VADE-MECUM 
OF 
TREATMENT 
A PRACTICAL GUIDE AND 
INDEX OF TREATMENT 
FOR THE USE OF MEDICAL 
STUDENTS AND PRACTITIONERS 
BY 
EDWARD C. SEUFERT, A. M., M. D., F. A. C. P 
\\\ 
Professor of Medicine and Clinical Medicine, Chicago College o 
Medicine and Surgery; Medical Department of Loyal University, 
Chicago; Attending Physician, Cook County Hospital; 
Physician in Chief American Hospital, Chicago, etc. 
1924 Copyright, 1911, 
By 
EDWARD C. SEUFERT, M. D. 
JOHN STUART, M. A., M. D 
Copyright 1924 
BY 
CHARLES W. WARNER 
■ M. A. DONOHUE A CO« 
PRINTERS, BINDERS* 
PUBLISHERS, CHICAGO PR,EFACE 
To The First Edition. 
In the compilation of this vade-mecum, the authors 
have aimed at utility rather than originality. Indeed, 
in the department of therapeutics, originality is justly 
regarded with a considerable degree of suspicion. The 
proper scientific attitude towards all new claims for 
cures, is one of the strictest scepticism. Drugs which 
were once much vaunted, often " have their little day, 
then cease to be," after a short vogue. One cannot but 
sympathize with the witty French professor who, when 
lecturing to medical students, would say, whenever he 
had occasion to speak of a new drug, "Gentlemen, it 
would be well for you to employ this remedy while it is 
still curing." 
In assessing the value of a new remedy, so much de- 
pends upon the personal equation of both patient and 
physician, as well as on the proper diagnosis of the dis- 
ease which it is alleged to cure, that the general practi- 
tioner, and more especially the young physician for whom 
this work has been specially written, would be well, at 
least until he has gained a considerable amount of ex- 
perience, to restrict himself to the old-established methods and materials which have stood the test of time Nor 
should it be forgotten that in most diseases there is usually 
a tendency for the patient to return to his normal con- 
dition without the exhibition of any drugs, and what we 
are often vain enough to claim as the result of our own 
ability, may be merely due to the vis medicatrix naturae. 
In our treatment of the different diseases we have en- 
deavored in every case to give a suitable prescription. 
The patient usually expects this; indeed often regards it 
as the most important part of the treatment, and would 
be disappointed if one were not left behind by the physi- 
cian. It is, however, hardly necessary to remind even 
the youngest practitioner that rest, proper diet, exercise, 
change of air, etc., are as effective as the exhibition of 
drugs, in many cases indeed, much more so. We have 
now got beyond the ideas of former days, ridiculed by 
Moliere and Voltaire, when the public, aided and abetted 
by the medical faculty itself, imagined that the practice 
of medicine should consist merely in giving certain drugs. 
The doctors of Voltaire's time, as that philosopher put it, 
"simply poured drugs, of which they knew little, into 
human bodies, of which they knew still less." 
Every prescription inserted here has been thoroughly 
tested by the authors themselves in their practice both at 
home and in the tropics. No apology need be offered for 
dealing in so much detail with tropical diseases. Our 
present relations with Cuba, Porto Rico, Panama, Hawaii, 
Guam and the Philippines, render this as imperative now 
in an American hand-book as it has long been in British 
medical treatises. 
It is possible that our inclusion of symptoms, such as 
biliousness, headache, etc., along with diseases, may 
meet with criticism in some quarters, but our aim has been to prepare a hand-book which will be practical and 
useful, rather than scientifically accurate in all details, 
and, therefore, useless for the purpose intended. 
Criticisms, corrections and suggestions will be gladly 
received for the use of future editions. 
E. C. SEUFERT. 
2444 N. Kedzie Boul., Chicago, 
May 1, 1908. PREFACE 
To The Second Edition. 
The great and unexpected demand for this small text- 
book amply demonstrates the fact that it supplies a 
long-felt want among medical students, and more 
especially among country practitioners whose numerous 
orders from all parts of the United States speedily ex- 
hausted the first edition. The authors most cordially 
thank those correspondents who have kindly favored them 
with suggestions, some of which have been acted upon in 
the present volume. We also thank Mr. Joseph A. 
Hellmuth for the thorough manner in which he has 
overlooked all of the prescriptions from a pharmaceutical 
standpoint. 
EDWARD C. SEUFERT. 
April 1, 1911. 
PREFACE 
To The Third Edition 
It affords the author much pleasure to note that a 
Third Edition of this little book has become necessary. 
It has also been gratifying to receive the many favor- 
able comments from physicians in the service of the 
U. S. Army and U. S. Navy, who found it necessary to 
dispense with bulky treatises, and found "Vade 
Mecum " an ever present help. 
EDWARD C. SEUFERT. 
May 1. 1919. PREFACE 
To the Fourth Edition 
The purpose of this little book is set forth in the pre- 
face to the first edition. 
The demand for it having again exceeded the supply, 
another edition becomes necessary. Some minor changes, 
in the subject matter, were made by Dr. Seufert, whose 
death occurred before the work was finished. I have 
drawn other new matter from Current Medical Litera- 
ture; ever keeping in mind the fact that the book must 
be inexpensive, and small enough to be carried in the 
pocket or hand bag of the busy practictioner. 
CHAS. W. WARNER 
April 8, 1924 VADE-MECUM 
OF 
TREATMENT 
ALPHABETICALLY ARRANGED 
ABORTION, HABITUAL. 
If the abortion is due to syphilis, do not allow the 
patient to become pregnant until the completion of 
two years' treatment for syphilis. Give for the 
first year: 
f$. Hydrarg. bichlor gr. iss 
Syr. sarsapar. co.. q. s. ad §vi 
M. Sig. One teaspoonful three times a day. 
Gradually increase the above dose until gr. of 
hydrarg. bichlor, is taken three times a day. 
Or: 
I|. Pil. hydrarg. proto-iodid gr. 14 
No. C. 
Sig. Begin with one four times a day, and increase 
until four grains a day are taken. 
For the second year give: 
Py Potass, iodid §i 
Aqu® § ii 
Elixir digestiv. co. N.F q. s. ad 5vi 
M. Sig. One teaspoonful in a glass of hot water 
after each meal. 
Or: 
I|. Sol. potass, iodid. sat 5ii 
Sig. Ten drops three times a day in hot water. 
If the abortion is due to lacerations of the cervix 
sew them up. 
7 If it is due to displacements of the uterus, correct 
them by pessary, or by shortening the supporting liga- 
ments. 
In all cases of habitual abortion the patient should 
do her housework, and not lie on sofa or sit about under 
the impression that she is a confirmed invalid. Moder- 
ate physical exertion is always beneficial. Sexual ex- 
cesses should be avoided. 
ABORTION, INDUCTION OF. 
Abortion should never be resorted to unless after 
consultation, and then only to save life. Abortion- 
ists and irregular midwives use as their routine 
abortifacient, quinine and ergotin of each two grains 
in pill form every three hours. The life of the patient 
is endangered by this method, because of the violent 
irritation necessary to expel the contents of the 
uterus. When abortion is absolutely imperative, the 
regular practitioner usually resorts to dilatation of 
the cervix, and rupture of the membranes under the 
strictest antiseptic precautions, by passing a sound 
into the uterine cavity. 
Then encourage uterine contractions by hot mus- 
tard sitz baths and give the following internally: 
I). Fluidextr. ergotgi 
Fluidextr. gossypii radioo ss 
Tinct. cinnamom. q. s. adgiii 
M. Sig. One teaspoonful in water, three times a day. 
ABORTION, INEVITABLE. 
If there is considerable haemorrhage, and the cer- 
vix has not yet dilated, pack the vagina with anti- 
septic gauze. Give fluidextract of ergot'in thirty 
drop doses every three hours, and morphine sulph- 
ate (% gr-)> when there is severe pain. Next morn- 
ing the ovum with membranes can usually be readily 
peeled out with the finger. If not, pack again. Do 
not curette unless fever is present. 
After-treatmnet. Rest in bed for three or four 
8 days. Light nourishing diet. Hot douches with 
carbolic acid (one drachm to a quart of water) three 
times a day. Give the following tonic: 
T|. Mass. ferr. carb 5ii 
Strych. sulph -gr. % 
Mangan, dioxid grs. xii 
Acid, arsenios gr. J4 
Aloin gr. iv 
M. et ft. caps. No. xxiv. 
Sig. One three times a day, after meals. 
ABORTION, PREVENTION OF. 
When patient has uterine contractions and haemorr- 
hage, put to bed at once and give hypodermically 
morphine sulph. gr.) with atropin sulph. (TJ5 
gr.). Repeat in four hours by mouth if necessary. 
Do not give hot douches. Apply heat to lumbar 
region. Viburnum prunifolium is a useful uterine 
sedative and tonic: 
I). Fluidextr. vibum. prunif 5iss 
Tinct. cinnamom §iss 
M. Sig. One teaspoonful every three hours, in hot 
water. 
Or: 
3. Elix. viburn. opul. comp. N. F §iv 
Sig. One teaspoonful in hot water every three hours. 
ABRASION. 
Cut away ragged edges with scissors and clean 
thoroughly with a two per cent solution of carbolic 
acid (about one drachm in six ounces of water). 
Then dry the wound, apply powdered stearate of 
zinc, and seal with cotton and collodion. If abrasion 
is extensive, clean as above and apply iodoform 
gauze, and bandage. After several days change 
dressing and apply: 
1$. Unguent, resorcin, co. N. F §ii 
Sig. Use once a day. 
9 ABSCESS, PREVENTION OF. 
Locally. Abort formation of abscess by ice-bag 
in conjunction with: 
]$. Liq. plumb, subacet. 
Tinct. opii.aa gviii 
M. Sig. Add two ounces to one pint of water, satu- 
rate gauze with solution, and apply to inflamed area. 
Internally. Give aperients and calcium sulphide: 
1$. Calc, sulphidgrs. vi 
Sacchar. lactgrs. xxxvi 
Div. in caps. No. xviii. 
Sig. One every three hours. 
ABSCESS, TREATMENT OF. 
The treatment varies with the location. Pus 
should be evacuated no matter where it occurs. The 
abscess should be freely incised at the most dependent 
portion and packed with iodoform gauze daily. 
Curettage and squeezing should be avoided. When 
the discharge begins to lessen the cavity may be 
swabbed out with tincture of iodine daily, and re- 
packed with gauze until it closes. If abscess is 
large, especially in children, tonics are indicated. 
For a child of five years: 
I|. Syrup, hypophosphovi 
Sig. One teaspoonful three times a day. 
For adults: 
1$. Syr. hypophosph. co§vi 
Sig. Two teaspoonfuls four times a day. 
ACCOMMODATION, FAILURE OF. 
Treat presbyopia by ordering convex glasses which 
will enable the patient to read at nine inches or a 
greater distance. The smaller the quantity of accom- 
modation remaining, the less is the range of clear 
vision; and if accommodation is abolished, clear sight 
is possible only when the object is at the focus of the 
glasses. Hence the increase of strength of the glasses, 
which becomes necessary as age advances, should 
be made gradually that the patient may grow ac- 
10 customed to the loss of range, and to the necessity 
for keeping his book more and more at an unvarying 
distance. As the book has to be placed nearer by 
artificial light, than by daylight, it is best to have a 
rather stronger pair of glasses for evening use than 
for the daytime. 
ACETANILID HABIT. 
Usually easy to cure. Patient must assist. Tem- 
porarily substitute codein or chloral at bedtime to 
procure sleep, then gradually withdraw all hypnotics. 
Strengthen the system with tonics as: 
3- Elix. ferri, quin, et strychgiv 
Sig. One teaspoonful in water after each meal. 
ACETANILID POISONING, ACUTE. 
Wash out the stomach. Give a saline cathartic 
and support the heart by strychnine, strophanthus, 
or nitro-glycerin: 
Strych. sulphgr. % 
Nitroglyceringr. 
Spts. vini gall giii 
Sig. Give one teaspoonful hypodermically, or by 
mouth every 3 hours. 
If cyanosis and severe dyspnoea are present, bleed 
and give an injection of one pint of physiologic salt 
solution (six-tenths per cent of sodium chloride), hypo- 
dermically. 
See Bleeding, Practical Directions For. 
ACHYLIA GASTRICA (ABSENCE OF HYDROCHLORIC 
ACID). 
Diet. Meat finely divided, puree soups, green 
vegetables, cream, butter, anchovy paste, caviar in 
small quantities, eggs with milk, stale bread or toast. 
Water relieves the pain. On account of the absence 
of hydrochloric acid in the stomach, it should be 
supplied with pepsin and a bitter tonic: 
11 1$. Acid, hydrochlor, dil 3vi 
Pepsin C.P 3i 
Tinct. nuc. vom 5iv 
Elix. gentian, glycerin, q. s. ad §iii 
M. Sig. One teaspoonful in water after each meal. 
Lavage with a hot physiologic salt solution is use- 
ful. This should be followed by faradism, one electrode 
being in the stomach with about half a pint of salt 
solution, and the other on the epigastrium. If diarrhoea 
complicates the condition give: 
1$. Salol 3ii 
Bismuth, subcarb 3iss 
M. et ft. chart. No. xxiv. 
Sig. One four times a day. 
ACIDITY, GASTRIC. (HYPERCHLORHYDRIA.) 
The patient should have nitrogenous foods in small 
quantity, but good quality, and well cooked for easy 
digestion. He should avoid new bread, pastry, and 
vegetables. He should masticate his food thoroughly 
and beware of overeating. Cream and butter may 
be taken freely, but starchy foods should be taken 
cautiously, and should be well cooked. If there is a 
large amount of fermentation, lavage should be em- 
ployed. Opium should be avoided in the treatment 
unless the pain is very great. The pain is often re- 
lieved by eating, or by increasing the number of 
meals. 
Medicinal treatment. For the "sour stomach" of 
children a tablespoonful of liq. calcis may be given 
with milk, every two hours. It prevents the rapid 
formation of casein and assists in digestion. For 
adults, give: 
3. Sodii bicarb 5ii 
Spt. ammon. aromat 3ii 
Tinct. zingiber 3i 
Infus. gentian, co. q. s. ad Bviii 
M. Sig. One tablespoonful after each meal. 
Or: 
12 Sodii bicarb 3i 
Pulv. ligni grs. xxx 
Zingiber grs. xii 
Magnes. sulphat 3i 
M. et ft. chart. No. xii. 
Sig. One after each meal. 
ACIDS, CORROSIVE, POISONING BY. 
(Hydrochloric, nitric, sulphuric, oxalic.) 
Do not use stomach tube or emetics. Neutralize 
acid by whiting, chalk, wall-plaster, washing soda, 
potassium carbonate, magnesium carbonate, or soap 
mixed with plenty of water. 
Next give olive oil, thick gruel or milk and egg. 
Diminish shock and ease pain by hypodermic in- 
jection of morph, sulphat. gr.) Sustain patient 
with predigested meat or nutrient enemata. 
See also Carbolic Acid Poisoning and Prussic Acid 
Poisoning. 
ACNE VULGARIS 
Dietetics, cold bathing, medicines to improve the 
circulation and digestion, mechanical contrivances to 
stimulate the over-distended glands to contraction, are 
of much greater importance than the application of 
salves and lotions to the face. If the circulation is 
poor, as shown by coldness and clamminess of the 
hands and feet, give: 
I). Sodii bromid 3iv 
Infus. digital, fol. q. s. ad §vi 
M. Sig. One tablespoonful three times a day. 
If tongue is coated and appetite poor give: 
I|. Tinct. nuc. vomic 3iv 
Tinct. gentian, comp 3ii 
Tinct. quassiae 3ii 
Elix. digestiv. co. (N.F.) q.,s. ad 3iii 
M. Sig. One teaspoonful in a wineglassful of water 
before each meal. 
13 If constipation is present, give a capsule containing: 
1$. Extr. cascar. sagradgr. i 
Extr. nuc. vomic 
Extr. belladonn. folgr. 
Pulv. ipecacgr J/g 
Podophyll. resingr. 
Aloingr. 
M. et ft. caps. No. 1. 
Sig. One or two at bedtime. 
If anaemia or disordered menstruation is the cause, 
give: 
1$. Mass. ferr. carb. (Blaud's mass) 5ii 
Div. in caps. No. xxiv. 
Sig. One after each meal. 
Local treatment. The face should be thoroughly 
washed every night with any good soap. Washing the 
face with cold water is one of the best tonics for the 
skin that we possess. The face should be pinched and 
rubbed between the finger and thumb every night for 
at least five minutes. An inflammatory process re- 
sults but this is very desirable. Sulphur is one of the 
oldest and best preparations for local use. It checks 
the formation of pustules, and causes the redness to 
subside. "Lotio alba" is one of the most common 
preparations in use, its composition is: 
1$. Potass, sulphurat 3i 
Zinci sulphat 5i 
Glycerini 5i 
Aquae rosae q. s. ad§iv 
M. Sig. Shake well, apply to skin and allow to dry. 
Frequently a more stimulating application is neces- 
sary. Vleminckx' solution is very good. It should be 
used carefully as it may inflame the skin and cause 
pain. Its formula is: 
Calcis (freshly slaked)5 ss 
Sulphur, sublim 51' 
Aquae destillat 
M. Boil with constant stirring until the mixture 
has evaporated to six ounces, then strain. 
14 Sig. Use several times a week. 
Steaming of the face does harm. 
In recent years X-ray exposures have cured many 
stubborn cases and should be tried. The X-ray causes 
a partial atrophy of the sebaceous glands and checks 
pus formation. 
A sharp curette may be used vigorously on the face 
to remove pustules and oily material, Inoculation by 
bacterial vaccines has also proved very effective, al- 
though it is still beyond the reach of the general prac- 
titione 
ACNE ROSACEA. 
Look for cause and treat it e. g. gastro-intestinal 
disturbance, constipation, uterine or ovarian irrita- 
tion, gout, rheumatism, lithsemia, anaemia, plethora, 
tuberculosis, etc. Regulate diet. Forbid highly 
seasoned stimulating foods, cheese, oatmeal, sweets, 
pastries, and nuts. Stop beer, whisky, and all sweet 
beverages, but a light claret may be allowed at meals 
if desired. Forbid tea, unless weak and freshly 
made, and allow coffee, but without milk. 
Internal remedies. In early cases, diuretics such 
as the citrate of potash and saline purgatives may 
be used to divert the blood to some other part of the 
body. When the redness has not become persistent 
the mineral acids are useful: 
1$. Liq. acidi arseniosm. xxx 
Acidi hydrochlor, dil 3iv 
Tinct. gentian, co. q. s, ad giii 
M. Sig. A teaspoonful in water after meals. 
The above prescription is of value in acne rosacea 
associated with dyspepsia. 
In acute cases characterized by hypersemia and burn- 
ing, the following soothing application may be used 
locally: 
15 I}. Bismuth, subnitratgrs. xxx 
Bismuth, oxychloratisgrs. xl 
Magnes. carbonatgr. xx 
Aq. rosse §i 
M. Sig. Use as lotion twice a day. 
In acne rosacea of the chronic type, a more stimulat- 
ing treatment is necessary to improve the vaso-motor 
tone of the blood vessels. For this purpose the following 
paste is useful: 
1$. Resorcinolis 5i 
Ichthyoli 5ii 
Cerati 5vi 
M. Sig. Apply freely every three hours until epider- 
mis desquamates. 
After the epidermis has desquamated, reduce the 
strength of the ointment to one-fourth and apply once 
daily. 
The dilated blood vessels remaining after subsidence 
of the congestion should be destroyed by multiple 
scarification, electrolysis or the thermocautery. Large 
excrescences may be removed by the knife or the gal- 
vanocautery. 
ACONITE POISONING. 
Stomach tube or emetic. Tinct. of digitalis in 20 
minim doses. Give stimulants for depression, or 
inject diluted brandy into the rectum. Recumbent 
posture. Artificial respiration and friction. Hypo- 
dermic injection of strychnin sulph. (g\, gr.). 
ACROMEGALY. 
Treatment is symptomatic; extract of pituitary 
body may be tried. This extract will frequently 
cause the disappearance of the severe headache and 
nervous symptoms: 
1$. Pulv. glandul. hypophysis (hypophysin). 3iv 
Div. in chart. No. xxiv. 
Sig. One three times a day. 
Rest in bed is very important during the exacerba- 
tions. 
16 For the headache and pain in bones, give: 
T|. Antipyrini 5ii 
Sodii bromidi 3ii 
Aquse §i 
Syr. rub. idaei q. s. ad §ii 
M. Sig. One teaspoonful every three hours if neces- 
sary 
ACTINOMYCOSIS. 
Animals are more easily cured than man. Potas- 
sium iodide is almost a specific on animals, but is 
also of great benefit to man: 
I|. Sol. potass, iodid sat Biii 
Sig. Use 15 drops in hot water three times a day. 
Gradually increase to 50 or more drops three times a 
day. 
When abscesses form they should be freely opened, 
curetted and swabbed with tincture of iodine. 
ADDISON'S DISEASE. 
Attend to general health, rest in bed in advanced 
cases, nutritious nitrogenous assimilable diet. An 
absolute milk diet may be necessary. Drugs used: 
Iron, [arsenic, strychnin. Extract of suprarenal 
gland cures a few and benefits many cases: 
I). Extr. glandul. suprarenal, sicc 3iv 
Div. in caps. No. xxiv. 
Sig. One capsule four times a day. 
Bismuth, salol and cerium oxalate will control vomit- 
ing. For prescription, see Vomiting. 
I|. Ferr. reduct grs. xxiv 
Strych. sulph gr. 
Acid, arsen gr U2 
M. Et ft. pil. No. xxiv. 
Sig. One four times a day. 
ADENITIS. 
Treat the cause: diphtheria, scarlet fever, tuber> 
culosis, etc. 
17 The glands should be covered with cotton and a 
bandage, after the inunction of some ointment as: 
T|. Ungt. iodini3iv 
M. Sig. Rub in thoroughly morning and night. 
If much pain is present give: 
I}. Ungt. belladonn 5ii 
Ungt. hydrarg3 ii 
Lanolin5iv 
M. Sig. Rub in thoroughly twice a day. 
Internally give tonics as syrup ferri iodide, cod liver 
oil, malt, etc. 
For an adult give: 
1$. Syr. ferr. iodidoii 
Sig. One-half teaspoonful three times a day. 
Or: 
I). Syr. hypophosph. co§iii 
Sig. One tablespoonful three times a day in water. 
Plenty of fresh air, sunshine, cream, butter and other 
nourishing articles of diet should be recommended. 
AFTER-PAINS (LABOR). 
The following is a good prescription for the severe 
pains after labor, one or two doses being usually all 
that is required: 
1$. Morphin. sulphgr. i 
Sodii bromidgrs. Ixxx 
Chloral, hydrat 3i 
Aquae 3iv 
Syrup, aurant. q. s. ad§i 
M. Sig. One teaspoonful every three hours if necessary. 
AGALACTIA (See Suppression of Milk). 
AINHUM. 
Earlier stages. Process of strangulation may be 
arrested by division of the constricting ring. 
Later stages. When the affected little toe becomes 
useless and is the source of pain or inconvenience, 
it should be amputated. 
18 Last stages. The disease usually ends in spon- 
taneous amputation, though it may take ten years 
to do so. 
ALBUMINURIA. 
General treatment. Patient should lead a quiet 
life, without worry or excitement. He should live 
in a warm, dry house, preferably on gravel, and in a 
warm, dry, equable climate. Warm clothing should 
be worn next the skin all the year round. He should 
also wear a body belt and sound boots and take 
every possible care to avoid catching cold. He 
should avoid alternately hot and cold baths, but may 
take warm baths, hot air, vapor or Turkish baths. 
Daily tepid sponging with friction of the skin is 
beneficial. Regular daily exercise should be taken, 
avoiding fatigue. He should maintain a free regular 
action of the skin, kidneys, and bowels. 
In the special treatment of albuminuria, the cause 
must be sought and treated if possible. These may 
be (a) Congestion of the kidneys in its various forms, 
(b) All forms of nephritis, (c) Suppurative condi- 
tions, degenerations and neoplasms of the kidneys, 
ureters, bladder or urethra, (d) Acute infectious 
diseases, (e) Disorders of the blood, as in pregnancy 
pernicious ansemia, leukaemia, scorbutus, purpura, 
and poisoning by lead, mercury, or syphilis, (f) In 
certain abnormal conditions of the nervous system, 
such as apoplexy, cerebral concussion, tetanus, epi- 
lepsy, meningitis, and cephalic injuries. 
There is also a functional or physiological albumi- 
nuria which is observed in certain persons in health 
after violent exertion, cold bathing, mental emotion, 
or over-eating, especially of nitrogenous food. 
The main source of the albumin is nephritis, and 
can best be combated with potassium iodide. 
I). Sol. potass, iodid. sat §i 
Sig. 15 drops in hot water three times a day after 
meals. 
19 Where sufficient urine is not being excreted, give: 
I|. Potass, acet 3 iii 
Potass, citrat 3iv 
Accuse §iss 
Syr. ac. citric, q. s. ad §iii 
M. Sig. One teaspoonful every four hours in hot 
water. 
ALBUMINURIA, DIET IN. 
The following articles of diet should be forbidden: 
Ices, pastry, sweet foods generally; new bread, beef 
tea, meat essences, jellies, highly spiced foods, 
pickles and sauces; rich foods such as hare, duck, and 
goose; and lastly, cheese. 
The following articles may be taken in moderation: 
Potatoes, peas, beans, bacon, eggs, red wine, freely 
diluted with water. 
The following articles may be allowed: Soups, 
thickened with arrowroot, vermicelli, rice or barley; 
fish, fowl, pigeon, game, lamb, tripe, sweetbread, 
calf's head, cow-heel, butter, cream, green vegetables, 
celery, onions, salads, mushrooms, artichokes, cauli- 
flower, turnips, milk (plain or peptonized), skim 
milk, whey, koumiss, farinaceous foods, such as stale 
bread, toast, rice, tapioca, sago, vermicelli, arrowroot, 
macaroni, tea, cocoa, coffee, soda water, seltzer, 
Vichy. 
ALCOHOLISM, ACUTE. 
Wash out the stomach. If there is extreme ex- 
citement, give: 
1$. Chloral, hydrat 3ii 
Sodii bromidi 3i 
Potass, bromid 3i 
Aquae 3iv 
Syr. aurant. cort. q. s. ad §i 
M. Sig. One teaspoonful in water is usually all that 
is necessary. 
20 If emesis is desired give apomorphine hydrochloride 
(ra gr-\ hypodermically, or if patient is not too drunk, 
give a dessertspoonful of mustard in half a pint of hot 
water. 
If extremities are cold, and collapse is threatened, 
give a hot bath and one-half to one drachm of aromatic 
spirits of ammonia. Give cardiac stimulants, such as 
strychnine, if necessary. 
ALCOHOLISM, CHRONIC. 
Withdraw the alcohol at once. Institution treat- 
ment is preferable. The indications are: to produce 
sleep, to allay nervousness and thirst, and to tone up 
the system with tonics and nutritious diet. For 
thirst, allow patient to sip ice-water, to suck a lemon, 
or give: 
1$. Acid, sulphur, aromat 3iii 
Tinct. capsici 5iv 
Syr. aurant. cort. q. s. ad giii 
M. Sig. One teaspoonful in water every three hours. 
For sleep. Trional or sulphonal may be given in 
15 gr. doses and repeated once if necessary. Hydro- 
bromide of hyoscine TJ0 gr. also produces good results. 
When convalescence sets in, give: 
T$. Liq. potass, arsenit 3i 
Tinct. nuc. vomic 3iv 
Elix. gentian, glycer. N. F. q. s. ad... giii 
M. Sig. One teaspoonful in water every four hours. 
ALKALIES, CAUSTIC, POISONING BY. 
(Caustic potash, caustic soda, strong ammonia, soap 
lees.) 
Do not use stomach tube, or give emetics. Neu- 
tralize alkali by vinegar, lemon juice, citric acid, or 
tartaric acid, all freely diluted. 
After alkali is neutralized, give milk, olive oil, or 
white of egg. Hypodermic injection of morphine 
sulph. (gr. to relieve the pain. Stimulants for 
the prostration should be given. 
21 ALOPECIA (BALDNESS.) 
Improve the general health by Bland's pill or 
arsenious acid. Wash the head frequently with warm 
water and castile soap. Massage the scalp frequently. 
The underlying principle in the treatment of 
baldness is stimulation of the skin of the scalp by 
either massage or local stimulants which draw the 
blood by their irritation. The cause of baldness is 
frequently Dandruff, which see. 
The hair should frequently be cut short, and the 
following rubbed on the scalp: 
1$. Quin, bisulph grs. xxx 
Tinct. myrrh 5iv 
Tinct. cantharid 5i 
Spiritus myrciee q. s. ad giv 
M. Sig. Rub thoroughly into scalp at bedtime. 
Or: 
1$. Tinct. cantharid. 
Tinct. capsici aa 3ii 
Olei ricini m. xv 
01. ros. geran 3ss 
Spts. vin. rect oviii 
M. Sig. Use at bedtime. 
If the baldness is of syphilitic origin, potassium 
iodide and hydrarg. bichlor, should be given internally, 
in addition to the local treatment. 
When the alopecia is due to derangements of diges- 
tion, the following bitter tonic should be given: 
I|. Tinct. nuc. vomic 3iv 
Acid, sulph. aromat 5ii* 
Tinct quass. 
Tinct. gentian, comp. 
Tinct. cahimb aa 3ii 
Elix. digestiv. co. N. F. q. s. ad Siii 
M. Sig. A teaspoonful in a wineglass of water before 
each meal. 
22 ALOPECIA AREATA. 
Treat exactly like simple alopecia. The disease 
is probably an infection and should be treated ac- 
cordingly: 
I|. Hydrarg. bichlor grs. xx 
Glycerin 3iv 
Acid, salicylic 3i 
Spts. myrciae q. s. ad 3xii 
M. Sig. Apply to the bald spots night and morning. 
AMBLYOPIA and AMAUROSIS. 
If due to excessive use of tobacco, prohibit its use 
and give hot baths and strychnine sulphate (/o gr.) 
hypodermically, or by mouth, three times a day. 
If due to lead poisoning, gjve hot baths and potas- 
sium iodide: 
Potass, iodid 3iv 
Aquae §ii 
Elix. tarax. co. N. F. q. s. ad §iii 
M. Sig. One teaspoonful in hot water three times 
a day. 
If due to uraemia do not treat the amblyopia directly, 
but the uraemia, which see. Vision returns as sud- 
denly as it went. 
If due to hysteria, treat that disorder. 
AMENORRHEA. 
Ascertain the cause then treat it. If due to 
anaemia give Blaud's pill, mangan. dioxid., potass, 
permanganat., or: 
I). Strych. sulph gr. % 
Mass. ferr. carb 3ii 
Zinc, phosphid gr. iss 
Aloin gr. ii 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
If from pelvic congestion due to catching cold, give 
a saline purge with a hot sitz bath at bedtime, with 5 to 
10 grs. of Dover's powder, or: 
23 I) Tinct. opii cam ph 3iv 
Quin, bisulph grs.xx 
Syr. rhei aromat. q. s. ad 3iv 
M. Sig. One tablespoonful three times a day. 
For a simple atonic case, give: 
I}. Tinct. ferr. chlorid 3iii 
Tinct. cantharid 3i 
Tinct. aloes 3iv 
Ammon, tinct. guiac 3xii 
Syr. simpl. q. s. ad ovi 
M. Sig. One tablespoonful three times a day. 
When due to fear or excitement, give: 
1$. Tinct. cardamom, co 3vi 
Tinct. opii ' 5i 
Elix. ammon.valerian q. s. ad 5ii 
M. Sig. One teaspoonful every three hours. 
If from insufficient flow of blood to the internal 
genitals, administration of yohimbin hydrochlor, is. 
often of benefit, in x? gr. doses twice a day. 
If the amenorrhea is due to tuberculosis, treat the 
latter with tonics, fresh air, cream, etc., and not the 
amenorrhea, which is nature's effort to save strength. 
When the health of the patient is re-established men- 
struation will return. 
AMYLOID DEGENERATION. 
Prophylaxis. In any disease in which suppuration 
is present, check latter if possible. In chronic joint 
disease, psoas abscess, syphilitic disease of bone, or 
prolonged pyaemia, the diet should be nutritious, and 
especially rich in proteids, and should contain the 
potassium salts which the affected tissues lack, e. g., 
juice of fresh meat, and the green parts of vegetables. 
Iron, cod-liver oil and potassium salts (bicarbonate 
or citrate) should also be given: 
24 1$. Potass, bicarb oiii 
Potass, citrat 3ii 
Potass, acetat 3ii 
Aquae 3ii 
Syr. zingiber, q. s. ad §iii 
M. Sig. One teaspoonful in water three times a day. 
Arsenic and gold are of considerable service in general 
amyloid degeneration after the removal of the cause: 
1$. Liq. potass, arsenitgrs. xxx 
Auri et sodii chlorid gr. i 
Elix. simpl. q. s. ad §iii 
M. Sig. One teaspoonful in water three times a day 
after meals. 
If due to syphilis treat the syphilis. If due to chronic 
tubercular sinuses, apply Bier's hypersemia treatment, 
give bacterial vaccines, and remove any dead sequestra 
of bone. 
ANAEMIA (See Chlorosis). 
ANAEMIA, PERNICIOUS. 
Rest, massage, nutritious and easily assimilable 
diet, change of air, and pleasant surroundings. Gas- 
tric lavage, colonic irrigation, and intestinal anti- 
septics such as salol. Inhalation of oxygen. Iron 
frequently does more harm than good. Arsenic is 
of the greatest service, although no case is known 
which was cured by it. Give: 
I). Liq. potass, arsenit. (Fowler's solution).. 5iv 
Sig. Two drops three times a day. Gradually in- 
crease until 50 or 60 drops have been taken daily. 
The following prescription may be given as stimulat- 
ing treatment: 
I|. Acid, arseniosgr. | 
Zinci phosphidgr. ii 
Strychnin, sulphgr. % 
Extr. gentiangrs. vi 
M. et ft. pil. No. xxiv. 
Sig. One every three hours 
25 For complications, such as sudden blindness due to 
retinal haemorrhage, or paralysis due to haemorrhage 
into cord, nothing can be done. If there is gastric 
irritability and vomiting, treat them by lavage and 
other methods used in Acute Gastritis, which see. 
ANJEMIA, SECONDARY. 
Treat cause, e. g., haemorrhage, drain of chronic 
disease, cachexia of cancer, malaria or syphilis, lead, 
arsenic, or mercury poisoning, chronic indigestion 
and constipation, tubercle, leucorrhoea, prolonged 
lactation. 
Patient should have rest, nutritious food, fresh air, 
and sunshine. 
I| Syr. ferr. iodid giv 
Sig. One-half teaspoonful in water after each 
meal, through a glass tube. 
If stomach is irritable give: 
I|. Syr. ferr. lactophosphat. N. F oiv 
Sig. One teaspoonful after each meal. 
Or: 
1$. Malt, cum ferr. quin, et strych oviii 
Sig. One tablespoonful after each meal. 
AN7EMIA, SPLENIC. 
Medical treatment is of very little avail, but iron, 
arsenic, and extract of red bone marrow may be 
tried. 
Removal of the spleen is by far the most successful 
treatment. Complete recovery has followed in 20 
out of 25 cases. Operative results are best if insti- 
tuted early, that is, before the patient has become 
very weak, or the spleen has reached an enormous 
size. 
ANAL FISSURE. 
Extreme local cleanliness is necessary. Keep the 
motions soft by laxatives, such as sulphur, etc. Re- 
lieve pain by cocaine, or eucaine in lanolin. 
Or: 
26 1$. lodoformi gr. xl 
Olei olivae 5viii 
M. Sig. Inject one ounce into rectum after evacuat- 
ing bowel by enema. 
Suppositories of gall and opium, morphine, or bella- 
donna may be used to relieve pain. 
Expose the ulcer by gently separating the blades of 
the rectal speculum, and then apply phenol lightly 
with cotton swab or silver nitrate, as a cauterant. 
Then insert one of the following suppositories into the 
rectum: 
3. Acetanilidi grs. xviii 
Ichthyol m. xx 
Extr. opii gr. vi 
01. theobrom 3ii 
M. et ft. supposit. No. vi. 
Sig. Use one night and morning. 
ANASARCA (See Ascites). 
ANEURYSM (THORACIC and ABDOMINAL). 
Employ measures to favor the formation of a 
permanent clot within the sac which will obliterate 
it by the deposition of laminated fibrin. In Tufnell's 
postural and dietetic treatment the patient is con- 
fined to the horizontal posture from eight to thirteen 
weeks according to the progress made. The following 
starvation diet is also given, consisting of eight 
ounces of liquid and ten ounces of solids daily. 
Breakfast and supper each consist of two ounces of 
bread and butter, and two ounces of milk, tea, or 
cocoa; dinner of three ounces of meat, three ounces 
of potatoes, or bread, and four ounces of water or 
claret. Laxatives are given daily so that the blood 
pressure shall not be increased by constipation or 
straining at stool. This treatment is very fatiguing 
and it is difficult to secure the patient's obedience. 
Iodide of potassium in doses of fifteen to twenty 
grs. thrice daily is also administered, to relieve the 
27 pain, lower the blood pressure, and possibly thicken 
the blood by increasing the secretions. 
When the pain is very severe an ice-bag may be 
applied or morphine administered hypodermically. 
Cyanosis may be relieved by venesection. 
Coagulation may also be favored by the injection 
of gelatin (four ounces of a three per cent sterilized 
solution) hypodermically, although abscesses and 
other bad effects have sometimes followed from these 
injections. 
Gelatin may be given internally with equal benefit, 
and without tiring the patient if administered in the 
form of the ordinary flavored gelatin of the grocery. 
In order to increase the coagulating power of the 
blood, calcium chloride or calcium lactate may be 
given by mouth or by rectum: 
Calcii chloridi 3iv 
Aquae giss 
Syr. limonis q. s. ad. 5iff 
M. Sig. One teaspoonful every three hours. 
Aneurisms when small and within easy access, can 
be ligatured, injected, or filled with silver wire. 
ANGINA PECTORIS. 
Patient should lead quiet life, should avoid ex- 
cesses, should not overload stomach, and should 
avoid physical and mental fatigue. Diet should con- 
sist of simple, easily digested food; alcohol, tea, 
coffee, and tobacco should be prohibited. 
Relieve attack by inhalation of 3 to 5 drops of 
amyl nitrite sprinkled on handkerchief. If this fails 
give hypodermic injection of morph, sulph. (J4 gr.) 
with atrop. sulph. gr.). 
Hot water bag or mild mustard poultice, or some- 
times cold compress to chest. Glass capsules con- 
taining 3 to 5 minims of amyl nitrite should be carried 
by patient in pocket for use in emergency. 
28 When flatulence is present, give . 
T$. Spt. ammon. aromat 3iv 
Tinct. cardamom 5iv 
Tinct. nuc. vomic 3ii 
Tinct. capsici 3ii 
Syr. zingib. q. s. ad 5 hi 
M. Sig. One teaspoonful in water every three hours 
Or: 
I|. Pulv. rhei grs. xxxvi 
Sod. bicarb grs. xxxvi 
Pulv. zingib grs. vi 
Magnes. carb, pond grs. xxxvi 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
The cardiac depression which remains after the at- 
tack may be treated by strychnine, ammonia, camphor 
or ether, e. g. 
3. Strych. sulph gr. % 
Quinin. hydrochlor grs. xl 
M. ft pil. No. xx. 
Sig. One pill after meals. 
The general treatment consists in combating the 
chronic myocardial disease and the sclerosed condition 
of the arteries, with nitrites, iodides, arsenic and nitro- 
glycerin. 
I|. Potass, iodid 3iv 
Aquae 5i 
Ess. pepsin, q. s. ad 5iii 
M. Sig. One teaspoonful in water four times a day. 
ANI, PRURITUS. 
Search for and treat cause, e. g., internal haemorr- 
hoids, eczema, herpes, erythema, small fistula, worms 
in rectum, or lice on body. 
Search for and correct errors in diet, prohibit ex- 
cessive smoking or use of alcohol. Active exercise, 
plain living, and cold bathing of part, night and morn, 
ing. 
29 Prescribe a wash like this: 
I|. Argenti nitratgrs. xv 
Aquae destillat oi 
M. Sig. Apply to affected part with camel's hair 
brush. 
Or an ointment like this: 
I}. Acidi carbolgrs. xv 
Hydrarg. chlor, mitgrs. xx 
Unguent, zinc, oxid oi 
Sig. Apply locally twice daily. 
Or: 
I|. Mentholgrs. x 
Ungt. phenolgi 
M. Sig. Apply twice a day. 
In all cases of pruritus ani, the urine should be ex- 
amined for sugar, because diabetes is a frequent cause. 
ANKYLOSIS. 
When incomplete ankylosis has taken place, break 
down adhesions by gradual, or if necessary, forcible 
extensions under anaesthesia, by passive motion, by 
massage, by Bier's hyperaemia treatment, or by teno- 
tomy of the tense tendons. If ankylosis is complete, 
excision or osteotomy, or perhaps even amputation, 
may be necessary. 
Ankylosis may be avoided in diseases and injuries 
of the joints, in fractures, etc., by proper setting and 
by early passive motion. 
ANKYLOSTOMIASIS. 
Thymol may almost be regarded as a specific. It 
is given in capsules of ten grains each, one capsule 
being taken every 15 minutes until two drachms are 
taken, and then followed by a purgative. 
Phillips' formula is being used in Manila with ex- 
cellent results: 
I). OL eucalypt m. xxxvii 
Chloroform m. 1 
01 ricin giss 
30 M. Sig. Divide into two doses and give half an hour 
apart. The patient is first given a dose of magnesium 
sulphate, and two hours after the second dose, another 
dose of magnesium sulphate is administered. Fasting 
is imperative. 
Prophylaxis. If there is no pure water supply all drink- 
ing water should be boiled or filtered. Navvies, 
miners and all those whose hands or feet are liable to 
be soiled with earth or clay, should wash carefully 
before eating, and on returning from work. Navvies 
should be encouraged to wear shoes and putties, 
and not allowed to work barefoot. The workers 
should be regularly inspected and all anaemic individ- 
uals should be examined for ankylostomes and treated 
if necessary. 
ANOREXIA (Impaired appetite). 
Treat the cause, e. g., gastric disorder, hysteria, 
retarded convalescence, etc. Active out-door ex- 
ercise and change of climate ought to be recommended. 
The following will stimulate the appetite in most 
cases: 
I}. Tinct. nuc. vomic 5iv 
Tinct. gentian. 
Tinct. quass. 
Tinct. cardamom. 
Tinct. calumb aa 5ii 
Elix. pepsin, et pancreatin, q. s. ad . . §iii 
M. Sig. One teaspoonful in a wineglassful of water 
before each meal. 
Or the following: 
I|. Acid, nitro hydrochlor, dil m. c 
Syrup, aurant 5x 
Tinct. gentian, co . > 3v 
Aquse q. s. ad gin 
M. Sig. One teaspoonful three times daily before 
meals. 
ANTHRACOSIS (See Pneumoconiosis). 
31 ANTHRAX (WOOLSORTER'S DISEASE. SPLENIC 
FEVER). 
Prophylaxis. Disinfect all hides, wool rags, etc., 
infected with bacillus anthracis. Cremate animals 
which have died of this disease and prohibit grazing 
over infected pastures, etc. 
Diet: A plentiful supply of animal food; beaf tea, 
milk, and eggs. Tonics like quinine, iron and whisky. 
Opium to relieve pain. 
The painful nodes may be aborted in the early 
stage by a central injection of 15 minims of a ten per 
cent solution of carbolic acid in glycerin. 
Or: 
1$. Hydrarg. chlor, corros gr. i 
Aquae destillat gtt. c 
M. Sig. Inject into and around the border of lesion 
with hypodermic syringe. Make five punctures, in- 
jecting two drops at each puncture. Repeat injection 
once. 
If too late for this abortive treatment make firm 
compression by concentrically applied straps, leaving 
central opening free for discharge of sloughs. If 
symptoms of septicaemia supervene, deep crucial 
incisions should be made and the necrosed tissue ex- 
tirpated. 
ANTIMONY POISONING. 
(Tartar emetic, etc.) 
Encourage vomiting by draughts of warm water, 
or by emetic, or use stomach tube. Give strong 
tea, or 30 grs. of tannic acid in warm water. When 
vomiting subsides, give white of egg in water, or 
plenty of milk. Treat collapse with stimulants, and 
hot water bottles to extremities. Hypodermic in- 
jection of morph, sulph. gr.) to relieve the pain. 
ANURIA (See Suppression of Urine). 
APHASIA. 
If the aphasia occurs after excitement or overwork 
32 without paralysis, it is a warning of much importance, 
and may be the precursor of graver symptoms. The 
patient requires absolute rest and careful watching. 
Give bromides and other sedatives. Restrict the 
use of, or forbid, stimulants. 
If the lesion be a gummatous meningitis, or a gumma 
in the language zone, or in the sub-cortical speech 
tracts, treat with mercury and potassium iodide. 
If the aphasia occurs at the beginning of a uraemic 
attack, venesection is indicated. 
If it is due to tumor, abscess, or purulent meningitis, 
it may require the combined skill of the physician and 
surgeon to locate and remove the lesion. 
APHONIA, HYSTERICAL. 
General tonics and supporting treatment are 
indicated. Local application of the faradic current 
to the larynx gives good results. One pole is applied 
externally over the larynx, and by means of a suitable 
laryngeal director provided with a button for making 
contact, the other pole may be applied to the interior 
of the larynx itself. On making contact the patient 
should be firmly ordered to say one, two, three, etc. 
A fairly strong current is necessary and although 
good results are obtainable constant relapse is apt to 
occur. 
APHRODISIA. 
If the aphrodisia is due to reflex irritation of the 
genitals, treat the cause, e. g., phimosis, urethral 
stricture, disease of prostate, anal fissure, haemorr- 
hoids, eczema, irritating urine, worms in rectum or 
vagina, friction of thighs in bicycling or horse-back 
riding. 
General treatment is dietetic, hygienic and moral. 
Physical and mental work to the point of fatigue is of 
benefit, non-sedentary life, light diet, absence of 
meats, highly seasoned foods, coffee and alcohol. 
Patient should sleep in a cool, well-ventilated room, 
33 avoid sleeping on back, and should empty bladder 
on rising in the morning. 
Drugs used as anaphrodisiacs: Bromides, cam- 
phor monobromate, hyoscin, lupulin, antimony, 
chloral, salicin, conium. 
In cases of nymphomania, priapism, or chordee, 
give: 
1$. Potass, iodid 5ii 
Potass, brom 5iv 
Tinct. lupulin. 5iv 
Tinct. hyoscam. . 5iv 
Syrupi zingiberis 5 i 
Aquae camphor, q. s. ad Sviii 
M. Sig. One tablespoonful in water after meals. 
APHTHAE. 
Examine teeth, regulate the diet. Cleanse child's 
mouth and mother's nipple after each nursing with 
one of the following washes: 
I|. Sol. potass, chlorat. sat §iv 
Sig. Wash with piece of gauze every two hours. 
Or: 
Liq. antisept, alkalin. N. F 5iv 
Sig. Use as mouth wash every two hours. 
Internally give for a child one year old. 
I). Acid, nitromuriat. dilgtts. xvi 
Elix. digestiv. co. N. F. q. s. ad gii 
M. Sig. One teaspoonful three times a day. 
APOPLEXY. 
Place the patient in a horizontal position with the 
head elevated, and the feet low. Apply ice to the 
head, and hot-water bags to the feet. One to three 
drops of croton oil mixed with a little olive oil and 
placed on the back of the tongue, will secure prompt 
action of the bowels. About 8 ozs. of blood should 
be taken from one of the median basilic veins unti. 
the pulse softens. When venesection is impossible, 
tincture of aconite may be given in doses of one drop 
every 30 minutes until the tension becomes lower. 
34 If necessary, give a rectal enema, and draw urine 
from the bladder. 
Subsequent treatment. Preserve the nutrition, 
give a light unstimulating diet, and rectal feeding if 
necessary. Prevent bed-sores by attention to cleanli- 
ness both of the bed, and of the patient's skin. The 
buttocks and heels should be rubbed with alcohol 
and powdered daily. The position of the patient 
should be frequently changed. He should be turned 
gently on his side when collection of mucus inter- 
feres with his breathing, and also to guard against 
hypostatic pneumonia. After two or three weeks, 
massage, warm baths, and tri-weekly applications 
of the faradic current should be resorted to. Tonics 
such as strychnin may be given. Potassium iodide 
is frequently valuable in helping to produce absorp- 
tion of the blood-clot. 
1$. Potass, iodid 5iv 
PotaSs. bromid 5ii 
Aquae Siss 
Elix. taraxac. co. N. F. q. s. ad oiii 
M. Sig. One teaspoonful in half a glass of hot water 
three times a day. 
APPENDICITIS. 
Is a surgical disease. The best results are obtained 
if the appendix is removed within the first 24 hours. 
If this is not done and pus begins to form, simple 
incision and drainage will give relief. The appendix 
should then be removed between the attacks. If 
peritonitis is present, place the patient in a semi- 
sitting posture, and give continuous physiologic salt 
solution enemas. ' 
If operation is refused then treat medically. This 
consists in absolute rest in bed and complete suspen- 
sion of food by the mouth. Feed by rectal enemas. 
Give as little opium as possible for relief of pain be- 
cause it may mask serious symptoms. It is better to 
relieve pain by the ice-bag, by hot poultices, or by 
35 mild counter-irritants such as mustard or turpentine. 
Flush out the colon with hot water. Purgation should 
be avoided. 
If the stomach is very irritable, the following 
. frequently gives relief: 
R. Hydrarg. chlor, mitgrs. ii 
Sacchar. lact grs. xii 
Cerii oxalatgrs. xii 
M. et ft. chart. No. xii. 
Sig. One every two hours. 
If the patient is not seen within the first twenty-four 
hours, it is frequently best to treat him medically until 
the tenth day, on which it is as safe to operate as on the 
first day. The most dangerous time to operate is on 
the fourth, fifth, or sixth days. 
ARSENIC POISONING, ACUTE. 
Emetic or stomach tube. Freshly prepared ferric 
hydrate or dialysed iron in frequently repeated table- 
spoonfuls, each followed by weak solution of common 
salt. 
Next give milk and eggs, % pint olive oil in one 
pint of water. Hot water bottles to extremities, 
stimulants for prostration, ice for thirst. Hypoder- 
mic injection of morph, sulph. (14 gr.) when the acute 
symptoms have subsided. 
ARTERIOSCLEROSIS. 
Prophylaxis. Patient should avoid mental and 
physical fatigue, and should be temperate in the use 
of alcohol and tobacco, should avoid over-eating and 
especially too much animal food. He should take 
moderate exercise, plenty of baths, followed by mas- 
sage and friction. 
Treatment. Look for and treat the underlying 
cause: syphilis, gout, plumbism, alcoholism, renal 
disease, thyroid enlargement, rheumatism and over- 
eating. 
The only drugs that have any direct effect on the 
progress of arteriosclerosis are the iodides, nitro- 
36 glycerin and the saline cathartics. Treatment should 
be kept up for a long time; the iodides should be 
given for two weeks and then nitroglycerin for two 
weeks, then back to the iodides again: 
T|. Potass, iodid 3vi 
Aquae oi 
Essenci. pepsini. .' §i 
Syr. sarsap. co. q. s. ad giii 
M. Sig. One teaspoonful in water after each meal. 
I}. Tab. nitroglycerini gr. 3£<j 
No. xxx 
Sig. One tablet four times a day. 
The bowels should be kept loose, preferably with 
salines. 
Venesection is indicated when there is marked 
dyspnoea associated with high arterial tension. 
ARTHRITIS (See Gonorrheal Arthritis, Traumatic Ar- 
thritis, and Rheumatoid Arthritis). 
ARTIFICIAL RESPIRATION. 
The best method is that of Sylvester. Place the 
patient on his back, stand at his head, grasp his 
arms just above the elbows, draw the arms steadily 
upwards above the head and keep them stretched 
upward for two seconds. Then turn down the 
patient's arms and press them gently and firmly for 
two seconds against the sides of the chest. 
The above method is best for the cessation of 
respiration during chloroform anaesthesia, or in case 
of drowning. Another method frequently used, 
especially in asphyxia of the new-born, is Laborde's 
method of rhythmic traction of the tongue. The 
tongue is pulled out and then let go, and this is re- 
peated about twenty times a minute. 
ARTIFICIAL STERILITY (See Conception, Prevention of). 
ASCARIS LUMBRICOIDES. (Round worm.) 
Children are most frequently affected. 
Drugs used. Santonin, spigelia, chenopodium, tur- 
pentine, etc. 
37 Food should be abstained from for 12 to 24 hours. 
Give an active purge, three quarters of an hour 
after the remedy. 
Doses: santonin, one to two grains; fluidextract 
of spigelia, 2 drachms, or:, 
I|. Fluidextr. sennse. 
Fluidextr. spigelise aa 5ii 
M. Sig. One dose. 
Oil of chenopodium may be dropped on sugar in 
dose of 20 to 30 minims. 
The following is the most popular method of pre- 
scribing santonin. It should be given on an empty 
stomach: 
I|. Hydrarg. chlor, mit grs. xii 
Sacchar. lact grs. xii 
Santonini grs. viii 
M. et ft. chart, xii. 
Sig. One every three hours. Children in pro- 
portion. 
ASCITES. 
Treat the cause: Renal, hepatic or cardiac; the 
cachexia of malignant disease, or tubercular peri- 
tonitis. 
The drugs used are of three types: 1. Diuretics. 
2. Hydragogue cathartics. 3. Diaphoretics. 
Drugs used: Digitalis, strophanthus, elaterium, 
squill, jalap, potassium citrate, calomel, colocynth, 
and blue mass. 
When the ascites is due to renal, cardiac, or hepatic 
disease, use the following for diuresis: 
T$. Infus. digital, fol. (freshly made). ... §xii 
Sig. One tablespoonful four times a day. 
Or, Niemeyer's pill: 
I|. Pulv. digital. 
Pulv. scillae aa grs. x 
Hydrarg. chlor, mit gr. iss 
M. et div. in pil. x. 
Sig. One every three hours. 
Or: 
38 ]$. Diuretin 5ii 
Potass, citr oiss 
Potass, acetat §iss 
Infus. digital, fol. q. s. ad Bviii 
M. Sig. One teaspoonful three times a day in hot 
water. 
For free catharsis use: 
I|. Pulv. jalap, co oii 
Sig. Half a teaspoonful at bedtime. 
Or: 
I). Elaterin grs. ii 
Extract, hyoscyamgrs. xii 
M. et ft. mass, et div. in pil. No. xii. 
Sig. Take one and repeat in three hours if necessary 
for purgation. 
For diaphoresis use: 
I}. Tab. pilocarp. hydrochlor, hypoderm. .gr. 1/5 
Sig. One injection only. 
Where the fluid is in such large quantities as to inter- 
fere with the patient's comfort paracentesis must be 
employed. Tap the abdomen in the median line half 
w'ay between the pubis and the umbilicus. Allow the 
fluid to escape slowly to prevent collapse. Frequent 
tapping is often necessary to keep the patient com- 
fortable. 
ASPHYXIA. 
First ascertain the cause of the asphyxia, whether 
due to (a) absence of oxygen and the saturation of 
the system with carbonic acid gas, as in breathing 
impure air, or air charged with carbon monoxide, or 
obstruction to the entrance of air, as in drowning, 
smothering, hanging, pressure of tumor of disease of 
the air passages; or it may be due to (b) a direct 
action on the medulla, and to paralysis of respiration 
by shock, opium, chloroform and other poisons, or to 
disease of the brain. 
Treatment. If air of room is impure, remove 
patient to fresh air. Remove any foreign body in 
39 the air passages, relieve stenosis of the larynx by 
intubation or tracheotomy. In cases of drowning or 
smothering, try to remove fluid or foreign substance 
that may have entered the lungs. Apply the stomach 
pump or lavage, if poisons have been swallowed. 
If the bodily heat has been lowered by exposure or 
immersion in cold water, apply heat in the form of 
warm blankets to the body and hot water bottles to 
the extremities, after removing the patient to a warm 
room and removing his wet clothing. Friction over 
the skin and immediate immersion in a warm bath 
are also of service. 
Cardiac and respiratory stimulants such as strych- 
nin, digitalin, ammonia, ether and brandy hypo- 
dermically, and hot stimulating rectal enemata are 
also of value. When the lungs are congested and 
the right cavities of the heart distended venesection 
is of service. 
In failure of respiration during the administration 
of anaesthetics, lower the head and shoulders so as to 
favor the flow of blood to the respiratory centers in the 
brain. 
In cases of drowning, place the patient with the face 
downwards and the head lower than the body, and 
the tongue drawn forwards to allow any water to 
escape. 
In other conditions the greatest degree of ex- 
pansion of the chest is obtained by inclining the 
patient's body slightly upwards and placing a pad of 
clothing under the back to raise the chest. 
See also Artificial Respiration. 
ASTHMA. 
Remove exciting causes, such as odors, exhala- 
tions, localities, occupations, or foods which may 
bring on an attack. 
Treat digestive disturbances, bronchitis, emphy- 
sema, and cardiac disorders, and remove diseased 
40 conditions of the nose and throat, such as adenoids 
and enlarged turbinated bones in children. 
Treatment of the paroxysm. Give one hypoder- 
mic injection of Sr- morphin. sulphat. Amyl 
nitrite pearls containing 5 minims on a handkerchief 
for inhalation. A few whiffs of chloroform are also 
useful. Hot coffee or hot whisky and water. Mus- 
tard plaster to cover chest. 
Treatment during intervals. Drugs used: Potass- 
ium iodide, tincture of belladonna, arsenious acid, 
grindelia robusta, lobelia, pepsin, strychnine and 
morphine. 
1$. Potass, iodid 3iv 
Tinct. belladonn gtts. xxxvi 
Tinct. lobelise 3ii 
Tinct. digitalis 3ii 
Syrup, codein. (N. F.) q. s. ad §iii 
M. Sig. One teaspoonful every four hours with 
hot water. 
Or: 
I|. Potass, iodid.. . 3iv 
Sodii bromidi 3iii 
Extr. grindel. robust 5iii 
Tinct. lobeliae 3ii 
Elix. taraxac. co. (N. F. ) q. s. ad.... 3iii 
M. Sig. One teaspoonful in hot water every four hours, 
If emphysema and bronchitis are present, give: 
I|. Ammon, iodid 3iss 
Ammon, bromid 3ii 
Syrup, tohi §ii 
Tinct. lobel q. s. ad 3hi 
M. Sig. One teaspoonful three times a day. 
Inhalants are of great value to some patients, 
such as: 
I|. Pulv. stramon. 
Pulv. belladonn. fol aa grs. 375 
Pulv. potass, nitrat grs. 90 
Pulv. opii grs. 15 
M. Sig. Ignite a tablespoonful on a saucer by side 
of patient. 
41 The above drugs may be made into cigarettes and 
smoked with a cigar-holder. 
Diet.-Patient should avoid heavy meals and late 
suppers. Prohibit cheese, sausages, sweetmeats, pies, 
coffee, nuts and preserves. Carbohydrates should be 
sparingly indulged in. 
Climate.-There is no specific climate; one patient 
is best at the seashore, another in the mountains, and 
a third free from attacks only while living in the city. 
In general a woody country near pines is better than 
an open country. High altitudes or places in which 
certain plants give off unhealthy odors should be 
avoided. 
ASTIGMATISM. 
Correct the astigmatism by choosing for the patient 
a spectacle lens of asymmetrical refraction, of such 
power and so mounted as to equalize the refraction 
of the eye in its two principle meridians. This 
choice, however, can only be safely entrusted to the 
ophthalmic specialist. The general practitioner and 
the ordinary spectacle dealer should decide none but 
t e simplest questions in the choice of glasses. 
A person who has arrived at the age of fifty without 
having experienced any trouble with his eye-sight, 
can make no great mistake in buying convex glasses 
when he begins to suffer from presbyopia; but even 
in such a case an examination of the eyes by an 
optical specialist may reveal some degree of astig- 
matism which ought to be corrected, or perhaps some 
pathological condition which ought to be attended to. 
ATAXIA, LOCOMOTOR. (See Tabes Dorsalis.) 
ATELECTASIS IN EARLY INFANCY. (Undistended 
Lung.) 
Strengthen the respiratory process by clearing 
the air passages of obstructions and by sustaining 
the strength of the child. Provoke crying and cough- 
ing so that deep inspirations may be instinctively 
42 taken. Artificial respiration may be resorted to. 
Do not permit child to sleep too long or to remain too 
long in the same position. Maintain the bodily 
heat by wrapping the infant in cotton or flannel or 
keeping it in an incubator. 
ATROPINE, POISONING BY. 
Evacuate stomach by emetics or stomach pump. 
Antidotes: Animal charcoal absorbs the alkaloid, 
tannic acid renders it insoluble. Physostigmin (Cala- 
bar bean) is a physiological antidote, and should be 
administered hypodermically, using the condition of 
the pupils as a guide to the dosage. Begin with a 
dose of gr. and repeat if the pupils do not 
begin to contract. 
BACKACHE. 
This is a symptom of many diseases, functional and 
organic. It is frequently one of the first symptoms 
in some of the acute infectious diseases as typhoid, 
small-pox, tonsillitis, etc. It is a frequent symptom 
of uterine or ovarian disease and neurasthenic con- 
ditions, especially at the menopause. The pain of 
intercostal neuralgia causes a backache at the exit 
of the nerve from the vertebral column. The pain 
of gastric ulcer is characteristic on account of its 
burning, boring character. The pain of gall-stones 
may be referred to underneath the right shoulder 
blade. In Bright's disease the pain is of a dull 
aching character, whilst the pain of acute cystitis is 
much lower down and much sharper. In locomotor 
ataxia the lightning pains of the limbs begin in the 
back. Prolapse of the viscera from relaxation of the 
abdominal walls causes a dragging pain in the back. 
Rheumatic affections as lumbago are so severely 
painful that the patient is unable to move 
In order to relieve the backache due to the above 
■causes these diseases must be treated. For the in- 
fectious diseases massage of the back with alcohol, 
43 spirits of camphor or opodeldoc is all that is neces- 
sary. If due to uterine or ovarian disease correct the 
condition causing it, adding to the treatment iron 
and other tonics. The following prescription is of 
considerable benefit in uterine cases: 
1$. Tinct. gelsemii 5iss 
Sodii bromid 3iiss 
Tinct. hyoscyam 5iii 
Aquae. 5 ii 
Elix. simpl. q. s. ad §iii 
M. Sig. One teaspoonful every three hours in water. 
If the backache is due to neurasthenia or other 
functional nervous affection, give the following: 
Asafoetid grs. xxxvi 
Extr. sumbul. 
Ferr. reducti aa grs. xlviii 
Mangan, dioxid grs. xii 
M. et ft. caps. No. xxiv. 
Sig. One four times a day. 
If the backache is due to lumbago, gastric ulcer, 
cystitis, tonsillitis, cholelithiasis, or tabes dorsalis, 
treat these conditions. 
BALANITIS. 
Prophylaxis. Cleanliness, retraction of the pre- 
puce and daily washing of the glans penis. Circum- 
cision. 
Treatment. Pull back the prepuce and apply a 
mild antiseptic wash of corrosive sublimate (1 to 5000). 
Then carefully dry the exposed surfaces so as not to 
chafe them and dust on an unirritating powder com- 
posed of: 
T|. Bismuth, subnitr. 
Hydrarg. chlor, mit. 
Zinc, oxid aa $ii 
M. Sig. Use two or three times, a day. 
Lastly separate the powdered surfaces with a very 
thin layer of absorbent gauze. 
44 Erosions or ulcerations which do not heal readily 
should be touched with a piece of cotton moistened 
with a solution (5% to 20%) of nitrate of silver. 
Phimotic cases are very troublesome and should 
be irrigated very often. In severe cases dorsal in- 
cision or circumcision may be needed. 
For children it is safer to use the following lotion 
for cleansing purposes: 
1$. Creolin or Cresol 3ii 
Aquae q. s. ad 5viii 
M. Sig. Wash thoroughly outside and under the 
prepuce with this solution, and apply gauze soaked 
with same, changing every four hours. 
At bedtime apply the following if inflammation is 
severe: 
Plumb, acetat 3iii 
Tinct. opii 3i 
Aq. q. s. ad 5viii 
M. Sig. Apply freely on lint. 
BALDNESS (See Alopecia). 
BANTI'S DISEASE (See Anaemia, splenic). 
BARBER'S ITCH (See Tinea Barbae). 
BASEDOW'S DISEASE (See Goitre, exophthalmic). 
BED-SORES. 
Guard against them in the diseases which they 
most frequently complicate, e. g., long continued dis- 
eases like typhus, typhoid, phthisis, scurvy, cases 
of spinal disease in which particles of food, urine and 
feces irritate the skin; hemiplegia and paraplegia where 
voluntary movement is lost; and in trophic distur- 
bances due to injuries of the central nervous system. 
Preventive treatment consists in relieving the 
pressure to which the parts are subjected, by turning 
the patient and constantly changing his position in 
bed; by the use of a water-bed with air-cushions, 
pillows and rings; and by keeping the sheets clean 
45 and smooth. Next keep the parts clean, especially 
where there is incontinence of urine or feces. Beds 
are made with the part under the genitals removable, 
and one of these may be used. Next use chemicals 
to harden the skin. e. g., spirits and water, argenti 
nitras, tannic acid, lead, etc., thus: 
R. Aluminis oi 
Spt. vin. rect Sviii 
Aquse q. s. ad.... §xvi 
M. Sig. Sponge body freely thrice daily after bathing 
with water. 
If, in spite of care, red spots appear and threaten 
to break, give: 
R. Argenti nitratgrs. xl 
Aquse destillat §ii 
M. Sig. Paint red spots daily. 
If, through negligence or unavoidably, a bed-sore 
has formed, cleanse thoroughly with solution of hydrarg. 
bichlor (1 to 1000), encircle with soap plaster round the 
edges, apply iodoform freely several times a day and 
place the patient's body upon a rubber air-ring. Paint 
the ulcer every second day with solution of silver 
nitrate (20 grs. to 5i of distilled water). The following 
will also relieve the pain and promote healing: 
I). Zinci stereatis 3ii 
Chloretoni 3ss 
Acidi borici 5ii 
M. Sig. Apply freely. 
BED-WETTING (See Incontinence of Urine). 
BELLADONNA POISONING. 
Use the stomach tube or give an emetic. Give 
pilocarpine nitrate (gr. or morphine sulphate 
(gr. M) hypodermically. Give also stimulants and 
hot coffee. Apply warmth and use artificial respira- 
tion. 
BELL'S PALSY (See Paralysis, Facial). 
46 BERI-BERI. 
Prevention. Sleeping rooms should be dry and 
well-ventilated. Avoid over-crowding. Wholesome 
and liberal dietary rich in fatty and nitrogenous food. 
Treatment. Rest in bed, avoid bulky foods like 
rice, and give foo4 in small quantities at frequent 
intervals; meat, fresh vegetables and fruit. Guard 
against heart failure by cardiac tonics such as digi- 
talis and strychnine. During the cardiac paroxysms 
give 5 minim doses of amyl nitrite by inhalation, or 
nitroglycerin (T£o gr.) hypodermically. If hydro- 
pericardium or hydrothorax is present, relieve by 
aspiration. 
After the acute symptoms have subsided the func- 
tions of the nerves may be restored by massage and 
faradisation. Move patient as soon as possible to a 
non-infected place. 
BILHARZIASIS. 
The liquid extract of male fern, in doses of 15 
minims three times a day, though it does not expel 
the parasites, seems to weaken their power of doing 
harm. It diminishes hsematuria, allays vesical irri- 
tation, and reduces the number of eggs passed in the 
urine and faeces. 
For the cystitis, salol, benzoic acid, and urotropin 
(15 grs. three times a day) are of use, and for the 
rectal cases, suppositories of belladonna. 
The prescription for cystitis would be written in 
this way: 
J|. Urotropin or Hexamethylenamin.... §ss 
Fluidextr. tritici q. s. ad 3iii 
M. Sig. One teaspoonful in a glass of hot water, 
three times a day. 
In ordering male fern the prescription would be: 
1$. Oleoresin. filic. maris 5ss 
Chloroformi gtt. xxiv 
Syr. acac. q. s. ad §ii 
M. Sig. One teaspoonful three times a day. 
47 BILIOUSNESS. (LIVER, CONGESTION OF.) 
Regulate the diet; the patient should avoid rich 
food, pastries, condiments, sugars and starches. 
Food should be non-stimulating, e. g., milk, eggs, 
beef-broth, beef tea, lean meat, succulent vegetables, 
and acid drinks. Patient should take systematic 
exercise, such as walking, horseback riding, bicycling, 
motoring, etc. Change of air, sea bathing, cold 
bathing, sponging and douching are also of much 
benefit. 
The so-called biliousness which is characterized 
by malaise, headache, constipation and indigestion, 
is often attributed to an excessive secretion of bile, 
but may be due to astigmatism or other error of 
refraction. Examine the eyes separately for these 
defects, and if present, treat them. Examine also 
the urine for albumin. 
Treatment of acute attack. If due to hepatic 
congestion, deplete by saline purgatives, e. g., phos- 
phate of soda oz. doses), Rochelle salts or citrate 
of magnesia. Relieve nausea or vomiting by gr. 
doses of calomel frequently repeated, taken dry 
on the tongue. Relieve constipation with: 
R. Podophyllin. resin grs. ii 
Extract, colocynthidgrs. xxiv 
Aloin grs. iv 
Extr. belladonn grs. iii 
M. et ft. pil. No. xxiv. 
Sig. One night and morning. 
Mustard plasters, large poultices, wet cups, or leeches 
over liver, or leeches round anus may be of service. 
Morphine may be used to allay great pain. 
If the hepatic congestion be due to cold or checking 
of the perspiration give saline diaphoretics or Dover's 
powder, a foot-bath and aconite to quiet the circulation. 
BLACK-EYE. 
Very hot or very cold applications if made at the 
time of the accident, will prevent extensive discolors- 
48 tion of the skin, but neither will accomplish much if 
the application is delayed. Avoid warm fomenta- 
tions. Paint integument round eye to hide discolora- 
tion. 
During the first twenty-four hours apply: 
Lotio plumb, et opii 3iv 
Sig. Keep solution on ice and apply on gauze fresh 
every half hour. 
An excellent treatment for a black-eye is to paint 
over the bruised surface tincture of capsicum mixed 
with an equal bulk of mucilage to which a few drops of 
glycerine are added. A second or third coating is 
applied as soon as the previous one is dry. 
If a prescription is wanted for the above it may be 
given as follows: 
I). Tinct. capsici 3iss 
Mucilag. acaciae 3ii 
Glycerini 5ss 
M. Sig. Paint over the bruised surface. 
BLACKHEAD. (COMEDO.) 
Attend to patient's general health. Correct anae- 
mic, gastric, intestinal or other derangements. Diet 
should be plain but nutritious; forbid candies, oat- 
meal, cheese, nuts, rich entrees, etc. Patient should 
take outdoor exercise. 
Local treatment. Removal by watch-key or 
comedo extractor, face massage and face steaming. 
Give the following prescription: 
1$. Sod. borat 3ii 
Ungt. aq. rosae 3i 
M. Sig. Apply freely, and after half an hour wash 
off with soap and cold water. 
Then apply the following lotion: 
I|. Hydrarg. bichlor grs. ii 
Acid. acet, dil 3vi 
Aquae rosae. 
Spts. vini rect aa 3 ss 
M. Sig. Apply as lotion once a day. 
49 BLADDER, INFLAMMATION OF (See Cystitis). 
BLADDER, IRRITABLE. 
Irritability of the bladder may be caused by wet 
feet, by pressure of a displaced or pregnant uterus, 
by prolapse of the uterus, loaded rectum, pressure 
from tumor in the abdomen, stone in bladder, in- 
flammation in posterior portion of urethra and 
hysteria. 
Correct the above morbid conditions if possible. 
Frequently if no special cause can be discovered and 
the urine is very acid, give: 
I). Potass, citrat 3iv 
Fluidextr. buchu 3iv 
Fluidextr. uvae ursae 3iv 
Fluidextr. triticiq. s. ad giii 
M. Sig. One teaspoonful in hot water every three 
hours. 
Occasionally it becomes necessary to wash out the 
bladder once a day with a hot saturated solution of 
boric acid. 
If the irritability is due to hysteria or neurasthenia, 
give: 
I). Sodii bromidi 5iv 
Tinct. hyoscyam 3iv 
Aquae 3i 
Fluidextr. triticiq. s. ad. §iii 
M. Sig. One teaspoonful in water every three hours. 
Frequently small doses of tincture of cantharides 
quickly and entirely relieve irritability of the bladder 
in women, in whom there is no uterine displacement, 
and no acute inflammation: 
1$. Tinct. cantharid 3u 
Fluidextr. triticiq. s. ad §iii 
M. Sig. One teaspoonful in water three times a day. 
BLASTOMYCOSIS. 
In the localized form iodide of potassium is a 
specific. It cures all cases very rapidly. Begin by 
giving 20 grs. three times a day and increasing till 
50 grs. three times a day are taken. 
50 1$. Potass, iodidi 3iss 
Aquae; §ii 
Ess. pepsin q. s. ad §iv 
M. Sig. One teaspoonful in very hot water after each 
meal. 
The local lesions should be thoroughly curetted and 
dressed with gauze soaked in a hot lysol solution. 
For the systemic cases no treatment of any kind has 
had any curative value. All we can do is to open 
pustules when they appear on the surface and dress 
them with wet antiseptic dressings, as: 
I|. Lysol 3i 
Aquae q. s. ad §xii 
M. Sig. Apply with gauze twice a day. 
Internally, strychnine, iron and phosphorus may be 
administered to keep up the strength as long as possible. 
BLEEDING, PRACTICAL DIRECTIONS FOR. 
Observe strict antiseptic precautions in cleansing 
the site of incision, as well as the knife and bandages. 
Allow the patient's arm to hang suspended and apply 
a firm bandage above the elbow, sufficient to com- 
press the superficial veins but not tight enough to 
stop the arterial flow. Select the most marked vein 
on the front of the fore-arm (the median basilic, 
external to the tendon of the biceps is the best), and 
open it longitudinally, inserting the point of the blade 
directly into the vessel and withdrawing it with a 
downward cutting motion. 
When the blood flows freely, feel the pulse of the 
other arm and be on the lookout for symptoms of 
fainting. From twenty to forty ounces of blood may 
be removed according to the condition of the patient. 
When the operation is over check the flow by 
applying a compress over the incision, remove the 
bandage from above the elbow, and bandage the 
fore-arm. After twenty-four hours remove this 
bandage. 
51 BLEPHARITIS. 
It is most important to correct error of refraction 
with suitable glasses. If the blepharitis is part of a 
constitutional condition, give the following for a 
child of five years: 
I). Syr. hydriodic acid §iii 
Sig. Half a teaspoonful three times a day in water 
after meals. 
Locally. Wash off the crusts from the roots of the 
eyelashes twice a day with a hot saturated solution of 
boric acid. Dry and rub in thoroughly along the edges 
of the lids: 
ty. Hydrarg. oxid. flavgrs. iv 
Ungt. petrolat 5iv 
M. Sig. Rub in twice a day. 
BLEPHAROSPASM. 
Search for and treat cause, e. g., foreign bodies in 
the conjunctiva, cornea, nose or ear. Examine also 
the teeth and mouth. Treat conjunctivitis or kera- 
titis if present. Correct errors of refraction under 
atropinization and remedy any errors of the eye- 
muscles. Conium may be used both internally and 
externally. 
Prolonged uncontrollable blepharospasm continu- 
ing for weeks and months is an indication of disease 
of the seventh nerve within the cranium. Resection 
of the external nasal branch of the ophthalmic divi- 
sion of the fifth nerve is recommended. Bromides 
with morphine occasionally give temporary relief: 
1$. Morph, sulph grs. iii 
Strontii bromid 5iv 
Aquae Biss 
Syr. zingiberq. s. ad. oiii 
M. Sig. One teaspoonful three times a day in water. 
Canthoplasty is frequently indicated when the 
blepharospasm is due to inflammation of the cornea. 
When due to error of refraction atropin temporarily 
cures it: 
52 I). Atropin. sulph gr. i 
Aquae destill 3ii 
M. Sig. One drop three times a day. 
Internally give fluidextract of gelsemii in gradually 
increasing doses three times a day until the full physio- 
logic effect is obtained. 
BLINDNESS, PREVENTION OF. 
Most common cause of blindness is ophthalmia 
neanatorum, due to gonorrheal discharges from 
vagina. Eyes of all infants should be washed with a 
saturated solution of hot boric acid as soon as born, 
and a few drops of a two per cent solution of silver 
nitrate instilled. The above treatment is an abso- 
lute preventive of Ophthalmia Neanatorum, which see. 
BOILS. 
Examine the urine for sugar. Remove any press- 
ure from edge of collar, cuff, shirt-button, etc. 
Patient should have frequent baths and change of 
underclothing. Tonics may be given such as iron, 
quinine, cod-liver oil and hypophosphites. 
Prevention. Boils may be aborted by applying 
a few crystals of pure carbolic acid on a glass rod, 
or by the following paste: 
1$. Ichthyol. grs. x 
Unguent, hydrarg. 
Ungt. belladonn aa 3i 
M. Sig. Apply locally and make pressure with strips 
of adhesive plaster. 
Or, a few drops of a 3 per cent solution of carbolic 
acid may be injected. 
Or, the skin may be painted with silver nitrate, fol- 
lowed by collodion. 
Unguentum belladonna as well as fomentations and 
poultices relieve the pain. 
Hypodermic injection of anti-staphylococcus serum 
or vaccine is often of great service. 
Internal treatment. Drugs used. Mineral acids, 
Blaud's pill, arsenic, quinine and aspirin. 
A pill containing the following is very useful: 
53 I|. Acid, arsenios gr.r£0 
Ferri sulph. exsicc gr. i 
Calcii sulphid gr. J4 
Extr. gentian grs. ii 
M. et ft. Caps. No. 1. 
Sig. One three times a day after meals. 
BRAIN ABSCESS. 
If due to middle-ear disease, operate at once to drain. 
If the abscess is due to other causes, try to locate 
it. Medical treatment is very unsatisfactory. If 
there is a wound on the head, disinfect it carefully 
with antiseptic solutions after shaving the head. 
An ice-bag applied to the head, leeches behind the 
ear and a fly-blister to the back of the neck are of 
great value. Inunction with ungt. Crede twice a 
day is also of benefit. 
For pain and excitement, give: 
I). Chloral hydrat 5iii 
Potass, bromid 5ii 
Sodii bromid 5 ii 
Aquae r- oiss 
Elix. aromat. q. s. ad oiii 
M. Sig. One teaspoonful every three hours in water. 
BRAIN, CONCUSSION OF. 
Treat external wound if there is one. For col- 
lapse, administer stimulants by mouth, by rectum, 
or hypodermically. Avoid alcohol. Use ether, 
strychnine, atropine, nitroglycerine or camphor as 
in following prescription: 
1$. Strychnin, sulph gr. ss 
Spts. camphor® 5iii 
Aquae destillat. q. s. ad 3ii 
M. Sig. One teaspoonful by mouth or hypoder- 
mically every three hours. 
Apply sinapisms over praecordium and epigastrium, 
or to calves of legs. 
In stage of reaction give light diet, purgatives, or 
enemata, as required. Darkness and quietness. Shave 
54 head and apply ice-bag or Leiter's tubes if necessary. 
If cerebral irritation ensues, administer chloral 
hydrate and potassium bromide: 
I|. Chloralis hydrat 3 hi 
Potass, bromid 3 hi 
Aquae §i 
Elix. aromat. q. s. ad §ii 
M. Sig. One teaspoonful every three hours, if 
necessary. 
BRAIN FEVER (See Meningitis, Cerebro-Spinal). 
BRAIN, HYPEREMIA OF. 
The patient should rest in bed with his head ele- 
vated and his arms stretched upwards. The quan- 
tity of blood in the brain may be diminished by giving 
a drastic purgative such as croton oil or colocynth to 
produce congestion of the intestinal tract: 
I). Hydrarg. chlor, mitgrs. xviii 
Sacchar. lact grs. xii 
Extr. colocynthgrs. xviii 
M. et ft. chart. No. xii. 
Sig. One every hour until free purgation results. 
Diuretics, hot mustard baths for the extremities, a 
mustard plaster to the epigastrium, the actual cautery 
to the nape of the neck, an ice-bag to the head, and a 
hot bath to the body are also of service. 
When the condition is due to suppression of the 
menses, leeches to the anus or cervix uteri, as well as 
the electric brush to the thighs, warm applications to 
the loins and perineum are of great benefit. 
When the attack is over the patient should have com- 
plete mental rest, fresh air, and keep regular habits 
He should avoid tea, coffee, alcohol and tobacco. 
BRAIN, SOFTENING OF. 
Medication is of no value in senile softening. 
During an acute attack the patient should rest in 
bed with his head in sloping position in a room of 
uniform temperature. The body of patient should 
55 be kept warm with warm clothing and by artificial 
heat. Stimulants should be given cautiously. 
When the attack is over regulate the diet, pro- 
hibit all mental effort and give a nerve tonic like. 
I|. Phosphori gr. ss 
Lecithin grs. xxxvi 
M. et ft. pil. No. xxxvi 
Sig. One four times a day. 
BRAIN, SYPHILIS OR GUMMA OF. 
Give anti-syphilitic remedies as soon as the diag- 
nosis is made, and the earlier the better. Iodide of 
potassium is the drug to be depended upon, and may 
be given in increasing doses until so much as 500 
grains are taken daily. Potassium iodide is best 
given in very hot water. Prescribe it in 50 gr. 
powders so that the dose can be easily regulated. 
This drug in immense doses is better borne by the 
stomach than small ones. A bottle of essence of 
pepsin may also be prescribed; a tablespoonful may 
be added to each dose. 
If the patient is unconscious, the iodide may be 
injected (a drachm to a drachm and a half diluted 
with water or milk) into the rectum, every four hours. 
When the patient regains consciousness give the 
iodide by the mouth. 
After the serious symptoms have abated, reduce 
the dose of the iodide gradually, but continue the 
iodide treatment for a year or two. Mercury should 
also be added to the treatment, either by mouth or 
hypodermically, preferably the latter. Hypoder- 
mically, give: 
jfy. Hydrarg. bichlor gr. ss 
Aquse destillat $iii 
M. Sig. Inject one drachm deeply into the buttock 
once a day. 
Or: 
I|. Pil. hydrarg. proto-iodid gr. 
No. c. 
56 Sig. One four times a day, and increase till 3 or 4 
are taken at each dose. 
If the pains are not allayed by iodide, then morphine 
or applications of blisters to the nape of the neck may 
be of service. 
If convulsions occur often, add bromide to the iodide 
of potassium. 
If the patient becomes delirious gentle restraint may 
be necessary. 
Patient should avoid alcoholic or sexual indulgence. 
He should also shim excitement of any kind, and his 
bowels should be attended to regularly. 
Do not give headache powders for the pain in the 
head, but push the iodide of potassium. 
BRAIN, THROMBOSIS OF. 
The patient should be kept perfectly quiet. If 
the heart's action is failing, as shown by the state of 
the pulse, give stimulants. When the attack is over, 
faradization of the paralyzed muscles may be of 
service. 
BREAST, CONGESTION OF. ("CAKED" BREASTS.) 
This condition usually occurs on the third day after 
confinement, when the first rush of milk enters the 
ducts. It is liable to occur off and on for about a 
week until the supply has regulated itself according 
to the demand. It may cause a slight rise in tem- 
perature which is best treated by saline cathartics. 
The breasts should be pumped out and towels wrung 
out in hot water should tje firmly applied. Massage 
with cocoa butter rubbing from the nipple backwards 
is of considerable service. The child should be en- 
couraged to nurse freely. 
BREAST, CYSTS OF. 
These are benign. They may originate during 
puberty and become painful with each menstruation. 
57 They may at those times be gently massaged with the 
following ointment: 
1$. Ungt. hydrarg. 
Ungt. stramon. 
Ungt. belladonn. 
Lanolin aa 3ii 
M. Sig. Rub in gently twice a day. 
Cysts frequently disappear spontaneously or during 
pregnancy. If they should during middle life cause 
much pain and discomfort, or if they should suddenly 
begin to grow, they should be removed immediately. 
BREAST, FIBROMA OF. 
This tumor is not of a dangerous nature, except 
when the breast receives a blow or injury when it 
may become cancerous. If it attains a large size it 
should be removed with the breast, without the 
axillary glands. 
BREASTS, INFLAMMATION AND ABSCESS OF (See 
Mastitis). 
BREATH, FETOR OF. 
Examine teeth, nose, tonsils and fauces. May be 
due to retention of decomposing food, to caries of 
teeth, chronic rhinitis, tonsillitis, fetid bronchitis, 
bronchiectasis, gangrene, fetid empyema, constipa- 
tion, dyspepsia, or ingestion of certain drugs such as 
mercury or sulphur. It may also be due to chronic 
alcoholism, to excessive use of tobacco, or to bolting 
of food at meals. 
The patient should clean his teeth daily. All 
dental cavities should be filled. If dyspepsia is the 
cause, charcoal cake or powders should be taken: 
I|. Beta naphthol 3i 
Carbonis ligni 3iss 
01. menth. piperit m. xii 
M. et ft. caps. No. xii. 
Sig. One after each meal. 
If due to chronic catarrhal disease of nose or throat, 
58 spray with the following solution which is soothing, 
agreeable and efficient: 
I). Sod. biborat. 
Sod. bicarb. 
Sod. chlor aa grs. xxx 
Sod. salicyl grs. x 
Liq. antiseptic, alkalin §i 
Glycerini gi 
Aq. destillat. q. s. ad oviii 
M. Sig. Spray into nose and throat twice a day. 
The following should be used in conjunction with 
the above: 
Tinct. iodini gi 
Glycerini gi 
M. Sig. Apply with cotton to the throat every two 
days. 
If the tonsils are at fault remove them. 
If due to chronic bronchitis, gangrene, bronchiectasis, 
etc., treat these conditions as given under their headings. 
The following makes a very pleasant and effective 
toilet article: 
1$. Potass, permanganat grs. iii 
Aquas rosse 5iii 
M. Sig. Use as mouth wash two or three times a 
day. 
BRIGHT'S DISEASE (See Nephritis). 
BROMIDROSIS. 
Internally give a teaspoonful of sulph. precipitat. 
in milk twice a day. Locally: bathe the feet in 
water as hot as can be borne, then dust finely powdered 
boric acid well in between the toes and into the stock- 
ings and shoes. 
A five per cent solution of chromic acid may be 
painted on the feet every month. Mutton suet with 
two per cent salicylic acid may also be rubbed on 
the feet, or affected parts: 
I|. Acid, salicyl. 
Amyli. 
Acidi borici aa 3iv 
M. Sig. Use twice a day between toes or in axilla. 
59 BRONCHIECTASIS. 
The same treatment is applicable here as in Bron- 
chorrhoea, which see. Strychnine is of considerable 
importance in this condition to tone the lung. 
BRONCHITIS, ACUTE. 
Confine the patient to bed or to a room in which 
the air is warm and moist. The diet should be light 
and easily digestible, e. g., beef juice, etc. The 
bowels should be regulated by mild aperients. At 
the onset counter-irritation should be made by means 
of stupes, sinapisms, poultices, compresses, etc., e. g., 
a large mustard poultice covering the whole chest, 
applied not longer than half an hour; or hot kaolin 
poultices; or compresses spread with vaseline and 
sprinkled with a few drops of turpentine. 
