m '>,•;//*%«* I At s * \ /s* *&•■ V * ^ NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF ME NATIONAL LIBRARY OF MEC 3NIDI03W JO ASVS9I h hSEEDTDD LJ1N 3NDI03W jo A»»aan ivnoihn NLM001022244 Bethesda, Md. U.S. Department of Health, Education, and Welfare, Public Health Service Bethesda, Md. US. Department of Health, Education and Welfare, Public AN ENCYCLOPEDIA OF THK PRACTICE OF MEDICINE, BASED ON BdQTERIOLOQT, BY J. IJUCHANAN, M. I). FIRST EDITION. NEW YORK: Published by R. R. Russkll, i8qo. ft n v\ ^ f vV 3 A copyrighted By R. R. Russell, NEW YORK. of, J?'.'//•:?- \ ttCHAHtf.* Press of Avil Printing Co., philadelphia. 3 7^ PUBLISHER'S PREFACE. From various considerations it is evident that Good Health in a great measure rests upon abundance of pure air and light, good food and drink, proper clothing and housing, the daily removing by bathing and otherwise the waste matter of our bodies, which to each of us is a poison. Successive epidemics of preventable and unpreventable disease have taught us that if we wish to maintain the highest possible standard of health as a nation, with a people vigorous and sound, we must secure to them the necessaries of life in due proportion and of proper purity ; that if we are to prevent disease and degra- dation of elementary living matter, there must be no overwork, no exhaustion, no mental strain, and all insanitary states, together with animal and vegetable waste, must be got rid of as speedily and effectually as possible. The statistics of our country show that the greatest mortality, immense waste of human life, is due to the presence of microbial diseases. The aim and scope ot the present work is to aid in the elucidation of the Germ Theory of Disease; to the introduction of Bactericides in treatment, so as to give all scientific physicians the means of grappling with maladies which baffled his pre- decessors. It is therefore a Practice of Medicine based upon Bacteriology, bringing the science and art of medicine forward as a great na- tional prophylactic, not only to prevent the evolution of disease germs, but the best means of preventing their dissemination and securing their destruction and extinction. It is intended as an introduction to the science of Bacteriology, and has been written more especially for those who have neither the time nor opportunity to pursue a thorough investigation ot 12 puiii isukk s pui-;Fu:t:. the subject, our sole aim being to render the work as practical as possible. Theoretical discussions have been avoided, and as far as possi- ble accepted opinions and definite facts have been given. The introduction of a New Materia Medica, consisting of Bac- tericides or Microbicides, for sterilizing and destroying disease germs in and on the body, is an important feature of the work. The stamping out of disease germs, the creation of a higher type of manhood, the mitigation of human suffering and prolong- ing life, are themes which pervade the entire volume. The preventing of the dissemination of microbes, and their complete extinction, are briefly hinted at by opening up a new field of therapeutic success. The illustrations of the various Disease Germs are a marvel of art, being all microscopic, then photographed, and subsequently reduced to ordinary cuts. These are the work of two of the most celebrated artists in New York city, namely, Adolph Kleminger and Rudy Ortmayer. They have faithfully portrayed from pathological specimens, by original microscopic views, every microbe found in morbid states of the human body. The profession at large can attest their ac- curacy. The various specimens of morbid anatomy are also the pro- duction of those eminent artists. The photographing of the entire Eight Hundred Illustrations is the work of the Franklin Photo-Electro-Type Company, No. 305 Pearl street, New York city, the superior excellency of whose work is readily demonstrated by any one. We owe a deep debt of gratitude to the entire Medical Profes- sion of Great Britain and America for specimens of microbes, with the results of their culture and sterilization. The press-work and binding are the product of the famous Avil Printing Company, Nos. 3941-43-45 Market street, Phila- delphia, Pa., who are celebrated throughout the world for medical work. To Mr. John Avil we are specially indebted for his un- swerving, persevering solicitude in passing the work through the press. INDEX TO ILLUSTRATIONS. Abdomen, showing the viscera, 17, Acarus folliculorum, highly magnified, 21. Actinomyces, a fungus, micro-parasite, 23,401. A group from human liver, 24. The fungus, 24. Human liver, 24. From the tongue of an ox, 25. Alcoholic vapor bath, 588. Adipose tissue, highly magnified, 30. Amoeba of nasal catarrh 168, 389. Actively at work, 109. Animalcules in drinking water, 257. Anthrax in the blood and also in pustule, 59, 39- Anus imperforate, four varieties, 493. Aorta, 733. Apoplexy cerebral, clot in base of brain, 65. Spinal clot in cord, 67. Aquatic saprophytus, 947. Asperillus albus, 934. Vsperillus niger, three stages of growth, 75S" Aural fungus, in three stages of growth, 755- Aural polypu-, different varieties, 811. Bacteria, 390. Bacteria pneumonia, 391. Gastric fever, 321. Rhinoscleroma, 421, 917. Pemphigus, 793. Magnified, 947. Dental caries, 1015. Bacillus anthrax in human blood, 59. In pustule, 59. Alvei in honey, three diagrams, 258, 943- Alvei in intestines, 258. Amylobacta, 391, 573, 906. Comma cholera infantum, 181, 257. Epidemic cholera, 403. Cancer, 394. Figurans in garden earth, 257, 949. Foot sweat, 1013. Leprosy, 676. Loevis, 935. Bacillus Mallei, (glanders) 396, 425. Megatherium sauer kraut, 257. Boiled cabbage. 258, 94S, 949. Malaria, 323, 405. Attacking red discs, 324. In pink marrow, 325. hi oysters, sewage flats, 942. I'utrid fish, 258. Saprogenes, (caries and necrosis) 152, 397- Scarlatina, 359, 408. Large colony, 362. Stagnant water, 944. Subtilis, (microbe of hay fever) 351 399- 935- Syphilis, 400, 1184. Tuberculosis in blood, 397. Eye, 571, 1043, 1044, 1046. In rectum, 1049. On skin, 1053, 1054, 1069. Barber's itch, 792. Bladder diagram, 871, 977. Bladder and Seminal Vesicles, 978. Blood corpuscles, 45. Brain, 546. Breast, (female) 561. Calculi gall, vertical section, 108. Calculi renal, 112. Cartilages in gout, 429. Cincer on abdominal wall, 120. Of the lip in a woman, 122. Breast before removal, 124. After removal, 124. Scalps, 125. Brow, 126. Tongue, 126. Temporal region, 127. Antrum, 127. Outer canthus of eye, 128. Arm, 129. Lung, 130. Head of penis; 137. Tongue, 140, 141, 142, 143. Neck of uterus, 146. Microbe entering os uteri, 147. Infiltrating neck of litems, 147, 14S. 149. (13) 14 INDEX TO ILLUSTRATIONS. Cancer filling up its cavity, 150. External labia, 151. Cholera Bacilli, 403. Cocci found in the mouth in Quinsy. 045. Comma-bacillus in stools, 257. At work in bowels, 184. In sewers, 937,.946. Concretion, section intestinal, 235. Conferva in bronchitis, 99, 406. Crenothritis kuhniana, 946. Crystals of cholesterin from gallstone, 108. Cysts in the kidney, 246. Liver, 246. Lung, 247. Mesentery, 247. Cysticercus in the eye, 464, Fat of the hog, 778. Diphtheric Membrane, 271. Diphtheria Pasture Field evolution Germ, 272. Embryo Trichinia, 782. .Human, 832, 833. Emphysema of the Lungs, 299. Enteritis, Different stages, 557. Erysipelas, Microbe in skin, 308. Fatty Globules in cardiac degeneration, 3"- Fatty Liver, 312. . Filaria Sanguinis Hominis, 368. Fissure of the Rectum, 370, 371. Fistula Rectal, 372. Gall-Bladder, filled with calculi, 102. Gastritis, Section of stomach walls, 636. Chronic, 637. Glucose fungus in diabetes, 250. Gonococcus in .the eye, 571. Hair-lip, five different forms, 531. Hemorrhage in the kidney, 441. Hemorrhoids, internal and external, 447, 448, 453- Hydatids, 462, 463. In walls of uterus, 463. Young broods in eye, 464. In 'ung, 466. Hydrocele, 467. Hydrocephalus, 469. Hymen imperforate, 7 different varieties, 494- Hyperemia of the liver, 595, 597. Hypertrophy of the prostate gland, 478 ; 2 cuts, 479; 2 cuts, 480; 2 cuts, 481 ; 2 cuts, 482 ; 2 cuts, 483 ; 1 cut, 484. Human ova, 6 and 8 weeks, 832. Imperforate Anus, four different forms 493- Imperforate Hymen, seven different forms, 494- ■ • , , Inflammation of the bowels, enteritis, (3) 557- Influenza, Infusorial Catarrh, 652. Itch mite, 785. | Kidney, vertical section of a human kid- ney, 26. Cysts, 246. Contracted, 582. Three different forms of degenera- tion, 583. Labor, 841, 842, 843, 844,848, 849. Labor Complex, 856, 857, 858, 859, 860. ; Laryngitis, vertical section membrane, of j 592. Liver, Congestion, 595. Fatty, 1197. Lupus on the cheek, 682. Nose, 683. Mesentery, engorged with Typhoid Germ, 334, 335- Microbt of boils, 404. Actinomyces, 40L Cancer, 114. Catarrh Uterine, 176. Caries, 397. Cutaneous, 423. Cholera, 185. Diabetes, 250. Diarrhea, adults, 255,401. " infants, 252, 402. Diphtheria, 268, 274, 276, 278. Dysentery, 280, 281, 282, 403. " Dengue, 342., 416. Dental caries, 397. Ecchymosis, 239. Glanders, 396. Gonorrhea, 4.07, (3) 1175. Hooping-cough, 410, 459. Hay Fever, 351, 399. Indican, 395. Influenza, 404. Leprosy, 241, 676. Lupus, 681. Malaria, 326, 325, 678. Measles, 356, 408. Molluscum, 693. Neurasthenia, 704. Puerperal, 348. • Pneumonia, 391, 402, 403. Pemphigus, 790. Small-pox, 363, 409. INDEX TO ILLUSTRATIONS ic Microbe of Syphilis, 1187. Tetanus, 396, 1008. Tetragonas, 409. Typhus Fever, 401. Typhoid Fever, 332, 333, 334. Venereal, 1187. Micrococci Urea, 39, 157. In chains, 348. Microsporon Missitissimum, 310. Moulds, 948. Mouth, 611.- Nest of Lupus Germs. 681. Trichina in muscle, 781. Nipple, (oidium albicans) 562. Oidium albicans, (aphthse) 64, 270, 411, 562, 612. Omentum filled with cholera germs, 691. Ophidium Sanguinis in stagnant water, 946. Organisms in the mouth, 1013, 1022. Othsematoma in primary stage, 753. More aggravated, 753. ()va filiaria sanguinis hominis, 368. Oxaluria, 267. Pericarditis and its microbe, 616. Penis, illustrating three discharges from urethra, 979. Pigment liver, 592. Piles, 447, 448, 453. Phlebitis, 651. Phosphates and chlorides in urine, 265. Placenta prsevia, 850. Pleurisy and its microbe, 622. Pneumococcus, (pathogenic microbe) 391. Pneumonia, 601. Prune juice sputum, 602, 604, 605, 606. Pneumothorax, 806. Polypoid growths, 808, 809, 823. Polypus of the ear, 811. Rectum, 818, 819. Umbilical, 820. Uterus, 822. Pelvis, (female), 828. Presentations in labor, nine diagrams, 852. Prolapse of the rectum, 864. Uterus, 867. Puerperal fever germ, 348. Rectal fissure, 370. With piles, 370. From syphilis, 371. Rectal fistula varieties, 372. Renal hemorrhage infarction of kidney, 441, 578. Rupia, 795. I Sarchue ventriculi, 161, 166, 418. Aurantiaca, 934. Saccharine fungus of diabetes, 417. Scabies, 785. Sclerosis in paralysis, 770. Section of the molluscum, 693. Kidney in meat poisoning, 945. Rectal polypus, 818, 819. Skin with the trichoplyton, 789. Sewer gas and its microbes, 936. j Side view of female genital organs, 828. Spermatozoa dwarfed, 171, 960, 972. Healthy, 686, 977. Spermatic crystals, 486, 499. Spinal cord, 639, 640. Inflammation, 640. Spirillum plicatile, 411. Volitans, 257, 946. Marsh, 935, 946. Streptococcus of diphtheria, 268. Erysipelas, 308, 414. Cerebro-spinal meningitis, 354, 413 Foot disease, 414. Pyogenes, 415, 884, 885, Puerperal, 415. Stricture of Oesophagus, 994. Rectum, 996. Urethra, 999. Suppuration of liver, 598. T;«nia Solium, head, neck and joints 779- » Crown of hooks, 780. Tinea capitis, 787, Tonsurans, 786, 798. Favosa, 791. Versicolor, 790. Sycosis, 792. Tongue, ion. Trichina Spiralis, 781. Tubercle Bacilli, 1022, 1023, 1025, up to 1032. Tumors, Adenoma, 1115. Section of, on breast, 11 it:. Adeno-fibroma, (3) 1118. Adeno-fibroma, sarcoma, 1118. Angioma, (2) nil. Cystic of breast, 1098. Cystic on neck, 1098. Embryonic type, 1095. Epithelioma on lip, 1120. Fibroid, 1096. In female breast, 1096. Fibroma of the cerebellum, IC96. Hyaline myxoma, 1098. Lymphomata, 1105. Myoma, (2) 1108. Neuroma in skin, mo. Ovarian dermoid, (3) 1110. l0 INDEX TO I l-Li Tumors, Ovarian, with lock of hair, noi. Papilloma dermoid, 1113, (3) 1114- Pedunculated dermoid, 1100. Sarcoma, 1105. Sections of, (3) 1106. In bladder and in liver, 1107. Ulcers, Bacteria in, 1123, 1137. Cervix uteri, 1145. Discharge from, 1141. Duplicate, 1128. Ducts and acini, 1132. Germs in, Irritable, 1123. Hypertrophy with ulceration, 1145. Indolent, Bacteria in, n 24. Induration of neck of uterus, 1144. Internal walls, 1147. Intra-uterine catarrh with ulcer, 1146. Larynx, H35- Perforating of stomach, 1130. Phagedenic, II26. Pus from syphilitic, 1128, 1141. Rectal, 1141. Spores of anthrax in, 1129. Tubercular, 1124. Tubercular bacilli in, n 24. Urine, Uric acid, common form in, 1152. Blood in, 1163. Epithelial casts, 1162. Fatty casts, 1162. Fat globules from chylous urine, 1156. Glucose fungus, 1154. Granular casts, 1160. » Hyaline casts, n 63. Leucin, 1156. Phosphate of lime, 1159. Pus corpuscles of, 1158. Spermatozoa. 1164. Triple phosphates, n 60. Tyrosin, 1156. Urate of ammonia, 1157. Urate of soda, 1157. Uric acid crystals, 263. Uterus, normal, 646, 829. Metritis, 647. Internal view, two diagrams, 829. Gravid, uterus, two diagrams, 840. BACTERICIDES CONTAIN TWO 1 r.VI h >JNS. Varicocele, External appearance, 117I. Result of masturbation, U72' Testicle, natural, 1171. Healthy section of, 117L Venereal chancre on lip, 1185. Bacillus in lung structure, 1200. Of skin, 1207, (4) 1 2K1 Tubercle, 1207. The bone, 1210. Microbe in breast, 1185. Syphilis, 1187. In liver, 1197, 1198. Cerebral softening, 110,1 Dry gangrene, 1216. Fatty liver, 1197. Ichthyosis, 1215. Lichen, 1213. Microbes, 1217. Micrococcus furfur, (2) 1207. Papula, 1212 Psoriasis, 1212. Rupia, 1212, 1215. Sclerosis of brain, 1191. Syphilitic germ in kidney, J195. Bronchitis, 1201. Softening of cerebral pulp, 1191. Sputum, 1199. Syphilitic microbe—Lepra, 1210. of bone, 1210. Tenia tonsurans syphilitic, 1207. Vegetating condylomata of vulva. 1203. Vesicular emphysema, 299. Warts, Vertical section of, 1226. Wasting paralysis, appearance of gray matter, 771. Xeroderma pigmentosa, 1227, 1228. Yeast plant in gastric, intestinal catarrh, "161. Uterine cavity, 175. Associated with other germs, 175. In intra-uterine catarrh, 285. In sewer air, two varieties, 935. HUNDRED ILLUSTRATIONS. AN ENCYCLOPEDIA OF THE Practice of Medicine The trunk of the human body is divided by Abdomen, the diaphragm into two cavities ; the upper being the thorax or chest, and the under the abdomen or belly. Both the cavity and the viscera it contains are in- cluded in the term abdomen. It contains the liver, pancreas, spleen and kidneys, as well as the stomach, small intestine, colon and rectum. The bladder, lower bowel and internal organs of generation lie in the lowest part of the cavity, which is called the pelvis. The entire abdomen, with all its viscera, is lined with a serous membrane, the peritoneum, which is folded or reflected over every organ, keeping them in their proper relation to each other. The external division of the abdomen is into three parts, namely, the upper or epigastric region; the middle or umbilical, and the lower or hypogastric. These are again sub- divided by two vertical lines, the side divisions being called the hypochondriac, lumbar, and iliac regions respectively. Diseases of the abdominal vis- cera are frequent, and consist chiefly of acute and chronic disor- ders of the digestive organs or of derangements of the nerve- plexus and ganglia there situated. These disorders, owing to the presence of innumerable ganglia, and intimate anastomosing with the great sympathetic system, give rise reflexly to innumer- able cerebral affections. Besides, its importance is greatly enhanced as being the seat of 2 (17) . Diaphragm. 2. Gall-bladder. 3. Pyloric end of Stomach. 4. Right Lobe of Liver. 5. Duodenum. 6. Great end of Stomach. 7. Spleen. 8. Piece of Caul, or Omentum. 9. Pancreas (Sweetbread). 10. Small In- testine (Jejunum). 11. Great Intestine (Colon). 12. Small Intestine (Ilium). Tg DISEASE GERMS. the sympathetic nervous system, the seat or abode of orgs and emotional life, the abdominal brain, the great sympathetic which our emotions, desires, affections, passions, preside. The expulsion of the fcetus before the seventh Abortion, month of uterogestation, or before it is viable, is termed abortion ; between the seventh and ninth month, a miscarriage. When it once occurs it is apt to recur about the same time in subsequent pregnancies. Causes.—These are numerous and variable, and are referable to the mother or to the fcetus and its appendages. The causes in the mother may be extreme nervous susceptibility, great debil- ity, disease, plethora, faulty mechanism, violent mental emotion, fright, passion, violent exercise; disease germs lurking in her blood as tuberculae, syphilis, cancer and those which are the factors of fevers ; sexual excesses, racing, jumping, blows ; the use of certain drugs as iodide and bromide of potass, sabina, aloes, cinchona, cotton root, borax; thickening of the neck of the uterus is a common cause of habitual abortion at four and a half months. The causes seated in the fcetus are its death, disease or rupture of its membranes. The ordinary symptoms of abortion are one or more rigors of variable degrees of intensity, a disappearance of the morning sickness, flaccidity of the breasts, uterine hemorrhage, tenesmus or bearing down, flakes of decidua with intermitting pain, and other symptoms incidental to parturition. Treatment.—This is variable, according to the constitution of the patient, but in all cases an effort should be made to prevent such a catastrophe if possible, for which purpose the patient must maintain the horizontal position in bed, rigidly enforcing rest and quietness, with a perfect freedom from care, worry or excitement, at the same time uterine tonics should be adminis- tered to brace up that organ. The best of these is the distillation or wine of the aleteris farinosa, one of the most powerful vitaliz- ing uterine tonics in the Materia Medica. This is a remedy of unexcelled therapeutic power in toning and bracing up the uterus ; it is of the greatest efficacy to all ladies who have that organ in any way damaged or suffering inertia, or who happen to be the victims of habitual abortion or miscarriage. Its use during preg- nancy, especially prior to parturition, renders labor easy and speedy, and its peculiar action on the uterine fibres renders it a prophylactic against all ulterior results, such as after-pains metria, etc. Opium in some form is the remedy to arrest uterine contrac- BACTERICIDES. 19 tions, thus: Opii pulv. grs. x; Dover's powder and pulverized asclepias, of each grains xxx. Mix. Make 15 powders, one every three hours. No plug or tampon, or any other body should be introduced into the vagina unless there is excessive hemorrhage, as its presence excites uterine contractions and expulsion of its contents. If these means fail, the case should be treated same as an ordinary labor. This is not a threatened abortion, nor Missed Abortion, an imperfect abortion. Threatened abor- tion is very common at four and a half months, especially if there is the slightest thickening of the neck, for when it begins to stretch and emerge into the body, if there is resistance, there will be irritation communicated to the fundus and contractions. When a woman has threatened abortion, she suffers pain, has a bloody discharge, and mouth of the womb is opened. An abortion may be threatened and averted, and preg- nancy go on in a healthy way. There might be an abortion in the case of twins, one aborted and the other remain and go on to development. The abortion of one of the twins may be a missed abortion, or the miscarriage of one may be a missed mis- carriage. If the fcetus alone, or the entire ovum alone, comes away, the woman has miscarried, or aborted; it may not be complete, but imperfect. The ovum may come away alone, without the mem- branes, or the after-birth ; or only a portion come away. This is always dangerous, as it is liable to give rise to hemorrhage or else lead to putrid absorption. This is especially liable to be the case if the abortion has been caused by instruments or drugs, for then there is always less or more endometritis. Imperfect mis- carriage invariably induces endometritis in subsequent life. When a woman has a missed miscarriage, or abortion from a fright or blows, the natural course of events is as follows : The fcetus dies, the symptoms of pregnancy are arrested, milk may appear in the breasts, there may be a bloody oozing from the uterus, or otherwise; if the waters are not dried up, they are ab- sorbed, and the contents of the uterus shrivel up and become mummified. If the membranes remain entire, absorption is the rule, with mummification. The uterus steadily diminishes in size, but its contents remain and continue up to the full time, when they are expelled. The expulsion is frequently unex- pected ; happens while standing or defecating, and the mass, shrivelled up in a bundle, or rolled up in a parcel, is expelled. The mass is usually fresh, of a brown color, and contains the fcetus in the centre. 20 DISEASE GERMS. When such a case as the above is clearly made out, the intro- duction of a catheter, or catgut bougie, into the uterus for several hours, so as to excite contractions, together with quinine and caulophyllum to stimulate uterine energy, is indicated. A collection of pus in any part of the body Abscess, {streptococcus pyogenes). The process by which an abscess is formed is as follows: A damage of suffi- cient violence has been inflicted—capillary vessels relaxed. With this partial death exudation of blood products, lymph, and lymph degraded into bacteria, pass or flow through. This lymph, if the state of partial death is great, or vital force low, may break down as it is effused, becoming pus or purulent matter, or if not so greatly depressed, the exuded lymph may remain and form a thickening or induration which may remain in the minute interstitial struc- ture of a part. Effused lymph may remain in a part indefinitely or may be ab- sorbed, or may suffer some accidental shock, when it may sud- denly break down. The lymph dissolving into pus, making for itself a cavity, makes its way to the surface or to some natural outlet of the body. The breaking down of lymph into pus is invariably ushered in by a rigor or chill, and if there be pain, heat, redness, swelling, they each change in their character; pain becomes throbbing, heat diminishes, redness changes into a livid color; swelling be- comes soft, flaccid. Pus, or the streptococcus pyogenes, may make its appearance in a different part of the body from whence it was formed, as in the case of psoas abscess in disease of the spine. The pus may find an outlet either artificially or naturally, or it may be absorbed, and cause blood poisoning. In order to prevent suppuration or the formation of pus in a cavity, the stimulation over the affected part must be in propor- tion to the amount of depression which caused the original lesion —or as powerful as the structure of the part will bear without causing its destruction ; local stimulation should not only be pow- erful, but, as far as the nature of things can, germicidal. Who has not witnessed the splendid remedial action, the ozone gener- ating power, of turpentine in peritonitis, and pleuritis—the persist- ent action of a saturated tincture or oil of lobelia in periostitis of the phalanges of the fingers ? When the rigor comes, the precursor of abscess, heat and mois- ture unremittingly applied are the proper remedies, with free open- ings and counter openings to afford a free egress to all purulent productions. BACTERICIDES. 21 The pus of all abscesses is simply the lymph from the blood —altered, changed—degenerated into the bacillus pyocyaneus— the microbe of pus. This wood cut affords a beautiful illustration Acarus of a microscopic parasite residing in the seba- Folliculorum. ceous sacs, and hair follicles of the human skin. They are met with in h almost every person, but most numerous in those whose skin and liver is torpid, or in those who suffer sexual perversion. They vary in length from one-fortieth to one-hundredth part of an inch. The head is always directed downwards and when a large number is present, they collect into a conical bundle, the larger end of the cone being formed by their heads. Their number varies from two to three in a follicle and in some cases as many as fifteen. The parasite posseses eight thoracic appendages of the most simple and rudimentary kind ; the mouth is suc- torial ; sexes are distinct. In order to eradicate this parasite, the liver, bowels, skin should be well stimulated, brought into an active condition, sexual perversion overcome. On the nose, Acarus foiiicu- cheeks or other parts where sebaceous glands are ntfed.'mag" numerous, after first bathing with warm water and drying off, a ten-per-cent. solution of peroxide of hydrogen should be applied. ______ A perfect arrest of the function of the liver, so Acholia. that the various materials from which the bile is formed accumulate in the blood, and cause blood and brain poisoning. It is a state or condition which is extremely liable to occur during the progress of almost any acute or chronic disease of the liver, but an almost invariable attendant on acute atrophy and fatty degeneration, such as is present in yellow fever, in which there is a destruction of the hepatic cells, with rapid wasting of the gland. Acute atrophy of the liver is the direct result of the presence of a fungus or microbe in the blood impairing the nutrition of the gland, much aggravated by venereal excesses, mercury, alcohol, and by mental and physical prostration. It is impossible to explain how those microbes, or their spores or ptomaines, can cause such rapid metamorphosis in a gland so rich in blood vessels, as to cause one-half or more of it to disap- 22 DISEASE GERMS. pear in a few days, without the blood vessels themselves being affected. No other disease has the least analogy to it. It is most present in chronic alcoholism, where all cases show a fatty liver. Indeed the general pathological condition found among all drinkers is interstitial deposits of fat, and an infrequence of fibroid tissue. Next in order to alcohol comes the germ syphilitica, which acts directly as an eating fungus upon the hepatic cells; the cancer microbe eats up the glandular epithelium and thus leads to an arrest of function. More rarely is acholia due to chronic inflam- mation with either amyloid or fatty degeneration. Whether then the cause be microbes or poisons, or plastic lymph effused in an inflammatory process, an impermeable state of the ductus communis choledochus and an arrest of the capil- lary circulation take place. An effort at treatment should in all cases be tried. Locally over the liver, con. ozone, followed by hot poultices ; internally some of the following remedies should be tried: Chionanthus Virg., euonymus, with an eight vol. solution of peroxide of hydrogen. Inflammation of the sebaceous glands and hair fol- Acne. licles, with retention of the gland secretion, which is degraded into bacteria. The treatment embraces both local and constitutional measures. The diet should be very nutritious, but plain, embracing abun- dance of vegetables and fruit; all stimulants avoided, such as wine, malt liquors, tea, coffee. Glycerite of sulphur, administered in the evenings in sufficient doses to move the bowels. Boroglyceride paste applied to the patches, over night, is a par- ticularly serviceable and efficacious remedy. Distillation of jequi- rity is also of great value. That which is common in young men and women at and sub- sequent to puberty is best relieved by dusting on the microbe powder during the day, and applying an ointment made thus: Iodide of sulphur, grains 25 to one ounce of ozone ointment, or re- sorcin jelly. Baths of alkalies, iodine, are invariably of service. The liver in all cases should be well stimulated by chionanthus, perox- ide of hydrogen. The affection is presumably one which is Actinomycosis, dependent on the presence and activity of a micro-organism. The micro-parasite is a member of the fungoid class and consists chiefly of a mycelium which divides in a dichotomous fashion, and gives rise by its BACTERICIDES. 23 spread from a centre to a radiated appearance, whence its name— actinomyces—is derived. The circumferential ends of the myce- lial sprouts have a flask-shaped swelling. The little masses of felted mycelium may be recognized by the naked eye as sul- phur-yellow bodies of about the size of a hemp-seed. The disease which this parasite is supposed to cause may develop in many parts of the body. The most common site appears to be the jaw and parts bounding the mouth. The affection in animals has long been known in this situation under various names, and has been re- garded as a form of scrofula and as a new growth. It is believed that the parasite gains an entrance through the medium of a carious tooth or some wound of the gum leading to the jaw-bone. There is but little to be said of the morbid anatomy of the disease. A swelling forms in the jaw, and gradually increases in size. This tumor in its earliest stages may be punctured without any matter being let out, although it gene- rally has an elastic and semi-fluc- tuating consistence. A section made into a tumor in the early stage of its existence shows a reddish-white area sprinkled in places with gold-colored granu- les. Later on abscesses and fistu- lae form, in the discharge form which the sulphur-colored bo- dies may be seen. Broadly speak- ing, the tissueof the morbid new growth, which must be regarded as inflammatory rather than sarco- matous, has very much the characters of ordinary granulation tis- sue. Actinomycosis may occur primarily in the respiratory tract proper. It is localized to the bronchial mucous membrane, giving rise to the signs and symptoms of chronic bronchitis, with fetid ex- pectoration, in which the actinomyces are often readily discovered. Primary localization of the disease is in the parenchyma of the lung, from whence it is propagated to the pleura and to the pravertebral tissues. Some of the cases have many of the clinical characters of empyema with discharging sinuses, and in such cases a complex system of fistulae not infrequently undermines the morbid tissues. The structures in the posterior mediastinum and prevertebral re- gions are often affected, and the bodies of the vertebra may become carious. In another class of cases the disease begins primarily in the intestinal canal. In some of the cases the foci of the dis- ease are widely disseminated. The liver, spleen, muscles of the Actinomycosis. A nodule is shown composed of round cells, in the centre is the clump of actinomyces sur- rounded by large transparent cells. Magnify- ing power 350. 24 DISEASE GERMS. 1 back, and muscular substance of the heart, have been shown on post-mortem examination to have numerous centres of actinomy- cosis. Large abscess cavities may form behind the peritoneum as well as behind the pleura, and these may communicate by many perforations of the diaphragm. The symptoms necessarily depend chiefly on the localization of the disease as well as on its rate of progress, and present therefore extremely varied clinical pictures. A group X A Zeiss (— 3-5 inch; The portion of fungus as seen in shows probably the earliest stage of this cut is older, more matured. Under growth : each separate collection of this power some of the filaments are lungus consisting of fine filaments apparently thicker than the majority, radiating from a common centre. and are club-shaped. No doubt the fungus effects an entrance by the mouth, taken in with the food, through the medium of a crack, fissure on the gum or a carious* tooth, and at first appears as a whitish nodule looking like tubercle. This nodule becomes the neoplasm, the swelling or abscess, a purulent cavity. No doubt the disease is transmitted in man very readily by the .1 ,. c , Hie diagnosis rests ud< the discovery of the small yellow granules in which the funo- BACTERICIDES. 25 may be detected. The disease must not be confounded with extra-peritoneal abscess about the soft tissues of the jaw due to carious teeth. The fungus bears cultiva- tion well in almost any nu- trient menstruum—it pro- duces the same micro-or- g a n i s m by inoculation. The form we meet with in cattle is the same as what occurs in man. The treatment which is of utility is a general alter- ative and tonic course of re- medies, in which germici- dal medicaments should play an important part. If the germ is in the mouth peroxide OI hydrogen and Actinomycosis from tongue of ox, for comparison. solutions of boroglyceride are invaluable; if in the intestines, resorcin; if in the bronchi or lung, glycerite of ozone ; if in the bones, saxifraga. Actinomycosis finds a favorable location for breeding in the liver, which is often mistaken for cancer or syphilis, but a microscopi- cal examination of the faeces indicates its true character. It seems quite possible that the weakening of the system by the microbe of syphilis, cancer, or by the excessive use of mercury, is a cause why it is found in the liver. One thing is certain, the microbe is communicated from cattle to man, and passes from man to man by contact. It behooves us to take all possible means to make a careful diag- nosis, and if the disease is recognized in. animals it should be at once stamped out and not allowed to spread from one to another and endanger human beings. It has been recently demonstrated Addison's Disease, that disease of the suprarenal capsules, or what some term Addison's Disease, is due almost entirely to an infiltration of those glands with the tubercular bacilli. This disease germ, once deposited in the suprarenal capsules, grows, and goes through its different stages of growth and degeneration, causing chronic interstitial inflam- mation and fibro-caseous and calcareous metamorphosis. In the early stage of the disease the capsules become enlarged from 26 DISEASE GERMS. the presence or aggregation of the bacilli. These germs gene- rally localize in the centre of the gland, grow and breed outwards,. usurping its entire structure; as it reaches the vortex, cheesy and calcareous degeneration commences in the centre. This change is uniform. In rare cases the bacilli are deposited in points or nodules in the glands, which gives it a lobulated appear- ance ; whichever it ma)- be, their proper structure is entirely oblit- erated, no sign of gland structure is left; on a cut section it appears yellow. The structure and functions of the suprarenal capsules are the same as the lymphatics, pink marrow and mesenteric glands. The lesions of the nerve centres of the suprarenal capsules and great sympathetic account for the phenomenal pigmentation and discoloration of the skin. The spleen is enlarged and softened ; the liver, kidneys, lungs, stomach, intestines, spinal cord and brain are dotted over with tubercle; even the testes and prostate are implicated. The blood is anaemic, fibrin dimin- ished, red discs altered in size and form, and does not run together as normal corpuscles, owing to the lymph spaces being crowded with tubercle; the white globules are in-. creased in number. Lurking deep in the vital stamina there is great pov- erty of nerve force, a paralytic state of the vaso-motor fibres of the great sympathetic, and, as a consequence, the blood is imperfectly and unequally distributed. In addition to the discoloration or bronzing of the skin, we have the characteristic features—anaemia, gene- ral languor or debility, with extreme prostration, expressed by a loss of muscular power, weakness of pulse, remarkable feebleness of the heart's action, breathless- ness upon the slightest exertion, dimness of vision, functional weakness and irritability of the stomach. The progress of the disease is very sk^w; melancholia is not uncommon, drowsy dreamy languor, dizziness, and syncope not infrequen Heart failure predominates all through ; anaemic murmTs are heard a^d V™^^^ ^an? a >™ «~ Pigmented. Sight and memory^^^ A vertical section of the human kid- ney ; a, exhibits the suprarenal capsules, which are infiltrated with tubercle in Addison's disease. BACTERICIDES. 27 symptoms, followed by delirium or comatose state. The urine is normal in quantity, albuminous; uric acid, coloring matter are in excess with the microbe indicum. In eighty per cent, of all cases tuberculosis of the most intense character is present. It is regarded as an infectious blood dis- ease, more especially common among males in the adult period of life,, and is found associated with cancer, apoplexy, and waxy and fatty degeneration of glands. Numerous cases have recently been discovered in which there was no tubercular infiltration of the suprarenal capsules at all. As the tubercular diathesis is so intense, the germs blocking up all the important blood-raising glands, it has generally been regarded as incurable. All remedial measures, up to the present time, have been in- operative. Accepting the theory—a disease of nervous bank- ruptcy, with intense tubercular growth—positive benefit, at least a great prolongation of life, results from the use of germicidal remedies, and a tonic treatment, nutritious diet, the avoidance of everything that would debilitate, with rest in the recumbent pos- ture, and the avoidance of all insanitary states. Glycerite of ozone, in twenty-drop doses, has been found a most efficacious remedy; alternating with either the glycerite of kephaline or tincture of oats, to which quinine and tincture of ignatia have been added. The stimulation of the cervical sympathetic with concentrated ozone, with general faradization of that nerve, are important factors in the treatment. Pseudo-leucocythaemia is a peculiar disease Adenoma, of the blood, like leucocythaemia dependent upon an enlargement or hypertrophy of lymphatic glands; glands of neck, axilla, groin symmetrically enlarged, not inflamed or fused together; thoracic and abdominal glands also affected. Patient becomes weak, loses flesh, soon out of breath on exertion, symptoms of pressure at base of chest or abdomen, gradually increasing debility. It is also called Hodgkin's disease, or malignant lymphomata. The lesion of this disease does not differ from lymphomata. They are divided into hard and soft tumors. The soft lymphomata are of an encephaloid consistency. Their color is of a reddish gray, studded with spots of extravasa- tion. As the glands enlarge, they become confluent, forming a large, soft, fluctuating, lobulated tumor. Hard tumors have a fibrous feel. It is well known that the lymphatics preside over or are car- riers of nutrition or lymph, but how they influence the blood in 28 DISEASE GERMS. the production of white cells is unknown. The spleen, lymphat- ics, mesentery, suprarenal capsules, and the pink marrow of the bones constitute the great lymph channels ; in each or all of them when obstructed, damaged or diseased, there is the prevail- ing characteristic cropping out—excess of white corpuscles. • The diagnosis of the disease is not difficult, the swelling of the glands in the neck, armpit, or groin are significant; but when the deeper glands are affected it is more difficult. In all* forms, however, emaciation and anaemia are marked and progressive. Usually enlarged spleen, palpitation, slight fever, muscular weakness. A general alterative and tonic course should be tried, and a highly nutritious diet will be found to be the most available means in the line of treatment. Change of air, and sea bathing when the strength permits, are of advantage. The entire lymphatic system, including the Adenitis, lymph canals, the pink marrow of bones, spleen, suprarenal capsules, mesentery and other glands are in health actively at work raising the blood from elementary molecules, to leucocytes, thence to red discs. Leucocytes are protoplasmic units partly differentiated so as to assume a function higher than a mere amoeba, that is, they unite in forming struc- tures that have the property of vital endowment in a particular direction. All the structures of organic things are made or built of cells, and these cells are differentiated leucocytes. The white cells have amoeboid movements, and thus change place and form. Tissues become active as these movements are differentiated and then there are classifications of types of tissues. The respiratory, circulatory and digestive tissues are primordial, and in the first of the series of life ; generation is carried out only on the primi- tive plan of motion by mere division, as fission, budding, etc. In the organic structural animal wherein tissues are so far differ- entiated as to be set apart for the performance of certain specific functions for the good of the organism at large, the leucocytes that form the secretory cells are only slightly differentiated from the primitive leucocyte, and their functions are substantially the same as the primitive ones, but they have the additional property of converting the pabulum of their nutritive material into a func- tionating product in a special way. A gland cell is the singular thing that is creating out of its own protoplasm a new material, using its nutritive substance to elaborate the constituents of its secretion. A muscle cell uses its pabulum to differentiate move- ment ; a nerve centre cell to differentiate impulses that originate reflex movements. BACTERICIDES. 29 In the treatment of disease we have to do with these differen- tiated leucocytes, or modified amcebas. Sometimes the power to take oxygen is degraded, or the power to expel detritus from the innermost parts is impaired, or the power to rejuvenate itself is injured in someway by some adverse state, into other living matter. We are ever dealing with primitive elements when we approach a living thing, no matter how complex it may be in arrangement of its cells and tissues. A partial death of a portion of the lymphatic system strikes at the root of organic life. An inflammatory condition may arise from various causes. 1. Simple Adenitis.—May be the direct result of a blow, walking, absorption of some irritating poison through an abrasion. Such an inflammation or irritation is very common at the elbow, axillae, knee, groin. The chain of femoral glands may enlarge as the result of a wound on leg, foot, ingrowing toe-nail; while irritation of the penis affects the inguinal chain (bubo). The glands at the back of the neck frequently enlarge when there is irritation of the scalp, and the cervical glands become enlarged in diphtheria, malignant stomatitis, scarlatina, etc. 2. Tubercular Adenitis.—In individuals whose vital forces are greatly below par, where the tubercular bacilli are present in the blood, either as the result of an infection, or a special degradation of normal bioplasm into the bacilli, or from both, especially in children, the glands of the neck from some irritation will become inflamed, irritated, enlarge slowly, suppurate, the tubercular bacilli will undergo its usual changes, become caseous then calca- reous. If there happens to be irritation of the bowels, the mes- entery will take on an analogous condition, become engorged with the products of inflammation, and the microbe of tubercle, masses or chunks of the bacilli can be felt through the abdominal walls. 3. The Microbe of Syphilis.—The adenitis which almost in- variably accompanies a soft chancre, or a gonorrhea, is very apt, if the treatment be not correct, to be accompanied with a viru- lent bubo, which comes on about a week after infection ; inflam- matory symptoms run high, acute pain, rigors, fever, great swelling and sometimes suppuration. The true syphilitic germ,. in the inoculation, the hard chancre, often migrates to the lym- phatics of the groin giving rise to multiple bubo ; as a rule the migration of the germ is painless, no suppuration. The indura- tion proceeds slowly from gland to gland, in the inguinal chain till all are affected. They are never very large, are always hard,. and can be moved about under the finger. Various other glands throughout the body become germ-laden and enlarged, as in induratedc hancre of the lip, the submaxillary become indurated ; 30 DISEASE GERMS. in chancre of the fingers in washerwomen the glands of the axillae are enlarged. 4. Cancerous Adenitis.—In whatever part of the body a can- cerous infiltration takes place the lymph glands in close prox- imity to the aggregation of germs become engorged, partly with products of inflammations, and partly with cancer germs. In grave cases the}' become a valuable element of diagnosis and prog- nosis. The most common examples are the enlarged sub- maxillary in cancer of the lip and tongue, the axillae in cancer of the breast. 5. Adenia, or Hodgkins Disease.—This affection is character- ized by an enlargement of all the lymphatic glands of the entire body. They often attain great size, but do not suppurate, but there is invariably associated with it marked anaemia, vastly diminished red corpuscles in the blood, but no increase in the white, spleen and suprarenal capsules generally enlarged. 6.—In the plague, or relapsing fever, anthrax, glanders, or farcy, malignant erysipelas, dissection wounds, phlebitis from' any cause, malaria, bite of an enraged man, etc., there is apt to arise a general enlargement of the lymphatic glands throughout the body, along with hypertrophy of the spleen, and an increase of the white corpuscles of the blood. Treatment of all forms of adenitis require great energy and sdund judgment. Within these few years past, it has been clearly demonstrated that the filling up of the lymphatics, as we have in adenitis, is chiefly due to the germs of disease, a concrete essence, an absolute and visible germ in all cases, whatever the form may be. The gland is but a bacteriological colony when irritated. So in all cases a rigid germicidal treatment should be inculcated, both internally and locally. In all cases, comp. saxifraga, phytolacca, iodol, and special remedies to sterilize the microbe; locally plantain leaves, iodo- form, sozoiodol, resorcin and ozone ointment; peroxide of hydrogen. An animal membrane Adipose Tissue, or tissue, consisting of an aggregation of minute spherical pouches or vesicles, filled with fat or oil. The tissue itself is organic and vital, the vesicles secreting the fatty matter from the capillary blood-vessels with which they are surrounded ; the secreted matter or fat is inorganic and Appose Tissue, devoid of vitality. The adipose tissue differs magnifiedl from cellular or filamento is tissue in having the vessels closed BACTERICIDES. 3* so that the fat does not ooze through even when fluid. A con- siderable layer of fatty tissue under the skin, over kidneys and in or on the mesentery, around large vessels and nerves, around joints, is not incompatible with a high standard of health. Fucus vesiculosus with dioxide of hydrogen strips the muscular tissue of a redundancy of fat. By this term we mean the presence in the Albuminuria, urine of an albuminous body, which is coagu- lated by heat or precipitated by neutraliza- tion. It was once regarded as a diagnostic symptom of Bright's disease, but recent researches have caused it to lose this its primi- tive meaning. The variety of the pathological conditions under which albu- men may appear in the urine is very great, as congestions, inflammation, mechanical obstruction to the circulation of the kidney; whenever disease germs are present in blood as the malarial microbe, the bacillus of tubercle, cancer syphilis ; the germs of diphtheria, scarlatina, variola, erysipelas, etc.; in blood diseases proper, as anaemia purpura, and also in diseases of the heart, lungs, liver, in peritonitis, pregnancy, diseases of the brain and spinal cord, in epilepsy and various skin diseases, even after bathing. For convenience, all conditions in which albumen may be found in the urine may be arranged under the following groups : 1. Congestion of the Kidneys. — Congestion of the kidneys may result from a chill to the skin, as in bathing, exposure to cold; from the elimination of some irritating poison, such as alcohol, uric acid, phosphorus, lead, cantharides; from the direct action of a microbe blocking up the kidneys, as we have in scarlet fever, diphtheria, typhoid, variola, erysipelas, or from vaso- motor paralysis, the result of a concussion of the spinal cord. Passive congestion may result from cardiac, pulmonary, hepatic disease; or from peritonitis, pregnancy, or from heart failure in anaemia. 2. Acute or chronic inflammation, as we have when the glands . are literally blocked up with disease germs. 3. Degeneration, fatty, amyloid, cystic, forming dep osits, usurpation of normal structure, with softening or thinning of the renal arterioles. These are some of the causes, and it would be interesting to discuss the mechanism by which albumen passes into the uri- nary secretion, and what causes the transudation. Is there a physical change in the lining membrane, or is there some altera- 32 DISEASE GERMS. tion in the blood pressure, or the rapidity of the blood current? In all the states mentioned, from simple congestion up to con- tracting kidney, the walls of the glomeruli are actually perme- able, permitting the passage not only of thin fluids and colloids, but even of semi-solids, and this too in parts of the kidney pre- senting no recognizable structural alterations. Even a slight relaxation temporarily induced will give rise to albuminuria, and it may occur in dyspeptic people, in weak, overgrown persons, without being an indication of actual or potential renal disease. To arrest the escape of albumen, in addition to general tonics and nutritious diet, try first nitro-glycerine, then either erigeron or gallic acid and port wine ; or convallaria maidis ; or ergot, or corn smut; or aromatic sulphuric acid and quinine. This is met with either acute or chronic. Alcoholism. In acute alcoholism, the mucous membrane of the stomach and duodenum is greatly congested. Patches of aphthae {oidiumalbicans) are formed upon it, and the mucous membrane of the stomach is covered all over with a thick ropy mucus, heavily loaded with the sarcinae ventriculi, slightly tinged with blood. The gastric juice is altered in quantity as well as quality. The brain, lungs, kidneys are congested and the pericardium and pleura are filled with bloody serum. In chronic alcoholism, there are always and invariably present chronic gas- tritis, congestion or cirrhosis of the liver, emphysema, or tuber- culosis of the right lung, fatty degeneration and dilatation of the heart, atheroma of the blood vessels and interstitial nephritis. As the whiskey in the blood circulates as a free agent, it irritates and degenerates every organ, gland and tissue of the body, retards their working capacity, and arrests the normal metamorphosis. The poison has a special action on the brain, inducing in all cases chronic inflammation, with effusion of lymph, which causes thick- ening of its entire substance; besides the brain is literally steeped in the poison, which withers, whittles down the organ to a mis- erable state of atrophy, an anaemia. In long standing cases, cer- ebral softening occurs, and in such the viscera are fatty, the sub- cutaneous tissue and omentum being loaded with that non-vital element, if they are beer, ale or wine drinkers ; while those who drink spirits are thin, spare, prematurely old, on account of the increase of the connective tissue. Perpetual drinking gradually induces a tubercular diathesis, with the tubercular bacilli in blood. The blood in chronic alco- holism besides contains more fat than normal; one of the first effects of the alcohol is a true chemical combination with nerve BACTERICIDES. 33 tissue, and as the ingestion of spirits is constant, both the gray and white progressively atrophy and harden. This is hastened by a state of poor blood. Differential Diagnosis.—The greatest care must be exercised in making a diagnosis. The coma of alcoholism must never be con- founded with that due to urcemia, or apoplexy, or opium, or any other form of cerebral irritation. In inflammation of the brain, we have the firm, hard pulse, pyrexia, retracted abdomen, and that agonizing headache aggra- vated by noise, light, heat, motion, photophobia, all of which are absent in alcoholism. Alcoholic tremor has often been confounded with shaking palsy, locomotor ataxia, and softening of the brain. Prognosis.—If the patient is manageable, usually good. Death may occur in the acute form from active gastritis, or lobular pneumonia. Danger of passing off in a comatose state or from apoplexy. In chronic alcoholism there is always danger from chronic gastritis, ulcer of the stomach, degenerative changes in the brain, blood vessels and nerves, fatty liver and kidneys— which predispose to a long list of diseases that tend to shorten life. Insanity, impotence, epilepsy, organic brain disease are its frequent sequelae. Treatment.—In acute maniac delirium, wash out the stomach by a copious emetic of infusion of lobelia leaves and bicarbonate of" soda, in repeated doses until free emesis is effected, hot infu- sion of capsicum between each dose, getting full free emesis, if possible; follow this with a saline purge, and warm bath, followed by friction and massage to the entire body. Subsequently in- duce sleep by repeated doses of sulphonal in 30 grain doses— dose to be repeated every half hour. If sulphonal does not succeed, then try 15 grains of chloral hydrate with 15 grains of bromide of potassa in syrup of orange peel, which can be repeated. If this is not successful, then a hypodermic injection of ^ of a grain of sulphate of morphia. There must b« a remedy selected and administered to procure 10 or 12 hours of profound sleep. On arousing from this sleep, the patient should be placed upon large doses of capsicum in alternation with tincture of green root of gelsemium or digitalis. At the same time abundance of fluid nourishment should be given, as essence of beef. The patient should be kept quiet, and diffusible stimulants like capsicum, prickly ash, ammonia, administered till he is tided over the crisis, when coca et celerina should be administered in teaspoonful doses every three hours, to appease or satiate the appetite for stimulants. Such is the most efficient treatment. 