch with a biscuit. 
 
 In the early stages of tuberculosis the author has found this mixture very valuable. 
 
 17. Brandy and Egg Mixture. 
 
 Take the whites and yolks of three eggs and beat them up in four ounces of plain 
 water. Add slowlj' three or four ounces of brandy, with a little sugar and nutmeg. 
 This form is preferable to that in the London Pharmacopoeia for 1851. Two table- 
 .spoonfuls should be given every four or six hours. In some cases of great prostration 
 the efficacy of the mixture is much increased by the addition of one drachm of the 
 tincture of yellow cinchona to each dose. 
 
 18. Bread Jtlly. 
 
 Take a quantity of the soft part of a loaf, break it up, cover it with boiling water, 
 and allow it to soak for some hours. The water — containing all the noxious matters, 
 with which the bread may be adulterated — is then to be strained ofl' completely, and 
 fresh water added; place the mixture on the fire, and allow it to boil for some time 
 until it becomes smooth ; the water is then to be pressed out, and the bread on cooling 
 will form a thick jelly. Mix a portion of this with sugared milk and water, for use 
 us it is wanted. — Dr. Churchill. 
 
 A good food for infants at the time of weaning, for children with acute disease, &c. 
 
 19. Nutritious Demulcent Drinks. 
 
 Mix together half a pint of Mucilago Acacise, Mistura Amygdalae, and pure milk ; 
 sweeten with sugar-candy or honey; and add one large tablespoonful of any liqueur. 
 Allow the whole to be taken during the day. — Or, a large pinch of isinglass may be 
 boiled with a tumlilerful of milk, half a dozen bruised almonds, and two or three 
 lum[)s of sugar. To be taken warm once or twice in the day. 
 
 These drinks are very grateful in cases of tonsillitis, ulceration of the pharynx, &c. ; 
 also in some cases of debility with irritability of the stomach, and a tendency to 
 diarrhoea. 
 
 20. Indian Sarsaparilla and Barley Water. 
 
 R. Syrupi Hemidesmi, fl. oz. ij : Glycerini, fl. oz. j ; Decocti Hordei, fl. oz. ix. 
 Mix, and direct twotablespoonfuls to be taken frequently. An agreeable demulcent, 
 slightly alterative, and diaphoretic mixture. 
 
 Usettal in the eruptive fevers, and in inflammations of the mucous membranes. 
 
 21. Beef Tea and Cream Enemata. 
 
 An excellent nutritious enema may be made by mixing together from four to 
 eight ounces of strong beef tea, an ounce of cream, and half an ounce of brandy ur an 
 ounce and a half of port wine. It may be administered twice or thrice in the course 
 of twenty-four hours. 
 
 In cases of acute gastritis, carcinoma of the stomach, obstinate vomiting, «&c., 
 where it is necessary to avoid giving food by the mouth. 
 
 Another form may run thus : Take four or six ounces of restorative soup (F. 2), 
 one ounce of cream, two teaspoonfuls of brandy, ten or fifteen minims of liquid ex- 
 tract of opium, and ten grains of citrate of iron and quinia. 
 
 22. Cod-Liver Oil and Bark Enema. 
 
 Take four ounces of essence of beef (F. 3), two ounces of port wine, an ounce of 
 cod-liver oil, two drachms of tincture of yellow cinchona, and twenty minims of 
 liquid extract of opium. Mix. To be administered every twelve hours. 
 
 23. Quinine and Beef Enema. 
 
 Take one tablespoonful of brand}', five grains of suljihate of quinia, one teaspoonful 
 of glycerine, two tablespoonfuls of cream, and from four to eight ounces of restorative
 
 ALTERATIVES AND RESOLVENTS. 293 
 
 soup (F. 2). Mix. This enema may be administered every six or eight hours. Where 
 the rectum is very irritable, or it is necessary to relieve ])ain, from fifteen to twenty 
 minims of the liquid extract of opium may be advantageously added. 
 
 II. ALTERATIVES AND RESOLVENTS. 
 
 24. Compound Pill of Calomel and Opium. 
 
 R. Pilulae Calomelanos Compositse, gr. 5; Extracti Opii, gr. ^. Make a pill, and 
 direct it to be taken every night, or night and morning. 
 In disorders dependent on a venereal taint. 
 
 25. Calomel and Opium. 
 
 R. Calomelanos, gr. 2; Pulveris Opii, gr. \; Confectionis Kosae Gallicae, sufficient 
 to make a pill. To be taken every four hours. 
 
 As an alterative, when it is wished to get the system quickly under the influence 
 mercury. 
 
 26. Mercury and Conium. 
 
 R. Hydrargyri cum Creta, gr. 2; Extracti Conii, gr. 3. Mix, and form a pill to 
 be taken three times a day. 
 
 In syphilitic tubercular diseases. 
 
 27. Corrosive Sublimate. 
 
 • 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 1 ; Ammonias Hydrochloratis, gr. 5; Ex- 
 tracti Sarsa3 Liquidi, fl. drs. xij ; Decocti Sarsae Compositi, ad fl. oz. xij. Mix. Di- 
 rect, — " Two small tablespoonfuls to be taken three times a day." 
 
 In confirmed constitutional syphilis; as well as in some forms of eczema, prurigo, 
 follicular vaginitis, chronic metritis, &c. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 1 ; Glycerini, fl. oz. j ; Tincturte Cinchonae 
 Composit;e, ad fl. oz. iij ; Olei Mentha^ Piperitte, min. xxv. Mix. Direct, — "One 
 teaspoonful in a wineglassful of water three times a day." 
 
 In constitutional syphilis, and some forms of hemorrhage. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 1 ; Extracti Opii, gr. 3 — 6; Guaiaci Re- 
 sinae, gr. 100 ; Glycerini, sufficient to make a mass. Divide carefully into twenty- 
 four pills, and order two to be taken three times a day. 
 
 In some varieties of chronic rheumatism. 
 
 28. Mercury^ Squills, and Digitalis. 
 
 R. Pilulae Hydrargyri, gr. 3; Pulveris Digitalis, gr. i; Pulveris Scillae, gr. 1|' 
 Mix, and form a pill to be taken twice or three times a day. 
 As an alterative and diuretic, in some cases of dropsy. 
 
 29. Bromide of Mercury and Sarsaparilla. 
 
 R. Hydrargyri Bromidi, gr. ^; Extracti Sarsas Liquidi, fl. drs. ij ; Decocti Sarsae 
 Compositi, ad fl. oz. iss. Mix. To be taken three times a day. 
 In syphilitic lepra, and secondary syphilitic eruptions. 
 
 30. Podophyllum Peltafum., or May-Apple. 
 
 R. Podophylli Resinae, gr. ^ — J; Pulveris Ipecacuanhae, gr. J; Extracti Gentiana) 
 gr. 3. Mix. Make a pill, to be taken twice or thrice daily. 
 
 In syphilis, scrofula, jaundice from suppression, skin diseases, &c. As a simple 
 alterative it is perhaps as valuable as mercury, without possessing any injurious 
 qualities. One or two grains of quinine may be advantageously added to each pill, 
 where there is general debility. See E. 160.
 
 294 APPENDIX OF FORMULA. 
 
 31. Iodide of Potassium llixtures. 
 
 R. Potassii lodidi, gr. 20 — 30 ; Tincturse SerpentariiB, fl. drs. iij , Misturas Guaiaci, 
 ad fl. oz. viij. Mix. One-sixth part to be taken three times a day. 
 Valuable in chronic rheumatism, and in acute tonsillitis. 
 
 R. Potassii lodidi, gr. 20; Liquoris Potassse, fl. drs. ij ; Tincturse Hyoscyami, fl. 
 drs. iij ; Infusi Cinchonse Flavte, ad fl. oz. viij. Mix. One-sixth part three times a 
 day. 
 
 In chronic rheumatism with an abundance of lithates in the urine ; as well as in 
 some cases of eczema, &c. 
 
 R. Potassii lodidi, gr. 2; Vini Colchici, min. xv ; Tincturse Aconiti, min. iij — 
 viij ; Infusi Khei, fl. oz. j. Make a draught, to be taken three times a day. 
 In chronic gout. 
 
 R. Potassii lodidi, gr. 3 — 5; Spiritus Ammonite Aromatici, min. xxx ; Tincturae 
 Belladonnte, min. v — xv ; Tincturaa Cinchonse Compositse, fl. drm. j ; Aquie Menthae 
 Piperitfe, ad fl. oz. iss. Make a draught, to be taken three times a day. 
 
 In some cases of asthma the author has found remarkable benefit from this formula. 
 
 R. Potassii lodidi, gr. 15 — 30: Vini Colchici, fl. drs. iss; Tincturae Hyoscyami, 
 fl. drs. ij ; Magnesia? Sulphatis, gr. 220; Infusi Anthemidis, ad fl. oz. viij. Mix, 
 One-sixth part three times a day. 
 
 In some instances of gout with fever and constipation, and in chronic pleurisy with 
 effusion. Also in cases of lead and mercurial poisoning occurring in gouty subjects. 
 
 R. Potassii lodidi, gr. 40; Tincturaa Khei, fl. oz. j ; Extracti Sarsse Liquidi, fl. oz. 
 ij. Mix. Label, — " A small teaspoonful in a wineglassful of water three times a 
 day." 
 
 In follicular inflammation of the pharyngo-laryngeal mucous membrane, &c. 
 
 R. Potassii lodidi, gr. 30 — 120; Glycerini, fl. oz. j ; Tincturas Aconiti, min. xx ; 
 Vini Ipecacuanha^ fl. drs. iss ; Succi Taraxaci, fl. drs. vj ; Decocti Sarste Compositi, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In severe gonorrhceal rheumatism, constitutional syphilis, bronchocele, scrofulous 
 sores, aneurism, &c. 
 
 R. Potassii lodidi, gr. 15; Tincturae Assafcetidsie, fl. drs. iss ; Tincturaa Senegse, fl. 
 drs. iij; Syrupi Mori, ad fl. oz. iij. Mix. Label, — "One teaspoonful every two, 
 three, or four hours." 
 
 For a child about two years old, sutfering from croup. Also in cases of infantile 
 pneumonia. 
 
 32. Iodide of Iron Mixtures. 
 
 R. Perri lodidi, gr. 6 — 18; Glycerini, fl. drs. xij ; Infusi Calumbte, ad fl. oz. viij. 
 Mix. One-sixth part three times a day. 
 
 In the early stages of tuberculosis, and in strumous ulcers, where the stomach will 
 not tolerate cod-liver oil. 
 
 R. Potassii lodidi, gr. 30; Ferri et Ammoniae Citratis, gr. 60; Aqua? Destillatae, 
 fl. drs. ij ; Glycerini, fl. drs. vj ; Olei Menthse Piperitse, min. x ; Olei Morrhua3, ad 
 fl. oz. vj. Mix. One tablespoonful after the two chief meals of the day. 
 
 R. Potassi lodidi, gr. 12; Ferri et Quinise Citratis, gr. 30; Tincture Aconiti, 
 min. XXV ; Infusi Chiratae, fl. oz. vj. Mix. One-sixth part three times a day. 
 In chronic rheumatism with debility, &c. 
 
 R. Tincturae Ferri Perchloridi, Tincturao lodi, na min. x ; Aquaa Camphoras, fl. 
 oz. j. Make a draught, to be taken tRree times a day. 
 
 Useful in strumous afl"ections of the cervical glands, mesenteric disease, and some 
 cutaneous disorders. 
 
 R. Syrupi Ferri lodidi, Extracti Sarsae Liquidi, na fl. oz. j. Mix. Direct, — 
 «' One teaspoonful in two tablespoonfuls of water three times a day." 
 In chronic rheumatism, old-standing venereal aflbctions, &c. 
 
 R. Potassii lodidi, gr. 3— f! ; Ferri et Ammonira Citratis, gr. 20; Syrupi Papa- 
 veris, fl. drs. iij ; Infusi Quassias, ad. fl. oz. iv. Mix. One tablespoonful three times 
 a day. 
 
 For children with tabes mesenterica. Useful also for strumous subjects who have 
 had ascarides.
 
 ALTERATIVES AND RESOLVENTS. 295 
 
 33. Iodide of Potassium and Mercury. 
 
 R. Ammoniaj Carbonatis, gr. 30; Potassi lodidi, gr. 20; Tincturae Aconiti, min. 
 xxx; Tinctura) Cinchonte Flava?, fl. drs. vj ; Aqua; Montha; Piperitie, ad fl. oz. viij. 
 Mix. Direct, — "One-sixth part three times a day, viz.: at 9 a.m., 2 p.m., and 7 
 p.m." 
 
 R. Hydrargyri lodidi Viride, gr. 2; Extract! Opii, gr. 1; Extract! Hyoscyami, 
 gr. fi. Mix, divide into two pills, and order one to be taken every night at 11 o'clock 
 as long as the mixture is continued. 
 
 Very useful in many forms of constitutional syphilis. 
 
 34. Mercury and Chalky with Dover's Powder, ^c. 
 
 R. Hydrargyri cum Greta,, Pulveris Ipecacuanhfe cum Opio, aa gr. 5. Mix, and 
 make a powder to be taken every eight or twelve hours. 
 
 In diarrhcea with unhealthy secretions, and in mild dysentery. 
 
 R. Sodas Biearbonatis, Hydrargyri cum Greta,, aa gr. 2; Magnesias Garbonatis, gr. 
 5. Mix, and make a powder to be taken every other night. 
 
 An alterative and aperient for children, where there is great acidity of the secre- 
 tions. 
 
 35. Chloride of Calcium. 
 
 R. Liquoris Galcii Chloridl (Phar. Dub.), fl. oz. j ; Tincturae Aurantii, fl. oz. ij. 
 Mix. One teaspoonful in a wineglassful of water three times a day. 
 
 As. a liquefacient in scrofula, tabes mesenterica, bronchocele, fibroid tumors of 
 uterus, &c. 
 
 36. Tar Pills and Capsules. 
 
 R. Picis Liquidae, oz. 1; Pulveris Aromatici, oz. \. Mix, divide into five-grain 
 pills, and order two or three to be taken three times a day. 
 
 Tar Capsules are made, each containing about six grains. Two or three may be 
 taken for each dose. 
 
 In some chronic skin diseases, pruritus of the anus, and chronic catarrhal a9"ections. 
 
 37. Bromide of Ammonium^ 
 
 R. Ammonii Bromidi, gr. 12 — 60; Infusi Aurantii, fl. oz. viij. Mix. Direct, — 
 "One-sixth part to be taken three times a day, an hour before meals." 
 
 Kecommended by Dr. Gibb for diseases in which the nervous system is function- 
 ally involved, — as epilepsy, &c. It is a valuable absorbent in glandular enlargements, 
 and in excessive corpulency ; while it has also a peculiar soothing influence upon the 
 mucous membranes. 
 
 R. Ammonii Bromidi, gr. 24; Aqua;, fl. oz. ij. Mix. One teaspoonful in a small 
 cup of sweetened tea three times a day. 
 For an infant with hooping-cough. 
 
 38. Iodide of Ammonium. 
 
 R. Ammonii lodidi, gr. 3 — 15; Infusi Cinchonas Plavae, fl. oz. i — ij. Make a 
 draught, to be taken twice or thrice daily before food. 
 
 Very valuable in strumous enlargement of the absorbent glands. The dose is to 
 be graduated according to the patient's age. At the time this medicine is given 
 internally, an ointment of the iodide of ammonium (gr. 60 to lard oz. 1) should be 
 rubbed into the swellings night and morning. 
 
 39. Iodide of Sodium. 
 
 R. Sodii lodidi, gr. 60; Decocti Sarsae Compositi, fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 As an antisyphilitic where the iodide of potassium disagrees. Moreover, it will 
 sometimes eft'ect a cure after the latter has failed to be of use.
 
 296 APPENDIX OF FORMULiE. 
 
 40. Benzoate of Ammonia. 
 
 R. AmmonijB Benzoatis, gr. 10 — 30; Aqiue, fl. oz. iss. Mix. To be taken three 
 times a day. 
 
 In chronic bronchitis, chronic inflammation of the bladder with alkaline urine, and 
 in cases attended with the copious excretion of phosphates. 
 
 41. Creasote. 
 
 R. Creasoti, min. xx — xl ; Pulveris Aromatici, gr. 80: Mucilaginis Acacise, suffi- 
 cient to form a mass. Divide into twenty pills and order one or two to be taken 
 three times a day. 
 
 In some forms of neuralgia, chronic bronchitis, and obstinate vomiting unconnected 
 with inflammation or organic disease — such as sea-sickness. After taking creasote 
 for a short time, the urine occasionally assumes a dirty or brownish-black color. 
 Inunction with tar may give rise to the same eflect. Under these circumstances, 
 creasote has been obtained from the urine by distillation. 
 
 In the officinal Mistura Creasoti the unpleasant flavor is tolerably well disguised 
 by the Spirit of Juniper. Dose, fl. oz. j — ij. See F. 90 
 
 42. Bromide of Potassium. 
 
 R. Potassii Bromidi, gr. 3 — 8; Aqua3, fl. oz. j. Mix. To be taken three times a 
 day. 
 
 Efficacious, according to the late Dr. Kobert Williams, in reducing enlarged 
 spleens. 
 
 R. Potassii Bromidi, gr. 60 — 90; Potassii lodidi, gr. 12; Potassse Bicarbonatis, 
 gr. 40; Tincturse Aurantii, fl. drs. vj ; Aquas, ad fl. oz. viij. Mix. One-sixth part, 
 on an empty stomach, night and morning. 
 
 The favorite remedy in epilepsy (1865). 
 
 R. Potassii Bromidi, gr. 30 — 60; Tincturae Valerianatae, Ammoniatse, fl. drs. vj ; 
 Aqua3 Camphorae, vel Infusi Chiratse, ad fl. oz. viij. Mix. One-sixth part three 
 times a day. 
 
 In hysteria, insomnia due to nervous irritability, functional disturbance of the 
 uterine functions, spermatorrhoea, &c. 
 
 R. Pulveris Guaiaci, gr. 40; Potassii Bromidi, gr. 30; Magnesise Carbonatis, gr. 
 60. Mix. Divide into six powders, and order one to be taken three times a day. 
 Useful in cases where it is required to exert a sedative action on the sexual organs. 
 
 43. Cruaiacum Mixtures. 
 
 R. Tinctura3 Guaiaci Amraoniataj, fl. drs. iv ; Tincturse Aconiti, min. xxx ; 
 Mucilaginis Tragacanthse, Aqua Cinnamomi, aa fl. oz. iv. Mix. Two tablespoon- 
 fuls, twice or three times a day. 
 
 In the chronic rheumatism of old and weak people. Also in some skin diseases 
 where there is a strumous taint. 
 
 R. Extracti Opii Liquidi, min. xxx ; Tincturte Quinaj Compositae, fl. drs. vj ; Mis- 
 turte Guaiaci, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In chronic skin diseases. Guaiacum has also been highly extolled in tonsillitis. 
 
 R. Sulphuris Sublimati, oz. 2; Potassae Tartratis Acidae, oz. 1; Pulveris Rhei, 
 gr. 120 ; Guaiaci Resinae, gr. 60 ; Mellis, lb. j ; Myristicae, unum in pulverem redacti. 
 Mix thoroughly, and order two teaspoonfuls to be taken night and morning until the 
 whole is consumed. 
 
 This compound was formerly in much repute for the cure of chronic rheumatism ; 
 being said to be especially useful in old-standing cases, when the skin is inactive and 
 the intestinal glands, «&c., torpid. It was well known under the name of the " Chel- 
 sea Pensioner." 
 
 44. Quinine and Ipecacuan. 
 
 R. Quiniaj Sulphatis, gr. 8 ; Pulveris IpecacuanhiP, gr. 24 ; Pulveris Ipecacuanha 
 cum Opio, gr. 30; Glycerini sufficient to form a mass. Divide into sixteen pills, and 
 order two to be taken every three or four hours. 
 
 In subacute dysentery, occurring in tropical regions. See P. 384.
 
 ALTERATIVES AND RESOLVENTS. 297 
 
 45. Quinine and Belladonna. 
 
 R. Qiiinipe Sulphatis, gr. 2; Extrnoti BclladonnjB, srr. \ ; Extract! Opii. ejr. \ — 1 
 Extrac'ti Hyosoyami, <i;r. 2. Make a pill, to be taken evpry six or_ eight hours. 
 In neuralgia,*pruritus of the vulva, carcinoma, «S:c. See F. 383. 
 
 46. ColcMcum, <f<?. 
 
 R. Calomelanos, Extraoti Colchici Acetici, Extract! Aloes 'Barbadensis, Pulveris 
 Ipecaciianhie, aa gr. 1. Make a pill, to be taken every four hours until the bowels 
 are well acted upon. 
 
 In gout, with congestion of the liver. . 
 
 R. Extract! Colchici Acetici, Extracti Aconiti, aa gr. 1 ; Pilulae Hydrargyri, gr. 3. 
 Make a pill, to be taken every night at bedtime. 
 
 In gout, with deficient action of the liver. 
 
 R. PotassiB Citratis, gr. 120; Vini Colchici, fl. drs. j — i j ; Liquoris Morphiae Hy- 
 drochloratis, fl. drm. j ; Aqute Camphora>, ad. fl. oz. viij. Mix. One-.sixth part 
 every six hours. 
 
 In some forms of gout, where there is but little constitutional depression. 
 
 R. Spiritus Ammoniie Aromatici, fl. drs. vj ; Vini Colchici, fl. drs. ij — iv ; Tinc- 
 turie Aurantii, ad. fl oz. ij. Mix. Direct, — "One teaspoonful in half a bottle of 
 soda water, three times a day." 
 
 47. Oxide of Silver. 
 
 R. Argenti Oxidi, gr. 1 — 2 ; Pulveris Aromatici, gr. 2 ; Extracti Cannabis Indicse, 
 gr. J; Glycerini, sufficient to make a pill. To be taken three times a day. 
 Of doubtful efficacy in dyspepsia, pyrosis, haemoptysis, monorrhagia, &c. 
 
 48. Sulphite of Soda, ^c. 
 
 R. Sodae Sulphitis, gr. 30—60; Infusi Quassiae, fl. oz. iss. Mix, and make a 
 draught to be taken three times a day. 
 
 Dr. Jknner. — In diseases of the stomach, accompanied by the formation of the 
 sarcinae ventriculi. The patient should eat unfermented bread while taking this 
 medicine. 
 
 The Sulphite of Magnesia may be given in the same way, with the object of 
 neutralizing blood-poisons. It is richer in sulphurous acid than the sulphite of soda, 
 is more stable, and has a much more agreeable taste. This salt has been strongly 
 recommended by'Dr. Polli, of Milan, in cases of pyaemia, typhus, puerperal fever, 
 hospital gangrene, dissecting wounds, glanders, cholera, «&c. 
 
 49. Benzoic Acid. 
 
 R. Acidi Benzoici, gr. 3 — 20; Theriacte sufficient to form one or more pills. 
 
 Administered in proper doses, three or four times a day, this remedy is useful in 
 jaundice from suppressed action of the liver, and in uraemia. It has also been recom- 
 mended in some cases of incontinence of urine in children. See F. 246. 
 
 50. Turpentine Mixtures. 
 
 R. Olei Terebinthinae, fl. oz. j ; Vitelli Unius Ovi ; beat together and add gradu- 
 ally Misturifi Amygdalje, fl. oz. iv ; Syrupi Aurantii, fl. oz. ij ; Tincturfe Lavandula? 
 Compositae, fl. drs. iv ; Olei Cinnamomi, guttai iv. Mix. Two tablespoonfuls to be 
 taken three times a day. 
 
 Carmichael. — Recommended in iritis, where the use of mercury is contra- 
 indicated. 
 
 R. Spiritus ^Etheris, fl. drs. ij ; Olei Terebinthina?, fl. drs. iss. ; Mucilaginis Aca- 
 ciae, fl. oz. iij ; Aquae Cinnamomi," ad fl. oz. vj. Mix. Direct, — "One-sixth part 
 three times a day." 
 
 To prevent the formation of gall-stones, or to aid in dissolving them. The utility 
 of this mixture is doubtful. 
 
 R. Olei Terebinthina?, fl. drs. iss— iij ; Svrupi Limonis, fl. drs. vj ; Mucilaginis 
 Tragacanthie, fl. oz. iij ; Aquae, ad fl. oz. vj! Mix. Direct,— "One-sixth part every 
 four or six hours."
 
 298 APPENDIX OF FORMULJi;. 
 
 Useful in some forms of hsematemesis, hsemoptj'sis, epistaxis, purpura hemorrha- 
 gica, &c. Its effects must be watched, so that it may be discontinued directly any 
 unpleasant results — such as strangury or severe vomiting — arise. — If the symptoms 
 are very urgent, the first dose of the turpentine may consist of fl. drs. iv — vj, beaten 
 up with mucilage; the succeeding doses being according to the formula. In some 
 cases the turpentine may be advantageously given with gallic acid, or the tincture 
 of the perchloride of iron, or with the acid infusion of roses, or with the dilute nitric 
 acid. A drop of creasote with each dose materially lessens its tendency to cause 
 nausea. 
 
 R. Terebinthinae Chiae, gr. 2; Pulveris Ehei, gr. 3; Saponis duri, sufficient to 
 make a pill. To be taken twice a day. See F. 102. 
 
 51. Donovan 8 Triple Solution. 
 
 R. Liquoris Hydriodatis Arsenici et Hydrargyri, min. xx — xxx ; Tincturse Zingi- 
 beris, fl. drm. j ; Aqute, fl. oz. j. Make a draught, to be taken twice a day, directly 
 after meals. 
 
 Useful in lepra, psoriasis, &c. 
 
 52. Arsenical Mixtures. 
 
 R. Liquoris Arsenicalis, min. iij ; Tincturje Lupuli, min. xxx; Infusi Quassioe, fl. 
 oz. j. Make a draught, to be taken three times a day, directly after meals. 
 
 Very useful in many obstinate cutaneous diseases. In ague the quantity of arsenic 
 must be trebled. Under any circumstances, the dose should be diminished directly 
 the tongue gets thoroughly coated with a silvery-looking fur, or the conjunctivas be- 
 come irritable, or diarrhoea sets in, or gastric pain is complained of. 
 
 R. Liquoris Sodae Arseniatis, m. iij — v; Vini Colchici, min. x; Tincturse Cin- 
 chonse Compositte, fl. drm. j ; Tincturse Aconiti, min. v ; Aquae, ad fl. oz. j. Mix. 
 To be taken three times a day, directly after meals. 
 
 In some forms of chronic rheumatism, &c. 
 
 R. Quiniie Sulphatis, gr. 20; Liquoris Arsenici Chloridi (Phar. Lond., 1851), fl. 
 drs. iij — iv; Acidi Sulphurici Aromatici, fl. drs. ij ; Syrupi Zingiberis, ad fl. oz. iij. 
 Mix. Label,—" One teaspoonful in two tablespoonfuls of w^ater directly after break- 
 fast, dinner, and tea." 
 
 In severe neuralgia, chorea, chronic rheumatism, asthma, hay-fever, and intermit- 
 tent fever. See F. 381, 399. 
 
 R. Liquoris Arsenicalis min. xxx; Tineturae Cantharidis, fl. drm. j; Tincturse 
 Aurantii, fl. drs. vj ; Potassii lodidi, gr. 18 — 30; Infusi Aurantii, ad fl. oz. vj. Mix. 
 One-sixth part directly after the two chief meals. 
 
 Valuable in some inveterate cutaneous diseases, as lupus, lepra, psoriasis, &c. 
 
 R. Liquoris Sodae Arseniatis, fl. drs. iss ; Succi Scoparii, fl. oz. iij. Mix. One 
 teaspoonful three times a day, in a wineglassful of water. 
 In some cases of dropsy from chronic renal disease. 
 
 R. Acidi Arseniosi, gr. 1; Pulveris Zingiberis, gr. 40; Extracti Jalapae, gr. 20; 
 Pulveris Tragacanthae Compositi, gr. 80; Confectionis Kosae Caninae, gr. 10. Mix 
 very intimately, divide into twenty pills, and order one to be taken three times a day, 
 immediately after meals. 
 
 In psoriasis, chronic eczema, and other cases where it is desirable to administer 
 arsenic in a solid form. 
 
 53. Green Iodide of Mercury. 
 
 R. Hydrargyri lodidi Viride, gr. 12; Extracti Lupuli, gr. 60; Extracti Opii, gr. 
 2 — 5. Mix. Divide into twenty-four pills, silver them, and order one to be taken 
 three or four times in the day. 
 
 The green iodide of mercury (Syn. Iodide of Mercury) will cure some of the 
 pustular and tubercular diseases of the skin, as well as certain secondary venereal 
 ulcerations, when all other means fail. Sec F. 33. 
 
 R. Hydrargyri lodidi Viride, gr. 6 ; Extracti Conii, gr. 30. Mix. Divide into 
 six pills, and order one to be taken every night at bedtime. 
 In small secondary sj'philitic ulcers about the tongue.
 
 ALTERATIVES AND RESOLVENTS. 299 
 
 54. Red Iodide of Mercury. 
 
 R. Ilydrarujyri lodidi Riibri, gr. 2 — 3 ; Mor])hi;c Ilydrochloratis, gr. 1 ; Extnicti 
 Gentiaiiio, vel Extracti Conii, gr. 40. Mix. Divide into twdvo pills, and order one 
 to be taken twice a day. A cou])lo of ounces of the Compound Decoction of Sansa- 
 parilla may be taken with each pill, or an ounce of the Guaiac Mixture. 
 
 Useful in the same cases as demand the green iodide of mercury. The red iodide 
 (Syn. HiNiODiDE of Mercury), is, however, less likely to cause gastric irritation. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 1; Ammonije Hydrochloratis, gr. 5; 
 Potassii lodidi, gr. 40; AquiB, fl. drs. ij ; Extracti Sarsaj Liquidi, ad fl. oz. ij. Mix. 
 Label, — "A small teaspoonful in a wineglassful of water three times a day." 
 
 This formula gives a convenient extemporaneous mode of exhibiting the red iodide 
 of mercurj' in a fluid form. 
 
 R. Hydrargyri lodidi Rubri, gr. 3 ; Potassii lodidi, gr. 60 — 120; Spiritus Vini 
 Rectificati, fl. drm. j; Syrupi Zingiberis, fl. drs. iv ; Aquae Destillata?, fl. oz. iss. 
 Mix. Label, — " Thirty drops three times a day in a wineglassful of water." 
 
 Mr. Lakgston Parker says — and the author can confirm the remark — that this, 
 remedy, used in conjunction with the mercurial vapor bath, produces excellent results 
 in some obstinate forms of tubercular disease of the skin ; as well as in secondary 
 venereal ulcerations, proving intractable after the employment of other remedies. 
 
 55. Red Iodide of Mercury and Arsenic. 
 
 R. Hydrargyri lodidi Rubri, gr. 1 ; Potassii lodidi, gr. 120; Liquoris Arsenicalis ; 
 fl. drs. iss ; Tincturte Lavanduhe Compositse, fl. oz. ij ; Spiritus Chloroformi, fl. drs. 
 iv ; Aquie, ad fl. oz. xij. Mix; and direct, — " One tablespoonful to be taken three 
 times a day, immediately after food." 
 
 In psoriasis, and some inveterate squamous and tubercular and ulcerous affections 
 of the skin. 
 
 56. Puccoon and Iodide of Arsenic. 
 
 R. Sanguinarias Canadensis, gr. 12; Arsenici lodidi, gr. 2; Extracti Conii, gr. 40. 
 Mix carefully, divide into twenty-four pills, and order one to be taken three times a 
 day. 
 
 Said to be beneficial in cases of cancer. 
 
 57. Chloi'ide of Bromium. 
 
 R. Bromidi Chloridi, guttse iij — iv ; Pulveris Glycyrrhizae, gr. 60. Mix inti- 
 mately, and divide into twenty pills, one to be taken twice or thrice daily. 
 Recommended by Landolfi in cancer. 
 
 58. Bael and Spirit, of Chloroform. 
 
 R. Extracti Belfe Liquidi, fl. oz. ij ; Spiritus Chloroformi, fl. oz. j. Mix. Direct, 
 — " One teaspoonful in a cup of barlej''-water three or four times a day." 
 Has been found useful in diarrhoea and dysentery. 
 
 59. Nitrate of Silver. 
 
 R. Argenti Nitratis, gr. 1 ; Extracti Hyoscyami, gr. 3. Make a pill. To be taken 
 every twelve hours, on an empty stomach, for about ten days. 
 
 In cases of idiopathic jaundice dependent upon gastro-duodenal disturbance rather 
 than on disease of the liver. 
 
 R. Argenti Nitratis, gr. 3 — 12 ; Micao panis, gr. 30. Divide into twelve pills, and 
 order one to be taken three times a day. 
 
 In progressive locomotor atax}', &c. See F. 419. 
 
 The gums should be watched, as the gingival mucous membrane becomes discol- 
 ored before the skin is affected. There is consequently time to prevent the latter by 
 discontinuing the silver salt. 
 
 60. Hydroclilorate of Ammonia. 
 
 R. Ammonias Hydrocliloratis, gr. 90; Syrupi Hemidesmi, fl. oz. j; Infusi Dul- 
 camarse, ad fl. oz. viij. Mix. Two tablespoonfuls every six hours. 
 In some forms of chronic rheumatism.
 
 300 APPENDIX OF FORMULA. 
 
 R. Liquoris Ammonise Acetatis, min. xxx ; Ammonias Hydrochloratis, gr. 15. 
 Aquae Camphors, fl. oz. ij. Make a draught, to be taken every four hours. 
 
 In some varieties of rheumatism, phlegmasia dolens, thrombosis, &c., where the 
 fibrine of the blood is in excess. The efficacy of this remedy is increased by giving 
 120 or 200 grains of the Acid Tartrate of Potash (Syn. Bitartrate of Potash) in 
 half a pint of water, early in the morning. 
 
 R. Ammoniae Hydrochloratis, gr. 20; Extracti Taraxaci, gr. 15; Tincturae Gen- 
 tianae Compo.«it», fl. drs. iss ; Infusi Sennae, ad fl. oz. ij. Make a draught, to be 
 taken twice or thrice daily. 
 
 In some cases of ascites dependent on cirrhosis, in jaundice, in diminished secre- 
 tion of bile, &c. 
 
 61. Chlorate of Potash. 
 
 R. Potassae Chloratis, gr. 120; Aquae Camphorae, vel Infusi Cinchonae Flavte, fl. 
 oz. viij. Mix. One-sixth part every four or six hours. 
 In inflammatory aff'ections of the mouth. 
 
 R. Potassae Chloratis, gr. 90; Spiritus ^theris, fl. drs. iij ; Infusi Chiratae, ad fl. 
 oz. iv. Direct, — " One tablespoonful in a wineglassful of water, three times a day." 
 
 III. ANTACIDS. 
 
 62. Carbo7iate of 3Iagnesia. 
 
 R. Magnesias Carbonatis, gr. 80; Extracti Opii Liquid!, min. xxx; Spiritus 
 ^theris, fl. drs. iij ; Aquae Menthae Viridis, ad fl. oz. vj. Mix. One-fourth part 
 occasionally. 
 
 Useful where there is much oppression from flatulence. 
 
 R. Magnesiae Carbonatis, Sodae Bicarbonatis, aa gr. 15; Infusi Serpentarise, fl. oz. 
 iss Make a draught, to be taken twice or thrice daily. 
 In chronic urticaria. 
 
 63. Ammonia and Chiretta. 
 
 R. Ammoniae Carbonatis, gr. 5; Tincturae Aurantii, fl. drm. j ; Infusi Chiratae, fl. 
 oz. j ; Aquae, ad fl. oz. ij. Make a draught, to be taken night and morning. 
 A good remedy in dyspepsia, with acid eructations and debility. 
 
 64. Preparations of Lithia. 
 
 R. Lithiae Carbonatis, gr. 3 — 6; Aquae, fl. oz. j. Make a draught, to be taken 
 twice a day. It is an improvement to add it to a bottle of soda water. 
 
 Dr. Garrod speaks highly of this remedy in cases of the uric acid diathesis, and 
 in chronic gout. Where uric acid gravel is being voided, it causes a marked 
 improvement. The carbonate of lithia exists in many of the continental springs — 
 as Carlsbad, Marienbad, Kreuznach, Aix-la-Chapelle, Kissingen, Ems, Vichy, Ba- 
 den-Baden, &c. 
 
 R. Lithia? Citratis, Magnesiae Carbonatis, aa gr. 10. Make a powder, to be taken 
 twice daily. 
 
 In chronic gout. 
 
 65. Bismuth, ivith Magnesia or Soda. 
 
 R. Bismuthi Albi, Magnesiae Carbonatis, aa gr. 10. Make a powder, to be taken 
 in half a bottle of soda water three times a day. 
 
 R. Bismuthi Albi, gr. 15; Sod* Bicarbonatis, gr. 12; Pulveris Tragacanthaj 
 Compositi, gr. GO. Make a powder, to be taken twice or thrice in the twenty-four 
 hours, in a wineglassful of brandy and water.
 
 ANTISEPTICS. 301 
 
 R. Liquori.-i Bismuthi, fl. drm. j ; Inftisi Quassia', fl. oz. j. Make a drauirht, to be 
 taken tlirci" times a day. One drachm of the solution of bismuth is equal to twenty 
 grains c)f the powder. 
 
 These preparations are very useful in pyrosis, gastrodynia, and many diseases of 
 the stomach, caeum, «fec. See also F. 112. 
 
 66. Chalk Mixture and Hops. 
 
 R. Tinctursp Lupuli, fl. drs. vj ; Tincturse Cardamorni CompositiP, fl. drs. iv ; Vini 
 IpecaeimnhiB, fl. drs. ij ; Extracti Opii Liquidi, min. xxv ; Misturaj Cretae, ad fl. oz. 
 vj. Mix. One tablespoonful every three or four hours. 
 
 In diarrha?a due to acidity of the prinise vise. 
 
 67. Potash and Ammonia. 
 
 R. PotassiB Bicarbonatis, gr. 120; Spiritus Ammoniae Aromatici, fl. drs. iij ; Tine- 
 tune Aconiti, min. xxx ; Infusi Lupuli, ad fl. oz. viij. Mix. One-sixth part three 
 times a day. 
 
 In gastrodynia. 
 
 68. Ammonia, Potash, and Bark. 
 
 R. ATnmoni!eCarbonatis,gr. 30; Potassaj Chloratis, gr 90; Extracti Opii Liquidi, 
 min. xxx ; Decocti Cinchona} Flavae, fl. oz viij. Mix. One-sixth part three times 
 a day. 
 
 In debility with acid secretions. 
 
 69. ^Solution of Potash and Buchu. 
 
 R. Liquoris Potassse, min. x — xv ; Tincturje Hyoscyami, min. xx ; Infusi Bucco, 
 fl. oz. iss. Make a draught, to be taken three times a day. 
 In catarrl) and irritability of the bladder. 
 
 70. Soda, Morphia, and Dilute Hydrocyanic Acid. 
 
 R. Sodae Bicarbonatis, gr. 15; Liquoris Morphias Hydrochloratis, min. xv; Acidi 
 Hydrocyanici Diluti, min. v; Infusi Cascarillse, fl. oz. j. Make a draught, to be taken 
 immediately. 
 
 In gastrodynia, &c., after the stomach has been emptied by an emetic. In angina 
 pectori.s, immediately after a paroxysm. 
 
 71. Potash and Aloes. 
 
 R. Potassse Bicarbonatis, oz. J; Tincturise Chiratie, fl. drs. ij ; Decocti Aloes Com- 
 positi, fl. oz. viij. Mix. Take one-.sixth part early every morning. 
 In chronic gout. 
 
 72. Bicarbonate of Potash. 
 
 R. Potassas Bicarbonatis, gr. 30; Aquaj, fl. oz. iss. Make a draught, to be taken 
 every two hours. 
 
 In acute rheumatism, continuing the medicine until the joints are free from pain. 
 It generally renders the urine alkaline in twenty-four hours. 
 
 73. Potash and Lime Water. 
 
 R. Liquoris Potassse, min. xv — xlv ; Liquoris Calcis Saccharati, fl. drs. ij. Mix. 
 To be taken in a cupful of beef-tea, or of milk, two or three times a day. See E. 14. 
 
 IV. ANTISEPTICS. 
 
 74. Artificial Disinfectants. 
 
 The most useful agents are — chloride of lime, quick lime, and permanganate of 
 potash. In certain cases the perchloride of iron, sulphate of iron, ammonia, iodine, 
 and chloride of zinc are applicable ; or chlorine gas, or sulphurous acid gas (obtained.
 
 302 APPENDIX OF FORMULA. 
 
 by burning a couple of ounces of flowers of sulphur in a pipkin), may be employed ; 
 or powdered charcoal can be tried. 
 
 No night-stool or bed-pan should be used, especially in hospitals, without its con- 
 taining the solution of permanganate of potash, or some chloride of lime, or chloride 
 of zinc, or carbolic acid, or half an ounce of tincture of iodine. The first has the 
 advantage of not being corrosive, but the last is one of the most efficacious. — To re- 
 move quickly any unpleasant smell from the sick-room, dried lavender or cascarilla 
 bark may be burnt, while the door and window must be opened, so as to allow of a 
 free current of pure air. 
 
 To disinfect linen and washing apparel they should be soaked in a mixture of two 
 ounces of the solution of permanganate of potash to the gallon of water, and after- 
 wards in boiling water. Woollens, bedding, or clothing may be thoroughly purified 
 by exposing them for about two hours, in an oven, to a temperature of 220° F. 
 
 75. Chlorine Gas. 
 
 As a fumigating agent, antiseptic and disinfectant, chlorine stands unrivalled. 
 The ingredients for producing it should be contained in saucers placed in the higher 
 parts of tlie room, as the gas which is developed will descend by its density, and soon 
 become mixed with the surrounding air. Dr. Faraday adopted the following method 
 at the Millbank Penitentiary : One part of common salt was intimately mixed with 
 one part of the black or binoxide of manganese, and placed in a shallow eartheai pan ; 
 two parts of oil of vitriol, previously diluted with two parts by measure of water, were 
 then poured over it, and the whole stirred with a stick. Chlorine continued to be 
 liberated from this mixture for four days. 
 
 Another plan for causing the free evolution of chlorine gas is the addition of half 
 a pint of hydrochloric acid mixed with a quarter of a pint of water, to a quarter of a 
 pound of finely powdered black oxide of manganese. Whichever mode is adopted for 
 producing this disinfectant, it is necessary while employing it that the doors, windows, 
 and chimney of the room be kept carefully closed for some hours. 
 
 The Chlorides of Lime and Soda, when exposed to the air, gradually absorb car- 
 bonic acid and give oft' chlorine. Hence either of these salts can be used as disin- 
 fecting agents. Cloths, dipped in an aqueous solution of chloride of lime, may be 
 hung up in an inhabited room to fumigate it ; the quantity of chlorine given oflT being 
 too small to be mischievous. It was probably in reference to these .salts, that Aber- 
 nethy said of disinfectants, — "They are sometimes very useful, very useful indeed; 
 for they make such an abominable stink that the patient is obliged to have the win- 
 dows opened." 
 
 76. Solution of Chlorinated Soda. 
 
 R. Liquoris Sodae Chloratse, fl. drs. ij — iij ; Extracti Opii Liquidi, min. xxx ; 
 Aqua? Camphorse, ad fl. oz. viij. Mix. Two tablespoonfuls three times a day. 
 
 In gangrene of the lung, low fever, &c. It not only relieves the fetor, but acts as 
 an alterative, &c. If necessary, the opium can be omitted. 
 
 77. To prepare Chlorine for Internal Administration. 
 
 Put eight grains of chlorate of potash in a strong pint bottle, and pour upon them 
 one drachm of strong hydrochloric acid. Close the mouth of the bottle until the 
 violent action ceases, when add one ounce of water and agitate well ; add another 
 ounce, again shake, and continue this process until the bottle is full. One or two 
 tablespoonfuls may be taken frequently according to the age. An adult may use the 
 whole pint in one day. 
 
 The dose of the officinal Liquor Chlori is from min. xxx to fl. drs. ij in a wine- 
 glassful of water several times daily. 
 
 Useful in scarlet fever, t,yphus, diphtheria, chronic aff'ections of the liver, &c. 
 
 78. Permaiiganate of Potash. 
 
 The permanganate of potash is an excellent disinfectant, and is the basis of Con- 
 dy's Antiseptic Fluid. The latter is double the strength of the officinal Liquor 
 PoTAssiK Pkrmanganatis. 
 
 From fl. drs. j — vj of the solution of permanganate of potash in one pint of water, 
 may be applied to all kinds of suppui-ating sores. The author has frequently ordered
 
 ANTISEPTICS. 303 
 
 such a lotion with great benefit to destroy the horribly offensive odor of a malignant 
 nicer ; or for the same purpose in su})purating scalds and burns. The solution should be 
 made only of such a strength as to ln' l)()rii(} without any ])ain or even uneasiness. It 
 must be frequently sj-ringed over the sores, since contact with lint and sponges 
 decomposes it. Linen is stained by it, but the discoloration may be removed b}' sul- 
 phate of iron. As a wash for stinking feet, or for the removal of offensive odors 
 from the hands, after handling morbid specimens, &c., the liquor ought to be used in 
 the proportion of one fluid drachm to the ounce of distilled water. As an injec- 
 tion in cancer of the uterus, the strength ought not to be greater than half a fluid 
 ounce to one pint of water. To deprive night-chairs of offensive odor, a wineglass- 
 ful of Condy's Fluid should be mixed with two ])ints of fresh or salt water, and put 
 into the pan previous to its use. 
 
 79. Chloride of Zinc. 
 
 This substance is a most powerful caustic, which has long been used to destroy 
 cancerous and other growths. It has been administered internally — dose, gr. 1, 
 largely diluted — but without any benefit. It forms, however, a valuable disinfectant 
 gargle — gr. 10 to water fl. oz. viij ; or in still larger proportions it is a most effica- 
 cious antiseptic. Sir W. Burnett's Disinfecting Fluid consists of gr. 25 of this salt 
 to water fl. drm. j. For use, about one ounce of this solution is added to two pints 
 of water. To disinfect a sick-room, a piece of flannel three or four feet square is to 
 be moistened with a solution thus made, and frequently waved through the air. 
 Some of it should also be [)laced in the close-stools and bed-pans. 
 
 80. Chlorinated Lime Lozenges. 
 
 R. Calcis ChloratiE, gr. 60; Sacchari Albi, oz. 4; Amyli, 07.. 1; Olei Menthse 
 Piperitie, fl. drm. j; Pulveris Tragacantha^ Compositi, gr. 120; Aquse Menthie 
 Piperitie, sufficient to form a mass. To be divided into lozenges of twenty grains 
 each. 
 
 One may be taken frequently to remove fetor of the breath, whether due to mer- 
 cury or other causes. 
 
 81. Iodine. 
 
 This agent has been recommended for disinfecting and deodorizing purposes by 
 Wynn Williams, Campbell de Morgan, Nunn, and Richardson. Two hundred grains 
 are placed in a common chip box and suspended over the patient's bed, or they may 
 be put into a cup or saucer on the mantel-shelf. If desired, the metal may be at once 
 volatilized and the vapor diflused through the apartment, by placing it on a heated 
 fire-shovel. In rooms occupied by small-pox patients the air may be kept free from 
 smell by using iodine in this manner, — probably the strongest proof which could be 
 adduced of the value of this simple and manageable remedy. 
 
 R. Tinctvirse lodi, fl. drs. vj ; AquiB Destillatte, ad fl. oz. viij. Mix. 
 Useful as a lotion to unhealthy ulcerations with offensive discharges. 
 
 82. Extract of Logwood. 
 
 R. Extracti Haematoxyli, oz. 1 ; Butyri Cacao, Adipis, aa oz. \. Mix. 
 
 This is an excellent disinfectant when applied to malignant sores or suppurating 
 wounds. The remedy is equally efficacious when used as a lotion or powder. If 
 any haemostatic be needed, the logwood may be combined with tannin or perchloride 
 of iron. 
 
 83. Chlorate of Potash Lozenges. 
 
 R. Potassse Chloratis, gr. 150; Balsami Tolutani, gr. 35; Spiritfts Vini Rectifi- 
 cati, sufficient to make a solution. Then add Sacchari Albi, oz. 10; Mucilaginis 
 Acacije, sufficient. The paste thus made is to be divided into 50 lozenges, each of 
 which will contain three grains of chlorate of potash, and nearly one of balsam of 
 Tolu. 
 
 Twelve or fifteen may be taken in the course of the day, to remove foulness of the 
 breath. These lozenges are useful also in healing ulcerations of the gums. 
 
 84. Bark and Camphor. 
 
 R. Spiritfis CamphorEe, min. xx ; Spiritfis Rectiflcati, fl. drm. j ; Infusi Cinchonae 
 Flavie, ad fl. oz. iss. Make a draught.
 
 304 APPENDIX OF FORMULA. 
 
 To be taken every six or eight hours hy a nervous attendant in a sick-room. Its 
 efficacy may be increased by the occasional addition of a glass of port wine. 
 
 V. ANTISPASMODICS. 
 
 85. Ether Mixtures. 
 
 R. Spiritus ^theris, min. xl — fl. drm. j; Extracti Opii Liquidi, min. x — xv ; 
 Tinctuiie Castorei, ti. drm. j ; Aquifi Menthaj Piperita^ ad fl. oz. iss. Make a draught. 
 To be taken occasionally when the system is oppressed with flatulence or spasms. 
 
 R. Spiritus ^theris, Spiritus Chloroformi, aa fl. drs. iij ; Tincturse Cardamom! 
 Compositaj, fl. drs. vj ; Spiritus Myristicse, fl. drs. ij ; Olei Carui, min. xij ; Mucila- 
 ginis Tragacanthse, fl. oz. iij ; Aquse Mentliae Piperita^, ad fl. oz. viij. Mix. Two or 
 three tablespoonfuls occasionally, when there is oppression from flatulence. 
 
 R. Spiritus ^theris, fl. drs. iss; Spiritus Ammonite Aromatici, fl. drs. ij ; Tinc- 
 turic Campliora3 cum Opiu, fl. drs. iss; Aqu;* Camphora?, ad fl. oz. iv. Mix. Label, 
 — "Two tablespoonfuls everj' half-hour, until the pain is relieved." 
 
 In spasmodic diseases, angina pectoris, &c. 
 
 86. Ammonia Mixtures. 
 
 R. Spiritus Ammoniae Aromatici, fl. drm. j ; Acidi Hydrocyanici Diluti, min. iij 
 — V ; Syrupi Zingiberis, fl. drm. j : Aquae C|arui, ad fl. oz. iss. Make a draught, to 
 be taken twice or thrice a day if there be flatulence or languor. 
 
 In dyspepsia, or debility with irritable stomach. See F. 67, 08. 
 
 R. Tincturse Assaftetida, fl. drs. ij ; Ammonise Carbonatis, gr. 20; Aquae Cam- 
 phorffi, ad fl. oz. iv. Mix. One or two tablespoonfuls occasionally when the patient 
 IS feeling languid or hysterical. 
 
 R. Spiritiis Ammonise Aromatici, min. xxx ; Magnesias Carbonatis, gr. 20; Spiritus 
 Chloroformi, fl. drm. j ; Aquae Menthae Piperitse, ad fl. oz. iss. Make a draught, to 
 be taken occasionally. 
 
 In severe colic. 
 
 R. Spiritus Ammonite Aromatici, fl. drs. iss; Spiritfts Etheris, fl. drm. j ; Tinc- 
 turae Belladonnae, min. xij ; Acidi Hydrocyanici Diluti, min. viij ; Syrupi, ad fl. oz. 
 ij. Mix. One teasp(^onful in the same quantity of water every four hours. 
 
 For a child two years old with hooj)ing-cough. 
 
 87. Valerian Drauglit. 
 
 R. Tincturae Valeriana Ammoniatte, min. xl ; Iiafusi Valeriana', fl. oz. j. Make 
 a draught, to be taken occasionally. 
 In hysteria. 
 
 88. Lobelia, Ether, ^c. 
 
 R. Tincturae Lobelite ^Ethere;«, fl. drs. iij ; Vini Ipecacuanhae, fl. drs. ij ; Misturie 
 Ammoiiiiici, ad fl. oz. vj. Mix. Two tablespoonfuls every six hours. 
 In the dyspnoea of asthma, when there is vesicular cmj.hysema. 
 
 89. Assafcetida and Chiretta. 
 
 R. Tinctura? Assafcetidaj, fl. drs. ij ; Spiritiis Ammoniae Aromatici, fl. drs. iij; 
 Tincturai Chiratas, fl. drs. vij. Mix. Direct, — "Sixty drops in a wineglassful of 
 water every two or three hours, until the paroxysms cease." 
 
 In hysteria. 
 
 90. Aconite and Creasote. 
 
 R. Tincturae Aconiti, min. xlv ; Misturae Creasoti, ad fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 In some cases of obstinate sickness, such as occur during pregnancy and in hysteria. 
 See F. 41.
 
 ASTRINGENTS. 305 
 
 91. Nitric Acid 3Iixture. 
 
 R. Acidi Nitrici Diluti, fl. clrs. xij ; Tinctiirse Cardamomi Composita;, fl. drs. iij ; 
 Syrupi, fl. oz. iiiss ; Aquit', fl. oz. j. Mix. One or two small teaspoonfuls every two 
 hours. 
 
 Dr. Gibb states that nitric acid i? a specific in the treatment of hooping-cough, 
 curing the disease in from two to fifteen days. He recommends this formula. 
 
 92. Sulphate of Zinc and Belladonna. 
 
 R. Zinei Sulphatis, gr. 8; Extracti Belladonnse, gr. 2; Aqu.ie, fl. oz. iv. Mix. 
 Half an ounce four times a day. 
 
 Dr. Fuller. — For a child above three years of age with hooping-cough. Every 
 other day the strength of the mixture may be augmented in the proportion of one 
 dose. The belladonna may be thus gradually increased to doses of five grains with- 
 out any mischief. See F. 3'26. 
 
 93. Valerianate of Quinia. 
 
 R. Quinia3 Valerianatis, gr. 12 ; Extracti Gentian*, gr. 40. Divide into twelve 
 pills, silver them, and order one to be taken three times a day. 
 In hysteria, and analogous nervous disorders. 
 
 94. Stramonium, Colchicum, and Digitalis. 
 
 R. Potassse Citratis, gr. 120; Tincturse Stramonii, fl. drm. j; Tincturne Colchici 
 Scminis, fl. drs. ij ; Infusi Digitalis, fl. oz. iij ; Aquae Menthae Piperitae, ad fl. oz. viij. 
 Mix. One-sixth part three times a day. 
 
 In irregular gout, with dyspnoea or violent palpitation, and a full pulse. 
 
 95. Sumhul and Ether. 
 
 R. Sumbulii Radicis, gr. 240; Spiritiis ^theris, fl. oz. iv. Macerate in a stoppered 
 bottle for seven days, and then filter. Dose, min. xx — xxx. 
 In neuralgia, hysterical fits, «&c. 
 
 VI. ASTRINGENTS. 
 
 96. Rhatany Mixtures. 
 
 R. Tincturse Rhei, fl. drs. iij ; Infusi Krameria?, fl. oz. viij. Make a mixture, and 
 order one-sixth part to be taken every six or eight hours. 
 A valuable astringent in common diarrhoea. 
 
 R. Extracti Kramerise, gr. 20; Aquie, fl. oz. iss. Make a draught, to be taken 
 three times a day. 
 
 In hematuria, passive intestinal hemorrhage, «&c. 
 
 R. Potassae Chloratis, gr. 60 ; Tincturae Kramerite, fl. drs. vj ; Aqu;e, ad fl. oz. 
 viij. Mix. One-sixth part three times a day. 
 
 In relaxation of the buccal mucous membrane, sponginess of the gums, &c. 
 
 97. Catechu Mixtures. 
 
 R. Tincturae Catechu, fl. drs. iij — vj ; Pulveris Cretae Aromatici, gr. 90; Olei 
 Mentha; Piperitae, min. vj ; Extracti Opii Liquidi, min. xxx; Misturte Uretffi, ad. fl. 
 oz. viij. Mix. One-sixth part after every relaxed motion. 
 
 Efficacious in checking simple diarrhoea. In some instances half an ounce of castor 
 oil should be given four hours before commencing this mixture. 
 
 R. Tincturae Catechu, fl. drm. j ; Acidi Sulphuric! Aromatici, min. xv ; Olei 
 Menthae Piperitae, min. j ; Infusi Catechu, fl, oz. j. Mix. To be taken two or three 
 times a day. 
 
 20
 
 306 APPENDIX OF F0RMUL.J1. 
 
 R. Tincturre Catechu, fl drs. iij ; Spirit^? Chloroformi, fl. drs. vj ; Extract! Belee 
 Liquida, fl. drs. xij ; Infusi Maticse, ad fl. oz. vj. Mix. Two tablespoonfuls to be 
 taken three or four times a day. 
 
 In chi-onic diarrhoea and dysentery. 
 
 R. Pulveris Catechu Compositi, gr. 30; Pulveris Cretaj Aromatici cum Opio, gr. 
 20. Make a powder ; to be taken night and morning. 
 
 98. Vegetable Charcoal. 
 
 R. Carbonis Ligni, Theriacse, aa oz. 1. Mix. Direct one teaspoonful to be taken 
 three or four times a day. 
 
 In some cases of chronic diarrhoea, when the irritation is kepit up by fecal fermen- 
 tation. In fetid eructations. The charcoal should be recently prepared. Charcoal 
 biscuits are also useful. 
 
 99. Tanniyi and Nitric Acid. 
 
 R. Acidi Tannici, gr. 30 ; Acidi Nitrici Diluti, fl. drm. j ; Tincturfe Lupuli, fl. 
 drs. iv ; Infusi Gentianas, ad fl. oz. viij. Mix. Direct, — "One-sixth part three 
 times a day." 
 
 To restrain secretion in chronic bronchial catarrh, in phthisis when the cavities 
 are large and the w^alls throw out considerable quantities of purulent matter, in 
 nervous debility, and in most cases where an astringent is required. When a ferru- 
 ginous tonic is indicated, the above mixture may be given night and morning, and 
 some preparation of steel in the middle of the day. 
 
 100. Aromatic Sulphuric Acid and Opium. 
 
 R. Acidi Sulphurici Aromatici, fl. drs. ij ; Tincture Camphorje cum Opio, fl. oz. 
 j ; Aquaj Cinnamomi, ad fl. oz. viij. Mix. Label, — " One-sixth part three times a 
 day, about an hour before each meal." 
 
 101. Per chloride of Iron. 
 
 R. Tincturse Ferri Perchloridi, min. xv ; Acidi Hydrochlorici Diluti, min. x; 
 Olei Menthse Piperitae, min. j ; Infusi Quassias, fl. oz. iss. Make a draught, to be 
 taken every six hours. 
 
 In some cases of epistaxis, hemorrhage from the stomach, &c. 
 
 102. Oil of Turpentine. 
 
 R. Olei Terebinthinse, min. x — xx ; Misturae Amygdalte, fl. oz. j. Make a 
 draught, to be taken every hour. 
 In severe haemoptysis especially where the individual is weak and cachectic. 
 
 R. Mucilaginis Acaciae, fl. drs. iv ; Sodas Bicarbonatis, gr. 10; Olei Terebinthinae, 
 min. X ; Olei Anethi, min. j ; Aquaj Destillatae, ad fl. oz. iss. Make a draught ; to be 
 taken thrice daily. 
 
 In passive haematemesis. See F. 50. 
 
 103. G-allic Acid. 
 
 R. Acidi Gallici, gr. 10 — 15; Aqua3 Destillatae, fl. oz. iss. Make a draught, to be 
 taken every four hours. 
 
 R. Acidi Gallici, gr. 4; Extracti Cannabis Indicie, gr. J; Confectionis Eosae 
 Gallicae, gr. 1. Make a pill, to be taken every night at bedtime. 
 To check the night-sweats in phthisis. 
 
 R. Acidi Gallici, gr. 8; Morphiae Hydrochloratis, gr. \; Confectionis Kosse Gal- 
 lic*, sufficient to make two pills. Label, — " To be taken every night at bedtime." 
 In the night-sweats of phthisis. 
 
 R. Acidi Gallici, gr. 15 — 25; Acidi Sulphurici Aromatici, min. xv — xx ; Tinctura? 
 Cinnamomi, fl. drs. ij ; Aquae Destillatae, ad fl. oz. ij. Make a draught, to be taken 
 every four hours until the bleeding ceases. 
 
 In profuse menorrhagia, haemoptysis, haematemesis, &c.
 
 ASTRINGENTS. 307 
 
 R. Acidi Gallici, gi". 12; Pulveris Ipccacuanlije cum Opio,gr. 5. Make a powder, 
 to be taken every eight or twelve hours. 
 
 A valuable astringent in hemorrhage from the lungs, stomach, intestines, or 
 kidneys. 
 
 104. Cinnamon Mixtures. 
 
 R. Tincturfe Cinnamomi, fl. drs. vj ; Acidi Nitrici DiUiti, fl. drs. ij. Mix and 
 label, — "Thirty drops in a winogjassful of water every two hours." 
 
 Useful in passive hemorrhages from the kidneys, bladder, uterus, &c. . 
 
 R. Tinctune Cinnamomi, fl. drs. iv ; Spiritus Ammonite Aromatici, fl. drs. ij ; 
 Decocti Hiematoxyli, ad fl. oz. vj. Mix. One-fourth part after every relaxed motion. 
 
 R. Tinctura3 Cinnamomi, fl. drs. ij ; Aqua^ Cinnamomi, fl. oz. j. Make a draught ; 
 to be taken thrice daily. 
 
 In menorrhagia especially, but also in other varieties of passive hemorrhage. See 
 a paper by the author, " Lancet," 15th October, 1853. 
 
 105. Matico and Rhatany. 
 
 R. Tincturaj Kramerise, fl. drs. xij ; Syrupi Papaveris, fl. drs. vj ; Infusi Maticae, 
 ad fl. oz. viij. Mix. One tablespoonful every three or four hours. 
 In the diarrhoea of phthisis. 
 
 106. Sulphate of Qopper and Opium. 
 
 R. Cupri Sulphatis, Extract! Opii, aa gr. \; Extract! Gentiana), gr. 3. Make a 
 pill, to be taken three times a day. 
 In obstinate diarrhoea. 
 
 107. Nitrate of Silver and Opium. 
 
 R. Argenti Nitratis, gr. ^; Extract! Opii, gr. 2. Make a pill, to be taken night 
 and morning. 
 
 In very obstinate diarrhcea where opium agrees with the system. See F. 59. 
 
 108. Kino and Logwood. 
 
 R. Tincturfe Kino, fl. drs. vj ; Vini Ipecacuanbfe, fl. drs. ij ; Decocti Ha3matoxyli, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 In chronic dysentery, diarrhcea, «&c. 
 
 109. Cascarilla and Squills. 
 
 R. Tincture Scillie, fl. drs. iss — ij ; Acidi Sulphuric! Aromatici, fl. drm. j ; 
 Liquoris Morphiie Hydrochloratis, min. xxx ; Infusi CascarilliB, ad fl. oz. viij. Mix. 
 One-sixth part three times a day. 
 
 In chronic bronchitis with profuse expectoration. 
 
 110. Alum and Syrup of Red Poppy. 
 
 R. Aluminis Exsiccati, gr. 16: Syrupi Khoeados, fl. drs. iij ; Aquse, ad fl. oz. ij. 
 Mix. One teaspoonful every two or three hours. 
 
 In the catarrh of infants, where the secretion from the bronchial tubes is excessive. 
 
 111. Oxide of Zinc. 
 
 R. Zinc! Oxidi, gr. 12; Extract! Conii, vel Hyoscyami, gr. 18. Make a mass, 
 divide into six pills, and order one to be taken every night at bedtime. 
 
