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OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRA aan ivnouvn 3NiDia3w do Aavaan ivnouvn snidiqsw do Aavaan ivnouvn snidiqsw do a; MODERN THERAPEUTICS: A COMPENDIUM OF RECENT FORMULA, APPROVED TREATMENT, AND SPECIFIC METHODS \ IN MEDICINE AND SURGERY, WITH AN APPENDIX ON HYPODERMIC MEDICATION, INHALATION, AERATION, AND OTHER REMEDIAL AGENTS AND THERA- PEUTIC METHODS, OF RECENT INTRODUCTION. By GEORGE H. ^APHEYS, a.m., m.d., etc. JFcmrtl) (gbttton, Jte~turittm anb (£nlarjgeb. PHILADELPHIA: ^~^fBj,\W^ D. G. BRINTON, 115 SOUTH SEVENTH STREET 1877. I ST J Entered according to Act of Congress, in the year 1876, by D. G. BRINTON, in the Office of the Librarian of Congress, in Washington, D. C. All rights reserved. JAMES A. MOORE, PRINTER, 1222 and 1224 Sansom Street, Philadelphia. EDITOR'S PREFACE. When this work was somewhat nfore than one-third through the press, the author was attacked by the malady which brought his life and labors to their close. The MSS. were transferred by his representatives to the present editor, with the request that the publication be completed. This has now been done, in general conformity with the author's plan, as stated in his Preface. Some incompleteness, however, in the references and resumes will be noted in the later pages. The author had not entirely carried out his arrangement in this portion of his manuscript, and although the editor has filled up the lacunae to some extent, he has been obliged to defer the completion of the scheme until another edition, which, he hopes, will in no long time be demanded. The unusual popularity of the previous editions encourages this hope. In fact, this work stands alone, of its kind, in medical lit- erature. It presents the Art of Therapeutics in all its aspects, and divested of that barren theorizing which has been its bane. Ac- quainting the reader with the exact treatment of each disease by living clinical teachers and careful practitioners of several countries, it vastly widens his therapeutic resources, prevents him from be- coming a routinist, and inspires him with confidence in the reme- dies he employs. So far from leading him to become a mere formularum prce- scriptor, the diversity it exhibits teaches him independence of thought; while the care with which the indications calling for particular remedies or combinations are given, awakens and in- structs his powers of clinical observation. But this remark is not intended to belittle the value of definite iii IV editor's preface. formulae. The author has most wisely preserved these whenever possible. By skilful combinations, nauseous articles are rendered palatable, which is often no slight matter; ingredients of facile decomposition may be given permanence; the labors of the pharma- cist are lightened; and, more than all, the efficiency of pharmaceu- tical products may be very largely increased. The intelligent recognition of the last-mentioned fact may be claimed as one of the later advances of medical science. The poly- pharmacy of our forefathers in the profession has disappeared, not giving way to any nonsensical "law of the single remedy," as Homoeopathy advocates, but to a clear insight into the synergic action of remedies, by virtue of which a judicious combination of several drugs acts in a given direction more forcibly than any one of them singly. It is needless here to quote instances of this truth. They may be found in abundance in the pages which follow. If studied and applied in daily professional practice, they will con- vince the most doubting that the nihilism in therapeutics, which is so prevalent to-day, comes either from an ignorance of the correct methods of prescribing drugs, or from a pursuit of that ignis fatuus, " physiological therapeutics." D. G. B. AUTHOR'S PREFACE. This volume differs from ordinary works on the practice of Medicine, in being devoted exclusively to Practice; from works on Materia Medica, in treating only of Therapeutics; and from a Formulary, in that it is not a mere collection of prescriptions, but aims at a systematic analysis of all current and applied means of combating disease. The contents of the book are nearly doubled in this edition. Many diseases omitted in the previous editions here find a place. The sections on Diseases of Women and Diseases of Children, as well as many other parts, are greatly enlarged. The division on Surgical Therapeutics is new. It does not embrace operations nor apparatus, but the application of articles in the materia medica to surgical practice. As I have received a portion of the matter here presented directly from the authors, in this country and in Europe, this much of the volume will not be found elsewhere. When I have drawn from medical periodicals, the name and date of the journal are given in the text. But where a monograph or systematic treatise has been the source of information, the name of the author and his residence are given, and by consulting the index to his works the reader can readily verify the quotation or abstract of his views. Formulas from foreign sources have generally been rendered into the terms of the United States Pharmacopoeia, equivalent officinal preparations replacing those unknown to the shelves of our apothe- caries. A formula that cannot be filled by the druggist is useless to the physician, or, at least, puts him to the labor of translating it into familiar ingredients. The new nomenclature is adopted, the v vi author's preface. salts of the alkaline metals being designated as of the particular metal, and not of its oxide, etc. The diseases are arranged in alphabetical order under the gen- eral nosological division to which they belong. The treatment of each is first stated as given by different practitioners, then by vari- ous hospitals, after which follows a resume* of the more important remedies employed in its management. An asterisk * designates those especially commended. American, English and Continental practitioners are quoted in nearly equal numbers. As I have not attempted to mention every remedy employed for a disease, but only such as have some good authority, or else a very plausible theory for their use, so I have endeavored to select as authorities either practitioners of acknowl- edged reputation, or else such who have sustained their therapeutic suggestions by sound reasoning and sufficient evidence. TABLE OF CONTENTS. PAGE Editor's Preface.............................................................,............„„„ m Author's Preface................................................,.......................,...... v Table of Contents.....................,....................................................... vn PART I. MEDICAL THERAPEUTICS. I. DISEASES OF the nervous system. Apoplexy............................................................................................. if Resume of Remedies...................................................................... 20 External Remedies........................................................................ 21 Chorea................................................................................................ 22 Resum© 0f Remedies...................................................................... 29 External Remedies........................................................................ 31 Delirium Tremens........................................................'...................... 32 Resume of Remedies...................................................................... 34 External Remedies......................................................................... 37 Epilepsy.............................................................................................. 38 Resume of Remedies...............................................t...................... 43 External Remedies......................................................................... 46 Headache............................................................................................ 47 Nervous........................................................................................ 47 Bilious, Sick or Dyspeptic.............................................................. 56 Congestive, or Plethoric.................................................................. 57 Gouty................................................................................•••<....... 57 Hysterical and Nervous.................................................................. 57 Neuralgic................................................•.............••......••"............ 59 Periodic.......................................•..............•■..........•.......•"•......... 60 Rheumatic.................................................................................... 60 Severe Idiopathic..........................»......•••>......»..................».........* 60 . From Mental Derangement............................•............................... 60 vii Viii TABLE OF CONTENTS. PAGE HEMICRANIA ....................................................................................... 61 Resume of Remedies...................................................................... ° Hypochondriasis................................................................................. 62 Resume of Remedies..................................................................... " Hysteria............................................................................................. 65 Resume of Remedies..................................................................... "° Insolation.......................................................................................... 70 Resume of Remedies...................................................................... '" Insomnia............................................................................................. /4 Resume 0f Remedies...................................................................... °" Acute Meningitis............................................................................... 81 Resume of Remedies...................................................................... °2 Neuralgia.......................................................................................... 83 Resume of Remedies..................................................................... 91 External Remedies........................................................................ 94 Paralysis............................................................................................ 97 Resume of Remedies...................................................................... 97 Hysterical Palsy............................................................................ 99 Lead Palsy................................................................................... 99 Mercurial Palsy............................................................................. 99 Rheumatic Palsy........................................................................... 99 Progressive Locomotor Ataxia........................................................ 100 Resume of Remedies...................................................................... 101 External Remedies........................................................................ 101 Sciatica............................................................................................... 102 Resume of Remedies...................................................................... 103 External Remedies........................................................................ 103 Tetanus................................................................................................ 105 Resume of Remedies...................................................................... 107 External Remedies...................................................,.................... 109 Tic Douloureux................................................................................. 110 Resume of Remedies...................................................................... 112 External Remedies........................................................................ 112 Vertigo............................................................................................... 114 Resume of Remedies...................................................................... 114 II. DISEASES OF THE RESPIRATORY SYSTEM. Aphonia.............................................................................................. 115 Catarrhal Aphonia........................................................................ j^g Hysterical and Nervous Aphonia ................................................... H7 Functional Aphonia ..................................................................... H7 Asthma................................................................................................. 113 Resume of Remedies..........................'............................................ 125 External Remedies......................................................................... !28 Acute Bronchitis............................................................................... 129 Resume of Remedies......................................................... ........... jog Chronic Bronchitis........................................................................... 138 Resume of Remedies.................................................................... -. ,„ External Remedies............................................................... -,,-n TABLE OF CONTENTS. ix PAGE Catarrh............................................................................................. 151 Resume of Remedies...................................................................... 152 Chronic Catarrh............................................................................. 153 CORYZA................................................................................................. 154 Resume of Remedies...................................................................... 155 External Remedies........................................................................ 156 Emphysema.......................................................................................... 157 Resume of Remedies...................................................................... 161 HAEMOPTYSIS......................................................................................... 162 Resum'J of Remedies....................................................................... 165 LARYNGITIS.......................................................................................... 167 Resume of Remedies..................................................................... 167 External Remedies........................................................................ 168 Phthisis............................................................................................... 169 Resume of Remedies...................................................................... 189 Inhalations.................................................................................... 192 The Anaemia of.............................................................................. 193 The Aphthse of.............................................................................. 193 The Constipation of........................................................................ 193 The Cough and Expectoration of..................................................... 194 The Diarrhoea of........................................................................... 194 The Dyspepsia of.........................,.„.............................................. 195 The Dyspnoea of............................................................................ 195 The Hemorrhage of........................................................................ 195 The Neuralgia of........................................................................... 195 The Profuse Perspirations of............... ............................................ 196 The Vomiting of............................................................................ 196 The Preventives of........................................................................ 196 Pleurisy, Acute................................................................................. 197 Resume of Remedies ..................................................................... 199 Pleurisy, Chronic.............................................................................. 200 Resume of Remedies..................................................................... 202 Pneumonia ....................................................................................... 203 Resum<' of Remedies...................................................................... 206 Chronic........................................................................................ 208 III. DISEASES OF THE CIRCULATORY SYSTEM. Angina Pectoris................................................................................ 209 ResurcT' of Remedies..................................................................... 210 Cardiac Dilatation............................................................................. 210 Resume 0f Remedies..................................................................... 212 Cardiac Hypertrophy....................................................................... 213 Resume of Remedies...................................................................... 214 Carditis, Endo-carditis and Peri-carditis....................................... 215 Resume 0f Remedies..................................................................... 216 Rheumatic Carditis....................................................................... 216 Fatty Degeneration of the Heart................................................ 217 Resume 0f Remedies..................................................................... 218 Functional Palpitation of the Heart.......................................... 218 Resume of Remedies..................................................................... 219 X TABLE OF CONTENTS. PAGE Internal Aneurisms......................................................................... 22° Resume of Remedies..................................................................... 22 Valvular Disease of the Heart..................................................... 221 Resume of Remedies..................................................................... 223 IV. DISEASES OF THE DIGESTIVE SYSTEM. The Mouth......................................................................................... 225 Stomatitis.................................................................................... 225 Aphthse...................................................................................... 226 The Fauces........................................................................................ 227 Inflamed Sore Throat.................................................................... 227 Anorexia......,.................................................................................... 228 Biliary Calculus.............................................................................. 230 Resume of Remedies..................................................................... 231 Cholera Asiatica.............................................................................. 232 Resume of Remedies..................................................................... 238 Colic.................................................................................................. 242 Simple Flatulence........................................................................ 242 Resume of Remedies..................................................................... 243 Ileus.................................................................................................. 245 Resume of Remedies.................................................................... 246 Painters' Colic—Lead Colic............................................................. 246 Resume of Remedies..................................................................... 246 Constipation, Habitual..................,.................................................. 247 Resume of Remedies.................................................................... 252 Diarrhoea and Dysentery................................................................ 254 Resume of Remedies.....,............................................................... 256 Subacute and Chronic Diarrhoea..................................................... 257 Dysentery, Acute.............................................................................. 259 Resume of Remedies.................................................................... 262 Dysentery, Chronic......................................................................... 263 Resume of Remedies...................................................................., 265 Dyspepsia.......................................................................................... 267 Resume of Remedies.................................................................. 272 Gastralgia........................................................................................ 277 Resume of Remedies.................................................................... 278 Gastritis............................................................................................ 279 Resume 0f Remedies........................................................,........... 279 Gastric Ulcer.................................................................................... 280 Resume of Remedies .................................................................... 280 HjEMATEMEsis .................................................................................... 281 Resume of Remedies.................................................................... 282 Hepatitis, Acute .............................................................................. 283 Hepatitis, Chronic........................................................................... 283 Resume of Remedies.................................................................... 285 Jaundice............................................................................................ 285 Resume of Remedies.................................................................... 287 Torpidity and Functional Derangement op the Liver................ 288 Resume of Remedies.................................................................... 289 TABLE OF CONTENTS. XI PAGE Pyrosis............................................................................................. 289 Resume of Remedies .................................................................... 290 Vomiting............................................................................................. 291 Resume of Remedies.................................................................... 291 V. DISEASES OF THE URINARY SYSTEM. Albuminuria...................................................................................... 294 Resume of Remedies.................................................................... 295 Height's Disease................................................................................. 296 Resume of Remedies..................................................................... 301 Cystitis ............................................................................................ 301 Local Internal Treatment............................................................... 304 Resume of Remedies...................................................................... 305 Diabetes............................................................................................. 306 Resume of Remedies.................................................................... 311 Hematuria........................................................................................ 318 Resume of Remedies..................................................................... 318 Incontinence of Urine..................................................................... 319 Nephritis........................................................................................... 320 Resume of Remedies..................................................................... 320 Sabulous Deposits (Gravel).............................................................. 320 Resume of Remedies..................................................................... 322 VI. DISEASES OF THE BLOOD, Anaemia............................................................................................... 323 Resume of Remedies..................................................................... 325 Cerebro-spinal Meningitis.............................................................. 326 Erysipelas......................................................................................... 328 Resume of Remedies..................................................................... 330 Local Applications....................................................................... 331 Gout................................................................................................... 332 Resume of Remedies..................................................................... 335 External Applications................................................................... 336 Malarial Diseases............................................................................ 337 Personal Prophylaxis......................................•............................. 337 Milk Sickness.................................................................................... 338 Purpura Hemorrhagica.................................................................... 338 Resume of Remedies..................................................................... 338 Rheumatism, Acute.....................................•.................................•••■ 339 Salicylic Acid Treatment.............................................................. 339 Alkaline Treatment...................................................................... 340 Resume of Remedies.................................................................... 351 Local Applications........................................................................ 352 Scrofula............................................................................................ 6™ Resume of Remedies..................................................................... xii TABLE OF CONTENTS. PAGE Typhoid Fever.................................................................................. 357 The Antipyretic Treatment............................................................ 357 The Antiseptic Treatment.............................................................. 36° Variola—Small-pox.......................................................................... 360 Resume of Remedies..................................................................... i*"1 VII. DISEASES OF WOMEN. TnE Constitutional Treatment of Diseases of Women................. 363 Abortion............................................................................................ 364 Resume of Remedies.............................................................................. 36o Amenorrhea..................................................................................... 365 Resume of Remedies.................................................................— 368 Chlorosis .......................................................................................... 370 Resume of Remedies..................................................................... 371 Dysmenorrhea.................................................................................. 373 Resume of Remedies..................................................................... 374 Mammary Diseases............................................................................ 375 Menorrhagia..................................................................................... 378 Resume of Remedies.................................................................... 382 Ovarian Diseases.............................................................................. 384 Resume of Remedies..................................................................... 385 Pruritus Vulv^;................................................................................. 386 Resume of Remedies................................................... ................. 387 Uterine Diseases.............................................................................. 389 Intra-Uterine Medication.............................................................. 391 The Medical Treatment of Uterine Tumors..................................... 391 Uterine Ulceration........................................................................ 393 Cancer of the Uterus..................................................................... 393 Vaginismus......................................................................................... 394 Vaginitis, Vaginal Catarrh, Leucorrhcea...................................... 395 Resume of Bemedies..................................................................... 396 Vaginal Injections........................................................................ 397 Vomiting of Pregnancy.................................................................... 399 Vulvitis.............................................................................................. 400 VIII. DISEASES OF CHILDREN. Infantile Therapeutics.................................................................... 401 Anemia.............................................................................................. 402 Resume of Remedies..................................................................... 402 Bronchitis and Laryngitis............................................................... 402 Cholera Infantum.............................................................,.............. 404 Convulsions...........................................................................:........... 499 Resume of Remedies..................................................................... 499 CORYZA................................................................................................ 410 Croup, Membranous and Spasmodic.................................................. 411 Resume of Remedies..................................................................... 415 TABLE OF CONTENTS. Xlll page Diarrhcea in Children..................................................................... 416 Diphtheria........................................................................................ 420 Resunifi of Remedies..................................................................... 424 External Applications................................................................... 425 Hydrocephalus.................................................................................. 427 Resume of Remedies..................................................................... 428 Incontinence of Urine..................................................................... 429 Pertussis............................................................................................ 430 Resume of Remedies..................................................................... 432 Pneumonia, Infantile........................................................................ 433 Rachitis............................................................................................. 435 Scarlet Fever................................................................................... 436 Stomatitis......................................................................................... 439 Tonsillitis......................................................................................... 441 Worms................................................................................................ 442 PART II. SURGICAL THERAPEUTICS. I. WOUNDS AND INJURIES. The Open Treatment of Wounds.................................................... 445 Water Dressings............................................................................... 446 Earth Dressings................................................................................ 447 Antiseptic Dressings........................................................................ 447 Local Anaesthesia............................................................................. 454 Bites and Stings............................................................................... 454 Burns and Scalds.............................................................................. 455 Frostbite........................................................................................... 457 Sprains and Bruises.......................................................................... 459 II. SURGICAL DISEASES. Cancer............................................................................................... 460 Carbuncles and Furuncles.............................................................. 464 Carious Teeth................................................................................... 467 Epistaxis............................................................................................ 468 Fissure of the Anus......................................................................... 468 Goitre................................................................................................ 469 Hemorrhoids..................................................................................... 470 xiv TABLE OF CONTENTS. PAGE Hospital Gangrene........................................................................... 473 N^evi................................................................................................... 475 Necrosis............................................................................................. 476 Orchitis.................................,........................................................... 477 0&£xa................................................................................................. 478 Prolapsus Ani.................................................................................... 479 Prostatic Enlargement.................................................................... 480 Pruritus Ani...................................................................................... 481 Spermatorrhea................................................................................. 481 Synovitis............................................................................................ 484 Tumors............................................................................................... 485 Ulcers................................................................................................ 487 Varicose Veins.................................................................................. 490 III. THE EYE AND EAR. Blepharitis....................................................................................... 491 Conjunctivitis.................................................................................... 491 Corneal Opacities............................................................................. 495 Corneal Ulcer.................................................................................. 495 Granular Lids................................................................................... 496 Hyperemia of the Conjunctiva...................................................... 496 Iritis.......................................................................................,.......... 497 Keratitis............................................................................................ 502 Styes................................................................................................... 502 Wounds and Injuries........................................................................ 502 Otitis, Acute...................................................................................... 503 Otorrhea.......................................................................................... 503 IV. DISEASES OF THE SKIN. Acne................................................................................................... 505 Alopecia............................................................................................ 507 Eczema............................................................................................... 508 Erythema.......................................................................................... 512 Favus................................................................................................. 513 Herpes............................................................................................... 514 Impetigo............................................................................................. 515 Lepra................................................................................................. 515 Lichen................................................................................................ 516 Lupus.................................................................................................. 517 Mentagra.......................................................................................... 519 Pityriasis.......................................................................................... 5ig Prurigo.............................................................................................. 52q Psoriasis............................................................................................. 52i Rosacea............................................................................................. 523 Scabies............................................................................................... 524 Tinea.................................................................................................. 525 Urticaria.......................................................................................... 526 TABLE OF CONTENTS. XV PAGE The General Therapeutics of Skin Diseases................................ 528 Arsenic in Skin Diseases............................................................... 528 Mereury in Skin Diseases.............................................................. 533 On Parasiticides........................................................................... 534 Diet in Skin Diseases.................................................................... 539 V. VENEREAL DISEASES. Balanitis........................................................................................... 543 Gonorrhea........................................................................................ 544 Gonorrhceal Orchitis..................................................................... 551 Prostatic Gleet.............................................................................. 552 Gonorrhoeal Rheumatism............................................................... 555 Resume of Remedies..................................................................... 555 External Measures........................................................................ 560 Syphilis.............................................................................................. 561 Syphilitic Laryngitis.................................................................... 575 Syphilides................................................................................... 576 APPENDIX. 1. Aeration; the Use of Compressed and Rarefied Air............... 577 2. Endermic Medication, Rules for................................................ 578 3. Hypodermic Medication, Formulae and Doses for..................... 579 4. Inhalation, Formulae and Doses for.......................................... 589 5. Insufflation.................................................................................. 592 MODERN THERAPEUTICS. 1= -AK/T I. itte&ual €l)crap£ttttC0. I. DISEASES OF THE NERVOUS SYSTEM. Apoplexy— Chorea—Delirium Tremens—Epilepsy—Headache— Hemicrania — Hypochondriasis —Hysteria — Insolation—In- somnia—Meningitis, Acute—Neuralgia —Paralysis—Progres- sive Locomotor Ataxia—Sciatica—Tetanus—Tic Douloureux— Vertigo. APOPLEXY. The treatment of this disease of the nervous system is given as follows by PROF. WILLIAM AITKEN, M. D., EDINBURGH. Active purgatives generally do good after the patient has in some degree revived, by relieving the head and improving the secretions of the alimentary canal. 1. R. Hydrargyri chloridi mitis, gr.v Pulveris jalapae compositi, 3j. M. This powder given as soon as the patient can swallow, and fol- lowed up by an ounce of sulphate of magnesium in camphor water every four or six hours, and continued according to its effects, for a greater or less length of time, is the best method of promoting re- 2 18 DISEASES OF THE NERVOUS SYSTEM. covery, and preventing relapse in cases associated with simple ple- thora. If the attack be in consequence of hypertrophy of the heart, without valvular disease, then eight or ten minims of tincture of digitalis may be added to each dose of the purgative medicine. If the patient cannot swallow, three or four drops of croton oil should be put on the back part of the tongue, and stimulating enemata thrown up the rectum. The following enemeta are recommended:— 2. R. Olei ricini, Olei terebinthinse, aa f.giss Tincturse assafcetidse, f'vf'J.. Decocti avenae, f-Sxy- M. To be thrown up by means of a long stomach-pump tube. 3. R. Olei ricini, Olei terebinthinae, aa f.^j Olei tiglii, T*lvj Decocti avenae, f.^iv. M. For an enema. All employment of emetics is to be condemned. Blood-letting may be resorted to, if the patient be seen during the fit, if the tendency to death is by coma, if the pulse be full, or hard, or thrill- ing, if the vessels of the neck be congested, the heat of the scalp increased, if the face be full and turgid, and especially if the action of the heart be vigorous, its sounds normal, and the heat of the skin preserved. Ten ounces will generally be sufficient, if taken at the first outset of the attack; but if the pulse does not improve, and the symptoms remain unrelieved, sixteen to twenty ounces may be taken. The head and shoulders should be raised while the blood is flowing. When the pulse is small and slow, feeble or almost imperceptible, the skin cold and clammy, with a tendency to death by syncope, then no advantage is to be gained by the ab- straction of blood. Blood-letting is, therefore, contra-indicated in anaemia, aortic valvular disease, and in cases commencing with syncope. If the blood-letting be not followed by some degree of consciousness, it may be inferred that the amount of blood effused is considerable, and that the patient, in all probability, will not re- cover. Still, an additional chance may be given by applying to the head cold cloths, or crushed ice in a bladder, leeches to the tem- ples, and mustard cataplasms to the feet; also by placing a drop or two of croton oil on the tongue, and by throwing up a cathartic enema of castor oil or other purgative. APOPLEXY. 19 The diet should be low until all apprehension of a relapse is past. It should be limited to milk, boiled vegetables, light puddings and fish. At no subsequent period should a full animal diet or undi- luted wines be indulged in. At the same time, the irritability of the system and the heart's action must not be increased by ordering too lowering a regimen. J. HUGHLINGS JACKSON, M. D., LONDON. There is, unfortunately, little to be done. The chief thing is to keep the patient quiet. Two drops of croton oil should be put on the tongue and the urine drawn off, if it do not pass freely with- out help. The application of blisters to the back of the neck, or of mustard plasters to the calves of the legs, is a common practice, with no evidence to show that these applications are of service. Still, in certain cases of chronic cerebral disease, blisters relieve the patient of severe pain in the head; and it is not possible to deny that they may be of service -when the circulation of the brain is quickly disturbed after a clot. Were our author to use blisters, which he never does, he would only employ them where there is secondary disturbance of the circulation. It is hard to believe that mustard plasters to the calves of the legs can be of any service or disservice. Dr. Jackson never prescribes any medi- cine, except croton oil, by the mouth. If the patient is found in, or has passed into, a condition in which the face is flushed, the temperature above 100, the veins promi- nent, and the respiration and circulation largely disturbed, treat- ment, beyond, perhaps, purgatives, is of little use. If, however, the pulse be not very rapid, little more than 100, and if it and the respiration be regular, it is not unreasonable to think that the system may be relieved—though the ultimate size of the clot may not be influenced—by bleeding. The practice of bleeding in cerebral hemorrhage, deprecated by Trousseau and Todd, must be exceeding rare in England, as in the whole course of Dr. Jack- son's life he has seen but one person bled for cerebral hemorrhage. If the pulse be very high, 120, 130 or 150, or if it be weak, vene- section must not be thought of. This is about all of the little that can be done for patients who are in the apoplectic condition. When this condition is passed, we are practically unable to help in the immediate difficulty of infu- sion of blood in nervous tissue. We have still, as in many other 20 DISEASES OF THE NERVOUS SYSTEM. diseases, to improve the general health. The proper care of a patient who has a clot of blood in his brain, and who is liable to have more effused, consists in attending to his diet, excretions, sleep and exercise. Yet there is nothing in this peculiar to the treatment of cerebral hemorrhage. For the immediate lesion, blood in nervous tissue, our author knows of no direct treatment. prof, pajot, faculte DE MEDECINE DE PARIS. According to the age and strength of the subject, bleed, or apply leeches to the anus or behind the ears. Kepeated and energetic counter-irritants should be applied, from place to place, along the limb. A purgative enema is often of great benefit. The head should be kept raised, and all constriction of the circulation care- fully guarded against. Cold compresses of water, or water and vinegar, may be applied to the head, or even a bladder half filled with ice, which should be withdrawn at intervals. RESUME OF REMEDIES. Acidum Arseniosum is of benefit in strong plethoric subjects with a tendency to apoplectic congestion, but is not applicable to old weakly persons. It is supposed to act by reducing the excess of the red globules of the blood. Aloes. Aloetic purgatives are frequently indicated and often prove beneficial. Colocynthis. In full doses, repeated until it operates freely, colocynth is use- ful as a powerful cathartic and derivative. *Hydrargyri Chloridum Corrosivum. Dr. Headland recommends for the threatenings of apoplexy in old age (e. g., vertigo, confusion of ideas and general embarrassment of the mental faculties) corrosive subli- mate in doses of gr. -fa in solution, three times a day, for three or four weeks. Hydrargyri Chloridum Mite. Administered as recommended by Dr. J. Cop- land (grs. x-xv, mixed with a few grains of gamboge, rubbed up with butter, and placed at the root of the tongue), calomel, al- though a speedy and effectual purge, is not unattended with danger. Alarming ptyalism has followed this treatment. Oleum Terebinthinoz is used both externally and internally. A full dose with an equal quantity of castor-oil, acts, when the patient can swallow, as a useful purgative. * Oleum Tiglii is peculiarly adapted as a purgative, derivative and revulsive in apoplexy, from the readiness with which it may be administered, by being simply placed at the back of the tongue. Potassii Iodidum has been recommended in cerebral apoplexy, on account of its eliminative power, after the acute symptoms have subsided. Sinapis. In cases of apoplexy from over distention of the stomach, mustard, in doses of a tablespoonful or less in a tumbler of warm water, is a good and quick emetic, which, by removing the exciting cause, is of essential benefit. Strychnia. Dr. Marshall Hall has derived great benefit from the use of ace- APOPLEXY. 21 tate of strychnia in the threatenings of apoplexy. He advises the following formula :— 4. R. Strychniae acetatis, gr.j Acidi acetici, Tt\,xx Alcoholis, f.^ij Aquae, f.^vj. M. Dose, ten drops, combined with a rigid system of mental discip- line, diet, etc. Blood-letting is no longer the routine practice in apoplexy. It is now gene- rally recognized that there is less danger in not bleeding at all than in taking mood in doubtful cases, in which there may be some of the indications for bleeding. The contra-indications of bleeding in apoplexy are an age over sixty; a feeble, very frequent, intermitting, slow or large pulse, or one inclined to double beat; a respiration labored and accompanied with cold perspiration ; great mobility of the nervous system, with weak muscles, whether the body be thin or corpulent; an attack soon after a full meal, or after great mental or bodily fatigue. The indications for bleeding are a quick, wiry, resisting pulse, flushed countenance ; warm perspirations ; noisy breathing ; a tend- ency to spasmodic muscular contraction ; and an age under sixty. * Diffusible Stimulants may be given with advantage, particularly when the pulse has a double beat, in atonic cases where bleeding is contra-in- dicated. Aqua ammonia; is one of the best of these ; tti, xij-xv may be administered in water, and the vapor also applied to the nostrils. Or f.g ss-j of the aromatic spirit of ammonia may be given in water or camphor mixture. Or grs. v of the carbonate of ammo- nium may be ordered. Enemata. Terebinfchinate and other enemata often afford relief, not only by removing scybala, but by their powerful revulsive action. (F. 2, 3.) EXTERNAL REMEDIES. Counter-irritation. Capsicum cataplasms to the feet are powerful and excel- lent revulsives, which will, however, cause vesication if kept on too long. Sinapisms to which have been added powdered capsicum, or oil of turpentine, may, in most instances, be applied with evident benefit to the soles of the feet and the inner parts of the calves and thighs. Blisters applied to the calves of the legs and sometimes to the nape of the neck, are of benefit in simple or •' serous11 apoplexy, but of little advantage in sanguineous apoplexy. An open blister at the nape of the neck (or better, a seton or issue there) is often very useful when there is a tendency to apoplexy. Turpentine stupes to the extremities are frequently productive of benefit. Ice applied to the head while the feet are immersed in hot water, is sometimes productive of benefit, but must be employed with great caution in debilitated or old subjects *Leeches. In threatened apoplexy arising from the suppression of a habitual discharge, as from piles, leeches applied to the verge of the anus often afford prompt relief. If the threatened attack arise from suppression of the menses, the leeches should be applied to the inner side of the thighs. Sir Henry Holland states that he knows of no mode in which a given quantity of blood can be removed with equal good effects. Leeches to the verge of the anus give more immediate bene- fit than three times the number to the temples or elsewhere. 22 DISEASES OF THE NERVOUS SYSTEM. CHOREA. PROF. WILLIAM AITKEN, M. D., EDINBURGH. The indications of cure are: 1. To remove, if possible, all mor- bid states of the body which may tend to aggravate the disease, such as constipation, anaemia, amenorrhea, worms. 2. By well regulated purgative medicines to subdue any cerebral congestion. 3. To sustain the strength and improve the vigor of the nervous system by tonic and stimulant medicines, by food and by the cold bath. 5. R. Camphorae, 9V Syrupi, q- s. M. Divide into 20 pills. One three times a day. Useful after discharges have become healthy by the action of the purgatives. 6. R. Spiritus aetheris nitrosi, f.^j Aquae camphorae, f-3uJ* ^. Tablespoonful three times a day. Many young women, who attribute the attack to fright, get well under this treatment. G. H. BARLOW, M. D., LONDON. In ordinary cases the exhibition of purgatives to keep the bowels freely open, and the sulphate of zinc, in doses gradually increased from gr. j-xij-xv-xx, or even more, will effect a cure; when, however, the sulphate has been used in these large doses, its sudden discontinuance seems to be felt by the system, and a return of the symptoms ensues; the best rule, therefore, for its exhibition is as follows: The bowels being kept open, the sulphate should be commenced in doses of gr. j, for a child set. 12 years, and this should be increased by the addition of gr.j to each dose, daily, until it either causes sickness, or there is an obvious diminution of the choreal move- ments. In the former case, the dose should be diminished by at least one-half, and so continued for several days, with a view of estab- lishing a tolerance; but if, on the other hand, there be marked improvement, it should be no further increased, but continued without alteration until either the improvement ceases—in which case it should be again gradually increased—or the disease has altogether subsided. When the latter is the case, the dose should be diminished day by day, rather than discontinued suddenly, as CHOREA. 23 by following the former course, we have less reason to dread a relapse. When anaemia is present, iron has more control over the disease than zinc. PROF. BOUCHUT, PARIS. In the treatment of chorea, Dr. Bouchut prescribes chloral, two and a half scruples in the course of the day. During the sleep thus provoked no choreic movements are observed. Our author affirms that chloral carefully prepared may be administered to children of from twelve to fifteen years, in doses of gr. xxx-9 iv, repeated daily during ten or fifteen days, without any bad results. THOMAS KING CHAMBERS, M. D., ETC., LONDON. 7. R. Liquoris potassii arsenitis, nVv Thrice daily ; to be increased to ^Ixvj. Also cod liver oil and iron, if indicated by the general condition. Injudicious management of patients afflicted with chorea fre- quently protracts the case. One of the most common forms of in- judicious management is the fixing of the attention of patients upon their infirmity, by telling them how bad they are, offering unne- cessary help, etc. They should be encouraged to make every ex- ertion to direct the movements of the limbs; as by slow walking to music, carrying trays and crockery, and other things that demand care. In order that their attention may be withdrawn from their deficiencies, looking glasses and the distressing sight of other choreics should be avoided. They should be got away from home as soon as possible. Sent under the care of a judicious person to the seaside, or anywhere else for an excuse, children often recover rapidly; whereas, had they remained at home, they would have continually relapsed. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 8. R. Zinci valerianatis, 9jj Cinchoniae sulphatis, 9j. M. For 20 pills; one thrice daily. The Bromide of Iron has lately been employed by our author with excellent effects. It should be given in increasing doses, be- ginning with never less than five grains for a child, and running up the dose rapidly to twenty grains three times a day. 9. R. Cupri ammoniati, gr.^ In pill thrice daily; to be gradually increased to gr.j. 24 DISEASES OF THE NERVOUS SYSTEM. 10. R. Extracti cimieifugae fluidi, gtt.xx. For one dose, three times a day. THOMAS HILLIER, M. D., LONDON. 11. R. Liquoris potassii arsenitis, ^J.. Potassii bicarbonatis, gr,uj Potassii iodidi, gr.ij Aquae camphorae, f-^ss. M. For one dose, thrice daily, to children aged five, for aggravated chorea, attended with severe pains in the limbs, and rheumatic persistent swellings. Arsenic in full doses is a valuable remedy in a fair proportion of cases, but in some instances it entirely fails. Iodide of potassium is useful when the patient is subject to chronic rheumatism. Occasionally purgatives and tonics, especially iron, are attended with much success. Strychnia, so highly recommended by Trous- seau, seems, to our author, to be highly injurious in the acuter stages of the disease; in the more chronic form, and where there is a tendency to paralysis, it is of service. Iron and strychnia may be combined thus :— 12. R. Strychniae, gr.J Vini ferri, f.^iv. M. A dessertspoonful thrice daily, to a child ten years of age. Narcotics, such as opium, belladonna, cannabis indica, or conium, are of little or no use. Antispasmodics, such as valerian and assafcetida, are also useless. Our author has seen good results from the employment of baths of sulphuret of potassium:— 13. R. Potassii sulphured, ^iv Aquae (90° F.), C.xxx. For a bath ; the patient to remain in it for an hour daily. This bath is also recommended by Dr. Felix Von Niemeyer when there is anaemia. Gymnastic exercises, shampooing and passive movements are of service. As many muscles as possible should be exercised, without fatiguing any of them. Shower baths are useful in the latter stages, when the patient is not timid, or too much excited by them. Dr. Niemeyer quotes Benedikt, who declares that out of more than twenty cases of chorea, treated by him by the constant gal- vanic current, not one has failed to recover. The current which he employs is just strong enough for the patient to feel it distinct- chorea. 25 ly, and he applies it along the spine, the patient standing erect. Painful currents aggravate the symptoms. J. W. OGLE, M. D„ LONDON. 14. R. Pulveris physostigmatis, 3j Alcoholis, f.gj. M. Begin with twenty minims, thrice daily, and increase, by ten minims a dose, to f.^j. Our author reports several cases treated in this manner successfully. C. B. RADCLIFFE, M. D., LONDON. Our author, though he has great faith in the efficacy of arsenic in chorea, has been obliged to discontinue it in a number of cases, on account of the gastric disturbance it produced. He, therefore, resorted to its use hypodermically and endermically, with favor- able results. Hypodermically, he employs Fowler's solution, diluted with an equal part of water, in doses of ninj per day, gradually in- creased in about two months' time to n\xiv. Endermically, he advises:— 15. R. Liquoris potassii arsenitis, tt\,xv-xx. M. To be dropped upon lint moistened with water and applied, covered with oil silk, night and morning, to a raw blistered surface. This treatment gives rise to much local irritation, and has gene- rally, on this account, to be suspended every six or seven days. PROF. O. REVEIL, M. D., PARIS. 16. R. Extracti hyoscyami, Zinci valerianates, aa. gss Bismuthi subnitratis, 5J- M. Divide into 40 pills. Three or four a day. 17. R. Extracti hyoscyami, 3ss Ferri valerianatis, 3J. M. Divide into 40 pills. One thrice daily in the chorea of chlorotic patients. 18. R. Valerianae pulveris, 9ij Belladonnae radicis pulveris, gr.ij Oastorei pulveris, gr.iv Sacchari, giss. M. Divide into 20 powders. One five times a day. DR. H. ROYER, FRANCE. 19. R. Sodii arseniatis, gr.j Syrupi acaciae, f.^iv. M. Dessertspoonful thrice daily. 26 DISEASES OF THE NERVOUS SYSTEM. T. CURTIS SMITH, M. D., MIDDLEPORT, OHIO. 20. R. Tincturae cimicifugae, Tincturae hyoscyami, Syrupi, aa. f.^ij. M. A teaspoonful every six hours. Also, 21. R. Ferri redacti, 9jij Zinci sulphatis, 9|ss Quiniae sulphatis, 9j. M. Divide into 20 pills. One thrice daily. Our author reports {Medical and Surgical Reporter, August 5th, 1874) a case occurring in a girl of 18, cured by this treatment, together with the use of a strong salt bath every day, with friction from head to foot with a coarse towel, and the production of a strong mental impression of her misery if not relieved, and of the certainty of a cure if the treatment be carried out. Quinine, he has, however, found detrimental in some cases of chorea. Cimici- fuga and sulphate of zinc are two powerful agents for combating this disease. LAWSON TAIT, M. D., LONDON. Dr. Tait advises a jet of ether directed against the vertebral column. This application has always the effect of procuring several hours' sleep, and lessening the violence of the movements. The cure was obtained in one case after several days' treatment in this manner. THOMAS HAWKES TANNER, M. D., LONDON. 22. R. Zinci phosphatis, gr. xx-xl Acidi phosphorici diluti, Tincturae ferri chloridi, aa. f.^iss Aquam menthae piperitae, ad f.^vj. M. Two tablespoonfuls thrice daily. The only plan to be followed in treating chorea, consists in regu- lating the bowels, subduing irritation, and strengthening the sys- tem. For the first purpose, calomel and jalap, or, when worms are suspected, oil of turpentine, may be employed. A combination of tonics or antispasmodics, with purgatives, is often serviceable. The two great remedies are the cold shower or douche bath, and iron. The former should be employed every morning, on the patient's rising. Cod-liver oil is generally useful, administered CHOREA. 27 with tonics. Mental excitement should be guarded against, and nutritious food and exercise in the fresh air insisted upon. PROF. TROUSSEAU, PARIS. 23. R. Strychniae sulphatis, gr.j. Syrupi, f.^iijss. M. A teaspoonful thrice daily; the dose to be gradually increased until itching of the scalp and slight stiffness of the masseter muscles are observable. This remedy must be employed with caution. JAMES TURNBTJLL, M. D., LIVERPOOL. 24. R. Anilinis sulphatis, ^ss. Divide into 20 powders, one to be taken three times a day. The sulphate of aniline has also been given in as large doses as three grains every third hour. {Half Yearly Compendium of Medical Science, January, 1869). It is a white powder, easily taken. M. WENZ, M. D., DORSBACH. Local ancesthetization of the skin over the spine has been employed with success in chorea. Eichardson's apparatus is used, with from fifteen to thirty drachms of ether, slowly traversing, once a day, the whole length of the spinal column. {Aerytliches Literaturblatt, July 7th, 1871). HOSPITAL FOR SICK CHILDREN, LONDON. A large number of cases of chorea have been treated (The Lancet, October 21st, 1871) with gradually increasing doses of sulphate of zinc at this hospital. In no single case was its use unattended with some advantage, for those patients who did not entirely recover on sulphate of zinc only, appeared to derive considerable benefit from it. In some cases, recovery followed its exhibition with remarkable rapidity, and in others, it succeeded after the failure of many other remedies. The tolerance of the drug which may be established in what would appear to be decidedly emetic doses, is well shown in every case. The mode of administration in this hospital is as fol- lows :— 25. R. Zinci sulphatis, gr.viij-xvj Aquae, f.^iv. M. A tablespoonful three or four times a day, after a meal. 28 DISEASES OF THE NERVOUS SYSTEM. Occasionally to this is added, in anaemic patients, a grain or two grains of sulphate of iron. The quantity of zinc is then increased by the addition of a grain every day, or every other day, until either the choreic movements have very decidedly diminished, or until the medicine has caused excessive sickness, when either the quantity is gradually lessened or its use is at once discontinued. As regards diet and confinement to bed, the children have usually been kept recumbent, and fed on pounded meat, or beef-tea and milk, during the earlier stages of the treatment; but as the irregu- lar movements decreased, and without reference to the quantity of zinc then taken, they have been put upon meat diet and allowed to get up. Stimulants, too, have always been allowed in those cases which appeared to require them. One fact has often been noticed— namely, that if no other treatment be adopted than mere confine- ment to bed, the choreic movements will often frequently diminish in a marked degree during the first week or ten days, after which no further improvement takes place. Whether the sulphate of zinc acts as a nervine tonic, or whether, as Dr. West has expressed his opinion, in his lectures at the Col- lege of Physicians, it may exert " a specific power over chorea," is a question which still awaits decision. HOPITAL DES ENFANTS, PARIS. The means of treating chorea more particularly employed at this hospital, are the tartar emetic plan advocated by Gillette, and still employed by Eoger ; gymnastics advocated by Blache ; and sulphurous baths. The tartar emetic plan i3 this : Three days' treatment: during the first day, 3 to 6 grains of the remedy (ac- cording to age); during the second, 5 to 10 grains; during the third, 8 to 12 grains; then three days' rest; then three days' treatment; commencing the new series with a dose one grain stronger than in the first series—to end with a third turn, often attended by good effects. Gymnastics are highly beneficial in milder cases of chorea, and in the declining stage of the severer forms. As much may be said of sulphurous baths. The other means employed at the hospital are: Opium, chloroform inhala- tions, salt baths, hydrotherapy, tonics, etc. Strychnia, so warmly advocated by Prof. Trousseau, is scarcely ever employed at the Hopital des Enfants. CHOREA. 29 RESUME OF REMEDIES. *Acidum Arseniosum is highly recommended by Drs. C. B. Radcliffe (F. 15); Thomas King Chambers (F. 7); Thomas Hillier (F. 11); S.Ringer ; Romberg, and others. Dr. Begbie, who, in an experience of thirty years, states that he has never known it to fail, prescribed five drops of Fowler's twice daily, after a meal, and added one drop to the dose every day, until the specific effects appeared, when he suspended it for a time. JEther as well as chloroform inhalations are employed. Ether is also applied in spray along the spine. Ammonii Carbonas is favorably mentioned by Dr. C. B. Radcliffe. Ammonii Valerianas has been employed with success. Anilin, first employed by Dr. James Turnbull (F. 24), is also recommended by Dr. F. E. Anstie. Antimonii et Potassii Tartras is recommended by Dr. C. West in acute cases, given in full doses. Dr. Thomas Hillier, however, condemns its use (which he has found inutile), as a depressing remedy, ill adapted to a disease like chorea of weakly, badly-fed children. In French practice it is advocated by Gillette and Roger (p. 28). Apomorphia has had a limited but favorable trial in this disease. Argenti Nitras is much less employed than formerly, before the discovery of other remedies of greater efficiency. Assafeetida has been recommended in cases due to the irritation of intestinal worms. Belladonna, though formerly much employed, is characterized by Dr. Thomas Hillier as of " little or no service," and such seems to be the general modern verdict. Brominium, see Potassii Bromidum. Camphora is a remedy in which Dr. 0. B. Radcliffe states he has considerable confidence. He gives it generally, dissolved in cod-liver oil (F. 5, Cannabis Indica has been found useful in some cases. Drs. C. B. Radcliffe and Thomas Hillier, however, hold it in light estimation. In the sleeplessness attendant upon severe chorea the tincture has proved an excellent hypnotic, in full doses. Chloral, by its hypnotic effect and the consequent ameliorating influence of the sound sleep it produces, has been found of benefit in many cases. Chloroformum Purijicatum. Chloroform inhalations are not approved of by Dr. C. B. Radcliffe, unless alcoholic stimulants are given before the inhalation. Friction along the course of the spine night and morn- ing, with a liniment composed of equal parts of chloroform and oil of almonds, is beneficial in some cases. * Cimicifuga is highly recommended by many physicians. Prof. A. Still£ considers it as one of the most valuable remedies in this disease in purely uncomplicated cases, given in doses of sufficient strength to develop its specific effects. Dr. Sydney Ringer, however, finds it only effectual in cases of rheumatic origin, and even in these he pre- fers arsenic (F. 10, 20). *Conium is very highly lauded by Dr. John Harley. He gives the succus in full doses, and asserts that, apart from its effects on the motor centre, conium possesses no direct influence on the circulatory, nutritive or secretory functions, and that its use can be prolonged with safety, it being entirely destitute of any cumulative action. 30 DISEASES OF THE NERVOUS SYSTEM. Cupri Sulphas has been thought useful, but is doubtless of less value than conium, and a number of other remedies. Cuprum Ammoniatum once enjoyed a high reputation in the purely nervous form of chorea (F. 9). *Ferri Bromidum. This remedy is much used by Prof. Da Costa. He was led to it almost accidentally at first, but having now used it for three or four years, his experience from the treatment of a large number of cases giving abundant opportunity to witness its good effects, induces him to like it better than any other one article in the treatment of chorea. It should be given in increasing doses, never starting with less than five grains for a child, and rapidly increasing the dose to twenty, thrice daily. It may be given in plain syrup and water, in the form of a pill, or better, in an effervescing powder. It not only affects the chorea, but also influences the nervous system as a seda- tive, quieting it and giving the patient rest. It is a valuable agent in treating the incontinence of urine in children, and it was in a case of this kind, complicating chorea, that he first observed its value; being surprised and pleased to see that, as the symptom which led to its administration improved, the chorea also diminished, and soon disappeared. Since then he has used it almost continuously. In answer to the question whether it is the bromine or the iron that benefits, he thinks it is the combination ; that neither alone accom- plishes the result; for it will benefit cases that have previously taken iron without improvement, and, as regards the other bromides, we certainly cannot claim for them any especial value in chorea, as they frequently disappoint us. The remedy occasionally fails, as all remedies sometimes do in this obstinate affection, but it certainly is one of the most valuable agents we possess for the treatment of chorea. Ferri Carbonas is often a useful remedy. Ferri Oxidum Hydratum in large doses (3ss-j increased to ^iij-iv, every six hours) is highly recommended by Drs. Elliotson and Wilks, con- joined with the use of active purgatives. Children readily take half- drachm doses in treacle. Ferri et Quinia; Citras has also been found useful. Ferrum Redactum has been given with benefit (F. 21). Hypophosphites are recommended by Dr. Radcliffe, combined with cod-liver oil. *Morrhuo3 Oleum is very favorably spoken of by Drs. F. E. Anstie, C B. Rad- cliffe and Thomas Hillier, in cases of chorea in scrofulous children or those of spare habit. Dr. Radcliffe generally gives the oil in conjunction with hypophosphite of soda (gr. v-viij), making the draught containing the hypophosphite the vehicle for the oil. Some- times he adds carbonate of ammonia to the solution of the hypophos- phite ; and sometimes dissolves camphor in the cod-liver oil, thus masking the taste of the oil and making the stomach more tolerant of it. Moschus has been employed with benefit, but generally fails. Nux Vomica was employed by Rougier in minute doses gradually increased. Trousseau preferred strychniae sulphas (which see). Oleum Terebinthinoe is sometimes given with the view of obtaining its anthel- mintic, purgative and stimulant effects. Opium is tolerated in very large doses in this disease, but Dr. Radcliffe's experience is not favorable to its use. Phosphorus is favorably reported upon, by a number of physicians, as a remedy in this disease. J Physostigma has been used with success by Drs. Harley and Ogle (F. 14") CHOREA. 31 *Potdssii Sulphuretum. Drs. Hillier and Von Niemeyer recommend baths of this salt (F 13). Potassii Bromidum has proved a failure in the hands of Dr. Ramskill, but has been favorably reported upon by a number of French physicians. Potassii lodidum is considered useful by Dr. Hillier, in cases of chorea occurring in children subject to chronic rheumatism (F 11). It is also beneficial in patients tainted by syphilis or scrofula. Quinice Sulphas has been employed in some cases with advantage (F. 21). *Santonin proves often valuable, by disclosing the unsuspected cause of the choreic movements, viz., worms. Sodii Arsenias is useful in those cases in which other arsenical preparations are badly borne (F. 19). Stanni Chloridum has been employed in doses of gr. ^ to \ three times a day in pill, or dissolved in hydrochloric ether. If it increase the symp- toms at first, this is regarded as a good omen. If it be followed by gastro-intestinal irritation or dryness of the throat, it must be stopped or the dose lessened. Stramonium is of doubtful efficacy in chorea. Strychnia; Sulphas is recommended by Trousseau (F 23). Its effects should be carefully watched, and its administration confined to obstinate chronic cases (F. 12). Valeriana is recommended by some writers (F. 18). Zinci Oxidum is generally considered inferior to the sulphate of zinc. *Zinci Sulphas is very highly recommended by some physicians (Barlow, Golding Bird and West), but in the hands of others (Stone, Hil- lier, etc.), it has not fulfilled expectations (p. 22, F. 21, 25). Zinci Valerianas is employed by Prof. Da Costa and others (F. 8, 16). * Cathartics, when combined with antispasmodics and tonics, give better results than can be obtained from either singly. The tendency to constipa- tion which exists in this disease requires to be combated by their administration. EXTERNAL REMEDIES. Electricity is principally useful in cases dependent upon deranged catamenial function. Dr. Golding Bird recommends it in the form of sparks taken in the course of the spinal column, every alternate day, for about five minutes at each time. Ether Spray. The application of atomized ether along the spine has proved of service in relieving the spasms, especially in recent cases and those originating in fright. It is said also to be of benefit in chronic cases and in rheumatic chorea (p. 27). Frigus. Cold Shower Baths are often valuable adjuncts to other treatment. Dr. Hillier considers them useful in the later stages of the disease, when the patient is not too timid or too much excited by them ; cold effusions to the back of the head and neck, each morning, are also useful, but rarely proper in the winter season, and seldom applicable to very feeble and excitable children. Hygienic Measures. Fresh air, change of scene, regulated _ movements, good food and friction to the spine are of the utmost importance in all cases. Gymnastics are especially recommended in the milder forms of chorea, and during convalescence in the severer cases (p. 28). Sulphur Baths are often of value in conjunction with other remedies (F. 13). They are particularly indicated when there is anaemia. Vapor Baths are also useful. 32 DISEASES OF THE NERVOUS SYSTEM. DELIRIUM TREMENS. PROF. WILLIAM AITKEN, M. D., EDINBURGH. The two indications for treatment are: 1. The elimination of the poison; 2. The sustenance of the patient during this period. Our author opposes bleeding and the administration of opiates or stimu- lants in large doses. The strength is to be supported by nutri- tious diets, such as yolk of eggs, soups, beef-tea, and egg-flip, in small quantities and often. The danger in the first instance is from exhaustion, which is to be met by careful nursing. Opium may only be administered in protracted cases, and then never in doses larger than would be con- sidered safe for a healthy person of the age and sex of the patient. G. H. BARLOW, M. D., LONDON. 26. R. Camphorae, • gr. jj Ammonii carbonatis, gr. iv Tincturae hyoscyami, Tincturae lupulinae, Syrupi aurantii, Mucilaginis acaciae, aa. f.^j. Aquae camphorae, f-5J- M. For one dose, to be taken at bedtime, after the action of an aperient. J. WARING CURRAN, M. D., DUBLIN. 27. R. Zinci oxidi, Bj-ij Confectionis rosae, q. s. M. For 10 pills ; one thrice daily. When morphia or cannabis has done its duty in this disease, the after treatment by oxide of zinc is something to be observed rather than described; the constant dread, restlessness, and dis- turbed sleep are quickly overcome by the bracing agency of the drug (London Lancet, October 24th, 1868). In administering the oxide of zinc, care must be taken not to give it upon an empty stomach, as it produces nausea and a dislike for the medicine. PROF. R. J. GRAVES, M. D., DUBLIN. 28. R. Antimonii et potassii tartratis, gr-iv Tincturae opii, f.gj Camphorae, &r'xv Alcoholis, f.^ss Aquae destillatae, f-Hviij. M. Powder the camphor by the aid of the alcohol, add the water, pass through a piece of fine linen and then add the tartar emetic and the laudanum. Give a tablespoonful every two hours. DELIRIUM TREMENS. 33 G. M. JONES, M. D., JERSEY, ENGLAND. 29. R. Tincturae digitalis, f.giss. M. A tablespoonful (f.|ss.) to be given at a dose, mixed with a little water. If the first be not sufficient, which, however, it generally proves to be, a second, equally large, is to be administered in about four hours. If a third dose be, in rare instances, required, it should not exceed a dessertspoonful (f.^ij). Under the influence of this medication, it is stated, the pulse becomes fuller, stronger, and more regular, the skin grows warm and the cold clammy perspiration ceases. These effects are fol- lowed by a sleep of several hours' duration. No action on the kidneys nor any alarming symptoms are observed. Dr. T. Hawkes Tanner confirms the above statements. This treatment answers best when the symptoms have assumed a resemblance to those of acute mania, and when there has not been much exhaustion. DR. LYONS, HARDWICKE HOSPITAL, DUBLIN. 30. R. Pulveris capsici, gr.xx-xxx Mellis ros33, q. s. Make a bolus. For one dose. This usually suffices to produce quietude and sleep. In excep- tional instances, however, a second and even a third dose is required before full tranquillity is secured. The drug is well borne, and quiets the stomach in cases in which irritability and vomiting are present. Our author sums up {British Medical lournal, Novem- ber 7th, 1869), his experience as follows : 1st. Capsicum is a valu- able and reliable drug when opium fails or is for any cause contra- indicated. 2d. It is a safe drug for general employment in delirium tremens, and as such may be confidently recommended. 3d. It is not open to the objection which attaches to the con- tinued use of opium, which, when it fails to tranquilize and produce sleep, adds to the state of excitement, and when pursued beyond a certain limit may induce opium coma. 4th. Capsicum has been employed in the delirium of fever when opium has failed to cause sleep, and with marked success in certain cases. As a member of the family of solonaceous plants, capsicum might, a priori, have been expected to contain a narcotic principle. As yet the alkaloid in which it resides has not been isolated; but in some researches, conducted at the request of Dr. Lyons, M. 3 34 DISEASES OF THE NERVOUS SYSTEM. Alphonse Gages, a distinguished member of the chemical staff of the College of Sciences for Ireland, has found sufficient indications of its presence to warrant him in predicting its ultimate detection and isolation. It will, Dr. Lyons expects, form a valuable boon to practical medicine when eliminated from the acrid oils of the capsicum fruit. H. S. PURDON. M. D., LONDON. Our author finds {Medical and Surgical Reporter, August 1st, 1874), in the treatment of this disease, nourishment, such as plenty of milk, eggs, and in some cases, a moderate allowance of stimu- lants, necessary. He has remarked that when the patient is pale, thin, and not a confirmed tippler, Graves' plan of treatment (see p. 32), by tartar emetic and opium, succeeds very well; how- ever, opium sometimes stimulates, even when guarded with anti- mony. A good purgative is a capital preparation for this or any plan of treatment. Chloral is useful, but does"not always agree, and often seems to stimulate the heart and brain. Red pepper, in twenty grain doses, has not succeeded in his hands, nor has bromide of potassium. He has had no experience of the tincture of digitalis in half ounce doses, as recommended by Jones, of Jersey (see p. 33), nor of the hypodermic injection of eaffein. For the tremor and unsteadiness that remain after an attack, the oxide of zinc, in two grain doses, thrice daily, has done good, or if the appetite is bad, quinine, given with the ammoniated tincture of valerian, may be ordered. RESUME OF REMEDIES. .Ether, by inhalation, has been recently recommended. When the pulse is weak, the extremities cool, and the patient restless rather than vio- lent, it should not be pushed to full anaesthesia. *Alcohol. There is a wide difference of opinion in the profession, in regard to the use of stimulants in this affection. Most practitioners, how- ever, regard the sudden withdrawal of accustomed stimuli as injuri- ous and dangerous. Anstie is among those who are of the opinion that in first attacks in young subjects, it is proper to abstain altogether from the use of alcohol, and in every case to abstain as long as possi- ble. When deemed indispensable, alcoholic stimulants should be conjoined with nutritives, e, g., in the form of milk punch, egg flip, etc. Gerhard obtains satisfactory results by simply continuing the use of alcoholic stimulants in moderate quantity. Flint says that so long as the affection continues, it is, in general, injudicious to dis- continue the use of stimulants, which must be given freely when the symptoms denote failure of the vital powers. After sleep has been secured, and the patient is convalescent, the habitual use may be broken up with safety. Stili.E states that alcohol acts as a specific DELIRIUM TREMENS. 35 cure. In mild cases, he prefers porter to distilled liquors, on account of the narcotic and tonic elements it contains : in severe ones the stronger preparations of alcohol are alone effectual. Wine may be used with advantage, but is less resorted to than brandy or whisky. Ammonii Bromidum has been employed with good results in delirium tremens by Dr. Peacock [British Medical Journal, July 3d, 1869). Anthemis, in an emetic dose, may be given at the commencement of an attack. Antimonii et Potassii Tartras is much employed by German physicians in this affection, but little used in America or England, excepting in combination with opium, when it often induces sleep after the failure of opium alone (F. 28). Atropia, hypodermically, is recommended by Bartholow when there is ob- stinate insomnia with great restlessness, weakened action of the heart, coldness of the surface, clammy sweat, with a failure of nutrient?, bromide of potassium, chloral and hypodermic injections of morphia. Belladonna has been suggested as a remedy when the pupil is greatly con- tracted, but there is yet little clinical evidence as to its utility. Brominium, see Potassii bromidum. Camphora is recommended by Dr. Laycock in those cases occurring in persons of a nervous habit, where the exhaustion is great, and morphia inad- missible. Two to three grains may be given every third hour, alone, or combined with carbonate of ammonia and hyoscyamus (F. 26). Caffein, hypodermically, has been recommended. Cannabis Indica is regarded by Dr. Anstie as preferable to opium when there is any reason, from the quality of the pulse, to believe the circulation much enfeebled. He prescribes gr.^-^ of a good extract. H. J. Tyrrell records {Medical Press, March 13th, 1867), a case of delirium tremens, in which, after three doses of n\,xx of the tincture of canna- bis indica, every third hour, the benefit was marked after the failure of capsicum, and when opium was contra-indicated. * Capsicum in large doses is strongly recommended by Dr. Lyons and others (F. 30). * Chloral has proved of benefit through its hypnotic influence. It may be given by the mouth or hypodermically. (Langenbeck, of Berlin). Chloroformum by inhalation has been recommended by some, but most writers are of the opinion of Dr. Wilks {Medical Times and Gazette, Septem- ber 19th, 1868), that "you may quiet the patient by it for a time, but you do not in any way influence the disease." Dr. Anstie men- tions two cases of death from cardiac palsy while the inhalation was proceeding. Internally, Dr. Goodfellow recommends {British .Medi- cal Journal, July 3d, 180'J), the following formula for the adminis- tration of chloroform:— 31. R. Chloroformi, n\,xx Quiniae sulphatis, gr.ij Tincturae cardamomi compositae, f.3j Aquae, f-3x. M. For one dose. Cinchona in strong infusion is said to act very happily in this disease ani in the tremulousness which affects habitual drunkards. Conium is recommended by Dr. Harley, in combination with opium, thus : 32. R. Succi conii, f^iv-vj-viij Tincturae opii, n\,xx-xxx. For one dose. 36 DISEASES OF THE NERVOUS SYSTEM. * Digitalis in large doses is recommended by Dr. Jones (F. 29), and others. Hydrargyri Chloridum Mite in full purgative dose, repeated if necessary, is useful in those cases in which there is hepatic congestion or abdo- minal plethora, when its action is sometimes followed by sleep, after the failure of opium to produce it. Hyoscyamus is favorably spoken of by Dr. Barlow (F. 26), and others. Ipecacuanha in full doses (gr.xx every fifteen minutes until emesis is pro- duced) is the practice of Dr. Schenck, of Osage City, Kansas (New York Medical Journal, October, 1873). Lupulina is recommended in tincture by Prof G. B. Wood, as an admirable adjunct to opium, the combination succeeding, after the failure of opium alone to induce sleep. During convalescence from this disease, he considers it as one of the best remedies which can be employed to sustain a moderate tonic and soporific influence. Morphia hypodermically is recommended by Dr. Anstie and others. The former says that opium should never be administered by the stomach, but always in the form of morphia hypodermically injected, in the dose of gr.j^—^-i. Opium is no longer employed indiscriminately in heroic doses in every case of delirium tremens. To give it in large and repeated doses, on the principle that sleep must be produced at all hazards, is to run the risk of killing the patient. Dr. Anstie {The Practitioner, July, 1868) asserts, that great mischief was formerly done by the custom of plying the patient with larger and larger successive doses of opium, to drown the delirium in narcotic stupor, and says that opiates should never be gi\eu by the mouth when the hypodermic injection of morphia is possible. Prof. Graves recommends, in young, robust subjects, when there is much vascular excitement, the following combination : 33. R. Tincturae opii, Vini antimonii, aa rtLxx. To be repeated every three or four hours, according to circumstances. When the patient is old, and when there is much depression, the opium may be advantageously combined with carbonate of ammonia (grs.iij-iv) or quinine (grs.ij-iij), or with camphor. Chloral as a hypnotic promises to supersede opium in this disease. Prof. Stille says the best method of administering opium in delirium tremens is to begin with gr.J or its equivalent, and progressively augment the dose by small and hourly additions until sleep is produced, or a suf- ficient degree of tranquillity obtained. * Potassii Bromidum is recommended by Dr. Ringer as of conspicuous benefit, by removing the delusion, calming the delirium and procuring sleep in the earlier stages of the disease, before the delirium has become furious. It is also of service in removing any delusions that may remain after the attack has been partially subdued. It should be given in doses of from twenty to thirty grains, or even larger, every two hours till sleep ensues. Unfortunately, it is not uniformly bene- ficial, and in some cases it seems entirely inert. "Quiniee Sulphas is the nervine tonic in which Dr. Anstie has the most con- fidence, in grain doses two or three times daily. It should be given from the first, if possible, being, if the stomach is very irritable ad- ministered in effervescence with bicarbonate of potash and citric acid. Its superior efficacy in producing that nervous tranquillity which makes sleep possible is very marked. When it fails he advises sulphuric ether Tt\, xxx thrice daily, or DELIRIUM TREMENS. 37 34. R. iEtheris sulphurici, f.^j Tincturse sumbuli, ttl.xxx. M. For one dose at bedtime. Sinapis. In that stage when a timely emetic will cut short the attack, none is so appropriate as mustard. Valerian is a valuable adjunct to treatment, and often effective alone in slight cases. * Zinci Oxidum is recommended in delirium tremens, after opiates have done their work, by Dr. Waring Currax, and others. Cathartics are of service at the outset in the young and robust, when the attack results from the ingestion of a large quantity of spirits, but in the old, broken-down, habitual drunkard they are contra-indicated. Emetics have recently been re-introduced in the treatment of this disease. At the beginning of the attack, when there is reason to suppose that the stomach contains a large amount of spiritous fluid, they are useful, but otherwise they are inferior to the supporting plan of treatment. Stimulants, see Alcohol, above. EXTERNAL REMEDIES. Hypodermic Injections. Atrojn'a, injected in a dose not exceeding gr.5:¥ at one time, is recommended by Prof. Bartholow in certain cases (see p 35) ; Caffein, in the dose of gr.j of the citrate, dissolved in glycerine, has been employed with good effects ; Chloral has been recommended, but its use, hypodermically, is objectionable, on account of the local irritation it occasions and the eschars which may result; Morphia, the use of which, hypodermically, in delirium tremens, was first sug- gested by Hunter, is advised by Ogle, Semeleder, Lovent. Eulen- berg, Ruppaner, Anstie and others. The practitioner should be warned, however, against abusing this remedy (see Opium, p. 36). Prof. Bartholow gives the following as the indications for the use of morphia, hypodermically, in this disease : the condition of " horrors." or wakefulness, preceding delirium; excessive and uncontrollable vomiting of food, drink and medicine ; mild cases, in which there is little tendency to depression of the vital forces, and in which the assimilation of food proceeds satisfactorily. The following are the contra-indications for the use of this method : severe and protracted cases, with great depression of the vital forces and non-assimilation of food; cases in which serious organic lesions of liver and kidneys have occurred; cases in which the attack is consecutive to traumatic or other serious lesion of brain. Ice to the shaven scalp is sometimes of benefit, when there is much vascular excitement, but is to be employed with caution in the case of habitual, debilitated drunkards, and in no instance to be too long continued, lest dangerous depression should result. Dr. Chapman's spinal ice bag exercises a favorable influence in some cases. Wet Sheet Packing is of great value in delirium tremens. The patient, stripped naked, is rolled in a wet sheet, and then a blanket wrapped around this. So soon as a hot vapor surrounds the patient he falls, in many cases of delirious excitement, into a quiet sleep. 38 DISEASES OF THE NERVOUS SYSTEM. EPILEPSY. PROF. C. E. BROWN-SEQUARD, M. D. 35. R. Potassii iodidi, _ . Potassii bromidi. aa 3.1 Ammonii bromidi, 3^ Potassii bicarbonatis, 9l) , , Infusi calumbae, f-3vJ- M- A teaspoonful before each of the three meals, and three tablespoonfuls at bedtime, with a little water. The above is given in cases of idiopathic epilepsy, in which pa- tients derive no benefit, or have ceased to have any, from the bromide or iodide of potassium alone or combined, or of the bromide of ammonium alone. When the patient's pulse is weak, substitute for the bicarbonate of potassium in the above formula the carbonate of ammonium, and for the six ounces of infusion of columbo, an ounce and a half of the tincture of that medicine, with four ounces and a half of dis- tilled water. Dr. Brown-Sequard gives the following very important rules relative to the treatment of epilepsy by the bromide of potassium and ammonium, employed together or separately. 1. That the occurrence during the day of the sleepiness caused by these remedies can be avoided by giving relatively small doses in the daytime and a much larger dose late in the evening. 2. That the quantity of these medicines to be taken each day must be large enough to produce an evident though not complete ansesthesia of the fauces and upper parts of the pharynx and larynx; that daily quantity being from 45 to 80 grains of the bromide of potassium, and from 28 to 45 grains of the bromide of ammonium, when only one of these salts is employed, and a smaller quantity of each, but especially of the second, when they are given together. 3. That an acne-like eruption on the face, neck, shoulders, etc., should be produced, and it is most important to increase the dose when there is no eruption, and also when the eruption is disappear- ing unless the dose already given in the twenty-four hours is so large that any increase of it causes great sleepiness in the daytime, a decided lack of will and of mental activity, dullness of the senses, drooping of the head, considerable weakness of the body, and a somewhat tottering gait. EPILEPSY. 39 4. That it is never safe for a patient taking either of the bro- mides or both, and receiving benefit therefrom, to be even only one day without his medicine, so long as he has not been at least fifteen or sixteen months quite free from attacks. 5. That the debilitating effect of the bromides in patients already weak, as are most epileptics, ought to be prevented or lessened by the use of strychnia, arsenic, the oxide of silver, ammonia, or cod-liver oil, cold douches or shower baths, and, of course, wine and a most nourishing diet. In making use of strychnia or arsenic, it must be kept in mind that not only the bad influences of the bromides, but also their favorable influence against epilepsy, can be diminished by these powerful agents (especially strychnia), and that it is therefore necessary, when these agents are used, to increase the dose of the bromides. 6. That iron and quinine—which are generally injurious to epi- leptics, except in cases in which the nervous affection is caused, or at least aggravated, by chlorosis, anaemia, or malarial cachexia— are more particularly injurious in cases in which the bromides are taken. 7. That a gentle purge every five or six weeks usually gives a new impulse to the usefulness of the bromides against epilepsy. 36. R. Morphiae sulphatis, gr.| Atropiae sulphatis, gr-,iV ^- For one hypodermic injection, in a few minims of distilled water. Our author has succeeded in curing a case of epilepsy by the use of this injection. Inhalation of Chloroform.—In a case of a gentleman who had pretty regular weekly attacks of epilepsy, our author employed chloroform by inhalation, almost without interruption, for two or three days successively, with the object of preventing the expected fit or fits. It was of the greatest importance in that case to pre- vent a fit, as the patient, in a preceding attack, had fractured and dislocated one of his arms. The inhalation of chloroform saved him from the expected attack, and the callus had time to be formed before he had another fit. George Johnson, m. d., King's College Hospital, London, also speaks in high terms of chloroform in connection with bromide of potassium in this affection. He thinks that the action of chloro- form inhalation in warding off a threatened fit and in cutting short 40 DISEASES OF THE NERVOUS SYSTEM. a violent and prolonged paroxysm, is as uniform and certain as the action of anaemia in exciting convulsions. Thomas Hawkes Tanner, m. d., London, has also used the vapor of chloroform, and believes that the fits have diminished, both in severity and numbers, from its employment. J. Philpot Webb, m. d., of Nevada City, California, Licen- tiate of the Royal College of Physicians of Edinburgh, etc., has recently reported a case of epileptiform convulsions arrested by chloroform inhalation in a boy aged fifteen. Mechanical and Physical Means.—Dr. Brown- Seojjard has found : 1. That it is not necessary to apply an irritation (by a ligature, pinching, etc.), on the very limb from which an aura seems to start, as the same means applied elsewhere may succeed; but the chance of success is much greater by the former than by the latter way. 2. That a constant or a frequent irritation (by a blister, an issue, a seton, the actual cautery, etc.), on the place from which an aura seems to start, may not only prevent fits, but, by some change of nutrition locally (if the aura is really of peripheric origin), and in the nervous centres, may reduce or even destroy altogether the tendency to fits, and lead to a complete cure. 3. That as a circular ligature may procure a temporary good effect, so a narrow circular blister applied all around a limb, a toe, or a finger, or a circular cauterization with a white-hot iron, may cure epilepsy in cases with a distinct aura. 4. That even in cases in which there is no aura, felt or unfelt, ligatures, pinching, and other means of irritation, may prevent the occurring of expected fits. When an attack of epilepsy is followed by a comatose state, or even a sleep with heavy breathing, it is of the greatest importance to place the head of the patient in such a position that the tongue, which is then paralyzed, will not fall on the larynx and cover its aperture. T. S. CLOUSTON, M. D., EDINBURGH. From extensive and very elaborately conducted experiments, to determine the precise effect of bromide of potassium in epilepsy, and its proper dose, Dr. Clouston found that the diminution of the fits, and all the other good effects of the medicine reached their EPILEPSY. 41 maximum in adults, at thirty-grain doses thrice daily; while ill effects were manifested when thirty-five grain doses thrice daily were reached. J. WARING CURRAN, M. D„ DUBLIN. 37. R. Zinci oxidi, gr.ijss Extracti glycyrrhizae, q. s. M. For one pill. One or two thrice daily. This, together with the bromide of potassium in mixture, forms a method of treatment not to be equaled in epilepsy, when assisted by the occasional application of Chapman s spinal ice bag. Neither remedy succeeds so well alone; the one is essential to the other. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 38. R. Zinci valerianatis, £r-Uj Extracti belladonnas, gr.^ Pulveris digitalis, gr-4- M. For one pill. To be taken thrice daily in cases of epilepsy, associated with irregularity of the heart. PROF. WM. A. HAMMOND, M. D., NEW YORK. In regard to the dose of bromide of potassium in epilepsy, Dr. Hammond states that the symptoms due to large doses of the bromide may be enumerated as follows, in the usual order of their occurrence: 1. Contraction of the pupils; 2. Drowsiness; 3. Weakness of the arms and legs; 4. Depression of mind; 5 Fail- ure of memory; 6. Delusions. The first three of these are the usual accompaniments of a dose of the medicine capable of pro- ducing any influence over epilepsy. In adults they never follow less doses than ten grains. Doses of five grains produce no effect. MARSHALL HALL, M. D., LONDON. 39. R. Strychniae acetatis, gr.j. Acidi acetici, tr\,xx Alcoholis, f.,~ij Aquae destillatae, f-3vj« M- Ten drops (gr. -£$) to be taken in water thrice daily. J. SPENCE RAMSKILL, M. D., LONDON. 40. R. Bruciae, gr.iv Alcoholis, f.^ij Aquae destillatae, f-3vj- M- Ten minims to be taken diluted with water twice daily: every third day an addition of five minims should be made to the dose, until from a third to a half grain is reached, in the treatment of stomachal epilepsy. 42 DISEASES OF THE NERVOUS SYSTEM. If any stiffness of the jaws or other toxic symptoms appear, the dose is to be diminished five minims, and continued until any new ob- j ectionable symptom is manifested; then it is again lessened. No bene- fit will be derived until a full dose is reached; often the reverse effect (London Lancet, January 16th, 1869). As a rule, patients will take twice as much brucia as strychnia without any necessity for diminishing the dose. After the continuous administration of brucia for a month, it is well to suspend its use for some days, and then again resume it. Great satisfaction will be obtained by giving the bromide of potassium in large doses at bedtime, and at the same time ordering brucia twice daily, thus insuring the sedative influence of the bromide and the tonic effect of the brucia on the whole nervous system. DR. SCHMITT, GERMANY. 41. R. Tincturae iodinii, gtt.xv Aquae menthae piperitae, Aquas destillatae, aa, f.^ij Syrupi, f.Jj. M. A tablespoonful every two hours, to prevent the return of an attack. 42. R. Tincturae iodinii, f sjj Alcoholis diluti, f-^ss Spiritus calamus, gtt.j. ^- Five drops, every two or three hours, in sweetened water, to prevent a return of an attack. WALTER TYRRELL, M. D., LONDON. Our author states that he has watched the effects of strychnia upon various forms of epilepsy, and has no hesitation in affirming that in a large majority of cases its effects are most beneficial. He found but three cases in which it produced no favorable result, and no cases in which it produced an unfavorable effect. He gives a medium quantity as a dose, for a lengthened period, rather than carrying the dose too high at first. The best results are obtained from gr. ^ to gr. ^, twice a day, in solution, the system appearing to regain its nervous strength under the continued use of the medicine. HOSPITAL OF DISEASES OF THE CHEST, LONDON. 43. R. Potassii bromidi, Tincturae conii, Tincturae Valerianae ammoniatae, Aquae camphorae, For one dose, thrice daily. gr.x "bxxx nix fjj- M. EPILEPSY. 43 HOSPITAL OF UNIVERSITY COLLEGE, LONDON. 44. R. Potassii bromidi, Spiritus chloroformi, Infusi quassiae. For one dose, thrice daily. RESUME OF REMEDIES. Ammonii Bromidum is often prescribed in epilepsy alone, or in combination with bromide of potassium (F. 35). Ammonii_ Carbonas^ is a valuable palliative, though possessed of no curative influence in this disease. Dr. Anstie and others assert that, if there be time to administer a dose previous to an impending attack, it will often avert it. Pereira recommends it in large doses (grs. x -xx), in the hysterical form of the disease. Ammonii Formias has been of service in some forms of epilepsy, hurtful in others. Dr. Ramskill advises a further trial of this remedy. Ammo nice Aqua is recommended by Dr. Hope and others, in epileptic conges- tion of the brain, arising from debility. The following formula is most efficacious:— 45. R. Aquae ammoniae, ^ixij Aquae menthae viridis, f.^iss. M. For one dose. If taken at the first warning of an attack of this character, it seldom fails to arrest its supervention. The inhala- tion of ammoniacal vapor immediately after the first warning of an attack, is recommended by Pereira, Pixel and others, as often averting its occurrence. Ammonii Valerianas, although very deliquescent, and therefore uncertain in its operation, is favorably reported upon by a number of writers as a remedy in epilepsy. Anilin is recommended by Drs. Turnbull and Anstie. The latter finds that large doses aggravate the fits, but that one grain thrice daily, with an additional grain on the occurrence of any prodromata of a fit, delays or mitigates the paroxysm, or even averts it for a considerable time. Antimonii et Potassii Tartras has been used internally, and also in the form of the tartar emetic ointment, to secure pustulation of the scalp and spine. Argenti Xifras is no longer given in prolonged courses, at the risk of the pa- tient's turning blue, a fate so frequently reserved for epileptics in former times. Other remedies of equal or greater efficacy, and less danger, have now, to a great extent, displaced it. *Arseniosum Acidum is employed in epilepsy, but it is much less effective in this disease than in chorea. Dr. Radcliffe employs it hypodermic- ally and endermically, in the same manner as for chorea, see p. 25. Assafoetida is recommended by Dr. Pollock (Lancet, Aug. 21, 1869), as capa- ble of giving satisfactory results in the following combination :— 46. R. Tincturae assafoetida, TT\,xxx Ammoniae carbonatis, grs.iij. M. For one dose, to be repeated thrice daily In cases of epileptic seizures. due to the presence of worms in the alimentary canal, assafoetida is a useful agent. gr.x _ n\,xviij f-3j. M. 44 DISEASES OF THE NERVOUS SYSTEM. Barii Chloridum is occasionally employed. Bellaelonna, though praised by Trousseau, Wilks and IIarley (particularly in cases arising from emotional excitement, when it should be com- bined with zinc) is superseded in practice by the superior claims of bromide of potassium. Bismuthi Suhnitras has been employed by Dr. Copland (the bowels being kept freely open) alone and in combination with tonics and antispas- modics, with good results. Brominium, see Potassii Bromidum. Camphora seems to be useful in cases associated with hysteria or uterine dis- orders. It should be given in combination with tonics and antispas- modics. Cannabis Indica has not proved of value in epilepsy. Cantharis, see External Remedies, Blisters. Castoreum is a very old remedy in this disease, having been recommended by Celsus. Cerii Oxalas is recommended by Prof. Simpson. Chloral sometimes mitigates and even prevents the recurrence of periodical fits, by putting the patient to sleep. * Chloroformum. Chloroform inhalations are recommended by Drs. Brown- Sequard (p. 39), Johnson, Tanner, Webb (p. 40) and others, both dur- ing the paroxysm and in the interval. Dr. Brown-Sequard considers this method of treatment particularly valuable in cases partaking of a hysterical character. Cinchona is rarely successful in true epilepsy, but of great benefit in the epileptiform paroxysms of intermittent fever. Conium has been found by Dr. IIarley to cause rapid and decided improve- ment in epilepsy arising from sexual abuse, or from the irritation of dentition, but in that arising from peripheral disorder of sensation, from menstrual irregularity, or from emotion, it fails to exercise any beneficial influence. Cupri Sulphas has been successfully employed in \ gr doses, combined with quinine.. Cuprum Ammoniatum is now not much used in epilepsy. Digitalis has proved of little service in epilepsy, though it has been recom- mended in large doses. Hydrargyri lodidum Rubrum has been recommended by Dr. Fuller (Medical Times, February 14, 1857) in cases where there is reason to suppose thickening of the dura mater. Hyoscyamus in occasional full doses (f.^iv-viij of the succus or f.^iv-viij of the tincture) has been found by Dr. Harlev very serviceable in epilepsy arising from emotional disturbances, but in other varieties of this disease it has proved useless in his hands. *Morrhuos Oleum has been employed by Dr. Anstie, with encouraging results, in cachectic cases. It must be persevered in for a lono- time? Moschus is sometimes useful. Dr. A. T. Thomson says that it diminishes the violence of the paroxysms of idiopathic epilepsy, and greatly length- ens the intervals, when administered as follows :— " 47. R. Moschii, -• In a bolus for one dose, every eight hours. Nitrite of Amyl by inhalation, has been found eminently useful by Weir- Mitchell, in a case brought on by inordinate venery. Nux Vomica. In epilepsy following the disappearance of the menstrual dis charge, Copland recommends nux vomica combined as follows'-— EPILEPSY. 45 48. R. Extracti nucis vomicae, gr.x Pilulae aloes cum myrrha, gij M. For 36 pills. From one to two night and morning. Its employ- ment demands caution. Opium is now rarely employed, since the discovery of the value of bromide of potassium, in this affection. Oxygen Inhalations are recommended by Dr. Ramskill (Medical Times, July 4th, 1863). On the accession of giddiness, or other uncomfortable symptoms, they should be stopped. Phosphorus is regarded by Dr. Anstie as well worthy of further trial in this disease, as it improves the patient's general health and relieves the sense of languor and depression. Plumbi Acetas was formerly much employed, but is now rarely administered. **Potassii Bromidum is the remedy par excellence in epilepsy. See opinions already given, of Drs. Brown-Sequard (p. 38), Clocston (p. 4U), Hammond (p. 41). It cures in very many cases, and rarely fails to diminish the number of attacks. Quinice Sulphas is sometimes prescribed. * Santonin is of service when the epilepsy is due to the presence of worms in the alimentary canal. Sinapis is a useful emetic in epilepsy, for over distention of the stomach. Stanni Chloridum has been employed in doses of gr. \ to \ thrice daily, in pill, or dissolved in hydrochloric ether. Stramonium is of doubtful efficacy in epilepsy. Strychnia is strongly recommended by Walter Tyrrell (p. 42), and in the threatenmgs of epilepsy, by Marshall Hall (F. 39). Tabacum is supposed to have a curative influence in epilepsy produced by onanism, as the use of tobacco allays sexual lust. Terebinthince Oleum, though little used in epilepsy, is strongly recommended by Sir Thomas Watson (who states that if he was called upon to name any single drug from which in ordinary cases he should hope for relief, he should mention turpentine), and by Dr. Headland, who prescribes it as follows :— 49. R. Olei terebinthinae, f.^8 Thrice daily. Or 50. R. Olei terebinthinae, Olei ricini, aa f-^iij. M. For one dose at occasional intervals. Valeriana is highly praised as a remedy for epilepsy, by Brisbane, Fother- gill, Haller, Willis, and others, but regarded as of little value by Cullen, Heberden, and Home. Zinci Lactas was first recommended in epilepsy by Dr. Herpin (Bull. G6n. de Th6rap., November, 1856), who regards it as of equal medicinal value with the oxide, and superior to it in taste and tolerance. He gives it at first in two grain doses, in pill, thrice daily, and gradually in- creases the quantity until ten grains are taken during the day. *Zinci Oxidum is regarded by Dr. Russell Reynolds as superior to the sul- phate of zinc in epilepsy. He gives it in doses of grs. iii-v thrice daily. Dr. Waring Curran strongly urges it as an adjunct to bromide of potassium (p. 41). 46 DISEASES OF THE NERVOUS SYSTEM. Zinci Sulphas is a long used remedy in epilepsy, but is now generally-consid- ered inferior, in this disease, to both the oxide and valerianate. Zinci Valerianas is considered by many as the best salt of zinc in epilepsy- 11 is especially valuable in cases of a hysterical character 1 «£ dose should be small at first, one grain, gradually increased as the stomach will bear it. Dr. Da Costa sometimes prescribes it with belladonna and digitalis (F. 38). Emetics, given when an attack is imminent, will often, according to Dr. Mar- shall Hall, ward it off. Sedatives are useful by controlling undue readiness of action of certain portions of the nervous centres. Stimulants. A draught of wine or of some diffusible stimulant may put off an attack. EXTERNAL REMEDIES. Cold Shower Baths are useful in epilepsy when the patient is not too timid nor too much excited by them. Turkish Baths are sometimes employed, but great caution is required in the use of so powerful an agent. *Blisters. A narrow circular blister applied above or at the starting point of the aura will sometimes prevent or modify a paroxysm. Cathartics are of little service in epilepsy, excepting when the bowels are overloaded. Dry Cupping, sometimes, according to Dr. Graves, averts a paroxysm of epi- lepsy where previous headache or other premonitory symptoms adver- tise its approach. Electricity has given unsatisfactory results in epilepsy. Dr. Copland says that " the safest method of employing electricity is to place the patient on the insulating stool and subject him to the electric bath, and to draw sparks from different parts when thus insulated, and placed in connection with the prime conductor." Forcible Extension of the muscles where the aura is seated, or the application of pressure between the starting point of the aura and the trunk, may avert an attack. Hypodermic Injections. Atropia, subcutaneously, in this disease, was pro- posed by Brown-Sequard, combined with morphia (F. 36). Prof. Bartholow has also employed this combination. ^Morphia alone, or in combination with atropia, has been found, when injected hypo- dermically, not only to relieve quickly the paroxysms in violent cases, but to afford permanent benefit by diminishing the number, frequency and severity of succeeding attacks, and, therefore, to dispute with the bromide of potassium for the foremost position among the remedies against epilepsy. As one may succeed when the other fails, Prof. Bartholow points out that bromide of potassium is most effective in cases of grand mat, in which the paroxysms occur frequently, with great violence, and during the day-time, and less effective in those which occur chiefly at night; while the hypodermic injection of mor- phia is preferable in epilepsy, the paroxysms of which occur at night, in the petit mat, and in convulsive tic, but not proper, as a general rule, in cases of epileptoid character dependent upon cerebral lesion. Prof. B. advises, when the paroxysms succeed each other rapidly, and are violent, that the injection be made during an attack, and without loss of time, but states that ordinarily two or three times a week will suffice (dose gr.£), the onset of an expected attack being anticipated whenever practicable. HEADACHE. 47 HEADACHE. PROF. HARVEY L. BYRD, M. D., BALTIMORE. In the treatment of sick headache, Prof. Byrd recommends the use of an emetic of ipecacuanha, and after its action the use of the following: 51. R. Chlorali, gj Aquae. f.3ij. M. A tablespoonful every hour until sleep is induced. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. In congestive headache the use of saline cathartics is of service. Also, a mustard foot bath every night. The application of a hot salt bag to the back of the neck often affords relief. This form of headache is frequently associated with cardiac enlargement. PROF. AUSTIN FLINT, M. D., NEW YORK. Periodical headaches, as regards • successful treatment, belong among the opprobria of medical art. If patients be not unplea- santly affected by opiates, an attack may sometimes be warded off, or its severity much lessened, by a full dose of opium or one of its alkaloids. The carbonate of ammonium and a saline purgative are sometimes effective at the commencement of an attack. Vari- ous palliative measures may be resorted to, such as inhalation of chloroform, evaporating lotions to the head (alcohol, spirits, vinegar, ether), etc. In some cases a towel or napkin, wrung out in water as hot as can be borne, and wound around the head, is more efficient than cold applications. Warm stimulating pediluvia, strong coffee or tea, and the application of the galvanic or the electro-galvanic current, are useful in some cases. During the intervals the reme- dies which are sometimes of service by way of prophylaxis are, nux vomica or strychnia in small doses, arsenic, small doses of quinia, belladonna, and the preparations of zinc, more especially the valerianate. They may be tried in succession. Hygienic measures are important, and the avoidance of everything which experience shows, in individual cases, to act as exciting causes. NERVOUS HEADACHE. PROF. R. J. GRAVES, M. D„ DUBLIN. 52. R. Olei terebenthinae, f-3j-i.b For one dose, to be given in cold water. 48 DISEASES OF THE NERVOUS SYSTEM. Our author places much reliance on this medicine in the hysteri- cal and nervous headaches of young women. Some will bear and derive benefit from two or three of these doses in the day, experi- encing from its use a diminution of headache, the removal of flatulence, together with a moderate action on the bowels and kid- neys. The turpentine may also be given in the form of an enema. Occasionally it causes dysuria and cannot be persevered in. Dry Cupping at the nape of the neck, between the shoulders, and below the clavicles, is often of great service in hysterical headaches. Six cups should be applied and allowed to remain on for ten or fifteen minutes. PROF. WILLIAM A. HAMMOND, M. D., NEW YORK. 53. R. Zinci oxidi, Bij-v Confectionis rosae, q. s. M. Divide into 20 pills. One to be taken three times a day, after meals. This formula is of great value. The minimum dose (gr.ij) should be commenced with, gradually increasing to the maximum (gr.v) if necessary. 54. R. Extracti nucis vomicae, gr.v Ferri redacti, 9j Quiniae sulphatis, gr.x Syrupi, q. s. M. Divide into 20 pills. One to be taken three times a day, after meals. Nux vomica is preferable to strychnia. 55. R. Bismuthi subcarbonatis, 9ij Confectionis rosae, q. s. M. Divide into twenty pills. One after each meal. These pills will often take the place of those of oxide of zinc (F. 53). They are particularly useful when there is gastric disturb- ance. Bromide of potassium is serviceable when the nervous system ha,s been irritated; when exhausted it does harm. Bromide of ammonium is similar to the bromide of potassium in its action, but the dose need not be so large. Our author often uses both combined. Opium and its preparations are rarely of value in this disorder. If used, the hypodermic method is the best. Narcein has, Dr. Hammond still thinks, a decided hypnotic effect when given in large doses. HEADACHE. 49 Phosphorus is beneficial in all the forms of nervous headache. It is, however, difficult of administration, and leaves an unpleasant odor about the person. The best results are obtained from the following method of administration :— 56. R. Acidi phosphorici diluti, f.gvj Syrupi phosphatum compositi, f.^iij. A dessertspoonful, in water, three times a day. Arsenic as a nerve tonic stands next in value to zinc. Granules of arsenious acid (gr.^) are preferable to Fowler's solution. Galvanism is highly praised by some and severely condemned by others, in this affection. The brain cannot be acted upon to any considerable extent by the induced current or by reflex action. Our author advises always the constant current; being careful to avoid too great intensity, lest amaurosis be produced {Half-yearly Compendium of Medical Science, July, 1868). GEORGE KENNION, M. D., HARROWGATE, ENG. 57. R. Carbonis bisulphidi, fl^ij. As a local application in neuralgic, periodical and hysterical headache, and even in many cases of dyspeptic cephalalgia. About two drachms of the bisulphide of carbon is poured upon cotton wool, with which a small glass-stoppered bottle is half filled. The mouth of the bottle is applied closely to the temple or behind the ear, or as near as possible to the seat of pain, and so held from three to five or six minutes. In a minute or two a sensation as of several leeches biting the part is felt, and in three or four minutes more the smarting and pain become rather severe, but subside almost immediately after the removal of the bottle. {Medical Times and Gazette, July, 1868). It is very seldom any redness of the skin is produced. The effect of the application is generally immediate; it may be repeated, if necessary, three or four times a day. The sedative vapor of the bisulphide is probably absorbed through thejBkin, and acts upon the superficial nerves of the part to whicb/it is applied. DR. LETENNEUR, FRANCE. 58. R. Potassii bromidi, 3j Aquae destillatae, f.^x. M. A tablespoonful before the mid-day meal, and two tablespoonfuls at bedtime, in migraine with periodical returns. During the attack the patient will take, three or four times a day, small doses of morphia. 4 50 DISEASES OF THE NERVOUS SYSTEM. DR. LABORDE, FRANCE. 59. R. Quiniae sulphatis, 3s8 Tincturae aconiti radicis, Tt\,xv Althaeae pulveris, q- 8- Divide into 30 pills. Three or four a day in hemicrania. JAMES PERRIGO, M. D., MONTREAL. Our author reports (Canada Medical Record, March, 1874) a case of severe headache in a business man, which resisted all ordi- nary treatment, but which yielded promptly to guar ana. Thirty grains of the powder in water were prescribed, to be taken when the pain was severe. The medicine acted exceedingly well, com- pletely relieving him of all his headache. He can invariably pre- vent an attack by taking the above dose when he feels the pre- monitory symptoms coming on. THOMAS HAWKES TANNER, M. D., LONDON. 60. R. Quiniae sulphatis, gr.xxiv Pulveris rhei, gr.xxxvj Glycerinae, q. s. M. Divide into 12 pills, and order one to be taken at night. Often of service in curing bilious headaches; the patients also taking daily exercise in the open air, and avoiding too much sleep. 61. R. Acidi nitro-muriatici diluti, f.gij Strychniae, $r'%~% Spiritus chloroformi, f»3vj Tincturae zingiberis, f.^iij Aquam, ad. f.^iij. M. A teaspoonful in water three times a day, in nervous headache. Holding the arms high above the head produces a marked effect upon the cerebral circulation, and will frequently relieve the se- verity of that peculiar morning headache with which some persons constantly awake. Compression of the temporal arteries with a couple of pads and a bandage may sometimes be of service. Cold lotions, eau de cologne, etc., to the head, dry cupping or blisters, or setons to the nape of the neck; the removal of decayed teeth or stumps from the mouth, and change of air, are occasion- ally indicated. 62. R. Zinci valerianatis, gr.xij-xxiv Extracti belladonna, gr.iij-yi Extracti gentianae, gr.xxiv. M Divide into 12 pills. One to be taken three times a day. HEADACHE. 51 Useful in hysterical headache, especially when there is habitual constipation. 63. R. Zinci phosphatis, Bj-ij Acidi phosphorici diluti, f.giss Tincturaa cinchonae, f-3vj Aquam menthae piperitae, ad. f-liij. M. Tablespoonful in a half wine glass of water three times a day, in hysterical headache associated with debility. HENRY G. WRIGHT, M. D., LONDON. 64. R. Tincturae capsici, f.gij Liquoris ammoniae acetatis, Tincturae aurantii, Syrupi aurantii corticis, aa f.^vj Aquae, f.^ss. M. A teaspoonful, to relieve the headache that ensues after inebriety, etc. 65. R. Linimenti chloroformi, Linimenti belladonnas, aa f.^iss Tincturae opii, f.gj. M. For external application, in rheumatic headaches. Mustard plasters applied to the neck are also exceedingly useful as a means of counter-irritation. In such cases (rheumatic head- ache) the following aperient is of advantage, viz:— .,;IH.uJ 66. R. Pilulae colocynthidis compositae, gr.xv Extracti colchici acetici, gr.iij Olei carui, ttij. M. Divide into 4 pills. Two to be taken at bedtime, and one on consecu- tive nights. These pills should be followed, in persons of a costive habit, by a morning purgative, as follows:— 67. R. Magnesias, 9iv Liquoris potassae, rr\,xlv Extracti sennas fluidi, f.gij Syrupi zingiberis, Tincturae aurantii, aa f.^ss Aquae, fjj. M. Dose—a tablespoonful. The administration of an alkaline medicine containing potash, if continued with regularity, will generally be followed by rapid amelioration of the pain and tenderness. The following may be used:— 68. R. Potassii carbonatis, 9iv Potassii chloratis, 3iss Tincturae cinnamomi, Tincturae aurantii, aa f.gvj Syrupi aurantii corticis, f.^iss. M. A dessertspoonful to be taken twice or three times a day. 52 DISEASES OF THE NERVOUS SYSTEM. If imprudent exposure to cold has produced an aggravation of the headache, and particularly if the patient be subject to catarrh, it is advisable to administer a sudorific at bedtime, such as 69. R. Pulveris ipecacuanhas compositi, gr-xy Pulveris camphorae, Pulveris guaiaci, aa gr.iv. For one powder, to be taken about bedtime. M. In gouty headaches colchicum may be employed with greater freedom than in ordinary gout, care being taken that the bowels are freely open during its administration. An actual attack is best relieved by a brisk aperient (F. 66), followed by an effervescing mixture, containing an excess of potash, viz.:— 70. R. Potassii carbonatis, 9iv Ammonii carbonatis, 9ij Tincturae serpentariae, f-3ss Aquae camphorae, f.^iijss. M. Two tablespoonfuls to be added to a tablespoonful each of water and lemon juice, and to be taken effervescing twice or three times a day. In the treatment of plethoric headaches the employment of medicines should, as far as possible, be dispensed with. They should only be resorted to when the necessities of business prevent, or the solicitations of indolence interfere with, a strict control over the diet and regimen. In these cases a saline diuretic should be ordered, such as 71. R. Potassii acetatis, gij Potassii nitratis, 3j Spiritus juniperi compositi, f-3xj Aquam menthae piperitae, ad. f.^iv. M. A teaspoonful twice a day, together with an occasional aperient at night, viz:— 72. R. Pilulae colocynthidis compositae, gr.l Saponis castilliensis, gr.ix Olei anethi, H^j; ]yj Divide into 12 pills; two to be taken at bedtime, and followed by a Seidlitz powder in the morning. Persons subject to plethoric headaches should not partake of animal food more than once a day; should never indulge the appe- tite to satiety; should avoid beer, spirits, coffee, and all stimulating beverages; should bathe the head freely at night and lie with it elevated on a hard pillow during sleep; should have an airy bed- HEADACHE. 53 room and rise so soon as fairly awake, for otherwise activity of the thoughts in a recumbent position will congest the head and cause it to ache. When the patient has been exposed to cold and the headache comes on at night, with the head hot and the skin harsh and dry, the following sudorific, taken at bedtime, is often of great service, the body being kept warm during its action :— 73. R. Antimonii et potassii tartratis, gr.£ Pulveris Jacobi veri, gr.v Pulveris potassii nitratis, gr.x. M. To be taken at night. In the plethoric headache of pregnancy, relief is afforded by the use of saline medicines, as 74. R. Magnesii sulphatis, Sodii sulphatis, aa ^j Acidi sulphurici diluti, f.gij Tincturae cardamomi compositae, f.$iss Syrupi aurantii corticis, f-3*ss Aquae cinnamomi, f-3"j. M. A dessertspoonful twice a day. Fluids should be avoided as far as possible. Sea air and spong- ing the body with tepid salt water generally prove beneficial. In the treatment of congestive headaches, the aperients so frequently required should be cordial and saline, such as 75. R. Extracti sennas fluidi, f.^ijsa Magnesii sulphatis, 3"ij.. Acidi sulphurici aromatici, f.^ij Syrupi aurantii corticis, f.fj Infusi rhei, f-gijss. M. Dose—a tablespoonful in the morning. There are no medicines so invariably useful in cases of congestive headache, attended with debility, as the preparations of Iron. If the patient be of stout phlegmatic habit, the tonic may be combined with a cordial and saline, according to the following formula:— 76. R. Ferri sulphatis, gr.xxxij Magnesii sulphatis, 3* Acidi sulphurici diluti, f-3>ij Tincturae cardamomi compositae, f-Sy Syrupi, Aquae pimentae, S.8- f-3J- *!• A dessertspoonful in water twice a day. 54 DISEASES OF THE NERVOUS SYSTEM. 77. R. Tincturae ferri chloridi, f-3y Acidi muriatici diluti, f-388 Tincturae cinnamomi, f-3J8S ^P*'. . -- *-„• M Aquae cinnamomi, aa i-3vJ- iA' A dessertspoonful in water, twice a day, about an hour after food. In the congestive headache of females past the middle period of life, especially when these headaches accompany alterations of the whole system, at the great climacteric period. In the treatment of dyspeptic headaches, when the pain comes on directly after a meal, and when it can be traced to indigestible articles of food, and the patient is tolerably strong, an emetic is useful. 78. R. Pulveris ipecacuanhas, gr.xxv Ammonii carbonatis, gr.v Aquas menthae viridis, f.giss. M. Take at one dose and follow by some warm fluid. Where the pain ensues some hours after taking food, a warm draught, with the following formula, is generally beneficial:— 79. R. Pulveris rhei, 9ijss Magnesii carbonatis, 9ij Spiritus ammoniae aromatici, f.^ij Syrupi zingiberis, f.^ss Aquam menthae piperitae, ad. f.^ij. M. A tablespoonful in water. Such a headache may often be warded off by the following:— 80. R. Pulveris rhei, gr.xviij Pulveris capsici, gr.v Sodii carbonatis exsiccatae, Pulveris aloes, Saponis castilliensis, aa gr.xij. M. Divide into 12 pills. One to be taken before the meal, as a dinner pill. 81. R. Pilulae hydrargyri, Pilulae rhei compositae, aa, gr.iv Extracti hyoscyami, gr.ij. M. Divide into 2 pills. To be taken at night, in cases of headache depend- ing upon dyspepsia, Or, 82. R. Pulveris ipecacuanhas, gr.j Pilulae colocynthidis compositae, gr-vij Extracti gentianae, gr.ij Olei carui, n\,£. M. Divide into 2 pills. To be taken at bedtime. HEADACHE. 55 When the system is debilitated it is often more advisable to em- ploy the following, in place of the night pills :— 83. R. Infusi sennas, Infusi rhei, aa, f.gv Tincturae cardamomi compositae, f.^j Syrupi, f.gss. M. To be given as a draught in the morning. Great benefit is generally derived from the combination of a bitter with an alkali, as in 84. R. Sodii carbonatis, gij Spiritus ammoniae aromatici, f.gvj Tincturae aurantii, Syrupi aurantii corticis, aa f-^iij Tinctures gentianae compositae, f.^iss. M. A dessertspoonful twice a day. If the stomach be very irritable, with excessive flatulence, the following mixture is more suitable : 85. R. Bismuthi subnitratis, Sacchari, Pulveris acaciss, aa gj Tincturae cardamomi compositae, Tincturas zingiberis, aa, f.^ss Aquae anethi, f.^iijss. M. A tablespoonful taken twice a day. The same medicine may be combined with soda and capsicum, thus:— 86. R. Bismuthi subnitratis, Sodii carbonatis exsiccatae, aa By'ss Pulveris capsici, gr.viij. M. For 8 oowders. One to be taken twice a day, in dyspepsia with much acidity, with loss of appetite and general want of tone. 87. R. Argenti oxidi, ^ gr.xij Pulveris capsici, gr-iy Extracti gentianae, gr.xxiv. M. Divide into 8 pills. One to be taken twice a day. In atonic dyspepsia, when the tongue is pale at the tips and edges, and the system weakly, few recipes prove so invariably successful as the above. 88. R. Morphiae muriatis, gr j Pulveris camphorae, gr.xxiv Mucilaginis acacias, q- s. M. Divide into 6 pills. In Intermittent Headache. One pill to be taken when the headache is very intense. Five hours are to be allowed to elapse before re- peating the dose. 56 DISEASES OF THE NERVOUS SYSTEM. 89. R. Quiniae sulphatis, 38S Ferri carbonatis saccharatae, 3j# Pulveris aromatici, 3yss- M# Divide into 20 powders. One to be taken twice or three times a day, commencing with half a powder. Useful in periodical headache occurring in delicate and weakly persons. In the treatment of Nervous Headache and of cases of megrims, the combinations of hyoscyamus with camphor, with chloroform, or with a diffusible stimulant, generally affords great relief. The following formulae may be used : 90. R. Extracti hyoscyami, _ Pulveris camphorae, aa By88- M. Divide into 20 pills. Two to be taken when the pain is severe. 91. R. Chloroformi, f-3i88 Tincturae hyoscyami, Tincturae cardamomi compositae, aa f.^ss Olei limonii, "Uvj Sacchari, Pulveris acaciae, • aa 388.. Aquae camphorae, f^"j- M. Dose—a tablespoonful. 92. R. Tincturae hyoscyami, Spiritus ammoniae aromatici, aa f.3*ss Syrupi aurantii corticis, ^<|>L Aquae menthae piperitae, f.31J• ^- Dose—a tablespoonful. 93. R. Pulveris camphorae, Quiniae sulphatis, aa gr-x„ Extracti aloes, gr-xij Extracti hyoscyami, 38S Mucilaginis acaciae, q. s. M Divide into 18 pills. Two pills to be taken twice a day, in cases of nervous headache when there is great debility and sluggishness of the system. (For additional recipes, see Hemicrania). RESUME OF REMEDIES. BILIOUS, OR SICK, AND DYSPEPTIC HEADACHES. Ammonii Acetatis Liquor is recommended by Prof. Still£, who considers few remedies so successful in sick headaches, as a teaspoonful or two of this solution. Ammonii Carbonas will sometimes offer almost instantaneous relief. * Ammonii Chloridum is useful in bilious, as well as hysterical headaches. Ac- cording to Dr. Anstie, gr.x-xx, if given early enough, seldom fails to cut short and greatly mitigate the attack. It is given with great benefit when the pain is most intense in any form of headache. Argenti Nitras is recommended by Dr. J. Johnson (in combination with minute doses of compound colocynth pills), in the habitual stomach head- ache to which delicate and literary men are so subject. HEADACHE. 