3 34 DISEASE GERMS. The effects of the prolonged use and abuse of alcohol are most disastrous in the production of a deteriorated race; in the creation of a type of nervous diseases of the insane group. A partial or complete deficiency of hair usually Alopecia, results from the presence of disease germs in the blood, or from indirect starvation of the follicular or peri-follicular tissues inducing a state of atrophy. The epidermis suffers from defective nutrition, the derma con- tracts, hair follicles shrink, become patulous; efforts may be made by the nuclei, and abortive results at hair formation may be recognized at the base of the hair sacs. The correct treatment of alopecia consists in imparting to the blood the elements of which the hair is made, such as avena and glycerite of sulphur, then stimulation to excite a state of hyper- aemia in which growth results ; this involves bathing, friction, rub- bing, shampooing, etc., simply damping the scalp with the ozone hair restorer. A scanty crop of soft, short, downy hair is peculiar to the mi- crobes of syphilis and tuberculae, and requires germicidal treat- ment and the local application to the hair and scalp daily of the following: Jfy Ozone ointment, . . . . . i ounce. Oil of boroglyceride, .... 3 drachms. Resorcin,......1 drachm. Chrysophanic acid, . . . .10 grains. Mix. In the treatment of those cases no remedy has a higher and more established value than the Ozone Hair Restorer. Partial, or complete amaurosis, or loss of Amaurosis, or vision from some disease of th% retina, optic Blindness. nerve, or brain, the optical instrument, the eye, being in a normal or healthy condition. The causes that are likely to affect the brain, optic nerve, or retina, are embraced under five distinct heads, viz., anaemia, hyperaemia, reflex irritation, poisons, organic changes. General Symptoms.—Partial or complete loss of vision, without effusion in the cornea or on lens, or any form of opacity. This impairment of vision naturally gives the gait and countenance a peculiar expression. He walks with an air of uncertainty • his eyes, instead of being directed to surrounding objects, have an BACTERICIDES. 35 unmeaning look, appear to be staring at nothing, or are in constant rapid motion. In partial amaurosis, movements of the iris slug- gish, and pupil dilated; in total blindness, pupil greatly dilated, and iris immovable. When both eyes are affected, they are often unnaturally prominent, and of an unhealthy -color, the sclerotic being often yellow and covered with varicose veins. An examination of the eye with the ophthalmoscope usually reveals inflammation of the optic nerve, changes in the retina or brain. Those changes are variable, consisting chiefly of relaxa- tion, effusion, thickening deposits and extravasation. Another class seems to depend on atrophy, or wasting of the retina, optic nerve, or brain. This atrophy may follow neuritis, or exist with- out. When due to tobacco, this shrivelling up or whittling down of retina and optic nerve proceeds to utter blindness without in- flammation being present. I. Blindness due to ancemia will exhibit an impairment of vision, with all the symptoms of a diminution of red corpuscles in the blood, as vertigo, ringing in the ears, specks or spots before the eyes, pale face, lip, tongue, murmurs in the left carotid, and general debility. The causes that lead to this may be meagre, poor, or bad food, absence of sunlight, over-work, drugs, disease, fevers, long or excessive nursing, want of exercise, sexual excess. Best cured by a removal of cause, building up of blood with abundance of best of food, fresh air, exercise, and by using com- pound tincture cinchona and mineral acids, or pill quinine, iron, hydrastin, nux, sulphate quinine and aromatic sulphuric acid. 2. Blindness due to congestion or plethora, or over-feeding and stimulation, with all the symptoms of that condition. Best treated with removal of cause or causes, free purgation, heat to feet, blisters to nape of neck, followed by irritating plaster; alteratives, as iodide of potass in syrup of stillingia or Phytolacca ; and even here, cinchona or its alkaloids, because we have no drug equal to it in restoring the integrity of the optic nerve. 3. Blindness may be due to reflex irritation, as the irritation of teething, worms, ovary, uterus, pregnancy, but more especially self-pollution, or masturbation—this latter form usually common, as all the inmates of our prisons, refuges, asylums, boarding- schools, retreats, are addicted to this loathsome and degrading practice. Nearly all the young and middle-aged men and women to be seen on our streets with defective vision and glasses, have been inmates of some charitable college or institute, and exhausted, drained off, their nervo-vital fluid, and obliterated the finer cere- bral convolutions of their brain, and are partially blind. The origin of the optic nerve being in the spinal cord, medulla, and 6 DISEASE GERMS. brain, the reflex centre, or bulb, suffers intensely, and the whole process of growth is arrested, and the perpetrator becomes a miserable victim of self-conceit, egotism and puniness. Cured upon general principles, by removing cause, and treating for masturbation and for the eye ; stimulants to nape of neck, quinine, glycerite of ozone, kephaline and other tonics. 4. Blindness may be due to poisons, as tobacco, chloral hydrate, opium, whiskey, belladonna, conium, syphilis, mercury, and the use of hair dyes and cosmetics, as the nitrate of silver, lead, bismuth, which act very disastrously upon base of brain along the ophthalmic tract. Much of the defective vision to be seen is due to the use of those agents. A discontinuance of the use of the poison, with a general alterative and tonic course, is usually sufficient for a cure, if seen early and persevered in. 5. Blindness way be due to organic changes in the retina, optic nerve, or brain.—These changes may be inflammatory, and proceed on to softening of the nerve or its branches, or due to atrophy from anaemia or want of nutrition. This is the most hopeless form, as white softening, or ramollissement, is an irre- parable affection. General Treatment.—In all cases, if it is possible or practicable, the following plan of procedure should be carried out: The bowels regulated ; skin stimulated with daily baths ; two open sores at nape of neck, one inch square, on each side of the spinal column ; flannel clothing; appetite to be stimulated and a diet consisting of animal food, eggs, white-fish boiled, oatmeal porridge and cream—a brain diet, an important factor in a case. As the optic nerve not only originates in the spinal cord, but is freely blended with the medulla, the seat of reflex action, morn- ing and night all the peripheral extremities of the nerves of the entire superficial portion of the body should be stimulated from half an hour to two hours with friction, shampooing, palpation and electricity. This faithfully performed, raises the standard ol vitality of cord and bulb, and the patient sees better at once or after a few applications. The medical treatment is the same as for chronic inflammation and softening of brain—alteratives and tonics, iodide of potass, cinchona, and especially the ozonized pre- parations, as they tend to cleanse brain and optic nerve of all extraneous substances ; glycerite of ozone, ozone water, kepha- line. Treatment to be persevered with for six or twelve months; change of air and scene often of utility; other cases benefited by rest and quietness, especially those caused by exhaustion and nervous debility. If a real organic change has taken place in the optic nerve all BACTERICIDES. 37 remedies are useless. In all cases there should be an avoidance of all rnalt or alcoholic liquors ; all acro-narcotic drugs, especially tobacco, and hair dyes or tonics; and sexual congress only per- mitted at rare intervals. Probably of all causes that give rise to the great frequency of organic amaurosis, tobacco, sexual excesses and syphilis are the most common and detrimental, and most likely to produce degeneration of the optic nerve. An absence of the menstrual flow. It is Amenorrhcea. met with under two forms : i. Retention of Menses.—This may de- pend on a variety of congenital conditions, as arrested develop- ment, organic affections, malformations, such as absence or atrophy of ovaries, uterus. Those organs may be present, but vagina may be absent, or suffer occlusion, so that if the menses are secreted, they cannot find their way out. It may depend on some disease of brain, spinal cord, or blood. A large per- centage of such cases can be rectified either with medical treat- ment or some surgical proceeding. 2. Suppression of Menses.—This is the most common form of amenorrhcea. The flow having appeared, been properly estab- lished for a while, has, from some cause, become suddenly arrested. The front part of the uterus being very profusely supplied with branches of the sympathetic nerve in highly-civilized females, the menses, while on, are liable to cease or stop from violent emotion, grief, anxiety, or from cold, damp, exposure. Instead of ceasing suddenly, as in those cases, it may disappear gradually, returning at the proper time, but becoming less and less, and then entirely stopping. It is liable to cease in acute and chronic disease, as in fevers, blood-disease, especially anaemia, cancer, tuberculosis, albuminuria. In all cases the greatest care should be observed, so as not to overlook pregnancy. The sup- pression is always attended with some constitutional disturbance; great, if sudden ; not so well marked, if slow and gradual. Treatment.—If the case is seen at once during an attack of acute suppression, there should be an effort made to re-establish the flow, by alcoholic vapor-bath, with hot mustard foot-bath ; put to bed between blankets, with hot bricks to feet, and dry heat to vulva or over bladder, consisting of baked bran, or hops, or chamomile flowers, in bags. Aconite, with compound tincture of serpentaria, administered internally, with infusion of pennyroyal; no cold drinks nor ice. If several days have elapsed, it is useless to try the above, or any other means, but begin at once and pre- pare patient for next period. Bowels should be regulated, cloth- ing warm, flannel round waist and hips, warm foot and hip-baths, g DISEASE GERMS. nourishing food. If there is any special disease it should be at- tended to, especially anaemia, with acetate of iron three times daily with cinchona and mineral acids ; and about a week before the expected period, begin with the compound betin pill, one or two three times a day; and if the case is stubborn put mustard plasters on the nipples, for a short time before bedtime, for one or two nights. The compound betin pills excel all drugs in their mildness, efficacy, and certainty; they arouse the inert, sluggish uterus into active life, restore its natural movements, andTmpart tone and vigor ; they are our best emmenagogues, and excel all other drugs in their prompt action. They super- sede entirely those old and deleterious drugs, such as cotton- root, savin, aloes, ergot. As soon as the flow is established they are to be stopped, and resumed the following month about seven days before the expected period. Ladies who suffer from habi- tual suppression, or where the flow is scanty, or who dread early suppression, can maintain menstrual activity for a long length of years, and thus keep the freshness of youth in their nervous sys- tem and skin indefinitely. Of the long list of remedies noticed, there remain caulophyllin and pulsatilla, and of these much can be said of a favorable nature. Caulophyllin, the resinoid pre- pared from caulophyllum thalictroides, known under the various names of squaw root, pappoose root, blue berry, has been recog- nized as a valuable therapeutic agent from very early times, and has been highly spoken of by many physicians of note. Its name, " pappoose root," suggests the uses it was put to by the natives long before the cultured minds of our present physicians investigated its properties and catalogued its claims. There seems to be a general agreement amongst those who have studied its action that its effect is chiefly felt by those motor nerves which are connected sympathetically with the menstrual organs, and that this action is of a sedative character, allaying that irrit- able condition of the generative system which so often lies at the root of functional irregularities. As a remedy in these derange- ments, in " irritable neurotics," especially when they are marked by disturbances in the sacral plexus, it has undoubtedly acquired a sounder reputation than most of its competitors, and deserves a permanent place in the select circle of approved remedies. But its action, although often favorable when administered alone, is much more reliable when given in combination with pulsatilla {anemone pidsatilla, Pasque flower), which has long been known as a popular and effective remedy in uterine functional derange- ments. As pulsatilla increases the beneficial action of caulo- phyllin, so the latter increases the action of the former, and it is, therefore, when they are both combined that we get the most BACTERICIDES. 39 perfect emmenagogue that our present state of knowledge has yet suggested. Indeed, it is not too much to say that this com- pound emmenagogue redeems from the charge of imposture the reputation of its dilapidated class. Vicarious Menstruation may occur as a form of amenorrhcea; that is, the menses may be suppressed at the vaginal orifice, but are thrown off by the nose, mouth, eyes, ears, or blood-stains by the skin, by ulcers or by necrosis, if present, or by odors about umbilicus, or eruptions. The real cause of vicarious menstruation is either inertia or atrophy of the uterus; so great that the uterine wave is abolished or. abrogated. The cure consists in stimulating the uterus with hip-baths, horseback exercise, or moderate walking exercise, the betin pill, massage, iron, pulsatilla, cinchona, and most nourish- ing food. _______ The prolonged retention of urine in the Ammonaemia. bladder over a definite time results in its de- composition, in a change of its constituent elements, the most prominent of which are a fungus and carbon- ate of ammonia, which are taken up into the circulation, produc- ing a special form of blood-poisoning. The retention of the urea and its conversion into carbonate of ammonia give rise to cystitis, a catarrhal and dysenteric state of the bowels, in which a greenish, alkaline, yellow fluid is passed from the bowels, with abundant spores of the fungus. The causes which give rise to this state of fungus growth and decomposition are stricture, en- larged prostate, paralysis or atony of the bladder, pyelitis, sacculated kidney, cystitis, etc. Old or young men, with en- larged prostates are the victims of this malady. It is an affection which can- not be mistaken, even by the most superficial observer: the retention of urine, or, if a drib- bling, its ammoniacal odor, A ., *?. . . . Micrococci Ureae (of ammoniacal urine). .Present alkaline reaction, Containing in cystitis, and is found in great abundance in r i the blood and in all the vital organs of the body, immense amounts OI phOS- jn ammonaemia. phates; the breath and skin are also highly ammoniacal. If no relief is afforded, there are rigors, vomiting, fever, with strong typhoid aspect; tongue dry, brown, shining; complexion sallow, dingy brown ; headache; 40 DISEASE GERMS. insomnia; and, as the blood becomes more crowded with the spores and carbonate of ammonia, insomnia is more persistent; restlessness gives rise to somnolence, lethargy, with low, mutter- ing delirium, with the ammoniacal odor more intense. The most important point in the treatment is the removal of the cause; but as atony of the bladder and enlarged prostate are the common causes, time is needed. The patient must have im- mediate relief, or death will ensue. Relief is best afforded by the introduction of a catheter and draining off of every drop of the ammoniacal urine, subsequently injecting the bladder with a tepid germicidal solution of either boroglyceride or peroxide of hydrogen—if the latter, a few drops to the pint. This proceeding must be resorted to even when the patient seems to be sinking, because the moment the bladder is washed out a rapid improve- ment takes place. The bladder must thus be emptied and washed out daily, and the patient placed upon the proper doses of either peroxide of hydrogen, or ozone water, or comp. oxygen, to neutralize the excess of ammonia present in the blood. Virginia stone crop operates well in alternation with the uric acid solvent; the pichi in that last compound operates in all cases most favorably; they should be used persistently. The enlarged prostate must be got rid of, and till that is effected, the urine must be drawn regularly off. I have found the following formula to be unexcelled to get rid of an enlarged prostate; thus, say about 7 p. m. insert one cocaine suppository ; allow it to remain; before retiring wash out the rectum with about half-a-pint tepid solution of boro- glyceride, which is to be passed off; as soon as that is effected, inject one tablespoonful of the following: Jfy Ozonized distillation of hamamelis, . . 5iv; Papoid,...........grs. xxxii. Mix. This is to be permitted to remain over night. This mixture of ozonized hamamelis and papoid acts energetically upon the effused lymph which, in the process of chronic inflammation, has been effused into the interstitial structure of the prostate. To be effective, it must be applied as above. The cocaine sup- pository produces anaesthesia of the prostate, a state most favor- able for the dissolution or absorption of lymph. Follow it in about two or three hours with the papoid mixture. Peroxide of hydrogen has also been most successful. BACTERICIDES. 41 Or waxy or starchy usurpation of structure, Amyloid De- is a peculiar affection occurring only in indi- generation. viduals who have suffered long from the pre- sence of the microbe of syphilis, the bacilli of tuberculae, the micro-organisms of cancer; prolonged osseous suppuration. This form of degeneration is decidedly an attend- ant upon old sores, wherever there is pus or muco-purulent mat- ter present in the body, as in empyema, chronic bronchitis and pemphigus, malignant variola, dysentery, ulceration of the blad- der, phosphorus necrosis. Besides, amylosis occurs sometimes in chronic gout, rheumatism, malarial poisoning, alcoholism. Although this appears to be the field of origin, still there is some mysterious cause, some terrible wreckage of vital ele- ments, which so degrades or alters the living matter of our own bodies into a disease germ, which in some manner evolves starch granules or molecules; these are carried by the blood through- out the entire body and deposited only in weakened parts and in- crease in bulk by aggregation of molecules. The microbe, which is present in all cases of amylosis, and which is pathogenic of the disease is : The Bacillus Pyocyaneus.—This microbe is present in the blood in all cases, but is most abundant if pus or muco-purulent matter be present, especially if that be of a greenish color. Taken either from pus or blood, it appears in the form of slender rods, linked in twos or threes, or collected in irregular masses, spore formation present and active. Easily cultivated in liquid gelatine, in twenty- four hours the culture has the greenish appearance of pulp. The pigment or coloring principles is " pyocanin." Micrococci can be extracted with chloroform from the pus or washing of bandages—the microbes crystallize in the same fluid in the form of needles, rods, prisms. The injection of this microbe into animals gives rise to amyloid degeneration. The bacillus pyoganeus which gives rise to this species of degen- eration is not a carbo-hydrate, but a nitrogenous body. The heart, spleen, intestines, liver, kidneys are most frequently affected —each one besides may be complicated with the presence of other germs, or the amyloid germ may exist alone. The symptoms of general amyloid degeneration, present noth- ing very distinctive. Great and progressive debility, pale, waxy ap- pearance, inability to get around, urine abundant, of low specific gravity, small amount of albumen, paraglobunuria, hyaline casts. The treatment of amyloid degeneration is not by any means encouraging. The removal of causes is most important as the 42 DISEASE GERMS. destruction of the germs of syphilis, tubercles, cancer—any suppurating focus, by a general alkaline and tonic course—but when the proper structure of an organ is once usurped by starch granules it can never be restored. Amyloid degeneration naturally takes place on the coats of arter- ies, which carry the starchy products in the blood, small arteries, especially the renal glomeruli, also the vessels of the spleen, liver, intestines and lymph gland. Waxy degeneration of the intestine is usually a complication ot waxy kidney and liver. The primary seat of amyloid deposit in the intestines is the arterioles. The small intestines are much more frequently than the large. When it takes place it entirely destroys the secreting faculty of the absorbents, causes the mucous membrane to become pale, shiny and slightly oedema- tous ; on the application of the iodine test, small maroon-colored spots appear in the villi, where the earliest changes occur; later on the entire muscular coat becomes involved, until finally the entire walls of the intestine are fused into one homogeneous mass. G2nerally infiltrated of the solitary glands;' Peyer's patches are less affected than the surrounding tissues. The symptoms of amyloid intestinal degeneration are usually masked with those of waxy liver and kidneys with which it is invariably associated. A general amyloid degeneration of the intestinal tract exerts a potent influence upon the general nutrition of the body—great exhaustion, emaciation, anaemia—a serous, persistent diarrhea are the best points in diagnosis. Amyloid Degeneration of the Spleen.—The causes which give rise to waxy spleen are the same as predispose other organs to it, as the germs of syphilis, tuberculae, cancer, chronic alcoholism, malaria, etc. It is found deposited either through the entire spleen, or in nodules, or granules in large quantities, which causes the enlarge- ment. On cutting the speen, it is crispy, smooth, shining and gives the characteristic reaction to iodine. Late in the disease anorexia, vomiting, hemorrhages. Amyloid Degeneration of the Kidneys.—Chronic intestinal nephritis, invariably precedes starchy deposit in the kidney—it is a weakening process which permits an exudation from the blood, and is effused into all weakened structures simultaneously. The primary causes we have stated. When the deposit takes place in the minute arteries, the secreting tubes and cells soon become involved, waxy products appear on isolated patches, when an increase of size takes place, the kidneys become hard, crispy—the change is most marked in the malpighian tufts. BACTERICIDES. 43 The increase of size is due entirely to the presence of starch bodies, which look like grains of boiled rice. All parts, the glomeruli, arterioles, veins and basement membrane of the tubules become infiltrated. In addition, fatty granular and hyaline bodies are found. However slight or indistinct, the iodine test is most reliable— placed upon the degenerated tufts, it always gives the character- istic iodine reaction. The usual method of the disease making its appearance is as follows: An individual suffering from tuberculae, syphilis, cancer, rheumatism or some suppurative disease, begins to realize that he is losing flesh, strength, becoming weaker, more feeble, loss mental and physical, a general goneness on very slight exertion, short- ness of breath, has a very pallid, waxy countenance and passes a very largely increased amount of urine—being compelled to rise several times during the night in order to pass it and in large quantities ; weight in the upper part of the abdomen, with a gen- eral fulness, with enlarged liver, spleen and kidneys ; oedema at the ankles, indigestion, occasional vomitings. Such a train of symptoms are significant, together with the altered, pale, waxy complexion. The usual increase in the quantity of urine is up to about ioo ounces, with a very low specific gravity of 1005. Very little dropsy. The nephritic trouble is simply an emunctory of the body weakened; anatomical changes due to a usurpation of the structure of a gland by starch. Recovery is impossible. It may be arrested, retarded, but never cured. Our best remedies consist in a general alterative and tonic course, pushing special remedies, such as the iodide of potassium, iron and nux vomica. Amyloid Degeneration of the Heart.—Waxy degeneration is never met with except in connection with similar changes in other organs of the body, and is invariably due to a constitutional cause; it consists in the formation of a shining homogeneous sub- stance in the primitive muscular fibres, which gives the reaction of amyloid material. It is most frequently met with in the walls of the right ventricle, causing its cut surface to present the char- acteristic appearance of waxy metamorphosis. The primary changes take place in the connective tissue surrounding the mus- cle-bundles. The presence of the syphilitic germ is the primary cause. The principle symptoms attending it are cardiac failure, with waxy degeneration of" other organs, as the liver and spleen. Cardiac failure, with a syphilitic taint, affords good reason to suspect starchy degeneration. 44 DISEASE CERMS. The treatment, a general alterative and tonic course, with strophanthus, convallaria and other remedies to strengthen the heart. Amyloid Degeneration of the Liver.—Seventy-five per cent, of all cases of waxy liver occur in males between 30 and 50. The presence of the microbe of syphilis in the interstitial structure of the liver is undoubtedly the chief cause. Malarial germ saturation of the liver is also a very prominent cause, as well as prolonged suppuration of bone and the micro-organism of tubercle in lung. The degenerative process begins in the walls of the capillaries and minute arteries. The microbe causing the pecular blood changes gives rise to the deposit of a substance resembling albu- men in its reaction. Its reaction is characteristic, a watery solu- tion of iodine changing it to a deep red-brown. The liver is always enlarged, hard, like a stone, non-elastic, and its substance some- what heavier than normal. The liver cuts with a creaking sound, like bacon, hence the name lardaceous is applied to it. Its advent is never well defined—rather obscure—occurring as it almost invariably does with other wasting diseases of the body. A sense of weight, fulness and constriction in the right hypochon- drium, never amounting to pain, great discomfort; jaundice, ascites ;ire not essential symptoms. When jaundice is present, it is due to an intermittent catarrh of the bile ducts. Later on in the dis- ease, diarrhea and vomiting on the slightest irregularity in diet. Anaemia and progressive debility are ever present. There is a great increase in the white corpuscles of the blood—the patient has a peculiar waxy look and peculiar odor; faeces are pale, they do not contain any bile. The urine is highly albuminous, of a lower specific gravity, increased in quantity. These urinary symptoms increase as the disease advances. There is a bulging of the hepatic and splenic regions, the area of dulness of both being greatly increased. The prognosis in all cases is most unfavorable; it has no exact duration, but usually merges onward to a fatal termi- nation. General principles of treatment are strict attention to warm dottiing, general hygienic surroundings, daily baths of iodine and ammonia are of importance, followed by massage. A most gen- erous diet; but in all cases forbid saccharine, starchy and alcoholic 0l0f ?k" Vegetablctonics such as hydrastis, salix niger, STL I ° marticana, cinchonia. Preparations of iodine shouL?h?Cr,? ' *?a arG lnY;ariably of the greatest utility. These should be alternated with the chloride of ammonia, which always produces most salutarv results. y BACTERICIDES. 45 Dropsy of the cellular tissue is the most striking Anasarca, symptom of chronic interstitial nephritis, and one which very naturally attracts the attention of the patient. It is common in both the large white as well as the con- tracting kidney. It seldom makes a decided appearance until the hypertrophied heart breaks down, when it appears with other signs of collapse of the whole body. It is first seen in a bagging oelow the eyes in the mornings, then in the legs and ankles, latterly higher up, indicating a failure of the heart to maintain the struggle any longer. The dropsy of the cellular tissue is due in a great measure to obstruction in the kidneys, although in every case there is a decided heart failure. A breaking down of the kidney, and heart failure ; in addition, there invariably exists a watery state of the blood, accompanied with increased permeability of the capillaries, caused by the pres- ence of urea, an acid toxic, in the blood. (See Dropsy.) Poverty of the Blood.—A condition in which the Anaemia, red corpuscles are diminished or reduced to eighty, sixty or even lower than forty to the one thousand parts, instead of one hundred and thirty, which is the healthy standard. The liquor sanguinis is also poor in albumen, but may contain an excess of salts. The common causes are poor food, over-work, absence of sunlight, deleterious trades, as operations in lead, mercury, phosphorus, the fumes of which are powerful agents in impoverishing the blood ; disease, hemorrhages, drUgS, Red Corpuscles as seen in normal atrophy of gastric glands, defective assi- milation, lack of fresh air and muscular activity, malignant dis- ease, imperfect nutrition and impaired sanguinification, excessive loss or drain of vital secretions, excesses, passions, mental shocks, and it may be due to parasites, as the trichinae, taenia, and other micro-organisms that find their way into the alimentary canal by food and water. The Ordinary Symptoms of anaemia are great debility, pallor, blanched appearance of skin and mucous membrane, loss of appe- tite, in some cases with an intolerance of food, often nausea and vomiting, constipation or diarrhea. As a rule, in the earlier stages of the disease the breathing is quiet, only on exertion, which produces marked breathlessness; but in the advanced 46 DISEASE GERMS. sta^e we have great difficulty in breathing. Attacks of syncope or fainting fits are liable to occur, but not so frequent as one would expect; the action of the heart is generally regular and quick often very feeble; the impulse is often widely visible, undulating and thrilling ; the area of cardiac dulness is increas- ing laterally, due either to dilatation of the heart or retraction of the lung. Aortic and pulmonary systolic murmurs, with palpi- tation of the large arteries of the neck, often visibly pulsate and are the seat of local murmurs. The jugular hum is seldom ab- sent, and pulsation of the jugular vein is often observed. The pulse is soft and compressible, quick, jerking, empty. There may be enlargement of the thyroid, protuberance of eyeballs, with vertigo and nausea, volitantes or specks or spots before the eyes, albumen in urine, oedema and dropsical effusions into the chest, pericardium, peritoneum and cellular tissue; amenorrhcea; occasionally fatal syncope, coma. There is'usually no enlargement of either liver, spleen or lym- phatics, and albuminuria is slight and transient. As the disease is often due to hemorrhage, epistaxis, haemop- tysis, menorrhagia, haematuria, we are liable during an attack to have a recurrence which should be guarded against; but in the sanguine or hemorrhagic diathesis, this is so persistent that it is liable to occur even in the retina of the eye, being most abundant around the optic nerve entrance. It is frequently associated with white spots and areas due in part to leucocyte-like cells, in part to degeneration of retinal tissue. Slight febrile symptoms are the rule. Amemia is often divided into simple and pernicious, the latter term being applied to it when due to bad food, conjoined with pregnancy or lactation, or repeated pregnancies, or digestive or intestinal disorders. Malarial influences in the production of haematuria give us the best and most common illustration of per- nicious anaemia. It is not well to call the profound blood change that is set up by direct nervous shock, fright, grief, very perni- cious, as it is a factor of simple anaemia. The cause for anaemia should be sought for in two directions, diminished activity of blood formation, or excess of activity in blood destruction. The degree to which the haemoglobin may be diminished without being fatal, is about one-fifth of its normal quantity. After the blood is drawn we observe irregular massing of corpus- cles into pear-shaped, biscuit-shaped or globular forms, and the coloring matter accumulating in the corpuscle at one point, indi- cating a greater proneness to form changes in healthy blood. At the same time can be seen small fragments of corpuscular matter, evidence of the disintegration of the corpuscles. BACTERICIDES. 47 In our diagnosis of anaemia neither the spleen, nor lymphatic system is to show any evidence of change ; if they do, then it may come under another head. The theory of the blood formation of the bone marrow has not been sustained. The alterations in the blood and marrow in the form of altered corpuscles are met with in cancer, and they seem to be dependent on the cachectic state rather than the cause of it, and not in anaemia. There are three other blood diseases that bear a close resem- blance and analogy to anaemia—a resemblance due to the factor common to all of them : the diminution of the oxygen-carriers of the blood. In anaemia, a decrease of red corpuscles ; in chlorosis, an imperfect evolution of the blood; in leucocythaemia, an increased production of white corpuscles and an incomplete conversion of them into red; in pseudo-leucocythaemia there is deficient formation of red corpuscles; in leucocythaemia, hyper- trophy of spleen almost invariably present; in pseudo-leucocy- thaemia, the lymphatic system greatly infiltrated. Chlorosis is essentially a disease of nervous origin ; centres of life are depressed, hence the process of cure is slow but pro- gressive. In the treatment of anaemia general principles must be ob- served as to the removal of cause, enjoining quietness or rest in recumbent posture, attention to clothing and secretions, abund- ance of fresh air and sunlight. The true aim in treatment is to introduce, as quickly as assimilation will take it up, the most nutritious food with mineral acids, iron, cinchona and other tonics. The nourishing diet embraces milk, raw eggs, restora- tive soup, raw beef, essence of beef, blood, fish, poultry, roast beef and mutton, at stated intervals with pepsin if digestion is feeble. Our best remedies are those that increase blood formation most rapidly. Aromatic sulphuric acid and sulphate of quinine : one ounce of the former to thirty grains of the latter. Dose— fifteen to twenty drops thrice daily in water; or compound tinc- ture cinchona and simple syrup, of each two ounces ; to which add two drachms of muriatic acid.—Mix. Dose—a teaspoonful thrice daily in water. The greatest possible benefit is derived from peroxide of hydrogen in anaemia, it acts as a scavenger to the blood, it is a life-giving element, oxygenizes every tissue, increases the red discs. Benefit will be derived from iron, provided it does not cause irritation or fever, or provoke constipation, the acetate or muri- ated tinctures or iron by hydrogen. To prepare the acetated tincture, take a pound of lath nails and cover with good strong, sharp cider vinegar, or dilute acetic acid ; s DISEASE GERMS. steep for ten days, then strain. Dose-Half a teaspoonful in a glass of water three times in twenty-four hours, or fifteen drops Sf the muriated tincture in the same quantity of water, and as frequent. Iron by hydrogen operates well in the following com- bination: . . , .. ., . , Iron by hydrogen, thirty grains; sulphate of hydrastin, thirty -rains; sulphate of quinine, twenty grains; sold extract nux vomica, eight grains.—Mix. Make thirty pills. One every four hours. In administering those remedies, select one preparation of iron to one of tonic ; give each every four hours, two hours apart. Open bowels with nutritive enemata or suppositories. As the patient progresses to recovery glycerite of ozone should be given, as it supplies deficiencies in the blood. It is an invaluable remedy in anaemia—aids powerfully in the restora- tion of the devitalized fluid to its normal constituency. When recovery takes place, a change of air to the sea shore is good, fresh food if available, is judicious. The term anchylosis signifies a fusion or Anchylosis, union of the ends of bones in a joint, in which lymph, one of the products of inflammation, has been effused and become organized either into ligament or bone. This naturally divides it into two forms, true and false, the former in which the effused lymph has become thoroughly organized into bone; the latter in which it is simply ligamentous. Bone or ligament, neither tissue in a joint being of original formation, nor so vital, is capable of absorption with modern remedies, and the aversion existing among a very large percent- age of physicians against interfering with stiff or anchylosed joints is removed. The precaution of removing the urate of soda or uric acid from the blood by the uric acid solvent should always be observed, as it is not desirable to have either of those agents liberated in the joint during treatment. It has been demonstrated in thousands of cases that ozonized clay will excite and procure absorption of all adventitious matter in the form of fibrous tissue, that class of tumors in the breast, stomach, bowels, ovaries. The action of the ozonized clay made into a poultice with cold spring water, and applied to either a true or spuriously anchy- losed joint is destructive to the inherent elements of the lymph in whatever state it may be; has marvellous power of absorption of the disintegrating mass, and its prompt elimination from the body. BACTERICIDES. 49 It acts by endosmosis, penetrates right to the mass, and will cause the lymph to gradually disappear. The peculiar faculty in effecting this is, that the clay must pro- duce no irritation, no pain, no redness of the cutaneous surface. It must be applied daily, and as it is very hydroscopic, will not retain its ozone very long unless in a dry state; it is best to mix a little, what is to be used at one time. There are numerous old cases in which bony union is perfect —joint immovable; on these the clay will act well in diminishing the calibre of the effused products, but on the phosphate of lime it exercises no chemical action, hence in true anchylosis, forced rupture, a breaking up of organized products is often necessary. The more general use of one of nature's products will speedily rid us of a class of deformity very common. It is well to bear in mind in the management of all cases of anchylosis that the secre- tion of synovia is much augmented by increased nutrition of the brain, so that in all cases, while guarding against the formation of uric acid, the vital elements of brain nutrition should be stimu- lated with oats, kephaline, etc. A swelling, pouch, sac or tumor, caused by the Aneurism, dilatation of the coats of an artery. It may em- brace one or all the three coats of the vessel, and may extend a long distance. When all the coats of an artery are dilated, but not ruptured, it is called a true aneurism. Dilatation, with rupture of one or more coats, constitutes a false aneurism. The internal and middle coats are frequently ruptured or removed in patches by the detachment of foreign particles or the burrow- ing of disease-germs; the blood then comes in contact with the external cellular sheath, dilating it into a pouch or sac. The ex- ternal wall of the tumor in this case condenses, acquires a cover- ing by effused lymph, and becomes thick; and if the patient enjoys average health, the sac will become very firm. The divi- sion or rupture or tear of an artery may result in extravasation of blood into the areolar tissue, and thus form a diffused aneurism. Varicose aneurism can only happen when a vein runs over an artery, as when the brachial is punctured in opening a vein. The blood rushes into the vein, rendering it varicose; naevus, or aneurism by anastomosis, so common on the heads of children. Causes.—The absence of support, inherent weakness of or- ganization, a weakened or diseased state of the walls of blood- vessels, the deposit of morbid matter in the blood on the walls of an artery, as particles of starch, fat, calcarea, tubercle, and these, being washed away by the current of the circulation, leave the 4 5Q DISEASE GERMS. spot to which they adhered weak or ulcerated, and impair the elasticity and vital power of resistance of the vessel; when, if the circulation is excited by mental or physical exertion, as cough- ing, straining, lifting, hoisting, pulling, rowing, jumping, the force of the circulation presses heavily on the weakened part, and a bulging or aneurismal sac is formed. Morbid states of blood are favorable for aneurismal tumors. If they arise from local violence, they are called traumatic, and spontaneous when they arise without local injury—a distinction of no moment. Symptoms.—A sac, pouch, swelling or tumor, pulsating syn- chronously with the action of the heart, located over an artery, which, when equally compressed, is emptied of its contents, and when pressure is removed the blood rushes in with a whirring sound. They tend to increase in size, and if near the heart give rise to different morbid states of that organ. Treatment.—Men, from their more laborious mode of life, are more obnoxious to aneurisms than females, and are better sub- jects for a spontaneous cure by coagulation, as their blood con- tains more fibrin and a much greater percentage of red corpuscles than women. We shall briefly enumerate the various methods of treatment before speaking of nature's method. A ligature applied to the main trunk of an artery cuts off the circulation, the pulsation in the sac at once ceases, a coagulum is formed, which, if vital force is good, is gradually absorbed, and the whole mass degenerates into an impervious cord, the circula- tion being carried on by the collateral branches. This may all look well, but if there is disease of the artery, as there often is, a union of its internal coats may not take place, and when the ligature sloughs off in one or two weeks, secondary hemorrhage and death ensue; besides, it is only on the thigh in Scarpia's tri- angle, or in the arm over the brachial or about the head that it can be applied. It is not adapted for the internal forms which are so common. Pressure, where it can be applied, is of great efficacy in dimin- ishing the flow through the sac. It gives the fibrin of the blood a chance to coalesce and cause coagulation, which is ultimately absorbed. Electricity, applied by means of several needles in- serted into the aneurism, produces instantaneous coagulation of its contents. It is best adapted to small tumors. Nature's method is the best. Fibnnize the blood, restrain the circulation, and coagulation is certain. Begin by the administra- tion of a rich animalized diet, beef, eggs, milk, cream. Improve the digestive organs and increase fibrin in blood with nitro- munatic acid and compound tincture cinchona, or aromatic sul- phuric acid and quinine. After a few weeks, enjoin absolute rest BACTERICIDES. 51 of mind and body, and put patient on digitalis to keep pulse at sixty, steady. Fresh, rich food, no alkalies; do not use acon- ite^ or veratrum viride, or belladonna, for however valuable their action on the heart may be they keep up fluidity of blood. After the pulse has been kept at sixty, under care of a skilled nurse, for one week, use either ergot or carbolic acid internally for about a week, and coagulation of contents of the sac is almost certain. Under such treatment patient must retain the recumbent position, as that slows the heart's action about twelve per minute. The digitalis must be administered in from eight to fifteen drops in water, every three hours, never permitting contractions to ex- ceed sixty. This drug not only slows the heart, but contracts or astringes the heart, arteries and veins; their calibre is smaller, and the tendency is for the blood, if rich enough, to clot in hollow organs, as the aneurism. This clotting begins on the walls of the aneurism and gradually merges to the centre until a clot forms. The ergot or carbolic acid must be very carefully watched, and discontinued if any bad feelings are experienced about the heart. Of all methods this is the best. Aneurism of the heart is found in two Aneurism, Cardiac, forms : 1. The acute variety depends on a laceration of the endocardium and muscular tissue, through which the blood passes to form a pouch. In this pouch fibrin is de- posited, while at its entrance is a fringed margin with vegetations attached. 2. The chronic form results from some inflammatory condition of muscular fibre or endocardium. Walls of sac consist of endo- cardial and pericardial membranes unbroken, while the muscular fibre seems to be replaced by a fibroid tissue. Either kind gives rise to obscure and uncertain symptoms; passage of blood into sac may cause a murmur. Death usually occurs suddenly from rupture. Aneurism of coronary arteries is not infrequent. The symptoms of this form of Aneurism of Thoracic aneurism are often obscure in their Aorta. early stages, bearing a strong resem- blance to disease of the heart. If the aneurismal tumor be large and is developed quickly, there is disturbed action of the heart, with some modification of radial pulse; dulness on percussion around portion of vessel from which 52 DISEASE GERMS. aneurism springs; cough, wheezing, difficulty of breathing, spit- ting of blood, difficulty and pain about back and chest, superficial veins of chest and neck swollen. If the aneurismal tumor be- comes very large and pulsating, rises out of the chest, producing protrusion of sternum and ribs, then the diagnosis is easy. If the aneurism presses upon the trachea, there is difficulty of breath- ing and cough ; when on one or both recurrent laryngeal nerves, aphonia, with troublesome cough, severe paroxysms of laryngeal suffocation, pain coming on at intervals; when on oesophagus, symptoms of difficulty of swallowing, engorgement of absorbent vessels and glands, inanition and symptoms of stricture. If the aneurism is in the ascending, near the heart, the patient suffers from angina pectoris, resulting from pressure on the plexus of nerves ramifying on each side of the aorta and communicating freely with the cardiac ganglia and plexuses of the ventricles. Contraction or dilatation of pupil on the affected side, accord- ing as pressure is sufficient to irritate or paralyze branches of sympathetic nerve. Often blowing murmurs can be detected. If the heart be compressed by a tumor, so as to impede the action of the valves, a systolic or diastolic murmur will result. Pressure on aorta or on pulmonary artery may produce a murmur. In false aneurism there is generally a murmur both with entrance and exit of blood into the sac; or there may be one loud and rasping murmur from the passage of blood over the roughened inner sur- face of the vessel. In true aneurism, or the mere dilatation of a part of the wall, murmurs seldom audible. Even a small open- ing into the canal of an artery into aneurismal sac, and a rough- ened state of the arterial tunics from degeneration, will give rise to a murmur. A peculiar thrilling or purring tremor is often felt over the sternum.. The termination may be death from rupture externally, or into pericardium, or into the pleural cavity, or into the trachea, or into the bronchial tube ; or the patient may die from exhaustion consequent upon long-continued suffering, or there may be a fatal destructive inflammation of lung, owing to the compression of pulmonary vessels or pressure on pneumogastric. Very common in ladies from Aneurism of Abdominal falls, lifts, strains and bearing Aorta. down efforts in labor. Patient describes it as a feeling as if something had given way; most generally met with just behind stomach. It exists from a mere distension of the descending aorta to a large sac; machinists, especially those pulling long heavy bars of steel, are common sufferers. BACTERICIDES. 53 Empty the bowels ; see the patients before they partake of food ; lay them on back, knees drawn up, and the tumor can be easily made out. If large enough to interfere with the vermicular move- ments of the stomach, the case is not so favorable for a cure. If that organ be undisturbed, treatment will soon do its work in effecting a speedy cure. In aneurism in chest or abdomen all bodily and mental excite- ment must be avoided, all prominent symptoms alleviated; gen- erous, reparative diet to be allowed; not over one pint of fluid to be used per day; great attention to the secreting and excreting functions, and in the abdominal, the method of treatment by slowing the heart and fibrinizing the blood resorted to. Aneurism by anastomosis, or mother's mark, afor- Aneurism mation of .dilated arteries, veins or capillaries. or Arterial Xcevi, met with most commonly in Naevus. infancy and youth. The diseased vessels become enlarged, elongated and tortuous, forming tumor variable in size, irregular in shape, spongy, compressible and pulsating—a murmur being audible. Venous Ncevi give rise to irregular tumors of a purple color, which feel doughy, and are diminished in size by pressure. Capillary N&vi are most common; for the most part they are congenital, begin usually as a red or purplish spot, which gradually spreads. They are generally met with on the scalp, or face or neck ; rarely on other parts, and involve skin or subcutaneous parts, and of all sizes, from a strawberry up. Treatment.—When very small and producing no disfigurement, and not increasing in size, they are best left alone, as nature often effects a spontaneous cure by a coagulation and absorption of their contents. There are several methods of treatment, a removal by the knife, or ligature, which is rarely advisable; destruction with caustics, as brushing it over with ethiate of sodium, or nitric acid, or super- phosphate of zinc; electrolysis and coagulation of blood by gal- vanism, or in the application of remedies to excite adhesive in- flammation, as injecting with perchloride of iron, or vaccination with croton oil, or painting with collodion and tannic acid, paint- ing with tincture of iodine. ______ Cardiac neuralgia, or as some term it Angina Pectoris, cardiac epilepsy, from the fact that some cases are accompanied with a warning, a partial death of the cardiac nerves, in which severe intermittent 54 DISEASE GERMS. pain is felt about the heart, with a sense of strangulation and a feeling of impending death, or it is a neurosis due to organic change in the nerves ; occurs most frequently in advanced life; more common in men than women. It seems to be associated with ossification of the coronary arteries and fatty degeneration. The cardiac nerves are specially involved in cases of ossification of the coronary arteries, as they are in such close proximity throughout their whole course, for these nerves not only accom- pany the arterial trunks, but pass into the muscular parietes of the heart along with the coronary vessels; for nervous filaments can be traced as far as the third or fourth subdivision of the arter- ies ; here we lose sight of them, even in the largest animals. The pain radiates or shoots through the connection of the cardiac plexus with the spinal to the brachial and cervical plexus. Causes.—Disease of the brain, morbid states of blood, stimu- lants, tea, whiskey, tobacco, sexual excesses, mental excite- ment, heart starvation from impure blood, defect in organs of diges- tion and assimilation, mal-assimilation, heart badly nourished, over-exertion, mental or physical, loss of sleep, liver working sluggishly, brain under-fed, the weakened nerves of heart poi- soned by products of mal-nutrition or disease-germs, as syphilis; the waste-laden or disease-germ blood produces spasm, worry, struggle for existence, etc. It is intimately associated with gout; albuminuria, diabetes and hepatic disorder. Synnptoms.^GzvizxdWy the first attack comes on after ascending some slight acclivity, or making some slight exertion, or after a meal. It comes on with a sudden seizure of excruciating pain in the heart, shooting from the breast-bone to back, often accom- panied by a feeling of constriction in the chest as if grasped by a vise. The pain is localized, still, it may shoot toward the shoulder, down the left or both arms, even down to the lumbar nerves. This brings the patient to a stand-still; he fears to breathe, but if he chooses to breathe he can do so freely enough ; he feels a sen- sation as if of impending death,and a ghastly paleness overspreads his countenance. The pulse may be regular, or it may intermit or stop, or be feeble and irregular. After a few minutes pain suddenly ceases, and the patient is well, but dreads another attack or recurrence. At first there is often no lung difficulty, as asthma or emphysema or dyspepsia ; it seems to be brought about by some trifling exertion, some emotional excitement of heart's ac- tion, but as it progresses it does not seem necessary to require an exciting cause, as it will come on when he is asleep, the patient waking up in a paroxysm of anginous pain—a pain so excruciat- ing and commanding that no words can express its intensity; it is appalling; it unnerves the strongest mind, and death would BACTERICIDES. 