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A 
COMPEND 
OF THE 
Practice of Medicine. 
ESPECIALLY ADAPTED FOR THE USE OF 
MEDICAL STUDENTS. 
BY L/ 
DAN’L E. HUGHES, M.D., 
DEMONSTRATOR OF CLINICAL MEDICINE IN THE JEFFERSON MEDICAL COLLEGE OF 
PHILADELPHIA; FELLOW OF THE COLLEGE OF PHYSICIANS 
OF PHILADELPHIA, ETC. 
IN TWO PARTS. * 
PART I. 
CONTINUED FEVERS; ERUPTIVE FEVERS; PERIODICAL FEVERS; DISEASES 
OF THE STOMACH; DISEASES OF THE INTESTINES ; DISEASES OF * 
THE PERITONEUM; DISEASES OF THE BILIARY PASSAGES 
DISEASES OF THE LIVER; DISEASES OF THE KID- 
NEYS; GENERAL DISEASES. /T&X V" 
PHILADELPHIA.: 
P. BLAKISTON, SON & CO., 
1012 Walnut Street. 
1883. Entered according to Act of Congress, in the year 1882, by 
P. BLAKISTON, SON & CO., 
In the Office of the Librarian of Congress, at Washington, D. C. TO 
HIS ESTEEMED FRIEND AND TEACHER, 
J. M. DA COSTA, M.D., 
Professor of the Practice of Medicine 
in THE 
Jefferson Medical College, 
THIS WORK 
IS RESPECTFULLY DEDICATED BY 
THE AUTHOR. PREFACE. 
This “Compend” is the outgrowth of the author’s system of notes, as 
employed in the Quiz-room during the past four years. 
Written for students of medicine, it has been his aim to present, in as 
compact a form as is consistent with clearness and completeness, the most 
essential features of the Practice of Medicine. 
From the inability of students to follow the lectures by reading large 
text-books, it is believed that this Compend will be a valuable aid in the 
acquisition of the fundamental facts, although it is not to be considered as 
a substitute for the more elaborate treatises upon the subject—they are to 
fully teach, this only to remind, the student. 
It may be regarded as a full set of notes upon the Practice of Medicine, 
and as such, it is hoped, will prove far more valuable and satisfactory than 
the ordinary imperfect and hurriedly taken notes. 
Free reference has been made to the. works and writings of Professors 
DaCosta, Bartholow, Flint, Reynolds and Roberts, acknowledgment of 
which is made here, in place of by foot notes on the different pages. 
D. E. H. 
Philadelphia, September, i88j. CONTENTS. 
PART I. 
PAGE 
INTRODUCTION 9 
FEVERS . 12 
Continued Fevers 12 
Simple Continued Fever 13 
Catarrhal Fever 14 
Typhoid Fever 15 
Typhus Fever 18 
Cerebro-spinal Fever 19 
Relapsing Fever 20 
Periodical Fevers 21 
Intermittent Fever 21 
Remittent Fever 23 
Typho-malarial Fever 24 
Pernicious Fever 25 
Congestive Fever. 25 
Yellow Fever 26 
Eruptive Fevers 28 
Scarlet Fever 28 
Measles 30 
Rubeola .' 31 
Smallpox 32 
Vaccination „ 35 
Varicella 35 
Erysipelas 36 
Dengue 37 
DISEASES OF THE STOMACH 38 
Acute Gastric Catarrh 38 
Acute Gastritis 40 
Chronic Gastric Catarrh 41 
Gastric Ulcer.. 42 
Gastric Cancer 44 
Gastric Dilatation 45 
Gastric Hemorrhage 46 
Gastralgia 47 
Atonic Dyspepsia 
DISEASES OF THE INTESTINAL CANAL..™^:^n£...\.... 50 
Lead Colic 50 
Diarrhoea ’yfrv 52 
Catarrhal Enteritis 54 
Croupous Enteritis 1. L. 56 
Cholera Morbus 57 
Acute Dysentery . 61 
Typhlitis 63 
Perityphlitis 64 CONTENTS. 
PAGE 
Proctitis 65 
Intestinal Obstruction 66 
DISEASES OF THE PERITONEUM 67 
Peritonitis 67 
DISEASES OF THE BILIARY PASSAGES 72 
Catarrhal Jaundice 72 
Biliary Calculi 73 
DISEASES OF THE LIVER 74 
Congestion of the Liver 74 
Abscess of the Liver 76 
Acute Yellow Atrophy 77 
Sclerosis of the Liver 78 
Atrophy of the Liver 78 
Amyloid Liver 79 
Hepatic Cancer 80 
DISEASES OF THE KIDNEYS 81 
The Urine 81 
Tests for Urea, etc 81 
Test for Phosphates 82 
Test for Chlorides 83 
Tests for Albumen .'. 1 83 
Tests for Blood „.... 84 
Tests for Bile, etc 85 
Tests for Sugar 86 
Acute Bright’s Disease 88 
Uraemia.... 89 
Chronic Parenchymatous Nephritis 90 
Interstitial Nephritis 91 
Pyelo-nepliritis 95 
Peri-nephritis.... 95 
Renal Calculi 95 
GENERAL DISEASES 95 
Diphtheria 97 
Acute Articular Rheumatism 102 
Gonorrhoeal Rheumatism 103 
Muscular Rheumatism 105 
Rheumatoid Arthritis 107 
Lithaemia 111 
Diabetes Insipidus 114 
Cholera 116 COMPEN D 
OF THE 
PRACTICE OF MEDICINE. 
PART I. 
INTRODUCTION. 
The Practice of Medicine embraces all that pertains to the knowledge 
and cure of the diseases of which the physician is called upon to treat. 
Disease may be defined as a deviation or alteration in the functions, 
properties or structure of some tissue or organ, whereby its office is no 
longer performed in accordance with the natural standard ; Organic, when 
associated with an organic change in the affected part; Functional, when 
the phenomena are independent of any recognizable lesion. The study of 
disease, whether organic or functional in character, is termed Pathology. 
Pathology explains the origin, causes, clinical history and nature of 
the morbid conditions to which the economy is liable. 
Etiology, or the causes of disease, are twofold, viz: Predisposing and 
Exciting. 
Predisposition to disease signifies a special liability or susceptibility to 
its occurrence, and may be hereditary or acquired. 
Hereditary predisposition to certain diseases is also called Diathesis, 
viz; offspring of phthisical parents are said to be of Phthisical Diathesis, etc. 
Diathesis is a morbid constitution, predisposing to the development of a 
particular disease, and may be inherited or acquired. 
Acquired predisposition is such as arises from 
I. Habits, viz : Strain on the nervous system resulting in nervous 
diseases. 
9 10 
PRACTICE OF MEDICINE. 
II. Age, viz: Children, very liable to catarrhal disorders. 
Young adults, fevers, perverted sexual disorders, etc. 
Middle age, heart and digestive disorders, cancer, etc. 
Old age, degeneration of vessels, etc. 
III. Occupation, viz ; Miners, weavers and cutlers, lung diseases. 
IV. Sex, viz: Women,emotional nervous diseases. 
Men, as more exposed, rheumatism, pneumonia, etc. 
V. Race, viz: Negro, phthisis and scrofula; exempt from malaria. 
Exciting causes of disease are divided into those acting from within 
and those acting from without. 
Causes from within are the emotions, passions, etc., viz: fear may pro- 
duce chorea ; anger has caused jaundice ; worry, heart troubles. 
Causes from without are food, air and light. 
The Clinical History of disease includes all the symptoms and signs 
which may occur from the period of incubation until its final termination. 
Symptoms are such alterations of the healthy functions that give 
evidence of the existence of a diseased condition, and may be either ob- 
jective or subjective. Objective, when evident to the senses of the observer, 
viz: redness or swelling. Subjective, when felt by the patient, viz : pain 
or numbness. 
The Period of Incubation is the interval between the entrance of the 
poison into the system and its manifestation, seldom presenting recogniz- 
able symptoms. 
The Prodromes are the earliest recognizable symptoms; viz: rigors, 
during the invasion of fever, the various aura preceding an epileptic fit, etc. 
Acute disease is one in which the invasion is rapid, and, as a rule, 
severe; when less rapid and intense the disease is said to be subacute; 
when gradual or slow the disease is said to be chronic. 
Pathognomonic is the term applied to such symptoms as belong to one 
particular disease, and are therefore characteristic of it, viz : rusty sputum 
of pneumonia. 
Physical signs are, strictly speaking, objective symptoms. 
The Termination of a diseased action may occur in one of three ways, 
viz: Cure, Secondary Processes, or in Death. 
Cure may occur by 
I. Lysis, or slow return to health. 
II. Crisis, abruptly, with a critical discharge. 
III. Metastasis, or changing from one location to another. INTRODUCTION. 
11 
Secondary processes is when the diseased action is substituted by a new 
morbid process, viz: Rheumatism followed by endocarditis; apoplexy by 
cerebral softening. 
By Death is meant a complete cessation of tissue change occurring by 
I. Asthenia, or an ever increasing debility, viz: phthisis, cancer, 
etc. 
II. Amzmia, or insufficient quantity or quality of blood. 
III. Apncea, or non-aeration of blood, viz : acute lung diseases, croup, 
etc. 
IV. Coma, death beginning at the brain, viz: uraemia, narcotic 
poisoning, etc. 
Morbid or Pathological Anatomy is the knowledge of structure or 
tissue changes after death. 
Diagnosis of disease implies a complete, exact and comprehensive 
knowledge of the case under consideration, as regards the origin, seat, 
extent and nature of all the morbid conditions. 
A direct diagnosis is made when the morbid condition is revealed by a 
combination of clinical phenomena, or some one or more pathognomonic 
symptoms. 
A differential diagnosis is the result when the diseases resembling each 
other are called to mind and eliminated from each other. 
A diagnosis by exclusion is by proving the absence of all diseases which 
might give rise to the symptoms observed, except one, the presence of 
which is not actually indicated by any positive symptoms. 
Prognosis of disease is the ability or knowledge to foretell the most 
probable result of the condition present, and involves an amount of tact or 
knowledge only acquired by prolonged experience. 
Treatment. The ultimate and most important object of the study of 
medicine, in a practical point of view, is to learn how to cure, relieve, or 
prevent disease, and it must be borne in mind that this does not consist solely 
in the administration of medicine, but requires strict and faithful attention 
to diet and hygiene. 
When the object is to prevent disease, viz.: smallpox by vaccination, it 
is called Prophylactic or Preventive treatment. 
When disease is to be broken up, although already begun, viz.: abort- 
ing the chill of malaria, it is called Abortive treatment. 
When the disease is allowed to run its natural course without attempting 
its removal, but being constantly on the alert for obstacles to its successful 
issue, viz.: the generally adopted plan of treating continued fevers, it is 
called Expectant treatment. 12 
PRACTICE OF MEDICINE. 
When the disease is incurable, and removal of marked suffering is the 
indication, it is called Palliative treatment. 
When marked weakness and prostration are to be overcome, it is called 
Restorative treatment. 
FEVERS. 
Fever is a condition in which there are present the phenomena of rise 
of temperature, quickened circulation, marked tissue change and disordered 
secretionj . 
The primary cause of the fever phenomena is a disorder of the sympa- 
thetic nervous system giving rise to disturbances of the vaso-motor filaments. 
Rise of temperature is the pre-eminent feature of all fevers, and can only 
be positively determined by the use of the thermometer. The term feverish- 
ness is used when the temperature is 990 to ioo0 Fahr.; slight fever if loo° 
or ioi°; moderate 102° or 103°; high if 104° or 105°; and intense if it 
exceed the latter. 
Quickened circulation is the rule in fevers, the frequency usually main- 
taining a fair ratio with the increase of the temperature. A rise of one 
degree Fahr. is usually attended with an increase of eight beats of the 
pulse per minute. 
The tissue waste is marked in proportion to the severity and duration of 
the fever phenomena, being slight or nil in febricula, and excessive in 
typhoid fever. 
The disordered secretions are manifested by the deficiency in the sali- 
vary, gastric, intestinal and nephritic secretions, the tongue being furred, and 
the mouth clammy, anorexia, thirst, constipation, and scanty, high-colored, 
acid urine. 
An Idiopathic or Essential fever is one in which no local affection 
gives rise to the fever phenomena; although lesions may arise during its 
course. 
A Symptomatic or Secondary fever is one dependent on an acute 
inflammation. 
CONTINUED FEVERS. 
All continued fevers are characterized by a steady progress of the febrile 
movement, without either a too decided rise or fall of the temperature to 
modify the impression of a continuous action. FEVERS. 
13 
SIMPLE CONTINUED FEVER. 
Synonyms. Irritative; febricula; ephemeral; sun; synocha. 
Definition. A continued fever, of short duration, mild in character, not 
due to specific cause, rarely fatal, but when death does occur, presenting 
no characteristic lesion. 
Causes. Fatigue, mental and physical; exposure to heat; excesses in 
eating and drinking; excitement and violent emotion; most common in 
childhood. 
Symptoms. An abrupt feeling of lassitude, followed by a decided 
chill or chilliness, a sudden and rapid rise of temperature, quick, tensepulse, 
headache, dry skin, intense thirst, coated tongue, and scanty, high-colored 
urine. Cases due to errors in diet are accompanied by nausea and vomit- 
ing ; those, in childhood, due to excitement, fright or emotions, may have 
slight convulsions. The temperature may, within an hour or two, reach 
ioj° F. or more, when slight delirium often occurs. 
Duration. From 24 hours to 6 or 7 days. Never exceeds ten days. 
Termination. Within a few hours, to a day, the temperature rapidly 
falls to the norm—(crisis); or it may continue for several days gradually 
falling—(lysis). Herpes about the lips and nostrils often observed at the 
close of an attack. Convalescence rapid. 
Prognosis. Recovery, without sequelae, the rule. 
Diagnosis. Unless the fever can be attributed to some one of the 
causes that give rise to it, a doubt may exist for the first twenty-four hours, 
after which time it can hardly be mistaken for any other disease. 
Treatment. Very little medicine. A full dose of hydrargyri chlorid. 
mite, or an enema, sponging the surface with cold water, and the adminis- 
tration of saline diaphoretics and diuretics. If great arterial excitement, 
aconitum may be added. Light diet is most agreeable. Cases in which 
the nervous symptoms are prominent do well on Fothergill’s “ fever mix- 
ture of the future,” viz:— 
}jc. Acid, hydrobrom fgss-j 
Syr. simplicis f^ss-j 
Aquae M. 
SlG.—Every four hours. 
Quinina in tonic doses during convalescence. 14 
PRACTICE OF MEDICINE. 
CATARRHAL FEVER. 
Synonyms. Influenza; epidemic catarrhal fever; contagious catarrh. 
Definition. A continued fever, occurring generally as an epidemic; 
due to specific cause; characterized by a catarrhal inflammation of the 
respiratory organs, and sometimes of the digestive; always accompanied 
by nervous symptoms and marked debility. 
Causes. A specific Vegetable germ, uninfluenced by soil, climate or 
atmospheric changes. 
Symptoms. The onset is sudden, chill, followed by fever, temperature 
reaching ioi° to 103°, quick, compressible pulse and severe, shooting pains 
in the eyes, frontal sinuses, joints and muscles. The chill and fever are 
rapidly followed by chilliness along the spine, pain in the throat, coryza, 
sneezing, injected, watery eye, and a dry, irritative cough, laryngeal and 
sometimes bronchial. Also disgust for food, pasty tongue and diarrhoea. 
In some epidemics the digestive symptoms are the most prominent, when 
dysentery may occur. 
The above symptoms are always associated with decided weakness and 
debility. Delirium is rare, but marked hebetude and cutaneous hypercesthe- 
sia are common. 
Duration. Four to seven days. Relapses frequently occur. 
Complications. Lobar or Catarrhal Pneumonia frequently occur, 
which adds to the gravity of the attack. The cough may outlast the dis- 
ease one or more weeks. 
Prognosis. Recovery is the rule when it attacks the healthy and 
vigorous. Grave, when the very young, very old, or those suffering from 
organic diseases, such as Bright’s disease, fatty heart, etc., are attacked. 
Diagnosis. Isolated cases may be mistaken for a “ bad cold.” But 
when epidemic, the sudden onset, marked general catarrh and decided 
prostration should prevent error. 
Treatment. No specific. Support the system and treat indications. 
The catarrh, pains and cough are at least ameliorated by the following :— 
R. Quininse sulph grs. ij-iv 
Morphinae sulph gr. 
Aquae lauro-cerasi sjj. M. 
SiG.—Every four hours, 
and the frequent inhalation of tinct. benzoin, comp., 3 ss-j., aqua bul. Oj FEVERS. 
15 
If the bronchial symptoms become troublesome use 
R. Ammonii muriat grs. x 
Mist, glycyrrh. comp M. 
p. r. n. 
Should Pneumonia occur treat as ordinary case, but never depress. 
TYPHOID FEVER. 
Synonyms. Enteric; gastric; nervous fever; entero-mesenteric; 
abdominal typhus. 
Definition. An acute, self-limited, febrile affection, due to a special 
poison; characterized by insidious prodromes; epistaxis; dull headache 
followed by stupor and delirium; red tongue, becoming dry and brown, 
and cracked; tympany, abdominal tenderness, and early diarrhoea; a 
peculiar eruption upon the abdomen; rapid prostration and slow conva- 
lescence ; a constant lesion of Peyer’s patches, mesenteric glands and 
spleen. 
Causes. Predisposing and Exciting. Predisposing are Age, viz.: 
young adults, and Season, viz.: hot and dry autumn. The Exciting 
cause is a special typhoid germ. It does not originate de novo, but results 
from the decomposition of typhoid excreta. Klebs claims to have identi- 
fied a specific “ typhoid bacillus.” 
Pathological Anatomy. The characteristic lesions of typhoid fever 
consist in certain changes in the Peyerian patches and solitary glands, 
which may be divided into well defined stages, to wit: I. Infiltration. 
II. Sloughing and Ulceration. III. Cicatrization, or in rare cases, Per- 
foration. 
The Mesenteric glands become enlarged and soften, but seldom ulcerate. 
The Spleen also enlarges and softens. There are besides, parenchy- 
matous degeneration of all the tissues of the body. 
Symptoms. Stage of Prodromes—The onset insidious with malaise, 
vertigo, headache, disordered digestion, disturbed sleep, epistaxis, depres- 
sion, and muscular weakness, followed by a chill or chilliness. 
First Week dates from onset of fever, when are present hot skin, frequent 
pulse, coated tongue, nausea, diarrhoea, headache, and upon the seventh 
day a few reddish spots resembling flea bites appear upon the abdomen, 
Second Week, foregoing symptoms exaggerated ; fever continuous, fre- 
quent and compressible pulse, tympanitic, tender abdomen,gurgling in iliac 
fosses, nocturnal delirium, severe and constant headache and stupor, a 16 
PRACTICE OF MEDICINE. 
short cough, with distinct sibilus on auscultation, irregular muscular con- 
tractions (subsultus tendinum), sordes upon the teeth and lips, the diar- 
rhoea continuing. 
Third Week. Fever changes from continuous to remittent; the evening 
exacerbations continue as high as the preceding week, and all the symp- 
toms remain about the same until near end of week, when they ameliorate. 
Fourth Week. The fever decidedly remits; almost normal in morning, 
the pulse becomes less frequent and more full, the tongue gradually clears, 
the abdomen lessens in size, the diarrhoea ceases, the patient passing into 
a slow convalescence, greatly emaciated, which may last for some weeks. 
Analysis of Symptoms. The temperature record of typhoid fever is a 
characteristic one. The fever on the morning of the first day may be stated 
at 98.5° F., evening 100.5°; second morning 99.50, evening 101.50; 
third morning, IOO.50, evening 102.50; fourth morning, 101.5°, evening 
103.50 1 fifth evening 104.50. From that time until end of the second 
week, evening temperature ranges between 103° and 105°, the morning’s 
being a degree lower. 
Diarrhoea is the principal intestinal symptom; if absent, the lesion is 
slight. The stools are at first dark, but early in the second week they 
become fluid, offensive, ochre-yellow, resembling “ pea-soup,” and may be 
streaked with blood. They number from three to fifteen in the twenty-four 
hours. 
Eruption is almost constant. Consists of from five to twenty small 
rose-colored spots, on abdomen, chest or back, sometimes on limbs, appear- 
ing in crops, lasting about five days, disappearing on pressure and at death. 
Return with relapses. Eruption day from seventh to ninth. 
Nervous symptoms are, pronounced headache, early and severe. Dull- 
ness soon following, passing into drowsiness and stupor. Deafness pro- 
nounced. Sight impaired, grave cases double vision. Delirium low and 
muttering, generally pleasant in character, a late symptom. 
Convalescence protracted. Great debility and anaemia, causing pronounced 
sweating. 
Complications. Intestinal hemorrhage may occur from fourteenth to 
twentieth day; decline of temperature to norm or below precedes passage 
of blood. The hemorrhage is due to the erosion of a vessel during the 
ulcerative action. 
Perforation makes case hopeless. Peritonitis without perforation adds 
to gravity, but not necessarily fatal. Lobar pneumonia, hypostatic conges- 
tion and bronchitis are frequent occurrences. Albuminuria may occur. FEVERS. 
17 
Relapses common. The symptoms all return suddenly ; duration half 
the time of original attack; occur end of fourth or beginning of fifth 
week. Not so fatal as might be expected. 
Prognosis. A positive one cannot be made. Favorable indications 
are constipation, slight diarrhoea, low temperature and moderate delirium. 
Diagnosis. The typhoid condition differs from typhoid fever, in absence 
of diarrhoea, eruption, and the characteristic temperature record. 
Enteritis has intestinal disorders alone. 
Peritonitis, abdominal symptoms only, with constipation. 
Acute miliary tuberculosis often mistaken for typhoid fever. 
Meningitis lacks the intestinal symptoms and fever record. 
Treatment. No specific. Intelligent nursing; pure air; quiet; disin- 
fecting urine and stools; liquid diet at intervals of every two or three hours. 
The following remedies have advocates, claiming that they modify the 
course of disease ; viz: Mercurials, iodum, acidum carbolicum, mineral 
acids, argent, nitras, and ergota. 
The present popular so-called “ specific treatment ” of this disease consists 
in the administration every second evening, until four doses are taken, of 
hydrargyri chlor. mite, gr. vij-x, which seemingly lessens the frequency of 
the stools in the later stages of the attack, although slightly increasing 
them at the time. Also administering from the beginning of the attack— 
R. Tinct. iodi gi) 
Acid carbol. liq gj. M. 
Sig.—One, two or three drops in ice water, every two or three hours, after 
food. 
To reduce temperature, cold bath, cold pack, and cold sponging, or 
quinina, gr. x-xx, repeated within an hour. 
Diarrhoea should not be checked unless it exceeds three stools in twenty- 
four hours, when may be used— 
R . Bismuth subnit gr. xx 
Acid carbol gtt. j 
Tinct. opii deodorat gtt. x-xv 
Mucil. acacias gj 
Aquae giij. M. 
Sig.—Every three or four hours; 
Or 
R . Cupri sulph gr. 
Opii ext gr. X- M. 
Sig.—In pill, every four hours. 
Tympanites; cold compresses or turpentine stupes to the abdomen; or 18 
PRACTICE OF MEDICINE. 
ol. terebinthince, gtt. x, morphines sulph., gr. every third hour, or tinct. 
nucis vomicis, gtt. x, p. r. n. 
Headache; cold to head, mustard to neck, and foot baths; if these fail, 
morphina or atrophia hypodermatically. 
Delirium; if from debility, increase stimulants; other causes, morphina. 
Restlessness and coma vigil; chloral alone or with potassii bromidum or 
morphina. 
Debility ; nourish every three hours ; don’t permit sleep to interfere with 
nourishment. Stimulants are indicated early; best guide is the heart’s 
action; an average amount would be q vj spts. vini gallic i, per diem. 
Bladder should be attended to daily. 
Intestinal hemorrhage; at once morphina, gr. hypodermatically, 
and ext. ergotce fid., gtt. xx-xl, repeated; or Mansells solution, gtt. ij-iv, 
every two hours. 
Perforation and peritonitis ; at once gr. lf morphina hypodermatically, 
and gr.j opii extract., every hour, and bold stimulation. 
TYPHUS FEVER. 
Synonyms. Contagious fever; ship fever; jail fever. 
Definition. An acute febrile, epidemic disease; contagious and char- 
acterized by sudden invasion, profound depression of the vital powers, and 
a peculiar petechial eruption; favorable cases terminating by crisis in 
fourteen days. No lesion. 
Cause. A special infecting germ, the character of which is unknown, 
but which is influenced by filth, overcrowding, etc. 
Pathology. Blood dark and thin; lessened fibrin ; tissues soft and flabby. 
Symptoms. Begins abruptly; chill followed by violent fever; tem- 
perature within few days reaches 104° to 105° ; frequent, bounding pulse, 
soon becoming compressible; severe headache followed by violent delirium; 
from fifth to seventh day, coarse, red, measly eruption, with a mottling of 
the skin all over the body, except face, not disapppearing on pressure; 
constipation the rule. End of second week, temperature suddenly declines 
and passes into rapid convalescence. 
Complications. Pneumonia and swollen parotid glands are common. 
Prognosis. Unfavorable indications; high temperature, frequent 
pulse, early stupor, presentiment of death. Favorable; youth, moderate 
temperature and pulse, and mild nervous phenomena. FEVERS. 
19 
Diagnosis. From typhoid fever, age, season, onset of disease, character 
of eruption, and intestinal symptoms. 
Measles begin milder, with coryza and cough, and seldom such pro- 
nounced nervous phenomena, but an early eruption appearing on face. 
Treatment. Much the same as typhoid. As typhus is distinctly 
contagious, isolation is imperative, with immediate removal and disinfec- 
tion of the patient’s excreta. 
For high temperature, cold pack, cold bath, cold sponging, or full doses 
of quinina. 
For headache, delirium, etc., cold to head; in young and strong, a few 
leeches to the temple, and chloral, with or without bromides. 
For constipation, mild laxatives. 
Debility; alcohol early and in full doses; chloroformi spts., in drachm 
doses, where danger of collapse. 
CEREBRO-SPINAL FEVER. 
Synonyms. Epidemic cerebro-spinal meningitis; epidemic cerebro- 
spinal fever; spotted fever; cerebro-spinal typhus. 
Definition. A malignant epidemic fever, characterized by painful con- 
tractions of the muscles of the neck, retraction of the head, hyperaesthesia, 
disorders of the special senses, and frequently an eruption of petechia or 
purpuric spots. Lesions of cerebral and spinal membranes are found at 
post-mortem. 
Cause. Special poison, nature unknown; attacks young by preference; 
most common in winter; not contagious. 
Pathological Anatomy. Hypefcemia, followed by an exudation of 
lymph and an effusion of serum upon the membranes of the brain and 
spinal cord, causing pressure. 
Symptoms. Divided, according to the severity of the lesion, into three 
groups; to wit, the common form, the fulminant and the abortive. 
The Common Form begins with a chill, excruciating headache, persist- 
ent nausea, vomiting, vertigo and an overwhelming sense of weakness. 
Within a few hours the muscles of the neck become rigid and retracted, 
with decided pain upon moving the head; this rigidity and retraction soon 
extends to the back, when opisthotonus obtains. The surface of the body 
becomes highly sensitive (hypercesthesia) and convulsions or delirium 
occur. Intolerance of light, and in some cases amaurosis, more or less 
deafness, loss of smell and taste soon follow. The temperature and pulse 20 
PRACTICE OF MEDICINE. 
record are irregular. From the first day to the fifth an eruption of pete- 
chise or purpura occurs in a majority of cases. The disease reaches its 
height in from three to eight days, and passes into stupor and coma or 
ameliorates and parses into a protracted convalescence. 
The Fulminant Form. Severe chill, depression, and in a few hours 
collapse. Patient is overcome by the poison and never reacts. 
The Abortive Form consists of one or more pronounced characteristic 
symptoms during the course of an epidemic. 
Sequelae. Result from thickening of either the cerebral or spinal mem- 
branes ; Persistent headache, blindness or deafness, partial or complete ; 
epilepsy or different forms of spinal palsies. 
Prognosis. Varies according to epidemic; from twenty to fifty, and 
even seventy-five per cent. die. 
Diagnosis. Typhoid Fever begins slowly, without intense headache, 
muscular rigidity, vomiting, active delirium, ending in coma and constipa- 
tion, and has a typical temperature record. 
Typhus fever has higher fever, is of longer duration, and has peculiar 
measly eruption, not attended with muscular rigidity and retraction, hyper- 
esthesia, nor disorders of the special senses. 
Tubercular nieningitis is not epidemic, and has no characteristic erup- 
tion, and is preceded by long prodromes, and runs a tedious course. 
A congestive chill resembles the fulminant cases in suddenness of 
depression, but the latter has not the history of the former. 
Inflammation of the meninges of the cord are due to exposure to cold, 
or syphilis, and is not attended with cerebral symptoms or an eruption. 
Treatment. Full doses of opium. Hypodermatic use of morphina, 
gr. % to every two or three hours; or opii extract., gr. j every hour 
until stage of effusion, when quinina in tonic doses, and potassii iodidum 
are indicated. Prof. DaCosta alternates potassii bromidum with opium, 
especially in children. Locally, cold to head and spine. A generous 
diet from onset. P'or sequelce, potassii iodidum, course of hydrargyrum, 
and flying blisters along the spine. 
RELAPSING FEVER. 
Synonyms. Famine fever; bilious typhoid. 
Definition. An acute, contagious, febrile disease, self-limited; charac- 
terized by a febrile paroxysm, succeeded by an entire intermission, which is 
in turn followed by a relapse similar to the first seizure. No specific lesion. FEVERS. 
21 
Cause. A specific poison; contagious; acquiring the greater activity 
the more filthy, crowded and unhealthy the population amid which it 
prevails. 
Pathological Anatomy. During febrile paroxysm only, blood con- 
tains minute spiral filaments—spirilli, constantly twisting and rotating. 
Liver and spleen greatly swollen. 
Symptoms. No prodrotnes. Onset abrupt, with fever, I02°-I04° ; 
frequent, rather weak pulse, headache, nausea, vomiting, and lancinating 
pains \n limbs and muscles, marked in the calf of leg; second day, feeling 
of fullness and pressure in right and left hypochondrium, due to swollen 
liver and spleen ; jaundice is frequent; seventh day ends by crisis; four 
teenth day symptoms return in milder form, continuing about four days, 
when enters slow convalescence, much emaciated. Several relapses may 
occur. 
Prognosis. Recovery the rule, but protracted, as decided emaciation 
results. 