57 Bismuthi Subnitras is frequently advised, variously combined, in dyspeptic headache, by Dr. Wright (F. 85, 86). Carbonis Bisulphidum is recommended by Dr. Kennion, in dyspeptic head- ache, applied locally (F. 57). Chloral is recommended in sick headache, by Prof. Byrd (F. 51). Hydrargyri Chloridum Mite is of service in headaches arising from biliary derangement, or a torpid state of the bowels. It should be followed, at a short interval, by a saline or other purgative. Magnesia, in cases accompanied with constipation, affords great relief. Magnesii Citratis Liquor. A dose of the effervescing citrate is often very effectual in dyspeptic headache. Podophyllum is prescribed with benefit in many forms of bilious headache. Potassii Bromidum has been recommended for the prompt and certain relief of the paroxysm. Rheum is advised by Drs. Tanner (F. 60) and Wright, variously combined (F. 75, 79, 80, 81, 83). CONGESTIVE OR PLETHORIC HEADACHE. Asarum Europceum, gr.ij-iij of the powdered root, snuffed into the nostrils, has proved useful in cases of severe chronic headache originating in inflammation of the frontal sinuses. Aloetic purgatives are beneficial in congestive headaches. * Leeches may be applied with advantage to the temples, to the crown of the head, or to the verge of the anus. Saline aperients are recommended by Drs. DaCosta (p. 47) and Wright (p. 53). Shower Baths are of advantage in congestive as well as hysterical headaches. Sinapisms, to which have been added powdered capsicum or oil of turpentine, are often applied with benefit to the soles of the feet and the inner parts of the calves and thighs. * Water, locally applied, hot, is often more effectual than the cold lotions usually employed. Diligently steeping the temples, forehead, occi- put, and nape of the neck with water, as hot as can be borne, in many cases will be found a useful remedy. The hot foot-bath is often of signal service. GOUTY HEADACHE. Colchicum may be employed with greater freedom in gouty headache than in ordinary gout, according to Dr. Wright (p. 52). HYSTERICAL AND NERVOUS HEADACHES. Ammonii Chloridum is advised by Dr. Anstie, to be administered in the same manner as for bilious headache (which see above). Ammonii Bromidum is recommended by Prof. Hammond, alone or combined with the bromide of potassium (p. 48). Argenti Nitras is highly prized by Dr. Graves, administered in considerable doses ; i. e., gr. | five or even six times daily, for five or six days at a time, when the paroxysm has abated. If there be constipation, the nitrate should be combined with minute doses of compound colocynth pill. Bismuthi Subcarbonas is often prescribed by Prof. Hammond, particularly when there is gastric disturbance (F. 55). Cajuputi Oleum is used both externally and internally, in nervous, rheumatic, and neuralgic headaches. 58 DISEASES OF THE NERVOUS SYSTEM. Camphora is useful, combined with hyoscyamus (F. 90, 91, 93). * Chloroformi Spiritus, in the dose n\,xv-xxx, often affords prompt relief in nervous and hysterical headaches. Cimicifuga is useful in the headaches attendant on uterine derangement. Caffea. A cup of strong coffee is of service in many cases of hysterical and nervous headache. The addition of the juice of a lemon adds greatly to its efficacy. Guarana is particularly efficacious in the relief of sick headache, in doses of half a drachm to a drachm (see p. 50). Hyoscyamus is strongly recommended by Dr. Wright, in nervous headache. It may be combined with camphor, with chloroform, or with a diffu- sible stimulant (F. 90, 91, 92, 93). Lavandula. The compound tincture, administered according to the following formula, makes an agreeable stimulant:— 94. R. Tincturae lavandulae compositae, Spiritus chloroformi, Spiritus aetheris compositi, aa f.3j Aquae camphorae, f-^iij- M. Dose, two tablespoonfuls in water. Opium may be added if indicated. This is a very effectual recipe for the headache of hysteria. Narcein is recommended as a hypnotic by Prof. Hammond (p. 48). Nitro-muriaticum Acidum is recommended by Dr. Tanner (F. 61). Opium is, Prof. Hammond states, of little value in these disorders. Phosphorus is recommended by Prof. Hammond in all forms of nervous head- ache (F. 56). Quinioz Sulphas is beneficial in hysterical headaches associated with anaemia. Rosmarinus. The infusion is a mild stimulant, sometimes of service. Stramonium has been prescribed with benefit by Dr. Copland. Strychnia. Prof. Hammond considers nux vomica as preferable to strychnia in nervous headaches (F. 54). Terebinthince Oleum is recommended by Dr. Graves in hysterical headache (F. 52). * Valeriana is of especial benefit in hysterical headache. Dr. Ashwell re- commends the following formula:— 95. R. Tincturae Valerianae, Spiritus aetheris compositi, Spiritus lavandulae compositi, aa vr^.xxx Tincturae hyoscyami, Vt^xx Aquae camphorae, f.gx. M. For one dose. Dr. Connolly recommends the following:— 96. R. Tincturae Valerianae ammoniatae Spiritus aetheris compositi, aa ttbxxx Aquas camphorae, f.^iss. M. Or, 97. R. Tincturae Valerianae ammoniat33, f.gj Acidi sulphurici diluti, tt^xv Aquas camphorae, f.^iss. M. Make a draught, to be given twice or thrice a day. Zinci Oxidum is regarded as of great value in nervous headache by Prof Hammond (F. 53). ' J HEADACHE. 59 Zinci Phosphas is recommended by Dr. Tanner, in hysterical headache, as- sociated with debility (F. 63). Zinci Valerianas is also recommended by Dr. Tanner, combined with bella- donna (F. 62). EXTERNAL REMEDIES JEther to the forehead, on a very thin compress, to avoid irritation of the skin, by thus favoring its free evaporation, is an excellent application. Camphora, locally applied, is a valuable remedy in nervous headaches. The following formula may be employed:— 98. R. Camphorae, |j Aceti Oj Aquae, Oj—ij. M. Another excellent local application is what is known in France as " l'Eau Sedative de Raspail," which is made as follows :— 99. R. Aquas ammoniae, 100 parts. Camphorae, 2 " Sodii chloridi, 20 " Aquae, 900 " Olei rosae, q. s. M. Dry Cupping is recommended by Dr. Graves (p. 48). Oleum Cajuputi. A few drops rubbed upon the painful part are often effectual. Shower Baths are often of great advantage in hysterical headache. NEURALGIC HEADACHE. Ammonii Chloridum, given when the pain is most intense, in the dose of gr. x-xx, sometimes affords prompt relief. Cajuputi Oleum is used, both externally and internally, by Dr. Copland and others. Camphora, in the form of " Raspail's sedative water" (F.99), is sometimes very useful. Carbonis Bisulphidum is recommended by Dr. Kennion (F. 57). Caffein. The citrate has been recommended in doses of gr.j, every hour, for some time before the expected attack. Coffee is much used by Bel- gian physicians. The juice of a lemon makes a valuable addition to a cup of strong coffee in these cases. Caffein may also be employed hypodermically. Nitrite of Amyl, by inhalation, has been successfully employed in neuralgic headache, associated with a diminished supply oi blood in the brain. EXTERNAL REMEDIES. Acetum. A compress wet with vinegar and water, and bound upon the tem- ples, often affords relief. JEther applied to the forehead, on a very thin compress, so as to permit of its rapid and complete evaporation, is useful. Sinapisms over the seat of pain sometimes afford relief. Spiritus JEtheris Nitrosi makes a pleasant, cooling, evaporating lotion, if not continued 60 long as to irritate the skin. 60 DISEASES OF THE NERVOUS SYSTEM. PERIODIC HEADACHE. Arsenici lodidum has been found, by Dr. Walshe, to give relief in the most violent cases of periodic headache. It should be given in doses ot gv.T^\, twice a day, two hours after eating, and continued tor a month or two. Ammonii Carbonas and a saline purgative, at the commencement of an at- tack, are recommended by Prof. Flint (p. 47). Belladonna is sometimes of service as a prophylactic (p. 47). Nectandra is a useful remedy in periodical headaches. Potassii Bromidum often rapidly relieves headache of a paroxysmal charac- ter, with heat of the head and flushing of the face. Quinice Sulphas, in small doses, is recommended, by way of prophylaxis, by Prof. Flint (p. 47). Zincum. The various preparations of this metal, more especially the valerian- ate, may be employed with advantage in the intervals of the attacks. RHEUMATIC HEADACHE. Aconitum in small doses, either alone or in combination with other remedies, is often of service. Chloroform liniment is recommended by Dr. Wright (F. 65). Colchicum, combined with an aperient, is useful (F. 66). Potassii Carbonas is prescribed by Dr. Wright (F. 68). Stramonium is recommended by Dr. Copland and others. *Sulphur internally is often of great benefit in rheumatic headaches and those which occur in women about the period of the cessation of the menses. Alkaline treatment, if continued with regularity, will generally be followed by satisfactory results (F. 68). SEVERE IDIOPATHIC HEADACHE. Ferri Carbonas has been prescribed with signal success, in the dose of gr.j twice a day. Potassii Bromidum often proves a valuable remedy. Zingiber. A ginger plaster applied to the forehead is said, by Pereira, to afford much relief. Frigus. A freezing mixture of ice and salt is serviceable in those cases in which the headache is combined with much heat of the integuments, and when the symptoms appear to threaten secondary local inflam- mation. Issues. Obstinate headache occurring in robust subjects often yields to an issue at the nape of the neck. HEADACHE FROM MENSTRUAL DERANGEMENT. Aloetic Purgatives are useful in cases arising from suppression of the cata- menia. Ammonii Chloridum is variously estimated by different physicians in cases of headache arising from irregularity or suspension of menstruation, some finding it powerless, others of great service. Cimicifuga is often useful. * Sulphur given internally is of benefit in headaches occurring in women about the period of the cessation of the menses. HEMICRANIA. 61 HEMICRANIA. M. BERTRAND, PARIS. 100. R. Veratrias, gr.v Morphias, gr.iij Adipis, |j. M. The painful parts to be rubbed with this ointment frequently, when the paroxysms of pain are at their height. Two or three frictions ordinarily suffice. A number of cases of facial neuralgia, and of neuralgic headache, in which quinine and blisters had been tried without effect, yielded promptly to this application. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 101. R. Extracti conii fluidi, n\l Ammonii chloridi, gij Syrupi aurantii corticis, Aquae, aa, f.giss. M. Teaspoonful thrice daily, in neuralgic headache associated with ple- thora, rather than anemia, in young women. Also, a drachm of cream of tartar, before breakfast, daily, or twice a day. A small cup of strong coffee, with which the juice of a lemon has been mixed, will, in some cases, afford relief in an attack of hemicrania. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 102. R. Caffeini oitratis, gr.x Syrupi, q.s. Divide into 10 pills. One to be given every hour, on the first symp- toms. An infusion of unroasted coffee, drank daily, appears sometimes to render the attacks more rare and less severe. RESUME OF REMEDIES. *Acidum Arseniosum is highly praised by Sir Thomas Watson, who states that four to six drops of Fowler's solution, three times a day, with due at- tention to the bowels, will, in nine cases out often, remove hemicrania. Caffein, in the doses of one grain every hour, for some time before the ex- pected paroxysm, is of great service (F. 102). Cannabis Indica is sometimes very effective. Conium is used in some cases, combined with chloride of ammonium (F. 101). Digitalis has proved successful in conjunction with quinine. Ergota has been employed with very satisfactory results by Dr. E. Waakes (British Medical Journal, Aug. 8, 1868). Ferri Sulphas, in doses of gr. viij-x, daily, either alone or combined with ex- tract of hyoscyamus, will occasionally cure intermittent hemicrania. Quinice Sulphas is a most valuable remedy in intermittent hemicrania. Veratria is highly praised by a number of writers. M. Bertrand's recipe (F. 100) may be employed, or the following formula by Dr. Fuller : 103. R. Veratrias, gr.xx-xxx Glycerines, f.3y Spiritus rectificati, f-£vj. M. Apply with a camel-hair brush night and morning, and rub in well along the course of the affected part, care being taken that there is no abrasion of the cuticle. 62 DISEASES OF THE NERVOUS SYSTEM. HYPOCHONDRIASIS. W. W. GULL, M. D., LONDON. It is obvious that the first duty of the physician is to encourage the hypochrondriac to forget his woes, a difficult thing in practice, as it is a fallacy to suppose that his sufferings are unreal; on the contrary, they are most vividly real, and it is impossible that he should forget them until they cease. The key to the moral treat- ment is the breaking down of the patient's morbid self-concentra- tion, and this object may be achieved to some extent, in many cases, by a change in the course of his daily life. This may be most readily carried out with those in whom the constitutional tendency to hypochondriasis is aggravated by the ennui of an idle life. For these an active career or occupation which forces them to mix with the world is an immense gain. The isolated activity of the student, is no real diversion from the fancies of hypochondriasis, as the case of Dr. Johnson and of many other famous intellectual workers abundantly proves. It is needless to say that all actively depress- ing influences should be removed, such as immoderate venereal in- dulgence, of whatever kind, or alcoholic intemperance. On the other hand, the influence of new emotions, which tend to lift the patient out of himself, can scarcely fail to benefit. It would be a real good fortune to a hypochrondriac if he could fall in love in a natural and healthful manner, or if he could interest himself warmly in philanthropic schemes or other plans of public usefulness. And above all, something like a police supervision should be exercised over his studies, in order that he may be vigorously kept from the perusal of medical or other books which might remind him of his miseries, for though we do not believe that these things can create hypochondriasis, yet they may certainly prevent its cure. The constitutional treatment is to be directed towards improving the general nutrition. The administration of iron is doubtless of great use to some anaemic patients, and sea-bathing frequently ap- pears to exercise a very beneficial influence; but the first of these remedies is generally the most efficacious when taken in the form of the chalybeate waters of some foreign spa, and there is good reason to doubt whether both mineral waters and sea-bathing do not owe most of their apparent power to the moral influences of travel, and change of scene, and mode of life. The more specific HYPOCHONDRIASIS. 63 nervous tonics, such as strychnia, quinia or phosphorus, seem to exercise but a doubtful and exceptional influence. While it is desirable to avoid concentrating the patient's atten- tion on parts which are the apparent seat of morbid sensations, it is important to relieve him of the distress caused by real (though mere functional) disorders of the digestive system. Decided acidity of the stomach should be counteracted by the use of antidotes, of which none is more efficacious than magnesia in ten grain doses thrice daily, with gentian or cascarilla. The excessive or too pro- longed use of alkalies is, of course, to be avoided. The distressing flatulence which is often one of the earliest, and also one of ths. most annoying symptoms, is greatly relieved by creosote (one drop in a pill, two or three times daily) or the infusion of valerian. Alcoholic tinctures should be cautiously employed, if at all, for there is real danger of the patient getting to appreciate the comforting sensations given by the spirit so highly that he gradually takes to drink; this is particularly apt to occur in hypochondriacal women, and in patients exhausted by masturbation, or other venereal in- dulgence. The constipation, frequently so obstinate and trouble- some, should be remedied, if possible, without drugs, so as to avoid stimulating the patient's love of self-doctoring in the direction of the habitual use of purgatives. Fruit, green vegetables, etc., and active bodily exercise, are 'desirable means of accomplishing this object. Physical exercise should be amusing, and never produce severe fatigue. A short continuance of the malpractice of carrying exer- cise to the fatigue point will usually suffice to produce a profound deterioration of the vigor of the nervous system, and an aggravation of the hypochondriacal fancies. DR. HOMOLLE, FRANCE. 104. R. Extracti aloes, Quinias sulphatis, aa, gss Extracti Valerianae, q. s. Divide into 40 pills. One to four a day in hypochondria. Exercise in the open air, amusements and appropriate regimen. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. The only way to cure a hypochondriac, is to rid him of his mor- bid sensations, but it is useless to dispute with him and try to con- vince him of the error of his ideas. In the first place, any exist- ing derangement of the system which would cause a feeling of 64 DISEASES OF THE NERVOUS SYSTEM. illness in a sane person, should be corrected. The benefit derived from various natural mineral springs is no doubt due to their happy effect upon the gastric disorders which so frequently give rise to this disease. Preparations of iron, sea bathing, and cold foot-baths, are frequently appropriate. Drastic cathartics must be used with caution, though they cannot be altogether dispensed with, and generally afford temporary relief. Patients should be warned against over-dosing. This also applies to the use of car- minatives, for which they nearly always beg. The psychical treatment should have in view the diversion of the attention from the sensory to the motor and intellectual spheres. This object will not be attained in educated patients by ordering long walks, wood-sawing, gymnastics, and mechanical pursuits, because the attention is not diverted by such action out of the sphere of sensation. A hypochondriac merchant sawing wood is always busy with the thought that he is doing so because he is sick. General rules are of little value, as the directions must always be in accordance with the capacity, education and means of the patient. RESUME OF REMEDIES. Assafoetida, in combination with bitter tonics and mild aperients, may often be given with advantage in hypochondriasis attended with dyspepsia. Creasotum, one drop, in pill, two or three times daily, will greatly relieve the distressing flatulence of hypochondriasis. Fel Bovinum Purifcatum is advised by Dr. Copland in hypochondriasis at- tended with torpor of the intestines :— 105. R. Fellis bovini purificati, Pilulae assafostidas compositae aa gr.xxx Extracti aloes, gr.xx Saponis gr.x Pulveris ipecacuanhas compositi, gr.viij. M. For 30 pills. One or two to be taken before dinner. Ferri Sulphas is useful when anaemia co-exists. Hyoscyamus has been found of service by Dr. Harlet, in occasional full doses (f.giv-viij) of the succus. Moschus, in the dose of one grain every two hours, often proves successful in the sleeplessness of hypochondriasis. Potassii Bromidum is an uncertain remedy in this disease, affording great relief in some cases, and proving inert in others. Rosmarinus. The infusion is sometimes useful. Sumbul Radix. The resinous extract of this root, in doses of gr.j-ij thrice daily, has proved beneficial in the hands of Russian physicians. * Shower Baths are often highly useful. Turkish Baths have been employed with marked advantage. HYSTERIA. 65 HYSTERIA. PROF. WILLIAM AITKEN, M. D., EDINBURGH. The following directions are given by our author as to what may be done during a fit of hysteria: Everything tight about the patient's person should be loosened. The window should be opened and the cold air allowed to blow over her. The horizontal posture on a bed or the floor should be secured. This being done, many modes of further, proceeding may be followed. Bleeding is, in all cases, of doubtful efficacy. When the jaw is locked, the following enema (recommended by Dr. Wood) may be used:— 106. R. Assafoetidae, gij Aquas, f.Oss. M. To be beaten up with the yolk of an egg, or, what is still better, 107. R. Olei terebinthinae, f.^ss. To be mixed with the yolk of an egg, and then added to half a pint of water. Another remedy is to fill the mouth with salt. But that which supersedes all others, and is unquestionably the best, is a good drenching with cold water. If the patient lie on the bed, the head should be drawn over its side, and a large quantity of water poured on it, from a considerable height, out of a pail, jug, or other large vessel, and directly over the mouth and nose of the patient, so as to stop her breathing and compel her to open her mouth. This prac- tice is generally introduced into hospitals, and until it was adopted, it was not unusual to see three or four patients in hysteria in the same ward and at the same time. Under this practice, however, a hysterical case is rare, and the fit seldom occurs twice in' the same person, and never becomes epidemic. PROF. BOUCHUT, PARIS. 108. R. Chloroformi, rt\,.xx Alcoholis, f.3"iss Syrupi, f.gviij. M. Mix the chloroform and alcohol, then add the syrup, and shake. To be given by tablespoonfuls to hysterical patients, during the attack. 109. R. Moschii, 3"ss Assafoetidae, 9ij Camphorae, gr-xv Extracti gentianae, q s. Divide into 15 pills. Three a day in nervous and hysterical affections. 5 66 DISEASES OF THE NERVOUS SYSTEM. 110. R. Zinci valerianatis, gr'*? Extracti belladonnae, gr.aJ Extracti gentianae, 9j- Divide into 12 pills. One thrice daily in hysterical headache, asso- ciated with habitual constipation. • THOMAS KING CHAMBERS, M. D., LONDON. 111. R. Acidi muriatici diluti, f.^iss Aquas calefactae, (95° F.) C.xxx. M. For a bath. This tonic warm bath is to be used once a day, in order to prepare the patient for a shower bath twice a day. Shower baths, in hysterical cases, are highly recommended by Dr. C. The making up the mind to the shock of a cold shower bath is a capital exercise of the will. Such baths have also a good influence by arterializing the cutaneous circulation, driving the venous blood home to the heart and lungs. Our author rings the changes upon the following prescriptions in the treatment of this disease:— 112. R. . Pilulae assafoetidae, No. xxx. Three to be taken thrice daily. 113. R. Spiritus ammoniae fcetidae, f.^iij. A teaspoonful in water three times a day. 114. R. Tincturae castorei ammoniatae, Aquas fceniculi, aa f-^ij- A dessertspoonful in water thrice daily. 115. R. Pilulae galbani compositae, No- xxx. Two thrice daily. 116. R- Zinci valerianatis, 3J Syrupi, q. s. Divide into 20 pills. One to be taken three times a day. SIR CHARLES LOCOCK, LONDON. 117. R. Potassii bromidi, 3iJ83 Aquas cinnamomi, f«3iv. M. A dessertspoonful thrice daily. In hysterical epilepsy, with disordered uterine functions, the treatment being prolonged. It was this use of bromide of potas- sium, suggested by our author, which led to its introduction as a remedy in forms of epilepsy other than the hysterical. PROF. FELIX VON NIEMEYBR, M. D., TUBINGEN. 118. R. Aurii et sodii chloridi, gr.v Tragacanthae, gj Sacchari, q. g. M. Divide into 40 pills. Order at first one of these pills to be taken an hour after dinner, and another an hour after supper. Afterwards order two pills to be taken at these hours, and gradually inorease the dose up to eight pills daily. HYSTERIA. 67 Our author speaks of this preparation as a nervine of great efficacy in hysteria. He has made use of it with signal effect in many cases where there was no indication for the local treatment of uterine disease, or else, where the hysteric symptoms persisted, although the local uterine affection had been cured. THOMAS HAWKES TANNER, M. D., LONDON. 119. R. Tincturae assafostidas, f.gij Ammonii carbonatis, 9j Aquam camphorae, ad. f.^iv. M. One or two tablespoonfuls occasionally, when feeling languid or hysteri- rical. 120. R. Tincturae assafoetidae, f.gij Spiritus ammoniae aromatici, f-3iij Tincturae chirettas, f-3vij. Sixty drops in a wineglassful of water every two or three hours, until the paroxysms cease. 121. R. Tincturas valerinas ammoniatae, f-Syss Infusi Valerianae, f.^iv. Two tablespoonfuls to be taken occasionally. 122. R. Ferri phosphatis, 9ij Acidi phosphorici diluti, f.giss Syrupi aurantii corticis, f.3*j Syrupi acaciae, f.^iij. A tablespoonful, largely diluted, three times a day. 123. R. Phosphori, gr.j. Olei amygdalae dulcis, f.^iij. M. One teaspoonful in a wineglassful of barley water three times a day. The patient's diet should be regulated. She should have nour- ishing food, and often a moderate quantity of wine or beer. Hot rooms and evening parties are to be proscribed, and stays ought not to be worn. Healthy mental occupation should be afforded. EDWARD JOHN TILT, M. D., LONDON. 124. R. Tincturae castorei, f.^iij Spiritus lavendulas compositi, f.gvj Aquam camphorae, ad. f.^vj. M. A tablespoonful two or three times a day, when cerebral symptoms and hysterical phenomena are marked. The therapeutical indications in the treatment of hysteria are : 1st. To blunt the sensitiveness of the nervous system by sedatives and antispasmodics, and to strengthen it by metallic and other tonics, and by hygiene. 2d. To cure all diseases of the sexual organs, and save the nervous system from visceral irritation, by 68 DISEASES OF THE NERVOUS SYSTEM. good hygiene at menstrual periods; or by marriage, when the sexual organs crave for their legitimate satisfaction. GERMAN PHARMACOPOEIA. 125. R. Tincturae assafoetidae, f-3}?m Tincturae castorei, f-3jy Tincturae opii, f-3J- . ^. From fifteen to thirty drops, by the mouth or in enemata, twice or three times a day, in the hysterical attacks of dysmenorrhoea. Bitter drinks and preparations of iron in the intervals of the attacks if the patient be anaemic. RESUME OF REMEDIES. .Ether. Nothing, according to Stille, so distinctly moderates the paroxysms of this disease as the inhalation of ether. Those who have found the spasms aggravated by a certain degree of etherization have not ad- ministered a sufficient quantity of the vapor. If persisted in it would undoubtedly have put an end to the fit. Allium. The smell of bruised garlic will sometimes promptly terminate a hysterical paroxysm. Auriiet Sodii Chloridum is prescribed by Dr. Niemeyer (F. 118). Aloes. The pill of aloes and assafoetida is very serviceable in the constipation of hysteria. * Ammonium. The carbonate, the aromatic spirits, the foetid spirit, the valeri- anate, and other preparations, are much used and of great value (F. 113). Anthemis. A wineglassful of the infusion of chamomile may be given with advantage thrice daily. * Assafoetida is a most valuable medicine in this disease. It may be given alone, or combined as directed in (F. 119, 120), or the following form may be used: 126. R. Tincturae assafoetidae, Tincturae castorei, Tincturae Valerianae ammoniatae, aa f.gij Aquas camphorae, f-§vij. M. Dose—one or two tablespoonfuls every hour. Assafoetida may also be given, in the form of an enema (F. 106). Aurantii Flores. Orange flower water is much used and valued in France. It is an elegant stimulant and antispasmodic, in doses of one to two fluid ounces. Brominium. See Potassii Bromidum. Cajuputi Oleum internally is often of benefit. Camphora is a very serviceable remedy, either alone or in combination with assafoetida or opium. Cannabis Indica is sometimes useful. Castoreum is a remedy of considerable value (F. 114, 124, 125). Chloral may prove of use in calming hysterical excitement. Chloroform inhalation is highly praised by Dr. Brown-Sequard and Dr. Graily Hewitt in severe and prolonged hysterical paroxysms. In- ternally it may be given with ammonia or assafoetida. A liniment of chloroform often speedily relieves hysterical pain in the side. Cupri Sulphas, in small doses, long continued, is recommended by Sir. B. Brodie, in obstinate hysteria. HYSTERIA. 69 Cusparia Cortex. The infusion is an eligible light tonic in hysteria. Ferrum is indicated in hysteria associated with anaemia. It may be given combined with valerian and other antispasmodics (F. 122). Galbanum sometimes agrees better than assafoetida, and may produce equally favorable results, particularly in cases associated with disordered uterine functions. A galbanum plaster over the sacrum often affords relief (F. 115). * Lavandula is sometimes an effectual remedy (F. 124). Lupulin has been recommended in chronic hysteria, attended with morbid vigilance, in doses of ten grains every six hours. Mvschus, in doses of gr. x-xv thrice daily, is. a valuable remedy, particularly when the surface is pale and the pulse languid. Opium is useful in cases in which the paroxysms are brought on by pain. Phosphorus is prescribed by Dr. Tanner (F. 122, 123). Potassii Bromidum is sometimes a useful sedative in hysteria. Its use was suggested by Sir C. Lococx (F. 117). Ruta. From two to five drops of the volatile oil, on sugar, is a popular reme- dy ; so also is the infusion of rue. *Santonin sometimes proves useful in revealing the true cause of the hysteri- cal symptoms, viz., worms in the intestinal canal. *Spiritus ^Etheris Nitrosi is often very effectual in relieving hysterical spasms. Terebinthince Oleum, in enema, will often arrest a severe paroxysm when ordinary means fail. * Valeriana is a valuable remedy ; it may be given both during the paroxysm and in the intervals (F. 121). Zinci Oxidum is considered by Dr. Waring Curran as more efficacious in hysteria, than the valerianate. Zinci Sulphas, in the dose of one grain, combined with extract of gentian, in pill, two or three times a day, is a valuable remedy in cases of hysteria depending upon debility. It will be found to agree better with many women, than the preparations of iron, causing less irri- tation. Zinci Valerianas is recommended by Dr. Chambers (F. 116). Shower Baths often prove highly useful. Turkish Baths are sometimes beneficial. Cathartics are to be administered if constipation exists, as it is important in hysteria to keep the bowels open. Aloes are indicated if there be torpor of the uterine system; mercurials or podophyllin, if there be biliary derangement; and saline, if there be plethora; but active purgation is in no case advisable. Dry Cupping at the nape of the neck, between the shoulders, or below the clavi- cles, during a paroxysm of hysteria, has been found, by Dr. Graves, to be attended with the best results. Electricity. Dr. Laycock advises the persevering and systematic application of electro-galvanism to the abdominal and pelvic regions, in combi- nation with the internal use of tar. Emetics. An emetic of ipecacuanha given when the paroxysm is impending, often prevents it. Enemata of assafoetida, turpentine, and other antispasmodics, are often of ad- vantage (F. 106, 107). Frigus. The sudden application of cold to the surface of the body, in hyste- rical cases simulating death, will revive the signs of life. Water Douche over the head and face, strongly recommended by Dr. Aitken, p. 65. 70 DISEASES OF THE NERVOUS SYSTEM. INSOLATION. PROF. WILLIAM AITKEN, M. D., EDINBURGH. Our author recommends the following line of treatment of Dr. Barclay:— In the class of cases in which death tends to occur suddenly, from syncope, there is little opportunity afforded for relief; but the measures indicated are—the cold douche ; keeping the surface wet and exposed to a current of air, or assiduously fanned ; exclusion of light as far as possible; the immediate employment of stimulants, external and internal, by the rectum as well as by the mouth. Depletory measures of any kind are not to be thought of. In the less rapidly decisive cases, prompt treatment is of the greatest use, while delay is fraught with the greatest danger. The patient must be immediately stripped of his outer clothing, placed in a semi-recumbent position, and the cold douche applied, from a height of three or four feet, over his head and along his spine and chest, while his extremities are sponged with cold water. Kelaxa- tion of the pupil is the first favorable symptom under this treat- ment, which may require to be repeated several times, on account of returning insensibility. If there is any evidence of failure of the pulse, this treatment must be discontinued, for application of cold to the head is then all that can be borne. The hair is to be cut short as soon as possible, and a blister applied to the nape of the neck. When the first violence of the attack is subdued, increasing confidence in the ultimate result may be indulged in so soon as vesication takes place; and in cases where insensibility recurs after an interval of ten or twelve hours, it may be removed by the ap- plication of a second blister to the vertex. A blister may also be applied along the spine in the worst cases. Stimulation by the electro-galvanic current, with the moist sponges applied along the sides of the neck, chest and epigastrium, ought also to be employed. Sinapisms ought generally to be applied to the extremities, and to the chest or sides. In cases where the breathing is much oppressed, and the bronchial tubes loaded with mucus, the patient should be turned occasionally over on his face and side. In the convulsive form of the disease, where the greatest irrita- bility of the nervous system prevails, the douche is found to be in- INSOLATION. 71 admissible, from the agony which it occasions. In such cases, Dr. Barclay has found great benefit from the inhalation of chloroform. Great care is necessary in its employment, and the cases in which it is indicated are rare. Dr. A. P. Merrill, of New York, and others, have recom- mended the use of chloroform internally. DR. WHITEHILL, OF ST. LOUIS. Our author has had a large experience with sunstroke, having seen as many as fifty cases in a single day during a forced military march in 1863. (St. Louis Medical Archives, September, 1868.) The treatment found most successful was cold to the head and chest, friction of the extremities, and the internal administration of stimulants, such as brandy and ammonia. In his own case, the nausea and vomiting were relieved by full draughts of strong green tea and Khenish wine. In all cases, a most important part of the treatment was to place the patient in the recumbent position in the shade, where there was a free circulation of air, and at the same time disencumber him of everything that could in any wise inter- fere with either circulation or respiration. Under this treatment every case had recovered. C. G. HILL, M. D., MARYLAND. Our author recommends (Virginia Medical Monthly, November, 1874), oxygen inhalations in heat stroke. The oyxgen should be applied loosely to the nostrils, so as to allow a free admixture of atmospheric air. W. C. MACLEAN, M. D., LONDON. When blood-letting was the rule for sunstroke recovery was the rare exception. There is now great unanimity of opinion on the treatment, and the lancet has no place in it. At the earliest possi- ble moment, let the sufferer be carried to the nearest shade, stripped and assiduously dashed with cold water, over the head, neck and chest. If this be effectually and quickly done, the powerful impression on the cutaneous nerves will soon re-establish respiration, at first by gasps and catches, soon in a more regular and tranquil manner. It will also reduce the heat of skin. It may be required to be done again and again; in hospital it may be necessary to envelope the patient in a wet sheet and to ply the fan or punkah over him vigorously, until the skin is reduced to a 72 DISEASES OF THE NERVOUS SYSTEM. more natural temperature. The patient should be encouraged to drink freely; if vomiting follows it will often aid in relieving the congestion of the lungs. The douche, used as above described, is a powerful remedy, and as Dr. Abercrombie long since pointed out, it may be abused, particularly if it is applied too long to the shaven scalp. Morehead also cautions us against its prolonged use in a routine way when the skin is cold and clammy and the respiration sighing; under such circumstances we must restrict ourselves to dashing water over the face and chest. When the heat of the skin is excessive we may avail ourselves, if ice be at hand, of Dr. Parkes' suggestion, and give an enema of ice cold water. We should apply ammonia, with the usual caution, now and then, to the nostrils; the bowels being always constipated, the sooner they are relieved the better, by the use of purgatives and enemata. The occurrence of moderate diarrhoea seems to favor recovery. Support and a judicious use of stimulants must not be neglected. If sensibility be not restored and maintained by the douche, a blister should be applied at once to the nape, and if needs be, to the shaven head. There is much unanimity as to the good effects of this measure. Dr. Barclay has found chloroform inhalation useful in a convulsive form of the disease, attended with extreme nervous irritability, a class of cases in which the douche is inadmissible, from the agony it occasions. In some cases life was saved by this remedy; in all it was prolonged. Treatment of the Sequelce.—Great attention to the function of the skin forms an essential part of the treatment of all the varieties of sequelae of sunstroke, for it is impaired in all. Frictions, bath- ing, exercise in the open air, are beneficial. When the headache is not fixed, but shifting, it will often be found to depend on a weak condition of the digestive organs, and careful treatment, suited to the particular features of each individual case, is required. EDWARD JOHN WARING, M. D., LONDON. Blood-letting was formerly much employed; but from the mor- tality which attended this treatment, in the hands of Dr. Russell and others, it has fallen into comparative disuse. Dr. Morehead indeed, goes so far as to say, that he " should have no hesitation in altogether interdicting this proceeding in the treatment of sun- stroke." This is, perhaps, rather too sweeping a direction; but it is certain that, except in young, plethoric constitutions, and where INSOLATION. 73 vascular action runs high, by far the most successful treatment consists in cold affusion to the head, throat, chest, spine, and epi- gastrium, the application of ice to the spine, stimulants internally (ammonia, ether, weak brandy and water), and frictions to the sur- face. In the stage of reaction, leeches to the temples, or cupping at the nape of the neck, may be required. The first thing to be done after removing the patient into the shade, is to dash cold water over the head, neck and chest. If this be effectually and quickly done, the powerful impression on the cutaneous nerves will soon re-establish respiration, at first by gasps and catches, and soon in a more regular and tranquil manner; it will at the same time reduce the heat of the skin. When the patient can swallow, cold water should be freely drank, and Dr. Parkes suggests the use of enemas of ice-cold water. The use of the douche to the head requires some discrimination, especially if the skin be cold and clammy, in which case it must be re- stricted to the face and chest. RESUME OF REMEDIES. Chloroformum, internally, and by inhalation, has been recommended. Morphia, hypodermically, in the dose of gr. \, has been given with success by Dr. James H. Hutchinson, in cases marked by nervous symptoms, such as convulsions, jactitation, delirium and general excitement. Oxygen by inhalation has been recommended in heat stroke (p. 71). Quinice Sulphas is regarded by Waller (India Medical Gazette, July 1869), who has had a large experience in India, as a specific in this affection, whether the skin is hot and dry or cool and moist, and whether or not muscular spasm be present. It rapidly diminishes the stupor and spasm, restores consciousness, and cures the attack. He gives it at every stage of the attack, either by the mouth (gr.xx at first, and gr.x every successive hour), or if the patient be unable to swallow, hypodermically (gr.iss. injected in each arm). * Water, freely drank, cold, is beneficial, as well as its use by free affusions. Stimulants are useful by the rectum and mouth. Blood-letting is rarely indicated, and often very dangerous. EXTERNAL REMEDIES. Cantharis. A blister to the nape, or to the shaven head, produces excellent results if insensibility continue (p. 72). Enemata of ice cold water have been advised (p. 72). Frigus. The application of cold to the general surface of the body, by strip- ping the patient and steadily rubbing the entire skin with large pieces of ice, keeping, at the same time, pieces in each axilla, is a method of treatment employed at the Pennsylvania Hospital with success (Pennsylvania Hospital Reports, 1868, p. 380). Iced wine and water are given internally. Dashing cold water over the head, neck and chest is excellent practice (pp. 70, 71). 74 DISEASES OF THE NERVOUS SYSTEM. INSOMNIA. PROF. ROBERTS BARTHOLOW, M. D., CINCINNATI, OHIO. Morphia and atropia may be combined for hypodermic injec- tion, so as to procure sleep, care being taken that there is no ex- cess of atropia, or an amount of atropia sufficient to antago- nize the cerebral effects of the morphia. They should be used in the proportion of gr.j^-^ of atropia to gr.£-$ of morphia. As the susceptibility to atropia varies immensely, the precise quantity to be employed in any case must be regulated accordingly. C. E. BROWN-SEQUARD, M. D., LONDON. 127. R. Potassii bromidi, 3"ss Aquae cinnamomi, f.^ij. M. A dessertspoonful a quarter of an hour before the last meal, and the same dose, or three teaspoonfuls, repeated at bedtime, for adults. Excepting when pain is one of the causes preventing sleep (in which case the alkaloids of opium, aconite, or hyoscyamus should be employed), Dr. Brown-Sequard has found that this remedy has a most wonderful power to produce a quiet and refreshing sleep, without any drawbacks. In some cases it is necessary to increase the dose of the bromide, and to give also a small dose of narceine or codeine an hour before bedtime. In those affections in which the bromide of potassium is not powerful enough as a sleep-inducing agent, a warm bath of four, five, or six hours' dura- tion is often successful. PROF. J. M. DA COSTA, M. D„ PHILADELPHIA. 128. R. Assafoetidae, gr.x Extracti hyoscyami, gr.iij-v. M. For one suppository. To be introduced at night, to quiet restlessness and induce sleep where it is not desirable to give opiates. (Graves mentions that in persons of irritable and nervous dis- position he has found musk or assafoetida, given more or less fre- quently during the day, effectual in procuring sleep at night.) 129. R. Pulveris digitalis, gr-»j Extracti hyoscyami, Camphorae, aa gr.xij. M. For 12 pills. One to be taken at night. Prof. Da Costa has found, in reference to the soporific and ano- dyne properties of narceine, that it appeared, in doses in which INSOMNIA. 75 morphia is prescribed, totally destitute of either; and in larger doses uncertain, and often palpably inert. It does not allay irrita- tion. (Pennsylvania Hospital Reports for 1868.) PROF. R. J. GRAVES, M. D., DUBLIN. 130. R. Tincturae calumbae, Tincturae quassiae, Tincturae gentianae, Tincturae cinchonas, aa f.^j Morphias muriatis, gr-j—ij- M. A teaspoonful thrice daily, in a small cup of tea, an hour before the evening meal, to stop the nausea, quiet the nervous irritability and in- duce sleep, particularly in the case of those who abuse alcoholic drinks. 131. R. Assafoetidae, gj Morphias sulphatis, gr-ij Mucilaginis acaciae, q. s- Divide into 30 pills. One or two at bedtime, in the insomnia of hypo- chondria, hysteria, and in general of nervous affections. 132. R. Chlorali, 9iv Aquas destillatas, f.^v Syrupi, f.^iss- M. A tablespoonful from hour to hour, until sleep is produced. » PROF. WILLIAM A. HAMMOND, M. D., NEW YORK. The principles which should prevail in the treatment of wake- fulness may be arranged into two classes. 1st. Those which, by their tendency to soothe the nervous sys- tem, or to distract the attention, diminish the action of the heart and blood vessels, or correct irregularities in their function, and thus lessen the amount of blood in the brain. 2d. Those which directly, either mechanically or through a specific effect upon the circulatory organs, produce a similar effect. In slight cases, the measures belonging to the first class often prove effectual. Among them are music, monotonous sounds, gentle frictions of the surface of the body, soft undulatory move- ments, the repetition by the insomnolent of a series of words till the attention is diverted from the existing emotion which engages it, and many others of similar character. In persistent insomnia, however, these are nugatory. Chief among the means embraced under the second head are those which tend to improve the general health of the patient. In regard to food, while it is an error to suppose, as is generally done, that a moderately full meal, eaten shortly before bedtime, is necessarily productive of wakefulness, there is no doubt that this 76 DISEASES OF THE NERVOUS SYSTEM. condition is induced by an excessive quantity of irritating or indi- gestible food. A hearty supper of plainly cooked and nutritious food rather predisposes to sleep. This is due to the fact that the pro1 cess of digestion requires an increased amount of blood in the organs which perform it, and consequently the brain receives a less quantity. This hypnotic effect is neutralized, however, when the food is immoderate in amount or irritative in quality, as it then, either by the pressure upon the abdominal vessels or through a reflex action on the heart, augments instead of dimin- ishes the quantity of blood circulating in the brain. Attention should, therefore, be paid to the diet of the insomnolent. As a rule people are under-fed. This is especially true of women. The tone of the system is thus lowered, and local congestions of different parts of the body are produced. If the brain be one of these, wakefulness results. Most of the cases of insomnia in women are of the passive variety, and require not only nutritious food, but stimulants. Whisky is generally to be preferred to brandy and many kinds of wine. Nothing can be better, as a good stimulant, and at the same time tonic, than Tarragona wine, drank at dinner, to the ex- tent of a glass or two. Next must be ranked good lager beer. There are cases in which coffee induces sleep. Our author men- tions several in which passive wakefulness was entirely and speedily cured by a cup of strong coffee, taken for three or four nights in succession, at bedtime. In females of languid circulation and a consequent tendency to internal congestions, it is particularly use- ful. The employment of stimulants is only of service in the asthenic or passive form of insomnia; in the sthenic or active form they would, of course, increase the difficulty. Physical exercise in the open air, extended to the point of in- ducing a slight feeling of fatigue, is productive of good effects. The warm bath calms nervous irritability and determines blood from the head. Putting the feet in water of the temperature of 100° F. will often induce sleep, particularly in children, after other means have failed. Cold water (32° F.) applied directly to the scalp has a good in- fluence in those cases in which the individual is strong, the heart beating with force and frequency, and the mental excitement great. It is not admissible in the asthenic form of wakefulness. INSOMNIA. 77 Among the purely medicinal agents, bromide of potassium holds the first rank. It diminishes the amount of blood in the brain, and allays any excitement which may be present in the sthenic form of insomnia. The flushed face, the throbbing of the carotids and temporals, the suffusion of the eyes, the feeling of fullness in the head, all disappear as if by magic under its use. It may be given in doses of from ten to thirty grains; the latter quantity is seldom required, but may be taken with perfect safety in severe cases (see F. 127). 133. R. Zinci oxidi, ^ij Confectionis rosae, q. s. For 20 pills. One thrice daily, the last dose being taken just at bed- time. Our author seldom employs opium; there are cases of insomnia, however, in which its influence is decidedly beneficial. 134. R. Tincturae hyoscyami, f-3"ij- From one to two teaspoonfuls in water, at bedtime. Especially indicated in those cases which are accompanied by great nervous irritability. A good preparation of this drug is difficult to obtain. It possesses no advantage over bromide of potassium, to which it is not equal in any respect. Our author has nothing to say in commendation of valerian, assafoetida and other antispasmodics. Tonics, especially iron and quinine, are almost always useful, even in the active forms of the affection. In insomnia dependent upon severe and long-continued mental exertion, all means will fail if the individual will not consent to use his brain in a rational manner. Proper intervals of relaxa- tion must be insisted upon, and in some cases mental rest. Travel is always of the greatest advantage in such cases. C. HANFIELD JONES, M. B., LONDON. It is often well, when sleeplessness depends upon hyperesthesia, to give not only a stimulant, but also some digestible nourishment, about the time of going to rest, or even in the course of the night, when debility to a serious extent exists. A mustard poultice to the epigastrium is also an excellent hypnotic in some cases, proba- bly owing to its stimulating a languid solar plexus. Among the 78 DISEASES OF THE NERVOUS SYSTEM. various soporifics, it is doubtful whether any are more potent, especially for the weakly and hypersesthetic, than prolonged expo- sure to the cold open air. This should be so managed as not to cause great fatigue, and be followed by a sufficient meal. The effects of a monotonous voice in inducing sleep are well known, particularly when the speaker or reader is dictating some matter not without a considerable tinge of dullness. The old monk's pre- scription for sleeplessness, viz., to tell your beads, was sound ad- vice. Hyoscyamus frequently proves itself a really valuable remedy. It is well given in enema, in a dose not exceeding that for the mouth. ANTOINE RUPPANER, M. D., NEW YORK. 135. R. Tincturae hyoscyami, gtt.x-xx. For a single hypodermic injection. 136. R. Tincturae cannabis, gtt.x-xx. For one hypodermic injection. THOMAS HAWKES TANNER, M. D., LONDON. 137. R. Extracti stramonii, gr.iij Extracti hyoscyami, gr.xviij Extracti lupulinae, §ij. M. For 12 pills. One to be taken every four hours until relief is obtained, in chronic disorders attended with suffering ; in diseases of the ner- vous system accompanied with pain and restlessness; and in the dyspnoea of phthisis and emphysema. Our author has seen good results in cases of wakefulness, par- ticularly when there is any debility, from a tumblerful of port wine negus, or of mulled claret, or of white wine whey, taken the last thing at night. Where the skin is hot and dry a glass of cold water appears to be useful. When there is any physical cause it must be removed. If the bowels are constipated or the excretion unhealthy, laxatives and alteratives will be required. Patients afflicted with heart-burn should take three or four bismuth lozenges before retiring to rest. If sedative drugs are necessary, resort should first be had to hyoscyamus, hops, Indian hemp, or conium. When stronger drugs are needed the following may be prescribed:__ 138. R. Morphias muriatis, „r ;_j: Spiritus chloroformi, & -J J Tinctures cardamomi compositae, aa f.5j. Jtf Dessertspoonful at bedtime; INSOMNIA. 79 Or, 139. R. Extracti opii, gr-iij Extracti hyoscyami, gr.xxiv. M. For 6 pills. One at bedtime. Frequently the exhibition of opiate enemata or suppositories is preferable to the use of this drug by the mouth. The following may be employed :— 140. R. Tincturae opii, Tn^xx-xxx Mucilaginis amyli, f-3"ij- M. For one enema. 141. R. Pulveris opii, gr.j—ij Saponis, gr.x. M. For a suppository. EDWARD JOHN TILT, M. D., LONDON. 142. R. Extracti hyoscyami, gr.xxiv Extracti cannabis indicae, gr.iij. M. For 12 pills. One or two to be taken at night, or oftener. But Dr. Tilt gives Indian hemp in one-grain doses, as soon as he finds it agrees, and sometimes in larger doses. If he desires a tonic as well as sedative effect, he orders 143. R. Extracti hyoscyami, Quiniae sulphatis, aa, gr.xij. M. For 12 pills. One to be taken every night. This is a preparation that he has often found to be well borne by women who could not bear large doses of any tonic; some have continued to take it for months, not leaving it off during the men- strual period; and it will not interfere with the action of any pur- gative that may be required. In one case of sleeplessness, one drachm of lupulin, in the form of pill, produced sound sleep after opium and hyoscyamus had failed. CHARLES WEST, M. D., LONDON. Our author states that the value of tincture of hyoscyamus as a sedative in the diseases of children can scarcely be too highly esti- mated. He orders 144. R. TincturaB hyoscyami, Ti\,.xviij Syrupi, f.giij Aquae, f.jix. M. Dessertspoonful every six hours, for a child a year old. 80 DISEASES OF THE NERVOUS SYSTEM. To this mixture there may be added, if there is much peevishness. 145. R. Potassii bi carbonatis, Acidi citrici, aa gr.xx. (The treatment of Insomnia caused by pain is considered under the heads of Neuralgia, and of Rheumatism, which see.) RESUME OF REMEDIES. Atropia and Morphia, combined hypodermically, are recommended by Prof. Bartholow (p. 74.) Cannabis Indica is often prescribed in sleeplessness, alone or combined with hyoscyamus (F. 136,142). Dr. Fuller gives it in chronic rheumatism", to induce sleep, and Dr. Oxley (Liverpool Medical and Surgical Re- porter, 1868) in chorea, in doses of n^x of the tincture, for a child of seven, and so on. *Chloral is a valuable remedy (F. 132), for sleeplessness in exhaustion of the brain through severe mental application or excitement of feeling, in convalescence from acute febrile diseases, and in insanity. Caffea is recommended by Dr. Anstie in alcoholic sleeplessness. Dr. Ham- mond also recommends it in certain cases of insomnia (p. 76). Hyoscyamus is prescribed by Drs. Hammond (F. 134), Ruppaner (F. 135), Tilt (F. 142, 143), and West (F. 144). Lupulina is employed by Dr. Tilt (p. 79). Moschus has proved eminently successful in the hands of Dr. Graves, in per- sons of irritable and nervous disposition. He administers it in one grain doses every two hours during the day, either alone or with as- safoetida, in order to procure sleep at night. Narcein in the hands of Dr. Da Costa, has failed as a soporific (p. 74),.but Dr. Hammond finds it a decided hypnotic in large doses. Opium or Morphia may be given in certain cases, combined with hyoscyamus (F. 131,138,139), or in enema or suppository (F, 140,141). Morphia, given hypodermically in combination with atropia, is advised by Prof. Bartholow (p. 74). * Potassii Bromidum is a powerful hypnotic, especially in cases of over-taxed mental energy or emotion, when opium and other narcotics have failed to procure sleep, and in the sleeplessness of convalescence from fever, at the termination of acute diseases, or after surgical operations. In such cases, from twenty to thirty grains at bedtime, repeated in the morning, and persevered in for days, will do more than the most powerful narcotics. It is highly praised by Dr. Brown-Sequard (F. 127), and Prof. Hammond (p. 77). Quiniai Sulphas is sometimes prescribed with hyoscyamus by Dr. Tilt (F. 143). Stramonium has been found a useful adjunct to hyoscyamus and lunulin bv Dr. Tanner (F. 137). P Zinci Oxidum is sometimes employed in insomnia (F. 133). EXTERNAL REMEDIES. * Water, Warm Baths, Pediluvia, and Cold Water to the scalp, are remedies recommended by Prof. Hammond in appropriate cases (p. 76). Prof. StillE speaks of the value of cold affusions, or simply of the cold bath, in sleeplessness arising from over-excitement, due to severe study or the stimulus of painful, or even of pleasant thoughts or oc- cupations. ACUTE MENINGITIS. 81 ACUTE MENINGITIS. PROF. WILLIAM AITKEN, M. D., EDINBURGH. When arachnitis arises from mechanical injuries, the treatment is generally by bleeding, active purgatives, especially by calomel and scammony, and by cold applications to the head. In advanced life general blood-letting is rarely indicated, but in vigorous constitutions it is sometimes necessary. As a rule, local blood-letting is more safe and more beneficial, especially when aided by keeping the head well raised and by the constant applica- tion of cold water to the scalp, or the occasional use of bladders filled with crushed ice. The bowels should be opened as rapidly as possible, unless the patient is feeble, emaciated or greatly ex- hausted. For this purpose employ 146. R. Hydrargyri chloridi mitis, gr.ij-iij Extracti colocynthidis compositi, gr.iv-v. Divide into 2 pills. Both to be taken at a dose, in cases accompanied with gout or Bright's disease, and followed in a few hours by a dose of salts and senna. A fair proportion of nutriment must be given, in the form of milk, strong beef tea, sago, tapioca or arrowroot; and the patient should be kept in a quiet and darkened room. The more active symptoms being subdued, but not till then, a blister should be placed on the nape of the neck, if coma should ensue. If nervous irritability continues during convalescence hyoscyamus or chloride of ammonium may be given. The bowels are to be kept open and the strength supported by unstimulating nutriment. Tranquillity of mind and body must be preserved. PROF. FELIX VON NIEMEYER, M. D„ TUBINGEN. In the treatment of acute meningitis it is not generally proper to bleed from the arm, but leeches may be applied to the brow and behind the ears, and, if the strength of the patient permit, the application may be repeated. The shaven head may be covered with cold compresses, and an active purge of calomel and jalap administered, viz.:— 147. R. Hydrargyri chloridi mitis, gr.ij Extracti jalapae, gr.viij. M. Divide into 2 pills and order both to be taken. In the latter stages of the disease, if there be coma and other 6 82 DISEASES OF THE NERVOUS SYSTEM. signs of cerebral palsy, apply a large blister to the nape of the neck, and rub the following pustulating ointment on the head: 148. R. Oleitiglii, IJlxv M Adipis, . J88- M- One-fourth part to be rubbed into the skin every eight hours, until an abundant eruption is produced. Still more efficacious than these derivatives are douche baths, pouring cold water over the head from a pitcher held some distance above it. The patient almost always recovers consciousness as this is being done, but it must be repeated at intervals of a few hours to secure a permanent result; with each successive employment the number of pitcherfuls is to be increased. Frictions with mercurial ointment and continued doses of calomel are much employed. J. S. RAMSKILL, M. D., LONDON. The application of cold to the head, by irrigation, often produces an almost magical effect. A small stream of cold water should be allowed to run on the shaven head from a vessel placed a little above it. This method of treatment should be employed with caution in children and aged persons. RESUME OF REMEDIES. Antimonii et Potassii Tartras has been exhibited in repeated fractional doses with benefit. It is contra-indicated if the patient be very young, if there have been prodromic symptoms, and if the inflammatory condition be not well marked. Hydrargyrum. In regard to the use of mercury in acute meningitis, authorities differ. Dr. Russell Reynolds has never seen any good results from its administration. Dr. J. S. Ramskill recommends it as a valuable remedy, and states that the system should be quickly brought under its influence, by combining with its internal administration (in 6mall and frequently-repeated doses), the use of inunctions in the groin and axilla. Opium is a most valuable agent in epidemic meningitis, when administered at the outset of the attack in cases in which the inflammatory pre- dominates over the septic element. Cathartics are indicated, unless the patient be very feeble (F. 146, 147). EXTERNAL REMEDIES. Cantharis. Blisters to the nape of the neck or vertex, although inadmissible during the acute stage of meningitis, are sometimes of great value after the excitement has passed. Frigus. Cold affusions are recommended (p. 82). Oleum Terebinthince. Turpentine stupes applied to the extremities, often do good, as also do turpentine enemata. For Tubercular Meningitis, see Hydrocephalus. NEURALGIA. 83 NEURALGIA. PROF. WILLIAM AITKEN. M. D.. EDINBURGH. When the neuralgia is superficial, compresses steeped in the solution of atropia have a good effect. 149. R. Atropiee sulphatis, gr.v Aquae destillatae, f-^iij- Renew the compresses several times in twenty-four hours. Continue them for at least an hour each time, and cover them with oiled silk to prevent evaporation. This is the formula recommended by Trous- seau. FRANCIS E. ANSTIE, M. D., LONDON. 1. Constitutional treatment.—(a.) Nutritive remedies: fat, cod-liver oil, butter, etc. (6.) Preparations of iron are useful (the carbonate especially) only where there is actual ansemia. (c.) The nerve tonics (quinine, arsenic and zinc) are beneficial in some cases and not so in others. Sulphate of quinine is useful in malarial neuralgia, and also, in small doses, in some cases of non-malarial neuralgia, especially in ophthalmic branches of the fifth pair. Arsenic is useful, and more widely so than quinine, in both the above classes of neuralgia. Valerianate of zinc has also been employed with benefit, {d.) Constitutional remedies directed against a real or presumed depravation of the blood by some special poison; as, iodide of potassium and corrosive sublimate against syphilitic neuralgia; colchicum against gouty neuralgia; and iodide of potassium against rheumatic neuralgia. 2. Narcotic stimulant remedies for neuralgia.—At the head stands opium, represented by morphia. Next, belladonna, or more exactly, atropia. The subcutaneous injections of these substances are of considerable benefit. Best medium, hypodermic dose of morphia gr. \; or atropia gr. ^j-^. Belladonna (gr. -J-J of the extract), given by the m<5uth, has a special influence on painful affections of the pelvic organs. Indian hemp, internally (in pills of gr. \-\, one every night), is very effective in certain forms of neuralgia, especially migraine and clavus. Chloride of ammonium (doses of gr. 10-20) is useful in migraine, clavus, intercostal and hepatic neuralgias. Sulphuric ether is supremely useful in certain visceral neuralgias, as gastralgia, uterine or ovarian neuralgia. Turpentine pearls are beneficial in sciatica. Aconitia is, ordinarily, too depressing. Alcohol is most useful taken at meals, or especially for the relief of pain. 84 diseases of the nervous system. 3. External remedies.—Flying blisters, of extreme and general use; mustard plasters; liniments and ointments (best is chloroform, diluted with 7 parts of oil liniment); and electricity (continuous low tension current from Bunsen's or Daniell's battery) are recom- mended. A. BERTRAND, M. D., PARIS. 150. R. Veratriae, gr-X. Morphiae muriatis, §r,11J Adipis, 3j- M« To be employed in friction during the paroxysms of facial neuralgia. H. BOURDON, M. D., PARIS. 151. R. Morphias acetatis, gr.iss Chloroformi, ^liv Olei amygdalae dulcis, f.giss Ceras aloae, 3*ss Adipis, 3v. M. Melt together the wax and lard and add the oil; mix the morphia and chloroform by shaking together in a wide-mouth flacon; add the melted wax and lard and shake until cold. To be applied to the painful parts several times a day. C. E. BROWN-SEQUARD, M. D. 152. R. Extracti belladonnas, gr.£ Extracti stramonii, gr.| Extracti cannabis indices, gr.5 Extracti aconiti, gr.| Extracti opii, gr.£ Extracti hyoscyami, gr.f Extracti conii, gr.j Pulveris glycyrrhizas, q. s. For one pill. According to circumstances Brown-Sequard gives, without producing any great constitutional disturbance, three, four, and even five pills in a day, and sometimes in about eight or ten hours, for the relief of neuralgic or other pains. There must be, there- fore, some influence exerted by some of these substances upon the others, diminishing their bad and not their good effects. He recommends the following hypodermic injection:— 153. R. Morphiae sulphatis, gr.$-§ Atropias sulphatis, gr-sV For one injection, in gtt. xx of distilled water. The doses Brown-Sequard at first employed were gr. \ of the sulphate of morphia to gr. ^ of the sulphate of atropia. He now employs those given above, the antagonistic effects of morphia and atropia on the brain rendering it possible, while securing the good effects against pain of the two remedies, to use safely, or at least neuralgia. 85 without great or lasting cerebral or cardiac disturbance, large doses of these narcotics. In this connection, we may give the doses employed by other authorities in administering morphia and atropia subcutaneously in neuralgia. Dr. Charles Hunter, of London, gives, as a rule, never to use, in the first injection, in any case, more than one-half the stomachic dose of these alkaloids for males, and not more than a third for females. "" Dr. Ruppaner, of New York, places the minimum dose of mor- phia at gr. |; the maximum, gr. f; the minimum dose of sulphate of atropia, gr. ^; the maximum, gr. J5. Dr. Tilt, of London, states that the initial hypodermic dose of morphia (used alone) for a woman, should not exceed gr. | (the acetate being the salt he prefers), and that of atropia should not exceed (used aloney gr. ^. In combination, gr. | of the sulphate of morphia with gr. ^ of the sulphate of atropia. PROF. HARVEY L. BYRD, M. D., BALTIMORE. 154. R. Olei menthae piperitae, f-3iij Olei origani, f-3ij Olei sassafras, f-3j Olei terebinthinae, f.giss Tincturae opii, fjss Tincturae aconiti radicis, f..3ij Alcoholis, f-|ij. M. For local application in neuralgia and chronic rheumatic pains. DR. CAMINITI, ITALY. 155. R. Morphiae muriatis, gr.xv Collodii flexilis, f.gj. M. Apply by means of a small brush on the parts, the seat of the neural- gie pains. If the pain return periodically, give the sulphate or va- lerianate of quinine. 156. R. Ammoniaci, 3>ij88 Spiritus lavandulae, Tt\,xv Camphoras, 9iv Alcoholis, f.|j. # M. This liniment is useful in tic douloureux. A compress moistened with it is applied to the painful part, covered with dry linen, and retained until the skin reddens; then the reddened skin is to be rubbed with a solution of morphia until the pain ceases. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 157. R. Aconitias, gr-iv Veratriae, gr xv Glycerinae, f.^ij Cerati, gvj. M. To be rubbed over the painful parts, care being taken to see that there is no abrasion of the skin. 86 DISEASES OF THE NERVOUS SYSTEM. (Prof. Gross sometimes employs veratria ointment in cases of neuralgia, of the strength of gj to Jj). 158. R. Potassii bromidi, 3"ss Succi conii, f-3x.. Aquam cinnamomi, ad. f.^iij. M. A dessertspoonful to be taken three times a day. Useful in epileptiform neuralgia. 159. R. Strychniae sulphatis, gr.ss Quiniae sulphatis, gr.xv Cinchoniae sulphatis, 3j Pulveris rhei, 3SS Extracti gentianae, q. s. M. Divide into 30 pills. One to be taken four times a day, in intercostal neuralgia of malarial origin, associated with constipation. DR. DUMAS, MONTPELLIER, FRANCE. 160. R. Castorei, gr.xxx Camphorae, gr.xv Pulveris opii, gr.viij Confectionis rosas, q. s. To be divided into 15 pills, and used for nervous affections of the ab- dominal organs in women. H. W. FULLER, M. D., LONDON. Our author recommends highly the external application of aco- nitia in neuralgia, and in intercostal rheumatism. When from the situation or other circumstances, it is difficult to apply the ointment, he directs the following solution :— 161. R. Aconitias, gr.iij-iv Spiritus rectificati, f-3~vj Glycerines, f.^ij. M. To be applied by means of a camel-hair brush until the pain is relieved. It should only be employed in chronic cases, it proving ineffective so long as there is acute action. Even when the relief of pain is only temporary, this is an advantage of no inconsiderable importance. Another local application recommended by Dr. Fuller, is the following:— 162. R. Extracti belladonnas, gj Tincturae opii, f.'?i Glycerinae, fgjjj. m. A piece of lint wet with this mixture, and covered with oiled silk, often affords great relief when placed along the course of the nerve. The following local application is also often useful:— 163. R. Acidi hydrocyanici diluti, f.5ss Glycerinae, Aquae rosae, aa f.gij. M. To be painted over the seat of pain with a camel-hair brush. NEURALGIA. 87 The following local application is also recommended:— 164. R. Tincturae opii, Spiritus aetheris compositi, Glycerinae, aa f.giij Extracti belladonnae, ^j. M. Speedy relief often follows the application of a strip of flannel soaked in this mixture along the course of the nerve, and then covered with oiled silk to prevent evaporation. DR. GRAY, FRANCE. 165. R. Tincturae aconiti, Chloroformi, aa f.^ijss Adipis, gx. M. After applying the ointment to the affected part, the place is covered with cotton. H. GREEN, M. D., NEW YORK. 166. R. Zinci valerianatis, gr.xv Extracti hyoscyami, gr.xxv. M. Divide into 30 pills. Two or three a day in facial neuralgia. 167. R. Zinci sulphatis, gr.xv Morphiae sulphatis, gr.iij Strychniae, gr.ij Pimentae, Extracti hyoscyami, aa gr.xxx. M. Divide into 30 pills. One every five or six hours in neuralgia uncon- nected with any organic lesion. PROF. S. D. GROSS, M. D., PHILADELPHIA. 168. R. Quiniae sulphatis, T)ij Morphiae sulphatis, gr.j Strychniae, gr.f Acidi arseniosi, gr.j Extracti aconiti, gr-x- M. Divide into 20 pills. One to be taken three or four times a day. Add to the recipe ferri sulphatis, 9ij, if the system be anaemic. This pill is useful in a great variety of cases of neuralgia. Its effects should, of course, be carefully watched. PROF. WILLIAM A. HAMMOND, M. D., NEW YORK. 169. R. Extracti belladonnae, gr.v. Divide into 20 pills. One thrice daily, the dose to be increased as necessary. The use of belladonna is chiefly to change the habits of the sys- tem. This drug, although at one time much overlauded, is vera efficient in the treatment of neuralgia. Our author has not used atropia often, as the dose is difficult to graduate. Hypodermic injections of morphia may be used during the par- 88 DISEASES OF THE NERVOUS SYSTEM. oxysms of pain. In their use avoid the face; a good point is the inside of the arm. 170. R. Tincturae aconiti, f-3"88- Rub with a rag upon the painful part until a sense of pricking is felt. This is next in value to the subcutaneous use of morphia. The action is often very powerful. Dr. H. once caused temporary paralysis of the arm in a lady, by the too free application of the tincture. Chloroform may be used externally, internally, or by inhalation, not carried to insensibility. Repetitions of the inhalation may break up the paroxysm. Hypophosphites are useful; may be given in doses of from ten to twenty grains. They act by setting free phosphorus in the stomach. Galvanism.—The direct galvanic current may be successfully used both for the relief of the paroxysm and for breaking up the habit of the disease. For the first apply the poles so that the position is near the seat of the greatest pain, and pass the current continuously for several minutes. To change the habit of the sys- tem, apply one pole to the nape of the neck, and the other over the course of each sympathetic nerve, moving it along the neck. Duchenne says, that neuralgia can generally be relieved by Fara- dization. Dr. H. has not been so uniformly successful, but often effects a cure by the application mentioned The use of tea generally aggravates neuralgia, while coffee, on the contrary, does not, but if strong is often of service. DR. RAIMBERT, FRANCE. 171. R. Extracti opii, Extracti belladonnae, Extracti stramonii, aa gr.xv Aquae laurocerasi, f-3"iij. M. Introduce from four to six drops of this solution into the ear, close the canal with cotton, and incline the head to the opposite side. A use- ful mode of treatment in facial and dental neuralgias. PROF. P. RICORD, M. D., PARIS. 172. R. Extracti hyoscyami, Extracti belladonnae, aa gj Glycerinae, f ?; jj Anoint several times a day, with this liniment, the testicle affected with neuralgia. Employ at night suppository containing from one-half to three-fourths of a grain of the extract of belladonnas. NEURALGIA. 89 173. R. Extracti belladonnae, gss Chloroformi, nil Glycerinae, f.gss. M. Anoint with this liniment, several times a day, the affected parts in neu- ralgia of the anus, when there exists neither fistula nor any lesion of the rectum. THOMAS HAWKES TANNER. M. D., LONDON. 174. R. Quiniae sulphatis, gr.xxiv Extracti belladonnae, gr-iv Camphorae, gr.xxx Confectionis rosae, q. s. Divide into 12 pills. One to be taken two or three times a day, in cases of neuralgia in which the attacks are periodic. 175. R. Quiniae sulphatis, 9j Liquoris arsenici chloridi, f.giij-iv Acidi sulphurici aromatici, f.gij Syrupum zingiberis, ad. f.^iij. M. One teaspoonful in two tablespoonfuls of water directly after breakfast, dinner and tea, in severe neuralgia. 176. R. Ammonii chloridi, giij Aquas, f-3"iij- M. A tablespoonful in water every hour, while the paroxysm of pain is on. If after the fourth dose there be no diminution of pain, it will be use- less to persevere. As soon as the pain is relieved the dose may be reduced to a dessertspoonful three times a day. EDWARD JOHN TILT, M. D., LONDON. 177. R. Extracti hyoscyami, gj Extracti belladonnae, gr.v Butyri cocoae, q. s. M. Make into 20 suppositories, round, in pill form. One to be introduced into the rectum at night. This is the suppository Dr. Tilt most fre- quently prescribes, for it relieves pain without constipating. 178. R. Extracti opii, 9j Extracti belladonnas, gr.x Butyri cocoae, q. s. M. Make into 20 round suppositories. One to be well introduced into the bowel at night. 179. R. Morphiae sulphatis, gr-iij Butyri cocdae, q. s. M. Divide into 6 vaginal suppositories. One to be used at night. 180. R. Liquoris opii (Battley's), f.gj Tincturae hyoscyami, f.Jj'j Aquae, f-Iiij- M. One tablespoonful of this, or double the quantity, to be added to a little warm milk for an enema. 181. R. Morphiae sulphatis, gr.viij Atropias sulphatis, gtt.iv Olei rosae, gtt.ij Alcoholis, f-3"ss Oleum olivae, ad. f.^iv. M. For a liniment. To be shaken before use. 90 DISEASES of THE NERVOUS SYSTEM. The sulphate of atropia is preferable to atropia, because it is more soluble, and oil is much better than glycerine as a constitu- ent of liniments. Another excellent, and elegant, and sedative liniment is the fol- lowing :— 182. R. M. 183. R. Atropias sulphatis, gr.vnj Morphiae sulphatis, gr- xvj Aconitiae, gi'-y Acidi sulphurici diluti, n\,v Alcoholis, fjss Oleum olivae, ad. f.Jiv. riant effect is also desired, Chloroformi, f.gss Spiritus terebinthinae, f-Sj Camphorae, 3ij Olei lavandulae, ttlxx Oleum olivas, ad. f.^vj. M. The first four ingredients should be mixed before adding the oil, and the liniment should be well shaken before it is applied. 184. R, Atropias sulphatis, gr.ij ( vel Morphiae sulphatis, gr.x Glycerinae, f-3"ss Olei neroli, gtt.iv Unguenti glycerines, 3*j. M. Make an ointment, to be rubbed into the skin twice a day. DR. TOURNIE, PARIS. 185. R. Zinci valerianatis gr.v Extracti opii, gr.iss Extracti hyoscyami, gr.ijss Confectionis rosae q. s. Divide into 6 pills. Give one every three hours until three are taken, in tic douloureux. Repeat the same medication the following day. JAMES TURNBULL, M. D., LIVERPOOL. 186. R. Extracti aconiti, Qij Adipis, 3ij. M. A useful ointment in neuralgic pains. 187. R. Quiniae sulphatis, gr.vij Morphiae sulphatis, gr.1. M. Divide into 3 powders. Give one from hour to hour, in periodical neuralgia. 188. R. Morphiae sulphatis, gr.iss Sacchari, gr!xxx. M. Divide into 6 powders. One morning, evening and night, in facial neuralgia. NEURALGIA. 91 AUGUSTUS WALLER, M. D., GENEVA. Our author has found that certain substances, such as atropia, strychnia, morphia, and the tincture of aconite, when mixed with chloroform and applied to the skin, are absorbed rapidly; but if alcohol is used instead of chloroform, absorption is delayed or altogether prevented. The ability of introducing rapidly into the blood these active narcotics, without the use of the hypodermic syringe, will be of much importance in those cases in which even a slight puncture of that instrument is dreaded. It will also be of value in those instances in which it is necessary or advisable to keep up the effect for a long time, as in hydrophobia, chronic neuralgia, etc. 189. R. Aquae calcis, f.^j Spiritus terebinthinae, f.Jiss Saponis, q. s. Introduce the lime water, the essence of turpentine, and a small quan- tity of soap in a matrass, shake, and add, little by little, more soap, until the mixture acquires the consistence of a pomade. Useful in pains of a neuralgic or rheumatismal character. GUY'S HOSPITAL. LONDON. 190. R. Liquoris plumbi subacetatis, Tincturae opii, Mellis, aa f.gij Confectionis rosae, 3j. M. Make a liniment. This is known in the pharmacopoeia of the hospital as linimentum plumbi opiatum, and is much used. LONDON HOSPITAL. 191. R. Tincturae aconiti, Tiinimenti saponis, aa f.^j. M. To be used as an anodyne liniment. RESUME OF REMEDIES. *Acidum Arseniosum is a remedy of a deservedly high reputation in neural- gia, having a wider range of application than quinine. In malarial cases it should be given in larger doses (nl, x-xxx, thrice daily, of Fowler's solution) than in non-malarial. In the latter, Tt\, v of Fow- ler or gr.T^ of the arseniate of sodium, in pill, with extract of lupu- lin, will prove effectual in the cases amenable to this remedy. It may also be given hypodermically and endermically. *Aconitum is a remedy of great value in chronic cases of neuralgia, when the secretions are in order and the general health not much impaired. Its use should, therefore, be often preceded by purgatives and tonics. In acute cases it is not indicated before all signs of active disease 92 DISEASES OF THE NERVOUS SYSTEM. have been subdued by other means. Its external use should usually precede its internal administration, which need only be resorW to in case of failure of the former. The combination of quinine with aco- nite seems to increase its efficacy, and add permanency to the reliet afforded by it. This combination is especially indicated in anaemic or debilitated patients, where there is no apparent nerve lesion or ex- citing cause. jEsculus Hippocastanum. The alkaloid of horse chestnut, esculin, has been given in doses of gr.xv, twice daily, with success, by French physi- cians, in the treatment of periodic neuralgia. jEther. In simple neuralgia, particularly of the nerves of the head, Prof. Stille recommends combining the anodyne effect of ether with its revulsive effects, by applying it on small compresses covered with some solid substance, immediately over the points where the painful nerve emerges from its bony canal, or where it in any other way be- comes superficial. Alcohol. Dr. Anstie has several times observed, in acute neuralgia, that after large doses of various narcotics had been tried in vain, the first real and substantial relief was obtained by the use of a moderate dose of alcohol; the consequence of overdosing the remedy is, however, nearly always disastrous. Ammonii Chloridum is often of signal benefit (F. 176). Ammonii Valerianas is favorably spoken of by some writers. Anthemis. Chamomile, in substance, in doses of gr.lx, or in a very concen- trated infusion, is administered with success in France, in neuralgia of the fifth nerve. Apiol is said to be of service in intermittent neuralgia. Assafoetida is of little value in neuralgic affections. * Belladonna, whether used externally or internally, ranks among the first of the sedatives and anodynes of service in neuralgia (p. 83). It occasion- ally fails of effect, however. Brown-Sequard combines it with six other narcotics, for the relief of neuralgic pains (F. 152). Atropia is preferred by some to the preparations of belladonna, but the dose is more difficult to graduate. Beberice Sulphas has proved successful in some cases, after the failure of quinine. In doses of gr.x., night and. morning, it is more effective than in smaller doses. Brominium. See Potassii Bromidum. Caffea is much employed by Belgian physicians. Prof. Hammond finds that it is often of service, but that tea generally aggravates neuralgia. Cannabis Indica is ranked as a neuralgic remedy, next in value to opium and belladonna, and their alkaloids. Chloral is sometimes of service in this affection. Chloroformum always acts as a palliative in, but rarely cures neuralgia, Cinchona, see Quiniae Sulphas. Colchicum is recommended in conjunction with carbonate of ammonia and cinchona, by Dr. Copland. It should be preceded by cathartics. Conium is occasionally useful, both externally and internally administered, but is inferior to opium and belladonna. Creasotum has been given with success by Dr. Elliotson in facial neuralgia. Croton Chloral Hydrate, in doses of gr.ij every hour, has been found to promptly mitigate paroxysms of neuralgic pain. Digitalis has proved of service in the hands of Dr. Fuller, in cases in which the pain is intermittent. He gives ttlx-xx of the tincture three or four times a day. NEURALGIA. 93 Fatty Remedies, like cod-liver oil, olive oil, butter and cream, are often of reat service. Ferrum (particularly Ferri Carbonas) is useful in cases associated with anas- mia ; in others it fails. Galbanum has been found of service in neuralgia dependent upon uterine derangement, given as follows :— 192. R. Pilulae galbani compositae, gr.iij-vij Pilulae hydrargyri, gr.iij. M. One pill to be taken every other night. Glonoin (nitro-glycerin) in very small doses (one drop diluted with 100 of rec- tified spirit) has been recommended, but should be used with caution. Guaiacum is of service in forms of neuralgia of a rheumatic character. From n\,xx to HlxI of the ammoniated tincture may be given every five hours, until relief is obtained. Hyoscyamus is considered by Dr. Harlev as more efficacious than belladonna in neuralgic affections of the internal viscera. lodinium, see Potassii lodidum. Ipecacuanha. Dover's powder at night often affords much comfort. An eighth or a quarter of a grain of morphia may be added when indicated. *Morphia, hypodermically injected, affords speedy and often permanent relief. Dr. Anstie has cured cases by three or four injections of gr. £, which would have been very tedious under the older plan of treatment. Many cases yield in a week or ten days to hypodermic injections twice daily. Nux Vomica has been used with occasional success. Oleum Cajuputi may be employed with advantage, either externally or inter- nally, in cases unconnected with inflammatory action. * Oleum Morrhuo3 is sometimes successful after the failure of quinine and other ordinary remedies. Oleum Terebinthince is not unfrequently of benefit. It is equally appropriate to the inflammatory and non-inflammatory states of neuralgia and it is said relapses are less frequent after it than after most other remedies. Oleum Tiglii has been used with success in some cases, in which it has seemed to exercise a special influence apart from its purgative action. Opium, both internally and externally used, is of great service in certain cases; but ordinarily, far inferior to morphia injected subcutane- ously (F. 160). Oxygen inhalation sometimes relieves or cures neuralgia. Physostigma has exerted local anodyne effects in several cases of neuralgia reported. * Plumbi Acetas is said to be a safe and effective remedy in many cases of superficial neuralgia, and even in neuralgia of the abdominal viscera. *Potassii Bromidum, in full doses, often effectually relieves some forms of neuralgia. Dr. Da Costa sometimes prescribes it with conium (F. 158). Potassii Chloras, in doses of gr.xxx a day, has, in three weeks' time, it is reported, produced wonderful effects in facial neuralgia. Potassii lodidum is of service in neuralgic affections dependent upon an inflammatory state of the nerve coverings. *Quinice Sulphas is of great value in all neuralgias of malarial origin, and in a certain number of non-malarial cases. In the former, it should be given in full doses (gr.v-xx) shortly before the expected attack; in 94 DISEASES OF THE NERVOUS SYSTEM. the latter, doses of gr. ij-iij thrice daily are as large as are likely to benefit. Dr. Anstie says that he knows of no circumstances which indicate beforehand that quinine will be useful in non-mala- rial cases, excepting that in neuralgia of the ophthalmic branches of the fifth it is more effective than in other non-malarial neuralgias. Prof. Gross frequently combines quinine with morphia, strychnia, arsenic and aconite, in the treatment of neuralgia (F. 168). Dr. Tanner combines it with belladonna and camphor (F. 174), and with the chloride of arsenic (F. 175). Salix is recommended, but rarely used. Sodii Arsenias is of service in neuralgia where other arsenical preparations are badly borne. Sodii Carbonas, often, in full doses, speedily arrests neuralgia connected with acidity of the stomach. Sodii Hypophosphis, in drachm doses, given in beef tea, thrice daily, has proved successful. Stramonium is only found of benefit by Dr. Fuller, where the symptoms shift from limb to limb, but never when the disease is stationary. Strychnia is of use in epileptiform neuralgia. Valeriana exerts a favorable influence in neuralgia associated with hysteria. The ammoniated tincture may then be given combined with guaiacum. Zinci Valerianas is a serviceable remedy in those cases in which the disease is purely nervous, and in those which accompany uterine derangement. Cathartics are indicated when there is an overloaded state of the colon. Tur- pentine, by the mouth or by enema, and croton oil, are valuable pur- gatives in these cases. Emetics are useful in commencing the treatment of neuralgia arising from dyspepsia, and in those cases which are regularly intermittent an emetic should be given an hour before the expected paroxysm. * Stimulants. Dr. Anstie has found, in some cases of acute neuralgia (particu- larly of the fifth nerve), that after the failure of various narcotics a moderate dose of alcohol has at once given relief. He also states that in certain chronic neuralgias of the aged, where the power of digest- ing ordinary food is almost suspended by reflex irritation, an almost exclusively alcoholic diet, continued for some time, occasionally works wonders. EXTERNAL REMEDIES. * *Aconitia locally applied over the seat of pain is a most powerful palliative in neuralgic affections. Dr. Fuller, having observed that it fails so long as signs of active disease exist, restricts its use to purely chronic cases (F. 161). Dr. Da Costa sometimes prescribes it with veratria, in ointment (F. 157). *Aconitum is a valuable local application in chronic cases (F. 186). The tincture may be combined with chloroform (F. 165), with soap lini- ment (F. 191), or with turpentine, etc. (F. 154). Acupuncture is of use after inflammation has subsided, in those cases in which there is effusion within the sheath of the nerve. It then promises speedy and effectual relief, but is useless, and may be prejudicial in all other cases. JEther. The local application of atomized ether is now usually resorted to. Antimonii et Potassii Tartras. Tartar emetic counter-irritation is sometimes employed over the affected part, but its use is disapproved of by Dr Fuller, on account of the pain and discomfort it occasions NEURALGIA. 95 Aqua Ammonice. The following method of applying strong water of ammonia in neuralgia, is recommended by Prof. Stille : Take small disks of cloth, about a half or three-quarters of an inch in diameter, and apply them, moistened with the ammonia, over such points in the course of the affected nerve as are tender upon pressure, or are the seat of spontaneous pain. Cover the pieces of cloth with coins, buttons, or other convenient bodies, to prevent evaporation. Cotton contained in a thimble and saturated with the caustic liquid forms a still more convenient arrangement. As soon as slight vesication occurs, the pain is relieved, yet not so thoroughly as when the same effect has been obtained by means of cantharides. The addition of morphia to the vesicating liquid renders its effects more prompt and certain. Belladonna is much used externally (F. 162, 172, 173). Trousseau highly recommends the external application of belladonna when the neural- gia is superficial. In such cases may also be employed a compress saturated with a solution of atropia (F. 149). Dr. Flint uses atro- pia in preference to belladonna, in liniments and ointments. These applications, however, are all inferior to the hypodermic injection of atropia. * Cantharis. Blisters should be tried in cases of any severity ; if the hypoder- mic injection of morphia and atropia has failed, flying blisters should be employed. Dr. Anstie states that in numerous early cases, one or two flying blisters, applied successively over the differ- ent points in the course of the painful nerve, have at once and per- manently arrested the disease. Calor. The actual cautery and the moxa are sometimes employed in severe cases. Chloroformum may be applied pure (especially serviceable when the pain is localized in a small space) or in liniments (F. 173, 183). " Gelatized chloroform," made by incorporating 1 part of chloroform and 2 parts of white of egg, is a useful form for application. Dry Cupping is recommended by Dr. Graves. Electricity seems to be of service only in those cases of a purely neuralgic character, unconnected with irritation in distant parts of the body ; then the continuous galvanic current is often of essential service. If employed before the pain has subsided, the interrupted current very generally aggravates the patient's sufferings. See Prof. Ham- mond's remarks, p. 88. Enemata of turpentine and of opium are often beneficial. Frigus. Ice applied to the spine, by means of his spinal bag, is recommended by Dr. Chapman. Hydrargyri lodidum Viridum. The following ointment has been strongly recommended:— 193. R. Hydrargyri iodidi viridi, 9ij Adipis, gj- M- Hydrocyanicum Acidum Dilutum is recommended locally by Dr. Fuller (F. 163). **Hypodermic Injections. Dr. Anstie says that the discovery of the hypoder- mic method has instituted a new era in the treatment of severe neu- ralgias. Atropia, or morphia, or the two combined, may be used. The face should be avoided in making the injection. Prof. Bar- tholow says: " The neuralgias are best treated by the combined morphia and atropia solution. There are several reasons for this: much larger doses of morphia may in this way be injected without danger to the patient; and the larger the quantity, as Brown-Se- 96 DISEASES OF THE NERVOUS SYSTEM. quard has shown, the greater the curative power. Morphia and atropia combined are more effective than either singly. The sys- temic effects during the time of maximum narcosis, and also alter the narcosis has disappeared, are much less unpleasant and depress- ing when the two agents are combined than when morphia is used alone. Sometimes atropia is better borne than morphia, and vice versa: in this case, the agent whose effects are least unpleasant should be in excess." He recommends the following proportions: ■ij to jhs of a grain of atropia, \ to £ of a grain of morphia. The phy- siological effects of atropia here predominate, but the toxic effects are guarded by the morphia. For the facial neuralgia of pregnancy he uses morphia alone. This treatment promptly cures the affection, a fact first pointed out by Dr. H. R. Storer, of Boston. "These cases, as is well known, are extremely obstinate under the old methods of treatment, and those who have suffered from them on former occa- sions are exceedingly grateful for the relief so promptly and perma- nently afforded by the hypodermic method." Dr. Ruppaner reports a number of cases of the various forms of local and general neuralgia treated with success by the hypodermic injection of the acetate of morphia. Caffein has also been found to relieve neuralgia when thrown into the subcutaneous cellular tissue. In one instance in the practice of Dr. Anstie, of severe neuralgia of the superficial branches of the circumflex in the shoulder, two successive injections of caffein (over the biceps) appeared to cut short the malady altogether. In a case of dorso-costal neuralgia, attending shingles, a daily injection of caffein, during five or six days, notably mitigated the pain on each occasion. Iodoform has been recommended for local use in neuralgias, in the form of a saturated solution in chloroform. *Leeches applied along the course of the nerve often afford immediate relief after the failure of anodynes and other local measures. They are particularly indicated when there is inflammatory action or much vas- cular excitement. Monarda. Oil of horsemint, in liniment, with camphor and laudanum, some- times affords prompt relief. Morphia is second to no remedy for the relief of neuralgia, employed hypoder- mically (see above). The endermic application (gr.^-gr.j, sprinkled on a blistered surface over the seat of pain) is sometimes beneficial. Oleum Cajuputi is occasionally of service locally applied, in cases unconnected with inflammatory action. Oleum Tiglii, in liniment alone, or diluted with soap liniment, makes an excel- lent friction in many cases. Opium is recommended locally by Dr. Fuller (F. 162), and others, but its use is inferior to the subcutaneous injection of morphia. Rectal Suppositories of belladonna, hyoscyamus, and opium, are sometimes employed (F. 177, 178). Sinapis. Sinapisms over the seat of pain often afford relief. Stramonium is sometimes employed locally in the same manner as belladonna, to which, however, it is inferior. Turkish Baths have been employed in some cases with advantage. Vaginal Suppositories (medicated pessaries) are also occasionally used. They are highly recommended by Dr. Tilt (F. 179). Veratria, when there are no active or inflammatory symptoms present, is often beneficial, externally applied, the ointment being rubbed in dili- gently until it causes a sense of heat and tingling. It is inferior, however, to aconitia (F. 150, 157). PARALYSIS. 97 PARALYSIS. F. W. HEADLAND, M. D., LONDON. Strychnia is only successful in paralysis in cases where the injury to the nervous centre has healed up, and when the limb continues paralyzed merely because the motor nerves have lost the power of transmitting the necessary impulse, from having been so long unaccustomed to discharge this office. On the other hand, when the lesion of the nervous centre is of recent occurrence, or when it has been of so serious or extensive a nature as to admit of no repair in the course of time, the remedy will be ineffectual. CHARLES HUNTER, M. D., LONDON. Strychnia is a useful remedj^ given hypodermically, in paralysis. If, however, after three or four injections, improvement does not take place, it is almost useless to continue its employment. SIR THOMAS WATSON, LONDON. No good can reasonably be expected from strychnia, but much harm, unless the cord be free from organic disease. The tincture of cantharides has sometimes a very beneficial effect in thirty- minim to half-drachm doses. RESUME OF REMEDIES. Aloetic purgatives often prove beneficial conjoined with nux vomica. Ammonii Formias is recommended by Dr. Ramskill as a stimulant in cases of chronic paralysis accompanied by general torpor. Argenti Nitras, in doses of gr. f-j daily, has been employed with success, by Bouchut, in paraplegia and progressive general paralysis, result- ing from sexual or alcoholic excess. Arnica has been employed with good results. Cantharis. Sir. TnoMAS Watson recommends tincture cantharides in para- plegia. Generally, when it does good, it acts as a diuretic. Cinchona. Full doses of quinine promptly break up intermittent paralysis. Ergota is recommended in those forms of paralysis arising from spinal con- gestion, in paraplegia complicated with menstrual irregularity (Meadows), and in the constipation of the paralytic, after the most powerful cathartics have failed (Waring Curran) . Ferri et Strychniae Citras is serviceable in paralysis associated with anaemia. Hydrargyrum. Dr. Maudslet says: " To administer mercury systematically in general paralysis, as has been done, is as unaccountable in theory, as it undoubtedly is pernicious in practice." Ntix Vomica. See Strychnia. Oxygen inhalations have been employed by Dr. Ramskill. Petroleum has proved serwceable, used externally and internally. 7 98 DISEASES OF THE NERVOUS SYSTEM. Phosphorus has been successfully employed in some cases, in the form of the oil (made by gently warming 2 parts of phosphorus in 100 parts of almond oil, in a closed flask, for about twenty minutes, and decanting off, when cool, the oil from the undissolved phosphorus. Dose, gtt.iij-viij, in emulsion, or with cod-liver oil). Potassii lodidum occasionally proves successful in some forms of paralysis. *Strychnia is a remedy much prescribed in paralysis, but very variously re- ported upon. The different results obtained in different hands have been accounted for by the impurity of the drug, the inability of the patient to bear the remedy, and its injudicious application to all forms of the disease. When the brain is still in a disordered state, and sanguineous effusion exists, it will prove injurious rather than bene- ficial, having the effect of exciting inflammatory action. When, however, the effusion has been absorbed, and the paralysis continues, as it were, from habit, strychnia will be found of great service. It is most beneficial in those forms of paralysis not dependent upon disease of the nervous centres, as in lead, mercurial and rheumatic palsies. See opinions of Drs. Headland, Hunter, and Sir Thomas Watson As for the manner of administering strychnia in paralysis, it may be commenced in doses of gr.-jV-rs *w0 or three times a day, and the quantity cautiously increased. After continuing it for a few days or a week, slight convulsive twitchings or a creeping sensation will be experienced in the paralytic limb. It should then be discontinued for two or three days, and resumed as before. It may be employed hypodermically with great advantage in some cases. Sulphur gives very good results, according to Dr. Graves, in paralysis of an asthenic or chronic character, when employed as a sequel to a course of strychnia. He uses it in the form of an electuary and in baths. Toxicodendron is recommended by Trousseau in paraplegia from concussion of the spinal marrow, administered as follows: gr.v the first day of treatment, increased daily by the same amount until gr.lx a day are reached. It is asserted that it strengthens rather than enfeebles digestion, and causes no inconvenience other than occasionally slight strangury. EXTERNAL REMEDIES. Armoracice Radix. Poultices of fresh horseradish root form a ready counter- irritant in paralytic affections. Cajuputi Oleum makes an excellent embrocation for paralytic limbs. Dili- gently rubbed in it stimulates the parts and relieves pain when pre- sent. Delphina is believed, by Dr. Turnbull, to be more useful in paralysis than veratria, from its property of exciting the circulation in the affected part. Mucuna. The setae maintained on the affected limb by a bandage have been employed as a local stimulant in paralysis. Myristica. The oil, diluted with soap liniment, forms a useful stimulating em- brocation. Oleum Tiglii, in liniment, with or without the addition of soap liniment, may be employed with advantage as a stimulating friction. Petroleum has proved serviceable in some cases. Rosmarinus is a useful ingredient in ointments and liniments, to be rubbed over paralyzed muscles. Sinapisms, with the addition of powdered capsicum, act as speedy deriva- tives, useful in some .cases of paralysis. PARALYSIS. 99 Sulphuricum Acidum. The following ointment, perseveringly employed, has resulted beneficially:— 194. R. Acidi sulphurici, f.gj Adipis, gj. M. It acts as a powerful irritant. Veratria ointment, diligently used, has occasionally been followed by great im- provement. Cold Shower Baths, in cases of paralysis consequent on severe inflammatory attacks of the brain and spinal column, are often attended with bene- fit, but sometimes fail, and may even aggravate the symptoms. Turkish Baths, cautiously employed, sometimes benefit. Cantharis. Blisters to the spine are useful when there is reason to expect effu- sion within the theca. Electricity, carefully employed, is highly beneficial in appropriate cases. It should never be resorted to in recent cases, if there be reason to sup- pose that effused blood or coagulum remains unabsorbed, nor so long as there are any febrile or inflammatory symptoms present. It i? of no benefit in cases with organic lesion of the nervous system. Its greatest utility lies in cases of purely local paralysis. Great and terrifying shocks are rarely beneficial where small and repeated shocks have failed. Both faradization and galvanism have been em- ployed with success. Electro-puncture has been used with good re- sults in paraplegia and hemiplegia. Frigus. Ice to the spine is recommended by Dr. Chapman. Issues and Setons are sometimes employed with advantage. Leeches at the verge of the anus are beneficial, where there is suppression of a habitual discharge, as from piles. HYSTERICAL PALSY. *Cantharis. Dr. Russell Reynolds says that he knows of no mode of treat- ment in hysterical paralysis comparable in efficiency with that of placing narrow strips of blister completely around the affected limbs. It succeeds perfectly and rapidly, after all other measures have failed, and is worthy of trial in all cases. LEAD PALSY. * Strychnia is of especial benefit in this form of paralysis. Galvanism proves highly beneficial in these cases. MERCURIAL PALSY. Argenti Nitras has been employed with success. The dose should be gr.£ daily, at first, and gradually increased until gr.iij in the course of the day are taken. *EUctricity is very useful in these cases. *Potassii lodidum is useful in very small and cautiously increased doses. *St>ychnia is very beneficial in this form of paralysis. Sulphur Baths are considered, by Dr. Lettsom, almost as a specific in mercu- rial palsy. RHEUMATIC PALSY. Conium has been successfully employed in some cases. *Strychnia is of great benefit in most cases of paralysis resulting from rheumatism. ^Electricity is employed with the same great advantage in this, as in lead and mercurial palsies. 100 DISEASES OF THE NERVOUS SYSTEM. PROGRESSIVE LOCOMOTOR ATAXIA. PROF. WILLIAM AITKEN, M. D., EDINBURGH. Persistent counter-irritation over the spine (by blisters, moxa, actual cautery, or ice) is indicated, cautiously employed. Phos- phorus, in the form of phosphates of metals and salts, of diluted phosphoric acid as a drink in the daily allowance of water, and of phosphate of sodium as an aperient, may be given with advantage. Nitro-muriatic acid as a tonic, and cod-liver oil as a dietetic, may be of use. Flannel should be worn next the skin, and a chamois leather jacket over it. The diet ought to be of the most nutritious character. Cannabis indica and belladonna give the greatest re- lief to the pains. If used at all, electricity ought only to be employed during the pauses in the course of the disease, and then with great caution, in the form of a constant current, rather than the induced current in faradization. W. LAMBERT, M. D., AMHERSTBURG, ONTARIO, CANADA. 195. R. Acidi phosphorici diluti, f-£>vj Syrupi, f.|iij. A teaspoonful in water thrice daily, gradually increased to a dessert- spoonful, together with the application of electricity (New York Medi- cal Journal, February, 1869). PROF. TROUSSEAU, PARIS. Our author advises not to employ setons, moxas, etc., along the spine, as they cause great pain and irritation, and do no pos- sible good. Electricity is the great remedy which he recommends, combined with flagellations prudently employed, with belladonna to abate pain, with sulphurous baths, which have been very suc- cessful. Hydrotherapy may be of great service in the constitu- tional treatment, as well as other appropriate remedies of a like action. Preparations of mercury and of iodide of potassium are of great good, where there exists a syphilitic taint. Trousseau re- commends his " compresseur " of the prostate in the spermator- rhoea which sometimes attends the outset of the disease. Turpen- tine is useful in the vesical manifestations of the malady. Hy- gienic rules are to be strictly observed. ' PROF. EBEN. WATSON, M. D., GLASGOW. 196. R. Tincturae physostigmatis, ... ____rnv-xxv. For one dose, to be given every half hour. "~-->^ PROGRESSIVE LOCOMOTOR ATAXIA. 101 Five minims of the tincture equals one-half grain of the extract of calabar bean. {The Practitioner, September, 1869). RESUME OF REMEDIES. * Argenti Nitras is recommended by Dr. Althaus, as useful in a large proportion of cases (Lancet, December 30th, 1865). It should be given in doses of gr.^s—£ two or three times daily. Its combination with hypophos- phite of soda seems to add to its efficacy. After its use has been continued for four or six weeks consecutively, its administration should be interrupted for two or three weeks, and a slightly aperient mineral water given. The nitrate may then be resumed for a month or two. The gums should be carefully watched, and on the appear- ance of the slightest blue coloration, the remedy should be discon- tinued. Nitrate of silver has been thus employed in ataxia with variable success. In some cases it disagrees, and has to be stopped ; in others it seems without effect, but in the majority of cases it has proved very useful. It is a remedy upon which considerable reliance can be placed in this disease. Belladonna and Cannabis Indica are both said, by Dr. Aitken, to give great relief to the pains. Hydrargyrum is advised, by Prof. Trousseau, when the syphilitic taint is present. Nitro-muriaticum Acidum is an excellent tonic in these cases (p. 100). Oleum Morrhuce is of use as a dietetic. Phosphorus is recommended by Dr. Aitken. The administration of the phosphates of the metals and salts may be conjoined with the use of dilute phosphoric acid as a drink, in the daily allowance of water, and with phosphate of soda as an aperient (F. 195). Physostigma has been used with advantage (F. 196). Potassii lodidum has been employed, but not very favorably reported upon. It is useful where there exists a syphilitic taint. EXTERNAL REMEDIES. Counter-Irritation over the spine, by blisters, actual cautery, moxa, or ice, per- sistently but cautiously employed, is sometimes resorted to, but the practice is deprecated by Trousseau (p. 100). ^Electricity has been employed with good results. Dr. Aitken says it must be resorted to with great caution, and only during the pauses in the disease (p. 100). Prof. Trousseau highly recommends its use. Prof. Niemeyer considers it a very active remedy, but cannot claim any success from its use, though he has had an excellent apparatus in his clinic, and treated all his cases with it during four years, in the man- ner advised by Remak. He intends hereafter to continue the use of eleetricity, but instead of letting the current act on the spinal column, as hitherto, he will try the current through the spinal nerves, as ad- vised by Benedict. Sulphur Baths are recommended by Dr. Althaus as an adjunct to the nitrate of silver treatment. They relieve the pain and diminish the numb- ness (Lancet, December 30th, 1865). 102 DISEASES OF THE NERVOUS SYSTEM. SCIATICA. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 197. R. Emplastri epipasticas. I£in.x5m. To be applied over the affected part. Let it draw for five or six hours, poultice it, and then remove the cuticle and dress with 198. R. Morphiae sulphatis, gr I Pulveris marantae, graJ- M. For 1 powder. Also ten grains of Dover's powder, to be taken at night. DR. LABORDE, FRANCE. 199. R. Olei terebinthinae, f-^viij Chloroformi, Tincturae opii, aa f.^ij. M. A useful liniment in sciatica. To be rubbed on by means of a piece of flannel, several times a day. 200. R. Aquas ammonias, f-3v Olei terebinthinas, Olei amygdalae dulcis, aa f-3*j. M. Rub on three times a day, in obstinate sciatica. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 201. R. Olei terebinthinae, f..3J Mellis, f.gj. M. . For an electuary. A tablespoonful twice daily. Romberg also speaks very highly of this as a specific remedy in the treatment of sciatica. THOMAS HAWKES TANNER, M. D., LONDON. 202. R. Sodii sulphatis, Bij-iv Sodii carbonatis, 9j Sodii chloridi, gr.xv Cretas preparatae, gr.x Ferri carbonatis saccharatas, gr.xv. M. Make a powder and direct it to be taken early in the morning, in half a pint of water. In some cases in which Dr. T. could detect no cause for the sciatica, a cure has been effected by this treatment, with the use of the hot-air bath twice a week. EDWARD WAAKES, M. D., LONDON. 203. R. Extracti ergotas fluidi, f.gij Aquas cinnamomi, f^iij. M. A dessertspoonful in water every four hours. SCIATICA. 103 Tinctura ferri chloridi may be added if indicated. When ero-ot is likely to be useful, its good effects commence immediately. RESUME OF REMEDIES. Aconitum is, in the opinion of Dr. Fuller, not only a valuable and efficient remedy in many obstinate forms of this disease, but is also safe and manageable, when properly administered and carefully watched. Ammonii Chloridum is recommended by Dr. Anstie in the milder cases of sciatica occurring in the young. * Atropia, hypodermically, is a successful form of treatment, now much em- ployed. * Belladonna is one of the most valuable sedatives and anodynes we possess in this affection. * Cannabis Indica ranks next in value to belladonna and opium. Conium is sometimes of service, and may be resorted to when belladonna and opium fail or are contra-indicated. Creasotum has been employed internally by Dr. Elliotson, with apparent benefit. Digitalis is recommended by Dr. Fuller as a reliable remedy, when the pain is intermittent and of a purely neuralgic character. He gives either the powdered leaves (gr. j-iss), or the tincture (n^x-xx thrice daily). Ergota has been advised (F. 203). ^Morphia, given hypodermically, affords speedy and often permanent relief. It may also be employed endermically (F. 198). Nitro-muriaticum Acidum, in full doses, (n\,vi-x), is an effectual remedy in sciatica accompanied with malaria. Its action should be aided by an occasional brisk purgative, the cold shower bath, or a cold douche down the spine, followed by friction and change of air and scene. Oleum Tiglii has been employed with success internally. Opium, although of great occasional service, is less used since the introduction of the more effective treatment by the hypodermic injection of morphia. Potassii lodidum is strongly advised by Dr. Graves, in doses of gj in the course of the day, dissolved in a decoction of sarsaparilla, in cases of a subacute or chronic character, and where the patient has to follow his out-door avocations. Strychnia is inadmissible in acute or inflammatory cases, but in others, nux vomica has been used with occasional success. *Terebinthince Oleum is considered by Dr. Anstie as a remedy worthy at least a trial, in doses of n\,x thrice daily, in the more obstinate cases of sciatica. It is, however, usually very disagreeable to the patient. Dr. Niemeyer also recommends it in electuary (F. 201), and Dr. Rom- berg speaks of it almost as a specific. Cathartics are often indicated and of service. EXTERNAL REMEDIES. Aconitia is a very certain and powerful palliative applied over the seat of pain (F. 157, 161). Aconitum is frequently employed externally (F. 154, 165, 1S6, 191). Acupuncture is limited to purely chronic cases, and to those in which there is effusion within the sheath of the nerve. In appropriate cases, it promises speedy and effectual relief. Belladonna may often be employed with benefit as a local application (F. 1G2). 104 DISEASES OF THE NERVOUS SYSTEM. Cantharis. Great and immediate relief sometimes results from applying a blister to the heel. Chloroformum is advised externally by Dr. Fuller, who says that a strip of flannel, soaked in chloroform, placed along the course of the nerve, and covered with oiled silk to prevent evaporation, proves sometimes extremely serviceable. Morphia may be employed endermically (F. 198), but its use in this way is in- ferior to subcutaneous injection. See Hypodermic Injections, below. Opium is often used externally (F. 162). Pix Burgundica. Enveloping the whole thigh in a Burgundy pitch plaster, has, according to Trousseau, cured sciatica after the failure of blisters and the endermic use of morphia. Sidphur, externally, is highly praised by Dr. Fuller, who finds it very gener- ally eflksacious and worthy of a trial in every case, when all active symptoms have been subdued or are absent. He sprinkles a piece of new flannel, thickly, with precipitated sulphur, encases the whole limb in this, from the foot upward, and covers it with oiled silk or gutta-percha, which has the effect not only of increasing the warmth and confining the vapor of the sulphur, but of obviating the odor, annoying to the patient. It should be kept applied night and day. Absorption takes place rapidly, and the breath, urine, stools and per- spiration unmistakably attest its presence in the system. Dry Cupping often proves beneficial. Electro-puncture, which should only be applied during the intermissions of pain, is sometimes serviceable. Hypodermic Injections. Prof. Bartholow strongly recommends Atropia hy- podermically. He says : " The principal triumphs of atropia over neu- ralgia have been in cases of sciatica. It is now admitted that atro- pia is one of the best remedies for this disease. First proposed and used by Mr. Hunter, it was afterwards employed by Behier, Courty, Oppolzer, Lorent, and others. It has been found, however, that distant injection, and even injection into the subcutaneous tissue of the affected thigh, do not produce such good results as throwing the fluid deeply into the neighborhood of the affected nerve. More fre- quently, indeed, than in any other form of neuralgia, except the most obstinate and protracted cases of tic douloureux, the nerve itself, or its sheath, has undergone structural alteration ; the limb is often diminished in size, its temperature and sensibility lowered, and the power of its muscles impaired. Under these circumstances more ad- vantage is to be derived from local than from distant injection, just as Luton, Bertin, and Ruppaner have cured such cases by the in- jection of irritants into the affected parts. In severe cases of sciatica gr.^V of sulphate of atropia may be injected ; but it should not be forgotten that this quantity will excite very severe symptoms in sus- ceptible subjects. Generally gr. will produce decided atropinism. Cessation of the pain is not immediate upon the systemic effects, as Mr. Hunter originally pointed out; indeed, the pain is often at first increased, but improvement takes place after a variable interval, and is often more permanent than after the morphia injection." When atropia fails Morphia may be tried, or both may be employed together. Morphia injected into the thigh, four inches below the hip joint, and over the course of the nerve, has been called " almost the only remedy for sciatica." Prof. Bartholow says, in regard to the subcutaneous use of morphia, that " in severe and protracted cases, in which changes in the nerve and in the nutrition of the limb have taken place, permanent relief cannot always be guaranteed to the patient • but the injections, steadily continued in the maximum doses will in a great majority of cases, effect a cure finally." TETANUS. 105 TETANUS. PROF. ROBERTS BARTHOLOW, M. D., CINCINNATI, OHIO. Of all the remedies which have been proposed for tetanus, phy- sostigma must be regarded as the most useful. All cases treated by calabar bean are not managed with equal judgment and skill. Dr. Fraser has indicated {The Practitioner, vol. I, p. 83) the following mode of using it: Commence the treatment by subcuta- neous injection; repeat such injection until the system is decidedly affected, then administer the remedy by the mouth, in a dose three times as large as is found necessary by subcutaneous injection. This plan may be safely followed, even in a child of nine years. If the administration by the mouth continue to produce remedial effects it should be persevered with; but in severe cases, subcuta- neous injection should alone be employed, and it should always be preferred when severe and continued spasms occur, when a fatal result is imminent from exhaustion, and when apncea threatens a fatal termination. No arbitrary rules of dosage can be laid down. For an adult, gr.j of the extract, by the mouth, or gr.j, by subcu- taneous injection, will generally suffice to begin with. This should be repeated in two hours, when its effects will usually have passed off, and the succeeding doses modified according to the experience thus gained. The doses are to be continued in increasing quantities until the physiological effect, in diminishing reflex excitability, is produced, or until the sedative action of the drug on the circulation is carried to a dangerous extreme, or until constant nausea and vomiting compel a discontinuance. WILLIAM FEN WICK, M. D., GLASGOW. 204. R. Pulveris physostigmatis, Pulveris rhei, aa gj. M. Divide into 20 powders. One to be taken every four hours during the day, also an occasional dose at night, making the average quantity of fifteen grains of each in twenty-four hours. Under the influence of this combination, Dr. F. has seen none of the depressing effects which the bean produces by itself. He re- ports (Glasgow Medical Journal, May, 1869) the improvement under this treatment as marked. DR. E. FICK, REVAL. 205. R. Morphiae sulphatis, gr.| Aquae, "Ivj. M. For one hypodermic injection, between the shoulder blades, near the spine. 106 DISEASES OF THE NERVOUS SYSTEM. G. OLLIVER, M. ©., LONDON. 206. R. Atropiae, gr.*V In the form of a granule, one every three hours; and linimen- tum belladonnae to be rubbed over the spine and rigid muscles every six hours. A successful case of treatment by this method is reported in the British Medical Journal for August 22d, 1868. The patient was kept under the influence of atropia for three weeks. He then quickly and completely recovered his usual health under iron and quinine. C. V. RIDENT, M. D., LONDON. 207. R. Extracti physostigmatis, gr.viij Alcoholis, f.3j. M. The extract of calabar bean to be well rubbed down in the alco- hol. The dose is ten minims (gr. ^ of the extract). Our author records (London Lancet, October 31st, 1868) a case of traumatic tetanus in which this dose, ten minims of the tinc- ture, was given every hour. It appeared to retard the progress of the case and to ameliorate the severity of the symptoms, but aever fully to control them. The following directions are given in the British Pharmacopoeia for making the EXTRACT OF CALABAR BEAN. 208. R. Calabar bean, in coarse powder, 1 pound Rectified spirit, 4 pints. Macerate the bean for forty-eight hours, with one pint of the spirit, in a close vessel, agitating occasionally, then transfer to a percolator, and when the fluid ceases to pass, add the remainder of the spirit so that it may slowly percolate through the powder. Subject the residue of the bean to pressure, adding the pressed liquid to the product of the percolation; filter, distill off most of the spirit, and evaporate what is left in the retort, by a water-bath, to the consistence of a soft extract. B. ROEMER, M. D., ST. LOUIS, MISSOURI. According to our author (St. Louis Medical and Surgical Jour- nal, July, 1873), a good summary of the treatment of tetanus is as follows:— 1. Division of a nerve can be of benefit only if practiced very early; amputation is similarly practicable, but generally of little avail, because decided symptoms have already been developed. TETANUS. 107 2. Local applications and general attention to the wound are of the utmost importance, to prevent complications, and to insure local quietude and avoid derived irritation. Fresh air is, for a like reason, instrumental in successful management of tetanus. 3. General and unconditional quiet and rest around the patient are enjoined; all noises, even to speaking in an elevated tone, are to be interdicted, remembering that sudden death has often fol- lowed after exciting impressions. 4. Supporting nourishment, in concentrated form, and stimu- lants, should supply the exhaustion in a disease which is not char- acterized by disorganization of any vital organ. 5. In cases where the patient is plethoric, the pulse full but not frequent, and where there exists a disposition to, or symptoms of, isochronic inflammatory action, venesection, leeching and cup- ping are indicated in the outset, and should be promptly but care- fully practiced. The subsequent action of the therapeutic agent is thereby rendered more certain. 6. Purgatives of prompt action are necessary in all instances, and should be repeated and interchanged, until a desired effect is obtained, aided by enemata if demanded. 7. The selection of the anti-tetanic should be made according to the most promising statistics on tetanus. PROF. EBEN. WATSON, M. D., GLASGOW. 209. R. Tincturae physostigmatis, tt\,v-xxv. For one dose, to be given every half hour. Five minims of the tincture equals one-half grain of the extract of calabar bean. RESUME OF REMEDIES. ' * Aconitum in large doses has been employed by a number of practitioners, and deserves further trials. There seems to be great tolerance of the drug in this disease. It acts by diminishing the irritability of that portion of the nervous centre which controls reflex muscular action. * JEther has been found to be very useful in arresting tetanic symptoms in the wounded. Cases, both of idiopathic and traumatic tetanus, cured by the inhalation of ether, have been reported. Alcohol. Stimulants, first proposed by Dr. Rush, in this disease, are now rarely trusted to alone. Large doses of wine, brandy and porter, have been given with success, in a number of reported cases. Allium has been administered internally, in this disease, and by frictions along the spine and limbs, with alleged success. Antimonii et Potassii Tartras has, it is said, proved effectual in nauseant and emetic doses. 108 DISEASES OF THE NERVOUS SYSTEM. * Atropia and Belladonna have been successfully employed in a number of cases (F. 206). Atropia is given also hypodermically, but with uncer- tain results. Brominium, see Potassii Bromidum. * Cannabis Indica has been largely employed, but with very diverse results. It has been given in the form of the extract (gr. iij) or of the tinc- ture (ttlxxx.), repeated every half hour, hour, or two hours, the ob- ject being to produce and maintain narcotism. Chloral appears to have been efficacious in a number of cases. * Chloroformum. The inhalation of chloroform in small and frequently repeated doses, with a large admixture of air, relieves the muscular spasms when it fails to produce a lasting benefit. By some recent writers it is claimed to be the agent which has cured the most cases. Chlo- roform frictions are also recommended. Colchicum has been used, but not with very satisfactory results. *Conium is regarded by Dr. Harley as the natural antagonist of this disease, but to be effectual large doses of the succus must be given. If the patient cannot swallow, from f.gvj-xij of the succus, warmed to the temperature of the body, should be injected into the bowels, and re- peated every two, three or four hours, according to the condition of the muscles. Glonoin. Nitro-glycerin has been employed, but must be given cautiously. Morphia has been frequently used hypodermically in this disease; see Hypo- dermic Injections below. Nicotia has been given hypodermically. Internally nicotine, in doses of gtt.ss- ijss in sherry and water, several times a day, has been employed with success. The alkaloid has the effect of relaxing the muscles, stopping the delirium, and producing profuse sweating, which exhales a strong odor of snuff. So powerful a poison must be given with caution. Nitrite of Amyl, by inhalation, has been exhibited with success in traumatic tetanus. Nux Vomica, see Strychnia. Oleum Terebinthince, internally, or by enema, sometimes exerts a beneficial in- fluence. It may be used as an adjunct to other remedies. Opium has been given in large doses, but is inferior, in this disease, to aconite, belladonna, chloroform, or physostigma. Dr. Ruppaner recommends the hypodermic injection of gtt.xxv-lx, of liquor opii compositus, in the back, near the spinal column. *Physostigma is a remedy of much value; and one of which there is great tolerance in this disease. Dr. Fraser, of Edinburgh, is in favor of subcutaneous injections, especially in severe cases (Practitioner, August, 1868), but Dr. Eben. Watson, who has had great experience in its use, has failed to obtain, in this way, any very decided effect. He prefers to prescribe the alcoholic extract in solution, as a weak tincture; but should the stomach reject this, he gives a double dose in a starch-water enema (Practitioner, April, 1870) He agrees with Dr. Fraser in the necessity of giving it in large and repeated doses, the sole limit being the complete subsidence of the tetanic spasms, or the development of the poisonous effects of the drug to a danger- ous degree. The strength of the patient must also be well supported by fluid nourishment, and stimulants. Physostigma may fail, how- ever, even when its full physiological effects have been produced (F. 204, 207, 208, 209). p Potassii Bromidum, in doses of gr. xx-xl, every two or three hours has been given in a number of reported cases of idiomatic and traumatic te- tanus, with markedly favorable effects. Quinioz Sulphas, has been used, but is of doubtful power. TETANUS. 109 Strychnia, in doses of gr.rx2-TV, every two hours, has been employed with benefit. Tabacum. Enemata have been employed with success in the hands of some practitioners, but have failed entirely in others. Their strength should never exceed, gr.xxx of the leaves in Oss of water, and ammonia, brandy and other stimulants must be given, to prevent too great depression. The topical application of tobacco has been recom- mended in traumatic tetanus, a strong infusion of cavendish tobacco being applied to the wound and surrounding parts, previously blis- tered ; in idiopathic tetanus, it being applied to a blistered surface over the spine. See, also, Nicotia. Woorara, in large doses hypodermically, gr.^\—fa-^ is successful in the hands of Spencer Wells and others. It has not, however, justified the confident hopes that were at first entertained of its powers in tetanus. Cathartics are useful in most cases. EXTERNAL REMEDIES. Actual Cautery, applied to the wound, in traumatic tetanus, was proposed by Larrey. Baths. Warm baths, 97°-100° F., of three to four hours' duration, repeated daily, have been advised. Blood-letting. When there exists a disposition to isochronic inflammation, and the patient is plethoric, and the pulse full, venesection at the onset has been advised. Cantharis. Prof. StillE states that in tetanus, " even when of traumatic origin, blistering on either side of the spinous processes and through- out the entire length of the spine, is an important if not an essential element of treatment. It is possible, though not certain, that the endermic use of the salts of morphia on the parts thus denuded adds greatly to the efficacy of the vesication. It were, perhaps, bet- ter to introduce the narcotic by inoculation." Chloroformum. Chloroform frictions are said to afford relief. Electricity. Dr. Mendell, of Berlin, has successfully treated two cases by the local application of a gentle current of electricity to the affected muscles, with the apparent effect of subduing the excessive irritabil- ity of the sentient nerves. When a strong current is directed to the cord, powerful contractions result. The positive pole should be di- rected to the antagonists of the affected muscles. Frigus. Cold Effusions have proved of little value in traumatic tetanus, but of great service in the idiopathic form, particularly in warm climates. Ice in bladders, steadily applied along the whole length of the spine, has proved efficient in both the traumatic and idiopathic varieties of the disease. Hypodermic Injections. The following remedies have been employed hypo- dermically in tetanus : Atropia, without much success ; Liquor opii compositus, gtt. xxv-lx, by Dr. Ruppaner, with the effect of securing comparative calm and ease ; Morphia, gr. j-ij during the day, of the muriate, by Demarquay, the needle being carried deeply into the contracted muscles, and, if possible, to the point of entrance of the nerves ; Nicotia, gr. fa, about one-half of the traumatic cases, accord- ing to Prof. Bartholow, treated with it getting well—a better result than from any other remedy excepting physostigma ; ^Physostigma, gr. ^ to commence with, which may be considered as one of the most useful remedies yet employed (p. 105) ; Woorara, gr -fa—fa-i2, with varying results, but short of the expectations based upon its pecu- liar physiological action. Potassa. Counter-irritation, by caustic potassa, over the spinal column, has repeatedly proved of service in traumatic tetanus. 110 DISEASES OF THE NERVOUS SYSTEM. TIC DOULOUREUX. FRANCIS E. ANSTIE, M. D., LONDON. In the treatment of this terrible kind of facial neuralgia, to which Trousseau gave the name of epileptiform, Dr. A. recommends {Half- Yearly Compendium of Medical Science, July, 1869) the following plan in the earlier stages of the malady:— • 1. Counter-irritation, applied, not to the branches of the fifth, but to those of the occipital nerve, at the nape of the neck. A blister in the former situation is often as hurtful as useful; in the latter, it is sometimes strikingly effective in gaining a short respite. 2. Nutritive Tonics. The assiduous use of cod-liver oil, or of some fatty substitute for it, should be insisted on from the first, and is of the highest consequence. 3. Subcutaneous Injection of morphia, or of atropia, according to circumstances. Commence with the use of one-sixth of a grain of morphia twice daily, increasing this, if necessary, to one-fourth and one-half a grain, and in rare cases to one grain. If this pro- duces, along with the other measures, a notable remission of the pain, it should be cautiously and steadily decreased, as circum- stances may admit. In cases where morphia fails, atropia may be tried in doses commencing at one-sixth of a grain. The injection of a less quantity than this would probably be useless in severe tic. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 210. R. Liquoris potassii arsenitis, gtt.v Syrupi rhei aromatici, f.gj. M. For one dose, thrice daily, after meals. At night apply a hot salt bag to the back of the neck, and order the following pill:— 211. R. Extracti belladonnae, gr.^ Extracti hyoscyami, Extracti colocynthidis compositi, Pulveris zingiberis, aa gr.j. M. ASHLEY N. DENTON, M. D., SUTHERLAND SPRINGS, TEXAS. 212. R. Olei camphorae, f.^ij Pulveris opii, Qi Potassii nitratis, gr.xv. Mix well in a mortar, and apply to a denuded surface. Useful in re- lieving the intense suffering from facial neuralgia. TIC DOULOUREUX. Ill Dr. D. also recommends (St. Louis Medical Reporter, June 15th, 1867) chloroform, as advised by Dr. Tanner, as one of the most useful palliatives in his hands. W. MUNRO, M. D., ENGLAND. Believing that in tic douloureux the blood vessels of the part affected are in a state of constriction, our author has used calabar bean in several cases {Medical and Surgical Reporter, December 5th, 1874) with exceedingly satisfactory results. He drops into the eye two or three drops of a solution of extract of calabar bean (1 in 40), or applies one of Streatfield's ophthalmic squares to the eye. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 213. R. Extracti hyoseyami, Zinci oxidi, aa 9ij. M. Divide into 40 pills. Begin with one pill, morning and evening, and increase to twenty or thirty of them daily. These, known as Meg- lin's pills, have a good reputation in Germany. THOMAS HAWKES TANNER, M. D., LONDON. 214. R. Extracti belladonnae, Extracti opii, aa giss Glycerinae, f-3iv Extracti papaveris, §iss. M. To be painted over the affected part. A fomentation, flannel, or hot linseed poultice, is to be applied, being separated from the extracts by a sheet of tissue paper. 215. R. Aconitiae, gr.ij Alcoholis, gtt.vj Mix thoroughly and add Adipis, &• M- A small portion to be cautiously smeared over the track of the painful nerve once or twice a day; but it must not be used where there is the slightest abrasion. EDWARD WAAKES, M. D., LONDON. 