55 seem to be preferable to such suffering. The sudden violent pain produces sickness, faintness, depression of heart's action, pale and anxious countenance, coldness, cold, clammy sweat. As the struggle passes off patient regains his usual health, often appears quite well. Whatever produces depression in the function of the fibres coming from the posterior roots of a spinal nerve, and as its result pain or neuralgia, produces also depression of function of motor fibres coming from the anterior root of the same nerve, and as its result sub-paralysis of the parts to which it is distributed. Hence we have in angina pectoris two distinct sources of depres- sion of the cardiac action ; (i) we have the most depressing effect of a pain, the most acute and severe that the human body can ex- perience ; and (2) we have the action on the cardiac motor gan- glia of the same .pause which, acting on sensitive nerves, gives rise to this excruciating agony; for we cannot suppose that the de- pression of motor is any less than the sensitive ones; that is, that the epileptic paralysis of motion bears a relation to the acute- ness of the pain, which is the index of the depression of the nerves of sensation. Should death take place as the result of an attack, the heart will be found flabby, uncontracted, due to inhibitory paralysis. Death is not due to spasm, for if it was it would be instantaneous ; whereas, it is gradual, a progressive lowering of the heart's action, becoming feebler and feebler until it ceases to beat. The main theories that have been advanced to explain the phe- nomena of the seizure are, spasm of the heart, depression of car- diac plexus, dilatation of heart, and ossification of coronary arter- ies. Pain is a symptom of variable significance here; it is always intense, arising and ceasing suddenly, and accompanied with a feeling of approaching death. Angina pectoris has no relation to fatty degeneration, in which there are faintings, cardiac asthma, feebleness of the pulse or of the cardiac impulse, with yellowness or pastiness of the com- plexion, and an arcus senilis. Treatment.—This resolves itself into two distinct divisions—dur- ing the fit and intermission. During the fit our measures are but palliative, but much more ample than what our forefathers possessed. They had only the use of external stimulants and narcotics—vain hope where minutes are precious. Modern discovery has changed all this. We now have remedies that can be administered by in- halation or hypodermic injection, that can give the patient instant relief of that terrible pain. Foremost among all our modern appliances for this dreadful breast pang, we place nitrate of amyl, a drug of great power, a volatile narcotic. To obtain a satisfactory result it must be fresh ; 56 DISEASE GERMS. not kept in bottles, but in hermetically sealed capsules or pearls, a dose ranging from three to eight drops in each, opened dropped on a piece of lint and inhaled. It is perfectly safe, and may be entrusted to the patient with the certainty that he will not injure himself by its use. It gives immediate relief, alleviates and re- moves the pain. It flushes the face, quickens the pulse and lowers the blood pressure on the heart. If the nitrate is not procurable, or fails on account of its properties being lost in bottles, let the patient inhale a few drops of chloroform, and just as it begins to narcotize, inject hypodermically one-quarter of a grain of sulphate of morphia, so as to have the patient pass from the chloroform sleep into the morphia sleep, from which the patient will wake up in about eight hours, free from pain, but exhausted. Is there no danger from chloroform in fatty or flabby heart ? No, not if carried to the point we desire. Nearly all cases of fatty or flabby heart are due to heart starvation, and are benefited by such a stimulant if car- ried to a certain point, just its slightest effect, from which the morphia at once reacts. No diseased condition need deter the careful and cautious use of the remedy. In reckless hands it is not safe, but with care it is all right. Angina is such a depress- ing disease that we need perfect narcotism of the nerve centres through which the action takes place—a perfect setting free from all depressing influences. Ether is also excellent, but not rapid enough in its action. Nitro-glycerine gives the most complete relief in angina; one to two drops of a one-per-cent. solution in serious cases gives the most complete relief from pain. Administer in water, and con- tinue during the intermission thrice daily, increasing the dose to eight drops. It lessens the attacks, breaks their frequency and force. Lobelia, sambul, and other antispasmodics are of little utility. However satisfactory our treatment may be with some of the above or other remedies during the paroxysm, it is during the intermission that the most striking results are to be obtained. Dur- ing that period the most strenuous efforts must be made to improve the patient's general health, and especially to tone up his heart; avoidance of cold, damp, strong exercise, walking after meals, sexual intercourse and mental excitement; rest, warmth in open air, driving or sitting is to be recommended. His diet must be regulated, to consist of the blandest, most nutritious and unstimulating foods, as broiled beefsteak, boiled fish, eggs, milk, cream; avoid everything difficult of digestion, or that will give rise to flatulence, or stimulate and thereby weaken the heart. Prohibit tobacco, tea, whiskey, etc. The whole sys- BACTERICIDES. 57 tern must be attended to. Mild laxatives; an active skin by sponging and friction. A healthy stomach and liver does much to improve the tone of the heart, but a healthy brain and pure blood will aid more. The irritating plaster, two pieces an inch square, or else repeated small blisters, of undoubted efficacy. A very persevering course of vegetable alteratives and tonics should be resorted to, as phytolacca and iodide of potassa, stil- lingia and iodide of sodium ; mineral acids and cinchona, qui- nine and iron. Either the irritating plaster or belladonna plaster to be worn constantly over the heart; the former is preferred; some are partial to the latter. While pursuing an alterative and tonic course, changing remedies weekly, and keeping two open sores at nape of neck freely discharging, then a special class of remedies are to be given to improve the faulty nutrition of the heart. We shall enumerate a few of those remarkable drugs: digitalis, arsenic, sulphur, quinine, phosphate of iron, nux vomica. Digitalis in small doses, not exceeding four drops of the tincture thrice daily, is invaluable in promoting the nutrition of the heart. Fowler's solution, in four-drop doses after meals, is invaluable in cardiac neuralgia and weak heart, being a special tonic to the nerves of the heart. Quinine, iron, hydrastin and nux increase the nerve nutrition, render them less liable to pain, and are especially valu- able in all cardiac neuroses. More recently cases have been most successfully treated with sulphate of sparteine and strophanthus. Domestic animals, as the cow, horse, sheep, goat, Anthrax, camels, poultry, etc., like man, if placed in a condi- tion adverse to their vitality, are liable to have the primary elements of their nutrition degraded, changed or altered into a disease germ, a giant form of bacteria, which, either in their own bodies, or if communicated to man, have wondrous power of growth and reproduction in the blood. The bacillus anthrax is peculiar to cattle, and may be com- municated either by close contact, food or water, or otherwise, from one species to another, during which the microbe acquires an intensity, virulence and activity which is typically fatal to life. Its migration from animals to man is attended with most fatal results. The micro-organism is so very tenacious of life that it will live for centuries in the wool, hair, hides, dried flesh, or blood of the affected animals. The causes are adverse states, as ex- posure, insanitary conditions, over-crowding, bad, meagre food, neglect; essentially contagious and infectious. 58 DISEASE GERMS. Anthrax may attack man in three different ways—malignant pustule, anthrax oedema, and internal anthrax. The malignant pustule is usually the result of inoculation, and is most frequently met with on the hands, arms, face and neck, or some exposed part of the body, and commences as a small red point or pimple, which may be painless or attended with a sting- ing sensation like that of a wasp-sting. A small papule speedily forms, which becomes covered by a flat vesicle which enlarges and usually bursts, discharging a clear bloody fluid ; a central black eschar forms at the base of the discharged vesicle, and a crop of other smaller vesicles form around it. The surrounding tissue becomes inflamed, so that the vesicle is seated on a hard base, with a sort of erysipelatous blush and swelling extending for a considerable distance. The central eschar enlarges, and the corona of vesicles, as well as the inflammatory sore, enlarges, and the oedema becomes quite great, so much so that if seated on the face, the head, neck, and shoulders become involved in the general doughy swelling. The lymphatics of the neck are seriously involved. If the patient weathers the crisis, the central slough separates and the wound granulates and heals. The constitutional symptoms are those of a malignant poison, —rigors, high fever, nausea, vomiting, prostration, sleeplessness, labored breathing, exhaustion and delirium. Death may occur early or not for several days. Internal anthrax is as rapidly fatal with or without internal lesions. It is usually brought about by the bacteria giant cells finding their way into the blood by the air, food and water. Lesions, or rather colonies, of the micro-organisms are found in the bowels, liver, spleen, brain and blood. The symptoms of the internal are prostration, vomiting, dys- phagia, pain, uneasiness in abdomen, colic and diarrhoea, the latter often bloody from the first; collapse and cyanosis. Death is often quick. The symptoms of the form without internal or external lesions are those of extreme prostration and malignancy. After death in any of the forms the blood is found filled with large bacteria. Thrombosis of blood-vessels bv masses of bacilli,' not uncommonly an artery or vein being filled with a clot or plug loaded with germs. The recognition of anthrax is often difficult and obscure, unless we have a good history, as a wool-sorter, butcher, tanner, or hair or wool operative, or an attendant upon diseased cattle, or drink- ing water into which the refuse of an alpaca, or mohair, or tan factory empties, or is close bv. BACTERICIDES. 59 The prevention of anthrax among our domestic animals is of national importance,—the mode is simply good food and care, an avoidance of overcrowding, and all insanitary states, abundance of pure water, cleanliness, ventilation, etc. The blood of all suspected cases of anthrax should be at once examined, and if there are present in that fluid stiff and long rods as seen in the annexed diagram, _ ^ and those rods multiply by divi- v Q j'^' q _©,_§' h sion of spores and grow into long, ^-P-j' j^ Q®*~ ^ Qs <£> homogeneous looking, straight or MDCS-'J. © $ '' Q/^'T®® twisted filaments, then our diag- ^~"v 0-,. ®,' 0^'G _ nosis is positive, as the germ is q © n\®j& & ® ~&~~(?\ ^ & pathogenitic of the disease. To q0»^ j^ qV^Pq^ aid this the spleen is usually large, *vj Q © $\J? * « X!?^-^__±!r'Q 0/; in its pustular form in a factory in -'~/''q £> ® (b pTf_ * which wool is used, or alpaca, mo- £?',^) -5 GK^ " » »Q hair, or the fleeces of our own Bacillus Anthrax as seen in the blood of a domestic animals who have died wool-sorter. from the disease. If the serum or any exudation from the pustule is placed in the field of the microscope it will give us the annexed appearance. Bacillus anthrax, the degraded bioplasm of cattle changed under adverse circumstances into a giant bacteria, give rise to splenic fever, cattle plague, malignant pustule, wool-sorter's disease. A thorough knowledge of this bacillus is of the greatest importance to the human race. Its morphological and bio- logical characteristics have been thoroughly worked out. It is one of the best of all mi- crobes to study out, to cultivate, and give one v#"~ an appreciation of germ evolution. BthfPu^0fhaXpuSstuTenon The bacillus anthrax will grow in a nutrient the hand of a wooi-soner. fluid at almost any temperature ; besides, it will grow in water and cast off spores, which become permanent seeds. The effusions, effluvia from mouth and nostrils of affected animals, being germ-laden in a pasture field where decaying animal and vegetable matter affords nutrition, the bacillus will grow on the surface of the soil. The treatment of anthrax must be highly germicidal, and carried out according to the indications present; no time for experimenting, as it runs its course with amazing rapidity. If there be fever, antifibrine, in sufficient doses to equalize circulation. Peroxide of hydrogen is a remedy of rare value, administered 6o DISEASE GERMS. every two hours in alternation with 15-grain doses of resorcin. These two remedies seem to be capable of annihilating the germ; and, to the pustules on the hands, face, or elsewhere, a paste made of either iodol or resorcin with an equal quantity of ozone ointment. If a good preparation of peroxide of hydrogen is not obtainable, then some of the following remedies should be used: Con. ozone, in 15 drop doses, alternated with 15 grains of re- sorcin every two hours respectively. Concentrated ozone, two ounces ; chloroform, one ounce. Mix. Keep constantly applied over spleen. Concentrated tincture of kurchicine is a remarkable germicide in anthrax, kills the microbes, and virtually grasps the patient from the abyss of death. It must be administered in precisely the same manner as in malignant malaria—not a drop of water given till the drug has done its work, which will be known by an ex- tremely profuse, fetid sweat, prostration, when beef tea and brandy must be freely given. Mysteriously strange, obscure, sudden death, occurring in the families of woolen operatives, tanners, alpaca and mohair sorters, should in all cases be regarded with extreme suspicion, and the slightest evidence of indisposition on their part promptly at- tended to. Loss of the cerebral faculty of speech and of Aphasia, the power of expressing thoughts by writing or gesture. A simultaneous loss, in a greater or less degree, of the memory of words or acts, by means of which words are articulated, and also of intelligence. That transitory form so common in the recovery from fevers, typhoid and diphtheria, due to congestion or anaemia, from which recovery always takes place, is not what we desire to notice; it is the form that is permanent and due to softening of the brain from embolism or thrombosis, hemorrhage, or poison of syphilis, or due to the absorption of lead, nitrate of silver in hair dyes, or the inunction of bismuth and arsenic in face powders, or to the terrible effects of nicotine in tobacco. These agents in their use cause irritation and softening of the posterior portion of the third frontal convolution of the brain on the left side. Symptoms.—It may come on either slowly or suddenly, and may or may not be associated with germinal softening. It is ushered in by loss of the power of speech, which may be regained and recur again and again. In some cases words are recovered and employed and ultimately lost. Again, speech may make a temporary return under excitement, and then leave. Movement of lips, tongue and larynx may be healthy. There may be con- BACTERICIDES. 61 sciousness of what is wished to be expressed, and yet complete inability to express the thoughts by speech, writing or even ges- ture. The patient may know the use of an object, but cannot name it. They may read, but if they understand what they peruse they forget directly, as they will pore over and over again the same page. There is the greatest possible diversity in the impairment of the mental powers, usually hemiplegia and a com- plete breaking down, with the worst form of cerebral disease. In cases clearly due to the use of hair dyes, face powders, tobacco, syphilis, gout, if not of too long standing, there may be hope from the general treatment of chronic inflammation of the brain ; especially, plasters and blisters to nape of neck, with alteratives and tonics. Iodide potassa in alternate use with ozone-water. These two remedies are of infinite value in clearing the brain of such deleterious compounds. When aphasia is due to the use of the peroxide of hydrogen as an auriferous hair dye, no remedy is of any avail. Loss of Voice from Functional, Blood or Organic Aphonia. Disease, operating upon the vocal cords, varies in degree from a slight hoarseness to complete dumb- ness. There are numerous varieties, as aphonia from absence of tongue ; aphasia, the loss of the cerebral faculty of speech by dis- ease of the base of brain from nitrate of silver, lead, bismuth in hair dyes and cosmetics, and disease-germs as syphilis, tuberculae, diphtheria ; aphonia from warts, tumors near the glottis; aphonia from the different forms of chronic laryngitis : aphonia from loss of nerve power, as in typhoid, and aphonia from irritation re- flected, as in teething, worms, masturbation. It is unnecessary to describe them all as they are spoken of under their respective heads. There are two forms, however, that might be enumerated—functional and organic. i. Functional Variety.—Reflected irritation tells badly on the larynx. Children often lose their voice in teething, worms and the like; women who suffer from uterine, ovarian or other forms of irritation of the genito-urinary organs suffer much and often. The irritation of the clitoris with hypertrophy of that organ causes a wonderful harshness of voice, rough and masculine. Males of effeminate type, sensitive disposition, are great victims of aphonia, if addicted to masturbation. The squeaky voice, with or without loss, is notorious. Some men will suffer from aphonia from sexual excess or a gonorrhea. If this reflected or functional form is permitted to continue long, the vocal cords are liable to suffer atrophy or paralysis, to become flaccid and power- less. €2 DISEASE GERMS. Aphthae. 2. Organic Form.—This is apt to be present in old cases of chronic laryngitis, perforating ulceration in the syphilitic or mercurial form. It might also follow diphtheria, morbid growths disease of blood and brain. Treatment.—This requires great tact and good judgment. The removal of causes is of vast importance; teething, worms, irrita- tion of the organs of generation, male and female; the destruc- tion of all disease-germs in the blood, appetite promoted, nourish- ing diet, shower baths, irritating plaster to nape of neck, equable temperature, 75 °, moist atmosphere, inhalation of warm, atom- ized sprays of ammonia, tincture of hydrastin, gargles of chlorate of potass, bayberry, iodol and oxygen. General alterative and tonic course of treatment, usino- freely such remedies as glycerite of ozone and kephaline;' phosphated tincture of oats, saxifraga, phytolacca ; and as tonics, quinine iron, hydrastin, nux vomica, fluid extract black willow bark! If the cases do not yield, large doses of bromide of potass^ calabar bean, and tincture of green root gelsemium, to diminish' irritation of cerebro-spinal axis; atomized sprays of peroxide of hydrogen. ------- This affection is one of the most common of all diseases due to the presence of a disease germ. This is not surprising when we realize the fact that 75 per cent, of our entire population suffer from tubercular and 50 per cent, from the syphilitic germ. Aphthae, properly speaking, consists in a degradation or alter- ation of the living matter of nutrition of the mucous membrane of the mouth into the disease germ oidium albicans and lepto- thrix buccalis. A pure change of bioplasm in the mucous and sub- mucous coats, which first exhib- its itself to the naked eye as a point of redness, small, round, then effusion takes place which elevates it into a vesicle or blister. There may be only a few or a crop of them, they may re- main isolated or coalesce and form patches. They may take place on the hps, gums, cheeks, tongue, palate, tonsils, or extend down- wards through the oesophagus. blood, more especially ThV miwol^f^ f"? *" the huma" poisons of mercury, lead, etc <* tubercle, syphilis; the The Oidium Albicans of Aphthae. Causes are very numerous all BACTERICIDES. 63 Simple mal-nutrition will so change the embryonic elements of nutrition into the disease germ the oidium albicans, which when once evolved, is capable of independent existence with pro- digious powers of reproduction. Associated with the evolution of the germ, there is usually profound constitutional debility. The germ may be evolved as the result of simple malnutrition, then there is no real diagnostic mark but the mal-nutrition and ordinary symptoms of inflammation and ulceration. When the bacilli of tubercle act as the predisposing cause, the diagnosis rests chiefly upon the peculiar mottled cheesy appear- ance; usually there are associated with it laryngitis, bronchitis, pulmonary tuberculosis. The syphilitic form is recognized by the copper-colored ap- pearance of the ulcers in which the germ is imbedded. That due to mercury and lead has a slate-colored, metallic hue in the ulcers and also a peculiar fetor of the breath. The form peculiar to infants, Infantile Aphthce, is very apt to arise from the imperfect cleansing of the mouth, or the child being permitted to lie with the nipple in its mouth. Particles of milk lodging in the crevices of the mucous membrane become sour or rancid, and give rise to irritation of the mucous mem- brane ; or it may be due to heated milk from over-work on the part of mother, or the lactiferous fluid may be bad. It may come from diseased children kissing each other, or diseased adults kissing healthy babes. Once the disease germ is developed in the child's mouth, the nipple of the mother becomes similarly affected ; vesicles forming, then cracks and fissures, filled with colonies of oidium albicans. The general health suffers. The child becomes irritable and restless; some fever, debility, cough, vomiting, diarrhea, and general want of nutrition. The small white blisters become ulcers on the tongue, cheeks, gums, palate, tonsils; breath is fetid, and if they extend down there may be difficulty in swallowing; and if there be much debility, the case may merge into ulcerative stomatitis or can- crum oris. All forms highly contagious and infectious. Treatment.—In the treatment of all forms of aphthae we must recognize the pathology of the disease, an innervation of the powers of life, a condition of constitutional debility which predis- poses to this peculiar degradation. So in the treatment a strenuous effort must be made to im- prove the general health by a tonic and alterative course—such tonics as preparations of cinchona and mineral acids, avena 64 DISEASE GERMS. sativa, glycerite of kephaline, remedies to correct the mal-nutri- tion, and alteratives, as comp. saxifraga. All insanitary states avoided and a most generous scale of dietetics prescribed. In the form of mouth washes or gargles, such germicides should be used as will annihilate the germ, painting the microbe patches with either aromatic sulphuric acid, or tincture of siegesbeckie orient or distillation of jequirity, and then using washes of either infusion of hyssop and resorcin; or solution of boro- glyceride; or of comp. oxygen; or a few drops of peroxide of hydrogen added to water; or chlorate of potassa, or chlorate of carbon ; or infusion of hydrastis, and boroglyceride. If the aphthae has descended, there is usually great prostration or debility, and germicides must be administered internally. In such cases either the glycerite of sulphur or ozone act promptly, kill the oidium albicans, and heal up the diphtheric-looking ap- pearance of the mucous membrane which had been so completely riddled soft, loose, friable by the germs. This term is applied to an engorgement of blood, Apoplexy, with or without extravasation of blood, in or upon any organ, as the brain, cerebral apoplexy; in or on the cord, spinal apoplexy ; in the lung, pulmonary ; and so on with other organs. As generally used, the term denotes an exhausted state of the cerebral pulp, either with anaemia or congestion—the state of vital exhaustion so great as to cause the patient to fall down as if from a blow. Causes.—Anything that tends to exhaust the vital integrity of the brain, whether that cause may be predisposed to by hereditary tendency, peculiar types of conformation, aggravated or intensified by sedentary habits, high living, protuberant bellies, large heads, florid features, short, thick necks, high shoulders, a predisposition to hemorrhage. Apoplexy is also engendered by disease of the liver, heart, kidneys, ossification and calcareous degeneration, and deposits of cerebral blood-vessels, gout, intemperance, embolism, impure air, tight neckties, stooping posture. Varieties.—Nervous or simple apoplexy, fatal with a trace, is rare; the sanguineous, or that accompanied with extravasation of blood into the brain, very common; and the third form, the serous, in which the serum effused is simply present and has no relation to an attack. A stroke or an attack is usually followed by stupor or coma, and the comatose condition may cease in various ways. It may gradually pass off, leaving the patient well • BACTERICIDES. 65 or it may terminate in incomplete recovery, mind impaired and some part of the body paralyzed; or it may terminate in death. In the latter case, on examining the brain, we find either no ap- pearance of disease, or else extravasated blood is discovered in the ventricles, or pons varolii, or to a certain amount in the cen- trum ovale majus, or in sac of arachnoid, or thare may be a copious effusion of serum into ventricles or beneath arachnoid, with or without cerebral softening. That form which is fatal without any trace is very rare. That in parturient women is generally a clot embolism from ergot. Morbid Anatomy.—Cerebral hemorrhages are of all sizes, from minute capillary extravasations to large clots containing several ounces of blood. Preceding the hemorrhage, the ruptured vessel is the seat of miliary aneurisms, due to arterio-capillary fibrosis, which begins in the perivascular lymph spaces, and extends to the tunica intima. Microscopic deposits, or aneurismal dilatations, globular, sacculated or fusiform, are developed in innumerable numbers, and it is through their ruptured walls that the hemorrhage occurs. Besides, it is often due to fatty and calcar- eous degeneration. The general locations of ex- travasation are the intraventri- cular nucleus of the corpus striatum, optic thalamus, cere- bellum and pons varolii. If the apoplectic clot is not immediately fatal, change will take place in the clot—the se- rum will be absorbed—the clot may undergo fatty or other forms of metamorphosis, and it may become encysted. Warnings.—Frequently there are no premonitory indications or threatenings; when there is, they are characterized by head- ache, vertigo, muscae volitantes, or transient blindness, or double vision, ringing in the ears, a feeling of weight and fulness in the head, often bleeding from nose, fits of nausea, occasional sense of numbness in limbs, loss of memory, great mental depression, in- coherent talking, drowsiness, indistinct articulation, and partial paralysis of foot, limb, face, eyelids. An attack usually begins in one or other of three forms: 1. Patient falls suddenly down, deprived of sense and motion 5 Cerebral Apoplexy. Horizontal section of the cerebrum through a clot in the left optic tract. A, A. Clots from hemorrhage. B, />. Area of tissue stained with blood pigment. 66 DISEASE GERMS. like a person in a sleep; flushed or even livid ; breathing ster- torous, pulse full but slow, much below the natural standard; often convulsions, or rigidity, or contraction of the muscles of the limbs on one side. 2. Sudden, and it may be excruciating pain in the head, pallor, sickness, faintness, often vomiting; frequently the patient falls to the ground in a state of syncope, coma. In other cases, instead of falling, the pain in the head is accompanied by a slight and transient loss of consciousness, then headache, with heavy op- pressed feeling in the head, which terminates in forgetfulness and coma, from which recovery is rare. Clot of great size is generally found in the brain. 3. Or it may come on with all the symptoms of cerebral hem- orrhage, paralysis of one side, loss of speech, but no loss of con- sciousness. The paralysis leads to coma, or it may pass off and the patient recover; or it may pass off and death suddenly occur in a few hours or days, or it may terminate in another attack. Apoplexy has well marked and general characteristics; its duration varies in all cases from a few hours to as many days. Complete and total unconsciousness ; pulse generally at first im- perceptible or small, but as the patient rallies, stronger and fuller as the shock wears off, but slower than natural and often inter- mittent; respiration is slow and embarrassed, or stertorous; frothy saliva flows from the mouth, and in bad cases the body is covered with a cold, clammy sweat; face is either congested, swollen, livid or very pale; eyes dull, glassy, pupils insensible to light, often one contracted or the other widely dilated; ptosis, or drop- ping of eyelids, or squinting, according to the nature of the effu- sion and its location ; teeth firmly clenched, power of deglutition lost or impeded, bowels constipated, motions passed involuntarily, involuntary micturition. When it is of the sanguineous type, it is not unusual for neck and even shoulders to show congestion and lividity. Incomplete recovery is almost always followed by paralysis. Treatment.—If the condition in any of its three forms is sus- pected, the patient should be warned to guard against all bodily exertion, as running, jumping, lifting, hoisting, or violent mental emotion or passion, or straining at stool; and tea, coffee, tobacco, whiskey, beer and venereal excitement strictly forbidden; heavy meals or much animal food, stooping, tight neckties, hot baths, and even extremes of temperature to be avoided. Diet to be nutritious but light, bedroom cool, well ventilated, to sleep on a hair or straw mattress with head high; hair kept'short, shower or cold water bathing, daily moderate exercise, bowels to be open twice daily. Two points of irritation between shoulders kept BACTERICIDES. 67 discharging, at least one inch square; a little capsicum in socks. If there is vertigo, bleeding at nose and headache, bowels more active, bromide of potassa, tinctures of aconite and belladonna administered. If not speedily relieved, wet cups to nape of neck and shoulders. If anaemia is predominant, cinchona, mineral acids, with nutritious, easily digested food. Suppose an attack to have taken place, and that it is of the sanguineous type, with coma, labored breathing, pulse slow, im- perceptible almost, the face turgid with blood, almost purple or black, neck ecchymosed, etc. Then our treatment would be precisely the same as for acute inflammation of the brain: shave the head and apply hot water, wet cup nape of neck and shoul- ders ; mustard roller to feet and limbs, free purgation with com- pound powder of jalap and senna, with a few drops of croton oil, and repeat it; head high, and if stertorous breathing continue to be placed on right side; then veratrum viride with bromide of potassa; otherwise, general principles. Suppose it is an attack with anaemic syncope; no pulse, sighing respiration, cold clammy skin, pale face, etc.; we must stimulate; warm water to head, no cups nor free purgation, but stimulants. An effort must be made to rouse the patient with stimulating enemas, nutritious diet, and a course of treatment similar to •chronic inflammation of brain. Effusion of blood into the cord may take place Apoplexy, at any part, and in a small or great degree, either Spinal. in its substance or from its membranes. It may be a result of active inflammation or of concus- sions, blows, falls, over-exertion, degeneration of coats of blood- vessels, as fatty, calcareous caries of the vertebrae. A meningeal hemorrhage may extend quite a distance in the cord, but generally is cir- cumscribed ; a clot of varying -size may involve either the gray or white matter, or both. The symptoms will vary ac- cording to the seat of lesion. Acute and sudden pain in back, sometimes in head; of ten severe convulsions; diffi- . _ . ,.,..... , . , . . - . . , . , An effusion of blood with the substance of the cord. ■cult breathing if high up, with heart's action depressed, with pale and cold skin; if not high 68 DISEASE CERMS. up consciousness not impaired, the spasm then being confined to limbs. Effusion into substance of cord produces paralysis in all parts supplied with nerves coming off below its seat. If hem- orrhage be very slight, loss of power occurs slowly. If effu- sion is suspected, a further amount is to be checked by perfect repose and application of ice in an intestine along the spinal column. Subsequently, the galvanic cautery followed by poul- tices, the faces of which are covered with aconite and belladonna liniment. Large doses of bromide of potassa and calabar bean with general alteratives and tonics, guarding all points very care- fully. ------ Extravasation of blood into the lung tissue Apoplexy, is usually greater in amount than what takes Pulmonary, place in the brain—usually there is a complete laceration of tissue, or a cavity of considerable size with the blood in it either completely or semi-coagulated. The apoplectic extravasations are never much circumscribed, usually a mass of blood in shreddy cedematous infiltrated parenchyma. It may prove immediately fatal, if the pleura is extensively perforated. If the patient does survive the accident, recovery takes place either by adhesion of the torn surfaces of the lung after the absorption of the extravasated blood, or by the formation of a capsule of connective tissue around the clot, after which the latter undergoes a cheesy, cretaceous or pigment degeneration, and remain permanently imbedded in the lung. Diffused pulmonary apoplexy may occur from a very large infraction; it results from disease and degeneration of arteries. A branch of the pulmonary artery may suffer from a small aneu- rismal condition, and give way through slight exertion, as runnings jumping, a fall, fractured rib, gun-shot wound. Disease of the coats of the artery may cause it, or erosions from the devastations of the cancer germ, or the bacilli of tubercle. Common in males three to one after the twenty-first year. Symptoms.—Profound collapse, profuse hemorrhage, extreme difficulty of breathing, lividity, are the chief symptoms. Asphyxia, convulsions, due to the bronchi being filled with blood. It is often difficult to determine this from other diffuse pul- monary hemorrhages. It often goes unrecognized until a post- mortem is made. Recovery is rare, and only possible when the rent in the lung is slight. Treatment.—The diffuse form of pulmonary hemorrhage is not amenable to treatment, as the patient dies from the hemorrhage and shock. Diffusible stimulants with quinine may be tried,. administered freely. BACTERICIDES. 69 A genus of entozoa or intestinal worms. The Ascaris. species are very numerous, one of the best known is the ascaris lumbricoides, commonly called the round worm, which occurs in the intestines of man and some of the lower animals, and bears a striking resemblance to the common earth worm. When once in the alimentary canal, to which it gains access by its eggs being incorporated in some article of food or drink, it produces a deterioration of the general health and reflexly irritates the brain, giving rise to cerebral anae- mia, which is indicated by the pale face, dilated pupil, indigestion, fetid breath, cough, grinding of teeth, rolling of head, spasms. An immense number of remedies are in general use for the expulsion of this parasite, the most effectual of which is santonine. It does not in all cases kill the worm, but acts by making their dwelling-place disagreeable to them. One or two grains of pulverized santonine should be triturated in five or ten grains of sugar of milk and administered every other night on retiring, in water, followed the morning afterwards with a dose of comp. syrup of rhubarb and potassa to move the bowels. As a general tonic to the intestinal tract, so as to brace it and prevent the eggs of those parasites lodging in its folds, the ozon- ized extract of stone crop should be administered for six or eight weeks. _______ Ascaris vermicularis, or thread worm, is a very Ascarides. common species, both in children and adults. It infests chiefly the lower portion of the colon and rectum, great numbers often being present. They are white in color, not more than half an inch in length. Their presence is indicative of great inherent weakness of organization, and their generation due either to eggs swallowed in food or drink. They occasion intolerable itching, irritation, loss of sleep and impairment of the general health. In the treatment of ascarides an effort must be made to improve the general health by all possible means. A most generous diet, gentle exercise, a judicious use of tonics and alteratives. The patient should be placed upon the internal use of Virginia stone crop for three months. Before the usual daily evacuation of the bowels, an injection of any one of the following agents, infusion of quassia, golden seal, wormwood, goldthread, stone crop, or a solution of boroglyceride ; resorcin, naphthaline, will be found of great efficacy. On retiring in the evening the bowels should also be copiously injected, so that its contents may pass off; then about two ounces 7o DISEASE GERMS. of ozonized witch hazel injected and permitted to remain over night. In this way a speedy cure is effected. An effusion of serum into the cavity of the abdo- Ascites. men may arise from numerous causes, although the two principal are peritonitis and disease of the liver i. In acute, but more especially in chronic, inflammation of the peritoneum, effusion of serum takes p'ace in great abundance, but the inflammatory process may subside, leaving the cavity of the abdomen pretty well filled up with fluid, when effusion still pro- gresses onward owing to a distension or unravelling of the peri- toneal fibres or sacs. 2. All morbid states of the liver, whether it be an inflammatory process or due to the gland being blocked up by disease germs or microbes, causing an interstitial death or destruction of the hepatic cells, with either hypertrophy or atrophy of the gland. Microbial engorgement of the liver is a more common cause ol enlargement than either alcohol or mercury. Enlargement is a more fertile source of effusion than atrophy, from the oblitera- tion or wiping out of its proper structure by fatty, amyloid or cystic degeneration, blocking up the portal vein, obstructing its normal circulation. In addition to those two principal sources of dropsy of the abdomen, there are always more or less exosmosis of serum from the blood in disease of the heart, spleen, kidneys, anaemia; besides, it is often the result of extensive burns. The recognition and diagnosis of ascites are not by any means difficult. The history of the case and the physical appearances are good points as to whether the dropsy arises from an ob- structed or clogged-up liver, or from chronic peritonitis. If from the liver, the sallow or yellow skin, congested conjunctiva, brown-coated tongue, cough, dulness on percussion of the upper lobe of the right lung, pain in shoulder, liver indurated either small or large, drowsiness, urine loaded with bile; whereas, it from chronic peritonitis, none of the above symptoms will be present, but the upper portion of the body will be greatly ema- ciated, features pinched, countenance anxious, skin shining, super- ficial veins dilated, abdomen greatly enlarged. Ovarian cysts sometimes become enormously enlarged, so as to fill up the entire abdominal cavity, and the diagnosis is often difficult; at a late period generally, however, it can be made out. A good plan is to cause the patient to stand up, spread the fingers of the left hand over the right side of the abdomen of the patient, and tapping gently with the right hand the left side of the abdomen; a wave, a sense of fluctuation can be felt undulat- BACTERICIDES. 71 ing from side to side. This fluctuation or vibration is most valuable and reliable. Bowels might be emptied with a dose of oil, then the patient placed in the recumbent posture, then on percussion there is resonance, bowels floating on the top of i:he fluid. In the recumbent posture, if there is water in the cavity of the abdomen, there will be a sense of suffocation from the water pressing up against the diaphragm; great difficulty of breathing; respiratory murmur cannot be heard so low down as in health ; tubular breathing ; apex of heart elevated and pressed to the right side. Very generally there is swelling of the feet and limbs ; if the heart and kidneys suffer, oedema of the face and arms. There is a general depreciation of vital force,—debility. emaciation, prostration, want of appetite, sleeplessness, inability to lie down, invariably ending fatally when due to organic disease of the liver. In the treatment of these cases, success usually attends our efforts when due to peritonitis; but when dne to organic disease of the liver, the effusion may be removed again and again, but it will re-accumulate, because the cause does not permit of removal. The removal of the water from the cavity of the abdomen is effected thus:—the patient must be built up in every possible manner, placed upon the richest diet, and every possible means taken to improve his general health. A few days before any strenuous effort is made to remove the effusion by the three emunctories of the body, the patient should be either placed upon an infusion of digitalis, or upon the tincture of stro- phanthus. The action of either pf these two remedies gives tone to the heart,—unlocks the flood gates of the body. These reme- dies should be followed up with diaphoretics, of which the alcoholic vapor bath is probably the best; diuretics, of which hair-cap moss, squills, bitartrate potassa and apocynum are efficient; hydra- gogue cathartics, as mandrake combined with nitrate and bitar- trate of potass; squirting cucumber. These means failing, an alterative course should be tried; all remedies failing, then the abdomen should be tapped. This term is generally used to designate sus- Asphyxia. pended animation, produced by the non-conver- sion of the venous blood of the lungs into arterial. The supply of air being cut off, the unchanged venous blood of the pulmonary artery passes into the minute radicles of the pul- monary veins, which require arterial blood to excite them; more or less stagnation takes place in the pulmonary capillaries, and death frequently ensues from this cause. Besides, the non-oxy- 72 DISEASE GERMS. genized blood is very poisonous to the brain, and has no stimulus to the ventricles of the heart. It is believed that asphyxia occurs before the oxygen has dis- appeared from the blood, because it is held by the haemoglobin so firmly that the tissues cannot obtain it. Thus, suppose no oxygen is admitted by respiration. It is well known that all the blood in the body passes through the heart and lungs in the time of one complete circulation, that is, in about twenty seconds; and we have it on eminent authority that in this time one-third of the oxygen is used up by the tissues. According to the per- cussion theory, the stroke of the left ventricle arterializes the blood, that is, liberates the oxygen from the haemoglobin, and this arterialized blood is carried to the tissues. The haemoglobin does not get sufficient time to recombjine with the oxygen, because of the successive strokes of the heart and the vibrating thrill kept up in the arterial ramifications. Tne free oxygen is used up by the tissues in the capillary circulation to the extent of one-third. After leaving the capillaries, the two-thirds of oxygen again re- combine with the haemoglobin, and in this condition return to the heart, along with one-third of haemoglobin that has lost its oxygen. In ordinary circumstances this one-third would again obtain oxygen from the alveoli of the lungs; but if all the oxygen there has been used up, of course it cannot obtain any oxygen. The blood flows from the lungs to the left ventricle, when it is again arterialized, and again sent out through the arteries; but as there is now a large amount of free haemoglobin present in the capillary circulation, it will seize, hold of a part of the oxygen, and the tissues will obtain less than the usual supply. With each successive circulation, the amount of oxygen available for the tissues will become less and less, until the tissues receive none, because all the oxygen set free by each beat of the left ventricle is seized hold of in the capillary circulation by the reduced haemoglobin. The tissues die from want of oxygen, because there is too much reduced haemoglobin present, a substance having a greater affinity for oxygen than the tissues possess, a result that would probably Occur, as in drowning, in the time of six or eight complete circulations, that is, in three or four minutes. Causes.—Whatever prevents the ingress of air into the lungs, as effusion of lymph in acute laryngitis ; congestion of the lungs in pneumonia; drowning, strangulation; obstruction of the larynx by foreign bodies ; inhalation of chloroform, carbonic acid gas, other poisonous gases ; narcotic pqisons ; injuries to the medulla oblongata; dislocation of the spine in cervical portion. In all forms the treatment resolves itself into the removal of BACTERICIDES. 73 foreign bodies, or water; allowing an ingress of pure air into the lungs, and in inducing warmth and circulation. Asphyxia from Drowning.—The first effect felt by a drowning person is an urgent feeling of anxiety in the chest; the pulse becomes weak; the respirations become less, and the blood of a venous hue. The venous blood acts as a narcotic poison on the brain—produces insensibility, loss of voluntary motion; surface becomes of a livid hue; the heart ceases to beat; the sphincters relax; body sinks to the bottom. If life is utterly extinct, the pupils are dilated, jaws clenched, fingers and thumbs contracted, face pale. Reanimation may take place from five minutes to three-quarters of an hour after immersion. Asphyxia from Strangulation.—The first effect of tightening the cord around the neck is the suspension of respiration, and en- gorgement of the brain with blood; then sensibility decreases ; epileptic convulsjons come on—suffusion, lividity, turgidity of the face and upper part of the body ; eyes open ; features distorted ; hands clenched; sphincters relaxed. If the air is not perfectly -excluded, the sufferings are: engorgement of head and brain greater. The action of the heart becomes more active as the death-struggle progresses, and continues beating after respiration has ceased. Asphyxia from Poisonous Gases.—Carbonic acid gas is the most •common—burning charcoal. The usual symptoms being a deep sleep, with intense, throb- t>ing headache, with weight and heat, especially about back of head ; strong pulsations and tightness across the temples ; vertigo ; increased action of the heart, and often violent palpitation ; con- fusion of ideas; failure of memory; nausea; hysteric sobbing. If the vapor has been breathed for some time, the symptoms will be : noises in the ears, partial or total loss of vision, disturbance of the senses. Asphyxia, under the above conditions, depends upon accumu- lation of carbonic acid gas in the lungs, the want of oxygen in the blood—the natural stimulus of living tissue. Appearances zvhich Indicate Death.—Total suspension of breathing and heart's action; eyelids half closed and pupils dilated; jaws clenched; tongue appearing between teeth, with frothy mucus about the mouth and nostrils; fingers semi-con- tracted, with coldness and pallor of the surface. Treatment of Asphyxia from Strangulation or Suffocation, Anesthetics, Gases, etc.— Rule i. To Maintain a Free Entrance of Air into the Wind- pipe.—Cleanse the mouth and nostrils; open the mouth ; draw 74 DISEASE (JERMS. forth the patient's tongue and keep it forward ; an elastic band over the tongue and under the chin will answer this purpose. Remove all tight clothing from neck, chest or waist. Make sure that there is no foreign body lodged in pharynx, larynx or (eso- phagus. If water is there, place patient on abdomen, over a hogshead and give half a dozen rapid rolls. Then Rule 2. To Adjust the Patient's Position.—Place the patient on his back, on a flat surface, inclined a little from the feet upwards ; raise and support the head and shoulders on a small, firm cushion, or folded article of dress, placed under the shoulder- blades. Supposing natural respiration has ceased, proceed— Rule 3. To Imitate the Movements of Breathing.—Grasp patient's arms just above the elbows, and draw the arms gently and steadily upwards until they meet above the head. (This is for the purpose of elevating the ribs, and thus expanding the chest and drawing air into the lungs.) Pressure on the breast- bone will aid this. Repeat these movements alternately, deliber- ately and perseveringly, fifteen times in a minute for two or three hours, or until a spontaneous effort to respire is perceived; imme- diately upon which, cease to imitate the movements of breathing, and proceed to induce circulation and warmth. Should a warm bath be procurable, the body may be placed in it up to the neck, continuing to imitate movements of breathing. Raise the body in twenty seconds in a sitting posture, and dash cold water against chest and face, and pass ammonia under the nose. Patient should not be kept in the bath longer than five or six minutes. Rule 4. To Excite Inspiration.—During employment of above method, excite nostrils with snuff or ammonia, or tickle throat with a feather. Rub chest and face briskly ; dash, alternately, hot and cold water on them. Rule 5. To Excite Circulation and Warmth.—Wrap patient in dry blankets and commence rubbing limbs upwards, firmly and energetically. Friction must be continued under dry blankets or over dry clothing. Promote warmth of body by application of hot flannels, bottles or bladders of hot water; heated bricks, etc., to armpit, over stomach and heart, between thighs and to soles of feet. On restoration of life, when power of swallowing has returned, a teaspoonful of warm water, warm brandy and water, or coffee^ should be given. Patient should be kept in bed ; disposition to sleep encouraged. During reaction, large mustard plasters to chest and below shoulders will greatly relieve distressed breathing. In cases where the base of the brain is weak, or where the nar- cotic, or gas, or anaesthetic operate with peculiar violence upon that part of the nervous organism, the jaws become not only BACTERICIDES. 75 clinched, but immovably rigid, so that the mouth cannot be opened ; then the following method of resuscitation must be enforced. It is of special utility to the drowned. The Method of Artificial Respiration for the Treatment of the Drowned.—Rule i. The moment patient is taken out of the water instantly turn him downward, with a large, firm roll of clothing under stomach and chest. Place one of his arms under his forehead, so as to keep his mouth from the ground. Press with all your weight for three or four, or five seconds, each tine upon the patient's back, so that the water is pressed out of lungs and stomach and drains freely out of mouth. Then : Rule 2. Quickly turn patient, face upward, with a roll ot clothing under back, just below shoulder-blades, and make the head hang back as low as possible. Place patient's hands above his head. Kneel, with patient's hips between your knees, and fix your elbows firmly against your hips. Now, grasping lower part of patient's naked chest, squeeze his sides together, pressing gradually forward, with all your might, for about three seconds, until your mouth is nearly over patient's mouth ; then with a push, suddenly jerk yourself back. Rest about three seconds; then begin again, repeating these bellows-blowing movements with perfect regularity, so that the foul air may be pressed out and pure air drawn into the lungs, about eight or ten times per minute, for at least one hour, or until the patient breathes naturally. Note.—The above directions must be used on the spot, the first instant the patient is taken from the water. A moment's delay, and success may be hopeless. Prevent crowding around patient, as abundance of fresh air is important. Once he breathes be careful not to interrupt it. If they are very long apart, carefully continue between them the bellows-blowing movements, as before. After breathing is regular, let patient be rubbed dry, wrapped up in warm blankets, a little brandy and water can be given in small occasional doses, and then be left to rest and sleep. If no physi- cian is near, any bystander can carry out these rules, as it requires no expert. The above method is undoubtedly the best for the ejectment ot fluids from the stomach and thorax; with it there is no need in opening the mouth, which is usually closely clinched, and of drawing the tongue forward, which is impossible, the position of the patient obviating this necessity. The compress on is most complete, and capable of the most delicate adaptation ; it can be performed by one person in almost any situation, and continued as long as there is any use. It is the essential method in drown- ing, as it empties the water-logged thorax, relieves the filled /6 DISEASE GERMS. bronchi, releases the immovable diaphragm, and thus makes respiration possible. In the first position, a roll of clothing under the stomach and thorax makes shoulders the highest point; the nostrils and mouth the lowest. The displaced fluids run downwards, cleans- ing the upper air passages, which are perfectly drained. Then the pressure upon the back causes a complete ejectment of the fluid, and we have a free passage for air established; an open air- way and imitation of the natural movements. The best method of compression is to place the thumbs at the bottom of the cartilages of the ribs along their front part. The force then applied to the ribs is through the medium of the thoracic walls, so distributed as to give no shocks, no violence, but cause the ribs to move in their intercostal spaces. A person of the most average intelligence can easily understand the two rules laid down. The kneeling position is not tiresome ; the parts to be pressed are raised to the hands ; the weight of the body is the chief force, and there are intervals of complete rest. It is true, the rate of respiration is one-half slower than other methods ; but even with that, there is more oxygen supplied than a partially asphyxiated person can breathe, or bear, or assimilate; besides, it has the advantage of allowing better diffusion and minimizes superfluous disturbances. It is of especial advantage in drowning, because in that form of asphyxia the jaws are inseparably clinched, the slippery tongue is receded into the pharynx, and the epiglottis has fallen back so that no air can enter, and our first method cannot be carried out. It is very doubtful whether it is not the best for chloroform and syncope ; it is certainly the quickest. In asphyxia from chloroform, same management, and cloths wrung out of boiling water over heart, even to vesication. Intense Cold.