 For the relief of night-sweats in phthisis and other exhausting diseases, there arc 
 few remedies more serviceable than the foregoing. 
 
 R. Zinc! Oxidi, gr. 2; Morphias Hydrochloratis, gr. \; Extract! Anthemidis, gr. 
 3, Make a pill, to be taken night and morning.
 
 308 APPENDIX OF FORMULA. 
 
 112. WJiite Bismuth. 
 
 R. Bismnthi Albi, gr. 60 ; Syrupi Papaveris, fl. drs. iv ; Mneilaginis Tragaeanthse, 
 fl. oz. iv ; Aquae, ad fl. oz. viij. Mix. One-sixth part every six or eight hours. 
 Useful in checking the diarrhcea of phthisis. 
 
 R. Bismuthi Albi, gr. 80; Pulveris Kino cum Opio, gr. 30: Tincturse Cinna- 
 momi, fl. drs. iij ; Mucilaginis Tragacanth.-e, fl. oz. ij ; Aquje, ad fl. oz. r]. Mix. 
 One-sixth part every four hours. 
 
 R. Bismuthi Albi, gr. 10; Pulveris Ipeeacuanhse cum Opio, gr. 5. Make a 
 powder, to be taken every night at bedtime. 
 
 As a sedative and astringent in the diarrhcea of phthisis. See F. 65. 
 
 113. Agtriyigent Enemata. 
 
 R. Olei Terebinthinse, min. xxx ; Tincture Kino, fl. drs. ij ; Extracti Opii 
 Liquidi, min. xxv ; Mucilaginis Amyli, fl. oz. ij. Make an enema. 
 
 To check the purging in typhoid fever. It may be employed twice or thrice in 
 the twenty-four hours, if necessary. 
 
 R. Bismuthi Albi, gr. 20; Tincturre Catechu, fl. drm. j; Liquoris Morphiae 
 Hydrochloratis, min. xxx ; Mucilaginis Amyli, fl. oz. ij. Mix. 
 
 To check the purging of phthisis, fever, &c. It may be administered every twelve 
 hours. 
 
 114. CJdoroform, Opium, and Castor Oil. 
 
 R. Chloroformi, min. vj — xij ; Tincturse Camphorse cum Opio, fl. drs. ij ; Olei 
 Ricini, fl. drs. iij ; Mucilaginis Tragacanthae, fl. drs. iij. Make a draught, to be 
 taken immediately. 
 
 In choleraic diarrhoea. 
 
 115. Alum and Sulphuric Acid. 
 
 R. Alurainis Exsiccati, gr. 60; Syrupi Ehoeados, fl. drs. vj ; Infusi Eosse Acidi, ad 
 fl. oz. viij. Mix. Two tablespoonfuls every six hours. 
 In passive hemorrnage. Also in some cases of lead colic. 
 
 116. Ammonia Iron-Alum. 
 
 R. Eerri Ammonio-Sulpbatis, gr. 30 — CO; Aquae Destillatae, fl. oz. viij. Mix. 
 One-sixth part every six or eight hours. 
 
 An excellent astringent in some forms of haematemesis, haemotpysis, &c. 
 
 117. Lead and Acetic Acid. 
 
 R. Pilulae Plumbi cum Opio, gr. 4. To be taken every two or three hours, with 
 the following draught: R. Acidi Acetici Diluti, fl. drs. ij ; Aqua? Cinnamomi, fl. 
 drs. vj. Mix. 
 
 In severe haemoptysis. The acetate of lead is inferior to gallic acid as an astringent, 
 unless given in larger doses than are commonly employed. According to Dr. C. K. 
 Irwin, this lead salt may be prescribed in 60, 120, or 180 gr. doses, with great advan- 
 tage, in cases of uterine hemorrhage requiring prompt suppression. 
 
 118. Cold, as a Local Astringent. 
 
 The best and cheapest freezing mixture is made with ice and common salt in 
 equal parts. Any of the following, however, will prove useful : 
 
 MIXTURES. PARTS. THERM. SINKS. 
 
 Hydrochlorate of Ammonia, .... 5 ) 
 
 Nitre, 5 I From 50° to 10° 
 
 "Water, 10 J 
 
 ^^^^^^oiAmmoT^\^, J | pr^m 50° to 4° 
 
 Common Salt, 1/ 
 
 Snow or Ice, 12 ) 
 
 Common Salt, 5 ^ From 18° to —25° 
 
 Nitrate of Ammonia, 5 J
 
 BATHS. 309 
 
 VII. BATHS. 
 
 119. Temperature of Simple Baths, 
 
 B\TH. WATER. VAPOR, AIR. 
 
 The Cold, . . 33° to 65° F. 
 " Cool, . . 65° to 75° 
 *' Tcunperate, 75° to 85° 
 
 " Tepid, . 85° to 92° ... . 90° to 100° . . . . 96° to 106° 
 " Warm, . 92° to 98° ... . 100° to 115° .... 106° to 12i)<» 
 " Hot, . . 98° to 112° . . . .115°tol4U° . . . .120° to 170° 
 
 120. Nitro-HydrocMoric Acid Baths, 
 
 R. Acidi Nitrici, fl. oz. iss ; Acidi Hydrochlorici, fl. oz. j — iij ; Aquae Calidse, 
 Cxxx. Mix. To be prepared in a wooden bath. The patient should remain in it for 
 from ten to twenty minutes. 
 
 Useful in cases where the liver is inactive, — as in invalids from tropical climates. 
 
 R. Acidi Nitrici, fl. drs, iv; Acidi Hydrochlorici, fl. oz. j ; Aquae Calidse, Civ. 
 Mix, for a footbath. 
 
 In dyspepsia, with derangement of the liver and constipation. To be used in a 
 wooden or earthenware vessel. 
 
 121. Alkaline Bath. 
 
 R. Sodae Carbonatis, lb. 1 ; Aquae Ferventis, Cxxx. Mix. 
 
 In the lithic acid diathesis, chronic squamous diseases of the skin, chronic rheu- 
 matism, &c. 
 
 122. Conium and Starch Bath. 
 
 R. Extract! Conii, gr. 120; Pulveris Amyli, lb. 1; Aquae Ferventis, Cxxx. Mix, 
 for a bath. 
 In certain skin diseases, attended with great irritability. 
 
 123. Creasote Bath. 
 
 R. Creasoti, fl. drs. ij ; Glycerini, fl. oz. ij ; Aquae Ferventis, Cxxx. Mix. 
 In squamous diseases of the skin. 
 
 124. Iodine Bath. 
 
 R. lodinii, gr, 60; Potassii lodidi, oz. ^; Liquoris Potassae, fl. oz. ij ; Aquae Cali- 
 dae, Cxxx. Mix, 
 
 In scrofula, chronic rheumatism, secondary syphilis, and certain skin diseases. 
 
 125. Sulphur Baths. 
 
 R. Potassae Sulphuratffi, oz. 4; Aquje Calida^, Cxxx. Mix. 
 Useful in scabies, lead colic, paralysis from lead, »!cc. 
 
 R. Potassae Sulphuratae, oz. 4; Sodae Hyposulphitaj, oz. 1; Acidi Sulphurici, fl. 
 drm. j ; Aquae Calidae, Cxxx, Mix. 
 
 126. Iroti, or Oak Bark, Baths. 
 
 R. Ferri Sulphatis, oz. J; Aquae, Civ. Mix. 
 Especially useful for strumous and rickety children, 
 
 R. Quercfis Contuse, lb, 1; Aquae Calidae, Oij, Mix. Boil for half an hour, and 
 add the strained decoction to three gallons of warm or tepid water. To be used every 
 morning. 
 
 For delicate children, &c.
 
 310 APPENDIX OF FORMULA. 
 
 127. Salt-water Baths. 
 
 B. Salis Marini (vnlgo, "Bay-salt"), lb. ^; Aquie Tepid«, Civ. Mix. Make 
 a sponge-bath, to be used every morning. 
 
 In general debility, chronic rheumatism, &c. The surface of the body should be 
 thoroughly rubbed with a flesh-brush and coarse towels. 
 
 K. Salis Marini, lb. 2; Magnesise Sulphatis, oz. 8; Potassii lodidi, gr. 120; Li- 
 quoris Calcis Chloratse, fl. oz. iss ; Aquaj, Cxxx. Mix. 
 
 128. Arsenical Bath. 
 
 R. Sodffi Carbonatis, oz. 4; Sodas Arscniatis, gr. 20; Aquse Calidse, Cxxx. Mix, 
 In rheumatoid arthritis, skin diseases, &c. 
 
 129. Borax Bath. 
 
 R. Boracis, oz. 4; Glycerini, fl. oz. iij ; Aquje Calidje, Cxxx. Mix, 
 In some squamous and other irritable diseases of the skin, 
 
 130. The Turkish Bath. 
 
 The general effect of a hot air bath is to increase the force and rapidity of the cir- 
 culation, and to induce free perspiration ; but if too hot or too )irolonged the determi- 
 nation of blood to the skin and lungs becomes so great, that the brain suffers. There 
 is then consequently a lowering of the circulation, with depressed nervous power. 
 A temperature varying from 120° to 1(56° will usually suiBce : while if the perspira- 
 tion is etflcient and continuous, and the sensation agreeable, the patient may remain 
 in the calidarium for from forty to sixty minutes. — The bath is usejid in removing 
 local congestions, in clearing the pores and in inducing a healthy condition of the 
 skin and mucous membranes, in eliminating noxious matters from the blood, and in 
 imparting a sense of elasticity and vigor to the system. It is injurious when there is 
 any obstruction to the circulation, or when the heart or vessels are aft'ected with 
 fatty degeneration, or when there are any symptoms of disease of the nervous centres, 
 or when there is a tendency to vertigo or syncope, and in advanced life. Women 
 who are pregnant, or who are menstruating, ought not to have recourse to it. 
 
 131, Mercurial Vapor Baths. 
 
 The patient is seated on a chair, and covered with an oil-cloth lined with flannel, 
 which is supported by a proper framework. Under the chair are placed a copper bath, 
 containing water, and a metallic plate on which is put from sixty to one hundred 
 and eighty grains of the bisulphuret of mercury, or the same quantity of the gray 
 oxide, or the red oxide of this metal. In syphilitic atl'ections of the skin, testes and 
 bones, from five to thirty grains of the green iodide of mercury may be employed ; 
 or a mixture of twenty grains of the green iodide with ninety grains of the bisul- 
 ]ihuret often proves efficacious. Under the bath and plate, spirit-lamps are lighted. 
 The patient is thus exposed to the influence of three agents — heated air, steam, and 
 the vapor of mercury. At the end of five to ten minutes perspiration commences, 
 which becomes excessive in ten or fifteen minutes longer. The lamps are now to be 
 extinguished; and when the patient has become moderately cool he is to be rubbed 
 dry. He should then drink a cup of warm decoction of guaiacum or sarsaparilla, 
 and repose for a short time. — Langston Parkek. In constitutional syphilis when 
 mercury is indicated. This method of introducing mercury into the system may also 
 be adopted with benefit in other diseases, in place of administering the metal by the 
 mouth. 
 
 Mr. Hknry Lke's mode of proceeding is more simple, and is the one which the 
 author has frequently adopted with great success. A convenient apparatus is used, 
 made by most instrument makers, consisting of a kind of tin ease, containing a spirit- 
 lamp. In the centre, over the flame, is a snuill tin plate, upon which from fifteen to 
 thirty grains of calomel are placed ; while around this is a sort of saucer filled with boil- 
 ing water. The lamp having been lighted, the apparatus is placed under a common 
 cane-bottomed chair, upon which the patient sits. He is then enveloped, chair and 
 all, in one or more large blankets; and so he remains, well covered up, for about 
 twenty minutes, when the water and mercury will be found to have disappeared. 
 About five minutes afterwards he may put on his shirt and go to bed ; but it is better 
 not to use a towel, since it can only be disadvantageous to wipe oti" the calomel depos- 
 ited on the skin.
 
 BATHS. 311 
 
 132. Gelatine Bath. 
 
 Take of Gelatine, or Common Glue, lb. 1 ; dissolve in a little boiling water, and 
 then add twenty gallons of hot water to form a hath. 
 In eczema and other irritable cutaneous atfections. 
 
 133. Mustard Foot Bath. 
 
 R. Pulveris Sinapis, oz. 2 — 4; Aquae Calidse, Civ. Mix, for a foot bath. 
 In congestions of the head and chest, in some cases of amenorrhcca, &c. 
 
 134. Cold Affusion. 
 
 The patient is seated in an empty bath, and from four to six buckets of cold water 
 (about 40° F.) are poured over his head and chest from a height of two or more feet. 
 He is then quickly dried and replaced in bed. The colder the water and the greater 
 the height from which it is poured, the more stimulating the effect. Aliusion, as 
 thus practised by Dr. Carrie, proved very valuable in the treatment of typhus. It 
 may be resorted to when the temperature of the body is permanently above its nor- 
 mal (about 98.4° F.) standard, when there is no feeling of chilliness, when the body 
 is not wholly bathed in sweat, when there is not much irritability of the nervous 
 system, and when there is great stupor. The etiect is to lower the temperature, to 
 lessen the frequency of the pulse and respiration, to render the tongue njoist and 
 soft, to diminish or remove the stupor, to procure sleep, and sometimes to produce a 
 critical perspiration. It may be used every twenty-four hours if necessary. 
 
 When it is desirable to apply a douehe-bath to one or more of the joints, it is only 
 necessary to affix two or three yards of large-sized India-rubber tubing to the tap of 
 a cistern. The patient must sit in an emjjty bath, into which the water may fall as 
 it jjlays upon the limb. 
 
 135. The Shalloiv Bath. 
 
 The patient sits in a bath some six feet long, with a depth of water (temperature 
 60° to 80° F.) varying from eight to twelve inches. The extremities and trunk are 
 well rubbed by an assistant, while water is gently poured over the head. The dura- 
 tion of the bath ought to vary from live minutes to three-quarters of an hour, until 
 the temperature of the body is lowered. The colder the water and the shorter the 
 stay in it, the more stimulating and less sedative will be the effect. This bath is less 
 exciting than the cold affusion, and is chiefly indicated where the latter would be 
 improper, — i. e., where there is much nervous irritability. It is also better for 
 women, who seldom bear the cold affusion. 
 
 As a substitute for the shallow bath the drippinr/ sheet is sometimes used. The 
 patient stands upright in an empty bath, while the attendant, placed at his back, 
 suddenly envelops him in a sheet dipped into water. The surface of the body is 
 quickly rubbed by the servant's flat hands for some three minutes, until the batlier 
 is in a glow; when a dry sheet is quickly substituted for the wet one, and the rub- 
 bing continued. The whole process should be over in five or six minutes. 
 
 136. Wet-sheet Packing, S^c. 
 
 The patient is closely enveloped in a sheet which has been dipped in cold or tepid 
 water and well wrung out. He is then carefully wrapped in a blanket, covered with 
 three or more blankets, and a down coverlet is tucked over all. He should remain 
 thus for 30, 45, or GO minutes, lying on his side, or in a semi-recumbent position ; 
 the duration being timed by the sedative effect produced. The sweating is not gener- 
 ally excessive. But the water, urea and chloride of sodium of the urine are slightly 
 increased; this increase being considerable when the sheet is continued forfou'r 
 hours. At the conclusion the shallow bath may be used for two or three minutes, 
 as a tonic. 
 
 A blanket-bath affords an easy means of inducing sweating. A blanket is wrung 
 out of hot water, and wrapped round the patient. lie is to be packed in three or four 
 dry blankets, and allow^ed to repose for thirty minutes. The surface of the body should 
 then be well-rubbed with warm towels, and the patient made comfortable in bed. 
 
 The wet-compress consists merely of a roll of flannel or calico, dipped in cold water 
 and wrung out, and then applied around the scat of pain. Over this a piece of water- 
 proof cloth is to be worn.
 
 312 APPENDIX OF FORxMUL^. 
 
 137. Tlie Warm Bath as a Cooling Agent. 
 
 The warm bath at a temperature of 95° F. must prove a cooling agent to the body 
 of a fever patient at 100° or 105° F. The immersion shoukl continue from fifteen 
 minutes to an hour or longer. Its sedative eflects render it valuable where the nerv- 
 ous system is irritable. 
 
 In cases of delirium tremens with high fever, cold superfusion may be used while 
 the patient is held in the warm bath. From ten to thirty buckets of cold water are 
 to be poured slowly over the head ; hot water being continually added to the bath to 
 maintain its heat at 95° F. This treatment generally produces sound sleep. 
 
 138. Acid Sponging. 
 
 One part of vinegar is to be added to two or three of cold water, and the body well 
 sponged with the mixture. Simple tepid water may sometimes be advantageously 
 used. The patient being weak and unable to move, the sponging must be done by 
 degrees : i. e., the arms, chest, back, and legs are to be rapidly washed and dried. 
 
 In many cases of fever, inflammation, scarlatina, &c. 
 
 VIII. CATHARTICS AND ANTHELMINTICS. 
 
 139. The Common Black Draught. 
 
 R. Magnesias Sulphatis, gr. 120; Mannae, gr. 160; Tincturae Sennse, fl. drs. ij ; 
 Infusi Sennaj, ad fl. oz. iss. Make a draught, to be taken early in the morning. 
 
 140. Calomel, Jalap, and Epsom Salts. 
 
 R. Calomelanos, gr. 5; Pulveris Jalaps, gr. 15. Make a powder, to be taken 
 immediately ; with the following draught three hours afterwards : 
 
 R. Magnesiae Sulphatis, gr. 120; Mannae, gr. 60; Tincturae Jalapae, fl. drs. ij ; 
 Aquae Carui, ad fl. oz. iss. Mix. 
 
 A good active purgative in head afl^ections, «S:c., as well as at the commencement of 
 ■many acute diseases. 
 
 141. Tlie White Mixture of Hospitals. 
 
 R. Magnesiae Sulphatis, oz. IJ; Magnesiae Carbonatis, gr. 120; Aquae Menthse 
 Piperita, fl. oz. viij. Mix. The addition of two fluid drachms of Colchicum wine is 
 sometimes advantageous. One-sixth part early every morning. 
 
 142. Epsom Salts and Sulphuric Acid. 
 
 R. Magnesiae Sulphatis, oz. 2; Acidi Sulphuric! Diluti, fl. drs. iss; Tincturae 
 Hyoscyami, fl. drs. iij ; Infusi Quassiae, ad fl. oz. viij. Mix. One-sixth part two or 
 three times a day. 
 
 In painter's colic, copper colic, &c. 
 
 R. Magnesiae Sulphatis, oz. ^; Infusi Kosae Acidi, fl. oz. ij. Make a draught, to 
 ■be taken early in the morning. 
 
 In mild febrile att'ections with constipation. 
 
 143. Crlaubers Salts and Sulphuric Acid. 
 
 R. Sodae Sulphatis, gr. 120; Ferri Sulphatis, gr. 3; Acidi Sulphuric! Diluti, 
 min. XV ; Tincturae Hyoscyami, min. xx ; Infusi Calumbie, fl. oz. ij. Make a draught 
 to be taken the first thing in the morning. 
 
 In obstinate constipation with debilit}'. 
 
 R. Sodie Sulphatis, gr. 240; Acidi Sulphurici Diluti, fl. drm.j ; Infusi Gentianse 
 •Compositi, fl. oz. vj. Mix. Three tablespoonfuls to be taken daily after luncheon 
 or dinner. 
 
 In habitual constipation with flatulence.
 
 CATHARTICS AND ANTHELMINTICS. 313 
 
 144. Crlauhers Salts and Taraxacum. 
 
 R. Sodae Sulphatis, gr. 120; Succi Taraxaci, fl. drs. iss ; Decocti Taraxaci, fl. 
 oz. ij. Make a draught, to be taken every morning before breakfast. 
 In constipation witli deficient secretion of bile. iSee F. 148. 
 
 145. Aloes, Senna, and Jalap. 
 
 R Tinctura; Sennae, Tinctura3 Jalapse, aa fl. drs. ij ; Infusi Sennaj, fl. oz. ij ; De- 
 cocti Aloes Compositi, fl. oz. vss. Mix. Two tablespoonfuls to be taken night and 
 morning. 
 
 146. Rhubarb, Gentian, and Senna. 
 
 R. TinctursB Khei, fl. drs. ij ; Infusi Gentians Compositi, Infusi Senna?, aa fl. drs. 
 vij. Make a draught, to be taken every morning an hour before breakfast. 
 A mild aperient in gouty dyspepsia. 
 
 147. Nitric Acid, Senna, and Taraxacum. 
 
 R. Acidi Nitrici Diluti, fl. drs. iss; Spiritus ^theris Nitrosi, fl. drs. ij ; Succi 
 Taraxaci, fl. oz. iss; Tincturse Sennae, fl. oz. iv ; Infusi Gentianao Compositi, ad fl. 
 oz. viij. Mix. One-sixth part twice or thrice daily. 
 
 In dyspepsia with debility and constipation. Also in passive hepatic congestion, 
 in amenorrhoea with a loaded liver, &c. 
 
 148. Alkaline Aperients. 
 
 R. Decocti Aloes Compositi, Infusi Gentianee Compositi, aa fl. oz. iv ; Liquoris 
 Potassie, fl. drs. ij. Mix. One-sixth part early every morning. 
 Useful in bilious headache. 
 
 R. Sodae Sulphatis, oz. 1§; Sodae Phosphatis, oz. 1 ; Syrupi Zingiberis, fl. drs. vj ; 
 Aquae, ad fl. oz. viij. Mix. Three large tablespoonfuls immediately ; the dose to be 
 rejjeated after two hours, unless the bowels should be freely acted on. 
 
 R. Sodiie Sulphatis, Sulphuris Praecipitati, aa oz. \\. Mix. Label, — " One tea- 
 spoonful in a tumblerful of milk and water early in the morning." 
 In rheumatoid artliritis, chronic rheumatism, sciatica, &c. 
 
 149. Pliosphate of Soda and Aloes. 
 
 R. Extracti Rhei, gr. 10; Sod;c Phosphatis, gr. 60; Decocti Aloes Compositi, fl. 
 drs. vj ; Aqute Menthte Viridis, ad fl. oz. ij. Make a draught, to be taken at bed- 
 time. 
 
 In some forms of chronic gout, jaundice from gallstones, &c. 
 
 150. Aloes, Senna, and Epsom Salts. 
 
 R. Vini Aloes, fl. drs. ij ; Infusi Sennae, fl. drs. xiv ; Magnosiie Sulphatis, oz. ^. 
 Mix. Half of this mixture to be taken about 7 o'clock in the morning, and the 
 remainder two hours after breakfast, if required. 
 
 151. Jalap and Senna. 
 
 R. Tincturae Senna, fl. oz. j ; Tincturae Jalapa?, fl. drs. ij ; Vini Colchici, fl. drm. j ; 
 Aqua- Pimentae, fl. oz. ij. Mix. Label, — " Half of this draught immediately, and 
 the remainder in six hours, if necessary." 
 
 R. Pulveris .Falapse Compositi, gr. 30; Syrupi Sennae, fl. drm. j ; Aquaj Camphoroe, 
 fl drs. xj. Make a draught, to be taken early every morning. 
 In dropsy. 
 
 152. Saline Purgative. 
 
 R. Vini Antimoniale, fl. drm. j ; Magnesiae Sulphatis, oz. J; Liquoris Ammoniae 
 Acetatis, fl. drs. iv; Syrupi Papaveris, fl. drs. vj ; Aquae Camphors, ad fl. oz. viij. 
 Mix. One-eighth part two or three times in the twenty-four hours. 
 
 In hepatic congestion, &c.
 
 314 APPENDIX OF FORMULA. 
 
 153. Sulphur and Magnesia. 
 
 R. Magnesiae Carbonatis, gr. 20; Sulpburis Pr;ecipitati, gr. 25; Sodse Bicar- 
 bonatis, gr. 10 ; Pulveris Zingiberis, gr. 3. Make a powder, to be taken earlj- in the 
 morning in a tumblerful of milk. 
 
 A valuable aperient for delicate females subject to rheumatism. Also in some skin 
 diseases. 
 
 154. Steel and Aloes. 
 
 ' R. Ferri Sulphatis Granulatse, gr. 2; Pilulse Aloes et Myrrh se, gr. 3. Make a 
 pill, to be taken thrice daily after meals. 
 
 In amenorrhcea, chlorosis, hysteria with constipation and debility, &c. See F. 421. 
 
 155. Pepsine and Aloes. 
 
 R. Pepsinse Porci, gr. 32; Extracti Aloes Barbadensis, gr. 8; Glycerini, sufficient 
 to make a mass. Divide into eight pills, silver them, and order one to be taken every 
 day at dinner. 
 
 In dyspepsia, some diseases of the rectum, certain forms of suppressed menstrua- 
 tion, &c. 
 
 156. Aloes and Cralbanum. 
 
 R. Pilulas Aloes et Myrrhte, Pilulse Assafcetidse Compositse, aa gr. 5. Make two 
 pills, to be taken night and morning. 
 
 In hysteria with attacks of flatulent colic, and in some forms of amenorrhcea. 
 
 157. Ulaterium, or Wild Cucumber. 
 
 R. Liquoris Ammoniaj Acetatis, fl. drm. j ; Spiritfis iEtheris Nitrosi, fl. drs. iv ; 
 Elaterii, gr. 1 ; Syrupi Zingiberis, fl. drs. iij. Mix. Direct, — "One small teaspoonful 
 in a wineglassful of water every two hours, until the bowels are freely acted on." 
 
 In the early stages of acute di"opsy with albuminuria. 
 
 R. Elaterii, gr. 1^; Pulveris Capsici, gr. 9; Calomelanos, gr. 12; Extracti Hyos- 
 cyami, gr. 18. Make a mass, divide into twelve pills, and order two to be taken for 
 a dose. 
 
 If a very active purgative is required, the quantity of elaterium may be doubled. 
 The Capsicum prevents the nausea which elaterium often produces. 
 
 R. Elaterii, gr. 1 ; Extracti Gentianse, gr. 12. Divide into four pills, and order 
 one to be taken every night. 
 
 In dropsical efl'usions, and where it is desirable to produce copious watery stools. 
 
 158. Gamboge and Cralbanum. 
 
 R. Pilulse Cambogise Compositse, Pilulse Assafcetidse Compositse, aa gr. 5. Make 
 two pills, to be taken every night at bedtime. 
 
 A good drastic hydragogue cathartic, acting chiefly upon the small intestines. 
 
 159. Calomel and Jalap, ^c. 
 
 R. Calomelanos, gr. 2 — 3; Pulveris Scammonii Corapositi, gr. 4; Pulveris Aro- 
 matici, gr. 5. Mix, for a powder to be taken at bedtime. 
 
 A valuable purgative in the cerebral atfections of children ; also in cases of thread- 
 worm. 
 
 R. Calomelanos, gr. 2; Extracti Jalapa?, gr. 8. Make into two pills, and order 
 them to be taken at bedtime. 
 In cerebral atiections, &c. 
 
 R. Calomelanos, gr. 6; Pulveris Jalapse Compositi, gr. 20 — 40. Make a powder, 
 to be taken every night at bedtime. 
 
 A good hydragogue cathartic. The calomel increases the effect of the jalap and 
 acid tartrate of potash (cream of tartar). 
 
 R. Calomelanos, gr. 2; Pulveris Rhei, gr. 20; Pulveris Zingiberis, gr. 2. Mix. 
 To be taken as a bolus, in a little wafer paper, at bedtime.
 
 CATHARTICS AND ANTHELMINTICS. 315 
 
 160. Podophyllum Peltatum^ or May-apple. 
 
 R. Podophylli Resinne, gr. h; Piilveris Rhei, gr. 5; Extract! Hyoscyami, gr. 3. 
 Make two jiill.*, to be taken every night at bedtime. 
 
 As a purgative in jaundice from suppression, in torpid liver, and in dropsy from 
 cardiac or renal or hepatic disease. Podophyllin produces copious bilious stools ; but 
 is rather uncertain, and is apt to gripe unless combined with henbane. 
 
 R. Podophylli Resinse, gr. 6 ; Pulveris Zingiberis, gr. 20 ; Extracti Hyoscyami, 
 gr. 24. Make a mass, divide into twelve pills, and order two to be taken every other 
 night at bedtime. 
 
 As a drastic purgative in dropsy. See F. 30. 
 
 161. Ammonia and Rliuharh. 
 
 R. Spiritfts Ammonise Aromatici, fl. drs. iij ; Tincturse Rhei, fl. drs. iv ; Infusi 
 Rhei, ad fl. oz. vj. Mix. One-sixth part to be taken night and morning. 
 
 162. Gentian, Ether, and Rhubarb. 
 
 R. Tincturse Rhei, fl. oz. j ; Tincturse Gentianae Compositae, fl. drs. iv ; Spiritfis 
 Ammoniie Aromatici, Spiritus jSitheris, aa fl. drs. iij ; Aqua; Piraentse, fl. oz. iv. 
 Mix. Two tablespoonfuls to be taken occasionally. 
 
 In cases of colic, flatulence, nausea, or languor, where a warm stomachic aperient is 
 needed. 
 
 163. Hellebore and Colehicum. 
 
 R. Tinctursa Hellebori (Phar. Lond. 1851), min. xxx; Vini Colchici, min. xxv ; 
 Tincture Rhei, fl. drs. ij ; Aqure Camphoraa, ad fl. oz. iss. Make a draught, to be 
 taken occasionally early in the morning. 
 
 Useful in gout, chronic rheumatism, &c. 
 
 164. Castor Oil. 
 
 R. Olei Ricini, fl. drs. ij — iv. To be taken occasionally about 11 a.m. The taste of 
 castor oil is entirely destroyed by mixing it with a teacupful of well salted and pep- 
 pered beef-tea. 
 
 R. Mucilaginis Tragacanthaa, fl. oz. ij ; Aquae Cinnamomi, fl. oz. iij ; Olei Ricini, 
 fl. drs. xij ; Tincturre Rhei, Syrupi Aurantii, fui fl. drs. vj ; Tincturaj Opii, min. xxx. 
 Mix. One-eighth part every three hours. 
 
 In dysentery, when there are scybala in the rectum. Also where an aperient with 
 a sedative is indicated. 
 
 165. Rhubarb and 3Iagnesia, or Soda. 
 
 R. Magnesias Carbonatis, gr. 120; Pulveris Rhei, gr. 60 ; Pulveris Aromatici, gr. 
 40; Aquaj Menthte Piperitae, fl. oz. vj. Mix. Two tablespoonfuls to be taken every 
 morning. 
 
 R. Pulveris Rhei, Sodse Bicarbonatis, aa gr. 20; Infusi Rhei, fl. oz. 1. Make a 
 draught, to be taken early in the morning two or three times a week. 
 Por gouty and rheumatic subjects. 
 
 The oflicinal Pttlvis Rhei CoMPosiTtrs, in doses of 20 to 120 grains, is a valuable 
 mild aperient where the intestinal becretions are deranged or diminished in quantity. 
 It is commonly known as Gregory's powder. 
 
 166. Epsom Salts and Sulphate of Iron. 
 
 R. Magnesiae Sulphatis, gr. 120; Ferri Sulphatis, gr. 4; Acidi Sulphurici Diluti, 
 min. XV ; Extracti Quassia?, gr. 20; Aquce Pimento, fl. oz. iss. Make a draught, to 
 be taken early in the morning. 
 
 In constipation with general debility.
 
 316 APPENDIX OF FORMULA. 
 
 167. Colocynth and Tartarated Antimony/. 
 
 R. Pilulae Colocynthidis et Hyoscyami, gr. 56; Antimonii Tartarati, gr. 4. Di- 
 vide into 12 pills, and order one to be taken every night at bedtime. 
 A valuable purgative in the cerebral congestions of strong subjects, 
 
 168. Croton Oil. 
 
 R. Olci Crotonis, min. j — ij ; Olei Caryophili, min. ij ; Micse Panis, sufficient to 
 make a pill. To be taken immediately, and repeated in two hours if necessary. 
 
 R. Olei Crotonis, min. ij ; Butyri Cacao, gr. 30. Make a suppository. To be in- 
 troduced into the rectum early in the morning. 
 
 R. Olei Crotonis, min. j — ij ; Pilula? Colocynthidis Composita?, gr. 30; Piluhe As- 
 safostidse Compositae, gr. 60. Make a mass, divide into eighteen pills and order three 
 to be taken every night at bedtime. 
 
 In cases of sciatica, obstinate neuralgia, &c., w^ith constipation. 
 
 169. Seidlitz Powder. 
 
 R. Sodpe Bicarbonatis, gr. 40; Sodae et Potassse Tartratis, gr. 120. Mix, and make 
 an etfervescing draught with thirty-seven grains of Tartaric or Citric Acid dissolved 
 in a tumblerful of water. 
 
 The Effervescent Citrate of Magnesia, in doses of a couple of teaspoonfuls, 
 in a small tumblerful of water, is a very agreeable and mild aperient. 
 
 170. Purified Ox Bile. 
 
 R. Ammonias Carbonatis, gr. 34; Fellis Bovini Purificati, gr. 36. Make a mass, 
 divide into twelve pills, silver them, and order one to be taken three hours after each 
 of the principal meals. 
 
 In dyspepsia with nausea, constipation, and a deposit of urates in the urine. 
 
 R. Pulveris Rhei, gr. 24; Fellis Bovini Purificati, gr. 20; Olei Carui, min. x ; 
 Pilulfe Assafoetidae Compositse, gr. 18. Make a mass, divide into twelve pills, and 
 order two to be taken every night two hours after supper. 
 
 To prevent an accumulation of faeces, when the large intestines are torpid. Also, 
 where there is a deficiency of bile. 
 
 R. Pilulaj Colocynthidis et Hyoscyami, Fellis Bovini Purificati, Extracti Lupuli, 
 aa gr. 20. Make a mass, divide into twelve pills, silver them, and order one to be 
 taken every day three houz*s after dinner. 
 
 In constipation with flatulence and imperfect digestion of the food. 
 
 R. Magnesise Carbonatis, gr. 30; Tincturae Jalapaa, fl. drs. ij ; Tincturae Sennas, 
 fl. oz. j ; Fellis Bovini Purificati, gr. 30; Aqua3 Camphorae, ad fl. oz. iv. Mix, and 
 label, — " Half of this mixture immediately, and the remainder in three hours if 
 necessary." 
 
 A valuable purgative when the rectum is blocked up by hardened faeces. 
 
 Capsules containing pig's bile, evaporated to dryness, have been prepared accord- 
 ing to the directions of Dr. Harley. Each capsule contains five grains of prepared 
 bile, — equal to one hundred grains of liquid bile fresh from the gall-bladder. Two 
 or three are to be taken for a dose, about two hours after a meal; when stomachal 
 digestion being nearly conij)leted, the chyme is ready to pass into the duodenum. 
 The capsules imbibe moisture in the stomach : and then in their soft swollen condi- 
 tion, generally get ruptured as they pass through the pylorus. In this way the bile 
 is mingled with the chyme at the same time that this happens in the healthy organism. 
 
 In jaundice from long-continued obstruction. Also in some forms of duodenal 
 dyspepsia arising from sedentary habits. 
 
 171. Rhubarb, Mercury, and Henbane. 
 
 R. Pilulae Hydrargyri [vel Hydrargyri cum Creta), Piluhe Rhei Compositae, Ex- 
 tracti Hyoscyami, aa gr. 20. Mix, divide into twelve pills, and order two to be 
 taken occasionally at bedtime. 
 
 Where a stronger })urgutive is required the compound colocynth may be substi- 
 tuted for the compound rhubarb pill.
 
 CATHARTICS AND ANTHELMINTICS. 317 
 
 172. Sulphate of Manganese. 
 
 R. Manganesia? Sulphatis, gr. 180; Vini Colchici, min. xv; Infusi Senna?, Tnfusi 
 Gentianix^ Compositi, Afi fl. oz. j. JVIake a draught, to be taken curly in the morning. 
 In gouty or rheumatic habits, with a doticient secretion of bile. 
 
 173. Colocynth and Assafaiida. 
 
 R. Pilulje Colocynthidis et Hj'oscyami, Pilula; Assaffjetida? Composita?, aa gr. 5. 
 Mix into two yiills. To be taken occasionally at bedtime. 
 
 In constipation with flatulence. A valuable purgative for hypochondriasis. 
 
 174. Gamboge, Aloes, and Blue Pill. 
 
 R. Pilulffl Cambogiae Compositfe, gr. 5; Pilulse Hydrargyri, gr. 3. Make two 
 jiills, to be taken night and morning. 
 
 In dropsy from cardiac or hepatic disease, where a drastic purgative is required. 
 
 175. Extract of Nux Vomica. 
 
 R. Extracti Nucis Vomicte, gr. 3 ; Pulveris Ipecacuanhas, gr. 6 ; Pilulae Rhei 
 Composite, vel Pilula? Aloes et AssafoetidaJ, gr. 40. Make a mass, divide into twelve 
 pills, and order two to be taken every alternate night at bedtime. 
 
 In habitual constipation from atony of the coats of the bowel, with deficient secre- 
 tion of intestinal mucus. 
 
 R. Extracti Nucis Vomicae, gr. 2; Extracti Aloes Barbadensis, gr. 6; Extracti 
 Rhei, gr. 20. Mix, and divide into six pills. One to be taken every day at dinner. 
 In some diseases of the rectum, &c. 
 
 R. Extracti Hyoscyami, gr. 40; Pilula? Colocynthidis Composita?, gr. 20; Ex- 
 tracti Nucis Vomica?, gr. 3. Mix, and divide into twelve pills. Two to be taken 
 every night. 
 
 In habitual constipation. They may be continued for about ten days. See F. 378, 
 387, and 409. 
 
 176. Rhubarb and Magnesia for Infants. 
 
 R. Pulveris Rhei, gr. 15: Magnesiae Carbonatis, gr. 60; Aquae Anethi, fl. oz. iss. 
 Mix, and order one teaspoonful to be taken every two hours until the bowels are 
 freely acted on. 
 
 177. Sulphate of Zinc. 
 
 R. Zinci Sulphatis, Extracti Gentiana?, iia gr. 5. Make into two pills, and order 
 them to be taken three times a day. 
 
 Recommended by Mr. Baly, in habitual constipation, after the bowels have been 
 cleared out with a purgative of calomel and colocynth. The pills should be taken 
 immediately after meals, for two or three weeks. 
 
 178. Quinine and Rhubarb. 
 
 R. Quiniae Sulphatis, gr. 2; Extracti Lupuli, gr. 5; Pilulae Rhei Compositse, gr. 
 3. Mix into two pills, and order them to be taken every day at dinner. 
 Useful in some forms of dyspepsia. 
 
 179. Ipecacuan, Rhubarb, and Oxide of Silver. 
 
 R. Pulveris Ipecacuanha?, gr. 1 ; Pulveris Rhei, gr. 3 ; Argenti Oxidi, gr. 1 ; Con- 
 fectionis Rosse Canina?, suflicient to form a pill. 
 
 A good dinner pill where there is uneasiness and oppression after meals, the result 
 of slow digestion. 
 
 180. Steel, Glauber's Salts, ^c. 
 
 R. Eerri Sulphatis Granulata?, gr. 10; Sodae Sulphatis, Magnesia? Sulphatis, iia oz. 
 1; Sodii Chloridi, gr. 120; Aquae, Oj. Mix. Four tablcspoonfuls in a tumblerful 
 of warm water early in the morning. 
 
 A rough imitation of the Cheltenham Waters. Useful in debility with constipa- 
 tion.
 
 318 APPENDIX OF FORMULA. 
 
 181. Steel, Glauber s Salts, and Soda. 
 
 R. Sodse Bicarbonatis. gr. 60; Sodii Chloridi, gr. 4; Sodre Sulphatis, gr. 10; Mag- 
 nesifB Sulphatis, gr. 3 ; Ferri Sulphatis, gr. \ — 1 ; Aquae, Oj. Mix. By adding forty 
 grains of Citric Acid an effervescing water is produced. 
 
 A rough imitation of the Vichy Waters. In some forms of chronic gout, &c. 
 
 R. Sodai Sulphatis, gr. 120—240; SodfB Carbonatis, gr. 20; Sodii Chloridi, gr. 15; 
 Cretaj Preparataj, gr. 10; Ferri Carbonatis Saccliaratte, gr. 15. Make a powder, and 
 direct it to be taken early in the morning in half a pint of water. 
 . An imitation of the Carlsbad Waters. 
 
 182. JCamela, as an Anthelmintic. 
 
 R. Pulveris Kamelaj, gr. 60 — 180, vel Tincturas Kamelae, fl. drs. ij ; Syrupi Au- 
 rantii, fl. drs. ij ; Mucilaginis Tragacanthfe, fl. oz. iss ; Aquse, ad fl. oz. iij. Make a 
 draught, to be taken earlj' in the morning. A purgative should be administered six 
 hours afterwards. Kamela is an orange-red resinous substance found adhering to the 
 capsules of the Rottlera tinctoria, and is imported from India. 
 
 Strongly recommended in tapeworm. 
 
 183. TurjMntine, as an Anthelmintic. 
 
 R. Olei Ricini, fl. drs. iv ; Olei Terebinthinse, fl. drs. iij ; Mucilaginis Tragacanthte, 
 fl. drs. iv ; Syrupi Zingiberis, fl. drm.j ; Aquse, fl. drs. iv. Make a draught, to be 
 taken early in the morning. 
 
 In tapeworm, &c. 
 
 184. Kousso, as an Anthelmintic. 
 
 R. Cusso, in pulvere, gr. 240; Mellis Depurati, sufficient to make an electuary. 
 Label, — " Half of this electuary to be taken early in the morning, and the remainder 
 six hours afterwards." 
 
 In tapeworm. 
 
 The officinal Infusum Cusso may also be taken in the same way, in doses of fl. 
 oz. iv. 
 
 185. Santonin, as an Anthelmintic. 
 
 R. Santonini, gr. 2 — 6; Sacchari Lactis, gr. 15. Make a powder. To betaken 
 early in the morning, suspended in a tablespoonful of cream. The patient ought to 
 have fasted for twelve hours previously. The dose may be repeated for eight or ten 
 days, if necessary ; and its exhibition should be followed at the end of six hours by 
 the administration of an ounce of the Compound Decoction of Aloes. 
 
 A specific for the ascaris lumbricoides. Less useful for the ttenia solium and 
 oxjj^uris vermicularis. The patient should be warned that after a few doses the sight 
 sometimes becomes perverted, so that objects seem to acquire a blue or yellow or some 
 other color. 
 
 186. Pomegranate, as an Anthelmintic. 
 
 R. Spiritus ^theris, fl. drm. ss — j ; Decocti Granati Radicis, fl. oz. j — ij. Make a 
 draught, to be taken every three hours until four doses have been used. 
 
 R. Granati Radicis Corticis, gr. 180; Pulveris Sabadilla?, gr. 6; Pulveris Aro- 
 matici, gr. 60. Mix, and divide into six powders. One to be taken every two hours, 
 ■until the whole is consumed. 
 
 More active than the preceding. A saline purge should be given after the last dose. 
 
 187. 3fale Fern, as an Anthelmintic. 
 
 R. Extracti Filicis Liquidi, fl. drs. j — ij ; Syrupi Zingiberis, fl. drs. ij ; Mucilaginis 
 Tragacanthse, fl. oz. j ; Aquie, ad fl. oz. iv. Make a draught, to be taken earlj' in the 
 morning; only liquid nourishment having been allowed the previous day. Four hours 
 afterwards a purgative dose of castor oil or aloes should be administered. 
 
 Especially useful for destroying tapeworms.
 
 CAUSTICS AND COUNTER-IRRITANTS. 319 
 
 188. Simple Enemata. 
 
 R. Sodii Chloridi, oz. 1; Decocti Hordei, fl. oz. xij. Mix, to form an Enema. 
 In simple constipation, to destroy oxyurides, &c. 
 
 R. Olc'i 01iva>, fl. oz. vj — viij. To be warmed and then injected into the rectum. 
 It should be retained f(jr twelve or eighteen hours. 
 
 Very useful in structural disease of the bowel, impaction of hardened fa;ces, &c. 
 
 R. Olei Olivaj, fl. drs. xij ; Magnesias Sulphatis, gr. 220; Decocti Hordei, ad fl. oz. 
 xij. Mix, for an Enema. 
 
 R. Saponis Mollis, oz. 1 ; Aqusc Calidte, fl. oz. xij. Mix, for an Enema. 
 
 189. Castor Oil and Rue Enema. 
 
 R. Olei Kutffi, min. vj ; Olei Ricini, fl. oz. j ; Tincturae Assafcetida, fl. drs. ij ; De- 
 cocti Aven£e, fl. oz. vij. Mix. 
 
 Exceedingly useful in flatulent colic. 
 
 190. Castor Oil and Turpentine Enema. 
 
 R. Olei Ricini, fl. drs. xij ; Olei Terebinthinse, fl. drs. iv ; Tincturae Assafcetidae, fl. 
 drs. ij ; Decocti A vena?, ad fl. oz. xij. Mix. 
 
 In obstinate constipation. It should be thrown up into the bowel by means of a 
 long tube like that of the stomach-pump. 
 
 191. Croton Oil Enema. 
 
 R. Olei Crotonis, min. vj ; Olei Ricini, fl. oz. j ; Olei Terebinthinae, fl. drs. ij ; 
 Decocti Hordei, ad fl. oz. vj. Mix. 
 In obstinate constipation. It should be retained for three or four hours, if possible. 
 
 192. Steel Enema. 
 
 R. Tincturae Ferri Perchloridi, fl. drs. j — iij ; Infusi Quassiae, fl. oz. viij. Mix. 
 To destroy oxyurides. It has often seemed advantageous to the author to admin- 
 ister a dose of calomel and scammony at the same time. 
 
 193. Tobacco Enema. 
 
 R. Tabaci Communis, gr. 15: Aquae Bullientis, fl. oz. viij. Mix. 
 To be employed cautiously in some exceptional cases of strangulated hernia, ob- 
 stinate constipation, &c. 
 
 194. Purgative Electuaries. 
 
 R. Confectionis Sennae, Potassae Tartratis Acidfe, Succi Taraxaci, aa oz. 1. Mix. 
 One teaspoonful, to be taken occasionally, an hour before breakfast. 
 In constipation with inactive liver or hemorrhoids. 
 
 R. Confectionis Piperis, Syrupi Sennae, Confectionis Sulphuris, aa oz. 1 ; Pulveris 
 Jalapae, gr. 10. Mix. One teaspoonful every morning. 
 In constipation with chronic rheumatism. 
 
 R. Confectionis Sennae, Confectionis Scammonii, Syrupi Zingiberis, aaoz. 1 ; Ferri 
 Carbonatis Saccharatae, gr. 220. Mix. One teaspoonful early every morning. 
 In some forms of constipation and want of tone. 
 
 IX. CAUSTICS AND COUNTER-IRRITANTS. 
 
 195. Acid Solution of Nitrate of Mercury. 
 
 R. Liquoris Hydrargyri Nitratis Acidi, fl. drs. ij ; Pulveris Tragacanths Com- 
 positi, sufficient to make a mass.
 
 320 APPENDIX OF FORMULA. 
 
 Instead of this paste it is sometimes better to apply the caustic fluid itself, in cer- 
 tain cases of cancer or lupus. The solution may also be carefully used to sloughing 
 ulcers, boils, small najvi, &c. It is to be verj' lightly painted on by means of a glass 
 brush, or a glass rod. 
 
 196. Chromic Acid. 
 
 R. Acidi Chromici, gr. 60; Aquse, fl. drs. iv. Mix. 
 To destroy warts, small growths of epithelial cancer, &c. 
 
 197. Chloride of Zinc, ^c. 
 
 R. Bromii Chloridi, Zinci Chloridi, Auri Chloridi, Antimonii Chloridi, of each 
 equal })arts. Mix into a paste of sufficient thickness with flour or powdered liquorice. 
 To destroy cancerous growths. Commonly known as Landolfi's paste. 
 
 R. Sanguinaria? Canadensis, oz. J — 1; Zinci Chloridi, oz. ^ — 2; Aqua;, fl. oz. ij ; 
 Farinje, sufficient to make a paste. Mix. 
 
 The paste thus formed should have the consistence of treacle. This is the caustic 
 which was employed by Dr. Fell. 
 
 R. Zinci Chloridi, gr. 30 — 60; Farinae, gr. 120; Aquae Destillatie, sufficient to 
 form a mass. To be applied over the diseased surface. 
 
 198. Supersulphate of Zinc. 
 
 Take half a fluid ounce of sulphuric acid, and saturate it with sulphate of zinc, pre- 
 viously dried and powdered. Sir J. Y. Simpson recommends that this caustic should 
 be used by dipping a pen in it, and then drawing lines across the tumor, so as to eat 
 through the skin in a few minutes. The fissures thus made are to be filled with the 
 paste; renewing the scratching and caustic every day or two. In this way, five or 
 eight days may suffice for the removal of a good-sized tumor. By this combination 
 also we can penetrate deeply without hardening the parts, and without fear of pro- 
 ducing hemorrhage. 
 
 This is a very valuable caustic, and has been found particularly useful by the author 
 for the removal of cancerous tumors of the breast, &c. The pain which it produces 
 will be best mitigated by employing the subcutaneous injection of morphia (F. 314) 
 at each application. 
 
 199. Arsenical Mucilage. 
 
 R. Acidi Arseniosi, Pulveris Acacise, aa oz. 1 ; Aqune, fl. drs. v. Mix. 
 
 Dr. Marsden speaks highly of this caustic in cjiithelioma. The afl'ected part is to 
 be painted over with it night and morning ; taking care rigorously to limit the appli- 
 cation to the diseased parts, and not to let it extend over more than one superficial 
 inch at a time. As the part sloughs, its separation is to be aided by bread-and-water 
 poultices ; and when all the disease has been got rid of by the repeated ap})lications 
 of the mucilage, a carrot poultice is to be applied during the night, and a weak black- 
 wash (calomel gr. 60 to lime-water Oj) during the day until the part is healed. 
 
 200. Lime and Arsenic Powder. 
 
 R. Calcis recentis, oz. ^ ; Arsenici Sulphureti Flavi, gr. 20; Pulveris Amyli, gr. 
 180. Mix, to form a powder. 
 
 To be used very cautiously as a depilatory powder. 
 
 201. Med Oxide of 3Iercury Powder. 
 
 R. Hydrargyri Oxidi Kubri, Aluminis, aa gr. 60. Make a powder. 
 
 To be sprinkled over exuberant and spongy granulations. 
 
 202. Carbonate of Copper Ointment. 
 
 R. Cupri Carbonatis, gr. 60; Adipis Preparati, oz. ^. Mix, to form an ointment. 
 Devkroie. — In chronic eczema and impetigo of the scalp where stimulating appli- 
 cations are required. 
 
 203. Dupu'i/tren 8 Arsenic and Caloinel Powder. 
 
 R. Acidi Arseniosi, gr. 12 ; Calomelanos, oz. 1. Mix. 
 In ulcerated lupus. Must be cautiously used.
 
 DIAPHORETICS AND DIURETICS. 321 
 
 204. Vienna Caustic. 
 
 R. Potassnc Ilydratis, Calcis, fiu oz. 1. Mix thoroughly. 
 
 This paste is dikitnd witii alcohol, and applied with a spatula over a small surface. 
 It is identical with the Potassa cum calce of the London Pharmacopoeia. 
 
 205. Iodine Paint. 
 
 R. lodinii, gr. 40 — CO; Potassi lodidi, gr. 30; Spiritus Vini Eectificati, fl. oz. j. 
 Mix. 
 To be applied with a camel's- hair pencil. Very useful in many chronic pains, &c. 
 
 R. lodinii, Potassi lodidi, aa grs. 20; Collodii, fl. oz. j. Mix. 
 
 The oflBcinal Linimkntum Iodi may also be used, but it must be diluted with from 
 three to six parts of spirit or glycerine, or tincture of aconite. 
 
 206. Tartar Emetic Embrocation. 
 
 R. Antimonii Tartarati, gr. 40; Aqua? Eos.-e, fl. oz. ij. Mix, and then add Tinc- 
 tur;e Cantharidis, fl. oz. j. Make an embrocation. 
 
 To be employed if the Unguentum antimonii tartarati (Phar. Brit.) fails to produce 
 the required erudition. 
 
 207. Croton Oil Liniment. 
 
 R. Olei Crotonis, min. xxx ; Olei Olivae, fl. drs. ijss. Mix, for a liniment. 
 
 To produce rubefaction and a pustular eruption, where counter-irritation is re- 
 quired to relieve diseases of internal organs. The ofiicinal liniment is only 1 part to 
 7, and is scarcely strong enough. 
 
 208. Blistering and Epispastic Papers. 
 
 These papers of M. Albespeyre have long been used in this country with great 
 advantage, though they are less appreciated than in France. 
 
 They consist — of an epispastic paper for dressing blisters; a dulcifying paper for 
 issues, causing neither smell noc pain ; and blisters formed of an adhesive cloth with- 
 out a plaster. 
 
 The Epispastic Paper, for dressing blisters, is prepared of four degrees of strength, 
 under the designation of No. 1 feeble, No. 1, No. 2, and No. 3. No. 1 feeble possesses 
 the least strength, and is suitable as a dressing for persons of irritable temperament, 
 and for children. No. 1 has rather more salve spread upon it, and is adapted for 
 patients whose blisters have risen well. No. 2 is employed for those whose blisters 
 do not draw sufliciently, and require stimulating. Whilst No. 3 possesses a still 
 stronger power, and is used only in cases where the blister has a tendency to dry up. 
 They all maintain an abundant discharge, without pain or heat; prevent the forma- 
 tion of false membranes ; produce no irritation of the urinary passages ; and cause 
 no disagreeable smell. 
 
 The blisters — applied by the adhesive black side — readily adhere to the skin, pro- 
 ducing vesication in a few hours (twelve at the furthest) ; and, if necessary, the same 
 piece put on four or five times always produces the blistering eft'ect. 
 
 X. DIAPHORETICS AND DIURETICS. 
 
 209. Nitr^ and Ipecacuan, 
 
 R. PotassfB Nitratis, gr. 60, vel Potassie Citratis, gr. 120; Vini Ipecacuanha?, fl. 
 drs. iss ; Syrupi Hemidesmi, fl. oz. j ; Decocti Hordei, ad Oj. Mix. One teacui)ful 
 to be taken every two or three hours. 
 
 In severe catarrh with sore throat. 
 
 21
 
 322 APPENDIX OF FORMULA. 
 
 210. Antimony and Opium. 
 
 R. Yini Antimoniale, fl. drs. j — ij ; Liquoris Abimoniffi Acetatis, fl. drs. iv ; Ex- 
 tract! Opii Liquidi, min. xxx ; Aquae CamjDhoriB, ad fl. oz. vj. Mix. One-sixth part 
 three times a day. 
 
 Each fluid drachm of the wine contains one-quarter of a grain of antimony. 
 
 211. Citrate of Potash and Ammonia. 
 
 R. Potassje Citratis, gr. 120; Liquoris Ammonise Acetatis, fl. drs. iv ; Spiritus 
 Ammoniae Aromatici, fl. drs. iij ; Tincture Aconiti, min. xx ; Aquae, ad fl. oz. viij. 
 Mix. One-sixth part every four or six hours. 
 
 In pneumonia, and many other acute inflammations. Sometimes it is preferable 
 to give only the Solution of Acetate of Ammonia diluted with water (one fluid drachm 
 to two ounces). • 
 
 211. Ether and Ammonia. 
 
 R. Potassae Nitratis, gr. 30 — 60; SpiritCis ^theris Nitrosi, fl. drs. iij; Liquoris 
 Ammonite Acetatis, fl. drs. iv ; Aquae Camphorae, ad fl. oz. viij. Mix. One-sixth 
 part three or four times a day. 
 
 In the early stages of many febrile and inflammatory disorders. 
 
 R. Ammoniae Carbonatis, gr. 18 — 30 ; Spiritus Chloroformi, fl. drs. vj ; Vini 
 Colchici, min. xxx ; Liquoris Ammonice Acetatis, fl. drs. iij — vj ; Mucilaginis Traga- 
 canthas, fl. oz. iv ; Aquae, ad fl. oz. viij. Mix. One-sixth part every four hours. 
 
 Valuable in some forms of pneumonia, &c. 
 
 213. Dover 8 Powder and Antimony, ^-c. 
 
 R. Pulveris Ipecacuanhae cum Opio, gr. 5; Antimonii Tartarati, gr. \. Mix, and 
 make a powder, to be taken every six hours. 
 
 R. Pulveris Opii, Pulveris Ipecacuanhae, aA gr. 1 ; Potassae Nitratis, gr. 8. Make 
 & powder, to be taken every night at bedtime. 
 
 An improvement on the ordinary Dover's powder. 
 
 214. Senega and Guaiac. 
 
 R. Tincturae Guaiaci Ammoniatae, fl. drs. iij — vj ; Mucilaginis Tragacanthae, fl. 
 oz. iij. Mix thoroughly together, and then add, — Infusi Senegie, ad fl. oz. viij. 
 Three tablespoonfuls to be taken thrice daily. 
 
 Useful in the latter stages of bronchitis, tonsillitis, «S:c. The action is diaphoretic, 
 diuretic, stimulant, and expectorant. 
 
 R. Tincturre Guaiaci Ammoniatae, fl. drs. ij ; Vitelli Ovi, 1. Beat thoroughly 
 together, and then add, — Misturas Amygdalae, fl. oz. iv. Direct, one-half to be taken 
 twice a day. 
 
 In chronic rheumatism. 
 
 215. Benzoate of Ammonia. 
 
 R. Ammoniae Benzoatis, gr. 60 — 120; Syrupi Hemidesmi, fl. oz. j ; Aqua?, ad fl. 
 oz. viij. Mix. One-sixth ])art three times a day. 
 
 As a diuretic in dropsy and gout. Also in catarrhal inflammation of the bladder 
 with alkaline urine. 
 
 216. Ipecacuan and Syrup of Poppies. 
 
 R. AMni Ipecacuanha', fl. drs. ij ; Syrupi Papaveris, fl. drs. iij ; Mucilaginis Traga- 
 canthae, fl. oz. j ; Aquic, ad fl. oz. iij. Mix. One teaspoonful every two or three 
 hours. 
 
 An infantile couirh mixture.
 
 DIAPHORETICS AND DIURETICS. 323 
 
 217. Antimony and Ipecacuan, 
 
 R. Vini Antimoniiilo, fl. drs. iss ; Vini Ipccacuanhse, fl. clrs. ij ; Syrupi Rhcinados, 
 fl. drs. iij ; Liquoris Ainmoniio Acetatis, fl. drs. ij ; Aqute, ad fl. oz. vj. Mix. A 
 small tablespooufiil every two lidurs. 
 
 A depressing mixture'for children two or three years of age. 
 
 218. Ipecacuan and Syrup of Poppies. 
 
 R. Vini Ipecacuanliie, fl. drs. ij ; Syrupi Papaveris, fl. drs. iij ; Liquoris Ammonije 
 Acetatis, fl. drs. ij ; iSpiritus ^Etlieris Nitrosi, fl. drm. j ; Aquae, ad fl. oz. ij. Mix. 
 One teaspoonful every two or three hours. 
 
 In the early stage of infantile fever, severe catarrh, bronchitis, and pneumonia. 
 
 219. Squills, Digitalis, Broom, ^c. 
 
 R. Potassiie Acetatis, gr. 120; Syrupi Scilla3, fl. drs. vj ; Spiritus yEtheris Nitrosi, 
 fl. drs. iij ; Tiacturte Digitalis, min. xxx — fl. drm. j ; Succi Scoparii, fl. drs. vj ; 
 Aquie, ad fl. oz. viij. Mix. One-sixth part every six or eight hours. 
 
 As a diuretic in dropsy dependent upon disease of the heart, liver, or peritoneum. 
 
 R. Tincturse Scilla3, fl. drs. ij ; Tincturae Camphorse cum Opio, fl. drs. iv; Liquoris 
 Ammonias Acetatis, fl. drs. iv ; Decocti Scoparii, ad fl. oz. viij. Mix. One-sixth part 
 three times a day. 
 
 Diuretic and diaphoretic. In dropsies unaccompanied by inflammation, and not 
 due to renal disease. 
 
 R. Spiritus Juniperi, fl. drs. ij ; Potass* Tartratis Acidae, oz. 1; Decocti Scoparii, 
 ad fl. oz. xij. Mix. One-sixth part three times a day. 
 Diuretic and laxative. 
 
 R. Pulveris Scillfe, gr. 6 ; Pulveris Digitalis, gr. 8 — 12; Pilulae Hydrargyri, gr. 30 
 Make a mass, divide into twelve pills, and order one to be taken night and morning 
 with a wineglassful of the Decoctum Scoparii. See F. 224. 
 
 220. Solution of Potash and Digitalis. 
 
 R. Liquoris Potassaj, fl. drs. j — ij ; Spiritus ^Etheris Nitrosi, fl. drs. vj.; Tincturse 
 Croci, fl. drs. iij ; Infusi Digitalis, fl. drs. xij ; Syrupi, fl. drs. vj ; Aquie, ad fl. oz. viij. 
 Mix. One-sixth part three times a day. 
 
 A valuable diuretic in some forms of cardiac and hepatic dropsy. 
 
 221. Nitre, Juniper, and Ether. 
 
 R. Potasspe Nitratis, gr. 60; Spiritus Juniperi, fl. drs. j — ij ; Spiritus ^Etheris 
 Nitrosi, fl. drs. iij ; Decocti Chimaphilaj (Phar. Lond. 1851), ad fl. oz. viij. Mix. 
 One-sixth part every six hours. 
 
 A tonic and stimulating diuretic. In scrofula, atonic dropsies, catarrhal inflam- 
 mation of the bladder, and some skin diseases. 
 
 222. Buchu and Cream of Tartar. 
 
 R. Potassaj Tartratis Acidaj, gr. 180; Infusi Bucco, fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 Diuretic and laxative. In irritable conditions of the bladder owing to excess of 
 uric acid in the urine. Also in chronic rheumatism, dropsy, and some cutaneous 
 diseases. 
 
 223. Buchu, Borax, and Pareira. 
 
 R. Boracis, gr. 40; Tincturse Bucco, fl. drs. vj ; Extracti Pareira?, oz. \; Decocti 
 Pareirffi, ad fl. oz. viij. Mix. One-sixth part every six or eight hours. 
 In chronic catarrh of the bladder, calculous aflections, &c.
 
 324 APPENDIX OF FORMULA. 
 
 224. Digitalis, Squills, cj-c. 
 
 R. PotassEO Citratis, gr. 200; Tincture Scillaj, fl. drs. ij ; Vini Colchici, fl. drs. 
 iss ; Liquoris AmmoniiB Acetatis, fl. drs. ij ; Infusi Digitalis, fl. oz. iij ; Aqua3 Menthae 
 Piperitas, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 Diuretic and sedative. In some forms of dropsy with disease of the mitral valve. 
 
 R. Pulveris Digitalis, Pulveris Scillix% aa gr. 12; Extracti Taraxaci, gr. 86. Make 
 a mass, divide into twelve pills, and order one to be taken twice a day. 
 
 Valuable as a diuretic in mitral, but injurious in aortic disease. See F. 219. 
 
 225. Urea. 
 
 R. Urefe, gr. 5 — 15 ; Syrupi Aurantii, fl. drm. j ; Aqua, fl. oz. j. Make a draught, 
 to be taken every six hours. 
 
 Recommended by the author as a diuretic in dropsj^ due to cardiac disease. See 
 Medical Times and' Gazette, 8th May, 1852. 
 