Diagnosis. Yellow fever has many points of resemblance, but has 
shorter febrile stage, remission not so complete, vomiting late and charac- 
teristic, normal spleen, and late appearance of yellow color. 
Reynittent fever begins with decided chill, followed by fever and sweats, 
and not the progressive rise of temperature till fifth or seventh day. 
Treatment. Expectant. Act on secretions; nourish patient and 
meet urgent symptoms. For fever, sodiisalicylat.; for pain, hypodermatic 
of morphina ; nausea and vomiting, acidum carbolictim or cerii oxalas ; 
during remission, ferruin and quinina. 
These affections are characterized by the distinct periodicity of the phe- 
nomena, having intervals during which the patient is wholly or nearly free 
frofn fever. 
PERIODICAL FEVERS. 
Synonyms. Ague; chills and fever; malarial fever. 
Definition. A paroxysmal fever, the phenomena observing a regular 
succession; characterized by a cold, a hot and a sweating stage, followed 
by an interval of complete intermission or apyrexia, varying in length, 
according to the variety of the attack. 
Cause. Malaria. 
INTERMITTENT FEVER. 22 
PRACTICE OF MEDICINE. 
Pathological Anatomy. Blood dark, from formation of pigment 
(Melancemia). Spleen swollen [Ague cake). Liver engorged and swollen. 
Varieties. Quotidian when a daily paroxysm; tertian when every 
other day; quartan when it occurs first and fourth days; octan when 
weekly; duplicated quotidian when two paroxysms daily; duplicated 
tertian, two every second day ; double tertian, daily paroxysm, but more 
severe every second day. Dumb ague, or masked ague, is irregularity of 
the characteristic phenomena. 
Symptoms. Each paroxysm has three stages, to wit: cold, hot and 
sweating. 
Cold stage begins with prodromes, to wit: lassitude, yawning, etc., 
followed by chill; teeth chatter, skin pale, nails and lips blue, nausea 
and great thirst, while thermometer shows a decided rise of temperature, 
102°, F.,-1040; these phenomena continue from one-half to an hour. 
Hot stage begins gradually, by shivering ceasing, surface becoming hot 
and flushed, temperature rising to 106°, F., or more, pulse full, headache, 
nausea, excessive thirst, scanty urine, and other phenomena of pyrexia, 
continuing from one to eight or ten hours. 
Sweating stage begins gradually on forehead, spreading over entire 
surface; fever lessens, temperature rapidly falls to 990 or 98°, pulse less 
full, headache lessens, and feeling of comfort, sleep often following ; dura- 
tion from one to four hours, when the intermission occurs, the patient 
apparently well, excepting a feeling of general debility. The occurrence 
of the next paroxysm depending upon the variety of the attack. 
The paroxysm may be ushered in by a decided pain in one or more 
nerves, instead of the cold stage, to wit: “ brow ague.” 
Prognosis. Recovery the rule. Without treatment many cases end 
favorably after several paroxysms; others passing into the chronic form or 
malarial cachexia;. 
Diagnosis. No difficulty when characteristic chill, fever, and sweats. 
Hectic fever. Known by its irregularity, and . occurring secondary to 
organic disease. 
Pycemia, produced by other causes than malaria. 
Nervous chills show absence of temperature rise. 
Treatment. Cold stage can be averted and the other stages greatly 
modified by a hypodermatic injection of either morphince sulph., gr, , 
or pilocarpin muriat., gr. j/g, or a drachm of chloroform by stomach. Hot 
stage, cool drinks and cold sponging. Sweating stage, when excessive, 
sponging with alumen and hot water. FEVERS. 
23 
Tntermission; at once, brisk purgative, followed by cinchona in some 
form, the most efficient being quinince sulph., gr. xx-xxiv, in solution or 
freshly-made pills, in one or two doses, three to five hours before the 
expected paroxysm. 
After paroxysms are broken up use liq. potassii arsenit. gtt., v-x, t. d. 
for a long time; or tinct. ferri. chloridi, gtt. xx, every four hours. 
Relapses being common, quinina should be given on second or third 
day ,fourth to sixth, twelfth to fourteenth, and nineteenth to twenty first 
days. 
REMITTENT FEVER. 
Synonyms. Bilious fever; bilious remittent fever; marsh fever; 
typho-malarial fever. 
Definition. A paroxysmal fever, with exacerbations and remissions ; 
characterized by a moderate cold stage (which does not recur with each 
paroxysm); an intense hot stage, with violent headache and gastric irrita- 
bility ; and an almost imperceptible sweating stage, which is frequently 
wanting. 
Cause. Malaria, aided by high temperature. 
Pathological Anatomy. Blood dark (Melanamia); spleen enlarged, 
soft, filled with blood, and of an olive color; liver congested and swollen, 
brain hypersemic and olive-colored; gastro-intestinal canal markedly 
hyperaemic. 
Symptoms. Cold stage; moderate chill, temperature rises i° to 2°, 
oppression at epigastrium, slight headache. 
Hot stage; persistent vomiting, furred tongue,/tillpulse, rising to loo or 
120, flushed face, injected eye, violent headache, pains in limbs and loins, 
hurried respirat.io7i, the temperature rising 104° F., to 1060. The bowels 
costive, stools tarry and offensive, and the surface becoming yellow. 
Delirium occurs when the temperature is very high. 
Sweating stage ; after six to twenty-four hours the symptoms abate and 
slight sweating occurs; the pjilse, headache, vomiting, etc., subside, and 
the temperature falls to 990, F., or ioo°. 
This is the remission. 
After some two to eight or twelve hours the symptoms return, generally 
minus the chill, and this is termed the exacerbation, which is in turn 
followed by the remission. 
Duration. From seven to fourteen days, the average. Frequently the 
fever ceases to remit, and instead, becomes continuous, the symptoms re- 24 
PRACTICE OF MEDICINE. 
sembling, if they are not identical with, the typhoid state, whence the term 
typho-?nalarial fever, or malario-typhoid fever. 
Sequelae. Malarial cachexia follows when the poison has not been 
eliminated. 
Persistent headache and vertigo are the results of the intense meningeal 
hyperaemia that sometimes obtains. 
Prognosis. Uncomplicated cases are favorable. 
Diagnosis. In intermittent fever each paroxysm begins with a chill, 
while the chill seldom recurs in remittent fever; a distinct intermission 
follows each paroxysm of the intermittent form, while a remission occurs 
in remittent, the thermometer showing that the fever does not wholly 
leave; during the intermission the patient is apparently well; such is not 
the case in remittent fever. 
Acute congestion of the liver resembles remittent fever, on account of 
the yellow skin. The exacerbations and remissions distinguish between 
the two. 
Typhoid fever is mistaken for remittent fever, but the absence of diar- 
rhoea, eruption, tympanitis, deafness and severe prostration should prevent 
the error. 
Treatment. Quinines sulph., gr. xvj-xx per diem, is the remedy. Best 
given during the remission, if possible. If irritable stomach prevents its 
administration by mouth, use by hypodermatic injection or suppository. 
During hot stage, cool sponging, cold to head, and if tendency to cerebral 
congestion, dry or wet cups to the nape of the neck and 
R. Tinct. aconit. rad gtt. j-ij 
Liq. potas. citrat z ij 
Liq. ammon. acetat 3 ij. M. 
Every two hours. 
Purgation during remission, with 
R. Hydrarg. chlor. mite gr. v 
Sodii bicarb gr. x 
Pulv. aromat gr. v. M. 
In pulv., p. r. n. 
The same precautions are essential after the paroxysms are broken up, 
to prevent their return on the septenary periods, that were mentioned for 
intermittent fever. FEVERS. 
25 
PERNICIOUS FEVER. 
Synonyms. Congestive fever; malignant intermittent; malignant 
remittent. 
Definition. A malignant, destructive, malarial fever, which may be of 
the intermittent or remittent form; characterized by intense congestion of 
one or more internal organs, together with dangerous perversion of the 
functions of innervation. 
Cause. A high degree of malarial poison. 
Varieties. Gastro-enteric ; thoracic; cerebral; and hemorrhagic. 
Symptoms. Any of these varieties may begin either as an intermittent 
or remittent form; again, the first paroxysm is rarely pernicious, but ap- 
pears as the ordinary malarial attack. 
The gastro-enteric variety has as distinctive features, intense nausea and 
vomiting, purging of thin discharges, mixed with blood, tenesmus, burning 
heat in stomach, intense thirst, frequent, weak pulse, face, hands and feet 
cold, with shrunken features, and intense depression of all the vital forces. 
This condition continues from half an hour to several hours, when either 
an inter- or remission occurs. 
Thoracic variety often combined with the one just described. Its char- 
acteristic features are due to overwhelming congestion of the lungs, such 
as violent dyspnoea, gasping for air, 50 to 60 respirations per minute, 
oppressed cough with slight amount of blood-streaked sputa, frequent, weak 
pulse, cold surface, and terror-stricken features; duration same as above. 
Cerebral variety, due to intense congestion of the brain; sometimes effu- 
sion of serum into the ventricles, or even rupture of small blood vessels. 
Characterized by violent delirium, followed by stupor and coma, slow, full 
pulse, the surface either flushed or livid. Cases may either resemble 
apoplexy or acute meningitis. Duration same as other forms. 
Hemorrhagic variety or the yellow disease, as it has been termed, begins 
as an ordinary inter- or remittent fever, soon followed by signs of internal 
congestion, to wit: nausea, vomiting, dyspnoea, severe pains over liver and 
kidney, continuing for a few hours, when the suiface suddenly turns yellow 
and bloody urine is voided, after which an inter- or remission and marked 
abatement occurs, to be sooner or later followed by a second paroxysm, 
which is more severe, with additional signs of cerebral congestion. Blood 
may also escape from other parts than the kidneys. 
Duration. Pernicious fever, in any of its forms, may last from a few 
hours to a few days. Recovery is rare after a third paroxysm. 26 
PRACTICE OF MEDICINE. 
Prognosis. With early treatment, one in eight perish. 
Diagnosis. Yellow fever is most apt to be confounded with the hemor- 
rhagic variety, and as they both occur in the same localities, the diagnosis 
is difficult; the early yellowness of surface, with hcematuria, and the ab- 
sence of the black vomit, are the chief points of distinction. 
Treatment. The first indication in all varieties is to bring about re- 
action. If cold stage, heat to surface, with stimulating lotions; hot stage, 
cold to surface and hypodermatic injection of morphina, gr. at once. 
After reaction, quinince sulph., not less than gr. xl, repeated p. r. n.; ad- 
minister by stomach, rectum, or better still, by hypodermatic injection. 
Dr. Bartholow pronounces the following one of the best formulae for the 
hypodermatic use of quinia:— 
R. Quininae di-sulph gr. 50 
Acid sulph. dil ; 100 
Aquae font g j 
Acid carbol. liq v. M. 
Gastro-enteric variety, Prof. DaCosta suggests— 
R . Morph, sulph gr. jf 
Pulv. camph gr. j 
Mass, hydrarg gr. ij 
Pulv. capsici gr. ss. M. 
In pills every half hour until stools change. 
For thoracic variety, dry or wet cups and ammon. carbonatis. 
Cerebral variety, venesection, or cups or leeches to neck, cold to head, 
active purgation, and act on kidneys and skin. 
Hemorrhagic variety, purgatives, morphina hypodermatically, and either 
acid sulph. dil., acid gallic, or MonselP s solution, for hemorrhages. After 
paroxysms are broken up, long course of ferrum, with quinina on sep- 
tenary days. 
Synonyms. Bilious malignant fever; typhus icterode; Mediterranean 
fever; sailors’ fever. 
Definition. An acute, infectious, paroxysmal disease, of three stages, 
to wit: the febrile, the remission, and the collapse; characterized by vio- 
lent fever, yellowness of the surface, and “ black or coffee-ground vomit.” 
Tendency fatal; one attack confers immunity from a second. 
Cause. A specific poison, existing only with a high temperature, and 
destroyed by frost. Not malaria. 
YELLOW FEVER. FEVERS. 
27 
Pathological Anatomy. Skin, lemon or greenish yellow color, due 
to dissolution of red blood corpuscles; heart softened by granular degen- 
eration; stomach, veins deeply engorged and mucous membrane softened ; 
it contains more or less “ coffee-ground ” matter, consisting of blood cor- 
puscles deprived of their haemoglobin, white corpuscles, epithelial cells 
and debris. Intestines much same as stomach; liver yellow color and a 
fatty degeneration of the hepatic cells; kidneys, granular degeneration of 
the epithelium of the tubules. 
Symptoms. First stage, the febrile, beginning either with the pro- 
dromata of malaise, etc., or suddenly with a chill, high fever, in a few 
hours reaching 104° F., high false, brilliant eye, flushed countenance 
coated tongue, irritability of the stomach and severe neuralgic pains in the 
head, limbs and back, and large joints. The patients are restless and 
anxious. In severe attacks delirium is Frequent. Albumen in the urine 
and a peculiar and characteristic odor is emitted from the patient. Dura- 
tion of the first stage from thirty-six hours to three or four days. 
Second stage, the remission, when the temperature declines and all the 
distressing symptoms abate or subside and, with some critical evacuation, 
convalescence obtains, or, more commonly, after from one to four days the 
Third stage, the stage of collapse, is ushered in by a return of all the 
symptoms of the first stage in an exaggerated form, followed by yellowness 
of the skin, passing to a deep mahogany color, black vomit and henior- 
rhages from other parts, feeble pulse, cold surface, irregular respiration and 
death from exhaustion, the mind remaining clear to the end. 
The above symptoms represent a sthenic case; other varieties are the 
algid, hemorrhagic and typhus. 
Duration. Depends on the variety, from a few hours to a few days. 
Rarely continues longer than one week. 
Prognosis. One in four perish. Short cases unfavorable, as are 
hemorrhagic. 
Diagnosis. Pernicious fever, hemorrhagic variety, apt to be mistaken 
for yellow fever. Yellow fever, a disease of one paroxysm, one remission, 
epidemic, albuminuria and black vomit. Pernicious fever more than one 
paroxysm, not epidemic, rarely black vomit or albumen in urine. 
Treatment. No specific; a “ self-limited” disease. The indications 
are to treat symptoms and nourish patient. Good nursing, ventilation, 
early emesis and purgation, with diaphoretics and dmretics, are apparently 
beneficial. Large doses of quinina,early in attack, for high temperature; 
for the irritable stomach, ice slowly dissolved in the mouth and acidum 28 
PRACTICK OF MEDICINE. 
carbolicum, gr. in aqua menthce pip., every two hours, alternated with 
liquor calcis and milk, each an ounce; and MonselFs solution or plumbi 
acetas, for black vomit and hemorrhages; the pains, restlessness or de- 
lirium are best controlled by the hypodermatic use of morphina and atro- 
pina. Free stimulation from onset is essential. 
ERUPTIVE FEVERS. 
As a group, the eruptive or exanthematous fevers have many features in 
common. All have a period of incubation, are characterized by a fever of 
more or less intensity preceding the eruption, by an eruption which is 
peculiar to each, occur most commonly in childhood, rarely attack the same 
person twice, very prone to occasion serious sequelae, and are contagious. 
Their origin is as yet unknown. 
SCARLET FEVER. 
Synonym. Scarlatina. 
Definition. An acute, self limited, infectious disease; characterized 
by high temperature, rapid pulse, a diffused scarlet eruption, terminating 
with desquamation, inflammation of the throat, and frequently more or less 
grave nervous phenomena. .Serious sequelae usually follow an attack. 
Cause. A specific poison, maintaining its vitality for a long time. 
Eminently contagious, the contagion residing chiefly in the desquamated 
epidermis. Incubation short, one to seven days. 
Symptoms. Onset sudden, decided chill and vomiting, followed by high 
fever, soon reaching 105°; rapid pulse, no to 140 being common. At 
the end of twenty-four hours a bright scarlet rash appears on the neck and 
chest, spreading over the entire body within a few hours ; the eruption is 
not raised, there is no intervening healthy skin, and scattered irregularly 
are points of a darker hue. With the appearance of the eruption burning 
heat of surface, burning in the throat and difficulty in deglutition are 
complained of, the throat on inspection presenting the appearance of a 
catarrhal inflammation. Tongue at first furred, later, red, with prominent 
papillae—the “ strawberry tongue.” 
On the fourth or fifth day the fever declines by lysis, the eruption fading, 
and on the sixth or eighth day desquamation begins, continuing for a 
week or more, the convalescence being slow, the patient emaciated and pale. 
Scarlatina anginosa are cases with great inflamnntion and swelling of FEVERS. 
29 
the throat and neighboring glands, the swollen glands pressing upon the 
surrounding parts, causing difficulty of breathing and of deglutition. 
Scarlatina maligna are cases with decided nervous phenomena, to wit: 
convulsions, delirium and muscular twitching, the temperature reaching 
107° to iio°, the eruption delayed, purple and in patches. 
Sequelae. Chronic sore throat; conjunctivitis; otorrhcea; chronic 
diarrhoea; subacute rheumatism; endocarditis; acute Bright’s disease; 
cutaneous dropsy. 
Prognosis. Depends upon the character of the attack. Never can be 
positive of the result. Mortality ranges from ten to twenty-five per cent. 
Diagnosis. A typical case should cause no difficulty ; the high fever, 
rapid pulse, sore throat, and early scarlet eruption, followed by desquama- 
tion, should leave no doubt. 
Measles; the above symptoms are absent, and catarrhal symptoms 
present. 
Smallpox ; eruption on third day, in spots, changing to pustules with 
secondary fever. 
Dengue or break-bone fever; absence of above typical symptoms, and 
presence of severe pains in the bones. 
Diphtheria ; gradual invasion and absent eruption. 
Meningitis may be suspected from the symptoms of scarlatina maligna ; 
the epidemic influence, eruption, and rapid pulse, are points of difference. 
Treatment. No specific. Treatment must be symptomatic. 
For fever and rapid pulse, either tinct. aconit. rad. or digitalis. If 
temperature reaches over 1060, cold bath or pack, in addition. 
For itching of eruption, local use of oils or fats, in some form, produce 
great relief. 
If the surface is pale, the circulation feeble and the eruption tardy in 
making its appearance, use tinct. belladonnce, gtt. ij-x, according to age. 
For throat, ice internally, and, if it does not cause chilliness, externally ; 
if so, apply heat externally ; also gargles in those old enough, and in those 
too young, swabbing the throat is an efficient substitute. The following 
formula is satisfactory for either purpose :— 
U . Potass, chlor z iij—vj 
Tinct. myrrh f^ij 
Mel. desp £ iij 
Infus. cinchonse f§ iv. M. 
From the onset, in all cases, either ammon. carb., or tinct. ferri chlor. 
and quinina should be used, proportioning the dose according to the 30 
PRACTICE OF MEDICINE. 
severity of the attack. For malignant cases bold stimulation from the 
onset. 
It is claimed that a characteristic micrococci are found in the blood, 
and that, consequently, the disease can be favorably influenced by acidum 
carbolicum or thymol. 
For the various sequela, the treatment is the same as if they occurred 
primarily, plus tonics. 
The disease being infectious, every means should be taken to prevent 
its spread, to wit: isolation, cleanliness, disinfection, fumigation, etc. 
Small doses of quinina, in those exposed, said to prevent or modify the 
severity of an attack, but no true prophylactic is known. 
MEASLES. 
Synonym. Morbilli. 
Definition. An acute epidemic and contagious disease ; characterized 
by catarrhal symptoms, referable to naso-broncho-pulmonary mucous 
membrane, fever, and a crimson eruption which terminates by desquama- 
tion. 
Cause. A specific poison, with a special susceptibility for childhood. 
Contagious by contact, and has been communicated by inoculation. One 
attack, as a rule, protects from a second. Incubation, ten days. 
Symptoms. Onset gradual, irregular chills, fever, the temperature 
rising to ioi° or 102°, muscular soreness, headache, and intense nasal, 
pharyngeal and laryngeal catarrh ; on the evening of the second day a 
decided remission takes place in the fever, the catarrh continuing; on the 
fourth day occurs an eruption of a crimson color, on the face, soon spread- 
ing over the body, in the form of dots, slightly elevated, which coalesce 
into irregular circles or crescents, and with the appearance of the eruption 
the fever returns, the catarrh is aggravated and extends to the bronchial 
mucous membrane. About the ninth day eruption fades, symptoms 
abate, and slight desquamation occurs. Some cough and catarrh may 
remain for a long period. 
Black measles or camp measles are a variety occurring in camps, jails, 
et£., in which occur dangerous chest symptoms, and black spots or pete- 
chise, from deteriorated blood, and severe prostration. 
Rather common complications are lobar and catarrhal pneumonia. 
Sequelae. In those of strumous diathesis, scrofula or phthisis may de- 
velop. FEVERS. 
31 
Prognosis. As a rule, perfect recovery. If phthisis develop, prog- 
nosis bad. Black measles, the majority perish. 
Diagnosis. A typical case begins gradually, chilliness, nasal catarrh, 
watery eye, and fever, which decline before eruption, rising afterwards; 
eruption crescentic in shape, crimson color. 
Scarlet fever; absence of catarrh, and earlier appearance and different 
character of the eruption. 
Typhus fever ; absence of the catarrh, febrile remission and eruption on 
face, and with decided cerebral phenomena. 
Treatment. No specific. Mild cases generally require no medicine, 
simply regulating diet and bowels, and cool sponging. 
If fever high,— 
R. Liq. potass, citrat gj 
Spts. aether nitrosi gtt. v-x 
Tinct. aconit. rad gtt. ss. M. 
Every two hours, soon controls it. 
For itching of eruption, local use of oils and fats. For catarrhal sy mp- 
toms, inunction of nose, neck and chest with camphorated oil and pulv. 
ipecac comp., at bedtime; if extends to bronchial mucous membrane, 
expectorants. 
During convalescence, for the strumous, protect from exposure, and ol. 
morrhuce with syr.ferri iodidi. For black measles, bold stimulation, with 
ferrum and quinina. 
RUBEOLA. 
Synonyms Rotheln; German measles; French measles; false 
measles. 
Definition. An acute, self-limited disease; characterized by mild 
fever, suffused eyes, cough and sore throat, enlargement of the lymphatic 
glands of the neck, and a rose-colored eruption, in patches of irregular size 
and shape, appearing on the first day. 
Cause. Propagated by infection. That a peculiar germ exists is 
probable, but thus far it has not been isolated. Incubation from one to 
three weeks. 
Symptoms. Onset sudden, with 7nild fever, suffused eyes, with little 
or no coryza, and sore throat, and enlargement of the cervical glands, and 
not limited to those about the angle of the jaw, as in scarlatina. Any time 
from the first to the fourth day appear rose-colored spots, size of pin head, 
slightly elevated, which coalesce, forming irregular shaped and sized 32 
PRACTICE OF MEDICINE. 
patches, with intervening healthy skin, fading on the upper part of the 
body while just appearing on the lowrer. Symptoms all terminate within a 
week by lysis, the patient being none the wmrse for the attack. 
Prognosis. Most favorable. 
Diagnosis. From scarlet fever, by absence of high fever, rapid pulse, 
color and character of eruption and sequelae. 
From measles, by absence of intense catarrhal symptoms, late appearance 
of eruption not of crescentic shape. 
Treatment. Mild laxatives and restricted diet. If fever high, saline 
mixture. Itching of skin, sponging with vinegar and water. 
Synonym. Variola. 
Definition. An acute, epidemic and contagious disease; characterized 
by severe lumbar pains and vomiting, and an initial fever, lasting from 
three to four days, followed by an eruption, at first papular, then vesicular 
and afterwards pustular ; the development of the pustule being accompa- 
nied by a secondary fever, during which grave complications are prone to 
occur. 
Causes. A specific poison whose nature is unknown, maintaining its 
contagious vitality for a long period. There is no period, from the initial 
fever to the final desquamation, when the disease is not contagious, but 
the stage of suppuration is the most virulent. One attack, as a rule, pro- 
tects from a second. Vaccination has positive protective influence from 
the disease, as extensive observation has fully proven that in proportion 
to the efficiency of vaccination is the rarity and mildness of variola. In- 
cubation, fourteen to sixteen days. 
Pathological Anatomy. A granular and fatty degeneration occurs in 
the liver, spleen, kidneys and heart. The pustules are found in the larynx, 
trachea, bronchial tubes, and on the pleura; do not occur in the stomach 
or intestines. 
Varieties. Discrete; confluent; malignant; varioloid or modified 
smallpox. 
Symptoms. Discrete form. Onset sudden, with violent chill, vomit- 
ing, and agonizing pains in the back, shooting down limbs; fever, in short 
time, rising to 103° to 104° F.; full, strong and rapid pulse, ranging from 
100 to 130; the face red, eyes injected, intense headache and sleeplessness ; 
SMALLPOX. FEVERS. 
33 
delirium and convulsions occur at times. During the third day the char- 
acteristic eruption makes its appearance, first on the forehead and lips, con- 
sisting of coarse red spots ; with the appearance of the eruption all the 
marked symptoms of the fever abate, the patient feeling quite comfortable. 
On the fifth day of the disease the spots become papules; on the sixth day, 
transformed to vesicles, which are soon umbilicated; on the eighth day the 
vesicles change to pustules; on ninth day the pustules are entirely puru- 
lent, and each surrounded with a broad red band, the halo or areola, the 
face swollen, the features distorted; on eleventh day, pus oozes from the 
pustules, and drying, forms the scab or crust, which, on the seventeenth to 
twenty-first day drops off, leaving a red, glistening depression or pit, soon 
changing into a white cicatrix. With the formation of the pustules, eighth 
day, severe rigors and fever set in, and a characteristic odor is emitted, all 
the original symptoms returning; this secondary fever is the most critical 
period of the disease, generally attended with violent delirium. In favor- 
able cases the secondary fever subsides after three or four days, and conva- 
lescence is established. 
Confluent smallpox differs from the discrete in being more severe, the 
eruption appearing during the second day, the pustules coalescing into 
large patches, causing great distortion of the features. 
Malignant smallpox is characterized by the intensity and irregularity of 
the symptoms, death resulting before the characteristic eruption, by convul- 
sions or coma. In these cases hemorrhages are frequent and petechire are 
observed. 
Varioloid, or modified smallpox, is the form modified by previous vac- 
cination or by a former attack of smallpox. Its course is shorter and 
milder than the other, and is not attended with secondary fever. 
Complications. During the course of the secondary fever there is a 
great tendency to grave inflammations, to wit: pleuritis, pneumonitis and 
dysentery. During convalescence, boils and abscesses on the skin are frequent. 
Prognosis. Depends upon the variety of the attack, the age of the 
patient, and whether vaccinated or not. Discrete mortality four per cent.; 
confluent, fifty per cent.; malignant, all perish; under five years and over 
forty years, fifty per cent. 
Diagnosis. Cannot be confounded with any other disease if have 
typical symptoms, to wit: chill, vomiting, pains in back and legs, high 
fever and pulse, all declining on third day, when the eruption appears, first 
spots, then papules, then vesicles, finally pustules, drying and forming 
crusts, and the marked secondary fever. 34 
PRACTICE OF MEDICINE. 
Treatment. No specific. The treatment is symptomatic. 
For initial fever and full pulse— 
R. Tinct. aconit. rad gtt. j-ij 
Spts. aether nitrosi 3 ss 
Liq. ammonii acetat ij 
Aquae iss- M. 
Every hour or two. 
Or 
R. Acid, salicyl gr. v 
Spts. vini rect gtt. xx 
Elix. simp J ss. M. 
Every three hours. 
If headache and backache are intense, hypodermatic of morphina, or ice 
bag to head and back. 
For sleeplessness and restlessness or early delirium full doses of polassii 
bromidum. 
For secondary fever'Cao. best remedy is quinina, gr. v, every three hours, 
and for cerebral excitement of this period, either full doses of potassii bro- 
midum, by stomach, or the following by rectum :— 
R. Chloral gr. xv-xx 
Mucil. acacia f£ ij 
Aquae fg ij. M. 
p. r. n. 
The secondary fever being pyaemic in character, the depression should 
be anticipated by large doses of tinct. ferri chloridi and judicious stimula- 
tion, brandy in tablespoonful doses being the best. 
From the onset, milk, eggs, animal broth, oysters and beef juice should 
be administered every three hours. Ice is always grateful and should be 
given freely, and if pustules appear in the mouth, ice should be held in the 
mouth as long as possible, and washes of potass, chlor. or acid carbol. 
employed. 
The disease being contagious, isolation, ventilation, cleanliness and dis- 
infection are imperative. 
To prevent pitting keep patient in dark room, well ventilated. Masks 
of some unctuous material, thoroughly applied, to exclude air, have benefi- 
cial effect, a good formula being, Ung. hydrarg., pulv. marantce, equal 
parts, or glycerit. amylii, painted over eruption, changing to tinct. iodi 
as vesicles are about to develop. Cold water dressings constantly to face 
and hands are beneficial, besides allaying heat, pain and swelling. IVarm 
ivater can be used if more grateful. FEVERS. 
35 
VACCINATION. 
Definition. Inoculation with the matter of vaccinia or cow-pox—bovine 
virus. The person properly vaccinated is protected from an attack of 
smallpox, and especially from a severe or fatal attack. 
Vaccination should at least be performed twice in every individual, to 
wit: infancy and puberty; and it is safer to have it again performed if 
special exposure is liable or occurs. 
In practicing vaccination the skin should be rapidly scraped until the 
true skin is reached and is ready to bleed, the lymph being then brushed 
over; or make three or four horizontal and transverse cuts, about four 
lines long, and rub the virus over them; a little blood, but not much bleed- 
ing, should be caused. 
Symptoms. If the vaccination “takes,” on the third day a papule 
appears; on sixth day a vesicle has formed, with a central depression; on 
eighth day a pustule, fully formed and distended with lymph, with a red- 
dish areola, which becomes very wide. The areola begins to fade on the 
tenth day, the vesicle begins to dry, and by the fourteenth day a brown, 
mahogany scab or crust has formed, which is detached about the twenty- 
third day. The cicatrix is circular, depressed, radiated and foveated, 
becoming, after a time, paler than the surrounding integument. 
During the course of a vaccination, more or less constitutional disturb- 
ance occurs, especially in children. 
Eczematous and papular eruptions often develop in strumous children, 
for which the virus is unjustly held responsible. 
VARICELLA. 
Synonym. Chicken-pox. 
Definition. A mild, slightly contagious, febrile affection; character- 
ized by a moderate fever, and the appearance of a vesicular eruption, 
drying up and falling off in from three to five days. 
Cause. A peculiar poison; attacking only children ; occurring sporadi- 
cally and as an epidemic. 
Symptoms. Moderate fever, thirst, anorexia and constipation, followed 
by eruption of vesicles, which rapidly dry up, and within the week drop off, 
leaving slight pit. Pustules never occur. Symptoms so slight that, were it 
not for the vesicles, would be overlooked. The eruption appears on the 
trunk and extremities; very rarely on forehead and in mouth. 