216. R. Potassii bicarbonatis, jisp Extracti ergotae fluidi, f-3j # Infusi ergotae, f-3"vj. M. Two tablespoonfuls every four hours. B. M. WALKER, M. D., PLYMOUTH, NORTH CAROLINA. Our author reports {American Journal of the Medical Sciences, April, 1874) a case of tic douloureux treated by ice. The patient, a lady aged 60, had been treated in various ways during five years, no remedy securing a longer period of relief than a few weeks. She was directed to use ice upon the part, which was over the fifth 112 DISEASES of the nervous system. pair of nerves, and to continue the application as long as she could bear it, at the same time holding brandy in the mouth. The pain, for a while, was more intolerable than ever before; then it began to subside, and perfect quiet was obtained. The pain did not return the next day, as was customary, nor was there any subse- quent return nor necessity for treatment. RESUME OF REMEDIES. Acidum Arseniosum is sometimes prescribed by Prof. Da Costa (F. 210). Aconitum is employed with benefit in this, as in most other forms of neu- ralgia. Ammonii Chloridum, in doses of gss, four times daily, often succeeds. If the pain does not yield after five doses, no benefit need be expected from this remedy. Aqua Ammonice has been found of benefit in some cases, in doses of n\,xx- xl in a cupful of thick gruel, at bedtime. Argenti Nitras has been found, by Romberg, of great but not permanent benefit, in doses of gr.j. several times daily. * Atropia, hypodermically, is a valuable remedy, in this, as in other forms of neuralgia. Belladonna ranks among the first of sedatives and anodynes, in this, as in other neuralgic affections (F. 211, 214). Beberice Sulphas (in doses of gr.x night and morning), has been recom- mended by Prof. J. Y. Simpson and others. Cannabis Indica is a capricious remedy, but one which (TT^xij-xx of the tinc- ture) often allays pain after the failure of other sedatives. Chloroformum is frequently a useful palliative. Caffein. One grain doses of the citrate every hour, for some time before the expected paroxysms, has been recommended. Ergota has been found useful, by Dr. E. Waakes (British Medical Journal, August 8, 1868). Ferrum is of service in anaemic cases. Hyoscyamus, combined with oxide of zinc, has an excellent reputation in Germany (F. 213). *Morphia, hypodermically injected, is a speedy and powerful remedy (p. 110). The injections should not be made under the skin of the face. Oleum Tiglii has been employed with benefit internally. Opium is inferior to morphia injected subcutaneously. Cathartic Enemata of castor oil, turpentine and assafoetida are valuable aids to treatment when there is an overloaded colon. EXTERNAL REMEDIES. Aconitia, in purely chronic cases, is a most valuable application (F. 215). * Aconitum, locally, often subdues the disease, attention being paid, at the same time, to the state of the bowels, and to the general health. Antimonial^ counter-irritation occasions so much pain and discomfort that it is rarely resorted to. Aqua Ammonice has been found, by a number of French physicians, to rapidly cure some obstinate cases, when applied with a camel-hair TIC DOULOUREUX. 113 brush to the palate and gums, so as to cause a profuse discharge of tears and saliva. Belladonna is frequently employed locally, with benefit (F. 214). * Chloroformum may be applied in liniment or pad. Counter-Irritation at the nape of the neck is recommended by Dr. Anstie (p. 110). Dr. Da Costa sometimes orders a hot salt bath to the back of the neck. Delphinia, applied externally, is stated, by Dr. Turnbull, to be very efficient. It may be employed in the form of a solution : — 217. R. Delphinias, J}ij Alcoholis, f-3xij. M. Or, in ointment:— 218. R. Delphinias, gr.xxx Olei olivae, f.gj Adipis, 3j. M. Frigus. The local application of ice has been successfully employed (p. 111). Hydrargyri lodidum Viridum is recommended, in ointment, of the strength of forty grains to the ounce of lard. Opium is applied locally with benefit, but is far inferior to morphia, intro- duced hypodermically. Physostigma. A solution of the extract of calabar bean (1 in 40) applied to the eye, has been'used successfully (p. 111). Veratria is of great service, applied in ointment (F. 150, 157). Electro-puncture, employed during the intermission of pain, is often a valuable method of treatment. Hypodermic Injections. Dr. Anstie employs injections of morphia or of atro- pia, according to circumstances (p. 110). Dr. Ruppaner reports a number of cases treated with success by the injection of liquor opii compositus, T(\jx. In general, in regard to the use of hypodermic in- jections, the same is true as in other forms of neuralgia (pp. 95, 104). Neurotomy. Prof. Niemeyer quotes Bruns in support of division of the nerve, or excision of part of it, in proper cases. He shows, after a careful examination of the cases where it had been done, that, after excluding those where its want of benefit depended on error of diag- nosis or operation, and after excluding the cases where the recurrence of pain was to be regarded as a new attack, not as a relapse, there was a considerable number of cases where the neurotomy caused either a complete and permanent benefit, or at least a temporary one for a few months or years. The operation is indicated when the pain is very limited, when it is probable that its exciting cause is situated at a point beyond which the nerve is accessible to the knife, when other treatment has proved fruitless, and when the pain renders the patient unfit for business. There is also an indication to operate when we cannot hope to divide the nerve between the point of dis- ease and the brain, but when the pain never occurs spontaneously, being always the result of some external irritation acting on the peripheral terminations of the nerve. In such cases the operation may, to some extent, protect the patients from the exciting causes of their attacks of pain. The temporary compression of the affected nerve, and the artery supplying it, has also sometimes proved an ex- cellent palliative, and deserves a trial in suitable cases. 114 DISEASES OF THE NERVOUS SYSTEM. VERTIGO. PROF. AUSTIN FLINT, M. D., NEW YORK. The first and most important measure in the treatment of vertigo consists in the removal of the cause or causes at work. All mea- sures, such as blood-letting, counter-irritation and purgation, ad- dressed to cerebral congestion, are hurtful. On the contrary, tonic remedies, nutritious diet, and other hygienic means of invigorating the general health, are useful. The practitioner should bear in mind the importance of assuring the patient positively of the ab- sence of all danger. C. HANDFIELD JONES, M. D., LONDON. 219. R. Hydrargyri chloridi corrosivi, gr.j Glycerinae, f.3*j Tincturae cinchonas compositae, f 3*ij Olei menthae piperitae, n^xxv. # M. A teaspoonful in a wineglassful of water three times a day, in the vertigo of old persons, which occurs sometimes paroxysmally, as a single symptom, unassociated with any special state that can ac- count for it. Dr. Thomas Hawkes Tanner also recommends this treatment for the attacks of temporary dizziness to which the aged are liable. RESUME OF REMEDIES. Ammonii Bromidum has been found, by Dr. Ramskill, of great help, when given in an effervescing form with cascarilla, in cases of vertigo from overwork in the well-fed. when there is usually restlessness, insom- nia, and depression of spirits, with a sense of impending evil. Cubeba, in doses of gr.l, three times a day, at meal times, is recommended by Dr. Debout in vertigo occasioned by excessive mental emotion or intellectual labor, and associated with dyspeptic derangement. *Ferri et Strychnia Citras is recommended by Dr. Ramskill in essential ver- tigo (i.e., that [Unaccompanied with any other head symptoms). The patient should be placed on a long course of it, given in an effervesc- ing form, and ialternating, month by month, with tincture of larch and small .doses of digitalis. *Hydrargyri Chloridum Corrosivum is recommended, in small doses with bark, by Drs. C. Handpield Jones and T. H. Tanner, in the temporary vertigo of old persons (F. 219). Potassii Bicarbonas is very serviceable in dyspeptic vertigo. * Potassii Bromidum is, according to Dr. Russell Reynolds, often of service in vertigo, especially in cases which occur paroxysmally, without the co-existence of obvious spasm or organic disease of the brain. Tonic remedies are recommended by Prof. Austin Flint. Valeriana is very serviceable in that form of vertigo, with cardiac palpitation, which is not an unfrequent accompaniment of the menopause, or of the first establishment of the menses, in which the blood seems to rush into the head and then suddenly back upon the heart. Zinci Valerianas, in doses of gr.i-ij, thrice daily, associated with extract of valerian, is recommended by Dr. Delioux in the treatment of nerv- ous vertigo. II. DISEASES OF THE RESPIRATORY SYSTEM. Aphonia—Asthma—Bronchitis, Acute—Bronchitis, Chronic— Catarrh— Coryza—Emphysema—Haemoptysis — Laryngitis— Phthisis Pulmonalis—Pleurisy, Acute—Pleurisy, Chronic— Pneumonia, Acute—Pneumonia, Chronic. APHONIA. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 220. R. Ammonii chloridi, ^ss Syrupi pruni virginianae, f.^iij. A teaspoonful thrice daily, in intermittent aphonia,' together with 221. R. Strychniae sulphatis, gr-A- In granule, thrice daily. Used in a case of intermittent aphonia in which the voice was lost for an hour at a time several times a week. A catarrhal con- dition in this woman, a school teacher, led to a weakening of the cords, so that any over exertion brought about temporary inability to generate distinct voice. The local application of sulphate of zinc to the cords is product- ive of permanent good in such cases. The following formulas may be used for inhalation :— 222. R. Zinci sulphatis, gr.j-vj Aquae destillatae, f.3*j. M. 223. R. Ferri chloridi, gr-i-ij Aquas destillatae, f.3*j. M. As a weak inhalation in hysterical aphonia. FREDERICK FIEBER, M. D., VIENNA. 224. R. Tincturae opii, gtt-vj Zinci sulphatis, gr-vj Aquae destillatae, f.3*j. M. For inhalation. In laryngo-tracheal catarrh, our author reports a case with 116 DISEASES OF THE RESPIRATORY SYSTEM. almost complete aphonia, in which the voice soon returned under the inhalation of this solution. In aphonia from paralysis of the vocal cords, local faradization should be employed. N. GALLOIS, M. D., PARIS. 225. Immerse a piece of thick paper in a solution of nitrate of potassium, and dry it; then cover it over with the compound tincture of benzoin, cut it up into pieces 3£ by 1£ inches, and make into cigarettes. These cigarettes are highly praised in aphonia. PROF. O. REVEIL, M. D., PARIS. 226. R. Pulveris benzoinii, ^ss. Place a portion on some live coals, and inhale the vapor, by deep in- spirations, in cases of aphonia and hoarseness. L. WALDENBURG, M. D., BERLIN. 227. R. Sodii chloridi, gr.ij Aquae destillatae, f.3*j. M. Used with benefit in a case of aphonia in a patient affected with laryngitis and tuberculosis. RESUME OF REMEDIES. CATARRHAL APHONIA. Alumen. Bennati, formerly physician at l'Opera Italien, Paris, ordered the following prescription to restore the natural tones of the voice :— 228. R. Alumenis, gj Decocti hordei, f.^ijss. M. To be used as a gargle, the strength to be gradually increased. The general health should be, at the same time, carefully looked after, and the exercise of the voice regulated. The internal administra- tion of alum (gr.x a day, in divided doses, gradually increased to gr.xlv) has been also found very beneficial. Alum lozenges are indicated to complete the cure, and alone, in milder cases. * Ammonia. The inhalation of ammoniacal vapor, disengaged from a mixture of a solution of chloride of ammonium and carbonate of potassium, has given excellent results in aphonia in consequence of exposure to cold. The utility of inhalations of chloride of ammonium vapor in these cases has been tested by Dr. Beigel in a number of cases (Practi- tioner, Aug., 1868). Dr. Da Costa sometimes prescribes chloride of ammonium internally (F. 220). Benzoinum, in vapor, is recommended by French physicians (F. 226). Chlorinium. Chlorine inhalations are serviceable in aphonia following an ordinary cold, without organic lesion. APHONIA. 117 lodinium. Iodine inhalations, and the application of the tincture of iodine to the fore part of the neck, are worthy of trial in cases arising from chronic thickening, or from debility and relaxation. Opium inhalations have been recommended (F. 224). Sodii Chloridum has been used in inhalation (F. 227). Strychnia; Sulphas has been prescribed by Dr. Da Costa in intermittent apho- nia, together with chloride of ammonium internally (F. 221). Zinci Sulphas is of use, either locally applied, in solution, to the cords, or in- haled (F. 222, 224). Zingiber.^ A ginger gargle, or a piece of the root employed as a masticatory, is often useful in aphonia from relaxation of the parts. HYSTERICAL AND NERVOUS APHONIA. /Ether. Some cases have been reported as cured by the inhalation of ether. Ferri Chloridum, diluted, makes a useful inhalation in hysterical aphouia. (F. 223). Pyrethrum has been found useful in nervous aphonia. EXTERNAL REMEDIES. *Cantharis. Dr. Russell Reynolds mentions an obstinate case of hysterical aphonia which yielded to a strip of blister round the throat. ^Electricity, according to Dr. G. Johnson (Medical Times, Jan. 15, 1870), is the best application in nervous and hysterical aphonia. Dr. Morrell Mackenzie's "laryngeal galvanizer" should be used. The shock excites spasm and a scream, and the cure is sometimes very rapid. FUNCTIONAL APHONIA. Argenti Nitras, in solution, applied to the larynx, has been found very bene- ficial in functional aphonia arising from paralysis of the vocal cords. Emetics of ipecacuanha, sulphate of copper, or sulphate of zinc, are beneficial in aphonia arising from an atonic or paralytic state of the larynx, if followed by tonic and stimulant remedies. Local Faradization is of service. Inhalations are of service in almost all the forms of aphonia. Among those recommended are: Ammoniacal vapor (p. 116); vapor of benzoin (F. 226); chloride of iron (F. 223); chloride of sodium (F. 227); vapor of chlorine ; vapor of iodine ; opium (F. 224); sulphate of zinc (F. 222, 224). Counter-irritation. Many cases of aphonia yield to a local external applica- tion, as a blister, a mustard poultice, or camphor liniment, or some other stimulating application. Tonic Regimen, the fundamental basis of which may be summed up in the three words, "air, exercise, and diet," of the most sanitary kind, is gener- ally, according to Prof. Aitken, sufficient to bring about a cure in aphonia. The shower bath has often been of service. It must not be forgotten that this disease can be easily feigned. 118 DISEASES OF THE RESPIRATORY SYSTEM. ASTHMA. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 229. R. Spiritus aetheris compositi, Extracti Valerianae fluidi, aa, f.|j Tinctures lobelias, f-3ss Potassii chloratis, 3iss Syrupi tolutani, f.^j. M. A dessertspoonful in water three times a day. Direct also the following stimulating liniment:— 230. R. Chloroformi, f.^ss Olei terebinthinae, f.§j Spiritus rosmarini, f.^iss. M. To be rubbed on the chest several times a day. 231. R. Potassii iodidi, sjij Morphiae sulphatis, gr.f Tincturae scillae, Tincturae lobelias, Syrupi, aa f.^j. M. A teaspoonful thrice daily, in asthma with emphysema and chronic bronchitis. 232. R. Zinci valerianatis, 9ij Extracti belladonnae, gr.j. M. For 20 pills. One thrice daily, in nervous asthma. In the treatment of the paroxysms of asthma all nauseants have a certain influence in relaxing the bronchial spasms. Lobelia is particularly serviceable because it acts both as a nauseant and ex- pectorant. 233. R. Tincturae lobelias, Tinctures hyoscyami, Spiritus astheris compositi, Syrupi tolutani, aa f.^j. M. A teaspoonful in water every half hour during the paroxysm, until some effect is produced on the breathing, and then every hour or two. Strong coffee is also sometimes of service in averting a paroxysm (Dr. Niemeyer directs two ounces of mocha to the cup). The fumes of nitre paper often give relief. 234. Take some ordinary blotting paper, dip it into a concentrated solution of nitrate of potasssium, and allow it to dry. When wanted for use, ignite it in an open vessel covered with a news- paper made into a cone, so that the fumes will be inhaled. ASTHMA. 119 In order to prevent the recurrence of the paroxysms, too great care cannot be taken to inquire into the state of all the functions. In perhaps one-half of the cases, asthma is not a disease of the lungs, but a reflected trouble. In cases of stomach origin, 235. R. Pilulae hydrargyri, gr.ij. At night, to be followed by one-half an ounce of Rochelle salts in the morning. Afterwards direct arsenic combined with gentian or bel- ladonna ; as, 236. R. Liquoris potassii arsenitis, f.gj Tincturae gentianae compositae, f-Iiij- M. A dessertspoonful thrice daily. M. FAURE, FRANCE. 237. R. Aquae ammoniae, f-3"ss. To be placed in a bowl and the vapor inhaled, taking care, however, to close the nostrils. The inhalation is to be continued for fifteen min- utes, and to be repeated four times a day. N. GALLOIS, M. D., PARIS. 238. R. Extracti opii, gr.f-iss Belladonnae foliae, gj. Dissolve the extract in a small quantity of water, and then moisten the belladonna leaves with this solution; dry them and roll into cigar- ettes. Trousseau substitutes for the belladonna leaves, stramonium leaves. These cigarettes of opiated belladonna are useful in nervous asthmas and dry coughs. C. HANDFIELD JONES, M. D., LONDON. The treatment of asthma is eminently that of a neurosis. It consists first in the removal of all causes of irritation, such as catarrhal inflammation of the bronchi, dyspeptic disorder, unwhole- some diet and unsuitable climate, etc., and secondly, in the use of various appropriate tonics and sedatives. Arsenic is sometimes of much advantage. 239. R. Liquoris potassii arsenitis, tt\1v-v. For one dose thrice daily, either alone or combined with an ordinary cough mixture. 240. R. Extracti cannabis indicae, gr.v For 10 pills. This drug occasionally proves very useful, one pill immediately checking the spasm. 120 DISEASES OF THE RESPIRATORY SYSTEM. 241. R. Liquoris opii sedativi (Battley), Ttlx- For one subcutaneous injection into the left front of the chest. 242. R. Atropias sulphatis, gr-;.? Aquas, TTlx- M' For one hypodermic injection in the vicinity of the left vagus nerve. DR. LECLERC, FRANCE. 243. R. Extracti belladonnae, gr-xv Myrrhae pulveris, __ Ipecacuanhas pulveris, aa -Jss. M. Divide into 36 pills One thrice a day, in nervous asthma. Nitre paper to be burned in the chamber of the patient, and stramonium leaves to be smoked. J. S. MONELL, M. D., NEW YORK. Our author recommends (New York Medical Record, August 15th, 1866), forced expiration and inspiration, for the relief of spasmodic asthma. He directs that all the air be expired that it is possible for the patient to do, and not to inspire until it is found absolutely neces- sary. Then carry inspiration to its fullest capacity, and retain with great effort for many seconds. This act of forced expiration, waiting, thorough inspiration, and again waiting, should be con- tinued for some fifteen minutes, when it will be found that the spasm is relieved. It requires great exertion on the part of the patient to perform this act. The first attempt at retaining the in- spired air during the asthmatic attack will cause the patient to think he cannot continue it, but perseverance will soon delight him with relief from the spasm. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. Among medicaments especially in repute for the prevention of new paroxysms, and for the radical cure of asthma, quinine stands first. The shorter and more regular the intervals of the attack, so much the more is to be expected from this drug. It is unsuitable when the pauses between the seizures are very long or irregular in their occurrence. In such cases we must have recourse to other remedies from the list of the so-called nervines. As a rule, the metallic nervines are to be preferred before tinc- ture of valerian, assafetida, castor or camphor. The following may be used:— 244. R. Ferri carbonatis, gj Syrupi, q. s. M. For 20 pills. One thrice daily. ASTHMA. 121 245. R. Zinci oxidi, gr.xxv Syrupi, q. s. M. For 20 pills. One thrice daily. 246. R. Argenti nitratis, gr.iij-iv Confectionis rosae, q. s. M. For 24 pills. One thrice daily. DR. PRIDHAM, BIDEFORD, DEVONSHIRE, ENGLAND. Our author has been very successful in the treatment of asth- matic cases by means of a duly regulated diet and sedatives during the intervals of the paroxysms {British Medical Journal, June 5 to December 29, 1860). The secretions from the bowels are, first of all, to be corrected by the following pill, at bedtime, succeeded by a saline aperient in the morning:— 247. R. Pilulae alo*es cum myrrha, gr.iij Pilulae hydrargyri, gr j Extracti taraxaci, gr.ij Extracti stramonii, gr.ss. M. For 2 pills. Or, by giving every alternate night, in the form of a pill, 248. R. Pilulae hydrargyri, gr-iv Pulveris ipecacuanhas, gr.j. M. For one pill. And on the following morning, 249. R. Misturae sennas compositas, f.3*j Magnesii bicarbonatis, gr.x Sodii bicarbonatis, gr.viij. M. For one draught. During the day small doses of compound rhubarb powder, of which the following is the formula (Br. Pharm.) :— 250. R. Pulveris rhei radicis, 3*ij Magnesias, 3*yj Pulveris zingiberis, 3*j. To be mixed thoroughly and passed through a fine sieve. Dose—20-60 grains. After having thus attended to the general secretions for about ten days, the strict dietary system is to be commenced: He restricts his patients at first to two ounces of fresh meat, with as much dry bread for dinner, at one P. M., and the same for sup- 122 DISEASES OF THE RESPIRATORY SYSTEM. per, at seven; allows a cup of tea with cream, and dry bread, in the morning; and for drink, weak brandy or whisky and water, which is not to be taken till three hours after animal food. Eest is also enjoined for the same period, though air and exercise are recdmmended. The following sedatives are also to be given:— 251. R. Extracti conii, 3j Extracti cannabis indicae, gr.v. M. For 20 pills. One to be taken four times a day, at the hours of seven, twelve, five, and ten. Gradually the dose of extract of conium is to be increased to gr.v, and that of Indian hemp to gr.j, five times a day. HYDE SALTER, M. D., LONDON. 252. R. Potassii nitratis, 3*iv Aquae, Oss. M. This solution should be used in the making of nitre paper, for which red blotting paper should be employed. Coffee relieves about two-thirds of the cases in which it is tried. Che relief is very unequal, often merely temporary, sometimes very .light, sometimes complete and permanent. The following are valuable hints on its administration: 1. It cannot be given too trong. Unless sufficiently strong to produce its characteristic »hysiological effects it does no good, but rather harm; moreover, f given very strong, it need not be given in much bulk, and quan- tity is a disadvantage, rendering less rapid the effect, and oppres- sively disturbing the stomach. 2. It is best given without sugar and milk—pure cafe noir. 3. It should be given on an empty stomach; if given on a full stomach it often does great harm, by putting a stop to the process of digestion; indeed, so much is this the case, that coffee accompanying a meal, especially late in the day, is so peculiarly apt to induce asthma that it deserves to be classed among its special provocatives. 4. It seems to act better if given hot-—very hot. Lobelia is given by Dr. S., in the form of the tincture, in repeated doses, every half hour, increasing the dose n\v each time, till either the physiological effects (faintness, sickness) are manifested, with or without relief, or that relief is obtained without such symptoms. In either case, the medicine is to be at once discontinued. Gener- ally no relief takes place until symptoms of lobelia poisoning show themselves. Any amount may be given, short of producing the effects, without any relief at all. The quantity required differs in each case—generally n^l-lx suffices ; in others f.giss fail to produce an effect. When once the necessary dose has been ascertained in ASTHMA. 123 this way, the patient should start with it on the next occasion, which generally has the desired effect at once. Iodide of potassium entirely fails in a great many cases. Some- times, however, the most striking results attend its use. It often requires to be continued for some time before it begins to manifest its effects. It should be used in every case in which it has not been tried, because of its occasional great value. Quinine is the best of all tonics in asthma; next to it is iron. The two may be combined with a mineral acid and given with good results. Stramonium is, in some cases, the remedy; in the majority of cases, as ordinarily used, it does some good; and in some few it is positively injurious. Its value in any case can only be ascer- tained by personal experience. When the leaves and stems fail, substituting the seeds may prove effectual. The}7 appear to be more powerful in their action. The inhalation of the smoke, and swallowing the saliva, may be advantageously combined with the ordinary method of smoking. The earlier in a paroxysm it is had recourse to, the more likely will it be to relieve the spasm; over one that has been long established, it has but little power. As the great thing is to give it in time, an asthmatic should keep his pipe already filled, with the means of lighting it by his bedside, so that, on awaking with dyspnoea, he may immediately use it. A good plan is to adopt the habit of smoking a pipe of it the last thing at night, whether a paroxysm is threatened or not. The stramonium seems to leave, for some hours, a state of the nervous system in which the asthma is not likely to come on, and, since the attack is almost always at night, it seems to conduct the patient through the critical time. The extract (gr.j, gradually increased to gr.j) some- times produces excellent effects, or the tincture (n\,x-xx every four hours), may be substituted. Tobacco smoking affords, in some cases, remarkable ease. The habit of smoking has rendered powerless, in a large number of cases, what may, without any qualification, be called its most potent remedy. A pipe is preferable to a cigar, and "bird's eye" to the stronger forms of tobacco. For women and children a few whiffs of a mild cigarette are quite sufficient. Chloroform inhalations, short of anaesthesia, are often of benefit. The following are the conclusions of Dr. S. in regard to this remedy: 1. It holds a high place among the remedies for asthma, 124 DISEASES OF THE RESPIRATORY SYSTEM. there being probably no agent that relieves in so large a number of cases. 2. It operates with very various completeness in differ- ent cases. 3. Where it does not cure, it is of great value by afford- ing a temporary respite. 4. No amount of asthmatic apncea or dyspnoea is any bar to its use. 5. If given constantly, however, in large doses, for a long period, a state of things arises which con- stitutes a bar to its continuance. 6. The sooner it is given in a paroxysm the better, for if the spasm has existed for some time it is apt to recur as soon as the influence of the chloroform passes off. A few drops at the first indication of an attack may act as a preventive. THOMAS HAWKES TANNER, M. D., LONDON. 253. R. Potassii iodidi, ^ijss-^iv Spiritus ammoniae aromatici, f-3J Tincturae belladonnae, r^l-f.gij ss Tincturae cinchonas compositae, f.^ij Aquae menthae piperitae, f-3j. M. A dessertspoonful, in water, three times a day. In some cases of asthma the author has found remarkable bene- fit from this formula. It requires to be persevered with for some weeks, the patient being watched, lest it impoverish the blood and produce purpura or boils, or even a carbuncle. If there be con- stipation order 254. R. Pilulae rhei compositae, Extracti conii, aa gr.v. For 2 pills. To be taken at bedtime. PROF. TROUSSEAU, PARIS. 255. R. Potassii iodidi, gijss Spiritus vini gallici, {.%iss Decocti senegas, f-3"iij Syrupi papaveris, f.Sjj. M. In essential asthma give a tablespoonful, twice a day, an hour before the meals, in a little sweetened water. During the attack, the tincture of lobelia may be administered, in doses of from twenty to thirty drops, from half-hour to half- hour. The respiration of chloroform is also useful; also stramo- nium cigarettes. DR. WISTINGHAUSEN, GERMANY. 256. R. Liquoris potassii arsenitis, gtt.x-xv--xx Aquae destillatae, f ?j, jy^ For inhalation, by means of atomizer, once or twice a day. ASTHMA. 125 RESUME OF REMEDIES. Acetum. As a preventive, bathing the chest every morning with vinegar and water has been advised. JEther by inhalation is sometimes resorted to with benefit in asthma. Ammonii Carbonas has proved (in doses of gr.x-xv) more successful than any other remedy, in the hands of Dr. J. Hope, in cases of asthma aris- ing from, or cennected with, disease of the heart. In a very obstin- ate case the following afforded much relief:— 257. R. Ammonii carbonatis, gr.viij Antimonii et potassii tartratis, gr.^ Aquas anisi, f.^iss. M. A draught to be taken every alternate hour. Ammoniacum is of great service in both spasmodic and hysterical asthma. In the former case it should be combined with tincture of squill and a small portion of hyoscyamus or conium ; in the latter, with equal parts of assafetida. Plasters of ammoniacum applied to the chest often prove useful. Antimonii et Potassii Tartras. Counter-irritation to the chest by tartar emetic ointment is occasionally useful. Aqua Ammonice (four parts to one of water), applied to the velum palati has proved of service in simple idiopathic asthma. This application, which may prove dangerous, is only to be made, if at all, with great caution, so as not to touch the back part of the pharynx. The inha- lation of the vapor of aquae ammonia is useful (F. 237). Argenti Nitras is recommended by Dr. Niemeyer (F. 246) and others. Arsenicum is recommended by Dr. Handfield Jones (F. 239) and others, but is inadmissible in organic disease of the lungs and heart (F. 236, 256). Assafoetida, in combination with other antispasmodics and with narcotics, is often very beneficial in spasmodic asthma. 258. R. Tincturae assafoetidae, f.gss Tincturae opii, rr^xx Spiritus aetheris compositi, f.^ss Aquas camphorae, f.3*iss. M. For one draught. ^Belladonna is a valuable remedy in spasmodic asthma, administered in the manner directed by Dr. Hyde Salter, viz., in one full dose, suffi- ciently large to produce the full physiological effects of the drug, every night at bedtime. This plan he regards as infinitely superior to the system of divided doses during the day. It is curative as well as prophylactic, for, by preventing the attack for a series of nights in succession, it breaks through the habit. As there is a marked differ- ence in the tolerance of belladonna in individuals, the proper dose may be ascertained by commencing with small doses and gradually increasing them until the requisite full dose is ascertained. Atropia is injected hypodermically with excellent results (F. 242). Brominium, see Potassii Bromidum. Camphora is recommended by Dr. Copland as one of the most generally beneficial of any of the class of narcotics or antispasmodics. In the nervous and spasmodic forms of asthma it should be given in large doses (gr. iij-x), and combined with musk, castor, assafetida, etc., or with sedatives. 126 DISEASES OF THE RESPIRATORY SYSTEM. Cannabis Indica is said to occasionally prove very beneficial (F. 240, 251), but in the hands of Dr. Hyde Salter it has been a complete failure in the few cases in which he employed it. Castoreum combined with ipecacuanha (equal parts of the tincture of castor and the wine of ipecac), is recommended by Dr. Graves. Chloral has been employed with benefit. *Caffea is a simple, safe and very efficacious remedy. Asthmatic patients should avoid using it as an ordinary beverage, lest the habit of taking it should impair its efficacy as a medicine. For its administration see Dr. Hyde Salter's directions (p. 122). Chloroformum by inhalation is an excellent and prompt remedy for spasmodic asthma. Cinchona, see Quiniae Sulphas. Conium is sometimes given (F. 251). Datura Tatula is the new remedy, said to be of great efficacy smoked in ciga- rettes. Digitalis has been employed, but is inferior in efficacy and safety to other remedies. Dracontium sometimes succeeds (in doses of gr. xxx-1 of the powdered roo$ during the paroxysm), in obstinate cases of spasmodic asthma. Ferri Carbonas is recommended by Dr. Niemeyer (F. 244). Galbanum is occasionally useful, but is inferior to ammoniacum. Hyoscyamus is, according to Dr. Harley, the appropriate remedy in cardiac and pulmonary asthma. It is best administered subcutaneously. lodinium, see Potassii lodidum. * Ipecacuanha, in full emetic doses (not less thangr. xx), is often effectual in arresting a paroxysm of spasmodic asthma, if given at or near the outset of the attack. Proportionate doses to children may be given with safety and advantage. Small doses of the wine (v\, v) repeated every ten to thirty minutes for two or three hours, unless relief comes much sooner, in which case the dose may be diminished and taken less frequently, is a method of treatment recommended by Dr. C. D. Phillips (Practitioner, Nov., 1869), in nocturnal spasmodic asthma, when there is no organic disease of the heart or lungs. *Lobelia, although, from want of uniformity in its action, and from failure to fulfill the high expectations at one time entertained of it, it has fallen into comparative disuse, is, in cases which tolerate it, a valuable remedy. Dr. Hyde Salter reports favorably of the tincture (p. 122). Dr. Ringer, while regarding it as a remedy of great efficacy, con- siders that it should be given with caution where heart disease exists, as the pulse may become irregular and very weak. It should also be remembered that some persons exhibit great intolerance of its action, poisonous effects following the smallest doses, and that differ- ent specimens differ considerably in strength. It is sometimes given by Prof. Da Costa, combined with hyoscyamus and Hoffman's ano- dyne (F. 229, 231, 233). Moschus, in doses regulated according to the severity of the attack, is often productive of benefit in purely spasmodic or nervous asthma. It has also been applied endermically (gr.vj-xv) with advantage. Myrrha is useful in the asthma of old persons, by arresting the exhaustion consequent on profuse expectoration. Nitrite of Amyl. Cases have been reported in which the inhalation of five drops of this liquid has arrested very distressing attacks of spas- modic asthma. ASTHMA. 127 Opium is of questionable value in asthma. Dr. Hyde Salter says, " Prefer any other sedative to opium ; and unless there is some special com- plication that indicates it, never give it at all." Oxygen Inhalations have been tried with reported "wonderful" results in nervous asthma. Petroleum is a stimulant expectorant, of use in asthma unattended with inflammation. Potassii Bromidum, in full doses, at night, has been recommended in spas- modic asthma. In the spasmodic asthma of childhood, given in syrup, in doses of gr.vj every two hours, it has proved very success- ful after the failure of other remedies. Potassii lodidum is an uncertain remedy, which sometimes, however, proves strikingly successful (F. 253, 255). Potassii Nitras. The inhalation of the fumes of paper impregnated with nitn is often of striking benefit (F. 234, 252). The following formula i, given in the Journal de Pharmacie et de Chemie:— 259. Take four ounces of white paper, and allow it to macerate in warm water, un- til reduced to a uniform paste. Then press out the greater portion of water and mix the residue in a mortar with the following powder:— Potassii nitratis, ^ij Myrrhae, Olibani, aa gijss Belladonnas, Stramonii, Digitalis, aa gr.x. When a uniform mass has been formed, roll out into sheets a line or so thick, dry and cut into strips. This paper is said to burn less quickly than the ordi- nary nitre paper, and to be more effect- ive. Quinia; Sulphas is highly recommended by Dr. Niemeyer and Hyde Salter (see pp. 120, 123). Sanguinaria has been prescribed with good effects. Scilla. Benefit is sometimes derived from squill, combined with hemlock or henbane. The following formula is often useful:— 260. R. Tincturas scillae, gtt.xv Extracti hyoscyami, gr.iij Acidi nitrici diluti, ti\,xxx Aquas, f.^iss. M. For one dose. Spiritus JEtheris Compositus. Hoffmann's anodyne, though favorably spoken of by some writers, has proved entirely useless in the hands of Dr. Hyde Salter, and in some cases has seemed to increase the spasm (F. 229, 233, 258). * Stramonium, smoked in a pipe, in doses of gr.x to gr.xx, is often of very great service, but not uniformly so. If it produce any ill effects it should be at once discontinued. The extract or the tincture may be given internally (p. 123). 128 DISEASES OF THE RESPIRATORY SYSTEM. Sulphur, in doses of about gr.viij daily, to be given while fasting, and perse- vered in for a long period, has been recommended by French physi- cians. Tabacum. The palliative effects of tobacco fumes in nervous asthma are well known (p. 123). Veratrum Viride has been advised in nervous asthma. Zinci Oxidum is strongly recommended by Dr. Symonds (British Medical Journal, June 13th, 1868), who states that whether for abating the morbid susceptibility of the respiratory nerves, which engenders the spasmodic paroxysms, or for diminishing the liability to catarrhs, he knows nothing to surpass long courses of the oxide of zinc, with or without extract of conium, for the one indication, and quinine for the other. It is also recommended by Dr. Niemeyer (F. 245). Zinci Sulphas has been employed, with the result of diminishing the frequency and force of the attacks. Zinci Valerianas is sometimes prescribed (F. 232). Cathartics are often of service (F. 235, 247, 248, 249, 254). *Cold Bathing, employed in the intervals of the attacks of spasmodic asthma, is stated to lessen the morbid sensibility to the impression of cold at- mospherical changes, and to give tone and vigor to the system. Simply sponging the body is preferred by some to immersion; salt (3j ad. aquam, Oj) may be added, and a rough towel or flesh brush employed. The best time is immediately after getting out of bed in the morning. The shower-bath is preferred by Sir. T. Watson. EXTERNAL REMEDIES. Electricity has been employed in some cases, but Dr. Hyde Salter condemns altogether its use. Hypodermic Injections are frequently employed with great advantage. The following are the principal drugs which have been thus adminis- tered :—Atropia (F. 242); Hyoscyamus (Dr. Harley says that in cardiac and pulmonary asthma, the injection of gr.fa of sulphate of hyoscyamia will often bring immediate relief); Opium (F. 241). Inhalations are of great benefit. The.following are the principal drugs which have been thus administered:—Aqua Ammonice (F. 237); Arsenicum (F. 256) ; ^Chloroform (p. 123); Conium; Nitro-muriaticum Acidum Dilutum (f.gj ad. aquam f.^iv at 150° F., but should be used with great caution during a paroxysm); Oxygen (not to be employed when there is heart disease) ; * Potassii Nitras Fumes (F. 234, 252, 259); * Stramonium Smoke (p. 123); Sulphurous Acid Spray; * Tobacco Smoke (p. 123). Forced Inhalatian and Expiration has been recommended (p. 120). Issues at the nape of the neck are sometimes effectual in mitigating the symp- toms. Local Applications to the Chest are often of service. For this purpose the fol- lowing may be employed:—Chloroform and Turpentine Liniments (F. 230); Tincture of Iodine; Ointment of Iodide of Potassium; Tar- tar Emetic Ointment; Hot Turpentine Stupes (especially useful in the old and debilitated); Hot Water Stupes (flannel wrung out of water as hot as can be borne, applied to the whole chest during the fit, is recommended by Dr. Graves). Hay Asthma, see Hay Fever. ACUTE BRONCHITIS. 129 ACUTE BRONCHITIS. PROF. WILLIAM AITKEN, M. D., EDINBURGH. When the symptoms of a " common cold " first express them- selves, and even when the trouble has extended to the chest, as indicated by the hoarseness and tendency to cough, the disease may at once be subdued in a healthy person by a full stimulant but not narcotic dose of opium or morphia, i. e., 261. R. Pulveris opii, vel 262. R. Liquoris morphiae sulphatis, For one dose, at bedtime. Or by five grains of carbonate of ammonium; or by ten to twenty grains of chloride of ammonium; or by an alcoholic dia- phoretic drink; or, if the appetite is unimpaired, by a full supper, followed by a moderate amount of some alcoholic stimulant. If such remedies are delayed too long, the object to be aimed at most is to induce a copious perspiration, and a continued action of the skin and kidneys. From the frequent inhalation of steam great benefit is derived. If the disease shows a disposition to pass into the chronic stage, the following may be administered, and will generally facilitate expectoration and relieve the dyspnoea, viz:— 263. R. Ammonii carbonatis, Tincturae benzoini compositae, Tincturae cinchonae compositae, For one dose. JAMES COPLAND, M. D., LONDON. 264. R. Liquoris ammonii acetatis, f-5.j Spiritus aetheris nitrosi, f.3jjj Vini antimonii, f-3'jss Misturas amygdalae, ad. f-|viij. M. One or two tablespoonfuls every third or fourth hour, in the treatment of primary or simple bronchitis. The bowels should be moderately opened by a small dose of calomel or blue pill, with antimonial powder at night, and a gentle aperient in the morning. If the patient be aged, delicate, or vitally depressed, the antimony may be omitted from the prescrip- tion, and a portion of the infusion of cinchona, or of the decoction 9 gr-j gr.v f.gss f.giss- M. 130 DISEASES OF THE RESPIRATORY SYSTEM. of senega added. The dose of the antimony may, of course, be increased, if indicated. When the fever is considerable, or the patient complains of soreness or pain in the chest, a mustard poultice may be applied over the sternum, or the following tere- binthinate embrocation employed:— 265. R. Linimenti saponis, Linimenti terebinthinae, aa f.^iss Olei olivas, f.3vij Olei cajuputi, f-3J- M- This embrocation, having been well shaken, should be sprinkled on two or three folds of flannel, or on spongeo-piline, and placed either over the thorax or between the shoulders- PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 266. R. Vini ipecacuanhae, f.^ij Liquoris potassii citratis, f-3"iv Tincturae opii camphoratae, Syrupi acaciae, aa f.^j. M. A tablespoonful thrice daily, in the first stage of ordinary acute bron- chitis. 267. R. Morphiae acetatis, gr.j Potassii acetatis, 3HJ Liquoris ammonii acetatis, f.3 iij Syrupi tolutani, f-3j. M. A dessertspoonful every third hour. A useful diaphoretic alkaline mixture. 268. R. Ammonii carbonatis, gr-xvj Spiritus aetheris compositi, f.giss Syrupi tolutani, Aquae, aa f.3j. M. A teaspoonful every two hours ; a stimulating expectorant for a child a year old, affected with bronchitis of two weeks' standing. Counter-irritation to be applied to the chest by means of weak mustard plasters (one part of mustard to four of Indian meal). Also, if the child be much debilitated, 15 gtt. of brandy every four hours. When the child is seen frequently, so that the effect may be watched, there is no better treatment than relieving the lung mechanically by emetics. Hoffman's anodyne, in the above recipe, acts as a diaphoretic and quieting agent, which latter influence would not be obtained from sweet spirits of nitre. PROF. A. P. DUTCHER, M. D., CLEVELAND, OHIO. If the patient be robust, and the attack very acute, attended with a frequent and hard pulse, hot and dry skin, costive bowels, labori- ous breathing, and a troublesome, dry cough, our author recom- ACUTE BRONCHITIS. 131 mends (Philadelphia Medical and Surgical Reporter, August 17th, 1867) the taking of twelve or fifteen ounces of blood from the arm. If bleeding has no influence in curing the disease, the won- derful power it has in mitigating the patient's sufferings places it far beyond every other known therapeutical agent. After the bleeding, if the skin remains hot and dry, the patient may be treated to the alcoholic fumigating bath and one of the fol- lowing powders, given every four hours until the bowels are freely moved:— 269. R. Podophyllin, gr.j Hydrargyri chloridi mitis, 9j Potassii nitratis, gss Pulveris ipecacuanhae, gr-viij. M. For 4 powders. If, after the bowels have been freely moved, the skin should re- main hot and dry, the patient may again be subjected to the fumi- gating bath, and a teaspoonful of the following mixture administered every two hours, until free perspiration and expectoration are pro- duced :— 270. R. Tincturae veratri viridi, f-3~ss Syrupi scillae compositi, f-giij Spiritus aetheris nitrosi, f^ss Extracti lobelias fluidi, f.gij Tincturas opii camphoratae, f.^ss. M. A teaspoonful every two hours. If this should produce nausea or vomiting after a few doses, it will commonly prove very beneficial. After free expectoration has been produced, it may be given at longer intervals, or superseded by the following:— 271. R. Tincturae sanguinariae, f.gij Vini ipecacuanhae, f.3*j Morphiae sulphatis, gr.ij Syrupi, f.gj. M. A teaspoonful every six hours. To relieve cough and produce rest at night, give the patient eight or ten grains of Dover's powder early in the evening. If the disease still proves obstinate, and if the dyspnoea and cough still continue, the patient complaining of great weight upon the chest, with a deep, burning pain just under the sternum, apply a blister immediately over the seat of the difficulty. It will almost invariably relieve all the symptoms, cut the disease short, and secure a safe and speedy convalescence. 132 DISEASES OF THE RESPIRATORY SYSTEM. After the disease has passed its climax, very little medical treat- ment is demanded. If the cough should remain troublesome, and the expectoration scanty and tenacious, our author is in the habit of prescribing the following:— 272. R. Ammonii bromidi, Ammonii iodidi, aa gij Morphiae sulphatis, gr.ij ^ Syrupi phellandrii aquatici compositi, f-3"viij. M. A dessertspoonful every six hours. In the treatment of acute bronchitis in the aged, our author re- commends vegetable emetics in small doses, and expectorants, espe- cially those of a stimulating nature, as the most valuable remedies. Senega is the best of the vegetable expectorants, and the decoction the best form. 273. R. Decocti senegae, f.^viij Two fluid ounces to be administered every four or six hours. If the patient be weak, add ammonii carbonatis, gr.v, and quiniae sulphatis, gr.ij, to each dose. A small glass of ale three or four times a day is a mild stimulant, expectorant and anodyne, much to be preferred to wine and ardent spirits. In bad cases of acute bronchitis, our author never hesitates to blister; in mild cases he uses turpentine stupe. After the violence of the disease has passed, tonics and expector- ants should be freely used. The following is a useful expectorant: 274. R. Syrupi scillas, Syrupi senegae, Syrupi ipecacuanhas, aa f.^ss Morphiae sulphatis, gr.ij Syrupi, f.giss. M. A teaspoonful every six hours. J. C GLONER, M. D., BRUSSELS. 275. R. Olei tiglii, gtt.xv ^theris, f.|S8. M. Rub on the front and back of the chest, in acute bronchitis. 276- R. Aquas laurocerasi, f.gij Syrupi tolutani, f.2?iss Spiriti Jamaicensis, f.gji Ovi vitelli, }j Aquae tepidae, f.gvjss. M. For one draught, to be given at the outset of bronchitis, to provoke perspira- tion, and quiet the cough. ACUTE BRONCHITIS. 133 Repeated sinapisms on the sternal region. PROF. R. J. GRAVES, M. D., DUBLIN. 277. R. Acidi nitro-muriatici, f.gj Spiritus terebinthinae, f.gij Adipis, gj. M. Mix thoroughly, with an ivory spatula, the acid and lard, and then add the spirits of turpentine. This liniment, which ought to be prepared only in a small quan- tity at a time, as it alters easily, is to be employed in frictions on the chest, in acute bronchitis. 278. R. Acidi acetici, f.gss Spiritus terebinthinae, f.giij Aquae rosae, f.giss Spiritus limonis, gtt.x Ovi vitelli, q. s. to suspend the turpentine. To be applied to the chest by means of a sponge. This liniment reddens the skin, and after several frictions causes an eruption of fine pustules. A useful rubefacient in bronchitis. DR. HEIM, GERMANY. 279. R. Ipecacuanhas pulveris, Digitalis pulveris, aa gr.iv Extracti opii, gr.iss Extracti hyoscyami, grxv Althasae pulveris, q. s. Divide into 20 pills. One every third hour, to calm the cough of acute bronchitis. Warm drinks to provoke an abundant transpiration. 280. R. Confectionis rosae Mellis, aa giss. Tragacanthae, gr.xxiv Pulveris ipecacuanhae, gr-v.j Syrupi tolutani, f.giij. M. A teaspoonful three or four times a day. PROF. GEORGE JOHNSON, M. D., LONDON. Acute bronchitis is an exaggerated catarrh; the two diseases are essentially the same, and they require the same principle of treat- ment, only modified according to the character of the symptoms {British Medical Journal, Oct. 23, 1869). In the early stage of acute bronchitis, when the mucous mem- brane is dry and swollen, the hot-air bath or the wet packing may 134 DISEASES OF THE RESPIRATORY SYSTEM. be employed once or oftener with advantage. Another very useful remedy in this stage is tartar emetic, in doses of one-sixth of a grain, combined with liquor ammonii acetatis :— 281. R. Antimonii et potassii tartratis, gr0#4 Liquoris ammonii acetatis, f.gij Syrupi tolutani, Aquas, 5a, f.gj. M. A tablespoonful thrice daily. The inhalation of steam, repeated sev- eral times in the course of the day, is often very soothing and benefi- cial. Venesection is very rarely required. In the second stage, when free secretion has been established, antimony and acetate of ammonium are to be discontinued. At this period a combination of carbonate of ammonium, with spirit of chlo- roform, is useful as a stimulating expectorant or antispasmodic. 282. R. Ammonii carbonatis, giss Spiritus chloroformi, f.gv Syrupi acaciae, f.gij Aquam, ad. f.giv. M. A dessertspoonful thrice daily. Brandy or wine in moderate quantities may now also be required to sustain the strength. When in the advanced stage there is a profuse secretion, with copious perspiration, the ammonia mixture may be replaced by the following :— 283. R. Quiniae sulphatis, gr-xyj Zinci sulphatis, gj Acidi sulphurici aromatici, f.gv Aquae menthae piperitae, f.giijss. M. A dessertspoonful thrice daily, in water. This combination often checks very rapidly the excessive secre- tion from the bronchial mucous membrane. The stimulating ex- pectorants are sometimes useful at this stage of the disease — senega, squill, ammoniac, and the compound tincture of benzoin. If, as sometimes happens, the stimulating expectorants suddenly check secretion, tighten the breath, and increase dyspnoea, their employment must at once be discontinued. When the secretions accumulate and threaten suffocation, the patient being blue, and cold, and drowsy, and the cough nearly or quite ceasing, an emetic of sulphate of zinc is often wonderfully efficacious in clearing the air-passages. ACUTE BRONCHITIS. 135 Our author gives an especial warning with regard to opium. Never order an opiate for a bronchitic patient who has the slightest blueness of the lips. THOMAS HAWKES TANNER, M. D., LONDON. The patient should be confined to bed in a room of the tempera- ture of from 65° to 70° (F.), with the air kept moist. Beef-tea, milk, arrow-root or gruel, tea with milk, and a mucilaginous drink ought to be allowed, such as 284. R. Misturae acaciae, Misturae amygdalae, aa Oss. To be mixed with half a pint of pure milk and sweetened with sugar- candy or honey. Then add one large tablespoonful of any liquor. Allow the whole to be taken during the day. Or, 285. Boil a large pinch of isinglass with a tumbler- ful of milk, half a dozen bruised almonds, and two or three lumps of sugar. To be taken warm once or twice in the day. If there be indications of debility, white wine whey, made ac- cording to the following formula, will prove a good restorative :— 286. To half a pint of boiling milk add one or two wineglassfuls of Sherry or Madeira. Separate the curd by straining through a fine sieve or piece of muslin. Sweeten the whey with re- fined sugar. The following is a useful and agreeable demulcent drink :— 287. R. Extracti sarsaparillae fluidi, Syrupi scillas, aa f.giss. M. A teaspoonful in a teacupful of barley-water, to be frequently taken during the day. Then, after a brisk purgative, either of the following may be administered:— 288. R. Syrupi scillae, f.gvj Spiritus aetheris nitrosi, Tincturae hyoscyami, aa f-giij Infusi rosae compositi, f.giss. M. A tablespoonful every six hours. 289. R. Potassii nitratis, 9ij Vini antimonii, f.gj Liquoris ammonii acetatis, f-g^s Aquam camphorae, ad. f.giij. M. A tablespoonful every four hours. 136 DISEASES OF THE RESPIRATORY SYSTEM. If there be any depression, stimulating expectorants, such as the following, must be ordered:— 290. R. Ammonii carbonatis, 3SS... Spiritus aetheris compositi, f-gjy Tincturae scillae, ^'^?8. Tincturae opii camphoratas, f-gij-iv Tincturae lavendulae compositae, f-3v.j.. Infusum senegae, ad. f.gviij. N. Two tablespoonfuls every four hours. 291. R. Spiritus ammoniae aromatici, f*8S. Spiritus chloroformi, f-giij Tincturae aconiti, f-gss Tincturae senegae, f-Syj. Aquam camphorae, ad. f.giij. M. A tablespoonful every six hours. Gentle counter-irritation to the front of the chest, by dry cup- ping, turpentine stupes or sinapisms, will prove useful. Should the phlegm appear to accumulate in the bronchial tubes the follow- ing emetic will readily remove it:— 292. R. Antimonii et potassii tartratis, 8r-j.-ij Vini ipecacuanhae, f-gij- M. For one dose, to be added to a wineglassful of water, and its action aided by the free administration of warm water. For the treatment of Acute Bronchitis in Children, see the sec- tion on Diseases of Children. RESUME OF REMEDIES. Ammonii Acetatis Liquor makes a useful diaphoretic alkaline vehicle for anti- mony, morphia, etc., (F. 267, 289). Ammonii Carbonas may be given with benefit, combined with ipecacuanha, squills when expectoration is scanty or difficult, or with tincture of lobelia, if much spasm be present. Five grains given at bedtime, when the first symptoms of a common cold express themselves, often at once subdues the disease (F. 263, 268, 282, 290). Ammonii Bromidum has been recommended (F. 274). * Antimonii et Potassii Tartras is of service in small doses (gr. T\-j) in the earliest stages of acute bronchitis in young, plethoric subjects, and where much febrile action is present (F. 264, 289). When the phlegm accumulates in the bronchial tubes, an antimonial emetic will readily remove it (F. 292). The nauseating and depressing effects of anti- mony should n it, however, be long kept up in this disease, as they interfere with proper nutrition, which is of much importance in these cases. Chloroformum by inhalation is said to palliate the cough and excitement, and directly favor the resolution of the extravasated fibrin, and prevent the deposit of more. A drachm of chloroform should be inhaled in ACUTE BRONCHITIS. 137 the course of fifteen or twenty minutes, and the inhalation repeated from two to twelve times in the twenty-four hours. Colchicum is recommended in acute stages of gouty bronchitis by Dr. Green- how, who gives the following, with great success :— 293. R. Potassii iodidi, Ammonii carbonatis, aa gr.iv Vini colchici, nix Tincturae scillae, Tincturae hyoscyami, aa tt\xx Aquae camphorae, q. s. Make a draught, to be taken thrice daily. *Ipecacuanha is a valuable expectorant and diaphoretic, and a useful adjunct to other remedies of the same class (F. 266, 271, 273, 276, 279, 280, 292). Linum. Flaxseed tea is a favorite vehicle for mild expectorant remedies. Monarda. The warm infusion of horsemint makes an excellent diaphoretic. Oleum Ricini seems, more than any other medicine of its class, to mitigate the inflammation and promote resolution by expectoration. Opium, or morphia, given in full dose at the very outset of a common cold, often averts the attack (F. 261, 262, 266, 272, 276, 279, 290). But an opiate should never be given to a bronchitic patient with the slightest blueness of the lips. Oxygen. In the dyspnoea of capillary bronchitis, the inhalation of oxygen affords relief, and has been the means of preserving life. Podophyllin has been used with good results (F. 271). Potassii Nitras is frequently administered (F. 271, 289). Dr. Graves speaks highly of the following combination:— 294. R. Potassii nitratis, gij Antimonii et potassii tartratis, gr.j Tincturae opii camphoratae f-gss Misturae amygdalae, f.gxij. A tablespoonful every hour. Senega in decoction is a valuable remedy in the treatment of acute bronchitis in the aged (F. 275, 276, 290). Veratrum Viride is often of service (F. 270). Zinci Sulphas is useful in the advanced stages, when there is profuse secretion (F. 283). Blisters are hurtful in the earlier stages, but are often of service in the ad- vanced stages of the disease (p. 131). Blood-letting is recommended by Prof. Dutcher, in very acute attacks, in robust patients (p. 131). The application of a few leeches to the chest, or moderate wet-cupping, is sometimes indicated. Counter-irritants to the chest are often of service. For this purpose, dry-cup- ping, *hot turpentine stupes, or mild sinapisms, may be employed (pp. 130, 136. F. 277, 278). Turpentine embrocations are also ser- viceable (F. 265). Demulcents are always indicated (F. 284, 285, 286, 287). Stimulants are often useful, and sometimes necessary, as in the bronchitis of the aged, attended with profuse secretion, threatened apnoea and a weak pulse. At the very outset of a common cold, a fuli supper, with a moderate alcoholic stimulant, will frequently abort the attack (p. 129). Water. The vapor of hot water is often of signal benefit (p. 129). Wet pack- ing is also of service in the early stages (p. 134). 138 DISEASES OF THE RESPIRATORY SYSTEM. CHRONIC BRONCHITIS. PROF. WILLIAM AITKEN, M. D., EDINBURGH. In chronic cases of bronchitis, especially in patients who have made considerable progress in the journey of life, remedies which tend to invigorate the general system are indicated. Besides the selection of a beneficial climate and the use of nutritious, easily digested food, stimulating embrocations are useful. The following liniment, employed at the Meath Hospital at Dublin, is highly recommended for this purpose :— 295. R. Spiralis terebinthinae, f.giij Acidi acetiei, f-gss Vitelli ovi. j Aquas rosae, f-3*ijss Olei limonis, f.gj. M. To be rubbed, morning and evening, not only over the chest, before and behind, but also along the sides of the neck. It generally reddens the skin and produces small pimples. Of the fetid gums, ammoniac in particular is a useful remedy. From the following combination (formula of Prof. Easton, of Glas- gow) decided beneficial results are obtained:— 296. R. Ammoniaci, gij Acidi nitrici diluti, f.gij Aquae, f-Jxij. M. Two tablespoonfuls in gruel, thrice daily. It is often advantageous to administer astringent remedies, as 297. R. Acidi tannici, Bj-gj For 20 pills. One thrice daily. Or, 298. R. Oleicubebas, gtt.x. For one dose, three or four times a day, on a piece of sugar. In the protracted bronchitic affections of the aged, diuretics are of great service. The following formulas are recommended by our author and by Drs. Maclachlan and Stokes, as well suited in a variety of cases of senile chronic catarrh:— 299. R. Potassii nitratis, gr.xxxvj Tincturae conii, f.5ss Spiritus aetheris nitrosi, Oxymellis scillas, aa f.gvj Decocti senegae, ad. f.gvj. M. A tablespoonful thrice daily. CHRONIC BRONCHITIS. 139 300. R. Potassii acetatis, gss Aceti scillae, Spiritus aetheris nitrosi, aa f.gvj Tincturas opii camphoratas, f-g8s Liquoris ammonii acetatis, f.giijss Syrupi aurantii corticis, f-gvj. M. A tablespoonful thrice daily. DR. BEIGEL, LONDON. 301. R. Pulveris alumenis, gr.ij Tincturae opii, rr\,x Aquae destillatae, f.gj. M. For inhalation by means of atomizer, night and morning, in obstinate cases of chronic bronchitis. The following inhalation also affords relief in severe cases :— 302. R. Acidi tannici, gr-iij Extracti hyoscyami, gr.ij Aquae destillatae, f.gj. M. To be inhaled night and morning. On account of the taste, sulphate of iron (gr.iv to f.gj.) may be substituted for the tannic acid. J. SOLIS COHEN, M. D., PHILADELPHIA. 303. R. Liquoris iodinii compositi, gtt.x-xl Aquas destillatae, f.gj. M. For inhalation by means of atomizer two or three times a day. If there co-exists pain, the narcotics and sedatives may be added to the inhalation, but preferably in minute quantity. DR. VAN DER CORPUT. 304. R. Morphiae muriatis, gr.j Ammoniaci, gss Extracti scillae, gr.xv-xxv. M. For 20 pills—take from two to four in the course of the day, in chronic bronchitis and bronchorrhoea. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 305. R. Ammonii chloridi, gij Misturae glycyrrhizae compositae, f.^Iij. M. A dessertspoonful three times a day. Chloride of ammonium, in order to be effective, should be given in ten-grain doses. In the bronchitis of patients affected with phthisis, it may be combined as follows:— 306. R. Ammonii chloridi, gss Morphiae muriatis, gr j Extracti pruni virginianas fluidi, f.^iij. M. A teaspoonful three or four times a day. 140 DISEASES OF THE RESPIRATORY SYSTEM. 307. R. Ammonii chloridi, g}j Potassii chloratis, 3.1 Tincturae hyoscyami, _ ^ f-388 Extracti pruni virginianae fluidi, fgys8- "1- A dessertspoonful, thrice daily, when there is a tenacious secretion. Chlorate of potash thins the secretion and promotes expectora- tion ; it is useful in both acute and chronic bronchitis. 308. R. Potassii chloratis, 3U Tincturae scillae, # *-.|8.8 M Misturae glycyrrhizas compositae, f.gy88* M- A dessertspoonful three or four times a day, when there are dry rales. 309. R. Vini picis liquidae, f-3»j- A dessertspoonful thrice daily, in cases of bronchial catarrh, together with 310. R. Plumbi acetatis, ^ By Extracti glycyrrhizae, q. 8« For 20 pills. One three times a day. M. 311. R. Potassii carbonatis, I88. Yini ipecacuanhae, f-gy Tincturae opii camphoratas, Syrupi tolutani, aa f.giss. M. A teaspoonful three times a day, as an alkaline expectorant mixture, to thin the secretion. Or, the following may be used when a tonic is also indicated:— 312. R. Sodii carbonatis, gj Ammonii chloridi, gij Extracti gentianae fluidi, f.gvj Extracti hyoscyami fluidi, f.gij Syrupi tolutani, f-Sy- ^1> A dessertspoonful three times a day. 313. R. Pulveris alumenis, gr-viij Extracti conii fluidi, gtt vj Aquas destillatae, f.gj. M. For atomization. The alum to be gradually increased to gr.xx-f.gj. PROF. A. P. DUTCHER, M. D., CLEVELAND, OHIO. As local remedies the inhalation of the vapor of hops, iodine, chloroform, tar, extract of conium and belladonna are at times very useful (Philadelphia Medical and Surgical Reporter, October 12th and 19th, 1867). The vapor of iodine should be watched with the greatest attention. If it increases dyspnoea, and produces an unusual feeling of heat and distress in the bronchial region, it should be immediately discontinued, for it will produce congestion CHRONIC BRONCHITIS. 141 in the smaller bronchia, which may extend to the air cells and ultimately end in pneumonia. The constitutional treatment must vary with the wants of each particular case. Tonics, such as iron, gentian and quinine, with minute doses of mercury, are commonly useful to improve the state of the secretions and functions generally. When the expectoration is profuse, with much febrile excitement, the mineral acids and metallic astringents are useful. When the urine is loaded with the oxalate of lime, and the bronchial trouble appears to depend upon indigestion, from some defect in the functions of primary as- similation, the nitro-muriatic acid, administered according to the following formula, will sometimes produce a wonderful change for the better, in cases that have resisted every other form of medica- tion :— 314. R. Acidi nitrici, fgj Acidi muriatici, f.gij Morphiae sulphatis, gr.ij Tincturae cinchonas composite, f giv. M. A teaspoonful thrice daily, before each meal. In mild cases of chronic bronchitis, the iodide of potassium is a most valuable remedy; it seems to restrain low degrees of inflam- mation affecting the fibrous part of the tubes, and counteracts the process of induration to which they tend. In bad cases of the dis- ease, where there is no tendency to tuberculosis, our author is in the habit of prescribing the iodide of potash and corrosive chloride of mercury, thus:— 315. R. Hydrargyri chloridi corrosivi, gr.j Potassii iodidi, giij Extracti lobelias fluidi, f.gj Syrupi, f.gv. M. A teaspoonful three times a day, after each meal. Where there is a tendency to tuberculosis the mercury should be omitted. The following is a useful combination, where it can be borne by the stomach, to allay cough and restrain expectoration:— 316. R. Copaibas, f.gij Tinctures cubebae, f.gj Morphiae sulphatis, gr-iv Syrupi, f.gj. M. A teaspoonful three times a day. Ipecacuanha as an expectorant, in ordinary cases of chronic 318. R. Potassii ferrocyanidi, giv Morphiae sulphatis, gr.v Tincturae colchici radicis, Syrupi scillas, aa f.gss Aquas destillatae, f.giv. A teaspoonful three or four times a day. 142 DISEASES OF THE RESPIRATORY SYSTEM. bronchitis, may be given in doses of a grain or two of the powder, or twenty to thirty drops of the wine, repeated several times a day, or combined with other agents, according to the following:— 317. R. Vini ipecacuanhae, Syrupi scillae, aa f.gj Tincturae digitalis, Spiritus aetheris nitrosi, aa f.gss Tincturae opii camphoratae, f.gij M. A teaspoonful three times a day. In the chronic bronchitis of aged people, where, from alterations in the structure of the tubes, a cure cannot be expected, the disease may often be palliated and the patient rendered very comfortable by the use of the following combination, which is one of our author's favorite prescriptions:— M. When expectoration is viscid, alkalies are useful; and when the vital powers are feeble, Dr. D. is in the habit of prescribing, in connection with other treatment, the following:— 319. R. Ferri pyrophosphatis, Quiniae sulphatis, aa gj Strychniae, gr.j Extracti hyoscyami, gr.xxx. M. For 60 pills. Two to be taken three or four times a day, after each meal. 320. R. Potassii iodidi, giij Hydrargyri chloridi corrosivi, gr.ij Extracti lobelias fluidi, f.gj Syrupi stillingiae compositi, Syrupi phellandrii aquatici compositi, aa f.gvijss. M. One-half an ounce, three times a day, before each meal; and the chest over the bronchial regions to be painted most thoroughly every night on retiring to rest, with 321. R. Iodinii, gj Potassii iodidi, gij Aqu9e> f.giv. m. 322. R. Iodinii, gr.xx Chloroformi, f.gj. ]yj 40 drops to be inhaled every night, before going to bed. After which, to quiet cough and secure good rest at night, take one of the follow- ing,:— CHRONIC BRONCHITIS. 143 323. R. Quiniae sulphatis, Extracti hyoscyami, aa, gss Morphiae sulphatis, gr-iij- M. For 20 pills. FREDERICK FIEBER, M. D., VIENNA. 324. R. Zinci sulphatis, gr.v Aquae destillatae, f.gj. M. For inhalation. Of marked benefit in a case of chronic bronchitis, of the variety simulating consumption, of twenty-five years' standing. E. HEADLAM GREENHOW, M. D., LONDON. 325. R. Vini ipecacuanhae, Acidi nitro-muriatici diluti, aa tt\,x Tincturae hyoscyami, rr\,xx Tincturae gentianae compositae, f-gss Aquam, ad. f.gij. M. For one dose. To be taken in water three times a day, in chronic bronchitis. In almost all cases of chronic bronchitis a time arrives when expectorants, cease to be useful. The expectoration has become of the nature of an habitual flow from the bronchial membrane. Treatment of a tonic character is then required. In these cases Dr. Greenhow has long been accustomed to prescribe with great advantage the mineral acids, especially the nitro-muriatic, in com- bination with a vegetable bitter, as above. In chronic cases at- tended by very copious expectoration, he adds to each dose of the above mixture twenty minims of the tincture of larch, which has the effect not only of lessening the expectoration, and with it the cough and dyspnoea, but also apparently of restoring the debili- tated membrane to a more healthy tone, and of rendering patients less liable to catarrhal attacks at every change of the weather or season. JOHN FORSYTH MEIGS, M. D., PHILADELPHIA. 326. R. Acidi carbolici fluidi, n\,x-xv Aquas, Oss. M. To be placed in an ordinary inhaling bottle, and used three or four times a day, in bronchial catarrh, offensive secretion from the bron- chial tubes, etc. L. PARISEL, OF PARIS. 327. R. Pulveris cinchonae flavae, ^ulphuris loti, aa gss Syrupi althasae, q. s. M. 144 DISEASES OF THE RESPIRATORY SYSTEM. This solution should be inhaled by means of an atomizer ; use- ful both in the simple form of chronic bronchitis and in that which usually complicates the advanced stages of phthisis. It dimin- ishes the secretion and thereby lessens the waste of substance and the exhaustion occasioned by repeated and urgent coughing. PROF. ALFRED STILLE. M. D., PHILADELPHIA. 328. R. Acidi carbolici fluidi, gtt.xv-xx Tincturae conii, f>3J-ij Aquas destillatae, Oij. M. For inhalation. THOMAS HAWKES TANNER, M. D., LONDON. 329. R. Syrupi scillss, f.gvj Acidi nitrici diluti, f.gj Tincturae hyoscyami, f«giij Spiritus chloroformi, f-gvj Infusum cinchonas flavae, ad. f.gvj. M. Two tablespoonfuls twice or thrice daily, in chronic catarrh, with de- bility and restlessness. 330. R. Syrupi scillae, f.gvj Spiritus ammonias aromatici, f-gi'j Morphiae muriatis, gr.ss Infusum serpentariae, ad. £gvj. M. Two tablespoonfuls two or three times a day, in chronic catarrh. 331. R. Pilulae scillae compositae, Extracti conii, aa gss. M. For 12 pills. Two to be taken every night at bedtime. In chronic catarrh when opium is objectionable. 332. R. Tincturae scillae, f.gij Tincturae stramonii, f.giss Infusum dulcamaras, ad. f.gvj. M. Two tablespoonfuls thrice daily. In chronic catarrh, especially when the secretions of the skin and kidneys are deficient. 333. R. Olei terebinthinae, f.gj Aquae calidae, f.gv. M. In chronic bronchitis with excessive secretion. 334. R. Creasoti, tt^xxx Aquas bullientis, f.gviij. M. In chronic catarrh. JAMES TURNBULL, M. D., LIVERPOOL. 335. R. Ipecacuanhas, gjj Olei olivas, f.gj: Adipis, gss. M. This pomade is to be spread upon the skin once or twice a day, when it is desired to produce an eruption or a rubefacient effect in bronchitis. CHRONIC BRONCHITIS. 145 Or, 337. R. Emetinas, gr.xv Adipis, gss. M. The emetine is to be dissolved in a small quantity of alcohol, and the solution thus obtained is thoroughly mixed with the lard. Rubbed on the skin for a few minutes once or twice a day, this ointment produces a copious crop of small pustules, unattended with pain, which remain out for many days and leave no scars. In this last point it has an advantage over tartar emetic ointment, for which Dr. T. proposes it as a substitute. DR. DE SMET, FRANCE. 338. R. Cinchonas rubrae pulveris, Sulphuris prascipitati, aa gv Syrupi althaeas, q.s. M. Make an electuary, of which give three or four teaspoonfuls a day, in the chronic bronchitis of old persons, and of those in feeble health predisposed to diarrhoea. 339. R. Antimonii et potassii tartratis, 9j Tinctures cantharidis, f-giij« M. Rub a small quantity of this liquid on the front of the chest and apply a flannel. In this manner an eruption is developed which acts efficiently in acute bronchial affections. Or, for the same purpose, the follow- ing may be used:— 340. R. Spiritus camphorae, Tincturae cantharidis, aa f.giss. M. To be employed as above. PROF. WILLIAM STOKES, M. D., DUBLIN. 341. R. Potassii iodidi, giij Tincturae opii camphoratae, f-gss Decocti senegas, f.giv Syrupi tolutani, f.giss. M. Two teaspoonfuls a day, in chronic bronchitis. 342. R. Tinctures opii camphoratae, f.gss JEtheris, Tincturae tolutanae, aa f.gij. M. A teaspoonful in a small quantity of a warm drink, to quiet the cough, in bronchitis. 343. R. Tincturae opii camphoratae, Tincturae scillae, aa f.giss Ammonii carbonatis, gr.xviij Decocti senegas, f-giv Syrupi tolutani, f.gss. M. Two or three teaspoonfuls a day in chronic bronchitis, after the inflam- matory symptoms have lost a little of their intensity. 10 146 DISEASES OF THE RESPIRATORY SYSTEM. 344. R. Acidi benzoici, Ammoniaci, aa gss Saponis, q. s. M. Divide into 20 pills. From four to eight in the twenty-four hours, in chronic pulmonary catarrh. Repeated sinapisms to the chest. SIR THOMAS WATSON, LONDON. In cases of chronic bronchitis, which are especially remarkable on account of the great abundance of the bronchial secretion, our author has derived great advantage from the administration of the sulphate of iron in two or three grain doses, in the compound in- fusion of rose, thrice daily. When there is any fever present, these remedies are apt to augment it; but when the pulse is quiet and the skin cool, they are often of the greatest service. Our author has also seen the excessive expectoration diminish, and the patient gain strength, under the use of the balsams, the com- pound tincture of benzoin, for example, a form of medicine much employed formerly, and too much neglected at present. JOHN WILLIAMS, M. D., LONDON. 345. R. Ammoniaci, Ammonii carbonatis, aa gr.xv Ipecacuanhae, gr-iv Morphiae muriatis, gr.iss Mucilaginis acaciae, q. s. M. Divide into 10 pills, which coat with a solution of balsam of tolu in chloroform. One pill, morning and evening, in chronic bronchitis; especially when the secretion is thick and the expectoration difficult. RESUME OF REMEDIES. Acidum Carbolicum, by atomized inhalation, is of service when the bronchial secretions acquire a repulsive fetor. Allium. After the febrile stage has passed, syrup of garlic, or the domestic onion syrup, is a very useful expectorant, particularly for children. Alumen. Dr. F. L. Andrews, of London, recommends alum in acute as well as in chronic bronchitis, both in children and adults, when the ex- pectoration is ropy. To children of three years he gives one grain in solution every five or six hours, to adults six or eight grains at like intervals. Ammoniacum is often a decidedly useful remedy (F. 296, 304, 345). Ammonii Carbonas is an excellent stimulant expectorant, of benefit in the ad- vanced stages of bronchitis when there is no febrile action present. The following formula may be employed :— 346. R. Ammonii carbonatis, gr.iv Spiritus chloroformi, TT^xx Aquae camphorae, f.gx. M. To be taken every three or four hours. Infusion of senega may often replace with advantage the camphor water in this recipe. It its of especial benefit in the asthenic bron- chitis of old age. CHRONIC BRONCHITIS. 147 * Ammonii Chloridum is a most valuable remedy in chronic bronchitis, but must be given in ten-grain doses in order to be effective (F. 305, 306, 307, 312). The following is a useful formula:— 347. R. Ammonii chloridi, gij Spiritus aetheris compositi, f.gij Extracti glycyrrhizas, gj Decoctum senegae, ad. f.3vj. Tablespoonful every two or three hours. Ipecacuanha or squill may be added, if indicated. Angelica is useful in the chronic bronchial catarrh of aged and feeble persons, under circumstances when senega is usually prescribed. Antimonii Oxy-iodidum is of service in subacute bronchitis. Arsenicum is recommended by Dr. Thorowgood (Lancet, November 13th, 1869) in chronic bronchitis, where copious expectoration and much emaciation are present. At times he finds it to act quite like a spe- cific in improving the breathing. He gives ttlij of Fowler's solution in alkaline infusion of columbo thrice daily. Assafoetida is of service when the cough is spasmodic, and the expectoration difficult, on account of general debility. It is, therefore, often useful in the chronic bronchitis of old persons. Balsamum Peruvianum. The balsams, both of Peru and of Tolu, are useful stimulant expectorants, and vehicles for squill and other remedies of the same kind, in chronic bronchitis (F. 311, 341, 342, 343, 344). The vapor, obtained by placing them upon a piece of hot iron or hot coals, is also of benefit. Benzoinum. The compound tincture of benzoin is a useful stimulant expec- torant ; the tincture of benzoin may often be employed with benefit, by means of a steam atomizer. Benzoin must be used only in cases not injuriously influenced by stimulation. Calcis Phosphas, in doses of gr.i-ij several times a day, is recommended by Dr. Ringer, as of great value in checking profuse discharges in chronic bronchitis. Cetraria has been highly recommended in chronic bronchitis attended with copious purulent or mucous expectoration. Chiretta has proved useful in chronic bronchitis associated with copious ex- pectoration and exhausted powers of the system. Chondrus has an extended reputation in chronic bronchitis, but is not a very active agent. Cimicifuga is especially useful in the chronic bronchitis and coughs of old age. Cinchona. The acidulated cold infusion of bark is very useful when there is rapid wasting of the system, under the influence of profuse expecto- ration and night sweats. Colchicum is sometimes prescribed ; it is more particularly indicated in gouty bronchitis (F. 318). Conium, in the form of the compound pill (gr.v-x) is frequently useful. Squill increases its efficacy. Vapor coniae may be inhaled with bene- fit. Copaiba often restrains and modifies the bronchial secretion in chronic bron- chitis attended with profuse expectoration, when there is no fever and not much vascular irritability (F. 316). Creasotum is sometimes given by inhalation and by the stomach, in the bron- chorrhosa of old persons. Creta Praparata is recommended by Dr. Copland in chronic bronchitis in the 148 DISEASES OF THE RESPIRATORY SYSTEM. advanced stages, particularly when colliquative sweats and diar- rhoea are present. He employs the following mixture, which, even when the bowels are regular, is by no means productive of constipa- tion :— 348. R. Misturae cretae, f-3*vjss Vini ipecacuanhas, f.giss Tincturae opii camphoratae, f-gvj Syrupi tolutani, f-giij- M- Tablespoonful three or four times daily. Cubeba, in small and often repeated doses, is of service in the chronic bron- chitis of old age, attended with profuse secretion and much debility of constitution (F. 298, 316). Cuprum Ammoniatum is said to be serviceable in severe chronic bronchitis accompanied with spasmodic cough. Digitalis. The tincture is occasionally useful as a sedative adjunct to ex- pectorants. Dulcamara is frequently a useful sedative for the cough. Ferri Mistura Aromatica is highly praised, as calculated to improve the general health and check superabundant secretion, by Dr. Graves. He orders 349. R. Misturae ferri aromaticae, f.giss-iij Aquae menthae piperitas, f-Svj. M. Tablespoonful thrice daily. Ferri Nitratis Liquor is of service in doses of gtt.x-xv, thrice daily, when tonics and astringents are indicated. Ferri Sulphas is recommended by Sir Thomas Watson when there is exces- sive bronchial secretion (p. 146). Ipecacuanha is a useful expectorant, usually given combined with other remedies (F. 300, 311, 317, 325, 335, 341, 342, 343, 345). Larix Europcea is recommended by Dr. Greenhow, to check profuse passive expectoration in chronic bronchitis (p. 143). Lobelia is a serviceable sedative, allaying spasm and facilitating expectora- tion. It is usually given in combination with other remedies. Marrubium. The expressed juice of the fresh plant, taken with milk, has been strongly recommended. Myrrha, when there is no fever or irritability present, is a valuable medicine in long standing chronic bronchitis, particularly after a course of ex- pectorants. Nitro-muriaticum Acidum is of service when tonics are indicated (F. 314, 325). Oleum Morrhuce is often of signal service in chronic bronchitis. Opium, though often of much service in allaying bronchitic cough, may prove dangerous if there is much accumulation in the bronchi. Pix Liquida is of some value in bronchial catarrh (F. 309). The following formula was recommended by the late Prof. Dunglison :__ 350! R. Picis liquidae, f.gj Aquae destillatae, Oij. M. Digest for eight days and decant. Dose, from eight to twelve table- spoonfuls daily, in milk. Plumbi Acetas frequently proves useful when there is profuse mucous secre- tion (F. 310). CHRONIC BRONCHITIS. 149 Potassii Carbonas is of service in thinning the secretion (F. 311). Potassii Chloras is recommended by Prof. Da Costa in both acute and chronic bronchitis, to thin the secretion and promote expectoration (F. 307, 308). *Potassce Liquor, n\,x-xv added to an ordinary expectorant mixture, is often attended with good results when the sputa is scanty, thick and viscid. Potassii Ferrocyanidum is recommended by Prof. Dutcher (F. 318). *Potassii lodidum acts beneficially in the advanced stages of chronic bron- chitis, in restraining inflammatory action and promoting absorption. (F. 315, 320, 321, 341). Sanguinaria is sometimes employed alone, but is usually associated with other remedies. Scilla is of service after all active inflammation has subsided, in mild cases unattended with purulent expectoration. It is best combined with an alkali and a small quantity of opium (F. 300. 304, 308, 317, 318, 329, 330, 331, 332, 343). *Senega is a highly serviceable remedy, particularly when combined with carbonate of ammonium. *Sodii Hypophosphis, or potassii hypophosphis, is useful in very chronic cases, with thick fetid expectoration. Camphor water is a good vehicle. Stramonium is recommended, combined with expectorants, by Dr. Headland, in the form of the tincture (ntx), in the chronic bronchitis of the aged, where there is great dyspnoea, accompanied by a dry state of the tubes. Strychnia or nux vomica, in small doses, with iron, is advocated by Dr. Tho- rowgood, especially when there is constant dyspnoea with prolonged expiration (Lancet, Nov. 13, 1869). Sulphur combined with acid tartrate of potassium is recommended by Dr. Graves. Tannicum Acidum is useful when an astringent is indicated. Uva Ursi has proved of benefit when there was purulent expectoration and hectic fever. Zinci Stdphas is recommended by Dr. Barlow. He employs the following combination for moderating the cough and expectorations:— 351. R. Zinci sulphatis, gr.j Extracti conii, gr-iv. M. One pill thrice daily. Zingiber. The infusion is sometimes useful in the bronchial catarrh of ad- vanced life. Alkalies are useful in chronic bronchitis, when the expectoration is thick and viscid. Diuretics are of benefit in the protracted bronchitic affections of the aged (F. 299, 300). Emetics are recommended in chronic bronchitis, by Dr. Graves, when there is no fever, no remarkable dyspnosa nor acceleration of the pulse, but when the secretion is very copious. In such cases,* an emetic every night for two or three nights is productive of great advantage, freeing the stomach and lungs from a large amount of mucus, rendering the expectoration easier, clearing the tongue and improving the appetite. Inhalations are frequently employed in the treatment of chronic bronchitis; The following are the principal drugs used:—Alum (F. 301, 313) . Balsams of Peru and Tolu; Carbolic Acid (F. 326, 328); Chlorine j 150 DISEASES OF THE RESPIRATORY SYSTEM. Chloroform, a few whiffs, n\,vi-l often of signal but only temporary benefit (F. 322) ; Conium Vapor; Creasote (F. 334); Iodine (F. 303, 322); Olibanum Fumigations (the gum rosin placed on burning coals); Tar Vapor (generated by heating tar over a spirit lamp, with the addition of a small quantity of potash to neutralize the irritant fumes); Nitre Paper Fumes (F. 234, 252, 259) ; Sulphurous Acid Spray or Fumigation ; Tannic Acid (F. 302); Turpentine (F. 333); Hot Water Vapor; Sulphate of Zinc (F. 324). Stimulants are frequently indicated in the bronchitis of the aged. EXTERNAL REMEDIES. Baths. An alkaline bath sometimes proves useful. Counter-irritants. The following combination of aqua ammonice applied to the chest is an efficient counter-irritant:— 352. R. Aquae ammoniae, f-3*ss-j Olei amygdalae, f-gss Olei rosmarini, f.gj Aquae, f.gij. M. Tartar-emetic ointment is occasionally employed as an irritant to the chest, but other irritants are generally preferred. Croton oil liniment is some- times very useful. Turpentine liniments are highly serviceable. The following combination, supposed to be an imitation of that used by St. John Long, is recommended by Dr. Graves :— 353. R. Olei terebinthinae, f.giij Acidi acetici, f.gss Ovi vitelli, j Olei limonis, f.gj Aquas rosmarini, f.gijss. M. To be well rubbed in over the chest, the nape of the neck, the epigas- trium, and the course of the cervico-spinal and pneumogastric nerves generally. Sinapisms to the chest are sometimes of service. Electricity. A fine primary induction current, of low intensity, passed through the chest from the back and neck, stimulating the sympa- thetic and spinal nerves, has been found productive of great benefit. Xitro-muriatic Acid lotions sponged over the chest are recommended for check- ing profuse expectoration, and mitigating the severity of the symp- toms. Plasters. A Burgundy pitch plaster often proves of service as a protective against atmospheric changes, and as a rubefacient. An opiate plas- ter is sometimes of benefit. *Poultices. Large, light, soft linseed-meal poultices, made to cover the whole of the chest often afford great relief in chronic bronchitis. If it be desirable to stimulate the skin, Mustard (1 part to 4) may be added; if there be much pain, Laudanum may be sprinkled over the surface. Issues at the nape of the neck sometimes remove or mitigate the symptoms. See, also, Chronic Catarrh, p. 153. CATARRH. 151 CATARRH. HORACE DO BELL, M. D„ LONDON. Catarrh steals, in an insidious way, its marches on its victims. However simple in character and short in duration the first attacks may be, they dispose the mucous membrane to fresh attacks; each attack involves a larger extent of surface than its predecessor; when once the complaint has reached the finer ramifications of the bronchi, it lurks there still—even after the larger tubes have been restored to temporary health—every fresh attack of catarrh in the larger passages supplying the lurking enemy with reinforcements, and enabling it to advance from its fastnesses, and to encroach further and further upon the respiratory tract, until, at last, it needs but a breath of wind upon the lining of the nose or fauces to raise a storm of rebellion throughout the length and breadth of the naso-pulmonary mucous membrane. If we could nip every catarrh in the bud, what a catalogue of ills we should prevent! And yet this is not a very difficult thing to do, when there is a chance of trying it. But, unfortunately, colds are thought so lightly of by patients, that they seldom try to stop them till they have become severe, have lasted an unusual time, or have produced some complication. Nevertheless, it is our author's opinion, they would do better in this respect if they had more faith in the possibility of stopping colds; if their doctors would impress upon them more the importance of stopping them; and especially if they knew that colds can be stopped without lying in bed, staying at home, or in any way interfering with business. Our author's plan of stopping a cold, while it will not answer if the cold be thoroughly established, is almost infallible if begun directly the first signs of catarrh show themselves in the nose, eyes, throat or chest—in fact, before any considerable amount of secretion has taken place. The plan is as follows:—1. Order. 354. R. Ammonii carbonatis, Bj Morphiae sulphatis, gr.^ Misturae amygdalae, f-giv. M. Two tablespoonfuls every three hours. 2. At night give a tablespoonful of spirit of mindererus in a tumbler of cold water, after the patient has got into bed and been covered up with several extra blankets; cold water to be drank 152 DISEASES OF THE RESPIRATORY SYSTEM. freely during the night should the patient be thirsty. 3. In the morning, the extra blankets should be removed, so as to allow the skin to cool down before getting up. 4. Let him get up as usual, and take his usual diet, but continue the ammonia and morphia mixture every five hours. 5. At bedtime, the second night, give a compound colocynth pill. No more than twelve doses of the mix- ture, from first to last, need be taken, as a rule; but should the ca- tarrh seem disposed to come back after leaving off the medicine for a day, another six doses may be taken and another pill. During the treatment, the patient should live a little better than usual. As everything depends upon the promptitude of the treatment, persons who are subject to catarrh, especially if it inclines to the influenza character, should be provided with a prescription for the medicine, and full instructions how to manage themselves when a cold sets in. Many old catarrhal patients of the author, who have been accustomed for several years to stop their colds in this way, have given their medicine the somewhat unprofessional title of the " Magic Mixture," so often has it saved them from their old enemy. An addition to this plan is needed in persons whose colds seize at once upon the bronchial mucous membrane. Besides the manner of proceeding just described, they should use the following inhala- tion :— 355. R. Extracti conii, gr.x Tincturae benzoini, f.gj Spiritus ammoniae aromatici, f.gss Aquas (170° F.), Oj. M. Inhale the steam for fifteen minutes at bedtime each night, put a mus- tard plaster on the front of the chest one night, and between the shoulders the next; and unless the weather is warm, wear a respira- tor out-doors until all signs of the cold have disappeared. RE'SUME' OF REMEDIES. Acetum. Bathing the chest every morning with vinegar and water, often di- minishes the liability to an attack in persons subject to repeated catarrhs. Aconitum is highly recommended by Dr. Ringer, at the outset of febrile catarrh:— 356. R. Tincturae aconiti radicis, ^viij-xvj Aquas, f.gij. m. A teaspoonful every ten or fifteen minutes, for two hours, and after- wards repeated every hour. If there be much prostration and the pulse be feeble and weak, the dose should be diminished. So soon as the sensation of " pins and needles " be produced, the aconite, which has then been pushed to its full extent, should be stopped. Ammonii Acetatis Liquor is often of great service. CATARRH. 153 Ammonii Carbonas is a very useful remedy in this affection. For Dr. Dobell's method of employing it to stop a cold, see p. 151. Arsenicum is of benefit, when the affeotion is of a local character, and when there is an absence of inflammatory action and febrile disturbance, which states contra-indicate its use. Ipecacuanha. A full dose of Dover's powder (gr.x), taken at bedtime and at the very outset of the attack, often arrests it. Lini Infusum is an excellent demulcent. * Opium. A full opiate at bedtime, followed by a laxative in the morning will, if given at the outset, frequently cut short a common attack of catarrh. Scilla is useful after all active inflammation has subsided, before which time it should never be employed. It unloads the air passages and re- lieves congestion and dyspnoea. Dr. C. J. B. Williams states that squill is principally useful in mild cases, unattended with purulent expectoration. He combines it with an alkali and a small portion of opium, to prevent its too rapid passage by the kidneys. Spiritus JEtheiHs Nitrosi is a popular and efficacious remedy. Baths. A Turkish Bath is often beneficial. Inhalations. Conium inhalations are recommended by Dr. Dobell (F. 355). Turpentine inhalations are recommended by Dr. Beigel. The fre- quently repeated inhalations of the vapor of hot water, in most instances, afford a remarkable amount of relief. CHRONIC CATARRH. Ammoniacum is a useful remedy in the chronic catarrh of old age. 357. R. Ammoniaci, gij Acidi nitrici diluti, f.gij Misturae acaciae, f-gviij. M. Two tablespoonfuls in any bland fluid, every two hours. Cannabis Indica is highly praised by Dr. Waring Curran (Medical Press, September 9, 1868) as a sedative and expectorant. He orders the following mixture:— 358. R. Tincturas cannabis indicae, f.gij Pulveris tragacanthas compositi, gj JEtheris chlorici, f.giss Aquas anisi, f-3*vj. M. Two tablespoonfuls every second hour. Galbanum is frequently serviceable. Sanguinaria. The regular employment of small doses of the tincture of this root often affords relief in protracted catarrhal affections, assuming the character of incipient phthisis. It should be persevered in for several weeks. *Senega is a very useful remedy in chronic catarrh. Fumigations. Prof. Trousseau highly recommends benzoin fumigations in chronic catarrh. The air of the patient's apartment should be impregnated with the vapor of benzoin, the drug being thrown upon burning coals; or it may be inhaled from a common inhaler, the balsam being placed in barley water. Inhalations. Oxygen inhalations have been advised in catarrh complicated with emphysema. Sulphurous acid fumigation (sprinkle from time to time, on a few red hot cinders, a small portion of sulphur, so as to fill the room not inconveniently with the fumes), or spray, is highly recommended. 154 DISEASES OF THE RESPIRATORY SYSTEM. CORYZA. J. SOLIS COHEN, M. D., PHILADELPHIA. 359. R. Pulveris alumenis, gr.v-xxx Aquas, f-3j". M. The nebulized spray to be drawn into the nostrils three or four times a day, to diminish the profuse secretion of coryza and destroy fetor when present. DR. LOMBARD, GENEVA. 360. R. Pulveris opii, Pulveris benzoini, Sacchari, aa gr.ij. M. For one powder. To be used in catarrhal neuralgia complicating coryza, in the following manner: Heat in the fire a thin plate of iron—a shovel—and throw upon it this powder, holding the head over it, so as to breathe the fumes through both nose and mouth. To be re- peated two or three times a day, or oftener. It acts like a charm, frequently giving immediate relief. M. LUC, SURGEON, FRENCH ARMY. Our author recommends the inhalation of iodine vapor in this affection, effected by placing a bottle of the tincture under the nose, the hand supplying warmth enough to vaporize the iodine. The inhalations, each lasting a minute, are to be repeated every three minutes during an hour. J. FORSYTH MEIGS, M. D., PHILADELPHIA. 361. R. Unguenti hydrargyri nitratis, gss Extracti belladonnas, gr.x Adipis, gss. M. Useful in chronic coryza of children; to be completely softened by gentle heat, and applied at night on a camel's hair pencil, to the sur- face of the mucous membrane itself, and not merely to the outside of the hardened scabs. Injections should be employed during the day. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. In the treatment of acute nasal catarrh, the production of active diaphoresis is the only procedure worthy of confidence. A Russian bath should be advised where practicable. In most cases, all that is necessary is to direct the patient to confine himself to his room for a few days; to keep the head and feet warm ; to swallow some hot drinks frequently during the day; to use linen pocket-hand- kerchiefs, not silken or cotton, and to change them frequently; and to smear the upper lip with salve, to protect it from the acrid secretion. In the latter stages, a long walk in the open air, or even CORYZA. 155 an occasional pinch of snuff, hastens the cure. In infants at the breast, the nostrils should be cleared by syringing them with warm water, and they should be fed by the spoon or bottle so long as the obstacle to sucking continues. In the treatment of chronic nasal catarrh, the cachexia, whatever it may be, should be attended to. Local remedies are also of the utmost importance. The most effective is penciling the swollen mucous membrane with the following solution :— 362. R. Argenti nitratis, gr.iv-xxx Aquae destillatae, f.gj. M. Or cauterizing with the lunar caustic in substance. The fol- lowing, to be used as a snuff, is in great repute:— 363. R. Hydrargyri chloridi mitis, Hydrargyri oxidi rubri, aa gr.xij Sacchari, gss. M. For one powder. When the discharge is offensive, and the above treatment fails, the following may be tried :— 364. R. Iodinii^ gr.ij-iv Potassii iodidi, gr.iv-viij Aquae, f-^vj. M. To be used as an injection into the nostrils. L. WALDENBURG, M. D., BERLIN. 365. R. Ammonii chloridi, gr.iv Aquas destillatae, f.gj. M. For inhalation by atomizer, in that form of coryza known as dry snuffles. When the mouth is closed and the proper inclination given to the head, the nebulized spray can readily be inspired into the nostrils. Solutions of common salt may also be employed in the same manner. For the treatment of the coryza of children, see Section on Dis- eases of Children. RESUME OF REMEDIES. Acidum Aceticum. The emanations of acetic acid are useful in arresting the development of coryza. Acidum Tannicum. Prof. Trousseau recommended, in chronic coryza, a snuff of finely pulverized tannin. Prof. Stille also recommends a snuff containing tannic acid and white sugar, reduced to a very fine 156 DISEASES OF THE RESPIRATORY SYSTEM. powder and forcibly inspired twice a day or oftener, according to the exigencies of the case; or, a glycerite of tannin, applied with a brush, after the parts have been cleaned by the usual douche or otherwise. Ammonii Acetatis Liquor is often very useful in coryza. Ammonii Chloridum, in powder, is a very effective errhine, in coryza. Arsenicum may often be ordered with benefit, in chronic coryza. JEtheris Nitrosi Spiritus is a popular and efficacious remedy, in doses of f.gj-iss, in a cupful of a convenient vehicle. Camphora. Snuffing the emanations from a piece of camphor often arrests, it is said, commencing coryza. lodinium and its compounds, aided by local iodine applications, are of service in scrofulous coryza. * Ipecacuanha. A full dose of Dover's powder, taken at bedtime, at the very outset of the attack of coryza, will often arrest it. * Opium. A full opiate at bedtime, followed by a laxative in the morning, will often cut short an attack of coryza, if given at the outset. Sanguinaria. The powdered root, conjoined with cloves and camphor, and employed as snuff, has been recommended. Inhalations. Alum will diminish profuse secretion and destroy fetor (F. 359). Benzoin and Opium fumes are of service in cases complicated with catarrhal neuralgia (F. 360); iodine vapor is useful (p. 154). EXTERNAL REMEDIES. Argenti Nitras. Penciling the swollen mucous membrane with a solution of nitrate of silver is recommended by Prof. Niemeyer (F. 362). Baths. A Russian Bath, when practicable, is of service. Curcuma. Inhaling the fumes of burning tumeric is a common East Indian remedy. A small piece of burning tumeric should be placed under a small funnel, and the vapor, as it passes through the small aper- ture, drawn up into the nostrils. Electricity. In the acute stage a constant current from six to eight cups, applied by means of a nasal bath, produces good effects. In chronic coryza nearly all cases, it is asserted, may be cured by galvanic and faradic stimulation. Glycerina may be employed to good effect to soften the plugs of hardened mucus which obstruct the nasal passages, in some forms of chronic coryza. Hydrargyri Chloridum Mite A mixture of calomel, red oxide of mercury and white sugar, is recommended as a snuff, by Prof. Niemeyer (F. 363). Iodine injections into the nostrils are efficacious when the discharge is offen- sive (F. 364). 6 Liquor Sodce Chlorinatce. A diluted solution (n^xv-xxx ad. aquas, f.gj), is useful as an injection, when the discharge is fetid. The strength of the solution should never be such as to cause pain. Snuffs of chloride of ammonium, camphor, sanguinaria and calomel have all been employed. Zinci Oxidum. The ointment or glycerine introduced into the nasal cavity, by a camel-hair brush, night and morning, is highly serviceable. The patient should be subjected at the same time to a course of iodine, quinine or iron, and the bowels kept soluble. EMPHYSEMA. 157 EMPHYSEMA. PROF. WILLIAM AITKEN, M. D., EDINBURGH. Little can be done, apart from the treatment of the bronchial congestion. If bronchial spasm prevail, the following may give relief:— 368. R. Spiritus aetheris compositi, f.giv-viij Aquas camphoras, f.giv. M. A tablespoonful thrice daily. THOMAS KING CHAMBERS, M. D„ LONDON. 369. R. Tincturae ferri chloridi, f.gijss Tincturae lobelias aethereae, f.gij Aquas camphorae, f-giv. M. A tablespoonful, in water, thrice daily. The object of the iron is to try and restore its full vital powers to the creative arterial blood, so that it may renew the pulmonary membrane, that it may form healthy elastic tissue, instead of the imperfectly elastic degenerated tissue. The lobelia is ordered as a substitute for a more powerful medicinal agent, tobacco. Nothing calms the distressing asthma so well as a few whiffs of strong Virginia. Like tobacco, lobelia is a very variable article; there seems to be as much difference between one specimen and another, as between the mildest cigarette and strongest shag. The strongest sort should be used, paying for it the best price at the best shop, so that it may be given in moderate and graduated doses. MEREDITH CLYMER, M. p., NEW YORK. For the relief of the asthmatic fits of emphysema, nothing is so sure as a full dose of opium with sulphuric or chloric ether. 370. R. Tincturae opii, f.gj. ^Etheris, f.gij. M. Sixty drops every twenty minutes. To each dose may be added Tincturas lobelias aethereae, gtt.xx. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 371. R. Potassii chloratis, giss Tincturae belladonnas, f.giss Extracti pruni virginianae fluidi, Tincturae cinchonas composites, aa f.gij- M- A dessertspoonful four times a day, in emphysema with chronic bron- chitis and loss of appetite. Also, dry cups applied to the chest morn- ing and evening. 158 DISEASES OF THE RESPIRATORY SYSTEM. In the treatment of emphysema, strychnia and nux vomica are of no benefit. Chlorate of potassium in large doses is of ser- vice, so also is the iodide of potassium. Care should be taken to prevent the emphysematous patient from having attacks of bron- chitis, which aggravate the affection. In the bronchial complications of emphysema, the following formulae will be found useful:— 372. R. Tincturas lobelias, f.gj Syrupi scillae, Syrupi tolutani, aa, f.gss Misturae glycyrrhizas compositae, f-giv. M. A dessertspoonful every three hours; with counter-irritation to the chest, with the following :— 373. R. Acidi acetici, Olei terebinthinae, Linimenti saponis, aa. f.^ij. M. To be rubbed on night and morning. 374. R. Potassii iodidi, By Syrupi ipecacuanhas, Tincturas scillae, aa f.gss Syrupi, f.gij. M. A tablespoonful thrice daily. Together with counter-irritation to the chest. 375. R. Chloroformi, f.gss Linimenti ammoniae, Linimenti saponis, aa f.giss. M. To be rubbed on morning and evening, and to be placed on flannel, and allowed to remain against the skin for fifteen minutes. 376. R. Potassii iodidi, gij Extracti senegae fluidi, f.gj Syrupi pruni virginianas, f-^ij« M. A teaspoonful thrice daily. 377. R. Tincturae lobelias, f.gss Extracti Valerianae fluidi, f.gj Spiritus aetheris compositi, f.gj Potassii chloratis, >)iv Syrupi tolutani, f.gj Aquas, f.gss. M. A dessertspoonful, in water, four times a day or oftener if the oppres- sion be great. Also the following:— 378. R. Chloroformi, f.gsa Olei terebinthinas, f.gj Spiritus rosmarini, f.giss. M. To be rubbed on morning and evening. EMPHYSEMA. 159 379. R. Atropias sulphatis, gr.^V In granules, thrice daily. The treatment in cases of emphysema should be a double one, to modify the bronchial trouble which keeps up the affection, and to alleviate the difficulty of breathing, which may at times rise into paroxysms of attacks of asthma. In point of radical treatment, there are no means which will cause the distended air vessels to resume their natural size. As a matter of absolute experience our author has thought that he has seen, in cases of pure emphy- sema, not associated with bronchial symptoms, a long course of iodide of potassium (three to five grains, thrice daily, for several months), favorably influence the disease, the respiratory murmur becoming fuller and freer, and the prominence of the chest walls less visible. Good results are also obtained from persistent coun- ter-irritation. Small flying blisters at various portions of the chest are serviceable. A number of cases are reported in which the constant employment of the continuous galvanic current has led to a diminution in the size of the chest. E. HEADLAM GREENHOW, M. D„ LONDON. 380. R. Potassii iodidi, gr.xxxvj Ammonii carbonatis, gj Tincturae scillae, Tincturae hyoscyami, aa f.gss Aquae camphorae, f.gv. M. A tablespoonful thrice daily. Also, direct the patient to smoke a stra- monium cigarette so soon as he feels the commencement of an asth- matic attack. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. The symptomatic indications in emphysema (our author con- siders we are totally unable to fulfill the indications of the disease itself, the nutritive alterations upon which it depends being irre- parable), are first, the proper treatment of the bronchial catarrh, which almost always accompanies this affection, and greatly adds to the distress of the patient. Habitual wearing of flannel next the skin, stimulants to the chest, warm baths of water or vapor, and the alkaline muriatic mineral springs (especially the thermal springs of Ems), are often of signal benefit. The next symptomatic indication is to moderate the habitual shortness of breath and the attacks of severe dyspnoea. Sending the patient during the summer to the pine wood region, and par- ticularly to places where there is a heavy fall of dew, will allay the 160 DISEASES OF THE RESPIRATORY SYSTEM. persistent oppression of the chest. The inhalation of compressed air, for the same reason, is an excellent palliative. To avert the asthmatic attacks, a strict diet, the avoidance of food likely to induce flatulence, light suppers and the keeping of the bowels open, are required. During the attacks of emphysematous asthma, the narcotics should be used with caution, unless called for by bronchial spasm. The more suitable remedies (beside the emetics, which are very appropriate), are the stimulants, camphor, musk, benzine, and 381. R. Vini portensis, f.gj-iss. Every three hours. When these fail, use 382. R. Olei terebinthinae, f.gj-iv Aquas menthae piperitae, f.giv Sacchari, Pulveris acacias, aa gj. M. A tablespoonful every three hours. For the dropsy complicating the affection, vigorous diaphoresis will give excellent results whenever it depends upon a capillary bronchitis. Later in the disease, when it arises from failure of the heart to compensate for the circulatory derangement of the lungs, it may be relieved for a time, by 383. R. Pulveris digitalis, Bss-j Aquae, f-3*vj. M. For an infusion. A tablespoonful thrice daily. Where digitalis fails, squills may be employed. 384. R. Aceti scillas, f.gj Aquas destillatae, f-3*vj Potassii carbonas, ad. saturationem. M. A tablespoonful every two hours. THOMAS HAWKES TANNER, M. D., LONDON. 385. R. Spiritus aetheris compositi, f.giss Spiritus ammoniae aromatici, f.gij Tincturae opii camphoratae, f.giss Aquae camphorae, q. s. ad. f.giv. M. Two tablespoonfuls every half hour until the spasm is relieved. 386. R. Sambulii radicis, gS8 Spiritus aetheris compositi, f.giv. M. Macerate in a stoppered bottle for seven days, and then filter. Dose, n\xx-xxx EMPHYSEMA. 161 387. R. Ammoniaci pulveris, gr.xv Ipecacuanhae pulveris, gr.iij Morphiae acetatis, gr.iss Ammonii carbonatis, gr.xv Mucilaginis acaciae, q. s. M. Divide into 20 pills. Two to six a day in emphysema. Ipecacuanha troches to facilitate the expectoration, revulsives on the chest. For the most part, all that can be done is to give relief by an invigorating diet, rest, warm clothing, attention to the digestive organs, and by the occasional use of tonics and antispasmodics. Amongst the former, quinine and iron are the most useful. Strych- nia has failed to be of any service. Cod-liver oil ought also to be administered. Amongst the latter remedies, ammonia, ether, hy- drocyanic acid, sumbul, etc., are the most promising. Occasion- ally the vapor of chloroform is of great temporary service. A warm climate is often very beneficial to sufferers from this affec- tion, the dyspnoea being always most urgent in cold weather. RFjSUME^ OF REMEDIES. Ammoniacum has been recommended (F. 387). Ammonii Carbonas is often employed in combination with other agents (F. 380, 387). Atropia and Belladonna are useful (F. 371, 379). Digitalis is of benefit in the dropsy complicating the affection (F. 383). Ferrum. Iron is highly recommended by Dr. Chambers (F. 369). Hyoscyamus is employed by Dr. Greenhow (F. 380). Ipecacuanha troches facilitate the expectoration. Lobelia, when a good article can be procured, relieves the asthmatic breathing (F. 369, 370, 372). Oleum Terebinthinae is advised by Prof. Niemeyer, during the attacks of emphysematous asthma (F. 382). Opium, in full doses, affords relief to the asthmatic fits of emphysema. It may be combined with advantage with ether (F. 370). Potassii Chloras, in large doses, is of service (F. 371, 377). Potassii lodidum is often useful (F. 374, 376, 380). Scilla is of benefit in the bronchial complications of emphysema (F. 372, 374, 380, 384). Senega is useful in the same class of cases as squills (F. 376). Spiritus JEtheris Compositus gives relief when bronchial spasm is present (F. 368, 377, 385). Strychnia and Nux Vomica are, according to Prof. Da Costa, of no benefit in this disease. Tabacum. Nothing, according to Dr. Chambers, calms the distressing asthma so well as a few whiffs of strong Virginia. Stimulants are recommended by Prof. Niemeyer, during the attacks of emphysematous asthma (p. 160). EXTERNAL REMEDIES. Counter-irritants to the chest are often useful (F. 373, 375, 378). 11 162 DISEASES OF THE RESPIRATORY SYSTEM. HEMOPTYSIS. PROF. WILLIAM AITKEN, M. D.. EDINBURGH. 388. R. Potassii bitartratis, gj Pulveris opii, gr.ij-iv. M. For 8 powders. One every four or six hours. 389. R. Plumbi acetatis, BJ-3J Pulveris opii, gr.x. M. For 20 pills. One every four or six hours. When haemoptysis is connected with amenorrhoea, preparations of iron often succeed when the above remedies fail. Thus :— 390. R. Ferri sulphatis, 9y Magnesii sulphatis, 3*ijss. M. For 20 powders. One thrice daily. This will often restore the menstrual secretion and cure the haemoptysis. Indeed, it is in this form of amenorrhoea that iron is most successful. 391. R. Spiritus terebinthinae, f.gss. For one dose, if the bleeding is attended with vascular excitement. PROF. J. M. DA COSTA. M. D.. PHILADELPHIA. 392. R. Acidi gallici, gr.xx. For one powder. In acute haemoptysis. To be repeated every ten minutes until hemorrhage ceases. 393. R. Cupri sulphatis, gr.£ Ferri sulphatis, gr.ij Extracti hyoscyami, gr.j. M. For one pill, thrice daily. In persistent slight pulmonary hemorrhage. Sulphate of copper in such cases seems to control the circulation within the lungs, and to arrest a tendency to bleeding. This action is not due to its nauseating effect, for, in this dose, it does not nauseate. The ad- ministration of cod-liver oil should be postponed until the haemop- tysis is gotten rid of. 394. R. Ferri chloridi, gr.ii-x Aquas destillatae, f.gj. v. For inhalation by atomizer. 395. R. Liquoris ferri subsulphatis, tr^x-xl Aquae destillatae, f?; jj For inhalation by atomizer. HAEMOPTYSIS. 163 396. R. Acidi tannici, gr.x-xx Aquas destillatae, f.gj. M. For inhalation by atomizer. 397. R. Pulveris alumenis, gr.xxx Aquas destillatas, Egj. M. For inhalation by atomizer. HORACE DOBELL, M. D., LONDON. 398. R. Extracti ergotae fluidi, f.gij Tincturas digitalis, f.gij Acidi gallici, gj Magnesii sulphatis, gv Acidi sulphurici diluti, f.gj Infusi rosae compositi, f-gvj. M. Two tablespoonfuls every three hours until the hemorrhage is arrested. In spite of the fashionable outcry against complicated prescrip- tions, Dr. Dobell recommends the above as the most efficacious and the most rational combination of remedies for a case of profuse tubercular pulmonary hemorrhage. In any given case, either of the ingredients may be omitted, if the symptoms indicate that it is not required, or that it has already done its duty. The object of the ergot is to contract the vessels ; of the digitalis, to steady the heart; of the gallic acid, to clot the blood; of the epsom salts, to relieve the congestion; and of the dilute sulphuric acid, to assist the rest. DR. GUENEAU DE MUSSY, FRANCE. 399. R. Extracti krameriae pulveris, gj Ergotae pulveris, By Digitalis pulveris, gr-vij Extracti hyoscyami, gr-iv. M. Divide into 20 pills. From five to six a day, in the spitting of blood so frequent in pulmonary consumption. Absolute rest; ice by the mouth; sinapisms to the upper and lower limbs successively. 400. R. Acidi sulphurici diluti, f.gj Aquas menthae piperitas, f.gvj Syrupi rubi, f.gj. M. A tablespoonful to be given every hour, in haemoptysis or passive hemor- rhages. 401. R. Extracti kramerias, gr.xv-gj Aluminii et potassii sulphatis, gr.iss Infusi rosae compositi, f.giv Syrupi acidi citrici, f.gj. M. A tablespoonful every half hour, in haemoptysis. Energetic counter- irritation to the skin. 164 DISEASES OF THE RESPIRATORY SYSTEM. 402. R. Ergotae pulveris, B}.v Acidi tannici, Bij> ^. Divide into 10 powders. One morning and evening, in haemoptysis. If there exists a disease of the heart at the same time, give digitalis and apply counter-irritation to the lower limbs. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 403. R. Copaibas, Syrupi, Aquae menthas piperita?, Alcoholis, aa f.gj Spiritus aetheris nitrosi, f.gss. M. A dessertspoonful every two to four hours. A formula much in use in very obstinate haemoptysis. 404. R. Aluminii et potassii sulphatis, gj Morphiae muriatis, gr.f Sacchari, gj. M. Divide into 12 powders. One every hour, in haemoptysis. Cold com- presses to the chest, absolute rest and silence. In the first place, the physician should seek to calm the spirits of the patient, which are always much excited; and, inasmuch as the attacks are almost always repeated several times, it is well to save him from further agitation, by straightway informing him that there is more blood to come, while, at the same time, we should absolutely deny the possibility of his bleeding to death. Indeed, we are certainly warranted here in deceiving the patient, by affect- ing to make light of the affair, and even to represent the hemor- rhage as a salutary process. With a little tact the physician may leave his patient in a state of comfort and peace of mind—a suc- cess of no slight importance. The chamber must be kept cool, all hot drinks forbidden, and all food eaten cold. Conversation should be interdicted, and the patient urged to resist stoutly the provoca- tion to cough. Coughing in haemoptysis is quite as hurtful as is snuffing and wiping the nose in epistaxis. PROF. WALTER HAYLE WALSHE, M. D., LONDON. The treatment resolves itself into (a) means for removing the conditions causing the flow, and (6) into means for stopping it, in spite of the continuance of these conditions. (a.) To fulfill the first indication : bleeding from the arm is useful when there is active congestion, febrile excitement, and strong cardiac action; ligature of the limbs, to prevent the free return of the blood through the veins, is a timely adjuvant, occa- sionally; free circulation of cool air, light bed clothes; a hard bed, HEMOPTYSIS. 165 quietude and silence, are essential aids; mouthfuls of ice, and the cautious application of ice-bags to the spine, or over the heart, will sometimes instantaneously arrest the flow, heat being at the same time applied to the extremities; digitalis is valuable in cases of irrit- able heart and moderate haemoptysis; refrigerants, such as nitrate of potassium, sulphuric and other acids, are useful adjuvants. (6.) To fulfill the second indication : acetate of lead, in doses of two to four grains, with dilute acetic acid and laudanum, every half hour, hour, or two hours ; alum; ergot; matieo ; and gallic acid. Dr. W's experience leads him to place greater trust in gallic acid than in any other agent of the class, in doses of 20 to 30 grains, every half hour at first. Drachm doses of kitchen salt, either in powder or dissolved in water, sometimes, even when they produce emesis, promptly arrest the hemorrhage. Hypodermic injections of ergotine are deserving of trial. RESUME OF REMEDIES. Aceticum Acidum Dilutum is employed both externally and internally, but is a remedy of minor importance. Alumen is serviceable in purely atonic haemoptysis. It may be given in solu- tion, by inhalation (F. 397), or be allowed to dissolve slowly in the mouth, in substance or in lozenge. In moderate but persistent tuber- cular haemoptysis Dr. Symonds recommends (British Medical Jour- nal, June 13th, 1868) the following:— 405. R. Alumenis, Bij.. Acidi sulphurici diluti, f.gijss-iv Magnesii sulphatis, Biv Aquas, f.giv. M. A tablespoonful in water, every three hours, or oftener, as required Ammonii Chloridum is recommended by Dr. Copland, in combination with muriatic acid, in passive cases of hasmoptysis, when the vital powers are depressed. The following is his formula:— 406. R. Ammonii chloridi, giss Acidi muriatici, f-gss Decocti hordei compositi, Oj. M. A small wineglassful every two or three hours. Argenti Oxidum, in doses of gr.ss-j, thrice daily, has been recommended, in atonic hasmoptysis. Copaiba is much employed by Prof. Niemeyer (F. 403). Creasotum fails to give satisfactory results. Cupri Sulphas is highly recommended, by Prof. Da Costa, in cases of persist- ent slight hemorrhage (F. 393). *Digitalis is advised by Dr. Walshe when there is irritable heart and moder- ate haemoptysis. By some it is regarded as the best remedy for hemorrhage from cavities in the advanced stages of phthisis (F. 39M, 399). 166 DISEASES OF THE RESPIRATORY SYSTEM. Erqota is strongly recommended by Dr. Dobell, who, however, usually asso- ciates it with other remedies (F. 398, 399, 402). Ferrum is particularly of service in haemoptysis connected with amenorrhoea. The preparations most employed are the tincture of the chloride, the solution of the nitrate (in large doses, n\,xxx-lx), and the sul- phate (P. 390, 393). **Gallicum Acidum is highly recommended by Prof. Da Costa, Walshe, and others, as one of the best remedies in haemoptysis, but it must be given in large doses (F. 392, 398). Hydrocyanicum Acidum seems to possess some power in controlling haemop- tysis when the system is irritable and spasmodic symptoms are present. * Ipecacuanha is recommended by Prof. Graves and other practitioners, as a remedy of considerable value. From one to two grains are given every fifteen or thirty minutes until nausea is felt, when the benefit is generally evident, and the medicine is discontinued. Many cases are reported attesting the efficacy of this treatment in arresting the hemorrhage and restoring heat and life to patients who were in a state of collapse from excessive loss of blood. Although it is better to avoid vomiting, no ill effects, it is said, are produced by it. The haemoptysis of the early stages of phthisis may often be readily ar- rested by this remedy. Matieo is sometimes employed. In slight cases the infusion alone is often sufficient. Phosphoricum Acidum, Dilutum, in doses of gtt.x-xxx in mucilage, thrice daily, is reported upon favorably by M. Hoffman (The Practitioner, August, 1868). who considers it superior to other mineral acids in haemoptysis. * Plumbi Acetas. in combination with morphia and acetic acid, or with opium, is a remedy much used. Dr. Pereira considers that the action of sugar of lead and opium in haemoptysis is rendered more certain and speedy, by being given with a draught containing nitric acid, nitrate of lead being thus formed in the stomach. Potassii Nitras is useful when there is much excitement and fever, but is not to be relied upon alone. It may be given in doses of gr.viij-x, several times daily, largely diluted, or combined with tartar emetic or digitalis. Sodii Chloridum is recommended, by Prof. Walshe, in drachm doses, either in powder or dissolved in water. It is sometimes promptly success- ful, even when it produces emesis. *Sulphuricum Acidum Dilutum is a useful remedy, though less certain in its action than gallic acid, and is a valuable adjunct to other treatment. (F. 398, 400, 405). Tannicum Acidum, in combination with opium and ipecacuanha, has been highly recommended. Terebinthince Oleum deserves a trial, if other less nauseous remedies fail (F. 391). Refrigerants are useful adjuncts to treatment. Nitrate of potassium, sul- phuric acid, or cream of tartar (F. 388, 398) may be employed. Hypodermic Injections of Ergotine are recommended, by Prof. Walshe, as deserving of trial. Frigus. Ice cautiously applied to the spine, or over the heart, will sometimes instantaneously arrest the flow, heat being also applied to the extremities. Inhalations. The following have been advised : alumen (F. 397); ferri chlori- dum (F. 394); ferri subsulphas (F. 395); tannicum acidum (F. 396). LARYNGITIS. 167 LARYNGITIS. PROF. WILLIAM AITKEN, M. D., EDINBURGH. If there be time, in a case of acute laryngitis, commence by the inhalation of the steam of boiling water, as much by the nostrils as possible. Leeches, followed by hot fomentations, may be ap- plied to the throat. If benefit do not follow these remedial measures, tracheotomy ought not to be delayed. The air for respiration ought to be warm and moist, and plenty of it, through a large-sized canula, the orifice of which must be kept clear of secretion. PROF. J. M. DA COSTA. M. D., PHILADELPHIA. 407. R. Ammonii chloridi, gr.x-xx Aquae destillatae, f.gj. M. Use with any form of steam atomizer, throwing a tine spray. In laryngeal catarrh, acute as well as chronic. The dose best borne is not above ten grains to the ounce, although as much as two drachms to the ounce have been employed. THOMAS HAWKES TANNER, M. D., LONDON. 408. R. Acidi hydrocyanici diluti, n^xv Spiritus chloroformi, f-giij Aquas bullientis, f-Iviij. M. For inhalation. The patient should frequently inhale the steam from medicated boiling water, and in the interval it will prove advantageous for him to wear a respirator. He is to be closely watched, kept very quiet, and not allowed to talk. The air of the room must be made warm and moist. L. WALDENBERG, M.D., BERLIN. 409. R. Sodii chloridi, gr.iv-x Aquae destillatae, f.gj. M. For inhalation in acute laryngeal catarrh by means of nebulizer. LONDON HOSPITAL. 410. R. Tincturae benzoini compositae, f.gj Aquae bullientis, f.gx. M. Let the vapor be inhaled frequently. 411. R. Tincturae iodinii, n\,xl Aquae bullientis, f.gx. M. To be inhaled frequently. RESUME OF REMEDIES. Acidum Carbolicum. The inhalation of pulverized solutions of carbolic acid (gtt.j-v to f.gj, aq., with a few drops of glycerine added) is frequently of service. Alumen, as an emetic (teaspoonful doses mixed with honey or syrup, and repeated every ten or fifteen minutes until it operates), is an excel- lent remedy in pseudo-membranous laryngitis. See Croup. 168 DISEASES OF THE RESPIRATORY SYSTEM. Antimonii et Potassii Tartras is sometimes employed in pseudo-membranous laryngitis as an emetic, but is inferior to sulphate of copper or alum. See Croup. Argenti Nitras, in solution, is a very useful local application. Balsamum Peruvianum. The recommendation originally made by Hoffman, in chronic inflammation of the larynx, of diffusing the vapors of the balsam of Peru, or of benzoin or tolu throughout the air of the patient's room, by throwing the drug upon hot coals, is an excellent one. Or, the vapor may be inhaled through an inhaler. Benzoinum is of service in strumous laryngitis. The following formula may be ordered:— 412. R. Tincturae benzoini compositae, Mucilaginis acacias, Syrupi papaveris, aa f.gj Aquae cinnamomi, f-gvj. M. For one dose. Bismuthi Subnitras has been found highly efficacious, applied by means of insufflation. Calx. Lime water has been successfully employed in pseudo-membranous laryngitis. See Croup. Catechu is an excellent ingredient for lozenges to be held in the mouth. Glycerina is often a beneficial topical application. Hydrargyrum. For the use of mercury in pseudo-membranous laryngitis, see Croup. Inhalations are frequently employed with great benefit in this disease. The following are the principal preparations used:—Ammonii Chloridum (F. 407); Balsams of Peru and Tolu (vapor generated by placing them upon hot iron) ; Benzoinum (vapor generated by throwing the drug upon hot coals, and thus impregnating the patient's apartment, or from a common inhaler, F. 410); Hydrocyanicum Acidum Dilutum (F. 408); lodinium (F. 411); Olibanum (vapor generated by placing the gum-rosin on burning coals); Sodii Chloridum (F. 409) ; Sul- phur osum Acidum (spray or fumigation); Vapor of Hot Vinegar; Steam of Boiling Water (as much as possible by the nostrils). lodinium. Iodine inhalations, and the application of tincture of iodine to the fore part of the neck, are advantageous forms of treatment in chronic laryngitis. Ipecacuanha is an excellent remedy in simple catarrhal laryngitis, of the spas- modic form. Potassii Chloras, in doses of gr. vj-xviij, two or three times a day, has been used with success in pseudo-membranous laryngitis. See Croup. EXTERNAL REMEDIES. Baths of hot water are often of great value. Blood-letting, to be advantageous, must be employed early and copiously, when the powers of the patient are beginning to sink, it will hasten the fatal result. Leeches to the throat are advised by Dr. Aitken and others, but wet-cupping at the nape of the neck is preferred by some practitioners. Cantharis. Blisters are injurious in the acute, but often beneficial in the chronic form. Counter-irritants are of benefit in chronic laryngitis. The following may be employed :—Tartar-emetic Ointment (not much used); Sub-clavicular Setons (three or four silk threads); pustulation of the skin of the throat by croton oil. PHTHISIS. 169 PHTHISIS. PROF. WILLIAM AITKEN, M. D., EDINBURGH. 413. R. Olei morrhuae, f.giss Olei creasoti, gtt.iv Pulveris tragacanthas, Pulveris acaciae, Pulveris amyli, aa Bj Sacchari, gj Aquas anisi, f.givss. M. Take two tablespoonfuls three times a day. This is recommended as making a palatable mixture. The creasote is said to render the stomach more tolerant of the remedy. Besides cod-liver oil, other animal fats and oils, where they can be taken and assimilated, are sure to be followed with benefit. Hence milk rich in fatty matters, such as asses' milk, and milk drawn from cows at a short interval after the greater part of their milk has been withdrawn, are found to be followed by improve- ment, where they are persevered in and are assimilated. So, also, with cream and butter. Dr. Bennett instances the partial success occasionally of caviar, bacon, pork, mutton chops and the marrow of bones of oxen; while Dr. Thompson instances the good effects he has obtained from the use of oil from the foot of the young heifer (neat's foot oil). But medicine is utterly powerless and useless, unless hygienic means are carried out to the uttermost. They may be enumerated as follows:— I. A constant supply of pure and fresh air for respiration. II. Active exercise in the open air. The risk is in staying in the house, and not in going out of it. III. It is important to secure for the patient a uniform, shel- tered, temperate, and mild climate to live in, with a temperature about 60°, and a range of not more than 10° or 15°; where, also, the soil is dry and the drinking-water pure and not hard. IV. The dress of the scrofulous patient ought to be of such a kind as to equalize and retain the temperature of the body. Water- proof coats, boots, and shoes are to be condemned. Flannel ought to be invariably worn next the skin in all seasons. V. The hours of rest should extend from sunset to sunrise. VI. In-door or sedentary occupation should be suspended; but out-door employment in the fresh air, even in the midst of snow, has been and may be advantageous. 170 DISEASES OF THE RESPIRATORY SYSTEM. VII. Cleanliness of body is a special point to be attended to. VIII. Marriage of consumptive females, for the sake of arrest- ing the disease by pregnancy, is morally wrong and physically mischievous. IX. The medicinal treatment must be adapted to the site of the local deposits and the general nature of the particular case. To promote and preserve an appetite for food should be con- stantly kept in view as one of the great objects of treatment. The following chalybeate very rarely disagrees :— 414. R. Vini ferri, f.gij. A teaspoonful thrice daily. 415. R. Pilulas saponis compositae, Pilulae scillae compositae, aa Bj- M. For 8 pills. One at bedtime, to procure sleep. Two may be given if the cough is troublesome. Or, 416. R. Pulveris ipecacuanhas compositae, B*v Tincturae scillae, Tincturae tolutanas, aa f.gij Misturae acaciae, f.giss Aquam, ad. f.giij. M. A dessertspoonful at night, to quiet the cough. J. F. CHURCHILL, M. D., PARIS. •* The treatment of phthisis by the hypostfdphites prepared by Dr. Churchill, has been highly vaunted. The author claims that from the first day of their use there is frequently observed a remarkable increase of nervous power, with a feeling of vigor, strength, and comfort, to which the patient has been long unaccustomed. The digestion is invigorated and the appetite increased. The bowels become regular and the evacua- tions more copious and less frequent. The cough is relieved, the sleep becomes calmer and more profound, whilst the night sweats diminish or cease altogether. The face becomes fuller, the lips red, the eyes brighter. If these results be not produced, either the salts are impure, or they are not administered in accordance with the rules laid down by Dr. Churchill, or the patient is suffering from a complication of some other disease, independently of consumption, or the extent of lung structure involved is too great to hope for much benefit. It is especially as a prophylactic that the hypophosphites are recommended by the author, who states that if, without any appa- PHTHISIS. 171 rent cause, or under the influence of any cause which induces weak- ness and exhaustion, such as want, grief, over-fatigue, excess, pregnancy, child-bearing, nursing, rapid growth, slow recovery from illness, a person begins to lose strength, flesh, or appetite, if he suffer from pain in the chest or back, or from shortness of breath; if he complain of sleeplessness, and experiences a general feeling of languor and depression, there is reason to believe that he is predisposed to consumption, or is even already laboring under the general disease. If to the above symptoms be added cough, however slight, especially if it should have come on slowly and during the fine weather season, the probability is greater still. If, with all this, there is feverishness towards evening, sweating, or clamminess at night, particularly about the head or neck, if spitting of blood should occur, it is probable that the complaint has already arrived at the stage of local manifestation in the lungs. Now if, on the earliest appearance of these signs, particularly those first enumerated, the patient takes daily one or two tablespoonfuls of syrup of hypophosphite of lime or soda, he will usually find all the symptoms disappear, and by continuing the remedy, prevent their return. When all the symptoms shall have disappeared, through the use of the hypophosphites, it will be necessary to continue the treatment for a few months, gradually diminishing the doses, ceas- ing altogether for a week or two, then beginning again. In this way the disease may be completely eradicated. Dr. Churchill's usual method of treatment is to give a table- spoonful of the syrup of hypophosphite of soda or lime (of the strength of six grains of the salt to the fluid ounce), once or twice a day, in the absence of any inflammatory symptoms. Sometimes a teaspoonful of syrup of hypophosphite of lime in the morning, and the same dose of syrup of hypophosphite of soda at night. For females, particularly persons of nervous temperament or deli- cate constitution, leading a sedentary life, and unused to physical exertion, the dose should be decreased one-half. For children from seven to fifteen, the dose is the same as for females. From two to seven years of age, one or two teaspoonfuls daily, of the syrups, are sufficient. For infants of a more tender age, the dose should seldom exceed a quarter or half a teaspoonful in twenty-four hours. The syrups may be taken alone or in a wineglass of water, and should, in general, be exhibited at meal time, either before or after. They have no medicinal taste whatever. % 172 DISEASES OF THE RESPIRATORY SYSTEM. Contra-indications. 1. The use of the hypophosphites ought not to be commenced during an acute inflammatory state. 