( 
Cd C/f 
. 
rd C) 
kJ ■ 
g 
O* 
□ THE 
Physician's Companion: 
A POCKET REFERENCE BOOK FOR 
PHYSICIANS AND STUDENTS. 
BY 
CLARENCE A. BRYCE, M. D., 
Editor of "The Southern Clinic,'' Author of "Medical Advice 
to Young Men,'' " Bryce's Visiting List,'' and "The 
C^^wBSJ^Clinic Visiting List''; Member of 
' l^an Medical Press As- 
Relation, &c., &c. 
/ X 
RICJ1MOND, YA.: 
THE SOUTHERN CLINIC. 
1890. Copyrighted by C. A. Bryce, M. D., 
1890. PREFACE. 
We have endeavored in this little volume to present a cer- 
tain amount of practical information for the physician, hos- 
pital interne, or student. While in its preparation we have 
freely availed ourselves of current literature, we have written 
from the standpoint of personal experience ; and while there is 
very little especially original matter to be found in most large 
text-books, we hope our readers will be able to see in this 
little effort something more than a mere compilation. What- 
ever may be said, it cannot be accused of having very much 
useless matter between its pages, as will be apparent from its 
size! To our friend, Dr. Isaiah H. White, of this city, we 
are greatly indebted for the chapter on " Diseases of Women" 
which he kindly furnished us. TO MY DEAR LITTLE SON, 
Clarence, 
Tins little book is affectionately inscribed, with 
THE HOPE THAT IT MAY PROVE OF SERVICE 
TO THE PROFESSION, AND TO HIM 
IN YEARS TO COME. 
C. A. B. THE PHYSICIAN'S COMPANION. 
A SUMMARY OF PRACTICE, SYMPTOMATOLOGY, 
AND TREATMENT. 
Inflammation and General Fever. 
Inflammation.-Heat, pain, redness, and swelling, with 
disturbance of function. Constitutional symptoms-irri- 
tation, fever, and general disturbance in secretion and 
assimilation. 
Treatment for local forms : Cold, sedatives, rest, eleva- 
tion of limb, depletion, leeches, poultices, incisions, etc. 
For constitutional symptoms : Bleeding, cathartics, nau- 
seants, diaphoretics, diuretics, opium, potass, bromide, 
nutrition, stimulation, etc. In all inflammations search 
for specific cause and treat additionally for such causes. 
General Fevers.-Elevation of temperature abnor- 
mally, disturbance of nervous and digestive systems, 
diminished secretions of mucous membranes, skin, and 
kidneys. 
Treatment: Arterial sedatives, aconite, veratrum viride, 
hydrocyanic acid. Restore secretions-calomel, ipecac, 
nitre, cooling and refrigerant drinks, salines, etc. 
Typhoid Fever.-Continued without intermissions, 
prostration, bronchitis, nervous disturbances, dull, per- 
sistent headache. Pulse 70 to 140 beats, small and irreg- 
ular. Temperature steadily rises from morning to eve- 
ning one to two degrees a day, with a decrease of one 
degree from night to morning. The maximum tempera- 2 
THE PHYSICIAN'S COMPANION. 
ture is reached by the fourth or fifth day of fever, about 
104 degrees; this holds for a week or more and then de- 
scends by similar steps. Diarrhoea and tympanitis are 
usual symptoms, while the rose-colored spots on abdo- 
men and chest may be looked for during second week. 
Treatment: It is safe and proper to give small doses of 
blue mass or calomel with ipecac or Dover's powder at 
first to clear the bowels and help restore the secretions. 
Later on beware of purgatives and guard against exces- 
sive diarrhoea. Throughout disease-liquid diet, con- 
stant nourishment, milk, strong coffee, brandy, beef 
essence, quietude, sponging body, and general attention 
to symptoms arising. 
Intermittent and Remittent Fevers.-Sudden high tem- 
perature with remissions will aid in diagnosis. 
Treatment will be directed to the liver at first; then 
quinine, salicin, cinchonidia, &c. Later, mineral acids, 
iron, and general tonics. 
Eruptive Fevers. 
Measles.-Ten to fourteen days incubation; eruption 
on fourth day of fever, small red dots like flea bites, 
bronchial cough, weak eyes. Eruption fades on seventh 
day of fever. 
Treatment: Equable temperature, milk diet, encourage 
eruption on skin, flax seed lemonade, nitre, spts. min- 
dereri, syr. senega, and similar agents. Grease the skin 
thoroughly to relieve itching. Look out for pulmonary 
complications. 
Scarlet Fever. -Four to ten days incubation ; eruption 
on third day of fever, bright scarlet and diffused, disap- 
pearing about fifth or sixth day of fever. 
Treatment: Grease body well, liquid diet, liq. amnion, 
acet., equable temperature, supporting treatment. Look out for kidney complications, and use Buffalo Lithia 
Water as a drink freely throughout the entire course of 
the disease. 
Chicken-Pox.-Four days incubation ; eruption second 
day of fever, small pimples, becoming vesicles in a few 
hours. 
Treatment suggests itself. 
Small-Pox.-Ten days incubation ; eruption on third or 
fourth day about lips, palate, and forehead. Eruption 
papular ; in a day it becomes vesicular and then pustular, 
maturating by the eighth day. Scabs begin to fall by 
twelfth day. 
Treatment: Supportive from the start; vaccinate the 
patient at once ; encourage the eruption on the chest by 
some counter-irritant; give salicylic acid promptly 
throughout the febrile stage. Treat symptoms as they 
arise. 
Diseases of the Lungs. 
Pneumonia.-Quiet arterial excitement-aconite, vera- 
trum viride, hydrocyanic acid dil. Equalize the circula- 
tion-quinine, ipecac, nitre, tartar emetic. Relieve local 
congestion-cups, leeches, blisters, poultices, and, if 
necessary, venesection. Watch patient and hasten reso- 
lution. Small doses calomel at first; then mur. and carb, 
ammonia, tolu, senega, brandy, beef essence, and gen- 
eral supportive course. 
Bronchitis- In acute cases use nauseating expecto- 
rants-salines, aconite, ipecac, paregoric, counter-irrita- 
tion. Chronic cases require stimulating expectorants- 
brown mixture, mur. and carb, ammonia, alum, squills, 
pot. bromide, tinct. benzoin co., atomization, counter- 
irritation over chest, nutritious diet, comfortable clothing, 
and avoidance of sudden or undue exposure. 
PRACTICE. 
3 4 
THE PHYSICIAN'S COMPANION. 
Catarrh.-Quinine, Dover's powder, mur. ammonia, 
aconite, rest, and equable temperature. 
Asthma.-Antispasmodics-digitalis, stramonium, chlo- 
ral hydrate, and potass, bromide. [Fid. ext. grindelia 
robusta has done great good in our hands.-Editor.] 
Pertussis.-Tonics, antispasmodics, pure air and sun- 
shine. 
Pleurisy.-Rest, hot fomentations, anodynes, calomel, 
veratrum viride, jaborandi, blisters. 
Hcemoptysis.-Salt, ergot, turpentine, opium. If ex- 
cessive, ligature around extremities, ice, aconite, cool 
drinks. 
Diseases of the Blood. 
Scurvy, Purpura, Ancemia, and Chlorosis can all be 
treated on general principles as regards pure air, bracing 
tonics, vegetable acids, fruits, iron, hypophosphites, and 
good diet. 
Pycemia.-Symptoms of general blood poisoning, shiv- 
ering, sweats, rapid pulse, diarrhoea, and intense prostra- 
tion. Quinine, tonics, stimulants, ammonia, sulphites, etc. 
Diabetes Mellitus.-Feverishness, great debility, ex- 
cessive flow of urine, sugar on testing. Give a non- 
starchy diet, the mineral acids, tr. iron ; encourage action 
of skin. 
Urcemia.-Blood poison from retained urea. Convul- 
sions, coma, albuminuria. Jaborandi, elaterium, salines, 
stimulants. Buffalo Lithia Water is invaluable in these 
cases. Do not confound this with other waters of less 
value. PRACTICE. 
5 
Diseases of the Bones. 
Caries.-General disturbance, fever, deep-seated pain, 
fistulous openings. Removal of dead bone, tonics, cod- 
liver oil, iron, phosphate of lime, generous diet. 
Necrosis.-Surgical interference, tonics, and generous 
diet. 
Periostitis.-Pain, feverishness, tenderness locally, and 
increased severity of symptoms at night. Iodides, opium, 
mercurials, blisters, belladonna and mercury liniment. If 
due to syphilis, treat with minute doses of hyd. bichloride 
in alcoholic solution-l-64th gr. three times a day. 
Rickets, Spinal Caries, Hip-joint Disease, etc.-Rest, 
tonics, Reed & Carnrick's peptonized cod-liver oil with 
milk, and the hypophosphites will be found to fill the 
want exactly in such cases. A nutritious diet of animal 
food, and fixation so as to support, rest, and relieve pres- 
sure on diseased surfaces, is absolutely essential in all con- 
ditions of this kind. 
Diseases of the Brain. 
Apoplexy.-Onset sudden, insensibility, snoring, dilated 
pupils, general paralysis. If pulse is full, hard and thrill- 
ing, with flushed face, bleed ; if tendency to syncope, 
avoid it. Use cold to head, turpentine enemas, mustard 
foot baths, rapid purgatives-croton oil, etc. 
Concussion.-Easy breathing and usually natural pu- 
pils, insensible to light, however; pupil may be contracted, 
or one contracted and one dilated ; complete loss of mus- 
cular power, mental confusion or unconsciousness, heart's 
action feeble and irregular. Stimulate until reaction sets 
in, cold to head, with quiet and rest, saline or croton oil 
purge. 6 
THE PHYSICIAN'S COMPANION. 
Sunstroke.-Sudden faintness, vertigo, coma. Stimu- 
lants, cold to head and spine, sinapisms to extremities, 
stimulating enemata, amyl nitrite by inhalation, nitro- 
glycerine. 
Convulsions in children due to gastric or intestinal irri- 
tation. Favor vomiting, give enemas, calomel and soda. 
At first use warm bath, then cold to head, quiet, etc. 
Convulsions of Epilepsy.-Cold to head : put cork be- 
tween teeth to prevent tongue from being bitten. Chloro- 
form, amyl nitrite. When seizure is over treat with bro- 
mides, alteratives, and tonics. It will pay you well to 
search for the exciting cause in every case of epilepsy. 
Many of these unhappy cases depend upon removable 
causes and are curable.. 
Puerperal Convulsions.-Bleed promptly, fully and 
fearlessly, chloroform, cold to head, and prompt delivery. 
After delivery, chloral and potass, bromide, with gelse- 
mium or veratrum viride, if necessary. 
Meningitis.-Fever, pain, delirium, intolerance to light 
or sound, coma. Calomel and jalap, croton oil, potass, 
iodide, blisters to nape of neck, or shave scalp and apply. 
Diseases of the Bladder. 
The chief bladder troubles commonly met with are Irri- 
tation and Cystitis. The acute and simple conditions are 
treated by rendering the urine bland and unirritating, rest 
to the organ and avoidance of errors of diet and exposure 
to cold and dampness. 
Cystitis of a chronic character, and due to retention of 
urine, prostatic disease, or stricture, requires relief by 
catheter, surgical removal of cause, and attention to the 
condition of the urine, washing out bladder with warm 
borax water, administration of benzoic acid, fid. ext. 
golden rod, etc. The value of benzoic acid is truly wonderful in these 
conditions of chronic cystitis with retained urine, for this 
urine, becoming highly ammoniacal, behaves like a caustic 
upon the coats of the bladder, and the benzoic acid pre- 
vents decomposition and renders the urine acid and inert. 
Dr. Bird recommends the following as of great service in 
chronic uric acid gravel: 
Carbonate of sodium 3 iss. 
Benzoic acid grs. xl. 
Phosphate of sodium 3 iij. 
Hot water ^iv. 
Dissolve and add- 
Cinnamon water 5 vijss. 
Tincture of hyoscyamus 3 iv. 
Take two tablespoonfuls three times a day. 
Diseases of the Kidney. 
The quantity of urine excreted by the healthy adult per 
day is between 30 and 60 ounces, slightly acid, which 
acidity is greatly increased by animal food and diminished 
by vegetable food. Specific gravity about 1020. 
Albuminuria.-Give patient milk, eggs, and diet rich 
in albumen. Avoid much lean meat; rest the body, and 
clothe so as to avoid all changes affecting the cutaneous 
circulation; keep skin and bowels moderately active. 
The iron tonics do much good in these cases. Buffalo 
Lithia Water is of great service not only in this trouble, 
but in a wide range of kidney, bladder, and blood 
troubles. In gout, rheumatism, and many forms of dys- 
pepsia it is a pleasant and potent remedy. 
Hcematuria.-If of a malarial origin, treat specifically 
with quinine and the usual tonics. When from sudden 
congestion or capillary weakness, use ergot, gallic acid, 
iron, turpentine, with local counter-irritation. 
PRACTICE. 
7 8 
Diabetes Mellitus.-See Diseases of the Blood. 
Diseases of the Liver. 
The chief forms of liver trouble encountered in daily 
practice are congestion and inflamm ition. The treat- 
ment consists essentially in relieving this very large gland 
of its undue quantity of blood and restoring secretion. 
To do this, rest is important, counter-irritation by cups, 
blisters, and leeches if necessary, while its action may be 
stimulated by calomel, blue mass, and ipecac, Epsom 
salts, senna, aloes, taraxacum, and cream tartar. 
Biliary Calculi.-Ether, hot hip-bath, olive oil, castor 
oil, &c. 
Jaundice.-Act upon skin, restore secretion-taraxa- 
cum, mineral acids, ammonia muriate, podophyllin, aloes, 
beef gall, acid bath, fruits and acids, exercise and counter- 
irritation. 
Diseases of the Gastro-Intestinal Tract. 
Gastritis.-Acute-pain, tenderness, loss of appetite, 
nausea, with symptomatic febrile disturbance-thirst, red 
tongue. 
Treatment: Clear the stomach of offending matter with 
a gentle emetic; rest, bland and liquid diet (mostly milk, 
ice, frozen cream); morphia, opium, bismuth, blisters, 
iodine, cups, leeches. 
Enteritis may be treated generally as gastritis, allow- 
ing fur anatomical differences, and paying greater atten- 
tion to rest for the bowels by opiates. 
The chronic form of both the above will require a 
modified form of above treatment, but on the same gen- 
eral principles. 
Dyspepsia.-Symptoms too numerous to attempt to de- 
scribe, but referable to the stomach and after eating. The 
THE PHYSICIAN'S COMPANION. PRACTICE. 
9 
most intractable is the nervous form, in which the patient 
is always uneasy, with indescribable symptoms. Here a 
careful attention to diet, exercise, and cheerful society 
will be worth everything. According to circumstances, 
acids or alkalies may be indicated, tonics, iron, gentian, 
pepsin, strychnia, bismuth. 
Colic.-Clear stomach of offending matters with emetic 
of ipecac and mustard. Then follow with purgative and 
anodyne. If due to flatulence, ammonia, brandy, alka- 
lies, peppermint, ether, &c. 
Diarrhoea. -Regulate action of liver. Calomel and 
Dover's powder in small doses, castor oil and laudanum, 
followed with gentle astringents and farinaceous and sim- 
ple diet, bismuth, mineral acids, &c. 
Dysentery.-Treat as for diarrhoea as to diet and gen- 
eral medication, and insist on rest in bed, poultices, blis- 
ters, astringent and opiate enema, castor oil and lauda- 
anum, bismuth, mercury, mineral acids, tannic and gallic 
acid, quinine, and supportive treatment-milk punch, beef 
essence, &c. 
Cholera.-Calomel in immense doses every quarter or 
half hour until liver acts ; ice and iced water in unlimited 
quantities ; rapid and diffusible stimulants ; restore cu- 
taneous circulation by sinapisms, warmth, &c. ; brandy, 
beef essence, milk punch. 
Hcematemesis.-Ice, digitalis, aconite, acid hydrocyanic 
dil,, rest, tannic acid, ergot, turpentine. 
Hceniorrhage from bowel.-Treatment similar. 
Hcemorrhoids.-Relieve conges'ion of the portal circu- 
lation, and constipation. Locally-tannin and glycerine, 
belladonna and opium ointment, sulphur ointment. Sur- 
gically-ligatures, injection with ergot, carbolic acid, &c. 10 
THE PHYSICIAN'S COMPANION. 
SURGERY AND SURGICAL EMERGENCIES. 
Probably more surgeons are deterred from active work 
by a fear of hemorrhage than from any other cause. It 
is, therefore, important that the student or practitioner 
should familiarize himself with the methods of prevent- 
ing and controlling unexpected hemorrhage. Many ope- 
rations are ill performed through a fear on the part of th,e 
operating surgeon that he might "cut an artery." We 
will therefore mention the methods of arresting hemor- 
rhage as they occur to us. 
They are the ligature, acupressure, torsion, cold water, 
hot water, the actual cautery, persulphate of iron, and 
other styptics. First and foremost, for the arresting of 
arterial hemorrhage, the result of the incision of an artery, 
is the ligature. It is presumed that the method by which 
a severed artery becomes contracted, so far as its middle 
coat is concerned, and thus attempts to arrest hemor- 
rhage itself, is understood by the practitioner. It will be 
seen, therefore, that the effort will be to so constrict the 
severed end of the artery as to enable a clot to be formed, 
and thus meet the end desired. Consequently the amount 
of force required in applying a ligature should be neither 
very great nor applied in a jerky, spasmodic manner. 
The object should be simply to apply the ligature suffi- 
ciently tight to partly or entirely sever the middle coat. 
It is impossible to go closely into details in a manual of 
this size, but we would advise all to fam liarize them- 
selves with them by tying a few arteries as soon as pos- 
sible. 
The material used for ligatures may consist of almost 
anything. Good waxed silk or catgut will meet every in- 
dication. Of late years catgut has been very much in 
vogue on account of its being quickly absorbable and en- SURGERY AND SURGICAL EMERGENCIES. 
11 
couraging the healing of wounds by the first- intention. 
Our experience has been in favor of silk, which should be 
rendered antiseptic by soaking in solution of bichloride 
of mercury. 
It should be remembered that for the immediate arrest 
of hemorrhage in the extremities we have a valuable aid 
in the compression afforded by contraction of the mus- 
cles. When limbs are flexed forcibly in this way, many 
hemorrhages can be at once stopped, thus allowing the 
surgeon time to prepare for more permanent treatment. 
The advantages of arterial sedatives, elevation, cold 
compresses, and styptics, where the bleeding is of general 
character, should not be lost sight of at any time. 
The administration of anaesthetics should also be care- 
fully studied by the surgeon before be commences any 
operation, for upon the safe and judicious administration 
of these agents will in a great measure depend the suc- 
cess of his work. Most southern surgeons prefer chloro- 
form simply, whereas ether, or a mixture of ether and 
chloroform, is used generally among our northern friends. 
With proper precautions we have found chloroform a very 
safe anaesthetic. We would advise, however, that the 
condition of the patient's heart be always examined, as 
well as his general nervous system. Undue fear should 
be taken into account, as this factor has been known to 
increase the risk. Where the heart and kidneys are 
sound, and the patient is hopeful and cheerful, it has been 
our custom to administer an alcoholic stimulant, with a 
minimum dose of morphia about fifteen minutes before 
giving the chloroform. An enema of chloral is an excel- 
lent preliminary to chloroform. The patient should be 
in the recumbent posture; the collar, waistband, &c., 
loosened, and a sufficient amount of air should be kept 
passing through the room. The anaesthetic should be THE PHYSICIAN'S COMPANION. 
12 
administered slowly and gradually, allowing a due ad- 
mixture of atmospheric air at the same time. It should 
be borne in mind that chloroform vapor is heavier than 
atmospheric air, and the idea of having an opening above 
for air to reach the patient through the inhaler is wrong. 
Use a cuff, napkin, or any stiff material folded in shape 
of a cone ; put a sponge or thin handkerchief in this, satu- 
rate with chloroform, and hold an inch or two above 
patient's nose, and allow air to come in under the inhaler. 
More attention should be paid to the respiration and the 
color of the patient's face than to the pulse-beat; but both 
pulse and respiration should be watched. In the event of 
the sudden cessation of the heart's action, you should be 
prepared to use the galvanic battery, nitrite of amyl, 
nitro-glycerine, and Nelaton's method, which consists in 
lowering the head and shoulders at once, and filling the 
brain with blood on hydrostatic principles. In chloroform 
narcosis pull the tongue forward to prevent its falling- 
back over the larynx. Do not shake or roughly handle 
the patient, and thereby insure his death, but practice 
artificial respiration cautiously. 
By selecting proper cases, using due care, and remem- 
bering the measures for restoring the patient, death from 
the administration of chloroform should be of very rare 
occurrence. 
Antisepsis.-At the present time another very impor- 
tant feature in successful surgery will be found in the 
application of antiseptic principles. While too much 
certainly has been claimed for antiseptics, there is, never- 
theless, some justification for the great enthusiasm in 
their favor exhibited by some of the first surgeons of our 
country. It is possible at the present day, by the obser- 
vance of certain well-defined rules, to perform a surgical 
operation of a grave character and heal the wound with- HEMORRHAGE FROM ACCIDENTS. 
13 
out the formation of a single drop of pus. This is the 
claim of antiseptic surgery, and it well merits the atten- 
tion cf all who desire to give their patients the benefit of 
advanced scientific progress. It is advisable, if possible, 
to render the patient and his surroundings, as well as the 
hands of the assistants, the sponges, &c., all antiseptic 
before the commencement of the operation by immersing 
in and washing with the solution of bichloride of mercury 
of various strengths, usually one to one, two, or three 
thousand parts of water. During the operation the in- 
cised portion should be sponged with this solution. In- 
struments should be rendered antiseptic by immersing in 
boiling water. After the operation the wound should be 
cleansed with it, antiseptic silk ligatures applied and cut 
off short, approximated with antiseptic sutures, dusted 
over with iodoform, and dressed with iodo'ormized gauze 
or bandage, thus hermetically sealing it and preventing 
the ingress of any external germs. A wound so treated 
will, in the majority of instances, heal by first intention. 
HEMORRHAGE FROM ACCIDENTS. 
Scalp Wounds.-If no large artery, temporal or occi- 
pital, bi wounded, pressure alone will be sufficient treat- 
ment. Clip the hair closely, cleanse the wound thorough- 
ly with antiseptics, bring the edges carefully together, 
dust over with iodoform, place a pad of dry lint upon 
the wound, and apply a bandage. Should one of the 
arteries be partially divided, sever it completely and 
apply pressure. It is not usual to put stitches in a scalp 
wound, although, under certain circumstances, this may 
be safely done. 
Wounds of the Face.-These are disposed to bleed 
freely. The ligature, compress, and collodion will be found 14 
THE PHYSICIAN'S COMPANION. 
serviceable. Sutures should be of light material, so as 
to cause no disfigurement. Adhesive plaster may be re- 
lied upon in these injuries to a considerable extent. 
Cut Lip.-The lip is frequently cut by a fall driving it 
upon the teeth. Hemorrhage from division of the coron- 
ary artery is sometimes profuse. The introduction of the 
hare-lip pin and the use of the twisted suture is an excel- 
lent method of closing the wound and arresting the 
hemorrhage. Collodion may be applied over the wound. 
Nose Bleeding.-This may frequently be checked by 
the upright position, the application of cold water, the 
administration of ergot, spirits of turpentine, &c. Pow- 
dered alum may be snuffed up the nose or blown in with 
an insufflator. Solution of bromide of potassium is very 
valuable applied locally. Where the bleeding is intracta- 
ble the nostrils should be plugged anteriorly and poste- 
riorly. 
Bitten Tongue.-Hemorrhage may be secured by tor- 
sion or the actual cautery. Ligatures and sutures do but 
little good in this position. 
Ruptured Frccnum.-Snip the little artery of the fraenum 
across with a pair of scissors. Bleeding will cease at once. 
Wounds of Arteries.-Stop the immediate flow of blood 
b pressure above the seat of injury ; cleanse the wound 
and look for the bleeding point. Apply a ligature or tor- 
sion. If the artery is large and it is impossible to find it, 
it may be necessary to ligate above. Sometimes it is well 
to secure bleeding by the graduated compress, which 
consists in opening the wound and packing in from the 
bottom continuous pledgets of lint, securing the whole 
with roller. Elevated position of the limb, arterial seda- 
tives, &c., will assist in preventing further hemorrhage. HEMORRHAGE FROM ACCIDENTS. 
15 
Wounds of the Palmar Aich.-These are not so diffi- 
cult as many claim. Frequent'y the artery can be found 
and twisted, though binding the hand upon a back splint 
and using sufficient pressure will answer every purpose. 
If pressure does not stop the hemorrhage, tie both radial 
and ulnar arteries. 
Hemorrhage from the Rectum.-Dilate with a specu- 
lum ; touch the bleeding point with nitrate of silver, or 
the actual cautery, and plug the rectum with lint, tannic 
acid, &c. 
Hemorrhage from the Bladder.-Tincture of iron, 
ergot, gallic acid, benzoic acid, astringent injections into 
the bladder, with ice in the rectum and over pubes. 
Rupture from Varicose Veins.-Elevation of the limb ; 
use compress secured by bandages from below up to 
and above the rupture ; abso'ute quiet. 
Esmarch's Bandage. 
We would advise all who have not one to possess them- 
selves of one of these bandages and some elastic tubing. 
This may consist of ordinary Martin's elastic bandage, 
which can be bought for a trifle, and three or four feet of 
India rubber gas tubing. By applying the elastic bandage 
with a reasonable degree of tension, all blood may be 
driven out of the extremities and its return prevented by 
making one or two wraps with the tubing at the point to 
which the bandage has been carried. This allows the 
surgeon to perform an absolutely bloodless operation, 
and to quietly and carefully examine any injured portions. 16 
THE PHYSICIAN'S COMPANION. 
In simple fracture the bone is merely broken into two 
pieces. In comminuted fracture it is broken into several 
pieces. In impacted fracture fragments of bone are 
driven into one another. A fracture is compound when 
it communicates with an open flesh wound. It is com- 
plicated when the bone is not merely broken, but when 
some large vessel or other organ is injured as well. 
Fractures are transverse, longitudinal, oblique, &c., ac- 
cording to the direction of the fissure. Fractures are 
complete when the bone is broken entirely ; incomplete 
when there is partial breakage and partial bending. This 
bending occurs only in young persons. 
The special features of fracture are deformity, unnat- 
ural mobility, and crepitus or grating, and usually short- 
ening. With these signs there is sometimes pain and 
swelling. When all these signs are present they prove 
that fracture has taken place, but the surgeon must not 
expect to find them all equally well marked in every 
case. Deformity is caused either by the direct violence 
of the blow or by subsequent muscular action. The 
surgeon should use the tape-line to avoid being deceived 
by apparent deformity. He should bear in mind also 
the attachments of the various muscles, and the effect 
that would naturally be produced by their contraction. 
If the surgeon grasps the injured bone he finds unnatural 
mobility, broken fragments moving freely one upon 
another. 
The most important sign is crepitus, the grating which 
is produced by rubbing the broken ends of the bone 
together. This grating may be both felt and heard. 
When present it is an unmistakable indication of fracture. 
Crepitus cannot, however, always be heard or felt, for 
FRACTURES. FRACTURES. 
there may be impaction of fragments ; and it should not 
be presumed that a fracture does not exist because crepitus 
cannot be obtained. 
When the fragments of broken bone are kept in appo- 
sition union takes place by the deposit of new bone 
around and between them. Such new bone is called 
callus. That which is formed first, and which is generally 
very abundant, is termed provisional callus, while that 
which remains ultimately, after a good deal has under- 
gone absorption, is termed the definitive callus. 
When a simple fracture occurs the injury itself sets up 
inflammation in the surrounding tissues, and this inflam- 
mation is of the adhesive kind. Plastic lymph is poured 
out, forming a thick and dense sheath- a sort of natural 
splint around the broken fragments. Between the ends 
of the bones the same plastic material is effused, and the 
medullary canal is filled up and obliterated by it. Grad- 
ually the effused lymph becomes developed into bone. 
Although the bone is firmly united by the end of about 
six weeks or two months, it is not reduced to its normal 
shape and size until after the lapse of some considerable 
time. The superfluous callus undergoes gradual absorp- 
tion, a fibrous periosteum is formed, a medullary canal 
is established, and at length the bone returns almost en- 
tirely to its natural state. 
When broken bones are kept in accurate apposition- 
when they are covered by little more than their own 
periosteum-provisional callus is small in quantity. 
Treatment of Fractures.-In treating all fractures our 
aim should be to reduce the fragments to their proper 
position, and to keep them in such position until nature 
has effected their union. It is important, therefore, to 
reduce the fragments at the earliest possible moment, 
and thus endeavor to prevent muscular contraction and 
17 18 
THE PHYSICIAN'S COMPANION. 
injury to the soft parts. Where there is great rigidity of 
the muscles, and the fragments have been unreduced for 
some time, chloroform will be found a valuable aid. 
When the fragments have been reduced the limb should 
be placed in the most favorable position to prevent con ■ 
traction. To this end bandages, splints, and mechanical 
appliances will have to be used. 
Bandages and splints may be constructed of various 
materials. For splints we have wood, leather, felt, gutta 
percha, binders' board, and almost any light article ; and 
besides these we have plaster of Paris, starch, &c., for 
making immovable splints, bindings, &c. Bandages, or 
rollers, as they are sometimes called, are of several dif- 
ferent kinds. Those most commonly used are made of 
unbleached cotton or calico. Some are composed of 
woven cotton fabrics, and pass under the name of elastic 
or cotton bandages. Others are made of flannel. Some- 
times oarse muslin or crinoline roller is required in the 
application of plaster of Paris or starch. Bandages are 
classed under three heads, and, according to their length 
and breadth, are spoken of as arm bandages, leg band- 
ages, and rib bandages. They are suitable for other 
purposes, of course. The arm bandage should be two 
inches wide by eight yards long; the leg bandage two 
and a half inches wide by ten yards long, and the rib 
bandage five inches wide by twelve ya'ds long. These 
are the dimensions into which bandages are usually cut, 
and which will be found most generally useful in prac- 
tice, but they may be made broader, narrower, longer, 
or shorter, according to the purposes for which they are 
intended and the situation to which they are to be ap- 
plied. They should be cut off as soon as their object 
has been attained, as there is no advantage in any un- 
necessary turns of a roller. When a bandage is rolled FRACTURES. 
19 
from one end only it is called a single-headed bandage ; 
when it is rolled from both ends it is called a double- 
headed bandage. Sometimes we desire a bandage to 
contract, a little upon the part to which it has been 
applied, so as to keep up a slight degree of pressure, or 
to afford some slight support. Then we must have re- 
course to an elastic cotton or flannel bandage. These 
may very properly be applied to an cedematous limb, to 
support varicose veins, or to promote absorption of the 
thickening and effusion that frequently remain consequent 
upon fractures or other injuries. A flannel bandage has 
special advantages. It is capable of absorbing moisture, 
it retains warmth, and its surfaces adhere to one another, 
so that it keeps its place better than other kinds of roller. 
Bandages should be made of one continuous piece, 
without any joining ; the selvages should alw'ays be torn 
off. If blood has been extravasated, its absorption may 
be promoted by the exhibition of spirituous lotions. If 
the swelling becomes great--so that splints and bandages 
interfere seriously with the circulation, and the extremi- 
ties in consequence become cold and blue-the bandages 
must be loosened at once, or gangrene may supervene. 
The starch bandage may be appli.d as follows : Starch is 
to be mixed with water until it forms a thick paste ; a 
little spirit is added to hasten its drying. A cotton roller 
is then saturated with the paste. The surgeon should 
keep a basin of paste at hand, and while he is app ying 
the bandage it would be well for an assistant to smooth 
a little more of the extra paste over it. The bandage 
should be applied just as an ordinary roller. The whole 
surface of the limb should be covered with at least two 
layers of bandage ; and if, after this, there are any parts 
which appear weak, they should be strengthened by short 
straps of bandage or lint in order to give the necessary 20 
THE PHYSICIAN'S COMPANION. 
support. Before applying either the starch or the plaster 
of Paris we prefer to apply next to the limb, for purposes of 
protection, either layers of cotton-wool or a flannel roller. 
In applying plaster of Paris to the leg we often put on 
a long, close-fitting stocking, which protects the limb well, 
and furnishes a good hold for the plaster. What we have 
said of the starch bandage will apply almost equally as 
well for the plaster. Of course it requires much greater 
speed in application of the plaster on account of its 
quicker setting ; though to a man of average intelligence 
or of any mechanical tact but little instruction should be 
necessary as regards the details attendant upon the man- 
agement of either bandages or other mechanical appli- 
ances necessary to the treatment of fractures. There are 
many points which will arise in individual cases that can 
be better treated on their own merits than by any instruc- 
tion derived from text-books. 
The limb should be kept thoroughly still, and until the 
bandages have become thoroughly dry and hard. It will 
take eight or ten hours for a starch bandage to dry thor- 
oughly, and from one to two hours for plaster of Paris. 
Before putting on splints of any kind, it is proper to 
bandage a limb nicely with a first roller, as this ensures 
against undue muscular contraction, and obtains uniform- 
ity of pressure. 
What we have said above applies to all fractures of the 
extremities. We will only mention specifically a few 
fractures which require special consideration. 
Fracture of the Skull, with depression, constitutes the 
most serious injury to which a patient is liable. Here 
immediate operative interference is demanded. An in- 
cision should be made through the scalp of sufficient size 
to allow of a thorough inspection of the seat of injury. 
The depressed bone should be lifted. Spiculae of bone FRACTURES. 