Prognosis. Most favorable. 36 
PRACTICE OF MEDICINE. 
Treatment. Best left alone. If vesicles on face, means may be used 
to prevent pitting. 
Synonyms. Erysipelatous dermatitis; the rose; St. Anthony’s fire. 
Definition. An acute specific affection; characterized by fever of low 
type, and a peculiar inflammation of the skin, generally of the neck and 
face. This inflammation exhibits a marked tendency to spread, to induce 
serous infiltration and suppuration of the areolar tissue, and to affect the 
lymphatic vessels and glands. 
Cause. A poison, the nature of which is not known. Feebly conta- 
gious. One attack predisposes to another. 
Symptoms. Onset sudden; chill, followed by fever, which soon 
reaches 104° or 105frequent pulse, 100 to 130, coated tongue, nausea 
and vomiting, severe pains in the limbs, with epistaxis in adults and 
convulsions in children, and often diarrhoea. 
Delirium is frequent, and in those of alcoholic habits it resembles deli- 
rium tremens. The eruption soon follows the fever, beginning in red spots, 
which rapidly coalesce and spread ; a sense of heat, tension and tingling 
is caused by the great oedema, which presents a tense, shiny appearance, 
the swelling being so great at times as to close the eyes and distort the 
features. In many cases small vesicles rise, which may coalesce, forming 
blebs, of considerable size, containing a clear yellow serum. After five or 
six days the eruption begins to subside, symptoms abate, the part affected 
tender, and moderate desquamation. 
During the height of the attack albumen appears in the urine, so that 
the possibility of urcemic symptoms must be remembered. 
When extensive infiltration into the areolar tissues occurs, the swelling 
and tension become great, and it is termed phlegmonotis erysipelas. 
When the eruption spreads to different parts of the body, it is termed 
erysipelas ambulans. 
Complications. Throjnbosis of cerebral capillaries or sinuses, or as it 
is sometimes called, “ erysipelas of the brain,” is explained by the intimate 
anatomical connection of the facial vein with the pterygoid plexus and 
cavernous sinus. 
CEdematous laryngitis, from extension to the larynx. 
Pneumonia, pleurisy and meningitis are frequent complications. 
Prognosis. Favorable. Unfavorable if it attacks drunkards; if be- 
comes gangrenous; if thrombosis of sinuses occur, or if extends to the 
larynx. 
ERYSIPELAS FEVERS. 
37 
The convalescence, even from the mildest attacks, is slow, the patient 
continuing weak and anaemic. 
Diagnosis. Not difficult. The fever, early spreading eruption, with 
burning, swelling, tension and tingling and albumen, separate it from the 
other eruptive fevers or erythema. 
Treatment. Mildest cases only require a laxative, nourishing diet, and 
locally vaseline or bismuth oleat., to modify the heat and burning. 
According to Reynolds, aconitum will cut short an attack. He admin- 
isters Tip %-], every fifteen minutes for the first two hours; then in hourly 
doses, until the surface is moist and the temperature lowered. The author 
corroborates this plan, from a personal experience. 
In severe cases, tinct. ferri chlor., gtt. xx-xxx, every third hour, well 
diluted. Also quinina in gr. ij, every third hour. Ext. belladonnce, gr. f, 
added, with benefit. The diet from the onset should be of the most nourish- 
ing character, administered at regular intervals. 
Cerebral symptoms, stimulants, opium and chloral. 
Extension to throat, argenti nitrat., brushed over parts. 
Locally, soothing applications are indicated, to wit: Vaseline, ung. 
zinci oxidi, ol. olivce cum glycerines, or bismuth oleat. 
In phlegmonous variety, argenti nitrat., j, spts. eetheris nitrosi, 3 ij, 
brushed over and beyond the affected part, gives good results. 
DENGUE. 
Synonyms. Break-bone fever; neuralgic fever ; dandy fever. 
The word dengue is pronounced dangay. 
Definition. An acute, epidemic, febrile disease, consisting of two 
paroxysms of fever with an intermission. The first paroxysm is character- 
ized by high fever, distressing pains in the joints and muscles, and a 
peculiar eruption; the second paroxysm is characterized by a milder fever, 
an eruption of different character, attended with intense itching, by some 
recurrence of the joint pains, and by debility. 
Cause. Unknown; but it is evident that a peculiar condition of the 
atmosphere has some influence in its development. 
Symptoms. Onset sudden, fever, 103° to 105°, intense headache, 
burning pains in temples, backache, severe aching and swelling of the 
joints and stiffness of muscles, nausea, vomiting, constipation, and appear- 
ance of a rash, resembling scarlatina, from which the disease has been 
mistaken for scarlatinal rheumatism. After some hours to two or three 
days, a distinct intermission obtains, of one or two days’ duration. 38 
PRACTICE OF MEDICINE. 
The onset of the second paroxysm is also sudden, but the severity of the 
symptoms much less, the patient at same time being greatly debilitated; it 
is at this time the characteristic eruption appears, being either erythema- 
tous or rubeolous, and attended with intense itching, remaining about two 
days, when desquamation occurs and convalescence is established, but is 
prolonged by the great debility of the patient. Average duration of 
disease eight days. Relapses are common. 
Prognosis. Favorable. 
Diagnosis. Most apt to be mistaken for acute articular rheumatism, 
especially during first paroxysm, but the course of the disease and the 
epidemic influence prevents error. 
The eruption might mislead for scarlet fever or measles, were it not for 
the severe joint and muscle pains. 
Treatment. No specific. Entirely symptomatic. 
At onset, free purgation and diaphoresis. 
For fever, quinina, gr. v, every five hours. 
For pains, opium or acidum salicylicum. 
For itching, lotion of acidum carbolicum. 
DISEASES OE THE STOMACH. 
ACUTE GASTRIC CATARRH. 
Synonyms, ,Acute mild gastritis; gastric fever; bilious fever; acute 
indigestion. 
Definition. An acute catarrhal inflammation of the mucous membrane 
of the stomach; characterized by feverishness, loss of appetite, nausea, 
with occasional vomiting, painful digestion, irregularity of the bowels, and 
in severe attacks, vertigo {stomachic vertigo). 
Causes. Errors of diet, insufficient mastication of food, swallowing 
liquids which are either too hot or too cold, and especially, the abuse of 
alcoholic drinks. Occasionally the result of sudden changes of tempera- 
ture. 
Pathological Anatomy. The mucous membrane is irregularly con- 
gested and engorged, and covered with a grayish, semi-transparent and DISEASES OF THE STOMACH. 
39 
tenacious mucus, having an alkaline reaction. The true gastric juice is 
secreted in lessened amount or is entirely suspended. 
Symptoms. At first, loss of appetite ; at times, disgust for food; heavily 
coated tongue, persistent nausea, and at times, vomiting; first of undi- 
gested food, then viscid mucus, acid and bitter, and finally, bilious matter; 
slight irritative fever is present, with considerable thirst; acid drinks 
eagerly sought after; digestion imperfect, giving rise to pain, feeling of 
weight and eructations; bowels often loose; sometimes, however, consti- 
pated. Vertigo is a prominent symptom in many cases, causing great 
anxiety. 
The symptoms are aggravated by errors in diet, and if saccharine or fatty 
articles are taken, heartburn occurs. 
Prognosis. Favorable. Duration about a week; recovery slow, even 
under treatment, as far as perfect digestion is concerned. 
Diagnosis. Acute gastric catarrh with fever, may be confounded with 
remittent and typhoidfever of the first week, but all doubts will disappear 
as these maladies develop. 
The vertigo may be mistaken for cerebral disease, but the disappearance 
of this symptom when stomachic treatment is inaugurated dispels all 
doubt. 
Treatment. Give the stomach as complete rest as possible. If the 
stomach is overloaded, and ipecac emetic is indicated, or if vomiting has 
begun, it may be encouraged by swallowing large draughts of warm water, 
which will act as a sedative if the stomach is empty. Irritability of the 
stomach is readily controlled by— 
R . Hydrarg. chlor. mite gr. 
Sodii bicarb gr. ij 
Pulv. arom gr. v. M. 
Every two hours, 
which has the additional advantage of relieving the bowels. 
Weak alkaline mineral waters or liquor calcis, should be freely used. 
After the acute symptoms have subsided— 
R. Tinct. nucis. vom gtt. iv-x 
Acid hydrochlor. dil gtt. x 
Glycerinae g ss 
Aquae lauro cerasi M. 
Before meals, will improve the appetite and digestion. 40 
PRACTICE OF MEDICINE. 
ACUTE GASTRITIS. 
Synonym. Toxic gastritis. 
Definition. An acute and violent inflammation of the mucous, sub- 
mucous and muscular coats of the stomach, with loss of tissue ; character- 
ized by great pain, constant vomiting of blood-streaked or bloody mucus 
and symptoms of collapse. 
Causes. Ingestion of irritant and corrosive poisons, to wit: mineral 
acids, arsenic, corrosive sublimate, copper, etc. 
Pathological Anatomy. The mucous membrane is vividly red and 
injected, more marked at some portions than at others; it is soft and 
friable; erosions are irregularly scattered, and the sub-mucous, muscular, 
and at times serous coats show decided destructive changes. The gastric 
tubules are destroyed in large numbers. In many cases the oral mucous 
membrane presents signs of severe inflammation. 
Symptoms. Immediately or soon after swallowing there ensues a 
deadly nausea, rapid and persistent vomiting; first, the contents of the 
stomach acted upon by the poison; afterwards, shreds of mucous mem- 
brane, blood clots, etc. ; great anxiety and depression, a weak, rapid pulse, 
slow and shallow respiration, cold skin, covered with a cold sweat, intense 
burning heat at the epigastrium, thirst with burning in the fauces 
and gullet, and exhaustive purging; the features are more or less retracted 
or sunken ; these symptoms terminating in collapse and death, or slow con- 
valescence and recovery with a crippled stomach. 
A diagnosis of the character of the poison swallowed is often afforded 
by the stain of the lips, face and mucous membrane, viz.; sulphuric 
acid, blackish eschar; nitric acid, yellowish eschar; caustic potash, 
spreading widely and softening the tissues; corrosive sublimate, whitish 
or glazed. 
Prognosis. Very grave. Majority perish. Early treatment when no 
perforation of the walls of the stomach and recovery is possible, the organ 
being ever after much weakened. 
Treatment. At once, hypodermatic injection of morphina, repeated at 
regular intervals. 
Vomiting should be encouraged by the free use of demulcents. 
If the case is seen within a short period of the swallowing of the poison, 
the proper antidote should be used ; but if some hours have elapsed, it is 
useless. Ice, internally and externally, gives great relief. The stomach 
should be washed out with the stomach pump, thereby removing any DISEASES OF THE STOMACH. 
41 
remaining poison, while at the same time it acts as a sedative to the 
inflamed membrane. 
Milk and lime water is the only food that should be given by the 
stomach, enemata being used to support the system. 
CHRONIC GASTRIC CATARRH. 
Synonyms. Chronic gastritis; chronic dyspepsia; drunkards’ dys- 
pepsia. 
Definition. A chronic catarrhal inflammation of the stomach, with 
thickening of the coats and atrophy of the gastric glands ; characterized by 
tenderness over the epigastrium, impaired appetite, painful and imperfect 
digestion, thirst, and great depression of the mental powers. 
Causes. Repeated attacks of acute gastric catarrh; habitual use of 
spirituous liquors; disease of the heart, lungs, pleura or liver producing 
chronic congestion of the stomachic vessels; cancerous or other degenera- 
tive diseases of the stomach. 
Pathological Anatomy. The mucous membrane is of a brownish or 
slate color, elevated into ridges from hypertrophy, the result of constant 
congestion; the glands first increase in size, then undergo granular change, 
atrophy of their cells resulting. The mucous membrane is covered with 
a thick, alkaline tenacious mucus. These changes may affect the entire 
organ or be limited in extent. 
Symptoms. Loss of appetite, disagreeable feeling of fullness in the 
stomach, tenderness at the epigastrium, but slightly influenced by eating, 
prominence of the epigastrium, from distention by decomposing gases, 
occasional nausea and vomiting, the latter more common in drunkards, 
occurring on arising, termed morning vomiting and consisting of glairy 
mucus raised after great retching; constant thirst, water and at times 
stimulus being craved; often great burning at the pit of the stomach, the 
result of acidity; bowels constipated, urine high colored. A feeling of 
mental depression and sleeplessness, with occasional attacks of vertigo, add 
to the misery of the patient. The imperfect digestion causes more or less 
loss of flesh, the fat disappearing, the muscles relaxed and the skin dry. 
Prognosis. Favorable as to life, but not as to complete recovery, the 
atrophied glands more or less hindering digestion and assimilation. 
Treatment. Regular diet. Avoid fatty, saccharine and starchy food. 
Also all tonics, bitters, or acids, unless specially indicated. 
Locally, few leeches, dry cups, a blister, or emplas. bclladonnce. 42 
PRACTICE OF MEDICINE. 
Purgatives are doubly indicated; first, relieving the constipation; 
second, clearing the stomach of the tenacious mucus, which neutralizes 
what gastric juice is secreted. Appropriate purgatives are the natural min- 
eral waters, such as Saratoga or Friedrichshall, or— 
R. Magnesii sulph 3 i-ij 
Sodii et potass, tart 3 ss-j 
Acid, tartaric gr. xx. M. 
Dissolved in a glass of water and drank, effervescing, an hour before 
breakfast. 
Digestion may be temporarily aided by pepsin or lactopeptin with the 
meals. 
For the morbid condition itself may be used, liq. potass, arsenitis, gtt. 
i-ij, before meals, or bismuth subnit., gr. x-xx, before meals, to which may 
be added sodii bicarb., gr. v; or argenti nitrat., gr. or argenti 
oxidi., gr. fi—], in pill, before meals. 
Pain is so severe in some cases that resort must be had at times to 
opium or belladonna in small doses, after meals. 
Rest of body is almost as imperative as rest of the stomach. 
Synonym. Chronic gastric ulcer. 
Definition. A solution of continuity, involving the mucous mem- 
brane and one or more layers of which the walls of the stomach are com- 
posed ; characterized by pain, disorders of digestion and vomiting of blood. 
Causes. Anaemia or its sequelae the chief factor. Most common in 
young anaemic women. Virchow claims emboli or the thrombi form in 
nutrient gastric arteries which have lost their tonicity, an ulcer forming at 
the point of obstruction. 
Pathological Anatomy. In the majority of cases the ulcer is solitary. 
The posterior wall near the pylorus is the most common site. 
In a typical case there is a circular hole, with sharp borders in the 
serous coat of the stomach; the loss of substance is greater in the mucous 
membrane than in the muscular coat, and greater in this than in the serous 
coat, so that the ulcer looks like a shallow funnel, the apex at the outer 
wall, the base at the inner wall of the stomach; it is first round, growing, 
becomes elliptical, bulging at portions, becoming irregular ; size, from 
inch in diameter. When the ulcer heals before all the coats are 
perforated, a distinct cicatrix marks the location. During its progress 
nutrient vessels are eroded, causing profuse hemorrhage. Chronic gastric 
catarrh complicates the majority of cases. 
GASTRIC ULCER. DISEASES OF THE STOMACH. 
43 
Symptoms. More or less prominent symptoms of indigestion. Pain 
constant at the pit of the stomach, increased by taking food, especially of 
an irritant kind, the pain often felt in the back, of a burning, gnawing 
character. Tenderness at one or more points, extending from the front to 
the back. Vomiting is almost as constant as pain, coming on soon after 
eating, if ulcer is at the cardiac orifice; an hour or so after, if at or near 
the pylorus; rejected matter may be undigested or partly digested food, 
or simply acrid mucus. Vomiting of blood in large quantities and 
arterial in color is almost diagnostic of gastric ulcer; the blood maybe 
dark in color if it has remained in the stomach some time before being 
rejected. 
Severe and frequent attacks of gastralgia may add to the suffering of 
the patient. The general condition of the patient is not significant, some 
being greatly debilitated, while in others the nutrition is but little deranged. 
Duration. The ulcer is slow in forming, and runs a very chronic 
course, an average duration being, perhaps, a year. Cases are recorded in 
which the disease has suddenly developed and terminated by perforation, 
peritonitis and death within two weeks, but they are rare. 
Prognosis. Not very unfavorable. Recoveries are frequent. The 
dangers are perforation, peritonitis, or fatal hemorrhage. 
Diagnosis. Duodenal tilcer presents symptoms so akin to those of 
gastric ulcer that a differential diagnosis is impossible. 
Chrotticgastritis is often confounded with gastric ulcer; the distinctive 
points are, absence of vomiting of blood, no localized constant pain 
aggravated by food, and no tenderness in the back ; while the symptoms 
of indigestion are marked and persistent, with, as a rule, a history of spirit 
drinking, and the age of the patient—middle life; ulcer in the young. 
The points of distinction between gastric cancer and gastralgia will be 
pointed out when treating of those affections. 
Treatment. Give the stomach as complete rest as possible; this is 
accomplished by rectal alimentation, or where it cannot be carried out, 
exclusive milk diet, adding lime water, to enable the stomach to better 
retain the milk; the amount of milk should be one or two ounces every 
two hours. Rest in bed is paramount, and should be insisted upon. 
For pain, small doses of morphina should be used as needed. 
For hemorrhage, hypodermatic injections of ergota are most reliable. 
For the ulcer, liq. potassii arsenit., gtt. j-ij every five hours, has given 
excellent results in several cases treated by the author; bistnuth, gr. xx- 
xxx, combined with sodii bicarb., gr. iij-v, three times a day, stands second 44 
PRACTICE OF MEDICINE. 
in importance; argenti nitrat., gr. every four hours, or argenti 
oxidi, gr. ss, every four hours, are at times beneficial. 
If perforation and peritonitis result, full doses of opium are indicated. 
GASTRIC CANCER. 
Synonyms. Cancer of the stomach ; gastric carcinoma. 
Definition. A peculiar malignant growth, occurring for the most part 
at the pyloric extremity of the stomach, making constant progress, destroy- 
ing the gastric tissues and infecting the lymphatic glands; characterized 
by disorders of digestion, pain, vomiting, marked anaemia, and terminating 
in all cases by the death of the patient. 
Cause. Hereditary. Develops after forty years, for the most part. 
Pathological Anatomy. Cancer of the stomach is the most common 
form of cancer. It is, as a rule, a primary cancer. The variety is most 
commonly the scirrhus, next in frequency, medullary, the least frequent, 
colloid. As regards the location, eighty per cent, occur at the pylorus. 
It originates usually in the tubules, rapidly infiltrating the remaining 
tissues, thickening everywhere as it progresses, and either remains a hard 
nodulated mass or undergoes ulceration. The hard nodulated growth at 
the pylorus constricts the orifice, resulting in distention of the stomach. 
The lymphatic glands adjacent to the stomach are infiltrated, secondary 
cancers resulting. Ulceration into an artery causes hemorrhage into the 
peritoneum, causing local peritonitis. 
Complications. Fatty heart; thrombosis ; tuberculosis. 
Symptoms.—Indigestion, progressive in character, with marked acidity, 
flatulency and fetid breath. 
The majority of cases have vomiting immediately after eating if at the 
cardiac orifice, and some hours after if at the pylorus; and if much dilatation 
of stomach, some days after. The rejected matter is food in various stages 
of digestion, and frequently black, grumous masses or changed blood. 
Pain, marked and constant, dull, heavy, increased by pressure, seldom 
lancinating. Marked ancemia, emaciation, and towards the end dropsy, 
the surface having an earthy or fawn color. A tumor is found in three- 
fourths of the cases, occupying the epigastric region, not moving with 
inspiration. 
The duration of the disease is about one year, patient dying from 
exhaustion, peritonitis or hemorrhage. 
Prognosis. Unfavorable. Recovery never occurs. DISEASES OF THE STOMACH. 
45 
Diagnosis. Chronic gastric catarrh differs from gastric cancer, in the 
absence of a tumor, bloody vomit, characteristic pain, peculiar color of 
surface and dropsy and rapid emaciation. 
Gastric ulcer differs in the character of the pain, age of the patient, 
large amount of bloody vomit, and absence of a tumor and progressive 
emaciation. Still the diagnosis is often difficult. 
Abdominal tumors may raise the question of a gastric cancerous tumor ; 
the points of distinction are the characteristic symptoms of gastric cancer, 
and that abdominal tumors, especially of the liver and spleen, the ones 
most apt to cause error in diagnosis, are influenced by inspiration, while 
tumors of the stomach are not so influenced. 
When a scirrhus of the pylorus lies upon the aorta, a pulsation may be 
communicated to it, raising the question of aneurism of the abdominal 
aorta, but the expansile pulsation of aneurism (Corrigan’s sign) is wanting, 
as are. the other symptoms of the affection, and if the patient is made to 
rest upon his hands and feet, the stomachic tumor falls away from the 
aorta and pulsation ceases. 
Treatment. We possess no means of arresting the disease. Pro- 
fessor Billroth has excised the pylorus, thereby prolonging life seven 
months. 
For acidity and fetor of the breath, acid, carbol., gr. or charcoal, 
modifies. 
For vomiting, bismuth and opium, or washing out the stomach with the 
stomach pump. 
For pain, morphina. Avoid stimulants. 
GASTRIC DILATATION. 
Synonym. Pyloric obstruction. 
Definition. An abnormal expansion of the cavity of the stomach, with 
the walls either hypertrophied or decreased in thickness; characterized 
by pronounced indigestion, vomiting of partly digested and partly decom- 
posed food, at intervals of every few days, and moving of flatus in abdo- 
men (borborygmus). 
Causes. Most common, stricture of the pylorus, the result of cancer; 
pressure of tumor against the pylorus, preventing exit of stomach contents. 
Loss of muscular tone, occurring in anaemia. Prof. Bartholow cites cases 
resulting from excessive beer-drinkers, who drank thirty to forty glasses of 
beer habitually, every day. 46 
PRACTICE OF MEDICINE. 
Pathological Anatomy. When obstruction exists at the pylorus, 
the whole organ is dilated, with hypertrophy of the muscular layer 
of the stomach. Dilatation without pyloric obstruction, the muscular 
layer is thinner than normal, pale in color, and presents signs of fatty 
degeneration; the mucous membrane also is pale, thin, and without 
rugae. 
Symptoms. Those of the disease producing the obstruction plus those 
of obstinate chronic gastric catarrh, with characteristic vomiting; the 
cavity having a greatly increased capacity, large accumulations take place, 
which are rejected every few days, partly digested and partly decomposed. 
Regurgitation of partly digested aliment, acrid, acid and offensive, very 
common. Bowels constipated, stools hard and dry. 
Physical signs of gastric dilatation are : on inspection, abnormal promi- 
nence of the whole epigastric region ; percussion, if empty, tympanitic note 
extending to or below umbilicus, having metallic quality; if full, high- 
pitched and flat; auscultation, splashing and rumbling sound, the succus- 
sion sound being distinct if body is shaken. 
Diagnosis. The cause being ascertained, no difficulty is experienced 
in making a diagnosis. 
Treatment. Regulated diet. Restrict the use of fluids, using a “dry 
diet” almost exclusively. 
Regardless of cause, washing out the stomach with the stomach pump, 
every day or two, gives relief, and, if no stricture, administering strychnina 
or nux vomica, and very favorable results may follow. 
GASTRIC HEMORRHAGE. 
Synonyms. Hsematemesis; gastrorrhagia. 
Definition. Gastric hemorrhage is not, strictly speaking, a disease, but 
a symptom ; still, vomiting of blood occurs under such a variety of condi- 
tions, that a separate consideration is desirable. 
Causes. Ulcer of the stomach; cancer of the stomach; scurvy; pur- 
pura ; hemorrhagic malarial fever; congestion of the liver or spleen; 
vicarious at menstrual period; yellow fever. 
Symptoms. Added to the symptoms of the cause of the hemorrhage, 
are a feeling offaintness and sinking at the pit of the stomach, followed by 
the ejection of blood of a black, grumous, or coffee-ground appearance. 
Rarely, and then generally in gastric ulcer, the ejected blood may have a 
bright red appearance, the gastric juice not having had time to act upon it. DISEASES OF THE STOMACH. 
47 
If the amount of blood escaping into the stomach is large, blood will be 
voided by stool. 
Prognosis. Depends entirely upon the cause, the most unfavorable 
being the result of either gastric ulcer or cancer. 
Diagnosis. Hemorrhage from the lungs may be confounded with 
gastric hemorrhage. In the former, the blood is red, is coughed up, not 
vomited, and associated with a history of pulmonary disease. The chief 
point of distinction between pulmonary hemorrhage and the vomiting of 
red blood is, that in the former you can discern rales on auscultating the 
chest; they are absent in the latter. 
Treatment. Perfect rest in bed. Ice, swallowed and over epigastrium. 
Hypodermatic of morphina quiets the patient’s fear, and at the same 
time has a constringing effect upon the vessels. Ergota, as fluid extract, 
or ergotin hypodermatically after the patient is quieted, or liquor ferri 
subsulph., gtt. j-v, well diluted, by stomach. 
Allow no food by stomach for several days, nourishing the patient by 
rectal alimentation. 
The hemorrhage controlled, the future treatment is guided by the 
exciting cause. 
GASTRALGIA. 
Synonyms. Cardialgia; gastrodynia; stomachic colic; spasm of the 
stomach ; neuralgia of the stomach. 
Definition. A painful condition of the sensory nerves of the stomach, 
induced by various sources of irritation; characterized by violent parox- 
ysms of gastric pain and spasm, associated with feeble cardiac action. 
Causes. The affection belongs to the group of neuralgias. The most 
important factor in its causation is general nervous depression; other 
causes are malaria, rheumatic or gouty diathesis, anaemia, and certain 
articles of diet. 
Symptoms. Like most neuroses, gastralgia is distinguished by its 
paroxysmal character. Romberg thus describes an attack: — 
“ Suddenly, or after a feeling of pressure, there is severe griping pain 
in the stomach, usually extending to the back, with a feeling of faintness, 
shrunken countenance, cold hands and feet, and an intermittent pulse. 
The pain becomes so excessive, the patient cries out. The epigastrium is 
either puffed out, like a ball, or retracted, with tension of the abdominal 
walls. There is often pulsation in the epigastrium. External pressure is 48 
PRACTICE OF MEDICINE. 
well borne, and not unfrequently the patient presses the pit of the stomach 
against some firm substance, or compresses it with his hands. Sympa- 
thetic pains often occur in the thorax, under the sternum, and in the 
oesophageal branches of the pneumogastric, while they are rare in the 
exterior of the body. 
“ The attack lasts from a few minutes to half an hour; then the pain 
gradually subsides, leaving the patient much exhausted; or else it ceases 
suddenly, with eructation of gas or watery fluid, or with vomiting, and 
with a gentle, soft perspiration, or with the passage of reddish urine.” 
Besides such severe attacks, we often see painful sensations in the epi- 
gastrium, of various degrees of intensity, with passing faintness or sinking 
at the pit of the stomach. 
Prognosis. As to perfect recovery, unfavorable, but not dangerous to 
life. A chronic affection, in that attacks are prone to return from time to 
time. The cause has much to influence a radical cure. 
Diagnosis. From myalgia of the abdominal tnuscles, by the pain of 
gastralgia being more acute and lancinating, and accompanied by nausea 
and vomiting and absence of tenderness on pressure. 
From intercostal neuralgia, by the fact that in this affection the pain is 
in the left hypochondrium, painful spots along the course of the nerve trunk 
and at the spine, and absence of nausea and vomiting. 
From gastric cancer, by the age, character of vomited matter, constancy 
of the pain, the cachexia, emaciation and the tumor. 
From gastric ulcer, by the localized pain and its constancy, with ten- 
derness and vomiting of blood, and constant dyspeptic symptoms, which is 
not the case in gastralgia. 
Treatment. For the paroxysm, hypodermatic of morphina, gr. 
or the stomachic administration of the “ compound of anodynes,” the 
so-called chlorodyne, in doses of p. r. n. The relief afforded by 
opium in some form is apt to lead to the opium habit when the attacks are 
frequent 
In the interval, regulated diet and one or more of the following reme- 
dies : quinina, arsenicum, bismuth, ferrum, liq. iodi. comp., or small 
doses of potassii iodidum. DISEASES OF THE STOMACH. 
49 
Synonyms. Dyspepsia; indigestion; heartburn; pyrosis. 
Definition. A functional derangement of the stomach, with either 
deficient secretion in quantity or quality of the gastric juice; character- 
ized by disorders of the functions of digestion and assimilation. 
Causes. Imperfect mastication; bolting of food; eating large quan- 
tities of food ; same diet long continued; depressed nervous system, from 
worry, tire, etc. It is often inherited. 
Symptoms. Perverted appetite, capricious or lost; difficult digestion, 
feeling of weight or fullness in epigastrium ; acidity, from decomposition of 
albuminoids; heartburn, flatulency, regurgitation, or vomiting of portions 
of partly digested food or acrid fluid—water brash or pyrosis. Pain or 
soreness at pit of stomach during digestion. Tongue either clean or broad, 
flabby and pale, showing marks of the teeth. Bowels constipated; urine 
generally scanty and high-colored, with excess of urates or oxalates, or, in 
persons of nervous type, it is pale, of low sp. gr., and contains phosphates. 
Drowsiness after meals, with wakefulness at night, defective memory, head- 
ache and absent mental vigor, with flashes of heat, followed by more or 
less perspiration. 
Prognosis. With careful living, dyspepsia, functional in character, is 
curable. It has been aptly termed “ remorse of the stomach.” 
Treatment. The most important is to regulate the diet. Forbid sac- 
charine, starchy or fatty articles of food. Eat small amounts at a time. 
Rest after eating, from a half to an hour. Allow but small quantities of 
liquids with the meals. In the vast majority of cases forbid the use of 
stimulants with meals. 
Aid digestion with pepsin, with or without acidum hydrochloricum 
dilutum. 
Stimulate stomachic peristalsis with mix vomica, gentian or cinchona. 
For acidity, alkalies at times of acidity. 
For pyrosis, bismuth andpulv. aromat., in large doses. 
For constipation, pil. rhei comp., at bedtime. 
For ancemia, mas. ferri carb. or ferri lactas. 
For flatulency, tinct. nux vom., before meals, vegetable charcoal or 
acidum carbolicum. 
ATONIC DYSPEPSIA. 50 
PRACTICE OF MEDICINE. 
DISEASES OF THE INTESTINAL CANAL. 
INTESTINAL COLIC. 
Synonyms. Enteralgia; tormina; gripes. 