 226. Cantharides ajid Nitrous Ether. 
 
 R. Tincturse Cantharidis, fl. drs. j — ij ; Spiritiis ^theris Nitrosi, fl. drs. iij ; 
 Spiritus Juniperi, fl. drs. iv ; Syrupi Zingiberis, fl. drs. vj ; Aquae, ad fl. oz. viij. 
 Mix. One-sixth part three times a day. 
 
 May be cautiously tried in some cases of suppression of urine. Also in some skin 
 diseases. 
 
 227. Taraxacum and Nitric Acid. 
 
 R. Acidi Nitrici Diluti, fl. drm. j ; Succi Taraxaci, fl. drs. vj ; Decocti Taraxaci, 
 ad fl. oz. viij. Mix. One-sixth ])art three times a day. 
 
 Laxative, alterative, and diuretic. Especially useful in disease of the liver unac- 
 companied by inflammation. 
 
 228. Cream of Tartar and Taraxacum. 
 
 R. Potassae Tartratis Acidae, oz. 1 ; Extracti Taraxaci, gr. 30; Decocti Taraxaci, 
 fl. oz. viij. Mix. One-sixth part three times a da^^ 
 In jaundice independent of hepatitis or obstruction of the duct of the gall-bladder. 
 
 229. Oil of Juniper. 
 
 R. Olei Jutiiperi, min. xx ; Syrupi Limonis, fl. drs. vj ; Mucilaginis Acaciao, fl. oz. 
 iv ; Aquse, ad fl. oz. viij. Mix. One-sixth part every six or eight hours. 
 
 The oil of juniper has not only a diuretic action, but it is also a diaphoretic and an 
 emmenagogue and a cathartic. In too large doses it may cause inflammation of the 
 bladder. 
 
 230. Conium, Digitalis, and Calomel. 
 
 R. Pulveris Digitalis, Calomelanos, aa gr. 5; Extracti Conii, gr. CO. Make a 
 mass, divide into fifteen pills, and order one to be taken three times a day. 
 As a sedative and diuretic in dropsy from cardiac disease. 
 
 XI. EMETICS AND EXPECTORANTS. 
 
 231. Depressing Emetics. 
 
 R. Antimonii Tartarati, gr. 1—2; Vini Ipecacuanha?, fl. drs. ij ; Aqute, ad fl. oz- 
 iss. Make a draught, to be taken immediately. 
 Its action should be aided by the free administration of warm water. 
 
 R. Antimonii Tartarati, gr. 1; Pulveris Ipecacuanhse, gr. 20. Make a powder. 
 To be taken in honey or cream, or as a bolus in wafer paper. 
 
 R. Vini Ipecacuanhse, fl. oz. j. To be taken when it is desired to induce vomiting. 
 For children one fluid drachm, in sweetened water, will generally suflice.
 
 EMETICS AND EXPECTORANTS. 325 
 
 232. Stimulant Emetics. 
 
 R. Pulveris Sinapis, oz. \] Aquae, fl. oz. iij. Make a draught. To be taken im- 
 mediately. 
 R. Cupri Sulphatis, gr. 10; Aquie, fl. oz. iij. Make an emetic draught. 
 R. Ziuci Sulphatis, gr. 20 — 40; Aqua3, fl. oz. iij. Mix. 
 
 233. A Warm Emetic. 
 
 R. Pulveris Ipecacuanha}, Ammonia3 Carbonatis, afi gr. 20; TincturiB Lavandulae 
 Composit;c, fl'. drm. j ; Aqua% fl. oz. ij. Make a draught. After taking it, a tumbler- 
 ful of infusion of Chamomile Flowers (Infusum Anthemidis) should be drunk. 
 
 Suggested by a formula of Dr. Druitt's. In the incipient stages of fever, erysipe- 
 las, &c. 
 
 234. Tartar Emetic Mixture. 
 
 R. Antimonii Tartarati, gr. 2; Syrupi Khoeados, Aqua?, aa fl. drs. iv. _ Mix and 
 label, — " One teaspoonful every two hours, in a wineglassful of water, until there is 
 nausea." 
 
 As a depressant to the circulating and nervous systems. 
 
 235. Ammonia and Senega. 
 
 R. Ammonia? Carbonatis, gr. 30; Spiritus iEtheris, fl. drs. iij; Tincturre Scillse» 
 fl. drs. iss ; Tinctura? Camphorje cum Opio, fl. drs. ij — iv ; Tincturto Lavandula? Cora- 
 positie, fl. drs. vj ; Infusi Senegae, ad fl. oz. viij. Mix. Two tablespoonfuls every 
 four hours. 
 
 In the chronic bronchitis of old people. 
 
 R. Spiritus Ammonia? Aromatici, fl. drs. iv ; Spiritus Chloroformi, fl. drs. iij ; 
 Tinctura? Aconiti, min. xxx ; Tincturaa Senegse, fl. drs. vj ; Aquse Carnphora?, ad fl. 
 oz. viij. Mix. One-sixth part every six hours. 
 
 A valuable stimulating expectorant in some cases of bronchitis. 
 
 R. Ammonise Carbonatis, gr. 12; Vini Ipecacuanha, min. xl ; Tincturse Senegse, 
 fl. drs. ij ; Syrupi Rhceados, fl. drs. iij ; Aqua?, ad fl. oz. iij. Mix. One dessertspoon- 
 ful every two or three hours. 
 
 An excellent stimulating expectorant for young children recovering from croup. 
 In hooping-cough, where the bronchi are loaded with mucus. 
 
 236. Squills, Nitric Acid, and Bark. 
 
 R. Syrupi Scillie, fl. drs. vj ; Acidi Nitrici Diluti, fl. drra. j ; Tinctura? Hyos- 
 cyami, fl. drs. iij ; Spiritus Chloroformi, fl. drs. vj ; Infusi Cinchonae Flava?, ad fl. oz. 
 viij. Mix. One-sixth part twice or thrice daily. 
 
 In chronic catarrh with debility and restlessness. 
 
 237. Ammoniacum and Opium. 
 
 R. Tincture Scillas, fl. drs. iss; Extracti Opii Liquidi, min. xx — xxx; Syrupi 
 Tolutani, fl. drs. vj ; Misturse Ammoniaci, ad fl. oz. vj. Mix. One-sixth part three 
 times a day. 
 
 A sedative and expectorant mixture in the chronic bronchitis of elderlj' people. 
 
 238. Sarsaparilla and Squills. 
 
 R. Extracti Sarsfe Liquidi, Syrupi Scilhe, aa fl. drs. xij. Mix, and label, — "One 
 teaspoonful in a teacupful of barley-water frequently during the day." 
 
 An agreeable demulcent and expectorant in inflammation of the mucous mem- 
 branes about the throat and air-passages. 
 
 239. Squills, Ammonia, and MorpJiia. 
 
 R. Syrupi Scillpe, fl. drs. vj ; Spiritus Ammonise Aromatici, fl. drs. iij ; Liquoris 
 Morphia? Hydrochloratis, fl. drm. j (equivalent to half a grain of the salt) ; Infusi 
 Serpentaria^, ad fl. oz. viij. Mix. One-sixth part twice or thrice a day. 
 
 In chronic catarrh.
 
 326 APPENDIX OF FORMULA. 
 
 240. Antimony and Ether. 
 
 R. Yini Antimoniale, fl. drs. iss ; Spiritus Athens, fl. drs. iij ; Muoilaginis Trag- 
 acanthit, fl. oz. iij ; Aqiue, ad fl. oz. vj. Mix. One-sixth part every four hours. 
 
 The quantity of antimonial wine should be doubled when it is desirable to induce 
 nausea. 
 
 241. Ipecacuan and Indian Sarsaparilla. 
 
 U. Yini Ipecacuanhje, fl. drs. ij ; Syrupi Hemidesmi, fl drs. iij ; Mucilaginis 
 Acaciffi, fl. oz. j ; Aquje, ad fl. oz. ij. Mix. One teaspoonful every two hours. 
 Tor children threatened with an attack of croup or bronchitis. 
 
 R. Yini Ipecacuanhse, fl. drs. i j ; Syrupi Hemidesmi, fl. oz. j ; Infusi Lini, ad fl. 
 oz. viij. Mix. One-sixth part every four hours. 
 An emollient and expectorant in catarrh. 
 
 242. Indian Tobacco and Hemlock. 
 
 R. Tincturse Lobelife yEtherese, fl. drs. iij ; Syrupi Papaveris, fl. drs. vj ; Tincturse 
 Conii Fructus, fl. drs. ij — iv ; Misturse Amygdahe, ad fl, oz. vj. Mis. One-sixth 
 part every four hours. 
 
 In spasmodic cough, and some forms of asthma. 
 
 243. Squills and Hemlock. 
 
 R. Pilulffi Scillfe Composite, Extracti Conii, aa gr. 30. Make a mass, divide into 
 twelve pills, and order two to be taken every night at bedtime. 
 In chronic catarrh when opium is objectionable. 
 
 244. Nitrous Uthcr, IpecacuanJia, and Hemlock. 
 
 R. Yini Ipecacuanha, fl. drs. iss ; Spiritus ^Etheris !Nitrosi, fl. drs. vj ; Succi Conii, 
 fl. drs. iij ; Infusi Senegas, ad fl. oz. viij. Mix. One-sixth part every six hours. 
 In chronic bronchitis, when an expectorant and sedative is required. 
 
 245. Didcamara and Stramonium. 
 
 R. Tinctura3 Scilla3, fl. drs. ij ; Tincture Stramonii, fl. drs. iss; Infusi Dulcamarse, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In chronic catarrh and rheumatism, esj^ecially where the secretions of the skin and 
 kidneys are deficient. 
 
 246. Benzoic Acid and Squills. 
 
 R. Acidi Bonzoici, gr. 40; Syrupi Scillae, Syrupi Rhceados, aa fl. oz. iss. Make a 
 linctus, of which one small teaspoonful is to be ordered to be taken every four hours. 
 In chronic bronchial atiections with suppressed action of the liver. See F. 49. 
 
 247. Opium and Squills. 
 
 R. Syrupi Scillfc, Syrupi Papaveris, Syrupi Limonis, Mucilaginis Tragacanthse, 
 aa fl. drs. iv. Make a linctus, of which a teaspoonful is to be directed to be taken 
 frequently. 
 
 R. Syrupi Scilla}, fl. drs. xij ; Tincturaj Camphors cum Opio, fl. drs. iv. Make a 
 linctus, and order one teaspoonful to be taken when the cough is troublesome. 
 
 XII. GARGLES AND INHALATIONS. 
 
 248. Hydrocldo7'ic Acid Gargle, (J-'c. 
 
 R. Acidi Hydrochlorici Diluti, fl. drs. iij ; Mellis Dcjuirati, oz. 1 ; Infusi Eosae 
 Acidi, ad fl. oz. viij. Mix. 
 In tonsillitis after the acute stage, and in relaxed sore throat.
 
 GARGLES AND INHALATIONS. 327 
 
 249. Zinc and Rhatany Gargle. 
 
 R. Zinoi Sulphatis, "jr. 20; Syrupi Mori, fl. drs. iv; Glycerini, fl. oz. j ; Infusi 
 Kraineriie, ad fl. oz. viij. Mix. 
 For relaxation of the uvula and fauces. 
 
 250. Borax Gargles. 
 
 R. Borncis, G^r. 160; Tinctura; Myrrhaj, fl. oz. j ; Aqua?, ad fl. oz. viij. Mix. 
 Useful in aphtha) and ulcerations about the fauces. 
 
 R. Boracis, gr. 120; Glycerini, fl. oz. j. Mix. To bo painted over the gums, 
 tongue, &c., with a camel's-hair pencil. 
 
 In aphtha?. It is preferable to the ofiicinal Borax Honey, as the sugar of the 
 latter favors the formation of fungi. 
 
 R. Boracis, gr. 60 ; Glycerini, fl. drs. xij ; Aquae Kosse, ad fl. oz. iv. Mix. 
 To be painted over the tongue in some forms of ulceration, fissure, &c. 
 
 R. Boracis, gr. 180; Syrupi Scilla;, fl. oz. j ; AquiB, ad fl. oz. viij. Mix. 
 As a gargle in chronic inflammation of the fauces. 
 
 251. Tannin Gargle. 
 
 R. Acidi Tannici, gr. 20; Spiritus Vini Gallici, fl. oz. j ; Aquae Camphoraa, ad fl. 
 oz. viij. Mix. 
 
 252. Alum and Myrrh Gargle. 
 
 R. Aluminis Exsiccati, gr. 80; Tincture Myrrhae, fl. oz. j ; Aquae, ad fl. oz. viij. 
 Mix. 
 In mercurial salivation, ulceration about the mouth and fauces, &c. 
 
 253. Opium and Belladonna Gargle. 
 
 R. Tincturte Opii, fl. drs. ij ; Tincturae Belladonnse, fl. drm. j ; Aquie Camphors, 
 ad fl. oz. viij. Mix. 
 
 To be used frequently in acute tonsillitis. 
 
 254. Chlorinated Soda Gargle. 
 
 R. Liquoris Soda3 Chloratae, fl. drs. vj ; Aqufe, ad fl. oz. viij. Mix. 
 In ulcerated sore throats, profuse salivation, &c. It may also be used as a lotion 
 to foul gangrenous ulcers, as well as to the seat of irritation in prurigo. 
 
 255. Creasote Gargles. 
 
 R. Creasoti, min. xx ; Mucilaginis Tragacanthae, fl. oz. iij ; .Aquae, ad fl. oz. viij. 
 Mix. 
 
 R. Creasoti, min. XX ; Tincture Lavandula Compositae, Tincturie Myrrhse, aa fl. 
 drs. iv ; Syrupi Limonis, fl. drs. xij ; Aqua\ ad fl. oz. viij. Mix. 
 In chronic inflammation of the throat, dysphonia clericorum, &c. 
 
 256. Corrosive Sublimate Gargles. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 2; Acidi Nitrici Diluti, min. xxx ; Tinc- 
 turae Myrrhae, fl. oz. j ; Aquae, ad fl. oz. viij. Mix. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 3 ; Glycerini, fl. oz. j ; Extracti Conii, 
 gr. 60 ; Aquie, ad fl. oz. viij. Mix. 
 
 Useful in syphilitic aftections of the tongue and throat. The patient must use one 
 tablespoonful at a time, and should be cautioned against swallowing it. 
 
 257. Capsicum and Alum Gargle. 
 
 R. Aluminis Exsiccati, gr. 100; Tincturae Capsici, fl. drs. ij ; Syrupi Mori, fl. 
 oz. j ; Aqute Rosre, ad fl. oz. viij. Mix. 
 
 In hoarseness, sore throat, &c., with relaxation of the uvula or tonsils.
 
 328 
 
 APPENDIX OF FORMULA. 
 
 258. Sulphite of Soda. 
 
 R. Sodre Sulphitis, gr. 60; AqujB Destillatne, fl. oz. j. Mix. To be frequently 
 applied by means of a camel's-hair pencil to the mucous membrane of the mouth and 
 fauces. 
 
 In cases of aphthae. 
 
 259. Iodine Inhalation. 
 
 R. Tincturse lodi, min. xxx ; Aquse Calida?, fl. oz. iv. Mix. The vapor is to 
 be cautiously inhaled. 
 
 In some cases of laryngeal phthisis. 
 
 In severe coryza great relief is given by holding a small bottle of Tincture of Iodine 
 under the nose. The warmth of the hand suffices to vaporize the iodine. 
 
 260. Turpentine and Creasote Inhalations. 
 
 R. Olei Terebinthinfe, fl. oz. j ; AquteCalidaa, ad fl. oz. vj. Mix. 
 
 In chronic bronchitis with excessive secretion. To be used with a common inhaler. 
 
 R. Creasoti, min. xxx ; Aquae Bullientis, fl. oz. viij. Mix. 
 In ozjena and other affections of the nostrils, pharynx, «&c. 
 
 261. Hydrocyanic Acid Inhalations. 
 
 R. Acidi Hydrocyanici Diluti, min. xx ; Tincturie Hyoscyami, Tinctura; Lupuli, aa 
 fl. oz. j ; Aquie Calidre, ad fl. oz. viij. Mix. 
 
 In phthisis, ulceration of the larynx, &c. Can be used with any common inhaler. 
 
 R. Acidi Hydrocyanici Diluti, min. xv ; Spiritfis Chloroformi, fl. drs. iij — vj ; 
 Aqua3 Bullientis, fl. oz. viij. Mix. 
 In laryngitis, oedema of the glottis, &c. 
 
 262. Atomized Fluids for Inhalation. 
 
 The following drugs may be used in the form of spray. 
 be added to one ounce of water : 
 
 The dose mentioned is to 
 
 Alumen Exsiccatum, . . 
 Acidum Tannicum, . . 
 Argenti Nitras, . . . . 
 Aqua Laurocerasi, . . . 
 
 Borax, 
 
 Extractum Belladonnaj, . 
 Extractum Conii, . 
 Extractum Cannabis In- 
 
 dicse, 
 
 Extractum Opii, . . . 
 Hydrargyrum Corrosi- 
 
 vum Sublimatum, 
 
 grs. 
 
 5 to 
 
 30. 
 
 grs. 
 
 3 to 
 
 12. 
 
 grs. 
 
 1 to 
 
 5. 
 
 nm. 
 
 V to 
 
 XX. 
 
 grs. 
 
 5 to 
 
 20. 
 
 gr. 
 grs. 
 
 } to 
 5 to 
 
 1. 
 10. 
 
 gr. 
 gr. 
 
 i to 
 i to 
 
 1. 
 
 2. 
 
 gr. 
 
 to 
 
 grs. 
 errs. 
 
 Liquor Calcis Sacchara- 
 
 tus, 
 
 Oleum Terebinthinje, 
 Potassie Chloras, . 
 Potassii Bromidum, 
 Potassii lodidum, . 
 kSodii Chloridum, . 
 Tinctura Fcrri Perchlo- 
 
 ridi, min, 
 
 Tinctura lodi, .... min, 
 Zinci Sulphas, .... grs. 
 
 min. XV to xc. 
 min. j to V. 
 
 grs. 
 
 to 10. 
 to 10. 
 to 10. 
 to 40. 
 
 V to xxx. 
 j to XV. 
 3 to 15. 
 
 The best instruments for dispersing the finest sjiray arc, — Dr. Sicgle's, in which 
 steam is applied as the dispersing medium : a modification of this a])paratus, made by 
 Krohne, 241 Whitechapel lioad : Dr. Andrew Clarke's double handball spray-pro- 
 ducer : Mr. Maunder's single handball. 
 
 Atomized medicated fluids may be advantageously used in affections of the lining 
 membrane of the nose, mouth, and fauces. In croup, and diphtheria. Syphilitic 
 affections of palate and throat. Laryngitis. CEdema of the glottis. Tubercular or 
 sy|)hilitic ulcerations of larynx. Hoarseness and loss of voice. Hoo|)ing-cough. 
 Bronchitis. Plitliisis. During their apjjlication the patient should make deep and 
 long inspirations and expirations. Excej)! in acute cases, one application daily will 
 suffice.
 
 LOTIONS, LINIMENTS, ETC. 329 
 
 XIII. LOTIONS, LINIMENTS, COLLYRIA, AND OINT- 
 MENTS. 
 
 263. Hydrocyanic Acid Lotions. 
 
 R. Acidi Hvclrocyaiiici Diluti, fl. drs. iij ; Plumbi Acetatis, gr. 60; Spiritus Rec- 
 tific'iiti, fl. 07.. j ; A(jna> Sambuci, ad fl. oz. viij. Mix. 
 In impetigo, prurigo, &c. 
 
 R. Liquoris PotasssG, fl. drs. ij ; Acidi Hydrocyanici Diluti, fl. drs. iss ; Glycerini, 
 fl. oz. j ; Aquaj Eosa^, ad fl. oz. viij. 
 In some cases of pityriasis. 
 
 R. Liquoris Ammonia Acetatis, fl. oz. j ; Acidi Hydrocyanici Diluti, A- drs. iss; 
 Infusi Tabaci (made with sixty grains of Bird's-eye tobacco), ad fl. oz. viij. Mix. 
 To be sponged twice or thrice daily over the seat of irritation. 
 
 In pruritus about the anus, vulva, &c. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 3; Acidi Hydrocyanici Diluti, fl. drs. iss; 
 Mistunx? Amygduliip, ad fl. oz. viij. Mix. 
 
 To check the irritation in prurigo and other skin diseases. 
 
 264. Astringent Lotions. 
 
 R. Glycerini, fl. oz. j ; Liquoris Plumbi Subacetatis, fl. drs. ij ; Spiritus Eectificati, 
 fl. drs. iv ; Aqu£e Ros;w, ad fl. oz. viij. Mix. 
 In eczema, ecthyma, pityriasis, &c. 
 
 R. ZinciSulphatis, gr. 16; Spiritus Rosmarini, Tinctura? Lavandulae Compositse, 
 aa fl. drs. ij ; Aquae, ad fl. oz. viij. Mix. 
 
 The common " Red Lotion" of Hospitals. Very useful for strumous and other 
 ulcers. 
 
 R. Potassce Chloratis, gr. 80; Aqua?, fl. oz. viij. Mix. 
 For many ill-conditioned ulcers. 
 
 R. Acidi Citrici, gr. 120; Aquae, fl. oz. viij. Mix. 
 
 Por cancerous sores. Also as a gargle in cancer of the tongue or tonsil. It relieves 
 pain, and encourages cicatrization. 
 
 265. Anodyne Lotions. 
 
 R. Tincturae Aconiti, fl. oz. iss; Aquie, ad fl. oz. iv. Mix. 
 In acute superficial pain, hyperaesthesia of skin, pruritus, &c. 
 
 R. Tabaci Communis, gr. 120; Aquro Bullientis, Oj. Infuse for an hour, and 
 strain. 
 
 To be freely used in pruritus of the vulva or anus. 
 
 R. Tincture Belladonna, fl. oz. j ; Spiritiis Chloroformi, fl. oz. ij ; Aquaj Destillatie, 
 ad fl. oz. viij. Mix. 
 
 R. Extracti Belladonna, gr. 120; Glycerini, fl. oz. j. Mix. 
 To be painted over the seat of pain in neuralgic diseases. 
 
 266. Alkaline and Anodyne Lotions. 
 
 R. Liquoris Morphiae Hydrochloratis, fl. oz. iss; Liquoris Potassae, fl. drs. ij ; 
 Glycerini, fl. oz. j ; Aqua^ Laurocerasi, fl. oz. j ; Aquae Sambuci, ad fl. oz. viij. Mix. 
 For the relief of pruriginous aflections. 
 
 R. Potassae Sulphuratje, gr. 60; Liquoris Potasste, min. xxx ; Tincturae Aconiti, 
 fl. drs. iv; Aquaj Destillat^, ad fl. oz. viij. Mix. 
 
 267. Acid and Anodyne Lotion. 
 
 R. Acidi Acetici, fl. drs. iss; Morphia Acetatis, gr. 10; Vini Colchici, fl. oz. iij. 
 Mix. 
 
 To be applied over the inflamed joint in gout, on a piece of lint covered with oiled 
 silk.
 
 330 APPENDIX OF FORMULA. 
 
 268. Borax or Soda, and Glycerine Lotions. 
 
 R. Boracis, gr. 60 — 120; Gh^cerini, fl. oz. j ; Aquas Sambuci, ad fl. oz. viij. Mix. 
 An excellent local palliative in many of the squamous diseases of the skin. 
 
 R. Boracis, gr. 200; Morphife Hydrochloratis, gr. 10; Glycerini, tl. oz. j ; Aquoe 
 Eosse, ad fl. oz. viij. Mix. 
 
 In obstinate pruritus of the vulva. The parts to be sponged twice or thrice in the 
 twenty-four hours with this lotion, previously washing them with glycerine (or 
 honey) soap and warm water. 
 
 R. Sodse Carbonatis, gr. 120; Aqute Sambuci, fl. oz. vij ; Glycerini, fl. oz. j. Mix. 
 To allay the itching attendant on many skin diseases, healing ulcers, &c. 
 
 269. Iodine Lotions. 
 
 R. Tincturae lodi, fl. oz. j ; Glycerini, fl. drs. xij ; Aquaj Destillatse, ad fl. oz. viij. 
 Mix. 
 
 For indolent and scrofulous ulcers, &c. 
 
 R. Linimenti lodi, fl. drs. iv ; Tincturse Aconiti, fl. oz. j ; Aquae Destillata?, ad fl. 
 oz. viij. Mix. 
 
 In some cases of chronic peritonitis ; chronic pleurisy with efi"usion; chronic eftu- 
 sions into joints, «S:c. See F. 81. 
 
 270. Creasote, or Carbolic Acid, and Glycerine. 
 
 R. Creasoti, min. xxxv; Glycerini, fl. drs. xij; Aquae, ad fl. oz. viij. Mix, for a 
 lotion. 
 
 In pityriasis, &c. 
 
 R. Acidi Carbolici, fl. drm. j ; Glycerini, fl. oz. j ; Aquae, ad fl. oz. viij. Mix, for 
 a lotion. 
 
 In pruriginous afi"ections. 
 
 271. Corrosive Sublimate Lotion. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 4 — 6; Aqufe Destillatae, fl. oz. iij. Mix. 
 Useful in tinea favosa, and other parasitic skin diseases. 
 
 272. Sulphurous Acid Lotion. 
 
 R. Acidi Sulpburosi, fl. oz. j ; Aquae Destillatae, fl. oz. vij. Mix. 
 In skin diseases dependent on a parasitic plant. 
 
 273. Cold Lotions. 
 
 R. Liquoris Ammonia Acetatis, fl. oz. j ; Spiritus Kectificati, fl. oz. ij ; Aqu« EosiB, 
 ad fl. oz. viij. Mix. 
 
 As an evaporating lotion in inflammation of the membranes of the brain. To be 
 applied after the scalp has been shaved. 
 
 R. Ammonias Hydrochloratis, oz. ^; Spiritus Eectiflcati, fl. oz. j ; Acidi Acetici 
 Diluti, fl. drs. xij ; Aqua^, ad fl. oz. viij. Mix. 
 
 274. Absorbent Lotions. 
 
 R. Zinci Oxidi, gr. 100; Aquae Eosa;, ad fl. oz. viij. Mix. 
 Useful in impetigo, eczema, &c. 
 
 R. Zinci 0.xidi, gr. IGO; Mucilaginis Tragacanthao, Aquaj Destillata?, ati fl. oz. iv. 
 Mix. 
 
 275. Solutions of Arnica. 
 
 R. Tincturae Arnicae, fl. drs. j — vj ; Aqua? Destillataj, ad fl. oz. viij. Mix. 
 As a lotion in sprains, contusions, and burns. 
 
 R. Tincturae Arnicaj, fl. drs. ij ; Tincturie Belladonnie, fl. oz. j ; Linimenti Saponis, 
 ad fl. oz. viij. Mix, for an embrocation.
 
 LOTIONS, LINIMENTS, ETC. 331 
 
 27G. 3I(ircurial Liniments. 
 
 R. Linimenti Hydrargyri, fl. oz. ij ; Linimenti Belladonnas, Linimenti Opii, uii fl. 
 oz. j. Mix. 
 
 In syphilitic tubercles, nodes, «&c. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 8; Aquae Destillatae, fl. oz. viij. Mix. 
 To be used every night in cases of chloasma. 
 
 R. Unguenti Hydrargyri, oz. 1 ; Glyccrini, fl. oz. j ; lodi, gr. 120; Olei Oliva?, fl. 
 oz. ij. Mix. 
 
 To be gently rubbed over syphilitic nodes. 
 
 277. Rubefacient Liniment. 
 
 R. Pulveris Capsici, gr. 30; Olei Macis, min. xxx ; Linimenti Terebinthinse, fl. 
 oz. iij ; Linimenti Camphoric Compositi, ad fl. oz. viij. Mix. 
 As a liniment to the chest in some cases of bronchitis. 
 
 278. Stimulating Liniment. 
 
 R. Linimenti Saponis, Linimenti Opii, Linimenti Camphorae Compositi, aa fl. oz. 
 j ; Tinctur?e Arnicas, fl. drs. ij. Mix. 
 
 To be applied round the throat, on a strip of flannel, in subacute tonsillitis, common 
 sore throat, «S:c. 
 
 279. Gamyhor Liniment and Opium, ^c. 
 
 R. Linimenti Camphorae Compositi, fl. oz. ij ; Tincturse Opii, Tincturse Bella- 
 donnas, au drs. iv. Mix. 
 
 To be rubbed over the scrobiculus cordis to check obstinate nausea and vomiting, 
 pain, &c. 
 
 280. Iodide of Potassium Liniment. 
 
 R. Potassii lodidi, vel Ammonii lodidi, gr. 40; Aquse, fl. drs. iv. Mix, and add — 
 Glycerini, fl. oz. j. 
 
 Useful in some glandular enlargements, as "well as for dispersing the chalk-stones 
 of gout. 
 
 281. Belladonna and Aconite Liniment. 
 
 R. Linimenti Belladonnas, Linimenti Aconiti, aa fl. drs. iv ; Linimenti Camphorse 
 Compositi, fl. oz. iij. Mix. The seat of pain to be rubbed with this liniment for ten 
 minutes at bedtime. 
 
 In pleurodynia, chronic rheumatism, and painful nervous affections. 
 
 For the same class of cases a good liniment may be made with one part of bella- 
 donna liniment, one of opium liniment, and four of turpentine liniment. 
 
 R. Linimenti Belladonna, fl. drs. iij; Glycerini, fl. drs. v; Linimenti Saponis, fl. 
 oz. ij. Mix. The spine to be rubbed with this liniment night and morning for five 
 minutes. 
 
 In hooping-cough. 
 
 May be used for a child five years old. 
 
 282. Chloroform, Belladonna, and Aconite Liniment. 
 
 R. Linimenti Chloroformi, Linimenti Aconiti, Linimenti Belbulonna?, Linimenti 
 Opii, aa fl. oz. ss ; Linimenti Saponis, fl. oz. j. Mix. To be rubbed into the painful 
 part night and morning. 
 
 In neuralgic and rheumatic pains of great severity. 
 
 283. God-Liver Oil Embrocations. 
 
 R. Olei Morrhuae, fl. oz. iiiss ; Spiritus Ammonias Aromatici, fl. oz. j ; Tincturae 
 Opii, fl. drs. iv ; Olei Lavandula?, min. xxx. Mix. One-half to be well rubbed over 
 the chest and abdomen, nio-ht and morning;.
 
 832 APPENDIX OF FORMULA. 
 
 In phthisis and other cases where the use of cod-liver oil is indicated, but where the 
 stomach will not bear it. 
 
 R. Olei Morrhufe, fl. oz. j ; Olei Cajuputi, fl. drm. j. Mix. To be rubbed over 
 the chest at bedtime. 
 
 The cajuput oil well disguises the smell of this embrocation. 
 
 284. Caoutchouc Solution. 
 
 Take some thin pieces of Indian rubber, or of pure gutta-percha, and dissolve them 
 in chloroform. A good protective solution. 
 
 To be painted over superficial excoriations, threatened bed-sores, &c. 
 
 285. CoUodium Paints. 
 
 R. Collodii, fl. oz. j ; Olei Palmae, min. xx ; Anchusse Eadicis, sufficient to give 
 color. — A good artificial cuticle, which when spread on the skin will not crack, may 
 also be formed by mixing two parts of glycerine with one hundred of collodium — A 
 similar preparation can be made with one part of collodium to two of castor oil. 
 
 Either preparation may be used as a varnish in various cutaneous affections, excoria- 
 tions, or superficial burns. 
 
 286. Crlycerine and Lime- Water. 
 
 R. Glyeerini, fl. oz. j ; Pulveris Tragacanthse Compositi, gr. 120; Mellis Depurati, 
 gr. 120; Liquoris Calcis Saccharati, fl. oz. iss ; Misturse Amygdalse; ad fl. oz. viij. 
 Mix. 
 
 A good bland embrocation in cases of herpes, superficial burns, chapped hands, ex- 
 coriations, &c. 
 
 The officinal Linimentum Calcis, consisting of equal parts of olive oil and lime- 
 water, is also useful in some of the above-mentioned cases. 
 
 287. Ammonia and Cantharides, ^c. 
 
 R. Spiritus Ammonife Aromatici, Spiritus Rosmarini, Glj'cerini, aa fl. oz. j ; Tinc- 
 turse Cantharidis, fl. drs. iij — vj ; Aquas Eosa?, ad fl. oz. viij. Mix. 
 
 To be gentlj' brushed into the scalp night and morning, when the hair is falling off" 
 after fever or any severe illness. 
 
 A more elegant embrocation may be made by adding two fluid drachms of Tincture 
 of Cantharides to two ounces of Eau de Cologne. 
 
 R. Balsami Tolutani, gr. 120; Olei Rosmarini, min. xx; Tincturse Cantharidis, fl. 
 drs. iv ; Olei Ricini, fl. oz. j ; Adipis Prueparati, oz. 1. Mix. 
 
 A valuable pomade in cases of baldness following ringworm, pityriasis, or tinea 
 decalvans. It should be brushed into the scalp night and morning. 
 
 288. Sulidliate of Atropia. 
 
 R. Atropise Sulphatis, gr. 1 ; Aquae Destillata?, fl. drs. iv. Mix. 
 
 Dilatation of the pupil is effected most speedily and is longest maintained by a solu- 
 tion of this kind. A full drop must be placed in the eye by means of a camel's hair 
 pencil : the effect will be produced in from fifteen to twenty minutes, and will some- 
 times continue for seven or eight days. 
 
 The officinal Liquor Atropine contains half a grain of the alkaloid in each drachm. 
 But the spirit which is used to keep it in solution causes considerable pain to the eyes 
 when it is applied. 
 
 Discs of gelatine impregnated ^ith atropine are prepared according to the instruc- 
 tions of Mr. Ernest Hart and Mr. Streatfeild. These discs dissolve and act very 
 efficiently when placed in contact with the moist conjunctiva. A piece, one-fifth of an 
 inch square, contains as much of the Sulphate of Atropine as a drop of the solution of 
 two grains to the ounce of water. 
 
 289. Alum Coagulum. 
 
 Take the whites of two eggs, and shake them with fragments of alum to form a 
 coagulum. 
 
 Useful when painted under the eyelid to produce contraction in trichiasis, en- 
 tropion, &c.
 
 LOTIONS, LINIMENTS, ETC. 333 
 
 200. Sedative Collyria. 
 
 R. Extract! Belladonna, gr. 3 — 10; vel Extract! Opii, gr. 2 — 5; vel Morphia; Hy- 
 drocliloratis, gr. 1 — 2, wei Acidi Hydrocyauici Dikiti, min. x; vei Tincturje Aconiti, 
 mill. V — XXX ; Aqute Destillatse, fl. oz. j. Mix. 
 
 291. Astringent Collyria. 
 
 R. Zinci Sulphatis, gr. 2 — 4 ; vel Aluminis Exsiccati, gr. 1 — 4 ; vel Tincturse Arnicse, 
 min. V — XXX ; ^e^ Cupri Sulphatis, gr. 1 — 4; vel Argenti Nitratis, gr. 1 — 'l;^vel Liq- 
 uoris Plumbi Subacetatis, min. x ; vel Cadmii Sulphatis, gr. 1 — 3 ; Aquae Destillatse, 
 fl. oz. j. Mix. 
 
 R. Zinci Oxidi, gr. 60; Aquae Roaj, fl. oz. viij. Mix. For an eye- water, to be used 
 night and morning. 
 
 292. Iodide of Potassium Collyrium. 
 
 R. Potassii lodidi, gr. 6 — 8; Aqua? Destillatse, fl. oz. j. Mix. 
 To remove stains of nitrate of silver from the conjunctiva. 
 
 293. Iodide of Lead. Ointments. 
 
 R. Plumbi lodidi, gr. 60; Unguenti Atropiae, gr. 60 — 120 (each ounce contains 
 eight grains of the alkaloid) ; Unguenti Simplicis, ad oz. 1. Mix. 
 In some malignant ulcerations. 
 
 R. Plumbi lodidi, gr. 90; Unguenti Cetacei, oz. 1; Linimenti Belladonnae, vel 
 Linimenti Aconiti, fl. drm. j. Mix. 
 
 For malignant and painful strumous ulcers. 
 
 294. Sulphate of Zinc Ointment. 
 
 R. Zinci Sulphatis Exsiccatae, gr. 120; Unguenti Simplicis, oz. 1. Mix. 
 Very useful in some forms of lupus, rodent ulcer, &c. The ofliciual Altjmex Exsic- 
 CATUM may be employed in the same cases. 
 
 295. Tar and Citrine Ointment. 
 
 R. Unguentum Picis Liquidae (Phar. Lond. 1851), oz. 1^; Unguenti Cetacei, oz. 
 1 ; Unguenti Hydrargyri Nitratis, oz. h. Mix. 
 In lepra, psoriasis, chronic eczema, &c. 
 
 296. Aconitine Ointments. 
 
 R. Unguenti Aconitiae, oz. \ {= to grs. 2 of the alkaloid) ; Unguenti Calomelanos, 
 oz. 1 — 2. Mix. 
 
 In some forms of neuralgia. 
 
 R. Aconitiae, gr. 2; Spirittis Eectificati, guttae vj. Mix thoroughly, and add-^ 
 Adipis Prajparati, gr. 60. 
 
 Recommended by Dr. Turubull for severe neuralgia. A small portion is to be 
 painted over the nerve, but it must not be used where there is the slightest abrasion. 
 
 297. Belladonna and Opium. 
 
 R. Extract! Belladonnae, Extract! Opii, afi gr. 90; Glycerini, fl. drs. iv ; Exti'acti 
 Papaveris, oz. 1^. Mix. 
 
 To be painted over the seat of inflammation in pleurisy, peritonitis, gastric disease, 
 &c. A fomentation flannel, or hot linseed poultice, or wet compress is to be applied ; 
 being separated from the extracts by a sheet of tissue paper.
 
 334 APPENDIX OF FORMULA. 
 
 298. 3Iercurial and Opiate Ointments. 
 
 R. Unguenti Hydrargyri, gr. 10; Pulveris Opii, gr. 2. Mix. 
 
 Recommended by Dr. Watson in cases of severe nocturnal pain around the orbit. 
 It is to be rubbed into the temple just before the pain may be expected. 
 
 R. Hydrargyri Corrosivi Sublimati, gr. 5 ; Pulveris Opii, gr. 10; Unguenti Sim- 
 plicis, oz. 1. Mix. 
 In chloasma, &c. 
 
 299. Calomel and Belladonna Ointment. 
 
 R. Linimenti Belladonna;, fl. drs. ij ; Unguenti Calomelanos, oz. 1. Mix. 
 In syphilitic tubercular diseases. 
 
 300. Ammoniated Mercury and Sulphur. 
 
 R. Unguenti Hydrargyri Ammoniati, gr. 120; Unguenti Sulphuris, gr. 360- 
 Mix. 
 
 A good antiparasitic ointment. 
 
 301. Creasote and Red Oxide of 3Iercury. 
 
 R. Creasoti, min. x; Unguenti Hydrargyri Oxidi Rubri, gr. 120; Unguenti Sim- 
 plicis, gr. 860. Mix. 
 
 In parasitic diseases of the skin, the ulcerations of rupia, »&c. 
 
 302. Red Iodide of Mercury Ointment. 
 
 R. Hydrargyri lodidi Rubri, gr. 8 ; Unguenti Simplicis, oz. 1. Mix. 
 
 In chronic glandular tumors, a small portion rubbed in every night proves very 
 useful. The officinal ointment is double the strength of the foregoing, and hence it 
 causes pain and blistering. 
 
 303. Croton Oil and Lard. 
 
 R. Olei Crotonis, min. xv ; Adipis Prseparati, oz. J. Mix. One-fourth part to be 
 rubbed into the skin every eight hours, until an abundant pustular eruption is pro- 
 duced. 
 
 Useful as a counter-irritant. 
 
 304. Ver atria Ointment. 
 
 R. Unguenti Veratriae, Unguenti Potassii lodidi, aa oz. 1. Mix. 
 In chronic rheumatism, chronic gout, «fcc. 
 
 305. Diluted Citrine Ointment. 
 
 R. Unguenti Hydrargyri Nitratis, gr. 40 — 120; Unguenti Cetacei, gr. 240. Mix. 
 As a stimulant and alterative in chronic skin diseases. May be applied to the edges 
 of the eyelids in ophthalmia to prevent their adhering at night. 
 
 306. Compound Spermaceti Ointments. 
 
 R. Acidi Hydrocyanici Diluti, 11. drm. j ; Unguenti Atropia;, gr. 120 ; Unguenti 
 Cetacei, oz. 1. Mix. 
 
 In cutaneous diseases attended with pain or itching. 
 
 R. Balsami Peruviani, gr. 60; Unguenti Cetacei, oz. 1. Mix. 
 In slight excoriations. 
 
 R. Balsami Peruviani, gr. 60; Unguenti Cetacei, oz. 2; Alkannse Tinctoriae 
 Eadicis, gr. 00; Olei Rosie (Otto of Roses), min. x. Mix. 
 
 Useful as a lip-salve, and as an application to chapjied hands and sore nipples.
 
 NAllCOTICS AND SEDATIVES. 335 
 
 807. Belladonna and Iodide of Potassium. 
 
 R. Linimonti Belladonnyo, fl. drs. ij ; Unguenti Potassii lodidi, oz. 1. Mako an 
 ointment. Tlic Liniiuunt of Aconite may be substituted for the JJelladonna, if de- 
 sired. 
 
 In painful chronic tumors, neuralgia, «fcc. 
 
 308. Iodine and Cod-Liver Oil Ointment. 
 
 R. Unguenti lodi Compositi, Olci Morrhua?, aa fl. drs. iv. Mix. 
 
 Useful wlien rubbed upon the throat in bronchocele ; as well as when applied to 
 strumous glands, unsuppurating buboes, and the tumid bellies of children with mesen- 
 teric disease. 
 
 309. Bole Armeniack and Lead. 
 
 R, Boli Armense Kubrse, Plumbi Oxidi Semivitrei, aa gr. 30; Camphorro, gr. 5; 
 Cer;o Flavaj, gr. 180; Adipis Pr:eparati, gr. 3G0. Mix. To be spread on thick linen. 
 
 Keveral German physicians speak of this as an efficacious apjilication for preventing 
 and curing bed-sores. 
 
 310. Iodide of Sulphur Ointments. 
 
 R. Sulphuris lodidi, gr. 20; Unguenti Simplicis, oz. 1. Mix. 
 In acne, applied thrice daily. 
 
 R. Sulphuris lodidi, gr. 12; Sulphuris Prscipitati, gr. 20; Olei Amygdalie Amai-£e, 
 min. V ; Adipis Prajparati, oz. 1. Mix. 
 
 311. Creasote and /Sulphur Ointment. 
 
 R. Unguenti Creasoti, Unguenti Sulphuris, aa oz. ^. Mix. 
 In pityriasis, and some other chronic cutaneous aifections. 
 
 312. Iodide of Cadmium Ointment. 
 
 R. Cadmii lodidi, gr. 60; Adipis Prajparati, oz. 1; Linimenti Aconiti fl. drs. iss. 
 Mix. 
 
 Superior to iodide of iwtassium ointment for rubbing into tender and enlarged 
 strumous glands, nodes, &c. 
 
 XIV. NARCOTICS AND SEDATIVES. 
 
 313. Anoesthetics. 
 
 The chief anaesthetics which have hitherto been used in the practice of medicine are 
 chloroform, sulphuric ether, and amylene. As the emploj'ment of one or other of 
 these agents is often indicated in neuralgia, delirium, convulsions, the paroxysmal 
 dyspncea of infantile laryngismus and diphtheria and croup, as well as in spasmodic 
 diseases generally, a few words on their mode of administration may ziot be out of 
 place. 
 
 The principal advantages of inhalation are these : That by means of the immense 
 surface ottered by the air-cells of the lungs for absorption, a deeper and more rapid 
 ottect is induced than it would be safe or easy to eff"ect by other means. At the same 
 time, the digestive functions are less interfered with than when narcotics are given in 
 the ordinary way. 
 
 In every form of inhalation the anajsthetic should be freely diluted with common 
 air, and no attempt made to produce rapid narcotism ; while the breathing ought to be 
 allowed to go on quietly and naturally. The patient should be tranquil, "fearless, and 
 usually in the recumbent posture. And the administrator of the narcotic agent, while 
 watching the respiration and the countenance, had better also keep his linger on the 
 pulse. For if the breathing becomes stertorous, or if there is evidence that the circu- 
 lation is getting weak and faltering, the inhalation must be suspended.
 
 336 APPENDIX OF FORMULA. 
 
 Chloroform was introduced into practice by Sir James T. Simpson, of Edinburgh i 
 in November, 1847. The vapor of this hot, sweet, heavy liquid, may be inhaled by 
 individuals of all ages, from infants under one year to persons as old as ninety ; and 
 in almost all states of the system. The exceptional cases which preclude its employ- 
 ment, at all events in medical practice, are instances of marked blood poisoning, of 
 far-advanced cardiac or pulmonary or cerebral disease, and perhaps of habitual drunk- 
 enness. It is best administered from an apparatus such as the late Dr. Snow recom- 
 mended ; though Sir James Simpson always uses a simple napkin folded into the shape 
 of a funnel. A crumpled handkerchief in a tumbler forms a convenient inhaler. But 
 in whatever way it is exhibited care must be taken that it does not come into contact 
 with the lips and nose ; since it produces painful excoriations. Chloroform should also 
 be given slowly and cautiously; and it acts best before breakfast, or when the patient's 
 stomach is empty. If administered immediately after food, sickness is sure to result. 
 According to Dr. Snow, about four cubic inches of vapor, or rather more than live 
 grains of chloroform to each hundred cubic inches of air, is the proportion most suit- 
 able for causing insensibility to surgical operations ; while in medical and obstetric 
 cases it should only be used in a more diluted form. — When an overdoSe has been 
 given, the patient should be made to inhale ether, as it counteracts the depressing 
 action which chloroform exerts on the heart. Or artificial respiration, performed in 
 the manner to be presently described, may be resorted to ; the success of which will 
 depend upon the extent to which the heart and the muscles of respiration have been 
 paralyzed by the chloroform. Dr. Snow gave this anajsthetic in four thousand or more 
 cases, with the loss of only one person while inhaling it; and amongst these were 
 patients with heart disease, phthisis, and several who had suffered from apoplexy. It 
 has been computed that during the Crimean war chloroform was administered forty 
 thousand times, death resulting in only one case. 
 
 ^ther (first used as an anaesthetic in September, 1846, by Dr. W. T. G. Morton, of 
 Boston, Massachusetts), is thought to be a safer agent for inducing narcotism than 
 chloroform ; but although it is so, still it must be given with the same caution. About 
 one fiuid ounce is usually inhaled by an adult in becoming insensible ; though not 
 more than half this quantity is absorbed, the remainder being thrown back from the 
 lungs, mouth. Sec. An excellent anaesthetic for obstetric practice may be made with 
 equal parts of ether and chloroform. 
 
 Aniylene is made by distilling amylic alcohol (obtained from crude fusel oil, or oil of 
 potato spirit) with chloride of zinc. In the present state of our knowledge, it is not 
 advisable to resort to this agent. Dr. Snow seems to have administered it in 238 cases, 
 and to have had two deaths from it. 
 
 In apparent death from any anesthetic, artificial respiration, after the plan recom- 
 mended by Dr. Silvester, ought to be tried. The body is to be laid on its back with 
 the head and shoulders slightly raised. The mouth and nostrils are to be cleansed from 
 mucus ; and the tongue should be drawn firmly forwards so as to keep the tip well 
 protruded at the side of the mouth. Then the operator is to compress, for two or three 
 seconds, the front and sides of the chest by the patient's own arms. Thus the medi- 
 cated vapor will be partly expelled from the lungs; while upon the pressure being 
 suddenljr removed, the elastic walls of the chest will expand, and give the primary 
 impetus to respiration. To assist expansion to the utmost, the ribs should be drawn 
 upwards by means of the pectoral muscles. This is effected by the operator grasping 
 the arms just above the elbows, and drawing them upwai'ds until the}' nearly meet 
 above the head. Then they must be lowered, and replaced at the sides; at the same 
 time making moderate pressure with them, for a couple of seconds, against the chest- 
 walls. This process is to be repeated fifteen times in the minute. 
 
 In some instances, galvanism of the phrenic nerve, diaphragm, and intercostal 
 muscles would be useful in keeping up the movements of respiration; one pole of the 
 battery being applied over the outer edge of the sterno-mastoid muscle just above the 
 clavicle, while the other is pressed deeply into the seventh intercostal space. The 
 diaphragm must be made to contract and relax alternately, by interrupting the cur- 
 rents at equal intervals. 
 
 "Wiule attempts are thus being made to oxygenate the blood, an assistant is to rub the 
 limbs I'rom the extremities towards the heart. If no resjiiratoiy efibrts supervene, the 
 face and chest are to be daslied with cold water, or with hot and cold water alter- 
 nately. "When success folh^ws this plaii, the temperature of the body must be main- 
 tained by friction, hot blankets, the warm bath, cV:c. 
 
 314. 3Ior2)hia, Atropine^ Aconitine, ^c.,for Hypodermic Injection. 
 
 The solution of Acetate of Morphia as used for injection under the skin is generally 
 made by mixing ten grains of this salt with onedraclim of distilled water. Suthcient 
 acetic acid is then added to dissolve the morphia ; the fluid being afterwards neutral-
 
 NARCOTICS AND SEDATIVES. 837 
 
 izod by the addition of Liquor Potassae until a cloud appoars. Finally, one or two 
 drops of acetic acid are u.scd to gently acidulate the mixture. 
 
 Each six minims of this solution will contain one grain of acetate of morphia. For 
 first injections, not more than one minim and a half should be used ; as it is certain 
 that this narcotic acts more jiowerfully when thus employed, than when taken into 
 the stomach. In diseases which are continuf)usly painful the ease given by an injec- 
 tion will last for about twelve hours. To relieve the suffering of advanced cancer, ice, 
 tile injection may be advantageously given, night and morning, for many months. 
 
 The subcutaneous injection of Atropine is sometimes useful in cases of intestinal 
 obstruction, asthma, tetanus, neuralgia, chorea in the adult, &c. Great caution is 
 necessary : not more than two minims of the officinal Liquor Atropia? ( = to gr. 1-50) 
 should be employed at first. 
 
 Chloroform n~iay be used in same manner. The injection of ten or fifteen minims 
 often efiects a cure for the time in pleurodynia, neuralgia, sciatica, &c. It has the 
 disadvantage of sometimes producing an irritable ulcer, which may be slow in healing. 
 
 A solution of Aconitlne maybe made thus: Aconiti^, gr. 1; Spiritfis Kectificati, 
 min. x; Aquse Destillatie, ad ti. drs. ij. Mix. For first injections not more than two 
 minims should be employed : the dose may afterwards be safely increased to four 
 minims (gr. 1-30). It is better, though not absolutely necessary, to make the injec- 
 tion at the seat of j^ain. 
 
 315. 3Iorphia Draughts, ^^c. 
 
 R. Liquoris Morphise Hydrochloratis, min. xxx (= to gr. \ of the salt) ; Syrupi 
 Limonis, fl. drm. j ; Aqute'Oamphora;, fl. oz. j. Mix. To be taken at bedtime. 
 In insomnia with pain. 
 
 R. Liquoris Morphise Hj^drochloratis, min. xv — xxx; Spiritus Chloroformi, fl. 
 drm. j (=to min. iij of chloroform); Spiritus ^Etheris, min. xxx; Tinctura; Bella- 
 donnoe, min. xx ; Tincturaa Cardamomi Compositis, fl. drm. j ; Aquae, ad fl. oz. iss. 
 Mix. To be taken every two hours (the patient being watched) until the pain ceases. 
 
 Useful in facilitating the passage of gall-stones. 
 
 R. Liquoris Morphise Hydrochloratis, min. xl ; Acidi Hydrocyanici Diluti, min. 
 XX ; Syrupi Scillse, fl. drs. vj ; Mucilaginis Acacite, ad fl. oz. vj. Mix. One table- 
 spoonful every three or four hours. 
 
 In many irritable coughs. 
 
 316. Chloroform and Opium. 
 
 R. Chloroformi, min. X — xv ; Extracti Opii Liquidi, min. xv — xxx; Syrupi Rhoea- 
 dos, fl. drm. j ; Mucilaginis Tragacanthie, fl. oz. j. Mix, for a night draught. 
 In severe colic and other spasmodic disorders. 
 
 317. Morphia, Chloroform, and Indian Hemp. 
 
 R. Liquoris Morphite Hydrochloratis, min. xx ; Chloroformi, min. x; Tincturje 
 Cannabis Indicfe, min. xx ; Pulveris Tragacanthffi Compositi, gr 30; Spiritiis ^theris, 
 min. xl ; Acidi Hydrocyanici Diluti, min. iv ; Aquae, ad fl. oz. iss. Mix, for a night 
 draught. 
 
 In many chronic diseases attended with pain or restlessness. 
 
 The medicine called Chlorodyne probably consists essentially of chloroform, In- 
 dian hemp, morphia, and hj'drocyanicacid. In the Canada Lancet (15th October, 1864) 
 Dr. W. E. Bowman gives the following formula for its preparation : Take of Chloro- 
 form, half a fluid ounce ; Sulphuric Ether, ninety minims ; Oil of Peppermint, eight 
 drops; Kesin of Indian Hemp, six grains; Capsicum, two grains. Mix, shake occa- 
 sionally, and allow it to stand for a few days. Take of Muriate of Morphia, sixteen 
 grains, dissolved by the aid of heat in two fluid drachms of water; to which when 
 cold, add of Scheele's Hydrocyanic Acid, sixty-five minims ; Perchloric Acid, one 
 fluid drachm ; Treacle, two fluid ounces. Add this gradually to the first mixture, and 
 then make the whole measure four fluid ounces by the addition of treacle or water. — 
 Each, dose of thirty minims contains of chloroform min. iv, ether min. iss, extract of 
 hemp, gr. 1-lOth, hydrochlorate of morphia, gr. \, and of Scheele's acid min. j. 
 
 22
 
 338 APPENDIX OF FORMULA. 
 
 318. Brandy and Egg Mixture, with Opium. 
 
 R. Misturpe Spiritus Yini Gallici (see F. 17) fl. oz. j ; Extracti Opii Liquid! min. 
 Y — x; Spiritus Chloroformi, min. xl. Mix. To be taken every four hours. 
 In exhaustion from pain. 
 
 319. Tolu and Camphorated Opium. 
 
 R. Tincturse Tolutanffi, fl. drs. ij ; Syrupi Tolutani, fl. oz. j ; Tincturas Camphorse 
 cum Opio, fl. drs. iv (= to gr. 1 of opium) ; Mucilaginis Tragacanthse, ad fl. oz. viij. 
 Mix. Two tablespoonfuls three times a day. 
 
 For old people, where the mucous secretion from the bronchi is excessive. 
 
 320. Cimicifuga Macemosa, or Black Snake-root. 
 
 R. Tincture Acteae Eacemosaj, min. xxx — fl. drs. ij ; Aquae, ad fl. oz. j. Mix, for 
 a draught. To be administered every three or four hours until nausea ensues or the 
 pulse becomes lowered. 
 
 This drug possesses narcotic and eliminative properties, and is useful in chronic 
 rheumatism, lumbago, chorea, obscure nervous pains, and in backache from uterine 
 disturbance. 
 
 321. American Hellebore. 
 
 R. Tincturffi Yeratri Yiridis (a saturated solution), min. v — x ; Aquae, fl. oz. j. 
 Mix. This draught may be given every three hours, adding one drop of tincture to 
 each dose, until the pulse becomes sufficiently lowered, or nausea is produced. The 
 latter is readily counteracted by small doses of morphia. 
 
 It is a valuable arterial sedative ; and is particularly used by American physicians 
 in inflammations of the lungs, pleura, or peritoneum, and in acute rheumatism. 
 
 322. Lobelia and Ether. 
 
 R. Spiritfis Ammonise Aromatici, fl. drs. ij ; Tincturae Lobeliae ^therae, fl. drs. iij 
 — vj ; Tincturaj Aconiti, min. xxx ; Aquae Camphors, ad fl. oz. viij. Mix. One- 
 sixth part twice or thrice daily. 
 
 As a sedative in some cases of asthma. 
 
 323. Stramonium and Henbane. 
 
 R. Extracti Stramonii, gr. 3; Extracti Hyoscyami, gr. 20; Extracti Lupuli, gr. 
 40. Mix, and divide into twelve pills. One to be taken every four hours until relief 
 is obtained. 
 
 In chronic disorders attended with suffering, in diseases of the nervous system ac- 
 companied witii pain and restlessness, and in the dyspncea of phthisis and emphysema. 
 
 R. Tincturae Stramonii, fl. drs. j — ij ; Tincture Hyoscyami, fl. drs. ij ; Tincturae 
 Cantharidis, fl. drni. j ; Spirittis Chloroformi, fl. di"s. iij; Aquae, ad fl. oz. viij. Mix. 
 One-sixth part three times a day. 
 
 In some cases of asthma. 
 
 324. Opium and Ipecacuanha. 
 
 R. Extract! Opii, Pulveris Ipecacuanhae, aa gr. 1; Potassae Nitratis, gr. 8; Gly- 
 cerini, sufficient to make a mass. Divide into two pills, and order them to be taken 
 at bedtime. 
 
 A good narcotic and diaphoretic. It is preferable to the officinal Powder op 
 IPECAC0AN AND Opium, as the nitrate of potash acts better than the sulphate. 
 
 R. Yini Ipecacuanh;e, fl. drs. iiss ; Extracti Opii Liquidi, min. xxx; Syrupi Tolu- 
 tani, fl. drs. v; Mucilaginis Tragacanthae, fl. oz. j. Mix. One teaspoonful every 
 two or three hours. 
 
 In chronic cough.
 
 NARCOTICS AND SEDATIVES. 339 
 
 325. Henbane, Camphor, and Hop. 
 
 R. Extracti Hyoscyami, Caiiijiliora', Lu])ulinie, aa gr. 20. Mix, divide into twelve 
 pilLs, and order two to bo tak(!n every niglit at bedtime. 
 
 An excellent sedative for hysterical and hypochondriacal patients suflering from 
 sleeplessness. 
 
 R. Spiritfls Camphorae, min. xxx ; Tinctimc liyosoyami, Tinctnrm Lu]iuli, aa fl. 
 drm. j ; Mucilaginis Acacitu, 11. oz. j. Mix, for a draught to be taken at bedtime, 
 
 326. Belladonna. Atropia. 
 
 R. Extracti Belladonnas, gr. 5 ; Zinci Sulphatis, gr. 30; Extracti Gentianse, gr. 90. 
 Make a mass, divide into twenty pills, and order one to be taken three times a day. 
 
 In cases where a sedative and tonic action is to be produced. Especially useful in 
 some diseases attended with irritability of the urinary organs. Also in many spas- 
 modic coughs. See F. 92. 
 
 R. Extracti Belladonnas, gr. \ ; Extracti Quassia?, gr. 2. Mix into a pill, to be 
 taken night and morning. 
 
 In epilepsy. Eequires to be given for a long period. 
 
 R. Camphoras, gr. 5; Extracti Belladonnse, gr. J; Extracti Conii, gr. 4; Spiritus 
 Kectificati, sufficient to make two pills. To be taken every night at bedtime. 
 
 In spermatorrhoea ; convulsions ; as well as in certain spasmodic atfections of the 
 air-passages. 
 
 R. Liquoris Atropia?, fl. drs. ij. One drop (=gr. 1-120) in a tablespoonful of 
 brandy and water, night and morning. 
 
 In epilepsy. The dose to be increased by one drop every second or third week. A 
 preparation of zinc may be given at the same time, if desired. 
 
 327. Camphor and Blue Pill. 
 
 R. Camphorse, gr. 5 ; Extracti Opii, gr. 1 ; Pilulje Hydrargyri, gr. 4. Mix, divide 
 into two pills, and order them to be taken at bedtime. 
 
 In restlessness with congestion of the liver and irritability of the sexual organs. 
 Also in venereal sores with nocturnal emissions. 
 
 328. Codeia and Assafmtida, 
 
 R. Codeia, gr. J; Pilulte Assafcetida? Composita^, gr. 5. Mix into a pill, to be 
 taken every night at bedtime. 
 
 Especially useful in attacks of spasmodic cough, dyspnoea, .&c. 
 
 329. Morphia and Assafoetida. 
 
 R. Morphine Hydrochloratis, gr. 2; Assafoetida?, gr. 30; Camphoris, gr. 20. Make 
 a mass, divide into twelve jiills, and order one to be taken at bedtime. 
 A good stimulant and antispasmodic. 
 
 330. Aconite and diaiacum. 
 
 R. Tincturae Aconiti, min. xx — xl ; Spiritus ^Etheris, fl. drs. iv ; Misturae Guaiaci, 
 ad fl. oz. viij. Mix. One-sixth part every six hours. 
 
 As an anodyne, stimulant, and alterative in chronic rheumatism, neuralgia, «S:c. 
 
 331. Aconite and Mercury. 
 
 R. Extracti Aconiti, gr. 1—3; Pilulae Calomelanos Compositaj, gr. 3. Make into 
 a pill, and order it to be taken every night at bedtime. 
 In sleeplessness from a syphilitic taint. 
 
 332. Aconite and Opium. 
 
 R. Extracti Aconiti, Extracti Opii, aa gr. 8; Extracti Hyoscyami, gr. IG. Mix, 
 and divide into eight pills. One to be taken every four, six, or eight hours. 
 In some acute inflammations, — as peritonitis, pleurisy, ovaritis, &c.
 
 340 APPENDIX OF FORMULA. 
 
 333. Opium and Sugar of 3Iilk. 
 
 R. Pulveri? Ipecacuanhse cum Opio, gr. 1 ; Sacchari Lactis, gr. 120. Mix, and 
 divide into four powders. One to be taken every night, beaten up in a teaspoonful of 
 cream. 
 
 A safe opiate for infants from two to six weeks old. 
 
 R. Tincture Opii, min. j ; Sacchari Lactis, oz. ^ ; Mucilaginis Tragacantbse, Aquse 
 Anethi, aa fl. drs. iv. JVlix. One teaspoonful twice or thrice in the twenty-four 
 hours. 
 
 In the painful diseases of early life. 
 
 334. Tincture of Digitalis. 
 
 R. Tincturae Digitalis, fl. drm. j ; Aqua? Anethi, fl. oz. viij. Mix. One-sixth part 
 every four hours. 
 
 Recent experiments tend to prove that digitalis is a cardiac stimulant and tonic ; 
 and that it is therefore especially useful in diseases due to weakness of the muscular 
 ■walls. 
 
 R. Tincture Digitalis, fl. drs. j — ij ; Tincturse Cardamomi Composita3, fl. drs. vj ; 
 Acidi Hydrocyanici Diluti, min. xx ; Aquae Camphoraj, ad fl. oz. viij. Mix. One- 
 sixth part three times a day. 
 
 In some forms of cardiac disease, with irritability of the stomach. 
 
 R. Acidi Sulphurici Aromatici, fl. drs. ij ; Tincturae Digitalis, fl. drm. j ; Extracti 
 Opii Liquidi, min. xxx ; Infusi Chiratte, ad fl. oz. viij. 5lix. One-sixth part three 
 times a day. p 
 
 335. Hemlock and JTenbane, ^c. 
 
 R. Extracti Conii, Extracti Hyoscyami, Pilulae Ehei Compositae, aa gr. 3. Mix, 
 and divide into two pills. To be taken at bedtime. 
 
 To relieve sleeplessness with constipation. In some forms of asthma. 
 
 R. Extracti Conii, Extracti Hyoscyami, Pilulae Hydrargyri, aa gr. 3; Pulveris 
 Ipecacuanhas, gr. 1. Mix, and divide into two pills. To be taken at bedtime. 
 