If the patient is robust and in the "dry stage" of 
the disease, tartar emetic (gr. i) should be dissolved 
in a cup of water, and a teaspoonful taken every ten 
minutes until nausea is produced. This relaxes the 
spasm of the bronchial tubes and a watery secretion 
with expectoration follows. 
Or an expectorant may be given: 
I}. Apomorph, hydrochlor gr. ii 
Sodii bromidi 5iii 
Tinct. sanguinar 5ss 
Syr. tolut q. s ad. §iii 
M. Sig. One teaspoonful in a wineglass of water every 
two hours. 
Or the following may be given: 
1$. Codein. phosphat gr. iv 
Ammon, chlorid 5i 
Syr. lactucar 5ii 
Syr. tolut. q. s. ad 5iii 
M. Sig. One teaspoonful every three hours. 
Frequently we can abort an attack by giving a hot 
foot bath and a hot drink of lemonade or whisky, with 
a full dose of Dover's powder and an extra blanket in 
bed to promote diaphoresis. 
co The old-fashioned remedies, linseed oil and flaxseed 
tea, are beneficial because of their soothing effect. 
The acute bronchitis of infants should be treated by 
general methods. No nauseating and digestion-destroy- 
ing medicines should be given. Hot linseed poultices 
for several hours a day. Inunctions of hot camphorated 
oil twice a day and cotton around the chest are of much 
more benefit. If the cough is very irritating, the follow- 
ing may be given for a child one year old: 
I). Ammon, chlor grs. vi 
Syr. lactucar 3ii 
Syr. tolutan • 3iss 
Meilis 3 i 
Syr. hypophosph. q. s. ad 3iii 
M. Sig. One teaspoonful every three hours. 
Inhalations are also of great service for children, the 
vapor being conducted into a tent of blankets arranged 
over the patient: 
IJ. Tinct. benzoin, co 3iv 
Creosot 3ss 
Fluidextr. belladonn 3ii 
Olei terebinth 3i 
Olei eucalypt. q. s. ad §ii 
M. Sig. Add one teaspoonful to a quart of boiling 
water, for inhalation. 
In adults, when the secretion becomes plentiful, give 
a stimulant expectorant like this: 
I|. Ammon, chlorid ' 3iss 
Syrup, scill 5ii 
Syr. lactucar 3iv 
Elix. terpin, hydrat 3iv 
Syr. tolutan 3iv 
Syr. prun. virg. q. s. ad 5 iii 
M. Sig. One teaspoonful every three hours. 
During convalescence from a prolonged attack, 
change of air with cod-liver oil, iodide of iron, quinine 
and arsenic are of benefit. 
61 BRONCHITIS, CHRONIC. 
Since pure air is the natural disinfectant for the 
respiratory passages, the patient should be removed 
to a climate where he can have plenty of out-door life. 
A warm, dry climate is to be recommended in cases 
where there is much expectoration, and a warm, 
moist one, where there is little expectoration. The 
patient should avoid chills by wearing flannel next 
to skin of whole body (not merely chest-protectors), 
and seeing that his shoes are strong and dry. Dur- 
ing the summer the patient should take salt-water 
baths followed by skin friction. In the winter the 
whole body may be rubbed briskly with oil in a warm 
room every morning. Respiratory exercises and 
thoracic massage are also of value. 
Medical treatment should be directed towards 
toning up and stimulating the general circulation, 
and relieving the congested bronchial tubes. The 
first indications are met by giving cod liver oil, iron, 
malt, strychnine, etc. The second indications are 
met by giving ammonium carbonate, ammonium 
chloride, terebene, creosote, balsams of tolu and Peru 
potassium iodide and guiacol. 
The following is excellent to liquefy expectoration 
and to stimulate excretion: 
I}. Potass, iodid 5ii 
Syr. tolu oi 
Tinct. senegae■ 3h 
Tinct. scillae 3ii 
Syr. prun. virg. q. s. ad §iii 
M. Sig. One teaspoonful every three hours. 
The following capsule is of importance: 
I}. Guiacol carbon 3i 
Terpin hydratgrs. xlviii 
Strych. sulphgr. § 
Codein phosphgrs. iii 
M. et ft. caps. No. xxiv. 
Sig. One four times a day. 
When stimulation is necessary, give: 
62 I}. Ammon, carbon 3ii 
Ammon, iodid 3 hi 
Syr. glycyrrhiz gii 
Syr. tolu q s. ad 5iv 
M. Sig. One teaspoonful three times a day. in water. 
Inhalants are very beneficial, e. g.: 
Eucalyptol 3i 
Camphor §i 
Thymol 3i 
Menthol 3ss 
01. terebinth, q. s. ad 3ii 
M. Sig. One teaspoonful in a pint of hot water, for 
inhalation. 
Or: 
T|. Beechwood creosote 3ii 
Oil pine needles 3iv 
Oil wintergreen 3i 
Eucalyptolm. xx 
Thymolgrs. xv 
M. Sig. Inhale from 2 to 5 drops three times a day. 
Put into a small cup and while being warmed over a 
spirit lamp, inhale the vapor. 
When the cough is irritating, give: 
3. Creosoti m. xxiv 
01. morrhuse 3ii 
M. et ft. caps. No. xxiv. 
Sig. One three times a day. 
BRONCHO-PNEUMONIA (See Pneumonia, Lobular). 
BRONCHORRHCEA. 
The treatment is the same as for chronic bronchitis, 
which see. 
In addition it is very essential to give reconstruc- 
tive tonics, as: 
1$. Strych. sulphgr. % 
Quin, sulphgrs. xviii 
Acid, arseniosgr. 
Ferri citrat 3ii 
M. et ft. caps. No. xxiv 
Sig. One four times a day. 
63 The balsams are of great benefit, e. g.: 
U. oi. santal 3i 
Copaibse 5iss 
Terebene 3i 
M. et ft. caps. No. xxiv. 
Sig. One every three hours. 
The inhalants are very soothing and should be used 
in the same way as in Chronic Bronchitis, which see. 
The salts of ammonium and the iodides are of little 
benefit in this condition. 
The patient can frequently help to empty the pro- 
fuse secretions out of his lungs by allowing his body to 
hang head downwards out of bed, or he may take the 
knee-chest position. 
BRUISES AND CONTUSIONS. 
Lessen the amount of extravasation by cold or 
great heat (not mere warmth), both of which con- 
tract the smaller blood-vessels. Intense heat allays 
pain better than cold. The part may be gently 
rubbed and placed in such a posture as will help the 
return circulation. The rubber coil is the best way 
of applying heat or cold. 
If the pain is very severe it may be allayed by 
morphine or antipyrine, hypodermically or by the 
mouth, or by cocaine hypodermically. 
The inflammatory reaction may be treated with 
aconite, a saline purgative and a low diet. 
When extravasation and inflammatory reaction 
have subsided pressure by a Martin's rubber bandage, 
or gentle rubbing, helps to remove the effused blood. 
BUBO. 
If possible treat cause, e. g., infection from genitals, 
infected wounds in extremities, syphilis, tuberculosis, 
etc. See also Plague and Climatic Bubo. 
If due to infection on external genitals, cleanse 
the latter thoroughly with: 
64 I). Hydrarg. bichlor, sol. Bvi 
Sig. Use three times a day. 
Shave the bubo and apply: 
I). Ungt. hydrarg. 
Ungt. belladonn. 
Ichthyol. 
Lanolin aa 3ii 
Sig. Apply thickly to bubo twice a day. 
If after a few days rest in bed the bubo goes on to 
suppuration, poultice for a few days with: 
1$. Cataplasmae kaolini N. F 3xvi 
Sig. Apply hot and thickly to bubo three times a day. 
Then incise freely and pack daily with iodoform 
gauze after swabbing with tincture of iodine. 
If the bubo is due to infected wounds in the ex- 
tremities, as corns, bums or abrasions, treat these 
with hot antiseptic dressings, e. g.: 
1$. Creolin or Lysol 5ii 
Sig. One teaspoonful in a quart of hot water. Apply 
frequently. 
In these cases the bubo usually subsides in a few 
days from the following application: 
3. Ungt. iodini ' -.. §i 
Sig. Apply once a day and cover with cotton and 
b'andages. 
BUBO, CLIMATIC. 
During the first week of the illness, enlargement 
of the groin-glands may be prevented by rest in bed, 
light diet, attention to bowels, and by the application 
of pressure on the gland itself. 
If there is undoubted evidence of pus the gland 
should be exposed by a long incision parallel to the 
groin, and packed with antiseptic gauze daily 
BUNIONS. 
Patient should rest, and hot or cold applications 
should be made during the active stage. Lead water 
and laudanum may also be applied: 
65 I). Liq. plumb subacetat. 
Tinct. opii aa 3ss 
Aq. destillat. q. s. ad 5viii 
M. Sig. (Local use only.) Apply freely on soft 
cloths or absorbent cotton. 
Pressure on the foot may be relieved by wearing a 
proper shoe. A metallic support for the arch of the 
foot will remove direct pressure on the toe. Mechanical 
contrivances may be devised to draw the toes inward. 
BURNS AND SCALDS. 
Stimulants should be given for the shock. The 
intense thirst may be allayed by ice, or by sips of 
ice-cold aerated water. 
Local treatment. The main indication is to ex- 
clude the air by such substances as flour, starch, oil 
or molasses, which make a coating for the nerve 
filaments, that have been uncovered. Carron oil 
(equal parts of linseed oil and lime-water) or equal 
parts of carbolic oil (1 in 20) and lime-water may be 
applied on lint or soft linen or muslin to the burned 
surface, and then enveloped in layers of cotton 
batting, and held in place by a roller bandage. Great 
pain may be allayed by the hypodermic injection of 
morphine (J4 gr.). 
If the burns are very severe and extensive, a con- 
tinuous warm (100° F.) bath of decinormal salt solu- 
tion may be necessary. The patient may sleep in 
the bath propped on rubber air pillows. 
Perhaps the best all-round application for bums is 
picric acid. It is a fair antiseptic, a good oxidizing 
agent and it has to a high degree, the power of co- 
agulating albumen. It is best made in combination 
with citric acid in the following proportions: 
Picric acid 10 parts 
Citric acid 20 parts 
Water > 70 parts 
The fluid should be sopped freely on the burn, so 
that it may reach the interior of every vesicle, and 
66 when the excess has been drained off, the part is 
covered with soft gauze; the dressing should be re- 
applied every 2 or 3 days, but only to those areas 
where exudative fluid has collected. 
BURSITIS. 
In acute bursitis the patient should have rest, with 
hot fomentations, compression and iodine or ichthyol 
should be used to stimulate lymphatic absorption of 
the effused fluid. 
3. Ungt. iodini. 
Ichthyol. 
Ungt. petrolatiaa 3ii 
M. Sig. Rub in thoroughly twice a day. 
In later stages tapping may be necessary, or tapping 
followed by injection of irritant fluids, e. g., 5 or 10 
drops of a 10% solution of carbolic acid. 
CAISSON DISEASE (DIVER'S PARALYSIS). 
Prophylaxis. The transition from high to low 
pressure should be made gradually by arranging 
chambers through which the workmen must pass 
slowly before going back to the ordinary pressure of 
the atmosphere. An elevator should be employed 
to take workmen up to the surface and thus avoid 
over-exertion. Hours of labor in high pressure air 
should be short. The air chamber should also be 
thoroughly ventilated. After de-compression, the 
workman should have rest, a warm drink and a 
change of warm clothing. 
Treatment. Morphine hypodermically for the 
severe pains. Electric current and massage to re- 
lieve the pains of the joints. Hot compresses should 
be applied to the spine and to the extremities. The 
paralyses, sensory disorders, etc., should be treated 
as in Acute Myelitis. 
CAKED BREAST (See Breasts, Congestion of). 
CALCULI, BILIARY (See Cholelithiasis). 
67 CALCULI, RENAL (See Nephrolithiasis). 
CALCULI, URINARY (See Nephrolithiasis). 
CANCER. 
Removal by caustics, by electrolysis, by parenchy- 
matous injections, or by injection of the toxin of 
erysipelas seems to be of very' little use. Nor does 
internal medication seem to have any permanent 
effect on cancer, though in some cases large doses of 
arsenic, in others, iodide of potassium would seem 
to have brought some improvement. 
Operation. Cancer can only be cured if thoroughly 
removed with the knife during its early stages. Par- 
tial operations, in which there is a large amount of 
infected tissue left behind, should never be under- 
taken. The neighboring lymphatic glands with their 
connecting lymphatics, should always be removed 
as well as the tumor itself. 
Removal of foul fungating masses may sometimes 
be necessary, for though this operation may not pro- 
long the patient's life, it will add greatly to his com- 
fort. 
CANCER OF BREAST. 
The disease should be treated surgically in all cases. 
Every tumor of the breast that originates after the 
age of forty should be removed as soon as it appears, 
including the breast, axillary and supraclavicular 
glands. No time should be lost in trying to differ- 
entiate between cancer, fibroma, adenoma and cysts. 
We should not wait for retraction of the nipple and 
other late symptoms. Pastes of all kinds ought to be 
condemned. Early operation is the only chance of 
permanent cure and prolongation of life. 
If the case appears late and the infection has 
already traveled by the lymphatics, remove the over- 
lying skin, breasts, axillary and supraclavicular 
glands, fascia and pectoralis major muscle. 
68 CANCER OF CERVIX UTERI. 
Early diagnosis of this disease is of the utmost 
importance, because this is the most frequent form 
of cancer, and the most dangerous. When a woman 
over forty presents herself complaining of an irregu- 
lar, bloody, foul-smelling discharge, vaginal examina- 
tion should be made immediately. The physician 
who neglects to do so does not do his duty. 
The only curative treatment for cancer of the 
cervix is early operation, which should consist of 
removal of the uterus tubes, ovaries, and retro-perito- 
neal lymph glands. 
Frequently patients present themselves for treat- 
ment when operation is too late; these cases should 
be treated either by excision of the cervix or burning 
by red hot iron. This line of treatment makes the 
' patient less offensive to herself and to those around 
her. 
In advanced cases where the pain is usually very 
severe at intervals, enough morphine (|to|gr.) should 
be given to control it. For the reflex vomiting which 
is incessant sometimes for 24 to 48 hours, cocaine 
muriate tablets (| to ' gr.) every 2 hours often give 
surprising relief. For the offensive discharge frequent 
douching with the stronger antiseptics (phenol, lysol, 
cresol) becomes necessary. If uterine hemorrhage 
occurs it becomes necessary to pack with gauze, 
which may be soaked in: 
1$ Ichthyol gii 
Glycerini gii 
M. Sig. Use on tampon twice a day. 
CANCER OF INTESTINE. 
Surgical treatment consists in resection of the bowel, 
making anastomosis, and short-circuiting the con- 
striction. If the cancer is in the small intestine use 
the Murphy button; if in the large intestine and near 
the rectum, do colostomy. 
If an operation is refused or is inadvisable, attend 
69 to the general condition of the patient. Give stimu- 
lants and easily digested food by the mouth or 
rectum. Intestinal obstruction should be guarded 
against by regulating the bowels so that they move 
at least once daily. 
CANCER OF LIP. 
A V-shaped portion of the lip and a half inch mar- 
gin of healthy tissue should be removed with the 
knife or scissors. The submental and submaxillary 
glands should also be removed although they may 
not appear to be enlarged, and any other enlarged 
glands should be removed as well. 
CANCER OF LIVER. 
Surgical interference is justified only when the 
cancer is single, primary, and favorably situated. 
In other cases the condition is hopeless, the dura- 
tion of life varying from a few months to a year. 
Medical treatment is only palliative. Morphine 
may be given hypodermically for the pain with the 
addition of a small quantity of atropine to lessen the 
tendency to constipation. The pain may also be 
relieved by hot or cold compresses, poultices, anodyne 
plasters, liniments, or counter irritants like tincture 
of iodine. The vomiting may be controlled by bits 
of cracked ice kept in the mouth, or by gastric lavage. 
The diet should be nourishing and easily digestible. 
Milk with Vichy or lime-water, meat extracts, cereals 
and gruels may be given. 
CANCER OF (ESOPHAGUS. 
It may occur in any part of the oesophagus, but is 
most frequently found at the upper and lower ends. 
If at the lower end the only operation that can be 
done to relieve the patient is gastrotomy, whereby 
he can be fed through a tube to prevent starvation. 
If it occurs at the upper end, it spreads more rapidly 
to the surrounding tissues as the larynx, making it 
necessary to remove important structures. Dilata- 
70 tion by bougies may help for some time, but haemorr- 
hage and sloughing soon result. 
CANCER OF PENIS. 
Partial or complete removal is necessary, as well 
as the inguinal glands, whether they are enlarged or 
not. The strictest antiseptic precautions are neces- 
sary. Check the oozing of blood from the corpus 
cavemosum by pressure from iodoform gauze, and 
tie blood vessels as soon as they are cut. 
CANCER OF RECTUM. 
This form of cancer is most frequent between the 
ages of twenty and thirty. 
The rectum should be entirely removed well up 
above the seat of the disease. The surrounding 
connective tissue and muscle should also be removed 
if infiltrated. The upper end should be brought 
down and stitched to the anus. 
If the disease has already advanced too far for 
radical operation, nothing remains but colostomy, 
in which case the patient usually ends a miserable 
life on account of the continuous escape of the feces. 
CANCER OF THE SKIN. 
This form of cancer when it occurs on the face, 
especially in the aged, may be treated with success 
by X-ray exposures. Excision is sometimes neces- 
sary before applying the X-ray treatment. 
CANCER OF STOMACH. 
Early operative interference gives the only hope of 
complete recovery. 
The medical treatment is merely palliative and is 
directed to relieving the pain, improving the digestion 
and keeping up the patient's nutrition. 
If the cancer is at the cardiac orifice and prevents 
ready entrance of food into the stomach, use the 
stomach tube in feeding the patient and give liquid 
or semi-solid food. 
71 If the cancer is at the pyloric orifice it may cause 
gastric dilatation and catarrh. Food should be 
given which will make small demands upon the 
stomach and leave little residue, e. g., milk, eggs, 
scraped beef, peptonoids and strained gruel. This 
may be supplemented, if necessary, with rectal 
feeding. 
Pain may be allayed by hot or cold applications 
to the epigastrium, or by opium or sedatives, like 
hydrocyanic acid and chloroform. Lavage often 
allays pain and controls vomiting if due to retained 
and fermented food. 
The appetite may be improved by bitters like 
calumba, gentian, and condurango, with hydro- 
chloric acid and pepsin as useful adjuncts: 
Fluidextr. condurang §ii 
Strych. sulph gr. 
Acid, hydrochlor, dil 3iv 
Fluidextr. gentian, q. s. ad giv 
M. et Sig. One teaspoonful in a wineglass of water, 
through a tube after meals. 
If the pain is very severe the following should be 
given: 
1$. Acid, hydrocyan, dil 5i 
Tinct. belladonn 3iss 
Morph, sulphat grs. iv 
Elix. digestiv. co. q. s. ad oiii 
M. Sig. One teaspoonful three or four times a day. 
CANCER OF TESTIS. 
Castrate and remove both cord and cord vessels 
well within the internal ring. If the inguinal glands 
are involved, remove them at the same time. 
CANCER OF TONGUE. 
As soon as the diagnosis is made the whole or part 
of the tongue should be removed. But if the disease 
extends far back, or if the glands of the neck are very 
much enlarged or fixed, or if the jaw is involved, 
operation is useless. 
72 CANCER OF (BODY OF) UTERUS. 
Can only be diagnosed early by the scrapings 
from the uterus. Remove the uterus per vaginam 
with tubes and ovaries. This form of cancer is 
much less frequent and malignant than that of the 
cervix. There are the same indications for treatment 
as for cancer of the cervix, i. e., thorough removal. 
CANCRUM ORIS. 
Prophylaxis. Attend to the condition of the mouth 
during all infectious disease, e. g., diphtheria, scarlet 
fever, measles, etc. Frequent use should be made of 
antiseptic solutions, as: 
I|. Sol. hydrogen, peroxid oi 
Formalin m. v 
Aquae q. s. ad §iii 
M. Sig. Use as wash four times a day 
Or: 
I). Potass, permanganatgrs. xx 
Aquae §x 
M. Sig. Use as wash every three hours. 
General treatment. Patient should rest in bed 
and should have concentrated nutritious food; tonics 
such as quinine and iron, stimulants such as milk punch 
and liquid food. When the stomach is irritable nutri- 
ent enemata should be given. 
Local treatment. Remove the gangrenous parts and 
arrest the progress of the disease into the sound tissue 
either by the knife, the paquelin cautery or nitric acid. 
CANTHARIDES, POISONING BY. 
Evacuate stomach by stomach pump or tube, if 
throat is not inflamed. If it is inflamed, inject 
apomorphin hypodermically. Allay the pain and 
strangury by opium and hot sitz baths. Give plenty 
of water and mucilaginous drinks, but no fats nor 
oils. 
CARBOLIC ACID POISONING. 
Carefully insert stomach tube, and wash out the 
73 stomach with successive quantities of sodium sul- 
phate (half an ounce in a pint of warm water), until 
there is no smell of carbolic acid in the liquid coming 
from the stomach. 
Next empty the stomach and give white of egg 
in water freely. 
Then give magnesium sulphate, half an ounce in 
warm water. 
Give alcohol and general stimulants freely, and 
apply warmth to the extremities. 
Artificial respiration and intravenous or rectal 
injection of salt solution may also be necessary. 
Strong alcohol is one of the best antidotes in carbolic 
acid poisoning. 
CARBONIC ACID GAS, POISONING BY. 
Prophylaxis. Care should be taken when explor- 
ing mines, deep wells, etc., where this heavy gas often 
accumulates. Before a workman enters these places, 
a lighted candle should be introduced beforehand. 
If carbonic acid gas is present the light will go out. 
Treatment. Removal to the open air, artificial 
respiration and the administration of pure oxygen. 
CARBON MONOXIDE POISONING. 
Artificial respiration by itself is of no value, since 
a stable compound is formed between the carbon 
monoxide and the haemoglobin and the blood. Vene- 
section and transfusion of fresh blood are to be 
recommended. 
CATALEPSY. 
External stimulation should be given at intervals 
to arouse consciousness: ammonia to the nostrils, 
cold douches, a pinch of snuff, faradization of the 
limbs or spine. Hypodermic injection of apomor- 
phine (1/20 gr.) to produce nausea or emesis is often 
successful in arousing the patient. Rubbing tur- 
pentine along the spine is often successful. The fol- 
74 lowing prescription is often useful in the milder 
forms: 
1$. Chloroform 3ii 
Ether 5iv 
M. Sig. Use thirty drops for inhalation. 
In the intervals between attacks, firm moral treat- 
ment, removal from home influences, cold baths, aloe tic 
aperients, iron, and antispasmodics, like valerian should 
be given: 
I|. Extr. sumbulgrs. xlviii 
Extr. valeriangrs. xxxvi 
Asafcetid®grs. xxxvi 
M. et ft. caps. No. xxiv. 
Sig. One four times a day. 
CATARACT. 
Prophylaxis. Proper care of the eyes. Use of 
lenses ordered by competent oculists at frequent 
intervals instead of carelessly selecting them in a 
jewelry store. Diet and proper hygiene may do 
much to retard degeneration of the lens in cases 
due to diabetes, or to malassimilation in gouty 
or rheumatic persons. 
Treatment. In the early stages of nuclear cata- 
ract, smoked or dark glasses may give some relief 
by favoring dilation of the pupil and permitting the 
entrance of rays of light through the clear cortex 
surrounding the opaque nucleus. For cortical cata- 
racts this method is of course useless. The sight 
may often be much improved by keeping up moder- 
ate dilatation by using an ointment consisting of 
atropin grain) and vaseline (4 drachm). There 
are frequently advertised numerous remedies and 
treatments "without the knife," which are mostly 
solutions of some mydriatic which by dilating the 
pupils, allow the entrance of more light and hence 
improve vision temporarily. But the treatment of 
mature cataract by drugs or apparatus is useless 
75 and the long-continued use of mydriatics may 
induce glaucoma or chronic conjunctivitis. 
Cure may be effected by one of several surgical 
operations. These consist in reopening a path for 
the rays of light to reach the retina, either by the 
side of the existing obstruction (iridectomy) or by 
« its absolute removal. The latter may be effected 
in one of three ways: The cataract may be left 
in the eye, but be pushed aside from the axis of 
vision (reclination, depression); it may be caused 
to undergo absorption by being brought in direct 
contact with the aqueous humor (discission), or 
it may be removed bodily from the eye through an 
operation made for the purpose (extraction). 
Iridectomy made early and effectually, may 
postpone the progress of lenticular opacity, if due 
to increased intra-ocular tension; in partial cata- 
racts which have become stationary, iridectomy for 
artificial pupil may be done to expose the clear 
portion of the lens. 
Sometimes in the onset of cataract the crystalline 
lens swells before it begins to become opaque, and 
by this change in refraction the aged person is enabled 
to read for the first time in many years without 
glasses. This is the so-called second sight. Gener- 
ally if the patient lives long enough vision is almost 
totally lost, and operation is necessitated. 
CATARRH (See Rhinitis). 
CATHETERIZATION, DIRECTIONS FOR. 
Sterilize the catheter before use. Cleanse the ure- 
thra, more especially the meatus. Sterilized vaseline 
ought to be used for the lubrication of the catheter. 
When introducing the instrument,'keep the tip of 
the catheter close to the floor of the urethra and it 
will very seldom catch in any fossa. If any apparent 
obstruction occurs at the triangular ligament, with- 
draw the catheter a little, tilt it differently so that 
76 it may scrape the roof of the urethra rather than its 
floor. When the instrument reaches the neck of the 
bladder, a sudden depression of the outer end will 
help it to enter. 
If it is impossible to empty a distended bladder 
with a catheter, make a supra-pubic puncture with 
an aspirator needle. 
CHAFING (ERYTHEMA INTERTRIGO). 
Keep the rubbing surfaces apart by absorbent 
cotton after bathing them with a lotion of boric acid. 
The following dusting powder may be used: 
I). Zinci stearat 5iv 
Sig. Apply freely several times a day. 
CHALAZION. 
The tumor or nodule should be freely incised from 
the inside of the eyelid after anaesthetizing the con- 
junctiva with a 4% solution of cocaine. The incision 
should be along the inner side of the conjunctiva and 
the sac should be thoroughly curetted. It takes 
several days for the tumor to disappear on account 
of the swelling caused by the blood-clot within the 
cavity. Apply hot boric acid dressings. Correct 
errors of refraction. 
CHANCROID (SOFT CHANCRE). 
When the sore is mild, simple cleanliness and the 
use of hydrogen peroxide followed by the local use 
of an ordinary antiseptic powder will usually be all 
that is necessary: 
1$. Bismuth, subnitrat. 
Acid, boric. 
Hydrarg. chlor, mit aa 3ii 
Sig. Use twice a day. 
Or: 
I|. Acetanilid. 
Acid, boric aa 5ii 
M. Sig. Use twice a day as dusting powder. 
If the venereal ulcer tends to spread, clean it, apply 
77 cocaine, and then cauterize with glacial acetic acid, 
nitric acid or with the actual cautery. 
In phagaedenic cases general anaesthesia may be 
necessary, then the use of scissors or a sharp spoon 
followed by cauterization of the raw surface. Con- 
tinuous immersion of the hips in a sitz bath as hot as 
the patient can bear it often gives relief. If the case is 
an aggravated one it may be necessary to give stimu- 
lants, to take invigorating and tonic measures and to 
improve the nutrition and give laxatives. 
If phimosis is present and the ulcers can not be 
treated, circumcision or dorsal incision becomes 
necessary. 
Mercurial treatment for this sore is of no avail. 
CHANCRE, SYPHILITIC. 
Mild antiseptic applications are all that is usually 
necessary because the sore tends to heal spontane- 
ously, but constitutional treatment should begin as 
soon as the diagnosis is made. (See Syphilis.) 
If the chancre is in a place where it is difficult to 
keep the parts clean, an incision of the prepuce or a 
circumcision or an incision of the hymen may be 
necessary. Wash the chancre with soap and water, 
follow with hydrogen peroxide, and dust on a powder 
consisting of one part of calomel to three of bismuth 
subnitrate. 
To preserve cleanliness about the female genitalia, 
antiseptic gauze may be necessary. 
Inform the patient of the infectious character of 
the discharge, and warn him to use separate utensils, 
as well as soap, towels, etc. In some cases it might 
be as well to temporarily isolate the patient. 
CHAPPED LIPS, HANDS, AND FACE. 
The skin should be protected as much as possible 
from atmospheric changes. When the hands or 
face are washed or wetted they should be carefully 
rubbed dry with warm towels. Avoid partially 
78 drying with damp cloths and then heating before 
a fire. The following ointment is very useful: 
1$. Liq. carb, deterg piss 
Hydrarg. ammon gr. xxv 
Lanolini gii 
M. Sig. Apply freely at night to the hands with 
gentle friction and cover with chamois gloves. 
For chapped lips use the following: 
I). Tinct. benzoin, co Si 
Sig. Apply several times a day. 
CHICKEN POX (See Varicella). 
CHIGOE, (CHIGGER, JIGGER, SAND-FLEA). 
Prophylaxis. Thorough cleanliness of person and 
rooms. Bathe feet, forbid walking barefoot. Dis- 
infect room with insect powder. Feet should be 
anointed frequently with a pungent essential oil, 
such as oil of cloves. Natives employ infusion of 
tobacco leaves. 
Extract insect at earliest possible moment, intact if 
possible. If part of insect remains behind, touch 
part with pure carbolic acid and dress with mer- 
curial ointment. 
CHILBLAINS (DERMATITIS CALORICA, PERNIO). 
The skin of a person subject to chilblains should 
not be warmed too suddenly after exposure to cold. 
The circulation should be re-established gradually by 
dry friction, or by exercise, or by rubbing the part 
with camphorated alcohol or eau de Cologne. Or the 
patient should rub the part with snow or ice-water 
before entering the house. Warm clothing should 
always be worn. If the skin is unbroken the part 
should be painted with dilute hydrochloric acid, 
tincture of opium, or tinct. of iodine, e. g.: 
]J. Tinct. iodini 
Tinct. opii 
Tinct. amicae aa 5ii 
M. Sig. Apply with a camel's hair pencil twice a day. 
79 Internal remedies. The defective circulation may- 
be improved by drugs such as kola, digitalis and 
iron, e. g.: 
I). Ferri reducti grs. xxiv 
Extr. digital grs. ii 
Caffein. citrat grs. xii 
M."et ft. caps. No. xii. 
Sig. One three times a day. 
CHLOASMA UTERINUM. 
The pigment is always slow to disappear, but local 
treatment assists in its removal. The remedies used 
have a bleaching effect, and by causing desquama- 
tion of the epidermis help to remove the pigmented 
cells. Pure peroxide of hydrogen may be applied to 
the spots twice a day. 
Or the following may be prescribed: 
1$. Hydrarg. ammoniat grs. xl 
Bismuth, subnitrat .grs. xl 
Vaselini oi 
Olei rosse gtt. i 
M. Sig. Apply gently to the discolorations at 
night, and wash off in the morning with green soap. 
CHLORAL HABIT (CHLORALISM). 
Isolate patient and give careful attention; prevent 
access to drug. For the sleeplessness give bromides. 
A mixture of trional (15 grs.) and veronal (5 grs.) 
is also of benefit. Heart may be stimulated by am- 
monia, strychnine and digitalis. Give tonics, nour- 
ishing food and agreeable occupation. Electricity 
and massage are often of service. 
The above mixture in prescription form would be: 
1$. Trional 5iii 
Veronal 5i 
M. et ft. chart. No. xii. 
Sig. One at bedtime. 
80 The cardiac stimulant would be prescribed thus: 
I). Ammon, carb grs. xxiv 
Strychnin, sulph gr. 
Digitalin gr. J4 
M. et ft. caps. No. xxiv. 
Sig. One three times a day. 
CHLOROFORM POISONING (During anaesthesia). 
Place the head lower than the body and pull out 
tfye tongue. Give the patient fresh air and make him 
inhale amyl nitrate. Apply artificial respiration, 20 
to the minute. Give strychnine (gr. g*0) hypo- 
dermically, and diluted brandy by the rectum. As 
a last resource bleeding through the jugular vein 
may be tried. 
Opening the thorax and compressing the heart has 
recently, in several instances, proved successful. 
CHLOROSIS. 
Iron is the chief indication. It very rapidly 
restores the haemoglobin. The best method of ad- 
ministration is by Blaud's pills: 
I|. Pil. Blaud gr. v... .No. c. 
Sig. One four times a day after meals. 
Or: 
I|. Mangan, dioxid grs. xii 
Mass. ferr. carbonat 5ii 
Zinci phosphid gr. iss 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
Iron should be given for three months to prevent 
relapse. 
In severe constipation give the following pill: 
I). Aloin gr. 5 
Extract, belladonnae gr. 
Strychnin, sulph gr. Jg 
Pulv. ipecac gr. 
M. et ft. pil. No. 1. 
Sig. Two at bedtime or one after every meal 
81 In severe cases where the heart is weak the patient 
should be kept in bed in a well-ventilated, bright, 
sunny and cheerful room and should avoid mental 
excitement. The diet should be light and nutritious: 
milk, soups, beef tea, eggs, and toast. 
CHOLANGITIS et CHOLECYSTITIS. 
When there are no indications of suppuration, the 
patient should rest in bed and be put on a light diet. 
Tonics, medicines to allay gastro-intestinal irritation, 
morphine to allay pain and mild laxatives may be 
given. 
Ten grain doses of salicylic acid, given three times 
a day, increases the flow of bile and prevents the in- 
flammation from extending. 
When signs of suppuration occur, immediate sur- 
gical interference is necessary. This consists in 
laying open and draining the gall-bladder. When 
there is evidence of persistent obstruction and infec- 
tion the stones should be removed from the common 
duct. 
CHOLELITHIASIS (GALL-STONE DISEASE). 
Prevention. Diet should be mixed and meals 
should be limited in amount and taken frequently to 
cause a constant flow of bile. The meals should be 
taken with plenty of plain or mineralized water. 
Prohibit alcohol. The patient should take regular 
exercise in the open air. Plenty of water-drinking 
between meals. Sugars and fats should be avoided. 
Congestions and inflammations in the portal system 
and dependent organs are diminished and controlled 
by the spa treatment. For this Neuenahr, Kissingen 
and Vichy in Europe and Bedford, Sharon and Las 
Vegas in this country are preferred. Carlsbad has 
too many attractions to be of much benefit as they 
divert patients from the serious business of attending 
to their health. 
Treatment of an attack of hepatic colic. For the 
82 great pain give morphine gr.) and atropine 
(iso gr-) hypodermically. If the pain is agonizing, 
keep the patient lightly under the influence of chloro- 
form by inhalation until the effect of the morphine is 
evident. A few doses of antipyrine in hot water given 
early in the paroxysm and hot applications to the 
hepatic region are often very useful. Nausea, pain 
and vomiting are often controlled by gastric lavage 
and the administration of carbonated water and 
champagne. 
Surgical intervention. Surgical treatment should 
be confined to cases in which the mechanical removal 
of the foreign body is necessary, e. g., when attacks 
of colic occur so frequently and of such severity that 
the patient's life becomes a burden, or in persistent 
obstruction of the common duct, etc. 
Phosphate of soda given for a long time continuously 
has proved of great benefit in lessening the number 
and severity of the paroxysms. It may be prescribed 
as follows: 
Sod. phosphat. gran, effervesc 5xii 
Sig. One heaping tablespoonful three times a day 
twenty minutes after meals. 
Biliary antiseptics as salicylic acid, salol, sodium 
benzoate, and aspirin have proved of considerable 
value in the treatment of this disease. 
The following prescriptions are of benefit: 
B- Sod. benzoat 5ii 
Acid, salicyl 3ii 
Menthol grs. vi 
M. et ft. caps. No. xxiv. 
Sig. One four times a day with hot water. 
Or: 
B Acid, glycocholat grs. xxiv 
Aspirin 5ii 
M. et ft. caps. No. xxiv. 
Sig. One four times a day in hot water. 
83 CHOLERA, ASIATIC A. 
Rest in bed. Evacuations should be received in a 
bed-pan. Give abundant fluid. Give stimulants, 
hot soups and broths. 
Check the preliminary diarrhoea, vomiting, cramps 
and collapse, by combinations of opium with astrin- 
gents and antispasmodics: 
1$. Acidi sulph. aromat 5iv 
Spiritus camphorae 5 iv 
Spiritus chloroformi 3ii 
Tinct. capsici 3ii 
Tinct. opii deodorat 3ii 
Fluidextracti hsematoxyli 5 i 
Vini rubri q. s. ad §viii 
M. Sig. Shake and give two teaspoonfuls, every half 
to one hour. 
If circulation fails as shown by feeble and thready 
pulse, give mild stimulant, e. g., iced champagne and 
soda water, weak brandy and water (iced), in tea- 
spoonfuls, or ammonia, or spirit of chloroform well 
diluted. 
In case of collapse hypodermic injections of ether, 
or cautious doses of nitrite of amyl, or nitroglycerin, 
may be given, or the intravenous injection of warm 
saline solutions, e. g., one drachm of sodium chloride 
and 45 grs. of sodium carbonate to the quart of sterile 
water. 
The bodily heat should be conserved by hot ap- 
plications, or hot baths, or by rubbing the skin with 
soft cloths or dry powdered ginger. 
If urinary excretion is suppressed, dry cupping, hot 
fomentations, and poultices may be applied. 
Prophylaxis in the sick room. Isolate the patient 
and take the greatest care to destroy all the cholera 
germs in the faeces and vomitus, on the bedding and 
clothing, and on the hands or persons of those attend- 
ing him. As soon as the evacuations are received in 
the bed-pan they should be disinfected before being 
84 disposed of. For this fresh chloride of lime may be used, 
a large heaping tablespoonful of the powder being added 
to each quart of the evacuations and thoroughly mixed 
with them. In half an hour the mixture may be re- 
garded as harmless. The attendant's hands imme- 
diately after coming into contact with the patient 
should be disinfected with a three per cent solution of 
carbolic acid. This carbolic solution should also be 
used to cleanse the patient with, and to soak sheets 
and linen in for twelve hours. 
The bodies of the dead should be disinfected or 
wrapped in a sheet wet with solution of corrosive sub- 
limate (1 to 1000), and placed in a tight coffin upon a 
layer of some absorbent material. The sick room 
should be disinfected with sulphurous acid gas and 
should be well aired before being again occupied. 
CHOLERA, PERSONAL PROPHYLAXIS. 
Persons may render themselves specially liable to 
attack by cholera by such circumstances as bodily 
fatigue, mental worry, panic, disorder of stomach 
from consumption of raw fruits and vegetables 
(melons, cucumbers, etc.), decomposing animal food, 
especially fish and shell-fish, abuse of alcohol, drink- 
ing impure water or milk, the use of purgatives, 
especially saline medicines, exposure to cold and any- 
thing tending to depress the general vigor and derange 
health. Well persons should avoid infected localities, 
and if possible remove to a higher and drier place, 
where the disease is not prevalent. Some are of the 
opinion that protection against attack is got by the 
administration of quinine and by the mineral acids, 
but this is doubtful. 
Attempts have been made by Haffkine, Kolle, 
Strong and others to render the system immune to 
cholera infection by the injection of vaccines. 
85 CHOLERA, PREVENTION OF, BY SANITARY OFFI- 
CERS. 
Inland quarantine is an acknowledged failure, be- 
cause dissemination of the disease may be effected by 
other agencies than human-by insects, birds, ani- 
mals, wind or water. 
Maritime quarantine though still practiced by 
some nations, is probably also inadvisable since de- 
taining large numbers of men in unwholesome laza- 
rettos, subject to infection by new arrivals, may turn 
out disastrous. 
The best method of dealing with cholera, as also 
with plague and yellow fever is: (a) a system of 
accurate and early information; (b) careful in- 
spection; (c) isolation of the sick and suspected, and 
(d) vigorous sanitation both general and special. 
Good drainage and good water-supply prevent 
cholera by making it impossible for the faeces of one 
person to gain access to the drink or food of another. 
Cholera is most likely to take on its epidemic character 
on a soil which is porous, more or less charged with 
decomposing organic matter, moistened with water, 
and having its interstices filled with air. The preva- 
lence of cholera in a country largely depends upon the 
habits of the people, especially on habits of careless- 
ness as to the cleanliness of food and drink. 
CHOLERA, INFANTUM. 
Prophylaxis. The infant should have proper food, 
good nursing and wholesome surroundings, including 
cleanliness of person, of clothing, of nursing bottle, 
etc. Sudden changes of temperature ought to be 
guarded against. If possible, send the child to the 
country, for fresh air is of the greatest importance. 
Treatment. All food, especially cow's milk, should 
be stopped at once. On account of the great irri- 
tability of the stomach, hypodermic medication 
must be resorted to. Begin by giving a hypodermic 
injection of morphine sulphate (gr. rJ0) with 
86 atropin sulphate (gr. gJa) to an infant from six 
months to one year of age. Remarkable results 
frequently follow this treatment. If the vomiting 
and diarrhoea do not cease in one or two hours, re- 
peat the dose. As soon as the gastric irritability 
ceases, give the following: 
1$. Hydrarg. cum cretagrs. vi 
Pulv. Doveri gr. i 
Bismuth, salicylatgrs. xii 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
The high fever is best controlled by cool sponging. 
In order to relieve the intense thirst high rectal 
enemas of saline solution (one tablespoonful of salt to 
two quarts of water) may be given. Normal salt solu- 
tion may also be given under the skin to the amount 
of one pint in twenty-four hours. Washing out the 
stomach also gives relief from vomiting. 
When the surface of the body is cold and the tem- 
perature is subnormal, give a warm mustard bath and 
apply hot bottles to the extremities. 
After the urgent symptoms have subsided, gradually 
return to the child's usual amount of food. Begin 
with barley water or albumen water. Skim milk and 
buttermilk are excellent articles in this disease. Stimu- 
lants such as brandy are also of service. 
CHORDEE. 
Rest in bed, low diet, purgatives, monobromate of 
camphor with opium for the pain. Locally hot sitz 
baths, hot or cold compresses and leeches to the 
perineum. If an abscess forms, open early to prevent 
it from bursting into the urethra. In chronic cases 
galvanism may help to absorb infiltrated material. 
(See also Aphrodisia.) 
As a preventative measure give the following 
prescription in gonorrhea, which is usually the cause 
of this condition: 
87 T|. Camphorse 
Extr. opii, aagrs. xii 
M. et. ft. caps. No. xii. 
Sig. One at bedtime from the beginning of the 
gonorrhea onwards. 
A good prescription for the chordee is as follows: 
1$. Sodii bromidi gii 
Potass, bromidi 5ii 
Chloral hydrat pi 
Aquse gi 
Syr. simpl. q. s. ad gii 
M. Sig. One teaspoonful every four hours and at 
bedtime. 
CHOREA. 
Patient should have rest of both body and mind. 
Remove child from school or abridge studies. If 
weather is fine, amusement, but not exercise in the 
open air is advisable. Patient should be secluded for 
a few hours daily in a dark room. Sea air and sea 
baths are often beneficial. Massage, warm baths, 
generous diet, plenty of milk, cream, fresh butter, 
substantial soups, and condensed nitrogenous 
nourishment. Prohibit tea and coffee, and do not 
gratify capricious appetite of patient. 
Examine patient for errors of refraction, adenoid 
growths, enlarged tonsils, worms, haemorrhoids or 
other peripheral irritation and treat cause if found. 
If there is a history of rheumatic fever, administer 
quinine salicylate and aspirin. 
The drugs used in this disease are arsenic in full 
doses, strychnine and iron. 
Arsenic is the drug which is of greatest benefit, it 
should be given in gradually increasing doses: 
T|. Liq. potass, arsenit gi 
Sig. Five drops in water, three times a day. In- 
crease one drop per dose every three days. 
If rheumatic endocarditis is present, give salicylates. 
88 Quinine is also of considerable benefit and may be com- 
bined with the salicylates, e. g.: 
1$. Aspirin 3ii 
Quinin. sulphgrs. xxiv 
Acid, arsenics gr. 
M. et ft. caps. No. xxiv. 
Sig. One every four hours. 
If the choreic movements are very violent, bromide 
of potassium and chloral hydrate are indicated. To a 
child ten years old give: 
I). Potass, bromid 5ii 
Chloral hydrat 5ii 
Aquae gii 
Syr. limonisq. s. ad giii 
M. Sig. One teaspoonful three times a day. 
Chorea during or following pregnancy receives the 
same treatment. If abortion occurs see Abortion, 
Inevitable. 
CIRRHOSIS (See Liver, Cirrhosis of). 
CLIMACTERIC, DISORDERS OF. 
The headaches and reflex nervous symptoms should 
be relieved by potassium bromide. If there is con- 
stipation and portal congestion, give saline pur- 
gatives or blue pill with aloes. Bleeding and cupping 
are also of benefit. The diet should be plain and un- 
stimulating. Forbid beer and spirits and allow a 
little light wine if at all. Cold bathing followed by 
brisk rubbing and lukewarm baths taken at intervals 
of a few days, tend to calm the nerves. If there is 
irritability or melancholia the patient should be en- 
couraged by a favorable prognosis. 
For the hot flushes give a nerve sedative such as: 
1$. Sod. brom 3iv 
Potass, brom oii 
Tinct. valerian 5iv 
Tinct. hyoscyam 3ii 
Elix. simpl. q. s. ad §iii 
89 M. Sig. One teaspoonful in water three times a 
day. 
Or: 
I|. Extr. valerian grs. xliv 
Asafcetid grs. xxx 
Extr. sumbul grs. xxxvi 
Ferri citrat 5ii 
M. et ft. caps. No. xxiv. 
Sig. One three times a day. 
COAL-GAS POISONING. 
Fresh air, stimulants, transfusion of blood or of 
normal salt solution. Inhalation of oxygen may also 
be tried. 
Give hypodermic injections of nitroglycerin (rJs 
gr.) every three hours. This is almost a specific. 
For the intense headache following coal gas poison- 
ing, give: 
I|. Sodii bromidi 3iiss 
Antipyrin 5i 
Aquae q. s. ad §ii 
M. Sig. One teaspoonful every two hours, if neces- 
sary. 
COCAINIZATION, INTRASPINAL. 
The object in this operation is to spread cocaine 
solution over the surface of the spinal cord and 
beneath the arachnoid. Freeze the skin at site of the 
operation with a freezing spray, or anaesthetize it 
with a hypodermic injection of cocaine. Use a gold 
or platinum plated needle about four inches long, 
and a syringe which holds two to four cubic centi- 
meters and which can easily be attached to the needle 
after it has entered the canal. The patient should be 
seated leaning forward so as to curve the back and 
open the intervertebral spaces. The injection is 
usually made between the third and fourth lumbar 
spines. The needle is entered about half an inch to 
the right of the middle line and passed forward. 
90 inward and upward to a depth of about three inches 
in the ordinary adult, until the resistance offered by 
the tissues is felt to have been passed, and the point 
to have entered a cavity. The escape of a drop or 
two of cerebro-spinal fluid will indicate that the 
spinal canal has been entered. Attach the springe 
to the needle and inject a solution containing about 
half a grain of cocaine. 
COCCYGODYNIA. 
Look for cause and treat it if found, e. g., uterine, 
ovarian or rectal disease. If no such cause is found 
try the ordinary remedies for neuralgia such as opium, 
quinine, arsenic, salicylate of soda, blisters or elec- 
tricity. 
If these remedies fail, the coccygeal bones may be 
isolated from the surrounding tissues by means of a 
tenotomy knife, or remove the coccyx entirely. 
COLIC, FLATULENT INTESTINAL. 
Recurrent attacks of colic may be due to lead 
poisoning or local disease, e. g., gastric ulcer, appen- 
dicitis, gall stones or kidney stones. 
First stop the pain and spasm by mild opiates 
and carminatives, warming agents for the stomach 
and bowels, such as cardamom, mint, aromatic 
spirits of ammonia The following is useful: 
I|. Pulv. opii grs. xii 
Camphors;grs. xii 
Capsicigrs. vi 
Zingibergrs. xii 
M. Ft. pil. xii. 
Sig. One pill, repeated in two hours, if necessary. 
The pain may also be relieved by hot fomentations, 
mustard sinapisms, turpentine stupes, poultices, or by 
a copious enema of warm water. 
In the more severe attacks, chloroform and ether by 
inhalation or by the stomach, or morphine (X gr-) with 
atropine (jjg gr.) hypodermically, may be necessary 
91 After the pain has been allayed, give mild cathartics 
or enemata to evacuate the bowels: 
R. Hydrarg. chlor, mitgrs. iii 
Sacchar. lactgrs. xii 
Sod. bicarbgrs. xxx 
Extr. colocynthidgrs. iv 
M. et ft. chart. No. xii. 
Sig. One every two hours. 
In cases where there is a habitual tendency to colic, 
the following pill may be given: 
R. Extr. gentian. 
Rhei, aa 5i 
M. Ft. pil. xx. 
Sig. One or two pills thrice daily. 
All food should be stopped for 24 hours in order to 
rest the stomach and intestines. 
COLIC, HEPATIC (See Cholelithiasis). 
COLIC IN CHILDREN. 
Prophylaxis. Colic in infants at the breast is most 
frequently caused by indiscretions in the diet of the 
mother. She should avoid cabbage, sauerkraut, acid 
fruit, etc. Frequently also it is due to an excess of 
proteids in the mother's milk, and this can be pre- 
vented by the mother taking daily fresh air exercise, 
and excluding from her dietary pastry, pies, sweet- 
meats, and by restricting the quantity of meat. 
Colic in bottle-fed infants is always due either to 
improper food or to an excess of fat or proteids, as 
shown by the presence of curds in the stools. Colic 
may also be due to a child being allowed to empty its 
bottle too fast; each feeding should occupy twenty 
minutes. 
Flannel bands ought to be worn by infants until 
they are at least 18 months old. 
Colic in older children is usually due to improper 
diet, or to swallowing air when exposed to the wind. 
Treatment. To relieve an attack of colic give a 
92 few drops of brandy or compound spirits of ether well 
diluted with water, e. g., for a child 6 months to 2 
years old, give: 
1$. Spirit, aether, co 3i 
Sig. Five to ten drops in cold water every two hours. 
This should be followed by a high rectal enema of 
warm water and the application of hot flannels to the 
abdomen. 
If these measures fail, give the following to a child 6 
months to 2 years old: 
1$. Sodii bicarb grs. ii 
Tinct. opii deodorat gtt. ii 
Olei ricini 5i 
M. Sig. One dose. 
Children predisposed to colic should be given small 
doses of belladonna or the bromides, e. g.: 
1$. Sodii bromidi grs. xvi 
Potass, bromidi grs. xii 
Tinct. belladonn gtts. viii 
Aq. menth. pip 3iii 
Aq. anisi q. s. ad §ii 
M. Sig. One teaspoonful every four hours. 
COLIC, RENAL (See Renal Calculus). 
COLITIS, ACUTE (See Ileo-Colitis Acute). 
COLLAPSE (See Fainting). 
COLOR BLINDNESS. 
A medical practitioner is occasionally asked to test 
a patient for color blindness, to test his fitness for the 
occupation of pilot, railway engineer, etc. Those 
who are color blind cannot distinguish between the 
red and green lights ordinarily used as signals. The 
proper way to test applicants is by the "Holmgren 
method," which requires him to select from a pile 
of worsteds of various colors, those shades which seem 
to him to resemble standard skeins of green and pink. 
Simply asking the applicant to name colors which are 
shown to him does not give satisfactory results. 
93 COMEDO (See Blackheads.) 
COMPLEXION, CARE OF. 
The face should be washed twice daily in cold water 
to improve the circulation in the skin and delay 
wrinkles. If the complexion is sallow, pinching the 
face by the fingers improves the complexion. Cold 
creams are mixtures of a solid fat, like spermaceti, with 
an oil such as almond oil, and a fragrant substance 
added: 
01. amygd. express Bvii 
Aq. rosae fort Biiss 
Spermaceti §iss 
Cer. alb Biss 
Sod. borat 5ss 
M. Sig. Apply twice daily. 
These cold creams are not injurious to the com- 
plexion. 
Toilet or face creams are mucilaginous preparations 
containing tragacanth and other ingredients, and are 
pleasant applications for a fissured or chapped skin. 
Face powders consist of one or more of the following: 
talcum, starch, bismuth, chalk, zinc oxide, magnesia, 
flour, etc. They are harmless and often improve the 
appearance. 
CONCEPTION, PREVENTION OF. 
This may be necessary in cases of contracted pelvis, 
obstruction from tumor or other similar cause. It is 
best done by tying the Fallopian tubes in two places 
and cutting between the ligatures. Tying the tubes 
in a single place cannot be depended upon. The 
successful operation will not interfere with menstrua- 
tion, but will effectually prevent future pregnancies. 
The ovaries may be removed or even the entire 
uterus, but this should only be done in case of disease, 
and not merely for the purpose of sterilizing the 
patient. In the case of a single woman this is a 
serious moral question. 
Artificial sterility is only justifiable if it saves the 
94 lives of certain women as in cases of syphilis, tuber- 
culosis, insanity, epilepsy, heart disease, diabetes, 
nephritis, cancer, etc., and at the same time avoids 
feticide. 
Sometimes a separation, temporary or permanent, 
may be suggested between husband and wife. Or 
coitus may be restricted to the so-called agenetic 
period (from 17 to 24 days after the cessation of 
menstruation), but this only diminishes the risk of 
impregnation and does not prevent it with certainty. 
Some authorities recommend antiseptic hot douches 
after coitus, e. g., a tablespoonful of tannic acid, boric 
acid or alum in two quarts of hot water to be used 
while in the recumbent posture immediately after 
coition. But the ethics of this procedure are doubt- 
ful. Be this as it may, the practitioner under no 
circumstances should sanction the use of such debili- 
tating means of preventing conception as the coitus 
interruptus, the coitus reservatus, the wearing of 
coverings for the penis, or obturators for the uterus. 
These deleterious practices produce in women such 
disorders as endometritis, ovaritis, leucorrhea, 
dysmenorrhea, metrorrhagia, as well as sterility; 
while in man, they frequently produce neurasthenia. 
CONDYLOMATA. 
Extreme cleanliness should be insisted on. If 
the lesion is small, keep the part dry and apply an 
astringent. Larger condylomata may be removed by 
excision or by caustics, e. g.: 
1$. Liq. hydrarg. nitrat 3ii 
Sig. Apply locally with match stick or glass rod. 
Small ones are frequently cured by washing with a 
solution of chlorinated soda and dusting with: 
I|. Hydrarg. chlor, mit. 
Bismuth, subnitrat. 
Acidi borici, aa 3ii 
M. Sig. Use twice a day. 
95 For still larger growths ligature of the pedicle or 
the Paquelin cautery may be necessary. 
CONJUNCTIVITIS, ACUTE CONTAGIOUS. (PINK EYE.) 
In the inflammatory stage the eye should be 
frequently washed with a saturated solution of boric 
acid. Ice compresses of the same solution afford 
considerable relief. When the discharge becomes 
mucopurulent then the lids should be anointed with 
vaseline to prevent them from sticking together. 
Sulphate of zinc in the strength of one grain to the 
ounce of distilled water should now be used, a few 
drops in each eye three or four times a day. Poul- 
tices of all kinds should be avoided, they encourage 
corneal ulceration. 
After the acute symptoms have subsided the 
lids should be painted daily with a 5% solution of 
protargol. 
Prophylaxis. Isolation must be enforced, espe- 
cially in schools, public institutions and barracks. 
Each individual should have his own soap and towels 
The fingers should be kept from the eyes. 
CONJUNCTIVITIS, CATARRHAL. 
In all forms of conjunctivitis extreme cleanliness 
is necessary, both of patient himself, and of all towels, 
utensils, etc., used by him. Isolate him if necessary 
and attend to his general health. A mild astringent 
lotion of silver nitrate solution (ten grains to the ounce) 
or argyrol (30 to 50%) applied locally will often 
shorten the attack. Patient may go out of doors in 
mild weather for fresh air and exercise if he wears 
protection glasses. In ordinary simple conjunctivitis 
the use of atropin is not necessary. 
The following prescriptions refer to the above 
treatment. In the acute stage, give: 
3- Sodii biborat grs. xii 
Aquae campho rat 3iii 
Sat. sol. acid, boric, q. s. ad §iv 
M. Sig. Instil every two hours. 
96 After the acute stage of inflammation is over give a 
mild astringent such as: 
Zinci sulphatgrs. v 
Acid, boricgrs. xx 
Aquae destillat. q. s. ad §ii 
M. Sig. One or two drops twice a day. 
CONJUNCTIVITIS, FOLLICULAR. 
The follicles should be touched twice a week with 
copper sulphate. Very large follicles should be 
treated by expression. 
The patient should be placed on tonics such as 
the syrup of the iodide of iron, one-half teaspoonful 
in water after each meal taken through a glass tube. 
A hygienic mode of living and a change of occu- 
pation frequently add to the rapidity of recovery. 
The lids should be painted daily with a solution 
of nitrate of silver (two grains to the ounce of dis- 
tilled water). 
CONJUNCTIVITIS, PURULENT. 
Pus should not be allowed to accumulate in the 
eyes. Severe cases require isolation and rest in bed 
in a darkened room. The eye should be cleansed 
every few minutes day and night. When the dis- 
charge first appears apply an astringent lotion every 
few hours, and a caustic application like silver nitrate 
solution (20 grains to the ounce) to the inner surface of 
the lids once a day. If only one eye is affected the 
other should be closed with a glass watch-crystal 
fastened over it with an adhesive plaster. 
If the case is seen soon enough the disease may be 
aborted by a thorough cleansing and a caustic ap- 
plication of the above silver nitrate solution to the 
inner surface of the lids. 
CONSTIPATION, DIET IN. 
The following articles of diet should be avoided: 
New bread, pastry, peas, beans, new potatoes, nuts. 
97 If eggs are taken they should be eaten in modera- 
tion and lightly cooked in the form of scrambled eggs. 
Rice, tapioca, etc., should only be taken with fruit, 
jam or honey. Milk should only be taken in small 
quantities or mixed with Vichy. 
The following articles should be allowed: Clear 
soups, fish, meat (except veal or pork), poultry, game, 
ham, bacon, the coarser breads with bran and whole- 
meal, gingerbread, oatmeal, cabbage, cauliflower 
sprouts, celery, spinach, salads, onions, apples, figs, 
prunes, dates, pears, oranges, grapes, bananas, 
strawberries, gooseberries, currants, jam, golden 
syrup, molasses, preserved fruits, coffee, beer, water, 
Vichy, Kissingen, Carlsbad 
CONSTIPATION, HABITUAL. 
Avoid medicinal treatment as far as possible. 
The patient, if an adult, should drink at least three 
pints of fluid daily. Hot water, with or without a 
saline aperient should be slowly sipped immediately 
on rising in the morning. Two wineglassfuls may 
be thus sipped while dressing. An equal quantity 
• of hot water should be drunk at bedtime. Tea should 
always be freshly made and never taken strong or with 
meat. Laxative articles of food should be taken such 
as fruit, jam, honey or treacle with blanc mange or 
rice. Every night and morning stewed figs, baked 
apples, bananas, etc., may be taken. To avoid 
chills the body should be warmly clad and the feet 
kept warm and dry by thick shoes, often changed, 
with cork or asbestos insoles. Abdominal massage 
by the patient for ten minutes before rising, especially 
digital kneading in the direction of the colon, should 
be carried out regularly. Attempts should be made 
every morning at a regular hour to get the bowels 
to act whether there be a desire or not. In addition 
there should be regular exercise, especially of those 
kinds which bring the abdominal muscles into play, 
e. g., golf, fencing, skipping. There should also be 
98 cold bathing or cold sponging followed by sharp 
friction with a rough towel and flesh-glove to secure 
vigorous action of the skin. 
The drug treatment of constipation always requires 
caution. Purgatives are hardly ever indicated. 
Mineral waters such as Hunyadi-janos, Friedrichshall, 
Saratoga, Bedford are of service because of their 
mineral ingredients, as well as because they induce the 
patients to drink large quantities of fluid which other- 
wise they would not do. 
An excellent pill for chronic constipation is one con- 
taining aloes, strychnine and belladonna. The aloes 
acts especially on the colon, the strychnine over- 
comes atony of the intestines, and the belladonna 
prevents griping: 
I}. Aloini gr. iv 
Strychnin, sulphat gr. | 
Extracti belladonn gr. iii 
M. ft. pil. No. xxiv. 
Sig. One pill at bedtime. 
Cascara sagrada, in doses of 30 minims and over, of 
the fluidextract is an excellent mild laxative. 
Cold or hot water injections may be practiced daily 
as an adjuvant to other treatment and enemas of soap 
and water or suppositories of glycerin are of some serv- 
ice. 
In cases of mechanical rectal obstruction it may be 
necessary to remove the impacted feces with the fingers 
or with a scoop. 
In some inveterate cases of constipation, it may be 
necessary to have recourse to drugs after all. The 
following may prove of service: 
Extr. cascar. sagrad grs. ii 
Aloin gr. | 
Extr. podophylin gr. 
Extr. colocynthid gr. J4 
Extr. belladonn gr. 
M. et ft. caps. No. 1. 
Sig. One at bedtime. 
Or: 
99 T|. Phenolphthaleingr. i 
Strychin. sulphgr. 
Aloingr. J 
Extr. podophylingr. 
M. et ft. caps. No. 1. 
Sig. One at bedtime. 
Or: 
]$. Extr. cascar. sagrad. fluid 5ii 
Sig. Ten, twenty, or more drops, as required in 
water, before each meal. 
Or: 
1$. Ferri sulph. exsicgr. iss 
Extr. nuc. vomic gr. X 
Extr. belladonn gr. 
Pulv. rhei co gr. iii 
M. ft. pil. No. 1. 
Sig. One (or more if required), each night. 
CONVULSIONS IN CHILDREN. 
The first indication is to stop the convulsions by 
administering carefully a small quantity of chloro- 
form by inhalation from a handkerchief or by plac- 
ing the child in a hot mustard bath. 
Next treat the cause, whether it be worms, gastro- 
intestinal disorders, constipation, rickets, whooping 
cough, onset of acute infectious disease, meningitis, 
or injuries. There is often an inherited predis- 
position. 
If indigestible food is the cause, give an emetic, 
and also a purgative or a large rectal enema. If 
fever is present, give a hot pack or hot bath, with ice 
to the head. 
Drugs used: Potassium and sodium bromides, 
chloral hydrate, belladonna. 
For a child one year old, give: 
I). Chloral, hydrat 5ss 
Sodii bromid 5ss 
Potass, bromgrs. xii 
Aquae gi 
Syrup, simpl. q. s ad §ii 
100 M. Sig. Give one teaspoonful. Repeat if necessary, 
in one hour. 
CORYZA (See Rhinitis, Acute). 
COUGH. 
Is not a disease, but a symptom. It may some- 
times be beneficial when it expels injurious matters 
from the lungs. When the cough is insufficient it 
may be stimulated and when it is excessive should be 
restrained. 
In treating cough look for and treat any source of 
irritation in the pharynx, larynx, trachea, bronchi, 
lungs, pleura, or stomach. It may also be due to 
elongated uvula, wax in the ear, nasal polypi, en- 
larged tonsils, etc. 
If the cough is violent and paroxysmal it may be 
due to whooping cough or to a foreign body in the 
larynx. 
If the cough is due to enlarged uvula or relaxed 
palate, treat with astringents. 
If due to pharyngeal inflammation ice and cold 
applications give relief. In some cases inhalation of 
the vapor of boiling water, medicated with opium, 
hops, cannabis indica, etc., often is of service. 
The cough of chronic pharyngitis is relieved by 
astringent lozenges of guaiac or catechu. 
The cough of acute laryngitis is relieved by in- 
halation of vapor impregnated with tincture of ben- 
zoin. co. and paregoric. 
For the cough of chronic laryngitis, give bromides 
and opiates, and apply a cold compress over the front 
of the neck at bedtime. 
In the cough of congestion due to deficient action 
of the heart, give digitalis, strychnine and strophan- 
thus. 
For the cough of acute bronchitis, give ammonium 
chloride if the expectoration is difficult. 
When the expectoration is too great and the 
101 cough too frequent, give acid sulph. aromat. and 
codeine. 
For the painful cough of pleurisy, strap the ribs or 
give hot applications or an ointment containing 
menthol should be well rubbed over the seat of pain. 
The cough of pneumonia should rarely, if ever, be 
checked by opium. Nor should opium be used in the 
cough of hypostatic pneumonia, pulmonary cedema, 
or capillary bronchitis of the old and debilitated. 
The cough of laryngismus stridulus may be relieved 
by the inhalation of amyl nitrite. 
The cough of phthisis should rarely be suppressed, 
as is so often done, for the cough clears the air pass- 
ages of the morbid accumulations. 
Opium in some form is a usual constituent of cough 
mixtures, but should not be used unless specially 
indicated. 
In spasmodic cough or nervous cough, a bella- 
donna plaster to the chest or belladonna is of value. 
Cod liver oil and creosote are often of service in 
chronic cough. 
CORNS. 
If the coms are soft, inflamed and painful, bathe 
the foot in hot water, dry, and apply: 
1$. Argent, nit rat grs. xxx 
Aquae destillat 3iv 
M. Sig. Apply with brush once every three days. 
The essential ingredient of all corn cures is salicylic 
acid, which in strong solution removes excess of epider- 
mis, warts, and coms. 
If corn is hard, give: 
I|. Alcohol 5iiiss 
Extract, cannab. Indic gr. x 
Acid, salicylic grs. xxx 
Collodion 5iss 
M. Sig. Apply with brush twice daily till corn soft- 
ens, then soak foot in hot water and remove corn. 
102 Well-fitting shoes are necessary to prevent their 
recurrence. 
CRAMPS, MUSCULAR. 
During the attack, vigorously rub and knead the 
affected muscles. Cramps can often be broken by 
the patient jumping up and putting the muscles on 
the stretch. Afterwards the muscles should be 
quieted by a little rubbing and exercise. 
If patient is very subject to cramps, search for and 
treat the cause, e. g., rheumatism, gout, anaemia, 
diabetes, constipation, dyspepsia. Massage and 
faradization of the limbs, or small doses of strych- 
nine will sometimes ward off the attacks. 
A dose of bromides with alkalies at night, or a mix- 
ture containing 5 grs. each of lupulin and camphor 
will be found to be of service. 
The following liniment thoroughly rubbed in, is of 
service: 
3- Chloral 
Camph. 
01. Cajuput , aa 3i 
Lin. saponis q. s. ad §iii 
M. Sig. Use twice a day. 
CRETINISM (See Myxcedema). 
CROUP, SPASMODIC. 
Prophylaxis. Remove adenoids and enlarged 
tonsils, attend to digestion, diet and general hygiene. 
Treatment of laryngeal spasm. Cause vomiting 
by giving vin ipecac, in doses of thirty minims to one 
drachm, every five minutes till effective. Or give 
repeated five grain doses of alum in a little simple 
syrup. 
If constipation is present, empty the bowels by an 
enema. To prevent attacks give two or three doses 
of antipyrine, two grs. every four hours for a child of 
two. On the second night give a dose of antipyrine 
at bedtime. 
103 The laryngitis may be relieved by inhalation of 
steam from a croup kettle, the patient being in a tent 
made by pinning blankets over its crib: 
3. Menthol 3ii 
Tinct. benzoin, co oiii 
M. Sig. One teaspoonful in a kettle of boiling water 
for inhalation every two or three hours. 
CUPPING (DRY), DIRECTIONS FOR. 
The small cupping glasses are rinsed in alcohol, 
their edges wiped and the remaining film within the 
glass is ignited from a flame. The glass is then in- 
stantly applied to the affected area. The oxygen 
in the air of the glass being consumed, a partial 
vacuum is caused and the skin is forced upwards by 
atmospheric pressure into the glass. The cups are 
allowed to remain for a few minutes or until they 
drop off. The blood being thus forced into one part 
of the body, relieves congestion underneath, and thus 
has the temporary effect of venesection. 
CYSTITIS, ACUTE. 
The patient should be put to bed immediately and 
the diet reduced to a liquid one. Tea, coffee, spices, 
and alcohol must be withheld. Milk, barley water, 
rice water, oatmeal water, custards, eggs, etc., can 
be taken. 
Hot sitz baths two or three times a day are of 
great benefit. 
Elevation of the hips frequently contributes greatly 
to the comfort of the patient by preventing the urine 
from coming in contact with the trigone of the bladder 
and consequently relieves the constant desire to urinate. 
If the disease is due to gonorrhea all injections 
should be stopped. 
The cystitis may be of an (1) acid or (2) alkaline 
type. If the former the following are indications 
for treatment: 
194 I|. Potass, acetat 5i 
Potass, bicarbon oii 
Potass, citr 5 ii 
Aquae q. s. ad 5iii 
M. Sig. One teaspoonful in water four times a day. 
Or: 
3. 01. sandalwood 3ii 
Div. in caps. No. xx. 
Sig. One every four hours with hot water. 
Or: 
1$. Morph, sulph grs. iii 
Potass, bicarb 3iv 
Tinct. belladonn gtts.xviii 
Extr. buchu fluid 3iv 
Extr. tritici fluid q. s. ad 5 iii 
M. Sig One dram in hot water four times a 
day. 
If the cystitis is of the acid type, give: 
I). Acid benzoic 3ii 
Acid borici 3i< 
M. et ft. caps. No. xxiv. 
Sig. One every four hours. 
Or: 
I). H examethylenam. or urotropin... . Jii 
Div. in caps. No. xxiv. 
If severe stranguary is present, hot rectal enemas 
are soothing, and morphine internally acts almost like 
a specific. It may be added to any of the above 
prescriptions or given by rectal suppositories: 
R. Morphin. sulph gr. iss 
01. theobrom q. s. 
M. et ft. rect. suppos. No. xii. 
Sig. One inserted in rectum for pain. 
When the disease begins to subside the bladder 
may be irrigated with any of the solutions mentioned 
under Cystitis, Chronic. 
CYSTITIS, CHRONIC. 
The cause should be sought and treated, e. g., gon- 
105 orrhea, stone in bladder, enlarged prostate, stricture, 
residual urine or gout. It is sometimes remarkable 
how quickly a chronic cystitis disappears when the 
cause is removed. 
When the urine is very ammoniacal and foul smell- 
ing, boric acid administered internally in capsules in 
doses of 5 to 10 grains 3 times a day in conjunction 
with lavage of the bladder with a boric acid solution. 
The strictest antiseptic precautions should be taken 
in all manipulations about the bladder. 
The bladder may be washed out with a soft sterile 
rubber catheter once or twice a day with any of the 
following solutions: 
1. Boric acid 1 dram to 10 ozs. 
2. Nitrate of silver 3 grains to 10 ozs. 
3. Argyrol 5 to 10% sol. 
4. Potassium permangan. . . .3 grs. to 10 ozs. 
5. Lysol sol. 
6. Sulphate of zinc 5 grains to 10 ozs. 
7. Sulphate of copper. ... 5 grains to 10 ozs. 
8. Resorcin 3i to 10 ozs. 
9. Protargol 
All solutions in the bladder should be used warm. 
DACRYOCYSTITIS, CATARRHAL (INFLAMMATION OF 
LACHRYMAL SAC). 
First slit open the canaliculus by inserting a small 
knife after putting the lower lid on the stretch by 
pulling outwards and downwards. After this is 
done wash out the lachrymal sac with an antiseptic 
solution, such as a hot saturated solution of boric 
acid, and open the lachrymal duct with probes, be- 
ginning with a small one and gradually increasing in 
size. 
If a cure does not result after careful treatment, 
then the lachrymal sac and gland must be extirpated. 
The catarrhal inflammation frequently ends in 
Dacryocystitis, Phlegmonous, which see. 
This may result in Lachrymal Duct, Stricture of, 
which see. 
106 DACRYOCYSTITIS, PHLEGMONOUS. 
Try to cut short the attack by leeches or by apply- 
ing a lotion: 
Extr. opii grs. x 
Plumb, acetat. ' grs. xv 
Aq. destillat giv 
M. Sig. Keep the lotion on ice and apply on gauze 
every half hour. 
At the same time give a brisk calomel cathartic fol- 
lowed by 15 gr. doses of phosphate of soda every two 
hours. 
If inflammation does not subside, apply constantly 
a pad of gauze wet with this lotion: 
1$. Extr. opii grs. xv 
Acid, boric grs. lx 
Aq. destillat §iv 
M. Sig. Apply the lotion every hour. 
The pad should be covered with a piece of rubber 
protective to prevent evaporation. 
When fluctuation is detected or it is evident that pus 
has formed and is making its way to the surface, make 
a free and deep incision through the skin and the an- 
terior wall of the lachrymal sac. The incision should 
be made in the direction in which the skin tends to 
wrinkle, that is, from above downward and outward, 
in order that no perceptible scar may be left. 
If the suppuration should become chronic, it is 
necessary to extirpate the entire sac, and at the same 
time the lachrymal gland. 
DANDRUFF (SEBORRHCEA). 
The scaly condition of the scalp must first be treated 
by the use of an antiseptic soap, such as that of 
biniodide of mercury. Use this three or four even- 
ings in succession. Then brush the scalp with: 
1$. Hydrarg. bichlor. (1 to 1,000) 5iv 
Sig. Brush the scalp once a day until irritation is 
produced. 
107 This treatment should be followed by an ointment 
composed of sulphur, resorcin and tar: 
3. Sulph. prsecipgrs. xv 
Resorcingrs. xv 
Olei amygd. amar m. iii 
Paraffin, mollis gi 
M. et ft. ungt. 
Sig. Rub thoroughly into roots of hair once a day 
for two weeks, and afterwards occasionally. 
If the patient objects to greasy preparations, a hair 
wash may be substituted, as: 
I). Acet, cantharid 5ss 
Hydrarg. bichlor gr. i 
Spts. camphor m iii 
Aquse destillat gi 
M. et ft. lotio. 
Sig. Use at bedtime. 
Washing the hair too often and not drying it properly 
favors the formation of dandruff. Dyspepsia and con- 
stipation aggravate the condition but do not cause it. 
Give the following if these two disorders are present: 
I). Tinct. nuc. vomic giv 
Acid, sulph. aromat giii 
Tinct. cardamom 
Tinct. quassiae. 
Tinct. calumbae aa gii 
Elix. gentian, glycerin. N. F. q. s. ad giii 
M. Sig. One teaspoonful in a wineglass of water 
before each meal. 
For the constipation give: 
1$. Extr. cascar. sagradgrs. xxx 
Aloin gr. v 
Podophyllin resingrs. vi 
Extr. colocynthgrs. xxiv 
M. et ft. caps. No. xxiv. 
Sig. One or two at bedtime. 
In order to improve the general tone of the skin, 
give: 
3. Liq. potass, arsenit gi 
Sig. Five drops in water after each meal. 
108 Prophylaxis. In all diseases of the head, brushes, 
combs and other necessaries should be thoroughly 
disinfected with boric acid or carbolic acid solution 
DAY-BLINDNESS (NYCTALOPIA). 
Prophylaxis. If the patient is a soldier, the prac- 
tice of compelling him to go from crowded and often 
dark quarters in barracks, to drill for hours in the 
sun on unshaded parade grounds should be stopped. 
Treatment. Confine the patient to a darkened 
room, treat any pathological condition that is present, 
and improve his health by a nutritious diet. Change 
of locality is often of benefit. 
DEAF-MUTISM (See Dumbness). 
DEATH, CERTIFICATE OF. 
The health authorities furnish a "certificate of 
death" form, and this contains on the reverse side 
concise information regarding the legal requirements. 
The physician should carefully read these so as to 
avoid making any mistakes and so causing trouble 
to himself and others. Never put down a mere 
symptom as the cause of death. If the death is due 
to other than natural causes, e. g., if from criminal 
violence, from accident, or very suddenly during ap- 
parent health, or when unattended by a physician, 
etc., the case should be referred to the coroner, the 
county physician, or the justice of the peace, accord- 
ing to the law of the state. 
Always make a report of a still-birth to the proper 
authorities. Concealing the still-birth of a child, 
which if bom alive would be a bastard, is punishable 
in many states, and if the physician fails to make a 
proper return to the authorities, he may be charged 
with being a party to such concealment. 
It is always best for the physician never to falsify 
the certificate of death, especially in the case of in- 
fectious disease, no matter what pressure is brought 
to bear upon him when the relatives of the deceased 
109 wish a large public funeral, or desire to have the body 
taken within a church. In these cases it is his duty 
to give a truthful return, not merely from a moral 
standpoint, but also to prevent the unnecessary 
spread of a virulent contagious disease. Kissing 
the dead in these cases should be strictly forbidden. 
DEATH, SIGNS OF. 
The following are the methods employed to deter- 
mine whether dissolution has taken place or not. 
First, examine the pupils (with the electric pocket 
light if convenient). In case of death the pupils will 
not respond to light and will remain widely dilated. 
Second, the application of a red-hot needle to the 
toe will produce no blister if death has taken place. 
Third, a dry mirror should be held in front of the 
mouth and nostrils. If death has occurred the mirror 
does not become dimmed with moisture. (This test, 
however, is unreliable and by itself is of little value. If 
death is recent, the fluids of the still warm body are 
evaporating through the skin, especially in cases such 
as cholera, when the temperature may rise after death, 
and this evaporation may dim the mirror as easily 
as moisture from the breath.) 
Other observations should be made upon the 
cadaver and regarded as confirmatory or otherwise, 
of the tests already made. Immediately after death 
there sets in a period of muscular relaxation which 
precedes the onset of rigor mortis. Within eight to 
seventeen hours the body becomes cold to the touch, 
though this may be delayed by obesity. The globe 
of the eye loses its normal tension, becoming flaccid 
•and softer because of evaporation. The cornea loses 
its transparency and is thrown into folds usually in 
a few hours after death. 
DELIRIUM TREMENS. 
Patient should be kept in bed and constantly 
watched. Restrain only if it becomes absolutely 
110 necessary. Cold bath is very beneficial. Withdraw 
all alcohol. If symptoms of collapse appear, give 
strychnine and aromatic spirits of ammonia. 
I). Spts. ammon. aromat 3iv 
Strych. sulphat gr. % 
Tinct. capsici 3 hi 
Essenc. pepsini q. s. ad giii 
M. Sig. One teaspoonful every three hours. 
Produce sleep by trional grs. 15; repeat in one hour if 
necessary. Give morphine (J4 gr.) hypodermically if 
required. After delirium is over give tonics and nutri- 
tious food just as in chronic alcoholism. A pill may be 
given like this: 
I|. Ferri hypo phosph gr. ii 
Quin, bisulph gr. i 
Acid, arsenios gr. 5'0 
Strychnin, sulph gr. 
M. et ft. pil. No. 1. 
Sig. One after each meal. 
If the stomach is irritable, give: 
I|. Hydrarg. chlor, mit grs. ii 
Cerii oxalat grs. vi 
Sacchar. lact grs. xii 
M. et ft. chart. No. xii. 
Sig. One every two hours. 
When convalescence begins give dose of castor oil. 
DEMENTIA PARALYTICA (GENERAL PARALYSIS). 
Patients with this disease cannot be properly 
treated at home, they should be sent to an institution 
where a hygienic mode of life can be carried out with 
plenty of fresh air, bathing and massage. Drugs are 
of no avail in this disease except when due to syphilis, 
and then iodide of potassium should be given in in- 
creasing doses up to 100 or more grains per day. 
Continuous rest in bed should be postponed as long 
as possible, because of the tendency to bed-sores. 
The excitability should be relieved by bromides (20 
grs.), the sleeplessness by veronal (15 grs.), and the 
Ill marked delirium by hyoscine hydrobromide (TJ0 gr.) 
hypodermically. 
The patient should be cautiously watched because 
of his tendency to suicide and other forms of violence. 
DENGUE. 
Rest in bed, light diet and avoidance of chills. 
Isolate patient. 
At onset give mercurial aperient followed by a 
saline purge. For the fever give a saline diaphoretic 
mixture with aconite. If severe pain and high fever 
present, give antipyrin or antifebrin or belladonna 
and cold applications to the head. 
For the pains of convalescence rub with chloroform, 
belladonna, or camphor liniment, and wrap the painful 
parts in cotton wool. 
Prescription for mercurial aperient: 
I). Hydrarg. chlor, mit grs. xii 
Sacchari lactis grs. xii 
Sodii bicarb . . .grs. xxiv 
M. et ft. chart. No. xii. 
Sig. One every hour. 
Prescription for the pain and fever: 
1$. Tinct. aconiti. 
Tinct. belladonn aa gtts. xxiv 
Antipyrini 5ii 
Aquae oii 
Syr. rub. idaei q. s. ad oiii 
M. Sig. One teaspoonful in water every three hours. 
Prescription for an anodyne liniment: 
I). Chloralis hydrat. 
Campho rae aa 5i 
Tinct. belladonnas 5iii 
Chloroformi 5ii 
Lin. saponis q. s. .ad 3 hi 
M. Sig. Rub in thoroughly three times a day. 
DEPILATORIES. 
The only reliable way to remove superfluous hairs 
112 is by electrolysis. This is absolutely effective after 
two or three sittings. 
So-called depilatory powders are useless, for they 
simply bum off the tops of the hairs leaving the roots 
intact, and the effect is the same as that of shaving. 
A very common depilatory is: 
I). Barii sulphid 3iss 
Zinci oxid . 5vi 
Carmin gr. i 
Sodii sulph 3ii 
Cret. preparat 3vi 
M. Sig. Mix a little of the powder with water and 
spread on skin. 
DERMATITIS CALORICA (See Chilblains). 
DHOBIE ITCH (WASHERMAN'S ITCH. MANILA 
ITCH). 
Prophylaxis. Short cotton bathing drawers should 
be worn and changed daily. The skin of the crui ch 
should be frequently powdered with dusting powder 
containing equal parts of boric acid, zinc oxide and 
starch. 
Treatment. Remove the crusts, scales and dis- 
charges by scrubbing with hot water and soft soap 
on a piece of flannel. Then rub in a 2% chrysarobin 
ointment twice daily until the skin round the af- 
fected parts becomes red and inflamed. Warn the 
patient that chrysarobin stains the clothing and he 
must be careful not to let it touch his eyes, since it 
is a powerful irritant. After the itch seenls cured, 
the part should be painted every second day with 
10% solution of tincture of iodine in 60% spirit to 
prevent any recurrence of the disease. 
DIABETES INSIPIDUS. 
Look for and treat cause, e. g.,nervous, abdominal 
syphilitic, or constitutional disease or injuries . 
Hygienic treatment. Patient should live in well 
ventilated, warm, dry room. He should wear flannel 
113 next the skin and should take warm baths followed 
by brisk friction with flannel and should take open 
air exercise. 
The distressing thirst may be relieved by bits of 
ice or acidulated drinks such as lemonade. Diuretic 
drinks like beer or cider should be avoided. The 
patient need not restrict the quantity of water he 
desires, but should avoid too much sugar. 
Drugs are not to be relied on, but the following is 
often useful: 
I|. Liq. ac. arsenios 5ii 
Ferr. et ammon. citrat Siiss 
Aq. cinnamomq. s. ad oiv 
M. Sig. One teaspoonful in a wineglass of water after 
each meal. 
Codein acts well in some cases; it should be given in 
J4 gr. doses after meals. 
DIABETES MELLITUS. 
Diet is of the utmost importance. The patient 
should take regular exercise, but avoid fatigue, ex- 
posure and excitement. Massage and hot baths are 
beneficial. Insulin promises much for Diabetic pat- 
ients. As this treatment is given subcutaneously 
and the symptoms, reaction and diet must be 
watched carefully it seems adviseable to use it only 
in institutions. 
Medicinal treatment, Morphine, Arsenic, Codine 
and Antipyrin are the best drugs, in the order 
named. Morphine may be given in % grain 
doses, after each meal. Codein may be substi- 
tuted in some cases. Antipyrin in 10 grain doses, 
three times a day is worthy of a trial. Arsenic is 
best given in the form of Fowler's solution, 5 drops 
in water three times a day gradually increasing 
114 until the physiologic effect is produced, e. g., puffi- 
ness of the eyelids in the morning. 
Diabetic coma is always fatal, but sodium bicar- 
bonate in large doses, inhalation of oxygen, intra- 
venous or rectal injection of saline solution are of 
benefit. 
For the complications of diabetes such as Pruritus, 
Gangrene, etc., see under these headings. 
DIABETES MELLITUS, DIET IN. 
At first the carbo-hydrates should be lessened until 
the sugar has disappeared from the urine. After- 
wards they may be replaced gradually and with cau- 
tion, noting the effect on the urine of each addition 
as a guide. 
Foods forbidden. Sugar and starch in any form 
at first. Rice, tapioca, sago, vermicelli, arrowroot, 
cornflower, oatmeal, potatoes, peas, beans, parsnips, 
beets, carrots, onions, pastry, puddings, ale, stout, 
porter, port, champagne, liqueurs and cider. 
Foods allowed but only in great moderation. 
French beans, asparagus, cauliflower, koumiss, milk, 
strawberries,- gooseberries, raspberries, currants, 
peaches, nectarines, claret, hock, dry Sauteme, 
Chablis, Burgundy, brandy, whisky, soda water, 
Apollinaris, Seltzer, or Vichy. 
DIABETES, VON NOORDEN'S DIETETIC TREATMENT 
OF. 
After the carbohydrates in the diet in diabetes 
have been gradually reduced the following standard 
diet is given containing 204 grammes of proteid, 
135 grammes of fat and no carbohydrates: Break- 
fast: 5 grammes of tea infused in 200 c.c. of water; 
ham, 150 grammes; one egg. 
Lunch: cold roast beef, 200 grammes; cucumber, 
60 grammes, with vinegar (5 grammes), olive oil 
(10 grammes), salt and pepper to suit the taste; 
115 Apollinaris water, 400 c.c. with 20 c.c. of brandy; 
and coffee without milk or sugar. 
Dinner: clear bouillon, 300 c.c.; beef, 250 grammes; 
butter, 10 grammes; green salad, 80 grammes; 
vinegar, 10 grammes; olive oil, 20 grammes; three 
sardines; Apollinaris, 400 c.c. with 20 c.c. of brandy. 
Supper: Two eggs; Seltzer water, 400 c.c. 
This diet is continued until there is either an 
absence of sugar in the urine or until it shows the 
amount of sugar that is being formed in spite of 
the absence of carbohydrates from the diet. 
This method offers a basis for the special dietetic 
treatment of the different forms of diabetes whether 
mild, moderate, or severe. 
If a patient shows no sugar in his urine for some 
days as the result of the carbohydrate-free diet, he 
is allowed some form of starch in gradually increasing 
quantities until sugar reappears in the urine. We 
can thus determine the ability of the economy to 
metabolize varying amounts of carbohydrates. The 
starch-tolerance may be expressed in the following 
formula: starch-tolerance equals standard diet plus 
x-grains of starch. 
Von Noorden claims that a non-carbohydrate 
diet improves tissue metabolism, thus increasing 
the power of the system to warehouse carbohy- 
drates, and recommends a rigid nitrogenous diet 
at intervals of a few months. 
Foods allowed: 
All clear soups and broths; meats of all kinds, fish, 
shellfish, beef juice, eggs, cream, butter, cheese, 
gluten, bran and almond bread and biscuits, greens, 
turnip tops, tomatoes, lettuce, mushrooms, cucum- 
bers, oranges, lemons, nuts, pickles, olives, vinegar 
whipped cream and custards. Saccharin should be 
used as a sweetening agent instead of sugar. 
116 DIARRHCEA. 
To effect a prompt cure in mild cases all food should 
be withheld for twenty-four hours with rest in bed. 
If the pain is severe give a hypodermic injection of 
morphine (J4 gr-)- If the pain is not severe clean 
out the alimentary tract first. If only a few move- 
ments have taken place, two grains of calomel or an 
ounce of castor oil may be given. This may be fol- 
lowed by: 
I). Bismuth, subnitrat. 