2. Their employment should be temporarily suspended, if, during the course of the treatment, the patient be attacked by any inflamma- tory complication; but resumed as soon as the acute complication shall have disappeared. 3. They should not be given during an active haemoptysis, but may, however, be administered boldly, and without fear, in chronic haemoptysis of a passive form. 4. Their effects should be carefully watched, in the case of patients affected with disease of the heart. 5. The dose should not be too high nor the administration too prolonged. Great mischief may result from incautiously pressing the remedy. Among the signs which indi- cate that the hypophosphites have been given in excessive doses, are lassitude, wandering pains, headache, buzzing in the ears, vertigo, sudden loss of appetite and strength, and above all, bleed- ing at the nose, however slight the loss of blood may be. MEREDITH CLYMER, M. D., NEW YORK. Counter-irritation to the chest walls, in the earlier stages, before there is much loss of strength, is undoubtedly beneficial; but later it is weakening and annoying. Croton oil liniment is chiefly used for this purpose. A prompt and not too severe application is the following ointment (recommended by Dr. Fuller) :— 417. R. Hydrargyri chloridi mitis, gr.viij Iodinii, gss Alcoholis, f.giss Unguenti, gj. M. Rub in a portion over the affected lung, morning and evening, until a pustular eruption comes out DR. OORBEL-LAGNEAU, FRANCE. 418. R. Iodinii, J}iv Althaeas pulveris, %x Potassii nitratis, gj Alcoholis, q. s. Aquae, q. a. M. Triturate the iodine with the alcohol, to obtain a minute division, add the nitrate of potassium and the marshmallow, make a fine mixture, and by means of the water, a firm paste, which divide into ten equal cones. One or two to be burned, morning and evening, in the chamber of persons affected with phthisis. J. WARING CURRAN, M. D., DUBLIN. 419. R. Zinci oxidi, gr j: Extraeti conii, „r; yi For one pit, to be taken three times a day. The quantity of the oxide of zinc is gradually to be increased. PHTHISIS. 173 In the latter stages of phthisis, where profuse sweating and col- liquative diarrhoea harass the patient and rapidly lower the vital capacity, this combination is very effective. It is of great value also in the earlier stages of the disease. It seems to steady the nervous system and act as a sedative to the wandering pains. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 420. R. Morphiae acetatis, gr.ij Potassii cyanidi, gr.j Acidi acetici, f.gj Extracti pruni virginianae fluidi, Misturae acaciae, aa f.gij. M. A teaspoonful four or six times a day, as a sedative mixture, for the cough of phthisis. 421. R. Liquoris morphias sulphatis, f.gj Extracti pruni virginianae fluidi, f.gij Acidi sulphurici diluti, f.gij. M. A teaspoonful three or four times a day, when night sweats and cough are troublesome. 422. R. Syrupi hypophosphitis, f.giij. A teaspoonful thrice daily, after meals. 423. R. Extracti opii, gr.ss Aquae, f.gj. M. For one inhalation, twice a day, by means of any form of steam atom- izer throwing a fine spray. In the irritative cough of phthisis, causing gastrio irritability. 424. R. Tincturas iodinii compositae, n\,x Aquae, f.gj. M. For atomization. 425. R. Tincturas ferri chloridi, f.gj Acidi muriatici diluti, f.gij. M. Twenty-five drops in sweetened water drawn through a tube before meals. In the treatment of tubercles in the lungs, complicated with tubercular diarrhoea and impairment of digestion. Also the following :— 426. R. Extracti opii, 9j Plumbi acetatis, J)ij. M. Make into 20 suppositories. One to be introduced morning and evening, 427. R. Syrupi hypophosphitis, Extracti pruni virginianae fluidi, aa f.gij. M. A dessertspoonful thrice daily. 428. R. Olei morrhHae f.gj Aquas menthae piperitas, f.gss Tincturae aurantii, f.gss Misturae acaciae, f.giijss Olei gaultheriae, tibx. M. A dessertspoonful three times a day. This formula disguises some- what the taste of the cod-liver oil. 174 DISEASES OF THE RESPIRATORY SYSTEM. Or, 429. R. Olei morrhuas, f.gss. For one dose; to be taken three times a day in carbonic acid water. Place in a tumbler a small amount of any preferred syrup (orgeat or sarsaparilla is the best adapted to disguise the taste of the oil), and fill up with carbonic acid water, from a bottle fur- nished with a syphon for table use; then, while it is still foaming, put in a tablespoonful of the oil. It is astonishing how perfectly the taste is concealed in this manner. Other modes of taking the oil are, floating on ice water, in lemon juice, and in the froth of porter. Less than a tablespoonful is not worth taking. The best time for its administration is between meals, after the process of digestion is pretty well finished. Persons are exceptionally met with who take it in preference just before meals, and thus avoid the disagreeable eructations. Nobody likes to take it the instant after meals. 430. R. Acidi arseniosi, gr.j Ferri lactatis, gss Syrupi, q. s. M. For 30 pills. One thrice daily. Arsenic is an agent which may frequently be employed with ad- vantage in cases of slow consumption. It may be given as above, or as follows :— 431. R. Liquoris potassii arsenitis, f.gij Extracti pruni virginianae fluidi, f-Iiij- ^ A teaspoonful thrice daily. , 432. R. Calcis hypophosphitis, gss Sodii hypophosphitis, gij Misturae acaciae, f.giij. M. A teaspoonful thrice daily, with plenty of cream, eggs, etc., about three ounces of whisky daily and F. 420 for the irritative cough. In a case in which cavities had formed in the lungs. 433. R. Quiniae sulphatis, ^ij Acidi tannici, Qj Extracti gentianae. q. g. M. For 20 pills. One thrice daily, to reduce night sweats. HORACE DOBELL, M. D., LONDON. Our author, after a long series of observations, and a process of inductive reasoning, arrived at the conclusion that in tubercular disease there is a defective action of the pancreas on fats, and par- ticularly on solid fats, and thus was led to study the action of the PHTHISIS. 175 secretion; first, with the view to determine its exact character and nature; and secondly, to find some means of obtaining and pre- serving the active principles of the pancreas in a form suitable for administration as a remedial agent. He was thus led to the inven- tion and use of the " Pancreatic Emulsion of Fat" and " Pancrea- tine." It is the best to give the Pancreatic Emulsion from one to two hours after a full meal, such as breakfast or dinner, particularly avoiding a longer interval, and also avoiding warm drinks for two or three hours afterwards. When cod-liver oil agrees, give a tablespoonful of oil directly after breakfast, to supply olean to the blood through the portal system, and a tablespoonful of emulsion, in a cup of milk or water, two hours after dinner, to supply the blood with pancreatized solid fats through the lacteal system. If cod-liver oil cannot be taken, give the emulsion two hours after breakfast, and two hours after dinner. In the very few cases in which the stomach does not easily tolerate the emulsion, it is due, almost as a rule, to excessive acid- ity of the digestive fluids; and an alkaline powder of soda and columbo, or an effervescing draught of citrate of sodium and potas- sium, given before the meal which precedes the dose of emulsion, generally overcomes the difficulty. It must be borne in mind that some adults cannot digest milk, and in these cases the emulsion should be mixed with water instead. Brandy or rum may be added in any case, if preferred, and a small plain biscuit should be taken after the dose {Lancet, November 17, 1866). Pancreatine is given in doses of three to five grains, in wine or water, or on bread and butter, directly after food, or immediately after each dose of cod-liver oil. Dr. Dobell has prescribed the " Pancreatic Emulsion " in about 2500 hospital cases, and in 187 cases in private practice. Of the latter careful notes were taken and published in the London Lancet. In the 187 published cases, emulsion agreed in 180; disagreed in seven. Cod-liver oil agreed in 75; disagreed in 98 ; was not tried in 14. In these 187 cases no cod-liver oil was given during treat- ment with emulsion, so as not to confuse the effects of the two remedies. But in daily practice, Dr. Dobell recommends both oil and emulsion to be taken, if the stomach will bear them. The proportion of cases in which emulsion agrees will not be as large as here stated, unless care is taken to correct obvious defects in 176 DISEASES OF THE RESPIRATORY SYSTEM. digestion by other remedies. In the true first stage, our author's experience is derived principally from private practice, such cases not often appearing at hospitals. Of the 2500 hospital cases who have taken the emulsion, many have been in an extremely ad- vanced stage of disease; and in some of these the emulsion has appeared to prolong life in a remarkable manner, being retained on the stomach long after all other kinds of food had ceased to be tolerated. The experience of the effects of the Pancreatic Emulsion of Fat, as referred to in several journals by a number of independent observers, corresponds in a remarkable degree with the result of Dr. Dobell's investigations and experiments. PROF. BALTHAZAR W. FOSTER, M. D., LONDON. 434. R. ^Etheris, f.^ijss Olei morrhuae, f-giv. M. Dessertspoonful thrioe daily, before meals. This is a new physiological attempt to introduce cod-liver oil into the system, by overcoming the difficulty of assimilating fat, which is developed to the greatest extent at the very stages of the disease in which perfect assimilation is most needed. To pour oil into a patient's stomach, without at the same time taking measures to insure its digestion, is a crude kind of therapeutics. Experi- mental physiology has taught us that the only fluids in the body which have the power of acting upon fat, so as to render it fit for absorption, are the secretions of the pancreas and the duodenal glands. iEther has the power of stimulating the glands to renew their healthy action and places the fatty matter in a state of fine division with their abundant secretion. It also masks the un- pleasant taste of the oil. PROF. FURTER, MONTPELLIER. Our author reported some time ago, before the Paris Academy, his treatment of phthisis, as employed with good results at the clinic in Montpellier, under his charge. It consists in the use of raw mutton or beef, given in conjunction with strongly diluted alcohol, in small doses. 435. Take some finely minced raw mutton or beef, and roll it up in sugar or in a saccharine elec- tuary. Give in teaspoonful doses to the amount of T3jj of an ounce per day. PHTHISIS. 177 436. R. Alcoholis, f.gj Syrupi, f.giij. M. A teaspoonful dose every hour. The dose and frequency of adminis- tration are to be modified by the patient's individuality. PROF. R. J. GRAVES, M. D., DUBLIN. 437. R. Quiniae sulphatis, gr.iss Acidi sulphurici diluti, f.gss Tincturas hyoscyami, Ti^xxv Infusi cascarillas, fgiij- M. To be given during the day, in three doses, to combat the night sweats in beginning tubercular phthisis. 438. R. Antimonii et potassii tartratis. gr.xxx Ipecacuanhas pulveris, gj Olei tiglii, gtt.xx Unguenti rosae, gj. M. A useful ointment to produce slight counter-irritation in delicate women and children. DR. GUENEAU DE MUSSY, FRANCE. 439. R. Belladonnae radicis pulveris, gr-xv Acaciae pulveris, Bvij. M. To be used as a snuff, ten or twelve times a day, by consumptive patients with tickling sensations in larynx, and attacks of dry and painful coughing. 440. R. Sodii bicarbonatis, gijss Sulphuris loti, Bismuthi subnitratis, aa Qij. M. Divide into 20 powders. Give one every two hours. Four or five days of treatment suffice to suspend or notably lessen the night sweats of the consumptive patient, of whom the condition is greatly improved at the end of several weeks. PROF. JACCOUD, PARIS. On the Administration of Arsenic in Phthisis.—In chronic phthisis, so soon as the phenomena attributable to anaemia have been remedied by iron, or in the. absence of amelioration after a de- lay of a couple of months, the author abandons ferruginous prepa- rations, and has recourse to arsenical medication. He employs ex- clusively granules of arsenious acid, of gr.^ each, and administers them at the commencement of each of the two principal meals. He commences with two a day, amd every week increases two a day, until eight or ten a day are given. When this maximum dose is attained, he maintains it indefinitely, unless phenomena of intoler- ance make their appearance, such as cramps, inflammation of the eyes, cutaneous eruptions, vomitings, diarrhoea. Then, however, he does not stop the medicine, but diminishes, temporarily, the 12 178 DISEASES OF THE RESPIRATORY SYSTEM. dose, and returns, as soon as possible, to the maximum of tolera- tion. Arsenic acts powerfully upon the nutritive processes in chronic pulmonary phthisis. It quiets the nervous excitement, and pos- sesses an anti-febrile action sufficiently marked to effectually com- bat the evening intermittent fever. So long as the disease remains chronic, and does not develop acute attacks of pseudo-continuous fever, the arsenical medication ought to be maintained at the maximum of toleration, conjointly with the special regimen, cod-liver oil, cinchona and alcoholized raw meat. On the Administration of Cod-liver Oil in Phthisis.—When the cod-liver oil is badly supported alone, in chronic pulmonary phthisis, the author adds to it brandy, rum, kirsch or whisky, in the pro- portion of two parts of the oil to one of the spirit, and recommends the patient to close the nostrils at the moment of swallowing it. He commences by small doses of the oil and spirit mixture; then two tablespoonfuls a day, and advances to five or six fluid ounces a day. On the Administration of Iron in Phthisis.—The author re- serves the employment of ferruginous preparations for those cases where the patients present the certain signs of globular anaemia. He gives, in preference, the syrup of the iodide of iron to young children, and the pills of the iodide of iron in other cases. From four to eight of these pills are to be taken a day, at the commence- ment of the meals. He advises not to administer the iron where there has been recent hasmoptysis. On the Administration of Raw Meat in Phthisis.—In the treat- ment of patients with whom the physician is obliged to dissimulate, he may order the pulp of raw filet of beef, well deprived of all fibrous matter, in some unleavened bread, under the pretext of administer- ing medicinal boluses. When he can act openly the author pre- fers to mix the pulp of the raw meat, properly prepared, with brandy, rum or whisky, in such a manner as to obtain a dough-like mass, which the patient takes with sugar or salt, according to taste, in tablespoonful doses, during the day. This mixture is very palat- able, and does not produce that rapid intolerance which is often observed with other meat preparations. On the Employment of Counter-irritation in Phthisis.—The author, in acute phthisis, attacks the pulmonary disorder by means PHTHISIS. 179 of large flying blisters, renewed without interruption. Instead of the ordinary dressing, he covers the vesicated surface, and envelops it in every direction, a finger's breadth, by diachylon plaster. On removing the protecting plaster at the end of four days, the cicatri- zation is found complete. In commencing chronic phthisis, the author applies, under the clavicle of one or both sides, cauteries of Vienna paste, of the size of a sixpence at the maximum, and repeats these punctiform cauteri- zations as long as any favorable influence is noticed. 441. R. Extracti cinchonas, gss-j Tincturas canellas f.gij Syrupi aurantii corticis, f.gj Vini rubri, f-giv Spiritus vini gallici, f-3J-iij- M. A tablespoonful every couple of hours, in the exhaustion and delirium of acute phthisis. The patient should also take meat broth or beef essence several times a day. 442. R. Vini cinchonas f-giv Tincturae canellas, f.gij Syrupi aurantii corticis, f.gj Spiritus vini gallici, f-3j-iij. M. To be used in the same manner as the above formula, the wine of cin- chona replacing the extract and making a mixture not so thick. 443. R. Digitalis, gr.v-vij Aquas bullientis, f.gj. M. Make an infusion, filter and add 444. R. Extracti cinchonas, gss~j Tincturas canellas, f.gij Syrupi aurantii corticis, f.gj Vini rubri, f.giv Spiritus vini gallici, f.gj-iij. M. A tablespoonful to be given every hour when, in acute phthisis, the pulse is nearly effaced and the symptoms of cyanosis and dyspnoea increase. The digitalis is to be withdrawn so soon as the contractil- ity of the heart is restored. 445. R. Chlorali, gijss Olei morrhuae, f-3vj. M. One or two tablespoonfuls in the evening, to induce sleep, lessen night sweats, and awaken the appetite. The cod-liver oil, to which chloral is added, is less nauseous than the pure oil. 446. R. Spiritus vini gallici, f.giij Tincturae canellas, f.gj Syrupi, Aquas, aa f.giss. M. Dose, a tablespoonful. A convenient way of administering alcohol when indicated in phthisis. 180 DISEASES OF THE RESPIRATORY SYSTEM. RODERICK MACLAREN, M. D., CARLISLE, ENGLAND. Our author recommends a long sea voyage in phthisis pulmonalis, and prefers the Australian one. But a sea voyage is a rough remedy, and it cannot be expected that it will be beneficial in every case. To send away a patient who is in the last stage of phthisis, with night sweats, diarrhoea, and cavities in the lungs, is only cruelty; to hope even to survive the remedy, he must be able to stand some fatigue, to bear even some further reduction in strength without being brought to a stage from which there is no return; for the possibility of sea- sickness at the outset must be considered; or even without this— for, strange to say, phthisical patients often escape it—there is change of mode of life, and probability of stormy weather, to be taken into account, and there is the chance of detention in the tropical calms, which produce loss of appetite, profuse perspira- tion, and often diarrhoea. The cases which offer the best prospects are those in which the patient undertakes the voyage before pulmonary alteration is far advanced; and especially when, in addition to close confinement, long hours at business, or close application to mental work seems to have been a predisposing cause of the illness; also those in which the progress of the disease is very slow, which improve during a favorable, and grow worse during an unfavorable season, year after year. When the infiltration of the lung is localized and chronic, when it is confined to the one side, and there is absence of evi- dence of disease elsewhere, it may be looked on as a favorable case, and the further the departure from this condition the less are the patient's chances of benefit. It is stated that cases in which haemoptysis is the first, or at least a very early symptom, do especially well. Cases are unsuitable for a voyage, in which there are signs of extensive progressive excavation, and all in which there is great muscular weakness. When we have evidence of the disease being general, as shown by glandular, bowel or laryngeal disease, our recommendation should certainly be withheld. The bowels in particular should be in good trim, for the sedentary life and peculiar diet of a ship are apt, in healthy people, to produce intestinal disturbance (constipation and subsequent diarrhoea, or either of these alone). In a case which persistently grows worse under favorable circumstances of habitation, etc., on shore the prospect of benefit would be small. A phlegmatic habit of body PHTHISIS. 181 should also be looked upon, to a considerable extent, as a counter- indication for this remedy. While speaking on this part of the subject, it is to be borne in mind that during its early stage phthisis is a curable, perhaps a very curable disease, under proper treat- ment. In its later stages it is cured with difficulty, and a sea voyage does not seem in any degree to lessen this difficulty. A. MALET, M. D., RIO DE JANEIRO. Our author gives {Bulletin Generate de Therapeutique, August 30th, 1868), in the therapeutics of pulmonary phthisis, the prefer- ence to the iodide of calcium in all cases not of syphilitic origin. He does not claim it as a specific, but says it awakens the appetite, regulates the digestion, renders the respiration freer and deeper, diminishes the cough and modifies the expectoration, increases the strength and lessens the perspiration. If constipation ensue in consequence of its long use, it will often disappear of itself; other- wise the dose may be diminished, or the remedy temporarily stopped. He gives the iodide of calcium in a simple aqueous solution, to be taken at meal-times. Not more than eight grains of the salt should be given, in divided doses, during the day. A larger amount than this does harm. DRS. MONTARD MARTIN AND HEEARD, PARIS. 447. R. Acidi arseniosi, gr.j. For 60 granules. Seven or eight a day, of these granules, to be taken at first, the dose to be speedily carried up to ten or fifteen. Never more than two should be given at a time, and they should be admin- istered as often as possible before meals. The treatment should be suspended from time to time. Researches have shown the entire harmlessness of arsenic, when properly employed, as well as its undeniable efficacy in certain forms of tubercular phthisis. Almost all the patients, after a few days' treatment, exhibited a marked improvement in their general condition. The appetite improves, the strength returns, the com- plexion is clearer, and the eye is more animated; and at the end of three weeks or a month flesh begins to be gained. The local malady undergoes less change; but even this is sometimes sensibly modified. The most favorable cases are those in which there is no acute fever or serious digestive disturbance. M. Lolloit, the most recent observer, finds that the daily administration of one- tenth of a grain produces a diminution of temperature, and a very notable diminution in the amount of urea. 182 DISEASES of the respiratory SYSTEM. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. Cod-liver oil has a special and well-merited reputation. On the other hand, perhaps, no remedy has ever been so much abused as this one. Whoever supposes that the mere presence of a thick nose, a sore upper lip, or a bunch of enlarged cervical glands, affords sufficient grounds for the prescription of this medicine, will often fail to benefit his patient, and sometimes will do him harm. Daily experience teaches, however, that such is the general belief, and that he who seeks to combat it does not merely fight a wind- mill. A most serviceable means of distinction between the cases in which cod-liver oil is indicated and those in which nothing is to be expected from it, is afforded by the symptoms of the torpid and erethitic forms of scrofula. When the patient's slender frame, the lack of fat beneath his skin, and his accelerated pulse warrant the belief that his nervous system is in a state of over-activity, cod- liver oil is generally of most signal benefit. Under its use the plumpness of the body increases, while the general susceptibility of the system, and the diseases consequent upon it, subside. These are the cases to which this article owes its name as an anti-scrofu- lous remedy. But if the patient be clumsy and thick-set; if the nose and upper lip be enlarged, and the adipose layer over the rest of the body strongly developed; if the action of the heart be retarded rather than accelerated; if the irritability of the nervous system seem unusually obtuse; in short, should there be reason to suppose that the waste of the system is diminished rather than increased, we cannot hope to relieve the disease by means of the oil. Nevertheless, it is precisely this class of patients who in vain have taken such enormous quantities of it in the course of their lives. Besides the oil, and as a corroborant of its effects, so to speak, articles containing a little tannin, such as parched acorns, " acorn coffee" and home-made infusion of walnut leaves, are very often prescribed. Such a practice is greatly to be commended whenever there is a chronic catarrh of the intestines, embracing the diges- tion and the absorption of chyle, and where apprehensions are entertained that the oil may aggravate the intestinal disorder. In order to make children take the acorn coffee as willingly as real coffee, it is sufficient to add a few coffee beans to the acorns before roasting them. In the treatment of phthisis, fever is the symptom which prin- cipally demands attention whenever it persists at all severely, in PHTHISIS. 183 spite of the remedies directed against the main disease. Digitalis and quinia have a well-merited reputation as means of arresting the abnormal calorification, and reducing the animal heat, in spite of the continuation of the disease. 448. R. Pulveris digitalis, Pulveris ipecacuanhae, Pulveris opii, Extract helenii, For 20 pills. One three times a day. Add quiniae sulphatis, Bj, to the above prescription when the type assumed by the fever becomes periodical, the evening exacerbations severe, and the chills by which they are ushered in pronounced. Our author is so much in the habit of using this (known as Heim's) pill, with or without quinine, in consumption, when the fever proves refractory to other remedies, that it has become a very common prescription at his clinic. The exhibition is sus- pended whenever a distinct reduction of the temperature and of the frequency of the pulse becomes apparent, and is resumed so soon as the effect subsides. Patients pretty soon learn to judge for themselves when it is time to stop the pills, and when to resume them. DOUGLASS POWELL, M. D., BROMPTON. 449. R. Potassii chloratis, Bij-iij Morphiae muriatis, grs.iss-ij Glycerinae, f-gss Syrupum, ad. f.giv. M. A teaspoonful, to be swallowed slowly, in the rawness of the tongue and painful deglutition of advanced phthisis. It acts locally on the parts affected, relieving at the same time the cough. Of course, in the latest stages of the disease this will but render the remaining hours of life more comfortable; but there are some cases where this condition of the tongue and throat will come on earlier, and by rendering the taking of nutrients or stimulants almost impossible, cause death from exhaustion. In such instances, the above combination relieves pain, cleanses the tongue, and enables the patient to take nourishment and remedies which greatly prolong life {Lancet, December 19, 1868). DR. SUNDERLIN. 450. R. Ammonii chloridi, gr.xxx Opii pulveris, gr-'lx Digitalis pulveris, Scillae pulveris, aa gr.xv. M. Divide into 30 pills. One every six hours, to quiet the cough and facilitate the expectoration in the early stage of phthisis. gr.x aa gr.v q. s. M. 184 DISEASES OF THE RESPIRATORY SYSTEM. 451. R. Morphiae sulphatis, grj Syrupi ferri iodidi, i-EBa Glycerinae, f.gijss. M. A teaspoonful two or three times a day, to quiet the cough and re- tard the emaciation in phthisis. THOMAS HAWKES TANNER, M. D., LONDON. 452. R. Ferri iodidi, gr.vj-xviij Glycerinae, f.gij Infusum calumbae, ad. f.gvj. M. Two tablespoonfuls three times a day. In strumous ulcers, etc., where the stomach will not tolerate cod-liver oil, the above is useful. 453. R. Ammonii iodidi, £r-j_vj Infusi cinchonae flavae, f.gss. M. For one dose, 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 the medicine is given internally, the following ointment should be rubbed into the swelling night and morning :— 454. R. Ammonii iodidi, gj Adipis, gj. M. In cases of phthisis where the stomach will not tolerate any form of cod-liver oil, resort may be had to cod-liver oil embrocations:— 455. R. Olei morrhuas, f.giijss Spiritus ammoniae aromatici, f.gj Tincturae opii, f.gss Olei lavandulae, n\xxx. M. One-half to be rubbed over the chest and abdomen, night and morning. Or, 456. R. Olei morrhuae, f.gj Olei cajuputi, f#3j. M. To be rubbed over the chest at bedtime, and applied by means of lint well saturated with it. The cajuput oil well disguises the smell of the embrocation. 457. R. Ferri ammonio-sulphatis, gss-gj Aquae destillatae, f.gvj. M. Two tablespoonfuls every six or eight hours, in cases where, on ac- count of haemoptysis, an astringent preparation of iron is indicated. 458. R. Liquoris potassae, f.giij Tincturas cinchonae compositae, f.gvj Decoctum cinchonae flavae, ad. f.gvj. M. Two tablespoonfuls twice or thrice daily. Often beneficial in the early periods of the disease. But it is a less favorite remedy with our author than, phthisis. 185 459. R. Spiritus ammoniae aromatici, Spiritus chloroformi, aa f.gvij Morphias muriatis, gr.j Extracti cinchonae fluidi, f.gss Tincturam cinchonae, ad. f.giij. M. One teaspoonful in a wineglass 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. If the night sweats weaken and annoy the patient, they may be treated with, 460. R. Acidi gallici, gij Extracti cannabis indicas, gr.v Confectionis rosae, gr.x. M. For 10 pills. One to be taken every night at bedtime. Or, 461. R. Zinci oxidi, gr.xij Extracti conii, vel, Extracti hyoscyami, gr.xviij. M. For 6 pills. One to be taken every night at bedtime. For the relief of night sweats in phthisis and other exhausting diseases, there are few remedies more serviceable than the foregoing. SYMES THOMPSON, M. D. The tincture of the chloride of iron is far superior to other chalybeates. The improvement of appetite, diminution of flatu- lence, etc., which occur under its administration, are often remark- able, cod-liver oil and other fats, refused previously, being digested without discomfort. It both checks diarrhoea and relieves constipa- tion, by giving tone to the feeble muscular fibres of the bowels ; it lessens night sweats, though these often call for oxide of zinc in addition, and is a valuable remedy in haemoptysis {Practitioner, September, 1868). JOHN C. THOROWGOOD, M. D., LONDON. 462. R. Sodii hypophosphitis, gr.v Glycerinae, Aquas, aa f.gss. For one dose, thrice daily. In addition to Dr. Thorowgood, Drs. C. J. B. Williams and C. J. Williams (the latter one of the physicians at the Brompton Hospital), speak of the value, in phthisis, of the hypophosphites, 186 liseases of the respiratory system. which, at first so highly lauded by Dr. Churchill, of Paris, have of late fallen somewhat into disrepute. WALTER HYDE WALSHE, M. D., F. R. C. P., LONDON, EMERITUS PROFES- SOR UNIVERSITY COLLEGE HOSPITAL, LONDON, ETC. Among the conclusions at which our author has arrived in regard to the treatment of chronic consumption by cod-liver oil are as follows:— (1.) That it more rapidly and effectually induces improvement than any other known agent. (2.) That its power of curing the disease is undetermined. (3.) That it relatively produces more marked results in the third than in the previous stages. (4.) That it increases weight, in favorable cases, with singular speed, and out of all proportion with the actual quantity taken. (5.) That it sometimes fails to increase weight. (6.) That in the great majority of cases when it fails to increase weight it does little good in other ways. (7.) That the effects traceable to the oil in the most favora- ble cases, are: increase of weight, suspension of colliquative sweats, improved appetite, diminished cough and expectoration, cessation of sickness with cough, and gradual disappearance of active physical signs. (8.) That in some cases it cannot be taken, either because it disagrees with the stomach, impairing the appe- tite (without itself obviously nourishing) and causing nausea, or because it produces diarrhoea. (9.) That in the former case it may be made palatable by associating it with a mineral acid; and in the latter prevented from affecting the bowels, by combination with astringents. (10.) That intra-thoracic inflammations and haemop- tysis are contra-indications to its use, but only temporarily so. (11.) Diarrhoea, if depending on chronic peritonitis, or secretive change, or ulceration in the ileum, affords no contra-indication to the use of the oil; even the profuse diarrhoea caused by extensive ulceration of the large bowel is not necessarily made worse by it. (12.) That the beneficial operation of the oil diminishes, caeteris paribus, directly as the age of those using it increases. (13.) That the effects of the oil are more strikingly beneficial when a small extent of lung is implicated to an advanced degree, than where a relatively large area is diseased in an incipient stage. (14.) That when chronic pleurisy or chronic pneumonia exists on a large scale, the oil often fails to relieve the pectoral symptoms. (15.) That it often disagrees when the liver is enlarged, and probably fatty. (16.) That the weight may be increased by it and yet the PHTHISIS. 187 local disease go on. (17.) That weight may increase, the cough and expectoration diminish, night sweating cease, the strength which had been failing remain stationary, under the use of the oil, and yet the local disease be all the while advancing. (18.) That of the three kinds of oil, the brown, light brown, and pale, the brown is the most efficacious. (19.) That the dose of the oil at the outset should never exceed, often fall short of, a drachm; it may be taken immediately before, immediately after, or midway between meals, the idiosyncrasy of the patient being the best guide as to the fittest time. (20.) That the vehicle may be water, milk, orange wine, infusion of quassia or chiretta, weak brandy and water, or any aromatic water agreeable to the patient. (21.) That the dose may be gradually increased to half an ounce, twice, or at most, thrice in the twenty-four hours. (22.) That if there be dis- position to regurgitation of the oil, the whole daily quantity may be taken with advantage at bedtime. (23.) That if the stomach reject the oil absolutely, it may be administered in enemata, com- bined with an astringent, or by inunctions; the rectum, however, ordinarily grows irritated too soon to allow of sufficient continua- tion of the enemata; through the skin, the oil acts more effica- ciously ; often an inunction of simple olive oil after the warm bath improves the flesh, and diminishes the cough and chest irritation. (24.) That ozone, if combined with the oil, slackens the pulse some ten or fifteen beats per minute. (25.) That the attempts to prove almond oil, cocoanut oil, and neat's foot oil as efficacious as the oleum morrhuae, have failed. (26.) That some patients to whom the oil is unbearable, digest cream well; a pint to a pint and a half has been taken daily without gastric disturbance, and with mani- fest increase of flesh. (27.) That glycerine often agrees well when the cod-liver oil is unbearable, and then, especially in children, decidedly increases the weight. (28.) That the pancreative emul- sion of solid fat, recommended by Dr. Dobell (see page 175), is certainly well borne by some persons unable to digest or even retain cod-liver oil in their stomachs. Our author, without daring to endorse the statement of Berton, of Montpellier, France, that the compressed air-bath will, unaided, occasionally cure phthisis, can, however, bear witness to the great relief of dyspnoea, cough, expectoration, and constitutional ereth- ism, which may be effected by its cautious employment. Inhalation of dry iodine vapor certainly controls excessive 188 DISEASES OF THE RESPIRATORY SYSTEM. secretion from the tubes, and has occasionally appeared to improve the constitutional state. The inhalation of warm water, impreg- nated with emollient herbs, such as althcea officinalis, or with nar- cotic extracts, palliates cough, dryness of throat, and laryngeal irritation. Inhalations of tar, creosote and carbolic acid, simple, or in association with sedative extracts, have occasionally produced remarkable improvement in the local and constitutional state. A palliative influence appears to be exercised in the early stages by the mineral waters of Ems, Oeynhausen, Eaux-Bonnes, St. Sauveur, and Cauterets. But Eaux-Bonnes should be avoided when there is haemoptoic tendency. A sea-voyage, more especially in the case of young adult males, will occasionally work more effectual change in the phthisical organism than any other single influence, or any combination of influences. Not only is the local disease in some cases stayed, and the damaged lung restored to the maximum of possible repair, but the whole constitution undergoes such remodeling, as to render a fresh outbreak of the tuberculizing process an unlikelihood. For the influence of climate upon phthisis, see further on, in the section on Climate for Invalids. C. J. B. WILLIAMS, M. D., LONDON. The following directions for the administration of cod-liver oil in phthisis are useful {Lancet, July 4th and August 15th, 1868):—1. The best time for administering it is immediately after, or to those who prefer it, at or before a solid meal. 2. In cases of peculiar weakness of stomach, with tendency to retching or vomiting, strychnia (gr. ^5-^) proves a most valuable adjunct. So does sali- cine. Neither of these, though a powerful tonic, has any of the heating properties of quinine or iron. If their bitter taste is ob- jected to, they may be given in the form of pill, after or before the oil. 3. It may be advantageously combined with a mineral acid. Nitric acid is best in inflammatory cases, and in those attended with much lithic deposit in the urine, but its tendency to injure the teeth is an objection to its long-continued use. Sulphuric acid is more eligible where there is liability to haemoptysis, profuse sweats, or diarrhoea. But in most cases, for long continuance, diluted phosphoric acid is preferable to either. 4. The bulk of the whole dose of the oil and vehicle should be so small that it may be swallowed at a single draught; therefore, the vehicle should not exceed a tablespoonful, with at first a teaspoonful of the oil, to be PHTHISIS. 189 gradually increased to a tablespoonful. 5. The dose of the oil should rarely exceed a tablespoonful, twice or thrice daily. Larger quantities either derange the stomach or liver, or some of it passes unabsorbed by the bowels. 6. The diet requires attention. With some persons the oil agrees so well, and so much improves their digestive powers, that they require few or no restrictions in diet, but this is not the case with the majority. The richness of the oil proves more or less a trial, sooner or later, to most persons ; there- fore, it becomes proper to omit or reduce all other rich and greasy articles of food. All pastry, fat meat, rich stuffing, etc., should be avoided, and great moderation observed in the use of butter, cream, and very sweet things. Even new milk in any quantit3r is not generally well borne during a course of oil, and many find malt liquor too heavy, increasing the tendency to bilious attacks. A plain nutritious diet of bread, fresh meat, poultry, game, with a fair proportion of vegetables, and a little fruit, and only a moderate quantity of liquid at the earlier meals, commonly agrees best. 7. Should a bilious attack come on, indicated by nausea, headache, furred tongue, offensive eructations, high-colored urine, etc., it is necessary to suspend the oil, lighten the diet, and give blue pill or calomel, with an aperient on alternate nights, and an effervescing saline twice or thrice during the day. In a few days, when the attack has passed off, the oil may be resumed, beginning with small doses, as at first. 8. In all cases, during the use of the oil, the bowels should be kept regular in action, and if this cannot be done by regularity of habit and diet, it should be effected by the use of a mild daily pill of rhubarb or aloes. 9. According to Dr. Ringer, the taste of the oil is removed, and nausea often prevented, by a little salt taken immediately before and after the oil. CONSUMPTION HOSPITAL, LONDON. 463. R. Morphias muriatis, gr.ss Acidi hydrocyanici diluti, ™.xv Acidi muriatici diluti, "lijss Oxymellis scillae, f.gss Aquas, q. s. ad. f.gj. M. Dose—One to two drachms. RESUME OF REMEDIES. Acidum Carbolicum. The inhalation of pulverized solutions of carbolic acid are of frequent benefit in the advanced stages of phthisis, by dimin- ishing the secretion and lessening the cough and exhaustion, and by correcting fetor of the expectorations. A solution of drops xv-xx, in two pints of water, with -the addition of one or two ounces of tinc- ture of conium, or of alcohol, may be used (See Inhalations, p. 192). 190 DISEASES OF THE RESPIRATORY SYSTEM. Acidum Tannicum. Prof. Stili,£ says that this medicine appears sometimes to remove the crepitating rhonchi so generally observed around crude tubercles at the apex of the lung during the first stage of phthisis, while it diminishes the dyspnoea, cough and expectoration. At a late period, it sometimes so manifestly palliates all the symptoms as to inspire a belief that a cure has been accomplished, converting moist rhonchi, or gurgling, into signs of solidification merely, or of a dry cavity. The value of such an influence should not be underrated, for it is in the highest degree probable that the extension of tuberculous deposits is preceded by a congested state of the pulmonary paren- chyma, and that by restoring the latter, we may prevent the former. The more nearly the disease resembles the acute form of phthisis, the less appropriate will the medicine become. j^ther has been recommended to promote the assimilation of cod-liver oil, by Dr. Foster (F. 434). The objections to his preparation are its dis- agreeable taste, and the eructations it occasions. *Alcohol. Dr. Anstie says that there is a variety of pulmonary phthisis, es- pecially common in persons with delicate skin and slight frame, with marked tendency to colliquative sweating, and a notable inability to assimilate either ordinary food or fatty matter of any kind, in which the tolerance for large and long-continued doses of alcohol is very remarkable, and the benefit produced by such treatment very great. Prof. Flint also recommends strongly the alcoholic treatment in cases in which stimulants are well borne M. Furter recommends strongly diluted alcohol with raw mutton or beef (F. 435, 436). Wine may be given in the form of enema; it should be diluted with water, and care taken not to overload the bowels. Ammonii lodidum is recommended in incipient phthisis, by Dr. Richardson. It is also advised by Dr. Tanner, in cases in which cod-liver oil is not tolerated (F. 453). * Arsenicum is often a remedy of great value, but it is frequently badly borne by the stomach. Prof. Da Costa recommends it as often beneficial in slow consumption (F. 430, 431). It is highly advocated by a num- ber of French physicians (pp. 177, 181). Calcii lodidum has been recommended (p. 181). Calcis aqua and milk is highly spoken of, by Dr. T. K. Chambers and others, as an ordinary beverage in phthisis. Cetraria has been much praised, not only as a nutrient, but as an expectorant, in consumption. Cimicifuga has considerable reputation in the treatment of phthisis, but Prof. Still£ considers the cases reported as benefited as probably chronic bronchial affections. Cinchona. The acidulated cold infusion of bark is an excellent remedy for the profuse perspiration, night sweat and hectic fever. Digitalin has been recommended, but no decided results have been reported. Digitalis enjoyed formerly a higher reputation than it now possesses, although it is still highly spoken of. Dr. Niemeyer considers it, in combina- tion with quinine, as an admirable agent for arresting the abnormal calorification. (F. 448). It is often very useful in haemoptysis, espe- cially in the advanced stages of the disease (F. 398.) Ferri Ammonio-sulphas is useful where, on account of haemoptysis, an astrin- gent chalybeate is indicated (F. 457). Ferri Bromidum is sometimes prescribed. *Ferri Chloridi Tinctura is regarded by many as decidedly the best form of iron in phthisis (Dr. Symes Thompson, p. 185). *Ferri lodidum, alone or with cod-liver oil, is an excellent remedy, especially in the early stages of the disease (F. 451, 452). PHTHISIS. 191 Ferri Mlstura Composita is much used in England, in phthisis, especially when much debility and anaemia exist. If, however, it induce head- ache, nausea, and heat of skin, it must be discontinued. Ferri et Potassii Tartras is often a useful chalybeate in phthisis, as it is easily assimilated, non-astringent, and may be prescribed with alkalies, which are so frequently indicated in this disease, on account of undue acidity of the stomach. Ferri Vinum is highly recommended, especially for children and young per- sons, given with, or immediately after meals. *Gallicum Acidum is useful for checking the diarrhoea, excessive expectora- tion, hemorrhage and profuse perspirations in this disease. Glycerine is said, by Dr. Walshe, to often agree well when cod-liver oil is unbearable, and then, especially in children, to decidedly increase the weight. It may be given in combination with the syrup of the iodide of iron. Hydrogenii Peroxidum is said to greatly improve digestion in the first stage of phthisis, and aid the action of iron; in the last stage, it unques- tionably affords relief to the breathlessness and oppression, acting like an opiate without producing narcotism. * Hypophosphites. (The principal " alkaline hypophosphites," are those of soda, potash and lime). These remedies were introduced by Dr. J. F. Churchill, of Paris, as curative in every stage, but the word palliative better designates their action. They are of late less em- ployed, but are still highly recommended by a number of authorities (F. 422, 427, 432, 462). In some cases, when tubercular softening has commenced, they are alleged, by several practitioners, to act pre- judicially. lodinium as an internal remedy, has been almost entirely displaced by cod-liver oil, though the action of the latter has been attributed, in part, to the small quantity of iodine it contains. **Morrhuce Oleum is deserving of the highest confidence. The earlier it is employed in the disease the better (F. 289, 303, 304, 310). In regard to its mode of action and method of administration, see opinions of Dr. Aitken (p. 169), of Prof. Da Costa (p. 174), of Dr. Foster (p. 176), of Prof. Jaccoud (p. 178), of Dr. Niemeyer (p. 182), of Dr. Walshe (p. 186) and of Dr. C. J. B. Williams (p. 188). For man- ner of disguising its taste, see Index of Remedies. Muriaticum Acidum, alone or in combination with other mineral or vegetable tonics, is an important auxiliary to treatment. Opium, by the mouth or enema, is often a valuable palliative in advanced stages of phthisis, to relieve the cough, lessen the expectoration, check diarrhoea, and afford comfort to the patient. Oxygen inhalations seem to possess the power of promoting the digestion of cod-liver oil, and, therefore, often of great service (see Inhalations). "^Pancreatic Emulsion, introduced by Dr. Horace Dobell (p. 110), is an ex- cellent remedy, either with or without cod-liver oil, and is well borne by persons unable to retain the oil. For method of administration (see p. 175). *Pancreatine, introduced by Dr. Horace Dobell, is highly recommended (p. 175). Phosphorus has been employed, but possesses no special value. Plumbi Acetas is very useful in diminishing expectoration, checking hem- orrhage and diarrhoea, and to a less extent, the profuse perspirations of phthisis, but its administration is objectionable, because of the anorexia which often speedily results. 192 DISEASES OF THE RESPIRATORY SYSTEM. Potassii Chloras is recommended in the painful deglutition of advanced phthisis (F. 449). Potassa; Liquor is sometimes prescribed (F. 458). Potassii lodidum is of value, given with iron and cod-liver oil, when there is a syphilitic taint. Prunus Virginiana improves the appetite and palliates the cough. Quinia; Sulphas is a valuable tonic in phthisis, given in conjunction with iron and cod-liver oil. Saccharum. Dr. Symonds recommends (British Medical Journal, June 13th, 1868) sugar as an article of diet in phthisis, taken to the extent of a quarter of a pound or more daily. He regards it, with eggs, a suo- cedaneum for cod-liver oil, when the latter disagrees. Sanguinaria has been advised in protracted catarrhal affections assuming the character of incipient phthisis. Small doses of the tincture should be given for several weeks. Serum Prmparatum* Suet is a popular and useful remedy, boiled in milk, and taken in the morning. Sodii Chloridum has been recommended, but has probably no direct influence on the disease when fully developed. It is useful in haemoptysis. Sodii Sulpho-carbolas has been recommended by Dr. Sansom (Practitioner. July, 1869). Sulphur is useful in the costiveness of phthisis, and may also be employed against profuse perspirations. Taraxacum is often serviceable, from its power of diminishing abdominal ple- thora. Zinci Oxidum is strongly recommended, by Dr. Waring Curran, as steadying the nervous system and acting as a general sedative (F. 419). INHALATIONS. Arsenicum. Trousseau and others have recommended arsenious fumigation by means of cigarettes—a mode of treatment which should be con- ducted with caution. Carbolicum Acidum. Dr. Marcet recommends (Practitioner, November, 1868) the atomization of the following solution :— 464. R. Acidi carbolici, gr.ss-iss Aquas, f.gj. M. This inhaled in the form of spray acts beneficially in the first stages of the disease, by improving the circulation in the lungs, but in the advanced stages it should be withheld. Chloroformum. A few whiffs (n^vj-x) are often useful in the cough and dysp- noea of phthisis, but the effect is only temporary. * lodinium. In cases of troublesome cough and abundant expectoration, benefit sometimes results from employing, night and morning, vapor iodine. 465. R. Tincturae iodinii, f.gj Aq«», f.gj. M. Apply gentle heat, and let the vapor that ariseB be inhaled. Or, the dilute compound tincture of iodine may be atomized. lodoformum. The inhalation of the dilute vapor obtained by mixing iodoform with starch, spreading it on paper and allowing it to volatilize, has been recommended. PHTHISIS. 193 Opium, by inhalation, is an excellent means of soothing irritative cough. Oxygen inhalations can only be looked upon as palliative, and seem, in some cases, after affording immediate relief, to invite fresh and more in- tense exacerbations. Pix Liquida. Tar vapor is now little used, having lost the reputation it once enjoyed in phthisis. EXTERNAL REMEDIES. Aceticum Acidum Dilutum. The application of diluted vinegar to the chest and upper part of the body, to allay the profuse perspirations of phthi- sis, is recommended by Dr. Walshe, Sir C. Scudamore, and others, as a measure greatly conducing to the comfort and well-being of the patient. The mixture of one part of vinegar, one of eau de cologne, and two of water, is employed by Sir C. Scudamore. Ammonii lodidum, in ointment, is recommended by Dr. Tanner (F. 319). Baths. The Turkish Bath is sometimes of service in incipient phthisis. The Compressed Air Bath may often be employed with great advan- tage. Cod-liver Oil embrocations may be employed when the stomach will not toler- ate the oil (F. 320, 321). Counter-irritation. The counter-irritants most frequently resorted to in phthisis are the following: Aqua ammonice; Tartar Emetic Oint- ment; Calomel and Iodine Ointment (F. 283); Croton-oil Liniment. *Tincture of Iodine (painted over the chest every night) also does good, by the iodine which is inhaled, from the air around the patient being slightly impregnated by the evaporation of the tincture; Bur- gundy Pitch Plaster; the following plaster is recommended by Dr. Barlow, in the first stage of phthisis:— 466. R. Emplastri picis com., giss Antimonii et potassae tartratis, gr.x. M. Make a plaster. Setons (in the early stages a sub-clavicular seton of three or four silk threads sometimes retards the progress of the disease). THE AN.2EMIA OF. Ferri lodidum is one of the best chalybeate tonics which can be employed in the anaemia of phthisis, if it do not prove too stimulating. The syrup (TT\,xx-f.gj, thrice daily) is the best form. THE APHTHJE OF. Catechu. The infusion makes an excellent gargle in aphthae occurring in the advanced stages of phthisis. Potassii Chloras, with morphia, glycerin, and syrup, is recommended for redness of the tongue, etc. *Sodii Biboras. Sir T. Watson recommends the mel boracis. THE CONSTIPATION OF. Ferri Chloridi Tinctura sometimes relieves constipation in phthisis, by giving tone to the feeble muscular fibres of the bowels. *Podophyllin often gives better results than any other purgative. 13 194 DISEASES OF THE RESPIRATORY SYSTEM. THE COUGH AND EXPECTORATION OF. Aniseed. The infusion of aniseed (giij-iv of the bruised seeds in Oss of water, at 120°, to stand until cool) has considerable power in allay- ing the irritation on which the cough of phthisis depends. Sir T. Watson recommends it as a vehicle for paregoric. Codeia has been given with benefit. Conium Inhalations often greatly relieve the cough. *Gallicum Acidum is frequently useful for arresting excessive expectoration. * Hydrocyanicum Acidum Dilutum is a valuable addition to cough mixtures, particularly when there is much irritation. Hyoscyamus. Inhalation of the vapor of henbane (gr.iv-vj of the extract in Oj of boiling water) often affords great relief to the cough and dyspnoea. Lactuca. The extract has been employed as a sedative. Morphia and Opium are frequent additions to cough mixtures in phthisis (F. 291, 292, 295, 298.) Plumbi Acetas is of service in diminishing excessive expectoration. Potassii Cyanidum is frequently prescribed for the cough of phthisis, by Prof. Da Costa (F. 295). Prunus Virginiana is an admirable calment. Tannicum Acidum. Dr. Ringer strongly recommends the application of the glycerine of tannin, with a small quantity of morphia added, to the throat; when the cough is troublesome, a good night's rest may often be obtained by applying it at bedtime. Dry Cupping on the chest, under the clavicles, often gives great relief in dis- tressing dyspnoea and cough. THE DIARRHCEA OF. Argenti Nitras, in doses of gr.j three or four times daily, is regarded by Dr. Graves as one of the best remedies in the diarrhoea of phthisis. Bismuthi Subnitras, in doses of gr.v three or four times daily, has been re- commended. Calcis Carbolas, in doses of gr.j, combined with hyoscyamus, is recommended by Dr. Habershon (Lancet, January 4th, 1868), when there is evi- dence of fermentive changes in the colon. *Cupri Sulphas is recommended by Sir. T. Watson, combined as follows:— 467. R. Cupri sulphatis, Pulveris opii, aa gr.^. M. For one pill. Ferri Chloridi Tinctura is often very useful (F. 300). *Gallicum Acidum is an excellent remedy, alone or combined with sulphuric acid. *Hcematoxyli Lignum is recommended by Dr. F. W. Parry, in the following combination:— 468. R. Extracti hasmatoxyli, gij Misturae cretas, gx'ij Vini ipecacuanhas, f.gij Vini 0P»» f.gj. M. A tablespoonful twice, thrice, or oftener daily. Hydrargyrum cum Creta, in half-grain doses, is sometimes effectual in check- ing the discharge. PHTHISIS. 195 Nitricum Acidum is recommended by Dr. Barlow, in the following formula:— 469. R. Acidi nitrici diluti, TTLxij Tincturae opii, Tt\,v-x Syupi,. f-gj Aquae cinnamomi, f.gx. M. Make a draught, to be taken every fourth or sixth hour. *Opium, alone, or in combination with acetate of lead, with sulphuric acid, etc., is a most valuable remedy in the diarrhoea of phthisis. *Plumbi Acetas, in combination with opium, sometimes succeeds after the failure of stronger direct astringents. *Rheum is sometimes useful. Its astringency is said to be increased, and its purgative power diminished, by roasting (in an iron crucible, until it loses two-thirds of its weight) ; then, given in doses of gr.v-x, it is highly recommended as giving better results than chalk or opium. Oleum Ricini is serviceable in those cases in which the diarrhoea seems to be excited by irritating matters in the intestinal canal. Dr. Barlow, in such cases, prescribes the following:— 470. R. Olei ricini, Tincturae rhei, aa f.gij Tincturae opii, ttbiv Aquae cinnamomi, f.giv. M. To be taken at a draught. *Sulphuricum Acidum Dilutum is often very useful. It may be combined with opium (nixv-xx, with tincture opii n\,x-xx), or, as advised by Dr. Graves, with henbane. Tormentillce Radix is said to be particularly useful in the diarrhoea of phthisis. Zinci Oxidum is highly praised by Dr. Waring Curran, in combination with conium. THE DYSPEPSIA OF. * Hydrocyanicum Acidum is found, by Dr. Wilson Fox, to be, in the irritative dyspepsia of phthisis, the most efficacious remedy, in combination with carbonate of potash or soda, and infusion of columbo, two or three times a day, between meals. THE DYSPNCEA OF. * Chloroformum. A few whiffs often afford signal relief. Croton Oil liniment to the chest is frequently useful in distressing dyspnoea* Hyoscyamus, in vapor (gr. iv-vj of extract, to Oj of boiling water), is some- times prescribed, with benefit. Stramonium gives great relief (gr.|-j, daily, of the extract), when the- dyspnoea is constant. Dry Cupping under the clavicles is frequently useful. THE HEMORRHAGE OF. See Haemoptysis. THE NEURALGIA OF. Ammonii Chloridum is highly recommended by Dr Anstie, in the intercostal neuralgia of phthisical patients. Zinci Oxidum is said, by Dr. Waring Curran, to act, in combination with conium, as a sedative to the wandering pains of phthisis (F. 294). 196 DISEASES OF THE RESPIRATORY SYSTEM. THE PROFUSE PERSPIRATIONS OF. Aceticum Acidum Dilutum, alone, or with cologne water (1 part of vinegar, 1 of eau de cologne and 2 of water), affords great comfort, sponged over the chest and upper part of the body. Apiol has been recommended in the night sweats of phthisis. Ferri Chloridi Tinctura often lessens the night sweats of phthisis, particularly if the oxide of zinc be also given. Gallicum Acidum, alone or with sulphuric acid, proves very effectual. Ipecacuanha. Dr. Graves says that a few grains of Dover's powder at bed- time will often put a stop to the profuse perspirations. He observes, it is hard to account for this, but it is a fact. *Kino. Sir T. Watson recommends pulv. kino co. as having much power over the perspirations. It has the further advantage that (containing opium) it tends to control the diarrhoea and check the cough. Plumbi Acetas has a certain influence over the profuse perspirations, but less than it possesses over the diarrhoea and hemorrhage of phthisis. Sidphuricum Acidum Dilutum has, according to Dr. R. Christison, no equal in the profuse perspirations of phthisis. Tannicum Acidum is often very effectual when given with quinine, or with nitric acid. Zinci Oxidum is frequently highly useful. Zinci Sulphas is very highly praised by Dr. Barlow in the night sweats of phthisis. He employs the following formula:— 471. R. Zinci sulphatis, gr.j Extracti hyoscyami, gr-iv. M. For one pill. THE VOMITING OF. Nux Vomica. The tincture (tt\,x) will often, according to Dr. Douglass Powell (Practitioner, November, 1868), arrest the vomiting of phthisis, and in some cases, where there is little catarrh, strychnia is efficient for this purpose. THE PREVENTIVES OF. Aceticum Acidum Dilutum is praised by Dr. Graves as a preventive of phthisis. The chest should be washed daily with vinegar and water, begin- ning with it tepid, and gradually reducing the temperature, until it can be employed completely cold. Ferrum. The experiments of M. Coster upon the efficacy of iron in prevent- ing the development of tubercular disease are important. A number of dogs and rabbits were placed in circumstances generally supposed to be the most favorable to the development of scrofula and tubercu- lar disease, namely, cold damp cellars without light, where they were prevented from moving, and exposed to a most unwholesome atmos- phere. Those fed upon ordinary food, became, with one or two ex- ceptions, tuberculous ; whilst not one fed upon ferruginous bread (containing half an ounce of the sesquioxide of iron in each pound of bread), presented even a trace of tubercles. But, as Dr. Symes TnoMPSON remarks, iron cannot be rapidly assimilated in large quan- tities by feeble persons, but must be taken, like food, hour by hour, day by day, and year by year, till the blood is no longer poor, the tissues no longer short-lived and unresistant, and until the " tuber- cular dyscrasia" is overcome. PLEURISY, ACUTE. 197 PLEURISY, ACUTE. PROF. WILLIAM AITKEN, M. D., EDINBURGH. In acute pleurisy, during the first stage, or that of hypercemia, the best practitioners of all times and of all countries have taken blood from the arm, provided the strength be good and the symp- toms sthenic. If, says L^nnec, after one or two bleedings the pain in the side and fever have not abated, blood should be taken from the side by leeches or cupping. The practitioner should also remember that effusion often takes place after the bleeding, during the subsidence of the inflammation, so that the breathing is often more oppressed, and the symptoms for a time aggravated, although the condition of the patient is in reality improved. The lung, however, soon gets accustomed to this new state of things; and the fluid in a few hours beginning to be absorbed, the symptoms are generally ameliorated. The patient should be bled in an upright posture, in a full stream, until he can take a deep breath freely, or faints—from ten to twenty ounces. Hot poultices and leeches should always be employed when pain on inspiration is present, of a " catching " or " stabbing " nature. Tartar emetic, says Ljennec, is, in general, well supported in pleurisy, and contributes powerfully to subdue the inflammatory tendency; but, nevertheless, when the pain in the side and fever have ceased, it loses further power over the disease; at least, it does not appear to promote the removal of the fluid effused, so that its use must generally be abandoned as soon as the acute symptoms have passed away. Blisters are not to be used until the acute stage is past; but when the pain has ceased for some days, and absorption proceeds slowly, and the disease promises to become chronic, a succession of blisters may be applied. After free evacuation of the bowels has been effected, calomel, to the extent of producing the slightest mercurialization, is the most beneficial line of treatment in certain cases only—those which do not acknowledge any constitutional diseases as their cause. The more rapidly slight mercurialization can be produced the better; hence the following prescriptions are useful:— 198 DISEASES OF THE RESPIRATORY SYSTEM. 472. R. Hydrargyri chloridi mitis, gr.xviij Pulveris opii, gr.ij Syrupi, q- s- M- Divide into 12 pills. Take one every half-hour, until all are taken. At the same time rub mercurial ointment into the skin of the af- fected side, near the axilla, every fourth hour. The amount of opium may be increased if the pain is very acute. Or, 473. R. Hydrargyri chloridi mitis, gr.xij-xxiv Pulveris digitalis, gr.vj Pulveris opii, gr.vj-xij Syrupi, q. s. M. Divide into 12 pills. One to be taken every three or four hours, and the whole side to be covered with a piece of linen spread with mer- curial ointment, over which is to be placed a poultice covered with oil silk. The patient must be carefully watched that neither ptyalism nor narcotism be produced. The moment mercurial action has been established, the further administration of the mineral must cease. Opium and digitalis are advised to be continued after the use of calomel has been suspended. With these may be given two grains of squills or of nitrate of potassium, which will act beneficially as a diuretic. After twelve or more hours very small quantities of tartar emetic in solution may be given at night, combined with small doses of opium and ipecacuanha, to allay the cough and gen- eral irritation. After the febrile action has in some measure subsided, and the active stage of the disease is at an end, a blister may be applied over the lateral region of the chest, but not over the seat of pain; and if the fluid continues to accumulate, the blisters ought to be repeated, so as to maintain a surface at a distance from the affected part in a constant state of counter-irritation. Diuretics ought, at the same time, to be given freely. The compound tincture of iodine, in doses of twenty minims, freely diluted, is a valuable medicine at this juncture. PROF. ROBERTS BARTHOLOW, M. D., CINCINNATI, OHIO. 474. R. Morphiae sulphatis, gr-xvj Aquas destillatae, f.gj. M. Dissolve and filter. Dose, for a hypodermic injection, five to ten Nothing can be more satisfactory than the treatment of pleurisy in its early stage by the hypodermic injection of morphia. It re- PLEURISY, ACUTE. 199 lieves at once the pain, and arrests or diminishes the morbid process. PROF. J. M. DA COSTA. M. D., PHILADELPHIA. 475. R. Potassii acetatis, &r-XT Spiritus aetheris nitrosi, f-gss Vini ipecacuanhae, gtt.iij Syrupi tolutani, f.gss. M. For one dose, four times a day. Useful in subacute pleurisy. 476. R. Tincturas veratri viridi, rr^xxiv Pottassii acetatis, gss Morphiae acetatis, . gr.ss Liquoris potassii citratis, f.^ijss Syrupi tolutani, f.gss. M. A dessertspoonful every three hours in dry pleurisy. Locally, apply, two or three times a day, turpentine stupes. RESUME OF REMEDIES. Antimonii et Potassii Tartras, in doses ffc.xt~h sometimes proves useful in the earliest stages of acute pleurisy in young, plethoric subjects. Digitalis is recommended by Dr. Aitken (F. 473). Hydrargyrum. Mercury in pleurisy is objected to by the majority of modern practitioners. It is contra-indicated if there be any organic disease of the kidneys (F. 473). *Morphia, hypodermically, gives the most satisfactory results in the early stage of pleurisy (F. 474). * Opium is very desirable in many cases, relieving pain and procuring sleep. Veratrum Viride is frequently employed with benefit (F. 476). Blood-letting. Venesection is rarely resorted to. The local abstraction of blood by Heeches is often of great service. Diuretics are useful after the febrile action has subsided. Stimulants are sometimes indicated. Dr. Anstie relates a case successfully treated by stimulants, the only other remedy given being morphia in large doses. EXTERNAL REMEDIES. Cantharis. Blisters are rarely productive of benefit in the early stages. But after the pain and febrile action have subsided, and especially after effusion has taken place, they are of great advantage. Turpentine stupes may be resorted to at a far earlier period than blisters, and in addition to relieving the pain, they seem to aid in arresting the inflammatory action. ^Poultices. The prolonged use of light, soft, hot linseed poultices, large enough to cover the whole side, is of great benefit. Mercurial oint- ment may sometimes be applied under the poultice. 200 DISEASES OF THE RESPIRATORY SYSTEM. PLEURISY, CHRONIC. PROF. WILLIAM AITKEN, M. D., EDINBURGH. 477. R. Pulveris digitalis, Pulveris scillae, Pilulae hydrargyri, aa gr.iss. M. For one pill, two or three times a day, as a diuretic in chronic pleuritic effusion. Also, 478. R. Hydrargyri chloridi corrosivi, gr-iv Tincturae iodinii compositae, f.giv-vj Glycerinae, f-^iij Aquas destillatae, f.givss. M. For a lotion, to be applied over the chest by spongeo-piline, or by lint covered with oiled silk. One or other of the following ointments may also be rubbed in upon the skin, over the side of the chest, namely:— 479. R. Hydrargyri chloridi corrosivi, Unguenti iodinii compositae, Adipis, gr.iv-v giv-vj giv-gj. M. Or, 480. R. Make an Hydrargyri chloridi corrosivi, Potassii iodidi, Aquae destillatae, Adipis, ointment. gr.iv-v q. s. to make solution £• M. DR. CRUVEILHIER, FRANCE. 481. R. Tincturae aloes, f-gj-ij Tincturae scillae, Tincturas digitalis, aa gtt.xx. M. To be taken every two or three days, in the morning, on an empty stomach, in a small glass of a diuretic infusion. Used in chronic pleurisy with effusion. Flying blisters on the chest. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 482. R. Potassii iodidi, zj Extracti pruni virginianae fluidi, f.gj Spiritus juniperis compositi, f.giij. M. A tablespoonful thrice daily. 483. R. Potassii acetatis, ?j Tincturae digitalis, ftjj Extracti cinchonae fluidi, f?i M^, fg'ij. M. A teaspoonful thrice daily, in pleuritic effusions. PLEURISY, CHRONIC. 201 484. R. Potassii iodidi, gij Tincturae scillae, f.gvj Tincturae opii camphoratae, f.giss Misturae acaciae, f-gvj. M. A teaspoonful four times a day, in chronic pleurisy with consolidation of the lung. Also, a good nourishing diet; either whisky or gin, half an ounce three times a day ; and counter-irritation by means of tincture of iodine. Afterward, when effusion has begun to disappear, the following tonic diuretic may be ordered:— 485. R. Tincturae ferri chloridi, f.gj Acidi acetici, f.gj. M. And add:— 486. R. Liquoris ammonii acetatis, f.gv Syrupi aurantii corticis, f-^ij* M. A dessertspoonful increased to a tablespoonful, thrice daily. 487. R. Potassii iodidi, 9iv Potassii acetatis, gss Elixiris cinchonas, f.giij Curacao, f.gj M. A dessertspoonful thrice daily, in pleuritic effusion, with roughening above effusion. Also a blister and an occasional cathartic. NELIGAN. 488. R. Iodinii, gijss Potassii iodidi, gj Camphorae, gss Alcoholis, f-^ij« M. Dissolve successively, in the alcohol, the iodine, the iodide and the cam- phor. A counter irritant liniment, to be employed in pleurisy with effusion, with caution, however, on account of its energetic vesicant powers. Useful when the action upon the kidneys of a cantharidal vesicant is feared. THOMAS HAWKES TANNER, M. D., LONDON. 489. R. Pilulae hydrargyri, gr.iij Pulveris digitalis, gr.ss Pulveris scillas, gr.iss. M. For one pill. To be taken as an alterative and diuretic, two or three times a day. (The dose in this pill differs somewhat from the same combination given by Dr. Aitken. F. 339). Very often, however, mercury in any shape does harm. Then the compound tincture of iodine, the iodide of iron, or cod-liver oil, is much more likely to be useful. The patient ought to be kept on a moderate diet, free from stimulants. A series of flying blisters may be applied. Purgatives as well as diuretics should be administered. 202 DISEASES OF THE RESPIRATORY SYSTEM. CHARLES WEST, M. D, LONDON. 490. R. Potassii iodidi, gr.xij Potassii nitratis, gr.xxx Spiritus aetheris nitrosi, f-gj Tincturae scillae, nXxxx Tincturae digitalis, tt\,xxiv Syrupi aurantii corticis, f.gss Aquam, ad. f.giv. M. Tablespoonful every four hours, for a child six years old. Employed in the treatment of pleuritic effusion, and continued steadily for several days. Its action may be seconded by a small dose of mercury given once or twice a day, as one grain of calomel, or three of gray powder. The mercury may be discontinued at the end of a week, but the iodide of potassium may be persevered with for two or three weeks. RESUME OF REMEDIES. Digitalis is sometimes given, combined with squill and mercury, in chronic pleuritic effusion (F. 339, 349). Hydrargyrum. Blue pill is sometimes useful, combined with digitalis and squill (F. 279, 249). Oleum Morrhuce, conjoined with iron and tonic regimen, is of benefit in pleu- ritic effusions associated with debility. Potassii Acetas is, in some cases, prescribed by Prof. Da Costa (F. 483). Potassii lodidum, variously combined according to indications, is of the highest value in restraining inflammatory action and promoting absorption (F. 343, 345, 348, 350). Quinice Sulphas, in the advanced stages, when the case assumes a typhoid character, especially when the patient is old or debilitated, is of great service. Scilla is sometimes given, combined with digitalis and mercury (F. 239, 249). Diuretics are, of course, indicated in chronic pleuritic effusions. The princi- pal drugs employed are Digitalis, combined with squills and mercury (F. 239, 249), with acetate of potash (344), or with iodide of potassium (F. 350); Ferri Chloridi Tinctura (F. 346); Potassce Acetas (F. 337, 344, 348) ; Potassce Nitras (p. 130); Scilla (F. 339, 345, 349). EXTERNAL REMEDIES. Cantharis Blisters may be employed with manifest advantage. Counter-irritants are of service. The principal employed are Aqua Ammonia; Hydrargyri Chloridum Corrosivum, combined with iodine (F. 340, 341, 342); *Tincture of Iodine. PNEUMONIA. 203 PNEUMONIA. PROF. WILLIAM AITKEN, M. D., EDINBURGH. 491. R. Antimonii et potassii tartratis, gr.iij-xij Hydrargyri chloridi mitis, gr-xij. M. For 12 pills. One to be given every five or six hours, according to the severity of the disease- This combination is believed to have saved a much larger number of cases than antimony alone. It is to be adopted in some cases. The. bowels should be well cleaned out before resorting to it. So soon as the gums are touched, the prescription should be discon- tinued. PROF. BOUCHUT, PARIS. 492. R. Veratrias, Pulveris opii, aa gr.iss Pulveris ipecacuanhae, gr.iij Syrupi, q. s. M. For 20 pills. From one to five to be taken during the day. PROF. HARVEY L. BYRD, M. D., BALTIMORE. 493. R. Potassii bromidi, gj. Make 12 powders. One powder every two hours, and between each dose, as long as necessary to keep down activity in the circulation, two drops of Flemming's tincture of aconite. PROF. J. M. DA COSTA, M. D., PHILADELPHIA. 494. R. Potassii iodidi, 9iv Tincturae cinchonias compositae, f.giv. M. A dessertspoonful thrice daily, in subacute pneumonia with pleurisy. Also, 357. R. Emplastri cantharidis, 4x5 in. To be followed by a poultice and dressed with basilicon ointment. PROF. FELIX VON NIEMEYER, M. D., TUBINGEN. 495. R. Quiniae sulphatis, 9j. For 10 pills. One every two hours. According to experiments of our author in the administration of quinine in this disease, it is called for when there is great danger, arising chiefly or entirely from excessive elevation of the tempera- ture of the body. It may then be given as above, or in two or three ten-grain doses within a few hours. 204 DISEASES OF THE RESPIRATORY SYSTEM. JOHN POPHAM, M. D., CORK. 496. R. Potassii bicarbonatis, gj-vj Misturae acaciae, f.giij. M. A dessertspoonful in water, four, six or eight times in the twenty- four hours. The evidence of the good effects of this alkaline treatment ap- pears on the second or third day {British Medical lournal, Decem- ber 28th, 1869). It acts as a sedative by allaying the cough and abating the state of congestion on which it depends. A blister applied for four or six hours, but not for suppuration, is a valuable auxiliary. Suppuration from blistering is exhaustive and prejudi- cial. A. T. H. WATERS, M. D., LONDON. Our author is opposed to the prolonged administration of tartar emetic in small doses. There are very few cases that are not in- jured by such a practice, and whenever the dose produces a depress- ing effect, or whenever it gives rise to sickness or purging, it does harm, and should not be persevered with. At the same time, there can be no doubt that large doses (gr.j—ij) may be safely given in some cases, and continued even for days, without producing its physiological effects—vomiting, purging, etc., and in such instances the antimony appears to do good; the symptoms of the pneumonia yield during its administration, and convalescence becomes estab- lished. But whilst these full doses of tartar emetic are well borne by some patients, it is doubtful whether it is ever desirable to ex- hibit them, for I believe we can get all the good effects which the drug is capable of affording, by using it in smaller quantities. The treatment employed by Dr. W., with a loss of only one case in forty-four, consisted mainly (apart from the occasional use of antimony, as above) of carbonate of ammonia, combined with chloro- form (F. 501), chloric ether, opium, a generous, nutritious diet, beef tea, milk, etc., with the judicious use of alcoholic stimulants from an early period. Turpentine stupes, sinapisms, and linseed meal poultices were employed in the early stages of the disease, and blisters in the more advanced. Dr. W. considers that too high a value has been placed upon mercury as a remedy in the stage of hepatization, for which it has been considered peculiarly applicable. He finds that in these cases it possesses no special properties for promoting absorption of PNEUMONIA. 205 the effused matters. As a purgative, it is very useful, as it tends to relieve the portal system, often overloaded in pneumonic inflam- mation ; but if given in frequent doses, or with the view of pro- ducing salivation, its effects, save in a few exceptional cases, will be more or less prejudicial. It was only administered in one of the above-mentioned forty-four cases, and then it in nowise hast- ened, in the opinion of Dr. W., the recovery. Opium is very desirable in many cases, often relieving pain, allaying the distressing cough, and procuring sleep. The pain in the side which so frequently accompanies pneumonia, and for which depletion was formerly prescribed, may generally be relieved by a dose of opium. It is believed of great value in arresting the delirium so apt to supervene in this disease. On the first appear- ance of the indications of approaching delirium, e. g., want of sleep, restlessness, slight staring of the eyes, and slight tremor of the hands, a few doses of opium, and the exhibition of stimulants and nourishment, may at once arrest the attack. At the same time, all depletory measures should be avoided; the aim should be to improve the nutrition of the brain and give vigor to the cir- culation, for, when these results are accomplished the delirium will disappear. Few cases are now met with which are benefited by general bleeding, and the abstraction of blood by cupping or leeching is not often necessary. The pulse affords an excellent indication as to the need for stimu- lants. As a rule, it may be said that when the pulse is below 100 the case is not a grave one, and will yield to treatment of a simple character; but when it rises to 110, 120, and upward, the case is more serious. The more frequent the pulse, the greater is the need for stimulants, and it is very remarkable to see the effect they produce on the pulse when it is abnormally frequent, in some cases of pneumonia. Intermission of the pulse is an invariable indication for the free use of stimulants. In the pneumonia of aged people stimulants may be given without hesitation. GERMAN HOSPITAL, PHILADELPHIA. 497. R. Extracti cinchonas, gj Moschii, gr-vj Syrupi aurantii corticis, f.gj Aquae aurantii florum, f.giij- M By tablespoonful doses in pneumonia with adynamic symptoms. 206 DISEASES OF THE RESPIRATORY SYSTEM. 498. R. Ammoniae acetatis, gijsa Extracti cinchonae, gss Tincturas canellas, f.giss Syrupi aurantii corticis, f.gj Aquas menthae piperitae. f-giv. M. By tablespoonful doses, from hour to hour, in adynamic pneumonia. 499. R. Ipecacuanhas, 8r-xv. Antimonii oxy-sulphureti, gr-vij Camphorae pulveris, grxv Sacchari lactis, gijss. M. Divide into 10 powders. One powder every two hours, in adynamic pneumonia. 500. R. Antimonii oxy-sulphureti, gr.ij Camphorae pulveris, gr.v Sacchari, giss. M. Divide into 12 powders. From four to six a day, to facilitate expectora- tion. RESUME OF REMEDIES. * Ammonii Carbonas is recommended, combined with chloroform, by Dr. A. T. H. Waters, in cases in which antimony is contra-indicated. His formula is, 501. R. Ammonii carbonatis, gr-iv Spiritus chloroformi, n\,xx Aquae camphorae, f-gx. M. To be given every three or four hours ; may be given either with or without alcoholic stimulants. Ammonii Chloridum, combined with ether, is often productive of excellent results in the advanced stages of pneumonia. Antimonii et Potassii Tartras is much less employed in modern therapeutics than formerly. Large and repeated doses are now seldom given, and small doses (gr.^-4) only in young, robust subjects, when febrile action is strong, and in the earliest stages of the attack. Very few cases are benefited, or escape injury, from its prolonged administration. Dr. Aitken has obtained good results by combining it with calomel. For Dr. Waters' opinion in regard to its use, see p. 204. Antimonii Oxy-iodidum is said to be particularly useful as an alterative and diaphoretic in the second stage of pneumonia. Apomorphia has been favorably reported upon. Belladonna is highly spoken of by Dr. Harley, who found that under its use the grave symptoms rapidly subsided, and convalescence was speedily established. Camphora is recommended by Dr. Copland, as one of the most valuable remedies in asthenic pneumonia, in doses of gr.ij-viij, every four, five, or six hours, combined with calomel and opium, or with anti- mony and henbane, according to the character of the attack; the latter being preferred when the inflammation approaches the sthenic form, in which case the doses of the camphor may be lessened. Chloroformum, by inhalation (8 or 10 drops at a time, three or four times a day), is said to relieve the stitch in the side and palliate the cough and oppression. PNEUMONIA. 207 Cinchona. See Quiniae Sulphas. Digitalis has been much employed of late years. M. Rony-Saucerotte re- gards it (Practitioner, March, 1869) as one of the best means of relieving the febrile and other grave symptoms ; less active as an antipyretic than veratrum, but more easily managed and less offen- sive ; acting more slowly than leeches, but producing more durable results. Hydrargyri Chloridum Mite was formerly regarded as indispensable, combined with ether, antimony or opium, in the treatment of pneumonia. Although still employed, it is very much less so of late years. Ipecacuanha is sometimes serviceable as an expectorant and diaphoretic, but is not to be trusted to alone, nor continued when it nauseates and prevents the patient from taking nourishment. Moschus, in doses of gr.xxiv-xxx daily, has been recommended when pneumo- nia assumes a typhoid character, particularly if attended with deli- rium. * Opium is frequently a valuable remedy in arresting delirium, relieving pain and cough, and inducing sleep. Plumbi Acetas is highly recommended in asthenic pneumonia, occurring in debilitated subjects. It may be combined with quinine (gr.j of each every two hours), or, if the cough be very violent, opium may replace the quinine. Potassce Liquor, in doses of tt^x-xv, added to an ordinary expectorant mixture, is often beneficial in the advanced stages of pneumonia when the sputa is scanty, thick and viscid. Potassii Bromidum is prescribed by Prof. Byrd (F. 493). *Potassii lodidum is frequently useful, combined according to circumstances, in the advanced stages of pneumonia (F. 494). Potassii Nitras has been recommended. *Quinice Sulphas is of the highest value in asthenic pneumonia, and in the advanced stages of pneumonic inflammation of the old and debili- tated. Under the administration of gr.v every third hour, the pulse becomes slow and steady, and the respiration free. If the patient be young, with evidences of capillary congestion generally over the system, local depletion should precede its use. Dr. Nie- meyer recommends quinine (F. 495) when there is great danger, arising from excessive elevation of the temperature of the body. Sanguinaria is recommended in typhoid pneumonia, when respiration is very difficult, the extremities livid, and the pulse full, soft and compressi- ble. The dose should be large in proportion to the violence of the disease, and repeated until it excites vomiting or relieves symptoms. *Senega, in decoction, is recommended by Dr. C. J. B. Williams, when the inflammatory symptoms have subsided, and any amount of debility, with weak pulse, cool skin, eough, and dyspnoea remains. Cases which have resisted other remedies, often almost immediately improve by its use, the pulse becoming slower, the breathing freer, the tongue cleaner, and the strength greater. Serpentaria is productive of good results in typhoid pneumonia. Valeriana. The ammoniated tincture, combined with camphor, is sometimes employed in the advanced stages of pneumonia, but is inferior to musk. Veratria has been employed with great advantage. It may be given in pills (F. 492), or in solution (if the stomach be irritable, with an efferves- cing draught). Prof. Vogt, of Berne, commences with gr.yV, every two or three hours, until it produces vomiting or diminution of the pulse. 208 DISEASES OF THE RESPIRATORY SYSTEM. *Veratrum Viride is much employed in pneumonia. The plan recommended by Dr. Norwood, is to begin with gtt.viij of the tincture every third hour, and add one drop to each successive dose, until the pulse is sufficiently reduced or nausea supervenes ; the subsequent doses are then to be regulated so as to sustain the depressed state of the circulation, with as little disturbance of the stomach as possible, any excess of nausea being controlled by a little morphia. With the reduction of the pulse the inflammatory symptoms decline and con- valescence ensues. Many physicians have reported very favorably upon this remedy. Alkalies often prove useful in the advanced stages, when the expectoration is thick and viscid (F. 496). Blood-letting. Venesection is seldom employed in pneumonia. Local bleed- ing, by cupping or leeching, often affords great relief to the pain, but most practitioners prefer to seek this relief by opium. *Stimulants are often indicated, particularly in cases of very frequent pulse, and in aged people. EXTERNAL REMEDIES. Blisters are not beneficial in the early, but are useful in the advanced, stages of pneumonia. Counter-irritants may be employed in the early stages of the disease. The principal applications employed are tartar-emetic ointment; croton oil; *tincture of iodine ; ^turpentine stupes. Poultices are especially useful in the early stages of the inflammation. Flax- seed poultices, made so as to envelope the whole chest, give great relief, and exercise a salutary influence on the inflammatory action. PNEUMONIA, CHRONIC. Lobelia often proves useful in chronic pneumonia. Sanguinaria has been found to be of essential benefit in some cases. Sumbul Radix is employed by Russian physicians. For the treatment of the pneumonia of children and infants, see Diseases of Children, Section vm. III. DISEASES OF THE CIRCULATORY SYSTEM. Angina Pectoris—Cardiac Dilatation—Cardiac Hypertrophy— Carditis—Fatty Degeneration of the Heart—Functional Palpi- tation of the Heart—Internal Aneurism— Valvular Disease of the Heart. ANGINA PECTORIS. DR. ALFRED L. LOOMIS, NEW YORK. This author states that the only remedies he has found of service in delaying and rendering less severe the paroxysms of this disease are iron, strychnine and arsenic, administered daily in small doses. During the paroxysm, rest and free administration of digitalis are of the greatest service. He adds that opiates, chloroform, and nitrite of amyl should not be used. DR. T. L. BRUNTON, LONDON. On the other hand, Dr. Brunton {British Medical Journal, July 13, 1872) highly extols the amyl nitrite, and in the same journal (November 28, 1874) and elsewhere, instances of its great value are given. About two or three drops, used by inhalation, are generally sufficient to afford relief. Fatty degeneration contra- indicates it. DR. N. GALLOIS, PARIS. 502. R. Tincturae digitalis, Tincturas belladonnas, Tincturae valerianas, Spiritus aetheris compositi aa f.gj. M. Dose ten to twenty drops during the access of pain; stimulating frictions over the sternum; and if the attack prolongs itself, hypodermic injections of atropia. 503. R. Quiniae sulphatis, gr.xxx Acidi arseniosi, gr-8S Extracti Valerianae, q.s. Divide into 30 pills. From two to four a day for persons subject to attacks, in order to lessen their frequency. 14 2Q£ 210 DISEASES OF THE CIRCULATORY SYSTEM. RESUME OF REMEDIES. Acetici Acidum Dilutum. Bathing the chest every morning with vinegar and water is said to lessen the liability to attacks. Amyl Nitrite (see above). Argenti Nitras, gr.j daily, in the form of a pill, is favorably spoken of by Dr. Copland. * Arsenic. Dr. Anstie says he has seen the most remarkable relief afforded by this remedy. It may be given in the form of Fowler's solution; in pill of arsenious acid ; or (gr. ^f) of arseniate of soda, with extract of hop; by subcutaneous injection ; or by inhalation of the smoke of arsenical cigarettes. Assafoetida, combined with opium and ether is sometimes of service. Camphor, in combination with opium or hydrocyanic acid, sometimes acts favorably. Ether is praised as a palliative by Dr. Anstie, who considers it, however, as inferior to arsenic or strychnia. *Morphia, by hypodermic injection, is highly praised by Prof. Bartholow. *Strychnia, by hypodermic injection (gr.jhs-zo), twice daily for several weeks, is highly lauded by Dr. Anstie, who has seen remarkable benefit attending its use in presence of a threatening paroxysm. Quinice Sulphas has been advised in intermittent angina pectoris. Zinci Sulphas sometimes proves of great benefit when persevered in during the intermissions. Stimulants. The relief of pain is better accomplished by the use of ether, or of morphia or atropia hypodermically, than by large doses of spirits. * Turpentine stupes, applied to the chest, often mitigate the severity of the paroxysm, particularly in the old and debilitated. Issues. An issue at the nape of the neck sometimes acts favorably in miti- gating the symptoms. CARDIAC DILATATION. DR. ALFRED L. LOOMIS, NEW YORK. The indications are: 1. To maintain nutrition; 2. To avoid vio- lent cardiac action. For the first, our author commends an exclu- sively milk diet, the fluid taken in small quantities at short intervals. " As a rule, it is always safe to daily administer iron to a patient with dilated heart." Slightly stimulating baths, flannel next the skin, the avoidance of emotion, and the arrest of all exhausting discharges are important. A dry, bracing atmosphere is most suitable. The most important remedy is digitalis, in sufficiently large doses to regulate the heart's action. As it loses its controlling power by continued use, it should not be exhibited indiscriminately. CARDIAC DILATATION. 211 J. M. DA COSTA, M. D., PHILADELPHIA. 504. R. Pulveris digitalis, gr.v Extracti belladonnae, gr.j Ferri redacti, Qij. M, For xx pills. One thrice daily. 505. R. Emplastri belladonnas, 4x4. To be worn over the cardiac region. Belladonna is one of the best agents that can be employed to overcome irregularity of the action of the heart, and to relieve pain. Digitalis is also useful for the same purpose, especially where the action of the heart is feeble ; it is the only sedative which will reduce the frequency and not the force of the heart. It may be combined as follows:— 506. R. Ferri lactatis, gss Pulveris digitalis, gr.v. M. For xx pills. One thrice daily. 507. R. Tinctaras digitalis, f.gss. Ten drops thrice daily, in cases of dropsy caused by cardiac dilatation. Also, 508. R. Pulveris jalapae compositus, gr. x. For one dose at night. In such cases, a tablespoonful of lemon juice, three times a day, acts as a diuretic and stomachic. Baths, also, are advantageous. Dry cups applied to the chest relieve the pulmonary congestion. It is more important to start the secretions and relieve internal con- gestions than to give tonics and iron, which find their appropriate place in the after-treatment. DR. FELIX VON NIEMEYER, PROF. UNIVERSITY OF TUBINGEN. Our author has convinced himself, by a great number of obser- vations, that digitalis is a very efficient means of extemporarily strengthening the heart's contractile power, and of thus allaying dropsy and cyanosis. In dilatation of the heart, digitalis, combined with an exclusively milk diet, is an invaluable remedy. Dr. von N. has repeatedly succeeded in obtaining complete removal of dropsical effusions of great magnitude and producing consider- able temporary relief by this mode of treatment. Iron, which fortunately no longer has the reputation of being " heating," should always be prescribed when the patient shows any signs of anaemia or hydrsemia. 212 DISEASES OF THE CIRCULATORY SYSTEM. DR. WALSHE. When dropsy appears in cases of dilatation of the heart, the diuretics which yield most relief are the acetate, nitrate, iodide, and bitartrate of potassa, nitrous ether, compound tincture of iodine, the infusion and spirits of juniper, and gin. Hydragogue cathartics, elaterium, gamboge, citrate of potassa and the compound jalap powder, also aid in subduing the dropsical effusion. The following formula is a useful one for the administration of elaterium: . 509. R. Extracti elateri, gr-^~j Extracti creasoti, gr.ij Extracti hyoscyami, gr-U- M. For one pill. RESUME OF REMEDIES. ^Belladonna is prescribed by Prof. Da Costa to overcome irregularity of the heart's action, and to relieve pain. * Digitalis is recommended in dilatation by Prof. Da Costa and Professor Niemeyer (see above), Drs. Gull, Wilks, Fuller, Handfield Jones, Trousseau, and others. The conclusions of Dr. W. Murray are as follows: 1. That digitalis will stimulate and strengthen a weak heart, and that the weaker are the muscular tissues of the heart the safer will be the administration of the medicine. 2. That in hypertro- phied heart it will fail to reduce the pulse either in frequency or strength, and in such cases will prove dangerous. 3. That in a weak organ, acting, on account of its weakness, with great rapidity, it will reduce the number of its contractions, and, as it were, strengthen or tone them down. To strengthen and quicken the action of a weak, slowly-acting heart, and to reduce the number of the rapid strokes of a full heart, is, according to Anstie, to do the work of a true stimu- lant ; bringing action up to the normal standard on the one hand, and reducing it to that level on the other (Brit. For. Med.-Chir. Rev., July, 1865). Prof. Da Costa says that digitalis is the only remedy which will reduce the frequency and not the force of the heart. Prof. Niemeyer recommends digitalis, combined with an exclusively milk diet, as an invaluable treatment for dilatation. Ferrum, according to Prof. Da Costa, finds its appropriate place in the after- treatment, the secretions being regulated and the internal congestions relieved. Prof. Niemeyer says iron should always be prescribed when the patient shows any signs of anaemia or hyuraemia. Diuretics are indicated when dropsy appears. Dr. Walshe finds that those which yield the most relief are the acetate, nitrate, iodide, and bitar- trate of potassa, nitrous ether, compound tincture of iodine, the in- fusion and spirits of juniper, and gin. Dry Cups to the chest are often useful to relieve the pulmonary congestion. CARDIAC HYPERTROPHY. 213 CARDIAC HYPERTROPHY. ALFRED L. LOOMIS, M. D., NEW YORK. This author condemns the practice of blood-letting to which the full pulse and symptoms of cerebral hypersemia have prompted some practitioners in this disease. Of all remedial agents to di- minish the force of the heart's action, he has found aconite the best. His prescription is— 510. R. Tincturas aconiti rad. (Fleming's) q. s. Two to three drops every three or four hours. " No drug so fully and promptly relieves the vertigo and other painful sensations that attend cardiac hypertrophy." It is contra- indicated if the dilatation overbalances the hypertrophy of the cardiac walls. Digitalis is contra-indicated unless there is degen- eration of the hypertrophied walls. J. M. DA COSTA, M. D., PHILADELPHIA. In the treatment of hypertrophy of the heart, as much rest as possible should be insisted upon. The patient must be directed to lie down for several hours each day. The sinking of the pulse, which naturally occurs in the recumbent position, makes this pos- ture as potent a cardiac sedative as we possess. All stimulants to the action of the heart should be removed. This includes the re- moval of any dyspeptic symptoms which may be present, and of any other disordered function which can react upon the heart. There are only two drugs in which our author has any confi- dence ; one is aconite, or its active principle, aconitia, and the other veratria. These are the only medicines which directly and posi- tively control the element of muscular power of the heart. Digi- talis does not compare as a pure sedative with either aconite or veratrum viride. Gelseminum is useless; it has a false reputation. It is time lost to employ it. Hydrocyanic acid is often a useful and pleasant adjunct when there is gastric disturbance; alone it is of no value. These principles apply both in the treatment of simple hyper- trophy, and in that complicated with valvular disease. A certain amount of hypertrophy with valvular disease is beneficial, and judg- ment must be exercised in order to determine when to interfere, and when not. 214 DISEASES OF THE CIRCULATORY SYSTEM. 511. R. Tinct. veratri viridis, f-gis8 " aconiti radicis, f-gs8 " zingiberis, f.gvss. M. Fifteen drops thrice daily, two hours after meals, in water. The addition of the tincture of ginger causes the veratrum viride to be better borne by the stomach. Our author also frequently orders— 512. R. Tinct. aconiti radicis, gtt.j. Thrice daily for many months, its effects being watched. In a large number of cases this remedy thus employed prevents the further growth of the heart, and in some it lessens the already existing bulk of the organ. DR. WALSHE. 513. R. Extracti aconiti alcoholici, gr.ijss. For 20 pills. One as a dose. In repeating the dose, the effect must be watched. Our author prefers this to all other cardiac sedatives in this affection. RESUME OF REMEDIES. Aconite is one of the only two drugs (the other being veratrum) in which most authorities have any confidence in hypertrophy of the heart. Camphor has been recommended, in doses of from grs. iij-xij, daily, as ren- dering regular the most tumultuous palpitations, and removing the dyspnoea attendant on hypertrophy of the heart with dilatation. *Digitalis. In regard to the value and propriety of the use of this remedy in hypertrophy there is considerable difference of opinion. Prof. Da Costa says it does not compare, as a pure sedative, with either aconite or veratrum viride. The best effects of digitalis in hypertrophy are obtained from small doses, large doses being regarded by many as hurtful, if not dangerous, in this affection. Drs. Gull, Wilks, Ful- ler, W. Murray, and Handfield Jones, regard digitalis as prejudi- cial, and even dangerous, in simple hypertrophy, and would restrict its use to cases of dilatation and enfeeblement of the heart. Fel Bovinum Purificatum has been recommended in certain forms of hyper- trophy. Hydrocyanic Acid alone has, according to Prof. Da Costa, no value, but is often a useful and pleasant adjunct, when there is gastric disturb- ance. Plumbi Acetas has been recommended in the incipient stages of hypertrophy, but is of doubtful value other than in relieving, in some cases, vio- lent palpitations connected with hypertrophy. Potassii Bromidum has been employed, but its utility is not established. Potassii lodidum in small doses, long continued, seems to exercise, in some cases, a beneficial influence. CARDITIS, ENDOCARDITIS AND PERICARDITIS. 215 * Veratrum Viride is one of the only two drugs (the other being aconite) in which Prof. Da Costa has any confidence. Diuretics are strongly recommended by Dr. J. Hope in hypertrophy, not only when there is dropsy but also when there is none, as powerful de- rivatives. CARDITIS, ENDOCARDITIS AND PERICARDITIS. PROFESSOR ARM AND TROUSSEAU, PARIS. This eminent clinician recommends in endocarditis, and in peri- carditis, general or local blood-letting, according to the strength of the patient, and the application of blisters. Internally, digitalis or digitaline, or the administration of the latter by the ender- mic method; or praecordial frictions with the tincture of digitalis. ALFRED L. LOOMIS, M. D., NEW YORK. Whatever the conditions which develop endocarditis, the patient should be kept in bed. Opium in small doses is proper. The tem- perature of the room should always be above 70° Fah. The chest should be covered with flannel, and not exposed. If the heart becomes feeble, digitalis is indicated. " Best, opium, iron and the most nutritious diet, with occasional use of stimulants, consti- tute the most serviceable agents to be employed in the treatment of this affection." In the acute ulcerative form of endocarditis large doses of qui- nine and stimulants are our only dependence. In pericarditis the same cautions about rest, etc., are to be observed. Blisters, blood-letting, diuretics and cathartics our author considers useless; digitalis of doubtful value. "Opium, iron, moderate stimulation, rest in the recumbent posture, anodyne poultices and concentrated nutrition, are about the only measures which I have found of service in the treatment of acute pericar- ditis." Aspiration he commends only when it can be positively determined that pus is in the pericardium. DR. 8HINGLET0N SMITH, LONDON, Regards {Lancet, August 22d, 1874) the use of aspiration in copious effusion into the pericardium as of great value. From ten to fifteen ounces of fluid may be withdrawn, and the relief is immediate. The needle may be introduced in the space between 216 DISEASES OF THE CIRCULATORY SYSTEM. the fourth and fifth rib, about two inches to the left of the middle line of the trunk. RESUME OF REMEDIES. Aconite is recommended by Dr. Ringer in pericarditis when the heart throbs violently, and thus produces extreme pain. Antimonii-ses-iodidum is sometimes employed. Aspiration (see above). *Digitalis, combined with hyoscyamus tincture (aaTi\xv-xx),i8 recommended by Dr. J. Hope in pericarditis, after the acute symptoms have been subdued. Hydrargyrum is considered by Dr. A. T. II. Waters as rarely if ever desir- able in pericarditis, except as a purgative. He prefers to the mercu- rial treatment and venesection recommended by Drs. Latham, Hope, and others, the milder but more effectual remedies of opium, bicar- bonate of potash, the moderate and cautious use of stimulants, large linseed poultices to the chest, and blisters in the advanced stage, with good nourishment throughout the disease. * Opium, in grain doses, every three, four, six or eight hours, is recommended by Dr. A. T. II. Waters in pericarditis. The great relief to pain which often follows the local abstraction of blood in this disease may be equally obtained by the administration of opium. Potassii lodidum, in doses of gr.iii-v ter die, is sometimes given with advan- tage in chronic pericarditis, appearing to favor the absorption of effused fluid. Veratrum Viride is recommended by Dr. Waring-Curran (The Practitioner, August, 1868) in pericarditis. He gives it in the form of an extract made by inspissating the juice of the root, and combines with it gr.j of calomel, every two hours, carefully watching the effect. Blood-letting. Venesection, which was formerly regarded as indispensable in inflammation of the heart and its membranes, is now much less fre- quently resorted to. The local abstraction of blood by cups or leeches often affords great relief to the pain, but many practitioners prefer to seek this relief by means of opium. Blisters are hurtful in the early stages of cardiac inflammation, but useful in the advanced stages. *Poultices. Large linseed-meal poultices are of signal service in the earlier stages of inflammatory action. *Turpentine stupes, which can be employed at a far earlier period than blis- ters, are often of manifest advantage in relieving pain and distress, and arresting inflammatory action. Issues in the praecordial region frequently give relief in chronic inflamma- tion of the heart or its membranes. RHEUMATIC CARDITIS. *Colchicum, with alkalies, etc., is, according to Dr. Fuller, necessary in rheu- matic carditis, to counteract, and get rid of the materies morbi, with- out the removal of which it is difficult to conceive that a cure can be effected. *Hydrargyrum, combined with opium, and carried to the extent of slight salivation, is strongly recommended by Dr. Fuller in rheumatic inflammation of the heart, occurring in young, robust subjects, but FATTY DEGENERATION OF THE HEART. 217 he does not advocate its use in weakly, irritable and unhealthy constitutions. *Opium, in large and repeated doses, is strongly recommended in rheumatic pericarditis by Drs. Walshe, Farre (St. Bartholomew1 s Hospital Report, n, 1867), and others. If the surface has been blistered, morphia may be used endermically; and often, when opium inter- nally is inadmissible, benefit is obtained from morphia hypodermi- cally. Dr. Fuller says that in rheumatic carditis opium in full doses is indispensable in every case. In the weak and irritable, where mercury is of little service, it proves particularly valuable. It is, of all remedies, that which comes most powerfully in aid of blood-letting and mercury. If, after all active Bymptoms have subsided, much irritability of the heart remains, occasional doses of opium and digi- talis should be given, and an opium or belladonna plaster applied to the chest, while the general health is being attended to. Quinia? Sulphas, in doses of gr.ijss, combined with gr.xx of carbonate of potash, given in mucilage every four hours, was found by Dr. Winn (Lancet, November 14th, 1868) highly beneficial in a case of rheu- matic pericarditis attended with delirium. Stimulants. Alcoholic stimulants are often very beneficial in rheumatic peri- carditis, especially when the attack is characterized by great pain, sleeplessness and jactitating movements of the limbs. In this form of the disease Dr. Anstie regards alcohol as superior to opium as an anodyne and specific. It should be given in repeated small doses, the production of even the minor signs of intoxication being care- fully avoided. Blood-letting. Dr. Garrod states that so much relief follows the application of leeches to the cardiac region in rheumatic pericarditis, and in endocarditis, that he has no hesitation in recommending the measure, the bleeding never being allowed to produce any appreciable weak- ening of the patient. Generally, from three to twelve leeches are sufficient. The slow loss of blood by leeching is preferable to the more expeditious abstraction by cupping. *Blisters are recommended by Dr. Fuller in the advanced stages of rheu- matic carditis, when effusion has taken place, as, of all local remedies, the most serviceable, their virtue being most unequivocally displayed when the amount of fluid is greatest. FATTY DEGENERATION OF THE HEART. MR. JOHN MARTIN, OF DUBLIN. This writer {Dublin Journal of Medical Sciences, February, 1875), believing that the fatty change is owing to an excess of car- bonate of lime in the system, recommends the use of the nitric and hydrochloric acids in combination with iron. They should be taken in small quantities and for a long time. The diet should be one avoiding compounds of lime. 218 DISEASES OF THE CIRCULATORY SYSTEM. DR. A. T. H. WATERS, OF LIVERPOOL. Ferri Tinctura Chloridi is highly recommended by Dr. A. T. H. Waters, who believes that if it be given in small doses for a long time, it will often restore to an enfeebled and fatty heart a good deal of its vigor, and possibly of its structure. But its administra- tion must be continued for months, and even years, being omitted from time to time, as the digestive organs may demand. A cha- lybeate mineral water may be substituted for the tincture of chloride of iron, if the latter cannot be taken. RESUME OF REMEDIES. Digitalis, according to Dr. A. L. Loomis, will sometimes afford relief when there is yielding of the cardiac walls. Ergot is recommended by Dr. Waring Curran, as of material use in severe cases. FUNCTIONAL PALPITATION OF THE HEART. J. MILNER FOTHERGILL, M. D., LONDON. This writer commends {Medical Times, April, 1876), as the most satisfactory prescription, the following, or an appropriate modifica- tion of it:— 514. R. Potassii bromidi, grs.xv Tincturas digitalis, gtt.v. M. This amount thrice daily. If there is anaemia present, the potassio-tartrate of iron will be found to combine nicely with this prescription. A belladonna plaster should be worn over the region of the heart. J. M. DA COSTA, M. D., PHILADELPHIA. Inquiry should always be made as to the cause, for the first step in the treatment is its removal. The cause may be found to be drinking of coffee, chewing of tobacco, smoking, alcoholic drinks, masturbation, etc. In all cases of functional disorder of the heart, attended with palpitation, digitalis is very serviceable, more so than aconite. If FUNCTIONAL PALPITATION OF THE HEART. 219 there be masturbation as the exciting cause, the following is a useful combination:— 515. R. Potassii bromidi, gvss Tincturae digitalis, f.giJ8S Infusi cascarillae, f.giv. M. A dessertspoonful two or three times a day. ROBERTS BARTHOLOW, M. D., CINCINNATI. The violent and irregular actions of the heart occurring in hys- terical subjects are immediately relieved by the use of the hypo- dermic syringe. Morphia alone is used. In cases of dyspnoea, dependent upon dilated right cavities, pulmonary oedema and mitral disease, advantage is derived from the following HYPODERMIC INJECTION. 516. R. Morphias sulphatis, gr-xvj Atropiae sulphatis, gr.j Aquae destillatae, f.gj. M. Filter. Dose—five minims (equal to one-sixth of a grain of morphia, and one ninety-sixth of a grain of atropia). DR. BOUOHUT, PARIS. 517. R. Assafoetidae, gr.xxxvj Digitalis pulveris, gr-iij Extracti Valerianae, gr.vij. M. Divide into 18 pills; one morning and evening, to remedy nervous palpitations of the heart. If the blood be impoverished, a ferrugi- nous natural mineral water is a useful drink with the meals, mixed with wine. RESUME OF REMEDIES. Aconite, in small doses, often controls nervous palpitations of the heart. Camphor, in doses of gr.iij-xij daily, is recommended in tumultuous palpitation. ^Digitalis is recommended by Prof. Da Costa as more serviceable than aconite in all cases of functional disorder of the heart. Hyoscyamus, in large doses, is especially indicated in functional disturbance of the heart arising from emotion. Dr. Harley recommends in these cases the hypodermic injection of gr.^y of sulphate of hyoscyamia. Morphia, hypodermically, is recommended by Prof. Bartholow in violent palpitation produced by emotion or reflex irritation. *Potassii Bromidum, in doses of gr.v--x ter die, is recommended by Dr. Rus- sel Reynolds in palpitation or fluttering of the heart, arising from disturbances of the vaso-motor system. Senega, in combination with hyoscyamus and ammonia, often proves useful in hysterical palpitations. 220 DISEASES OF THE CIRCULATORY SYSTEM. INTERNAL ANEURISMS. J. M. DA COSTA, M. D.. PHILADELPHIA. This author states there are but two remedies in which he has any faith in the radical treatment of internal aneurism. The first is iodide of potassium. It should be used boldly. The following recipe was given continuously for ten months, with the most marked beneficial results, in a case of chronic aneurism:— 518. R. Potassii iodidi, gr.xv Syrupi tolutani, Aquae, aa f.gj. M. For one dose, thrice daily. This remedy does no good excepting early in the disease. The second remedy referred to is ergot. It is not yet known definitely how much good it really does. Some very excellent results have been obtained by Langenbeck. It may be given internally or by hypodermic injections. In a disease so dangerous, so almost necessarily fatal, the importance of a knowledge of any remedy which seems to exert an influence is apparent. As both the iodide of potassium and ergot can be tried without injury to the patient, it is the duty of every practitioner, in cases of internal aneurism (in which, of course, surgical treatment is out of the question), to try one or the other of these drugs. The following formula may be used for the hypodermic injection of ergotin:— 519. R. Ergotinas, gr.ij Spiritus vini rectificatas, Glycerinae, aa f.gss. M. Five minims (equal to gr.j of ergotin) for a dose. This is the formula of Eulenberg. Prof. Langenbeck employs the aqueous extract of ergot or Bon- jean's ergotin. It is usually administered hypodermically in the dose of gr.4;. In a case reported by Langenbeck, thirty grains of this preparation were injected in forty days with great benefit. The subclavian aneurism diminished in size, and the other symp- toms improved. Prof. Bartholow gives the following formula:— 520. R. Extracti ergotas fluidas (U. S. P.), f.gij. Carefully filter and inject in ten-minim doses. VALVULAR DISEASE OF THE HEART. 221 A. T. H. WATERS, M. D., OF LIVERPOOL. In the Lancet, April, 1872, this writer recommends absolute rest, so far as possible, and a restricted diet. The patient should not so much as sit up in bed for weeks. His medicinal treatment is iodide of potassium, twenty grains three times a day, continued for months. The application of an ice-bag over the tumor has also produced good results at his hands. Dr. Ward {Medical Times and Gazette, September 26th, 1874) also found decided value in the application of the ice-bag. He also administered digitalis with iron, and succeeded in causing the dis- appearance of the evidences of the tumor in a case of thoracic aneurism. RESUME OF REMEDIES. *Ergot. This is one of the only two remedies (the other being iodide of potas- sium) in which Prof. Da Costa has any faith in the radical treat- ment of internal aneurism. Ergotin may be injected hypodermically. Plumbi Acetas is sometimes employed with success, but in the hands of many practitioners has proved a failure. *Potassii lodidum, used boldly, is on« of the only two remedies (the other being ergot) in which Prof. Da Costa has any faith in the radical treat- ment of internal aneurism, but it only does good early in the disease. Senega, combined with other diuretics, is recommended by Dr. Barlow in aneurism of the aorta, to allay excitement without depressing the vital powers (see Valvular Disease). VALVULAR DISEASE OF THE HEART. ALFRED L. LOO MIS, M. D„ NEW YORK. All valvular diseases require rest, the avoidance of strong emo- tions, a nutritious diet, and temperance. If anaemia is present, iron is called for. Digitalis should be employed carefully; " it should never be resorted to in aortic regurgitation while the hypertrophy compensates for the dilatation." Dr. Loomis thinks the best mode of administering it is by infusion. The following tonic combination is commended by Bartholow :— 521. R. Pulveris digitalis, Bij Ferri redacti, Quiniae sulphatis, aa 9j. M. To make 20 pills. One to be taken two or three times a day. 222 DISEASES OF THE CIRCULATORY SYSTEM. There is considerable diversity of opinion in the books as to the use of digitalis in aortic cases, though in other forms of heart disease opinions are pretty well agreed. Some authorities would regard aortic insufficiency as a nearly absolute contra-indication to the use of the drug. Dr. G. W. Balfour regards it as the most valuable remedy in this lesion. Mr. Thomas Hayden says: " Given as the tincture, and combined with iron and ether, I have rarely known digitalis to cause unpleasant symptoms; on the con- trary, in numerous instances it has been followed by the most favorable and satisfactory results. I have in a few instances been under the necessity of suspending the use of digitalis owing to threatened syncope; but in the cases referred to there was fatty degeneration of the heart, in some instances with, and in others without, disease of the aortic valves." Mr. Hayden's prescription is: ten minims each of tincture of digitalis, tincture of chloride of iron, and spirits of nitric ether in an ounce of infusion of quassia, thrice daily. Dr. Balfour, however, will not allow the fatty degeneration to be the explanation, as he quotes a very good case in which the drug was most useful, and says, speaking of fatty heart, " I have never seen any reason to withhold digitalis, and have always hitherto been rewarded by considerable and well-marked improve- ment." He prefers the tincture, and orders n\,v-xxx every four hours, to be suspended if there is any faltering of the pulse or nausea on movement {Edinburgh Medical Journal, Feb., 1875). PROFESSOR SEE, PARIS. This distinguished teacher recommends (Union Medicate, May, 1875) the following combined treatment in the oedema and anasarca which so frequently complicate cardiac affections. He claims to have effected their speedy disappearance. 522. R. Extracti scillae, gr.xv Pulv. rad. scillae, gr.iss. M. For 10 pills. Six to ten of these a day. Also, 523. R. Potassii bromidi, gj. This amount to be taken daily, in divided doses. VALVULAR DISEASE OF THE HEART. 223 ROBERT J. GRAVES, M. D„ DUBLIN. 524. R. Potassii nitratis, gj-ij Tincturae digitalis, TTLxxv Tincturae hyoscyami, n^v Misturae amygdalae, f.gx. M. A tablespoonful from hour to hour in the oedema which accompanies disease of the heart. DR. BOIJCHUT, PARIS. 525. R. Digitalis pulveris, Qiv Morphiae muriatis, gr.v Camphorae pulveris, gss Confectionis rosae, q. s. M. Divide into 40 pills. One to be administered morning and evening, in organic affections of the heart. 526. R. Tincturas digitalis, f.givss Vini colchici, f.giss Potassii iodidi, gijss Syrupi sarsaparillas, f.giss Aquas destillatae, f-gijss. M. A teaspoonful three or four times a day in the anasarca of heart dis- ease. The patient should be purged every third day with compound jalap powder. 527. R. Tincturae aloes, f.gj Tincturae scillas, Tincturas digitalis, aa tt\,xv. M. For one dose, every second or third day, in the dropsies of heart disease. RESUME OF REMEDIES. Aconite is contra-indicated or to be used with the utmost caution, in organic disease, where the power or force of the heart is impaired. Belladonna is recommended by Dr. A. T. H. Waters in form of plaster or lotion over the heart in palpitation combined with valvular disease, the patient at the same time being kept at rest in bed; rest alone is often efficacious. In severe cases belladonna is superior to digitalis (which see). ^Digitalis is recommended by Dr. A. T. H. Waters in valvular disease, especially when there is hypertrophy of the heart. Dr. E. Mackey (British Medical Journal, May 31st and July 11th, 1868) thinks that neither mitral regurgitation nor mitral obstruction contra-indicates the use of digitalis, and gives numerous cases in which it was em- ployed with advantage ; but he regards its employment in aortic regurgitation and in fatty degeneration as contra-indicated or of doubt- ful safety. In any case where the heart's action is very feeble, Dr. M. considers that the commencing dose of the tincture should be TT^v-x every four or six hours; this dose may be increased to Tr^xv-xx, or even ttlxxx, with benefit; but, as a general rule, such a dose as trixxx should not be repeated more than twice in the twenty-four hours. An equiva- lent dose is f.gss of the fresh infusion, or gr.j of the powdered leaves. The patient, before taking such a dose, must be kept recum- bent at least half an hour, and kept so for two hours after. Dr. M. 224 diseases of the circulatory system. hesitates to prescribe a larger dose than n\,xv of the tincture to any patient following his occupation, and believes that half-drachm doses of the tincture, repeated several times at short intervals, especially in the upright position, may dangerously interfere with the circu- lation, whether by over-stimulation or partial paresis. But given in the manner directed, no cumulative action has been observed. Ferri Chloridi Tinctura is recommended in chronic valvular disease by various writers; given in long-continued small doses, is directed for fatty degeneration (which see). *Morphia has been employed hypodermically by Dr. Clifford Allbut (Prac- titioner, December, 1869) with marked advantage in diseases of the heart. He gives the injection in the evening and enjoins perfect quiet afterward. His commencing dose is gr.£ or ^ of the muriate increased, in ordinary cases, to gr.^ for an adult. He finds it valuable in mitral regurgitation, but less valuable in mitral obstruction and in disease of the aortic valves; but in aortic disease, when the heart is big and pumping, it gives much ease. The urine, however, should always be examined and the morphia given with caution or with- held, if albumen be found. Prof. Bartholow also recommends morphia hypodermically in mitral disease, but is opposed to its employment in narrowing and obstruction of the aortic orifice. * Senega, combined with some other diuretic, is recommended by Dr. Barlow in valvular disease of the heart, to promote the action of the kidneys and relieve the palpitation, especially the palpitation arising from aortic disease. He employs the following formula:— 528. R. Spiritus aetheris compositus, f.gij Tincturae hyoscyami, f.giss Deoocti senegae, f.3iij Misturae camphorae, q. s., ad. f.giv. M. Take \ thrice daily. Veratrum Viride is often employed with benefit on the pulse. Zinci Sulphas is favorably spoken of by Dr. Barlow in mitral disease. He employs:— 529. R. Zinci sulphatis, gr.iij Extracti lupuli, gr-vJ« M. Make six pills. Take one thrice daily. The dose of the zinc should be gradually increased to gr.iij. When there is much palpitation, he advises its combination with camphor. 530. R. Zinci sulphatis, grj—iij Camphorae, gr.j Extracti hyoscyami, gr.ij. M. Make into pills. Take thrice daily. When there is much irri- tability of the stomach the iodide should be substituted for the sulphate. Diuretics are found beneficial by Dr. Hope in every stage of valvular disease of the heart. They draw off the serous portions of the blood, diminish the quantity without deteriorating the quality of that fluid, and thus relieve palpitation and dyspnoea, and obviate infiltration, without materially reducing the strength. IV. DISEASES OF THE DIGESTIVE SYSTEM. The Mouth—The Fauces—Anorexia—Biliary Calculi—Cholera Asiatica—Colic {Flatulence, Reus, Colica Pictonum)—Constipa- tion, Habitual—Diarrhoea {acute, chronic)—Dysentery {acute, chronic)—Dyspepsia— Gastralgia— Gastritis— Gastric Ulcer— Hematemesis—Hepatitis, {acute, chronic)—Jaundice,—Liver: Functional Disorders of—Pyrosis— Vomiting. THE MOUTH. STOMATITIS. In this disease Dr. Roberts Bartholow extols the following:— 531. R. Potassas chloratis, gj Acidi carbolici gss Aquas destillatas, giv. . M. For a lotion. Apply directly to the affected part. " There is no more effective remedy for ulcerative stomatitis, the stomatitis of nursing women, and aphtha." PROF. S. D. GROSS, PHILADELPHIA. 532. R. Liquoris plumbi subacetatis, f.gj Aquas, f-Iviij. M. To be used as a mouth wash every hour or two in cases of mercurial stomatitis. The only objection to this lotion is that it discolors the teeth, which effect, however, quickly disappears. At the same time, internally, the chlorate of potassa should be administered. Fifteen to thirty grains are to be taken ter die in mucilage or lemonade. J. COPLAND, M. D., OF LONDON. 533. R. Acidi muriatici diluti, f.gss Tincturas capsici, f-gjss Mellis, f.gv Infusi rosae, f.gv. M. To be used in stomatitis when the ulcers are slow in healing. 15 225 diseases of the digestive system. 534. R. Manganesii carbonatis, g.) Ferri carbonatis, gjss Potassii iodidi, gy Tincturae gentianae compositae, Syrupi sarsaparillas compositae, aa f-gijss M. Two teaspoonfuls a day in ulcerous stomatitis. DR. MAURICE JEANNEL, OF PARIS. 535. R. Tincturas myrrhas, Mellis rosae, aa f.gij. Liquoris calcis, f.giss. M. Touch several times a day the superficial ulcerations of the mouth. 536. R. Potassii chloratis, gijss Acidi muriatici diluti, f-gss Mellis rosas, f-3v"j Aquas, f-3jss. M. A useful gargle in ulcerations and gangrenous stomatitis. 537. R. Tincturae myrrhas, f.gij Acidi muriatici diluti, gtt.x Infusi rosas, Decocti cinchonae, aa f-giij- M. Use as an astringient and alterative gargle in inflammation of the mouth and throat. 538. R. Liquoris calcii chloridi, f-giij Mellis rosas, f-gvij Aquas distillates, f.gv. M. Useful in ulcerous stomatitis and in fetid breath. APHTHA. DR. N. GALLOIS, OF PARIS. 539. R. Sodii boratis, gss Glycerinae, f.gss Mellis despumatas, f-giij- M. . Touch lightly with the solution, by means of a camel's-hair pencil, several times a day, the aphthous ulcerations of the mouth. In case of the insufficiency of this remedy, resort to the nitrate of silver. 540. R. Aluminii et potassii sulphatis, ^j Tincturae myrrhae, f.giss Aquas destillatae, f.giv. M. A useful gargle in aphthous stomatitis. 541. R. Tincturae myrrhae, f.gv Tincturae opii camphoratae, f.giss Mellis rosas, f.gj Decocti hordii, f.gv. M. A useful gargle and wash in aphthous inflammation of the mouth and throat; THE FAUCES. 227 Or employ: 542. R. Tincturas myrrhas, f-giij Mellis despumatas, f.gj Infusi rosas, f.giv. M. Used as a gargle, as above. THE FAUCES. INFLAMED SOBE THROAT. J. M. DA COSTA, M. D., PHILADELPHIA. 543. It. Cupri sulphatis, gj Aquae, f.gj. M. Apply with a brush three times a week in cases of follicular pharyn- gitis. E. W. FRISBIE, M. D., EAST SPRINGFIELD, NEW YORK. 544. R. Iodinii, gr.x Potassii iodidi, gr.xx Mucilaginis acaciae, f.gj Sacchari albi, g'j-giv Aquas, f.gss. M. To be applied with a camel's-hair pencil two or three times daily in irritable and inflamed sore throat, follicular pharyngitis, etc. PROFESSOR JOSEPH PANCOAST, M. D., PHILADELPHIA. 545. R. Cinchonas rubri, gss. Aquas bullientis, Oss. M. Strain and add: 546. R. Tincturae myrrhae, Tincturae krameriae, Mellis despumatas, aa f.gj Acidi muriatici diluti, gtt.xv. M. Use as a gargle in cases of chronic sore throat. DE. N. GALLOIS, PARIS. 547. R. Aluminii et potassii sulphatis, gj Decocti que re us albas, f-giv Vini albas, f-gijss. M. This is a useful gargle in chronic inflammatory affections of the throat attended with relaxation of the uvula. 548. R. Sodii boratis, gj Extracti opii, 9j Mellis, f.gj _ Infusi salvias, f-3vj. M. Employ as a gargle in inflammatory sore throat. 228 DISEASES OF THE DIGESTIVE SYSTEM. 549. R. Acidi tannici, 3|9 Mellis rosas, Vl- ! Aquas rosas, Employ as a gargle in chronic sore throat. f.givss. M. si 550. R. Potassii nitratis, Sodii sulphatis, . ov Antimonii et potassii tartratis, gr-?3 Syrupi acaciae, *-3jM Aquas sambuci, i.3ivh». A tablespoonful every hour or two in acute inflammatory sore throat. 551. R. Sodii boratis, jplss M Glycerinae, I,5J* Or: 552. R. Acidi tannici, 3L. Glycerinae, 3J- Dip a fine brush in either of these solutions, and touch the false mem- branes several times a day. 553. R. Acidi tannici, p> gs Aluminii et potassii sulphatis, 3J* Reduce to a fine powder, and use by insufflation. DR. RENAULDIN, FRANCE. 554. R. Ammonii chloridi, Zh Spiritus camphorae, *-|.ss Oxymellis, *-4) .. M Decocti cinchonas rubras, I-3V1J. iU- Employ as a gargle in gangrenous sore throat. 555. R. Acidi muriatici, gtt.xx-xxx Mellis rosae, *-|J M Decocti cinchonae rubras, 1-3V- iU< Employ as a gargle in gangrenous sore throat. ANOREXIA. DR. N. GALLOIS, PARIS. 556. R. Tincturas nucis vomicae, gtt.v Extracti gentianas, gr-xv Syrupi aurantii corticis, f.giss Vini cinchonae, f-3v« .' One-half to be taken half an hour before each of the two principal meals, in order to awaken the appetite. ANOREXIA. 229 557. R. Rhei, gr.xxxv Aloes socotrinas, gr.xxv Myrrhae, Saponis, aa 9j Spiritus menthae piperitas, n\,. iij. Extracti taraxaci, ^ij. M. Divide into 45 pills, and order from one to three at a dose, as laxatives, and to stimulate the functions of the stomach. 558. R. Aloes socotrinas, gr.xvj Ipecacuanhae, gr.vijss Zingiberis, gr.xxv Sjrupi, q. s. M. Divide into 16 pills, order one a day, before dinner, to stimulate the appetite and regulate the system. 559. R. Fel bovini purificati, Qiv Ferri carbonatis, sjsa Rhei, Extracti gentianae, aa T)iv. M. Divide into 120 pills, order six or ten a day, to combat a want of appetite. DR. REECE, FRANCE. 560. R. Sodii carbonatis exsiccatas, Qj Extracti gentianae, gij Zingiberis, gr.xij M. Divide into 36 pills, and order two morning and evening, as absorbents and stomachics. PROF. FONSSAGRIVES, MONTPELLIER, FRANCE. 561. R. Extracti cinchonas flavae, gss Tincturae nucis vomicae, gtt.v Syrupi aurantii corticis, f.giss Claret wine, f-gviij. M. Take several tablespoonfuls, at the commencement of the meals, to stimulate the appetite. LONDON HOSPITAL. 562. R. Pulveris anthemidis, gss Pulveris rhei, Pulveris zingiberis, aa gij. M. Divide into 16 powders. Take one a day, an hour before or after meals, to stimulate the appetite and facilitate digestion. DR. HUSS, FRANCE. 563. R. Pulveris nucis vomicae, gr.xv-xx Pulveris quassias, Cretas prasparatas, aa gss. M. Divide into 20 powders, and order one three times a day, half an hour before each meal, to stimulate the appetite and favor digestion. 230 DISEASES OF THE DIGESTIVE SYSTEM. DR. KLEIN, FRANCE. 564. R. Pulveris rhei, Potassii tartratis, Pulveris aurantii amari corticis, aa gss ^ Olei cajuputi, gtt.iij. ^ M. To be given in one dose, to obtain a purgative effect and establish the appetite. DR. CAFFE. PARIS. 565. R. Extracti nucis vomicae, Pulveris rhei, Cretas prasparatas, Spiritus menthae piperitas, Sacchari, Divide into twelve powders. One to be taken half meal when there is want of appetite. DR. BERNAUDEAU, FRANCE. 566. R. Extracti columbae, Extracti quassias, aa gss Malaga wine, Oj. M. Dissolve and filter. Two tablespoonfuls half an hour before each of the two principal meals, in dyspepsia, and to stimulate the appetite of convalescents. BILIARY CALCULUS. DR. M. SCHIFF, OF FLORENCE. The cholinate of soda is recommended {LImparziale, Feb. 16, 1873) by our author in the treatment of biliary calculus. He says that biliary calculi are generally produced, not in consequence of an excessive formation of cholesterine, but because there is a deficiency of its solvents in the bile—the cholinates and cholates of soda and potash. He suggests the administration of these salts in cases of gall-stone; not to remove the cholesterine already deposited, which he does not think possible, but to hold it in solu- tion and prevent further deposit. It has been proved that bile or a solution of biliary salts, taken into the stomach or intestine, is conveyed to the liver, and that the bile discharged is richer and more dense. He advises that the cholinate of soda should be given in doses of 7 J grains twice a day, until symptoms of disturb- ance of digestion or of circulation are noticed. Saturation of gr.xv gtt-u gr.v. M. an hour before the BILIARY CALCULUS. 231 the system with the medicine is indicated by irregularity of the pulse, which becomes very slow during rest, and is sensibly accel- erated by movement of the body or by slight excitement. When this occurs the medicine should not be interrupted, but the dose must be diminished. No good effect is to be expected unless the remedy be continuously administered for some time. DR. DURAND, PARIS. 567. R. Olei terebinthinae, f-giij ^Etheris sulphurici, f.gij- M. Half a teaspoonful night and morning. This is the celebrated "solvent" of Durand, endorsed by Trous- seau. It has unquestionable utility as a preventive of the recur- rence of an attack. Alkaline drinks, such as Vichy water, or as Dr. Prout recommends, bicarbonate of soda, gi or gij in warm water Oj, aid its action. RESUME OF REMEDIES. *B-Madonna. Dr. Murchisov highly recommends the extract of belladonna, in one-half grain doses, every two or three hours, in the passage of gall-stones. Chloral is frequently employed with advantage, on account of its producing muscular relaxation. * Chloroform by the mouth, or in the form of inhalation, relieves pain, dimin- ishes spasm and does not interfere with the onward propulsion of the stone. Ether, internally, has been recommended on account of its power of dissolv- ing cholesterine, as well as because of its anti-spasmodic properties. * Opium in full doses (gr.ij or gtt.xl of laudanum) by the mouth or rectum, repeated in half an hour if necessary, generally relieves the intense pain attending the passage of biliary calculi better than any other remedy. It should be combined with the use of the hot bath. The administration of ether or chloroform may also be advantageously resorted to. The hypodermic injection of morphia (gr.£), repeated if necessary, is particularly useful, from the rapidity of its action. 232 DISEASES OF THE DIGESTIVE SYSTEM. CHOLERA ASIATICA. THE MEDICAL STAFF, U. S. ARMY. The classical work on The Cholera Epidemic of 1873 in the United States, mainly prepared by Dr. Ely McClellan, U. S. A., contains the well-digested experience of practitioners during the last cholera epidemic in this country. We quote some of the most successful measures adopted. Dr. R. W. Mitchell, of Memphis, Tenn., writes: "When satisfied that I had cholera to contend with, as indicated by rice- water discharges, vomiting, cramps and shrinkage of extremities, I ceased medication by the stomach, and used the formula given hypodermically:— 568. R. Acidi sulphurici, gss Morphiae sulphat, gr.