Definition. A spasmodic contraction of the muscular layer of the 
intestinal tube; characterized by acute paroxysmal pain near the umbilicus, 
relieved by pressure, and associated with feeble cardiac action. 
Causes. Constipation; presence of indigestible food; collections of 
flatus; an abnormal amount of bile discharged into the intestines; lead 
poisoning; syphilis ; chronic malaria ; hysteria. 
Symptoms. Romberg thus describes a paroxysm : “ There are attacks 
of pain, spreading from the navel over the abdomen, alternating with 
intervals of ease. The pain is tearing, cutting, pressing, most frequently 
twitching, pinching, accompanied by peculiar bearing down pains. The 
patient is restless, and seeks relief in changing his position and in com- 
pressing the abdomen ; his surface may be cold and his features pinched. 
The pulse is small and hard. The abdomen is tense, whether puffed up 
or drawn inward. There are often nausea and vomiting, and desire for 
stool. There is usually constipation, but sometimes the bowels are regular 
or even too loose. Duration from a few minutes to several hours, relaxing 
at intervals. It ceases suddenly, with a feeling of the greatest relief, 
although some soreness remains for a few days.” 
Lead colic is always preceded by symptoms of lead poisoning, to wit: 
slate-colored skin, dark gums, showing blue line,heavy breath, with sweetish, 
metallic taste, obstinate constipation, impaired appetite, slow pulse and 
contracted abdominal walls. 
Prognosis. Most favorable. Death is the rarest termination possible. 
Diagnosis. Gastralgia differs from colic, in the pain being in the 
epigastric region and associated with disorders of digestion. 
In hepatic colic, or the passage of gall stones, the pain is in the hepatic 
region, attended with soreness over the gall bladder, and retching and 
vomiting, followed by jaundice and the presence of bile in the urine. 
In nephritic colic the pain follows the course of one or both ureters, 
shooting to loins and thigh, with retraction of the testicle of affected side, 
strangury and bloody urine. 
In titerine colic the pain is in the pelvis, and associated with menstrual 
disorders, in fact, a dysmenorrhoea. DISEASES OF THE INTESTINAL CANAL. 
51 
In ovarian colic or neuralgia, pain on pressure over ovaries, with 
hysterical phenomena. 
Inflammatory disorders of the abdomen differ from colic by the presence 
of fever and tenderness on pressure. 
Treatment. Relief of pain is the first indication, and is best accom- 
plished by a hypodermatic of morphina, gr. l/e>—y$, which has the additional 
advantage of relaxing the spasm, thereby favoring the action of purgatives, 
which should soon follow. One of the best in colic, no matter from what 
cause, is— 
& . Sodii bicarbonatis gr. viij 
Hydrargyri chloridi mite gr. viij 
Pulv. zingib gr. iij. M. 
After the relief of the pain and free action of the bowels, the cause of the 
attack should be ascertained and corrected, to prevent future suffering. 
CONSTIPATION. 
Synonyms. Intestinal torpor; costiveness. 
Definition. A functional inactivity of the intestinal canal, due to either 
atony of the muscular coat, causing lessened peristalsis, or to a deficiency 
of intestinal and biliary secretion; characterized by a change in the char- 
acter and quantity of the stools. 
Causes. Dyspepsia; character of food; habits of patient; diseases of 
the stomach and liver; malaria; lead poisoning; syphilis. 
Symptoms. In the normal condition, the majority of persons have one 
stool each day, although it is not to be considered abnormal if more than 
that number occur. 
The bowels are moved every three or four days, with great straining and 
distress, the face often flushed, the cerebral vessels full. 
Or in other cases the bowels may be relieved once a day, but the stool is 
small and hard, causing great pain. 
Another group of cases have frequent stools during the day, small and 
non formed, due to retained hardened faeces acting as an irritant upon the 
rectum. 
The change in the character of the stools is soon followed by symptoms 
of dyspepsia, and in many cases with great distention of the abdomen. 
Prognosis. Death never results from functional constipation. 
Treatment. The successful treatment depends upon the removal of 
the cause and the cooperation of the patient. 52 
PRACTICE OF MEDICINE. 
First, the patient must have a regular hour each day for going to stool, 
and must remain a sufficient time to permit a thorough evacuation of the 
bowels. 
Second, the diet must be carefully regulated and lived up to. 
Thh'd, purgative mineral waters or cathartic medicines are to be used with 
caution, their reckless administration often doing more harm than good. 
Fourth, either of the following formulae, aided by the enforcement of 
the above rules, will give good results:— 
R. Ext. nucis. vom gr. 
Ext. belladonnae alco gr. 
Aloes soc gr. ss 
Pulv. rhei gr. j 
Ol. cajuputi gtt. j M. 
In pill, at bedtime, and after a week, every second or third night. 
R. Resinae podophyl., 
Ext. physostig., 
Ext. belladonnae alco., 
Aloine..... ait gr. %. 
In pill, every night, or second or third night. 
R. Tinct. physostig., 
Tinct. nucis vomicae, 
Tinct. belladonnae aa gtt. x 
Tinct. aloes et myrrh gtt. xxx M. 
At bedtime. 
Synonyms. Enterorrhcea; alvine flux ; purging. 
Definition. Frequent loose alvine evacuations, without tenesmus ; due 
to functional or organic derangement of the small intestines, produced by 
causes acting either locally or constitutionally. 
Causes. Those acting locally, such as indigestion, indigestible food, 
impure food and water, irritating matters or secretions poured into the 
bowels, entozoa, etc., cause the flux by direct irritation of the mucous 
surface. 
Those due to constitutional derangement may be secondary to such 
diseases as tuberculosis, pycemia, albuminuria, typhoidfever, or disturbances 
of the functions of other organs, giving rise to vicarious fluxes, etc. 
Forms. Acute and chronic. 
Symptoms. Acute diarrhoea presents itself in several forms, the result 
of its cause, to wit:— 
Feculent diarrhoea. Few hours after meals the patient feels colicky 
DIARRHCEA. DISEASES OF THE INTESTINAL CANAL. 
53 
pains ana flatulency, with a desire for stool. There is often nausea, foul 
tongue, but seldom vomiting. The pain is generally relieved by the 
purging which ensues. The stools have a feculent character, are of brown 
fluid, containing faeces, often offensive, the color becoming lighter after 
four or five evacuations. Constitutional symptoms are wanting. 
This form is the result of over eating, eating too rapidly, or indigestion 
of different forms, or worms in the intestinal canal, and patients generally 
recover in a day or two. 
Lienteric diarrhoea. In this form there is, with the frequency of evacu- 
ations, a want of assimilation of food, which passes through the intestines 
more or less unaltered. The stools are frequent, mucous or serous, more or 
less covered with bile, mixed with undigested food. In this form the 
patients emaciate rapidly, owing to the deficient assimilation, the digested 
portions of the food being hurried on by the irritated bowel. It is usually 
subacute in its course. 
Bilious diarrhoea. The stools are frequent, green or yellow, with scald- 
ing sensations at the anus and griping pains in the abdomen. Excessive 
biliary secretion is the irritating cause. 
Any of the above forms may pass into chronic diarrhoea by exciting 
permanent diseases of the intestines. Diarrhoea due to constitutional 
causes will be mentioned when speaking of those conditions. 
Chronic diarrhoea results from repeated attacks of the acute form, or 
the result of some cachexia. The symptoms, as far as the stools are con- 
cerned, are much the same as the acute disease, except they are paler, 
w'hence it has been termed white flux ; in addition, dyspeptic symptoms, 
aphthotis condition of mouth and tongue, flatulency, colic, emaciation and 
ancemia. The appetite at times capricious, again impaired. 
Prognosis. Favorable in feculent and bilious forms; unfavorable in 
lienteric and chronic forms when emaciation begins. Diarrhoea occurring 
as a symptom, the prognosis is controlled by the original disease. 
Treatment. Acute diarrhoea. If caused by indigestion the indication 
is a laxative; for adults, tinct. rhei or ol ricini, or both; for children 
between one and two years of age— 
1£ . Pulv. ipecac gr. TA 
Pulv. rhei gr. 
Sodii bicarb gr. ss-ij M. 
Every four hours until the character of the stools change. 
After irritant is removed, for adult, opium in some form, combined with 
kino or tannin ; for children— 54 
PRACTICE OF MEDICINE. 
R. Bismuth gr. iij-v 
Cretae. praep gr. v M. 
Every two hours. 
In adults, an opium suppository often checks a flux that is uninfluenced 
by opium internally. 
For bilious form— 
R. Hydrargyri chlor. mite gr. 
Sodii bicarb gr. ij 
I’ulv. opii gr. M. 
In pill, every two or three hours, until eight pills are used, followed by 
large doses of bismuth and pepsin. 
In all acute forms restricted and regulated diet are imperative, milk being 
the most suitable. 
Chronic diarrhoea. Bismuth gr. xxx—xl, in milk, every four hours; 
Hope's camphor mixture, every four hours; cupri sulph., gr. Txy, ext. opii, 
gr. TXj, every four hours; argenti nitrat., gr. l/2, ext. opii, gr. i, every five 
hours; may all be used with more or less success; when dry tongue and 
great flatulency, use— 
R. 01. terebinthinae fgj 
Ol. amygdal. express ss 
Tinct. opii f.^ij 
Mucil acaciae f 5JV 
Aq. lauro-cerasi M. 
SlG.— every three or four hours. 
The diet should be nutritious in character, and moderate stimulants are 
indicated. Activity of the skin and kidneys should be encouraged. 
CATARRHAL ENTERITIS. 
Synonyms. Ileo-colitis; acute diarrhoea; inflammation of the bowels. 
Definition. A catarrhal inflammation of the mucous membrane of the 
small intestines; characterized by fever, pain, tenderness and looseness of 
the bowels. When the catarrh is limited to the duodenum, it is termed 
duodenitis, the symptoms being of a different character. 
Pathological Anatomy. There first ensues hyperccmia of the mucous 
membrane and intestinal glands, manifested by redness, swelling and 
oedema; this is followed by increased secretion and an overgrow/k and 
desquamation of the epithelium, together with a copious generation of young 
cells. As a result of the hyperaemia, often occur rupture of the capillaries 
and extravasation of blood. DISEASES OF THE INTESTINAL CANAL. 
55 
The swollen glands show a strong tendency to ulcerate. This catarrhal 
process may involve the entire tube or be limited to portions. 
Causes. Improper and indigestible food; summer temperature and 
exposure to cold and wet, while perspiring. 
Symptoms. Begins with languor, followed by chilliness and fever, the 
temperature ranging at I02°-I03°, this is followed by pain, colicky in 
character, situated about the umbilicus, localized tenderness and loose 
evacuations. Nausea and vomiting often occur. The stools contain but 
little fecal matter, are yelloiv or greenish-yellow in color, mixed with un- 
digested food ; if the stools are numerous, they become whitish and watery, 
the so-called “ rice-water ” discharges. The appetite is impaired, and 
this, with the want of assimilation and great waste, soon produce extreme 
weakness and emaciatioji, which is always marked in children. 
Duration. In mild cases, four or five days; severe cases continue more 
or less marked, for a week or two. 
Prognosis. Favorable, if early and proper treatment are obtained. 
Diagnosis. From colic, by the absence of tenderness and fever, and 
the presence of constipation and its paroxysmal character. 
From typhoid fever, by absence of prodromes, characteristic temperature 
record and eruption. 
For points of distinction from dysentery ox peritonitis, see those affections. 
Treatment. Rest the bowels by a restricted diet, to wit: milk and lime 
water, or weak mutton or chicken soups, with well boiled rice added. 
Keep the patient quiet in bed, a difficult matter in the case of children. 
For adults, opium is the remedy, in doses to control the symptoms; mild 
cases do well with- 
in . Ext. opii gr. 
Camphorae gr. iij M. 
In pill, every three hours. 
Or— 
ft. Tinct. opii deodorat gtt. x 
Liq. potassii citrat 3 ij M. 
Every four hours. 
The strength and the frequency of administration of either of these form- 
ulae must be governed by the severity of the attack. 
For children— 
ft. Tinct. opii deodorat gtt. j 
Bismuth, subnit gr. v 
Mist, cretae fg j M. 
Every four hours, for a child of one year. 56 
PRACTICE OF MEDICINE. 
If the case shows the least tendency to linger, the acid treatment should 
be substituted for the above, the best of which is “ Hope’s Camphor Mix- 
ture,” the formula being— 
R. Acidi nitrosi fgj 
Tinct. opii gtt. xl 
Aquae camphorae viij. M. 
The dose ranging from to fjf ij> according to age. 
Acidum sulphuricum dilutum may be substituted for the acidurn nitro- 
sum in the above formula. 
Locally, poultices, warm fomentations, or ung. belladonna or oleum 
camphorat., give great relief. 
CROUPOUS ENTERITIS. 
Synonym. Membranous enteritis. 
Definition. A croupous inflammation of the mucous membrane of the 
small intestines; characterized by tenderness, paroxysmal pain, moderate 
fever, and the formation and discharge of membranous shreds or casts. 
Causes. A disease of adult life. The female sex more liable than the 
male, and neuralgic, nervous, hysterical or hypochondriacal subjects are 
more subject to it than are other types. 
A peculiar state of the nervous system seems necessary to its production. 
Pathological Anatomy. A subacute inflammation of the small intes- 
tines, during which the mucous membrane becomes covered with a whitish 
or grayish-white, firmly adherent, membranous deposit, cemented together 
by a coagulable exudation, and prolonged by rootlets from its under sur- 
face into the intestinal follicles. 
Symptoms. Begins by feverishness, feeling of soreness and distention 
of the abdomen ; these are followed by pains of a colicky character, severe 
and depressing, felt around the umbilicus, continuing for half an hour, an 
hour or longer, and after a longer or shorter interval occurring again ; these 
phenomena obtain for a day or two, when looseness of the bowels, with 
distressing pain and tenesmus occurs, the stools containing mucus, with or 
without blood, and shreds of membrane or cylindrical casts of the bowel. 
Great relief is then experienced, although a feeling of rawness or soreness 
persists for a day or two. 
Preceding the local manifestations of the disease are attacks of hysteria, 
hypochondriasis, neuralgia, nervousness or excitability. 
The paroxysms recur at intervals of a week or two, or after several 
months; as long an interval as three years between attacks is recorded. DISEASES OF THE INTESTINAL CANAL. 
57 
Prognosis. Favorable as to life, but one of the most difficult of diseases 
to eradicate. 
Diagnosis. Peritonitis may be suspected until the characteristic stools 
occur. 
Dysentery is excluded when the shreds and casts of membrane appear. 
Treatment. The diet must be such as contains but a minimum of 
fecal-forming matter. 
For the pain and suffering, opium in some form is indicated, the most 
effective being a hypodermatic of morphina. 
For constipation during a paroxysm, an emulsion of oleum ricini and 
terebinthina is of benefit. To prevent a return of the paroxysms either liq. 
potassii arsenitis, gtt. j-ij t. d., or hydrargyrum chloridum corrosivum, gr. 
t. d., with a course of oleum morrhuce, seems to answer in the majority 
of cases. Prof. Da Costa speaks highly of pix liquida in some form, as 
an alterative to the mucous membrane. 
Under no circumstances must the bowels become constipated. 
CHOLERA MORBUS. 
Synonyms. Sporadic cholera; English cholera; bilious cholera. 
Definition. An acute catarrhal inflammation of the mucous membranes 
of the stomach and intestines, of sudden onset; characterized by severe 
colicky pains, vomiting, purging, cold surface, rapid, feeble pulse, and 
prostration. 
Causes. A disease of summer and early autumn, climatic influence 
being an important factor. Irritants of all kinds, unripe fruits and vege- 
tables, and fermentation of foods. 
Symptoms. Onset sudden and violent, and unfortunately, generally 
after midnight, with chilliness, intense nausea, vomiting and purging, 
accompanied with distressing intestinal pain or colic. The vomited matter 
at first consists of the ordinary contents of the stomach, and the stools of 
ordinary faeces, but soon the discharge by vomit and stool are liquid, 
whitish or of & green ox yellowish tint; if the attack is severe or protracted 
the discharges partake of the “ rice-water*' character. The patient is 
rapidly emaciated and reduced in strength, the body shrinks, the stirface 
cold and covered with a clammy sweat. Intense thirst is present, and 
when drink is given it is at once rejected. 
Aggravating the distress of the patient are severe cramps of the muscles, 
and especially those of the calves. 58 
PRACTICE OF MEDICINE. 
Termination. Mild cases terminate without treatment, the patient able 
to be around the next day, although weak. 
Severe cases, the vomiting and purging cease after some hours, but the 
patient remains weak, with irritable stomach and bowels, for a week or 
more. 
Grave cases, the true cholera type, recover from the prostration very 
gradually; reaction comes on slowly and usually passes into a typhoid 
condition of some weeks’ duration. 
Prognosis. In the majority of cases favorable. The mortality about 
five per cent. 
Diagnosis. Asiatic cholera and cholera morbus are easily confounded 
during an epidemic of the former, and there are no positive points of 
discrimination. 
Iri'itant poisons, such as tartar emetic, elaterium, etc., cause vomiting 
and purging, similar to cholera morbus, and are only discriminated from it 
by the history. 
Treatment. At once, regardless of the cause, a hypodermatic of 
morphina, gr. and atropina, gr. T to be repeated in an hour if 
no improvement; for patients who object to the hypodermatic mode, opium 
in some form by the mouth or rectum, giving preference to the liquid 
preparations. 
At the same time mustard locally over the abdomen, small pellets of ice 
by the stomach, and if much depression, small doses of brandy or dry cham- 
pagne. The intense thirst must not be gratified by the use of liquids. If 
the vomiting and purging continue, make use of— 
R. Bismuth subnit gr. xx 
Acid, carbol ; gr. ss 
Glycerinae gtt. xx 
Aquae, ad f£ iv M. 
Every two or three hours. 
Dr. Hartshorne strongly recommends— 
R. Spts. ammon. aromat fg j 
Magnes. optim fz j 
Aq. menth. pip fg iv. M. 
Sig.— gj every twenty minutes. 
If the case is seen early, and if the diarrhoea is copious, he adds tinct. opii 
camph., f3 iv, to the mixture. 
The closer the case approaches the true cholera type, the more severe are 
the muscular cramps, and treatment is indicated. Prof. DaCosta suggests— DISEASES OF THE INTESTINAL CANAL. 
59 
R. Chloral £iv 
Cosmoline M. 
To be rubbed over the affected muscles. 
Dr. Bartholow suggests— 
, R. Chloral 
Morphinse sulph 'gr. iv 
Aquae fifj. M. 
SlG.— Twenty minims, hypodermatically. 
The after treatment depends upon the symptoms; generally, an acid 
mixture and regulated diet, with tonic doses of quinina, are indicated. 
CHOLERA INFANTUM. 
Synonyms. C!holeriform diarrhoea; summer complaint. 
Definition. An acute catarrhal inflammation of the mucous membrane 
of the stomach and intestines, together with an irritation of the sympa- 
thetic nervous system, occurring in children during their first dentition; 
characterized by severe colicky pains, vomiting, purging, febrile reaction 
and prostration. 
Cause. Age; bad hygiene, or as it is now entitled, “ civic malaria; ” 
continuous high temperature; improper food; dentition; constitution, as 
the feeble, delicate, nervous or irritable. 
Pathological Anatomy. Resembles closely, if not identical with, 
the phenomena of catarrhal gastritis and enteritis, together with a powerful 
irritation of the fibres of the sympathetic nerve. 
Symptoms. The onset is sudden in a child previously well, or in a 
child suffering from a bowel affection. 
Begins with vomiting, purging, abdominal pain, fever, rapid pulse and 
intense thirst. 
The vomited matter is partly digested food, sero-mucous, and finally 
bilious, and is accompanied with distressing retching. The thirst is a 
marked phenomena of the disease, and ice and water will be taken inces- 
santly, though rejected only a few moments after. 
The stools are first partly fecal, but soon watery or serous, soaking the 
clothing, leaving a faint greenish or yellowish stain; their odor is musty, 
at times fetid ; their number is from ten to twenty in the day. 
Pains precede the vomiting and purging, colicky in character. 
The fever begins at once, the temperature varying from ioi° to 105°, 60 
PRACTICE OF MEDICINE. 
with morning remissions. The pulse is rapid and feeble, ranging from 130 
to 160. 
These symptoms continue but a few hours, until rapid wasting ensues, 
the body shrinks, eyes sunken and partly closed, mouth partly open, lips 
dry, cracked and bleeding. The child, at first irritable and restless, soon 
passes into semi-comatose condition, death soon following, or the symptoms 
slowly ameliorate, convalescence being slow and tedious. 
Prognosis. Difficult to predict the result, and so care must be used in 
giving a prognosis. The duration of the choleraic symptoms is short, under 
five days, but relapses are common, and sequelae protracted. 
Diagnosis. The entero-colitis or inflammatory diarrhoea of childhood 
is constantly being mistaken for cholera infantum. The symptoms of the 
former are : gradual onset, with fretfulness, loss of appetite, feverishness, 
nouse 1, and moderate vomiting, soon followed by diarrhoea, the stools 
being semi-fluid, greenish, mixed with yellowish particles of faeces and un- 
digested casein, with a sour odor, the “ chopped spinach ” stools, the 
abdomen distended and tender, moderate fever and thirst, having a dura- 
tion of about two weeks. 
Treatment. The first indication is to arrest the vomiting and purging, 
for which, use— 
R. Bismuth subnit gr. v-x 
Mucil. acacise 
Acidi carbolici gr. T\ 
Tinct. opii deodorat gtt. j 
Mist, cretae ! giss M. 
Every two hours for child between one and two years. 
If this fail, or the stomach will not retain it, tinct. opii may be given by 
the rectum, with zinci sulph. afnd amylum. 
For fever, quinina or aconitum are indicated. 
For depression regulated nursing or feeding, every two hours, and water 
or ice to quench the intense thirst, and cognac brandy, gtt. x-xxx, every 
hour or two, in water. 
Locally ; over epigastrium, mustard, spice poultice or turpentine stupes. 
If the nervous symptoms become aggravated, small dose of potassii bro- 
midum or valerian, which “ reduces the reflex excitability, motility and 
sensibility,” are indicated. DISEASES OF THE INTESTINAL CANAL. 
61 
ACUTE DYSENTERY. 
Synonyms. Colitis; colonitis; ulcerative colitis ; flux ; bloody flux. 
Definition. An acute inflammation of the mucous membrane of the 
large intestines, either catarrhal or croupous in character; characterized by 
fever, tormina, tenesmus and frequent, small, mucous and bloody stools. 
It occurs either in the sporadic, endemic or epidemic form. 
Causes. Sporadic and endemic dysentery is caused most commonly by 
atmospheric changes, viz : hot days and cool nights; also from malarial 
attacks, and rarely, errors in diet. 
Epidemic dysentery prevails in armies, jails, tenement houses, etc., pro- 
pagated by decomposition of dysenteric stools, and the unfavorable hygienic 
surroundings. 
It is not contagious. 
Pathological Anatomy. Sporadic dysentery is catarrhal in character; 
congestion, swelling and oedema of the mucous membrane and sub-mucous 
tissue, with an over-production of mucus; the follicles are enlarged, from 
retention of their contents, the result of the swelling; the congested vessels 
often rupture; the mucous membrane softens in patches, and is detached, 
forming ulcers. Recovery follows, if the destruction of tissue is small, 
smooth cicatrices, minus gland structure, marking the site. 
Epidemic dysentery is croupous in character; begins with intense con- 
gestion, swelling, and oedema of the mucous and sub-mucous tissue, with 
extravasations of blood and the whole rAicous membrane covered with a 
firm fibrinous exudation; the mucous membrane softens and sloughs, leav- 
ing large ulcers and gangrenous spots. If recovery occurs, large cicatrices 
form, which narrow the calibre of the bowels. 
The mesenteric glands enlarge, soften, aftd abscesses form in them ; the 
liver becomes the seat of small abscesses, from embolic obstruction of the 
radicles of the portal vein; the heart muscles are flabby and more or less 
fatty. 
Symptoms. Catarrhal form begins gradually, with diarrhoea, loss of 
appetite, nausea, and very slight fever, which continues for two or three 
days, when the true dysenteric symptoms set in, to wit, pain on pres- 
sure along the transverse and descending colon, tormina or colicky pains 
about the umbilicus, burning pain in the rectum, with the sense of 
the presence of a foreign body and desire to expel it, or tenesmus, 
which is almost constant; the stools for the first day or two contain more 
or less fecal manner, but soon they consist of a grayish, tough, transparent 
mucus, containing more or less blood and pus; during the tormina, nausea 62 
PRACTICE OF MEDICINE. 
and vomiting may occur; the urine scanty and high colored; the number 
of stools ranges from five to twenty or more in twenty-four hours. 
The duration is about one week, the patient being much emaciated and 
enfeebled. 
The croupous or epidemic form sets in suddenly, the stools being more 
frequent, containing more blood and pus, with patches of membrane, even 
casts of the bowel, together with more or less gangrenous mucous mem- 
brane ; nausea, vomiting, and great prostration, cold skin, feeble pulse and 
emaciation, with anxious expression, the odor surrounding the patient being 
fetid. 
The duration of the grave symptoms is three or four days, when collapse 
and death occur, or slow convalescence begins, continuing for weeks. 
Complications. Peritonitis ; hepatic abscesses ; phlebitis of the intes- 
tinal veins; intestinal perforation. 
Prognosis. Catarrhal form favorable. Croupous form, the prognosis 
is always grave, for if recovery does occur the bowel may be crippled, from 
loss of structure, or from narrowing of its calibre, from resulting cicatrices. 
Diagnosis. Entei-itis lacks the tenesmus and characteristic stools. 
Peritonitis, when idiopathic, sfyows higher temperature, greater tender- 
ness and constipation. 
Treatment. Emaciation being rapid, the diet must be attended to from 
the onset, and be of the most nourishing character, to which stimulus should 
be added if much prostration occur. 
The most common treatment is opium, combined with one or more 
astringents, viz.:— 
R. Ext. opii gr. ss 
Plumbi acetat gr. ij M. 
Every two hours ; or— 
R. Pulv. opii gr. ss 
Plumbi acetat gr. ij 
Pulv. ipecac gr. j M. 
Every two hours; or— 
R. Pulv. ipecac comp gr. x 
Bismuth subnit gr. xx M. 
In milk, every two hours. 
If the case is seen early the very best prescription possible is— 
R. Magnesii sulph •. gj 
Acid.'sulph. dil Tip v 
Tinct. opii deodorat rrp x 
Aquae menth 3 ij M. DISEASES OF THE INTESTINAL CANAL. 
63 
Every two or three hours, until feces appear in the stools, when small 
doses of opium and quinina may be used. 
Ipecac, in gr. xx-xl, is largely used in the first stages of dysentery, until 
the characteristic ipecac stools appear ; the first doses being often rapidly 
rejected by the stomach, the treatment is difficult to pursue outside of 
hospital practice; but of its efficacy in many cases there can be no doubt. 
The patient should be confined to bed in even the mildest attacks, and 
the stools removed at once and disinfected. 
Washing out the rectum with either tepid, hot, cold or iced water, as 
suggested by Prof. Da Costa, adds greatly to the patient’s comfort and to 
the decrease of the inflammatory process. 
TYPHLITIS. 
Synonyms. Inflammation of the caecum; catarrh of the caecum. 
Definition. A catarrhal inflammation of the mucous membrane of the 
caecum and ascending colon; characterized by pain, tenderness, constipa- 
tion, and in certain cases a characteristic vomit. 
Causes. In a majority of cases mechanical, from the lodgment of 
seeds or hardened faeces. 
Pathological Anatomy. Similar to the catarrhal inflammation of 
dysentery. 
Symptoms. Pain and tenderness in the right iliac fossa and along 
the ascending colon, with some prominence of this region; the bowels are 
usually constipated, or small liquid stools may occur from time to time, 
due to the accumulation of hardened faeces in the sacculated periphery of 
the caecum, leaving a central cavity through which the liquid contents 
of the upper bowel can pass. 
In severe cases, “ the local pain, tenderness and swelling are greater, 
there are impaction of faces and no movetnents. There are decided fever, 
restlessness, and also nausea and vomiting. The vomited matters, at first 
contents of stomach, then of duodenum, with bilious matter, and ulti- 
mately, if the impaction persists, of material having the odor of faeces. With 
these symptoms occur great depression of the vital powers. Peritonitis is 
finally developed by contiguity of tissue or by rupture of the bowel.” 
Duration. The mild form lasts about one week. The severe form 
may terminate in acute peritonitis, continuing about two weeks. 
Prognosis. Mild form favorable. Severe form grave, although not 
necessarily fatal. 64 
PRACTICE OF MEDICINE. 
Diagnosis. The mild form is distinguished from other intestinal 
affections, by the localized pain and tenderness and prominence and con- 
stipation. 
The severe form can only be distinguished from the other forms of in- 
testinal obstruction by the history of the case and attack, and the results of 
treatment. 
Treatment. The patient should be kept in bed, and placed on a 
strictly milk diet. 
In mild cases, act upon the bowels, with either oleum ricini or magne- 
sii sulphas in small doses, followed by an opium influence, to be main- 
tained until convalescence is well pronounced. 
In severe cases, begin opium influence at once, by hypodermatic injections 
of morphina guarded with atropina, continued until all symptoms of in- 
flammation have subsided, when.attempts to remove the accumulated faeces 
may be made by irrigation of the bowel with warm soap-suds, and the 
cautious administration of magnesii sulphas in one drachm doses, every 
two hours. 
Locally. Ice bags, cold compresses, or, if patient prefers, poultices. 
PERITYPHLITIS. 
Synonym. Perityphlitic abscess. 
Definition. An acute inflammation of the connective tissue around the 
caecum, tending to the formation of an abscess; characterized by pain, 
swelling, and febrile reaction. 
Causes. Injuries to the abdomen over the caecum ; and also extension 
of inflammation from caecum by perforation. Often occurs with typhlitis. 
Symptoms. Begins with a feeling of weight, soreness and paroxysms 
of acute pain extending into the hip, thigh and abdomen, with the devel- 
opment of a hard swelling in the right iliac region. Its special tendency is 
toward suppuration, which is announced by irregular chills, feverishness, 
and sweats, and a feeling of tension and throbbing. Its development is 
slow, and if associated with typhlitis the symptoms of that affection are 
added. 
Treatment. If not associated with typhlitis, the treatment is to allay 
the inflammation in the first stages, by either ice, locally, or freely painting 
with tinct. iodi; if suppuration is evident, hasten by poultices, and follow 
by evacuation of pus with the aspirator or free opening, conjoined with the 
use of opium and quinina. DISEASES OF THE INTESTINAL CANAL. 
65 
PROCTITIS. 