21 
and blood clots should be removed from the brain. The 
parts should be cleansed, antiseptically treated, and the 
scalp wound closed by sutures and covered with a com- 
press. Of course the general condition of the patient 
must be carefully witched ; quiet insisted upon ; diet kept 
light and unstimulating, and the least tendency to an in- 
flammatory condition guarded against promptly. 
Fracture of the Bones of the Face.-The nasal bones 
are not unfrequently broken by direct violence. The 
bridge of the nose is depressed, and the whole organ 
looks flat and broad. The depressed bones should be 
lifted by a director or other suitable instrument, and re- 
tained in their proper position by a roll of lint intro- 
duced into the nostril, while strips of plaster are placed 
outside. 
Fracture of the Lower Jaw.-The most usual seat 
of injury is near the bicuspid tooth. The diagnosis is 
easy. The mental portion is depressed, while the ramus 
is drawn upwards or inwards. Crepitus is distinct. The 
point of fracture can be felt. The gums are lacerated, 
and the saliva dribbles from the half open mouth. In 
this the te;th which are only loosened should be left and 
secured in their places by silver wire. Teeth which are 
entirely loose and fragments of detached bone had best 
be removed. When the fragments have been restored to 
their proper places or removed, and the teeth brought 
into line, the jaw should be fixed in its position by mould- 
ing binder's board or gutta percha splints over it, the 
same being secured by a proper roller Under the head 
of "Fracture of the Lower Extremity of the Humerus," 
we describe the best dressing for fractured jaw. 
These cases are usually fed on liquid diet. This may 
be sucked through an opening where one or more teeth 22 
THE PHYSICIAN'S COMPANION. 
may be absent, or through a rubber tube ; mush and gruel 
being taken as soon as possible. 
Fracture of the Ribs.-This Ls indicated by sharp local 
pain, aggravated by the drawing of a long breath, and 
great tenderness on pressure. Crepitus may sometimes 
be felt or heard, and a depression detected in the outline 
of a bone. When the injury is confined to one side the 
broken ribs should be supported with broad strips of ad- 
hesive plaster passing half round the chest. In this way 
they are kept at rest, while the respiratory movements of 
the sound side are not interfered with. But when ribs on 
both sides are broken a broad roller should be applied in 
circular turns around the chest, beginning from below and 
gradually ascending, each fold overlapping about one 
third of the preceding one. The bandage should be 
drawn sufficiently tight to give a firm and even support 
to the whole chest; and in order to retain it in its place 
a separate strip of calico should be placed around the 
neck in the form of a brace, with ends coming down in 
front as low as the bandage extends. These ends should 
be stiiched to each circular turn of the bandage. 
In all cases in which the point of a rib or the fractured 
bone has been driven in upon the pleura or lung, or other 
important organ, the surgeon should not hestitate to cut 
in and promptly remove this great source of immediate 
danger. 
Fracture of the Clavicle.-This usually occurs about 
the middle of the bone, and sometimes n ar the acromial 
end. When the seat of fracture is near the acromial end 
the signs are not well marked, but when it is about the 
middle there is displacement which is very characteristic. 
The outer fragment is drawn downwards and inwards. 
This is owing partly to the weight of the arm, and partly 
to the action of the pectoralis minor and subclavius. FRACTURES. 
23 
When the clavicle is broken near its acromial end all that 
is needed is to put a figure of eight bandage around the 
shoulders, and to support the elbow and forearm in a 
sling. In this way we raise the point of the shoulder and 
draw it outwards and backwards, these being two leading 
indications in treatment. When the fracture is situated, 
as it generally is, about the middle of the clavicle, there 
are then three points to which special attention should be 
paid. The shoulder should be drawn back by a figure of 
eight bandage, the point of the shoulder kept out by a 
pad placed in the axilla, and the elbow and forearm well 
supported in a sling. Another method is to fasten the 
arm back by strips of adhesive plaster carried around the 
arm and fastened on the back, then carry the band over 
upon the opposite shoulder and fasten it there with adhe- 
sive plaster. 
Fracture of the Humerus.-This bone is occasionally 
though rarely broken at the anatomical neck-that is, 
just within the line of insertion of the capsule. This is, 
of course, an intra-capsular fracture. The signs of the 
injury are obscure. There is pain, swelling, loss of power, 
the outline of the upper end of the bone is irregular, and 
if the fracture is impacted there is a slight degree of 
shortening. It s unetimes happens that the greater tube- 
rosity is broken off. In this case the shaft and head of 
the bone are drawn upwards and inwards, while the 
greater tuberosity is carried upwards and outwards. By 
this displacement the breadth of the shoulder is increased 
to a remarkable degree, and the separation of the frag- 
ments is very distinct. We have also fracture at the sur- 
gical neck, which lies between the tubercles above and 
the insertion of the latissimus dorsi and the associated 
mus des below. In this accident the upper fragment is 
turned upwards and outwards by the muscles which are 24 
THE PHYSICIAN'S COMPANION. 
inserted into the greater tuberosity, while the lower frag- 
ment is drawn upwards and inwards by the deltoid and 
the pectoralis major. Sometimes the head of the bone 
remains in its right place, but below it there may be a 
depression. The lower fragment points beneath the skin 
in the direction of the coracoid process, the limb is short- 
ened, and crepitus can easily be obtained. 
Fractures which occur about the shoulder-joint are ex- 
tremely difficult to diagnose with accuracy, and in prac- 
tice it is ro easy task to determine the precise nature of 
the injury, though for practical purposes these nice dis- 
tinctions are of no special importance. 
Fracture of the Anatomical Neck, and where there is 
separation of the greater tuberosity, require principally 
that the arm should be kept at rest and supported in its 
natural position. As soon as the acute symptoms have 
been subdued it is usual to envelope the shoulder and 
upper arm in a leather or gutta-percha cap, and to place 
the forearm in a sling, which must support the elbow 
without pressing it upwards. The shoulder cap should 
be large enough to fix the parts thoroughly and to keep 
them perfectly still. To do this it should extend from 
the middle of the clavicle nearly to the lower end of the 
humerus, and should be moulded upon the shoulder and 
arm accurately and uniformly. This mould should be 
softly and smoothly lined with some soft material, and 
have holes pierced through it to admit of ventilation and 
to add to its lightness. The whole should be secured 
with a light roller. 
Fracture through the Surgical Neck and fractures 
through the epiphysis generally present some displace- 
ment, and require accordingly other appliances. Here 
the object is not only to keep the parts perfectly at rest, 
but also to press the lower fragment outwards, for it has FRACTURES. 
25 
a tendency to be drawn upwards and inwards by muscu- 
lar contraction. Under these indications the splint should 
be put on the outside of the arm, and be long enough to 
reach from the shoulder to the elbow, s > as to fix the 
whole length of the humerus. A second shorter splint is 
then placed on the inner side of the arm, so as to push 
the lower fragment outwards and keep it in its proper 
position, and in order to carry out this object more 
efficiently it may be necessary to apply a smaller pad 
over the point of fracture. Whatever splints are used 
should be well padded, and there should be additional 
padding above the condyles, so as to prevent any undue 
pressure upon these prominences. These splints may 
be secured by bands or webbing encircling the limb and 
fastened upon the outer side by buckles. This makes 
the splint lighter and cooler. After the splints have been 
applied the upper arm should be fixed by a few turns of 
a roller passed around the chest. The hand and wrist 
should then be supported in a sling, but do not include 
the elbow, as we desire the weight to assist in bearing 
down the lower fragments; indeed, the arm can be 
allowed to hang down and make extension by its weight. 
Fracture of the Shaft of the Humerus.-The arm 
should be first bandaged from the hand upwards. A 
splint should be placed at the outside extending from the 
shoulder to the elbow. A second shorter splint should 
next be fitted upon the inner side of the arm, and if 
needed one or two smaller ones may be placed anteriorly 
and posteriorly to correct any displacement. The arm, 
of course, should be first bandaged from the hand upwards 
above the seat of fracture. After the splints have been 
adjusted the hand and wrist should be carefully supported 
in a sling. We prefer the use of binders' board or plas- 26 
THE PHYSICIAN'S COMPANION. 
ter of Paris in these injuries. Either may be easily and 
quickly applied, and they afford every necessary support. 
Fracture of the Lower Extremity of the Humerus.- 
These fractures are either comminuted or compound, 
and are frequently associated with dislocation. On ac- 
count of the rapid inflammation which usually sets in, it is 
difficult, oftentimes, to discover the precise nature of the 
injury. The treatment will be about the same in either 
case. Active inflammation must be treated by fomenta- 
tions, cold lotions, leeches, &c.; simply laying the arm 
upon a pillow, without any appliances or bandages, &c. 
After the inflammation has subsided, the arm should be 
bent to rather less than a right angle, so as to give the 
most useful member in the event of anchylosis. A rect- 
angular splint should then be applied on the inner side 
and fastened by straps of webbing or buckles, or by 
bandages. A good splint for this kind of work is one 
made of iron or perforated zinc, and jointed at the elbow, 
so as to allow us to make any angle that we may desire. 
If necessary, the rectangular splints may be applied on 
each side of the limb, though where the outer one can be 
dispensed with it is better. Over prominences these 
splints should be well padded. After the apparatus has 
been adjusted, the forearm must be supported in a sling. 
Here, as in other fractures of the humerus, nothing 
comes in so well as the plaster of Paris bandage, which 
may entirely encircle the limb, or be put on in sections. 
While upon this subject, we will describe a method of 
making a plaster bandage suitable for a number of frac- 
tures where accurate moulding is desirable. Cut from 
three to seven or more pieces of crinoline or stiff muslin, 
and into each piece rub an abundance of plaster of Paris 
with the hand, laying one piece upon another until you 
have a layer of the proper thickness all charged with the plaster. Roll the whole over lightly ; place it in a ba^in 
of hot water until it becomes thoroughly saturated ; then 
unroll, spread it out smooth in this condition, apply to 
the limb, or wherever it is required, moulding it accurate- 
ly, and pass a roller over it to keep it in exact position. 
In ten or fifteen minutes this will become sufficiently hard 
to take off and trim, pad, &c., and we have a firm splint, 
accurately adapted to the parts, and which may be taken 
off from time to time, in order to examine or dress the 
parts, if necessary. 
In fractures of the shoulder-joint, or, in fact, of any 
portion of the arm or forearm, the bones of the leg in 
children, fractures of the lower jaw, and other minor 
fractures, we recommend this appliance, and over all 
others that we have already mentioned. 
If the fracture is compound, and the opening into the 
joint is but slight, an attempt may be made to save it by 
continuous application of cold, or by antiseptic treatment; 
but if the joi it is freely opened, excision or amputation 
must be considered. 
Fracture of the Forearm.-The olecranon may be 
broken either by external violence or by muscular action. 
In simple fracture of this bone the forearm should be kept 
extended by means of straight splints on the anterior sur- 
face. The splint should extend from the middle of the 
upper arm to the middle of the forearm, and be well 
padded. It is well, also, to place a small pad on the back 
of the arm just above the elbow, to assist in drawing down 
the upper fragment. In this fracture the plaster of Paris 
bandage comes in admirably. The union of this bone is 
not always satisfactory, and it is well for the surgeon to 
warn the patient of the fact. 
Fracture of the Middle of the Forearm.-Both bones 
may be broken, or only one. When both are broken, 
FRACTURES. 
27 28 
displacement and crepitus make the diagnosis easy. 
When one only is broken, it may be more difficult to de- 
termine the exact nature of the injury. Fractures about 
the middle of the forearm, whether of one or of both 
bones, should be treated by placing the arm in the mid- 
position between pronation and supination, and fixing a 
straight splint on each side. The splint should be a little 
broader than the arm, and long enough to support the 
whole arm. The inter-osseous space should be carefully 
preserved by placing a proper amount of padding, or lay- 
ing a compress between the bones. After the arm is put 
up, it should be carried in a sling, or leather or binder's 
board trough, which will support the entire arm and hand. 
Fracture of the Lower End of the Radius.-This is 
known as Colles' fracture, and special care must be taken 
in its treatment. It must be carefully distinguished from 
dislocation of the wrist, which is a very rare accident, 
while fracture is very frequent. The conspicuous symp- 
toms are a distinct prominence on the dorsal aspect of 
the wrist, which looks as if dislocation backwards had 
occurred. Corresponding to this, on the palmar surface, 
is a well-marked depression, and above this again there 
is another prominence similar but less distinct than that 
on the dorsal aspect. The hand is thrown a little towards 
the radial side, and the styloid process of the ulna be- 
comes remarkably prominent. The prominence on the 
dorsal aspect is due to the lower fragment of the radius, 
which is thrown backwards on to the lower end of the 
upper fragment, carrying the carpus along with it. This 
also explains the palmar depression. The prominence 
of the palmar aspect is caused by the lower end of the 
upper fragment. The obliquity of the hand and the pro- 
jection of the styloid process of the ulna are due to mus- 
cular action, and are brought about by the contraction of 
THE PHYSICIAN'S COMPANION. FRACTURES. 
29 
the supinator longus, the extensors of the wrist, and the 
pronator quadratus. In this fracture it is advisable to 
make as much extension as possible, and to strongly 
bend the hand over towards the ulnar side. As a reten- 
tive apparatus, a pistol splint has been recommended. 
This should reach from the elbow to the roots of the 
fingers. It is generally placed on the anterior aspect of 
the limb, or, if necessary, it may be applied on the pos- 
terior aspect. It should be secured by means of an arm 
bandage. The arm may be carried in a sling. In our 
own practice we have had good results, and never trouble 
the patient with wearing the pistol splint. We have sim- 
ply preserved the inter-osseous space by carefully using 
the proper compress, or pads and two straight splints. 
Fractures of the Metacarpal Bones and Phalanges.- 
These are generally detected by the history of the injury, 
loss of power, pain, and crepitus. The best mode of 
treating the fracture of metacarpal bones is by laying the 
extended hand upon a wooden or gutta-percha splint, cut 
to the parts. 
Fractures of the Pelvis.-These fractures are often 
complicated with injury to the internal organs, which 
makes them very serious. Very often there is fracture of 
the rami of the pubes, or ischium, or the sacro-iliac articu- 
lation. We have pain, inability to stand or walk, unnatu- 
ral mobility, and crepitus. The complications that are 
most likely to arise are rupture of the bladder or urethra, 
with extravasation of urine, laceration of the rectum, or 
fracture through the acetabulum. A catheter should be 
passed to ascertain the condition of the urethra or bladder. 
A broad bandage or padded belt should be placed around 
the hips, the knees should be tied together, and the patient 
kept perfectly quiet. THE PHYSICIAN'S COMPANION. 
30 
Fractures of the Upper Extremity of the Femur are 
divided into intra-capsular and extra-capsular. The former 
is almost peculiar to persons over fifty years of age, and 
arises from very slight causes, such as tripping or stum- 
bling. We have pain, loss of power, crepitus, absence of 
the natural prominence of the trochanter, and shortening 
and eversion of the leg. Impaction may obscure these 
signs. The union of these fractures is usually fibrous. 
It is seldom necessary to use any splints. The patient 
should be kept in a recumbent position for ten or fourteen 
days, and then be allowed to get up and move around on 
crutches. He will probably be slightly lame for the rest 
of his life, but with the help of a stick he will walk 
very well. In the latter (extra-caps dar) the injury comes 
on before the age of fifty ; the symptoms resemble those 
of the foregoing, but are more strongly marked. In this 
case we aim to get bony union A broad bandage should 
be passed around the hips so as to prevent movement 
between the fragments. The limbs should be then ex- 
tended, and fixed in that position by means of the long 
splint. 
Fractures of the Shaft of the Femur. -Diagnosis is 
simple. There is deformity, pain loss of power, crepitus, 
shortening and eversion. This may be treated either by 
the long splint or by the double inclined plane. The long 
splint is the more valuable, and will be required in the 
majority of cases. The splint should be long enough to 
reach from the fold of the axilla to about four inches be- 
low the foot. It should be pierced with two holes near 
its upper end, and at its lower end it ought to be deeply 
notched. It should be well padded, and it is advisable to 
carry the pad over the upper end of the splint, so as to 
prevent it from galling the skin of the axilla. The pad 
should be pierced with holes corresponding to those in FRACTURES. 
31 
the splint, so that the perineal band may slip through it 
easily and be loosened or tightened at pleasure. In ap- 
plying this splint the surgeon should be supplied with a 
piece of strong tape, a silk pocket handkerchief, or some 
other strong, soft material long enough to pass from the 
upper end of the splint around the perineum back to the 
same point, to be tied in a bow. This constitutes the 
perineal band, and it should be well padded where it 
presses upon the perineum. 
Having applied the perineal band, the splint must then 
be laid along the outer side of the affected limb, and the 
foot must be fastened to the lower end of it. In doing 
this it is a good plan first to bandage the foot and ankle 
in the ordinary way, to protect them from the pressure of 
the splint and to prevent their swelling; or, instead of 
this, the foot may be enveloped in a layer of cotton wool. 
The surgeon should then take a leg bandage and make 
a tew turns around the foot and ankle in the form of a 
figure eight, so as to obtain a firm hold, after which he 
should carry the roller in the regular way around the 
ankle and through the notches in the lower end of the 
splint, so as to fasten it securely to the foot. Then he 
should get an assistant to make extension from the foot 
while he draws the perineal band tight and ties it in a 
bow on the outer side of the splint. In order to keep the 
parts in position it is sometimes necessary to apply a 
bandage over both the leg and the splint, and also to put 
a few turns of a broad roller around the pelvis and chest. 
It is useless to add that all bony prominences should be 
thoroughly protected by padding, and that before put- 
ting on any apparatus the entire limb should be well 
bandaged from the toes to above the seat of fracture. 
Much can be done by attending to the position of the 32 
limb, supporting it by pillows, sand-bags, and other 
appliances alongside and underneath it. 
Extension should be looked after throughout the treat- 
ment of this fracture, which may be further ensured by 
the application of pulley weights and sand-bags to the 
feet and extending over the end of the bed. 
Fracture of the Lower Extremity of the Femur.- 
When the femur is broken near its lower end great care 
should be taken to keep the limb at rest, so as to pre- 
vent, as far as possible, any inflammation of the knee 
joint. The simpler cases of this fracture are very well 
treated by Liston's long splint and the perineal band. If 
the injury is more severe, or the patient very restless, 
McIntyre's splint or Salter's swing may be used. It must 
be remembered that in severe injuries of this kind an- 
chylosis make take place. The surgeon should so warn 
his patient, and at the same time remember that a slight 
degree of flexion at the knee is the position that will leave 
the patient the most serviceable limb. Plaster of Paris 
comes in well in this case. 
Fracture of the Patella.-The symptoms are inability 
to stand, or to extend the joint, with crepitus. We have 
never found it necessary to wire the patella, or use hooks, 
or resort to any barbarous method. Extend the limb 
and bandage well, using a figure of eight bandage at the 
knee ; put on a back splint, elevate the foot and leg so as 
to relax the muscles, and as soon as possible put on a 
plaster cast from the foot well up over the knee-joint. 
Let the patient walk on crutches. 
Fractures of the Leg.-In simple fractures of both 
bones, if there is very little swelling or displacement, we 
may place the patient in bed for a few days, with the leg 
laid between sand-bags. If we have no fear of inflamma- 
THE PHYSICIAN'S COMPANION. FRACTURES. 
33 
tion or swelling we can apply the plaster of Paris bandage 
and let the patient go about on crutches. In all ordinary 
cases of simple fracture of both bones a very good plan 
is to apply two side splints, with foot pieces, the splints 
being well padded, and secured above and below the 
seat of fracture by broad strips of plaster or by a few 
turns of the roller. A common fracture box has certain 
advantages. It consists of a long box with foot pieces 
and hinged sides, in which the leg is well packed in bran 
or in some similar material. This will be found especially 
serviceable in compound fractures. 
Fractures about the Ankle-Joint.-When the foot is 
violently twisted outwards, the fibula is apt to give way 
about two or three inches from its lower end, and such 
fractures are frequently attended with more or less injury 
to the ankle-joint. In simple cases, where the fibula alone 
is broken, the leg should be laid upon a pillow for a few 
days, and then the fracture can be put up with strapping 
and bandage, with a starch or a plaster bandage. If, in 
addition to the fracture, we have laceration of the external 
lateral ligament and fracture of the internal malleolus, it 
will be necessary to confine the patient to bed and keep 
the leg at rest by some kind of apparatus. When the 
fibula is broken and the internal ligament ruptured, the 
foot not unfrequently suffers, and partial dislocation out- 
wards takes place, being known as Pott's fracture. The 
same thing may happen with the internal malleolus when 
splintered off. The toes point outwards, and the external 
edge of the foot is turned slightly upwards. As this dis- 
placement is due in part to the action of the muscles 
which pass under the outer malleolus, our object must be 
to relax them. With this view, the ankle should be 
moderately bent, and then the leg may either be laid 
upon its outer side, on a side splint, or fixed between two 34 
THE PHYSICIAN'S COMPANION. 
side splints, with foot pieces; care being taken to apply a 
roller in such a way that the outer splint shall press the 
foot inwards towards the middle line. Dupuytren's splint 
is an excellent application here. It is an ordinary straight 
wooden splint about three inches broad, and long enough 
to extend from the knee to a short distance below the 
sole of the foot. It should be well padded, so as to 
adapt itself to the inside of the leg, the pad being espe- 
cially thick and firm where it fits into the hollow above 
the internal malleolus. The splint is applied along the 
inner side of the leg, at its upper end, by a few turns of a 
roller. The foot is then bent over the thick portion of 
the pad, which serves as a fulcrum and presses outwards 
the upper end of the lower fragment, and retained in this 
position by broad strips of plaster or by a bandage. The 
limb with the splint affixed may be semi-flexed upon its 
outer side on a pillow, or upon its inner side. 
Frachires of the Tarsal and Metatarsal Bones.-These 
are generally the result of great and direct violence, and 
no broadly marked rules can be laid down for the guid- 
ance of the surgeon. We would advise placing the in- 
jured part in the most natural and comfortable position, 
giving attention to any comminuted wound or threatened 
inflammation. As soon as possible secure the parts in 
as perfect apposition as possible by a roller, sand-bags, 
splint, or retentive apparatus that may be moulded to the 
parts. 
Where the calcaneum is broken a gutta-percha splint 
should be moulded upon the heel, and the leg flexed so 
as to relax the muscles When the tendo Achillis is rup- 
tured the leg should be well flexed and kept so by a cord 
fastened to the heel of the patient's slipper and connected 
with a bandage around the thigh. After either of these 
latter injuries a high-heeled shoe should be worn for some DISLOCATIONS. 
time on the injured foot when the patient commences to 
walk. 
DISLOCATIONS. 
This signifies the misplacements of bones entering into 
the composition of joints. Distal bone is said to be dis- 
located from the proximal. Dislocations may be partial 
or complete, simple or compound, or may be complicated 
with f acture. They are most common in adult life ; the 
bones of young people are more apt to break. The signs 
of dislocation are distortion of the limb or part, loss of 
power, immobility, and an irregular and unnatural outline 
of the joint. Sometimes there is lengthening, and at 
others shortening. Dislocation is, of necessity, attended 
with rupture of the capsule of the joint, or the ligaments, 
and laceration of the soft tissues. Dislocation should be 
reduced as quickly as possible. The aim of all treatment 
is to bring the articular surfaces into such a position that 
the muscles may be able to restore them to their proper 
places. The great difficulty is in overcoming the contrac. 
tion of the muscles. In simple cases this may be done by 
manipulation with the hands. In others it is necessary to 
make use of pulleys, chloroform, &c. 
Dislocations may be distinguished from fractures by 
attention to the following points, viz: Absence of crepi- 
tus. The dislocated part is usually fixed and immovable, 
whereas in fracture there is unnatural mobility. A frac- 
tured bone may be easily replaced, but there is great diffi- 
culty in keeping it in position whereas when a dislocation 
is once reduced it remains in place. 
A broken bone is generally shortened, but one dislo- 
cated is unaltered in length. When fracture and disloca- 
tion co-exist, the rule is to put up the fracture firmly in 
splints, and then reduce the dislocation. 
35 THE PHYSICIAN'S COMPANION. 
36 
Dislocation of the Lower Jaw.-The chin is protruded ; 
the mouth is open; speech and deglutition are very im- 
perfect; saliva flows from the mouth, and the condyle can 
be felt under the zygomatic arch. When one side only is 
displaced the signs are less distinct; the chin is then 
pointed to the sound side. Place two corks or rubber 
stoppers on the inside of the molar teeth on both sides ; 
press the chin up, and the angles of the jaw down and 
backwards, and the bone can be ridden back into its 
socket easily. The chin should be bandaged for a few 
days to prevent recurrence. 
Dislocation of the Clavicle.-The sternal end may be 
disp'aced either forwards or backwards-in front of the 
sternum or behind it. Put a pad in the axilla and draw the 
shoulder back, as in fracture. Keep the end of the bone 
in place by suitable pads and bandages. The outer end 
of the bone is generally dislocated upwards on the acro- 
mion. Treatment may be conducted on the same princi- 
ples as in the preceding case. 
Dislocation of the Shoulder.-The shoulder is liable to 
four dislocations-downwards into the axilla; forwards 
beneath the clavicle; backwards on the dorsum of the 
scapula ; a partial dislocation forwards, where the head of 
the bone rests on the edge of the glenoid cavity and the 
coracoid process. In all of these there is loss of power 
and immobility. The shoulder loses its roundness, looks 
angular; the acromion projects, and there is a marked 
depression below it. Additionally, in the first variety the 
head of the humerus may be felt in the axilla ; the arm is 
lengthened ; the elbow points outwards, and there is 
numbness from pressure on the axillary plexus of nerves. 
In the second the head may be both seen and felt below 
the clavicle; the arm is shortened, and the elbow points 
outwards and backwards. In the third the head may be DISLOCATIONS. 
37 
felt on the dorsum of the scapula, and the elbow points 
forwards. In the fourth the head may be seen and felt 
under the coracoid process. 
Reduction of Dislocation Downwards into the Axilla.- 
There are two methods of treating this dislocation. One 
consists of making extension by drawing the arm down- 
wards and outwards ; the other in making extension by 
drawing the arm upwards. In the first method the patient 
should be stripped and laid upon a couch ; if necessary, 
chloroform may be administered. The surgeon, having 
taken off his boot, seats himself on the margin of the 
couch or bed, facing his patient, and, having grasped the 
dislocated limb at the wrist with both his hands, he places 
his near foot in the patient's arm-pit, so that the hollow 
of the foot fits into the fold of the axilla. He then draws 
the arm slowly downwards and inwards; at the same time 
he presses steadily with his, foot. The same principle 
may be carried out by setting the patient in a chair and 
placing his knee in the axilla, while the surgeon bends 
the arm over it. 
The second method of treatment is by drawing the arm 
upwards. The patient is laid flat on his back ; the shoul- 
der is fixed by the hand of the operator, or by a jack 
towel thrown around it; the arm is raised by the side of 
the head, and traction is made either by manual or by 
mechanical force until the head of the bone is lifted into 
the socket. 
The other varieties of dislocations at the shoulder-joint 
may be reduced by extension downwards, though in each 
case the direction of the extending force must be modified 
to suit the positions of the bones. 
After all reductions of the shoulder-joints pads should 
be placed in the axilla, the upper arm bandaged to the 38 
side, and the forearm carried in a sling for two or three 
weeks. 
Dislocations of the Elbow.-These are considered un- 
der three heads-dislocation of both bones, those of the 
u'na alone, and those of the radius alone. Both bones 
may be displaced, either backwards or forwards. In the 
former case the coronoid process is very likely to be 
broken, and in the latter the olecranon. The ulna may 
be dislocated backwards When this happens the point 
of the olecranon projects unnaturally, and there is a 
hollow above it. The elbow is fixed at a right angle. 
Pronation and supination will show that the radius is not 
implicated. Here, too, the coronoid process is very liable 
to be broken. 
The only dislocation of the radius worthy of mention 
is forwards on to the external condyle, though sometimes 
it is seen backwards or outwards. 
If the ulna is dislocated, with fracture of either of its 
processes, it will be easy, by extension or by flexion, to 
restore the bones to their proper positions, though it will 
be difficult to retain them in situ. If the ulna is dislo- 
cated without fracture, reduction is more difficult. It may 
be effected, however, by bending the elbow across the 
surgeon's knee, which he uses as a fulcrum. In the dis- 
location of the radius the arm should be extended, while 
the head of the bone is pressed down into its place. 
After reduction the arm should be fixed upon an angular 
splint and carried in a sling. 
Dislocation of the Wrist.-This is extremely rare. It 
should be distinguished from the Colles' fracture. Ex- 
tend the joint and apply a flat splint. 
Dislocations of the Hand.-The metacarpal bones of 
the thumb and the phalanges of the thumb or of the 
THE PHYSICIAN'S COMPANION. DISLOCATIONS. 
39 
fingers are sometimes dislocated. Treatment consists in 
making extension by means of narrow tape, or by clove- 
hitch notch, and then securing by a splint. Sometimes 
it is necessary to divide the ligaments in reducing disloca- 
tion of the thumb. 
Dislocations of the Hip are four in number : Upwards 
on to the dorsum of the ilium ; downwards into the ob- 
turator foramen; forwards on the pubes ; backwards into 
the sciatic notch. In the upward dislocation on the dor- 
sum, the head of the femur rests on the smooth surface 
immediately above and behind the acetabulum. In this 
situation it forms a prominence which may be felt, espe- 
cially on rotating the limb. There is loss of power and 
distinct shortening. The thigh is slightly flexed on the 
pelvis and the leg on the thigh. The knee is bent towards 
its fellow on the opposite side, and the foot is turned in- 
wards. The patient should be placed under anaesthesia, 
and laid on his back on a mattress, or placed on the floor. 
The pelvis should be firmly fixed by means of a jack 
towel placed under the perineum and fastened to some 
stationary object or staple driven into the floor. A belt 
should be attached to the lower end of the femur and 
connected with pulleys. The extending force should be 
applied slowly and gradually in the direction of the axis 
of the limb until the muscular resistance is overcome. 
At the same time the leg should be rotated outwards. 
Sometimes it is necessary to pass another towel or band- 
age between the thighs, so as to abduct or pull out the 
upper part of the femur and lift the edge of the bone over 
the acetabulum. After reduction the patient should be 
kept in bed for nearly a fortnight. A long splint or ex- 
tension by weight should be applied to the limb, and 
additional security afforded by a bandage around the hips. 40 
THE PHYSICIAN'S COMPANION. 
Dislocation downwards is marked by a lengthening, the 
leg is abducted, the toes point forwards, and sometimes 
a little outwards. The prominence of the trochanter is 
lost, and the head of the bone may be felt in its new situ- 
ation. Fix the pelvis by fastening a belt around it, firmly 
fastening to some stationary object on the opposite side. 
The upper end of the femur is then to be abducted by 
means of a towel passed a-ound it and connected with the 
pulleys. The bone is then drawn directly out Aards until 
it reaches a point where the muscles can act upon it and 
restore it to its place. At the sam? time the knee should 
be adducted-drawn towards the middle line so as to use 
the femur as a lever. 
Dislocation forward on the Pubes.-The prominence 
of the trochanter is gone, the limb is shortened and ab- 
ducted, the toes point outwards, and ihe head of the bone 
can be distinctly f.lt above Poupart's ligament. Fix the 
pelvis by a perineal band, make extension downwards 
and backwards, and you can assist matters by passing a 
towel around the upper part of the thigh and lifting the 
edge of the bone above the acetabulum 
Dislocation backzvards into the Sciatic Notch presents 
pretty much the same symptoms as the first dislocation. 
The affected thigh points across the middle of the oppo- 
site one. The mode of reduction differs very little from 
the first mentioned. 
Dislocation of the Patella.-The knee is extended or 
slightly bent; depression may be felt in front of the joint, 
while the patella may be felt in its new situation. Flex 
the thigh on the pelvis and raise the leg, and the bone may 
be restored to its proper place by manipulation. After 
reduction the patient should wear a bandage or an elas- 
tic knee-cap for a few weeks. T.IGATURE Of ARTERIES. 
41 
Dislocations of the Knee-Joint are usually the result 
of great violence, and are more often complicated than 
simple. The tibia may be displaced backwards or for- 
wards, or to either side. Flex the thigh, fixing it in that 
position ; then make extension by drawing from the ankle. 
When this is done use a little pressure, and the bones can 
be restored to their position without much difficulty. 
Bandage, and order that quiet should be observed for a 
few weeks. 
Dislocations of the Ankle may occur backwards or 
forwards, or to either side, and may be accompanied by 
fracture of the external malleolus. In all cases reduction 
may be effected by drawing upon the foot until the bones 
are brought into their position, and fixing them by means 
of side splints or immovable plaster bandages. 
LIGATURE OF ARTERIES. 
Ligature of Lingual Artery.-The artery may be most 
commonly reached near its margin just above the greater 
cornu of the hyoid bone, and before it passes beneath the 
hyoglossus muscle. An incision should be made almost 
from the point of the chin downwards and backwards to 
a little beyond the greater horn of the hyoid bone. This 
incision should then be turned and carried upwards almost 
at a right angle to near the angle of the jaw. The flap, 
when dissected back, will correspond nearly wi h the 
digastric triangle. The posterior border of the submaxil- 
lary gland will have to be held aside. This will bring into 
view the central tendon of the digastric and the posterior 
edge of the mylo-hyoid muscle. The hypoglossal nerve, 
with a vein, will be seen lying horizontally upon the hyo- 
glossus muscle. Feel for the posterior margin of this 
muscle; the lingual artery will be found lying just above 42 
THE physician's COMPANION. 
the greater cornu of the hyoid bone. It may be neces- 
sary to divide a portion of the muscle before the ligature 
can be placed. 