^ Spiritus vini gallici, giss Aquas destillatas, giij. M. "Theabove was injected under the skin of the arms, legs and over the stomach every hour until the symptoms of the disease were relieved." Dr. G. B. Thurston, of Memphis, Tenn., writes: " The general treatment that I adopted was about as follows: Calomel and opium in alterative doses, say in two of the former to one of the latter, repeated every hour for several hours. In conjunction with this, used the following:— 569. R. Extracti canabis indicas, Gum camphor, Chloroform, Olei terebinthinae, Mucilag. acaciae, Syrupi simplicis, Aquas cinnamomi, Dose, a teaspoonful every one or two hours. Dr. J. T. Jones, of Nashville, Tenn., reports that, in the cold stage of cholera, he has used creasote with greater success than any other article of the materia medica, and suggests the following formula:— 570. R. Creasoti, „\xj\ Aquas camphorae, Infusi gentianae compositae, aa gvj. M. At a dose, and repeated every two hours. gr.xvj gss gss aa gss gj- M. CHOLERA asiatica. 233 Dr. S. T. Chandler, of Campbellsville, Ky., who treated, during the epidemic of cholera in 1854, some sixty to seventy cases of the disease in its various stages, records his experience as having been largely in favor of the use of dilute sulphuric acid in full doses and repeated every fifteen to thirty minutes, until the vomiting and purging are arrested. In the epidemic of the year 1873, the same plan of treatment was adopted, and with like results. " The acid relieves the nausea, arrests the vomiting like a charm, and gradually the dejections are stopped." Dr. McClellan adds, that the necessity of instituting treat- ment at the earliest moment after the occurrence of a diarrhoea was most generally recognized throughout the area of infection. Whenever physicians, during the progress of the epidemic, ceased the attempt to diagnose between cholera, cholera-morbus and diar- rhoea, and treated all cases that occurred as cases of cholera, the lists of mortality were reduced; while, on the other hand, increas- ing mortality was shown whenever too great reliance was placed upon diagnostic powers. The evidence is conclusive that the exhibition of opium, followed by alterative doses of calomel, and absolute rest in the recumbent posture, almost invariably arrested the disease when in the pre- monitory stage. In the advanced stages, the entire range of the pharmacopoeia seems to have been brought into use, with no better results than had been obtained in previous epidemics. The experience of the writer is strongly corroborative of the beneficial results which may be obtained from the use of sulphate of iron and dilute sulphuric acid as prophylactics during an epi- demic of cholera; and, further, that the most successful treatment of the disease is to be found only in all that is implied in the word sanation. Dr. John M. Woodworth, Supervising Surgeon U. S. Marine Hospital Service, records the experience of his department in the following language: "Beginning with the year 1814, the cholera literature down to the present time abounds in proofs, clinical, physiological, pathological and meteorological, of the efficacy of sulphuric acid, and there can be no doubt, despite the dicta of the last International Sanitary Conference, that we possess in the min- eral acid a certain means of prophylaxis against cholera. The lessons of the epidemic of 1873 point strongly to the value of sul- phuric acid even as a therapeutic agent against the disease. 234 DISEASES OF THE DIGESTIVE SYSTEM. According to Dr. McClellan, mortality among cholera patients treated with acids was only eight per cent., while the lowest mortality rate where other remedies were used was twenty-three per cent., and the highest fifty-nine per cent." DR. WILLIAM STEVENS, OF LONDON. This author in two epidemics claims to have had very successful results from the saline treatment, in his hospital and prison patients. Cases presenting premonitory symptoms—diarrhoea and vomiting—were removed into an observation ward, where an even temperature was constantly maintained. A seidlitz powder was immediately administered; if sinking was felt, without purging, three or four teaspoonfuls of Epsom salts were added to the powder. On these agents acting, plenty of thin beef tea, well seasoned with salt, was given; if there was any pain, a sinapism was applied to the gastric region; and thirst was relieved with seltzer water, soda, or pure water ad libitum. Most of the cases were thus cured. If, however, cramps, coldness or shrinking of the pulse came on, the patients were considered as cholera cases in the second degree. The following was then administered:— 571. R. Sodii chloridi, gij Sodas carbonatis, gij Potassas chloratis, 9ij Aquae, f-JvJ- M. Two tablespoonfuls in water about every half-hour. If there was much irritability of stomach, a large sinapism was applied; if much heat or burning pain, an additional quantity of carbonate of soda was added to the mixture. In cases in the stage of collapse, a strong solution of the same salts, dissolved in hot water (100° F.), was thrown into the bowels, and repeated every two or three hours. Sinapisms were also applied to the stomach, between the shoulders, etc.; and in the cold stage, frictions with warm towels were used. A pure air for the patient to breathe was considered of the greatest importance. In mild cases, the " wet-sheet envelope " will favor reaction, but it has only proved mischievous in severe instances. When the vomiting is severe, or the thirst insatiable, nothing gives more relief than permitting ice to be continually sucked. The patient is also to.be isolated as far as possible. He is to have plenty of fresh air; and care must be taken that the water he drinks is un- CHOLERA ASIATICA. 235 contaminated—particularly, that it has not been drawn from a well near any sewer. Moreover, his excreta should be received in a pan containing a disinfecting fluid, and then at once thrown away. The greatest caution will subsequeutly be required for many days as to diet; not a few deaths have occurred from the too early use of animal food. As a rule, broths and farinaceous substances only should be allowed, without any solids whatever, until the renal secretion has been fully re-established, and all the symptoms have vanished. DR. FLEMING, QUEEN'S HOSPITAL, BIRMINGHAM. 572. R. Plumbi acetatis, gr.xxiv Liquoris morphiae acetatis, f.gj Acidi acetici diluti, ttl-xij Aquas destillatae, f-gvj- M. A tablespoonful every two hours (an hour before or an hour after food is taken) in a tablespoonful of water; beef tea and milk, alternately, every four hours ; warm negus in moderation. The value of acetate of lead and opium in diarrhoea is well known. Dr. Fleming calls attention to the mode of administration. The astringent action of both lead and morphia is in consequence of their absorption and conveyance in the blood to the affected part. Hence, the marked advantage of giving them in a thorough solu- tion in distilled water, which promotes their passage into the blood. This is further secured by giving the medicine on an empty stomach before meals, and so avoiding, as far as possible, precipita- tion of the lead by contact with the gastric fluids. In the ordinary lead and opium pill, more or less lead is probably converted into the meconate; or the pill dissolving slowly in the stomach in con- tact with the gastric secretions, the lead runs much risk of conver- sion into the insoluble chloride. Our author has adopted this mode of administration for many years, and speaks strongly of its effi- ciency. In the diarrhoea of children the same mixture, according to the following formula, gives most valuable results:— 573. R. Plumbi acetatis, gr.xij Liquoris morphiae acetatis, '"b-xij Acidi acetici diluti, f.gj Aquas destillatae, f-giij- M. A teaspoonful every five, six or eight hours, to a child one year of age. WILLIAM SEDGWICK, M. R. C. S., ETC., LONDON. Our author strongly recommends (the Lancet, August 19th, 1871) dilute phosphoric acid in half-drachm doses, combined with syrup of orange, and largely diluted with ice-water. 236 DISEASES OF THE DIGESTIVE SYSTEM. In cases of choleraic diarrhoea, and in the early stage of con- firmed cholera, this remedy appears to be capable of checking the progress of the disease with greater certainty than sulphuric acid. GEORGE JOHNSON, M. D., F. R. C. P., PROFESSOR OF MEDICINE IN KING'S COLLEGE, LONDON; PHYSICIAN TO KING'S OLLEGE HOSPITAL, ETC. In the treatment of cholera and choleraic diarrhoea, which is, in fact, cholera in a mild form, the main principle to bear in mind is, that the discharges are as essentially curative as is the eruption of small-pox. The discharges are not to be abruptly stopped by opiates. Experience has abundantly proved that this is a pernicious practice. Neither are they permitted to accumulate in the aliment- ary canal. There is one remedy which is almost universally ap- plicable in all forms and stages of the disease, and that is an abundant supply of cold water, to flush the intestinal sewer and to wash out the poisonous discharges. A copious imbibation of pure cold water will suffice for the cure of most curable cases. Palpation and percussion of the abdomen reveal the fact that there occurs not unfrequently a painful and sometimes a paralyzing over-distention of the bowel by rapidly effused morbid secretion. This, if not promptly relieved, may even go to the extent of causing a fatal obstruction. More especially is this likely to happen when the sensibility of the bowel has been deadened by opium. The plan to prevent and to remove this accumulation is to give some quickly-acting yet unirritating evacuant dose. For this purpose, castor oil is, on the whole, better suited than any other remedy. The objection sometimes raised—that all remedies must be useless, because none are absorbed—obviously does not apply to such a remedy as castor oil, which, by its merely local action upon the mucous surface, stimulates the bowel and expels its contents. Experi- ence has amply proved the success of the treatment in this and kindred classes of cases. The time to give opium, if at all, is in small doses, to soothe the bowel, after the expulsion of the poisonous secretions. Opiates are useless, or even dangerous, when the blood is poisoned, or when the bowel contains offensive, morbid secretions. Opiates in the early stages of diarrhoea and cholera would be more frequently and decidedly injurious, were it not for the fact that their absorp- tion is prevented by the rapid current of liquid which is being passed from the blood into the alimentary canal; therefore, they CHOLERA ASIATICA. 237 are quickly expelled, together with the morbid secretions, and they are powerless to arrest the discharges {The British Medical Jour- nal?, August 19th, 1871). Sir Thomas Watson, Bart., m. d., etc., states in the last edition of his Practice that he firmly believes that the doctrines advanced by Dr. Johnson are well founded, and approves his rules of treat- ment. No doubt the true indication of treatment is to stop the flow as soon as possible; but this may sometimes be best effected (as also in cropulous diarrhoea and in the summer cholera of Syden- ham) by carrying off the offending matter. JOHN MURRAY, M. D., INSPECTOR GENERAL OF HOSPITALS, INDIAN MEDICAL SERVICE. When irritating or indigestible food in the bowels is the cause, as is frequently the case, of the early diarrhoea, it should be re- moved, if it has not previously been discharged in the evacuations, and a recurrence of the looseness guarded against. For this pur- pose our author recommends the following cholera pill:— 574. R. Pulveris opii, gr.j Piperis, gr.ij Assafoetidae, gr.iij. M. To make one pill. It appears to check the looseness and stimulate the secretions, and does no harm if needlessly exhibited. It should be repeated should the looseness continue. It will cure most cases, and in all restrain the symptoms until regular medical advice can be procured. It may be distributed to every house and be available in a few minutes, whereas the delay of a few hours may allow the disease to advance beyond control. These pills have been distributed in tens of thousands in the towns and villages of-India with most satisfactory results. Some surgeons prefer red to black pepper, and others add camphor to the opium and assafoetida, and report favorably of the combination. They are distributed in the dispen- saries and placed in the charge of the police in India (The British Medical Journal, August 12th, 1871.) In a discussion at the Thirty-ninth Annual Meeting of the British Medical Association, between Drs. John Murray and George Johnson, Dr. M. stated that Dr. Johnson seemed to confound elimination with purgation, and that nature was best assisted by restraining the further advance of the disease, of which the most 238 diseases of the digestive system. dangerous symptom is looseness, whether naturally induced by indigestion, by improper food, or by purgative remedies. Dr. Johnson said that the main difference between Dr. M. and himself was with regard to the treatment of the early stage of cholera, Dr M. considering evacuants dangerous and opiates safe, while he (Dr. J.) held an opposite opinion with regard to both classes of remedies {The British Medical Journal, August 26th, 1871). DR. N. GALLOIS, PARIS. 575. R. Sinapis nigras pulveris, giij Spiritus terebinthinae, f-3vj- After standing four days, filter and add, Camphorae pulveris, gij. M. This liniment is to be employed in frictions to induce revulsion in the skin. A still more energetic rubefacient is the following:— 576. R. Spiritus sinapis, f-gijss Alcoholis, f-Svj. M. Or, 577. R. Spiritus sinapis, gtt.l Olei amygdalae dulcis, f.gj. M. These mixtures are to be spread on the skin and covered with com- presses during about ten minutes. DR. BOURGOYNE, FRANCE. 578. R. Tincturas opii camphoratas, gtt.xxx Aquas menthae piperitas, f-gvj Syrupi aurantii florum, f.gj Malaga wine, f-giv. M. A tablespoonful to be given every quarter to half an hour, to patients affected with cholerine. For drink, rice-water, with a little old Bordeaux wine added. Mustard plasters over the abdomen ; starch enemata. RESUME OF REMEDIES. Ammonice Aqua, when inhaled or taken internally, largely diluted, is a useful stimulant and restorative in the collapse of cholera. Argenti Nitras has been recommended injected into the colon, by means of a long flexible tube. The following solution is thus injected :— 579. R. Argenti nitratis, gr.xvj Aquae destillatae, f.giv. M. Ten minutes afterward the following enema is to be administered :— 580. R. Tincturae opii, f.^iy G^el, f.gvj. M. CHOLERA ASIATICA. 239 Dr. Waring considers this treatment worthy of trial. In an epidemic of cholera at Assam, in 1853, Dr. Barry used nitrate of silver internally with great success, giving one grain after each stool. Atropice Sulphas, hypodermically, in dose gr. ^fa-hi i8 recommended by Dr. Harley as one of the most appropriate and useful means of resuscita- tion in the collapse of cholera. It stands at the head of all our stimulants in such cases, for there is no medicine which approaches belladonna in its simple, direct, immediate, and powerful influence in exalting the force and rapidity of the heart's action. * Camphor is recommended by Dr. Sydney Ringer, from personal experience. He gives six drops of a strong alcoholic solution of camphor every ten minutes, until the symptoms have abated, and then less frequently. By this treatment he generally, at once, controlled the vomiting and diarrhoea, and often altogether checked them, removed the cramps, and restored warmth to the extremities. An Italian physician, Dr. Rubini, of Naples, is said to have treated with success nearly six hundred patients by a solution of camphor in alcohol at 60° over proof. The commencing dose was gtt.iv, every five minutes (in severe cases, gtt.xx, or more), persevered in until reaction set in, the patient being well wrapped up in blankets. It should be given in sugar, and not in water, as in the latter the camphor solidifies and loses its power. Cannabis Indica has been highly spoken of, TT\,x-xxx of the tincture being ad- ministered in repeated doses. Carboligni, in drachm doses has been employed with repeated benefit. Carbolic Acid has, it is stated (Medical Press, Jan. 22d, 1868) proved success- ful. *Chloroform, in doses of tt\,v-viij every hour or half-hour, often arrests the vomiting and relieves the spasms and cramps in the early stages of cholera. When the vomiting is excessive, a little chloroform, on lint, placed over the epigastrium and covered with oiled silk or gutta- percha, will frequently relieve it. Chloroform liniment, alone or with turpentine, diligently used, is very effectual against the spasms and cramps. The spasms are also quickly relieved by chloroform inhalations, stopped short of complete anaesthesia. In giving chloro- form internally, some prefer to combine it with the carbonated alkalies, soda or potash (grs.xl-lx) in solution ; others, with the oil of turpentine (rt\,xx-xxx). Dr. T. M. Lowndes, of the Bombay army, advises (British Medical Journal, Aug. 29th, 1868) the following for- mula, which he has used for years in the treatment of choleraic diar- rhoea, with (the best results :— 581. R. Chloroformi, n^xv-xx Tincturas opii, tt\,v.xv Spiritus vini, f.gj Aquas, f.gj. M. Chloroform, as a remedy in cholera, has the advantage that, being very volatile, it does not, like calomel and solid opium, accumulate in the stomach, and thus produce serious effects when reaction is es- tablished. Hydrargyri Chloridum Mite has, as Dr. Waring remarks, been given in cholera for upward of half a century, in every variety and stage of the dis- ease, in every gradation of dose, from one grain to sixty, in almost every possible form of combination, with the view, by turns, of ob- taining its purgative, or its cholagogue, or its stimulant, or its sedative action, and the reported results have been of the most diversified and unsatisfactory character. Dr. Ayre has reported great success 240 DISEASES OF THE DIGESTIVE SYSTEM. from the following plan of treatment, which, probably, deserves the preference, if mercury be employed at all:—grs.j-ij of calomel, with nbj-v of laudanum, are given every five, ten or fifteen minutes, omitting the latter when the dose has reached 60 or 80 drops. Per- haps a great measure of the success recorded of this treatment is due to the patient being allowed to drink freely of cold water, the colder the better. During the stage of collapse, the fact must not be lost sight of, in administering calomel and other powerful drugs, that the stomach has lost its power of absorption, exposing the patient to all the dangers of an accumulated drug when reaction sets in. Ipecacuanha, as an emetic, at the outset of the attack, forms part of the elim- inative treatment recommended by some. Small repeated doses (gr.j-ij every fifteen or thirty minutes, until nausea is felt) have been recently advised. The power of minute doses of ipecacuanha to arrest many forms of vomiting is now well known, and would seem to indicate its utility in cholera. Nitric Acid, given in copious draughts of stimulants, has been recommended as an adjunct to treatment. Morphia, hypodermically. Dr. W. Bates relates a case (Lancet, August 21st, 1869) treated with success by the subcutaneous use of morphia. * Opium, though still much employed in the earlier stages of the disease, alone or conjoined with the acetate of lead or camphor, or calomel, is no longer regarded, as formerly, as the sheet-anchor in cholera. Its use in the solid form in large and repeated doses, in all stages of the disease, is now nearly abandoned, in consequence of the inutility, and even danger, of its employment. In the liquid form, in very small doses, it frequently arrests the action of other remedies. Piper Nigrum is, it is said, often prescribed in cholera by the natives of India, in the form of an infusion of recently-roasted black pepper. A popu- lar Bengal cholera pill is the following :— 582. R. Pulveris piperis nigri, Assafoetidae, aa gr.j Camphorae, gr-ij- M. For one pill. If given early, it is stated that it frequently arrests the disease. *Plumbi Acetas, in combination with opium, at first proposed by Dr. Graves, of Dublin, is very effectual at the outset of cholera in checking the diarrhoea. Dr. Fleming prefers combining the acetate of lead with a solution of acetate of morphia. Dr. E Goodeve also prefers admin- istering the acetate in a fluid form, but gives the opium independ- ently. He employs the following :— 583. R. Plumbi acetatis, grs.xxx Acidi acetici, n\jx Aquae destillatae, f-^vj. M. Two to three tablespoonfuls every half-hour or hour. Opium, in doses of one grain, repeated once or twice, is given separately. He limits, as a rule, the quantity of the acetate of lead to grs.x-xv, and of the opium to grs.iij, in the first three hours. If the disease shows signs of yielding, the doses are to be diminished or stopped altogether. Potassii Chloras is frequently employed ; it forms part of the " saline treat- ment" of this disease (see Salines). Quinine, though recommended by Dr. Bell and others, as both a curative and prophylactic in cholera, is not often employed, excepting as a tonic in convalescence. CHOLERA ASIATICA. 241 * Ricini Oleum is the purgative par excellence employed by Dr. G. Johnson in the " eliminative treatment." He directs, as early in the premonitory diarrhoea as possible, a tablespoonful of castor oil in a mixture of orange or lemon juice and water, or cold water, or other convenient vehicle. If this be vomited, it should be again given, and the patient directed to lie still and take no more liquid for half an hour, by which time the oil will have passed from the stomach into the bowels. Within an hour or two the oil will usually have acted freely, when a tablespoonful of brandy in thin arrowroot or gruel is given; and if there be much feeling of irritation, with a sense of sinking, gtt.v-x of tincture of opium, in cold water. In this manner most cases of choleraic diarrhoea are promptly arrested. Rhubarb (gr.xv of the powder, or f.gss of the tincture) may be employed if objections exist to castor oil. If vomiting be present, it should be encouraged by copious draughts of tepid water; and if nausea exists without vomit- ing, especially if the stomach is supposed to contain congested or unwholesome food or morbid secretions, an emetic is advised (gr.xx of ipecacuanha, or a teaspoonful of mustard, or a tablespoonful of common salt). The approval given to this " evacuant system " of treatment by Sir T. Watson, and the success reported fr«m it in the hands of numerous practitioners, entitle it to consideration and general trial. Sodii Carbonas forms one of the principal ingredients in the " saline treat- ment" of Dr. William Stevens. Sodii Chloridum was formerly given in large draughts of cold water, with the view of inducing emesis, and at the same time supplying the blood with the saline constituents supposed to be carried out of the system in the evacuations. Sulphur was first suggested as a remedy by Dr. A. Blacklock, of the Madras army, in 1848. He recommended, also, as a prophylactic, during epidemics, sulphur internally, and a diet rich in sulphureted ingredients. Dr. J. Grove (in his work on epidemic cholera, in 1865) highly praises this remedy, which he prescribes as follows :— 584. R. Sulphuris prascipitati, Sodii bicarbonas, aa giv Spiritus lavandulae compositus, f.gxxiv Aquas, f.glxxij. M. The soda and sulphur are to be first thoroughly triturated together, in a mortar, the spirit of lavender gradually added, till the whole is well mixed, when the water is added. Dose, two teaspoonfuls, in a little water, every two, three or four hours, in simple choleraic diarrhoea; but if the case is urgent, every ten or fifteen minutes. In sudden or severe attacks, tt\,x-xxx of laudanum are given with the first dose. Terebinthince Oleum has been employed internally, as well as externally, with benefit. Blood-letting has its advocates in cholera, who consider that by relieving the pulmonary embarrassment, and freeing the circulation, it increases the excreting power of the intestinal mucous membrane. But if employed, it should invariably be conjoined with the use of stimu- lants. *Ice in lumps and iced drinks, given ad libitum, are grateful to the patient, and highly beneficial in relieving the burning heat at the pit of the sto- mach, and the intolerable thirst, arresting the vomiting and exciting reaction. Salines. The saline treatment has been already described. 16 242 DISEASES OF THE DIGESTIVE SYSTEM. Stimulants are useful, but their indiscriminate use is not to be recommended. Champagne, ammonia and turpentine are among the best, but weak brandy-and-water is sometimes retained better than any other stimulant. Blisters are sometimes beneficial, applied, in the collapse of cholera, to the epigastrium, over the heart, etc. Turpentine Stupes, applied hot successively to the abdomen, the cardiac region and along the spine and extremities, and turpentine frictions and enemas, are valuable aids to the other treatment. * Water, iced, and freely used as a drink, aids whatever mode of treatment may be adopted. Even if rejected for the first four or five times, it should be persevered in, and so soon as it remains on the stomach a change for the better will be observed. COLIC. SIMPLE FLATULENCE. CHARLES MURCHISON, M. D., F. R. S., LONDON. Flatulence will often be relieved by the various ethers and the essential oils of peppermint, anise and cajuput, by vegetable char- coal, galbanum and assafoetida. When, however, it is due to de- composition, from deficient or deteriorated bile, those remedies will be found most useful which act by checking decomposition, such as creasote, turpentine or carbolic acid. 585. R. Acidi carbolici fluidi, Spiritus chloroformi, aa f.gi-iij Aquas menthae piperitas, f-giij- M. Dose—A tablespoonful. Or, a pill containing one drop of creasote. Flatulence, and other dyspeptic symptoms arising from want of bile in the bowels, are also greatly relieved by the use of purified bile from the ox or pig, which may be given in doses of from three to six grains, about two hours after meals. As it is not desirable that the bile should come in contact with the stomach, it is well to give it inclosed in capsules or in pills coated with a solution of tolu in ether. The following recipe will be found useful for the same purpose:— 586. R. Sodas chloratis, „r.x Aquas menthae piperitas, f.gss. M. For one dose. colic. 243 PROF. ROBERTS BARTHOLOW, CINCINNATI, Has found marked advantage from the use of permanganate of potassa in the flatulence and dyspepsia so constantly attendant on obesity, as follows :— 587. R. Potasses permanganas, gr.vij Aquae destillatae, f-^ij- M. Keep in a glass-stoppered bottle. Dose—A teaspoonful thrice daily. DR. BOUCHUT. PARIS. 588. R. Chloroformi, f-gijss Alcoholis diluti, f-gijss Syrupi acaciae, f-gviij. M. A small wineglassful thrice daily, to persons subject to hepatic colic. Abstinence from fats, oils, fatty food and strong wine. DR. TOURASSE, FRANCE. 589. R. Chloroformi, f.gss Olei amygdalae dulcis, f.gj Syrupi acaciae, f.giss. M. To be well shaken. A tablespoonful every quarter or half-hour in hepatic colic. 590. R. Magnesii carbonatis, f.gj Rhei pulveris, gr.xxx Tincturae rhei, f. giij Tincturae opii, Ttxv Spiritus anisi, gtt.vj Spiritus menthae piperitas, f.gij Aquas destillatas, f-gvj. M. This is a popular remedy in the west of England in intestinal pains. From three to six tablespoonfuls a day RESUME OF REMEDIES. Ammonii Carbonas, in doses of gr.v-viij in some aromatic water, frequently proves useful, especially in the flatulence of atonic dyspepsia or of hysterical females. Anthemis, in strong infusion, or gtt.ij-iij of the volatile oil, frequently affords relief after the failure of other remedies. Assafcetida, in enema, is of especial value in the flatulent colic of hysteria. Cajuputi Oleum often affords immediate relief. Carbo Ligni, inclosed freshly prepared in gelatine capsules, each containing gr.x of heavy vegetable ivory charcoal (dose, two, i. e. gr.xx), is a valuable remedy, from its gas-absorbent property. If administered in this manner, the large nauseous doses so frequently prescribed are avoided. Carbolic Acid is recommended by Dr. Kempter in cases accompanied with foul breath. Cardamomum, in the form of the compound tincture, is highly serviceable. Carui Oleum is often of benefit, in doses of gtt.ij-v on sugar. 244 DISEASES OF THE DIGESTIVE SYSTEM. Caryophyllum in infusion, or the volatile oil (gtt.iij-v), is useful. Cinnamomum is a pleasant and excellent carminative. Creasotum, in doses of gtt.j in pill thrice daily, will greatly relieve the dis- tressing flatulence of hypochondriasis. Etheris Spirittis Nitrosi, in doses of a teaspoonful in a cupful of any conven- ient vehicle, is a popular and efficacious remedy. Etheris Spiritus Compositus is useful, particularly in the flatulence of hysteri- cal females. Juniperi Oleum is an efficient carminative. Lavandula, in the form of the compound tincture, is an agreeable remedy. Mentha; Piperitce Oleum, with or without a few drops of laudanum, is a pleasant carminative. Myristicce Oleum, in doses of gtt.ij-v, affords relief. Grated nutmeg may be given in a little warm brandy-and-water. Rutce Oleum, in doses of gtt.ij-v on sugar, is a popular remedy ; or the infu- sion of rue may be given. Sodii Bicarbonas is effectual when there is acidity of the primas viae. *Nux Vomica is valuable in obstinate flatulence. Dr. Barlow recommends the following useful formula :— 591. R. Extracti nucis vomicae, gr.iss Argenti nitratis, gr.ij Extracti lupuli, gr.xij. M. Make six pills. Take one thrice daily. This formula is partic- ularly serviceable when there is also pyrosis and heartburn. Terebinthince Oleum in enema is an excellent remedy. Zinci Sulphas has been recommended in flatulent affections of the bowels, especially of the colon. The following formula has been employed:— 592. R Zinci sulphatis, gr.xviij Pulveris opii, gr.iij Mucilaginis, q. s. M. Make six pills. Take one four or five times a day, after a meal. When the stomach can dispense with the opium, substitute extract of gentian or rhubarb. Zingiber in tincture or effusion (with or without the addition of carbonate of soda and aromatic spirit of ammonia), is of great benefit. A ginger plaster over the epigastrium often admirably relieves colicky pain. * Carminatives act by stimulating the stomach, causing the expulsion of flatus and the relief of the pain produced by its presence. Cathartics. A purgative of castor oil, or of oil of turpentine, frequently affords immediate relief. ILEUS. 245 ILEUS. PROF. A. TROUSSEAU, PARIS. In this dangerous form of colic, characterized by feculent emesis, when the pain is severe, local blood-letting sometimes lessens the spasm by disgorging the tissues. Prolonged baths are useful. The local application of emollients and narcotics, repeated purga- tives, cold baths, or ice to the abdomen, iced drinks and the swal- lowing of pieces of ice, may all be resorted to. If the tympanitis be very considerable, relief may be afforded by puncture with a fine trocar. Should all other remedies fail, gastrotomy may be performed. DR. J. COPLAND, LONDON. This author remarks that, notwithstanding constant or even feculent vomiting, advantage will sometimes be derived from one to two tablespoonfuls of the unrectified oil of turpentine, taken with aromatics. He has seen the vomiting cease and the disten- tion of the abdomen rapidly subside immediately after this dose, which should be repeated if rejected at first. Large injections of warm flaxseed oil (Oij-iv), steadily and slowly thrown up (regurgitation being prevented by pressing the guard of the pipe against the anus), often prove remarkably successful even after feculent vomiting has come on. The patient should be placed on the right side, with the pelvis elevated, and a ball of linen firmly placed against the anus to prevent the premature return of the injection. This clyster, with the addition of opium, if much exhaustion is present, should be repeated every three or four hours. A case, accompanied with fecal vomiting, is reported {Dublin Quarterly Journal of Medicine, November, 1864) as successfully treated by the application of galvanism to the mucous surface of the intestine. A sponge, with the metallic handle to which it was attached, was passed up the rectum two or three inches, whilst the other sponge was applied to the abdominal walls. The effect was immediate, the constipation being at once relieved and the patient recovering from an apparently hopeless condition. 246 DISEASES OF THE DIGESTIVE SYSTEM. PAINTERS' COLIC, LEAD COLIC-COLICA PICTONUM. PARIS HOSPITALS. Sulphuric acid is much employed in the Paris hospitals in the treatment of saturnine poisoning, with the most marked success. Mild cases yield in about three days, severe ones in six or seven days. 593. R. Acidi sulphurici diluti, f.gij Aquae, Oij. M. This quantity is given during the day. The stomach soon be- comes accustomed to it, even when the first dose or two is rejected. The abdominal pains are relieved after the first or second day, the constipation yielding soon after. This treatment should be com- bined with the repeated use of sulphur baths. DR. LUTZ, PARIS. 594. R. Sulphuris lotj, Mellis despumati, aa giv. M. Give an ounce and a half of this electuary three consecutive days in lead colic, then give in doses gradually lessened. On the third day the acute pain has disappeared. 595. R. Chloroformi, f.gss Alcoholis diluti, f.gss Mix and add, Aquas, f-gviij. M. To be given as an enema in lead and nervous colics. 596. R. Podophyllin, Extracti nucis vomicae, Extracti belladonnas, aa gr.iij. M. Divide into ten pills. One twice or thrice a day, to relieve the painful constipation of workers in lead. At the same time, sulphur baths are to be administered. PROFESSOR NIEMEYER. 597. R. Olei ricini, f.gij Olei tiglii, gtt.iij. M. A tablespoonful every two hours in lead colic. The patient also to take in the twenty-four hours three opium pills of from gr.^-f. Warm baths, narcotic fomentations, enemata, sometimes purgative, sometimes narcotic. RESUME OF REMEDIES. * Alum has long been successfully employed in the treatment of lead colic. From one to two drachms may be given in the course of the day, with a little laudanum, and an occasional dose of castor or croton oil, to CONSTIPATION—HABITUAL. 247 procure one or more motions daily. The following formula has been advised:— 598. R. Aluminis, gj Acidi sulphurici diluti, f.gj Aquae, Oij. M. This, sweetened to the taste, should be drunk during the day. A grain of opium may be taken at night, and sulphurous baths employed. Chloroform has been given with good results, by the mouth, and by the rectum in enemas, and externally applied, compresses moistened with it, diluted, being placed on the abdomen. * Hydrargyri Chloridum Mite. A full dose of calomel, with or without opium, and followed in a few hours by castor oil and an enema of turpentine, frequently gives great and prompt relief. *Opium, in full doses (gr.j—ij), alone or combined with alum or calomel, and followed by castor oil, is a most useful remedy, its administration being repeated until relief is obtained. The hypodermic injection of morphia is advisable in severe cases. Strychnia has been recommended, but should be used with caution, espe- cially in acute cases. CONSTIPATION-HABITUAL. The habit of constipation may be broken up by massage, change of diet, enemata, laxative mineral waters, or drugs. In regard to massage, or the movement cure, the following little operation executed by the patient upon himself, when properly per- formed, is valuable :— Place the tips of the fingers of the right hand exactly over the csecal region, with very slight pressure; carry them upward, along the ascending colon, to the right hypochondrium; continue the movement without any intermission over the region of the trans- verse colon to the angle of junction with the descending colon; stop not, but proceed downward, gently and steadily, to the iliac region of that side; instead of the previously very gentle pressure, the finger must now be pressed firmly and deeply (without pain) into the pelvic cavity, and there retained for about fifteen seconds, then remove the hand altogether, rest a few seconds, and repeat the procedure. This may be continued for the period of from a few minutes to a quarter of an hour or more. Some little care and tactile dexterity are needed to do this properly; and where the hand is dry, or the cuticle thick and hard, it is advisable to slightly moisten the ends of the fingers. When the right hand is tired, the left can be used, and to alternately, but it ia fetter not to alternate 248 DISEASES OF THE DIGESTIVE SYSTEM. them too rapidly. If there be failure, it must not necessarily be given up. Invalids themselves will often fail, almost invariably, if their bowels be extremely intractable. But now the aid of a friend for passive movements may be invaluable. The medical adviser can give instructions regarding the precise anatomical rela- tions of the parts involved, and the method of performance. The proceeding should usually extend over a period of from five or six minutes to occasionally twenty-five minutes. For occasional use, in the treatment of constipation in old age, the following pill affords an excellent formula: 599. R. Extracti colocynthidis compositi, gr.v-viij Extracti hyoscyami, gr.ij. M. For one pill. J. M. DA COSTA, M. D., PHILADELPHIA. 600. R. Podophyllin, Extracti belladonnae, aa gr.j Capsici, gr.v Pulveris rhei, 9j. M. For twenty pills. One three times a day. Belladonna is undoubtedly a stimulant to the muscular fibres of the intestines. It acts on them as it acts on the bladder ; it stimu- lates to contraction. It also increases the action of purgatives, enabling the physician to get along with smaller quantities of pur- gative medicine. Podophyllin is useful in torpor of the upper por- tion of the bowel, to increase the secretion of the liver. 601. R. Tincturas gentianae compositae, f-3*iij Tincturas rhei dulcis, f.gj Tincturas belladonnas, f.giss M. Dessertspoonful thrice daily. 602. R. Extracti gentianae, gj Extracti nucis vomicae, Podophyllin, aa gr.ijss Olei cajuputi, gtt.xx. M. For twenty pills. One twice a day as a tonic for chronic constipation. 603. R. Extracti belladonnae, gr.iss Pulveris rhei, gr.xxiv. Pulveris zingiberis, gr.xij. M. For twenty-four pills. One four times a day. S. S. BIRCH, M. D., LONDON. 604. R. Extracti rhei .lcoholici, gss Extracti taraxaci, gr.xxiv Quiniae sulphatis, gr.ij. M. Divide into twelve pills. CONSTIPATION—HABITUAL. 249 One should be taken either on rising in the morning or at din- ner-time, or even at both periods when the constipation is very obstinate. This is a very gentle stomachic and tonic evacuant, particularly useful for the delicate. In addition, when there is torpor of the liver, deficiency or perversion of the biliary secretion, the patient should be ordered:— 605. R. Hydrargyri cum creta, gr-4-j Sacchari albi, gr.v. M. For one powder. This is a sufficient dose, when given alone at bedtime, for two or three successive nights, or in very sensitive persons every second or third night. But the hydrargyrum cum creta. is often prepared imperfectly, and then causes considerable annoyance and dissatis- faction to the practitioner. PROF. ROBLEYaDUNGLISON. 606. R. Magnesias sulphatis, gj Potassas bitartratis, gj Ferri sulphatis, * gr.x. M. For one powder. Add to a quart of water and take a wineglassful, on rising, every morning. This recipe was frequently recommended in his lectures by the late distinguished professor of physiology. JOHN FORSYTH MEIGS, M. D. 607. R. Confectionis sennas, gj Potassas bitartratis, gij Sulphuris prascipitati, Ferri subcarbonatis, aa gj Mellis despumati, q- a. M. Make an electuary. Teaspoonful after meals. PROF. METCALF, M. D., OF NEW YORK. 608. R. Extracti aloes (purif.), Extracti hyoscyami, aa gj Extracti nucis vomicae, gr.xij Olei anisi, gtt.x. M. Divide into sixty pills. One to be taken after each meal, particularly for constipation in women. THOMAS HAWKES TANNER, M. D., F. L. S., LONDON. 609. R. Zinci valerianatis, gr.xij-xxiv Extracti belladonnae, gr.iij-vj Extracti gentianae, gr.xxiv. M. Make twelve pills and silver them. One to be taken three times a day in nervous cases of habitual constipation, and in spasmodic contrac- tion of the sphincter ani. 250 DISEASES OF THE DIGESTIVE SYSTEM. PROF. W. H. VAN BUREN, M. D., OF NEW YORK. 610. R. Extracti aloes, 388 Extracti nucis vomicae, R -m Extracti hyoscyami, SJ M< Pulveris ipecacuanhas, £ J" Divide into twenty pills. One to be taken at night. This recipe, termed the "Pil. salutis," is of special value in the constipation of females. DR. J. COPLAND, LONDON. 611. R. Potassii bitartratis, || Sodii boratis, » . Sulphuris loti, |.J Confectionis sennas, 3«» Syrupi zingiberis, f-| J M A teaspoonful1 Ta dessertspoonful of this laxative electuary in the evening, at bedtime. 612. R. Potassii bitartratis, 3.1 Sulnhuris loti, |?.8. M Mellis despumati, 3nJ- A teaspoonful once or twice a day, in habitual constipation. It has been observed that aloes is useful in habitual constipation due to atony of the colon, the result of fever and debilitating dis- eases, old age or sedentary habits. It may be combined, as indicated, with aromatics, hyoscyamus, ipecacuanha, nux vomica or quinine. Dr. Spender recommends {Medical Times and ga- zette, February 19th, 1870) the following pill :— 613. R. Extracti aloes aq., gr\88"J.. M Ferri sulphatis, gr.iss-ij. »• For one pill, to be taken thrice daily, immediately after the principal meals Pand continued regularly for a few days till ^e occurrence of the first loose motion, after which one only is to be taken night ana morning. At the end of a week or two another pill may be omitted, and within a month a single pill once or twice a week suffices. Nothing approaching purgative ought ever to be permitted. Profs. Metcalf and Van Buren both combined aloes with hyos- cyamus and nux vomica. DR. J. CLELAND, EDINBURGH. This author highly recommends the saccharate of lime. He first introduced it, through the Edinburgh Medical Journal, Au- gust, 1859, to the profession. He prepares it as follows :— CONSTIPATION—HABITUAL. 251 614. R. Slake of quicklime, ^viij Rub up with it of white sugar, gv Add of water, f.gxx. M. Stir and filter. The product should be perfectly clear, with only a slightly yellowish tinge. Each ounce, by weight, should contain 18 grains of lime. Dose—n^xv-xxx, or f.gj. Dr. C. finds this saccharate of lime a very valuable means of overcoming gradually that chronic constipation which so frequently accompanies dyspepsia, and that persons who for years have been in the constant habit of using aperient medicines have been able to abandon them, in a great measure, after taking this remedy for some time. DR. MIALHE, PARIS. 615. R. Sulphuris loti, gijss Magnesii carbonatis, gv Mellis despumati, gxv. M. A teaspoonful in the morning before eating. 616. R. Extracti belladonnae, gr.v Rhei pulveris, Aloes socotrinas, aa gr-xv. M. Divide into twelve pills. One or two in the evening, at bedtime, every other day, in habitual constipation. 617. R. Aloes socotrinas, Rhei pulveris, aa gij Pulveris aromatici, gss Saponis, gj Syrupi, q. s. M. Divide into sixty pills. Two in the evening, in the habitual constipa- tion of dyspeptics. Or, 618. R. Aloes socotrinas, Rhei pulveris, aa gj Ipecacuanhas pulveris, Saponis, aa gss. M. Divide into thirty pills. One or two in the evening. DR. CONTARET, FRANCE. 619. R. Extracti belladonnae, Extracti rhei, aa gr.vij Althaea pulveris, q. s. M. Divide into twenty pills. One three hours after dinner, in habitual constipation. DR. C. PAUL, PARIS. 620. R. Podophyllin, gr.v Mellis, q. s. M. Divide into ten pills. One at bedtime, in habitual constipation. Podo- phyllin can be employed for a long time, without losing its efficacy, and its purgative effects are not followed by consecutive constipation. 252 DISEASES OF THE DIGESTIVE SYSTEM. 621. R. Sulphuris loti, Magnesias, Sacchari lactis, aa gijss. M. Mix with care. Persons subject to constipation will take a teaspoon- full of this laxative powder at bedtime, from time to time. 622. R. Sodii sulphatis exsiccatas, gij Saponis pulveris, giv Mellis despumati, q. s. M. Divide into four suppositories. Useful in habitual constipation. They are to be oiled before introduction into the rectum. RESUME OF REMEDIES. Aloes. (See above.) ^Belladonna is highly recommended by Trousseau, who obtained from it the happiest result, given as follows :— 623. R. Extracti belladonnae, gr-2V~i Extracti gentianae. gr.j—Ij. M. For one pill, to be taken every morning at rising. Prof. Da Costa recommends belladonna as a stimulant to the muscular folds of the intestine, and as increasing the effect of purgatives. Benzoini Tinctura, in doses of gtt.xx thrice daily, is said, in cases of con- stipation apparently depending upon stricture of the colon, to keep up the peristaltic action without irritating the bowels, Colchicum, in doses of gtt.v of the tincture of the root several times daily, has been highly recommended in obstinate constipation. Colocynth. Dr. Crichton recommends (Bmtish Medical Journal, November 28th, 1868) the Prussian tincture of colocynth, in doses of tr^v-x in a little water, taken about an hour before breakfast, as an efficient remedy. The formula of the Prussian tincture is as follows:— 624. R. Colocynthidis pulpas, gj Illicii anisati, gj Alcohol, f.gxx. M. Dr. Birch recommends colocynth combined with hyoscyamus, in the constipation of old age. Fel Bovinum Purificatum. When there is torpidity of the liver and defici- ency of the biliary secretion, ox-gall may prove useful by supplying the deficiency. Either of the following formulae may be used :— 625. R. Fel bovini purificati, gij Olei carui, tt^x Magnesias carbonas, q. s. M. Make thirty-six pills. Take two twice daily. Or. 626. R. Fel bovini purificati, Pilulae assafoetidae compositae, aa gr.xxx Extracti aloes, gr.xx Saponis duris, gr.x Pulveris ipecacuanhae, grviij. M. Make thirty pills. Take one to two daily, before dinner. CONSTIPATION—HABITUAL. 253 Ferri Carbonas has not, in the opinion of Dr. Graves, been duly appreciated as a remedy in habitual constipation. He has succeeded in curing with it alone a patient who had long been subject to extreme con- stipation, and who had been reduced to the necessity of taking an immense dose of purgatives almost every week. Magnesice Sulphas, in small, frequently-repeated doses, with the addition of a few drops of diluted sulphuric acid, will sometimes subdue obstinate constipation after the failure of other means. Combined with sul- phate of iron and bitartrate of potassa, it was a favorite prescription of the late Prof. Robley Dunglison. Nitrici Acidum, in the opinion of Dr. Graves, is a very reliable remedy in habitual constipation, and combines tonic with aperient qualities. Pix Liquida, persevered in for some time, often effectually removes habitual constipation. Podophyllin is useful when there is torpor of the upper portion of the bowel. Rheum. Dr. F. W. Pavy recommends the following pill in habitual constipa- tion :— 627. R. Pilulae rhei comp., gr.ij-iij Pulveris capsici, gr.j. M. To be taken with the food, and repeated daily, as occasion requires. In the constipation of anasmic females Dr. Ashwell recommends the following mixture :— 628. R. Pulveris rhei, Magnesii carbonatis, aa. gss Confectio aromatica, gr.xx Aquas cinnamomi, f-gix Tincturae cardamomi compositae, f.gj. M. Make a drink. To be taken at bedtime, every three or four days. Dr. Birch advises it combined with taraxacum and quinine, and Professor Da Costa combined with belladonna and ginger. Ricini Oleum is one of the best purgatives which can be employed in habitual constipation, acting speedily, without much griping, and causing less subsequent constipation than any other purgative given to remedy this state. Senna, particularly in the form of confection, is a mild, efficient purgative, causing little excitement, and leaving no subsequent constipation. Dr. John Forsyth Meigs combines it with bitartrate of potassa, sul- phur, and subcarbonate of iron. *Nux Vomica is often of equal benefit. Dr. Copland recommends the fol- lowing pills :— 629. R. Extracti nucis vomicae, gr.iij . Extracti colocynthidis compositae, 9ii Saponis castiliensis, gr.xij. M. Make twelve pills. Take one every other night for a few weeks. Veratrum Viride, in doses of gtt.iij of the tincture four or five times daily, is said (Practitioner, November, 1868) to be useful in some cases of obstinate constipation. Zinci Valerianas is recommended by Dr. Tanner in nervous cases of habitual constipation, combined with belladonna and gentian. Electricity. Dr. Althaus reports (Lancet, November 16th, 1865) several cases of habitual constipation which yielded readily to faradization of the bowels after the failure of other remedies, but in the hands of Leclerc electricity is rarely or never of service in these cases. 254 DISEASES OF THE DIGESTIVE SYSTEM. DIARRH(EA AND DYSENTERY. WILLIAM AITKEN, M. D., EDINBURGH. 630. R. Salicin, gr.v. For one powder. To be taken every four or six hours. In case of diarrhoea with clear tongue, which will not yield to opiates, astringents, or stimulants, either singly or combined, and which, probably, depend on a want of tone in the intestine. In these cases the above recipe has often stopped a diarrhoea that ap- peared fast hurrying the patient to his grave. One general rule may be acted on in the cure of diarrhoea, which is, that in the adult, whatever be the form of the diarrhoea, if the stools be dark at first, and then become light-colored, purgative medicines are no longer beneficial, and in no instance ought they to be continued longer than is sufficient to remove any irritative substance accumulated in the alimentary canal. J. M. DA COSTA,. M.D., PHILADELPHIA. 631. R. Bismuthi subnitratis, 5j Acidi tannici, Pulveris ipecacuanhas compositae, aa, gr.iij. M. For one powder. To be taken three times a day in chronic dysenteric diarrhoea. It is particularly in cases in which there exists persistent irri- tability of the bowels, influenced by the taking of much food which cannot be digested, and in which there are gastric symptoms in connection with the dysenteric affection, that the subnitrate of bis- muth will be found very serviceable. In order that it shall pro- duce an effect, it is necessary that it shall be administered in suffi- ciently large doses, not less than twenty grains. The dose may gradually be increased to a drachm. THOMAS HILLIER, M. D., F. R. C. P., LONDON, ETC. 632. R. Acidi gallici, gr.xij Tincturae cinnamomi, f.giss Tincturas opii, ffiviij Aquas carui, q. 8. ad. f.gij. M. Dose—Two teaspoonfuls for a child two years old, with chronic diar- rhoea and irritable stomach. 633. R. Olei ricini, f.^ij Pulveris acaciae, 3j Tincturae opii, ^iviij Syrupi, f.^ij Aquas carui, q. 8. ad. f.gij. M. Dose—A tablespoonful for a child six years old. DIARRHQ3A AND DYSENTERY 255 A useful oleaginous mixture in dysenteric diarrhoea. W. KEMPSTER, M. D., UTICA, N. Y. 634. R. Acidi carbolici, gr.j Aquae, f.gj M. This is the strength of the standard house solution in the State Luna- tic Asylum at Utica, New York. Of this a dessertspoonful is given thrice daily, in case of sluggishness of the bowels accompanied by offensive breath. Diarrhoea produced by eating unripe fruit, or other articles which promote fermentation, is relieved by combining a drachm or two of the solution with the usual remedies. When a fetid smell emanates from the cutaneous surface, order a warm bath, and then wash the surface with a solution, gr.v--f.gj. JOHN FORSYTH MEIGS, M. D. 635. R. Pulveris opii, gr.vj Extracti nucis vomicae, gr.iij Cupri sulphatis, gr.j. M. Divide into twelve pills. One three times a day, in chronic diarrhoea. The value of this pill has been proved by army surgical experi- ence. CHARLES MURCHISON, M. D., F. R. C. S., ETC. 636. R. Acidi tannici, 9iv Tincturae opii, tr^xl Glycerinae, f-gss Aquas menthae piperitas, ad. f.giv. M. A tablespoonful in a tablespoonful of water every four hours. After the diarrhoea is checked order:— 637. R. Acidi nitro muriatici, f.giss Tincturae opii, tt\xl Syrupi, f.gss Aquae, ad. f.giv. M. A tablespoonful in water, four times a day. DR. JEANNEL, PARIS. 638. R. Cinchonae flavae pulveris, Calcii phosphatis precipitatas, aa, ^iv Aurantii amari corticis pulveris, gss Confectionis rosas, gijss Syrupi, q. s. M. Make an electuary, of which give a teaspoonful or tablespoonful several times a day in diarrhoea. DR. BOSSU, PARIS. 639. R. Extracti opii, gr.iss Hydrargyri chloridi mitis, Ipecacuanhae pulveris, aa gr.iij Confectionis rosas, q. s. M. Divide into ten pills. One morning and evening in chronic diarrhoea. Roast meat at the meals, exercise in the open air. 256 DISEASES OF THE DIGESTIVE SYSTEM. 640. R. Bismuthi subnitratis, gj Cinchonae flavae pulveris, gss Carbonis ligni, gj. M. Divide into twenty powders. One twice or three times a day, between meals, in chronic diarrhoea. DR. DELIOUX, FRANCE. 641. R. Bismuthi subnitratis, 9iv Rhei exsiccatas, gr.xxv Simarubas pulveris, gss. M. Divide into ten powders. One twice or thrice a day in chronic diar- rhoea. 642. R. Cretas prasparatas, Bismuthi subnitratis, aa gijss Pulveris opii, gr.iij. M. Divide into ten powders. One an hour before each of the principal meals, in chronic diarrhoea. RESUME OF REMEDIES. Camphor is regarded by Dr. Ringer as one of the most efficacious of remedies in summer diarrhoea, but it must be employed at the very commence- ment of the disease, or it will fail of its effect. Capsicum is regarded by Dr. Copland as almost a specific in diarrhoea arising from putrid matters in the intestines, and especially when occasioned by fish. Carbolici Acidum has been recommended in the diarrhosa caused by eating unripe fruit, etc. ^Ipecacuanha is often of benefit after other remedies have proved useless. Leptandrin is valuable when the stools are destitute of bile and the mucous membrane is irritable. In such cases, the stools under its use are said to assume their natural color and consistence. Limonis Succus is sometimes found of service. Linum. The infusion of flaxseed is an excellent demulcent in diarrhoea. * Opium is a most valuable remedy in diarrhoea. In cases due to the ingestion of indigestible food, etc., an aperient should be first given, to remove the irritating matter, then, if the diarrhoea persist, opium, in mixture or pill, or enema, will often arrest it. Dr. Waring recom- mends in the so-called summer or autumnal diarrhoea the combina- tion of laudanum (n\x-xx), with dilute sulphuric acid (n\,xv-xx), as often successful. Plumbi Acetas proves useful in many forms of diarrhoea. Quassia has been recommended in the advanced stages of diarrhoea. *Rheum is often of great benefit, by its property of first removing irritant matters from the bowels, and then acting as an astringent and tonic. The following is an excellent formula for general use, which by itself will often effect a cure:— 643. R. Pulveris rhei compositus, gj Sodii carbonatis, gr.xx Tincturas opii, Tt\,x-xv Aquas menthae piperitas, f.gx. M. Make a drink. If after its operation the diarrhosa continues, chalk mixture and opium may be given. DIARRH03A AND DYSENTERY. 257 Sodii Bicarbonas, in full dose Oij-gj), combined with tincture of ginger (f.gss-f.gj) and aromatic spirits of ammonia (f-gss-f.gj) and a little laudanum, is of great service in diarrhoea attended with colic and gastric irritability and flatulence, especially when this is consequent on the ingestion of unwholesome food. Emetics. An ipecacuanha emetic, repeated once or twice, according to cir- cumstances, often arrests a diarrhosal discharge. Enemata are often of great service, either mucilaginous or containing opium, ipecacuanha or astringents. SUBACUTE AND CHRONIC DIARRHOEA. Alum, in doses of gss-gj daily, or in enema Oj-vi), is often of benefit in diarrhosa dependent upon a relaxed condition of the mucous intes- tinal membrane. The following formula is useful:— 644. R. Aluminis, gr.x Pulveris kino compositus, gr.v Confectionis rosas, q. s. M. Make pill. Take every sixth hour. Argenti Nitras is of service in chronic diarrhoea when the stools are watery or mucous. Arsenic is highly spoken of by Dr. Ringer in chronic diarrhoea. He gives one to two minims of Fowler's solution before each meal. Benzoin has been recommended. *Bismuthi Subnitras, in doses of not less than twenty grains, is recommended by Professor Da Costa in chronic diarrhoea where there exists per- sistent irritability of the bowels. Professor Byrd also prescribes it. Calcis Carbolas, in one-grain doses, combined with henbane, has been suc- cessfully employed by Dr. Habershon (Lancet, January 4, 1868) in diarrhoea attended with flatulent distention of the colon. Calcis Phosphas, in doses of gr.j—ij, several times a day, is praised by Dr. Ringer as of great value in chronic diarrhoea, effecting both a general and local improvement. Carbazolate of Ammonia, in grain doses, thrice daily, has proved successful in very chronic cases. Cascarilla is much used in Germany in the advanced stages of diarrhoea. * Catechu, when there is no inflammatory action, is useful (in doses of gr.x-xv of the compound powder, or f.gj-ij of the infusion) in diarrhoea depending upon a relaxed state of the mucous membranes of the intestinal canal. Cetraria Islandica, in the form of decoction or jelly, is a useful tonic and nutritive aliment in convalescence from diarrhosa. Cinnamomum, in combination with chalk and opium, is often of benefit in chronic diarrhoea. Creasotum is occasionally effectual. The following formula may be used:— 645. R. Creasoti, Nlj-iv Spiritds ammoniae aromatici, rn^xv Aquae, f.giss. M. When there is much pain paregoric may be added. 17 258 DISEASES OF THE DIGESTIVE SYSTEM. *Cupri Sulphas, combined with opium, is often very serviceable. Dr. Waring recommends the following formula:— 646. R. Cupri sulphatis, gr-^-ss Pulveris ipecacuanhae compositus, gr.v. M. Make powder. Take thrice daily. Dr. John Forsyth Meigs combines it with opium and nux vomica, Dr. Tanner, with opium and gentian. Cusparice Cortex may be given with advantage in the latter stages of diarrhosa. Ergot, in doses of gr.v thrice daily, has been employed, with marked improve- ment, when dysenteric symptoms were coming on. Ferri Pernitratis Liquor, in doses of gtt.x-xv thrice daily, is a valuable astringent and tonic. Ferri et Potassii Tartras. The following formula is recommended by Dr. E. Goodeve in chronic diarrhosa attended with anaemia :— 647. R. Ferri et potassii tartratis, 9j-ij Tincturae opii, f giss-iij Aquae cinnamomi, f-giv. M. A tablespoonful in water thrice daily. Galla, in doses of gr.x-xx of the powder, several times a day, is occasionally useful in chronic diarrhoea. Hcematoxylum, in decoction, or in the form of an extract (gr.x-xxx), is a use- ful astringent and tonic after active inflammation has subsided. Dr. F. W. Pavy recommends in chronic diarrhoea the formula for extract of logwood advised for the diarrhoea of phthisis. *Kino, in doses of gr.xij-xx, with or without opium, is a valuable astringent in chronic diarrhosa, especially that connected with follicular de- rangement. It is also frequently prescribed even when febrile symptoms are present. Krameria is much employed by Spanish physicians in chronic diarrhoea, and is especially useful when the stools are mucous and slimy, and when there is no inflammatory action. Matieo, in infusion, is usually of benefit in chronic diarrhosa. Muriatic Acid, combined with tincture of nux vomica, and given before meals, is found of benefit, by Dr. William Fox, in the nervous disorder of digestion associated with diarrhoea. Myristica, in mild cases of asthenic diarrhoea, is recommended by Dr. Pereira as a substitute for opium, with warm brandy-and-water (if not con- tra-indicated) as a vehicle. Nitrici Acidum Dilutum, in doses of gr.v- xv, combined with laudanum (tt\_xv-xx) in a little vegetable infusion, has been recommended in chronic diarrhoea. * Opium is frequently given, alone or in combination with other remedies. Plumbi Acetas, by the mouth or in the form of an enema, is often an effect- ual remedy. Potassii Chloras is recommended by Dr. Copland in chronic mucous diarrhoea with whitish, grayish or mucilage-like stools, arising from the absence of bile, etc. He combines it with pulvis tragacanthae compositus and aromatics, with great benefit. Granati Fructus Cortex, in decoction, is recommended by Dr. Waring in DYSENTERY, ACUTE. 259 chronic diarrhoea unattended by inflammatory action. It is par- ticularly useful in diarrhoea consequent on debilitating diseases. Quercus Cortex, in decoction, is sometimes serviceable. Acorns, roasted and powdered, have also been used. *Nux Vomica is highly praised by Prof. Graves in obstinate chronic diarrhoea which resists ordinary remedies, and in that form especially which accompanies exhaustion after fevers. It may be combined with opium and sulphate of copper. Salicin, in cases of chronic diarrhoea dependent on want of tone, is recom- mended by Dr. Aitken. Tannin, with opium, sometimes proves of surprising efficacy in cases of chronic diarrhoea which have resisted all ordinary treatment, and which are not dependent on obstructive disease of the heart or liver. It is especially useful where there is an irritable, weakly mucous membrane. It may be given in the form of a pill or mixture. Turpentine Stupes, applied to the whole abdomen and allowed to remain on as long as the patient will endure them, are often of great benefit. Tormentilla, in decoction, is frequently of service in the advanced stages o%f diarrhoea, when inflammatory action has been subdued. Zinci Oxidum. in doses of gr.iij-v thrice daily, has been recommended by Dr. Waring-Curran. Zinci Sulphas, combined with ipecacuanha and opium, occasionally proves of advantage. Blisters. A small blister to the abdomen is often very effectual in obstinate subacute diarrhosa. DYSENTERY, ACUTE. DR. CARL SCHWALBE, OF COSTA RICA. In the Deutsches Archiv fur Klinische Medicin, March, 1875, this writer gives a very judicious treatment of acute dysentery as it occurs in hot climates, by pursuing which he had the good for- tune not to lose a case. He advises, whenever a diarrhoea sets in during a heated term, or immediately after a marked fall in the temperature, to suspect the possibility of dysentery, and at once to administer a large enema of lukewarm water, 100° Fah., after it has been thoroughly boiled. This should be repeated until one and a half to two gallons have been thrown up and the colon thoroughly emptied. After the onset of the dysenteric symptoms, these copi- ous clysters should be repeated thrice daily. Against the tenesmus, when very annoying, Dr. Schwalbe uses:— 648. R. Atropias sulphatis, gr.j Aquas destillatae, f-gj- ^- Two or three drops every half-hour, in water, until the pupil enlarges and the throat feels dry. 260 DISEASES OF THE DIGESTIVE SYSTEM. When there is much intestinal pain the following recipe proves of value:— 649. R. Acidi muriatici diluti, Morphias sulphatis, Aquas destillatae, A teaspoonful three or four times daily. Mustard plasters should be applied to the abdomen. The diet should be fluid and nutritious. White-of-egg water, made by shaking thoroughly the whites of four eggs in a pint of boiled and cooled water, is especially serviceable. PROF. W. C. MACLEAN, M. D., OF ENGLAND. * Ipecacuanha should be administered in large doses as early in the disease as possible. From grs.xxv to xxx should be given in as small a quantity of fluid as possible. Some advise the adminis- tration half an hour previously of m„.xxx of laudanum, or a few drops of chloroform. The patient should be kept perfectly still in bed, and abstain from fluid for at least three hours. If thirsty, he may suck a little ice, or may have a teaspoonful of cold water. Under this management, nausea is seldom excessive, and vomiting rarely troublesome, usually not setting in until two hours after the medicine has been taken. Sinapisms or turpentine stupes should be affixed to the abdomen. In from eight to ten hours, according to the urgency of the symptoms and the effect produced by the first dose, ipecacuanha, in a reduced dose, should be repeated, with the same precautions as before. The effects of this treatment are surprising, and soon manifest; the tormina and tenesmus subside, the motions quickly become feculent, blood and slime disappear, and often, after profuse action of the skin, the patient falls into a tranquil sleep, and awakens refreshed. The treatment may require to be continued for some days, the medicine being given in dimin- ished doses, care being taken to allow a sufficient interval to admit of the patient taking some mild nourishment suited to the stage of the disease. As the disease abates, the dose should be reduced, but it is well to administer grs.x-xij at bedtime for a night or two, after the stools are, to all appearance, healthy. Fomentations, turpentine stupes, or chloroform liniment to the abdomen, lessen tormina and diminish suffering. If a little diar- rhoea without the dysenteric odor remain, it may be checked with f-gy gr-y f-giij- M. DYSENTERY, ACUTE. 261 a small quantity of an astringent mixture; but astringents, in any shape, during the acute stage, are not only useless but dangerous. The hot bath is of great service in the mild forms of dysentery. It should be brought to the bedside, and kept at a high tempera- ture, the patient remaining in until he feels faint. He should then be quickly and carefully dried, put to bed, and given ipecacuanha (gr.xv-xx), which may require to be repeated in eight or ten hours, the patient abstaining from all fluid for some hours after taking the medicine, and turpentine stupes being applied to the abdomen. This simple form of treatment, if it be resorted to early, will suffice in a great many cases of the mild form of dysentery which follows chills without much charging the system with malaria. Dr. Maclean condemns blood-letting in dysentery, for the follow- ing reasons:—1. Because, although from the violence of the symp- toms there is an appearance of power, this is deceptive, for alarm- ing depression often follows free depletion. 2. Even where the measure appears to relieve the symptoms, the heart's action is weak- ened to such an extent that congestion of the affected mucous mem- brane remains, a condition nearly as destructive to the tissues as the more acute action. 3. Because convalescence after bleeding is tedious. 4. Because, although bleeding has fallen into disuse, the mortality from dysentery has decreased. Ipecacuanha has superseded the lancet. In malarial dysentery, quinine, in full doses, should be given, not less than a scruple, in solution, some time before commencing ipecacuanha (which should be given as recommended above), and it should be repeated until cinchonism is induced; the two drugs should then be given in alternate doses until the characteristic effects of both are produced. Many others have testified to the value of massive doses of ipe- cacuanha in dysentery. DR. PARIS, PARIS. 650. R. Iodinii, gr-ix Potassii iodidi, gr.xv Aquas destillatae, f-gij- M. To be employed as an enema in dysentery. It is sometimes necessary to administer it twice in the course of the twenty-four hours, and to continue its use several days. One of the principal effects of the iodine enema is to relieve promptly the tenesmus. 262 DISEASES OF THE DIGESTIVE SYSTEM. RESUME OF REMEDIES. Argenti Nitras, in doses of gr.ss-iss daily, reduced to fine powder, and con- joined with Dover's powder in the form of pill, is highly recom- mended by Dr. Waring and others in the advanced stages of acute dysentery. Ergotin, in doses of gr.vj in emulsion, or in bland enema (gr.xij-xv), has been used with excellent results by Dr. Gros (Practitioner, Novem- ber, 1868). One of the effects noted under this treatment was the speedy reduction in ths quantity of blood voided. Hydrargyrum, formerly always resorted to, in large doses, in acute dysentery, has now fallen into comparative disuse, except as an occasional aperient, and ipecacuanha has taken its place. Particularly in the asthenic and scorbutic forms of dysentery, mercury in every form should be avoided. If, in exceptional cases of acute dysentery, it be employed, the following formula, for many years very generally used in Southern India, may be given:— 651. R. Pilulae hydrargyri, gr.ij—iij Pulveris ipecacuanhae radicis, gr.i-ij Opii. gv.\. M. Make pill. Take one every four or five hours. The following is also an effectual combination :— 652. R. Hydrargyri chloridi mitis, gr.ss Morphiae sulphatis, gr.£ Quiniae sulphatis, gr-ij. M. Make pill. Take one every two or three hours. *Ipecacuanha, justly called ''radix anti-dysenterica," is of the highest value in dysentery. Although from its introduction (by Piso, in 1658) its power in this disease has been more or less recognized, it was not, in consequence of the practice of conjoining it with other remedies supposed to possess similar virtues, until 1858 that its real value was demonstrated by Mr. Docker (Lancet, July and August, 1858), who re-introduced the original plan of Piso and Helvetius of giving it alone, in large and effective doses. The following facts now seem to be established : that acute dysentery is more successfully and speedily treated by large doses of ipecacuanha than by other means; that this remedy is more effectual in the acute than in the chronic forms; that large doses (gr xxv-xxx) may be given with perfect safety, without fear of hyperemesis or other ill effects. The mode of treat- ment, in the main, now generally practiced, is that detailed by Dr. W. C. Maclean in the article on dysentery in Reynolds' System of Medicine, a condensed statement of which has already been given. Limonis Succus should form an essential part of the treatment when the state of the gums or other circumstances lead to the belief in a scorbutic taint. A mixture of equal parts of lime juice, decoction of cinchona and port wine was employed with good results in the British army in the first Burmese war. Linum. The infusion of flaxseed is an excellent demulcent. * Opium fulfills three important indications :—1. Allaying pain and muscular excitement; 2 Moderating the peristaltic motion of the intestines; and, 3. Promoting the cutaneous secretion. It is considered by Dr. Waring as, on the whole, however, inferior, especially at the onset of an acute attack, to ipecacuanha. A preliminary dose of opium is often of great service in enabling the stomach to retain ipecacuanha DYSENTERY, CHRONIC. 263 and in preventing its emetic operation. The dose of solid opium may be increased from gr.j to gr.iij-iv, three or four times a day, not only without inconvenience, but with benefit, there being a marked tolerance of opium in this disease. The signs that its administration has been carried as far as is consistent with safety are nausea or vomiting, tympanitic distention of the abdomen, and scanty stools. Tormina and tenesmus are best relieved by opiate enemata. Plumbi Acetas, in doses of gr.iij-iv, in combination with Dover's powder (gr.iv-v), may be given with advantage in the advanced stages of acute dysentery, especially when the stools contain much mucus. The following enema may often be advantageously employed: — 653. R. Plumbi acetatis, gr.x Acidi acetici diluti, tt^x Morphiae acetatis, gr.^ Aquas tepidas, f-giv. M. Potassii Bitartras. In the advanced stages of acute dysentery, when laxa- tives are indicated and the stools abound with thick viscid mucus, cream of tartar seems to exercise a special influence in diminishing the mucous intestinal secretion and in unloading the portal system. It may be given with equal parts of sulphur, or with jalap, in the form of the approved pulvis jalapas compositus. Turpentine Stupes are highly serviceable in lessening tormina and tenesmus. Blood-letting. Venesection has fallen into nearly total disuse in dysentery. *Leeches to the verge of the anus often afford great relief to the tormina and tenesmus, and, by unloading the portal and hemorrhoidal veins, exercise a favorable influence in the course of the disease. Cathartics. When given judiciously, mild cathartics are often beneficial, but ill-chosen or ill-timed, they do much mischief. Castor oil, though valuable, is inferior to cream of tartar alone, or combined with sul- phur or with jalap, in the officinal pulvis jalapas compositus. Enemata. Large enemata (four or six pints thrown into the transverse colon by means of a long flexible tube per rectum) are sometimes given. Small enemata (f.giss-ij) containing opium and ipecacuanha are often useful in allaying tormina and tenesmus. DYSENTERY, CHRONIC. DR. RICHARD B. MAURY, OF MEMPHIS. Some of the most satisfactory results in chronic dysentery have been obtained by the plan first advocated by this gentleman in the Atlanta Medical and Surgical Journal, December, 1872, and later in the New York Medical Journal, March, 1876. The patient is placed in the left lateral position, used for making uterine examina- tions, and the interior of the rectum is exposed to view by means of a small Sims', or other appropriate speculum. This reveals one or more superficial ulcerations of the mucous surface. These are carefully 264 DISEASES OF THE DIGESTIVE SYSTEM. cleansed with cotton-wool, and a solution of nitrate of silver, gij, to f.gj of water, is thoroughly and carefully applied to the ulcerated surface. The treatment causes considerable pain, which should be relieved by morphia hypodermically, and the patient be kept in bed. The improvement is immediate, the movements become less frequent, and the sanguineous discharges cease. In from four days to a week the caustic application should be repeated, which is often sufficient to effect a permanent cure. The following specific directions are given:— Proceed deliberately and carefully, as in any other surgical pro- cedure. Always etherize the patient, and always stretch the sphincter ani. When properly done, these are both perfectly safe measures. The patient being etherized, the operator is enabled to explore the rectum, and make his applications deliberately and thoroughly. Paralyzing the sphincter is not only necessary to complete any satisfactory explorations, but the quieting influence secured thereby to the rectum can hardly be over-estimated. Put the patient in Sims' position for uterine examinations, and use Sims' vaginal speculum for examining the anterior and lateral walls of the rectum, and the bivalve with hinges on one side for examining the posterior wall. If much disease is discovered on examination, the surgeon may use nitric acid. If ulceration is superficial, and the mucous mem- brane not much hypertrophied, the nitrate of silver does well. The patient should be required to remain in bed for a week or two, on a milk and meat diet. LUCIUS M'GUIRE, M. D., SAN FRANCISCO. Our author recommends the use of iron in chronic dysentery:— 654. R. Ferri subsulphatis, ^ij Glycerinae, f.gj Aquae, f-gvij. M. One-half to be given as an injection every two hours. A single injection will often arrest the discharges almost imme- diately. The doctor has had occasion to try the Monsell salts a number of times as a dernier resort in dysentery, and with uniform success. W. E. WHITEHEAD, M. D., ASSISTANT SURGEON, U. S. A. Our author recommends ipecacuanha in chronic dysentery. He directs the following treatment:— A hot salt bath daily, or several times a week, just before going DYSENTERY, CHRONIC. 265 to bed; such nourishing food as best agrees; flannel next the skin; a well-ventilated, dry and warm sleeping-room; and 655. R. Pulveris ipecacuanhae, giij. For twelve powders. One to be taken morning and evening, on an empty stomach. As improvement takes place lessen the dose of ipecacuanha to ten grains twice a day, and then to eight grains at bedtime. After the ipecacuanha is stopped, it may be followed with advantage by ten drops of the muriated tincture of iron morning and night. Other testimony to the value of ipecacuanha in chronic dysentery has been recently given by Dr. A. A. Woodhull, U. S. A., and others. THOMAS HAWKES TANNER, M. D., F. L. S., ETC. 656. R. Cupri sulphatis, Extracti opii, aa gr.v Extracti gentianae, gj. M. For twenty pills. One three times a day in obstinate diarrhoea. 657. R. Argenti nitratis, gr.ss Extracti opii, gr.ij. M. Make a pill. To be taken night and morning. In very obstinate dysenteric diarrhoea, where opium agrees with the system. RESUME OF REMEDIES. Alum is much less employed in chronic dysentery now than formerly. It may be given in combination with Dover's powder. * Argenti Nitras is of great service in chronic dysentery. It should be given in the same manner as directed for the advanced stage of the acute affection. Arnica is praised by German authorities in chronic dysentery, when the vital powers are greatly depressed. Benzoinum has proved successful in the hands of Dr. Chipperfield, of Ma- dras (Madras Quarterly Medical Journal, January, 1867), given as follows:— 658. R. Tincturae benzonii compositae, f.3j—ij Tincturae opii, TT^xx-xl Pulveris acaciae, gr.xxx Aquas carui, ad. f.gvj. M. Dose—One-fourth part every four hours. *Bismuthi Subnitras is highly praised in subacute and chronic dysentery by Trousseau and Recamier. It is also much employed by Prof. Da Costa. • Calcis Aqua by the mouth, or by enema, proves useful in some cases. 266 DISEASES OF THE DIGESTIVE SYSTEM. Carbo Ligni was recommended by Prof. Chapman, who found it, internally administered, to remove the acrid and offensive character of the stools. Carbonic Acid Gas introduced per anum has been advised. Cascarilla is highly thought of by the Germans. Cetraria Islandica, in the form of jelly or decoction, is a valuable tonic and nutritive during convalescence. *Cupri Sulphas, combined with opium, is often highly serviceable in chronic dysentery. Cusparia may be given with advantage in the latter stages. Fermentum has been recommended for removing the fetor of the stools and diminishing their frequency :— 659. R. Fermenti, f.gx Camphorae, gr.xxx Spiritus aetheris nitrosi, f.gss. M. A tablespoonful every two or three hours, according to the severity of the symptoms. Ferri Chloridi Liquor, in doses of gtt.iij-vij, well diluted with water and syrup, is frequently employed in France. The same doses in enema, combined with opium, are often serviceable. *Ferri Nitratis Liquor is of great benefit, particularly in those anaemic from loss of blood and the depraving influence of malaria. Ferri Subsulphatis Liquor, diluted in enema, has been recommended. Hcematoxylum, in decoction or extract (gr.x-xxx), is an excellent tonic astrin- gent, but inadmissible so long as any active inflammation exists. Hydrargyrum, excepting very occasionally as a purgative, when there is con- gestion of the liver, is wholly uncalled for in chronic dysentery. * Ipecacuanha, in the form of Dover's powder, is often of the greatest benefit in chronic dysentery, given at bedtime in full dose (gr.x-xij), or in small, frequently-repeated doses, in combination with nitrate of silver. Jalapa, in the form of pulvis jalapas compositus, is the best purgative which can be employed in dysentery. Leptandrin is said to be useful when the stools are destitute of bile and the mucous membrane is irritable. Nitro-muriaticum Acidum Dilutum, in lotion (f.gj to aquas Oj), applied to the abdomen, is of benefit, especially when there is hepatic disease. * Opium is of great value in chronic dysentery, and may be given combined with nitrate of silver, sulphate of copper, or sugar of lead. Plumbi Acetas, though less effectual perhaps than nitrate of silver or sul- phate of copper, may be employed at an earlier stage than either of those salts. Potassii Bitartras is one of the best purgatives which can be employed when laxatives are indicated. Granati Fructus Cortex, in decoction, occasionally, in the absence of inflam- matory action, proves useful. Quercus Cortex, in decoction, has been recommended in the advanced stages of chronic dysentery. *Quinice Sulphas, in full doses (not less than 9j, in solution), should be given in malarial dysentery, and repeated until cinchonism is induced. Ipecacuanha should then be given as directed. Nux Vomica, combined with opium and iron, is worthy of trial when there is much exhaustion. DYSPEPSIA. 267 Sulphur appears to exercise a favorable influence in some cases of chronic dysentery. Tannin, in combination with opium and ipecacuanha, is often of service. Tormentilla, in decoction, may be given with advantage in the advanced stages of dysentery, after inflammatory action has been subdued. Zinci Oxidum, in doses of gr.iij-v thrice daily, is recommended by Dr. Waring-Curran. Zinci Sulphas, combined with ipecacuanha and opium, has been employed with success. Water Belt. Dr. W. C. Maclean recommends the use of a water belt over the abdomen for some hours daily. It acts as a fomentation, and the steady, uniform pressure it maintains seems to favor the absorption of the fibrine effused between the intestinal coats. If there be much uneasiness about the anus, a water compress over the part often affords more relief than an opiate enema. The cold hip-bath daily, for a few months, is also of service. DYSPEPSIA. WM. AITKEN, M. D., EDINBURGH. 660. R. Sodas bicarbonatis, gv Potassas nitratis, gj. M. For twenty powders. Order one two or three times a day in those forms of indigestion marked by excessive acidity and heartburn. At the same time free excretion from the liver and bowels must be sus- tained by occasional doses of blue pill or podophyllin, combined with extract of colocynth and of henbane, while exercise and diet are duly attended to. 661. R. Ammoniae carbonatis, 9j Extracti gentianae, 9ij. M. For twenty pills. One thrice daily in weakened digestion from over- fatigue. 662. R. Extracti nucis vomicae, Ferri sulphatis, aa gr.ss Extracti colocynthidis compositi, gr-iv. M. This combination, taken early in the morning, generally induces gentle action of the bowels. In prescribing the mineral acids, our author calls attention to the following general rule, stated by Dr. Bence Jones, namely, that the influence of sulphuric acid is astringent, while that of muriatic acid promotes indigestion, and of nitric acid secretion. THOMAS KING CHAMBERS, M. D., CONSULTING PHYSICIAN AND LEC- TURER ON THE PRACTICE OF MEDICINE AT ST. MARY'S HOSPITAL, LONDON. 663. R. Acidi hydrocyanici diluti, nil Infusi gentianae, f-^vj. M, A tablespoonful thrice daily in heartburn due to over-sensitiveness. 268 DISEASES OF THE DIGESTIVE SYSTEM. 664. R. Zinci oxidi, Pilulae alo'es et myrrhae, aa, giss. M. Divide into twenty pills. One thrice daily, in the nervous trembling, indigestion of food and vomiting, arising from indulgence in spirit drinking, between meals and in the forenoon. J. M. DA COSTA, M. D., PHILADELPHIA. 665. R. Acidi nitro-muriatici, f.gij Vini pepsini, f.giij. M. A teaspoonful three times a day, before or after meals. In functional indigestion owing to a want of proper secretion of gastric juice. When there is constipation, add also:— 666. R. Pulveris rhei, 9j Quiniae sulphatis, gr.x. M. Divide into ten pills. One to be taken at night. If this be not suffi- cient to produce a laxative effect, take one night and morning. Meat diet almost exclusively, avoiding starchy substances. C. W. FRISBIE, M. D., EAST SPRINGFIELD, NEW YORK. 667. R. Hyoscyami, gj Argenti nitratis, Extracti nucis vomicae, aa gr.xv Pulveris opii, Pulveris camphorae, aa 9j. M. Divide into sixty pills. Give one three times daily, from a half to one hour before eating, in painful digestion, over-sensibility of the sto- mach, etc. THOS. HAWKES TANNER, M. D., F. L. S., LONDON, ETC. 668. R. Acidi nitro-muriatici diluti, f.gij Acidi hydrocyanici diluti, rn„.xxv Tincturae arnicae, f.gj Tincturae gentianae compositae, f.gj Infusum sennas, q. s. ad. f.giij. M. A tablespoonful two or three times daily in dyspepsia with sluggish action of the liver. The efficacy of this prescription may often be increased by giv- ing with each dose the following pill:— 669. R. Zinci sulphatis, gr j-ij Extracti gentianae, gr.iv. M. 670. R. Quiniae sulphatis, gr.xij Pulveris ipecacuanhae, gr.xij-xxiv Extracti gentianae, gr.xxiv. M. Divide into twelve pills, and order one to be taken every day at dinner. An excellent remedy in cases of slow indigestion. DYSPEPSIA. 269 PROFESSOR ROBINSON, BOWDOIN COLLEGE. 671. R. Extracti cimicifugas fluidi, Tineturae sanguinariae, Syrupi sarsaparillas, aa f.gj. M. Dose—One teaspoonful three times daily. Very useful in cardiac pal- pitation resulting from dyspepsia. One of the finest preparations in dyspepsia with flatulence is the following:— 672. R. Sulphatis sodas, gj Tincturae nucis vomicae, f.gv Aquas, f.giv. M. A teaspoonful thrice daily, after meals. 673. R. Ferri sulphatis exsiccatas, Extracti hyoscyami, aa gj Extracti nucis vomicae, 9j. M. For sixty pills. Give one half an hour before each meal, three times daily, in water. 674. R. Ferri redacti, gr.xxxvj-gj Pepsinae, gr.xxxvj Zinci phosphatis, gr.xviij Glycerinae, q. s. M. Divide into twenty-four pills, silver them, and order two to be taken every day at dinner. In anaemia, etc., with weakness of the digestive organs. PROF. T. GAILLARD THOMAS, NEW YORK. 675. R. Magnesias sulphatis, gij Ferri sulphatis, gr-xvj Acidi sulphurici diluti, f.gj Aquas, Oj. M. Two tablespoonfuls in a tumbler of ice-water every morning upon rising, when a ferruginous tonic, combined with a saline, is indicated. Or, 676. R. Potassas et sodas tartratis, gij Vini ferri amari, f.gij Acidi tartaraci, giij Aquas, f-gxij. M. Two tablespoonfuls in a tumbler of ice-water before breakfast. Should this dose be not sufficient, two or three may be taken daily, for the result will prove tonic and reparative as well as cathartic. 677. R. One rennet, washed and chopped. Vini rubri, Oj. M. Macerate for twelve days, and then decant, filter, and add :— Acidi nitro-muriatici diluti, f.gij Tincturas nucis vomicae, f.gij Bismuthi subnitratis, gij. M. One tablespoonful in a quarter of a tumbler of water before each meal, as a digestive tonic. 270 DISEASES OF THE DIGESTIVE SYSTEM. This prescription embraces the tonic properties of nux vomica and the peculiar restorative influence of bismuth, with a fluid which resembles the gastric juice. In many cases of habitual in- digestion our author has obtained from it the best results. 678. R. Quiniae sulphatis, J}ij Ferri sulphatis, 9j Acidi sulphurici aromatici, gtt.x Mucilaginis acaciae, q. s. M. Divide into twenty pills. One to be taken three times a day, before each meal. DR. WILLIAM BRINTON, LONDON. This writer gives the following useful hints in regard to the salts of iron in dyspepsia. They are generally beneficial, not only in proportion to the ansemia and general derangement of nutrition present, but in proportion to the patient's deprivation of a due share of light, air and exercise, which is the cause of so much of the dyspepsia of civilized life. Hence iron is more useful in females than in males, more in the sedentary dyspeptic than in the florid and over-fed. Where great nausea and irritability exist, it should generally be avoided. It should always be given immedi- ately after a meal, excepting after tea. The effervescing citrate will generally be borne by the most delicate stomach. Neither this nor any other salts of iron should be given in doses sufficiently large to cause nausea or flatulence. The carbonate, phosphate, sulphate and chloride form a scale of increasingly irritative preparations, and therefore demand not only a diminished dose, but an increased dilution. Thus, while we may give gr.x of the citrate as a com- mon dose, gr.ij of the sulphate, and TT^vij-viij of the tincture of the chloride with half a wineglassful of water, are as much as most dyspeptics will safely bear. The oxide and other compara- tively insoluble preparations should be avoided. The efficacy of the salts of iron in dyspepsia often appears to be increased by conjoining them with the sulphate or oxide of zinc. Cathartics, according to Dr. W. Brinton, are of great service in dyspepsia in emergencies; of little service, almost hurtful, as promi- nent features in treatment, which ought always to aim at such a tonic effect as is incompatible with habitual purgation. They should be given in the smallest doses, on an empty stomach, either before dinner, in the shape of a slowly-acting pill, or early in the morning, in that of a more rapidly-acting liquid. The pill form is prefera- DYSPEPSIA. 271 ble, as a rule, especially when the aperient is often repeated, the liquid aperients, especially the saline, often acting injuriously on an irritable stomach. Castor oil, however, is in many constitutions an exception to this rule. PROF. FONSSAGRIVES, MONTPELLIER, FRANCE. 679. R. Magnesiae, gj Liquor calcis, Aquas destillatae, aa f.gij Syrupi aurantii florum, f.gj. M. A tablespoonful from time to time, in the intestinal colic of dyspepsia ; cold enemata of the infusion of chamomile. 680. R. Potassii bicarbonatis, gj Tincturas cardamomi compositae, Tincturas rhei, aa f.gij Spiritus ammoniae aromatici, f.gj Aquas menthae piperitas, f.giijss Syrupi aurantii corticis, f gj. M. Take two tablespoonfuls half an hour before each of the two principal meals, in flatulent dyspepsia. DR. PARIS, PARIS. 681. R. Magnesiae, gss Spiritus lavandulae compositi, f.gss Spiritus cari, f-gijss Syrupi zingiberis, f-giij Aquas menthae piperitas, f-gij- M. Take one-half after the meal, when the digestion is accompanied with an abundant development of gas. 682. R. Bismuthi subnitratis, Cinchonae florae pulveris, aa gr.xxv Calumbas pulveris, gr.xv Opii pulveris, gr-vj. M. Divide into ten powders. One an hour after each of the two principal meals, when there is atony of the stomach and pain during diges- tion. DR. BONNET, PARIS. 683. R. Bismuthi subnitratis, gv Morphiae muriatis, gr.f-iss. M. Mix carefully and divide into twenty powders. One immediately after each of the two principal meals, in two tablespoonfuls of sweetened water, in dyspepsia with a tendency to diarrhosa. DR. GUIPON, FRANCE. 684. R. Potassii bitartratis, giij Magnesias, gj--ij Jalapte pulveris, gr.xv--xxx. M. As a purgative in some cases of chronic dyspepsia; to be given in one dose. 272 DISEASES OF THE DIGESTIVE SYSTEM. DR. MAYET, FRANCE. 685. R. Canellas pulveris, gijss Piperis, Cardamomi, aa. gss Cinchonae, gj Krameriae, gv Lunel wine, Oij. M. Bruise these substances and macerate them in the wine during several days; then filter. A wineglassful morning and evening, to give tone to the stomach. SWEDISH PHARMACOPOEIA. 686. R. Sennas, giv Coriandri seminis, Fosniculi seminis, aa gij Vini serici, Oij. Bruise the senna leaves and the seeds, digest three days in the wine and add :— Raisins, giij. Macerate twenty-four hours and filter. A wineglassful in the morning, on an empty stomach, as a laxative and carminative, in flatulent dyspepsia. DR. VANCE, FRANCE. Extracti colocynthidis compositi, Biv Scammonii, 9j Extracti rhei, gr-xj Saponis, gr.ivss Spiritus canellas, gtt.iv. 687. R. M. Divide into twenty-four pills. One or two in the morning, on an empty stomach, to provoke bilious stools and increase the appetite. RESUME OF REMEDIES. Aloes, in doses of gr.ij-iv, combined with ipecacuanha (gr.j-ij), two or three times a week, is useful in the dyspepsia of persons of a relaxed habit, or those debilitated by long illness, especially if it be probable that the duodenum is implicated. Ammonii Carbonas is prescribed by Dr. Aitken in weakened digestion from over-fatigue. * Argenti Nitras is useful in many obstinate cases of dyspepsia attended with morbid sensibility and hypochondriasis. The following formula may be used:— 688. R. Argenti nitratis, gr.ss Extracti hyoscyami, gr.ij-iv. M. Make pill. Take every night. The quantity of the nitrate may be gradually increased to grs.ij-iij daily, and this may be continued with safety for six or eight weeks, but not beyond that time. It may sometimes be advantageously com- bined with small doses of quinine. The diet should be carefully directed. Or the nitrate may be given in solution:__ DYSPEPSIA. 273 689. R. Argenti nitratis crystallini, gr.vi Aquas destillatae, f-^iij- M. A tablespoonful to be taken at bedtime, on an empty stomach, and repeated every night, or every second, third or fourth night, according to the severity of the symptoms. Argenti Oxidum was much employed by Dr. Golding Bird in gastralgia, gas- trodynia, and in those forms of dyspepsia attended with irritable sto- mach and pain after food. He regarded it as a valuable sedative and tonic, possessing all the virtues without the inconveniences of the nitrate. Dr. J. Eyre used it with advantage in pyrosis. It must be remembered that it cannot, in these cases, be combined with creasote, for violent decomposition, attended with heat, and even flame, follows the mixture of these substances. *Arsenic is a valuable remedy in gastrodynia, particularly when of a neu- ralgic character. Fowler's solution should be given after a meal, commencing with small doses (i^iy), and gradually increasing them, adding a few drops of laudanum when large doses are reached, to prevent purging. Dr. Ringer recommends Fowler's solution (n\j- ij), shortly before each meal, in many forms of chronic dyspepsia. He finds it very effectual in checking the morning vomiting of drunk- ards. Aurantii Amari Cortex, in tincture or infusion, is an elegant tonic in dys- pepsia. Assafoetida, in combination with bitter tonics and mild aperients, is useful in dyspepsia attended with hypochondriasis and other mucous affec- tions. *Bismuthi Subnitras is of great value in atonic dyspepsia. Dr. W. Brinton finds it particularly useful in the " morbid sensibility of the stomach " of old writers. Dr. Wilson Fox especially recommends it in the milder forms of gastric inflammation. He finds that in pyrosis, when combined with opium, it seldom fails to relieve, but that in order to effect a cure a more direct astringent, like kino, is required. Profes- sor R. J. Graves considers it one of the best remedies we possess in gastrodynia. Calcis Aqua, in doses of f.gij, in milk, is useful in dyspepsia connected with acidity of the stomach ; also when the urine shows a strong acid reac- tion, and when vomiting is a prominent symptom. Calcis Saccharas is a good tonic in obstinate dyspepsia. *Calumba, in infusion, is a valuable vegetable bitter tonic in atonic dyspep- sia. It may be given at an earlier period than other remedies of the same class, and forms an excellent vehicle for other appropriate remedies. Capsicum is especially useful in the atonic dyspepsia of hard drinkers and long residents in hot climates. The following formula may be em- ployed :— 690. R. Pulveris capsici, gr.ij-iij Pilulae rhei compositae, gr.v Pulveris ipecacuanhae radicis, gr.ss. M. Make two pills. To be taken daily, an hour before dinner. * Carbo Ligni, enclosed freshly prepared in gelatine capsules, is a valuable remedy in dyspepsia attended with obstinate flatulence and gastro- dynia. Cardamomum, in the form of the compound tincture, is highly serviceable in the dyspeptic affections of old persons. 18 274 DISEASES OF THE DIGESTIVE SYSTEM. Caryophyllum, in infusion, or volatile oil (gtt.iij-v), is of benefit in atonic dyspepsia attended with a sense of coldness in the stomach and much flatulence. Cerii Oxalas was much employed by the late Prof. Simpson in irritable dys- pepsia, attended with gastrodynia, pyrosis and chronic vomiting. Colocynth is useful in some forms of dyspepsia and gastrodynia, when no in- flammatory symptoms are present. The following formula may be employed:— 691. R. Extracti colocynthidis compositi, 9ij Pilulae rhei compositae, 9j Saponis, gr.vj Olei caryophylli, gtt.iv. M. Make sixteen pills. Take one or two every half-hour. Ferrum. (See above). Gallicum Acidum has been recommended in dyspepsia arising from a relaxed state of the mucous membrane of the stomach. It is useful in pyrosis, unaccompanied by organic disease of the stomach, or of the liver. Gentian, in the form of tincture in an aromatic water, is a valuable stomachic in atonic dyspepsia and in the dyspepsia of gouty subjects. Hydrargyri Pilula, in doses of gr.ij-jv, is useful in dyspepsia attended with hepatic derangement, or when the duodenum is supposed to be the seat of the disease. It may be combined with ipecacuanha (gr.j-ij) and with a sedative. Ptyalism must be avoided. Hydrargyri Chloridum Mite is sometimes productive of marked benefit in dyspepsia characterized by hepatic derangement. But its habitual use, even as a purgative, is not without detriment, and its constitu- tional effects are mischievous. Hydrocyanic Acid, in doses of nUj-iv, combined with infusion of columbo, ia often signally useful in dyspepsia attended with gastric irritation. Dr. Wilson Fox states that in the irritative dyspepsia of phthisis it is a most effectual remedy. Ipecacuanha, in doses of gr.ss-j, in the form of pill, with gr.iij—iv of rhubarb, taken before meals, often proves serviceable in atonic dyspepsia, especially when the biliary secretion is deficient or vitiated. Kino is useful in the incipient stages of follicular dyspepsia. It does not appear to constipate the bowels, if diarrhoea be not present. Sir T. Watson recommends it highly in pyrosis, in the form of pulvus kino compositus:— 692. R. Kino, giv Pulveris opii, gr.xv Cinnamomi, gj. M. Divide into thirty powders. One thrice daily. Dr. Wilson Fox also regards it as the best remedy in pyrosis. *Lactic Acid, first introduced as a remedy in dyspepsia by Magendie, has been employed with success by Dr. C. Handfield Jones in cases of irritative dyspepsia, when the digestion has been for a long time painful and imperfect. Its use is not advised at the commencement of a severe case, butonly after the irritation is somewhat reduced. The dose is n^xv-xx, in a tablespoonful of water, taken at meal-times. Its use may be extended to all cases where it is desirable to improve the tone and power of the stomach. But it is essential, in order to obtain good effects, that the acid should be pure and of good quality, DYSPEPSIA. 275 which unfortunately is frequently not the case with that which is generally dispensed. Magnesia; Sulphas, in small doses, has been found very effectual in dyspepsia accompanied by costiveness. The following formula may be used: — 693. R. Magnesiae sulphatis, gj Infusi quassias, Oiss Spiritfis ammonias aromatici, f.gij. M. Drink a wineglassful of this every morning, fasting. Or the following may be employed:— 694. R. Magnesiae sulphatis, gvj Magnesiae carbonatis, giss Vini aloes, f-gvj Tincturas humuli, f.gij Acidi hydrocyanici diluti, ttbxv Infusi cascarillas, f.§vij. M. Take three tablespoonfuls thrice daily. ■> Manganesii oxidum nigrum, in doses of gr.x-xv thrice daily, has been recom- mended in certain irritable conditions of the stomach and forms of dyspepsia. Morphia, subcutaneously injected, in doses of one-fourth grain, has been used with excellent success by Dr. Clifford Allbutt (Practitioner, June, 1869) in those forms of dyspepsia characterized by irritability or erethism, or such as is often associated with hysteria, or which arises from great mental exertion or depression. Muriaticum Acidum Dilutum, in doses of n^.xv-xx, properly diluted, given immediately before, during, or directly after a meal, is highly recom- mended by Dr. Wilson Fox in atonic dyspepsia. It may be com- bined with vegetable bitters. In nervous disorder of digestion asso- ciated with diarrhoea he combines the acid with tincture of nux vomica, and gives before meals. Pepsine is especially indicated in dyspepsia connected with deficient secretion of gastric juice. It is particularly useful in gastric disturbances fol- lowing the use of animal food, often enabling a patient who has not dared attempt it, to eat of it with impunity. The severest cases of gastralgia are relieved by it. If it fails after three or more doses, it is probable that the dyspepsia does not arise from a defect of the gas- tric secretion. Dr. Wilson Fox strongly recommends it, not only in atonic dyspepsia, but in irritative states of the gastric mucous mem- brane. It may be advantageously combined with muriatic acid at meal-times (a similar combination is recommended by Prof. Da Costa). It may be combined with other medicines which do not impede its therapeutic action ; thus, with muriate of morphia, to relieve violent pain of the stomach; with strychnia, to stimulate peristaltic move- ment ; with subnitrate of bismuth, lactate or iodide of iron, etc. Potassii Sulphuretum, in doses of gr.x, alone or combined with an aromatic, is useful when the mucous follicles are supposed to be implicated. Potassii Sulphas, in doses of gr.xv-9ij, alone or combined with rhubarb (gr.v-x) or aloes, is a safe and efficient aperient in dyspeptic affections. Potassii Tartras is sometimes employed as a mild purgative in dyspeptic affec- tions, attended with slight febrile action. * Potassii lodidum, in small doses (gr.j-ij), with bicarbonate of potash (gr.vij-x), is recommended by Dr. W. Brinton in flatulent dyspepsia, in which, whether from a too starchy diet, deficient or hasty mastication, de- cayed teeth, the abuse of tobacco or other causes, the salivary excre- 276 DISEASES OF THE DIGESTIVE SYSTEM. tion seems either deficient in quantity or faulty (/. e., acid) in quality. Two or three administrations will often induce a marked change. Quassia, in infusion, combined with carbonate of soda, is recommended by Trousseau in dyspepsia attended by acidity of the stomach, sour eructations, and marked especially by vertigo and a tendency to syncope. It is peculiarly useful in the dyspepsia of drunkards. * Rheum is often highly serviceable, as it is warm and carminative in its nature, speedy, and neither stimulant nor drastic in its action. Eight grains made into pills with soap, and taken every night at bedtime, together with some mild bitter infusion, and an alkali in the daytime, is a very effectual mode of treatment. The following mixture is useful:— 695. R. Aloes, gj Rhei, Glycyrrhizas, _ aa gss Spiritus lavandulae compositus, f-388... Aquae calcis, f-^viij. M. Infuse for twelve hours and strain. Dose—Two tablespoonfuls two or three times daily. The following formula is of benefit when acidity is a prominent symptom :— 696. R. Rhei, giss Potassas carbonatis, giij Aquas ferventis, f-^xij. M. Macerate for twelve hours, strain and add :— Tincturae cinnamomi compositus, f.gij. M. Dose—A tablespoonful to a wineglassful. The old plan of chewing a piece of solid rhubarb is an excellent one. as by this means no more is swallowed than what is dissolved in the saliva, and this is frequently sufficient to keep the bowels regular, and impart tone to the digestive organs without producing subsequent constipation. Professor Da Costa sometimes combines it with quinine. *Rieiiii Oleum, in doses of a teaspoonful daily, given at bedtime, is one of the most valuable remedies in dyspepsia attended with inflammation or vascular excitement of the pylorus and duodenum. The nature of the morbid condition of the mucous membrane of the stomach is in- dicated by the effects of castor oil. In atonic dyspepsia it is borne with the greatest difficulty, causing nausea and vomiting; in irri- table dyspepsia it acts severely, and with much griping ; but in vas- cular excitement of the mucous membrane of the stomach it soothes most admirably, and produces the best effects when it has no aperient action. It may be combined with liquor potassae, or administered in emulsion, in coffee, or in a mild carminative water. Sapo, in combination with rhubarb and an essential oil, is useful in dyspepsia attended with acidity; also in pyrosis, given either alone or with opium. Senna. A mixture of equal parts of the infusions of senna and gentian is often beneficial in atonic dyspepsia, especially when attended by con- stipation. Serymtaria is recommended by Dr. A. T. Thomson in dyspepsia when the skin is hot and dry. GASTRALGIA. 277 Sinapis. White mustard seeds, in doses of two or three teaspoonfuls two or three times a day, have been advised in some forms of dyspepsia. *Sodii Bicarbonas, in full doses Oij-iij), combined with tincture of ginger (n^xxx) and aromatic spirits of ammonia (f.gss-j), is very useful in dyspeptic attacks attended with colic and gastric irritability, espe- cially when consequent on the ingestion of unwholesome food. Dr. Aitken combines it with nitrate of potash when there is excessive acidity and heartburn. Sodii Hyposulphis is praised by Sir W. Jenner and Dr. W. Brinton in flatu- lent dyspepsia. In doses of gr.x-xv, in infusion of quassia, it has proved successful in saracina ventriculi. *Strychnia or Nux Vomica is useful in chronic dyspepsia in preventing dis- tention by flatus. It is also serviceable in pyrosis and heartburn. Tannic Acid, which may advantageously be combined with dilute nitric acid, is often very serviceable in dyspepsia, the symptoms disappearing under its use, the appetite improving, and the bowels, far from being constipated, often becoming more free. Taraxacum is much used where the liver is implicated, and in the indigestion of gouty subjects. The following formula may be employed : — 697. R. Extracti taraxaci, gij Potassii nitratis, gss Spiritus aetheris nitrosi, Lgj Infusi aurantii, f-3vj« M. Take two tablespoonfuls thrice daily. Zinci Sulphas is recommended by Dr. Golding Bird in dyspepsia associated with irritability of the nervous system. Zinci Oxidum has, according to Dr. Wilson Fox, the advantage over the sul- phate in irritable conditions of the nervous system associated with dyspepsia, when given at bedtime, in doses of gr.ij-iij for procuring sleep. GASTRALGIA. PROF. F. NIEMEYER. 698. R. Tincturas nucis vomicae, Tincturas castorei, aa f.gj. M. Twelve drops during the attack of gastralgia, in a small cupful of infu- sion of valerian. Warm applications to the epigastrium. DR.'GALLARD, PARIS. 699. R. Morphias muriatis, gr.iss Aquas lauro-cerasi, f.giss. M. One drop on a piece of sugar, immediately after each meal, to persons affected with gastralgia. 700. R. Tincturae aconiti, n\,xl Sodii carbonatis, 9jv Magnesii sulphatis, giss Aquas, f.gv. M. A tablespoonful to relieve the pains of gastralgia. 278 DISEASES OF THE DIGESTIVE SYSTEM. 701. R. Extracti belladonnae, gr.vij Quiniae sulphatis, gj- M. Divide into thirty pills. One thrice daily, in the treatment of gas- tralgia. DR. MILLET, FRANCE. 702. R. Bismuthi subnitratis, giss Morphiae muriatis, ^r/}i' Rhei pulveris, By Syrupi, q- 8- M- Divide into thirty pills. One morning and evening, an hour before meals, to persons suffering from painful digestion. 703. R. Aluminii et potassii sulphatis, gj Extracti opii, gr;»j Confectionis rosas, gij- "*■• Divide into forty pills. From four to six a day in painful digestion. 704. R. Extracti belladonnae, gr.v Quiniae sulphatis, gr.xxx Extracti Valerianae, q- s. M. Divide into fifteen pills. One thrice daily, in gastralgia. 705. R. Extracti hyoscyami, 9ij Argenti nitratis, gr-vj Bismuthi subnitratis. gr.xxx. M. Divide into forty pills. One morning and evening, in the variety of gastralgia which intervenes frequently during the course of chronic gastritis. Counter-irritation to the epigastrium. DR. CALVO, PARIS. 706. R. Morphiae muriatis, gr.j Bismuthi subnitratis, gr.xij Cretas prasparatas, gr-vij Tragacanthas, q s. M. Divide into ten pills. One an hour before each of the principal meals. 707- R. Bismuthi subnitratis, Qij Magnesias, 9iv Opii pulveris, Ipecacuanhas pulveris, aa, gr.vj. M. Divide into twenty powders. From one to three a day, an hour before meals. RESUME OF REMEDIES. * Argenti Nitras, in doses of gr.^-ss twice or thrice daily, in combination with taraxacum, is particularly useful in those cases which prevent a combination of nervous irritability with chronic or passive conges- tion of the stuna -h. Argenti Oxidum is recommended by Dr. Folding Bird as possessing all the good qualities of the nitrate without its inconvenience. Bismuthi Subcarbonas This salt, a* w-11 as the subnitrate of bismuth, is useful in those cases att^n I -i with laborious digestion, putrid or acid eruftat' us, and a tendency r > diarrhoea and spasmodic vomiting. GASTRITIS. 279 im is a highly useful remedy, which ith bismuth. "Pepsine sometimes affords relief in the severest cases of gastralgia. *Hydrocyanicum Acidum Dilutum is a highly useful remedy, which may be given in combination with bismuth. GASTRITIS. DR. A. L. COX. OF NEW YORK. 708. R. Nucis vomicae pulveris, sjsa Argenti oxidi, grxv Extracti gentianae, sjiss# jyj Divide into forty pills. One thrice daily in chronic gastritis. 709. R. Bismuthi subnitratis, 3j Calumbas pulveris, ^iij Acaciae, ^j; ]yj Divide into twenty lobules. One thrice daily in chronic gastritis. 710. R. Magnesiae, gr.vii Sodas bicarbonatis, Canellas pulveris, aa, gr.iv. M. Divide into six powders, of which give one several times a day to child- ren, where dejections are green and acid. J. M. DA COSTA, M. D., PHILADELPHIA. 711. R. Bismuthi subnitratis, gr.x-xxx. Sodas bicarbonatis, gr.x. M. For one powder, to be taken after meals, when there is acidity. 712. R. Bismuthi subnitratis, gss Acidi hydrocyanici diluti, tt^xxiv Misturae acaciae, f-giij. M. A teaspoonful after meals. When there is pyrosis, the following is useful:— 713. R. Olei succini recti ficatas, f.gss Misturas acacias, f-gijss. M. Teaspoonful after meals. RESUME OF REMEDIES. * Argenti Nitras is one of the most effectual remedies in chronic gastritis. The injection into the stomach of the crystallized nitrate, dissolved in dis- tilled water, has been advised. Bismuthi Subnitras is especially useful in the milder forms of gastric inflam- mation. Hydrargyrum. Mercurial purgatives are excellent remedies in acute gastritis. Three to f.ur grains of calomel, followed by castor oil or a saline, may be given to an adult, vigorous patient. Blue pill, with a little colocynth and ipecacuanha, followed by seidlitz powder, may be given when active effects are undesirable. 280 DISEASES OF THE DIGESTIVE SYSTEM. * Hydrocyanicum Acidum Dilutum is often serviceable in subacute gastritis, given in an ordinary effervescing draught. Prof. Da Costa sometimes combines it with bismuth. Morphia is a valuable palliative in chronic gastritis, though generally con- sidered inferior to hydrocyanic acid. Drs. Bardslet and Stokes advise it in doses of gr.^, twice the first day, three times the second, and so increasing the quantity until the patient takes one to one and a half grains in the twenty-four hours. When there was an abundant secretion of mucus, it was found particularly serviceable. Opium is recommended by Dr. Wilson Fox in subacute inflammation of the stomach, when great nervous irritability and atony co-exist, in which cases it may often be combined with nitrate of silver. ^Turpentine, applied hot in stupes, is of great benefit. GASTRIC ULCER. PROF. H. ZIEMSSEN, OF ERLANGEN. This writer {Medicinische Central Zeitung, April, 1872) recom- mends the use of alkalies, especially Carlsbad water, continued several months. Most vegetable, and fatty, and saccharine matters are injurious. A milk diet has proved of benefit in numerous instances; but veal, chicken, ham, white bread and light claret are harmless. Morphia, hypodermically, must be employed to combat the cramps in the stomach. J. M. DA COSTA, M. D., PHILADELPHIA. 714. R. Argenti nitratis, gr.v Extracti opii, gr.x. M. For twenty pills. One thrice daily. The following is an excellent combination for the pain and vomit- ing, when opium is inadmissible:— 715. R. Bismuthi subnitratis, ^ij Acidi hydrocynaci diluti, f.gss Mucilag. acaciae, Aquas menthae piperitas, aa f.gij. M. A tablespoonful thrice daily. RESUME OF REMEDIES. Argenti Nitras, though generally considered of value in ulcer of the stomach, is believed by Dr. W. Brinton to be, as generally prescribed, abso- lutely inert, so far as the gastric ulcer is concerned. He prefers bis- muth. Professor Da Costa sometimes prescribes the nitrate with opium. HiEMATEMESIS. 281 Arsenic is recommended by Dr. Ringer who gives one to two minims of Fow- ler's solution before each meal. *Bismuthi Subnitras is highly spoken of by Dr. W. Brinton, who gives gr x- xx every six or eight hours either alone or combined with gr.v?x of pulvus kmo compositus. It relieves pain and vomiting, as well as diarrhoea, when present. 6 Calumba in infusion, combined with iodide of potassium and bicarbonate of potash is recommended by Dr. W. Brinton for the relief of vomiting painful nausea, and flatulence of ulcer of the stomach. VOmitinS' Cannabis,i*t extract, often answers admirably as a sedative, and would re- place opium entirely were its effects more uniform Opium is highly recommended by Dr. W. Brinton in ulcer of the stomach. In his opinion, its efficacy in this affection is not due to its sedative hnnt?n yDer°Pertie8' but rather to it8 8«PP<>rting the strength! ture of the tissues generally. When vomiting is moderate, or where diarrhoea is prominent, pulvus kino compositus is a convenient for' rM, ™ J£ W-^Il-VOmiitung K. excessi™> and resists a combination of this powder with bismuth, opium is best borne in a solid form. Thus SJ'S effects ar.e often ve.T striking. Large and frequently- repeated doses are of great service in perforating ulcer of the stomach. Plumbi Acetas often allays the severity of the symptoms. Ricini Oleum, in a moderate dose, may often be given in the ordinary way without increasing the pain or vomiting. When the latter is frequent, however, the oil is best given in enema. ^Turpentine stupes often relieve the pain. When, however, the strength is exhausted by constant vomiting, dry cupping is preferred by Dr. W Brinton as a more effectual means of relieving the pain. In com- paratively recent cases in the young and well-nourished, blisters are to be preferred. *Enemata Life may be prolonged, and even in some cases preserved, in those ulcerous conditions of the stomach in which it is unadvisable or impossible to give food by the mouth, by the persevering use of enemata of beef-tea, milk, raw eggs, cod-liver oil, wine, and, in ex- treme cases, even diluted brandy or opium. The quantity of each should be as small as possible, and should rarely be repeated in less than three or four hours. *Ice, in small lumps and raspings, greatly relieves the pain and vomiting. Leeches to the epigastrium often relieve the pain, but their use is of doubtful propriety m the weak and cachetic. MMATEMESIS. DR. JACCOUD, PARIS. There is no better treatment than that by ice, internally and externally. The mineral acids or alum may be given, but their efficiency is neither as rapid nor certain as that obtained from ice. Dry cups on the limbs and trunk are useful when the hemor- rhage is copious. 282 DISEASES OF THE DIGESTIVE SYSTEM. FREDERICK T. ROBERTS, M. D., M. R. C. P., LONDON. The judicious rules laid down by this author, in his treatise on Practice, are: bodily rest, and nutrition by enema, if the case is severe; small lumps of ice should be swallowed at intervals, and a light ice poultice to the epigastrium, followed by sinapisms if the vomiting is violent. It is of the utmost importance to check the emetic efforts, and if the means just mentioned are insufficient, recourse should be had to a few drops of dilute hydrocyanic acid in cold mucilage ; morphia internally or by subcutaneous injection; or an enema containing tincture of opium. Should there be signs of sinking, stimulants are called for, and should be given by enema. The most efficient medicines are gallic acid or acetate of lead, in full doses, combined with opium; or oil of turpentine. RESUME OF REMEDIES. Alum, in doses of gr.viij-xij, in combination with opium, thrice daily, is useful, though inferior to sugar of lead. Ammonii Chloridum is sometimes employed with advantage. Argenti Oxidum, in doses of gr.ss-j, thrice daily, is highly recommended by Sir J. Eyre. *Ergotine has been successfully employed by Mr. Charles Stewart (Edin- burgh Medical Journal, December, 1871), in hypodermic injections of griij- *Ferri Nitratis Liquor, in large doses, is very efficacious. *Gallici Acidum. Dr. W. Brinton recommends the following formula:— 716. R. Acidi gallici, Qij Acidi sulphurici diluti, tt^xl Aquae, f.gij. M. Dose—A tablespoonful in a little water. *Ipecacuanha often appears to exercise a powerful influence. It should be given in the manner recommended in hasmoptysis. Magnesice Sulphas. Dr. Barlow considers that in hoematemesis and melasna it is advisable to clear out the bowels before resorting to astringents. For this purpose he employs the following formula:— 717. R. Magnesiae sulphatis, gj--ij Acidi sulphurici diluti, n\,x Aluminis, gr.x Syrupi papaveris, f.gss Infusi rosas compositi, f-gxj. M. Make a drink. Take every four hours. Matieo has been advised. *Plumhi Acetas, in doses of gr.ij-iij, combined with acetate of morphia, gr.|-ss, is very useful in controlling hemorrhage from the stomach whether idiopathic or from ulceration. The auxiliaries are the ex- ternal application of cold, acidulated drinks, perfect rest, and anti- phlogistic diet. HEPATITIS, CHRONIC. 283 *Sulphuricum Acidum' Dilutum, alone or combined with gallic acid, is a very efficient remedy. Tannicum Acidum, in doses of gr.iij-vj, three or four times a day, is a useful astringent and tonic, only contra-indicated by the presence of inflam- matory symptoms. Turpentine deserves a trial after the failure of less nauseous remedies. *Ice, in lumps, coming in contact with the bleeding vessels, acts as a powerful astringent. HEPATITIS, ACUTE. PROF. W. C. MACLEAN, M. D.. LONDON. This distinguished surgeon strongly opposes the usual treatment of acute hepatitis by venesection, mercurials and purgatives, and recommends in place of it ipecacuanha, in large doses, gr.xx-xxx, repeated every few hours until the symptoms subside:— 718. R. Pulvis ipecacuanhae, 9j Mucilaginis acaciae, q. s. M. Make four pills. The whole to be taken every sixth hour, day and night. Dr. Alfred A. Woodhull, u. s. a., has recently published some cases corroborating the value of this treatment. Dr. Maclean considers ipecacuanha in hepatitis almost as valuable as in dysen- tery. HEPATITIS, CHRONIC. J. M. DA COSTA, M. D., PHILADELPHIA. A certain amount of drain should be kept up from the portal circulation. For this purpose, very small doses of podophyllin, cream of tartar, or Rochelle salts, now one and now another, are useful. A very good pill is the following:— 719. R. Podophyllin, gr.vj Capsici, gr.iv Pulveris rhei, gr.xij. M. For twelve pills ; one on alternate nights. In order to reduce the state of induration or enlargement of the 284 diseases of the digestive system. liver, the mineral acids may be employed. Or, when the case is not chronic, the salts of soda, as in the following formula:— 720. R. Sodas bicarbonatis, gss Infusi gentianae, f-^vj. M. A tablespoonful three times a day, after or between meals. Should this fail, employ nitro-muriatic acid baths. Sulphur baths are of advantage; or those of sulphuret of potassium; or the use of sulphur ointment, followed by warm baths. SIR RANALD MARTIN, LONDON. Nitro-muriaticum acidum is employed, both externally and in- ternally, with great advantage in chronic hepatitis, and in the ad- vanced stages of acute hepatitis and congestion of the liver. It is most serviceable in the form of a bath, for which the following direc- tions are given {Lancet, December 9th, 1865) by Sir Ranald Martin :—1. The proportions of acid are given by the following formula:— 721. R. Acidi muriatici, f-^iij Acidi nitrici, f.gij Aquae, f.gv. M. 2. Two gallons of water (about ten bottles) may suffice for a bath. 3. To each gallon of water add fjiij of the above acid mixture. 4. The bath thus prepared will keep in use for three days, by adding f.gss of the acid mixture and Oj of water, morning and evening, to make up for the waste by evaporation. 5. A portion only of the bath to be heated for use, after which it is to be added to the remainder, so as to make the whole of a comfortable warmth (96°-98°). 6. Let both feet be placed in the bath, while the in- side of the legs and thighs, the right side (over the liver), and in- side of both arms, are sponged alternately. This should be con- tinued for ten or fifteen minutes, morning and evening. 7. While using the bath, a gentle aperient should be taken every morning. 8. Earthenware or wooden vessels should be preferred for foot-baths, and all the sponges and towels should be kept in cold water, as the acid corrodes them. 9. In urgent cases, a general bath, to envelope the whole body, may be used. 10. If the acid bath create much irritation of the skin, the quantity of the acid may be diminished. 11. The influence of the acid is not in the least degree counteracted by opium, even when exhibited in the largest doses. JAUNDICE. 285 RESUME OF REMEDIES. Colchicum is advised by Dr. Copland, to increase the biliary secretion in chronic inflammation or enlargement of the liver, and to promote the resolution of the former and the diminution of the latter state. Hydrargyri Bromidum has been administered with relief in chronic hepatitis with enlargement. Hydrargyri lodidum Rubrum, in ointment, is recommended by Dr. W. C. Maclean in malarial enlargements of the liver and spleen, to be rubbed in for ten minutes in the morning, and the patient exposed to the powerful heat of a fire as long as he can endure it. Hydrargyri Chloridum Mite. Mercury is much less employed than formerly in chronic hepatic affections, it having been superseded by nitro- muriatic acid and iodide of potassium. Iodine and its preparations are beneficial in chronic hepatic affections, but their indiscriminate use is to be avoided. Nitricum Acidum, with sarsaparilla or taraxacum, is often productive of good in chronic hepatitis, especially of old persons, where mercurials have been largely used. Nitro-muriatic fomentations and baths may be employed at the same time. * Potassii lodidum, combined with taraxacum, is of value in chronic inflam- mation and enlargement of the liver. Dr. Copland has found that it is chiefly when enlargement, obstruction or torpor of the liver occurs after periodic fevers, or in the scrofulous diathesis, that iodide of potassium, employed internally or externally, or both, and in con- junction with other deobstruents, as liquor potassas, or alternated with purgatives, is of most benefit. * Taraxacum is an efficient remedy in chronic inflammation of the liver ; where mercury is advisable, rendering it more efficient, and under certain circumstances taking its place advantageously. Sir Ranald Martin has found in indolent enlargements of the liver, accompanied with torpid action of the viscus, that mercury is of little service, and that he has derived more advantage from the following formula, conjoined with a spare diet and the external application of cantharides:— 722. R. Extracti taraxaci, gr.xxxvj Extracti aloes, gr-xij Extracti acetici colchici, Pulveris ipecacuanhae, aa gr.vj. M. Make twelve pills. Take two every night. JAUNDICE. ROBERTS BARTHOLOW, M. D., CINCINNATI. Excellent results have been obtained by this practitioner in malarial and catarrhal jaundice by the use of manganese:— 723. R. Chinoidin, gj. Manganesii sulphatis exsiccatae, By. M. For twenty pills. One three times a day, in malarial jaundice. 286 diseases of the digestive system. 724. R. Fel bovini purificati, _ 3J.. Manganesii sulphatis exsiccatas, dl3 Resinas podophylli, gr-v- M- For twenty pills. One three times a day, in catarrhal jaundice. In similar cases he also finds the following of great use :— 725. R. Quiniae sulphatis, . 9VI Ferri sulphatis exsiccatas, iJj. Acidi arseniosi, grJ- # Ml To make twenty pills. One thrice daily, in malarial jaundice. PROF. WILLIAM PEPPER, M. D., PHILADELPHIA. In simple jaundice—acute congestion of the liver—the indica- tions are to check vomiting, to relieve the congestion, and to start the bile. To accomplish the first, give hydragogue cathartics, elaterium, bitartrate of potash, etc.; or, if the stomach is too irri- table, administer an enema of croton oil, gtt.ij, in emulsion. The congestion of the stomach and liver can be relieved by counter- irritation, as by a large blister over the epigastrium. This is very effective to -arrest the vomiting. By the mouth, give the following:— 726. R. Hydrargyri chloridi mitis, gr-"J Pulveris opii, gr-ij Bismuthi subnitratis, By88- M Make six powders. One to be given every three hours. This combination powerfully aids the mercurial in relieving the hepatic congestion, and stimulating the gastro-intestinal glands. The diet in such cases should be restricted to milk {Medical and Surgical Reporter, November 27th, 1875). PROF. A. GUBLER, FACULTE DE MEDECINE, PARIS. 727. R. Aloes socotrinas, Gambogias, Hydrargyri chloridi mitis, aa gr.xv Syrupi, q- s. -«• Divide into ten pills. Order one or two a week, to keep the bowels soluble, in icteric disease of the liver. MIDDLESEX HOSPITAL, LONDON. 728. R. Pilulae hydrargyri, gr.xxx Digitalis pulveris, Scillae pulveris, aa gr.v. M- Divide into ten pills. One morning and evening, in icterus, to elimin- ate the coloring matter of the bile from the blood. JAUNDICE. 287 RESUME OF REMEDIES. Aloes has been used with benefit in jaundice. Ammonii Chloridum, in doses of gr.xx every five hours, has, in the hands of Dr. Anstie, restored the biliary secretion, in a few doses, when it had been suppressed by a powerful nervous shock or mental perturba- tion. In his opinion it is one of the most powerful of all biliary functional restoratives. Benzoicum Acidum has recently attracted attention as a remedy in jaundice due to suppression of the biliary secretion. Colchicum, in small doses, combined with mild mercurials, or soap, or alka- lies, or with magnesia or the neutral salts, according to circumstances, has been prescribed by Dr. Copland with benefit. It must be con- tinued for a considerable time, and carefully watched. If there be much debility, or if it produce depression, it should be combined with camphor. Ether, from its power of dissolving cholesterine and its anti-spasmodic prop- erties, has been recommended as an internal remedy in jaundice de- pending on the presence of gall-stones. Hydrargyri Chloridum Mite. Jaundice sometimes yields rapidly to a calomel purgative (gr.v), followed by a saline, which, however, proves useless when the affection is connected with obstruction by gall-stones, or organic diseases of the liver. Magnesii sulphas. The following formula is sometimes useful in severe forms of jaundice :— 729. R. Magnesii sulphatis, gss-j Magnesii carbonatis, gr.xv Spiritus ammonii aromatici, n\,xxx Aquas, f.gx. M. Make a drink. Take thrice daily. Nitro-muriaticum Acidum Dilutum is useful both internally and externally, in the form of a bath. It is contra-indicated if there be inflammatory action present. *Podophyllin is often a very reliable remedy in jaundice. Potassii Chloras, combined with carbonate of soda, is useful in chronic 0/ asthenic jaundice, accompanied by a torpid state of the liver. Potassii Sulphas is recommended by Dr. A. T. Thomson as more useful than other saline purgatives in jaundice. Sanguinaria, in the form of the powder (gr.ij-v), or the infusion, has been employed with advantage in jaundice and torpor of the liver. Taraxacum, combined with small doses of colchicum, has been found service- able in jaundice depending upon hepatic disease. * Cathartics. Dr. Gross states that in jaundice depending upon hepatic derangement, after bilious evacuations have been produced, an active aperient, every second or third day, for the space of ten days or a fortnight, should never be omitted, so as to carry off the remains of the disease, and prevent a relapse. This is a simple but successful practice which should not be neglected. 288 DISEASES OF THE DIGESTIVE SYSTEM. TORPIDITY AND FUNCTIONAL DERANGEMENT OF THE LIVER. CHARLES MURCHISON, M. D., LL.D., F. R. 8., LONDON. In the " Croonian Lectures" of 1874 this eminent authority discussed the functional derangements of the liver and their treat- ment. Commencing with diet, he recommends one chiefly of stale bread, plainly cooked mutton, white-fish, poultry, game, eggs, a moderate amount of vegetables, and weak tea, cocoa, or coffee. In severe cases, potatoes, rice, sago and fruits have to be given up; milk suits some, not all. The principal meal should be in the morning, and the quantity not beyond the needs of the system. All alcoholic drinks should be prohibited. Cholagogues: great advantage is derived from aperient medicines ; salines are the best, as sulphate of magnesia, sulphate of soda, tartrate of potash and soda, Friederichshall, Pullna, or other saline water; as to the benefit of mercury, our author says that the skepticism of the most doubting physician would be removed should he unfortunately find it necessary to test its efficacy in iris own person. Calomel is the form he prefers. Podophyllin he regards as less certain in its action and more liable to cause griping. Colchicum is a useful adjunct to other aperients. Taraxacum, he thinks, has no specific action, but is useful as a mild aperient, and may be advantageously combined either with alkalies or mineral acids. Alkalies: these are next in importance. One grain of carbonate of lithia, or of carbonate of ammonia, nearly equals a grain and a half of car- bonate of soda, or two grains of carbonate of potash. It is well to suspend their use occasionally, as, when long continued, they derange gastric digestion. CJiloride of ammonium has a great and well-deserved reputation in hepatic congestion and other func- tional derangements of the liver :— 730. R. Ammonii chloridi purificati, gss Aquas menthae piperitas, f.giij. M. Dessertspoonful three times a day. It may be combined with either alkalies or mineral acids. The last-mentioned remedies our author considers of minor value in these complaints. Tonics are apt to disagree in many cases of functional hepatic derangement. Neither iron nor quinine acts well. Gentian, chiretta, cascarilla, serpentaria and nux vomica PYROSIS. 289 are preferable to preparations of cinchona. Arsenic suits some patients. Opium is contra-indicated except in those functional hepatic troubles which arise in diabetes. RESUME OF REMEDIES. Ammonii Chloridum is worthy of trial when there is want of biliary action. Hydrargyri Pilulce. Abernethy's practice, in bilious derangements, of giving, almost indiscriminately, five grains of blue pill at night and a senna draught in the morning, is still continued by many practitioners. * Ipecacuanha, in small and long-continued doses, is frequently productive of great benefit in functional derangement of the liver. Iridin is a cholagogue aperient, gentler in its action than podophyllin. It is very useful in a sluggish state of the bowels arising from torpidity of the liver, or when the stools are pale, particularly in the intervals of overt attacks in gouty persons. Leptandrin is useful in torpidity of the liver, in which case it is said to be a valuable adjunct to podophyllin and iridin. "Podophyllin is now much employed in torpor of the liver. Sanguinaria has been used with evident advantage in torpidity of the liver, the powder (gr.ij-v) or infusion being preferred to the tincture. Senna, in infusion (f.gj-iij), either alone or combined with sulphate of mag- nesia (gij-iv) or tartrate of potash (Bij-gij), is an efficient purgative in bilious derangements. "Taraxacum is a valuable remedy in torpor of the liver. Turkish Baths are sometimes of great advantage as excitants of the liver. PYROSIS. PROF. PIORRY, PARIS. 731. R. Sodii bicarbonatis, giss Aquas destillatae, Syrupi aurantii florum, aa, f.gj Olei anisi, gtt.j. M. For one dose, in pyrosis. 732. R. Quiniae sulphatis, gr.xxij Pepsinas, Bvss Extracti absinthii, q. s. M. Divide into forty pills. Two before each meal, in functional derange- ments of the stomach, particularly pyrosis, flatulence and gastralgia after eating. 733. R. Sodii bicarbonatis, gr.xiv Tincturas columbas, f.gj Aquas destillatae, f-Jiij Syrupi gentianae, f.gj. M. To be taken during the day, in the same manner as the above formula. 19 290 DISEASES OF THE DIGESTIVE SYSTEM. 734. R. Magnesias, gss Sodii bicarbonatis, gj Cretas prasparatas, 9iv Sacchari, gij88- M. Divide into ten powders. One before each of the two principal meals, in acid dyspepsia. 735. R. Magnesiae, gr.iss Bismuthi subnitratis, gr.iv-vij Opii pulveris, gr.ss. M. For one dose, to be taken before eating, in acid dyspepsia. DR. GUIPON, PARIS. 736. R. Ferri redacti, By'ss Magnesiae, Rhei pulveris, aa gss. M. Divide into ten powders. One to be taken before each of the two principal meals in acid dyspepsia of chloro-anasmic women. 737. R. Cretas prasparatas, Rhei pulveris, aa, 9ij Opii pulveris, gr.iv. M. Divide into twelve powders. One half an hour before each of the two principal meals, to stimulate the appetite and quiet dyspeptic pain. 738. R. Bismuthi subnitratis, ^vij Magnesii carbonatis, giijss Calcii carbonatis prascipitatae, gv Sacchari, giij Acaciae pulveris, gj Mucilaginis acacias, £gij Aquas rosae, q. s. M. Divide into one hundred troches. Two or three after the principal meals, in acid dyspepsia. RESUME OF REMEDIES. Alum, in doses of 9j thrice daily, in the form of an electuary, has been strongly recommended. Argenti Nitras is an excellent remedy. Argenti Oxidum has been employed with marked benefit. It must not, in these cases, be combined with creasote, as the combination causes violent decomposition and the development of great heat, and even flame. "Benzoin. A fluid drachm of the tincture, with mucilage, is said to be effica- cious in many cases. "Bismuthi Subnitras, combined with opium, seldom fails to afford relief. Carbolicum Acidum has been employed with success by Dr. Podmore Jones (Practitioner, November, 1868), in the following formula :— 739. R. Acidi carbolici, gr.j Alcoholis, f.3j. M. Twenty-five drops in a wineglassful of water, an hour before each meal. VOMITING. 