Synonyms. Catarrh of the rectum; dysentery; rectitis. 
Definition. A catarrhal inflammation of the mucous membrane of the 
rectum and anus ; characterized by pain, tenesmus and frequent stools of 
hardened faeces, or of mucus, pus and blood. 
Causes. Chief cause constipation; also sitting on damp ground or 
stone steps; habitual use of enemata or of purgatives; diseases of the liver. 
Pathological Anatomy. Similar to those occurring in catarrhal dys- 
entery. 
/ 
Symptoms. Uneasy sensations and burning in the rectum, with con- 
stant desire for stool, or tenesmus, often so severe as to cause prolapse of the 
mucous tnembrane. The stools may be either hardened fceces or scybala 
from the distended colon, which cause intense pain when they reach the 
rectum ; or the stools may be of mucus, muco-pus, or bloody or blood- 
streaked. Generally there are present nausea, especially during the tenes- 
mus, headache, feverishness and malaise. In severe cases there is stran- 
gury, and with the tenesmus, straining with urination. 
If the case is protracted and severe, inflammation of the connective 
tissue around the rectum occurs, causing periproctitis, which usually ter- 
minates in various kinds of fistulae. 
Complications. Periproctitis; peritonitis; abscesses of the liver. 
Prognosis. Uncomplicated cases favorable. Either of the compli- 
cations adds greatly to the gravity'of the affection. 
Diagnosis. In males, the disease cannot be confounded with any 
other affection, save, perhaps, hemorrhoids. In females, displacements of 
the uterus may somewhat simulate the symptoms of proctitis. 
Treatment. In cases due to constipation the chief indication is to 
empty the bowels, for which the magnesia mixture mentioned for dysen- 
tery is the most suitable remedy; after which emollient enemata, with 
opium are indicated. Irrigation of the bowel with warm water once or 
twice daily assists in the liquefaction of the hardened fseces. 
Cases other than those due to constipation, emollient enemata and opium, 
one of the best being— 
U. 01. olivse § ij 
Tinct. opii deodorat..... 11\, xv M. 
Every three or four hours. 
If symptoms of periproctitis occur, use ice to parts, and if suppuration 
ensue, evacuation by a free opening and quinina. 66 
PRACTICE OF MEDICINE. 
INTESTINAL OBSTRUCTION. 
Synonyms. Intestinal occlusion; strangulated hernia; invagination; 
intestinal stricture. 
Definition. A sudden or gradual closure of the intestinal canal; 
characterized by pain, nausea, vomiting, constipation, and finally col- 
lapse. 
Causes. The numerous causes are arranged as follows, viz:— 
1. Accumulations within the bowel, to wit: hardened faeces, foreign 
bodies, etc. 
2. Strictures, to wit: from cancer, ulceration, cicatrices, etc. 
3. Pressure against the bowel, to wit: peritoneal adhesions, tumors, 
abnormal growths, etc. 
4. Strangulations, to wit: the numerous forms of hernia. 
5. Invagination or intussusception, the most common. 
6. Twisting or rotation of the bowel. 
Pathological Anatomy. Invagination is the only form calling for 
special description. It is most usually caused by the lower portion of the 
ileum slipping down into the caecum, as the finger of a glove might be 
invaginated, causing thus an actual mechanical obstruction; this is pro- 
duced by a spasm of the ileum, whereby its calibre is greatly diminished, 
thus permitting its descent into the lower bowel. Resulting from this 
occlusion or compression, are congestion, inflammation, with secondary 
constitutional reaction and death, or more rarely the invaginated bowel 
sloughs off, and is voided by stool, union taking place at its site and 
recovery following. 
Symptoms. The onset of the symptoms may be either sudden or 
gradual, and are as follows :— 
Constipation, with more or less severe colicky pains, not relieved by 
either purgatives or injections; feeling of weight and soreness, with disten- 
tion of the abdomen and nausea and vomiting; the symptoms all grow 
more pronounced, the pain becoming violent, tenderness in limited areas, 
the vomiting becoming stercoraceous, the abdomen hard and tense, the 
eyes sunken, the pulse quick and feeble, the skin cold and covered with a 
clammy sweat. The above continue more or less pronounced for a week 
to ten days, when collapse and death occur, or more rarely gradual return 
to health. 
Cases occur rarely in which small, fecal, muco purulent stools contain- 
ing more or less blood exist, instead of constipation. DISEASES OF THE PERITONEUM. 
67 
Prognosis. Always grave, but guided by the cause. Impacted fceces 
favorable. Invagination less favorable, but recoveries occur ; the longer 
the symptoms continue, the more favorable the outlook. Strangulations 
unfavorable, but many recoveries recorded. Strictures, due to cancer, 
cicatrized ulcers and the like, are the most unfavorable. 
Diagnosis. One of the most difficult, and can only be solved by a 
careful study of the case along with the different causes producing the 
affection. The site of the occlusion can rarely be determined positively. 
Treatment. Stop all forms of purgatives as soon as the diagnosis of 
obstruction is determined. 
Opium is indicated in all forms, and is best administered in the form of 
morphina, combined with small doses of atropina, hypodermatically. 
If impacted faces is the cause, irrigation by tepid soap-suds seems bene- 
ficial. 
If invagination, raising the buttocks and lowering the chest, and 
repeated injections of warmed oil, are recommended. Distention of the 
bowel by pumping air through long rectal tubes, or disengage carbonic 
acid gas in the bowel, by first injecting a solution of sodii bicarbonas, and 
follow this with a solution of acidu?n tai'taricum, about one drachm of 
each, pressure being made against the anus, to prevent escape. 
Flatulent distention can be removed by the long aspirator needle. 
Laparotomy is no doubt the operation of the future, when our means of 
diagnosticating the location of the trouble is more perfect. 
DISEASES OF THE PERITONEUM. 
PERITONITIS. 
Synonym. Inflammation of the peritoneum. 
Definition. A fibrinous inflammation of the peritoneum, either acute or 
chronic in character, characterized by fever, pain, tenderness, vomiting 
and prostration. It may be limited to a part—local, or it may involve the 
whole membrane—general, peritonitis. 
Causes. Intense cold, protracted irritation by blisters, and blows upon 
the abdomen, cause prbnary peritonitis. 
Inflammation of the abdominal or pelvic organs, or their perforation, or 
during the course of tuberculosis, pyaemia or albuminuria, cause secondary 
peritonitis. 68 
PRACTICE OF MEDICINE. 
Pathological Anatomy. Acute form; hyperaemia of the serous mem- 
brane, the capillaries distended and occasional extravasations of blood 
from their rupture; the normal secretion is arrested, and the shiny mem- 
brane becomes dull and opaque, from an exudation of pure fibrin, which is 
adhesive, glueing the parts together; if the inflammatory action is now 
arrested, it is termed adhesive peritonitis; if, however, the action pro- 
gresses, an effusion of serous fluid, of a reddish or bright yellow color, is 
poured out into the peritoneal cavity, the amount varying from a few ounces 
to several gallons; this is termed exudative peritonitis. If recovery re- 
sults, the fluid is absorbed, with much of the solid exudation, the unab- 
sorbed portions forming adhesions between the membrane and the different 
abdominal organs, often causing great deformity and irregularity in their 
relations. 
The chronic form follows the acute, or is associated with tuberculosis, 
Bright’s disease, or cirrhosis of the liver. 
The membrane is irregularly thickened, opaque, with strong adhesions 
to one or more coils of intestines, the liver, spleen, etc.; the quantity of fluid 
present is small, purulent or sero-purulent in character, and encysted by 
the agglutinated membrane. 
Symptoms. Acute form; when idiopathic, onset sudden, with chill, 
fever, 102 -f, pulse 100-140, wiry and tense, severe pain, cutting or boring in 
character, and tenderness, becoming so great that the slightest touch aggra- 
vates it, the decubitus being on the back, with flexed thighs; the abdomen 
distended and rigid, from constipatioti and 7neieorism; impaired appetite, 
nausea and vomiting are almost constant, with costal respiration and 
hiccough. 
These symptoms continue from six to eight days, when they begin to 
ameliorate and a tedious convalescence ensues, or pain and tenderness 
grow more marked, strength fails, surface cold, pulse rapid, and collapse, 
with hippocratic face, to wit: anxious expression, pinched features, 
sunken eyes and drawn upper lip. 
Secondary form, from extension, temperature increases, pulse becomes 
tense, exaggeration of pain and vomiting; from perforation, announced by 
severe pain and symptoms of shock. 
Chronic form ; irregular chills, fever and sweats; distended abdomen, 
constipation, alternating with diarrhoea ; diffused tenderness, with points of 
intenseness and hardness; colicky pains during digestion, rapid emaciation 
and failure of strength. Usually, the lower portions of abdomen give a 
dull note on percussion, from presence of fluids, or scattered points of dull- 
ness, showing presence of encysted fluid. DISEASES OF THE PERITONEUM. 
69 
Prognosis. Idiopathic cases favorable, and especially if continue 
longer than a week, as fatal cases usually end during the first week. 
Cases from perforation unfavorable. 
Chronic peritonitis being generally of tuberculous origin, the prognosis 
is unfavorable, although partial or complete recovery results in the cases 
following the acute form of the disease. 
Diagnosis. Acute gastritis differs from peritonitis in having a history 
of corrosive poisoning, severe pain, limited to stomach, early and severe 
vomiting; while the latter has fever, diffused abdominal pain and tender- 
ness, with decided distention. 
Acute enteritis has localized pain and tenderness with marked diar- 
rhoea. 
Rheumatism of the abdominal muscles occurs with a rheumatic history, 
is subacute, lacks the great distention of peritonitis, and while tenderness 
exists, it is not aggravated by deeper pressure. 
Treatment. Acute form : Idiopathic and robust cases, locally, leeches 
or wet cups, followed by cold or hot applications, as most agreeable to the 
patient; adynamic cases, dry cups, followed by warm applications medi- 
cated with tinct. opii. 
Opium and quinina are the remedies indicated at the onset of the disease, 
to wit: at once hypodermatic of morphina, gr. maintaining the effect 
by hourly doses of either morphina or opium, by the mouth. Prof. Clark 
ascertained the tolerance of opium in this disease, by the tremendous 
amounts used in a case under his care; the first day he gave 200 grs., the 
second day 472 grs., the third day 236 grs., fourth day 120 grs., fifth day 
54 grs., sixth day 22 grs., and on the seventh day 8 grains. Prof. Clark 
found that, as a rule, however, morphina, gr. every two hours, would 
maintain the effects of the drug. Quinina, gr. v, every four hours until 
exudation, after which gr. ij, four times a day, is of marked benefit. 
The decline of the vital powers must be averted by regulated nutrition 
and free stimulation. 
During convalescence, perfect quiet, nourishing aliment, moderate stimu- 
lants, scattered flying blisters, and the following :— 
Potassii iodidi gr. v 
Ferri pyrophos gr. ij 
Spts. lavend. comp tip xv 
Syr. aurantii cortex ad gij M. 
Every six hours, 
should constitute the treatment, with tonic doses of quinina. 70 
PRACTICE OF MEDICINE. 
Peritonitis from perforation, absolute quiet, hypodermatic injections of 
?norphina, ice locally, and stimulants per mouth or rectum. 
Chronic peritonitis; locally, iinct. iodi, and internally, opium, for 
pain ; potassii iodidum as an absorbent, with nourishing diet, ol. morrhuce 
and stimulants, and rest in bed. 
ASCITES. 
Synonyms. Dropsy of the abdomen; peritoneal dropsy. 
Definition. A collection of serous fluid in the abdomen, or more 
correctly in the peritoneal cavity; characterized by swollen abdomen, 
fluctuation, dullness on percussion, displacement of viscera, embarrassed 
respiration, plus the symptoms of its cause. 
Causes. Ascites may form part of a general dropsy, to wit: cardiac 
or nephritic; the most common factor in its production is mechanical 
obstruction of the portal system, from cirrhosis of the liver, tumors, diseases 
of the heart or lungs. 
Pathological Anatomy. The quantity of fluid in the peritoneal sac 
ranges from a few ounces to many gallons. It is generally of a straw 
color, or at times greenish, and is transparent, having an alkaline reaction. 
When blood is present in any great quantity, it points to cancer as a cause. 
The peritoneum becomes cloudy, sodden, and thickened, from long con- 
tact of the fluid. 
Symptoms. The onset is insidious, and considerable swelling of the 
abdomen occurs before the attention is attracted. Constipation, from pres- 
sure of the fluid on the sigmoid flexure. Scanty urine, from pressure on the 
renal vessels. Embarrassed respiration and cardiac action, from pressure 
of the diaphragm upwards. The umbilicus is forced outward. 
Physical signs; on palpation, a peculiar wave-like impulse is imparted 
to the hand laying on the side of the abdomen, while gently tapping the 
opposite side. 
Percussion ; patient erect, the fluid distends the lower abdominal region, 
with dullness over site of fluid and tympanitic note above; if the patient 
turns on his side the fluid changes, and dullness over the fluid, tympanitic 
over the distended intestines. 
Prognosis. Influenced by the cause producing it. Idiopathic ascites, 
which is most rare, terminates in health within a few weeks. If peritoneal, 
generally favorable. If from organic disease, most unfavorable, for while 
it may be removed, it rapidly returns. DISEASES OF THE PERITONEUM. 
71 
Diagnosis. Ovarian tumors differ from ascites in history, enlarge- 
ment limited to the iliac fossa, instead of uniform abdominal enlargement, 
does not change its position when the patient changes posture, and by 
detection of a tumor by conjoined manipulation through vagina, or by 
rectal exploration. 
Pregnancy differs from ascites in the character of the enlargement, the 
history, absence of menses, increase of mammae, change in the neck of 
the uterus, absence of fluctuation, and presence of the sounds of the foetal 
heart. 
Distention of the bladder has been mistaken for ascites; the points of 
distinction are, in the former the history, presence of tenderness over 
bladder, rounded outline of the percussion dullness, and the relief afforded 
by the catheter. 
Chronic Peritonitis is differentiated by the history, pain, tenderness, 
more or less vomiting, thickened abdominal walls, and its generally being 
associated with tubercle or cancer. 
Chronic Tympanites presents the enlarged abdomen, but lacks the 
history, the dullness and the fluctuation, giving instead a tense abdomen 
and an universal tympanitic note. 
Treatment. The first indication is to treat the cause of the ascites, and 
the second to remove the fluid. 
Three modes present themselves, to wit: first, by hydragogue cathartics, 
second, diuretics, and third, tapping. The first and second modes may be 
combined, as follows : 
R. Pulv. jalapse comp %) ij 
In water, an hour before breakfast, and 
R . Potassii acetat gr. x-xx 
Tinct. scillae gss 
Infus. digitalis iss M. 
Every six hours. 
If these fail, as they certainly will after a time, the embarrassed respiration 
and cardiac action call for tapping, which may be done with the trocar, 
or better still, the aspirator. 72 
PRACTICE OF MEDICINE. 
DISEASES OF THE BILIARY PASSAGES. 
CATARRHAL JAUNDICE. 
Synonyms. Catarrh of the bile ducts; icterus. 
Definition. An acute catarrhal inflammation of the mucous membrane 
of the bile ducts and of the duodenum; characterized by gastro-intestinal 
derangements, yellowness of the skin, feverishness and mental depres- 
sion. 
Causes. Excess in eating and drinking; a debauch; malaria; cli- 
matic, as cool nights succeeding warm days. 
Pathological Anatomy. The mucous membrane of one or more of the 
bile ducts or of the duodenum become hypersemic, swollen and thickened, 
from an effusion of serum into the sub-mucous tissue; the result of this con- 
dition is closure of the biliary passages, thereby impeding the outward flow 
of bile. The bile in the hepatic ducts being retained by the obstruction, 
the result is a staining of the liver substance and an absorption of bile and 
its appearance in the blood. 
Symptoms. Begins by epigastric distress, coated tongue, impaired 
appetite, nausea, with, perhaps, vomiting and looseness of the bowels and 
slight feverishness, the phenomena of a gastro-intestinal catarrh. In from 
three to five days the eyes become yellow, and jaundice gradually appears 
over the whole body; the feverishness disappears, the skin becomes harsh, 
dry and itchy, the bowels constipated, the stools whitish or clay-colored, 
accompanied with much flatus and colicky pains; the urine heavy and 
dark, loaded with urates and containing biliary elements. 
A few drops of the urine placed on a whitish surface, and a drop or two 
of nitric acid made to flow against it, will exhibit the following “play of 
colors; ” a greenish tint, from the conversion of bilirubin into biliverdin, 
quickly followed by blue, violet, red, and yellow, or brown. 
When the jaundice is complete, the surface is cold, the heart's action 
slowed, the mind torpid and greatly depressed, and pain or tenderness on 
pressure over the hepatic region. 
Duration. In from three to five days after the jaundice appears, the 
symptoms subside, save the torpid bowels, depression and discolored skin, 
which slowly disappear, often requiring a week or two. 
Prognosis. Always favorable; if the attacks are of frequent occur- 
rence, however, they are apt to lead to organic hepatic disease. DISEASES OF THE BILIARY PASSAGES. 
73 
Diagnosis. After the appearance of jaundice mistakes are impossible. 
The numerous diseases of which jaundice is a symptom will be differen- 
tiated when treating of them. 
Treatment. At the onset quinina, gr. x, morning and night, may 
modify the disease, and as soon as the diagnosis is established the indica- 
tions are for diaphoresis, diuretics and purgatives. 
For diaphoresis, the warm bath, to which potassii carbonas, j, may 
be added, morning and night. 
For diuresis, bitartrate of potassa lemonade, every four hours. 
Forpurgation, either sodiipyrophos., 3 j-ij, every four hours, well diluted, 
or ammonii murias, gr. xv—xx, every five hours, well diluted. 
Restricted diet, avoiding all starchy, fatty or saccharine articles, milk 
being the most suitable. 
For convalescence— 
R . Acid, nitrohydrochlorici dil gtt. v-x 
Elix. taraxaci comp zj-ij M. 
Before meals. 
BILIARY CALCULI. 
Synonyms. Hepatic calculi; gallstones; hepatic colic. 
Definition. Concretions originating in the gall-bladder or biliary 
ducts, derived partly or entirely from the constituents of the bile. Their 
presence is generally unrecognized until one or more attempt to pass along 
the ducts, when an attack of hepatic colic is produced. 
Causes. Gall stones result from the precipitation of the crystallizable 
cholesterine and its combination with inspissated mucus in the gall bladder 
or ducts. 
A disease of middle life, and more frequent in the obese, and in women. 
Gall stones are said to be common in carcinoma of the stomach or liver. 
Pathological Anatomy. Cholesterine is the chief constituent of 
biliary calculi. Commonly several stones exist, and rarely one; as many 
as six hundred are recorded. They are generally found in the gall bladder 
or cystic duct, rarely in the liver or hepatic duct. 
Symptoms. Hepatic colic begins suddenly at the moment a gall stone 
passes from the gall-bladder to the cystic duct. 
The patient is seized with a piercing, agonizing pain in the region of the 
gall-bladder, and spreading over the abdomen, right chest and shoulder; 
the abdominal muscles are cramped and tender; there is nausea and 74 
PRACTICE OF MEDICINE. 
vomiting, a small, feeble pulse, cool skin, pale, distorted, anxious face, with, 
may be, fainting, or spasmodic trembling, or chills. 
The paroxysm continues from an hour or two to several days, with re- 
missions, but entire relief is not afforded until the stone reaches the duo- 
denum, when the pain ceases suddenly. 
Jawtdice usually succeeds the paroxysm of pain. When the calculi 
reaches the intestines, the pain, nausea and vomiting cease, the appetite 
returns, and the jaundice soon disappears. 
Should the calculi become impacted, ulcerative perforation and 
quent peritonitis follow, the calculi discharging by the intestine, stomach, 
or through the abdominal walls. 
Prognosis. Usual termination is in health. The prognosis becoming 
more unfavorable if ulcerative perforation results. 
Diagnosis. The malady should not be mistaken if are present severe 
pain, 7iausea, vomiting, suddenly terminating, followed by slight jaundice. 
Treatment. For the colic, hypodermatic injections of morphina, gr. 
combined with atropina gr. and warm fomentations over 
the hepatic region, are indicated. 
Dr. Bartholow strongly urges the following prophylactic treatment. 
Carefully regulated diet, abstinence from all fatty and saccharine substan- 
ces, daily exercise, stoppage of all excesses, and the long use of sodii 
phosphas, gj, before meals, well diluted, to which may be added, if 
gastro-intestinal catarrh be present, sodii arsenias, gr. together with 
either Vichy or Saratoga Vichy water. 
DISEASES OF THE LIVER. 
CONGESTION OF THE LIVER. 
Synonyms. Torpid liver; biliousness. 
Definition. An abnormal fullness of the vessels of the liver, with 
consequent enlargement of that organ; it is termed active when arterial; 
passive when venous. The condition is characterized by torpidity of the 
digestive and mental functions, and slight jaundice. 
Causes. Active congestion ; malaria; excesses in eating and drinking ; 
alcoholic or malt liquors. 
Passive congestion ; cardiac and pulmonary diseases. DISEASES OF THE LIVER. 
75 
Pathological Anatomy. The liver is enlarged in all directions, and 
is abnormally full of blood. Cases due to obstructive diseases of the heart 
or lungs present the so-called “ nutmeg liver,” to wit: “ At the centre of 
each lobule the dilated radicle of the hepatic vein, enlarged and congested, 
may be discerned, while the neighboring parts of the lobule are pale,” f!he 
radicles of the portal vein containing less blood. 
Long continued congestion establishes atrophic degeneration of the or- 
gan ; the decrease in size is confounded with the condition of cirrhosis, but 
the “ atrophic liver ” is smooth, while the “ cirrhotic liver ” is nodulated. 
Symptoms. Active congestion; following cause rapidly produced 
malaise, aching of limbs, eveningfeverishness, headache, yellowish tongue, 
disgust for food, nausea, and, may be, vomiting, constipation, scanty, high- 
colored urine, with feeling of fullness, 7veight, and soreness in hepatic 
region, and slight jaundice, the eye yellow, and the complexion muddy. 
Passive congestion ; onset gradual, with feeling of weight and fullness in 
hepatic region, slight jaundice, and symptoms of gastro-intestinal catarrh. 
On percussion the hepatic dullness is increased in all directions. 
Prognosis. Active congestion favorable, unless repeated attacks rapidly 
succeeding each other, when “ atrophic degeneration ” results. 
Passive congestion controlled entirely by the cause. 
Diagnosis. Acute congestion is continually confounded with catarrhal 
jaundice; the latter begins with marked gastro-intestinal symptoms and 
distinct jaundice; in the former these are less marked. 
Obstructive congestion is diagnosticated by the clinical history. 
Atrophic or nutmeg liver will be differentiated from cirrhotic liver when 
speaking of the latter. 
Treatment. Attacks due to excesses in eating and drinking:— 
R. Sodii bicarb gr. x 
Hydrargyri chlor. mite gr. iij-v 
followed by 
R. Acidi nitrohydrochlorici dil TTLviiss 
Elix. taraxaci c gij. 
Before meals, and care in diet. 
Attacks due to malaria; the above purgative followed by quinince 
sulph., gr. iv, every four hours. Attacks occurring with cardiac or pulmo- 
nary diseases must be managed by treating the cause. 
Locally, in acute attacks, hot cloths, sinapisms, etc., are of benefit. 
In chronic cases benefit follows, ehx. quinince ferri et strychnines, gj, 
three times a day, and great comfort and support is given by the use of the 76 
“ hydropathic belt,” which is made of stout muslin shaped to the abdomen, 
with cross pieces of tape on the inner side, which keeps next to the skin a 
fold of cloth wrung out of cold water, and a piece of waterproof cloth or 
oiled silk, to prevent evaporation. 
PRACTICE OF MEDICINE. 
ABSCESS OF THE LIVER. 
Synonyms. Parenchymatous hepatitis; acute hepatitis; suppurative 
hepatitis. 
Definition. A diffused or circumscribed inflammation of the liver cells, 
resulting in suppuration, the abscesses being sometimes single and some- 
times double; characterized by irregular febrile attacks, hepatic tenderness 
and symptoms of deranged gastro-intestinal and hepatic functions. 
Causes. The result of the absorption of putrid material by portal 
radicles in dysentery; ulcer of the stomach; malaria; blows and injuries; 
heat; pyaemia. 
Pathological Anatomy. Hyperaemia, swelling, effusion of lymph, 
degeneration and softening of hepatic cells; suppuration, beginning in 
points in the lobules and coalescing. The abscess walls consist of the 
liver structure, more or less changed. 
The abscess may advance toward the surface of the liver, bursting into 
the peritoneum, intestines, stomach, gall bladder, hepatic duct or vein, or 
into the pleura or lungs, or externally through abdominal walls; after the 
discharge of pus, cicatrization, or the pus may be absorbed, the tissues 
around forming a dense cicatrix. 
Symptoms. Very obscure. Fever simulating markedly intermittent 
or remittent; disorders of gastro-intestinal canal, with obstinate vomiting, 
debility, great irritability of the nervous system, slight jaundice, and if of 
long duration, typhoid symptoms. 
Locally, if the abscess is near the surface, prominence of hepatic region, 
throbbing, limited tenderness, and if it tends to the surface, redness, 
oedema and fluctuation. The abscess may burst into intestines, stomach, 
lungs, pleura, etc., the symptoms of which will be pronounced. 
Prognosis. Unfavorable. Recoveries, however, do occur. If the 
abscess bursts into the lungs, bowels, or externally through abdominal wall, 
the case is more favorable. 
Diagnosis. Hepatic abscess may be confounded with hydatids of the 
liver, hepatic or gastric cancer, abscess of the abdominal walls, and puru- 
lent effusion in the right pleural cavity. DISEASES OF THE LIVER. 
77 
The differentiation is most difficult, but great aid is obtained by the use 
of the aspirator. 
Treatment. Symptomatic, and when pus is present, use of aspirator 
to remove it, and sustaining treatment, viz.: quinina, ferrum, alcohol and 
oleum morrhuce. 
ACUTE YELLOW ATROPHY. 
Synonyms. General parenchymatous hepatitis; malignant jaundice ; 
hemorrhagic icterus. 
Definition. An acute diffused or general inflammation of the hepatic 
cells, resulting in their complete disintegration ; characterized by diminu- 
tion in the size of the liver, deep jaundice, and profound disturbance of the 
nervous system; terminating in death, usually, within one week. 
Causes. Unsettled. It occurs most frequently in young pregnant 
women, from the third to the sixth month of pregnancy. Other causes, 
venereal excesses; syphilis; action of phosphorus, arsenic or antimony. 
Pathological Anatomy. Begins with hypersemia of the cells, with a 
grayish exudation between the lobules, followed by softening, dull yellow 
color, and disappearance of the cells, fat globules taking their place. The 
liver is reduced in size and in weight. The peritoneum covering the liver 
is thrown into folds. The spleen is enlarged. The kidneys undergo degen- 
eration. The blood contains a large amount of urea and considerable 
leucin. The urine is loaded with bile pigment, and contains albumen. 
Symptoms. Prodromic period; begins as a gastro-intestinal catarrh, 
coated tongue, nausea, vomiting, tenderness over epigastrium, headache, 
quickened pulse, slight fever and slight jaundice. 
Icteric period; jaundice deepens, pulse slows, headache increases, and 
great and obstinate sleeplessness. 
Toxcemic period; fever, rapid pulse, more complete jaundice, pain, 
nausea, vomiting of blackish, grumous blood, or “ coffee grounds,” tarry 
stools, ecchymotic patches, convulsions, or epileptiform attacks, coma, 
insensibility, death. 
Percussion shows markedly decreased hepatic dullness. 
Duration. Short. After appearance of jaundice, about six days. 
Prognosis. Unfavorable. 
Treatment. Symptomatic entirely. Dr. Bartholow “ advises the trial 
of very small doses of phosphorus, as early as possible, as this remedy 
affects the organ specifically, and an action of antagonism may be dis- 
covered between them.” 78 
SCLEROSIS OF THE LIVER. 
PRACTICE OF MEDICINE. 
Synonyms. Interstitial hepatitis; cirrhosis; hob-nailed liver; gin- 
drinkers’ liver. 
Definition. An inflammation of the intervening connective tissue of 
the liver, chronic in its progress, resulting in an induration or hardening of 
the organ; characterized by gastro-intestinal catarrh, emaciation, slight 
jaundice and ascites. 
Causes. The prolonged use of alcoholic stimulants, gin, whiskey, beer, 
porter, etc.; syphilis. 
Pathological Anatomy. First stage; hypersemia of the connective 
tissue (Glisson’s capsule) of the liver, and the development of brownish-red 
connective tissue elements, whereby the organ is increased in size and 
density; this increase of the connective tissue presses upon the hepatic cells, 
causing them to undergo fatty degeneration. Second stage; the newly 
formed imperfectly developed connective tissue contracts, causing decrease 
and induration of the organ, its surface being nodulated. The hepatic and 
portal circulation is obstructed, from obliteration of their radicles. 
The hepatic peritoneum is thickened and opaque, and adhesions are 
formed to the diaphragm, gall-bladder, etc. 
Cases occur in which the sclerosis takes place while the organ continues 
enlarged; these are known as hypertrophic sclerosis. 
Symptoms. No characteristic symptoms of the early stage of the 
affection. Persistent gastro-intestinal catarrh, with attacks of jaundice, 
in a drinking man, are suspicious. Symptoms of second stage are, abdominal 
dropsy, enlarged superficial abdominal veins, dyspepsia, localized peri- 
toneal pain, hemorrhages from stomach or intestines, muddy or slightly 
jaundiced skin, decided emaciation. 
Prognosis. Terminates in death. Average duration after appearance 
of dropsy, one year. 
Diagnosis. Atrophy of the liver, or the nutmeg liver, is almost always 
confounded with sclerosis ; the former occurs most commonly with obstruc- 
tive diseases of the heart and lungs, and the surface of the organ is not 
nodulated, nor is there a history of alcoholism. 
Ca7icer and tubercle of the peritoneum have many symptoms akin to 
sclerosis. The points of differentiation are, great tenderness over abdo- 
men, rapidly developed ascites, rapid decline in strength and flesh, absence 
of jaundice, absence of long-continued dyspepsia, absence of hepatic 
changes on percussion, and the presence of tubercle or cancer deposits in 
other organs. DISEASES OF THE LIVER. 
79 
Treatment. For the changes in the hepatic structure, little if anything 
can be done; the following are some of the remedies recommended, to 
wit: hydrargyri chlor. corro., gr., three times a day; kydrargyri 
chlor. mite, gr. TJ-7, three times a day; aurii et sodii chloridi, gr. after 
meals; sodiiphosphas, after meals. 