Tinct. cardam. 
Tinct. catechu. 
Tinct. opii. 
Mist, cretse aa 5iv 
Syr. acac q. s. ad. §iii 
M. Sig. One teaspoonful every three hours. 
Or: 
I). Pulv. opii grs. xii 
Plumb, acetat grs. xxiv 
Pulv. camphor® grs. xii 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
Relieve thirst with chipped ice. 
In severe cases with vomiting and purging, give at 
first morphine (J4 gr-) hypodermically. If collapse re- 
sults, give the following: 
I). Strych. sulphat gr. ss 
Nitroglycerin gr. 1 
Spt. vin. gallic q. s. ad. oiii 
M. Sig. One teaspoonful hypodermically or by 
mouth. 
For the relief of the tenesmus give: 
1$. Tinct. opii m. xx 
Starch water 5 ii 
M. Sig. Inject into the rectum. 
A large mustard plaster should be placed over the 
abdomen (one part of mustard to six or eight of flour) 
117 DIARRHCEA, NERVOUS. 
Place the patient on liquid diet for several weeks. 
In severe cases the patient should be placed on a 
skim-milk diet. Later on it may be followed by a 
diet consisting of rice, toast, eggs, rare beef, junket> 
milk and corn starch. He should avoid fats, sweet 
fruits, pastry and alcohol. Remove the cause, 
which is usually mental worry. The patient should 
wear a flannel abdominal band over the stomach. 
Relief of the neurasthenic condition is frequently 
all that is necessary to stop the diarrhoea. Astrin- 
gents do not do much good and opium should not be 
used. Nerve sedatives are indicated such as: 
I). Ammon, bromid oi 
Ammon, valerian 5i 
Asafoetidsegrs. xxiv 
Extr. sumbul.. grs. xxxvi 
M. et ft. caps. No. xxiv. 
Sig. One every four hours. 
Or: 
Ty. Zinci valerian .grs. xii 
Ferri valeriangrs. xlviii 
Quinin. valeriangrs. xxiv 
M. et ft. caps. No. xxiv. 
Sig. One every four hours. 
DIARRHCEA OF CHILDREN (See Gastroenteritis, Acute). 
DILATATION OF THE STOMACH (GASTRECTASIS). 
The patient should not eat or drink large quantities 
at a time, but should take small amounts at frequent 
intervals. .Not more than three pints of fluid should 
be drunk in twenty-four hours. If the thirst is 
troublesome, water and meat broth should be given 
by the rectum. Gastric lavage prevents retention 
and fermentation of the food and also relieves vomit- 
ing. The patient should avoid all foods likely to 
ferment, especially sweets and fats. 
The muscular tone of the stomach should be im- 
118 proved by means of strychnine. A carefully fitted 
abdominal bandage gives mechanical support to the 
stomach and gives ease to the patient. 
Gastric analysis will indicate the kind of drugs to 
be given. If the hydrochloric acid is diminished, 
prescribe dilute hydrochloric acid. If hyperacidity 
is present, neutralize it by: 
1$. Magnes. carb 5ii 
Bismuth, subcarb. 
Sodii bicarb aa 5i 
M. et ft. chart. No. xii. 
Sig. One to be taken about an hour after meals. 
If fermentation is present, it may be retarded by the 
following: 
Resorcinolis grs. Ixxv 
Bismuth, salicylat. 
Pulv. rhei. 
Sodii sulphat aa 3iiss 
Sacchari lactis 5iiiss 
M. Sig. Half a teaspoonful twice a day. 
Abdominal massage is of considerable use to tone the 
musculature of the stomach. Faradization of the 
stomach is also of benefit. 
In prescribing strychnine as a muscular tonic it 
should be combined with atropine: 
1$. Strych. sulphat gr. 24 
Atropin sulphat gr. 14 
Ess. pepsini q. s. ad. oiii 
M. Sig. One teaspoonful three times a day in water, 
before meals. 
Gastric lavage should be carried out at least once a 
day. The patient should be taught to wash out his 
own stomach. It is of most service if done before the 
evening meal. A solution containing two teaspoonfuls 
of bicarbonate of soda to the quart of hot water is of 
use to dissolve the mucus in lavage of the stomach. 
119 DIPHTHERIA. 
The sick-room should be kept cool (G5° F.) and 
freely ventilated. The air of the room should be 
kept moist by generating steam in a kettle or by 
slaking large quantities of quicklime in the room. 
In the early stages and especially when laryngeal 
symptoms are present, steam inhalations by means of 
a croup kettle, the spout of which is introduced under 
a tent of blankets constructed over the child's crib 
are indicated. The diet should be fluid and very 
nourishing. If nursing, the child should not be 
allowed the breast, but should be fed on milk with- 
drawn by means of the breast pump. Allow the 
patient to drink plenty of cold water. 
Antitoxin should be administered as soon as pos- 
sible. In mild cases one dose of 2,000 to 3,000 units is 
often sufficient. Late in the disease when the con- 
dition is profoundly toxic 10,000 units may be given 
and repeated until improvement takes place. All 
cases with laryngeal involvement require from 6,000 
to 8,000 units. The injection may be made with 
strict antiseptic precautions into the thigh, buttock 
or side of the chest. 
The local treatment is directed towards cleanliness 
rather than destruction of the bacilli, and if the child 
struggles violently it is better to desist than exhaust 
it. Irrigate the nose and pharynx with a warm normal 
salt solution or a weak boric acid as hot as the patient 
will bear, by means of a soft catheter attached to a 
fountain syringe. The child should lie on its side 
with the head slightly lower than the rest of the body, 
so that the fluid can easily flow from the mouth into 
a convenient receptacle. 
The patient should be held by the nurse and the 
mouth held open by a cork between the teeth or by 
a mouth gag, while the following application is made 
to the throat by means of a cotton swab or brush: 
(Loeffler's solution.) 
120 Mentholis 5iiss 
Toluolis 5x 
Liquoris ferri chloridi 3i 
Alcoholis absoluti 3ii 
M. Sig. Apply three times a day. 
A solution of hydrogen peroxide, 1 part to 3 of lime- 
water may also be used for the same purpose. 
As soon as a tendency to heart weakness is noticed 
stimulants should be given. Half a drachm of brandy 
or whisky, diluted with water is a proper amount for a 
child of five years. Strychnine is also valuable in 
doses of 1/120 gr. every three hours. If there is low 
arterial tension combined with heart weakness digitalis 
may be given in small doses. Impending cardiac 
paralysis may be combated by hypodermic injections 
of morphine. In profound adynamia hypodermic in- 
jections of camphor dissolved in ether or sterile oil 
may be given. 
For the painful enlarged glands of the neck and for 
the earache, apply hot camphorated oil three times a 
day followed by a hot poultice. 
When convalescence begins the local treatment should 
be gradually dropped and more attention should be 
paid to toning up the general system with iron, cod 
liver oil, etc. For a child six to ten years old, give: 
I). Syr. ferri iodid 3iii 
Sig. Ten drops in water through a glass tube, 
three times a day. 
If antitoxin is given early we will seldom be called 
upon to do intubation or tracheotomy. These meas- 
ures should be employed as soon as the indications 
appear rather than wait till the patient is in extremis. 
Intubation is better than tracheotomy. When the 
tube is in the larynx, feed the child with the head 
hanging low. 
Paralysis may intervene in diphtheria as early as the 
sixth day, and as late as six weeks. The muscles of 
the pharynx are the first to be affected and frequently 
121 the only ones. The paralysis is temporary. Strych- 
nine in large doses should be given, 6'0 gr. of the sul- 
phate three times a day to a child six years old. 
DIPHTHERIA, PROPHYLAXIS OF. 
One nurse should take entire charge of the patient 
and should hold no communication with the rest of 
the family. Discharges from the nose and mouth 
should be received on cloths which should be im- 
mediately steeped in carbolic acid solution (six ounces 
of acid to two gallons of water). All linen, etc., 
which has come in contact with the patient should be 
immersed in this solution for two hours and then boiled 
in water for one hour. In making applications to 
the throat a pane of glass should be held between 
patient and nurse to prevent discharges being coughed 
into the face of the attendant. The hands of the 
attendant, surfaces soiled by discharges and utensils 
used by the patient should be washed in the carbolic 
solution. The sick-room should have all hangings 
and unnecessary furniture removed from it, and 
should be thoroughly aired two or three times a day. 
It should be frequently swept after scattering wet 
tea leaves on the floor to prevent the dust from rising. 
The nurse and all members of the family who have 
been exposed to the infection should receive an im- 
munizing dose of antitoxin (100 units for a child of 
one month to 800 units for an adult) and at the first 
sign of a sore throat a full dose should be given. 
After the patient is removed disinfect and 
thoroughly air the sick room and all its furniture. 
DIPSOMANIA (See Alcoholism, Chronic). 
DISINFECTION, DIRECTIONS FOR. 
A disinfectant for common use should be simple, 
cheap and reliable, e. g., 1st. Four per cent solution 
of chloride of lime. Dissolve six ounces of the best 
chloride of lime in one gallon of water. Discharges 
122 from the bowels of a patient suffering from a con- 
tagious or infectious disease, should be received in a 
vessel containing this solution, and allowed to stand 
for an hour or more before being thrown into the 
water closet. Discharges from the throat or lungs 
should be received in a vessel containing this solu- 
tion. Chloride of lime in powder should be used in 
privy vaults, cesspools, drains, sinks, etc. Instead 
of this solution a 5% solution (six and a half ounces 
to the gallon) of carbolic acid may be used. 
2nd. Bichloride of mercury, 1 to 1,000. Dissolve 
one drachm each of corrosive sublimate and muriate 
of ammonia in one gallon of water. Dissolve in a 
wooden barrel or earthen crock. In disinfecting 
soiled underclothing, bed linen, etc., immerse the 
articles for four hours and then wring them out and 
boil them. This solution is excellent for wetting 
floors before sweeping. Mixed with an equal quan- 
tity of water, it is used for washing the hands, etc., 
of attendants on the sick. 
3rd. Milk of lime (quicklime). This should al- 
ways be freshly prepared. Slack a quart of freshly 
burnt lime in small pieces with three-fourths of a 
quart of water. A dry powder of slack lime results. 
Make milk of lime not long before it is to be used, 
by mixing one part of this dry powder with eight 
parts of water. This disinfectant can be used to 
whitewash exposed surfaces, to disinfect excreta in 
the sick room, or on the surface of the ground in 
sinks, drains, etc. 
DISLOCATIONS. 
Recent dislocations should be reduced or the parts 
restored to their normal condition at the earliest pos- 
sible moment. Too much inflammation or swelling 
or too great a shock may justify delay for a few hours 
or even days. 
The after treatment consists in keeping the joint 
at rest for from 10 days to two or three weeks. Then 
123 passive movements should be made for several days, 
to remove stiffness. 
The following prescription for a liniment may be 
given: 
1$. Chloroform 3 hi 
Camphor 3ii 
01. terebinth 5i 
Ether 3ih 
Lin. saponisq. s. ad. §iv 
M. Sig. Use twice a day. 
DIVER'S PARALYSIS (See Caisson Disease). 
DRINKS FOR THE SICK. 
Albumin water. Beat up the white of an egg 
until it becomes slightly foamy. Squeeze in the 
juice of half a lemon. Sugar to taste, and add a few 
pieces of chipped ice and fill the glass with water. If 
lemon juice is disagreeable to the patient, substi- 
tute half a dram of vanilla or syrup of raspberry. 
Egg-nog. Take one egg and beat it up, then add 
two teaspoonfuls of sugar, a glassful of milk, and 
lastly one tablespoonful of brandy. Add to this 
mixture a little ground cinnamon or nutmeg. 
Orangeade. Pour a cupful of boiling water over 
the rind of one orange, and add the juice of the 
orange with a tablespoonful of sugar. Strain after 
cooling and serve with shaved ice. 
Egg broth. Beat up an egg and add to it half a tea- 
spoonful of sugar and a pinch of salt; pour a glass of 
hot milk over it and serve at once. Hot water, 
broth, soup, or tea may be used in place of milk. 
Flour ball. Place a half a pint of flour in a small 
cheese cloth and boil for at least four hours. After 
removing, peel off the outside and grate the hard 
ball, dry in the oven and keep in a covered jar. 
Kumiss. Into strong bottles pour one quart of 
fresh milk, half an ounce of sugar, a piece of fresh 
yeast cake half an inch square, and keep at ordinary 
124 room temperature for one week (60° to 70° F.) 
Shake them five or six times a 'day, then put on ice. 
Peptonized milk. To a pint of milk add four 
ounces of water, and the contents of one of Fair- 
child's peptonizing tubes, or five grains of extract 
of pancreas and fifteen grains of bicarbonate- of soda. 
This mixture should be placed in a clean graniteware 
saucepan and gradually heated until it boils, stirring 
continuously. Allow the mixture to boil for ten 
minutes, strain into a sterile bottle, cork and keep in 
a cool place. Shake the bottle Well before using. It 
may be served hot or cold. If the above directions 
are followed it will not become bitter. 
Flaxseed tea. Flaxseed, half a teacupful, water, 
one quart. Boil half an hour, sWeeten with sugar 
or honey to suit the taste, add the juice of four lemons 
and some lemon peel, cool and strain. 
Imperial drink. Cream of tartar, one drachm, 
boiling water, one pint; sugar and lemon peel to suit 
taste. Mix, cool and strain. 
Jelly water. Add currant or other acid jelly to 
hot water, cool and strain. 
Oatmeal water. Half a teacupful of oatmeal in a 
quart of cold water. Let it stand two hours in a cool 
place, then pour off as required. 
Toast water. Toast thoroughly without burning, 
a thin slice of bread. Pour over it six ounces of boil- 
ing water. Let it stand for an hour or two in a 
covered dish. Administer it by the teaspoonful. 
Rice water. Steep an ounce of rice for three hours 
in a quart of cold water. Let it simmer slowly and 
gradually raise to the boiling point. Add lemon peel 
to suit taste. Cool and strain. This is a very useful 
drink in diarrhea, dysentery, and other intestinal 
troubles. 
Lemonade. Cut the rind of a lemon into thin 
slices. Put the peel and one sliced lemon into a 
pitcher with one ounce of sugar. Pour on one pint 
125 of boiling water; cover, let stand and strain before 
using. Hot lemonade is often used in colds, and cold 
lemonade in fevers. 
Wine whey. Heat half a pint of milk to boiling 
point. Add two ounces of sherry wine. Mix and 
strain. Used in colds and fevers. A tablespoonful 
may be given to a child when food and stimulant are 
necessary. 
DROPSY (See Ascites). 
DULLNESS OF HEARING. 
When a patient, through pathological changes in 
his organ of hearing, is unable to understand words 
spoken in an ordinary tone of voice, the physician 
should resort to some mechanical device to aid his 
patient's hearing, after all medical and surgical 
methods of treatment have failed. All or many of 
the numerous contrivances sold should be tried, and 
the patient should not be contented until the one is 
found which is most beneficial. Improvement of 
hearing from these devices is to be expected when the 
function of the auditory nerve has not been entirely 
destroyed. When acute inflammation exists in the 
ear these contrivances should never be used. In 
chronic ear affections they should be used at a suf- 
ficiently early stage to furnish the necessary stimulus 
to the nerve which is tending towards atrophy owing 
to the absence of its normal vibration. 
When the dullness of hearing is due to tobacco 
("tobacco deafness"), sharpness of hearing usually 
returns when the tobacco habit (smoking dr chewing) 
is given up. 
When the deafness is due to relaxation of the tym- 
panic membrane, contractile collodion should be 
applied to that membrane. 
If the deafness is due to throat trouble, inflation 
with the Politzer bag or Eustachian catheter is often 
of service. 
126 Tinct. gelsemium in 15-drop doses twice or thrice 
daily is of use in nervous deafness. 
When the deafness is due to too much wax in the 
external canal, remove it, and when due to deficient 
secretion of wax, put a few drops of the following into 
the meatus: 
1$. 01. terebinthgtts. xl 
Glycerini gss 
M. Sig. Instil a few drops in the ear at bedtime. 
DUMBNESS (DEAF-MUTISM). 
When the dumbness is due to deafness, complete 
or partial, the power of speech may be developed by 
teaching the patient to imitate the process of speaking 
in others, and by a methodical training in lip-lan- 
guage. Sign language, either by hand or gesture should 
not be cultivated at the same time. Dumbness due 
to fright may be cured by faradization of the muscles 
of the neck, combined with hygienic treatment. 
When due to feeble-mindedness, the treatment 
requires great tact and patience. The patient should 
be taught monosyllabic sounds by being shown the 
object represented by the sound, while the patient 
imitates the sound when watching the teacher's lips. 
If a child already possesses speech which was ac- 
quired before hearing was lost, great efforts should 
be made to retain his speech and to cultivate the 
habit of reading the speech of others. 
The relations between the nerve centers for speech 
and hearing are most intimate. The ear plays a 
constant part in the tuition of the vocal organs in 
either speech or song. So-called "dumbness" is the 
result usually, not of defects in the vocal organs, 
but of lack of hearing, and hence of inability to con- 
trol by the ear. the pitch or quality of the vocal notes 
DYSENTERY, AMCEBIC. 
Prophylaxis. The water supply should be from a 
pure source and should be safely stored and filtered. 
127 Protect cisterns and tanks from contamination. The 
soil should be thoroughly drained. A good water 
carriage system should be substituted for privies and 
cesspools. All vegetables to be eaten raw should be 
thoroughly washed and scalded. All water used for 
domestic or drinking purposes should be boiled. 
Prevent the pollution of soil and water. Thoroughly 
disinfect and dispose of dysenteric stools at a distance 
from the dwelling. 
Treatment. During the acute symptoms the 
patient should rest in bed and restrict his diet to milk, 
chicken-broth, barley water, egg-albumin, beef- 
juice, etc. 
Poultices, turpentine stupes, or morphine hypo- 
dermically will relieve the severe abdominal pains. 
Small enemas of starch and opium will relieve tenes- 
mus. 
Ipecacuanha internally is not of much service in 
this form of dysentery. 
Amcebacidal drugs should be injected high up into 
the bowel. One and a half pints of warm quinine 
solution (1 to 1,000) should be introduced slowly by 
gravitation well up the bowel through a soft rubber 
tube. Other amcebacides may be tried, e. g., two 
pints twice a day of peroxide of hydrogen diluted with 
eight times its bulk of water, or permanganate of 
potassium (seven grains to a pint), etc. 
Internally, sulphate of sodium in drachm doses 
every three or four hours, or castor oil once or twice 
a day should be given along with salol in 15 gr. doses 
three times a day. 
DYSENTERY, BACILLARY. 
Prophylaxis. The soil near the dwelling should be 
free from fecal pollution. The water-supply should 
be pure. All water should be boiled before use and 
surface water avoided for drinking. All raw vege- 
tables, salads and fruit should be avoided or at any 
rate scalded before use. Abuse of alcohol, wet, cold, 
128 and exposure to the tropical sun should be avoided. 
An abdominal belt (cummerbund) should always be 
worn in the tropics. Dysenteric stools should be 
disinfected and buried deeply in the earth at a dis- 
tance from the dwelling. Bedpans, enema syringes, 
bedding of the sick room should be thoroughly dis- 
infected. 
Treatment. Rest in bed in a room which is 
well-aired and free from draughts. A large linseed 
poultice should cover the whole abdomen. A sinapism 
should be applied over the epigastrium, or spongio- 
piline placed in hot water, and sprinkled with 
turpentine. 
Careful diet, mostly milk, either pure or peptonized, 
or diluted with lime-water. If there is great pros- 
tration give wine, brandy, ammonia or other cardiac 
tonics. 
The ipecacuanha treatment is of great value in 
this form of dysentery. First give a preliminary 
dose of an unirritating purgative such as Epsom 
salts, calomel or castor oil. Next give opium 
(20 to 30 drops of laudanum) or morphine hypo- 
dermically to check peristalsis and relieve tenesmus 
as well as to prevent emesis by ipecacuanha, the 
next drug given. A single large dose of 20 to 40 
grains of powdered ipecacuanha is given, stirred up 
in water. This dose is repeated every 6, 8, or 12 
hours, according to the urgency of the symptoms, 
until the appearance, usually within 24 hours, 
of a copious black stool. Hypodermic injections of 
anti-dysenteric serum should be given within the 
first two or three days of the disease. 
DYSENTERY, CHRONIC. 
Successful treatment is best accomplished by regu- 
lation of the diet and irrigation with antiseptic solu- 
tions. The diet should be fluid in character: milk, 
meat, broths, milk-toast, thoroughly boiled rice, 
beef juice, junket, albumen, etc. The patient should 
129 be confined to bed and not allowed to exert himself 
or to return to solid food too soon. 
Irrigation gives by far the best results. It should 
be done twice a day through a long rectal tube, using 
one to three quarts of water (100° F.) at a time. In 
mild cases a physiologic salt solution should be used 
Antiseptic drugs may be added to the water as fol- 
lows: Quinine (1 to 2,500), mercuric chloride (1 to 
5,000), carbolic acid (1 to 2,000), salicylic or boric 
acid (1 to 2,000). 
Silver nitrate is also of much benefit, using 2 or 3 
pints of warm water containing 20 to 30 grs. to the 
pint. The patient should be given Sr- morphine 
and placed on his back or on the left side with the 
hips well elevated. The water reservoir should not 
be more than two feet above the rectum and the 
water should flow in very gently. 
DYSMENORRHEA. 
Patient should avoid narcotics and alcohol, except 
in cases of special urgency. She should rest in the 
recumbent posture three days before the flow begins 
and during its continuance. If there is undue pelvic 
congestion a hot-water bag, or a flannel wrung out 
of hot water should be applied over the lumbar region 
for 15 minutes four or five times daily. Rectal sup- 
positories containing five grs. of iodoform and | gr. 
extract of belladonna often give great relief. During 
the inter-menstrual period faradization of the pelvis 
three times a week is of great service. When dys- 
menorrhea occurs in young stout girls, it is wonder- 
fully relieved by viburnum given frequently just 
before menstruation, and three times a day during 
the interval: 
Extr. vibum. prunifol. fluid oi 
Tinct. belladonngtts. xxiv 
Tinct. hyoscyam 3ii 
Syr. cinnamon.q. s. ad. giii 
M. Sig. One teaspoonful in hot water for two days 
130 previous to menstruation and until it is well established. 
During the interval take one teaspoonful three times 
a day. 
Morphine should never be given unless absolutely 
necessary. Control the pain with the following: 
1). Antipyrin 5i 
Sodii salicyl 3i 
Tinct. opii co 3ii 
Syr. aurant. cortq. s. ad. §ii 
M. Sig. One teaspoonful every two hours until re- 
lieved. 
Many cases of dysmenorrhea will resist all medical 
treatment; in these it becomes necessary to dilate and 
curette the uterus. 
DYSPEPSIA, FLATULENT. 
See that the teeth of the patient are sound and all 
in regular use, that none are tender to the touch. Un- 
used teeth usually get discolored. The patient should 
thoroughly masticate his food and take little or no 
fluid at meals. Meals should be at regular hours with 
pleasant company and no haste. The cooking should 
be good and a short rest should be taken before and 
after each meal. Fresh air, exercise, Turkish baths, 
friction of the skin are of benefit; attention should 
be paid to the movements of the bowels. 
Forbid the following articles of diet. New bread, 
pastry, sweets, sauces, curries, pickles, all fried or re- 
cooked meats, all salted, preserved and highly sea- 
soned fish and meats, sausages, liver, kidneys, duck, 
goose, eels, green vegetables generally, acid or unripe 
fruits, sour wines, coffee, chocolate, lemonade. 
Allow the following: Clear soup in very small 
quantity if at all, beef juice, boiled fish, chicken, 
lamb, mutton, roast beef, boiled (never fried) 
ham, eggs poached or soft boiled, tripe, cow heel, 
calf's head, dry toast, stale bread, green vegetables 
in very small quantities, milk, peptonized or diluted 
with Vichy or Seltzer, weak tea freshly made. 
131 The following alkaline mixture is very useful in 
this class of cases: 
I). Potass, bicarb 5iii 
Sodii bicarb 3iii 
Spt. ammon. aromat 3iv 
Tinct. rhei 3ii 
Infus. calumb q. s. ad. 3vi 
M. Sig. One tablespoonful in water three times daily, 
a quarter of an hour before meals. 
Or alkaline cachets may be given each containing: 
Potass, bicarb grs. xv 
Sodii bicarb grs. xv 
Pulv. rhei grs. ii 
M. ft. pulv.-cachet; mitte tales No. xxxvi. 
Sig. One three times daily, a quarter of an hour 
before food. 
The following menthol mixture for flatulence is of 
service: 
I|. Menthol grs. iv 
Spt. ammon. aromat. 
Spt. chloroform aa §i 
M. Sig. One teaspoonful in water when required. 
EARACHE (OTALGIA, OTITIS). 
Examine carefully the ear, mouth, teeth, throat 
and nose for the cause and treat it. Wash mouth 
and gargle throat frequently with hot water. 
Local treatment. Allow a hot saline solution 
(100° to 105° F.) to run into the ear from a fountain 
syringe. One to four leeches may be applied upon 
the tragus or behind the ear. Instil a solution of 
atropin sulphate (two grs. to the ounce) or of cocaine 
hydrochlor. (4% solution) well down into the exter- 
nal meatus. The "heart" of a hot onion applied to 
the canal often quiets the pain. The following is a 
good "earache drop:" 
3- Cocain. muriat gr. v 
Tinct. opii 5ii 
Glycerini 5ii 
132 M. Sig. Three drops of this mixture on absorbent 
cotton to be placed in the ear twice a day. 
Hot fomentations (poppy heads or chamomile) 
are often useful. Blisters behind the ear often give 
relief. 
Internally. The drugs used are: aconite, bella- 
donna, Dover powder, aspirin, and calomel. 
I|. Tinct. aconit .gtt. xvi 
Liq. ammon. acetat 5ii 
Syrup, simplic 3ii 
Aquaeq. s. ad gii 
M. Sig. One teaspoonful every four hours during 
acute inflammation, for a child of three years. 
For neuralgic headache give: 
3. Acetphenetidini 5 i 
Ft. chart. No. xii. 
Sig. One powder every hour till the severe pain 
ceases. 
ECHINOCOCCUS DISEASE. (See Hydatid Disease.) 
ECHTHYMA. 
Good food and tonics such as iron, quinine, strych- 
nine and cod-liver oil are of the greatest service. 
The crusts should be softened by sweet oil, boric 
acid poultices or ointment, and removed. The fol- 
lowing stimulating ointment may then be applied 
I). Ungt. hydrarg. ammoniat 3vi 
Ungt. zinci oxidi 3iv 
Acidi salicylici gr. x 
Petrolatiq. s. ad §ii 
M. Sig. Keep applied to the pustule constantly. 
For an anaemic strumous child prescribe: 
I}. Syrupi ferr. iodid 3i 
Olei morrhuae §ii 
Acaciae 5iv 
Aquaeq. s. ad §vi 
M. Sig. One teaspoonful two hours after each meal. 
133 ECLAMPSIA GRAVIDARUM. 
Preventive treatment. More important than the 
curative. If a pregnant woman exhibits symptoms 
like albuminuria, oedema, alimentary disturbances, 
headache, lassitude, deficiency of urine or of total 
solids, a rapid and highly tense pulse, the indica- 
tions are to diminish the amount of nitrogenous food 
to a minimum, to hinder the production of poisonous 
materials in the intestines and tissues, to eliminate 
these poisons by the action of the bowels, kidneys, 
liver, skin and lungs. 
Diminish the amount of nitrogenous food by re- 
stricting the patient to an absolute milk diet (with 
Vichy and other table waters). Two or three liters 
of milk daily should be sipped slowly. 
Eliminate the poisons from the body-tissues by 
pure air, inhalation of oxygen, gentle exercise, mas- 
sage, etc. 
To eliminate the poisons by the bowels give daily 
doses of colocynth and aloes followed by a saline 
next morning: 
3. Ext. colocynthgrs. xxiv 
Aloes grs. v 
Extr. belladonna) grs. iii 
Podophyllin. resin grs. vi 
M. et ft. caps. No. xxiv. 
Sig. One or two at bedtime. 
When the heart is sluggish and is accompanied by 
albuminuria give: 
I). Infus. digitalis fol. (freshly made).... § vi 
Sig One tablespoonful every four hours. 
If it is necessary to use the skin as an eliminant, 
give hypodermically: rl0 gr. of pilocarpin muriate. 
Treatment of the convulsions. If the convulsions 
come on before labor, the uterus should be emptied 
as quickly as possible. Rupture the amniotic sac and 
dilate the uterus either with Barnes' bags, the finger 
or Bossi's dilator. 
134 To stop the convulsions use chloroform or better 
still J4 Sr- morphine hypodermically. The morphine 
does the work. 
If the arterial tension is high, perform venesection 
and remove about sixteen ounces of blood. Replace 
the blood by an injection of a physiologic salt solution. 
Veratrum viride should be given in 30 drop doses every 
hour until the pulse becomes soft. 
Make the patient sweat by giving gr. of pilo- 
carpin hypodermically. 
High rectal injections of saline solution should be 
given and a drop or two of croton oil should be placed 
on the back of the tongue to produce free purgation. 
After treatment. Usually the patient regains her 
former strength in a very short time. The albumi- 
nuria should be treated by: 
1$. Potass, citrat 3 hi 
Infus. digitalis fol. (freshly made).... §iv 
Sig. One dessertspoonful every four hours. 
Or: 
I}. Tinct. digital 3iv 
Tinct. strophanth.... 3i 
Potass, acetat 3 ii 
Ess. pepsinq. s. ad 3 hi 
M. Sig. One teaspoonful in water every four hours. 
ECTROPION. (Eversion of margin of eyelid.) 
The acute form may be cured by the application 
of astringents, scarification of the swollen tissue, or 
excision of a portion of the thickened membrane. 
In the chronic form treat the cause: exophthal- 
mos, paralysis of the seventh nerve, or cicatricial 
contraction of the skin following burns, injuries, or 
necrosis of bone. In most cases it is necessary to 
excise a portion of the ciliary border of the eyelid. 
ECZEMA. 
The inflamed part should be placed at rest and all 
sources of irritation (washing with soap, or hard 
135 water, scratching, exposure, etc.) should be avoided. 
If the eczema is acute and widespread put the pa- 
tient to bed where the rest and equable temperature 
is of value. The affected part should not be washed 
in hard water or with soap, but rain water or dis- 
tilled water may be used. Or prohibit washing 
altogether and dab the parts with a solution of ha- 
mamelis. 
Prevent venous engorgement by attending to the 
position of the affected part. Diet should be light 
and non-irritating; alcohol should be avoided. The 
bowels should be attended to with sulphate of mag- 
nesia, and in gouty cases and dyspeptics give: 
I). Potass, bicarb 3iii 
Sodii bicarb 5iii 
Sp. ammon. aromat 3iv 
Tinct. rhei 3ii 
Inf. calumbse q. s. ad §vi 
M. Sig. A tablespoonful in water three times daily, 
a quarter of an hour before food. 
In the chronic forms of eczema, general and nervine 
tonics (cod-liver oil, arsenic, nux vomica, etc.) are of 
service. 
If crusts or scabs are present, they must be removed 
by soaking in oil, boracic-starch poultices, the con- 
tinuous water bath, etc. 
Local treatment. Sedative applications are espe- 
cially useful in acute eczema, while astringent and stim- 
ulating applications are best in the subacute and chronic 
forms of the disease; but in many cases a combination 
of astringents with other applications such as tar prep- 
arations, is useful. 
Thus in acute cases tinct. of hamamelis, the ordinary 
lead lotion, and weak alkaline lotions such as biborate 
of soda and bicarbonate of soda (20 grs. to the ounce) 
are of great value. 
For moist eczema it is best to use lotions and for dry 
136 eczema to use ointments. The following ointment is 
very satisfactory: 
I|. Acidi borici 3ii 
Zinci oxidi 5ii 
Acidi salicylici oss 
Lanolini o i 
Vaselini .....ad §iii 
M. Sig. To be applied twice a day. 
In the chronic and dry forms of the disease, weak tar 
preparations; and for the pustular forms of eczema 
and eczema of the scalp, mercurial preparations are 
very valuable: 
I|. Acidi salicylici 5i 
Ungt. picis liquids §i 
Petrolati q. s. ad 5iv 
M. Sig. Apply freely, and with forceps carefully 
remove all softened crusts once daily. 
Or: 
I). Hydrargyri ammoniat grs. xx 
Ungt. zinci oxidi 3i 
M. Sig. Use once a day. 
EGYPTIAN CHLOROSIS. (See Ankylostomiasis.) 
ELECTRIC SHOCK. 
In accidents where there is only momentary con- 
tact with currents of high pressure, perform arti- 
ficial respiration. Also apply it if heart happens not 
to be in the direct conducting path of the current. 
But if the heart has ceased to beat, artificial respi- 
ration is of no value. See also Lightning Shock. 
ELEPHANTIASIS GRAECORUM. (See Leprosy.) 
ELEPHANTOID DISEASES. ( CHYLURIA, VARICOSE- 
GROIN-GLANDS, LYMPH SCROTUM, CHYLOCELE, 
LYMPHORRHAGIA, ORCHITIS, ENDEMIC LYMPHAN- 
GITIS and ELEPHANTIASIS ARABUM. (See Filariasis.) 
EMISSIONS. (See Seminal Emissions.) 
137 EMPHYSEMA OF THE LUNGS. 
Prophyaxis. Avoid the causes of bronchitis so 
as to prevent frequent recurrences of this condition 
which is the chief cause of emphysema. Plenty of 
fresh air, proper exercise and diet as well as residence 
in a temperate and equable climate are to be recom- 
mended. Playing on wind instruments and occu- 
pations where impure air is breathed are harmful. 
Over-eating and abdominal distention must be care- 
fully guarded against. 
Treatment. When symptoms of cardiac failure are 
present strychnine (3J0 to 4*5 gr.) may be given 
combined with digitalis: 
1$. Strychnin, sulphat gr. ss 
Pulv. digital. 
Pulv. scillae. 
Ferri reducti aa gr. xx 
M. ft. pil. No. xx. 
Sig. One three times a day. 
The inspiration of compressed air, followed by ex- 
piration into rarified air is often of considerable value 
the compressed air thoroughly aerating the blood and 
the rarified air withdrawing the residual air from the 
lungs. 
When marked cyanosis and dyspnoea are present 
bleeding and the withdrawal of ten to twenty ounces 
of blood may be necessary. See Bleeding, Practical 
Directions for. 
Dyspnoea may sometimes be relieved by drugs such 
as apomorphine hydrochloride (gr. /g) which increases 
the secretion of bronchial mucus. 
The following mixture which combines an expecto- 
rant, two antispasmodics and potassium iodide will be 
, found useful in many cases of emphysema: 
1$. Potass, iodid 5ii 
Tinct. belladonn 3iii 
Spt. aether. co §i 
Syrup, pruni Virginian 3i 
Aq. destillat q. s. ad 3iv 
138 M. Sig. One teaspoonful every four hours. 
For the relief of pain mild poultices of mustard or 
linseed, or a liniment consisting of equal parts of men- 
thol, hydrated chloral and camphor well rubbed to- 
gether will be found useful. 
Tfc. Menthol. 
Chloral hydrat. 
Camphorse. 
01. cajuput aa 5i 
Lin. saponis q. s. ad oiv 
M. Sig. Use twice a day. 
EMPYEMA. 
This is a surgical disease. Time should not be 
lost in trying measures to absorb pus. The diag- 
nosis is made positive by aspiration. The pus should 
be evacuated in the mid-axillary line at the lowest 
possible point which is usually the seventh rib. Re- 
sect two inches of one rib in the following manner: 
Cut through the skin and superficial fascia until a 
rib is exposed. Incise the periosteum longitudinally, 
take a blunt dissector and loosen the bone from the 
periosteum all the way around. With a bone forceps 
cut out two inches of the rib. Incise through the 
periosteum with a sharp knife, allow the pus to 
escape and insert a double drainage tube pinned to 
the skin with a safety pin. Do not wash out the 
cavity. Change- the outer dressings daily. In a 
few days the temperature comes down, the patient's 
appetite returns, and he begins to pick up strength. 
Tonics should now be given as: 
I|. Elix. ferri quin, et strych oiv 
Sig. One teaspoonful in water four times a day. 
The patient should be put on forced feeding. Give 
plenty of eggs, milk, broth, egg-nogs, etc. 
Occasionally the pus works its way into the lungs 
and ruptures into a bronchus, and is expectorated. In 
these cases it is not necessary to do a resection of the ribs. 
139 ENDOCARDITIS, ACUTE. 
Prophylaxis. Patient should avoid exposure and 
wear proper clothing, for rheumatism is the most 
frequent cause. 
Treatment. Absolute rest in bed, prolonged if 
necessary, for several months, in order to give the 
inflamed organ as much rest as possible. If the 
action of the heart is too rapid apply a Leiter coil or 
ice-bag on the chest, over the heart. When there 
are signs of heart-weakness give strychnine in doses 
of go to gr. three times a day. Combat 
heart failure with alcohol, ammonia and caffein. Pro- 
longed use of potassium iodide in doses of 10 grs. 
three times a day is of benefit as a resolvent of the 
connective tissue changes in the valves. 
The diet should be nourishing and frequent, small 
meals are preferable to a few hearty ones. The 
dietary should be such as not to cause tympanitic 
distention of the stomach and intestines, for this 
would cause an interference with the action of the 
heart. 
When the endocarditis is secondary to acute rheu- 
matism, give the salicylates to the fullest extent: 
1$. Sodii salicylat 5iv 
Vini colchic semin 5iv 
Aq. menth. pip §i 
Ess. pepsinq. s. ad giii 
M. Sig. One teaspoonful every three hours in hot 
water. 
If associated with chorea, give arsenic in the form of 
Fowler's solution in gradually increasing doses. See 
Chorea. 
If the chorea and endocarditis are due to rheumatism 
give the salicylates instead of the arsenic. 
ENDOCARDITIS, CHRONIC. (CHRONIC VALVULAR 
DISEASE OF THE HEART.) 
This includes the treatment for the following con- 
ditions: 1. Aortic incompetency. 2. Aortic sten- 
140 osis. 3. Mitral incompetency. 4. Mitral stenosis 
5. Tricuspid valve disease. 6. Pulmonary valve disease. 
7. Combined valvular lesions. 8. Hypertrophy and 
dilatation. 
The treatment is best considered under: 1. The 
stage of compensation. 2. The stage of broken 
compensation. 3. The treatment of special symp- 
toms. 
Stage of compensation. The patient during this 
stage does not require any treatment specially di- 
rected towards the heart. It is best not to inform 
the patient that he has "heart disease," because it 
may alarm him and make him much worse, especially 
if he is already very nervous. If the patient is 
performing hard manual labor, or is leading a "stren- 
uous life," he should be warned not .to overwork, 
worry or indulge in excesses. 
The diet may not need any restriction, but over- 
eating or attacks of flatulency are dangerous. The 
following should be avoided: alcohol, tobacco, hot 
baths, excessive venery, especially in aortic insuffi- 
ciency, and suddenly changing to altitudes above 
2,000 feet. 
Any exertion or excitement that causes palpitation, 
dyspnoea, or precordial pain must be avoided. 
Stage of broken compensation. Loss of compen- 
sation may be sudden or more usually gradual. 
Sudden loss of compensation is usually immediately 
fatal from acute dilatation. Gradual loss of com- 
pensation is usually indicated by attacks of nocturnal 
dyspnoea, cyanosis, dropsy, angina, anaemia, palpi- 
tation, arrhythmia or tachycardia. 
Treatment should be started with rest in bed, 
both mental and physical, for at least ten or twelve 
days. A saline purgative such as Epsom or Rochelle 
salts in half ounce doses in half a glass of water, should 
be given. Or give: 
I|. Pulv. jalap co gii 
Sig. Half a teaspoonful in water twice a day. 
141 The embarrassed circulation in cases of dilatation 
with cyanosis is best relieved by withdrawing from 20 
to 30 ounces of blood. 
Cardiac tonics such as digitalis, strophanthus, strych- 
nine, and occasionally alcohol should be given. Digi- 
talis should be given in every case of failing compen- 
sation in large doses. Begin with the tincture in the 
dose of 15 to 20 drops, four times a day, and continue 
its use for about three or four days or until it produces 
a tendency to nausea or vomiting, or until it slows the 
pulse to 65 or 70. 
In cardiac dropsy digitalis is the best drug. The 
infusion should be given in tablespoonful doses three or 
four times a day. 
Strophanthus in doses of from five to eight minims 
of the tincture acts the same as digitalis. It may 
steady an intermittent heart better than digitalis. 
Iron and strychnine are also indicated in valvular 
lesions, the former for anemia, the latter for toning the 
heart muscle. For the anemia give: 
I). Basham's mixture oviii 
Sig. One tablespoonful three times a day. 
Strychnine may be given in /g gr. doses at any time. 
Caffeine citrate in doses of three grains is indicated 
when diuresis is desired. 
Treatment of special symptoms. 
Dyspnoea is treated by cupping the chest and in- 
creasing the digitalis. Nocturnal dyspnoea is best re- 
lieved by gr. doses of morphine, which is an excellent 
cardiac tonic. If the dyspnoea is due to hydrothorax, 
remove the fluid by tapping. 
Dropsy is usually relieved by digitalis and hydragogue 
purgatives. The quantity of fluid taken into the body 
hould be restricted. Do not puncture the cedematous 
limbs, because erysipelas frequently follows. If, how- 
ever, it is done the strictest antiseptic precautions should 
be taken. 
Palpitation and cardiac distress are best relieved by 
142 potassium iodide in ten grain doses three times a day 
and nitroglycerin (T£o gr.) three times a day. If 
the arterial tension is high especially in cases of aortic 
insufficiency, give tincture of aconite in two to three 
minim doses every three hours. An ice-bag should be 
placed over the precordium. If the palpitation is due 
to flatulence give the following: 
TJ. Spts. ammon. aromat 3iv 
Tinct. nuc. vomic 3ii 
Sod. bicarb 3i 
Potass, bicarb 3 i 
Aq. menth. pipq. s. ad §iii 
M. Sig. One teaspoonful three or four times a day 
if necessary. 
Insomnia may be relieved with trional in 15 gr. doses 
at bedtime or may be combined with half a grain of 
codeine, as: 
I|. Trionalgrs. xlv 
Codein. sulphat gr. iss 
M. et ft. chart. No. iii. 
Sig. One at bedtime with water. 
If the ordinary remedies for insomnia fail, give mor- 
phine sulphate (% gr.) with atropine sulphate (TJ0 
gr.) at bedtime. 
Cough and haemoptysis. Cough is almost always 
present in cardiac insufficiency due to engorgement of 
the pulmonary vessels. Treat the heart rather than 
give remedies specially directed against the cough. 
Haemoptysis requires no special treatment; it usually 
makes the patient feel easier. 
Diminished urine. Sometimes the amount of urine 
falls to 5 or 6 ounces a day. Calomel in 3 grain doses 
every six hours for three days acts well in many cases. 
Digitalis and strophanthus usually increase the flow, 
but it may be necessary to use diuretin in 15 gr. doses 
three times a day with hydragogue cathartics or rectal 
injections of hot salt solution (one teaspoonful of 
salt to a pint of water). 
143 The diet in chronic valvular disease is of importance. 
Egg albumen, milk and beef juice may be given every 
three hours. Restrict the amount of liquids. When 
the patient is better give scraped meat, fish, fowl and 
eggs. Stimulants such as whisky or brandy may 
occasionally be given. 
ENDOCARDITIS, MALIGNANT or ACUTE ULCERA- 
TIVE. 
Treatment is of very little avail. Only a few cases 
recover. All that can be done is to sustain the 
patient's strength with carbonate of ammonia, strych- 
nine, brandy or digitalis. Apply ice-bag over heart. 
Do not keep the ice-bag against the skin but inter- 
pose a dry light cloth. If the heart and circulation 
begin to fail, remove the ice-bag and apply hot 
fomentations over the heart. 
Antistreptococcus serum is of doubtful benefit, 
but may be tried in doses of 10 c.c. repeated once 
or twice. 
ENDOMETRITIS, ACUTE CATARRHAL. 
The treatment depends upon the cause, which may 
be any form of irritation in the uterine mucous 
membrane, for example, the too frequent occurrence 
of pregnancy, especially when one after another ends 
in abortion; polypi and intrauterine fibroids; ex- 
posure to wet and cold; gonorrhoea; excessive sexual 
excitement; diseases of the blood; syphilis, eruptive 
fevers, typhus, typhoid, cholera, dysentery, etc. 
Complete rest in bed must be insisted on, and the 
patient placed on a fish and milk diet. 
Treatment is best started by regulating the bowels. 
I). Hydrarg. chlor, mit grs. ii 
Pulv. rheigrs. xx 
Jalap, resin grs. ii 
Pulv. zingiber grs. iv 
M. et ft. caps. No. i. 
Sig. One at bedtime. 
144 Where there is no hemorrhage a hot sitz bath should 
be ordered night and morning, followed by a hot boric 
acid douche. 
Or: 
I|. Acid, tannic 3ii 
Pulv. alum gi 
Acid, boric oii 
M. Sig. One tablespoonful in two quarts of hot 
water twice a day. 
Internally some preparation of Viburnum should be 
administered. 
I). Tinct. viburn. opul. comp. (N. F.).... giv 
Sig. One teaspoonful in hot water every three hours. 
If much pain is present give: 
1$. Tinct. opii 5*v 
Elix. viburn. opul. comp. (N. F.) 
q. s. ad giii 
M. Sig. One teaspoonful in hot water every three 
hours. 
ENDOMETRITIS, CHRONIC. 
Childbirth, abortion, and gonorrhoea are the most 
frequent causes of this disease. 
The treatment is constitutional and local. Too 
much stress has been laid on the local treatment and 
too little on the general care of the patient's health. 
Plenty of good, nourishing food, sunshine and fresh 
air with moderate exercise should be supplied. If 
the chronicity of the disease has affected the stomach 
and bowels they should be carefully treated. 
Tonics should be given for long periods of time, 
such as iron, arsenic, mercury, and cod liver oil. 
If due to gout or rheumatism these conditions 
must be treated. 
3- Elix. ferri, quin, et strych giv 
Sig. One teaspoonful in water after each meal. 
Or: 
145 T|. Syr. ferri iodid $iii 
Sig. One-half teaspoonful in water after each meal 
through a glass tube. 
Or: 
I}. Mass. ferr. carbon 5ii 
Ext. gentian grs. vi 
Ac. arseniosi gr 
Mangan, dioxidgrs. xviii 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
Local treatment. The vaginal douche is one of the 
most important of local methods. Two or more quarts 
of hot water should be used once or twice a day, with 
the patient in a semi-recumbent position, with the hips 
on a douche pan. If the disease is due to sepsis or 
gonorrhoea, antiseptics and astringents may be added 
to the water, e. g., corrosive sublimate (1 to 4000), or 
sulphate of zinc (1 5 to 1 pint). 
Or: 
I}. Acid, tannic §ii 
Acid, boric oi 
Pulv. alum oi 
M. Sig. One tablespoonful in two quarts of hot 
water once or twice a day. 
Vaginal tampons may also be used. Glycerine is 
considered the best menstruum, to which can be added 
ichthyol (10 per cent), or boric acid (30 per cent). 
Intrauterine applications can be made with cotton 
wrapped around a forceps and dipped into Churchill's 
solution: 
I). lodingrs. Ixxv 
Potass, iodid grs. xc 
Spts. vin. rect oi 
M. Sig. Swab uterus twice a week. 
Or: 
]$. lodin;grs xl 
Phenol. o i 
M. Sig. Use with applicator in uterus once a week. 
Curettage ought to be done before beginning local 
treatments. 
146 ENEMA, NUTRITIVE (See Feeding, Rectal). 
ENTERIC FEVER (See Typhoid Fever). 
ENTERITIS, ACUTE. 
Rest and diet are absolute necessities in the 
treatment. In mild cases all food ought to be 
withheld for 24 to 36 hours if the patient is in a 
good state of nutrition. The patient must re- 
main in bed, especially if fever is present. The 
diet should be of the very lightest, e. g., rice 
water, barley water, arrowroot water, or oatmeal 
water. Boiled water and a little tea may be given. 
Ice water and all waters containing carbonic acid 
should be avoided. 
If the disease is due to improper diet or to 
decayed food, it is necessary to first give a good 
dose of castor oil or some other purgative. The 
following is a good formula for an emulsion of 
castor oil: 
I|. 01. ricini gi 
Pulv. acaci® 3iii 
01. menth. pip gtts. iii 
Aquae destillat q. s. ad §iv 
M. Sig. One tablespoonful to a dose. 
It is frequently beneficial to clean out the colon 
with a large enema containing one dram of ich- 
thyol to the quart of warm water. 
If the diarrhoea still continues with consider- 
able pain after the intestine is empty, it becomes 
necessary to use some preparation of opium. It 
may be given as follows: 
I). Bismuth, subnitr 3iv 
Tinct. opii 5iv 
Tinct. gambir, comp 3ii 
Tinct. cardamom 3iii 
Pulv. acaci® 3i 
Aquae cinnamon q. s. ad §iii 
M. Sig. One teaspoonful every three hours. 
Or: 
147 I}. Puh opii grs. xviii 
Plumbi acetat grs. xxiv 
Pulv. camphor grs. xii 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
If severe vomiting should be present a half ounce 
of champagne given occasionally relieves the vom- 
iting as if by magic. 
If the tenesmus is severe a suppository should 
be inserted into the rectum. 
Pulv. opii grs. xii 
Ext. belladonn gr. iss 
Plumbi acetat grs. xxiv 
01. theobrom 3vss 
M. et ft. suppos. No. xii. 
Sig. Insert one in rectum two or three times a 
day. 
Locally a large linseed poultice over the whole 
abdomen often helps to ease the pain. 
When the symptoms have disappeared the diet 
should be very carefully regulated. Starchy foods 
are injurious, such as bread, potatoes, rye bread, 
cabbage, etc. Bland meat food is more easily taken 
care of, as chicken broth, chicken jelly, young pigeon, 
broiled trout, boiled or broiled sweetbreads, etc. 
ENTERITIS, CHRONIC. 
The longer this disease lasts the more difficult it is 
to cure. We must have the hearty cooperation of 
the patient, especially in the matter of diet, and in 
unnecessary exposure to colds. 
If the disease is due to alcohol forbid its use. 
If due to inflammation in the colon it is necessary 
to use high irrigations with warm water to which 
may be added five grams of boric acid to the quart, 
or two grams of tannin to the same amount of 
water. 
148 If it is desirable to cleanse the intestinal tract 
from above down give a tablespoonful of castor oil. 
Calomel in grain doses every two hours will also 
accomplish the work well. 
Do not allow the patient to drink very hot or very 
cold drinks. The diet must be very carefully 
chosen, it should be semi-solid or liquid. If con- 
stipation is present give apple sauce, stewed apricots 
or stewed prunes, buttermilk and kumiss. Soups of 
barley, rice, sago or farina agree if well cooked. 
Eggs, peas, spinach, toast, weak tea, acorn chocolate 
and milk diluted with lime water and claret is 
allowable. 
All foods containing fats should be avoided, e. g., 
fatty soups, gravy, fried eggs, fried fish, cheese, 
lobsters, wine, lemonade, alcoholic liquors, fresh 
bread, black bread, pancakes, sausages, pastry, 
strawberries, dumplings, etc. 
The drug treatment consists of antiseptics and 
astringents. The following prescriptions will be 
found useful: 
I). Salol 5i 
Guiacol carb 5ss 
Zinc, sulphocarbol 5ss 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
Or: 
]$. Tannigen 5i 
Bismuth, subgall 3i 
Pulv. opiigrs. xii 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
Or: 
]$. Betanaphtol. bismuth 3i 
Bismuth, salicylat 3i 
Plumbi acetatgrs. xxiv 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
149 If there is a deficiency of hydrochloric acid in the 
stomach, the following may be given: 
1$. Acid, hydrochlor, dil 3iv 
Pepsini C. P 5i 
Resorcin 5i 
Aquae §iss 
Syr. aurant. cort q. s. ad. 3 iii 
M. Sig. One teaspoonful in wineglassful of water 
after each meal. 
ENTEROCOLITIS (See Ileo-Colitis). 
ENTEROPTOSIS (GLENARD'S DISEASE, DOWNWARD 
DISPLACEMENT OF THE VISCERA). 
The patient should not wear tight corsets nor 
tight waistbands with heavy skirts. The skirts should 
be suspended from the shoulders rather than from 
the hips. Only those belts or abdominal supporters 
should be used which encircle the abdomen and ex- 
ercise the same degree of pressure over the whole 
abdominal surface. These belts will increase the 
intra-abdominal pressure, elevate the intestines and 
keep them in their new position. The patient should 
be taught how to replace the viscera. The patient 
should then do this every morning in bed and apply 
the belt before the erect posture is assumed. The 
strength of the abdominal muscles should be increased 
by regulated exercise. The bowels should be regu- 
lated, the food should be nutritious and every 
measure possible should be taken to raise the tone 
of the whole muscular system. Many small meals are 
better than a few heavy ones, since the overloaded 
stomach might increase the ptosis. 
Surgical treatment should be undertaken only after 
other methods have failed and then always with the 
greatest caution. These consist in taking reefs in 
the lengthened mesenteries, lifting the stomach and 
fixing the serosa of the lesser curvature of the stom- 
ach to the anterior wall of the abdomen, and, where 
150 there is separation of the recti muscles, suturing the 
edges of these muscles together. 
ENTROPION. (Turning in of the eyelids.) 
Treat the cause such as diminution of size of the 
eyeball, spasm of the orbicularis, bandaging the 
eye, enucleation, etc. 
In mild cases cuie may follow the pulling out of 
the intruding eyelashes and the application of sev- 
eral coats of collodion to the skin of the inturning 
lid. Adhesive strips answer the same purpose. If 
simple remedies fail, a piece of the eyelid must be 
excised, and the two opposing surfaces brought 
together. 
ENURESIS IN CHILDREN. 
Successful treatment depends on discovering the 
cause. Every organ and reflex must be carefully 
studied. The feces and urine must be frequently 
examined. Look for phimosis, pin worms, enlarged 
tonsils, adenoids and stone in the bladder. Proper 
diet, hygiene, habit and training are the elements 
of success in treatment. 
Diet. Children should be fed on easily digested 
food. Avoid overfeeding especially before bedtime. 
Alcoholic drinks and all liquids should be withheld 
before retiring. Many children have chronic in- 
testinal indigestion and should be treated for such. 
A plain enema before retiring is of service. 
Hygiene. Mental and physical exertion should 
be avoided. Children should be taught regular habits 
as to diet, exercise and sleep, also as to the evacu- 
ation of the bowels and bladder. The urine should 
be held as long as possible in the daytime. At night 
the child should be awaked at a certain time to uri- 
nate. The cold spinal douche is of benefit in some 
cases. Children should have a hard bed and moderate 
covering. Elevation of the foot of the bed and other 
measures to prevent the child from lying on the back 
should be insisted on. 
151 Medicinal treatment. If the enuresis is due to 
highly acid or irritating urine give the following: 
I). Potass, acetat 3ii 
Potass, citrat 3ii 
Fluidextr. buchu 5ii 
Fluidextr. tritici q. s. ad Biii 
M. Sig. A teaspoonful in hot water three times a 
day. 
For weakness of the sphincters give such drugs as 
strychnine, quinine and ergot, or iron and arsenic when 
necessary as a tonic. Atropin should be pushed for 
weeks and months; when cure results the dose may 
be gradually lessened. For a child five years old give: 
1$. sulphat gr. 
Aquae q. s. ad 3i 
M. Sig. Five to ten drops every four hours and 
gradually increase. 
When due to masturbation tincture gelsemium in 
physiological doses may be given along with sodium 
bromide. For a child ten years old, give: 
I). Tinct. gelsemii gtts. xxx 
Sodii bromidi 3iii 
Tinct. belladonn gtts. Ixiv 
Aquae : Biss 
Syr. aurant. cortic q. s. ad Biii 
M. Sig. One teaspoonful three times a day. 
When due to weak innervation of the bladder give 
strychnine and ergot for a long period of time. For 
a child five years old prescribe: 
1$. Strych. sulphat. gr. 
Fluidextr. ergot 3ii 
Aquae 3 ii 
Syr. rub. idae q. s. ad oiii 
M. Sig. One teaspoonful in water three times a day. 
EPIDIDYMITIS and ORCHITIS. 
Rest in bed should be insisted upon. The testicle 
must be elevated either by placing a pillow under it 
152 or by pulling it up with rubber adhesive plaster. 
Locally use ice in the beginning to try to abort the 
attack. If inflammation progresses, resort to hot 
linseed poultices for the relief of pain. We may also 
use for the same purpose: 
I). Lot io plumbi et opii gviii 
Sig. Apply hot to testicle with gauze. 
When the inflammation begins to subside use the 
following: 
I|. Ungt. hydrarg. 
Ungt. belladonn aa 3vi 
M. Sig. Apply twice a day. 
Strapping the testicle is also a very useful measure. 
It is done in the following way: Shave the scrotum 
and push the testicle down as far as possible in the sac, 
and place a strip of adhesive plaster above it to prevent 
the testicle from slipping upward. Now apply cir- 
cular and longitudinal strips of plaster. This reduces 
the swelling. A snugly fitting suspensory is of good 
service. 
Internally give a few doses of calomel followed by 
a saline. Place the patient on a milk diet. For the 
fever and pain give: 
I). Antipyrini 3iss 
Tinct. aconit gtts. xvi 
Codein. phosphat gr. iiss 
Aq. menth. pip . q. s. ad 5ii 
M. Sig. One teaspoonful every two hours if neces- 
sary for the pain. 
If the disease is secondary to mumps the same treat- 
ment should be employed. 
EPILEPSY. 
A symptom of many pathological states. Treat 
any possible cause of irritation, e. g., brain tumor, 
gumma, decayed teeth, worms, uterine trouble, ade- 
noid growths, phimosis, stricture, fissure; astig- 
matism or other error of refraction. 
153 Maintain the general health with good food, fresh 
air and tonics, friction, cold baths, and exercise. 
Diet should be almost vegetarian. Meats are inju- 
rious, but moderate use of game, poultry, fish and 
oysters is advisable. Fresh vegetables, fruit, milk 
and bread ought to be the chief part of an epileptic's 
dietary. All stimulants should be prohibited ex- 
cept perhaps mild coffee. 
Abortion of attack. If aura begins in an extremity, 
an encircling blister or ligature about the arm often 
stops its progress. Also the inhalation of ammonia, 
or of nitrite of amyl, or swallowing a tablet of nitro- 
glycerin (/0 gr.) 
Margarit. amyl, nitrit gtts. v No. x. 
Sig. Crush a pearl in handkerchief, lie down, and 
inhale, when threatened with an attack. 
Treatment of status epilepticus. Inhalations of chloro- 
form, ether, or amyl nitrite. Hypodermic injections 
of hyoscin gr.), hyoscyamine (/c gr.), picro- 
toxin (6'(J gr.), or morphine (J4gr-) Enemas of chloral 
(20 to 30 grs.), and the hot bath. 
Internal remedies. The most reliable are the bro- 
mides, especially those of sodium, ammonium and po- 
tassium. One to two drachms of sodium bromide may 
be given daily in divided doses, the largest one just 
before the expected attack. 
Or give: 
I). Potass, bromid. 
Ammon, bromid aa 3iii 
Liquor potass, arsenit 3i 
Antipyrin 3i 
Aquae menth. pip q. s. ad §vi 
Sig. A. tablespoonful in water night and morning. 
When the stomach is weak lithium bromide is pref- 
erable. 
1$. Lithii bromid 3i 
Aquae 3 iss 
Syr. aurant. cort.. q. s. ad §iii 
154 M. Sig. One teaspoonful three times a day in water. 
Treatment with 20 grs. of bromides should be kept 
up for one year, then reduced to 10 grs. for another 
year, and reduced still further to 5 grs. for the third 
year. 
EPILEPSY, JACKSONIAN. 
Look for cause and if possible remove it, e. g., 
meningitis, brain tumor, traumatism, syphilis, etc. 
In all cases of doubt as to whether syphilis is the 
cause give iodide of potassium, e. g., for a boy of ten 
years: 
I|. Potass, iodid 3iv 
Aquae q. s. ad 3 m 
M. Sig. One teaspoonful three times a day. Mer- 
cury should also be given. Thus for a child four years 
old give: 
1$. Hydrarg. cum creta grs. xxiv 
Sacchar. albi grs. xlviii 
M. et ft. chart, xxiv. 
Sig. One three times a day. 
EPISTAXIS. (NOSE, BLEEDING AT.) 
Do not check unnecessarily vicarious bleedings 
of menstruation, of plethora, or of the crises of 
certain fevers. 
The patient should have absolute rest, and the 
head should be kept erect, not forwards and down- 
wards as is commonly done. If the bleeding comes 
from the anterior part of the nasal cavity, pressure of 
the alse against the nasal septum will often stop 
the bleeding. The application of cold to the nose 
or the insufflation of cold water is also effective. 
Dry the place where the bleeding is taking place 
with absorbent cotton and apply nitrate of silver, 
chromic acid or the galvano-cautery. Astringents 
like alum or tannin are also useful. 
When these simple means fail, pack part of the 
nasal cavity where the bleeding is. Introduce a 
155 narrow strip of surgical gauze and pack it against 
the bleeding part. The gauze may be soaked in 
adrenalin solution 1 to 1000. 
The following solution is frequently followed by 
prompt cessation of the hemorrhage: 
1$. Antipyrin grs. xx 
Aquae o i 
M. Sig. Inject into nose lukewarm with nasal 
syringe. 
If there is a hemorrhagic tendency, calcium chloride 
should be given internally: 
IJ. Calcii chloridi 3iii 
Fluidextract, ergotae 3ii 
Aquae 5 i 
Syr. limonis. q. s. ad §ii 
M. Sig. One teaspoonful every two hours. 
Feeding the patient on gelatin is also useful. The 
ordinary flavored gelatins on the market answer the 
purpose well, especially in the case of children. 
ERYSIPELAS. 
Prophylaxis. The patient should be isolated in 
a room free from draperies. All wounds and scratches 
on the attendants should be antiseptically dressed 
when waiting on a patient who has erysipelas. Dur- 
ing epidemics of erysipelas all -wounds should receive 
special attention because of the danger of infection. 
An erysipelatous patient should never be admitted 
to a general hospital where operations are performed 
unless it contains a special isolation building. No 
physician should go from a case of erysipelas to an 
obstetrical case. One attack does not confer im- 
munity from a second attack but predisposes to it. 
The local treatment consists in applications to 
relieve pain and tension: 
J$. Lolio plumbi et opii 5viii 
Sig. Apply on gauze and soak with the above fre' 
quently. 
156 Solution of carbolic acid (1 in 40) is also of service. 
Ichthyol is one of the most useful local applications 
(10 to 20 per cent): 
1$. Resorcin 5i 
Ichthyol 3i 
Ungt. hydrarg .. 3iv 
Lanolin 5iv 
M. Sig. Anoint the affected parts with this and cover 
with oiled silk. Then envelop in a light dressing and 
bandage. 
The general treatment is symptomatic. The fever 
is best reduced by cold sponging and cold applications. 
The salicylates and phenacetin are of benefit in re- 
lieving pain and headache: 
1$. Phenacetin 3iss 
Salol 3iss 
Quin, sulphat grs. xviii 
M. et ft. caps. No. xviii. 
Sig. One every three hours. 
Tincture of the chloride of iron in 15 to 30 minim 
doses has been given for many years but it is of doubt- 
ful benefit. 
Erysipelas is a self-limiting disease. 
ERYTHEMA INTERIGO (See Chafing). 
ERYTHEMA, SIMPLEX, NODOSUM and MULTIFORME. 
There is little difference between the causes and 
treatment of the above forms. They are associated 
with either intestinal or rheumatic disturbances. 
If due to absorption of deleterious intestinal prod- 
ucts give intestinal antiseptics as salol, guiacol, 
zinc sulphocarbolate and laxatives: 
I). Hydrarg. chlor, mit grs. iii 
Sacchar. lactis grs. xviii 
Saloli 3iss 
Zinci sulphocarbolat 3i 
157 M. et ft. caps. No. xviii. 
Sig. One every three hours. 
The diet should also be regulated, especially in chil- 
dren. 
If the erythema is due to rheumatism give anti- 
rheumatics as sodium salicylate, wine of colchicumroot, 
aspirin, etc.: 
1$. Aspirini 3iss 
Salicini 3iss 
M. et ft. caps. No. xviii. 
Sig. One every four hours with hot water. 
The local treatment is directed against the redness 
and burning of the skin. Dusting with flour or the 
application of a lotion should be employed when pro- 
ductive of a sense of comfort to the patient: 
I). Acidi borici 3ss 
Acidi carbolici gtts. x 
Glycerini 5ii 
Aq. rosae q. s. ad §iv 
M. Sig. Apply three or four times a day. 
The following dusting powder may also be used: 
I}. Pulv. amyli. 
Pulv. zinci oxidi aa 3iv 
Pulv. camphor 3i 
M. Sig. Use three times a day. 
EYE, ARTIFICIAL. 
An artificial eye may be fitted as soon as the wound 
left after enucleation is entirely healed, usually in 
the second or third week. To put the eye in: Place 
the left hand flat upon the forehead, and with the 
two middle fingers raise the upper lid toward the 
eyebrow; then, with the right hand push the upper 
edge of the artificial eye beneath the upper lid, 
which may be allowed to drop upon the eye. The 
eye must then be supported with the middle fingers 
of the left hand while the lower eyelid is raised over 
its lower edge with the right hand. To take the eye 
out: The lower lid must be drawn downward with 
158 the middle finger of the left hand; and then, with 
the right hand, the end of a small pin must be put 
beneath the lower edge of the artificial eye, which 
must be raised gently forward over the lower lid 
when it will readily drop out. The artificial eye 
must be removed every night and carefully cleaned. 
EYE FATIGUE. 
General hygienic measures may be necessary. 
Treat digestive troubles and regulate the bowels 
Attend carefully to any accompanying irritation of 
the conjunctiva. In some cases it may be necessary 
to use pupil dilatants (mydriatics) such as atropin, 
cocaine or hyoscyamin, to assure complete physio- 
logical rest of the mechanism of accommodation. In 
other cases it may be necessary to stimulate mildly 
the accommodation by the use of pupil contractors 
(miotics) especially of pilocarpin in a weak solution. 
Strychnine is of special value to students during the 
strain of eyework in preparation for examinations. 
EYE, FOREIGN BODIES IN. 
Foreign bodies rarely attach themselves to the 
conjunctiva of the bulb or to that of the lower lid. 
They usually rest on the tarsal conjunctiva of the 
upper lid or on the cornea. 
Instil a few drops of a 2% solution of cocaine 
into the eye. Grasp the upper eyelid, asking the 
patient to look downwards, then with a lead pencil 
laid in the tarsal fold, grasp the lid by the eyelashes 
and turn the lid over. Then look for the foreign 
body, and if found, remove with a sharpened match 
stick or toothpick which has a little moist absorbent 
cotton wrapped round the sharp end. 
If the foreign body is a caustic, use dilute vinegar 
for an alkali and a solution of bicarbonate of soda 
for an acid. Application of castor oil soothes the 
raw surface. 
If the foreign body is lodged on the cornea, remove 
159 it with a sharp pointed needle or special remover. 
While doing this stand behind the patient who sits 
on a chair in front resting the head against the oper- 
ator. Fix the cornea by placing one finger firmly 
on the lower lid and the other on the upper lid. If 
the foreign body is difficult to see, have an assistant 
hold a magnifying glass over the cornea. 
After the foreign substance is removed prescribe 
the following eyewash: 
T£. Sodii biboratgrs. xii 
Aq. campho rat 5ii 
Sat. sol. ac. boricq. s. ad §ii 
M. Sig. Ten to twenty drops in eye every two hours. 
When the foreign body penetrates the eyeball, the 
general practitioner should put on a wet antiseptic 
dressing and take the patient to a specialist, because 
great judgment is necessary to decide whether an iri- 
dectomy or complete enucleation is indicated. Per- 
nicious tampering may cause the patient to lose the 
sight of the other eye through sympathetic inflammation. 
EYESIGHT, IMPAIRMENT OF, IN SCHOOL CHILDREN. 
Prophylaxis. The printing in school books should 
be of the most legible character. The lines should 
be amply spaced or leaded. The paper should be 
white with a dull unreflecting surface. Blackboards 
should be kept clean and black. Slates are not so 
good as paper, for they become greasy, their writing 
is more illegible than that of paper, and they are 
more insanitary. While writing, the pupil should 
not assume bad postures but should sit erect and the 
book should not come nearer to the eyes than twelve 
inches. Children who are found by the teacher to 
be short-sighted should be properly seated with re- 
spect to the light, and the defect of the eyesight 
should be reported to the parents so that the proper 
glasses may be bought. 
160 FAINTING. (COLLAPSE, SYNCOPE.) 
Patient should be placed in a horizontal position 
with the head low. Give fresh air and sprinkle cold 
water over the face and chest. Sal volatile may be 
applied to the nose, and mustard or the electric brush 
over the cardiac region. 
Internally, give cardiac stimulants such as nux 
vomica, digitalis, coffee, ether, or alcohol, either in 
the form of champagne or brandy. 
Where fainting is repeated at short intervals, give: 
I). Strych. sulph gr. | 
Tinct. digital 3ii 
Tinct. strophanthgtt. xxx 
Elix. simplq. s. ad §iii 
M. Sig. One teaspoonful every three hours. 
FARCY (See Glanders). 
FAVUS. (TINEA FAVOSA.) 
Being a parasitic disease it must be treated by 
local antiseptics. The diseased hair should be ex- 
tracted. The crusts must be loosened and removed 
by rubbing with sweet oil, or green soap and hot water. 
Or: 
J$. Formalin m iv 
01. olivae ovi 
M. Sig. Keep the crusts soaked until easily remov- 
able. 
Then apply one of the following parasiticides, mer- 
cury, sulphur, chrysarobin, etc.: 
I). Resorcin,grs. xxx 
Ungt. picis §i 
Ungt. sulphuris 5i 
M. Sig. Apply freely twice a day after removing 
the crusts. 
Or: 
161 I). Hydrarg. bichlor grs. vi 
Ac. acet, dii 3vi 
Sod. borat ..... 5ss 
Aq. rosse q. s. ad §iv 
M. Sig. Apply morning and night. 
Treatment must be continued for a long time to 
prevent recurrence. 
Radiotherapy has given very encouraging results. 
The affected patches should be exposed to a tube of 
low vacuum for from 10 to 15 minutes twice or thrice 
a week until the hairs fall out. Protect the healthy 
scalp with lead foil. 
FECES, IMPACTION OF. 
Give large enemata of oil, soapsuds, salines, etc., 
in the knee-chest position. If these fail perform 
laparotomy and manipulate the intestine so as to 
break up the mass. Colotomy may be performed if 
the colon is ulcerated and there is danger of rupture. 
Prevent recurrence by toning up the intestine with 
belladonna, nux vomica, aloes and cascara sagrada. 
Daily massage of the abdomen and a proper diet 
should be recommended; see Constipation. 
FEEBLE-MINDEDNESS IN CHILDREN. (IMBECILITY.) 
The legs of the child may be strengthened by mas- 
sage and passive movements, and it may be taught 
to walk by various mechanical devices. A careful 
and watchful nurse should teach habits of cleanliness 
of the person and be on the lookout for bad habits, 
as masturbation. It may be necessary to tie the 
child at night. After the child has learnt the simpler 
things at school, manual and industrial training 
should follow. Better results are obtained in a good 
institution than at home. 
Surgical intervention such as tapping the lateral 
ventricles in hydrocephalus or trephining is rarely 
justifiable. 
It may be stated as a general rule that it is the 
duty of instructors to teach very young children, 
162 concrete things and not abstract conceptions, and 
this duty becomes absolutely imperative in the case 
of the feeble-minded. 
FEEDING, FORCIBLE, DIRECTIONS FOR. 
Introduce a soft rubber stomach tube into the 
stomach by way of the mouth or nostril. Then 
attach to the outside end by means of a connecting 
glass-piece another rubber tube with a funnel attach- 
ment. Pour the food in liquid or semi-liquid form 
from a vessel into the funnel. At first the funnel 
should be lowered so as to prevent the entrance of 
too much air into the stomach, and then it should be 
raised to about the level of the patient's face until it 
has all been ingested. In withdrawing the tube 
be careful to compress it with the fingers so that no 
contents may escape from it while it is in the pharynx. 
A quart and a half of milk with three raw eggs 
beaten up in it may be given twice a day. The milk 
may also be combined with cream, beef juice, puree 
of brain, peas, etc., and a tablespoonful of sugar and 
a little salt may be added. 
FEEDING OF INFANTS AND CHILDREN. 
For the first eight or nine months the sole nour- 
ishment of the infant should be the milk of its mother, 
if she is healthy. For the first six weeks the infant 
should be "nursed" every second hour from 5 a. m. 
till 11 p. m., and should be removed from the breast 
whenever it shows any inclination to stop sucking. 
From six weeks up to eight months the intervals 
should be three, gradually increasing to four hours. 
After the eighth month, other foods may be given 
sparingly, and the child should be gradually weaned 
between the tenth and twelfth months. 
If the mother is unable to suckle the child, obtain 
a young and healthy wet nurse, which see. 
If that is too expensive, the infant may be reared 
on substitute foods, such as the milk of the cow, 
163 ass, or goat. Cow's milk is a food which, compared 
with breast milk, contains a little less fat, an excess 
of indigestible proteids, an insufficiency of sugar, 
and an excess of saline matter; we must try there- 
fore to so modify its composition and the character 
of its proteids as to render it suitable and digestible 
by the young infant. Besides, human milk is alka- 
line and practically sterile, while cow's milk as it 
reaches the consumer is usually slightly acid and 
always contains bacteria. Hence the cow's milk 
should not only be modified but sterilized. 
By diluting cow's milk with water the proportion of 
proteid (casein) can be reduced to its proper level, 
while the addition of cream and milk sugar (lactose) 
gives the cow's milk its proper amount of fat and 
sugar. The water for dilution should be boiled, and 
it is better to use very thin barley water, this pre- 
vents the curds formed being too large. Steriliza- 
tion of the milk is best done in a proper milk ster- 
ilizer; failing which, heating the milk to the boiling 
point and then cooling rapidly is the method em- 
ployed. Pasteurization of milk consists in keeping 
it for at least twenty minutes at a temperature of 
150° to 160° F. This process is found to destroy 
pathogenic microbes, and the natural taste and quality 
of the milk are retained. 
Up to the age of one month the dilution should 
be in the proportion of two of water to one of milk; 
from one to three months equal parts; from three 
to four months, two of milk to one of water; from 
four to five months, three of milk to one of water. 
From the fifth month onward, the milk may be 
given undiluted. 
Sixty grains of milk sugar should be added to 
every four ounces of diluted milk. 
One dessertspoonful of cream to every four ounces 
of diluted milk will supply the proper proportion of 
fat. 
164 Between the ages of twelve and eighteen months, 
th eaild should have five meals in the day; at 6 a. m., 
milk and a plain biscuit; at 8 a. m., bread and milk, 
or oatmeal porridge and milk; at noon, mashed 
potato and gravy or broth, milk pudding, egg cus- 
tard, milk and barley water; at 4 p. m., bread and 
butter, the yolk of a lightly boiled egg, or bread 
and milk; at bedtime, milk and a biscuit. 
FEEDING OF PREMATURE INFANTS. 
About six hours after birth give a warm solution 
of milk sugar (5%) half a teaspoonful every hour. 
After twenty-four hours add an equal part of milk 
got by massage and expression or by the breast 
pump from a wet nurse if possible who is two or 
three weeks post partum. Increase the amount gradu- 
ally so that by the end of the week the child will 
be taking about an ounce every hour. Gradually 
increase the amount of breast milk and diminish the 
solution of sugar. Feeding can be carried on by a 
small medicine-dropper or by sucking through a 
small nipple. When an infant is very weak and will 
not suck or swallow, forced feeding may be necessary. 
As soon as the baby is strong enough it should be 
tried at the mother's breast. 
FEEDING, RECTAL. 
This procedure is used when the patient is 
unable to retain food by the mouth, or when it is 
not desirable to feed him in that manner. About 
one-fourth of the nourishment necessary to main- 
tain life can be absorbed in this way. Rectal 
feeding may be successful for four to six weeks if 
carefully carried out. 
Solutions for rectal feeding should be between 
90° F. and, 95° F., if too hot or too cold they are 
promptly rejected. It is very necessary to have 
the patient in proper position; he should lie on 
his side with the hips elevated, or the foot of the 
165 bed should be sufficiently raised. The tube 
should be one-half inch or less in diameter. 
Lubricate it with oil but not with glycerin. It 
should be introduced into the rectum for eight or 
ten inches. Allow the enema to flow in slowly, 
instructing the patient to be as still as possible 
and to occupy his mind with other affairs. 
Should the enema be rejected precede it by a 
small suppository of opium, or fifteen drops of 
tincture of opium may be added. 
If hemorrhoids are present, a soothing ointment 
should be applied before and after the enema, e. g.: 
Cocain. muriat grs. xv 
Zinc oxidi 5 ii 
Bismuth subnitr 5ii 
Lanolin oss 
Petrolati q. s. ad Bii 
M. Sig. Apply before and after each enema. 
The quantity of each enema should not exceed 
one-half pint; frequently the rectum will not 
retain more than from 1 to 4 ounces. 
Every 5 or 6 hours is often enough for rectal 
feeding. If intense thirst is present, weak salt 
solution enemas may be given. 
After operations in the vagina where there is a 
good deal of gauze packing, the rectum will not 
hold much food and consequently interfere with 
the giving of the enema. 
The following are some recipes extensively used 
in general practice: 
1. Egg and Milk Enema. 
Milk 8 ozs. 
Eggs 3 
Salt 
2. Sugar and Milk Enema. 
Grape sugar. . . 2 ozs. 
Milk 8 ozs. 
166 3. Pancreas Enema (Leube.) 
Pancreas 2 ozs. 
Lean meat 5 ozs. 
Fat 1 oz. 
Lukewarm water 5 ozs. 
The mixture should be chopped fine. 
4. Milk and Peptone Enema. 
Milk 8 ozs. 
Peptone 2 ozs. 
5. Singer's Enema. 
Milk . 4 ozs. 
Wine 4 ozs. 
Yolks of eggs 1 or 2 
Salt 15 
Witte's peptone 1 5 
6. Riegel's Enema. 
Milk 8 ozs. 
Eggs 2 or 3 
Salt 15 
Red wine 1 or 2 ozs. 
7. Jaccoud's Enema. 
Bouillon 7 ozs. 
Wine 4 ozs. 
Yolks of eggs 2 
Dry peptone 1 to 5 5 
FEET, SORE, FROM WALKING. 
Preventive: Soap the feet or inside of socks and 
use strong alum foot baths. Sore feet should be 
well washed, dried and then greased, and salicylate 
of soda dusted on to check excessive perspiration. 
Prevent chafing of shoes by means of a powder made 
up of 3 parts salicylic acid, 10 parts of starch, and 
87 of powdered soapstone. Or give: 
1$. Sodii salicyl grs. xxx 
Potass, permangan 5i 
Bismuth, subnitrat 5iss 
Acid, boric q. s. ad §iii 
M. Sig. Dust on feet and into stockings and shoes 
every morning. 
167 FILARIASIS. 
Prophylaxis. Those who are infected by filariae 
should sleep below mosquito bars. In filaria coun- 
tries (East and West Indies, Brazil, India and China) 
every one should use mosquito bars and mosquitoes 
should be exterminated as far as possible (see Malaria, 
Prophylaxis Personal and Public). Persons known 
to be infested with filariae should avoid injuries 
which might cause the parent filariae to abort or 
might cause rupture in congested lymphatic areas. 
Treatment. For the chyluria, lessen the pressure 
on the vessels of the leaking renal or vesical lymphatic 
varix by placing the patient in the recumbent posi- 
tion with raised pelvis until the urine becomes clear 
and free from clot and albumin. To lessen the chy- 
lous appearance of the urine all fats and albuminoids 
should be avoided and the amount of fluid drunk 
restricted. Give a saline aperient occasionally. 
Support varicose inguinal glands or a lymph- 
scrotum by a well-adjusted bandage. Excise a lymph- 
scrotum when it is passing into a confirmed elephan- 
tiasis. 
Tap a chylocele, then inject or incise it. Amputate 
elephantiasis of the scrotum, retaining the penis and 
testes. 
Treat elephantiasis of the leg by rest, elevation, 
massage and elastic bandaging. During acute attacks 
prick the distended limb so as to provide an escape 
for the effusion and dress the parts antiseptically. 
FLATULENCE (See Dyspepsia, Flatulent). 
FLOATING BODIES BEFORE THE EYE. (MUSCAE 
VOLITANTES.) 
Most patients who complain of muscse have some 
error of refraction (myopes). If this be corrected 
relief is obtained. 
If due to liver trouble, potassium iodide may be 
used. 
168 The eye may be rested and neutral-tinted glasses 
worn to render the muscse less visible. 
The condition is also frequently due to anaemia 
and must be treated: 
1$. Ferri reduct grs. xlviii 
Quin, sulph grs. xii 
Extr. nuc. vomic grs. vi 
Acid, arsenics gr. J4 
M. et ft. caps. No. xxiv. 
Sig. One four times a day. 
FOOD POISONING. 
If the vomiting induced by the poisonous food is 
not sufficient to relieve the stomach of its contents, 
gastric lavage should be resorted to. Repeated frac- 
tional doses of calomel followed by a saline, will 
empty the intestine. Relieve abdominal cramps with 
hot water bags or compresses, or by hypodermic in- 
jection of morphine if necessary. Combat the ten- 
dency to collapse by hypodermic injection of alcohol 
and strychnine, and stimulants by the mouth when 
the gastric irritation has passed. 
FRECKLES, REMOVAL OF. 
Apply the following lotion to the face morning and 
evening: 
Zinci sulphocarbolat oi 
Glycerini 3 ii 
M. Sig. External use. 
Cover the freckles every other day with the following 
ointment: 
I). Hydrarg. ammoniat. 
Bismuth, subnitrat aa 3i 
Glycerit. amyl q. s. ad 3ss 
M. ft. ungt. 
Sig. External use. 
When there are only a few freckles, all that is neces- 
sary is to apply peroxide of hydrogen with cotton on the 
end of a toothpick twice a day. 
A veil should be used to protect the face from the sun. 
169 FRENKEL'S TREATMENT OF ATAXIA BY CO-ORDI- 
NATED EXERCISES. 
It should first be explained to the patient that 
his inability to walk is not due to muscular weak- 
ness, but to an inability to associate movements 
correctly; that the method of treatment is really 
a process of re-education, and that it is not the 
muscular force which he uses in performing the 
exercises which is of importance, but the care 
and precision with which he makes the individual 
movements. 
Exercises while in bed. The patient lies on his 
back in bed and slowly raises his extended leg 
until he touches with his great toe the finger of 
the attendant held immediately above his foot, 
at a distance of about two feet from the bed. 
This exercise should be repeated several times 
with either leg. 
Still lying on his back he flexes his leg on the 
thigh to its full extent, and then slowly flexes the 
thigh on the abdomen; the whole limb is then 
gradually extended until he touches with his 
great toe the finger of the attendant, which is 
held in the same position as in the previous ex- 
ercise. The limb is then slowdy lowered to the 
bed. 
For the next exercise a simple piece of appa- 
ratus is necessary, namely, two boards 3J feet 
long and nine inches in breadth. One long edge 
of board A is attached along the middle of B, so 
that, looked at from the end the extremities of 
the board form the letter T, the limbs of the T 
corresponding to the breadth of the boards, 
namely, nine inches. The apparatus is placed 
across the foot of the bed, resting on board B. 
Along the unattached edge of board A are six 
grooves 1| inch deep, 3 inches wide, and at a dis- 
tance of 3 inches from each other. 
170 The patient lies on his back with his heels 
resting in two of these grooves; at the word of 
command he lifts one heel from the groove in 
which it lies and places it accurately in the 
groove named by the attendant. For this purpose 
it is convenient to have the grooves numbered; 
they should also be well padded. 
Standing exercises. A very ataxic patient 
who has been long confined to bed has forgotten 
how to stand, and when helped out of bed his 
legs slide away from under him. His feet are to 
be placed in position, and, with some one sup- 
porting him on either side, he is to be encouraged 
to practice his balancing power, gradually put- 
ting more and more weight upon his legs. He is 
to practice standing with his feet close together, 
lifting one foot off the ground and placing it 
down again accurately. 
Walking exercises. A black stripe twelve 
inches broad is painted across the floor of a room 
or on a piece of oilcloth. The patient walks 
along this stripe, either with support or in the 
go-cart, taking care to keep his feet within its 
margins. He next practices walking along a 
similar stripe, on which at distances of one foot 
cross lines are painted. This is more difficult 
than the last exercises, for he has not only to 
keep his feet within the limits of the black 
stripe, but whenever he takes a step the toe 
must be placed down exactly at the cross line. 
This exercise is very important, since, bv teach- 
ing the patient to take steps of regular length, it 
greatly simplifies the co-ordination required in 
the act of walking. The patient next proceeds 
with more difficult exercises upon a narrower 
stripe six inches in breadth. 
As soon as the patient has learned to walk on 
level ground fairly and confidently, he may be 
taught to walk up and down stairs. In a hospi- 
171 tai where cases of tabes are constantly being 
treated, a specially constructed staircase of 
several steps, three or four feet in breadth, will 
be found of value. With a rail in each hand the 
patient soon acquires confidence, and makes 
more rapid improvement than on an ordinary 
staircase. In a private house, where such a 
. staircase is not available, he will probably at 
first require the support of an arm while he holds 
the banister in his other hand. 
Many other exercises may be devised for the 
lower limbs and for the upper limbs as well. 
The length of time daily which should be given 
to the exercises must depend on the individual 
case. A quarter of an hour two or three times a 
day, will probably be sufficient at first. An 
exercise must be stopped on the earliest appear- 
ance of fatigue, or if there are any signs of the 
patient's attention beginning to wander. 
This method of treatment can be heartily rec- 
ommended by the authors, who have had some 
remarkable results from it. One patient who 
was bedridden for three years was able, after six 
months' treatment by Frenkel's method, to climb 
a ladder and work at his trade as a painter. 
FRIEDREICH'S ATAXIA. (HEREDITARY ATAXIA.) 
The same treatment as in Tabes Dorsalis, which 
see. Potassium iodide does not benefit many cases. 
Massage and other methods for the prevention of 
contractures should be adopted. 
FUMIGATION, PRACTICAL DIRECTIONS FOR. 
1. By burning sulphur. Tightly close all windows 
and doors except the door of egress. Paste strips 
of paper securely over keyholes and cracks, and 
leave no opening through which gas can escape. 
Hang clothing, bed-covers, window shades, curtains, 
etc., on lines across the room. Open mattresses, 
trunks, and pillows so as to expose inside to th* 
172 fumes. Calculate the cubic contents of the room 
and use three pounds of powdered sulphur for every 
1,000 cubic feet (a room 10x10x10 feet). Take a 
common washtub, place in it four bricks, pour in 
water to the level of the top of the bricks, put a deep 
pan containing the required amount of sulphur on 
the bricks, then place the tub and contents on the 
table. Moisten the sulphur with alcohol and ignite. 