—Cold acts chiefly from without, freezing inwards, causing serous congestion of the three great cavities, with giddi- ness, inability to see, weakness and rigidity of limbs; almost imperceptible respiration and pulse; tendency to profound sleep, or coma. Patient must be placed in a room without fire, and an attempt made at restoration of circulation and sensibility by rub- bing the body with snow, or ice, or cold water. Frictions with flannels, long continued ; very gradual application of warmth; a stimulating enema, warm milk, with capsicum, coffee, beef-tea or warm wine. Syncope.—Fainting, sudden prostration. Remedies are : recum- bent posture, to slow heart twelve or fifteen beats per minute ■ head low, cold air; cold water dashed over head and chest' smart beating on chest with a wet towel; friction or mustard BACTERICIDES. 77 plasters over region of heart; small quantities of ammonia or brandy. The syncope in anaemia and chlorosis must be cautiously treated, with brandy, wine, carbonate of ammonia and beef juice, given both by the mouth and rectum, with artificial heat over the heart and extremities. The recumbent position should be maintained until the action of the heart is nearly normal. Narcotic Poisons.—Patient to be placed on side, head slightly raised; cold affusion; heat to extremities ; stimulating applica- tion to chest and back ; the use of stomach pump. The antidote with tea, or coffee, or solution of acetate of ammonia, or one drop of a one-per-cent. solution of nitro-glycerine upon the tongue will often excite the heart to action. An irritation of the nerves that supply the circular Asthma, muscular fibres of the bronchi, causing spasm or contraction. This irritation may be in the periphery in the bronchi, or in the medulla oblongata, so that paroxysms or fits may be induced by reflex or direct mechanism, that is to say, the stimulus to contraction may be central in the medulla, or it may be in pulmonary or gastric portion of the pneumogastric, or in some other part of the nervous system, besides the vagus, and being transmitted to the medulla by incident, is thence reflected by motor filaments. A very good plan is to arrange causes under three divisions r (i.) Central causes in the medulla oblongata. (2.) Peripheral causes in the bronchi, lung, stomach, heart. (3.) Affections of blood. (1.) Often hereditary; peculiar types of conformation ; idio- pathic. (2.) Reflex; disease of heart, stomach, lungs, alimentary canal,. skin. (3.) Germs in blood irritating the weakened cerebral bulb or periphery, as tuberde, syphilis, rabies, gout, etc., so that asthma has always at the root of it some central nervous irritation, or some peripheral source of it. The causes embraced under these, then, are very numerous, as diseases of the chest and abdomen, some latent skin disease, certain winds, changes in atmosphere, especially dryness, with increase of oxygen and diminished electricity; inhalation of disease-germs or irritating substances, the micro-organisms of plants, flowers, hay, malaria, gout, rheumatism; non-acclimati- zation or incompatibility to soil, location or country. If there is no apparent cause, blood-germs, as syphilis, rabies, tuberculae. 78 DISEASE GERMS. An asthmatic is thin, of a nervous temperament, round-shoul- dered ; countenance expressive of attacks of suffering; cheeks hollow; voice rather hoarse; slight cough; suffers from nervous dyspepsia. Symptoms.—Languor, lassitude, debility, headache and drowsi- ness, often digestive derangement; or it may occur suddenly without any of those signs. Most generally the patient falls into a sleep, when he suddenly awakes with a sense of suffocation or constriction about the chest; smothering and difficulty of breath- ing increases until there is a most fearful struggle for breath. Patient gets right up in the sitting posture and assumes various positions to facilitate respiration. Chest becomes distended to its utmost limit. The contractions of the circular muscular fibres of bronchi are so great that they offer a perfect obstruction to the entrance or exit of air. On placing ear to the chest, no natural breathing audible, but dry murmurs, loud wheezings, shrill whist- lings are heard. Pulse becomes small, feeble, almost impercepti- ble ; eyes staring, protruding from sockets ; countenance anxious; lips purple ; temperature of body falls to nearly 8o° Fahr. But after a while of intense suffering, the skin becomes bathed in a copious sweat. After that usually the spasm breaks and the pa- tient obtains relief. Cough, with some expectoration ; paroxysms ceases, and patient falls asleep. One attack may follow another, or there may be a series of light attacks violent enough to keep patient up in his chair to midnight. Attacks may come on every night or at long inter- vals—often periodical. Asthma is very capricious, kept up by some climates, some aromas, gases, houses, beds, etc. During the interval or between attacks patient enjoys moderately good health. Men are more frequently attacked than women. Asthma, denominated hay, ragweed, roses and the micro- organism of plants and trees does not differ in symptoms. The bacilli of the vegetable kingdom acts as an irritant to the peri- phery of nerves in the bronchi; it is reflected to the bulb and transmitted back—hence the spasms. The duration of asthma is apt to be tedious if not arrested promptly at the start. Its effects or results are, thickening of the circular muscular rings, with effused lymph, causing a permanent narrowing of tubes and wheezing respiration ; dilatation of the air vessels into sacs or pouches, as in emphysema; dilatation of ventricles of the heart from embolism ; general breaking down of the nervous system, nervous dyspepsia, alkaline diathesis, etc. Treatment— During the attack, if the stomach is loaded, an emetic of lobelia; or if suffering from constipation, copious enemas. Then the great object in treatment is to relax bronchial BACTERICIDES. 79 spasm. For this purpose some of the following remedies should be tried, selecting one until one is procured that is effectual. Lobelia, useful in a number of cases; when it produces nausea and collapse the attack often ceases. Compound powder is best form. A cup of strong coffee will often ward off an attack; so will a strong glass of hot whiskey punch. Inhalation of chloroform or other anaesthetics, like ether, are of little utility. Iodoform dissolved in ether and inhaled may be useful if due to catarrh. A dose of two grains of iodide of potassa, the same of car- bonate of ammonia, with twenty drops of tincture of belladonna, may ward off an attack. Sulphate of sparteine is an effective remedy in asthma—it begins to act in about thirty minutes after it has been taken by the mouth', and its action lasts from about five to six hours. This rapidity of action, at first consisting in a stimulation of the heart, rise of arterial tension not occurring until a little later, indicates the use of sparteine in asystolic conditions of valvular disease where a speedy effect is desired, giving it superiority over more slowly acting drugs in asthma. In these conditions, too, a small dose should be employed (one- sixteenth to one-quarter of a grain), since in these doses sparteine seems powerfully to stimulate and regulate the heart with the smallest rise of arterial tension, perhaps not more than is the normal accompaniment of increased cardiac force. Diuretic effect is most marked with fairly large doses, half a grain to two grains ; with small it is not so evident, but is often present. Flushing of the surface of the body occurs in from one to two hours after administration in most cases. Nitrite of amyl, five drops on a cloth and inhaled, or iodide of ethyl, six to ten drops inhaled; either one increases the bron- chial secretion, gives instant relief. Their effects are transient but often curative. Nitrite of amyl in alcohol operates like a charm, as follows : Alcohol, half an ounce; water, one ounce and a half; nitrite amyl, three drops.—Mix. Add to half a tumbler of ice or -cold water and drink at once. The alcohol keeps up the action ot the nitrite of amyl for some time. Such a combination relaxes the arterial vessels to their minutest subdivision, relaxes organic mus- cular fibre. One or more drops of a one-percent, solution of nitro-glycer- ine produces, within a few minutes, a diminution of tension and wonderful relief in breathing. Its effects are marked and durable. The fluid extract of quebracho is used most successfully in asthma. A teaspoonful, repeated every ten minutes, relieves the ■difficulty of breathing. 8o DISEASE GERMS. The fluid extract of euphorbia pilulifera has a most decided effect in nearly all cases of asthma. Catalpa of most use in chronic nervous cases Members of the medical profession are disgusted with the end- less complications and combinations of antispasmodics, and have sought other remedies, as jaborandi and its alkaloid, pilocarpin, The^ powerful revolution which that remedy produces in the dis- tribution of the blood, has a most beneficial effect in asthma, attract- ing the blood to the skin and salivary glands, and by diminishing its volume through the copious perspiration and salivation. The interstitial changes in the lung after its exhibition is followed by amelioration of all the symptoms. Its use requires care and cau- tion. The alkaloid, by hypodermic injection, is preferable to the fluid extract, in doses of about one-third of a grain. During the action of drug, recumbent posture. Antispasmodic fumes may be used in the absence of better remedies ; they owe their properties chiefly to ammonia, or some acro-narcotic, nitre paper, stramonium, belladonna and lobelia; cigarettes produce when inhaled intense hyperaemia, as may be seen in the buccal, pharyngeal, laryngeal mucous membrane of habitual smokers, and exudation which tends to soften and detach obstinate mucus. With such remedies, we endeavor to overcome spasm ; and with the use of the bromine compound as laid down under hooping-cough, in doses of a teaspoonful every three hours, we make an effort to ward off attacks, and in the interval we try curative measures. Curative Treatment.—Great care and diligence to ascertain cause or causes. If there seems to be a catarrhal condition, treatment as laid down under that head; if there are latent germs present in the blood treat accordingly. Dogs licking children's hands, in whose mouths the germ of rabies are often present, is a fruitful but unthought-of cause of asthma in adult life. Power- ful alteratives, as iodide of potass and ozonized glycerine ; indeed, these constitute the most certain way of curing asthma, whatever its origin may be. Blisters or irritating plasters to nape of neck on both sides, an open sore. If there are any reflex conditions, remove them. If digestion is weak, cinchona compound and mineral acids, pepsine, gentian. If there is evidence of malaria, tincture iodine, green-root tincture of gelseminum with quinine. If no cause can be discovered, a general alterative and tonic course. Rosin-weed and a large list of worthless drugs are now dis- carded in the cure of asthma. Every possible means taken to improve the general health by tonics ; the most nutritive diet, regular mode of life; daily use of BACTERICIDES. cSl the cold shower or sponge bath ; removal of dyspepsia; meals to be taken at such hours that digestion may be completed before retiring to bed. Flannel clothing. To sleep on hair or straw mattress ; bed in all cases to be insulated from the floor or wall by glass castors, so as not to permit the electrical forces to be drawn off. A suitable house, location or climate selected. As to the effects of asthma, thickening of the rings of the bronchi, alteratives, irritating plaster are of great utility ; other terminations managed on general principles. One of the most common diseases of the spinal Ataxia cord, and consists in an increase of its interstitial Locomotor, connective tissue, forming a ribbon-like sclerosis of the white posterior columns and horns of the cord, and posterior roots of the spinal nerves, leading to gray de- generation, with peripheral structural change in the cranial nerves. These changes usually begin in the lateral part of the posterior column in the upper lumbar and lower dorsal regions and extend upwards and downwards, and in old chronic cases the sclerosis may even extend to the medulla oblongata, Ataxia is most frequently met with in men (rarely in women), generally between the ages of twenty and fifty. Neurasthenia acts as a predisposing cause; whereas, anything; which will impair the integrity of the nervous system, as cold, wet, mental and physical overwork; masturbation, sexual ex- cesses ; depression of spirits ; deleterious food ; insanitary condi- tions ; poor blood; prolonged lactation; the use of tobacco; sup- pression of the menses ; blows ; falls; concussions, act as excit- ing causes. It may either, be an attendant or a sequela of dis- ease germs in the blood, more especially the microbe of syphilis ; pneumonia, diphtheria, fevers, and the like. Ataxia is generally ushered in with nervous prostration, fol- lowed by a gradual disturbance of sensation, loss of co-ordinating; power of the lower extremities, with indications of paralysis.. There is sometimes temporary diplopia and color blindness, with unequal contraction of the pupils. The course of the disease is slow and progressive. In a large majority of cases, in the pre- monitory stage there is intense pain in the limbs, of a sharp, tear- ing character ; incontinence of urine; spermatorrhea or nocturnal pollutions ; sexual hyperaemia; but most generally there Is a per- fect loss of sexual desire. Extreme weariness, nausea, vomiting, aching in the stomach, with a sense of formication and numbness in the skin, with a tightness or girdle sensation round the body are present in a number of cases ; while in another class we 6 82 DISEASE GERMS. have rectal, vesical and nephritic neuralgia, with cerebral c.is- turbance. The nervous disturbance is very variable, a sense of numbness in the hip, a pricking sensation in the knee joints, a sensation of some soft substance between the feet and the ground, an un- steadiness of gait; walks like one intoxicated; if the feet are brought closely together, the eyes closed, the body will sway to and fro and then fall; patient is compelled to watch his feet while walking. Later on he throws out his feet and hands with forcible, irregular, jerking movements. The loss of co-ordinating power is so great that the patient by and by is unable to walk. Marked loss of sensation in feet and legs and of temperature. Sensation blunted, senses impaired, but the higher cerebral faculties are rarely impaired. The abolition of the tendo-reflex is one of the diagnostic signs of the disease. A peculiar inflammatory affection often attacks the joints, knee hip, shoulder, elbow, which often terminates in a complete disor- ganization of the articular surfaces. Paralysis of the sphincter muscle of the bladder and rectum, bed-sores and numerous other distressing symptoms. The recognition of the disease is based entirely upon the symp- toms enumerated, and it cannot possibly be confounded with any other malady. The efficacy of treatment depends a good deal upon the stage at which it is commenced. An alterative and tonic course is the most reliable. The utility of comp. saxifraga, phytolacca, in alternation with cinchona and the mineral acids cannot be doubted. The glycerite of kephaline, tincture of oats, comp. tincture mar- ticaria, in alternation with tincture of belladonna, cannabis Indict, phenacetin merit a trial. Locally to the lumbar region of the spine, an irritating plaster 9-inch x 6-inch, longways across, should be worn so as to keep up an absorbent action, but never to cause an ulcerated surface—on about one half the time, off the other. The use of electricity, by faradization and otherwise, is of little benefit compared with warm baths of sulphuret of potassium, alternated with cold baths and massage. These are of great efficacy. The suspension treitmcnt is barbarous in the extreme; there is nothing in it to commend it to common sense, far less science. Bowels should be scrupulously cared for, well regulated. The diet and mode of life should be such as is most conducive to the highest degree of health. Everything which will preserve nerve-force and prevent exhaustion. BACTERICIDES. 83 Pulmonary collapse or atelectasis is a condi- Atelectasis. tion of the lungs in which there is a partial or total absence of air in the alveoli. Congenital atelectasis occurs in feeble infants or those born pre- maturely, where the nares or other parts necessary to respiration are plugged with mucus. Pulmonary collapse is more rare in adults than in infants. Any disease or condition which weakens or obstructs the power of inspiration may induce it, such morbid states of the brain, light clothing, paralysis of the vagus; syphilitic disease of the cord; in bronchitis, that is the catarrhal-pneumonic form, in which the bacilli are abundant, where they crowd the bronchi and tena- ciously aggregate together, forming a plug in a bronchus—not permitting air to enter. Collapse from aneurisms, hydrothorax, tumors, pus, air, very common. From the total mortality of infants nearly thirty per cent, is due to collapse. The pathological condition of collapse or where lung substance has not been penetrated by air is, engorged with blood, looks like a piece of liver " splenified," will sink in water; fatty degenera- tion, cell and germ proliferation soon occur in the collapsed part. The entire lungs may be affected or only part. It may be suspected or recognized in the new-born by feeble breathing, very slight motion of the chest, a low, almost inaudi- ble whining cry, lividity and coldness of the extremities, constant sleepiness, often muscular twitchings and convulsions. Child cannot nurse. Since the foramen ovale and ductus arteriosus so often remain open in congenital atelectasis, anomalies of the cir- culation may cause asphyxia, convulsions, suffocation and death. Blood clots often form in the cerebral sinuses. When collapse occurs in advanced life during the progress of acute capillary bronchitis or some other affection of the respiratory organs, there is labored breathing, dyspnoea, frequent cough, with muco-puru- lent expectoration, frequent respirations, from seventy to one hun- dred per minute. Passive hyperaemia and oedema of the ex- tremities are common results of pulmonary collapse. The pulse is small, feeble ; the skin cool, urine scanty. ' An interval between inspiration and respiration. The physical signs are, an absence of intercostal movement, dulness or percussion over the collapsed lung; respiratory sounds feeble or absent. Later on bronchial breathing and bronchophony. Rales due to associated bronchitis, coarse and sonorous. Its recognition from pneumonia is easy: there is no fever, no flush on the cheek, no prune-juice expectoration—from the 84 DISEASE GERMS. tubercular bacilli, in which there is hectic, wasting, cough, microbe in sputum, etc. Well-marked atelectasis is very fatal, especially if complicated with the mycelium of hooping-cough, or the germs of pneumonia or pulmonary tuberculosis, or asphyxia. Treatment.—In the new-born the treatment should be the hot bath, followed by dashing cold water on the nuchal region, which excites strong inspiratory impulses; kept rolled up in warm flan- nel, 8o° F. Rubbing, friction, stimulating liniments, massage ; a reapplica- tion of the bath. The salts of ammonia and potash are most admirable remedies. Small doses of lobelia and bloodroot are most admirable drugs, to relieve bronchi, carried to emesis to dislodge clot or plug. In all cases tonics, stimulants and active nutrition are indicated. Blows, violence, strains, tension of blood- Atheroma. vessels measurably weaken their coats and pre- dispose them to disease. This may involve a large area of a vessel, but most generally it is limited to points or patches. If there be extraneous or adventitious matter in the blood, as there is in tuberculosis, syphilis, cancer, gout, rheumatism, lead poisoning, chronic alcoholism, waxy, fatty,. calcareous and other forms of degeneration. Some of these states or conditions give rise to an inflammation or irritation of the internal coats ©f the vessel, which give rise to- the multiplication of cellular elements. Granular, fatty degenera- tion of these speedily give rise to arterial sclerosis. When this. commences, first the internal and by and by the middle coat fol- lows, a point or focus of deposit which comes from the blood current. This deposit, a mere pellicle at first, takes on a yellow,. atheromatous condition. The changes begin in the centre of the patch; when duly completed it contains a putty-like mass of cholesterin crystals,. fat granules and crystals of fatty acids. When there is little or no fatty change in the patches the process is called "sclerosis,"' and they are stained dark brown. When these processes progress slowly, calcareous granules infiltrate the tunica intima, and later on form thin, friable, calcareous plates just underneath the original. internal pellicle. Arterial sclerosis is peculiar to advanced life and to males ;• any artery of the body may be affected, but the larger trunks are more susceptible to this change. When so, they become still, more enlarged, irregular, friable. BACTERICIDES. 85 Nature frequently makes an effort to rid the vessel of the offending material. Then the stiffened calcareous coats break ; chinks are formed, into which blood flows, which after a time becomes melanotic. In large vessels the middle coat often dis- appears entirely, connective tissue taking its place. Destruction of the middle coat almost invariably gives rise to aneurism. The symptoms of atheroma are often obscure : heart failure, mechanical rigidity, pulse almost imperceptible, coldness of extremities, extreme debility, dry gangrene; apoplexy, epilepsy, dementia, petrification. Special organs may atrophy, lungs become emphysematous; general bankruptcy of all parts of the body. The diagnosis is often difficult; if near the heart, paroxysms of angina pectoris ; other parts, different symptoms. Calcifica- tion of arteries gives rise to aneurism. Atheroma is justly regarded as an incurable disease, but if it were possible to recognize it early enough much good might be effected by charging the blood frequently with proper doses of -comp. oxygen, hydrogen peroxide, which has the effect of causing a dissolution of the deposit, whatever it may be. A want of nourishment; a morbid condition Atrophy, resulting in deficient nutrition of the body, or a part of it; a decay or waste of substance. If cer- tain causes exist it may attack any organ, gland or tissue. Atrophy of the Brain.—Cerebral atrophy may be congenital, or the result of old age. It may follow cerebral hemorrhage, or softening, or induration, or tumors, or chronic inflammation, or effusion. Injury, or destruction of vessels, or calcareous degene- ration induces atrophy. Masturbation wipes out the typical fissures of thought and invariably brings about a shrinkage; so do sexual excesses, but not in such a marked degree. The use of alcohol, opium and tobacco induces anaemia of the brain, which is followed by atrophy. The infantile form of marasmus of the brain is generally due to defects in the parents, as tuberculae, syphilis, mercury; to maternal impressions, injuries. Brain liable to be atrophied is irregular, hard, misshapen, owing to defective fcetal development. Physiologically the brain begins to diminish in size and weight after the sixtieth year, in drinking men and masturbators much earlier. Slight atrophy belongs to old age, bnt interstitial wasting of the connective tissue belongs to habits and germ-laden blood. 86 DISEASE GERMS. The greatest waste of brain substance in any known disease is paralysis of the insane, where the cerebrum is often only one- half its size and weight. Cerebral atrophy is attended by a general failure of the mental faculties and senses. Memory is first impaired, movements arc- unsteady, then accompanied by tremor. Patient sleeps the greater part of the time. Incomplete paralysis accompanies these atrophic changes. Epileptiform seizures are often fre- quent. Such symptoms as headache, vertigo, irritability of temper, decided weakness of memory, thickness of speech, change in the voice, hallucinations of untold riches, terrible outbursts of rage, followed by complete imbecility. Atrophy of the brain in time involves the medulla, implicat- ing the life centres situated therein ; deglutition and respiration are much interfered with. Senile atrophy can never be mistaken for any other brain lesion, as it comes on slowly and steadily in advanced life, and is progressive. Congenital atrophy is very apt to terminate fatally about the fourth year. Improvement of the general health is the most important indication in treatment. Gentle exercise; bathing twice daily. followed by massage and faradization of the entire body. The diet should be generous and the bowels carefully regulated, and some of the following cerebral stimulants should be tried: Tinc- ture avena sativa; glycerite of kephaline; ozonized water, etc. General alteratives and tonics. Atrophy of the Heart.—This consists in a diminution in the size and weight of the heart. It is described as simple, concen- tric and eccentric; but these terms are scarcely necessary, as all cases of true cardiac atrophy are concentric ; that is, are accom- panied by a diminution in the capacity of its cavities. In some cases, wasting of the cardiac muscle is attended by an increase of intermuscular connective tissue; in such cases, there is a decrease in the size, but a very marked diminution of its contractile power. A decrease in size and number of the muscular fibres often takes place, due to morbid states of the pericardium, which is often ad- herent, indurated, puckered, opaque. The tendency of all forms of muscle waste is to fatty degeneration ; when the cardiac muscle reaches that point it is called yellow atrophy. In atrophy due to old age, the heart muscle is brown, due to extensive pigmentation. The common causes of cardiac atrophy or wasting are an im- poverished brain, exhausting disease, germ-laden blood, as in phthisis, syphilis, cancer; typhoid or any morbid state, accompanied by defective nutrition, may produce atrophy of the heart-muscle ; BACTERICIDES. *7 old age, pressure from pericardial effusion, morbid growths, aneur- isms operate by pressure, causing constriction, fibrous thickening of the pericardium, atheroma, thrombosis, may cause atrophy. It is not infrequently congenital, associated with the dwarfed in- tellectual faculties of children whose fathers may have been ine- briates. Cardiac atrophy is easily recognized by the decreased area of dulness over the region of the heart, its diminished contractions and respirations ; enfeebled heart-power ; impulse feeble ; sounds indistinct; lowered temperature. That form which results from local interference with the nutri- tion of the heart, as adhesions and thickening of the pericardium, tumors, presents symptoms nearly analogous to those of a fatty heart. The prognosis of any special case will depend upon the cause and extent of the atrophy; when it passes into fatty degenera- tion, which is known by its irregular action, sense of suffocation, or by the presence of pericardial adhesions or effusions, the prog- nosis is most unfavorable ; the atrophy of old age is not neces- sarily fatal. In the treatment of atrophy of the heart, physical exercise and mental excitement and study must be avoided. The diet should be generous to a fault, highly animalized, indulged in freely. Some of the following remedies should be tried, so as to stim- ulate or promote growth of muscle fibre: Iron, arsenic, mineral acids, preparations of cinchona are in- variably serviceable in all cardiac affections attended by feeble nutrition and heart failure. Sparteine sulphate excels all known remedies as a cardiac tonic, and cactus, strophanthus, convallaria are also good. Atrophy of the Lung.—Is commonly due to senile changes incidental to old age ; emphysema; general marasmus ; hydro- thorax ; pressure from tumors. An atrophied lung is small, dry, anaemic; pigmented, or marbled by lines or dots; some degree of fatty degeneration always present, most invariably accompanied with numerous complications. The most prominent symptoms are difficulty of breathing; oedema and coldness of the extremities; cyanosis ; a pigeon- breast appearance of the thorax, moving as if it was in one piece. Atrophy of the lung admits of no treatment. Atrophy of the Prostate.—The greatest therapeutical use of fl. • ex. of the saw palmetto, even greater than its nutritive action, is the restoration of the glandular structure of glands. Atrophy of the testes is a common result of spermatorrhoea, masturbation, 88 DISEASE GERMS. sexual excesses, varicocele, but atrophy of the prostate is much more rare ; still it is common, generally associated with prosta- torrhoea, from self-abuse or imperfectly cured gonorrhea. No greater calamity could befall a man, for when it exists the force of ejaculating the semen is impaired or entirely gone. Besides, when the gland wastes or withers, there is a deficient or scanty secretion. Cases of this kind occurring in practice require nice tact and judgment; remedies used must have a vitalizing effect on the entire genito-urinary tract, as well as a general alterative and tonic course. It is true the saw palmetto and kephaline excel all other remedies, but it is not to be understood that when these drugs enter the body that they intelligently avoid all other parts and reach directly to the prostate and brain. No ; they have an effect upon the entire body, more or less. Not a gland that is not stimulated when the palmetto is administered, not a fissure of the brain that is not roused into activity under the influence ot the ozonized glycerite of kephaline. Those two remedies are indicated in all prostatic affections, in atrophy, prostatorrhcea, inflammation, congestion, etc. In addition : direct medication of the prostate can be effected by the introduction of ozonized urethral bougies prepared either from damiana or salix niger, and also by the use of rectal sup- positories prepared from the same agents. Atrophy of the Testes, due to varicocele and like causes, best treated by local stimulation, bathing the scrotum with oil of pal- metto berries; wearing a suspensory; a general constructive treatment. Atrophy of Muscles.—Muscular structure may waste its fibres, become small, pale, inelastic, and its proper texture usurped by fat. This may happen from non-use ; from injury to their nerves ; from the presence of microbes, eating up the neurine or pabulum of nerves, as in fevers and microbial disease ; from the presence of the amylobacta of rheumatism ; from shocks, concussions of the spinal cord, and a variety of other causes. Its recognition is easy ; there is wasting, a decided decrease in size of the affected parts, its temperature diminishes, sensation impaired, numbness, formication, imperfect nutrition ; if the patient is young it fails to grow in proportion to the rest of the body. The process of wasting may or may not be painless. If the nerves are irritated by disease germs circulating in the blood, there will probably be pain. The wasting of muscular structure, if not arrested, is proeres- sively onward to fatty degeneration ; that is, the muscular fibres BACTERICIDES. 89 arc usurped by fat, a non-vital, inelastic body, devoid of contrac- tility and all power of motion. This can be easily ascertained by placing the positive pole of a battery near the insertion of the muscle supposed to be affected, and the negative near its insertion, permitting a pretty strong current to run, gradually bringing the two poles within about four inches of each other. If muscular fibre be still good, the muscle, in a few seconds, will bulge up or contract at its centre between the two poles of the battery. If muscular structure has degenerated, that is become usurped by fat, the muscle will remain quiescent and exhibit no sign of contractility. Treatment.—Once it is positively ascertained by the above test that the muscle has lost its contractility and undergone fatty degeneration, no known remedy is of any avail; but if there be a slight motion or evidence of contraction between the poles of the battery with a fair current, a cure can be effected if the cause can be removed. Suppose slight evidence of contractility exists, a careful examination should be made to ascertain whether or not there exists in the blood or other vital structures of thebody -any microbe or disease germ, such as the microbe of syphilis, cancer, tubercle or the bacillus of fevers, or diphtheria; and if such exist the patient should be placed on special bactericides to kill the microbe, and a general tonic course, embracing such remedies as cinchona, mineral acids and very nutritious, highly- fibrined food. To the affected muscle or muscles, massage, which will embrace stimulating frictions, baths, electricity for a specified time, once or twice daily, so as to stimulate growth of muscular fibre, and this to be continued for a period of some months. If there be pain, there are microbes present, nibbling at the withered or blighted nerves, hence the need of potent germicides. If those germs have caused stiffness rigidity, they should be managed on general principles. Consists of an irritation, inflammation, with a Balanitis, shining, glistening redness, or excoriation of the covering of the glans penis and inner aspect of prepuce. Some call it balanitis when the glans only are affected, and balanitis-posthitis when both glans and internal lining mem- brance of prepuce are involved. The distinction is unnecessary and altogether uncalled for, as the two conditions are essentially the same. Causes.—Excessive sebaceous secretions around corona glandis often give rise to it in boys and virtuous young men, and cause 90 DISEASE GERMS. anxiety, which ignorant or knavish physicians will magnify into something venereal, so as to extort a fee. Rubbing of clothes, chafing in hot weather, masturbation, a natural rankness in some women, will cause it in highly-organized and susceptible men; catamenial discharge, and the venereal germs. From whatever cause it arises, it can be communicated to the opposite sex by contact; as the parts, whether dry or freely exuding muco-puru- lent matter, are freely covered or filled with bacteria. Anti- septic precautions should be rigidly observed; destruction of the dressings, and great cleanliness, especially about the hands, lest any of the matter reaches the eye. Symptoms.—Heat, redness, itching about the glans. In some cases it is of a smooth, shining redness; in others, a muco-puru- lent discharge. On uncovering the glans, by drawing back the prepuce or foreskin, patches of redness and excoriations are per- ceived, with flakes of curd-like matter. If there be swelling of fore-skin, or if its sphincter fibres are irritated, it may be con- tracted, so that it cannot be drawn back over the head o£ the penis, so that retraction is impossible, and then there is phimosis. There are many reasons why the foreskin should be drawn back in cases of this kind ; there may be a perforating ulcer, a chancre, or an abscess, or mortification may be taking place; bubo from the irritation may take place ; there may be a gonorrhea, or an indurated or infecting chancre. Vulvitis in women is an analogous affection. Treatment.—Draw the foreskin gently back ; make a wash ot permanganate of potass, ten grains to the pint of water, or a tablespoonful of boroglyceride to the pint; take a small sponge, saturate with the wash, and squeeze it so that it drops from a height of twelve inches on the affected part. Continue this douching till the pint is used ; do it three times a day. After having performed this, press gently a fine piece of muslin, or silk, on the affected part, so as to dry it; then smear over glans and prepuce with ozone ointment. When the foreskin can be drawn back, this plan will effect a cure in a few days. The ozone ointment could be spread on a thin layer of cotton-wool if desired. In cases where the foreskin cannot be drawn back, take a small. gonorrheal syringe, and inject round and round it with same wash. If an ulcer, or chancre, or gangrene is suspected, circum- cision, slitting up of prepuce ; or sometimes it can be relaxed with a warm poultice and belladonna. If there is danger of con- traction, a little cotton-wool smeared with ointment should be kept applied. Mothers should be instructed to draw back the foreskin in the daily ablutions of the child, and apply a little oil to unite with BACTERICIDES. 95 the sebaceous secretion, and then wash off. Young men should follow same practice every day. This would not only promote health, vigor, and growth of the penis, but would do much to prevent masturbation, nocturnal emissions. It would have a salutary effect. The oil need not be used unless there is the white, cheesy secretion ; it will suffice to drop cold water on its neck, with the foreskin retracted, or drawn, back. _______ The poison of venemous reptiles Bites of Rabid Animals and rabid animals is a living; and microbe, which when introduced Venomous Reptiles. through the true skin enters the circulation, where it grows with prodigious rapidity, excretes ptomaines freely. The micro-organ- isms from all bites either have a tendency' to destroy the blood or by their ptomaines the nervous system. In the former case, a species of erysipelatous inflammation of the skin and cellular tissue is predominant; in the latter, a peculiar train of nervous sy mp- toms, as intense pain in the wound, radiating in the course of the nerves; prostration, faintness, rapidly followed by feebleness of pulse, bilious vomitings, difficulty of breathing, profuse sweatings, jaundice, convulsions. The treatment of the bites of all rabid animals should be : a ligature above and below the bitten part to prevent if possible the ingress of micro-organisms into the blood, or necve cells; wet cups, hot fomentations if cups are not handy, free incisions with abundance of hot water, peroxide of hydrogen, to encourage free bleeding and annihilate all microbes ; after the wound has bleed freely and been thoroughly cleansed of microbial matter, it should be dried, and wood ashes or caustic potassa freely applied, then irrigation with ozonized vinegar, followed again with a spray of peroxide of hydrogen, or chloride of ammonia in a poultice. Immediately, or as soon as possible, bactericides should be administered so as to render the blood so thoroughly sterilized that no microbe can live in it. This can be effected with a variety of remedies, subsequently mentioned. In the case of bites by rabid animals, giving rise to erysipela- tous inflammation, the microbe may be in the cellular tissue or blood or both ; the nearest lymphatics are apt to become engorged with the microbial mass, which gives rise to abscess and doughy swellings. In cases of this kind free incisions cannot be resorted to too early, followed by germicide poultices, as charcoal and yeast; linseed meal and resorcin. , DISEASE GERMS. Before the application of these poultices, the entire affected I surface should be painted with an ointment of salicylic acid and creasote, or oil of boroglyceride. . In another class of cases the germ of the reptile or snake becomes imbedded in a nerve or its neurilemma, and grows with crreat rapidity so prodigious that either the germ development or its ptomaine may cause death in twenty minutes, the entire nervous system becoming perfectly paralyzed, the cutaneous surface shrunk and withered and as white as snow, constriction of chest, threatened paralysis of the involuntary muscles often taking place a few minutes after the bite. In all such cases there is no time to wait on the action of drugs, and the quickest and safest plan is to procure anaesthesia of the nervous system for ten or twelve hours by the copious drinking of good brandy or whiskey until perfectly drunk. It must be given in half-pint doses every few minutes to obtain the desired result. It is most extra- ordinary the quantity necessary to be given in some cases, During the quasi-suspension under whiskey there seems to be no pabulum for the germ elaborated, and it dies in the body, the bitten person recovering from his anaesthesia or stupor well. A still more certain method is to combine liquor potass with the brandy or whiskey. The liquor potass completely neutralizes snake poison. It should be given in the brandy in ten, twenty or thirty drop doses sufficiently often. The brandy stimulates, rouses, carries the potash into the blood, and enables it to over- take and neutralize the poison in the blood. The saturation of the system with the alkali until the secretions are alkaline is the point to be aimed at. The permanganate of potassa has the same power, but owes its property to the potash alone. To all bites of venomous insects, as wasps, mosquitos, spiders, and poisoning with ivy, sumach and other agents, a saturated solution of muriate of ammonia, or better still concentrated ozone or peroxide of hydrogen. A boil or carbuncle is an oil-gland of the skin Boils filled with lymph, and interspersed through that or lymph are to be found the staphylococcus pyo- Carbuncles, genus aureus. The microbe is pathogenic of the malady, bears cultivation well in chicken broth. Carbuncles only differ from boils in their size, they contain the same microbe. The pus of either will inoculate and reproduce the original in either man or animal. The primary cause is depression of the vital powers and the exciting causes are malnutrition, derangement of stomach and BACTERICIDES. 95 bowels, and a degradation of normal living matter into bacteria, which pass into the blood and find their way into the oil-glands of the skin, probably in search of free oxygen. The cause of the malassimilation may be overcrowding, bad ventilation, filth, bad diet, as pork, meagre, or insufficient or sameness of food, indeed, anything that depresses the stomach. Symptoms.—Brown-coated tongue; nausea ; loathing of food ; constipation ; fetid breath ; heats and colds ; fever, with head- ache and languor; inflammation of an oil-gland on nape of neck, back, limbs, or anywhere where glands of that class are numerous; gland fills up with the lymph and bacteria, and resem- bles a sugar-loaf, apex pointing inwards and broad base on sur- face ; vary in size from a pea to a large pear; the largest are usually met with on back. The gland is a regular cyst or sac, whose lining membrane is a secreting one. By proper treat- ment, before lymph breaks down, they may disappear ; but if they progress, lymph breaks down, patient has a rigor, then throbbing, and suppuration goes on until either relieved by na- ture or art. In some cases there is a large crop, great constitu- tional disturbance and danger; in other cases, a solitary one may create quite alarming symptoms. In the treatment of all cases of boils or carbuncles, we have a bacteria-coated tongue, very sluggish liver, and in order to excite a healthy action of the alimentary canal, it is good practice here to adminster a rousing emetic of lobelia; and in order to cause rapid absorption of the drug let the patient drink abundance of tepid alkaline water, or warm water to which bicarbonate of po- tassa has been added. This will aid in cleansing the stomach, and the lobelia has a most marvellous effect in retarding and even retrograding microbe evolution. This should be followed with an alcoholic sweat; and the bowels freely opened with a saline cathartic. For a tonic to promote an appetite and keep up a brisk stimu- lating action on the liver, a teaspoonful of the following mixture should be administered every four hours : Compound tincture of cinchona; simple syrup; of each two ounces; nitro-muriatic acid, two drachms. Mix. Bowels kept free with salines, or a dose of the phosphate of soda at bedtime. Some bactericide should be given between the respective doses of the cinchona mixture, such as either tincture of lycopodium glycerite of sulphur, or peroxide of hydrogen, or ozone water, or brewer's yeast, resorcin, creolin, sulphide of calcium. Some remedy to sterilize or annihilate the microbe. The lyco- podium or glycerite of sulphur has a most remarkable action upon the microbe of boils, so have the other remedies enumerated! —one selected which the physicians deem best. , DISEASE GERMS. Locally, if case is seen early, before any indication of the forma- tion of pus, and the patient is desirous to prevent an abscess, the boil may be injected with cither peroxide of hydrogen or gluco- zone, which will destroy the bacteria, and the lymph will be ab- sorbed; or another plan, a paste of the solid extract of bella- donna and resorcin, equal parts, might be tried ; or it might be painted with concentrated ozone and chloroform. liven more energetic discutients might be applied, such as ozonized clay, iodized oil, iodol, etc. If there is the slightest speck or point of softening, any evi- dence that a change to perfect downward evolution has taken place, that suppuration is inevitable, there are several plans which can be adopted. In resorting to surgical procedures, it must be borne in mind that the shape of the boil is like a regular sugar-loaf cone, and for a perfect cure a complete riddance of the germ colony, the sac with its contents must be exfoliated or thrown off, or destroyed, as its contents are extremely contagious, .liable to affect healthy parts. A most excellent method is to protect the adjacent parts, all around the boil, wipe the surface of the boil dry, then take a stick of caustic potassa and apply, burning down into the sub- stance of the boil. This should be done thoroughly. Subse- quently the action of the caustic potassa must be neutralized with vinegar, and an antiseptic poultice applied; latterly it should be healed up with black salve or ozone ointment. Another good method is to make a crucial incision down through the boil and divide it into four parts ; subsequently treat as above. Electrotysis may be tried, but it is simply a method of less painful cauterization. The diet in boils should.be the best, and very generous, includ- ing beef, mutton, poultry, eggs, milk, with abundance of vegeta- bles and fruit. Operatives in copper, zinc and tin are Brass Founders' liable to several morbid conditions from Disease. the inhalation and absorption of the fumes of the metals. Most generally the metal has an affinity for the fine delicate nerves of the duodenum and brain, like lead and bismuth, but workers in brass have a regular cachexia produced by the metal, a feeling of languor and depres- sion, peculiar sallow hue of skin, with anaemia, and febrile attacks like intermittent fever. The attacks, however, do not come on with regularity. In the stage of chill there is usually constriction or tightness about BACTERICIDES. 95 the chest, and in the last stage, which is followed by a profuse sweat, the linen is usually stained with the eliminated metal, and it has a brassy odor. Poisoning by brass and tin is much more common than is generally supposed. Many of the indescribable derangements of the digestive tract are due to minute portions of those metals finding their way there from various culinary articles, as kettles, pots, etc., and also from the cocks and spigots of soda fountains, mineral-water bottles, and ordinary water-pipes. An oxalate of tin is to be found in every article preserved in tin cans, as toma- toes, peas, asparagus, which is exceedingly toxical and capable of producing a well-marked train of symptoms, identical in their character with brass poisoning. The preservation and cooking of edibles in tin and brass vessels is a prolific source of disease, and measures of some kind should be adopted to arrest the spread of this latent form of poisoning. Treatment.—Workmen should avoid the fumes of zinc and brass; iodide potass unites with them freely and causes their elimination. In some cases lobelia emetics are of great efficacy, followed by cinchona and mineral acids ; bowels to be regulated and alkaline baths used daily. The degree of heat that can be borne by Burns, Scalds, the human body without causing injury depends very much upon the medium through which it is applied, as well as the organization of the individual. The degree of partial death inflicted upon the body may be embraced under three grades, as erythema, vesication, ulceration. The danger of burns depends a good deal on their intensity; the extent of surface injured; the degree of disorganization; the importance of the part, the age and power of vital resistance of the patient. Symptoms.—There is the shock; state of prostration or col- lapse, which is often dangerous. The pallor, coldness, sighing respiration, shivering, feebleness of pulse, and other indications of imperfect reaction and exhaustion, followed by fever with congestion or effusion in or upon brain, lungs, bowels ; or it may be reflex, and produce spasms, convulsions, or there may be the tedious, dragging symptom of hectic during the stage of cicatri- zation or otherwise. Besides the above, the arrest of the insensi- ble perspiration of the skin naturally gives rise to a tendency to serous effusion in one or all of the three great cavities, and if the burn partakes of the character of a blister, there are grave changes 96 DISEASE GERMS. that take place in the blood, especially if the blister is extensive. The serum in the blister is found not to be water from the blood, but rich fibrinous liquor sanguinis—and this exudation of blood plasma causes the blood to be thicker, more concentrated, and its relative proportions of corpuscles and plasma modified to even a fatal extent. This concentration of the blood reduces the blood pressure, and retards the flow of lymph, and interferes with the general nutrition of the part. Treatment.— The first point is to bring about reaction by dif- fusible stimulants and artificial heat to the extremities. After reaction, open bowels with castor oil or cascara. If reaction is imperfect then administer aconite and serpentaria for fever. If there are reflex symptoms, as spasm, antispasmodics by mouth and rectum, followed by bromide of potass and calabar bean. Pain must be relieved with hyoscyamus and opium. Repeat until comfortable. Any congestion of brain, lungs, bowels to be treated on general principles. If tonics are required, let them be cinchona and ammonia. Give plenty of fluid nourishment, as milk, beef-tea, raw eggs, juice of raw beef, or raw beef extracts. In all cases relieve pain and nervous irritability. Locally, to burns, nothing can excel the carbolic acid and olive oil; one ounce of the acid to six or ten of the oil, according to age and thickness of skin. It stimulates, destroys micro-organ- ism, and aids healing ; saturate lint and apply. The following is excellent in burns or scalds : Boroglyceride paste, eight ounces ; two-per-cent. solution of cocaine, one ounce; resorcin, half an ounce; mix; absorbent cotton, a sufficient quantity to hold the above in suspension. Apply to any burn. Instant relief of pain,. all inflammatory symptoms arrested, bacteria destroyed. Any application that will exclude air from the injured surface should! be applied until this is procured ; as molasses, lard, and flour, vinegar or starch, and white oxide of zinc and oil. In burns of the second degree (blisters) do not puncture nor interfere with the cuticle. The great danger of burns in this stage is due to the amount of liquor sanguinis in the blister, and death is due to the blood changes so induced in that fluid. This, of course, is best remedied by the juice of meat. The dressing in all cases should be changed thrice daily, and precautions taken against deformity. _______ Inflammation or partial death of the mucous Bronchitis, membrane of the bronchial tubes. It may be acute or chronic, and affect the larger or smaller tubes, or both; or one or both lungs throughout, or only a por- tion of them. BACTERICIDES. 97 A very dangerous form of inflammation, Bronchitis, accompanied with great fever and prostration, Acute. and danger of a spread of the inflammation to the vesicular texture of the lungs, or a plug- ging up of the bronchi with effused lymph and collapse, or inflam- mation of the substance of the lung with blood, lymph, liquor sanguinis, etc. The causes are usually cold, damp, wet, exposure to vicissi- tudes of weather, inhalation of irritants, etc. Symptoms.