The diet must be regulated, milk being the most suitable, and avoiding 
fatty and saccharine foods. 
The abdominal dropsy may be temporarily benefited by purgatives and 
diuretics, but sooner or later tapping becomes imperative. 
AMYLOID LIVER 
Synonyms. Waxy liver; lardaceous liver; scrofulous liver; albumi- 
noid liver. 
Definition. A peculiar infiltration into, or a degeneration of, the struc- 
ture of the liver by the deposit of an albuminoid material, which has been 
termed amyloid, from a superficial resemblance to starch granules. 
Causes. The chief cause is prolonged suppuration, especially of the 
bones ; coxalgia; syphilis ; cancer. 
Pathological Anatomy. The liver is uniformly enlarged. It pre- 
sents a pale, glistening, translucent appearance, and has a doughy 
consistence. On section, the surface is homogeneous, is anaemic and 
whitish. The deposit begins in the arterioles and capillaries, finally 
closing them. 
The reaction with iodine and sulphuric acid affords a certain test of the 
amyloid or albuminoid deposits. After thorough cleansing brush over 
parts a solution of iodine with iodide of potassium in water, when they 
will assume a mahogany color, and if diluted sulphuric acid is added, a 
violet or bluish tint is produced. 
A pretty reaction is to take a one per cent, solution of anilin violet, 
which strikes a red or pink color with the amyloid or albuminoid material, 
while the unaltered tissues are stained blue, thus showing a beautiful con- 
trast. 
The amyloid change involves the spleen, kidney, intestines and other 
organs. 
Symptoms. Nothing characteristic. Hepatic dullness increased, with 
prominence over the liver. Absence of pain. Splenic dullness in- 
creased. Emaciation and amemia. Urine increased in amount, pale, 
and containing some albumen, due to amyloid changes in the kidneys. Dis- 80 
PRACTICE OF MEDICINE. 
orders of digestion, with diarrhoea, due to amyloid changes in the intestines. 
Jaundice is rare. Ascites seldom occurs. 
Prognosis. Unfavorable. The progress is rapid or slow, depending 
upon the cause. 
Treatment. No specific. Symptomatic, with prolonged use of ferrum, 
syr. calcii lacto-phosphas and oleum morrhuce. 
Synonym. Carcinoma of the liver. 
Definition. A peculiar morbid growth, progressively destroying the 
hepatic tissue; characterized by disorders of digestion, anaemia, emaciation, 
jaundice and ascites, and terminating in the death of the patient. 
Causes. Hereditary, when it is termed primary cancer ; from exten- 
sion from other organs, when it is termed secondary cancer. It is a disease 
of advanced life, from forty to sixty years. 
Pathological Anatomy. The most common variety of cancer of the 
liver is a compound of the medullary and scirrhus. 
The cancer cells develop from the interlobular connective tissue, and as 
they grow the hepatic cells disappear. The branches of the hepatic artery 
enlarge and permeate the growth, while the branches of the portal vein 
are compressed and atrophied, thereby blocking up the portal circulation. 
The cancer may develop in nodules or masses, or may be diffused ; the 
nodules vary in size, and those on the surface are rounded, with a central 
umbilication. The peritoneum is adherent, cloudy and thickened. 
Symptoms. The recognition of hepatic cancer is preceded by a history 
of dyspepsia, flatulency and constipation. Then uneasiness, weight and pain, 
increased by pressure, are noticed ; jaundice, ascites, occasional intestinal 
hemorrhages, emaciation, feebleness, ancemia, cold, dry, harsh skin, pinched 
feattires, with dejected, worn expression. Fever never occurs. The hepatic 
dullness is increased, pain on palpation, and the liver is indurated, irregular 
and nodulated. 
The duration is less than a year from the time the disease is recognized. 
Prognosis. Always terminates in death. 
Diagnosis. The points of differentiation are the age, cachexia, pain 
and tenderness, enlarged liver with hard nodules, and rapid progress. 
Treatment. Entirely symptomatic. Sooner or later opium must be 
used to relieve the terrible and persistent pain. 
HEPATIC CANCER. DISEASES OF THE KIDNEYS. 
81 
DISEASES OF THE KIDNEYS. 
The normal quantity of urine varies from 20 to 50 ounces in the twenty- 
four hours; it is decreased by free perspiration and increased by chilling 
of the skin. 
The normal color is light amber, due to tirobilin; the intensity is 
deepened if the quantity is decreased, and vice versa. 
The normal reaction is slightly acid, due to the acid sodic phosphate, 
uric and hippuric acids. After meals it may be neutral or even alkaline. 
The normal specific gravity varies from 1.008 to 1.020; it is low when 
an increased quantity is passed and high when the quantity is diminished. 
The most important organic and inorganic solid constituents held in 
solution are, urea (the index of nitrogenous excretion), from 308 to 617 
grains , daily; uric acid, from 6 to 12 grains; urates of sodium, ammonium, 
potassium, calcium and magnesium, from 9 to 14 grains; phosphates of 
sodium, etc., from 12 to 45 grains, and chlorides of sodium, etc., from 154 
to 247 grains daily. 
THE URINE. 
Fill a graduated glass tube one-third full of 
mercury, and add one-half drachm of the 24 
hours’ urine; then fill the tube evenly full 
with a saturated solution of hypo-bromite of 
sodium, and close it with the thumb imme- 
diately ; invert the tube and place its open end 
beneath a sat. sol. of chloride of sodium ; the 
mercury flows out and is replaced by the solu- 
tion of salt; nitrogen gas is disengaged from 
the urea in the upper part of the tube. 
Each cubic inch of gas represents .645 gr. of 
urea in the half drachm, from which the amount 
passed in 24 hours may be calculated. 
I. Quantitative test 
for urea, by hypo-bro- 
mite of sodium (Davy’s 
Method). 82 
PRACTICE OF MEDICINE. 
Urine containing an excess of urates and 
uric acid, on cooling, precipitates them (viz : 
“ brickdust deposits ” in “ pot de chambre ”). 
Heat dissolves them to a certain extent. 
Nitric acid deprives the soluble neutral 
urates of their bases, and produces, at first, 
a faint, milky precipitate of amorphous acid 
urates ; adding more acid, the still less soluble 
red crystals of uric acid are deposited. 
Put a small quantity of nitric acid in a test 
tube, and pour the urine carefully down the 
sides of the tube upon it, and a zone of yellow- 
ish-red uric acid and altered coloring matter 
will form at their union; and a dense, milky 
zone of acid urates above this, which, how- 
ever, dissolves upon agitation. (See albumen 
test.) 
II. Tests for urates 
and uric acid by nitric 
acid. 
To three ounces of the 24 hours’ urine 
(after being slightly acidulated, boiled and 
filtered while hot) add one-tenth as much 
nitric acid; place in a cool place for 24 hours, 
then collect the deposit of uric acid on a 
weighed filter, wash it thoroughly, and dry at 
212° F. The increased weight represents the 
uric acid in part excreted, approximately. 
III. Quantitative test 
for uric acid by nitric 
acid. 
Heat or liquor potassa increases the cloudi- 
ness caused by earthy calcium and magnesium 
phosphates. Acetic or nitric acid clears it by 
dissolving them. 
To two ounces of urine add one third as 
much of the following solution, viz : R . Mag- 
nesium sulph., ammonium chlorid. puras, 
liquor ammoniae, each one part, aquae destil., 
eight parts; if the precipitate has a milky, 
cloudy appearance, the quantity of phosphates 
are normal; if creamy, the phosphates are in 
excess. 
IV. Test for the 
earthy and aWaWnephos- 
phates by the magnesian 
fluid. DISEASES OF THE KIDNEYS. 
83 
To a convenient quantity of urine add a 
small amount of nitric acid, to prevent the for- 
mation of the phosphates *and other salts of 
silver; filter this if cloudy; add to this one 
drop of a solution of nitrate of silver (i part 
to 8) and the precipitate of white cheesy lumps 
of chloride of silver denotes that the amount 
of chlorides are normal; if,Tiowever, only a 
faint milkiness occurs, the chlorides are di- 
minished. 
V. Test for the chlo- 
rides by nitrate of silver. 
Mucus alone is not visible, but causes cloudi- 
ness, from having entangled mucus or pus cor- 
puscles, epithelium, granules of sodium urate, 
crystals of oxalate of lime and uric acid in 
various amounts. 
Add to the urine a little acetic acid, or, in 
addition, a few drops of liquor iodi comp., 
when threads or bands of mucin are made 
visible. The addition of nitric acid dissolves 
them. 
VI. Test for by 
acetic acid and liquor 
iodi comp. 
Slightly acidulate the urine, if necessary, by 
addition of nitric or acetic acid, and boil; this 
causes a white deposit of coagulated albumen, 
which is not dissolved by nitric acid, unless in 
excess. 
Nitric acid causes a white deposit of coag- 
idated albumen, which is dissolved if a large 
excess is added. A delicate test is to put the 
nitric acid in the tube first, and then gradually 
pour the urine down the side of the tube upon 
it, when a white zone or ring of coagulated 
albumen appears. Precaution, see tests Nos. 
3, 4, 9 and n. 
VII. Tests for albu- 
men by heat and nitric 
acid. 84 
PRACTICE OF MEDICINE. 
Add a few drops of nitric acid to a propor- 
tion of the urine, and boil; set this away for 
24 hours, and the proportionate depth of the 
resulting deposit is the comparative indication, 
viz., %-l/2, etc. 
VIII. Quantitative test 
for albumen. Approxi- 
mately. 
IX. Test for blood by 
heat and nitric acid. 
Heat or nitric acid causes deposit of albu- 
men, with the coloring matter changed to a 
dirty brown. 
Heat the urine, then add caustic potash and 
heat anew.' The phosphates are thus precipi- 
tated, taking with them the coloring matter of 
the blood, which imparts a dirty, yellowish- 
red color to the sediment viewed by reflected 
light, and when seen by transmitted light, 
gives a splendid blood-red color. 
Neither the coloring matter of the blood nor 
that of the bile is precipitated with the phos- 
phates, so that coloration of urine which shows 
this reaction cannot be ascribed to the presence 
of the latter pigments. 
When the quantity of blood in the urine is 
very large, it is of a dark or brownish red, and 
after standing, forms a coagulum of blood at 
the bottom of the vessel. 
X. Test for blood by 
heat and caustic potash 
(Heller’s). 
Caution. Heat or nitric acid causes coagu- 
lation of the albumen in pus. 
Add to the urine, or preferably to its deposit 
from standing, an equal volume of liquor 
potassa ; when well mixed, a viscid gelatinous 
fluid or mass is formed, which pours like the 
white of an egg, or jelly. 
XI. Test for pus by 
liquor potassa. DISEASES OF THE KIDNEYS. 
85 
Allow a specimen of urine and a few drops 
of red “fuming” nitric acid to gradually 
intermingle on a porcelain dish, and a “ play 
of colors,” green, blue, violet, red and yellow 
or brown, occur, if biliary coloring matter is 
present. 
XII. Test for bile by 
“ fuming ” or red nitric 
acid. 
Pour into a test-tube about 1.6 fg of pure 
hydrochloric acid, and add to it, drop by drop, 
just sufficient urine to distinctly color it. The 
two are mixed. Then drop down the side of 
the test-tube pure nitric acid, which will 
“ underlay” the mixture of hydrochloric acid 
and urine. At the point of contact between 
the mixture and the colorless nitric acid a 
handsome “ play of colors appears.” If the 
“ underlying ” nitric acid is now stirred with a 
glass rod, the set of colors which were super- 
imposed upon one another will appear along- 
side of each other in the entire mixture, and 
should be studied by transmitted light. 
If the hydrochloric acid, on addition of the 
biliary urine, is colored reddish-yellozv, the 
coloring matter is bilirubin; if it is colored 
green, it is biliverdin. 
XIII. Test for bile 
pigment by pure hydro- 
chloric and pure nitric 
acids (Heller’s). 
Add to the urine half its volume of liquor 
potassa. (Caution. This may give a white, 
flaky precipitate of the earthy phosphates, 
which should be removed by filtering.) Now 
boil; this causes, at first, a yellowish-brown 
color, becoming darker if much sugar is pre- 
sent, due to glucic, and finally to melassic 
acid. 
XIV. Test for sugar by 
liquor potassa and heat 
(Moore’s). 86 
PRACTICE OF MEDICINE. 
Add to the urine half its volume of liquor 
potassa, and then a little bismuth subnitrate, 
shake and thoroughly boil; the presence of 
sugar reduces the salt and black 7?ietallic bis- 
muth is deposited, or if but little sugar, a gray 
deposit occurs. 
Caution. Albumen must be absent. 
XV. Test for sugar by 
subnitrate of bismuth, li- 
quor potassa and heat. 
Add to the urine a few drops of a solution 
of cupric sulphate, and then its own volume of 
liquor potassa. (Caution. On first addition 
a light greenish precipitate occurs, which, on 
further addition of the reagent, if sugar or cer- 
tain other organic matters are present, are 
dissolved, giving a transparent blue liquid). 
Now boil, and a yellowish precipitate of hy- 
drated cupric suboxide, occurring at once, 
denotes the presettce of sugar. 
Caution. Albumen must be absent. 
XVI. Test for sugar 
by a solution of cupric 
sulphate, liquor potassa 
and heat (Trommer’s). 
Take of Pavy's solution of cupric protoxide, 
recently prepared (see margin), 200 minims 
or a multiple of this quantity, and boil in a 
porcelain dish; while boiling, add, minim by 
minim, from a measured portion of the 24 
hours’ urine, and it gives a yellowish precipi- 
tate of hydrated cupric suboxide, if sugar be 
present. 
Note carefully the gradual disappearance of 
the blue color, and when completed (best de- 
termined by looking through the margin of 
the fluid against the white porcelain dish), 
from the amount of urine used, determine the. 
amount of sugar passed daily. The quantity 
of wine containing one grain of sugar being 
just sufficient to reduce the 200 minims of the 
copper solution. 
XVII. Quantitative 
test for sugar by Pavy's 
solution, viz :— 
R. 
Cupric sulphate, gr. 320 
Neutral potassic 
tartrate, gr. 640 
Caustic potash, gr. 1280 
Distilled water, fg 20 
Keep corked. DISEASES OF THE KIDNEYS. 
87 
Take two measured . specimens from the 24 
hours’ urine, and to one add a little yeast. 
Place each specimen in a temperature of 750 
to 8o° Fah.; in 24 horns, fermentation having 
destroyed the sugar in the one containing the 
yeast, the difference in the specific gravity of 
the two specimens expresses the number of 
grains in each ounce of the urine. Approxi- 
mately. 
XVIII. Quantitative 
test for sugar by ferment- 
ation and the specific 
gravity. 
CONGESTION OF THE KIDNEYS. 
Synonym. Catarrhal nephritis. 
Definition. An increase in the amount of blood in the vessels of the 
kidneys; when arterial, it is termed active congestion; when venous, 
passive congestion ; characterized by pain, frequent desire for urination, the 
amount of urine being scanty, high-colored, with occasional slight albumen. 
Causes. Active; by cold; irritating substances eliminated by the kid- 
neys, viz.: turpentine, copaiba, etc.; during the eruptive or continued 
fevers; injuries over the kidneys. Passive ; obstructive diseases of the 
heart or lungs, and pressure of the pregnant uterus. 
Pathological Anatomy. The kidneys enlarge and increase in weight: 
increased redness (the color being bluish if passive), with points of vascu- 
larity corresponding to the Malpighian bodies, and occasionally minute 
ecchymoses. The abnormal hypersemia causes a catarrhal state of the 
ducts of the pyramids, with shedding of their epithelium. 
If mechanical (passive) obstruction continues for some time, increase 
of the connective tissue, with consequent induration and contraction 
results, or a form of chronic Bright’s disease. 
Symptoms. Active ; pain over kidneys and following course of ureters 
into testicles and penis, irritable bladder, almost constant and pressing 
desire for urination, the urine scanty, high-colored, and occasionally bloody, 
with fibrin, casts and albumen. 
If the condition persists, inflammation results. 
Passive ; the kidney changes are masked by the lung or heart trouble, 
until dropsy, scanty, high-colored, albuminous urine is observed. 
Prognosis. Active ; if recognized and properly treated, favorable. 
Passive, controlled by the cause, and if prolonged, terminating in in- 
terstitial nephritis. 88 
PRACTICE OF MEDICINE. 
Treatment. Rest of body, dry or wet cups over the loins, saline 
purgatives, warm bath or other mild diaphoretics; if great irritability 
of the bladder, camphora, gr. ij—iv, every four hours, combined with 
morphines sulph., gr. T12—or the hypodermatic injection of morphina, 
Sr- tV 
ACUTE BRIGHT’S DISEASE. 
Synonyms. Acute desquamative nephritis; acute parenchymatous 
nephritis; acute tubal nephritis. 
Definition. An acute inflammation of the epithelium of the uriniferous 
tubules; characterized by fever, scanty, high-colored or smoky urine, 
dropsy, with more or less constant nervous phenomena, the result of 
uraemia. 
Causes. The young more liable than the aged; cold and exposure; 
scarlatina; persistent use of irritants, viz : turpentine, cantharides, etc. 
Pathological Anatomy. The kidneys are greatly swollen, engorged, 
more vascular, of red color; in the second stage the organ remains large, 
irregularly red, especially the cortex; the tubules are engorged and filled 
with epithelium, blood corpuscles and fibrin. The capsule is easily 
detached, and is more opaque than normal. 
If favorable termination, the swelling lessens, the vascularity diminishes, 
the tubules returning to a normal condition. 
Symptoms. Usually begins suddenly. Fever, with nausea and violent 
and persistent vomiting, pain over kidneys, following ureters; skin harsh 
and dry; pulse quick, tense and full. Soon dropsy appears, the eyelids and 
face becoming puffy and swollen, followed by general oedema of the 
extremities, scrotum and abdominal walls. 
The urine is scanty, smoky (like beef washings) in color, due to the 
presence of blood. Albumen is present in large quantities, and the micro- 
scope reveals casts of the uriniferous tubules, blood corpuscles, uric acid 
crystals and epithelium. 
Duration from one to four weeks. 
Complications. Pericarditis, pleuritis and peritonitis, from retention 
and decomposition of urea in blood. Also marked nervous phenomena, 
from the same cause, termed urcemia, in which have rapidly recurring 
convulsions or delirium, terminating in stupor, coma and death, unless 
speedily checked. DISEASES OF THE KIDNEYS. 
89 
Prognosis. Favorable. Majority of cases recover under prompt treat- 
ment. Rarely passes into chronic Bright's disease. Urcemic symptoms 
add to the gravity of the prognosis. 
Diagnosis. The history, fever, scanty smoky albuminous urine, with 
dropsy beginning in the face, should prevent any error. 
Albuminuria may be confounded, on account of the presence of albumen 
in the urine, but lacks the clinical history, usually occurring in the course of 
some constitutional affection, viz.: diphtheria, cholera, etc. 
Treatment. Absolute rest in bed. Milk diet, or if much depression, 
also weak animal broths and oysters. Drink freely of -Water, but neither 
tea, coffee nor stimulants. Counter-irritation over the kidneys by dry or 
wet cups, and poultices of digitalis. 
I’ ree purgation by pulv. jalapce comp., !jj, in water, before breakfast. 
Diaphoresis by warm baths, or an infusion of jaboranda leaves ( X ij to 
aqua, Oj), wineglassful every four hours, or vinum ipecacuanlue, gtt. j-ij, 
every half hour. 
Diuresis, by— 
R . Potass, acetas gr. x-xx 
Infus. digital f ij 
Infus juniperi f3 ij M. 
Every four hours. 
For urcemic convulsions, morphina, gr. hypodermatically, re- 
peated if necessary; venesection, or inhalation of chloroform, or chloral, or 
potassii bromid., per rectum, and rapid and free purgation by oleum tiglii, 
or elaterium; also acting on the skin by warm baths or pilocarpin, gr. JL-i, 
hypodermatically. 
As soon as the blood disappears from the urine, a course of ferrum, in 
the shape of Basham's mixture, until albumen disappears and health is 
restored. The following is the formula of Basham’s mixture :— 
R. „ Liq. ammon. acetat f vj 
Acid acetic 
Tinct. ferri chlor f,Tv 
Alcoholis \ ij 
Syrup ff iv 
Aquae f:fiv. M. 
Sig.—Dose f^j-f^j. 
G 90 
PRACTICE OF MEDICINE. 
CHRONIC PARENCHYMATOUS NEPHRITIS. 
Synonyms. Chronic Bright’s disease; chronic tubal nephritis; chronic 
albuminuria; large white kidney. 
Definition. A chronic inflammation of the cortical and tubular tissues 
of the kidneys; characterized by albuminous urine, dropsy, increasing 
anaemia, with attacks of urcemia. 
Causes. Occasionally follows the acute form; syphilis; chronic mala- 
ria ; chronic alcoholism; chronic mercurialism; lead poisoning; pro- 
tracted suppuration. It is a disease of the young, rarely occurring after 
forty. 
Pathological Anatomy. A large white or yellowish white, smooth 
kidney, often twice the normal size. The capsule is nowhere adherent to 
the organ. Upon section, considerable tumefaction of the cortical substance 
and the rarity of vascular striae are recognized. The medullary substance 
shows nokappreciable alteration, its color being normal. The convoluted 
tubes are irregularly dilated and thickened, and filled with broken-down, 
granulated epithelium and fibrinous casts. In pronounced cases there is 
fatty degeneration of the tubular epithelium. 
Symptoms. Onset gradual and insidious, and'seldom seen until the 
appearance of dropsy, beginning under the eyes and in the face, extending 
all over the body, causing dyspnoea, from ascites or hydrothorax. The 
urine scanty, high-colored, albuminous, and under microscope shows tube 
casts, granular epithelium, and if fatty degeneration occurs, fatty tube casts 
and oil globules. 
Ancemia is pronounced, from the large waste of albumen. Gastro- 
intestinal disorders and vague neuralgic pains are common occurrences. 
Bronchial catarrh, with slight oedema of the larynx, causing husky voice, are 
frequent complications. Urcemic symptoms occur, and especially uramic 
asthma (renal asthma). 
Complications. Pneumonitis, pleuritis, pericarditis, and peritonitis. 
Prognosis. Not unfavorable, unless urine contains persistently large 
numbers of fatty tube casts and oil globules. Relapses are frequent, but 
many complete recoveries are recorded. 
Treatment. Regulated dietary, viz: milk, eggs, animal broths, etc. 
Rest, even in bed, for days at a time. Alcoholic stimulants contra-indicated. 
Promote free action of the skin by warm bath, friction, jaboranda and 
other diaphoretics. 
For dropsy, purgatives, such as pulv. jalap, comp., hydragogue cathartics DISEASES OF THE KIDNEYS. 
91 
and alkaline mineral waters. If there is great distention of the cavities 
interfering with respiration, the aspirator should be used. Puncture of the 
skin may be necessary at times, and is well accomplished with an ordinary 
cambric needle. 
For the disease and the condition of the blood, ferrum in some form 
does good, to wit: Basham's mixture, tinct. orferri chloridi with liq. animo- 
nii acetat., or the syrup ferri iodidi. 
To check the waste of albumen, a difficult matter, the following reme- 
dies have been used with more or less success: ergota, quinina, acidum 
gallicum, acidum benzoicum, tinct. cantharidis, potassii iodidum, and 
lastly, the Russia remedy, blatta orientalis (cockroach). 
INTERSTITIAL NEPHRITIS. 
Synonyms. Chronic Bright’s disease; sclerosis of the kidneys; con- 
tracted kidneys; small red kidney; gouty kidney. 
Definition. An inflammation of the intervening connective tissue of 
the kidney, chronic in its progress, resulting in an induration or hardening, 
with contraction of the organ; characterized by frequent passing of large 
amounts of pale, albuminous urine, of low specific gravity, disorders of the 
gastro-intestinal and nervous systems, and a strong tendency to cardiac 
hypertrophy and changes in the vessels. 
Causes. A disease of middle life, from forty to sixty years. Gout a 
very common cause; lead cachexia; syphilis; alcoholism; alterations in 
the renal ganglionic centres (DaCosta and Longstreth). 
Pathological Anatomy. The kidneys are reduced in size. The 
capsule is thickened, opaque and adherent. The surface of the kidney is 
granular, with cysts of various sizes, of transparent color, irregularly over 
the surface. On section the tissue of the kidney is tough and resistant. 
The cortical portion is thin, from atrophy, being only a line or two in 
thickness. The connective tissue is greatly thickened, compressing the 
tubules into mere threads, the glomeruli being grouped together in 
bunches, owing to the wasting of the intermediate tubes. The color varies, 
from a darkish-brown to a yellowish-gray, according to the amount of 
blood in the organ. 
The left side of the heart is hypertrophied, and there is also hypertrophy 
of the muscular fibre of the arterioles throughout the body; if the case is 
protracted the hypertrophied tissues undergo fatty degeneration. 
The retina undergoes atrophy, termed retinitis albuminuria. 92 
PRACTICE OF MEDICINE. 
The “ganglionic centres ” undergo fatty degeneration and atrophy 
(DaCosta and Longstreth). 
Apoplexy is a frequent termination of interstitial nephritis, the rupture 
of the cerebral vessel suggesting it a disease of degeneration. 
Symptoms. Onset insidious and often marked alterations in the kid- 
neys, heart and vessels before recognized. Any of the following symptoms 
may first attract attention, to wit: frequent micturition, increased amount 
of urine, pale color, containing small amount of albumen, which maybe 
absent for days, occasional epithelial cells and hyaline casts. No dropsy, 
but a little puffiness and oedema of conjunctiva—the Bright’s eye. Disor- 
ders of vision. Forcible cardiac action with high arterial tension. And 
any of the following symptoms, the result of urcemia : Persistent dyspepsia, 
occasional vomiting, regardless of food; headache, vertigo and stupor, or 
drowsiness; violent itching of the skin; tremors, convulsions, epileptic 
seizures, or apoplectic attacks. 
The body weight declines, the skin is dry and scurf), the strength fails, 
with shortness of breath on exertion. 
The termination is usually by convulsions, coma and death. 
Complications. Bronchitis ; pneumonitis ; pleuritis; pericarditis. 
Prognosis. Pursues a very chronic course; cases recorded under 
observation eleven years; but the termination is always fatal. 
Diagnosis. Differs from parenchymatous nephritis in the following: 
large quantity of urine, clear, and low specific gravity, and small amount 
of albumen, with few hyaline casts; the hypertrophied heart and tense 
arteries and marked disorders of vision. 
Treatment. Regulated diet. Diaphoresis. Diuretics. Avoid alco- 
holic stimulants. As near absolute rest as patient’s general health will 
permit. 
To prevent the growth of the connective tissue the following remedies 
are recommended, to wit: potassii iodidum, hydrargyri corrosiv. chlor., gr. 
aurii et sodii chloridi, ferri iodidum and arsenicum. 
For urcemia, if patient is conscious, purgatives, diaphoretics and diu- 
retics. If unconscious, morphina hypodermatically or chloroform inhala- 
tions. DISEASES OF THE KIDNEYS. 
93 
AMYLOID KIDNEY. 
Synonyms. Chronic Bright’s disease; waxy kidney; lardaceous 
kidney. 
Definition. A peculiar infiltration into, or a degeneration of, the 
structure of the kidney, by the deposit of an albuminoid material, having a 
superficial resemblance to starch granules. Similar changes occur in the 
liver, spleen, intestines and other organs. 
Causes. The chief cause is prolonged suppuration, especially of the 
bones ; coxalgia; syphilis; cancer. 
Pathological Anatomy. The kidney is uniformly enlarged. It 
presents a pale, glistening, translucent appearance, and has a doughy 
consistence. On section, the surface is homogeneous, anaemic and whitish. 
The deposit occurs along the renal vessels and in the vascular tufts of the 
glomeruli, progressing until all parts of the organ are infiltrated. When 
the organ is thus infiltrated the proper structure undergoes an atrophic 
degeneration, from pressure. 
The reaction with iodine and sulphuric acid affords a certain test of the 
amyloid deposit. Brush over a section of the affected kidney a solution of 
iodine with iodide of potassium in water, when a mahogany color will be 
produced, and if diluted sulphuric acid is now added, a violet or bluish 
tint results. A very pretty reaction is to take a one per cent, solution of 
anilin violet, which strikes a red or pink color with the amyloid material, 
while the unaltered tissues are stained blue, making a beautiful contrast. 
Similar changes occur in other organs of the body. With the amyloid 
change may be associated either parenchymatous or interstitial nephritis. 
Symptoms. Associated with wasting are cedema of the lower ex- 
tremities and ascites, with increased flow of urine, pale, watery and 
of low specific gravity, containing albumen and hyaline casts, which are 
transparent. If the amyloid change is associated with other forms of renal 
change, the urine will show the characteristics of such condition. A pro- 
fuse, watery and persistent diarrhoea adds to the suffering caused by amy- 
loid changes in the intestinal canal. 
Prognosis. Controlled by the suppurating disease with which it is 
associated; the termination, when the amyloid change is fully developed, 
is unfavorable, death occurring within a few months, or under favorable 
conditions, extending to one or more years. 
Diagnosis. Differs from parenchymatous nephritis in its clinical his- 
tory, and the fact of its always being associated with a suppurating disease. 94 
PRACTICE OF MEDICINE. 
From interstitial nephritis, in its history, character of urine, absence of 
ura;mia, cardiac hypertrophy, changes in vessels, and the fact of its associa- 
tion with suppurating diseases and similar changes in other organs. 
Treatment. Sustaining and symptomatic in character. Generous 
diet, persistent use of ferrui?i and oleum morrhuce. 
If caused by syphilis, a thorough course of potassii iodidum and ferri 
iodidum with oleum morrhuce. 
Synonyms. Suppurative nephritis ; pyelo-nephritis. 
Definition. An acute catarrhal inflammation of the pelvis of the kid- 
ney ; the term pyelo-nephritis is used when suppurative inflammation is 
superadded to the pelvic inflammation. The disease is characterized by 
lumbar pains, irritability of the bladder, the urine neutral or alkaline in 
reaction, and milky in appearance; if pyelo-nephritis occur, symptoms of 
hectic fever and exhaustion are added. 
Causes. Cold or exposure; cystitis; obstruction of the ureters by 
renal calculi; pressure of tumor, etc. 