When the sulphur begins to bum, leave the room, 
close the door of egress, paste strips of paper over 
the keyhole, and over all chinks in the door. Keep 
the room closed for at least ten hours After the 
expiration of that time open the room, take out all 
articles and place them in the sunshine. Beat the 
carpets well and expose them to the sun. Next 
thoroughly wash all surfaces in the room, floor, walls, 
and ceiling, with a reliable disinfectant. If the walls 
and ceilings are plastered, wash them with lime. 
Next ventilate the rooms for some hours and scrub 
all woodwork with soap and hot water. 
2. By pouring formaldehyde solution over crystals 
of potassium permanganate. A 14-quart milk-pail, 
set in a wooden bucket to prevent loss of heat, is used 
as the receptacle, and into this is placed a quantity 
of crystals of potassium permanganate (10 ounces to 
every 1,000 cubic feet of room space, or 13J/£ ounces 
when the temperature is below 60° F.). Over this 
salt is poured "formalin," or the 40% aqueous solution 
of formaldehyde (24 ounces to every 1,000 cubic feet 
of room space, or 32 ounces when the temperature 
is below 60° F.). The formaldehyde gas is immediately 
liberated, and the operator should leave the room 
at once. All the rest of the fumigation is the same 
as that given under sulphur. 
GALACTORRHEA. (EXCESSIVE SECRETION OF MILK.) 
The breasts should be firmly tied up after being 
emptied with the breast pump. They may be rubbed 
with belladonna ointment or a solution of atropin 
may be painted on them. 
173 Internally atropin or iodide of potassium should 
be given. Atropin may be given in the form of 
the sulphate, gr. to a dose every three hours 
until the mouth becomes dry: 
Ty. Atropin. sulphat gr. ss 
Aquae anisi §vi 
M. Sig. One teaspoonful three times a day until 
the mouth becomes dry; then reduce the dose. 
The following prescription containing iodide of 
potassium* is useful: 
I}. Potass, iodid grs. xxiv 
lodini grs. xxiv 
Syr. tolu 3vi 
Aqua; q. s. ad giii 
M. Sig. One teaspoonful in hot water every four 
hours. 
A good local application is: 
I}. Pulv. camphor 3iv 
Lanolin 5 ii 
M. Sig. Apply freely to the breasts three times 
a day. 
Or: 
3- Atropin. sulphat grs. xii 
Aquae rosae 5 iii 
M. Sig. Apply to the breasts on a piece of gauze. 
GALL STONE DISEASE (See Cholelithiasis). 
GANGRENE. 
Prophylaxis. When gangrene is threatened com- 
bat the inflammation and favor the return circula- 
tion with massage and external heat. Envelop 
the part in hot flannels which should be changed 
frequently. Support the patient with tonic and 
stimulant remedies. 
Treatment. This varies widely with the cause, 
which should be carefully searched for. Examine 
specially the condition of the blood vessels. Ex- 
amine the urine for albumin and sugar. Then treat 
174 the cause if found. In some cases amputation is 
advisable, in others, nature should be allowed to 
take her course, e. g., in the dry gangrene of old 
people. 
When the gangrene has become complete, local 
remedies are of no avail except to favor the produc- 
tion of sloughs, to hasten their separation and to 
render the odor less offensive. 
The following may be used as an antiseptic and 
deodorant: 
Hydrarg. chlor, cor grs. viii 
Sol. hydrogen dioxid §xxxii 
M. Sig. (Poison) Apply to affected area freely two 
or three times a day. 
Or: 
I|. Potass, permangan 3ii 
Aquae destillat 3xvi 
M. Sig. Apply freely as wash, three times a day. 
GANGRENE, SYMMETRICAL (See Raynaud's Disease). 
GASTRECTASIS (See Dilatation of the Stomach). 
GASTRIC ULCER. (PEPTIC, ROUND or PERFO- 
RATING ULCER.) 
Rest in bed is essential for about six weeks after 
the diagnosis is made. After this the change to 
walking should be very gradual and the patient 
should rest after each meal. Rest to the stomach 
is also necessary and the patient should be fed by 
rectal enemas for the first week. The rectal enemas 
should be given every six hours and should contain 
six ounces of broth with egg, a little salt and, if nec- 
essary, a little whisky. (See Feeding, Rectal.) The 
rectal feeding should be gradually decreased while 
alimentation by the mouth is being resumed. The 
diet should consist at first of milk and lime-water, 
strained oatmeal gruel, or albumin water, a few 
ounces every two hours. The greatest care should 
175 be taken in changing to a more solid diet consisting 
of soft boiled eggs, minced white flesh of chicken, 
pounded fish, tender beef and light puddings. 
About two weeks after this treatment has begun 
Carlsbad salts in drachm doses in warm water should 
be given early every morning as a laxative. 
Alkalies such as bicarbonate of soda combined with 
magnesia may be given to relieve the acidity. Stupes, 
sinapisms or a wet compress over the epigastrium 
are useful in allaying the pain, but if the pain is 
severe, morphine may be needed. The vomiting 
may be relieved by ice, bismuth or nitrate of silver. 
The following prescriptions may be given alternately 
for a period of about a week each: 
Argent, nitrat. 
Extr. belladonnaa grs. vi 
M. ft. pil. No. xx. 
Sig. One pill half an hour before meals. 
And: 
I}. Bismuth, subnitrat 5vi 
Acid, hydrocyan, dil m. xxiv 
Aquae ovi 
Sig. A tablespoonful three or four times a day, 
half an hour before meals. 
For the hematemesis absolute rest and quiet, ice 
to suck, and 10 to 20 drop doses of a solution (1 to 
1,000) of adrenalin chloride every 3 hours are of value, 
but if the bleeding be profuse and dangerous recourse 
must be had to a surgical operation between the attacks. 
This may be either gastro-enterostomy, pyloroplasty 
or partial gastrectomy. 
GASTRITIS, ACUTE. 
Patient should have absolute rest. Empty the 
stomach if necessary with warm water or ipecacu- 
anha. Give ice to quench thirst. Apply mustard 
plaster or turpentine stupe to relieve pain. If con- 
stipation is present give a mercurial laxative. Rest 
176 the stomach by giving very little food or drink. 
Give nutrient enemata to delicate subjects. After 
a day's fast allow milk in small quantities diluted 
with lime-water or Vichy water and peptonized. 
As beverages give champagne with soda water, 
barley water and light broths. There should be a 
gradual return to solid food. 
To stop vomiting and retching, give: 
1$. Acid, hydrocyan, dil gtts. xxx 
Acid, carbolic m. ii 
Bismuth, subnitr 3ii 
Morph, sulph gr. ii 
Aquae menth. pip 3iv 
Syr. acac q. s. ad 5ii 
M. Sig. One teaspoonful every two or three hours 
if necessary. 
Or: 
I). Bismuth, subnitrat 5ii 
Cerii oxalat grs. xii 
Cocain. muriat gr. i • 
Sacchar. lact grs. xii 
M. et ft. chart. No. xii. 
Sig. One every two hours if necessary. 
GASTRITIS, CHRONIC. 
Remove cause if possible. Patient must stop beer 
and whisky if addicted to these drinks, and should 
take' regular meals, thoroughly masticating, and 
avoiding overeating. He should avoid taking a large 
quantity of fluids during meals. For proper diet 
see Dyspepsia. 
There should be systematic lavage, or the stomach 
may be cleansed by the following draught: 
I|. Sodii sulph 3x 
Sodii bicarb 3iv 
Sod. chlor 3ii 
M. Sig. A teaspoonful in a glass of hot water before 
breakfast. 
177 Change of air, sunshine, regular exercise, freedom 
from worry are often of the greatest benefit. 
Bitter tonics are of great service to stimulate the 
gastric juice, e. g.: 
I). Tinct. nuc. vomic oiv 
Tinct. quassise 5ii 
Tinct. gentian oii 
Tinct. cardamom oii 
Elix. calisayq. s. ad §iii 
M. Sig. A teaspoonful in a wineglassful of water 
before each meal. 
If an examination of the stomach contents after a 
test meal should show a deficiency of hydrochloric 
acid, give the following: 
I|. Acid, hydrochlor, dil 5iv 
Pepsini C. P 5ii 
Aquae §iss 
Syr. aurant. cortq. s. ad oiii 
M. Sig. One teaspoonful in water 15 minutes after 
each meal. 
If the patient is troubled with flatulency, give: 
I}. Pulv. rhei 3i 
Sodii bicarb oiss 
Magnes. carb, pond oii 
Pulv. zingiber oss 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
Or: 
1$. Acid, sulph. aromat 5iv 
Tinct. nuc. vomic oii 
Tinct. cardamom oiv 
Aq. menth. pip 3iv 
Aq. anisiq. s. ad oiii 
M. Sig. One teaspoonful after each meal. 
If decomposition takes place in the stomach several 
hours after a meal give: 
]$. Bismuth, subnitrat 3iv 
Saloli 5ii 
178 M. et ft. chart. No. xxiv. 
Sig. One to be taken two hours after each meal 
in hot water. 
If constipation is present give: 
I). Extr. cascar. sagrad. fl. aromat 3iii 
Sig. One teaspoonful in hot water at bedtime and 
on rising in the morning. 
Carlsbad salts in teaspoonful doses in the 
morning in very hot water will accomplish the same 
purpose and also dissolve the mucus in the stomach. 
If lavage of the stomach becomes necessary, teach 
the patient to do it himself every morning with a 
quart of very hot water containing a tablespoonful of 
sodium bicarbonate. 
GASTROENTERITIS, ACUTE. (SUMMER DIARRHCEA 
OF CHILDREN.) 
Wash out the stomach and bowels with lukewarm 
water. Carefully regulate the diet, especially in the 
case of those that are bottle-fed. For the first 24 
or 48 hours withhold all milk. Give barley water 
or rice water in small quantities with a teaspoonful 
of brandy to each eight ounces. Do not give too 
much water as it will aggravate the vomiting. 
The child should be kept in a well-ventilated cool 
room. It should be continually in the fresh air day 
and night. Children in tenement houses ought 
to be removed into the country. Medicines should 
be directed towards cleaning out the intestinal tract 
and then checking the diarrhoea: 
ly. Hydrarg. chlor, mit gr. iss 
Magnes. calcin 5 iss 
Sacchar. lactis gr. xxxvi 
M. et ft. chart. No. xviii. 
Sig. One every three hours. 
If the diarrhoea does not cease in 24 hours give the 
following for a child 3 years old: 
I|. Bismuth, subnitrat 5iv 
Tinct. gambir, co 3i 
179 Tinct. opii camphor 3i 
Elix. digestiv. co. N. Fq. s. ad giii 
M. Sig. One teaspoonful every three hours. 
This should be followed by intestinal antiseptics. 
]$. Salolgrs. xviii 
Zin ci sulphocarbolat gr. ii 
Resorcin grs. iii 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
GENERAL PARALYSIS (See Dementia Paralytica). 
GESTATION, HYGIENE OF. 
Avoid indigestible foods. Diet should be simple, 
especially in early months when morning nausea and 
vomiting are present. Avoid pressure on the grow- 
ing uterus by the clothing; the garments should 
be loose and neither corsets nor garters should be 
worn. If the abdominal walls are relaxed a well- 
fitting abdominal supporter should be worn. Walk- 
ing exercise in the open air should be taken, but 
horseback riding or similar jolting should be avoided, 
also long journeys on the train. Abundance of 
sleep should be taken and cold baths taken daily, 
but not so cold as to cause a shock. There should 
be frequent bathing of the external genitals. Sex- 
ual intercourse should be moderated, or better, 
abstained from altogether. During the last three 
months of gestation the nipples should be gently 
scrubbed daily with a soft brush, water, and Castile 
soap. 
If the pelvis is small and previous labors have 
been difficult, it is frequently of advantage to 
restrict the mother's diet during the last three 
months of pregnancy, making labor easier by re- 
ducing the size and weight of the child, without 
in any way doing harm to the child. 
GINGIVITIS (See Gums, Inflammation of). 
180 GLANDERS. (FARCY, MALLEUS HUMIDUS.) 
Prophylaxis. Those working about stables should 
be able to recognize glanders promptly or should 
employ a veterinary surgeon to do so. The disease 
is easily recognized by the mallein test. If a sus- 
picious case in a stable gives a positive reaction all 
the other animals in the stable should be tested. 
Animals should be killed when the diagnosis of 
glanders is made and the stables, harness, curry 
combs and brushes should be thoroughly disinfected. 
The discharges from a glanders patient should be 
disinfected and destroyed. 
Treatment. Very little can be done for the 
acute form; symptoms must be treated as they 
arise, e. g., vomiting, diarrhoea, pain, rigors, etc. 
When abscesses form they must be freely opened 
and treated with hot antiseptic compresses. At- 
tendants should be very careful not to inocu- 
late themselves with the disease. 
In the chronic form there is more hope for 
recovery. The seat of inoculation should be 
freely excised either by the knife or galvano- 
cautery. 
Benzoate of soda in twenty grain doses has 
been highly recommended. The subcutaneous 
use of mallein in doses of to c. c. every two 
or three days for two months has recently been 
recommended. The lesion should be excised early 
and cauterized, then antiseptic dressings applied. 
All abscesses and ulcers should be treated surgi- 
cally. Antiseptic sprays and gargles of dilute phenol 
or hydrogen dioxide should be employed in the 
nasal form of the infection. 
GLAUCOMA. 
This is one of the diseases of the eye which the 
general practitioner must be able at least to diag- 
nose. Above all things the practitioner should 
never use atropin until he has eliminated glaucoma, 
181 for he would be helping the patient along to the 
complete destruction of his eye. 
In patients who are threatened with glaucoma, 
where the intra-ocular pressure is increased, and 
where there is neuralgia and headache, eserine will 
frequently, if used early, prevent an attack of in- 
flammatory glaucoma. It should be prescribed thus: 
I). Eserin, sulphat gr. ss 
Aquae destillat 3iv 
M. Sig. One drop three times a day in eye. 
The only treatment for inflammatory glaucoma is 
iridectomy and the sooner it is performed the better. 
If it is done immediately the entire vision can be saved; 
if postponed, partial or complete loss of vision may 
result. 
Prophylaxis. All errors of refraction or accommo- 
dation should be corrected. 
GLEET. 
If the disease has not lasted too long, the 
remedies ordinarily employed in acute gonorrhoea 
are found to be of benefit, especially where there 
is a history of a neglected attack. 
The general health should be built up with 
tonics, all forms of fatigue, excessive sexual 
intercourse, smoking, overeating and drinking, 
should be avoided. Sea bathing and cold baths 
are very beneficial. 
The local treatment of gleet is by far the most 
important. A sound passed into the bladder 
twice or three times a week for several weeks 
frequently cures the condition. 
The urethroscope is of considerable service in 
finding the irritated areas and allowing us to 
make applications directly thereto. 
The following injections may be of use: 
1. Nitrate of silver 1 to 3 grs. to 1 oz. 
2. Sulphate of zinc 3 grs. to 1 oz. 
3. Permanganate of potassium..! gr. to'loz. 
182 4. Iodoform 20 grs. in 1 oz. of oil 
5. Acetate of lead 10 grs. to 1 oz. 
6. Sulphocarbolate of zinc 2 grs. to 1 oz. 
7. Sulphate of copper 3 grs to 1 oz. 
8. Creolin 1 to 5 per cent. 
Dilate pathological narrowings or divide them 
by urethrotomy, and remove all mechanical ob- 
stacles from the urethra. This should be done be- 
fore beginning injection or other local treatment. 
The following injection may be used whether the 
urethritis is anterior or posterior: 
]$. Phenolis gtt. xv 
Zinci sulphat gr. xv 
Aluminis gr. xv 
Aquae q. s. ad ovi 
M. Sig. Use as injection. 
In anterior urethritis use the above prescription 
daily with an ordinary syringe. If the urethritis is 
posterior it should be used every third day, at first 
diluted with two-thirds water and the strength grad- 
ually increased. A long nozzle syringe should be used 
and ten to twenty drops injected. 
GLENARD'S DISEASE (See Enteroptosis). 
GLOSSITIS. 
If due to syphilis give mercury internally (see 
Syphilis). Good results may be obtained by 
using Heath's method of pickling the tongue. 
He places grain of bichloride in one ounce of 
water, and the patient is instructed to hold this 
in his mouth for ten to fifteen minutes, three 
times a day. 
If the disease is due to mercurial salivation or 
iodism these drugs must be temporarily stopped. 
If the tongue protrudes from the mouth and is 
accompanied by great swelling inside, so as to 
threaten suffocation, then it becomes necessary 
to make free longitudinal incisions to each side 
183 of the middle line of the tongue from behind for- 
wards. Hot antiseptic mouth washes should be 
used every hour, as follows: 
1. Boric acid . i. .4 3 to 1 pint 
2. Chlorate of potash 3 5 to 1 pint 
3. Liq. antiseptic (U. S. P.) 13 to 1 oz. 
4. Phenol 1 3 to 1 oz. 
Purgatives in the form of croton oil should be 
given (one or two drops on back of tongue), and 
the inhalation of steam is sometimes soothing. 
GLOSSOLABIO LARYNGEAL PARALYSIS (See Paralysis, 
Bulbar). 
GOITRE, EXOPHTHALMIC (Basedow's Disease, Graves' 
Disease). 
Belladonna given in gradually increasing doses 
until the physiologic effect is produced, is one of 
the best remedies: 
J$. Tinct. belladonn 3i 
Sig. Five drops three times a day. Gradually 
increase the dose until the throat feels dry. 
Arsenic in the form of Fowler's solution benefits 
some cases. It should be given in five drop doses 
in water three times a day after meals. Gradually 
increase until eight to ten drops three times a day 
are taken. Stop the arsenic for about one week in 
every four or five weeks. 
Galvanism should be employed at the same time as 
the belladonna. The negative electrode is applied to 
the thyroid, and the positive to the back of the neck. 
The strength should be from 25 to 60 milliamperes. 
When the patient's heart is very rapid and causing 
extreme nervousness, it is best to put the patient at 
complete rest in bed. At the same time give the 
bromides as: 
I|. Strontii bromidi 5iv 
Potass, bromidi 3ii 
Aquae Biss 
Syr. simplic q. s. ad §iii 
184 M. Sig. One teaspoonful in water every four hours. 
Thyroid extract should not be tried because it makes 
the patient much worse. Digitalis, veratrum viride, 
and aconite should be given very cautiously, if at all. 
If rest in bed, belladonna and galvanism fail, then 
resort to surgical treatment. 
Do not wait for the patient to become a physical 
wreck before resorting to surgical measures, because 
the death-rate in these cases is high. Remove the 
thyroid, leaving behind as much of the gland as 
normally exists in the adult. If too much is removed, 
myxoedema results, if too little we have a recurrence 
of the symptoms. 
The serum treatment is still in the experimental 
stage, but from present appearances seems to be at- 
tended with encouraging results. 
It is obtained from animals from which the thyroid 
has been removed. 
The serum may be given in two forms, liquid and 
desiccated. The former is preferable. At least twenty 
to fifty drops should be given three times a day. The 
dose of the desiccated form is twenty to sixty grains 
daily. Both are administered by the mouth in capsules. 
GOITRE, SIMPLE. 
Internally we should give thyroid tablets, 5 grains 
each, four times a day after meals. Iodide of po- 
tassium can also be given and frequently acts as well 
as the thyroid extract: 
I). Potass, iodid 3iv 
Essen, pepsin 3hi 
M. Sig. One teaspoonful after each meal in hot 
water. Increase to two teaspoonfuls if reduction in 
size does not take place in two weeks. 
Locally unguentum iodi may be rubbed into the 
gland once a day, or it may be painted with the tincture 
of iodine once a day. 
If the goitre has become cystic the tumor will not 
disappear under any line of treatment, except surgical. 
185 GONORRHOEA, IN MALE. 
Prophylaxis. The disease can be prevented by in- 
jecting a syringeful of a 10 per cent solution of pro- 
targol immediately after coition. 
The patient should be Warned of the danger of 
infecting his own eyes and those of others. The 
discharge should be received on a piece of absorbent 
gauze, and the hands thoroughly scrubbed and 
washed after each redressing. He should also be 
warned not to put a pledget of cotton under the 
foreskin, because the discharge backs up in the 
urethra, causing an extension of the disease upward. 
He should avoid exercise; if possible it is preferable 
to keep the patient in bed during the first week. 
Sexual intercourse should be forbidden. 
Nearly every physician of experience has his own 
method of treating this disease, but no matter what 
line of treatment is employed, the disorder lasts on 
an average of about six weeks. 
The treatment may be divided under three heads: 
1. Diet. 
2. Internal medication. 
3. Local medication. 
Diet. A liquid or semi-liquid diet should be in- 
sisted on, at least during the first week. It may 
consist of milk, buttermilk, weak coffee, oatmeal, 
milk-toast, broths, etc. 
Prohibit the use of all alcoholic drinks, as malt, 
beer, whisky, gin, liqueurs and wines; also carbo- 
nated drinks, as vichy, soda water, lemonade, etc. 
Tea is also injurious, especially if strong. Condi- 
ments and seasoned foods, pickles, mustard, radishes, 
celery, tomatoes, asparagus, onions, cheese, salads, 
mayonnaise dressing, etc., are also very harmful. The 
last meal of the day should be the lightest, and 
should be eaten at least three hours before bedtime. 
Prohibit all physical exertion, especially of a 
violent form. He must not ride on horseback, 
186 dance, cycle, jump on or off street cars or other 
moving vehicles. 
Smoking should be sparingly indulged in. 
Internal medication. This consists of giving 
drugs that act as antiseptics and sedatives, as: 
1$. Misturae copaibae (N. F.) 3vi 
Sig. One teaspoonful every four hours. This mix- 
ture is also known as Lafayette's mixture. Its formula is: 
Ty. Liq. potass, hydroxid gtts. xl 
Copaibae 
Tinct. lavandulae comp . 
Spirit, seth. nitros aa 3 iii 
Syrupi § i 
Mucilag. acaciae q. s. ad 5 iii 
M. "Shake" label. 
Or: 
T|. Potass, citrat 3iv 
Potass, acetat 3iv 
Ext. buchu. fl 3iv 
Ext. tritici fl q. s. ad § iii 
M. Sig. One teaspoonful in water every four hours. 
Or: 
Ty. Urotropini 3ii 
Ft. caps. No. xxiv. 
Sig. One four times a day. 
Or: 
Saloli 5ii 
Ft. caps. No. xxiv. 
Sig. One every four hours with water. 
Or: 
3- 01. santali 3 ii 
Ft. caps. No. xii. 
Sig. One every four hours with hot water. 
Or: 
I}. Copaibae 3i 
01. cubeb 3i 
Ft. caps. No. xii. 
Sig. One every four hours with hot water. 
Or: 
187 1$. Bals, copaibae 
01. santali aa §ss 
Liquor, potassse 3vi 
Syr. aurant. cort 
Aq. cinnamonii q. s. ad §iv 
M. Sig. One teaspoonful three or four times a day 
in a wineglassful of water. 
Local medication. This consists in the use of anti- 
septics and astringents injected into the urethral canal. 
Protargol, potassium permanganate, zinc sulphate and 
argryol are the most useful for this purpose. 
Before taking an injection the patient should be in- 
structed to urinate. If urination is painful, the penis 
and testicles should be immersed in hot water until 
the act is over. 
Protargol may be used from the beginning of the 
disease in weak solution (one-half to one per cent), 
and gradually increased in strength toward the end of 
the disease (one to two per cent). 
I|. Protargol, sol. aq 1% §iv 
Sig. Use a small syringeful three times a day. 
This solution is best prescribed alone, and should be 
held in the urethra at least five to ten minutes. 
Argryol should be prescribed the same way but in 
stronger solution (2 to 5 per cent). 
Permanganate of potassium is one of the best solu- 
tions that we possess. It should be injected warm: 
J$. Potass, permangan ■ gr. 1 to 2 
Aq. destillat oiv 
M. Sig. Use a small syringeful three or four times a 
day. 
Hydrogen peroxide and mercury are seldom used to- 
day. 
The following is a good injection towards the end of 
the disease: 
I) Zinc, sulphat grs. xv 
Plumb, acetat grs. xxx 
Tinct. opii 3iii 
Aquae q. s. ad 3vi 
188 M. Sig. Use as injection two to three times daily. 
Any of the following drugs can be used for in- 
jecting: 
Bichloride of mercury y gr. to 16 ozs. 
Salicylate of mercury 1 gr. to 5 ozs. 
Sulphate of zinc 1 to 3 grs. to 1 oz. 
Acetate of zinc 2 to 3 grs. to 1 oz. 
Carbolic acid 5 grs. to 1 oz. 
Boric acid 10 grs. to 1 oz. 
Alum 3 grs. to 1 oz. 
Sulphate of zinc and acetate of lead.. 5 grs. 
each to 1 oz. 
Nitrate of silver 1 gr. to 6 ozs. 
Anti-gonococcus serum has not given any results in 
acute gonorrhoeal processes. 
For the treatment of complications see Balanitis, 
Epididymitis, Prostatitis, Chordee, Cystitis, Gleet and 
Gonorrhoeal Arthritis. 
GONORRHCEA, IN FEMALE. 
Prophylaxis. The disease may be prevented by 
using a very hot antiseptic douche immediately 
after intercourse, as, 
I|. Hydrarg. chlor, corros oss 
Spirit, vini rect §viii 
M. Sig. One tablespoonful in fotH* quarts of hot 
water for douche. 
The treatment consists in destroying the gonococcus 
in the vagina with antiseptic flushings frequently re- 
peated. 
The vagina should be thoroughly washed with one 
or two quarts of warm water before giving the anti- 
septic douche. 
The antiseptics usually employed are permanganate 
of potassium, carbolic acid, bichloride of mercury, 
lysol, creolin and boric acid. 
Permanganate of potassium should be used in the 
strength of 5 to 10 grains to the pint of hot water; 
189 bichloride of mercury in the proportion of 1 to 4,000; 
carbolic acid, lysol and creolin. 2 drams to one quart; 
boric acid one tablespoonful to the quart. 
The following powder is of benefit when the acute 
stage has passed: 
1$. Acid, tannic giss 
Pulv. alum 3i 
Acid, boric 3iss 
M. Sig. One tablespoonful in one quart of hot water 
three times a day. 
When the discharge begins to cease, sulphate of 
zinc, one dram to the pint, becomes very useful. 
If considerable ulceration of cervix has resulted, it 
is necessary to tampon with: 
I). Ichthyol 5iii 
Glycerin Sxiii 
M. Sig. Use twice a day after an antiseptic douche. 
If complications arise treat according to methods 
described under their respective subjects, as Cystitis, 
Endometritis, Salpingitis, etc. 
GONORRHCEAL ARTHRITIS. 
Rest in bed, immobilization of the limb by splints 
or plaster for a short period. Beware of ankylosis. 
Counter-irritation may be procured by tincture 
of iodine, Misters or cautery. If effusion persists, 
the fluid in the joint should be aspirated under the 
most rigid antiseptic precautions. Bier's method 
of passive congestion is often of great service. 
Crede's silver ointment thoroughly rubbed into 
the affected joint occasionally gives prompt relief: 
I}. Unguent. Crede oi 
Sig. Rub half a drachm thoroughly on the joint 
three times a day. 
At the same time, constitutional treatment by iron, 
arsenic, quinine, and strychnine should not be for- 
gotten. 
Treat also the local gonorrhoea if present. 
190 Sufficient clinical reports are now at hand to estimate 
the value of anti-gonococcus serum in the treatment of 
the various forms of gonorrhoea and its complications. 
In some cases of gonorrhoeal arthritis it acts as a 
specific, sometimes within a few hours after its admin- 
istration, but it seldom fails to benefit, no matter how 
severe the case. 
It should be given hypodermically in the dose of 2 c. 
c. every second, third or fourth day. In very chronic 
cases it should be continued for a long period of time. 
It should be injected into the subcutaneous tissue under 
the strictest antiseptic precautions. 
The serum is put on the market in the form of 2 c. c. 
bulbs. 
It has also been found worthy of a trial in the 
following complications of gonorrhoea: cystitis, prosta- 
titis, epididymitis and salpingitis. 
GOUT. 
Treatment of acute attack. The pain is best 
relieved by ten to twenty drops of vinum colchici 
well diluted and given every two hours till the symp- 
toms subside, when it may be given in smaller 
quantities. Empty the bowels by a full dose of 
calomel followed by a saline such as the liquid citrate 
of magnesia. The patient should abstain from food 
for 24 hours and should be encouraged to drink plenty 
of water. 
Next to colchicum, salicylate of sodium or of lith- 
ium will be found useful to hasten the elimination 
of the purin bodies which cause the attack. Alkalies 
are also valuable adjuncts. 
The following prescription will be found of service: 
I}. Sodii salicylat 3iv 
Sodii nitrat 3iiss 
Potass, iodid oiiss 
Vin. colchic. radic. 5iss 
Aq. gaultheriae q. s. ad §vi 
191 M. Sig. One tablespoonful in half a glass of water 
twice daily for forty days. 
Or: 
I). Extract, colchici cormigr. xxiv 
Phenylis salicylatis 5i 
M. ft. pil. No. xxiv. 
Sig. One pill every four hours. 
Local treatment. A soothing application should be 
made to the affected joint, e. g.: 
I|. Pulv. lini §iv 
Sodii bicarb 5iv 
Aquae fervent is q. s. 
M. Ft. cataplasma. 
Sig. Spread on cheesecloth and apply to the pain- 
ful part. 
When this application has been made the affected 
part is elevated and wrapped thickly in flannel or cot- 
ton wool to protect it from cold and to promote local 
sweating. 
GOUT, CHRONIC. 
Hygienic treatment. The patient should be mod- 
erate in the use of animal food and liberal in vege- 
tables. He should not eat more than is absolutely 
necessary to satisfy his hunger. He should take 
plenty of fluids and every night and morning he 
should slowly sip a quantity of hot water. He 
should take regular exercise and should walk not 
less than three to four miles daily. Warm baths, 
tepid or cold sponging, skin friction, massage and 
Turkish baths are of great benefit. He should be 
warmly clad, avoid fatigue, keep regular hours, 
and maintain the free action of his skin, kidneys 
and bowels. He should go early to bed and rise 
early, and should not take more than eight hours 
sleep, nor less than seven. 
GOUT, DIET IN. 
The following should be avoided: Fats, rich 
foods, sauces, rich gravies, made dishes, pastry, 
192 jellies, sugar, meat essences, strong soups, crabs, 
oysters, salmon, eel, lobster, duck, goose, hare, 
mushrooms, truffles, pickles, spices, ale, porter, 
stout, port, champagne, Burgundy, sherry, Madeira, 
liqueurs. 
The following should be taken in moderation: 
Bread, biscuits, butter, cheese, potatoes, asparagus, 
tomatoes, beans, peas, lentils, eggs, whisky and 
brandy (not to exceed two ounces daily), unsweet* 
ened gin, claret, hock (freely diluted). 
The following may be allowed: Fresh fruits and 
vegetables, fish, white meats, vegetable soups, 
toast, salads, celery, milk, skimmed and diluted 
with Vichy, Apollinaris or Seltzer, lime juice diluted, 
weak tea freshly made, cocoa. 
GRAVEL (See Renal Calculus). 
GRAVES' DISEASE (See Goitre). 
GREEN SICKNESS (See Chlorosis). 
GRIPPE. (INFLUENZA.) 
During epidemics the feet should be kept dry. 
The nasal secretions and sputum of those suffering 
from the disease should be destroyed, and if possible 
the patient should be isolated. 
Treatment. The use of drugs has been overdone 
in this disease. 
At the beginning of the attack give one grain of 
calomel, and gr- every half hour until three 
grains are taken. 
For the headache, pain and mental depression give: 
1$. Antipyrini 3i 
Salol 3i 
Kryofini 3ss 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
If laryngo-bronchial irritation is present give: 
I). Codein. phosph... gr. iv 
Ammon, chlorid 5ss 
Syr. tolu 3 iss 
Syr. prun. Virginian q. s. ad §iii 
193 M. Sig. One teaspoonful every three hours. 
Diaphoretics are of considerable benefit: 
I|. Fluidextr. gelsemii 5iv 
Sig. One or two drops every half hour until free 
perspiration takes place. 
Locally. Warm poultices composed of equal parts 
of flaxseed meal 'and mustard, should be applied to 
the chest when there is much bronchial irritation. 
For the coryza use the following with an atomizer: 
1$. Sod. bicarb grs. xv 
Sod. chlorid grs. x 
Glycerini 3iv 
Aquae q. s. ad. 3iii 
M. Sig. Use with an atomizer every three hours. 
Plenty of water should be consumed, at least a quart 
daily, to wash out the toxic substances from the blood. 
The diet should be liquid as long as the tempera- 
ture is high; thereafter a light diet of milk, soups, 
rice, eggs, etc., may be given. 
During convalescence, iron tonics are indicated, as 
Blaud's pills, each 5 grains, one after each meal, or: 
I|. Liq. ferri peptonat. N. F §vi 
Sig. Two teaspoonfuls four times a day. 
Or: 
I}. Strych. sulphat gr. % 
Zinci phosphidi gr. iss 
Quin, sulph grs. xii 
Ac. arsenios gr. J4 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
GUINEA-WORM DISEASE. 
Prophylaxis. Thoroughly filter and boil all drink- 
ing water in the tropics. Surface water is particu- 
larly suspicious. 
Treatment. Frequent hot fomentations to en- 
courage worms to discharge embryoes. When worm 
is empty and begins to emerge spontaneously, its 
exit may be hastened by seizing the end of the 
194 worm firmly between two sterile toothpicks, be- 
tween which it is gradually rolled up, great care 
being taken to avoid breaking the slender body. 
Dress with boric lotion and lint till the wound heals. 
GUMMA OF BRAIN (See Brain, Gumma of). 
GUMS, INFLAMMATION OF. (GINGIVITIS.) 
In the gingivitis of pregnancy the teeth should 
receive the attention of a dentist. Precipitated 
chalk pressed between the teeth at bedtime is of 
some service. Milk of magnesia may be used as 
a mouth wash during the day. 
If the gum over a wisdom tooth which is about 
to make its appearance be greatly inflamed or ul- 
cerated it should be incised and the borders of the 
incision should be cauterized so that immediate 
union may not take place. If abscesses form in 
the gum, tongue, cheek or cervical glands, they 
should be opened. 
In infants local prophylaxis consists in gentle 
friction of the inflamed gums w'ith the ball of the 
finger, or the smooth handle of a silver spoon, and 
in providing the baby with a piece of hard rubber 
on which to chew. The gums may be painted with 
the following: 
I}. Tinct. benzoini co 3ii 
Liquoris antiseptici (N. F)q. s. ad Si 
M Sig. Apply to the gums with a camel's hair 
brush three times a day. 
HiEMATEMESIS. 
For this condition see Cancer of Stomach, Gastric 
• Ulcer, and Liver, Cirrhosis of. 
HEMATURIA. 
Treat the cause, e. g., purpura and other blood 
diseases, gonorrhoea, calculus, new growth, tubercle 
of kidney or bladder, nephritis, prostatitis, etc. 
Haemorrhages arising from the urethra usually 
precede the act of urination, while bleedings from 
the bladder either follow the passage of clear urine 
195 or else urine which is slightly blood-tinged at the 
beginning of urination, becoming progressively darker 
toward the end of micturition. In bleedings which 
arise in the kidneys, there is no difference in color 
of the urine throughout the duration of the micturi- 
tion and except a clot be passed blood and urine 
as voided are equally mixed together. 
Treatment. Rest in bed. The application of dry 
cold to the loins and the hypodermic injection of 
ergotin are of service. Internally drugs may be 
given which increase the coagulability of the blood 
such as calcium lactate or calcium chloride, in doses 
of 20 grs. three times a day: 
I). Calcii chloridi 3i 
Aquae 3 iii 
M. Sig. One teaspoonful in w'ater three times a 
day. 
Gelatin may also be given for the same purpose 
either hypodermically or by the mouth. 
Haemostatics such as the extract of hamamelis or 
gallic acid may also be used. In haemorrhage from 
the kidney or prostate give: 
I}. Ac. gallic 5ii 
Extracti ergotae gr. xxiv 
M. et fiat in capsulas No. xxiv. 
Sig. One capsule every four hours. 
In bleeding from the bladder or urethra give: 
I}. Fluidextracti hamamelidis 5i 
Sig. Twenty to thirty drops in water every two 
hours. 
In the haematuria due to purpura the following will 
be found useful: 
1$. Acidi gallici 5ss 
Acid, sulph. dil 
Tinct. opii deodorat aa 5i 
Infus. digitalis 5iv 
M. Sig. One tablespoonful every four hours. 
196 HEMOGLOBINURIA, PAROXYSMAL. 
Prophylaxis. The patient should be warmly clad, 
and should not be exposed to cold. Outdoor oc- 
cupation should be exchanged for indoor work. He 
should live in an equable and warm climate. 
Treatment. When an attack begins the patient 
should be put to bed and kept warm. After the 
attack is over the patient should be placed on iron, 
or iron and arsenic. Arsenic should be given for 
a long time to increase the resisting power of the 
red cells. 
HEMOPHILIA. 
Surgical operations should not be done on those 
affected. Even vaccination should be done with 
care. The authors have seen a case where a pint 
of blood was lost from making a small needle-point 
opening in the lobule of the ear, for a blood ex- 
amination. The disease being transmitted through 
the females, marriage should be prohibited. 
Internally give calcium lactate or calcium chloride 
in 20 to 30 gr. doses three times a day either by mouth 
or rectum. If given by the mouth it may be given 
in powder form or in the following mixture: 
1$. Calcii chloridi 5iiss 
Aquae Bi 
Syr. aurantii cortic q. s. ad Bit 
M. Sig. One teaspoonful three times a day in water. 
Gelatin should be eaten in large quantities. If the 
haemorrhage is concealed, give the following: 
1$. Acid, sulph. aromat 3iv 
Acidi gallici 3ii 
Tinct. cinnamon -. Bi 
Tinct. opii 3iv 
Fluidextr. ergotae .q. s. ad Biii 
M. Sig. One teaspoonful in water every three hours. 
If the. haemorrhage is accessible, apply a strong 
adrenalin chloride solution (1 to 1,000) with a firm 
packing of gauze, not cotton. 
197 Transfusion of blood is of no benefit. 
Recently it has been shown that a haemophilic haem- 
orrhage can frequently be controlled by the injection 
of 20 c. c. of fresh ox serum. Finding this to be of 
benefit, anti-diphtheritic serum was tried in from 10 
to 20 c. c. doses, repeated in two days, and found to 
be of equal benefit. This should be tried. 
HAEMOPTYSIS. 
Prophylaxis. The patient should avoid physical 
effort, mental excitement and any other causes of 
active pulmonary congestion. If the haemoptysis is 
a symptom of pulmonary tuberculosis, for treatment 
see Tuberculosis. 
Treatment. The patient should be kept at abso- 
lute rest in a semi-recumbent position. He should 
use his voice as little as possible. The sick-room 
should be kept cool and well-ventilated and the bed- 
coverings should lie lightly on the patient's chest. 
The patient should cough as little as possible. Place 
an ice-bag over the seat of the suspected haemorrhage 
and give the patient ice to suck and order hot foot 
baths. Ligation of the extremities is of benefit by 
retaining the venous current in the limbs while the 
arterial circulation is not arrested; in this way the 
intra-pulmonary pressure is lowered. 
To increase the coagulability of the blood and 
relieve haemoptysis, calcium chloride or lactate may 
be given in 20 gr. doses three times a day. Ordinary 
gelatin which is found in every grocery may be 
given for its haemostatic properties. It may be given 
dissolved in water, in doses of two ounces every two 
hours. 
Opium and morphine are favorite and very effect- 
ive remedies. Very frequently all that is necessary 
to stop the haemorrhage is a hypodermic injection of 
gr- of morphine sulphate. If opium is used it 
may be combined with lead: 
193 I}. Pulv. opii grs. xii 
Plumb, acetatgrs. xxxvi 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
HAEMORRHAGE, INTESTINAL. 
This is usually first discovered by the appearance 
of blood in the faeces; the darker the blood the 
further from the anus does it come. It may be due 
to duodenal ulcer, typhoid ulcer, cirrhosis of liver, 
haemorrhoids, etc. 
The first indication in treatment is absolute rest 
in bed. An ice-bag should be placed on the abdo- 
men, and all food should be withheld from the stom- 
ach. 
The drugs which are of most use are ergot, opium, 
morphine, lead and adrenalin. Give the following 
capsule: 
I). Pulv. opii grs. xii 
Plumb, acetatgrs. xxiv 
Extr. ergotae grs. vi 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
Adrenalin chloride in 20 drop doses every three hours 
should also be tried. 
In severe typhoid haemorrhages, morphine sulphate, 
gr., hypodermically every half hour for three doses 
is a very important measure. Repeat in two or three 
hours if necessary. 
During the course of a haemorrhage do not give the 
patient any food, water, bath or enema, but keep him 
quiet, both mentally and physically. 
After the bleeding has stopped, stimulants such as 
brandy, strychnine or digitalis may be given. 
Gelatin (a 2% solution) has been used by injection 
with good results. 
When the haemorrhage is due to haemorrhoids treat 
them as directed under that heading. 
199 HAEMORRHAGE, POST PARTUM. 
The obstetrical patient should not be left by the 
attendant if the pulse is 120 or more, because this 
is always a premonitory sign of haemorrhage. 
Try Crede's method first. It consists in grasping 
the fundus of the uterus through the abdomen, fin- 
gers behind and thumb in front, and by firm pres- 
sure induce contraction to force out the accumulat- 
ing clots. 
If this does not stop it, with the hand introduced 
into the uterus empty all the clots out of it, then 
firmly grasp the fundus of the uterus through the 
abdominal wall and massage it. Give the patient 
a teaspoonful of fluidextract of ergot hypodermically. 
If the haemorrhage does not cease on emptying 
the uterus, give a very hot intra-uterine douche, 
containing a cupful of vinegar, and pack the interior 
• of the uterus firmly with gauze which should be left 
in at least six hours. 
If much blood has been lost elevate the foot of 
the bed, bandage the limbs, and give an intravenous 
saline injection, or resort to Hypodermoclysis, 
which see. 
After the haemorrhage has ceased give a little hot 
coffee, beef tea, or malted milk. Keep up the fluid- 
extract of ergot for twenty-four hours in the dose 
of half a teaspoonful every four hours. 
Sometimes the haemorrhage comes from a torn 
vagina or a tom cervical artery. In these cases pack 
with gauze or sew up the rents. 
HAEMORRHAGE, UTERINE. 
If due to abortion make use of the methods de- 
scribed under that heading. 
If due to carcinoma, remove the uterus as soon as 
the diagnosis is made. If due to an inoperable ad- 
vanced case, use the cautery or tampon with gauze 
containing adrenalin chloride solution (1 to 2,000). 
If due to fibroids within the uterus, give ergot, 
200 and tampon with gauze twice a day. The patient 
should be at absolute rest in bed. Prescribe the fol- 
lowing: 
I}. Fluidextr. ergotae oi 
Acid, sulphuric, aromat 3iv 
Tinct. cinnamon q. s. ad. §iii 
M. Sig. One teaspoonful in water every three hours. 
Or: 
I). Extr. ergotae grs. xii 
Plumbi acetat oiss 
Tannin 5iss 
Pulv. opii grs. xxiv 
M. et ft. caps. No. xxiv. 
Sig. One every three hours. 
The above treatment will usually stop the haemor- 
rhage, but should it continue then surgical intervention 
becomes necessary. 
If the uterine haemorrhage is due to a miscarriage 
where the uterus has not properly emptied itself, dilate 
and curette and swab the cavity with tincture of iodine 
or carbolic acid. Follow this with two hot daily douches 
containing a tablespoonful of common salt or boric acid. 
If the uterine haemorrhage occurs in young girls 
who are first beginning to menstruate or who have 
already menstruated several times irregularly, it is 
necessary to prevent overstudy or overwork, the bowels 
must be kept open and iron must be given if anaemia 
is present. In many obstinate cases it becomes neces- 
sary to keep the patient in bed, to tampon, to give 
calcium chloride in 10 gr. doses, and to administer 
gelatin. The following prescriptions may be given for 
this condition in young girls: For the anaemia give: 
R. Ferr. carb, mass 3ii 
Acid, arsenios gr. 14 
Mangan, dioxid grs. xii 
Zinci phosphidi grs. iss 
M. et ft. caps. No. xxiv. 
Sig. One four times a day. 
For the bowels: 
201 I}. Extr. cascara sagrad 3i 
Extr. nuc. vomicgrs. viii 
Extr. physostigmin grs. ii 
Extr. hyoscyam grs. v 
M. et ft. pil. No. xxx. 
Sig. One night and morning. 
For the excessive haemorrhage: 
1$. Calcii chloridi 3iv 
Fluidextr. ergotae 3iv 
Aquae gi 
Tinct. cinnamon, coq. s. ad. §iii 
M. Sig. One teaspoonful every three hours. 
HAY FEVER. 
Prophylaxis. The patient should avoid going into 
the country at the time of the ripening of the pollen 
and seed of plants which cause the irritation in his 
case, usually the ragweed. If he is able to afford 
the change of climate, he should go to the moun- 
tains, until the first frost appears. 
Treatment. So far there is no curative treatment 
for this disease but relief can always be obtained. 
In children the disease may be due to irritation from 
polypi, adenoids, etc. If these are removed the 
relief of the hay fever is sometimes immediate. 
Belladonna is of great service. It should be started 
at least two weeks before the expected attack. Give 
the tincture in five-drop doses three times a day. 
When the attack begins gradually increase the dose 
until the physiological limit is reached. 
During the attack the patient can be made com- 
fortable by using a nasal atomizer containing adre- 
nalin solution (1-2000). The nose should be sprayed 
five or six times a day. 
Dunbar's pollantin has cured a few cases, bene- 
fited some, and has not had any influence whatever 
on many. So far the results of treatment with it 
are no better than other lines of treatment. 
202 When the nasal symptoms are very severe, a 2% 
cocain spray may be used, but patients very readily 
acquire the cocain habit in this way. 
When the patient is kept awake at night give: 
1$. Sod. bromid 3ii 
Potass, bromid 3ii 
Chloral hydrat 3ii 
Aquse oiss 
Syr. simplic q. s. ad. 5ii 
M. Sig. One teaspoonful at bedtime in water. 
For the conjunctivitis, give the following: 
I). Zinci sulphat gr. ii 
Aq. cam pho rat 3i 
Sat. sol. ac. boric q. s. ad. 3i 
M. Sig. Instil a few drops into the eye three times 
a day. 
The following may be used as a spray to the nose: 
1$. Cocain. hydrochlor grs. x 
Ac. boric grs. x 
Sodii bo rat grs. xx 
Supra-renalin (1 to 1,000) 3iv 
Glycerini 3ii 
Aquse camphorat q. s. ad. §iv 
M. Sig. Use as spray to the nose four or five times 
a day or oftener, if necessary. 
HEADACHE. 
Search for cause of chronic or recurring head- 
ache: astigmatism, or some error in refraction of 
the eyes, nasal obstruction, decayed teeth, indi- 
gestion, brain tumor, deficient coagulability of the 
blood, fecal accumulation, displaced uterus, lacera- 
tion of cervix, cerebral congestion, meningitis, 
malaria, pneumonia, typhoid and other infectious 
diseases, syphilis, etc. 
Headaches in school-children are in the great 
majority of cases due to error of refraction. 
Frequently it is necessary to prescribe for the head- 
ache in addition to the other appropriate treatment. 
203 The following answers the purpose: 
I|. Sodii bromid 5ii 
Phenacetin 5i 
Kryofini 5i 
Caffein. citrat grs. xii 
M. et ft. chart. No. xii. 
Sig. One every three hours if necessary. 
Wherever there is high fever and the patient is very 
weak, headaches should be controlled by the ice-bag 
to head and the above prescription given only where 
the patient's suffering is more harmful than administra- 
tion of the coal-tar products would be. 
Headaches of nasal origin can only be relieved by 
appropriate treatment applied to the nose; if due to 
obstruction by a polypus or adenoids remove them. 
If due to a simple catarrhal condition use: 
I|. Liq. alkalin. antisept. (N. F.) §vi 
Sig. Spray into nose and throat with atomizer three 
times a day. 
If the headache is of a dull character and on the 
top of the head it is possibly of renal or uterine origin; 
in which case examine the urine and prescribe accord- 
ing to the diagnosis made. 
If of uterine origin, correct displacements by pessary 
or other appropriate methods. 
If the headache is of nervous origin remove the 
patient from excitement and worry and give the fol- 
lowing prescription: 
1$. Sodii bromidi 3iv 
Tinct. valerian 3iii 
Aquae 3iss 
Syr. limonis q. s. ad §iii 
M. Sig. One teaspoonful in water three times a day 
after meals. 
Tonics are also frequently indicated, especially iron, 
as in the following: 
I|. Ferri reduct grs. xlviii 
Extr. gentian grs. viii 
Extr. sumbul grs. xxiv 
204 M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
If due to errors of diet, correct them. See Dys- 
pepsia, Constipation, etc. 
HEARTBURN (PYROSIS, WATER-BRASH). 
The patient should be careful about his diet, well 
masticating his food. He should take plenty of 
exercise and a cold bath every morning. The fol- 
lowing articles of diet should be avoided: Cabbage, 
nuts, fatty food, pastries, salt meats, sharp condi- 
ments, coffee, beer or whisky. The following may 
be allowed: Weak tea, milk, cocoa, dry toast and 
butter, roast meat, chicken, eggs, soup with egg, 
omelet, mashed potatoes, asparagus tips, Vichy, 
Apollinaris or hock. 
If fermentation is present, lavage of the stomach 
may be necessary. The alkaline carbonates are of 
service. Sodium carbonate or magnesia usta in hot 
water, taken half an hour before the pain is expected, 
often prevents attacks. 
The heartbum of pregnancy should be treated in 
the same way. 
A soda mint powder after meals containing the 
following, is often useful in checking the attack: 
1$. Sod. bicarb 5iss 
Potass, bicarb grs. iv 
01 menth. pip gtts. ii 
M. et ft. chart. No. xii. 
Sig. One after each meal. 
HEART, DILATATION OF. 
Rest in bed and digitalis are the important indi- 
cations. The patient can only rest in a semi-recum- 
bent position, and should have a suitable back-rest 
and pillows. The dyspnoea compels him to sit up. 
The dyspnoea can be relieved by codeine or mor- 
phine (gr. hypodermically. Apply dry cups 
to the chest occasionally. Many obtain consider- 
able relief from inhalation of oxygen. The kidneys 
205 should be kept active by diuretin (gr. xv) three times 
daily in water, or citrate of caffeine (gr. ii) three 
times a day. 
Strychnine is the most valuable remedy in doses 
of /jj to gr. every three hours. Tincture of digi- 
talis m. xx to m. xxx every four hours may be used. 
Attacks of faintness should be met by such reme- 
dies as aromatic spirits of ammonia, strychnine and 
whisky: 
1$. Spt. ammon. aromat 5vi 
Strych sulphat gr. 2/3 
Brandy q. s. ad. oiii 
M. Sig. One teaspoonful three times a day.# 
Alcohol is of little use; it should be kept for emer- 
gencies. 
HEART, FATTY. 
Treatment is along two lines: 1st. Obesity with 
anaemia. 2d. Obesity with plethora. 
Schott's Treatment is of benefit in the former and 
Oertel's in the latter (see under these headings). 
Alcohol should be entirely prohibited. Saline ca- 
thartics are of benefit, also potassium iodide for the 
accompanying sclerosis. Hard work, mental strain 
and excitement should be avoided. If diminution 
in the weight of the patient is attempted do not 
reduce him more than two or three pounds a week. 
Exercise is the best way to reduce the weight; walk- 
ing should be done from one to four hours after meals. 
Cardiac tonics such as strychnine, digitalis, stroph- 
anthus, camphor, ammonia and nitroglycerin are 
of service. Cathartics of the type of Pluto water, 
Carlsbad, Hunyadi, and Apenta should be used to 
keep the bowels free. Occasionally a purgative 
should be given such as compound infusion of senna, 
four ounces to be taken at one dose at bedtime. 
HEMORRHOIDS. (PILES.) 
Prophylaxis. Hard seats should be used instead 
of soft ones, for the latter favor the production of 
piles by pressing on the arteries as they emerge 
206 from the pelvis and so tend to drive the blood 
into the interior. A daily evacuation of the bowels 
should be obtained if possible without medicine. 
Highly seasoned dishes, gravies, salads, old cheese, 
alcohol and tobacco should be forbidden. A cold 
sitz bath should be taken every morning after stool, 
or after each passage apply freely cold or ice water. 
The treatment consists of astringent ointments 
and suppositories. 
The following ointment is useful in bleeding piles: 
I|. Gallse (pulv)grs. xx 
Opii pulv grs. x 
Ungt. plumb, subacetatgrs. xl 
Ungt. simplic 3i 
M. et ft. unguentum. 
Sig. Apply night and morning on lint after bathing 
parts with cold water. 
The following suppositories may be prescribed for 
internal piles: 
I). lodoformi 3i 
Balsam, peruv 3ii 
Magnes. oxidi 3i 
Cetacei 3ss 
01. theobromq. s. 
M. et ft. suppositoria No. xii. 
Sig. Insert one twice daily into rectum. 
Or: 
Extr. opii grs. ii 
Extr. belladonn grs. ii 
Ac. tannic 3ss 
01. theobromq. s. 
M. et ft. suppositor. No. x. 
Sig. One at bedtime. 
If much itching is present give a 1% carbolic salve, 
to be used twice daily. 
If the bowels refuse to act alone give: 
Fluidextr. cascar. sagrad. aromat... . §ii 
Sig. Fifteen drops in warm water before each meal. 
Increase or decrease the quantity if necessary. 
If local measures fail, surgical treatment is indicated. 
207 HERPES FEBRILIS or LABIALIS. 
Occurs during infectious diseases as pneumonia, 
and from the effects of a common cold. Little treat- 
ment is necessary because the sores are not very 
painful. An ointment like unguentum aquae rosae 
or unguentum resorcin co. N. F. will answer the 
purpose. 
HERPES PREPUTIALIS. 
Arsenic in the form of Fowler's solution, 5 drops 
in water three times a day usually cures this disorder. 
HERPES ZOSTER. (SHINGLES.) 
The treatment is directed first towards the relief 
of the pain, second to prevent suppuration and scar- 
ring. At the beginning give an active purge. For 
the fever and pain give: 
I). Quinin. sulphat grs. xxiv 
Phenacetin grs. xlviii 
Sodii salicylat 3iss 
M. et ft. caps. No. xii. 
Sig. One three times a day with hot water. 
If the pain is severe give larger doses of phenacetin. 
Locally, apply a saturated solution of menthol in olive 
oil four or five times a day. 
In order to avoid pitting, care should be taken to 
prevent suppuration and rupture of the vesicles. The 
vesicles should be painted over with flexible collodion, 
or dusted with a drying powder such as: 
I|. Powdered talc 87 parts 
Powdered starch lOparts 
Acid salicyl 3 parts 
M. Sig. Use three or four times a day. 
The general system should be toned up with qui- 
nine, arsenic, nux vomica, etc. 
HICCOUGH. (HICCUP, SINGULTUS). 
Often a temporary state after eating or exposure 
to cold, resulting from clonic spasm of diaphragm. 
In mild cases it can usually be arrested by a deep 
208 inspiration, holding the breath as long as possible. 
Sipping cold water, sneezing, drinking hot water, 
or binding a firm belt around the epigastrium are 
also of service. 
Sometimes hiccough is more serious, occurring in 
extreme exhaustion following acute or chronic dis- 
eases. It may also be reflex as from overloaded 
stomach, or from stomachic, hepatic, intestinal, or 
peritoneal disease. In these cases remove cause if 
possible. Correct the diet and give the meals dry. 
General tonics, rest, and massage are also of service. 
Pressure over the phrenics in the neck, pressure or 
ethyl chloride spray on the epigastrium, galvanism 
and faradism (one pole over each phrenic) may also 
be tried. Inhalation of amyl nitrite, and hypoder- 
mic injection of morphine and pilocarpine have also 
been found of service. Lastly, the Administration 
of atropine, hyoscine, nitrites, sodium bicarbonate 
or peppermint is of some value. 
HIVES. (URTICARIA, NETTLERASH.) 
Regulate the diet. Allay the itching by lini- 
mentum chloroformi, or a sponge bath with sodium 
bicarbonate, common salt, borax, ammonium chlo- 
ride, or vinegar: 
T|. Sod. bicarb §iv 
Sig. One tablespoonful to a cupful of water, and 
apply with a sponge. 
Or: 
I|. Chloroformi 3iv 
Olei gossypii sem gvi 
Sig. Shake well and apply freely to the body. 
For the constipation, saline laxatives should be given 
such as magnesium citrate or sulphate. Treat digestive 
disturbances with bismuth, or calomel and sodium 
bicarbonate. 
The following special drugs are also used: Sodium 
salicylate, quinine, tincture of belladonna, strychnine, 
and potassium bromide. 
209 In very severe cases the following should be painted 
with a camel's hair pencil on the parts which itch most: 
I|. Menthol 3ss 
Spts. vin. rect §iss 
Ether 3iss 
M. Sig. Apply two or three times a day with camel's 
hair pencil. 
Tinct. belladonna given internally is perhaps the 
best drug to use: 
I). Tinct. belladonn §ss 
Sig. Five drops three times a day. 
The patient should be instructed not to take violent 
exercise to make him perspire, because it is always 
followed by an outbreak of new wheals. Neither should 
the patient cover too warmly at night. 
Frequently an attack is brought on by eating straw- 
berries, cannted goods, as lobster, peas, etc.; these should 
be avoided. Alcohol should also be avoided. 
HOARSENESS. 
Look for and treat the cause if found. Hoarse- 
ness is generally due to accumulation of mucus on 
the vocal cords, or by roughness, swelling or relaxa- 
tion of the cords from laryngeal disease. 
The patient should avoid tobacco and alcohol. To 
give rest to his vocal cords he should keep perfectly 
silent, although when the hoarseness is due to misuse 
of the voice, a course of elocution or of vocal exer- 
cises may be of benefit. If any obstruction be found 
in the upper air passages, nose or pharynx, remove 
it. A change of climate is often beneficial. 
Of internal drugs, iodide of potassium and chlo- 
ride of ammonium are of some service, e. g.: 
1$. Ammon, chlorid grs. xx 
Tinct. belladonn m. xv 
Fluidextr. liquoric 5ii 
Glycerin 3iii 
Aqua? q. s. ad. §ii 
M. Sig. One teaspoonful every two or three hours. 
210 Local applications are preferable to sprays for the 
desired points can be touched exactly. The parts 
should be previously prepared by spraying them with 
a mild solution of cocaine (3 to 5%). Nitrate of silver 
(10 grs. to 1 oz.) or glycerite of tannin are of much 
benefit. 
If singers' nodes (trachoma of the vocal cords) are 
present they should be removed with a fine delicate 
forceps or with the galvano-cautery or an application 
of chromic acid. 
HODGKIN'S DISEASE (See Lymphaderoma). 
HOOKWORM DISEASE (Uncinariasis). 
Thymol, if properly administered, is a certain spe- 
cific for this disease. 
The patient should begin treatment by abstaining 
from all food for at least 18 hours previous to the 
administration of the thymol. 
To avoid toxic effects from the thymol the patient 
should not eat fats in any form during the treatment, 
as cream, milk, bacon, butter, etc. He must also 
avoid whisky, beer and wines, as they also dissolve 
thymol. 
The evening before giving the thymol a good-sized 
dose of epsom salts should be given. 
The thymol ought to be given in two doses, one 
hour apart. It is best given in cachets mixed with 
sugar of milk. For an adult give: 
I). Thymolgrs. lx 
Sacch. lactgrs. lx 
M. et ft. each. No. ii. 
Sig. Give one hour apart. 
Follow this in 3 or 4 hours with another dose of ep- 
som salts, or give sooner if symptoms of thymol 
absorption appear. The patient must lie on the 
right side after the administration of the thymol. 
The State Board of Health of Florida has given 
out the following table for the dosage of thymol: 
211 Under 5 years of age up to 8 grs. 
5 to 10 years of age 8 to 15 grs. 
10 to 15 years of age 15 to 30 grs. 
15 to 20 years of age 30 to 45 grs. 
20 to 60 years of age 45 to 60 grs. 
Over 60 years of age 45 grs. 
The general condition of the patient should also 
guide us in the dosage of the drug. 
The treatment ought to be repeated at intervals 
of one, two or three weeks, until the faeces are free 
from worms. 
The day after the thymol treatment the patient 
should have plenty of food, fresh air and sunshine. 
Iron should be administered to restore the blood: 
I|. Mass. Bland oii 
Mangan, dioxid grs. xii 
Strych. sulph gr. ss 
Ext. gentian grs. vi 
Ac. arsenios gr. 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
Or: 
I}. Syr. ferri iodid oi 
Sig. 15 to 30 drops three times a day in water through 
a glass tube. 
Or: 
I|. Liq. ferri et ammon. acetat oviii 
Sig. One tablespoonful three times a day. 
HORDEOLUM. (STYE.) 
When it is the result of constitutional debility, 
nourishing diet, fresh air and tonics are indicated. 
Look also for a local exciting cause, e. g., con- 
junctivitis or error of refraction and treat it if found. 
Spirits of camphor often abort the inflammatory 
process, while the application of hot water relieves 
the pain and hastens the termination of inflamma- 
tion. Warm poultices should not be used to hasten 
suppuration because of their irritating effect on the 
212 conjunctiva. The knife is very seldom necessary 
for the evacuation of the pus. Calcium sulphide 
in | grain doses every 3 hours may be given to abort 
the stye if seen early enough. 
HYDATID DISEASE. 
Prophylaxis. If there were no dogs containing 
taenia echinococcus there would be no hydatid dis- 
ease. High license fees and laws requiring the regis- 
tration of dogs would restrict the class of vagrant 
dogs which are more liable than the registered ani- 
mals to be infected by the offal of butchers' shops 
and abattoirs. Owners of dogs should not feed them 
with raw meat, cooking destroys any bladder worms 
which may exist. The water supply should be pro- 
tected from contamination with the tapeworm ova 
which are usually conveyed by the faeces of dogs. 
All who keep dogs should observe the strictest clean- 
liness in cleaning up their faeces. Suspicious water 
should be boiled and those ground vegetables which 
are usually eaten raw (lettuces, etc.) should be thor- 
oughly washed or scalded. Kissing pet dogs is not 
only a disgusting but a dangerous habit. 
Treatment. Puncture under antiseptic precau- 
tions, with an aspirator needle which should not 
exceed rle inch in diameter. This withdrawal of 
fluid cures by causing the death of the parasite. 
This operation is, however, dangerous because it 
sometimes induces suppurative changes. A safer 
proceeding is the removal of the parasite by incision 
and leaving the cavity of the adventitious sac to 
drain externally. 
HYDROCELE. 
The sac should be tapped under the most antiseptic 
conditions to prevent infection. After withdrawing 
the fluid with a syringe, inject ten or fifteen drops 
of carbolic acid or the same amount of tincture of 
iodine or chloroform to cause an adhesive inflam- 
213 mation. (This may be done by unscrewing the syr- 
inge from the needle, leaving the needle in position 
in the sac. Inject the solution through the same 
puncture.) Strap up the testicle for a few days and 
order the patient to remain in bed during this time. 
Before ten days elapse the sac usually refills, but 
this is gradually absorbed and is gone in about six 
weeks. If after that time the sac still remains large, 
repeat the operation. 
In children hydrocele is frequently curable by mul- 
tiple punctures with a needle. 
HYDROCEPHALUS. 
Very little can be done from a medical stand- 
point. Compression of the head with tight bandaging 
has been tried with occasional improvement. Punc- 
ture of the lateral ventricles with slow withdrawal 
of the fluid has done good in a few cases. Attempts 
to obliterate the ventricles have recently been made, 
but with a large percentage of failures. 
HYDROPHOBIA. (RABIES.) 
Prophylaxis. Systematic muzzling of all dogs. 
Immediate treatment. Suck bite and wash mouth 
immediately. Cauterize with red-hot iron or Pa- 
quelin cautery; or use strong carbolic acid. Then 
the patient should be sent immediately to a Pas- 
teur institute for treatment with attenuated virus, 
consisting of bits of spinal cord properly prepared 
from artificially infected rabbits. Confine animal 
which bit patient, keep it under observation, and 
send notes of its condition and progress to the Pas- 
teur institute. Do not kill the animal. 
If, in spite of everything, an attack comes on, the 
treatment is only palliative. Keep patient quiet in 
a darkened room, maintain nutrition by rectal ene- 
mata, and allay the paroxysms by chloroform in- 
halation, and hypodermic injection of morphine. 
214 The following may be given by the rectum tc 
assist in calming the convulsions: 
I|. Chloralis hydrat 5i 
Potass, bromid 5i 
Aquae 5 ii 
M. Sig. One dose. Repeat every three hours. 
HYPERCHLORHYDRIA (See Acidity, Gastric). 
HYPOCHLORHYDRIA (See Achylia, Gastric). 
HYPOCHONDRIASIS. 
Improve the general health. Give the patient 
congenial occupation and recommend amusements. 
He should avoid the ennui of an idle life. If any 
diseased conditions exist remove them, but do not re- 
move healthy organs or make too many exploratory 
incisions. Gain the patient's confidence, but do not 
ridicule his symptoms or supposed sufferings. Sug- 
gestive therapeutics may be of some benefit in these 
cases. 
HYPODERMOCLYSIS, PRACTICAL DIRECTIONS FOR. 
To the distal end of the rubber tube of an ordinary 
clean glass irrigating apparatus, tie a needle with a 
caliber about that of an antitoxin needle. Fill the 
reservoir with normal saline solution about 110° F. 
(to allow for cooling), and hang the reservoir about 
two feet above the level of the patient's body. 
Clean thoroughly and antiseptically the skin at 
the site of the operation, which should be about mid- 
way between the navel and the anterior superior 
spine of the ilium, and insert the needle taking care 
to avoid any large vessels. 
Another favorite place of injection is the chest, 
either on one side or on both sides at the same time 
with a double needle. 
It is necessary to avoid certain accidents and 
mistakes in using normal salt solution. One must 
know that the solution is sterile when it enters the 
' tissues of the body. Avoid air bubbles entering into 
215 bloodvessels or cellular tissue. The fluid must be at 
a sufficiently high temperature when it reaches the 
body. Chills occur from a cold solution and these 
are dangerous to very weak patients. The vessel 
containing the solution, as well as the tube and needle 
conducting it, must be aseptic and thoroughly per- 
vious; the tube should have a glass window so that 
the current and the presence of any foreign body 
may be noted. When the solution is to be intro- 
duced through the skin, either into cellular tissue 
or a vein, the local surface should be cleaned as much 
as the limited time will permit. Probably not more 
than half a liter should be injected into the tissues 
through one puncture, as localized necrosis and 
septic inflammation have resulted from over-dis- 
tension of the tissue spaces. Ordinarily not more 
than one ounce per minute should be injected into 
tissues or veins. 
HYSTERIA. 
Prophylaxis. Children who are predisposed to 
functional nervous disease should be trained and 
educated with the utmost care. Their self-control 
should be cultivated. Their whims should not be 
gratified and while they should not be over-indulged, 
neither should they be too severely punished nor 
ridiculed. They should be removed from associa- 
tion with hysterical persons. Early marriage should 
not be encouraged for it may aggravate the neu- 
rotic tendency. 
Treatment. This should be both firm and gentle 
and should be directed to the body as well as to 
the mind. Much depends upon the personality of 
the physician who should inspire the confidence of 
his patient. The patient should not be sympathized 
with too much, nor ridiculed as if she were shamming. 
Attend to the patient's general health. System- 
atic exercise in the open air, hydrotherapy, mas- 
sage and electric treatment are of the utmost im- 
216 portance. In obstinate cases, especially when as- 
sociated with mal-nutrition, Weir Mitchell's rest 
cure often gives excellent results. See Weir Mitchell's 
Rest Cure. 
The anaemia should be combated with arsenic 
and iron. Disease of the uterus if present should 
be attended to, but undue handling of the genitals 
should be avoided. 
For nervous irritability give bromides, camphor 
monobromata, asafoetida, phenacetin, chloroform, 
or valerian, but do not give chloral, opium or alcohol. 
The following pill may be given: 
3- Zinci valerianat grs. xlviii 
Quin, valerianat grs. xxiv 
Ferri valerianatgrs. xlviii 
M. et ft. caps. No. xxiv. 
Sig. One every four hours. 
ICHTHYOSIS. 
This congenital condition is readily relieved by 
the administration of thyroid extract in 5 grain 
doses four times a day. The condition returns 
however when the tablets are discontinued: 
IJ. Tab. extr. thyroid gr. v 
No. c. 
Sig. One four times a day. 
The external treatment consists in giving a hot 
bath with soft soap and plenty of friction to remove 
the epidermal masses. Morning and evening the parts 
should be massaged with some simple ointment to 
keep the skin supple and pliable. 
ICTERUS. (JAUNDICE.) 
Jaundice is a symptom, not a disease. Look for 
and treat the cause which may be any obstruction 
• in the biliary passages such as gall-stones, parasites 
or tumors (gumma, carcinoma, sarcoma). It may 
also be due to catarrhal swelling of the large or small 
biliary ducts, or it may be due to an extension of 
inflammation from the stomach closing the opening 
217 of the common duct. It may also be due to toxic 
substances as phosphorus, arsenic, snake venom, and 
the poisons of yellow fever, typhoid, pneumonia, 
etc. 
Icterus is a constant symptom of acute yellow 
atrophy, icterus neonatorum and atrophic cirrhosis 
of the liver. Emotions such as fright, etc., will 
often cause a mild jaundice. 
For the treatment of the above causes see the 
appropriate headings. In cases of temporary icterus, 
hot baths, sodium phosphate and salicylic acid prepa- 
rations are very useful. 
ICTERUS NEONATORUM. 
Little or no treatment is required, for this con- 
dition passes off in a few days. Syrup of rhubarb 
and calomel however are often administered. 
1$. Hydrarg. chlor, mit gr. i 
Sacch. lactgrs. xii 
Ext. rhei grs. ii 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
ILEO-COLITIS, ACUTE. (ENTEROCOLITIS, ACUTE 
COLITIS.) 
Prophylaxis. Diarrhoea in summer should never 
be neglected. Plenty of fresh air and proper clothing 
are essential. Indiscretions in diet should be avoided. 
The diet. During the first few days, milk should 
be withheld. Give skimmed milk, animal broths, 
rice and barley water; later on after the acute stage 
is over give raw beef, kumyss, eggs, boiled milk and 
milk gruels. Avoid such articles as potatoes, corn, 
tomatoes, and all fruits. 
At the beginning of the attack, give purgatives, 
stop all foods, and irrigate the colon. Castor oil 
should be given in the dose of one teaspoonful for 
a child six months old. It cleans and soothes the 
intestinal tract. If the stomach is irritable give: 
218 3- Hydrarg. chlor, mit grs. ii 
Sacchar. lact grs. xii 
Cerii oxalat grs. iv 
M. et ft. chart. No. xii. 
Sig. One every two hours. 
Opium must be given for the pain and tenesmus, 
but should not be given until twelve hours after the 
first dose of the purgative. Give it as in the following 
prescription: 
I). Bismuth, subnitrat 3iiss 
Tinct. opii camphorat 3iss 
Aquae anisi 3ii 
Aq. menth. pip 3ii 
Tinct. catechu 3ii 
Syr. acac q. s. ad. §ii 
M. Sig. One teaspoonful every three hours. 
Irrigation of the colon should be practiced in con- 
junction with other remedies. The water should con- 
tain a saline such as common salt (one drachm to the 
pint) at a temperature of from 100° to 110° F. One 
or two quarts should be injected high up into the 
colon with a long rectal tube twice a day. 
If the tenesmus is very severe, small injections of 
hot water, ice water and mild astringents may be 
given. The best astringents are tannic acid and hama- 
melis. Add one drachm of tannic acid to the pint of 
water. Injections should not be given when they do 
more harm than good, that is, if the child resists and 
screams. Some cases are much benefited by castor 
oil in small doses; that is, in emulsion every two hours. 
In cases which resist the above treatment, bismuth 
may be tried in large doses, one or two drachms in 
24 hours to a child one year old. For severe tenesmus 
inject: 
I|. Cocain. muriat gr. 
Amyli 3ii 
Tinct. opii gtts. v 
Aquae q. s. ad. §iii 
M. Sig. Inject into rectum at one time. 
219 Stimulants are necessary in most cases. For a child 
one year old give 10 drops of brandy in a teaspoonful 
of water every hour. When convalescence begins, 
carefully watch the diet so that an over-anxious parent 
does not overfeed. The following tonic may be given 
to a child one year old: 
I}. Liq. potass, arsenit gtts. vi 
Tinct. nuc. vomic gtts. xxiv 
Elix. gentian, glycerin §iss» 
Vin. xerci q. s. ad. §iii 
M. Sig. One teaspoonful three times a day. 
IMPETIGO 
The treatment of this disease is simple and rapidly 
curative. Remove the crusts by a thorough soaking 
in olive oil until they can be easily picked off, then 
apply: 
1$. Hydrarg. ammon. grs. x 
Ungt. petrolat Bi 
M. Sig. Apply twice a day. 
Usually complete cure results after a week's treat- 
ment. 
IMPOTENCE. 
Look for the cause and remove it if possible. 
The following prescription will be found of benefit 
in many cases of impotence: 
I|. Mass. ferr. carbonat 5ii 
Zinci phosphidi gr. iss 
Strych. sulphat gr. j 
Extr. damiani grs. xxxv5 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
The following may be given to debilitated patients 
with spermatorrhea: 
I). Auri et sodii chloridi gr. i 
Sodii arsenatis gr. ss 
Barii chloridi grs. iv 
Extr. nuc. vomic grs. xii 
Extr. cannabis indicse grs. vi 
220 M. et ft. pil. No. xxiv. 
Sig. One after each meal. 
Cantharis, phosphorus and strychnine are also of 
service. The following may be prescribed in cases of 
nervous debility: 
3. Camphorse grs. xxiv 
Quin, hydrochlor grs. xxiv 
Extr. nuc. vomic grs. xii 
Tinct. cantharid m. xxiv 
Oleoresinse capsici grs. iv 
M. Ft. pil. No. xxiv. 
Sig. One after each meal. 
If the patient is newly wed and the impotence is 
due to nervousness or to overwrought desire after a 
long engagement or sexual abstinence, he should be 
advised to sleep apart from his wife for a time and to 
make no attempt at sexual intercourse. Hydrotherapy 
and a diet of highly seasoned food, red meats, etc., 
will in a few days or weeks at most result in a condi- 
tion of restored vigor when coitus (usually matutinal) 
may be successfully performed. 
If the patient's impotence is due to sexual excesses, 
moral, or, what in this case is the same thing, hygienic 
advice should be given. This is of more value than 
drugs but in some instances bromides may be given. 
If the patient is the victim of quacks, masturbation 
or prolonged gonorrhoea, or of all combined, reassure 
him, and attend to his general health. At the same 
time the following prescription may be given in the 
hope of stimulating the sexual centers: 
1$. Zinci phosphid gr. J4 
Ferri arsenitis gr. i 
Strych. sulphat gr. i 
Quin, hydrochlor grs. xxiv 
M. et ft. pil. No. xxiv. 
Sig. One after each meal. 
The patient's mind should be diverted from his trou- 
bles, some imaginary, e. g., "lost manhood," others 
221 real, by change of air and pleasant surroundings. He 
should take outdoor exercise and if possible, salt water 
baths. The cold shower and sponge bath, followed by 
friction, and the alternate hot and cold douche to the 
spine are of considerable value. 
In some cases massage in the genital region includ- 
ing the perineum, testicles and groin, or the interrupted 
current passing from the perineum to the glans and 
from the groin to the testicle have been found of bene- 
fit. If, however, erections appear during these manipu- 
lations this treatment should be stopped. 
In cases of impotence and seminal weakness the 
following may be given: 
1$. Mangan, dioxid grs. xii 
Quin, valerian . . . grs. xxiv 
Ferri valerian grs. xlviii 
Acid, arseniosi gr. J4 
Extr. ergot® . . grs. viii 
M. et ft. caps. No. xxiv. 
Sig. One three times a day. 
Damiana forms the principal ingredient of the so- 
called "manhood-restorers" of quacks, and although it 
has some stimulant effect upon the sexual appetite 
and function its aphrodisiac powers are by no means 
so wonderful as charlatans have alleged their "man- 
hood-restorers" to be. Damiana is specially useful 
in cases of functional impotence and should be com- 
bined with nux vomica and phosphorus and especially 
with proper hygienic treatment. 
IMPREGNATION, PREVENTION OF. (See Conception, 
Prevention of.) 
INCONTINENCE OF URINE. 
In women this condition is often due to a vesico- 
vaginal fistula. Close the opening by operation. 
In old women it is often due to atony of the bladder 
so that coughing, laughing, and similar jars cause 
a sudden passage of small quantities of urine. Ten 
222 drops of tincture of cantharides in water after meals 
often relieves this condition. 
In old men the incontinence is often due to re- 
tention; the residual urine being due to enlarged 
prostate or other long-standing urethral obstruction. 
Incontinence is also found in certain long-standing 
nervous diseases as locomotor ataxia, etc. Strych- 
nine sulphate (3*0 gr.) may be given three times 
a day in locomotor ataxia. 
Urotropin should be used when the bladder is 
infected and the urine is alkaline in 5 to 10 grain 
doses, three times a day, well diluted with hot water. 
(See also Enuresis in Children.) 
INCUBATION PERIODS. 
In the following infectious diseases the incubation 
periods in days, are: (a) chicken pox, 10 to 16; (b) 
diphtheria, 2 to 10; (c) German measles, 7 to 18 or 
more; (d) measles, 10 to 14; (e) mumps, 10 to 22; 
(f) scarlet fever, 1 to 8, usually 3 to 5; (g) small-pox, 
12 to 14; (h) typhoid, 7 to 21, usually 10 to 14; 
(i) typhus, 5 to 14, very variable; (j) whooping 
cough, 7 to 14. 
INFANTILE SPINAL PARALYSIS. (ACUTE ANTERIOR 
POLIOMYELITIS.) 
Before paralysis occurs the treatment is symp- 
tomatic. The bowels are kept open by calomel fol- 
lowed by a saline. Tincture of aconite one minim 
every half hour may be given for the fever. 
When paralysis has occurred apply counter-irri- 
tation to the spine by painting with iodine, cupping, 
leeches, the Taquelin cautery, mustard poultices, 
etc. The child should be encouraged to lie on its 
stomach. A general mustard bath may be of use. 
Wrap the affected limbs in cotton wool. 
The following prescription is of use in the acute 
stage, or a child five years old: 
223 1). Tinct. aconit m. iv 
Spts. aether, nitres 5ii 
Aquae anisiq. s. ad. oii 
M. Sig. One teaspoonful every three hours. 
Chronic or paralytic stage. After two or three weeks 
apply counter irritants to the spine, e. g., iodine paint- 
ing and cupping, and begin galvanic electric treat- 
ment, applied both to the spine and paralyzed muscles. 
One large flat electrode (anode) is slowly stroked over 
the affected muscles and the other (cathode) over 
the spinal column. The applications should last about 
five minutes and should be repeated once every sec- 
ond day, and treatment kept up for several months. 
Massage, local bathing and shampooing are also of 
service. Give strychnine also in gradually increasing 
doses. 
The patient should take moderate exercise in the 
open air, and should use light gymnastic apparatus. 
For the prevention or correction of deformities and 
contractures application of splints, braces, and other 
orthopaedic appliances are necessary. Surgical inter- 
vention such as tenotomy and tendon-grafting may 
have to be resorted to. 
INFANTILISM. 
Try to determine the cause. If due to defective 
secretion of the pancreas (pancreatic infantilism) 
give pancreatic extract, three drachms per diem, 
to be taken two hours after food, with a little bi- 
carbonate of soda to prevent it being rendered in- 
active by the acid stomach contents. 
Infantilism may also be due to chronic diarrhoea, 
defective thyroid secretion or congenital syphilis, or 
it may develop without any apparent cause. 
INFANTS, FIRST CARE OF. 
Tie the umbilical cord, wash the child's eyes with 
boric acid solution, and wrap it in soft warm flannel. 
The first bath should be given in water at a tem- 
224 perature of 98° F. and the child should be dried be- 
neath warm flannel so as to avoid chilling its body. 
The second bath should be given at a temperature 
of 93° F. when the navel string has become detached 
(from the fifth to the ninth day). 
The infant's clothing should be warm, loose and 
easily removable. There should be no dragging on 
the navel, nor undue pressure on the chest or abdo- 
men; all should hang loosely from the shoulders. 
An abdominal band is not necessary, but if used it 
should not be pinned so tightly as to interfere with 
respiration or digestion. 
Apply the infant to the breast as soon as the mother 
has recovered from the exhaustion of childbirth. 
Feeding should be as regular as possible. The mother 
should not give the child the breast as soon as it 
cries for the fretting is generally due to colic and not 
to hunger. The child should be weighed every week 
to ascertain its gain or loss. (See also Feeding of 
Infant.) 
INFECTION PERIOD, CESSATION OF. 
In case of the following infectious diseases the 
period of infection ceases in (a) chicken pox, when 
every scab has fallen off; (b) diphtheria, in four 
weeks if no discharges and no albumin, and if the 
bacteriological examination of the nose and throat 
be negative; (c) German measles, in not less than ten 
days from the appearance of the rash; (d) measles 
in not less than two weeks from the appearance of 
the rash; (e) mumps, in not less than three weeks, 
and then only when one week has elapsed since 
the subsidence of all swelling; (f) ringworm, when 
examination reveals no broken-off diseased hairs; 
(g) scarlet fever, when desquamation and sore throat 
and albuminuria disappear, but never in less than 
six weeks; (h) small-pox, when every scab has 
disappeared; (i) typhus, after four weeks; (j) whoop- 
ing cough, in five weeks from the beginning, provided 
225 all characteristic spasmodic cough and whooping 
have ceased for at least two weeks. 
INFLUENZA (See Grippe.) 
INGROWN TOENAIL (UNGUIS INCARNATUS). 
Prophylaxis. Patient should take proper care of 
the feet and wear well-fitting shoes of good length, 
wide across the toes and with low broad heels. 
Treatment. The soft parts should be pressed back 
from the nail at its root and sides and the epithe- 
lium should be frequently removed. The middle of 
the nail should be scraped thin with a knife and a 
notch cut in the center of the free border in order 
to stimulate the growth there and away from the 
edges. 
INHALATIONS, HOW TO GIVE. 
Inhalations should be given in an inhaler or in 
a jug with a towel placed round it so that the pa- 
tient breathes only the steam. Water at 140° F. to 
150° F. should be used. A tent and steam kettle, 
so often used in bronchitis and tracheotomy may 
be made of folding screens covered by quilts or 
blankets so as to exclude all draught, and enable 
the space to be filled with steam. An equable 
temperature should be maintained especially in the 
case of young children and the supply of steam should 
be kept constant. 
INJECTIONS, HYPODERMIC, HOW TO GIVE. 
Great care must be taken in sterilizing both needle 
and syringe. Having first cleansed both needle and 
syringe fill the syringe accurately with the solution 
to be injected. Then drive the fluid to the point 
of the needle so as to expel the air. Next cleanse 
the skin and hold it firmly raised into a fold, then 
insert the needle in a direction nearly parallel with 
the surface into the fold. When the point has passed 
226 into the subcutaneous tissue empty the syringe slowly 
then withdraw it and place a finger over the puncture 
for a minute or two. Be very careful to avoid 
veins. 
INSANITY. 
Prevention by the State. A good deal might be 
done by government in the prevention of insanity, 
by the enactment of laws prohibiting the marriage 
of imbeciles, chronic epileptics, habitual drunkards, 
or persons belonging to markedly neurotic families. 
Colonies for the insane under government control 
should be fostered. Persons in indigent circum- 
stances showing signs of incipient insanity, as well 
as patients discharged from insane institutions 
should receive government aid and protection to 
enable them to support themselves. 
Treatment. To meet the excessive waste of tis- 
sues which is so characteristic of mental disease, 
concentrated nourishment should be given. In some 
cases forced feeding or nutrient and stimulant ene- 
mata may be necessary. Forced feeding is best 
done by nasal tubes with the patient seated, but 
the stomach pump may be necessary at times. Meat 
pulp and purees may be given in amounts 20% 
above the average rations in order to combat the 
constant danger of inanition. Chronic insanity is 
often due to defects in feeding at the curable stage. 
The frequent insomnia of insane persons may 
be combated by keeping the patient for a long time 
in the open air, by warm baths with cold applied to 
the head, and by giving hot drinks about bedtime. 
When these simple means fail, chloral hydrate either 
alone or combined with morphine or bromide of 
potassium may also be given. (See also under 
Insomnia.) 
The tendency to violence requires the most care- 
ful vigilance of experienced and sympathetic nurses. 
Restraint is unnecessary in the great majority even 
227 of acute cases, but when restraint must be resorted 
to, mechanical restraint by means of a restraining 
sheet is better than manual restraint by attendants 
and nurses. Manual restraint is too liable tc be 
abused by impatient attendants. 
In insanity due to syphilis the usual anti-syphilitic 
remedies are indicated. 
Patients with melancholia who refuse to take 
exercise, or who mope listlessly when sent out of 
doors, are often much benefited by vigorous massage. 
Turkish baths are of great service in melancholic 
and neurasthenic cases whether the patient be strong 
or debilitated, or whether he be old or young. 
In all cases of insanity the indications are to 
build up the weak and exhausted, encourage and 
divert the depressed, restrain the violent and ex- 
cited, and to care for the chronic and demented as 
if they were children. Above all, the methods should 
be humane; amusement, recreation, and useful 
employment should be given when feasible; there 
should be no punishments and very little physical 
restraint and that only when absolutely necessary. 
INSOMNIA. 
Treat cause if possible. In children it is usually 
due to gastro-intestinal disturbance. In the middle- 
aged often due to alcoholism or to business worries. 
In the aged to arterio-sclerosis. Insomnia is fre- 
quently one of the first symptoms of mania. The 
urine should be examined in every case of insomnia. 
Treatment. A warm bath or a hot foot bath, with 
mustard or a glass of hot milk on retiring is often 
sufficient. Usually hot whisky and water induces 
sleep, but sometimes causes sleeplessness. The in- 
terval between supper and bedtime should not be 
too great. 
Drugs used: chloral hydrate, opium, morphine, 
potassium bromide, potassium iodide, veronal, sul- 
phonal, trional. 
228 Of great benefit are trional in doses of 15 grs. 
at bedtime, or sulphonal in doses of 10 grs. to be 
repeated in one hour if necessary. 
In the insomnia of the acute fevers, e. g., typhoid, 
no special treatment is necessary beyond that for 
the fever itself. 
The following prescription may be used in nearly 
all cases of insomnia with satisfactory results: 
J|. Chloral, hydrat 3 iii 
Potass, bromid 3 iii 
Tinct. hyoscyam 3ii 
Aquae 5i 
Syrup, aurant. cortic q. s. ad. §ii 
M. Sig. One teaspoonful at bedtime. 
In stubborn cases repeat every hour until sleep is 
produced. 
This prescription is of special benefit in cases of 
insomnia due to alcoholism. 
INTESTINAL OBSTRUCTION, ACUTE. (ILEUS.) 
This is a condition where prompt diagnosis and 
treatment save many lives. The old treatment of 
"rest, opium and starvation" has no place in modem 
medicine. It is mentioned here only to be con- 
demned. 
When beginning treatment, do not under any 
circumstances give purgatives. Enemata may be 
tried. Food should not be given by the mouth as 
it only increases the patient's discomfort. If no 
relief is obtained after washing out the lower bowel 
several times, then the only proper treatment is 
laparotomy. Further delay is serious. The sooner 
the patient is operated on, the better are the chances 
of success. We should not wait for fecal vomiting. 