Ligature of the Common Carotid Artery.-The ante- 
rior border of the sterno-mastoid muscle, or a line drawn 
from the sterno-clavicular joint to the depression behind 
the angle of the jaw, serves as a guide to the course of 
the artery. Here it lies upon the anterior spinal muscles, 
having the sympathetic nerve behind it and the descen- 
dens noni in front. On its outside is the internal jugular 
vein, and between the vein and the artery, and behind 
them both, is placed the pneumogastric nerve. The 
vein, nerve, and artery are all included in a common 
sheath, though each has its own compartmen''. An in- 
cision is made about three inches long, commencing op- 
posite the upper border of the thyroid cartilage, and car 
ried along the anterior edge of the sterno-mastoid muscle. 
After cutting through the skin, platysma, and superficial 
fascia, the sheath of the vessels comes into view. The 
sheath should be then lifted with a forceps at the point 
where the ligature is to be applied, and a nick made in it, 
the flat of the blade being turned towards the artery. 
The opening in the sheath should then be enlarged on a 
director. If the vein overlaps the artery, as it sometimes 
does, it must be held back with a retractor. The pneumo- 
gastric nerve will probably be drawn aside along with it. 
Before tying the ligature be sure that it includes nothing 
but the artery, and see that pressure arrests hemorrhage 
or controls pu'sation in the aneurism, as the case may be. 
Draw the ligature tightly, so as to divide the two inner 
coats of the artery. One end may be cut off and the other 
left hanging out of the wound ; or, pursuing antiseptic 
methods, both ends may be cut short off. Silk is used, LIGATURE OF ARTERIES. 
43 
or we can use catgut, and so get the wound closed, with 
an effort to obtain union by first intention. 
Ligature of the Subclavian Artery.-The ligature at 
the third part of the course of this artery is the only point 
at which it is recommended. Lower the shoulders as 
much as possible, draw the skin evenly down, and make 
an incision upon the clavicle from the anterior border of 
the trapezius to the posterior edge of the sterno-mastoid 
muscle. Divide the platysma myoides and fascia of the 
neck on a director. The external jugular vein will be 
seen near the inner part of the wound, and must be held 
aside, along with any other veins that may traverse the 
space. In a similar way draw aside the omohyoid mus- 
cle ; carefully separate the various parts with a silver 
probe until the outer margin of the scalenus anticus is 
felt. This will serve to guide the surgeon's finger to the 
first rib, and the artery will be felt passing over that bone. 
Be careful to avoid the vein, and do not mistake any of 
the branches of the brachial plexus for the artery, nor in- 
clude them in the ligature. 
Ligature of the Axillary Artery.-The artery may be 
secured in the lower part of its course by raising the arm 
from the side and making an incision in the axilla over 
the head of the humerus and in the line of the great ves- 
sels. By cautious dissection the median nerve and the 
axillary vein are brought into view. These must be held 
aside while the artery is separated with a silver probe and 
the ligature is placed around in the usual manner. 
Ligahire of the Brachial Artery.-This is generally 
tied at the middle of the upper arm. It lies under the 
inner edge of the biceps, covered only by integument and 
fascia. At this point it is crossed from without inwards 
by the median nerve. It is also in close relation to the 44 
THE PHYSICIAN'S COMPANION. 
basilic vein, ulnar nerve, and the inferior profunda artery. 
Make an incision about three inches long ; keep close to 
the inner border of the biceps, which is a sure guide to 
the artery. The median nerve and the two venae comites 
must be gently drawn aside with ihe blunt hook, while the 
ligature is passed around the vessel and tied in the ordi- 
nary way. 
Ligature of the Radial Artery.-This is tied at the 
wrist, where it lies beneath the integument and deep 
fascia, between the tendons of the supinator longus and 
the flexor carpi radialis. It is accompanied by its venae 
comites, but in this situation it bears no immediate rela- 
tion to its corresponding nerve. Pulsation in the artery 
will form the best guide to its exact situation. 
Ligature of the Ulnar Artery.-It is mostly for wounds 
of the palm that the ulnar artery requires to be tied, and 
then the ligature may be conveniently placed around it 
just above the wrist. An incision two inches in length 
should be made over the artery a little to the outer side 
of the flexor carpi ulnaris. When the vessel is exposed 
pass a needle from the ulnar to the radial side so as not 
to disturb or injure the nerve. 
Ligature of the External Lliac Artery.-The course 
of the external iliac artery may be described by a line 
drawn from the left side of the umbilicus to a point mid- 
way between the anterior and superior spine of the ilium 
and the symphysis pubes. It lies a'ong the inner edge of 
the psoas muscle, in a sheath derived from the iliac fascia. 
Its accompanying vein will be found behind it, and a little 
to its inner side. It is overlaid in front by the perito- 
neum. Near its termination it comes into relati m with 
the spermatic vessels and the vas deferens. On the front, 
and near the side of the artery, are a number of lymphatic LIGATURE OF ARTERIES. 
45 
glands, with their vessels. The ligature must not be placed 
too near the external iliac at the upper end, or the epi- 
gastric and circumflex vessels at the lower end. The in- 
cision should be made about three inches long; it should 
begin about one-half inch above and to the outer side 
of the external abdominal ring, and be carried upwards 
and outwards parallel to Poupart's ligament. 
When the aponeurosis of the external oblique muscle 
has been fairly exposed it must be divided to the same 
extent, or slit up on a director. The internal oblique 
and transversalis must be cut through in the same way, 
but with even greater caution. The edges of the wound 
should then be retracted and the fascia transversalis 
scratched through with the knife and broken down with 
the finger. The peritoneum should next be very lightly 
and gently raised and pushed upwards until the vessel 
can be reached. An opening should then be made in the 
sheath, the artery carefully separated from the vein, and 
the aneurism needle parsed from within outwards. The 
wound should be brought together with sutures, and 
pressure kept upon it by means of a pad and bandage. 
The patient should be propped up in bed, so as to relax 
the abdominal muscles. Before the operation is under- 
taken the rectum should be emptied and the pubes shaved. 
Ligature of the Superficial Femoral Artery.- -The su- 
perficial femoral artery is generally tied in Scarpa's tri- 
angle, just above the point where it is crossed by the Sar- 
torius muscle. It is covered only by the integument and 
the fascia lata, and has the superficial femoral vein almost 
immediately behind it. The thigh should be slightly 
flexed and abducted before the operation is commenced. 
The course of the artery may be ascertained by its pulsa- 
tion, or by a line drawn from the middle of Poupart's 
ligament to the inner condyle of the femur. The incision 46 
THE PHYSICIAN'S COMPANION. 
should begin about three inches below Poupart's ligament, 
and be carried down the limb in the line of the artery for 
the space of four inches. The fascia lata should be divided 
to an equal extent, and the sartorius drawn a little out- 
wards. The sheath of the vessel should be then raised 
with a forceps and opened, the flat of the blade being 
turned towards the artery. The aneurism needle should 
be passed from within outwards, great care being taken 
to avoid injuring the vein. The point at which the liga- 
ture is applied should be about five inches below Pou- 
part's ligament. When bleeding has ceased the edges of 
the wound should be brought together with sutures and 
strips of plaster. The limb should be lightly covered 
with flannel or enveloped in cotton wool, so as to main- 
tain an equable temperature and lessen the chances of 
gangrene. 
Ligature of the Popliteal Artery.-This is seldom tied, 
except for wounds. In such cases the opening should be 
enlarged, and the bleeding vessels secured both above 
and below the seat of injury. In the upper part of the 
popliteal space the tendon of the semi-membranosus may 
be taken as a guide to the artery, and the incision carried 
along its outer border. In this situation the external 
popliteal nerve and the popliteal vein are both superficial 
to the artery, and a little to its outer or fibular side. 
Ligature of the Tibial Arteries is a difficult operation, 
and is usually undertaken for a wound of the vessel. In 
such instances the wound should be enlarged, and the 
vessel secured above and below the seat of injury. 
Ligature of the Anterior Tibial Artery.-The vessel, 
the course of which is indicated by a line drawn from the 
head of the fibula to the base of the great toe, may be 
secured at three different points. The artery, in the supe- LIGATURE OF ARTERIES. 
47 
rior third of its extent, lies underneath and behind the 
anterior tibular and common extensor muscle, and may 
be exposed by a vertical incision four inches long, and 
carried down in the direction of the line just mentioned. 
The skin and superficial fascia being divided, the aponeu- 
rosis is to be slit open by a director to the full extent of 
the outer wound: the two muscles are then to be sepa- 
rated one from each other, along their raphe, and the 
artery, which lies in close contact with the interosseous 
ligament, is surrounded with the ligature, care being 
taken not to injure the accompanying veins. In the mid- 
dle third of its course the relations of the vessel are 
essentially the same as in the upper, except that the long 
extensor of the toe is interposed between the anterior 
tibular and the common extensor. The artery is still 
deep-seated, and a long incision is required for its full 
exposure. A branch of the peroneal nerve sometimes 
attaches itself to the artery here, and must be drawn 
away before passing the ligature. In the inferior third of 
the limb the artery lies on the tibia, between the tendons 
and the common extensor of the great toe, the latter en- 
veloping it on the inside. The vessel, therefore, is com- 
paratively easy of access. 
The Dorsal Artery of the Foot.-The continuation of 
the anterior tibial may be easily tied in any portion of its 
extent, as it runs down across the instep, its course being 
indicated by a line extending from the centre of the ankle- 
joint to the posterior extremity of the first interosseous 
space. It lies under cover of the integuments and aponeu- 
rosis, and maybe readily exposed by carrying the knife 
along the outer border of the tendon of the long extensor 
muscle of the great toe. 
Ligature of the Posterior Tibial Artery.-The situation 48 
THE PHYSICIAN'S COMPANION. 
of this artery is very deep. Its course is first obliquely 
inwards, and then vertical, being indicated by a line ex- 
tending from the inferior border of the popliteal muscle 
to the fascia, between the heel-bone and the ankle. It is 
covered in the superior two-thirds of its extent by the 
gastrocnemial, soleal, and plantar muscles, but during 
the remaining portion it lies immediately below the in- 
tegument. It is accompanied and embraced by two 
veins, one being on each side of it. The attendant nerve 
lies internal to it, in the upper part of the limb, but as 
it descends it crosses the artery superficially, and places 
itself along its outer margin. The artery may be exposed 
and tied in the upper and middle portions of its extent. 
A long, vertical incision, extending through the centre of 
the muscles of the calf, should be made down and directly 
upon the artery, which, though deep-seated, may be 
reached more expeditiously in this manner than by other 
methods. 
To ligate in the lower portion of this artery, between the 
heel and the ankle, the pulsation should be taken for the 
guide to the artery, and the surgeon should make an in- 
cision about two inches long directly along its track, 
which is nearly midway between the two points here in- 
dicated. The direction of the incision should be some- 
what curvilinear, with the cavity towards the inner mal- 
leolus. The artery lies beneath three aponeurotic layers, 
which must be successively divided upon the director, when 
the needle is passed under the vessel from behind forwards, 
care being taken not to include the accompanying veins 
and nerves. The two plantar arteries begin opposite the 
two heads of the abductor muscle of the great toe, being 
the terminal branches of the posterior tibial. They are 
d^ep-seated, and are exceedingly difficult to find, and all 
anatomical knowledge concerning these vessels will be DISEASES OF WOMEN. 
49 
found unsatisfactory in the search for them. The best 
plan is to be guided by the external wound. Use the 
knife freely, cutting in the direction of the length of the 
foot. 
DISEASES OF WOMEN. 
Symptoms of Disease of the Genital System which 
Proceed from the organs themselves.-Abnormal sensa- 
tions of heaviness, of distension, of sharp, penetrating, 
lancinating, dragging pain in the abdomen or back; 
anomalies in secretion, either qualitative or quantitative, 
and disturbances in function; menstruation irregular, 
either too profuse or too scanty, accompanied by painful 
manifestations; cohabitation a torment, dr sensation ab- 
sent, or the act is impossible ; frequently sterility. 
From neighboring organs: Swelling of the abdomen, 
disturbances of vesical or rectal function ; dysuria, reten- 
tion and incontinence of urine, painful defecation, consti- 
pation, rectal tenesmus, hemorrhoids, and finally cystitis 
and pyelitis. 
Evoked in distant organs : Gastric, such as heaviness in 
the stomach, regurgitation, nausea, vomiting, loss of appe- 
tite ; abnormal function of sensory, motor, and trophic 
nerves, included under the term hysteria, such as hyper 
sesthesia, anaesthesia, neuralgias (migraine, intercostal, 
mastodynia, &c.), spasms, vaginismus, globus hystericus, 
singultus, general convulsions, respiratory spasms ; further 
paralysis, local congestions, chloasma, acne, eczema, 
urticaria ; finally alterations in the psychical functions. 
Etiological factors, of heredity, of early childhood 
(anomalies in development, scrofula, rachitis), the first 
appearance of menstruation and its after course, later dis- 
eases (chlorosis, heart affections), abortions and labors, 
the course of the puerperium, the climacteric, and finally 50 
THE PHYSICIAN'S COMPANION. 
the diseases which have effected the patient. As direct 
factors, trauma, excesses of various nature (venery, infec- 
tious coitus, onany, &c.), the application of pessaries, in- 
jections, injuries during labor, and injudicious local treat- 
ment. 
Vaginal Examination. 
Vaginal touch is best made in dorsal position, the blad- 
der and rectum emptied, the buttocks elevated and near 
edge of bed or table, the knees flexed and thighs rotated 
outwards, the clothing loosened or removed, and a 
sheet thrown over patient. For exploration of uterus 
use the hand corresponding to the side of patient on 
which examiner stands ; for examination of lateral fornices 
use opposite hand. Anoint finger with oil, vaseline, 
glycerine, or soap. Avoid pressure on abdomen or any- 
thing which might effect a change in the position of the 
examined parts. Before inserting finger in vagina ex- 
amine external genitals, their size, consistency, tender- 
ness, the perineum and posterior commissure, labia mi- 
nora, and meatus urethrae. In the vestibule note the 
hymen, carunculae myrtiformis, the vulvo-vaginal glands, 
the bulb of the urethra, the anterior and posterior vaginal 
walls as regards sagging, and lastly, tumors or errors in 
development. The finger, when in the vagina, must take 
account of the direction and capacity, temperature, and 
moisture of the canal, the posterior and anterior walls as 
regards smoothness, distensibility and rugosity. When 
the vaginal portion of the cervix is reached it is felt as a 
more or less conical projection, divided into anterior and 
posterior lips by the os, which is round or oval in 
nullipara ; generally in women who have borne children 
elliptical and transversely slit, with irregular edges. The 
size and condition of the os, its smoothness or roughness, 
laceration, tumors within it or its neighborhood (Nabo- DISEASES OF WOMEN. 
51 
thian follicles, mucous polypi, &c.); the shape, direction, 
and length of the cervix, its consistency, and the tender- 
ness on pressure are quickly determined. Next carry the 
finger around the cervix and examine the fornix in regard 
to the same points. Through the cul-de sac examine for 
a tumor or increased resistance. If found, note size, form, 
condition of surface, consistency, tenderness, and relation 
to cervix. When a tumor is found in the vault decide 
whether it is the body of the uterus or not, and its rela- 
tion to the cervix. By p'-netraiing with the finger as far 
as possible between the uterus and supposed tumor to 
establish its separation or continuity displacements may be 
detected, but not with certainty, unaided by external pres- 
sure. 
Next determine the movability of the uterus. The cer- 
vix is pushed upwards, to the right and left, forwards and 
backwards, and note whether the body moves with it, and 
if after such movements the uterus returns to its former 
position. Thus is obtained information in regard to the 
length of the ligaments, their relaxation, the existence of 
remnants of parametritis or parametritic exudations, as 
evidenced by thickened bands, and note the weight of the 
uterus, its position and connection with other organs, 
and finally, the sensibility of the uterus and surroundings. 
Before withdrawing the finger from the vagina proceed 
with the bimanual examination. The hand on the abdo- 
men presses the pelvic organs downwards and fixes them. 
If the uterus be now lifted up by the finger in the vagina, 
or if the uterus is enlarged, we readily feel the fundus, or, 
in case of anteversion, the posterior surface of that organ, 
and while this is palpated by the external hand the finger 
in the vagina examines vaginal portion of cervix and the 
anterior surface of the body. By proper fixation of the 
uterus we may estimate its form and size, the relative size 52 
THE PHYSICIAN'S COMPANION. 
of the cervix and body, the curvature of its anterior sur- 
face, the thickness, consistency, sensitiveness, and the 
presence of even minute tumors on its surface. Next 
determine the movability of the uterus. The internal 
finger pushes the cervix forward, while the external hand 
depresses the fundus towards the hollow of the sacrum, 
and the external hand examines the anterior surface of 
the uterus. Where finger in the vagina has ascertained 
that the cervix is deviated to one or another side, or that 
there is present a tumor or increased resistance near, by 
bimanual palpation we detect the reason. The absence 
of the body of the uterus from its normal position, the 
size, shape, consistency of the questionable tumor, the 
continuity of the tissues between this tumor and the cer- 
vix, in conjunction with what is gained by testing the 
mobility of the uterus, give us information as to the con- 
dition of affairs. We ascertain the nature of the flexion, 
whether it may be overcome, and if so, whether the organ 
will remain straight dr resume its flexed form. In case of 
anteflexion, the internal finger in the anterior fornix, with 
the external hand lift the body of the uterus upwards, then 
transfer the internal finder to the posterior fornix and esti- 
mate how much the org in is straightened by the external 
hand. In a similar manner estimate the amount and be- 
havior of backward and lateral flexi m. The other pelvic 
organs may also be examined. 1 he finger in the vagina 
may touch the anterior pelvic wall, the round ligaments, 
and the utero-vesical pouch. It is only possible to ap- 
proximate the finger in the posterior fornix, where the 
abdominal and pelvic walls are relaxed and thin. The 
lateral fornices may be similarly examined. Test the 
sides of the uterus, then the broad ligaments and the 
tubes within them which simulate between the fingers 
rolling, thin, round cords. Behind and externally the DISEASES OF WOMEN. 
53 
ovaries are examined as regards heir position, form, size, 
surfaces, sensibility, and mobility. Determine, also, the 
mobility of the uterus to one or another side; also the 
tenseness of the lateral ligaments. 
In the differential diagnosis of pelvic tumors the bi- 
manual examination is of the greatest utility. 
Tumors which occupy the walls of the uterus project 
beyond the surface of the organ, and appear to be im- 
bedded in its tissues. Growths not intimately connected 
with the uterus may be determined as attached to it by 
the finger passed between them and the organ. Motion 
imparted to the uterus and the tumor may inform us as 
to the connection. 
Tumors which spring from the uterine adnexa lie in the 
beginning laterally. Those in the parametrium, due to 
exudation, are so close to the uterine wall that it is im- 
possible to find a point of separation. Small exudations 
may be generally differentiated by their form, immova- 
bility, unequal consistency, and sensitiveness; but the 
larger so frequently surround the uterus that it seems to 
be completely merged in them. The most one can do is 
to feel the cervix surrounded by tense tissue. Collections 
of fluids in the neighborhood of the uterus are examined 
as to their consistency and relation to the vagina, the 
bladder, and the rectum. Tumors of the ovary, the 
broad ligament, or the tubes may be at the outset differ- 
entiated from the uterus ; but as they increase in size 
and approach it more c'osely, or become imbedded in 
exudative product, the difficulty becomes greater. 
Bodies apparently immovable are frequently found 
easily displaceable by change of posture. The recogni- 
tion of the ovary apart from the tumor certifies that the 
growth is not ovarian. 54 
Examination with Sound.-'The sound is used both 
for diagnostic and therapeutic purposes. The instru- 
ments most frequently used are those of Simpson and 
of Sims. The use of the sound should always be 
preceded by the bimanual palpation to determine the 
position and shape of the uterus. The patient in the 
dorsal position, a finger is inserted into the vagina 
up to the external os, and the sound is guided along 
this finger up to the os and into it. In case of great dis- 
placement it is useful to steady the cervix by means of 
a tenaculum. When the internal os is passed the sound 
usually glides in to the extent of about three-quarters of 
an inch, unless it catches in the folds of the mucous mem- 
brane. In case it catches, the instrument must be drawn 
out a trifle and an attempt made to pass it in another 
direction. Frequently the end of the sound must be bent 
in order to pass by Nabothian follicles or mucous polypi. 
At the extremity of the cervical canal a slight obstacle- 
the internal os-is encountered. In the normal uterus, 
and especially in young girls, slight pressure is required to 
pass into the uterine cavity. Always remember that the 
finger in the vagina constitutes a fulcrum, and that pres- 
sure on the handle, the long arm of the lever, is much in- 
tensified at the point of the instrument. Stricture of the 
internal os, which is uncommon, generally yields to pro- 
longed slight pressure. In general, marked narrowing of 
the os is due to swelling of the cervical mucous membrane, 
or to flexion, or the pressure of new growths. In women 
who have borne children, in whom the os has been 
widened by inflammatory process in the endometrium or 
the parenchyma, the passage of the internal os is not 
marked by any increased resistance at that point. Gen- 
erally, as the sound enters the uterine cavity it produces 
an unpleasant sensation to the patient. Ordinarily the 
THE PHYSICIAN'S COMPANION. feeling is the same as that which precedes the onset of the 
menses. In sensitive individuals, with a narrow canal, 
there frequently results uterine colic, which may be in- 
tense. 
When the body of the uterus lies forward, the sound 
enters with its concavity forwards and handle against the 
perineum. Extreme flexions necessitate the giving a 
sharp curve to the instrument. When the uterus lies 
backwards the sound is directed downwards from the in- 
ternal os, with its concavity downwards. On the way to 
the fundus we test the condition of the uterine mucous 
membrane by gentle pressure with the extremity of the 
sound along the anterior and posterior wall. By moving 
the sound backwards and forwards it is possible to detect 
the presence of tumors in the cavity and the nature of 
their attachment to the uterus. We at the same time ob- 
tain an idea of the movability of the organ. The uterus 
being steadied by the sound, continued vaginal touch 
will enable us to determine its relation to other pelvic 
organs or to tumors. 
To measure the depth of the uterine cavity, the index 
finger in the vagina is placed along the sound close to the 
external os, the other fingers surround the instrument, 
which is then withdrawn, taking care lest the index finger 
slips. 
It may be necessary sometimes to pass the sound in 
the lateral position. The cervix, exposed through a 
speculum, steadied by a tenaculum (and a flexion, may in 
a measure, be effaced by traction). 
For therapeutic purposes the sound may be used as an 
elevator to lift up a retroverted uterus. Introduced into 
the uterus with its concavity downwards, the handle de- 
scribing a large half-circle as the "tour de maitre'' is made 
in introducing a catheter, the sound is rotated on its long 
DISEASES OF WOMEN. 
55 56 
axis until the concavity, which was downwards, becomes 
uppermost. The finger in the vagina, placed below the 
sound at the external os, is used as a fulcrum, and the 
uterus is lifted by depress:ng the handle of the sound. 
The sound has been used for assisting in the involution 
of the puerperal uterus and correcting flexion. 
Since it is often impossible to recognize pregnancy at 
its inception (and there are women who, in their desire to 
have a miscarriage induced, will purposely give such a 
history as to lead the examiner to pass the sound), it is 
well to bear in mind that by rupturing the ovum or ex- 
citing uterine contractions the introduction of the instru- 
ment may cause miscarriage, notwithstanding the fact 
that it was formerly recommended by such high authority 
as Scanzoni and Kiwisch for the diagnosis of pregnancy. 
Examination with Speculum.-The ones most com- 
monly used are the cylindrical, the bivalve, and duck- 
bill. The advantages of the first is the ease with which it 
may be used and the protection it affords to the vaginal 
walls when the actual or potential cautery is used. It, 
however, is not self-retaining, as the bivalve, which gives 
a better view of the cervix, and leaves both hands of the 
operator free for use, thus dispensing with the presence 
of a third person. When this objection has not to be 
contended with, the duck-bill speculum is the most use- 
ful. It reveals the cervix in normal condition in re- 
gard to shape and color. The examination by means 
of the finger and sound may be readily resorted to. Only 
the posterior wall of the vagina is left unexposed, and 
sufficient space is obtained for therapeutic and operative 
manipulation. The cylindrical and bivalve are best used 
in the dorsal position. To avoid exposure the patient 
should be covered with a sheet, and only the vulva ex- 
posed. Before inserting the speculum inspect the exter- 
THE PHYSICIAN'S COMPANION. nal genita's, and by means of the vaginal ton h determine 
the direction the instrument must take to expose the 
cervix. In case of displacement-particularly antever- 
sion-bring the uterus into normal position by the bi- 
manual method, and fix the cervix in the speculum by 
pressure with the external hand. 
When the cervix appears, endeavor to bring the exter- 
nal os as far as possible in o the centre of the field. 
Scrutinize the form, size, and surface of the cervix, the 
border of the os, the state of its mucous membrane as 
regards erosion, tumors, and the nature. of discharge 
issuing from it. When the os is patem we look a short 
distance into the cervical canal. Pressure on the specu- 
lum may cause the lips of the cervix to roll out and sim- 
ulate an ulceration, but the transverse ridges and the 
sharply-marked boundary line of the mucous membrane, 
when there is no erosion, will correct such an error. 
The duck-bill speculum is used with patient in the left 
lateral position. The labia are separated and the well- 
oiled speculum inserted under the guidance of the index 
finger. The instrument should be made to follow the 
curve of the vagina, else the point of the blade will enter 
the anterior fornix. Then the perineum is retracted back- 
ward and a li'.tle upward, and the speculum handed to an 
assistant, who with one hand elevates the right buttock. 
In addition to speculum, a depressor is needed to prop- 
erly expose the cervix, and if a sound is to be introduced 
a tenaculum to hook into the anterior lip of the cervix, 
which will steady the uterus and serve to draw it down- 
ward, if requisite. 
As soon as the recto-vaginal septum is retracted, air 
rushes in, and we see the anterior vaginal wall and the 
cervix. If this is directed greatly backwards it is brought 
fully into the field by means of the tenaculum hooked 
DISEASES OF WOMEN. 
57 58 
THE PHYSICIAN'S COMPANION. 
into the anterior lip. When the vagina is large'or the 
anterior wall relaxed this wall prolapses into the field of 
vision, and must be elevated by the depressor. 
Before the inspection of the cervix and vaginal walls 
the secretion (blood, pus, or mucus) must be wiped away 
by absorbent cotton held in long forceps or twisted 
around a probe. If the secretion, like that of the cervix, 
is very thick, it may be dissolved by flipping the cotton 
in an alkaline solution before application. 
Acute Oophoritis.-Symptoms: Severe pain and great 
sensitiveness to touch in region of ovary, which is usually 
enlarged. Fever and chill. Resolution occurs within a 
week or proceeds to abscess-rare. Causes : External vio- 
lence, gonorrhoea, suppression of menses, or extension 
from pelvic peritonitis. Treatment: Chloral enemata, 
morphia hypodermically, bromide of potassium, ice-bag, 
leeches. 
Chronic Oophoritis.-Symptoms: Fixed pain over 
ovary, dysmenorrhoea and hysteria, pain in rectum and 
down thighs, exaggerated after defecation, leucorrhoea, and 
sometimes dyspareunia. Course : Chronic and common, 
usually due to uterine displacement. Treatment: Bromide 
of potassium, cannabis indica; locally, tincture iodine, 
blisters, oleate of mercury, correct displacement of uterus. 
Amenorrhoea.-Where menstruation is and always has 
been absent there is imperfect or tardy development of 
ovaries and uterus. Treatment consists in everything 
that will favor physical development. Where menstrua- 
tion is scanty or irregular, if the general health is good 
and no pain, no special treatment is required ; but if there 
is disordered health and the most common condition 
(anaemia and constipation), give iron (Blaud's pills), deu- 
toxide of manganese, aloes, and salines, ergot; hot hip DISEASES OF WOMEN. 
59 
baths several nights in succession before expected period ; 
good diet, fresh air, and plenty of exercise in open air. 
Some patients flow more if they remain in bed during the 
period. Galvanism will sometimes succeed when every- 
thing else fails. 
Dysmenorrhoea.-Varieties: Neuralgic, congestive or 
inflammatory, obstructive, membranous, and ovarian. 
Remedies: Liq. ammoniae acet., belladonna, chloral 
hydrate (preferably by enema), iron, deutoxide of man- 
ganese, guaiacum, opium, potass, bromide, galvanism, 
dilation of cervix (in obstructive form), and correction of 
displacement when present. 
Menorrhagia and Metrorrhagia are symptoms of sev- 
eral uterine affections, and an examination is essential to 
diagnosis. It is sometimes due to debility from protracted 
nursing, local causes, tumors, polypi, &c., affections of 
the os and cervix, congestion of the womb or ovaries, 
subinvolution or inversion of the womb. Remedies: 
Arsenic, Rockbridge alum water, cannabis indica, ergot, 
gallic acid, bromide of potassium, quinine in malarial dis- 
tricts, hot vaginal injection, with or without astringents, 
such as alum and tannin ; tampon the cervical canal. 
Inflammation of the endometrium may be confined to 
the cervix, or the body may be also implicated. The 
salient points of diagnosis are leucorrhcea, pain in back, 
loins, and pelvis; menses too scanty or severe, too fre- 
quent or reverse; nervous disorders. Bimanual examina- 
tion elicits pain in fundus or cervix; in cervical form, os 
enlarged, lips puffy or eroded, and sound encounters ob- 
struction at internal os. Where the fundus is involved 
the os interum is usually patulous, uterine cavity pro- 
longed, and there is tenderness when touched by the 
probe. 
Treatment: There is a tendency on the part of gynae- 60 
THE PHYSICIAN'S COMPANION. 
cologists to greater conservatism in the management of 
these cases. The heroic intra-uterine medication is losing 
favor as a consequence of the untoward results which 
sometimes followed. Some of the cases will recover 
without local treatment under a judicious constitutional 
treatment, such as sexual hygiene, the avoidance of con- 
stipation and everything which tends to produce engorge- 
ment of the pelvic vessels. An occasional blue pill, 
saline purgatives, heart tonics, such as digitalis and stro- 
phanthus; nerve tonics, as strychnine and quinine. Iron 
is positively hurtful. If anaemia exist, subnitrate of bis- 
muth and arsenic are preferred. Local treatment: Hot 
vaginal douche, tampons of glycerine in vagina, correc- 
tion of displacements. The erosions and so-called ulcers 
of the os are best treated by solution of nitrate of silver 
applied by means of absorbent cotton on probe, and car- 
ried up into the cervical canal short of the os interum. 
Acute Pelvic Peritonitis.-Same grave, alarming, initial 
symptoms as general peritonitis; chill, high fever, great 
tenderness on pressure, early tympanitis, limited to lower 
part of abdomen. The starting point of pain and spot of 
greatest tenderness indicate locality of greatest intensity. 
Later, bimanual examination reveals points of resistance 
or swelling, usually lateral, produced by adhesions of in- 
testine, broad ligament, or uterine appendages. These 
swellings and areas of tympanites change seat with intes- 
tinal distension, &c. 
Acute Parametritis.-Initial symptoms not as violent 
as in pelvic peritonitis. Fever and pain may be as in- 
tense, but tenderness and tympanitis are absent. Severe 
pain on pressure produced only when uterus is moved or 
sides touched. A day or two after initial symptoms the 
uterus is found enlarged transversely where broad liga- DISEASES OF WOMEN. 
61 
rr.ents leave it. A vaginal examination shows presence 
of large masses at the sides of the uterus, extending an- 
teriorly or laterally to the pelvic wall. If, with continued 
or interrupted fever, we find fluctuating points in the 
masses of exudation, or if the masses rapidly increase in 
size and become soft, suppuration has taken place. 
The treatment is the same for both forms. 
In the acute stage : Object to lower the local inflamma- 
tion-best accomplished by antiphlogistics ; leeches to 
points of greatest pain and tenderness ; applications of ice, 
and absolute rest. If impacted feces suspected, enema 
of tepid water, and then opium or morphine, or chloral. 
Saline cathartics are preferable to all others when required. 
Chronic Exudations.-After violent pain subsides, in- 
stead of cold apply moist heat, poultices, or warm com- 
presses. If exudative masses do not disappear in a fort- 
night, resorbents, with the continued use of the warm 
compresses ; order warm sitz baths, 92° to 94° F. 
In chronic cases, with long-continued fever, pain, and 
extensive exudations, baths and resorbents of no benefit. 
In these cases, tonics, good nourishment, and attention to 
hygeine indicated. 
Where masses remain unaltered for months or years, 
use warm vaginal injections, iodide of potassium inter- 
nally, oleate of mercury to abdominal walls ; paint vaginal 
portion of cervix with tincture iodine. 
Surgical interference indicated in all cases where large 
abscesses have formed in or about pelvis, whether they 
originate in peritoneum or parametrium. Open where 
they approach the surface and where the pus can have a 
free exit. 
Remnants of inflammation in the neighborhood of the 
uterus and its adnexa may remain for years or for^life; 
and while they may exist without giving rise to the slight- est pain or sensation, it is of importance to recognize 
their great frequency in order to diagnose their influence 
on the health of the woman. Symptoms differ according 
to the locality and extent of residue-endometritis, too 
frequent menstruation and irregular hemorrhages, dif- 
ferent varieties of dysmenorrhoea, and pain in the inter- 
vals. Pain each step or forcible motion calls attention to 
the fixed uterus. Many feel pressure in the pelvis or drag- 
ging sensation in the course of broad ligaments. Bimanual 
examination causes pain only when uterus is moved. 
When the uterus has become anteverted, retroverted, or 
retroflexed, and, as is frequently the case, the tubes and 
ovaries are matted together and fixed, pain is produced 
in attempting reposition. Patients worry about their com- 
plaint; cohabitation causes pain, and finally disgust. 