 336. Hemloch and Dover's Powder. 
 
 R. Extracti Conii, gr. 36; Pulveris Ipecacuanhae cum Opio, gr. 24. Mix, and 
 divide into twelve pills. One to be taken every three or four hours. 
 To relieve the pain arising from malignant disease. 
 
 337. Henbane and Indian Hemp. 
 
 R. Extracti Cannabis Indicae, gr. \ — 1; Extracti Hyoscyami, gr. 4. Make into a 
 piU. To be taken every twelve or twenty-four hours. 
 
 338. Iodoform Pills and Suppositories. 
 
 R. lodoformi, gr. 2—6; Extracti Conii, gr. 4. Mix. Divide into two pills, and 
 order them to be taken at bedtime. 
 
 In painful diseases of the stomach. The author has once or twice found a full 
 dose of iodoform relieve a paroxysm of asthma. 
 
 R. lodoformi, gr. 3 — 8; Butyri Cacao, gr. 20. Mix, for a suppository. 
 As a local anaesthetic in cancerous and odier painful diseases of rectum. 
 The anodyne action of iodoform is uncertain. 
 
 339. Opiate Enemata. 
 
 R. Tincluraj Opii, min. xx — xxx ; Vini Ipecacuanhae, min. xxx ; Mucilaginis 
 Amyli, fl. oz. ij. Mix. The bowel should be washed out with warm water before 
 the administration of this enema. 
 
 In diarrhoea, tenesmus, strangury, &c. 
 
 R. Extracti Opii Liquidi, min. xx— fl. drm. j ; Tincture Belladonnae, min. xv— 
 xxx; Mucilaginis Amyli, fl. oz. ij. Mix. 
 In cancer of uterus, rectum, &c.
 
 NARCOTICS AND SEDATIVES. 341 
 
 340. Opiate Suppositories. 
 
 R. Piilveris Opii, gv. 1—2; Saponis Diiri, gv. 10. Mix, for a suppository. 
 To allay pain or irritation about the pelvic viscera. 
 
 R. Extracti Opii, gr. 1—3; Extracti Belladonna;, gr. ^; Butyri Cacao, gr. 20. 
 3Iix into a suppository. 
 
 Especially useful in diseases of the bladder and rectum. 
 
 341. Lettuce Opium. 
 
 R. Lactucarii, gr. 8—10. To be divided into two pills, to be taken at bedtime. 
 A doubtful narcotic. Has been chiefly used as an anodyne in phthisis, or where 
 opium cannot be borne. 
 
 342. Indian Hemp, Aconite, and Ether. 
 
 R. Tincturse Cannabis Indicte, min. xx ; Spiritus .Juniperi, min. xxx ; Spiritiii? 
 iEtheris, min. xlv ; Tincturse Aconiti, min. x ; Mucilaginis Acaciie, ad fl. oz. iss. Mix, 
 for a draught. To be taken at bedtime. 
 
 In neuralgic dysmenorrhoea, &c. 
 
 343. Opium, or Morphia, and Henbane. 
 
 R. Extract! Opii, gr. 1 — 3, vel Morphias Hydrochloratis, gr. \ — 1. Extracti Hyos- 
 cyami, gr. 3. Make into a pill, to be taken at bedtime. For the relief of severe pain, 
 and to afford sleep in lingering diseases. 
 
 344. Opium and Belladonna. 
 
 R. Extracti Opii, gr. 1 ; Extracti Belladonnse, gr. J; Extracti Conii, gr. 3. Make 
 into a pill, to be taken every three or four hours. 
 
 In intestinal obstruction And in other cases where it is necessary to relieve severe 
 pain without inducing constipation. 
 
 The belladonna may be omitted where only the influence of the opium is required. 
 
 345. Opium and Capsicum. 
 
 R. Extracti Opii, gr. 1 — 2; Pulveris Capsici, gr. 2; Extracti Hyoscyami, gr. 4. 
 Make into two pills, to be taken every night at bedtime. 
 
 In those diseases where opium is needed, but where it is not well borne, owing to 
 its producing headache, sickness, &c. The stimulating eflect of the cajjsicum will 
 often ward ofl" these unpleasant results. 
 
 346. 3Iorphia and Squill Linctus. 
 
 R. Syrupi Scillaj, Syrupi RhcEados, aa fl. oz. j ; Liquoris Morphia; Hydrochloratis, 
 fl. drm. j. Mix, and label, — "A small teaspoonful to be taken frequently, if the cough 
 is troublesome." 
 
 347. Compound Linctus. 
 
 R. Spiritus Chloroformi, fl. drs. iv ; Vini Ipecacuanhse, fl. drs. ij ; Liquoris Morphiaj 
 Hydrochloratis, fl. drm. j ; Acidi Hydrocyanici Diluti, min. xv ; Syrupi Mori, ad fl. 
 oz. iij. Mix, and label, — " One teaspoonful every two or three hours, until the cough 
 is relieved."
 
 342 APPENDIX OF FORMULA. 
 
 XV. REFRIGERANTS AND SALINES. 
 
 348. Saline Draughts. 
 
 R. Sodfe Bicarbonatis, gr. 20; Aqua? Laurocerasi, min. x ; Syrupi Limonis, fl. drm. 
 j ; Aquiie, ad fl. oz. iss. Mix. An efl'ervescing draught is to be made by the addition 
 of a tablespoonful of lemon-juice, or of eighteen grains of citric acid. To be taken 
 every four or six hours. 
 
 In fever with nausea. 
 
 R. Spiritus yEtheris Nitrosi, fl. drs. iv ; Liquoris Ammonise Acetatis, fl. drs. iij — 
 V j ; Vini Colchici, fl. drm. j; Aqute Camphorte, ad fl. oz. viij. Mix. Two table- 
 spoonfuls every four hours. 
 
 R. Syrupi Scillpe, fl. drs. vj ; Spiritus ^theris Nitrosi, Tinctura3 Hyoscyami, aa fl. 
 drs. iij ; Infusi Rosie Acidi, ad fl. oz. viij. Mix. One-sixth part every six hours. 
 In influenza, catarrh, «&;c. 
 
 R. Potassse Nitratis, gr. 40, vel Potassae Citratis, gr. 100 ; Vini Antimoniale, fl. 
 drm. j ; Liquoris Ammonife Acetatis, fl. drs. iv ; Aqu« Camphorse, ad fl. oz. viij. 
 Mix. One-sixth part every four hours. 
 
 349. Saline with Excess of Ammonia. 
 
 R. Liquoris Ammonife Acetatis, fl. drs. vj ; Spiritus Ammonias Aromatici, fl. drs. 
 iij ; Syrupi Liraonis, fl. drs. vj ; Aquae, ad fl. oz. viij. Mix. One-sixth part every 
 four hours. 
 
 In the early stages of fever, tonsillitis, &G. 
 
 350. Dr. Stevens's Saline Mixture. 
 
 R. Sodii Chloridi, gr. 20; Potassre Chloratis, gr. 7; Sodse Carbonatis, gr. 30; 
 Aquise, fl. oz. iss. Mix. To be taken every half hour. 
 In malignant cholera. 
 
 351. Colehieum and Magnesia. 
 
 R. Vini Colchici, fl. drs. iss; Magnesia? Carbonatis, gr. 120; Spiritfts Ammonise 
 Aromatici, fl. drs. iij ; Tincturte Hyoscyami, fl. drs. ij ; Aquae Camphorse, ad fl. oz. 
 viij. Mix. One-sixth part night and morning. 
 
 In slight cases of gout, &c. 
 
 352. Colehieum and Chlorate of Potash. 
 
 R. Vini Colchici, fl. drs. ij ; Potassae Chloratis, gr. 120; Liquoris Ammonise Ace- 
 tatis, fl. drs. vj ; Aquaj Camphorse, ad fl. oz. viij. Mix. One-sixth part three times 
 a day. 
 
 In gout with heat and dryness of the skin. 
 
 353. Borax and Nitric Ether. 
 
 R. Boracis, gr. 80; Spiritus ^theris Nitrosi, fl. drs. iij ; Syrupi Papaveris, fl. drs. 
 vj ; Infusi Lini, ad fl. oz. viij. Mix. One-sixth part every six hours. 
 
 354. Ammonia, Chlorinated Soda, and Serpentary. 
 
 R. Ammonise Carbonatis, gr. 30; Liquoris Sodse Chloratse, fl. drm. j ; Infusi Ser- 
 pentariic, fl. oz. viij. Mix. One-sixth part every six hours. 
 
 As a diaphoretic and stimulant in the low stage of continued fever. See P. 368. 
 
 355. Bicarbonate of Potash Drink. 
 
 R. Potassae Bicarbonatis, oz. \ — ^ ; Syrupi Limonis, fl. oz. j ; Aquse, ad Oij. Mix, 
 for the day's drink. 
 
 Very useful in the uric acid diathesis, in acute rheumatism, &c. A drink called 
 "Constitution-water" owes its efficacy to the bicarbonate of potash it contains.
 
 STIMULANTS. 343 
 
 35G. Cream of Tartar Drink. 
 
 R. Potassse Tartratis Acidse, oz. 1; Olei Limonis, min. xv ; Sacchari Albi, oz. 2; 
 Aqua} Bulliontis, Oij. Mix. To be used, when cold, as a common drink. 
 In simple fever, with constipation and great thirst. 
 
 357. Hydrochloric Acid Drink. 
 
 R. Acidi Hydrochlorici Diluti, fl. drs. ij — iij ; Mellis Depurati, oz. 1; Decocti 
 Hordoi, Oij. Mix, for the daily drink. 
 In typhus, «&c. 
 
 358. Hydrochloric Acid and Chlorate of Potash Drink. 
 
 R. Acidi Hydroehlorici Diluti, fl. drs. ij ; Potassce Chloratis, gr. 180; Syrupi Zin- 
 gibcris, fl. oz. j ; Decocti Hordei, Oij. Mix. 
 A valuable drink in some cases of fever. 
 
 359. Phosphoric Acid Drink. 
 
 R. Acidi Phosphorici Diluti, fl. drs. iij ; Glycerini, fl. oz. j ; Decocti Hordei, Oij. 
 Mix. 
 
 An efficacious drink for assuaging thirst in some diseases attended with nervous 
 exhaustion. It was recommended by Dr. Paris and Sir Thomas Watson as useful in 
 diabetes ; but according to Griesinger it positively increases the quantity of sugar 
 excreted. 
 
 360. Chlorate of Potash Drinks. "^ 
 
 R. Potassae Chloratis, gr. 60; Syrupi Hemidesmi, fl. oz. j ; Aqufe, Oj. Mix. 
 In the eruptive fevers, some inflammations, &c. 
 
 R. Potassa? Chloratis, oz. 1 ; Potassse Bicarbonatis, oz. 2 — 4. Mix, and divide into 
 eight powders. One to be dissolved in a pint of barley-water for the day's drink. 
 In acute rheumatism. 
 
 XVI. STIMULANTS. 
 
 361. Ammonia and Bitters. 
 
 R. Ammonise Carbonatis, gr. 30; Spiritiis Myristicae, fl. drs. ij ; Tincturse Carda- 
 momi Compositse, fl. drs. vj ; Infusi Caryophylli, ad fl. oz. viij. Mix. One-sixth 
 part every four or six hours. 
 
 In debility with nausea and flatulence. Also in erysipelas, tonsillitis, scarlet 
 fever, &c. 
 
 R. Spiritus Ammonise Aromatici, fl. drs. iij ; Tincturae Lupuli, fl. drs. vj ; Tinc- 
 tur£e Gentians Compositae, fl. oz. j : Infusi Sennae, ad fl. oz. viij. Mix. One-sixth 
 part twice or thrice daily. 
 
 In phosphuria with constipation. 
 
 R. Spiritus Ammonire Aromatici, fl. drs. iij ; Aquae Laurocerasi, fl. drm. j ; Sodae 
 Bicarbonatis, gr. 60; Tinoturre Calumbie, fl. drs. vj ; Aquae Anethi, ad fl. oz. viij. 
 Mix. One-sixth part two or three times a day. 
 
 To relieve nausea, or vomiting, with heartburn. 
 
 362. Ammonia in Effervescence. 
 
 R. Ammonia Carbonatis, gr. 120; Acidi Hydrocyanici Diluti, min. xx; Tincturae 
 Cardamomi Composita^, fl. drs. vj ; Infusi Aurantii, ad fl. oz. viij. Mix. One-sixth 
 part to be made into an eftervesc'ing draught with one tablespoonful of fresh lemon- 
 juice, or with eighteen grains of citric acid. To be taken twice or thrice daily. 
 
 In irritability of the stomach, with depression.
 
 344 APPENDIX OF FORMULA. 
 
 R. Spiritus Ammoniffi Aromatici, fl. drs. iv ; Potassa; Bicarbonati?, gr. 120 ; Spiritus 
 Chloroformi, fl. drs. iij ; Tincturaj Hyoscyami, fl. drs. iij ; Infusi Cascarilla?, ad fl. oz. 
 viij. Mix. One-sixth part every four hours, made into an etJervescing draught with 
 one tablespoonful of lemon-juice. 
 
 In irritable stomach with undue acidity of the secretions. 
 
 363. Ammonia, Valerian, and Rhubarb. 
 
 R. Tincturae Yalerianas Ammoniatse, fl. drs. iij ; Tincturse Ehei, fl. drs. vj ; Tinc- 
 ture Lavandula; Compositse, fl. oz. j ; Aqua; Pimentae, fl. oz. viij. Mix. One-sixth 
 part when oppressed with languor or faiutness. 
 
 In hypochondriasis and hysteria. 
 
 364. Ammonia and Ether. 
 
 R. Ammonia; Carbonatis, gr. 30; Spiritus JEtheris, fl. drs. iij ; Infusi Caryophylli, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 In debility with flatulence. 
 
 365. Hydrochloric Acid a7id Ether. 
 
 R. Acidi Hydrochlorici Diluti, fl. drm. j ; Spiritus ^theris, fl. drs. iij ; Syrupi 
 Aurantii, fl. drs. vj ; Infusi Aurantii, ad fl. oz. viij. Mix. One-sixth part every six 
 hours. 
 
 In continued fever, and in cases where the respired air is ammoniacal. 
 
 366. Cajuput Oil and Cloves. 
 
 R. Olei Cajuputi, min. v; Pulveris Tragacanthte Compositi, gr. 60; Aquae Destil- 
 latee, fl. drs. ij. Beat thoroughly together, and add — Infusi Caryophylli, fl. drs. x. 
 Mix. To be taken occasionally. 
 
 In hysteria, flatulent colic, and many spasmodic diseases. 
 
 R. Olei Cajuputi, min. iv ; Sacchari Lactis, gr. 120. Beat up thoroughly, and add — 
 Decocti Aloes Compositi, fl. oz. iss. Mix. To be taken occasionally, early in the 
 morning. 
 
 As a stimulant and laxative, where there is a tendency to flatulence and a loaded 
 rectum. 
 
 367. Ether and Brandy. 
 
 R. Spiritus JEtheris, fl. drs. iij ; Spiritus Vini Gallici, fl. drs. xij ; Infusi Cinchonae 
 Flavje, ad fl. oz. viij. Mix. One-sixth part every four or six hours. 
 At the commencement of convalescence from many acute diseases. 
 
 R. Spiritus Chloroformi, fl. drs. vj ; Misturae Spiritus Vini Gallici (F. 17), fl. oz. 
 viij. Mix. One-sixth part every six hours. 
 In the low stages of fever with restlessness. 
 
 368. Solution of Chlorinated Soda. 
 
 R. Liquoris Sodse Chloratae, fl. drs. i — ij ; Syrupi Tolutani, fl. oz. j ; Tinctura? Ser- 
 pentariae, fl. drs. vj ; Aquae, ad fl. oz. viij. Mix. One-sixth part every six hours. 
 
 In low fever this mixture will clean the tongue, promote the action of the skin and 
 kidnevs, correct the oflensive state of the evacuations, and rouse the patient. See F. 
 354. 
 
 R. Liquoris Soda? Chloratae, fl. drm. j ; TincturaB Cinchona3 Compositae, fl. drs. vj ; 
 SpiritCis Vini Gallici, fl. drs. xij ; Aquae, ad fl. oz. viij. Mix. One-sixth part every 
 three or four hours. 
 
 In low fever, with great prostration. 
 
 369. Sumbul and Mop. 
 
 R. Tincturae Sumbulis, fl. drs. vj ; Infusi Lupuli, ad fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 In some cases of hysteria, epilepsy, threatened delirium tremens, &c., where a 
 stimulant and antispasmodic is needed. See F. 95.
 
 TONICS. 345 
 
 370. Quinine, Rhubarb^ and Hop. 
 
 R. Tinctune QuiniiB Compositae, Tincturse Khci, Tincturaj Liipuli, aa fl. drs. iv. 
 Mix. One tcaspounfiil in a wineglassfiil of water twi(;e a day. 
 
 In dyspepsia from weakness of the digestive organs, and constipation. See F. 385. 
 
 XVII. TONICS. 
 
 371. Bark and Ammonia. 
 
 R. Ammonia} Carbonatis, gr. 30; Tincturae LavanduUe Compositae, fl. oz. j ; Infusi 
 Cinchonaj Flavie, ad fl. oz. viij. Mix. One-sixth part every six hours. 
 
 R. Ammonia? Carbonatis, gr. 30: Tincturse Aconiti, min. xl ; Tincturse Cinchonie 
 CompositaB, fl. drs. vj ; Aquae Menthse Piperitae, ad fl. oz. viij. Mix. One-sixth part 
 three times a day. 
 
 R. Ammonia? Carbonatis, gr. 30; Extracti Opii Liquidi, min. xxx ; Spiritfts 
 ^theris, fl. drs. iij ; Decocti Cinchonse Flava?, ad fl. oz. viij. Mix. One-sixth 
 part every three or four hours. 
 
 In cases where it is feared that a deposition of fibrine has taken place in the heart 
 or one of the large vessels. 
 
 R. Spiritus Ammoniie Aromatici, Spiritus Chloroformi, aa fl. drs. vij ; Liquoris 
 Morphige Hydrochloratis, fl. drs. ij ; Extracti Cinchonaa Flavaj Liquidi, fl. drs. iv ; 
 Tinctura3 Cinchonaj Flavse, ad fl. oz. iij. Mix. Direct, — " One teaspoonful in a 
 wineglassful of Port wine three times a day." 
 
 In certain cases of phthisis this mixture is very useful, especially in conjunction 
 with cod-liver oil and a liberal diet. 
 
 372. Ammonia, Bark, and Rhubarb. 
 
 R. Spiritus Ammonise Aromatici, fl. drs. iv ; Extracti Cinchonas Flavae Liquidi, 
 fl. drs. iss ; Tincture Rhei, fl. drs. iv ; Infusi Rhei, ad fl. oz. viij. Mix. One-sixth 
 part twice or thrice daily. 
 
 In nervous depression, &c., with constipation, 
 
 373. Bark and Liquor Potassce. 
 
 R. Liquoris Potassa;, fl. drs. iij ; Tincturas Cinchonae Composita?, fl. drs. vj ; De- 
 cocti Cinchonae Flava?, ad fl. oz. viij. Mix. One-sixth part twice or thrice daily. 
 In debility attended with the lithic acid diathesis. 
 
 374. Bark and Serpentary. 
 
 R. Tincturae Cinchonae Compositae, fl. oz. j ; Tincturae Aconiti, min. xxx ; Tinc- 
 turae Serpentariae, vel Tincturae Acteae Eacemosae, fl. drs. iij ; Aquaj Menthas Pipe- 
 rita?, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In some cases of chronic rheumatism, lumbago, and rheumatoid arthritis. 
 
 375. Bark and Hemlock. 
 
 R. Tinctura? Cinchonae Compositae, fl. drs. vj ; Succi Conii, fl. drs. iv; Aqua? Pi- 
 mentas, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 In chronic diseases attended with debility and pain. 
 
 376. Acid 3Iixtures and Bark. 
 
 R. Acidi Sulphurici Aromatici, fl. drs. ij ; Syrupi Aurantii, fl. oz. j ; Tincturae 
 Cinchonae Compositte, fl. drs. vj ; Infusi Cinchonte Flavte, ad fl. oz. viij. 3Iix. One- 
 sixth part twice or thrice daily, on an empty stomach. 
 
 Especially useful in depressing disorders accompanied with occasional attacks of 
 hemorrhaii-e.
 
 846 APPENDIX OF FORMULA. 
 
 R. Acidi Phosphoric! Diluti, fl. drs. iss ; Tincturne Aconiti, fl. drm. ss ; Tincturse 
 Cinchoiiie Compositse, fl. oz. j ; Infusi Aurantii, ad fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 In debility, with nervous irritability. 
 
 R. Acidi Nitrici Diluti, vel Acidi Phosphorici Diluti, fl. drs. iss ; Tincturie Nucis 
 Vomicffi, fl. drm. j ; Extracti Cinchonse Plavse Liquidi, fl. drs. ij ; Aquffi Menthse 
 Piperita, ad fl. oz. viij. Mix. One-sixth part three times a day, two hours before 
 each meal. 
 
 In general weakness, with nervous exhaustion. 
 
 377. Acid Mixtures with Calumbo, S^e. 
 
 R. Tincturse Calumbo, fl. drs. vj ; Acidi Sulphurici Aromatici, fl. drs. iss ; Syrupi 
 Aurantii, fl. oz. j ; Infusi Aurantii, ad fl. oz. viij. Mix. One-sixth part three times 
 a day, when the stomach is empty. 
 
 R. Acidi Hydrochlorici Diluti, fl. drs. iss ; Acidi Hydrocyanici Diluti, min. xx ; 
 Infusi Chirataj, ad fl. oz. viij. Mix. One-sixth part three times a day, immediately 
 before the meals. 
 
 As a stomachic, especially in the dyspepsia of gouty subjects. 
 
 R. Succi Limonis Kecentis, fl. drs. xij ; Syrupi Limonis, fl. oz. j ; Infusi Chiratse, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 Where there is debility with a threatening of rheumatic fever. In cancer of the 
 stomach, &c. 
 
 378. Nitro-IIydrochloric Acid 3Iixtures. 
 
 R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. iss — iij ; Tincturse Chiratse, fl. drs. 
 iij ; Tincturpe Aconiti, min. xxx ; Syrupi Aurantii, fl. oz. j ; Infusi Aurantii, ad fl. 
 oz. viij. Mix. One-sixth part three times a day, an hour before each meal. 
 
 In oxaluria, dyspepsia, rheumatoid arthritis, &c. 
 
 R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. ij ; Acidi Hydrocyanici Diluti, min. 
 XXV ; Tincturse Arnicae, fl. drm. j ; Tincturaj Gentianae Composite, fl. oz. j ; Infusi 
 Sennse, ad fl. oz. viij. Mix. One-sixth part twice or thrice daily. 
 
 In d^'spepsia, with sluggish action of the liver. The eflScacy of this mixture may 
 often be increased by giving with each dose a pill containing one or two grains of 
 sulphate of zinc and four of extract of gentian. 
 
 R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. ij ; Liquoris Strychnife, min. xxx — 
 fl. drm. j ; Spiritus Chloroformi, fl. drs. vj ; Tincturte Zingiberis, fl. drs. iij ; Aquae, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In any form of functional paralysis after all the appreciable causes are remedied. 
 Also in obstinate debility, hj-pochondriasis, diabetes insipidus, alkaline urine, &c. 
 
 R. Acidi Nitro-Hydrochlorici Diluti, fl. drs. iss; Tincturse Belladonnas, fl. drm. j; 
 Extracti Pareirae Liquidi, fl. drm. j ; Decocti Pareine, ad fl. oz. viij. Mix. One- 
 sixth part every six hours. 
 
 In incontinence of urine, when the reaction of the latter is alkaline. 
 
 379. Quinine Mixtures and Pills. 
 
 R. Quinise Sulphatis, gr. 12; Acidi Nitrici Diluti, re^ Acidi Phosphorici Diluti, 
 vel Acidi Sulphurici Aromatici, fl. drs. iss ; Tincturse Lupuli, fl. drs. vj ; Aqu», ad 
 fl. oz. viij. Mix. One-sixth ptirt three times a day. 
 
 Amongst other purposes, this mixture may be used to check the night-sweats in 
 phthisis. 
 
 R. Tincturse Quinise Compositse, fl. drs. xiv ; Tincturse Aconiti, fl. drs. ij ; Glyce- 
 rini, fl. oz. j. Mix. One teaspoonful in a wineglassful of water three times a day. 
 In neuralgia, nervous irritability, weakness, &c. 
 
 R. Quinio3 Sulphatis, gr. 18; Extracti Lupuli, gr. 40. Make a ma.ss, divide into 
 twelve pills, and order one to be taken three times a day. 
 
 R. Quinife Sulphatis, gr. 4; Acidi Phosphorici Diluti, min. xx ; Syrupi Aurantii, 
 fl. drs. iv; Aquse. ad fl. oz. iv. Mix. One small tablespoonful three times a day. 
 In strumous ophthalmia and other cases of debility in children.
 
 TONICS. 347 
 
 R. Qiiinise Rulphatis, gr. 64; Acidi Siilphnrici Dihiti, min. x; Aqiite, fl drs. iv. 
 Mix. Proin lif'tcon minims to half a drachm (gr. 4-8) may be carefully injected into 
 the subcutimoous areolar tissue. 
 
 In intermittent fever, &c. 
 
 380. Quinine and Steel. 
 
 R. Quinia3 Sulphatis, Ferri Snlphatis, aa gr. 12; Liquoris Strychnifc, min. xxx ; 
 Acidi Suiphurici Aromatici, fl. drs. iss ; Infusi Quassias, ad fl. oz. viij. Mix. One- 
 sixth part throe times a day. 
 
 Tile black stools, which are passed while any preparation of steel is being taken, 
 are due to the combination of the metal with part of the sulphur of the food, — form- 
 ing sulphuret of iron. . 
 
 R. Quinise Sulphatis, gr. 9; Acidi Hydrochlorici Diluti, fl. drm. j; Tincturae 
 Arnicie, min. xxx — fl. drm. j ; Tincturae Ferri Perchloridi, fl. drs. iss; Infusi Caryo- 
 phylli, ad fl. 0/5. viij. Mix. One-sixth part three times a day. 
 
 In general debility, diphtheria, erysipelas, &c. 
 
 R. Quinife Sulphatis, gr. 12; Tincturjc Ferri Perchloridi, fl. drs. ij ; Tincturae 
 Nucis Vomicaj, fl. drm. j ; Tincturas Lupuli, fl. drs. vj ; Magnesiae Sulphatis, oz. 1 ; 
 Infusi Lupuli, ad fl. oz. viij. Mix. One-sixth part daily, three hours after break- 
 fast. 
 
 In habitual constipation with debility. 
 
 R. Quiniffi Sulphatis, Ferri Sulphatis Exsiccatffi, aa gr. 20; Extracti Hyoscyami, 
 gr. 30. Make a mass, divide into twelve pills, and order one to be taken twice a day. 
 In debility with irritability of the nervous system. 
 
 R. Quiniae Sulphatis, gr. 12; Ferri Eedacti, gr. 30; Extracti Aconiti, gr. 12; 
 Glycerini, sufficient to form a mass. Divide into twelve pills, and order one to be 
 taken an hour after dinner and supper. 
 
 In neuralgia, rheumatoid arthritis, painful chronic aflections with debility, &c. 
 
 R. Ferri et Quiniae Citratis, gr. 30; Tincturae Chiratse, fl. drs. iss; Aquae, ad fl. 
 oz. viij. Mix. One-sixth part three times a day. 
 
 An excellent tonic where there is exhaustion, with a weak and irritable stomach. 
 If the strong bitter is objectionable, Tincture of Calumbo may be substituted for the 
 Chiretta. 
 
 381. Quinine, Steel, and Arsenic. 
 
 R. Tincturae Quiniffi Compositae, fl. oz. j ; Liquoris Arsenicalis, min. xviij ; Ferri 
 et Ammoniaj Citratis, gr. 30; Aquae Aurantii, ad fl. oz. viij. Mix. One-sixth part 
 three times a day, after meals. 
 
 In diseases of the skin, &c., with impoverished blood. 
 
 R. Quiniae Sulphatis, gr. 9; Acidi Phosphorici Diluti, Tincturae Ferri Perchloridi, 
 aa fl. drs. iss; Liquoris Arsenici Chloridi (Phar. Lond. 1851), min. xxx — fl. drm. j ; 
 Syrupi Zingiberis, fl. drs. vj ; Aquae, vel Infusi Quassiae, ad fl. oz. viij. Mix. One- 
 sixth part directly after breakfast, dinner, and supper. 
 
 In many skin diseases, rheumatoid arthritis, carbuncular inflammation, &c. See 
 F. 52, 899. 
 
 382. Quinine and Iodide of Iron. 
 
 R. Tincturae Quiniae, fl. oz. j ; Syrupi Ferri lodidi, fl. drs. iij — \'j ; Infusi Calumbae, 
 ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In debility with a strumous taint, chronic rheumatism, goitre, &c. 
 
 383. Quinine and Belladotma. 
 
 R. Quiniae Sulphatis, gr. 24 ; Extracti Belladonnae, gr. 4; Camphorae, gr. 30 ; Con- 
 fectionis lloste Gallicae, sufficient to make a mass. Divide into twelve pills, silver 
 them, and order one to be taken twice or thrice daily. 
 
 In some painful diseases (neuralgia, cancer, dysmenorrhoea, &c.) where a sedative 
 and tonic are needed. See F. 45.
 
 348 APPENDIX OF FORMULA. 
 
 384. Quinine and Ipecacuanha. 
 
 R. Quinife Sulphatis, gr. 12; Pulveris Ipecacuanhae, gr. 12—24; Extract! Gen- 
 tiaiiiB, gr. 24. Mix. Divide into twelve pills, and order one to be taken every day 
 at dinner. 
 
 An excellent remedy in cases of slow digestion. See F. 44. 
 
 385. Quinine and Rhuharh. 
 
 R. Quiniifi Sulphatis, gr. 24; Pulveris Pvhei, gr. 36; Glycerini sufficient to form a 
 mass. Divide into twelve pills, and order one to be taken night and morning. 
 
 386. Quinine and Ammonia. 
 
 R. Tincturaj Quiniae Compositpe, fl. oz. j ; Glycerini, fl. drs. vj ; Spiritus Ammonife 
 Aromatici, Spiritfis yEtheris, aa fl. drs. iij ; Extracti Opii Liquidi, min. xxx ; Infusi 
 Aurantii, vel Infusi Cinchonse Elavaj, ad fl. oz. viij. Mix. One-sixth part every six 
 hours. 
 
 In great exhaustion, with low muttering delirium and restlessness. 
 
 387. Quinine and Nux Vomica. 
 
 R. Quinia3 Sulphatis, gr. 18; Extracti Nucis Vomicae, gr. 3 — 6; Extracti Gen- 
 tian;e, gr. 35. Mix, and divide into twelve pills. One to be taken night and morning. 
 In debility with constipation. See E. 175, 409. 
 
 388. Substitutes for Quinine. 
 
 R. Beberiffi Sulphatis, gr. 30; Acidi Sulphurici Aromatici, min. xl ; Syrupi Au- 
 rantii, fl. oz. j ; Aquae Aurantii, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In neuralgic afl'ections assuming a periodic character ; as well as in intermittent 
 and remittent fevers. Beberia does not produce cerebral disturbance and headache 
 like quinine. This sulphate of an alkaloid is said to be an ingredient of Warburg's 
 Fever Drops. 
 
 R. Salicini, gr. 60; Extracti Sarsas Liquidi, fl. drs. vj ; Infusi Gentianse Com- 
 positi, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 During convalescence from acute disorders of the digestive organs. The antiperiodic 
 properties of salicin render it useful in intermittent and some other fevers. 
 
 R. Salicini, gr. 120; Glycerini, fl. oz. j ; Tincturae Aurantii, ad fl. oz. iij. Mix. 
 One teaspoonful in a wineglassful of water night and morning. 
 
 Where the stomach is easily nauseated and cannot digest quinine, this formula will 
 be useful. 
 
 389. Cod-Liver Oil. 
 
 The oil most commonly used is of a pale straw color, the dose varying from a tea- 
 spoonful to a large tablespoonful twice or thrice daily. It should be taken imme- 
 diately after meals ; floating it on milk, coifee, beef-tea, orange wine, brandy and 
 water, cherry brandy, &c. Chewing a piece of lemon-peel or cinnamon, or a few 
 cloves previously, will disguise the flavor. Sometimes it is preferred made into an 
 emulsion ; which may be done by beating it up with an equal proportion of lime- 
 water, or of milk, or with a yolk of an egg and some compound tincture of cardamoms. 
 Dr. De .Fongh's oil is pure, and is prescribed by many practitioners. 
 
 Cod-liver oil may be impregnated with various drugs, — such as any of the essential 
 oils, morphia, arscmic, iodine, mercury, quinine, zinc, iron, &c. Too large a quan- 
 tity of the solution must not be made at a time, as the oil soon becomes rancid. Com- 
 bined with ozone (an allotropic modiflcation of oxygen — hkxo^, another, and t/jittoc, 
 manner of existence), it has been found to lessen considerably the froqflency of the 
 pulse in phthisis. The dose of ozonized oil, according to Dr. E. Symes Thompson, is 
 from two to four drachms, two or three times a day. See F. 22, 32, 283, 3'JO, and 418.
 
 TONICS. 
 
 349 
 
 390. Iodide of Iron and Cod-Liver Oil. 
 
 R. Sjn-upi Ferri lodidi, fl. drs. iv ; Miu-ilagini.s Tragaoanthio, fl. oz. j ; Olei Mor- 
 rhiue, fl. oz. ivss. Mix. One tablespoon fiil twice or thrice daily. 
 In some forms of scrofula, phthisis, mild constitutional syphilis, &c. 
 
 R. Potassii lodidi, gr. 3 — 5; Glycerini, fl. drs. ij ; Vini Fcrri, fl. drs. iv ; Olei 
 Morrhua), fl. drs. vj. Mix, and make a draught to bo taken twice a day. 
 In chronic rheumatism, tertiary syphilis, strumous skin disea,ses, «!iisc. 
 
 391. Steel and Cocoa-nut Oil. 
 
 R. Olei Cocos Nucis, fl. drs. ij ; Spiritus Ammonia; Aromatici, min. xxx ; Ferri et 
 Amm()nia3 Citratis, gr. 5; Aqute Menthie Piperita?, ad fl. oz. j. Mix, and make a 
 draught to be taken twice or thrice daily. 
 
 Deserving of trial when cod-liver oil causes nausea. 
 
 392. Steel and Grlycerine. 
 
 R. Tinctura3 Ferri Perchloridi, fl. drs. iss — ij ; Zinci Phosphatis, gr. 6; Tincturae 
 Calumbie, fl. drs. vj ; Glycerini, fl. oz. j ; Aquae, ad fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 In some cases it is better to omit the glycerine from this mixture; administering 
 cod-liver oil instead, after one or two of the chief meals of the day. 
 
 R. Tincturte Ferri Perchloridi, fl, drs. ij — iv ; Glycerini, fl. drs. iv ; Aquae, ad fl. 
 oz. viij. Mix. One-eighth part every three or four hours. 
 
 In diphtheria, erysipelas, &c. 
 
 R. Spiritus Ammoniae Aromatici, fl. drs. iv ; Ferri et Ammonise Citratis, gr. 40; 
 Infusi (^uassiae, fl. oz. viss; Glycerini, fl. oz. j. Mix. One-sixth part three times a 
 day. 
 
 393. G-riffitJis Mixture with Aloes. 
 
 R. Misturae Ferri Compositae, Decocti Aloes Compositi, aa fl. oz. iv ; Zinci Sul- 
 phatis, gr. 12. Mix. One-sixth part twice a day. 
 
 In anaemia, hypochondriasis, general debility with constipation, &c. 
 
 394. Steel and Pepsine. 
 
 R. Ferri Kedacti, gr. 36 — 60; Pepsinae Porci, gr. 36; Zinci Phosphatis, gr. 18; 
 Glycerini, suflicient to make a mass. Divide into twenty-four pills, silver them, and 
 order two to be taken every day at dinner. 
 
 In anasmia, &c., with weakness of the digestive organs. 
 
 R. Ferri et Ammonias Citratis, gr. 20; Spiritus Vini Gallici, fl. oz. j ; Vini Pep- 
 sinae, fl drs. iv ; Aquas, ad fl. oz. vJ. Mix. One-half to be taken every day at din- 
 ner. See F. 420. 
 
 395. Steel and Hemlock. 
 
 R. Pilulaj Ferri Carbonatis, gr. 60; Extracti Conii, gr. 36 — 60. Mix, and divide 
 into twenty-four pills. Two to be taken twice or thrice daily. 
 
 In incipient phthisis, and in many diseases attended with cough and debility. 
 
 396. Steel Electuaries. 
 
 R. Ferri Peroxidi, Mellis Depurati, aa oz. 2. Mix. One teaspoonful twice a day. 
 In chorea, &c,. 
 
 R. Ferri Carbonatis Saccharata?, gr. 120 — 240; Oxymellis, fl. oz. iij. Mix. One 
 teaspoonful twice or thrice daily after meals. 
 
 397. Steel and Hydrochloric Acid. 
 
 R. Tincturae Ferri Perchloridi, fl. drs. iss; Acidi Hydrochlorici Diluti, fl. drs. ij ; 
 Tincturae Hyoscyami, fl. drs. iij ; Infusi Quassite, ad fl. oz. viij. Mix. One-sixth 
 part three times a day.
 
 350 APPENDIX OF FORMULA. 
 
 398. Steel and Gentian. 
 
 ' R. Felri Sulphatis Granulatse, Extract! Gentiante, aa gr. 30. 3Iix, divide into 
 twelve pills, and order one to be taken three times a day. 
 In chlorosis, «&c. 
 
 399. Steel and Arsenic. 
 
 R. Vini Terri, fl. oz. iv; Liquoris Arsenicalis, min. xx ; Syrupi Zingiberis, fl. oz. 
 ij. Mix. One-sixth part, with three tablespooufuls of water, three times a day, im- 
 mediately after meals. 
 
 For cases of purpura. In reduced doses as a tonic and alterative in some of the 
 skin diseases of children. See F. 52, 381, 402. 
 
 R. Syrupi Ferri Phosphatis, fl. oz. ij ; Liquoris Sodse Arseniatis, min. xxx. Mix. 
 One teaspoonful in a wineglassful of water directly after dinner and supper. 
 In some forms of spleen disease, &c. 
 
 400. Steel and Cantharides. 
 
 R. Tincturse Cantharidis, fl. drs. iss ; Glycerini, fl. oz. j ; Misturas Ferri Com- 
 posite, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In debility of the generative organs, some forms of incontinence of urine, &c. 
 
 R. Tincturse Cantharidis, Tincturse Ferri Perchloridi, aa fl. drm. j : Tinctura? Cap- 
 sici, fl. drs. iss; Syrupi Hemidesmi, fl. oz. j ; Aquae, ad fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 401. Steel and Ammonia. 
 
 R. Ferri Tartarati, gr. 60; Spiritus Ammonise Aromatici, fl. drs. iij ; Infusi Quas- 
 sias, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In chlorosis, leucorrhoea from relaxation of vaginal mucous membrane, &c. 
 
 R. Ferri et Ammonias Citratis, gr. 40; Ammonise Carbonatis, gr. 30; Tincturae 
 Zingiberis, fl. drs. iij ; Aqua, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 402. Steel and Chlorate of Potash. 
 
 R. Tincturse Ferri Perchloridi, fl. drs. iss; Potassae Chloratis, gr. 120; Liquoris 
 Arsenicalis, min. xv ; Aquae, ad fl. oz. viij. Mix. One-sixth part three or four times 
 a day, in a wineglassful of water. 
 
 In certain skin diseases, onychia, &c. Also in anaemia dependent on a syphilitic 
 taint, in erysipelas about the fauces, and in tonsillitis, &c., omitting the solution of 
 arsenic from the mixture. 
 
 403. Steel and Citrate of Potash. 
 
 R. Ferri et Ammonias Citratis, gr. 60 ; Spiritfis Ammoniac Aromatici, fl. drs. iv; 
 Potassae Bicarbonatis, gr. 120; Infusi Calumbte, ad fl. oz. viij. Mix. One-sixth part 
 to be taken twice a day with one tablespoonful of lemon-juice. 
 
 As a tonic where there is nausea and dyspepsia. 
 
 404. Steel and Aloes. 
 
 R. Ferri Carbonatis SaccharatsB, gr. 40; Infusi Anthemidis, fl. oz. viij. Mix. 
 One-sixth part twice a day. The following draught is also to be taken every other 
 morning before breakfast: R. Sodie Phosphatis, gr. 120; Extracti Ehei, gr. 10; 
 Decocti Aloes Compositi, fl. drs. iv ; Aquaj Carui, fl. oz. j. Mix. 
 
 Useful for atonic gouty subjects. 
 
 R. Ferri Kedacti, gr. 30; Pilulae Aloes et Myrrhae, gr. 24-40; Extracti Nucis 
 Vomicae, gr. 4. Make a mass, divide into twelve pills, and order one to be taken 
 three times a day. 
 
 In anaemia with constipation. See F. 393.
 
 TONICS. 351 
 
 405. Phosphate of Iron. 
 
 R. Fern* Phosphatis, gr. 40; Acidi Phosphorici Dihiti, fl. drs. i.=s; Syrupi Au- 
 rantii Floris, fl. oz. j ; Mucilaginis Tragacanthai, ad fl. oz. viij. Mix. Ont'-.sixth 
 part three times a day. 
 
 In scrofula, cancer, low nervous vigor, &c. 
 
 R. Ferri Phosphatis, gr. 20; Pulveris Myrrhs, gr. 15; Sacchari Albi, gr. 30. 
 Mix, and divide into six powders. One to be taken night and morning. 
 In rickets, and other strumous diseases of children. 
 
 A syrup of the Phos])hates of Iron, Lime, Soda, and Potassa, has been prepared by 
 Mr. Parrish, of Phibulclpliia. It may be obtained from most London chemists; be- 
 ing known as "Chemical Food." The dose for a child ten years of age, is one tea- 
 spoonful in water after the two principal meals of the day. 
 
 This preparation is of great value in all forms of strumous disease, and general 
 debility. 
 
 406. Steel and 3Ianganese. 
 
 R. Ferri Phosphatis, gr. 120; Manganesii Phosphatis, gr. 90; Tincture Calum- 
 bse, fl. oz. j ; Syrupi Zingiberis, fl. oz. ij. Mix. One teaspoouful in u wineglassful 
 of water three times a daj^ 
 
 In chlorosis, scrofula, &c. 
 
 407. Acetate of Strychnia. 
 
 R. StrychnifB Acetatis, gr. 1; Acidi Acetici, min. xx ; Alcoholis,fl. drs. ij ; Aqufe 
 Destillata?, fl. drs. vj. Mix. Ten drops (= to gr. 1-50) to be taken in water thi-ee 
 times a day. 
 
 Kecommended by Dr. Marshall Hall as a tonic in cases of nervous exhaustion. 
 
 R. Strychnite, gr. 1 ; Pulveris Zingiberis, gr. 40; Extracti Gentianie, gr. 60. Mix 
 very thoroughly, divide into twenty pills, and order one to be taken night and morn- 
 ing. 
 
 In partial paralysis, amaurosis, «&c., when the acute symptoms have subsided. 
 
 408. Strychnia and Steel. 
 
 R. Ferri et Ammonite Citratis, gr. 40 ; Liquoris Strychnia, fl. drm j. (= to gr. 
 ^) ; Infusi Quassite, ad fl. oz. viij. Mix. One-eighth part twice a day. 
 In chronic nervous aftections with debility. 
 
 R. Ferri Redacti, gr. 40; Zinci Valerianatis, gr. 20; Strychnia^, gr. 1; Glycerini, 
 suflicient to make a mass. Divide very carefully into twenty pills, silver them, and 
 direct one to be taken three times a day, after food. 
 
 In hypochondriasis, great nervous depression, &c. 
 
 409. Zinc and Nux Vomica. 
 
 R. Zinci Sulphatis, gr. 24; Extracti Nucis Vomicse, gr. 6; Extracti Pihei, gr. 30. 
 Make a mass, divide into twelve ]iills, and order one to be taken twice a day. 
 
 In weakness of the muscular system, atony of intestinal walls, «S:c. See F. 175, 
 
 387. 
 
 410. Valerianate of Zinc. 
 
 R. Zinci Valerianatis, gr. 12-24 ; Extracti Belladonnte, gr. 3-6 ; Extracti Gen- 
 tianie, gr. 24. Make a mass, divide into twelve pills, and silver them. One to be 
 taken three times a day. 
 
 In some nervous disorders, in cases of habitual constipation, and in spasmodic 
 contraction of the spliincter ani. 
 
 R. Zinci Valerianatis, Zinci Phosphatis, ail gr. 18 ; Extracti Pihei, gr. 24. Make 
 a mass, divide into twelve pills, and silver them. Order one to be taken three times 
 a day. 
 
 For epilepsy, neuralgia, hysteria, &c. The valerianate of quinine, of soda, of am- 
 monia, and of steel, may be employed in the same manner. In some cases of neu- 
 ralgia as many as twelve or twenty grains of valerianate of ammonia in infusion of 
 calumbo have been given every four hours.
 
 352 APPENDIX OF FORMULiE. 
 
 411. Valerianate of Zinc and Quinine. 
 
 R. Zinci Valerianatis, gr. 12; Quinite Sulphatis, gr. 6; Pilulse Ehei Compositse, 
 Extract! Anthemidis, aa gr. 20. Make a mass, divide into twelve pills, and silver 
 them. One to be taken three times a day. 
 
 In hysteria, neuralgia, &c. 
 
 412. Valerianate of Steel and Savin. 
 
 R. Perri Valerianatis, gr. 24; Olei Sabinte, min. xxiv; Pilulse Assafoetidfe Com- 
 positse, gr. 30. Make a mass, divide into twelve pills, and silver them. One to be 
 taken three times a day. 
 
 In anjemia, hysteria, and neuralgia with amenorrhoea. 
 
 413. Sulphate of Zinc. 
 
 R. Zinci Sulphatis, gr. 24 ; Extracti Aconiti, gr. 12 ; Extract! Quassias, gr. 24. 
 Make a mass, divide into twelve pills, and order one to be taken three times a day. 
 
 In epilepsy with neuralgic pains, lumbago, pleurodynia, &c. Its efficacy is much 
 increased by giving cod-liver oil at the same time. 
 
 R. Zinci Sulphatis, gr. 12-24; Extracti Conii, gr. 36. Make a mass, divide into 
 twelve pills, and order one to be taken three times a day. 
 
 In the chronic bronchitis of old people, as a tonic and sedative, &c. 
 
 414. Phosphate of Zinc, cfc. 
 
 R. Zinci Phosphatis, gr. 20-40; Acidi Phosphorici Diluti, fl. drs. iss ; Tincturae 
 Cinchonae Flavaj, fi. drs. vj, vel Tincturae Ferri Perchloridi, fl. drs. iss; Aquae Men- 
 thae PiperitiB, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 In some afli'ections of the nervous system with debility. 
 
 415. Oxide of Zinc. 
 
 R. Zinci Oxidi, gr. 24-40; Extracti Anthemidis, gr. 30. Make a mass, divide 
 into twelve pills, and order one to be taken twice a day. 
 
 In chronic alcoholism (?), chorea, hysteria, <tec. Dr. Golding Bird entertained an 
 opinion that zinc hils a specific influence on tlie nervous system, just as iron has on 
 the blood. The dose may be gradually increased until twenty or even thirty grains 
 of the zinc are taken in the day. It can sometimes be advantageously combined 
 with opium. 
 
 416. Zinc, Bark, and Crlycerine. 
 
 R. Zinci Sulphatis, gr. 12 — 20; Tincturae Cinchonae Compositie, fl. oz. j; Gly- 
 cerini, fl. drs. xij ; Aquae Mentha; Piperitae, ad fl. oz. viij. Mix. One-sixth part three 
 times a day. 
 
 During convalescence from acute disease, especially where there is emaciation with 
 great nervousness and constipation. 
 
 417. Phosphorus Pills. 
 
 R. Micae Panis, gr. 60; Aquas Dostillatas, sufficient to make a mass. Then add — 
 Phosphori, gr. 1. Mix thoroughly, divide into twenty pills, and order one to be 
 taken thrice daily. 
 
 In extreme debility and mental depression. After cholera, diphtheria, «&c. 
 
 418. Phosphorus and Oil. 
 
 R. Phosphori, gr. 1 ; 01(>i Morrhuae, fl. oz. vj. Mix. One or two teaspoonfuls 
 three times a day, immediately after food. 
 In tuberculosis, rickets, .scrofula, &c. 
 
 R. Phosphori, gr. 1 ; Olei Amygdah-B, fl. oz. iij. Mix. One teaspoonful in a wine- 
 glassful of barley-water three times a day.
 
 TONICS. 353 
 
 419. Eypophosphile of Soda. 
 
 oz^;iif'^M{^^P7;nriK.i?' '1 ^fl^i%Hypopho.sphite, gr. 30-80; Infusi Chirate, fl. 
 w, \iij. iviix. Une-sixth part three times ii day. ' 
 
 In phthisis, tabes mesenterica, <fee. In pr<.-ressive locomotor ataxy the efficaov of 
 wUhS'lur^''^ "'""^^' by giving a pill containing Nitrate oVfcl;fv:f(F%9) 
 
 bun.' S!^^Ti!^-?°''''n-f'''l*'^' ^'- 8f>-240; Spiritiis ^theris, fl. oz. j • Tinotura> Sum- 
 
 ^ni;it(.ySwL^r:';LSr;;;;y'- ^^- ^- ^^^- ^- teasi;oon../in^£^e 
 
 420. Preparations of Pepsine, 
 
 lescence from acute disease '"&'^'i"» li^ness, and duiing conva- 
 
 coI!i:tSg'li^^;;;5ir;^i:;M'r^r^ '\'^^rr? of the gastnc juice; a secretion 
 stance havino- the n }u?. V f ^ "" ""'^ hydrochloric acids, and of an azoti^ed sub- 
 of th gi'trif gl4 sSI-idLtor ^ ■ ^''"" 'rT ""^^ ^'^"^ the secretion 
 
 pepsine with gTel adv,nt " Th?s ,tT ' '''•"''' T ^' ^'^ '^"'^ '" '^^ "«^ ^^ ^'■tifi'^i"! 
 bags (the foiu?h om , J th? ^."^stance is usua ly prepared from several rennet 
 mucouVmen bri.' p Tl °* *'^^^"'"'"'^"ts) by washing them, and scraping off the 
 
 to the liquor, Zl^^^^^^^ A sufficiency of acetate of lead is added 
 
 passed through t' ^T it is .. i filt;'^ ^ '"'"'T".' °' ^^'phuretted hydrogen 
 
 in such pro,,ortior» that om- mr?, f . ' ' ' '° ^T'"" '» """"^ »"'' »t«ffll 
 
 between tw^iec^itreaj SriL'^LC/o ro7r;;::;;:^rs;,', "Z '"^ '°="' ■=""" 
 
 ^ Morson's ft;,,,,,, ,„;„„ is obtained from tile .-astric juice oh, if- ..„. u t. 
 
 p;:,;:fxXr .'s ,*edttr..™ : 
 
 Riillnr.lr w p^ ^'^ 'f^f^ oj the Same chemist are convenient and atrreeable 
 
 stoma h of the^'pT^'In^.^CLittfl'^"-""'; '' ''' "'-"^ i-I^H- from the 
 thor superior to^ hat of mo t othe k^l ^^^'^^^^^^^ ''""'^ ^'^* ^""'"^ '^>' ^'^^ «"- 
 
 into a pill with glycerine. ^' '^'''^ '' *'"'" t^° t« ^^^ grains, made 
 
 And lastly, there is the Rennet or Pepsine wine of Dr "Plli<: ^f n i,r .u 
 tion of which is thus described T-ikp f hTct !f i .• ,^ ? I^ublin, the prepara- 
 
 a„deuto.ah„,,tthteeorSi„rif^th:'^p;",\°;:s!„v^^;e^;;;;:.:i:hS::S:n^
 
 354 APPENDIX OF FORMULA. 
 
 taining few glandular follicles, may be thrown away. Slit up the organ longitudinally ; 
 and wipe it gently with a dry napkin, taking care to remove as little of the clean 
 mucus as possible. Then cut it into small pieces (the smaller the better), and put all 
 into a common wine bottle. Fill up the bottle with good sound sherry, and let it 
 remain corked for a fortnight ; at the end of this time it is fit for use. The dose is a 
 teaspoonful in a wineglassful of water immediately after meals. Dr. Ellis also sug- 
 gests this test for pepsine : Put a small cup containing milk in a vessel of hot water 
 until the milk becomes blood-warm. Then add a teaspoonful of rennet wine ; and if 
 it be genuine, the milk in two or three minutes will become as solid as blancmange.— 
 F. 394. 
 
 XVIII. UTERINE THEEAPEUTICS. 
 
 421. Ferruginous Emmenagogues. 
 
 R. Potassii lodidi, gr. 18 — 30 ; Ferri et Ammonia? Citratis, gr. 40 ; Tincturas Nucis 
 Vomicae, fl. drm. j ; Infusi Quassia?, ad fl. oz. viij. Mix. One-sixth part three times 
 a day. 
 
 In amenorrhoea with a torpid circulation. 
 
 R. Syrupi Ferri lodidi, Glj'cerini, aa fl. oz. j ; Olei Limonis, min. x. Mix. One 
 teaspoonful in a wineglassful of water three times a day. See F. 32. 
 
 R. Pilulse Ferri Carbonatis, gr. 30; Pilulse Cambogise Compositae, gr. 15; Olei 
 Sabinae, min. xij. Make a mass, divide into twelve pills, and order two to be taken 
 twice a day. 
 
 In amenorrhoea with anaemia and habitual constipation. 
 
 R. Ferri Valerianatis, gr. 18 ; Olei Sabinae, min. xxiv ; Extracti Aloes Barbadensis, 
 gr. 6 ; Pilula? Assafoetida Composita?, gr. 36. Mix thoroughly, and divide into twelve 
 pills. One to be taken three times a day. 
 
 In amenorrhoea with hysteria. See F. 412. 
 
 R. Tincturae Ferri Perchloridi, fl. drs. iss; Potassae Chloratis, gr. 60; Tincturae 
 Acteie Racemosa?, fl. drs. iv ; Infusi Serpentarije, ad fl. oz. viij. Mix. One-sixth 
 part three times a day. 
 
 In debility, with imperfect menstruation, pains in the back, and an irritable con- 
 dition of the buccal or gastric mucous membrane. See F. 320. 
 
 422. Stimulant Emmenagogues. 
 
 R. Extracti Ergotae Liquidi, fl. drs. iij ; Tincturae Serpentariae, fl. drs. vj ; Decocti 
 Aloes Compositi, ad fl. oz. viij. Mix. One-sixth part early every morning. 
 In amenorrhoea dependent on simple atony of the uterine organs. 
 
 R. Potassii Bromidi, gr. 60; Tincturae Cantharidis, fl. drs. iss; Tincturae Cinna- 
 momi, fl,. drs. vj ; Aquae, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 R. Olei Rutae, min. xv ; Extracti Ergotae Liquidi, fl. drs. ij ; Mucilaginis Traga- 
 canthffi, ad fl. oz. viij. Mix. One-sixth part three times a day. 
 
 R. Boracis, gr. 60; Tincturae Ergota?, fl. drs. iv ; Aquai Cinnamomi, ad fl. oz. viij. 
 Mix. One-sixth part three times a day. 
 
 R. Tinctura? Hellebori (Phar. Lond., 1851), fl. drs. iij ; Syrupi Zingiberis, fl. drs. 
 vj ; Infusi Senna?, ad fl. oz. viij. Mix. One-sixth part once or twice a day. 
 In amenorrhoea with torpid action of the bowels. 
 
 R. Liquoris Strychniae, fl. drm. j ; Tinctura? Ferri Perchloridi, fl. drs. iss ; Tincturae 
 Acetae Racemosie, fl. drs. iv ; Ini'usi Quassias, ad fl. oz. viij. Mix. One-sixth part 
 three times a day. 
 
 R. Podophylli Resinae, gr. 6; Extracti Ilyoscyami, gr. 24; Pilulae Aloes et Myr- 
 rlue, gr. 30. Mix, and divide into t,welve pills. One to be taken at bedtime for three 
 or four nights in succession. 
 
 Where the menstrual flow is scanty, and the liver sluggish.
 
 UTERINE THERAPEUTICS. 355 
 
 423. 3Ieclicated Vaginal Pessaries. 
 
 R. Plunibi lodidi, gr. 80; Extract! Belladonn.'c, gr. 24 — 40; Butyri Cacao, oz. 1 ; 
 Olei Olivte, fl. drs. ij. Mix; melt into a mass with gentle heat; and pour it into a 
 tube or roll of paj)cr, about eight inches long and of the circumference of the little 
 finger. Divide into eight pessaries, and order one to be introduced into the vagina 
 every night or every other night. 
 
 In chronic inflammation and induration of the labia uteri, in ovaritis, in pelvic 
 cellulitis, and in chroiiic cystitis. 
 
 For an account of the advantages of cocoa butter over other materials in making 
 these pessaries the reader is referred to a paper by the author in the " Obstetrical 
 Transactions," vol. 4, p. 205, London, 1863. 
 
 R. TJnguenti Hydrargyri, gr. 80 — 120; Butyri Cacao, oz. 1 ; Olei Olivap, fl. drs. ij. 
 Mix. Divide into eight pessaries. Where there is tenderness of the cervix uteri, or 
 of the ovaries, thirty grains of Extract of Belladonna or eighty grains of Extract of 
 Conium should be added to the mass. 
 
 R. lodoformi, gr. 80; Butyri Cacao, oz. 1 ; Glycerini, fl. drs. iss. Mix. Divide 
 into eight pessaries. 
 As a local anaesthetic in cancerous and other painful uterine diseases. 
 
 R. Extract! Aloes Socotrinae, gr. 60; Olei Sabinae, fl. drm. j ; Butyri Cacao, oz. 1 ; 
 Olei Oliva?, fl. drs. ij. Mix. Divide into eight pessaries, and order one to be intro- 
 duced into the vagina every night. 
 
 As an emmenagogue and purgative. 
 
 R. Plumbi Acetatis, gr. 20; Extract! Opii, gr. 24; Butyri Cacao, oz. 1; Glycerini, 
 fl. drs. ij. Mix. Divide into eight pessaries, and order one to be used every night. 
 In chronic leucorrhcea, acute and follicular vaginitis, &c. 
 
 R. Zinci Oxidi, gr. 60; Extract! Belladonnas, gr. 40; Butyri Cacao, oz. 1; Olei 
 Olivae, fl. drs. ij. Mix. Divide into eight pessaries. 
 
 In the same cases as the preceding. Also in cancer of the cervix uteri, and in irri- 
 tability of the bladder. 
 
 R. Potassi! lodidi, gr. 40; Extract! Conii, gr. 120; Butyri Cacao, oz. 1-; Olei 
 Olivae, fl. drs. ij. Mix. Divide into eight pessaries. One to be used every night. 
 In induration of the labia uteri in strumous subjects. 
 
 R. Acidi Tannic!, gr. 120; Pulveris Catechu, gr. 60; Butyri Cacao, oz. 1; Olei 
 Olivae, fl. drs. ij. Mix. Divide into eight pessaries, and order one to be used twice 
 a week. 
 
 In prolapsus uteri with relaxation of the vaginal tissues, and in menorrhagia. 
 
 424. Medicated Uterine Pessaries. 
 
 R. Acid! Tannici, Butyri Cacao, aa oz. ^. Mix. Divide into eight pessaries, each 
 having the diameter of an ordinary stick of nitrate of silver. 
 
 In menorrhagia with a patulous condition of the os uteri, one of these pessaries may 
 be introduced up the canal of the uterus and left there. It soon dissolves and coats 
 the lining membrane with the tannin. 
 
 R. Aluminis, gr. 80; Zinci Sulphatis, gr. 40; Butyri Cacao, oz. \. Mix. Divide 
 into eight pessaries, as in the preceding formula. 
 
 R. Unguent! Hydrargyri, Butyri Cacao, aa gr. 200; Extract! Belladonna?, gr. 20. 
 Mix, and divide into eight pessaries as in the first of these formulae. 
 
 425. Vaginal Injections. 
 
 R. Extracti Haematoxyli, oz. 1; Aluminis, gr. 120; Aquae, fl. oz. ij. Mix, and 
 label — " To be added to one pint of cold water to form an Injection." — It is to be used 
 with a vulcanized India rubber syphon syringe, a pint or more of plain water being 
 first thrown up. 
 
 In diseases attended with an ofl'ensive discharge. The patient should be cautioned 
 that the fluid will dye linen, &c., soiled with it. 
 
 R. Zinci Sulphatis, oz. 1; Aluminis Exsiccatae, oz. 5. Mix. Label, — "One tea- 
 spoonful to be mixed with a pint of tepid or cold water to form an Injection." 
 In leucorrhcea, gonorrhoea, »S:c.
 
 356 APPENDIX OF FORMULA. 
 
 R. Zinci Chloridi, gr. 80; Aquae, fl. oz. iss. Mix. Label, — "One teaspoonful to 
 be mixed with a pint of cold water to form an Injection. To be used night and 
 morning." 
 
 In gonorrhoea. 
 
 R. Liquoris Plumbi Subacetatis, fl. oz. vi ; Extracti Papaveris, oz. 2. Mix, and 
 label, — " One large tablespoonful to be mixed with a pint of warm or tepid water to 
 form an Injection." 
 
 In cases of leucorrhcea, with an irritable condition of the os uteri or vagina ; as 
 well as in rodent ulcer of the uterus. 
 
 R. Extracti Papaveris, oz. 1| ; Tincturse Belladonnse, fl. drs. iv. Mix, and label, — 
 " Two teaspoonfuls to be added to one pint of linseed tea, to form an Injection." 
 
 As a soothing remedj' in cancer of the cervix uteri, when there is but little ten- 
 dency to hemorrhage. — It may be emploj^ed twice or thrice in the twentj^-four hours. 
 
 426. Sponge-Tents^ ^c. 
 
 For the purpose of dilating the mouth and cavity of the uterus, the female urethra, 
 a strictured rectum, or a contracted orifice of the male prepuce, nothing can be better 
 than the sponge-tents introduced into obstetric practice by Sir James Simpson. 
 These instruments are of a narrow conical form, and of various sizes. They are 
 made by dipping a piece of sponge into water, and then compressing it around a cen- 
 tral wire with whip-cord. After drying, the cord is removed ; the surface of the tent 
 being then coated with a mixture of lard and wax, while three or four inches of tape 
 are fastened to its base. The tents which the author has generally used have been 
 made by Duncan & Flockhart, of Edinburgh, and they are perfect. A metallic 
 director, somewhat resembling the uterine sound with a sharp point, is needed for 
 their introduction up the uterine canal ; while their removal is accomplished by pull- 
 ing the tape. A fresh tent must be introduced every twenty-four or forty-eight hours, 
 until the tissues are sufficiently dilated to allow the finger to explore the cavity of the 
 uterus. 
 
 Dr. Sloan, of Ayr, has suggested the use of the dried stem of the sea-tangle 
 (Laminaria digitata) as a substitute for sponge. The stem of this common marine 
 plant is cylindrical, soft, flexible, firm, and capable of being greatly reduced in size 
 by drying. On subsequently being supplied with suiBcient moisture it dilates to at 
 least three or four times its size. The tangle-tents produce equable dilatation, are in 
 all respects very efficient, are cleanly, and ought to be cheap. They are more easily 
 introduced into the uterus than the sponge-tents, but they are also more liable to slip 
 out again when the pressure of the finger is removed. In employing these tents it 
 seems best to dip them in hot water just prior to introducing them ; avoiding the use 
 of oil, iis it interferes with their absorbing power. 
 