No case is too late for operation. The authors 
have recently seen recovery in a woman 65 years 
old who had bowel obstruction for six days and in 
whom it was necessary to remove 18 inches of 
gangrenous intestine. 
229 INTESTINAL OBSTRUCTION, CHRONIC. 
If due to stricture within or without the intestine! 
proper food should be taken. All indigestible ar- 
ticles of diet should be avoided, for example, cherry 
stones, watermelon seeds, raisins, orange pips, 
etc. Enemata should be given but purgatives should 
be avoided. If the stricture is in the rectum it 
should be stretched by bougies. If the stricture 
is due to carcinoma of the rectum, early operation 
will frequently prolong life three or four years. 
If the stricture is in the small intestine, resect and 
bring the ends together with a Murphy button. 
Bands around the intestine frequently cause chronic 
obstruction. The life of these patients is a miser- 
able one. They ought to be encouraged to submit 
to laparotomy early. 
INTUBATION, DIRECTIONS FOR. 
When there are progressive dyspnoea, labored 
breathing, cyanosis, physical depression and a fail- 
ing pulse, intubation is indicated, in cases of diph- 
theria. This operation is preferable to tracheotomy, 
because it is bloodless, shorter, easier and quicker. 
Two physicians and a nurse are usually necessary 
for the operation. The nurse sits upright holding 
the child in an upright position firmly against her 
left shoulder. The child is covered with a light 
blanket and its legs are firmly gripped by the legs 
of the nurse. The assistant physician standing be- 
hind the nurse's chair grasps the child's head be- 
tween his hands and holds it as though the child 
hung from the top of its head. 
The operating physician sitting in front of the 
child inserts the mouth gag between the left jaws 
and gives the handle of the instrument to the as- 
sisting physician to hold. Next a tube of the proper 
size is selected: 5 to 6 millimeters, one to two 
years; 6 to 7 millimeters, two to four years; 7 to 8 
230 millimeters, four to six years; 8 to 9 millimeters, 
six to eight years. The eye of the selected tube 
is threaded with braided silk. The operating phy- 
sician then inserts his left index finger into the 
patient's mouth, hooks back the epiglottis and 
passes the tube in the middle line until its tip en- 
gages in the glottis. By gentle pressure it is passed 
downwards until the introducer lies crowded against 
the tongue. The left forefinger is then taken from 
the epiglottis and pushes home the head of the 
tube at the same time that the obturator is released 
and withdrawn from the mouth. The finger and 
gag are then removed. 
The tube is usually replaced two, three or four 
times, and need rarely remain more than five or 
six days when the serum is used. It is removed 
by the extubator (extractor) or by a string. In 
an emergency when, there is a sudden blocking of 
the tube or in cases where the tube has slipped below 
its proper position, the child should be held head 
downwards and pressure made on the trachea just 
below the tip of the tube. 
INTUSSUSCEPTION. 
If the diagnosis is made before adhesions have 
formed, the intussusception may be reduced by in- 
flation with air or injection with about 6 quarts 
of normal saline solution. 
Air should be forced into the bowel by the anus, 
by means of a soft rubber catheter to which a bel- 
lows is attached. The air may be prevented from 
escaping by compressing the nates. This operation 
is best done under anaesthesia. 
Injection of fluid is made from a soft catheter to 
which a fountain syringe is attached and placed 
about five feet above the patient. In both pro- 
cedures the patient should be in an inverted position. 
Too much time, however, should not be spent 
over the methods of inflation or injection; if the 
231 condition is not relieved promptly, it should be 
treated as Intestinal Obstruction, Acute, which see. 
IRITIS. 
The treatment is both local and constitutional. 
Most cases are either syphilitic or rheumatic. 
Local treatment. Atropin should be used from 
the beginning to the end of the disease: 
1$. Atropin sulphat gr. i 
Aquae destillat 5ii 
M. Sig. One drop in the eye four times a day. 
When an eye is under atropin the patient should 
not go into direct sunlight, as it will produce headache. 
Hot water continuously applied on gauze for sev- 
eral hours a day relieves the tension and inflammation, 
besides assisting the action of the atropin. Blood- 
letting is also an important measure for the relief 
of pain and congestion. Three leeches should be 
applied to the temple. 
Constitutional treatment. If due to syphilis, push 
anti-syphilitic treatment as actively as possible. If 
the patient is in a hospital, give gr. of bichloride of 
mercury three or four times a day hypodermically. 
If it is not possible to use this method give inunctions 
of ungt. hydrarg. One drachm should be thoroughly 
rubbed into the skin two or three times a day until 
the gums become tender. If the inunctions are not 
convenient give the following pill: 
Pil. hydrarg. protoiodidgr- M 
No. c. 
Sig. Begin with two four times a day and gradu- 
ally increase till four grains a day are taken. 
If ptyalism results, stop the mercury and give iodide 
of potassium in large doses. Use the saturated so- 
lution which represents about one grain to the drop. 
Begin with 20 drops th"ee times a day and gradually 
increase. 
The internal treatment should be kept up for at 
232 least two years. See that the patient lives on proper 
food and under hygienic conditions. 
If anaemia is present give: 
I|. Hydrarg. cum creta gr. iss 
Ferri reducti gr. i 
Quin, sulphat gr. ss 
Pepsin gr. iss 
Pulv. opii gr. | 
Extr. gentian gr. 
M. et ft. pil. No. i. 
Sig. One three times a day. 
If the iritis is due to rheumatism, give some prepa- 
ration of salicylic acid, e. g., sodium salicylate, as- 
pirin, etc. 
I|. Sodii salicylat 5iv 
Vin. colchic. semin 3iv 
Aquae 3 iss 
Ess. pepsin q. s. ad. §iii 
M. Sig. One teaspoonful in a glass of hot water 
every three hours. 
In chronic cases, iodide of potassium, hot baths 
and diaphoretics ought to be used: 
I|. Potass, iodid 3iv 
Vin. colchic. semin 5iv 
Aquae 3 iss 
Syr. aurant. cortic q. s. ad. §iii 
M. Sig. One teaspoonful in water three times a 
day. 
ITCH. (SCABIES.) 
In all cases the burrows of the parasite must be 
opened up. This is done by soaking the patient 
in hot water for twenty minutes, then soaping thor- 
oughly with a strong alkaline soap such as sapo 
viridis. The affected parts should be scrubbed with 
a hard bristle brush so as to break the burrows. 
The patient should then be dried and either of the 
following ointments rubbed into the affected parts 
233 if the case is recent, or over the whole body if the 
case is chronic: 
Sulphuris sublimati oi 
Balsami Peruviani 3ss 
Adipis 3 i 
M. Sig. Rub in thoroughly. 
Or: 
I|. Betanaphthol 3ii 
Sulphuris loti 3ii 
Adipis benzoinati 3 ii 
M. Sig. Apply freely after hot bath. 
The patient should sleep with the applications on 
all night and take a soap and water bath in the morning, 
putting on clean underclothing. This treatment should 
be repeated for three nights in succession but never 
more. The underclothing should be sterilized with 
boiling water. 
IVY POISONING. (RHUS TOXICODENDRON.) 
The intolerable itching may be relieved by strong 
alkali solutions or by brine, or by a dilute solution 
of bromine. Hypodermic injection of morphine, etc., 
may be given to secure sleep. Vigorous cathar- 
tics are also of some value. 
The following prescription may be given: 
I). Sodii hyposulphit 3i 
Glycerini 3iv 
Aquas destillatq. s. ad. §viii 
M. Sig. Keep constantly applied. 
JAPANESE RIVER FEVER. 
The ulcer which develops at the point of en- 
trance of the germ into the body should be kept 
' surgically clean. The lymphangitis may be relieved 
by the application of cold. The rest of the treat- 
ment is symptomatic. The cautious use of quinine 
and sodium salicylate is often of service, and European 
234 observers have pointed out that the Japanese react 
much more readily to antipyretics than the white 
races. 
JOINTS, CHRONIC DISEASE OF. 
Blisters, counter-irritation, cauterization, appli- 
cation of heat and cold, massage, friction and gal- 
vanism are all usually beneficial in joint disease 
because of the improvement which they effect in the 
external circulation, and the corresponding diminu- 
tion of the internal congestion. 
Compression by means of rubber bandages pro- 
motes absorption of fluid from the cavity of a joint. 
By means of pads cut so as to fit in the depressions, 
this pressure should be exerted chiefly on the affected 
tissues and not on the prominent healthy parts of 
the bone. 
During active inflammatory conditions of the 
joint, its motion should be prevented (fixation). 
When convalescence is taking place, however, the 
natural function of the joint (motion) should be 
restored. 
The diseased joints should also be protected from 
jars, e. g.,by the use of crutches when the joints of 
the lower limb are affected. 
When the inflamed epiphyses are being crowded 
together, the bones should be pulled apart (dis- 
traction). 
KALA AZAR. (TROPICAL SPLENOMEGALY.) 
Prophylaxis. All cases should be isolated as soon 
as they are recognized. The families of the patients 
should be segregated also, and the houses in which 
they lived should be destroyed in order to prevent 
the disease from spreading among the other coolies. 
Treatment. Quinine in large doses helps to con- 
trol the fever and to lengthen the periods of apyrexia. 
Red bone-marrow given either raw or in tablet 
235 form often increases the number of polynuclears 
and in this way may benefit the leucopenia. The 
diarrhoea may be controlled by giving astringents 
like bismuth and salol, as well as by proper dieting. 
Change of climate or removal of the patient to a 
more healthy locality is of some service. 
KELOID. 
This new growth may be removed temporarily 
by means of caustic pastes, electrolysis or excision, 
but it is almost certain to return and in an aggravated 
form. 
The most hopeful treatment is by the injection 
of a ten per cent solution of thiosinamin either in 
alcohol or in equal parts of glycerine and water: 
[}. Thiosinaminse grs. xii 
Glycerini 3 ss 
Aquae destillatq. s. ad. §iii 
M. Sig. Inject hypodermically ten or fifteen minims 
into or around the keloid every three days. 
Good results have also followed the use of the 
X-rays, with quarter hour exposures of three amperes, 
using a vibrating interrupter and holding the tube 
about three inches away. 
Satisfactory results have also followed from em- 
balming the tumor and the skin in its neighborhood. 
This is done by injecting a twenty per cent sterilized 
solution of creosote in oil with a Pravatz syringe. 
KERATITIS, INTERSTITIAL. 
Treat the cause which may be syphilis, malaria, 
rheumatism, anaemia, rachitis, etc. 
If due to syphilis, give mercury by inunctions or 
internally in the form of the protoiodide of mercury 
pill (J4 gr- each) two to four, thrice a day. 
If due to malaria give 5 to 10 grs. of quinine three 
times a day. 
If due to rheumatism give salicylate of soda in 
15 gr. doses in hot water after each meal. 
236 If due to anaemia give Blaud's pills, 5 grs. each 
four times a day. 
If due to rickets give nourishing food, orange 
juice and syrup of hypophosphites, one teaspoonful 
four times a day. 
In cases due to debility give: 
I|. Liq. acid, arsenios 3i 
Syr. ferri iodid oiss 
Syr. aurantii cortic q. s. ad. §iii 
M. Sig. One teaspoonful in water after each meal. 
Plenty of fresh air and sunshine combined with 
good nourishing food in the country or at the sqashore 
are important adjuncts to the medicinal treatment. 
Local treatment. The patient must wear dark 
glasses to protect the eyes from the light. Hot stupes 
and atropin should be used: 
I|. Atropin. sulphat gr. i 
Aquse destillat 3ii 
M. Sig. One drop in eye three times a day. 
When the inflammation is on the wane, absorption 
may be hastened by massage with the yellow oxide of 
mercury ointment: 
I|. Hydrarg. oxid. flav grs. iii 
Ungt. petrolat 3iv 
M. Sig. A small quantity the size of a pin head 
on the lower conjunctiva. Rub thumb over upper lid. 
KERATITIS, PHLYCTENULAR. 
Remove its causes which usually are struma, 
intestinal parasites, adenoids, measles, eczema, im- 
proper feeding, etc. 
Treatment. The general health being below par, 
it is necessary to give such tonics as iron, phosphorus, 
and cod liver oil: 
3. Liq. ferr. peptonat. cum mangan. 
(N. F.) 3iii 
Sig. One teaspoonful in water after each meal. 
Or: 
237 I). Syr. ferr. iodid 5ii 
Sig. Half a teaspoonful in water after each meal. 
The diet should exclude candy, pastry, tea, coffee, 
bananas, etc. 
Locally. Frequent cleaning with a saturated so- 
lution of boric acid is necessary. Atropin should be 
used: 
I). Atropin. sulphat gr. i 
Aquae desHllat 3ii 
M. Sig. One drop in the eye four times a day. 
Hot stupes are very beneficial and also the following 
yellow oxide of mercury ointment: 
Hydrarg. oxid. flav grs. iv 
Ungt. petrolat. ... §ss 
M. Sig. Use once a day. 
KERATITIS, TROPHIC. 
When due to disease of the cranial nerves treat- 
ment is usually of little avail. 
The blebs and vesicles should be pricked open and 
the ulcers frequently washed with a hot saturated 
solution of boric acid. 
Internally, bismuth, arsenic, quinine and strych- 
nine are of some value: 
I|. Quin, sulphat grs. xlviii 
Strych. sulphat gr. % 
Ac. arsenios gr. 
Zinc, phosphid gr. J4 
M. et ft. caps. No. xxiv. 
Sig. One four times a day. 
KIDNEY, ACTIVE HYPER7EMIA OF. 
The patient should be put to bed and kept at 
an equable temperature (70° F.) for at least a week. 
The diet should be confined to liquids, such as milk, 
kumyss, barley water, etc. The bowels should 
be kept open with Carlsbad salts, one teaspoonful 
in hot water in the morning. The skin should be 
238 kept open by means of baths, hot or Turkish. Cup- 
ping over the loins is of decided benefit. Avoid 
liniments or poultices containing turpentine, mustard 
or cantharides lest absorption takes place and fur- 
ther irritates the kidneys. Give the patient plenty 
of water. Irritating diuretics must be avoided. 
The following may be given: 
1$. Potass, citrat oiii 
Spts. seth. nitros 3iii 
Aquae §ii 
Syr. limonis q. s. ad. Biii 
M. Sig. One teaspoonful every three hours. 
KIDNEY, AMYLOID OR WAXY. 
This disease can be prevented in the majority of 
cases if the cause (syphilis, tuberculosis, chronic 
suppuration) is properly treated. All chronic dis- 
charging sinuses should be freely opened. The 
urine of those suffering from the above disease should 
be frequently examined. /If albumin is present, 
treat as in Nephritis, Chronic, which see. 
KIDNEY, FLOATING OR MOVABLE. 
If the patient is thin, try to replace the peri- 
nephritic fat by forced feeding with cream, milk, eggs, 
etc. A properly fitting pad will frequently keep the 
kidney in place. If mechanical means fail, resort 
to surgery and stitch the kidney in its place. 
KIDNEY, PASSIVE CONGESTION OF. (CYANOTIC 
INDURATION.) 
Treat the cause which is usually some obstructive 
disease of the heart or lungs. The patient should 
be prohibited from leading a "strenuous life." 
Treatment should begin with ten days' rest in bed. 
Elimination should be encouraged by the skin, bow- 
els, and urinary organs. To secure free diaphoresis 
give hypodermically r10 gr. pilocarpin muriate. 
To secure free catharsis give Rochelle salts, Carls- 
239 bad salts, etc., in teaspoonful doses in hot water 
twice a day. Calomel in % gr. doses every hour 
till six grains are taken, produces not only free 
catharsis but diuresis. 
The drug which has been of most benefit is digi- 
talis; it may be given in the form of the infusion 
or tincture: 
1$. Infus. digital, fol. (freshly made).... gvi 
Sig. One tablespoonful four times a day. 
Or: 
I). Tinct. digital 5i 
Sig. Twenty drops in water three times a day. 
A liquid diet should be strictly adhered to. 
KYPHOSIS. (HUMPBACK.) 
Prophylaxis. In the young the strength should 
not be overtaxed and slouching habits should be 
forbidden. In the young adult a proper position 
should be assumed during occupation. In the aged, 
hot air baths, massage and exercise often give relief 
from the almost natural bowing of the back. 
LABOR, PROLONGED. 
When due to infrequent weak pains it is not usually 
necessary to do anything, for after a time the pains 
gradually become more severe. If they last for 
several days it is perhaps best to give a hypodermic 
of morphine sulphate (J4 gr.) at bedtime. 
When the pains are continuous and cramp-like 
causing considerable suffering without doing any 
good, a hypodermic injection of morphine sulphate 
(J4 gr.) combined with atropin sulphate (rJe gr.) 
may be given, or: 
I). Chloral hydratgrs. xxx 
Warm milk giv 
M. Sig. Inject this quantity into the rectum, and 
repeat in one hour if necessary. 
240 When due to secondary uterine inertia, give chloral 
hydrate in 20 gr. doses every three hours. 
Quinine in five grain doses is sometimes beneficial, 
and the same is true of ergot. One teaspoonful of 
the fluidextract may be given, but the use of ergot 
in labor should usually be restricted to the third stage. 
LACHRYMAL DUCT, STRICTURE OF. 
If possible, remove the cause, e. g., nasal hyper- 
trophy, acute or chronic inflammations of the lach- 
rymal sac, etc. 
Probes should be passed into the ducts and left 
in for ten to twenty minutes. This should be re- 
peated at first every two or three days, then gradu- 
ally increas the intervals and the size of the probes. 
Before passing through a probe a 2 per cent solution 
of cocaine should be used to allay pain. 
After the probe is withdrawn wash out the sac 
with a saturated solution of bicarbonate of soda, fol- 
low this with a per cent solution of nitrate of silver. 
If the stricture shows no sign of improvement 
after a couple of months' treatment, then remove 
the lachrymal sac and gland. 
LACTATION, TO DIMINISH. 
When the secretion of milk is excessive and poor 
in quality because of exhaustion (tabes lactealis), 
or if it persists when the child is not nursing (galac- 
torrhea), the child should be weaned at once, both 
in the interest of the child and of the mother, for the 
excessive flow is exhausting to the mother, and its 
poor quality is hurtful to the child. 
Tonics and change of air are to be recommended. 
Locally, atropin in glycerin or a belladonna plaster 
or ointment will be found beneficial. Electricity 
may be found of service, as also the internal ad- 
ministration of iodide of potassium. 
241 The practice of some women to prolong the nurs- 
ing period in order to avoid conception or because 
it is the custom of the country, e. g., in Japan and 
the Philippines where it may extend to two or more 
years, is a bad one and should be prohibited by the 
medical attendant. 
When the milk-secretion is out of all proportion 
to the needs of the child (polygalactia), the diet 
and especially the amount of fluids should be re- 
stricted. The over distended breasts may be emp- 
tied by massage or by the breast pump. 
LACTATION, TO INCREASE. 
When the quantity of milk is normal it cannot 
be increased by feeding, although individual con- 
stituents may, e. g., forced feeding with proteids 
or fats, increases the percentage of fatty matter in 
the mother's milk. 
But when there is a deficiency of milk due to the 
poor health of the mother or to poor diet, the secre- 
tion may be considerably increased by a generous 
diet consisting of rich food, Guinness' stout, malt 
extracts, beef juice, tonics, etc. Hard or soft shelled 
crabs, shell fish and other forms of sea food are of 
special value in stimulating the milk secretion. 
Among vegetables, boiled fresh beets are also of 
benefit. Gentle massage, change of air, etc., are 
all valuable adjuncts. Pilocarpine nitrate gr.) 
injected hypodermically also increases the secretion. 
LANDRY'S PARALYSIS. 
The treatment is the same as that for Myelitis, 
which see. 
LARYNGISMUS STRIDULUS. (SPASMODIC CROUP.) 
Prophylaxis. Remove adenoids and hypertro- 
phied tonsils, attend to the digestion, diet, and 
general hygiene of the patient. 
242 Treatment of the paroxysm. Dash cold water 
on the face and head, or give for inhalation a few 
drops of nitrite of amyl, or cause emesis by giving 
vin. ipecac, in doses of half a drachm to one drachm 
until vomiting is produced. The emesis not only 
rids the stomach of any irritating contents but it 
relieves the spasm of the laryngeal muscles. 
In the interval between the attacks, give the 
child nutritious diet, cod liver oil, hypophosphites 
and arsenic: 
I|. Pancreatini 3ii 
Olei morrhuae §ii 
Syrupi hypophosphiti 
Acaciae 3iv 
Liq. calcq. s. ad. oviii 
M. Sig. Shake the bottle. One to two teaspoon- 
fuls three times a day two hours after each meal. 
The following mixture, combined with a rectal in- 
jection to evacuate the bowels, may be used to abort 
an impending attack: 
]$. Potass, bromidgrs. xxiv 
Chloral, hydrat gr. viii 
Syrupi acaciae 3ii 
Aquaeq. s. ad. §i 
M. Sig. One teaspoonful in water every four hours. 
In all cases of laryngismus stridulus look for the 
exciting cause; the stomach may require attention, 
or the gums may need lancing. 
LARYNGITIS, ACUTE CATARRHAL. 
The patient should avoid using his voice. If 
the case is a mild one he need not be confined to 
bed but should remain in a room, the air of which 
is at a temperature of 70° F. to 75° F. and is ren- 
dered moist by means of steam. An ice-bag or the 
application of hot or cold compresses to the throat 
will relieve the pain and discomfort. A mild ape- 
rient may be given at the outset and the cough may 
be controlled by: 
243 I|. Codein® phosphat gr. v 
Aquae amygdalae amarae §ss 
M. Sig. Five to fifteen drops every two hours. 
Or give: 
I}. Potass, citrat 3ii 
Vin. ipecac 3iv 
Tinct. opii camphorat 3iv 
Syr. tolutan 3 iss 
Aquae q. s. ad. §iv 
M. Sig. A dessertspoonful every three hours. 
Relief may also be obtained by frequent inhalations 
of steam medicated with compound tincture of ben- 
zoin, turpentine or eucalyptus. About one part of 
each may be used to 128 parts of boiling water. 
LARYNGITIS, CHRONIC. 
Prophylaxis. Persons subject to this disorder 
should avoid exposure to cold and wet, the abuse 
of tobacco and alcohol, and the inhalation of dust 
and irritating vapors 
The larynx should first be cleansed with an 
alkaline spray such as dilute liquor antisepticus 
alkaline and then terebene, or eucalyptol should be 
inhaled from the surface of boiling water. Or after 
cleansing the parts should be treated by an astrin- 
gent spray such as zinc sulphate (10 grs. to the oz.) 
While the larynx is being sprayed the patient should 
inhale so that the vapor may be drawn into con- 
tact with the inflamed area. 
Powder insufflation is often very useful; the fol- 
lowing may be prescribed: 
I). Ortho form gr. i 
Ac. boric gr. i 
Morph, sulphat gr. 
M. Sig. Powder for insufflation. 
In all cases of chronic laryngitis the expectoration 
should be examined for the tubercle bacillus. 
244 LARYNGOSCOPE, DIRECTIONS FOR USE OF. 
To inspect the larynx, hold the tongue well out 
so as to pull forward the epiglottis and then the 
structures below appear in the laryngoscopic mirror 
in the reversed position. Beneath the middle of 
the epiglottis, the cushion of the epiglottis may 
be seen as a slight swelling, and continuing down- 
wards and backwards from the edges of the cartilage 
may be seen the false and true vocal cords, each 
marked at its extremity by two rounded nodules. 
In quiet breathing the glottis is nearly stationary 
and open to the extent of about three to five milli- 
meters. The vocal cords bounding it look white 
and glistening in contrast with the red color of the 
general mucous membrane. 
LARYNX, FOREIGN BODY IN. 
Patient breathes more easily if placed on his back 
on table with head hanging over edge, and removal 
of body is thereby facilitated. Use laryngeal for- 
ceps, aided by laryngoscope. If asphyxia threatens 
perform tracheotomy. If the foreign body is round 
and smooth, invert the patient head downwards 
and strike upon the back. 
LARYNX, TUBERCULOSIS OF. 
The treatment must be local and general, whether 
the disease is primary or secondary. 
Local treatment. Occasionally we are able to 
arrest the ulceration by cauterizing the affected 
area with 25, 50, or even 75 per cent lactic acid, after 
the spot has been thoroughly anesthetized with a 
10 per cent solution of cocaine. 
The ulcerated area should be sprayed once or 
twice a day with 20 grains of menthol to a drachm 
of olive oil. Or: 
I|. Menthol grs. xl 
01. eucalypt 3i 
01. pin. pumil m. xxx 
Liq. petrolat. U. S. P.. ..q. s. ad. giv 
M. Sig. Spray into larynx once a day with atomizer. 
245 I). Cocain. muriat grs. xxv 
Orthoform■ grs. cc 
Iodoform grs. cl 
Zinci stearat. co.. grs. c 
M. Sig. Blow a small quantity into the larynx 
with a powder blower. 
Inhalations of steam impregnated with oil, as creo- 
sote, carbolic acid, etc., occasionally do some good. 
General treatment. The patient should have fresh 
air, plenty bf sunshine, properly ventilated rooms, 
exercise in the open air, and a good nutritious diet of 
milk and eggs. For further treatment see Tuberculosis. 
LEAD POISONING, ACUTE. 
Use the stomach tube or give an emetic. Give 
either (a) half an ounce of magnesium sulphate 
in a glass of water, or (b) half an ounce of sodium 
sulphate in a glass of water, or (c) thirty minims 
of dilute sulphuric acid in a glass of water. 
Give freely milk or white of egg or a demulcent 
drink. The pain may be relieved by the hypoder- 
mic injection of morphine sulphate. 
LEAD POISONING, CHRONIC. 
Prophylaxis. In factories where lead is used, 
the dust and smoke in the workrooms should be 
carried away by hoods fitted over the mouths of 
furnaces or over work-tables. Before eating, the 
hands of the workmen should be washed, and their 
outer clothing changed. No workman should be 
allowed to eat in the workshop. The men should 
be encouraged by free baths to bathe as much as 
possible. 
Treatment. During an attack of colic the first 
indication is to empty the bowels. This is best ac- 
complished by a heaping teaspoonful of magnesium 
sulphate every two hours, or by several doses of castor 
oil. If the pain is very severe it may be necessary 
to give a hypodermic injection of morphine (J4 gr.) 
246 every four to six hours. A high enema of warm 
water with soap suds should be used to clear the 
lower bowel. Apply hot poultices or fomentations 
to the abdomen. A daily hot bath also helps to 
eliminate the lead from the system. After the colic 
is over give potassium iodide in 5 to 10 grain doses 
three times a day to drive the lead from the tissues. 
3- Potass, iodid oiv 
Ess. pepsin §iii 
M. Sig. One teaspoonful in water three times a day. 
Sodium sulphite is also extensively used for the 
elimination of lead; it is given in doses of to 1 grain 
every four hours. 
1$. Sodii sulphitisgrs. xii 
Tinct. cinnamon 3iv 
Aquaeq. s. ad. §iii 
M. Sig. One teaspoonful every four hours. 
If paralysis occurs eliminate the lead as described 
above and locally apply electricity and massage. Hypo- 
dermic injections of strychnine sulphate (gr. -g\j) three 
times a day should also be used. If the wrist drops 
down it should be carried in a sling rather than allow 
it to hang down. 
LEECHES, DIRECTIONS FOR APPLYING. 
Wash the patient's skin well with hot water and 
plain soap (not scented). Never apply antiseptic 
lotions. Place the leech in a test-tube half full of 
cotton wool and hold it over the place. Put a little 
milk on the skin if the leech is slow in biting. When 
the leech is full allow it to fall off. or sprinkle a 
little salt on it to hasten its removal. Never pull 
them off, as their teeth may remain in the wound and 
cause a troublesome sore. Warm fomentations over 
the bite encourage bleeding. When the bleeding is 
to be arrested, a film of cotton wool placed on the 
bite, or pressure, cold applications, or a styptic like 
adrenalin is usually successful. 
247 LEECHES, LAND. (PHILIPPINES, CEYLON, NEW 
GUINEA, FORMOSA, ETC.) 
Travelers should be very careful in entering forests 
in these countries, and should ascertain from the 
natives whether leeches abound in them or not. 
On stepping into a forest one may be warned by 
hearing them rustling among the leaves. When 
they have bitten they may be made to loose their 
hold by the application of salt or a weak acid. At- 
tempts to pull them off should be avoided, as parts 
of the biting apparatus are often left in the wound 
and may cause inflammation. Sometimes the wound 
may become infected with bacteria and cause trouble. 
LEPROSY. 
Prophylaxis. Prohibit the importation of known 
lepers, though the disease easily evades ordinary 
inspection, making this very difficult. Isolation 
should be resorted to in countries where leprosy has 
a great extension. Obligatory notification of the 
. disease. Compulsory segregation when possible. If 
not possible, care for indigent lepers in an institution, 
while well-to-do patients may remain at home under 
proper care and restrictions. 
Hygienic treatment. Fresh air, dry, well-vent i- 
lated dwellings, plentiful and varied diet, warm 
clothing, frequent changes of clothing, daily hot 
baths (105° F. or higher). 
Medicinal treatment. Chaulmugra oil in doses 
of 5 minims, morning and evening, gradually in- 
creased until the patient is taking 250 minims daily 
in three doses. This drug may also be given hypo- 
dermically (5 min. increasing to 60 min.) 
Externally, chrysarobin, ichthyol or resorcin may 
be applied to the affected parts. 
Under the influence of the X-rays discolored patches 
and nodules often diminish and sometimes disap- 
pear. 
248 Surgery often can do much for lepers. Amputa- 
tion of a useless or gangrenous member, nerve- 
stretching to relieve pain, and tracheotomy when the 
larynx becomes invaded and dyspnoea is threatened. 
LEUCORRHEA. 
This is a symptom and not a disease. Look for 
and treat any local cause, and at the same time 
improve the general health of the patient by inter- 
nal remedies like quinine sulphate, iron and arsenic. 
In the leucorrhea of pregnancy, give a vaginal 
douche at bedtime of a tablespoonful of alum in 
a quart of water followed by the following sup- 
pository: 
I). Zinci borat gr. i 
Extr. belladonna gr. 
Hydrastin hydrochlor gr. i 
Boroglycerid 5 ss 
M. et ft. suppos. No. i. 
Sig. Insert one in vagina at bedtime. 
In gonorrhoeal leucorrhea keep the skin of the sensi- 
tive and swollen genitals clean by means of a vulval 
pad of absorbent cotton held in position by a napkin. 
Replace pad and napkin several times daily. When 
the swelling and sensitiveness have subsided, intro- 
duce a speculum and remove the secretion from the 
entire surface with absorbent cotton. Then use: 
I). Argent, nitrat .grs. xc 
Aquae B iii 
M. Sig. Apply carefully to vaginal mucous mem- 
brane through speculum thrice a week. This treat- 
ment should not be stopped till all discharge has ceased. 
In the leucorrhea of children look for worms (lum- 
bricoids or ascarides) and destroy them if found. 
Dislodge them from the rectum by a suitable cathar- 
tic. Then irrigate the vagina with the following: 
I}. Sodii bicarb §ii 
Ac. carbolic 5iv 
Glycerini 5iv 
Sat. sol. ac. boricq. s. ad. Bxvi 
249 M. Sig. One tablespoonful in a pint of water once 
or twice a day. 
If leucorrhea is due to exposure to cold give: 
I). Plumb, subacetat gii 
Laudani - gii 
M. Sig. One tablespoonful in a quart of hot water 
once a day. 
Or: 
Plumb, subacetat giss 
Zinci ace tat giss 
M. Sig. One teaspoonful in a quart of hot water 
once or twice a day. 
For the leucorrhea of unmarried girls the following 
may be given: 
I|. Hydrastin commercial 5i 
Acidi borici gii 
M. Sig. One teaspoonful to each quart of hot water 
once a day. 
Where an astringent is necessary give: 
I}. Acidi borici §i 
Pulv. alum. 5iv 
Ac. tannic 5iv 
M. Sig. One teaspoonful to each quart of hot water 
twice a day. 
Where an antiseptic is necessary (e. g., gonorrheal) 
give: 
3- Liq. cresolis comp. (U. S. P.) 5ii 
Sig. Half a teaspoonful to each quart of hot water 
three times a day. 
Or: 
I}. Alumin 3i 
Zinci sulphat 3ss 
Ac. boric grs. iv 
M. Sig. Dissolve in half a pint of warm water 
and use with a vaginal syringe twice a day. 
Another useful solution is a tablespoonful of boric 
acid or sodium chloride to a quart of hot water. 
250 LEUKAEMIA, ACUTE LYMPHATIC. 
This disease runs a short but fatal course in six 
weeks or less. The high fever should be treated 
with hourly cold sponging and ice-bag to head. 
The weakness should be met with strychnine, am- 
monia, nitroglycerin or digitalis: 
I). Strych. sulphat gr. f 
Tinct. digitalis 3ii 
Sp. glyceryl, nitrat. (U.S. P.) m. xxv 
Spts. vin. gall q. s. ad. 3iii 
M. Sig. One teaspoonful every three hours by 
mouth or hypodermically. 
Iron is of no value; X-ray treatment is of no avail. 
LEUKEMIA, CHRONIC LYMPHATIC AND MYELOG- 
ENOUS. 
The treatment is unsatisfactory in most cases. 
Arsenic in the form of Fowler's solution should be 
tried. It-can be given in 5-drop doses three times 
a day and gradually increased until the physiologic 
limit is reached. 
If haemorrhages occur from the nose, intestines, 
etc., they must be controlled by remedies recom- 
mended under those headings. 
X-ray treatment has been used with considerable 
success in prolonging the patient's life. The authors 
have repeatedly seen leucocyte counts of 200,000 
drop to 30,000 with marked improvement in the 
patient's general condition. This improvement, how- 
ever, is only temporary. 
Rest in bed is also of considerable importance 
as an adjunct to treatment. 
LEUKOPLAKIA BUCCALIS. (SYPHILITIC.) 
Smoking, use of condiments, etc., and other 
sources of irritation should be forbidden, and irreg- 
ular teeth attended to. The teeth should be cleaned 
and the mouth washed out with Condy's fluid at 
least twice daily. A two per cent solution of chromic 
acid or perchloride of mercury painted on daily gives 
251 relief. The brush must not be dipped directly into 
the bottle containing the perchloride of mercury 
solution or the solution soon becomes inert. In 
severe cases painting on strong acid nitrate of mer- 
cury will give relief for a month or two and may be 
used once in three months. 
LICE, ON BODY. 
Boil the clothing so as to kill the lice (pediculi 
corporis) which live in the seams and deposit their 
eggs there. Relieve the itching by warm baths to 
which sodium carbonate or bicarbonate has been 
added. White precipitate ointment may be smeared 
over the shoulder and armpits. 
LICE, ON HEAD. 
Cleanly habits are usually all that is necessary; 
but some aggravated cases may require preparations, 
e. g., kerosene oil and olive oil in equal parts (in 
using this warn the patient to keep it away from 
light or heat), carbolic acid lotion, corrosi ve sub- 
limate lotion, white precipitate ointment (made 
with lanoline), oleate of mercury, or the following: 
1$. Acid, salicyl pts. ii 
Aceti pts. xxv 
Alcohol (80%) pts. Ixxv 
Sig. Rub on area affected with a piece of flannel. 
As a preventive measure the patient, as well as his 
brushes, towels, etc., should be isolated to prevent 
infection. 
LIGHTNING SHOCK. 
If the patient has been struck by lightning, rouse 
him and keep up the respiration and circulation. 
The cold douche, friction of the limbs, warmth 
applied to the extremities and the administration 
of stimulants by the mouth or in the form of ene- 
mata should be tried. 
LIVER, CIRRHOSIS OF. 
Remove the source of the irritation if discoverable. 
Stop the use of alcohol at once. The diet should 
252 be carefully regulated; exclude coffee and spices. 
Milk is the ideal diet at least until the irritation of 
the stomach quiets down. Bitter tonics should be 
given to stimulate the appetite as: 
Tinct. nuc. vomic 3iv 
Tinct. quassise 3ii 
Tinct. gentian comp 3ii 
Ess. pepsin q. s. ad. giii 
M. Sig. One teaspoonful in water before each meal. 
Or: 
I|. Acid, nitro-muriat dil 3iv 
Tinct. nuc. vomic 5iv 
Aquae §ii 
Syr. aurant. cortic q. s. ad. §iii 
M. Sig. One teaspoonful in water after meals. 
Dropsy should be treated by restriction of diet, 
withholding common salt, decreasing the quantity of 
fluid ingested, and by the use of diuretics. Hydragogue 
purgatives such as compound jalap powder, one tea- 
spoonful every morning should be given. Turkish 
and Russian baths are indicated in robust individuals. 
Tapping should be resorted to after all other means 
are exhausted. 
Haematemesis is controlled by cold applications to 
the abdomen and the use of opium. Adrenalin and 
other astringent drugs are useless. 
Small doses of phosphate of soda seem to produce 
frequently an improvement in the general symptoms: 
I). Sod. phosphat 5iii 
M. Sig. One teaspoonful in water three times a day. 
LOCOMOTOR ATAXIA (See Tabes). 
LUDWIG'S ANGINA. 
Early and free incision should be made to evacuate 
pus, relieve tension, and so to lessen the danger of 
suffocation. For the oedema of the glottis trache- 
otomy may be necessary. Tonics and nourishing 
food should be given to support the strength of the 
patient while recovering from the ptomaine poison- 
ing- 
253 LUMBAGO. 
Patients subject to this disease should dress 
warmly and avoid overheating and exposure. 
Local treatment. Fomentations, flannel binder, 
ether spray, ice blister, mustard, camphor, capsicum, 
turpentine, hot iron, needle passed into erector spin® 
muscle, high frequency electric current followed by 
vibration massage, belladonna or menthol co. plaster. 
Liniments may be applied such as: 
1$. Chloral, hydrat. 
Camphor. 
01. cajuput .aa 3i 
01. gualtheri® 3ss 
Lin. saponis .. . q. s. ad. " iv 
M. Sig. Use three times a day. 
Or: 
J). Lin. ammon. N. F giv 
Sig. Use three times a day. 
The benefit from liniments such as these is as much 
due to the rubbing as to the liniment itself. 
Turkish baths, hot air baths, and hypodermic in- 
jection of morphine are also of service. 
Internal treatment. The drugs used are: salicyl- 
ates, aspirin, potassium iodide, guiacum, ammonium 
chloride. The following may be given: 
1$. Sodii Salicylat 3iv 
Tinct. cimicifug® . 3i 
Potass, iodid 5ii 
Aqu® § i 
Ess. pepsin . ,q. s. ad. §iii 
M. Sig. One teaspoonful in very hot water every 
three hours. 
Or: 
I). Salicini. 3ii 
Kryofini .... „. 3ss 
Pulv. Doveri grs. xxiv 
M et ft. chart. No. xii. 
Sig. One every three hours with hot water. 
254 LYMPHADENOMA. (HODGKIN'S DISEASE, PSEUDO- 
LEUKEMIA.) 
The general nutrition should be maintained by 
regulating the diet and attending to hygienic meas- 
ures. Tonics such as iron, strychnine and cod liver 
oil are of service. Bone marrow should be tried. 
Of the drugs used arsenic is the most efficacious 
in diminishing the swellings and improving tne 
condition of the patient. Three or four minims 
of Fowler's solution should be given well diluted, 
three times daily after meals. Increase the dose 
each week by one minim until the patient is taking 
20 to 30 minims three times a day. 
The Roentgen rays are also of great benefit in 
this disease. (See X-Rays, Employment of.) The 
rays are applied to the enlarged glands, the spleen, 
chest, elbows and knees. Care should be taken to 
avoid bums, and the organs of generation should 
be protected by an opaque screen. 
LYMPHANGIOMA. 
An elastic support will prevent the further dilata- 
tion of the lymphatic vessels. The masses may be 
extirpated if they are not too extensive. Appro- 
priate precautions should be taken when rupture 
of the vessels is imminent. 
LYMPHCEDEMA. 
Elevation of the part, massage and wearing an 
elastic bandage are of service. In stubborn cases 
excision of the redundant tissue may be resorted 
to when the genitals are affected. In severe cases 
where the lower limbs are involved ligation of the 
main artery may be necessary in order to cut off 
the vascular supply. 
MALARIA, PERSONAL PROPHYLAXIS. 
Those who live in a malarious locality should 
take mechanical and medicinal measures to avoid 
the disease. The mechanical measures consist in 
2.55 precautions to avoid being bitten by mosquitoes. 
Mosquito bars should be used on the beds, and holes 
in them carefully repaired. A mosquito net improp- 
erly used is as bad as none at all. Wear a hat 
provided with a mosquito net as well as gaiters 
for the ankles, and gloves for the hands if one is 
obliged to expose himself among infected mosquitoes. 
Dwellings should be located on as high ground as 
possible and away from stagnant water. Doors and 
windows should be screened with netting. Since 
the mosquito is much more active about sunset, 
and at night, it is best to remain indoors at those 
times if possible. 
The medicinal measures consist in the use of 
daily doses of about six grs. of quinine. 
MALARIA, PUBLIC PROPHYLAXIS. 
This consists in the reduction of mosquitoes by 
drainage or other treatment of their breeding waters. 
Permanent works of drainage should be established, 
pools, ponds, and marshes should be filled up. An 
oily film over the surface of water containing the 
larva or pupa of the mosquito prevents them from 
getting air and thus kills them. Coal oil is the 
best and cheapest for this purpose. Drainage, or 
coal oil, or both, have nearly exterminated the 
mosquito at Havana, Oyster Bay, Long Island, 
Port Swettenham, and Ismailia. 
MALARIA, TREATMENT OF. 
During the paroxysm the patient is to be put 
to bed. In the cold stage he should be made as 
comfortable as possible with warm coverings and 
hot drinks. In the hot stage he should be lightly 
covered and given cold sponging or tub baths and 
cool drinks. For the fever give: 
I|. Antipyrinaegrs. x 
Ft. chart. No. i. 
Sig. Give one powder and repeat in an hour if 
required. 
256 When the patient is perspiring freely, wiping his 
skin with hot flannel gives relief. 
The great and reliable remedy in this disease is 
quinine, but before beginning this drug the bowels 
should be cleaned out. Give: 
J|. Hydrarg. chlor, mit grs. xii 
Sacchar. lact grs. xii 
Extr. colocynth grs. xii 
M. et ft. chart. No. xii. 
Sig. One every hour until purgation is produced. 
In ordinary intermittent malarial fever the total 
amount of quinine required per day to cut short the 
paroxysms is from 15 to 20 grs. This may be given in 
the following way: A four grain dose immediately 
after the close of the hot stage; a five grain dose five 
hours later; and the remaining six (to eleven) grains, six 
hours before the time for the next paroxysm. This 
division of the dosage is not only convenient, but 
avoids the slight toxic symptoms (tinnitus, deafness, 
nausea, etc.), which are apt to follow single large 
doses. Administering the largest dose six hours be- 
fore the expected paroxysm impregnates the blood for 
about an hour before sporulation takes place. 
The quinine may be given in solution, in pill form, 
or in capsules. The solution is more readily absorbed 
than the other two forms, but the bitter taste is an 
objection. Compressed tablets and stale pills are 
likely to pass through the body undissolved. 
In aestivo-autumnal fever the patient should be 
treated as in ordinary intermittent fever, but larger 
doses of quinine (30 to 40 grains per day) are usually 
necessary, and the patient needs more careful nurs- 
ing. Vomiting may interfere with the administration 
of quinine by the mouth and it may be necessary to 
give it hypodermically in the form of the hydrochlo- 
rate. Enemata of quinine dissolved in starch water 
are also useful in these conditions. 
In pernicious malarial fever the most energetic 
257 treatment is necessary. The patient should be brought 
as quickly as possible under the influence of quinine 
by injecting at once into the tissues of the buttock 
the following solution: 
1$. Quininae hydrochloridi grs. xv 
Sodii chloridi gr. i 
Aquae destillat 5iiss 
This injection should be done under strict anti- 
septic precautions to avoid the formation of abscesses. 
Malarial cachexia. In this condition Warburg's 
tincture in half ounce doses three times a day is of 
great service. Here iron and arsenic are of great 
value in addition to the quinine: 
I|. Quininae hydrochlor 5ii 
Ferr. et potass, tartrat 5ss 
Arseni trioxidi gr. i 
Aquae destillatae q. s. ad. 5iv 
M. Sig. One teaspoonful after each meal. 
MALTA FEVER. (MEDITERRANEAN FEVER, 
PHILIPPINE FEVER.) 
Prophylaxis. Isolate patient and treat him in 
a special ward as in other infectious diseases. Dis- 
infect clothing, bedding and excreta. Attend to 
the proper sanitation of the house. 
Treatment. Support the strength and combat 
the symptoms as they arise. Give a mild laxative 
if constipation is present, morphine and hydro- 
cyanic acid to relieve the nausea and vomiting. 
Tinct. ferr. perchlor, may be given for the diarrhoea, 
ergot to arrest haemorrhage, and hot fomentations 
for the orchitis. If hyperpyrexia threatens immerse 
the patient for ten minutes in a cold bath at a tem- 
perature of 68° F. 
Careful nursing and a light diet (milk, beef tea, 
chicken jelly, etc.) are of the utmost importance. 
MANIA, ACUTE. (DELIRIOUS, TOXIC, TRAUMATIC, 
POST-PARTUM.) 
Best treated in a special hospital, although an 
258 undeserved stigma is attached to this method of 
treatment. If the patient is treated at home, care- 
ful and competent nurses are essential. 
Frequent, and, if necessary, forced feeding is of 
the utmost importance. Liquid food with chopped 
meat may be given, and small doses of alcohol may 
be necessary 'to induce sleep. If the insomnia is 
stubborn give bromides, trional or sulphonal. (See 
Insomnia.) To secure rest, forced detention in 
bed by mechanical restraint may be necessary. 
Manual restraint is not advisable. A sheet or some 
bed-harness is much to be preferred. 
When the stage of exhaustion is over, tonics such 
as iron, strychnine and phosphorus are necessary. 
In case of cerebral congestion the following pow- 
der may be given: 
1$. Elaterini grs. % 
Sacchari lactis grs. vi 
M. ft. chart. No. iii. 
Sig. Place one on tongue and repeat in two hours 
unless free purgation. 
In violent cases when milder remedies fail give: 
I|. Morph, sulphat grs. iii 
Hyoscinse hydrobrom gr. J/g 
Sacchari lactis grs. xx 
M. ft. caps. No. xii. 
Sig. One capsule by mouth. Repeat in one hour if 
necessary. This will usually quiet excitement and in- 
duce sleep. 
MASSAGE, METHOD OF APPLYING. 
Massage stimulates the peripheral nervous system, 
increases the tone of the circulatory system, helps 
metabolism, develops and exercises the muscles 
and soothes the central nervous system. 
The masseur should have clean, soft, warm and 
dry hands. Massage should not be practiced for 
an hour after a meal, and if given in the daytime, 
should be followed by an hour's rest. 
259 Massage is of distinct advantage in neurasthenia, 
writer's cramp and allied affections, chorea, neuralgia, 
neuritis, obesity, dry symmetrical gangrene, sprains, 
fractures, and displaced semilunar cartilages. 
It is contra-indicated in fever, enlarged veins, 
tumors, and pregnancy. If as sometimes but rarely 
happens, it irritates rather than soothes, then it 
should be discontinued for a time. 
The movements of massage are: Effleurage or 
the gentle surface stroking of the part, which quietly 
starts the circulation before the more vigorous 
rubbing begins. Massage a friction, which make a 
firmer and deeper pressure-rub than effleurage. 
Petrissage is a very deep kneading of the part and 
completes what has been begun by the two pre- 
ceding. Tapotement, or tapping in a rapid, 
vibratory manner with the balls of the fingers of 
one or both hands held gently closed, similar to the 
position of holding a pen. 
The patient is first asked to relax all his muscles 
and to lie on his right side. Manipulations are begun 
on the left foot, toes, ankle, thigh, hip, and buttock, 
in turn. The patient then turns on the opposite 
side and the right side is rubbed just like the left. 
Next the patient lies on his back and the fingers, 
forearm, arm and shoulder are given the long sweep- 
ing effleurage, followed by friction, petrissage and 
tapotement. 
The patient lies next on his abdomen on a pillow. 
The long series of strokings down the vertebral gutters 
are made alternately with the fingers of each hand 
spread on either side of the spinous processes. Then 
comes a spreading movement from the spines out- 
ward with the balls of both thumbs; next a firmer 
petrissage with both hands; followed by that motion 
with the palms of both hands alternately run down 
either side of the spinal column, giving a delightful 
sensation; while the final effleurage finishes and 
the patient is asked to turn on his back. 
260 The chest movements consist of a firm stroking, 
following the ribs from the sternum out and down; 
and of firmer petrissage with the balls of both thumbs. 
Next the thighs are flexed on the abdomen, and legs 
on thighs in order to relax the abdominal walls. 
Effleurage is followed by thorough kneading begun 
over the small intestine, working with both hands 
in a spanning-like manner. Then start at the head 
of the colon, and work along the ascending, trans- 
verse, and descending portions, one hand following 
the other in rotary motions. This with effleurage 
usually cures constipation. The face, head and 
neck are not rubbed in ordinary work, but if requested 
this is done by a series of strokings and kneading 
movements in the direction of the venous circulation. 
In all movements the greater pressure should be 
from the periphery toward the heart. 
MASTITIS. (INFLAMMATION OF BREASTS.) 
Prophylaxis. This condition can be prevented in 
most cases by careful attention to fissured nipples. 
They should be kept very clean during lactation. 
A saturated solution of boric acid should be used 
forthat purpose. As soon as a fissure is noticed apply 
a nipple shield to the breast until healing takes place. 
Compression of the nipple by the clothes or corset 
should be avoided. Olive oil may be applied to the 
nipple between the times of suckling, and the child's 
mouth should be inspected regularly and if it is 
not perfectly healthy it should be cleansed with 
boric solution. Milk engorgement should be pre- 
vented by suitable methods. 
Treatment. When mastitis threatens remove the 
child from the affected breast and withdraw the 
milk with a breast-pump or by massage. Keep 
the patient at rest in bed and apply ice-bags or an 
ice-coil over the inflamed area protected by a layer 
of flannel. A compress soaked in lead and opium 
lotion and covered by oiled silk gives some relief. 
261 The breast should be supported when the patient 
sits up by means of a binder and cotton wool. Free 
movements of the bowels should be secured by salines 
and the patient put on a light dry diet, to restrain 
the secretion of milk. 
Pus should be evacuated as soon as it is detected; 
do not wait until the mammary abscess "points." 
To avoid cutting milk ducts and veins the incision 
should be radial, i. e., in line with these vessels. 
In the absence of other indications, the free incision 
• is best made below and to the outer side. A local 
anaesthetic such as cocain or ethyl chloride is usually 
all that is necessary, but sometimes a general anaes- 
thetic like nitrous oxide may be advisable. Gauze 
packing or drainage tubes may be used to obtain 
free drainage, after irrigating the cavity with 
hydrogen peroxide or other mild antiseptic solution. 
MASTURBATION. 
If the patient is a child look for and treat the 
cause, e. g., adherent prepuce, phimosis, or very 
long foreskin. 
In boys about the age of puberty with long fore- 
skin, circumcision not only interrupts the pernicious 
habit for a time, but removes a constant source 
of irritation. 
In girls remove any pathological condition of the 
genitals which may be present, and insist on absolute 
cleanliness of these parts. 
In all cases moral treatment should be tried and 
if this fails, tie the patient's hands when in bed, 
ao not let him sleep alone, and fasten a hard body 
over spine to prevent him from lying on his back 
during sleep. 
Free purgation, the removal of thread-worms or 
of any irritation or itching of the anus and genitals 
are often.of service. The patient should be recom- 
mended to take free open air exercise, cold baths 
and plain unstimulating food. The preponderant 
262 attention paid to athletics in many schools and col- 
leges has this to recommend it that it often acts 
as a prophylactic against masturbation. 
In some cases of abnormal sexual desire the fol- 
lowing may be given: 
R. Sodii iodid 3ii 
Sodii bromid 5 iv 
Tinct. lupulin 5iv 
Tinct. hyoscyam 5iv 
Syr. zingiber §i 
Aqu® camphorat gvi 
M. Sig. A tablespoonful in water after each meal. 
When prostatorrhea results from the masturbation 
give: 
I|. Extracti ergot® grs. xxiv 
Extracti nuc. vomic grs. vi 
Extr. gentian® grs. xxiv 
M. et ft. pil. No. xxiv. 
Sig. One pill three times a day after meals. 
If leucorrhea results give the following astringent 
lotion: 
I}. Aluminis 5ii 
Sig. A tablespoonful in a quart of water as vaginal 
douche twice a day. 
In all cases of masturbation occurring at the age of 
puberty, open air exercises and games should be 
insisted on. These not only quicken the circulation 
of the blood and cause more oxygen to be inhaled, 
whereby the impurities of the blood are oxygenated 
and destroyed, and removed by the excretory organs 
of the body, but they also check morbid desire 
and sensations by the expenditure of superfluous 
energy, which ensures purity of life. 
MEASLES, PROPHYLAXIS. 
It is a great mistake for parents to wilfully allow 
their children to expose themselves to measles on 
the ground that every one must contract the dis- 
ease and that it is less likely to prove serious in 
263 childhood than in adult life. It is true that measles 
is so intensely contagious that nearly all persons 
are attacked by it before adolescence. But se- 
rious results so often follow the disease that wilful 
exposure is never justified. Measles is extremely 
contagious during the prodromal stage when accu- 
rate diagnosis is often impossible and this increases 
the difficulty of prophylaxis. The patient should 
be isolated and other children should be removed 
from the house. These should be kept from associat- 
ing with other children for at least two weeks in 
order that the disease if contracted, may develop. 
Only the attendants should be allowed to enter 
the sick room. All soiled linen should be soaked in 
solutions of carbolic acid or corrosive sublimate 
and boiled separately. During the eruptive stage 
the whole body should be oiled once or twice daily 
to lessen the dissemination of the contagion. The 
contagion of measles is of feeble vitality and there- 
fore quarantine need not be kept up longer than 
about a month. 
In the military service the prophylaxis of measles 
is of much greater importance than in civil life 
for the disease among soldiers is always attended 
with danger, especially in the field where the patients 
are exposed to inclemencies of the weather. Measles 
is sure to occur among newly raised rural troops. 
Special preparations should be made to meet it 
for the contagion spreads so rapidly that large 
numbers will sicken simultaneously. 
MEASLES, TREATMENT OF. 
The patient should be put to bed in a well-ven- 
tilated but warm room which ought to be moderately 
darkened. Two weeks at least should be spent in 
bed. During the period of fever the diet should be 
fluid and should consist of milk, soups, broth, jun- 
ket, fruit juices, eggs and gruels. Water should 
be given at frequent intervals. 
264 The burning and itching of the skin may be re- 
lieved by daily inunctions with cold cream or cocoa- 
nut butter or by sponging with tepid water to which 
a little sodium bicarbonate has been added. The 
following prescription may be given: 
"fy. Phenolis gtt. viii 
Olei olivse 3 viii 
M. Sig. Anoint the body several times a day. 
The bowels should be kept open at the beginning 
of the disease by fractional doses of calomel followed 
by a saline and they should be kept open throughout 
the disease by means of laxatives. 
The skin and the kidneys should be kept active by 
alkaline diuretics. The following may be given as a 
febrifuge and diuretic: 
T|. Spiritus setheris nitrosi 5iv 
Syrupi 5iv 
Liquoris potassii citratis q. s. ad. 5 viii 
M. Sig. One teaspoonful in water every two hours. 
For the conjunctivitis apply cloths moistened in 
cold water or by dropping a few minims of saturated 
solution of boric acid into the eyes at intervals. The 
eyelids may be prevented from sticking together by 
smearing their edges with vaseline. If the conjunc- 
tivitis becomes purulent, give the following eye-drop: 
Argyrol grs. iv 
Aquae destillatae §i 
M. Sig. Instil several drops into the eye every 
two hours. 
Since the middle-ear frequently becomes involved 
by extension from the nasal cavity and the throat, 
these parts should be frequently sprayed with dilute 
liquor antisepticus. 
When there is bronchial catarrh, give an expectorant 
such as ammonium chloride: 
3. Ammonii chloridi grs. xlviii 
Syrupi 3 iv 
Mucilagin. acac q. s. ad. 3viii 
265 M. Sig. One teaspoonful in a little water every 
two hours For a child two to six years of age. 
Or the following sedative might be given: 
1$. Potass, citrat 5ii 
Tinct. opii camphorat 3 in 
Glycerini gi 
Aquae q. s. ad. §iii 
M. Sig. One teaspoonful every two hours. For a 
child of three years. 
During convalescence cod liver oil and tonics like 
iron and strychnine are indicated, and a change of 
climate is advisable, preferably to a high altitude 
where slight humidity and a mild temperature prevail. 
MELANCHOLIA. 
Rest in bed, with frequent, and, if necessary, 
forced feeding, are essential. In mild cases diver- 
sion may be of benefit, but in severe cases it is not 
advisable. 
Mild laxatives or enemata, warm baths and mas- 
sage are of service. For the insomnia trional may 
be given, or: 
I|. Spiritus chloroformi 3iv 
Potass, bromid 3ii 
Syrupi 3iv 
Aquae q. s. ad. 3 iii 
M. Sig. Two teaspoonfuls in water at bedtime. 
For the great fear so often present give 5 minims 
of tincture of opium three times a day. 
Vigilant nursing is absolutely essential because of 
the danger of suicide. 
When the patient is anaemic and there is impair- 
ment of appetite, give: 
I}. Tinct. ferr. chlor. 
Tinct. quasshe aa 3iv 
M. Sig. Twenty drops in water through a glass 
tube, after each meal. 
When the patient is debilitated, give: 
1$ Olei phospho rati m. xxiv 
Olei morrhuae §ss 
266 M. Pone in caps. No. xxiv. 
Sig. One capsule two hours after meals. 
The following may be given to induce sleep: 
Hyoscinse hydrobromidi gr. 
Camphorae monobromatae 5i 
M. ft. caps. No. xv. 
Sig. One capsule at bedtime; repeat in six hours 
if required. 
MENINGITIS, CEREBRO-SPINAL. 
Prophylaxis. Proper ventilation, drainage and 
general sanitation will help to prevent epidemics. 
The organism which causes this disease undoubtedly 
enters the body through the nose; for this reason it is 
best during an epidemic to spray the nostrils of all 
children affected with catarrhal trouble with some 
such antiseptic solution as liquor antisepticus or 
Dobell's solution. The composition of the latter 
solution is: 
Acid, carbolic, cryst gr. xxiv 
Sod. borat. 
Sod. bicarb aa 5ii 
Glycerini 5 ss 
Aq. destillat q. s. ad. Oi 
Sig. Use three times a day with atomizer. 
Treatment. Isolate the patient in a well ventilated 
room, bandage his eyes to relieve the photophobia, and 
elevate the head of his bed. Maintain the nutrition 
of the patient with milk, broths and gruels. Relieve 
the pain by wet cups to the back of the neck, ice-bags 
along the spine, and by cauterizing the nape of the neck. 
Give a hot bath (104° F.) lasting from 15 to 20 
minutes, once or twice a day, to relieve pain and 
lessen restlessness and delirium. Lumbar puncture 
relieves the symptoms due to pressure. When the 
pressure symptoms are marked withdraw 8 to 15 
drachms; when they are slight only 5 drachms should 
be withdrawn. 
267 Intraspinal injections of lysol (1%) may also be 
tried. 
The bowels should be regulated in the course of the 
disease by calomel, salines or enemata. Allow plenty 
of drinking water to eliminate toxins by the kidneys. 
If the nose and throat are inflamed, spray and irri- 
gate with mild alkaline solutions, e. g., liquor anti- 
septicus N. F., and give a mouth-wash: 
I). Sol. potass, chlorat alkalinus .... 5viii 
Sig. Use as mouth-wash every two hours. 
If there is difficulty in swallowing, feed by stomach 
tube or nasal tube or by rectum. 
Sucking cracked ice or the application of cold to the 
epigastrium relieves the vomiting. Give antipyrine 
to relieve the headache and chloral per rectum or by 
inhalation for the convulsions. 
For the cardiac weakness of the later stages, give 
alcohol, ammonia, or hypodermic injections of camphor 
in oil. High hot saline irrigations per rectum not only 
benefit the cardiac weakness, but by their diuretic 
action help to eliminate toxins through the kidneys. 
In chronic cases with meningeal thickening, give 
potassium iodide in 5 to 10 gr. doses every three hours, 
or syr. hydriodic acid one teaspoonful four times a day 
in water to induce absorption. 
The death rate from this disease has been reduced at 
least 50 per cent in the last two years by the use of 
anti-meningococcus serum. It should be injected di- 
rectly into the spinal canal, after withdrawing as much 
cerebro-spinal fluid as the amount of the serum to 
be injected. The earlier the treatment is started the 
better the prognosis. If used within the first three or 
four days the mortality is not more than fifteen to 
eighteen per cent. 
The first injection should consist of from 10 to 30 
c. c. for a child under one year, and 30 to 45 c. c. for 
an adult. The injections should be repeated at least 
four times at twenty-four hour intervals. If there is 
no recurrence of the symptoms after that time then 
268 it will be unnecessary to make further injections. The 
best criterion is the cerebro-spinal fluid, if no men- 
ingococci are present and the degenerated leucocytes 
have been replaced by normal ones, we are certain that 
no further injections are needed. 
Within twenty-four hours after the first injection, 
such symptoms as headache, coma, fever, pallor of the 
face, delirium and insomnia, rapidly clear up. 
MENINGITIS, TUBERCULOUS. 
Prophylaxis. General measures for the preven- 
tion of tuberculosis. Every influence which tends to 
develop the nervous system at the expense of the 
digestive and muscular systems should be eliminated. 
Treatment. This is merely symptomatic and 
palliative. Place the patient in a darkened room 
and exclude all sources of cerebral excitement. 
Apply an ice-cap to the head and upper part of the 
spine, leeches to the temples, ears, and nape of the 
neck, and warmth to the extremities. Give the 
following calomel purge at once: 
1$. Hydrarg. chlor, mit grs. v 
Sacchar. lactis grs. xxx 
M. et ft. chart. No. xii. 
Sig. One powder every hour till free purgation, 
then one every two or three hours during the first 
twenty-four hours of the disease. 
For the headache, restlessness and convulsions give 
morphine hypodermically: 
1$. Morphinae sulphatgr. iss 
Aquae destillat 3ii 
M. Sig. Two to ten drops, according to age and idio- 
syncrasy every two to four hours. • 
Or the following may be given by the mouth: 
I|. Antipyringrs. xxx 
Morph, sulphat gr. i 
Syr. limon 3vi 
Aqq. s. ad. §ii 
269 M. Sig. Half to two teaspoonfuls, according to age, 
every two hours. 
For convulsions or for insomnia the following may 
be given to a child of three to four years: 
I|. Chloral, hydrat grs. xxx 
Sodii bromid 3 ii 
Sodii iodid 3 hi 
Syr. aurant §i 
Aquae q. s. ad. §iv 
M. Sig. One teaspoonful in water every two or 
three hours. 
MIGRAINE. (MEGRIM, SICK HEADACHE.) 
If possible remove cause, e. g., errors of refrac- 
tion, diseased teeth, worry, etc. Regulate the diet. 
Patient should avoid sugar and red butcher meat. 
Allow plenty of milk, fish, and white meat. Alcohol, 
tobacco, tea and sexual excesses require regulation. 
Attend to bowels. 
Give phenacetin, in 20 gr. doses as soon as attack 
occurs. If no relief is obtained give another dose 
at end of an hour. If this still does not give relief, 
give 20 grs. more in an hour but no more. To pre- 
vent the recurrence give: 
I|. Sodii salicyl 3iv 
Liq. potass, arsenit 3i 
Essenc. pepsin q. s. ad. 3iii 
M. Sig. One teaspoonful in water three times a 
day. 
MILK, EXCESSIVE SECRETION OF (See Gnlactorrhea). 
MITRAL INCOMPETENCY (See Endocarditis, Chronic). 
MITRAL STENOSIS (See Endocarditis, Chronic). 
MORPHINE HABIT. 
Prevention. All prescriptions containing mor- 
phia should be marked "not to be refilled without 
the order of the physician." Do not put a hypo- 
dermic syringe into the hands of a patient to use 
in case of pain or sleeplessness. 
270 Treatment. Isolate the patient in an institution 
where careful watching is obtainable. Do not with- 
draw the morphine suddenly. Diminish it gradually 
until at the end of a week none at all is given. 
Stimulate the heart if weak, by ammonium, strych- 
nine, digitalis or caffeine. Do not give alcohol or 
cocaine. Relieve insomnia by bromides, sulphonal 
(20 grs.), or veronal (15 grs.). Avoid the use of 
chloral. 
T|. Sulphonal 3ii 
Ft. chart. No. vi. 
Sig. One at bedtime. 
Control mental excitement by baths, warm or cold. 
MOSQUITO BITES. 
Oil of lavender or oil of tar rubbed on the skin, 
or sponging the surface with infusion of quassia is 
a protection. Now that mosquitoes are known to 
be carriers of malaria, yellow fever, filaria, etc., 
the importance of a good prophylactic against mos- 
quito bite is obvious. • 
A mixture of equal parts of camphor and chloral, 
with menthol dissolved in the mixture gives local 
relief from the itching and pain of insect bites. 
Weak liquor ammonia and carbolic oil are also good 
remedies. 
MULTIPLE NEURITIS (See Neuritis Multiple). 
MUMPS. (PAROTITIS.) 
Rest in bed. Isolation for three weeks. 
The swelling and pain are best combated by: 
3. Tinct. opii §i 
01. camphor 5 i 
M. Sig. Rub on swollen gland and cover with cot- 
ton batting. 
Hot poultices are frequently of great service in 
relieving pain. 
For a child 3 to 6 years old give at the beginning of 
the disease: 
271 I}. Hydrarg. chlor, mit grs. ii 
Sacchari lact grs. xii 
Extr. colocynth grs. ii 
M. et ft. chart. No. xii 
Sig. One every three hours. 
After the bowels have been thoroughly evacuated 
the following may be given: 
I). Spts. aeth. nitros 5ii 
Potass, citrat 3iii 
Tinct. aconit.... m. iv 
Syrup, tolu q. s. ad. §iv 
M. Sig. One teaspoonful every two hours. 
In adults the disease is sometimes very severe causing 
orchitis or ovaritis. If the former, suspend the testicles 
and make applications of: 
I|. Lotio plumb et opii §vi 
Sig. Apply hot with gauze every two hours. 
When the inflammation is beginning to subside use: 
1$. Ungt. hydrarg 3iii 
Ungt. petrolat q. s. ad. §i 
M. Sig. Apply thoroughly three times a day. 
The diet should be liquid because the mouth can 
only be opened with difficulty. 
Keep the mouth clean with: 
I}. Liq. antiseptic, alk. N. F §iv 
Sig. One teaspoonful in a wineglassful of hot water 
for a mouth-wash every three hours. 
Mumps rarely if ever go on to suppuration. 
MUSC2E VOLITANTES (See Floating Bodies Before the 
Eyes). 
MYELITIS. 
During the acute stage the patient should have 
absolute rest in bed for at least two weeks. A 
water or air bed should be used and the patient 
guarded against bed-sores. His position should be 
frequently changed, the parts subjected to pressure 
kept absolutely clean, powdering with talcum, tannic 
272 acid or lycopodium, and bathing with alcohol and 
astringent solutions. Blisters and other forms of 
counter-irritation should be avoided on account of 
the danger of bed-sores. Warm baths ( 85° F. to 
90° F.) may be given daily and lasting for about 
ten minutes. Ice-bags applied to the spine, and 
the employment of galvanism with the electrodes 
applied to the vertebral column over the seat of the 
lesion are often of benefit. Pain and local congestion 
may be relieved by leeches or by applying wet 
or dry cups to the spine. If there is retention of 
urine systematic catheterization will be necessary 
with the strictest antiseptic precautions. Cystitis 
is very liable to develop when the catheter is used 
and the tendency should be met by daily irrigating 
the bladder with a solution of boric acid and the 
internal administration of salol and urotropin (5 to 
10 grs. each) three times a day. At the beginning 
of the disease the bowels should be kept open with 
laxatives, but in the later stages the bowels should 
be opened by irrigation rather than by purgatives. 
Massage is of benefit in exercising the muscles, 
improving the circulation, and preventing wasting 
of the muscles. 
In the chronic stage the contracted limbs may 
be straightened by mechanical appliances or by 
tenotomy. In compression myelitis the pressure on 
the cord should be relieved by proper orthopaedic 
apparatus. 
MYOPIA. 
Rest eyes from near work, protect from exposure 
to too great light, regulate the general health. Keep 
eyes under full influence of atropin for two weeks in 
dark room and then allow the patient to use dark 
glasses when he goes about. Prescribe concave 
glasses of such a strength as to correct the vision 
accurately for distance. Correct any astigmatism 
which may be present as well. 
273 MYXCEDEMA. 
Myxcedema and sporadic cretinism (the infantile 
form of myxcedema) are due to absent or defective 
thyroid secretion, and the myxoedematous condition 
can be removed by thyroid treatment: 
fy. Tabellas glandulae thyroideae siccse.... grs. v 
Sig. One tablet once daily, to be increased. 
The dry extract in the form of tablets is an active 
and reliable preparation; the activity of the drug is 
not impaired by keeping; the dose can be conveniently 
regulated and consequently it is a very convenient 
preparation. 
Most patients affected with myxcedema are very 
susceptible to the action of the thyroid extract; and 
since it is rarely if ever advisable to produce the full 
physiological effects of the remedy (acute thyroidism) 
a small dose should be at first administered as in the 
above prescription. If this preliminary small dose 
is insufficient to produce "reaction" and improve- 
ment, the dose should be gradually but cautiously 
increased. 
It is advisable to keep the patient in bed during 
the first three or four weeks of the thyroid treatment, 
and the diet during that stage should consist of milk, 
fish, and white meat. 
The immediate effects of thyroid treatment 
are: rapid disappearance of the myxoedematous swell- 
ing; loss of weight; increased liveliness and activity; 
a rise in temperature and pulse; disappearance of 
the feeling of cold; improvement in the nutrition of 
the skin and its appendages; growth of hair, etc 
Too large doses of the extract are liable to produce 
acute thyroidism-rapid action of the heart, palpi- 
tation, great prostration, profuse sweating, great and 
rapid loss of weight, anaemia, furred tongue, vomiting, 
diarrhoea, headache, a feeling of general discomfort, 
etc. 
274 NAIL MATRIX, INFLAMMATION OF (See Onychia). 
NASAL HEMORRHAGE (See Epistaxis). 
NEPHRITIS, ACUTE PARENCHYMATOUS. (ACUTE 
DIFFUSE NEPHRITIS, ACUTE BRIGHT'S DISEASE.) 
It is absolutely necessary to put the patient to 
bed in a warm room and to keep him away from 
worry or excitement. The object to be pursued 
may be expressed in the word "elimination." This 
is accomplished through the intestines, skin and 
kidneys. 
If there is suppression of urine apply dry cups 
to the loins and follow this with large hot linseed 
poultices. 
Elimination through the kidneys is best encour- 
aged by purgation. Salines act best. Give one 
tablespoonful of Epsom salts, or a bottle of citrate 
of magnesia, or a tablespoonful of bitartrate of 
potassium in hot water on arising. 
Elimination through the skin should be accom- 
plished by the administration of the fluid extract 
of jaborandi, 10 to 15 drops every two hours. Pilo- 
carpine in doses of to grain, should react 
still more promptly. Hot baths are also of benefit 
in assisting the skin to get rid of its poisons. 
Elimination through the kidneys is effected by 
the use of diuretics, especially in case of dropsy 
and scanty urine. 
The best diuretic is digitalis and by far the best 
method of administering it is the infusion. It 
ought to be given in tablespoonful doses three or 
four times a day, depending upon the severity of the 
case. After a week a change may be made to the 
tincture of digitalis which may be given in doses 
of 15 to 20 drops three times a day. It is best 
to give the digitalis alone at first, later on it may 
be combined with potassium citrate, potassium 
acetate or potassium bitartrate in the dose of 20 
grains, three times a day, thus: 
275 I|. Tinct. digitalis 5vi 
Potass, citrat 3vi 
Potass, ace tat 3iv 
Aquse q. s. ad. 3 iff 
M. Sig. A teaspoonful in a glass of water three 
times a day. 
Trousseau's diuretic wine has been in general use 
for many years and its effects are good. The formula 
for this wine is: 
I|. Juniper, contus 3x 
Pulv. digital 3ii 
Pulv. scillse 3i 
Vin. Xerici Oi 
Macerate for four days and add 
Potass, acetat 3 iff 
Express and filter. 
M Sig. One tablespoonful three times a day. 
The patient should be encouraged to drink plenty 
of water. The diet should be light and easy to digest. 
Milk is by far the best food, it may be given raw, 
peptonized or diluted with lime water, Vichy or Seltzer. 
Animal food should be avoided so as not to throw 
too great a strain on the kidneys in eliminating the 
nitrogen. Beef tea and beef extracts should for this 
reason be strictly avoided. 
For the treatment of convulsions accompanying 
nephritis see Uraemia. 
NEPHRITIS, CHRONIC INTERSTITIAL. 
The diet should be very carefully regulated. 
Nitrogenous foods should be avoided as much as 
possible. Strong alcoholic drinks like brandy, 
whisky, champagne, sherries and port should be 
avoided. Light drinks such as red wines, lager 
beer, and porter may be allowed in small quantities. 
Alkaline mineral waters such as Vichy, Kissingen 
and Vais may be taken in abundance. The warmth 
of the body should be maintained by woolen gar- 
ments. Wetting the body in the rain should be 
276 avoided. The feet should be kept dry and rubbers 
worn. Sea bathing should be forbidden. Resi- 
dence in a warm climate is of considerable benefit 
in some cases. Mental and bodily fatigue should 
be avoided. A warm bath daily and an occasional 
Turkish bath may be taken. 
The treatment by drugs must be very carefully 
considered. Large doses of iron do harm, but it 
may be given in small doses when there is anaemia: 
1|. Basham's mixture gvi 
Sig. One dessertspoonful three times a day. 
Diuretics are not indicated unless the flow of urine 
should become scanty. The bowels should be care- 
fully regulated by a daily dose of half an ounce of 
Epsom salts. 
High arterial tension is best regulated by nitro- 
glycerin : 
I|. Tabell. nitroglycerin gr- ioo 
No. 1. 
Sig. One every three hours. 
Complications must be treated as they arise, e. g., 
pericarditis, pleurisy, pneumonia, endocarditis, etc. 
If dyspepsia is present give: 
1$. Acidi hydrochlor, dil 3iv 
Pepsini 5i 
Aquae §i 
Syr. aurant. corticq. s. ad. §iii 
M. Sig. One teaspoonful in water after each meal. 
If the patient is troubled with insomnia give sul- 
phonal, trional, chloral and bromides. (See Insomnia.) 
If uraemia occurs it should be treated according to 
the directions under that heading. (See Uraemia.) 
There is no known method of removing the inter- 
stitial growth of connective tissue. Iodide of potassium 
in long-continued small doses (5 grains every 4 hours) 
may be tried. 
Recently the operation of decapsulation of the 
kidneys has saved some moribund cases of nephritis. 
277 Some were completely cured, others considerably ben- 
efited. The cause of such improvement is probably 
the freer circulation in the kidneys upon the removal 
of the constricting capsule. 
NEPHRITIS, CHRONIC PARENCHYMATOUS. (CHRONIC 
DIFFUSE NEPHRITIS.) 
When this disease is not treated the patient usually 
goes on from bad to worse, whilst with appropriate 
treatment the fatal ending can sometimes be long 
delayed. 
The indications in the treatment are to keep up 
the patient's strength by improving the quality of 
the blood, and to get rid of the poisonous materials 
that accumulate in the blood. 
The diet should consist of nourishing food, but 
articles should be chosen which have a small per- 
centage of nitrogen. Milk is the ideal food; under 
its use the most dangerous symptoms frequently 
abate, as albuminuria, dropsy, etc. An adult should 
use 2 to 3 quarts of milk per day. It should be 
taken in quantities of 6 or 8 ounces every two hours. 
It may be diluted with Vichy, Seltzer, Apollinaris, 
etc. 
Rest in bed, even if not continuous, is of impor- 
tance in reducing oedema. The patient should be 
protected with woolen underwear in order to avoid 
chilling of the surface of the body. 
The patient's blood should be sustained with 
iron, quinine, and strychnine. Iron is the most 
important drug. It should not be given in excess- 
ive doses. Basham's mixture has been the standard 
preparation of iron in nephritis for years. Its 
formula is: 
I|. Tinct. ferri chlorid 5ii 
Acid. acet, dil 5ii 
Liq. ammon. acetat §ii 
Syr. simplic. 
Aquae aa. q. s. ad. 5vi 
278 M. Sig. A dessertspoonful in water, twice a day. 
The following is as good as the above: 
I). Tinct. ferr. chlorid .. 5ii 
Spt. tether. nitros 5iv 
Strych. sulph gr. ss 
Infus. calumbse q. s. ad. Biii 
M. Sig. One teaspoonful in water three times a day. 
The dropsy should be treated in the same manner 
as indicated under acute nephritis, viz., hot baths, jab- 
orandi, pilocarpin, saline laxatives and purgatives, etc. 
In chronic nephritis there is a retention of chlorides 
in the blood. Frequently the dropsy can be retarded 
by the strict withdrawal of sodium chloride from the 
diet. 
For the dietary, see Albuminuria, Diet in. 
NEPHROLITHIASIS (See Renal Calculus). 
NETTLERASH (See Hives). 
NEURALGIA. 
Correct any astigmatism, or error of refraction 
of the eyes; carefully examine every tooth, and 
treat, if present, gout, syphilis, rheumatism, anaemia 
or malaria. Good hygienic conditions should be 
secured and excessive lactation, sexual excesses, 
overwork, emotional conditions, and alcoholism 
should be avoided. A full diet with milk, cod 
liver oil, the Weir Mitchell rest treatment, change 
of climate, massage and hydrotherapy are of the 
greatest value. 
As local measures for the pain, pressure on tender 
points, blisters, sinapisms, the cautery, acupunc- 
ture, and injections of cocaine should be tried. 
Menthol, camphor-chloral (equal parts) and a lini- 
ment like the following are of some value: 
3. Tinct. aconiti 
Tinct. chloroformi 
Tinct. belladonnse aa 3ii 
Liniment, saponis §iv 
279 M. Sig. Rub in thoroughly three times a day. 
Iron, strychnine and phosphorus are of value in 
anaemic patients; arsenic and quinine in malaria and 
trifacial neuralgia. 
Nerve-stretching is of some value in neuralgia on 
account of its effect in diminishing the conducting 
power of the sensory fibers; the operation should be 
done under proper antiseptic precautions. 
Electricity in the form of galvanism is often of 
service; one pole being applied near the nerve cen- 
ters the other near the nerves of the affected part. 
In surgical therapy, section, resection, or divulsion 
of the affected nerve has been successful in many 
cases, as also extirpation of the Gasserian ganglion 
in trigeminal neuralgia of' an obstinate character. 
Freezing the skin by ethyl chloride often gives good 
results: 
Ethylum chloridum in tuba. 
Sig. Use as spray for freezing painful area. 
In severe sciatica the following injection may be 
given: 
Morph, sulphat grs. iii 
Atrop. sulphat. . gr- 10 
Aquse destillat 5 iv 
M. Sig. Inject 20 drops deeply into the region 
of the painful nerve. 
In neuralgia of a superficial nerve the following 
inunction may be used: 
I}. Oleati veratrinse 5iv 
Sig. Apply a small quantity to the painful area 
by inunction. Large quantities must not be used 
lest absorption of the veratrine takes place. 
Or: 
I|. Thymolis 3i 
Camphorse 5i 
Alcohol 5i 
M. Sig. Apply over painful area with a brush. 
Any one of the following prescriptions may be given 
to relieve pain: 
280 T|. An tipy rinse Jii 
Caffeinse citratse. grs. xii 
Potassii bromidi 5ii 
M. pone in cachetas No. xii. 
Sig. One cachet every four hours. 
Or: 
I|. Acetanilidi grs. xii 
Camphorse monobrom 3i 
Caffeinse citrat grs. vi 
M. et ft. chart. No. xii. 
Sig. One powder every three hours till relieved. 
Or: 
I|. Potass, bromidi 3ii 
Fluidextract, guaranse 
Syrupi aurantii cortic 3i 
Aquse q. s. ad. 3iii 
M. Sig. Shake the bottle. One teaspoonful in 
water every two hours. 
Or: 
3- Crotonchloralis 5i 
Pone in capsulas No. xx. 
Sig. One capsule every two hours until relieved. 
Or: 
1$. Tinct. aconit. 
Tinct. colchic. sem. 
Tinct. cimicifugse 
Tinct. belladonn. fol aa 3i 
M. Sig. Six drops every hour until relieved. 
For local use the following may also be given: 
I|. Mentholis grs. xlv 
Cocain. hydrochlor grs. xv 
Chloral, hydrat grs. x 
Petrolati 3v 
M. ft. ungt. 
Sig. For local use three times a day. 
Recently remarkable success has been obtained 
in the treatment of tic-douloureux by deep injections 
of alcohol directly on the nerve at its exit from the 
skull. 
281 NEURASTHENIA. 
Remove the cause. Treat the mind as well as 
the body. The patient should have pleasant sur- 
roundings, cheerful companionship, outdoor games, 
drives and other diversions. Physical exercise is 
of the utmost importance as it increases respiration, 
circulation, oxidation and elimination. Sun baths 
should be used as part of the treatment. The 
patient should be encouraged to make up his mind 
to get well. If the disease is due to chronic alcohol- 
ism, morphinism, etc., these conditions must first 
be treated. In women when the disease is due to 
derangements of the sexual organs, correct such 
conditions as displacements, sew up lacerations, etc. 
The patient should avoid the excitement, noise 
and worry of city life. All excesses in diet, alcohol, 
and sexual matters should be avoided. The more 
regular the habits the better. 
The patient should have plenty of sleep. Mas- 
sage in the morning, accompanied by a sponge bath 
and an alcohol rub are very refreshing. The cold 
douche may be employed after the patient is on 
the road to recovery. Electricity along the spine 
soothes the nervous system; the static or mild 
faradic current should be employed. Weir Mitchell's 
treatment should be employed in the worst cases. 
For insomnia the hot pack is very beneficial. 
The patient should be put on forced feeding. 
The diet should consist of easily digested foods 
frequently administered. 
Suggestion, simple or hypnotic, is often followed 
by a cure. Change of climate, change of scenery, 
sea baths, or a sea voyage are important adjuncts 
to treatment. 
The drugs used in this disease are chiefly tonics. 
Symptoms as diarrhoea, anorexia or constipation 
must be treated. The following tonic prescriptions 
are indicated: 
282 1$. Strych. sulphat gr. f 
Zinci phosphidi gr. iss 
Calcii glycerophosph grs. Ixxii 
Ferr. carb. mass. 3 ii 
Mangan, dioxid grs. xii 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
Or: 
1$. Liq. ferri peptonat. N. F §viii 
Sig. One tablespoonful after each meal in water. 
The following may be given to stimulate the appetite: 
I|. Ac. nitro-muriat. dil 3iv 
Elix. calisaya 3 iss 
Elix. digestiv. co. N. F q. s. ad. 5iii 
M. Sig. One teaspoonful in water before each meal. 
NEURITIS, MULTIPLE. (POLYNEURITIS.) 
Try to discover the cause and discontinue or 
remove it, e. g., alcoholism, plumbism, mercurialism, 
etc. 
The treatment is the same in all cases. Rest 
in bed is essential. Give plenty of nourishing food, 
eggs, milk, soups, etc. If the patient is strong 
enough give a daily hot bath extending over 15 
minutes. 
Deformities should be prevented by putting on 
necessary braces to the paralyzed muscles. 
Strychnine sulphate in fa grain doses every three 
hours should be given over a long period of time. 
Systematic massage and electricity are also of 
importance. 
Use morphine for the relief of pain. If deglutition 
is interfered with, the patient must be fed with a 
tube. 
NEURITIS, OPTIC. (PAPILLITIS, CHOKED DISK.) 
Look for and treat the cause as nephritis, syphilis, 
rheumatism and exposure to cold. If due to neph- 
ritis, treat by purgation, diaphoresis, and diuresis, 
(See Nephritis.) 
283 If due to rheumatism give large doses of salicyl- 
ates. (See Rheumatism.) 
If due to syphilis push the anti-syphilitic reme- 
dies. 
Locally, blood-letting by leeches, blisters, and 
atropine should be used. 
NIGHTMARE. 
When not due to cerebral congestion, haemorrhage, 
or paresis, nightmare may be prevented by light 
diet, attention to the digestive organs and avoidance 
of late meals and indigestible food. Camphor water 
or potassium bromide may be given before bedtime 
if the nightmare occurs habitually, or give for a 
child 5 years old: 
1$. Sod. brom 3iss 
Tinct. hyoscyam 3ss 
Potass, brom 3i 
Aquae 3 i 
Syr. limonis q s. ad. gii 
M. Sig. One teaspoonful in water at bedtime. 
NIGHT-SCREAMING IN CHILDREN. 
If round worms are the cause give: 
1$. Santonini grs. ii 
Hydrarg. chlor, mit grs. ii 
M. ft. chart. No. ii. 
Sig. One powder night and morning after fasting. 
If the screaming occurs in nervous children and 
is accompanied by unpleasant dreams or fright (night 
terrors) give for a child 5 years old: 
1$. Potass, bromidi 3ii 
Tinct. hyoscyami 3i 
Syrupi 3iv 
Aquae q. s. ad. §iii 
M. Sig. One teaspoonful in water at bedtime. 
The child should have a light diet and avoid indi- 
gestible food. 
It may also be due to delayed dentition or to indi- 
gestion. If the latter give to a child 4 to 12 years old: 
284 T$. Pulv. rhei grs. xlviii 
Sodii bicarb 3iss 
Taka diastase grs. xxiv 
Carbo, ligni grs. xii 
M. et ft. chart. No. xxiv. 
Sig. One every four hours 
Nurses and older relatives should be warned not 
to tell ghost stories and horrible tales. 
(See also Nightmare.) 
NIGHT SWEATS. 
Treat the cause, change the night-clothes if wet 
and give hot milk at bedtime. As these sweats 
usually make their appearance in the early morning 
a good way to relieve them is to awake the patient 
about 4 a. M. and give him a glass of warm milk 
containing a little whisky; or a light midnight 
meal may be given and the body sponged with 
dilute acid washes. 
The most reliable internal remedy is atropin: 
1$. Atropin. sulphat gr. g 
Acidi sulphur, aromat 3iii 
Aq. men th. pip q. s. ad. §iii 
M. Sig. A teaspoonful in water at bedtime. 
Or: 
I). Acidi camphorici 3ii 
Pone in cachetas No. xii. 
Sig. One or two cachets about two hours before 
expected sweat. 
Or the following, especially in tuberculosis: 
I|. Agaricin gr. 
Picrotoxin gr. 
Atropin. sulphat gr. 
M. et ft. pil. No. i. 
Sig. One at bedtime. 
NIPPLES, SORE. 
Prophylaxis. Exposure of the nipples to the 
air and bathing with brandy are excellent ways 
to harden them. A saturated boric acid solution 
as a wash is also useful 
285 If the nipples become sore and fissured during 
lactation a shield should be used to give the nipple 
rest while the child sucks. The nipples should be 
washed after use. The following local application 
may be given: 
I|. Balsam, peruvian 3ii 
Olei amygdalae 3 iss 
Mucil. acac 3ii 
01. rosae m. ii 
M. Sig. Apply to the nipples after each nursing. 
If the nipples are inflamed the following lotion may 
be used: 
Liq. plumb, subacetat 5ss 
Extr. opii 3i 
Aquae rosae giiiss 
M. Sig. Lotion to be used after a bread-and-milk 
poultice. 