Vesical Symptoms are present in a few cases, and are 
variable. In one case there is tenesmus; in another dif- 
ficult micturition, or different varieties of catarrh. 
Rectal Symptoms: Constipation or diarrhoea, abnormal 
accumulation of gas, abnormal movements, rectal ca- 
tarrh, &c. 
Nervous System.-No marked nervous phenomena ob- 
served in women of a healthy nervous system, but where 
this is more or less diseased the most marked and varia- 
ble phenomena are presented, especially in individuals of 
the higher classes. 
The most frequent reflex neuroses are constant pressure, 
burning and painful sensation in sacrum, sensation of 
burning deep in pelvis or in epidermis of lower abdomen 
or external genitals, motor or sensory disturbances in 
lower extremities; sympathetic neuroses -eructations, 
nausea, vomiting, globus, cardialgia, enteralgia, dyspepsia, 
anorexia; cerebro-spinal neuroses-spinal irritation, tender 
62 
THE PHYSICIAN'S COMPANION. DISEASES OF WOMEN. 
63 
spots in spine, with hyperaesthesia, producing neuralgia 
of cervical, intercostal, lumbar, or sacral nerves, and 
coccyodynia ; psychic disturbances of a mild character; 
sometimes patients become depressed, dissatisfied, mel- 
ancholic, hypochondriac, or very irritable. 
Treatment: Parametritic and peritoneal cicatrices and 
the pseudo-membranous adhesions between the pelvic 
organs cannot be removed by any medical treatment. 
Even surgical interference is not successful in every case. 
Cure endometritis as the best prophylactic against fre- 
quently recurring parametritic inflammation. 
Hot Vaginal Irrigation.-Massage, by stretching cica- 
tricial bands, often has a good result upon the local symp- 
toms, as well as upon the radiating pains and the reflex 
neuroses; bimanual stretching, using a pair of forceps on 
the neck to steady the uterus, and with the external hand 
pull the uterus in a direction opposite to the cicatrix. 
Removal of the uterine appendages, though still under 
discussion, is, we think, justifiable when the tubes and 
ovaries are considerably diseased. 
Hsematocele. 
Symptoms vary with rapidity and amount of hemor- 
rhage. In some cases there have been previous men- 
strual disorders, but in many the patients have never 
complained. Usually, at a menstrual period, severe pain 
is suddenly felt in the pelvis, sometimes so intense as to 
cause collapse, accompanied with a sense of fear and 
agitation, nausea, vomiting, and chill; usually a sense of 
weight or heaviness in the pelvis, creating a desire to make 
water or go to stool; afterwards febrile symptoms, due 
to pelvic peritonitis. The lower abdomen is slightly en- 
larged. The sudden pain during menstruation and the 
subsequent peritoneal symptoms are important points in 64 
the diagnosis. After the subsidence of pain, fever, and 
abdominal tension, a tumor behind the uterus is felt on 
palpation, varying in size with extent of hemorrhage ; it 
may not rise above the true pelvis or extend above the 
umbilicus. Doughy at first, it feels harder as resorption 
occurs. Per vaginum is felt a tumor, depressing Douglas' 
pouch, and varying in size from an apple to a man's head, 
displacing the uterus forwards and upwards. As the 
tumor becomes harder rectal and vesical symptoms be- 
come more prominent. Swollen abdomen, constipation, 
and painful defaecation, constant symptoms. 
Treatment: If seen early, first care to arrest hemor- 
rhage-best accomplished by keeping patient in bed, the 
application of cold to the abdomen, and cold irrigation 
of vagina and rectum, the latter best carried out with a 
rectal irrigator, providing for a return of the water. 
Hemorrhage having ceased, we have to combat peri- 
tonitis and the anaemia which ensues. Patient must re- 
main in bed several weeks, and the cold applications 
continued until peritonitis is subdued ; attention paid to 
regular evacuation of the bowels and bladder. No medi- 
cine, whether administered internally or locally, exerts 
any influence on the absorption of the tumor. Anaemia 
and weakness met by generous diet and wine. 
During the pe:iod of absorption patient should be care- 
ful of herself, especially during the menstrual period. 
Prohibit sexual intercourse. 
Most cases recover by absorption of the tumor ; some 
break into the vagina or rectum, and some suppurate. 
Surgical interference may be called for when a largef 
tumor, causing much pain, has remained unchanged in size 
for several weeks, or where symptoms of suppuration 
occur. Make a free incision into the tumor through the 
vagina, and allow all pus or putrid blood to escape that 
THE PHYSICIAN'S COMPANION. will do so without pressure, and wash out the cavity three 
or four times a day with a two per cent, solution of car- 
bolic acid. 
Displacements may be often corrected by relieving the 
congestion to which they are frequently due, and those 
due to relaxation of the vagina by astringent injections 
and tonic treatment. Prolonged repose is hurtful, 
though rest in the recumbent posture for a few hours 
daily, after having first assumed the knee-breast posture, 
will greatly relieve the pain and congestion. Before ap- 
plying any mechanical support all inflammatory action 
should be subdued and the displacement corrected. Re- 
troversions are best treated by the Thomas modification 
of the Smith hard-rubber pessary, and those cases accom- 
panied by relaxed vagina or imperfect perineal support 
by the Thomas-Cutter pessary ; anteversions and ante- 
flexions by Thomas' anteversion pessary. In cases of 
simple prolapse most comfort is derived from the ring 
pessary. 
Vaginitis-the most common inflammatory affection of 
the vagina-usually affects the mucous membrane in the 
form of a catarrh, caused by irritants which come from 
without or neighboring organs, such as mechanical irri- 
tants (pessaries, &c.), infection (gonorrhceal, contagion, 
the decomposable substances from the uterus, &c.), and 
oxyorides from the rectum. In the acute form, at the very 
beginning the secretion is scanty and serous, but soon 
becomes abundant, muco-purulent, and yellow in color. 
In chronic catarrh the secretion may vary much-some- 
times it is abundant, cheesy, or purulent ; at others gray- 
ish-white and mucoid. 
Subjective Symptoms in Acute Catarrh.-Feeling of heat 
and burning in the pelvis, with difficulty in urination ; 
DISEASES OF WOMEN. 
65 66 
THE PHYSICIAN'S COMPANION. 
often troublesome itching and burning around the geni- 
tals. The gonorrhoeal form causes the most violent 
symptoms. In the chronic form the local difficulties not 
so marked, chiefly confined to burning and itching about 
the genitals. Treatment: Suitable diet, rest, care of the 
bowels, and avoidance of stimulating drinks. If caused 
by uterine affections they must be treated, and chlorotic 
and ansemic conditions, when present, must be looked 
to. The removal of foreign bodies (frequently pessaries) 
may sometimes suffice. Ordinarily, however, treatment 
must be directed towards overcoming infection-that is, 
the destruction of the bacteria in the secretion by vaginal 
irrigations. Disinfecting agents should be as dilute as 
possible, yet effective to prevent irritation. At least tw'O 
quarts of warm disinfecting fluid should be used three 
or four times a day. The best agents are corrosive sub- 
limate of the strength 1 to 3,000, or carbolic acid 5 to 1,000, 
or the application of a ten per cent, solution of nitrate of 
silver through a cylindrical speculum. 
Pruritus Vulva is an annoying symptom of several mor- 
bid conditions-such as pediculi, vaginitis, eczema, ery- 
thema, diabetes, herpes, prurigo, new growths, cervical 
endometritis, oxyuris, and nervous disorders. Treat- 
ment should be directed to cause. Of local remedies the 
best are carbolic acid, chloral, campho-chloral, cocaine, 
corrosive sublimate, nitrate of silver, and boracic acid. 
OBSTETRIC EMERGENCIES. 
Abortion.-In the earlier months of pregnancy we may 
endeavor to prevent this accident and tide the patient on 
to full term. Where the pains are slight, the os not much 
dilated, and but little hemorrhage, we should treat by 
rest in the recumbent posture, sedatives, cool drinks, and OBSTETRIC EMERGENCIES. 
67 
general quietude. Where there is moderate hemorrhage 
without much pain, we may give acetate of lead, with the 
addition of a little acetic acid, gallic acid, acid sulph. aro- 
matic, and similar remedies. Where there is much pain 
along with hemorrhage, opium in some form is the rem- 
edy of all others. Counter-irritation over loins and ice 
over the uterus, though recommended by some authors, 
are only mentioned to be condemned. Where there is 
progressive dilatation of the os, violent pains, consider- 
able hemorrhage, and discharge of the liquor amnii, we 
know that the discharge of the ovum is inevitable, and 
our efforts should be to hasten its expulsion and relieve 
the patient from further risk. Here, for the purpose of 
arresting hemorrhage and hastening the expulsion of the 
ovum, we may have recourse to the administration of 
ergot, by mouth or hypodermically, and the insertion of 
a tampon into the vagina. 
To Tampon the Vagina.-There are many contrivances 
in the shape of bags, with pumps and tubes for inflating 
with air or water, which will be found described in the books, 
and for sale by the instrument and supply houses. The 
trouble with these ready-made appliances is that they are 
never on hand when wanted, nor can they be bought or 
borrowed when we are without them. The best tampon 
to be had may be found anywhere and at any time in the 
shape of plugs of absorbent cotton tied with a string or 
light tape. A long roller bandage makes a most excel- 
lent tampon also. These may be saturated in slightly 
astringent solutions, or in carbolized glycerine, and packed 
into the vagina, either with or without the use of the spec- 
ulum. In all cases it is much easier and more satisfactory 
to tampon with a speculum, but where none is at hand it 
may be well done without this assistance. If no specu- 
lum is handy we would suggest that the roller bandage 68 
be used, as it can be managed easier, carrying in one 
end on the finger and packing it in until the vagina is 
filled. After a time-from eight to twenty-four hours- 
if the tampon has been saturated with an antiseptic solu- 
tion, it may be removed, or we may find it expelled along 
with the product of conception and the secundines ; or it 
may be necessary to continue tamponing. 
The placenta should be removed at once by passing 
the finger gently into the cervix, and as far up as possible 
into the womb, and hooking out the secundines. This 
can be done if the case is seen before firm contraction of 
the cervix takes place. In this effort the left hand 
presses down the womb through the abdominal parietes 
upon the finger which is introduced. If necessary, the 
entire hand can be introduced into the vagina, under 
chloroform, and the finger passed up into the uterus. If 
the case is seen after firm contraction of the cervix the 
expulsion of the secundines can be left to the natural 
efforts of the uterus. Sometimes it may be weeks before 
this is accomplished. If, however, the symptoms become 
serious by reason of hemorrhage or septicaemia it will be 
necessary to dilate the os and cervix and remove the 
retained mass. 
Hemorrhage Before Delivery.-This is known as ac- 
cidental hemorrhage, unavoidable hemorrhage, and 
placenta praevia, and is due in the majority of cases to 
the implantation of the placenta, partially or entirely, 
over the os uteri. It is easy to understand the physio- 
logical reason for this hemorrhage when we consider the 
changing relations of the placenta and its surface attach- 
ments. In all hemorrhages of this character the physician 
should exercise good judgment, sufficient courage, and 
prompt and decisive action. If the case is far from full 
term, and the chances favorable, an attempt may be made 
THE PHYSICIAN'S COMPANION. OBSTETRIC EMERGENCIES. 
69 
to prolong the period and encourage the birth of a viable 
child. To this end, rest, quietude, sedatives, general as- 
tringents, and tampons may be used. If the case is near 
full term, or serious in character, and the life of the mother 
is threatened from loss of blood, there should be no hesi- 
tancy or useless delay on the part of the physician. 
Here improper delay becomes criminal. With the finger 
carefully peel off and detach the placenta partially, rup- 
ture the membranes, and encourage immediate uterine 
contraction if the presenting part of the child is favorable 
and will come down and engage in the superior strait. If 
this cannot be accomplished, pass the hand up, turn, and 
deliver by the feet. Remember the essential treatment 
in these cases of accidental hemorrhage is to tampon as 
long as there is a likelihood of tiding the case on; but 
otherwise to deliver as speedily as possible. As a caulion, 
never tampon for hemorrhage after delivery; this would 
be fatal. 
Puerperal Convulsions.-There is no more dangerous 
or alarming condition to be met with in the practice of 
obstetrics than that of convulsions during labor. Here, 
as in post-partum hemorrhage, the physician must not 
only know his duty, but he must be cool-headed enough 
to perform it promptly and thoroughly. In all of these 
cases, whatever may be the pathology-whether there be 
hysteria or a poisoned condition of the nervous centres- 
we know that the child in utero is the exciting cause. 
Our duty is to relieve the enormous pressure upon the 
brain, to quiet the arterial and nervous system, and to 
speedily deliver. Do not hesitate to bleed promptly from 
one or more orifices. Bleed until there is a perceptible 
effect upon the circulation. Administer chloroform until 
there is thorough relaxation. Matters may be further 
aided by a rectal injection of choral hydrate, potass. bromide, and tinct. veratrum viride. The convulsions 
being reasonably under control, if necessary encourage 
or hasten dilatation of the os, rupture the membranes, 
deliver with forceps at the superior strait, or pass the hand 
up and deliver by podalic version. Unless you are pre- 
pared to treat such emergencies as this in the manner 
described, you have no right to answer a call to a mid- 
wifery case. When the patient returns to consciousness 
between paroxysms, our treatment need not be so pre- 
cipitate, as we can rely to some extent upon the adminis- 
tration of remedies for controlling the circulation by the 
mouth and hypodermically, for in these cases we some- 
times find an element of hysteria associated with mild 
convulsions. 
Hemorrhage After Delivery.-This is popularly known 
as "flooding," or among the profession as post-partum 
hemorrhage. There is no circumstance in the life of a 
physician which will more severely tax his courage and 
equanimity than to be suddenly confronted by an unex- 
pected case of post-partum hemorrhage. Once or twice 
we have seen cases in which medical men have allowed 
women to die while trying to collect their ideas. A 
woman will bleed to death easily in less than five min- 
utes. It In ay not be amiss to call attention to the fact 
that the cause of post partum hemorrhage is due to the 
partial or complete separation of the placenta and an un- 
contracted uterus, leaving a multitude of large venous 
sinuses thoroughly patulous, and through which the 
mother's life-blood is poured out in an immense and un- 
obstructed stream. 
The object of treatment is to free the womb of all clots 
and other contents, such as pieces of placenta, mem- 
branes, &c., and secure its immediate and permanent 
contraction. The practitioner should ever remember, 
70 
THE PHYSICIAN'S COMPANION. OBSTETRIC EMERGENCIES. 
71 
with this knowledge before him, that no time should be 
lost in trying a number of remedies recommended by the 
text-books. Ergot cannot be relied upon here ; there is 
no time for it to act. Ice over the abdomen may be of 
more service, but we cannot wait for it. The remedy of 
all others that will never fail us is the hand. Promptly 
pass the hand into the uterine cavity, turn out all clots, 
&c-., and if this stimulation by the hand does not produce 
uterine contraction, with the other hand grasp the uterus 
through the abdominal parietes, and thus mechanically 
compress the uterus and control the hemorrhage. Now 
we have an opportunity to resort to systemic remedies. 
The attendants may be ordered to administer stimulants, 
ergot, turpentine, elevate the hips, and pay attention to 
other details. We have never known this treatment to 
fail except in one instance, in which a premature labor 
occurred in a patient of ours already greatly debilitated 
by typhoid fever. The child was born before our arrival, 
but we were present before the separation of the placenta, 
which soon became partially detached, and a fearful 
hemorrhage commenced. We immediately separated the 
entire placenta and removed it, filled the uterus with our 
hand, and grasped it from without. There was no sign 
of contraction. The slightest removal of pressure would 
cause a flood of blood to gush past our wrist and arm. 
All attempts at producing contraction failing, we sent for 
a friend, Dr. O. A. Crenshaw, who, while we held on to 
the woman's life, as it were, mixed up a half pint of Mon- 
sell's solution of iron, passed the long nozzle of a syringe 
alongside of our wrist into the uterus, and injected the 
whole cavity of the uterus with this powerful styptic as we 
withdrew our hand. The contraction of the uterus and 
the arrest of hemorrhage was prompt, and the woman 
finally made a safe recovery. 72 
THE PHYSICIAN'S COMPANION. 
Labor Cases Requiring Assistance. 
Attention to Bladder and Rectum.-At the commence- 
ment of labor the attendant should ascertain the condition 
of the rectum, and if loaded, to empty it by an injection 
of warm water, or warm water with castor oil and tur- 
pentine. Many cases of labor are retarded by a loaded 
rectum obstructing the descent of the child's head. Later 
on especial attention should be paid to the bladder. Ft 
should be kept empty by the use of the catheter if neces- 
cary, not only for the sake of promoting the descent of 
the head, but to prevent prolapse or rupture. The pres- 
ence of polypi, vaginal tumors, and similar obstructions 
should be noted early and removed or guarded against as 
labor progresses. 
Presentations.-In natural labors we may have, besides 
the vertex in the first position, presentations of the fore- 
head anteriorly, of the face, and of the breech, all of which 
may go on to a safe termination by the efforts of nature 
alone. Occasionally these latter cases are very slow, and 
sometimes require some assistance. We may occasionally, 
in the absence of a pain, alter the position of the head, 
where the forehead presents anteriorly, by embracing the 
cranium between the first three fingers and thumb of one 
hand and giving the face an inclination to the right or left 
ilium, according as its original direction was to the right 
or left groin. Though, without affecting this alteration of 
position, the case is a perfectly natural one and requires 
no assistance except where there is impaction and all pro- 
gress is stopped, then the forceps may be used. Face 
cases, as a general rule, require no interference, unless the 
head becomes arrested or the chin fails to come round 
beneath the pubic arch, when the vectis or forceps will 
be required. OBSTETRIC EMERGENCIES. 
73 
Breech Cases.-Where the woman has borne children, 
and the birth is rapid, no interference is necessary in 
these cases ; but where matters are delayed the safety of 
the child demands our attention. The cord must be pro- 
tected from pressure to allow the child to live until its 
head reaches the external world. As soon as the cord 
can be reached it may be pulled down somewhat to relax 
it, and the remainder be placed in the hollow of the sac- 
rum, where it will be more out of the way of pressure. 
Wrap the child's body in flannel and hasten expulsion by 
traction during pains. 
To Bring Down the Arms.-If the arms be raised 
above the head, they must be brought down. It is easier 
to bring down the posterior one first. Pass two fingers 
over the shoulder from the back and depress the arm 
obliquely downwards and forwards across the chest. 
Then bring down the anterior one in like manner. Un- 
less the arms are carefully brought down in the proper 
direction the humerus will be fractured. 
To Bring Down the Head.-If the face be to the front 
and the chin much raised from the chest, we must change 
the position of the head. Pass the first two fingers of the 
left hand into the mouth and press the chin backwards 
towards the sacrum and downwards towards the chest 
of the child. Then pass two fingers of the other hand 
behind the occiput, grasp the head between both hands, 
and extract it first downwards and backwards in the axis 
of the brim, and then downwards and forwards in the 
axis of the outlet of the pelvis. 
Knee or Footling Cases may be managed as breech 
cases, except that there is still greater reason for delaying 
the first part of the labor. If one foot or one knee pre- 
sent, the other should not be brought down, for we wish the 74 
THE PHYSICIAN'S COMPANION. 
larger dilating body in the form of the limb flexed upon 
the trunk. 
Coiling of Cord Around Neck.-When the head is 
born it sometimes happens that the cord is twisted one or 
more times around the neck. The attempt may be made 
to draw down a loop of the cord and slip it over the 
head, or, if too tight, over the shoulders. When strangu- 
lation is threatened the cord should be divided and the 
vessels secured by ligatures. 
Brozv Presentations.-These positions require altering 
by manual interference. Push the brow up and convert 
the case either into a vertex or face presentation. 
Presentations of Superior Extremity.-These presen- 
tations of shoulder, elbow, or hand must be attended to 
promptly. Here the child lies transversely and cannot be 
born. Spontaneous version has occurred, and children 
have been born under the above conditions; but such 
good fortune cannot be relied upon, and we should lose 
no time in correcting this condition of affairs by turning 
and causing the vertex to engage in the superior strait, 
or by delivering by the feet. 
Hydrocephalus or Ascites of Foetus.-Here the head or 
abdomen, as the case may be, should be tapped with a 
small trocar, allowing an escape of fluid and reducing the 
size of the foetus so that it can pass through the pelvic 
canal. 
We have given the usual amount of information required 
in general obstetric practice as a guide in unusual cases. 
It is presumed that the student or practitioner is acquainted 
with the anatomical relations of the pelvis and the foetal 
head, and that he will use his own judgment where book 
or memory m iy fail him. There are graver operations in 
obstetrics than we have mentioned, but in such cases there OBSTETRIC EMERGENCIES. 
75 
is time for more careful thought, study, or consultation. 
In impacted head or arrest of descent from inertia the for- 
ceps should be used. It is needless, we hope, to tell any 
one that the hand should be introduced and the mother's 
parts protected while insinuating the blade of the forceps 
between them and the foetal head; or that the lower or 
male blade should be introduced first; or that after intro- 
ducing and locking, we should make examination to be 
sure that the mother's parts are not caught before mak- 
ing traction; or that in making traction with the forceps 
we should remember to keep in line of the various axes 
of the several planes of the pelvis. 
Again : Cases will arise in which, from enormous cra- 
nial development or pelvic deformity, craniotomy will be 
demanded, or we may have to perform Caesarean section 
for very great pelvic deformity or for ruptured uterus. 
These cases all require help and consultation, and we 
should take time to verify the diagnosis and obtain pro- 
fessional assistance. 
Troubles After Delivery. 
Inversion of Uterus.-1This accident is comparatively 
rare, but when it occurs it is usually very soon after the 
birth of the child. It may occur spontaneously, but is 
more often due to improper traction on the cord when the 
placenta is attached. It may be partial or complete in- 
version. In the complete form the uterus is turned com- 
pletely inside out, and extends beyond the os externum. 
It then presents itself as a globular elastic tumor, with a 
bright red, rough, bleeding surface. With the descent 
of the uterus the woman experiences a sensation as if a 
second child were coming into the world, and is imme- 
diately afterward attacked with vomiting, syncope, and 
alarming prostration, accompanied frequently with pro- 
fuse hemorrhage. 76 
The uterus should be returned without delay. Com- 
press the tumor firmly with both hands ; then push the 
fundus upwards into the pelvis, in the direction of the 
vaginal canal, by means of the fingers placed in the form 
of a cone. If the placenta adheres to the uterus, it should 
be returned with the uterus. If it be impossible to return 
it, it may be separated. After the uterus is returned the 
hand should be kept in its cavity until it is expelled by 
contraction of the organ. Should the first attempt at re- 
turning the uterus fail, the rectum and bladder should be 
emptied and further efforts made to restore the organ to 
its proper place. 
Nervous Shock After Delivery.-Some women-espe- 
cially those of hysterical temperament-present symptoms 
of severe shock after delivery. They appear much ex- 
hausted ; are liable to attacks of syncope ; there is often 
severe headache, and much intolerance of light and 
sound. The pulse is soft and compressible ; the counte- 
nance pale and anxious ; the tongue moist and tolerably 
clean ; the skin soft and perspirable. The best remedy 
is an opiate, with a diffusible stimulant; and this may be 
repeated, if necessary, in smaller doses every four hours. 
The most perfect repose should be enjoined. The head 
should be placed rather lower than usual, and the hori- 
zontal position strictly maintained. 
Sleeplessness After Delivery.-This is frequently a 
troublesome sequence to delivery. Absolute quiet should 
be insisted upon. Tea and coffee should be forbidden, 
and an opiate or chloral or bromide of potassium should 
be administered. 
Retention of the Urine After Delivery.-This is some- 
times the consequence of a tedious labor, and arises from 
the swelling of the vaginal orifice and meatus urinarius, 
THE PHYSICIAN'S COMPANION. 77 
together with some loss of power in the bladder. Warm 
fomentations to the vulva may be tried. If these do not 
produce the desired effect, the catheter must be used. If 
the inability continues, tonics and diuretics should be 
given. The following is a very excellent prescription : 
B Tinct. ferri chlorid .... 
Spts. aether, nit aa ^ij. 
Aquae ad .... 5 viii. 
M. S.-Tablespoonful three times daily. 
Deficiency of the Lochial Discharge.-This may be 
deficient in quantity, or may entirely disappear within two 
or three days after delivery. This is not unusual after the 
birth of first-born children, and need occasion no alarm, 
provided it be unaccompanied with febrile symptoms. 
Warm fomentations should be applied to the vulva, and 
the vagina should be syringed daily with warm water. A 
moderate dose of quinine and capsicum will very fre- 
quently restore the discharge. 
Excessive Lochial Discharges.-in every case when 
the lochia may .be excessive in quantity, or may last be- 
yond the usual time, producing much debility, the proper 
treatment is to enjoin rest, and give tonics, such as qui- 
nine and iron and to build up the system generally. 
Ergot and astringent injections are sometimes useful. 
Iron tonics come in well, and aromatic sulphuric acid is 
an excellent agent. 
Offensive LochialDischarges.-We sometimes find the 
lochia exceedingly offensive, and changed in quantity and 
color. This sometimes may depend upon the presence of 
putrid matters in the uterus, such as decomposed portions 
of the placenta, clots, &c. The vagina should be 
thoroughly syringed two or three times daily with warm 
OBSTETRIC EMERGENCIES. 78 
THE PHYSICIAN'S COMPANION. 
water, or with weak disinfectant lotions. The following 
are good formulae : 
B Liq. sodae chloratae ^ss. 
Aquae, destil. ad Oj. 
M.-Ft. lotio. 
B Liq. potass, permanganat . . . 5 ss. • 
Aq. destil. ad Oj. 
M.-Ft. lotio. 
Lacerated Perineum-Slight lacerations of the perineum 
are common, and require very little attention except 
cleanliness; but where the lacerations extend through the 
sphincter ani, and sometimes even through the recto 
vaginal septum, we have a serious and unfortunate case. 
In the deeper lacerations the parts should be thoroughly 
cleansed antiseptically, and immediately united by a suffi- 
cient number of deep sutures of silver wire or silk, and 
protected as much as possible from the discharges as they 
flow down. The patient should be kept perfectly quiet 
in bed, resting upon one side or the other, with the limbs 
tied together. 
Retracted Nipples.-In some women the nipples are so 
retracted and short that the child cannot seize them. 
They should be drawn out by means of an air-pump imme- 
diately before putting the child to the breast. The use of 
a nipple shield will sometimes enable the child to get at 
the milk. A very excellent substitute for the air-pump 
may be constructed in the following way : A decanter or 
soda water bottle is to be filled with hot water. The bot- 
tle is then empted, and the nipple immediately inserted 
into its mouth. As the air cools within the bottle a 
vacuum is formed, and the nipple is nicely drawn out. 
Sore Nipples.-This is a very painful affection to 
women, and in endeavoring to save themselves pain they OBSTETRIC EMERGENCIES. 
79 
often allow themselves to get a rising breast. The sore- 
ness depends upon the presence of excoriations, chaps, 
fissures, or even deep ulcers around and about the nipple. 
Ordinary excoriations may be treated by astringent 
lotions, such as alum, sulphate of zinc, &c. Excoriations 
about the base of the nipple may be painted with collo- 
dion, and thus protected ; but if there are very deep 
fissures or ulcers the application of nitrate of silver or 
the ointment of nitrate of mercury will be likely to do the 
most good. The strength of the silver lotion should be 
about ten grains to the ounce of rose water. 
Inflammation of the Breast.-Inflammation of this 
large gland is easily excited, and should be carefully 
guarded against. It is accompanied with febrile excite- 
ment, great pain, soreness and redness, and temporary 
suspension of the secretion of milk. It quickly terminates 
in suppuration if neglected. As far as possible, the breast 
should be relieved of its engorged condition by stroking 
out as much milk as possible, by the exhibition of saline 
purgatives, and the enjoinment of perfect quiet. Inflam- 
mation of this organ, at its commencement, should be 
treated by the application of ten or fifteen leeches to the 
part affected, or, if there is much fever, by a moderate 
blood-letting. Flax-seed meal poultices are recommend- 
ed, though we ourselves are much inclined to give prefer- 
ence to moderated pressure, cooling applications, or lead 
lotions, and attempts to relieve the breast of its super- 
abundant milk. Of course, when pus is formed its speedy 
evacuation is indicated. 
Puerperal Fever.-This is one of the most unfortunate 
accidents following delivery. From the inflammatory 
lesions that are present in various cases these fevers have 
been called metroperitonitis, hysteritis, uterine phlebitis, 
&c. The usual period of invasion is about three days 80 
after delivery. The especially prominent symptoms are 
rigors, followed by severe headache, fever, quick and 
often feeble pulse, suppression of milk, and lochia, pain and 
tenderness on pressure in the uterine region, extending 
over the whole abdomen. The woman loses all interest 
in her child, and her countenance betokens anxiety and 
great prostration of strength. Besides the above symp- 
toms there are generally delirium, vomiting, tympanites, 
and sometimes diarrhoea. Unfortunately this disease too 
frequently terminates in death. The cases most amena- 
ble to treatment appear to be the more acute forms of 
peritonitis. This somewhat resembles ordinary perito- 
nitis, and may be treated similarly by bleeding, leeches, 
mercurials, opiates, and warm fomentations. In other 
forms, in which the stomach and liver seem involved, 
heavy purgation seems to do the most good. For this 
purpose calomel is especially indicated. To summarize, 
the most important remedies are mercurials, opiates, and 
possibly stimulants. 
The First Care of the Infant.-As the child is received 
into the hands of the accoucheur it should be carefully 
laid upon the bed and the cord properly tied. If no 
efforts at respiration are made by the infant it will do good 
to allow the cord to bleed a little before tying it. Usually 
a smart slap or sudden dash of cold water in the face, or 
a little brandy and water wiped over the face and in the 
lips, will start the new-comer off with a vigorous squall. 
In the event of failure in this direction artificial respiration 
may and should be practiced. 
To Tie the Cord.-The ligature for this purpose should 
be neither very small or too large A cord made of sev- 
eral strands of silk thread well twisted and waxed, and 
tied in a secure double knot, is the best. Small silk braid 
will an-wer very well. Indeed, anything will do which 
THE PHYSICIAN'S COMPANION. INFANT FEEDING. 
81 
will properly constrict the vessels of the cord without cut- 
ting through prematurely. 
To Wash the Baby.-The child is usually covered with 
a cheesy-looking, sebaceous substance, which will not 
yield to soap and water, greatly to the surprise of the un- 
initiated. Grease the infant well with lard, oil, or some 
oleaginous compound, and then proceed to wash it. 
The Dressing for the Cord.-This is considered a mat- 
ter of great importance by old women and midwiives, andi 
many are the exact devices for covering and protecting, 
the cord. The most common plan is to take a small 
square piece of linen, cut a hole through its centre, pass 
the cord through this hole, and fold the linen over it. A 
simple and better plan is to take a small strip of muslin: 
or linen, grease it well with lard or Cosmoline, and lay it 
upon the child's abdomen. Then lay the stump of the 
cord upon this and cover with some old linen or absorb- 
ent cotton, and secure the whole with a light flannel ban- 
dage around the abdomen. The cord usually falls off 
within about a week's time. 
Hemorrhage from Cord.-Sometimes we have trouble- 
some and continued hemorrhage from the umbilicus after 
the separation of the stump of cord. Sometimes this 
may be very easily controlled by a little compress and 
bandage, or by the use of the ordinary styptics, such as 
tannin, alum, Peruvian bark, &c., but it is occasionally 
necessary to resort to the application of persulphate of 
iron or caustic. 
INFANT FEEDING. 
There is probably no question connected with medicine 
that has given more trouble to the practitioner than that 
of properly feeding the infant for the first year or two of 82 
THE PHYSICIAN'S COMPANION. 
its existence. When we consider the immense mortality 
in early life, and the fact that nearly three-fourths of such 
cases are the result of improper or insufficient food, the 
thought is an appalling one. No one with common rea- 
son will deny the fact that a full amount of healthy human 
milk is the very best food for an infant until it can masti- 
cate and digest other food. But here we are confronted 
with grave difficulties, for this fortunate circumstance of 
a full amount of human milk, and of the proper quality, 
is the exception rather than the rule. The child is con- 
stantly increasing his capacity for more and better food, 
while the mother's supply under the steady demand 
gradually grows less in quantity and inferior in quality. 
Therefore, where the milk is thus lacking we are com- 
pelled to feed the child artificially to keep it from starv- 
ing, and unfortunately we, in endeavoring to save life by 
feeding, give improper food and bring on disease. 
There is not a physician anywhere who has not felt his 
utter helplessness when confronted by cases of infantile 
gastritis enteritis, and starvation, the results of trying to 
feed these poor little ones artificially. When the mother's 
milk fails it is usual to resort to cow's milk, properly 
diluted and sweetened to somewhat represent the human 
milk, or to try some of the many sugary and farinaceous 
foods upon the market. 
Just here we will call attention to a few facts based upon 
physiology, which will explain why so few artificial foods 
answer. 
As to Cow's Milk.-First, if we could get it always 
pure, fresh, and free from contaminating germs and com- 
mencing products of decomposition, it would be better 
for the infant who was compelled to live upon cow's milk 
alone. But this is impossible. One has only to pay the 
slightest attention to the milk supply of our cities to see INFANT FEEDING. 
83 
that our little ones are in constant peril when dependent 
upon a varied and uncertain grade of milk, drawn from 
cows fed on all manner of garbage, and when hot and 
panting from heat or long drives. This milk is then care- 
lessly handled, receiving dust, germs, and other impuri- 
ties, and put in hot cans, driven in the sun over rough, 
jolting roads and streets, and finally delivered to the con- 
sumer. Good milk, gotten under the best conditions, is 
very indigestible for young babies by reason of its abun- 
dance of casein, which is very apt to form into hard curds. 