Pathological Anatomy. The inflammation is catarrhal; it is charac- 
terized by injection of the mucous membrane of the pelvis of the kidney, 
with slight extravasations of blood ; relaxation and softening, shedding of 
the epithelium, and the subsequent discharge of mucus and pus. If the 
morbid process has existed for some time, the kidneys, one or both, are 
in a process of suppuration, they are enlarged, deeply congested, except 
where suppuration is proceeding, where they are of a yellowish-white 
color—pyelo-nephritis. Pus is constantly forming, and if there is no 
obstruction, flows away with the urine ; should there be an impediment to 
its escape, pus accumulates in the pelvis of the kidney, which distends it, 
giving rise to the condition known as pyo-nephrosis. The pressure caused 
by the obstruction finally leads to destruction of the entire organ, a mere 
sac, or renal cyst, remaining. 
Symptoms. If caused by cystitis, symptoms of this condition precede ; 
if from renal calculi, its characteristic symptoms precede those of pyelitis. 
Begins by chilliness, feverishness, lumbar pains following course of 
ureters, frequent micturition, the urine milky in appearance when voided, 
acid or neutral reaction, and depositing a copious sediment, whitish or 
yellowish white in color, containing only a small amount of albumen, not 
more than is proper to pus. 
PYELITIS. DISEASES OF THE KIDNEYS. 
95 
If pyelonephritis follow, symptoms of pyaemia supervene, to .wit; fever, 
typhoid in character, low, muttering delirium, suhsultus tendinum, stupor, 
decline in strength, and loss of flesh, with perhaps a tmnor in lumbar 
region. 
If both kidneys are affected urcemic symptoms are frequent. 
Prognosis. Simple cases, where no obstruction to flow of pus, recover 
in a week to ten days. If obstruction of the ureter, the prognosis grave. 
Suppurative cases unfavorable. 
Diagnosis. From cystitis, by history, lumbar pains and acidity of 
purulent urine, the urine in cystitis being always alkaline. 
Peri-nephritis, a disease of loose tissue, around about the kidneys, 
terminating in abscess, giving lumbar pain, increased by motion or pres- 
sure, hectic fever, sense of fluctuation over kidneys, the urine remaining 
normal. 
Treatment. Rest in bed. Milk diet. Free use of water to dilute the 
urine, and free diaphoresis. Quinina to keep down temperature, prevent 
formation of pus and maintain the powers of life. 
To change the character of the secretion, Prof. DaCosta strongly recom- 
mends//.y liquida ; other remedies are oleum santali, copaiba, eucalyptol, 
terebinthma and cubeba. 
If abscess result, aspiration, quinina and stimulants. 
Synonyms. Nephro lithiasis; gravel; renal colic. 
Definition. Renal calculi are concretions formed by precipitation of 
certain substances from the urine, around some body or substance acting 
as a nucleus. 
Their presence may not be recognized until one or more attempt to pass 
along the ureters, when an attack of renal colic results; or, by irritation, 
pyelitis is produced; or, more rarely, they are voided by the urine without 
exciting any symptoms. 
By gravel is meant very small concretions, which are often passed by the 
urine in large numbers. 
Causes. Occur at all ages; frequent before the fifth year and from 
five to fifteen. Males are more liable than females. A special liability 
seems to exist in some families, but the precise etiology of calculi is not 
yet determined. 
Varieties, i. Uric acid, as calculi and gravel, and especially asso- 
ciated with the gouty diathesis. 
RENAL CALCULI. 96 
PRACTICE OF MEDICINE. 
2. Urates, chiefly urate of ammonia; nearly always in childhood. 
3. Oxalate of lime or mulberry calculus; characterized by hardness, 
roughness and very dark color. 
4. Phosphatic calculi form as frequently in the bladder as in the kidney, 
and present a chalky or earthy appearance. 
5. Alternating calculi, consisting of alternate layers of two or more 
primary deposits. 
Anatomical Characters. In structure, a urinary calculus usually con- 
sists of a central nucleus, surrounded by the body, and outside of all there 
may be a phosphatic crust. The nucleus may or may not be of the same 
material as the rest of the stone, sometimes being a foreign body, mucus or 
blood. 
A section generally shows a stratified arrangement, or it may be partly 
or completely radiated. 
Symptoms. The clinical signs of renal calculi are those consequent 
on the results of their presence, to wit: hemorrhage, renal congestion, in- 
flammation, terminating in abscess, pyelitis or pyelo-nephritis, cystitis or 
renal colic. 
The symptoms of renal colic begin abruptly, by severe, agonizing pain in 
the lumbar region, following the ureters into the corresponding groin and 
thigh. Pain and retraction of corresponding testicle, also of glans penis. 
Face pale and featwes pinched, the surface cold and damp. Irritability of the 
bladder, the urine passed in drops containing some blood. So severe is 
the pain at times that the patient may faint or pass into unconsciousness 
with a general convulsion. If both ureters are obstructed urcemic symp- 
totns will arise. 
The paroxysm usually terminates suddenly after some minutes or hours, 
the stone escaping into the bladder. 
Prognosis. Renal calculus is attended with many dangers. It may 
produce extensive disorganization of the -kidneys, or its passage along the 
ureter may prove fatal. If the stone is very large, or if more than one, the 
prognosis is more grave. Calculus is a disease very apt to recur. Renal 
sand (gravel) and small concretions may, after more or less delay, be 
voided with the urine. 
Treatment. An attack of renal colic is best relieved by a hypodermatic 
injection of morphina and a warm bath or a suppository of ext opii, 
gr. j, ext. belladonnae alco., gr. ss., repeated if needed. 
For attacks of gravel, liquorpotassii citratis, fg ss., every three hours, 
and if much vesical irritability adding find, opii catnph., f g ss-j. GENERAL DISEASES. 
97 
GENERAL DISEASES. 
DIPHTHERIA. 
Synonyms. Putrid sore throat; malignant ulcerous sore throat; ma- 
lignant quinsy ; membranous angina. 
Definition. An acute specific constitutional disease, both epidemic and 
contagious, beginning by an affection of the throat, and characterized by a 
local exudation and glandular enlargements; attended with great prostra- 
tion of the vital powers and albuminuria, and having for its sequelae 
various paralyses. 
Causes. A specific poison, the character of which is unknown. It is 
preeminently a disease of childhood. Rare among adults; very rare 
in old age. It is apt to recur in those who have once been affected. All 
conditions of bad hygiene increase its virulence and favor its diffusion, 
although the chief cause of its spread is contagion. 
The poison exists in the exudations and secretions of the fauces and the 
breath, and floats in the atmosphere at a considerable distance from the 
original source. 
The theory of “ No bacteria, no diphtheria,” is not entirely proven. 
The period of incubation is from three to five days. 
Pathological Anatomy. The diphtheritic inflammation differs from 
either the croupous or catarrhal form, in that the exudation is not only 
upon, but also within, the substance of the mucous membrane. At first 
there is redness, which may begin in any part of the throat, associated with 
swelling and increased secretion of viscid mucus. The redness spreads 
over the entire mucous surface, when the exudation makes its appearance. 
The deposit may commence from one or several points, such as on one 
tonsil, the soft palate, or the back of the fauces, which, however, speedily 
extend and coalesce, forming extensive patches, or cover uniformly the 
entire surface. 
The patches are of variable thickness, which is increased by successive 
layers being formed underneath. 
The color is usually gray, white or slightly yellow, but may be brownish 
or blackish, the consistence ranging from “ cream to wash leather.” 
On removing the membrane, which is accomplished with more or less 
difficulty, a raw, bleeding surface is exposed; at times an ulcer, which is 
speedily covered with a fresh deposit. 98 
PRACTICE OF MEDICINE. 
If the exudation separates itself, it is either not renewed at all or only in 
thinner films. 
Occasionally considerable ulceration or sloughing of the soft palate, uvula, 
or tonsils result, or abscesses may form. 
The exudation or membrane, examined by the microscope, is composed 
of fibrin, pus corpuscles, epithelial granular cells and bacteria. 
If the larynx, trachea or nasal mucous membranes participate in the 
disease, the croupous and not the diphtheritic form of inflammation occurs. 
The lymphatic glands of the neck, whose vessels originate in the faucial 
tissues, are enlarged and inflamed, and contain large numbers of bacteria, 
probably originating as the result of decomposition. 
The muscular tissue of the heart becomes soft, is easily torn, and its 
fibrillse are far advanced in fatty degeneration. Ulcerative endocarditis 
has been frequently observed. 
The kidneys undergo a granular degeneration in severe attacks. 
The blood undergoes alteration, being black and fluid. 
Symptoms. Following the law of contagious diseases, the symptoms 
vary in intensity in different cases, the prominent symptoms being often 
disproportionate to the gravity of the attack. 
The invasion may be mild, with rigors succeeded by moderate fever, 
headache, languor, loss of appetite, stiffness of the neck, tenderness about 
the angles of the jaw, or slight soreness of the throat. 
In other cases the invasion is more abrupt and severe, with chilliness 
followed by great febrile reaction, 103° to 105°, F., pain in the ear, aching 
of the limbs, loss of strength, painful deglutition and swelling of the neck, 
compelling the patient to take to bed from the onset. 
The appetite is poor, the tongue slightly coated; sometimes more or less 
exudation appearing upon it, the bowels being either regular or slightly 
relaxed. The pulse, at first full and strong, soon becomes either frequent 
or slow, but compressible. The urine is scanty, high colored, and contains 
albumen. 
The local symptoms in the majority of cases are associated with the 
throat. The patient complains of a frequent and persistent desire to hawk, 
in order to clear the throat. On inspection the fauces are seen red and 
swollen, and more or less covered with the diphtheritic exudation ; some- 
times the tonsils and uvula are greatly swollen and spotted with exuda- 
tion. In bad cases, more or less ulceration or sloughing may be observed. 
Not unfrequently fragments of exudation, the false iriembrane, are expec- 
torated, with particles of the ulcerated tissues, having an offensive odor GENERAL DISEASES. 
99 
which is transmitted to the breath. The lymphatic glands of the neck 
are enlarged and tender, and in severe cases the tissues of the neck 
are greatly tumefied. 
Extension to the nasal cavities causes a sanious and offensive discharge 
from the nose, with attacks of epistaxis. 
Extension to the larynx is indicated by hoarseness or complete loss of 
voice, croupy cough and obstructive dyspncea, which often becomes urgent, 
the breathing being noisy and stridulous, and subject to paroxysmal ex- 
acerbations. If the inflammation extends to the bronchi, the breathing 
becomes still more embarrassed. 
Duration. Ranges from two to fourteen days, an average being about 
nine days, although complications and sequelae may prolong its course. 
Relapses are not uncommon. 
Sequelae. Those who recover from a severe attack remain often for 
weeks with a pale and cachectic appearance, due to the profound blood 
alteration. 
Paralysis is a common sequelae, following the mild as often as the se- 
vere attacks. Usually not occurring until the patient seems fully conva- 
lescent. 
Pharyngeal paralysis is the most common, causing difficulty or inability 
of deglutition, fluids regurgitating through the nose. 
Cardiac paralysis is not unfrequent, the pulsations descending to 60, 50, 
40, and in a case seen by the author, to 20 per minute. 
Diphtheritic paralysis may affect the motor muscles of the eye, 
causing strabismus; the muscles of one side, hemiplegia ; of the legs, 
paraplegia ; and of the bladder, leading to retention of urine, or difficulty 
in passing it. 
Sensation is also diminished in the paralyzed parts. 
Prognosis. Always grave, but more so in children than in adults. Its 
gravity, in the majority of cases, is proportionate to the local symptoms. 
The average mortality is about ten per cent. 
Favorable indications are, moderate fever, strength slightly impaired, a 
good constitution, and moderate exudation. 
Unfavorable indications are, great depression, spreading exudation, 
great swelling of the cervical glands, large amount of albumen, extension to 
larynx and nasal mucous membranes, hemorrhages from the fauces and 
nose, and an epidemic character. 
Diagnosis. From follicular ulceration of the tonsils, which is fre- 
quently termed diphtheria, by the slight or absent systemic symptoms, the 100 
PRACTICE OF MEDICINE. 
ulcerated condition being limited to the tonsils, often but one, and the ab- 
sence of glandular enlargement and following palsies. 
¥xom pharyngitis, by the absence of exudation and loss of faucial tissue, 
and constitutional symptoms. 
From membranous croup, by the difference in the constitutional symp- 
toms ; in diphtheria of the larynx the depression is markedly that of blood 
alteration, while in croup all symptoms of depression are in proportion to 
the obstruction to respiration. In croup the pharynx contains no mem- 
brane, and is but slightly inflamed, the reverse obtaining in diphtheria. 
Again, in croup the laryngeal symptoms are from the onset, while in 
laryngeal diphtheria the pharyngeal symptoms almost always precede. 
From scarlatina, by tb£ presence of the eruption and the absence of 
membrane in the fauces. 
Treatment. No specific. The blood being more or less altered, it 
follows that sustaining measures must be resorted to in all cases. 
The diet must be of the most nutritious character from the onset, such 
as milk, eggs, broths, oysters, etc., at intervals of every two or three hours. 
If deglutition is too painful, resort must be had to nutritious enemata. 
Stimulants must be used boldly from the onset, guiding the dose by the 
effect; usually, a child of two years requires from thirty to sixty minims 
of spiritus vini gallici every two or three hours; an adult, from two to 
four drachms every three hours. 
Ferrum and potassii chloras, in full doses, frequently repeated, have 
seemed, when begun early in the attack, to modify the course of the mal- 
ady, and they have the additional advantage of locally acting upon the 
throat as they are swallowed. A good formula is— 
]£. Tinct. ferri chlor gtt. v-x-xv 
Potassii chlor gr. iij—v 
Glycerinae n\, xv 
Syr. zingib ad f:jj-ij. M. 
SlG.—In water every three hours, for a child of two or three years. 
The efficacy of the above is greatly enhanced, in the author’s experience, 
by the addition to each dose of tinct. belladonna;, gtt. j-v. 
Quinina, gr. xvj-xxiv per day for young adult, and gr. v-x for child, 
should be used throughout the disease. 
Calomel in small doses, combined with sodii bicarbonas every hour 
until the breath becomes fetid, is beneficial, and especially in cases showing 
a tendency to spread toward the larynx. Indeed, a tolerance to calomel 
seems to exist in diphtheria. GENERAL DISEASES. 
101 
Hydrarg. chlor. corros., gr. -jViV repeated every second or third hour, 
also acts well in many cases. 
Locally. Cleanliness of the fauces is of the utmost importance, and if a 
non-irritating disinfectant is added, its value is enhanced. Dr. Bar- 
tholow “ has seen excellent results from the frequent application of a solu- 
tion of acidum lacticum, strong enough to taste sour, by means of a mop.” 
The following, used as a gargle, or applied by mop, is useful:— 
R . Acid, salicyl gr. xx 
Glycerinae f 3 j 
Aquae destil fj§ iij. M. 
Or— 
R. Potass, chloras giv 
Acid carbol . gr. ij-iv 
Tinct. myrrh Sj 
Inf. cinchonae gij. M. 
Or— 
R. Thymol gr. x-xx 
Glycerinae sjj-ij 
"Aquae j—ij M. 
Inhalations of steam and hot water, and allowing patient to suck pellets 
of ice, give relief. Sponges dipped in. hot water and applied to the 
angles of the jaw are beneficial. 
For laryngeal diphtheria same general treatment, especially the mercurial, 
with inhalations of lime by slaking freshly burned lime in a vessel and direct- 
ing the vapor to the child by a newspaper, or some similar contrivance, or 
using three parts of liquor calcis and one part of glycerin, in an atomizer, 
every half hour or hour. If these means fail, resort must be had to trache- 
otomy, which has succeeded in many desperate cases. 
For nasal diphtheria the same general treatment, and syringing the 
nose every two or three hours with a weak solution potassii chloras, or 
acidum carbolicum, or the following:— 
R. Sodii sulphit 3 iij 
Glycerinae f% ij 
Aquae f §iv. M. 
For the paralysis, strychnina and ferrum internally, or strychnina hypo- 
dermatically, with the galvanic current locally. 102 
PRACTICE OF MEDICINE. 
ACUTE ARTICULAR RHEUMATISM 
Synonyms. Rheumatic fever; inflammatory rheumatism. 
Definition. A constitutional disease, characterized by fever, inflamma- 
tion in and around the joints, occurring in succession, and a great ten- 
dency to inflammation of either the endocardium or pericardium. 
Causes. The predisposing causes are inherited tendency, scarlatina, 
and the puerperal state. 
The exciting causes, exposure to cold and chilling of the body. Rheu- 
matism rarely occurs before seven or after fifty years. The liability to the 
disease is increased by having had an attack. 
Pathological Anatomy. The blood contains an excess of lactic acid. 
The joints bear the brunt of the attack; the synovial membrane is 
reddened, the vascularity of the synovial fringes is increased, so with the 
synovial fluid, which is thinner, of a reddish color, containing some gela- 
tinous coagula of fibrin, and under the microscope nucleated cells, ordi- 
nary pus cells being rarely seen. 
The swelling visible about the affected part depends mostly on inflam- 
matory oedema of the connective tissue around the joint. 
The pain is probably due, in all cases, to stretching of and pressure on 
the elements of the tissue by the dilated capillaries and the inflammatory 
oedema. For the changes which ensue when the endo- or peri-cardium 
is attacked, the reader is referred to the articles on those diseases. 
Symptoms. Begins suddenly, generally at night, with a chill or chilli- 
ness, pain and stiffness in the joints, loss of appetite, at times, nausea and 
vomiting, followed by fever, the temperature soon reaching 102°, F., to 
104°, in rare cases 108° to iio° {the hyperpyrexia'), the pulse seldom 
exceeding 95, great thirst, profuse acid sweats, scanty, high colored, acid 
urine, at times showing traces of albumen, the bo7oels constipated. The 
fever continues throughout the attack, showing marked remissions. Deli- 
rium is absent, except the hyperpyrexia occur. Sleep is prevented by pain 
and profuse perspirations. The strength is moderately well preserved. 
The skin is often covered with an eruption of miliaria rubra, redpapulce 
and miliaria alba, the result of irritation at the orifices of the perspiratory 
glands, from excessive sweating. 
The local phenomena are pain, tenderness, increased heat, swelling 
and redness of one or more joints; if but one joint, it is termed 1710710- 
arthritis, if more than one, polyarthritis. Pain is aggravated by motion 
and pressure. Swelling is most apparent in those joints not covered with GENERAL DISEASES. 
103 
muscle, viz: knee, wrist, elbow, ankle, and the hands and feet, and is 
proportionate to the acuteness of the attack. The inflammation may 
abruptly cease at one or more joints, and as suddenly attack others. 
The disease is extremely irregular as regards the number of joints 
affected, although the local manifestations are controlled by an important 
pathological law, viz: the law of parallelism. Corresponding joints are 
often affected together, and when not, the different affected joints are 
either on one side of the body, or those on both sides which are analo- 
gous, viz: knee, elbow, wrist, ankle, hip and shoulder, are attacked 
together. 
Complications. Pericarditis, endocarditis, myocarditis, cerebral 
endarteritis, bronchitis, pneumonitis and pleuritis. 
Duration. The duration of acute rheumatism is governed entirely by 
the presence or absence of complications. Uncomplicated cases recover 
in from thirteen to twenty-one days, although they may be prolonged to 
five or six weeks. 
Prognosis. Recovery the rule in uncomplicated cases, the mortality 
being about three per cent. When death occurs it usually depends upon 
hyperpyrexia, cardiac complication, or cerebral endarteritis. 
Diagnosis. A typical case cannot be mistaken for any other disease, 
but cases running a subacute course may be mistaken for acute rheumatoid 
arthritis, gonorrheal rheumatism, or pysemia. 
Acute rheumatoid arthritis attacks one joint at a time and becomes 
permanent, has slight if any fever, no sweats or cardiac lesions. 
Gonorrhoeal rheumatisr?i is associated with a gleety discharge, attacks 
either the ankle or wrist only, is slowly influenced by treatment, and lacks 
the febrile phenomena. 
Pycemia is usually manifested at a single joint at the time, and is fol- 
lowed by suppuration and all the symptoms of hectic fever. 
Treatment. Rest in bed, whether the pain forces it or not, is impera- 
tive. Next, keep the patient warm, for which purpose he should be kept 
in blankets—no sheets, and wear woolen garments. The diet must be 
easily digested food, milk being the best. 
Locally, the affected joints should be wrapped in cotton-wool or flannel, 
saturated with a solution of tinct. opii, one part, and liq. plumb, subacetat. 
dil., two parts. Dr. Bartholow finds the application of blisters an effective 
method. He says, “ I have small blisters, the size of a silver dollar, 
placed around the joint, leaving an interval between for succeeding appli- 
cations. It is by no means so painful and disagreeable as it appears at first 104 
PRACTICE OF MEDICINE. 
sight. The blisters remarkably relieve the pain, bring about a more alka- 
line condition of the blood, and render the urine less acid, or bring it to 
neutral, or even to alkaline.” 
Strong and vigorous patients do best with acidurn salicylicum or the 
salicylates in large and frequently repeated doses, viz :— 
R . Acid, salicyl gr. xx 
Liq. ammon. acetat fg iss 
Spts. aetheris. nitrosi IT^xv 
Syr. simplicis b\xv 
Every three hours, well diluted. 
Or, 
R. Sodii salicyl gr. xx 
Spts. lavend. comp Ttpxv 
Glycerin® £ss 
Aquae ad fHjss 
Every three hours, well diluted. 
If benefit follows, the evidence is quickly afforded in relief of pain and 
decline of temperature and swelling. If, therefore, after three or four 
days’ use of the salicylates or acidurn salicylicum, as above recommended, 
signs of improvement are wanting, the treatment had better be changed 
for the alkaline treatment, which consists in the administration of an ounce 
and a half of the alkaline carbonates, either alone or with a vegetable 
acid, each twenty-four hours, until the urine becomes neutral or alkaline, 
when the quantity is reduced to an amount sufficient to maintain alkaline 
urine, viz:— 
R . Potass, bicarb sj ij 
Acid tartaric gr. xv 
Dissolved in a glass of water and drank effervescing every three hours. 
Or, 
R. Potass, bicarb 3 ij 
i Succi limonis zj 
Aquae cinnamomi ad M. 
Sig.—In water every three hours. 
After the more acute symptoms are passed, change either ■ of the above for 
tind. ferri chlor., gtt. xx every four hours, well diluted. 
Pale, feeble and anaemic patients, or attacks following scarlatina, etc., 
are most favorably influenced with 
R. Tinct. ferri chlor gtt. xx-xxx 
Syr. limonis gtt. xx 
Aquae fgj. M. 
Sig.—Every four hours, in glass of water. GENERAL DISEASES. 
105 
Prof. DaCosta reports a lessened proportion of cardiac complications with 
ammonii bromidum, gr. xv-xx, every four hours. 
Subacute attacks and lingering cases are favorably influenced by 
R. Lithii citras gr. xxx 
Syr. zingib ' f^j 
Aq. lauro-cerasi fgj M. 
Every four hours. 
Pain and restlessness should be controlled by opium in some form, in 
full doses, or atropina, gr. hypodermatically. 
For the hyperpyrexia, quinina, gr. xxx-lx repeated p. r. n., with the 
cold bath or wet-pack. 
The complications are to be treated according to their character. 
MUSCULAR RHEUMATISM. 
Synonyms. According to location, viz.: lumbago; torticollis ; pleu- 
rodynia, etc. 
Definition. An affection of the voluntary muscles, inflammatory in 
character, either acute or chronic ; characterized by pain, tenderness, and 
stiffness of the affected muscles. It is never complicated with cardiac 
disease. 
Cause. A disease of adult life. One attack predisposes to another. 
Almost always due to cold and damp, or direct draught of cold air. Gout 
increases the tendency to attacks. 
Pathological Anatomy. The true nature of muscular rheumatism is 
not yet determined. Virchow suggests a “ hyperaemia of, and. scanty 
serous exudation between, the muscular striae, and in chronic cases inflam- 
matory proliferation of the connective tissue.” 
Symptom's. The first attack is generally acute. Onset rather sudden, 
with pain in affected muscles, slight tenderness, and considerable stiffness, 
with difficulty of movement, by which also the pain is increased. 
The suffering may be severe and constant, or only on motion. Spasm 
of the affected muscles may occur. Objective symptoms are wanting, 
except it is evident the patient keeps the affected muscles as quiet as pos- 
sible. Fever is absent. The pain may prevent sleep. 
Duration, acute form, about one week. Chronic returns frequently, 
and finally becomes constant and aggravated when the weather is damp. 
Varieties. It may affect any or all of the voluntary muscles, but its 
most frequent and important varieties are:— 106 
PRACTICE OF MEDICINE. 
1. Cephalodynia. Situated in the occipito-frontal muscle. Distin- 
guished from neuralgia of the trifacial, or occipital nerve, by pain on 
both sides of the head, excited or aggravated by movements of the muscle, 
and by absence of disseminated points of tenderness. 
The muscles of the eye may be -affected when movements of that organ 
excite pain. If the temporal and masseter muscles are attacked, mastica- 
tion excites pain. 
2. Torticollis. Wry-neck, or stiff-neck. Situated in the sterno-mastoid 
muscles. Generally limited to one side of the neck, towards which side 
the head is twisted, great pain being excited on attempting to turn to the 
opposite side. Rheumatism of the muscle of the back of the neck, cervi- 
codynia, may be mistaken for occipital neuralgia. 
3. Pleurodynia. Situated in the thoracic muscles, and may be mistaken 
for pleuritis, or intercostal neuralgia, from which it is differentiated by the 
absence of the diagnostic features of each. Pain is excited by forced 
breathing, coughing and sneezing. 
4. Lumbodynia or lumbago. Situated in the mass of muscles and 
fasciae which occupy the lumbar region. Most common variety. Usually 
affects both sides. It may set in rapidly and become very severe. Motion 
of any kind aggravates the pain, often becoming sharp or stabbing in char- 
acter. It is sometimes complicated with acute sciatica, when the suffering 
is agonizing. 
Prognosis. Difficult to eradicate, and in chronic cases to ameliorate; 
but is not dangerous to life. Death never results. 
Diagnosis. The different varieties may be mistaken for any of the 
following ailments, to wit: trifacial, occipital or intercostal neuralgia, 
pains of progressive muscular atrophy, syphilis, metallic poisons, or 
painful affections of the loins, arising from calculi or gravel in the 
kidney. 
A careful examination of the history is usually sufficient to arrive at a 
correct diagnosis. 
Treatment. Rest is the first indication. This is accomplished in 
pleurodynia by firmly strapping the affected side with broad strips of plaster, 
extending from mid-spine to mid-sternum. 
The local application to the affected muscles of hot poultices, made of 
tw-o-thirds pilocarpus leaves and one-third flaxseed meal, changing them 
every two hours, is, in the opinion of the author, the most rapidly successful 
treatment in acute cases. GENERAL DISEASES. 
107 
For the pain and consequent sleeplessness use— 
‘ R . Pulv. ipecac comp gr. x 
Potass nitras gr. v-x. M. 
Sig.—In powder, morning and night. 
Or, hypodermatically,at the seat of pain, morphina, gr. |-£, and atropina, 
gr. p. r. n. 
Chronic cases; Rest, flannel worn next to skin, stimulating and anodyne 
liniments, mild galvanism, dry heat, as ironing over the affected part with 
a common flat-iron, a piece of paper, towel, etc., being placed next to the 
skin. 
Internally, potassii iodidum, amnion, murias, sulphur, guaiacum or 
arsenicum, variously combined. 
RHEUMATOID ARTHRITIS. 
Synonyms. Arthrititis deformans; rheumatic gout. 
Definition. An inflammation of the joints, accompanied with but slight 
fever, without suppuration, progressive in character, causing nearly symmet- 
rical enlargement and deformity of various articulations. 
Causes. More common in females than in males, and in the weak and 
anaemic. Among the causes are bad hygiene, exposure, prolonged lacta- 
tion, frequent pregnancies, menopause, grief, tubercular diathesis, and 
following attacks of articular rheumatism. 
Pathological Anatomy. It is not rheumatism, as the blood contains 
no lactic acid. It is not gout, as uric acid is not found in the blood nor 
urate of sodium in the joints. 
At first rheumatoid arthritis is attended with hyperaemia of t]ie affected 
synovial membrane and increase of the synovial fluid. Soon the capsular 
ligament becomes irregularly thickened, the synovial fluid decreasing. If 
the process continue, the internal ligament is destroyed, thus allowing 
dislocations, to occur. The inter-articular fibro-cartilages ulcerate and 
disappear, as does the cartilages covering the ends of the bones, the ends 
of the bones becoming smooth and eburnated, and often greatly enlarged. 
Symptoms. Either acute or chronic, the latter most common. 
Acute form involves several joints at the same time, and is attended 
with slight pyrexia. 
Chronic form slowly involves one joint, which seemingly soon recovers, 
and is attacked again, and may never recover, but grow progressively 
worse. 108 
PRACTICE OF MEDICINE. 
The joint slowly enlarges, is painful, movement exciting neuralgic pains 
along the limb. Soon the articulation becomes rigid or slightly movable 
after prolonged attempts. Redness and tenderness are wanting. Crepita- 
tion is distinct after ulceration has destroyed the cartilages. 
The hands are first involved, the disease spreading symmetrically from 
articulation to articulation, until in severe cases every joint is deformed. 
Prognosis. If early treatment is instituted, the disease may be held in 
abeyance for several years. After pronounced structural changes have 
begun, the malady is incurable, although it may remain stationary for 
a long time. 
Diagnosis. Chronic articular rheumatism is often confounded with 
rheumatoid arthritis; but the former lacks the marked structural changes 
and the progressive involvement of joint after joint. 
Gout differs from rheumatoid arthritis by the presence of deposits of 
urate of sodium in the joints, the ears, tips of fingers and the bursae over the 
olecranon process of the elbow, the presence of uric acid in the blood, and 
ie decided history of acute paroxysms. 
Gonorrhoeal rheumatism, so-called, has symptoms akin to rheumatoid 
arthritis, but the history of urethral suppuration clears up the diagnosis. 
Paralysis agitans, when pronounced, might be confounded with rheu- 
matoid arthritis, if the examination were limited to the joints, but the whole 
history, such as the tremor, the gait, etc., should prevent mistake. 
Treatment. If treatment is instituted before serious structural lesions 
have occurred, the author has seen benefit in many cases by the following 
treatment: Oleum morrhuce carefully and thoroughly rubbed into the 
affected joints, three times a day, with the internal use of lithii citras. 
effervescentes 3 j, three times a day, and the following tonic mixture : — 
]£. Massae ferri carbonat gr. v 
Liquor, potass, arsenit v 
Vini xerici 3 j 
Aquae 3; j. M. 
After meals, well diluted. 
Attention to diet, hygiene, etc., are also necessary. When structural 
changes have destroyed portions of the joint, palliative treatment is the 
only indication. GENERAL DISEASES, 
109 
GOUT. 
Synonyms. Podagra, gout in the foot; chiragra, the hand; gonagra, 
the knee. 