291 Gallicum Acidum is of benefit in cases accompanied by organic disease of the stomach, or by disease of the liver. "Kino Pulvis Compositus is said by Sir T. Watson to be an admirable remedy in this affection, in doses of gr.x thrice daily. Liquor Ferri Nitratis, in doses of gtt.x-xv thrice daily, is useful in those cases where tonics and astringents are indicated. Lupuli Extractum has been found serviceable. Magnesice Carbonas is occasionally an effectual remedy. "Nux Vomica is very useful in many cases. Dr. Barlow recommends the following formula:— 740. R. Extracti nucis vomicae, gr.iss Argenti nitratis, gr.ij Extracti lupuli, gr.xij. M. Divide into six pills. One thrice daily. "Opium, in combination with gentian, frequently affords speedy relief. "Sulphurosum Acidum, in the hands of Dr. Lawson (Practitioner, September, 1868), has produced the best effects, in doses of f.gss-j thrice daily, shortly before meals, in plain distilled water. VOMITING. RESUME OF REMEDIES. Ammonii Citras has been recommended in the vomiting attendant on ulcer of the stomach, but Dr. W. Brinton considers that the salts of am- monia do more harm than good in these cases. Ammonii Chloridum is said to relieve the vomiting attendant on scirrhus of the stomach more promptly and uniformly than any other remedy. Armoracice Radix. Dr. Tilt recommends, in vomiting connected with uterine affections, a small portion of horse-radish scraped and moistened with vinegar. Arseniosum Acidum, in the form of Fowler's solution, is advised by Dr. Ringer, in the morning vomiting of drunkards. Bismuthi Subnitras, especially when combined with hydrocyanic acid, often speedily allays vomiting in connection with stomach diseases, but in sympathetic vomiting (e. g., from uterine disorder) it has little or no effect. Calcis Aquce sometimes succeeds when hydrocyanic acid and other remedies fail. It has less influence on sympathetic vomiting than on that con- nected with functional derangement of the stomach. "Calumba is useful in many forms of vomiting, especially in that of preg- nancy. Its efficacy is greatly increased by combination with hydro- cyanic acid. Carbolicum Acidum, in drop doses of the crystallized acid liquefied by heat, in mucilage, thrice daily, is recommended (British Medical Journal, March 13th, 1869) in the vomiting of pregnancy and other forms of sympathetic vomiting. Carbonic Acid, in the form of an effervescing draught, is often an effective remedy. 292 DISEASES OF THE DIGESTIVE SYSTEM. Cerii Oxalas appears to be an uncertain remedy, but is sometimes effective in the sickness and vomiting of uterine disease. "Chloroform, in doses of a few drops, is often very useful in obstinate vomit- ing. Sir C. Locock recommends (British Medical Journal, August 22d, 1868) chloroformization, almost to insensibility, in obstinate vomiting of pregnancy. Cinnamomum in aqueous infusion is often of benefit in continued nausea and vomiting. Creasotum is considered by many as an overrated remedy in vomiting. Dr. Ringer considers the principal cause of its failure as due to its being given in too large doses. He obtains the best effects by adding just sufficient creasote to water to make it taste distinctly, but not strongly of the medicine, and administering of this a dessertspoon- ful frequently. He finds it effectual given in this manner, in allay- ing nausea and retching, though some consider it to have less power over actual vomiting. "Hydrocyanicum Acidum, given in an effervescing draught, is a very efficient remedy in vomiting arising from any morbid conditions. "Ipecacuanha is considered by Dr. Ringer to have few equals in checking some forms of vomiting. In numerous instances he has found drop doses of the wine, administered every hour or thrice daily, according to the urgency of the case, check vomiting of pregnancy, the morn- ing vomiting of drunkards, the vomiting which accompanies general weakness aftrt: acute diseases, and that of acute catarrh of the stomach, in children. That form of vomiting after meals in which there is no nausea or pain, or even discomfort, is quickly stopped by these small doses of ipecacuanha. Even in vomiting from cancer of the stomach he has sometimes succeeded with it after the failure of other remedies. Dr. C, D. Phillips states (Practitioner, November, 1869) that its beneficial operation is clearly discernible in most cases of continued and obstinate retching, or vomiting where the stomach is not primarily affected, but disturbed by sympathy with some other organ or part of the body, whether the primary affection be acute or chronic. Dr. C. Fuller bears testimony also (Lancet, December 4th, 1869) to its value in the vomiting of pregnancy. He found single drops of the wine in a teaspoonful of water every hour, to arrest obstinate vomiting in the course of two days. But it failed in his hands in the treatment of vomiting of drunkards. Magnesia, in doses of gr.xv-xx, is sometimes given with advantage in sympa- thetic vomiting. Magnesii Carbonas also occasionally affords relief in sympathetic vomiting, especially in that of pregnancy. Opium. A few drops of laudanum, given in beef-tea, as an enema, and re- peated as necessary, is sometimes useful in the vomiting of preg- nancy. Dr. Graily Hewitt recommends in those cases an opiate liniment rubbed over the hypogastric region, or morphia applied endermically. Hypodermic injections of morphia are also serviceable. Sodii Carbonas is beneficial in vomiting arising from acidity of the stomach. Nux Vomica, in the form of the tincture, is recommended in the vomiting of pregnancy. Dr. Douglas Powell states (Practitioner, November, 1868) that the tincture, in doses of n\jc., will often arrest the vomiting of phthisis. Dr. Barlow recommends, in vomiting connected with malignant disease of the stomach, the following formula :__ 741. R. Extracti nucis vomicae, gr.j Extracti conii, gr.xij. M. Make six pills. Take one three times a day. VOMITING. 293 Strychnia. Dr. Tilt recommends, in vomiting connected with uterine dis- ease, the following formula:— 742. R. Strychniae, gr.^ Tincturas zingiberis, f.gvj Aquas, f.giv. M. Dose—A teaspoonful every one or two hours. Sulphurous Acid, in doses of n\,xxx thrice daily has been employed by Dr. Drys- dale, with success (Lancet, July 24th, 1869) in constant vomiting and eructation. Tartaricum Acidum, in effervescing draughts, sometimes succeeds in allaying vomiting. Blisters. A small blister over the epigastric region frequently effectually checks vomiting arising from functional or nervous disorder of the stomach, and also that consequent on fevers. Ice in lumps, or minute quantities of iced brandy and water, or champagne, given every hour, is useful in severe vomiting attendant on pregnancy or uterine disease. Leeches. Dr. Tilt states that in vomiting connected with uterine affections, after the failure of ordinary measures, he has, on several occasions, seen it suddenly checked by the application of six leeches to the pit of the stomach, although there was no sign of inflammation there, and the patient's debility was such as not to justify loss of blood. The same procedure sometimes succeeds in idiopathic vomiting. Y. DISEASES OF THE URINARY SYSTEM. Albuminuria-BrigMs Disease-Cystitis-Diabetes-Dropsy- Hematuria-Incontmence of Urine-Nephritis-Sabulous and Calculous Deposits. ALBUMINURIA. WILLIAM AITKEN, M. D.f EDINBURGH. 743. R. Acidi gallici, ?j Acidi sulphurici diluti, J,-3»s Tincturae lupuli, *•& . M Infusi lupuli, f-3vJ- M> A tablespoonful three times a day. Said by the author to check the waste of albumen, especially in the more acute and recent forms of albuminuria. J. M. DA COSTA, M. D., PHILADELPHIA. 744. R. Ammonias muriat, 3VJ. Tincturae ferri chloridi, t-|J88 M Aquae, i-5vJ- ' A tablespoonful thrice daily, in anaemic albuminoid degeneration ot the kidneys or liver. This author considers the muriate of ammonia one of the best agents we possess to counteract the tendency to albuminoid degen- eration in any organ. JOHN W. MARTIN, M. D., DUBLIN. This author gives, in the Medical Press and Circular, December, 1874, a typical case of his plan of treatment. It consisted of hydragogue purgatives, diuretics, and tonics, as follows:— 745. R. Pulveris jalapas compositae, gj-viij« One to be taken at bedtime. 746. R. Pulveris scillae, Pulveris digitalis, aa gr.j. Make pills. One to be taken three times a day. 294 ALBUMINURIA. 295 747. R. Potassas iodidi, gj Ferri citratis, 3j Spiritus chloroformi, gij Spiritus ammonii aromatici, gij Aquas, ad. gxij. M. Two tablespoonfuls to be taken three times a day. 748. R. Linimentum terebinthinae, gvj. To be applied over the kidneys twice or thrice daily. A flannel binder to be worn round the loins. RESUME OF REMEDIES. "Antimonii et Potassii Tartras is recommended by Dr. Barlow in the acute forms of albuminuria. He considers it indicated by the nature of the affection, and calculated to equalize the circulation, subdue the inflammatory action and restore the functions of the skin. But he does not employ it to the exclusion of other remedies, as moderate venesection, hydragogue cathartics, the warm bath, and the applica- tion of large linseed-meal poultices to the loins. Belladonna will, in the opinion of Dr. Harley, prove very serviceable in chronic albuminuria, provided that the kidney has not passed into the degenerative state bordering on fatty degeneration. Cantharis, internally, has, it is said, been employed with benefit in purely chronic cases, but must be used with great caution. * Ferri lodidum is often beneficial, particularly in old broken down constitu- tions. Ferri Chloridi Tinctura is one of the most generally useful preparations of iron in albuminuria, possessing diuretic as well as chalybeate proper- ties. Gallicum Acidum, in doses of gr.x, thrice daily, has been successfully employed. Potassii Sulphuretum has been recommended in the following formula, to establish free diaphoresis:— 749. R. Potassii sulphureti, gr.v Tincturae guaiaci ammoniatas, f.gss Liquoris ammoniae acetatis, f-gss Aquae, f.gj. M. For one dose, to be taken at bedtime, followed by a pint of hot whey. Sodii Carbonas has been recommended in albuminuria, on the ground that alkalescence is a necessary condition of the blood ; that the free alkali is soda; that when this constituent is deficient, the result is coagula- tion of blood in the capillary vessels and ensuing inflammation, and that potash or soda (uncombined or as carbonates), taken into the stomach, have the power of rendering the urine alkaline and dissolv- ing fibrine. The following formula may be employed:— 750. R. Sodii carbonatis, gij Liquoris potassas, f.gij Decocti chondri crispi, fgviij. M. A tablespoonful every two hours, in milk. Tartrate of iron may be added when anaemia is very marked. 296 DISEASES OF THE URINARY SYSTEM. Tannicum Acidum, in from gr.xxx-lx per day, has been advised in the ana- sarca accompanying albuminuria. Tiglii Oleum is one of the best hydragogue cathartics which can be given in albuminuria, as it produces copious evacuations with less sickness and discomfort than elaterium. BRIGHT'S DISEASE. ALFRED L. LOOMIS, M. D., OF NEW YORK. This author is convinced that the diaphoretic and cathartic plan of treatment is wrong, and its apparently good results deceptive, and prefers the following:— In the acute stage of parenchymatous nephritis, whatever may have been the exciting cause, the patient must be kept in bed, in a large, well-ventilated apartment, with a temperature of 75° Fah.; milk should be his only article of diet. Dry cups should be applied over the kidneys, followed by poultices of digitalis leaves, and the infusion of digitalis leaves should be administered at the rate of half an ounce every two hours for twenty-four hours, after which it may be continued at longer intervals, so long as ursemic symp- toms are urgent. When the flow of urine commences, the digitalis should be discontinued, and diluent drinks freely administered to keep up the diuresis. If renal secretion is not restored within twenty-four hours after the commencement of this treatment, warm baths, or hot air baths, should be used in addition; and if the symptoms remain urgent, hydragogue cathartics may be. given. In the later stages, those commonly known as chronic Bright's disease, the plan of treatment is essentially tonic. Iron and cod- liver oil are the two great remedial agents, and should be daily administered if they do not disturb the stomach. Milk should be the principal article of diet, and the patient should seek a warm and equable climate. The milk may be taken cold or hot, from a half pint to a pint at a time. Wine, in moderation, may be taken with the food. No depletory remedies should be employed in this stage, except in times of an emergency, when, from some sudden renal congestion, the remaining healthy portion of the kidney is impaired, and active ursemic symptoms present themselves. At such times, a hot air bath, hydragogue cathartics, or stimulating diuretics are to be employed, but with great caution. bright's disease. 297 wm. aitken, m. d. edinburgh. 751. R. Acidi gallici, -•_- Acidi sulphurici diluti, fLg Tincturas lupuli, f'2- Infusi lupuli, f-f . M bS?H°fi°°ful thre- timeS ? da? when the uri^ is « smoky," or when blood is seen on microscopic examination. The objection to these remedies is the constipation they are apt to induce. Two or three movements from the bowels should be secured daily. For this purpose the medicine most generally use- 752. R. Pulveris jalapas compositi, Pulveris zingiberis, 0wa0tnerd08e- T° ^ ^ in the morninS' fasting> ™ a wineglass'of ruivens jalapas compositi, ?8S_; Pulveris zingiberis, Jr ^ M When, by repetition, this loses its effect, and eletarium be not deemed advisable, the following saline draught may prove em- cigh u * 753. R. Magnesias sulphatis vel, Sodas sulphatis, aa ~- •• Athens sulphurici, }#XJ Acidi sulphurici diluti, ™ x Ferri sulphatis, \.•_;• Aquas menthae viridis, f giij-iv M For one dose To be taken the first thing in the morning once'or eTaCcuaati!ns " °Ught t0 pr°d°CetTOor three loose andwate?y When dyspeptic symptoms predominate, the following pill is use- ful (recommended by Dr. Goodfellow) :— 754. R. Ferri sulphatis, _p: Extracti nucis vomicae, er ss-i Pilulae galbani compositae, gr.ij-iij. M For one pill. To be taken twice or thrice daily. If there be co-existent bronchitis, order :— 755. R. Spiritus astheris nitrosi, f siss iii Oxymellis scillas, f"'|sg J Liquoris ammonias acetatis, f.giv# ^ A tablespoonful to be taken immediately with the above pill. If much nausea prevail, add to the prescription:— 756. R. Acidi hydrocyanic! diluti, tiLxxiv. And apply mustard to the stomach. 298 DISEASES OF THE URINARY SYSTEM. For the want of sleep often complained of, henbane should be given instead of opium, which will constipate. 3 If diarrhoea occur, it must not be too suddenly checked. Order:— 757. R. Spiritus ammonias aromatici, __ TinotiiTtp Vino. aa I#3J- Tincturas kino, M. A teaspoonful in water after every loose stool. This in general will be all that will be found necessary. Mercurial preparations are dangerous in Bright's disease, because of the tendency to salivation. The following may be used instead :- 758. R. Podophyllin, # f'fi M Extracti hyoscyami, Sr-J- For one pill. The following is also serviceable as an occasional mild aperient pill:- 759. R. Pilulae rhei compositae, gr.ij—uj Extracti nucis vomicae, gr0. ^ Pilulae galbani compositae, gr-y« For one pill. THOMAS KING CHAMBERS, M. D., ETC., LONDON. 760. R. Tincturae ferri chloridi, f-3y Potassas nitratis, 3'J ,j Aquas camphorae, t-5.iv- A tablespoonful in water thrice a day, and a hot-air bath every night. J. M. DA COSTA, M. D., PHILADELPHIA. For the treatment of an acute case, following scarlatina :— 761. R. Pulveris ipecacuanhas compositi, gr.nj Potassas nitratis, gr,v For one powder. To be taken at night. And, 762. R. Liquoris ammonias acetatis, f-guJ Spiritus aetheris nitrosi, nlxx .. Syrupi tolutani, t^xxxvij Tincturas digitalis, ^"J- "' For one dose, thrice daily. The skin should be made to act freely by means of hot baths and a few drachms of Eochelle salts, administered on alternate days. The diet should be mild and unirritating, all stimulants being avoided. BRIGHT'S DISEASE. 299 763. R. Tincturae ferri chloridi, f-g^ss Acidi acetici, f.gss. Mix and add, Liquoris ammoniae acetatis, f.gv Curacoae, gij. M. Teaspoonful thrice daily. This recipe, a modification of Basham's mixture, is useful in chronic Bright's disease, and in all those cases in which the union of a chronic and diuretic effect is desired. DR. FELIX VON NIEMEYER, PROFESSOR UNIVERSITY OF TUBINGEN. The loss of albumen from the blood being the immediate cause of most symptoms of the disease, the most important task of the physician is to cover the loss of albumen by a diet rich in protein substances and by appropriate medication. Soft-boiled eggs, milk, strong meat broths and roast beef, in as large quantity as the patient is able to digest, are probably the best preventives of the dropsy. Besides this, a moderate quantity of beer or good wine should be prescribed, as by the use of these the waste of tissue is retarded and nutrition promoted. Quinine and iron are the most suitable medicines. Our author has obtained most brilliant results, where all other treatment had failed, by putting the patients upon an exclusive diet of milk. They took no medicine whatever, but drank five or "six pints of cow's milk daily. After the " cure " had been continued in this manner for about five weeks, some of the patients, who, prior to the treatment, had been in the most wretched condition, had got rid of their dropsy, recovered an appearance of health, and regained so much strength as even to be able to per- form hard labor. If the above measures fail in averting or allaying the dropsy* active diaphoresis is strongly to be recommended. Patients in an advanced state of dropsy often rid themselves of it completely in a few weeks by the daily use of a hot bath, of a temperature of 80° to 100° F., followed by sweating for two hours in woolen blankets. Debilitated patients sometimes, however, suffer so much from this treatment as to compel its discontinuance. Whatever the theoretical objections to the employment of diu- retics may be, yet, in desperate cases, recourse should always be had to them. Squills and other stimulating diuretics must not be employed without the utmost caution. But there are certain salts, particularly cream of tartar, which are decidedly beneficial in their 300 DISEASES OF THE URINARY SYSTEM. effects. The free use of buttermilk, conjoined with the employ- ment of cream of tartar and small doses of Dover's powders, will prove serviceable. The drastic cathartics should only be resorted to in cases of extreme need, since the patient is liable to be affected by them, and since, by their persistent use, the digestion becomes impaired. Those most frequently employed are colocynth and 764. R. Elaterii, gr.£-ss. For one dose, as occasion requires. THOMAS HAWKES TANNER, M. D., ETC., LONDON. 765. R. Salacini, gij Glycerinae, f.gj Tincturas aurantii corticis, f-^ij- M. A teaspoonful in a wineglassful of water, night and morning. Often useful in imparting a temporary sense of renovation. So also is, 766. R. Ferri et ammoniae citratis, gss Spiritus vini gallici, f.gj Vini pepsinas, f-gss Aquas, f-gijss. M. One-half to be taken every day at dinner. For the administration of elaterium, when indicated, our author employs the following formulae :— • 767. R. Elaterii, gr.iss Pulveris capsici, gr.lx Hydrargyri chloridi mitis, gr.xij Extracti hyoscyami, gr.xviij. M. For twelve pills. Two to be taken at a dose. The capsicum prevents the nausea which the elaterium often produces. If a very active purgative is required, the dose may be doubled. 768. R. Elaterii, gr.j Spiritus aetheris nitrosi, f-gss Liquoris ammonias acetatis, f.gj Syrupi zingiberis, f-giij. M« One small teaspoonful in a wineglassful of water, every two hours, until the bowels are freely acted on. CYSTITIS. 301 RESUME OF REMEDIES. Elaterium is a useful purgative when there is much dropsy, but it is best to combine it with hyoscyamus, as it sometimes causes exhausting diarrhoea, especially if given after symptoms of urasmic poisoning have set in. Guaiacum, in tincture or decoction, is regarded by Dr. Copland as the best diuretic in Bright's disease, especially when the skin is cool as well as dry. Ipecacuanha, in the form of Dover's powder, (gr.v-viij, thrice daily), is not only a useful diaphoretic in Bright's disease, but also allays pain and irritability, especially if assisted by a warm bath every other evening, or oftener. Potassii Bitartras is recommended as a diuretic by Prof. Niemeyer. Potassii lodidum is said by Dr. Ringer to prove sometimes of signal service, even when the dropsy has been extensive and the urine very scanty. Scoparius, in decoction, combined with nitric ether, is recommended by Dr. Barlow, when the renal secretion is very deficient. A pint of the infusion may be given. Diuretics. Drs. Bright, Osborne, Watson, and others, condemn the use of diuretics, particularly those which are stimulating, in inflammatory dropsy attendant on granular disease of the kidneys. Dr. Chris- tison believes, however, that they can be used without risk, and advises the following formula:— 769. R. Pulveris digitalis, gr.i-ij Potassii bitartras, SHJ- M. Ter in die, ex aq. Diuretics may be sometimes employed, with good^results, by the endermic method. CYSTITIS. PROFESSOR S. D. GROSS, M. D., D. C. LM OF PHILADELPHIA. In the early stages of the complaint the remedies are local and general bleeding, cathartics and diaphoretics, with low diet. When there is no marked biliary derangement, castor oil is the best purgative. When such is present, calomel, either alone or with jalap. After depletion and catharsis, the following "antimonial and saline mixture " seldom fails to relieve the symptoms:— ..!*.. 770. R. Antimonii et potassii tartratis, gr.ijss Magnesias sulphatis, gij Morphiae sulphatis, gr.ij Tincturae veratri viridis, f.giss Acidi sulphurici aromatici, f.gss Zingiberis syrupi, f.gij Aquas, f.gx. M. A tablespoonful every two. three or four hours. 302 DISEASES OF THE URINARY SYSTEM. The action of these drugs may be favored by tepid drinks, warm baths and fermentations. Diuretics should be avoided. If the urine is scanty, a small quantity of nitrate of potassa or spirit of nitrous ether may be given in a demulcent fluid. Fifteen to twenty leeches may be applied to the perineum and verge of the anus. Dry or wet cups to the sacro-lumbar region will relieve the pain in the back. Anodynes by the rectum are very valuable, as:— 771. R. Pulveris opii, gr.iij Butyri cacaonis, q. s. M. Mix thoroughly for a suppository. Or a drachm of laudanum in f Jij of tepid water may be thrown up with a syringe having a long nozzle after the lower bowel has been washed out. Chronic cystitis, or catarrh of the bladder, demands an unirritant, farinaceous diet, without condiments, acids, or spirits, in any form. Exposure to cold must be carefully avoided. The acrid remaining urine should be drawn off, and pain and sleeplessness may be al- layed by the following suppository:— 772. R. Pulveris opii, gr.ij Pulveris camphorae, gr.v «, Extracti belladonnae, gr.ss Butyri cacaonis, q. s. M. Make one suppository. A particularly serviceable recipe where there is a morbid irrita- bility of the neck of the bladder is the following:— 773. R. Uvae ursi folia, giss Humuli folia, gss. Infuse in a quart of water, in a covered vessel, for two hours, and add: Sodas bicarbonatis, gij Morphiae sulphatis, gr-ij- M- Of this a wineglassful is to be taken five or six times a day. In ordinary cases no remedy equals the balsam of copaiba, as follows:— • 774. R. Copaibas, f.gj Morphiae sulphatis, gr.ij Pulveris acaciae, ^jj Sacchari alba, zjj Olei gualtherias, gtt.x Aquas, f.gvj. M. A teaspoonful to a dessertspoonful three or four times a day. CYSTITIS. 303 DR. G. W. SIMPLE, OF VIRGINIA. In the Virginia Medical Monthly, June, 1876, this writer records striking success in cystitis with:— 775. R. Atropias sulphatis, gr.j Acidi carbolici, gtt.xij Aquas destillatae, f.gviij. M. Forty to sixty drops of this in half an ounce of water as a rectal injec- tion, twice a day. It uniformly and immediately arrests the frequent strangury and painful micturition, gradually checks the mucous and sanguineous discharges, and relieves the supra-pubic pain with the cystic in- flammation. When the urine is alkaline, Mettauer's nitro-muriatic acid mixture is given to correct it; and when it is so acid as to irritate, the acidity is corrected by antacid remedies, of which the bicarbonate of potash, with subnitrate of bismuth, is generally pre- ferred, because of the tonic effect of the bismuth, and its very soothing effect on the mucous surfaces of the urinary organs. PROFESSOR ROBERT DRUITT, M. D., SCOTLAND. 776. R. Decocti chimaphillas, f.gj Syrupi zingiberis, Spiritus aetheris nitrici, aa f.gj. M. For a dose. Twice a day in chronic cystitis. PROF. RICORD, PARIS. 777. R. Argenti nitratis, Sr^vy Aquas destillatae, f.giijss. M. By the aid of a sound introduced into the bladder, water is in- jected into this organ; this is allowed to pass out immediately, and replaced by the half of the above solution, which, in its turn, is evacuated after about a minute's sojourn. This injection is to be repeated on the third or fourth day, if necessary, in chronic cystitis. 778. R. Extracti belladonnae, gr.v Extracti Valerianae, gj. M. Divide into thirty pills. One thrice daily, in chronic cystitis, when the patient supports opium badly ; also belladonna suppositories. 779. R. Opii pulveris, 9ij Camphorae pulveris, £r,xv Saponis, 9 vss. M. Divide into sixty pills. One thrice daily, in acute cystitis. 304: DISEASES OF THE URINARY SYSTEM. LOCAL INTERNAL TREATMENT. Injections into the bladder are sometimes used in chronic cystitis. When all acute symptoms have subsided, tepid water, or, still better, tepid urine, may be employed, retained for thirty or forty seconds and repeated once or twice a day; or the following medi- cated injections may be resorted to :— Argenti nitras, gr.i to f.giv of warm water, to commence with, and going up to gr.ss or gr.j, at the outside, to the ounce. Carbolic acid, mj-ij to f.giv of warm water, when the urine is offensive. Nitricum acidum dilutum, ny-ij to f.gj of warm water. Plumbi acetas, gr.j to f.giv of warm water once a day, when the urine is alkaline and depositing phosphates. Potassse chloras, gr.iv-v to f.gj of warm water, when the urine is putrid. Sodse biboras is recommended by Sir Henry Thompson in the following formula:— 780. R. Sodas biboratis, gj . Glycerinae, f-Sy- M- Add two or three teaspoonfuls to f.giv of warm water. In administering injections into the bladder the following rule given by Sir Henry Thompson should be carefully observed:—A flexible catheter being first introduced into the bladder, "have ready a five-ounce india-rubber bottle with a brass nozzle and stop- cock, the nozzle long and tapering, so as to fit a catheter of any size between Nos. 5 and 10, filled with warm water, say at 100° F.j attach the nozzle gently to the catheter and then throw in slowly a fourth of the contents; let that run out; it will be thick and dirty, no doubt; then inject another fourth, which will be less so; again another, which will return clearer than the preceding; and the fourth portion will probably come away nearly clear. Now these four separate washings of an ounce each will have been really more efficient than two washings of four ounces each, and you will have reduced the amount of instrumental irritation to a minimum. . . . Never, under any circumstances, throw in more than two ounces at a time, and even this quantity, for efficient washing, is better avoided." Dr. Braxton Hicks advises that the point of the catheter, in giving an injection, should not pass far beyond the neck of the bladder, otherwise, if it touches the sides or back, it occasions great distress. cystitis. 305 DR. MALLEZ, PARIS. 781. R. Sodii hyposulphitis, 9iv Aquas destillatae, Oj. M. This solution to be employed in five injections into the bladder, in chronic vesical catarrh. 782. R. Potassii permanganatis, 9ij Aquae destillatas, fgx. M. Inject one-third of this solution into the bladder, in chronic catarrh, when the urine is purulent. 783. R. Tincturas iodinii, ^ij Potassii iodidi, gr.xv Aquas destillatae, f-gx. M. Inject one-third into the bladder, on threecons ecutive days, in chronic cystitis, with light mucous catarrh. If this injection causes pain, use the following:— 784. R. Tincturae iodinii, tt\,xv Potassii iodidi, Extracti belladonnae, aa gr.xv Aquas destillatae, f.gx. M. One-third to be injected as above. 785. R. Potassii iodidi, Qiv Extracti hyoscyami, Extracti conii, aa gr.v Butyri cocoae, 9iv. M. For one suppository. To be introduced into the rectum in engorge- ments and hypertrophy of the prostate. RESUME OF REMEDIES. Ammonice Benzoas is recommended by Dr. Garrod, where a tendency to phosphatic deposit exists. Benzoicum Acidum is advised by Sir Henry Thompson in chronic cystitis. It should be administered in the form of a pill (gr.iij-iv, with glycerine), and not less than gr.xxiv taken daily. Buchu, in the form of infusion, given to the extent of half a pint daily, has proved of service in the hands of Sir Henry Thompson. Colchicum is of value in the cystitis of rheumatic and gouty subjects. It may be either given alone or in connection with pareira brava or buchu. It is indicated, according to Sir Benjamin Brodie, when the urine is alkaline. Copaiba, alone or combined with cubebs, is useful in relieving intense irrita- tion, particularly in persons of a strumous diathesis or debilitated constitution. Sir Henry Thompson states that the dose in these cases should not exceed ttb.v, in mucilage, three or four times a day. Cubeba, given cautiously, in small doses (gr.x-xv, thrice daily), is recom- mended by Sir. Benjamin Brodie as often useful in relieving the symptoms, both in primary inflammation and in that resulting from the presence of a calculus in the bladder. Ferri Chloridi Tinctura has been employed, when persevered in, with ad- vantage, by Sir Benjamin Brodie, in doses of TT\,.viij-xv twice a day, in water or an infusion of buchu. 20 306 DISEASES OF THE URINARY SYSTEM. 786. R. Pulveris opii, gr-y-iv Extracti hyoscyami, gr.x-xv. iu. This should be preferably exhibited at the hour of sleep, and usually secures a s"ate of enviable comfort for twelve or sixteen hours. Sir Senry Thompson employs a suppository of morphia (gr.BB-j). action. He gives the following formula :— 787 R. Pareiras bravas radicis, I?s Aquas, ad. Onj. ..... Simmer over the fire until reduced to Oj. Dose-f.gvnj-xy daily. Tincture of hyoscyamus may be added, and where there is a deposit of the phosphates, hydrochloric or nitric acid. terebinthince Oleum, in the form of hot epithems over the hypogastric region, is highly serviceable. Triticum Repens, in decoction, is highly spoken of by Sir Henry Thompson and Dr. Graily Hewitt. Uvce TJrsi Folia, in decoction, Oss daily. DIABETES. WILLIAM AITKEN, M. D.. EDINBURGH. The whole materia medica has been exhausted in search of a remedy for this disease. It may be said nearly every patient dies whose treatment is left entirely to drugs. A full and generous diet is unquestionably useful in these cases; but the patient soon gets disgusted with mutton or beef, or both, for breakfast, dinner and supper: he consequently nauseates a meat diet, and abandons it altogether. A diet of salt fish has been attempted, but the pa- tient in a short time so loathes it that it has to be given up. A mixed diet, therefore, if contra-indicated by some theories, is at least the best to adopt in practice, if only regulated and aided by other means. It will be evident, however, that vegetables^ which contain a large amount of saccharine matter should be avoided in some degree, as potatoes, grapes, or other very ripe fruit, and a fortiori, sugar itself. But milk and eggs may be taken, if biliary diabetes. 307 derangement is not induced by them, and fish is a most important article with which to vary the monotony of the dietary. Milk also may be indulged in occasionally, as it is not found that the sugar it contains is readily converted into glucose. Its influence, however, requires watching. It should be combined with half its bulk of lime-water, or be used in the form of buttermilk. If it be found desirable or necessary to employ alcoholic drinks, a selection should be made from those wines and spirits which are freest from sugar. Of these, clarets may be chemically considered the best, then Burgundy. The so-called "fruit wines" must be interdicted, and of all alcoholic beverages, weak brandy-and-water is the safest. The amount of brandy should always be measured. A teaspoonful in a tumblerful of water is generally sufficient for an ordinary din- ner drink. No diabetic need expect to recover or continue well who cannot exercise self-control, and make up his mind to be tem- perate in all things. Tea and coffee without sugar may be per- mitted. If cocoa agrees, it may be taken, prepared from the nibs only. When soups are allowed, they ought to be really good, and flavored with aromatics and onions, to the exclusion of carrots, tur- nips and peas. They may be thickened with some bran, finely powdered. Pickles in small quantities may be permitted to conva- lescents. Lettuces agree well when eaten sparingly with oil and vinegar, or with a little salt only, if the vinegar is likely to dis- agree. The great value of bran cakes, as a substitute for bread in cases of diabetes, has now been established by the experience of so many individuals that its use ought to be insisted upon. The bran should be thoroughly washed, so that it may be as free from starch as pos- sible, and finely powdered, so that it may not irritate the suscep- tible mucous membrane of the intestines. GEORGE W. BALFOUR, M. D., M. R. C. P., ETC. Our author highly recommends the milk treatment in diabetes. This treatment does not exclude the employment of opium, of iron, or quinine, or any other remedies otherwise considered appropriate to such cases; indeed, they maybe very properly conjoined: in some patients they need not be given, because not required. From two to three months is the period usually stated as sufficient to cause the complete disappearance of sugar from the urine; and then the diet may, if desired, be rendered more solid by the detraction 308 DISEASES OF THE URINARY SYSTEM. of some of the milk, and the addition of butcher's meat and green vegetables. It is doubtful, however, whether diabetic patients, even though apparently cured, can ever return to ordinary diet. Present experience of such cases is too limited to afford any data at all in regard to this. When the milk diet is employed in the cure of other forms of ill-health, it is often conjoined, after the first few days, with a small amount of solid food; and what such patients relish most is plain bread with salt, or a salt herring, the mawkish sweet taste of milk inclining them this way. In diabetes, the thirst present usually make3 it better to give the patient his full allow- ance of milk, and let him divide it over the day as he pleases. A. BOUCHARDAT, PROFESSOR OF HYGIENE TO THE FACULTY OF MEDI- CINE, PARIS, ETC. Our author has proved, by the comparison of the articles of food which a diabetic may take without prejudice, that it is quite possi- ble to keep up a sufficient degree of variety in the character of the meals. The list of articles which it permits is about as follows: All sorts of meat, roasted, stewed, and even dressed with spices, but not with flour; fresh-water fish and marine fish, in eating which the want of bread is less felt than in eating meat; oysters, muscles, crabs, lobsters, etc.; eggs in all forms known to the culinary art; rich, good cream, but no milk; of vegetables, spin- nach, artichokes, asparagus, green beans, the different varieties of cabbage; of the salads, water-cresses," endives, lettuce; of fruits, strawberries and peaches. Although the loss of sugar is aug- mented by a very free supply of liquid, and decreased by a priva- tion of it, yet it is not advisable to forbid the patient to quench his thirst. THOMAS KING CHAMBERS, M. D., ETC., LONDON. 788. R. Pulveris opii, gr.j. In pill. To be taken every night. In some cases opium seems to diminish the secretion of water, and our author has never distinctly traced any harm to its action. Cinchona, however, which, like opium, lessens the flow of 'irine, has, in Dr. C's hands, produced coma and death. He therefore shuns it, even when he wishes to give tonics to increase the appe- tite. He prefers iron and strychnia. 789. R. Potassii iodidi, ;\v Aquas, f.gvj, M. A tablespoonful three times a day. DIABETES. 309 This drug was prescribed on purely empirical grounds. Dur- ing its administration the patient continued to gain weight and strength, and did not exhibit any of the usual symptoms of intoxi- cation by iodine. , Patients may drink as much as they feel disposed; for the grati- fication of the thirst provides the normal outlet for the abnormal constituent of the blood. J. M. DA COSTA, M. D., PHILADELPHIA. 790. R. Pulveris opii, gr.ss. For one pill, thrice daily. The opium treatment, Dr. Da Costa has found to be productive of the most good in his hands. He cannot explain the rationale, but he does know that it has the most influence in lessening the thirst, the excretion of sugar and the general waste of flesh. °The only objection to its use is the risk which is run of accustoming the patient to taking this powerful drug. 791. R. Ammonias carbonatis, Sij-iv Aquas cinnamomi, f-gvj. M. A tablespoonful three or four times a day. This, in addition to a moderately restricted diet, forms a very good treatment. 792. R. Tincturas ferri chloridi, gtt.xx-lx. For one dose, in water, thrice daily. This will often do good when nothing else proves of service. The pepsin and rennet treatments amount to nothing. Dr. Da Costa has tried them faithfully, and merely lost time. Diet.—Although substances containing a great deal of sugar, and still more those containing a great deal of starch—which is readily converted into sugar—are poisonous to diabetic patients, yet it is not advisable to put them on a strictly animal diet. Such a regimen is irksome in the extreme, and will not be followed out. After all, it is not the saccharine substances which go into the body that cause diabetes; they merely add to it. It is simply impossible to avoid giving food capable of being converted into sugar. Bran bread is perfectly unobjectionable; but a small quantity of ordinary bread should be permitted. Cakes made from almond- flour are favorites with English physicians. Fruits should be in- terdicted, and potatoes sparingly used. Bran baths (two or three handfuls of bran in the bath) are very 310 DISEASES OF THE URINARY SYSTEM. serviceable in relieving the dryness of the skin, which is so trouble- some. 793. R. Infusi cascarillas, Oj. A wineglassful three or four times a day. The use of this light bitter lessens the thirst. Of course, water must be allowed beside; but the infusion will take the place of a good deal of water. THOMAS HAWKES TANNER, M. D., F. L. S., LONDON, ETC. 794. R. Ferri ammoniae citratis, 3j Spiritus ammoniae aromatici, f-3vj Potassas bicarbonatis, 3ij Infusi calumbas, q. s. ad. f.giij. M. A tablespoonful to be taken twice a day, with one tablespoonful of lemon juice, in a little water. This recipe often proves very valuable. It should be taken for two or three weeks at a time, then discontinued, and recommenced according to the general strength. 795. R. Pulveris opii, Quiniae sulphatis, aa gr.j. M. For one pill, thrice daily. Useful in some cases. 796. R. Creasoti, lr^xx Pulveris aromatici, 9iv Mucilaginis acaciae, q. s. M. Divide into twenty pills. One to be taken three times a day. It is believed that this remedy tends to check the conversion of the food into sugar. DR. J. HOAG, INDIANA. This writer claims, in the Journal of Materia Medica, Septem- ber, 1874, to have achieved uniform success with the following treatment:—The patient is forbidden all fruits and vegetables save bread of unbolted wheat flour, and this in the most limited quanti- ties. Tea, coffee, liquors, and all drinks except pure water and milk diluted with lime-water, at meals, are also forbidden. The diet should be fresh meats, cream, cheese, butter, soft eggs, fish, oysters and small quantities of bran bread. The entire body is sponged daily with an alkaline bath, and the following ordered:— DIABETES. 311 797. R. Antimonii sulphurati, 9j Pulveris ipecacuanhae et opii, Qij Ammoniae carbonatis, 3j Pulveris opii, gr.x. M. Make twenty powders. One to be taken morning and night. Also, 798. R. Tincturas cinchonae, f.gij Tincturas ferri chloridi, f-.^iv Tincturae digitalis, f.^j Spiritus lavandulas compositi, f.gj. M. A teaspoonful daily, at noon. DR. ORSON MILLARD, MICHIGAN. 799. R. Tincturas ferri chloridi, f.gij Olei morrhuas, f-giv Acidi carbolici, f.giss. M. A teaspoonful before each meal. Said by this writer (Michigan Uni- versity Medical Journal, January, 1872) to bring about the disap- pearance of the sugar promptly in uncomplicated cases. RESUME OF REMEDIES. Ammonice Carbonas is regarded by Dr. Barlow (Guy's Hospital Reports, vol. x), in doses of gr.v-viij, with a few drops of tincture of opium, in a light bitter infusion, every six hours, as a most efficient remedy. Animal food, together with cruciferous vegetables, as greens, broccoli, turnip tops, etc., should, at the same time, be freely taken. Ammonia; Citras, conjoined with the use of Dover's powder or ipecacuanha, is considered by Dr. W. Prout as one of the best of diaphoretics in diabetes. Ammonice Phosphas is recommended by Dr. Basham (British Medical Jour- nal, April 10th, 1869), combined as follows:— 800. R. Ammonias phosphatis, Ammoniae carbonatis, aa, gr.x Spiritds ammoniae aromatici, TH,xxx Aquas, f.gj. M. Add this to the juice of a fresh lemon, and order to be taken thrice daily. Its use must be persevered in. Codeia is preferred by Dr. F. W. Pavy (Guy's Hospital Reports, 1870) to opium and morphia, as being equally effectual in controlling the dis- ease without exerting the same narcotic effect. The proper com- mencing dose is gr.ss thrice daily, which may be gradually increased to gr.ij-iij. Creasote has been recommended by Sir T. Watson and Dr. T. H. Tanner. Ferrum, in various forms, as a tonic. "Ipecacuanha; Pulvis Compositus is a useful remedy, highly recommended by Dr. W. Prout, in combination with full doses of reduced iron. "Opium has been found by Prof. Da Costa a most efficient remedy in his 312 DISEASES OF THE URJNARY SYSTEM. hands, and is regarded by Prof. F. W. Pavy as superior to all other medical agents in its controlling influence over the disease, none other giving the same immediate and striking effects. It should be given in full doses and persevered in, diabetic patients being very tolerant of its use. It produces its best effects in old cases occurring in the aged. Phosphoric Acid, largely diluted, lessens the inordinate thirst more effectually than any other acidulated drink. Rheum is praised by Dr. Copland, not only as a useful aperient in diabetes, but as a promoter of the digestive and assimilative processes. Sodce Phosphas is regarded by Dr. W. Prout as one of the few saline purga- tives admissible in this disease. DROPSY. FREDERICK T. ROBERTS, M. D„ M. R. C. P., LONDON. This esteemed authority remarks that far too little heed is usually given to the question of rest and position in the treatment of dropsy. The part affected should be maintained in an elevated posture; the legs, for instance, if anasarcous, placed higher than the body. Pressure should be applied by bandages or adhesive strips, and is a very valuable adjunct. All external dropsical parts should be kept clean and dry. A decided diminution of drinks and liquid articles of food is adapted to dropsical accumulations in serous cavi- ties. The only diaphoretic he considers of much practical value is some form of bath which promotes perspiration, such as the warm, vapor, hct-air, or Turkish bath. They are most valuable in renal dropsy. The best purgatives are extract of elaterium (gr.|, gradu- ally increased to gr.ss), jalap (Bj to 3j), and cream of tartar (3j to jij). For a diuretic, the following:— 801. R. Extracti elaterii, gr.v Pulveris scillae, gr.xx Pulveris digitalis, gr-xx Extracti hyoscyami, gr.xxx. M. To make twenty pills. One to be given every other night. C. MURCHISON, M. D., F. R. S., ETC., LONDON. 802. R. Pulveris scillae, gr.iss Pulveris digitalis, gr.ss Pilulas hydrargyri, gr.ij. M. For one pill, two or three times a day. This is a pill which has enjoyed a long and merited reputation for treatment of dropsy in the Middlesex Hospital. DROPSY. 313 Diuresis will also sometimes be induced by fomenting the ab- domen with an infusion of digitalis of about four times the usual strength. 803. R. Potassas acetatis, „r xx Spiritus aetheris nitrosi, f zss Decocti scoparii, f.f iss To be given with each dose of the above pills. f.giss. M. At the same time, an ointment composed of equal parts of blue ointment and ointment of belladonna is to be applied over the ab- domen. This treatment is a successful one in cases of ascites due to cirrhosis. ROBERT J. GRAVES, M. D., DUBLIN. 804. R. Potassii nitratis, Potassii carbonatis, aa zj Tincturas scillae, Tincturae digitalis, aa gr.xxx Melhs despumati, f ?jj# M For an electuary. To be taken in teaspoonful doses,'in 'the course'of wTorWs&ops^" t0 1DCrea8e the aCtIvity °f the kid^8> in 805. R. Oxymellis scillae, f.5iss Potassii bitartratis, g'iij ^j Dose—A teaspoonful, as a diuretic, in various forms of dropsy. DR. GUIBERT, PARIS. 806. R. Tincturas scillas, Tincturas digitalis, Tincturae colchici, aa f.ziij Linimenti camphorae, f zvj Aquae ammonias, i^a. M To be rubbed well into the abdomen and thighs in dropsy. DR. PORCHER, PARIS. 807. R. Sodii sulphatis, Potassii bitartratis, aa 5j Spiritus aetheris nitrosi, f zijSg Syrupi, f-f-J. * * v, 27' - **™- M- A tablespoonful twice daily, in dropsy accompanied with an active, full circulation. It procures an abundant alvine evacuation, and often, at the same time, a copious secretion of urine. 808. R. Tincturas cantharidis. f ?-lsa Spiritus aetheris nitrosi, fVv; Syrupi aurantii corticis, f Sj Aquas fosniculi, f-gviij. M. A tablespoonful two or three times a day, in different forms' of dropsy. 314 DISEASES OF THE URINARY SYSTEM. PROF. A. GUBLER, FACULTE DE MEDECINE DE PARIS. 809. R. Tincturas digitalis, Extracti ergotae fluidi, aa f.^ss Acidi gallici, Bj Potassii bromidi, 3ij Aquas lauro-cerasi, f.^ij Syrupi, f-giij Oxymellis scillas, f-^iv. M. A tablespoonful in water, or a diuretic infusion, two or three times a day, in various forms of dropsy. 810. R. Scillae pulveris. Digitalis pulveris, Scammonii, aa 9iv Syrupi, q. s. M. Divide into one hundred pills. From one to five a day, in various forma of dropsy. ST. MARY'S HOSPITAL, LONDON. 811. R. Elaterii, gr.iss Extracti hyoscyami, Extracti gentianas, aa. gr.ix. M. Divide into ten pills. From one to three as a drastic purgative in certain forms of dropsy. HENRY WILLIAM FULLER, M. D., LONDON. 812. R. Scillas pulveris, Digitalis pulveris, aa J)j Potassii nitratis, 3v. M. Divide into fifteen powders. One or two a day, in various forms of dropsy. 813. R. Potassii sulphatis, Potassii bitartratis, Potassii nitratis, aa, giss Digitalis pulveris, gr-xv. M. Divide into twenty powders. From one to three a day, in osdema of the lower limbs. Repeated purgatives. DR. W. R. BASHAM, LONDON. 814. R. Liquoris ammoniae acetatis, f.gj Acidi acetici diluti, f.^ijss Tincturas ferri chloridi, f-3j-ij Aquas, f-gviij. M. Mix the acetate of ammonia and acetic acid first; then add the iron. The resultant should be of a bright sherry-red color. Dose—Two tablespoonfuls three or four times daily. This is the original " Ba- sham's mixture," which has stood the test of the fullest experience. DIURETICS AND CATHARTICS. Diuretics are of much service in dropsical affections. In passive dropsies they may be combined with tonics and mild stimulants. DROPSY. 315 Their operation is greatly aided by previous depletion, if the patient be not much debilitated. Dr. J. Hope finds diuretics of the highest service in dropsy connected with disease of the heart, especially when accompanied by a scanty secretion of high-colored urine. He recommends particularly in these cases, digitalis, squills and acid tartrate of potash. The dyspnoea, palpitation and cough decrease as the quantity of the urine increases. In inflammatory dropsy attendant on granular disease of the kidneys, the use of diuretics, particularly those of a stimulating character, is generally condemned. The administration of diuretics by the endermic method is sometimes effectual in removing dropsies. The diuretics usually employed in the treatment of dropsies are digitalis and digitalin, sweet spirits of nitre, juniper, acetate of potash, nitrate of potash, cream of tartar, squills, broom tops. The following for- mulae have been recommended:— 815. R. Digitalin, gr.f Pulveris scillas, Pulveris scammon., aa gr.lxxv Mucilaginis, q. s. M. Make one hundred pills. Of these two, then four, and lastly, six are to be given daily, according to the effect produced. 816. R. Potassas nitratis, 3"j Baccar. juniper., 3XV Vini alb'i, Oiss M. Dose—f.giss daily. 817. R. Potassas bitartratis, Juniper baccar. contus., aa gss Aquas ferv., Oj M. This infusion is considered by Prof. Stille to have few superiors in the idiopathic forms of general dropsy. 818. R. Scoparii (seeds), gij Alcoholis, f-^viij. M. Macerate for ten days. Dose—f-3j-ij thrice daily. If it cause diarrhoea, five or six drops of laudanum may be added; if the patient is much debilitated, iron or quinine may be added. This formula is of service in all forms of dropsy excepting ovarian. Cathartics, particularly elaterium, gamboge and cream of tartar, are of great service in dropsical affections, but they are to be used with great caution when the patient is nearly debilitated, and, as a rule, to be avoided in dropsy connected with heart disease. Dr. 316 DISEASES OF THE URINARY SYSTEM. Christison recommends gamboge in doses of gr.v-vij, every other day, finely powdered and combined with cream of tartar as a cer- tain and easily managed cathartic in reducing dropsy. Colocynth may be employed in dropsical affections connected with disease of the liver, but is inferior to elaterium. Croton oil is sometimes useful when given with great caution in small and only gradually increased doses, but is inadmissible if the patient is old or debilitated. Elaterium is a very efficient cathartic in dropsy, anasarca and oedema arising in connection with disease of the heart. Dr. J. Hope gives it in the form of a pill, in the dose of gr. J—|, combined with capsicum, to prevent griping, and with a grain of calomel, to prevent its emetic effects. One of these pills should produce six or eight watery evacuations, and may be repeated two or three morn- ings in succession, or every second or third morning, according to the patient's strength. The dose of elaterium may be carried, with caution, to two grains. The effects of this remedy, according to Dr. Hope, are sometimes truly astonishing, removing an extreme uni- versal anasarca in three or four days, but as it is apt to be violent in its operation, it should be given to strong subjects only. The following formulas are also valuable :— 819. R. Elaterii, gr.ij Extracti gentiani, gr.xx. M. Divide into four pills ; order one every hour till it causes free evacua- tions. Repeat every two or three days for a fortnight, and then sus- pend for a short time. 820. R. Elaterii, gr.j Extracti colocynthidis compositi, gr.xl Extracti hyoscyami, gr.xij. M. ■ Divide into twelve pills. Take one every night. 821. R. Pulveris jalapas compositi, gr.xx-xxx Potassas bitartratis, gr.v-x--xv Olei carui, gtt.ij Aquas, f.giss. M. For one dose, to be repeated, so as to keep up an unremitting discharge from the bowels. This formula is recommended by Dr. Chapman. RESUME OF REMEDIES. Ammonice Murias and Benzoas are useful in dropsy dependent upon hepatic disease, and also in ovarian dropsy. Dr. Copland recommends these combinations with warm diuretic effusions. Armoracice Radix. Horse-radish was much employed as a diuretic by Syden- ham and the older physicians, in dropsical affections. DROPSY. 317 Cannabis Indica has been used (Tt^xx of the tincture every four hours) as a diuretic in dropsy. "Digitalis is much employed in dropsical affections, alone or combined with squills, mercury, carbonate of ammonia or tincture of the chloride of iron. Sir II. Holland recommends a combination of digitalis and tincture of the chloride of iron in the dropsy following scarlet fever. The same combination is useful in many other forms of dropsy attended with anasmia. Diuresis is sometimes induced by the exter- nal application of digitalis to the abdomen, either by fomentation with an effusion of about four times the usual strength, or by fric- tions with an embrocation of equal parts of tincture of digitalis and soap liniment, or by poulticing with a warm linseed poultice, to which a fluid ounce of the tincture has been added. Ferri et Potassii Tartras has been found useful as a tonic and diuretic in cases of anasarca connected with disturbed action of the heart, in which it would be dangerous to give any stimulating tonic. Phosphoricum Acidum Dilutum, diluted with oil and acid as an embrocation over the abdomen, has been employed with benefit in some cases of dropsy. Rheum, in small doses, or in infusion as a vehicle for the saline diuretics, squills, juniper or colchicum, is regarded by Dr. Copland as a useful medicine in dropsies. Sinapis is sometimes beneficial, because of its diuretic and stimulant qualities. It is best given in the form of whey, made as follows :— 822. R. Bruised mustard seeds, gss. M Boil in Oj of milk and strain. The whole to be taken daily in divided doses. Terebinthince Oleum, in doses sufficient to act freely on the bowels and kidneys, is occasionally useful in ascites, unconnected with renal disease or with great gastric irritability or inflammatory action. Acupuncture is sometimes a useful palliative in anasarca, the needles not Toeing introduced more deeply than to pierce the cutis. Calcii Chloridum has been found serviceable in ovarian dropsy. Ferri lodidum is favorably reported upon by Dr. Copland, who conjoins with its internal use the external application of iodine to the inner sides of the thighs, or over the abdomen. Iodine, employed in the form of injections into the ovarian cysts in cases 0/ ovarian dropsy, is a form of treatment in regard to the safety and propriety of which there is much discussion in the profession. The experience of Dr. West and Sir J. T. Simpson is in favor of the operation, but Dr. Tyler Smith reports adversely. 318 DISEASES OF THE URINARY SYSTEM. HEMATURIA. DR. CHARLES HORION, PARIS. 823. R. Ergotae pulveris, gr.xv Acidi tannici, Kr-"j Digitalini, gr.$. M. Divide into ten pills. Give five a day, in hasmaturia. Prolonged cold injections into the bladder, cold compresses to the perineum and pubis. DR. W. LANGE, ERLANGEN. 824. R. Extracti ergotae fluidi, rn„xxv Acidi tannici, gr.xxx Aquas destillatae, f.gvj Syrupi, f-gj- M. The whole to be given in tablespoonful-doses, in the course of the twenty-four hours, in haematuria. Cold compresses to the hypogas- trium, ice by the mouth, cold enemata. PROF. S. D. GROSS, M. D., D. C. L„ PHILADELPHIA. 825. R. Olei terebinthinae, Acidi sulphurici diluti, aa f.^j Acidi gallici, gr.xxx Mucilaginis acaciae, f.gss Aquas, f.gj. M. A dessertspoonful every three hours. In all cases ice to the hypogastrium and in the rectum or vagina is serviceable; rest in the recumbent posture, the pelvis elevated, and the room cool, are important accessories. RESUME OF REMEDIES. Alumen injected into the bladder, in a solution of the strength of gr.xx to aquas Oj, sometimes arrests the discharge in haematuria after the failure of ordinary remedies. As an internal remedy in hasmaturia, alum is less effectual than gallic acid. Argenti Nitras, in very weak solution, injected into the bladder in haematuria arising in connection with vesical tumor, is recommended by Sir H. Thompson. Ferri Chloridi Tinctura, in doses of rr\yx--xx, several times a day, is a valuable remedy in hemorrhage from the bladder. * Gallicum Acidum, alone or combined with sulphuric acid, opium or digitalis, is an excellent astringent in hasmaturia. Dr. W. Brinton recom- mends the following formula:— 826. R. Acidi gallici, gr.x Acidi sulphurici diluti, n\x Aquas, f.gj. M. For one dose. INCONTINENCE OF URINE. 319 "Ipecacuanha is a valuable remedy in hasmaturia. It should be given in the manner recommended for hasmoptysis. Krameria, in scruple doses of the extract, is highly commended by Sir T. Watson, after all ordinary remedies have failed. "Matieo, in infusion, doses f.gij every two or three hours, is regarded by Sir II. Thompson as equal to gallic acid or lead in haematuria. "Plumbi Acetas, in doses of gr. ij--iv, combined with gr.ss-j of opium, is a well-known and effectual remedy. Tannicum Acidum, in the form of a pill, is an effectual astringent in hemorrhage from the bladder. Terebinthince Oleum is employed with benefit where there is debility, relaxa- tion and anaemia. Prof. Bartholow commends the following formula:— 827. R. Olei terebinthinae, f.giij Extracti digitalis fluidi, f.gj Mucilaginis acacias, f-gss Aquae menthae piperitas, f.gj. M. A teaspoonful every three hours.' INCONTINENCE OF URINE. DR. BRUGELMANN, COLOGNE. Our author relates {Berliner Klinische Wochenschrift, Feb- ruary 10th, 1873) a case of well-marked incontinence of urine in a girl aged thirteen, very nervous, and distinctly anaemic, where the administration of syrup of iodide of iron afforded marked relief in eight days. After persevering with it for another fortnight, she was completely cured. PROFESSOR S. D. GROSS, OF PHILADELPHIA. In the nocturnal incontinence of children, there should be a bland and unirritant diet, late suppers should be avoided, no drink taken after supper, and the bladder emptied on retiring. The po- sition in bed should be upon the side or belly, to prevent the urine from irritating the neck of the bladder. The internal remedies of most use are as follows:— 828. R. Strychniae, gr.j Pulveris cantharidis, gr.ij Morphiae sulphatis, gr.iss Fern pulvis, 9j. M. Make forty pills. Give one three times a day to a child ten years old. The cold shower-bath once or twice a day is a valuable auxiliary. 320 DISEASES OF THE URINARY SYSTEM. NEPHRITIS. ALFRED L. LOOMIS, M. D., OF NEW YORK. Incipient nephritis, or active renal congestion, can, in most cases, be speedily relieved by the following treatment:—First, place the patient in bed, in a room with a temperature above 75° Fah., then apply a dozen dry or wet cups over the lumbar region. Let the patient drink freely of diluent drinks, and administer one or two drastic purgatives. Induce moderate diaphoresis, and avoid care- fully all stimulants. In passive renal congestion, which is generally associated with some cardiac disease, digitalis is the most serviceable remedial agent. RESUME OF REMEDIES. Belladonna is recommended by Dr. J. Harley in acute nephritis. Colchicum, conjoined with magnesia, is useful in the nephritis of gouty sub- jects. Opium is a remedy of great value, when assisted by diluents, the hip-bath, and large flaxseed poultices over the lumbar region. "Baths. The hot bath, or the hot hip-bath, is a useful soothing remedy. Enemata of three or four quarts of water, at blood heat, will, it is said, some- times cut short an attack of nephritis. The first injection usually brings away with it much fecal matter; the second, to be given im- mediately after the return of the first, is usually retained without difficulty. "Poultices. Large light flaxseed poultices not only afford present relief, but arrest the progress of the disease. SABULOUS DEPOSITS (GRAYED. SIR HENRY THOMPSON, F. R. C. S., ETC., LONDON. This distinguished surgeon delivered some lectures in 1873 on the preventive treatment of calculous disease, and as nineteen out of twenty stones are urates, his especial question was, " How to prevent uric-acid calculus ?" He condemns reliance on diuretics and strongly alkaline waters, such as Vichy. At the bottom of the tendency to uric acid production there often lies inactivity of "the liver. For this, nothing is so valuable as the saline mineral waters, as Piillna, Friederichshalle, Marienbad, Carlsbad or Fran- SABULOUS DEPOSITS. 321 zensbad (in the order of their strength). These waters should be given, from three to ten ounces, with half the quantity of hot water, before breakfast. In regard to diet, the patient should eschew alcohol, saccharine and fatty articles. Butter, cream and pastry are included in the last mentioned. Fresh, green vegetables may be taken freely, but not sweet fruits, as grapes, pears and plums. All medicinal agents, secret or professional, are solutions of lime, soda or potash, alone or combined. Of all these, the citrate and the bicarbonate of potash are preferred by our author. The former may be taken in doses of gr.xl to gr.l, every three or four hours, in aquae f.giv. The following conditions are essential to success; certainty that the stone is uric acid and of small size; that the urine is acid, and never ammoniacal. 829. R. Potassas bicarbonatis, 3xij Acidi citrici, gr.viij--xxiv Aquae, ad. f.gxij. M. One or two tablespoonfuls in a glass of water, thrice daily. Each ounce contains 3j of citrate of potassa. DR. VENABLES, LONDON. 830. R. Sodii boratis, gr.vij Sodii bicarbonatis, gr-ix Syrupi aurantii corticis, f.giss. M. To be taken during the day, in soda-water, for the red deposit seen in the urine of persons predisposed to gravel. The borax and the bi- carbonate of sodium may be replaced by from four to six grains of carbonate of lithium. S. W. BUTLER, M. D., PHILADELPHIA. 831. R. Fresh root of hydrangea arborescens, 2 pounds Water, 6 quarts. Boil down to two quarts ; strain, and add one quart of honey, and boil down to one quart. A teaspoonful twice or three times a day. Dr. Butler highly recommends this remedy in cases of sabulous and gravelly deposits in the bladder. Under its use large quanti- ties of sand and gravel have been removed. A fluid extract of the hydrangea arborescens is prepared by the leading pharmaceutists, and may be readily obtained. C. W. FRISBIE, M. D., NEW YORK. 832. R. Sodas biboratis, 3jj Extracti uvas ursi fluidi, f.gj Spiritus aetheris nitrosi, Tincturae opii deodoratas, aa f.gss Aquas, fjiij- M. A teaspoonful from three to six times daily, in uric acid diathesis or brickdust deposit. 21 322 DISEASES OF THE URINARY SYSTEM. The celebrated Harlem oil, used in Holland as a remedy against stone, is:— 833. R. Olei cadini, f.^iy Olei terebinthinae, f.giij Sulphuris loti, 3j. M. Make one hundred and twenty capsules. One three times a day. RESUME OF REMEDIES. * Chloroform given by the mouth or by inhalation relieves pain without inter- fering with that muscular contraction which probably assists in the onward propulsion of the stone. The same remark applies to ether. "Opium, in full doses, given by the mouth, or in the form of enema or sup- pository, is a remedy of great value. But morphia, hypodermically, is usually more effectual than any of these modes of administering opium. Triticum Repens, in decoction (gij to aquas Oj, boiled for fifteen minutes and strained), is said to have afforded great relief in renal calculus. "Baths. The hot bath or hip bath is a useful, soothing remedy. Ice. Dr. W. Prout states that in protracted suffering in the passage of renal calculi he has occasionally obtained relief from the application of pounded ice to the region of the kidney. It is chiefly applicable when the calculus is of oxalate of lime, or the phosphate, but is not to be employed in plethoric, gouty patients suffering from lithic acid calculi. VI. DISEASES OF THE BLOOD. Anazmia— Cerebrospinal Meningitis—Erysipelas— Gout—Mala- rial Diseases—Milk Sickness—Purpura Hemorrhagica—Rheu- matism—Scrofula—Typhoid Fever— Variola. ANEMIA. PROF. JOHN B. BIDDLE, M. D., PHILADELPHIA. 834. R. Quiniae sulphatis, gr.ij Ferri sulphatis, gr.j Strychniae, gr-eV M- For one pill, thrice daily. An excellent tonic combination, frequently prescribed by our author. THOMAS K. CHAMBERS, M. D., LONDON. TONIC BATH. 835. R. Acidi muriatici, f-Ij-ij Aquae calidae, C.xxx. In a wooden bath, the patient to remain in it for from ten to twenty minutes. Dr. Chambers has found this bath to confer muscular strength, even when employed alone. When used in cases of anaemia, while iron is being given internally, it gives an impetus to the improve- ment of the patient; more iron is taken up, and the blackening of the faeces ceases. J. M. DA COSTA, M. D., PHILADELPHIA. TONIC INHALATION. 836. R. Ferri lactatis, gy**^ Aquas destillatae, f^j. For one inhalation. To be administered (by means of any form of steam atomizer throwing a fine spray) two or three times a day. Useful in anaemia, when iron given by the stomach is not assimi- lated. Also in cases of gastric ulcer, when the constitutional effect of this agent is called for, while it is desirable to spare the stomach. 323 324 DISEASES OF THE BLOOD. 837. R. Ferri pyrophosphatis, 3J_ Aquas bullientis, 1.3ss. Mix and add, Extracti gentianae fluidi, f|ss Curacoas, £Ilss „ Vini q- s- ad. fiat f.jiv. M. Teaspoonful thrice daily. This preparation, known as elixir gentiance ferrates, is much used and highly esteemed in this city. PROF. EASTON, UNIVERSITY OF GLASGOW. The following formula of our author has become very popular in England since its first publication in Aitken's " Practice of Medi- cine," as a general tonic in anaemia and cachexia. It is known as the Syrupus Ferri, Quinice et Strychniae Phosphatum :— 838. R. Ferri sulphatis, 3v Sodas sulphatis. 3vJ-gj _ Quiniae sulphatis, gr.ccxij Acidi sulphurici diluti, q- s. Aquae ammonias, 0.- 8-, Strychnias, _ gr-.vj Sacchari albi, gxiv Acidi phosphorici diluti, f.gxiv. Dissolve the sulphate of iron in one ounce of boiling water, and the phosphate of soda in two ounces of boiling water. Mix the solution and wash the precipitated phosphate of iron till the washings are tasteless. With sufficient dilute sulphuric acid dissolve the sulphate of quinia in two ounces of water. Precipitate the quinia with ammonia water and carefully wash it. Dissolve the phosphate of iron and quinia thus obtained, as also the strychnia, in the diluted phosphoric acid ; then add the sugar and dissolve the whole, and mix without heat. The above syrup contains about one grain phosphate of iron, one grain phosphate of quinia, and one thirty-second of a grain of phosphate of strychnia in each drachm. The dose might, there- fore, be a teaspoonful three times a day. The amount of phosphate of quinia might be increased according to circumstances; and if eight grains of strychnia were employed in place of six, as in the above, the phosphate of strychnia would be in the proportion of one twenty-fourth of a grain in every fluid drachm of the syrup. A much larger dose should scarcely be ven- tured upon. PROFESSOR S. D. GROSS, M. D„ PHILADELPHIA. 839. R. Tincturae ferri chloridi, f.gj Quiniae sulphatis, gr.xx. M. Twenty drops thrice daily, in sweetened water, through a tube. ANEMIA. 325 He prefers the tincture of the chloride to all the other prepara- tions of iron. Prof. Chas. D. Meigs considered reduced iron (ferrum redactum) to be the most efficient of the chalybeates, in two-grain doses three times a day, after each meal, on a full stomach. DR. JOHN FORSYTH MEIGS, M. D., PHILADELPHIA. 840. R. Ferri et quiniae citratis, ^iv Extracti gentianae fluidi, Spiritus lavandulae compositi, aa f-^iij Alcoholis, f.^vj Aquas, f.givss. M. A tablespoonful thrice daily. PROFESSOR ELLERSLIE WALLACE, M. D., PHILADELPHIA. 841. R. Ferri pyrophosphatis, sjij Curacnae, f-.5ss Aquas, f-gijss. M. A teaspoonful four times a day. RESUME OF REMEDIES. Ferrum. Chalybeates, given until the blood contains its normal amount of iron, are productive of the best effect in anaemia. If given too long, however, they produce plethora, indigestion and general derange- ment. Ferri Mistura Aromatica. The following formula is an excellent one:— 842. R. Pale cinchona bark, powdered, gj Calumba root, in coarse powder, gss Cloves, bruised, g| Fine iron wire, gss. Macerate in peppermint water, f.gxij, for three days, agitating occasionally. Filter, add peppermint water, q. s. ad. f.gxijss ; then add compound tincture of cardamoms, f.giij ; and tinc- ture of orange peel, f.gss, and preserve in a well-stoppered bottle. Dose—f.gi-ij. Ferri Peroxidum Hydratum. Dr. S. Ashwell recommends the following formula, as one which will often agree when other ferruginous com- pounds cause irritation:— 843. R. Ferri peroxidi hydrati, gr-viij Pulveris ipecacuanhae radicis, gr.j Hydrargyri cum creta, gr.ij. M. Make powder. Take one twice a day. Ferri Sulphas is a very effective salt of iron in anaemia. It may be com- bined with gentian ; with quinine and strychnia; with a sedative, as conium ; with an aperient, as rhubarb or aloes ; with hops, as advised by Dr. S. Ashwell. 326 DISEASES OF THE BLOOD. 844. R. Ferri sulphatis, Sr-.HJ.. Extracti humuli, gr.ij-iij. M. Make pill. Three to be taken daily. Magnesii Oxidum Nigrum has been employed with success in simple anaemia, instead of iron. "Oleum Morrhuce is a valuable remedy in all forms of anaemia, its efficacy being increased by combination with a ferruginous salt. Oxygen inhalations have been found of benefit in anaemic conditions. CEREBROSPINAL MENINGITIS. J. LEWIS SMITH, M. D., NEW YORK. This author, in speaking of this disease, especially as it appears in children, disapproves of blood-letting, even by leeches. The one drug he relies upon is bromide of potassium, in doses of gr.v-vj every two, three, or four hours, to a child of five years, according to the urgency of the case. After the first week it should be given less frequently, and finally omitted. Small doses of hydrate of chloral are best to relieve the pain. Quinia is of no service. Bis- muth, in large doses, controls most effectively the nausea. Frequent counter-irritation along the spine by dry cups or an irritating liniment is useful from the first, and also vesication of the nucha later in the disease. Sustaining measures should be commenced early. DR. J. B. HAMILTON, NEW YORK. In the New York Medical Journal, February, 1875, this writer gives his treatment as follows: For the first twenty-four or forty- eight hours:— 845. R. Extracti ergotae fluidi, gj Spiritus ammonias aromatici, gij. M. A teaspoonful in a little water every four hours. 846. R. Potassas acetatis, ^xij Aquas camphorae, f-g^vj. M. A tablespoonful every two hours, until diuresis is produced. In addition to these remedies, direct a warm bath, followed by wrapping in flannel, or rubbing with dry mustard, every three, four, CEREBRO-SPINAL MENINGITIS. 327 or six hours, according to the urgency of the case. Stimulants may be necessary from the outset. As soon as the symptoms show any amelioration, the ergot mix- ture may be diminished in frequency, and at the third or fourth day discontinued. Quinine in large doses will then be found of advantage, and a more stimulant diuretic, as spiritus aetheris nitrosi, may be substituted for the potassa acetate; and for the sequelae nothing has proved more serviceable than iodide of potas- sium, as occasion demanded. This writer considers the bromide of potassium treatment "utterly worthless." DR. WILLIAM READ, BOSTON, MASS. One of the most rational and also successful methods of treatment of this disease is described by Dr. Read {Medical and Surgical Reporter, vol. xxx, page 469). He usually commences with a full dose of castor oil, or other mild laxative, and then prescribes:— 847. R. Ergotinas (Bonjean's), gr.x Extracti belladonnae, gr.j—ij. M. Make ten pills. One every three hours. Croton oil is applied to the nuchas until a copious eruption is produced, and if the spine is tender it is blistered. Concentrated nourishment is ordered. PROF. VON ZIEMSSEN, GERMANY. The treatment of this accomplished physician comprises leeches behind the ears, and ice-bags to the head, neck and back; the in- unction of fifteen to thirty grains of mercurial ointment twice daily; frequent rinsing the mouth with chlorate of potash solution, to pre- vent stomatitis; and especially morphine, in full doses, gr.|—ss, hypodermically in adults. Quinine is useful only in those rare cases where the temperature ranges very high. It is then required in doses of gr.xv-xxx. In a later period of the disease, iodide of potassium is of great service in producing absorption of the exuda- tion. 328 DISEASES OF THE BLOOD. ERYSIPELAS. DR. WILHELM ZUELZER, CHARITfi HOSPITAL, BERLIN. This observer believes no specific treatment for erysipelas has been established. For the rational treatment for the more serious forms the mineral acids may be used, and quinine in full doses :— 848. R. Quiniae sulphatis, 3.1 .. Acidi sulphurici diluti, t-SU. Aquas, f-3»J- M- A dessertspoonful three times a day. Cold baths, several times a day, are a valuable means to reduce the temperature, especially in protracted cases. Violent cerebral symptoms must be met by cold applications to the head, and by active purgatives. When oedema of the glottis is threatened, the inhalation of solutions of tannin and alum is called for, and the energetic use of cold, by the administration of small pieces of ice and by ice-bags to the throat. Local treatment may be limited to sprinkling with powdered starch and covering with wadding. To exert a mild compression, the skin may be painted daily with :—■ 849. R. Collodion, Glycerinae, Great tension of the skin may be relieved by warm poultices or by superficial punctures. In violent inflammation, ice-bags and ice-water compresses are indicated. MR. JOHN HIGGINBOTTOM, LONDON. This surgeon maintains {Practitioner, January, 1869), after forty years' experience, that no agent is so safe, powerful and efficacious as the nitrate of silver. The affected part should be well washed with soap and water, then with water alone, to remove every par- ticle of soap, which would decompose the nitrate, and then be wiped dry with a soft towel. He employs the following solution :— 850. R. Argenti nitratis, Aquas, This should be applied two or three times carefully over the affected surface and beyond, on the healthy skin, to the extent of two or three inches, by means of a piece of clean linen attached yiv f.gss. M. ERYSIPELAS. 329 to the end of a short stick. In the course of twelve hours it will be seen whether the solution has been well applied; if any part of the inflamed surface be found unaffected, the application must be repeated. By applying the nitrate so as to encircle the inflamed part, the extension of the disease may be sometimes arrested. Iodine (see below) is preferred by some physicians. DR. RUSSELL REYNOLDS, LONDON. Several preparations of iron have been supposed, by various surgeons, to exert a specific effect on erysipelas. Velpeau used the sulphate; but the most popular has been the chloride of iron. Dr. Russell Reynolds advises the following formula:— 851. R. Tincturae ferri chloridi, Spiritus chloroformi, Olycerinae, aa f.gj Aquas, f-g»j- M. One tablespoonful in a wineglassful of water every four hours. So soon as the first effects of this medicine, which are often seen after the second dose {i. e., the local inflammation ceasing to extend, the inflamed part becoming paler, less tender, less swollen, the feeling of exhaustion diminishing, and with it the exaggerated frequency of the pulse and the exalted temperature, and frequently sleep ensuing), the quantity of the tincture may be reduced. Alco- holic stimulants are frequently indicated in connection with this treatment. Cool lotions should be avoided, the only local applica- tions called for being hair-powder and cotton or wadding, to protect the parts from cold currents of air. The Germans use Bestuschefs mixture, the ethereal tincture of chloride of iron, the latest improved form of which is:— 852. R. Tincturas ferri sesquichloridi, 1 part Spiritus aetheris nitrosi, 14 parts. Mix and expose to the rays of the sun in well-closed bottles, till the brownish color disappears. One to two teaspoonfuls every three hours. It is well, in this connection, to note that Dr. Charles Bell, of Edinburgh, who strenuously advocates the treatment of erysipelas by tincture of muriate of iron, holds that a natural difference exists between the effects of the two so-called similar preparations of iron—viz., the muriate and the perchloride. He insists par- 330 DISEASES OF THE BLOOD. ticularly on the administration of the former preparation in full and frequent doses. PROFESSOR ROBERTS BARTHOLOW, CINCINNATI. This writer attributes to belladonna " a real curative power in erysipelas," especially in idiopathic and facial erysipelas. It may be combined with aconite or digitalis, if the fever is high; with quinia, if there is depression. 853. R. Quiniae sulphatis, 3ss Belladonnas extracti, grsnj. M. Make ten pills. One every four or six hours. He questions the value of the chloride of iron treatment, but believes that by the local use of nitrate of silver effective results may be obtained in traumatic erysipelas. For the facial variety, he prefers inunctions of oil and cocoa butter. DR. BEHIER, PARIS. 854. R. Tamarindi, gisa Mannas, 3j Aquas, f-gx- Boil, and add toward the end, Potassii bitartratis, 3vj Antimonii et potassii tartratis, gr.iss. M. To be given in four or five doses, at the intervals of an hour,.in the commencement of erysipelas. If there be delirium, order an enema of musk and opium. 855. R. Antimonii et potassii tartratis, gr. f Sodii sulphatis, £iv. M. Add to a pint of veal broth, and give a cupful every one or two hours, as a sedative in the beginning of acute erysipelas. 856. R. Spiritus camphorae, f.gj Infusi sambuci florum, Oj. M. A useful fomentation in erysipelas. RESUME OF REMEDIES. Aconite was a favorite remedy, in sthenic cases with much febrile action, of the late Mr. Liston, of London. "Ammonii Carbonas is strongly recommended by Sir Thomas Watson, who precedes its use by a purgative. Belladonna, in repeated doses of gr.y1^, is often of benefit in reducing arterial excitement. Its effects are enhanced by the previous administration of aconite. Ferri Bromidum has been employed, with good results, by a number of Ameri- can physicians. 1 ERYSIPELAS. 331 Potassii Chloras, in combination with the tincture of cinchona, is recom- mended by Dr. Copland in erysipelas supervening upon anasarca, or if there be any tendency to gangrene, or if the temperature of the surface be low and the color deep or dark. "Quinioz Sulphas is indicated in all cases where the tongue becomes clean and the skin moist, and should at once be resorted to if the pulse be soft, tremulous, or very rapid, the heat moderate, and the delirium low and muttering, or if suppuration or sloughing has commenced. In such cases it may be combined with the tincture of the chloride of iron, with great advantage. "Sodii Sulphis (as also the bisulphite, and the hyposulphite, and sulpho-car- bolate of soda) is strongly recommended by Professor Polli, of Milan. Terebinthince Oleum has been given with great benefit when the coma has been intense, the pulse sinking, and the tongue dry and glazed. Dr. Copland counsels the local application of turpentine epithems. LOCAL APPLICATIONS. Adeps. Lard inunction is regarded by Erasmus Wilson as superior to all fluid applications. He first relaxes the skin with hot water or steam, then saturates the surface with hot lard, and afterward covers with wool. Ammonii Carbonas allays the irritation of the surface. The following lotion, recommended by Erasmus Wilson, may be employed :— 857. R. Ammonii carbonatis, Plumbi acetatis, aa 3j Aquas rosas, f.gviij. M. Brominium. Dr. Goldsmith, U. S. A., recommends (American Medical Times, 1863) the following solution:— 858. R. Brominii, gj Potassii bromidi, gr.clx Aquae destillatae, q. s. ad. f.giv. M. Calx Chlorinata. The following solution has been found of benefit:— 859. R. Calcis chlorinates, 3j-ij Aquas, Oj. M. The parts should be kept constantly wet with this lotion. Ferri Sulphas was much employed by Velpeau, both in solution and in ointment:— 860. R. Ferri sulphatis, 3j Aquae, Oj. M. 861. R. Ferri sulphatis, gij Adipis, gj. M. Glycerina is of great service, by allaying irritation and preventing the action of the air. Hcematoxyli Lignum has been found by M. Desmartis (Medical Times, June 14th, 1862) of value in severe traumatic erysipelas, applied in oint- ment :— 862. R. Extracti hasmatoxyli, Adipis, aa gss. M. 332 DISEASES OF THE BLOOD. Hydrargyri Chloridum Corrosivum was found by Dr. Dewees to be as effectual as mercurial ointment, when applied in the following solution :— 863. R. Hydrargyri chloridi corrosivi, gr.j Aquae, f.gj. M. Hydrargyri TJnguentum sometimes arrests the course of the disease, when smeared over the parts three or four times. It usually causes salivation. "Iodine, painted over the inflamed parts, often quickly alleviates the symp- toms. By many it is preferred to the nitrate of silver solution. Plumbi Subaceiatis Liquor Dilutus, kept constantly applied, soothes the parts. Potassii Permanganas is recommended by Dr. Leavitt (Braithwaite1 s Retro- spect, vol. vi, 1867), in the following solution :— 864. R. Potassii permanganas, gr.xxx Aquae, gj. M. Sulphurosum Acidum, with equal parts of glycerine, has been found to arrest the spread of the inflammation and relieve the burning. GOUT. DR. HENRY W. FULLER, LONDON. For the purpose of clinical instruction, Dr. Fuller divides cases of acute gout into two classes, namely: 1. Cases in which the excretory organs are originally sound and functionally active— cases in which the attack of gout is due principally to excess and indiscretions of diet; and 2. Cases in which the excretory organs are in some way disordered, and fail in performing their elimina- tory functions—cases in which the patient is not necessarily guilty of indiscretions of diet, but in which the liver and kidneys fail in their action, either as the result of functional disorder, or of or- ganic change in their structure. The first class of cases correspond with those which pass under the name of asthenic gout; the tongue is usually furred, the urine loaded, and the bowels are commonly torpid. In these cases, until the acute symptoms have subsided, Dr. Fuller restricts the diet to liquids, administers a saline draught containing sulphate and carbonate of magnesia, and a few drops of colchicum wine; occa- sionally gives an aperient pill containing calomel, aconite and opium, and wraps the joints in finely carded wool, or in flannels steeped in a solution of soda and laudanum. As the acute symp- toms subside, a more generous diet is permitted, and some hght, GOUT. 333 bitter tonic, such as tincture of gentian or calumba, is added to the mixture. The second class of cases have more affinity with what is termed atonic gout: the tongue is often clean and the urine clear—some- times of low specific gravity—and the bowels are regular. In these cases Dr. Fuller does not restrict the diet to the same degree; he allows a little meat without vegetables, and also, if desired, a glass of sherry or a little spirits and water. He acts freely on the skin by means of the hot-air bath; administers an aperient in the morning, containing taraxacum and sulphate of magnesia, and during the day he gives a warm stomachic draught containing ammonia and a few grains of soda in a light bitter infu- sion. Occasionally a dinner pill is prescribed containing rhubarb and a grain of colchicum; and in some instances, characterized by pale, clear urine, a draught containing quinine, the mineral acids, and taraxacum, is substituted for the mixture just referred to. In these cases, as soon as the acute symptoms have subsided, a drachm of the syrup of phosphate of iron is given each morning before breakfast. DR. H. SALTER, LONDON. The local treatment of this author is all that is peculiar. It consists in the application of the following lotion:— 865. R. Potassii iodidi, 3j Potassas bicarbonatis, gj Aquas bullientis, Oj. M. To this a little tincture of opium may be advantageously added. Double lint, saturated with this lotion, is applied to the part affected, and covered with oil-silk; to that is put a layer of cotton- wool, and the whole swathed in a flannel bandage. The lint should be taken off from time to time, and re-dipped in the lotion. The relief that the patients experience from this application is very great. With or without this lotion there are three other things on which Dr. Salter insists in the local treatment of a gouty joint— perfect physical rest, protection, and preventing the part affected being too dependent. PROF. S. D. GROSS, PHILADELPHIA. 866. R. Vini colchici radicis, f.gj Morphias sulphatis, gr.j. M. For one dose, at bedtime, in gouty affections of the joints. 334 DISEASES OF THE BLOOD. This treatment should be preceded by purgation or venesection, if indicated, and be followed in the morning by a gentle laxative. These doses are recommended by our author* as the most efficient, and as seldom disappointing the most sanguine expectations. Where there is a full, bounding pulse, indicating excessive arterial action, then the following will come into play :— 867. R. Tincturae aconiti radicis, f.gj Morphiae sulphatis, gr.ij Antimonii et potassas tartratis, gr.j Aquas, f.giss Syrupi zingiberis, f.gss. M. A teaspoonful every three hours. Veratrum viride may be substituted for the aconite in the same or double the dose. The action of these potent remedies should, of course, be carefully watched and kept within proper limits. Together with the above means the following should be employed, to neutralize the acid state of the blood :— 868. R. Potassas bicarbonatis, gj Sodas bicarbonatis, gij. M. For six powders. One to be taken every six hours, in a • wineglassful of water. As a local application nothing will be found better than, 869. R. Tincturas opii, f.gj Linimenti saponis, f-gij- M. To be rubbed in twice a day, and constantly kept in contact with the affected joint by means of a piece of flannel covered with oiled silk. A fly-blister may be used if the disease manifests a disposition to linger. PROF. A. B. GARROD, KING'S COLLEGE, LONDON. 870. R. Lithii carbonatis, gr.iv Aquas rosas, f-gvj. M. This solution is to be warmed and then imbibed by means of charpie or a piece of sponge, and applied on the seat of pain, and covered by a sheet of gutta-percha. Two or three times a day the application is to be wet with the solution, in order to keep it always moist. Internally, the carbonate of lithia, in doses of gr.iij-vj, or the citrate, in doses of gr.v-x, in aerated water. 871. R. Fraxini folias, gss. Aquas, Oj. The leaves are to be boiled in the water during ten or fifteen minutes, GOUT. 335 then strain and sweetened. To be taken in fractional doses during the day, an hour before the meals, in chronic gout. The leaves of common ash, though much extolled in France and Germany in the treatment of gout and rheumatism, have not suc- ceeded in the hands of our author, in acute gout; when taken for a long time and in large quantities, in the form of decoction of the leaves, they have probably some influence in keeping off the attacks in chronic gout. DR. GALTIER-BOISSIERE, FRANCE. The author gives eight drops of the tincture of colchicum about every two hours, in a small cup of tea or weak coffee, until thirty- two drops are administered during the first day, in acute gout. The next day the colchicum is stopped, and the patient put on the use of sulphate of quinine, fifteen grains being given, in four doses in the course, with a few drops of dilute sulphuric acid in a cup of weak coffee. The third day, forty drops of tincture of colchicum are given; the fourth day, fifteen grains of quinine; and the fifth day, fifty drops of the tincture; that is to say, each time one-fourth more. This increase of dose is to be stopped so soon as abundant diaphoresis and diuresis show themselves, which usually are followed by a marked diminution of the pain. But the quantity of one fluid drachm and a half of the tincture is never to be exceeded during the day, taken in four doses, at four hours' interval. RESUME OF REMEDIES. Aconite. Professor Gross recommends tincture of aconite root, with morphia and antimony, when there is excessive arterial action. Ammonii Phosphas has been recommended, in gj doses daily, highly diluted. Dr. Garrod has derived much benefit from the long-continued use of this salt in chronic conditions of the gouty habit. Qajuputi Oleum, in doses of gtt.v-vj, frequently repeated, is serviceable in retrocedent gout. Colchicum, in gout, has been compared to cinchona in ague, but unfortunately, unlike the latter remedy, it does not prevent a return of the dis- ease. Dr. A. B. Garrod states that often an almost magical change is produced by a single large dose, without the least increase in any of the secretions, the effect showing itself in the rapid decrease of the pain, and other symptoms of the joint inflammation. Fraxini Folia. Ash leaves, in infusion, have been used by Dr. A. B. Garrod with advantage, but, as he remarks, the amount of the infusion given daily being considerable, the action of the diluent must not be for- gotten. Guaiacum is considered by Dr. A. B. Garrod as especially useful in the 336 DISEASES OF THE BLOOD. asthenic gout of old subjects. It may be given continually, for a long timerwithout injury. This remedy is much employed in Ger- many. t i? r> Muriaticum Acidum Dilutum is strongly recommended by Dr. J. *. Duncan Viaticum Acta ^b ^ ^ , th mary cause of the disease, the presence of lithic acid in the blood, and holding out a greater prospect of effecting a real cure than any ant- acids, "lie directs the following mixture :-— 872. R. Acidi muriatici diluti, f.giss Spiritus chloroformi, f-gy Tincturae colchici, f-3J . Infusi cascarillas, f-5vJ- M- Two tablespoonfuls every three hours. Lithioz Carbonas is a valuable remedy. So also are the natural lithia waters of Baden-Baden. Maanesioz Carbonas, dissolved in an excess of carbonic acid, is an excellent Mag manner of exhibiting magnesia, which is often of great service in chronic gout. Manna is an excellent aperient, in the following combination :- 873. R. Mannas, 319S Vini colchici, nVxx Potassii tartratis, 3!J. Tincturas cardamomi compositae, f.gj Infusi sennas compositi, f-3x- M- For one draught. Oleum Olives is strongly recommended by Dr. J. Spencer Ramskill, of Lon- don. See above. . ,. v:««j Opium is now rarely given alone internally in gout, but is frequently combined with other remedies. Podophyllum is given with good effect, in the form of pill, with henbane or belladonna, when it is important to secure free biliary evacuations. Potassii lodidum is frequently indicated in chronic gout. When fluid effused into the joint cavities is slow of absorption, the iodide often acts to great advantage. Potassii Nitras is recommended by Professor Bennett, of Edinburgh, in acute gout. "Rheum, taken regularly between the attacks, often wards off a return. At the period of an impending paroxysm, Professor Graves, ot Dublin, advises the following :— 874. R. Pulveris rhei, .|j, Aurantii corticis, &]i Pulveris aloes c. canella, gij ,, Spiritus vini gallici, Oiv. M- A tablespoonful of the strained liquor, in water, night and morning. EXTERNAL APPLICATIONS. Aconitia, applied locally, over the seat of the pain, is an excellent palliative. Alcohol. Sir C. Scudamore recommends a tepid lotion of one part of alcohol and three of camphor mixture. MALARIAL DISEASES. 337 Cajuputi Oleum, externally, is of much benefit. Colchicum, locally to the affected part, is highly praised by Dr. Laycock. Iodoform, externally applied, has succeeded in the hands of some practitioners in relieving the pain. "Iodine, locally used, is a very valuable remedy. The following formula is said to afford sometimes almost instant relief:— 875. R. Iodinii, 9jj Alcoholis, f.gj Aquas, f-gvj-fgj. M. Dr. J. Pereira says that no external remedy gives such relief as iodine, but that the skin of different individuals is most unequally susceptible to its influence; in some it excites great pain, while in others it produces scarcely any. It is especially useful when effu- sion into the synovial membranes or sheaths has taken place. Morphia. A solution of morphia, applied by means of lint, often affords great relief:— 876. R. Morphiae muriatis, gr-v"j Aquas, f.gj. M. Sinapisms to the inflamed part often afford speedy relief. They are also useful in retrocedent gout, in inviting a return of the disease to its original seat. Sodii Phosphas. The finely powdered bibasic phosphate of soda, sprinkled over moistened spongeo-piline, and applied so as to envelope the whole of the affected part, affords immediate relief in many cases. Sulphur. The exposure of the bed-clothes to strong sulphur fumes, before they are spread over the patient, is recommended to induce copious perspiration and relief of the pain. Tabaci Folia. The application of the moistened tobacco leaf often affords great relief. Veratria, in ointment, is of occasional service, and is recommended by Sir C. Scudamore:— 877. R. Veratrias, gr.xxx Unguenti, gj. M. Zingiber. A ginger plaster placed over the epigastrium relieves the pain or gout in the stomach. MALARIAL DISEASES. THE PERSONAL PROPHYLAXIS OF MALARIA. The general belief, which has also received the sanction of late medical authority (Professor Hertz, in Ziemssen's Cyclopaedia, vol. ii, page 657), that the cinchona alkaloids are safe and efficient pro- phylactics in malarial regions, is incorrect, and should be re- 22 338 DISEASES OF THE BLOOD. nounced. It is even dangerous, for it has been well established, by the observations of the English surgeons in West Africa and else- where, that when long used as a preventive, it not only loses its prophylactic, but also its therapeutic powers (see Surgeon Gore's "Medical History of the "West African Campaign," page 164). The best prophylactics are a generous diet, plenty of work, mental and physical, but not to exhaustion, avoidance of night air and wet, proper clothes, and a cheerful disposition. The eucalyptus, in the form of infusion or extract, and infusion of box leaves, have been lately advocated on respectable authority. The free use of pepper in the food, and the habit of taking a small cup of strong coffee on rising, may be favorably mentioned. During the night, doors and windows should be closed, and an open fire should be lighted in the evening and early morning. The drinking water should be filtered, or thoroughly boiled before using- PROFESSOR S. M. BEMISS, M. D., NEW ORLEANS. In violent forms of congestive chill, or algid pernicious malarial fever, this experienced physician states that opium, chloroform, belladonna, chloral hydrate and bromide potash, prove more or less valuable, according to the idiosyncrasy of the patient, or the cir- cumstances under which they were used. Opium is the most valu- able of the agents, and may be combined with other drugs, as an adjuvant. It is better to use it in moderate doses, and repeat these at short intervals. Twenty drops of laudanum, with half a tea- spoonful of chloroform, is an efficient prescription. One-sixth of a grain of morphia, with one-fortieth of a grain of atropia, may be injected subcutaneously. Nitrite of amyl is highly recommended. These remedies may be used at any stage of the chill without fear of prejudicing the subsequent career of the case. PROFESSOR HARVEY L. BYRD, M. D., BALTIMORE. In the treatment of that much-dreaded and often rapidly fatal condition, the " Congestive Chill," Prof. Byrd knows nothing of equal value to chloroform and opium, used as follows:— 878. R. Chloroformi, q. B. Inhale to anaesthesia, or to the restoration of the circulation in the extremities. The doctor often prescribes inhalation of chloroform to a limited extent to mitigate or curtail the cold stage in intermittent and remittent fevers. Or, MALARIAL DISEASES. 339 879. R. Pulveris opii, 7)j Pulveris capsici, gr.j. M. Make viij powders. One powder every hour, in severe cases, until the re-establishment of the circulation. He is accustomed to give between the powders ten to fifteen drops of aromatic sulphuric acid, in a little water. When reaction of the circulation is established in " congestive chill," the case should be treated in the usual manner. DR. ALONZO HARLOW, DETROIT, MICHIGAN. In typho-malarial fever, this physician states {Peninsular Medi- cal Journal, December, 1873) that he had used with much satis- faction the following:— 880. R. Quiniae sulphatis, gr.xxx Olei piperiti nigri, gtt.xxiv Acidi sulphurici aromatici, gj Syrupi simplicis, giv Alcoholi, gj. M. Tablespoonful every hour until half the quantity has been used; after- ward, every other hour. If the chills recur, repeat in same or less quantity; milk punch to be used freely. He used aconite, or veratrum viride, or gel- seminum, for the fever, and did not believe in too general stimula- tion with alcoholic stimulants. At a later stage, and in some cases, diffusible stimulants, as ammonia carbonate and brandy, are neces- sary. DR. BENJAMIN LEE, PHILADELPHIA. This practitioner recommends a full dose of quinine about an hour before the chill, and half an hour before it, the following:— 881. R. Chloral hydratis, 9j Aquae camphorae, gj. M. For one dose. PROFESSOR GREENSVILLE DOWELL, M. D., TEXAS. 882. R. Quiniae sulphatis, gr-xx Ferri et quiniae citratis, gr.xxx Extracti gentianae, gr.x Extracti hyoscyami, gr.xij. M. Make twelve pills. Give one every hour till six are taken. This experienced practitioner says of this prescription that when administered after the liver has been acted on by a mercurial, it will cure any case of enlarged spleen or chills, if persisted in. 340 DISEASES OF THE BLOOD. JOHN HERBERT CLAIBORNE, M. D., OF VIRGINIA. " 883. R. Hydrargyri chloridi mitis, Pulveris ipecacuanhae et opii, aa, gr.iv Quiniae sulphatis, gr-xvj. M. For four pills. Two to be given at bedtime, and two the following morning. This is Dr. Claiborne's usual first prescription in quotidian intermittent and remittent fever, and it rarely fails. C. W. FRISBIE, M. D., EAST SPRINGFIELD, N. Y. There are some cases of intermittent fever which will not yield to quinine alone, when the following pill answers a nice purpose:— 884. R. Quiniae sulphatis, gj Zinci sulphatis, gss Capsici, Pilulae hydrargyri, aa 9j. M. Divide into sixty pills. In order to get the best effect from the above pill, commence with six daily, and reduce one each day. DR. FELIX DE WILLEBRAND, PROFESSOR OF MEDICINE IN THE UNIVERSITY OF HELSINGFORS, FINLAND. Prof. De Willebrand believes that malarial fever can be combated by other specifics besides cinchona, and that iodine is one of them. He directs :— 885. R. Iodinii, gj Potassii iodidi, gij Aquas destillatae, f.giss. M. Five drops in a small glass of water every two hours during the day. Various physicians have lately extolled chloroform in obstinate chills:— 886. R. Chloroformi, Tincturas cinchonas, aa f.gj. M. One or two teaspoonfuls in water hourly, for four hours preceding the expected chill. DR. PAVESI, MORTARA, ITALY. 887. R. Sodii chloridi, gisa Ferri redacti, ~y Acidi hydrjchlorici, f.gv Salicin, %\ M Gr.v-x three times a day, in debility from malaria. MALARIAL DISEASES. 341 Salicin, in one to two-scruple doses, three to six times daily, is an efficient remedy in mild intermittents. DR. CLEMENS, PARIS. 888. R. Acidi arseniosi, Potassas carbonatis, aa gj. Dissolve in water, f.gix, and add brominii, gij. Keep in the dark, and shake frequently, for four weeks. Three or four drops, in water, twice a day. 889. R. Extracti eucalypti, gij Tincturae cinchonas, f-fiij- M. One or two teaspoonfuls three times daily. The eucalyptus has not yet met the expectations of American physicians. 890. R. Quiniae sulphatis, Ferri redacti, aa, 9j Acidi arseniosi, gr.ij Piperinas, §iss. M. Make twenty pills. One three or four times a day. A favorite pre- scription, in obstinate chills, with some Southern physicians. The hypodermic use of quinine is of extreme value in severe congestive and comatose cases, and elsewhere when, for any reason, it cannot be administered by the mouth. The following formula, containing gr.iv to f.gj, is an appropriate one:— 891. R. Quinias sulphatis, gr.xxxij Alcoholis diluti, f.gvijss Aquas ammoniae, f.gss. M. In the enlarged spleen, often associated with leucocythemia, which so frequently follows malarial disease, the iodide of ammonium, gr.v three times a day, with inunctions of the red iodide of mercury, has been found efficient. Dr. Da Costa prefers, however, the treatment by the hypodermic administration of ergo tine, gr.iii-v daily, which has certainly produced excellent results. 342 DISEASES OF THE BLOOD. MILK SICKNESS. DR. J. C. PATTON. OF INDIANA. This practitioner describes (Indiana Journal of Medicine, Aug. 1875) a treatment which, he says, " almost deserves the character of a specific:"— 892. R. Infus. sennas foliarum, Oj Magnesias sulphatis, ^XU« M- Of this give from one to two ounces, which will be vomited; then im- mediately give a second dose, and so continue until it is retained. Large injections of cold whiskey and water should be thrown well up the rectum. For milder cases, sulphur, in free doses, until the bowels are moved, followed by diffusible stimulants, is sufficient. PURPURA HEMORRHAGICA. PROF. E. TROUSSEAU, PARIS, Ferri et potassii tartratis, SJ—ij Acidi tartaraci, Sr-"j Syrupi tolutani, f-3j Aquas cannellae, f.gv Aquas destillatae, fgiijss. 893. R. M. A tablespoonful from hour to hour, in purpura hasmorrhagica. RESUME OF REMEDIES. Ergot should be combined with tonics, and will be found of value. Ferrum is always useful. The following prescription is a good one :— 894. R. Ferri sulphatis exsiceatae, gij Quiniae sulphatis, gij Strychniae sulphatis, gr.ss. M. Make twenty pills ; one thrice daily. Sulphuricum Acidum sometimes acts happilv in purpura. Terebinthince Oleum is an important agent in the treatment of purpura. ] should be given in emulsion. ACUTE RHEUMATISM. 3-13 ACUTE RHEUMATISM. SALICIN AND SALICYLIC ACID TREATMENT. DR. T. MACLAGAN. DUBLIN. This author {Lancet, March, 1876), praises the action of saliein in acute rheumatism. Relief is afforded in forty-eight hours or less:— 895. R. Saliein, gr.xv. This amount in water every three hours. Later observers corroborate this statement; gr.x, every two hours, is preferred by some. Decoction of the inner bark of the willow {Salix fragilis, etc.), which contains the active principle, saliein, has also been used with excellent results. Salieylie acid, now produced by synthesis, was formerly derived from saliein. Dr. L. Traube, of Berlin, and many following him, give it high praise in acute and subacute rheumatism. It disperses the fever and soothes the pain. Grains xv to xxx in powder, in a capsule, may be given every hour. Or, 896. R. Acidi salieyliei, gss Sodas boratis, gj Glycerinae, f.gj Aquae menthae, f-gv. M. A tablespoonful as occasion may require. The borax makes the acid more soluble. Dr. Stricker, of Berlin, in a resume of his experience with salicylic acid, says:— 1. If the salicylic acid act thoroughly in the manner expected of it, there should be, during the treatment of articular rheumatism by a certain quantity given internally, no return of the disease in a hitherto unaffected joint, nor any secondary inflammation of the endocardium or other serous membranes. 2. In order to prevent a relapse, it is necessary to continue the use of the salicylic acid in small doses for some days after the end of the principal treatment. 3. Salicylic acid is of doubtful use in chronic articular rheuma- tism. 4. It is not likely to be useful in gonorrhceal and dysenteric rheumatism, or in septsemic inflammation of the joints. 344 DISEASES of the blood. THE ALKALINE TREATMENT. DR. H. W. FULLER. OF LONDON. The treatment of rheumatic fever adopted by Dr. Fuller, at St. George's Hospital, is essentially alkaline, and consists not only in administering salines and small doses of alkalies, but in pushing alkalies, as rapidly as possible, to the point of producing alkalinity of the secretions. He usually prescribes: — 897. R. Sodas bicarbonatis, giss Potassas acetatis, gss Liquoris ammoniae acetatis, f-giij Aquae, fgiss. M. For one dose. To be taken in a state of effervescence, in combination with 898. R. Acidi citrici, gss Aquas, f.gij. M. The quantity of the fluid not only takes off from the nauseous quality of the medicine, but promotes its absorption, and thereby facilitates its action. As soon as the urine manifests an alkaline reaction, the dose is repeated three times only in twenty-four hours; and on the following day, if the urine still remains alkaline, twice only. After three days, two doses only of this mixture in twenty- four hours usually suffice to keep the urine alkaline; and then Dr. Fuller adds two grains of quinine to each dose; or, if quinine be not well borne, he substitutes:— 899. R. Sodas bicarbonatis, Potassas acetatis, aa, gss Tincturas cinchonae, f.giss Decocti cinchonae flavae, f.giss. M. For one dose. Day by day, as the tongue cleans, and the other symptoms sub- side, the quantity of alkali is cautiously diminished, until a simple quinine draught is taken; but the condition of the urine is con- stantly watched, with a view to the immediate administration of a small quantity of alkali, should the least acidity call for its use. The diet is another point on which Dr. Fuller lays particular stress. He gives beef-teaj or broth throughout, and, if stimulants appear to be needed, does not object to their being administered cautiously; but he withholds solid food until the tongue is quite clean, and has often proved to his class in the wards that a too early recourse to meat will induce a relapse, and prevent convalescence. ACUTE RHEUMATISM. 345 Under this treatment, Dr. Fuller says, the pains commonly sub- side in five or six days, and the patients are seldom ten days in bed. Moreover, the heart may be regarded as safe from attack; for in two instances only, in the whole course of his hospital experience, has inflammation, either of the endocardium, or pericardium, arisen after the patient has been twenty-four hours under treatment. DR. FINCFTAW, WESTMINSTER HOSPITAL, LONDON. 900. R. Potassas bicarbonatis, gj Potassas nitratis, gij Liquoris ammonias acetatis, Aquas, aa f-giij- M. A tablespoonful, in water, every four hours, with a full opiate at night, if the pain be severe. He does not think it advisable to continue the alkaline treatment for any lengthened period; but to give quinine, in doses of two or three grains, every six hours, when the urgent symptoms begin to yield, especially if the sweating is over-profuse. He believes that, by giving quinine earlier than is generally the custom, convalescence is less tedious, and there is less chance of relapse. As regards cardiac complications, if pericarditis supervene, and there be sharp, catching pain, he applies a few leeches, followed by linseed poultices; should the pain be slight or absent, he omits the leeches. In all cases he applies, subsequently, one or more blisters. As to medi- cines, he continues the alkalies, giving at the same time a grain of opium every four or six hours. Should endocarditis manifest itself, he contents himself with the alkaline treatment, as he cannot satisfy himself that local remedies have any effect. HENRY POWER, F. R. C. S., ETC., LONDON. 901. R. Tincturae aconiti radicis, n\,xxiv Tincturae colchici, f-gijss Aquas camphorae, f-giv. M. A tablespoonful three or four times a day. In feeble patients, in women, and in children of from ten to four- teen years of age, the quantity of each tincture may be reduced to one-half; and when the water is or has been high-colored, with deposits of the lithates, the bicarbonate and nitrate of potash, with a little spirit of chloroform or of nitric acid, may be advantageously added. Our author has applied these remedies to a considerable extent in various cases of rheumatic disease for the last few years, and 346 DISEASES OF THE BLOOD. finds their use attended with great benefit when judiciously employed. They are particularly beneficial in rheumatic ophthalmia. In many instances, when the disease presents a periodic character, recurring with great regularity at a certain period of the night, the addition of two or three grains of quinine, or a few minims of Fowler's solution, may be made. DR. F. J. FARRE, LONDON. Dr. Farre's ordinary mode of treating acute rheumatism is the " alkaline." He usually commences with three five-grain doses of calomel, followed by: — 902. R. Magnesias sulphatis, Tincturae sennas, SpiritQs ammonias aromatici, Infusi sennas compositi, For one dose. He repeats this daily till the evacuations are natural. At the same time he gives the bicarbonate or acetate of potash, in twenty or thirty-grain doses, every four or six hours, according to the severity of the attack, generally using the former, but preferring the latter when there is synovial effusion. When there is little or no perspiration, or when the heart is much excited, he adds ten or fifteen grains of nitrate of potash. He not unfrequently, also, gives one grain of opium every night. For local treatment, especially of the smaller joints, he relies chiefly on the tincture or liniment of iodine, using the tincture for women and children, the liniment for the robust; one or the other of these is used in almost every case, and with nearly certain relief. When, however, there is synovial effusion, Dr. Farre uses either mustard or cantharides plaster. Mustard is always useful, especially when applied to the larger joints, as the shoulder. The appetite being always faulty, Dr. Farre gives milk diet until the tongue is clean or cleaning. Meat given before it can be digested, immediately brings back pain in the joints. He keeps the patient between blankets. As soon as the pain has gone, and the tongue is clean, he gives bitter tonics, omitting or diminishing the alkali if the urine is alkaline or neutral. DR. FLEMING, BIRMINGHAM, ENGLAND. 903. R. Potassas bicarbonatis, gr xxx Aquas, f.gij. M. For one dose, before each meal. Add one-half an ounce of fresh lemon juice, and take the mixture during effervescence. 3« f-gij "Ux f.giss. M. ACUTE RHEUMATISM. 347 If there be high fever, from one to three minims of Fleming's tincture of aconite are added to each draught. If there be much pain in the muscles, in place of aconite, from five to ten minims of tincture of hemlock are added to each dose of the alkaline. If, on the other hand, the periosteum be affected, from two to six grains of the iodide of potassium are given. To relieve pain and secure sleep, Dr. Fleming orders, at bedtime, a full draught of morphia and Indian hemp; as a drink, potassa water, or lemonade, freely. If necessary, colocynth and hyoscyamus pill is given to relieve the bowels. Cotton wadding is applied to the affected joints. Active and repeated counter-irritation, and poultices over the heart, are employed in cardiac inflammation. During convalescence, warm clothing, full diet, with quinine and iron. After considerable experi- ence, Dr. Fleming has found that this treatment has furnished very good results, and that the number of those attacked with cardiac inflammation, after their admission into the hospital, is undoubtedly small. Placing the patient between blankets materially promotes perspiration, and prevents chills. THOMAS KING CHAMBERS. M. D., ETC., LONDON. This author calls rheumatic fever " a pleasant disease for the doctor to treat, though not for the patient to bear," and gives a very simple, uniform plan of treatment, which, he states, hardly ever requires modification. Bedding.—The patient's bed is made in a peculiar fashion. No linen should touch the skin. A slight calico shift or shirt may be allowed; but if the patients possess underclothing only of the pro- hibited sort, they are better naked. Even a linen front to the shirt is dangerous. The sheets should be removed and the body carefully wrapped in blankets, the newest and fluffiest that can be got. The head is to be carefully protected from currents of air. Fomentations.—Those joints or limbs which are swollen, red, or painful, are to be wrapped up in,flannels, soaked either in hot water or a decoction of poppy heads, with half an ounce of car- bonate of soda to each pint. Curative Drugs.—If the skin is red, swollen or painful about the joints, if motion is impossible or the cause of exquisite suffering, and especially if these phenomena are metastatic, then the " alka- line treatment" is employed, as follows:— 904. R. Potassas carbonatis, Bj Aquas camphoras, f«gij- M. 348 DISEASES OF THE BLOOD. For one dose. To be repeated every three hours, day or night, when awake. If, however, the above symptoms are insignificant, and the pain is felt more in the bones, being intensified by pressure rather than by motion, and fixed, not metastatic, then two grains of iodide of potassium are to be added to each dose. So soon as the symptoms take a favorable turn, the alkali is to be omitted altogether, and only the iodide of potassium given. Palliatives.—Opium is to be administered in amounts propor- tionate to the subjective sensation of pain—from one to two grains at a dose. Immediately upon the relief of the pain, the quantity is diminished. Pure opium in the pill, and the tincture, are the best prepara- tions. If the pain remains fixed in one joint after it has left the other places, leeches are to be applied there and the part kept poulticed. Bruised laurel leaves may be mixed with the poultice. If the heart becomes affected, leeches and poultices are to be applied to the cardiac region. Diet.—The food is to be varied to some extent by the social and personal state of the patients. If they have been hearty and well- to-do persons before the attack, simple diet is proper, i. e., bread and butter, gruel and tea. If they have been ill-nourished, a pint of broth or of beef-tea is added. J. M. DA COSTA, M. D., PHILADELPHIA. 905. R. Ammonii bromidi, gss Tincturas aurantii corticis, f.gss. Aquae, f-giJ88. M. A dessertspoonful every three hours, except at night. In acute rheu- matic fever the beneficial influence of the bromide of ammonium is undoubted. Over the pains and aches of acute rheumatism this remedy also exerts an unquestionable control; but in chronic rheumatism it is decidedly inferior to iodide of potassium. But slight ameli- oration follows its use in persistent swelling of the joints of rheu- matic origin, and none in rheumatism due to a venereal taint. 906. R. Atropias sulphatis, gr-?V Aquas destillatae, n\,x. M. For one injection. To be thrown under the skin, in certain forms of muscular rheumatism, particularly wry neck, over or into the rigid parts. To be repeated once a day. Sometimes the most marked and ACUTE RHEUMATISM. 349 speedy relief follows this treatment, after ordinary remedies have failed. 907. R. Potassii iodidi, gj Vini colchici radicis, f.gij Morphiae sulphatis, gr.iij Syupi, f.gj Aquas, f.gij. M. A teaspoonful three times a day, after meals, in muscular rheumatism. 908. R. Potassas carbonatis, gij Potassae acetatis, giij Vini colchici seminis, f.gj Syrupi tolutani, f.giss Aquas, f.gss. M. A teaspoonful thrice daily, in lumbago, the following liniment to be rubbed in night and morning :— 909. R. Chloroformi, f.gss Linimenti ammonias, f.giss Linimenti saponis, f-gij- M. In a week or ten days, after the pain has subsided, apply:— 910. R. Emplastri picis cum cantharide, Emplastri Logani, aa equal parts. M. The quickest way of treating lumbago is by throwing ^th of a grain of atfropia under the skin near the affected muscles. This will sometimes dissipate the attack as if by magic. 911. R. Tincturas guaiaci, f.gij Vini colchici radicis, f.gij Potassae bicarbonatis, gss Syrupi aurantii corticis, f-^ij. M. A dessertspoonful in water, thrice daily, in rheumatic arthritis. Also have the joints wrapped in cotton, and painted, morning and even- ing, with equal parts of tincture of iodine and alcohol until they become sore. Sulphur baths are beneficial. Small blisters are also of service in the neighborhood of the joints, frequently repeated and dressed with:— 912. R. Morphiae acetatis, gr.| Pulveris marantas, gr.j. M. Arsenic is an excellent remedy in rheumatic arthritis. It may be administered as follows:— 913. R. Liquoris potassas arsenitis, f.gij Potassii iodidi, gij Syrupi, f.giij. M. A teaspoonful thrice daily, between meals, in water. 350 DISEASES OF THE BLOOD. 914. R. Vini colchici seminis, f-^j Potassas acetatis, gvj Spiritus aetheris nitrosi, Syrupi, aa f.gj. M. A teaspoonful thrice daily, in pleurodynia. Also use a stimulating liniment and keep the parts warm. 915. R. Potassii iodidi, gy Vini colchici radicis, f-o88 Extracti cinchonae fluidi, Elixir cinchonae, aa f.giss. M. A dessertspoonful thrice daily, in muscular rheumatism. Cinchona disguises the taste of the iodide of potassium. Quinine is often serviceable alone in those cases in which the joints are not affected, and in which there is pallor and loss of strength. 916. R. Potassii iodidi, gij. Tincturae belladonnae, f.giss Syrupi aurantii corticis, f-gss Aquas, q- s. ad. f.giij. M. A teaspoonful thrice daily in muscular rheumatism associated with vesical incontinence. In case of swelling and stiffness of the joints following acute rheumatism, nothing does so much good as sulphur baths. When practicable, send the patient to the sulphur baths of Vfrginia to get rid of these remnants of the acute attack. Artificial sulphur baths are also useful. When these are not practicable, great benefit will be obtained from the iodide of potassium and compound tincture of guaiacum. 917. R. Potassii iodidi, gij Tincturas guaiaci compositae, f-3vJ- M. A dessertspoonful thrice daily. This prescription is a very efficient though not an elegant one. It is very unpleasant to take. There are few who will go on with it for a long enough time to get its full therapeutical effects. In the treatment of the sub-acute form of muscular rheumatism, nitrate of potash is very valuable. This is an old remedy, but the advance of therapeutics has shown no other, in this form of rheu- matism, of which our author thinks so highly. It may be conjoined with Dover's powder. 918. R. Potassas nitratis, gr.xv Pulveris ipecacuanhas compositi, gr.iij. M. For one powder, to be taken every fourth hour. ACUTE RHEUMATISM. 351 WILLIAM AITKEN, M. D., EDTNBURGH. 919. R. Hydrargyri chloridi mitis, gr.v Pulveris jalapas compositi, §ij-gj Pulveris zingiberis, gr.iij-iv. M. This powder to be taken in a little milk at the commencement of rheu- matic fever. It will secure an abundant secretion from the glandular follicles of the intestinal mucous membrane. The daily evacuations of the bowels is then to be maintained by salines, such as Rochelle or Epsom salts. 920. R. Veratrias, Extracti opii, aa gr.j. M. For ten pills. Take two thefirst day, three the second, four the third, five the fourth, and so on, increasing one pill each day, until the con- dition of the pulse or the irritation of the mucous membrane compels a diminution. 921. R. Pulveris guaiaci, gj Pulveris rhei, gij Potassae bitartratis, Sulphuris sublimati, aa gj Pulveris nucis moschatas, gij Mellis, flb.j. M. Of this compound, two large spoonfuls are to be taken night and morn- ing. It is used in some large hospitals, both civil and military, in the treatment of old chronic cases. The beneficial effects of guaiacum are obtained in those cases which are unaccompanied by perspira- tion, and in which the secreting organs are gently excited by this drug. When the diaphoresis is free, it does little good. THOMAS HAWKES TANNER, M. D., F. L. S., ETC., LONDON. 922. R. Ammonias muriatis, giij Liquoris ammoniae acetatis, f.gvj Aquas camphoras, q. s. ad. f.gvj. M. A tablespoonful, in water, every four hours. RESUME OF REMEDIES. Aconite is, according to Dr. Reith (Edinburgh Medical Journal), ordinarily given in too large doses in acute rheumatism. He obtains good results in mild cases by its agency alone in small and often-repeated doses (rt\4 of the tincture every two hours). In some cases he com- bines it with the full alkaline or blister treatment. Cimicifuga was brought forward as a remedy in acute rheumatism by Dr. F. N. Johnson, of New York. It is less employed in the acute than in the chronic form. "Colchicum relieves the symptoms and shortens their duration, when combined with small doses of calomel, ipecacuanha, alkalies and opium. It is less benefioial, according to Dr. Fuller, in the weak and nervous than in the robust; less in purely fibrous rheumatism than in that com- plicated by synovial inflammation; less in proportion as the fever 352 DISEASES OF THE BLOOD. exceeds the articular swelling, and as the urine is less highly charged with the lithates. During its use, its operation must be carefully watched, the bowels kept regulated, and if the lithates disappear from the urine, if the pulse become weak, if faintness, or nausea, or purging supervene, it must be discontinued. The acetous extract or the inspissated juice (gr.j-iss), or the wine (n^xv-xx), may be given twice or thrice daily. Ferri Chloridi Tinctura has been employed by Dr. Russell Reynolds, of London, in doses of about tt\,xxx every six hours, with the effect of shortening the duration of the disease, and relieving the joint affection. "Opium, in large and repeated doses, is given by Sir D. Corrigan, of Dublin. He commences with gr.j every two or three hours, and increases the dose both in frequency and quantity until the patient feels decided relief, when it should be kept up at that dose until the disease is steadily declining. The average quantity required in twenty-four hours is about gr.xij, and even that amount does not affect the head ; occasionally it produces diarrhoea, when astringents are required to check it. The tolerance of opium in this disease is remarkable. Potassii Acetas is much employed. The dose usually given is about gr.xxx, every four hours. "Potassii Bicarbonas is a favorite remedy. Dr. A. B. Garrod, of London, gives gr.xxx in solution every four hours, until the joint symptoms and febrile disturbance have completely disappeared. Dr. Fuller, of London, considers that giss is the minimum dose which will suffice to overcome the acid condition of the blood during the first twenty- four or forty-eight hours of treatment, and in sthenic cases gij are often needed. Small doses he regards as useless. Potassii Nitras. Dr. Basham, who instituted a series of experiments to as- certain the real value of nitre in acute rheumatism, arrived at the following conclusions :—1. That it is a most valuable remedy in doses of gij-iij in Oiv of barley-water, daily. 2. That it acts by restoring the saline constituents of the blood, and by lessening the excess of fibrine. 3. That there is a certain amount of exemption from cardiac complication, and that cardiac inflammation, when it supervenes, is more amenable to remedies. 4. That the tendency to collapse is much diminished, and the acute or inflammatory symptoms usually give way on the third or fourth day. Potassii Bitartras, in doses of gr.xv-xx, every four hours, given in mint water alone, or in combination with tincture of hyoscyamus (ttbxxx-xl), is said to produce good results. Quinioz Sulphas, according to Dr. Fuller, should ordinarily only be used as a restorative when the febrile paroxysm is beginning to abate, and not as a cure during the active stages of the disease. LOCAL APPLICATIONS. Baths, Dr. N. J. Butler (Medical Press, August 5th, 1868), has found great benefit in acute rheumatism from baths containing valerian. He directs:— 923. R. Valerianas radicis, ib.j Aquas, C.j. Boil together for a quarter of an hour, strain the liquor and add to an ordinary bath at 98°, the patient remaining in it for twenty or thirty minutes. For any remaining inflammation about the joints, he applies lin- scrofula. 353 seed-meal poultices, prepared with a strong decoction of valerian. In the arthritic form of the disease, he considers valerian of ex- traordinary efficacy in subduing the pain and inflammation. Prof. Da Costa, of Philadelphia, recommends sulphur baths. artificial or natural, for the swelling and stiffness of the joints following acute rheumatism. ^Blisters. The blister treatment has been prominently advocated. Dr. Herbert Davies directs armlets, wristlets and even fingerlets of blister-plaster to be applied at the time the inflammation is most acute, linseed-meal poultices being subsequently applied to keep up the serous discharge. He places these blisters entirely around the affected limbs, and in the case of the knees, orders them at least three inches wide, regarding any slight strangury which may arise as of little importance compared with the benefit afforded by the free vesication. This treatment may be aided by a mild course of alkali, but he does not regard this as essential, excepting when the rheu- matic virus attacks the heart in the first instance and seems to hesi- tate in fixing itself upon the joints. Dr. Ringer, of London, con- siders all the alleged good effects may be obtained by the use of "flying blisters." Dr. A. Fleischman (Lancet, May 1st, 1869), looks upon a blister, about two inches square, placed an inch and a half below the left clavicle, as an almost certain preventive of car- diac mischief. SCROFULA. PROFESSOR J. LEWIS SMITH, M. D., NEW YORK. As scrofula is an essentially hereditary disease, its treatment must commence in infancy. The most enlightened rules of diet and hygiene must be observed. Of the strictly medicinal agents, cod-liver oil is the most useful. It possesses real value in the ere- thitic form of the diathesis, but none in the torpid form. Iodine, internally, is especially serviceable in glandular hyperplasia. The iodides of iron and starch are the best forms. The latter may be given by dropping one to five drops of the officinal tincture of iodide on a little powdered starch, and giving it in syrup. For the swollen glands the officinal preparations of iodine are too stimulating. The following is better:— 924. R. Potassii iodidi, gj Extracti stramonii, gj. M. To be rubbed over the gland several times daily. Or, 925. R. Liquoris iodinii compositi, Glycerinas, aa, gss. M. To be applied three times daily, with thorough friction, till the skin is irritated. 23 354 DISEASES OF THE BLOOD, When the glands become actively inflamed, iodine applications should no longer be employed. Poultices should be applied, and resolution hastened. DR. F. P. PORCHER, CHARLESTON. 926. R. Decocti stillingias, Oj Acidi nitrici, gtt.xvj. M. Two ounces, thrice daily, in scrofulous and syphilitic cachexia. A neater formula for administering this popular anti-scrofulous remedy is:— 927. R. Fluidi extracti stillingias. f-3S8„. Syrupus sarsaparillas, f-^viij. M. A tablespoonful three times a day. This is undoubtedly an efficacious remedy. PROFESSOR NEGRIER, OF ANTWERPT. 928. R. Extracti juglandis, gij Syrupi simplicis, t Aquas, aa giv. M. A tablespoonful three times a day. Pronounced to be very efficacious in the scrofula of children. Professor Steiner, of Prague, speaks of using the walnut leaves externally as a bath. DR. JEANNEL, PARIS. 929. R. Ammonii chloridi, ft.iv Ferri chloridi, ^J... Eau de cologne, f-3"j- Mix with the water of the bath. A useful bath for scrofulous and chloro-anasmic persons. DR BOINET, PARIS. 930. R. Tincturas iodinii, f.gss Acidi tannici, gr-iv- ^, Give five or six drops, once or twice a day, in a small cup of strong coffee, at the end of the meal. This iodized coffee is highly recom- mended in scrofulous affections. Milk may be iodized in the same manner. DR. LABOULBEYE, PARIS. 931. R. Pulveris conii, Extracti conii, aa, gr.xv Mucilaginis, q. s. M. Divide into twenty pills. Three or six a day, in strumous engorge- ments. SCROFULA. 355 DR. HARDY, PARIS. 932. R. Hydrargyri iodidi rubri, Adipis, aa gij. M. A useful ointment in scrofulous skin affections) when there is no ulcer- ation, or when it is superficial. Spread a layer of the ointment on the affected part, which causes a sort of artificial erysipelas, which is nearly as beneficial as a natural erysipelas. DR. DUVAL, PARIS. 933. R. Camphorae, Extracti conii, Plumbi iodidi, aa gj Adipis, gj. M. To be rubbed on scrofulous tumors, to favor their resolution. PROF. GUENEAU DE MUSSY, M. D., PARIS. 934. R. Ammonii carbonatis pulveris, Qiv Camphorae pulveris, gr.xv Adipis, gj. M. To be rubbed on the indolent cervical ganglions of scrofulous patients. 935. R. Magnesii sulphatis, gj Adipis, gj. Dissolve the salt in a smpll quantity of water and incorporate with the lard. Useful in scrofulous engorgements. It causes sometimes a pustular eruption, like antimonial ointment. RESUME OF REMEDIES. Ammonii lodidum is useful in scrofula attended with glandular enlargement. Barii Chloridum is especially valuable when languid circulation and irrita- bility of the mucous surfaces are present. It is said to be particu- larly adapted for females with menstrual irregularity. The following formula may be employed :— 936. R. Barii chloridi, gr.x Tincturas ferri chloridi, f.gij-iv Syrupi aurantii, f.gx. M. One or two tablespoonfuls two or three times a day. Bromine is a useful remedy. The following solution is a good one for external administration:— 937. R. Brominii, n\,x Aquas, f-gvij. M. To commence with, gtt.vj, three or four times daily. Calcis Aquce is sometimes productive of benefit in long-standing scrofula, when gland after gland is attacked. A tablespoonful should be given in milk three or four times a day. Calcis Phosphas Prozcipitata has been recommended as an excellent palliative. In scrofulous ulcers it is given with benefit, in doses of gr.viij-xx daily, taken with the meals, so as to be thoroughly mixed with the 356 DISEASES OF THE BLOOD. food. In scrofulous diarrhoea, good results are obtained from doses of gr.vj-x daily. Ferri et Ammonice Citras is a useful remedy, particularly recommended by its mild taste, which adapts it for administration to children. Ferri Bromidum has been recommended, in ointment, as an application to scrofulous swellings:— 938. R. Ferri'bromidi, Glycerinae, aa 1 part Adipis, 14 parts. M. "Ferri lodidum, in the form of the officinal syrup, is a powerful remedy in all * forms of scrofula. "lodinium and its compounds are the most efficient remedies we possess in scrofulous affections. They are employed both externally and inter- nally. "Morrhuce Oleum is of the greatest benefit in the scrofulous or tuberculous diathesis, but scrofulous glandular enlargements are generally but slightly influenced by it. After, however, suppuration has taken place, the action of the oil is more manifest. Discharges from scrofu- lous abscesses often speedily disappear under its use. In scrofulous diseases of the skin, joints and bones, as well as in scrofulous ozaena, otorrhosa and ophthalmia, it is productive of excellent results, when persevered in and accompanied by good hygienic treatment. Phosphoricum Acidum Dilutum has been strongly recommended, in doses of rn v, gradually increased to n\,xx, or #aore, in infusion of calumba. Thus given, it may be continued for a long time, without unpleasant P IT P 01S Potassii Chloras, in doses of gr.v-xx, four times daily, in pure water is highly spoken of as a remedy in scrofulous enlargements and ulcerations. As a local application to swellings and enlarged scrofulous joints, the following ointment may be used : — 939. R. Potassii chloratis, gij Adipis, §J- M- Potassce Liquor, in doses of tt\,xxx-1x, three times a day, is said to frequently diminish scrofulous tumors, without, however, exerting any influence on the diathesis. Potassii lodidum, given alone, does not seem to exert much influence in scrof- ula, but combined with iodine, it increases the activity (and solubil- ity) of the latter remedy. In combination with quinine, it is very useful in scrofulous ophthalmia. Sulphur formerly enjoyed a good reputation in the treatment of scrofula, but it has fallen into disuse. Attention has lately been Called to it as a valuable remedy. 940. R. Sulphuris, 9!Jriv Syrupi, £|i.- M Aquas, f-^vij. Al. Two tablespoonfuls, once or twice a day, in a tumblerful of milk^ Zinci lodidum has been used externally in enlarged lymphatic glands. 