—Shock, with indications of prostration, violent headache, with rigors, and a high grade of fever ; pulse often 140; respirations from thirty to forty ; heat 105 ° up ; a sense of intense soreness or rawness over the affected part; tightness or constric- tion of the chest; hurried or excited respiration, with rough wheezing; incessant hacking, dry cough at first, afterwards expectoration of viscid, glary, frothy mucus, and afterwards of muco-purulent matter ; pulse, although frequent, is weak ; tongue heavily coated, nausea, great anxiety, with indications of pros- tration and collapse. Inflammation of the main trunk or large-sized tubes is attended with much less danger than the smaller branches. In the smaller branches, there is a greater tendency, in a fit of coughing or excitement, for the tube or tubes to be blocked up by thick viscid, tenacious phlegm, which, on taking a deep inspiration, is liable to be pushed down; acting as a cork, preventing the air from reaching a lobe of the lung, hence collapse. A portion of lung not filled by air becomes quickly hepatized or vesicular, emphysema is produced; so that in either case we have a vital organ incapable of aeration. On percussion of the chest in bronchitis, the lungs should exhibit resonance and clearness from top to bottom ; at least, no marked aeration should be detected, with the exception of increased resonance in emphysema, or the dull, flat sound of hepatization in collapse. On auscultation, in the early stages, dry sounds or rales can be distinctly heard, like air rushing through a red hot tube. If heard over the main trunk or large branches, it is called rlionclius; if over the small branches, sibilus. Rhonchus to the large, sibi- Ius to the small. Sibilus bespeaks danger; rhonchus almost free from it. These dry sounds are usually only heard the first few days, for once the inflammation has terminated in effusion and its products have poured out from the inflamed membrane, those dry sounds arc displaced by moist sounds, called large crepita- tion, if over the large tubes ; small crepitation if over the small. So rhonchus and large crepitation are the dry and moist sounds 7 98 DISEASE GERMS. of large air passages ; sibilus and small crepitation of the smaller branches. Its duration, under good treatment, should not take over a few days. Treatment.—Recumbent posture in bed, temperature, 700 Fahr., air to be moistened by hot steam. If stomach is badly deranged and tongue foul, a gentle emetic of lobelia ; if there be constipa- tion, open bowels quickly with enemas and salines. Diet to con- sist of warm beef tea, warm gruel, or warm milk and arrow-root, warm mucilaginous drinks, as flaxseed tea, wine whey ; heat to feet. Mustard is to be applied over chest and back, large plasters, followed with hot poultices of flaxseed meal and glycerine. There are several methods of breaking up the attack. If seen early, one is by the administration of large doses of tinctures of aconite and veratrum every half hour, till pulse is seventy, and then at less frequent intervals. This is a good plan, another plan is to administer either antipyrine, or antifebrin till temperature is normal; still another is to give small does of lobelia until the patient becomes slightly nauseated and pulse down, and then at less frequent intervals. And a fourth good expedient is to use jaborandi or its alkaloid ; the former in fluid extract, or, if the latter, by hypodermic injection. If jaborandi or pilocarpin be used, the patient must cease drinking and spit out his saliva freely. The powerful revolution which this latter remedy pro- duces in the distribution of the blood, has an instantaneous effect in attracting the blood to the skin, relieving the bronchial mucous membrane. Its action is quick in giving relief; besides, it favors the expulsion of the obstructing plug in the air passages, prevents the formation of viscid mucus, prevents the swelling ol the large bronchial glands and initiates reparatory process in the bronchial tract. In an urgent case the four methods might be combined. As soon as the urgent symptoms are perfectly con- trolled, an alkali, such as the muriate of ammonia or chlorate of potassa, or carbonate of ammonia or potassa. The effects of alkalies are very marked, indeed. They soothe, soften and aid expectoration, and if given in combination with an acid, the dry rales subside and are replaced by moist ones ; expectoration copious, and cough less frequent and less troublesome. Con- valescence to be established upon alteratives, as the ozonized glycerine, phytolacca, and tonics, like quinine and mineral acid-. may be a sequel of an acute attack, Bronchitis, Chronic, or it may come on of itself from the same causes that produce the acute, or from the presence of microbes in the blood. BACTERICIDES. 99 Symptoms.—General symptoms of nervous prostration, lan- guor, lassitude, debility, face white, features sharp-pointed; nervous dyspepsia; phosphates and chlorides in urine ; great emaciation, harassing cough, even habitual; great difficulty of breathing, shortness of breathing ; sometimes a sense of soreness or rawness, in other cases this is absent. The lungs in ordinary cases should be clear from top to bottom, but as it generally assumes one or other of two forms, this may not be the case. One form, without expectoration, tends to emphysema; the other, with copious expectoration, leads to pulmonary consolidation. • The former will have unusual resonance on percussion; the latter, dulness. If there is expectoration, it is copious, and aggravated by exposure to cold or damp, bad living or change of temperature. There is little rhonchus or sibilus in chronic bronchitis, but abundance of moist crepitation, large and small. In all cases the nutritive disturbance proceeds from the surface of the bronchi and gradually spreads to the stroma of the lungs, terminating in atrophy or in sclerosis. Dilatation of bronchi, with condensation of surrounding tissue, often results; some- times a sort of bronchial catarrh, with excessive muco-purulent discharge. The winter coughs or colds, recurring annually, are but the precursors of more permanent forms of bronchial inflam- mation. When interstitial sub- _______y~-~^^<^::=:y:::cxrx^ccy x> stance of lung is "E^1--5- ^______________i_)j ^ greatly affected ^^^^^^ ^t in cltllcr 1UI III, Conferva of bronchitis as found in the sputum of all chronic cases. non-aeration of blood to a limited extent, which gives rise to a blueness of nails or lips, slate or even livid appearance of skin, especially of the lower extremities. It is essentially a chronic affection, lasting years, seldom directly fatal, but may be so by the causing of other diseases. In chronic bronchitis there is always a true ulceration of the bronchial mucous membrane, and a degradation of the living matter concerned in its nutrition into bacteria, which are found in great abundance in the sputum ; not however in such irnrnep.se quantities as in chronic laryngitis, still, enough co place chronic bronchitis as a somewhat contagious disease. There are invariably present in every case of chronic bronchitis, no matter whether it be simple, tubercular, syphilitic, the vege- table microbe, the conferva. It is the presence of the original germ, and this latter, which renders it such a stubborn malady. Treatment.—This is varied, but embraces certain welr-defined principles. A warm, moist atmosphere, which contains a small IOO DISEASE GERMS. amount of oxygen, is the most suitable; flannel or silk clothing, especially next to skin; daily bathing, alkaline or acid, followed by inunction of warm clive oil to the amount of three or four ounces; diet and drink to be warm and of the most nourishing kind, such as milk, eggs, boiled fish, broiled tenderloin steak, with'abundance .of cooked vegetables. Warm food and drink are powerful expectorants, and in all cases it is well to have the patient drink a cup of hot coffee or milk before getting up, or warm beef tea. Stomach to be looked to with tonics, and bow- els carefully regulated. All physical and mental exertion or excitement to be guarded against. On the front and back of chest there is no liniment or stimulant that can equal the irritat- ing plaster. It should be worn as much as possible, at least one-half the time. If the irritating plaster cannot be tolerated, then painting the chest with concentrated ozone should be resorted to. As it is a chronic disease there should be a persistent course of alteratives and tonics, changing them weekly ; the tonics before meals, alteratives two hours after. Such alteratives as ozonized glycerine, compound syrup phytolacca, ozonized saxifraga, with iodide of potassa, and tonics, ozone-water, solution of quinine, tincture cinchona, compound golden seal. Besides the above there must be a treatment with expectorants and bronchial stimulants, so as to arrest or mitigate cough and promote a healing process in the bronchi. For this purpose various preparations of ammonia are expectorants, such as muri- ate of ammonia in syrup of squills, carbonate or citrate of ammo- nia in syrup senega ; chloride or bromide of ammonia in syrup of ippecac.; nitric acid and compound tincture cinchona; tolu, conium, and belladonna; balsam copaiba dropped on sugar; cubebs and extract horse-radish; benzoate of ammonia in port wine ; lobelia and blood-root. It is impossible to mention a single curative remedy; whichever affords the greatest relief should have the preference. Besides the above, the greatest benefit is to be derived from the inhalation of moist, warm, medicated antiseptic vapors several times a day. The remedies to be of any utility must be anti- septic ; such as sulphurous acid, creosote, chlorate or permanga- nate of potassa; tincture of benzoin, benzoate of soda, resorcin, naphthaline, creolin, concentrated ozone, boracic acid, carbolic acid, and a variety of others. The inhalation-of stimulating antiseptics proves very beneficial in all cases, and is one of our valuable aids in cure. The action of a disinfectant and stimulant on the ulcerated surface, with its destructive influence on the germs, is of great benefit; and one thing can be said of it BACTERICIDES. IOI —that it in no way interferes with the use of CDnstitutional and internal remedies. It is best to be used frequently, for half an hour or more at a time, and as often as four or five times a day, but in no case must either its use or strength excite any cough. The physician will find himself taxed to the utmost in the selec- tion of the particular remedy to be used; and the patient will be required to second his efforts by a persevering adherence to the treatment prescribed by him. There should be at least three inhalations per day ; the remedy used every time should be a germicide. Alteratives, tonics, inhalation, and a very free use of expecto- rants is undoubtedly the best method of treatment in patients under forty-five years of age. When chronic bronchitis occurs over that, the use of expectorants is of doubtful efficacy, often injurious. is a peculiar and dangerous form of chronic Bronchitis bronchitis, occurring in persons over forty-five, Senilis or in the aged, and is due to natural decay or degeneration of the bronchial mucous membrane, as a result of age. It is spoken of under various names, as catarrhus senilis, bronchitis of the old. It seems at first to con- sist of a general inflammation of the capillaries of the tubes, fol- lowed by atrophy and interstitial death; sometimes comes on in an acute form, attended with great danger; more generally it is insidious, making its appearance with great difficulty of breathing, and excessive • secretion of frothy mucus. Its symptoms and treatment are the same as chronic bronchitis, with the exception that, as a general rule, expectorants operate badly, aggravating the symptoms, whereas under tannin or vegetable astringents there is a remarkable amelioration. consists usually in acute catarrh, laryngitis, Bronchitis, bronchitis, general and capillary. It is usually Infantile, due to cold, and is easily recognized by its ten- dency to asphyxia, difficulty of breathing, great congestion of the skin, perpetual cough, general restlessness, in- creasing prostration, and in fatal cases, somnolence, muttering, delirium, coma. General management as to warm, moist atmosphere, warm bath, oil to chest and throat, aconite and belladonna for fever, and a free use of lobelia are our best remedies. One heaped tea- spoonful of pulverized green lobelia, and the same quantity of 102 DISEASE GERMS. carbonate of potassa to a teacupful of boiling water, allowing it to cool and settle ; and begin by administering half a tea- spoonful every hour, half hour, or less frequent, giving it largely morning and night to procure free vomiting. The vertical posi- tion of a child's stomach during the early years enables it to vomit easily; and this act is indispensable in children, because they swallow the products of inflammation, lymph, mucu-purulent matter, etc., which, in themselves, tend to aggravate the symptoms and keep up a sort of hectic fever. There are no remedies so useful in infantile bronchitis as lobelia and potassa ; the latter softens, while the former keeps up free expectoration. As the case improves, ipecac, tolu, senega, squills, wild cherry, etc. This is simply a form of chronic bronchitis, in Bronchitis, which there is a drying up of the lymph and Plastic. muco-purulent matter in the tubes, in which they become solid in the shape of the tubes, tubular concretions of exudative matter within bronchi. Symptoms.—The same as the chronic, to which are to be added expectoration of casts of tubes, or of moulds of notable size, preceded by a great difficulty of breathing, dry, hacking, racking cough, followed by hemorrhage, and the haemoptysis often excessive. Small casts are expelled easily, while large ones, especially if fibrinous, are not easily got rid of, as they are congealed and adherent, sometimes a pure congelation of lymph or blood. Such bodies, by their irritation, often give rise to re- newed irritation. It is even more troublesome and intractable than the chronic form. Treatment, same as for chronic, with the exception that such remedies as carbonate of potassa, chlorate of potassa, muriate of ammonia, iodide and bicarbonate of potassa should be given more freely and repeatedly ; hemorrhage arrested with digitalis in preference to gallic acid or iron. Usually chronic, and due to the inhalation of Bronchitis., particles which irritate, inflame and ulcerate Mechanical, bronchi. For example: file-makers, knife- grinders, carpet-shakers, dust of coal in miners, cotton, woolen and silk operatives in factories, and other occupations. It is customary to so designate the bronchitis. BACTERICIDES. 103 Chronic bronchitis occurring when there arc Bronchitis, disease-germs or morbid states of blood ; germs Microbial, are apt to colonize in the weakened, ulcerated mucous membrane of the bronchi, and greatly aggravate the difficulty. We have the vibrios of typhoid fever irritating a feeble bronchi tract; the latent germs of rabies, the germs of syphilis, tuberculae, etc., gout, rheumatism and other blood poisons. According to the germ or poison present, the bronchitis is so named. The symptoms are much worse, usually double, especially the emaciation or wasting debility is very great; night-sweats, copious or excessive mucu-purulent expectoration. Alteratives and tonics, same as chronic bronchitis, and special drugs to destroy germ or neutralize blood poison in each indi- vidual case. Especially in the tubercular and syphilitic forms, these microbes in their growth and development excite so much thick- ening as to form a false or germinal membrane around the tubes —these are occasionally thrown off, creating great constitutional disturbance and danger by hemorrhage. The microbes also excite more ulceration from the germs eating the tissues, follicles, glands and coats of the tubes, causing great excavations—germs active in destruction, freely excreting ptomaines which give rise to hectic, great suffering, rapid emaciation. The profession at large should in all cases search out in the sputum for the proper germ, and in seventy-five cases out of a hundred, they will find in all cases of chronic bronchitis, that either the microbe of syphilis or the bacillus of tubercle is at work in the production of the grave lesions that exist. Hay fever, summer catarrh ; often severe, with Bronchitis, asthmatic symptoms superadded; due to the Hay. micro-organisms of plants, or bacilli of hay and other grasses, causing a degradation of the normal bioplasm of the respiratory mucous tract from nose down to the air-vessels. Symptoms.—Quite complicated; headache, suffusion of eyes, sneezing, irritation of nose, fauces; larynx, bronchi, often greatly congested; cough, and the other physical signs of acute bronchitis. It is a sort of combination of acute catarrh, with sub-acute laryngitis and bronchitis. Ireatment.—Removal of cause, if possible. Quinine is the best preventive. If chiefly catarrhal, a solution of boroglycer- ide in infusion of golden seal with nasal douche. Some of the following remedies to give relief—compound lobelia, ammonia in 104 DISEASE CEEMS. some form, citrate of caffeine, belladonna, etc. If they fail, gen- eral treatment for chronic bronchitis. This is characterized by an enlargement of Bronchocele. the thyroid gland. The entire gland may be affected, or its centre, or either lobe. The swelling is usually unassociated with pain, and causes little incon- venience, beyond the deformity it produces, unless it presses upon the adjacent parts. Causes are very varied. It may be due to water impregnated with lime or magnesia ; to tuberculae; to irritation, reflected from the organs of generation to the nerves that supply the thyroid, causing enlargement and congestion ; to uterine disease, or an anaemic condition of blood. It is a true hypertrophy and is divided into three forms, accord- ing as the vascular, glandular or connective tissues are involved. I. Vascular Goitre is most common in this country, and con- sists merely of engorgement, congestion from suppressed men- struation, masturbation, gonorrhea, amenorrhcea. Branches of the sympathetic nerve covering the anterior por- tion of the uterus, clitoris, penis, are reflected over the mamma .and thyroid, hence the connection. Besides, the gland, from its peculiar function of aiding in controlling the circulation in the brain, is very profusely supplied with blood-vessels and is liable to take on congestion from very slight causes. Vascular goitre often terminates in rupture of vessels, blood absorbed and recovery. In other cases calcareous degeneration may take place. 2. Glandular or Cystic Goitre consists in a development ot the glandular capsules and their distension, and is filled with a gelatinous fluid. 3. The entire transformation of the structure of the thyroid into a calcareous or chalky mass. Symptoms.—The whole gland may be swollen or only the centre or side of it. Frequently no inconvenience but the de- formity. In other cases distressing symptoms are produced by the pressure upon surrounding parts, and respiration and deglu- tition may be rendered painful and difficult by the compression of the trachea or oesophagus. In other cases severe constitutional symptoms, as anaemia, palpitation, mental depression, dyspepsia; irregularity of uterine function, as scanty menstruation, profuse leucorrhcea. Its duration is somewhat tedious ; much more common among women than men. BACTERICIDES. 105 Treatment.—The cause must, if possible, be ascertained and removed; such as water, or irritation, or disease. Then a gen- eral alterative and tonic treatment inculcated, with the very best of food. Whether caused directly by tuberculae or not, that con- dition is inseparable from it; hence special drugs for the destruc- tion of that germ, such as iodine and bromine in their various forms, tincture of iodine, iodine and glycerine, iodide of starch, iodoform. Bromine is not so active. Fluoric acid in an alter- nated solution is acquiring great repute in the cure of a great number of cases. Locally, ozonized clay is extremely effica- cious, taking care to cause no redness of the skin. The bursa mucosa are membranous Bursal Swellings, sacs situated about the joints, particu- larly the large ones of the upper and lower extremities. They lie under the tendons, act as cushions, their internal lining membrane secrete an oily fluid which is de- signed to lubricate the surfaces over which the tendons play. In consequence of irritation, such as pressure, bruises, sprains, contusions, etc., the secretion becomes excessive, and they swell, become inconvenient from their size. They are generally round or oval. An effort should be made to excite absorption by pressure; by painting with colorless iodine ; by concentrated ozone. All fail- ing, a seton should be inserted through it. A bunion is simply an irritation, inflammation with thickening of the bursea mucosa at the ball of the great toe. To these the gutta-percha solution with iodole; or else the collodion and tannic acid might be conveniently applied. is a term applied to irritation, inflammation of the Bubo lymphatics of the groin. It may consist either of a simple irritation, or may depend on absorption of venereal germs into the lymph channels. Causes.—It may be caused by a simple inflammation of urethra, by balanitis, by masturbation or sexual excesses, long walks, horseback exercise, in-growing toe-nail. It may be due to the presence of the venereal germ, chancres, etc. Symptoms.—The gland swells, becomes indurated and tender, fills up with lymph, and when the lymph breaks down, a suppur- ation takes place; there are rigors and pain, burning, throbbing. In some cases, fever and great difficulty in walking. Pathology.—The contents of bubo are microbial, if not the io6 DISEASE GERMS. germs of syphilis or tubercle, then the microbe. Streptococcus pyogenus is always and invariably present. Treatment.—-In order to prevent the irritation of the lymphatics of the groin, all applications to any morbid condition of the genital organs should be of a soothing nature. No caustics or irritants should be used, or, if used, those should be selected that cause no pain; all applications to be of a soothing character. There are various remedies and modes of management, if they once form, in order to prevent suppuration. Gentle pressure, with plantain leaves next the skin, or iodo- form ointment, or phytolacca, or stramonium ointment, with iodide potass. The ozonized clay, without pressure, or hot poultices. If it is soft in centre, if pain is throbbing, poultices ; if desirous of hastening it forward, slippery-elm poultices, hot, with a good quantity of bicarbonate of soda in them during day, and linseed poultices during night. It may open itself, or have to be opened. In either event, it must be borne in mind that it must heal from the bottom ; that its internal lining membrane or sac must be destroyed, as it is a true secreting membrane; so, if opened by the knife, the incision should be made in four different directions,. so as to destroy its sac and permit it to heal from the bottom. If it opens itself, then, after its contents have been thoroughly evacuated, inject the sac with tincture iodine and iodide of potass, so as to destroy the secreting faculty of the internal lining mem- brane of the sac. The practice of aspirating buboes in the face of such an amount of microbial matter, is essentially wrong—even injecting them with peroxide of hydrogen is not admissible ; free openings and counter openings is the rule. are either superficial or deep-seated elevations of Bullae, the skin, having fluid contents, differing in color, or Blebs, shape and progress, and varying in size from a pea up to that of a goose's egg. Blebs are described as large vesicles; but this fails to explain their pathological character. Bullae, blebs, vesicles may contain serum, lymph, blood, pus; and be variously colored according to the character of their contents. They may be of various shapes, globoid, hemispherical, oval, crescentic, conical. They may be situated upon an apparent sound skin, or there may be an inflammatory areola. Bullae may persist or rupture ; they may dry up, or degenerate into ulcers; they may collapse after the escape of their contents, BACTERICIDES. 107 and their sac become adherent to the base from which it was originally raised. Vesicles represent the second stage of burns or scalds, their contents are the liquor sanguinis of the blood; but when they occur in the most depraved or debilitated states, as in syphilis, tuberculae, leprosy, erysipelas, gangrene, their con- tents are the microbes or micrococci of the respective disease germs, which act as the factor of the eruption. The treatment to be successful must be essentially germicidal, adapted to annihilate the special germ present, and at the same time eminently constructive. Calculus, or stone, a hard concretion, formed Calculus, within the body in consequence of the deposition of the solid matters which usually remain in solu- tion. The concretions found in the brain, gall duct, kidneys, blad- der are calculi. Urinary calculi is a disease of all ages, but most common in advanced life in the male sex ; more frequent among the gouty; those who lead an indoor life ; very rarely met with among those who live in the open air, eat little animal food, or use no alcoholic drinks. The early stage of calculi generally presents itself in the form of gravel, shown by the passage of small portions of a gritty sub- stance which may be seen in the urine as a deposit of little sand, or like grains of cayenne pepper. When such deposits occur fre- quently in passing urine, either in the warm or cold state, we may apprehend the formation of calculi; especially if there be symp- toms of irritation of the kidneys and adjacent organs. The chief varieties of calculi are: Uric acid, ureate of am- monia, soda, lime, phosphate of ammonia, magnesia, lime, oxalate of lime, carbonate of lime, cystine, xanthic bile and all its chemi- cal constituents. Under certain conditions, such as with an excess Calculi, of amylaceous, carbonaceous, saccharine food, malt Biliary, and alcoholic drink, together with monotony, indoor life, imperfect ventilation, non-aeration of the blood takes place ; the bile becomes thick, crystallizes, forms an obstruc- tion to its own escape, it is absorbed in great quantities, constitut- ing the phenomena of jaundice. The chemical composition of the human bile : water, 850 parts ; bile salts, 91 ; fat, 9; cholesterin, 2; mucus and coloring matter, 29; salts, 7, in 1,000 parts. The secretion of the bile is continu- ally going on, but somewhat retarded during fasting and acceler- ioS DISEASE GERMS. ated during the taking of food. The bile formed in the hepatic cells is discharged into the minute hepatic ducts, passes into the larger trunks, and from the main hepatic duct into the duodenum, The gall-bladder is a true reservoir for holding the bile, for the wants of economy. It is supposed that an ordinary-sized man secretes from twenty to forty ounces of bile in twenty-four hours. A thick, clotty, or crystallized condition of bile may arise from a variety of other causes, not so common in early life, unless due to malaria, but after thirty-five very common among the seden- tary, or in those who lead a physically inactive life, much more common among women than men. Pain, paroxysmal over the region of the gall-duct, with vertigo, nausea, vomiting, biliary- coated tongue, injected conjunctiva, constipation, favor the idea of the formation of biliary calculi. _ .. , , „ t , . Crystals of cholesterin from gall- Section of a lar?e gall-stone, showing successive layers. slones showing the character- A External crust.-B. Intermediate portion.-C. istic 'iates ^ith one corner Nucleus. Natural size. ____.:_„ v.v___ In all cases, calculi are made up of either a deficiency, or re- dundancy of certain elements of the bile; a scantiness of its watery elements, it may coagulate; an excess of cholesterin, it may crystallize. When the symptoms of gall-stone passing the duct are present, the curative indications are to facilitate its passage into the intes- tines, to relieve pain and prevent inflammation, which the presence of an extraneous body if large is calculated to produce in the duct. This is best effected with large doses of gelsemium. Dose after dose relaxes the duct and favors the expulsion of the calcu- lus. Warm bath, hot fomentations, are of great benefit. Between the attacks, solvents should be tried, to cause a chemi- cal disintegration of the calculi, and for this purpose the ozonized uric acid solvent should be preferred above all other remedies, Under its influence the calculi break up, disappear, without any trace in copious, bilious evacuations, which it produces. I have BACTERICIDES. IO9 used this remedy in several hundred cases and found it an excel lent solvent for those stones. It is well enough one or two days of each week to administer com- pound tincture of cinchona and nitro-muriatic acid, with phos- phate of soda, sufficient to keep the bowels free, but in all cases, five days out of seven, the patient should be placed upon the uric acid solvent ozonized. There is little doubt in my mind that this remedy owes its powerful solvent properties to the combination in it of chionanthus virg.and dioxide of hydrogen. The same prepara- tion is efficient in nearly all dormant states of the liver. Diet has a marked influence upon the quality of the bile, vegetables and fruit have a marked influence upon the . ...... " A- Section of a gall-bladder filled with biliary bile, With leail meats proportioned calculi. This bladder contained 260 gall- , , 1 c ,, L , stones. At B are single calculi showing to the wants of the system. facets. One of the most prevalent affections among men Calculi of all ages and stations of life. It is true that it is of often a sequel of gonorrhea, the germs migrating Prostate, back to the compressor urethra and prostate. Mas- turbation, excesses, dalliance, perversion of the sexual appetite, the wearing of condums, irritation of sedentary life, the use of velocipedes, instruments, drugs, passage of concre- tions, uric acid, stricture, licentiousness, reading modern literature, keep up a species of continued congestion of the prostate and mucous membrane of the urethra, which later on assumes the status of inflammation, penetrates deeply into the follicles of the gland. Then appears a moisture, sexual congress becomes im- perfect, increased frequency of micturition, bearing down uneasi- ness in the perinaeum and anus, slight pain or rather uneasiness at termination of micturition, tenderness around the prostate on the passage of a sound, an inability to urinate when making the at- tempt. Progressively onwards the case progresses, for it never remains stationary. There is increased micturition, with a diminu- tion in the force of the stream, with dribbling after urinating, the lesion extends to the neck of the bladder, which, when partially I 10 DISEASE GERMS. full, causes frequent erections and erotic desires with nocturnal seminal emissions. Later, partial or complete impotency. These cases diverge into numerous channels; in some there is a dis- charge of mucus from the urethra, in which spermatozoa often appear when straining at stool and also in the urine flakes, pros- tatic shreds, consisting of pus, prostatic epithelia, spermatozoa, A rectal examination reveals the prostate large and tender, with pain in the back. Reflexly this irritation is transmitted to the base of the brain, causing a state of mental incapacity, nervous bankruptcy. Here then is the affection which afflicts nearly all, young, middle-aged and old men—one that is sapping our very vitals as a nation. Nations owe their longevity, progress and courage to the in- tegrity, strength and vigor of their sexual power. The damaged prostate is a greater manufacturer of diseases and death than the glaring gin palace and secret brothel, as the condition of our male population demonstrates. The treatment of this affliction should be general and local; all stimulants should be avoided; nourishing food and tonics are indicated ; bowels regulated ; urine kept slightly alkaline ; moder- ate exercise, and sound elevating mental culture, and in general re-invigoration and construction of the brain. In chronic urethral and prostatic hyperaesthesia few remedies operate more beneficially than the introduction of the soluble ozonized gelatine damiana bougies, inserted right up to the neck of the bladder, permitted to remain and dissolve about three times a week. The cocaine suppository exercises a sedative influence over the motor sexual and urinary centre in the spinal cord; this influence extends along the anterior portion to the reflex centre, but if there is reason to suspect an atomic condition of the prostate ducts, such a motor stimulant as phosphated tincture of oats is indicated. If this state of chronic irritation be not effectually cured, it will inevitably terminate in hypertrophy of the prostate, with calculi. Calculi of this gland are either of the phosphatic or mulberry variety. The same treatment as for hypertrophy. Pichi, as prepared in the uric acid solvent ozonized, has a won- derful effect upon the prostate, causing it to disgorge calculi. Hydrogen peroxide also operates well, administered in alterna- tion with iris versicolor and phytolacca. Electrolysis of the prostate is of great utility. BACTERICIDES. I I I Concretions in the kidney vary much in size and Calculi, composition. They are found in all ages, but most Renal, common in the adult male, and in all parts of the kidney—in the pyramids, cortical substance and pelvis. Owing to mal-assimilation, perverted nutrition, to the presence of microbes and their ptomaines; to destructive metamorphosis ; there is an excess and precipitation of certain elements, which are either in excess, or fail to be eliminated. Usually they begin in this way; certain elements are in excess, either uric acid, phos- phate or oxalate of lime, constituting one or other of the three forms of gravel. A precipitation takes place of either uric acid or oxalate of lime. A colloid material composed of mucus, or a blood globule exist in all as a starting point; these molecules attract others, they increase by aggregation of molecules. Certain constitutional states are favorable for the elements of precipitation, and all that is necessary is a point of attraction and aggregation. The cause of calculi appearing in the kidney is often very ob- scure, but uric acid deposits are the most common; but deposits of lime and triple phosphates are common, This leads us back to the primary cause, the formation of uric acid and phosphate of lime and the constitutional conditions favorable to their develop- ment. Renal calculi vary greatly in shape and differ in their composi- tion, and may be deposited in the tubes of the pyramids, in the cortical substance, or in the pelvis of the kidney. In adults, the urate of soda in the form of crystals ; in the aged, carbonate and phosphate of lime. All the different urinary calculi may be impacted in the uriniferous tubes, rendering them impervious ; they vary in num- ber and in size, from a pin's head to a walnut. A kidney may contain one or a great number; large ones may fill the whole pelvis; small ones constitute kidney gravel. A calculus impacted in the pelvis of the kidney may assume a large size and produce great anatomical changes. The presence of calculi in the kidney gives rise to uneasiness, to a dull, aching pain in the loins ; to occasional twinges of sharper pain after motion or exercise of any kind; pain in the groin, re- traction, possibly pain in the testicle of the affected, aching, amounting to pain, in the anterior part of the thighs, itching at orifice of the urethra. Urine contains pus, blood and epithelium from the kidney. All symptoms aggravated by anything which disturbs the patient. The passage of a portion of the stone, or the whole of it, in- ,^ DISEASE GERMS. variably gives rise to renal neuralgia, which manifests itself in sudden intense pain in the kidney, constant desire to micturate, tenesmus of the bladder, great retraction of the testic e, collapse. How to Diagnose a Stone in Kidney, and its Character--There will be severe backache ; traces of pus in the urine. After exer- cise, especially on horseback, bloody urine. There will likely, if stone is any size, be epithelium of the pelvis of the kidney as well as blood corpuscles. The diathesis will guide us as to the kind of stone. But the nervous irritation is so great, in all cases, that if it begins as uric acid, it at once becomes phosphatic; the reflex nervous irritation creates that diathesis. Health suffers, loses strength and flesh. Stone gradually becomes larger ; excites suppuration; fills up the body of kidneys, and renders them use- less as secreting organs, and gives rise to uraemia. In addi- tion to the above, there are the minor symptoms of kidney irri- tation ; itching at the orifice of urethra, aching in thighs, retrac- tion of testicle. Passage of Stone into and through the Ureters.—A patient suffering from the above symp- toms has a sudden seizure of intense pain in the kidney, with nauseau, vomiting and great prostration ; a partial suppres- sion of urine; symptoms in- crease ; pain moves down along the course of the ureters, and the moment stone drops into the bladder all is well. In addition to the above, there may be all the indications of kidney irritation, and even haematuria. Indications of the Presence of Stone in the Bladder.—Severe attacks of pain in the bladder, perinaeum and at glans penis, either brought on or aggravated by exercise. Frequent micturition from the irritable bladder, or there may be continence or inconti- nence of urine ; or even if patient can make water freely, there is a feeling as if bladder was not thoroughly emptied in the act of urinating. Urine is likely to contain pus to a greater or less ex- tent, often thick, ropy, tenacious, muco-purulent matter, and per- haps blood. Always blood corpuscles and vesical epithelium under microscope. The act of micturition suddenly stopped, in large percentage of cases, by stone being forced against the neck of the bladder, when, if the patient suddenly throws himself upon Vertical section renal calculi, showing the dif- ferent layers, a, uric acid nucleus ; b, oxa- late of lime: c, phosphates of lime, and magnesia and ammonia. BACTERICIDES. H3 his hands and knees, thus causing the stone to move away, the flow of urine returns; tenesmus, prolapsus of the rectum, very common. None of those symptoms are to be positively relied on, not one, until a metallic sound or silver catheter is introduced, when the bladder is full, and the stone felt by its impulse on the fingers, and the peculiar click is heard by the ear. One examina- tion should not suffice, it should be made at least three times, on different days, before a final opinion is given.* Trcament of Stone in the Kidney, if Uric Acid or Red Gravel is the Cause.—Plain, nourishing food, milk, eggs, fish, animal food, nothing to increase uric acid ; avoid alcohol; mucilaginous drinks, linseed tea, infusion of marsh mallow; daily bathing, flannel clothing; belladonna plaster over kidneys; check hemorrhage; alteratives and tonics, selecting saxifraga, hydrangea, iodide potass, solution of potassa, citrate of potash in alternation with nitric acid in compound tincture cinchona, benzoic acid and borax. Undoubtedly the uric acid solvent ozonized is the most active agent known to cause a stone to crumble. To relieve pain, if it drops into ureters, inhale a little chloroform. When patient feels slightly exhilarated, follow with hypodermic injection of morphia, and discontinue the chloroform. If the stone has reached the bladder, and is small, patient might be encouraged to take copious warm mucilaginous drinks, with nitrate of potass and cream of tartar ; go into a hot bath ; take a large dose of tincture of green root gelsemium ; dry off; smear perinaeum with extract of belladonna; let urine accumu- late, and then discharge it forcibly. If that fail, an attempt might be made to dissolve it, if acid, by injecting alkalies or alkaline solution ; if a phosphatic calculus, acid solutions. Injecting sol- vents into the bladder must be done carefully; the water must be tepid, and not too strong of either the alkali or the acid; just strength enough for stomach ; the liquor potass, say a drachm to four ounces of water; nitric acid dilute, from fifteen to thirty drops to four ounces ; used about three times a week. At the same time * In order to ascertain the constituents of calculi, the following n ethods are adopted : Powder the stone and apply heat. If it disappears, it is in all probability uric acid, or compounds of uric acid. If there is any doubt, the murexide test may be applied. II the stone does not disappear upon being incinerated, it is composed either of phos- phates or of oxalate of lime. If it is the triple, or ammonio-magnesian phosphate, the application of heat to a piece of the original stone will melt it into a bead; if it does not melt, it is either phosphate of lime or oxalate of lime. If it is oxalate of lime, the incineration will convert it into carbonate of lime, which, in acetic acid, will dissolve with effervescence; if it is phosphate of lime, it dissolves without effervescence. Thus, with very little trouble, we may, with sufficient accuracy for practical purposes, ascer- tain the composition of a calculus. The bases are not ascertained, but this is not necessary. 8 '14 DISEASE GERMS. the patient should be placed upon an alterative and tonic course, with iodide potass in a vegetable alterative, and nitric acid in compound tincture cinchona as a preference. In the interval, pa- tient should be encouraged to drink freely of an infusion of hy- drangea and saxifraga with the uric acid solvent; three remedies of great value in causing the disintegration of all calculi, espe- cially the phosphatic ; they are true solvents, causing the stone to break down into a mealy powder, which is easily passed by the urethra. Their action is purely chemical; they perform what no other remedy or combination of remedies can perform. Their best effects are to be obtained by infusion; fluid extracts become worthless; ozone water has a powerful effect on the more solid forms, and reduces them to a pulp, which is gradually eliminated by the urine. (See Diathesis.) Cancer is a term which is applied to a dia- Carcinoma. thesis in which certain elements of the blood are degraded, altered or changed into a disease germ of the most malignant species, thus giving us one of the most appalling blood diseases in the whole range of medicine. In weakened parts of the body this germ localizes, and receives different names according to the presence or absence of certain adventitious tis- sue, as schirrus, or stone cancer ; medullary or brain. Cancer in its varied forms is most generally met with when vital force is on the wane, flickering out in the great bulk of cases between forty-five and fifty. Among 1000 cases noted, forty-three is the average. This climacteric period of life is obnoxious to the most remarkable changes in both sexes. Numer- ous though those cases be, the male is not exempt from alteration in structure of pink marrow, lymph canals, bone gland and im- pairment of function, although it is the female who essentially suffers at the change. The extra source of nerve deterioration, or defect of vital elements of brain at this period, gives the ele- ments by which normal living matter is change or altered, de- graded into a diseased germ. Six females to one male are the proportion or excess affected, and this can be accounted for by their isolation, monotony, grief, worry, care. When the primary elements of nutrition are altered into a disease germ, there is be- sides atrophy of the red corpuscles an excess of the colorless BACTERICIDES. "5 discs; and the force behind, the creative power of the blood is deteriorated, there being a defective organization which gives rise to this degradation of normal bioplasm in the blood. The predisposing causes which give rise to this change in the bioplasm of our blood are somewhat obscure. In some cases it depends upon peculiar type of conformation, and is hereditary, and like all germ diseases it is pre-eminently contagious and infectious. The large number of cases that are met with in every-day life are acquired in and under the various defects and vices of our highly civilized state; thus we have it more prevalent in sections or localities noted for high mental culture, especially if the ner- vous system has been enfeebled by grief, anxiety, worry, over- work. The peculiar innervation is very obscure and in many cases can be traced to sexual neurasthenia, masturbation, sexual excesses; in other cases it can be looked for planted with the germs of syphilis or the toxical effects of mercury; to the defects of modern sanitary science, to open sewers, imperfect drainage and ventilation, impure drinking water, adulterated food, isola- tion, monotony or sameness of living. How much the degenerating action of alcohol, or withering effects of tobacco, or other habits, have to do in creating this dia- thesis, it is impossible to estimate or even appreciate. To a greater or less extent the cancer germ must exist in the blood prior to the appearance of any malignant growth, it may be a longer or shorter period, or appear as if it was simultan- eous ; but a constitutional taint, a diathesis, cancerous germ- laden blood, must, in the individual, precede the appearance of the tumor and operate as a pre-existing cause in the blood. Cancer is never a local disease, without the germs in the blood. The exciting causes which bring the diathesis or germs into an active, local, breeding cancer, are local irritation, such as an injury, blow, bruise, contusion, disease, the use of tobacco on lip and tongue, violence of any kind, so that it causes the vessels to lose their contractility, or tonicity, which state enables the liquor sanguinis of the blood with the germs to pass through their coats or walls by a process of exudation or exosmosis, and deposit themselves in devitalized or weakened structure where they form a colony or nest. The most common seat or deposit of cancer germs is in parts most subject to irritation, those in exposed locations, as the female breast, the eye, the tongue, the lips, the genital organs, bones, liver, stomach, uterus, rectum, oesophagus, lymphatic glands, etc. Etiology.—The anatomical structure and relation of the part n6 DISKASE GERMS. and other conditions, together with the special fqrm of degrada- tion to which it owed its origin, have much to do with the char- acter and mode of formation ; thus scirrhus, or hard cancer, is most frequently met with in the female breast, uterus, stomach, extremities; eucephaloid (brain-like) medullary'or soft cancer, anywhere; melanotic, charged with a brown or black pigment matter; epithelial or epithelioma, on the skin and mucous mem- brane, on lip, anus, tongue, uterus ; ostoid, or bony, anywhere. The degree of growth of a cancer depends entirely on the amount of degradation of living matter in the blood, the amount of irri- tation present, and the status of local depression. If the lym- phatics are greatly engorged, vital force sadly deteriorated, it renders a cure more difficult. Any swelling, tumor, infiltration, may be properly termed cancerous, if it completely infiltrates the texture in which it arises, spreads, invades the nearest lymphatics adjacent to the part affected; when there is pain in it, stinging, darting, or sharp lancinating; or if it is ulcerated and open, the odor of the dead germs in the pus or discharge resembling the hydrosulphate of animonia; in the urine always persistent, dead cancer germs, best seen with microscope of 2000 diameters. If it is internal, as the stomach, the pain is anterior to posterior. The diathesis or cachexia is not always well marked, but if present should consist of indescribable languor, or goneness, a sinking sensation at pit of stomach, a peculiar fetor of breath ; pale clay-colored stools; straw-colored or muddy skin ; pearly conjunctiva. The cancerous diathesis is infectious and contagious. The af- fected or germ-smitten radiate or breathe off germs to contami- nate all in close proximity. The egress of germs is chiefly by the breath, urine, stool and from the skin, or by direct contact, inoculation. Diagnosis.—Many, very many individuals are literally swarm- ing with cancer germs, their blood and tissues saturated, the lymph channels crowded, but they in blessed ignorance live along to a good old age and die, without any cancerous tumor or growth being visible. That mysterious languor, that indescrib- able headache, that goneness, those aches, indigestion and in many cases Bright's disease, which are incapable of explanation, could all readily be detected by a careful microscopical exami- nation of the urine, sweat, saliva, and blood of the individual so complaining, and in ninety-nine cases out of one hundred cancer germs will be detected. In making a diagnosis, it is not necessary to note the mental irritability, the contracted features, sallow skin, pearly conjunc- tiva, the odor of the breath, the sinking at the pit of the stomach, BACTERICIDES. 117 the clay-colored stools, nor the dry, husky skin. It is sufficient that we have a thickening induration, or infiltration, or tumor, and in that there is pain of a sharp, lancinating character, with intervals between, and that it resembles a needle or knife; that if the cancer colony is in the chest or abdomen that there is pain anteriorly and posteriorly—direct through ; that if the cancer is on the face, breast, or other exposed part, and is ulcerating or disintegrating, then there is soreness, rawness, gnawing, as well as the intermittent pain, and the smell or odor of the discharge is most significant. Besides, in the cancer-juice and urine the can- cer germ can be seen with a very low power. We cannot well speak of diagnosing such varieties as long as covered by skin. The medullary, or acute, or brain-form may be known by the intensity and frequency of pain; if covered, lobulated, doughy; if exposed, one mass of cancer germs ; the hard, or stony feel of scirrhus having an excess of fibrous tissue and a few cancer cells, and in the early stages little pain ; the epithelial, or cancroid is easily known from its location, occurring where skin and mucous membrane meet; the black pigment matter of melanosis; the great excess of blood-vessels in fungous haematodes; the fatty feel of the lardaceous ; the bony hardness of the ostoid ; the jelly or gelatinous material of colloid; the leathery patch on skin of keloid. As to the engorgement of the lymphatics, they simply afford us an indication of the state of the blood as regards germ growth—if heavily engorged, germs abundant and active; if slightly, germs few and inactive. The characteristics of cancer are definite, and different from all other growths or swellings, inasmuch as it is made up parti- ally or wholly of malignant germs. There is a large number of growths or tumors—some simple and others compound—made up of the healthy tissues of the body, as fat, cartilage, and bone, which, when occupying their proper places, are essential to the perfection of the animal system ; but when misplaced, may inter- fere with normal functions or locomotion, it is indispensable to remove. But cancer has no counterpart in the healthy body, the very existence of its gerrns, or their localization, sufficing to constitute disease ; and more than that, their colonization in any part of the body is destructive, as they use up or convert healthy tissue into their own nutrition and growth. Cancer, although a large micro-organism, and quite weighty, nevertheless is contagious and infectious. It can be carried into a healthy organism by air, water, milk, or by contact, and ma)' remain in the blood and tissues in a latent condition until favor- able conditions exist for their growth. The cancer germ has wonderful capacity for resisting death, due to some inherent n8 DISEASE GERMS. power it posses. We do not mean that it has the tenacity of life of the small-pox germ, neither has it its great power of growth or dissemination. The symptoms of cancer are well defined. The change of nor- mal cells into this malignant germ is usually attended with ex- treme languor, lassitude, debility, goneness; strength and energy much impaired; the skin assumes a dirty yellow hue; the secretions are arrested, the conjunctiva of a pearly white- ness, features contracted, sinking feeling about stomach, stools clay-colored ; great loss of strength and energy ; general wast- ing, with mental irritability. WThen the germ escapes from the circulation and forms a colony, then we can detect a thickening, infiltration, induration, a separable tumor, which rapidly changes the structure of a part, usurps its original texture or organ; germs grow by millions, invade surrounding parts, extend to nearest lymphatic and induce general germ poisoning. The very moment a malignant germ colonizes itself there is pain, a congregation of a few germs resembles a needle ; a larger ag- gregation, a knife; the smaller the colony the less the pain, and at long intervals ; whereas in an immense collection the pain is not only like a large knife darting through the part, but it is fre- quent, almost continuous. If the cancerous infiltration occurs inside of the chest and abdomen, pain is both anterior and pos- terior, which is explained by the character of the spinal accessory nerves. It grows like all other living matter, and when from a deficient supply of nutriment or some other adverse condition, or natural death of the germ, disintegration and ulceration take place, a foul, excavating ulcer, sanious, fetid discharge, the odor of hydro- sulphate of ammonia, which the dead germ evolves, hemorrhages, progressive debility, anaemia, nausea, vomiting, diarrhea, complete exhaustion, death. The tendency of all cases of carcinoma is to death, unless man- aged with great skill and long experience. Treatment.—The general indications to be observed in all cases of the cancerous cachexia are to build up and maintain vital force, the nerve centres ; to promote and increase the powers of assimilation and digestion ; to resort to every possible means and known remedies to destroy the cancer germ in the blood; to remove the infiltration or tamor, if admissible. In addition, the most nourishing blood-making food, as abun- dance of highly animalized substances, beef, game, milk, cream, raw eggs, vegetable phosphates. Tonics must be administered in all cases, to promote an appe- tite, and energetic digestive agents as trypsin or papoid after meals, to give us the most perfect digestion. BACTERICIDES. 