Definition. A constitutional disease, usually inherited; characterized 
by the sudden occurrence of a paroxysm of severe pain and swelling in one 
of the smaller joints—the great toe usually—with the presence of uric 
acid in the blood, and the deposit of the urate of sodium in the structure 
of the joint. 
Causes. Predisposing; inherited; male more than female—woman 
after menopause. 
Exciting. Malt and wine drinking, whether male or female; large 
consumption of animal food; lead poisoning; winter season. 
When inherited tendency, may begin early in life; when acquired ten- 
dency, after thirty-five years. 
The pathological cause consists in the presence of an excess of uric acid 
in the blood, in the form of urate of sodium. 
Pathological Anatomy. Gout is characterized by the deposit of 
urate of sodium from the blood into the structure of the joints and tissues 
that are not very vascular. The deposit is associated with signs of inflam- 
mation, viz: hypersemia and redness of the surface, with swelling and 
effusion in and around the affected joint. The surfaces of the joint are 
incrusted with chalk-like masses, consisting of urates, which become greater 
with each attack, finally causing great deformity. 
The deposit usually begins in the metatarso-phalangeal joint of the great 
toe, but other and many joints soon suffer. 
The deposits may also be found in the knuckles, eyelids, and cartilages 
of the ear. 
“ Crystals of urate of soda are deposited in the tubules and intra tubular 
tissues” of the kidneys—“gouty kidney ”—and maybe seen by the naked 
eye, the kidneys becoming small, granular and fibrous. 
Hypertrophy of the left ventricle and the arteries, ending in atheroma- 
tous changes, are results of gout. 
Symptoms. Acute Gout. Occurs in paroxysms; one year’s interval 
between first and second attack ; six months usually between second and 
third, after which may occur at any time. 
Prodromes usually precede paroxysm for several days, viz : acid dyspep- 
sia, constipation, headache, etc. 
The paroxysm begins suddenly, between midnight and 2 A. M., with 110 
acute pain in the ball of the great toe, which becomes red, hot, swollen, and 
so sensitive that the slightest touch cannot be borne. 
The veins are filled, the foot, ankle and leg swollen, and the limb the 
seat of sudden spasmodic contractions, which increase the suffering. Slight 
relief is afforded by elevating the limb. Associated with the local symp- 
toms are, chill, fever, quickened pulse, thirst, coated tongue, constipation, 
and scanty, acid, high-colored urine, which deposits, on cooling, a heavy 
brick-dust sediment. 
Towards daylight the symptoms ameliorate, to return again at sundown, 
the severity gradually lessening, until the fourth or fifth day, when conva- 
lescence is established, the patient, as a rule, feeling better than before the 
attack. 
Chronic Gout. Either result of acute attacks or with a greater number 
of joints being attacked. 
The paroxysms occur at any time, but develop slowly, with less pro- 
nounced local and general symptoms. Deposits are noticed, the joints be- 
coming hard, knobby, and often distorted. The deposits or chalk-stones 
(urate of sodium) occur about the joints, tendons and bursae, helix of the 
ear, etc. 
Prognosis. Acute gout rarely fatal; is prone to return, but much de- 
pending upon the mode of living. 
Chronic gout decidedly shortens life The most serious signs are those 
indicating advanced renal disease, with non-elimination of uric acid. 
Gout influences unfavorably the prognosis from acute diseases or injuries. 
Diagnosis. An error cannot occur if the history of the case can be 
obtained, to wit: hereditary tendency, age, sex (females rare, until meno- 
pause), mode of living, character of symptoms and presence of the char- 
acteristic deposits. 
Treatment. For the acute paroxysms at once vinum colchici radicis, 
gtt. xv-xx-xxx, every two hours, well diluted, either alone or in combina- 
tion with an alkali, or sodii salycilas, gr. xx, every three or four hours, 
well diluted. 
For the pain, hypodermatic injection of mo7phina, and wrapping the 
inflamed joint with cotton wool saturated with liq.plumb, sub-acetat. dil. and 
find. opii. 
The diet must be reduced to liquid food. 
For chronic gout, regulated diet, free action on the secretions, and litkii 
citras. effervescentes, gj, three or four times a day, well diluted with water. 
To prevent paroxysm, keep secretions acting, regulated diet, systematic 
exercise and a prolonged course of alkaline waters. 
PRACTICE OF MEDICINE. GENERAL DISEASES. 
111 
LITH^EMIA. 
Synonyms. Lithiasis ; uric acid diathesis ; half gout. 
Definition. A condition in which the fluids of the body are saturated 
with nitrogenized waste, in the form of lithic or uric acid; characterized 
by marked dyspepsia, various nervous phenomena, muscular and articular 
pains, bronchial catarrh, all or any of these associated with scanty, high- 
colored, acid urine. • 
Causes. High living, with little exercise ; imperfect digestion of nitro- 
genized food; impaired elimination of uric acid. 
Symptoms. Those of dyspepsia associated with irregular bowels, 
scanty, high-colored, acid urine, sp. gr. 1.024-1.028 containing neither 
sugar nor albumen, but showing increased proportion of urates. Also, 
depressed spirits, impaired memory, loss of interest in occupation, sleepless 
nights, attacks of vertigo, neuralgic pains in head, and constant dread of 
apoplexy or cerebral disease. Also,pains in joints, of neuralgic character. 
If the condition is allowed to continue, the following organic changes 
may result, viz: fatty heart; fibroid kidney ; enlarged liver, or changes in 
the cerebral vessels. 
Prognosis. If properly recognized and treated, complete recovery will 
result, although it is of long duration. 
If not properly treated, results in some one of the organic diseases 
mentioned. 
Diagnosis. From gout by absence of acute paroxysms and resulting 
changes in joints. 
Treatment. Regulate diet, avoiding much meat and sugar, and all 
forms of stimulants. Act freely on all the secretions. Systematic exercise. 
Avoid tonics, bromides, chloral, opium, etc. Long course of alkaline 
waters. Good results follow lithii citras., gr. xx, t. d., sodiiphosph., gr. 
xxx, bis die, acidum benzoicum, gr. x, t. d., all well diluted with water. 
The author strongly urges the use of acid nitric dil., gtt. x, in half a glass 
of water, four times a day, with the occasional use of pilulce rhei comp., at 
bedtime. 
DIABETUS MELLITUS. 
Synonyms. Glycosuria; melituria. 
Definition. A chronic affection characterized by the constant presence 
of grape-sugar in the urine, an excessive urinary discharge, and the pro- 
gressive loss of flesh and strength. 112 
PRACTICE OF MEDICINE. 
Causes. Most common in males. Occurs at all age£, but most fre- 
quently between twenty-five and fifty years. It is often hereditary. Dis- 
orders of the nervous, hepatic and renal systems. Excessive use of farina- 
ceous food and malt liquors. Sexual excesses. 
The exact pathology of diabetes mellitus differs in different cases, and in 
the present state of our knowledge no exclusive view can be adopted. 
Still, there are reasons for believing that, in a large proportion of cases, 
the nervous system is primarily at fault, though the character of the lesions 
may differ. 
Pathological Anatomy. None peculiar to diabetes are yet recognized. 
Hyperaemia and hypertrophy of the liver and kidneys are generally 
present, the result of increased functional activity. 
The changes in the lungs peculiar to phthisis are often found in very 
chronic cases. 
The changes in the nervous system are not fully determined. 
Symptoms. Clinically cases differ greatly in their course and severity ; 
one class presenting slight symptoms and a chronic course; another group 
having marked local and constitutional symptoms and an acute course. 
The symptoms of a typical case may be arranged under the following 
heads:— 
Urinarv Organs and Urine. Micturition more frequent and the urine 
increased in quantity. Pain over the region of the kidneys. The quantity 
of urine may amount to 4, 8, 12, 20 or 30 pints in twenty-four hours. It 
is usually pale, clear and watery, having a sweetish taste and odor, the 
specific gravity ranging from 1.015 to 1.050. It ferments rapidly if kept 
in a warm place. It yields grape sugar to the usual tests, the amount 
present varying from an oitnce to two pounds in the twenty-four hours. 
The urea and uric acid are increased. Albumen may be present. 
Digestive Organs. An almost constant symptom is thirst, with a dry 
and parched condition of the mouth. At times the appetite is excessive, 
again absent. The breath may have a sweetish odor, the tongue irritable, 
red, and often cracked. Dyspeptic symptoms are common, and occasion- 
ally vomiting. The bowels are constipated, the stools pale and dry. At 
times diarrhoea may occur. 
General Symptoms. The' patient complains of feeling very weak, 
languid, and of soreness and pain in the limbs. The prominent features 
are more or less e?naciated, the skin harsh and dry, and the countenance 
distressed attd worn. 
The mind is often greatly altered; depression of spirits, decline in firm- GENERAL DISEASES. 
113 
ness of character and moral tone, with irritability, are present. Sexual 
inclination and power are diminished. Defects of vision are present. 
The blood and various secretions contain sugar. 
Complications. Pulmonary phthisis; Bright’s disease; defects of 
vision from atrophy of the retina or the formation of a soft cataract; boils 
and carbuncles, and chronic skin affections, such as psoriasis, etc. 
Course. The clinical history varies in different cases. In the majority 
of cases the course is chronic, lasting for years, the symptoms beginning 
insidiously, and becoming progressively worse, with, at times, decided 
remissions. Occasionally the disease runs an acute course, death occur- 
ring within four or five weeks. 
Termination. The majority of cases ultimately prove fatal, the symp- 
toms markedly changing, the urine and sugar diminishing in quantity, 
the occurrence of albuminuria, disgust for food and drink, and the de- 
velopment of hectic fever or colliquative diarrhoea. 
The fatal result usually arises from gradual exhaustion, from blood 
poisoning, leading to stupor, ending in complete coma, or occasionally to 
delirium or convulsions, or from complications. 
Rarely, death occurs suddenly, from urcemic convulsions or urcemic coma. 
Prognosis. Most unfavorable, as a cure, it being fairly ques- 
tionable if complete recovery has ever occurred in a typical case. Still, 
decided amelioration may take place in the symptoms, and the progress of 
the malady greatly retarded. The younger the patient the more rapid the 
fatal termination. 
Diagnosis. Diabetes mellitus only exists when grape sugar is perma- 
nently present in the urine. “ It is not the quantity, but the persistence of 
sugar which constitutes diabetes.” 
When are present grape sugar in the urine, with more or less increase in 
the urinary flow, it can be mistaken for no other affection. 
Treatment. Impress upon patients the importance of a strictly regu- 
lated diet. Prohibit or restrict the consumption of such articles as contain 
sugar or starch, especially ordinary bread or flour, sugar, honey, potatoes, 
peas, beans, rice, arrowroot, etc. 
The main diet should be of animal food, including meat, poultry, game 
and fish. 
A moderate amount of fluids should be allowed, and in a majority of 
cases milk will prove beneficial, although, theoretically, contraindicated. 
Tea, coffee and cocoa, without sugar, may be allowed in moderation, 
glycerine being used as a substitute for the sugar. 114 
PRACTICE OF MEDICINE. 
Regulated exercise is of importance. The patient should wear flannel, 
and have two or three warm baths every week, or an occasional Turkish 
bath. 
Therapeutical Treatment. Opium exercises an influence over the 
excretion of sugar, but the effect is not maintained. Pavy strongly urges 
the use of codeia in doses of gr. three times a day. Prof. DaCosta 
suggests the use of ergota, which has decreased the urinary discharge and 
the quantity of sugar in a number of cases. Dr. Bartholow has met with an 
apparent cure by ammonii carbonas. The author has met with decided 
partial success with uranii nitras, gr. j-iij, three times a day, the cases not 
yet being under observation a sufficient length of time to pronounce them 
cured, although in two the urine has been diminished from three quarts 
per day to normal, the quantity of sugar from nine ounces to less than half 
an ounce, in the twenty four hours. 
Potassii bromid., p>) during the twenty four hours, is strongly urged. 
The following remedies are recommended by different observers, viz.: 
pepsin, liquor potassii arsenites, iodum, potassii idod., sodii salicylas, acidum 
lacticum, glycerinum, quinina, ti7ict. cannab. indica, etc. The evidence 
in favor of the majority of these drugs is far from satisfactory 
Symptomatic treatment is mostly called for. For emaciation and 
and oleum morrhua ; for sleeplessness and restlessness, 
morphina, potassii bromidum, chloral or hyoscyamia ; the dyspepsia, lung 
symptoms, etc., must be managed on general principles. 
DIABETES INSIPIDUS. 
Synonyms. Polyuria; polydipsia. 
Definition. An affection characterized by the habitual discharge of a 
very large quantity of pale, watery urine, free from albumen and sugar. 
Causes. Occasionally hereditary, or diabetes mellitus may have existed 
in the parent; more common in children or young adults ; men are more 
subject than women ; injuries and diseases of the nervous system; exposure 
to cold; drinking freely of cold water; fatigue; prolonged debility; 
malaria; syphilis. 
The probable immediate cause of the excessive flow of urine consists in 
dilatation of the renal vessels, the result of paralysis of their muscular coat, 
caused by derangement of innervation, as the condition can be induced 
experimentally by irritating a spot in the fourth ventricle, or by section of 
portions of the sympathetic nerve. GENERAL DISEASES. 
115 
Symptoms. The affection is characterized by great thirst, with an 
increased flow of pale, watery, slightly acid urine, the amount varying from 
one to five or six gallons in the twenty-four hours. The specific gravity 
ranges from i.ooi—1.007. Sugar and albumen are absent. Urea and the 
other solids are increased. The appetite is voracious, the bowels are 
obstinately constipated, and the skin is dry and harsh. 
The large flow of urine is usually preceded by various nervous phe- 
nomena, viz: nervousness, irritability, inability to concentrate the mind, 
vivid imagination, failure of memory, and headache. 
Unless the affection is soon arrested, great loss of flesh and strength 
result. 
Prognosis. Unfavorable as to a radical cure, unless caused by syphilis. 
Death rarely is due to the diabetes, but to some intercurrent malady that 
the patient has been unable to withstand, on account of the weakness 
produced by the diabetes. 
Diagnosis. It differs from diabetes mellitus by the absence of grape 
sugar in the urine. 
From paroxysmal diuresis, by the absence of the increase of urine 
permanently. 
From interstitial nephritis, by the greater amount of urinary discharge 
and the absence of albumen, oedema, etc. 
Treatment. If due to syphilis, potassii iodidum and hydrargyrum are 
of real benefit. Prof. DaCosta has had success with ergota in the form of 
the fluid extract or the aqueous extract. Pilocarpus has been used with 
success. Dr. Bartholow recommends galvanism in cases not cured by 
potassii iodidum, placing “ one electrode to the neck below the occiput, the 
other to the hypochondriac regions in turn ” Valerian and potassii 
bromidtim have been used. The author has effected a cure in three cases, 
where other remedies had failed, by the use, internally, of— 
R. Strychninse sulph gr. 
Acid, hydrochlor. dil trp x 
Aquae lauro-cerasi 3 ij. M. 
Well diluted. 
CHOLERA. 
Synonyms. Epidemic cholera; Asiatic cholera; malignant cholera; 
spasmodic cholera. 
Definition. An acute, specific, infectious disease, epidemic in the ma- 
jority of, although endemic in other, localities; characterized by violent 116 
PRACTICE OF MEDICINE. 
purging of a peculiar, rice-water-like fluid, persistent vomiting of a similar 
material, severe muscular cramps, and a condition of prostration, followed 
by collapse and death, or of a reaction from the collapse and the develop- 
ment of the typhoid state (cholera typhoid). 
Causes. A specific poison, the nature of which is unknown. Cholera 
is not contagious, in the usual acceptation of that term, but it is unquestion- 
ably infectious. The evidence seems conclusive that the cholera stools are 
the main, if not the only, channel of infection, and that the great cause of 
the propagation of cholera is the contamination of the water used for 
drinking purposes with the stools. Milk may also be the vehicle by 
which it spreads. Little, if any, danger exists from being in the presence 
of the affected, although the emanations from the cholera excreta in the 
atmosphere may generate the disease if swallowed or inhaled. The dead 
bodies of cholera subjects apparently possess no infective property, “ the 
bacteria of decomposition” probably destroying the cholera germs. One 
attack does not afford protection against another. 
Pathological Anatomy. This is, as yet, far from satisfactory. The 
morbid appearances in the majority of cases of death from cholera may be 
thus summarized: The temperature generally rises after death, the body 
remaining warm for a considerable time. Rigor mortis rapidly ensues, the 
muscular contractions being often so powerful as to displace and distort 
the limbs. The skin is mottled and the body greatly shrunken. The 
blood is darker in color, thick, viscid, and feebly coagulable. The arteries 
are quite empty of blood, the veins, on the other hand, being distended. 
The organs are, as a rule, pale and shrunken. 
The stomach and intestinal mucous membranes are congested, and pre- 
sent evidences of extravasations and ecchymoses. They usually contain 
a quantity of whey-like material, having an alkaline reaction, as well as 
quantities of cast-off epithelium and micrococci. It is thought by many 
that the stripping-off of the epithelium is a post-mortem phenomena. The 
Peyer’s, solitary and Brunner’s glands are usually enlarged and prominent, 
and occasionally evidences of ulceration are apparent in the solitary glands. 
The villi of the mucous membrane, as well as the epithelium of the small 
intestines, are stripped off, leaving the basement membrane, for the most 
part, exposed. The liver is more or less advanced in fatty degeneration, 
presenting a somewhat mottled, yellowish discoloration. The kidneys 
are congested, the epithelium of the tubules granular and detached 
from the basement membrane, blocking up the tubes. Dr. Bartholow 
observed, in all of his autopsies, “ considerable hyperaemia and dilata- GENERAL DISEASES. 
117 
tion of the vessels of the medulla oblongata. The constancy of this lesion 
would seem to indicate a relationship between congestion of the medulla 
and the cramps.” 
Symptoms. In accordance with the law of epidemic infectious dis- 
eases, the onset, course and character of the symptoms vary in different 
cases and at different periods in the same epidemic. 
The disease may either set in suddenly in a patient previously in good 
health, or it may follow an attack of rather severe and persistent diarrhoea. 
In a typical case there are three stages : first, diarrhoea ; second, prostra- 
tion; third, collapse, or, in favorable cases, reaction. 
First Stage. Begins with chilliness, excessive thirst, coated tongue, 
unpleasant taste in the mouth, slight abdominal pain, and three or four 
copious, watery, yet fecal stools during the day, and a decided feeling of 
weakness, the stools rapidly becoming whey-like, easily voided, but with 
force and only slight pain. 
Second Stage. The stools rapidly increase in number, are voided with a 
rushing force, and consisting of many quarts of grayish, or whitish, rice- 
water-like fluid, accompanied with forcible vomiting, first of the contents of 
the stomach, mixed with more or less bilious matter, afterwards of the 
peculiar rice-water-like material; thirst becomes most intense, increasing 
or diminishing with the variations in the number of the vomit and stools; 
severe muscular cramps soon follow, most severe in the calves, although 
occurring in all parts of the body. 
Third Stage. The stools, vomit and cramps continue. The appearance 
of the patient becomes frightful; the eyes are sunken and surrounded by 
blackish rings, the nose pinched and pointed, the cheeks hollow, and the 
lips blue (facies cholerica); the surface cold and moistened with a sticky 
perspiration; the skin of the hands and fingers have the sodden appear- 
ance of the “ washerwoman who has washed all day,” and if picked up in 
folds, the fold but slowly disappears. The temperature rapidly falls, the 
pulse becomes small and compressible, barely perceptible at the wrist, and 
the heart beats are scarcely recognizable. The voice is weak, husky and 
sepulchral (vox cholerica), the tongue is like ice, the breath is cold, the 
urine markedly diminished and albuminous. The mind is not cloudy, but 
most patients are apathetic and indifferent to their danger. This, the 
algid stage of cholera, or cholera asphyxia, usually terminates in death in 
from three to twelve, twenty-four or forty-eight hours, but reaction may be 
established. 
Stage of Reaction. The temperature of the body rises, the pulse 
gradually becomes fuller and stronger, the countenance becomes brighter, 118 
PRACTICE OF MEDICINE. 
the stools less frequent and more fecal, the vomiting decreases, the thirst 
lessens, the urine increases in amount, but continues albuminous, the 
patient entering a slow convalescence, or typhoid symptoms develop, the 
so-called cholera typhoid, which prolongs the recovery for several weeks. 
Convalescence is often prolonged and complicated by the development 
of severe bed sores, boils, bronchitis, pneumonia or parotiditis. 
Prognosis. Very unfavorable, the mortality ranging from twenty to 
eighty per cent. The last epidemic in this country was much milder than 
former ones. The prognosis is controlled by the general condition of the 
patient, the age, habits and the development of the algid stage; the very 
young or very old, those addicted to the various excesses and surrounded 
by unfavorable hygienic conditions, are more apt to perish than are others ; 
also the rapid development of the algid stage is of bad omen. 
Diagnosis. The epidemic character, and rapid spreading, and great 
mortality of the affection prevents its being mistaken for any other 
disease, although isolated cases are often confounded with cholerine or 
with cholera morbus, the points of distinction being few. 
Treatment. During the prevalence of cholera the mildest cases of 
diarrhoea ought to receive prompt treatment, for many cases have their 
beginning as a mild diarrhoea. 
First Stage. The remedy of all others is opium in some form, to which 
may be added, with benefit, plumbi acetas, in doses of gr. iij-v, repeated 
p. r. n., and at the same time applying mustard over the abdomen. 
Water and food should be used with great caution, but ice is indicated in 
unlimited amounts, and at times iced dry champagne. The patient should 
be kept quiet, in bed. 
Second Stage. The opium treatment should be continued, together with 
the free use of stimulants. For the distressing vomiting ice, iced cham- 
pagne, acidum carbolicum or acidu>?i hydrocyanicum may sometimes give 
relief. 
Locally either continue the mustard application to the abdomen or the 
constant use of rubber bags filled with boiling water. 
For the cramps, hot water in bottles, hot irons or bricks applied over 
painful parts, or an ointment of chloroform or chloral, or the use of the 
hypodermatic solution given on page 59. 
For the collapse, heat to the surface and the free use of stimulants. 
If reaction occur, treat indications as they arise, and tonics, such as 
ferrum, quinina and arsenicum. 
All the discharges from the patient should be thoroughly disinfected 
as soon as voided, and the stools and vomited material buried. THE PQUIZ-COMPENDS? 
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BIDDLE’S MATERIA MEDICA. 
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BIDDLE’S MATERIA MEDICA. For the Use of Students and 
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CLOTH, $4.00; LEATHER, $4.75. 
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***This Ninth Edition contains all the additions and changes in 
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'Contains all Changes in the New Pharmacopoeia,) 
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College, Louisville Medical College, and a number of other 
Colleges throughout the United States. 
BIDDLE’S MATERIA MEDICA. For the Use of Students 
and Physicians. By the late Prof. John B. Biddle, m.d., 
Professor of Materia Medica in Jefferson Medical College, 
Philadelphia. The Ninth Edition, thoroughly revised, and 
in many parts rewritten, by his son, Clement Biddle, m.d., 
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m.d. Containing all the additions and changes made in the 
last revision of the United States Pharmacopoeia. Octavo. 
Ready. 
Bound in Cloth. Price $4.00; Leather, $4.73. 
“ It will be found a use?uF9iancl§ooic ify sfucleni's, especially, who may be 
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ical Journal. 
“ In short, it is just the work for a student, embracing as it does what will 
be discussed in a course of lectures on materia medica.”—Cincinnati Medical 
News. 
“ In truth, the work is well adapted to the wants of students.”—The Clinic. 
“ Nothing has escaped the writer’s scan. All the new remedies against 
disease are duly and judiciously noted. Students will certainly appreciate its 
shapely form, grace of manner, and general multum in parvo style.”—Ameri- 
can Practitioner. 
“ Biddle’s ‘ Materia Medica’ is well known to the profession, being a stand- 
ard text-book in several leading colleges.”—Arew York Medical Journal. 
“ It contains, in a condensed form, all that is valuable in materia medica, 
and furnishes the medical student with a complete manual on this subject.”— 
Canada Lancet. 
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proof of the value in which it is held by the profession.”—Medical and Surg- 
ical Reporter. 
“ The standard ‘ Materia Medica’ with a large number of medical students 
is Biddle’s.”—Buppalo Medical and Surgical Journal. 
“The larger works usually recommended as text-books in our medical 
schools are too voluminous for convenient use. This work will be found to 
contain in a condensed form all that is most valuable, and will supply students 
with a reliable guide.”—Chicago Medical Journal. 
*fk This Ninth Edition contains all the additions and changes in the U. S. 
Pharmacopoeia, Sixth Revision. 
P. BLAKISTON, SON & CO., Publishers and Booksellers, 
1012 WALNUT STREET, PHILADELPHIA. \cember, 1886. 
THE POLYCLINIC ADVERTISER. 
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? QUIZ-COMPENDS ? 
A Series of concise, practical manuals for medical students 
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on the lectures of prominent professors and the most popular 
text-books, and 220 Illustrations. 
Price of each, $1.00; Interleaved, $1.25. 
No. 1. ANATOMY. Including Visceral Anatomy, former- 
ly published separately. By Samuel O. L. Potter, m.d., 
Professor of Practice, Cooper Medical College, San Fran- 
cisco. 117 Illustrations. Fourth Edition. Enlarged. 
No. 2. PRACTICE, Part I. By Dan’l E. Hughes, m.d., 
Demonstrator of Clinical Medicine, Jefferson College, Phila- 
delphia. Second Edition. 
No. 3. PRACTICE, Part II. Same author. Second Edi-_ 
tion. 
No. 4. PHYSIOLOGY. By A. P. Brubaker, m.d., Dem- 
onstrator of Physiology, Jefferson College, Philadelphia. 
Third Edition. Enlarged and Illustrated. Index. 
No. 5. OBSTETRICS. By Henry G. Landis, m.d., Pro- 
fessor of Obstetrics and Diseases of Women and Children, 
Starling Medical College, Columbus, Ohio. Illustrated. 
Second Edition. 
No. 6. MATERIA MEDICA, THERAPEUTICS AND 
PRESCRIPTION WRITING. By Samuel O. L.' 
Potter, m.d., Professor of Practice, Cooper Medical Col- 
lege, San Francisco. 4th Edition. Enlarged. Index. 
No. 7. INORGANIC CHEMISTRY. By G. Mason 
Ward, m.d., Demonstrator of Chemistry, Jefferson College, 
Philadelphia. Second Edition. Revised. 
No. 8. DISEASES OF THE EYE AND REFRAC- 
TION. Compend on Diseases of the Eye and Refraction,* 
including Treatment and Surgery. By L. Webster Fox, 
m.d., Chief Clinical Assistant, Ophthalmological Depart- 
ment, Jefferson Medical College Hospital, and George M. 
Gould, a.b. 60 Illustrations. 
No. 9. SURGERY. By Orville Horwitz, b.s., m.d.,\ 
Demonstrator of Anatomy, Jefferson Medical College, Phi la-*" 
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No. 10. ORGANIC CHEMISTRY. Including Medical 
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Food. By Henry Leffmann, m.d., Professor of Clinical 
Chemistry and Hygiene in the Philadelphia Polyclinic. 
Index. 
No. 11. PHARMACY. Based upon “Remington’s Text- 
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December, i8<. 
Horsford’s Acid Phosphate 
vs. 
DILUTE PHOSPHORIC ACID. 
The attention of the profession is respectfully invited to some points V 
difference between Horsford’s Acid Phosphate and the dilute phosphor® 
acid of the Pharmacopoeia. Horsford’s Acid Phosphate is a solution cw 
the phosphates of lime, magnesia, potash and iron, in such fornl 
as to be readily assimilated by the system, and containing no pyro- on 
meta-phosphate of any base whatever. It is not made by compounding! 
phosphoric acid, lime, potash, etc., in the laboratory, but is obtained in the 
form in which it exists in the animal system. Dilute phosphoric acid is 
simply phosphoric acid and water without any base. Experience has 
shown that while in certain cases dilute phosphoric acid interfered with 
digestion, Horsford’s Acid Phosphate not only caused no trouble with the 
digestive organs, but promoted in a marked degree their healthful action. 
Practice has shown in a great variety of cases that it is a phosphate with 
an excess of phosphoric acid that will better meet the requirements of 
the system than either phosphoric acid or a simple phosphate. “ Phos- 
phorus,” as such, is hot found in the human body, but phosphoric acid in MEIGS AND PEPPER 
Dis eases of Children. 
SEVENTH REVISED EDITION. 
Recommended at thirty-five of the principal Medical Collegesin the United 
States, including Bellevue Hospital, New York, University of 
Pennsylvania, and Long Island College Hospital. 
A PRACTICAL TREATISE ON THE DISEASES OF 
CHILDREN. By J. Forsyth Meigs, m.d., one of the 
Physicians to the Pennsylvania Hospital, Consulting Physician 
to the Children’s Hospital, etc., and William Pepper, m.d., 
Professor of Clinical Medicine, University of Pennsylvania, 
Provost and ex-officio President of the Faculty, Physician to 
the Philadelphia Hospital, Fellow of the College of Physi- 
cians, etc. The Seventh revised and improved edition. In 
one volume, of over 1000 royal octavo pages. 
Price, in Cloth, $6.00; Leather, $7.00 
The rapid sale of etfilmns dP"£)rs. and Pepper’s work on 
Children, and the demand for the new edition now ready, is sufficient evidence 
of its great popularity. The large practice, of many years’ standing, of the 
authors imparts to it a value unequaled, probably, by any other book on the 
subject now before the profession. 
The whole work has been again subjected to' an entire and thorough 
revision. Some articles have been rewritten; many additions made; and great 
care observed by the authors that it should be most effectually brought up to 
the light, pathological and therapeutical, of the present day. 
The publishers have very many favorable notices of the previous editions, 
received from numerous sources, foreign and domestic. They append a few 
from leading journals, which will give a general idea of the value placed upon 
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work of reference for the practitioner.”—American Medical Journal. 
“ But as a scientific guide in the diagnosis and treatment of the diseases of children, we 
do not hesitate to say that we have seldom met with a text-book so complete, so just, and so 
readable, as the one before us, which in its new form cannot fail to make friends wherever it 
shall go, and wherever great erudition, practical tact, and fluent and agreeable diction are 
appreciated.”—American Journal of Obstetrics. 
“ It is only three years since we had the pleasure of recommending the Fifth Edition cf 
this excellent work. With the recent additions, it may safely be pronounced one of the best 
and most comprehensive works on diseases of children of which the American practitioner 
can avail himself, for study or reference.”—New York Medical Journal. 
P. BLAKISTON, SON & CO., Publishers and Booksellers; 
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