941. R. Zinci iodidi, gj Adipis, 3j- Ml TYPHOID FEVER. 357 TYPHOID FEVER. PROF. KARL LIEBERMEISTER, M. D„ OF TUBINGEN. This writer, whose essay on typhoid fever forms part of Ziems- sen's Cyclopcedia, believes it possible that both iodine and calomel may exert a specific influence in cutting short an attack of typhoid fever, if given early. He gave iodide of potassium, 9j-3j, in the twenty-four hours; and when he employed calomel, gr.viij, three or four times in the same period. He prefers the latter, and re- commends it in the stage of the disease before the ninth day. His main reliance, however, is the antipyretic treatment. This is to be carried out by cold baths and quinine. For adults, the full-length cold bath, 60° to 68° Fahr., is to be preferred. The duration of the bath should be ten minutes; but if the patient is feeble, seven or five minutes. After the bath, the patient is to be wrapped in a dry sheet, put to bed, and given a glass of wine. In very severe cases, the bath should be repeated every two hours; the average cases require four to eight baths daily. Contraindica- tions to the baths are hemorrhage and perforation of the bowels, weakness of the heart's action, and extreme debility. Quinine comes next as an antipyretic. But it must be given without timidity, and in a definite manner, as follows : from gr.xxij to gr.xlv must positively be taken within the space of half an hour, or, at most, an hour. Six or eight grains every ten minutes is a good rule. If this is boldly done, cinchonism is produced, and a material fall of temperature follows. This dose is repeated once every forty-eight hours; or, if the remission is not marked, once in twenty-four hours, the quantity being increased: When the fever spontaneously manifests a tendency to remissions, the quinine is of little value. This dose should reduce the temperature in the rectum to 100° Fahr. Of the two antipyretics mentioned, our author would generally rely on the quinine, if it is properly given. When the fever is of such obstinacy that additional antipyretic effects are required, he usually gives from eleven to twenty-two grains of powdered digitalis, extended over a period of about thirty- six hours; this should be followed by a full dose of quinine, say gr.xl, in one hour, as above directed. The diarrhoea he controls with opium, in small and repeated closes; meteorism with cold compresses to the abdomen, changed 358 DISEASES OF THE BLOOD. every half-hour; cold enemata, and frictions with turpentine; hemorrhage from the bowels with opium (gr.ij, in the twenty-four hours), ice to the abdomen, and perfect quiet. DR. SIREDEY, FRANCE. This practitioner gives in the first instance, especially in those cases in which the gastro-intestinal symptoms (coated tongue, nausea and diarrhoea) are present, twenty grains of ipecacuanha, with half a grain of tartar emetic, weak wine and water for drink, and beef-tea. The next day, julep of gum, four ounces, with thirty grains of liquid extract of cinchona, taken in divided doses, and an injection containing vinegar or carbolic acid. Several times a day the mouth of the patient is very carefully cleaned with a slice of lemon; morning and evening the body is sponged with a lotion containing vinegar, and is immediately rolled up in wool. This proceeding is peculiarly grateful to the patient. A glass of Seidlitz water is often given in the course of the disease, and as convales- cence sets in quinine is ordered in all its forms. PROF. S. JACCOUD, PARIS. This able clinical teacher, like most French and English physi- cians, discredits the cold bath treatment of typhoid. He abjures from the commencement all debilitating measures, such as purging. If needful, a mild laxative of Seidlitz water is given. During each twenty-four hours the patient takes a cordial mixture con- taining two or three scruples of extract of cinchona bark, two drachms of tincture of cinnamon, an ounce of syrup of orange peel, three ounces of red Bordeaux wine, and an ounce of old brandy, which may be increased, as occasion requires, to three or four ounces. The main constituent of the food is beef-soup, given at least twice daily; about eight ounces of old Bordeaux wine are allowed, and this is taken alternately with the stimulant mixture just mentioned. The ordinary beverage is lemonade, containing one-fourth -of red wine. If it appear needful, all this is supple- mented at the end of the second week by nutritive enemata twice daily. This mode of alimentation is stated to be well tolerated by the stomach and bowels. When the patient's temperature reaches 102° Fahr., with a rise in the evening not above 103°, M. Jaccoud directs that twice during the day the whole body should be well sponged with aromatic vine- TYPHOID FEVER. 359 gar. If the temperature rises higher, three, or even four, of these applications are made daily. They are continued, more or less frequently, until the close of the fever, and both comfort and benefit are derived from their refreshing and cooling effects. Should any threatenings of bronchial or pulmonary implication arise, they are met by dry cupping. BOSTON CITY HOSPITAL. The treatment at this hospital, as practiced under the surveil- lance of Drs. Stedman and Draper, is a modification of the bathing process, occupying an intermediate position between the full carrying out of cold-water' bathing and the expectant treatment. On en- trance, patients are immediately put to bed, and their diet restricted to milk, of which they are expected to drink about two and a half quarts in twenty-four hours. This is perhaps the most important part of the treatment; at first they may object to milk, but on becoming accustomed to it they take it freely. To keep up the strength is the chief aim, and if insufficient nourishment is taken, by giving a small amount at regular intervals the end sought for is accomplished. This diet is continued till the temperature has been normal for several days, when light soups and easily digested farinaceous articles are given; in a few days more, a gradual return to regular though still somewhat restricted diet is allowed. To lower the temperature sponge-baths, of equal parts of cold water and alcohol, are quickly applied to the surface of the body, which is immediately dried. In mild cases of diarrhoea nothing is done, two or three loose dejections per diem not being considered harmful; when, however, it becomes excessive it is quickly checked by a pill composed of a grain of opium and a quarter of a grain of sulphate of copper. In delirium and wakefulness, when the patient can be made to tolerate it, the ice-cap is of great benefit. The frequent use of a mouth-wash, of equal parts of glycerine and rose-water, is very pleasant to the patient, relieving the foul taste and dryness of the mouth. In very mild cases twenty drops of dilute nitro-muriatic acid may be given every two hours. Excepting the medicines above mentioned, no drugs are given, but every attention possible is shown to the comfort, nourishment, sleep and general welfare of the patient. 360 DISEASES OF THE BLOOD. THE ANTISEPTIC TREATMENT OF TYPHOID. Although this method of treatment cannot be considered as established, there has been enough testimony in its favor to com- mend it to careful consideration. In 1870 Dr. G. Wilkes, of England, recommended the administration of sulphurous acid, acidum sulphurosum, in enteric fever, and in this country Dr. J. Wesley Botkin, of Illinois {Medical and Surgical Reporter, May, 1876), and others have testified to its efficacy. The dose is from gtt.x-xx every three or four hours, in lemonade. It can be combined with opium or digitalis. It should be continued until the tongue is perfectly clean. In the Practitioner, September, 1873, Mr. Stephen Skinner reports very excellent results from the sulpho-carbolate of soda. He generally commenced with gr.xx every four hours, gradually increasing during the next four days to the full dose of gr.xxx. A larger dose than this may produce cerebral symptoms. When the diarrhoea was excessive, opium was combined with the salt. He also claims that by its early use the premonitory symptoms of the disease are dispersed, and the threatened attack aborts. SMALL-POX-VARIOLA. W. H. BARLOW, M. D. MANCHESTER, ENGLAND. Dr. Barlow has no doubt that the exclusion of light exerts a retarding influence upon the progress of the pustules in their later stages, as that, instead of acuminating in the usual way, they shrink and shrivel about the sixth or seventh day of the eruption. But some recent cases of confluent small-pox have led him to believe that death may have resulted from the exclusion of light, the poison having, by the abstraction of the accustomed stimulus, been prevented from taking its usual course to the skin, just as patients die from the suffusion of the exanthem of scarlatina or measles. This view, which he supports by the history of a number of cases, leads him to the conclusion that the mode of treatment of small-pox by the exclusion of light, although very useful in the lighter cases of unmodified, and in all cases of modi- SMALL POX—VARIOLA. 361 tied small-pox, should be employed with caution in the graver rases of a confluent character {Lancet, July 1, 1871). RESUME OF REMEDIES. Camphor is advantageously employed, particularly in confluent or malignant small-pox, when the vital power is greatly depressed. It may be given alone or in combination with opium. Carbolic Acid has been administered with marked benefit. It is more useful at an early stage of the disease, although, given afterward, it much modifies the symptoms, and hastens the curative process. 942. R. Acidi carbolici, Acidi acetici, aa f.gj-iss Tincturas opii, Spiritus chloroformi, aa f.gj Aquas, ad. f.gviij. M. A tablespoonful every four hours, till the fever subsides. After the first dose, the mixture is rather grateful to the pa- tient than otherwise. "Opium often fails to procure rest in the early stage of small-pox, but in the advanced stage of the disease patients who are wakeful, but other- wise doing well, are benefited by it, given once or twice. But neither it, nor any other anodyne, is to be given when there is copious saliva- tion and mucous expectoration, as the patient may die asphyxiated during sleep, from the secretion accumulated in the air-passages. Sodce Sulphis. The sulphites are recommended by Professor Polli, of Milan, as mitigating the febrile action, rendering the confluent and malig- nant forms benignant, shortening the course of the milder forms, and in all cases accelerating convalescence. Sulphuricum Acidum Dilutum. In confluent small-pox, treatment by dilute sulphuric acid, n^xv-xx, with gr.j of quinine, every three or four hours, together with stimulants and nutritives, is an excellent one. TO PREVENT PITTING. Amylum. A thick mucilage of starch has been used as a local application to prevent pitting, with excellent effect. The entire surface of the body should be first sponged with tepid water. Argenti Nitras. Velpeau and other French writers recommended the prac- tice of opening each vesicle on the third or fourth day of the eruption, and touching each with a stick of the nitrate scraped to a point. This, however, is a tedious and painful process, not unattended with danger. It has been recommended to wash the face on the fourth or fifth day with a strong solution of the nitrate. Calcis Aquoz. The application of cotton-wool, soaked in a mixture of equal parts of lime water and olive oil, is said to be an efficacious one. Carbolicum Acidum. Dr. H. Yates reports a case (Lancet, January 25th, 1868) treated with success by the following ointment:— 943. R. Acidi carbolici, f.gij Adipis, gij. M. The ointment was colored with lampblack, and applied thickly spread on wadding. It was changed every second day, the parts 362 diseases of the blood. first washed with soap and warm water, and then with warm water impregnated with carbolic acid. Glycerina, The following application is reooramended by J. F. Makson :— 944. R. Glycerinae. 1 Part Aquas rosae, 2 parts. M. Apply (after the pustules have discharged, and the discharge has begun to dry) freely for a few days, until the scabs begin to loosen. Hydrargyri TJnguentum. Inunction of mercurial ointment has been advised by Prof. Bennett and others, but excessive salivation may follow its use. The following ointment is employed in the Children's Hospital, Paris :— 945, R. Unguenti hydrargyri, gxxv Ceras flavae, gx Picis nigras, gvj- M. "lodinium. The tincture, applied once or twice a day, is a remedy which has been long used, Although it does not absolutely prevent pitting, it usually renders the marks and cicatrices less evident. Zinci Carbonas. Prof. Bennett, of Edinburgh, prefers the following to all other ointments:—- 946. R. Zinci carbonatis, giij Zinci oxidi, gj Olei olivas, q- s. M. The same object is said to be obtained by treating the whole sur- face thickly with powdered galamiue, This application has a very soothing effeQt. VII. DISEASES OF WOMEN. The Constitutional Treatment of Diseases of Women—Abortion— A menorrhcea — Chlorosis — Dysmenorrhea — Mammary Dis- eases— Menorrhagia— Ovarian Diseases—Pruritus Vulva and of Pregnancy— Uterine Diseases— Vaginismus— Vaginitis {Leucorrhcea)— Vomiting of Pregnancy— Vulvitis. THE CONSTITUTIONAL TREATMENT OF DISEASES OF WOMEN. HENRY M. FIELD, M. D., OF BOSTON. This writer lays proper stress upon the necessity of associating constitutional medication with topical applications in the treatment of diseases of women. He suspects that there is a too general tend- ency, in uterine therapeusis, to trust solely, or nearly so, to the" employment of local medication. For instance, in many cases of constipation, complicating uterine disorders, when the nervous system is impaired and the blood poor, to give strychnia or bella- donna, with the design of acting specifically upon a single function, and of restoring a condition of permanent health to the bowels, would be almpst as short-sighted, and almost as much of a temporary expedient, as it would be to give purgatives. The impoverished blood must first be fortified and enriched before we can look for the normal performance of any important function; and accordingly there are patients, answering the condition described, in whom a course of iron, properly regulated, is the only general therapeutic agent that is necessary. In some of his cases, he has found arsenic, and especially the arseniate of iron, very effective in removing constipation, and has sometimes received benefit from this agent when he had failed to make a successful impression with any of the more commonly used remedies. He has been very much pleased, in cases of female difficulties in which iron has been indicated, with the action of oxalate of iron, a preparation first brought to notice by Prof. Craig, of the Smith- sonian Institute. Being a light and tasteless powder, with nothing 363 364 diseases of women. repulsive in its appearance, it can be exhibited in that form to those occasional patients who are unable to swallow a pill. He values it particularly, because it is less liable to cause irritation or derange- ment of the stomach, or constipation of the bowels, where this common effect of ferruginous preparations is to be avoided, than is any other form of iron with which he is familiar. He has found it to agree with and benefit patients who, from past experience, believed themselves unable to take iron in any form. ABORTION. DR. ALFRED MEADOWS, OF LONDON. Ergot is exhibited by this author in habitual abortion dependent upon a weakened atonic condition of the uterus {Practitioner, September, 1868). He commences in small doses (n\,v-viij extracti ergotae liquoris, British Pharmacopicea), as soon as pregnancy is known to exist, and continues it in increasing doses (n\xx-xxx), as long as it may seem necessary, certainly till after the period of the accustomed abortion, but with the occasional omission of a week or two. In unsuitable cases, this mode of treatment may be product- ive of mischief, for, as Dr. Meadows remarks, its employment is a matter of extreme delicacy, requiring a very careful discrimination of the cause of previous abortions and of the actual present condi- tion of the uterus. On the general use of opium in abortion, it may be concluded, from the evidence offered, that it is of value in threatened abortion arising from accident, from mental causes, or from habit, when it may be given by the mouth, or in a cold starch injection thrown into the bowel, repeated every night, or oftener, according to cir- cumstances ; the application of cold, perfect quiet and unstimulating diet being at the same time enforced. When, however, abortion is threatened from fetal disease or imperfection, so that the prema- ture emptying of the uterus is but an effort of nature to get rid of that which she cannot accomplish, opium does harm, by retarding the emptying of the uterus, which must sooner or later take place. After abortion has taken place, opium allays excitement, tranquil- lizes the circulation, and procures sleep. AMENORRHCEA. 365 RESUME OF REMEDIES. Arsenic has been recommended in threatened abortion from irritable uterus, by Mr. Henry Hunt, of Dartmouth, England. Cannabis Indica has been found useful in impending abortion from conges- tion or irritability of the uterus. From v-xx drops of the tincture may be given every two or four hours. Drs. Clendenning, Rey- nolds, Lever and Churchill praise its effects. Plumbi Acetas is a valuable adjunct to opium in uterine hemorrhage with threatened abortion. Quinine is thought by many to act as a uterine stimulant, and to be advan- tageous in this accident. Sabina is useful against the hemorrhage which indicates approaching abor- tion in women of bad fibre. In these cases, the dried powder of the leaves may be given, in doses of gr.xv-xx thrice daily. In habitual abortion depending upon diminished vitality of the uterine system, savin has also been advised :— 947. R. Sabinas, gij-iv Aquas ferventis, f-gvj- M. A tablespoonful thrice daily, taken during the intervals of the menstrual period. This remedy must, however, be employed with caution. Tannicum Acidum, in combination with opium and ipecacuanha, has been strongly advised in threatened abortion. Terebinthince Oleum has been favorably reported upon by Dr. Fordyce Barker in the treatment of abortion ; given as an enema, he found it act as an effective oxytocic, as well as haemostatic. Ice, pounded and swallowed freely in considerable quantities, is an excellent remedy in abortion. AMENORRHCEA. PROF. R. J. GRAVES, M. D., DUBLIN. This author observes in his Clinical Lectures, that the periodicity of the function of menstruation can still be traced, even in cases where suppression has continued for a great length of time, by means of the menstrual molimina (pains in the loins, thighs, and hypogastric region, flushings, colicky pains of the abdomen, general feeling of malaise), which occur at stated intervals; in endeavoring to bring on the discharge, therefore, we must be guided as to the time the attempt should be made, by an observance of the period at which these molimina occur. For a few days before that time, our efforts to produce a determination of blood to the uterus may be judiciously employed; and if they fail, the attempt should be 366 DISEASES OF WOMEN. abandoned until a few days before the next-menstrual period. Of course, however, the general constitutional treatment must be con- stantly persevered in; one of the chief means of bringing back this evacuation being the restoration of health to the natural standard. But all such remedies as pediluvia, stuping of the genitals, leeches to the inside of the thighs, near the labia, aloes and other stimulat- ing purgatives, etc., should be only used at the times spoken of. To use them at any other period, either after the molimina have disappeared, or during the intervals between them, tends, in most cases, still further to derange nature, by determining to the uterus at an unreasonable time, when there is no natural tendency to that organ. Under such circumstances, the very same means fail, and prove injurious, which, applied so as to coincide with the time of the natural effort, would have been successful. To illustrate these principles by an example: we are consulted in the case of a young woman affected with various hysterical symp- toms for several months, and during that period more than usually subject to headache, languor, loss of spirits, diminution of appetite, and irregularity, and usually constipation of bowels; she is pale, and complains of various pains and uneasy sensations, and has not menstruated since the omission of these symptoms. Here it is evident that the constitutional treatment must be strengthening and tonic. The practitioner will therefore recommend regular hours, much gestation in the open air, a nutritive diet, and after- ward cold shower-baths; he will regulate the bowels, and afterward prescribe a course of tonic medicines, chalybeates, preparations of bark, strychnia, etc.; he will likewise inquire carefully when the last period happened, and where, and how often since that occur- rence menstrual molimina were observed. He thus ascertains when they should again recur, and contents himself with enforcing the constitutional treatment until about six days before the calculated time. Then he lays aside the other medicines, and has recourse to those means which determine to the uterus. Two leeches are ap- plied to the inside of the thigh, near the labium, every second night, until they have been three times applied. The bleeding is encouraged by stuping. On the intermediate days the bowels must be actively moved by aloetic pills; and for three nights before and after the molimina, hot pediluvia, rendered stimulating by mustard seed, may be used. During the same time also, frictions, with stimulating liniments, should be applied to the feet and legs every AMENORRHEA. 367 morning, and oil of turpentine or tincture of cantharides may be exhibited internally, while the necessity of more active exercise is inculcated. If these means fail, they must for the moment be laid aside, and the constitutional treatment must be again resumed, until the same number of days before the next period, when the list of remedies above spoken of must be again tried, and in few cases indeed shall we find them to fail. DR. PINTSCHOVIUS, OF KETZIN. 948. R. Extracti Pulsatillas, Folia Pulsatillas, aa, q. s. M. Divide into pills of three grains each ; one three times a day. J. M. DA COSTA, M. D., PHILADELPHIA. 949. R. Apiol, gr.iv. M. In the form of a granule, or " pearl," four times a day, as an emmenagogue. To be taken for three days before the expected period. Apiol is an excellent remedy for amenorrhoea when there is no uterine disease. DR. EMIL DILLENBERGER, VIENNA. Treatment demands the removal of those errors and lesions which lie at the bottom of the malady. If the amenorrhoea consists of some anomaly of the sexual organs, congenital or acquired, and such as cannot be remedied, or in some other irremediable malady, treatment is useless. If menstruation has been already established, the physician must convince himself, by a careful examination, whether or not pregnancy is the cause of the cessation of the peri- ods. Internally are used aloes and myrrh, as follows:— 950. R. Pulveris aloes, gr.lxviij Pulveris myrrhae, gr.xxxiv. Extracti glycyrrhizae, q. 8. M. For sixty pills. Two to four pills two to three times a day. 951. R. Pulveris aloes socotrinas, Pulveris myrrhas, aa, gr.xlviij Croci sativi, gr.xxxiv Extracti glycyrrhizae, q. s. M. For ninety pills. From four to six twice a day. Or, savine, as follows:— 952. R. Pulveris frondis sabinae, Sacchari albi, aa, gr.xxxiv Olei menthae piperitas, Rtt.iij. M. Divide into six powders. One to be taken three times a day. 368 DISEASES OF WOMEN. 953. R. Olei sabinas, gtt.vj-xij Sacchari albi, gr-lx- M. Divide into six equal powders. Put in waxed paper. Take one pow- der three times daily. 954. R. Pulveris frondis sabinas, gr.lxviij Croci sativi, gr-xxU Olei sabinas, gtt.viij Extracti gentianae, q. s. M. For sixty pills. From three to five pills two to three times daily. Or, direct crocus and borax, as follows :— 955. R. Boracis venalis, gr.xxxiv Croci sativi, gr.xiij Sacchari albi, gr.xxij Olei menthae piperitas, gtt.j. M. Divide into six powders. One powder three times a day. Amenorrohoea is often more certain to be cured by putting an end to serous or bloody discharges from various organs by treating for an improved condition of the blood with good nourishment and a corresponding regimen, with iron, preparations of cinchona, cold washing, etc., than by the employment of emmenagogues without any plan. For outward application, the following are useful:— Warm uter- ine douche; brushing the mouth of the womb with tincture of iodine; leeches to the portio vaginalis uteri, to the labia pudendi, to the inner side of the thighs, or to the perineum; dry cuppings and mustard poultices to the inner sides of the thighs; warm stimu- lating foot-baths, with mustard, salt, potash, or aqua regia; warm sitz baths, or half-baths; bath at Ems, etc. In many girls mar- riage is the first thing that regulates the menstruation. RESUME OF REMEDIES. Aconite may be employed, in the form of the extract, with advantage in amenorrhoea. Dr. Ringer, of London, recommends it in the sudden suspension of the menses, as from cold. Aloe, in a small enema, containing gr.x, employed at the proper menstrua' period, is said to be a very certain emmenagogue. Dr. F. Tilt, of London, recommends its internal administration combined with podophyllin. It is frequently combined with myrrh. Ammonii Murias, in the hands of Dr. Anstie, in gr.x doses, three times a day, in cases of amenorrhoea, marked rather by general feebleness than by anaemia, has occasionally seemed to conduce directly and consider- ably toward the cure. But of this as of all other emmenagogues it is pre-eminently true that it is worth absolutely nothing if not ex- hibited precisley on the fit occasion. AMENORRHEA. 369 Ammonice Aqua has been successfully employed in the form of injection into the vagina:— 956. R. Aquae ammoniae, f.gj Lactis, Oj. M. To be injected into the vagina daily. Apiol is highly recommended by Dr. Jaret (Bull. G4n. de Thirap., August 15th, 1860), as one of the safest and best of emmenagogues, not being even contra-indicated in incipient pregnancy. It is said to be especially adapted for cases attended with local or general nervous symptoms. Argenti Nitras, applied in substance lightly to the os uteri at the time of the expected appearance of the menses has proved successful in obstinate cases. Cantharides. Dr. W. T. Dewees placed much confidence in the internal use of tincture of cantharides, in doses of gtt.xx, gradually increased to gtt.xxxv or xl. Dr. T. H. Tanner, of London, combined it with bromide of potassium. Cimicifuga has been found an effectual remedy in some cases. Ergot is recommended by Dr. Tilt, of London (in doses of gr.v-x, in powder, two or three times a day). He usually gives it in conjunction with other remedies :— 957. R. Tincturas ergotae, tt\,xxx Syrupi croci, f.gss Decocti ahi'es compositi, f.giss. M. A teaspoonful three times a day. "Ferrum Redactum, and the other-ferruginous preparations, are indispensable in the anemia which constantly accompanies stoppage of the func- tion. Galbanum may frequently be combined with benefit, with the salts of iron. Hydrargyri Chloridum Mite is contra-indicated, if the patient be feeble, and is capable of doing much mischief in unsuitable cases. But Drs. Graily Hewitt, Ashwell and others have found it a decided emmenagogue. Dr. Hewitt directs that on two successive nights, at the time of the expected period, a dose be given of five grains of calomel and six grains of aloee, followed by a Seidlitz powder in the morning. Iodine frictions over the abdomen have been found to give good results. "Myrrh, in combination with iron and aloes, is a standard remedy in amenor- rhoea. Dr. Tilt, of London, recommends the following so-called "Elixir of Paracelsus" :— 958. R. Tincturae myrrhae, f.giv Tincturas croci, Tincturas aloes, aa f-giij« M. f.gij-iij, twice daily, in a little water. Ruta Graveolens. Rue is frequently prescribed with other emmenagogues. Sabina is considered by Dr. Tilt, of London, as the most reliable of a very 24 370 DISEASES OF WOMEN. uncertain set of remedies. He has never seen any ill effects from its use, though he has given gtt.xx of the oil, twice a day. He orders :— 959. R. Olei sabinas, f.gj Spiritus aetheris nitrosi, f-giij Mucilaginis, f.gj Aquas, f-Ivj. M. A teaspoonful every two hours, the bottle being previously shaken. A plaster containing the oil may also be worn over the ovarian region. Senega was first recommended as an emmenagogue by Dr. Hartshorn, of Philadelphia. He gave a pint of a saturated decoction daily during a fortnight before the expected appearance of the discharge. Sinapis. A hot mustard hip bath is often useful, the patient remaining in it for an hour each time. Sodce Biboras. Dr. Copland recommends the following:— 960. R. Sodas biboratis, gss Aloes socotrinas, Pulveris capsici, aa, gr.xx Olei lavandulae, q. s. Make eighteen pills. Take two thrice daily. Strychnia. Small doses of the extract of nux vomica, combined with aloes and myrrh are sometimes of service. Terebinthince Oleum. Turpentine enemas have been given with success:— 961. R. Olei terebinthinae, f.gss Barley water, Oj. M. For one enema, to be given once or twice a day. CHLOROSIS. This name, or that of green sickness, is given to the anaemic con- dition of young girls, associated with disordered menstrual func- tion. The blood has an excess of fibrin e, and undergoes some chemical change in its pigments which produces the greenish hue of the skin, whence the disease has its name. Under the head Ancemia (page 323), will be found a full selection of appropriate remedies for that feature of the disease; but a mere routine treatment with iron is neither creditable nor successful. Attention to hygienic conditions, baths, nutritious food, regularity of the bowels, and judicious mental and physical exercise, are first in importance. CHLOROSIS. 371 DR. FREDERICK T. ROBERTS. This writer on Practice considers aloes the best form of aperient, either the extract, or as pil. aloes cum myrrhd. For the unplea- sant sensations in the stomach, bismuth, with hydrocyanic acid, is particularly valuable. For the pain in the side often complained of, a belladonna plaster is usually efficacious. Iron is the great remedy; and it is frequently desirable to change the form of the preparation from time to time. PROFESSOR A. P. REID, OF MONTREAL. This writer (Canada Medical Record, 1875) has adopted, with signal success, in uncomplicated chlorosis, the use of liquor po- tassce, gtt.x-xv, in mucilage, thrice daily. It defibrinizes the blood, and often acts promptly for good where iron is of no avail. DR. BRETONNEAU, FRANCE. 962. R. Ferri redacti, gij Quinias sulphatis, Zingiberis pulveris, aa, gr.vij Extracti cinchonae, Extracti, aa 9j Aloes socotrinas, gr. iij. M. Divide into fifty pills. One to five a day. These pills have the advan- tage of not causing constipation. DR. GALLARD, PARIS. 963. R. Ferri carbonatis, Extracti cinchonae, aa gijss Extracti opii, gr.xv. M. Divide into one hundred pills. From two to four a day, principally at meal times. When there is constipation, this formula ought to be modified as follows:— 964. R. Ferri carbonatis, gij Extracti cinchonae, Extracti rhei, aa, giss Extracti opii, gr-xv Divide into one hundred pills. To be taken as above. RESUME OF REMEDIES. Aloes. (See above.) Bismuthi Subnitras. Sir II. Marsh states (Medical Press, March 6th, 1867) that in chlorosis bismuth is an excellent substitute for iron, when the latter is not well borne. 372 DISEASES OF WOMEN. Ergot, in five-grain doses, three or four times a day, is recommended by Dr. Churchill in chlorosis and leucorrhcea. ''Ferri lodidum. In chlorosis, accompanied by much torpor of the system, Dr. Ashwell has found this salt particularly efficacious, in the following formula:— 965. R. Ferri iodidi, gr.xvj Tincturae calumbae, f.gj Aquas, f-^vij. M. Take two tablespoonfuls twice a day. "Ferri Mistura Composita, Ferri Chloridi Tinctura, Ferri et Quinice Citras, Ferri Sulphas and. Ferri Vinum are all excellent ferruginous prepara- tions in chlorosis. Sir H. Marsh advises (Medical Press, March 6th, 1867) the follow- ing formulas :— 966. R. Liquoris ammoniae citratis, F.giij Ferri et quiniae citratis, gr.vij-xxiv Syrupi, f.gj Aquas, f-giv. M. Two tablespoonfuls three times a day. 967. R. Ferri sulphatis, Aloes, aa gr.ij Pulveris cinnamomi, gr-v. M. For two pills, to be taken at dinner-time, and repeated at night if necessary. Sodce Biboras. Dr. Copland advises the following formula:— 968. R. Sodae biboratis, 9ij Sulphuris prascipitatas, gj Mucilaginis acaciae, q. s. M, Make twenty-four pills. Three to be taken three times daily. Nux Vomica. Dr. Copland has derived benefit in some obstinate cases of chlorosis from the following formula:— 969. R. Pilulae aloes c. myrrha, gij Extracti nucis vomicae, gr.x. M. For thirty-six pills. Take one to two night and morning. Potassce Liquor. (See above.) DYSMENORRHEA. 373 DYSMENORRHEA. 970. R. Ammonii chloridi purificati, gij Extracti glycyrrhizas, gss Aquas, f-BvJ- ^. A dessertspoonful three times a day. Recommended by Dr. 0. Ward, of Tennessee, and others, in the painful dysmenorrhoea of the change of life. DR. EMIL DILLENBERGER, VIENNA. When there is evident hypersemia of the womb, several leeches to the portio vaginalis uteri, or to the insides of the thighs, warm soft poultices, or injections of lukewarm water, are very beneficial. When the dysmenorrhoea is of nervous origin, some advantage is derived from the application of warmth, warm baths, mustard poultices, or dry cuppings applied to the loins and thighs, and internally from narcotics, especially opium. 971. R. Pulveris opii, gr.j Sacchari albi, gj Olei menthae piperitas, gtt.ij. M. Divide into six powders. Take one every two to four hours. Or, 972. R. Tincturas opii, n\,xxx Infusi anthemidis, f-giv Aquas menthae piperitas, Syrupi simplicis, aa f.gss. M. One to two tablespoonfuls every one or two hours. THEODORE JEWETT, M. D., PROFESSOR OF OBSTETRICS, BOWDOIN MEDI- CAL COLLEGE. 973. R. Camphorae. gijsa Extracti belladonnas, Quiniae sulphatis, aa gss Pulveris acaciae, q. s. M. For eighty pills. One to be taken every four hours until relieved. 974. R. Extracti Scutellariae fluidi, Decocti aloes compositi, aa f.gss. M. A dessertspoonful every two or three hours until relieved. Dr. C. W. Frisbie, of East Springfield, N. Y., writes that he used the above formula in his practice many times, and, when the cases had been properly selected, with the most happy results. DR. A. DESPREZ, SURGEON TO THE LOURCINE HOSPITAL. PARIS. In dysmenorrhoea, warm water occasions congestion of the uterus, 374 DISEASES OF WOMEN. and the congestion is followed by a return of the menses, and consequently by a marked alleviation. Injections of warm water act like the cataplasm and warm lotions, which are so usefully employed in inflammation of the integument. The injections of warm water are practiced at the hospital with irrigators, of which the jet is not very strong. The water used should be of 95° to 104° Fah., and it is renewed two, four or six times in the day. This therapeutic means is convenient and not repugnant to the patient. DR. LISFRANC, PARIS. 975. R. Vini opii, gtt.x-xx Camphorae, gr.ij-ivss Decocti althaea, f.^ijss Yolk of egg, gijss. M. For an enema, to be given nearly cold, at bedtime, to relieve the pain of menstruation. Hot fomentations on the abdomen. 976. R. Assafoetidae, gj Vini opii, ttbxv Extracti Valerianae, gss Decocti althaea, f-giijss Yolk of egg, gv. M. An enema, in hysterical dysmenorrhoea. RESUME OF REMEDIES. Apiol, in the hands of Dr. Tilt, of London, acts like a charm when given in doses of four grains, so soon as the pains of dysmenorrhoea begin. It is of little use, however, when the dysmenorrhoea depends upon disease of the uterus. "Belladonna. In neuralgic dysmenorrhoea, Dr. Anstie, of London, recom- mends (British Medical Journal, August 22d, 1868) the extract, as a palliative, in doses of gr.£. lie obtained still better results from the hypodermic injection of the sulphate of atropia, in doses of gr. jhs~^jn twice a day, and continued for several weeks, at once reducing the quantity when marked dryness of the throat appeared. In con- stitutions very intolerant of belladonna in any form, the acetate of morphia may be advantageously substituted for the atropia. A bel- ladonna plaster to the sacrum is often of benefit; so also is a sup- pository of extract of belladonna. Camphor. Dr. Dewees regards camphor as a very certain and uniform pallia- tive, in doses of gr.x, every one or two hours, until relief be obtained. Or the following injection may be given:— 977. R. Camphorae, gss-j Tincturae opii, f.gj Mucilaginis, M. For an enema. Camphor liniment, or ointment, well rubbed into the loins, also affords relief. MAMMARY DISEASES. 375 Cannabis Indica is sometimes a useful remedy. Colchicum is useful in dysmenorrhoea connected with a tendency to gout or rheumatism. It should be given with blue pill every other night; flannel at the same time should be worn, and exposure to cold avoided. Ferri Chloridi Tinctura and Ferri Vinum are both excellent preparations in atonic dysmenorrhoea. Sir Charles Locock recommends the follow- ing formula:— 978. R. Vini ferri, Spiritus aetheris sulphuri compositi, aa f.gj Misturae camphorae, f-IvJ- M. Take one-fourth part every six hours. Guaiacum is often productive of the greatest benefit. The tinctura guaiaci ammoniata is especially serviceable. "Opium. Opiates are often best exhibited in the form of enemata. Dr. E. J. Tilt, of London, recommends a hot linseed-meal poultice, sprinkled with laudanum, to be applied to the hypogastrium. A single hypo- dermic injection of morphia, when the pain is habitually severe, will often be sufficient at each menstrual period. Potassii Nitras has been found highly serviceable, in doses of gr.xv-xxx, well diluted with barley water. Sinapis. Dr. Ashwell recommends the mustard hip-bath, to be repeated three or four times a day, the patient remaining in it for from thirty to sixty minutes, or even, if the pain be very severe, until faintness is induced. Sodoz Biboras is of advantage combined with extract of belladonna. Stramonium is said to be of marked benefit in the severe forms of the disease. Taraxacum. A half teaspoonful of the extract in a little warm milk, every night, proves useful, by keeping up a healthy action of the liver and skin. Veratria. Mild veratria ointment, rubbed over the hypogastric region twice a day, greatly relieves the pain. MAMMARY DISEASES. In acute mammitis, a number of observers have reported strik- ing success with the poke root:— 979. R. Fluidi extracti phytolaccas, q. s. Twenty drops every three hours. Others have "seen benefit from— 980. R. Tincturas belladonnas, Tincturae digitalis, aa f.gj. .M Ten drops every three or four hours. 376 DISEASES OF WOMEN. In chronic mammitis, Prof. Hunter McGuire, m. d., of Eich- mond, Va., condemns (Virginia Medical Monthly, September, 1875) the severe and needless practice of slitting up the sinuses, or of in- jecting them with stimulating fluids. Nearly every case can be cured by proper bandaging with adhesive plaster. Cut the plaster into strips from four to six inches in length, and from a half to three-quarters of an inch in width, according to the size of the breast. After warming the plaster, apply one end of a strip to the circumference of the gland, near the axilla. Take another strip of the same length and width, and fasten its end to the inner circumference of the breast, near the external bone. The ends of the two strips of plaster thus applied are held in place by an assistant, while the surgeon takes the free extremities of the strips, and drawing them toward each other, that is, drawing the breast from its circumference toward its centre, crosses the strips and fastens them. Two more strips are then applied just below, and lapping slightly the first two pieces. Continue in this way till the whole breast is covered (somewhat upon the same principle and manner that we use strips in an indolent sore on the leg), leaving the nipple and fistulous orifices uncovered. A piece of moistened lint is placed over the sinuses, to catch the pus which escapes. DR. ASHBURTON THOMPSON, LONDON. Speaking of mammitis, this writer {Medical Times and Gazette, January, 1875) mentions two modes of treatment, the administra- tion of tincture of aconite, and the total abstention from fluids during the necessary number of days. By giving minim doses of aconite every hour, he had succeeded in cutting short inflammations of the breast which there was no doubt would otherwise have run on to suppuration very frequently; indeed, in three cases out of four. In cases of still-birth, he had hitherto found abstention from fluids sufficient in every case to avoid every kind of mammary disturb- ance. Ice was allowed in moderate quantity, and no other fluid, from the time of delivery until the fourth or fifth day, when the breasts generally return to their normal state of quiescence. The deprivation of fluid caused but little distress. MR. ROBERT DRUITT, LONDON. 981. R. Acidi tannici, gr.iv Aquas destillatae, fgvj. M. This solution, as well as ointments and glycerites of tannin, is useful in cracked nipples. It should be applied on lint covered with oiled silk. MAMMARY DISEASES. 377 DR. BLACQUIERES, FRANCE. 982. R. Extracti kramerias, gr xv Olei amygdalae dulcis, f zgs Butyri cocoae, 3gsg> M *^£^$3&1'h** the ^ *" -sed to nurse 983. R. Zinci oxidi, Sodas boratis, aa -88 Olei amygdalae dulcis, f ?i8S Butyri cocoas, £?v Ole, bergamn, ^tv> M A useful liniment for cracked and chapped nipples. GERMAN HOSPITAL, PHILADELPHIA. 984. R. Extracti opii, igs Liquoris calcis, *-v Olei amygdalae dulcis, f'|:jj Dvigoroushiey.eXtraCt °f °piUm in ^ lime-™ter> *dd the oil, and shake MR. ERASMUS WILSON, LONDON, The mucilage of acacia is a useful application to sore nipples It should be penciled on the part immediately after suckling, and the nipple then be protected by a leaden shield. Or the following powder may be applied :— 985. R. Acaciae gummi pulveris, Sodas biboratis, aa gss. M. DR. HUEBNER, DRESDEN, SAXONY. The treatment pursued by this obstetrician in all lesions of the nipple and areola consists in the constant application, day and night, of lukewarm compresses, wet with lead-water; fissures, ulcers, and excoriations being touched once or twice a day with balsam of Peru, and the breast well supported. The child should nurse less often than usual, and, where possible, through a nipple- shield. He recommends the warm lead-water in mastitis also to be followed by strapping of the breast and free incision, while sup- puration is promoted by poulticing. 378 DISEASES OF WOMEN. MENORRHAGIA. DR. RACIBORSKI, PARIS. 986. R. Ferri redacti, gj Extracti nucis vomicae, gr-xij Mucilaginis acaciae, q. s. M. Divide into sixty pills. From two to four morning and evening, for chlorotic young girls whose menstruation is too profuse. DR. EMIL DILLENBERGER, VIENNA. The treatment of the Vienna school comprises rest, horizontal posi- tion with the pelvis elevated, low diet, and cooling drinks, such as:— 987. R. Acidi tartarici, gr.x-xxij Syrupi aurantii floris, f.gvj Aquas, f-gxv. M. For drinking. 988. R. Tamarindi, gj \ Fiat decoctum librae unius. (Acidi sulphurici aromatici, f-gj-ij) Syrupi rubri, f-gss-j. • M. For drinking. 989. R. Acidi sulphurici aromatici, f.gij Syrupi rubri, f.gj. M. One to two teaspoonfuls in a glass of water as a drink. These directions and prescriptions, together with pure air, only moderately warmed, in the room, are some of the most important points which alone will often restrain rather free bleeding. When there is passive hemorrhage, use cold dressings, injections of cold water, or the following astringents:— 990. R. Aluminis, Aquae, For vaginal injections. 991. R. Acidi tannici, Aquas, For vaginal injections. 992. R. Zinci sulphatis, Aquas, For vaginal injections. 993. R. Catechu, Aquas, For vaginal injections. gb'-ivss f-gxv. M. g88-iv f-gxy. M. gr.x-xxxiv Oj- M. gii f-^xv. M. MENORRHAGIA. 379 994. R. Extracti kramerias, gij Aquae, f-gxv. M. For vaginal injections. Plugging the vagina is also an effectual remedy. Among internal remedies, those that have generally shown them- selves the best are :— M. M. M 995. R. Ferii chloridi, Tincturas opii, Syrupi tolutani, Aquas, A tablespoonful every one to two hours. gr-xvj gtt X f.gij f-gvj. 996. R. Pulveris ergotae, Sacchari albi, Olei cinnamomi, aa, gr.xxxiv Divide into six doses. One powder every five minutes. 997. R. Extracti ergotae fluidi, Syrupi acaciae, Syrupi auranti floris, Aquas, n\xx-xl f-gij f.gss f-giij One tablespoonful four times a day. 998. R. Extracti kramerias, gr.vj-xx Aluminis, Sacchari albi, aa gr.xxij Olei cinnamomi, gtt.j. M. Divide into six powders. One powder every two to five hours. 999. R. Aluminis, gr.xxxij Tincturae cinnamomi, f.gij Syrupi auranti corticis, f-gss Aquas cinnamomi, f.giv. M. One tablespoonful hourly. Hemorrhage during pregnancy requires complete repose of body and mind, horizontal posture and acid drinks. The employment of other remedies depends on the answer to the question whether the physician can stay the bleeding without pregnancy being inter- rupted In the negative case, cold applications on the abdomen, or injections, introduction of bits of ice into the vagina, or plug- ging the vagina, are proceedings to be recommended. Bleeding which arises from the bursting of varicose vessels in the vagina requires to be treated with cold compression, plugging, hgature or transfixion of the bleeding vessels. The bleeding which occurs in mole pregnancies is stayed by the delivery of the moles. 380 DISEASES OF WOMEN. T. HAWKES TANNER, M. D., F. L. S., LONDON. 1000. R. Acidi gallici, gr.xv-xxv Acidi sulphurici aromatici, m^xy-xx Tincturae cinnamomi, f-gij Aquas destillatae, q. s. ad. f.gss. M. For one dose. Mix with two or three tablespoonfuls of water, and take every few hours, in profuse menorrhagia, until the bleeding ceases. PROFESSOR T. GAILLARD THOMAS, NEW YORK. This author says that in case of menorrhagia the patient should be kept perfectly quiet upon her back; cloths wrung out of cold water should be laid over the uterus, vulva and thighs; cold acidu- lated drinks should be given freely; and the injection of all warm fluids strictly interdicted. In addition, the apartments should be kept cool, the nervous system quieted by opium or an appropriate substitute, and all conversation prohibited. In mild cases this may suffice, but in severe ones it will not. Then the speculum should be introduced, a sponge-tent passed into the cervix, and the vagina filled with a tampon. This will rarely fail. But in certain cases, as, for instance, those of cancer of the neck, the tent will not be admissible. Under these circumstances, a soft sponge or wad of cotton should be saturated with a solution of tersulphate of iron, laid upon the cervix, and the tampon placed against it, or a small linen bag may be filled with powdered alum, placed in contact with the cervix, and held in place by a tampon; or two drachms of tannin may be left free against the part. To these means almost all cases will temporarily yield, more especially if the use of the tent is admissible. EDWARD JOHN TILT, M. D., M. R. C. P., LONDON. 1001. R. Olei terebinthinae, f.gss Tincturae capsici, f.gss Tincturae ergotas, f.gj Tincturae lavendulas compositae, f-Sib ^. In cases of uterine hemorrhage, give from half a drachm to a drachm of this mixture in milk, after shaking the bottle. In severe flooding after parturition, from half an ounce to an ounce may be given in plenty of milk, with good results. PROFESSOR ELLERSLIE WALLACE, PHILADELPHIA, 1002. R. Aloes, gr.v Olei tanaceti, gtt.xl Cantharidis, gr.vij Ferri lactatis, £)iv. M. Make a mass ; divide into twenty-eight pills. One morning, noon, evening and night, as an emmenagogue. MENORRHAGIA. 381 J. G. SWAYNE, M. D., PHYSICIAN ACCOUCHEUR TO THE BRISTOL GENERAL HOSPITAL, ETC., ENGLAND. The following formulae are of service in cases of accidental hemorrhage during pregnancy:— 1003. R. Acidi sulphurici diluti, f.gj Tincturas opii, tt\xl Infusi rosas compositi, f.gvj. M. Two tablespoonfuls every other hour. 1004. R. Plumbi acetatis, Acidi acetici, Morphiae acetatis, Aquae destillatae, Two tablespoonfuls every hour. The woman is also, of course, to be kept in a recumbent position, and cold compresses applied to the abdomen and vulva. Cold drinks and cold water enemata may be administered. By the employment of these expedients, the bleeding may be checked and the patient carried in safety to the close of her pregnancy. PROFESSOR FORDYCE BARKER, M. D., NEW YORK. In uterine hemorrhage at the change of life, this teacher adopts the following treatment:— Where the uterus is found to be increased in size and weight, he directs the patient to use, for a week previous to the return of the expected period, suppositories made after the following formula :— 1005. R. Extracti ergotae aquas (Squibb's), 9ij Cacao butter, gj. M. Divide into suppositories No. xij. One of these suppositories is to be introduced into the rectum morning, noon and night; and they must be carried far up into the bowel, and the patient must keep the recumbent posture for at least one hour. These are to be continued for a week previous to menstruation, and also throughout its duration. Ergot in this manner, rather than by the hypodermic syringe, avoids the risk of troublesome abscesses in the tegumentary walls of the abdomen. Now, if the hemorrhage is prolonged, although not excessive, he infers that there is some lesion affecting the lining membrane of the uterus, and then resorts to another plan of treatment, which it is rarely found necessary to repeat in any case beyond the second menstrual return. In those cases, he introduces into the cavity of gr.xvnj ttlxx f-gvj. M. 382 DISEASES OF WOMEN. the uterus cylinders of iodoform made according to the following formula:— 1006. R. Iodoformi, 31.)88 Gum tragacanth, gr.xv Mucilaginis, Ml Divide into cylinders No. x, each one and one-half inches in length. One of these cylinders is to be carried completely into the cavity of the uterus, and a pledget of cotton introduced against the cer- vix, to retain it in position. Introduce one of these cylinders daily for five or six days previous to menstruation. The only objection to them is the excessively disagreeable odor which attends their use. RESUME OF REMEDIES. Alumen often proves successful in controlling the hemorrhage. Dr. E.J. Tilt, of London, says that in uterine hemorrhage alum, in solution with sulphuric acid, is the first remedy to try. Argenti Oxidum is an efficient remedy in menorrhagia. More than three grains daily should not be given. Arseniosum Acidum. Fowler's solution is said to check uterine hemorrhage, given at first in the dose of nix-xx, and repeated in n\,x doses every twenty minutes until the discharge ceases. This remedy must not, of course, be pushed too far. "Cannabis Indica. Dr. Churchill, of Dublin, obtains from the tincture of Indian hemp, in doses of gtt.v-x, thrice daily, remarkable success in the treatment of menorrhagia and uterine hemorrhage. Cimicifuga. Dr. Ringer, of London, says this remedy will certainly arrest menorrhagia, though he regards it as inferior in this affection to the bromide of potassium. Digitalis is useful in menorrhagia and other forms of uterine hemorrhage, unconnected with organic disease. Dr. E. J. Tilt, of London, em- ploys the following:— 1007. R. Tincturae digitalis, f-gij Acidi hydrocyanici diluti, Tt^xxx Morphias acetatis, gr.j Aquas, ad. f.gvj. M. A dessertspoonful every two or three hours. Erqota though not equally beneficial in all cases, is a useful remedy in men- orrhagia. Dr. Waring-Curran states (Medical Press, November 17th, 1869) that it proves most useful in that form of menorrhagia which occurs in women of a scrofulous habit, who suffer from con- stipated debility, and in whom leucorrhosa exists as a consequence of previous hemorrhage. He gives freshly prepared infusion of ergot and borax in menorrhagia from obstructive cardiac disease, in that associated with a diseased portal system, in that consequent upon a Bcorbutic state of the system, and in genuine menorrhagia (i. e., an increase of the catamenia, continuing for a lengthened period, and returning before the proper period, without organic lesion). He finds it has little or no effect in menorrhagia dependent upon ulcera- MENORRHAGIA. 383 tion of the os, the presence of polypous growths or other tumors, or in that arising from retro-flexion of the uterus. Ergotin, subcutane- ously, should not be neglected. Ferri Chloridi Tinctura may frequently be given with advantage in atonic cases. "Gallicum Acidum was much employed by the late Sir J. Y. Simpson, of Edinburgh, in atonic menorrhagia. He gave it in doses of gr.x, xv or xx daily, and continued its use during the intervals, as well as the period of discharge. Dr. E. J. Tilt, of London, while testifying to its value as an astringent in many cases, finds that it often fails when the hemorrhage depends upon organic lesions. Ipecacuanha, in full emetic doses, is often productive of the best results. Under the use of gr.xx of the powdered root, in the evening, followed by an acidulated draught in the morning, the discharge frequently ceases in twenty-four hours; if a relapse occurs, a repetition of the emetic seldom fails to make the cure permanent. Dr. Tyler Smith thus explains its action in these cases: by its emetic power, it excites contraction of the abdominal muscles and compression of the uterus, which may, in turn, re-excite some amount of uterine reflex action ; but beyond this, it appears to have a special action upon the uterus, increasing its contractile power beyond what could be imagined to occur from the merely secondary effects of vomiting. Ipecacuanha thus appears to influence the medulla oblongata and the lower medulla spinalis. This double action upon the extremities of the spinal centre is very extraordinary. Krameria is particularly useful in menorrhagia occurring about the usual time of the cessation of the menses. Dr. Dewees employed the following formula :— 1008. R. Extracti kramerias, gij Pulveris rhei, gss Syrupi, q. s. M. Divide into forty pills, and order two thrice daily. Magnesice Sulphas is recommended by Dr. Graily Hewitt, of London, who found a mixture containing very small doses of this salt, with a little dilute sulphuric acid and syrup, very useful during the time of the catamenial flow. Matieo. The pounded leaves, made into a paste and introduced into the vagina, are said to arrest the hemorrhage after the failure of a strong solution of nitrate of silver. Plumbi Acetas often succeeds in severe cases, when given in enema:— 1009. R. Plumbi acetatis, gr.xv-xx Tincturae opii, ULxl Mucilaginis, f.gij. M. For an enema. In mild cases, the internal administration of sugar of lead and opium is usually successful. "Potassii Bromidum is a favorite remedy of Dr. Ringer, of London, who lays down the following rules for its administration in menorrhagia :—If the loss of blood occurs only at the natural menstrual period, it will be sufficient to begin the medicine about a week before the discharge is expected, and when this has for a time ceased, it should be discon- tinued till the next attack is about to begin. If, on the other hand 384 DISEASES OF WOMEN. the loss of blood occurs every fortnight, or oftener, it should be given without any intermission, till the disease is well controlled ; and when the discharge has been brought to its right period and amount, a few doses should be given for a short time before each monthly period. It has less control over uterine hemorrhage due to tumors of the uterus than ergot and other remedies. "Tannicum Acidum, alone or combined with a small portion of dilute nitric acid, has often the happiest effects. Zinci Sulphas, in doses of gr.j-ij, in pills, thrice daily, is often useful in the atonic forms of menorrhagia. VAGINAL INJECTIONS. Alumen. Dr. E. J. Tilt, of London, orders, in purely atonic case of men- orrhagia, the following vaginal injection :— 1010. R. Aluminis, gj Decocti quercus albas, Oj. M. This injection is inadmissible if inflammatory symptoms be present. Ferri Chloridi Tinctura, with equal parts of water, has been injected with success. Galla. Decoction of galls (gj|, aquas Oj), daily injected into the vagina, warm or cold, according to the feelings of the patient, is occasionally useful. Quercus Alba. The decoction, with or without alum (gj, ad. decocti Oj), is a serviceable and safe vaginal injection. OVARIAN DISEASE. PROFESSOR J. MATTHEWS DUNCAN, EDINBURGH On the subject of acute and chronic ovaritis, this author states there is no specific treatment. In chronic cases, two, three or four leeches may be applied to the cervix uteri, through a speculum, after the monthly periods. Croton oil liniment, or antimonial lini- ment, or a blister, may be applied to the inguinal canal adjacent to the affected gland. The bowels should be regulated by gentle saline laxatives. Leucorrhcea, if present, should not be actively treated, but by mild injections only. Mercury and iodide of potas- sium may be given in small doses. J. WARING-CURRAN, L. K. AND Q,. C. P. I., ETC. For ovarian neuralgia;— 1011. R. Ammonias muriatis, gij Tincturae aconiti, f.gij Syrupi aurantii corticis, f-gviij. M. A teaspoonful thrice daily in the treatment of ovarian neuralgia. OVARIAN DISEASE. 385 Our author states that this combination has almost a mao-ical influence in many cases. He reports {Medical Press and Circular August 19th, 1868), six cases in which various sedatives and ano- dynes had been tried in vain. In all he found that before the above mixture was finished by the patient the pains had entirely ceased. J Dr. T. J. Newman, of Chicago, confirms the usefulness of this mixture and records (in the Chicago Medical Examiner, for November, 1869), three cases of neuralgia of the ovaries treated by it with success, after the failure of other remedies. In the same painful complaint, Dr. K. Bartholow has obtained excellent results from the following recipe:__ 1012. R. Extracti belladonnas, „r.iv Extracti stramonii, gr'v Extracti hyoscyami, gr'v Quiniae sulphatis, Qij M ^S^ioXf66 MmM ° dayln °™ia" '»—«» ^ RESUME OF REMEDIES. Ammonice Marias is often efficient in ovarian neuralgia. Antimonii et Potassii Tartras. Counter-irritation by means of tartar emetic ointment is of service in subacute ovaritis/ Dr. Graily HewitT of London, advises together with this counter-irritation over the seat of the disease, the following internal treatment :— 1013. R. Pulveris opii, gry Extracti cannabis indices, Camphorae, aa gr.x. M. Divide into ten pills; one to be taken night and morning. Atropia, hypodermically, tI^V grain in ovarian neuralgia. Camphora; is very serviceable in ovarian pain. Hydrargyri TJnguentum. Dr. E. J. Tilt, of London, recommends in subacute 0V3iTltlS"~" 1014. R. Unguenti hydrargyri, %{\ Extracti belladonnas, gj Cerae, ?[; Adipis, gj. M Warm water enemas, and gentle aperients (castor oil), should ac company the treatment. *Unum. Large, light and soft linseed-meal poultices afford often the greatest relief in ovarian inflammation. *Opium. Pessaries of opium (gr.ij) frequently give the utmost relief in ovarian pain and irritation. 25 386 DISEASES OF WOMEN. "Terebinthince Oleum. Hot turpentine epithems applied over the seat of the disease are very useful. Blisters over the ovarian region are sometimes of service in subacute ovaritis. Enema. Warm water enemas (simple or medicated), retained as long as possible, are of great benefit. Ice, applied in a bag to the painful spot, is said by Dr. E. J. Tilt to relieve severe pain in acute ovaritis. Leeches may often be applied to the groin or inside the thigh with good effect. PRURITUS VULVM. PROFESSOR T. GAILLARD THOMAS, NEW YORK. This teacher believes that pruritus vulvae is usually excited by an irritating leucorrhoeal discharge in the lower part of the vagina {American Journal of Obstetrics, February, 1873). Cervical endometritis and abnormal growths, seat worms, the pediculus pubis and saccharine urine are other causes. For the first-mentioned variety, Dr. A. R. Jackson, of Chicago, has used, with gratifying results, the following:— 1015. R. Zinci sulpho-carbolatis, gss Aquae, f-gviij. M. Wash the parts twice daily, leaving it to dry upon the surface. PROFESSOR CARL SCHROEDER, ERLANGEN. Of actual curative agents, this writer (Ziemssen's Oyclopcedia) can only speak with confidence of— 1016. R. Acidi carbolici, gtt.iv-1 Glycerinae, Aquae, aa f.gss. M. Apply locally. He says of this combination:—" I am sure that whoever has once tried this will never return to any of the other remedies which have been recommended." A. C. GARRATT, M. D., BOSTON. 1017. R. Acidi hydrocyanici (Scheele's), f.gij Liquoris plumbi subacetatis, f.giv Aquae, f.giij. M. As a local application. PRURITUS VULV.E. 387 Dr. Horatio R. Storer states that he has long given great com- fort in this affection by Oldham's ointment of hydrocyanic acid and acetate of lead, with cocoa butter. Dr. G. S. Jones, of Boston, has employed with benefit, in pru- ritus of the vulva, the following:— 1018. R. Sodas biboratis, gj Camphorae, gj Olei gaultherias, gtt.xxx Aquas bullientis, Oij. M. When cool, pass through a cloth. To be used cold, as a wash for the parts, and as an injection into the vagina. RESUME OF REMEDIES. LOCAL APPLICATIONS. Ammonii Murias, in the following ointment, is useful:— 1019. R. Ammonii muriatis, gj Pulveris helleboris albas, gss Adipis, giij. M. Ammonice Aquce sometimes succeeds in obstinate cases like a charm, when injected in diluted form into the vagina :— 1020. R. Ammoniae aquas, f-g8s-j Aquas, Oss. M. To be freely injected into the vagina. Argenti Nitras. Dr. Graily Hewitt, of London, states that in obstinate cases a rather strong cauterization of the os uteri, with the solid nitrate, will sometimes succeed when other measures fail. Calcis Aqua, applied warm, together with perfect rest and light clothing, will sometimes afford the desired relief. Camphor, in powder, with starch, dusted over the parts, sometimes removes the distressing symptoms. "Chloral, by Prof. J. R. Black, of Ohio:— 1021. R. Chloral hydratis, giij Aquae, giv. M. Apply locally. "Chloroformum. Dr. Graily Hewitt, of London, obtains the greatest benefit from the application of— 1022. R. Chloroformi, f.gss Olei amygdalae expressi, f.giij. M. Oreasotum. A weak solution is sometimes useful. Hydrargyri Oxidi Rubri TJnguentum, well diluted with cod-liver oil, is fre- quently an effectual application. 388 DISEASES OF WOMEN. "Hydrargyri Chloridum Corrosivum. The favorite formula of Erasmus Wilson, of London, is the following :— • 1023. R. Hydrargyri chloridi corrosivi, gr.v-x Spiritus rosmarini, Alcoholis, aa f.gj Misturas amygdalae amaras, f-Ivj. M. Another formula, said to be effective, is given by Dr. Milton (Medical Press, March 11th, 1868):— 1024. R. Hydrargyri chloridi corrosivi, gr.iv Bismuthi oxidi, gr.xxx Acidi hydrocyanici diluti, TT\,xxx Aquas calcis, ad. f.gviij. M. Apply warm, twice or thrice daily. Hydrargyri TJnguentum is advised locally by Dr. Ringer, of London. Hydrocyanicum Acidum Dilutum is recommended, largely diluted, by Dr. West, of London. It must not be applied too freely nor over abraded surfaces:— 1025. R. Acidi hydrocyanici diluti, tr^x-xl Glycerinae, f.gj. M. lodinium. The tincture, locally applied, often affords relief. Morphia, subcutaneously, deserves trial in severe cases. "Olivce Oleum, spread over the parts with a feather, sometimes allays the pruritus. Plumbi Subacetatis Liquor Dilutus. The following soothing application is a useful one:— 1026. R. Liquoris plumbi subacetatis diluti, f.gj Tincturae hyoscyami, f.gij Misturae camphorae, f.gviij. M. To be applied tepid. Rest and an antiphlogistic regimen are at the same time to be ordered. Sodii Boras. The following formula is advised by Dr. West, of London :— 1027. R. Sodii boratis, giv Morphiae muriatis, gr-viij Aquas rosas, f.gx. M. Sodce Chlorinates Liquor, diluted, has been employed with success:— 1028. R. Liquoris sodas chlorinatas, f.gvj Aquae, f.gxij. M. Sodii Sulphis has been favorably reported on. 1029. R. Sodii sulphitis, gj Aquas, f.giij Glycerini, f,gj. M. UTERINE DISEASES. 389 UTERINE DISEASES. Chronic' Uterine Catarrh {chronic endometritis). Much can sometimes be done by bringing the habits in accordance with hygienic rules, the administration of tonics, especially ferruginous ones, and the occasional use of mild cathartics, as castor oil and the.saline mineral waters. Baths, cold, sponge, sea or salt, are re- quired. Of specific internal remedies, the only one deserving much at- tention is ergot. This should be administered regularly, in the form of the fresh powder, the fluid extract, or by hypodermic injection (gr.iij of the aqueous extract every other day). Undoubtedly, in many instances, this drug sets up a new uterine action, which, with other favoring circumstances, alters and arrests the mucous dis- charge. As is remarked, however, by Dr. W. Playfair, of King's Col- lege, London, in many long-standing cases of uterine catarrh it is vain to expect a permanent cure by any means which do not act directly on the seat of the disease, which is the lining membrane of the cavity of the uterus and cervical canal beyond the external os; accompanied, of course, with secondary morbid states of the body of the uterus and cervix, such as hypertrophy, congestion, etc. Rest, applications to the exterior of the cervix, and general treatment will unquestionably cause a temporary improvement, but on a recurrence to the old habits of life all the old symptoms return. There are serious objections to intra-uterine injections, unless the os is first dilated with laminaria tents, as they are apt to bring on severe uterine colics. By means of fine probes of whalebone or flexible metal, round which a thin film of fine cotton- wool is wrapped, alterative applications can readily be made to the interior of the uterus, without pain or danger. In the very numerous cases in which this plan of treatment has been carried out, in no single instance has anything but the greatest benefit accrued. It is no doubt advisable to select the cases judiciously, and where there is much uterine tenderness intra-uterine treatment should be postponed until this has been diminished by rest, leeching, etc.; but with proper precautions the treatment is perfectly safe. A concentrated solution of carbolic acid, eighty parts to twenty of water, is used, and it acts so well that for a long time nothing else 390 DISEASES OF WOMEN. has been employed. After the first application the discharge is sometimes increased, but after the second or third it is generally greatly diminished, and a single application is often sufficient to cure superficial erosions of the cervix. As a rule, there is no difficulty in passing the probes, as in true uterine catarrh the os is invariably patulous. DR. F. A. GALLOIS, PARIS. 1030. R. Morphias muriatis, gj-ij Sacchari, gr-iv Ceras albas, gj Butyri cacao, gss. Melt over a slow fire the cocoa butter and the wax, incorporate the sugar and morphia, carefully triturated together, and when the mixture is on the point of forming a mass run it into four horns of paper, and allow it to cool. These vaginal suppositories are useful in painful affections of the uterus, rectum and bladder. DR. ROBERTS, MANCHESTER, ENGLAND. In ulcerations of the os, this writer, while commending the car- bolic application, does not consider the strong acid necessary in superficial ulceration. A mixture of one part of the strong acid with two of olive oil seems to answer all ordinary purposes; but in cases of very deep ulceration the use of the strong acid may be called for. In such cases, Dr. Roberts desires the acid to be liquefied by the addition of a very small quantity of water. This has not been found always to answer the purpose, but it has been noted that the addition of a few grains of camphor will dissolve the acid, and will, moreover, prevent it again becoming solidified, even at a freezing temperature. The application of the carbolic oil to the os uteri is best effected by soaking a little cotton-wool in the liquid, securing it by a string, and introducing it through a speculum, the string being left depending out of the vagina, and the patient being directed to pull it away on the second day. This procedure is repeated in ordinary cases about twice every week. If it be desired to apply the acid to the cervical canal, it may readily be done by passing in a gum-elastic catheter smeared with the carbolic oil. UTERINE DISEASES. 391 INTRA-UTERINE MEDICATION. PROFESSOR CARL SCHROEDER, OF ERLANGEN. As cautions in the use of intra-uterine injections, this author mentions:— 1. Tenderness or inflammation of the uterus or its appendages. 2. There must be a free exit of the injected fluid; hence°it is better first to dilate, in every case, the uterine neck. 3. Only a small quantity of fluid must be injected. 4. The fluid should be slightly warmed, and slowly injected. 5. Where there is flexion of the uterus it is advisable to draw the fluid back into the syringe after a minute or two. Of substances used, probably the solutions of alum and iodine are the most useful, as these do not form precipitates with the albumen of the discharge, as iron, acetate of lead, nitrate of sil- ver, etc. Dr. Robert Barnes remarks {British Medical Journal, Janu- ary, 1873), that a most precious way of applying almost any medicinal agent to the interior of the uterus is in the form of an ointment or pasma. They can be introduced by means of a hollow sound, with a piston working in its centre, the "ointment positor." Where grease is objectionable, glycerine, cocoa butter, cosmoline, vaseline, etc., may be used. Thus bromine, iodine, mercury, etc., can be safely applied. Dr. W. W. Wilkens recommends {Transactions of the New Hampshire State Medical Society, 1875) the following as admira- bly adapted to chronic uterine catarrh:— 1031. R. Acidi carbolici, Aquas, Dissolve and add:— Glycerinae, f.g88. m. This mixture will not cauterize or destroy tissue, but acts as a healthy stimulus. None or little pain follows its use. It should be applied to the entire mucous membrane of the womb about once in ten days. THE MEDICAL TREATMENT OF UTERINE TUMORS. Fibroid Tumors. From numerous sources, lately, the assertion has been made that interstitial fibroid tumor of the uterus can be 3j f.^88 392 DISEASES-OF WOMEN. treated hypodermically by the aqueous solution of ergot with emi- nently more satisfactory results than by any other mode of treat- ment, or by operation. 1032. R. Ergotinas (Bonjean's), gj _ Glycerinae, f.gj Aquas destillatae, f.gj. M. Inject twelve drops daily, hypodermically. Dr. Lombe Atthill (of Dublin) prefers a solution of the ex- tractum ergotae liquidum (B. Ph.), one part to two of water, of which he injects fifteen to twenty minims. Uterine Polypi. The chloride of calcium, once popular as a remedy for goitre, has recently been advocated by various Irish physicians as efficient in bringing about the expulsion of uterine polypi {Irish Hospital Gazette, September 15th, 1874). The form- ula is:— 1033. R. Liquoris calcii chloridi, f.giv Tinctura ferri chloridi, Spiritus chloroformi, aa f.gj Tincturae aurantii, f"3y.. Infusi calumbas, f-gvij. M. Two tablespoonfuls three times a day. These polypi can, also, in many instances, be expelled by the administration of ergot, either by the mouth or subcutaneously. In the hemorrhage which accompanies these growths, perhaps the best injection is of solution of subsulphate of iron, as follows:— 1034. R. Liquoris ferri subsulphatis, f.gss Aquas, f.gij. M. To be used for intra-uterine injections. This strength cannot be exceeded with safety, and frequently one-half the amount of the salt will be sufficient. Prof. Jones, of the Medical College of Georgia, and other South- ern physicians, have claimed that the free administration of muriate of ammonia brings about the discussion of fibroid tumors of the womb, hypertrophic contractions of the uterine walls, and allied troubles. It may be alternated with ergot. In cockscomb granulations of the os, the best application is strong cider vinegar or crude acetic acid. It may be poured into a speculum and allowed to cover the diseased portion for about five minutes. This should be repeated every other day. Nitrate of UTERINE DISEASES.' 393 silver is liable to excite severe hemorrhages if applied to this form of erosion. In simple ulcerations of the os much good often follows the use of iodo-tannin:— 1035. R. Iodinii, gj Acidi tannici, f.gj Aquas, Oj. M. Filter and evaporate to giv. To be applied to the ulcerated surface. Or, for extemporaneous use :— 1036. R. Tincturas iodinii, Tincturas gallae, aa f.gss. M. For local use. UTERINE ULCERATION. DR. SAINT GERMAIN, PARIS. 1037. R. Acidi tannici, giij Glycerinae, f.giij. M. Prepare little bags of gauze about an inch and a half long and a little larger than the thumb, fill them with dry linseed meal, and after having immersed them in the above solution introduce them into the vagina for the relief of the pain accompanying ulceration of the uterine neck. One is allowed to remain in place for several days and then remove; after free injection of the vagina, a new sachet is in- troduced. When the pain is very acute, the above solution may be replaced by the following:— 1038. R. Extracti belladonnae, gij Glycerinae, giij. M. To be applied as above. CANCER OF THE UTERUS. 1039. R. Acidi sulphurici, f-gijss Aquas destillatae, fgxv. M. The patient being recumbent on the back, with the pelvis elevated, a glass speculum is introduced and a teaspoonful of this acid solu- tion is introduced in contact with the cancerous ulceration, and retained there for five or six minutes, after which it is replaced by simple water. This operation is to be repeated twice a day. It is alleged that under the influence of this treatment the hemor- rhages are more rare and less grave, and that the progress of the cancer is retarded. 394 DISEASES OF WOMEN. PROF. E. TROUSSEAU, PARIS. 1040. R. Belladonnas folias, Stramonii folias, aa gss Aquas, Oiss. Boil down to a pint, strain, and add, 1041. R. Tincturae opii, f-gss-j. This liquid is administered in the form of vaginal injections, to relieve the pains of uterine cancer. It is poisonous if given as enemata. VAGINISMUS. This common and distressing affection is frequently a neurosis, t without visible cause; but it is also, at times, owing to herpes, vaginal fissure, hypertrophied and painful papillae, mucous patches, or disease of the urethra. These various conditions require appro- priate treatment. DR. EUGENE BOUCHUT, PARIS. 1042. R. Extracti kramerias, gss Butyri cacaonis, gj. M. Make twelve suppositories. One to be introduced into the vagina night and morning. Valuable where there is vaginal fissure. PROFESSOR CARL SCHROEDER, OF ERLANGEN. Bathe the external genitals cautiously with dilute lead-water, and afterward, when the redness has subsided, pencil the sensitive parts with:— 1043. R. Argenti nitratis, gijss Aquae destillatae, f.gj. M. Or with, 1044. R. Acidi carbolici, gr.x Aquae, f.gj. M. VAGINITIS—VAGINAL CATARRH—LEUCORRHCEA. 395 VAGINITIS-VAGINAL CATARRH-LEUCORRHCEA. DR. T. FINCH, OF ILLINOIS. 1045. R. Potassas chloratis, giv Potassae permanganatis, gr.x Aquas, Oj. M. Inject a teacupful morning and evening, in acute vaginitis. Warm sitz-baths and saline laxatives are important accessories (Chicago Medical Examiner, December, 1874). DR. J. N. DEMARQUAY, PARIS. 1046. R. Acidi tannici, gr.xv-xxx Glycerinae, f-gijss. M. Tampons of wadding immersed in this solution are introduced into the vagina after the acute symptoms have been relieved by baths, emol- lient injections and repose. M. MAISSONNEUVE, PARIS. 1047. R. Ferri sulphatis, gijss Aquas, Oj. M. This solution is advised in injections in vaginitis. After each injection a certain quantity of starch is to be introduced into the vagina. DR. EDMOND LANGLEBERT, PARIS. 1048. R. Tincturae iodinii, f-gv-x Aquas destillatae, Oij Potassii iodidi, q. s. to prevent the precipita- tion of the iodine. M. A useful injection in vaginitis after the acute stage has passed. Ulceration, if any exist, should be lightly touched with nitrate of silver. If the vaginal discharge be offensive, the following injec- tion is useful:— • 1049. R. Liquoris sodas chlorinates, f-^vj Aquae destillatae, Oiss. M. DR. A. A. BOINET, PARIS. 1050. R. Tincturae iodinii, f^iij Acidi tannici, gj Potassii iodidi, gss. M. This solution is employed to paint the vagina, in acute or chronic vaginitis, and the uterine neck, in engorgement and ulceration. The proportion of the tincture of iodine is to be lessened according to the character of the inflamed tissues and the effect that it is desired to produce. 396 DISEASES OF WOMEN. PROFESSOR SCANZONI, VIENNA. The author recommends, in vaginitis, the employment of a tampon rolled in powdered alum. If the sensibility be too acute, the alum is to be mixed with two parts of sugar. The tampon should not remain in the vagina longer than twelve hours, and ought to be introduced every two or three days. When it is with- drawn, the vagina should be cleansed by warm-water injections, and a bath taken. Some physicians replace the alum tampon by a sachet of gauze filled with an astringent powder, such as oak bark. PROF. A. NELATON, PARIS. 1051. R. Cupri sulphatis, gr.xv Aquae, f-^vj. M. To be used in injections in chronic leucorrhcea. DR. GUIPON, PARIS. 1052. R. Ferri sulphatis, gij Ferri subcarbonatis, giij Cinchonae pulveris, Canellas pulveris, Ergotinas, aa gj. M. One or two pinches to be administered before the two principal meals, in idiopathic leucorrhcea. Its usage is to be suspended on the ap- proach of the menstrual epochs. Prolonged vaginal injections, morn- ing and evening, with cold water and vinegar. Tonic regimen. 1053. R. Acidi tannici, gr.ix Ceras albas, gvj Adipis, Qiv. M. Melt by a slow heat, and cool in a mould. This is a useful vaginal suppository in leucorrhcea. RESUME OF REMEDIES. Alumen, in doses of gr.v-viij thrice daily, in combination with pilulae aloes or with nitre (gr.x), is productive of good in some obstinate cases of leucorrhcea. Argenti Nitras is useful in uterine leucorrhcea:— 1054. R. Argenti nitratis, Opii, aa gr.v Pulveris rhei, Extracti hyoscyami, aa 9j. M. Divide into twenty pills ; one thrice daily. Bismuthi Subnitras, applied once a day in powder, on a small piece of charpie, by means of a speculum, to the whole of the vaginal mucous mem- brane, is an effectual remedy in some cases. VAGINITIS—VAGINAL CATARRH—LEUCORRHCEA. 397 Cantharides. The use of the tincture, once so highly praised by Dr. Dewees and others, has fallen into comparative disuse. It was given in gtt. xx thrice daily, in a demulcent draught, the dose being subsequently increased to gtt.xl-1, until it produced slight strangury, when it was diminished or the medicine discontinued. The average period of cure was about four months. Copaiba is highly spoken of by a number of writers, in doses of Tt^xv thrice daily. Cubebs have been employed with success. Ergot, in doses of gr.v thrice daily, often gives good results, especially if a blister be applied to the sacrum. Galloz Pulvis, in doses of gr.x-xx, in decoction of tormentilla, daily, is given with great benefit at the Lock Hospital, London. Hcematoxyli Lignum, in decoction, has been employed with advantage. Juniperus frequently exerts a beneficial influence. Krameria. The extract, in doses of gr.xx daily, often arrests the discharge and improves the tone of the system. Potassii Nitras. Dr. Dewees prescribed the following with success in some obstinate cases:— 1055. R. Potassii nitratis, gv Aluminis, gijss. M. Divide into thirty powders ; one thrice daily. Tannicum Acidum, in doses of gr.ij-iij twice or thrice daily, in aqueous solu- tion, combined with a small portion of dilute nitric acid, has been found an efficacious remedy. Terebinthince Oleum is recommended, in small and repeated doses, by Dr. Pereira, in chronic cases, unattended by inflammatory symptoms. VAGINAL INJECTIONS. "Alumen. Dr. Tyler Smith, of London, has found the following injection yery serviceable:— 1056. R. Aluminis, gss Acidi tannici, gj-ij Aquas, Oij. M. One-half to be used at night, and the other half in the morning. Oak-bark decoction also makes a good vehicle :— 1057. R. Aluminis, gj Decocti quercus albas, Oj. M. Dr. E. J. Tilt, of London, remarks that he has repeatedly known the prolonged use of alum injections produce an irritable, sub-inflam- matory state of the cervix uteri; he advises, therefore, when astrin- gent injections are long continued, to use those of alum, zinc and sugar of lead, on alternate days. Ammonii Murias has occasionally been used in vaginal injections :— 1058. R. Ammonii muriatis, gj-iv Aquae, Oj. M. 398 DISEASES OF WOMEN. Argenti Nitras, in solution, has been advised as a vaginal injection:— 1059. R. Argenti nitratis, gr.iij Aquas destillatae, f.gj. M. Calcis Aqua. The vaginal injection of a weak solution of lime-water some- times effects a cure after the failure of other remedies. Catechu. The infusion, injected once or twice a day, often greatly lessens the discharge. Cupri Sulphas. The following injection, given after previously washing out the vagina with soap and water, is of service :— 1060. R. Cupri sulphatis, gr.xx-xxx Aquas tepidas, Oss. M. To be used thrice daily. Hydrargyri Chloridum Corrosivum. Dr. Dewees employed the following solution as a vaginal injection :— 1061. R. Hydrargyri chloridi corrosivi, gr.ij Aquas, f-gij. M. To be used only in chronic cases ; given at first only once a day, then several times a day, until heat and irritation occur, when lotions of acetate of lead will effect the cure. Matieo. The infusion has been injected with benefit. Plumbi Acetas. The following are useful vaginal injections:— 1062. R. Plumbi acetatis, gr.vj Aquae, f.gj. M. 1063. R. Liquoris plumbi subacetatis, f.gij Aquae, Oj. M. Potassii Chloras. The following vaginal injection has been employed with success:— 1064. R. Potassii chloratis, gj Aquas destillatae, f.gviij. M. Granati Radicis Cortex. The decoction of the root-bark (gij, aquas Oij, boiled to Oj) is a useful vaginal injection, combined with alum :— 1065. R. Aluminis, gj Decocti granati radicis cortici, Oj. M. Quercus Alba. The decoction, with or without alum, is a safe and effective vaginal inj ection. Sodii Boras. Dr. Graily Hewitt, of London, advises, when the discharge is acrid, frequent ablutions of the external parts with a borax lotion, to prevent irritation. Tormentilla. The decoction (gij, aquae Oiss, boiled to Oj) is an excellent vehicle for alum, in vaginal injection. "Zinci Acetas. This salt forms a useful vaginal injection, in the strength of VOMITING OF PREGNANCY. 399 gr.ij-iv to aquas f.gj. The following was a favorite formula with Sir Astley Cooper :— 1066. R. Zinci sulphatis, gr.vj Liquoris plumbi subacetatis, n\,xxx Aquas, f.giv. M. By this formula decomposition takes place, the acetate of zinc resulting. Zinci Oxidum. The following vaginal injection has been given with success :— 1067. R. Zinci oxidi, gss Aquas, Oij. M. The sulphate of zinc, gr.j to water f.gj, is also excellent. VOMITING OF PREGNANCY. DR. ALBERT EULENBERG, BERLIN. 1068. R. Tincturae iodinii, n\,xv Alcoholis, f-giij- M. Give three drops several times a day, in a tablespoonful of an aromatic infusion. 1069. R. Tincturas iodinii, gtt.x Aquas destillatae, f.giij Syrupi aurantii corticis, f.gj. M. A teaspoonful, or even a tablespoonful. Other approved prescriptions are:— 1070. R. Bismuthi subnitratis, giij Acidi carbolici, gr.iv Mucilaginis acacias, f.gj Aquas menthae piperitas, f-Siij. M. A tablespoonful three or four times a day. 1071. R. Atropias sulphatis, gr.ij Aquas destillatae, f.gj. M. Two drops in water, before meals. 1072. R. Cerii oxalatis, gr.x Bismuthi subnitratis, gr.xxx. M, Make ten powders. One five or six times a day. 400 DISEASES OF WOMEN. VULVITIS. T. GAILLARD THOMAS, M. D., PROFESSOR COLLEGE OF PHYSICIANS AND SURGEONS, NEW YORK. In the treatment of purulent vulvitis, if the inflammatory action run high, the woman should be kept in bed and upon a low diet. Saline cathartics should be administered. Cleanliness is to be carefully enjoined, and cooling emollient applications applied and retained upon the part. The vulva should be freely bathed three or four times a day with warm water, and a warm poultice of powdered linseed, slippery elm, or grated potato, with the addition of lead and opium, directed. So soon as the acute symptoms have subsided, the following lotion should be kept in contact with the parts, by dossils of lint soaked in it and placed between the labia. 1073. R. Tincturae opii, f.gij Plumbi acetatis, gj Aquas, Oj. M. At a still later period the diseased surface should be painted over several times a day with— 1074. R. Liquoris ferri sulphatis, Glycerinae, aa, f.gss. M. If this treatment be not effectual in eradicating the trouble, a solution of nitrate of silver (gr.x to aquae f Jj) should be applied, by means of a brush, every other day, and the part kept constantly powdered with lycopodium, bismuth, or starch,, until the recovery is completed. VIII. DISEASES OF CHILDREN. General Remarks on Infantile Therapeutics—Ancemia—Bron- chitis, Acute and Chronic, and Laryngitis—Cholera Infantum —Convulsions—Coryza—Croup, Membranous and Spasmodic— Diarrhoea—Diphtheria—Hydrocephalus, Acute and Chronic— Incontinence of Urine—Pertussis—Pneumonia, Infantile— Rachitis—Scarlatina—Stomatitis— Tonsillitis— Worms. INFANTILE THERAPEUTICS. EDWARD JOHN WARING, M. D , LONDON. In childhood (as in old age) the same doses of medicines are not generally as well borne as in youth and manhood, and much nicety is sometimes necessary in regulating the dose. Several exceptions, however, present themselves; thus, in childhood (and in old age) much larger quantities of mercury are necessary to induce sali- vation than in manhood; indeed, Dr. Clarke states that, in a practice of twenty years, he never saw a child truly salivated; an observation corroborated by the experience of others. Prof. Graves ascribes the difficulty of inducing salivation in children and in old persons to the undeveloped state of the salivary glands in the former, and to their atrophied state in the latter. On the other hand, in infancy and childhood, opium in every form is a remedy that requires the utmost caution in its administration. Two and a half drops of laudanum have destroyed an infant three days old; three drops, a strong child of fourteen months; and four drops, a child of a few weeks old (Christison). In infancy and child- hood, blisters allowed to remain long in contact with the skin are apt to induce ulceration and gangrene; and leeches, on account of the thinness of the skin, and the vascularity of the subjacent tissues, draw more blood, and, consequently, make a more decided impression on the system in an infant, than a proportionate number would produce in an adult. [Prof. H. C. Wood, of Philadelphia, questions the great suscep- tibility of infants to opium. He has used that drug with great freedom in infantile therapeutics, and without injury.] 26 401 402 DISEASES OF CHILDREN. ANEMIA. DR. BOSSU, PARIS. 1075. R. Ferri redacti, gss Pulveris canellas, Pulveris gentianae, Magnesiae, aa gr.xv. M. Divide into twenty powders ; one morning and evening, for children, in cases of atony of the digestive tube. RESUME OF REMEDIES. "Calcii Phosphas is strongly recommended by Dr. Ringer in the anaemia of young, rapidly-growing persons, in the dose of one or two grains, several times a day. "Ferri et Ammonii Citras is useful, especially in irritable states of the stomach, when it may be given with infusion of calumba. BRONCHITIS AND LARYNGITIS. J. M. JULIAN, M. D., HOBOKEN, N. J. In the suffocative capillary bronchitis of children, says this writer {Medical Record, October 2d, 1871), the indications are to get rid of the excessive mucous secretion as speedily as possible. For twenty-five years he has used for this purpose, with eminent success, the following:— 1076. R. Zinci sulphatis, gr.xij Tincturae sanguinariae, f.gij Aquas, f.giss. M. A teaspoonful in mild cases to a child one year old, every three hours; in severe cases, triple the dose, and give it every half-hour or hour, regardless of vomiting. PROF. JOHANN STEINER, M. D.. OF PRAGUE. In chronic bronchitis and allied conditions, where there is de- bility and much irritation from the cough, this author has seen very great relief from the following prescription :— 1077. R. Quiniae sulphatis, gr.ij Pulveris folias digitalis, gr.vj Extracti opii, gr.j Pulveris sacchari albi, ad. gj. M. Divide into twelve powders ; one every three or four hours. BRONCHITIS AND LARYNGITIS. 403 PROFESSOR J. LEWIS SMITH. M. D., NEW YORK. Chronic laryngitis dependent on syphilis or tuberculosis requires specific treatment; local measures have but little effect. The chronic laryngitis occurring in children in general good health, sometimes resulting from an acute attack, is an obstinate affection. The patient should be warmly clad, and every effort made to guard against taking cold. The most satisfactory treatment is the appli- cation of tincture of iodine upon the neck, directly over the larynx, and in some cases of a solution of nitrate of silver, ten or twenty grains to the ounce, to the fauces, so that, if possible, some of it may enter the larynx. Little benefit is derived from stimulating expectorants. The following recipe has proved beneficial in a number of cases :— 1078. R. Extracti cubebae fluidi, r^xl-f.gj Syrupi simplicis, f.gijss. M. A teaspoonful three or four times daily. J. M. DA COSTA, M. D., PHILADELPHIA. 1079. R. Ammonias carbonatis, gr-xvj Spiritus aetheris compositi, f.giss Syrupi tolutani, Aquae, aa f.gj. M. A teaspoonful every two hours; a stimulating expectorant for a child a year old, affected with bronchitis of two weeks' standing. Counter-irritation to be applied to the chest by means of weak mustard plasters (one part of mustard to four of Indian meal). Also, if the child be much debilitated, fifteen drops of brandy every four hours. When the child is seen frequently, so that the effect may be watched, there is no better treatment than relieving the lung mechanically by emetics. Hoffman's anodyne, in the above recipe, acts as a diaphoretic and quieting agent, which latter influ- ence would not be obtained from sweet spirits of nitre. 1080. R. Syrupi ipecacuanhae, f.gss Liquoris potassae citratis, f-gijss Misturae glycyrrhizae compositae, • f.gj. M. A teaspoonful every three hours; for a child two years of age. After- ward, when the disease passes into second stage, to be changed to— 1081. R. Syrupi scillae, f.gij Tincturas opii camphoratae, fgij- M. Thirty drops four times a day. 404 DISEASES OF CHILDREN. 1082. R. Syrupi ipecacuanhae, f.gj. A teaspoonful every ten minutes until vomiting is produced; to be repeated every second day. For ordinary acute bronchitis in a child a year old. Together with :— "1083. R. Ammonias carbonatis, gss Syrupi senegae, f-gss Syrupi tolutani, f.gj Aquas, f-gijss. M. A teaspoonful thrice daily. For Resume of Remedies in Bronchitis, see Diseases of the Respiratory Organs, pp. 136, 146. CHOLERA INFANTUM. DR. IRVING C. ROSSE, U. S. A. In a communication to the Surgeon-General's Office, this writer states that the bromide of potassium is almost a specific in this affec- tion, careful attention to hygiene being observed. The following formula is used:— 1084. R. Potassii bromidi, 91"^ Mucilaginis acacias, f.3ij. M. From ten drops to a teaspoonful, regulated according to circumstances. Occasionally, a drachm of krameria is added to this recipe. The food is prepared by pounding a small quantity of fresh beef in a linen cloth, and expressing the juice, to which a very small seasoning of cayenne pepper is added. Minute quantities of brandy are administered when indicated. PROF. N. S. DAVIS. M. D., CHICAGO. In threatening cases this physician recommends— 1085. R. Acidi carbolici crystalisati, gr-i'j Glycerinae, f.gss Tincturae opii camphoras, f.gj Aquas, f.giss. M. Give twenty drops every half-hour, till the vomiting ceases; then every four hours. 1086. R. Hydrargyri chloridi mitis, gr.iv Pulveris opii, gr.j Sacchari albi, gr.xxx. M. Make eight powders. Give one every eight hours. CHOLERA INFANTUM. 405 If the vomiting ceases, but the discharge continues, and the child is fretful and emaciates, then— 1087. R. Olei terebinthinae, f.gij Olei gualtheriae, gtt.xx Tincturae opii, f.gij Pulveris acacias, Sacchari albi, aa giv Aquas, f-giij. M. From fifteen to thirty drops, every three or four hours. J. LEWIS SMITH, M. D., PROFESSOR IN BELLEVUE HOSPITAL MEDICAL COLLEGE, NEW YORK. Prompt measures are required in cholera infantum, as the child rapidly sinks under the prostrating influence of the frequent watery discharges. Some evacuant is indicated at the outset, if there be any irritating material in the stomach or bowels, causing or keep- ing up the trouble. Small doses of ipecacuanha (from two to five grains) are often beneficial. When, however, the stomach is irri- table and the alvine discharges fail to carry off the intestinal con- tents, calomel is the great remedy. As it is slow in its operation, castor oil may be administered after it with benefit, or its operation may be aided by a simple enema. It should not be given to the extent of more than one or two doses. If there be no indigestible substance in the intestines, purgatives are contra-indicated, as they are then hurtful. The continuance of the diarrhoea for several hours affords a pretty sure evidence of the removal of any irritating matter which may have been present, and hence no purgative is required. The cfbjects of the treatment then should be to diminish the frequency of the evacuations, and improve their character. No time should be lost. Opium in some form is the chief reliance. If laudanum be used, it may be administered in one-drop doses, every two or three hours, to a child one year old. Its effects should be watched. If the evacuations are partially checked, and there are signs of stupor, stop the opiate, or at least give it less frequently. Astringents, and often alkalies, may be employed as adjuvants to the opium. The opiates and alkali may be employed in the follow- ing combination:— 1088. R. Tincturae opii, gtt.xij Misturae cretas, f.giss. M. One teaspoonful every two or three hours to an infant one year old. 406 DISEASES OF CHILDREN. To this mixture an astringent may be added, as tincture of cate- chu or kino. It should be borne in mind, however, that astringents are less tolerated by an irritable stomach than opium or chalk. When they are vomited, therefore, they should be discontinued, even in cases in which they would doubtless be serviceable if the stomach were retentive. By means of the opiate and astringents, if they be retained, the passages are rendered, in a few hours, less frequent, and the stools more consistent. In cases in which calomel is employed our author does not recom- mend its use in larger doses than one-fourth of a grain, morning and evening (together with the astringent and opiate), to a child of one year. Dr. S. also advises small pieces of ice in the mouth at the begin- ning of the attack, to combat the irritability of the stomach, and the application of mustard to the epigastrium. In most cases Bourbon whisky or brandy, the best of the alco- holic stimulants, are required. They should be used from an early period of the disease, both for the purpose of sustaining the vital powers and of diminishing the gastric irritability. The diet should be simple, but nutritious, and taken often, but little at a time. If the child be a? the breast, it should be confined to the mother's milk. If it be weaned, cold barley or rice water, with whisky or brandy, should be given in the commencement of the attack; afterward, milk or broth may be employed in addi- tion. • 1089. R. Creasoti, gtt.j Aquas calcis, f-gij- M. One teaspoonful with a teaspoonful of milk, breast milk if the infant nurses, repeated pro re natd, for the vomiting so frequent in the summer epidemics of intestinal inflammation in the cities. This recipe is much used in the Nursery and Child's Hospital of New York city. Or, the following may be administered: — 1090. R. Potassae bicarbonatis, Acidi citrici, Aquas amygdalae amaras, Aquas, Teaspoonful, repeated pro re natd. gr.xxv gr.xvij 1. M. CHOLERA INFANTUM. 407 MEREDITH CLYMER, M. D., NEW YORK. This author gives the following indications for the treatment of cholera infantum:— The instantly threatening symptoms, purging and vomiting, are to be stopped. Fermentation, and not chymification, is going on in the stomach and duodenum. Hence, small doses of the bisul- phites of soda or potassa, with limed whey, will often act very happily, while the effect of poisonous drugs is always doubtful, and generally positively harmful. Mercury is, at best, negative. Opium and its preparations will be found valuable, if not contra- indicated by cerebral epiphenomena. The effects should be care- fully watched. Flannel, wrung out of hot water, and on which laudanum is poured, applied to the spine, will be found useful in checking vomiting. The function of the skin, which, in common with all the excreting organs, is inactive, must be excited. This may be done by gentle friction with woolen cloths, or a warm alka- line bath, in which the little patient should not remain longer than three minutes, being then quickly dried and wrapped in flannel. Food, of proper quality and quantity, should be given as soon as the stomach and bowels will tolerate it. Farinaceous articles are entirely inappropriate. Limed milk, to which a little gelatine has been added, or rennet whey, may be given; but in protracted cases, attended with great prostration and rapid emaciation, the raw meat diet, prepared as recommended by Prof. Trousseau, will be often seized with avidity and well borne. Lean beef or mutton is first finely hashed, pounded in a mortar to«a pulp, and then passed through a fine sieve. The thick concentrated juice thus obtained is nutritious and digestible, and, when salted or otherwise flavored, quite acceptable. aGive a half to three-quarters of an ounce, in fractional doses, the first day. If well borne by the stomach, in- crease the quantity day by day, until a quarter or half a pound is taken in the course of the twenty-four hours. For the first day or two, much of it may pass, hardly changed, from the bowels; but this alone should not occasion its discontinuance. If too long con- tinued, however, this diet is liable to generate tsenia. White of eggs, thinned with natural or artificial Seltzer, Vichy, or weak lime water, is an excellent drink, to which a few grains of bicarbonate of soda may be added. Tonics and stimulants are often required. Of the former, minute doses of arsenic, alone, or combined with quinine, or the chloride of iron, or the pernitrate of iron, or the 408 DISEASES OF CHILDREN. tincture of nux vomica, may be given. Wine-whey, or brandy-and- water, to which a few drops of the aromatic spirits of ammonia have been added, are the best stimulants. The effect of sending the patient to a cool and mountainous region is immediate and lasting. THOMAS HAY, M. D.. PHILADELPHIA. This practitioner has employed the following treatment in cases of cholera infantum, with the best results:— 1091. R. Hydrargyri chloridi mitis, gr.ij Bismuthi subcarbonatis, gr.xvj-xl Pulveris ipecacuanhae compositae, gr-j-rj Pulveris sacchari albi, gr.xij. M. For eight powders; one to be taken every three hours for two or three days, or until the tongue and mouth become moist, and the alvine ex- cretion changed in color and consistency. Then the following powders are given, and will ordinarily com- plete the cure:— 1092. R. Bismuthi subcarbonatis, gr.xvj-xl Pulveris ipecacuanhae compositae, gr.j-ij Pulveris aromatici, gr.viij-xvj Pulveris sacchari albi, gr.xij. M. For eight powders •, one to be taken every three or four hours, in the mother's or cow's milk. Counter-irritation is kept up over the abdomen with mustard plasters, applied at intervals of three or four hours. The infant is allowed to suck at a piece of ice held in its mouth. When stimu- lants are required, the doctor gives from fifteen to thirty drops of port wine. When the infant is artificially fed, he gives it cow's milk and lime-water, in the proportion of one fluid ounce of the latter to five fluid ounces of the former; also broiled mutton or beef, minced very fine. All farinaceous food is forbidden. The child must be nursed or fed at regular intervals, and not allowed too much at a time. CONVULSIONS. 409 CONVULSIONS. PROFESSOR JOHA.NN STEINER, M. D., OF PRAGUE. • It is not always easy to detect the cause of infantile convulsions. In such cases the causal treatment must give place to the sympto- matic. Of the various remedies, our author prefers in such in- stances the following combination :— 1093. R. Zinci oxidi, gr.iv Hydrargyri chloridi mitis, gr.ij Sacchari albi, gj. M. Make eight powders. Give one every hour. Remove all constricting clothing, apply mustard poultices to the trunk and extremities, and use clysters of cold water. The warm bath is often serviceable. Convulsions from malarial toxaemia demand quinine; from worms, anthelmintics; from phimosis or elongated uvula, exci- sion, etc. RESUME OF REMEDIES. Ancesthetics. Either chloroform or ether, by inhalation, are effective in emergencies. Belladonna is valuable in the constitutional treatment. Chloral, in doses of gr.v-x, every six hours, to a child of ten, frequently answers the purpose. Opium, in some form, is preferred by many practitioners. It may be adminis- tered hypodermically, or by enema, every twenty minutes, until the pupils contract. Potassii Bromidum, gr.x-gj, is usually a reliable means in idiopathic convul- sive disorders. Dr. Blachez (Gazette Midicale, December, 1875) recommends a mixed treatment, the bromide being given during the day and the chloral at night. Zinci Oxidum, especially when combined with tonics, aids much in restoring the nervous equilibrium. EXTERNAL REMEDIES. Warm Baths, in infants, often act as potent sedatives. Coldjto the head, as compresses wrung out with ice-water or dilute ether, is valuable. Trousseau commends pressure on the carotid arteries. The pulsa- tion should be sought at the lateral part of the neck, and the pressure be gradually backward upon the spinal column. If it does not re- lieve in two or three minutes, it should not be continued. Of course, all reflex irritation should be sought for in the first instance and re- moved. 410 DISEASES OF CHILDREN. CORYZA. PROF. J. LEWIS SMITH, M. D., NEW YORK. In children, ordinary attacks of this affection require little treat- ment beyond keeping the bowels open, soaking the feet in mustard water, and having the body warmly clothed. Friction with cam- phorated oil over the nose is of some benefit. In attacks which commence with greater severity, an emetic of syrup of ipecacuanha, given early, will moderate the inflammation, and may prevent the occurrence of bronchitis. Afterward, a simple diaphoretic mix- ture should be administered, such as the following:— 1094. R. Syrupi ipecacuanhae, f.gij Spiritus aetheris nitrosi, f.gj Syrupi simplicis, f-^ij- M. One teaspoonful every three hours to a child of six months. In place of sweet spirits of nitre, acetate of potash may be em- ployed, in the dose of one to two grains for infants. If there is febrile reaction, from half a minim to two minims, according to the age, of tincture of digitalis may be given in each dose. In pseudo-membranous coryza the laryngitis which usually ac- companies this affection demands the first attention. The injection of a solution of chlorate of potash, in water, several times a day, subdues the inflammation and removes the collection of mucus and pus. Or the following may be employed :— 1095. R. Pulveris aluminis, gr.xvj-xx Aquas, f-giv. M. The bromine solution (F. 1115), diluted as directed, will also be found useful when injected into the nostrils. Chronic coryza should be treated by tonics and by alteratives, directed to the cachexia which may be present. Together with such constitutional treatment, a solution of nitrate of silver (gr.iij-v to f.gj), may be injected into the nostrils. An excellent formula for application to parts which can be reached by a camel's-hair pencil is— 1096. R. Pulveris zinci oxidi, gj Glycerinae, f.gj. M. To be applied three or four times a day. CROUP, MEMBRANOUS AND SPASMODIC. 411 C. WEST, M. D. 1097. R. Liquoris ammonias acetatis, f.gj Vini ipecacuanhae, irixvj Potassae nitratis, gr-viij Misturae amygdalae, f-gvij- M. A teaspoonful every four hours for a child of six months. DR. P. GUERSANT, OF PARIS. In chronic coryza, with irritating secretions, this author recom- mends the following:— 1098. R. Hydrargyri ammoniati, Qiss Pulveris althaea, gj. M. Use as a snuff. CROUP, MEMBRANOUS AND SPASMODIC. PROF. FORDYCE BARKER, M. D., OF NEW YORK CITY. This teacher always commences treatment by the following emetic of turpeth mineral:— 1099. R. Hydrargyri sulphatis flavae, gr.iij-v. For one dose. If it does not act in fifteen minutes, give a second dose of three to five grains, according to the age of the child. This, however, is rarely necessary. He prefers this to all other emetics in croup. If on the next visit he finds the child with a quick pulse, hot skin, somewhat hurried breathing, and an occasional ringing cough, but with no thoracic rales, he directs that it shall be kept quiet in bed, comfortably covered, but not with too many clothes, and pre- scribes the veratrum viride, in one or two drop doses, according to the age of the child, as, for example, in the following formula:— 1100. R. Tincturas veratri viridis, gtt.xvj-xxx Spiritus aetheris nitrosi, f gij Syrupi simplicis, f.gj Aquas, f.gvj. M. A tablespoonful every second hour. He visits the child at least as often as every eighth hour, and increases or diminishes the dose, according to the effect of the medicine on the pulse. He is not satisfied until the pulse is below 412 DISEASES OF CHILDREN. eighty per minute, and then continues the veratrum in half the dose that was necessary to bring it down to that point. If thoracic rales, hurried and labored respiration, and other symptoms, indicate that the disease is extending downward, then substitute for the above prescription something like the following formula, of course varied according to the special indications of the case :— 1101. R. Tincturas veratri viridis, gtt.xvj-xxx Ammoniae carbonatis, gss Syrupi tolutani, Syrupi acaciae, aa f.gj. M. A teaspoonful every second hour. Sometimes, on account of increasing laryngeal and bronchial ob- struction, the emetic of turpeth mineral should be repeated on the second or third day, but it is not necessary or well to repeat it a third time. Quinine is a remedy of great value, and well tolerated in large doses in some of the diseases of the respiratory organs of children. It is of great service in some cases of croup in the advanced stages, when the respiration is hurried and irregular, the paroxysms of cough becoming less marked, the intermissions less distinct, and the cough husky instead of ringing. Our author then substitutes for the last formula the following:— 1102. R. Quiniae sulphatis, Ammoniae carbonatis, aa gss Syrupi senegas, Syrupi acaciae, aa f.gj. M. To be well shaken. A teaspoonful every fourth hour. When the croup is complicated with lobular pneumonia, give the quinine separately, four or five grains three times a day, while the little patient takes the last of the prescriptions containing veratrum viride. HERMAN BEIGEL, M. D., ETC., LONDON. Dr. B. recommends in a case of croup the use of the following medicated sprays, given in the order of their value. They are applied by means of the atomizer. 1103. R. Aquae calcis, f.gj. For one inhalation, lasting about a quarter of an hour, and to he repeated every two hours as long as bad symptoms are present. The method of Dr. A. Geiger, of Dayton, Ohio, is to pour hot CROUP, MEMBRANOUS AND SPASMODIC. 413 water on unslaked lime in a pitcher, and to have the patient inhale the vapor as it arises. 1104. R. Acidi tannici, gr.ij-xx Aquae, f.gj. M. For one inhalation, to last fifteen to twenty minutes. 1105. R. Potassii bromidi, gr.v-x Aquas, f.gj. M. This inhalation, at the early stage of the disease, will often be found to arrest the symptoms. With these inhalations the administration of emetics or other remedies may and must be combined, if considered necessary. MEREDITH CLYMER, M. D., ETC., NEW YORK. Blood-letting, either general or local, is generally harmful in the treatment of croup. The safest and best emetic is the sulphate of copper, in half or one-grain doses, every fifteen minutes, till the vomiting occurs. Afterward give the following:— 1106. R. M. Potassae chloratis, 9y Potassii iodidi, gr.viij Tincturae opii camphoratae, nul Liquoris potassas, Tilxij Aquas, f.SU. A dessertspoonful, in water, every second or third hour. Brush the throat and upper part of the larynx with the fol- lowing :— 1107. R. Tincturas ferri chloridi, f.gj Aquae, f.gij. M. Beef-tea, wine, quinine and iron are generally required. DR. FELIX VON NIEMEYER, PROFESSOR UNIVERSITY OF TUBINGEN. 1108. R. Cupri sulphatis, gr.x-xv Aquae, f-^ij- M. A large teaspoonful to be taken every five minutes until vomiting sets in. In regard to the employment of emetics in croup, Prof. N. thinks that they are only indicated when obstructing croup-membranes play a part in producing the dyspnoea, and when the child's efforts at coughing are insufficient to expel them. Impeded expiration is an indication of their employment. Sulphate of copper is preferable to tartar-emetic or ipecacuanha. 414 DISEASES OF CHILDREN. It should be given in full doses; in small ones it is uncertain, and more apt to operate as a poison. If the bowels be confined, administer a clyster, so that the dia- phragm may have room to act. The best is a cold one, as follows:— 1109. R. Acidi acetici diluti, f.gij Aquas, flvj. M. If, however, there is no remission, notwithstanding the employ- ment of the emetic and the cold application, apply the following concentrated solution, at intervals of several hours, to the entrance of the glottis :— 1110. R. Argenti nitratis, gss Aquas destillatae, £gij. M. Dip a curved rod of whalebone, with a small sponge made fast to its lower end, into this solution, press down the tongue of the child, and endeavor to reach the entrance of the glottis with the sponge. There the sponge is immediately compressed by the muscular contraction which takes place, whereby certainly a portion of the liquid, if only a small one, arrives at the larynx. Administer also half a grain of calomel every two hours. Should this treatment remain without effect, proceed at once to tracheotomy. Besides treating the dyspnoea upon the principles given above, it may be necessary to relieve the paralytic symptoms due to blood- poisoning by carbonic acid. For this purpose the powerful stimulus obtained by pouring cold water upon the child while in a warm bath is of great service. Lose no time in making use of it, the moment the child begins to grow drowsy, the skin to cool, the sensorium to be benumbed, or as soon as emetics fail to act. A few gallons of cold water, poured from a moderate height, over the head, nape and back of the child, almost always cause it to revive for a while and to cough vigorously. Thus, sometimes, after the bath, masses of exudation are expelled. Other stimulants, such as camphor or musk, are much less effective, and ought not to be employed, save when insuperable objections are opposed to the cold effusion. They should be given in large doses, immediately prior to the emetic. The following formula may be used:— 1111. R. Camphorae, gr.x iEtheris acetici, f-giij. M. Ten to fifteen drops to be given every quarter of an hour. CROUP, MEMBRANOUS AND SPASMODIC. 415 PROFESSOR J. LEWIS SMITH, M. D., ETC., NEW YORK. 1112. R. Potassas chloratis, gj Ammonias muriatis, ^ij Syrupi simplicis, f.3J Aqu*» fgij. M. One teaspoonful every twenty minutes to half an hour, or in cases not severe every two hours. This should be continued regularly night and day until the cough becomes looser, or until it is evident, if the case be unfavorable, that it can be of no service. The atmosphere the child breathes should be constantly loaded with moisture, without, however, that degree of heat which would add materially to the discomfort of the patient or attendants. The temperature, should be of 75° or 80°. Besides the nitrate of silver, three other substances have been used of late years for the topical treatment of the throat, which appear to be more effectual in removing the pseudo-membrane, and controlling the inflammation. One is liquor ferri subsulphatis ; the second, carbolic acid, and the third, bromine. The following formulae may be used:— 1113. 1114. 1115. R. Liquoris ferri subsulphatis, Glycerinae, f-3j f.gss. R. Acidi carbolici fluidi, Aquas, f-3j f-3vj. R. Brominii, Potassii bromidi, Aquas, 3ij gr.xlv M. M. M. This is called the bromine solution; but it must be considerably diluted for use. Twenty-four to forty drops should be added to an ounce of water for application to the fauces or larynx. Our author most highly recommends the sulphate of iron solution. J. M. DA COSTA, M. D., PHILADELPHIA. 1116. R. Extracti hyoscyami fluidi, mjij-x Aquas destillatae, f.gj. M. Used as an inhalation in spasmodic croup. RESUME OF REMEDIES. "Acidum Lacticum, as a solvent of false membrane in croup, is highly esteemed. The following is the formula of the London Throat Hospital:— 1117. R. Acidi lactici, gss Aquas destillatae, f.gx. M. Use with an atomizer. 416 DISEASES OF CHILDREN. Alumen was the favorite emetic in this disease with the late Prof. Charles D. Meigs. He gave gj, in molasses, as required. "Belladonna is of considerable value in spasmodic croup. Ferrum Redactum is useful in strengthening the system and diminishing the excessive nervous sensibility which is so constantly a cause of laryn- gismus stridulus. "Morrhuoz Oleum is an incomparable remedy in correcting the faulty consti- tution and diminishing that extreme nervous irritability, which of itself is sufficient to induce spasms. It may be given in teaspoooful doses to a child of from two to four months ; in tablespoonful doses to one of six months. If it cause diarrhosa, Dover's powder may be added; if it disagree, from one to two tablespoonfuls should be rubbed daily on the spine. "Quinioz Sulphas, given in the largest doses the child can bear, and during the intervals of the paroxysms, is a very satisfactory remedy, espe- cially in weak and obviously nervous infants. Valerian is highly recommended by Dr. G. Hill (British Medical Journal, April 11th, 1868), who, however, neglects to mention the preparation and dose he employed. For other remedies, see Diphtheria. DIARRHCEA IN CHILDREN. THEODORE TURK, M. D. In the Med. Chir. Centralblatt, No. 1, 1873, this author says, in the more chronic cases a series of careful observations have shown him that roasted acorns, prepared as coffee, with a few beans of the real article, form the best dietetic, and at the same time medicinal remedy. Often, when nitrate of silver, tannin, Dover's powder, etc., have proved useless, the simple acorn-coffee (boiled, in cases of specially profuse diarrhoea, with from one to three grains of tannin, and in meteorism or sickness, with the addition of a piece of orange-peel to the decoction) has, from the first, lessened the stools and improved their quality, and very shortly restored appe- tite and nutrition. At the same time the children become, not fat, but healthy. The acorn-coffee is more efficacious than alkalies, preparations of lime, tonics (Peruvian bark and extract) and car- minatives. Moreover, the children drink it readily, without be- coming tired, and the painful, formal, and frequent administration of medicine is avoided. DIARRHG3A IN CHILDREN. 417 R. W. ROSS, M. D. In infantile diarrhoea, gum acacia is a valuable remedy. In the simple forms the mucilage of acacia, one part, diluted with three parts of water, is given alone ; when the stools are green and ac- companied with vomiting, or when the discharges are almost con- stant, the addition of a little gray powder to the diluted mucilage is recommended {British Medical Journal, September 3d, 1870). JAMES S. HAWLEY, M. D., GREEN POINT, N. Y. In infantile diarrhoea the indications are as follows: First to remove all sources of irritation from the quantity or quality of the ingesta, or change of temperature. Second, to allay irritation by sedatives, of which the best are the preparations of opium and salts of bismuth. When irritation without pain exists, bismuth most promptly and satisfactorily allays it, but when accompanied with pain, the addition of a minute portion of opium becomes a neces- sary complement to its effectiveness. Thirdly, artificial digestion by the administration of pepsin. 1118. R. Pulveris pepsinas Americanas, Bismuthi subnitratis, aa gj. M For ten powders. One to be given every three or four hours to a child a year old. Opium may be combined if desired. THOMAS HILLIER, M. D., LONDON. F. R. C. P.. ETC. 1119. R. Acidi gallici, gr.xij Tincturas cinnamomi, f.giss Tincturae opii, r^vijj Aquas carui, q. s# a(j. f.gjj. M Two teaspoonfuls for a child two years old, with chronic diarrhoea and irritable stomach. 1120. R. Olei ricini, f-;: Pulveris acaciae, gj. M. The above line of procedure holds good in the case of children; but here, in addition, an absorbent powder is serviceable. It may be— 1439. R. Zinci oxidi, Calaminae preparatae, Amyli, aa gss. M. Our author prefers a lead or calamine lotion, with exclusion of air, and at night a layer of elder-flower ointment, to anything else, as simple applications in eczema infantilis. 1440. R. Pulveris aluminis, gij Infusi rosae, Oj. M. Used in eczema sine crustis. 1441. R. Potassae cyanidi, gr-v' Sulphuris. Potassae bicarbonatis, aa gss Cocci cacti, gr j Adipis, gj. M In eczema with pruritus. 512 DISEASES OF THE SKIN. 1442. R. Camphorae, gss Alcoholis, to dissolve, q. s. Add Zinci oxidi, Amyli, aa, gss. M. Use as a powder to allay the burning heat of eczema. 1443. R. Camphorae, gr.yiij Tincturae conii, f gij Cerati adipis, gj. M. 1444. R. Saponis mollis, gj. Aquas bullientis, Oj. M. Scent with some essential oil, and use in the second stage of eczema, to counteract the infiltration. 1445. R. Saponis mollis, Alcoholis, Olei cadini, aa f.gj. Olei lavandulae, f.giss. M. This preparation is more elegant than Hebra's "Tinctura saponis viridis cum pice." 1446. R. Olei juniperis pyrolignei, fgj-viij Adipis, gj. Mix with gss of mutton suet. 1447. R. Picis liquidas, f.gj Camphorae, gr.x Adipis, gx. M. ERYTHEMA. DR. L. DUNCAN BULKLEY, NEW YORK. In erythema simplex, as well as in other acute skin diseases, this author has derived great benefit from the use of "Startin's mixture ":— 1448. R. Magnesias sulphatis, gj Ferri sulphatis, gj Acidi sulphurici aromatici, f.gss Tincturae gentianae, f.gj Aquam, ad. f-gij. M. One teaspoonful after meals. J. M. DA COSTA, M. D., PHILADELPHIA. 1449. R. Unguenti picis, Unguenti hydrargyri oxidi rubri, aa gss. M. To be applied morning and evening, in chronic erythema. Internally, Donovan's solution, gtt.x, thrice daily. FAVUS. 513 In acute erythema, a useful sedative ointment is:— 1450. R. Liquoris plumbi subacetatis, Glycerjnas, aa f.gj Cerati simplicis, gvj. M. Or, 1451. R. Cerati plumbi subacetatis, gvj Glycerinae, f-gij- M. PROF. J. LEWIS SMITH, NEW YORK. 1452. R. Pulveris zinci oxidi, Lycopodii, aa gj. M. To be dusted occasionally over the inflamed surface in the erythema intertrigo of infancy, when the inflammation is severe and accom- panied by moisture. In slight cases of this affection, due to friction of opposing sur- faces of the skin, or to the irritation of certain discharges, if not accompanied by moisture and destruction of the epidermis, dusting the surface thickly with powdered starch, so as to prevent attrition, will be all the treatment required. The disease may also be satis- factorily treated in most cases by the following wash:— 1453. R. Cupri sulphatis, gr.ij-iv Aquae rosae, f-o^j- M. To be kept constantly applied by means of linen saturated with it and pressed between the inflamed surfaces. When this disease is caused by frequent acid stools, remedies which cure the diarrhoeal affection also cure the erythema. FAVUS. DR. HENRY G. PIFFARD, OF NEW YORK. The treatment is to remove the crusts, to epilate the part, and thoroughly rub in a solution of corrosive sublimate, gr.ij to water f.Sj. Sulphur or turpeth ointment, gr.xx-xxx to lard oj, will destroy the parasite upon the surface, but in a few weeks the disease will return. DR. TILBURY FOX, LONDON. The hair should be cut short; the crusts must be removed by soaking with— 33 514 DISEASES OF THE SKIN. 1454. R. Sodas hyposulphitis, giv Glycerinae, f-o-ij Aquae, ad. f.gvj M. Or, if preferred, with— 1455. R. Sodas hyposulphitis, ; giij Acidi sulphurosi diluti, f.gss Aquae, ad. Oj. M. When the scalp is cleaned, each hair must be extracted one by one, and parasiticides applied at once. Our author prefers for this purpose^- 1456. R. Sodas biboratis, gj Hydrargyri chloridi corrosivi, gr.x-xx Aquas, f.gij-iij. M. A certain portion of the surface should be cleaned each day, and the whole head meanwhile kept moistened with sulphurous acid lotion. HERPES. DR. L. DUNCAN BULKLEY, NEW YORK. In herpes zoster this author has found the following most efficient in controlling the neuralgic pain :— 1457. R. Zinci phosphidi, Extracti nucis vomicae, aa gr.^. M. This amount, in one pill, every three hours. For local treatment, he dusts the whole of the affected part with powdered starch, then dusts a wide bandage of muslin with starch, and covers with it the diseased surface. This bandage is not to be removed for a week or longer. TILBURY FOX, M. D., LONDON, PHYSICIAN TO THE SKIN DEPARTMENT, CHARING-CROSS HOSPITAL, ETC. 1458. R. Acidi carbolici, gij Glycerinae, f.gj Aquas rosas, ad. f.gviij. M Use in ring-worm, of the surface especially. IMPETIGO—LEPRA. 515 IMPETIGO. J. M. DA COSTA, M. D., PHILADELPHIA. 1459. R. Unguenti picis, Unguenti hydrargyri oxidi rubri, aa gss. M. For impetigo. To be rubbed in morning and night. If this fails, apply— 1460. R. Cupri sulphatis, B.j-ij Aquae, f.gj. M. Or use the solid sulphate of copper. TILBURY FOX, M. D., LONDON, M. B. C P.. ETC. 1461. R. Plumbi acetatis, gr.xv Acidi hydrocyanici diluti, Tt\,xx Alcoholis, f.gss Aquas, f-3vj. M. Use in impetigo, as a lotion. Subsequently, 1462. R. Hydrargyri ammoniati 9j Olei olivas, f.gj Adipis, gj Olei rosas, Hbvj Tincturae tolutani, gtt.xx. M. As an ointment. LEPRA. J. M. DA COSTA, M. D., PHILADELPHIA. 1463. R. Sodae sulphitis, gss Aquae, f-^vj. M. To be used as a wash, in lepra. The patient at the same time being ordered, internally— 1464. R. Liquoris potassae arsenitis, n\l Tincturas gentianae compositae, f.giv. M. A dessertspoonful thrice daily. In true leprosy, no cure is known. Of late, much has been said of "gurjun oil," obtained from a species of Dipterocarpus, and of 516 DISEASES OF THE SKIN. cashew-nut oil, from the fruit of the Anacardium occidentale. Dr. Von Someren {Medical Times and Gazette, April, 1874) believes the latter tends to disperse the tubercles. LICHEN. DR. L. DUNCAN BULKLEY, NEW YORK. The eruption of acute lichen arises from digestive diseases, and will yield to an active cathartic, followed by a course of " Startin's mixture" (F. 1448). To check the itching, a lotion may be used of an ounce of bicarbonate of soda to a pint of water. ERASMUS WILSON, F. R. S., ETC., LONDON. The constitutional treatment of lichen requires mild aperients, followed by bitters and mineral acids, by chalybeates and quinine. In chronic cases arsenic will generally effect a cure. The local treatment of lichen calls for the use of ablutions with the juniper-tar soap, tepid bathing, and anti-pruriginous and mod- erately stimulating lotions. But the most certain and powerful anti-pruriginous lotion is:— M. This is very successful in lichen urticatus. DR. TILBURY FOX. LONDON. In lichen circumscripta, an alkaline course is beneficial; and if there be any tendency to rheumatism, bromide of potassium may be given in addition. In this variety of lichen the following oint- ments are serviceable:— 1466. R. Unguenti hydrargyri nitratis, gij Adipis, gvj. M. 1467. R. Unguenti hydrargyri ammoniati, gj Adipis, gvij. M. 1465. R. Olei juniperi pyrolignici, Alcoholis, aa f-5j Aquas, f-|vj. In lichen agrius, maceration with glycerine, or the following, is useful:— lupus. 517 1468. R. Sodas biboratis, ^j.ij Glycerinae, f ^j Adipis, 3j. M Or, paint with— 1469. R. Argenti nitratis, gr ij-x A(luae> f.gj. M. . When the disease is very chronic, and there is much thickening of the skin in general, and in lichen pilaris, a course of bicyanide of mercury is necessary. 1470. R. Hydrargyri bicyanidi, gr.j Tincturae cinchonae compositi, f.giv. M. A dessertspoonful thrice daily. This will cause an absorption of the plastic material poured out into the derma; and local stimulation to the skin, with sulphur vapor baths, may then be employed. PROF. HARDY, FACULTE DE MEDECINE DE PARIS. 1471. R. Hydrargyri chloridi mitis, gr.xv Acidi tannici, gr.xxx-1 AdiPis> gj! M. To be applied several times a day in lichen. Alcoholic and vapor baths. Bitter infusions with bicarbonate of soda. 1472. R. Potassii cyanidi, gr.f-iss AdiPis» gj'. M. This ointment is useful in calming the itching occasioned by lichen. LUPUS. PROF. KAPOSI, VIENNA. 1473. R. Saponis viridis, fb.ij Alcoholis, Bb.j. M. Let it stand twenty-four hours, filter, and add— Spiritus lavandulas, f-S'j- This is the so-called spiritus saponatus kalinus. Prof. Kaposi uses it by repeated frictions on erythematous lupus, and states that he has caused the disappearance of the lesion without the slightest trace. 518 diseases of the skin. DR. HENRY G. PIFFARD, NEW YORK CITY. 1474. R. Saponis viridis, gviij Glycerinae, Olei cadini, f.gij Olei rosarum, q. s. M. Use, with repeated and energetic friction, in erythematous lupus. DR. TILBURY FOX, LONDON. In the non-exedent form, this author prefers the acid nitrate of mercury, or— 1475. R. Hydrargyri iodidi rubri, gr.x-xx Glycerinae, f.gss. M. Or, 1476. R. Equal parts of potassa fusa and water. In the exedent form, the solid silver caustic is the best. It must be deliberately and freely applied, chloroform being given, if necessary. The following is preferred by some:— 1477. R. Zinci chloridi, giv Antimonii chloridi, gij Amyli, gj Glycerinae, q. s. M. Others, again, commend nitric acid, mixed into a paste with sul- phur, and laid on with a spatula. After caustic application, a poultice should be applied, and the surface dressed with a soothing ointment. In all cases where the disease has been arrested and tends to heal, any mild stimulant or astringent application may be used, such as— GLYCERINUM ACIDI TANNICI. 1478. R. Acidi tannici, gj Glycerinae, fgiv. Rub together in a mortar, then transfer the mixture to a porcelain dish and apply a gentle heat until complete solution is effected. Or, 1479. R. Argenti nitratis, gr.xx-xxx Spiritus aetheris nitrosi, f.gj. M. It must be remembered that local remedies vary in efficiency in proportion to any improvement in the general health brought about by internal remedies. The disease can be made much worse by caustics. MENTAGRA—PITYRIASIS. 519 MENTAGRA. DR. HENRY S. PURDON. 1480. R. Acidi chromici, gj Aquas destillatae, f.gj. M. A useful application in sycosis menti, and other parasitical skin affec- tions. DR. VON VEIEL. OF CANSTADT. This practitioner usually cures barber's itch in four weeks. He cuts the hairs short, removes crusts, and rubs in— 1481. R. Saponis viridis, gss Picis, gj. M. He then removes the hairs with the forceps, and applies acetic acid, finishing with sulphur ointment. DR. JEANNEL, PARIS. 1482. R. Hydrargyri chloridi corrosivi, gr.vj Adipis, gj. Dissolve the corrosive sublimate in a little water, and incorporate with the lard. After having removed the crusts of the mentagra by the aid of poultices and warm fomentations, apply, morning and evening, a small quantity of this ointment. DR. DAUVERGNE, PARIS. 1483. R. Ferri sulphatis, gr.iss Carbonis ligni, gj. Reduce to a fine powder, and mix carefully. Cover the affected chin with this powder in the evening. 1484. R. Ferri sulphatis, gr.xv-xxx Aquas, f-gij- M. To be employed in lotions. But at the commencement, when the affec- tion is acute, recourse must be had to poultices and repeated purga- tives. Later on, vapor douches every other day to the affected parts are productive of benefit. PITYRIASIS. DR. HENRY G. PIFFARD, OF NEW YORK. This specialist has had the best success in this disease by a pre- liminary green soaping for several days, followed by tar ointment for a week or two, succeeded by a mercurial ointment (white pre- 520 DISEASES OF THE SKIN. cipitate or nitrate), and finally the prolonged use of some bland oily preparation, as— 1485. R. Hydrargyri sulphatis flavae, ST-xv Unguenti rosarum, gj. M. J. M. DA COSTA, M. D., PHILADELPHIA. 1486. R. Unguenti hydrargyri nitratis, Cerati simplicis, aa gss. M. For pityriasis of the scalp. To be applied morning and night. The hair should be cut short, and poultices applied before using this oint- ment. The scalp is to be kept clean with soap. TILBURY FOX, M. D.. LONDON, PHYSICIAN TO THE SKIN DEPARTMENT, CHARING-CROSS HOSPITAL. 1487. R. Creasoti, gtt.xl Glycerinae, f-giij Aquas, f.gvj-viij. M. Use in pityriasis. 1488. R. Hydrargyri ammoniati, 9j Olei olivas, fgj Adipis, gj Olei rosas, rr^vj Tincturae tolutani, gtt.xx. M. Use in pityriasis capitis. PRURIGO. ANTI-PRURITICS. The best applications suited for the temporary relief of pruritus are vinegar, lemon juice, weak solution of corrosive sublimate, tinc- ture and watery solution of opium, creasote ointment and lotion, tar ointment, and especially that of juniper tar, ointment of opium with camphor, the diluted nitrate of mercury ointment, ointment of lime, ointment of cyanide of potassium, lotion of hydrocyanic acid, aconite, acetate of ammonia, sulphuret of potash, chlorate of soda, etc. The following formulae are all useful:— 1489. R. Calcis hydratis, gij Sodas carbonatis, gss Tincturas opii, f.gss Adipis, gj. M. PSORIASIS. 521 1490. R. Tincturas opii, f.gss Sulphuris sublimati, gss Zinci oxidi, gj Olei amygdalae dulcis, f.gj Adipis, giij. M. 1491. R. Hydrargyri sulphureti rubri, gij Tincturae opii, f.gij Sulphuris sublimati, gss Adipis, gv. M. 1492. R. Ammonias muriatis, gj Pulveris hellebori albi, gss Adipis, giij. M. For local prurigo. A local remedy, frequently of service in allaying the itching of prurigo senilis, is glycerine, applied with a sponge. ERASMUS WILSON, F. R. S., LONDON, ETC. Arsenic, properly administered and watched, may be regarded as a specific in prurigo. Much may be accomplished toward the restoration of a healthy condition of the skin by ablutions with the juniper-tar and carbolic-acid soap, frictions and manipulations with the hand, after the manner of the shampooer, the tepid bath, the sweating bath, used with discretion, and moderately stimulating local applications. PSORIASIS. DR. HENRY G. PIFFARD, OF NEW YORK. This writer concedes arsenic a great repute in psoriasis, but believes that in the best practice it is being replaced by other means. Balsam of copaiva, four to eight capsules daily, is an efficient remedy. Carbolic acid, gr.j-iij thrice daily, is successful in some cases. Local applications are, strong alkalies, tar, emollients and baths. J. M. DA COSTA, M. D., PHILADELPHIA. 1493. R. Unguenti hydrargyri oxidi rubri, Unguenti hydrargyri, aa gij Glycerinae, f.gss. M. For psoriasis; to be rubbed in morning and evening, when there are no vesicles, after washing the parts with castile soap. 522 DISEASES OF THE SKIN. Internally, 1494. R. Liquoris arsenici et hydrargyri iodidi, f.gss Extracti dulcamaras fluidi, f.gijss. M. A teaspoonful thrice daily, after meals. Avoid fatty articles of diet and those highly salted. The most important thing in skin diseases is to determine, not so much their character externally, as to ascertain with what internal conditions they are associated. In the acute stages of psoriasis, the following may be used :— 1495. R. Cerati plumbi subacetatis, gij Glycerinae, f.gj Cerati simplicis, giv. M. Attention should be paid to the digestive system. Then, after the acute inflammatory condition has subsided, the red precipitate ointment (F. 1493) may be employed, or— 1496. R. Sulphuris iodidi, gr.x Adipis, 3j. M. To be rubbed in morning and evening. Or, 1497. R. Unguenti hydrargyri nitratis, Unguenti picis, Cerati adipis, aa gss. M. Internally, Donovan's solution, combined as above (F. 1494). Or, 1498. R. Liquoris arsenici et hydrargyri iodidi, f.gij Tincturas cinchonae compositae, f-Iiij- M. A dessertspoonful thrice daily. TILBURY FOX, M. D., LONDON, PHYSICIAN TO THE SKIN DEPARTMENT, CHARING-CROSS HOSPITAL. 