119 Baths are of infinite value, these must be of a decided germi- cidal character; they should consist of such agents as iodine, chlorine, sulphuret of potassium and sulphurous acid. Pain, in all cases, must be relieved with the conium pill. The patient should wear flannel clothing and take moderate exercise in the open air. The liver should be actively stimulated with the kola nut paste, the glucoside leptandra and leontodon ; the three in combination, in sufficient doses. After inculcating the most rigid attention to hygiene, dietetics, moral surroundings and the removal of every possible condition that would depress, a thorough germicidal treatment should be carried out. Such remedies as the comp. saxifraga, ozonized ; the glycerite of sulphur; Chian turpentine; chlorate of carbon; chlorine. The patient should be put upon one of those remedies. Com- mence with teaspoonful doses every three hours, and gradually increase it; let it be taken upon an empty stomach. These remedies will destroy the germ, act also as a powerful stimulant to the lymph canals, pink marrow and other blood- forming glands ; just as they destroy or sterilize the germ, they eliminate it. The evolution of the germ is arrested and pain ceases. The action of germicidal remedies is truly marvellous ; as they are persistently administered, so the germs are annihilated, and a return to health and normal vitality is the result. The internal administration of germicides must be carried out in all cases. If the cancerous tumor is small, an effort might, with some degree of hope, be made to kill the mass of germs, and ulti- mately absorb, them without breaking the skin. For this pur- pose, either of the following remedies will be found of great efficacy: an ointment of stramonium, .r)i ; chloride of ammonia and iodide of potass, ail on- Mix. Spread on leather and apply during the day, and during the night a lotion of sulphate of man- ganese or an ointment of phytolacca ; or lotions of distillation of the jequirity ; or ozonized clay ; or peroxide of hydrogen or boro- glyceride; ozone ointment and resorcin. We deprecate the use of the knife or caustics in the removal of all cancers, and depend upon removing cancerous tumors or mass of germs by the application of plasters composed of antiseptic materials which will unite with the cancer germs, enter into their composition and destroy them. These plasters, if properly selected and adapted to the case, will give rise to very little irritation. The length of time neces- 120 DISEASE GERMS. sary to remove a cancerous infiltration will vary with its size and the nature of the germicides used. The length of time necessary to heal it up afteiMt drops out, also varies much, the size of the cavitv, its location, health and vitality of the patient. From the large list of cancer plasters in general use by physi- cians we select a few that are the least painful in their applica- tion, such as the chloride of chromium and ozone pastes, two rapidly destructive agents, when either is applied. They are altogether less painful than the chloride of zinc paste, have more affinity to enter into the body of the tumor, destroy it and cause its perfect exfoliation root and branch without much suffering or the loss of blood. From the vegetable kingdom we take oak bark, phytolacca, yellow dock and sorrel, all crushed. Make an extract and apply ; or the expressed juice of the sheep sorrel alone in the form of an inspissated extract, and applied on leather, will remove it; but before these last two are applied, the cuticle must be destroyed. Another favorite paste for the removal of a cancerous tumor is to drop C. P. sulphuric acid on saf- fron, until a paste is formed; when of the proper consis- tency it is applied, and almost, as if by magic, re- duces the entire mass of germs to a charred mass. If the tumor is very large, it is re- peated daily until destroyed. It is unnecessary for us to give the different formuhie in use, suffice it to say that the chloride of chromium paste is in.very general use for all large cancers, and the ozone paste for small ones. These two do their work effectively, whichever is used, and should be applied daily until the cancer drops out, after which it is a good plan usually to poultice for a few days so as to cleanse the wound thoroughly. Poultices of linseed meal and boroglyceride should be applied every three hours, and as soon as the granulations exude healthy pus, strap it with adhesive strips and dress with either stramonium or ozone ointments, or an ointment made thus : Ozone ointment, one ounce ; lac sulphur, Scirrhous cancer of the abdominal walls. BACTERICIDES. 121 three drachms ; willow charcoal, pulverized, one drachm. Mix ; or an ointment composed of ozone ointment and resorcin. We shall now describe the microbe in various locations of the bod)-. This case (p. 120) of cancerous infiltration of the abdominal walls, involving the skin, cellular tissue and border of the recti muscle, was first removed by the application of the chloride of chromium paste ; roots or prolongations destroyed by papoid and thallin ; healed kindly under ozone ointment. The internal remedies were Chian turpentine, saxifraga, phytolacca. Owing to disease of the teeth and nose, the Cancer antrum is greatly weakened, and if the microbe of of the carcinoma be present in the blood, it is very liable Antrum, to be effused into this cavity with the liquid, semi- liquid and glandular substances, so often found in this locality. The symptoms are aching, uneasiness of the cheek, preceded by acute throbbing, pain, rigors, fever, followed by slow and progressive enlargement. If unrelieved, there will be bulging of the cheek, extrusion of the eye, obstruction of the lachrymal duct, depression of the hard palate, loosening and dropping out of the teeth and closure of the nostril. In some cases it will burst into the nostril, mouth, or through the cheek. The pain is intense. The treatment should consist in making a free aperture into the antrum by extracting either of the molar teeth, and a trocar pushed up through the empty socket into the antrum. If the teeth are all sound, then an opening should be made through the membrane of the mouth, above the alveoli of the molar teeth, and the bone be pierced by a strong trocar. The contents should be thoroughly stirred up, whatever they may be, and thoroughly evacuated ; the cavity washed out every morning with a solution ■of resorcin, creolin or other antiseptic, and general treatment for cancer inculcated. This makes its appearance chiefly in the form of Cancer epithelioma, although the scirrhous, medullary and of the melanotic forms are quite common. Lip. Irritation is the grand exciting cause ; the pipe or cigar has been mentioned as the principal source of irritation, but numerous cases occur where the individual is not addicted to this habit. It is also true that it is chiefly the lower lip that is affected, very seldom the upper. The great frequency l22 DISEASE GERMS. of cancer of the lower lip may partially be accounted for by it> situation, position and mobility. Most generally met with on one side. As all cases of cancer are both contagious and infectious, it i> doubtful how many cases may be directly due to the pernicious practice of kissing. We are strongly of the opinion that numer- ous cases of cancer of the lip are due to direct inoculation in the act of kissing. It is a notorious fact that all disease germs may be communicated in this way. Daily we see the germs of tubercle, syphilis, diphtheria, small-pox, etc., in the vapor and exhalations of the mouth, passed from the affected to the non- affected. This occurs at all hours and is thought nothing of. The indiscriminate kissing of infants is highly prejudicial to the little one, its tissues as a rule, are fresh, free from disease germs, the activity of growth great, metamorphosis rapid; in its nurse's arms, in the perambulator or carriage, it is the victim of kissing. How many of those maids and busybodies who kiss are free from the latent seeds of disease, especially disease germs ? What are the habits of those maids ? Echo answers—What ? The germs of cancer are deposited in early life upon the lips of children and are indelibly fixed there, remain latent if vital force is average, but break out the moment that is shattered. The activity or latency of disease germs in those who care, for children is of great importance ; active or latent they can be com- municated by close contact, especially by the mouth, in the secretions of which specific germs are always present, and all kissed children run a chance of inoculation by the saliva. The diagnosis of cancer of the lip is easy, the diathesis, the induration or sore on the lip, the pain sharp, lancinating, infiltration of the lym- phatics. The extreme difficulty in the applica- tion of any of the plasters at this point renders cancer of the lip the most eligible for removal by the knife; as a general rule it is the best method, push- ing local and internal remedies vigorously after its removal so as to prevent its re- currence. Some cases are effectually got rid of by either of the pastes, chloride of chro- mium, ozone ointment and resorcin. A most interesting case of epithelioma of the lower lip in a young lady, aged twenty-one. The exciting cause of irritation seemed to be the insertion of a peculiar colored thread between BACTERICIDES. 123 the teeth. At nineteen a little thickness was discovered and thought nothing of; it kept very painful, gradually enlarging until twenty-one, when she sought relief. This case was placed upon Chian turpentine mixture, saxifraga, phytolacca, glycerite of sulphur, etc., locally. The cancerous infiltration was brushed over every morning with lactic acid followed with a paste of resorcin and ozone ointment. It completely exfoliated in twelve days, leaving a healthy sore, but a little gaping. To rectify this deformity, a hair-lip pin was inserted and bound well in its place with metallic sutures. This was retained for six days. The dressing all through was the resorcin salve, it healed kindly and left no scar, irregularity or deformity. If the germs of cancer are present in the blood of Cancer an individual, latent or active, whether they are the of the result of hereditary contagion or infection, the breast, Breast, being an exposed portion of the body, is very liable to suffer an irritation, a deficiency of life, a relaxation ; and these micro-organisms being so small that they can float in the air, exude through the walls of the capillaries, colonize, form a growth or tumor. The very presence of throwing out germs, or infiltration, is in itself irritation which causes more to be effused, and when they are thus deposited, they are capable of a new and independent existence, with prodigious power of growth and reproduction, deriving their nutrition by endosmosis and roots or prolongations penetrating into the adjacent tissue. The sources of irritation of the female breast are very numer- ous, as the handling of the breast and nipple by the infant; articles of modern dress, as corsets ; certain occupations ; keeping articles of value in or near the bosom ; and as there is a perfect anastomosing, or blending or joining of the nerves of the uterus and ovaries, all abnormal conditions of the latter organs tell disas- trously on the breast, so that all diseases of the genito-urinary organs are productive of irritation in the breast, as a perversion of the sexual act, masturbation, metritis, catarrh, indeed all diseases. The natural weakness of the left side, the immense ganglia of the great sympathetic nerve, reflected over the spleen, heart and left breast, tell • us in unmistakable language why cancer is so frequently found in that breast. Besides, this furnishes a clue to why worry, struggle, care, sorrow, mental toil, neurasthenia, aid in the same condition. There can be no doubt, irrespective of causes already laid down, that monotony, sameness, isolation of 124 DISEASE GERMS. location, diet, with a toil-worn depressed nervous system, are productive of carcinoma. The male breast is a mere rudimentary gland, has none of the exquisite development of the female, none of that high organ- ization, very little sensibility, Cases in it are rare. A few cases, once in a while show themselves, due to irritation of the buckle of the suspender. In a total of 1000 cases of cancer of the breast, of which I have taken note, there were 150 cases of encephaloid against 850 cases of scirrhous. If it were possible to obtain statistics of all cases of cancer of the breast which present themselves, we think that the proportion of scirrhous breasts to those of the medullary would be about the same. All forms of cancer are met with in the breast; scirrhous and medullary most common ; while epithelioma, fungous haematodes or rose cancer and lardaceous are not so prevalent. The recognition of cancer of the breast is easy, the pain sharp, lancinating, serves to distinguish it from all other tumors; numb- ness of the arm of the affected side ; retrac- tion and oozing from the nipple; enlarge- ment or induration of the lymphatics in the arm-pit, with the ger- mal diathesis which is usually well marked. The general con- stitutional treatment for the destruction of The Same cancer' taken from a photograph after removal. the cancer germ should be enforced. If the tumor is very small, an effort to get rid of it without destroying the skin might be BACTERICIDES. 125 tried with the sulphate of manganese lotion or distillation of the jequirity, or a combination of the succus belladonna with iodide of potass, or the resorcin ointment. If too large, or growth too active, then its removal by one or other of the germicidal plasters should be decided upon. The attending physician is the best judge. All such applications are painful, some much less than others. These, if active enough, should have the preference. A case of open, mixed cancer of the breast (p. 124); scirrhus and medullary removed by the chloride of chromium paste in nine days ; healed up well in twenty-one days. No recurrence. All the illustrations in this article are taken from photographs of actual cases treated by the most scientific cancer specialists in the United States.* This case, a lady of immense wealth, widow, seventy years of age, had for seven years hid her malady from her nearest relatives. It commenced as a small pim- ple, and gradually spread until it assumed the appearance it has in this cut. From the back and left side of the head, an elevated, ulcerated, circular growth is seen to arise, measuring 55^ inches in diame- ter. It bled readily, and pre- sented all the appearances which are usually found associated with epithelioma. The general health was very poor, and there was quite considerable enlargement of the post-cervical glands. The treatment consisted in the use of tonics, alteratives, includ- ing the Chian turpentine mistura, alternated with the ozonized glycerite of sulphur. A paste consisting of one-half pound each of resorcin, and * The treatment of cancer in the United States has been completely revolutionized; the empirical and barbarous methods, the knife and caustics, have been very generally abandoned, and physicians of the highest culture, of the most eminent scientific attain- ments and profound skill have adopted the germ theory of its origin, and are to-day successfully curing a very large percentage of all cases which come under their cog- nizance with bactericides. Among those great luminaries of scientific medicine and benefactors of our race, we would respectfully mention E. J. Skelton 6° Sons, M. D., of Bloomfield, Iowa; Prof. F. I. Mehrman, M. D., of Oakland, California; R. II. Randolph, M. D., Portland, Oregon; C. II. Boulson, Iola, Kansas; Dr. After, M. D., Lima, Ohio; B. L. Robinson, M. D., McLean, N. Y.; Henry IVttrner. M. D„ Springfield, Mass. 126 DISEASE GERMS. ozone ointment, to which was added ten grains of hydrochlorate of cocaine. This was spread on leather and applied night and morning over the entire mass and a little beyond. In twenty-four hours it shrivelled up amazingly, and so continued for nine days, when it dropped off. The same remedy, about a half weaker, was continued till it healed up, which it did in twenty-eight days, forming an excellent cicatrix. A case of epithelioma of the forehead, under the charge of one of the enumerated specialists, was subjected to a very similar course of treat- ment : tonics, Chian turpen- tine mistura, glycerite of sul- phur ; locally to the tumor, ozone ointment, resorcin, papoid, and thallin. The germinal mass exfoliated in ten days, and healed up in a month. Three other sarcomatous nodules were forming on the cheek, to which the resorcin and ozone ointment alone were applied. Under this they disappeared in five weeks. This case originated in the removal of hairs by the barium depilatory when she was thirty-two, and had taken years to as- sume the present size. An excellent cure was effected. A very remarkable case ,pf epithelioma of the tongue, which had been tampered with until it assumed a true medullary form. The hopeless condition of the patient justified a trial of almost any remedy. He was placed upon a general alterative and tonic treatment, including saxi- fraga, Chian turpentine, etc. The germinal mass protuding from the substance of the tongue, was first sprayed with peroxide of hydrogen, and then brushed over with lactic acid, gargle of distillation of jequirity used. Not making as much progress as was deemed proper, a ten-per-cent. solution of chromic acid was used instead of lactic acid, with the best results, the entire mass exfoliating in eight days. BACTERICIDES. 12! The Chian turpentine, glycerite nally; and locally the peroxide of tillation of jequirity used till it healed up, taking in all about four weeks. At the age of forty-four, a small pimple appeared on the side of this gentleman's head, above the ear, which became very painful, and commenced to grow slowly and discharge sanious, ichorous, cancerous pus, with its characteristic odor. It continued to gradu- ally enlarge for nine years, when it presented this ap- pearance, a large fungating growth, involving the ear. When he applied for relief he was placed upon the usual germicidal remedies, Chian turpentine, saxifraga, phyto- lacca, etc. To the large medullary mass of sulphur, and saxifraga inter- hydrogen spray, gargle of dis- Carcinoma on the cheek. plied fresh twice daily. It kept of germs, the ozone paste was applied daily and care- fully watched, fearing it might penetrate to the bone. In six days the entire mass dropped off completely, leav- ing neither root nor branch. Sore healed kindly in five weeks under the ozone and resorcin ointment. This is the diagram of a case of scirrhous infiltration of the skin, cellular tissue over the antrum. It had been gradually increasing in size for over two years; pain intolerable, yielded kindly to the application of equal parts of ozone oint- ment and resorcin, which was bound over it and ap- peeling off, growing less and I2S DISEASE GERMS. less, till at the end of nine weeks it entirely disappeared. lhe internal treatment consisted in the use of the conium pill lor pain, and the use of Chian turpentine mistura, saxifraga, phytolacca. - An excellent cure was effected. This illustration affords a most instructive lesson as to the utility of bactericides in the treatment of cancer, the tumor at the outer canthus of the eye, on the lid, was removed by the knife, being a non-malignant sebaceous ; while that at the outer angle of the mouth was schirrous, very painful. Two lower bicuspids and a few craggy stumps of teeth were re- moved, and then to the cancer the ozone paste was applied every morning for seven consecutive days, when it dropped out, leav- ing a clean, healthy-looking sore. The edges were brought together by hair-lip pins and a few wire sutures, resorcin oint- ment applied, no other dressing. Wound healed promptly, pins and sutures removed, and good union effected. He shortly afterwards was discharged, with instructions to continue for six months the Chian turpentine mistura with the saxifraga. This he neglected. A month later on, he returned with a hard painful mass be- neath the chin, extending to the jaw on each side, but rather further to the right than the left side. In the centre of the mass below the jaw was a prominent swelling, the size of a marble, distinctly fluctuating; skin ever it red and thin, much pain and tenderness; movements of tongue unaffected ; speech clear; de- glutition, free. Four days later on, this swelling beneath the chin began dis- charging thin, watery, cancerous pus ; a few days later, as if by magic, the sore rapidly fungated, and became as large as an orange, with the surrounding tissue involved. The case looked very gloomy; Chian turpentine, saxifraga and the conium pill were ordered internally, and the ozone oint- ment, pound for pound, with resorcin, was ordered to be kept constantly applied. In a few days the whole aspect of things was changed, the mass commenced peeling and shrinking, and in five weeks entirely disappeared. Made a perfect recovery. BACTERICIDES. 129 In this diagram, the ozone paste was applied fresh every morn- ing ; both tumors dropped out entire on sixth day; subsequently dressed with the ozone oint- ment and healed up very kindly. The internal reme- dies consisted of alteratives and tonics, embracing saxi- fraga, phytolacca and gen- eral remedies; case pro- gressed well to a complete and perfect recovery. This, and all the illustra- tions of cases, exhibit clearly the utility of bacter- icides in the management and cure of cancer. The desideratum of the age is the introduction of more potent remedies to destroy the germ, and leave healthy tissue unimpaired. Two scirrhous infiltrations, one on arm, the other on forearm. It may truly be asserted that, in every Cancer of the case of the cancerous cachexia, the liver Liver. is implicated through the agency of the germ-laden blood passing through it, espe- cially if the liver is weakened by alcohol, malaria, mercury, or great mental strain. The varieties met with are scirrhous, medul- lary, melanotic, colloid. Germs deposit themselves in the interlobular spaces, crowd the capillaries, and obliterate them. Rapidity of development is the characteristic of the medullary. The melanotic is remarkable for its blackish pigment. The diagnosis of cancer of the liver is obscure, the loss of weight, strength, and ambition; anaemia, loss of appetite, flatulence, vomiting, constipation, alter- nating with diarrhea; jaundice, oedema of the feet; hemorrhages from all the orifices ; stools clay-colored, urine scanty. Cancer of the liver may run its entire course without pain, without jaun- dice, but in the largest proportion of cases there is pain anterior to posterior, pain in right shoulder. There may be a large bulging over the liver, large smooth nod- ules can be felt, and are visible. The nodules are umbilicated, and are diagnostic of the disease. 9 130 DISEASE GERMS. No curative measures of any avail, the palliation of symptoms are all that can be done. . . Cancer of the brain, arteries, heart, intestines, kidneys, gall duct, pancreas, spleen, pleura, are all incurable when once estab- lished The only point of decided interest is the diagnosis, which, in nearly all cases, can be made out by cachexia, by the pain, by the cancer germs in the urine. All varieties and grades of the cancer Cancer of the germ are found in the lung. Medullary or Lung. encephaloid are the most common, then the other forms. It occurs in nodules of various sizes, situated through the lung substance, or in more rare cases, in larger masses. In either form they cause great destruction of tissue and hemor- rhage. One lung is usually implicated, in which the germs make great ravishes. The etiology of pulmonary cancer is the same as cancer in general; often precedes or is asso- ciate with cancer of the breast. Diagnosis. In can- cer of the lung there is pain anterior and posterior; in the expectoration and urine the germ is easily detected by the microscope. Besides, the cancerous cachexia will aid the diagnosis, otherwise, difficulty of breathing, cough, haemoptysis, rapid emaciation, pleuritic symptoms resemble tubercle. There is usually very little difficulty in its recognition. Such cases are most unfavorable, and can only be palliated. Cancer microbe in the lung. Cancer of the Rectum. Cancer may be defined to be a disease in which certain primary elements of the blood are changed, altered, or degraded, by adverse states or conditions prejudicial to life, into a disease germ. This germ may remain latent in the blood until some part of the body is weakened, irritated, damaged, or BACTERICIDES. 131 ulcerated, when the blood so germ-laden passes through the weakened part, an exosmosis of the germ is likely to take place. Whenever a disease germ or microbe passes out of the bounds of the circulation, they acquire a prodigious faculty of growth and reproduction. The probability or improbability of extirpating a cancerous growth depends altogether upon the judicious use of local and internal germicides. It is, therefore, a wise rule to adhere to in all cases, never to tamper with a cancerous tumor or growth until the blood and lymphatics are cleared of germs; once this is accomplished the growth should be seen to. A very large number of our people possess a cancerous dia- thesis (blood-germ laden with the cancer microbe), and have no tumor or growth visible, simply because there is no local irrita- tion, no weak part through whose vessels the germ can pass out of the bounds of the circulation. The exciting causes about the rectum are irritation, fissure, catarrh, piles, ulceration, fistula in ano. General Symptoms.—The early indication of this distressing malady are often very slight, such as sluggishness of the bowels, or diarrhea from the presence of germs. As the germs grow, a slight discharge of blood, or blood mixed with mucus, or puri- form matter is commonly met with. This is at first voided with the faeces, or in micturating, or independent of any evacuation The quantity of blood thus lost varies from a streak upon the fecal substance, to two drachms, or as many ounces. The dis- charges are the results of the microbes burrowing in the rectal walls, perforating the vessels. Gradually the fecal evacuations are impeded in various de- grees, obstinate constipation or scanty discharges of thin fluid are from time to time ejected. When consistent the fecal matter is usually slender or flattened, ribbon-like, or hollowed on the surface. Later on evacuations are arrested, and relief is obtained at long intervals, and with much agony. This is the common run of cases. In others, fecal matter continues to be ejected in small pieces. The hindrance to the passage of the contents of the bowel is occasioned by the cancerous tumor or infiltration. Besides, the disease germs paralyze the bowel. The bladder is occasionally involved, and the discharge of urine is affected in various ways, sympathetically or by that organ being involved in the cancerous infiltration. Pain, anterior and posterior, is an in- variable attendant upon cancerous disease of the rectum. It may be inconsiderable in degree, a mere teazing uneasiness, to one of intolerable anguish, without remission. Pain in the rectum and 132 DISEASE GERMS. its immediate neighborhood; over the sacrum ; along the peri- naeum ; in the fold of the nates on both sides—when on one side, most frequently the left, down the thigh on its back part, and even, but rarely, the calf of the leg. The pain in sacrum is the most severe, even to the sphincter, so that the affected individual, if sitting, will sit sideways, or partly supported by two chairs. Cancer germs in the rectum give token of their presence by a perceptible loss of flesh ; by a puffed waxiness of appearance; by the yellow tinge of the eyes; by the deep aspect of depression and taint of the system ; lymph canals and liver engorged with the germs, the general health is undermined. The symptoms will vary with the location and character. Scirrhous, colloid, and epithelial, and soft and fungoid are common forms. Usually the deposit is first met with between the mucous and muscular coats of the bowel, usually at a single point, low down, two and one-half inches up, or so high that it is out of reach; or it involves the whole circumference of the gut, and spreads longitudinally towards the orifice of the bowel, as well as upwards, perforating in all directions. The germs often migrate to the neighboring parts ; to the anus, first infiltrating the skin, then ulcerating ; or an abcess and fis- tula may come in the ordinary way and extend from the skin to the interior of the bowel, and burrow far and deeply into the parts. When the cancerous deposit is high up, it is liable to eat through the bowel and form an immense shapeless mass, in which the bowel becomes imbedded. It often becomes adherent to the sacrum ; presses upon the nerves. In some cases it migrates into the bladder, uterus, vagina, ovary, etc., establishing communications by an ulcerative process, giving rise to grave complications. In tracing cancer of the rectum through its course, we have seen that the germ first locates between the mucous and muscu- lar coats of the intestines, and follows the course of the blood vessels ; most frequently the first deposit is at the distance of two and one-half to three inches above the orifice of the bowels. Treatment.—Patients so affected should be put upon a general alterative and tonic course, with the best of diet and good surroundings. Pain must in all cases be relieved with the comp. conium pill. Bougies of various kinds should have a fair trial, and should be used for months. They should be made of such agents as will destroy the germ colony in and on the bowel. They are made of the following ingredients : Resorcin, thallin, papoid, in butter of cocoa. Otherwise the general treatment of cancer should be vigor- ously enforced. BACTERICIDES. 133 They should be persevered with, and while using them, if any new growths sprout out and obstruct the canal, they should be destroyed by rubbing them over with lactic acid or ozone paste, or chromic acid. Then the introduction of a bougie, and later washing out the bowel. In manipulating a cancerous deposit in the rectum, the only immediate danger to be dreaded is hemorrhage, and this must be carefully looked for and skilfully managed. Constipation and looseness are equally to be dreaded; as the former is the most common, a laxative becomes necessary. The enema of water in very many cases accomplishes all that can be desired. The most frequent variety of oesophageal Cancer cancer is epithelioma, although scirrhous and of the medullary are not uncommon. (Esophagus. The infiltration of the mucous membrane by the germ begins, then it migrates slowly Into the muscular rings, invading all the tissues of the oesopha- gus, causing stricture of its calibre. Above this narrowing there is either uniform dilatation, or a pouch, often as large as an orange. If the mass of germs involve the entire oesophageal wall, it may press upon one or both pneumogastrics and lead to the development of pneumonia or pulmonary gangrene. Two-thirds of all cases of oesophageal cancer occur in males between the ages of forty and sixty. It is easily recognized by the pain. Anterior and posterior pain is one of the earliest symptoms of the affection, beginning dull, burning, lancinating, aggravated by the passage of food. As it grows the canal narrows, stricture takes place, flatulence, regur- gitation of food and vomiting, with steadily increasing emaciation; cough, difficulty of breathing, hoarseness from pressure of the mass of germs; cachexia is well marked, hemorrhages become frequent; the bloody fluid vomited contains large masses of the cancer germs; the adjacent lymphatics are usually implicated, and there are usu- ally fatal hemorrhages or septicaemia. The average duration of cancer of the oesophagus is one year, but many cases succumb in a few weeks. In the treatment great attention should be paid to nutrition, food finely chopped, semi-fluid, entirely fluid. Nutrient enemata should be given ; diet nourishing in the highest possible degree. Pain must be relieved by dissolving the conium pill, introducing it into the rectum. Bougies, armed with papoid, should be in- troduced with great care down to the cancerous mass and an effort made to dissolve it with papoid or trypsin, combined with thallin. 134 DISEASE GERMS. usually commences as a small pim- Epithelioma of the pie, which continually increases in Hard and Soft Palate size, becoming a fungating growth, with a grayish white color, raised, whose edges soon become hard and everted. With this deposit of the cancer germ the surrounding tissues soon become impli- cated, the tonsils become swollen and tender, hard and red, and gradually ulcerate. The uvula, the pillars of the fauces and the free edge of the velum palati also become implicated. Progressively onwards, fissures, ulceration in patches over the greater part of the soft and hard palate take place; in some loca- tions a mere excoriation ; over all the affected area, not occupied with the cancer germ, the mucous membrane is hard and thicker. The pain is usually severe in these cases. The most successful treatment of such cases is to paint over the nodules either with a ten-per-cent. solution of chromic acid or the pure undiluted lactic acid; use mouth washes of distilled jequirity or boroglyceride. The only remedy so far successful in killing the growth of the germicidal mass is the Chian turpentine, in half dozen teaspoonfuls daily; this, in such doses, speedily arrests germ evolution in the blood, affords complete relief from pain, the enlarged lymphatics diminish in size and ultimately disappear. Cancers of the hard and soft palate are generally slow in their progress and are more tardy in yielding to the action of ger- micides. Cancer of the pancreas, though by no Cancer of the means a disease of very great rarity, is suffi- Pancreas. ciently uncommon to call for more than pass- ing notice. Its rarity is, as already mentioned, not very great. The gland is usually enlarged, but not always. Sometimes it is even diminished in size. The growth invariably affects first, and most extensively, the duodenal end, or head, and it is by means of this peculiarity, as we shall see later, that its clinical diagnosis is rendered possible. The growth is usually a carcinoma containing large epithelial cells in alveoli, surrounded by fibrous tissue. The proportion of the cells to the fibrous tissue differs greatly. In some there are many collections of cells, while in others there appears to be hardly anything but fibrous tissue. It is these latter cases in which the gland is of small size, or even shrunk below the natural. Another sort of primary growth found in the pancreas resembles the structure of a tubular gland, and is called adeno-sarcoma. These two forms originate in the gland BACTERICIDES. 135 tissue and the excretory ducts respectively, and are called the type glandulaire and excretoire. As a rule the cancer does not give rise to deposit in many other organs. The liver is the most commonly infected, and the smallness and great number of the liver growths in this case, sprinkled thickly through its substance without altering its shape, are pathognomonic of their pancreatic origin; but they certainly do not always occur. The symptoms of the disease have been considered very nu- merous and very obscure, but they may be much simplified if we place them in their classes according as they depend on the ana- tomical position of the pancreas, its function in the general economy, and on the nature of the disease which has attacked it. To take the last condition first, where the growth reaches a large size a tumor may, of course, be felt with more or less dis- tinctness in the epigastrium, and the conjectures as to its origin will be more or less plausible accordingly. Where it remains small it cannot in general be felt at all. Pain is more inconstant here than in most other cancers. When it occurs it is often felt in the back, often referred with more or less accuracy to other parts of the abdomen. When these are absent we can only fall back upon the fact that cancer of this organ produces, as does cancer in other situations, anaemia and emaciation, but these symptoms are more marked and more rapid here than elsewhere, in proportion as the gland attacked is more concerned with nutrition. Cancer of the pancreas hardly ever lasts six months from the first appearance of symptoms. Nor is this surprising when we remember that the pancreatic digestion combines in itself the features of all the others. Like the saliva, it turns starch into sugar; like the gastric juice, it digests albumen ; and like the bile, it emulsifies fats. In disease of the organ we should therefore expect that traces of defect in all these functions should be discoverable; and of all of them, indeed, traces have been discovered. In some cases, though but few, starch has been recognized in the stools by the aid of the mi- croscope. In some undigested muscular fibres have been seen to pass away with the faeces or to return in the vomit. Both these, however, are less easily recognized and less distinctive than the fatty stools which have frequently been observed, and the fatty vomit which is occasionally seen. The fat is generally recog- nizable, by the naked eye as an oily liquid, as waxy lumps, or as an actual coating on the faeces. Sometimes, however, it needs a microscope to show the fat globules intimately mixed with the mass. An easier plan is to shake up a small piece of the faeces in ether, and either evaporate the latter in the tube, leaving a fatty deposit behind, or on blotting-paper, which will show the chara^- 136 D1SK\SE GERMS. teristic translucent greasy stain. In one case at least of pancreatic disease fat has been found in the urine, but this seems too rare an occurrence to be of any importance. In spite, however, of the enormous importance of the pancreatic digestion, its failure does not bring about other digestive symptoms with anything like the frequency that might have been expected. There certainly is often loss of appetite, but it is by no means constant. In a case known to us the appetite did not fail till a fortnight before death. Pain after food is occasional, but rather uncommon than the re- verse. It has been before now suggested that a typical symptom of pancreatic disease is a watery diarrhea, but on the contrary, many, if not most cases are constipated. One very curious symptom remains which, though rare in cases of cancer, is not infrequent in other pancreatic diseases, and is even common in pancreatic calculus. This is diabetes mellitus. Theories to account for it have been equally numerous and unsatisfactory; the fact alone remains. Summing up, then, the symptoms already detailed, we are obliged to confess that neither those derived from the nature of the growth nor, with the exception of fatty stools, those depend- ing upon the pathology of the gland can give us any trustworthy help to diagnosis; and even when the characteristic faeces are pre- sent it may be questioned whether they do not depend upon an al- teration in the supply of the bile, rather than upon disease of the pancreas. Luckily, the morbid anatomy of the affection is more fruitful. Cancer always, as before said, involves first and most extensively the head of the pancreas, and in this situation it can hardly avoid pressing on the common bile-duct as it passes down between pancreas and duodenum. The jaundice which is thus produced, though in rare cases absent, is by far the commonest symptom of pancreatic cancer, and is in itself peculiar. In the first place it is commonly very deep, far deeper, for instance, than the jaundice typical of cirrhosis of the liver. Next it is very per- sistent, not as often occurs in cases of gall-stones, intermittent, or as catarrhal jaundice, transitory. Thirdly, the liver is not greatly enlarged as in cases of cancer, nor diminished as in cirrhosis, but undergoes a curious change. In the early stages it is usually swollen, sometimes tender, and may reach to an inch or even two inches below the ribs in the right nipple line. But later it begins to shrink, and at death is hardly ever found larger, sometimes smaller than natural. This change probably is due to cirrhosis beginning round the bile-ducts, caused by the pressure of the ob- structed bile. When enlarged it might be thought to be a liver in the hypertrophic stage of portal cirrhosis, but this is excluded by the deepness of the jaundice, and more surely by the fourth BACTERICIDES. ^37 characteristic sign,the distended gall-bladder. The gall-bladder is always dilated, and may in some cases reach considerably below the umbilicus. This, taken with the deep jaundice, proves that both the cystic and hepatic ducts are free, while the common bile- duct is compressed or obstructed, and it is this combination which is so significant. For the common bile-duct, three inches in length, runs for two-thirds of its extent under cover of and between the duodenum and pancreas. For the first inch or so, it runs into the lesser omentum, and is here liable to compression from enlarged abdominal glands. Persistent jaundice points strongly either to a blocking up of the duct by calculus, stricture, or disease of the duodenum or pancreas. In all cases of deep and persistent jaundice, with distension of the gall-bladder, without symptoms of gall-stones, if the liver be but a little enlarged, the disease will in all probability be cancer of the head of the pancreas. This diagnosis will be confirmed if wasting sets in early and progresses quickly. The treatment which is available is to supply the deficiency by pancreating the food, before it is administered, and placing the patient upon the Chian turpentine mistura, which has a remarka- ble effect on the germ-laden pancreas, the ethereal peroxide of hydrogen. _______ All forms and varieties of cancer are to be Cancer of the met with in and on the penis. Usually a Penis. result of contagion and infection. Scirrhus, epithelioma, medullary, etc., etc. A very large percentage of these cases commences with a peculiar scaly or horny excrescence on the corona glandis, prepuce, and oftentimes on the areola of the nipples. This scaly or horny infiltration is in the early stages a\^>-r7\ unaccompanied with any decided pain, simply fyj :^;;A^T) uneasiness, misery. A scale from the prepuce y-.^f W'''■■({ placed in the field of a microscope gives us the y^c^ -^v u> annexed diagram. IX '* )'^*^r If attended to just at this point the growth is vX^'V^'^ arrested, and no further trouble. '^^"a-v^'^vIO There are two methods of procedure, either ]^J^^x^^i pack the head of the penis and all affected parts {/K^^ every night in boroglyceride paste, or apply the The horny excrescence ' . ° . , J .., ** J magnified joo diam- resorcin paste; either one will cause a complete eters. i. The spore exfoliation of the morbid tissue, leaving it soft areaa'and^!nt° -and in a healthy condition. The usual remedies for the destruction of the cancer microbe 138 DISEASE GERMS. should be resorted to for a period of six months. These should embrace active bactericides, saxifraga, Chian turpentine, phyto- lacca. The stomach, next to the liver, is the most Cancer of the frequent seat of the localization of the cancer Stomach. germ in the internal organs. We meet with all forms and varieties here ; we enumerate them in the order of their frequency as follows: scirrhous, medullary, colloid, villous, melanotic, epithelial. The germ in two-thirds of all cases deposits itself near the pyloric extremity, migrating or infiltrating the stomach upwards, and downwards into the duodenum ; the other one-third of cases infiltrates the cardiac orifice involving the oesophagus. Scirrhus, few germs, but much fibrous tissue, appears as a grayish, white, opaque nodule in the submucous tissue; the germs are few, the fibrous tissue abundant, so there is a great hardness' or induration, which causes contraction of the surrounding tissues, and puckering of the mucous membrane. The germs in their growth radiate in all directions where there is least resistance, forming nodules. A dark slough often forms on those eminences, which may ulcerate and expose the cancerous mass; this may either extend deeply or spread widely so that the neoplasm is found in all directions. The lesions which follow the presence of scirrhus are dilatation of the stomach, chronic gastritis, perforation. The medullary form begins at the same locations, and forms a large soft nodule. Cancer of the stomach occurs most frequently between the ages of forty-five and sixty-five ; more common in males than females. The diagnosis is not difficult, we have the cachexia, the breath, skin, urine, stools, the pain anterior and posterior, the cancer germs in the vomited products, and in urine. A tumor sometimes large, hard, irregular, nodulated; some- times small, deep-seated and elastic, can be felt; which will be a guiding landmark to distinguish it from all forms of dyspepsia. It is hardly possible to mistake cancer of the stomach for gastric ulcer, abdominal aneurism or nervous dyspepsia. The symptoms are plain and most decided: pain anterior and posterior, anorexia, a sense of goneness, uneasiness, distension, with nausea and vomiting, pyrosis, gnawing, lightness in stomach. The pain may not be referred to the stomach, but referred clear through to the interscapular region; those symptoms put in an appearance long before the germs in the walls of the stomach BACTERICIDES. 139 make much headway. But as germ growth becomes active, vomiting is persistent. Hiccough, flatulence, constipation are often annoying and dis- tressing. Great mental depression, debility, emaciation, haggard countenance as it progresses, hemorrhages set in, rusty, brown, blackish blood loaded with germs, or if from the bowel tarry. The yellowish green color of the skin changes to a jaundice hue,. chiefly due to the cancerous mass pressing upon the liver. Often febrile symptoms, hectic, tongue becomes loaded with the oidium albicans, urine loaded with urates, often serious com- plications. The duration is from a few weeks to three years and a half. The prognosis is regarded as unfavorable. The treatment almost altogether consists in ameliorating prominent symptoms, so as to afford all the relief possible from the pain and vomiting. The diet should be liberal, nutritious, concentrated, with a moderate allowance of milk-punch at stated intervals. During the whole course of the disease, the C. conium pill should be administered thrice daily for the relief of pain and to retard the cancerous growth ; constipation should be overcome by the use of kola nut paste. Germicidal remedies are often effective in retarding cancerous growth, and arresting the development of the microbe. The use of one or two of the following remedies at a time are worthy oF a trial. Papoid triturated with salicylate soda and resorcin have proved effective in causing the dissolution of the cancerous mass, let it be scirrhous or medullary. Trypsin has a similiar action, glycerite of sulphur, or the emulsion of Chian turpentine, have proved effective. Liquor ceril has been of great utility, peroxide of hydrogen in alternation with the sulphide of lime. The pill composed of papoid, thallin, and sulphonal operates well. Ozonized clay kept over the stomach has a magical effect (acting by endosmosis) in causing a dissolution of the germinal mass. It may be bound on over the region of the stomach, but never kept long enough applied to cause any irritation. If the stomach rejects all food, rectal alimentation will be necessary. The most common variety of cancer of the Cancer of the tongue is epithelioma. The diathesis being Tongue. present, some point of the tongue being sub- jected to constant irritation, there appears at that point a small unhealthy ulcer, or a deep-seated nodule,. 140 DISEASE GERMS. usually on its edge; ulcer becomes circular in shape, with ragged, everted edges and a wide indurated base. The surface of the cancerous mass has a dirty white or grayish aspect, later, red, papillated, friable, but very hard. As it progresses onward, it slowly involves the whole tongue, which becomes large, unevenly lobulated, covered with several ulcers; hemorrhages often take place. All the glands of the mouth and throat, submaxillary and sublingual are infiltrated, and the oral cavity is filled with the cancerous mass. Cancer of the tongue is met with most frequently in man in middle life, between thirty-five and sixty; some local irritation, as a carious tooth, the stem of a pipe, is an exciting cause. It is easily recognized by the sharp darting pain in the ulcer; the pain aggravated by the movement of the tongue; pain runs along the course of the fifth nerve. As the lymphatics become engorged, salivation be- comes profuse; as hemorrhages are not infrequent, anaemia is soon well marked ; the breath is truly diagnostic ; the germinal mass destroys healthy tissue with extreme rapidity. The duration of the disease is about fourteen months. The destruction of the germ, the relief of pain, the mainten- ance of the vital powers are the principal indications of treat- ment. i remarkable case ; cured by the Epithelioma of the tongue. Epithelioma of the tongue ; application of papoid. Ozone paste was applied twice; the mouth and throat gargled thrice daily by the distillation of the jequirity and solution of chlorate of carbon ; in the interim papoid was applied. Very similar cases of cancer of the tongue, with a fungating growth in the floor of the mouth on the left side, involving the gum and edge of the tongue for nearly two inches. All the sur- rounding tissues densely infiltrated. Ozonized emulsion of Chian turpentine was tried, in alternation with resorcin, and a sufficient quantity of glycerite of sulphur to move the bowels ; growth painted with a ten-per-cent. solution of chromic acid and gargle of chlorate of carbon was used. BACTERICIDES. 141 Epithelioma of the tongue. were used alternately every hours ; mouth kept moist with decoc- tion of slippery elm with a few drcps of peroxide of hydrogen. Ab ut every four days the lactic acid was used; this had an affinity for th ■ germs without destroying the norma! tissue of the tongue. In two weeks the dilute acid was used. Case made an excellent recoverv, healing kindly about the seventh week, and remains well. This case resembled the above in many of its essential features, and in- stead of the lactic acid, a ten-per-cent. solution of the ozone paste was used for killing the germs in the ulcer on tongue; this was brushed freely over it, and followed by a mouth wash of distillation of jequirity, alternated with a wash of peroxide of hydrogen. Same internal treatment as the first case. This is a photographic illus- tration of epithelioma of the side of the tongue, with a medul- lary mass protruding through it; a well marked fissure run- ning towards the point and an ulcer in the centre ; tongue well indurated throughout its whole substance. The submaxillary glands were considerably infil- trated and cancerous cachexia well marked. This case was placed upon comp. saxifraga and phytolacca, and the conium pill was admin- istered to relieve the pain. The large medullary patch, the fissure and ulcer in the centre, was brushed over with the pure concentrated lactic acid; mouth washes of chlorate of carbon and chWin^tp^ soda three Epithelioma on edge of tongue. '42 DISEASE GERMS. There was immense peeling off of the germ-smitten tissue, which seemed to make away with the induration. The re- sults were very efficacious. The recovery of the patient was rapid, and tongue healed up very kindly. This case was treated with the powdered jequirity, the beans decorticated, submitted to the action of peroxide of hydrogen, reduced to an im- palpable powder, blown or dusted on the ulcer every five days, caused a complete exfo- liation each time it was applied. Mouth washes of borogly- ceride were used every four hours, and occasionally a piece of resorcin jelly, dissolved in warm water, was used for wash Cancerous ulcers on tongue. Cancerous ulcer on tongue. and gargle. The result was ex- tremely beneficial, even miracu- lous, in ridding the mouth of this most destructive microbe; breath became sweet; the whole character of the patient changed to one of life and vivacity, in- stead of the lethargy of death. The internal treatment con- sisted in the use of saxifraga, Chian turpentine and exalgine. The numerous ulcers on this tongue, were each, once a week, brushed over with concentrated lactic acid; mouth washes of chlorinated soda, alternated with a wash prepared from the resor- cin jelly. Case improved rapidly at first, but rather slow after sixth week. Mouth washes were changed BACTERICIDES. H3 ICaneer of the tongue, involving its mucous membrane and papilla. to distillation of jequirity, and one of chlorate of carbon. This change operated beneficially; cicatrization set in, progressed favorably; healed entirely up in nine weeks. The fluid extract of hydrocotyle was used in this case instead of the saxifraga, and glycerite of sulphur to move the bowels. Exalgine was most beneficial for pain. A most remarkable case of cancer of the tongue, in which the microbe infiltrates its entire mucous mem- brane and its papilla; it has resisted the usual remedies. It drifted into the hands of one of the eminent specialists whose names are men- tioned in this article. A solution of ozone paste was tried, under which it seemed to do well, but it was discontinued on account of its diffusibility, and a paste made of thallin, papoid and glycerine was tried, that is, spread over the entire tongue ; this caused a dissolution of the can- cerous infiltration. It had to be ap- plied daily, but operated exceedingly well, so that he got rid of it entirely about the tenth week. The mouth wash used was a solution of boro- glyceride and peroxide of hydrogen. Internally, saxifraga comp. and Chian turpentine were the remedies used. The treatment of this case was en- tirely different and much more suc- cessful. The entire diseased surface of the tongue was brushed over with lactic acid, the ulcer in centre receiv- ing three applications. Mouth washes of distillation of jequirity, alternated with the chlorate of carbon, were used with most success. Large masses of dead germs were exfoliated after each application. The lactic acid was ap- plied six times, a week apart. Healed ^.