 Tents may also be made of gentian and of elm bark ; but the author has had no 
 experience with these kinds, having been perfectly satisfied with the sponge and sea- 
 tangle. 
 
 427. GalactopJiora and Cralactophyga. 
 
 a.. Galactophora {Ta\a, milk ; (^£pa>, to bear), or Galactagogues (rdXa ; ayo>, to 
 drive out), are remedies which increase the secretion of milk. Defective lactation is 
 not common amongst healthy mothers, but with the weak and delicate it is very fre- 
 quent. When it arises amongst the tirst class it is generally due to over-feeding; 
 when amongst the second, aniemia is its cause. In either class, a torpid condition of 
 the mammary gland may be its source. 
 
 Defective lactation from plethora will be best treated by purgatives, the most efficient 
 being castor oil. All kinds of beer, wine, and spirits are to be prohibited. Animal 
 food is to be allowed; with vegetables, bread, tea, &c. A mixture of milk and soda 
 water, in equal parts, forms an excellent drink in these cases. The patient is not to 
 be weakened; but she should be cautioned against the vulgar error, that a large 
 quantity of food is necessarj' simply because she is nursing. 
 
 Defective lactation frorn aiicemia is not uncommon. When the weakness is not such 
 as to forlaid suckling, the health ought to be improved by animal food ; by a fair 
 allowance of ale or porter; and by taking milk, or cocoa made with milk, instead of 
 tea or coflee. A raw egg beaten up in a tumblerful of milk, once or twice a day, will 
 do good. Then ammonia and bark (F. 371) may be given; or some non-astringent 
 ferruginous tonic (F. 403, 405) ; or cod-liver oil. 
 
 Defective lac1atL<iufru7n torpor of the maynma is the most frequent variety. In these 
 cases benefit will be derived from irritating the gland and nipple, — as by the careful 
 use of the breast pump ; by drawing out the nipple several times with the fingers,
 
 UTERINE THERAPEUTICS. 357 
 
 before the infant is applied; by passinc; an electric current through the gland, for 
 fifteen or twenty minutes daily, for several days in succession ; or by the application 
 of a hot carrot poultice, during some hours daily. The breasts are to be kept warm. 
 Moderate sexual intercourse is also useful. — Beef and mutton, game and poultr}-, 
 ■white fish, oysters, stewed eels, potatoes, parsnips, lettuce, carrots, turnips, ic, will 
 increase the secretion. There is no objection to stout, or to any other kind of malt 
 liquor, provided the stomach can digest it; while from one to two pints of cow's milk 
 should be allowed daily. — With regard to drugs perhaps the most efficacious is a de- 
 coction of the leaves and stalks of the Ricimis coynm.unift, or C'as/or-uil plant. Dr. 
 Kouth rccDinmiMids the administration of a strong decoction of this plant or of an 
 extract; the dose of the former being from one to two drachms daily in water, or of 
 the latter five grains. Tiie castor-oil leaves nuiy also be applied over the breasts, or 
 an infusion of them may be used with lint and oiled silk. Amongst other remedies 
 reputed to possess galactagogue properties may be mentioned, — Aqixa Ane^hi or Dill 
 waier, and Oleum Anethi; Aqua Anisi or Atiiseed waler, and Oleum Anisi ; and partic- 
 ularly Aqua; Famiculi or Fennel water, and Olenm Fveniculi. The dose of either of these 
 waters is from two to four ounces, and of the oils about five minims on a lump of 
 sugar, twice or thrice daily. — The value of such agents as the Malva Sylvestris or 
 Ma7:sh mallow, of the Sc/xmaria vaccnria or cow; basil., of the juice or decoction of 
 Broom,-tops, and of the infusion of Althcea root, is very doubtful. 
 
 Sure ydpples may indirectly be the cause of defective lactation. Slight excoriations, 
 as well as chaps and fissures, can generally be healed by the use of the dilute solution 
 of subacetate of lead, or by the liniment of lime, or by an ointment of balsam of 
 Peru, or by a lotion containing borax and glycerine. Frequently drying the nipple 
 ■with a soft rag, and then dusting it with spermaceti which has been finely powdered 
 by the aid of a few drops of proof spirit, will be found exceedingly efficacious. Where 
 the fissures are deep, light cauterization with nitrate of silver often answers well ; or 
 the painful spots may be painted with collodium, leaving the summit of the nipple 
 free for the escape of the milk. A well-made shield, provided with an artificial 
 nipple, will often enable a woman to suckle who would otherwise be unable to do so. 
 The child's mouth must be looked to, so that if there are aphthae they may be cured. 
 
 /?. Galactophtg\ (ruAa, milk ; 0£tiy&), to shun) are the remedies employed to arrest 
 the secretion of milk. 
 
 Extract of Belladonna, is I believe the most certain agent of this kind. Reduced 
 to the consistence of treacle, by the addition of a little giyceriHe or water, it should 
 be freely painted over each breast, night and morning ; the parts being also covered 
 with wet lint and oiled silk, or with a cold bread and water poultice. At the same 
 time, one-quarter or one-third of a grain of the extract, may be administered twice 
 or thrice daily, if a speedy eftect be desirable. Sometimes it is advantageously given 
 ■with quinine and camphor (F. 383). 
 
 Iodide of Potassium often succeeds, and is particularlj' useful if there be any painful 
 engorgement of the glands. Six or nine grains daily, in divided doses, should be 
 administered. Occasionally it may be better to give about ten minims of the tincture 
 of belladonna with each dose ; or the iodide vany be combined with an active purga- 
 tive salt, as the sulphate of magnesia (F. 31). 
 
 Colchicum has not succeeded well in the author's hands when given alone. But 
 combined with the sulphate of magnesia, in the proportion of twenty minims to sixty 
 grains, administered two or three times a day, it has appeared serviceable. 
 
 Camphor has been recommended. Three or four grains, with the same quantity of 
 henbane, may be given in a couple of pills at bedtime ; while frictions with the cam- 
 phor liniment, or the compound camphor liniment, may be employed twice or thrice 
 daily. 
 
 Tobacco acts in a similar manner to belladonna. An ointment, made bv boiling 
 half an ounce of fresh tobacco in eight ounces of lard, is to be kept continually 
 applied. Or this remedy may be enijdoyed in the form of a fomentation. 
 
 Sage tea is a popular remedy, which can certainly do no harm. 
 
 428. Aphrodisiacs and Anaphrodisiacs. 
 
 et. Aphrodisiacs C A<ppo6i(na, venery) are medicines which excite or increase the 
 sexual [lowers. 
 
 Many remedies have been supposed to act as sexual stimulants, but the majority of 
 those which have been recommended merely have the property of exciting the imagi- 
 nation. This is especially the case with Musk, Castoreum, and Ambergris; extravagant 
 suljstances which ladies may use as perfumes if they please, but which should be 
 abolished from the Materia Medica. The volatile sulphurated or allyle oils, obtained 
 from alliaceous and cruciferous plants [Allium sativum, Allium ceva, Sinaj)is nigra,
 
 358 APPENDIX OF FORMULA. 
 
 Cochlearia Armoracia, <|"c.), have had some slight repute. Indian hemp and Opium 
 have been used ; but the latter, at least, generally exercises a contrary eflect to that 
 desired. Ca)dharides, Turpeniitie, and Borax probably possess no aphrodisiac powers, 
 though popularly thought to do so. The only remedies which may truly be supposed 
 to act as sexual stimulants are the various preparations of Iron, Strychnia and Nux 
 Votnica, Quinine, and Phosphorus. 
 
 ff. Anaphrodisiacs ('a, priv., and a<j>poiiina, venery) are generally believed to have 
 the power of repressing the sexual feelings. 
 
 Nauseants {Tariarated Antimonj/ and Ipecacuanha), drastic purgatives [Ela.ierium, 
 Jalap, Calomel, ^c), Camphor in large doses. Carbonate of Soda, Hemlock, Tobacco, and 
 Alcoholic drinks, probably possess anaphrodisiac properties. 
 
 XIX. CLIMATES FOR INVALIDS. 
 
 429. General Observations. 
 
 Notwithstanding the excellent writings of Sir James Clark, Edwin Lee, Gran- 
 ville, Burgess, Alexander Taylor, D. J. T. Francis, Scoresby-Jackson, and 
 others, many invalids migrate every autumn to the south of Frajice, Italy, Spain, 
 &c., merely to find a grave. This happens partlj^ because cases of far advanced dis- 
 ease are still sent abroad, when they ought to be kept at home ; partly, because a 
 situation unfavorable to the particular malady is selected, the laws of climate being 
 ill-understood; and, in some measure, because it is difficult to persuade the sick that 
 simple change to another country is only one of the means by which they are to re- 
 gain health. For although there can be no doubt that in change of air physicians 
 have an efficient remedial agent, yet it is certain that this remedy, like all others, is 
 not of indiscriminate application, but must be prescribed with judgment and dis- 
 cretion. 
 
 The diseases most likely to be cured or alleviated by the benign influence of change 
 of climate are the following : Pulmonary consumption ; chronic laryngeal and bron- 
 chial affections; asthma; disorders of the digestive organs, with the various forms 
 of dyspepsia; chronic gout and rheumatism; functional derangements of the sexual 
 organs; affections of the kidneys; and hypochondriasis. A change is beneficial to 
 strumous delicate children ; is invaluable as a restorative during convalescence from 
 acute or prolonged disease; and especially is it one of the chief resources of "pre- 
 ventive medicine." 
 
 There is no model climate : no country can boast of being perfect. All that the 
 physician's knowledge and tact will enable him to do is to select that situation which 
 possesses the greatest advantages and the fewest drawbacks for the particular case he 
 has in hand. Phthisis, for example, is prevalent and fatal in all countries, though 
 more so in some than others. Moreover, it must be remembered, that through the 
 peculiar nature of zymotic (?w/i<5co, to ferment) diseases, towns usually healthy are apt 
 to be periodically visited by epidemics ; and such places can only be avoided by con- 
 sulting recent returns, or by instituting inquiries on the spot. In considering the 
 sanative influence of any climate, attention must be paid to the aspect of the locality, 
 its drainage, and its elevation above the sea level ; to the temperature and its equa- 
 bility; to the drj'ness or moisture of the soil and atmosphere, a degree of heat being 
 often well-borne when the air is dry, which is quite unbearable when it is moist; and 
 to the nature of the prevalent winds. The amount of rain which descends in a season 
 is not of such moment as the way in which it usually falls; a region liable to sharp 
 heavy showers being much more favorable for the invalid, than one where it drizzles — 
 like a Scotch mist — for days together. Luxuriant vegetation, though agreeable to 
 the senses, may merely mean high temperature combined with moisture ; conditions 
 not favorable to the phthisical. So also the districts where marshy lands abound, or 
 where occasional inundations occur, are notoriously unhealthy ; for the evaporation 
 of the water lowers the temperature, while the decaying vegetable matter becomes 
 the source of malaria. 
 
 The beneficial ettects of sea-air are due to its purity, to the equability of its temper- 
 ature, to the iodine it contains, and to the constant presence of ozone. The latter 
 — the most powerful oxidizing agent known — is a stimuhint to all the vital functions; 
 but if in excess, it causes great irritation, particularly of the organs of respiration.
 
 CLIMATES FOR INVALIDS. 359 
 
 Ozone, found also in the air of mountainous and rural districts, has the property of 
 deconi)iosinf>; iodide of potassium, uniting with the potassium and liberating th(! iodine, 
 which latter body may be detected by starch. Hence, test-papers saturated with a 
 solution of iodide of jjotassium and starch are employed; the iodine, when freed by 
 the ozone, uniting with the starch and forming blue iodide of starch. (See F. 389.) 
 — While sea-air has a certain amount of influence in preventing tuberculosis, it is by 
 itself insufficient to cure this disorder. Mountain-air is also pure, has an average low 
 teuipcM-ature, and contains a large proportion of ozone. 
 
 Altliough a classification of climates can only be artificial, and merely useful as 
 affording a rough view of their nature, yet those countries mostly resorted to by 
 invalids may be arranged in four divisions, viz., the relaxing, sedative, exciting, and 
 bracing. 
 
 1. In the relnxinrj climates (e. g., Pisa, Madeira, Torquay) there is an elevated tempe- 
 
 rature with an excess of communicable humidity. Tliey are unfitted for cases 
 where we wish to restore diminished tone — to build up shattered constitutions. 
 
 2. In the sedative climates (Rome, Pau, Cannes, Venice) we find a freedom from 
 
 great dryness on the one hand, and from communicable humidity on the other. 
 We should not select these where it is desirable to quicken a slow circulation, 
 or where the secretions are too abundant. 
 
 3. In the exciting climates (Nice, Naples, Montpellier, Florence, Genoa, &c.) there 
 
 is an excess of dryness, a highly electric state of the air, an excess of ozone, and 
 during the early months of the year keen irritating winds. Such climates are 
 injurious where there is nervous and vascular excitement, a tendency to inflam- 
 mation, or where functional repose is needed. 
 
 4. In the Smci«gf climates (Southport, Brighton, Mentone, Malaga, Algiers, &c.) 
 
 the winter temperature while comparatively high is not opjiressive, the air con- 
 tains a moderate proportion of ozone, there is a certain amount of dryness, and 
 the winds are less irritating than in the exciting class. They are generally to be 
 avoided where there is a very sensitive state of the system, a tendency to apo- 
 plexy from hypersemia, and in many affections of the heart or large vessels. 
 But, as a general rule, they are more suited to cases of pulmonary consumption, 
 and to renal and hepatic diseases than either of the others. 
 
 It would be of little practical use to introduce an extended table giving an approxi- 
 mation to the death-rate of difterent countries. But it is interesting to shortly n'otice, 
 that on an average of ten years (1851 — GO), the annual mortality from all causes, stands 
 thus : 
 
 For England and Wales, population in 1801 being 20,066.224, the deaths are 20 to each 1000 persons living. 
 
 " London, " " 2,803.989, " 24 " 
 
 « Bristol " " 66,027, " 27 " 
 
 " Birmingham, ... " " 212,621, « 27 " " 
 
 " Manelif^ster, ... " " 243,988, " 31 " " 
 
 " Liverpool, .... " " 269,742, " 33 " " 
 
 " Dover " " 31.575, " 20 " " 
 
 " Hastings « « 26.631, '' 18 " " 
 
 " Eastbourne, ... " " 10,721, " 17 " " 
 
 " Brighton, .... " " 77,693, " 22 " " 
 
 " Worthing " " 18,921, " 18 " " 
 
 " Isle of Wight,. . . " " 65.362, " 17 " " 
 
 " Scarborough, ... " " 30,425, " 21 " " 
 
 For Paris, .... population in 1862 numbering 1.606,141, the deaths are 28 to each 1000 persons living. 
 " Berlin,. ... " 1861 " 547,.57i, " 25 " " 
 
 " Vienna, ... '• 1861 " 512,000, " 49 " " 
 
 " Turin " 1858 " 179,635, " 26 " " 
 
 " St. Petersburg, . '• 1858 " 620,131, " 41 " " 
 
 " Moscow, ... » 1858 " 386,370, " 38 " " » 
 
 When the locality to which an invalid is to resort has been decided upon, he should, 
 on leaving home, be provided with a concise code of laws in writing; or he must be 
 directed at once to consult a physician in practice at the town selected. His route had 
 better be marked out for him ; he should be cautioned as to the rate at which he is to 
 travel ; rules must be laid down as to the regimen he is to adopt ; while he ought to be 
 reminded that warm clothing, especially flannel, will be required. Frccpicntly it will 
 be better to have cheerful apartments, with a southern aspect, secured beforehand ; so 
 that at the end of his journey a few days' perfect rest may be enjoyed. The object of 
 the tour ought to be clearly explained, while he is to be warned not to expect too much, 
 especially at first. The physician in sending his patient abroad, is merely placing him 
 in the position most favorable to recovery, — but still where other remedies and general 
 precautions will be indispensable. Foreign travel would be more agreeable to most 
 men, could the plague of sight-seeing be dispensed with. But for the sick man to visit 
 picture galleries, museums, damp old ruins, cold churches, &c., is frequently to frustrate
 
 360 APPENDIX OF FOEMUL^. 
 
 the only object he should have in view, viz., the restoration of his health. In giving 
 directions as to diet it must be recollected that travelling is very exciting and wearying 
 to the invalid ; that the organs of digestion almost always become more or less de- 
 ranged ; and that many articles of food which are taken with advantage in England, 
 disagree in warmer latitudes. 
 
 In many instances the author has found it advantageous for the invalid leaving 
 England for several months to carry with him a few pure drugs ; together with a brief 
 account of their properties, doses, and modes of combination. Not that he is to be 
 encouraged to tamper with his health by pla\'ing the dangerous part of the amateur 
 phj'sician ; but good advice cannot always be procured, or it may perhaps be had where 
 only inferior drugs are obtainable for compounding the prescription. The medicines 
 which are generally ordered are these : 
 
 Sulphate of Quinia, 1 oz. t Aromatic Powder of Chalk and Opium, 
 
 Reduced Iron, 1 oz. 3 oz. 
 
 Liquid Extract of Yellow Cinchona, 4 
 
 fl. oz. 
 Spirit of Ether, 6 fl. oz. 
 Chloroform, 2 fl. oz. 
 Bicarbonate of Soda, 4 oz. 
 Compound Powder of Rhubarb, 6 oz. 
 
 Liquid Extract of Opium, 2 fl. oz. 
 Sulphate of Zinc (for emetics, lotions, 
 
 coUyria, &c.), 3 oz. 
 Tincture of Arnica (for braises, burns, 
 
 &c.), 2fl. oz. 
 Morphia and Ipecacuan Lozenges, J to 
 
 1 lb. 
 
 Scales and weights: an ounce and a minim measure: a small spatula: an enema 
 syringe, the cheaper and more simple the better: with lint and strapping, will com- 
 plete the medical equipment. In certain special cases it may be well to substitute for 
 some of the above drugs — blue pill, iodide of potassium, colchictim, gallic acid, pep- 
 sine prepared from the pig's stomach, and oil of peppermint. Two invaluable medi- 
 cines — brandy and cod-liver oil — can be procured everywhere. 
 
 La Poudre Insecticide is sold in France, and is a very efficacious remedy against 
 fleas. One or two teaspoonfuls, sprinkled over the sheets, serve to d'^stroy these foes 
 to comfort and sleep. Persian powder, made with the leaves of a kind of groundsel, 
 will have a similar eff"ect ; and so will campbor, though in a less degree. Mosquito 
 curtains may also be taken from England ; ibr mosquitos are a serious nuisance to all, 
 but especially to the invalid, and they continue venomous in the south until the cold 
 nights set in. 
 
 430. Middlesex. 
 
 «t. London. — This city, the largest and most healthy in the world, is bounded by 
 moderate hills ; has a soil of loam and gravel, with clay resting on a bed of chalk ; 
 and is some fifty miles from the sea to the south and east. In 1801 the area of Lon- 
 don was 122 square miles,— giving about 23,000 persons to a square mile of surface. 
 The mean annual temperature is about 50° F. : the average winter temperature being 
 38°, ^nd that of the summer 63°. The nights especially are warmer than in the en- 
 virons. The annual rain-fall is 21.6 inches; the average number of days, more or 
 less wet, being 178. 
 
 Delicate invalids are often better in London during the winter and spring, than in 
 the country, owing to its greater warmth, and the greater steadiness of the tempera- 
 ture from day to day. — Asthma is such a capricious disease, that it is impossible to 
 say beforehand what particular climate will suit any special example of it. But it is 
 certain that very many asthmatics are better and more free from attacks in a large 
 city, than in the clearer atmosphere of the country. Sufferers from this atfection can 
 especially ap})ly to themselves the words of Bacon, — " The goodness of the air is better 
 known by experience than by signs." — Phthisical invalids will find BPwOMPTOn or 
 Chklsea the most sheltered spots of the metropolis ; but if they are benefited by a 
 bracing air they must resort to Bay.swater, or Highbury, or the upper part of 
 Kentish T^wx, or to Hiohgate. 
 
 yg. Hampstead. — Many years ago, a mineral spring of repute in this village ren- 
 dered it a fashionable watering-place. It is still a healthy suburb. From the heath, 
 upwards of 200 acres in extent, there are many tine views. The air is pure and 
 bracing, and well-suited for children and convalescents. The low parts are damp, and 
 %^hould be avoided. — Like Greenwich, Richmond, Lewisham, Sydenham, «jcc., it 
 often aftbrds a convenient temporary residence for families driven from their town 
 homes by the outbreak of some eruptive fever or other infectious disease.
 
 CLIMATES FOR INVALIDS. 361 
 
 431. Kent. 
 
 A. Margate. — The tonic and bracing air of this familiar locality render it a very 
 valuable temporary residence for many invalids. The atmosphere is extremely pure, 
 the soil is dry and absorbent, and the water-supply j^ood. Perhaps no place could 
 be named which is more suitable for restorinii; tin; iu-altb of children and young people 
 atHicted with any form of scrofula. The bathing is good; though the flatness of the 
 sands may be a disadvantage to the adult. 
 
 The mortality among the r(!sidents is very low. For a long series of years (1888 to 
 1862) the average annual death-rate has been only l(j per 1000 for this class. — The 
 season lasts from May until the end of September. Being open to the north and east, 
 the air is very bleak during the late winter and early spring months. 
 
 8. Kamsgate. — Is much frequented in the summer owing to its gayety, facilities 
 for sea-bathing, &c. It is an excellent residence for delicate children during the 
 months of October and November, when the crowds of visitors have left. The climate 
 is warmer than that of Margate, and more bracing than that of the south-coast water- 
 ing-places. — Bkoadstairs is about three miles from liamsgate, and is an excellent 
 and quiet sea-bathing place for children. 
 
 y. Dover. — This sheltered town is generally full in the summer and autumn. As 
 a winter residence it is colder and more exposed to high winds than Ha>tings, but it 
 is not therefore unsuitable for invalids who can bear a bracing air. The climate proves 
 especially serviceable to those subject to chronic dyspepsia, nervous debility, conges- 
 tion of the liver, &c. 
 
 S. Folkestone. — The beautiful country in the neighborhood, and the fine tonic 
 air of this town, render it a most agreeable residence from the end of May until the 
 beginning of November. Sufferers from dyspepsia, nervous irritability, and over- 
 work will derive most benefit from this climate. — Sandgate, about two miles to the 
 east, offers a milder winter climate, with an exemption from fogs. The mean winter 
 temperature is 41.7S°. Consumptive and dyspeptic invalids, who find Brighton too 
 bracing, and Hastings too relaxing, may well winter at Sandgate, especially if they 
 need quiet and seclusion. 
 
 432. Smmx. 
 
 ft. Hastings and St. Leonards. — Situated about midway between Brighton and 
 Dover, the climate of Hastings is very useful for invalids during the winter months. 
 Well sheltered from cold winds, with lofty cliffs and undulating downs, a beautiful 
 and cultivated country, a dry and absorbent soil of clay overlaid with sand, a j)ure 
 sea-air, and free from all sources of malaria, it may be regarded as a healthy sedative 
 climate during six or eight months of the year. The bathing also is good in the su?n- 
 mer. — The mean annual temperature is 51°; that of winter being 40°, of spring 44°, 
 of summer 60°, and of autumn 53°. The amount of rain in the year equals about 
 28.34 inches. South and southwesterly winds are most prevalent during the winter 
 and spring, but unless high they cause but little discomfort. In the neighborhood 
 are various springs impregnated with iron and carbonic acid, but they are not much 
 used. 
 
 Hastings is suitable for cases of dyspepsia with loss of tone, chronic bronchitis, 
 neuralgia, chronic rheumatism, gout, and scrofula. For the diseases of childhood it 
 is a good locality. The author has not seen phthisical sulyects derive much benefit 
 from it, however ; and sometimes he has thought that it seemed to induce luemoptysis. 
 Dr. Mackness [HaMbigs considered as a Resort for Invalids, London, 1842) has given 
 a table of the causes of death during four years ; from which it appears that the total 
 number was 865, of these 254 being from chest affections, and of these latter 161 from 
 consumption, — viz., 91 inhabitants, and 70 visitors. 
 
 Although Hastings and St. Leonards now form one town, yet the former is the 
 warmest and most protected, and hence best suited for very delicate invalids. Such as 
 find Brighton agree with them from October until the end of December, may often 
 advantageously spend January and February afSt. Leonards. 
 
 /?. Eastbourne. — Filling, as it were, a chasm between two cliffs, one of which is 
 Beachy Head, this watering-place is rapidly increasing in importance. It is visited 
 in the summer for sea-bathing ; but is a good residence for invalids requiring a bracing 
 air from September until the beginning of .January. Cases of scrofula, consumption, 
 hydrocephalus, and tabes mesenteriea often derive benefit here. It is also to be recom- 
 mended in functional disorders of the heart and nervous system.
 
 362 APPENDIX OF FORMULA. 
 
 y. Brighton. — The climate is bracing and restorative, and is especially beneficial to 
 invalids during the autumn and early months of winter. Although the town is shel- 
 tered on the north and northeast by the Southdowns, yet from the beginning of Febru- 
 ary until nearly the end of May cf)ld north and easterly winds prevail, which prove very 
 irritating even to the healthy. "^ The annual fall of rain is 25.6 inches. The western is 
 milder but more damp than the eastern clitl'; but the tonic air of the latter agrees ad- 
 mirably where the circulation is torpid. The Old Steyne offers a climate intermediate 
 between that of the western and eastern cliffs. 
 
 Diseases of a nervous hypochondriacal type are much relieved by the invigorating 
 atmosphere of Brighton. Great good is also experienced when the vital powers are 
 sluggish, when there is anaemia, or when disease of the kidneys exists. Strumous 
 children and convalescents from acute disorders may also be sent to this part of the 
 coast. It is unsuitable for individuals of an irritable or plethoric habit ; for such as 
 have a dry harsh skin ; and for those who have a tendency to asthma, inflammatory 
 affections, hemorrhoids, &c. 
 
 h. Worthing. — Lying twelve miles west of Brighton and with an aspect almost 
 due south, this town is fully exposed to the sun's rays. It is sheltered from the hot 
 winds of summer and the cold of winter by the Southdown hills, which have an average 
 height of 600 feet. Hence it is warm in winter until the middle of February, and 
 cool in summer ; the air being neither too bracing nor too sedative. The mean tem- 
 perature for the year is about 51°. The rainy days are fewer, and the quantity of rain 
 that falls is less, than at Ventnor or in the West of England. Occasionally, the east 
 and northeast winds render the air very bleak. — In summer the fine sands afford 
 excellent bathing. 
 
 Worthing can be recommended as a good residence for convalescents ; as well as for 
 sufferers from lung diseases, hooping-cough, scrofula, chronic rheumatism, and renal 
 affections. 
 
 433. Ha7npshire. 
 
 a. Southampton. — At the head of the Southampton-water, whicb stretches from 
 the Solent and Spithcad into the interior of Hampshire for some eleven miles, is the 
 clean and handsome town of Southampton. The climate is said to be mild and humid, 
 intermediate in character between that of Devonshire and Hastings. Though shel- 
 tered by the high grounds behind it, and by the New Forest, yet it is unsuited for most 
 invalids, the temperature being variable. The effluvia from the river at low water are 
 often very unpleasant. 
 
 A short distance from Southampton-water is Netley. Here has been built the 
 Royal Victoria Hospiial ; which is especially intended for the reception of invalid 
 soldiers from foreign stations, and which has become the headquarters of the Army 
 Medical School. The site seems to have been well chosen ; while in most respects the 
 arrangements of the building are excellent. 
 
 /?. Bournemouth. — This favorite watering-place, situated within a fine bay, is 
 about ten miles from the western extremity of the Isle of Wight. It is well screened 
 by hills and pine-woods from the north and northeast winds, but is exposed to the 
 southwesterly gales. Owing to the nature of the soil, outdoor exercise is practicable 
 immediately after rain ; while there are great facilities for easy walking. The mean 
 annual temperature is 51.00° ; that of winter being 42.38, spring 49.11, summer 60.18, 
 and autumn 51.71. 
 
 It may be recommended as a quiet, healthy resort, during the winter, for such in- 
 valids as are not affected by moderate variations of temperature, for those who are weak 
 without having actual organic disease, and for persons returning from tropical countries. 
 The climate is mild but not relaxing. During the spring and early summer months 
 thick fogs and cold easterly winds are rather prevalent. In summer there is good sea- 
 bathing; but the heat, and clouds of fine sand which rise when there is any wind, 
 render Bournemouth unpleasant to many at this season. 
 
 434. Isle of Wight. 
 
 a. Ryde. — The towns on the north side of the island — Ryde and Cowes — are more 
 suitable for summer visitors requiring change of air and occupation, than for invalids 
 needing a dry atmosphere and repose. Although the attractions of both localities are 
 great, yet in neither is the bathing good. 
 
 /?. The Undercliff. — This is the best part of the island for a winter and spring 
 residence. It extends from the village of Bonchurch to Black Gang Chine, a distance 
 of six miles along the southeast coast. The .scenery is romantic, sea-fogs are rare ex- 
 cept towards the end of May and during June, and both soil and atmosphere are dry ;
 
 CLIMATES FOR INVALIDS. 363 
 
 whilo it is well protected, by a rancje of lofty chalk and sandstone hills, from the north, 
 northeast, northwest, and west winds. It is raised some fifty or seventy ft-et above the 
 level of the beach; and may therefore be represented, in the words of Sir James 
 Clark, "as a lofty terrace, bucked by a mountainous wall on the nortli, and o]>cn on 
 the south to the full influence of the sun from his risinc; to his t^oinp; down, duriiis^ that 
 season at least wiien liis iuHucnce is most wanted in a northern (dimate." — The mean 
 annual temperature is 51.35° ; that of winter being 41.89, spring 49.00, summer 00.08, 
 and autumn 53.58. The mean annual fall of rain is 23.48 inches; whereas at New- 
 port, in the centre of the island, it is 33.00. — The best season is from the beginning of 
 November until the end of May: between August and October it is too relaxing and 
 humid. 
 
 The Undercliif may be resorted to by all those who need a genial and agreeable 
 winter and spring climate. It allows the phthisical invalid to re-oxygenate his frame 
 by almost daily exercise in the open air, at a season when he would be unable to do so 
 at most other parts of England. The air is mild, and yet of a bracing tonic character ; 
 and hence it difl'ers from that of Torqumj, which is of a more moist and relaxing na- 
 ture. Patients with laryngeal and bronchial affections, hepatic and renal disease, 
 atonic and nervous dyspepsia, and children with glandular swellings or strumous ulcers, 
 do verj' well at this part of the island. 
 
 435. Dorsetshire. 
 
 a. Poole. — Standing on a peninsula, this old-fashioned town is an agreeable place 
 for such as have to be driven from books and business to quiet and idleness. Owing to 
 geographical peculiarities in its position, the tides in Poole harbor ebb and flow twice 
 in the twelve hours. 
 
 0. Wetmotjth. — This town, with the adjacent Melcombe-Reois, is a favorite 
 summer resort; the beautiful bay of the latter, with its fine sands, being well adapted 
 for bathing. In the autumn and winter, the temperature is equable; whilst the air 
 is so pure that it is suitable for invalids froin various diseases. Indeed, so healthy 
 is the climate, that Dr. Arbuthnot is reported to have jocosely said, "A physician 
 could neither live nor die at Weymouth." As it is the nearest English port to Guern- 
 sey, seventy miles distant, it forms the station of the mail boats. 
 
 436. Devonshire. 
 
 a. BuDLEiGH Salterton. — A quiet retired village, nearly five miles to the east of 
 Exmouth, in a small open valley on the sea-shore. Eor invalids who can climb the 
 neighboring hills it offers a mild and protected winter residence. 
 
 p. Dawlish. — Resorted to in summer for bathing. Dawlish may be recommended 
 as a winter resort for those needing a mild air. It is more humid than Torquay. 
 Protected from northerly and southwesterly gales, it is still unfavorable in the spring, 
 owing to the biting east wind which finds access to the , picturesque valley on either 
 side of which this small town is placed. 
 
 y. Exmouth. — The new portion of this town stands high, and is much exposed to 
 Avind from every quarter. The old part lies along the margin of the river and the 
 base of Beacon Hill, and is damp ; though it has the advantage of being protected 
 from southwesterly and northerly gales. Invalids who require a bracing air may be 
 benefited here ; but the cold variable weather in winter makes it unsuitable for those 
 with pulmonary complaints. 
 
 i. Salcombe. — Well sheltered, this is said to be the warmest spot on the southwest 
 coast. For such as need a mild and equable winter temperature this small spot would 
 be useful were it not for the want of convenient ground for exercise. 
 
 £. SiDMOUTH. — Recommended in summer and autumn for its bathing. Sidmouth 
 is also a good situation for invalids requiring a mild relaxing air during winter. The 
 mean annual temperature is 50.1° ; that of winter being 40.3, of spring 48.1, of sum- 
 mer 00.3, and of autumn 51.0. — The annual rain-fall is 122.08 inches, the average num- 
 ber of days on which rain falls in the year being 141. — It is tolerably protected from 
 the northwest and north. 
 
 ?. Teignmouth. — The mean winter temperature is six degrees higher than that of 
 London, while that of summer is five degrees lower. On account of its exposed posi- 
 tion it is not suitable as a winter home for the sick. 
 
 r)- ToRQTJAT. — The climate of this favorite locality, while mild and equable, is less 
 humid than that of many other places on the southwest coast. It has a southern as-
 
 364 APPENDIX OF FORMULA. 
 
 pcct, and is sheltered on all other sides by heights. Mean annual temperature •52.1'^; 
 the average for the winter being 44.0, spring 50.0, summer 61.2, and for the autumn 
 53.1. The annual amount of rain is 28.20 inches; and it falls on about 132 days in 
 the year. The season is from September to May ; and though it is not absolutely 
 necessary for the invalid to leave during summer, yet it will be better for him to do 
 so. November is generally very tine, being bright and sunny. 
 
 Torquay is useful in many oases of phthisis, chronic bronchitis, laryngeal affections, 
 and rheumatism. In heart disease, when this organ is oppressed without much lower- 
 ing of the vital powers ; in inflammatory dyspejisiu, with an over-irritable condition 
 of the mucous membranes generally ; and for invalids returning from tropical cli- 
 mates, — this town may be recommended. 
 
 The climate has a soothing influence upon the organs of respiration ; but the effect 
 upon the nervous, digestive, and muscular systems varies according to the situation 
 which the invalid adopts for his residence. -Dr. Radclytfe Hall recommends a feverish 
 excitable consumptive patient to lodge in a sheltered part close to the sea, provided 
 sea-air does not disagree. When the feverishness is less marked, and there is danger 
 from a sinking of tlie powers of life, a situation part- way up the hills suits better ; or 
 the beautiful district of Meadfoot, protected from the east and northeast by an ex- 
 tensive range of cliff, may be selected if close proximity to the sea be desirable. After 
 a residence at the sea-level for a time, removal to the houses on the southern faces of 
 the hills often proves useful. 
 
 e. Exeter. — This fine old cit}', though standing upon elevated ground, is sheltered. 
 Except during July and August (when it is close and relaxing), it offers an advan- 
 tageous residence for invalids requiring a residence away from the sea. Its mean 
 temperature in winter is 41.4°, spring 49.5, summer 62.0, and autumn 51.9. The 
 average number of days on which rain falls in the year is 162, the annual amount 
 being 31.90 inches. 
 
 Other neighboring inland towns are agreeable and healthy, — Kingsbridge, Totnes, 
 Newton-Abbott, Tiverton, Crediton, Cullompton, Uttery, Honiton, &c. Of 
 the moor towns, it need only be said the air is moist and misty. Dartmoor is bleak 
 and chilly, the mornings and evenings even of summer being cold. 
 
 437. Cornwall. 
 
 a. Penzance. — This seaport, on the northwest side of Mount's Bay, is about ten 
 miles from the Land's End. The climate is mild but relaxing. It has a mean annual 
 temperature of 51.8° ; the mean for the winter being 44.0, for the spring 49.6, for the 
 summer 60.2, and for the autunm 53.3. As a winter residence for invalids it possesses 
 the twofold advantage of warmth, and great steadiness of temperature during the day 
 and nigiit. The disadvantages are that it is much exposed to wind and storm, and 
 that it is humid — the annual rain-fall being 44.6 inches. It should be avoided in the 
 spring. 
 
 Penzance may be useful in chronic bronchitis, in the earliest stage of consumption 
 if there is a dry harsh cough with scanty expectoration, and in the case of aged in- 
 valids who derive benefit from a warm moist atmosphere. It is injurious in phthisis 
 with relaxation of the mucous membranes and co})ious secretion, in cases of hemor- 
 rhage, in atonic dyspepsia, and in debility of a low nervous type. 
 
 0. Land's End. — The climate somewhat resembles that of South Devon, but as 
 regards humidity and exposure to winds it is inferior. Invalids should not remain 
 in this district during the winter and sj)ring. 
 
 438. Gloucestershire and Worcestershire. 
 
 A. Bristol. — This city, situated chiefly in Gloucestershire but partly in Somer- 
 setshire, has nothing to recommend it to an invalid. A few years since, a gentleman 
 who assured the author that he always suffered either from gout or asthma, remarked 
 that in Bristol he was generally afflicted with the former, but never with the latter; 
 though dirccth' he left this spot his breathing became impeded. Of the two evils he 
 preferred a smoky city with gout, to pure country air and asthma. 
 
 0. Clifton. — Built on the sides and summit of a precipitous limestone, hill, about 
 one mile west of Bristol. In former days invalids resorted to this spot on account of 
 its hot well : now it is in repute for its mild winter climate. The mean temperature 
 for the year is 51.26°; that for the winter being 39.91, spring 49.79, summer 63.87, 
 and autumn 51.49. The annual rain-fall is 32.56 inches ; and the number of rainy 
 days about 169. The lower part of the town is much milder, and more humid than 
 the upper ; and hence while preferable during winter for many cases, is too relaxing
 
 CLIMATES FOR INVALIDS. 365 
 
 in tlio summer. The loftier situations (such as York Crescent, with its soutliern 
 aspect and sheltered sunny promenade), are beautifully situated and well adapted for 
 invalids durinj^ the summer and autumn months. 
 
 QIk^ Hot Well lies at the foot of St. Vincent's Rock. It yields an abundant sup- 
 ply of water at ahout 75'' F., containing small nuantities of magnesia and lime, with 
 an unusual amount of carbonic acid gas. Owing to the latter, it might |i(Thaps be 
 advantageously taken in dyspepsia with irritability of the gastric mucous membrane ; 
 but it is very rarely, if ever, employed medicinally. 
 
 y. Malvern. — Perhaps there are few more healthy and pleasant spots in the king- 
 dom for a summer residence than this. Built on the declivity of the ^Malvern Hills, 
 situated eight miles 8.8. W. of Worcester, the scenery is all that can delight the con- 
 valescent, or the man who has broken d(jwn from over-work. The air is pure and 
 invigorating; and is well adapted for bracing the system of such invalids as can 
 bear an elevated site. Owing to the eastern aspect of the village, the strong winds 
 of the winter and spring are severely felt. 
 
 There are two springs in the neighborhood, which may be frequented for amuse- 
 ment. But the waters of St. Anne's Well and of the Holy Well are only pure and 
 soft; the very small quantities of muriate of lime, sul})hate of soda, and carbonate 
 of lime which they contain, being useless in a medical point of view. 
 
 439. Lancasliire and Yorkshire. 
 
 a.. SouTHPORT. — On the west coast of Lancashire, between the mouths of the Mer- 
 sey and the Kibble, this watering-place is eighteen miles from Liverpool and thirty- 
 two from Manchester. The climate is bracing and sedative, the air dry but not irri- 
 tating, fogs are very rare, and the atmosphere is light and pure. The temperature 
 is variable, changes occur ra]>idly, while the mean for the j'ear is 54°. The sea-bath- 
 ing is good, the shore sandy, the water clear and pure, and the bay so well shel- 
 tered tliat it is seldom too rough. 
 
 As a summer and autumnal residence it is useful in laryngeal, bronchial and pul- 
 monary atlections ; in tuberculosis; in dyspepsia with constipation and flatulence; in 
 chronic rheumatism ; in some forms of paralysis ; and in nervous depression after 
 long illness. 
 
 iS. Scarborough. — Built on the slopes of a beautiful bay on the Yorkshire coast, 
 this town is resorted to in summer for its sea-bathing. The season extends from 
 June to October. It is suitable for nervous and hypochondriacal patients, for such 
 as have been over-worked and need change of scene and amusement, and for conva- 
 lescents requiring a bracing air. 
 
 A short distance from the town are two niineral wells, — the North or cJiah/heate, 
 and the South or saline spring. There is not much ditference, however, between their 
 waters; those of both being aperient, alterative, and slightly tonic. Their tempera- 
 ture is about 49'' ; and they yield nitrogen gas, carbonate of iron, chloride of sodium, 
 sulphate of magnesia (most abundant in the South spring), sulphate of lime, and bi- 
 carbonate of lime. They may perhaps be useful in habitual constipation, torpidity 
 of the liver, and scrofulous complaints. 
 
 ■y. Filey has most of the advantages of Scarborough, with the additional one for 
 the invalid of quiet and retirement. It has also a saline chalybeate spring. 
 
 /. AVhitby. — The air of this sea-port town is bracing and pure, the sands are ex- 
 tensive and atlbrd good bathing, while there is a chalybeate spring which is thought 
 wi'll of for its mild tonic properties. As at Filey, the season extends from the be- 
 ginning of June until the end of September. 
 
 440. Ireland. 
 
 a.. Kingstown. — This is one of the best frequented sea-bathing places in Ireland. 
 Situated about seven miles southeast of Dublin, on the southern shore of the bay, 
 the harbor is said to be one of the most splendid artiticial ports in the United King- 
 dom. 
 
 The sharp and bracing air of Kingstown proves injurious, during the latter part 
 of the winter and the early spring months, to patients with disease of the lungs.
 
 366 APPENDIX OF FORMULA. 
 
 jg. HOLYWOOD. — A small watering-place much used by the residents of Belfast, 
 from which city it is about live miles distant. The beach is sandy, and good for 
 bathing. 
 
 y. QuEENSTOWN (Covc). — A town which consists of a series of terraces, built on 
 the southern acclivity of Cove island, in Cork harbor. It is well sheltered from 
 northerly winds ; is exposed to the full influence of the sun ; and the winter climate 
 is admirable, being mild and equable. The mean temperature for the year is 51.9"; 
 that for the winter being 44.1, spring 50.1, summer 61.3, and autumn 52.0. The an- 
 nual rain-fall is 33.25 inches ; the average number of days on which there is wet be- 
 ing 131. The invalid should settle here about the end of October; and he will 
 scarcely have a day during the ensuing four or live months when he will be unable 
 to take exercise in the open air. Owing to the way in which the houses are built at 
 a variety of elevations, the exact locality chosen must depend upon the patient's 
 malady and strength. 
 
 All diseases needing a sedative and slightly humid atmosphere may derive benefit 
 at Queenstown. Laryngeal, bronchial, and pulmonary complaints are especially re- 
 lieved by a winter residence here; and so also are dyspeptics, strumous, rheumatic, 
 and cutaneous aflections. It is admirably suited for delicate children ; and for con- 
 valescents from hooping-cough, eruptive fevers, &c. Functional disorders of the 
 uterine system are often cured by it.-^In the summer there is excellent sea-bathing. 
 
 441. Scotland. 
 
 The climate of Scotland is remarkably equable throughout the year ; the summer 
 heat and winter cold being mitigated by the ocean winds. The mean temperature 
 for the year is about 47*^ ; that for the northern counties being higher than for the 
 eastern. The prevailing winds are from a westerly quarter ; blowing, for more than 
 two-thirds of the year from between the southwest and northwest points. In 
 spring and early summer cold east winds prevail. The atmosphere is moist, nearly 
 100 inches of rain falling annually in some of the mountainous parts ; though along 
 the southern shores of the Firth of Forth the amount is under 30, at Glasgow about 
 29, and at Musselburgh not more than 24 inches. 
 
 The air of Edinburgh, though neither genial nor mild, is yet salubrious ; and is 
 said to be favorable to longevity, as well as to the development of the mental and 
 physical powers. The city extends northwards to the shores of the Firth of Forth ; 
 Granton and the old fishing village of Newhaven being only separated from the town 
 by a pleasant walk. The elevated situation of the city renders it exposed to violent 
 winds ; but the eflect of these is favorable, at all events to the inhabitants of the 
 Old Town, by driving away many impurities. As a place of education, for youths 
 needing a bracing climate, it has great advantages. 
 
 The old city of St. Andreavs, situated on a rocky promontory some fifty feet 
 above the level of the sea, has a wholesome genial climate. It should be avoided in 
 the spring months, as it is then visited by a disagreeable chilly mist from the north- 
 east; but from July until the end of October the air is pleasant and salubrious. Suf- 
 ferers from rheumatism, or invalids with weak lungs had better not remain long in 
 this city. 
 
 On the western coast there are several localities which seem to possess good winter 
 clinuites for invalids. The island of Bute, in the Firth of Clyde, has many advan- 
 tages ; the air being mild and equable, though rather humid. Its mean temperature 
 for the year is 48.25° ; that for winter being 39.02, spring 46.66, summer 58.06, and 
 autumn 48.59. The annual rain-fall is 38.62 inches ; there being more or less wet on 
 about 150 days. Snow rarely falls in the winter, and there is a freedom from fogs. 
 It is protected from the east winds of spring ; and there are great opportunities for 
 outdoor exercise. The climate being rather sedative, invalids needing a strong 
 bracing air must seek it elsewhere. 
 
 Hypochondriacs, sufferers from habitual constipation or sluggish action of the 
 liver, and young men with a predisposition to phthisis, are often much benefited by 
 a summer or autumnal walk through the Hiohlanu.s; and certainly for the over- 
 worked literary or j)rofessional laborer nothing can be more invigorating than such 
 a tour. "I verily believe that 1 should die," said Sir Walter Scott, "if I did not 
 see the heather every year."
 
 CLIMATES FOR INVALIDS. 367 
 
 442. The Channel Islands. 
 
 All the Channel Islands are remarkable for their beautiful and varied scenery, for 
 the temptations the}' otter to the zoologist and botanist, the mildness and humidity 
 of their climates, the absence of great heat in summer and great cold in winter, and 
 for the equability and duration of autumn. The violent east, northeast, and north 
 winds which prevail in the spring, are exceeding!}' disagreeable and injurious. 
 
 The climate of the Channel Islands is generally favorable to chronic disease, to 
 asthma, atiections of the urinary organs, and to convalescents from acute inflamma- 
 tions of the organs of respiration. The old and the young also are beneiitcd by it. 
 It is unfavora;ble in chronic rheumatism, hepatic disorders, structural diseases of the 
 uterus or ovaries, nervous dyspepsia, hypochondriasis, and in cases where tliere is a 
 tendency to hemorrhage. Pulmonary consumption appears to be as common and 
 fatal among the inhabitants as in most other localities. — The most favorable time for 
 a stay in either of the group is from August until the beginning of February. In 
 some instances, a change, for a time, from one island to another, is productive of 
 good. 
 
 These islands may be reached by steamers from Southampton or Weymouth in less 
 than twelve hours. Invalids, especially ladies and children, sliould choose their day 
 of sailing so as to avoid a rough passage across the English Channel; and so that 
 they may not have to land in small boats. The packets can generally enter the har- 
 bor of St. Peter's Port in Guernsey, and that of St. Helier's in Jersey, exce])t near 
 low water on a receding tide. 
 
 Guernsey, the most westerly and exposed of the islands, has an average annual 
 temperature of 51.50"; that for winter being 44.2, spring 47.7, summer 59.9, and 
 autumn 53.8. Sea fogs are rare. The mean annual rain-fall is rather less than 35 
 inches, falling on 164 days, and more often in night than day. The walks are too 
 hilly for most invalids. 
 
 Jersey is the largest of the group of islands, and the most important ; being about 
 twelve miles long, with an average breadth of live miles. The surface of hill and 
 dale is well wooded ; the coast is rocky and precipitous ; and it is exposed to the wind 
 from every quarter. The mean yearly temperature is the same as for Guernsey ; 
 during three-quarters of the year the average being higher, while it is lower in the 
 winter. Nevertheless, the latter is mild, frost and snow being very rare. The daily 
 range of the thermometer is small, but it is greater than in Guernsey. St. Helier's 
 contains nearly half the population of the island ; but it is more foggy and humid, 
 and therefore less suited for invalids, than St. Aubin's, which lies three miles to the 
 southwest of it. The sands are good for summer bathing. 
 
 The air of Alderkey and Sark is usually said to be drier and more bracing than 
 that of Guernsey ; while that of the latter is less relaxing than that of Jersey. 
 
 443. Soiith of France. 
 
 tt. Patj. — This, the chief tovr'n of the department of the Basses-Pyrenees, is about 
 125 miles south of Bordeaux and 56 miles east of Bayonne. It may be reached from 
 London in 48 hours ; and the season lasts from the beginning of November until the 
 end of May. The mean annual temperature is about 56'^. The average for Septem- 
 ber, October, and November is 56.4; that for December, January, and February 
 42.8; while for March, April, and May it is 54.0. The annual rain-fall is about 43 
 inches, the rainy days numbering 119. Owing to the gravelly soil any quantity of 
 moisture is readily absorbed. Dr. Playfair, quoted by Sir James Clark, sums up the 
 nature of the climate, thus: "Calmness, moderate cold, bright sunshine of consid- 
 erable power, a dry state of atmosphere and of the soil, and rains of short duration. 
 Against these must be placed, — changeableness, the fine weather being as short-lived 
 as the bad, rapid variations of temperature, within moderate limits. In autumn and 
 spring there are heavy rains." The air in December, January, and February is dry, 
 and out of the sun, cold ; but even in these months the rays of the latter are so pow- 
 erful that the pedestrian ought to protect his hc^ad with an umbrella. There are very 
 few days on which the invalid will be unable to take exercise between 12 and 3 
 o'clock. 
 
 Pau is not influenced by the west-northwest wind, the Cijxius of the ancients ; nor
 
 368 APPENDIX OF FOKMUL^. 
 
 by the north wind or Bise which produces a biting cold ; nor by the northwest wind 
 or Minii-al: in fact the climate is calm and soothing, high winds being rare. It is 
 useful in cases with a scrofulous taint, in preventing generation of tubercle, and in 
 checking softening of tubercle when formed. Indeed, as Dr. Taylor states, the pre- 
 disposition to disease favorably influenced by this town, may be summed up in one 
 general principle, — viz., wherever it depends upon increased nervous and arterial 
 action, permanently produced, either by temperament or by some cause leading to 
 more active disease. 
 
 The climate is sedative, modifying nervous and vascular irritation; and therefore 
 beneficial in irritations of the mucous membrane of air-passages or alimentary canal. 
 It is unsuitable where the powers of life are declining ; in chronic catarrh or bron- 
 chitis of old people, with loss of tone and excessive expectoration ; in chronic rheu- 
 matism or gout, with debility of digestive organs ; in tendency to apo]>lexy from 
 passive congestion; in chlorosis ; and in disorders attended with congestion of venous 
 system and diminished nervous energy. In all these cases the climate of Nice is the 
 remedy. In short, Pau is to be chosen when there is "functional derangement of a 
 tonic irritable type, which paves the way to organic mischief." Acting on persons^ 
 in health the air lowers the tone ; makes the sanguine, phlegmatic ; and the choleric, 
 melancholic. 
 
 0. Biarritz. — A fashionable sea-bathing village on the shores of the Bay of Bis- 
 cay, some 5 miles southwest of Bayonne, and 65 miles from Pau. The roads between 
 the two places are excellent, and communication by diligence or omnibus very ea.sy. 
 It can be reached from London in about 48 hours. Tiie air is warm ; the tempera- 
 ture of the sea high; and there is always a soft invigorating sea-breeze. When 
 benefit has been derived from a winter at Pau, it is often advisable for the patient to 
 go to Biarritz for the summer ; returning to Pau for a second winter. The sandy 
 gently-shelving beach is well adapted for bathing, which is no slight luxury in water 
 at a temperature of 75° F. 
 
 According to Dr. Henry Bennet, the climate not only renders Biarritz a favorite 
 summer and autumn watering-place, but puts it among the eligible winter stations 
 of the south. It is cheaper also in winter than summer, being then almost deserted 
 by fashionable visitors. In cases of severe disease it is not equal to Pau, Ajaccio, or 
 Mentone, the winter breezes from the Bay of Biscay being often very violent. 
 
 y. MoNTPELLiER. — The reputation which this city formerly enjoyed as a winter 
 residence for consumptive patients has entirely gone. The climate is dry, irritating, 
 and changeable; and though the heat of the sun is great, yet the winter winds are 
 cold and unbearable. Mean temperature of the year 59.5°; winter 44.2", and sum- 
 mer 76°. Phthisis is very prevalent amongst the native population. Invalids with 
 relaxed mucous membranes and copious secretions, sometimes find advantage from 
 spending the autumn here. 
 
 <r. Marseilles. — This city, second only in importance to Paris, offers no residence 
 for the invalid. Pulmonary consumption annually destroys a large number of young 
 women and men. Catarrhs, pleurisy, and pneumonia are common; and so are cuta- 
 neous atfections, diseases of the generative organs, and cancer. 
 
 Mean annual temperature 58.32° ; winter 45.22, spring 55.91, summer 72.93, and 
 autumn 59.21. Although these figures are high, yet the winter is sliarpand cold, the 
 winds being high and prevalent — especially the mistral (northwest). In spring, the 
 variations in temperature are sudden and dangerous, and there is much rain. During 
 summer the heat and dust and insects are intolerable. 
 
 1. Hyeres. — This little town is agreeably situated, about two miles from the shores 
 of the Mediterranean, and an hour and a half's drive from Toulon. The climate is 
 clear, pure, dry, and tolerably mild. The greater portion of the town is sheltered 
 from north and east winds; while it is open to the south, benefiting by the influence 
 of the sun and :sea-breezes. But it is exposed to the mistral, as there are no protect- 
 ing hills on the northwest; and this blows frequently during the first three months 
 of the year. It has been thought one of the best localities in the South of France 
 for the winter abode of invalids with pulmonary disease; as there is much fine 
 weather, without great variations in temperature. The mornings and evenings, 
 however, are cold ; and hence, remembering too the prevalent winds, it should not 
 be recommended. In summer the heat and dust prove very annoj-ing. The best 
 season is during April and May, or from the beginning of September to the end of 
 November. 
 
 ^. Cannes. — An agreeable sea-port, on the shore of a small bay, well protected 
 from cold winds. It has a climate more moist and sedative than Nice, and less so 
 than Pau. The lower parts of the town should be avoided, as the drainage is bad.
 
 CLIMATES FOR INVALIDS. 369 
 
 The overworked man of business, seeking fresh air, e^enial sunshine, and a locality 
 possessins^ a combination of tine sea and mountainous scenery, may advantaj^eousiy 
 winter here. Cases of nervous dyspepsia are jjarticularly benefited, and so arc some 
 forms of phthisis. 
 
 Inthesumnu!r Cannes is resorted to for sea-bathina;, the extensive sands being 
 well adapted for this purpose. Sand baths are sometimes used for the relief of rheu- 
 matic and (taralytic atiections of the limbs; the patients being immersed up to the 
 chest in sand warmed by the sun. Like mud baths they may serve to amuse the 
 invalid, while he is breathing pure air and living by rule. 
 
 M. Nice. — The reputation long enjoyed-.vby Nice for salubrity, has been found to 
 have been greatly overrated. Protected towards the interior by the Maritinn; AljiS 
 and the Estreiles, cooled by the breezes of the Mi'diterranean, and with a mild dry 
 climate, it would seem to be a favorable locality for phthisic'ul j]atients. JJut not- 
 withstanding these advantages the valley is exposed, during winter and spring, to 
 cold irritating winds from the east and northeast; and the Nisands tlusn suffer much 
 from catarrh, ophthalmia, skin eruptions, pneumonia, and irritable gastric affections. 
 The mean temperature for the year is 59.U1°; for winter 46.38, spring 55.92, summer 
 71.83, and autumn 61.62. The variations between the warmth of night and day, of 
 sun and shade, are remarkable. The annual rainfall is about 26 inches ; most fall- 
 ing in October and November, leaving the other winter and spring months compara- 
 tively dry. 
 
 M. Carri^re has compared the valley in which Nice is situated to an open fan, the 
 arch of which is formed by the mountains, and the point by the shore, where the 
 Var discharges itself into the sea. But the mountainous semicircle is indented in 
 parts, and down these interruptions the winds blow from certain points, and inju- 
 riously affect consumptives. — The mistral is "the scourge of the Mediterranean 
 shores of Prance and Sardinia." It may continue one, three, seven or more; days at 
 a time; in autumn and winter it blows frequently, and hence it is absurd for inva- 
 lids requiring a mild temperature and calm atmosphere to winter at Nice. The 
 southeast wind, or sirocco, so injurious on the continent of Italy, becomes changed 
 into a mild beneficial breeze during its transit across the Mediterranean to Nice; it 
 modifies winter cold, and summer heat and dryness. La Croix de Marbr-e, the suburb 
 of Nice inhabited by the English, is most unfavorable for pulmonary invalids; it is 
 exposed to the libeccio (a relaxing southeast wind), and to the blighting influence of 
 the mistral. The invalid if he will go to Nice should live at the foot of the heights, 
 in one of the shady valleys open to the south. The brilliant sun entices him out of 
 doors, and then the blighting piercing wind attacks him; no flannel will keep out 
 the cold. The bills of mortality of the Nisands give one-seventh of the deaths as 
 from phthisis. That " Nice is one of the last places to which a foreigner laboring 
 under tubercular phthisis should resort," is the ojunion of Dr. Burgess. It is also 
 unfavorable for nervous and susceptible invalids. The air may sometimes be bene- 
 ficial in chronic rheumatism and gout; in uterine derangements connected with a 
 relaxed and torpid state of the system; for delicate children of a strumous habit; 
 and for invalids returning from tropical climates. The stay should extend from the 
 middle of October until the end t)f April. The author has been told that there are 
 well-conducted Pensions both at Nice and Cannes which are preferable to the hotels 
 as being more quiet and home-like. 
 
 9. Villa Franca. — This little town, a short distance from Nice, has a climate 
 somewhat warmer and drier, and is less exposed to the north and northwest winds. 
 The vegetation is luxuriant and early. 
 
 /. Mentone — Lately a small Italian town, but annexed to France in 1860, Men- 
 tone otters one of the most sheltered stations in the south of Europe. It is situated 
 on the northern shore of the Mediterranean, at the foot of the Maritime Alps, and 
 twelve or thirteen miles to the east of Nice on the road to Genoa. The bay, in the 
 centre of which the town is placed, is completely protected from the north, north- 
 west or mistral, and northeast winds by the mountains; while owing to the absence 
 of fogs, the paucity of rain, and the great power of the sun, the air is very jileasant 
 during the winter months. The mean temperature is a little higher than that of 
 Nice. 
 
 From the beginning of November until the end of April the climate is genial and 
 bracing. The invalid must not remain during the summer. A residence here is 
 very useful in phthisis, when the disease has not passed beyond the first stage ; and 
 even when it has reached the second or third, provided the tubercular deposit be 
 limited to a part of one lung. It is also beneficial in chronic cases of consumption ; 
 chronic bronchitis; and chronic gout and rheumatism. Strumous children improve 
 remarkably. Some who visit Mentone prefer the eastern bay, some the western ; 
 
 24
 
 370 APPENDIX OF FORMULA. 
 
 but w'hichever be chosen, care must be taken to select rooms having a south aspect, 
 and ^th the bedroom not on the ground floor. — For the sake of those who are not 
 overburdened with wealth, it may be as well to remember that Nice and Mentone 
 are both extravagant places, while San Remo is much cheaper, and the air is just as 
 good during the winter. 
 
 444. Corsica. 
 
 This island, one of the most important in the Mediterranean, has shores mostly 
 low, while the centre is mountainous. Dr. Henry Bennet has recommended Ajac- 
 Cio, on the west coast, as an admirable winter station for invalids. He describes it 
 as a clean and cheerful little French town, with quiet sunny streets; and which, not 
 being cramped in by walls, has spread itself out on the northwest side of a beautiful 
 bay directed due south. This bay is protected from all winds but the southwest, by 
 its hemicircle of grand mountains in the distance. The climate is as warm as that 
 of Nice (from which it is distant some eight or nine hours' sail by the mail steamer), 
 and it is unexceptionally healthy. — Napoleon Bonaparte was born here, 15th August, 
 1769. 
 
 Ajaccio is the only town of Corsica that appears thoroughly eligible as a winter 
 residence. The climate of Bastia is warm and agreeable; but the town has a small 
 tideless port, and is exposed both to southeast and northeast winds. Dr. Manfredi, 
 the surgeon of the civil hospital at Bastia, states that nearly all surgical wounds heal 
 at once by first intention, while purulent absorption is almost unknown. — Corsica 
 should be avoided in the autumn, on account of the malaria which then prevails in 
 many parts. 
 
 445. Spain and Portugal. 
 
 It. Alicante. — Lying along the shore of a bright open bavin the Mediterranean, 
 is this healthy town. It is sheltered on the north and northwest sides by a lime- 
 stone rock some 700 feet high, is free from malaria, and has a mild dry air with com- 
 parative immunity from high winds. The mean annual temperature is 63.7", that 
 for winter being 52.1. The rainfall is very moderate. In summer the calm open 
 sea, and sandy beach, afford good bathing. In winter, whatever may be the temper- 
 ature of the morning air, the middle and after-part of the day will genei-ally be 
 mild and calm. 
 
 As a winter residence it may be recommended to such as need a dry and somewhat 
 stimulating climate. It has been found useful in chronic bronchitis, with excessive 
 secretion ; as well as in atonic dyspepsia. 
 
 /3. Barcelona. — This, the chief city of Catalonia and the second in importance 
 of Spain, has a mild winter air. It is open to the sea on the south and southwest, 
 and is partially protected from westerly and northerly winds by the hills at the back. 
 The mean annual temperature is 68.14", that of winter being 50.18; while there is 
 rain on some 69 days in the year. Invalids requiring a rather stimulating and dry 
 climate may reside here, but it cannot be strongly recommended. April and May 
 are the most uncertain months. 
 
 y. Cadiz. — The semi-insular position of this commercial town, on the shores of 
 the Atlantic, would seem to point it out as a suitable winter residence for those re- 
 quiring sea-air. The climate is soft, humid, and relaxing ; the winters are mild and 
 the summer temperate ; the weather is showery, especially in winter and autumn, but 
 the soil being |»orous it soon dries; and there are few days during winter on which 
 exercise cannot be taken in the open air. The mean annual temperature is 62.76° ; 
 that for winter being 52.80, though very often at this season the thermometer, in the 
 shade, will stand at above 60. Kain falls on about 100 days in the year ; but it gener- 
 ally comes in showers, with intervals of sunshine. 
 