But it is absolutely dangerous to rely upon such as we 
have mentioned above. 
Returning to the physiological fact influencing the diges- 
tion of certain foods consisting of starchy, farinaceous 
■compounds, it should be remembered that the starch in 
our food is intended to be converted into glucose by the 
action of the saliva, and that in the infant this conversion 
of starch is impossible until the eruption of the teeth fully 
arouses the glands to a secretion of true ptyaline. There- 
fore we find no rational grounds for placing a child at the 
mercy of so many of these starchy, cane-sugar "infants' 
foods.'' 
We would call attention here to two products from a 
reliable and 'trustworthy house that we believe are the 
nearest possible approaches to healthy human milk, and 
that can be safely relied upon to properly nourish a child 
and support it entirely. Physiologically these prepara- 
tions are correct, and in practice in our hands they have 
done all claimed by the manufacturers. 
We refer to Lacto-Prepar ata and Carnrick's Soluble 
Food, manufactured by Messrs. Reed & Carnrick, of New 
York. 
These gentlemen have devoted much time and attention 
to the production of a food for infants made entirely from 84 
THE physician's COMPANION. 
cow's milk, with the constituents arranged so as to cor- 
respond very closely with human milk, and placing the 
same in hermetically sealed cans, with the constituents 
perfectly sterilized. This milk is all obtained within a 
short distance surrounding their factory at Goshen, and 
is evaporated in vacuo a few hours after being taken from 
the udder of the cow. Previous to its evaporation about 
thirty per cent, of the casein is digested, and the action 
of the pancreatine on the remaining portion destroys its 
tough character, so that it will coagulate only in soft, 
flocculent curds. This is practically an all-milk food, the 
only difference being the substitution of cocoa butter for 
the milk fat in consequence of the unstable character of 
the latter. This was done by the advice of Prof. Attfield, 
London, who devoted considerable time to investiga- 
tions on the subject in the interests of this house. 
His careful experiments led him to state that he believed 
cocoa butter would perfectly take its place, as its analysis 
shows that it is practically identical with the fat of cow's 
milk, less the constituents that produce rancidity. He 
also stated that in some respects it would be found supe- 
rior to milk fat, as it would be free from all possible 
germs that are found in much of the fat of cow's milk. 
Therefore cocoa butter has taken the place of milk fat in 
Carnrick's soluble food for more than a year and a half, 
and since then there have been no complaints of its keep- 
'ng qualities. This last production is called Lacto-Prepa- 
rata, and we believe that it is the most perfect food that 
can be produced for the artificial feeding of infants, and 
we think it removes all objections raised to the different 
methods thus far devised. 
The manufacturers have a new method of sterilizing 
their foods and placing them in hermetically sealed cans 85 
without coming in contact with the air or hands of the 
operators, everything being done by machinery. 
Lacto-Preparata is more especially adapted for infants 
from birth to six months of age, after which soluble food 
is probably better adapted. Soluble Food, as perfected, 
contains 37X per cent, of the solid constituents of milk, 
37X per cent, of wheat with the starch converted into 
dextrine and soluble starch, and 25 per cent, of additional 
milk sugar. 
THERAPEUTIC CLASSIFICATION OF DRUGS. 
The prescriber will find this a most useful table to have 
handy for consultation where memory fails him. It has 
been carefully compiled up to the 1 <test moment, and we 
have used both Professor H. C. Wood's excellent work 
on therapeutics, and Saunders' Question Compend in pre- 
paring this resume. 
Systemic Remedies. 
ASTRINGENTS. 
Vegetable.-Tannin, gallic acid, catechu, kino, haema- 
toxylin, rhatany, red-oak bark, sumach, port wine. 
Mineral.-Alum, lead, bismuth, zinc, copper, silver, 
and the various preparations of these metals. 
TONICS. 
Simple Bitters.-Quassia, simaruba, gentian, barberry, 
boneset, dogwood, columba. 
Peculiar Bitters.-Prunus Virginiana cort., cinchona, 
and its preparations and alkaloids. 
Aromatic Bitters -Chamomile, snakeroot (Virginia), 
cascarilla, angostura. 
Mineral Tonics.-Iron and its preparations, arsenic 
mineral acids, phosphorus. 
THERAPEUTIC CLASSIFICATION OF DRUGS. 86 
THE PHYSICIAN'S COMPANION. 
MEDICINES AFFECTING THE CIRCULATION. 
Heart and Vascular Stimulants.-Alcohol, ammonia, 
ether, atropia, caffein, digitalis, strophanthus, sparteine, 
strychnine, cimicifuga. 
Heart and Vascular Sedatives.-Acid hydrocyanic dil., 
antimoyials, aconite, veratrum viride, gelsemium, pulsa- 
tilla, &c. 
MEDICINES ACTING ON THE BODY BY INFLUENCING NUTRI- 
TION, TISSUE WASTE OR REPAIR, &C. 
Digestants.-Pepsin, pancreatin, vegetable pepsin (pap- 
ain), malt extracts. 
Alteratives.-Preparations of mercury, arsenic, iodine, 
iodides, cod-liver oil, hypophosphites, phosphates, calcium 
sulphide, sarsaparilla, cascara amarga, stillingia, bitter 
sweet, &c. 
MEDICINES ACTING PRIMARILY ON THE NERVOUS 
SYSTEM. 
Excito-Motors.-Strychnia, Ignatia, rhus toxicoden- 
dron. 
Depresso-Motors.-Calabar bean, potass, bromid., 
chloral hydrat, gelsemium, tobacco, cyanides, &c. 
Hypnotics.-Opium, hyoscyamus, paraldehyde, urethan, 
chloral, humulus. 
Mydriatics.-Belladonna, stramonium, duboisia, ery- 
throxylon. 
Ancesthetics.-Nitrous oxide, chloroform, alcohol, 
ether, bichloride of methyl, bromide of methyl. 
Antispasmodics.-Musk, castor, assafoetida, camphor, 
valerian, Hoffman's anodyne (co. spts. sulph. ether). THERAPEUTIC CLASSIFICATION OF DRUGS. 
DRUGS ACTING ESPECIALLY UPON CERTAIN ORGANS OR 
FUNCTIONS. 
Emetics.-Ipecac, bloodroot, apomorphia, mustard, 
squill, powdered alum, sulphate of copper, turpeth min- 
eral (yellow sulphate of mercury). 
Cathartics.-(Laxative) oatmeal, tamarinds, fruits, sul- 
phur, magnesia, &c. (Purgatives) calomel, castor oil, 
rhubarb, aloes, senna, euonymus, and salines. (Drastics) 
colocynth, gamboge, scammony, elaterium, croton oil, 
may apple, pill, cathartic co. 
Diuretics. -Digitalis, squills, nitre, potash and its prepa- 
rations, Buffalo Lithia Water, turpentine, buchu, pareira 
brava, chimaphila, juniper, copaiba, &c. 
Diaphoretics.-Liq. acet, ammonia, jaborandi, ipecac 
and nitrate of potash, spts. nitre. 
Expectorants.-Tartar emetic, ipecac, cubebs, tar, 
senega, ammonium chloride and carbonate, benzoic 
acid, squills, balsamic preparations. 
Emmenagogues.-Apiol, rue, savin, myrrh, camphor, 
tansy. 
Oxytocics.-Ergot, quinine, cotton root, corn ergot. 
Demulcents.-Gum arabic, gum tragacanth, slippery 
elm, Iceland moss, sassafras pith, barley. 
MISCELLANEOUS REMEDIES. 
Antacids.-Soda, lime, potassium carbonate, &c. 
Anthelmintics.-Pink root, wormseed, male fern, pump 
kin seed, santonin, turpentine, and castor oil. 
Disinfectants.-Chlorine, potass, permanganate, iodine, 
lime, sulphurous acid, thymol, carbolic acid. 
87 88 
THE PHYSICIAN'S COMPANION. 
Medication by the hypodermic syringe should be re- 
sorted to under the following conditions : Where stomach 
is irritable and will not retain the drug ; where the patient 
cannot swallow, either from obstruction, paralysis, or 
insensibility; where we wish to give a minimum dose ; 
where we desire prompt action of the remedy ; where we 
wish greater local effect, as in obtunding pain. 
As a general rule, the dose of a drug for hypodermic 
use should be about half of the dose used by the mouth. 
The point of introducing the remedy may be selected 
according to circumstances. If there is a general effect 
to be produced, we may select the inner portion of the 
arm or thigh. If we wish to relieve local pain, it is well 
to inject along the course of the affected nerve, or over 
the painful spot. For abdominal pain, or where we wish 
to produce vomiting, we inject over the abdomen. 
The Method of Injecting.-The principal care should 
consist in se'ecting the proper site for introducing the 
remedy, having clean antiseptic needles, fresh solution 
(or some of the excellent, handy, and accurate little tablets 
made by our chemists for the purpose-Messrs. Sharp & 
Dohme, of Baltimore, prepare a full line of these goods, 
and they are pure and reliable), driving all air out of the 
needle before injecting, and finally properly injecting the 
fluid. The skin should be lightly pinched up, and the 
needle introduced with a slight rotary motion well through 
the skin in a slanting direction into the cellular tissue. 
The piston of the syringe should be slowly and gently 
pushed down, driving the fluid out into the surrounding 
tissue; and after withdrawing the needle, the finger 
should be held over the point of puncture for a minute 
to prevent any escapement of the injected fluid, and at the 
HYPODERMIC MEDICATION. same time a little manipulation of the spot will further 
hasten the absorption of the fluid. Care should betaken 
to avoid injecting into a vein, as alarming symptoms have 
known to follow the too rapid introduction of morphia 
into the circulation. When this accident does occur, as 
is indicated by faintness, heart failure, cyanosis, and other 
pressing symptoms, a cord or ligature should be placed 
around the limb to retard any further absorption from the 
point of injection. Stimulants, belladonna, atropia, and 
electricity may be used. 
Another caution to be observed is the possibility of 
having the hypodermic dose increased or intensified by 
opium in some form previously administered. Nearly all 
of the fatal cases following morphia hypodermically have 
been traced to the fact of a previous dose or hypodermic 
of opium or morphia. The physician in all cases should 
know how much morphia his patient has in him when he 
is using his hypodermic syringe. If called to see a patient, 
and we are informed that he has been taking laudanum 
or other opium preparation, we are very careful about in- 
jecting morphia under his skin, or after one good hypo- 
dermic we wait sufficiently long before repeating the dose. 
Properly used, the hypodermic method is exceedingly 
valuable and perfectly safe, and we would urge the young 
or old practitioner to note the above points in all of his 
cases. 
We give the following as embodying the principal con- 
ditions under which hypodermics have been employed : 
Abortion has been caused by hypodermics of pilocar- 
pine. This should enforce caution. 
Arrest of Perspiration.-Pilocarpine, the alkaloid of 
jaborandi, will cause more or less profuse sweating, ac- 
cording to the amount injected beneath the skin. 
HYPODERMIC MEDICATION. 
89 THE PHYSICIAN'S COMPANION. 
90 
Bubo has been aborted by injecting carbolic acid into 
the centre of the swelling. 
Carcinoma.-Acetic acid-one part to three of water- 
injected into the cancer has proved successful in shrivel- 
ling the tumor, and thus obviating an operation. 
Chloroform Poisoning-One-tenth grain of digitaline 
hypodermically, followed an hour afterward with one- 
tenth grain of atropia in a similar manner. 
Congestive Chills.-Ten drops of tincture of belladonna 
hypodermically every fifteen minutes until the pulse be- 
comes distinguishable succeeded where the patient was 
unconscious and unable to swallow. 
Croup -Sulphate of atropia-one per cent, solution- 
injected into the neck, on a level with the pneumogas- 
tric ; three drops, repeated in four hours. 
Dysentery.-Morphia hypodermically, in one-third- 
grain doses, has been found more rapid in relieving tenes- 
mus than any other opiate. 
Erectile Tumors have been successfully treated by in- 
jections of perchloride of iron and chloride of sodium in 
solution ; the tumor to be surrounded by a ring. 
Foreign Body in the CEsophagus.-Threatened stran- 
gulation from impaction of the gullet has been promptly 
relieved by inducing vomiting. For this purpose inject 
hypodermically one-tenth grain apomorphia. 
Goitre has been successfully treated by subcutaneous 
injections of ergotin ; one-third grain, gradually increased 
to one grain. 
Hcemoptysis.-Sclerotinic acid-a five per cent, solu- 
tion-injected in the neck or arm? Ergotin may also be 
used. Hemorrhages.-Haemoptysis, haematemesis, and ute- 
rine hemorrhages have all been arrested by hypodermics 
of ergotin. If there is pain, add morphia. 
Hernia is more easily reduced by giving a hypodermic 
injection of morphia, with or without atropia. 
Hiccough.-In obstinate cases resisting all other means, 
three-eighths grain of chloro-hydrate of pilocarpine, hypo- 
dermically, quickly proved successful. 
Infantile Convulsions.-Morphia subcutaneously, with 
inhalations of five drops of nitrite of amyl immediately 
following, have proved successful. We would here cau- 
tion against the indiscriminate use of morphia in the case 
of children. 
Membranous Croup.-Equal parts of water and solu- 
tion perchloride of iron injected into the trachea, pierc- 
ing the needle through just below the thyroid cartilage, 
dissolves the membrane and assists its expectoration, 
and is thus a substitute for tracheotomy. 
Nasal Polypus.-Carbolic acid one part, glycerine four 
parts. Inject twenty drops into the tumor by means of a 
hypodermic syringe. 
Night Sweats.-Atropia has given good results in in- 
jections of about one-fortieth grain at bed-time. 
Obstructions of the Bowels.-Aloin has been used with 
success subcutaneously to move the bowels. 
Opium Poisoning.-Rapid recovery is reported to have 
followed warm hypodermics of fluid extract coffee in 
thirty minim doses. Caffein citrate, and sulphate of 
atropia may also be used. 
Puerperal Convulsions.-Veratrum viride, two to four 
drops of the tincture subcutaneously, to keep the pulse 
HYPODERMIC MEDICATION. 
91 92 
the physician's companion. 
down to about 60. A pilocarpine (two per cent.) solution 
is also recommended. 
Retention of the Urine, from paralysis of the bladder, 
accompanying typhus, variola, and hydrocephalus, has 
been promptly overcome by hypodermics of ergot in the 
fossa behind the great trochanter. 
Snake Bites.-Ammonia, brandy, carbolic acid, or 
salicylic acid are all recommended, hypodermically, in 
the case of snake poisoning, and have been with benefit 
injected into a vein. 
Strychnia Poisoning.-Caffein, one grain hypoder- 
mically ; chloral, alcohol. 
Surgical Shock.-Six grains quinine with one-third 
grain morphia hypodermically. 
Ununited Fractures.-Glacial acetic acid, five to ten 
minims between the ends of the bones with hypodermic 
syringe. Iodine has also succeeded when used in the 
same way. 
Urticaria.-Saturated solution of bisulphite of soda 
injected directly into the part affected. 
We append a few formulae for those who are compelled 
or prefer to prepare their own solutions for hypodermic 
use: 
R Apomorphiae gr. j. 
Aquae purae 3 iiss. 
M. One minim represents gr. Dose 5 to 20 nf ns. 
Very active emetic. 
R Atropiae sulph gr. j. 
Aq. purae 5 xv. 
M. One minim = gr. Dose 5 to 20 mins. HYPODERMIC MEDICATION. 
14 Caffein grs. x. 
Alcohol 3 iss. 
Aq. purae 3 iss. 
M. One minim = gr. Dose 4 to 18 mins. 
14 Digitalin gr. ss. (J) 
Alcohol 3 ij. 
Aq. purae 3 ij. 
M. One minim = gr. Dose 4 to 8 mins. 
14 Ergotin (watery ext.) gr. xx. 
Aq. destil 3 j. 
M. One minim = A gr. Dose 5 to 20 mins. 
14 Curarae (woorara) gr. 
Aq. destil 1 3 iv. 
M. S. 5 to 15 mins. 
14 Duboisiae mur gr. ss. (|) 
Aq. destil j. 
M. S. 5 to 16 mins. 
14 Hydrarg. chlor, corrosiv gr. iij. 
Sodii chlorid gr. iij 
Dissolve the above in a drachm and a half of distilled 
water, filter and add enough aq. destillat to make 3x. 
One minim = gr Dose 3 to 10 drops, which should 
be injected under the skin of the back on either side of the 
spinal column. 
14 Pilocarpin. mur grs. iij. 
Aq. purae 3 
M. One min. = -fa gr. Dose 10 to 20 mins. 
14 Strychniae sulph gr. j. 
Aq. destil 3 j. 
M. One min. = gr. Dose 4 to 15 mins. 
93 94 
THE PHYSICIAN'S COMPANION. 
With ths present advance of science no physician can 
afford to be ignorant concerning the ordinary uses of 
electricity and its application in medicine and surgery. 
And yet it is rare to find a physician possessing the most 
elementary knowledge of the subject. For this reason 
we will introduce a sufficient amount of information to 
enable the physician to properly grapple the subject and 
make a sensible application of this important agent in the 
treatment of disease, or in surgical cases requiring it. 
Galvanism is the current produced from the action of 
an exciting fluid upon two dissimilar metals, such as zinc 
and copper, zinc and carbon, etc. 
Faradism is the current of a galvanic battery passed 
through an induction coil and interrupted. 
Galvanism gives the constant current, the electrolytic 
current, and the potential current, and is used both for 
electrolysis -chemical decomposition-and for general 
diffused applications. Faradism is used to stimulate the 
nervous and muscular systems by shocks. You cannot 
practice electrolysis with a Faradic current. 
The Poles of a battery are the ends of the wires leading 
from the two terminals of the battery. The negative pole 
is always from the element most actively acted upon in 
the battery, which is the zinc in zinc-carbon, or zinc-copper 
battery. 
The positive pole is just the opposite of the above, and 
is found leading from the carbon or copper. 
The negative pole, or electrode, never corrodes or oxy- 
dizes the tissues of the body, and is the pole for treating 
strictures and other troubles of the mucous surfaces or 
sinuses. Under the action of the current, hydrogen and 
alkalies and electro positive elements of the body cluster 
ELECTRICITY IN MEDICINE AND SURGERY. ELECTRICITY IN MEDICINE. 
95 
around the negative pole and keep it bright and free from 
corrosion. The positive pole draws to it oxygen and 
acids and will oxydize the tissues and become corroded. 
It should be rarely used as a metal electrode in treating 
diseases, but should be used as the sponge electrode to 
the surface. 
An Electrode is the sponge or instrument connected 
with one or both of the poles of a battery and in contact 
with the patient's body. 
An Electrolyte is a substance capable of being acted 
upon or chemically decomposed by the galvanic current. 
Anode-the method or direction in which electricity 
enters the body-the positive pole. 
Cathode-the opposite of anode-negative pole. 
Ascending or Descending Currents are simply the 
passage of a current from the periphery of a nerve to its 
centre or origin, and vice versa. The positive pole fur- 
nishes the current that passes towards the negative elec- 
trode, wherever it may be placed; and hence, if you 
know your positive pole from the negative, you always 
know the direction of your current. It can be seen that 
one who simply puts two sponge electrodes on a patient 
without a proper knowledge of the ascending or de- 
scending currents is as likely to do harm as good. 
Besides galvanism and faradism, we have also frank- 
linic or static electricity-known as frictional electricity. 
In practice the galvanic and faradic are the chief forms of 
current used. 
Special Features of the Galvanic Current.-A thorough 
understanding of the peculiar features of the galvanic cur- 
rent, especially as contrasted with the faradic, is abso- 
lutely necessary. 
A plate of zinc and a plate of carbon, each having a 
wire attached, placed into a cell containing some acid- THE PHYSICIAN'S COMPANION. 
ulated or exciting fluid, and not touching each other, con- 
stitute the simplest form of galvanic cell or battery. Now 
'when these terminal wires are united a current of elec- 
tricity commences to flow, leaving the cell by way of the 
wire attached to the carbon plate, passing along this wire 
and around to the zinc plate in the battery, thus making 
an electric circuit. Now this current always flows in 
the same direction-is constant, without interruption or 
shock ; and when a number of such cells are coupled for 
intensity it will exhibit its chemical powers and break up 
electrolytes into their atomic elements. Now note the 
faradic current. If a bundle of soft iron wire, or a rod 
of soft iron, be wound around from one end to the other 
with insulated copper wire, and this same galvanic cur- 
rent be passed through this coil of wire, it renders this 
core of soft iron magnetic. Now if this coil of wire is 
insulated, and another coil of wire wound over it, we will 
have another current induced in this second coil when- 
ever the flow is suddenly stopped in the first coil. This 
current flows in the same direction as that of the inner or 
first coil, but when the current is re-established in the first 
coil a momentary wave will pass through the second or 
outer coil, but in an opposite direction to that flowing in 
the inner coil. 
This is the principle involved in all faradic machines, 
and this is the induced or interrupted current. It is use- 
less for any chemical or electrolytic purposes, is an inter- 
rupted current, and flows both backwards and forwards. 
It is used for stimulating the nerves and muscles in atro- 
phy, paralysis, &c., and its range of usefulness is quite 
limited, while its injudicious use may do much harm. 
Going back to the simple galvanic cell, we will point 
out the relative value of quantity and intensity. If 
in the simple cell that we have described the plates of 
96 URETHRAL STRICTURE. 
zinc and carbon should be one foot square, we would get 
a large quantity current. Such current would crowd 
along on a wire offering much resistance, and heat it or 
burn it up ; but it would possess little or no intensity-it 
would not decompose a single drop of water into hydro- 
gen and oxygen. If, on the other hand, these plates of 
zinc and carbon were cut up into strips one inch each in 
width, and twelve smaller cells made, which would ex- 
pose exactly the same amount of surface as the large 
cell, and these elements then connected, so that the cur- 
rent from the zinc of the first cell would flow to the car- 
bon, and from that carbon on to the zinc of next cell, and 
so on through the whole series, we would have a galvanic 
current as before, but of very little quantity, while it 
would possess high potential or intensity. This current 
would not heat the wire or burn, but would very rapidly 
decompose water or the morbid or healthy tissues of the 
body. 
Upon the above principles all applications in medicine 
and surgery depend, and if our readers will closely study 
these facts they will be able to pursue the study with sat- 
isfaction, both theoretically and in practice. 
THE TREATMENT OF URETHRAL STRICTURE BY 
ELECTROLYSIS. 
The principles upon which the scientific and successful 
treatment of stricture is based are these : All electrolytes, 
when brought within the galvanic circuit, are decomposed, 
hydrogen and alkalies going to the negative pole, oxygen 
and acids going to the positive pole. The simplest elec- 
trolyte is water, and under electrolytic action evolves at 
the positive pole oxygen, and at the negative pole hydro- 
gen. If a solution of iodide of potassium be subjected 
97 98 
THE PHYSICIAN'S COMPANION. 
to the influence of the galvanic current, the iodine with 
the oxygen appears at the positive pole, and the alkali 
with the hydrogen at the negative pole. In a solution of 
common salt chlorine is evolved at the anode and oxide 
of sodium at the cathode. Dr. Rockwell, in his work en- 
titled " Electricity as Related to Medicine and Surgery," 
says: "When it is remembered that in electrolysis of 
every compound substance the elements evolved are 
definite in quality and quantity, as well as electro-chemi- 
cal equivalents of each other, it can be readily understood 
that electro-surgery offers as great, if not greater, possi- 
bilities of exact and uniform results as electro-medicine." 
It can be readily understood that the tissues of the human 
body, composed, as they are, largely of water and salts, 
are very excellent electrolytes, and are readily decom- 
posed and broken up into their elements by the galvanic 
current. 
In the treatment of these cases we need a good steady 
galvanic battery of from twelve to twenty-four cells, and 
suitable urethral electrodes. The battery may be a zinc- 
carbon, Leclanche, chloride of silver, or even a good 
gravity battery. The zinc-carbon acid battery is by far 
the best. The best electrodes are firm bougies or sounds 
insulated with hard rubber, terminating in an acorn- 
shaped metal bulb. These are of various sizes, suitable 
for working all sizes of strictures. These electrode bou- 
gies are attached to the negative pole of the battery and 
passed down within the urethra to the point of obstruc- 
tion or stricture. Never use anything but the negative 
electrode in the urethra. The circuit is completed by 
attaching a covered carbon electrode to the positive pole 
and placing it in the patient's hand or on the thigh, or 
other part of the body. Galvanometer, rheostat, and 
milliampere-meter are of no real practical value. They URETHRAL STRICTURE. 
99 
are not exact, nor do they convey the information to the 
operator that he wishes. The best guide in regulating 
the current is the sensations of the patient. This is a 
meter that will never fail you. Start with your battery at 
zero and gradually add on cell by cell until the presence 
of the current is perceptible to the patient and free from 
pain. A gentle warmth or tingling either at the negative 
or positive pole is all that is necessary. Usually from six 
to twelve cells will be sufficient for.ordinary work. Do 
not expect to do too much at once, but use weak currents 
and work at long intervals, allowing ten days to three 
weeks between seances. From five to fifteen minutes is 
long enough to keep a patient under the current. Hold 
the electrode in contact with the stricture until it glides 
through, if you have to give several seances before you 
succeed. Select such electrode as is a little larger than 
the stricture, using larger and larger ones as you gain in 
decomposing the stricture. 
The intensity of the current may be graduated and 
modified (in addition to the regulation effected by the 
connectors, rheostat, &c.,) by the far or near point at 
which the connection or completion is made on the sur- 
face of the patient's body. For example, when the bulb 
of the electrode is at the seat of the stricture, and say six 
or eight cells are in use, the positive electrode being in 
the palm of the patient's hand, he may not be sensible 
of the action of the current; but if the sponge be placed 
on the thigh, or in the groin, or over the pubic region, it 
will be found that the current is appreciable without 
increasing the number of cells, and the stricture may be 
worked with this number of. cells; and in our hands 
the most successful and satisfactory results have been 
obtained by using the fewest possible number of cells 
that can be made to decompose the stricture. 100 
THE PHYSICIAN'S COMPANION. 
Whatever strength of current that is positively percepti- 
ble to the patient, and short of pain, is the proper strength 
to use in each case, whether such current be produced 
from one cell or from one hundred cells. The suscepti- 
bility of the patient to the action of the current, which is 
only known by the sensation which he experiences when 
the current is passing, is the only guide to us in regu- 
lating the intensity. Such a current as this will not burn, 
or cauterize, will not produce pain or inflammation, but 
will, with positive certainty, reduce the tissues in contact 
with the negative pole to their original elements, causing 
the salts of the blood or alkalies and the hydrogen to 
separate from their combinations and cluster around the 
bulb of the negative electrode, while the oxygen and 
acids seek the positive pole. And what is the result? 
The tyro in chemistry or medicine will answer: "The 
stricture is absorbed." Exactly so; without pain, without 
cauterization, but, as it were, by a chemico-vital process 
the stricture is absorbed, and the electrode passes 
readily into the bladder without force, but simply by its 
own weight, because there is nothing left to obstruct its 
passage. 
Complications Arising in the Treatment of Stricture of 
the Urethra by Electrolysis 
To any one who expects to simply work all strictures 
four or five times with an electrode bougie and look for a 
cure, we would say that disgust and failure will surely 
attend his efforts, it may be, in the very first case treated. 
Stricture may be aggravated and the patient greatly 
harmed by the injudicious and inexperienced use of the 
galvanic current. There is a time when the current may, 
and should be, used, and also a time when it should not be 
used. These points must be decided by the experience 
and judgment of the operator. And to aid the beginner URETHRAL STRICTURE. 
101 
we will point out some of the troubles likely to be met 
with. 
Inflamed strictures will be met with, and the pain ex- 
perienced upon the passage of any instrument will be out 
of proportion to the amount of resistance offered by the 
mere presence of the adventitious tissue or hypertro- 
phied mucous membrane. A stricture presenting such 
features is not in a suitable condition for the electrolytic 
treatment. The remedy consists in local treatment of 
this condition. Here the diet of the patient must be 
regulated, the urine rendered bland and alkaline or neu- 
tral in character ; the bowels should be kept moderately 
open, so as to avoid any sympathetic irritation in the 
urethra from an overdistended rectum. Granular effer- 
vescent citrate of potash, bicarbonate of potash, tr. gel- 
semii, bal. copaibae, flax-seed tea, and such agents will 
come in well. Deep urethral injections of two to five 
grain solutions of nitrate of silver, sulphate of zinc, with 
aq. ext. opii and glycerine, will be found serviceable. 
These applications should be made every day, or every 
other day, until the passage of such steel sound as the 
urethra will allow without pain or hemorrhage can be 
effected. In this way the urethra can be prepared in a 
week or ten days for the electrolytic treatment. We will 
take occasion just here to speak especially of one agent, 
which we have found of inestimable value in all such cases. 
We refer to the Buffalo Lithia Water, Spring No. 2, from the 
famous springs in Mecklenburg county, Va., owned by Col. 
Thomas F. Goode. This is truly a most valuable agent, 
and we employ it ad libitum in all cases of urethral or vesi- 
cal irritation. It seems to not only act as a neutralizer of 
the urine, but also as a nervous sedative to the genito- 
urinary apparatus. We remember to have attended a Cap- 
tain McG., of this city, some eighteen months ago, for a 102 
THE PHYSICIAN'S COMPANION. 
most distressing case of urethral and vesical irritation. 
After the free use of this most valuable water he passed 
a small calculus, which was partly crumbled, and he has 
had no further trouble since. Our belief is that the calcu- 
lus had lodged about the neck of the bladder and was 
the cause of the continued irritation, and that under the 
use of the water it was dissolved and finally reduced to a 
size which admitted of its expulsion per urethram. But 
it is not our intention to laud this water so much as a sol- 
vent of stone as for its unquestionable merits as a bland 
diuretic and sedative. 
Hemorrhage may, and does, occur after the use of the 
electrode bougie, and generally indicates the impropriety 
of such treatment until the cause is ascertained and re- 
moved. When the blood is fresh, bright red, and follows 
the immediate withdrawal of the instrument, it is gene- 
rally due to the presence of an ulcerated spot, or to 
granular inflammation, or to roughness in handling the 
electrode. The treatment proper in such cases is very 
similar to that laid down for inflamed stricture, and em- 
braces the general rules for allaying local and general 
irritation. The best local applications are made by means 
of the deep urethral syringe and the cupped sound, and 
by ointment-carriers of various patterns. The agents of 
most service in this condition are zinc, nit. silver, cupri 
sulph., tannin, and as adjuvants, glycerine, morphia, and 
belladonna. 
The strength of these agents should be modified to 
suit circumstances. No exact guide can be given, but we 
would enjoin caution in the use of all active caustics in the 
urethra. Our rule is to commence with a five-grain solu- 
tion of zinc, silver, or sulphate of copper carried down to 
the part affected by means of a Taylor's syringe, and 
gradually increase the strength until the patient feels a URETHRAL STRICTURE. 
103 
decided impression from the injections. If we use the cup- 
ped sound we commence with a similar strength in the 
shape of an ointment, but when it becomes necessary 
to touch the spot with a very concentrated solution of 
any of the active agents, we discard the cupped sound and 
rely upon Taylor's syringe or Dick's caustic catheter 
syringe, by means of which a drop of any solution may be 
placed at the exact spot which may need medication. We 
consider Lallemand's porte-caustic a very unsafe instru- 
ment, and do not recommend it, or use it ourselves. An- 
other very excellent method of applying strong medica- 
ments to certain diseased portions of the urethral canal 
is by means of a compound instrument which we have de- 
vised, and find can be made available for a number of 
purposes. 
This instrument, known as "Bryce's Urethral Appli- 
cator and Syringe," consists of a silver cylindrical tube, 
perfectly straight, ten inches long, with a number of per- 
forations near the vesical end; within this tube slides an- 
other tube of equal length, provided with a large fenes- 
trum to correspond with the perforations in the outer 
tube. An air-tight plunger fits accurately in this inner 
tube. An ointment may be placed in this tube, and the 
whole encased in the outer one. This instrument is so 
arranged that when it is carried down to any desired spot, 
by turning the inner tube and forcing a little gauge pin 
into a slot in the outer tube, the fenestrum is brought 
opposite the perforations in the outer tube. By gently 
forcing the piston rod down, an ointment may thus be 
applied in any quantity to any particular spot or spots 
within the urethral tract. The instrument may be used 
equally as well for a syringe. It is the best one we have 
ever used for medicating the urethra. The surgeon can 
with positive certainty know exactly where he is applying 104 
his remedies, and has perfect control of such agents, 
medicating only such spots as he may choose, applying 
large or small quantities as the case may demand. Any 
surgeon who is familiar with the anatomy of the parts 
knows that a perfectly straight instrument can be readily 
passed into the bladder. Therefore, this instrument can 
be used for the various purposes of a simple catheter, an 
ointment-carrier, or a syringe for caustic solutions. 
Urethral Hyperesthesia-Before closing this chapter we 
will mention one other complication, which will frequently 
be found one of the most embarrassing conditions encoun- 
tered in treating the urethra-existing after the stricture 
has been cured, and yet giving rise to symptoms which 
simulate stricture and may cause the patient to doubt his 
cure. We refer to urethral hyperaesthesia. 
Quite full articles on the subjects of electrolytic treat- 
ment of stricture (illustrative cases) and urethral hyperaes- 
thesia appeared from the author's pen in the December, 
1883, and January, February, and March numbers, 1884, 
of the Southern Clinic, Richmond, Va. 
DIRECTIONS FOR MAKING POST-MORTEM EXAMINA- 
TIONS. 
The instruments necessary are a dissecting case, to 
which are added a bone saw, a hammer and chisel, and 
some strong surgical needles, with stout linen thread, well 
waxed, for sewing up the incisions made in the skin. 