1499. R. Argenti chloridi, gr.v-xx Cerati adipis, gvj. M. A useful ointment in this affection. If the disease is slight and localized to a few spots only, treat- ment may be commenced at once with tarry applications, for the scales are thereby removed sufficiently well. ROSACEA. 523 M. 1500. R. Olei juniperis pyrolignei, Olei olivas, Adipis, To be used night and morning. f-o-ij f-gj Or, 1501. R. Creasoti, Unguenti hydrargyri, Adipis, gtt.vj gr.xv M. In chronic cases, with thickening of the patches, or where there is much elevation of the disease, as in the nummular variety, a more decided impression may be produced by— 1502. R. Picis liquidas, Alcoholis, aa f-gij. M. To be rubbed in with flannel. When there is a tendency to "discharge," use— 1503. R. Unguenti hydrargyri nitratis, gij Glycerinae, f.gij Linimenti camphorae, f.gj. M. PROF. MORIZ KOHN. 1504. R. Acidi carbolici, gr.xv Pulveris glycyrrhizae et syrupi q. s. M. Divide into twenty pills. Give at first six to nine a day, and increase gradually to twenty a day. Prof. Herba has also obtained good results from these pills in psoriasis. But it must not be forgotten in using them that the exhibition of large doses of carbolic acid irritates the kidneys and provokes the passage of albumen in the urine. 1505. R. Sulphuris loti, Extracti gentianae, aa gss Althaea pulveris, q. s. M. Divide into twenty pills. From two to ten a day, in squamous skin affections. Sulphur baths. ROSACEA. DR. LOUIS A. DUHRING, OF PHILADELPHIA. This writer observes that rosacea is a disease of the blood vessels, especially of the nose, and is not a species of acne, though they 524 DISEASES of the skin. often occur together. Cases with this disfiguring malady go about not cured, because physicians tell them nothing can be done for them. Dr. Duhring has had excellent results from stimulating washes and ointments, especially from— 1506. R. Sulphuris loti, gj Adipia, gj. M. Rub on the parts twice daily. Tonics, aperients, a carefully-regulated diet, etc., should be re- membered, if necessary. Three months should effect a cure. DR. TILBURY FOX, LONDON. In acne rosacea, diet and good hygiene are of vast importance. If there be many varicose vessels, they may be cut across, the inci- sions never being deeper than two lines. Cold water will stay the bleeding, and collodion may be subsequently used to contract and heal the incisions. Acids and pepsin, given internally, do much good. Much has been said of the efficacy of the iodo-chloride of mercury in acne rosacea and indurata. The following formula is used:— 1507. R. Hydrargyri iodo-chloridi, gr.v-xv Adipis, gj, M. The ointment requires care, as it produces a good deal of irrita- tion. SCABIES. DR. HENRY G. PIFFARD, NEW YORK. Put the patient into a warm bath, let him soak half an hour, then have him rubbed all over, except the face, with common soft- soap and a scrubbing brush. Then rinse with clean water, dry, and rub in, with strong friction, the following:— 1508. R. Potassii iodidi, Unguenti sulphuris, Let him go to bed, and the next morning put on clean under- clothes. One such application is usually sufficient. Sometimes the above treatment must be modified for one more mild. S3 M. TINEA. 525 Dr. McCall Anderson recommends the following, as less irri- tating than ordinary sulphur ointment:— 1509. R. Olei cadini, Sulphuris prascipitatas, aa giij Glycerinae amyli, f-gvj Adipis benzoati, giij. M. UNGUENTUM SULPHURIS CUM ANTHEMIDE. 1510. R. Unguenti anthemidis, gvij Sulphuris sublimati, gj Potassas carbonatis, ' gss. M. This is a mild ointment for scabies, and well adapted for persons of sensitive skin, and for children. TINEA. DR. L. DUNCAN BULKLEY. OF NEW YORK. 1511. R. Unguenti hydrargyri nitratis, gij Unguenti aquae rosas, gvj. M. Well rubbed in, morning and night, in ringworm of the body, tinea cir- cinnata. DR. TILBURY FOX, OF LONDON. In ringworm of the scalp, tinea tonsurans, this writer commends in medium cases, after clipping the hair off very short, Costers paste, i. e.:— 1512. R. Iodinii, gij Olei picis liquoris decolorati, f.gj. M. This applied once or twice, at intervals of four or five days, effects a cure. As matters mend, it is only necessary to use some para- siticide ointment, the white precipitate, sulphur, or— 1513. R. Hydrargyri ammoniati, Hydrargyri nitrici-oxidi levigati, aa gr.vj Adipis, gj. M. Or, 1514. R. Sodas boratis, gij Aquas, ad. f.gj. M. 526 DISEASES OF THE SKIN. MILDER PARASITICIDES (FOR ORDINARY USE). 1515. R. Potassii sulphureti, Saponis mollis, Aquae calcis, Alcoholis, giij fi7-iij f-3U- Used in the various forms of tinea, scabies, etc. 1516. R. Hydrargyri chloridi corrosivi, Ammonias muriatis, Alcoholis, Aquas rosas, ad, gr.ij-iv gss f-gss f.gvj. In tinea versicolor, scabies, prurigo. 1517. R. Acidi carbolici fluidi, Glycerinae, Aquas rosas, ad. f-3ij f-gj-f.gviij. M. M. M. Use in ringworm of the surface especially. Also, in the same affection, 1518. R. Sodas biboratis, gij Glycerinae, f.gj Adipis, gj. M. 1519. R. Hydrargyri sulphatis flavi, gss Olei amygdalae dulcis, Glycerinae, aa f.gij Adipis, gij. M. Used in tinea. 1520. R. Unguenti hydrargyri nitratis, gss Sulphuris, gij Creasoti, rt^x Adipis, gj-ij. M. Use in ordinary ringworm and tinea sycosis. URTICARIA. WILLIAM AITKEN, M. D., EDINBURGH. In the treatment of nettle-rash, emetics and purgatives are to be employed in the first instance; afterward faulty digestion is to be corrected. The surface of the eruption may be dusted with flour, or the following lotion may be used :— 1521. R. Ammonias carbonatis, gj Plumbi acetatis, gij Aquae rosas, fjfviij. M. URTICARIA. 527 ERASMUS WILSON, F. R. S., LONDON, ETC. In chronic urticaria, the deranged functions are to be restored. The administration of the mineral acids with a bitter is serviceable. Very chronic cases require arsenic. The following may be used:— 1522. R. Liquoris arsenici chloridi, f.gss Acidi muriatici diluti, Aquas aurantii fiorum, aa f.gij Syrupi simplicis, f-giij- M. A tablespoonful to be taken alone or in water, with the meals, three times a day. The local treatment consists in the use of remedies for the pur- pose of relieving the itching, tingling, and smarting. For this purpose employ sponging with hot water; ablution with the juniper-tar or carbolic-acid soap; frictions with— UNGUENTUM PICIS JUNIPERI. 1523. R. Olei juniperi pyrolignici, f.gj Adipis purificatas, gij Sevi ovilli purificati, gvj. M. Melt with gentle heat and make an ointment. This is an elegant preparation. It may be used of the above strength or diluted. Or the LOTIO HYDRARGYRI BICHLORIDI. 1524. R. Amygdalae amarae, No. xx Aquas destillatae, f-gvj Contuse and mix together, then strain and add Hydrargyri chloridi corrosivi, gr-xvj Spiritus vini rectificati, f-gij. M. Or the LOTIO ACIDI CARBOLICI. 1525. R. Acidi carbolici fluidi, f-gss-j Glycerinae, f-gss Aquas destillatas, f.gvijss. M, • Or, sponging with hot vinegar, with a lotion of carbonate of ammonia, a lotion of aconite, and liniments of opodeldoc and chlo- roform or laudanum. When one applicatian fails the other must be tried. The tepid bath affords almost instantaneous relief. 528 DISEASES OF THE SKIN. THE GENERAL THERAPEUTICS OF SKIN DISEASES. PROF. ERASMUS WILSON, F. R. C. S., F. R. S., ETC. This eminent author says in one of his lectures, that as regards the classification of skin diseases, we may regard it from a strictly therapeutical point of view alone, and go armed for the treatment of all cutaneous diseases with four remedies:— First. We must have sulphate of magnesia; this will form the basis of treatment of all disorders of assimilation, and include an extensive series, embracing nearly the whole of the eczemata of middle life. He does not allude to the adjuvantia and corrobo- rantia with which sulphate of magnesia may be associated: this part of the subject is left to the judgment and experience, to the taste and refinement, of the prescriber. Secondly. We may take arsenic, the typical remedy for defect- ive nutritive power in every tissue of the frame—the special agent of cure of the debility of the nutritive period of life; and under this head we may include the eczema of infancy, chronic eczema at every period of existence, the impetigos and ringworms of children, and the lepra vulgaris of all ages. Thirdly. There is a branch of nutritive diseases which is pecu- liarly represented by cod-liver oil—namely, struma and lupus. We cannot adopt struma as a group by itself, but only as a sub-group of the much more comprehensive family of diseases resulting from defect of nutritive power; whilst another sub-group of the same great family is one which includes epithelioma and cancer. As a fourth remedy, let us take quinine, which we may justly regard as representing the leading feature of cure in all the neurotic or neuropathic affections. And, finally, we have mercury and iodide of potassium, which represent another extensive and important group of diseases, to wit, those dependent on syphilitic poison. ARSENIC IN SKIN DISEASES. DR. L. DUNCAN BULKLEY, OF NEW YORK. According to this author, arsenic is valuable in chronic rheuma- tism, hence is useful in arthritic eruptions; it is serviceable in cer- tain neuroses, as chorea and neuralgia, therefore in skin diseases with neurotic elements; and it possesses anti-malarial properties, GENERAL THERAPEUTICS OF SKIN DISEASES. 529 and is consequently serviceable in diseases of the skin showing periodic symptoms, as intermittent urticaria, etc., likewise in patients with other skin diseases who have been exposed to mias- matic influences. Arsenic is certainly also valuable in psoriasis, eczema, pemphigus, acne and lichen, in proper cases, and when due regard is paid to the secretory organs, and to diet and other elements of general health; of less certain value in lupus, ichthyosis, sycosis, verruca and epitheliomatous and cancerous diseases; it is absolutely useless or harmful in the syphilodermata, the animal and vegetable para- sitic diseases (except in rare cases), in elephantiasis graacorum and arabum, m purpura, true prurigo, herpes zoster, scleroderma, mol- luscum contagiosum and fibrosum, keloid, vitiligo, neevus, etc. In reference to its administration, it is quite sure that it is elim- inated very rapidly, chiefly by the bowels and kidneys, so that the urine shows evidence of it in a few hours; no trace of it can be found on careful analysis of the body after death, two weeks after the last dose of arsenic. The drug, therefore, does not accumulate in the system, and no fear of this need be entertained; but when it is administered in increasing doses, absorption may be hindered, and when the doses become very large, active absorption of the large dose may give rise to a suspicion of cumulative action. The first symptom of a full dose of arsenic, in a very large share of cases, is a fullness about the face and eyes, and conjunctival irritation and tenderness. This need not be exceeded, but may often be kept up with advantage to a slight degree till the disease yields. Before any harm is done by the arsenic, either this or a slight nausea or diarrhoea manifests itself. It should always be given with or just after meals ; it is often best to give it alone, or with a small amount of bitter infusion. The bowels should be first well purged, and an occasional laxative will both assist the action of the drug and prevent or modify some of its unpleasant effects. If the urine becomes loaded and the tongue coated, it is best to stop the medicine for a short time and give diuretics; some of these disturbances can be prevented by combining an alkali, as acetate of potassa, carbonate of soda, or aromatic spirits of ammonia, with the arsenic. In regard to the most serviceable forms in which to use arsenic they are named in the order of their value:—Solution of the chloride of arsenic, solution of the arseniate of potassa, that of the arseniate 34 530 DISEASES OF THE SKIN. of soda, and the arseniate of ammonia, arsenious acid, iodide of arsenic, and the arseniates of iron and quinia; of as yet untried efficacy, solution of the chloro-phosphide of arsenic and arseniate of antimony. The dose of arsenic, small at first, is to be increased slowly until some of its physiological effects are manifested, or the disease yields ; it may then be somewhat diminished. It is very important that arsenic be taken very regularly and persistently, and always under the supervision and frequent inspec- tion of the physician. Frequently arsenious acid is better tolerated when combined with opium, as:— 1526. R. Acidi arseniosi, gr.j Pulveris opii, gr.iv. M. Make sixteen pills. Neligan recommends highly what he calls the ioduretted solu- tion of the iodide of potassium and arsenic, after the following formula:— 1527. R. Liquoris potassas arsenitis, rnjxxx Potassii iodidi, gr-xvj Iodidi puri, gr-iv Syrupi florum aurantium, f-gij- M. Each f.gj of this contains Tt^v of Fowler's solution. In skin diseases of a nervous type the following formula, after Routh, promises well:— 1528. R. Acidi arseniosi, gr.j Phosphori, gr.£ Acidi hydrochloridi diluti, f.gj. M. For an adult, tt\,xv-xx thrice daily. The only local application of arsenic which is justifiable is either one where the strength is so weak, and the extent of its use so small, that there is no danger from absorption, which may occur when not expected, or, one of such a strength as to kill the adjoining tissue at once, and so prevent absorption, as is the case with Marsden's mucilage (F. 1254). MR. THOMAS HUNT, F. R. C. S., LONDON. Mr. Hunt has urged the claims of arsenic in skin diseases more strongly than any other writer; and as he claims that everything GENERAL THERAPEUTICS OF SKIN DISEASES. 531 depends upon the particular mode of administering it, his directions should be closely scanned. He remarks that there are few medi- cines less likely to do harm than arsenic when administered in the manner about to be described. Its curative powers seem to reside alone in doses too small to be mischievous. It is impossible to push it. But a patient administration of small doses under favorable circumstances, for weeks, months, or years together, will be found to exercise an almost omnipotent influence over the cutaneous diseases to which it is adapted. The numerous failures of arsenic may be traced to one or more of the following sources: 1. —The syphilitic character of the cuta- neous disease; mercury is then wanted, arsenic having no influence whatever. 2. The administration of arsenic during the inflamma- tory or febrile stage of cutaneous disease, under which circum- stances it rarely fails to increase the inflammation and never does any good. 3. Its administration on an empty stomach, thus excit- ing gastric irritation. 4. Too large doses and too long intervals between the doses. 5. The serious error of directing gradually- increasing doses. The proper method is to increase the dose one- fifth, once or twice a month, if after a fortnight it produces no sensible effect whatever. So soon as it begins to assert itself the full dose is arrived at, and it should be continued without further increase. Five minims of Fowler's solution thrice daily is sufficient to begin with, and this may be reduced as occasion may require. It should be mixed with a little water, or with the beverage drank with or after meals. Children above five years old will bear nearly as large a dose as adults. A full dose being first administered at regular intervals, in a few days (or possibly weeks) a pricking sensation is felt in the tarsi, and the conjunctiva becomes slightly inflamed. At this crisis the disease is brought under arrest, and generally from this period appears to be shorn of its strength. The dose may now be re- duced, and in some cases a very small dose, taken with exact regu- larity, will suffice to keep the eyelids slightly tender and the skin healing, until at length even the disposition to disease appears to die away under the influence of the medicine. The patient should be examined at first once a week. The medicine must not be en- tirely abandoned until weeks or months after all disposition to mor- bid action appears to have subsided. The arsenical course should be protracted, in reduced doses, for about as many months after 532 DISEASES OF THE SKIN. the final disappearance of the disease as it had existed years before. This will prove the best security against a relapse. In plethoric and inflammatory subjects the disease will yet be liable to relapse, unless the diet be so regulated as to keep the system always free from increased vascular action. In some cases, stimulants must be entirely abandoned; in others, a sparing allowance of animal food appears to be essential to the preservation of health; and in a few, vegetable diet for life. Cutaneous diseases are sometimes com- plicated with diarrhoea, dyspepsia, or general irritability of the stomach. Arsenic, in small doses, will be found to soothe the bowels (the pulse being quiet) in proportion as it allays the irri- tability of the skin. This assertion of our author, when first made, was treated with ridicule; but after twenty years' further observa- tion he repeats it. Arsenic, if rightly used, is adapted to the treatment of six out of every seven cases of chronic skin disease the physician is called upon to relieve. More than this, the diseases which are curable by arsenic are absolutely incurable without it, try what you will. Our author gives the following specific directions for the use of Fowler's solution:— First. It should be given in divided doses, three doses in twenty- four hours, simply to avoid an unnecessarily large dose. Second. It should be diluted with.pure water, or if the case re- quire the influence of antimony, the following should be ordered:— 1529. R. Liquoris potassas arsenitis, f.gij Vini antimonii, f-gxiv Aquas, f.gj. M. A teaspoonful, diluted, three times a day. Third. This dose should be taken with, or immediately after, a meal, in order that, being mixed with the patient's food, it may find a ready entrance into the blood, and that the bare possibility of its irritating the mucous membrane of the stomach or bowels may be avoided. Not that there is any danger of mischief; but the patient, aware that he is taking arsenic, may thus be disabused of all fanciful or imaginary sufferings of this kind. Fourth. It should be clearly understood that arsenic acts very slowly, and therefore it is best to begin with an average dose, say five minims of Fowler's solution, and this should be increased, not day by day, but after two, three, or four weeks. It should always be freshly prepared. GENERAL THERAPEUTICS OF SKIN DISEASES. 533 MERCURY IN SKIN DISEASES. DR. R. LIVEING, LONDON. This writer attaches much importance to mercurial plaster in many skin diseases:— 1530. R. Hydrargyri, giij Olei terebinthinas, f.giss Emplastri plumbi, gxij- M. Of this he says it is most commonly used in the treatment of syphilides. In hard chancre it is the best local application, and can be conveniently used when spread on linen and wound round the penis. It is very useful in enlargement of the inguinal glands previous to the formation of an abscess. It is indicated in squa- mous and ulcerated forms of cutaneous syphilides, when its value may be shown by covering one portion of the affected skin with the plaster and leaving the other exposed, when it will be found that the former soonest recovers. It is very advantageously applied to the condylomata of children and in psoriasis palmar is. It is also use- ful in chronic non-syphilitic skin affections, especially sycosis, acne, indurata and lichen. Of other mercurial preparations he espe- cially commends the following:— UNGUENTUM HYDRARGYRI AMMONIATI COMPOSITUM. 1531. R. Hydrargyri ammoniati, Zinci oxidi, aa gr.xl Hydrargyri oxidi rubri, gr.v Unguenti simplicis, 3J. M. Used in chronic skin diseases. UNGUENTUM HYDRARGYRI CINEREI. 1532. R. Hydrargyri oxidi cinerei, gr.xx Unguenti cetacei, gss. M. Used in syphilitic and other ulcerations of the Schneiderian membrane ; applied to the nose, night and morning, with a pencil. UNGUENTUM HYDRARGYRI CUM PLUMBO. 1533. R. Plumbi acetatis, gr.x Zinci oxidi, Hydrargyri subchloridi, Unguenti hydrargyri nitratis, aa gr.xx Adipis recentis, gsa Olei palmas purificati, f.gss. M. An ointment largely used at the Skin Hospital, Blackfriars Road, in the treatment of eczema capitis, etc. 534 DISEASES OF THE SKIN. UNGUENTUM HYDRARGYRI CUM SULPHURE. 1534. R. Hydrargyri oxidi rqbri, gr.iij Hydrargyri ammoniati, grxi Sulphuris sublimati, gr.xx Unguenti simplicis, gj. M. Used in parasitic diseases, acne, etc. DR. L. CANE, OF LONDON. In some obstinate cases of ringworm of the scalp, this writer {Lancet, Aug., 1873) commends as the best of the mercurials the oleate of mercury. Other writers also emphasize its value in vari- ous skin affections. Dr. Cane states that the advantages which oleate of mercury seems to possess over other remedies are— 1. It is a certain remedy if carefully applied. 2. It produces no staining or injury of the skin. In cases where the disease appears on the face, it is of great importance to avoid any disfigurement or staining. 3. It is painless in its application. This is not the case with the ordinary strong parasiticides, most of which produce vesication, etc. 4. It readily penetrates into the sebaceous glands, hair follicles, and even into the hairs themselves, the mercury being in a state of solution in an oily medium, and it is therefore much more likely to destroy the fungus than the spirituous or aqueous solutions of mer- cury, etc. This penetrating power of the oleate may be increased by adding a small quantity of ether (one part to eight) to it. In very sensitive skins the irritation sometimes produced by it may be avoided by using a weaker solution (five per cent.), and by applying it with a camel's-hair brush. As the oleate of mercury is not officinal, the following formula, that used at the University College Hospital, London, is added:— 1535. R. Hydrargyri peroxidi prascipitati, gj Acidi oleici, f.gx Agitate the acid in a mortar, add the peroxide gradually, triturating frequently during twenty-four hours, until it is dissolved, and a viscid solution is formed. ON PARASITICIDES. DR. H. S. PURDON, LONDON. Parasiticides may be divided into those derived from the vegeta- ble, animal, and mineral kingdoms; but without going deeply into the subject, it may be briefly stated that the most valuable obtained GENERAL THERAPEUTICS OF SKIN DISEASES. 535 from the first are iodine, creasote, carbolic acid and acetic acid. The last three check the development of spores; creasote, accord- ing to Mr. Beauchamp, although it allows the mycelium to form, prevents the spores from germinating. From the second,* the only remedy in use is cantharides, which, when used in the form of the liniment of the British Pharmacopoeia (about the strength of the cantharidal collodion, U. S. P.), quickly cuts short the disease, especially tinea tonsurans, circinnata, and alopecia acuta; it like- wise stimulates the affected skin to take on a more healthy action. From the mineral kingdom we have mercury, especially the bichloride, chromate, nitrate, and white precipitate; sulphur, borax, etc. The first has a well-earned reputation, and the chromate of mercury our author has carefully tried in tinea versicolor, and some other forms of vegetable parasitic diseases. An objection to its use is that it does not mix with water; indeed, it is insoluble in any fluid, but may be used as an ointment. He has added gly- cerine and rectified spirits, so as to endeavor to suspend it in solu- tion, but without success. The only way to manage, is to shake the bottle before applying it. A useful auxiliary to the above remedies is epilation, which should be performed in inveterate cases. Of course, constitutional treatment is of the utmost importance, quinine being our chief remedy, which substance, it is asserted, has the property of destroying vegetable growth. The tincture is the best preparation for children. No doubt the growth and development of a fungus is favored by some peculiar condition of the system; for example, tinea versi- color flourishes and is common on the bodies of consumptive patients. In all cases of vegetable parasitic diseases, our author prescribes constitutional as well as local treatment. Cod-liver oil, pancrea- tinine, the syrup of the iodide of iron, quinine, and in hospital practice salicine, are the remedies relied on. The therapeutical fact should be remembered that parasitical affections are rarely, if ever, "cured" by destroying the parasite; but they can be eradi- cated by administering appropriate tonics and alteratives which are capable of correcting the blood dyscrasia, which tends to keep up the disease. 536 DISEASES OF THE SKIN. The following formulae for parasiticides are commended :— DR. MALASSEZ. 1536.- R. Hydrargyri sulphatis flavae, gr.xv Butyri cocoae, Olei ricini, Olei amygdalae dulcis, aa gv. A mild parasitic ointment. Apply twice daily in pityriasis, Bycosis, etc. DR. R. LIVEING. LOTIO ACIDI SULPHUROSI. 1537. R. Acidi sulphurosi, Aquas destillatae, aa f.giv. Used in all parasitic skin diseases. LOTIO CALCII SULPHURETI. 1538. R. Calcis vivas, ft>.|. Sulphuris, fb.ss Coque cum aqua, Ov Evaporetur, ad. Oiij. Used in scabies and other parasitic diseases. LOTIO HYDRARGYRI PERCHLORIDI. 1539. R. Hydrargyri perchloridi, gr.x Bismuthi subnitratis, gr.cxx Spiritus camphorae, f.gss Aquas, Oj. Used in parasitic diseases and acne. UNGUENTUM CREASOTI. 1540. R. Creasoti, n\,vj Unguenti hydrargyri, gr.xxx Hydrargyri oxidi rubri levigati, gr.xx Adipis recentis, gj. Used in parasitic and other skin diseases. J. M. DA COSTA. M. D., PHILADELPHIA. 1541. R. Calcis hyposulphitis, Sodae hyposulphitis, aa gss Aquae, f.giv. A useful lotion for sycosis mentis. The following are useful:— VESICATING, VEGETABLE PARASITICIDES. 1542. R. Tincturae iodinii compositas, f.gj Iodinii, gr.x. Potassii iodidi, gr.xv. Used in chronic stages of vegetable parasitic diseases. GENERAL THERAPEUTICS OF SKIN DISEASES. 537 1543. R. Pulveris cantharidis, gij Acidi pyro-acetici concentrati, f.gviij Acidi tannici, gj. M. Macerate for a week and strain. Used in tinea decalvans. 1544. R. Acidi carbolici fluidi, f.gj Glycerinas, f.gss. M. Used in tinea. SKIN HOSPITAL, LONDON 1545. R. Pulveris cantharidis, Acidi tannici, Acidi acetici, Macerate seven days and strain. DR. TILBURY FOX, OF LONDON. This writer, speaking of skin diseases of general character; remarks, as regards local remedies, there are three main rules to be observed, viz.:— 1. Whenever active hypersemia is present, be the disease what it may, applications of a stimulating nature should not be used, but the treatment should be essentially soothing, otherwise the inflam- matory symptoms will be increased, and the disease spread. 2. The action upon the skin of an external irritant—as scratch- ing—should be prevented, and the air excluded from inflamed or excoriated surfaces, especially by oil-packing and otherwise. 3. Not until the stage of active hypersemia has passed should astringents, stimulating applications, or revulsives be employed. These, and absorbents, are to be reserved for the stages of vascular sluggishness and inflammatory induration and thickening. As regards internal or general remedies, it is proposed to indi- cate below, in as practical and concise a form as possible, the conditions which should be taken into consideration in framing the treatment of such diseases as erythema, intertrigo, urticaria, ecze- ma, lichen, prurigo, pemphigus, hydroa, ecthyma, furuncuius, pity- riasis rubr.a and psoriasis; and inflammatory conditions of the glands and hair follicles, as acne, dysidrosis, and sycosis, which are an- alogous to, and only differ in regard to their anatomical seat from, those preceding. This short sketch or chart, inasmuch as it applies to the bulk of skin diseases, should be used regularly in determin- ing the treatment, which must necessarily vary with the different combinations of the influencing agencies referred to. These condi- tions are:— A Syphilitic Taint, which tends to induce induration from the gss f.giv. M. 538 DISEASES OF THE SKIN. presence of syphilitic tissue; or ulceration, cachexia, and general debility in eczema, psoriasis, pemphigus, ecthyma, acne and inter- trigo (infants). Constipation, which causes dyspepsia, liver torpor and retention of excreta, and occurs in all forms of skin diseases. Debility, including anaemia, which retards recovery from want of recuperative power in the system, all functions sharing in the debility. It is especially operative in furunculus, eczema, pityriasis, rubra, pemphigus, and ecthyma. Diabetes, which increases any inflammatory condition, favors phlegmonous inflammation, and leads to freer development of dis- ease, and to chronicity. Its influence is often seen in eczema, psoriasis, intertrigo in adults, furunculus, and anthrax. Dyspepsia, which induces debility, leads to liver disturbance, impurities the blood, and increases hypersemia by reflex action, as in acne, eczema, urticaria and sycosis. Errors of Diet, which introduce special irritative substances into the blood, cause dyspepsia, lead to accumulation of nitrogenous matters in the system, to liver disorder, etc., and complicate all forms of inflammatory eruptions without exception. Gouty and Rheumatic Diseases, which cause accumulation of uric and lactic acids and allied compounds in the blood, and give an inflammatory character to disease, as seen in eczema, psoriasis, lichen, ecthyma, sycosis and urticaria. Lack of Hygiene, which disposes to torpor of the skin, and favors the occurrence of morbid action and disease, as seen in acne and sycosis, eczema, intertrigo, and erythema especially. Repression of the special normal eliminatory functions (skin and menstrual), which throws the necessity of compensatory elimina- tion on the skin, which may fail to respond, and so become diseased. In dependent parts this leads to increase of fluid tissues. It occurs in furunculus, ecthyma, and eczema. Retention of Excreta, from kidney, liver and bowel inactivity, which gives the blood an irritative quality and aggravates hyper- semia in all inflammatory skin diseases. It also leads, in the case of kidney torpor, to increase of watery fluid in the tissues, as in ec- zema of the legs. Strumous Diathesis, which imparts an unusual purulent character to eruptions, and favors the application of the connective tissues, as in eczema, psoriasis, acne and sycosis. GENERAL THERAPEUTICS OF SKIN DISEASES. 539 DIET IN SKIN DISEASES. There are one or two observations to be made on this subject that may be of use in the management of these diseases. First. A distinction must be made between the diet of the private and hospital patient. The latter often only requires to be well fed up, and his disease then speedily goes; the former, on the other hand, often needs to have a check put on the quantity and quality of his food. Second. In children, skin diseases • may arise directly from de- fective alimentation, as in the case of eczema; and it is frequently the case that the child, the subject of eczema, intertrigo, or psori- asis, has not a sufficient supply of milk, either from excessive dilu- tion or otherwise. Third. The regulation of the diet, setting aside the question of quantity or quality, is, as a rule, needed not so much to directly in- fluence the skin disease as certain states of the general health, which modify the particular disease present; for instance, to meet especially dyspeptic, gouty, and rheumatic conditions, but particu- larly the former. In dyspepsia in connection with eczema, acne, psoriasis, or con- gestion of the face, it is advisable, especially if the urine be very acid, to avoid sugar, tea, coffee, alcoholics, beer, raw vegetable matter, with unripe or uncooked fruit, veal, pork, seasoned dishes, pastry, and the coarser kinds of vegetables, but especially all arti- cles whose use is followed by heat or flushing of the face, and by flatulence and the like. Milk, the common meats, a light kind of bread, and some very light wine should be the diet of dyspeptic patients, whose skins are at all in a state of irritation. In very many cases the stomach is at fault at the outset, and a careful regulation of the diet is of the utmost importance as an aid to the other means adopted to correct faults in other parts of the system. In gouty subjects, much the same line is to be pursued. As re- gards stimulants, hock, a good light claret, Moselle even, but not the sparkling, or whisky in Vals water, are the best beverages. In strumous subjects, the diet should consist of as much fatty matter as possible. Fourth. In children who suffer from ringworm, it is desirable to give as much fatty matter as possible, by means of milk, cream, eggs, and fat meat, if they can be got to eat it. 540 DISEASES OF THE SKIN. Fifth. In syphilis, the greatest care should be taken to avoid anything beyond the most moderate use of stimulants; their abuse in this disease is a source of the greatest aggravation. Sixth. In all cases in which the onset or early stage of a skin disease is accompanied by febrile disturbance, however slight, or in which the disease is very hyperaemic, stimulants should be avoided, and the plainest and simplest diet ordered. In marked cases of this kind, a milk diet for a while is often found to be very bene- ficial. Seventh. In some cases in which the skin is hyperaemic, this condition is much increased by the ingestion of food, especially if dyspepsia exists, in consequence of the sympathy existing between the stomach and the skin of the part affected. This state of things is especially marked in such diseases as acne, congestion of the face, and non-parasitic sycosis. Stimulants must be avoided, except they be diluted with some alkaline water: the use of a diet appropriate to the dyspepsia must be rigorously enforced. Eighth. It is said that psoriasis requires an ample meat diet; but the patient must be dieted, and not his disease—i. e., the diet should be plain and nutritious, and adapted to the constitutional peculiarities of the individual, according to circumstances. Ninth. In all cases where a skin disease has become chronic, and where there is debility, the patient should be allowed a full, unstimulating diet. Our author has at times employed rubber cloth in the treatment of every variety of eczematous affections, from eczema squamosum to eczema impetiginosum. He makes use either of closely applied pieces, roller bandages, or of whole garments made of this material. The rubber cloth {toile caoutchouque) consists of ordinary cotton, which is first coated with a solution of caoutchouc, and then sub- mitted to the process known as vulcanizing. This consists in sprinkling the stuff with a mixture of caoutchouc and sulphur, and exposing it to a high temperature under a pressure of sixteen atmospheres. The material obtained in this way is gray, black, or of any other desirable color, flexible, impermeable to watery fluids, smooth and polished on one surface, dull and rough on the other, and smells of caoutchouc and sulphur. Oil, as well as fats and alcohol, dissolve this layer of caoutchouc, thus destroying its desir- able qualities, and rendering it useless for the purpose in question. It can be worked like any other cloth, that is, be cut, sewed, and GENEKAL THERAPEUTICS OF SKIN DISEASES. 541 its surfaces be made to adhere by means of a cement containing caoutchouc. These properties led our author not only to apply it simply to the affected parts, but to have various pieces of clothing made of it; for instance, caps for the head, bags in which to envelop various regions of the body, gloves, stockings, and, finally, entire drawers, with and without feet attached, as well as shirts and blouses. Besides these, he has some of the ordinary gum-elastic (not vulcanized) made into bandages and gloves, and is convinced that this is also useful. In every case the smooth side of the vulcanized cloth is laid in contact with the skin, from which the collections of morbid pror ducts, the scales, crusts, etc., have been previously- removed, although in some cases the cloth is applied, for the sake of experi- ment, above these. On removing the cloths, at the end of twelve or fourteen hours, they are found very moist, often entirely soaked through, and the fluid, which had collected on the surface of the skin in considerable quantity, of a penetrating smell, worse even than that of the " stinking foot-sweat." The skin itself, however, when cleansed from the diseased products thus softened, appears odorless and only reddened, more or less robbed of its epidermis, moist and shiny. The sensations of the patient during their ap- plication are not at all unpleasant, there being no pain or itching. After their removal itching generally comes on, and, unless they are renewed within half an hour or so, a feeling of contraction and pain also, so that the patients long for their immediate reapplica- tion. If the treatment is continued in this way, the whole series of symptoms gradually diminish—the moistening, redness, itching and pain—and in many cases the cure of the eczema is seen to be complete in the course.of two months. But as it is known that under other treatment the cure of eczema may be effected in this period of time, the question arises what ad- vantage the caoutchouc method offers over others, such as by un- guentum diachyli, tar, zinc, sublimate, etc. The answer must be that, although in general no excessive advantage can be attributed to the caoutchouc, nevertheless there are cases in which this new remedy can be used with especial profit. It applies particularly to eczema of the hands, fingers, flexures of the joints, scrotum and feet, in which the application of salves, etc., is not only attended by much inconvenience to the patient, but in which also the caoutchouc preparations are able to afford a much 542 DISEASES OF THE SKIN. more speedy relief to the pain produced by the fissures, inasmuch as such parts can be kept constantly moist by the easy application of the gloves, coats, bandages, suspensories and stockings employed. Although, therefore, no new panacea has been introduced into der- mato-therapeutics by the use of caoutchouc in the treatment of eczemata, it must still be regarded as a very valuable addition to our means of cure, and all the more as it does not prevent the helping use at the same time of other known remedies. Thus in many cases the cure of eczema is powerfully assisted by the simul- taneous use of schmierseife, baths, douches, tar preparations, etc., • and these latter in turn made more serviceable by the application of the caoutchouc clothes. In the general treatment of skin diseases, it must always be borne in mind that there is very frequently debility present, which favors the development of the disease, and which must be got rid of, if the eruption is to be cured, in the best way. In fact, the skin of a healthy person will mostly resist the action of many local irritants, but cannot do so if the subject be weak and debilitated; so that it is an important point to give tonics, as a rule, in cases of eruptions excited by local irritants. There is, for example, one simple combination of causes, debility and local irritants, inducing erythema, eczema, lichen, etc. Other examples readily occur, such as eczema in a gouty subject, modified by neglect and scratching; psoriasis in a strumous subject in whom the tendency to the disease is hereditary; erythema in a rheumatic subject, in connection with dyspepsia; eczema occurring in cooks exposed to the irritating in- fluence of the fire, whilst the patient also has a blood current charged with retained excreta, in consequence of inefficient bowel and kidney action; lupus in a scrofulous subject; tinea tonsurans in a body with persistent anaemia and a phthisical tendency; pru- ritus in connection with senile atrophy of the skin, liver derange- ment, and gout. Other examples might be multiplied almost in- definitely. In setting about, therefore, the cure of any given cutaneous disease, attention must be paid not only to predisposing and excit- ing causes, but to coincident occurrences and accidental concomi- tants modifying the disorder. V. VENEREAL DISEASES. Balanitis—Gonorrhoea, Acute and Chronic {Complications and Sequelce)—Syphilis, Primary and Constitutional. BALANITIS. AUGUSTE CULLERIER, OF PARIS. When it is possible to uncover the glans, make three or four dressings a day with a piece of fine linen or lint (inserted between the glans and prepuce), wet with one of the following ASTRINGENT SOLUTIONS. 1546. R. Argenti nitratis, gr.iij-ivss Aquas destillatas, f-giv. M. 1547. R. Aluminis, Bij-iv Aquas rosas, f-giv. M. 1548. R. Acidi tannici, gr.xv-xxx Vini aromatici, f-gxj Aquae rosas, q. s. ad. f.giv. M. 1549. R. Tincturae iodinii, ttVxv-xxx Aquae destillatae, f-gix. M. SILAS DURKEE, M. D., BOSTON. The best topical application in this disease for slight abrasions and small patches of aphthae is the following:— 1550 R. Liquoris sodas chlorinatae, f-gss Aquas, f-gvij. M. This solution is to be applied on pieces of lint between the pre- puce and the glans, three or four times a day. If the erosion be considerable, and the puriform exudation copious, an astringent lotion may be appropriate, thus :— 1551. R. Zinci sulphatis, gr.ij Acidi tannici, gr-iv Glycerinae, f.gij Aquas, fgiv. M. Apply with lint. Simple lime-water will frequently effect a cure. 543 544 VENEREAL DISEASES. Balano-posthitis requires most frequently only local treatment. When, however, the inflammation tends to become phlegmonous, and threatens to terminate in gangrene, it is well to subject the patient to a severe regimen, and to the use of antiphlogistics, diet, repose, general baths, demulcent drinks, saline purgatives, etc. In order to combat gangrene, order— 1552. R. Camphorae, gss Extracti opii, gr-iij Moschii, gr.vijss. M. For forty pills. From six to ten a day. The penis should be wrapped up in compresses, moistened with the following strongly opiated solution :— 1553. R. Extracti opii, 9ij Vini aromatici, f-giij Aquas rosas, f-gvj. M. After the inflammation has subsided, lotions and intra-preputial injections, with the solution given above, should be resorted to. GONORRHCEA. DR. THOMAS F. BETTON, OF PHILADELPHIA. This physician {Medical Times, October, 1871) has found, by many years' experience, that weak injections of acetate of lead, gr.j-ij to rose water f.gj, assisted by a cold sitz-bath morning and evening, is sufficient in all cases of simple clap, when taken early. He considers the abortive treatment by strong injections as both useless and pernicious. AUGUSTE CULLERIER, PARIS. 1554. R. Copaibas, f.gv Cubebae, giv Spiritus menthae piperitae, q. s. M. Electuary. From four to five drachms a day are given. This formula is one of the most frequently employed at the Hopital du Midi. For the abortive treatment of gonorrhoea, our author uses large doses of copaiba (f.giv-v a day) or cubebs (gv-viij a day). He GONORRHOEA. 545 considers them more valuable than any of the abortive injections. They are to be employed only, however, when the gonorrhoea is of recent date, when there is little or no pain, and where the discharge is not as yet muco-purulent. Under favorable circumstances, when the abortive treatment is thus employed, the discharge will diminish, or disappear in the course of four or five days. The treatment should not then be suspended, but, on the contrary, continue for several days after the cure is apparently complete. If this precaution be neglected, the inflammation may reappear. If, after from six to eight days, no improvement is manifest, it is useless to persist longer in this form of treatment. Astringent injections should not be combined'with this use of the balsam. They have no advantage at this early period of the disease, and often keep up an amount of irritation, which may interfere with the effect of the internal remedy. When the inflammatory period of gonorrhoea is over, Cullerier advises injections to complete the cure. The following injections are those most frequently prescribed at the Hopital du Midi:— 1555. R. Zinci sulphatis, Plumbi subacetatis, aa, gr.xv Aquas, f-giv. M. 1556. R. Aluminis, giss Aquas, f-giv. M. 1557. R. Acidi tannici, gr.vij Aquas, f.gj. M. Two injections a day are sufficient. Before each injection the patient should urinate. SILAS DURKEE, M. D., BOSTON. 1558. R. Copaibas, f-giij Spiritus aetheris nitrosi, Tincturas kino, aa f.gss Morphiae sulphatis, gr.iy Aquas camphorae, f.gij. M. One teaspoonful thrice daily. Usually, an efficient check will be put to the gonorrhoea in eight, or ten days by the use of this preparation. 1559. R. Pulveris cubebas, gviij Pulveris aluminis, ^ 33 Pulveris cinnamomi,. gj- M. For thirty-two powders. One thrice daily. 35 546 VENEREAL DISEASES. This combination of cubebs and alum will usually diminish the urethral discharge in two or three days, and if the patient will observe a perfectly quiet state of the body, he will find that in eight or ten days the gonorrhoea will be nearly at an end. The strictest avoidance of exercise constitutes an important element in the treatment of every case of gonorrhoea, and the patient should even keep in a recumbent posture in order to secure the best effects in the shortest time. As with the balsam copaiba, so with cubebs; they should not be discontinued under a fortnight after the cessation of the urethral discharge. The tincture is an elegant and convenient form of administering cubebs. It may be given in doses of f.gj to f.gij four or five times a day, or combined thus :— 1560. R. Tincturae cubebas, f.gij Tincturae cantharidis, f.giss Morphiae sulphatis, gr.ij Aquas camphorae, f-giij- M. A dessertspoonful thrice daily, in half a gill of cold water. Or, the fluid extract may be used in this manner:— 1561. R. Extracti cubebae fluidi, f-giv Morphias sulphatis, gr.ij Mucilaginis acacias, Aquas camphorae, aa f-gij. M. Our author also recommends the following formulae of Drs. Druitt, Langston Parker, Beyran and Holmes Coote :— 1562. R. Copaibas, f.gss Olei cubebae, f-gss Liquoris potassae, f-g'ij Spiritfts mjristica", f-gss Aquas camphorae, f.gj. M. Two teaspoonfuls thrice daily. The combination of copaiba with the oil of cubebs, as above, will sometimes be found to agree better with the stomach than the cap- sules of any other combination. In chronic gonorrhoea or gleet, the balsam and the cubebs may be advantageously combined with iron, as follows:— 1563. R. Pulveris cubebae, gss Copaibas, f.gij Ferri sulphatis, gj Terebinthinae olei, giij. M. To be made into boluses of gr.x each. From fifteen to thirty a day. Usefully employed in lax constitutions. GONORRHOEA. 547 1564. R. Pulveris cubebae, 3j_ij Ferri carbonatis, gss-j. M. For one powder, to be taken thrice daily. The above is particularly useful after the acute symptoms have subsided. Our author employs the following in gleet :— 1565. R. Tincturae cantharidis, Olei terebinthinae, aa f.gj Mucilaginis acaciae, f-gij- M. A teaspoonful thrice daily, together with the following injection :— DR. N. GALLOIS, OF PARIS. 1566. R. Acidi tannici, gj Opii pulveris, gr.iv Glycerinae, q.s. M., Make into urethral suppositories, which, soft in summer, are quite solid during the winter. They are to be moistened with warm water and introduced into the urethra, where a piece of the length of about an inch and a half is to be allowed to remain. This quickly dissolves and turns into a whitened mass in mixing with the urethral mucus. Treated in this manner, it is said that the most violent cases cure in from one to three weeks. 1567. R. Copaibas, f-giv Spiritus menthae piperitas, ttbxx Mel despumatas, f.giss Sacchari, giss Aquas destillatae, f-giij- Place the copaiba, the honey, the sugar and the water in a vessel and warm over a slow fire, constantly stirring, to avoid a too great eleva- tion of the temperature and to favor the division of the oleo-resin of copaiba. At the end of ten minutes remove the fire, color the mix- ture, and add the peppermint after cooling. The product thus ob- tained, nearly deprived of the odor of copaiba, is of a gelatinous consistence, and can be administered to those who cannot take the ordinary preparations. DR. WILLIAM A. HAMMOND, NEW YORK. In simple gonorrhoea, after the discharge is well established, reli- ance should be placed upon injections. Those recommended in syphilitic gonorrhoea will be found most advantageous. The following mixture of copaiba is capable of doing more good than the uncombined balsam, and it is not much more disagreeable to the taste or stomach :— 548 venereal diseases. 1568. R. Copaibas, Spiritus aetheris nitrosi, Tincturas opii, Tincturas iodinii, f-gij f-gj aa f.gj Magnesiae, Mucilaginis acaciae, S\\ f.gv. One to two teaspoonfuls thrice daily. M. No internal treatment should be depended upon to the exclusion of injections. Stimulants should be avoided, as should also salt meat. In the management of the chronic stage of simple gonorrhoea or gleet, the affected individual should be placed upon a good, plain, nutritious diet, and the mind and body pleasantly and system- atically employed. The greatest benefit is derived from cold plunge baths, followed by frictions of the skin with coarse towels or hair-brushes. As internal remedies use— 1569. R. Ferri sulphatis, gr.ij Quiniae sulphatis, gr.ss. M. For one pill thrice daily. The oxalate or citrate of iron may be substituted in the same dose. In addition, our author has derived great benefit from the use of the following recipe :— 1570. R. Tincturas cantharidis, f.gss Strychniae, gr.j _ Syrupi limonis, f-giij- M. A teaspoonful morning and evening. Injections should be persevered with, changing one for another, as they lose their effect. MR. BERKELEY HILL, F. R. C. S., LONDON. In the early stage, copaiba and cubebs are not beneficial, and only two injections are of any service, viz., half-hourly injections of tepid water, or hourly injections of alum or sulphate of zinc, gr.| to aquse f.gj. The former are often useless, and the latter, if they increase the irritation, are to be stopped. SUPPOSITORY FOR CHORDEE. 1571. R. Morphiae sulphatis, gr.£-sa Butyri cocoae, gr.x. M. To be passed into the rectum on going to bed. GONORRHOEA. 549 When the pain is violent, thirty to forty drops of tinctura opii in a wineglassful of decoction of starch should be injected. Our author has repeatedly found of service in chronic gonorrhoea the following capsule devised by Sir Henry Thompson :— 1572. R. Extracti cubebae astherialis, Olei copaibas, aa m> Picis liquidas, n^. M For one capsule. One three or four times a day. A very useful formula for injection is that of the " four sul- phates:"— 1573. R. Zinci sulphatis, Ferri sulphatis, Cupri sulphatis, Aluminis, aa gr.x A(luae» f-gviij. M. The solution is not used in full strength at first, but the first day is diluted with three times its bulk of water. If severe smarting follow, it is further diluted. Its strength is gradually increased until its full strength is used or the discharge stops. This being attained, it is diminished in strength step by step until plain water is reached. In this plan ten days should be employed. DR. J. D. HILL. ROYAL FREE HOSPITAL, LONDON. 1574. R. Glycerini acidi tannici, f-giij Olei olivas, Misturas acaciae, aa f.gj. M. This injection our author has extensively employed in hospital and private practice. It should be used in the following manner : The bladder having been first emptied, the bottle containing the lotion is to be well shaken, and about two drachms of it briskly poured into a saucer, and quickly drawn into a syringe. The penis is then to be held in the left hand, with the thumb and little finger respectively placed upon the superior and inferior portions of that organ, close to the symphysis pubis, and the fore and middle fingers resting in like manner upon the superior and inferior surfaces of the glans, close to the meatus urinarius. The syringe, with the piston withdrawn, is now to be taken up with the right hand, and the nozzle, as far as its shoulder, carefully passed into the urethra. The thumb and little finger must press the root of the penis to prevent the passage of any fluid beyond that point. When a sense 550 VENEREAL DISEASES. of tension is felt, the syringe may be withdrawn; but the front fingers must previously be so applied as to compress the glans, and thus prevent any escape of the fluid. Next, with the thumb and forefinger of the right hand, the fluid in the urethra is to be set in motion, and so kept for four or five minutes. This will be attended with a gurgling noise, from the mixture of air and fluid. Thus, when the injection has insinuated itself within the folds and lacuna of the urethra, it is allowed to escape. In this manner, it is as- serted, the bladder is protected on the one hand, and on the other there is a certainty of the fluid being applied to the whole of the affected surface. Glycerinum acidi tannici, used in the above recipe, is officinal in the British Pharmacopoeia. It is made by rubbing together in a mortar one ounce of tannic acid and four ounces of glycerine, then transferring the mixture to a porcelain dish, and applying a gentle heat until complete solution is effected. M. Luc, a French military surgeon, uses in gonorrhoea, when the discharge is without pain, an injection of a thin paste of finely powdered starch and hot water. DR. FRANK F. MAURY, OF PHILADELPHIA. The abortive treatment is objectionable on account of its ten- dency to leave strictures. The patient should avoid all sexual excitement; all alcoholic beverages (the least harmful is claret); highly seasoned meats; asparagus; violent exertion. Locally, a routine practice must be avoided. One thing, however, should never be neglected; that is, to teach the patient— How to make a urethral injection. Let him first empty his bladder, then stand over a chamber, retract his foreskin, and hold his penis, with his thumb on one side and his finger on the other, so as to close the meatus against the nozzle of the syringe, never holding above and below, for that spreads the meatus. Then let him inject about a fluid drachm, slowly and deliberately. There is no danger of forcing the injection into the bladder, and no pains need be taken to prevent it. After the injection is in, let it be gently worked backward and forward along the urethra, to distribute it nicely, and retained for a few minutes. Then let it come away, as much as will flow off readily. . The nozzle of the syringe should not be longer than about three- GONORRHOEA. 551 eighths of an inch, because often the trouble is close to the orifice of the urethra, and a longer nozzle would prevent the injections coming well in contact with it. This application is best made in the morning, after the daily stool, again about noon, and again about five or six o'clock; not just before bedtime, as is sometimes recommended. The manipula- tions tends to increase the disposition to chordee, and should not be made just before going to bed. As for particular formulae, one can use a mixture containing vegetable and mineral astringents, say— 1575. R. Tincturas matieo, Tincturas catechu, aa f.gj Extracti opii aquosi, gr-xvj Plumbi acetatis, gr.x-xij Glycerinae, f.giv Aquas rosas, f.gvss. M. One may substitute for the acetate of lead sixteen grains of sulphate of zinc, or of the biborate of zinc. There is another form of injection, which acts by making a coating for the inflamed membrane. It consists of bismuth held in suspension, which, when injected, gives a mechanical protection: — 1576. R. Bismuthi subnitratis, gij Glycerinae, f-giv Aquas rosas, f.gvss. M. Shake well when used. Add the following internally:— 1577. R. Tincturae sanguinarias, Tincturas kino, Balsami copaibas, Spiritds aetheris nitrosi, a,a f.gj Olei gaultherias, f.gj. M. A teaspoonful every four hours. With these use large diluent drinks. COMPLICATIONS AND SEQUELiE OF GONORRHOEA. GONORRHOEAL ORCHITIS. GERMAN HOSPITAL, PHILADELPHIA. At this institution, if epididymitis resulted, the patient was put at rest on his back, the testicles supported on a cushion, and cool- ing lotions applied, if there were acute inflammatory symptoms. Should the epididymus become chronically indurated and indis- 552 VENEREAL DISEASES. posed to soften, then mercury was applied locally, either in the form of the simple ointment, or of that combined with belladonna ointment, in the proportion of eight of the former and to two of the latter. In place of the mercurial preparation, an ointment containing iodine was sometimes used. The following formula was one of the most common :— 1578. R. Unguenti iodinii, gij Extracti belladonnas, gr.xx Adipis, gij. M. Ointment. Apply externally twice daily. OEDEMA PR^EPUTII. 1579. R. Plumbi acetatis, Biv Aquae, Oj. M. Or, 1580. R. Aluminis, gviss Aquae, Oj. M. The cedematous organ is to be enveloped and lightly compressed by a linen bandage saturated with one of the above solutions. PROSTATIC GLEET. MR BERKELEY HILL, F. R. C. S., OF LONDON. An obstinate prostatic gleet is a not infrequent result of a neglected or ill-treated gonorrhoea. In its treatment Mr. Hill recommends that if there is much pain and nocturnal irritation, a very mild anodyne suppository passed into the rectum at bedtime should be ordered, such as one-third of a grain of extract of belladonna, a quarter of a grain of hydrochlorate of morphia, one grain of camphor, and ten grains of cocoa butter, melted together and cast into a conical shape. If the repeated use of the morphia interferes with the action of the liver, an occasional dose of calo- mel, with a little colocynth, should be given. While the discharge is whitish or opaque, two or three drops of copaiba in frequent doses is often useful; and when the prostate has lost tenderness if pressed by the finger, one or two drops of tincture of cantharides, in plain water, four times in twenty-four hours, is also sometimes magical in its effect. A good formula for the copaiba is— GONORRHOEA. 553 1581. R. Copaibas, Cinnamomi essentias, Mucilaginis acaciae, Aquas, This amount four times daily. When all the pain and spasmodic twitching of the compressor muscles have passed away, cubebs, in moderate doses—say, ten grains, four times daily—is sometimes useful to check the secretion completely. For local treatment, he states that when considerable pain is felt if the finger is introduced into the rectum, and the prostate feels large and soft, leeches are useful—that is, three or four applied by means of a leech tube to the mucous membrane within the anus; or if the introduction of a foreign body causes pain, which is often the case, and the requisite skill be not at hand, twenty leeches applied to the perineum are very beneficial. When the protastic tenderness has subsided, cool hip-baths for five minutes, morning and evening, beginning at 85° F., and gradually lowering the temperature to 50° F. by adding cold water, are use- ful. They may be continued several weeks with benefit. In continuous moderate counter-irritation, lauded by some surgeons in chronic prostatitis, he has no faith. He has used it over and over again, but could never satisfy himself that the repeated appli- cation of small blisters to the perineum lessened the prostatitis. If it benefited the patient at all, it did so only by engaging his attention and satisfying him that " something was being done." Counter-irritation by means of caustic solution of iodine is useful when applied in the following way :—Paint the perineum, the genito-crural folds, and neighboring parts of the thighs, so that the area is as large as half a square foot, and thus raise a consider- able amount of irritation too great to allow the patient to walk about for some days. Such irritation sometimes removes all the symptoms in a few hours, except the gleet, and that is then in a fair way to depart. But this favorable result is by no means constantly obtained; hence he avoids counter-irritation till he has tried other means. In the "irritable" or "relaxed" prostate which sometimes comes from this cause, sometimes from masturbation, unsatisfied de- sire, spermatorrhoea, etc., the treatment is first to allay the patient's fears, which are generally extravagant, inquire into his diet, and "lij tt\,xx f-gj. M. 554 VENEREAL DISEASES. warn him to eat his meals slowly. If, as is often the case, an examination of his urine shows that the phosphates are freely deposited, the following formula will be appropriate :— 1582. R. Acidi nitrici diluti, Tincturae nucis vomicae, aa gtt x Aquas, f.gj. M. This amount thrice daily. In regard to local treatment, examine the prostate with the finger, and if not specially tender, pass a flexible bullet-bougie along the urethra, and don't be alarmed by the amount of outcry it causes, or even should a drop of blood be found adhering to the end of the instrument when it is withdrawn. Of course the greatest gentleness must be used in passing the instrument. The pain, which is of a burning kind, disappears very quickly, and the patient, even if he have fainted from the nervous shock, in a few moments gets up and acknowledges that he feels no particular in- convenience from the operation. In the next three or four days he experiences great improvement; the amount of discharge is less; there is less aching in the sacrum and thighs after walking; and consequently his spirits are better and his several nervous disorders trouble him far less, so that on his next visit he will usually allow the bougie to be passed again, and may even beg for it spontane- ously. After the first introduction, the spasm is commonly much less, and when it has been passed a few times the amount of suffer- ing is very bearable. In order to reduce the pain to a minimum, Mr. Hill uses at first flexible black French bougies with tapering ends, till the irritation has considerably lessened, when a steel No. 10 sound, with short curve, is generally the most effective instru- ment. So long as any tenderness or spasm remains, the sound should be passed once a week if the good effect last so long, twice a week if the dull pain and sense of weight begin to revive after three or four days have elapsed. It now and then happens that the passing of a sound becomes real agony. In such cases he is accustomed to pass the catheter, and throw in from ten to fifteen drops of solution of nitrate of silver (twenty grains to the ounce); first rendering the patient insensible by chloroform, or, better still, by gas and ether, and emptying the bladder, if the patient has not already done so in the natural way, before the injection is thrown in. While he is still unconscious, it is well to inject one-third of a GONORRHOEA. 555 grain of morphia under the skin, to maintain insensibility for the three or four hours that elapse before the pain of the injection subsides. This injection is also useful in chronic prostatitis, and must be carried out in the same way. For this it may need repetition more than once, or even twice; but repetition is rarely if ever needed for simple irritable prostate, as after one injection the slight tenderness remaining is easily controlled by the regular introduction of a bougie about once a fortnight, which the patient may learn to do for himself. When the digestion has been restored or greatly im- proved, and the local irritability has subsided, the recovery may be made complete by sending the patient a long sea voyage. By such means his body is invigorated, his mind fully occupied, and he is removed from temptation to sexual excitement. In a year or so, by the time he is fitted for sexual intercourse in marriage, he should seek that as the best safeguard against relapse into his old con1 dition. GONORRHCEAL RHEUMATISM. PROF. RICORD, PARIS. 1583. R. Tincturas scillas, Spiritus camphorae, Vini opii, aa f.gv. M. A resolvent liniment, to be applied, in fomentations, to joints affected with gonorrhosal arthritis when the pains have nearly disappeared. DR. J. F. M. GEDDINGS, CHARLESTON. This writer {Charleston Medical Journal and Review, February, 1876) considers that affected joints must be given absolute rest, and the acute symptoms relieved by leeches and the cold or warm douche, as the patient prefers. After these have subsided, he knows of no remedy so beneficial as the actual cautery, applied lightly to many points around the joint, so as only to involve the epidemis and the superficial layer of the chorion. RESUME OF REMEDIES. Acetum. Cider vinegar, more or less diluted, has been found of good service in chronic gleet. Alumen. A saturated solution of burnt alum, used as an injection three times ' a day, is commended by Dr. A. de Vos, of Belgium, as the best of all injections in gonorrhoea when the acute symptoms are subsiding. 556 VENEREAL DISEASES. Argenti Nitras. The employment of this agent in gonorrhoea has been much discussed. The abortive method by strong injections (gr.xxx-gj, to water f.gj) has deservedly fallen into disrepute. This strength may, however, be safely applied to the vagina in specific vaginitis. It should be painted on the part with a brush through a speculum. In the male, the strength in the first stage should not be beyond gr.^ to the ounce of water. This may be used every three hours until the substitutive inflammation has been established. Belladonna is of service in chordee and the genesic erethism which precedes the disease. Dr. Van den Corput prescribes— 1584. R. Extracti belladonnae, gr.ij Camphorae, Lupulinas, aa gr.xij. M. For eight pills. From two to four at night. Bismuthi Subnitras is a popular ingredient in injections. It is best sus- pended in thin mucilage. Its action is mechanical, in keeping the inflamed surfaces asunder. The solution must be prepared fresh every day, as it sours and becomes irritating. Chloral, Hydrate of, has been used as an injection, gr.v-x to aquas f.gj. Cadmii Sulphas. This has been used in acute gonorrhoea, gr.j to water f.gj- f-giij- Camphora. Professor Ricord's favorite remedy in chordee and painful erec- tions : — 1585. R. Camphorae pulvis, Lactucarii, aa gr.ij. M. This amount in a pill every hour from supper until bedtime. Dr Durkee gives f.gj of the spiritus camphorae in sweetened milk on going to bed. If the patient wakes with the chordee, he is to re- peat the dose. Carbolicum Acidum has been found efficient in recent cases. Mr. George Ashmead, l r. c. s., Edin., commends (The Lancet, December, 1871), the following.— 1586. R. Acidi tannici, 9j Acidi carbolici, 9ij Glycerinae, f.gj Aquas, f-gvij. M. Half an ounce of this as an injection, thrice daily. Colchicum has been commended by Sir Benjamin Brodie in the gonorrhoea of gouty subjects. He also gave ttbxxx of the wine at night for chordee. Copaiba is regarded by many as a specific in gonorrhoea. It is contra-indi- cated by hyperasmia, and should not be exhibited until the acute symptoms have been conquered, and when the discharge is whitish and thick. Mr. Berkeley Hill uses the following:— 1587. R. Copaibas, Bij Mucilaginis acaciae, f.gij Aquas cinnamomi, f.gviij. M. Tablespoonful thrice daily. This drug has been often used as an injection. Langlebert em- ploys an aqua copaiba;. Dr. Dick, of London, recommends— GONORRHOEA. 557 1588. R. Olei copaibas, f.gj Pulveris acaciae, gij Aquas, f-gvj. M. In subacute gonorrhoea and in gleet this injection is to be used twice a day for a few days ; afterward more frequently. The formula of Velpeau is as follows :— 1589. R. Copaibas, f.gij Tincturae opii, f.gss Mucilaginis acacias, f.giss. M. For an injection, to be repeated twice or thrice a day. It is asserted that successful results have been obtained in this manner in cases in which the balsam could not be tolerated by the stomach. Creasote has been administered in doses of gtt.j-iij, thrice daily (Half-Yearly Compendium, January, 1874). Cubeba is often indispensable in gonorrhoea. It may be given in any and all stages of the disease with benefit. A pleasant form is the oleo-resin, gtt.x-xxx on a lump of sugar, three or four times a day. Some pre- fer the pill form, in which it may often be advantageously combined with copaiba and sandalwood oil:— 1590. R. Cubebae olei. Copaibas olei, San tali olei, aa f.gj Magnesias, gij. M. For sixty pills. Six to eight a day. Cupri Acetas is preferred by some. Dr. Reece, of Paris, uses— 1591. R. Plumbi acetatis, Cupri acetatis, aa, gr.ix Acidi acetici, gtt.v Aquas, f-gvij. M. Use as an urethral injection, thrice daily. Cupri Sulphas is a valuable remedy. In very weak solution (gr.j to aquae f.gj) it may be used as an abortive. After the acute stage has passed, the following is a useful formula :— 1592. R. Cupri sulphatis, &r •**... Morphiae sulphatis, gr-viij Liquoris plumbi subacetatis, f.gj Aquas rosas, f-giv. M. About half an ounce thrice daily as an injection. Erigeron Canadensis. The oil of the Canada fleabane, in doses of gtt.v-xx every two or three hours, has been found by Dr. G. A. Starke, of Milwaukee (Canada Medical and Surgical Journal, May, 1876), to cure gonorrhoea in from two to six days. Ferri Chloridi Tinctura has been found valuable as an internal remedy in the gleet of anaemic subjects. Ferri Subsulphatis Liquor, in weak solution, gtt.v-x to aquae f.gj, has been tern oucw> j ad*antage in 80me obstinate cases of gleet. 558 VENEREAL DISEASES. Hydrastin. The yellow root has been highly lauded in gonorrhoea. Professor R. Bartholow says he has seen no injection so frequently successful as— 1593. R. Hydrastiae, gj Mucilaginis acaciae, f-giv. M. A half ounce as an injection. Dr. J. N. Bredin (Medical Times, September, 1874) commends— 1594. R. Hydrastin, gj Morphiae liquoris (Magendie), f.gij Mucilaginis acacias, f-giv. M. Employ three times a day. Kava Kava, the root of the Piper methysticum, in form of infusion, has long been used in the islands of the Pacific Ocean as an agreeable popu- lar remedy for gonorrhoea. It has lately been introduced into this country and France. A drachm and a half is macerated for five minutes in a pint of water, with frequent agitation. The infusion is filtered and given in two doses daily, before and after meals, until a cure is effected. Twenty minutes after the first dose the patient ex- perienced a pressing desire to urinate. The urine passed is large in quantity and of a clear watery appearance. The smarting which is experienced at first in the discharge is removed, and a feeling of com- fort supervenes: a cure is effected in from ten to twelve days. In addition to this the kava acts as a bitter tonic, is agreeable to take, promotes the appetite, does not incommode the digestive organs, and finally occasions neither diarrhoea nor costiveness. Kaolin or white clay, suspended in water, was introduced as an injection by Dr. F. W. Godon, of New York. He mixes the earth with water to a thin paste and throws from two to three drachms in the urethra once or twice a day. The disease yields in five or six days. Nitricum Acidum makes an excellent injection in gleet. The strength of the solution should be gtt.ij to water f.gj, of which f.gj-ij should be thrown up frequently. Opium and its alkaloids render important service in the acute inflammatory stage of gonorrhoea. The following is a good formula:— 1595. R. Extracti opii aquosi, gr-vij Liquoris plumbi subacetatis, f.gj Glycerinae, f.gij Aquas destillatae, ad. f.giv. M. Use as an injection, two or three times a day, to lessen the pain- ful smarting from micturition. Plumbi Acetas forms a cooling and astringent injection. The following com- bination has been found excellent, in spite of the chemical change which takes place in it:— 1596. R. Liquoris plumbi subacetatis diluti, f.giv Zinci sulphatis, gr.viij. M. As an injection in inflammatory gonorrhoea. GONORRHOEA. 559 Potassii Bromidum is a valuable injection in the acute stage :— 1597. R. Potassii bromidi, giss. Glycerinae, f-gijss Aquas, f.giv. M. Use lukewarm, twice daily, in acute gonorrhoea. Potassii Chloras is especially useful in specific vaginitis. A useful combina- tion of the potash salts is :— 1598. R. Potassii chloratis, giv Potassii permanganatis, gr.x Aquas, Oj. M. Inject a teaspoonful night and morning in vaginitis. Potassii Permanganas is extolled by Dr. William A. Hammond. He believes it has the power of destroying the contagious property of the secre- tion from the mucous membrane :— 1599. R. Potassas permanganatis, Kr-i-ij Aquas, f.gj. M. The weaker solution should be used first, and gradually increased. Eight or ten injections should be made in the twenty-four hours. Quinioz Sulpha has been used with great advantage in the acute stage, where there is much sealding and a profuse discharge :— 1600. R. Quiniae sulphatis, gr-xvj Acidi sulphurici diluti, f.gj Aquas rosas, f-gviij. M. Use half an ounce twice daily as an injection. Santalum. Sandalwood oil has of late been prominently urged as a cure for gonorrhoea. It is given in capsules, or in the following prescription, which is that of Dr. Thomas B. Henderson, who introduced this product to notice : — 1601. R. Olei santali, gtt.xx-1 Alcoholis, f.gj Olei cinnamomi, gtt.ij-v. M. This amount three times a day, in water. Dr. Frank F. Maury gives gtt.xv, thrice daily, on sugar. This remedy sometimes causes vertigo, of which the patient should be notified. Berkeley Hill recommends the following formula:— 1602. R. Olei santali, f.gss Liquoris potassas, f.gj Aquas menthae piperitas, f-giv. M. A dessertspoonful thrice daily. Tannicum Acidum, dusted on the part, is the best application in balanitis, blennorrhea of the glans, and herpes prceputialis. It may also be 560 VENEREAL DISEASES. dissolved in glycerine, and applied with a brush. As an injection in subacute gonorrhoea, Ricord prescribes— 1603. R. Acidi tannici, gss Vini rubri, f.gviij. M. A favorite combination with Mr. William Acton, of London, was— 1604. R. Acidi tannici, Zinci sulphatis, aa gr.ij Aquas, f-gij- M. This amount to be used repeatedly during the day as an abortive injection. Terebinthince Oleum, in small doses internally, frequently hastens the cure of the urethral discharge when it is accompanied with an atonic condi- tion of the parts. Ten to fifteen drops in globules may be prescribed. Zinci Biboras has been recently used with success in injection, gr.ij to aquae f.gj- Zinci Chloridi, gr.j to water f.gj, is useful in gleet. Zinci Sulphas, a popular astringent ingredient, gr.j-iij to aquas rosas f.gj, for injections. EXTERNAL MEASURES. Catheterism, by medicated bougies, is practiced by many surgeons in obsti- nate gleet. It is usually painful, and should be adopted cautiously. The following ointments may be used to cover bougies of wax or rubber:— 1605. R. Argenti nitratis, gr.xv-xxx Adipis, gj. M. 1606. R. Acidi tannici, gj Adipis, gj. M. 1607. R. Hydrargyri chloridi mitis, gss Adipis, gj. M. 1608. R. Potassii iodidi, gj Adipis, gj. M. 1609. R. Extracti belladonnas, Qiv Adipis, gj. M. Counter-irritation has frequently been employed in chronic urethritis. Blisters may be applied high up on the inner surface of the thigh. Dr. Durkee extols them highly when there is no stricture present. In obstinate cases, the perineal integument may be strongly irritated with compound tincture of iodine with advantage. SYPHILIS. 561 SYPHILIS. DR. McCALL ANDERSON. ENGLAND. This author is convinced that mercury is indispensable in consti- tutional syphilis, and believes that the patient should be brought fairly under the influence of the drug, although in no case should salivation be produced. His favorite formula for its exhibition is— 1610. R. Potassii iodidi, -■ Hydrargyri chloridi corrosivi, gr ii Potassae chloratis, S8'gJ Infusi quassias, f^vii- M One or two teaspoonfuls after each meal. WILLIAM AITKEN, M. D., EDINBURGH. 1611. R. Hydrargyri chloridi corrosivi, gr i Potassii iodidi, gr xxx Liquoris potassas arsenitis, m xxxvi Alcoholis, f-: J Extracti sarsaparillas fluidi, f'giij Aquas cinnamomi, a(j. f]gxij. m. Two tablespoonfuls three times a day, after meals, in the treatment of some of the more intractable forms of syphilitic squamas. JOHN K. BARTON, M. D. (DUBLIN), F. R. C. S. I., ETC. Our author recommends mercury as generally necessary in the first and second stages of the disease, though, with Kicord, he believes its action is limited to causing the disappearance of the symptoms present when it is administered, and that it cannot be considered capable of neutralizing the poison. He lays great stress upon its gradual introduction into the system, and, in common with Colles, Brodie and Sigmund, prefers that this should be effected by inunction. The patient's diet and daily habits should in the first place be regulated; the former should consist of meat once daily, without any stimulants beyond beer or porter, sometimes better without any at all. He should keep regular and early hours, going to his bed not later than ten o'clock, and not rising before eight in the morn- ing ; during the day he may be engaged in business, if it be not of a laborious or exciting description. 1612. R. Unguenti hydrargyri, gj. Of this half a drachm should be rubbed in each morning after breakfast, for twenty minutes or half an hour. The morning is 36 562 VENEREAL DISEASES. the best time, because then the patient is the most vigorous; and besides, if rubbed at night, the heat and perspiration produced by lying in bed will cause a considerable loss of the ointment, and the patient breathes an atmosphere loaded with mercury. Unless the full time mentioned be given to the rubbing, half the ointment will be inefficient. It is usually necessary to impress the import- ance of this upon the patient, who, however, in a very short time lends a willing aid to the surgeon, finding his symptoms disappear- ing gradually, and his general health and strength improving rather than decreasing. The inside of the thigh and popliteal space is the region where the inunction can be practiced. The patient should be told to rub in on each thigh upon alternate mornings, carefully washing off the old ointment with warm water and soap before commencing the new inunction; this prevents the skin from becoming irritated, and mercurial eczema appearing; if, however, a few scattered pus- tules do appear, the rubbing should be applied to the axillae for a time. He is in the habit of directing the patient to take a hot-air or Turkish bath once or twice a week during treatment, and finds it not only preserves the skin from irritation by thoroughly cleans- ing it, but also facilitates the action of the mercury; patients, in- cluding those in hospital, always express a sense of comfort and relief from the use of the bath. Many cases, particularly those belonging to the first division of the tertiary stage, are most benefited by a combination of mercury and iodide of potassium. For this purpose add to the recipe grTV~r2 °f ^ne corrosive chloride, or the biniodide of mercury, to each dose. When our author employs mercury internally in secondary syphilis, he considers the following a good combination :— 1613. R. Pilulas hydrargyri, gj Excracti opii, gr.v. M. For twenty pills. One of these daily will be as good internal treatment as is possible. Iron or quinine may at times be advantageously combined with some of the preparations of mercury, particularly when marked symptoms of anaemia show themselves at the commencement of the secondary period, which is very frequently the case in women. SYPHILIS. 563 1614. R. Pilulae hydrargyri, gr.xx Ferri sulphatis exsiccatas, gr.x Extracti opii, gr.v. M. For twenty pills. 1615. R. Hydrargyri cum creta, Quiniae sulphatis, aa 9j Extracti opii, gr.iij. M. For ten pills. The special treatment for secondary ulceration of the throat is:— 1616. R. Argenti nitratis, gr.xxx-xl Aquae destillatae, f.gj. M. To be freely applied over the velum and back of the pharynx every day, or every other day, while any ulceration or redness continues. The solution may be used with the spray producer. If toward the close of the secondary period sore throat reap- pears, as it often does, it then does not yield so rapidly, and it will be necessary to prescribe the following mixture, which will quickly cause it to heal:— 1617. R. Potassii iodidi, 9ij Potassas chloratis, Qiv Aquas, f.gviij. M. Two tablespoonfuls thrice daily. In the tertiary stage, our author employs iodide of potassium, in doses of from eight to ten grains thrice daily. A salt of ammonia added to the solution seems to increase the activity of the iodide, thus:— 1618. R. Potassii iodidi, giv Ammoniae muriatis, gij Tincturas cinchonas compositae, f.giv. M. A teaspoonful, in a wineglassful of water, thrice daily. FREEMAN J. BUMSTEAD, M. D.. NEW YORK. 1619. R. Hydrargyri chloridi mitis, gr.xxxvj Tincturas opii, f.gj Cerati simplicis, f.gj. M. For application to chancre when an unctuous dressing is required. It is much used in French hospitals. Unguents are less desirable than lotions, and should only be employed when the evaporation of a water-dressing cannot be prevented, even with the assistance of oiled silk and glycerine, as may happen from the position of the sore, and during a journey, etc. 564 VENEREAL DISEASES. In most cases the lotion may consist of simple water or glycerine. When medicated, such ingredients should, as a general rule, be added as will not leave a deposit, or change the aspect of the sore, and thus render its condition obscure. The following may be used:— 1620. R. Acidi nitrici diluti, f.gj Aquas, f-gviij. M. The strength may he varied with the sensibility of the part. When the sore is situated upon the external integument, the dress- ing should be covered with oiled silk. Chancres located beneath the prepuce may be dressed with dry lint, which will be sufficiently moistened by the natural secretion of the part. Indurated chancres are not liable to give rise to suc- cessive sores in the neighborhood, and hence astringents and disin- fectants are rarely required. When the chancre assumes an exca- vated form, as is commonly seen in the furrow at the base of the glans, scraped lint is preferable to dry linen, since it is a better absorbent. The frequency with which local applications are to be changed must be determined by the amount of the secretion. A second dressing should be substituted before the first is soaked with the discharge. The dressing of the most uncomplicated chancres need be renewed only two or three times a day, but phagedenic ulcers require a much greater frequency. 1621. R. Ferri et potassae tartratis, gss Syrupi, Aquas, aa f.giij. M. From two teaspoonfuls to a tablespoonful three times a day, within an hour after meals, in phagedenic chancres, and a lotion containing the same salt to be applied to the ulcer. Ricord calls this preparation the " born enemy " of phagedena. Rules for giving Mercury.—Avoid mercury in all chancroids and all doubtful cases; even in well-marked cases of true chancre it is better to defer the administration of mercury until secondary symptoms appear. It should be used, however, if the chancre assumes a phagedenic form, or if circumstances demand that the sore be speedily healed. When giving mercury, do so actively, and for short periods, rather than in small and long-continued1 doses. SYPHILIS. 565 The corrosive chloride is the least desirable of all the prepara- tions for internal administration. He prefers either the pilulae hydrargyri or the protiodide. The latter should be given half an hour or an hour after meals, as it is irritating to some stomachs. He most frequently employs:— 1622. R. Mass. pilulae hydrargyri, gr-ij-iij Ferri sulphatis exsiccatas, gr.j. M. This amount, in a pill, three or four times a day, one hour after eating. BERKELEY HILL. M. B., LONDON, F. R. C. S., ETC. Our author states that in the treatment of soft chancres the first thing is to remove general causes of irritation, such as too stimulat- ing diet, wine, and especially venery. All severe exercise must be relinquished; in fact, confinement to the house for some days is often time gained by the progress the sore makes with rest. While the wound is healing the patient should always avoid standing long at a time, to lessen the risk of bubo ; the horizontal position, more- over, greatly promotes healing of the sore. If erections at night are troublesome, they may often be prevented by the patient's last meal being a light one, taken two or three hours before bedtime. For persons of ordinary health it is not necessary to do more than this, but if patients are exhausted, or in a debilitated condition, ordinary rules for improvement of the health are necessary; quiet rest, with good diet and stimulants, must be freely given. The digestion may be invigorated by tonics, such as— 1623. R. Acidi nitrici diluti, f.gj Extracti cinchonas fluidi, f-g'j. M. From thirty to forty-five drops, in water, thrice daily. Or, 1624. R. Tincturae ferri chloridi, Spiritus chloroformi, Glycerinae, aa f.gj. M. A teaspoonful thrice daily, in water. LOCAL TREATMENT OF THE SORES. Most sores need only cleanliness to allay irritation and induce them to granulate. The sore should be washed three or four times a day while the discharge is abundant, and covered with pieces of lint dipped in cold water, over which oil silk should be wrapped, if the sore is situated in an outward part, like the dorsum penis or groin. If the patient is a man, he should be directed to support 566 VENEREAL DISEASES. the penis in a suspensory bandage or handkerchief against .the abdomen, never to let it hang down, and to be particular that the dress is loose enough not to chafe the parts in walking. If the sore is underneath the foreskin, the lint should be so interposed that the skin does not touch it, both to prevent the sore being chafed and to avoid the formation of fresh ulcers. As chancres may excite bubo at any period of their existence* destruction of their surface with caustic may prevent this conse- quence whenever it is employed. Still, this advantage is not suffi- cient in practice to require the invariable use of caustics, as the chance of a particular sore not being accompanied by a bubo is two to one, even when left to run its course. Besides this, it is often exceedingly difficult to destroy several sores thoroughly by one application of caustic; hence the patient, after having under- gone all the suffering and inconvenience of cauterization, may be disappointed on finding, in a few days, his sore assume its origi- nal character. Among the most effectual caustics is one Ricord prefers. He makes a paste of powdered charcoal and strong oil of vitriol, which he lays on and rubs into the chancre. In a few minutes the surface is destroyed, and forms an eschar or crust, which falls off in a week, leaving the sore a simple granulating surface. It is a very effective remedy, being not liable to overflow the sides of the ulcer and attack the healthy skin, as is the case with liquid caustics. But it is not always at hand, hence less convenient than another— the strongest nitric acid. The best way to use this is to daub it, with a glass brush, over the floor and edges of the ulcer, and allow it to soak well into the surface of the sore for a few minutes, before the excess of acid is neutralized with a little carbonate of soda dissolved in water. The skin surrounding the ulcer should be protected by grease, but the edges may be left clear for the action of the caustic. The chloride of zinc and caustic potash are slower in action, and must be left longer in contact with the sore, or they will not penetrate deeply enough to destroy it altogether. The actual cautery, by hot iron or galvanic wire, is at times very useful when a large amount of tissue has to be destroyed; otherwise it is not preferable to chemical caustics, while#it alarms the patient much more than the latter. When the caustic has done its work and the excess is washed away with cold water, the sore should be wrapped in wet lint, and SYPHILIS. 567 the pain, which often lasts several hours, can be assuaged by the constant application of ice-cold water. The eschar usually sepa- rates in four or five days, and leaves a clean granulating surface. A favorite mixture of our author, in the late form of the diseasej is the freshly formed red oxide of mercury, which he makes according to the following formula:— 1625. R. Hydrargyri chloridi corrosivi, gr.iij Potassii iodidi, 9v Ammoniae carbonatis, gj Tincturas cinchonae compositae, Aquae, aa f.giv. M. A teaspoonful thrice daily, half an hour before meals. PROF. EDMUND LANGLEBERT. PARIS. For soft chancres (chancroids) it is often needless to employ cauterants. It is sufficient to dress them several times daily with one of the following ASTRINGENT LOTIONS. 1626. R. Aluminis, 9UrAv Aquas rosae, f-3"j- M. 1627. R. Vini opii, ttUy-xxx Vini aromatici, f-giij- M. (For formula for vinum aromaticum, see F. 1661.) 1628. R. Extracti opii, gr.xv-xxx Decocti cinchonas, f.giij- M. 1629. R. Acidi tannici, gr.xv-xxx Aquas rosae, f.giij* M. 1630. R. Argenti nitratis, fr,?.T-xlv „ Aquae destillatae, f-guj- M- 1631. R. Tincturae iodinii, f.giss-ijss Aquas destillatas, f.g»j- M- 1632. R. Ferri et potassas tartratis, Biv-gv Aquas destillatae, f-giij- M. 1633. R. Zinci chloridi, §r.iss-iij Aquas destillatae, f.g"J- M- The lotions of potassio-tartrate of iron and of the chloride of zinc are particularly indicated in order to combat phagedena. For the same purpose, the following may also be prescribed :— 1634 R. Pulveris carbonis ligni, mm Pulveris cinchonas, &a gyss. M. 568 VENEREAL DISEASES. 1635. R. Creasoti, gtt.xv-xlv Aquas destillatas, f.gx. M. 1636. R. Potassii iodidi, gr xv Tincturas iodinii, Lgiss-v Aquas destillatae, f-giij. M. The last recipe is the one which has given the best results in the hands of our author. DR. J. L. MILTON, EDINBURGH. This writer (Edinburgh Medical Journal, March, 1875) states that he has found " Zittmann's decoction " a very important aid in secondary syphilis. This is the decoctum sarsaparilloz compositum of the German Pharmacopoeia, and contains small portions of senna and of the mild chloride of mercury and red sulphide of mercury. A formula for it is given in the United States Dispensatory (thirteenth edition). Mr. Milton says that chance led him to try the Zittmann decoc- tion, and with such surprisingly good results that he now uses it in every case and form of syphilis. He first administers a course of iodide of potassium and bichloride of mercury. He strongly advises that, at the outset, the dose should be very small, not more than two or three grains of the potassium, and from the thirtieth up to the twentieth of a grain of the perchloride. Nothing can militate more effectually against the success of the treatment than to risk setting up irritation by giving the remedies too freely at first, or even by raising the strength of them too rapidly at any time. The object in view is effectually defeated so soon as ever symptoms of iodic poisoning begin. There is no choice but to entirely abandon the medicine for some days, perhaps weeks, but certainly until the symptoms have quite abated. But all precautions, for the purpose of enabling the stomach to bear the potassium and mercury, fail more or less frequently unless aperients are combined with them, and the patient is restricted to a proper diet. As to the aperient, it is essential that it should consist of two chief ingredients—a pill to be taken over night, and a draught for morning use. He has repeatedly tried both sepa- rately, and has failed quite often enough with both to deter him from any repetition of the experiment. The pill may consist of colocynth, blue pill, and hyoscyamus, or a mixture of rhubarb, soap, and jalap; a sedative or aromatic, sufficiently potent to obvi- SYPHILIS. 569 ate griping, is an essential feature in its composition. For the purgative draught nothing equals a freshly prepared salts and senna mixture. There may be at the outset some depression after a brisk aperient, but the reaction which follows is generally at- tended by a feeling of relief, of greater fitness to work, mental or bodily, and better spirits; signs not at all likely to attend a pre- judicial action of the medicine. So soon as ever these symptoms are observed, the dose of the iodide and perchloride may be raised at the discretion of the prac- titioner. He seldom, in his own practice, goes beyond five grains of the former, and an eighth of a grain of the latter, two or three times a day, and always stops short of setting up much irritation. The combined treatment is continued for four or five weeks prior to the beginning with a mercurial bath, and, if possible, during the whole time it is employed. Directly the dose of the iodide is increased, the patient may begin to take a simple vapor-bath once or twice a week, and under any circumstances a course of these should precede the use of the medicated bath. After a few weeks of simple vapor-bath, a mer- curial vapor-bath may be taken twice or three times a week. After a few weeks of this, he places the patient on the Zittmann decoc- tion for eight days. He modifies the decoction, however, quite materially. He omits the sarsaparilla, the antimony, and perhaps the mercury; so that the mixture becomes, in reality, a decoction of senna highly diluted by liquorice and aromatics. In other words, Mr. Milton's treatment is one in which the system is brought very gradually under the influence of mercury and iodide of potash, and is from time to time very thoroughly purged. If the purging leads to loss of appetite and debility, he administers dilute nitric, or muriatic, or phosphoric acid, to restore its tone. DR. ALEXANDER McBRIDE, OF CINCINNATI. This practitioner {Lancet and Observer, December, 1873) is one of several who, in the last few years, have urged the restoration of guaiacum to its old place as a very valuable remedy in syphilis. He has employed it for ten years with excellent results. He gives the drug in pill form, but it must be made in a particular manner, or it will be nauseous, and the patient will tire of it. Alcohol, and nothing else, is the only proper excipient. The way to make the pill is as follows: Pulverize the guaiac and sift out ligneous 570 VENEREAL DISEASES. and cortical impurities; then let the operator be in a warm room, have the mortar warm, and the pill machine warm; put the pow- dered gum into the mortar, add very sparingly of alcohol, beat thoroughly, and add more if necessary, but be careful and not get in too much. The object aimed at is to form a mass as stiff as can be worked by means of warmth and a very little alcohol. When the mass is formed, work it rapidly into pills, and roll them into a cold tin pan, in a cool room. If one makes these pills any other way, they will prove more or less a failure. Use no pulverized licorice, or other powder. If one uses never so little too much alcohol, the pill will be soft, and never harden. Of these pills, the patient can take from nine to eighteen per day, usually twelve, and will declare he feels better all the time; so much so, that if he runs out of pills he will soon call for more. This treatment applies to secondary and tertiary, is excellently adapted to external or cutaneous manifestations, and may be carried out without other medicines. ABORTIVE TREATMENT OF CHANCRE. SILAS DURKEE, M. D., ETC., BOSTON. If, as the result of contagion, or of a suspicious connection, the virile organ has upon it a papule, pustule, abrasion, or sore, which may be the forerunner of constitutional syphilis, the best thing the surgeon can do, locally, is to make a caustic application to the spot, if this can be done seasonably, say within ten days from the ap- pearance of the abnormal condition. The design of this operation is twofold: to destroy morbid structure, and to create a healthy re- cuperative action in the part. Our author employs for this purpose potassa fusa, the acid nitrate of mercury, or concentrated nitric acid. He never uses nitrate of silver or Vienna paste. In cases of abrasion, he generally applies nitric acid by means of a small bit of lint secured to a silver probe, or, if the surface be very small, by means of the end of a glass rod. The sore is to be freely covered with the acid, warm water being at hand to wash off any excess immediately. The acid nitrate of mercury, when used, is applied in the same manner. The slough will be detached in three or five days, and a healthy granulating surface appear. If a solitary vesicle, pimple or pustule is to be destroyed, he sometimes selects potassa fusa, which penetrates deeper than either of the SYPHILIS. 571 liquids mentioned. The end of the stick is reduced to a point and brought in contact with the apex of the morbid growth, or, what is better, break the dome of the pimple with a probe, and empty it of its contents before applying the potassa. To ascertain precisely the work done by the alkali, remove the debris or portion destroyed by means of the point of the probe. As the operation is painless, no haste is required, but caution and exactness are both necessary. It is difficult to preserve the solid stick of potassa in a dry state, therefore it had better be applied placing it on the end of a pointed glass rod or pen. A drop of vinegar will neutralize any super- abundance of the caustic. The extent of the surface destroyed by this corrosive substance is about twice as great as it appears to be at the time of its application; the same is also true in regard to the depth to which it penetrates. As the risk of increasing the inflammatory tendency is small, a moderate degree of inflammation co-existing with the pustule or sore need not prevent cauterization. Cold-water dressing, or a soft cracker poultice, may follow the use of the caustic for two or three days. The first is to be pre- ferred. The patient should rest and diet. When the eschar has separated, dress with— 1637. R. Ferri et potassae tartratis, 9ij Aquae, f.gviij. M. To be applied on lint. Nitric acid (gtt.ij to aquae f.gj) makes a clean and suitable dressing also. If the purulent discharge be abundant, order:— * 1638. R, Acidi tannici, gr-xv Vini aromatici, f-giij- M. (For vinum aromaticum, see F. 1661.) If the sore becomes painful, lay over it a piece of lint soaked in— 1639. R. Extracti opii, 9ij Aquae, f-giv. M. In occasional instances, after the application of the caustic and the after-dressing mentioned, the sore assumes a spongy or fungoid aspect. Then apply— 1640. R. Acidi tannici, 9j. Tincturas lavandulae, f.gss Vini rubri, f.giv. M. 572 VENEREAL DISEASES. CONSTITUTIONAL TREATMENT OF CHANCRE. Our author is partial to the use of corrosive sublimate inter- nally in the treatment of indurated chancre. He advises its use in pill form :— 1641. R. Hydrargyri chloridi corrosivi, Ammonias muriatis, aa gr.xvj Aquas destillatae, f.giss. M. Make a solution, and make up with bread crumbs into one hundred and twenty-eight pills. The formula gives one-eighth of a grain of corrosive sublimate to each pill. One to be taken morning and night, immediately after meals. In five or six days one may be taken thrice daily. If pills cannot be taken, order— 1642. R. Hydrargyri chloridi corrosivi, Ammonias muriatis, aa gr.vj Tincturae cinchonas compositae, f.gij Aquas, f-giv. M. A teaspoonful morning and evening for one week; afterward thrice daily, directly after eating. When this medicine has been taken for twelve or fifteen days, it is good practice to omit it for four or five days, and then resume it. PROF. S. D. GROSS, PHILADELPHIA. 1643. R. Unguenti hydrargyri nitratis, gj Cerati simplicis, gvj-gj. M. In the treatment of chancre no remedy is so efficacious as this. The objection made to greasy applications can only be considered as having any force when there is a want of cleanliness. The dressings should be changed every five or six hours, and care should be taken that the ointment shall always be very fresh. When the parts begin to granulate, apply— 1644. R. Cerati zinci carbonatis, gj Adipis, gvj. M. Or, merely a bit of dry lint carefully interposed between the con- tiguous surfaces often promotes cicatrization with remarkable rapidity. 1645. R. Hydrargyri chloridi corrosivi, gr.j Potassii iodidi, gij Syrupi sarsaparillae compositi, f-giij- M. Dessertspoonful thrice daily, shortly after meals, in tertiary syphilis. SYPHILIS. 573 Professor Gross almost invariably combines the bichloride of mercury with iodide of potassium in the treatment of tertiary syph- ilis, particularly when the affection is of long standing. An infirm, broken state of the system is-no bar to the use of mercury in this mode of combination; on the contrary, it often affords the medicine an opportunity for its best display. To counteract any disagree- able effects of the above recipe, such as gastric irritation, diarrhoea, etc. (which, however, rarely ensue), an anodyne, as a small quan- tity of morphia, or from five to ten drops of the acetated tincture of opium, may be combined with each dose. In regard to the dose of iodide of potassium in the treatment of tertiary syphilis, Professor Gross states that long experience has taught him that while less than ten grains thrice daily will rarely do much good, there are few cases in which more than this quan- tity is really ever needed. With reference to the employment of iodide of sodium and iodide of ammonium as substitutes for iodide of potassium, Professor Gross sometimes recommends their use in five-grain doses. Cul- lerier says that the iodide of ammonium gives no better results than the iodide of potassium, and he has abandoned its use. It has been asserted, however, on good authority, that the iodides of sodium and ammonium will sometimes succeed in doses in which the iodide of potassium has failed. (Tanner, and others.) They are more nauseous than the iodide of potassium. Bromide of potassium has been employed in tertiary syphilis recently. Cullerier says no reliance can be placed on this remedy; Berkeley Hill asserts that in small doses, in conjunc- tion with the iodide, it increases the energy of the latter very mate- rially. It should be borne in mind in administering the bromide of potassium that it is decomposed by a syrup. To overcome the disagreeable taste of the iodide of potassium, so often complained of by patients, Paget says that a mixture of whisky and the compound syrup of sarsaparilla makes the best vehicle. M. liegeois. ^ Our author employs the following formula for the hypodermic injection of corrosive sublimate in secondary syphilis :— 1646. R. Hydrargyri chloridi corrosivi, gr.iij Morphiae muriatis, gr.iss Aquas destillatae, f.gxxiijss. M. tt\,xvss. (= about gr. -fa of the sublimate). Ordinarily no inflammation follow* this injection. 574 VENEREAL DISEASES. DR. FRANK F. MAURY, PHILADELPHIA. This surgeon prefers, as a cauterant to the primary sores, either the fuming nitric acid or the acid nitrate of mercury. His abort- ive treatment of bubo is to paint it with six coats of tincture of iodine morning and evening, and in the intervals a half-brick, heated as hot as it can be borne, is wrapped in flannel and placed over the swelling. This leads to resolution of the tumor. For constitutional treatment he has found much advantage from Gibert's syrup, as follows :— 1647. R. Hydrargyri iodidi rubri, Potassii iodidi, Aquas, Dissolve, filter and add gr.ij 3j-ij fgj- Syrupi simplicis, A tablespoonful three times a day. f-gvi DR. H. E. WOODBURY, PHILADELPHIA. This writer condemns {Medical Times, October, 1874) the custom of opening buboes by free incisions. It is sufficient to pass a narrow-bladed bistoury through the gland, and then inject a drachm of diluted tincture of iodine (one part to four of water)- In some cases the use of the knife can be altogether avoided by the following treatment:— The patient is confined to his bed; a half-brick, covered with flannel—a single thickness—is laid upon the bubo. A lump of ice is kept upon the brick, and as it melts, the flannel is saturated with ice-water. He has seen a large bubo disappear in twenty- four hours under this treatment by cold and pressure; a combina- tion of iodine and iodide of potassium in syrup of sarsaparilla being administered internally. If this course be resorted to at the proper time, the necessity for surgical interference will often be avoided. If the knife be used, the smaller the incision, the better and more rapid the cure. SURGEON W. S. W. RUSCHENBERGER, U. S. N. 1648. R. Hydrargyri iodidi rubri, gr.j Iodinii, gr.ij Potassii iodidi, gj Syrupi sarsaparilla compositi, f-gxv Aquas, f.gj. M. Tablespoonful four times a day. SYPHILIS. 575 PROF. J. LEWIS SMITH, M. D., NEW YORK. In infantile syphilis, the following formulae may be employed :— 1649. R. Hydrargyri cum creta, gr.iij-vj Sacchari albi, 9j. M. Divide into twelve powders. One to be taken thrice daily. 1650. R. Hydrargyri chloridi corrosivi, gr.j—ij Syrupi sarsaparillae compositi, f.gij Aquas, f.gviij. M. A teaspoonful thrice daily. Mercury, in whatever form employed, should not be discontinued entirely until several weeks after the syphilitic symptoms in the child have disappeared. It is proper to continue it for a time, in diminished quantity, after the health seems fully restored. When the mercurial is omitted, tonics are often required. The preparations of cinchona are useful in these cases, as are also those of iron. The liquor ferri iodide is especially useful in this class of cases. THOMAS HAWKES TANNER, M. D., F. L. S., ETC., LONDON. 1651. R. Hydrargyri chloridi corrosivi, gr.ij Pulveris opii, gr.v-viij Pulveris guaiaci, gss. M. Divide into sixteen pills. One twice or thrice a day, where it is desira- ble to continue the use of the corrosive sublimate over many weeks. SYPHILITIC LARYNGITIS. MELCHIOR ROBERT. 1652. R. Hydrargyri chloridi corrosivi, gr.ij—iij Decocti conii, f.gvj. M. A useful gargle in syphilitic ulcers of the mouth and throat. 1653. R. Potassii iodidi, gr.xv Mellis despumati, f.gj Decocti hordei, f.giv. M. A gargle, to be employed as above. 1654. R. Potassii iodidi, gr.ix Tincturae iodinii, f.gss * Aquae destillatas, f.gv. M. A gargle, to be employed as above. 1655. R. Hydrargyri chloridi corrositi, gr.iij Vini opii, "l-v Mellis rosas, f.gj # Aquas rosas, f-gvj. M. A gargle, to be emp oyed as above. 576 VENEREAL DISEASES. SYPHILITIC SORE THROAT. DR. BIETT, FRANCE. 1656. R. Hydrargyri chloridi corrosivi, gr.ij ss Ammonii chloridi, 9j Vini opii, f.gj Mucilaginis acacias, Mellis despumati, aa f.gss Aquas destillatae, f.gv. M. A gargle, advised in syphilitic sore throat. DR. ROSS, FRANCE. 1657. R. Tincturas iodidi, Tincturas opii, aa f.gj Aquas destillatas, f-gv. M. This gargle is useful in syphilitio ulcerations of the throat. SYPHILIDES. DR. BOINET, FRANCE. 1658. R. Acidi tannici, Biv Tincturas iodinii, gr-vij Aquas, Oj. M. A tablespoonful, in wine, twice or thrice daily, in syphilitic diseases. H. GREEN. 1659. R. Hydrargyri chloridi corrosivi, gr-iv Tincturae gentianae, f-giv Syrupi aurantii florum, f.giss. M. A teaspoonful thrice daily in secondary syphilis and chronic skin affections. VINUM AROMATICTJM. The following formula is given by Bumstead, as a substitute for the aromatic wine of the French pharmacopoeia, when it cannot be procured:— 1660. R. Claret wine, Spiritus lavandulae compositae, aa f-gji Tincturas opii, f.gj Acidi tannici, gr.xv-gij Aquae, f-gvij. M. The dressing should be renewed several times a day. APPENDIX. 1. Aeration, the use of compressed and rarefied air. 2. Endermic medi- cation, rules for. 3. Hypodermic medication, formulae and doses for. 4. Inhalation, formulae and doses for. 5. Insufflation. I. AERATION: THE USE OF COMPRESSED AND RAREFIED AIR. The therapeutical effects of breathing air at different densities have long been matters of practical knowledge with the profession. Health resorts on mountains and by the sea have each claimed a particular class of patients. But the introduction of convenient apparatus to treat cases at their homes is very recent. That invented in 1875, by Dr. L. Waldenburg, Professor in the University of Berlin, more or less modi- fied, has been used in this country. Its value as a means of diagnosis is considerable. According to Dr. Louis Elsberg, of New York, by means of it, dyspnoea, difficulty of breathing, which could hitherto be denoted by indefinite expressions only, can be characterized with exacti- tude both qualitatively and quantitatively-the first by showing whether it is inspiratory or expiratory, or both combined, the latter by determin- ing in figures its precise extent or degree. And not only can the diffi- culty of breathing be determined when it exists subjectively as well as objectively, but in the first beginnings of a respiratory insufficiency, before the patient himself is conscious of it, except, perhaps, upon very unusual exertion, before we can discover its existence by any other method of examination hitherto known, the pneumatometer may indi- cate a deviation from healthy respiration. Again, in obscure cases of differential diagnosis, the weight of the evidence supplied by the pneu- matometer may turn the scale in the right direction, when this might not be discernible without its revelation. Dr. B. Frankel, of Berlin, has for practical purposes suggested that, if a metal tube, with a mouth- piece surrounded by an inflated rubber cushion, be inserted into the bellows of an accordeon, a pneumatic apparatus is devised, which is quite serviceable in many cases. If the bellows are expanded by draw- 37 577 578 APPENDIX. ing the accordeon apart, the air contained in it will be rarefied; if it is pressed together, the air is condensed. On the margin a scale should be placed, which will show how far the wooden sides of the bellows are apart, and thus indicate the amount of compression or rarefication of the contained air. There is no danger in using such an instrument, as the utmost condensation which can be obtained by manual force is one- eighteenth of an atmosphere, and of rarefication one-twentieth of an atmosphere. The patient should use the apparatus in a sitting posture, and apply his mouth to the cushion, and move the bellows with his hands; the rarefaction or condensation of the air in the bellows will thus be communicated to that in the lungs. The uses of rarefied and compressed air are; first, to induce artificial respiration in cases of chloroform asphyxia, that of the new-born, that from carbonic oxide, drowning, and similar accidents; secondly, in em- physema, chronic bronchitis, asthma, partial hepatization following pneumonia, and similar affections ; thirdly, in disorders of the circula- tion depending on mitral disease ; fourthly, in phthisis. In regard to the last-mentioned, its value is not at all established, but it is probable that it may prove a useful accessory to general measures. On the circulatory system the effect of breathing air at various densities is marked. Dr. Julius Sommerbrodt {Deutches Archiv fur Klinische Medicin, Bd. xvm) has shown that from the first inspiration of com- pressed air the pressure and amount of the blood is increased in the general circulation and decreased in that of the lungs, and the heart contracts more frequently and with greater force. When, therefore, there is passive hyperemia of the lungs dependent on mitral insuffi- ciency, for example, or chronic bronchitis, the use of compressed air is clearly indicated, as is the employment of rarefied air in the emphysema- tous condition so often associated with asthmatic complaints and recur- rent coughs. II. ENDERMIC MEDICATION, RULES FOR. Endermic medication is the introduction of medicines into the system by causing their absorption from a denuded portion of the surface of the body. Those medicines only are adapted for administration in this way whose dose is not large, and which do not irritate the surface to which they are applied. Morphia is the one the most frequently given in this manner. The part best suited for endermic medication is the epigastrium; but hypodermic medication, formula and doses for. 579 any portion of the anterior surface of the body, or the inner surface of the thighs and arms, may be chosen for the application. The denuded surface for the application is obtained by blistering; ordinarily the blister of cantharides is employed, but, in case of emer- gency, the more rapid action of the stronger solution of ammonia may be taken advantage of. The blistered surface should be, upon an average, three or four inches square. The medicine should be finely powdered, and, if irritant, mixed with acacia or other bland substances. It should be sprinkled equally over the surface or applied upon simple cerate dressings. If liquid, or so soft that it cannot be powdered, it may be rubbed up with solutions of gela- tine, mucilage, lard, or cerate, and applied upon pledgets of lint. The dose of medicines given endermically may be twice or thrice that by the mouth. As the offending matter can be readily removed, there is less danger from overdose than in the case of medicines taken into stomach. Though hypodermic has, in great measure, superseded endermic medication, Dr. Brown-Sequard protests (Lancet, March 10, 1866) against the abandonment of the latter, which possesses the double advan- tage of counter-irritation and rapid absorption, and may, in some cases, prove more useful than subcutaneous injection. Cautions.—Sloughing and a permanent scar may result from the incautious employment of an irritant medicine, as has been the case with the application of undiluted sulphate of quinine. III. HYPODERMIC MEDICATION, FORMULA AND DOSES FOR. APOMORPHIA. The dose of apomorphia, hypodermically used, for an adult, ranges . from gr.iV-irff, but in children it is quite large in proportion. For a child of 18 months..................er JL " " 2 years ..................2r i U il o u 6 « «* ..................gr.J* " " 3£ " ..................gr i 5 « ..................|P;v 8 « ..................|r.g Glycerine seems to preserve the strength of the drug, and alcohol will dissolve it more readily than water, so it may be prepared after the following formula:— 580 APPENDIX. 1661. R. Apomorphia, gr-vij Spiritus rectificatae, ff\,xx Glycerines, T"lx Aquas, 1^1. M. In a child of two years, gV of a grain may be used. Therapeutics.—A useful emetic in children with croup or diphtheria, in protracted labor from rigidity of the os, in poisoning, and generally where a prompt emetic effect is desired, and the hypodermic method indicated. AQUA. The use of pure cold water, by hypodermic injection, has been found very efficient in the relief of pain, especially that of a rheumatic and neuralgic character. The relief is often instantaneous and permanent- From gtt.x-xij may be used at once, and the injection repeated several times. The method was suggested by M. Lelut, of France, and has in this country been favorably reported upon by Dr. S. Henry Dessau, of New York, and others. ARSENIC. 1662. R. Liquoris potassas arsenitis, Aquas destillatas, aa T'liij. M. For one injection, gradually increased to ttbxiv of Fowler's solution. Prof. Roberts Bartholow suggests that liquor so doe arsenitis (in doses of "Iv, x, or even xv, on every other day) is less irritating than Fowler's solution. Therapeutics.—Dr. Radcliffe has used arsenic hypodermically, with benefit, in cases of chorea, neuralgia, epilepsy and other nervous affec- tions. atropia. 1663. R. Atropias sulphatis, gr.ij Aquas destillatae, f.gj. M. Five minims = gr.Js-. With this formula the dose can be better regulated than with stronger solutions. Dose.—Lorent begins with gr.^ and goes up to gr. J^; Sudekum and Behrer, gr.Jg-; Hunter, gr.2? ; Scholtz and Oppolzer, gr.J^; "Grtefe and Depuit, gr.J^ ; Nudifer, gr.Jg- ; Courty, gr.£; Bell, gr.}; Trousseau, gr.^¥-§; Ruppaner, gr.^-^. Dr. Bartholow says that 5"l of (F. 1662), or J^ of a grain, is the largest amount de- sirable in most cases, and that it will be rarely necessary to inject more than gr.J¥ at one time. hypodermic medication, formula and doses for. 581 atropia and morphia. 1664. R. Morphias sulphatis, gr.xvj Atropias sulphatis, gr.j Aquae destillatae, Si. M. Filter. J Five minims = gr.i of morphia and gr.jj. of atropia. Or, combine f.gj of F. 1662 with %iv of F. 1663, making a solution of which 5 minims = gr.}- of morphia, and gr.& of atropia. Therapeutics.—Used in insomnia (in the proportion of gr.^-j, of atropia to gr. }-£ of morphia); neuralgia ; epilepsy; asthma; angina pectoris, spermatorrhoea (atropia in excess); pelvic and uterine pain; rheumatic arthritis ; muscular and acute rheumatism (in all such cases atropia in excess). CAFFEIN. 1665. R. Caffeini puri, gr-vj Alcoholis, Aquas destillatae, aa f.gj. M. Twenty minims = gr.j. 1666. R. Caffeini citratis, gr.j Glycerinae, gtt.xxiv. M. For one injection. Dose.—Gr.j. Therapeutics.—In neuralgia, hysterical headache and opium poison- ing. Prof. Bartholow suggests that, as there is no incompatibility, caffein and atropia be used at the same time hypodermically in cases of opium narcosis. Dr. Eulenburg states that caffein, when injected in doses from one-fifth to two-thirds of a grain, relieves occipital neuralgia and hysterical headaches generally. CONIA. 1667. R. Conias, gr.ij Alcoholis, f.gij. M. Dissolve and add, Aquas destillatae, f.gij. M. Gtt.j = gr.T^. 1668. R. Conias, gr.ss Alcoholis, f-gss. M. Dissolve and add, Aquas destillatas, f.giss. M. Five minims = grr^V- DATURIA. 1669. R. Daturias, Aquae destillatas, gr-j f-3ij- Gtt.iv. = gr-sV DIGITALIN. 1670. Gtt.iv R. Digitalin, Alcoholis, Aquas, = gr-eV- aa gr.ss f-3j- 1671. R. Digitalin, Glycerinae, Aquas destillatae, aa gr-j f-Sfij- Gtt.iv = gr-^ff- 582 APPENDIX. As these solutions quickly decompose, they should be freshly made for use. Dose.—This ranges from gr.T^-T&y Therapeutics.—This drug has been employed in the treatment of tetanus, asthma, emphysema, angina pectoris, etc. M. M. M. The doses employed have been as follows:— Eulenburg, gr.iio—A; Franque, gr.A-rs; Lorent, gr.^fVi; Pletzer, gr.^b-. M. Dose.—About gr.& of ergotin; from gtt.x-xv or more of the fluid extract of ergot (U. S. P.). Therapeutics.—Used in post-partum hemorrhage, epistaxis, etc., and in internal aneurism, enlarged spleen, enlarged prostate, tumors. ACIDUM HYDROCYANICUM DILUTUM. 1674. R. Acidi hydrocyanici diluti, ^l»j-iv. For one injection. For ordinary purposes, the smaller dose should be preferred. It may be frequently repeated, as its influence is soon dissipated. Dose.—™Jj-iv of the officinal dilute acid (U. S. P.). Therapeutics.—This remedy is useful in functional nausea and vomit- ing, in gastralgia, and in mental disorders. ERGOT. 1672. R. Ergotinas, Alcoholis, gr.ij Glycerinae, aa f.gss. Five minims = gr.&. 1673. R. Extracti ergotae fluidi, n\,xv For one dose. HYPODERMIC MEDICATION, FORMULA AND DOSES FOR. 583 MERCURY. 1675. R. Hydrargyri chloridi corrosivi, gr.j Aquae destillatas, f.gj. M. Ten minims = gr.i. DR. STAUB, GERMANY. 1676. R. Hydrargyri chloridi corrosivi, Ammonii chloridi, aa, 9j Sodii chloridi, gj Aquas destillatas, f.giv. M. Dissolve and filter. Then dissolve the white of an egg in a sufficient quantity of distilled water to make four fluid ounces of solution, filter and mix with the above solution. Fifteen minims of this solution contain about gr.T^ of corrosive sub- limate. Inject hypodermically nbxv twice a day; i. e., gr.i of the cor- rosive sublimate a day. This chloro-albuminous solution has, according to the author, the advantage of avoiding the local accidents which sometimes occur from injecting a dose a little too strong of corrosive sublimate. The hypodermic injection should be made by a syringe in wood or vulcanized rubber. MORPHIA. 1677. R. Morphias acetatis, Acidi acetici, Aquas, Liquoris potassas, gr.x q. s. ad. f.gj One minim = gr.}. M. Pletzer uses the following solution :— 1678. R. Morphiae acetatis, gr.iij Aquae destillatas, f.gj. M. Five minims = gr.}. Dr. E. Lorent, of Bremen, uses these formulas:— SOLUTION No. 1. 1679. R. Morphiae acetatis, Bj Aquas destillatae, f.gj. M. Six minims = gr.}. SOLUTION No. 2. 1680. R. Morphiae acetatis, 9j Aquas destillatas, f-gij. M. Six minims = gr.j. 584 APPENDIX. SOLUTION No. 8. 1681. R. Morphias acetatis, Aquas destillatas, Six minims = gr.iss. DR. ALBERT EULENBURG. 1682. R. Morphiae muriatis, Acidi muriatici, Aquas destillatae, Three minims = gr.}. The objection to this solution is its acidity, which often provokes pain and local irritation. PROF. ROBERTS BARTHOLOW. 1683. R. Morphiae sulphatis, gr-xYJ Aquae destillatae, f.gj. M. Dissolve and filter. Five minims = gr.}. The advantage of this solution is that it contains no acid, and pure water causes very little irritation. REMARKS ON THE HYPODERMIC USE OF MORPHIA. Dose.—The dose is variously given by different authorities. The age, sex, constitution, temperament, and the nature of the disease, all, of course, influence the amount of each injection, as well as the frequency of administration. Drs. E. Lorent and Scholtz have used as high as gr.iss at a single injection. Dr. Bartholow varies the dose from gr.xV to gr.ss. He says that "in commencing it should not exceed one-third of that ordinarily adminis- tered internally." He regards the large doses (gr.ss, f and j) as unsafe for the first trial, unless the conditions requiring the injection be excep- tional. Dr. Ruppaner places the minimum dose at gr.}, the maximum at gr.f. Dr. Edward John Tilt says that the initial dose for a woman should never exceed gr.}. Dr. Chas. Hunter, of London, gives the rule never to use in the first injection more than one-half the stomachic dose for males, and not more than a third for females. Therapeutics.—Morphia is used hypodermically in neuralgia, delirium tremens, hysteria, epilepsy, insomnia, chorea, tetanus, hydrophobia, asthma, catarrh, emphysema, pleurisy, dyspepsia, cholera, colic, vomiting of pregnancy, urinary affections, and as an antidote to the toxic effects of atropia, strychnia and digitaline. Dr. Bartholow considers it in- ferior in strychnia poisoning to the calabar bean, and in poisoning by digitaline as less efficacious than atropia. Cautions.—Dr. Nussbaum has forcibly indicated the danger that gr.xxx f-3ij- gr.iv gtt.iv f-3j- M. HYPODERMIC MEDICATION, FORMULA AND DOSES FOR. 585 may arise from the penetration of a superficial vein by the point of the syringe. His experience may serve to put physicians on their guard against a fearful danger. He observes: " During the last two months I have undergone a frightful experience twice in my own person, and three times in the case of my patients. The point of the syringe entered a subcutaneous vein, and the morphia was thus injected directly into the blood, instead of into the subcutaneous tissue. On the first occasion I injected two grains of acetate of morphia* dissolved in fifteen minims of water, into one of my subcutaneous abdominal veins, and felt as if I should die in a few minutes. In a couple of seconds there was a pricking and burning sensation over my whole body, a strongly acid taste in my mouth, my whole face was nearly as red as the normal color of the lips, and in about four seconds after the injection there was a ringing sound in the ears, while scintillations flashed before the eyes, and there was intense pain in the integuments of the head. But the most terrible of all the phenomena was the extremely powerful and rapid action of the heart. Out of more than 25,000 patients, I have never felt such a pulse. Its beats ranged from 160 to 180 in the minute, while the carotids had no time to discharge their contents, and felt like thick tremulous iron cords on either side of the neck. The action of the heart and arterial pulsations were so strong that I felt as if the walls of the chest or the diaphragm must give way, and that my eyeballs must burst. This fearful state, in which the respiration was considerably im- peded, lasted on the first occasion about eight minutes. The suffusion of the face was followed by a deadly pallor, which lasted for an hour, while the acute pain in the head subsided in fifteen minutes. The mind was in no degree affected, and with an effort I could stand and speak. Cold applied in the form of washing, affusion, etc., was very agreeable and beneficial. In the course of two hours, the whole of the symptoms disappeared. In my other personal misadventure the symptoms were far less severe, in consequence of the injected dose being much smaller. Taught by experience, I have since then always injected very slowly, and as the phenomena come with such lightning-like rapidity, I thus secure time, if necessary, to reverse the pumping action of the syringe and to recover a part of the injected fluid mixed with blood. I have on several occasions seen the happy results of this manipulation. The three of my patients in whom a vein was entered were in even a more critical state than I personally was. There was a partial loss of con- sciousness, and there were convulsions, but no persistent consequences ensued." • This would have proved a highly dangerous dose to most persons If simply in- jected into the subcutaneous tissue. 586 APPENDIX. NICOTIA. DR. A. ERLENMEYER. 1684. R. Nicotiae, gr.ss Aquae destillatae, f.gij. M. Four minims = gr.^. Dose.—Gr.gij-. Therapeutics.—Prof. Houghton, of Dublin, has employed this agent with success in cases of traumatic tetanus, of which about one-half the cases treated recovered. Nicotia is a physiological antagonist to strychnia. PHYSOSTIGMA. PROF. ROBERTS BARTHOLOW. 1685. R. Extracti physostigmas, gr.ij Aquas destillatae, f.gj. M. Filter. Ten minims = gr.}. This solution must be prepared when wanted, as it soon becomes unfit for use. Its acidity should be neutralized by carbonate of soda. REMARKS ON THE HYPODERMIC USE OF CALABAR BEAN. Dose.—gr.} of the extract to begin with. Therapeutics.—Tetanus and chorea have both been treated with suc- cess by this remedy. In the first-named affection, it probably stands at the head of all known remedial agents. It is also employed in strychnia poisoning. Dr. Alois Monti, of the St. Ann's Child's Hospital, reports three cases out of five of trismus neonatorum cured by this remedy. He prefers subcutaneous injection, as he thinks the internal use uncertain. He repeats these injections every ten or fifteen minutes until the spasms cease; then intermits them, even for several hours, until the cramps return again. For new-born children he uses one-tenth grain of the extract per dose, and goes up to one-third, one-half, or a whole grain a day. Older children can commence with one-third grain per dose. For internal use, from one to four grains a day may be given. The antidote to physostigma is strychnia, which is its physiological antagonist. quinia. FOEMTTL^! FOR THE SOLUTION. PROF. ROBERTS BARTHOLOW, CINCINNATI, OHIO. 1686. R. Quiniae sulphatis, gj Acidi sulphurici diluti, tr^xl Aquas destillatas, f.gj. M. Give 15 to 30 minims. Carefully filter. HYPODERMIC MEDICATION, FORMULA AND DOSES FOR. 587 Inject where the areolar tissue is abundant. 1687. R. Quiniae, gr.viij ^Etheris, f.gj. M. dr. desvignes. 1688. R. Quiniae, gr.iss Acidi nitrici diluti, mj Aquas destillatae, n\,xv. M. For one injection. Our author has treated several hundred cases of intermittent fever with this injection. DR. ADDINELL HEWSON, PHILADELPHIA. 1689. R. Quiniae sulphatis, gr.iij Aquas destillatas. f.gj Acidi sulphurici diluti, q. s. M. To make a neutral solution. Ten gtt. = gr.ss. Two cautions should be noted, i. e., to have this solution neutral, and to have it freshly made. If these be observed, there is no danger of the formation of an abscess from its use. Ten drops may be thrown under the skin three times a day. Dr. Hewson has employed this injection as a tonic in bad cases of typhoid fever with signal success. He has also found it valuable in breaking up obstinate intermittents, when the ordinary treatment by the mouth failed. REMARKS ON HYPODERMIC USE OF QUINIA. In the intermittent fever arising from malaria, the hypodermic injec- tion of quinine is a preeminently successful mode of treatment. Dr. Schachana, of Smyrna, states that a single application suffices to effect a cure, good diet and chalybeates being also prescribed. Out of one hundred and fifty cases there was only one relapse. Dr. Gualla, of Breschia, similarly treated forty-nine cases without a single failure. Dr. Desvignes treated several hundred cases occurring in natives engaged on railway work in the Tuscan salt marshes, and met with uniform success. Dr. Eulenburg injected quinine in eleven cases of intermittent fever, and confirms the view propounded by previous observers, that this medicine, when injected in doses of one and a half or two grains before or during the cold stage, has the power of cutting short the attack. Five of his eleven patients complained of a sharp, burning pain while the fluid was being injected, and for some minutes subsequently. In his remarks upon "intermittent and remittent fever, independent of malaria," Dr. Eulenburg states that he convinced himself by many accurate observations that " by the subcutaneous injection of small 588 APPENDIX. quantities of quinine, we are able in a great number of febrile states of a remittent or intermittent type to produce a temporary, and frequently a considerable, diminution of the febrile temperature of the body." This fact, which he clearly proves by numerous cases, obviously has an important bearing upon the treatment of various forms of disease. In cases of typical neuralgia (sciatica and tic) this remedy has been highly serviceable, and especially so in sunstroke. strychnia. prof. roberts bartholow, cincinnati. 1690. R. Strychniae sulphatis, gr.ij Aquas destillatae, f.gj. M. Five minims = gr¥\. DR. E. A. ERLENMEYER. 1691. R. Atropias sulphatis, gr.j Aquas destillatas, f.gij. M. Five minims = gr. J^-. DR. ALBERT EULENBURG, BERLIN. 1692. R. Strychnias sulphatis, gr.ij Aquas, f.gij- M. One minim = gr. J^. DR. WALDENBURG. 1693. R. Strychnias sulphatis, gr.ij Glycerinae, f.gss Aquae destillatae, f.giss. M. One minim = gr^V- All these solutions become unfit for use if kept long on hand. REMARKS ON THE HYPODERMIC USE OF STRYCHNIA. Dose.—This alkaloid has been employed in various doses, thus:— Neudorfer, gr.Tb-; Echeverria, of New York, gr.^V-rb-; Charles Hunter, gr.^-Ts; Bartholow, gr.A-sV; Waldenburg and Delbeau, gr.fV; Eulenburg and Bois, gr.}; Courty, gr.}; Rup- paner, gr.^-}; Lorent, gr.aV-iV. ANTIDOTE FOR STRYCHNIA POISONING. The calabar bean (F. 1684) is a complete antagonist to the toxic effects of strychnia. In its absence, the inhalation of ether, successfully employed by Dr. Echeverria, may be resorted to. Dr. Eulenburg mentions a case that occurred at Konigsburg, in which a young man who had taken one gramme and a half of strychnia was apparently saved by the hypodermic application of woorara. INHALATION, FORMULA AND DOSES OF MEDICINES FOR. 589 Therapeutics.—The subcutaneous injection of strychnia is principally used in cases of paralysis and neuralgia. Anstie commends it as the remedy par excellence in gastralgia, injected in doses of gr.ilWo-. Dr. Eulenburg has found it (in doses of *W. Tinea, circinnata, 525. tonsurans, 525, 336. versicolor, 526. sycosis, 526, 536. decalvans, 537. Tongue, raw, in phthisis, 182. Toothache, 467. Tonsillitis, 441. Torpidity of the liver, 288. Tubercular disease, see Phthisis. meningitis, sec Hydrocephalus. consumption, see Phthisis. diarrhoea, 173. Tumors, scrofulous, 355, 356. uterine, 391. cancerous, 463. hemorrhoidal, 472. general, 485. Tympanites, 245. Typhoid fever, 357. bedsores of, 487. Typhoid pneumonia, 207. Typho-malarial fever, 339. Ulcer, of the stomach, 280, 323. of the cornea, 495. Ulcers, 487. Ulcerated chilblains, 458. | Ulcerative endocarditis, 215. stomatitis, 225, 226. in children, 440. ! Ulceration, of rectum, 264. of os uteri, 390. scrofulous, 356. of cornea, 495. of Sch neiderian membrane, 533. of throat, syphilitic, 563, 575. Ursemic poisoning, 301. Uric acid, diathesis, 321. Urinary system, diseases of, 294. Urethritis, see Gonorrhoea. Urine, incontinence of, 319. Urticaria, 526. Uterine neuralgia, 93. i hemorrhage, see Menorrhagia, I catarrh, 389. I Uterus, diseases of, 389. hemorrhage of, 378. tumors of, 391. ulceration of, 393. cancer of, 393, 461. Uvula, relaxation of, 227. elongated, 409. Vaginal catarrh, 395. Vaginismus, 394. Vaginitis, 395. Aralvular disease of the heart, 221. Varicose veins, 490. of nose, 523. A^ariola, 360. Vaso-motor system, disturbances of, 219. Venereal diseases, 54.'!. Venery, excessive, 44, Vertigo, 114. of aged and apoplectic, 20. from cardiac hypertrophy, 213. dyspepsia, 276. Vocal cords, paralysis of, 116. | Vomiting, 291. of phthisis, 196. of fecal matters, 245. of drunkenness, 273. of pregnancy, 399. Vulva, pruritus of, 386. cysts of, 485. ATulvitis, 400. Wakefulness, see Insomnia. Whites, the, see A'aciuitis. / -? Whooping cough, 4^3" [ " Wine mark, 475. Women, diseases of, 363. Worms, in children, 442, convulsions from, 409. Wounds, open treatment of, 445. dressings for, 446-450. 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