 This town may be recommended for some irritable atfections of the chest, and in 
 certain cases of heart disease. Women with any tendency to ovarian or uterine dis- 
 orders should avoid Cadiz. The stranger will find it best to reside in the central 
 portion of the town, — as on the sunny side of the square of G-eneral Mina or San 
 Antonio, or in one of the lesser plazas. The wall (Muralla del Mar) which nearly 
 surrounds the town has on its summit an agreeable walk. 
 
 i. Madrid. — The capital of Spain, situated nearly in the centre of the Peninsula,
 
 CLIMATES FOR INVALIDS. 371 
 
 is perhaps an attractivn city for the tourist ; but the irritatincj and stimulatinqrchar- 
 acter of the; climate rcrulcrs it an unf'avoriiljio one tor the Kni^lisli invalid. The 
 mean annual temperature is 57" ; but the ran<(e is so great that Dv. Francis has ob- 
 served a thermometer ])ointing to below freezing a little after sunrise, stand at 106 
 at 3 P.M. — Tlie winters are raw and long, with hard frosts and piercing cold winds ; 
 in summer the heat is irritating and oppressive, so that even the Spaniards cannot 
 stand it, — " The subtle air," .says Ford, in his Handbook, " which will not extinguish 
 
 a candle, puts out a man's life No wonder, according to Salas, that 
 
 even the healthy of those born there live on physic." 
 
 t. Malaga. — Dr. Francis speaks very highly of Malaga, which, indeed, seems to 
 be the El Dorado of cities; for he asserts tliat there is no place in Spain, nor in the 
 whole of Europe, as far as our present information goes, that po.ssesses a climate at 
 once so mild and equable, with so little variation from day to day. This seaport city is 
 situated on a bay of the Mediterranean, G5 miles east-northeast from Gibraltar. The 
 mean annual temperature is 66.11", that of winter being .54.41 ; the heat of .January 
 corresponding with that of May in London. The air is neither too moist, nor too 
 dry ; and a lofty mountain range forms a protecting background to the winter winds. 
 The annual rainfall is said to be only 16^ inches. 
 
 The longevity of the people is remarkable ; persons aged from 80 to 90 being seen 
 going about the streets in full possession of all their faculties. Though the ratio of 
 mortality is 1 in 37, yet it must be remembered that this is larger than it would other- 
 wise be ; not only from the excessive mortality in early life (42.3 per cent, during the 
 first five years) owing to the mothers not nursing their infants, but likewise from 
 the presence in the town of a large garrison and a crowded convict establishment. 
 The principal drawback seems to be the terral, a cold harsh wind from the north- 
 west, which occasionally blows during the winter with great force. It causes rest- 
 lessness, and oppression at the chest, where there is any pulmonary atlection. The 
 air is also unfavorable in cases of disease of the nervous centres. 
 
 The invalid who requires a warm, dry, and gently tonic climate, with constant 
 sunshine, may well visit Malaga for the winter. A residence here is especially use- 
 ful when phthisis seems to threaten, or even when it is present in an early stage. He 
 should live in the newer part of the town, where the soil is sandy, and through the 
 centre of which runs the Alameda, a fine broad promenade bordered by cheerful 
 well-ventilated houses. The Spanish custom of taking a siesta in the middle of the 
 day ought to be adopted. There is a regular steam communication with Liverpool, 
 the voyage lasting seven or eight days. 
 
 ^. Valencia. — This city, built upon the great plain of Valencia, is about three 
 miles from the sea. It may be reached in seven days from England, by way of Mar- 
 seilles. — The town is very clean, the climate unusually dry, though the water evap- 
 orated by the system of irrigation pursued impregnates the air with moisture ; there 
 are no cold fogs ; the wind is soft and mild during winter, in summer refreshingly 
 cool ; and the mean annual temperature is 63.5", that of winter being 49.7. The cold 
 is often appreciable in early morning and after sunset during winter, but it is warm by 
 mid-day. The springtime is the best — from the middle of February till the begin- 
 ning of May: autumn is to be avoided owing to the miasmata from the rice-planta- 
 tions. — Consumption is not uncommon among the poor ; but then in no part of Spain 
 does the laborer work harder, or subsist on a more meagre diet. 
 
 Useful for the overworked man of business, semi-invalids and hypochondriacs, 
 individuals with impaired health but no organic disease, gout and rheumatism, cal- 
 culous aft'ections, albuminuria, and nervous dyspepsia. There are several towns 
 within easy reach of Valencia where the invalid may go for a short stay, — such as 
 Alcira, Carcaje?ite, Jativa, San Felipe, ^'c. 
 
 ». Seville. — The famous capital of Andalusia, and the city of Figaro, possesses a 
 soft and tonic climate. It may be visited by the hypochondriac, by convalescents 
 from lingering disease, &c. ; or the invalid who has wintered in Malaga might ad- 
 vantageously stay here during May. The best part of the year is from November to 
 March. There is considerable rain in October, November, and April. Occasionally 
 during the summer the sultry and irritating levante or east wind prevails, giving rise 
 to fever, ophthalmia, mental irritability, and neuralgic atl'ections. 
 
 6. Aranjuez. — Situated 24 miles south of Madrid, on the left bank of the Tagus. 
 The season consists of April and May, during which months the climate is soft and 
 most agreeable. The water of the town contains a little sulphate of soda, and hence 
 is sometimes aperient if taken largely. 
 
 /. Lisbon. — The capital of Portugal has a dry and bracing climate ; though the 
 changes from sunshine to rain, from heat to cold, are sudden and remarkable. Hence
 
 372 APPENDIX OF FORMULA. 
 
 it is not to be recommended for pulmonary invalids ; while, moreover, phthisis is 
 very prevalent among the inhabitants. 
 
 The mean annual temperature is about 62.00" ; that for winter being 52.52, spring 
 59.66, summer 70.94, and autumn 62.48. The annual rainfall is 23 inches, most wet 
 days occurring in winter. The predominating winds are those from northeast to 
 southeast, and to them is due the cold of winter. 
 
 Dr. Francis says that the best situation for an invalid who wishes to pass the win- 
 ter in Lisbon, is the upper part of the Val de Pereiro ; a contituuition of the valley in 
 which the new part of the town and the public gardens lie. " Here, upon the southern 
 slope of the hill, are a few villas in the midst of orange gardens, which are well-shel- 
 tered, and afford choice views over the town and river. Those who prefer a country 
 residence, may select the neighborhood of Bemficn, a village on the Cintra road, about 
 a league from Lisbon. This place is in high reputation, among the Portuguese phy- 
 sicians, for the purity of the air, and it is here they send their convalescents." 
 
 K. Cintra. — A summer residence of the court and wealthy inhabitants of Lisbon, 
 from which it is only sixteen miles distant. Frequent breezes, a humid soil, and an 
 abundance of vegetation render the summer air cool and healthy. The winters are 
 wet and cheerless. 
 
 446. Gibraltar. 
 
 This strongly fortified portion of the British possessions, occupies a mountainous 
 promontory near the southern extremity of Spain, at the entrance of the Mediter- 
 ranean. The town is built on the western aspect of the rock. It is unsuitable as a 
 residence for invalids. For though the average winter temperature is 57.93°, yet the 
 southeast wind^the levante— renders the locality cold, raw, and verj^ unpleasant. 
 Snow and ice are very rare, but there is considerable rain. The annual rainfall is 
 43 inches. 
 
 447. Italy. 
 
 a. Lago Magqiore. — The largest of the lakes of Northern Italy. Along its shores 
 are small towns resorted to by English invalids in summer. Baveno, Arona, and 
 Sesfo are the most frequented. But the climate though clear and pure is often marred 
 by the violent thunder-storms which prevail in summer; there are heavy dews at 
 night; while the neighboring glaciers make it cold when the wind blows from that 
 quarter. T\w air is injurious to phthisical invalids, but useful in general debility, in 
 d^'spepsia, and for such as need a cool tonic atmosj)here. 
 
 yg. Lake of Como. — Situated at the northeast of Milan, from which it is not far 
 distant. — The air is genial and mild, the temperature equable, and the heat not op- 
 pressive owing to the alternate play of the tivano or north wind during the night, 
 and the breva or south wind in the day. For ordinary invalids in summer the best 
 situations on the lake are Balbianino^ Torno, and Bellngio ; but for the consumptive 
 Vare.na is more suitable. Cadenabbia. and Tremezzlne, on the shore near the middle 
 of the lake, are very beautiful spots; while according to Dr. Burgess, Plinia7ia, the 
 most noted spot along these classic shores, the supposed residence of Pliny, will not 
 jield precedence to either in climate or situation. The cold in the winter is great, 
 especially at the northern extremity of the lake. — No part of Italy perhaps is so suit- 
 able for the c()nsum])tive in sum nuu-, as the Lake of Como. That dreadi'd disease 
 pellagra, a kind of leprosy, is not uncommonly seen here. From one-third to a 
 fourth of the lunatics in the Lombardy Asylum are suffering from it, for it induces 
 insanity; while many cases of it, in early stages, are to be found in the hospitals. 
 
 ■y. Milan. — This city, the capital of the Lombardo-Venetian kingdom until 1859, 
 when it was made over to Sardinia, is situated in a fertile }i]ain between the Ohma 
 and Saveso rivers, at an elevation of 394 feet above the Adriatic. It is indifferently 
 sheltered from the various winds, so that the climate is cold ; snow and rain are fre- 
 quent during the winter; while the sudden transitions from humidity to a dry harsh 
 air, render it an unfavorable locality for any but the strong. It is frequented by 
 consumptives going to, or returning from the south of Italy ; but the shorter their
 
 CLIMATES FOR INVALIDS. 373 
 
 stay, thfi bpttor. In 1831, ofRcial returns showed that amongst the Milanese alone, 
 20,000 individuals were attacked by pellagra. 
 
 (T. BiiK.sciA, Pavia, Vekona, and Mantua. — The principal towns of Lonibardy, 
 arc all pjirticularjy unsuitable for invalids. Agues, fevi^rs, and inHaininati'Uis aie 
 very common. The cold in winter is intense ; the atmosphiu'e is saturatcid with moist- 
 ure; there are dense clouds and fogs ; there are large quantities of rain, in the form 
 of a tine continuous drizzle; and cold winds are very prevalent, especialiy the north- 
 east. 
 
 6. Venice. — This city, the Queen of the Adriatic of the poets, is built on piles in 
 midst of a lagoon or large marsh, two miles from the mainland of the (Continent. It 
 would seem to be slowly crumbling to decay. The climate is mild and Cfpiabic^ ; the 
 air bfjing impregnated with emanations of bromine and iodine. Consumption is 
 prevalent among the inhabitants. Invalids are not attracted to Venice by the cli- 
 mate, however, but by its historical associations, and many sickly persons are to be 
 found on the favorite promenade — the Piazza of St. Mark. The mean temperature 
 of winter is about 39° F., of spring 54, summer 73, and autumn 55. Drizzling rain 
 soin(!tim(^s falls for days togcllu^r. The result of seven years' observation gave a 
 mi'Mii of 5J days of snow in winter. — In Venice the dolce fiir niente practici^ is fully 
 carri(>d out ; the climate being favorable to indolence and voluptuous ease. Contrary 
 to what might be expected ague is unknown. The tranquillity which prevails over 
 the city is not unfavorable. As the climate is sedative and lowering, it is not fit for 
 those who are depressed by disease ; and except in the early stage it is injurious to 
 phthisical patients. It is suitable for such as have a tendency to inflammation, ha?m- 
 optysis, &c. Invalids may remain here from the close of autumn to the end of spring ; 
 but it is most agreeable in the latter season. 
 
 ^. Genoa. — This town, at the head of the Gulf of Genoa, is one of the last places 
 for a consumptive to pass any time at. The vicissitudes of temperature are rapid 
 and extensive ; there are sudden gusts of wind ; while the biting coldness of the tra- 
 montana or north wind, alternating with the warmth and humidity of the ijirocco or 
 southeast, the two prevailing winds of Genoa, proves very trying. The best time for 
 a visit to Genoa (not by a consum})tive) is about the autumn or the beginning of 
 summer. Pneumonia, hemoptysis, consumption, and catarrh are amongst the most 
 frequent diseases of the inhabitants. 
 
 n. Florence. — Situated on the Arno, a few hours' ride from Pisa, this city may be 
 an agreeable residence for the very strong. But certainly in no part of England 
 could a more unfavorable climate be found for consumptives. It is built in a deep 
 ravine, almost surrounded by the Apennines, and intersected by a squalid river. It 
 is one of the stations on the western zone of Italy where it rains the most. Extreme 
 cold in winter, great heat in summer, chilling northerly winds, occasional fogs, vio- 
 lent atmospheric and thermal variations, — these are its chief peculiarities in a sanitary 
 point of view. The nervous excitability of Florentines is explained by the topogra- 
 phy of the city. As the birthplace of Dante, Leonardo da Vinci, Machiavelli, &c., 
 as well as for. its churches, palaces, and magnificent works of art, it oilers many at- 
 tractions to the tourist. 
 
 fl. Pisa. — The dismal aspect of this neglected city surpasses that of any otlier in 
 Italy. The dreary solitude of the streets causes gloom and melancholy ; while every- 
 thing seems stricken with decay or death. It is often recommended for consumptive 
 invalids; but the climate is mainly indebted to tradition — being mild, humid, and 
 relaxing. The sky is dull and often murky. Perhaps the high walls around Pisa 
 assist in protecting portions of it from the cold winds, especially the Lung' Arno, or 
 that quarter where the invalids reside. The mean temperature of winter is about 45°, 
 spring 59, summer 74, and autumn 63. The winter is colder than at Rome. The air 
 is moist from the great prevalence of southerly and Mediterranean winds. The cli- 
 mate is very depressing — causing general lassitude while it enervates the faculties. 
 Many foreign invalids die within a few weeks of -their arrival. Haemoptysis fre- 
 quently sets in where there is any tendency to phthisis. 
 
 /. Rome. — Situated on marshy ground at the foot of a range of low hills, about four- 
 teen miles from the sea, and divided by the Tiber into two unequal portions, Rome 
 has not so much to recommend it to those really in search of health as many other 
 places. The climate is mild, soft, and sedative; but malarious effluvia, in a greater 
 or less degree, are never absent. The best time in the year is October and the first 
 ten days of November. The mean annual temperature is 60.49° ; that of winter being 
 46.75, spring 58.25, summer 74.24, and autumn 62.75. Owing to its exposure to cold 
 winds, the variations in temperature are great and sudden. Northerly wi?i(ls are com- 
 mon in the morning and evening, though in the middle of the day the wind blows
 
 374 APPENDIX OF FORMULA. 
 
 from the south. The tramontana is cold and searching ; but the prevalent wind is 
 the sirocco from the southeast, which is hot, sometimes dry, and sometimes so moist 
 as to render the streets slippery and damp. Under its influence the tissues relax, ap- 
 petite fails, bowels become torpid, spirits flag, and the weakly get oppressed with 
 lassitude and headache. If an invalid will go to Eomo in the winter, let him spend 
 as much time as he can in St. Peter's. No other public building can compare with 
 this church as regards possessing a dry equable temperature all the year round. The 
 mild genial air in its interior is so prized, that the sickly meet and promenade in St. 
 Peter's when the weather will not permit of exercise in the open air. 
 
 Dr. Burgess entertains a very unfavorable opinion of the sanitary value of this city. 
 And he points out that the popular feeling in favor of a mild and relaxing climate 
 for consumption is altogether wrong, being based upon erroneous data, if not upon 
 mere tradition. A cold climate, such as that of Norway or of Canada, and still air, 
 are evidently more rational indications, if the formation of tubercle is the result of a 
 relaxed state of the vital functions, involving impaired digestion, depraved nutrition, 
 and degeneration of the blood. Nothing is more calculated to derange the digestive 
 organs than the sedative influence of a malarious atmosphere. The mild climate 
 aliays bronchial irritation, at the expense of the general health and of disordered 
 nutrition. 
 
 The most fitting localities in the city for the invalid with any bronchial irritation, 
 chronic rheumatism, &c., are the north and west sides of the Piazza di Spagna, as 
 having a southern exposure : or he may choose one of the streets running east and 
 west from, and near to, the Piazza, — the Strada de' Condotti, Strada della Croce, 
 Strada Frattina, &c., the north sides of which gain the southern sun, and all of which 
 are on sheltered ground. The south side of the Strada del Corso should be avoided, 
 as the Tiber frequently overflows in winter, generating low fever, &c. The Piazza 
 del Pojiolo is also subject to damp fogs. In most cases the second and third floors of 
 a house are preferable to the first; since, owing to the narrowness of the streets, they 
 are more exposed to the sun. The higher and more exposed ground of the Monte 
 Pincio, Via Sistina, Piazza Barberina, &c., is suitable for those with healthy chests, 
 and who can bear a high wind. — The stay may extend from October till the end of 
 May. 
 
 K. Naples. — The climate somewhat resembles that of Nice, but is more variable 
 and humid. Situated on the northern shore of the Bay of Naples, on the slopes of a 
 range of hills, near the foot of Vesuvius, this city seems to ofter all that is charming 
 to the man in health, and everything that is pernicious to the invalid. The mean 
 annual temperature is 60.26°; winter being 47.65, spring 57.56, summer 74.38, and 
 autumn 61.46. Besides other winds, it is exposed to the sirocco or southeast, which 
 is enervating to both body and mind ; as well as to the mistral or northwest, which 
 brings raw piercing cold and damp. Catarrh, pneumonia, phthisis, rheumatism, 
 ophthalmia, uterine disease, and cutaneous aft'ections are common amongst the inhab- 
 itants. Eustace says, and apparently with reason, — " If a man be tired of the slow 
 lingering process of consumption, let him repair to Naples ; and the denouement will 
 be much more rapid." Indeed, so fatal is the climate to invalids with pulmonary 
 disease, especially during the winter, that the proverb, — " Vedi Najwli e po' mori," 
 may be interpreted in a more literal sense than that intended. 
 
 •y. V>AXM AND PozzTJOLi. — Situated in the vicinity of Naples, these towns are rec- 
 ommended by M. Carrifere as winter residences for invalids already sojourning in 
 the Neapolitan territory. The air is humid and warm, and little disturbed by violent 
 winds. But the undrained swamps in the neighborhood of Baias, and the fatality of 
 phthisis at Pozzuoli ought to deter any invalid from leaving England for these sta- 
 tions of classic renown, however anxious he might be to escape to them from Naples. 
 
 448. The Ionian Islands. 
 
 This group of islands in the Mediterranean, otFthe west coast of Greece and Epirus, 
 ceded to the Greeks by Great Britain in 1868, consists of Corfu, Cephalnnin, Znnfe, 
 Santo, Maura, Ithaca, with many smaller islands. Their surfaces are mountainous 
 and rugged, but in some of the larger islands are fertile plains. They vary but little 
 in climate ; the winters being stormy and wet with northerly winds, the springs warm,
 
 CLIMATES FOR INVALIDS. 376 
 
 and the summors dry and hot. Intormittcnt and remittent fevers, dysentery and 
 diarrlicea, phthisis and pneumonia are prevalent. As a tour for the hypochondriac 
 a visit to tliese islands may be recommended. 
 
 449. Malta. 
 
 Of an area not much exceeding that of the Isle of Wight, this island forms the chief 
 station of the British fleet in the Mediterranean, and is daily called at by ships of all 
 nations. The atmosphere is clesir and bright, the annual rainfall about 15 inches, the 
 air mild and bracing in winter, and the temperature equable with a yearly average 
 of about i'A^. Heavy gales of wind are not very frequent, though the atmosphere is 
 never entirely calm. The gregale or northeast wind is cold in winter, and often does 
 damage in the harbor of Valetta ; while the sirocco or southeast prevails especially 
 in August and September, is hot and humid, and produces lassitude with debilitj'. 
 
 The Rev. James Sherman, who suffered from consumption, writing from Malta 
 on the 16th January, 1861, said, — "A blazing sun shoots his rays into my room, and 
 a delicious breeze makes it sufficiently cool. I look out on a sort of Regent Square — 
 people traversing up and down in crowds — a beautiful garden opposite my window, 
 with hundreds of oranges on the trees — priests, beggars, and guides jostling one 
 another in every direction — a side view of the ocean — a deep blue sky, without a 
 cloud — and at night the stars looking so large, near, and brilliant, that I can scarcely 
 believe I am only 4.^ days from the frost and snow of England. The climate seems 
 most delicious, and well adapted to invalids." 
 
 The weather is most agreeable from the middle of October until the end of Janu- 
 ary. Asthma connected with chronic bronchitis, atonic dyspepsia, strumous glandu- 
 lar swellings, and deranged health from overwork, — these are the cases which are 
 most likely to be benefited by a stay i^ the cheerful bustling capital of Valetta. 
 
 450. Egypt. 
 
 One of the earliest civilized localities of the world, this country has long been 
 divided into the provinces of Said or Upper Egypt, Vostani or Middle Egypt, and 
 BaJiari or Lower Egypt. Upper and Middle Egypt are more healthy than the Delta. 
 There are only two seasons in Egypt, — the temperate from October to March, and 
 the hot from March to October. At Cairo, the capital, the climate is healthy, little 
 variable, and dry ; the mean temperature of the year being 72.2°, while that of winter 
 is 58.5, and of summer 85.1. Taking the whole of Egypt, the mean temperature in 
 December, January, February, and March, may be said to be about the same as that 
 of this country in June, July, and August. 
 
 The invalid should leave England rather early in October, so choosing his time of 
 sailing by one of the Peninsular and Oriental Company's steamers, as to be alile to 
 see the best spots on the south coasts of Spain and Portugal, Gibraltar, and INIalta. 
 This arrangement will usually be preferable to that of beginning the voyage at Mar- 
 seilles. From Malta to Alexandria occupies only a few days : the traveller ought to 
 arrive at the latter by the middle of November. Leaving this port as soon as " the 
 sights" are visited, he proceeds to Cairo by railway ; whence ho begins to ascend the 
 Nile, so as to reach Thebes by the beginning of December. The climate of Thebes 
 is all that the valetudinarian can desire ; and hence he may either remain there, or 
 proceed southerly in the direction of Nubia. But, however far his trip may extend, 
 he should be back in Cairo by the end of March ; whence he may arrange his home 
 journey, by way of Greece and Constantinople, so as to be in England by about the 
 latter part of June. 
 
 The necessity for travelling by, and living in boats after leaving Cairo, has of course 
 certain disadvantages, and is somewhat expensive. But with a dry balmy atmosphere, 
 and a sky bright and cloudless, the invalid may find much that is most agreeable and 
 exhilarating in the even progress of a Nile boat — a dahabeeh. — The two chief annoy- 
 ances to the traveller in Egypt are the dust, and " Baksheesh." The former may be 
 mitigated by suitable clothing, — mohair dresses for ladies, and flannel shirts with
 
 376 APPENDIX OF FORMULA. 
 
 tweed suits for gentlemen ; while the latter must be avoided by not exhibiting too 
 much liberality, and by bargaining beforehand with dragomen, guides, coachmen, 
 boatmen, «&c. The climate may especially be recommended in the early stages of 
 tuberculosis, in chronic bronchitis, some forms of humoral asthma, gout, and rheu- 
 matism, renal diseases, dyspepsia, and affections of the nervous system. 
 
 451. Algiers. 
 
 The city of Algiers, the capital of an extensive country of Northern Africa border- 
 ing on the Mediterranean, has been much resorted to by invalids. It can be reached 
 easily in seven or eight days from London ; by way of Folkestone, Paris, Lyons, Mar- 
 seilles, and thence by steamer in forty-eight hours. About the end of October is the 
 best time for thp invalid's arrival on the coast of Africa ; the great heat having then 
 usually ceased, and the first rains having refreshed the lands, so that the country has 
 the appearance of spring. 
 
 Speaking of this city, Dr. Mitchell says that with difficulty, if at all, will the Eu- 
 ropean traveller find a spot on earth where natural beauties so combine with those of 
 man's creation to please and interest him. One of the long sides of the oblong of 
 which the " Place du (rouvernement" is formed, is open to the sea ; commanding a 
 view of the bay, the harbor, the peaks of the distant Atlas, and the verdure of the 
 Sahel slopes. The "Place" itself is filled with a strange mixture of all races; the 
 Arab, the Moor, the turbaned Jew of Africa, the Maltese fisherman, the Spanish 
 fruitseller, the veiled women of Moslem, the picturesque Jewess, the pretty Spaniard, 
 «fec., «&c. The invalid will find objects of interest without seeking them, and will be 
 gratified and amused merely by wandering in the open air. — The mean annual tem- 
 perature is about 66.50° Fahr. The mean temperature for -each season is — winter, 
 56.91 ; spring, 67.60; summer, 77.73; and autumn, 63 80. The rainfall is 36 inches: 
 rainy days, 96. Winter fogs are rare. Snow has fallen once in seven years. Com- 
 pared with other points on the Mediterranean, Algiers has a warmer and a less vary- 
 ing climate than Marseilles, Wice, Genoa, and Naples; while it more nearly ap- 
 proaches, but is still superior to Malta, Corfu, and Gibraltar. — Dr. Mitchell quotes 
 the opinions of M. Odrultz, which are to the following efi'ect: 1st, the climate of 
 Algiers is opposed to the generation as well as to the evolution of tubercle in the 
 lungs : 2d. This morbid production is observed but very exceptionally among the 
 indigenous population : 3d. Europeans who do not bring the germ of the disease to 
 Algiers, almost never become phthisical : 4th. Those who do bring not only a predis- 
 position, but actually crude tubercle, in greater or less quantity, in the lung, are often 
 cured ; or, in the worst cases, the progress is extremely slow : 5th. When the tubercle 
 has softened, the climate is no longer favorable, but the reverse. 
 
 The climate is also beneficial in laryngeal and bronchial affections ; in chronic heart 
 disease; in gout and rheumatism; and in renal disorders. — Nervous complaints, 
 paralysis, epilepsy, and convulsions are aggravated by it. Cerebral congestions, and 
 a plethoric condition of the uterine organs, appear to be common in Algiers, 
 
 452. The Azores — Madeira — Canaries. 
 
 a. The Azokes ok Western Isles. — This group of nine islands belonging to Por- 
 tugal, lies in the midst of the Atlantic Ocean. They are of volcanic origin, all pos- 
 sess similar features, and have mild equable climates. The atmosphere is saturated 
 with moisture. A winter trip to the Azores may be recommended where a soothing 
 relaxing climate is needed. Hence it is beneficial in inflammatory dyspepsia, bron- 
 chial irritation with scanty secretion, and in the premonitory stage of consumption. 
 Sir James Clark thinks that a change from the Azores to Madeira, and from thence 
 to Tenerift'e, would in many cases jirove more beneficial than a residence during the 
 whole winter in any one of these islands. 
 
 ,fi. Madeira. — Of the group of Madeira Isles, the largest and most important is 
 Madeira, about P20 miles in circumfer(mce. Funchal, its capital, has long enjoyed 
 great reputation as a winter residence for the phthisical. The invalid who leaves this
 
 CLIMATES FOR INVALIDS. 377 
 
 country about the middle of October, can reach Madeira in from ten to fourteen 
 days; where he will find himself in a tro](ical climate, with an unclouded sky, a 
 ij^lowiuf^ sun, a deep blue sea, a luxuriant and varied foliaf^e, and beautiful hills which 
 were covered with tlourishinji; vineyards Wince the autumn of 18;')2, however, when 
 the vine disease suddenly broken out, there has been a sad change; the plants still be- 
 \u<^ destroyed by the deadly fungus. — The return voyage should be undertaken about 
 the beginning of June. 
 
 The climate of Madeira is mild, equable, and moist. There are occasional storms 
 of wind and rain, and tires are often necessary in the mornings and evenings. The 
 m(>an annual teni|)erature is (j4.'.)" ; that for winter being 60.0, spring G'2.3, summer 
 09.5, and autumn 07.3. The annual rainfall is 29.23 inches ; the days on which there 
 is wet being about 70, when-as in London they number 178. The most injurious 
 wind is the hot })arching Icste, from the east-southeast; which is often charged with 
 a line dust, very irritating to the air-passages. 
 
 The invalid who cannot bear a dry irritating, but needs a mild and soft atmos- 
 phere, will obtain it here. Laryngeal, bronchial, and pulmonary diseas(!s are 
 soothed; and benefit may be derived by patients threatened with consumption. If 
 he wish to spend a second winter in Madeira before returning home, a voyage may 
 taken to Teneritfe in June, and the stay prolonged there until the end of October. 
 
 y. The Canaky Islands. — This group (Fortunataj Insulae) consists of seven prin- 
 cipal islands, and several islets. The climate differs from that of the foregoing in 
 being warmer, drier, and less relaxing. At Santa Cruz, the capital of Tcnvriffe (the 
 only island possessing good accommodation for the valetudinarian), the mciin annual 
 temperature is 70.L5''; that for winter being 64.85, spring 68.87, summer 70.68, and 
 autumn 7-1.17. — Orotava and Laguna are sometimes preferred to Santa Cruz. 
 
 453. Cafe of Good Hope — Natal. 
 
 «. The Cape of Good Hope. — The climate is mild and healthy but very dry. The 
 seasons are the reverse of those in Europe ; December and January being the warm- 
 est, while June and July are the coldest months. The mean temperature for the 
 winter months of 1858, at Cape Town, was 57" F. The prevalent diseases appear to 
 be rheumatism and dysentery. Invalids from India are often benetited by spend- 
 ing a season at the Cape or at Natal. 
 
 &. Natal. — This British Colony lies on the southeastern border of Africa, about 
 800 miles from the Cape of Good Hope. There may be said to be only two seasons : 
 the summer from October to March, and the winter from the beginning of April to 
 the end of September ; even in the latter, during the coldest months of 1858, the tem- 
 perature was occasionally 78" F. in the neigborhood of Maritzburg ; while in the 
 hottest months it was occasionally below 60". [The Colony of NutaL. By Robert J. 
 Mann, M.D , p. 48. London, 1860.) Notwithstanding its almost tropical ))osition, 
 and the frecpient vicissitudes of temperature. Natal is very healthy. I)r. j\Iann re- 
 marks, that while 480 soldiers die yearly out of every 1000 stationed at Sierra Leone, 
 121 in 1000 at Jamaica, 78 in the West Indies generally, 48 in 1000 in the Madras 
 Presidency, 28 in 1000 at Bermuda, 27 in 1000 in the Mauritius, 25 in 1000 at St. He- 
 lena, 21 in 1000 at Gibraltar, 16 in 1000 in Malta and Canada, and 14 in every 1000 
 in Nova Scotia and New Brunswick, — -only 13 in 1000 die yearly in the western dis- 
 tricts of the Ca])e Colony, and only 9 in 1000 in the eastern district. During the 
 Kafir war in 1835, not a single officer or man was invalided during the five months 
 of active service. Newly-arrived settlers in Natal, remain for months under can- 
 vas, without the slightest injury. 
 
 454. Canada — New Brunsioich — Nova Scotia — Newfoundland. 
 
 «.- Canada. — The British colony of North America is divided by the Ottawa Kiver 
 into the provinces of Upper or West Canada (chief city, Toronto), and Lower or 
 East Canada (chief city, Quebec). The clinuxte is marked by extri'mes, the winters 
 being excessively cold, while the summers are just as hot. The coldness of the win- 
 ter is mitigated, however, by the dryness of the air and the absence of high winds ;
 
 378 APPENDIX OF FORMULA. 
 
 while the way in which the Canadian protects himself with thick furs, and his house 
 by well-managed stoves, enables him to set the frost at defiance. A gentleman, res- 
 ident in Canada for six years, told the author that with the thermometer — 20*^ he 
 never felt the cold so raw and unpleasant, as in London at the beginning of January 
 1864. — The climate is also much milder in Upper than Lower Canada; but that of 
 both provinces is healthy and conducive to longevity. 
 
 j8. New Brunswick. — The climate of this portion of British North America re- 
 sembles that of Canada ; the winters being very severe, and the summers excessively 
 hot. The winter, however, is mitigated by the length and fineness of the autumn, — 
 the "Indian summer." 
 
 y. Nova Scotia. — This peninsula of North America, forming part of the British 
 colonial territory, is separated from New Brunswick by an isthmus 14 miles across. 
 The climate is remarkable for vicissitudes of temperature, prolonged falls of rain, 
 and occasional fogs. The inhabitants, nevertheless, are said to enjoy a remarkable 
 degree of health. 
 
 (A Newfotijcdlanb. — This island, lying oiT the coast of Labrador, is separated 
 from the mainland by the Strait of Belleisle, 12 miles across. The surface is mostly 
 marshy, and the soil unfavorable to cultivation. The winters are less severe than in 
 LTpper Canada, but the summers shorter. Dense fogs prevail along its banks, some- 
 times for the greater part of the summer. The annual mortality, however, scarcely 
 exceeds 12 per 1000 of the population, so that the climate must be favorable to the 
 constitution. 
 
 455. West Indian Islands. 
 
 Invalids should not be sent to any of these islands ; for though they are not as un- 
 healthy as was formerly supposed, yet severe fevers and inflammatory diseases are 
 common and run a rapid course. Moreover, the returns show that nearly twice as 
 many cases of consumption originate among oiir troops stationed here, as at home. 
 If a man in search of health will visit them, however, he must only do so between 
 the months of December and April, after the heavy autumnal rains. Jamaica, the 
 chief of the British possessions, is reputed the most healthy. The Bahamas are re- 
 sorted to by American invalids. In the Bermudas and the Barbadoes, dysentery, 
 rheumatism, and yellow fever are the prevailing diseases. 
 
 456. mil and Marine Sanitaria in India. 
 
 The Indian hill staiions oflTer a climate which is of great use to convalescents from 
 fever, invalids from local cachexia, &c. ; and which exerts a powerful influence in 
 maintaining the health and vigor of Europeans. 
 
 According to Dr. W. J. Moore, of the Bombay Medical Service, the climate of 
 hill ranges differs from that of the plains in having a mean temperature some 10° to 
 15° cooler, in being above the influence of the hot winds, and in being more humid 
 during the monsoon season. Various localities ditfer in minor points : in the Hima- 
 Inyas, a greater elevation will procure a colder climate ; the fall of rain has sometimes 
 been excessive at Mahahleshwar, at Nynee Tal, &c., while at many of the hill stations 
 sanitary laws are still too much disregarded, and too little care is "taken to protect the 
 system from the inclemencies of the weather. 
 
 The climate of the hill stations in the Himalm/as, of Mount Aboo, of Ootocamund, 
 JBonqa.lo7-e, &c., &c., as well as of Mathcran and Mahableshwar' in Bombay, is of great 
 service to the European whose health has deteriorated from a residence on the Indian 
 plains. The air invigorates both mind and body. But it is unsuitable whete there 
 is structural disease of any internal organ ; diarrlux-a and dysentery being increased 
 by it, while aflections of the brain and lungs and liver are niueh aggravated. 
 Cholera, dysentery, and malarious fevers are less prevalent and fatal in the hill sta- 
 tions, than in the plains below. Yet these atfections are met with at high elevations; 
 as are also cases of hepatitis, tuberculosis, typhus, croup, diphtheria, snnill-pox, rheu- 
 matism, neuralgia, severe catarrh, and hill-diarrhcea.— It has been well suggested that 
 European troops should be located more on the hills, and less on the phuns than is 
 now the case ; not waiting until they are weakened by disease, climate, and service 
 to be sent to these more temperate and less malarious regions.
 
 CLIMATES FOR INVALIDS. 379 
 
 Many of tho disoasos winch aro a,c;c:rav,atocl by tho hill stations of India, arf much 
 benetited by the greater purity and uniformity of the sea climates. The invalid who 
 has been prostrated by the harsh parc-hins? winds of the interior, not only has his 
 bodily sutlerin<;;s greatly ameliorated by the moist fresh breeze from the sea, but the 
 mi're siglit of tile ocean raises his powers by giving him hope and contidence. It is 
 necessary to select an open spot, with high clitfs and a rocky sliore ; low, flat, sandy 
 coasts being generally unhealthy in the tropics. The proximity of the island of Mur- 
 lahnn to Madras and Calcutta, as well as its geological characteristics, have led Dr. 
 Macjihcrson to recommend it as a marine sanitarium. 
 
 The weak-chested, and those persons of a strumous habit predisposed to phthisis, are 
 often greatly benefited by a residence in India ; but where tubercle is deposited in the 
 lungs, the climate seems to accelerate the progress of the disease. Individuals of a 
 phlegmatic temperament with difficulty in digesting, and a languid circulation, often 
 improve very much in this country. 
 
 457. Australia — Tasmania — N'ew Zealand. 
 
 a.. Australia. — The immense extent of territory known as Australia, in the South 
 Pacific Ocean, possesses a temperate climate, which appears very favorable to the 
 Euro])ean constitution. In speaking of this antipodal region it is necessary to re- 
 member that the meteorological ]ihenoniena.are generally the reverse of those ex]ie- 
 rienced in this country ; the months of December, January, and February corres- 
 ponding to our summer, and having a mean temperature of about 80°, while those of 
 June, July, and August constitute the winter, the thermometer marking on an aver- 
 age 40° in an exposed situation. 
 
 In May, 1836, the number of settlers in the district of Victoria (formerly Port Philip) 
 was 177. At the end of a quarter of acentury (April, 1861), the amount had increased 
 to 540,322. The total area of Victoria (86,831 miles) is nearly as large as that of 
 England, Scotland, and Wales united. Melbourne, the capital of Victoria, is the 
 most prosperous commercial city of the southern world. The mean annual tempera- 
 ture is 57° ; extreme cold in winter, and excessive heat in summer (except nine or 
 ten times in the season, under the influence of hot winds), being unknown. Although 
 the annual rainfall is 26 inches (that for London being 21.6), yet the average number 
 of wet days is much less than in Great Britain ; for in Melbourne the rain falls with 
 great violence, but it only lasts a few hours, and then the sky clears. A continuance 
 of cloudy weather is unknown. There is a genial sun ; with a pure, dry, stimulating 
 air. 
 
 Dr. S. Dougan Bird says (Australasian Climates, and theb- hvfluence in Pulmonary 
 Consumption, p. 41, London, 1863), that the main characteristics of the Victorian 
 climate are these : " It is a temperate warm climate, whose average summer heat is but 
 two or three degrees above that of London ; while in winter it is warmer than Nice or 
 Naples, and as warm as Valencia or Barcelona ; and actual cold is never felt at, or 
 near, the sea level. The air is generally dry, always stimulating and ozoniferous ; but 
 so tempered by the prevalence of ocean winds, that it is prevented from becoming irri- 
 tating, like that of Nice or Provence. With this there is a very large proportion of 
 sunny cheerful weather during the whole year. In no climate with which I am ac- 
 quainted is there so much pleasant weather during the year as in Victoria — so many 
 unclouded days, when it is neither too hot nor too cold — and an invalid has, conse- 
 quently, every temptation to be in the open air." 
 
 Tuberculosis (i. e., scrofula, phthisis, tabes mesenterica, and tubercular meningitis) 
 is rare in Victoria, the mortality not being one-fourth of that in Great Britain from 
 the same cause. Yet the population is composed of those who, hereditarily, from oc- 
 cupation, and mode of living (except that animal food is much cheaper) are as much 
 predisposed to consumption, as the inhabitants of London or Liverpool. 
 
 In the penal establishments o{ Pentridc/e and Col I ingivood (the iormev &vo, the latter 
 two miles from Melbourne), with an average of 1000 male adult prisoners, the greater 
 number undergoing long sentences, there was no death from consumption in 1860 or 
 1861. Comparing this with the statistics to be found in the Reports of the Directors of 
 Convict Prisons in England, it appears that at Millbank, the greatest number of male 
 ])risoners in confinement, at any one time during 1860 was 741, the daily average 
 throughout the year being 531, and the total number in the year 2404. Of these 2 
 were recommended for pardon on account of advanced consumption ; 2 died from the 
 same ; and 102 were removed to the Invalid prisons of Dartmoor, Lewes, or Woldng,
 
 380 APPENDIX OF FORMULA. 
 
 on account of phthisis. These nnmbfr?, moreover, do not include 16 who were removed 
 for ha-moptysis. — At the same prison in 1861, the greatest number of such prisoners in 
 confinement at one time was 8(J9, the daily average throughout the year 615, and the 
 total number in the year 2612. Of these .5 died from phthisis, and 132 were removed 
 to Invalid prisons on account of it. This number also does not include 19 removed for 
 hffimoptysis. 
 
 At Si/dney (the capital of New South Wales, East Australia) the mean annual tem- 
 perature is about 6.5°. Heavy rains fall between June and September. Disease is 
 said to assume a milder form here than in European countries. Dysentery and pul- 
 monary affections are, however, not uncommon. The winters are colder than at 
 Moreton Bay, though this season is very salubrious and agreeable. 
 
 Moreion Bay (Queensland, East Australia), has a fine winter climate, which proves 
 very useful in advanced cases of phthisis, with irritability of the system and a tendency 
 to bronchial inflammation. The average temperature on the coast, during the cold 
 months, is 62° or 63; the air being soft and sedative, and the weather brilliant and 
 sunny. A few miles inland the ground rises, and the air is more dry and bracing. 
 
 In cases of consumption with copious expectoration, and in the chronic bronchitis 
 of old people, Adelaide, the chief city of South Australia, may be chosen as a resi- 
 dence. The air is dry, warm, and tonic; the winter temperature averaging 53°. 
 
 The invalid leaving England for Australia, will generally find the long uninter- 
 rupted voyage round the Cape of Good Hope, in a comfortable ship, much to be pre- 
 ferred to the more exciting and fatiguing "overland route," by way of Suez and 
 Galle. The best time for leaving this country is from the middle of October to the 
 end of November; when the new home will be reached in about ninety days from 
 Liverpool. Thus supposing him to arrive about the end of January he will find a 
 pale-blue cloudless sky, and the thermometer at 90° in the middle of the day without 
 any unpleasant sense of heat. With a feeling of new life, general exhilaration, and 
 a good appetite, he will experience a desire to be at work. The difBculty seems to be 
 to persuade the phthisical that they are not cured ; and that the general rules of hy- 
 giene must be adopted, and all excesses avoided to prevent the pulmonary mischief 
 again starting into activitj-, or to escape hepatic congestion, or that he may obtain 
 and retain health and vigor. 
 
 0. Tasmania. — This island (known as Yan Diemen's Land, until the abandonment 
 of transportation in 1852) is sepai'ated from the southernnn)st point of Australia by 
 Bass's Strait. The chief towns are Hobart Town in the south, and Launceston in the 
 north; the climate of both being salubrious and delightful, and highly conducive to 
 longevity. The latter jiort is reached in twenty-four hours, by steamer from Mel- 
 bourne, and is beneficial to such cases as are usually sent to Pau. The air is moist, 
 sedative, and equable. In the winter months of June, July, and August, there is 
 never great cold during the day. The mean annual temperature of Hobart Town is 
 52°. Tasmania is described as " the Garden of Australia." 
 
 y. New Zealand. — This group in the South Pacific Ocean, consists of two princi- 
 pal (the North and Middle) and several smaller islands. The chief British settlements 
 are Aitcklnnd, Neiv Plyniouih or Tarmiki, Haivkes Bay, and H'elluigion, in the North 
 Island; with AV.son, Marlborfnigh , Cnnterbury, and Ofayo, in the Middle Island. The 
 temperature of New Zealand is marked by its uniformitj'. The mean of the warmest 
 month at Auckland is 68°, and of the coldest at Otago 42°. The climate, which in 
 general terms may be described as mild and soft, appears to be favorable to the Eu- 
 ropean constitution. 
 
 XX. MINERAL WATERS. 
 
 458. General Observations. 
 
 Mineral waters have been used in medical practice since the days when /Esculapiua 
 was worshipped throughout Greece, and when his temples were erected in healthy 
 places, near wells which were believed to have healing powers. Like many other 
 important remedies their virtues have been regarded with singular skepticismat one 
 time, and with blind credulity at another. The practitioner in the present day wisely 
 attempts to keep the iniddle course ; neither over-estimating, nor unduly depreciating, 
 the value of these agents in subduing diseases. 
 
 A mineral water is merely a complicated medicine, containing various salts and 
 gases blended together. The ingredients are generally derived from the soil or rocks 
 through which the waters pass; and they consist of saline principles, organic and
 
 MINERAL WATERS. 381 
 
 inori^iuiic^ niattors, and more or less of a free gas (sulphiirottod hydrogen, carljonic 
 acid, nitrogen, or oxygen). The cause of the temperature of hot springs is a niys- 
 tery ; and piiiiosophers know not whcHiier it is due to the internal heat of the globe, 
 to electricity, to ciiemieal decomposition, or to volcanic agency. The heat is always 
 under that of boiling water (212° F.), and it has varied but little during a long suc- 
 cession of years. — The waters are administered internally and applied externally; and 
 they act chieHy by purifying the blood, increasing the processes of secretion and 
 excretion, iind by stimulating the cutaneous and visceral circulation. It cannot be 
 doubted that these etl'eets ai'(! due to tl)e ehemiciil (•ompii>iti<)n and tem])erature of the 
 waters ; though it is allowed on all hands that the bent'ticial influence is aided l>y the 
 locality of the spring, the nature of the climate, the absence of business and care, the 
 diet, and the general regimen. 
 
 Mineral waters are useful only in chronic disorders, where there is but little, if any, 
 structural change ; or in cases where disease is threatened. Hence the sutferers sent 
 to the Spas are for the most part affected with skin affections, rebellious ulcers, stiff- 
 ness of limbs from old sprains, etc. ; chronic gout, riieumatism, sciatica, or neuralgia; 
 hepatic or renal disorders ; ))aralytic affections, where all active disease has b(fen sub- 
 dued ; hysteria or hypochondriasis; or with cei'tain functional disorders of the uterine 
 system. Nothing but mischief can arise where there is either acute disease, tuber- 
 culosis, cancer, aneurism, or mischief about the heart. The young and the very aged, 
 moreover, will derive little or no benefit: and in pregnancy the use of the sj)rings, to 
 say the least, demands great caution. 
 
 The time for residing at some of the Spas is from May to September ; but at several 
 of the foreign ones it is only from June until the end of August. At a few of the hot 
 springs, invalids (chiefly the gouty) remain through the winter. The treatment, 
 however, is not commonly to be prolonged beyond six or eight weeks ; and often three 
 or four will suffice. The invalid should not l)e led to expect immediate relief. And 
 he should be cautioned against the popular idea that the benefit derived will be in 
 prop(jrtion to the quantity of water taken ; while it may be as well to let him know 
 that "critical eruptions" (psydracia thermalis), and "critical fluxes" are neither 
 necessary nor advantageous. As a rule, bathing and drinking ought not to be com- 
 menced on the same day ; and at first only a moderate quantity of the water should 
 be taken. Very hot water is also to be cooled, and very cold to be warmed, before 
 drinking. 
 
 When the strength will permit of it, early rising (at about 6 o'clock) is to be recom- 
 mended, so that the doses may be taken before breakfast. The contents of the tumbler 
 are to be sipped slowly and methodically, not hastily swallowed like a nauseous 
 draught; and an interval of fifteen minutes, at least, should be allowed between each 
 glass, which time may well be spent in a short walk. An hour after the last glass, a 
 light breakfast is to be taken. Then, a gentle saunter, the bath, reading, writing let- 
 ters, &c., will agreeably occupy the hours till the early dinner; at which fruit and 
 raw vegetables iiad better be avoided, while a moderate quantity of light wine, or of 
 mild bitter beer may be allowed. An excursion to the objects of interest in the neigh- 
 borhood, j)erhaps one or two more glasses of water — never more than half tlie quantity 
 taken in the morning, — a light supper at 8 o'clock, and bed two hours afterwards, will 
 complete the day's work. 
 
 Mineral waters are sometimes classified into the thermal or hot, and the cold 
 springs. But a more useful division is into chalybeate, sulphurous, gaseous or acid- 
 ulous, saline, iodo-bromated, and muriated lithia waters. 
 
 Class 1. Chalybeate or Feri'ijginous Waters. — A large number of waters contain 
 small quantities of iron, but none are considered as belonging to this class unless the 
 proportion of metal is considerable. The chief acidulous chalybeates (those which 
 contain much carbonic acid gas) are the waters of Schwalbach, S]»a, Pyrmont, Briick- 
 enau, the Cambray well at Cheltenham, and Tunbridge Wells. The princi]ial saline 
 acidulous chalybeates (such as, in addition to iron and carbonic acid, have a certain 
 amount of sulphate and carbonate of soda, with chloride of sodium) are the springs 
 of Franzensbad, Bocklet, Harrogate, &c. — Chalybeate waters are useful in anaemia, 
 and in functional disorders of the generative organs. 
 
 Class 2. Sulphurous Waters. — They have the odor of rotten eggs, owing to their 
 impregnation with sulj)hiiretted hydrogen. The chief sulphurous thermals are those 
 of Aix-la-Chapelle, Baden near Vienna, Aix-les-Bains, Bareges, Bagndres de Lu- 
 chon, St. Sauveur, Cauterets, Eaux-Bonnes, and Eaux-Chaudes. Amongst the cold 
 sulphurous springs may be mentioned Harrogate and Booklet. — Sulphurous waters 
 are recommended in cutaneous, hepatic, uterine, rheumatic, gouty, and old constitu- 
 tional syphilitic diseases. In chronic poisoning by mercury, lead, or copper, they 
 help to eliminate the injurious minerals. 
 
 Class 3. Gaseous or Acidulous Waters. — The carbonic acid gas gives these waters a 
 sharp acidulous taste, with a sparkling appearance. The most important are the
 
 382 APPENDIX OF FORMULA. 
 
 thermsil ?priii2:s of Yichy, and the cold of Fachingen and Bilin. The refreshing 
 and I'xhihirating waters of this class are recommended in dyspepsia, hepatic derange- 
 ment, gout and rheumatism, &g. 
 
 Class 4:. Saline \Vate7-s. — Those which are purgative and have sulphate of soda or 
 sulphate of magnesia as their chief ingredients, are Epsom, Cheltenham, Leaming- 
 ton, Seidlitz, Polna, Carlsbad, and Marienhad. Those which have chloride of so- 
 dium as their characteristic ingredient, are Wiesbaden, Baden-Baden, Homburg, 
 Kissingen, &c. The sulphate or carbonate of lime, or both, predominate in the ther- 
 mal waters of Bath and Buxton ; while the carbonate or bicarbonate of soda is the 
 characteristic ingredient of the thermal springs at Ems, Teplitz, &c. 
 
 Class 5. lodo-bromaied Waters. — The springs at Krcuznach are the most celebrated 
 of this class; while in England theje is the Woodhall spa. The waters are used in 
 all forms of scrofula, in many chronic skin diseases, in uterine tumors, and in old- 
 standing constitutional syphilis. 
 
 Class 6. Muriaied Liihia Wate7-s. — The springs of Baden-Baden have considerable 
 reputation for the cure of gout and the uric acid diathesis, owing to the chloride of 
 lithium which they contain. 
 
 459. Tunhridge Wells, in Kent and Sussex. 
 
 This town is more visited on account of its dry bracing air, beautiful varied 
 scenery, and fine walks, than for its chalybeate Spa. The water of the latter has a 
 temperature of 50°, is feebly ferruginous to the taste, contains about a quarter of a 
 grain of oxide of iron to the pint, and has just sufficient carbonic acid to hold the 
 metal in solution. Frequently, increased doses of steel are given with the water; or 
 sulphate of magnesia may be added, if an aperient be needed. The chief value of 
 the spring is witnessed in cases of an:emia and chlorosis, debility inducing dyspepsia, 
 and in general lassitude from a too sedentary mode of life. 
 
 460. Bath, in Somersetshire. 
 
 The thermal mineral springs, situated in the southern part of the town, near the 
 Abbev church, are four in number. The temperature of the waters varies from 120'* 
 F. to 104" F. Speaking generally, the solid contents are about ten grains to the 
 pint. The chief constituents are sulphate of lime, sulphate of soda, chloride of sodium, 
 chloride of magnesium, carbonateof lime, silicic acid, and a comparatively small portion 
 of iron. The gases evolved consist of nitrogen in large quantity, with oxygen and 
 carbonic acid. 
 
 The sparkling appearance of the waters at the springs, is due to the carbonic acid 
 they contain. The quantity generally drank is from one-quarter to one pint, before 
 breakfast and again in the afternoon. Taken quietlj' and leisurely, the etfect is usu- 
 ally to raise the temperature of the body, to quicken the circulation, to increase the 
 appetite, and to promote the salivarj- and renal secretions. When headache, loss of 
 appetite, thirst, nausea, mental depression, and a diminished llow of urine follow 
 their use, they should either be discontinued or taken in very small doses. 
 
 The accommodation for bathing is excellent; there being good douche, shower, 
 vapor, reclining, swimming, and chair baths. By the latter, worked with a crane, a 
 helpless invalid is lowered into, and raised from, the water. The bath is to be taken 
 three or four times a week, not too near the meal-times, and the patient should re- 
 main in it from ten to thirty minutes. The proper temperature is 96" to 98'' F. 
 
 The spring and autumn are the best seasons for taking the baths and waters, though 
 they may be advantageously employed in the winter. And the diseases which are 
 most benefited by them are subacute gout, chronic rheumatism, sciatica, neuralgia, 
 lumbago, rheumatoid arthritis, contracted or rigid joints, dyspepsia, paralysis from 
 rheumatism or inetallic poisoning, leucorrhoea, chorea, anaemia, lepra, eczema, and 
 psoriasis. 
 
 461. Cheltenham, in Gloucestershire. 
 
 Since the cure of George the Third by the waters of the Koyal Old Wells, the Spa 
 has been a fashionable resort. Situated 8 miles E.N.E. of Gloucester, Cheltenham 
 offers an agreeable permanent residence, particularly for valetudinarians from the 
 East or West Indies. The climate in winter is mild and equable, rather moist, and 
 sheltered by the Cotswold and other hills from the north and east winds. The sea- 
 son, however, is from the middle of April to the beginning of October. 
 
 The waters are chiefly taken internally. There are several cold springs, all of 
 them powerfully saline except the Cambray chalybeate. The waters of the Koyal 
 Old Wells contain chiefly chloride of sodium, chloride of calciu7n, chloride of tnag-
 
 MINERAL WATERS. 383 
 
 nesbnn, and su/pkafe of snrla. Thoy are but slio;htly c^aseous. Some of the wells of 
 the MoNTl'KLLlER Sl'A hjivo, in addition to the fore^iMnc, a little oxide of iron, and 
 iodtc7-etted itKH/nesian saline salts. There is an unusual amount of siUm in the Pitt- 
 viLLE saline; while the Camiiray spring is sirong\y c/mlyheate. The 3Iont](ellier 
 baths have accommodation for warm and cold bathing, swimming, medicated air and 
 vajior douches, «S:c. 
 
 These springs enjoy considerable reputation for relieving the diseases engendered 
 by a residence in tropical climates, and hence many old Indians with liver atl'ections 
 resort to them. They are also useful m gouty and rheumatic disorders, in the lithic 
 acid diathesis, in plethoric and irritable systems, in skin diseases, in dyspepsia with 
 torpidity of the bowels, as well as in some forms of amenorrhcea and chlorosis. The 
 dose is usually from half a pint to one pint before breakfast; it is better to take the 
 water pure, without the addition of any "solution" of the crystallized salts; and it 
 may be warmed if a more than ordinary aperient effect is needed. The sj)ring to be 
 recommend(!d must depend upon whether a simply alterative, or an alterative and 
 tonic remedy is indicated. 
 
 462. Purton and Melksham, in Wiltshire. 
 
 The healthy village of Purton in North Wilts, 4J miles W.N.W. of Swindon, has 
 a dry bracing air. The Spa is 2^ miles from the village, in a field known as Salt's 
 Hole, where a pump-room has recently (18-39) been erected for the accommodation of 
 visitors. An analysis of the water shows that it is rich in sulphate of soda, sutji/iate of 
 magnesia, sulphate of lime, carbonate of potash, and chloride of sodium. It has also 
 small quantities of sulphate of potash, silica, iodide of sodium, and bromide of mag- 
 nesium; with traces of iron, phosphoric acid, and sulphuretted hydrogen. There is a 
 large amount of free carbonic acid gas; and the temperature is 58.5U° F. 
 
 The Purton sulphated and bromo-iodated saline water may be recommended where 
 an alterative stimulant is needed. It seems to have been useful in strumous sores 
 and enlarged glands, threatened consumption, stomach and liver disorders, gouty and 
 rheumatic affections, obstinate skin diseases, and in functional derangements of the 
 uterine system. The dose is from half a pint to a pint before breakfast, with half a 
 pint in the evening. 
 
 The small town of Melksham lies 10 miles E.S.E. of Bath, in a fine open country. 
 In its vicinity are baths and a pump-room erected over the chalybeate and saline 
 springs. The chief constituents of the waters are the salts of lime and 7nag?iesia, with 
 smaller portions of soda and iro7i ; and they a»e artificially charged with gas for ex- 
 portation. In strumous, rheumatic, and cutaneous diseases, the medicated vapor and 
 douche baths may be employed simultaneously with the internal use of the waters. 
 
 463. Leamington, in WarwicJcshire. 
 
 Being less protected by hills than Cheltenham, the town of Leamington, 2J miles 
 E. of Warwick, has a lower temperature. The climate, however, is genial and bra- 
 cing, but humid ; while it is agreeable and healthy to the fiagging invalid during the 
 autumn and winter months. 
 
 The springs all lie near the banks of the Leam ; their principal salts being, — chlo- 
 ride of sodium, sulphate of soda, chloride of calcium, and chloride of Tnagncsium. The 
 chief gas is carbonic acid, with great quantities of nitrogen and oxygen. The most 
 ancient and most used of the springs is the Old W^ell. The water at Goold's 
 Spring and Baths contains more chloride of sodium, while Curtis's Well has 
 more muriate of mag7iesia than the others. Tlie Victoria Well and Pumi'-room, 
 possesses a weak mdphurous, and a saline chalybeate spring; and so does Lee's Well. 
 
 The temperature of the Leamington waters is about 48° F. ; and their action is 
 aperient and alterative. They are suitable for the same class of cases as is sent to the 
 Cheltenham springs ; but being more active, they agree better with invalids of a 
 torpid habit, than with those of a susceptible irritable temperament. 
 
 464. Buxton, in Derbyshire. 
 
 For invalids requiring mountain air Buxton may be recommended. Situated 31 
 miles W.N.W. of Derby, at an elevation of 900 fee\, while some of the neighboring 
 hills are 2000 feet above the sea, it enjoys a pure bracing air. The season is chiefiy 
 from June to October; the winds being sharp and cold late in the autumn, during 
 winter, and early in the spring. It is not to be selected where there is a tendency to 
 internal hemorrhage. 
 
 The Buxton waters issue abundantly from several crevicea in the limestone rock,
 
 384 APPENDIX OF FORMULA. 
 
 at a temperature of 82° F. Tlie chief saline salts in them, are, cnrbonate of lime, car- 
 bonate of magnesia, chloride of sodium and calcium, and potassi.i/.m., with silica, carbonate 
 of protoxide of iron, and traces oi fiuoride of calcium and j)hosj)hate of lime: though so 
 small is the quantity, that in the whole, they only amount to 18.434 grains in the im- 
 perial gallon. In the same amount of water Dr. Playfair found (1852) free carbonic 
 acid, in weight, 704.2 grains, nitrogen gas 206 cuhic inches, and carbonic acid gas 15.66 
 cubic inches. According to the most recent analysis by Dr. Sheridan Muspratt (1860) 
 the quantity of nitrogen gas, at the moment of issue, is no less than 504 cubic inches 
 per gallon. — As these waters, minus their gases, have only the composition of ordi- 
 nary spring water, their stimulating effects are generallj^ attributed to the nitrogen. 
 They are, however, chiefly used externally ; the accommodation for plunge, swim- 
 ming, and douche baths being excellent. The good which results from the latter is 
 most marked in cases of gout and rheumatism, sprains and muscular contractions, 
 and where it is wished to stimulate the vascular or nervous or digestive systems. 
 
 A plea.sant drive from Buxton is the picturesque village of Matlock, built on the 
 slope of a hill, at the base of which flows the Derwent. It is an agreeable summer 
 residence, and its springs supply large tepid baths. The water, however, has no 
 medicinal properties, though the guide-books describe Matlock as a valuable Spa. 
 
 465. Woodhall, in Lincolnshire. 
 
 This strong saline spring rises in a plain 3 miles W.S.W. of Horncastle, and con- 
 tains more iodine and bromine than any other English water. It has also 189 grains 
 oi chloride of sodium in the pint, with a little chloride of calcium and magnesium, bicar- 
 bonate of soda, and sulphate of soda. The temperature is 55°. It is chiefly used ex- 
 ternally in rheumatic and cutaneous afl'ections, and in scrofula. Taken internally, 
 half a pint acts as a mild aperient. 
 
 466. Harrogate, in Yorkshire. 
 
 High and Low Harrogate, half a mile distant from each other, and 27 miles W. 
 of York, are tilled with visitors during the season, — from June until the middle of 
 October. The air is pure and bracing, but somewhat humid. Low Harrogate is the 
 most sheltered. 
 
 There are upwards of fifty different springs, some of which have been in repute 
 since the end of the 17th century. The waters are all cold, being generally warmed 
 artificially before they are drunk. Dr. Kennion divides the springs into four distinct 
 groups: (1) The strong sulphurous waters. (2) The mild sulphurous waters with 
 alkaline impregnations. (3) The saline chalybeate waters. And (4) The pure cha- 
 lybeate waters. 
 
 1. Strong Sulphurous Springs. — As types of this class may be mentioned the Old 
 Sulphur Well in the Koyal Pump Koom, and the strong Montpelier Sulphur Well in 
 the Montpelier Gardens. Tliey are both impregnated with sulphuretted hydrogen gas 
 (upwards of 25 cubic inches in the gallon ; their chief salts being chlorides of sodium, 
 calcium, potassium, and magnesium, sulphide of sodium, and carbonate of lii^, with 
 traces vi bromide of sodimn, iodide of sodium, &c. The waters are alterative, aperient, 
 stimulant, and diuretic: they are taken internally, and used as baths. 
 
 2. Mild Sulphurous Springs with Alkaline Impregnations. — The two most 
 important are the mild Montpelier Well, and the one at the Victoria Gardens. They 
 contain much less sulphuretted hydrogen, less chloride of sodium, and less chloride of 
 magnesium than those of the preceding group; but they have in addition carbonate of 
 ■magnesia. They are antacid, alterative, diuretic, and deobstruent ; and are used 
 externally as wdl as internally. 
 
 3. Salink (Jiialyhkate Waters. — One of these springs is in the Cheltenham 
 Pump lioom, the other in the Montpelier Gardens. In iiddition to the salts already 
 mentioned they contain carbonate of iron, so that they have a tonic action, superadded 
 to their other properti(!S. 
 
 4. Pure Chalyheate Waters. — The springs of the Tewhit and St. John's Well 
 have almost the comjiosition of pure water, with the addition of a small quantity "of 
 carbona.te of iron. 
 
 Invalids with all forms of chronic disease visit Harrogate to drink the waters. But 
 the cases most likely to derive benefit are the following: Impcu-fect digestion, in men 
 too fond of good living, where the bowels and liver are inactive (the strong sulphur 
 springs) ; chronic skin diseases, such as eczema, le[)ra, psoriasis, pityriasis, lichen, «&c. 
 (the sulphur, beginning with the mild) ; gouty and rheumatic affections (the strong
 
 MINERAL WATERS. 385 
 
 sulphur) ; throatonod jihthisis, espooially in yoiinff women with disordernd menstrua- 
 tion (the tnild sulphur, alternately with the pure- ohulybeatej ; strumous atl'ections (the 
 saline chalybeate) ; and lupus, chronic ulcers, &c. 
 
 467. jSpa, in Belgium. 
 
 Situated near the frontier of Rhenish Prussia, in the beautiful valley of the Arden- 
 nes, at the foot of a steep mountain shelterins; it from the north winds, is Spa. It 
 possesses the only mineral springs found in Belgium. The waters of the principal 
 well — the Pouhon — have a temperature of 52° F., and are largely charged with car- 
 bonic acid ; the chief solid constituents being the bicarbonates of soda, iron, lime, and 
 viofinesia. 
 
 The wells of the Sauviniere, Groesbeck, Geroustfere, and the Tonnelet are situated 
 at short distances from the town. Their waters are similar to those of the Pouhon, 
 but the proportion of iron is smaller. The Tonnelet spring is the most e;aseous. 
 
 These gaseous chalybeate waters are employed to the extent of two or three pints 
 daily, commencing with a couple of glasses before breakfast. They impart power, 
 strengthen the digestion, and are valuable in such cachectic and other diseases as 
 require a ferruginous tonic. — The season is from the commencement of May until the 
 end of July. 
 