The physician should also provide himself with some 
strips of parchment paper for labelling specimens for 
microscopical examination, waxed paper for wrapping 
them up, and, in cases of suspected poisoning, with clean 
jars for the contents of the stomach and intestines to be 
examined chemically. 
THE PHYSICIAN'S COMPANION. POST-MORTEM EXAMINATIONS. 
105 
In medico-legal cases it is of the utmost importance 
that a careful record be kept of everything in connection 
with the post-mortem examination, and this is also very 
desirable in ordinary cases which are conducted for the 
purpose of determining the pathology of the disease, and 
therefore the operator should have paper and pen and 
ink to make the necessary notes. 
The following four cardinal points should be borne in 
mind, whereby the inquiry is systematized and much time 
and labor is saved: 
In medico-legal cases note- 
1. Was the individual viable and did he live? 
2. If he has lived, how long has he been dead ? 
3. The cause of death. 
4. The pathology of the disease from which he died. 
The latter point enters into the question only in ordi- 
nary non-medico legal cases. Nothing should be guessed 
at, but every fact stated correctly, without inferences of 
any kind. State the date and the hour of the day when 
the examination was begun, and in ordinary cases how 
long after death. 
External Appearances.-Note the position of the body, 
the condition of the clothes, wounds or bruises, or other 
external signs of violence, giving exact measurement of 
wounds, and compare the same with any instrument 
which may have been found near the body. In case the 
body is not known, examine the hair, the teeth, and 
other peculiarities, such as moles, scars, and other dis- 
tinctive features, for identification of the body afterwards. 
In ordinary cases only the rigor mortis need be noted. 
After the hands and arms have been bared and care- 
fully anointed with carbolized oil or cosmoline to prevent 
poisoning, make an incision into the skin from the upper 
edge of the sternum to the pubic bone, making a curve 106 
THE PHYSICIAN'S COMPANION. 
around the umbilicus. Then cut down carefully through 
the superficial and deep fascia of the abdominal walls an 
inch or so above the pubis, and lifting the abdominal 
integument with the left hand, introduce the knife, with 
its back downwards, into the cut, and slit the abdomen 
open up to the diaphragm, cutting through the muscles 
and peritoneum, thus exposing the abdominal viscera. 
Note the position of the diaphragm, the relative position 
of the abdominal viscera, the quantity and character of 
the fluid contained in the cavity, without, however, as 
yet disturbing anything by manipulation. Next open the 
thorax by dissecting the skin and pectoral muscles from 
the sternum and costal cartilages, and then by cutting 
through the sterno-clavicular articulation on either side, 
and through the costal cartilages as close to the ribs as 
possible. Lift the lower end of the sternum and detach 
the diaphragm and pleura from its under surface, when it 
can be lifted up and the thoracic viscera are exposed. 
Note amount and character of fluid in pleural cavities, the 
color and size of the lungs and heart, and their relative 
position. Examine and note the condition of the different 
organs in the following order : 
1. The pericardium and pericardial fluid. 
2. Ventricles of heart, valves, auricles, large vessels. 
3. Lungs, bronchi and trachea, mediastinal, and other 
glands. 
4. Larynx. 
5. CEsophagus. 
6. Internal surface of ribs and spinal column after the 
thoracic viscera have been removed. 
In the same way examine the abdominal organs and 
note their condition in the following order. 
1. Stomach.-In suspected poisoning remove the organ 
with its contents, empty the latter into a clean jar, seal it POST-MORTEM EXAMINATIONS. 
107 
and label it, adding date and hour; then open the stomach 
along its convexity and examine its mucous membrane, 
removing for microscopical examination small pieces (say 
one inch square) from different portions of the organ. 
2. Intestines, with omentum, mesentery, and glands. 
3. Liver and gall bladder, with duct. 
4. Pancreas. 
5. Spleen. 
6. Kidneys, with suprarenal capsules and ureters 
7. Abdominal vessels and ganglia. 
8. Bladder. 
9. Uterus and its appendages. 
In cases of sudden death in the female in which large 
effusion of blood is found in the abdominal cavity, search 
for rupture of sack of extra uterine pregnancy and care- 
fully search the blood clots for product of conception. 
In cases where it is deemed necessary to examine the 
nerve centres, the brain and spinal cord, the operator 
should place the cadaver upon the chest and abdomen, 
with the head projecting beyond the edge of the table; 
then part the hair across the vertex from ear to ear and 
make the incision on this line down to the bone. The 
scalp can then easily be drawn forward and reflected over 
the forehead and backwards over the occiput, thus baring 
the whole calvarium. An incision is then made around 
the skull through the occipito-frontalis and the temporal 
muscles, the line running from about an inch above the 
eyebrows to the level of the upper edge of the external 
ear, and from there to a point about one inch above the 
occipital protuberance, thus forming a sharp angle just 
behind the ear. This form of cut, when executed with 
the saw, will remove a sufficiently large piece of the skull 
for the examination of the brain, and which at the same 
time is held in place by the scalp alone, without wiring 108 
THE PHYSICIAN'S COMPANION. 
when the examination is completed. In making the saw 
cut, care should be taken not to wound the dura mater 
and brain, but to depend upon the leverage of the chisel 
to completely sever the bone. 
The brain being exposed, examine the inner surface of 
the skull cap for fractures, the surface of the dura mater, 
longitudinal sinus, pia mater and brain ; then open dura 
mater and note amount of cerebro-spinal fluid. Next 
make incisions into the brain, after having removed it from 
the cavity of the cranium, with as much of the medulla 
oblongata as can be reached, from before backward 
through the hemispheres, and note the condition of the 
brain substance and its vessels ; also open the ventricles 
and make incisions into the cerebellum. 
The last step in the examination is to open the spinal 
canal and examine its contents. To do this, make an in- 
cision through the skin along the whole length of the 
spinal column, retract the skin, and then divide the mus- 
cles on either side of the spinous processes of the verte- 
brae and dissect them back laterally, thus exposing the 
lamina of the vertebrae. A saw cut is then carried 
throughout the whole length of the spinal column on 
either side of the spinous processes, and by the aid of the 
mallet and chisel the bony vault is removed and spinal 
cord exposed. Examine the cord in situ and note the 
condition of the membranes, the amount and character 
of the cerebro-spinal fluid, and the superficial vessels. 
Then remove the cord from its bed, after having cut the 
nerve trunks on either side, and make transverse incisions 
at intervals of one or one and a half inches, so as to ex- 
amine the substance of the cord. If it is to be preserved 
for microscopic examination, the cord and portions of the 
brain should be placed in dilute alcohol or in Mueller's 
fluid. All organs should be weighed and their weights EXAMINATION OF URINE. 
109 
recorded and compared with the normal weight as given 
by Quain and Sharpey in Heath's Manual of Surgery. 
AVERAGE WEIGHT OF THE VARIOUS ORGANS. 
Brain 
Male. 
49 J oz. avoir. . 
Female. 
. 44 oz. avoir. 
Cerebrum 
43 " 15 dr. . 
. 38 " 12 dr. 
Cerebellum ... 
5 " 4 " . 
. 4 " 12J " 
Pons and medulla obl'gata, 
0 " 15f " . 
. 1 " i" 
Spinal cord 
1 " 5 " . 
. 1 " 4 " 
Heart 
11 " 0 " . 
. 9 " 0 " 
IS":::::: 
24 " 0 " . 
21 " 0 " . 
. 17 " 0 " 
. 15 " 0 " 
Thyroid gland 
1 " 0 " . 
. 2 " 0 " 
Liver .... 
53 " 0 " . 
. 45 " 0 " 
Pancreas 
3 " 0 " . 
. 3 " 3 " 
Spleen 
6 " 0 " . 
. 5 " 0 " 
Kidney 
5| " 0 " . 
. 5 " 0 " 
Suprarenal capsules . . . 
0 " i " . 
. 0 " J " 
Prostate 
0 " 9 " 
Testis 
1 " 0 " 
Uterus (virgin) 
7 to 12 " 
Ovary 
1 to 1^ " 
After the examination is completed the body should be 
sewed up and brought into as near a natural shape as 
possible. All traces of blood should be washed from the 
skin and clean clothes should be put on it before the 
family is admitted into the room. 
From Warner's Reference Book. 
EXAMINATION OF URINE. 
The specific gravity of urine is about 1020, varying 
somewhat with the season and the consequent amount of 
perspiration. It is increased in diabetes mellitus, some- 110 
THE PHYSICIAN'S COMPANION. 
times reaching 1050 in acute fevers, in the first stage of 
acute Bright's disease, and from excess of urea; it is 
diminished in all other stages of Bright's disease, in some 
forms of heart disease and hysteria, and where urea is 
diminished from any cause. In fact, "lower specific 
gravity generally means less urea." 
The quantity of urine voided in twenty-four hours 
averages about fifty ounces. This is greatly increased in 
both forms of diabetes, hysteria, etc., and decreased in 
cirrhosis of the liver, Bright's disease, etc. Increase in 
quantity and specific gravity is strong indication of 
diabetes mellitus, and calls for tests for sugar ; decrease 
in both quantity and specific gravity is presumptive of 
Bright's disease, and calls attention to test for albumen. 
Earthy phosphates in excess may render the urine par- 
tially opaque when passed. In the course of an hour 
they settle toward the bottom of the vessel, and leave a 
clear supernatant fluid. The addition of a few drops of 
acid will quickly dissipate a deposit of the phosphates, 
while the application of heat will increase it and render 
the urine turbid. 
For Albumen. 
Heat Test- Fill a test-tube one-fourth to one-third its 
depth with clear urine. If not distinctly acid add a drop 
or two of acetic acid. Boil over a spirit lamp. Any 
opacity so produced is due to albumen or earthy phos- 
phates. If due to the latter, a few drops of nitric acid 
will dissipate it; if to albumen, it is permanent. Further, 
if to the boiling urine we add half as much of a strong 
solution (1 part to 2 of distilled water) of caustic potash, 
the albumen will dissolve and the earthy phosphates will 
again be separated in flocculi. EXAMINATION OF URINE. 
111 
Nitric Acid Test.-Upon a convenient quantity of pure, 
colorless nitric acid, in a small test-tube, allow an equal 
amount of clear urine to trickle from a pipette down the 
side of the inclined glass. It will thus form a layer over 
the acid, and if albumen be present there will be a sharp 
white band or zone, of varying thickness according to the 
quantity of albumen present. A somewhat similar ap- 
pearance may arise from action of the acid upon the 
mixed urates when present in excess ; but the zone does 
not remain so sharply defined on its upper surface in this 
case, but is diffused into the urine above. Furthermore, 
the ring caused by urates is easily dissipated on the appli- 
cation of heat, while the albumen ring is made more dis- 
tinct. 
For Sugar. 
Trommer's Test.-Add to a small quantity of the sus- 
pected urine enough of a solution of cupric sulphate to 
give it a faint bluish tinge, and then an equal bulk of 
liquor potassae or liquor sodae. In addition to the earthy 
phosphates, there is immediately liberated a blue precipi- 
tate of hydrated cupric protoxide, which, if sugar is pres- 
ent, redissolves on agitating the mixture, producing a 
beautiful blue transparent liquid. If no sugar is present, 
the liquid is of a turbid greenish hue. If the liquid is 
boiled for a few seconds, a copious yellow precipitate of 
hydrated cupric suboxide takes place, which by losing its 
water becomes red suboxide of copper and falls to the 
bottom of the tube. The color, to be characteristic, must 
be a decided yellow or red. 
Moore's Test.-Add to the urine an equal bulk of solu- 
tion of caustic potash, and boil. If sugar be present, a 
dark cherry color will be obtained ; if in large quantity, 
a dark purple, sometimes almost black. 112 
THE PHYSICIAN'S COMPANION. 
For Bile. 
Noel's Test.-Immerse a strip of blotting paper for a 
few minutes in the fluid; dry, and add a drop of nitric 
acid containing a little nitrous acid. If bile be present, 
a violet color results, changing to red or yellow. 
Nitric Acid Test.-Place a drop of the fluid on a white 
porcelain plate, add carefully a drop or two of nitric acid, 
and at the point of contact of the fluids there will be seen 
a play of colors passing from red to green, pink, blue, 
violet, and yellow. 
For Chlorides. Phosphates, Etc. 
If albumen be present in considerable quantity it must 
be removed. 
Nitrate of Silver Test.-If a few drops of nitrate of 
silver solution be added to the urine, a cloudy precipitate 
will be formed if chlorides or phosphates be present. 
Nitric acid will dissolve the latter, but leave the former as 
chloride of silver. 
The chlorides are greatly diminished in fevers and 
pneumonia ; in the latter sometimes absent. Their re- 
appearance in the urine is a favorable indication. 
Earthy phosphates are thrown down by heating urine 
rendered alkaline by the addition of ammonia or solution 
of potash. They are diminished in renal disease; in 
creased in diseases of nervous centres, rickets, dyspep- 
sia, etc. 
Solution of nitrate of silver throws down alkaline phos- 
phates and chloride of silver. Ammonia will dissolve 
both precipitates, nitric acid only the phosphatic. By 
again neutralizing the acid with ammonia, the phosphatic 
deposit will reappear, and again dissolve by excess of 
acids. ARTIFICIAL RESPIRATION. 
113 
ARTIFICIAL RESPIRATION. 
In case of asphyxia, no time is to be lost in removing a 
patient to more comfortable quarters. Rubbing the limbs 
upward towards the trunk may be kept up and artificial 
warmth be applied by assistants, while artificial respira- 
tion is kept up by either of the following methods. The 
effort to resuscitate one apparently drowned, or otherwise 
asphyxiated, should be maintained for an hour at the very 
least, if success is not attained earlier : 
Sylvester's Method.-See that all tight bands and cloth- 
ing are unloosed, the mouth and nostrils clean, the tongue 
drawn forward and held out of the mouth (best by an 
elastic band around it and under the chin). Place the 
subject on his back, on a flat surface, inclined from the feet 
upwards; raise and support the head and shoulders on a 
small, firm cushion, or folded article of dress placed under 
the shoulder-blades; grasp the patient's arms just above 
the elbows, and draw the arms gently and steadily out- 
wards and upwards until they meet above the head, so as 
to draw air into the lungs, and keep the arms in that posi- 
tion 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, pressing at same time on the breast- 
bone so as to empty the lungs. Repeat these measures 
regularly fifteen times a minute. 
As soon as attempts at natural respiration occur, cease 
effort, and favor them by ammonia to nostrils. 
Marshall Hall's Method.-Clean out the mouth, loosen 
clothing, and lay the patient upon a hard surface on his 
face, in such a way that the forehead shall rest upon the 
arm laid transversely under it. Slowly and regularly turn 
the patient over upon the side and a little beyond it, then 
back again upon the face, momentary pressure being ap- 114 
THE PHYSICIAN'S COMPANION. 
plied to the spine as the patient reaches a prone position, 
so as to completely empty the lungs. Repeat regularly 
fifteen times a minute. 
POISONS AND ANTIDOTES. 
Acids, Mineral.-Chalk, magnesia (plaster off wall in 
emergency), solution carbonate of soda, emollient drinks, 
fixed oils. 
Aconite.-Emetics, stimulants external and internal. 
Antun. Tart.-Vegetable acids, such as tannic acid, 
catechu. 
Arsenic.-Moist peroxide of iron (obtained from per- 
chloride of iron and calcined magnesia), charcoal, am- 
monia, artificial respiration, cold affusion. 
Atropine-Same as belladonna. 
Argenti Nit.-Solution of common salt in demulcent 
drinks. 
Belladonna.-Emetics (chiefly sulphate of copper- 
gr. x), cold to head, active cathartics, ammonia exter- 
nally and internally, stimulants, opium. 
Cannabis Indica.-Hot brandy and water, vegetable 
acids (lemon juice, vinegar, etc.); allow patient to sleep ; 
blister to nape of neck. 
Cantharides.-Emetics, emollient drinks, opiates by 
mouth and rectum. 
Carbolic Acid.-Castor oil, olive oil. 
Chlorine Water.-Albumen, white of egg, milk, flour. 
Chloroform.-Fresh air, artificial respiration (inclining 
head down, pull tongue forward), galvanism to pneumo- 
gastric and through diaphragm, brandy and ammonia 
enemata. POISONS AND ANTIDOTES. 
115 
Colchicum.-Emetics, followed by demulcent drinks. 
If coma be present, brandy, ammonia, coffee. 
Conium.-Emetics, followed by stimulants, external and 
internal. 
Corrosive Sublimate.-Albumen, white of egg (4 grs. 
sublimate require white of one egg), flour, milk, proto- 
chloride of tin. 
Croton Oil.-Emetic of sulphate of copper (10 grs.)> 
followed by mucilaginous fluids, containing opium. 
Cupri Sulph.-Albumen or white of egg. 
Digitalis.-Recumbent posture after emetics, stimu- 
lants internally and externally. 
Elaterium.-Demulcent drinks and enemata, small 
doses opium, and the warm bath. 
Hydrocyanic Acid.-Fresh air and artificial respiration, 
with cold affusion; freshly precipitated oxide of iron, with 
an alkaline carbonate. 
Hyoscyamus.-Stomach pump, emetics, stimulants ex- 
ternal and internal, lemon juice. 
Iodine.-Emetics and demulcent drinks, starch or flour 
diffused in water. 
Lead Salts.-Sulphate or phosphate of'soda, epsom 
salts, succeeded by emetics, and afterwards opium and 
milk. 
Opium and Morphine.-Emetics, stomach pump, stim- 
ulants internal and external, brandy and coffee, cold 
affusion, ammonia to nostrils, galvanic shocks, compelling 
to move about, artificial respiration, and belladonna. 
Phosphorus.-Magnesia, turpentine, emetics and pur- 
gatives. 
Potash and Soda Salts.-Dilute acetic acid, citric acid, 
lemon juice, fixed oils, demulcents. Stramonium.-Same as belladonna. 
Strychnine and Nux Vomica.-Chloroform, belladon- 
na, tincture of aconite, morphine, tobacco, chloral in 
drachm doses; 8 grs. morphine, antidote to 1 gr. strych- 
nine. 
Tobacco.-Emetic, stimulants external and internal, 
strychnine. 
Zinc Salts.-Carbonate of soda, emetics, warm demul- 
cent drinks. 
General Antidote for Unknown Poisons. 
Where a patient has taken arsenic, zinc, digitaline, or 
other mineral poison, or where we are in doubt as to what 
the poison may be, the following will render the poison 
completely insoluble, and may be administered at once : 
Solution of sulphate of iron (sp. 
grav. 1.45) 2£ oz. 
Calcined magnesia 2 " 
Water 20 " 
Washed animal charcoal. ..... 1 " 
Keep the solution of the sulphate of iron in one vessel 
and the magnesia and charcoal in another with some 
water. When needed for use pour the solution of iron 
into the other vessel and violently shake up. Give 1J to 
3 ounces at a dose. 
DISINFECTANTS. 
There are three classes of disinfectants, as follows: 
1. Those agents which are capable of entirely destroy- 
ing and restraining every contagious or infectious virus. 
Under this head we find the caustic acids, acid salts of 
metals, carbolic acid, corrosive sublimate, &c. 
116 
THE PHYSICIAN'S COMPANION. DISINFECTANTS. 
117 
2. Those agents which arrest or prevent fermentation 
and putrefaction: Carbolic acid, salicylic acid, chloral 
hydrate, and a host of drugs. 
3. Deodorants, absorbents, &c., comprising all chemi- 
cals which deodorize or absorb gases, putrid exhalations, 
&c. The most valuable of these agents are charcoal, 
Chlorine, quicklime, and the like. 
For general use, copperas, tar, lime, charcoal, perman- 
ganate of potash, carbolic acid, and a few other agents 
are the most useful to recommend to the people. The 
following from Chambers' Physician's Reference Book 
will be found convenient: 
Privies.-Eight to ten pounds of sulphate of iron 
{copperas} and a pint of crude carbolic acid (if it can be 
had) dissolved in five or six gallons of water. Chloride 
of lime, chloride of zinc, six ounces to a gallon of water; 
chloride of iron, one pound to a gallon of water. 
Sewers, Ditches, Surfaces of Drying Ponds, etc.- 
Heavy oil or coal tar, or a quantity of the strongest 
solution of sulphate or sesquichloride of iron mixed with 
a twentieth part as much of crude carbolic acid; or mix 
one part of " heavy oil" with five parts of quicklime and 
ten parts of sawdust. 
Water-Closets, Bed-Pans, etc.-Labarraque's solution 
of chlorinated soda, a fluid ounce to a quart of water; 
carbolic acid solution, or, as recommended by Koch as a 
disinfectant germicide, corrosive chloride of mercury, two 
drachms to a gallon of water. In cases of typhoid fever, 
the last is recommended as the most efficacious disinfec- 
tant that we have. When cholera is in the country, the 
water-closets and necessaries should be regularly disin- 
fected every evening, allowing a pint of the copperas and 
carbolic acid, or half as much of the corrosive sublimate 
solution, to every four persons on the premises. 118 
Clothing.-If much contaminated, burn them up. If 
otherwise, boil thoroughly for an hour or more. Woolen 
goods should be fumigated with sulphur fumes. Towels 
and other articles of clothing should be thrown at once 
into a solution of permanganate of potassium, one ounce 
to three gallons of water, or a strong solution of carbolic 
acid, or the corrosive sublimate solution referred to above. 
Clothing that cannot be boiled should be exposed to a 
dry heat of 200° to 250° F. 
Occupied Rooms.-Free ventilation, sunlight, chloride 
of lime, carbolic acid solutions, spray of solution of ni- 
trate of lead, chloralum, bromo-chlor alum, Listerine, etc. 
Hospital Wards.-Carbolic acid, chloride of lime, bro- 
mine, iodine, etc. 
THE PHYSICIAN'S COMPANION. NAMES. 
INCUBATION. 
DAY OF RASH. 
CHARACTER OF' RASH. 
RASH FADES. 
DURATION. 
Measles. 
Rubeola. 
10 to 14 days. 
4th day of fever after 
72 hours' illness. 
Small red dots, resembling flea bites, 
first appearing on temples and fore- 
head, forming blotches with semilunar 
borders. 
On the 7th day 
of fever. 
6 to 10 days 
Scarlet Fever. 
1 to 6 days. 
2d day of fever after' 
Bright scarlet, rapidly diffused, first on 
On the 5th day 
8 to 9 days 
Scarlatina. 
Occasionally 
21 days. 
24 hours' illness. 
chest and upper extremities. 
of fever. 
Typhus Fever. 
Ship Fever. 
1 to 12 days. 
4th to 7th day. 
Mulberry-colored macula; general and 
abundant over abdomen, extending to 
extremities. 
14 to 21 days 
Typhoid Fever. 
Enteric F.ever. 
10 to 14 days, 
or suddenly. 
7th to 14th day. 
Rose-colored papules, elevated, few in 
number, limited to trunk ; fresh spots 
persisting to occur during career. 
22 to 30 days 
Small-Poi. 
Variola. 
10 to 14 days. 
3d day of fever after 
48 hours' illness. 
Small round red hard pimples, forming 
vesicles {umbilicated) ; then pustules, 
first appearing on face and wrists. 
9th day scabs 
form and about 
14th day fall off 
14 to 21 days 
Chicken-Poi. 
Varicella. 
4 days. 
2d day of fever after 
24 hours' illness. 
Small rose-colored vesicles, which do 
not become pustular. 
Slight scabs of 
short durat'n. 
6 to 7 days 
Erysipelas. 
Roseola. 
3 to 7 days. 
6 to 10 days. 
2d or 3d day. 
After 12 or 36 hours' 
illness. 
Diffused redness, either of a dusky or 
yellowish hue, with swelling. 
Rose-colored spots, not elevated, oc- 
curring regularly at different points. 
From 24 to 48 
hours. 
TAITLED OF ERUPTIVE EEVERS, 120 
THE PHYSICIAN'S COMPANION. 
TABLE OF DIGESTIBILITY OF FOOD. 
ARTICLE OF DIET. 
HOW PREPARED. 
TIME OF CHIMIFICATION. 
Pigs' feet, soused, 
Tripe 
Eggs, whipped . . 
Salmon trout, fresh 
fish ....... 
Venison 
Brains 
Liver 
Codfish, dried . . 
Eggs 
Turkey 
Gelatine 
Goose 
Pig, sucking . . . 
Lamb 
Chicken 
Beef 
4< 
Mutton 
Oysters 
Cheese 
Eggs 
4 4 
Beef 
Fowls 
44 
Ducks 
Pork 
Rice 
Apples, sweet and 
mellow 
Sago 
Tapioca 
Barley 
Boiled .... 
1 4 
Raw 
Boiled .... 
Broiled . . . 
Boiled .... 
Broiled . . . 
Boiled .... 
Roasted . . . 
Boiled .... 
( 4 
Roasted . . . 
44 
Broiled . . . 
Fricasseed . . 
Boiled .... 
Roasted . . . 
Boiled .... 
Roasted . . . 
Stewed . . . 
Raw 
Hard boiled . 
Fried .... 
4 4 
Boiled .... 
Roasted . . . 
44 
4 4 
Boiled .... 
Raw 
Boiled .... 
4 4 
4 4 
1 hour 0 minutes. 
1 " 0 
1 " 30 
1 " 30 
1 " 30 
1 " 45 
2 " 0 
2 " 6 
2 " 15 
2 " 25 
2 " 30 
2 " 30 
2 " 30 
2 " 30 
2 " 45 
2 " 0 
3 " 0 
3 " 0 
3 " 15 
3 " 30 
3 " 30 
3 " 30 
3 " 30 
4 " 0 
4 " 0 
4 " 0 
4 " 0 
5 " 15 
1 " 0 
1 " 30 
1 " 45 
2 " 0 
2 " 0 TABLE OF DIGESTIBILITY. 
121 
ARTICLE OF DIET. 
HOW PREPARED. 
TIME OF CHIM1FICATION. 
Apples, sour and 
mellow 
Cabbage, with vine- 
gar 
Beans 
Sponge cake . . . 
Parsnips 
Potatoes 
Apple dumpling . 
Indian corn cake . 
Indian corn bread, 
Carrot 
Wheaten bread . . 
Potatoes ..... 
Turnips 
Beets 
Cabbage 
Raw 
Boiled .... 
Baked .... 
Boiled .... 
Roasted . . . 
Baked .... 
Boiled .... 
Baked .... 
Boiled .... 
Baked .... 
Boiled .... 
c < 
c c 
< ( 
2 hours 0 minutes. 
2 " 0 
2 " 30 
2 " 30 
2 " 30 
2 " 30 
2 " 33 
3 " 0 
3 " 0 
3 " 15 
3 " 15 
3 " 30 
3 " 30 
3 " 30 
3 " 45 
4 " 0 
TABLE OF DIGESTIBILITY-Continued. 122 
THE PHYSICIAN'S COMPANION. 
The normal temperature of the human body is 98° F. 
Children have normally a higher temperature than adults 
(about one or two degrees). A temperature continued 
above 98.5° indicates prostration and illness; 101 to 105°, 
severe fever; 105 to 108°, great danger; 108 to 109°, 
impending death. A temperature of 105 or 106° on first 
day of illness indicates ephemeral or malarious fever; 
certainly not typhoid. In typhoid fever, an evening tem- 
perature of 103.5° indicates a mild course ; 105° in the 
evening or 104° in the morning, in the third week, indi- 
cates danger. An uniform temperature from morning 
until evening is favorable. A high temperature from 
evening until morning is unfavorable. A falling tempera- 
ture from evening until morning is favorable. A rising 
temperature from evening until morning is dangerous. 
COMPARATIVELY NEW REMEDIES 
Paraldehyd.-Prepared by heating ethylaldehyd with a 
mineral acid, or with chloride of zinc. Useful as a hyp- 
notic where sleeplessness is not due to pain, as in delirium 
tremens, hysteria, &c. Dose, ^j, and freely diluted. 
Hydroquinone.-Antiseptic, antifermentative, and anti- 
pyretic. Dose, gr. ii to x. 
Sparteine.-A liquid alkaloid obtained from sarotham- 
nus scoparius-a heart tonic acting somewhat as digi- 
talis. Dose : In form of sulphate, to | gr. hypoder- 
mically ; internally in pill or capsule, | to 1 or 2 gr. 
Apiol.-Prepared from parsley. Used for amenorrhoea, 
etc. Dose, 3 to 5 grains in capsules. 
Antipyrine.-Soluble in water and alcohol. Possesses 
strong antipyretic properties, used in typhoid fever and 
THERMOMETRY IN DISEASE. COMPARATIVELY NEW REMEDIES. 
123 
rheumatism. Dose, 15 to 30 grains, followed by smaller 
doses. Best given with syrup. Spirits of nitre and anti- 
pyrine should not be combined in prescription. 
Antifebrin {Acetani/id}.-Formed by action of acetic 
acid on aniline oil. Claimed to be a powerful antipyretic. 
Dose, 4 to 15 grains. 
Acid Osmic.-Used topically in one per cent, aqueous 
solution for goitre, parenchymatous swelling, neuralgia. 
Recommended internally for epilepsy. Dose, l-65th 
grain. 
Arbutin.-A glucoside contained in Uva Ursi leaves. 
Recommended for catarrh of bladder. Dose 40 to 60 
grains. 
Chrysarobin {Chrysophanic Acid}.-Soluble in fats. 
Used in form of ointment or chloroform solution for cuta- 
neous diseases, tinea capitis, psoriasis. 
Cocaine.-Active alkaloid of coca leaves. Crystalline, 
forming soluble salts, of which the muriate or hydrochlo- 
rate is generally used. Remarkable for producing local 
anaesthesia; useful, therefore, in various surgical opera- 
tions, especially ophthalmic surgery. Four per cent, 
aqueous solution is mostly used, either externally applied 
or hypodermically injected. Cocaine is also recommended 
for seasickness in J grain doses. 
Flomatropine Hydrobromide.-It dilates pupils rapidly. 
Also used for phthisical night-sweats like atropia. 
Hyoscin Hydrobromide-Obtained from henbane 
leaves, isomeric with atropia. Used in asthma, violent 
coughs, alcoholism, acute delirium, chorea, epilepsy. 
Dose, l-2O0th to l-100th grain. 
Hypnon.-Made by dry distillation of calcium acetate 
and calcium benzoate. Said to produce hypnotic effects 
in doses of 3 to 8 grains. 124 
THE PHYSICIAN'S COMPANION. 
Iodol.-A desirable substitute for iodoform. Used per 
se, or in form of ointment or alcoholic solution. 
Lanolin.-Sheeps' wool fat. Remarkable for its misci- 
bility with large proportion of water, and its property of 
being rapidly absorbed by tissues with which it is brought 
in contact. It is used as a basis for ointments when rapid 
absorption is desirable. 
Picrotoxin.-Used in doses of 1-200th to l-40th grain, 
hypodermically administered, for the night-sweats of 
phthisis. 
Resorcin.-Used as an antipyretic and antiseptic in 
typhoid fever, diphtheria, phthisical fevers, eczema, etc. 
Dose, 5 to 30 grains. 
Salol.-Used in place of salicylic acid in treatment of 
rheumatism, diabetes, etc. Dose, 5 grains. Externally 
applied as an antiseptic. 
Strophanthus.-A new cardiac remedy to take place of 
digitalis. A tincture is on the market, of which the dose 
is 2 to 6 drops. 
Terebene.-A hydrocarbon oil produced by action of 
sulphuric acid on turpentine. Aromatic odor not like oil 
of turpentine. Used in dose of 5 to 6 drops on sugar 
for bronchial coughs and flatulent stomach. 
Urethan.-Hypnotic, but devoid of anodyne proper- 
ties. Recommended especially for treatment of children,, 
as the sleep produced much resembles natural sleep. 
Adult dose, 30 to 60 grains in solution. MEDICAL ODDS AND ENDS. 
125 
MEDICAL ODDS AND ENDS. 
Battery Fluid for All Acid Batteries. 
Water 16 oz. 
Commercial sulphuric acid ... 1 " 
Bichromate of potash 1 " 
Bisulphate of mercury 2 drachms. 
Use hot water and thoroughly dissolve the bichromate 
and the bisulphate ; then slowly add the sulphuric acid. 
Let it cool before putting into the cell of battery. 
To Bleed a Patient. 
Do not worry with trying to stick a thumb-lancet into 
a rolling vein surrounded with fat and deeply seated. 
Just place a piece of tape moderately tight around the 
limb above the point at which you wish to bleed, then 
make an incision through skin and cellular tissue down to 
the vein. Now, with the parts held asunder and the vein 
before you, cut it partially in two in a slanting direction 
with your scissors, or cut it longitudinally with your 
scalpel. 
Pleasant Antiseptic Wash for Hands or Instruments. 
R. Acid boric ss. 
Acid carbolic zj. 
Alcohol 
Aq. destil gxv. 
Mix. 
To Prepare Catgut Ligatures and Sutures. 
Dr. R. W. Fry, of Roanoke, Va., clips the following 
and hands it to us with his endorsement: " They are 
placed in a large open-mouthed bottle filled with sul- 
phuric ether, and allowed to remain for forty-eight hours. 
When removed they are very nearly perfectly white, as 
the ether removes from the catgut all the animal oil. 126 
THE PHYSICIAN'S COMPANION. 
They are then placed in a mixture of three parts alcohol 
and one part juniper oil, with the addition of three 
drachms of hydronaphthol to each quart of the fluid. The 
strings are allowed to remain in this mixture for ten days, 
when they are ready for use. They are semi-transparent 
in appearance, are perfectly flexible, and exceedingly 
strong." 
To Relieve a Distended Bladder. 
When it is impossible to introduce a catheter to relieve 
a case of retention, a very simple and effective method is 
to take a whalebone filiform guide and carry it into the 
bladder, which can always be done if you are patient and 
gentle. In ninety-nine cases out of a hundred, when you 
very slowly withdraw the guide the urine will follow in a 
small but gradually increasing stream. Instead of buy- 
ing a variety of catheters, send on for three or four of 
these useful little guides. 