Lotions are of much better service than ointments 
or greasy applications. 
Astringents harden the nipples but tend to crack 
them; however, a mild astringent may be used such as 
an infusion of green tea. Glycerin of tannin (1 to 4) 
or glycerin of borax (1 to 5) are also simple but effect- 
ive remedies. 
NOSE, BLEEDING AT. (EPISTAXIS). 
Do not check unnecessarily vicarious bleedings 
of menstruation, of plethora or of the crises of 
certain fevers. 
The patient should have absolute rest, and the 
head should be kept erect, not forward and down- 
wards, as is commonly done. If the bleeding comes 
from the anterior part of the nasal cavity, pressure of 
the alse against the nasal septum will often stop 
the bleeding. The application of cold to the nose 
or the insufflation of cold water is also effective. 
Dry the place where the bleeding is taking place 
with absorbent cotton and apply nitrate of silver, 
chromic acid or the galvano-cautery. Astringents 
like alum or tannin are also useful. 
286 When these simple means fail, pack part of the 
nasal cavity where the bleeding is. Introduce a 
narrow slip of surgical gauze and pack it against 
the bleeding part. The gauze may be soaked in 
adrenalin solution 1 to 1000. 
The use of the following solution is frequently 
followed by prompt cessation of the haemorrhage: 
3- Antipyrin .'.... grs. xx 
Aquae o i 
M. Sig. Inject into nose lukewarm with nasal 
syringe. 
If there is a haemorrhagic tendency, calcium chloride 
should be given internally: 
I|. Calcii chloridi 5iii 
Fluidextract, ergotae 3ii 
Aquae . 5i 
Syr. sarsap. co q. s. ad. 3ii 
M. Sig. One teaspoonful every two hours. 
Feeding the patient on gelatin is also useful. The 
ordinary flavored gelatins on the market answer the 
purpose well, especially in the case of children. 
NYCTALOPIA (See Day-blindness). 
NYMPHOMANIA. 
Remove all sources of local irritation and give: 
I}. Sodii arsenatis gr. 
Hyoscyinae hydrobromidi gr. 
Potass, bromid §i 
M. ft. caps. No. xxx. 
One capsule after meals. 
Or: 
1$. Liq. potass, arsenit m. viii 
Sodii bromidi 3iv 
Aquae camphor q. s. ad. 3 viii 
M. Sig. A tablespoonful in water after each meal. 
Tobacco smoked or chewed ad nauseam is said to 
cure the disorder but is very depressing to the patient. 
(See also Aphrodisia.) 
287 OBESITY. 
Avoid overeating, diminish starches and fats 
in dietary, prohibit pastry and sweets. Lessen 
amount of fluids drunk, especially at meal times. 
Take regular exercise in the open air, such as walk- 
ing, golfing, bicycling, automobiling or horseback 
riding. The oxidation of the fats of the body is 
accelerated by massage. In some cases cold baths 
and sea baths are beneficial, in others Turkish and 
steam baths. The hours of sleep should be limited 
to six or at most eight hours. The liver should 
be stimulated with Carlsbad and Kissingen salts, 
and Vichy water. These salts are best prescribed 
in effervescing form after each meal. Carlsbad 
and Kissingen should be taken on alternate days. 
In some cases this treatment is very efficacious. 
The following prescriptions may be given, but 
only as adjuncts to the above: 
I). Tabell. glandul. thyroid, sicc grs. v 
No. xxiv. 
Sig. One tablet after each meal and cautiously 
increased. 
This drug should not be carelessly used, and its 
effects should be carefully watched. Palpitation, rest- 
lessness, headache and syncope indicate an excessive 
dosage. 
Another form of treatment is: 
I). Ext. phytolacc. fl §i 
Sig. Ten drops in water after each meal. 
Iodine with the alkaline iodides may also be ad- 
ministered, but only as an adjunct to strictly regu- 
lated exercise, diet, etc.: 
I|. lodingrs. iss 
Potass, iodidgrs. xxv 
Aquaeq. s. ad. Si 
Sig. A teaspoonful three times a day. 
Saccharin, a sweetening agent 500 times sweeter 
than sugar, is also used in the dietary of obese patients. 
One-half of a grain (tablet) may be used in place 
288 of each lump of sugar in sweetening tea, coffee, or 
cocoa. 
OERTEL'S TREATMENT. 
This combines a dietetic and a mechanical method 
of treatment. It consists (1) in restricting the 
amount of fluids ingested. This lessening of the 
fluids of the body seems to help in reducing the 
fat and stops the weakening of the heart muscle 
which is the starting point of the dangers of obesity. 
Beer is forbidden and small quantities of water 
are given at frequent intervals to allay thirst. Ex- 
cretion of water is stimulated by sweats and deep 
inspirations. (2) Stimulation of the circulation by 
systematized exercise in the form of walks and 
mountain climbing. This stimulates the heart, 
develops the respiratory muscles, increases the 
lung capacity and widens the vessels. In this 
way the combustion of the body-fat is effected 
and the tissue albumin is preserved. (3) The fats 
and carbohydrates in the diet are restricted. 
The following is Oertel's dietary: 
Morning meal: Coffee, 4J4 ounces; milk, 1 ounce; 
sugar, 77 grains; wheaten bread, ounces. 
Midday meal: Soup, 3 ounces; roast or boiled 
beef, veal, game, or lean poultry, 7 to 8 ounces; 
fresh salad, 1 ounce; bread, 1 ounce, never to exceed 
3 ounces; fruit, 3 to 6 ounces; a little fish if desired. 
Light wine, 6 to 8 ounces, if no fruit, or if very 
hot weather; otherwise no fluid with this meal. 
Afternoon meal: Coffee, ounces; milk, 1 
ounce; sugar, 77 grains; water, 2 ounces, never more 
than 6 ounces; bread, 1 ounce (exceptionally). 
Evening meal: Wine, 7 ounces; water, 2 ounces, 
one or two eggs; roast meat, 5 ounces; salad, 1 ounce. 
OLD AGE, DIET IN. 
Since persons who are small eaters and are spare 
and lean, usually live longer than fat people who 
are gross eaters, the indication is to provide sufficient, 
289 but no more, nutriment for persons in advanced 
life. The functions of the kidney are apt to fail 
because of shrinkage due to interstitial fibrosis, 
hence an old person should be sparing in the use 
of animal food. The main portion of his dietary 
should consist o.f carbohydrates and vegetable food, 
to which fish may be added. Further, the vigor 
of the digestive powers and the assimilative capacity 
tend to be lessened in the aged and hence the neces- 
sity for plain and readily digestible food. 
The following articles of diet satisfy these re- 
quirements: finely divided, or minced, and tender, 
. well-dressed, roast meat, mutton, fish and game in 
small quantities; well-cooked vegetable food, mashed 
potatoes, spinach, lightly boiled eggs, farinaceous 
puddings and mutton broth. 
Wine and warmth are proverbially good for the 
aged. From two to six ounces of mature port 
wine or two ounces of brandy or whisky per day is 
in most cases beneficial, but more than that should 
be forbidden. Tea, coffee, and cocoa are both 
grateful and salutary for old people. The following 
arrangement of meals is to be recommended. A 
light breakfast, a hearty luncheon with the above 
limited amount of stimulants, and an evening meal 
consisting of farinaceous food or oatmeal and milk. 
ONYCHIA. (INFLAMMATION OF MATRIX OF NAIL.) 
Prophylaxis. The occurrence of inflammation 
about a nail as a result of injury may be avoided 
by the immediate immersion of the finger in very 
hot water. 
Treatment. Inflammation may be aborted by 
painting the reddened skin with a 20% solution 
of silver nitrate. Or apply the following: 
IJ. Liq. plumb, subacet 3iv 
Tinct. opii 5iv 
Aquaeq. s. ad. gviii 
M. Sig. Apply freely on soft cloths or absorbent 
cotton. 
290 When there is moderate inflammation bind a strip 
of salicylic acid plaster (10%) tightly around the nail. 
If suppuration occurs make a deep incision, evac- 
uate pus and apply: 
Ichthyol 3ii 
Extr. opii grs. xv 
Lanolin 3iii 
Cerat. plumb, subacet 3iii 
M. Sig. Apply freely after evacuating pus. 
If it is necessary to remove the nail give the fol- 
lowing local anaesthetic: 
I|. Cocainse hydrochlor gr. i 
Morph, hydrochlor gr M 
Sodii chlor gr. i 
Phenolis gtt. i 
Aquae destillat® q. s. ad. 3i 
M. Sig Inject into tissue around base of nail. 
For treatment of onychia lateralis see Ingrowing 
Toe Nail. 
OPERATION, PREPARING A PATIENT FOR. 
An aperient should be given over-night and a 
simple enema early in the morning of the operation. 
No solid food should be given for at least four hours 
before the operation, but a cup of beef tea may 
be given two hours before it. All false teeth should 
be removed. If the skin at the seat of the opera- 
tion is hairy, it should be shaved for a considerable 
distance round and then thoroughly cleansed with 
a sterilized nail brush, soap, and hot water with 
a little washing soda dissolved in it. The grease 
is then removed with turpentine or ether. The 
part is then covered by a dressing soaked in a per- 
chloride of mercury lotion (1 to 2,000) and covered 
with protective, and the dressing is left on for six 
hours. The temperature of the operating room 
should be from 65° to 70° F. or even higher in the 
case of abdominal operations. Draughts should 
be carefully avoided. Care should be taken to see 
291 that the number of sponges at the end of the oper- 
ation is the same as at the beginning. Stimulants 
should be at hand as well as a hypodermic syringe and 
also the materials necessary for the infusion of saline 
solution. 
OPHTHALMIA NEONATORUM. 
Prophylaxis. Immediately after the birth of the 
child its eyes and eyelids should be wiped clear 
of mucus and two drops of a 2% solution of nitrate 
of silver should be dropped into each eye. This 
should be the routine practice whether the maternal 
vagina be infected or not. When the mother's 
passages are suspected the vagina should be douched 
once or twice daily before delivery with a mild alka- 
line solution and then with a solution of bichloride of 
mercury (1 to 5,000). 
Treatment. Wash the eyes every 15 to 30 
minutes, day and night, with saturated solution' 
of boric acid to keep them free from pus. An 
eye dropper attached to a fountain syringe may 
be used. Lay the child on its side and irrigate 
the lower lid, instilling the solution into the inner 
angle of the eye. In addition to this instil twice 
a day a few drops of a 10% protargol solution. 
During the acute inflammatory stage, cold appli- 
cations are necessary. Small pieces of gauze are 
laid on a block of ice and applied to the eye one 
after the other for two or three hours at a time. 
If only one eye is affected, protect the well one 
by laying on it small pledgets of cotton soaked 
in an antiseptic solution. 
OPIUM POISONING, ACUTE. 
First, remove the unabsorbed poison from the 
stomach, second, prevent death by coma and cessa- 
tion of respiration. 
Give an emetic or use the stomach tube. A 
strong infusion of coffee may be used as an antidote, 
and pilocarpin to increase the elimination by the 
292 skin. Rouse the patient and dash cold water on 
the face. Then walk him between two strong men 
up and down preferably in the open air for ten to 
fifteen hours if necessary. Atropin sulphate may 
be given hypodermically ( gr.) and repeated if 
necessary till grain has been given. The body 
should be kept warm and dry and warmth should 
be applied to the extremities. Artificial respiration 
and inhalation of oxygen may be resorted to. 
ORCHITIS (See Epididymitis). 
OSTEOMALACIA. 
If the case is seen early in pregnancy, abortion 
should be induced and the patient should then be 
placed on a substantial diet consisting largely of 
milk. Tonics as cod liver oil and phosphorus are 
of benefit: 
1$. Olei phosphorati 5ii 
Olei morrhuse giii 
M. Pone in capsulas No. cxx. 
Sig. One capsule after each meal. 
The following may also be found of service: 
I}. Syrupi calcis §iii 
Sig. Half a teaspoonful in water after each meal. 
If the case is seen late in pregnancy, Caesarean 
section may be necessary or preferably, supra-vaginal 
amputation of the uterus (Porro operation). This 
prevents further pregnancies and often arrests the 
disease. The suppression of the sexual function pro- 
duced by ovariotomy often cures the disease also. 
If the case is seen during lactation, nursing the 
child at the breast should be stopped. 
At the present time considerable success has fol- 
lowed the daily injection of 8 minims of adrenalin 
solution in the strength of 1 to 1,000. After twenty- 
five injections patients are able to walk. 
OSTEOMYELITIS, ACUTE. 
The indications for treatment are plain, the pus 
must be evacuated no matter where it is. An in- 
293 cision must be made down to the bone and the 
periosteum should then be incised. The sooner 
the above treatment is carried out the better. The 
pus cavity should be irrigated with a 1 to 2,000 
bichloride solution and then packed with gauze. 
Where much bone has been destroyed it becomes 
necessary to make a long incision to remove the 
dead sequestra of bone. 
OTALGIA (See Earache). 
OTITIS (See Earache). 
OTORRHEA. 
In strumous patients give the following to tone 
up the system: 
I). Syrupi ferri iodidi 5i 
Sig. Three to fifteen drops (according to age) in 
milk after meals. 
Syringe gently with corrosive sublimate lotion 
(1-5,000). Then dry, and dust in with insufflator 
gently the following powder: 
IJ. lodoformi 5i 
Pulveris acidi borici 3ii 
M. Sig. Dust in ear freely twice daily after cleans- 
ing. 
Then pack the meatus loosely with an antiseptic 
gauze. Repeat daily or twice daily until the discharge 
lessens; then syringe gently, daily, with the following 
lotion: 
]$. Acidi carbolici grs. x 
Plumbi ace tat grs. x 
Tinct. opii oii 
Aquee §viii 
M. Sig. Irrigate the auditory meatus daily. 
Force should never be used in irrigating an ear. 
Always allow plenty of space for the water to escape. 
Ordinary cases of otorrhea where there is no odor 
to the discharge, do not require irrigation. The canal 
should be wiped out every hour or two with cotton 
wrapped round a toothpick. 
294 OXYURIS (See Thread Worms). 
OZENA. 
Look for and treat the cause. In syphilitic ozena 
give: 
Hydrargyri chloridi mitgrs. xv 
Pulveris sacchari 3iv 
M. Sig. Use as snuff three times a day after cleans- 
ing. 
As a general rule attempts to cure ozena by local 
measures alone are useless. The tone of the general 
system should be restored by hygienic and tonic 
measures. 
The following may be given: 
I|. Syrupi ferri iodidi §i 
Emuls. olei morrhuae, U.S.P. .q. s. ad. §vi 
Sig. One teaspoonful two hours after meals. 
In the local treatment there are two objects to be 
kept in mind, to relieve irritability of the nasal mucous 
membrane by sedatives and protective applications, 
and to check the secretions. When the secretions are 
watery and profuse it is not necessary to cleanse the 
nasal cavity, but when they are muco-purulent the 
nose should be cleared before local remedies can have 
any effect. 
The nostrils may be cleansed with a five per cent 
solution of hydrogen peroxide or weak solution of 
sodium chlorid. Then give: 
I|. Ichthyol m. xl 
Menthol gr. v 
Lanolin 3 i 
M. Sig. At bedtime introduce a piece of ointment 
as large as a bean, and snuff back. 
The following may be used as a douche: 
I). Potass, permanganat 5i 
Aquae destillat ®xvi 
M. Sig. A tablespoonful to a pint of water as 
nasal douche several times a day. 
295 PACHYMENINGITIS, EXTERNA. 
Treat the cause. Infection usually comes from 
without. Surgical treatment is indicated in all 
cases and is followed by good results. 
PACHYMENINGITIS, INTERNA. 
Remove the cause if possible. 
The seizure should be treated with a rectal injec- 
tion of a drachm each of chloral and bromide of 
sodium. The head should be elevated, the ice-bag 
applied to it, and leeches applied to the back of the 
ear. Lumbar puncture is of no benefit. Morphine 
and chloral may be given to relieve the headache. 
PALPITATION OF THE HEART. 
This condition is frequently so troublesome as to 
require special relief. The cause should be dili- 
gently searched for and treated, e. g., overloaded 
stomach, acute dyspepsia, disease of the heart, an- 
gina pectoris, anaemia, exophthalmic goitre, hys- 
teria, etc. 
If due to an overloaded stomach, it should be 
promptly emptied by the stomach tube, followed 
by a brisk cathartic. 
Frequently what will benefit one case will not 
affect another in the least. 
When due to hysteria or emotional causes the 
following may be given: 
3. Asafetidagrs. xxiv 
Zinc, valerian grs. xii 
Ext. sumbul grs. xii 
M. et ft. caps. No. xii. 
Sig. One capsule every four hours. 
Or: 
I|. Camph. monobromgrs. xlviii 
Zinc, valeriangrs. xxiv 
Extr. hyoscyam grs. xii 
M. et ft. pil. No. xxiv. 
Sig. One pill every four hours. 
296 When due to arteriosclerosis or sudden increased 
tension in the blood vessels, a pearl of nitrite of amyl 
crushed in a handkerchief and inhaled frequently gives 
speedy relief. 
Some patients are relieved by the application of ice 
or cold to the precordium, others again by the inha- 
lation of ether, ammonia or strong acetic acid. 
Digitalis is of no use to relieve the paroxysm be- 
cause it acts too slowly. 
A mixture of carminatives usually gives relief in 
most cases: 
I|. Spt. aeth. nitros 3ss 
Spt. ammon. aromat 5ss 
Spt. camphor 5ii 
Tinct. zingiber 3iv 
01. menth pip 3i 
Tinct cardamom comp.. . .q. s. ad. Siii 
M. Sig. One teaspoonful in a wineglassful of water 
every fifteen minutes until relief is obtained. 
Sometimes an attack may be aborted by thoroughly 
rubbing the following ointment into the precordium: 
3. Veratrinae grs. iii 
Extr. opii*. grs. xv 
01. menth. pip m. xv 
Tinct. cantharid m x 
01. terebinth m ii 
Adip. benzoatq. s. ad. §i 
M. Sig. For external use. 
During the interval between attacks the patient 
should be forbidden the use of tea, coffee, tobacco and 
alcohol. Sexual excitement must also be avoided, as 
should strenuous work and brain-fag. 
If anaemia is the cause, iron, phosphorus and arsenic 
are indicated: 
3- Mass. Blaud 5ii 
Zinci phosphidgrs. ii 
Ext. gentiangrs. vi 
Ext. nuc. vomicgrs. vi 
Ac. arsenios ■ .. .' gr. | 
M. et ft. caps. No. xxiv. 
297 Sig. One capsule after each meal. 
If due to plethora, give salines in the morning on 
arising with hot water. Epsom or Carlsbad salts may 
be used, or some of the liquid salines may be substi- 
tuted, as Hunyadi Janos, Rubinat or Pluto water. 
The patient must also take plenty of fresh air exercise 
and have his diet carefully regulated. 
Some conditions, especially arteriosclerosis, are 
greatly benefited by the prolonged administration of 
potassium iodide, 5 grains four times a day. 
PARALYSIS AGITANS. 
The patient should not indulge in any excesses, 
but should lead a very quiet, retired life. Warm 
baths allay the nervous irritability. Electricity and 
massage are of no avail. 
The medicinal treatment should be directed against 
the tremor. Give hyoscin hydrobromate to Tf J 
gr.) twice a day hypodermically or orally. Arsenic 
and nux vomica are often of use when given together: 
1$. Acid, arsenios gr.' 
Extr. nuc. vomic. grs. iv 
Zinci phosphidi gr. iss 
M. et ft. caps. No. xviii. 
Sig. One every four hours. 
Occasionally it becomes necessary to employ mor- 
phine sulphate (gr. *4) at- bedtime to quiet the tremor. 
PARALYSIS, DIPHTHERITIC. 
Strychnine should be given in gradually increas- 
ing doses. For a child from six to ten years old 
begin by giving gr. three times a day, gradu- 
ally increasing the dose to gr. Electricity 
should be applied daily in the form of the galvanic 
and faradic current alternately; also the high 
frequency current along the spine and down the 
limbs following the course of the nerve trunks. 
Massage of the muscles is also' necessary to prevent 
wasting. Give plenty of good, easily digested, nour- 
ishing food. 
298 PARALYSIS, FACIAL. (BELL'S PALSY.) 
If due to syphilis or lesions of the middle ear give 
appropriate treatment. Ear drainage is often cura- 
tive. 
The patient should be kept indoors and hot fomen- 
tations kept up for two or three days. The appli- 
cation of a blister over the mastoid and one over 
the side of the neck are often of benefit. 
A weak galvanic current applied over the affected 
muscles just strong enough to cause contraction is 
often of service. 
Deformity may be corrected by massaging the 
cheek and mouth upwards, and placing a tape in 
the angle of the mouth and sustaining it by an adhe- 
sive plaster. The eye should be douched with boric 
acid, bandaged close during sleep and the lids 
massaged. 
Strychnine should be pushed in doses of grain, 
every three hours. 
PARALYSIS, GENERAL (See Dementia Paralytica). 
PARALYSIS, INFANTILE, CEREBRAL. 
The treatment of this disease is very discour- 
aging. The convulsions are controlled by inhalations 
of chloroform or by the administration of chloral 
by the rectum. For a child three years old dissolve 
15 grains of chloral hydrate in water and give per 
rectum. 
The epilepsy which results from this disease is 
incurable. Bromides are of no use. Operative inter- 
ference may be tried. The results are encouraging 
in those cases that do not die as the result of the 
operation. 
PARALYSIS, INFANTILE SPINAL (See Infantile Spinal 
Paralysis). 
PARAPLEGIA. 
Look for and treat cause if found. If due to 
hysteria, remove the patient promptly from her 
299 relatives and treat her in isolation by psychothera- 
peutic methods, either in a hospital ward or nursing 
home. If due to syphilis, give potassium iodide 
in doses of 10 to 15 grains three times a day, and 
rapidly increased until 100 grains are taken in the 
24 hours; while twice daily an inunction of mercury 
should be given and continued until salivation or 
redness of the gums appears. 
If the spinal cord is pressed on by a tumor an 
operation should be undertaken. In determining 
the exact segmental location of the tumor it should 
be noted that the constant tendency is to locate 
the tumor rather lower in the spinal cord than is 
actually the case. 
If the paraplegia is due to tuberculous disease 
of the spinal column, extension should be applied, 
with counter-extension to the head if the disease is 
situated in the cervical region. The patient should 
be kept in extension for two or three months. 
If there is reason to suspect a tuberculous abscess 
an operation hould be undertaken, more especially 
if the patient is a child. 
In traumatic paraplegia associated with fracture- 
dislocation of the spine, an early operation is at- 
tended with some hope of relief, if it so happens 
that the cord is pressed on by a piece of bone which 
is removable. 
Symptomatic treatment. If the patient is unable 
to pass urine it should be at once drawn off with 
the strictest aseptic precautions. A catheter should 
be passed three times a day. A statement to the 
effect that urine is being passed is to be accepted 
with caution, since a dribbling overflow may delude 
the patient into believing that all is well. 
To avoid bed-sores the patient should be placed 
upon a water bed. The prone position with pillows 
under the abdomen is advisable since in this position 
gravitation will be more likely to deplete the vessels 
in the neighborhood of the lesion. 
300 A sponge-bag filled with ice should be applied 
over the situation of the lesion, and if haemorrhage 
is suspected, full doses of ergot should be given. 
Mild laxatives or a daily enema of soap and 
water should be given to guard against constipation. 
Veronal in doses of 5 to 10 grains may be given 
for the flexor spasms. 
If cystitis exists the bladder should be washed 
out two or three times a day with a weak boric acid 
lotion, while salol, urotropin and acid phosphate of 
soda are given internally. 
In flaccid paraplegia, the paralyzed muscles should 
be massaged and faradic or galvanic current applied 
to them and strychnine given hypodermically. 
PAROTITIS (See Mumps). 
PARTURIENT WOMAN, AFTER-CARE OF. 
When the umbilical cord has been tied and cut 
and the eyes of the child washed with a saturated 
solution of boric acid (half a teaspoonful in a cup 
of warm water) wrap the child in warm flannel and 
hand it to the attendant. 
Give attention now to the mother and redouble 
precautions as to asepsis. Intra-vaginal or uterine 
manipulations are now exceedingly dangerous, for 
they are no longer made inside the amniotic cavity. 
The danger of infection is so much increased now 
that manual removal of the placenta is one of the 
most dangerous obstetric operations. It is usually 
expelled by the contractions of the uterus in from 
10 to 30 minutes after labor. Manual removal 
should only be resorted to when all other methods 
(Crede's, etc.) have failed, and then only after thor- 
ough disinfection of the hand. 
After the placenta and membranes are expelled, 
the maternal surface of the placenta should be 
examined by placing the fetal surface on the palm 
of the hand or by spreading it out in a large dish 
301 of water. Examine carefully whether any piece has 
been torn oft and left in the uterine cavity. 
Next examine whether the entire bag of mem- 
branes is present, by passing the hand into the mem- 
brane cavity and estimating its size, taking into 
account the size of the child and the amount of 
liquor amnii. 
A post-partum douche should only be given when 
the hand or instruments have been introduced into 
the uterus or where there is danger of uterine sepsis. 
The external genitals, thighs, buttocks, and lower 
abdomen should be washed with bichloride solution 
(1 to 4,000). The vulva should be covered with a 
sterile napkin, which may be a dry antiseptic pad 
or one soaked in an antiseptic solution. 
PEMPHIGUS. 
Iron, cod liver oil, general hygienic measures 
such as a nutritious diet carefully adapted to the 
stomach, or a bracing climate are usually of the great- 
est benefit. Quinine, phosphorus and strychnine are 
also of great value, and above all arsenic: 
1$. Liq. potass, arsenitis Bi 
Sig. One drop in water after meals, and gradually 
increase to tolerance. 
The following pill is useful in the case of anaemic 
subjects: 
I). Sodii arsenatis gr. i 
Quininse hydrochloridi Bi 
Massae ferri carbonatis 5ss 
M. ft. pil. No. xxx. 
Sig. One pill after each meal. 
Locally, dusting powders such as boric acid with 
oxide of zinc and starch are useful, or prescribe: 
I). Zinci stearatis 5 i 
Sig. Apply freely as a dusting powder. 
If the tension of the blebs is uncomfortable they 
may be punctured and then dressed with zinc ointment. 
302 PEPTIC ULCER (See Gastric Ulcer). 
PERFORATING ULCER (See Gastric Ulcer), 
PERICARDITIS, ACUTE. 
Patient should be kept absolutely quiet, free 
from worry. Treat the cause as, rheumatism, 
pysemia, septicaemia, acute lobar pneumonia. Occa - 
sionally an attack of acute pericarditis may be cut 
short by a blister, leeches or dry cups applied to 
the precordial region. The application of an ice- 
bag or very hot fomentations are highly recom- 
mended. 
At the beginning of the attack when the pulse 
is full and strong a brisk purgative should be given. 
The heart in this disease is usually weak, there- 
fore such drugs as antimony, aconite and veratrum 
viride are contra-indicated. 
Quinine is a useful remedy throughout the dis- 
ease, especially in the form of Niemeyer's pill which 
consists of: 
I}. Quin, sulph grs. xii 
Extr. digital grs. iii 
Extr. opii grs. iv 
M. et ft. caps. No. xii. 
Sig. One every four hours. 
Fly blisters should be applied over the region of 
the heart in rheumatic cases. They do no good in 
septicaemia, Bright's disease or diphtheria. 
Dry pericarditis requires little treatment, perhaps 
an occasional dose of morphine to relieve pain. 
In moist pericarditis, digitalis and strophan thus are 
indicated, especially when the pulse is rapid, irreg- 
ular, weak or dicrotic: 
I}. Tinct. digital oiv 
Tinct. strophan th 5i 
Syr. aurant. cortic q. s. ad 5 iii 
M. Sig. One teaspoonful every four hours. 
303 Restrict the quantity of liquids drunk while the 
exudation of fluids is going on. Absorption is pro- 
moted by blisters, iodine, etc., also by the adminis- 
tration of tonics such as quinine, strychnine, nux 
vomica, iron and cardiac tonics. Purgation, diuretics, 
and potassium iodide promote absorption of the fluid. 
Aspiration of the pericardial cavity is very rarely 
required, it is attended with danger. 
If symptoms of cardiac failure appear give digi- 
talis, strophanthus, strychnine, alcohol, ammonia, 
ether, etc.: 
1$. Strychnin, sulph gr. f 
Tinct. strophanth 3i 
Tinct. digitalis 3ii 
Brandyq. s. ad. §iii 
M. Sig. One teaspoonful every three hours. 
For sleeplessness give 10 grs. of sulphonal. 
PERINEUM, RUPTURE OF. 
Prophylaxis. During labor when the head reaches 
the outlet and presses upon the perineum, do not 
"strip" the perineum as is so often done by pressing 
back strongly against the tense perineum, for this 
aids laceration. Advise the patient to cease as 
far as possible from making expulsive efforts, so 
that the slight delay may give the tissues time to 
dilate naturally. For the same reason some advise 
direct pressure upwards and backwards against 
the head. Place the left hand against the perineum 
while the fingers of the right hand are pressed against 
the head. In this way extension of the head and 
retardation of its descent are at the same time 
accomplished. Free lubrication of the perineum 
may be employed in all cases where there is a 
threatening laceration, and where there is much 
rigidity an incision with the knife or scissors may 
be resorted to. 
Improper use of instruments should also be 
avoided; also the introduction of the hand with- 
out previous dilation. The more the thighs are 
304 extended the more the perineal tissues are relaxed, 
so that flexion of the thighs on the abdomen should 
be avoided. 
Treatment. If the rupture is only of small extent 
it may be left to nature, observing the strictest 
cleanliness by frequent sponging of the parts with 
a warm antiseptic solution such as weak Condy's 
fluid or carbolic lotion. 
Deeper tears should be stitched at the comple- 
tion of delivery. But if the light is poor and proper 
facilities and antiseptic precautions cannot be se- 
cured, the operation may be postponed for a few 
hours, not more than twelve. In the interval 
apply wet antiseptic dressings to the vulva. 
PERITONITIS, ACUTE. 
This should never be looked upon as an idiopathic 
. condition; always seek the cause such as appen- 
dicitis, typhoid fever, salpingitis, pancreatitis, chol- 
angitis, intussusception, impaction of feces, injury, 
gastric ulcer, strangulated hernia, etc. After the 
primary cause is discovered use those measures which 
are best suited for such cause. 
Medical treatment. Rest is of the first impor- 
tance, in fact the patient is usually found in bed 
with the knees drawn up. In some cases the weight 
of the bed-clothes is too much and it becomes neces- 
sary to protect the abdomen by a cradle or special 
appliance. 
The diet is of the utmost importance. Today 
the general tendency is to withhold everything 
by the mouth even water, in order not to set up 
peristalsis. Feeding per rectum is substituted. To 
relieve the intense thirst of peritonitis, four ounces 
of physiologic salt solution should be injected into 
the rectum every three or four hours. 
In some cases a chip of ice may be placed on the 
tongue for the relief of thirst. 
If collapse sets in, it may be necessary to give 
305 alcoholic stimulants either by mouth or hypoder- 
mically. The following may be used for this pur- 
pose: 
Strych. sulphatgr. -j 
Brandygiii 
M. Sig. One teaspoonful by mouth or hypoder- 
mically. 
Opium has been extensively used for years in the 
treatment of all forms of peritonitis, but is no longer 
considered of benefit except in the relief of pain. If 
there is no vomiting and the pain is very severe 15 
drops of tincture of opium may be given every two 
or three hours if necessary. 
Opium should never be given in pill form on ac- 
count of its accumulative effect. A hypodermic in- 
jection of grain of morphine sulphate and 
grain of atropine sulphate is no doubt the best method 
of controlling the pain. 
The vomiting is best controlled by lavage of the 
stomach. 
Purgatives should not be used under any circum- 
stances because they set up peristalsis which interferes 
with the rest which is so essential for the recovery 
of the inflamed peritoneum. 
Locally hot linseed poultices may be applied to 
the abdomen; they relieve pain and distension. 
The tympanites is best treated by hot turpentine 
stupes to the abdomen and by enemata of two quarts 
of hot water containing tincture of asafoetida 3iii, 
spirits of chloroform 3i, and spirits of turpentine 
3ss. 
Surgical treatment. This gives the patient the 
best chances for his life. Simple incision and drain- 
age are advisable, followed by placing the patient in 
a semi-erect position, and allowing saline solution 
to continuously flow into the rectum at low pressure. 
The reservoir should not be more than two feet above 
the patient. 
306 PERITONITIS, TUBERCULOUS. 
This is a surgical disease. Laparotomy gives the 
only hope of improvement or cure. It is not known 
why improvement takes place; some believe that 
daylight, others that evaporation, irritation of the 
peritoneal surface, hyperleucocytosis, etc., is the 
cause of the cure. The same line of treatment 
should be pursued as in cases of general tubercu- 
losis. Some surgeons simply open the abdomen 
and sew it up again. Others remove the exudate 
with dry sponges, and others still flush with physio- 
logic salt solution, or solution of salicylic acid. 
PHARYNGITIS, ACUTE. 
Put the patient to bed and begin with half-grain 
doses of calomel followed by a saline cathartic. If 
the case is seen early give a Dover's powder. To 
control the fever and benefit the local condition 
give: 
Tinct. aconit m. xxx 
Tinct. belladonna m. xxx 
Ammon, tinct. guiac 3v 
Syr. limon '.. 3iv 
Aq. cinnamon q. s. ad §iv 
M. Sig. One teaspoonful every three hours. 
Locally, cold applied externally by wet compresses 
or a cold coil, gives relief in the early stages. Heat 
is more agreeable in the later stages, applied in the 
form of hot compresses, flaxseed poultices or a mild 
mustard paste. 
Gargles are very comforting, for although they 
do not reach all the posterior wall of the pharynx, 
they do reach the adjacent part. The following may 
be given: 
I|. Potassii chlorat SIH 
Tinct. ferr. chlor 5i 
Glycerin 3 ss 
Aq. destillat q. s. ad. §iii 
307 M. Sig. One teaspoonful to be gargled and then 
swallowed every two hours. 
Or: 
Argyrol grs. xv 
Aq. destillat 3ii 
M. Sig. Use, undiluted, as a gargle every two or 
three hours. 
Guiacol (50% in sweet almond oil) used with brush 
or spray is a very good local application, or give: 
Argenti nitratis grs. xl 
Aquae destillatae §i 
M. Sig. Paint over pharynx, tonsils, and soft palate. 
Or: 
I|. Cocain. hydrochlor grs. x 
Boric acidgrs. xxx 
Aquae destillatae 5iv 
M. Sig. Cleanse throat by gargling, and after dry- 
ing apply with brush every two hours. 
PHARYNGITIS, CHRONIC. 
Prevent any cause of irritation, such as smoking, 
exposure to cold, misuse and overuse of the voice, 
mouth-breathing and intemperance in both eating 
and drinking. Remove adenoid growths and nasal 
obstruction if present. The patient should avoid 
hawking to clear the throat. He should avoid tea, 
coffee, and all very hot or highly seasoned greasy 
dishes. All food should be thoroughly masticated 
and very little fluid should be taken at meals. 
Treat any defect in the general health and attend 
carefully to digestive disturbances. Tonics like iron, 
strychnine, and cod liver oil are often beneficial. 
Salines, cholagogues and alkalies with bitters are 
of service. 
The following is often beneficial: 
1$. Liq. potass, arsenitis 3ss 
Syr. rub. idsei. 
Aquaeaaq. s. ad. 3iii 
Sig. One teaspoonful after meals. 
308 Local treatment. Frequently spray the nasophar- 
ynx with Dobell's solution: 
]$. Sodii bicarb. 
Sodii bo rataa grs. xv 
Acidi carbolicigrs. viii 
Glycerini 3ii 
Aquae o viii 
M. 
In clergyman's sore throat the following may be 
given: 
lodin grs. iii 
Potass, iodid grs. v 
Glycerin 3iv 
Aquae 3iv 
M. Sig. Apply with brush several times a day. 
In follicular pharyngitis galvano-puncture of the en- 
larged follicles is advisable and then application of the 
following: 
I|. Acidi carbolici grs. v 
Tinct. iodi 3ii 
Acidi tannicigrs. xxx 
Glyceriniq. s. ad. §ii 
M. Sig. Apply with a swab two or three times 
daily. 
PHLEBITIS. (INFLAMMATION OF VEINS.) 
Prophylaxis. Asepsis or antisepsis for all con- 
ditions from the slightest infected scratch to abortion 
with retained placenta. Carious teeth should re- 
ceive attention and paring corns with ordinary 
domestic instruments should not be practiced. Mas- 
toid and middle-ear disease should receive proper 
surgical treatment. 
The treatment of phlebitis is the same as that of 
Phlegmasia Alba Dolens, which see. 
PHLEGMASIA ALBA DOLENS. 
Place the patient on her back in bed and keep 
her perfectly quiet, wrap the affected limb in wool 
and keep it elevated on pillows. Avoid all manipu- 
309 lations on the limb and warn patient against making 
any movements in order to prevent detachment of 
thrombi and resulting embolism. Do not allow 
the patient out of bed until two weeks after the 
subsidence of the swelling. The diet should be 
nourishing and the bowels should be kept well 
regulated. 
The following may be given for the relief of the 
pain: 
1$. Phenacetini 5ii 
Div. in chart. No. xii. 
Sig. One powder not oftener than every four hours. 
The following is a common local remedy: 
Tinct. iodi oii 
Sig. Paint along the course of the swollen veins 
once daily or upon alternate days. 
Or: 
1$. Ungt. belladonn 3i 
Ungt. hydrarg aiv 
Ichthyoli ®i 
Adipis lanae hydrosiq. s. ad. §iv 
M. Sig. Apply freely but very gently, without fric- 
tion, along the course of the swollen veins. 
If, in the cellulitic form, abscesses develop in the 
femoral region they should be opened as soon as 
possible in order to avoid the formation of fistulae. 
PHOSPHORUS POISONING. (RAT PASTE, MATCHES.) 
Use the stomach pump or give an emetic. Give 
copper sulphate (grains 3) dissolved in 4 ounces of 
water every five minutes until vomiting is induced, 
then every twenty minutes. Copper sulphate acts 
not merely as an emetic but also as an antidote, 
forming an insoluble phosphide of copper. 
Twenty grains of zinc sulphate dissolved in 4 
ounces of water may be given as an emetic and 
after free emesis has been produced half an ounce 
of magnesium sulphate may be given as a purge. 
310 Demulcents like milk and eggs may be given but 
oils and fats should be avoided as they are solvents 
of phosphorus. Hypodermic injection of morphine 
sulphate may be given for the pain. 
PILES (See Hemorrhoids). 
PINK EYE (See Conjunctivitis, Acute Contagious). 
PLAGUE, BUBONIC. 
Prevention. Extermination of rats, isolation of 
patients, disinfection of excretions, bed-clothing, etc., 
and cremation of the dead. 
Treatment is symptomatic. Absolute rest in bed, 
and keep patient prone till the temperature has 
been normal for at least four days. Abundant 
ventilation. At onset of disease open bowels by 
5 to 10 grs. of calomel, followed in five hours by a 
saline purgative. Control the fever by tepid spong- 
ing, wet pack, cold to head and Leiter's tubas. 
For the tendency to heart weakness and collapse, 
give stimulants such as ammonia, digitalis, alcohol 
and strychnine. The food should be liquid and 
given frequently in small quantities. 
Local treatment of the glands. In early stages, 
soothing applications such as poultices, anodynes, 
or ice-bags. When suppuration occurs, prompt in- 
cision and drainage. Injection into the glands of 
solutions of mercury bichloride and carbolic acid 
has been tried with success. Injection of anti- 
plague serum or vaccine such as that of Haffkine 
or that of Yersin is said to be of great value. 
PLEURISY. 
The indications are: 1st, to cut short the inflam- 
matory process and limit the amount of exuda- 
tion; 2d, to relieve any urgent symptoms which 
may arise, e. g., severe pain, urgent dyspnoea, 
cough, etc.; 3d, whenever the effusion is so quickly 
poured out as to seriously embarrass the breathing, 
to perform paracentesis; 4th, as soon as the fever 
311 has subsided to help nature to absorb the inflam- 
matory products; 5th, if absorption is too slow, 
draw off a portion of the fluid. 
Treatment. Confine the patient to bed in a 
room at a temperature of 60° F. and keep him 
there so long as any considerable amount of fluid 
remains in the cavity of the pleura. The diet 
should consist of milk, and milk foods, soups, meat 
extracts, beaten-up eggs, etc. Restrict the amount 
of fluid drunk as much as possible. Give a little 
water, barley water, citric acid solution or lemon 
water to quench the thirst. 
If the case is seen at the beginning the attack 
may be cut short by cupping, the application of 
an ice-bag to the affected side, brisk purgation 
and the administration of calomel and opium, 
aconite, etc. 
1$. Tinct. aconiti oss 
Spirit, aether, nitros 3i 
Syrupi 3ii 
Liq. potass, citratq. s. ad. §viii 
M. Sig. One tablespoonful every hour until the 
pulse becomes soft and compressible, then every two 
or three hours. 
Give at the same time the following: 
1$. Hydrarg. chlor, mit grs. iii 
Pulv. opii grs. vi 
Saponis grs. xv 
M. et ft. pil. No. xii. 
Sig. One pill every hour or until the bowels move 
freely. To be followed by a full dose of magnesium 
citrate. 
If the febrile process is fully established and exuda- 
tion is present apply warm fomentations and give a 
brisk watery purge such as: 
I|. Pulv. jalapse co oii 
Sig. Half to two teaspoonfuls once daily to pro- 
duce profuse watery purging. 
312 In the average run of cases in which the fever is not 
high, quinine (2 or 3 grains every four hours), liquor 
ammonite acetatis (one or two drachms every three 
hours) may be given. The salicylates may also be 
given because of their influence over the inflam- 
mation of serous membranes, and are especially valu- 
able in rheumatic patients: 
I). Acidi salicylici 5ii 
Pone in cachetas No. xii. 
Sig. One or two cachets three times a day after 
meals. To be followed by a full glass of milk to pro- 
tect stomach. 
Or: 
Sodii salicylatis §i 
Potassii iodidi 3ss 
Syr. sarsapar. co oii 
Aq. menth. viridq. s. ad. Bviii 
M. Sig. Two teaspoonfuls in water or milk after 
meals. 
In the hope of lessening the effusion, hot air or 
steam baths or diaphoretics like pilocarpin may be 
employed: 
1$. Tab. pilocarpin® hydrochloridi gr-A 
No. xii 
Sig. One or two tablets by mouth or hypoder- 
mically every hour until profuse sweating. 
When the fever runs high (102° or 104° F.) and 
the pulse is hard and tense, tartar emetic in small 
and frequently repeated doses (15 drops of antimonial 
wine every four hours) and aconite (drop-doses of 
the tincture every hour) may be given. Should it 
appear necessary to bring down the temperature 
rapidly, cold sponging, the application of an ice-bag 
to the chest, and the administration of large doses 
of quinine are of most benefit. 
Treatment of urgent symptoms. For the severe 
pain which is often present in the earlier stages, hypo- 
dermic injection of morphia and the application of 
313 warm fomentations or leeches usually give relief. 
When cough is unusually troublesome, morphia or 
some preparation of opium may be given but opiates 
are contra-indicated when there are bronchial and 
pulmonary complications. Urgent dyspnoea, or par- 
oxysmal attacks of orthopnoea, when associated with 
and apparently due to pleuritic effusion, are best 
treated by Paracentesis, which see. 
The embarrassment of the action of the heart and 
of the circulation, which is frequently associated with 
a rapidly developed and copious effusion, is usually 
best relieved by aspiration; in many of these cases 
the pulse becomes slower, fuller and stronger as the 
fluid is withdrawn. Great general prostration and 
cardiac failure (manifested by great frequency, feeble- 
ness and irregularity of the pulse, cyanosis, etc.), which 
do not appear to be directly due to the presence of 
a large effusion, should be treated by the administra- 
tion of stimulants and cardiac tonics (brandy, ether, 
digitalis, strychnine, etc.) 
As soon as the fever subsides and the tongue clears a 
more liberal diet may be allowed (fish, chicken, red 
meat, etc.) A dry diet is advisable; the amount of fluid 
which the patient drinks should be restricted as much 
as possible. The rest of the treatment consists in assist- 
ing nature to effect absorption of the inflammatory 
exudation, 1st, restore the general health and nerve tone 
by suitable hygienic and dietetic measures, and by the 
administration of tonics; 2d, stimulate and strengthen 
the action of the heart by the administration of cardiac 
stimulants and tonics; 3d, promote the free action of 
the bowels, kidneys and skin; 4th, administer such 
internal remedies as are useful for promoting absorption 
of inflammatory products, as: 
J|. Sod. salicylat 3iv 
Potass, iodid 5ii 
Aqute 3i 
Elix. digestiv. co. N. Fq. s. ad. oiii 
314 M. Sig. One teaspoonful in hot water every four 
hours. 
PLUMBISM (See Lead-poisoning). 
PNEUMOCONIOSIS. 
The patient should be removed from all sources 
of bronchial irritation, e. g., dusty atmosphere, 
such occupations as coal mining, stone polishing, 
brass polishing, etc. 
The irritating bronchitis which is usually present 
is best treated by making the patient breathe pure 
air out of doors, by tonics and by drugs which 
relieve the local irritation, e. g.: 
I). Mentholis grs. vi 
Spt. vini rect 5ss 
Heroini grs. ii 
Syr. tolu §i 
Syr. prun. virg q. s. ad. §iii 
M. Sig. One teaspoonful every three hours. 
The patient should be well clothed, well fed and 
well housed. 
The drugs of benefit in this condition are arsenic, 
iodide of potassium and iron. 
f|. Syr. ferri iodid 3iii 
Sig. One-half teaspoonful in wineglassful of water 
after each meal. 
Potass, iodid 5ii 
Div. in caps. No. xxiv. 
Sig. One four times a day with water. 
P». Liq. potass, arsenit 5iv 
Sig. Five drops in water after each meal. 
PNEUMONIA, ACUTE LOBULAR. (ACUTE BRONCHO- 
PNEUMONIA, CAPILLARY BRONCHITIS.) 
Every attack of bronchitis in children should 
receive careful attention. 
When an attack of pneumonia begins the child 
should be placed in a large, airy room. Plenty of 
oxygen is essential. 
315 The child's position should be frequently changed. 
If there is much fever, reduce the quantity and 
quality of its food. Do not give medicines or 
stimulants in its food. 
Locally a mustard plaster may be applied to the 
chest, not longer than ten minutes at a time. Flax- 
seed poultices are occasionally of much benefit. 
Stimulation with brandy, whisky, sherry or Tokay 
becomes necessary in those cases that are secondary 
to other diseases. The character and rapidity of 
the pulse are guides for the administration of alcohol. 
From one-half to one ounce of brandy daily may 
be given to a child one year old. 
Stimulants are well borne by children. They are 
most needed when the temperature is low. 
Strychnine is of great value in this disease; 
grain may be given every four hours to a child four 
years old. 
Oxygen may be given continuously but it should 
always be mixed with air. 
For fever in this disease antipyretics should rarely 
be given. If the fever runs above 104° F. or 105° F. 
use cold sponging, or the cold pack, or the cold bath. 
An infant should be put in a bath of 95° F. which 
may be carefully lowered to 90° F. The duration 
of the bath should not exceed five minutes. Rectal 
injections of cold water are also of benefit. 
If the temperature still keeps up, then one grain 
of phenacetin may be given every three hours to 
a child one year old. The following makes a good 
fever mixture for children. For a child one year 
old give: 
1$. Spts. seth. nitros 3iv 
Potass, citrat 5ss 
Spts. minderer 3iii 
Aquae gi 
Syr. glycyrrhiz q. s. ad. giii 
M. Sig. One teaspoonful every three hours. 
316 Inhalations of steam are of great benefit in this 
type of pneumonia. Dry air such as is found in 
steam-heated apartments is irritating and decreases 
expectoration. Under these circumstances the air 
should be kept moist by placing a basin of water on 
the radiator. 
A good method of supplying steam to the child is 
to place a sheet over the bed in the form of a tent, 
attach a rubber hose to a kettle of boiling water and 
allow the steam to enter the tent through the hose. 
Creosote and other drugs may be added to the water 
but little extra benefit is derived from them. The 
plain steam loosens and liquefies the mucus so that 
it can be readily expectorated. 
When the child is too weak to expectorate the mucus 
and suffocation or extension of the disease is threat- 
ened thereby, it becomes necessary to give an emetic. 
First stimulate the child with a little brandy, then 
give a teaspoonful of ipecacuanha; repeat in ten 
minutes if emesis does not take place. If the child's 
reflexes are gone, the further administration of ipecac- 
uanha only helps to depress the child still further. 
Expectorants unquestionably do good in broncho- 
pneumonia. The following may be given to a child 1 
to 5 years old: 
3. Ammon, carbgrs. xxiv 
Ammon, iodid grs. xii 
Syr. tolu gi 
Syr. prun. virg §i 
Syr. licoriciq. s. ad. giii 
M. Sig. One teaspoonfui every three hours. 
Or. 
1$. Ammon, chloridgrs. xxiv 
Syr. lactucar. oiii 
Syr. tolu 3i 
Syr. senega; gss 
Glyceriniq. s. ad. giii 
M. Sig. One teaspoonful every three hours. 
317 When the cough is very irritating and incessant 
it becomes necessary to add a little codeine to the 
above prescriptions, but in this disease it must be 
given cautiously. To a child of from 3 to 5 years 
of age do not give more than grain of codeine to 
the dose. Bromides are also of benefit. Perhaps it 
is best to have a sedative mixture like the following 
from which to give an occasional dose when it is 
required. For a child 3 to 5 years old give: 
I). Tinct. opii. camph 5ii 
Sodii bromid 3i 
Ammon, bromid 3ss 
Syr. tolu gi 
Syr. prun. virgin 5 hi 
Syr. acaciseq. s. ad. gii 
M. Sig. One teaspoonful when necessary; not 
oftener than every three hours. 
In protracted cases of the disease which are usually 
secondary to some other disease, it is necessary to 
keep up treatment for 5 or 6 weeks before any improve- 
ment sets in. Stimulation by strychnine, brandy, 
digitalis and oxygen must be kept up. As soon as 
some signs of convalescence appear, a change of 
climate is almost indispensable. Sending a child 
out of a city or town to the country is occasionally 
followed by complete recovery. 
PNEUMONIA, LOBAR. (ACUTE CROUPOUS.) 
The treatment varies with the extent of the 
involvement and severity of the disease, and with 
the habits and peculiarities of each patient, It 
is a self-limited disease and all that we can do up 
to the present time is to carefully watch the heart. 
In the very beginning if the patient is robust 
and plethoric and the pulse is full and bounding, 
he ought to be bled (10 to 20 ounces). 
Pneumonia anti-toxin has so far been unsuc- 
cessful in lessening the severity or duration of the 
disease. 
31S The patient should be placed in a large, well-ven- 
tilated, airy room, with the temperature low rather 
than high. The bed-clothes should be light. Out-of- 
door treatment has become very popular of late, and 
certainly fulfils all that can be expected from it. 
At the beginning of the treatment give the patient 
a saline cathartic such as half an ounce of Rochelle 
salts. 
Sponging with cold or tepid water should be 
started from the beginning and should be continued 
at least once or twice a day. 
If the fever rims high the patient should be sponged 
with cold water every two or three hours, night 
and day. 
For the stitch in the side which is caused by 
pleurisy, a small hypodermic injection of morphine 
sulphate (| grain) may be given, or an ice-bag or hot 
poultices. In children hot poultices are preferable. 
The patient may lie in any position that is most 
comfortable to him. 
Good nursing is of the highest importance in 
this disease. The patient should have two nurses, 
one for night and the other for day. 
The diet regulation is important. Liquid food should 
be given, e. g., milk, milk foods, such as cornflour 
and arrow-root, raw eggs, meat extracts, meat juices, 
etc. Give one and a half pints of milk daily at 
least. If it produces flatulence, avoid milk, or try: 
£}. Mentholisgrs. vi 
Spts. vini rect 5ss 
Spts. ammon. aromat.. 5iv 
Spts. chloroform 3ii 
Infus. calumbq. s. ad. §iii 
M. Sig. One teaspoonful every four hours. 
For the intense thirst give plenty of water, but 
do not allow the patient to take too much at one time. 
Lemonade or claret and water may be given freely. 
The mouth should be kept scrupulously clean; 
319 allow the patient to rinse it with hot water or some 
antiseptic solution such as boric acid, or: 
Liq. alkalin. antisept. N. F giii 
Sig. One teaspoonful in hot water as mouth-wash 
every two hours. 
Such drugs as antipyrin, phenacetin, acetanilid or 
antifebrin are of no use in reducing temperature. 
The best way to reduce high fever is by cold sponging, 
or the application of an ice-bag or ice-pack to the chest. 
The internal administration of alcohol has in past 
years been overdone, but it unquestionably frequently 
stimulates a fagged-out heart until the crisis is safely 
passed. 
Those who have been in the habit of imbibing alco- 
hol freely should be allowed two or three ounces of 
brandy or whisky in the twenty-four hours. 
When it is necessary to stimulate the heart con- 
tinuously it is best to use digitalis or strophanthus. 
Tincture of digitalis should be given in five drop doses 
every three or four hours. 
Strychnine is one of the best known remedies in 
this disease; it should be given in grain doses 
every three or four hours. 
Oxygen inhalations with strychnine sulphate hypo- 
dermically are of considerable service. The oxygen 
should be allowed to flow in a continuous stream over 
the patient. 
Saline injections are of much service in combating 
the action of toxins in the blood. 
An ice-bag to the head, cold to the surface of the 
body, and the internal administration of alcohol are 
the best means of combating sleeplessness, restless- 
ness, and delirium. The following mixture may be 
used for sleeplessness: 
Potass, bromidi 3iiss 
Chloral hydrat 5iss 
Sodii bromidi 5ii 
Aquae 5 iss 
Syr. aurant q. s. ad. 3ii 
320 M. Sig. One teaspoonful in water. Repeat in two 
hours if necessary. 
If the patient has a severe crisis and is threatened 
with collapse, give brandy freely every half hour. 
The cough in pneumonia usually requires no treat- 
ment, but if it is very annoying the following may 
be given: 
1$. Vin. ipecac. 
Potass, nitrat aa 5i 
Morph, hydrochlor gr. f 
Acid, hydrobrom, dil 5iv 
Glycerin. 
Syr. aurant aa §ss 
Infus. senegte q. s. ad. gvi 
M. Sig. One tablespoonful every four hours. 
As soon as the crisis is over, hot linseed poultices 
may be applied to the consolidated area to help absorp- 
tion of the exudate. Inunctions of the following are 
also of benefit: 
J|. Ungt. hydrarg §ii 
Sig. Rub thoroughly into the affected side twice 
a day. 
After three or four days the following may be given 
to help in the absorption of the exudate: 
I}. Sodii salicylat 3ii 
Potass, iodidi 5ii 
Aquae 5i 
Ess. pepsin q. s. ad. §iii 
M. Sig. One teaspoonful in half a glass of hot 
water every three hours. 
Hot baths are also of some benefit. 
It is important, especially after the crisis, not to 
allow the patient's room to be swept up with a broom, 
because staphylococci and streptococci may gain en- 
trance to the weakened lung and set up secondary 
infection. 
During convalescence tonics should be given as: 
1$. Elix. ferri, quinin. et strych 3iv 
321 Sig. One teaspoonful in water four times a day. 
Or: 
Tinct. nuc. vomic 3iv 
Malt cum pepsin et pancreatin q s ad. Siii 
M. Sig. One teaspoonful before each meal. 
In delayed resolution, potassium iodide and cod 
liver oil are indicated: 
Sig. Ten drops in hot water every four hours. 
3. Sat. sol. potass, iodid 5i 
And: 
3- Emuls. ol. morrhuae U. S. P §vi 
Sig. Two teaspoonfuls three times a day. 
POLIOMYELITIS, ACUTE ANTERIOR (See Infan- 
tile Spinal Paralysis). 
POLITZERIZING THE MIDDLE EAR, DIREC- 
TIONS FOR. 
Introduce the end piece or nozzle into one of the 
nostrils, then close both nasal orifices by compres- 
sion between the thumb and fingers. The patient 
is then asked to swallow a small quantity of water 
and as soon as Adam's apple is seen to rise the Polit- 
zer bag is quickly compressed. 
The Politzerization should be done very gently 
at first and the patient told beforehand of the 
slight shock to be expected. The patient is usu- 
ally able to tell whether or not the air has entered 
his middle ear. The air will often enter both ears 
when one Eustachian tube is swollen, but it will 
enter on the diseased side with less force. When 
chloroform vapor is used instead of air, a sense of 
heat or cold is felt. 
PREMATURE INFANTS, CARE OF. 
The baby should be protected from noises, bright 
lights and unnecessary handling. To keep up the 
temperature use an incubator or hot water bags or 
bottles placed carefully around the baby in a 
crib basket padded with cotton. The top of the 
322 basket should be covered with a blanket which 
comes up to the baby's neck. An even tempera- 
ture between 90° F. and 95° F. must be kept up 
regularly. The temperature of the room should 
be from 80° F. to 85° F. The baby should not be 
washed but oiled every three days and wrapped 
in a quilted gown with a hood. Absorbent cotton 
may be used for a diaper. 
When necessary give one or two drops of brandy 
and gr. strychnine. 
Babies under two pounds usually die. The prog- 
nosis is fair when the weight is over four pounds. 
(See also Feeding of Premature Infants.) 
PRESBYOPIA. 
Supplement the failing accommodation by con- 
vex glasses. These should not much exceed one diop- 
trie when first given to a presbyopic emmetrope of 
from 40 to 45 years of age. To preserve the habit of 
accommodation, they should at first be used only 
in such work as cannot be performed without them. 
A presbyope should always keep a record of the 
power of his glasses and when he needs them 
stronger, the next glasses which he uses should be 
half a dioptrie more than the old ones. Too weak 
glasses do not give full relief, and too strong ones 
compel holding the book at too short a distance. 
PRICKLY HEAT. 
Cold water baths, light diet, wear linen or silk 
next the skin, discontinue soap. Avoid perspiring 
and take little or no exercise. Drink very little 
and only in very small quantities at a time. Relieve 
constipation with saline laxatives or mild diuretics 
like the citrate, acetate or nitrate of potassium. 
Relieve itching with lotions of carbolic acid (1 in 
80), or of boric acid followed by a simple dusting 
powder. Anoint body night and morning with lano- 
line (1 part) and almond oil (8 parts), or instead dust 
skin with Fuller's earth (or starch) and zinc oxide. 
323 PROGRESSIVE MUSCULAR ATROPHY. 
Attention to the general health, avoidance of 
fatigue, and careful diet. Phosphorus compounds 
are often of service. Strychnine nitrate in doses of 
.s'rt- grain given hypodermically is of great benefit. 
Electricity, massage and careful gymnastics are 
also serviceable. 
PROLAPSUS ANI ET RECTI. 
Look for and treat the cause, e. g., debility, 
worms, vesical calculus, phimosis, stricture, etc. 
In the case of children aim at diminishing the 
amount and frequency of the prolapse. Direct 
the act of defecation to be performed in the recum- 
bent posture, and give laxatives to prevent strain- 
ing, e. g., sulphur confection, laxative fruit, etc. 
Avoid cathartics and any source of irritation which 
will cause frequent passages. Each time that the 
bowel protrudes use an astringent such as: 
p. Plumb, acetatgrs. x 
Pulv. gallse 3i 
Ichthyolm.xxx 
Vaselin 3ii 
Lanolin 3vi 
M. Sig. Apply freely to the prolapsed mass and 
gently push behind the sphincter. 
If the prolapsed mass is inflamed, cedematous and 
irreducible, put the patient to bed, use freely cold 
applications and smear the tumor with an ointment 
of equal parts of extracts of opium and belladonna. 
In a week or so the tumor may be in a position to be 
replaced or removed by surgical means. 
The following may be given internally: 
I|. Strych. sulphat gr. i 
Ergotin 3ii 
Quinine 5i 
M. ft. pil. No. xl. 
Sig. One after each meal. 
324 PROSTATITIS, ACUTE. 
The patient should have absolute rest in bed in a 
horizontal position with the hips elevated a little. 
To ease the pain and give the bladder rest from 
spasm, give opiates by the mouth, or morphine 
and atropine hypodermically, or opium and bella- 
donna suppositories. 
If there is irritation of the bladder and tenesmus 
give: 
Tinctur® veratri 3ii 
Morphin® acetatis grs. iii 
Syrupi acidi citrici 3iv 
Liq. potass, citrat q. s. ad. §vi 
M. Sig. Two teaspoonfuls in water every 2 hours. 
The following suppository will be found useful: 
I). Extract! hyoscyami grs. ii 
Extracti opii grs. vi 
Olei theobromatis 3iss 
M. et ft. suppositoria No. vi. 
Sig. One suppository by rectum not oftener than 
every six hours. 
Irritation from injections, unsuitable diuretics, and 
instruments should be avoided. 
In very acute cases, leeches and hot poultices may 
be applied to the perineum and the bowels kept open, 
especially if opiates are administered, by aperients 
such as: 
1$. Hydrarg. chlor, mit grs. ii 
Sodii bicarb grs. xii 
M. ft. chart. No. vi. 
Sig. One powder on tongue every hour. To be 
followed by Seidlitz powder unless free evacuation 
of the bowels. 
The urine should be kept alkaline with diluents 
and alkaline diuretics. 
If signs of suppuration present themselves and 
fluctuation be distinct, the abscess may be aspirated 
or punctured by a sharp knife through the rectum. 
325 The nourishment of the patient should be bland and 
unstimulating, consisting of farinaceous gruels, milk, 
light broths, etc. Alcohol should of course be avoided. 
PROSTATITIS, CHRONIC. 
Cold sitz baths, cold enemata, counter-irritation 
by means of small blisters to the perineum, and 
the passage of a soft rubber catheter to draw off 
the urine when necessary. The following injection 
may be given: 
I}. Argenti nitrat grs. x 
Aquae destillat 5 i 
M. Sig. Instil a few drops into urethra once daily 
by means of a deep urethral syringe. 
The general treatment should be tonic with a gen- 
erous unstimulating diet, cold sponge baths in the 
morning, and moderate exercise in the open air. 
PRURIGO. 
The general health should be restored and main- 
tained by improved hygiene, a liberal dietary, cod 
liver oil and iron. 
Internally tincture of cannabis indica in full 
doses mitigates the itching considerably; thirty 
minims well diluted should be given after each 
meal. About every six weeks an interval of a fort- 
night should be allowed in its administration. 
Phenacetin and antipyrin are also valuable reme- 
dies. 
I|. Antipyrini 3iss 
Ft. chart. No. xii 
Sig. One powder when the itching is very annoying. 
The patient will be made more comfortable with 
rest, an even temperature, and alkaline or sulphur 
baths. For the alkaline (full-length) bath use five 
ounces of bicarbonate of soda in 30 gallons of water 
at a temperature of 90° to 95° F. A sulphur bath 
may be similarly prepared by adding three ounces of 
sulphuret of potassium to each bath. 
326 For the local treatment, naphthol, sulphur and tar 
relieve the itching and decrease the papular eruption: 
I). Naphthol resublim grs. x 
Sulphuris loti oi 
Ungt. picis 3iv 
Lanolin ad. 5 i 
M. Sig. Apply freely and leave on for two horn's; 
then soap and bathe in warm water. 
PRURITUS. 
Search for the cause and remove it if possible. 
Always examine the urine for sugar, as diabetes 
is a very frequent cause of pruritus. For pruritus 
ani see Ani, Pruritus. Pruritus vulv® may be due 
to ovarian or uterine disease, urethritis or diabetes. 
Pruritus of the hands and feet are mostly found 
in gouty subjects. Pruritus of the scrotum is usually 
due to eczema. Pruritus vulv® or itching of the 
nose in children is usually due to ascarides in the 
rectum or vulva. 
Treatment. The diet should be easily digestible, 
and alcohol, sauces and condiments should be for- 
bidden. The bowels should be carefully regulated, 
and calomel followed by saline aperients should be 
given at first. Afterwards the bowels should be kept 
regular by extract of cascara sagrada or compound 
liquorice powder. 
The best internal remedy is cannabis indica, which 
seems to act by diminishing cutaneous sensibility. 
Begin with five minims of the tincture, and increase 
the dose to 20 or 30 minims three times a day, 
well diluted and after meals. Or give, when debil- 
ity is also present: 
3- Strychnin® sulphat gr. i 
Extracti cannabis indie® grs. iii 
Quinin® hydrochloridi grs. xxiv 
M. ft. pil. No. xxiv. 
Sig. One pill after each meal. 
327 External treatment is useful even if it is not cura- 
tive, for by giving temporary relief it enables the 
patient to abstain from scratching, and this gives 
the irritated nerve filaments a chance of rest while 
internal remedies are being directed to the cause of 
the disorder. For general pruritus, lotions are pref- 
erable to ointments. The following is a good lotion: 
Liq. carbonis detergens 5iii 
Liq. plumb, subacetat • 5iv 
Glycerini. 5 iv 
Aq. destillat q. s. ad. Bviii 
M. Sig. Apply three times a day. 
Or: 
Acidi carbolici 5ii 
Glycerini 3ii 
Alcoholis. §ii 
Aquae q. s. ad. Oi 
M. Sig. Apply three times a day. 
A bran bath made by adding five pounds of bran 
to a tubful of water is very soothing. Also an alkaline 
bath made by adding five ounces of bicarbonate of 
soda to a tubful of hot water. After the bath do not 
rub the surface dry but dab it gently with a soft cloth 
and dust it with a soothing powder. 
In senile pruritus give: 
I|. Pilocarp. hydrochlor. gr. ss 
Aquae giii 
M. Sig. A tablespoonful at bedtime. 
In vulvar and vaginal pruritus give: 
I). Sat. sol. boric acid 3vii 
Aq. rosae 5 i 
M. Sig. Apply on compress, hot, several times a day. 
Or tincture of benzoin may be painted on the parts 
daily with a camel's hair brush. 
In scrotal pruritus give: 
1$. Lead acetate grs. x 
Cocain. hydrochlor grs. xv 
White vaselin 5iii 
Lanolin... 3v 
328 M. Sig. Apply once or twice daily. 
For pruritus hiemalis give alkaline baths and apply 
a two per cent solution of salicylic acid in vaseline. 
PRUSSIC ACID POISONING. 
If the patient is seen immediately after the poison 
is taken, he should be at once placed in the open 
air and a stomach pump applied or an emetic given. 
While a cold douche is being applied to his head 
and spine, artificial respiration (20 to a minute) 
should be practiced on him, and ammonia applied 
to his nostrils. 
Next dissolve iron sulphate (15 grs.) and tinct. 
ferr. perchlor. (20 minims) in a wineglassful of 
water, and add two drachms of magnes. carb, made 
into a thin cream with water. Ether may be given 
hypodermically, or stimulants internally. 
This poison acts with the greatest rapidity and as 
much haste as possible is necessary in dealing with it. 
PSEUDO-LEUKAEMIA (See Lymphadenoma). 
PSEUDO-LEUKjEMIA INFANTUM (V. JAKSCH). 
Treat the cause which m ay be syphilis, rickets, 
inanition, tuberculosis, etc. 
The disease being most frequent between the 
ages of six months and two years, a great deal 
depends upon the proper feeding of the child. The 
disease is most frequent in bottle-fed infants and 
they should be placed on a proper milk mixture. 
They should be placed in as hygienic surroundings 
as possible. 
The drug treatment is that of secondary anaemia, 
as hypophosphites, iron, arsenic, and cod liver oil. 
For a child one year old give: 
I|. Syr. ferri iodidi 3i 
Sig. One drop in water three times a day. 
Or: 
I|. Malt cum hypophosphit §iii 
Sig. One teaspoonful every four hours. 
329 Cod liver oil or olive oil may be introduced into 
the body by inunction. 
X-ray treatment to the enlarged spleen is of little 
use. 
Arsenic is frequently of considerable benefit; it 
should be prescribed in the form of Fowler's solution, 
one drop three times a day, or it may be combined 
with hypophosphites or other tonics. 
PSORIASIS. 
The general health should be attended to. The 
patient should avoid such depressing influences as 
overwork, worry, a relaxing climate, sexual excesses, 
suckling or other drain upon the system. 
In the gouty, alkalies are of value, e. g.: 
I}. Liq. potass, hydroxid 3iv 
Vini colchici semin 3i 
Syr. sarsapar. co 3ii 
Aquae q. s. ad. 3 viii 
M. Sig. A teaspoonful in water after meals. 
In psoriasis with anaemia, enlarged glands in chil- 
dren and youths give: 
1$. Syr. ferr. iodid 5iv 
Olei phospho rat m. c 
Olei morrhuae q. s. ad. 3vi 
Sig. One teaspoonful two hours after meals. 
Or: 
3. Liq. potass, arsenit. in. xlviii 
Olei morrhuae 3iv 
Syr. ferr. iodid 5i 
Acac 3 i * 
Aquae q. s. ad. 3 viii 
M. ft. emulsum. 
Sig. One to two teaspoonfuls after each meal, to 
be followed by a full draught of water. 
Arsenic although often disappointing in its effects is 
a drug of considerable value in this affection. It is 
usually employed in the form of Fowler's solution (liq. 
potass, arsenit.) in five-drop doses for an adult after 
330 each meal. This dose should be gradually increased (an 
additional drop every 24 hours) until the limit of toler- 
ance is reached. Another useful arsenical preparation 
is "Asiatic pill" the formula of which is: 
1$. Acid, arsenics gr. i 
Piper, nigrisgrs. xx 
Pill massq. s. 
M. ft. pil. xx. 
Sig. Begin with one after each meal; increase by 
one every day. 
Local treatment. The scales should first be removed 
by hot baths and alkaline soaps, e. g., sapo viridis, in 
order to permit the action of the remedies, such as tar, 
oil of cade, chrysarobin, salicylic acid, resorcin, sulphur 
or ammoniated mercury: 
1$. Olei cadin 3ii 
Adipis 
M. Sig. Apply night and morning. 
Or: 
TJ. Acidi salicylicgrs. xxx 
Ungt. pic. liquidse §i 
M. Sig. Rub thoroughly into patch night and 
morning. 
Or: 
I|. Chrysarobini 5i 
Acidi salicylicigrs. xv 
5i 
Olei ricini m. v 
Collodiiq. s. ad. oi 
M. Sig. Apply with camel's-hair brush and paint 
over with plain collodion. 
PTOMAINE POISONING. 
Since the poison itself has a purgative and emetic 
effect, the stomach tube, emetics or purgatives 
are usually unnecessary. But they should all be 
employed if something still remains behind. Calo- 
mel should be used as the purgative. For the col- 
lapse give stimulants such as strychnin grain 
331 hypodermically), or champagne, or milk mixed with 
carbonated water. The pain may be relieved by 
morphine ()4 grain) hypodermically and counter- 
irritation with mustard. Internally oil of eucalyp- 
tus globulus may be administered. 
PTOSIS. 
In the congenital and traumatic forms ptosis 
is apt to be one-sided. The form which is the result 
of disease of the central nervous system is usually 
bilateral. 
Galvanism is of importance. Drugs which cure 
syphilis and rheumatism may be tried. Most cases 
require resection of a piece of the tarsal cartilage 
before they get well. 
PTYALISM. 
Prophylaxis. Keep the mouth and teeth care- 
fully cleansed. If the gums are sore and tender 
and the teeth are sore on striking, or if "mercurial 
fetor" arises during the administration of mercury, 
stop giving the drug. In nephritis, mercurials 
should be administered with great care as in that 
disease ptyalism is specially liable to supervene. 
Giving small doses of potassium chlorate along 
with the mercury, lessens the chance of ptyalism, 
or the potassium chlorate may be given as a mouth- 
wash: 
1$. Potass, chloratis 3iv 
Sig. A teaspoonful in a glass of water as a mouth- 
wash after meals. 
Or: 
I). Tinct. myrrhae §i 
Potass, chlorat 3vi 
Aquae camphoraeq. s. ad. Sxvi 
M. Sig. Shake. Use as mouth-wash every two or 
three hours. 
Treatment. If the ptyalism is due to the adminis- 
tration of mercurials, stop the drug and administer 
332 a saline purge. Check secretion and harden the gums 
with an astringent mouth-wash, such as: 
I|. Glyceriti acidi tannici §ii 
Sig. Use upon swab in mouth three or four times 
a day. 
Or give: 
I). Liquoris antiseptici, U. S. P giv 
Sig. A teaspoonful in a wineglass of water as a 
mouth-wash every two or three hours. 
If the ptyalism is due to iodism, stop the drug and 
administer sodium bicarbonate. 
When the ptyalism is due to other causes as in 
pregnancy and in neurotic patients, the activity of 
the salivary glands may be diminished by atropin 
grain every four hours until there is a sensation 
of dryness in the throat. Tincture of belladonna 
may be given instead in ten minim doses three times 
a day or in the following way: 
I). Tinct. belladonn. fol 3ii 
Potass, bromid 3iv 
Aquse camphorseq. s. ad. §viii 
M. Sig. One teaspoonful every hour until dryness 
of mouth and throat, then lessen the dose or give at 
longer intervals. 
PUERPERAL FEVER. 
Prophylaxis. Select a large well-ventilated lying- 
in chamber removed from sinks or toilets. Make 
as few vaginal examinations as possible before, 
during, and after labor, and with strictest antiseptic 
precautions. The obstetrician's hands and fore- 
arms should be scrubbed with a sterile brush, green 
soap and hot water for three minutes, changing 
the water at least once. Clean and trim the finger- 
nails. Wash again for five minutes. Soak hands 
and forearms for three minutes in a bichloride of 
mercury solution (1 to 1,000). 
Before the onset of labor bathe the patient and 
give a rectal enema. Wash her external genitals 
333 first with hot water, then with a 1 to 2,000 solution 
of bichloride of mercury. Then protect them with 
a towel soaked in bichloride solution. 
Since perineal tears may give entrance to germs 
they should be repaired by placing the sutures 
during the third stage and tying them after the 
placenta has been expelled. 
After the birth of the placenta give ergot to 
secure contraction of the uterus, then clean the 
patient and cover the vulva with a sterile dressing 
pinned to the abdominal binder. 
During the puerperium cleanse the external geni- 
tals by frequent irrigation with a 1 to 4,000 solution 
of mercury bichloride and renew the vulval pads 
frequently. 
Treatment. At the onset of the fever give: 
]$. Hydrarg. chlor, mit grs. v 
Sodii bicarb grs. x 
M. Sig. Give at once on tongue. 
Keep the bowels open throughout. Give enemata 
of salt solution every six hours through the long rec- 
tal tube to regulate the bowels, relieve symptoms and 
promote diuresis. 
In severe cases give strychnine every two hours in 
grain doses with half an ounce of whisky every hour, 
reducing the quantity when the pulse shows improve- 
ment. 
Local treatment. When the lower part of the 
vagina is infected place the patient in the lithotomy 
position and expose the vagina. Wash out the in- 
fected area with 50% solution of peroxide of hydrogen, 
then place in the vagina a gauze tampon soaked in 
an antiseptic solution such as: 
]$. Formalin m. xxx 
Glycerin giv 
Sterile water Oi 
M. After twelve hours withdraw the gauze and, repeat 
the process until the infected parts are in a healthy 
condition. 
334 Antiseptic douches are dangerous and should be 
used with great caution. 
Clots and fragments of placenta may be removed 
from the uterus with the finger or the dull curette, 
but curetting is dangerous for it breaks down the 
protective wall of leucocytes and exposes fresh areas 
to infection. 
When there Is abundant foul discharge the masses 
of necrotic matter should be cleaned out with the 
finger or curette, and this should be followed by a 
large douche of salt solution, repeating the douche 
every six hours. 
For the relief of pain and especially when peritonitis 
co-exists give: 
IJ. Olei terebinth 5iv 
Ungt. belladonna 5iv 
Ungt. hydrarg gi 
Ichthyol 3iv 
Lanolin o iss 
M. Sig. Apply freely to the abdomen. 
Puerperal fever is most often due to the strepto- 
coccus. If the anti-streptococcus serum is used early 
we may sometimes save an otherwise hopeless case. 
It -should be administered immediately after the first 
chill when it will cause a drop in the temperature of 
three or more degrees in a few hours. The first dose 
should consist of 10 c.c. and be repeated two or three 
times in the first twenty-four hours. If reaction does 
not take place give 20 c.c. at the same intervals. 
PUERPERAL INSANITY. 
The treatment of this disorder is best carried 
out in an asylum. If the patient is kept at home, 
competent and trustworthy nurses should be en- 
gaged and the patient should never be left alone 
because of danger to herself (suicide) or to her 
child. The lochia should be carefully watched. 
If the insanity is due to sepsis, carefully treat the 
infection. Isolation and absolute rest in bed are 
335 essential and plenty of nourishment in an easily 
digestible form should be given. 
For the maniacal symptoms the following seda- 
tive may be given: 
1$. Hyoccin® hydrobromidi gr. 
Camphorse monobromat® 5i 
M. ft. caps. No. xv. 
Sig. One capsule at bedtime; repeat in six hours 
if required. 
Or: 
I). Chlorali hydrati 5ii 
Potassii bromidi 3iv 
Syrupi acaci® oi 
Aqu®q. s. ad. oiii 
M. Sig. One to two teaspoonfuls in water not 
oftener than every six hours. Shake well. 
The bowels should be kept regulated. For the 
constipation which is nearly always present give 
aperients, but if the constipation is obstinate give: 
1$. Elaterini gr. 
Sacchari lactis gr. vi 
M. ft. chart. No. iii. 
Sig. One on tongue and repeat in two hours un- 
less free purgation. 
PULMONARY ABSCESS AND GANGRENE. 
If the fever is high and the digestion feeble the 
diet should be semi-liquid and sustaining (eggs, 
milk, broth, meat juice and a little wine or whisky). 
Tonics such as strychnine, digitalis, caffeine and 
arsenic may be given and when convalescence sets 
in, iron, cod liver oil and hypophosphites are indi- 
cated. 
Expectorants should not be given for they derange 
the stomach of the patient and do little good. In- 
halations however are of service. A two per cent 
aqueous solution of oil of turpentine is made to boil 
over an alcohol lamp in the closed room where the 
patient resides for weeks. 
336 If a pulmonary abscess communicates with the 
pleural cavity or if it is on the surface of the lung, 
surgery should be resorted to. 
PURPURA. 
The great majority of cases terminate in com- 
plete recovery. 
Keep the patient at complete rest in bed, feed 
him on a purely milk diet, and if the gastro-intes- 
tinal symptoms are very marked, limit the diet to 
peptonized milk. In very severe cases the patient 
may be fed for a time per rectum. Administer inter- 
nally, tincture of the perchloride of iron: 
I). Tinct. ferri chloridi 5ii 
Glycerini 5iv 
Aquaeq. s. ad. §iii 
M. Sig. A teaspoonful in water through a glass 
tube three times a day after meals. 
In all cases in which there is any doubt as to the 
differential diagnosis between scurvy and purpura, the 
patient should be placed on an anti-scorbutic diet with 
plenty of vegetables. 
When the condition appears to be rheumatic, salic- 
ylate of sodium may be tried. 
When there is bleeding from the stomach and in- 
testines and especially in children with debility and 
vascular relaxation, turpentine given internally will be 
found useful : 
1$. Olei terebinthinae 5i 
Sacchari 3iv 
Acaciae 5iv 
Aquaeq. s. ad §iii 
M. fiat emulsum. 
Sig. One teaspoonful after each meal. 
Eating freely of gelatin and the administration of 
calcium chloride to increase the coagulability of the 
blood are also of service: 
1$. Calcii chloridi 5iv 
Aquae 5vi 
337 M. Sig. A tablespoonful in water three times a day. 
During convalescence, quinine, arsenic and iron are 
useful remedies. 
PYELITIS. (INFLAMMATION OF PELVIS OF KID- 
NEY.) 
Prophylaxis. Great care should be taken in the 
use of catheters. Irritating diuretics should be 
avoided and in the treatment of gonorrhea, etc., 
plenty of water, milk and mineral water should be 
given freely to flush out the urinary passages. The 
employment of the recent scientific methods of 
diagnosis by means of ureteral catheterization is 
of the greatest importance in the prevention of 
ascending infection. 
Treatment. Pain is relieved by hot applications 
(hot compress, turpentine stupe, dry cupping or 
mustard paste) over the kidney. Opium should 
rarely be given but if the pain is very severe a sup- 
pository containing one or two grains of opium may 
be given, or morphine ()4 grain) hypodermically. 
Alkalies, alkaline mineral waters, plenty of plain 
water and vegetable diuretics like buchu are of 
service, as: 
1$. Sodii bromidi. 
Sodii bicarb aa 3iiss 
Extract! belladonna), fluid m. xxiv 
Extracti buchu, fluid 3iv 
Syr. sarsap. co q. s. ad. §iv 
M. Sig. A teaspoonful in water four times a day. 
The urinary antiseptic urotropin (5 grains) may be 
given in combination with salol (5 grains) or sodium 
benzoate (10 grains) to acidify the alkaline urine, to 
ease the lumbar pain and to lessen the pus. 
The diet should be nourishing and tonics like cod 
liver oil, iron, quinine and strychnine are useful in 
combating weakness and emaciation. 
If the ureteral drainage is incomplete surgical inter- 
ference may be necessary to save the patient's life. 
338 PYEMIA. 
Prophylaxis. Strictest antiseptic precautions and 
free drainage to keep the wound healthy. Attend 
to patient's general health. Plenty of fresh air 
must be given and overcrowding avoided, especially 
of patients suffering from suppurating wounds. 
Treatment. Control fever by antipyretics or 
tepid sponging. Quinine in 10-grain doses every 
four hours is useful. Combat heart failure by stimu- 
lants such as large quantities of whisky and brandy. 
Give champagne for vomiting or, if severe, give bis- 
muth or small doses of hydrocyanic acid. Mor- 
phine to relieve the pain. Take precautions against 
the formation of bed-sores; open and drain secondary 
abscesses. Support the general health of the patient 
with plenty of light digestible nourishment and 
allow him unlimited supplies of fluid such as milk, 
barley water, or soda-water. 
PYROSIS (See Heartburn). 
PYREXIA, DIET DURING. 
In this condition catarrh usually invades the 
entire course of the alimentary canal and of the 
ducts which lead into it, and the digestive capacity 
of the patient is reduced to that which is the normal 
state of the infant during the first six months of 
life, more especially in respect of the inactivity 
of salivary and pancreatic functions. Hence, theo- 
retically, and amply confirmed by experience, the 
value of a diet consisting mainly of milk and meat 
juices. 
The milk should be fresh (not preserved) and 
scalded (not boiled) and should be diluted with 
barley water to the extent of about one-third of 
its bulk. If diarrhoea is present add about one- 
sixth of its bulk of lime water; and if constipation 
is present add sodium citrate instead (20 grains 
to the pint). 
339 Beef juices may be given at intervals in the form 
of well-made beef-tea, mutton-tea, chicken or veal- 
tea. Draughts of iced water regularly administered 
are always grateful to fever patients. Fruit such 
as grapes and oranges are of great use and cooked 
apples may also be given. When more nourish- 
ment is required add yolks of eggs to the milk or 
beef juice, or give with brandy as egg-flip. 
QUARANTINE PERIODS IN INFECTIOUS DISEASES. 
The quarantine periods (in days) required after 
the latest exposure to infection are in (a) chicken 
pox, 20 days; (b) diphtheria, 12; (c) German 
measles, 20; (d) measles, 16; (e) mumps, 24; (f) 
scarlet fever, 10; (g) smallpox, 16; (h) typhoid 
fever, 23; (i) typhus, 14; (j) whooping cough, 21. 
The above quarantines are fixed at about two 
days longer than the recognized incubation period 
of the disease in question. They can be considered 
safe only if thorough disinfection be carried out at 
the beginning of the quarantine period. 
Although the above list indicates the day on 
which a boy or girl may usually return to school 
after being exposed to infectious or contagious 
disease, the period of absence may usually be ex- 
tended by the school medical officer if in his judg- 
ment such extension be essential to the safety of 
the school. 
For similar figures relating to persons who have 
suffered from infectious diseases see Infection Period, 
Cessation of. 
RABIES (See Hydrophobia). 
RAILROAD SPINE AND BRAIN. 
Treatment. Mental and physical rest, massage, 
electricity and proper feeding. Narcotics should 
be avoided. The general treatment is similar to that 
for Neurasthenia and Hysteria, which see. Medi- 
340 cines however are not of much avail in this disorder 
except for their moral effect. Litigation as a rule 
has a bad effect on the patient. The aim of the 
physician should be to divert his patient's thoughts 
from morbid channels, and to arouse his interest 
in extraneous matters not connected with himself 
or his troubles. 
Legal relations. Do not on the one hand attach 
too much importance to the subjective symptoms 
and complaints, and on the other, knowing from 
experience how much exaggeration, both conscious 
and unconscious, occurs in cases of this kind, do 
not attach too little importance to the same facts. 
When the patient is obviously exaggerating, when 
there is a motive to deceive, and in many other cases 
as, for instance, in cases of coma and mental derange- 
ment, in which the patient is unable to give informa- 
tion, the diagnosis and prognosis must be chiefly 
based upon the physical signs and objective symp- 
toms. Although there may be no organic lesion, 
it would not be fair to the patient to make light 
of his symptoms or to advise an early settlement 
and a speedy return to work. On the other hand 
the physician should beware of making suggestions 
which may magnify his patient's symptoms. 
The medical witness should in all cases endeavor 
to be the mouthpiece of medical science and nothing 
more. Neglect of this has often brought discredit 
on the medical profession. Yet where there is 
room for honest doubt the physician should protect 
the interests of his patient. In all cases of litiga- 
tion between a poor man and a rich corporation 
or employer, it is the bounden duty of the physician 
to protect the poor; the rich always can, and do 
look after themselves. 
Take the case of a poor, perhaps also ignorant 
man who is badly shaken up in a railroad or street 
car accident. After he has recovered from his 
fright he finds that he can walk and is apparently 
341 uninjured. If he is seen soon after the accident 
by a railroad claim agent he may be persuaded 
to sign away his claim for compensation for a quite 
inadequate pittance. If, after a few weeks he 
develops the well-known symptoms of "railroad 
spine" his legal position is weakened by the pre- 
mature settlement, a manifest injustice. 
RANULA. (CYSTS UNDER TONGUE.) 
The most satisfactory procedure is to snip off 
the top of the cyst, allow the contents to escape 
and apply a strong solution of tincture of iodine 
or a strong solution of chloride of iron. In stub- 
born cases, the solid stick nitrate of silver may 
be rubbed over the interior of the cyst. 
RAYNAUD'S DISEASE. (SYMMETRICAL GANGRENE.) 
For the severe pain that is frequently present, X 
grain morphine sulphate with TJ0 grain atropine 
sulphate should be given either by mouth or hypoder- 
mically. 
The limb should be elevated and hot bottles placed 
to it. Give hypodermics of grain of nitroglyc- 
erine every four hours to dilate the arteries when 
pain is severe. 
The application of an Esmarch's constrictor for 
a few minutes often restores the circulation. 
When gangrene occurs we should wait for com- 
plete demarcation before advising amputation. 
RECTAL FEEDING (See Feeding, Rectal). 
RELAPSING FEVER. (FEBRIS RECURRENS.) 
The treatment is symptomatic; no known drug 
will cut it short. Quinine is of no use. When the 
disease begins give a purgative: 
I}. Hydrarg. chlor, mit grs. xii 
Sacchar. lactisgrs. xxiv 
Extr. colocynth grs. xii 
M. et ft. chart. No. xii. 
Sig. One every two hours if necessary. 