 468. Bagneres de Bigorre, in the Pyrenees. 
 
 This celebrated watering-place is situated at the foot of the Pyrenees, on the left 
 bank of the Adour, about thirty-five miles to the southeast of Pau. The season com- 
 mences in June and ends about the middle of October. 
 
 The springs in Bagneres and its neighborhood are numerous, and may be divided 
 into three classes: 1. The Saline. The temperature of these waters varies from 
 124° to 85° F. ; the chief chemical products found in them being carbonic acid, chlo- 
 rides of 77iag7iesiuni and sodium, sulphates of lime, soda, and jnngnesia, subcarhonates of 
 lime, magnesia, and iron, an infinitesimal proportion of arsenic, with resinous and 
 vegetable extractive matter, and silex. 2. The Ferruginous. There is only one spring 
 of this kind, properly so called — la Fontaine Ferrugineuse. 3. The Sulphurous. 
 Only one sulphurous spring has much reputation, — that of Lebassere ; and its waters 
 contain a minute quantity of carbonic acid, hydro-sulphuric acid, chloride of sodium, 
 hydro-sulphate of soda, subcarboyiate of soda, vegcto-animal matter, and silex. 
 
 The general etfect of the waters, taken internally and as baths, is that of a stimulant 
 to the mucous membranes, kidneys, lymphatic system, and skin. They are useful, 
 more particularly, in diseases of the bones and articulations ; in chronic rheumatism, 
 and allied disorders, as neuralgia, sciatica, &c. ; in atonic dyspepsia from over-mental 
 work ; and in nervous affections, — hysteria, palpitations, hypochondriasis, gastrodynia, 
 &c., especially if there be biliary derangements. The Labassere waters are beneficial 
 in cases of excessive secretion from the mucous canals, in many skin diseases, and in 
 some morbid states of the abdominal viscera. In an;emic conditions, valuable -elfects 
 result from the employment of the ferruginous spring. — Patients who have been 
 benefited by Pau during the winter may advantageously proceed to Bagnbres for the 
 summer. 
 
 When the saline waters are taken for their alterative eff'ects, the daily dose is small — 
 about a pint; but if a purgative action is needed, from one to two quarts, in divided 
 quantities, should be drunk daily. 
 
 469. Caphern, in the Pyrenees. 
 
 Situated about ten miles from Bagnferes de Bigorre, the waters of Capbern are of a 
 saline character like most of those of that neighborhood. Their chief constituents are 
 carbonic acid gas, sulphates of lime and mngnesin, with carbonate of lime. One authority 
 says that they also contain carbonate of iron, while another asserts that there is not a 
 trace of it. They are deemed useful in congestions of internal organs, and are sup- 
 posed to have warded otf apoplectic seizures, when the cerebral circulation has been 
 sluggish : they stimulate the uterus and ovaries, and have been said to cure sterilitv: 
 while many cases of chlorosis, leucorrhcea, dysmenorrhcea, &c., seem to have been 
 
 25
 
 386 APPENDIX OF FORMULA. 
 
 benefited by them. The dose is from four to six tumblers, early in the morning, 
 taking exercise between each glass. At the same time reclining or douche baths are 
 employed. 
 
 470. Bareges^ in the Pyrenees. 
 
 This village, on the Gave de Bastan, about forty-seven miles from Pau, is nearly 
 4000 feet above the sea. — The season lasts from the beginning of June to the middle 
 of September. 
 
 The well-known sulphurous and stimulating waters of Barfeges are of three kinds, 
 as regards temperature: viz., the hot source, the temperate, and the tejnd. The princi- 
 pal baths are, the Bain de l'Entree, 107° F. ; Bain du Fond, 98°; Bain de Pol- 
 ARD, 101° ; and Bain de la Chapelle, 84°. The waters of all are limpid, have an 
 oily nauseous flavor, and exhale an odor of rotten eggs. They contain nitrogen, sul- 
 phuret of sodium, sulphate of soda, chloride of sodimn, silica, lime, &c. On their sur- 
 face is found a thin pellicle called barlgine or glairine; which is probably of a vegeta- 
 ble character, and is supposed to have some peculiar power in curing chronic rheu- 
 matism. 
 
 These waters are beneficial in inveterate squamous, pustular, and papular skin 
 affections; in some forms of scrofula; in chronic rheumatism, sciatica, lumbago, and 
 stiffness of the muscles or tendons; in strumous and other indolent ill-conditioned 
 ulcers; and in irritation from the presence of carious or necrosed bone. Por healing 
 sinuses left by old gun-shot wounds they are considered particularly efiicacious. Pul- 
 monary cases derive more benefit from Eaux-Bonnes and Cauterets. And the waters 
 of Barfeges are not to be prescribed where there is any tendency to inflammatory dis- 
 orders, or in heart disease, or for irritable nervous temperaments. They are more 
 powerful and stimulating than the waters of St. Sauveur. 
 
 The waters are taken internally, as well as employed in the form of baths, douches, 
 lotions, and injections. 
 
 471. St. Sauveur, in the Pyrenees. 
 
 Situated on the Gave de Pau, in the valley of Laverdan, this watering-place is 
 44 miles from Pau, 4 from Bareges, and 1 from Luz. The still Alpine air is mild, 
 and yet bracing. The season is from May until October. 
 
 The waters are milder than those of Barfeges, but have the same constituents. They 
 are useful for women and children, in the same disorders as are sent to Bareges. 
 Hysteria, neuralgia, hypochondriasis, leucorrhoea, and irregularities of the catamenial 
 flow, are much benefited by them. When taken internally they have to be diluted, 
 their greasy properties, from the excess of bardgine, being so great. They are mostly 
 used as reclining and douche baths, vaginal injections, &c. 
 
 472. Bagneres de Luchon, in the Pyrenees. 
 
 This little town, in a magnificent valley surrounded by noble mountains, is 85 
 miles from Pau, and 2000 feet above the sea. The season lasts from May to October. 
 
 There are upwards of 48 thermal sulphurous springs, the temperature of the waters 
 varying from 152° to 62° F. Their chief constituents are sulphuret of sodium, chloride 
 of sodium, silicate of lime, and silica; with traces of the stiiphurets of iron and man- 
 ganese, iodide of sodium, sulphate of potash and soda, and sulphite of soda, &c. They 
 are efficacious in chronic skin diseases, in stiftness of limbs after dislocations and frac- 
 tures, in old ulcers, chronic bronchitis, rheumatism and neuralgia. Also in some 
 cases of torpid digestion, anaemia, hypochondriasis, hysteria, &c. Their effects are 
 injurious when tliere is a tendency to plethora and nervous irritability. They are 
 drunk, in doses of three or four glasses, pure or mixed with milk; and are used as 
 baths, injections, lotions, eye-washes, «&c. 
 
 473. Cauterets, in the Pyrenees. 
 
 This celebrated watering-place, imbedded among the mountains, in the valley of 
 Lavedan, 3057 feet above the level of the sea, and more sheltered than Barfeges, is 
 much frequented by Spanish invalids. July and August are the best months, but 
 September is also good. There are some 32 sulphuretted saline springs, the tempera- 
 ture of the warmest being 122° F.
 
 MINERAL WATERS. 387 
 
 Some of the waters are very stimulatinc:, causing headache and fcverishness. They 
 ntain niirogen, sulp/inret of sodium, sulphnie of soda, chloride of sodium, si/irn, hari- 
 e, »&c. They are not to be used whcire there is any tendency to inflammatory 
 actions. The cases most benefited are clironic derangements of digestive organs, 
 •onic rhevmiatism and rheumatoid arthritis, chronic skin diseases, uterine conges- 
 'is or irritations, bronchial catarrli, tlie early stages of phthisis, and struiiu^us af- 
 'ions. The waters are often taken diluted in milk. 
 
 'he baths are especially valuable in rheumatic affections, scrofula, and obstinate 
 1 diseases. 
 
 474. Eaux-Bonnes, in the Pyrenees. 
 
 laux-Bonnes, a village in a sheltered valley at the foot of the Pic de Gers, is 22 
 es from Pau. The air is remarkably pure and fresh. The mineral waters, of 
 eh the supply is scanty, have been deemed efficacious in the early stages of tuber- 
 ir and other chronic diseases of the respiratory organs. They are likewise useful 
 crofula generally, in chlorosis, in dyspepsia from want of tone, and in amenorrhoea. 
 ! springs are slightly alkaline, and contain chloride of sodimn, sulphates of lime and 
 X, iodide of sodium, &c. Their temperature is about 90° F. The sulphurous waters 
 mildly stimulating; and are taken internally, and less frequently applied in the 
 n of baths. In the commencement only small doses (three ounces) should be 
 i\\, the quantity being gradually increased to three or four glasses of six ounces 
 1. While undergoing treatment the patient is encouraged to live as much in the 
 n air as his symptoms will permit. A residence of about a month, for one or two 
 ons (the season lasts from June to the middle of September) is generally deemed 
 icient. Afterwards a trip to Biarritz, for the enjoyment of sea-bathing, may 
 3n be taken with advantage. 
 
 475. Uaux-Chaudes, Pyrenees. 
 
 Mie position of this village, hemmed in by precipitous limestone cliffs, is wild 
 I secluded. It lies about 26 miles from Pau, and 4 from Eaux-Bonnes. The sea- 
 lasts from the beginning of July until the end of October. 
 
 )f the six springs some are used for baths, others as internal remedies. The hot- 
 , source is Le Clot (96)°; while L'Esquirette has the largest amount of salts. 
 3 waters contain sulphuret of sodium, sulphate of lime, and silica. ^ They deposit 
 i^uraire, a gelatinous substance probably consisting of confervas. Their taste is 
 igreeable, the smell of rotten eggs being powerful. 
 
 'he waters (two to six glasses early in the morning) and baths are useful in rheu- 
 tism and sciatica, in neuralgia, in threatened pulmonary disease, in scrofula, and 
 itonic dyspepsia. 
 
 476. Ussat, in the Pyrenees. 
 
 'he mineral baths of Ussat, in the Department of the Ariege, are 70 miles from 
 ilouse, the inhabitants of which city value them highly. They contain about 11 
 ins of solids 4o the pint, — chiefly sulphates and carbonates of lime and magnesia, and 
 )ride of sodium, with traces of arsenic. The waters belong to the acidulous ther- 
 l class; are not at all unpleasant; are soothing to the nervous system; and hence 
 pruve useful in hypochondriasis, hysteria, chorea, paralysis agitans, neuralgia, cramp, 
 muscular pains, dysmenorrhoea, irritable conditions of uterus, &c. Though some- 
 times taken internally, they are chiefly used as baths. The season lasts from June to 
 October. 
 
 477. Vernet les Bains, in the Eastern Pyrenees. 
 
 The little village of Yernet, 16 miles from Perpignan, is placed in a deep well- 
 sheltered valley. The waters belong to the thermal sulphurous class, but are only 
 feebly charged with solids — amongst others, sulphuret of sodium. 
 
 "Where a long course of weak sulphur waters is needed, these baths maybe resorted 
 to in the winter as well as in the summer months. Sunny walks may be had on most 
 days in winter. The waters are taken internally, and employed as warm and vapor 
 baths ; and this combination of drinking and bathing is thought efficacious in chronic 
 chest afl'ections.
 
 388 APPENDIX OF PORMUL^. 
 
 478. Panticosa, in Arragon. 
 
 This remarkable Spanish watering-place, 56 miles from Pau, is situated at a level 
 of 8500 feet above the sea. It is romantically placed in one of the little green valleys 
 of the Pyrenees; being surrounded by the lofty granite mountains, except at one 
 part through which flows the river Caldares. There are four springs; two being 
 saline, one sulphurous, and one ferruginous. The chief source is the Fuente del 
 HiGADO, which contains nitrogen in large quantity, with feeble proportions of sul- 
 phaie of soda, chloride of sodium, carbonate of lime, chloride of magnesium, and silica. 
 Its waters are agreeable, have a temperature of 81° P., and numerous gas bubbles 
 (owing to its free nitrogen) escape with it. 
 
 The waters taken internally increase the secretions of the kidneys and skin ; pro- 
 duce a sedative eUect on the system ; increase the appetite and general powers; and 
 in pulmonary cases, relieve the cough. They are particularly recommended in laryn- 
 geal phthisis, in hemorrhage from lungs or stomach or uterus, and in chronic irrita- 
 tion of the bronchial or intestinal mucous membranes. Where there is softened 
 tubercle, or much debility of system, they do harm. The best part of the season is 
 from the beginning of July to the end of August. 
 
 Bicarb, soda, grs. .37. .50 
 
 Carbonic acid gas, grs. 6.97 to each 16 ozs. 
 
 " 3909 
 
 5.91 
 
 " 3860 
 
 8.21 
 
 39.19 
 
 «' 804 " 
 
 » 37.57 
 
 « 6.71 " 
 
 « 36.99 
 
 « 20.92 
 
 479. Vichy, in Central France, 
 
 This important alkaline thermal bath is situated on the right bank of the Allier, 
 in a large open valley, surrounded by hills covered with vineyards. The air is tem- 
 perate and pure. The season lasts from the middle of May to the 15th September. 
 
 The springs used at Yichy for drinking and bathing are nine in number; the 
 waters of all being limpid, and having somewhat the taste of soda water. Bicarbonate 
 of soda and carbonic acid gas form the predominating ingredients ; but they also con- 
 tain small quantities of the bicarbonates of potash and magnesia, with the arseniate of 
 soda. There is also some barigi.ne, most abundant at the Source de I'Hopital. The 
 proportion of chief chemical components, in the sources generally resorted to, is shown 
 in the following table : 
 
 Grande Grille, 107.R° F. 
 
 Puits-Chnmel 109 6° 
 
 Fontaine del'Hopital, . . 89° 
 
 Fontaine des Celestins, . 58.6° 
 
 Grand Puits Carr6, . . . 110.5° 
 Puits d'Hauterive, . . . 59° 
 
 "Wherever the use of strongly alkaline waters is indicated, those of Vichy will 
 prove useful. They may be taken internally, or employed as baths ; or used in both 
 waj's at the same time. The diseases which derive most benefit, are, — pulmonary 
 catarrh ; debility and irritability of the digestive organs ; chronic enlargement of the 
 liver and spleen ; uric acid gravel and calculi ; vesical catarrh ; chfonic gout and 
 rheumatism; diabetes; and some cases of albuminuria. Obesity has been lessened 
 by these waters; and they might be employed with advantage where the blood con- 
 tains an excess of fibrine. — The dose is from half a pint to two pints daily ; but they 
 must not be continued too long, lest a super-alkaline condition of the blood be 
 induced. 
 
 The Vichy waters are exported in considerable quantities, and it is supposed with- 
 out their undergoing any deterioration. 
 
 480. 3Iont jy Or, in Central France. 
 
 At this bath there are six thermal sources and one cold spring. The water of the 
 latter, St. Marguerite, is acidulous from the carbonic acid it contains, has a tempera- 
 ture of 52° P., and is an agreeable drink mixed with milk or wine. The thermal 
 sources are Le Grand Baix (108° P.), the Source of C^.sar (113°), the Pountain 
 Caroline (107°), the Bain Eaymond (109°), the Eigny (109°), and the Madeleine 
 (ll4°). The ingredients in the different waters only vary in quantity; consisting of 
 the carbonates of soda and lime, chloride of sodium, sulphate of soda, with mere traces 
 of iron and alumina. They all contain an excess of carbonic acid. The Madeleine 
 spring is also strongly arsenical.
 
 MINERAL WATERS. 389 
 
 Besides drinkins^ the waters, most invalids employ warm batiiing. The effect is to 
 increase the perspiration ; and at the end of a few days to produce " the bath-fever" 
 (lassitude, depression, constipation, &c.), which soon passes oft". The invalids who 
 will derive benefit from a visit to Mont D'Or are such as have chronic pulmonary 
 catarrh, some kinds of asthma, rlununatistn, and conj^estion of the liver. Miscliief 
 will result to persons of a languid circulation, and such as have a tendency to hemor- 
 rhage. 
 
 The season is from the middle of July to the end of August; but the waters should 
 not be used for more than a fortnight, on account of their exciting properties. The 
 visitors who drink them, take three or four glasses daily. 
 
 481. Neris, in Central France. 
 
 The thermal springs of Neris are resorted to, from May until October, for the pur- 
 pose of drinking the waters, and bathing in them. There are four wells ; the tem- 
 perature of the waters at their source being about 120° F. They are insipid and oily ; 
 containing only small j)roj)ortions of carhotiic acid, bicarbonate of Sdda, sidpfiafe of 
 soda, and c/i/onde of sudiuin. Conferva? grow freely in the basins. These waters are 
 recommended in cases of nervous and hysterical excitement, in rheumatism, and 
 prurigo. 
 
 482. St. Gralmier, in Central France. 
 
 These waters, owing to their richness in carbonic acid gas, are agreeable whether 
 taken pure or mixed with wine; while thej' have the property of hastening diges- 
 tion, increasing the appetite, and augmenting absorption from the alimentary canal. 
 The chief salts in them are the bicarbvna.tes of lime and magnesia. 
 
 The St. Galmier waters are cold, and resemble Seltzer water. They are in common 
 use at Lyons ; being deemed useful in gastric aflectious, and for preventing the form- 
 ation of urinary calculi. 
 
 483. Aix-la- Chapelle, in Rhenish Prussia, 
 
 This handsome city, 40 miles W.S.W. of Cologne, is situated in a valley between 
 the Rhine and Maas rivers, and is surrounded by well-wooded hills. The<re are eight 
 principal springs, — six thermal and slightly sulphurous, and two cold chalybeate. Their 
 therapeutical etiects are due to the high temperature of the water (varying from 111° 
 to 131" F.), and the sidpfmr and chloride of sodium contained in it. The latter salt is 
 found in the proportion of about 20 grains to the 16 ounces: while the sulphuret of 
 sodium varies from three-quarters to a quarter of a grain. — The chalybeate springs are 
 sometimes emploj'ed as an "after-cure;" but they have little power, one containing 
 half, and the other three-quarters of a grain of iron in the sixteen ounces, with some 
 carbonic acid. 
 
 In doses of a few glasses these clear transparent waters produce hut little apprecia- 
 ble effect ; their chief use being externally, — as vapor baths, douches, shampooing, &c. 
 They have considerable reputation for curing scrofula, skin diseases, ulcers, and gun- 
 shot wounds. — The season begins in June and ends about the middle of September. 
 
 484. Kreuznach, in Rhenish Prussia. 
 
 The rather nauseous and bitter waters of this Spa have a considerable reputation 
 for the cure of uterine diseases, as well as of most scrofulous afiections. The chief 
 waters are those of the Elizabeth Brunnen, having a temperature of 54.50^ F. 
 They contain about 90 grains of solid constituents in 16 ounces ; chiefly, — chloride of 
 sodium, {IZ), chloride of calcium (13J, chloride of magnesium (4), bromide of magnesium 
 {^), oxide of iron (^), with a trace of iodide of magnesium, &c. The Karlshalleb 
 WATER has a temperature of 59'', and 75 grains of salts in the sixteen ounces; the 
 Theodorshalle, 70.25°, and 87 grains; while for the chief well of Munster the 
 numbers are 81. 50*^, with from 64 to 76 grains. 
 
 In drinking the water it is better to begin with small quantities, which may be
 
 390 APPENDIX OF FORMULA. 
 
 drunk pure or mixed with hot milk. The baths are generally taken tepid; "mother- 
 lye" (the brownish or glutinous liquid left in the boiling pans, after the salt has been 
 crystallized and removed) being added to the water, in proportions suitable to the re- 
 quirements of each case. In uterine atiections, fomentations and vaginal injections 
 are employed in addition to the baths. 
 
 The Kreuznach waters have proved valuable in congestions of the uterine organs ; 
 as well as in chronic inflammatory affections of these parts, in hypertrophy and indur- 
 ation, in uterine displacements, and in derangements of the menstrual functions. 
 Dr. Prieger, who has had very great experience in the use of these waters, tells the 
 author that he has never seen a true fibroid tumor of the uterus absorbed through 
 their influence ; but when such a growth is cedematous or congested, the waters re- 
 lieve these complications. 
 
 The season extends from the end of April until the beginning of October. The 
 stay which a patient should make may vary from six to eight weeks. 
 
 The springs of Nauheim, a village of Hessen-Cassel, resemble those of Kreuznach, 
 except that they contain rather more chloride of sodium, only a trace of bromide of 
 magnesium, and none of the iodide of magnesium. There is also an abundance of 
 carbonic acid ; and the temperature of the four chief springs varies from 72° to 92° F. 
 The waters are drunk and used as baths ; while like those of Kreuznach, they are re- 
 commended for all strumous affections. 
 
 485. NeuenaJir^ in Hhenish Prussia. 
 
 This village, in the valley of the Ahr, is easily reached from Cologne. Of the 
 springs, the Victoria is the best. Mr. Miller, the late Professor of Surgery in the 
 University of Edinburgh, says that it is the richest of all known brunnens in carbonic 
 acid. It furnishes some 29,792 cubic feet of water daily ; an analysis of which has 
 shown the presence of small quantities of bicarbonate of soda, sulphate of soda, chloride 
 of sodium, bicarbonate of magnesia, bicarbonate of lime, protoxide of iron and alumina, 
 silica, and free carbonic acid. 
 
 The waters are taken internally and applied externally. The dose is from two to 
 five tumblerfuls, early in the morning ; with half the quantity in the evening. The 
 temperature of the water is between 78° and 80° F. ; and the taste is pungent and 
 pleasant, resembling — as an English valet said — "Seltzer water with the chill off." 
 The best time for the bath is two or three hours after breakfast ; the temperature of 
 the water being about 88° F., and the time for remaining in it twenty minutes. 
 When the invalid is acclimatized, the douche may be used if needful. 
 
 The waters are tonic and anti-rheumatic ; acting especially on the mucous mem- 
 branes and the glandular system. They are useful in simple dyspepsia, diminished 
 secretion of bile, irritability of bladder with excess of uric acid in the urine, chronic 
 gout and rfieumatism, asthma uncomplicated with organic disease, chronic aflections 
 of larynx or bronchi, eczema and prurigo, and chronic uterine maladies. — In a person 
 apparently healthy Dr. Weidgen found that the use of the waters was followed by 
 these eflects : A sense of warmth in the stomach soon after drinking ; exhilaration ; 
 increased flow of urine; increased appetite; and increased salivary and bronchial se- 
 cretions. After a week the bowels were affected ; copious, soft, bilious evacuations 
 being produced. The urine became neutral, but never alkaline. 
 
 486. JEms, Duchy of Nassau, 
 
 Ems, or Bad-Ems (as the Spa is called, to distinguish it from the village), lies on 
 the right bank of the sluggish Lahn, inclosed in a narrow valley between high moun- 
 tains, 16 miles N. of Wiesbaden, — There are several springs. The waters are alka- 
 line, saline, and gaseous; while the temperature varies from 86° F. to 133'^. The chief 
 constituents are bicarbonate of soda, chloride of sodium, and bicarbonate of magnesia; 
 with small quantities of iron, manganese, potash, and lithia. Their action is that of a 
 mild alterative, diuretic, and laxative ; and they are believed to favorably influence all 
 catarrhal aflections of the mucous membranes. 
 
 The principal drinking springs are the Kkanciienbrunnen and the Kesselbrun- 
 NEN. The waters of the former are clear, odorless, have a temperature of 91* F.,
 
 MINERAL WATERS. 391 
 
 and leave a soapy taste owing to the soda they contain. According to Struve each 
 10 ounces contains 15^ cubic inches of free carbonic acid gas. The Kesselbrunnen 
 or Knrbrunnun waters give out more carbonic acid gas, and are 118" F. The dose 
 is from one to six beakers, each liolding about 4 oz. In many cases it is an improve- 
 ment to add one-third part of goats' or asses' milk to the measure. 
 
 The waters are also employed externally, the baths being partly filled over-night 
 to lower the temperature. The Bubenquelle (boy's spring), 117° F., is used as a 
 vaginal douche, and is in repute for the cure of sterility. 
 
 The waters generally are rcicommended in bronchial and pulmonary affections, and 
 in the dyspepsia of such as have only a tendency to phthisis. For the relief of the 
 lithic acid diathesis they are valuable, but less so than those of Vichy. For drink- 
 ing and bathing, French and German visitors usually resort to Ems in June. Our 
 own countrj'inen, however, seem to prefer July and August; though the narrowness 
 of the valley in which this bath is situated causes the air to be very oijpressive and 
 relaxing during these months. 
 
 The mineral springs of FAcniNGEN, a village 9 miles E.N.E. of Nassau, on the 
 Lahn, resemble those of Ems, the salts being present in rather smaller proportions. 
 The waters form an agreeable antacid drink in some forms of dyspepsia. 
 
 487. Sellers, in Nassau. 
 
 This village, in a pleasant valley 37 miles N. of Wiesbaden, is everywhere famous 
 for its mineral springs ; an enormous quantity of Seltzer water being annually ex- 
 ported. 
 
 The water has a temperature of 60" F., and contains much more than its volume 
 of carbonic acid gas. It has about 32 grains of solids in the sixteen ounces ; chiefly 
 chloride of sodium (18), and carbonate of soda (9), with minute quantities of suljihate 
 of soda, lime, magnesia, and iron. Seltzer water stimulates the stomach ; and is a 
 grateful, antacid, slightly alterative drink. 
 
 488. Schwalhach and Scldangenhad, in Nassau. 
 
 ScHWALBACH Or Langensch WALBACH, 8 miles N.W. of Wiesbaden, consists of 
 one long street, in the middle of which is the Kursaal. The gaseous chalybeate wa- 
 ters, with a temperature of 50" F., owe their invigorating properties to carbonate of 
 iron, which is held in solution by an excess of carbonic acid. They also contain a 
 small amount of the bicarbonates of soda, magnesia, and li7ne. The chief springs are — 
 the Weinbrunnen, near the Kursaal, which contains most iron, and is belie s'ed to 
 counteract the evils arising from excessive indulgence in wine ; the Paulixenbkun- 
 NEN, the mildest, which is used by invalids from tropical climates with torpid livers ; 
 the KosENBRUNNEN, Only employed externalh', the baths being heated by steam to 
 86" ; and the Stahlbrunnen, in the northern valley, which is the most exciting of 
 the springs. The waters are drunk fasting, to the amount of one to three glasses ; 
 and they may be strongly recommended in cases of impaired strength where a ferru- 
 ginous tonic is indicated. The bath should be taken about two hours after breakfast, 
 omitting its use every third or fourth day. The best time for a visit to Schwalhach 
 is from the middle of June until the end of August. 
 
 Eather more than 2 miles from Schwalhach, in a pleasant valley, with romantic 
 environs, is Schlangenbad. The climate is pure and bracing ; but as a Spa it is of 
 insignificant value, owing to the small amount of solid constituents — only a few 
 grains of carbonate of soda, lime, and magnesia, with commo7i salt — in the waters. 
 W^arm saline and mud baths are used by the visitors; such amusements being in re- 
 pute for softening and whitening ("satinizing") the skin, and for allaying nervous 
 irritability. 
 
 489. Wiesbaden, in Nassau. 
 
 Wiesbaden, the capital of the Duchy of Nassau, lies on the southern slope of the 
 Taunus mountain, 5 miles N.N.W. of Mayence. It is the most frequented of the 
 watering-places in Germany. The season extends from June until September, but 
 it is very hot in July and August. Owing to the shelter aftbrded by the sevei'al 
 peaks of the Taunus, the autumnal and winter climate is good. 
 
 There are some eighteen or twenty thermal springs, but only one is of much im- 
 portance. This, the Kochbrunnen, appears literally to resemble a boiling well. 
 The temperature reaches IGO" F., volumes of vapor are emitted, and the water con-
 
 392 APPENDIX OF FORMULA. 
 
 tains somo 63 grains of solids in the sixteen ounces. The salts are chloride of sodium 
 (52^) ; with small quantities of poiash, lime, iron, magnesia, arseniate of lime, bi'omide 
 of magnesiutn, &c. The carbonic acid gas is one-fifth of the bulk of the water. Dr. 
 Granville compares the taste to that of weak chicken-broth slightly salted. Taken 
 in a dose of three or four glasses, cooled, before breakfast, it has a sliglitly laxative 
 effect, and increases the appetite. As baths, at a temperature varying from 86® to 
 98", about two hours after a light breakfast, the waters are somewhat soothing, while 
 they increase the action of the skin and kidneys. 
 
 The cases in which these waters are likely to prove valuable, are chronic gout and 
 rheumatism, hepatic congestion with haemorrhoids, and chronic skin disease con- 
 nected with abdominal plethora. They will be injurious in debility, in congestion of 
 the uterine organs, or where there is a tendency to apoplexy or any other form of 
 hemorrhage. The invalid maj- know that they disagree, when prostration, loss of 
 appetite, constipation, irritability, and palpitations are produced. 
 
 490. Soden, in Nassau. 
 
 The waters of Soden,in the Taunus near Frankfort, are saline and gaseous, issuing 
 from twenty-three springs, scattered through the village. Their temperature varies 
 from 64° to 75<^ F. 
 
 The most important springs are, — the Milchbkunnen containing 23 grains of 
 solids in the sixteen ounces; 17 grains being chloride of sodium, 8 chloride of potas- 
 sium, with 17 cubic inches of carbonic acid gas. The "VVarmbrunnen has 35 grains 
 of solids, 26 of which are chloride of sodium ; the carbonic acid gas being 35 cubic 
 inches. The Wilhelmsbruknen has 117 grains of salts, 104 being chloride of so- 
 dium, with 48 cubic inches of gas. Whilst "the Soolbri^nen has 129 grains, 114 of 
 which consists of the same salt that predominates in the others, together with 14 
 cubic inches of gas. — Where alterative aperients are needed, these waters may per- 
 haps be recommended. They are deemed useful in pulmonary, strumous, gouty, and 
 uterine aflections. 
 
 One advantage possessed by Soden is the presence of the two ferruginous springs of 
 Kroxthal ; so that the visitor having employed the alteratives of the first !Spa, may 
 strengthen the system with the mild chalybeates of the Stahlquelle or Wilhelms- 
 quelle. The climate of Xronthal is useful in chronic bronchial affections. 
 
 491. Somburg, in Nassau. 
 
 The air of Homburg is invigorating and bracing during the months of June, July, 
 and August; but it is injurious to such as have delicate lungs, owing to the tempera- 
 ture being very variable. There are four cold (about 50° F.) muriated mineral 
 springs. The most frequented is the Elizabkthquelle, containing about 110 grains 
 of salts in the 16 ounces, and being strongly charged with carbonic acid (48 cubic 
 inches). The chief salts are chloride of sodium (79), the chlorides of magtiesium and 
 calcium (15), and carbonate of Zwne (11); with small quantities of carbonate of mag- 
 nesia, sulphate of soda, carbo7iate of iron, and silica. The Kaiserquelle has more 
 chloride of sodium. (117), more chloride of calcium, and a little more iron. The Stahl- 
 quelle has the same amount of common salt as the Elizabeth spring, but is more 
 ferruginous than either of the others. While the Ludwigsquelle is weak in al- 
 most all its constituents. The flavor of all the waters is refreshing, saltish, somewhat 
 bitter, and ferruginous. 
 
 Gout, dyspeptic and other derangements of the abdominal viscera, strumous en- 
 largements of the external glands and mesentery, debility of the reproductive organs, 
 constipation, obesity, and hypochondriasis, are the diseases most likely to be benefited. 
 From two to four tumblerfuls of the waters are taken fasting during three or four 
 weeks. Though chiefly used internally, there are baths, douches, &c. 
 
 492. Baden-Baden.) in Grand Ducky of Baden. 
 
 This renowned Spa, in one of the most delightful valleys of the Black Forest, about 
 six miles from the Khine, has 16 weak saline springs, the temperature of which varies 
 from 117° to 161° F. The chief spring, and the only one demanding notice, is the
 
 MINERAL WATERS. 393 
 
 Ursprung ; which has a transparent, inodorous saltish water. Its chemical constitu- 
 ents are merely about 23 ejrains to the IG ouiic<-s, 18 t^rains beint? c/doride of sodium. 
 There are also 2i grains of Hnlphale of lime, about 1-lOth of a j^rain of carbonate of 
 iron, with less than half a cubic incli of carbonic acid. Keeent analyses have shown 
 the presence; of lHhia, in greater abundance than in any other springs. 
 
 Though their efficacy must be slight these waters are often taken internally. Some 
 drinkers udd goat's mi'lk to them, or whey, or aperient salts. But they are chiefly to 
 be employed where simple hot baths are needed, while the invalid is enjoying beauti- 
 ful scenery, in ]iure mild air. They may be recommended in chronic gout and rheu- 
 matism. The season Ihsts from the beginning of May until the 1st October. 
 
 The waters of Wildbad, some thirty miles from Baden-Baden, and situated in the 
 kingdom of Wiirtemburg, contain only four grains of salts in the 1(5 ounces, and have 
 a temperature varying from 86° to 98° F. Where hot baths and douches are needed 
 in chronic paralysis, rheumatism, «&c., a six weeks' sojourn at Wildbad may perhaps 
 be recommended. The climate is very bleak from November until May; and then 
 in the four succeeding fashionable months the heat is most oppressive. 
 
 493. Kissingen, in Bavaria. 
 
 Kissingen, one of the most fashionable watering-places of Germany, is situated in 
 a fertile valley, about 30 miles N.N.E. of Wlirtzburg. — The tonic, laxative, and 
 alterative waters are all cold (about 52° F.). The most important spring is the Rag- 
 OCZY, containing 65 grains of solids in the 16 ounces, according to Liebig, with 41 
 cubic inches of carbonic acid gas. The principal salts are chloride of sodium (45), car- 
 bonate of lime (8), sidphaie of magnesia (4), chlorides of potassium and magnesium (5), 
 with minute quantities of chloride of lithium, bromide and iodide of sodium, and carbon- 
 ate of iron. The waters of the Pandurbrunnen have rather a smaller amount of 
 solids ; while those of the Maxbrunnen and of the Theresienbrunnen are very 
 much weaker, and contain no iron. 
 
 The Kagoczy spring is most used early in the morning, from three to six glasses 
 being taken. In the evening the milder waters of the Pandur are preferred. The 
 efiect is to quicken the circulation, and to stimulate the secretions of the mucous 
 membranes generally but especially those of the alimentary canal. Hence they are 
 valuable in habitual constipation, congestion of the liver or kidneys, in dyspeptic 
 eructations or flatulence, and in tubercular diseases of the mesenteric glands. Gouty 
 and calculous cases also derive benefit. 
 
 The baths are prepared from the waters of the wells just named, some of the 
 " mother- water" of the Soolensprudel being frequently added. This spring has a 
 temperature of 62° F. ; and contains 187 grains of solids in the 16 ounces, upwards of 
 100 consisting of chloride of sodium. The astonishing flux and reflux of the Sprudel 
 is one of the sights of the town. 
 
 About A\ miles from Kissingen is the Spa of Bocklet, in Bavaria, which contains 
 several chalybeate and a weak sulphur si»ririg. The temperature of the waters is 
 about 52° F. ; while there is rather more than half a grain of carbonate of iron in the 
 16 ounce^ with 39 cubic inches of carbonic acid gas. They also contain a small amount 
 of the sulphates of soda and magnesia, chloride of sodium., carbonate of lime, &c. Inde- 
 pendently of the constant interchange of visitors between Kissingen and Bocklet, the 
 baths of the latter (especially the "douche ascendante") have a considerable reputa- 
 tion for the cure of sterility, and for breaking oft' the tendency to habitual abortion. 
 
 Bruckenatj, in Bavaria, is also only a few hours' drive from Kissingen. The 
 waters contain scarcely any salts, but have about a quarter of a grain of iro7i in the 
 16 ounces, with at least 35j cubic inches of carbonic acid gas. Their temperature is 
 49° F. They are often employed by those who, after going through a course of the 
 solvent waters of Kissingen, require a pure mild tonic.
 
 394 APPENDIX OF FORMULA. 
 
 494. Gastein, in Austria. 
 
 A few hours' drive, from Salzturg is the village of Gastein, in the most beautiful 
 part of the Tyrol. It is one of the highest baths in Europe, being 3200 feet above the 
 Mediterranean. The houses are grouped round the edge of the mountain torrent 
 Ache, which here forms a splendid waterfall. The bracing alpine air is invigorating 
 for such as have strong lungs, but the climate is often too raw and unsettled for the 
 delicate invalid to depend upon it. Mean annual temperature 47° F. 
 
 There are six or eight very weak thermal springs, having the same chemical com- 
 position, but varying m temperature from 95° to 118° F. In 16 ounces of water there 
 are only 2.08 grs. of solids, sulphate of soda being the chief (1.51). The waters, after 
 cooling to about 90°, are used as baths, and are said to stimulate the nervous system. 
 It seems certain that the prematurely old, the hypochondriac, the paralytic, and the 
 sufferer from chronic rheumatism derive benefit. 
 
 The waters of Teplitz, in Bohemia, very much resemble those of Gastein, as re- 
 gards temperature and chemical power. They contain only about 4.64 grains of 
 solids in the 16 oz. ; the carbonates of soda and lime, with sulj^hate of soda being the 
 chief ingredients. The baths are used in gouty and paralytic affections. 
 
 495. Friedrichshall, in Saxe-Meiningen. 
 
 This place has long been noted for the manufacture of Glauber's salts and common 
 salt. Of late years the waters have acquired a high reputation, especially for cases 
 where it is necessary to promote excretion from the liver, kidneys, and bowels. 
 
 The bitter saline water of Friedrichshall contains about 194 grs. of solids in the 16 
 ounces, with 5.32 cubic inches of carbonic acid gas. The chief ingredients are chlo- 
 ride of sodimn (61), sulphate of soda (46), sulphate of 'magnesia (39), chloride of 7nag- 
 nesium (30), sulphate of lime (10), with small proportions of sulphate of potash, car- 
 bonate of magnesia, bromide of inagnesiu^n, carbonate of lime, and silica. — The dose is 
 from three ounces to a pint or a pint and a half, according to the aperient effect 
 required. 
 
 496. Carlsbad, in Bohemia. 
 
 This town occupies the bottom of a narrow winding valley, on the banks of the 
 Topel, 70 miles W.N.W. of Prague. The season extends from the beginning of 
 June until the end of September ; but the month of May is very quiet, pleasant, and 
 healthy. The " cure" generally occupies from five to six weeks. 
 
 There are several important springs, chiefly differing from each other only in tem- 
 perature. The most important is the Sprudel ; the waters of which bound upwards 
 for four or five feet, and then fall back in foam while giving off clouds of vapor. 
 The temperature is about 165" F., and there are some 45 grs. of solids in the 16 oz. 
 The principal salts arc sulphate of soda (20), carbonate of soda (9), chloride of sodium 
 (8), and carbonate of lime (2); with small quantities of sulphate of potash, carbonate 
 of iron, phosphate of alunmia, and silica. The carbonic acid gas is nearly 8 cubic 
 inches. — The Schlossbrunnen contain only half the amount of sulphate of soda, 
 double the quantity of carbonic acid gas, and have a temperature of 113". The heat 
 of the waters of the Theresienbrunnen is 131", and as regards important ingre- 
 dients may be said to resemble the Schlossbrunnen. The Marktbrunnen differ 
 from the others principally in containing a little iodide and bromide of sodium. 
 
 T)ie waters are chiefly taken internally, early in the morning and again in the 
 evening. The dose varies from one or two glasses to ten or twelve ; according to the 
 stimulating and alterative effect on the digestive organs and abdominal viscera gen- 
 erally, which it is desirable to produce. The cases most benefited are, — liver and ab- 
 dominal diseases, diabetes, gouty and rheumatic disorders, calculous afl'ections, and 
 hypochondriasis with dyspepsia and constipation. Old Indians, with enlarged livers, 
 often derive remarkable relief. Baths of the cooled mineral water are now but sel-
 
 MINEKAL WATERS. 395 
 
 dom resorted to, though for one hundred and fifty years invalids only visited Carls- 
 bad for the purpose of butliiiig. Sometimes the jieat soil from tlie neighborhood, 
 mixed with Sprudel water, is used as a poultice, &c. 
 
 497. Marienhad, in Bohemia. 
 
 Maricnhad, in tlio territory of the Abbey of Tepl and the district of Eger in Bo- 
 hemia, is about five hours' drive from Carlsbad. The air is pure and dry, but changes 
 in temperature take ))lace rajiidly owing to the height of the village — 1912 feet above 
 the level of the North Sea. The season lasts from the commencement of May until 
 the end of September. 
 
 There are several cold (from 43° to 50® F.) saline chalybeate springs: the chief 
 constituent being sulphate of soda, with a moderate quantity of iron and carbonic 
 acid. The waters when drawn are quite clear, but as the gas escajies they become 
 turbid from deposition of tlie carbonates. The Krkuzbrxtnn has G9 grains of solids 
 in the 16 oz., with 8^ cubic inches of carbonic acid gas. The principal salts are sul- 
 phate of soda (38), chloride of sodium (13), carbonate of soda (9), and carbonate of mag- 
 nesia (3) ; with small quantities of the carbonates of lime, lithia, iron, manganese, &c. 
 The Fekdinandsbrunn has nearly the same solid ingredients, but with nearly 14 cubic 
 inches of carbonic acid gas. The Waldbrunn is much Aveaker in sulphate of soda 
 (7), and common salt (3), but its proportion of carbonic acidgasis 18f cubic inches. The 
 waters of these brunnen are all used for drinking. The Carolinenbrunn has only 
 11 grs. of solids in the 16 oz., sulphate of soda being the chief; but there are 15^ cu- 
 bic inches of carbtmlc acid gas. The Ambrosiusbrunn is still weaker (7 grs. in 16 
 oz.), with 13 inches of gas; while the Marienbrunn has scarcely any salts (2 grs. 
 in 16 oz.), with 9 cubic inches of carbonic acid gas. The well of the JVlarienbrunn is 
 used only for water and gas baths ; but the Caroline and Ambrosius waters are em- 
 ployed internally and externally. 
 
 The etfect of the Marienbad waters is laxative, alterative, and tonic, in proportion 
 to the dose (from one to six tumblerfuls) ; while they increase the action of the liver 
 and kidneys, and promote appetite. Hence they are particularly valuable in chronic 
 disorders of the abdominal viscera. The mud baths and poultices are made with the 
 Mailenbad Avater mixed with a black mineral pulverulent substance, brought from a 
 neighboring peat-bed. They stimulate the skin, heal chronic ulcers, and disperse 
 glandular swellings. The gas baths (carbonic acid with a small amount of sulphur- 
 etted hydrogen) soothe muscular and neuralgic pains, remove torpor of the female 
 sexual organs, and generally tranquillize the nervous system. 
 
 The bitter saline waters of Ptjllna, in Bohemia, are very nauseous and indigesti- 
 ble, while they possess no advantages over the ordinary preparations sold by the 
 chemist. Their chief ingredients are sulphate of soda (124 grains in the 16 oz.), sul- 
 phate of magnesia (93), chloride of magnesium (16), carbonate of magnesia (6), with 
 sulphates of lime and j^otash. 
 
 498. Uger, in Bohemia. 
 
 This frontier town stands on the right bank of the Eger, 92 miles W. of Prague. 
 In the district, some three miles oft" is the Spa of Fkanzensbad. The tonic solvent 
 waters of this spring have a refreshing acidulous taste, a temperature of 52" F., with 
 42 grs. of solids in the 16 oz. The chief of these are siclphate of soda (24), chloride 
 of sodium (9), and carbonate of soda (9) ; together with the carbonates of magnesia, 
 lime, iron, lithia, manganese, and strontia, and 40 cubic inches of carbonic acid gas. 
 
 The waters of the Franzensbad and other wells are taken internally and employed 
 as baths. They strengthen the nervous system, improve digestion, stimulate the circu- 
 lation, relieve bronchial affections, and act powerfully on the uterine organs. Mud 
 and gas baths are likewise employed ; the black mud containing iron, soda, lime, 
 alumina, and ulmic acid. They are perhaps beneficial in old rheumatic atfections, 
 gouty deposits, and in paralysis without active disease of the nervous centres. The 
 gas baths are considered as specifics for the cure of scrofulous ulcers. 
 
 499. Aix-les- Bains, in Savoy. 
 
 This beautiful and sheltered town, 768 feet above the sea, may be reached by railway 
 from Paris in about fifteen hours. The climate is mild but yet bracing, and is espe-
 
 396 APPENDIX OF FORMULA. 
 
 cially adapted to invalids from April until October. There are two chief springs ; but 
 as thev are only slightly mineralized, the eftects which they produce must chiefly be 
 due to their temperature, — about 116° F. The Sulphur Spring contains but little 
 more than three grains of salts in the sixteen ounces, with a small quantity of carbonic 
 acid and sulphuretted hyd^-ogen gas. The Alum-Spring, so called on the lucus d, non 
 lucendo principle, since it contains no alum appreciable to the senses, has the same 
 composition, minus the sulphuretted hydrogen. 
 
 The waters are chiefly used externally, and especially in the form of douches. They 
 are valuable in chronic rheumatism, sciatica, rigidity of tendons or muscles after 
 sprains and contusions, chronic skin aflections, diseases of the bones, nervous disor- 
 ders, &c. 
 
 500. Batlis of Switzerland. 
 
 Leuk or LouECHE, on the Khone, stands a little to the left of the high road passing 
 through the Vallais to the Simplon, and is nearly 501.0 feet above the sea. There are 
 twenty-three thermal mineral springs, varj'ing in temperature from 95° to 124° F. 
 The latter is the heat of the St. Laurent or Lorenzquelle. All the waters have the 
 same composition, the solid constituents being about fifteen grains in the sixteen 
 ounces. The chief salt is the sulphate of lime (nearly 13), with small quantities of 
 the sulphates of magnesia and soda, <fcc. It is the custom to bathe in common ; there 
 being four public piscina, each about a yard deep, and each capable of accommodating 
 some forty bathers, with their small floating tables. On the first daj' the patient 
 remains an hour in the water, clothed in a long flannel gown; the duration being 
 daily increased till it extends to four or five hours in the morning, and for a shorter 
 period again in the afternoon. About the twelfth day, an erythematous rash called 
 the poicssee appears over the body, with prickling sensations of heat, and febrile symp- 
 toms ; its disappearance being followed by desquamation of the cuticle. The duration 
 of the bath is then gradually diminished by half an hour daily, until the cure is com- 
 plete in some twenty-five or thirty days from the commencement. This peculiar 
 practice is recommended in cases of scrofula, enlargements of the liver or spleen, 
 chronic gout and rheumatism, obstinate eczema and psoriasis, old wounds and ulcers, 
 calculous affections, &c. The season is from May until October. 
 
 Pfafers, in the Canton of St. Gallen in the Orisons, is in a wild and sombre dell. 
 The thermal water is conducted down the romantic glen of the Tamina by wooden 
 tubes, to the hotel and bathing-house at Kagatz, in the valley of the Rhine. The 
 salts in the waters are scarcely equal to three grains in the sixteen ounces ; the chief 
 being the sulphates of soda and lime, with carboiiate of lime. The temperature is nearly 
 10d° F. The bath is used twice a day, for about an hour each time ; and is useful in 
 calming nervous irritability, and in relieving neuralgia, hysteria, &c. The waters 
 are also used for drinking, — from four to eight tumblerfuls. The invalid should be 
 advised to reside at Kagatz rather than at Pfafers. 
 
 Tarasp, on the right shore of the Inn in the Orisons, has cold gaseous springs, 
 somewhat resembling those of Marienbad. There are numerous wells, having their 
 source in a rocky hollow, some 4300 feet above the sea. The chief are the Grosse 
 Quelle and the Kleine Quelle, their composition being similar, and their temperature 
 45° F. Their salts (95 grs. in the 16 oz.) consist of chloride of sodium (29), carbonate 
 of soda (27), sulphate of soda (16), and carbonate of lime (12) ; with small quantities of 
 the carbonates of magnesia and (?-on, iodide of sodium, sidphate of potash, &c. The car- 
 bonic acid gas is 32 cubic inches. These aperient and resolvent waters are useful in 
 plethora of the abdominal viscera, and in incipient phthisis. 
 
 Baden, a few miles from Zurich, on the left bank of the Limmat, has several ther- 
 mal gaseous springs. The temperature of the waters ranges from 117° to 122° F., 
 and the salts are in the proportion of thirty-four grains to the sixteen ounces. The 
 principal are, chloride of sodium (13), sulphate of lime (10), smaller quantities of the 
 carbonates of iitne and of magnesia and of stroniia, sulphate of soda, and the chlorides 
 of potassium and magncnum, &c. There are 22 cubic inches of carbonic acid gas, 125 
 of nitrogen, and an odor of sulphuretted hydrogen. The action of these waters is chiefly 
 diuretic and constipating. They are recommended in gouty and rheumatic diseases, 
 in chronic diarrluea with congestion of the bowels, and in incipient phthisis. They 
 are used internally, and externally as baths and douches. The climate of Baden being 
 mild, invalids often remain throughout the winter.
 
 MINERAL WATERS. 397 
 
 BiRMENSDORF has hittor purgative wntors rosr mbliHf( those of Pullna. They are 
 cold (40*^ F.), hav(! only traces of carbonic acid <^as, and their solid constituents 
 slightly exceed five grains in the sixteen ounces. They are used principally for ex- 
 portation. 
 
 ScHTNZNACH, in the canton of Aargau, in a valley through which flows the Aar, 
 five miles from Baden, is well known for its saline sulphurous thermal spring. The 
 temperature of the waters is about 94" F., the solid constituents being nearly twenty- 
 five grains in the sixteen ounces, with 1^ cubic inches of carbonic acid (fa/i, and (5^ of 
 sulphuretted hydrogen. The chief salts are, sulfliate of .soda ((ij), su/p/iate of lime (7), 
 and chloride of sodium (5) ; with smaller quantities oi milphdie of maynesia, chloride of 
 7nagnesi,u7n, and carbonate of lime. The invalids both drink and bathe; the baths 
 being used for twenty minutes at first, and afterwards for a longer time if necessary. 
 The poussSe is milder but appears more quickly than at Leuk. The waters have a 
 reputation for relieving strumous and rheumatic afi'ections, for curing skin diseases, 
 and for healing callous spongy ulcers. The season lasts from the middle of May to the 
 end of September.
 
 Septembku, 18tO. 
 
 C^TA.LOGXJE 
 
 OF 
 
 WORKS ON MEDICL\E, SURGERY, DENTISTRY, 
 AND THE COLLATERAL SCIENCES. 
 
 PUBT.ISHET3 BY 
 
 LINDSAY & BLAKISTON, PHILADELPHIA. 
 
 C C) N T E N T S. 
 
 Lindsay & Blakiston's Vistttng List for 1871, see reduction in prices. 
 
 Tanner's Practice op Medicine, 5th American Edition (Just Ready.) 
 Reprinted from the 6th Enlartred and Improved London Edition. 
 
 Meigs and Pepper's Practical Treatise on Diseases of Children, the 
 Fourth Edition, very much enlarGred. 
 
 Cazeaux's Great Work on Obstetrics, the most complete Text-Book 
 on the subject now published. 
 
 Aitken's Practice, from the 5th enlarged London Edition, with additions 
 by Dr. Clymer equal to 500 pages of the English copy, made with 
 special reference to the wants of the American Practitioner. 
 
 Trousseau's Clinical Medicine, 3 volumes (the third volume just ready.) 
 Price reduced. 
 
 Works by Lionel S. Beale, F.R.S., Prices reduced. 
 
 New Books Just Ready and in Preparation. 
 
 Alphabetical List of Lindsay & Blakiston's Medical Publications, with 
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 Condensed List op Lindsay & Blakiston's Publications. 
 
 LINDSAY & BLAKISTON, in issuing a revised Catalogue of their Medical 
 Piililications, desire to call the attention of the Profession to the reduction they have 
 made in the price of their Visiting List for 1871. This little work having become 
 an almost indispensable companion to the Practising Physician, they wish to extend 
 as far as possible its usefulness by keeping the price down as low as the increased cost 
 of manufacture will permit. They have also, in order to meet to some extent the 
 demand for lower prices, reduced the price of Dr. Beale's books of Trousseau's 
 Clinical Medicine, the 3d volume of which has just been issued, and of many other 
 books in their Catalogue, and also their rates for the importation of Foreign Books 
 and Periodicals. 
 
 gf^°* Orders for any Medical Books, whether published in the United States or 
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 lowest prices.
 
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 PHYSICIAN'S VISITING LIST. 
 
 NOW READY FOR 1871. 
 
 "The simplest of all the visiting lists published, it must continue to hold, what it 
 now has, the preference over all other forms of this indispensable companion for the 
 Physician." — New York Med. Journal. 
 
 oonsTTEiNrTS. 
 
 1. Table of Signs, or Guide for Registering Visits, En- 
 
 g-agemente, &c. 
 
 2. An Alnijxnac for 1868. 
 
 3. Mar!?hall Hall's Ready Method in Asphyxia. 
 
 4. Poisons and their Antidotes. 
 
 5. Table for Calculating the Period of TJtero-Oestation. 
 
 6. The Visiting List arranged for 25, 60, 75, or 100 
 
 Patients. 
 
 7. Memoranda pages for every month in the year. 
 
 8. Pages for Addresses of Patients, kc. 
 
 9. " Bills and Accounts asked for and de- 
 
 livered. 
 
 10. " Obstetric Engagements. 
 
 11. " Vaccination. 
 
 12. " Recording Obstetric Cases, Deaths, and 
 
 for General Memoranda. 
 
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 For 25 Patients weekly. Tucks, pockets, and pencil, 
 
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 For 25 Patients weekly, interleaved, tucks, pockets etc., . . . . Si 50 
 60 " " " " " " . . ■ . . 1 75 
 
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 This Visiting List has now been published for Twenty Years, and has 
 met with such uniform and hearty approval from the Profession, that the 
 demand for it has steadily increased from year to year. 
 
 The Publi.'^hers, in order to still further extend its circulation and useful- 
 ness, and to keep up the reputation which it has so long retained, of being 
 
 THE CHEAPEST AND BEST, 
 
 as well as the Oldest Visiting List published, have now made a very 
 considerable reduction in the price. 
 
 It can be procured from the principal booksellers in any of the larr/p. 
 cities of the United States and Canada, or copies will be forwarded l)y mail, 
 free of postage, by the Pul)lishers, upon receipt by them of the retail price 
 as annexed. 
 
 In ordering the work from other booksellers, order 
 
 IJndsay ^ BlnL'tsfon/s Ph(/slcian*s Vis it fur/ List. 
 
 And in all cases, whether ordering from the Publishers or otherwise, 
 specify the size, style, &c., wanted. 
 
 LINDSAY & B.LAKISTON, Publishers, 
 
 2'"* Sotffh Si.rt/i St., P/i iff! fief phi a.
 
 "T/ie leading feature of this hook is its essentially practical character.^'— 
 
 London Lancet. 
 
 Tanner's Practice of Medicine. 
 
 FIFTH AMERICAN, FROM THE SIXTH LONDON EDITION. 
 
 ENLARGED AND THOROUGHLY REVISED, 
 
 JUST READY. 
 
 THE PRACTICE OF MEDICINE, hj Thomas Hawkes Tanner, 
 M.D., Felloiv of the Royal College of Physicians, Author of Tanner's 
 Practical Treatise on the Diseases of Children, &c., &c. Ffth Ame- 
 rican Edition, with a very large Collection of Formulae. One Volume, 
 Boyal Octavo, containing over 1100 pages. 
 
 Price, handsomely bound in Cloth, . . $6 00 
 " " " Leather, . . 7 00 
 
 OOISTTEH^TS. 
 
 Part 1 
 
 General Diseases, 
 
 2. Fevers. 
 
 3. Venereal Diseases. 
 
 4. Diseases of the Nervous System. 
 
 5. Diseases of the Organs of Respi- 
 
 ration and Circulation. 
 
 6. Diseases of the Thoracic Walls. 
 
 7. Diseases of the Alimentary Canal. 
 
 8. Diseases of the Liver. 
 
 9. Diseases of the Pancreas and 
 
 Spleen. 
 
 Part 10. Diseases of the Abdominal Walls. 
 " 11. Diseases of the Urinary Organs. 
 " 12. Diseases of tlie Uterine Organs. 
 " 13. Diseases of the Skin. 
 " 14. Diseases of Cutaneous Append- 
 ages. 
 " 15. Diseases of the Bloodvessels. 
 " 16. Diseases of the Absorbent System. 
 
 Appendix of Formulae 
 
 General Index. 
 
 "The rapidity with which edition after edition of this work has appeared and dis- 
 appeared is, on the whole, a true test of its merits. The fifth edition was, we believe, 
 a very large one, yet the book was for some time out of print before the present one 
 could be prepared. Dr. Tanner has chosen his title well; his work is essentially one 
 on the practice of medicine in its widest sense, and it is in what relates to pure prac- 
 tice, as contradistinguished from the theory of medicine, that the book is strongest; 
 for it has been the author's aim to collect everything he could think of which would 
 aid the practitioner in the discharge of his duties. But it is not to men engaged in 
 the active discharge of the duties of their profession alone to whom the book is wel- 
 come. With the student, preparing himself to enter upon these duties, the book has 
 long been a favorite, chieily, we believe, from the lucidity of its style and the character 
 of its substance. Other books there are, more eloquent and more recondite, but none 
 excel Dr. Tanner's work in these important features. All that is necessary to know 
 is here, disposed in such a manner as to admit of the readiest reference, and of being 
 most easily retained in the memory. Our limits will not admit of an extended review, 
 which would be out of place with regard to a book practically established as a standard. 
 It carries its own recommendation, and is its own best passport to general use. It has 
 been the result of very great labor — labor well spent; and it appears in a form which 
 is creditable to its publishers as it is pleasing to those who have to use the book. — 
 British and Foreign Medico- Ofiirurgical Review, April, 1870. 
 
 "Dr. Tanner's works are all essentially and thoroughly practical, — he never for one 
 moment allows this utilitarian end to escape his mental view. He aims at teaching how 
 to recognize and how to cure disease, and in this he is thoroughly successful. It is 
 indeed a wonderful mine of knowledge." — Medical Times and Gazelle, Jaly, 1SG9.
 
 MEIGS AND PEPPER ON CHILDREN. 
 
 " The most thorough and Practical Work on the subject now before the 
 
 Profession.^' 
 
 Meigs and Pepper's Practical Treatise on 
 the Diseases of Children. 
 
 Pourth Edition, thoroughly Eevised and greatly Enlarged. 
 
 By J. Forsyth Meigs, M. D., Felloio of the College of Physicians of 
 
 Philadelphia, &c., &c., and William Pepper, M. D., Physician to iht 
 
 Philadelphia Hospital, &c., &c., forming a Royal Octavo Yolume of 
 
 over 900 pages. Price, bound in Cloth, . . . $6 00 
 
 Leather, . . . . 7 00 
 
 Dr. Jleigfi' work has been out of print for some ye.irs. The r.apid sale of the three 
 previous editions, and the great demand for a new edition, is suiEcient evidence of its 
 great popularity; while the vei-y large practice of many years' standing of the author 
 in the speciality of " Diseases of Children,"' imparts to it a value unequalled, probably, 
 by any other work on the same subject now before the Profession. This present edition 
 has been almost entirely rewritten and rearranged, and no effort or labor has been 
 spared by either Drs. Meigs or Pepper, to make it represent fully in its most advanced 
 state the present condition of Medicine as applied to Children's Diseases. 
 
 The entire work has been subjected to careful revision. Several of the articles, as 
 those on Eclampsia, Chorea, and Parasitic Skin Diseases, have been much enlarged; 
 and others, as the various articles on the Diseases of the Stomach and Intestines, and 
 f.hat on Eczematous Atfections, entirely rewritten. In addition, articles have been 
 ttdded upon the following important subjects: 
 
 Diseases of the Heart. Facial Paralysis. 
 
 Cyanosis. Rheumatism. 
 
 Diseases of the Cfficum and Appendix. Diphtheria. 
 
 Intussusception. Mumps. 
 
 Chronic Hydrocephalus. Kickets. 
 
 Tetanus Nascentium. Tuberculosis. 
 
 Atrophic Infantile Paralysis, Infantile Syphilis. 
 
 Progressive Paralysis, with apparent Hy- Typhoid Fever, 
 
 pertrophy of the Muscles. Sclerema. 
 
 The new matter thus added amounts to nearly 200 pages. It has been the effort of 
 the authors, while endeavoring to make the work fully represent the state of our knowl- 
 edge upon the subjects treated of, to retain its eminently practical character; and with 
 this view, an unusually large amount of space has been devoted to the consideration 
 of the treatment of each disease. 
 
 "This is the fourth edition of ]Meigs on Diseases of Children, greatly enlarged and 
 improved by chapters upon a large number of new subjects, and also by a very copious 
 index, which facilitates reference, and makes the work more serviceable to the Prac- 
 titioner. As now enlarged, it is one of the most complete and comprehensive works of 
 its class, and will meet the wants of the Profession in this department most admirably." 
 — Buffalo Med. and Surg. Journal. 
 
 "It is very comprehensive, and embraces most of the maladies incident to childhood 
 and infancy. We consider it a very safe, reliable, and suggestive guide, being quite large 
 and full in detail, embracing almost everything pertaining to the subject, making it a 
 very useful book both for reference and stu<ly." — Medical Archives. 
 
 "It forms the most complete and comprehensive work upon the diseases of children 
 published in this country. It has for years been one of the standard authorities, and 
 in its present enlarged form will still more command attention. It presents the latest 
 views of pathology and treatment, and tak^s into consideration many subjects which 
 were entirely omitted in the previous editions.'' — Detroit Journal of Medicine, S^c. 
 
 "It is satisfactory to note that tiie authors have brought up their work to the level 
 «f the pathological knowledge of the day, and that their therapeutical notions are 
 equally advanced. The authors are enrolled among the more enlightened tlicrapeut- 
 ists of our time. One cannot fail to be struck thro&ghout the treatise with the very 
 judicious advice given by the authors on various points of treatment. The work, as a 
 whole, is entitled to rank with the best." — Medical Repertory
 
 Cazeaux's Great Work on Obstetrics. 
 
 THE MOST COMPLETE TEXT-BOOK NOW PUBLISHED. 
 GliEATLY ENLARQED ANO IMPROVED. 
 
 CONTAINING 175 ILLUSTRATIONS. 
 
 A Theoretical and Pmctical Treatise on Midwifery, including the Diseuse>> 
 of Pregnancy and Parturition, by P. Cazeatjx, Member of the ImpeHai 
 Academy of Medicine ; Adjunct Professor in the Faculty of Medicine of 
 Par-is, etc., etc. Revised and Annotated by S. Tarnter, Adjunct Pro- 
 fessor in the Faciil:y of Medicine of Paris ; Former Clinical Chief of the 
 Lying-in- Hospital, c'c, etc. Fifth American from the Seventh French Edi- 
 tion. Translated />»/ \Vm. R. Bullock, M. D. In one volume Royal Oc- 
 tavo, of over 1100 pages, with numerous Lithographic and other Illastra- 
 tious on Wood. 
 
 Price, bound in Cloth, bevelled boards, $6.50 
 
 " " Leather, 7.50 
 
 M. Cazeaux's Great V/ork on Obstetrics has become classical in its character, and 
 almost an Encyclopagdia in its fulness. Written eipresslj for the use of students of 
 medicine, and those of midwifery especially, its teachings are plain and explicit, preseHt- 
 ing a condensed summary of the leading principles established by the masters of the 
 obstetric art, and such clear, practical directions for the management of the pregnant, 
 parturient, and puerperal states, as have been sanctioned by the most authoritative 
 practitioners, and confirmed by the author's own experience. Collecting his materials 
 from the writings of the entire body of antecedent writers, carefully testing their correct- 
 ness and value by his own daily experience, and rejecting all such as were falsified by 
 the numerous cases brought under his own immediate observation, he has formed out of 
 them a body of doctrine, and a system of practical rules, which he illustrates and eni-brces 
 in the clearest and most simple manner possible. 
 