To Tap th*e Bladder. 
If the bladder is dangerously distended, and no en- 
trance can be had per urethram, in the absence of an 
aspirator, a common trocar will answer every purpose. 
Enter the trocar just above symphisis pubis and with a 
quick rotary motion direct it downwards and backwards 
into the bladder. Let the patient rest upon the side with 
the hips slighted raised. When the bladder is empty 
simply withdraw the cannula and put a little iodoform 
over the point of puncture. 
Abbreviations in Prescription Writing. 
R-recipe-take; Aa-ana-of each; Ad-to; Ad 
lib.-ad libitum-at will; Aq.-aqua-water; Bis ind.- 
bis indies-twice a day; C. or cong.-congius-a gallon ; 
Cht. or chart.-chartula-a little paper or powder; Cochl. MEDICAL ODDS AND ENDS. 
127 
-cochleare-a spoonful (hence cochl. parv.-teaspoonful; 
c. med.-dessertspoonful; c. mag.-tablespoonful); Cort. 
-cortex-bark ; Dil.-dilutus-diluted ; Dim.-dimidius 
-one-half; F. or ft.-fiat-let it be made ; Gr.-granum- 
a grain ; Gt. or gtt.-gutta or guttce-a drop or drops ; 
Ind.-indies-daily; Liq.-liquor- a solution ; M.-misce 
-mix ; Mic. pan.-mica panis-bread crumb ; O.-octa- 
rius-a pint; Ol.-oleum-oil; Ov.-ovum-an egg; P. r. n. 
-pro re nata-as occasion demands; Rad.-radix-root; 
Sem.-semen-seed ; S.-signa-write; Tinct., tr., or tra. 
-tinctura-tincture ; Usq. ad diliq.-usquce ad diliquium 
-to fainting. 
lodoformized Gauze or Cotton. 
To iodoformize your own gauzes, cotton, or other 
dressings, dissolve the iodoform in ether or alcohol, 
which is a perfect solvent for iodoform ; saturate the 
material thoroughly, and when the alcohol or ether 
evaporates your dressings are evenly and uniformly iodo- 
formized. 
How to Prepare Sponges for Surgical Use. 
1. Beat well in muslin bag to remove sand. 2. Im- 
merse in solution of muriatic acid, one ounce to water 
one pint, for three hours, to dissolve remainder of sand. 
3. Keep for eight hours in hot running water. 4. Im- 
merse in bichloride of mercury, 1 to 1,000, for ten hours. 
5. Preserve in four per. cent, carbolic solution. 
A Non-Bitter Solution of Quinine (M. Lutz). 
R . Sulphate of quinine gr. viij. 
Dilute sulphuric acid " 
Essence of mint gtts. v. 
Saturated solution of saccharine ... 5 iiss. 
Distilled water 3 xxiiss. 
-Journal de Medecine. 128 
THE PHYSICIAN'S COMPANION. 
Sir Andrew Clark's Pill for Chronic Constipation. 
An anti-constipation pill, a little different from some 
others offered for the same purposes, bears the name ol 
the eminent president of the Royal College. It contains 
one-half a grain each of aloin, extract of nux vomica, 
sulphate of iron, powdered ipecac, and myrrh. This pill 
should be taken half an hour before the last meal of the 
day. 
To Acidify the Urine. 
It is said that saccharin, in five-grain doses thrice daily, 
will promptly acidify alkaline urine, to the great relief of 
cases of cystitis. 
Uterine Pencils. 
R. Iodoform 3 v. 
Acaciae pulv., 
Starch pulv., aa.gr. xxx. 
Glycerini gtt. xxx. 
Make pencils No. iii. Sig. Insert one in uterus for 
abrasions in genital tract after delivery, or after opera- 
tions in or around vagina. It disinfects for a day or two. 
Lotion for Bed-Sores. 
Professor Forbes gives the class the following as a pre- 
ventive against bed-sores and to harden the skin in case 
of fracture: 
R. Salt 3 iv. 
Alum 3 iv. 
Water f 3 viij. 
Alcohol f 3 ij. 
M. Sig. Apply over the surface affected. 
For Flatus in Children. 
Many young children are irritable and cry because they 
have intestinal flatus. Instead of using opiates, which MEDICAL ODDS AND ENDS. 
129 
are the basis of most of the soothing syrups, Professor 
Bartholow gives the following as a valuable remedy: 
R . Misturae asafcetidae f 3 j. 
Sodii bromid gr. iij-v.-M. 
This is a dose for a child from one to four months old. 
To Soften Wax in the Ear. 
R. Acid boric gr. xx. 
Glycerini, 
Aqua distillat . aa 5 ss. 
M. Sig. Warm it and drop 5 to 10 drops in the ear 
twice a day. 
Injection for Infantile Convulsions. 
R. Musk gr. iij. 
Hydrate of chloral gr. x. 
Camphor gr. xv. 
Water 3v. 
Sulphur Externally for Sciatica. 
Enveloping the limb for one night in flowers of sulphur 
is claimed to be a cure for sciatica. The urine the next 
morning smells strongly of sulphuretted hydrogen. 
For Erysipelas. 
A mixture of one drachm of ichthyol to the ounce of 
vaseline, applied thickly over the affected parts and cov- 
ered with lint or cotton batting, is recommended to ease 
the disease and prevent its spreading. 
Collodion for Corns. 
A saturated solution of salicylic acid in flexible collo- 
dion applied twice each day for ten or twelve days will 
secure their complete removal. Cocaine and Lanolin for Burns. 
Dr. Wende recommends a preparation made of these 
substances. It excludes the air and quiets the pain. The 
cocaine should be pure and the mixture freshly prepared. 
Bismuth Test for Sugar in Urine. 
Professor DaCosta prefers the use of the bismuth test 
for sugar in the urine. Take equal parts of urine and 
liquor potassae, add a pinch of bismuth subnitrate ; boil 
thoroughly. If sugar is present, the powder turns brown 
or black. 
Injection for Angina Pectoris. 
Professor Dujardin-Beaumetz presents: 
R . Ilydrobromate of cocaine gr. x. 
Alcohol gtt. xxv. 
Distilled water of cherry-laurel . . . f % vi.-M. 
Dissolve and inject beneath the skin a quarter or half 
of a Pravaz syringeful during the attack. 
Resarcin in Asthma. 
Andeer {Alleg. Med. Central Zeitung) recommends 
that 15 grains of resorcin be given in a half-glass of water 
during an attack of asthma. It is said that the attack 
rapidly subsides under this treatment. 
Cough Mixture. 
Dr. Beck gives for troublesome cough of a violent 
paroxysmal nature the following mixture : 
R. Cocaine hydrochlorate gr. ij 
Morphinae sulphate gr. iss. 
Fluid extract glycyrrh., 
Glycerini aa m xx. 
Aquae q. s. ad. f 5 iv. 
M. Sig. One dessertspoonful every two hours till the 
cough is relieved ; then less frequently. To be swallowed 
slowly. 
130 
THE PHYSICIAN'S COMPANION. MEDICAL ODDS AND ENDS. 
131 
Tests for Purity of Cocaine. 
Hartge (Der Pharmaceut, January 15, 1887) gives the 
following as practical tests of the purity of cocaine : 
1. When heated upon platinum it must disappear with- 
out residue. 
2. Solutions of cocaine must be of neutral reaction. 
3. Sulphuric acid, when added, should not discolor its 
solution. 
4. When to a solution of cocaine, 1 to 200 or 1 to 500, 
one drop of a two per cent, solution of potass, perman- 
ganate is added, the liquid should become red, but remain 
clear. If the permanganate is added in drops beyond 
this point a red precipitate of cocaine will fall, which will 
become brown on heating, but will give no odor of bitter 
almonds. 
The writer tested six samples of cocaine, finding only 
one pure. 
Hydrotherapy in Typhoid Fever. 
Dr. C. S. Bradfute, of Philadelphia, adopts the follow- 
ing: 
In a simple case of uncomplicated typhoid fever the 
patient is sponged with tepid water, containing a little 
alcohol, twice daily, morning and evening, irrespective 
of the temperature. If the temperature should reach 104° 
simple cold water is substituted, and the patient sponged 
every half-hour or hour until the temperature falls. It is 
not necessary to employ antipyretic measures unless the 
temperature rises to 104° ; below that point Nature is fully 
able to combat it herself. This simple method of re- 
ducing the fever has been uniformly successful in the 
hands of the writer, and he believes, when properly 
applied, it never fails. Cases with ugly complications 
are, of course, to be excepted. It may be added that the 132 
THE PHYSICIAN'S COMPANION. 
pleasant sensations and feeling of well-being which occur 
in a fever patient after a cold sponge bath introduce a 
physical element which is not without a favorable in- 
fluence in the course of the malady. 
Diagnosis of Lead-Poisoning. 
Moulin (Gaz. Med. Torin) states that the skin of a per- 
son poisoned with lead becomes intensely black when 
bathed with an aqueous solution of sodium sulphide, lead 
sulphide being formed. The reaction is not noticed on 
parts which have been recently washed. This reaction is 
said to precede the appearance of the blue lines on the 
gums, and is therefore especially important in diagnosis. 
Treatment of Hip-Disease. 
The following conclusions are reached by Dr. B. E. 
McKenzie in a recent article on the above subject: 
1. Constitutional treatment, such as is employed in 
other wasting diseases, is of prime importance in all 
cases. 
2. In early stages of the disease, treatment by rest for 
the joint is indicated. 
3. Rest can be better obtained by employing a portable 
fixation apparatus than by any means requiring confine- 
ment in bed. 
4. Deformity, if not fixed by adhesions or contractured 
muscles, may be corrected by the use of portable splints. 
5. Deformity, maintained by contractured muscles and 
adhesions about the joint, may frequently be corrected 
by myotomy or tenotomy, and the adhesions broken up 
by using a moderate degree of force. 
6. When deformity cannot be so corrected, osteotomy 
should be performed. 
7. If faithful trial of these means fail to give satisfactory 
results, excision or amputation should be performed. MEDICAL ODDS AND ENDS. 
133 
8. Pus, or sequestra, when known to be present, should 
be removed by operation. 
To Clear and Purify Muddy Water. 
To each gallon of water add four drops of perchloride 
of iron, stirring it well. This will cause all mud to be 
precipitated, leaving the water clear and free from the 
iron at the same time. This is far superior to alum or any 
other clearing agent commonly used. 
Dewees' Emmenagogue Mixture. 
B. Tr. Ferri. Chlorid 5 iij. 
Tr. Cantharid i i. 
Tr. Aloes 3 ss. 
Tr. Guaiaci 5 iss. 
Syr. q. s. ad 5 vi. 
M. S. Tablespoonful. 
Donovan's Solution. 
The officinal liquor of the iodide of arsenic and mercury. 
Godfrey's Cordial. 
An opiate preparation made of carbonate of potash, 
water, molasses, tincture of opium, alcohol, and sassafras 
oil. Each ounce contains about 1] gr. opium. This was 
a very popular remedy years ago. 
Substitute for the Stomach Pump. 
The stomach pump, when it is wanted, like the pistol, 
is wanted very badly, and generally is out of place or out 
of order. Take a medium sized piece of rubber tubing 
about six or seven feet long, oil it well at one end; shove 
the tongue far back, and pass the tube over tongue and 
gently into the stomach. Carry the other end up upon 
a level with the face, and, with the aid of a small funnel, 
pour down one to three pints of warm water. Pinch the 
upper end of this tube between the thumb and finger and 134 
THE PHYSICIAN'S COMPANION. 
bring it down belozv the level of the stomach, when the 
contents of the stomach will flow out on the principle of 
the syphon. The stomach can be easily and safely washed 
out in this manner. 
Note. 
The majority of the following prescriptions we have 
taken from the Medical Calendar, published quarterly 
by Messrs. Reed & Carnrick, of New York, and which 
we presume would be mailed free of charge to physicians 
sending their address to the above-named gentlemen. 
Resorcin in Whooping Cough. 
A two per cent, solution of resorcin in water is a good 
spray for cases of whooping cough. Andeer, of Munich, 
also uses this solution internally in doses of one ounce 
four times daily in a child seven years of age. The fits 
of coughing became less frequent, and the patients were 
quite free from coughing in eight or ten days. In one 
case, the patient was only six months old, and the solu- 
tion had to be sweetened and given by means of a nursing 
bottle. 
Carbolic Acid and iodine in Whooping Cough. 
Dr. Roth has realized very happy results from a com- 
bination of iodine and carbolic acid, as follows : 
R. Ac. carbolici grs. xv. 
Spts. vini f 3 ss. 
Tr. iodi gtt. x. 
Tr. belladonnae 3 ss. 
Aq. menthae pip f iij. 
Syr. papaveri f 5 iiss. 
M. Sig. A teaspoonful of this is given to children over 
two years of age every two hours. When this treatment 
was carried out from the commencement of the com- 
plaint, the severity was never great, and even when it was only begun in cases that had been going on for six or 
seven weeks, it soon cut them short. He has treated 
hundreds of cases, and cannot remember one in which 
the affection lasted longer than four weeks. 
Treatment of Eczema. 
Dr. Unna, in a recent article, recommends for pustular 
eczema : 
R. Oxide of zinc 1 qnHnarts 
Gelatin J aa parts' 
Glycerin 25 " 
Water 45 " 
M. 
Heat slightly and apply with a camel's hair brush. 
New Remedy for Pediculi Pubis. 
The treatment of pediculi pubis by the usual blue 
ointment has so many inconveniences, with its disagree- 
able application and its toxic after-effects, that the use of 
the well-known anti-parasitic action of salicylic acid has 
of late been much extolled. The formula is : 
R. Salicylic acid 2 to 3 parts. 
Aromatic vinegar 25 " 
Alcohol (eighty per cent.) . ... 72 " 
The parts are to be rubbed with a piece of flannel wet 
with the mixture. One application is usually sufficient. 
Sulpho-calcine is also excellent in this trouble, as well 
as innocent of any irritation in its application. 
Injection for Gonorrhoea. 
A new specific for gonorrhoea is a one per cent, solution 
of creosote in decoction of hamamelis combined with 
boric acid. It is claimed that this will destroy gonococci 
in two hours. 
MEDICAL ODDS AND ENDS. 
135 136 
Mixed Anaesthesia. 
Obalinski combines chloroform and cocaine and gives 
the following method: After giving chloroform for a few 
minutes until general anaesthesia is noticed, a quantity of 
cocaine, varying from three-fourths to one grain, is in- 
jected into the tissues to be operated upon. No further 
Chloroform is administered. 
Gargle for Sub-acute Pharyngitis. 
Dr. W. F. Mittendorf has satisfactory results from 
R. Ferri et ammonii sulphatis, 
Potassii chloratis aa 5 j. 
Aquae f 5 xvi.-M. 
Dissolve. Use as a gargle morning and evening. 
How to Make Antiseptic Gauze. 
Dr. R. F. Weir advises the use of the following formula 
for making antiseptic gauze. One part of sublimate and 
two parts of common salt are dissolved in five hun- 
dred parts of water; the gauze is soaked in this for an 
hour, wrung out, and partially dried in a clean room. 
That is to say, it should not be made or handled in a hos- 
pital ward or sick room, and it should be kept in a moist 
condition in glass jars. The chloride of sodium is intended 
to prevent the conversion of the sublimate into calomel. 
Chloride of ammonium will also accomplish this. A 
small quantity of glycerine is of service in like manner, 
especially when the gauze is likely to be kept some little 
time. 
Tinea Circinata. 
A lotion of hyposulphite of sodium, of one drachm to 
the ounce of water, applied frequently, is a cleanly, effec- 
tive, and safe remedy, according to Duhring. Ointments 
THE PHYSICIAN'S COMPANION. MEDICAL ODDS AND ENDS. 
137 
of sulphur, naphthol, chrysarobin, corrosive sublimate, or 
white precipitate also will usually effect a cure. 
To Sterilize the Urine. 
B. Sodie biborat 3 ij. 
Acidi borici • 3 j. 
Svr. tohitani f 3 ss. 
Aq. oest f 3 .j. 
M. Sig. One tablespoonful, in water, every four hours. 
-Dr. Palmer, Louisville. 
Treatment of Senile Pruritus with Salicylic Preparations. 
Prof. Besnier, of Paris, advises the following treatment 
for senile pruritus: The entire body should be washed 
every evening with a quart of warm water, to which about 
two drachms of the following solution have been added : 
B. Carbolic acid 3 j. 
Aromatic vinegar . . f 3 vij.-M. 
Then either of the powders given below should be 
dusted over the body. 
Salicylate of bismuth 3 v. 
Starch • .3 iij.-M. 
or 
B. Powdered salicylic acid 3 iij. 
Starch 3 iij.-M. 
Creasote in Tuberculosis. 
Dr. Bourget, of Geneva, is an ardent disciple of the 
creasote treatment in consumption. He urges the neces- 
sity of saturating the system with creasote. In winter the 
creasote is given in cod-liver oil. In summer it may be 
combined as follows: 
B. Creasoti 3 ss. 
Liq. potassii arsenitis gtts.xx. 
Vini malagse 3 xxiv. 
M. Sig. Two wineglassfuls at meal time. 138 
THE PHYSICIAN'S COMPANION. 
The patient constantly wears a permanent inhalation 
apparatus, consisting of two small pipes, one for each 
nostril, through the centres of which runs tissue-paper 
saturated with creasote. 
Preventive Treatment of Megrim. 
Dr. Hanimersclilag hoc uaad the following Avutima in 
warding off attacks of megrim with great advantage. So 
far it has not failed him in a single instance: 
R. Citrate of caffeine grs. xv. 
Phenacetin grs. xxxj. 
White sugar grs. xv.-M. 
Make into ten powders in capsules. Sig. One capsule to 
be taken between the attacks for premonitory symptoms. 
Phenacetin alone is not so efficacious. 'The treatment 
may be continued until the attacks cease, which, however, 
will not be long. 
For Perspiring Feet. 
Talc 10 parts. 
Alum 2 parts. 
Largely used in Swiss army; preferred to chromic acid, 
and applicable even for sore feet. 
Specific for Rhus Poisoning. 
R. Ol. sassafras f 5 iss. 
Boro-glyceride 5 iv.-M. 
Sig. Apply to affected parts with fine brush, once in six 
hours. The above will cure in a few hours. 
Prurigo and Dry Eczema. 
The following is said to be efficacious : 
R. Acid, carbolic f 3 j-ij. 
Glycerini q. s. to dissolve. 
Syrup, aurantii f 3 xij.-M. 
Sig. Tablespoonful morning and evening. MEDICAL ODDS AND ENDS. 
139 
Gargle for Inflammatory Troubles-(Abraham Jacobi's 
"Special"): 
R. Potassii chloratis gr. Ixxx. 
Tr. ferri chloridi m clx. 
Glycerini f * ij. 
Aquae q. s. ad f viij. 
Dissolve and mix. Used as a gargle and internally in 
doses of half ounce. 
For Alopecia-(By Professor Bartholow, Philadelphia) : 
R . Ext. pilocarpi, fld f 5 j. 
Tinct. cantharidis f 5 ss. 
Linimenti saponis, q. s f 3 iv.-M. 
Sig. Rub in the scalp daily. 
For Cystitis.-(By Professor A. J. C. Skene) : 
R. Acid, benzoici, 
Sodii borat aa 5 ij. 
Infus diosmae 3 xij.-M. 
Sig. Wineglassful three or four times a day. 
Bismuth Ointment for Freckles. 
R. Subnitrate of bismuth 3 ij. 
Simple ointment 3 ij. 
Apply to the skin at night and remove in the morning 
with a little cold cream previous to washing. 
For Freckles. 
R. Lemon juice 3 ij. 
Borax, powdered 3 j. 
Sugar, powdered gr. xxx. 
Mix. Let stand a week and then apply a few drops to 
the spots. 140 
THE PHYSICIAN'S COMPANION. 
Lotion for Sun-Burn. 
B. Citric acid 3 ij. 
Pure sulphate of iron grs. xviij. 
Camphor grs. ij. 
Elder flower water 5 iij. 
Apply with soft bit of cloth. 
Quinsy. 
B. Tannin, . . • gr. xv. 
Tinct. iodi gtt. iij. 
Acid, carbol 3 ss. 
Glycerini 3 v. 
Aquae 5 iiss. 
M. Sig. Apply with a brush. 
Pruritus Vulvae. 
For this troublesome and annoying malady, Fox gives : 
B. Sodii hyposulphitis . . . 5 ss. 
Glycerini, * 3 ij. 
Aquae destillat q. s. ad. 5 vi. 
Misce. Sig. As a lotion. Is equally good in tinea versi- 
color. 
Remedy for Warts. 
B. Salicylic acid, 
Alcohol aa 2 parts. 
Sulphuric ether 5 " 
Collodion 10 " 
M. Sig. The warts are to be painted with the solution 
daily.-E. Vidal. 
Treatment of Syphilitic Condylomata (which is simply a 
papular eruption in a moist situation). 
Wash well with soap and water, then with bichloride, 
1 to 1000; then touch with the following solution : MEDICAL ODDS AND ENDS. 
141 
B. Hydrarg. chlorid. corrosiv Bj- 
Aquae destillat f 5 j.-M. 
-Prof. Gross. 
Sexual Weakness and Spermatorrhoea. 
B. Fid. ext. sabal. serrulate 5 j. 
Tr. nucis vomicae 3 iij. 
Acidi phosphorici dil ad 3 iv. 
Sig- 3 j ter in die.- Win. R. Lowman, M. D., Orange- 
burg, S. C 
Chronic Rheumatism. 
Fothergill's favorite remedy for chronic rheumatism is 
given as: 
B. Acidi arseniosi gr. iij. 
Pulv. guaiaci 3 iij. 
Pulv. capsici 3 ss. 
Pil. aloes et myrrhae 3 iij. 
Misce et div. in pil. cxx. Sig. One pill thrice daily. It 
should be combined with general tonic treatment-espe- 
cially fatty foods. 
Rheumatism. 
B. Sodii salicylatis 3 iv. 
Glycerini 3«ij. 
Ol. gaultheriae . . . . m xx. 
Tinct. ferri chloridi 3 iv. 
Acidi citrici gr. x. 
Liq. ammonii citratis q. s. ad 5 iv. 
M. Sig. A teaspoonful every three to four hours. For 
anaemic and poorly nourished patients this is excellent. 
Varicose Veins. 
The Journal de Medicine gives the following: 
B. Chloride of barium grs. xv. 
Distilled water q. s. 
Lanoline B. xi. 
Oil of sweet almonds B iv. 142 
THE PHYSICIAN'S COMPANION. 
Dissolve the chloride of barium in the distilled water 
by shaking, and then add the fatty mixture. Rub the 
dilated veins with this three times a day. 
Treatment of Alopecia. 
R . Tincture of jaborandi 
Tincture of cantharides 
Soap liniment 
Tincture of pyrethrum 
aa 5 iiss. 
Spirits of citron 1 
Tincture of to hi 
Tincture of vanilla J 
. . . . aa 3 iss. 
Apply every morning and evening with friction. 
Specific for Dysmenorrhoea (when no narrowing exists).- 
By C. H. B. Gile, M. D , Venango, Kansas. 
R. Pulv. resinae guaiaci. 
Terebinthinae canadensis aa 5 j. 
Ol. sassafras % ij. 
Alcoholis $ viij. 
Macerate for seven days and filter; then add hydg. 
chloridi corrosive, J} j. 
Sig. 15 to 20 drops in wineglass water three times a day 
between the periods. 
Whooping Cough. 
R. Powdered belladonna root gr. 1-5 (1). 
Dover's powder gr. ss. 
Sublimed sulphur gr. iv. 
White sugar gr. x. 
M. Sig. Take in one dose from two to ten times a 
day, according to age of patient and effect produced.- 
Germain See, Journal de Medicine. 
Papain in Diphtheria. 
Dr. J. B. Richardson, Louisville, Ky., advises the use 
of the following in diphtheria : R. Papain 3 ij. 
Hydronaphthol gr. iij. 
Acid, hydrochlor dil gtt. xv. 
Aq. destil. adde 3 xxxij. 
M. ft. sol. Sig. Use carefully and thoroughly, by 
means of hand atomizer, every half hour on throat, and 
through nostrils on posterior nares and pharynx, if de- 
posit extends to these localities. 
A Cure for Dandruff. 
Dr. A. J. Harrison, of Bristol, recommends the follow- 
ing salve for dandruff: 
Caustic potash gr. viij. 
Phenic acid gr. xxiv. 
MEDICAL ODDS AND ENDS. 
143 
Lanolin, 
Cocoanut Oil, 
aa 3 iv. 
M. This preparation should be rubbed into the scalp 
morning and evening. Complete cure is usually effected 
in one to three months. 
Dysmenorrhcea, Scant and Irregular Menstruation. 
The following is worthy of a place among your favorite 
prescriptions: 
R. Cimicifuga rac., 
Tr. pulsatilla . . aa 3 j. 
Tr. gelsem . . 3 ss. 
Tr. viburnum prun 3 ij. 
Syr. aurantii cor 3 iv. 
M. Sig. A teaspoonful four times a day, four days 
prior to and during the menstrual period.-J. C. Fear, M. 
D., Waverly, Kan. 
Baldness. 
Those who wish to try the virtue of pilocarpine as a 
preventive of baldness are recommended by M. Vigier 144 
THE PHYSICIAN'S COMPANION. 
to try a pomade consisting of one part of the alkaloid in 
200 parts of petrobaselin, the new colorless, inodorous 
fluid substitute for vaseline. Use it instead of other dress- 
ings for the hair, to which it is said to give a glossiness 
that is unattainable by any other article of the sort. 
Treatment of Anaemia. 
Dr. R. B. McCall recommends the following mixture : 
R. Hydrarg. chlordi corrosivi gr. i. 
Liq. pot. arsenit > gtt. xl. 
Tr. ferr. chlor. 
Acid, hydrochi. 
Syr. simp aa 5 ss. 
Elix. simp. 
Aq. pur aa 5 xvi. 
M. S. Teaspoonful three times a day after meals. This 
dose may be diminished one-half, or doubled, according 
to age of patient and the peculiar indications of the case. 
Prophylactic Hair Wash. 
The following hair wash is said to keep the scalp cool 
and the hair dry and free from oil; also to prevent dan- 
druff, besides being a most agreeable toilet preparation : 
R. Spirit etheris 2 iss. 
Tinct. benzoin 5 iss-5 ij. 
Vanilin mj. 
Heliotropin m iij. 
Ol. geranium gtt. j. 
M. Sig. For hair wash. Keep well corked, and do not 
expose to flame, as the mixture is highly inflammable. 
Treatment of Tubercular Meningitis. 
Dr. E. W. Pyle, of Jersey City, writes that he relies upon 
the following formula in chronic tubercular meningitis : MEDICAL ODDS AND ENDS. 
145 
R. Potass, iod. gr. xxxij. 
Potass, bromid 3 iv. 
Fid. ext. gelsem gtt. xvj. 
Syr. acaciae 5 ij.-M. 
Sig. A teaspoonful every four hours to a child four 
years old. 
After a careful experience of fifteen years, the doctor 
has learned to depend upon this formula for his good 
results. The dose to be increased or diminished accord- 
ing to the urgency of the case. 
Sore Nipples. 
Dr. G. W. Mott, of Springfield, la., has good results 
from a lotion of chloral hydrate and aq. dest. (chloral 
hydrat, grs. xxx, aquae dest. fid. 5 xxiv.-M. Apply on 
lint.) as an efficient remedy for sore nipples in the early 
period of lactation. He has used it in six cases where it 
afforded complete relief. A solution of sulpho calcine is 
excellent for this disease, applied on absorbent cotton. 
Calcium Sulphide in Croup. 
The Medical Register, in an editorial, recommends the 
use of sulphide of calcium for croup in doses of one- 
tenth of a grain hourly for the worst cases 
The use of sulphide of calcium is not open to the same 
objections as turpeth mineral, alum, copper, and squill, 
and has the virtue of being readily administered, a quali- 
fication by no means to be despised. 
The Topical Use of Acetanilide. 
Dr. Mewth has used acetanilide as an external appli- 
cation and reports it a valuable adjunct to other remedies. 
He has used it in psoriasis, in association with mercurials, 
with excellent results. He has employed it in chronic 146 
irritable ulcer, erysipelas, urticaria, herpes, and a few 
other conditions of the skin where there has been con- 
siderable irritation. The strength of these applications 
has been generally twenty grains of the drug to an ounce 
of lanolin or vaseline. 
For Croup. 
By J. B. Johnson, M. D., Washington City, D. C. 
R. Aquae destil 5 j. 
Potass, chlorat. 
Potass, iodid aa 3 j. 
Emulsio arabica 5 ij. 
Mucilag. acaciae ext. ipecac fid. 
Ol. res. copaiba; aa 5 j.-M. 
Sig. Shake well. Dose, a teaspoonful every ten min- 
utes, to an infant of eight months, until free vomiting en- 
sues ; and then continue the same dose every half hour 
or hour until the disease is cured. The dose must be 
given according to the age of the child. 
Treatment of Tapeworm. 
Dr. W. A. Rape, of Ballinger, advises the following 
treatment of tapeworm. Half drachm of chloroform is 
to be given in a bland, acceptable vehicle, to be followed 
in half an hour by 
R. Ol. tiglii . gtt. iv. 
Ol. ricini 3 iv. 
Cdycerini 3 iv. 
Aq. destil. ad f 3 xvi. 
M. Sig. Give two teaspoonfuls three hours apart, 
regularly, till the worm is expelled. 
Give salicylic acid in small doses every three or four 
hours during the day, being careful to keep the bowels 
open. The patient should fast for twenty-four hours pre- 
vious to beginning the treatment. 
the physician's companion. MEDICAL ODDS AND ENDS. 
147 
List of Examining and Licensing Bodies in United States. 
1. Medical Examining Board of Alabama. 
2. Board of Examiners of the Medical Society of the 
State of California. 
3. Board of Examiners of the California State Homoeo- 
pathic Medical Society. 
4. Board of Examiners of the Eclectic Medical Society of 
the State of California. 
5. State Board of Medical Examiners of Colorado. 
6. State Board of Medical Examiners of Florida. 
7. State Board of Homoeopathic Medical Examiners of 
Florida. 
8. Illinois State Board of Health. 
9. State Board of Medical Examiners of Iowa. 
10. State Board of Medical Examiners of Minnesota. 
11. Mississippi State Medical Association, Board of Cen- 
sors. 
12. State Board of Health of Missouri. 
13. State Board of Medical Examiners of Montana. 
14. Medical Society of New Jersey. 
15. Board of Regents of the University of the State of 
New York-three Boards. 
16. Board of Medical Examiners of North Carolina. 
17. State Board of Medical Examiners of Oregon. 
18. State Board of Medical Examiners of South Carolina. 
19. Board of Medical Examiners, State of Tennessee. 
20. Censors of the State Medical Society of Vermont. 
21. Medical Examining Board of Virginia. 
22. State Board of Health of West Virginia. 
MEDICAL EXAMINING BOARD OF VIRGINIA. 
Composition of the Board: The Board consists of three 
physicians from each congressional district in the State, 
and two from the State at large, making thirty-two mem- 
bers, and, in addition also, five homceopathic physicians. 148 
THE PHYSICIAN'S COMPANION. 
Persons Required to be Examined: Every applicant 
for the practice of medicine in Virginia, who has not been 
assessed with a license-tax as a physician or surgeon in 
this State at some time prior to January 1, 1885, is required 
to pass a satisfactory examination before he can com- 
mence practice. 
Application for Examination: Persons wishing to be 
examined are required to fill out and file with the Secre- 
tary of the Board a form of application, stating : (1) age; 
(2) residence; (3) college where graduated (if a graduate), 
and date of graduation. The application must be accom- 
panied by recommendations from two citizens of the 
county in which the applicant resides, and a fee of five 
dollars. 
Mode of Conducting Examination: Examinations are 
held by the Board in session regularly twice each year. 
1. Examination questions and answers are to be in 
writing or printing. 
2. The applicant is required to answer at least three- 
fourths (75 percent.) of the questions satisfactorily, and 
show a fair general knowledge of all the branches upon 
which he is examined. 
The examinations are in : (1) chemistry; (2) anatomy ; 
(3) physiology; (4) hygiene; (5) medical jurisprudence ; 
(G) materia medica and therapeutics; (7) obstetrics ; (8) 
gynaecology; (9) practice of medicine; (10) surgery. 
The Virginia laws require that no person shall be 
rejected on account of his adherence to any particular 
school of medicine or system of practice. COMPLETE DOSE LIST. 
149 
COMPLETE DOSE LIST. 
Acid 
arseniosum, 1-40 co 1-20 gr. 
benzoicum, 10 to 30 grs. 
borieum, 20 to 30 grs. 
carbolicum, 1 to 3 grs. 
gallicum, 5 to 15 grs. 
hydrobrom. dil., 1 to 2 fl. drs. 
hydrochlor, dil., 15 to 30 mins, 
hydrocyanic dil., 2 to 4 gtts. 
lacticum, | to 1 dr. 
nitricum dil., 20 to 40 mins. 
nitro-muriat. dil., 10 to 20mins 
phosphoric dil., 20 to 60 mins, 
salicylicum, 10 to 20 grs. 
sulphuric dil., 10 to 20 mins, 
sulphuric arom., 5 to 30 mins, 
tannic, 2 to 15 grs. 
Aconitina, 1-400 to 1-200 gr. 
Adonidin, | to J gr. 
Aloes, 2 to 5 grs. 
Aloinum, 1 to 3 grs. 