342 For the severe muscular pains, phenacetin, aspirin, 
antifebrin, etc., arc of the most benefit: 
1$. Phenacetini .' 3i 
Kryofini 3i 
Codein. phosphat grs. ii 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
The patient should be carefully nursed. He should 
be isolated in the fresh air and should take only milk 
and broths while the fever lasts. Use cold sponging 
every two or three hours to keep the temperature 
down. Twenty grains of trional may be given at 
night for insomnia. 
RENAL CALCULUS. (NEPHROLITHIASIS, STONE IN 
THE KIDNEY, GRAVEL.) 
The treatment is surgical if the stone is large. 
There is no other method of dispelling the stone. 
Its further increase in size may be prevented by 
appropriate treatment. 
If from urinary examination it can be deter- 
mined that the stone is composed of uric acid 
then alkaline treatment should be adopted. Large 
quantities of alkaline waters should be taken as 
Saratoga, Vichy, Vais, Buffalo lithia water, etc. 
The diet should consist chiefly of vegetables and 
milk-foods, using white meat sparingly. 
If the stone is composed of phosphates, then 
the opposite treatment should be adopted. The 
urine should be acidified by the administration of 
benzoic or boric acid: 
]$. Acid, benzoic 5ii 
Div. in caps. No. xxiv. 
Sig. One four times a day. 
Or: 
3. Acidi borici 5ii 
Div. in caps. No. xxiv. 
Sig. One four times a day. 
In the dietary, red meats are allowable. 
343 RENAL COLIC. 
A hypodermic of J4 grain of morphine should 
be given first and followed by a few whiffs of chlo- 
roform until the morphine begins to act. Hot lin- 
seed poultices should be applied to the loins and 
if convenient the patient should be put in a hot 
bath. 
If relief is not obtained in half an hour give another 
hypodermic of *4 grain of morphine. 
As soon as the stone drops into the bladder imme- 
diate relief is obtained. If large it will remain in 
the bladder and enlarge, if small it will pass out 
through the urethra. Occasionally it sticks in the 
urethra and will require instrumental delivery. 
REST CURE (See Weir Mitchell Rest Cure). 
RETENTION OF URINE. 
The first indication in treatment is to empty 
the distended bladder with a sterile catheter of 
either hard or soft rubber, preferably the hard. 
This must be done under the strictest antiseptic 
precautions. 
Occasionally, placing the patient in a hot bath 
is sufficient to start the contraction of the bladder. 
If retention occurs after childbirth the catheter 
should not be used if placing the patient in the 
upright position enables her to empty the bladder. 
When difficulty is experienced in passing the 
catheter, it is sometimes of considerable help to 
pass one finger in the rectum to assist the point of 
the catheter to pass through the urethra. 
The ordinary causes of retention are stricture, 
enlargement of the prostate, impaction of a calculus 
in the canal, gonorrhea, hysteria, etc. 
When it is found impossible to pass a catheter 
into the bladder and the symptoms are urgent, 
it is best to pass a trocar into the bladder above 
the pubis, and then tie a rubber catheter in place. 
344 If the retention is due to stricture the latter 
should receive prompt attention, that is, dilatation 
or cutting. 
If due to enlargement of the prostate, then it 
becomes necessary to remove the gland because 
it usually does not take long before the continuous 
use of the catheter results in infection of the blad- 
der. 
If due to gonorrhea, use the drugs recommended 
under that heading, but if there is much swelling 
of the urethra, then it becomes necessary to put 
the patient in a hot bath. 
If due to temporary paralysis of the bladder, 
as in typhoid fever or after accident, a soft rubber 
catheter should be used to draw off the accumulated 
fluid. 
If the retention is due to hysteria, use the cold 
douche, moral suasion, and anti-hysterical reme- 
dies, as: 
I|. Sodii bromidi 3ii 
Potass, bromidi 3i 
Tinct. hyoscyam 5ii 
Aquaeq. s. ad. 3ii 
M. Sig. One teaspoonful in water every three hours. 
If this does not do any good then we must use the 
catheter. 
Frequently there is a dribbling of urine which may 
mislead the practitioner or nurse into thinking that 
the bladder is not full, but by placing the hand on 
the abdomen the conical bladder may be found to 
extend to the umbilicus, showing that there is really 
retention. 
In cases of retention of urine do not give diuretics, 
they only aggravate the trouble. 
RETINITIS, ALBUMINURIC. 
The treatment is that of nephritis. Special appli- 
cations to the eye are useless. 
345 RETINO-CHOROIDITIS. 
Give | of a grain of pilocarpin hypodermically to 
produce sweating. Mercury and potassium iodide 
should be pushed internally. 
Atropine must be used to paralyze accommodation: 
±|. Atropine sulphat gr. i 
Aquae destillat 3ii 
M. Sig. One drop in eye twice a day. 
Leeches and blistering the skin of the temples are 
also of benefit. The patient should wear dark glasses. 
RETINITIS, SYPHILITIC. 
Prompt treatment with anti-syphilitic remedies is 
of the greatest importance. Inunctions with mercury 
and increasing doses of potassium iodide should be 
given. Hot baths and leeches to the temple, help to 
lessen the pain. A hypodermic of grain of pilo- 
carpin muriate helps to control the pain. (See 
Syphilis, Treatment of.) 
RHEUMATISM, ACUTE ARTICULAR. 
No drug can take the place of salicylate of soda. 
It should be given in 15 grain doses every three hours 
for at least 24 hours, thereafter every four to six 
hours. It is best given in pepsin or in very hot water, 
on account of its nauseating properties. Aspirin or 
salicin in 5 to 10 grain doses may be given instead 
at the same intervals. They are not as liable to 
irritate the stomach or produce nausea. Salol is also 
frequently used in 5 to 15 grain doses, but the kid- 
neys must be carefully watched. 
The following prescriptions are equally good: 
I}. Sodii salicylat 3vi 
Sodii bicarb 3iv 
Aquae Si 
Ess. pepsin q. s. ad. 5 iii 
M. Sig. One teaspoonful in hot water every three 
hours. 
346 Or: 
3- Sodii salicylat 3vi 
Vin. colchic. radio 3iv 
Aquse 3i 
Elix. digestiv. co. N. F q. s. ad. giii 
M. Sig. One teaspoonful in hot water every three 
hours. 
Or: 
I). Aspirin 5i 
Salicin 5i 
M. et ft. chart. No. xii. 
Sig. One every three hours with hot water. 
What is known as the alkaline treatment may be 
used in conjunction with the salicylates. The following 
is one of the best combinations in the alkaline treat- 
ment: 
fy. Potass, citrat 5ii 
Potass, acetat 5iv 
Sodii bicarb 5iv 
Potass, bicarb 5i 
Aquae gii 
Infus. calumb q. s. ad. giv 
M. Sig. One teaspoonful in a glass of water three 
times a day. 
Local treatment. The affected joints should be 
wrapped up in cotton after the application of some 
soothing liniment, as: 
I). Lin. belladonn. 
Lin. aconiti. 
Lin. saponis aa §i 
M. Sig. Rub in thoroughly three times a day. 
Or: 
1$. Acid, salicylic 3iss 
01. terebinth 5i 
Adipis lanse hydros q. s. ad. o ii 
Painting painful joints with three coats of tincture 
of iodine is frequently very soothing. 
The affected joints must be kept at absolute rest 
with or without splints. 
347 The patient should be kept in bed for at least two 
to four weeks in order to lessen the chances of heart 
complications. He should lie between blankets as the 
profuse perspiration may make him very uncomfortable 
if he were to lie between sheets. The excessive perspi- 
ration may be checked by sponging with warm water 
and alcohol. The bowels should be kept free by : 
I). Hydrarg. chlor, mit grs. ii 
Sacchar. lact grs. xii 
M. et ft. chart. No. xii. 
Sig. One every 15 minutes followed in four hours 
by a bottle of citrate of magnesia. 
When convalescence is established give the patient 
tonics, as iron, cod liver oil, etc. 
RHEUMATISM, DIET IN. 
The following should be forbidden: beef tea, meat 
extracts, pastry, sugar, sweets and alcohol. 
During the stage of fever and joint inflammation 
fluids only should be given such as milk, diluted 
with soda water and lime water or peptonized. Also 
thin oatmeal gruel, barley water, fresh lemonade and 
weak tea. 
After the febrile stage is over give light clear soups 
and broths flavored with fresh vegetables and herbs, 
with a little pounded chicken, light puddings, bread 
and milk. 
Two weeks after the temperature is normal allow 
bread and butter, eggs, white fish, chicken, pounded 
lean meat, mutton, veal, stewed celery, mashed pota- 
toes, spinach asparagus and the pulp of fresh fruit. 
May be Eaten Freely. 
Milk, sweet, and butter- 
milk. 
Fresh fish. 
White meats. 
Ready-made (flake) break- 
fast-foods. 
Most dried fruits. 
Uncooked cabbage. 
Corn, green, canned and 
hominy. 
Cucumbers. 
Beets. 
348 Potatoes, Irish and sweet. 
Butter and cheese. 
Macaroni, spaghetti, ver- 
micelli. 
Oatmeal, rice, barley, sago, 
tapioca. 
Vegetable soups. 
Lettuce. 
Turnips. 
Peaches. 
Pears. 
Grapes. . 
Raisins. 
Apples. 
To be Eaten in Moderation. 
Red and dark meats. 
Fat bacon, lard, suet. 
Game. 
Puddings, without eggs. 
Beef, pork and mutton. 
Meat soups. 
Oysters and oyster soup. 
Bananas. 
Sweet cider, lemonade and 
fruit juices. 
Tea, coffee and cocoa. 
Most nuts except peanuts. 
Dried peas, beans and len- 
tils. 
Kale and spinach. 
Tomatoes. 
Celery. 
Rhubarb. 
Pickles. 
Salted and fried meats 
Salt and preserved fish. 
Mushrooms. 
Liver. 
Sweetbreads. 
Pancreas. 
Veal. 
To be Avoided. 
Gooseberries. 
Strawberries. 
Peanuts. 
Hot breads and cakes of all 
kinds. 
Custard. 
Greasy pastries. 
Heavy meat meals of all 
kinds. 
Soft drinks. 
Beer and whisky. 
RHEUMATISM, MUSCULAR. (MYALGIA.) 
When the pain is very severe it is necessary to 
give morphine internally and hot applications locally. 
Sodium salicylate should be given either with or 
without other coal tar products as phenacetin,etc.: 
I|. Sodii salicylat 5iv 
Vin. coichic. radic 5iv 
Aquse §iss 
Ess. pepsin q. s. ad. Jiii 
349 M. Sig. Half a teaspoonful in half a glass of hot 
water every three hours. 
Massage and electricity are of some benefit. Friction 
with some good stimulating liniment is often of some 
benefit to the patient, as: 
B. Chloral hydrat. 
Camphor. 
01. cajuput aa 5i 
Lin. ammon q. s. ad. §iv 
M. Sig. Liniment. Use twice a day. 
RHEUMATOID ARTHRITIS. (CHRONIC RHEUMA- 
TISM, ARTHRITIS DEFORMANS.) 
The treatment is frequently very unsatisfactory. 
Internally. Give tonics such as cod liver oil, 
arsenic, and syrup of the iodide of iron: 
B. Emuls. ol. morrhuse cum hypophos- 
phit. U. S. P oxii 
Sig. A teaspoonful three times a day. 
Or: 
B. Syr. ferr. iodid §iii 
Sig. Half a teaspoonful in water three times a day 
after meals. 
The patient should be placed in the best hygienic 
surroundings in a warm, dry climate where plenty of 
sunshine is to be enjoyed. A cold, damp and variable 
climate is bad. Flannel should be worn next the skin. 
During the acute exacerbations of the disease when 
the affected joints become swollen and painful, give: 
B- Quinin grs. xlviii 
Phenacetin grs. Ixxx 
Sodii salicylat 5 iii 
M. ft chart. No. xxiv. 
Sig. One every three hours after meals. 
The following will also be found useful: 
B. Liq potass, arsenit m. xlviii 
Potass iodid oiv 
Sodii salicylat 3iv 
Syr. sars. co Bi 
Aq. menth. virid q. s. ad. §iii 
350 M. Sig. One teaspoonful in water after meals. 
Local treatment. Great benefit is obtained from 
hot baths, hot douches and dry heat, also from rubbing 
the affected joints with a saturated solution of menthol 
in olive oil (25 grs. of menthol to the ounce of olive 
oil). 
When the patient can afford it, hydropathic treat- 
ment at such places as the Hot Springs of West Vir- 
ginia and Arkansas is often most valuable. 
Massage and electricity to the affected joints and 
atrophied muscles are often useful. The faradic cur- 
rent may be applied to the atrophied muscles, and the 
galvanic current to the joints. Electric baths are use- 
ful in a few cases. 
Where there is leucorrhea, local treatment (douching, 
astringent injections, etc.) together with internal tonic 
remedies (iron, arsenic, etc.) should be employed. 
RHINITIS, ACUTE. (ACUTE NASAL CATARRH.) 
A cold can frequently be aborted by a hot foot 
bath, a full dose of Dover's powder (15 grs.), and a 
very hot glass of lemonade or whisky before going 
to bed, followed next morning by a saline aperient, 
e. g., Seidlitz powder. Hot baths and Turkish baths 
are also useful, as is also insufflation of menthol snuff. 
The nose may be sprayed with an atomizer every four 
hours containing an alkaline solution, e. g., Dobell's: 
I}. Sod. bicarb. 
Sod. borataa grs. xv 
Acidi carbol grs. viii 
Glycerini 5ii 
Aquae o viii 
During the first 24 hours when the nose is discharging 
large quantities of serous fluid, give: 
R. Tinct. belladonn 5iv 
Sig. Five drops every three hours until the discharge 
lessens. 
The salicylates are of considerable use throughout the 
351 attack, especially to prevent the clogging of the nose 
with mucopurulent material; if much frontal headache 
is present give: 
3- Aspirin 5iss 
Kryofin 5i 
Caffein. citrat grs. xii 
M. et ft caps No. xviii. 
Sig. One every three hours with hot water. 
RHINITIS, CHRONIC. (CHRONIC NASAL CATARRH.) 
The treatment should be local and constitutional. 
Local treatment. Consists in relieving the irrita- 
bility of the mucous membrane, checking the secre- 
tions and preventing their accumulation in the nose. 
Watery applications should be avoided because 
they may increase the swelling and have little in- 
fluence on the mucopurulent secretion. 
Oily applications are useful because they coat the 
surface and protect it from irritation. The following 
answers this purpose: 
1$. Menthol grs. vi 
Thymol grs. 
Oil of cloves m. ix 
Albolene §iii 
M. Sig. Spray into nose three times a day. 
Or: 
T$. Terebene m. xxx 
Thymol grs. iii 
Menthol grs. vi 
01. cinnamon m. iii 
Albolene 5 iii 
M. Sig. Use three times a day. 
Should it become necessary to wash out the nasal 
cavities, use Dobell's solution: 
I). Ac. carbolic grs. vi 
Sod. bicarb grs. xxx 
Sod. biborat grs. xxx 
Glycerin 5i 
Aquae q. s. ad. giv 
352 M. Sig. Spray into nose twice a day. 
Sedative powders give considerable relief: 
I|. Ac. boric 3iiss 
Iodol 3i 
Amyli 3ss 
Sacchar. lact §ii 
M. Sig. Blow into nose three times a day. 
In cases where there is great sensitiveness it fre- 
quently becomes necessary to cauterize the spot. 
RICKETS. (RACHITIS.) 
Improve the general nutrition of the child by 
good hygienic conditions (sunlight, mountain air or 
sea air), and by a good diet (milk, cream, eggs, 
raw meat-juice, fruit jellies, and juices of fresh fruits, 
especially orange juice). 
When there is anaemia give: 
1$. Olei morrhuae Biss 
Olei sassafras. 
Pulv. acac. 
Pulv. sacchar. . . aa q. s. ad. emuls. 
Syrup, ferr. iodid oiii 
Aquae q. s. ad. giii 
M. Sig. One teaspoonful to a dessertspoonful after 
meals. 
Phosphorus is of the greatest service in allaying 
nervous symptoms, like insomnia, convulsions, tetany 
or laryngospasm. It stimulates bone formation and 
favors dentition. It may be given in Tto grain 
doses in pill form or as the oleum phosphoratum (1 per 
cent solution): 
I|. Olei phosphorat 3i 
Olei morrhuae §iii 
Pancreatini 3iv 
Acaciae Bi 
Aquae q. s. ad. Bviii 
M. ft. emulsum. 
Sig. One teaspoonful with cream or milk three 
times a day an hour after food. 
353 Phosphorus may also be given in 5 to 15 minim doses 
of the Nat. Form, elixir three times a day. 
If the child is breast fed ascertain the quality 
of the mother's milk and supplement it with properly 
modified cow's milk if necessary. The diet should 
contain little carbohydrates but should be rich in 
proteids and fats, a condition which few, if any, of 
the proprietary infant foods fulfil. 
Surgical intervention may be necessary to correct 
deformities of the extremities. To relieve kyphosis 
the child should sleep on a hard, flat mattress without 
a pillow. The child should not be allowed to assume 
a posture which will increase any deformity. 
RIGOR. (CHILLS.) 
This is frequently the initial symptom Or an acute 
infectious disease as pneumonia, pyemia, small-pox, 
typhoid fever, tonsilitis, etc. In some diseases the 
rigor is of short duration but very severe, in other 
diseases it may extend over a few days. 
Put the patient to bed and cover him up with 
blankets. Place hot water bottles to the extrem- 
ities and give a hot drink of brandy or lemonade. 
Rigors following the use of the catheter may be 
promptly relieved by a hypodermic 'of grain of 
morphine. 
Nervous chills may be controlled by nerve seda- 
tives as sodium or strontium bromide in 15 to 20 
grain doses every three or four hours. 
Quinine in chills is too slow in action. Nitrite of 
amyl and chloroform sometimes promptly cause their 
cessation. 
RINGWORM OF BODY. (TRICHOPHYTOSIS COR- 
PORIS, TINEA CIRCINNATA.) 
The treatment is simple. Any irritating applica- 
tion that removes the epidermis will do: 
3. Acidi carbolici pur §i 
Sig. Paint with brush over patch once. 
354 Or: 
1$. Ungt. chrysarobin. (10%) 3i 
Sig. Apply once. 
The physician should personally make the applica- 
tions. 
RINGWORM OF SCALP. (TRICHOPHYTOSIS CAPITIS.) 
This extremely contagious disease requires long- 
continued patient treatment to eradicate it. The 
physician should not allow the patient to infect 
others carelessly. 
The object in treatment is to destroy the fungus. 
This is easy when it affects non-hairy portions but 
extremely difficult in such places as the scalp or beard. 
The hair should be cut close and the scalp vigor- 
ously shampooed daily with soft soap and then thor- 
oughly rubbed with carbolized oil (1 in 20). Then 
apply the following ointment: 
I}. Chrysarobin 3i 
Hydrarg. ammon grs. xx 
Liq. carb, deterg m. x 
Lanolin 3i 
Adipis 3vi 
M. Sig. Rub thoroughly into the scalp for ten 
minutes daily. 
Or: 
I). Acid, salicyl grs. xxx 
Ether §i 
M. Sig. Rub in thoroughly twice a day. 
Epilation is also of service in ringworm. 
The lining of caps should be frequently changed or 
paper placed in them. 
In infants a few weeks old the disease is easily cured. 
Use the following: 
I). Sulphur 3i 
Ac. carbolic 3 ss 
Lanolin §i 
M. Sig. Apply once a day. 
355 ROCKY MOUNTAIN FEVER. (TICK FEVER.) 
The tick-bite should be cauterized with 95% solu- 
tion of carbolic acid. 
Sulphate of quinine in 15 grain doses every four 
hours should be given persistently from the beginning 
of the fever. 
The diet, general management, and control of tem- 
perature are the same as in Typhoid Fever, which see. 
The rest of the treatment is symptomatic. Plenty 
of water to flush out the kidneys, Dover's powder, 
small doses of morphia for the severe pains, and 
aperients to regulate the bowels. 
RUPIA. 
The treatment is that of syphilis, of which this 
skin disorder is a manifestation, but the mercury 
must not be given in full doses. The eruption usually 
occurs after mercury has been given in too large 
doses and has disagreed and been laid aside for a 
time. Give: 
]$. Liquoris arseni et hydrarg iodid 5iv 
Aquae destillatse 5iv 
M. Sig. One or two drops three times a day. 
Sometimes it may be advisable to suspend the 
mercury for a few weeks and give large doses of iodides 
instead. 
Locally do not disturb the crusts as they usually fall 
off after the ulceration heals. 
If an ulcerated surface results in spite of everything, 
a fumigation bath with sublimed calomel is of great 
value, or give: 
I|. lodoformi 5ii 
Sig. Dust upon lesion if scabs are removed. 
Or: 
I|. Red mercur. oxidgrs. vi 
Ichthyol 5i 
Lanolin 5vi 
Vaselin 5iv 
M. Sig. Apply locally with care once a day. 
356 SALISBURY DIETETIC TREATMENT. 
This system is intended to influence diseases pro- 
duced by " unhealthy and indiscreet feeding," obesity, 
and various forms of dyspepsia, especially acid dys- 
pepsia, due to imperfect digestion of carbohydrates. 
Many dyspeptics can digest a meal of proteids with 
benefit who are unable to dispose of a mixed meal of 
proteids and carbohydrates. 
The essentials of the Salisbury system are the 
taking of hot water and a diet consisting of animal 
food, finely minced, and not too much cooked, in 
quantities varying from half to three pounds each 
day. No bread or vegetable food is allowed. 
Such a proteid dietary naturally throws a very 
heavy burden on the kidneys, and for its continuance 
necessitates a large quantity of water to flush these 
organs. The water should be taken as hot as the 
patient can bear it; one pint in bed in the morning 
or on rising, one pint an hour and a half before each 
meal, and a half an hour before bedtime. It should 
be slowly sipped, so that the time taken is five to 
fifteen minutes, uncomfortable distension being thus 
avoided. 
The gristle, fat, and tougher connective tissues 
must be removed while preparing the meat. 
The body should be washed twice daily with soap 
and water, and afterwards rubbed with equal parts 
of glycerine and water. This promotes the eliminat- 
ing function of the skin. Regular exercise, short of 
fatigue should be taken; or where this is impossible, 
the body should be well rubbed from head to foot 
for from ten to twenty minutes three times daily. 
SCABIES (See Itch). 
SCARLET FEVER, PROPHYLAXIS OF. 
When the disease is recognized, remove the patient 
to a clean well-ventilated room, perferably at the 
top of the house. One attendant should take entire 
357 charge of the patient and should have no, communi- 
cation with the rest of the family. Other children 
in the family should not be allowed to go to school 
and if sent away they should be kept from other 
children until the stage of incubation has passed. 
To prevent the physician from carrying the disease 
to other patients, he should put on a cap covering 
the head and back of the head, a gown reaching 
from the neck to the floor and rubber overshoes 
before entering the patient's room. When these are 
removed they should be dipped in corrosive sublimate 
solution and hung up to dry in an ante-room for use 
next day. Handkerchiefs that have received the 
discharges from the nose and mouth, as well as cloth- 
ing and bed linen that have come in contact with 
the sick person should be soaked in carbolic solution 
and then boiled in soapsuds for one hour. They 
should be laundered separately from the household 
articles. The sick-room should be thoroughly aired 
several times a day and swept frequently, tea leaves 
being scattered on the floor to prevent the dust from 
rising. While the room is being aired the patient 
should be protected from draughts by a blanket 
thrown over his head. The temperature of the room 
should not exceed 70° F. nor fall below 65° F. When 
the patient is beginning to recover and the skin is 
peeling off, the body should be washed daily in warm 
soapsuds, and afterwards rubbed with carbolated 
vaseline. This should be continued until all rough- 
ness of the skin has disappeared. If desquamation 
is complete the patient may be discharged from 
quarantine at the end of the sixth week, although 
to secure absolute immunity it is safer to delay until 
the eighth. Cases complicated with nephritis, empy- 
ema, otitis or glandular abscess should be detained 
until the cure is completed. The Health Depart- 
ment should be immediately notified when the 
patient has recovered and disinfectors will be sent 
to disinfect the room, bedding, clothing, etc. The 
358 room should not be occupied until it is thoroughly- 
disinfected. 
SCARLET FEVER, TREATMENT OF. 
The sick room should be kept at a uniform tem- 
perature of about 70° F. and should be large and 
well-ventilated. The bed-clothing should be light 
and the patient should wear a light flannel night- 
dress. The diet should consist of milk, broths, jun- 
ket, kumiss, egg-white, gruels, ice cream, and fruit 
juices. The thirst may be relieved by plenty of 
water which also keeps the secretions active. After 
the fever has subsided a soft diet may be allowed 
but the proteids should be restricted for several 
weeks. 
Stimulation in the milder forms of fever is unnec- 
essary, but when evidences of heart enfeeblement 
arise they must be combated with such drugs as 
alcohol, strychnine and digitalis. To a child of four 
with weak, rapid and irregular pulse one drachm of 
whisky or brandy may be given every second hour, 
and the dose may be increased if necessary. Tinc- 
ture of digitalis in doses of one drop every five or six 
hours may also be of benefit for a child of 5 years, 
or strychnine in doses of from to grain. 
When the fever is not very high it may be neglected 
or the following mild febrifuge may be given to a 
child 5 years old: 
I};. Spiritus aether, nitros 5vi' 
Liq. ammon. acetatq. s. ad. 3iii 
M. Sig. One dessertspoonful with water every three 
hours. 
Cold or tepid sponging is also very refreshing and 
beneficial. 
When the temperature rises above 103° F. it may 
be reduced by cold applications to the head, an ice-coil 
over the heart and cold sponging or cold packs. 
Thoroughly sponging the patient three or four times 
359 daily with carbolized water (1 to 60) may protect the 
patient from disastrous complications and sequelae. 
For the cerebral symptoms the application of an 
ice-cap and the administration of bromides or small 
doses of chloral, phenacetin or acetanilid may be 
employed. These not only control the restlessness and 
insomnia but phenacetin and acetanilid are useful also 
for their antipyretic effect. Acetanilid is better for 
young children and may be given in doses of one-third 
as many grains as there are years in the child's life. 
For older children phenacetin combined with quinine 
in capsules may be given 
When the cerebral symptoms are due to the high 
temperature, cold bathing is most beneficial. 
The bowels should be kept freely open throughout 
the disease; small doses of calomel followed by a saline 
aperient being of service at the onset. High intestinal 
irrigation with hot water (112° F.) is of the greatest 
service as an aperient, stimulant and diuretic, and 
aids in the elimination of the fever poison from the 
system. 
The care of the nose, throat and ears is of the greatest 
importance. The nose and throat should be cleansed 
with Dobell's solution or a (25%) solution of hydrogen 
dioxide. If there is severe tonsillitis give: 
I). Potass, chlorat grs. xx 
Tinct. ferr. chlor. 
Glycerini aa 3ss 
Aqu® .q. s. ad. gii 
M. Sig. Apply to the tonsils several times a day 
with a cotton swab. 
The tympanic membranes should be inspected daily 
for any signs of bulging, and if necessary, immediate 
paracentesis should be performed and the opening kept 
free so long as there is any tendency to discharge. 
The discharging ear should be irrigated freely with 
warm solution of boric acid every four hours. 
In acute otitis media the application of a leech behind 
S60 the ear and gently syringing the auditory canal with 
hot water are very beneficial. 
To guard against nephritis the patient must care- 
fully avoid exposure to draughts, especially after the 
febrile symptoms have disappeared. The urine should 
be examined daily. As prophylactics, urotropin and 
digitalis are highly recommended. 
If in spite of all precautions nephritis develops, dry 
cupping over the loins and warm fomentations are of 
benefit. The danger to the kidney may be warded off 
by stimulating the skin with warm baths, hot packs, 
vapor baths, or a diaphoretic like pilocarpin to 
grain). Saline aperients are also indicated, and when 
the urine is scanty, unirritating diuretics like potassium 
acetate or digitalis: 
I}. Spiritus aether, nitros 5iv 
Syrupi 3ii 
Liq. potass, citrat q. s. ad. §iii 
M. Sig. One teaspoonful in water every two hours. 
Or, for a child of 8 to 10 years: 
1$. Infusi digitalis 3 iii 
Sig. One teaspoonful in water three times a day. 
The vomiting which usually occurs at the beginning 
of the disease is best controlled by withholding all 
food and milk and giving the following internally. For 
a child from 5 to 10 years of age give: 
I|. Bismuth, subnitrat 5iss 
Cerii oxalatis grs. iv 
Hydrarg. chlor, mit gr. i 
Sacchar. lactis grs. xii 
M. et ft. chart. No. xii. 
Sig. One every three hours on a teaspoonful of 
hot water. 
The exudative sore throat which so frequently accom- 
panies scarlet fever is not benefited by diphtheria 
antitoxin unless culture shows that it is complicated 
with diphtheria. Swabbing the throat with pure hydro- 
gen dioxide every hour is of more benefit. 
361 SCHOTT'S TREATMENT. 
This consists of 1st-baths in warm springs con- 
taining sodium and calcium chloride, carbonate of 
iron, and carbonic acid gas. The baths last from 
five to twenty minutes and are given once daily 
for three days and then intermitted. 2d - resisted 
movements carefully and gradually employed. These 
exercises are made against slight resistance applied 
by the physician or a trained assistant. Before 
beginning the exercises proper, the employment 
of massage is advisable. 
The patient should not hold the breath but should 
breathe with regularity. Exercises which cause an 
intermittent heart action must be omitted. Only 
moderate resistance should be employed at first. 
No movements should be used which bring the 
hands above the level of the shoulders, for raising 
the hands increases the arterial tension and retards 
the heart's action. Lateral and rotatory move- 
ments of the body are included. They should 
never be continued until the patient is tired. 
The following are some of the resistance move- 
ments. 1st-The arms are extended in front of 
the body at the level of the shoulder, with the palms 
of the hands touching. The two arms are then 
moved slowly outwards till they are in a line with 
each other; they are then brought back to their 
original position. 2d-The arm and hand hanging 
down with the palm turned forward, the forearm 
is flexed upon the arm (which is kept still) until 
the fingers touch the shoulder. The forearm is 
then extended to its original position. This is 
first done with one arm and then with the other. 
3d-Same as No. 1, but with fists clenched. 4th- 
Same as No. 2, but with fists firmly clenched. 5th- 
The body is bent forward and then brought back 
to the erect position, the knees not being moved. 
6th-The body is rotated, without any movement 
362 of the feet, first to the right and then to the left, 
and then back to its oftginal position. 7th-Sup- 
porting himself by placing both hands in front on 
the back of a chair, the patient first flexes one leg 
and then the other upon the thigh as far as he can. 
Sth-Each leg in turn is abducted as far as possible, 
the knees being kept straight, the patient resting on 
one or other hand the while. 9th and 10th- 
Flexion and extension first of the wrists, and second 
of the ankles. 
In resisting these movements the operator places 
the palm of his hand on that side of the patient's 
limb or body toward which the movement is to be 
made. In the movements of the wrist the operator 
closes his thumb and forefinger round that joint. 
Contra-indications to Schott's treatment are 
chronic nephritis, aneurysm, arteriosclerosis, angina 
pectoris, acute cardiac insufficiency, tendency to 
haemorrhage and embolism. 
SCIATICA. 
Search for and treat the cause, e. g., rheumatism, 
gout, syphilis, rectal disease, etc. 
If due to rheumatism the salicylates must be 
given, see Rheumatism. 
If due to syphilis treat with mercury and potassium 
iodide as recommended under Syphilis. 
Rest in bed should be insisted upon, and a long 
splint should be applied from the axilla to the heel, 
and the entire leg bandaged in cotton. 
Counter-irritation by blisters, hot iron, liniments 
and electro-cautery may be used. The following 
makes a good liniment in this disease: 
3. 01. gualtherise oi 
Chloroform 3iv 
Tinct. aconit 3iv 
Tinct capsici 3ii 
Menthol grs. xxx 
Spt. vin. rect q. s. ad. 5iv 
3C3 M. Sig. Apply freely over seat of pain twice a day. 
Internally many drugs are recommended but few 
are of value. Phenacetin, antipyrin, acetanilid, sali- 
pyrin, or aspirin may be tried: 
J|. Antipyrini 5ii 
Phenacetin 3ii 
Quin, sulphatgrs xxxvi 
Aspirini 3ii 
M. et ft. chart. No. xxiv. 
Sig. One every four hours. 
If the pain is very severe resort must be had to 
morphine, always remembering, however, that this 
is one of the diseases in which the morphine habit is 
easily acquired. It may be given hypodermically in 
grain doses or it may be given in the following mixture: 
I). Morph, sulph grs. vi 
Atrop. sulph gr. 
Tinct. aconit m. xxiv 
Ext. cannab. indie® m. Ixxii 
Elix. simplicq. s. ad. §iii 
M. Sig. One teaspoonful every three hours until 
relief is obtained. 
Freezing the painful area is also of benefit in some 
cases: 
I). Ethyl chloride one tube 
Sig. Use as spray from tube until painful area is 
frozen. 
Hypodermic injection of the following, directly down 
on the nerve will also relieve pain: 
I|. Morph, sulph gr. i 
Cocain. hydrochlor grs. ii 
Aqu® destillat 5iv 
M. Sig. Inject one teaspoonful deep down on the 
nerve. 
The fluid extract of gelsemium is also of great bene- 
fit in some cases. It should be given in 2 minim doses 
every three or four hours until tingling in pharynx or 
fingers is produced 
364 Nerve stretching may be tried if all other methods 
fail. Place the patient under anaesthesia and strongly 
flex the hip, extend the knee, flex the foot dorsally 
and immobilize the pelvis firmly. 
Direct exposure of the nerve is no longer practiced. 
SCLERODERMIA. 
It is of the utmost importance to protect the 
patient from exposure to cold winds and draughts 
He should be clothed in flannel. 
The general nutrition of the body should be kept 
up to the highest possible standard with cod liver 
oil and ferruginous tonics. 
Mercury, potassium iodide, and arsenic are useless. 
Massage with olive oil or other simple ointment 
frequently restores mobility to the part. 
SCLEROSIS, DISSEMINATED. 
Attend to the general health of the patient and 
avoid nervous stress and strain. Arsenic and nitrate 
of silver are of special benefit. Massage, electricity, 
especially the faradic current, and X-ray treatment 
are often beneficial. The systematic employment of 
co-ordinated muscular exercises (Fraenkel's treat- 
ment) is also of some service. Attention to the con- 
dition of the bladder is of the utmost importance in 
those cases in which the urinary reflex is markedly 
deranged. Bed-sores should be guarded against, 
although this is by no means easy. 
SCOLIOSIS. (LATERAL CURVATURE OF SPINE.) 
The treatment resolves itself into three measures: 
1st, preventive; 2d, forcible correction; 3d, gymnas- 
tic exercises. 
Preventive measures. Correct malpositions such 
as the bad seating of children in schools; usually 
desks that are too low will help to cause the deform- 
ity. If patient has torticollis or a short leg, correct 
these conditions. 
365 Forcible correction. May be obtained by suspend- 
ing the body by the shoulders and making forcible 
pressure and counter pressure at certain points. 
Gymnastic exercises. These may be given with- 
out apparatus, or with such apparatus as weights 
and bars, bells, etc. In this way the general muscu- 
lar system may be improved or special weak muscle 
groups may be strengthened. 
SCURVY. (SCORBUTUS.) 
Prophylaxis. This disease is very easily pre- 
vented. Ships making long voyages should have on 
board a good supply of fresh vegetables. 
Treatment. The disease can only be cured by 
attention to diet. The patient should receive plenty 
of fresh meat and green vegetables such as spinach, 
watercress, cabbage, celery, onions, lettuce, aspara- 
gus, etc. Fruit juices as lemon and orange should 
be given daily. The juice of one lemon or two oranges 
is sufficient. 
Bitter tonics should be given as: 
Tinct. nuc. vomic 3iv 
Tinct. quassiae 3ii 
Tinct. gentian 3ii 
Tinct. cardamom 5iii 
Tinct. calumbae 5ii 
Ess. pepsin q. s. ad. §iii 
Sig. One teaspoonful in water three times a day 
before meals. 
Treat the sore mouth and gums by antiseptic mouth- 
washes as: 
I|. Sat. sol. potass, chlorat Bviii 
Sig. Use as mouth-wash every three hours. 
Or: 
I). Potass, permanganat grs. viii 
Aquae rosae §vi 
M. Sig. Use as mouth-wash every three hours. 
In the haemorrhages that occur in this disease give 
calcium lactate or calcium chloride as: 
366 I|. Calcii chloridi 3iv 
Fluidextr. ergotse 3ii 
Tinct. cinnamon 3iv 
Syr. aurantii corticq. s. ad. §iii 
M. Sig. One teaspoonful in water every three hours. 
For the constipation give warm soapsuds enemas. 
Other complications must be treated independently. 
SEA-SICKNESS. 
Prophylaxis. All passengers who are susceptible 
to sea-sickness should take a calomel purge, followed 
by a saline, two days before sailing. All prepara- 
tions for the voyage should be finished at least 24 
hours before sailing in order to avoid exhaustion 
from overwork and loss of sleep. A moderate meal 
should be eaten before going on board. To avoid 
too much motion, a stateroom should be selected 
near the center of the vessel, away from the engines. 
As much time as possible should be spent on deck 
and the passenger should move about from time to 
time if possible. If however the sea becomes rough 
he should go to bed before getting sick. 
For the first day or two on board, light easily 
digested food should be taken at short intervals, 
but over-eating should be avoided. Sponge or 
bathe daily with cold water, or with hot water 
preceded by cooling of the head and neck, and fol- 
lowed by a cold friction rub or shower. A little 
of something should be eaten before rising in the 
morning. Saline laxatives should be taken for the 
first few days on board. 
Abdominal compression by means of a bandage 
and towel is often useful. If the abdomen is hollow, 
a soft folded blanket may be fitted into the depression. 
Sometimes the prone position is beneficial. 
Diet in sea-sickness. A moderate amount of food 
should be taken at short intervals, in order to have 
something in the stomach all the time. Syrups, 
broths, gruels, junket, matzoon, kumyss, clam broth, 
367 beef juice, and curry with a semi-solid diet when 
that is tolerated. Mulled wine, grog, eau de menthe, 
iced dry champagne, cider, brandy, ginger ale, 
seltzer, eau sucree with lemon juice or citric or 
tartaric acid, pieces of ice held in the mouth, and 
very hot coffee and tea are some of the drinks which 
may be given. 
Drug treatment. Large doses of bromides (ammo- 
nium, potassium, sodium, strontium) may be given 
three or four days before starting and keeping this up 
while at sea until all danger of sea-sickness is over. 
I). Potass, bromidi 3iv 
Ft. caps. No. xxiv. 
Sig. Two capsules every four hours, two days 
before sailing, and one capsule every four hours for 
the first two days at sea. 
To regulate the bowels the following may be given: 
R. Extr. taraxaci grs. xx 
Extr. colocynth. co grs. xx 
Extr. hyoscyam grs. iii 
Extr. nuc. vomic grs. v 
Hydrarg. mass grs. xv 
M. ft. pil. No. xx. 
Sig. One or two each night for three nights before 
sailing and three after. 
To relieve the vomiting, the following agents are 
used: dilute chloroform, hydrocyanic acid, Worcester- 
shire sauce in teaspoonful doses, sodium carbonate in 
doses of 10 to 20 grains, creosote in drop doses every 
hour, cerium oxalate and cocaine: 
1$. Menthol grs. ii 
Cocain. hydrochlorgrs. iii 
Syr. simplic 5i 
Alcohol §i 
M. Sig. One teaspoonful every hour. 
Recently strychnine grain) and atropine 
grain) either by the mouth or hypodermically have 
been highly recommended. 
368 SEBACEOUS CYSTS. 
When they occur on the head the hair should be 
shaved for a distance of at least two inches round the 
cyst. Sterilize the skin by scrubbing with soap and 
water followed by ether and alcohol. 
An incision should be made through the skin with 
a fine sharp scalpel, just long enough to allow the 
cyst to be shelled out by the blunt end of the scalpel. 
If the cyst is removed without rupture drainage is 
unnecessary; the wound may be sewed with fine 
catgut sutures after thoroughly drying out the cav- 
ity. If the cyst is on the face, always make the line 
of incision parallel with wrinkles. 
Local anesthesia with a 2% solution of cocaine 
is all that is necessary. First freeze the skin with 
ethyl chloride, and then inject the cocaine. 
SEBORRHEA (See Dandruff). 
SEMINAL EMISSIONS. 
Local, general and mental hygiene are necessary, 
Strengthen tone of urethra and of prostatic muscles 
by counter-irritation with sounds, with cold-water, 
rectal douche, or mild electric current. Patient 
should take systematic outdoor exercise and should 
avoid pruriency in books, pictures and conversation. 
The bowels should be kept regular and no fluids 
should be drunk for two hours before bedtime. The 
bladder should be emptied after the first deep sleep. 
He should avoid a feather or soft bed and should 
not lie on his back. If the urine is too acid or alka- 
line, or if worms are present in the rectum these 
conditions should be treated. 
The following prescription may be of service: 
I). Potass, brom 5iv 
Fluidextract, ergot 3iv 
Tinct. belladonn. fol 3ii 
Aquae camphorq. s. ad. 3viii 
M. Sig. One tablespoonful at bedtime. 
369 SERUM RASHES, PREVENTION OF. 
The pruritus, joint pains and urticarial rashes 
which sometimes follow the administration of serums 
being due to a condition of reduced coagulability 
of the blood, may be relieved or prevented by the 
administration of calcium salts which increase the 
coagulation power: 
R. Calcii lactat grs. v 
Calcii chlorid grs. v 
M. et ft. caps. No. 1. 
Sig. Give three hours before the administration of 
the antitoxin. 
SHINGLES (See Herpes Zoster). 
SHOCK. 
In the treatment of shock the condition of the 
heart must be attended to. The patient should be 
placed in the horizontal position and he should be 
warmly covered. Artificial heat should be applied 
externally by hot blankets, hot water bottles and 
gentle friction of the surface in order to correct the 
falling bodily heat. 
The action of the heart should be stimulated by 
the application of heat or mustard paste over the 
precordium, or by subcutaneous injections of strych- 
nine, atropine, morphine or whisky: 
I). Tabellas strychninae sulphat gr. 3% 
No. xx 
Sig. One tablet in ten minims of water hypoder- 
mically and repeat as required. 
Or: 
R. Tabellas atropinae sulphatis gr. r^a 
No. xii. 
Sig. A tablet dissolved in ten minims of water to 
be administered hypodermically, and repeated once or 
twice if required. 
If the patient can take medicines by the mouth they 
should be given hot and concentrated. 
R. Spiritus ammoniae 3i 
370 Sig. One teaspoonful in water by the mouth and 
repeat as required. 
Or: 
I|. Spiritus frumenti 5viii 
Sig. One teaspoonful to be given hot as frequently 
as required. 
In the case of surgical shock in children the following 
may be given: 
1$. Ammoniae carbonatis grs. viii 
Syrupi 3ii 
Aquae camphorse q. s. ad. 3i 
M. Sig. One teaspoonful every two hours. 
Enemata of hot water, fluid extract of coffee or 
whisky may also be administered: 
3. Ammon, valerianat grs. xxx 
Tinct. digitalis 3ii 
Brandy 5 iv 
M. Sig. One tablespoonful in two ounces of warm 
water by rectum every two hours. 
Before a surgical operation the following may be 
given as a prophylactic against shock: 
I|. Glandulae suprarenales siccae grs. vii 
Pulv. digitalis grs. ii 
Sacchar grs. i 
M. ft. chart. No. i. 
Sig. Administer before operation. 
In cases of haemorrhage the infusion of 40 to 50 ounces 
of normal salt solution is of benefit, or the following: 
I|. Calcii chloridi grs. iv 
Potass, chlorid grs. iss 
Sodii chlorid grs. cxl 
Aquae destillat. (steril.) gxxxii 
Sig. Inject warm under strict antiseptic precau- 
tions into vein from fountain syringe to which is at- 
tached a cannula, care being taken not to inject air 
bubbles. 
In haemorrhage a temporary ligature or tight band- 
age may be applied to the thighs to prevent the blood 
371 entering the lower extremities, or an Esmarch's band- 
age may be applied to the limbs or a tourniquet to 
the femoral artery. 
SILVER NITRATE (LUNAR CAUSTIC), POISONING BY. 
Give two tablespoonfuls of common salt in a glass- 
ful of water in order to form insoluble silver chloride. 
Then give an emetic to remove the precipitated 
silver chloride. Follow this up with large draughts 
of white of egg in water. 
SKIN DISEASES, ELECTRIC TREATMENT OF. 
The following skin affections are suitable for treat- 
ment by discharges of the high-frequency apparatus: 
pruritus, eczema, psoriasis, lupus vulgaris, lupus 
erythematosus, alopecia areata, impetigo and acne. 
The treatment consists in the use of the effluve 
of the resonator given without sparking, from a 
metallic brush electrode, or of the finer effluve of the 
"glass condenser" electrodes, which may either be 
exhausted to a conducting vacuum or filled with 
water or salt solutions. 
When the skin affection is chronic, indolent and 
dry, a few fine sparks should be applied to the surface 
by means of a wire brush as well. Two or three 
applications weekly of a duration of ten minutes 
are sufficient. 
The following skin affections are suitable for treat- 
ment by the X-rays: eczema, psoriasis, herpes zoster, 
sycosis, favus, acne vulgaris, acne rosacea, naevus 
flammeus, cutaneous blastomycosis, mycosis fun- 
goides, tinea tonsurans, dermatitis herpetiformis and 
pruritus. The X-ray may also, if used with care, 
be employed in the removal of superfluous hair. 
For superficial affections like those of the skin a 
set of tubes of low resistance should be employed. 
These tubes emit a large proportion of rays of low 
penetrating power that are easily absorbed near 
the surface. The exposures should be of five min- 
372 utes' duration for the first few sittings and then 
increased if necessary. They should be given two 
or three times a week and the tube should be at a 
distance of six to eight inches. If a large area is 
affected the distance of the tube should be some- 
what increased and the exposure lengthened in 
proportion. 
SLEEPLESSNESS (See Insomnia). 
SLEEPING SICKNESS. (TRYPANOSOMIASIS.) 
Purgation with castor oil counteracts the per- 
sistent constipation and thus gives great relief. If 
malaria complicates the disease, iron, arsenic, and 
quinine are of benefit. Arsenic in increasing doses, 
nutritious diet, and careful nursing may delay con- 
siderably the almost invariably fatal termination. 
Besides arsenic the only other drugs of benefit in 
this disease are trypanred and atoxyl. The former 
is an aniline body and received its name from Ehrlich. 
The latter is a meta-aniline arsenic compound. The 
two drugs may be given separately or together. 
Intravenous injection should be made twice a week 
with 5 c. c. of a 5% solution of atoxyl. Increase 
the quantity gradually till headache and nausea 
appear. It should be given for a year or over. 
Trypanred is given in pill form in the dose of five 
grains. 
SMALL-POX (VARIOLA), PROPHYLAXIS OF. 
Isolate the patient completely, preferably in a 
special hospital for infectious diseases. Remove all 
superfluous furniture, carpets, curtains, etc., from 
the sick-room and ventilate it thoroughly. Suspend 
before the door a sheet kept constantly wet with 
solution of phenol (1 to 20). Disinfect all objects 
that have been in contact with the patient. Vacci- 
nate all those who have been, or are likely to be, 
exposed to the contagion. The physician and attend- 
ants while in the sick room should wear a gown 
373 over their other clothing, and this should be removed 
when leaving the patient. The patient should be 
supplied with separate utensils and dishes; and all 
dressings and crusts from the pustules should be 
burned. Do not allow any bed-linen and clothing 
to be sent to the laundry before being soaked for 
at least two hours in bichloride solution (1 to 1,000) 
If the patient recovers he should be thoroughly 
washed and shampooed with soap and warm water, 
and then sponged with a bichloride of mercury 
solution (1 to 3,000). He should be quarantined 
until the skin is clean and smooth, and there are no 
traces of the crust left. 
If death takes place, sponge the body with strong 
mercury bichloride solution, plug the mouth, nos- 
trils, and anus, with cotton pledgets soaked in the 
same solution. Next wrap the body in a sheet satu- 
rated with strong bichloride solution, place it in 
an air-tight coffin and bury it as soon as possible, 
or better still, cremate it, if practicable. 
SMALL-POX. (VARIOLA.) 
Treatment. Isolate patient in a well-ventilated 
room kept at a constant temperature of 65° F. The 
patient should have absolute rest and the bed-clothes 
should be light. The diet should be sustaining and 
easily assimilable and cool drinks should be freely 
given throughout the disease. 
At the onset the bowels should be kept open 
with fractional doses of calomel frequently repeated 
and followed by a saline. 
The pain in the back and head may be relieved 
by acetanilid or antipyrin in combination with caffein 
to prevent heart weakness: 
1$. Antipyrinae 3i 
Caffeinae citrataegrs. vi 
M. ft. chart. No. xii. 
Sig. One powder every three hours if required. 
Or the following may be given for the same purpose: 
374 I). Pulv. ipecac, et opii 5i 
Ft. chart. No. vi. 
Sig. One powder as required to ease pain in back 
and head. 
The ice-cap to the head and the application of hot- 
water bags to the lumbar region are also useful. The 
following liniment is also of benefit: 
1$. Camphorse. 
Chloralis. 
Mentholisaa gi 
M. Sig. Rub thoroughly over the back. 
The vomiting may be relieved by swallowing small 
pieces of cracked ice, or by frequent sips of iced 
champagne as well as by dilute hydrocyanic acid 
(2 min.), subnitrate of bismuth (10 grains), or cocain 
(i grain). 
Cerebral symptoms are usually relieved by cool 
sponging, tepid tub baths, or the ice helmet, but when 
these fail opium with bromides, or chloral with bromides 
may be given per rectum or by the mouth: 
I|. Potassii bromidi 5v 
Syrup, aurantii flor 5vi 
Aquae camphoraeq. s. ad. gviii 
M. Sig. One tablespoonful every 3 hours if required. 
When delirious the patient should be carefully 
watched as there is danger that he may injure himself 
or commit suicide. 
If there is cardiac weakness stimulants such as 
caffeine, alcohol, or strychnine may be given hypo- 
dermically. Alcoholic stimulants are often of great 
benefit, especially in confluent cases. 
The eruptive stage. To prevent pitting the room 
should be darkened by covering the window panes 
with red flannel. Daylight, and especially its chem- 
ical rays, seems to have an injurious effect in bringing 
about the suppuration of the vesicles. The skin of 
the patient should be covered with a thin gauze com- 
press which is kept moist with a weak solution of car- 
375 bolic acid (1 to 200) or of corrosive sublimate (1 to 5,000). 
Besides preventing pitting these wet compresses have 
a soothing effect. A suitable mask should be made 
for the face. When the lesions are deep-seated, pitting 
can hardly be avoided. 
The eruptions in the mouth, nose and throat are 
treated by the external application of cold and frequent 
cleansing of the nasopharynx with antiseptic sprays, 
douches and mouth-washes. Dobell's solution or di- 
lute liquor antisepticus, potassium chlorate or iron per- 
chloride are useful: 
I). Potassii chloratis 3vi 
Tinct. myrrhae 3i 
Aquae camphoraeq. s. ad. gxvi 
M. Sig. Shake well, and use as a mouth-wash every 
hour or two. 
Or: 
1$. Tinct. benzoini co 3i 
Liq. antisepticiq. s. ad. Sviii 
M. Sig. One teaspoonful to half a cup of water, 
and use as a mouth-wash every hour or two. 
If ulcers appear they should be touched with a 20% 
argyrol' solution. 
The eyes should be kept clean by frequent applica- 
tions of a weak warm boric acid solution (15 grains to 
the ounce) or: 
]$. Acidi boricigrs. xl 
Aqu® camphorae §iv 
Aquae destillatq. s. ad. oviii 
Sig. Bathe eyes freely every few hours. 
A few drops of a 10% solution of protargol may also 
be instilled. If the eyelids tend to become gummed 
together during sleep, give: 
1$. Acidi borici 3i 
Camphorae grs. v 
Petrolati mollis 3 i 
Sig. Rub small quantity along margin of eyelids. 
After the crusts have formed, they should not be 
376 removed before they are completely loosened. Children 
should be prevented from scratching by bandaging 
their hands with gauze. The following ointment may 
be used to prevent pitting, soften scales, and relieve 
itching: 
Phenolis 5ss 
Ungt. aquae rosse gviii 
M. Sig. Apply freely every two or three hours 
Or: 
B. Ung. resorcin co. N. F 3iii 
Sig. Apply every three hours. 
SMOKER'S TONGUE. 
Clean the mouth, take care of the teeth and stop 
smoking. Touch the patches with lunar caustic 
once every week or so. Antiseptic and astringent 
mouth washes may be given, e. g.: 
I|. Liq. antiseptic. U. S. P 3 vi 
Sig. Use one teaspoonful in a wineglassful of water 
three times a day. 
To take off the discoloration from the teeth and 
whiten them, use peroxide of hydrogen on tooth- 
brush every morning. 
SNAKE-BITE. 
Prevent absorption of the poison by ligaturing the 
part above the bite, sucking the wound and rubbing 
in powdered potassium permanganate. Dissect care- 
fully and deeply all parts of the wound likely to 
contain poison. Burn with a red-hot iron. 
Next counteract or lessen the effect of the poison 
which has been absorbed. Administer sufficient 
whisky to overcome the depressing effect of the poi- 
son. Ammonia and strychnine are also of value. 
Give strychnine sulphate hypodermically in doses 
of Tj'jj grain. Keep the patient quiet and warm. 
The intravenous or hypodermic injection of Cal- 
mette's anti-venom serum has proved to be effective 
in some cases of snake-bite. Each snake-venom 
requires its own specific anti-serum. 
377 We have not so far a polyvalent serum, that is, 
one that will counteract the poison of all snakes. 
SPA TREATMENT OF DISEASE. 
Only the springs of North America are enumer- 
ated here. 
1st. Simple thermal waters whose temperature 
varies from 80° F. to 150° F. or more. These springs 
are poor in solid and gaseous contents. To this class 
belong the Lebanon Springs of Columbia County, 
New York; the Hot Springs, Warm Springs and 
Healing Springs of Bath County, Virginia; the Hot 
Springs in North Carolina; the Warm Springs in 
Georgia; the Hot Springs in Arkansas; the Idaho 
Hot Springs in Colorado; the Calistoga Hot Springs; 
the Geysers in California and the Las Vegas Hot 
Springs in New Mexico. 
These springs are useful in gastralgia, neuralgia, 
gout, rheumatism, hysteria and in irritable conditions 
of the mucous membranes of the digestive and respi- 
ratory organs. 
2d. Muriated or chloride waters containing com- 
mon salt, iron, carbonates of sodium, lithium, mag- 
nesium and calcium, sulphates of sodium, magnesium 
and calcium. To this class belong St. Catherine's 
Wells, Ontario; Ballston Spa, New York; Saratoga 
Springs, New York; Spring Lake Well, Michigan; 
Fruit Port Wells, Michigan. The Mount Clemens 
Mineral Spring, Michigan, is a strong bnine containing 
sulphuretted hydrogen. 
These springs are useful in sluggish action of the 
bowels and stagnation in the branches of the portal 
vein, in dyspepsia, congestion of the pelvic organs, 
and haemorrhoidal vessels and in enlargement of the 
liver. Also in catarrh of the stomach, intestines and 
respiratory organs, in chronic rheumatism, gout, sci- 
atica and chronic enlargement of the womb. 
3d. Alkaline waters containing bicarbonate of so- 
dium and other salts. To this class belong the Geyser 
378 and Vichy Springs of Saratoga; the Sheldon Springs 
of Vermont; the Bladon Springs of Alabama; the 
California Seltzer Springs; the St. Louis Spring, 
Michigan, and the Royal Gorge Hot Springs near 
Canyon City, Colorado. 
These springs are useful in dyspepsia with acidity 
or catarrh of the stomach and intestines. Muriated 
alkaline waters like the Bladon and Sheldon Spring 
are useful in chronic catarrh'of the respiratory organs. 
Sulphated alkaline waters like those of the Royal 
Gorge Hot Springs are useful in atonic constipation, 
passive congestion of the liver, cholelithiasis, tendency 
to uric acid gravel, some forms of rheumatism and 
gout, and in the glycosuria of corpulent persons. 
4th. Sulphated or bitter waters containing the 
sulphates and chlorides of magnesium and sodium. 
To this class belong the so-called American Carlsbad 
Springs in Washington County, Illinois, and the Crab 
Orchard Springs in Kentucky. 
These springs are useful in habitual constipation, 
passive congestion of the liver, chronic malaria and 
syphilis. They also help to eliminate metallic poi- 
sons, as lead and mercury. 
5th. Iron waters containing the bicarbonate, 
sulphate or chloride of iron. The bicarbonate is by 
far the most useful, because it is more agreeable to 
the stomach. To this class belong the White Sul- 
phur Springs, Iowa; the "Round" Spring at Aurora 
Springs, Missouri; the Matchless Mineral Wells, 
Alabama; Addison Springs, Maine; Austin Springs, 
Tennessee; Adirondack Mineral Spring and Oak 
Orchard Acid Springs, New York. 
These springs are useful in all forms of anaemia, 
after severe haemorrhage, in amenorrhoea, and in 
the various cachexias. They are contraindicated in 
plethora, vertigo and congestive headaches. 
6th. Arsenic waters containing an appreciable 
quantity of arsenic along with iron or saline sub- 
379 stances. To this class belong some of the Yellow- 
stone National Park Springs. 
These springs are useful in chronic skin affections 
with anaemia, in lymphatic and glandular diseases, 
and in malarial cachexia. 
7th. Sulphur waters containing either sulphide of 
sodium, calcium, potassium, or magnesium, or sulphu- 
retted hydrogen. Some are thermal and others are 
cold. To this class belong the Cold Sulphur Springs 
of Virginia; Lane's Mineral Springs of California; 
Beck's Hot Sulphur Springs in Utah; the Columbia 
Springs in New York, and the Louisville Artesian 
Well in Kentucky. 
These springs are useful in chronic rheumatism, 
gout, syphilis, chronic skin disease, hemorrhoids, and 
in chronic bronchial, laryngeal and pharyngeal 
catarrhs. They have also an ancient reputation in 
lead and mercury poisoning. 
8th. Earthy or calcareous waters containing car- 
bonate and sulphate of calcium and carbonate of 
magnesium. To this class belong Butterworth's 
Springs, Eaton Rapids Well and Leslie Well in 
Michigan; the Gettysburg Springs in Pennsylvania; 
the Alleghany Springs in Virginia, and the Old Sweet 
Springs in West Virginia. 
These springs are useful in dyspepsia with irrita- 
bility of the mucous membrane, acidity and diar- 
rhoea. They are also useful in gall stones, gout, 
and in washing out small stones in the bladder and 
kidney. 
SPA TREATMENT OF DISEASE, FOREIGN. 
If the patient can afford or desires a trip to 
Europe or elsewhere overseas, one of the following 
may be chosen for him: 
1st. Simple thermal waters. Buxton, England; 
Bath and Matlock, England; Mont Dore, Bagneres- 
de-Bigorre, Plombieres, Dax and Luxeuil, France; 
Landeck, Wildbad, Liebenzell, Warmbrunn, Schlan- 
380 genbad, Germany; Loeche-les-Bains, Pfaeffers, Rag- 
atz, Switzerland; Bormio, Acqui, Lucca, Monsum- 
mano, Battaglia, Italy; Panticosa, Spain (Pyrenees); 
Johannisbad, Teplitz, Bohemia; Biskra, Algeria; 
Caledon, Cape Colony; Rotorua, New Zealand. 
2d. Muriated or chloride waters. Droitwich, 
Nantwich, Middlewich, Ashby-de-la-Zouche, Wood- 
hall, Harrogate, Llandrindod, Bridge of Allan, Melk- 
sham, Leamington, Cheltenham, Great Britain; 
Bourbonne, Lamotte, Uriage, St. Gervais, Chatel- 
Guyon, Salins, Brides-les-Bains, France; Kissingen, 
Homberg, Soden, Nauheim, Oeynhausen, Kreuznach, 
Wiesbaden, Reichenhall, Ischl, Hall, Niederbronn, 
Krankenheil, Salzungen, Cannstatt, Cronthal, Aachen, 
Germany and Austro-Hungary; Bex, Rheinfelden, 
Switzerland; Monte Cattini, Castro Caro, Salsomag- 
giore, Italy; Caldas-de-Montbuy, Caldas-de-Mala- 
vella, Cestona-Guesalga, Spain; Caldas-de-Rainha, 
Portugal. 
3d. Alkaline waters, (a) Simple alkaline: Vichy, 
Vais, Le Boulou, France; Neuenahr, Obersalzbrunn, 
Fachingen, Birresborn, Germany; Bilin, Bohemia, 
(b) Muriated alkaline: Royat, La Bourboule, Saint- 
Nectaire. Chatel-Guyon, France: Ems, Toennisstein, 
Germany; Luhatschowitz, Bohemia; Szczawnica, 
Galicia, (c) Sulphated alkaline: Bertrich, Elster, 
Germany; Tarasp, Switzerland; Carlsbad, Marien- 
bad, Franzensbad, Bohemia; Fuered, Hungary. 
4th. Sulphated or bitter waters. Melksham, 
Scarborough, Leamington, Cheltenham, England; 
Montmirail, France; Friedrichshall, Mergentheim, 
Germany; Birmensdorf, Switzerland; Pullna, Sedlitz, 
Saidschutz, Bohemia; Rubinat, Condal, Carabana; 
Villacabra, Spain. 
5th. Iron or chalybeate waters, (a) Bicarbonate 
of iron group: Tunbridge Wells, England; Rennes- 
les-Bains, Sylvanes, Lamalou, France; Brueckenau, 
Griesbach, Liebenstein, Godesberg, Booklet, Innau, 
381 Driburg, Schwalbach, Germany; Spa, Belgium; 
Ceresole, Reale, Santa Catarina, Recoaro, Italy; 
Koenigswarth, Bohemia; (b) Sulphate of iron group: 
Flitwick Well, Bedfordshire, England; Alexisbad, 
Germany; Civillina, Italy; Ratals, Mitterbad, 
Levico, Roncegno, Austrian Tyrol. 
6th. Arsenic waters. La Bourboule, Mont Dore, 
France; Levico, Roncegno, Austrian Tyrol; Ceresole 
Reale, Italy. 
7th. Sulphur waters, (a) Hot. Eaux-Bonnes, 
Eaux-Chaudes, Cauterets, etc., in the French Pyre- 
nees; Aix-les-Bains and Uriage, France; Aachen or 
Aix-la-Chapelle and Burtscheid, Germany; Acqui, 
Battaglia and Abano, Italy; Panticosa and Trillo, 
Spain; Caldas-de-Rainha, Portugal and Helouan in 
the desert near Cairo. (b) Cold. Harrogate, 
England; Llandrindod Wells, Builth, Wales; Strath- 
peffer, Moffat, Scotland; Lisdoonvarna, Ireland; 
Chalies, Enghien, Bagneres-de-Bigorre, France; Eil- 
sen, Nenndorf, Weilbach, Meinberg, Germany; Al- 
veneu, Gurnigel, Stachelberg and Heustrich, Swit- 
zerland. 
SPINAL CORD, TUMORS OF. 
In every case antisyphilitic remedies should be 
pushed to their limit whether there is a history of 
syphilis or not, for at least four weeks. 
The location of tumors of the cord in most cases can 
now be readily ascertained. The only treatment is 
operative surgery. From 50 to 70 per cent of the 
tumors of the cord can be removed without difficulty, 
and with a large percentage of complete cures. 
SPLENIC AN2EMIA. (See Anaemia, Splenic). 
SPLENIC FEVER (See Anthrax). 
SPLENOMEGALY, TROPICAL (See Kala Azar). 
SPRAIN. 
If sprain is mild, the part should be immersed in 
hot water or otherwise subjected to moist heat, and 
382 then it should be massaged for a considerable time. 
Next strips of adhesive plaster should be applied 
so as to give firm support to the joint. 
If there is considerable swelling and extravasa- 
tion of blood, apply the following: 
Py. Liq. plumb, subacetat §i 
Tinct. opii 5i 
Aquse Oi 
M. Sig. Apply hot to joint. 
Sprains of the ankle are best treated by firmly fitting 
strips of adhesive plaster; this relieves the pain almost 
immediately. In four or five days remove the plaster 
and apply stimulating liniments, followed by a tight 
bandage until complete recovery has taken place: 
I|. Lin. aconit. et chloroformi, N. F 3iv 
Sig. Apply twice a day. 
Or: 
1$. Menthol 5ss 
Chloroform 3iii 
Spts. camphor 5iv 
Spts. vini rect 3vi 
Lin. saponis q. s. ad. ovi 
M. Sig. Apply twice a day. 
SPRUE. (PSILOSIS, TROPICAL DIARRIICEA, MANILA 
SORE MOUTH.) 
Treatment chiefly dietetic and hygienic. Clothe 
warmly in flannel. Pad of cotton over abdomen. 
Hot wet packs, changing to tepid and cold for two 
hours twice daily. Commence treatment with one 
drachm of castor oil. Diet wholly of milk, three 
to four ounces slowly sipped, not drunk, every hour, 
increasing the interval as the patient improves. 
Strawberries added to the milk are of great benefit. 
Alleviate the raw state of the mouth by painting 
tongue before eating with a 2% solution of cocain 
solution, and rinsing mouth out after eating with a 
weak solution of borax. 
383 Give sodium bicarb. 15 minutes before meals. 
Castor oil, one to two teaspoonfuls every third day. 
Remove if necessary to high altitude or to a tem- 
perate zone. 
Or the diet may consist wholly of meat; fresh 
juice of scraped beef, beef jelly every half hour or 
hour. When improvement takes place give pounded 
beef, chicken or fish, 5 oz. thrice daily with baked 
bread. Occasionally a combination of milk and 
meat diet is of service. 
SQUINTING. (STRABISMUS.) 
In convergent squint with hyperopia, atropin will 
temporarily remove the condition by paralyzing the 
ciliary muscles and so stopping the efforts at accom- 
modation. In these cases convex lenses correcting 
the hyperopia should be worn constantly and at the 
earliest date possible. In all young subjects these 
glasses should have a fair trial and children of two 
or three years will receive most benefit from them, 
since in them the vision is not usually permanently 
damaged. 
In many cases the use of convex glasses fails 
owing to the changes which have already taken 
place in the relations between the external and 
internal recti muscles. If they fail, tenotomy of 
the internal rectus in one or both eyes must be 
resorted to. This should not be done sooner than 
the eighth year, by which time the patient will be 
able to wear glasses. 
Convergent squint, the result of myopia, is gener- 
ally remedied by suitable glasses, but when these 
fail, tenotomy should be performed. 
In myopia, concave lenses correcting it may be 
used to prevent divergent squint which is a more 
troublesome affection to remedy than is convergent 
squint. The very mild forms may be sometimes 
removed by suitable concave glasses to correct the 
myopia to which it is usually due. 
384 STAMMERING AND STUTTERING. 
Look for and treat any abnormalities or patho- 
logical conditions in the mouth, throat or air passages. 
Irregularities of the teeth near the tip of the tongue 
should be corrected. 
Give the patient vocal exercises and insist on 
great slowness and deliberation. He should prac- 
tice again and again the sounds which give him 
most difficulty, and should not be allowed to talk 
when excited, nervous or angry. 
In bad cases, begin the vocal exercises with sing- 
ing or intoning, followed by repeated exercises in 
loud, slow reading. 
The stuttering child should be kept as much as 
possible from association with other stutterers. Even 
normal children may learn the habit from associ- 
ating with stuttering children. 
No notice should be taken of the disorder in sensi- 
tive children since sympathy may make them nerv- 
ous as much as blame does, and so foster the habit. 
Breathing exercises should be given by causing 
the patient to take a long breath, hold it for a moment, 
and then let it out slowly with occasional stops, 
but without sound. He should take a deep breath 
at frequent intervals, and should never speak with 
nearly empty lungs. 
Some adult patients if they have patience and 
perseverance enough, may educate themselves out 
of the habit but proper teaching may save them 
time, and in some cases, disappointment. 
STARVATION, TREATMENT OF. 
Give some stimulant and apply external heat. 
Give nourishment in very small quantities, e. g., 
scraped raw beef flavored, in teaspoonful doses every 
half hour. Do not satisfy at first the ravenous 
appetite of the patient. Milk may be given next 
alternately with the beef juice, then gradually more 
solid diet. 
385 STERILITY IN WOMEN. 
In the case of husband and wife, the male potency 
being established, look for a possible cause in the 
woman. 
Attend to her general health. Recommend sexual 
moderation or even abstinence for several months. 
Intra-uterine galvanism is beneficial in the case of 
hyperinvolution or when the uterus is badly devel- 
oped. In infantile uterus, curettage, intra-uterine 
pessaries, and hot douches are often beneficial. If 
acrid discharges from the uterus kill the spermatozoa 
alkaline injections should be given before congress, 
and Vichy water should be taken internally. In 
chronic metritis, amenorrhea, or coldness, aurum 
chloride in -fa grain doses is beneficial. When 
there is obstruction with dysmenorrhea, or endo- 
metritis from anteflexion, dilation or divulsion of 
the cervix should be tried, followed by curettage. 
If there is blocking of the cervical canal with dis- 
charge from the cervical glands, cleanse the canal 
with a probe wrapped in cotton. 
In brief, sterility in the female often depends upon 
remedial causes, and sometimes more than one cause 
may be present at the same time. For details of 
treatment of these causes see under the headings 
Leucorrhea, Metritis, Uterine Displacements, Gon- 
orrhea, Dysmenorrhea, Vaginismus, Syphilis, Sal- 
pingitis, Obesity, etc. 
STERILIZATION OF HANDS BEFORE OPERATION. 
Scrub hands and arms thoroughly for five minutes 
in hot water, taking special care to clean the nails. 
Then wash the hands for two minutes in a carbolic 
(1 to 40) solution, using a nail-brush which is kept 
in a 1 to 20 solution. Next soak the hands for one 
minute in a 1 to 1,000 solution of biniodide of mercury 
in spirit diluted four times with sterilized water. 
Then rinse for one minute in sterilized water. 
386 STOKES-ADAMS DISEASE. 
Treatment is unsatisfactory; a sufficient number 
of cases are not on record to formulate any definite 
line of treatment. Morphine, digitalis, nitroglycerin, 
camphor and ammonia have individually helped 
some cases. The attack may sometimes be mitigated 
by the patient assuming a position which will favor 
the cerebral circulation. He should support him- 
self on his hands and knees while the head hangs 
low. To calm the nerves and promote sleep hypo- 
dermic injection of J4 grain of morphine is of great 
benefit. 
STONE IN KIDNEY (See Renal Calculus). 
STRANGULATION OF BOWEL (See Intussusception). 
STRYCHNINE POISONING. 
In severe cases the first step in the treatment 
is the free administration of chloral followed by 
inhalations of chloroform sufficient and sufficiently 
prolonged to control the convulsions until the poison 
is eliminated. 
Unabsorbed poison should be removed from the 
stomach by washing it out with a strong infusion 
of tea, or a solution of some form of tannin, or by 
water holding powdered charcoal in suspension. An 
emetic may be given, of which apomorphine hydro- 
chloride is the best in this case in hypodermic injec- 
tions of grain. 
Two drachms of potassium bromide in a glassful 
of water should be given and repeated every quarter 
of an hour if necessary. 
Artificial respiration should also be tried. 
STYE (See Hordeolum). 
SUB-ACIDITY OF GASTRIC JUICE (See Achylia 
Gastrica). 
SULPHONAL, TRIONAL AND VERONAL POISONING. 
Empty the stomach by means of a stomach tube 
or with an emetic. Give stimulants and apply 
387 warmth to the extremities. Strychnine sulphate 
to grain) hypodermically, or digitalin ( grain) 
hypodermically are of service. Artificial respiration 
should be given and the recumbent position is to be 
maintained. 
SUMMER DIARRHCEA (See Gastro-Enteritis, Acute). 
SUNSTROKE. (HEAT-STROKE, INSOLATION, THER- 
MIC FEVER.) 
In mild cases take patient into a cool place or 
at least into shade. Loosen clothing, bathe head 
with cold water; apply ice if possible. Give stimu- 
lants such as aromatic spirits of ammonia, Hoff- 
man's anodyne, liquor ammoniae acetatis or whisky. 
Give iced tea or coffee. Relieve headache with: 
Sodii bromidi 3ii 
Phenacetini 3iss 
Caffein. citr grs. xii 
M. et ft. chart. No. xii. 
Sig. One every three hours if necessary. 
In severer forms, give hypodermic injection of gr. 
of strychnine. If high temperature, place patient in 
bath of iced water and rub with ice. Also enemas of ice 
water in which salt has been dissolved (one teaspoonful 
to one pint). In collapse give hot bath and apply 
artificial respiration, and: 
1$. Spt. nitroglycerin 1% m. xxv 
Digitalin gr. 
Strychnin, sulph gr. 
Spt. vin. Gall q. s. ad. 3iii 
M. Sig. One teaspoonful every three hours hypo- 
dermically or by mouth. 
SUPPRESSION OF MILK. (AGALACTIA.) 
The patient should have rich food, Dublin stout, 
beef juice, the various malt extracts with or without 
cod liver oil and tonics such as strychnine sulphate. 
Massage of the breasts is also of benefit. In stubborn 
cases pilocarpine nitrate hypodermically may be 
tried, or: 
388 I|. Pilocarpin. hydrochlor gr. iss 
Strychnin, sulph gr. 
Tinct. vanill 5i 
Elix. simpl q. s. ad. gii 
M. Sig. One teaspoonful in water every four hours. 
Or: 
I|. Malt, cum ferr. quin, et strych §xii 
Sig. One tablespoonful four times a day. 
SUPPRESSION OF URINE. (ANURIA.) 
Treatment in children. Hot applications over 
the kidneys. 
Give internally the following for a child three 
months old: 
1$. Spts. seth. nitros m. xvi 
Potass, citrat grs. xvi 
Aquse q. s. ad. §ii 
M. Sig. One teaspoonful every half hour until the 
urine appears, usually in six or eight hours. 
Treatment in adults. Depends upon the cause. If 
mechanical obstruction then prompt surgery is impera- 
tive. In non-obstructive cases, free purgation, hot 
fomentations or dry cups to the kidneys and sweating 
by the use of fa gr. of pilocarpin are indicated. It is 
best for the patient to live on a milk diet. Withhold 
sodium chloride entirely from the patient's food if there 
is headache, itching, convulsions or delirium. 
Rectal irrigation with very hot water is beneficial 
Internally give the following: 
1$. Diuretin 3 iss 
Potass, acetat 3vi 
Infus. digital, fol q. s. ad. §vi 
M. Sig. One tablespoonful every three hours. 
SYCOSIS. 
In obstinate cases the patient's general condition 
should be improved by hygienic and tonic treat- 
ment. Bitter tonics may be given to tone up im- 
paired digestion, and cod liver oil to overcome the 
389 debility which may be at the root of the disease. 
Laxatives and alkaline diuretics may help to 
lessen the acute hypersemia which is often present. 
In acute cases a soothing application such as a 
saturated solution of boric acid should be applied 
to the affected area and then an application of oxide 
of zinc ointment. 
In chronic cases the crusts should be softened 
with oil and removed. The hair should be closely 
cut or preferably, shaved. The pustules should 
be punctured and loose hairs epilated daily, in order 
to preserve the follicles. One of the following 
applications may be prescribed: 
Resorcinolis 3i 
Glycerini 5ii 
Ungt. aquae rosseq. s. ad. oii 
M. Sig. Apply several times a day. 
Or: 
1$. Sulph. precipitat grs. xxx 
Ichthyol 3 i 
Petrolat 3iv 
Lanolin 3iv 
01. rosse m. ii 
M. Sig. Apply at night and several times during 
the day if possible. 
Or: 
I|. Ichthyol m. xl 
Chrysarobin grs. xl 
Acid, salicylic grs. xv 
Vaselin 3vi 
Lanolin 3vi 
M. Sig. Rub in well, and cover part with thin 
layer of gutta-percha tissue. 
SYNCOPE (See Fainting). 
SYNOVITIS. 
In acute synovitis absolute rest should be secured 
for the joint by means of splints, sand-bags, etc. 
A sense of relief is gotten from the application of 
390 cold by means of a poultice of ice and sawdust, by 
the ice-bag, or by the rubber coil wound round the 
limb In other cases hot water bags or poultices or 
fomentations of laudanum and hot water may 
give relief. Or the following may be prescribed: 
3. Liq. plumbi subacetat gii 
Tinct. opii gii 
Aquae bullientisq. s. ad. gxxxii 
M. Sig. Apply upon soft cloths saturated with solu- 
tion, and place joint at rest. 
To promote absorption produce free saline purgation 
by sulphate of magnesia, followed by a diaphoretic 
containing grain of tartar emetic at short intervals, 
or give: 
I|. Magnesii sulphatis §ii 
Antimonii et potass, tart grs. ii 
Tinct. aconiti m. v 
Syr. aurantii 5 i 
Aquae menth. pipq. s. ad. §xvi 
M. Sig. Two tablespoonfuls to be taken every 
second hour. 
Local applications of tincture of iodine or compound 
ointment of potassium iodide may also be used to 
promote absorption, or the following may be given 
internally: 
I). Potass, iodidi 5iv 
Sodii salicylat 3iv 
Aquae menth. viridq. s. ad. §iii 
M. Sig. One teaspoonful in water after meals. 
The following local applications are useful in promot- 
ing absorption of fluid from the joint: 
1$. Ungt. potass, iodid 5iv 
Ichthyoli 3iv 
Adipis lanae hydrosi §i 
M. Sig. Apply freely on cloth. 
Or: 
1} Guiacolis 3ii 
Adipis lanae hydrosi 5 i 
391 M. Sig. Apply twice daily over affected area and 
cover with a rubber protective. 
In severe cases of acute synovitis the joint should be 
put to rest in a good position, so that if ankylosis 
should take place the limb may not be entirely useless. 
The elbow should be put up at a right angle, the knee 
very slightly flexed, the hip very slightly flexed on the 
trunk and neither adducted nor abducted, the ankle at 
a right angle, the wrist in the line of the arm, and the 
shoulder with the arm at the side. 
As soon as the heat and extreme tenderness of the 
early stage have disappeared, massage of the joint with 
gentle flexion and extension of the joint should be 
begun. 
Traumatic purulent synovitis, where a penetrating 
wound of the joint exists, requires the enlargement 
of the penetrating wound and a thorough flushing out 
of the joint with a stream of warm antiseptic solution, 
and the insertion of a drainage tube under a liberal 
supply of antiseptic dressing. 
When a distinct rheumatic element is present, large 
doses of salicylate of sodium should be given, and the 
joint treated with rest, compression and ice-bags. 
In gouty synovitis, colchicum may be prescribed, and 
a padding of absorbent wool placed round the joint 
which should then be enveloped in oiled silk. 
SYPHILIS. 
There are only two drugs which have curative 
properties in this disease, they are mercury and 
iodide of potassium. 
There is still a good deal of controversy as to 
when treatment should begin, as to the period of 
time it should be continued, as to whether the two 
drugs should be given together or apart, and as to 
the best method of administration. 
The treatment may be divided into: 1st-The 
treatment of the primary sore. 2d-The treatment 
392 of the secondary stage. 3d-The treatment of the 
tertiary stage. 
Treatment of the primary sore. Extirpation is 
fruitless. The sore should be kept clean by an 
antiseptic solution, as: 
1$. Hydrarg. bichlor. (1 to 4,000) ....<.. 3vi 
Sig. Bathe sore at least four times a day. 
After carefully washing and drying the sore apply 
the following powder: 
I|. Acidi borici. 
Hydrarg. chlor, mit. 
Bismuth subnitrat aa 3ii 
M. Sig. Apply three or four times a day. 
Internal treatment should not be started if the 
diagnosis is uncertain; we should rather wait for the 
appearance of the secondary symptoms, unless we can 
demonstrate the spirocheeta pallida in scrapings from 
the primary sore. 
Treatment of the secondary stage. 
Mercury is the specific in this stage. It may be given 
(a) by the mouth, (b) by inunction, (c) by hypodermic 
injection, (d) by baths, (e) by fumigation. 
When given by the mouth it should be as follows: 
I|. Pil. hydrarg. proto-iodid gr. J4 
No. c. 
Sig. Begin with one four times a day and gradually 
increase. 
The dosage should be increased until the physiologic 
limit is reached or until about 4 grains a day are taken. 
Calomel may be given in J4 grain doses three 
times a day. This is well borne by children. 
Any of the following preparations may be obtained 
in pill form. The minimum and maximum doses are 
added: 
Hydrarg. chlor, corros /s to j grain 
Hydrarg. iodid. rubr ?<j to f grain 
Hydrarg. iodid. vir | to 3 grains 
Hydrarg. oxidi A t° | grain 
393 During the first year push the mercurials. Give the 
patient two or three weeks' rest after the first six 
months' continuous treatment. During the second 
year push the mixed treatment. 
Inunction. When mercury is given by inunction 
it should be rubbed into those parts where the skin 
is soft, thin, and free from hair. It should be applied in 
a systematic manner as: 
1st night, calves of legs; 
2d night, both thighs, inner surface; 
3d night, abdomen; 
4th night, the back; 
5th night, the chest; 
6th night, forearms and arms. 
Blue ointment should be used (ungt. hydrarg.) and 
30, 40. 50, or 60 grains may be used at one rubbing at 
bedtime. The ointment should be prescribed thus: 
1$. Ungt. hydrarg giv 
Div. in dos. sequal. No. xxx Dent, ad chartam cerat. 
Sig. The contents of one paper to be rubbed in 
at bedtime. 
Each treatment should take up 20 to 30 minutes' 
time. A hot bath should be taken daily. If an at- 
tendant gives the inunction he should protect himself 
with rubber gloves. Not more than 30 inunctions 
should be given. Should ulceration, diarrhoea, or stom- 
atitis occur the inunctions must be stopped. 
The only objections to inunctions are the publicity 
and the dirtiness. The advantages are that they do not 
so readily cause digestive disturbances, they produce 
the promptest results, and are well borne by children. 
Hypodermic injections. These are not popular in 
general practice, but are very convenient in hospital 
work. Their action is prompt but they cause consider- 
able pain. They should be given once daily for about 
30 days: 
I}. Hydrarg. bichlor grs. xv 
Sodii chlorid grs. xxx 
Aquae destillat o iii 
394 - M. Sig. Inject 15 drops daily. (| grain of bichloride 
of mercury. 
Injections are best made in the buttocks. 
The intravenous injections of mercury are dangerous 
and should be condemned. 
Baths. These are of benefit in helping to control 
the skin lesions of syphilis. With proper internal 
treatment most skin lesions require little treatment. 
To a daily bath, two to three drachms of mercuric 
chloride may be added. 
If lesions are on the face give the following ointment: 
I}. Hydrarg. chlor, mit grs. xxx 
Lanolin 5 i 
M. Sig. Apply once daily. 
Fumigations. These are seldom used at the present 
day. They are made by placing the naked patient in a 
chair and covering him from the neck down, as well as 
the chair, with a blanket. An alcohol lamp is placed 
under the chair, a small dish containing 15 to 30 grains 
of calomel is placed over the lamp. The calomel dish 
should rest in another dish containing water. The 
patient is seated, the lamp is lighted, and the fumes 
of calomel begin to rise, together with watery vapor, 
and are deposited on the patient's skin where they are 
readily absorbed. The process of fumigation should 
last 15 minutes. It may be done once or twice a week. 
After the fumigation the patient is wrapped in the 
blanket and placed in bed. 
Mercury should not be pushed beyond the appear- 
ance of the following symptoms: swollen, spongy, 
bleeding, red gums, increased flow of saliva, metallic 
taste, and sore teeth. If these conditions arise they 
must be treated with mouth-washes, as: 
I|. Sat. sol. potass, chlorat 5viii 
Sig. Use as mouth-wash every three hours. 
Or: 
I|. Tinct. myrrh gii 
Liq. antiseptic. U. S. P 3iv 
395 M. Sig. One teaspoonful in one ounce of water as 
mouth-wash every two hours. 
It is very important for an individual who acquires 
syphilis to have his teeth filled and put in good order 
by a dentist. 
Mixed treatment. During the second year this form 
of treatment should be pushed. Mercury and iodide 
of potassium may be given together or alternately for 
several weeks at a time: 
1$. Hydrarg bichlor gr. i 
Potass, iodid §i 
Tinct. opii 3i 
Aquae 3i 
Syr. rub. idaei q. s. ad. giv 
M. Sig. One teaspoonful in water after each meal. 
If anaemia is present iron may be combined with the 
mercury and potassium iodide as: 
1$. Potass, iodid 5i 
Hydrarg. biniodidi grs. iii 
Syr. ferr. iodid §i 
Aquae 5 iss 
Syr. aurant. cortic q. s. ad. §iv 
M. Sig. One teaspoonful in water three times a day 
after meals. 
For a case of marked syphilitic anaemia with lassitude 
and dyspepsia: 
1$. Hydrarg. cum creta gr. iss 
Ferr. redact gr. i 
Quin, sulphat gr. ss 
Pepsini gr. iss 
Pulv. opii gr. | 
Extr. gentian gr. ss 
M. et ft. pil. No. i. 
Sig. One three times a day after meals. 
If it is desired to give iodide of potassium alone use: 
1$. Sat. sol. potass, iodid §ii 
Sig. 15 drops in water three times a day (one drop 
equals one grain). 
396 Tertiary stage. Iodide of potassium is a specific in 
this stage. Such conditions as gummata, nodes, ulcera- 
tions, etc., are promptly cured by it: 
3. Potass, iodid 3vi 
Aquae Biss 
Syr. sarsapar. coq. s. ad. §iii 
M. Sig. One teaspoonful in a glass of water three 
times a day. 
Diet in syphilis. Alcohol and tobacco should be 
avoided as much as possible. Fruit and green vegeta- 
bles should also be forbidden. The patient should have 
fresh air, good nutritious diet and a moderate amount 
of exercise. 
The treatment of syphilis at the various springs has 
no advantage over home treatment. 
Salvarsan, 606 or Arsphenamin can be used to good 
advantage, especially early in the progress of the 
disease. Its early use usually results in the clearing 
up of the primary lesions, and prevents the appearance 
of the symptoms of the secondary stage. It may be 
given intravenously, intermuscularly or subcutaneous- 
ly, but is usually injected into the radial artery. 
The technic of this injection requires considerable 
skill and must be given under strictly aseptic condi- 
tions. Reactions frequently occur and complications 
may follow the injection. The technic for using neo- 
salvarsan or neoarsphenamin is similar to arsphena- 
min, but this drug is more freely soluble than the 
other. Without special training the general practic- 
tioner can hardly expect to use either of these drugs 
successfully. 
SYPHILIS, PROPHYLAXIS OF. 
Personal. The practitioner treating syphilitic pat- 
ients should be specially guarded in handling specific 
lesions. He should wear rubber gloves. He should 
also warn his patient that the disease may be com- 
municated to others by kissing, by sleeping with 
them, by the use in common with them of eating 
utensils, pipes, clothing,tooth brushes, towels, etc. 
In giving advice to patients who have not contracted 
397 syphilis, but whose fleshly lusts often lead them to 
have intercourse with prostitutes, the importance of 
physical and mental hard work as an anaphrodisiac 
should be insisted on. Early marriage may be recom- 
mended in those cases where continence is impossible. 