 OPINIONS OF THE PRESS. 
 
 "Itisunqtiestionably a work of the highest oxcellcuce, rich in information, and perhaps fuller in details 
 than any text-book with which we are acquainted. The author has not merely treated of every qaes- 
 tion which relates to the business of parturition, but ho has done bo with judgment and ability." 
 British and Foreign Medico-Cliirurgical lievieiv. 
 
 " The translation of Dr. Bullock is remarkably well done. AVe can recommend this work to those 
 egpecially interested in the subjects treated, and can especially recommend the American edition." 
 Medical Times and Gazette. 
 
 " The edition before us is one of unquestionable exoellence. Every portion of it has undergone a 
 thorough revision, and no little modification ; while co{)ious and important additions have been made to 
 nearly every part of it. It is well and beautifully illustrated by numerous wood and lithographic 
 engravings, and, in tjpographical execution, will bear a favorable comparison with other works of the 
 same class." — American Medical Journal. 
 
 "In the multitudinous collection of works devoted to the propagation of human beings, and to tho 
 details of parturition, none, in our estimatioo, bears nny comparison to the work of Cazeaux, in its 
 entire perfcctness ; and if wo were called upon to rely alone on one work on accouehments, our choice 
 would fall ujjon the book before us without any kind of hesitation." — West. Jour, of Med. and Sin-oarii. 
 
 "Wo do not hesitate to say, that it is now the most comjilctc and best treatise on the subiect in the 
 English language." — Buffalo Medical Journal. 
 
 "We know of no work on this all-important branch of our profession that we can recommend to the 
 itudent or practitioner as a safe guide before this." — Cliicac/o Medical Journal. 
 
 "Among the many valuable treatises on the science and art of obstetrics, the work of Cazeaux stands 
 pre-eminent." — St. Louis Med. and Sur(j. Journal. 
 
 " M. Cazeaux's book is the most complete we have ever seen upon the subject. It is well translated^ 
 «cd reflects great credit upon D-. Bullock's intelHgcnce and industry." — N. A. Medico-Cliinirg. Review.
 
 " The Representative Booh of Medical Science.^'' — London Lancet. 
 
 Aitken's Science and Practice of Medicine. 
 
 SECOND AMERICAN PEOM THE PIPTH LONDON EDITION. 
 
 Coiitaining Additions equal to 500 pages of the English Edition, prepared by 
 
 the American Editor with Special Reference to the 
 
 wants of the American Practitioner. 
 
 The Science and Practice of Medicine. By William Aitken, M.D. Second 
 American from the Fifth Enlarged London Edition, icith Additions bij 
 Meredith Clymer, M.D., late Professor of the Institutes and Practice of 
 Medicine in the University of Neio York, Physician to the Philadelphia 
 Hospital, etc. In 2 Volumes Royal Octavo. 
 
 With a COLORED MAP. a LITHOGRAPHIC PLATE, and ONE HUNDRED AND 
 THIRTY ILLUSTRATIONS ON WOOD. 
 
 Price, bound in Cloth, bevelled boards .... $12.00 
 
 Leather, .... ... 14.00 
 
 Fii'teen months have been spent bj Dr. Aitke.n in thoroughly revising this Great Work, 
 and adding to it many valuable additions and improvements amounting to about 100 
 pages of new matter, included in which will be found the adoption and incorporation in 
 the text of the " new nomenclature of the Royal College of Physicians of LondoJi; " to 
 which are added the Definitions and the Foreign equivalents for thnir English names. 
 
 The subjects of Malignant Cholera, of Paralysis, of Epidemic Cerebro- Spinal Menin- 
 gitis, and of Intestinal Obstruction have been entirely ro-written ; and several other sub- 
 ject* in connection with the treatment of disease, of the greatest importance, are con- 
 sidered for the first time in this edition. 
 
 The Press have referred to former editions of this work as " an admirable compila- 
 tion." "The most comprehensive of any in the practice of medicine." "It embodies 
 the most advanced knowledge of the time." " The most valuable class-book for students 
 yet published." " It may be looked upon as the standard text-book in the English lan- 
 guage." " The present work contains information that will not be found in any other 
 Mitnual of Medicine," ic, &c. 
 
 The author in this edition has endeavored to keep up this high reputation, and to 
 make it in every respect a Representative Book of Medical Science and the Practice of the 
 day, as understood and followed by the best men of the Profession. 
 
 Large additions have also been made by the American Editor, Dr. Meridith Clymer, 
 equal to over 500 pages of the London edition, and with particular reference to the wants 
 of the American Pr.\ctitio.\er, included in which are new articles upon the following 
 subjects: Spinal Symptoms of Typhoid Fever, Typho-Malarial Fever, Chronic 
 Gomp Dysentery, Cholera Morbus, Cholera Infantum, Hereditary Syjihilis, Gon- 
 orrhceal Rheumatism, The Delirium of Inanition, Chronic Alcoholism, Syphilitic 
 Disease of the Liver, Epileptiform Neuralgia, Capillary Bronchitis, lUasttc 
 Broyichitis, Dilatation of the Bronchia, Fibroid Degeneration of the Lung, 
 Chro/iic Pyaeviia, &c. rfc.
 
 Trousseau's Clinical Lectures. 
 
 VOL. III. NOW READY. 
 
 Lectures on Clinical Medicine, delivered at the Eolel-dieu, Paris. By 
 
 A. Trousseau, Professor of Clinical Medicine in the Faculty of Medi' 
 
 cine, Paris, &c., dec. 
 
 Trousseau's Lectures on Clinical Medicine, so favorably receivefl, as well by the 
 profesi^ion of the United States as abroad, are published in this country in connection 
 with the New Sydenham Society, under whose auspices the translation of Vols. II. and 
 III. have been made. Either of these volumes can be furnished separately, and in order 
 to still further extend the circulation of so valuable a work, the Publishers have now 
 reduced the price to Five Dollars per volume. 
 
 CoxTEXTS OF Volume I. — Tramlaled and Edited by P. Victor Bazire, M. D., ^c. — 
 Lkctcre 1. On Venesection in Cerebral Haemorrhage and Apoplexy. 2. On Apoplec- 
 tiform Cerebral Congestion, and its Relations to Epilepsy and Eclampsia. 3. On 
 Epilepsy. 4. On Epileptiform Neuralgia. 5. On Glosso-laryugeal Paralysis. 6. Pro- 
 gressive Locomotor Ataxy. 7. On Aphasia. 8. Progressive Muscular Atrophy. 9. 
 Facial Paralysis, or Bell's Paralysis. 10. Cross-paralysis, or Alternate Hemiplegia. 
 11. Infantile Convulsions. 12. Eclampsia of Pregnant and Parturient Women. 13. 
 On Tetany. 14. On Chorea. 15. Senile Trembling and Paralysis Agitans. 10. Ce- 
 rebral Fever. 17. On Neuralgia. 18. Cerebral Kheumatism. I'J. Exophthalmic 
 Goitre, or Graves' Disease. 20. Angina Pectoris. 21. Asthma. 22. Hooping Cough. 
 
 23. On Hydrophobia. 
 
 Contents of Volume II. — Translated from the Edition of 1868 {being the last revised 
 and enlarged edition), by John Rose Cormack, M. D., Edin., F.R.S.E , ^c. — Lecture 1. 
 Small-pox. 2. Variolous Inoculation. 3. Cow-pox. 4. Chicken-pox. 5. Scarlatina. 
 6. Measles, and in particular its unfavorable Symptoms and Complications. 7. Rubeola. 
 8. Erythema Nodosum. 9. Erythema Papulatum. 10. Erysipelas, aud in particular 
 Erysipelas of t-lie Face. 11. Mumps. 12. Urticaria. 13. Zona, or Herpes Zoster. 
 14. Sudoral Exanthemata. 15. Dothinenteria, or Typhoid Fever. 10. Typhus. 17. 
 Membranous Sore Throat, and in particular Herpes of the Pharynx. 18. Gangrenous 
 Sore Throat. 19. Intiammatory Sore Throat. 20. Diphtheria. 21. Thrush. 
 
 Contents of Volume III. — Translated from the Edition 0/I868, by John Rose Cormack, 
 M.D., Edin,, F.R.S.E., Sfc. — Lecture 22. Specific Element in Disease. 23. Contagion. 
 
 24. Ozaena. 25. Stridulous Lai-yngitis, or False Croup. 2G (Edema of the Larynx. 
 27. Aphonia: Cauterization of the Larynx. 28. Dilatation of the Bronchi and Bron- 
 chorrhoea. 29. Hemoptysis. 30. Pulmonary Phthisis. 31. Gangrene of the -Lung. 
 32. Pleurisy; Paracentesis of the Chest. 33. Traumatic Effusion of Blood into the 
 Pleura: Paracentesis of the Chest. 34. Hydatids of the Lung. 35. Pulmonary 
 Abscesses and Peripneumonic Vomicoe. 36. Treatment of Pneumonia. 37. Paracen- 
 tesis of the Pericardium. 38. Organic Affections of the Heart. 52. Alcoholism. G2. 
 Spermatorrhoea. C3. Nocturnal Incontinence of Urine. 64. Glucosuria: Saccharine 
 Diabetes. 65. Polydipsia. 67. Vertigo a Stumacho Lieso. 
 
 3 Volumes Octav'o, handsomely bound in Cloth, Price $5 GO each. 
 
 OPINIONS OF THE PRESS. 
 
 "Trousseau furnishes us with an example of the best kind of Clinical teaching. It is 
 a book that deserves to be popularized. The translation is perfect." — Medical Times 
 und Gazette. 
 
 "The great reputation of Prof. Trousseau as a practitioner and teacher of Medicine 
 in all its branches, renders the present appearance of his Clinical Lectures particularly 
 welcome." — Medical Press and Circular. 
 
 "The publication of Trousseau's Lectures will furnish us with one of the very best 
 practical treatises on disease as seen at the bedside." — British and Foreign Medico- 
 Chirurgical Review. 
 
 "A clever translation of Prof. Trousseau's admirable and exhaustive work, the best 
 book of reference upon the Practice of Medicine." — Indian Medical Gazette. 
 
 "The Lectures of Trousseau, in attractiveness of manner and richness of thoroughly 
 practical matter, worthily takes a place beside the classical lectures of Watson and 
 Graves." — British Medical Journal. 
 
 "Trousseau is essentially the French Graves, and his lectures should sooner than 
 this have been translated into English." — Lancet.
 
 WORKS BY DR. LIONELS. BEALE, F.R.S., 
 
 Professor of Physiolojg and of General and Morbid Anatomy in King's 
 College, London, &c., &c. 
 
 PRICES REDUCED. 
 
 Beale's How to Work with the Microscope. 
 
 Seventh Thousand — 400 Illustkations, some of which are Colored, 
 together tvilh a Photographic Frontispiece. 
 
 This work is'a complete manual of microscopical manipulation, and contains a full 
 description of many new processes of investigation, with directions for examining 
 objects under the highest powers, and for taking photographs. It is got up, both 
 plates and letter-press, in an elegant manner, and is, without doubt, the most complete 
 and beautiful book of the kind in the English language. 
 
 Octavo, cloth. Price, $t 50 
 
 On Kidney Diseases, Urinary Deposits, and 
 
 CALCULOUS DISORDERS. Lwluding the Symjyioms, Diagnosis, 
 and Treatment of Urinarnj Diseases. With full Directions for the 
 Chemical and Microscopical Analysis of the Urine in Health and 
 Disease. The Third Edition, very much enlarged. 
 
 This "Work is. Illustrated with 70 Plates, containing upwards of 400 separate 
 figures, all of which have been copied from Nature, and many are now published 
 for the first time. 
 
 A handsome volume Octavo. Bevelled, cloth. Price, . . $10 00 
 
 The complete and thoroughly practical character of this work may be judged of by 
 the fact that it contains as manj .*s thirty-six figures of different forms of Uric Acid 
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 and the work is the most complete, as well as the largest, ever published on the subject. 
 
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 A NEW AND VERY MUCH ENLARGED EDITION. 
 
 A Treatiae on Medical Electricity, Theoretical and Practical, and its 
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 The Second Edition, revised, and for the most part re-writteu. By 
 Julius Althaus, M.l)., Member of the Royal College of Physicians, 
 Senior Physician to the Infirmary for Epilepsy and Paralysis, &c., &c. 
 In one volume, octavo. Illustrated by a Lithographic Plate and sixty- 
 two Engravings on AVood. Price, $5 00 
 
 It is with gi-eat pleasure that we welcome, and cordially reconirnend. Dr. Altliaus's 
 treati.se, in the improved gui.se of a Second Edition. Dr. Althaus's work possesses the 
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 most recent information ; and the balance is evenly held between the relative virtues 
 of galvanization and faradization — a point of the highest importance in the treatment 
 of disease. 
 
 To the favorable opinions already accorded to the former edition of this treatise we 
 can add nothing, except in the way of sincere commendation ; and to Dr. Althaus belongs 
 the credit of having filled up a hiatus in English medical literature, by the production 
 of a sound, comprehensive, and practical work on the right use of an agent whose 
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 terh/, May, 1870. 
 
 Tyson's Work on the Cell Doctrine. 
 
 The Cell Doctrine: its History and Present State. With a Copious Bib- 
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 Denial Surgery. By James Tyson, M.L)., Lecturer on Microscopy in 
 the University of Pennsylvania, and on PJiysiology in the Pennsylvania 
 College of Dental Surgery ; Fellow of the College of Physicians of 
 Philadelphia, &g., dec. In one volume, with a Colored Plate, and 
 numerous Illustrations on Wood. Price, . . . $2 00 
 
 Dr. Tyson furnishes in this work a concise and instructive resume of the origin and 
 advance of the doctrine of Cell evolution. In it we find the theories of Virchow, Robin, 
 Huxley, Hughes, Bennett, Beale, and other distinguished men. its pages contain what 
 could otherwise only be learned by the perusal of many works, and supplies the reader 
 with a continuous, complete, and general knowledge of the history, progress, and 
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 bibliography. 
 
 Lesrs" on Urine, from the second london edition. 
 
 A Guide to the Examination of the Urine. For the Practitioner and 
 Student. By J. Wickiiam Lego, M.D., Member of the Royal College 
 of Physicians, &c., &c. Second Edition. 16ino. Cloth. Price, 75 cts. 
 
 Dr. Lcgg's little manual has met with remarkable success, and the speedy exhaustion 
 of the first edition has enabled the author to make certain emendations which have 
 added greatly to its value. We can now confidently commend it to the student as a 
 safe and reliable guide to such examinations of the urine as he may be called upon to 
 make. — London Medical Times and Gazette. 
 
 Kirkes' Hand-Book of Physiology. 
 
 THE SEVENTH LONDON EDITION. 
 
 HAND-BOOK OF PHYSIOLOGY, by William Senhouse Kirkes. 
 M.D. Seventh Edition, Edited by W. Morrant Baker, F.R.C.S., Lec- 
 turer on Physiology, &c., &c. With 241 Illustrations. In one volume, 
 demy-octavo, containing over 800 pages. Price, bound in cloth, $5 00 
 
 This edition of Dr. Kirkes' Hand-Book of Pliysiology is fully brought up to the tiu\es, 
 and forms one of the most complete and convenient Text-Books on the subject, for the 
 Student of Medicine, now in print.
 
 J. Soelberg Wells on the Eye. 
 
 A NEW ENLARGED LONDON EDITION. 
 
 A Treatise on Diseases of the Eye (the Author's Second Edition), illus- 
 trated by Colored Plates and 7iumerous Engravings on Wood. By 
 J. ScELBERG Wells, Professor of Ophthalmology in King's College, 
 London, &c., &c. The plates and letter-press elegantly printed on 
 cream-tinted paper. Octavo, bound in Cloth. Price, . . $6 50 
 Do. " Leather, " . . 1 50 
 
 THE AUTHOR'S PREFACE TO HIS SECOND EDITION, 
 It has afforded me no small gratification that the First Edition of this work should 
 have met with so favorable a reception, both by the Profession at large and by the 
 British and Foreign Medical Press, and especially that it should have been deemed 
 worthy of being translated into French and German, in both of which languages it will 
 be published in the course of this year. 
 
 Stimulated by such encouragement, I have endeavored to render the Second Edition 
 as complete as possible, and have made numerous additions, incorporating all the 
 important facts elucidated by the most recent researches, so that the work might be 
 brought up to the latest date. — 16 Saville Row, London, May, 1870. 
 
 Coles on Deformities of the Mouth. 
 
 SECOND EDITION, NOW READY. 
 
 On Deformities of the Mouth, Congenital and Acquired, with their 
 Mechanical Treatment. By James Oakley Coles, Dentist to the 
 Hospital for Diseases of the Throat, Member of the Odontological 
 Society, &c., &c. Second Edition, Revised and Enlarged, containing 
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 One Yolume, Demy-Octavo, in Cloth. Price, . . . S2 50 
 
 OPINIONS OF THE PRESS ON FIRST EDITION. 
 
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 encouraging." — Lancet. 
 
 "This beautifully illustrated work deals with a highly practical and interesting 
 subject." — Medical Times and Gazette. 
 
 "We take pleasure in commending it as a valuable, and therefore desirable, treatise 
 to possess." — Dental Cosmos. 
 
 Neumann's Hand-Book of Skin Diseases. 
 
 Translated from the Author's Second Edition. IN PEEPAEATIOE". 
 
 A Hand-Book of Stin Diseases, illustrated by Forty-nine Wood Cuts 
 of large size, beautifully executed, and showing the Microscopic Ap- 
 pearance of Sections of the Skin in its Vai'ious Diseases. By Prof. 
 Neumann, of A^ienna. In one Volume. 
 
 Dr. Neumann was for a long time Prof. Hebra's assistant, and his work is a concise 
 treatise founded on "Hebra's" Doctrines and Methods of Treatment, as the latter work 
 may not for a long time be completed, and as from its size and its publication in the 
 English language only by the New Sydenham Society, it cannot, even when all published, 
 be accessible but to a limited number. This work presenting his views, must necessarily 
 prove a great acquisition to the profession.
 
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 Dr. Aitken's work is now the most comprcliensive Text-Book on tlie Practice of 
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 Anstie on Stimulants and Narcotics. 
 
 Their Mutual Relations, with Special Researches on the Action of Alcohol, 
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 Medica and Therapeutics, etc., etc. Octavo, .... 83.00 
 
 Althaus' Medical Electricity, a New and very Much 
 
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 A Theoretical and Practical Treatise, and iti^ Ui^e in the Treatment of 
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 PEOF. BYFORD'S NEV/ EDITION 
 
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 The Practice of Medicine and Surgery , 
 
 Applied to the Diseases and Accidents Incident to Womeii. By \V. H. 
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 and Children in the Chicago 3Iedical College, do., tfcc. The Second 
 Edition, revised and enlarged, vsith additional illustrations. One 
 volume octavo. 
 
 Bound in Cloth. Price, .... . ^.00 
 
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 The rapid sale of the first edition of this book, which was exhausted in a little more 
 than a year, has enabled the author to carefully revise the whole work, add many 
 improvements, and to make a large addition of new matter, without, however, materially 
 increasing the size of the volume. 
 
 " Professor Byford's book may safely be said to fill a gap in a most important department of 
 the healing art. The treatise is as complete a one as the present state of our scionce will admit 
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 tion, but fully discusses all those uterine ailments which are to be benefited by medical treat- 
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 contained in the work, although the volume itself is very little, if any, increased in bulk. We 
 commend it to the diligent study of every practitioner and student, as a work calculated to 
 inculcate sound principles, and lead to enlightened practice." — N. Y. Med. Kecord. 
 
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 Biddle'S Materia MediCa. The Third Edition Enlarged. 
 
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 By J. B. BiDDLE, M. D., Professor of Materia Medlca and Therapeutics 
 in the Jefferson Medical College, Philadelphia, &c., &c. Octavo. $4.00 
 
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 seems to exist in the want of an elementary work on the subject. The larger works 
 usually recommended as Text-Books in our Medical Schools are too voluminous for 
 convenient use. This work will be found to contain, in a condensed form, all that is 
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 »B Materia Medica, as deliTwed at the various Medical Schools in the United States
 
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 Beasley's Book of Prescriptions. 
 
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 coviprising also a Compendious History of the Mata-ia Medica, Liits of 
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 both physician and diuggist, prescriber and compounder, may find, under the head of each remedy, the man- 
 ner in which that renieiiy may be most effectively administered, or combined with other medicines in the 
 treatment of various diseases. The alphabetical arrangement adopted renders this eaay ; and the value of the 
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 1b capable of affording in prescribing, should be in tlie possession of every niedical practitioner. Amongst 
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 the day, it affords an insight into the methods of treatment pursued by them, and of tlie remedies which thej 
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 SIXTH AMERICAN EDITION, REVISED AND IMPROVED. 
 
 Comprising a copious Veterinary Formulary, numerous Receipts of Patent 
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 "This is one of the most useful and practical manuals of its sort that has ever yet appeared, and we can- 
 not too strongly recommend it to every student of medicine. It is sufficiently comprehensive without being 
 lengthy, and the principles, wluch are eminently sound, can easily be mastered and understood." — Medical 
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 Bouchardat's Annual Abstract 
 
 Of Therapeutics, Materia Medica, Pharmacy, and Toxicology, 
 FOR 1867, with an Original Memoir of Gout, Gravel, Urinary Cal- 
 culi, &c. By A. Bouchardat, Professor of Hygiene to the Faculty 
 of Medicine, Paris, &c. Translated and Edited by M. J. De Rosset. 
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 Reports on the Progress of Medicine, Surgery, 
 and the Allied Sciences, containing: 
 
 1. Report on Physiology, by Henry Power, F.R.C.S., M.B., Lond. 
 
 2. Report on Practical MEDici>fE, by Francis Edmund Anstie, M.D., etc. 
 
 3. Report on Surgery, by T. Holmes, Esq., M.A., F.R.C.S., etc. 
 
 4. Report on Ophthalmic Medicine and Surgery, by Thomas Windsor, M.D. 
 
 5. Report on Midwifery and the Diseases of Women and Children, by R. Barnes, 
 M.D., F.R.C.P. 
 
 6. Report on Medical Jurisprudence, by C. Hilton Fagge, M.D., F.R.C.P. 
 
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 CONSTIPATED BOWELS; the various Causes and the Different 
 
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 Lectures chiefly clinical, illustrative of a Restorative System of Medicine. 
 By Tiios. K. Chambeus, M. D., Physician to St. Mary^s Hospital. 
 Author of " The ludigestions," &c., &c. Octavo, . . $5.00 
 
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 for this reprint of Dr. Chambers' Lectures — a work whose time is forever, everywhere in its 
 place, admirable in tone, full of valuable instructions and practical teachings, and written in 
 clear, compact, and often epigrammatic English. We can offer but a brief notice of this intrin- 
 sically good book, which is certain of finding a wide circle of readers, and we should hope a 
 place in every medical library." — Neto York Medical Journal. 
 
 "This work is of the highest merit, written in a clear, masterly style, and devoid of technicalities. It is 
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 Chew on Medical Education. 
 
 A Course of Lectures on the Proper Method of Studying Medicine. By 
 Samuel Chew, M.D., Professor of the Practice and Principles of 
 Medicine and of Clinical Medicine in the University of Maryland. 
 12mo Sl.OO 
 
 " The topics discussed in this volume are of books — of time to be devoted tostudy — and the manner — of 
 the order of medical studies — of the taking of notes — of clinical instruction — dissections — auscultation — 
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 was, there/ore, well fitted for the judicious performance of this task, upon which he seems to have eiitcivd 
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 •i
 
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 Canniff 's Manual of the Principles of Surgery, 
 
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 the principles of surgery, tested practically tlieir doctrines, and b:i3 presented bis own views, well arranged 
 and clearlj' expressed, for the advantage of others."' — Amivican Journal of Med. Science. 
 
 Cleaveland's Pronouncing Medical Lexicon. 
 
 A NEW AND IMPROVED EDITION (THE ELEVENTH). 
 
 Containing the Correct Pronunciation and Definition of most of the Terms 
 vsed by Sfjeakers and Writers of Medicine and the Collateral Sciences. 
 By C. H. Cleaveland, M.D., Member of the American Medical Associa- 
 tion, etc., etc. A small Pocket Volume $1.25 
 
 This little work is both brief and comprehensive; it is not only a Lexicon of all the 
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 and also to the rharmaccutical Student. This edition contains a List of the Abbrevia- 
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 Prof. Carson's University of Pennsylvania. 
 
 A History of the Medical Department of the University of Pennsylvania, 
 from its Foundation in 1765: With Hkelches of the Lives of Deceased 
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 and of all others interested in medical education in this country." — American Journal 
 of Mtdical Science. 
 
 DivrMT r\n flin Ji^\rr^ 1 A New Edition, thoroughly Eevised, and a 
 IXOll Ull lllb ±J\ I.. I great portion Ee-written. 
 
 A Guide to the Practical Study of Diseases of the Eye, with an Outline 
 of their Medical and Operative Treal,ment, with Test Types and Illus- 
 trations. By James Dixon, F.R.C.S., Surgeon to the Boyal London 
 Ophthalmic Hospital, &c., &c. In one volume. Price, . $2 50 
 
 " Mr. Dixon's book is essentially a practical one, written by an observant author, 
 who brings to his special subject a sound knowledge of general Medicine and Surgery." 
 — Dublin Quarterly. 
 
 "Our object is not to review, but to recommend this work to students, with the confi- 
 dent assurance that they will rarely be disappointed in their appeals to it as a reliable 
 guide to the practical study of the Diseases of the Eye." — American Medical Joiirnai. 
 
 " We have taken great pleasure in a careful perusal of this book, which, both in style 
 and matter, is unsurpassed in any language It embraces quite a wide riinge of topics, 
 and furnishes a very valuable practical guiile in the medical and surgical treatment 
 of diseases of the eye." — Buffalo Medical Journal.
 
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 Durkee on Gonorrhoea and Syphilis. 
 
 The Fifth Edition, Revised and Enlarged, with Portraits and Colored 
 
 Illustrations. 
 
 A Treatise on Gonorrhoea and Syphilis. By Silas Durkee, ISI.D., Fel- 
 low of the Massachusetts Medical Society, &c., &c. A New and Revised 
 Edition, with Eight Colored Illustrations. Octavo. . . S5.00 
 
 This work of Dr. Durkee's has received tlie unqualified approval 
 of the Medical Press and the Profession both in this country and in 
 Europe. The author has devoted himself especially to the treatment of 
 this class of diseases, and his 25 or 30 years experieuce in doing so is 
 here recorded. No one reading his work can fail in receiving very 
 valuable information from it. 
 
 " It is the work of a practical man, the subject is treated in a plain, shrewd manner. The 
 book is a good one, and the therapeutics are laid down with discrimination." — Liyndon Medical 
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 " Dr. Durkee's production ie one of those, the perusal of which impresses the reader in favor of the author. 
 The gencnil tonn. the thorough honesty erfrywliere evinced, the iihiIanthrop:c siiirit oliscrvahie in many pas- 
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 writer; nor is the reader less attracted by the skill with which the book is arranged, the manner in which 
 th" facts are cited, the clever way in which the author's e.-;perience is brought in, and the lucidity of th« 
 reasoning, tlie lix-'Hiciit aticl extremely f lir allusions to the labora of others, and the Care with which the the- 
 rapeutics of venereal compluiuts are treated." — Lancet. 
 
 Fuller on Rheumatism^ Rheumatic Gout, and 
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 Their Pailiolocjy, Sy7V2:)toms, and Treatment. By Henry William 
 Fuller, M.D., Fellow of -the Royal College of Physicians, London; 
 Physician to St, George's Hospital, etc. From the last London Edition. 
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 Graves' Clinical Lectures on the Practice of 
 
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 of the Institutes of Medicine in the School of Physic in Ireland. Edited 
 by J. Moore Meligan, M.D. From the Second Revised and Enlarged 
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 Register of Patients, combining not only the Accuracy and Essential 
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 labor and responsibility, but is also a Daily Register of Patients, &c., '&c. 
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 be kept in a very small space. (See Mitchell's account.) No transfer of accounts 
 from one book to another, or from one part of the book to another. No protracted 
 search for an account when wanted. Shows the exact state of an account at anj,' 
 moment.
 
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 Gross' American Medical Biography of the 
 Nineteenth Century. 
 
 Edited by Samuel D. Gross, M.D., Professor of Surgery in the Jefferson 
 Medical College, Philadelphia, &c., &c. With a Portrait of Benjamin 
 Rush, ]\LD. Octavo $3.50 
 
 Greenhow on Bronchitis, especially as connected with 
 
 Gout, Emphysema, and Disea^^es of the Heart. By E. Headlam Green 
 HOW, M.U., Fellow of the Royal College of Physicians, &c., &c. 
 
 Price, $2.00 
 
 " III viviii jiirtiires of the sort of cases which a prixctitioner enronnters in his daily walks, and in examples 
 cf tlie way in which a student ought to turn them over in liis mind and make thejn tools for self-improvm 
 meut, we have rarely seen a volume richer." — Bi-it. and For. Medico-Chirurg. Review. 
 
 Garratt's (Alfred C.) Guide for Using Medical 
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 Showing the most approved Apparatus, Methods, and Rides for the Medical 
 Employment of Electricity in the Treatment of Nervous Diseases, &c., &c. 
 With numerous Illustrations. One Volume, octavo. . . $2.00 
 
 "The largo work on the same suhjcct, and liy the same author, is pretty well known to the Profevaion, hut 
 It is hulky and cumbrous, and by no means so practically useful. The present coniparativtdy lirief volume 
 :.ontains every thiuj; of importance in regard to the various apparatuses useful to the Medical Electrician 
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 Hewitt on the Diseases of Women. 
 
 SECOND EDITION, REWRITTEN AND ENLARGED. 
 
 The- Diagnosis and Treatment of Diseases of Women, including the 
 Dia(ja<jsis of Pregnancy. Founded on a Course of Lectures delivered 
 at St. Mary's HoKpntal Medical School. By Graily Hewitt, M. D. 
 Loud., M. K. C. P., Physician to the British Lying-in Hospital; Lec- 
 turer on Midivifery and Diseases of Women and Children at St. 3Iary^s 
 Hospital Medical School; Honorary Secretary to the Obstetrical So- 
 ciety of London, &c. With a new Series of Illustrations. 
 Price, in clotli, $5.00 ; in leather, $G.OO. 
 
 Hfllier's Clinical Treatise on the Diseases of 
 
 Children. By Thomas Hillier, M.D., Physician to the Hosjntal 
 for Sick Children, and to Unicersity College Hospital, ivc, &c. Octavo. 
 
 Price, $3.00 
 
 "Our space is exhausted, but we have said enough to indicate and illustrate the excellence of Pr. Hillier'? 
 volume. It is eminently the kind of book needed by all medical men who wish to cultivate clini tal accwicj 
 Mid sound practice." — London Lancet.
 
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 Headland on the Action of Medicines in the 
 • System. 
 
 By F. W. IIeadlaxd, ^M.D., Fellow of the royal College of PJiT/sicians- 
 d'c., d'c. Sixth American frovi the Fourth London Edition. Revised 
 and enlarged. One Volume, octavo. ..... §3.00 
 
 Dr. Ileadland's work Las been out of print in this country nearly two years, awp-U- 
 ing the revinioua of the author, which now appear in thia edition. It gives the oiilj 
 scientific and satisfactory view of the action of medicine; and this not in the way of 
 iille speculation, but by demons'tration and experiments, and inferences almost as in- 
 disputable as demonstrations. It is truly a great scientific work in a small compass, 
 and deserves to be the handbook of every lover of the Profession. It has received thf, 
 most unqualified approbation of the Medical Pretf, both in this country and in Europe, 
 and is pronounced by them to be the most orif/inal and practically useful work that has 
 been published for many years. 
 
 Eille's Pocket Anatomist. 
 
 Being a Complete Description of the Anatomy of the Human Body ; for tho 
 Use of Stndents. By il. W. Hilles, formerly Lecturer on Anatomy and 
 Physiology at the Westminster Hospital School of Medicine. 
 
 Price, in cloth, 81.00 
 
 " in Pocket-book form, 1.25 
 
 Heath on the Injuries and Diseases of the Jaws. 
 
 The Jacksonian Prize Essag of the Royal College of Surgeons of Eng- 
 land, 1867. By Christopher Heath. F.R. C. S., Ai^si^tant Surgeon to 
 
 University College Hospital, and Teacher of Operative Surgery in Uni- 
 versity College. Containing over Ib^i Illustrations. Octavo. Price, $6.00 
 
 Hodge on Foeticide, or Criminal Abortion 
 
 By Hugh L. Hodge, M. D., Emeriius Professor in the University of 
 Pennsylvania. A Small Pocket Volume. Price in paper covers, 30 
 
 flexible cloth, 50 
 
 This little book is intended to place in the hands of professional men and others the means of answering 
 satisfactorily and intelligently any inquiries that may be made of them in connection with this importanit 
 tubject. 
 
 Hohi^es' Surgical Diseases of Infancy and 
 
 ChildllOOd. By J. Holmes, M.A., Surgeon to the Hospital fo^ 
 Si;k Children, &c. Second Edition. Revised and Enlarged. Octavo. 
 
 Price, 89.00 
 
 Hufeland's Art of Prolonging Life. Eduedby 
 
 Erasmus Wilson, M.D., F R.S. Author of "A System of Human 
 Anatomy,'' ''Diseases of the Skin,^^ &c., &c. 12mo. Cloth. $1.25
 
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 Mackenzie on the Laryngoscope, Diseases 
 of the Throaty &c. Second Edition. 
 
 The Use of the Laryngoscope in Diseases of the Throat. With additions, 
 and an Essay on Hoarseness, Loss of Voice, and Slridulous Breathing 
 in relation to Nervo- Muscular affections of the Larynx, by Morelt 
 Mackenzie, M.D., Physician to the Hoxpilal for Diseases of the Throat, 
 dec, &c. Second Edition, with additions, and a Chapter on the Nasal 
 Passages, by J. SoLis CoaiE,N,'M.D., Author of " Inhalation, Its Thera- 
 peutics and Practice,'''' &c. Illustrated by two lithographic plates, and 
 51 engravings on wood. Octavo. Price, .... $3.00 
 
 "While laryngoscopy was in its infancy, end before it had begun to engage to any extent the attention of 
 the Profession, it was s'tiulicd witli tlie greatest care ami eiitliusi:usni by the autlior of this treati.se. A per- 
 sonal frieud of Czermak's, who hua done wore thnn any other continental physician to introduce the laryimo- 
 Bcope into practice^ he lias profited l)y the oppnrtuiiilii'.s ivhirli he tliu.s possessud of Ijeeoniinn ac plain ted wilb 
 the anatomy and niorliid anatomy of the larynx. But lie has done niuoli more than this. As will be seen by 
 a perusal of this treatise, he has modified the iii^^lniMients at present in use for the examination of the 
 larynx, and has invente<l others for therapeutical piirpi^i*. Those \>ho are anxious to study the disea-ses of 
 the larynx and the mode of using the laryngoscope, cannot do better than purchase the treatise before us, a.s it 
 is by far the best which has been pub!i.-.lied, and is thorof ^hiy to be relieil upon." — Glasgow iltdical Jourtud. 
 
 Morris on the Pathology and Therapeutics 
 of Scarlet Fever. 
 
 By Casper Mokris, ]\I.D., Fellow of the College of Phtjsicians of Phila- 
 delpjhia, &c., &c. A New Enlarged J^dltion. Octavo. . $1.00 
 
 Meigs and Pepper's Practical Treatise on 
 the Diseases of Children. 
 
 Poixrtli Edition, thoroughly Revised and greatly Enlarged. 
 
 By J. Forsyth Meigs, M. D., Fellow of the College of Physicians of 
 
 Philadelphia, &c., &c.,and William Pepper, M.D., Physician to the 
 
 Philadelphia Hospital, &c., &c., forming a Royal Octavo Volume of 
 
 over 900 pages. Price, bound in Cloth, . . . $6.00 
 
 " " Leather, . . . 7.00 
 
 Dr. Meigs' work has been out of print for some years. The rapid sale of the three previous editions, and the 
 great demand for a new edition, is sufficient evidence of its great popularity: while the very large practice 
 of many years' standing of the author in the speciality Of " Diseases of Children," imparts to it a value un- 
 .'iiualled, probably, by any other work on the same subject now before the Profession. This present edition haa 
 been almost entirely rewritten and rearranged, and no efibrt or labor has been spared by either Drs. Meii?B 
 ir Pepper, to make it represent fully in its most advanced state the present condition of Medicine as applied 
 to Children's Diseases. 
 
 Murphy's Review of Chemistry for Students. 
 
 Adapted to Vm Cotirses as Taught in the Principal Medical Schools in the 
 United States. By John G. Murphy, jNI.D. In One Volume. $1.25. 
 
 " Tliis is an exceedingly well-arranged and converient Manual. It gives the most important facts and 
 principles of Chemistry in a clear and very concise manner, so as to subserve most admirably the object fM 
 wtiich it was designed." — J^orth Western Medical and SuTfjical Journal.
 
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 Maxson's Practice of Medicine. 
 
 A Xexv Text-Book on the Practice of Medicine. By Edwin R. !Max80N, 
 ^LD., formerly Lecturer on the Institutes and Practice of Medicine in the 
 Geneva Medical College. In One Volume. Royal 8vo. . $4.00 
 
 "Judging from his work, he must bo a correct observer, of plain, strong common seoso, having the pro- 
 Tess ami perfection of the healiug art. and the amelioration of suffering, earnestly at heart, free from pre- 
 tu»lice, and open to conviction. The fact of employing, and thereuiion reconiniending valuable remedial 
 ageot.s, uM yet, for various reasons, under the tan, and niii^understnod by many pbysiciaas, is an honor to 
 AiuQ, and gives a certain additional value to Uia book." — American Medical Monthly. 
 
 Meudenliairs Medical Student's Vade Mecum. 
 
 A Compendium of Anatomy, Physiology, Chemistry, The Practice of Medi- 
 cine, Surgery, Obstetrics, Diseases of the Skin, Materia Medica, Phar- 
 macy, Poisons, d'c, &c. By George Mendexhall, M.D., Professor of 
 Obstetrics in the Medical College of Ohio, Member of the American 
 Medical Association, &c., &c. The Eighth Edition, Revised and En- 
 larged ; with 224 Illustrations $2.50 
 
 "This volume puts the student in possession of a condensed medical library. Its accuracy is a strong 
 recommendation, while the portability uf a volume containing the whole circle of HKMiical scionc« is a matter 
 that will have weight with thoso for whoso service the l>ook was originally designed. The work is offered, 
 too, extremely cheap, and will be found a valuable assistant even to a well-informed practitioner of any 
 branch of medicine." — Builun Medical and Surgical JoumaL 
 
 Paget's Lectures on Surgical Pathology. 
 
 Delivered at the Royal College of Surgeons of England, by James Paget, 
 F.R.S., Surgeon to Bartholoview and Christ's Hospital, d-c, dx. The 
 Third American from the Second London Edition, Edited and Revised 
 by "Williabi Turner, M.B., Lond. Senior Demonstrator of Anatomy in 
 the University of Edinburgh, &c., dec. In One Volume, Royai Octavo; 
 with Numerous Illustrations. 
 
 Price, in bevelled cloth, $6.00 
 
 " ill leather, 7.00 
 
 Pennsylvania Hospital Reports. Edited by a com- 
 mittee of the Hospital Staff, J. M. DaCosta, M.D., and William Hunt, 
 M.D. Vols. 1 and 2, for 1868 and 1869, each, volume containing upwards 
 o/Twenty Original Articles, by former and jyresent Members of the. Staff, 
 now eminent in the Profession, with Lithographic and other Illustrations. 
 
 Price per volume, $4.00 
 
 At last, however, the work has been commenced, the Philadelphia Physicians bemg 
 the first to occupy tliis field of usefulness, having issued the first volume of the Reports 
 of the above hospital last year, and the .second volume on January 1st, 1869. The firnt 
 Reports were so favorably received on both sides" of the Atlantic, that it is hardly 
 necessary to speak for this volume the universal welcome of which it is deserving. We 
 cannot close our remarks without stating that the papers are all vnluable contributions 
 to the literature of medicine, reflecting great credit upon their authors, and the work 
 is one of which the Pennsylvania Hospital may well be proud. It will do much toward 
 •l^Mtingthe profession of this country in the estimation of their foreign brethren." 
 
 — American Journal of Obstetrics, May, 18G9.
 
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 Percira's Physician's Prescription Book. 
 
 Containing Lish of Terms, Phrasci^, Contractions, and Abbreviations, tised 
 in Prescriptions, with ^Explanatory Notes, the Grammatical Constructions 
 of Prescriptions, Pules for the Pronunciaiion of ] Pharmaceutical Terms, 
 A Prosodiacal Vocabulary of the Names of Drugs, etc., and a series of 
 Abbreviated Prescriptions illustrating the use of the preceding terms, etc. ; 
 to which is added a Key, containing the Prescriptions in an unabbreviated 
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 From the Fourteenth London Edition. 
 
 Price, in cloth, $1.25 
 
 " in leather, with Tucks and Pocket, . . . 1.50 
 
 This little work has passed through fourteen editions in London and several in this 
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 Physicians Visiting List. Published annually. 
 
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 For 25 Patients weekly, interleaved, tucks, pockets, etc, $1 50 
 
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 Prince's Orthopedic Surgery. 
 
 ORTnoPEDics : A Systematic Work upon the Prevention and Cure of 
 Deformities. By David Prince, M.D. With Numerous Illustrations. 
 Octavo $3.00 
 
 "Thia 1b a good book, upon an important practical subject; carefully written, abundantly illustrated, and 
 well printed. It goes over the wbole ground of deformities of all degrees — from cleft-pulato and club-fnot, to 
 spinal curvatures and ununited fractures. It appears, moreover, to l)e an original book, so far as one chiefly 
 cl' rx)mpilation can be so. Such a book was wanted, and it deserves success." — Mtd. dc Surg. Reporter. 
 
 Prince's Plastic Surgery. 
 
 A New Classification and a Brief Exposition of Plastic Surgery. By 
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 trations. Price, $1.50
 
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 Radcliffe's Lectures on Epilepsy, Pain, Pa- 
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 A7id certain other Disorders of the Nervous System, by Chaeles Bland 
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 12mo $2.00 
 
 "The reputation which Dr. Radcliffe possesses as a very able authority on nervous affeotious, •n'lU commend 
 his work to every medical practitioner. Disorders of the nervous system are very imperfectly comprehended, 
 much concerning them being involved in uiysterj'; and while Dr. Radcliffe has taken advantage of the ample 
 room to theorize, which his subject afforded, he has not failed to bring forward strong and formidable facts to 
 prove (he deductions he attempts to draw. We recommend it to the notice of our readers as a work that will 
 throw much light upon the Physiology and Pathology of the Nervous Pystem." — Canada MedicalJournaJ, 
 
 Robertson's Manual on Extracting Teeth. 
 
 Founded on the Anatomy of the Parts involved in the Operation ; the Kinds 
 and Proper Construction of the Instruments to he used; the Accidents 
 liable to occur from the Operation, and the Proper Remedies to retrieve 
 such Accidents. By Abraham Robertson, D.D.S., M,D., Author of 
 "Prize Essay on Extracting Teeth,'^ &g. In One Volume, with Illustra- 
 tions. Second Edition. Revised and Improved. . . $1.50 
 
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 cible writer, ho has devoted considerable care to the subject, and treated it with his usual ability. The work 
 is valuable, not only to the dental student and practitioner, but also to the niedic.il student and surgeon ; and 
 especjalLv so to the military surgeon, who, in times like the present, is called upon bo frequently to perform 
 the operation of extracting teeth." — Denial Cosmos. 
 
 Ranking's Half-yearly Abstract of the Medi- 
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 Price, per annum, if paid in advance, |2.f)0. Half-yearly volumes, $1.50. 
 The first thirty-two volumes, bound in sixteen volumes, leather, can be 
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 cine to the present time. By P. V. Renouard, M. D. Trayislated 
 from the French by Cornelius G. Comeoys, M. D., Professor of the 
 Institutes of Medicine in the Medical College of Ohio, etc. In One 
 Volume Octavo. Price, $4.00 
 
 "From the pages of Dr. Renouard, a very accurate acquaintance may be otitained with the history of medi- 
 cine— its relation to civilization, its progress compared with other sciences and arts, its most distinguished 
 cnltivators \Tlth the several theories and systems proiiosed by them, and its relationship to the reigning phil- 
 osophical dogmas of the several periods. His historical narration is clear an<l concise, tracing the progress 
 of medicine through its three ages or epochs — that of foundation or origin, that of tradition, and that of 
 renovation."- American Journal of Medical Science. 
 
 "The beat history of medicine extant, and one that will find a place in the library of every physician who 
 Aims at nn acquaintance with the past history of his profession. There arc many items in it we should like 
 to offer for the instruction and amusement cf our readers." — American Journal of Pharm-icy.
 
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 Ryan's Pliilosophy of Marriage. 
 
 In its Social, Moral, and Phtjdcal Relations, with an Account of the Dit- 
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 12ino $1.U0 
 
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 Being a Condensed Vienj of the most important Facts and Doctrines, r/e- 
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 "This monograph is a timely publication, comprehensive in its scope, and presenting within 
 b small compass a fair digest of our existing knowledge of the disease, particularly acceptable 
 at the present time. It is just such a one as is needed, and may be taken as a model for similar 
 works." — Am. Journal Med. Sciences. 
 
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 Its Action and Administration, by Arthur Ernest Sansom, M.B., 
 
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 the administration of these remedies, — passing concisely over the whole ground, giving the latest 'nformatioB 
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 although in his preface he objects to the 'hackneyed expression of endeavoring to supply a want,' this is juflt 
 what he has done — supplied and well supplied a want, for no such book existed before in our language." — 
 American Medical Journal. 
 
 Scanzoni's Practical Treatise on the Diseases 
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 with the ajjproval of the authors. By A. K. Gardner, A.M., M.D., 
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 lege. With Numerous Illustrations. Octavo. . . . $5.00 
 
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 Spratt's Obstetrical Tables. 
 
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 Price, $8.C0 
 
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 12mo $1.50
 
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 Tanner's Practice of Medicine. 
 
 FIFTH AMERICAN EDITION. 
 The Practice of Medicine, by Thomas IIawkes Tanner, M.D., Fellow 
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 the Diseases of Infancy and Childhood, etc., etc. Fifth American from 
 the Sixth London Edition. Greatly Enlarged and Improved. 
 
 Price, bound in cloth, $6.00 
 
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 Dr. Tanner's work on the Practice of Medicine is so well known in this country, and 
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 matter added, written in the same condensed and easy style. 
 
 "The leading feature of this book U its essentially practical character. Dr. Tanner has produced a more 
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 hard practice, and it is therefore valuable as a guide, and trustworthy as an exemplar." — i^orviun Lancet. 
 
 Tanner's Practical Treatise on the Diseases 
 of Infancy and Childhood. 
 
 Octavo $3.00 
 
 This book differs from other works of the kind, in embracing a wider range of sub- 
 jects than is usually contained in treatises on children's diseases; besides the ordinary 
 complaints of those subjects, it includes many afl'cctions which, though common to 
 adults and children, yet ofl'er some modification in form, or in the indications for treat- 
 ment, when occurring in the latter. Thus, we have an account of diseases of the eye, 
 ear, and skin, of small-pox, scrofula, tuberculosis, syphilis, bronchocele, and cretinism, 
 diseases of the kidneys and genital organs, and some of the accidents common to child- 
 hood. The style of the work is condensed, and the book might with truth be called 
 a manual, rather than a treatise, but there is nothing superficial about it; — every- 
 thing really important is given, while the discussion of disputed subjects, p.nd, in 
 fact, of everything which is not of practical importance in the study and treatment of 
 children's diseases, is omitted. 
 
 Tanner's Index of Diseases and their Treat- 
 ment. 
 
 With upwards of 500 Fonnulcz for Medicines, Baths, Mineral Waters, 
 Climates for Invalids, &c., &c. Octavo. .... $3.00 
 
 "Dr. Tanner has been peculiarly happy in appreciating and supplying the wants of the Profession. Ilia 
 Index of Diseases gives the derivation of words after the manner of a good Medical Dictionary; an outline of 
 every disease, including many surgical diseases, with their symptoms and mode of treatment; an admirable 
 collection of Formulae, and an account of the climates of the various parts of the world suitable for invalids. It 
 also contains at the beginning of the worlc a tabular synopsis of subjects, which does double duty at once, a 
 Nosology and an index. It will be found a most valuable companion to the judicious practitioner." — iancrf. 
 
 Tanner's Memoranda of Poisons. 
 
 Frovt, the Seccnd London Edition. • . . .... $0.50
 
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 Trousseau's Lectures on Clinical Medicine. 
 
 Delivered at the Hotel Dieu, Par in, by A. Tr.oussEAU, Professor of Clinv' 
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 with Notes and Appendices, by P. Victoke Bazire, M.D., Assistoai 
 Physician to the National Hospital for the Paralyzed aiid Epileptic, &c. 
 
 Volume One. Cloth 5 00 
 
 Volume Two, 5 00 
 
 \"olume Three, now Ready, . . . . . . . 5 00 
 
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 bo popularized. We scarcely know of any vurk better fitted for present^ition to a young man when entering 
 upon the practical work of his life. The delineation of the recorded ca.ses is graphic, and their narration de- 
 void of that prolixity which, desirable as it is for purposes of extended unilysis, is highly undesirable when 
 the object is to point to a practical lesson." — London Medical Timex <ind Gazettt. 
 
 Tyler Smith's Obstetrics. 
 
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 Toynbee on Diseases of the Ear. Their Nature, 
 
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 Thompson's Clioical Lectures on Pulmonary 
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 Tyson's Cell Doctrine: 
 
 Its History and Present State, with a Coinous Bibliography of the Sub- 
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 vania, &c., &c In Que Volume, with a Colored Plate, and numerous 
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 Tilt's Elements of Health, and Principles of 
 Female Hygiene. 
 
 By F. J. Tilt, JM.D., Senior Physician to the Lying-in Charity, Author 
 of Works on the Diseases of Menstruation, Uterine Therapeutics, d'c, 
 ct-c. 12mo SI 50 
 
 "Dr. Tilt divides life itifo the septennial epochs so long adopted by philosophers and medical men, .liscufs- 
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 devoted to the ago from fourteen to twtnty-oiKi yc'ars contain* mucli Tuliiable advice respecting the menstrual 
 ftmction during that period. Tables showing the value of life at each of the different jieriods of life, ar« 
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 The work of Dr. Taylor is a systematic treatise, containing the principles on which 
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 Virchow's Cellular Pathology. 
 
 As based upon Physiological and Pathological History. Translated from 
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 Or, the Mode in which, and, the Causes why. Beauty, Health, and Intellect 
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 great degree, under the coutrol of man. Although not strictly a medical work, we cannot refrain from conj- 
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 Medical Exaviiner
 
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 Wytlies' Physician's Pocket, Dose, and Symp- 
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 Containing the Doses and Uses of all the Prhicipal Articles of the Materia 
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 sures, Rules to Proportion the Doses of Medicines, Common Abbre- 
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 Waring's Manual of Practical Therapeutics. 
 
 Considered chiefly with reference to Articles of the Materia Medica. By 
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 Price, in cloth, $6.00 
 
 " in leather, 7.00 
 
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 in its completeness, the convenience of its arrangement, and the greater prominence 
 given to the medicinal application of the various articles of the Materia Medica in the 
 treatment of morbid conditions of the Human Body, &c., &c. It is divided into two 
 parts, the alphabetical arrangement being adopted throughout the volume. For the 
 further convenience of the reade- there is also added an Index of Diseases, with a 
 list of the medicines applicable as remedies, and a full Index of the medicines and 
 preparations noticed in the work. 
 
 " Our (xtmiration, not only for the immense industry of the anthor. but also of the great practical value of 
 the volume, increases with every reading or consultation of it. We wish a copy couU be put in the hands 
 of every student or pr.'ictitiouer in the country. In our estimation it is the best book of the kind ever 
 written." — N. T. Medical Journal. 
 
 Weber's Clinical Hancl-Book of Auscultation 
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 Watson's Practice abridged. 
 
 A Synopsis of the Lectures on the Principles and Practice of Physic. De- 
 livered at King's College, London, by Thomas Watson, M.D., Fellow 
 of the Royal College of Physicians, &c., &c. From the last London 
 Edition. With a concise but Complete Account of the Properties, Uses, 
 Preparations, Doses, &c., of all the Medicines mentioned in these Lectures, 
 and other Valuable Additions, by J. J. Meylor, A.M., M.D., &c., &c. 
 A neat Pocket Volume bound in cloth flexible. . . . $2.00 
 
 Wells' Treatise on the Diseases of the Eye, 
 
 illusf rated by Ophthalmoscopic Plates and Numerous E ngravingn on 
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 This is the author's own edition, printed in London under his supervision, and issued 
 in this country by special arrangement with him. 
 
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 Their Causes and their Cure. By Henry G. Wright, M.D., Membei 
 of the Royal College of Physicians, &e. &g. From the Fourth Loudon 
 Edition. 12mo. Cloth. . . . ' . . . . gL25 
 
 ♦' Few aflFections are more unmanageable and more troublesome than those of which 
 this essay treats; and we doubt not that any suggestions by which we can relieve 
 them will be gladly received by physicians. The author's plan is simple and practical. 
 He treats of headaches in childhood and youth, in adult life and old age, giving in 
 each their varieties and symptoms, and their causes and treatment. It is a most satis- 
 factory monograph, as the mere fact that this is a reprint of the fourth edition, testifies. 
 
 "The great pains which the author takes to clear up the dift'erential diagnosis of the 
 different varieties, and establish a satisfactory basis for rational treatment, are every- 
 where visible. While such a valuable fund of information is offered to the practitioner 
 Rt the cost of a single visit, he should. not let his patient suffer for want of it," — 
 Medical and Surgical Reporter. 
 
 and 
 
 Wells on Long, Short, and Weak Sight 
 
 their Treatment by the Scientific Use of Spectacles. Third Edition Re- 
 vised, with Additions and Numerous Illustrations. By J. S(ELBerg 
 Wells. Octavo. ..... Price, $3.00
 
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 Harris's Dictionary of Medical Terminology, 
 
 Dental Surgery, and the Collateral Sciences. By Chapin A. 
 Harris, M.D., D.D.S., Professor of the Principles of Dental Surgery in 
 the Baltimore College, Member of the American Medical Association, &c., 
 &c. The Third Edition, car (fully revised and enlarged, by Ferdi- 
 nand J. S. GoRGAS, M.D., D.D.S., Professor of Dental Surgery in the 
 Baltimore College, &c., &c. Royal octavo. Cloth, ^6.50. Leather, $7.53 
 
 This Dictionary has been for a long time out of print; a new edition has been much 
 needed by the Profession, a constant and increasing demand existing for it. The pres- 
 ent edition has been thoroughly revised by Professor Gorgas, Dr. Harris's successor in 
 the Baltimore Dental College. Many additions and corrections have been made, and 
 some iwo to three thousand new words added. The doses of the more prominent medici- 
 nal agents have also been added, and in every way the book has been greatly im- 
 proved, and its value enhanced. 
 
 Harris's Principles and Practice of Dental 
 Surgery. 
 
 The Ninth Edition, with 320 Illustrations. Royal octavo. 
 Price, bound in cloth, bevelled boards, .... $6.00 
 " leather, 7.00 
 
 This edition of Dr. Harris's work has been subjected to a very thorough revision 
 by competent professional gentlemen, and contains many and important additions, 
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 to its value. The illustrations have also been much improved; some have been replaced 
 by new drawings, and many new ones have been added. The publishers therefore 
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 practitioner. 
 
 Bond's Practical Treatise on Dental Medicine. 
 
 Being a Compendium of Medical Science, as Connected with the Study of 
 Dental Surgery. By TnoMAs E. Bond, M.D., Professor of Special 
 Pathology and Therapeutics in the Baltimore College of Dental Surgery. 
 The Third Edition. Octavo So.OO 
 
 "Wo have spoken, or Intended to apeak, heartily in praise of Dr. Bond's work. It lias nnniistakablo evi- 
 lence of thorough medical science in its Hnbject-nmtter, and of a capital authorship in Ita style and tieat 
 m<uit." — A merican Medical Journal. 
 
 Robertson's Manual on Extracting Teeth. 
 
 Founded on the Anatomy of the Parts involved in the Operation, the Kinds 
 and Projyer Construction of the Instruments to be Used, the Accidents 
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 By A. Robertson, M.D., D.D.S., &c. A iS'ew Revised Edition. $1.50 
 
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 •urgM u." — Pental Ousmos.
 
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 A NEW EDITION, THOROUGHLY REVISED. 
 
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 iviih additions, and fully brought up to the present state of the Science. 
 Containing over 100 1 llmtrations. Octavo. Leather, . . $4.50 
 
 "An examination of Mr. Tuft's treatise onablos us to speak most favorably of it. It is very Diorongti and 
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 reflects much credit ou the publishers." — Boston M'dical and Surgical Journal. 
 
 Fox on the Human Teeth. 
 
 Their Natural History and Structure, the Treatment of the Diseases to 
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 by Chapin a. Hahiiis, M.D., D.D.S., &c. With 250 Illustrations. 
 Octavo $4.00 
 
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 Sf:C0ND EDITION, MUCH ENLAEGED. 
 
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 cuted 1 llustrations. Octavo. Leather $4.50 
 
 Handy's Text-Book of Anatomy, 
 
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 With 312 Illustrations. Octavo $4.00 
 
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 Second Edition, Revised and Enlarged, with 8 Colored Engravings 
 and 51 Illustrations on Wood. Price, . . . . $2 50 
 
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 The Jacksonian Prize E^say of the Poyal College of Sui^geons of Eng- 
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 to University College Hosjntal Over 150 Illustrations. Octavo. 
 Price, $6 00 
 
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 of " Tomes' Dental Physiology," d'c, &c. With 208 beautifully executed 
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 respecting the Selection and Use of Perfumes, Cosmetics, and other Toilet 
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 and Ma7ivfactures." With Index to about 6000 Matters of Interest, Use 
 or Caution. Demi-Octavo. ....... $3.00 
 
 Ott on the Manufacture of Soaps and Candles. 
 
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 and the Modes of Detecting Frauds in the Mamfacturing and, the Making 
 
 of Talloiv and Composite Candles. By Adolph Ott, Pra,ctical and 
 
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 The author, in preparing this volume, has been careful to give a clear and concise 
 
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 by which they are efiected. Much new matter has also been incorporated in the book, 
 
 never before published. 
 
 Piesse's Whole Art of Perfumery. 
 
 A NEW REVISED AND ENLARGED EDITION. 
 
 And the Methods of Obtaining the Odors of Plants ; with Instructions for 
 the Manufacture of Perfumes for the Handkerchief, Scented Powders, 
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 Dr. Piesse's volume covers the entire ground of the subject upon which it treats. 
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 eral reader. 
 
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 and Mining. 
 
 With a Description of the Useful Minerals, and Instructions for Assaying, 
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 The object of this volume is to place before the public the characteristics and uscf 
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 tion of the Appearance of Minerals, with the localities in which they may or have been 
 found ; Assaying, or an Investigation of the value of Minerals, by means which are 
 within the reach of every one ; and Practical Mining in its simplest form. 
 
 Piggott on Copper Mining and Copper Ore. 
 
 Containing a full Description of some of the Principal Copper Mines of the. 
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 A Manual of the Chemical and Chemico- Mechanical Operations of the 
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 "The arrniifTPment of tlie whole is snch, that every Btiident will be able to go through the work without » 
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 study of the book will give the atteutive Htudeut a very UHcfuI insight in all the n)anipnlHtionB of the pharma- 
 ceutical cheniiiit, and thouMands, no doubt, who are jireveuted fom attending the Bchooln of {.tiarniacy and 
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 Branston's Hand-Book of Practical Receipts. 
 
 A Manual for the Chemist, Drufjgist, Medical Practitioner, dec, &c. 
 GompiHi<ing the Officinal Medicines, their Uses, (tnd Modes of Prepara- 
 tion, and Formulae for Trade Preparations, Mineral Waters, Poioders, 
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 12mo ... $1.50 
 
 Campbell's Manual of Scientific and Practical 
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 A Systematic Arrangeniejd of all Scientific Knowledge bearing in any man- 
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 By Prof. J. L. Campbell, of Washington College, Va. 12mo. With 
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 This volume has been prepared to supply those already engaged in the culture of the 
 soil with a guide, tlie study or perusal of which will enable them to improve upon the 
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 and has rendered the pursuit, in so many instances, unprofitable; and also to meet the 
 demands of teachers for a text-book of the right kind, which will give the student such 
 information as will fit him for the intelligent pursuit of agriculture as a busiueis. 
 
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 Or, Herborizing Companion. Containing all the Plants of the Middle 
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 complete Index, etc. By William Darlington, M.D. The Third 
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 Miller on Alcohol, and Lizars on Tobacco. 
 
 Alcohol: Its Place and Power. By James Miller, F.R.S.E., Professor 
 of Surgery in the University of Edinburgh ; President of the Medico- 
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 Surgery, etc., etc. The Use aiid Abuse of Tobacco. By John Lizars, 
 late Professor of Surgery to the Royal College of Surgeons, etc., etc. The 
 Two Essays in One Volume. 12mo. ..... $1.00 
 
 The first of these treatises was prepared by Prof. ^Miller at the request of the Scot- 
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 number of editions in Scotland, and has had a large sale in this country. The second 
 was prepared by Prof. Lizars to show the pernicious consequences of excessive oi 
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 NEW SYDEiNHAM SOCIETY'S PUBLICATIONS. 
 
 LINDSAY & BLAKISTON, Philadelphia, 
 
 Are now prepared to receive subscriptions for the publications of The New Sydkk- 
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 advance, and to furnish any of the previous years at the same rate and on the same 
 terms. 
 
 The Practical Character and Permanent Value of these publications, and the very 
 low price at which they are furnished, commend them to the favorable atteution of the 
 Medical Profession in the United States. 
 
 WORKS ALREADY PUBLISHED. 
 
 1S59. {First Year.) 
 
 Vol. 1. DiDAT on Infantile Syphilis. 
 2. GoocH on Diseases of Women. 
 8, Memoirs on Diphtheria. 
 
 4. A^iN DER KoLK on the Spinal Cord, 4c. 
 
 5. Monographs (Kussmal & Tenner, Qrsefe, 
 
 Wagner, &c.) 
 
 1800. (Spcmul Tear.) 
 Vol. 6. Dr. Bri«ht on .iliilominal Tumors. 
 
 7. Frerichs on Diseases of the Liver. A'ol. I. 
 
 8. A Ykarbook for 18.M). 
 
 9. Atlas of Portraits of Skin Diseases. (1st 
 
 Fasciculuc!.) 
 
 1S61. (nird Year.) 
 
 Vol. 10. A Yearbook for 1 JtiO. 
 
 11. MoNO'iRAPiis (Czermak. Dusch, Radicke, &c.) 
 
 12. Caspkr's Forensic Medicine. Vol. I. 
 
 14. Atlas of Portraits of Sldn Diseases. (2nd 
 Fasciculus.) 
 
 1862. {Fnirth Year.) 
 Vol. 13. Frerichs on Diseases of the Liver. Vol. II. 
 \^. A Ve.^rbook for 1S61. 
 
 16. Caspkr's Forensic Medicine. Vol. II. 
 
 17. Atlas of Portraits of Skin Diseases. (3d 
 
 Fasciculus.) 
 
 1S63. {Fifth Tear.) 
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