^^^S^S SSS 144 DISEASE GERMS. completely by the ninth week. The internal remedies the same as in the other cases. ___ Cancer of the generative organs is un- Cancer of the doubtedly the most formidable affection, Uterus. to which woman is liable. The liability exists at any age, but is most decided after thirty years of age, the proclivity existing up to fifty years ofage,; after which the liability becomes less and lc>s. The forms met with in the uterus are the scirrhous, medullary and epithelial. , The causes which give rise to so much cancer of the uterus are repeated abortions, sexual incompatibility and venereal disease, which give rise to chronic inflammation or partial deatfi of the uterus. A low grade of uterine inflammation lies at the root of all female complaints, which continues from year to year until the cancer germ is thrown out. It does not necessarily follow that all cases of chronic inflammation do thus terminate, but all such must be guarded with a jealous eye. Mercurialization, monotony, sameness, isolation, solitariness, sexual excesses and other states unfavorable to a high standard of vitality or longevity, or conditions unfavorable to a high state or grade of existence, a degradation of the normal living matter of the body takes place into a diseased germ called the cancer or malignant bacilli; true, these germs may also be received into the body by contagion and infection like other micro-organisms. In whatever manner they are brought about, by spontaneous de- gradation in the body, or by local contact, or by inhalation, they make the human blood their pasture-field, for in that fluid they grow and multiply prodigiously if vital force is low. It is a well- known fact that an individual with millions of cancer germs in the blood may live along to a good old age; if there is no local weakness or irritation, there is no colonizing of germs, but let an organ or tissue, or part of the body be weakened by anything, as the pipe on the lip of the smoker, or a contusion on the breast, or anything that will relax or weaken tissue anywhere, then an exosmosis or effusion, or exudation from the diseased gem- loaded blood takes, place and growth and fruition of the germs will go on with amazing rapidity. Now, of all organs in the body of modern ladies, none are so liable to suffer depression as the uterus ; its intimate connection with the ganglionic nervous system; those millions of little brains, those reservoirs of vitality ; its blending with the sympa- thetic system render it susceptible of being depressed by emo- tions, desires, affections, passions, so that the struggle for exist- BACTERICIDES. '45 ence, exciting literature, certain modes ot life, sedentary employ- ments, sexual excesses, etc., spend their action upon this special organism; besides, at-the climacteric period there are important anatomical and physiological changes that cause weakness, such as the atrophy and obliteration of vessels, shriveling up of ovaries and uterus and suppression of important functions, etc. Cancer of the uterus is, without a doubt, the most common and grave form of germ disease among women. The affection is generally ushered in with symptoms of general debility, a gone feeling, headache and backache. The neck of the uterus thickened, indurated, notched. In this state it may remain stationary for years, while, if the health is poor, it may proceed with rapidity towards cancerous ulceration. In- flammatory symptoms usually are present and darting pains like needles are felt, as if piercing the part, both anterior and pos- terior; ulceration follows. The leucorrhcea, which before existed, now becomes highly purulent and fetid, so much so that ts odor can be detected some distance from the patient; then follows con- stitutional irritation, disorder of the stomach; patient becomes gradually worse, insomnia, pain in the pelvis is constant, with oc- casional lancinating pain; the cachexia is well marked; the pa- tient becomes weak and irritated ; paroxysmal "hemorrhage, slight at first, but gradually becoming excessive and exhausting. On examination per vaginam we find the cervix uteri pain- ful to the touch; and instead of the natural nipple-like projec- tion, its surface is broad, hard, ragged, chapped. The extent of the induration can be appreciated by an examination per rectum. Bladder and rectal complications often set in early. If the disease is not arrested the germs eat in all directions, vessels are laid open, hemorrhages increase in frequency and in amount; ulceration extends to the bladder and rectum; and the state of the patient is truly deplorable. It is only in the earlier stages of the disease that any hope can be held out, if later on it admits of no cure, the patient must die, and all that can be done is to alleviate her sufferings. If seen early or late, the bowels must be kept very regular; the vital force must be sustained by a most nutritious diet; daily baths; the sensorium must be blunted with the conium pill, rectal suppositories of cocaine; and pastiles of hyoscyamus. Tonics and the general treatment for the annihilation of the germ carried out. In cancer of the uterus, the Chian turpentine has proved invalu- able and efficacious. The mode of administration is to keep the bowels regular by the administration of a sufficient dose of the ozonized glycerite of sulphur, and give one teaspoonful of the 10 146 DISEASE GERMS. emulsion ot Chian turpentine thrice daily—the emulsion is thus prepared: One ounce of the Chian turpentine is to be dissolved in two ounces of pure sulphuric ether. This solution has been termed the turpentine essence, and the emulsion is made by adding one ounce of this essence to a mucilage of acacia (one ounce and a half of powdered gum arabic and water to nine ounces), making a ten-ounce mixture, a teaspoonful of which contains about three grains of the drug. The vagina should be cleansed out thrice daily with any of the following antiseptic washes. Boroglyceride, iodine, chlorinated soda, permanganate, resorcin, by or with a fountain syringe. Our only hope is, if seen early, before the destruction of tissue of vital parts has taken place. This illustration exhibits an epithelial growth, the size of a small crab apple, situated in the posterior wall of the neck of the uterus; it bled freely when touched, and thus prevented any further exploration. The patient, aged thirty-five, had suffered for eight months with pain above the pubes, radiating back to the sacrum, with profuse muco-purulent discharge of an intensely fetid odor. The treatment of the case consisted in enjoining rest, with tonics and nourish- ing diet, vaginal douches were used morn- ing and night, consisting chiefly of boro- glyceride, creolin, resorcin, and internally the Chian turpentine mistura was pushed vigorously, commencing with one tea- spoonful three times daily, increasing gradually to ten teaspoonfuls. The growth every second day was painted with lactic acid. This treatment was continued for four months, the Chian turpentine being left off tor three or four days every two weeks consecutively. About the end of the first week the distressing pain had entirely disappeared, both the quantity as well as the factor of the discharge commenced to grow less; in five weeks the tumor began to wither, hemorrhages ceased, a new era of life seemed to dawn upon the patient. Gradually the tumor seemed to waste away, growing less and less, till about the fifth month it entirely disappeared. Epithelioma—neck of uterus radically cured by Chian turpentine mistura. BACTERICIDES. H7 On examining the uterine neck, the stump left was irregular, notched out but showed nothing whatever of a cancerous nature. In six months from the commencement of treatment she had entirely recovered and the normal function of the uterus was restored. Photographic illustration of a case of incipient infiltration of the os uteri, with the cancer microbe. A cure was effect- ed in six weeks by the following reme- dies : Once every seven days for four consecutive weeks the contents of three jequirity capsules Were blown OVer the Infiltration of the uterine os and neck with the microbe. dotted induration, which each time caused a gelatinous exfoliation to peel off; in quantity it would fill a tea-cup. The succeeding night the va- gina was packed with the boroglyceride paste, which caused an exudation of serum with dead cancer germs to the amount of four ounces ; the following night two cocaine cones. This plan was pursued persistently, one night the boroglyceride, the next the cones ; every seventh day the jequirity wafers for four weeks; induration entirely gone. Injections of slippery elm infusion, to which either peroxide of hydrogen or sulphide of lime was added ; alternated with a solution of resorcin. Internal remedies, Chian turpentine mistura, saxifraga and tonics. This illustration, in which the cancer germ had penetrated farther up the uterine neck, was treated precisely as the former, with the exception that the os and neck were painted every ten days with lactic acid, and in- jections of boroglyceride, chloride of lime were used. The cocaine cones were Epithelioma of the neck of the uterus—the microbe infil- USed per Vaginam thHce tration extending into the entire neck—ulceration just A^\\-.r beginning. Udliy. Internal remedies were Chian turpentine mistura, thallin, phytolacca, sulphide of lime. An excellent cure was effected in about four months. 148 DISEASE GERMS. Epiiheliom i of the neck of the uterus, proceeding into the stage of ulcera- tion; three distinct fissures. This wood cut is a representation of a case of very irritable, and exceedingly painful carcinoma of the os, neck, penetrating to the body ; induration, sharp lancinat- ing pain anterior and posterior; hemor- rhages and extremely offensive dis- charge. The patient was well broken down, the cachexia of cancer decided. The treatment here consisted in ap- plying the ozone paste directly to the three fissures and over the fungating nodules. In the application of this paste, the greatest care was observed, all around the cul de sac well pro- tected, the paste was applied by a small paint brush, moderately thick and retained two hours; then carefully washed off by repeated douches of castile soap and hot water. In a week a large mass completely exfoliated, leaving the parts ragged, uneven. These were touched up every few days with lactic acid, which gradually smoothed them off. Vag- inal injections of boroglyceride, resorcin, creolin and other bactericides were used. The internal remedies consisted of Chian turpentine mistura, with thallin, saxifraga and phytolacca. In nearly all cases in which the Chian turpentine was used, pain ceased about second or third day; not so in this case, so it was determined to try exalgine for the pain. This remedy was dissolved in dihite alcohol, and added to fl. extract of licorice. Six grains were administered at three, and six more at ten p. m. It had the desired effect, immediate amelioration of all pain; a subsidence of all that inhe- rent irritability. This drug is a powerful antiseptic, and seems to have an affinity for the cancer germs. The diagram here pre- sented, was an epithelioma of the posterior neck of the uterus, and wall of the va- gina; several nodules ap- peared. The growths bled freely on the slightest touch, and almost filled up the va- gina, and entirely prevented an exploration of the uterus; the lymphatic glands were free, and there was no rectal or bladder complication. As there was no plan of treatment left open, Epithelioma of the posterior neck of the uterus. BACTERICIDES. 149 she was placed upon the Chian turpentine emulsion ozonized, alternated with fifteen grains of resorcin, three times daily, to be rapidly increased to nine teaspoonfuls, and sufficient doses of the glycerite of sulphur administered to move the bowels; the growths were touched three times with a solution of ozone paste (one in twenty); the vagina washed out thrice daily with boro- glyceride solution. With this treatment the germ-growih was arrested, and gradually disappeared, and the neck of the uterus resumed its normal position. This treatment was kept up for four months, pain had ceased; all infiltration disappeared, and the very slight discharge had no odor; at the end of six months entire recovery took place. The diagnosis of uterine cancer in the early stages is best effected by the microscope ; in the latter stages the growth cannot be mistaken, as we have the discharge, its odor and pain to guide us. The cancer germ may localize itself in any part, usually the cervix, low down near the extreme orifice, or high up near the internal; evolution may begin in the glands near the surface, or in their deeper parts. The following remarkable case occurred in the practice of one of the physicians mentioned in this article. A patient after years of suffering, backache, pain in sacrum, frequent micturition, a vaginal ex- amination showed the os to be large and patulous; high up in the posterior wall of the cervix there was a hard mass the size of a bean, which felt like a small fibroid. She was not seen again for a year, when the neck of the uterus presented the appearance as is seen in the annexed cut. She was placed at the time under an active anti-cancerous treatment. The entire cancerous nodule was brushed over several times with lactic acid. This was followed by packing the vagina with boroglyceride paste. The next day this was removed, and the va- gina and cancerous infiltration well washed out with aten-per cent. solution of peroxide of hydrogen. The lactic acid was again ap- plied, when the cancerous mass began to assume a dirty, leather color; followed by the boroglyceride packing. I continued this right along for twelve consecutive days, when the entire mass exfoliated and was expelled. The edges from which it severed healed kindly in three weeks by the daily use of pastiles prepared from the boroglyceride. Cancer of neck'of uterus. 150 DISEASE GERMS. Numerous cases of uterine cancer commence at the inner orifice and form a nodule, occupying the whole of the posterior hp. At first in a case of that kind, the uterus is a little enlarged, freely movable. The posterior lip becomes thickened, and on its an- terior surface, a small ulcer appears which gradually extends on to the vaginal surface of the lip, a depression forms with hard edges, which soon begins to bleed on the slightest touch. The annexed diagram is taken from the frozen dissection of a patient's uterus who died while under treatment for cancer of the uterus from pneumonia. The uterus was extirpated. The organ was then found to be three and a-half inches in length ; the walls of the body were somewhat thickened, but appeared to be healthy. The cervix was considerably enlarged, the enlargement affecting chiefly the posterior wall, and an ulcer was situated on its anterior surface, just within the os exter- num. The surface of the anterior lip was f^WP^f■ ■i W^ ^^^v papillary. Section I i V/Fiiift//'/ J - ■^-*ttz^i .\P*>~ %;i ,\\ showed the posterior lip to be occupied by a mass of the size of the kernel of a walnut. This reached upward to the inner orifice, and occupied the whole thickness of the wall, and it reached down- ward to the portio va- ginalis, but it had nowhere penetrated through the mucous membrane of the portio. The growth looked to the naked eye as if it were encapsuled, but this appearance seemed to be due to the pressure of the growth on the parts immediately surrounding it. Cancer might develop in the cervix from more than one centre, one being situated near the os externum and the other near the os internum. And cancer might attack mucous polypi growing from cervical canal. Cancer appeared to attack the posterior more frequently than the anterior lip. It had a tendency to grow downward so as to invade the vaginal portion and outward into the peri-cervical tissues, and it showed but little tendency to in- vade the body, although growth in this direction had been ob- served. After having invaded the peri-cervical tissue, its tendency appeared to be to grow downward in the cellular tissue around the vagina, and outward into the bladder and broad ligaments. First commenced as an epithelioma, which eat away the neck followed by medulNry infiltration of the walls of the uterus and its entire cavity. BACTERICIDES. 151 Epithelioma of the Vulva and infiltration of groin. the glands of the The patient's age, thirty-nine. She states that nearly a year ago a small wart appeared on the skin, which she did not think anything of, as it gave her no pain, and was very small. It grew larger. She told no one about it, but of her own accord procured some caus- tic (acetic or nitric acid) to burn it away. After this she applied iodine to it, but it went on increasing, although it did not pain her or give her much discomfort, and she was able to take long walks. Last February she thinks that she strained herself in the left groin, lifting an invalid, for shortly after, she discovered a lump there, and felt pain from it. She thought that it was a rupture. At this period the lump on the vulva, which had been increasing to about the size of a walnut and was grow- ing rapidly, and continued so for five weeks, when it formed an oval mass four inches long by three wide. The surface of the tumor., . , , _ . , Epithelioma of the external labia ; the ap- WaS irregularly h.SSUred and pearance of the parts when treatment was 1 1 ,.1 'j* commenced. cracked; there was a sanious dis- charge loaded with cancer germs, great vascularity. There was no interference with micturition, although from the induration present the infiltration extended in every direction, but chiefly back towards the perineal and ischio-rectal regions. The very location of this malignant germinal mass precluded the use of any remedy but the resorcin, ozone ointment, equal parts, which was applied with the happiest results. This was applied every morning for six weeks, when the entire mass had totally disappeared. The internal remedies used were the Chian turpentine mistura, glycerite of sulphur, saxifraga, phytolacca. Those two terms are used to signify ulceration Caries of bone—caries ulceration of the spongy portion et of a bone ; necrosis to the same condition when it Necrosis, occurs in the hard, cancellous structure—the two affections are identical, both are the effect of in- flammation in bone, both have the same microbe, the bacillu. saprogenes, in addition to the pus germ. i; j DISEASE GERMS. fciS This microbe, when once present in either hard or spongy bone, causes softening, molecular degeneration, and destruction of the surrounding parts as well as the bone itself. Symptoms.—Inflammation of bone, with suppuration and forma- tion of sinuses, through which matter flows, in which gritty or sandy particles can be detected—bony granules. Introduce a probe through one of the openings; the bare, dead bone, or its exfoliated, or broken-down portions, can be detected. Discharge fetid; disease chronic, and with great constitutional disturbance. Microscopically the microbe can be readily seen by placing the discharge in the field of an ordinary microscope. As the bacillus saprogenes is a great ptomaine excretor, and in consequence of this alkaloid (toxical) being present in great abundance in the blood and neurine, we have fever, hectic, colli- quative sweats, profound prostration. Therefore the treatment should be most energetic and essen- tially germicidal. If the parts admit of it, the sinuses should be run into one opening by making free incisions down to the gangrenous bone, it should be thoroughly washed out, that is the cavity, with a mixture of i*y# I \M SkJ^l|\^* r°ur ounces of tepid * ^1 \**l '**/** %f\ vater in which one 0* I** /^ 11 fl a ' 'racnm of caustic potassa lias been dissolved. This cts as a detergent. This should be followed Bacillus saprogenes; the microbe of caries and neiru»is .... . r with injections of perox- ide of hydrogen; these to be followed with resorcin ointment; continue this treatment for a week or two. The destruction of the germ, the very fact that no ptomaines are excreted, wipes out fever, hectic, sweats, prostration. In caries, there is noth- ing to hope for but a healing of the bone with deformity; whereas, in necrosis, everything is to be gained by a speedy removal of the diseased bone and its microbe; so that the treatment should be pushed with all the energy possible, managing each case upon its merits and peculiarities. Internal treatment should consist of tonics, embracing cin- chona and mineral acids, together with avena, kephaline. A very remarkable disease of the brain and Catalepsy, nervous system, characterized by a sudden loss of the senses, intelligence and voluntary motion; the patient retaining the same position during the paroxysm as BACTERICIDES. 153 that held at the moment of the attack, or in which he or she may be placed during its continuance. Seizure may last a few min- utes, several hours or even days, without regard to regularity of periods. There may be premonitory symptoms, as headache, irritability of temper, yawning, tinnitus, vertigo, palpitations, im- pairment of mind, confusion of senses, all coming on suddenly; the eyes are fixed, either open or shut; pupils dilated ; restora- tion or recovery takes place suddenly, accompanied with sighing, pain or confusion in the head, with no recollection of what has occurred. No efforts to restore consciousness are effectual. Nervous and hysterical women are most liable to its attacks. Catalepsy differs from ecstasy, somnambulism or clairvoyance, in its being associated with disease. Absence of mind is, in many cases, a mild form of catalepsy. Mesmerism and spiritualism are also a species. There is usually little danger from the attacks, but the tendency is to terminate in apoplexy, insanity or white softening. It is often associated with some organic affection of the brain, as a tumor, a bony or calcareous growth. Anything that tells badly on the nervous system, as grief, worry, debility, intense mental application, the nervous exhaustion of tubercle, syphilis, mercury, may give a predisposition to it. The exciting causes are, violent mental emotion, as fright, ter- ror, suppression of menses, uterine and ovarian disease. Treatment.—Embraces general alteratives and tonics, directed to the supposed cause. Irritating plaster to nape of neck, skin well stimulated, bowels active, shower baths and a persevering use of such remedies as avena sativa, glycerite of kephaline, coca, erythroxylon, cerebrin. Ecstasy differs from catalepsy in every essential, still it is analogous in a deep trance. The patient is insensible to all ex- ternal impressions and is absorbed in the contemplation of some imaginary object. Eyes immovably fixed; will give vent to grand thoughts, impassioned sentences, form a connecting link between the seen and the unseen, between heaven and earth ; fervent prayers, beautiful hymns are recited with great fervency and zeal. It gives rise to a species of religious fanaticism, whereby the person (for filthy lucre) can fall into a trance, an in- cipient stage of spirit life, and give strange manifestations. It affects women mostly, effeminate men who suffer from hysteria, or that peculiar devitalized state of nerve centres. Pecuniary gain, faith, imagination, enthusiasm, and an irresistible desire to imitate and become notorious, will explain the condition best. •54 DISEASE GERMS. An opacity of the crystalline or its capsule, one Cataract, or both ; the effect being to intercept the rays of light on their way to the retina. Three forms are usually recognized according to situation of opacity, viz., lenticular, capsular and capsulo-lenticular. Causes.—The causes that give rise to opacity of the crystalline lens are either inflammation or degeneration of structure. Symptoms.—Hard or lenticular cataract, or degeneration is the most common form met with in both sexes between fifty and seventy years of age. It causes objects to be seen as if through a thick cloud, or gauze ; allows vision to be more clear when pupil is dilated with atropine, or by turning back to light. In advanced cases vision is reduced to distinguishing light from darkness. Commonly, one eye becomes affected first; then the other. Movement of iris natural ; when pupil is dilated with atropia, cataract can be distinctly seen with a glass of small focus; when cataract forms, lenticular opacities can be readily seen by the ophthalmoscope. Soft, or lenticular cataract of young people, may occur at any time of life. Congenital cataract is of this kind, due to disinte- gration of the whole substance of lens, which becomes opaque and swollen. Symptoms are the same as the hard, only vision more imperfect. This form often depends or is caused by a defect in the co-ordinating chemical centre in the brain ; hence it is common in diabetes, and other diseases connected with that part of the brain. Capsular cataract is more especially the result of chronic inflammation and effusion of lymph into its covering; opacity of a dead white color; it may affect any portion of capsule. Opacity of capsule always leads to opacity of lens, so that capsulo-lenti- cular cataract is very common. Treatment.—Various efforts to promote absorption of cataract have been tried ; the most successful has been in the early stage of hard and capsular cataract, chiefly with iodide of potass inter- nally, and by bringing fumes of fluoric acid in contact with the eye until the eye manifests a slight congestion. It should not be resorted to oftener than three times a week, and must be done very carefully, by putting the acid in a wide-mouthed, rubber bottle, guarding mouth, nostrils and other eye, and holding it up to the affected eye so that its fumes come in contact with the eye. More recently, an infusion of pulverized jequirity, eight beans to eight ounces, or stronger, if desirable, carefully percolated and dropped freely into the eye, produces artificial purulent ophthal- mia, in which a shedding, or peeling, or exfoliation of the various coats of the eye take place. This repeated at proper intervals of BACTERICIDES. 155 time, will gradually invade the lymph deposit of capsular cata- ract, and cause it to exfoliate and in time remove it. The remedy is worthy of an extended trial in all forms of opacity, although it is of no use in hard lenticular cataract. Common treatment is by operation, and one of three forms is usually selected, viz : Depression, displacement or couching, by which the lens is pushed from its natural position, so as to allow rays to pass through pupil to retina. Solution or absorption, in which the body of the lens is broken up at several sittings, so that it may be absorbed ; only successful with jequirity and fluoric acid ; and removal by opera- tion. ______ Associated with dyspepsia, or alone, affections Catarrh of the liver are extremely prevalent. This is to of the be accounted for by our ever-present malarial Bile Duct, atmosphere ; by the widespread dissemination of syphilis; by our beer-drinking, tobacco-using and pork-eating population. These, and other causes, give us a people with morbid livers. Whether it be the white liver of demon tippler, with his maniacal mind groveling in the earth, capable of performing every wrong to his brethren; or the pink liver of syphilis, or the starchy liver of the tubercular, or the mercurial liver, with catarrh of the vessels. Looking at those causes, common sense asks us—Is our treat- ment of liver disease by cholagogues in harmony with nature? Do we not rather irritate the liver when we prescribe mandrake and kindred drugs ? Are they useful in obstruction of the biliary ducts ? Assuredly not. Modern science emphatically points to liver stimulants as the proper remedies in all hepatic disease. Catarrh of the bile ducts consists in a weak, relaxed, devitalized condition of the mucous membrane of the large and small bile ducts, the ductus communis and gall bladder. This condition resembles all other catarrhal states—hyperaemia, followed by an abnormal secretion of mucus, with obstruction to the flow of bile. It usually originates in duodenal catarrh, in which the fungus sarcina intestinalis is present, which migrates along the deeper tissue of the ducts, dilates them by forming nests or cysts, giving rise to dilatations and constrictions. Later on, the lymphatics become engorged, then the liver becomes enlarged and nodu- lated, with its margins firm and sharp. Gastro-duodenal catarrh with proliferation of the sarcinae, gives rise to a large percentage of cases of structural disease of the i56 DISEASE GERMS. liver; a gouty and rheumatic state of the blood, calculi, parasites and disease germs in the bile passages. The ordinary symptoms of biliary catarrh are, loss of appetite, furred tongue, flatulence, nausea and vomiting ; usually some pain over the gall duct and liver. As a rule, the bowels are usually constipated, unless it be accompanied with extensive intestinal catarrh, then there is diarrhea; the fecal discharges are clay colored and contain very little bile; urine dark green color and contains bile pigment; jaundice sets in with its usual yellow sclerotic skin, with the usual apathy, drowsiness and itching of the skin. As a general rule the liver is enlarged and tender, especially in the region of the gall duct. Temperature is lowered ; headache ; vertigo ; very great depression of spirits and loss of strength are decided symptoms. In some cases there is no bile at all in the stools, but very great distension of the bowels from gas. As the disease progresses, faulty nutrition becomes greater, ascites and anasarca with acholia set in. The most common complications are pleurisy, pneumonia and dysentery. In the treatment, the diet throughout the entire case should contain no carbo-hydrate; there should be daily baths of water acidulated with nitro-muriatic acid. Locally, over the liver, the irritating plaster should be applied persistently. Then a selection made from two of either of the following, and administered internally. Peroxide of hydrogen in alternation with the simabicidia have a most marvellous action on the gall duct. Phosphate of soda, or ozone water, liquefies the bile, lixiviates the deposit of cholocrome and other amido acids, and destroys disease germs in the liver, or parasites like the liver fluke in the gall duct. These remedies, and others, when administered in liver disease, should be highly diluted in tepid water, as they act speedier, are more easily assimilated, and give us a definite result. Saxifraga and nitro-muriatic acid are best adapted to syphilitic germ colonization in liver. In these days of national deteriora- tion and widespread syphilitic contamination, it would prejudice no case to examine the mucous membrane of the arch of the mouth to ascertain if it had the copper color, the stamp of the colossal, tissue-destroying germ " syphilis." Chloride of ammonium in alternation with the fringe tree, operates well in catarrh of the ducts. Salol in alternation with euonymin is also very useful. Calcium hippurate is employed in such cases as owe their BACTERICIDES. 157- origin to superabundance of uric acid in the system. In physio- logical action it coincides with sodium hippurate. It is prescribed in doses of five grains. It is said to have produced good results with this remedy in the treatment of phosphaturia, and in cystitis associated with mucous and alkaline conditions of the urine. Moreover, it is claimed to have produced wonderful results in all diseases, which are due to diathesis, uric acid diathesis, tubercular incipient cirrhosis of the liver, connected with increased elimina- tion of urates and in tubercula. Calcium hippurate occurs in the form of a white powder, which readily dissolves in water. Lithium hippurate and sodium hippu- rate are employed in the same diseases as mentioned above, and in the same doses. ______ In our climate, with its sudden transitions Catarrh of the from heat to cold, with its neurasthenic popu- Bladder. lation predisposed to all diseases in which debility is a factor, gout, rheumatism and the very general dissemination of syphilis, with a male population notable for damaged prostates and venereal excesses, can we wonder that a weak, relaxed, catarrhal state of the bladder is so common ? The causes which induce catarrh of the bladder are gout, rheu- matism, beer-drinking, with tremendous excess of the crystals of uric acid; syphilis, spermatorrhoea, perversion of the sexual act, disease of the prostate; the migration of the gonococcus and other germs from the urethra; the metastasis of irritation from ad- jacent organs; the natural decay of old age. «=3=a^^ Certain drugs, as cantharides, balsam of copaiba. *^ ^ ^.~, ^*CT e'e, are very liable to cause it. Retention of Zrfg? ^f* urine from any cause is a prolific source of this affection. <&°" °°^^ .T , , . . Micrococcus urea, paiuo- JNo matter how caused, continence or in- genie of catarrh, or ui- continence of urine will occur; the evolution «»*» of the bladder. of the micrococci urea, a microbe which is indefatigable in keep- ing up acid fermentation in the bladder. The evolution of this germ in the bladder in all cases of catarrh adds greatly to the difficulty of cure. Besides the micrococcus urea by millions there is the pus microbe, and numerous others in a state of growth. The urine is scanty, passed with difficulty pain in the back and loins, an uneasy sensation in the bladder; if the urine is permitted to stand, it deposits more or less mucus ; sometimes the quantity is so great that on exposure to cold it becomes solid, and there is oftentimes difficulty in expelling it from the bladder. Impotency, loss of sexual desire and power; nocturnal emis- i58 DISEASE GERMS. sions are likely to occur; sometimes the patient is unable to urinate; has a sensation of scalding in the urethra; blood may occasionally be seen in the urine. Indispensable to a successful treatment the patient should be placed upon the very best of food, of the most nourishing charac- ter; daily bathing; flannel clothing; external warmth, and bowels regulated to once in twenty-four hours. Inculcate an alterative and tonic course of remedies, such as alteratives and tonics, embracing saxifraga, phytolacca; compound tincture cinchona; mineral acids; collinsonia; bayberry; stone-crop, At convenient intervals drink either an infusion of buchu, uva ursa, praira brava, queen of the meadow, couch grass, triticum repens—whichever two should be selected, which diminishes the muco-purulent discharge, and one used one week, the other the next. If the patient is unable to empty the bladder, urine should be drawn off with a catheter, not a drop of residual urine left in the bladder. Drinks of a demulcent character to be taken but very sparingly, and all alcoholic stimulants rigidly forbidden. Besides this general treatment, rest and the destruction of the micrococcus urea. To effect this, ozonized soluble bougies, composed of either re- sorcin, or thallin, or papoid ; one might be conveniently run into the bladder daily and permitted to dissolve. This mingling with the micrococci effects their destruction. Failing in this, the blad- der might be injected twice a week with glucozone, or a solution of resorcin, or peroxide of hydrogen. If the urine be loaded with other germ, besides the micrococci urea, as the microbes of syphilis, cancer, rheumatism, the use of the bougies, or injections are imperative. Internally, the course of remedies must be so modified as to permit the introduction of some bactericide to sterilize the blood, and to render it so that no germ will live in it or the bladder. Select some of the following, either the ozonized uric acid solvent, or the peroxide of hydrogen; benzoate of sodium, or the sul- phide of lime. Patience, perseverance, with those new remedies and powerful germicides, with attention to all minor details, will ultimately ■effect a cure. Catarrh is a general term applied to a devital- Catarrh, ized condition of mucous membrane. Catarrh of Bronchial, the frontal and nasal passages; catarrh of the bronchial tubes, of the pulmonary tissue, of the stomach, bowels, bladder, womb, vagina, prostate; in each and BACTERICIDES. 159 all there is a relaxed condition, an excessive secretion, a degrada- tion of bioplasm, into a disease germ of some species, the sim- plest of which is the amceba, the simplest and lowest type of mi- croscopic life. This disease germ, properly speaking, gives rise to catarrh bronchial, while the conferva, bacillus of tubercle and other mi- crobes give rise to bronchitis proper. This disease germ consists of a simple cell or an aggregation of cells, each of which maintains an independent existence, and capable of prodigious powers of reproduction by segmentation in a proper fluid, and so light that they may diffuse themselves through the atmosphere. They resemble an O or globose form* gelatinous or albuminoid, like those in nasal catarrh. No nervous system, no organs, no trace of a mouth can be detected in them, but contain a nucleus and by looking very minutely at them under a high power 2500 diameters, one or two or more pulsating spaces can be detected, which finally sprout off. Their movements are contractile, in which, by inhibitory action, they take in nourishment. They spread by contagion and infection, and are capable of entering the blood, producing a diathesis, in which anaemia and nerve prostration are predominant. The mucous membrane in health exudes a sufficient amount of secretion for lubrication and no more ; and in that no disease germs are present. But the slightest deviation from health, degradation takes place and disease germs are present. The symptoms and diagnosis same as chronic bronchitis. The profuse ex- pectoration and the presence of this microbe are the landmarks in diagnosis. Catarrh of the bronchial tubes is best and most successfully treated with bactericides. They should be inhaled nasally and orally; taken on the stomach, and also used in bath ; in other words, the blood and all the tissues of the body should be so saturated with germicides that no diseased micro-organism could possibly exist in the body. Glucozone is the best of all remedies for inhalation with the cold spray atomizer. Remedies on the stomach, select from some of the following : peroxide of hydrogen, distillation of pine needles, glycerite of ozone, ozonized tar syrup, avena sativa, tolu and resorcin, creo- sote, carbolic acid and tincture of iodine, tercbene. For baths, pine-tree-needles extract, which gives us a perfect saturation of all the fluids and solids of the body with ozone, in which condition no microbe can live. i6o DISEASE GERMS. A weak, relaxed, irritated state of Catarrh, the mucous membrane of the stomach, Gastric, in Adults, which gives rise to an excessive secre- tion of mucus. Whenever mucus is in excess in the stomach, the sarcinae ventriculi and yeast plant make their appearance in more or less abundance, according to the state of vital depression present. Whether this sarcinae be the result of degraded living matter of the mucous membrane, or a true vegetable germ or fungus, or parasite, produced like yeast plant by saccharine fermentation and swallowing atmospheric air, is not as yet definitely settled. It has, nevertheless, been clearly demonstrated that this fungus, let it be animal or vegetable, grows like all other living matter and with remarkable activity, so much so that it distends the stomach enormously by its presence and makes life a misery. Causes.—As eighty per cent, of our entire population suffer from the presence of this parasite in their stomachs and more than two-thirds of all cases of dyspepsia are of the catarrhal form, it is important that the causes that produce it should be clearly appreciated. Hurried or improper mastication stands first; in this the food is bolted down, has little if any secretion from the mouth glands, no parotid juice, no element in it to pre- pare it for gastric digestion, but simply an offending, irritating bolus. Add to this the pernicious habit of drinking at meals large quantities of fluids of any kind, but especially iced or cold drinks, which completely arrest the process of digestion for the time being. Beer and tobacco rank next as great stomach depres- sors; so are cold food and drink, ice cream, saccharine and starchy food, alcohol, drugs, as bromide of potass, alkalines generally. Our climate is productive of it, sudden vicissitudes of tempera- ture from heat to cold, insufficient clothing, anything that will cause congestion of the mucous coat of the stomach with an ex- cessive secretion of mucus. Hence it is often brought about by irritation or disease of adjacent organs, as morbid states of the liver, bowels arid rectum, chronic bronchitis, nasal catarrh, tuber- culosis of the lungs, and emphysema. The instant the mucous coat of the stomach is damaged or irri- tated, an excessive secretion of mucus takes place, and simultane- ously with that there appears in the stomach of the individual the sarcina and yeast plant. As the sarcina appears first upon the scene and is the more tenacious of the two plants, it merits our primary attention. The fungoid mass or jelly, thick, clear, ropy, cohesive in consistency, placed in the field of a microscope of ordinary power, reveals it to be made up of blocks, or squares, or BACTERICIDES. 1^l The sarcinae ventriculi as seen in the vomit of all patients suffering from gastric catarrh. cubes, or packages, as seen in the annexed wood-cut, quadrangu- lar in form, the' cubes consisting of fours, sixteens, sixty-fours, etc. These squares live, grow, propa- gate by millions by segmentation, imbib- ing nourishment from the degraded mu- cus of the stomach, and new additions from the same source. When this altered bioplasm or changed living matter takes place, the sarcina ap- pears in the stomach, and finds its way into the blood and is subsequently to be found in those having this form of dys- pepsia in the fluid of the ventricles of the brain, bronchi, bladder, rectum, uterus, vagina. The presence of this organism, this dangerous parasite, is in- variably accompanied with the cryptococcus cerevisia, or yeast plant. This fungus is too well known to need a description, being present in the process of fermentation. The annexed cut gives a true appearance of this plant as seen under the microscope in the form of round or oval disk cells, vary- ing in diameter from one four-hundredths to one eight-hun- dredths of a line, with smaller germs in their interior. They grow by protrusion of gemmules, and germinate from several points of the primitive fungus cells. These shoots throw off new gemmules and gradually form rows of single or branching cells, connected together like beads. This peculiar arrange- ment of cells, and the fact that they cannot be acted on by acetic acid, is characteristic of the plant. This fungus exists in great abund- ance with the sarcinae in the stomach, and is also found in the urine, uterus, faeces, with or without the co-existence of saccharine diabetes. Both the sarcinae and the yeast plant are to be found in all domestic animals as well as The yeast plant taken from the ejected fluid from the stomach in gastric ca. tarrh, magnified 200 di- ameters. In those cells marked x, a young cell is seen grow- ing in ihe interior ; while in the large cell marked xx, there is a simulta- neous internal produc- tion and external gem- mation of cells. man. The presence pf two such parasites in the human stomach necessarily gives rise to Symptoms of a pungent, depressing char- acter, general prostration, a feeling of gone- ness, faintness, emptiness, with all the symptoms of dyspepsia, flatulence, acid eructations, heartburn, pyrosis, coldness in the extremities ; tongue has a coat, but usually a white fur with slime; breath sour-smelling, with disturbance of the head, II l62 DISEASE GERMS. heart, liver and other organs ; appetite capricious, a craving for food, an inability to eat which vomiting relieves—tremen- dous spells of eructation of wind, with regurgitation of acid fluids, the result of a fermentation in which the sarcinae and the yeast plant are in abundance. The congenial abode of the sar- cinae is the stomach ; they always can be detected in the mouth, in the thick, ropy, glairy mass, brought up by a proper emetic, in which they can be seen, living, growing and reproducing by seg- mentation. They often attain great size, and break down and die, and they may be thrown off by the mouth or pass down on the bowels and pass off in a sudden, unexpected attack of diarrhea. If they become very large before breaking down and passing either by mouth or bowels, they give rise to great abdominal distension. The presence of the sarcinae ventriculi in either the stomach or bowels is the great factor of lactic acid in the human body (rheu- matism), and all the accumulated experience of Europe and America point to this plant as the precursor of cancer of the stomach, catarrh of the colon or rectum, and a factor in the pro- duction of tuberculosis. The treatment of this form of dyspepsia requires the finest tact, skill, and a thorough appreciation of the germ theory of disease. The malnutrition due to those parasites, their method of feeding being chiefly upon liquids, their removal by washing out the stomach, their starving out, their direct destruction, the prevention of the secretion of mucus which loads and obstructs the function of the stomach—in order to accomplish all this and more too, we must depart from the ordinary methods of grappling with disease. The general points to observe are, an avoidance of all care, worry, or mental strain, no over-work, no excess; active but not fatiguing exercise in open air; daily cold baths, followed by fric- tion ; flannel clothing; a diet consisting of broiled tenderloin steak or chicken, soft-boiled eggs, boiled fish, buttered toast, oat- meal mush, baked potatoes and ripe fruit. Rigidly forbid veal, pork, salt or corned beef or fish, fried or boiled meat, pastry, nuts, sweets, cabbage, tea, tobacco, alcohol, all fermented liquors and all liquids at meals. Order is Nature's first law, so there must be perfect regularity in all things, eating, sleeping, defecation—three meals of solid food per day, with proper intervals between, and in this interim between there must be no mastication, no nibbling, no odd snap or luncheon. The mastication of the food must be thorough, not hurried, but so that a proper admixture of the food with the sali- vary secretion takes place. Hurried meals are mischievous. BACTERICIDES. 163 Rest after meals, but no sleep, as the latter retards the digestive process. Having thus laid down the above and other precautions as to food and digestion, one or other of the following methods of treatment should be tried: either starve the germ out or destroy it. Method of starving the germ out.—If this method is decided upon, it must be arranged that twice a week, for a period of from six to twelve weeks, an emetic of pulverized lobelia leaves should be administered thus—the patient, prior to taking it, should drink very copiously of tepid water in which bicarbonate of potassa is dissolved; follow this with frequently-repeated draughts of lobe- lia infusion (one ounce of leaves to one-half pint of boiling water), sufficiently cold to admit of being drunk freely ; continue till free emesis and ejection of the germ or parasite or a portion of it takes place. Follow this lobelia emetic up by encouraging the patient to drink freely of an infusion of kaki (one ounce to the pint); add to this a few grains of capsicum to render it more stimulating to the gastric mucous membrane. The persistent administration of kaki infusion at stated intervals arrests the secretion of acid mucus in the stomach, braces, astringes the mucous coat, and thus cuts off the pabulum upon which the parasites, sarcinae, live —and thus it starves. Repeat the emetic every four days; fol- low closely with the kaki. No other emetic will serve the purpose; as lobelia itself is a great germicide in nature, it retro- grades all germs, checks their development and growth, steri- lizes their micrococci. An invaluable remedy for the purpose of starving out the mi- crobe is the Virginia stone crop in alternation with ten grains of resorcin in liquor cerii ozonized. Thus the remedies thoroughly astringe the mucous coat, and prevent the germ receiving nour- ishment from the gastric mucus. Destroying the germs in the stomach must be adopted or tried. Here, of course, it is very difficult to select remedies to be admin- istered on the stomach that will enter, unite with, or penetrate, or chemically cause a dissolution of the fungoid mass or jelly. Besides, patients who have had this parasite in the stomach for a long series of years suffer from atrophy of the pepsin glands, with functional incapacity. Remedies to be of service here must be highly antiseptic and not impair the stomach in any way, but rather increase its vigor. The sarcina ventriculi is sterilized, completely annihilated, in the presence of either of the following remedies : Peroxide of hydrogen, a few drops added to water, is most effectual. In attacking the fungus it liberates the ozone, which 164 DISEASE GERMS. unites with the fungus and destroys it—does not impair, but rather increases, the gastric function—tones, strengthens. The sulphide of lime or the chloride, well triturated in sugar of milk, is most efficacious. Ozone water or comp. oxygen must not be overlooked. Ozonized sulphur water, added to an infusion of columbo, is not to be despised. Ox-gall, thoroughly washed of all impurities with the dioxide of hydrogen, then evaporated to the consistency of molasses, to one hundred parts add two hundred of pulverized willow char- coal, with ten parts of capsicum ; mix. Make into three-grains pills ; one two hours after meals thrice daily. Papoid, a vegetable pepsin from the carica papaia, combined with the boroglyceride, gives excellent results, as it is one hun- dred times more potent in antiseptic power than ordinary pepsin,. and acts better on the peptic glands. Modern dietetics, adulterated food, early Gastric Catarrh precocity, have within these few years back in Children. given rise to the sarcinae in children— twenty years ago a rare disease. Now it is one of the commonest derangements of that period of life among rich and poor. It is a constant danger to hand-fed babies, and forms one of our chief obstacles to the raising of infants. In older children it is of frequent occurrence. It seriously affects their nutrition, and interferes with development and growth. Mothers term it biliousness. The little one loses its appetite, mopes, lies about, has a dull, pasty or yellow com- plexion, and looks dark under the eyes. At night it sleeps badly, and is restless and irritable during the day. If the tongue is protruded, there is a fur on it, with a coat in centre; the breath is sour-smelling; there is a fulness about the stomach; all indicating catarrh of the stomach, which, with its fungus, inter- feres with the digestion of the food. It may be vomited, or pass by the bowels, but it leaves the stomach weak, and another crop is likely to follow, nutrition is seriously impaired. In addition to the above symptoms, affected children complain of pains in abdomen and sides, and are likely to suffer from vertigo, syncope from pressure upward of the distended stomach against the dia- phragm and heart. Bowels usually are constipated. These symptoms are greatly aggravated by an injudicious diet on the part of the mother, as supplying the child with an excess of fermentable food, as potatoes, puddings, sweet cakes, etc., which feed the sarcinae and keep up the dyspepsia, which is a BACTERICIDES. I65 source of great discomfort to the child and anxiety to the parent. The whole system is being fed by an acid, generated by the germ, and aggravated by the food, and the child is irritable and exces- sively restless. His speech is hesitating ; he may stammer; his muscles may twitch; his eyes wink, and he is nervous. Nausea and vomiting are not always present. If there is vomit- ing, the products are sour-smelling fluid, and thick, ropy mucus. Frontal headache is rarely absent; it is often distressing; urine highly acid, loaded with uric acid. Nutrition is always inter- fered with ; the child wastes perceptibly, or there are fainting fits. In curing gastric catarrh in children, the sarcinae must be either removed, destroyed or starved out. The acrid mucus and germ is the constant cause of acidity and fermentation ; they keep up a bad train of symptoms. The greatest benefit is derived from the peroxide of hydrogen in small doses, frequently repeated. This should be alternated with the sulphate of cinchona or some bitter tonic. The peroxide of hydrogen, combined with an equal amount of glycerine, administered in a little water after meals, instantly parts with its ozone, which kills the microbe, the factor of gastric catarrh. The sarcinae being removed, digestion improves, increased assimilation, a priceless boon of the dyspeptic. The average dose is fifteen drops to one ounce of water. The ozonized cascara sagrada lozenge is a powerful microbi- cide. One administered thrice in twenty-four hours is efficacious in the destruction of the sarcinae, in destroying the activity of all bacteria and micrococci. Its active properties are due to the ozone which it contains, and which it liberates in the stomach and destroys the microbe. Resorcin, arsenic, naphthaline might be tried. The Virginia stone crop is the father of a class of remedies of the greatest possible utility in sterilizing the sarcinae ventriculi; it is much more energetic in its action than either collinsonia or bayberry. It is a drug from which the greatest possible benefit accrues in either catarrh of the stomach or bowels. Same remedies as in the adult may be tried with success. Bowels should be kept regulated by the administration of a decoction of flaxseed or slippery elm, to which a small amount of olive oil is added. Diet carefully guarded ; no starchy or saccharine agent given ; nothing to aid fermentation ; toast, milk and lime-water. As soon as tongue cleans, appetite returns; boiled fish, white of chicken, lean broiled mutton. It is not well to press the child to eat; rather refrain. To give tone to the stomach and strengthen digestive powers, sulphate of cinchona or wine bitters. ,66 DISEASE GERMS. In order to prevent gastric catarrh becoming a prevailing dis- ease among children, mothers must learn that all sugar and starch articles of diet are poisonous to children. They should also be made aware of the great utility of a flannel binder or roller next the skin as an indispensable article of a child's dress till it reaches three years of age. This roller should reach from the armpit to the groin; not pinned too tightly. The resisting power of all children should be fortified by gradually bringing their morning and evening bath to cold water. It must be a very gradual process in weak children, in all cases followed by active rubbing. To bring children to the cold bath, and practice it properly, has a most tonic effect upon the system generally, and confers great resisting power upon the part of the child, and reduces its susceptibility to any change. Mothers should also be instructed of the utility of brisk massage over body after child has been dried off. _______ Sarcina intestina has all the essential elements Catarrh of that found in the stomach, only much smaller Intestinal, in size. It is found in the duodenum, and throughout the entire intestinal tract; in the vomit, faeces, lungs, blood, urine, in the form of yellow patches, green or reddish. Peculiar groups of four, eight, sixteen, thirty- two cubical cells with rounded edges, closely placed against one another. The fungus gives rise to a functional disturbance of the bowels, independent of any organic lesion. Intestinal dyspepsia may be a primary affection, brought about by cold, mechan- ical irritation or mental depression, or it £*&gj&fTTW may be brought about by catarrh of the 4 '^^M^^tM stomach, or by structural changes in the mucous membrane of the alimentary canal; altered conditions of the secretions & of the small intestines ; the presence of ^SiSu^b^u'^uSK undigested food, or the ingestion of im- found m the duodenum m fuii- proper food ; an alterated state of the fledged masses, as in d; c in L *■ ' the smaii intestine; b and a, muscular coats of the intestines, gener- large bowel. 