Advice by physicians to patients to have sexual in- 
tercourse with private or nulicensed or non-inspected 
prostitutes is nothing short of criminal. Advice, such 
as Horace gives to have intercourse with a healthy 
woman (using, perhaps, a condom) is a moral rather 
than a medical question, but is probably unjustifiable. 
The present authors themselves differ on this point. 
To those who visit prostituted, temperance is espe- 
cially to be insisted on, for very many infections are 
acquired in a state of drunkenness when anti-vene- 
real precautions are neglected. The parts should be 
bathed after coitus, and antiseptics such as solution 
of bichlorid of mercury or protargol should be applied 
locally. Circumcision and the use of condoms lessen 
the chance of infection. 
Public. Clandestine prostitution should be pro- 
hibited by the police under severe penalties. Public 
prostitutes should be registered and compelled to 
live in special locations or "yoshiwaras." Each pros- 
titute should have a book in which her name, age, 
nationality, and address are recorded. She should 
be examined twice a week by a physician who should 
then sign her book if she is free from infectious 
disease. Any prostitute doing business when her 
book is not signed to date should be punished. No 
liquor should be allowed to be sold, given away, or 
drunk, in houses of prostitution. Each prostitute 
should be required to provide the means necessary 
for securing her own and her visitors' cleanliness. 
Cases of venereal disease should be at once reported 
to the health inspector. An ideal condition of things 
would be one in which the men visiting "yoshiwaras" 
could be medically inspected as well as the women. 
398 SYPHILIS, HEREDITARY. 
Treatment should be started as soon as the diag- 
nosis is made. 
Inunctions are well borne by children. Infants 
may have a drachm of blue ointment (ungt. hydrarg.) 
placed on their abdominal bandage; the child's 
movements gradually rub it in. For a child of two 
years, 30 grains may be rubbed in daily for about 
three weeks, then cease for one week and repeat as 
before. This should be continued for a year and then 
followed by mixed treatment. 
Calomel (hydrarg. chlor, mit.) is also well borne 
by children; it may be given in to | grain doses 
three or four times a day. 
If the father is syphilitic, treatment of the child 
should be begun in utero by treating the mother. 
Hydrarg. cum creta is also a very suitable prepa- 
ration for children in the dose of one to two grains 
three times a day. 
Prophylaxis. A person who has had syphilis 
should not marry in less than three years-preferably 
four or more-after the appearance of the initial 
sore; in any case a full year after the disappearance 
of the lesions should be insisted on. 
SYRINGOMELIA. 
The treatment is symptomatic and is of no avail 
in checking the progress of the disease. The patient 
should be warned of the danger of self-injury as 
the result of the peculiar anaesthesia. Prophylactic 
measures should be taken to prevent bed-sores, to 
avoid the over-use of atrophic muscles, to avoid 
exposure to injurious changes of temperature and 
especially to avoid bladder complications. 
If syphilis is suspected potassium iodide and mer- 
cury should be tried for a time. Mud baths and 
gentle massage sometimes help the contractures, 
and electricity may relieve pain or parasthesiae. 
Tonic and hygienic measures should be adopted 
399 and nourishing food should be given to maintain 
the patient's strength. 
TABES DORSALIS. (LOCOMOTOR ATAXIA.) 
The treatment is not so unsatisfactory as was 
previously supposed. These cases often come to a 
standstill by proper treatment. 
Alcohol, fatigue, sexual excesses, etc., should be 
avoided. 
Begin the treatment by giving mercury and 
potassium iodide for several months as directed 
under the treatment of Syphilis. 
The pain in the limbs is frequently very severe. 
It can be relieved by: 
I). Phenacetini 3ii 
Kryofini 3i 
M. et ft. chart. No. xii. 
Sig. One every three hours until relieved. 
Or: 
1$. Antipyrini 3ii 
Morph, sulphat grs. iii 
M. et ft. caps. No. xii. 
Sig. One only when absolutely necessary for pain. 
The frequency and severity of the pains are usually 
much less pronounced if the patient's diet and general 
habits are carefully regulated. The faradic current 
applied to the place of exit of the affected nerves often 
prevents and relieves the pain. 
What relieves one case does not always relieve 
another; one is benefited by applying the ice-bag to 
the seat of the pain, another by the hot water bag, 
and still another by anodyne liniments, as: 
I|. Chloral, hydrat. 
Camphorae. 
01. cajuput aa 3i 
Tinct. capsici 3iv 
Lin. ammonite q. s. ad. §iii 
M. Sig. Liniment. Use three times a day. 
Rest in bed at the beginning of treatment should 
400 be insisted upon, especially if pain is an early symptom, 
but the tone of the muscles should be kept up with 
massage and electricity. 
The patient's bowels and urinary apparatus should 
be carefully looked after. If retention takes place 
the patient must be taught how to pass a catheter 
under antiseptic precautions. Infection of the bladder 
may sometimes be prevented by the administration 
of Hexamethylenamina (urotropin) in five grain doses 
three times a day. If the bladder does become in- 
fected, then it must be washed out daily with a quart 
of boric acid solution. 
Electricity in this disease is not of much benefit, 
but tepid baths (80° F. to 90° F.) combined with 
massage give good results. 
The various painful crises which frequently occur 
in this disease are best controlled by hypodermic 
injections of morphine (J4 grain) every four hours, if 
necessary. In an attack of gastric crisis all food and 
liquids should be withheld from the stomach until 
morphine has controlled the vomiting. 
Perhaps the only drug that is of value in all cases is 
strychnine. It should be given in grain doses 
every three hours and kept up for several months at 
a time. Strychnine also in some cases increases the 
diminished sexual powers. 
Diplopia (double-vision) is a troublesome symptom 
in some cases for which nothing can be done. If 
slight it may be relieved by the use of glasses. 
Laryngeal crises often respond to a hypodermic 
injection of nitroglycerin ( grain). Repeat if nec- 
essary in two or three hours. 
In recent years a great deal has been done for the 
ataxia. Bed-ridden cases have been made to walk 
by what is known as Fraenkel's systematic exercises. 
The aim of this system of treatment is to re-educate 
the central nervous system by repeated and carefully 
planned muscular movements. 
401 TAPE-WORM. 
Prophylaxis. All meat or fish should be thor- 
oughly cooked before being used as food, drinking 
water boiled, and feces cremated which may con- 
tain segments or ova, lest they may be eaten by hogs 
or cattle. Cold storage destroys cysticerci in about 
a month. 
Treatment. Food should be withheld for at least 
twelve hours. It is best to begin treatment in the 
evening by a light supper and by giving the following 
at 8, 9, and 10 o'clock: 
Hydrarg. chlor, mit grs. iii 
Sacchar. lact grs. vi 
Extr. colocynth grs. iii 
M. et ft. chart. No. iii. 
Sig. One at intervals of one hour. 
The next morning on rising give: 
I|. Oleo-resin. felic. maris 3ii 
Chloroform gtts. v 
01. ricin q. s. ad. 3ss 
M. Sig. One dose. 
Or give the following, especially for children: 
1$. Pep. sem. (pumpkin seeds) §ii 
M. et ft. emuls. 
Sig. One dose on rising. 
This is a very effective remedy and is not poisonous. 
It may be repeated each morning until successful. 
After either of the above prescriptions has been 
taken, an active purge should be given three-quarters 
of an hour later, such as: 
I|. Tinct. jalap, co §i 
Sig. To be taken in one dose. 
A high rectal saline enema should end the treatment. 
If the head has not come away, segments of the worm 
will again appear in about six weeks. 
TETANUS. (TRISMUS, LOCKJAW.) 
Preventive treatment. Thorough antisepsis ap- 
plied to the wounds which must be cleansed and 
402 cauterized. Remove bits of wadding, gunpowder, 
and other particles, lay open the wound and cauter- 
ize with pure carbolic acid. Neutralize any toxin 
already absorbed by an injection of at least 5,000 
units of antitoxin. Then place patient in a dark- 
ened room with floors heavily carpeted, removed 
from irritant influences, stuff his ears with cotton 
and allow him to receive no visitors. 
Treatment should be instituted on appearance of 
the symptoms. Subdue the convulsions by the free 
administration of chloral and the bromides, and 
the hypodermic injection of morphine and hyoscya- 
mine in large quantities. 
To control the spasms and to permit of feeding 
by the stomach tube, two or three times a day 
chloroform by inhalation should be used. 
The intraspinal injection of a 25 per cent solution 
of magnesium sulphate has recently proved very 
successful. 
To relax spasm physostigmine may be given 
hypodermically: 
1$. Physostigminae salicylatis gr. 
Aquae m. c 
M. Sig. (Each ten minims represents fJa grain of 
physostigmine.) Ten drops hypodermically and repeat 
at intervals of one, two, or three hours until manifesta- 
tion of full physiological effect. 
To eliminate the poison give: 
3. Pilocarpinae hydrochlor gr. i 
Aquae 5i 
M. Sig. Ten drops hypodermically, repeated at 
intervals of' twenty minutes until profuse sweating, or 
until three doses have been administered. 
The Bacelli or carbolic acid treatment consists in 
the hypodermic injection of a 2 per cent solution of 
carbolic acid: 
I|. Phenolis 3ii 
Aquae destillat 5xii 
403 M. Sig. Inject hypodermically with a suitable syringe 
from 100 to 150 minims of the solution (two to three 
grains of carbolic acid) every two or three hours until 
improvement is noted, then reduce the dose. 
As much as six or eight grains of carbolic acid per 
diem may be given. Persons suffering from tetanus 
apparently bear well large doses of carbolic acid. 
THREAD-WORMS. (SEAT OR PIN WORMS, OXYURIS 
VERMICULARIS.) 
These parasites are most common in children. 
The drugs used are: quassia, saline solution, carbolic 
acid, lime water, iron, tannic acid, catechu and kino. 
Quassia is the best. It is non-irritating and non- 
poisonous. Give a rectal injection of one ounce of 
the fluid extract added to a pint of water. It is 
necessary before injecting to give the patient's 
bowel a thorough cleansing with hot water and soap. 
The injection should be retained about 15 minutes, 
and should go up into the colon. It is necessary to 
repeat the treatment several times with one or two 
days' interval. 
Internally give: 
I}. Hydrarg. chlor, mit grs. xii 
Sacchar. lactis grs. xii 
Santonin grs. xii 
M. et ft. chart. No. xii. 
Sig. One powder repeated every hour for several 
hours. 
TINEA BARBAE. (BARBER'S ITCH, TINEA SYCOSIS.) 
The first step in the treatment is the complete 
removal of the hair in the affected area. Each day 
a square inch or so should be cleared of hair. This 
is an easy matter because the hairs are already loose 
Then apply the following: 
fy. Sulphur. 3i 
Ac. carbolici 3ss 
Lanolin cum oleo 5i 
M. Sig. Rub in thoroughly twice a day. 
404 Or: 
1$. Naphthol grs. xxx 
Sapon. mollis. 
Cret. preparat. 
Sulphur, loti. 
Lanolin aa 5iii 
M. Sig. Rub thoroughly into face at bedtime. 
When the patches are inflamed and covered with 
crusts, the latter should be softened by rubbing with 
a 5% salicylated oil. 
Do not give up treatment too soon. 
Prophylaxis. The disease is transmitted not by 
the barber's razor but by his brush. All articles used 
by barbers ought to be sterilized after each customer. 
TINEA FAVOSA (See Favus). 
TOBACCO POISONING, CHRONIC. 
Prevention. The use of tobacco should be inter- 
dicted in the case of children, women, athletes, 
convalescents from acute diseases, ansemics, dyspep- 
tics, and persons with heart affections. The com- 
bination of the alcohol with the tobacco habit is 
of special danger. 
In smoking the smoke should not be inhaled. 
Pipes should have long stems and should be kept 
well cleaned. Do not smoke cigars too close to 
the end, and avoid chewing the end. It is best to 
smoke only after meals; this avoids contact of the 
tobacco juice with the mucous wall of the stomach. 
Treatment. Patient should give up the smoking 
entirely; there is no necessity of a gradual with- 
drawal as in the cases of the alcohol or morphine 
habit. The food of the patient should be abundant 
and easily digested, while fresh air and general 
tonics are of the greatest service. 
Strychnine in full doses is of value and also iodide 
of potassium when amblyopia is present. For the 
cardiac troubles and tobacco angina, rest, inhalations 
405 of amyl nitrite, nitroglycerin, digitalis, and other 
cardiac stimulants are to be recommended. 
TONGUE, INFLAMMATION OF (See Glossitis). 
TONSILLITIS, ACUTE. (QUINSY.) 
The treatment is internal and local. 
Internal treatment. The patient must be put 
to bed. It is very important that the bowels act 
freely, therefore give a purgative, preferably a saline, 
e. g., a tablespoonful of Epsom or Rochelle salts, or 
a bottle of citrate of magnesia. 
For the fever and restlessness at the beginning 
give tincture of aconite in half minim doses every 15 
minutes for 6 or 8 doses; it may be combined with 
half drop doses of tincture of belladonna. 
Now place the patient on: 
1$. Saloli 3i 
Antipyrini 3i 
Pulv. Doveri . .grs. xxiv 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
Or: 
1$. Quinin. sulphat 3iss 
Pulv. Doveri 3i 
M. et ft. caps. No. xviii. 
Sig. One every three hours. 
Frequently tonsillitis is a forerunner of acute rheu- 
matism; in these cases give: 
I}. Sodii salicylat 3iss 
Sodii bicarb 3iss 
M. et ft. chart. No. xviii. 
Sig. One every three hours in hot water. 
Iron is indicated in all forms of tonsillitis: 
Tinct. ferri chlorid 3iv 
Glycerini giss 
Syr. simplic q. s. ad. §iii 
M. Sig. One teaspoonful in Seltzer or Vichy water 
every three hours. 
406 When convalescence sets in give tonics as: 
1$. Tinct. nuc. vomic 3iv 
Acid, sulphuric, aromat 3iv 
Elix. gentian, glycer. N. F.. .q. s. ad. giii 
M. Sig. One teaspoonful in water before each meal. 
Local treatment. In the beginning of the attack 
towels wrung out of cold water and covered with oiled 
silk are very soothing. If there is an over-secretion 
of saliva, unguentum belladonnae rubbed on the neck 
externally is of service. 
When the case goes on to suppuration, hot linseed 
poultices continuously applied for hours do a con- 
siderable amount of good. Frequent inhalations of 
steam give great relief. The patient should sit with 
a basin of hot water on his knee and then a sheet should 
be placed over his head. 
For the dryness in the post-nasal space the fol- 
lowing may be sprayed through the nares every three 
hours: 
I). Cocain. hydrochlorgrs. iv 
Glycerini 3ii 
Acid, carbolic 3ss 
Aquae rosaeq. s. ad. §vi 
M. Sig. Spray through the nose every two hours. 
Dilute with an equal quantity of water. 
Or: 
1$. Acidi borici 5ss 
Acid, carbolic 5ss 
Infus. rosae § vi 
M. Sig. Spray throat every two hours. 
The carbolic acid in the above mixture paralyzes 
the palatal muscles and prevents the difficult attempts 
at swallowing mucus or saliva. 
When there is much fetor give the following gargle: 
Potass, permanganatgrs. vi 
Infus. rosae §iv 
M. Sig. Use as spray or gargle every two hours. 
If suppuration occurs, incise the tonsil freely and 
407 allow the pus to escape. Cut from above downwards 
with a protected knife. Do not scarify the surface of 
the tonsil but cut into it if pus is present. 
When attacks of tonsillitis recur frequently it is 
best to remove the tonsils. 
TONSILLITIS, CHRONIC. 
This may or may not be associated with hyper- 
trophy. The crypts contain white or yellowish cheesy 
masses which frequently give a foul odor to the breath. 
These crypts cause inflammation, irritation and fre- 
quently abscess. 
Open each crypt freely by means of a sharp knife, 
cutting from top to bottom. Then paint the ton- 
sil with tincture of iodine. This simple procedure 
usually gives immediate relief. 
TONSILS, HYPERTROPHY OF. 
General and local treatment may be tried for 
several months. General treatment consists in giv- 
ing fresh air, proper diet, tonics such as iron and 
cod liver oil and local applications. Every morning 
the neck should be sponged with cold, salt water and 
then the tonsils should be vigorously rubbed. Give 
internally syrup of the iodide of iron in 10 to 30 
drop doses three times a day. 
The tonsils should be painted with: 
]$. Tinct. iodini. 
Glyceriniaa 3iv 
M. Sig. Paint tonsils once a day. 
If reduction in size does not follow then remove 
them with the tonsillotome or with the scalpel and 
dissecting forceps. 
The haemorrhage following this operation is usually 
slight, but if it should be considerable, apply a piece 
of ice to the bleeding surface with a pair of forceps, 
or make pressure with gauze soaked in adrenalin solu- 
tion. 
408 TOOTHACHE. 
Determine which tooth is giving the trouble. Do 
not rely on the testimony of the patient, but examine 
all suspected teeth with a mouth mirror and an 
exploratory point. Cleanse out the cavity when 
found with a syringeful of warm water to remove 
irritating particles of food, then apply warm oil 
of cloves on cotton wool to the cavity. Strong 
carbolic acid or creosote may also be applied to the 
tooth with great care so as not to injure the skin or 
mucous membrane. If there is no cavity the gum 
may be rubbed with ammonium chloride, tincture 
of opium, cocaine lotion, camphor and chloral hydrate 
or chloroform. In rubbing the gum with chloroform 
great care should be taken to keep it away from the 
angle of the mouth and the lips. Hot fomentations 
to the inside of the mouth also help to relieve the 
pain. 
If the gums are inflamed the following may be 
given: 
I|. Cocaine hydrochlor grs. ii 
Chloroformm. xv 
Glycerin 3vi 
01. rosse m. vi 
M. Sig. Apply small quantity to painful gums. 
For an exposed nerve the following may be given: 
I). Extr. opii grs. xv 
Pulv. camphorse grs. x 
Balsam peruv grs. xx 
Mastic grs. xxx 
Chloroform 3v 
M. Sig. Cleanse out cavity, and insert absorbent 
cotton saturated in this solution. 
In some cases it may be necessary to extract the 
tooth. The following may be given for the post- 
extraction pain: 
409 I}. Chloroform 3i 
Ether m. Ixxx 
Cocain hydrochlor grs. ii 
Camphor grs. xxx 
Tinct. opii m. xxx 
M. Sig. Saturate pledget of absorbent cotton and 
press into cavity. 
In other cases it may be advisable to fill the cavity 
with some poor conductor of heat such as gutta percha 
or oxyphosphate cement. 
TORTICOLLIS. (WRY-NECK.) 
Examine carefully the ears, eyes, throat, teeth 
and spinal column for peripheral irritation; observe 
the condition of the th roigd land. Treat any cause 
when found. 
If congenital torticollis is discovered in early 
infancy it may be overcome by massage and stretch- 
ing. The child's arm is held firmly by one person 
and his head is drawn in the opposite direction by 
another person while the contracted muscles are 
massaged vigorously. This treatment should last 
ten minutes and should be carried out twice daily. 
In acquired torticollis the general health of the 
patient should receive attention. Massage and 
systematic exercise of the affected muscles are of 
great service. The neck may be wrapped in a heavy 
collar of cotton reaching from shoulder to ears. It 
should be so thick as to support the head and held 
in position by circular bandages. 
If the torticollis is rheumatic in character, the 
following may be given: 
1$. Antipyrinigrs. Ixxx 
Sodii salicylat 3ii 
Syr. aurantii 3iv 
Aquae ad 3 ii 
M. Sig. One teaspoonful every three hours till 
relieved. 
And as a liniment: 
410 ]$. Menthol. grs. x 
Oleoresin. capsici grs. iv 
Methyl salicylat 3i 
Ichthyol 5i 
Petrolat 5v 
Lanolin 3 x 
M. Sig. Anoint the painful muscles freely three 
times daily. 
In spasmodic torticollis the following may be given 
internally: 
3. Strych. sulphat gr. M 
Quinin. sulph grs. xx 
Extr. conii grs. vii 
Extr. belladonnas grs. ii 
M. ft. pil. No. xv. 
Sig. One after meals. 
TRACHEOTOMY. 
This operatfon with its variants, thyrotomy, crico- 
tomy, laryngotomy, laryngo-tracheotomy, and crico- 
tracheotomy are indicated in any affection, laryngeal 
or supra-laryngeal, which is threatening asphyxia. 
These conditions may be inflammatory, traumatic, 
neoplasms or neuroses. 
In such an inflammatory condition as diphtheria 
the operation is indicated when the heart is weak 
or when there is great asphyxia, much secretion' or 
gangrenous, diffuse or septic infiltration of the lungs. 
Of all operations for the relief of asphyxia crico- 
tracheotomy is the easiest. In young children the 
softness and elasticity of the cricoid make its inci- 
sion easy and the parts may easily be separated so 
as to admit of the introduction of a cannula. The 
cricoid cartilage is, besides, in young children, the 
most prominent and easily identified structure of 
the air tube. 
TRACHOMA. 
The treatment of this malady must be long con- 
tinued to produce satisfactory results. 
411 In the beginning of the attack when there is con- 
siderable photophobia and lachrymation, the eye- 
lids should be washed out four times a day with a 
saturated solution of boric acid or a 10 per cent 
solution of protargol twice a day. 
As soon as the irritation abates a 2 to 4 per cent 
solution of nitrate of silver should be painted on the 
lids with a camel's hair brush once a day. The excess 
should be washed off with a salt solution. A drop or 
or two of a 4 per cent solution of cocaine should be 
put into the eye before painting it with the silver 
nitrate. 
When the disease has reached the chronic stage, the 
lids should be rubbed with pure sulphate of copper, or 
a 20 to 40 per cent solution of protargol applied. 
The trachoma follicles should be expressed by 
the use of the roller forceps. The eye must first 
be cocainized. 
An infusion of jequirity of the strength of 2 
per cent is used in cases of trachoma to produce 
an inflammation to replace the pre-existing inflam- 
mation. This mode of treatment is very successful. 
Twenty-four hours should elapse between the appli- 
cations of the infusion. This should be kept up 
for three or four days or longer. The severe in- 
flammation which follows soon subsides and the 
corneal opacity in a small percentage of cases creeps 
up and destroys the trachoma infection. 
Relapses frequently occur after all forms of treat- 
ment. 
If the patient is anaemic give iron, arsenic, and 
cod liver oil: 
1$. Ferri reduct 3i 
Strych. sulphat gr. % 
Zin ci phosphid gr. iss 
Ac. arsenics gr. 24 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
412 TREATMENT OF DISEASE, CLIMATIC. 
First. Coast climates. The West Indian islands 
have a uniform high temperature varying between 68° 
F. and 83° F. Their action is sedative and relaxing. 
The Isle of Pines, south of Cuba, has a sandy soil and 
is famous for its pines, and has a reputation among 
Spaniards for its value in pulmonary tuberculosis. 
Emphysema with chronic pulmonary catarrh, and 
some cases of pulmonary tuberculosis, are said to 
do well at Jamaica and Barbados, but there is 
always the danger of failure of the digestive system 
with loss of appetite and chronic diarrhoea. Bermuda 
in late winter and early spring is suitable for con- 
valescents from acute illness and in cases of bron- 
chitis and insomnia. It is too damp for tuberculosis. 
The climate of Florida and that of the adjacent 
coasts of Georgia and South Carolina is useful during 
the winter for delicate persons suffering from em- 
physema, chronic bronchial catarrh, and early phthisis. 
These states, however, should be avoided during July, 
August and September when fevers are prevalent. 
The western part of Southern California has a 
warm and dry climate with a large proportion of sun- 
shine and a small rainfall. There is a considerable 
daily range of temperature, the prevalent westerly 
wind causing a fall of temperature in the afternoon. 
The damp, chilling sea-fogs rolling in from the Pacific 
are a drawback. The chief health resorts are: Los 
Angeles, with a mean annual temperature of 61° F., 
and Pasadena and Redlands at a higher elevation 
among the foothills; San Diego with a temperature of 
54° F. in January and 69° F. in August; Santa Barbara 
with a temperature of 50° to 55° F. in winter and 65° to 
70° F. in summer. Monterey, further north, is more 
exposed to fogs from the Pacific. The climate of 
the Pacific coast has an exciting effect on the nervous 
system. Sleeplessness is a common complaint on first 
reaching the coast, but in most cases this soon passes 
413 off. Neuralgia is often aggravated, and any hyster- 
ical or melancholic tendency is frequently made worse. 
Most persons, however, feel invigorated both in mind 
and body. The Californian climate, as it allows 
patients to spend a large portion of their time out of 
doors, is also suited to the treatment of tuberculosis, 
but adequate sanitoria for this disease are singularly 
lacking both in California and Colorado. 
Second. Elevated or mountain climates. In high 
altitudes the patient usually at first experiences dif- 
ficulty in breathing; any exertion causes him to pant; 
frequently he cannot sleep; sometimes he has headache 
he may have great thirst and his throat may be dry; 
his bowels may be constipated and he has generally a 
listless feeling. The respirations are quicker and the 
pulse accelerated, while the amount of carbonic acid and 
water given off by the lungs is increased. Acclimati- 
zation may take place in from three days to a month, 
and then the respiration will be fuller and deeper than 
on the plain, the bowels become regular, and sleep- 
lessness gone, and the appetite improved. The air 
cells of the lungs are better flushed out and the resist- 
ance of the lung tissue to micro-organisms is increased. 
The cold at these high altitudes produces a more rapid 
interchange in the tissues, and in consequence of this 
greater activity the tissues acquire an increased resist- 
ance to the action of micro-organisms. An increased 
resistance may also be brought about by the large 
amount of time spent in the open air, the tonic action 
of the dry, cold air, the purity of the atmosphere, and 
the large amount of sunlight. 
The elevated resorts of the Rocky Mountains are 
situated in the State of Colorado, on the eastern slopes 
of the chain as it traverses that territory, at altitudes 
of from 5,000 to 7,000 ft. The chief resorts are:- 
Denver (5,000 ft.), with a mean annual temperature 
of 50° F. and a rainfall of 14 inches. The mean tem- 
perature of January is 27.2° F. and of August 72.8° F' 
414 Colorado Springs (6,022 ft.), with a mean temperature 
of 46.4° F. Glenwood (5,000 ft.), on the Pacific slope( 
has a damper climate than that on the other slope. 
Hotel accommodation is excellent. 
Third. Forest and woodland climates at a moder- 
ate elevation of 500 to 2,000 ft. These climates have 
the advantage of purity of the air, absence of dust, 
shelter from wind and fragrance of the atmosphere 
from the woods which consist of fir, pine, white cedar, 
tamarack, red spruce and balsam. The plateau of 
the Adirondacks, an extensive forest and lake region, 
contains the following health resorts: Saranac Lake 
(1,535 ft.), with the Adirondack Cottage Sanitarium 
founded by Dr. Trudeau for tuberculosis patients of 
moderate means. Paul Smith's station, with the 
Sanitarium Gabriels. Lake Placid (1,863 ft.), Tupper 
Lake (1,546 ft.), Keene (1,000 ft.), Elizabeth Town 
(759 ft.), Old Forge (1,684 ft.), Fulton Chain (1,700 
ft.), Saranac Inn (1,530 ft.), North Elba (1,685 ft.), 
Chazy Lake (1,500 ft.), Blue Mountain Lake (1,800 
ft.), Schroon Lake (806 ft.) 
The climate of these resorts is suitable for the early 
stages of tuberculosis. It is also useful for the arrest 
or amelioration of advanced cases of tuberculosis. It 
is also beneficial in cases of chronic bronchitis, asthma 
and hay fever. It is not suited for cases of rheuma- 
tism or renal disease or for patient beyond middle life. 
Fourth. Desert climates. These are characterized 
by purity and dryness of the air, with a maximum 
of sunshine and heat. New Mexico has been sum- 
marized in the sentence "Sun, Silence and Adobe.'' 
The adobe soil does not readily absorb moisture, and 
when baked in the sun gives rise to a very fine dust. 
Dust and sand storms are therefore frequent, and 
constitute one of the disagreeable features of desert 
climates. These climates are well adapted for chronic 
cases of tuberculosis and are also beneficial in cases 
which progress slowly. 
415 The chief health resorts in New Mexico are Raton, 
a small town at an altitude of 6,600 ft. It faces south 
and east, with the Raton range of mountains behind 
it, and has several small hotels and boarding houses 
at moderate rates (25 to 30 dollars per month). Las 
Vegas, at an elevation of 6,384 ft., with a handsome 
hotel. There is also a sanitarium in charge of Sisters 
of Charity. Las Vegas Hot Springs, at an altitude of 
7,000 ft. and at a distance of seven miles from Las 
Vegas. It has an excellent winter climate, warm and 
dry, and good accommodation can be had at the Mon- 
tezuma hotel. There are some excellent mud baths 
which are of service in rheumatism. Santa Fe has a 
fair hotel and a good sanitarium in charge of Sisters of 
Charity. Other resorts with good hotels are: Albu- 
querque (5,000 ft.), Deming (4,300 ft.), and Silver 
City. Fort Bayard (6,040 ft.), nine miles to the 
north of Silver City, has been converted into a govern- 
ment hospital for the treatment of pulmonary tuber- 
culosis, and the results obtained so far are very en- 
couraging. Las Cruces (3,872 ft.) has an excellent 
ranch, "The Alameda, " which can accommodate forty 
guests at from ten to fifteen dollars per week. 
Arizona has also many health resorts. The plain 
country of that state has been aptly called the "Egypt 
of America." The chief resorts are: Yuma (eleva- 
tion 140 ft.), with a dry and warm winter climate but 
with a terribly hot summer. Phoenix (1,100 ft.), with 
good hotel accommodation. Tombstone (2,300 ft.), 
Tucson (2,400 ft.), Castle Creek Hot Springs (2,300 
ft.), Oracle (4,500 ft.), and Prescott (5,300 ft.) All 
of these resorts have a good winter climate, and a 
higher or lower locality may be chosen according as 
a more or less bracing climate is desired. 
TRICUSPID VALVE, DISEASE OF (See Endocardi- 
tis, Chronic). 
TRICHINOSIS. (TRICHINELLIASIS.) 
Prophylaxis. Pork, ham, sausages and similar 
416 preparations should be thoroughly cooked before 
being brought on the table. In countries where 
these are consumed uncooked, a regular service of 
official experts should conduct the systematic exam- 
ination of all carcasses with the microscope. 
Pig-sties ought to be kept clean and free from rats 
and the pigs ought not to be fed on uncooked offal. 
Treatment. A quick-acting emetic should be 
given after the ingestion of trichinous food, followed 
up by a smart purge such as calomel up to 20 grains. 
After the migration of the parasites, relieve the pain 
by opiates, hot baths, and warm embrocations. 
Maintain the strength of the patient by concentrated 
liquid diet and treat special symptoms as they arise. 
TRISMUS (See Tetanus). 
TRISMUS NEONATORUM. (TETANUS OF THE NEW- 
BORN.) 
Prophylaxis. In the dressing of the cord and in 
the treatment of denuded surfaces the strictest aseptic 
precautions should be observed, as the umbilicus is 
the usual point of entrance of the tetanus bacillus. 
Treatment. Give remedies to lessen the irrita- 
bility of the nervous centers, e. g.: 
I). Atropinae sulphat gr. 
Chlorali hydrati grs. x 
Mucilaginis amyli 3x 
M. Sig. Two teaspoonfuls by rectal injection until 
spasm is relieved. 
Or: 
I|. Coninae hydrobromidi gr. iV 
Aquae destillat 5ii 
M. Sig. Two to four minims hypodermically and 
repeat frequently to relax spasm. 
Or: 
I|. Chlorali hydrati grs. xvi 
Potass, bromidigrs. xvi 
Mucilagin. acaciae 3iv 
Aquaeq. s. ad. oii 
417 M. Sig. One teaspoonful in a little water every 
hour until spasm is relieved. 
All unnecessary handling should be avoided and 
everything done to prevent disturbing the child. If 
the jaws cannot be forced apart it may be necessary to 
feed the child and give stimulants by the nasal tube. 
TUBERCULOSIS, ACUTE MILIARY. (GALLOPING 
CONSUMPTION.) 
Treatment is of no avail. It is rare for recovery 
to take place. Death occurs in from 6 to 21 days. 
All that can be done is to treat symptoms as they 
arise. When the fever runs high, use systematic 
cold sponging and the ice-bag to the head. Stimu- 
lants are always indicated on account of the extreme 
prostration. Give brandy, ammonia, caffeine, and 
strychnine: 
1$. Spt. nitroglycerin 1% m. xxv 
Strych. sulphat gr. % 
Tinct. digital 3iv 
Spt. vin. gallq. s. ad. §iii 
M. Sig. One teaspoonful hypodermically or by 
mouth every three hours. 
TUBERCULOSIS OF LUNGS. (CONSUMPTION, 
PHTHISIS.) 
The treatment of this disease has been entirely 
changed within the last five years. The physician 
instead of filling the patient with nauseous drugs, 
now depends on "outdoor" treatment and "forced 
feeding." 
If the diagnosis is made early, and proper treat- 
ment instituted most cases of tuberculosis get well. 
There is but little to be done after the patient has 
reached the third stage. 
"Outdoor" treatment. This is the most important 
method of treatment and the one which has given 
418 the best results. The patient should have pure air 
and plenty of it. To give ideal results this line of 
treatment should be carried out at home by those 
who are in ordinary good circumstances. 
The patient should have a large, well-ventilated 
room exposed to the sunlight. The windows should 
remain open day and night, so that there is a con- 
tinuous circulation of pure air. The patient should 
be out of doors most of the day in warm or cold 
weather but should stay indoors during wet and 
stormy weather. He may recline in a chair or drive 
or take short walks. Fatigue should never be 
produced. Some light employment is preferable to 
doing nothing, so that the mind is engaged. The 
patient should not visit churches, lecture halls, 
theaters, railway cars, etc., because the air is impure 
in all crow'ded places. 
Sanitarium treatment has given good results but 
it has its disadvantages. The patient continually 
sees others who are suffering from the same disease, 
life becomes monotonous, and last, but not least, he 
gets homesick. 
The laborer who has to provide for himself and 
family, who cannot afford to go to a sanitarium or 
to the country may continue at his work but it 
must be outdoor work. He must look after him- 
self carefully, keep his feet dry and warm, and avoid 
exposure to wet and cold. Those who work in shops 
and factories must change their occupation. 
Diet. It is necessary to give the most nourish- 
ing food in quantities as much as the stomach will 
take care of. 
The following articles of diet should be forbidden: 
veal, pork, salt meat, recooked foods and pickles. 
The following are allowed: soups, broths, meat 
essences and juices, raw eggs, oysters, fish, poultry, 
game, scraped, pounded or minced meat, fresh 
vegetables, clean ripe fruit, butter, milk, kumiss, 
419 cream, tea, coffee, cocoa, chocolate, alkaline mineral 
waters, beer, wine and spirits in moderation, and 
malt extract. 
All food should be of the best quality, appetiz- 
ingly cooked and served, and of the greatest variety 
possible. 
On waking give hot milk with a little sodium 
citrate and gradually increase the milk in quantity 
till 12 ounces are taken. 
Give a substantial breakfast an hour later, pref- 
erably in bed, before dressing. 
An hour and a half after breakfast give a raw 
egg beaten up with a little milk, raw meat or 
beef juice. 
At noon give a substantial meal with beer or 
red wine. 
An hour and a half after this give milk, raw eggs 
or raw meat. 
In the afternoon give tea and milk with raw eggs 
or raw meat and plenty of bread and butter. 
At 7 p. M. give a substantial meal. 
At bedtime give milk with a raw egg beaten in it. 
Medicinal treatment. This must not be neglected 
even if it is not the most important part of the 
treatment. 
Drugs to increase the appetite such as bitter 
tonics are extremely useful: 
I). Tinct. nuc. vomic 3iv 
Tinct. gentian 3ii 
Tinct. quassise 3ii 
Tinct. cardamom 3 iff 
Ess. pepsin q. s. ad. §iii 
M. Sig. One teaspoonful in a wineglass of water 
before each meal. 
Other tonics such as iron, arsenic, strychnine and 
hypophosphites should be given: 
I|. Elix. ferr. quin, et strych 5vi 
Sig. One teaspoonful in water after each meal. 
420 Or: 
I). Syr. hypo phosph, co §vi 
Sig. One tablespoonful after each meal. 
Or: 
T|. Strych. sulphat gr. % 
Acid, arseniosi gr. *4 
Manganes. dioxid grs. xii 
Ferrous carb, mass 3ii 
Extr. gentian grs. vi 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
Cod liver oil has been given for decades and is prob- 
ably more popular than useful in this disease. Pure 
cream is of more value and is more palatable. A 
pint of cream may be taken daily in divided doses. 
Cod liver oil may be given in the advanced stages of 
the disease as a food. 
Guiacol carbonate may be given in 5 grain capsules 
three times a day as routine treatment against the 
tuberculous process. 
Creosote has recently been discarded on account 
of its irritating action on the stomach, but frequently 
when the cough is dry and irritating and does not 
respond to other treatment, it is of much value. It 
should be given in capsules after each meal with a 
little olive oil: 
I). Creosoti m. xxiv 
01. olivee 3iss 
M. et ft. caps. No. xxiv. 
Sig. One after each meal. 
The irritating cough which comes on usually after 
meals is frequently due to particles of food lodging in 
the pharynx and may be relieved by gargling with 
hot water or with hot water and an antiseptic added. 
Cough can frequently be controlled by the patient's 
will. He should practice restraint. If it becomes 
necessary to prescribe for the cough, then heroin or 
codein may be given: 
421 I). Codein. phosphat grs. iv 
Syr. lactucar 5iv 
Syr. tolutan gi 
Syr. prun. virg q. s. ad. 3iii 
M. Sig. One teaspoonful every three hours. 
Or: 
I|. Heroini grs. ii 
Tereben 3ii 
Spt. chloroform 3iv 
Ac. hydrocyan, dil m. xxiv 
Syr. acac q. s. ad. §iii 
M. Sig. One teaspoonful every three hours. 
Night sweats are very weakening and difficult to 
control. The patient should not cover too heavily 
and the atmosphere of the room should not be too 
warm. Sponging the body with quinine water (one 
drachm to the pint) is frequently successful in mild 
cases. If further treatment is necessary see under 
the heading Night Sweats. 
For the fever little special treatment is necessary. 
It usually disappears with the general improvement of 
the patient. Sponging with water and alcohol should 
be tried first and if this fails then give the following: 
I|. Phenacetin 5iss 
Ammon, carbonat 
Sacchar. alb 3i 
M. et ft. chart. No. xx. 
Sig. One twice a day if necessary. 
In the advanced stages of tuberculosis, diarrhoea 
is frequently a very troublesome and exhausting com- 
plication. 
For this give either of the following: 
1$. Plumbi acetat. grs. xlviii 
Pulv. opii. . grs. xxiv 
Pulv. camphorae grs. xxiv 
M. et ft. caps. No. xxiv. 
Sig. One every three hours. 
Or: 
422 I|. Bismuth subnitrat. 
Tinct. opii. 
Tinct. gambir, comp. 
Tinct. cardamom. 
Aq. menth. pip aa 3iv 
Syr. acaciae q. s. ad. §iii 
M. Sig. One teaspoonful every three hours. 
Or: 
I}. Salol 3iss 
Pulv. opii grs. xviii 
M. et ft. caps. No. xviii. 
Sig. One every three hours. 
Haemoptysis should be carefully treated. The indi- 
cations are (1) to stop the haemorrhage and (2) to pre- 
vent its recurrence. 
One of the most important points in treatment is to 
allay the patient's fears. He should be assured that he 
is not in any danger and *4 grain morphine sulphate 
with f grain atropine sulphate may be given hypoder- 
mically. He should be forbidden to sit up or even talk. 
Cold applications should be made to the chest. In very 
severe cases a hypodermic injection of to grain of 
atropine sulphate will cause the cessation of the haemor- 
rhage. Ergot should never be given in pulmonary 
haemorrhage. 
Faradization of the skin of the chest, injections of 
gelatin, and ligation of the extremities are other 
remedies highly recommended for the treatment of 
haemorrhage in this disease. 
In preventing recurrence we are not so successful. 
Drugs to reduce the arterial tension are of benefit, as 
nitroglycerin grain, morphine grain), aconite 
and acetate of lead. 
Hydrotherapy is an important adjunct to treatment. 
The patient each morning should take a rough towel 
wrung out of cold water and rub his body briskly 
until a general redness results. At first it may be 
necessary to restrict the rubbing to the chest, but the 
423 patient soon appreciates its benefit and takes in the 
whole body. 
Vaccine treatment. Remarkable results have been 
accomplished with vaccine therapy in local tuberculosis, 
but so far the treatment of the pulmonary form is 
still in the experimental stage. 
Tuberculin treatment under proper conditions is un- 
questionably of great benefit. It should not be used 
in acute or advanced cases, nor in those that are com- 
plicated by streptococcus, staphylococcus, or pneumo- 
coccus infection. Neither should it be used when the 
temperature is above 99.5° F. Acute cases do better 
on forced feeding and fresh air. The more chronic the 
disease the better,the results, if no complications exist. 
The treatment, to do good, must be continued at least 
from six months to a year. The injections, if bene- 
ficial, improve the patient's appetite, the fever and 
cough disappear, and a gain in weight soon follows. 
Intolerance to the tuberculin or over dosage is evi- 
denced by anorexia, malaise, headache, sleeplessness, 
loss of strength and weight, and other constitutional 
disturbances. 
It is very essential to begin with exceedingly small 
doses and to progressively increase as the patient's 
resistance increases; at first the intervals between injec- 
tions should be from three to five days, later only once 
a week. 
The initial dose ought to be milligram and each 
succeeding dose ten times the size of the previous dose, 
if no reaction occurs. After the dose of 1 mg. is reached 
the injections are made only once a week until the 
maximum dose of from 5 to 20 mg. is administered 
every 14 to 20 days. 
The injections are best made into the tissues of the 
chest or the back at about the height of the angle of 
the scapula. 
Climatic treatment. In many cases of incipient 
tuberculosis it is of benefit to send the patient to a 
424 high altitude. A few cases do not do so well, and a 
few are harmed by it. Never send a patient in the 
third stage to a high altitude. They either come 
home to die or are brought home dead. 
Since the effect of high altitudes is to expand the 
thorax because of the diminished atmospheric pressure 
and to flush out the stagnant air from the air vesicles, 
this can be imitated at the sea level or at low altitudes. 
The patient is instructed to take deep inhalations when 
in the open fresh air, to retain the air for a few seconds 
and then slowly expel it. 
The opinion of the authors as a result of close inves- 
tigation is that tuberculosis can be cured in any climate. 
Home is the best place to treat the patient, the best 
place to live, and if it must come to that, the best 
place to die. 
TUBERCULAR FISTULA AND ABSCESS. 
In the last two years much success has resulted from 
the use of Beck's Bismuth Paste in the treatment of 
sinuses, fistulas and abscesses. 
The paste is composed of: 
Bismuth subnitrate 33 % 
Petrolatum, yellow 67% 
It should be injected by a strong, conical-pointed 
glass syringe, like the ordinary urethral syringe. Not 
more than 100 grammes should be used at a time, as 
toxic effects may follow. 
Tubercular processes yield very rapidly to this treat- 
ment. Frequently one or two injections is all that is 
necessary to heal an abscess or sinus of long standing. 
TUBERCULOSIS, PROPHYLAXIS OF. 
(a) Compulsory notification of phthisis, (b) 
The removal of those conditions of domicile and of 
occupation which are known to promote the inci- 
dence of the disease, including the regulation of 
certain dusty trades, (c) The diffusion of knowl- 
edge by medical men, pamphlets, etc., regarding the 
425 nature and modes of spread of the disease, and the 
precautions which should be taken in order to pre- 
vent its extension, (d) The testing of sputum 
and other suspected discharges, and of milk, meat, 
etc., supposed to be tuberculous, the reports to be 
furnished free of charge, (e) Local authorities 
should undertake, without charge, the disinfection 
of houses recently occupied by phthisical persons, 
(f) The establishment of sanitoria and isolation 
accommodation for the cure of phthisical patients, 
and the isolation of those who are a distinct source 
of danger to fellow lodgers or workers, (g) The 
enforcement of measures against spitting in public 
conveyances and in places of public resort, (h) 
The efficient sanitary supervision of dairy farms, 
dairies, and milkshops. The periodic veterinary 
inspection and testing by tuberculin of milch cows, 
and the slaughter of tuberculous animals. The 
prohibition of the sale of milk of cows affected with 
tuberculosis, (i) The proper inspection of meat in 
public abattoirs and the adoption of due precautions 
for the control of imported meat and milk. 
TUMOR OF BRAIN 
Every case should receive the benefit of the doubt 
and be treated for syphilis for two or three months. 
This treatment frequently relieves the headache, 
no matter what the cause of the tumor. The ice- 
bag, morphine, atropine, and chloral often tempo- 
rarily relieve the symptoms. 
A small percentage of the tumors of the brain 
are accessible to surgery. If they are not remov- 
able, at least intracranial pressure is relieved. 
TURKISH BATHS, DIRECTIONS FOR TAKING. 
The best method of taking a Turkish bath is to 
go at once into the hottest room at a temperature 
of about 230° F. or higher, and remain five minutes 
or less. Then move into the second room at a temper- 
426 ature of about 190° F. for five minutes. Afterwards 
remain for twenty minutes in the coolest of the three 
hot rooms at a temperature of about 120° F. before 
being shampooed. By this method the hottest room 
is encountered before there is any heart fatigue. 
Its high temperature initiates perspiration, which 
begins freely in the second room, and is continued 
freely in the third. Many bathers find that the 
perspiration is increased by drinking freely tea, 
mineral water, hot or cold water. Others have 
a hot douche before entering the first hot room. 
TURPENTINE, POISONING BY. 
Empty the stomach by means of the stomach 
tube or with an emetic. Give one ounce of mag- 
nesium sulphate in a glassful of water as a purge. 
Give morphine sulphate grain) hypodermically, 
and demulcent drinks. 
TYPHOID FEVER, PROPHYLAXIS OF. 
Since the bacillus of typhoid fever is conveyed 
by drinking water, milk, oysters, shell-fish, ice, 
and flies, these sources of contagion must be care- 
fully avoided, especially during epidemics. 
Choose a room with good ventilation and sun- 
shine, and as much isolated as possible. It should 
have easy means of disposing of soiled linen and 
excreta, without contaminating others. The feces 
of the patient should be placed in a receptacle which 
contains about a pint of a suitable disinfectant, 
such as a solution of formalin (10%) or of carbolic 
acid (5%). Cover the feces completely with the 
disinfectant and mix them thoroughly with a stick, 
which must be afterwards burned, and empty them 
after standing for some time. 
Disinfect the urine also with about one-fortieth of 
its volume of formalin. The urine may also be dis- 
infected while in the bladder of the patient, by 
giving him ten-grain doses of urotropin three times 
427 a day for two days each week till convalescence 
is over. 
Soiled bed-linen and other infected articles should 
be soaked in a five per cent carbolic acid solution 
and then boiled or exposed to dry heat in a dis- 
infecting chamber. The sputum also should be 
disinfected and then burned. The hands of nurses 
and attendants as well as thermometers and other 
utensils should also be carefully washed and dis- 
infected. 
In country places disinfection is most important. 
All stools from a typhoid patient should be carefully 
disinfected with an equal quantity of slaked lime 
and four volumes of water, then burned after stand- 
ing for two hours. 
After each stool the perineum should be sponged 
with solution of bichloride of mercury (1 to 2,000), 
and, when there are involuntary evacuations, the 
thighs and back should be sponged as well. 
During an epidemic, healthy persons should be 
inoculated with typhoid virus. It is claimed that 
this preventive inoculation not only protects against 
the disease, but renders the disease less severe in 
the inoculated persons if they do become affected. 
Typhoid could probably be effaced by systematic 
co-operation regarding sewage regulation and water 
supply. A clean catchment area is essential for 
a satisfactory water supply. 
TYPHOID FEVER. (ENTERIC FEVER.) 
Up to the present time there is no specific treatment 
of typhoid fever. There are, however, certain proced- 
ures which lessen its mortality. These are: 1st-At- 
tention to rest and diet. 2d-Careful nursing. 3d- 
Hydrotherapy. 4th-Intestinal antisepsis. 
Rest, diet, and nursing. As soon as the disease 
is suspected the patient should be immediately put 
to bed, and under no circumstances allowed to leave 
it until convalescence is well established. A bed- 
428 pan should be used from the beginning to prevent 
the patient from getting out of bed even for a few 
moments. When possible the patient should be 
placed in the largest, best lighted, and best ventilated 
room in the house. A room with a sink should be 
avoided. If the room is large enough, two beds 
of the same height should be placed in it, so that 
the patient may be moved with the least amount 
of exertion from one to the other, thus allowing the 
bed to be made and the linen changed every second 
day with ease. Feather beds should be discarded 
whenever possible, and a hair mattress covered with 
a rubber cloth and a sheet substituted. The bed- 
clothes should be kept well smoothed out and the 
patient's back, hips, and heels should be frequently 
bathed in alcohol to prevent the formation of bed- 
sores. The position of the patient should also be 
frequently changed. 
Careful nursing and diet regulation are the life- 
saving agents in typhoid fever. In no other disease 
is an appropriate liquid diet of more importance than 
in the one under consideration, and not only must 
it be liquid, but also digestible and palatable; fur- 
thermore, it should leave the least possible residue. 
All clinicians agree that the ideal food for typhoid 
fever is milk when it fills those requirements. If 
it is thoroughly acted upon by the stomach before 
entering the intestines there will be little chance of 
its mechanically irritating the ulcerated surfaces. 
The stools should be examined daily for undigested 
curds of milk, because when present they are ex- 
tremely liable to cause fermentation, gases and 
ptomaines, the chief factors in distension and per- 
foration. 
The milk may be given raw, boiled, or diluted 
with plain water, seltzer, apollinaris, or lime water. 
When diarrhoea is present, it is best to give it boiled. 
The quantity of milk given each patient varies in 
429 quantity from one quart to three quarts in twenty- 
four hours; the average quantity that is well borne 
by adults being four to six ounces every two or 
three hours night and day. This quantity is usually 
sufficient to tide them over the height of the fever. 
When the milk is not being properly digested, 
one of three things must be done: (1) The quan- 
tity must be reduced; (2) it must be predigested 
or peptonized, or (3) it must be abandoned entirely. 
On some persons in perfect health milk acts like a 
poison. They either become constipated, with clay- 
colored or white stools, or else get diarrhoea, the 
result of the non-digestion and fermentation of the 
milk. When these subjects are attacked by fever, 
they stand it still less than in health. Kumyss, 
buttermilk or malted milk must then be given. 
We prefer kumyss if it can be obtained; one or two 
quarts a day can readily be digested by the weakest 
stomach. It is also a good diuretic. Buttermilk 
and malted milk may also be given as a change from 
time to time, especially in those cases where the 
prolonged use of milk has turned the patient's 
stomach against it. Beef juices, beef tea, and meat 
extracts should not be given when the boweis are 
loose, because they aggravate the trouble. 
When the temperature returns to normal, about 
the end of the fourth week, the patient becomes 
ravenously hungry, so that it is sometimes difficult 
to prevent them from stealing solid food, or from 
obtaining it by working on the sympathy of friends. 
In severe cases, no solid food of any kind should be 
allowed until the temperature has remained normal 
for ten days. In the milder cases, where there has 
been little gastric catarrh and the digestion is good, 
'■we can begin solid food two or three days earlier. 
It is best to begin with as light food as possible, 
and then allow a little more each successive day. 
Allow a diet somewhat like the following: 
430 First day: One or two cups of chicken broth 
and one piece of milk toast. 
Second day: Home-made beef tea, a cup of weak 
tea or coffee, and a biscuit. 
Third day: A soft-boiled egg, cream toast, and 
a little scraped beef in soup. 
Fourth day: Two or three soft-boiled eggs, rice 
pudding and a baked potato. 
Fifth day: A small piece of chicken breast, a 
baked apple, and one or two baked potatoes. 
Sixth day: A small piece of tenderloin steak, 
mashed potato, bread and butter and rice pudding. 
On the seventh day, the patient is allowed to select 
his diet from the previous six days; after that he 
is allowed anything he desires except fried and fat 
foods. If eating causes distress, the diet should 
be immediately reduced for a few days longer. 
Thirst during typhoid fever is a very prominent 
symptom, and sometimes a very troublesome one. 
Allow large quantities of water that have been pre- 
viously boiled and cooled. We are not in favor of giv- 
ing ice, because in several cases it increases instead 
of decreases the intense thirst. 
The free use of water favors the elimination of 
waste products from the system through the kidneys. 
Eight or ten drops of dilute phosphoric acid may be 
occasionally added to a tumblerful of water when the 
patient desires it. Not only does it seem to allay 
thirst, but also to aid digestion. 
A pleasant refrigerating drink is that known as 
"imperial drink." For its formula and that of 
other drinks see Drinks for the Sick. Whisky and 
brandy should not be given unless specially indicated 
Hydrotherapy.-Systematic cold sponging should 
be begun in each case as soon as the disease is 
suspected. Equal parts of water and alcohol may 
be used. When the temperature goes above 102.5° 
F., the patient should be thoroughly sponged every 
431 two hours; otherwise every three or four hours as 
necessity requires. The limbs should first be sponged 
and dried in succession, then the trunk; each spong- 
ing should take up fifteen minutes. An ice-bag to 
the head greatly increases the efficiency of the spong- 
ing. When the temperature can not be sufficiently 
controlled by sponging a wet pack is necessary. 
The patient is wrapped in a sheet which has been 
wrung out in cold water and kept constantly wet 
by the addition of more water. For the intense 
headache of the first week of the disease nothing 
gives as much satisfaction as the ice-cap or ice-bag. 
There is no doubt that antipyretics, while reducing 
the temperature, reduce the patient's strength and 
resistance, and they should therefore never be given. 
The Brand method of cold baths is no doubt in 
skillful hands the treatment which gives us the 
lowest mortality, but it is very impracticable in 
private practice, and is strenuously objected to both 
by the patient himself and by his relatives. We 
believe that cold sponging carried out systematic- 
ally accomplishes the same good. Cold sponging, 
like the cold bath, undoubtedly strengthens the 
heart, keeps the mind clear, lessens nervous symp- 
toms, induces sleep, and diminishes muscular twitch- 
ings and tremors. 
The mouth should be kept scrupulously clean. 
Nothing is so liable to coat the tongue as milk. 
After taking a glass of milk the mouth should be 
rinsed out with a saturated solution of boric acid. 
When this is faithfully done we seldom see those 
dry, brown, leathery, and fissured tongues called 
"typhoid tongues." With strict aural cleanliness 
we seldom find cases of abscess of the parotid or 
middle ear. 
Medicinal treatment. As soon as typhoid fever 
is suspected give: 
J$. Hydrarg. chlor, mit grs. xii 
Sodii bicarb grs. xii 
432 M. et ft. chart. No. xii. 
Sig. One every two hours. 
The above should be given whether the disease 
begins with diarrhoea or constipation. It checks the 
diarrhoea and also vomiting if present. 
After the patient's alimentary canal has been well 
cleared out, the administration of intestinal anti- 
septics may be begun. We may begin with: 
I). Saloli 3ii 
Div. in caps. No. xxiv. 
Sig. One every three hours. 
Or: 
I|. Saloli 3ii 
Zinci sulphocarbolat 5i 
M. et ft. caps. No. xxiv. 
Sig. One every three hours. 
If the stools are very offensive, naphthalin in 5 
grain doses may be given with the sulphocarbolate of 
zinc, thus: 
I}. Naphthalin 3ii 
Zinci sulphocarbolat 3i 
M. et ft. caps. No. xxiv. 
Sig. One every three hours. 
Guiacol carbonate in 5 grain doses may also be 
given as an intestinal antiseptic. It may be combined 
with salol or sulphocarbolate of zinc: 
1$. Guiacol carbonat 3ii 
Zinci sulphocarbolat 3i 
Saloli 3i 
M. et ft. caps. No. xxiv. 
Sig. One every three hours. 
For the headache of the first week the ice-bag usually 
gives relief, but if very severe, give: 
I|. Kryofini 3ss 
Sodii bromid 3i 
Phenacetin 3ss 
Caffein citratgrs. vi 
M. et ft. chart. No. vi. 
433 Sig. One every three hours till relieved. 
Cold sponging, cold baths, and the cold pack control 
the temperature in almost all cases. It does not be- 
come necessary to give antipyretics. 
Meteorism does not occur so frequently in those 
cases where the diet is properly regulated, but when 
it does occur, give the following: 
f$. Olei terebinth 3iss 
Tinct. opii deodorat 3 iii 
Syr. acaciae q. s. ad. §iii 
• M. Sig. One teaspoonful every three hours. 
Or: 
I}. Olei terebinth 3iss 
Olei anisi gtts. vi 
Glycerini §ss 
Mucil. acaciae. 3ss 
Syr. simplic §iss 
Aquae.. q. s. ad. 3iv 
M. et ft. emuls. 
Sig. One teaspoonful every two hours. 
High rectal enemas of two quarts of hot water con- 
taining tincture of asafoetida (3 iii), spirits of chloro- 
form ( 3 i), and spirits of turpentine ( 3 ss), are of 
much benefit in overcoming tympany. 
Cases that are constipated do better than those that 
have diarrhoea. Do not give cathartics to relieve 
constipation but use warm soapsuds enemas. 
If the bowels move more than four or five times a 
day, it is necessary to check them. The following 
prescriptions are all very valuable for this condition. 
Use the first ones for mild cases and the last ones for 
severe cases of diarrhoea: 
R. Acid, sulphuric, aromat 3ii 
Tinct. opii 3ii 
Tinct. catechu co 3iv 
Aquae cam ph q. s. ad. 3 iii 
M. Sig. One teaspoonful every three hours or after 
each loose movement. 
434 Or: 
1$. Bismuth, subnitrat 5iv 
Tinct. opii 5iv 
Tinct. catechu 3iv 
Aquae menth. pip 3iv 
Aquae anisi 3iv 
Syr. acaciae q. s. ad. 5iii 
M. Sig. One teaspoonful every three hours. 
Or: 
1$. Plumb, acetat grs. xxiv 
Pulv. opii grs. xii 
Pulv. camphorae grs. xii 
M. et ft. caps. No. xii. 
Sig. One every three hours. 
If vomiting occurs during typhoid fever it may be 
checked by the following: 
I). Cerii oxalat grs. xii 
Cocain. muriat gr. i 
Hydrarg. chlor, mit gr. i 
Bismuth, subnitrat 3iss 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
For the delirium there is nothing better than per- 
sistent sponging which keeps the temperature down. 
If it becomes severe give grain tablet of hyoscine 
hydrobrom., either by mouth or hypodermically every 
four hours. 
The patient should be constantly watched because 
he is very liable to sneak out of bed, and jump out of 
a window during the momentary absence of the nurse. 
Bed-sores can in most cases be avoided by careful 
nursing, but if they do occur they must be kept abso- 
lutely clean, and treated according to directions under 
Bed-sores. 
Haemorrhage from the bowels is a very frequent 
complication, and must be treated exactly as given 
under Haemorrhage, Intestinal. 
Perforation of the bowel in this disease is the most 
435 dreaded complication. It should be recognized easily, 
and operation should be performed at the earliest pos- 
sible moment. It gives the patient the best chance for 
recovery. If operation is refused then withhold all 
food and give sufficient opium to paralyze intestinal 
peristalsis and relieve pain. 
Hiccough is sometimes a very troublesome compli- 
cation, it is a symptom of profound depression. It is 
sometimes controllable by the administration of 15 drops 
of spirits of camphor, 10 drops of spirits of chloroform, 
or | grain morphine sulphate hypodermically Pressure 
on the vagus may also be tried. 
Phlebitis occasionally occurs in the third and fourth 
week of the disease. The limb should be elevated 
and wrapped in cotton. The patient should keep as 
still as possible in order not to displace the thrombus 
in the vein. Painting the limb .vith tincture of iodine 
is of some benefit. Above all things rubbing the limb 
should be avoided. For the oedema which follows 
phlebitis, a rubber bandage should be worn until all 
swelling has disappeared. 
TYPHUS FEVER. (WAR, JAIL, CAMP, FAMINE, 
PUTRID OR SPOTTED FEVER, BLACK DEATH.) 
Strict isolation and open-air treatment in tents 
are necessary. If treatment must be carried out 
in a private house or a hospital ward the most thor- 
ough ventilation must be carried on. The excreta 
and everything coming in contact with the patient 
should be thoroughly disinfected, and after recovery 
the patient's room and its contents should be fumi- 
gated. 
The treatment is symptomatic and much the same 
as in typhoid fever. Rest, good nursing and a diet 
of fluids (plain milk, milk punch with egg or brandy) 
are of the utmost importance. Cardiac stimulants 
are more often required than in typhoid and should 
consist of whisky, digitalis or strychnine, or in 
extreme cases of hypodermic injections of ether or 
436 camphor. The fever is best controlled by hydro- 
therapy even to the extent of six cold baths daily. 
Cold sponging is also useful. 
The vomiting may often be controlled by an 
effervescing draught with or without hydrocyanic 
acid (one or two drops). In other cases relief may 
be obtained by the administration of small and 
frequent doses (one minim) of vin. ipecac, or by sina- 
pisms to the epigastrium. 
The severe pains may have to be relieved by 
morphine or opium. 
ULCERS. 
Treat the cause, e. g., varicose veins, syphilis, 
tubercle, gout. Insist upon absolute rest in bed. 
The treatment is both constitutional and local. 
The constitutional treatment consists in giving 
tonics if necessary and treating the underlying cause. 
Local treatment. First reduce the inflammation 
in and near the ulcer by a moist dressing of a one 
per cent aqueous solution of ichthyol, or a solution 
cotnaining one part of salicylic acid and five parts 
boric acid to 500 parts of water. These solutions 
should be applied on a thick gauze compress and 
kept moist and cool. 
Next the ulcer should be cleansed by washing 
its surface with a solution of bichloride of mercury 
(1 in 1,000) or carbolic acid (1 to 60), or with hydro- 
gen peroxide, or: 
T$. Liquoris formaldehydi m. viii 
Aquae hydrogeni dioxidi 3xvi 
M. Sig. Use locally as a wash twice a day. 
Sloughs may be destroyed and removed by cauter- 
ization with a solid stick of nitrate of silver and the 
application afterwards of naphthaline powder. 
Next the granulations should be stimulated, if indo- 
lent, by the application of antiseptic powders, solutions, 
or ointments. A very popular application is Balsam 
437 of Peru, which has a powerful effect in increasing the 
growth of granulations: 
3. Balsami peruviani...... ...... 3iv 
Tinct. benzoin, co 5ii 
Petrolati q. s. ad. §ii 
M. Sig. Spread liberally on surgeon's lint and apply. 
Ointments are usually contra-indicated where there 
is a very profuse discharge, as they prevent its absorp- 
tion by the dressing. 
In chronic ulcers of the leg, and especially varicose 
ulcers, a cure is impossible until the congestion is 
relieved and a proper blood-supply is established. To 
do this a muslin or flannel bandage should be applied 
properly over the dressing, and Teach from the toes to 
the knee. 
UMBILICAL CORD, CARE OF. 
After the cord has ceased to pulsate it should be 
tied two inches from the child's body with thick 
aseptic silk. Use the following as a dusting powder: 
I). Ac. salicyl oii 
Ac. boric 3vi 
M. Sig. Use once a day. 
Envelop the cord in gauze and lay it with the cut 
end pointing upwards. Do not envelop it in cotton. 
Should granulations still be present after the cord 
drops off apply a little alum or silver nitrate to them. 
URAEMIA. 
The treatment of this serious condition may be 
summed up in the word "elimination." The kid- 
neys have ceased to act, therefore we must rely on 
the bowels and skin. If we find the patient in con- 
vulsions or coma, the first thing to do is to administer 
croton oil in a two-drop dose, thus: 
I|. 01. tiglii gtts. ii 
Glycerini gtts. x 
M. Sig. Drop this dose on the back of the tongue 
438 Elaterin may be given, thus: 
I). Elaterii gr. ss 
Aquse 3ii 
M. Sig. One teaspoonful at once. Repeat in half 
an hour if necessary. 
The skin should be stimulated by wrapping up the 
patient in a hot pack. The skin can also be stimulated 
by a hypodermic injection of pilocarpine muriate 
(| grain). Repeat in one hour if necessary. 
If the patient is not feeble, 10 to 20 ounces of blood, 
should be withdrawn. 
Chloral hydrate is of importance, one drachm in an 
ounce of water should be injected into the rectum. 
Chloroform may be used to control the convulsions.. 
If the convulsions persist, give half a grain of morphine 
sulphate hypodermically. Repeat in half an hour if 
necessary to stop the convulsions. 
URTICARIA (See Hives). 
UVULA, RELAXED. 
Look for and remove its causes: excessive eating, 
drinking, and smoking, exposure to night air, living 
in crowded and ill-ventilated rooms, and struma in 
children. Patient should live in a dry or bracing 
climate. Indigestion and constipation should be 
corrected if present. 
Local treatment. Mild astringent sprays or in- 
sufflations. Painting with the following solution 
is frequently useful: 
I}. Tinct. iodin. 
Glycerinaa § i 
M Sig. Paint throat every two hours. 
If local treatment does not reduce the hypertrophy 
of the uvula, part of it should be removed. 
VAGINISMUS. 
Absolute rest of genital organs and prohibition 
of coitus. Relieve hypersesthesia by hot sitz-baths 
or by the application of a solution (10 grains to the 
ounce) of nitrate of silver or ointment of belladonna. 
439 Dilate the vagina well with the thumbs or speculum 
and make the following application: 
I}. Argenti nitratis grs. xxx 
Aquae ji 
M. Sig. Apply to hypersesthetic or eroded spots. 
The following suppository may be given: 
1$. Cocainse grs. vi 
lodoformi 3i 
Extract! belladonn. folior grs. iii 
Olei theobrom 5 iii 
M. ft. suppositoria No. vi. 
Sig. Insert one into vagina at night. 
If these means fail dilate the vagina under an anaes- 
thetic and remove sources of irritation such as urethral 
caruncles, irritable carunculae myrtiformes, and treat 
any ulcers which may be present. 
The following internal treatment is sometimes bene- 
ficial, when the vaginismus is accompanied with severe 
pain: 
I|. Morphine sulphat gr. i 
Atropin. sulphat gr. 
Elixir, simplic §i 
M. Sig. Two teaspoonfuls at bedtime, or when 
suffering. 
In some cases it may be necessary to benumb the 
parts by the application of cocaine and then introduce 
a dilator. The dilator should be retained for an hour 
night and morning. Its presence blunts the sensi- 
bility. Day by day an instrument of larger size may 
be substituted until the vagina is overstretched. 
VALVULAR DISEASE OF HEART (See Endocarditis, 
Chronic). 
VARICELLA. (CHICKEN POX., 
This is the mildest of all the acute contagious 
diseases. At the onset of the disease put the child 
to bed for several days, restrict the diet, and give 
a mild laxative as: 
440 U Hydrarg. chlor, mit grs. ii 
Sacchar. lactisgrs. xii 
Pulv. rheigrs. vi 
M. et ft. chart. No. xii. 
Sig. One every three hours. 
The itching of the skin may be allayed by applying 
carbolized vaseline or by sponging with a weak solution 
of carbolic acid. 
As soon as crusting takes place the following oint- 
ment is useful: 
I|. Ac. boricigrs. xx 
Zinc, oxid 3i 
Bismuth, subnitrat 5ss 
Lanolin 3 i 
Ungt. petrolatq. s. ad. gii 
M. Sig. Use twice a day. 
If fever is present give to a child 2 to 10 years old: 
I}. Potass, citratgrs. xii 
Potass, acetatgrs. vi 
Aquae 3i 
Elix. digestiv. co. N. Fq. s. ad. §ii 
M. Sig. One teaspoonful every three hours. 
Prophylaxis. The disease is transmitted as long 
as the crusts are present, therefore isolation should not 
be discontinued until they have fallen off. Isolation 
should be enforced in school. 
VARICOSE VEINS. 
Preventive. The patient should avoid occupa- 
tions (e. g., waiter, etc.) and clothing which interfere 
with the venous return. Elastic garters especially 
should be avoided. When the patient is sitting 
down his feet should be elevated on a chair opposite. 
Constipation should be avoided. 
Treatment. The general health should be attended 
to. An elastic bandage or elastic stocking should 
be applied. A cheap, cleanly and most satisfactory 
bandage may be made from pure coarse white flan- 
nel. This is cut on the bias in strips about three 
441 inches wide and a sufficient number of them are sewed 
together to make a bandage about seven yards long. 
The bandage should be applied before the patient 
gets up in the morning. A bandage of this kind 
can be washed and ironed when soiled and will 
last a long time. 
If the patient wishes to apply for a position as 
policeman or fireman, or if he desires to join the 
army or navy, he should be advised to have the 
veins operated on. 
VARICOSE ULCER. 
These are among the most difficult ulcers to treat. 
Treatment should consist of: 1st-the relief of 
inflammation around the ulcer: 2d-the disinfection 
of the ulcer; 3d- the stimulation of the granulations; 
4th-the re-establishment of the circulation and the 
prevention of venous stasis; and 5th-the stimulation 
of the epithelium at the edges of the ulcer. 
Moist antiseptic dressings should be used at 
first to reduce the surrounding inflammation. An 
excellent dressing for this purpose is Thiersch's 
solution, the formula of which is: 
I). Acid, salicyl 1 part 
Acid, boric 5 parts 
Aquae 500 parts 
M. Sig. Apply frequently on a thick piece of gauze. 
The dead sloughs on the surface of the ulcer should 
be removed, and the ulcer cleansed with a one per 
cent solution of creolin. Bichloride of mercury (1 to 
1,000) answers the same purpose. It is best to use 
the creolin and bichloride solution hot. 
Granulation of the wound may be encouraged by 
the application of the following powders: iodoform, 
aristol, bismuth subnitrate, orthoform, etc. 
Balsam of Peru, ichthyol, myrrh, silver nitrate 
may be used instead. 
Ointments are preferred by some, e. g., ungt. resorcin 
co. (N. F.), Lassar's paste or ungt. salicylic acid. 
442 Powders act best when the secretions are profuse 
and the ulcers small. 
Ointments should not be used where the secretions 
are profuse. 
The following wash is an excellent one to encourage 
cicatrisation: 
3- Zin ci sulphat grs. xx 
Tinct. lavendulae co 5ss 
Aquae destillat § viii 
M. Sig. Apply twice daily. 
The following ointment should be tried in stubborn 
cases: 
I). Camphor® 3ss 
Zinci oxidi Sviiss 
Petrolati q. s. ad. §iv 
M. Sig. Use twice a day. 
Venous congestion of the limb must be removed 
before any line of treatment is successful. Usually 
a muslin or flannel bandage extending from the toes 
to the knee is all that is necessary. 
The authors have frequently had splendid results 
from the use of Unna's paste. The ulcer is thoroughly 
cleaned, powdered with iodoform, and gauze bandages 
are applied beginning at the toes and extending to 
the knee. Between each layer of bandage Unna's 
paste is applied with a brush. This dressing is allowed 
to remain on for several weeks. Frequently on remov- 
ing the dressing it is found that the ulcer has entirely 
healed. If the ulcer is discharging profusely, windows 
may be cut in the dressing, and the ulcer treated daily. 
Workingmen who have to be on their feet all day, 
are cured by this method of treatment without missing 
a day's work. The formula for Unna's paste is: 
I|. Glycerini. 
Aquae aa 10 parts 
Gelatin. 
Zinc, oxid aa 4 parts 
M. Sig. Warm before using. 
443 In severe cases of ulcer it is best to put patient to 
bed with the leg elevated. 
If the ulcer refuses to heal then it becomes necessary 
to operate. The veins may be cut and tied in several 
places or the internal saphenous vein may be tied. 
If an ulcer is so large that it cannot heal over, then it 
ought to be thoroughly curetted and skin transplanted 
over its surface. 
VERTIGO. (DIZZINESS.) 
Carefully and thoroughly examine the condition 
of the ears and remove the cause as far as possible. 
Remove any accumulation of wax, and treat any 
disease of the pharynx or Eustachian tube. Exam- 
ine the eyes for any errors of refraction and correct 
them if found. 
Counter-irritation over the mastoid process and 
bromides internally are often of value in lessening 
the morbid sensitiveness. Galvanization with the 
anode over the ear and the cathode to the neck are 
also beneficial. 
Treat any underlying diseases such as syphilis,gout, 
etc. To gouty patients give salicylates, colchicum 
and the iodides, and in syphilis employ the usual 
anti-syphilitic remedies. 
In bilious and plethoric vertigo give the following: 
1$. Hydrarg. chlor, mit grs. ii 
Pulv. jalapi co grs. x 
M. ft. chart. No. vi. 
Sig. A powder every half hour. 
In aural vertigo (Meniere's disease) give: 
3. Potass, bromidi 3iv 
Syr. aurant. cortic 5iv 
Aquaeq. s. ad. giii 
M. Sig. One teaspoonful three times a day. 
Or: 
1$. Spirit, glycer. nitrat 5i 
Sig. One drop in water three times a day to be 
gradually increased until temporal headache is produced. 
444 In cardiac vertigo give: 
T|. Strychnin, sulphat gr. i 
Extract, digital grs. vi 
Extract, cinchon® 3i 
M. ft. pil. No. xxx. 
Sig. One pill after each meal. 
For gastric vertigo give: 
3 Sodii bicarb 3iv 
Tinct. nuc. vomic 3ii 
Spts. ammon. aromat 3iv 
Aqu® menth. virid q. s. ad. giii 
M. Sig Shake, and take one teaspoonful in water 
after meals. 
VOMITING. 
Remove cause, e. g., gastritis, intestinal, renal or 
biliary colic, peritonitis, intestinal obstruction, appen- 
dicitis, hernia, kidney disease, cerebral tumor. 
Regulate the diet, apply a mustard poultice over 
the epigastric region, lavage the stomach, and give an 
enema to unload the rectum. 
Drugs used: Sodium bicarbonate, dilute hydro- 
cyanic acid, cerium oxalate, ammonium bromide, 
bismuth subnitrate, chloral hydrate, calomel, sips 
of champagne, morphine and cocaine. 
When due to acute gastritis give: 
TJ. Bismuth, subnitr 3iii 
Hydrocyan. acid, dil m. xxxii 
Morph, sulph gr. iss 
Aq. menth. pip §i 
Syr. acac q. s. ad. 5ii 
M. Sig. One teaspoonful every two hours until 
vomiting ceases. 
The following prescription is also of value in vomiting 
of reflex origin especially in that of pregnancy: 
3. Hydrarg. chlor, mit grs. ii 
Cerii oxalat grs. xviii 
Bismuth, subnitrat 5ii 
Ingluvin 3i 
Taka diastase 3se 
445 M. et ft. chartul. No. xii. 
Sig. One every three hours. 
In pregnancy one immediately before each meal. 
WART. (VERRUCA.) 
The commonest caustics used in the eradication 
of warts are: glacial acetic acid, silver nitrate 
crayon, chromium trioxide, etc. 
A common prescription is: 
I). Liq. hydrarg. nitrat. 3ii 
Sig. Apply locally with match stick. 
Or: 
I|. Acid, nitric 3ii 
Sig. Apply every three days with probe. This 
should not be given to patient. 
Another method is curettage, then cauterization 
of the oozing base with a silver nitrate crayon. Elec- 
trolysis is also successful, the base of the wart being 
transfixed with a needle connected with the battery. 
Radiotherapy has also been successfully applied, espe- 
cially to the warts of the aged. 
Magnesium sulphate given internally in ten grain 
doses has recently proved to be of benefit. 
The following may be given to the patient to apply 
once a day: 
1$. Chloral, hydrat. 
Acid, acetic aa 3 iss 
Acid, salicylic. 
Ether aa 3i 
Collodion 3iv 
M. Sig. Apply to warts once a day 
WASHERMAN'S ITCH (See Dhobie Itch). 
WATERBRASH (See Heartburn). 
WATER-ITCH. (COOLIE-ITCH.) 
Prophylaxis. Feet and legs of coolies should be 
painted every morning with tar, and then they should 
446 walk through fine sand or sawdust which sticks 
to the tar and forms an impermeable covering. 
Treatment. Bathe the feet daily in warm car- 
bolic lotion (1 in 40), then open the vesicles and 
dust on boroiodoform powder. 
WEIR MITCHELL REST CURE. 
Used especially in hysteria and neurasthenia. 
The patient is removed from her family and all 
sympathizing friends and given into the care of a 
competent nurse. She is kept absolutely quiet in 
bed and not allowed to read or, at first, even to feed 
herself. Massage and electric treatment (a slowly 
interrupted Faradic current) are given once or 
even twice daily for gradually lengthening periods, 
but are omitted during the menstrual epochs. Vol- 
untary exercise is forbidden so that the patient has 
no excuse for feeling tired. The diet consists at 
first of skimmed milk or milk mixed with half its 
bulk of oatmeal jelly. Four to six ounces of this 
are given every two hours and rapidly increased 
until the patient takes two quarts daily. Solid 
meals are then gradually added, e. g., a lunch of 
chops or raw oysters with bread and butter and a 
breakfast of eggs, roll and a cup of cocoa. Soon the 
patient is taking a large quantity of nourishment 
and in the absence of all other calls upon her nervous 
strength, digests it perfectly well 
The patient should be given a sponge bath daily. 
In from four to six weeks the patient is allowed to 
sit up, a few moments at first then for longer periods 
until she is allowed to drive out and to take short 
walks. A schedule of the treatment should be 
made for each day, the hours for feeding, massage, 
electricity, exercise, rest, etc., being fixed. The 
interval between the massage and the electric treat- 
ment should be three or four hours. 
. Tms treatment is specially adapted thin, 
poorly nourished patients. 
447 WET-NURSE, CHOICE OF. 
Examine the child of the wet-nurse, which should 
be about the same age as the infant she is to feed, 
for evidences of syphilis. The wet nurse herself 
should be free from any communicable disease such 
as syphilis, tuberculosis or gonorrhea, her nipples 
should be normal in development. She should have 
a good quantity of milk, but those with too large 
and flabby breasts should not be selected. Super- 
vise carefully the diet of the wet-nurse and guard 
against her over-indulgence in malt liquors, alco- 
holic stimulants and opiates. Her moral character 
should be good. 
WHOOPING COUGH. (PERTUSSIS.) 
The patient should be isolated till the cough 
ceases and all articles used by him should be dis- 
infected. In warm weather he should have plenty 
of fresh air and sunlight, but should be protected 
from the inclemency of bad weather. After children 
have passed through an attack of whooping cough 
they should not be exposed to raw chilling winds 
until the sensitiveness of their mucous membrane 
has disappeared. A tight abdominal binder should 
be put on in all cases. 
The diet should be light and nutritious. If 
fever is present the patient should rest in bed. 
Bromoform is on$ of the most effectual remedies 
in this disease. It may be given in one drop doses 
on lump sugar to a child four times a day. Or give 
for a child one year old: 
I|. Bromoform m. xxiv 
Spt. vin. rect 3i 
Syr. lactucar oiii 
Syr. hypophosph. ammon 5iss 
Syr. acaci q. s. ad. §iii 
M. Sig. Shake well. One teaspoonful three or four 
times a day. 
448 Tincture of belladonna may be substituted for the 
bromoform in the above prescription. 
Antipyrine is also useful but it should not be given 
if heart or severe pulmonary complications are present. 
When the paroxysms are specially marked it should 
be combined with sodium bromide or heroin. 
For a child eight months old give: 
I). Antipyrin grs. xii 
Sod. bromid 3i 
Aquse gii 
Elix. tarax. co q. s. ad. §iii 
M. Sig. One teaspoonful every two hours. 
For a child fifteen months old give: 
3. Antipyrin grs. xxiv 
Sod. bromid 5i 
Aquse §ii 
Elix. tarax. co q. s. ad. §iii 
M. Sig. One teaspoonful every two hours. 
For a child two to four years give: 
3- Antipyrin grs. Ixiv 
Sod. brom grs. Ixxii 
Aquse §ii 
Elix. tarax. co q. s. ad. §iii 
M. Sig. One teaspoonful every two hours. 
Local treatment with sprays, inhalations, insuffla- 
tions of powders and direct applications to the larynx 
may be prescribed. As an inhalant give: 
I). 01. eucalypti. 
01. terebinth aa 3ii 
Spt. rectific gii 
M. Sig. As an inhalation half an hour before each 
meal and at bedtime. 
A very useful formula for inhalation is the following: 
I). 01. eucalypt 5iv 
Tinct. benzoin, comp q. s. ad. §ii 
M. Sig. One teaspoonful in one pint of boiling 
water for inhalation three times a day. 
449 In severe cases when the coughing paroxysms are 
very violent give: 
1$. Chloroformi giii 
Pone in phialas No. xxiv. 
Sig. Pour the contents of a phial upon back of 
attendant's hand and allow child to inhale at beginning 
of paroxysmal cough. 
The following nasal and pharyngeal spray may be 
prescribed for a child eight to ten years old: 
1$. Resorcinolis grs. x 
Aquaeq. s. ad. giv 
M. Sig. Use as nasal and pharyngeal spray several 
times a day. 
During convalescence great care is necessary because 
of the danger of pneumonia. Change of air is recom- 
mended and sea air is of especial benefit. Tonics 
such as iron, quinine, and cod liver oil are very useful 
at this period. 
WOOLSORTER'S DISEASE (See Anthrax). 
WRITER'S CRAMP. 
Attend to the patient's general hygienic condition; 
fresh air, good food and tonics like iron, arsenic, 
strychnine, and cod liver oil are of benefit. 
Supplement this general treatment for the nervous 
symptoms with special treatment. Rest to the hand 
is absolutely necessary; the patient may learn to 
write with the other hand. Special apparatus may 
be used consisting of mechaincal devices to use 
another set of muscles, or the old in different 
co-ordination. Forearm splints with a pen attached 
to the end, pens with thick handles, a penholder 
with supports for the fingers, etc. 
Systematic exercises of the fingers with passive 
manipulation and massage are often of great service 
Wolff's method consists in moving the fingers, hands, 
forearms, and upper arms in every possible direction 
making an effort to contract forcibly each muscle 
from six to twelve times. 
450 A galvanic current of about four milliamperes 
applied every day for from five to ten minutes and 
the treatment continued for months is often of benefit 
Prophylaxis. If symptoms of approaching writer's 
cramp appear, the act of writing should be made 
as comfortable as possible by using an easy-writing 
pen, a suitable penholder, smooth paper, comfortable 
writing desk and chair and a proper writing position. 
The pen should be held lightly and grasped with 
as little force as possible. The manner in which the 
penholder is held by the fingers should be changed so 
as to bring new sets of muscles into play. Holding 
the pen between the first and second fingers often 
gives relief. The motions of writing should be car- 
ried on with the entire hand and forearm rather 
than with the fingers alone. 
Perhaps the best prophylactic treatment of all 
would be for the patient to give up penmanship 
altogether and learn typewriting. 
X-RAYS, EMPLOYMENT OF. 
These rays are valuable as a therapeutic agent 
in certain affections of the skin (see Skin Diseases, 
Electric Treatment of), in adenitis (especially tuber- 
cular), in goiter, enlarged prostate, for the enlarged 
spleen and glands of Hodgkin's disease, for sarcomas, 
rodent ulcer, cancer of the breast, for the enlarged 
spleen of leukaemia, and also as an analgesic. 
When used for superficial affections a tube that 
gives off a large proportion of easily absorbed rays 
should be used (see Skin Diseases, Electric Treat- 
ment of). When used for deep-seated diseases the 
« rays of low penetrating power should be excluded 
so that the length of exposure necessary to affect 
the diseased tissues deep down, may be given without 
burning the skin by the easily absorbable rays. For 
this purpose a tube of high resistance, giving off a 
large proportion of rays of high penetrating power, 
should be used An aluminum plate should be inter- 
451 posed between the tube and the patient. This tube 
should be of such a thickness that it will absorb most 
of the rays which would otherwise be absorbed by 
the tissues intervening between the surface and the 
site of the disease. 
The amount of light necessary is not the same 
for all deep-seated diseases. Sarcomas, for example, 
require less light than carcinomas. In sarcomas, 
Hodgkin's disease and certain other affections, 
treatment should be given at longer intervals than 
in other growths, because symptoms of toxaemia 
may follow a too energetic use of the rays, due to 
the large amount of the products of decomposition 
set free at one time into the circulation by the action 
of the rays on the diseased tissues. However, if 
opportunities for drainage exist, less absorption will 
take place. 
YAWS. 
Compulsory segregation of infected persons. 
Clean patient with soap and plenty of warm water. 
Avoid chills. 
Locally, disinfectant solutions or lotions of boric 
or carbolic acids, or of corrosive sublimate. 
Give nourishing food and medicinal tonics. Inter- 
nally iron, arsenic, iodide of potassium and mercury. 
During convalescence iron and arsenic should 
be given for a long period. 
YELLOW FEVER, PROPHYLAXIS OF. 
Prevent the multiplication of stegomyia by de- 
stroying its breeding places. Drain collections of 
water especially those in the low-lying districts of 
seaports. Fill up inequalities of the ground so that 
rain-water may run off easily. Ponds which cannot 
be drained should have petroleum spread over their 
surface to destroy the larvae of stegomyia. 
If a ship is in an infected port it should anchor to 
the windward of infected ships and at as great a 
452 distance from them as possible. Since the young 
stegomyias which bite by day are seldom infected, 
crew and passengers may be allowed restricted 
shore-leave during the day, but never after sunset. 
Cover tanks, barrels, and cisterns with gauze. A 
ship that has had yellow fever on board should not 
be allowed to approach near the shore or other 
vessels until it has been thoroughly disinfected by 
introducing sulphur dioxide into the hold. A pound 
and a half of sulphur should be allowed for every 
1,000 cubic feet of space. 
When a case of yellow fever does occur, successful 
prophylaxis depends on the fact that the stegomyia 
fasciata becomes infected by biting the yellow fever 
patient at any time during the first three days of 
the disease, while the insect becomes infecting twelve 
days after it has bitten the yellow fever patient. 
When a case breaks out on board ship the patient 
should be brought ashore under a mosquito bar 
to a mosquito-proof ward in a hospital. If the 
patient be treated either at home or on board ship 
a room should be fumigated to destroy any mos- 
quitoes and then screened before he is put in it. 
If the patient has infected any mosquitoes before he 
has come under observation, fumigate the patient's 
house as well as the houses immediately adjoining. 
YELLOW FEVER. 
Remove patient from focus of infection and pro- 
tect him from mosquitoes which might spread the 
disease to others. 
At outset if no albumin is found in the urine give 
20 grains quinine, and 20 grains calomel, followed 
by a saline purge. Apply ice to the head. 
If albumin is found in the urine, clear out bowels 
by an enema. Maintain action of kidneys by effer- 
vescing saline drinks such as Vichy water. If the 
urine is suppressed, dry cupping over kidneys and 
453 hot fomentations, hot packs, or mustard plaster are 
indicated. 
For the troublesome vomiting, an ice-bag should be 
applied to pit of stomach and pieces of ice frequently 
swallowed. If a feeble irregular pulse points to heart 
failure give strychnine hypodermically. 
Diet. No food first two or three days, then milk 
and lime water, then beef juice or beef jelly, or 
enemata of peptonized milk with brandy. Iced 
champagne or whisky. 
ZINC SALTS. (WHITE VITRIOL, BURNETT'S DIS- 
INFECTING FLUID) POISONING BY. 
Do not use the stomach tube or give an emetic, 
because of the corrosion of the membranes, but 
give large draughts of white of egg and milk. Give 
also large quantities of sodium carbonate dissolved in 
warm water, also demulcents and tannic acid or 
strong tea. For the pain give a hypodermic injection 
of morphine (% grain). 
454