Ammonii benzoas, 10 to 20 grs. 
bromid., 5 to 30 grs. 
carbonat., 3 to 10 grs. 
muriat., 5 to 30 grs. 
valerianat., 3 to 15 grs. 
Amyl nitris, 2 to 5 mins. 
Ant. et. pot. tart, (diaphoretic), 1-16 
to 1-6 gr.; emet., 1 to 2 grs. 
Antipyrin, 5 to 30 grs. 
Apiol, gtts., 3to 10. 
Apomorph.hydrochi., 1-30 to 1-6gr. 
Aqua ammoniae, 5 to 30 mins. 
camphorae, 1 to 4 fl drs. 
Argenti nitras 1-6 to | gr. 
Arsenii iodidum, 1-64 to 1-10 gr. 
Asafcetida, 5 to 20 grs. 
Atropinae sulph., 1-128 to 1-50 gr. 
Bismuthi subnit., 3 to 15 grs. 
Caffeina, 1 to 5 grs. 
Calcii hypophosphis, 3 to 15 grs. 
Calx sulphurata, j to I gr. 
Cambogium, 1 to 4 grs. 
Camphora, 3 to 10 grs. 
monobrom., 2 to 5 grs. 
Cantharis, to 2 grs. 
Castoreum, 6 to 15 grs. 
Catechu, 15 to 30 grs. 
Cerii oxalat., or nitrat., 1 to 3 grs. 
Chinoidinum, 3 to 30 grs. 
Chinoline, 7 to 15 grs. 
Chloral, 10 to 30 grs. 
Chloroform, 1 to 5 mins. 
Chrysarobinum, 3 to 15 grs. 
Cinchonidina, 1 to 30 grs. 
Cinchonina, 1 to 30 grs. 
Cocaine hydrochi., 4 p. c. solution. 
Codeina, £ to 2 grs. 
Coniina and its salts, 1-64 to 1-32 gr. 
Copaiba, 15 to 30 mins. 
Cotina, £ to 1 gr. 
Creasotum, 1 to 3 mins. 
Croton chloral, 1 to 10 grs. 
Cubeba, 15 to 60 grs. 
Cupri acetas, £ to 6 grs 
sulphas, £ to 10 grs. 
Cuprum amrnon., 1-6 to 1 gr. 
Curara, 1-64 to 1-32 gr. 
Digitalinum, 1-64 to 1-32 gr. 
Digitalis £ to 3 grs. 
Duboisina & its salts, 1-128 to 1-60 gr 
Elaterium, 1-16 to £ gr. 
Ergota, 15 to 60 grs. 
Ergotinum, 2 to 8 grs. 
Eserina and its salts, 1-64 to 1-20 gr. 
Euonymin, 2 to 4 grs. 
Hydro-Quinone, 2 to 10 grs. 
Kairine, 7 to 20 grs. 
Pulsatilla, 1 to 5 grs. 
Resorcin, 5 to 30 grs. 
Sparteine, sulphate, £ to 1 gr. 
" (hypodermic'y), 1-20 to £ gr. 
Strophantin (hyp'y), 1-100 to 1-60 gr. 
Thalline, 2 to 15 grs. 
Fluid Extract 
aconiti rad., 1 to 5 mins, 
anthemidis, 30 to 60 mins, 
apocyni cannab., 8 to 30 mins, 
arnicae, rad., 5 to 15 mins, 
aspidospermae, 15 to 45 mins, 
baptisiae, 7 to 30 mins, 
belladon. rad., 1 to 3 mins, 
belladon fol., 3 to 6 mins, 
brayerae, 2 to 4 fl. drs. 
bryoniae, 15 to 60 mins. 
buchu, £ to 2£ fl. drs. 
calami, 15 to 60 mins, 
calend., 15 to 60 mins, 
calumbae, 15 to 60 mins, 
cannabis ind., 3 to 6 mins, 
cantharidis, 1 to 3 mins, 
capsici, 1 to 3 mins. 
cardam. comp., 15 to 45 mins, 
cascarillae, $ to 2£ fl. drs. 
caulophylli, 15 to 30 mins. 150 
THE PHYSICIAN'S COMPANION. 
Fluid Extract 
chimaph., J to If fl drs. 
cimicifuge, 8 to 30 mins, 
cinchonae, 30 to 60 mins, 
cinchonae comp., I to If fl. drs. 
cocculi, 1 to 3 mins 
colch. rad., 3 to 15 mins, 
colch sem., If to 10 mins, 
conii fol., 3 to 15 mins. 
convallariae rad.. 15 to 30 mins 
corn flor , 30 to 60 mins. 
coto, 5 to 15 mins. 
cubebae, 15 to 30 mins, 
cypripedii, 15 to 60 mins, 
damianae, f to 2 fl drs. 
digitalis, 1 to 6 mins, 
droserae, 5 to 10 mins 
dulcamarae, 1 to 2 fl. drs. 
ergotae. 15 to 60 mins, 
erythroxyli, f to 2 fl. drs. 
eucalypti, 15 to 60 mins, 
euonymi. 15 to 60 mins, 
eupatorii, 30 to 60 mins, 
euphorb. ipec., 5 to 30 mins, 
gallae, | to 2 fl drs. 
gelsemii, 1 to 8 mins, 
gent., 30 to 60 mins, 
gent, comp., 30 to 60 mins, 
geranii, 15 to 30 mins, 
gilleniae. 15 to 30 mins, 
gossypii, 15 to 45 mins, 
granati rad. cort , f to 2 fl drs. 
grind, rob., 30 to 60 mins 
grind, squarr., 30 to 60 mins, 
guaiaci ligni, 30 to 60 mins, 
guaranae, 15 to 30 mins, 
haematoxyli, 30 to 60 mins, 
hamamelidis, 60 to 90 mins, 
helleb. nigris 5 to 15 mins, 
heloniae, 8 to 30 mins, 
hepaticae, 30 to 60 mins. 
humuli, 30 to 60 mins, 
bydrangae. 30 to 60 mins, 
hydrastis, 8 to 30 mins, 
hyoscyami fol., 3 to 30 mins, 
hyoscyami sem., 2 to 8 mins, 
ignatiae. 1 to 6 mins, 
ipecac., 3 to 60 mins, 
irid. versicol , 15 to 30 mins, 
jalapae, 15 to 60 mins, 
junip , 30 to 60 mins, 
kino, 15 to 30 mins 
krameriae, 30 to 60 mins. 
COMPLETE DOSE LIST-Continued. 
Fluid Extract 
leptandrae. 30 to 60 mins, 
lobeliae, 5 to 30 mins 
lobeliae sem., 3 to 15 mins, 
lupulini, 10 to 30 mins, 
lycopi, 5 to 30 mins, 
mezerei, 3 to 10 mins, 
nuc. vom., 1 to 5 mins, 
pareirae, 30 to 60 mins, 
petroselini, 1 to 2 fl. drs. 
physostigmae, 1 to 3 mins, 
phytolaccae bacca, 5 to 30 mins, 
phytolaccae rad., 5 to 30 mins, 
pilocarpi. 15 to 60 mins 
piper, nigr., 15 to 45 mins, 
piscidiae 15 to 60 mins, 
podophylli, 8 to 30 mins, 
prim virg.. 30 to 60 mins, 
pulsatillae, 2 to 10 mins, 
quassiae 30 to 60 mins, 
quercus, 30 to 60 mins, 
rhei, 15 to 45 mins. 
ricini fol., f to 2 fl drs. 
rosae. f to 2 fl. drs. 
rubi, 15 to 60 mins, 
sabinae, 5 to 15 mins, 
salicis, J to 2 fl. drs. 
salviae, s to 2 fl. drs. 
sanguin , 5 to 15 mins, 
santali citr., 1 to 2 fl drs. 
santonicae, 15 to 60 mins, 
sarsap , f to 2 fl. drs. 
sassafras, i to 2 fl. drs. 
scillae, 5 to 30 mins. 
scillae comp., 5 to 30 mins, 
scoparii, 4 to 1 fl. dr. 
senegae, 8 to 15 mins. 
sennae, 1 to 4 fl. drs. 
serpent., 30 to 60 mins, 
simarubae, 15 to 30 mins, 
spigebae, 15 to 60 mins, 
spigeliae et sennae, i to 2 fl. drs. 
stillingiae, 1 to 2 fl. drs. 
stillingiae comp., f to 2 fl. drs. 
stramonii, 1 to 6 mins, 
sumbul. 15 to 60 mins. 
taraxaci | to 2 fl drs. 
trit, rep., L to 4 fl drs. 
urticae rad., 5 to 15 mins, 
ustilag maid , 15 to 60 mins, 
uvae ursi, 30 to 60 mins, 
valer., 30 to 60 mins. 
. veratr. vir., 2 to 10 mins. COMPLETE DOSE LIST. 
151 
COMPLETE DOSE LIST-Continued. 
Ferri oxide hydrat , 4 to 2 ozs. 
phosphas, 1 to 5 grs. 
pyrophosphas, 1 to 5 grs. 
subcarb., 5 to 30 grs. 
sulphas exsiccat, 1 to 3 grs. 
valer., 1 to 3 grs. 
Ferrum dialysatum, 5 to 15 mins, 
redactum, 1 to 5 grs. 
Guarana, 10 to 30 grs. 
Hyd. chlorid. corros 1-64 to 1-10 gr. 
chlorid. mite, 1-30 to 10 grs. 
cyanid., 1-16 to 4 gr. 
iodid., flav., 1-6 to 1 gr. 
iodid. rubr., 1-16 to 4 gr. 
iodid. vir., 1-6 to 1 gr. 
subsulphas flav., J to 1 gr. 
c. creta, 1 to 8 grs. 
H> oscyamina and salts, 1-65 gr. 
lodoformum, 1 to 3 grs. 
lodum, 1-6 to 4 gr. 
loecacuanha J expect.. 1-6 to 1 gr. 
ipecacuanna emet , lg to grs 
Iridin, 2 to 4 grs. 
Jalapa, 15 to 30 grs. 
Kamala, 1 to 2 drs. 
Kino, 8 to 30 grs. 
Lactucarium, 8 to 15 grs. 
Liq. ammon. acet., 2 to 4 fl. drs. 
acidi arseniosi, 2 to 7 mins, 
arsen, et hydr. iod., 2 to 7 mins, 
ferri chloridi. 2 to 10 mins, 
potassae, 5 to 30 mins, 
potassii arsenit.. 3 to 7 mins, 
potassii citrat., 2 to 4 fl. drs. 
sodae, 5 to 30 mins, 
sodii arseniatis, 3 to 7 mins. 
Lithii benzoas, 2 to 5 grs. 
bromid., 1 to 3 grs. 
carb., 2 to 6 grs. 
citr., 2 to 5 grs. 
salicylas, 2 to 8 grs. 
Lupulinum, 5 to 10 grs. 
Magnesia, 15 to 60 grs. 
Magnesii carb., 15 to 60 grs. 
citr. gran.. 2 to 4 drs. 
Magnes, sulphas. 2 to 8 drs. 
sulphis, 8 to 30 grs. 
Mangani sulphas, 2 to 10 grs. 
Manna. 1 to 2 ozs. 
Massa hydrarg., 1 to 10 grs. 
Morphina and its salts, f to 4 gr. 
Narceina, 1-6 to 2 grs 
Nitro-glycerinum, 1-100 to 1-16 gr. 
Fluid Extract „ 
viburni [prunifolJ 'drs. 
xanthoxvli c--'>15 to 30 mlns- 
xantb fruct., 15 to 30 mins, 
zmgiberis, 8 to 30 mins. 
Solid Extract 
aconiti rad., 1-12 to J gr. 
aloes aqueos, 4 to 3 grs. 
bellad. rad., f to J gr. 
cannab ind., 1-6 to I gr. 
colch. rad., J to 14 grs. 
colocynth, 1 to 5 grs. 
colocynth comp., 1 to 5 grs. 
digitalis, 1-6 to 4 gr. 
ducamarae, 5 to 15 grs. 
ergotae, 1 to 8 grs 
gelsemii, 1 to 2 grs. 
haematoxyli, 8 to 30 grs. 
helleb nigris, 4 to 3 grs. 
humuli, 3 to 15 grs. 
hydrastis, 3 to 10 grs. 
hyoscyamus, 1 to 2 grs. 
ignatiae, f to 1J grs. 
iridis versicol., 3 to 6 grs. 
krameriae, 5 to 15 grs. 
leptandrae. 3 to 10 grs. 
nuc. vom , j to 1 gr. 
opii , J to 4 gr. 
physostigmae 1-16 to 1-6 gr. 
phytolaccae rad , 1 to 3 grs. 
podophylli, 4 to 14 grs. 
quassiae, 1 to 5 grs. 
rhei, 5 to 15 grs 
stramonii fol ale., 4 to f gr. 
stramonii sem., 1-6 to 4 gr. 
taraxaci, 5 to 15 grs. 
valerian, 5 to 15 grs. 
Fei bovis purif, 3 to 6 grs. 
Ferri arsen.. 1-20 to 4 gr. 
benzoas, 1 to 5 grs. 
carb, sacch., 4 to 15 grs. 
chlorid., 1 to 3 grs. 
citr., 5 to 10 grs. 
et ammon. citr., 1 to 10 grs. 
et ammon. tartr., 5 to 15 grs. 
et pot tartr., 5 to 30 grs. 
et quin, citr., 5 to 10 grs 
et strychn. citr.. 1 to 5 grs. 
hypophosphis, 5 to 10 grs. 
iodidum, I to 5 grs. 
lactas, 1 to 3 grs. 
oxalas, 1 to 3 grs. 152 
THE PHYSICIAN'S COMPANION. 
COMPLETE DOSE LIST-Continued. 
^antonica, 8 to 60 grs. 
bani^;„lim j t 5 grs 
Scatnmonium, b- 
Senna, 8 to 60 grs. 0 ®rs' 
Sodii aeetas, 15 to 60 grs. 
arsenias, 1-65 to 1-10 gr. 
benzoas. 5 to 15 grs. 
bicarb., 8 to 30 grs. 
bisulphis, 8 to 30 grs. 
boras, 8 to 30 grs. 
bromid., 8 to 30 grs. 
carb., 8 to 30 grs. 
hypophosphis, 8 to 15 grs. 
hyposulphis, 8 to 30 grs. 
iodidum, 5 to 15 grs. 
phosphas, 2 to 15 grs. 
salicylas, 5 to 30 grs. 
santoninas, 2 to 10 grs. 
sulphas, 1 to 2 drs. 
sulphis, 8 to 10 grs. 
Spir. aether., 30 to 60 mins. 
aether, nitrosi, £ to 2 fl. drs. 
ammoniae, 8 to 30 mins. 
ammoniac arom., 15 to 60 mins, 
camphorae, 8 to 30 mins 
chloroformi, 15 to 60 mins. 
lavend comp., 30 to 60 mins, 
menth. pip., 30 to 60 mins. 
Strych. (and salts), 1-64 to 1-12 gr. 
Sulphur, £ to 4 drs . 
Syrupus acidi hydriod., 1 to 4 fl. drs. 
calcis, 15 to 30 mins. 
ferri bromidi, 15 to 60 mins, 
ferri iodidi, 15 to 60 mins, 
hypophosphit., 1 fl. dr. 
ipecac, £ to 4 fl. drs. 
krameriae, £ to 4 fl. drs. 
rhei, 1 to 4 fl. drs. 
rhei arom., 1 to 4 fl. drs. 
rosae, 1 to 2 fl. drs. 
rubi, 1 to 2 fl. drs. 
sarsap. comp., 1 to 4 fl. drs. 
scillae, £ to 1 fl. dr. 
scillae comp., 15 to 60 mins, 
senegae, 1 to 2 fl. drs. 
sennae, 1 to 4 fl. drs. 
Tinctura 
aconiti fol., 5 to 16 mins, 
aconiti rad., 1 to 5 mins. 
aeon. rad. (Flemings), | to2£ m. 
aloes et myrrhae, 1 to 2 fl. drs. 
arnicae rad., 15 to 30 mins. 
Nux vomica, 1 to 5 grs. 
Oleoresina capsici, 1-6 to £ gr. 
cubebae, 5 to 30 grs. 
lupulini, 2 to 5 grs. 
piperis, 1 to 3 grs. 
zingiberis, 1 to 3 grs. 
Oleum copaibae, 8 to 15 mins, 
cubebae 15 to 30 mins, 
eriger, 5 to 15 mins, 
eucalypti, 10 to 30 mins, 
phosphoratum, 1 to 3 mins, 
sabinae 1 to 3 mins, 
terebinth., 5 to 60 mins, 
tiglii, 1 to 4 drops. 
Opium (14 p. c. mor.) 1-6 to 1£ grs. 
Pepsinum purum, 15 grs. 
saccharatum, 30 grs. 
Phosphorus, 1-128 to 1-20 gr. 
Physostigmine sa'i, 1-120 to 1-64 gr. 
Sulphas, 1-128 to 1-64 gr. 
Picrotoxinum, 1-64 to 1-32 gr. 
Pilocarpina and salts, 1-64 to £ gr. 
Piperinum, 1 to 8 grs. 
Plumbi aeetas, £ to 3 grs. 
iodidum, £ to 3 grs. 
Potassii aeetas, 15 to 60 grs. 
bicarb., 8 to 60 grs. 
bitartr., 1 to 2 drs. 
bromid., 8 to 60 grs". 
carb., 8 to 30 grs. 
chloras, 5 to 30 grs. 
citras, 15 to 60 grs. 
cyanid., 1-16 to 1-8 gr. 
et sodii tartr., £ to 1 oz. 
iodid., 5 to 20 grs. 
nitras, 8 to 15 grs. 
sulphidum, 1 to 10 grs. 
sulphis, 15 to 30 grs. 
tartras, 1 to 8 drs. 
Pulv. antimonialis, 3 to 10 grs. 
glycyrrh. comp., 30 to 60 grs. 
ipecac et opii, 5 to 15 grs. 
jalapae comp , 30 to 60 grs. 
rhei comp., 30 to 60 grs. 
Quinidina (and salts). 1 to 30 grs. 
Quinina (and salts) 1 to 30 grs. 
Quininae arsenias, 1-6 to 1 gr. 
Resina copaibae, 2 to 10 grs. 
jalapae, 2 to 5 grs. 
podophylli, £ to £ gr. 
scamtnonii, 2 to 10 grs. 
Rheum, 2 to 30 grs. 
Salicinum, 8 to 30 grs. COMPLETE DOSE LIST. 
153 
COMPLETE DOSE LIST-Continued. 
Tinctura 
asafcetidae, 30 to 60 mins, 
belladonnae, 5 to 15 mins, 
bryoniae, 15 to 30 mins, 
calendulae, 15 to 30 mins, 
calumbae, 1 to 4 fl. drs. 
cannabis ind., 15 to 30 mins, 
cantharid, 5 to 15 mins, 
capsici, 8 to 15 mins. 
catechu comp., 4 to 2 fl. drs. 
cimicifugae. 30 to 60 mins, 
cinchonae, 4 to 2 fl. drs. 
cinchonae comp., f to 2 fl. drs. 
colchici rad., 5 to 15 mins. 
coIchici sem., 5 to 15 mins, 
conii, 5 to 30 mins. 
cubebae, 1 to 2 fl. drs. 
digitalis, 5 to 15 mins, 
ferri chloridi, 15 to 60 mins, 
gelsemii, 5 to 10 mins, 
guaiaci, 30 to 60 mins 
guaiaci ammon. 30 to 60 mins, 
hellebori, 10 to 15 mins, 
humuli, 1 to 4 fl. drs 
hydrastis, 30 to 90 mins. 
hyoscyami fol., 15 to 60 mins, 
hyoscyami sem , 15 to 30 mins, 
ignatiae, 5 to 15 mins. 
iodi. 5 to 15 mins. 
ipecac, et opii 5 to 15 mins, 
jalapae, I to 2 fl. drs. 
kino, 1 to 2 fl. drs 
krameriae, } to 2 fl. drs. 
lavend. comp , I to 2 fl. drs. 
lobeliae, 15 to 45 mins, 
lupulini, I to 2 fl. drs. 
matico, 4 to 2 fl. drs. 
nuc. vomicae, 5 to 30 mins, 
opii, 5 to 25 mins. 
Tinctura 
opii camph., 1 to 4 fl. drs. 
physostigmatis, 5 to 15 mins, 
quassiae, J to 2 fl. drs. 
rhei, 1 to 8 fl. drs. 
rhei arom., 30 to 75 mins, 
rhei dulc, 1 to 4 fl drs. 
sanguinariae, 15 to 60 mins, 
scillae, 8 to 60 mins, 
serpentariae, I to 1 fl. dr. 
stramon. fol., 5 to 5 mins, 
stramon. sem, 6 to 15 mins, 
strophanthus, 1 to 10 mins, 
sumbul, 8 to 30 mins. 
valer., J to 2 fl. drs. 
valer., ammon., J to 2 fl. drs. 
veratr. vir, 1 to 10 mins, 
zingiberis, 15 to 60 mins. 
Tritur. elaterini, | to 1 gr. 
Veratrina, 1-100 to 1-32 gr. 
Vin. aloes, 1 to 2 fl. drs. 
antim { expect. & alt. 1 to 8 m. 
anum' 1 emet., 30 to 75 mins. 
colch. rad., 8 to 45 mins^- 
Vin. colch. sem., 5 to 30 mins, 
ergotae, 1 to 4 fl. drs. 
Vin. ferri amar., 1 fl. dr. 
ferri citrat., 1 fl dr. 
ineeae J expect., 5 to 15 mins, 
ipecac f emet., 2 to 4 fl. drs. 
opii, 5 to 10 mins. 
rhei, 1 to 2 fl. drs. 
Zinci acet., l.to 2 grs. 
bromid., | to 2 grs. 
iodid., i to 3 grs. 
oxid., 1 to 10 grs. 
phosphid., 1-10 to } grs. 
sulphas, emet., 15 to 30 grs. 
valerianas, 1 to 6 grs. 154 
THE PHYSICIAN'S COMPANION. 
NUMBER OF DROPS IN A FLUID DRACHM. 
(When dropped from ordinary bottle.) 
Acid, hydrocyan, dil., 45. 
muriatic, 54. 
nitric, 84. 
nitric, dil., 62. 
sulphuric, 90. 
sulphuric arom , 116. 
sulphuric dil., 54. 
Alcohol, 118 
Aq. ammoniae, 49. 
Creasote, 91 
Chloroform, 180. 
Liq. hyd. et arsen iod., 52. 
pot. arsenitis, 60. 
Tinct. aconiti, 118. 
Tinct. digitalis, 120. 
iron, 106. 
opii, 147. 
opii camph., 110. 
Vin. antimonii, 87. 
colchici, 75. 
opii, 92. 
The Southern Clinic-The leading ^ledical Journal of the South 
and Southwest. C. A. Bryce, M. D., Editor and Proprietor, Rich- 
mond, Va. 384 pages per year. Subscription price, $1.00. 
Bryce's Visiting List (Perpetual).-Elegantly bound in rich flexi- 
ble leather, with pocket and flap. Good for any month or year. Will 
allow an entry of 210 visits per week for 54 weeks. Only weighs 514 
ounces. Valuable printed matter. Price, postpaid, $1.00. Address 
The Southern Clinic, Richmond, Va. 
Medical Advice to Young Men.-By C. A. Bryce, M. d. 32 pages. 
Paper, 25 cents. 
The Physician's Companion-a Pocket Reference Book for Physi- 
cians and Students. By C. A. Bryce, M. D. Pp. 164. Cloth, $1.00; 
leather, $1.25, postpaid. This is one of the most complete and valuable 
little books on the market. Address Southern Clinic, Richmond, Va. 
Marchand's Peroxide of Hydrogen (Medicinal) and Glyco- 
zone. Laboratory, 10 west Fourth street, New York city. A valuable 
pamphlet on the therapeutic uses of the above. Mailed free from above 
address. 
Hayden's Viburnum Compound.-A valuable agent in all menstrual 
irregularities. For full information, with book free, address The New 
York Pharmaceutical Company, Bedford Springs, Mass. INDEX. 
Page. 
Asthma 4 
Anaemia 4 
Apoplexy 5 
Albuminuria 7 
Anaesthetics 11,80 
Antisepsis J2 
Amenorrhcea 58 
Abortion 66 
Astringents 85 
Vegetable 85 
" Mineral 85 
Alteratives 86 
Antispasmodics 86 
Antacids 87 
Anthelmintics 87 
Anode 95 
Ascending Currents 95 
Albumen-Tests for 110-111 
Antidote (general) 116 
Apiol 122 
Antipyrin 122 
Antifebrin 123 
Acid-Osmic 123 
Arbutin 123 
Antiseptic Wash 125 
Abbreviations in Prescription Writing .... 126 
Angina Pectoris-Injection for 130 
Asthma-Resorcin in 130 
Anaesthesia-Mixed 136 
Antiseptic Gauze 136 
Alopecia 139, 142 
Anaemia 144 
Acetanilide-Topical Use of 145 
Bronchitis 3 
Biliary Calculi 8 
Bitten Tongue . 14 
Bandage-Esmarch's 15 
Bandages-General 18 
Starch 19 
Plaster Paris 26 
Bimanual Examination 51 
Bleed-How to 125 
Battery Fluid .* 125 
Bladder-To Relieve Distended 126 
To Tap 126 
Bed Sores-Lotion for 128 
Burns-Cocaine and Lanolin in 130 
Bismuth Test for Sugar 130 156 
INDEX 
Page. 
Bismuth Ointment for Freckles 139 
Baldness 143 
Chicken Pox 3 
Catarrh 4 
Chlorosis 4 
Caries 5 
Concussion (of Brain) 5 
Convulsions (in Children) 6 
" Epileptic 6 
" Puerperal 6,09 
Cystitis 6 
Colic 9 
Cho'era 9 
Cathartics 87 
Cathode 95 
Chrysarobin 123 
Catgut Ligatures 125 
Convulsions-Injections for 129 
Collodion for Corns 129 
Cough Mixture 130 
Cocaine-Test for 131 
Creasote in Tuberculosis • • 137 
Cystitis-For 139 
Calcium Sulphide in Croup 145 
Croup-For . 146 
Diabetes Mellitus 4 
Dyspepsia 8 
Diarrhoea 9 
Dysentery 9 
Dislocations 35 
of Lower Jaw 36 
of Clavicle 36 
of Shoulder 36 
of Elbow 38 
" of Wrist. 38 
" of Hand 38 
" of Hip 39 
of Patella 40 
of Knee-Joint 41 
of Ankle . 41 
Dysmenorrhoea 59 
Digestants 86 
Diuretics 87 
Diaphoretics 87 
Demulcents 87 
Disinfectants ... . 116 
Digestibility of Foods 120 
Dewees' Emmenagogue Mixture 133 
Dysmenorrhoea 142, 143 
Dandruff-A Cure for 143 
Diphtheria-Papain in .... 142 
Donovan's Solution 133 
Enteritis 8 
Excito-motors 86 
Emetics 87 
Expectorants 87 
Emmenagogues 87 INDEX. 
157 
Page. 
Erectile Tumors 90 
Electricity in Medicine and Surgery 94 
Electrode 95 
Electrolyte ... 95 
Eruptive Fevers (table of) 119 
Ear-To Soften Wax in 129 
Erysipelas-For 129 
Eczema-Treatment for 135 
Dry and Prurigo 138 
Examining Boards in United States 147 
Board of Virginia 147 
Fever-General 1 
" Typhoid 1-2 
" Intermittent 2 
" Scarlet 2 
" Puerperal 79 
Fractures-General 16 
" of Skull 20 
" of Bones of Face 21 
" of Lower Jaw ...... 21 
" of Ribs 22 
" of Clavicle 22 
" of Humerus 23 
" of Forearm 27 
" Colles' 28 
" of Metacarpal Bones 29 
of Pelvis 29 
" of Femur 30 
" of Patella 32 
" of Leg 32 
" of Ankle-Joint 33 
" of Tarsal and Metatarsal Bones 34 
" Ununited 92 
Flatus in Children 128 
Faradism 94 
Feet-Perspiring 138 
Freckles-For ... 139 
Gastritis 8 
Goitre 90 
Galvanism 94 
Gauze-lodoformized 127 
Godfrey's Cord al 133 
Gonorrhoea-Injection for 135 
Garg'e for Pharyngitis 136 
" " Inflammatory Troubles 139 
Haemoptysis 4 
Haematuria 7 
Haematemesis .9 
Haemorrhoids 9 
Haemorrhage 10 
from Accidents 13 
before Delivery 68 
" Post-partum 70 
" from Cord 81 
" Urethral 102 
Haematocele 63 
Hypnotics 86 158 
INDEX. 
Page. 
Hypodermic Medication 88 
" Solutions 92 
Homatropine Hydrobrom 123 
Hyoscin 123 
Hypnon 123 
Hydrotherapy in Typhoid 131 
Hip Disease-Treatment of 132 
Inflammation 1 
Infant Feeding 81 
Infantile Convulsions 91 
Induced Currents 96 
Intensity-Electrical 96 
Iodol 124 
Jaundice 8 
Liver-Diseases of 8 
Ligatures 10 
l.igature of Arteries .41 
" Lingual 41 
" Common Carotid 42 
" Subclavian 43 
" Axillary 43 
" Brachial 43 
" Radial 44 
" Ulnar 44 
" External Iliac 44 
" Superficial Femoral ..... 45 
" Popliteal 46 
" Anterior Tibial 46 
" Posterior Tibial 48 
" Dorsal of Foot 47 
Labor Cases Requiring Assistance 72-75 
Lochia-Deficiency of 77 
" Excessive 77 
• " Offensive 77 
Lacerated Perineum 78 
Lacto-Preparata 83 
Lanolin 124 
Lead Poisoning-Diagnosis of . . . 132 
Measles 2 
Meningitis 0 
Menorrhagia 59 
Metrorrhagia 59 
Mydriatics . 86 
Membranous Croup 91 
Moore's Test Hl 
Muddy Water-To Clear 133 
Megrim-Treatment of 138 
Meningitis-Tubercular 144 
Necrosis 5 
Nose Bleeding 14 
Nipples-Retracted 78 
Sore 78,145 
Night Sweats 91 
Negative Pole 94 
Nitric Acid Test Hl 
Noel's Test 112 
Nitrate of Silver Test 112 INDEX. 
159 
Page. 
Oophoritis 58 
Chronic 58 
Obstetric Emergencies : 
Abortion 66 
Attention to Bladder 72 
Presentations 72 
Breech Cases 73 
To Bring Down the Arms 73 
To Bring Down the Head 73 
Knee or Footling Cases 73 
Cord Around Neck 74 
Brow Presentations 74 
Presentations of Superior Extremity 74 
Hydrocephalus 74 
Inversion of Uterus 75 
Nervous Shock After Delivery 76 
Sleeplessness After Delivery 76 
Retention of Urine After Delivery 76 
First Care of Infant 80 
To Tie the Cord 80 
To Wash Baby 81 
To Dress Cora 81 
Oxytocics 87 
Opium Poisoning 91 
Pneumonia 3 
Pertussis 4 
Pleurisy 4 
Periostitis 5 
Puerperal Convulsions ... 6, 69 
Peritonitis--Pelvic 60 
Parametritis 60 
Presentations 72 
Perineum-Lacerated. 78 
Perspiration-Arrest of 89 
Positive Pole 94 
Post-mortem Examinations 104 
Poisons and Antidotes 114 
Paraldehyd 122 
Picrotoxin 124 
Pruritus Vulvae 66,140 
Pediculi Pubis-Remedy for 135 
Pharyngitis-Gargle for 136 
Pruritus Senilis 137 
Prurigo . 138 
Papain in Diphtheria 142 
Prophylactic Hair Wash 144 
Quinine-Non-bitter Solution 127 
Quinsy 140 
Rickets ' 5 
Retention of Urine 92 
Respiration-Artificial 113 
Sylvester's Method 113 
Marshall Hall's Method 113 
Resorcin 124 
" in Asthma 130 
" in Whooping Cough 134 
Rhus Poisoning-For 138 160 
INDEX. 
Page. 
Rheumatism 141 
" Chronic 141 
Scarlet Fever 2 
Small-Pox 3 
Scurvy 4 
Sunstroke 6 
Surgical Emergencies 10 
Sound-Examination with 54 
Speculum-Examination with 56 
Snake Bites 92 
Strychnia Poisoning 92 
Surgical Shock 92 
Stricture (Urethral)-Treatment of by Electrolysis 97 
" Complications Arising in 100 
" Inflamed 101 
Sparteine 122 
Salol 124 
Strophanthus 124 
Sponges-How to Prepaie 127 
Sulphur for Sciatica 1'29 
Stomach Pump-Substitute for 133 
Sunburn-Lotion for 140 
Syphilitic Condylomata 140 
Spermatorrhoea 141 
Typhoid Fever I 
Tonics 85 
Therapeutic Classification 83 
Thermometry in Disease 122 
Terebene 124 
Tinea Circinata . . . •. 136 
Tapeworm-Treatment for 146 
Uremia 4 
Uterus-Inversion of . 75 
Urine-Retention of 76 
Urticaria 92 
Urethra-Stricture of 97 
Urethral Applicator-Bryce's 103 
" Hyperesthesia .... 104 
Urine-Examination of 109 
" Test for Albumen in 110 
" Test for Sugar in Ill 
" Test for Bile in . •. 112 
" Test for Chlorides, &c 112 
Urethan 124 
Urine-To Acidify 128 
Uterine Pencils 128 
Urine-To Sterilize. . . 137 
Vaginal Examination 50 
Vesical Symptoms 62 
Vaginal Irrigation 63 
Vaginitis 65 
Vagina-To Tampon 67 
Veins-Varicose Ill 
Whooping Cough-Resorcin in 134 
Carbolic Acid and Iodine in 134 
" " 142 
Warts-Remedy for 140