11 . 1 . • ■ ally accompanies malnutrition. In catarrh of the bowels, all or some of the symptoms of dys- pepsia are present. Pain may be present, of a dull aching char- acter, radiating over the upper portion of the abdomen. Not acute, more likely if present, to prevail two hours after the in- gestion of food, nausea and vomiting when they do occur, de- pend more upon the stomach derangement than upon any intes- BACTERICIDES. 167 tinal disturbance. .Constipation, gaseous distension of the large intestines, are prominent symptoms. The various coats of the bowels are so thoroughly relaxed that there are often immense fecal accumulation. After repeated attacks, general health fails, he loses flesh and strength and begins worrying about himself, fearing some organic disease. As a rule the appetite is seldom impaired To effect a correct diagnosis, administer a large dose of castor oil, followed with copious draughts of either an infusion of flax- seed or slippery-elm, then take the albuminoid portion of the evacuations and place a portion in the field of the microscope, and the sarcinae will be seen. In the treatment, it is well to regulate the diet. This is import- ant; patient should abstain from all fatty, saccharine, or starchy substances, and eat solid food, meat and vegetables; daily bath- ing ; an avoidance of tea, coffee, tobacco, and all fermented liquors; a freedom from care and worry; of drugs which yield the best results, collinsonia, stone crop, bayberry, salol, naphtha- line, resorcin. In intestinal catarrh, the peroxide of hydrogen is invaluable; true it does not, like salol, destroy the pathogenic germs, but it unites with them, renders their ptomaines inert, and thus the tissues, being relieved of the deleterious effects of the ptomaines, combat successfully the germs. Injection of the bowels above the sigmoid flexure with copious injections of creolin are of immense utility. The best of all these remedies is the Virginia stone crop, which is a priceless drug in intestinal catarrh. Nothing in the materia medica which can be compared with it. Repeated irritation of the lining mem- Catarrh Nasal brane of the nose, sinuses, posterior nares, (Chronic). larynx and bronchi, so devitalizes, modifies, changes and degrades normal living matter into a diseased germ; the amoeba, which is simply a degradation of the normal bioplasm that nourishes the lining membrane of the respiratory mucous membrane, that gives us rather a compli- cated disease, one both contagious and infectious. We also find the disease-germ in the mouth, urethra, vagina, but always more perfectly developed and in larger quantities in the air passages. Chronic catarrh, then, may be defined to be chronic inflam- mation of the Schneiderian membrane, with this change of its own living matter, or matter concerned in its nutrition, into the disease-germ, amoeba. It is most erroneous and unscientific to i68 DISEASE GERMS. assert that it is caused by syphilis or tubercle. Those disease- germs may impair the vital stamina of the patient, but cannot produce the amoeba. Our highly oxygenized atmosphere, our very variable climate, the extreme susceptibility of our people to climatic changes, with our violent winds and atmospheric currents, absence of trees, etc., render our people very liable to catarrhal affections. The most careful microscopical examinations of an immense number of cases fail to exhibit any germ but the amoeba. When it occurs in a young or tubercular subject, the tissues being soft and not very vital, the amoeba of catarrh eats up the structures rather voraciously, and as soon as they reach the cartilages of the nose, all their proper nutriment being gone (for they cannot live on cartilage), and the vital powers being very low, the oidium albicans makes its appearance; then we have that pungent, indescribable, fetid odor characteristic of ozaena. When the Schnei- derian membrane and frontal sinus are alone implicated, with no appreciable odor, it is termed catarrh ; when the amoeba have crept up the eustachian tube, aural; when they have penetrated down the fauces and larynx, laryngeal; when they have moved still further downwards on the bronchi, bronchial; asthmatic when they gnaw the periphery of nerves in the circular muscular fibres of the rings of the bronchi. Aromas or parasitical states, such as the bacilli of hay, the mycelia of roses, ragweed, and other vegetable germs, are not capable of living in human blood; nevertheless, they can blight normal bioplasm of the respiratory mucous membrane, and thus cause the appearance of the amoeba. Hence, catarrhal conditions are named after those special vegetable agents. Diseases of the respiratory mucous membrane are very prevalent, each capable of causing tuberculae: (i) by reflex action; (2) by the amoeba entering the blood. Catarrh is often the starting point, as it is the most common of the entire class. When it takes place, its offspring, the amoeba, begins to enter the blood and produce a special diathesis of its own. Its chief characteristics are languor, lassitude, debility; a peculiar pasty or doughy appearance of' the skin; pains in the limbs; headache, with a sense of tightness acros; The amoeba—the germ of na thin starch : R<. Oil eucalyptus............2 drams. Phenol sodique............4 drams. Glycerine..............3 drams. Mix. The following is of great utility, nay, unsurpassed, as a vital restorative to the rectum. Ij;. Fluid extract juglans........2 ounces. Fluid extract Virginia stone crop ... 2 ounces. Fluid extract stone root.......2 ounces. Mix. A teaspoonful added to half a teacupful of slippery-elm water every three hours. A catarrhal state of the entire alimentary canal is often present in pulmonary phthisis and insanity, and is often the cause of a fatal termination. The microbes of either affection along the entire tract, the exhausting discharge, soon reduce flesh and impover- ish the blood more than any other state. The real causes of this catarrhal state are the intense acidity, the presence of germs, ptomaines, lardaceous or phosphatic de- posits on the bowel. In nearly all these cases ulcers on the intestinal tract begin below the duodenum, but in the small intestines they are insigni- ficant compared to the worm-eaten appearance of the large bowel. The localizing of disease germs' follows the line of the blood vessels, specks of congestion isolated, coalescing, broad or per- *74 DISEASE GERMS. forating in the colon and sigmoid flexure, and as they reach the lower bowel it is not uncommon to find ulcers of great depth. Recognizing their microbe origin, there should be a persistent use of stone crop, salol, naphthaline, peroxide of hydrogen. Numerous and varied are the causes Catarrh Uterine which excite catarrhal conditions of the (Endometritis), inner lining membrane of the uterus. The most common are, various forms of ova- rian disease; frequent abortions; the irritation produced by the retention of the placenta, or shreds of lochial discharge; the introduction of instruments. Some drugs are productive of it, as excessive doses of bromide of potassa, aloes, savin, sudden suppression of the menses from cold or damp, masturbation, men- tal excitement, torpid liver, tight lacing, gout, rheumatism, incompatibility in married life. As there are, so to speak, so many grades of irritation, we have an immense variety of symptoms. Take the acute variety, in which there is fever, high temperature, rapid pulse and respi- rations, general irritation, sallow complexion, loss of appetite, headache, pain in the loins and the lower part of the abdomen, sacrum, groin and inside of the thighs; a sense of great heat and fulness about the pelvis, and bearing-down. Bladder very irrita- ble ; a desire to pass water every few minutes, which is loaded with uric acid. Diarrhea and tenesmus, and, subsequently, constipation. Tenderness on pressure over ovaries and uterus. After a day or two, thick, ropy, tenacious discharge; which, after a while, becomes muco-purulent, and is tinged with blood, and imparts a greenish-yellow or greenish-red stain to the chemise or other body linen. There is often piles. This acute form should be treated with rest; warm hip-baths;. mucilaginous drinks; open bowels with cascara; 'administer either antipyrine or antifebrin for fever; pastiles of cocaine both per vaginam and rectum every four hours. As soon as the acute stage has been overcome, three teaspoon- ful doses of the wine of aleteris farinosa should be administered every three hours, alternated with other uterine tonics. The chronic form is the most common, and runs a tedious course, with headache, languor, lassitude, debility, great mental depression, obstinate dyspepsia, flatulence and constipation. A sense of weariness, if not pain, about loins, sacrum, groin, inside of the thighs, and bearing-down. The discharge now is thick, ropy, tenacious, very abundant, glairy, like white of egg. Often, under the microscope, the sarcinae and yeast-plant germs can be BACTERICIDES. 175 Bacteria of yeast plant. -detected in it. The discharge is most abundant in the mornings, accumulating in uterus over night, or after lying down awhile; indeed, in bad cases, after being in the recumbent posture for some time, it will flow right out. The debility increases, and a train of other symptoms set in, as hysteria, convulsive affections, nausea, vomiting, tympanitis, tenderness of breasts, and menorrhagia, if the lining cover- ing the fundus is involved. In the chronic form a weak, relaxed state of the intra-uterine mucous membrane, in which the yeast-plant and sarcinae are evolved in the mucous secretion. One of the most common maladies of the modern female, brought about by numerous causes, as sexual incompatibility, metritis, miscar- riages, metastasis of disease germs, and the like, and reflexly gives rise to a feeling of goneness, hysteria so-called, headache, debility, dyspepsia, bloating, with an indescribable burning in the hands and feet; a leucorrhceal discharge, most copious in the morning, in which those micro-organisms are invariably present. The germ-laden secretion, as it oozes from the uterine cavity, is intensely acid owing to the presence of the three germs. This bacteria or vinegar-forming plant is often present in intra-uterine catarrh. It is found in all the hollow organs of the body; often grows to an immense size, alongside of the sarcinae and yeast-plant. It is completely sterilized in the presence of germi- cides. Dysmenorrhcea, sterility, and ulti- mately a cancerous germ is elabo- rated from the normal bioplasm. Such is the state of two-thirds of our married ladies. The most experienced physicians find this affection most difficult to manage ; indeed, by some incurable, simply because they have failed to realize that the cavity of the uterus, with its entire mucous covering, was a colony of a million microbes—factors of morbid action, often the precursor of cancerous infiltration. Authors recommend injecting the uterine cavity, in these cases with germicides; this must not be done with American ladies, whose reflex centres are so impressible, such a procedure, if resorted to, is sure to give rise to great trouble, nervous and con- The yea-jt plant and sarcinse present in all cases of intra-uterine catarrh. 176 DISEASE GERMS. vulsive affections. My method is to insert into the uterine cavity a soluble gelatinized bougie, composed of papoid, or tryp- sin, or iodol, a germicide of sufficient power to annihilate the yeast-plant and sarcinae. Use one about once a week three times during the month. One to three will cure; but as the cavity of the uterus is considerably dilated, and its walls so much thick- ened, to be thoroughly certain of a cure it is better to resort to this proceeding for three consecutive months. At the initial period of treatment the patient should in all cases be placed upon full doses of the distillation of the aleteris fari- nosa. This is a most efficacious remedy in those cases, being a uterine tonic and invigorator. In alternation, the fluid extract of the salix nigra is a decided sedative to the genito-urinary organs of both sexes. ______ The cervix uteri is a large, open gland, Catarrh Cervix extremely liable to suffer from very slight Uteri. irritation which is constant, and on this account catarrh is the commonest of all diseases incidental to woman. The causes are most numerous— irritating bodies in the vagina, childless marriage, abortions, tedious labor, suppression of the menses, gonorrhea. The general symptoms of an exhausting discharge are inva- riably present: debility, bear- ing down, aching in the thighs and hips. In parts of the cervix that can be seen through a speculum the mu- cous membrane of the neck is red, swollen, and will bleed easily, and secretes a specific muco-purulent matter; in other cases the mucous mem- brane has a granular or punc- tured appearance. Intercourse with a patient so affected (which passes by the name of leucorrhcea) is bound to give rise to all the symptoms of gonorrhea in the male. The mucus secreted by the glands of the cervix has .the identi- cal appearance of the annexed diagram. It consists of cysts or vesicles, which never appear in healthy mucus. These cysts are The microbe of chronic catarrh of the cervix uteri. BACTERICIDES. 177 regular cocci, which breed freely and give rise to profuse leucor- rhoeal discharge. As they have wonderful powers of reproduc- tion, they soon render the cervix loose, spongy, patulous, bur- rowing in its intestinal structure. This accounts for the greater frequency of cases in practice of men who have all the symptoms of gonorrhea after intercourse with women so affected. Avoid- ing the old caustic treatment for this malady, we have a most efficient one in boroglyceride ozonized, either in packing the vagina a few times with the paste, or using a saturated solution by means of a fountain syringe. In this way, with rest, removal of the causes, an easy and an effectual cure is established. More chronic still, these minute cysts become altogether inde- pendent, although merely obstructed follicles, are the regular breeding ponds, give rise to a crop of vesicles, the contents of which give rise to herpes preputialis, if applied to or coming in contact with the glans of the penis. The occurrence of these germinal eruptions calls for great care. If the above method fail, then make a pastile or pencil of the ozonized jequirity and insert it in the os ; allow it to remain. In a short time it will cause a peeling off of the old germ-eaten tissue. Leucorrhcea is a general term applied Catarrh of the indiscriminately to all discharges from the Vagina. vagina of a mucous or muco-purulent charac- ter, whatever may have been its origin or source. Either a weak, relaxed condition of the mucous mem- brane, or a catarrh of the os or cavity, to induration and ulcera- tion of the neck, to ovarian irritation ; all discharges from the vagina, when they exceed a slight moisture, are loaded with microbes, disease germs pathogenic respectively of each morbid condition. Therefore the treatment of all cases, irrespective of cause or condition, must be essentially germicidal, consisting internally of the wine of the aleteris farinosa, comp. syrup partridge berry, alternated with the peroxide of hydrogen; general tonics, rest and best of diet. Daily or more frequent vaginal injections with fountain syringe, holding from one to two quarts of tepid solutions of some effi- cient bactericide, such as boroglyceride, resorcin, iodine, creolin, naphthaline, preparations of calcium, glucozone. The cause must be removed, and those injections or others continued. In some cases the jequirity uterine wafers are of utility; pastiles of white pond lily; packing the vagina with boroglyceride is one of the best of all methods, as this germicide 12 i-.s DISEASE GERMS. exerts a chemical action upon the uterine secretions, restores the parts to their pristine vigor, obviates all conditions of blight or sterility, promotes fecundation. The degree of cold that can be borne by Chilblain the human body before freezing, depends a or good deal on the medium through which it is Frost Bite, applied (dry or moist), and the power of vital resistance in the individual. The exposed por- tions, as nose, ears, hands, feet, are most obnoxious to it, chiefly on account of their feeble circulation ; and the feet are peculiarly prone to frost-bite, if sweaty or damp. • This is one reason why it is so common in hired girls, who sleep in attics, and mostly sleep with their damp stockings on. A chilblain may be defined to be a subacute inflammatory swelling, due to cold, and the pre- mature restoration of the circulation by heat. In all chilblains, as well as in burns and scalds, there is a mi- crobe evolved from the damaged elements of nutrition of the part. Symptoms.—Burning, tingling, throbbing in the affected part, with swelling, redness, and itching. There may be vesication or ulceration and sloughing, in all respects similar to a burn. Treatment.—Frozen parts to be thawed gradually by rubbing with snow, or ice, in a cold room, without fire, and stimulants administered internally so as to get them to thaw from within outwards ; and for some time the parts should not be exposed to heat. The carbolic acid and olive oil, same as in burns, may be used here with good results ; or ozone ointment, black salve, or lime liniment. Better still, ichthyol, creolin, naphthaline, resorcin, either one rubbed up in ozone ointment; if the feet, lotions of boroglyceride, iodoform, thymol ; in all cases treatment essentially germicidal. To prevent frost-bite, a high standard of health ; very nourish- ing food ; tonics ; fire in bed-rooms ; avoid wearing damp stock- ings, either during day or night; tight shoes ; and proper pro- tection or covering for exposed parts. Our highly oxygenized, dry atmosphere, with its crispy feel, is not nearly so productive of frost-bite below zero as that which is humid and moist, with the oxygen greatly diminished. A peculiar form of anaemia, occurring in the Chlorosis, young of both sexes, in which there is a defi- ciency of the blood cells with a redundancy of the serous part of the blood. The defect is a genuine poverty of nerve force, generally most prominent about puberty, before the complete development of BACTERICIDES. 179 the sexes is established; owing to this neurasthenic condition, there is a defect in the evolution of red corpuscles of the blood; they are small, dwarfed in size, diminished in number. The causes which induce this condition of nervous bankruptcy or deterioration are: in males, masturbation, a draining off of the nervo-vital fluid, deleterious trades; indoor life, solitary confine- ment ; in young ladies, the same causes may exist, as well as un- due precocity brought about by erroneous modern education. Symptoms.—General symptoms of anaemia, with a wax-like hue of face, yellow pallor of skin, whence the name " green sick- ness." Deficient or depressed appetite, fetor of breath, heavy coat on tongue, skin dry, constipation, abundant limpid urine; weak, quick pulse; hysteria. If a woman, pale, scanty menstrual discharge; if a man, his semen entirely destitute of spermatozoa. Leucorrhcea in women; often a thin gleety pros- tatic discharge in men. Languor, listlessness, head and back- ache, palpitations, cardiac and vascular murmurs. Occasionally enlargement of thyroid and protuberance of eye-balls. The treatment should be pre-eminently constructive ; fresh air, sun-light, daily bathing, followed with massage; a most liberal and variated diet; bowels regulated with either the kola nut paste or cascara sagrada lozenges. Our best drugs in all forms of chlorosis in either sex. are either the peroxide of hydrogen, or glycerite of kephaline; or avena sativa; or nitro-glycerine, or pulsatilla et caulophyllin. This change in treatment operates speedily in a complete restoration to health. The living microbe of cholera, the comma-bacillus, Cholera, is undoubtedly derived from the degraded bioplasm of our own or others' bodies. The term cholera is applied to the presence or development of the cholera germ in the infant, middle-aged, and as an epidemic; conditions of the human body in which this special degradation takes place, which are brought about by diminished vitality, a lowered electrical state, abnormal meteorological conditions, with an absence of ozone in our breathed atmosphere, and other insanitary conditions, for there is little doubt that imperfect drainage, improper food, impure water, fasting, fatigue, intemper- ance, uncleanliness, breathing vitiated air, all aid in the produc- tion of the germ. From the reckless condition of modern society, it is a wonder that we are so free from disease-germs. There ought to be more attention paid to sanitary science. Many of our modern buildings are but murderous sepulchres, being contaminated throughout. The very hair in some plaster is from i8o DISEASE GERMS. the hide of some animal that has died of anthrax. The atmos- phere of many houses is tainted with sewer gas ; neither ventila- tion, lighting nor heating has been attended to. Heated with dry air from cellars impregnated with disease-germs; water- closets in houses, the reservoirs of contagion ; the very earth in our large cities is contaminated. All sewers should empty at least five miles from human abode, and the water into which they empty should not be drunk by man or beast; all dwellings should have open fire-places, as they burn up many noxious poisons that would otherwise enter our bodies. This is common among children of all large Cholera cities in tropical countries, between the ages of Infantum, four months and two years. Children of the poor suffer most, or those who are subjected to the direful influence of modern pestilence; for it is really the case of the little god's kissing carrion—compelled to swelter in the hot, insalubrious, death-dealing atmospheres during the months of June, July and August, the temperature ranging from 900 to ioo° Fahr. The degradation is brought about in one or other of two ways: 1. By some shock, such as a fall, blow, rocking, concussion of brain, or by some reflex irritation, as teething, diarrhea, or the action of some cerebral stimulant, as opium in a soothing cordial. 2. By irritation of the stomach and bowels, caused by indiges- tion of swill or diseased milk, giving rise to acidity, fermentation, vomiting, diarrhea. In the former case it is central; in the lat- ter, peripheral. In whatever manner it originates, the two con- ditions quickly coalesce, and the disease manifests itself as a ner- vous affection, with an irritation or paralysis of the eighth pair of nerves that supply the liver, and a chemical change in the secre- tions of the bile, which is highly acid and irritating to the fine, delicate nerves that supply the muscular coat of the bowels, which causes contraction of the muscular coat, giving rise to severe pain, frequent evacuations, loaded with the cholera germ. Symptoms.—These are well defined—nausea, vomiting, diar- rhea, great nervous prostration or irritability; patient feverish, restless ; heats and colds ; skin white ; sleeps with eyes partially open ; rolls head ; grinds teeth ; wakes up with a scream ; rapid emaciation ; stools, at first greenish, become like chopped spinach; and prior to each motion of the bowels, the child instinctively draws up its knees and cries with the excruciating spasmodic BACTERICIDES. x8i pain in the bowels, from the passage of the acid or acrid bile loaded with cholera germs, and their excretions, ptomaines, irri- tating the fine, delicate nerves of the bowels; the urine is very scanty and high-colored. As the case progresses there is more prostration; the skin becomes whiter and colder, and, in bad cases, bluish ; the features shrunken and pinched ; greater emaci- ation; breath cold, as the liver fails to secrete sugar for combus- tion ; the alkaloid ptomaines increase, and the case grows worse and worse. If the patient survives the first attack, the tubercular diathesis is created, and there is a complication in the deposit and growth of tubercle in or on membranes of brain, in or on the mesenteric gland. The duration of cholera infantum depends very much on the vitality of the child, its surroundings, the capabilities of the mother, and denseness of population. Some cases will commence in June, and struggle through to September; whereas others, under less favorable circumstances, will be attacked and die in a few days. vr c <~r Treatment.—Before considering the j r Oy /vj"^, treatment, it might be well to ask the t v> J$~ ( r^\ question, what means have we to pre- ^^^ vT^s—.-.x--) vent^this terrible scourge in all our (^ V /"v V. ^-^t^, large cities ? The insanitary condi- ^ ^ (£ .__^ ^U/~ ^r tion of cities during the heated term, /*4L )} r^jj\p. and the condition of overcrowding, "^"V/""* ^ "\ does not admit of a remedy ; but the "* l ^ O Vitality Of the Child and Welfare Of the Dwarfform of the comma-bacillus .1 i A i r -r-i found in the green stools of mother can be taken care of. 1 he cholera infantum; magnified 7oo mother is of primary importance—her times health and comfort; her food should be nutritious; her mental and physical powers should not be taxed; she should do everything possible to maintain a very high standard of health, and avoid work, anxiety, or any depressing influence. Men- struation and sexual congress should be prevented during nursing. The health of the little one should be promoted by fresh air, good milk, flannel clothing, and in an especial man- ner by wearing the flannel roller round the abdomen until they are two years of age. Daily bathing with cold water, followed by friction. Cradle-rocking to modern infants, whose parents' nervous system has been developed at the expense of the physi- cal, is very hurtful. Dandling, shaking or jolting is also very injurious. The little one should be kept quiet, cool, free from jolt or motion, and from the solar rays. Its diet, until teeth appear, should be the mother's milk; and if that is not sufficient, cow's milk, very slightly diluted; no starchy article of diet per- mitted to be used, nor sugar in any form. 182 DISEASE GERMS. As soon as the disease makes its appearance, vigorous means must be taken to arrest it; an emetic of the wine of ipecac, fol- lowed with sufficient doses of the neutralizing mixture to open the bowels freely, followed with lime-water and milk, and a plaster consisting of equal parts of pulverized allspice, cloves, cinnamon, peruvian bark, and a very small amount of capsicum, wet with vinegar, spread between fine book muslin, and applied over entire abdomen ; taken off every three hours, the caked mass broken up and remoistened with vinegar, or if not that, concen- trated ozone. An evening bath is also to be recommended; well dried and rubbed, and followed by inunction of several ounces of warm olive oil. If case does not improve, then give liver a rousing up by administering one or two grains of leptandra in a little compound licorice powder, following it up with teaspoonful doses of the expressed juice of raw meat every three hours; put- ting patient upon tincture of white hellebore, which has such an immense sphere of action on base of brain, eighth pair of nerves and liver—dose must be regulated by the physician in charge— and begin at once with bactericides. From among that class of drugs, the ozone-water, the sulphurous acid, or tincture of iodine and carbolic, or the solution of chloride of lime, salicylate soda, salol, lactic acid, resorcin, creolin, are probably the best to destroy the germ. Alkaline antiseptics, however valuable they may be, act rather freely on the liver. We cannot doubt the efficacy of the chlorate or permanganate of potassa, or sulphate of soda, but in few cases dare we sanction their use; so one of the above must be selected, and administered often and with regularity. The entire success or non-success in the treatment consists in the use of germicides and nourishments. Head to be kept cool; socks, with dry mustard, to feet; fever to be controlled with aconite ; any brain symptoms, the bromide mixture ; and, above all, keep up nutrition, confining diet to mother's milk, milk and lime-water, and juice of raw beef. If the case recovers, and means are available, the child should be removed to the country, away from the pestilential influence of a large city ; a tonic, antiseptic course of treatment carried out for some months, with such remedies as glycerite of ozone, ozone-water, cinchona, and aromatic sulphuric acid. Prof. James M. Bunn, M.D., of Altoona, Pa., the most brilliant bacteriologist in that State, says : The comma-bacillus is the cause of the green stools of cholera infantum. This can readily be ascertained by a microscopical examination of the discharges, when there will be found an innumerable number of the patho- genic bacilli; the coloration is not due to the bile pigments, which are entirely absent, but to a peculiar pigment secreted by BACTERICIDES. 183 the bacilli themselves, and which can be reproduced by artificial cultivations of the microbes. Bile is entirely wanting in the rice-water discharges of epidemic cholera, as well as in the green stools of cholera infantum. The disease in all its forms is essen- tially contagious, although indigestion, mal-assimilation prepares the soil, favors the production of the bacillus. The greatest success in treatment is from the use of germicide remedies. Take either mucilage acacia or syrup of tolu, four ounces; add to it three or four drachms of resorcin, thirty drops concentrated ozone. Mix well; give half a teaspoonful every hour. Stop milk entirely ; feed on barley water and port wine ; the bacilli lodges and breeds in the casein ; multiplies to an alarming extent in the casein clots. So starve and kill the germ. Paint abdomen with equal parts of con. ozone and chloroform— a powerful stimulant and germicide—arrests germ evolution. Care should be taken to employ disinfection of the stools to prevent the spread of the disease, and, with proper care, we claim that this microbic form of diarrhea may be reduced to a minimum. This term is applied to a condition of extreme Cholera nervous prostration, with cold skin, feeble pulse, in- Morbus. terrupted respiration, cold breath, a cadaverous ap- pearance of face, blue feet, hands, nose, ears, with nausea, vomiting, frequent motions of the bowels, with cramp or knotting of the intestines, and the cholera-germ in stools. In our climate, with its inhabitants suffering from an incessant nervous strain or worry or struggle, we meet with cases of cholera morbus in all seasons of the year, chiefly among our adult males, although it is more prevalent when the system is enervated by heat, or when there are violent transitions from heat to cold. Climatic changes affect those who have their nervous systems prostrated by overwork or anxiety; and especially so if the stomach is irritated by offending material, as green or unripe fruit, some acid or acrid cond tion, acting on the stomach and liver as an irritant, or upon the brain, involving its base and eighth pair that supply the liver. The disease may be traced to other causes, but the true cause is to be found in a depression of the great sympathetic, eighth pair, and brain, the spinal cord being involved in the first dorsal vertebrae. Bacteriology teaches us that in whatever way the microbe is evolved, either by nervous depression, aided by the irritating ac- tion of green fruit or vegetable, or some indigestible compound as clams, or some other irritant, the comma-bacillus is present in the bowels, actively, energetically excreting ptomaines, that deadly alkaloid which produces all the alarming symptoms of the disease. 184 DISEASE CERMS. Symptoms.—It usually comes on with nauseau, soreness, pain in stomach, vomiting, purging, which rapidly exhaust the patient; when, by and by, those terrible cramps or knotting of the intes- tines by spasm, the features becoming cadaverous ; breath cold; skin cold and clammy ; hurried or short respiration ; cramps in the legs ; coldness of extremities ; intermitting pulse. Treatment.—This must be pursued with great energy. Ad- minister at once thirty grains of bicarbonate of potassa in tepid water ; follow quickly with an emetic of a mixture of equal parts of lobelia, capsicum and valerian. Repeat dose after dose, until emesis is very thorough. Use the same as an enema. After the stomach is thoroughly evacuated, con- tinue with same remedy in small doses sufficient to keep down spasm of the bowels. Apply artificial heat to stom- ach, feet, limbs. Open bowels either with neutralizing mixture or com- pound licorice powder. Commence, as soon as the stomach will retain anything, with either the tincture ot white hellebore and antiseptics, as ozone-water, or tincture iodine, and carbolic or sulphurous acid, per- oxide of hydrogen or salol, or creo- lin, or naphthaline, or resorcin; or if these are not handy, then use eu- calyptol. The lobelia compound is invaluable for relaxing of spasm and overcoming the prostration. If, after the bowels have been freely moved, the stomach is still irritable from the presence of the germs, and will retain nothing, administer the following: cam- phor, thirty grains; capsicum, ten grains ; sulphate of morphia, one grain. Mix, and make ten powders; and, while triturating, add five or ten drops of oil of peppermint. Give one powder every half hour. After the stomach has been quieted, continue with antiseptics and tonics until recovery is complete. Human beings, whose nervous systems are Epidemic devitalized by overwork, exhaustion, privation, Cholera, anxiety, struggle for existence, and subjected to depressed electrical states of the atmosphere, ex- traordinary meterological conditions, and the absence of ozone, have within their bodies certain living elements altered or de- graded by those adverse conditions into the cholera-germ. There The comma-bacillus at work in the tubular glands of the bowels vigor- ously excreting ptomaines,the deadly alkaloid of rigor mortis, immediate- ly sterilized on the administration of ozonized creolin. BACTERICIDES. I85 The microbe of cholera (the comma-bacillus), the different forms it presents in its various stages of growth. can be little doubt that this germ is the modified living mat- ter, either of the base of the brain, the spinal cord down to the last cervical verte- brae, whence eman- ates the sympathetic, or else the eighth pair that supplies the liver. In proof of this, we often find cholera-germs, the comma-bacillus, in those whose nervous systems are shatter- ed, and who suffer from diarrhea. Be- sides, the appearance after death points to those parts as being at the origin of the trouble. When once developed, it is capable, like all other contagious diseases, of being propagated by con- tagion and infection. It is not, however, contagious in a high degree, but can be carried by human intercourse, by clothing, merchandise, ships; undoubtedly often spread by water, milk. Symptoms.—The symptoms of this disease are divided into three stages, which may be classed as follows : 1. Irritability, languor, lassitude, sleepiness, confusion of head, pale countenance with nausea, vomiting and diarrhea. 2. In addition to the above aggravated symptoms, the dis- charges become light-colored and serous; white flakes and rice- water discharges appear; the pupils become contracted, spasms, cramps, coldness of body, with intermittent pulse. 3. Blueness, with rigid spasm, suppression of urine, collapse. The general symptoms of those three stages in detail are as fol- lows : copious vomiting and diarrhea; stools are entirely des- titute of bile, and consist mostly of water, containing large quanti- ties of epithelium and albumen, resembling rice-water; they con- tain also a large quantity of chloride of sodium ; cramps in muscles, causing them to contract into cord-like masses or knots ; spasm; the pulse is soft and easily compressed; varies from ninety IFrom the rice-water stools of a case of cholera. Masses of single comma-bacilli ; circular forms; semi-circular forms; magnifying power about 1400. 186 DISEASE GERMS. to one hundred and ten; general temperature 65° to 70 K; the expression of the features is ghastly or cadaverous ; eyeballs sunken, glassy; cold, clammy sweat; breath cold ; so is the tongue and mucous membrane of mouth; distress at pit of stomach, with burning; albuminuria, suppression of urine; great thirst; circulation gradually diminished; respiration impeded; hence great prostration. The heart now becomes affected ; so do the blood vessels, by a spasm of their muscular coats. The sugar-generating faculty of the liver is suspended, so that there is an icy coldness of the skin and breath, and blueness of the lips and skin generally. The force of the germ-disease and its ptomaine is on the nervous sys- tem, which becomes early and decidedly affected ; hence the un- natural and whispering voice, shrinkage of the entire body, pinched features, and contracted pupils; muddy looking com- plexion ; sinking of the eyes, pupil immovable, cornea flattened. If symptoms are not relieved, the breathing becomes less frequent,. the whispering voice spasmodic, and if the pulse is at all percep- tible, thread-like and intermitting ; circulation arrested from para- lysis of the heart; intellect clear ; evacuations involuntary, and not a trace of bile in the stools. If the patient survive forty-eight hours, and exhibit signs of improvement, he may recover rapidly if the pulse rises and the stools become bilious, and respiration and circulation be restored. But very frequently improvement is only temporary, headache, drowsiness, tonic or clonic spasm, vomiting, stertor, coma, usher- ing in death. All those symptoms are due to the lightning-speed evolutiorv, of ptomaines by the microbe ; so rapid that the bacilli have not time to elaborate in the blood, the ptomaine of the comma- bacillus, is like alkaloid strychnine, chemically, for if it be injected into any animal it at once produces diarrhea, vomiting, spasms,. torpor, collapse, and finally death. The appearance after death, aside from the rigid contraction and stony feel of the muscles are a white liver, effusion in the ventricles of the brain and spinal, the latter being congested and compressed by a serous exudation, in which ptomaines are abun- dant. Death is so rapid from the excretions of ptomaines that the comma-bacilli are not to be found in the blood, but only in the tubular glands of the intestines. Treatment.—If an epidemic prevail, the most careful sanitary and hygienic measures should be observed, and the very highest possible standard of health maintained; the very best of food used ; no green fruit; no alcoholic drink ; no late hours; nr> mental or physical overwork ; no overcrowding. The best pre- BACTERICIDES. I87 ventive is small doses of sulphate quinine, and abundance of good food. On the very slightest derangement of the bowels, that is, nausea, vomiting, or diarrhea, give small doses of the neutralizing cordial, with tincture of opium, until it is relieved. At the same time, apply sinapisms of capsicum and vinegar over the bowels and down the spine; and, as a drink, give sulphurous acid in water. Any other symptoms should be promptly re- lieved, the patient kept in the recumbent position for a few days, and plain, nutritious food given. If the disease has set in, and is seen first in its premonitory or first stage, the patient should be put to bed in the best ventilated apartment in the dwelling ; its temperature kept about 8o° Fahr., and arrangements at once made to have him surrounded with dry heat, heated sand in bags. The diarrhea and vomiting are evidently efforts of nature to get rid of the germ, and it is often a good plan right here to administer an emetic of equal pares of lobelia, bayberry, and capsicum. After it has acted, try some one of the following remedies in solution, so as to get the liver to secrete and discharge'the bile : rub abdomen and spine with oil of capsicum cut with alcohol, and apply artificial heat, and let the drink be sulphurous acid and water. Opium in every form is contra-indicated, because it increases the congestion of the cord. Large doses of bromide of potassa, ranging from fifteen to thirty grains, with ten of carbonate of ammonia, and twenty drops of tincture of calabar bean should be given frequently. If the case is more advanced, pupi's contracted, spasms, cramps, coldness, blueness, intermitting pulse, these symptoms are promptly met with the following : Tincture of lobelia, capsicum, and American valerian, of each one ounce. Give a teaspoonful in water every half-hour, and occasionally a dose of the bromide, with tincture of white helle- bore. Cholera-germs are difficult to destroy, but with the lobelia compound we have had good success. Of all drugs in the ma- teria medica, it alone retrogrades the growth of the germ, and sterilizes it. Its properties are really incomprehensible ; it holds the position ; no more are developed under its influence; it gives nature a chance to rally to legitimate work; every drop that is given benefits; the respirations becomes more frequent; heat in- creases ; breath becomes warm ; pulse, imperceptible at first, be- comes wiry and full; blueness and contraction leaves the surface; the paralysis of the eighth pair is relieved; bile appears in the stools; spasm and contraction are relieved, and the eye acquires its brilliancy. It must never be given to the point of vomiting; its action i88 DISEASE GERMS. must be guarded, and held on to, and persevered with, so as to enable the vital forces to recover themselves. Its action is im- mense in cholera. If sinking is threatened, compound tincture of capsicum and quinine should be administered repeatedly. Juice of raw meat, well salted, should be given often. If thirst is intense, iced champagne or chloride of sodium, carbonate ot soda and chlorate of potassa in water should be given. If vomit- ing is incessant, medicine and drink in small doses every few minutes, with capsicum over abdomen. Dry heat, in the shape of hot sand bags around the entire body of the patient, reaching from axillae to toes, and from the groin down the inner aspect of the thighs, and also along arms ; while being changed, friction with tincture of capsicum. Hoid spasmodic action in abeyance. As soon as stomach settles, keep on with juice of raw meat, and give antiseptics, as ozone water, or sulphurous acid, or carbolic acid and tincture of iodine. In cholera the insulation of the patient is of great importance; bed in middle of the room, head to north, glass under feet of the bed. The evacuations should be removed in a bed-pan, with a solu- tion of sulphate of iron, and the greatest of caution should be exercised in diet, allowing little but beef-extract, milk and bicar- bonate of soda, farinaceous substances, until bile appears in the stools. Convalescence should be established upon cinchona and min- eral acids, baths, irritating plaster the entire length of the spine, holding on to antiseptics for four or five weeks after recovery. A morbid condition of the nervous system, char- Chorea, acterized by a want of control of the motor nerves which supply the muscles in the waking state; which gives rise to irregular, tremulous, and ludicrous movements of the voluntary motions, most common between the ages of five and fifteen, among those of a neurotic temperament and feeble constitution; girls are more obnoxious to the affection than boys. Causes.—It is supposed to originate in a jar, or want of har- mony, between the gray and white matter of the spinal cord, probably brought about by falls, blows, shocks of various kinds acting upon a weakened cord and bulb. More active, exciting causes are anaemia and other blood diseases; teething, worms, dyspepsia, skin eruptions, retarded catamenia, constipation, cold, insufficient food, excessive loss of blood, pregnancy, disease of bladder, rectum, mental emotion, passion, masturbation, and BACTERICIDES. 189 o.her reflex conditions at the origin of all starved cerebral areas. Nearly one-half of the cases of chorea that we meet with in city practice is due to defects in our high-pressure system of education. Over-schooling produces a nerve shock, peculiarly liable to affect the nervous system of children whose food is meagre or adulterated (their brain is under-fed), or who live in the midst of insanitary surroundings. A city child is more feeble, less able to cope with disease, than those in the country; the law of reflex impressibility is keen in the former, and the daily endurance of mental toil, with its incidental shocks, produce a jar, a want of equilibrium, between the gray and white matter of the spinal cord, hence the chorea, the penalty. With a different system of education, a vast amount of child-suffering might be prevented. Symptoms.—The commencement of this disease is character- ized by nervous depression and debility. The involuntary mo- tions begin by slight twitching of the muscles of the face; then other muscles become affected, and one or more limbs; features ofcen curiously contorted and twisted ; vacancy of countenance ; articulation impeded ; appetite irregular; often constipation ; gen- erally one-half of the body more affected than the other. Irre- gular action ceases during sleep. The disease may last for a life- time and produce no bad results, whereas in other cases the nervous system becomes impaired and there is a rapid breaking down. It produces difficulty of respiration and retards the functions of the heart. It is apt to be attended with danger. Treatment.—In the treatment of all cases of chorea, a complete change of habits and occupation, and a resort to the fresh air of the country; abundance of exercise, and a very generous diet, together with daily baths and friction to skin, are indispensable. The closest scrutiny of the case, as to whether there be any blood affection, or reflex irritation, especially of the genito-uri- nary organs. All causes must be removed, if possible, and a special treatment inculcated for each ; the secretions well stimu- lated. The great impressibility of the nerve-centres must be seen to by the daily application of stimulants to each side of the spinal cord, as friction with stimulating liniments, the irritating plaster, ice, or use of menthol; some one of these selected, and, internally, bromide, Scutellaria, calabar bean, sumbul. These latter not only relieve the impressibility of the cord to reflex action, but help to control the involuntary movements. Whatever treatment may be deemed best to control the move- ments, sumbul or scullcap, we must ever keep in mind that there exists starved cerebral areas, which must be overcome by kepha- 190 DISEASE GERMS. line and avena sativa, and as the brain only picks up its pabu- lum from the blood during repose, sleep must be prolonged indefinitely. Our best curative drug in chorea is the ozonized extract of sumbul, being a powerful antiseptic. It reaches a class of cases, in which the malarial, rheumatic and other microbes play an im- portant part in the excretion of ptomaines. The remedy kills the microbes and neutralizes the poisonous alkaloid in the intes- tines, and thus diminishes reflex irritation. The jar or want of equilibrium between the gray and white matter of the cord is completely arrested during sleep. It is therefore, a good plan to prolong sleep and thus cut short the mischief which is being carried on in the nerve-cells by the in- cessant, unnatural activity. Prolonged rest affords an oppor- tunity, a restorative, to the discordant nerve-cells to be at rest. Massage is most effective, persistent for two hours, morning and night; induces sleep. Sulphonal and paraldehyde are efficacious remedies, in alter- nation with the sumbul. The patient should be put upon an alterative and tonic course, and special remedies as to its cause. If retarded menstruation.be a cause, in addition to the bromide, pulsatilla and caulophyllin ; comp. betin pill and acetate of iron. If rheumatism be suspected, manaca, salicylate soda in liquor ammonia acetatis ; cascaradyne ; colchicum, phosphate of qui- nine ; uric acid solvent ozonized. If it has appeared subsequent to the metastasis of a skin erjp- tion, ozonized sulphur water; lycopodium, saxifraga. If uterine irritation is suspected, pulsatilla, aleteris farinosa wine, Indian hemp. If due to fright, mental distress, belladonna, stramonium, ma- crotys, nux. The usual remedies if worms are suspected. If due to disease germs in the blood, saxifraga, phytolacca. Other remedies sometimes successful are arsenic, bromide of gold, nitro-glycerine, avena; this latter being a powerful nerve tonic and food, is admirably adapted to imperfect development of the nervous system, whether partial or general, and is markedly suitable to children who are precocious, whose assimilative func- tions are not up to the task of supplying the waste consequent upon active brain expenditure ; such children while needing rest and restraint rather than encouragement in the development of their faculties, will be so greatly improved in physical strength by the use of the oats as soon to resume their intellectual training. BACTERICIDES. I9I Chylous urine, or the excretion _ of urine of a Chyluria. milky appearance from the presence of fatty mat- ter in a molecular state. In addition, there is gen- erally present liquor sanguinis, blood-corpuscles, fibrin, and albu- men. The urine, after standing a little while, coagulates into a trembling mass resembling common size or blanc-mange. Com- mon in tropical latitudes, and is associated, not always, but in many instances, with the filaria in the blood. Associated with this condition of the urine, there is great lassi- tude and debility; pains about loins and stomach; very great mental anxiety; loss of flesh. It is usually intermittent in its nature; chylous for months ; healthy for same space of time, and then recurs on and on. Treatment.—Sea air, salt-water baths, very nourishing diet; flannel roller over abdomen ; tonics, such as Warburg's tincture ; ■eucalyptol, kurchicine, cinchona, and mineral acids. According to the last census, there were Climacteric three millions of women in the United States Disorders, between the ages of forty-five and fifty, undergo- ing the change of life, and this number is annu- ally kept up by fresh recruits; so that we have, at all times, about that number. The importance of the period, the history of suffer- ing endured, cannot be approximated; neither has its diseases been adequately investigated. The terms, change of life, turn of life, critical period, etc., are understood to mean a period of life beginning with those irregu- larities which precede the last appearance of the menstrual flow, and ending with the resettlement of health on a new basis. This is usually divided into a premonitory period, the actual stoppage or cessation of the flow, and the adaptation of the system to the change. The first indication of failure of ovarian energy is irregularity, when the failure is complete, perfect cessation. Although it is termed a critical period, it is not to be deemed fatal, if the patient's system is healthy. It is a gradual change, leading to better or worse; to complete recovery more frequently than to death. The streams of life, instead of flowing on in a smooth, tranquil current from the cradle to the grave, are marked by rapids, or milestones, which are critical, metamorphic, or developing epochs. Seven, fourteen, twenty-one, are clearly and distinctly written on the first part of life; forty-two, forty-nine, and sixty-three, are less deeply cut, but are distinctly visible in the latter period of life. Those periods are characterized by important changes, 192 DISEASE GERMS. which give a peculiar aspect to the physiognomy of the human- body, and impart a family likness to the diseases of epochs justly deemed critical, in which one or several organs of the body undergo changes. The object of each critical change in our bodies is to insure the greatest amount of health for each subse- quent period of life. This object, if the vital forces are of average strength, is effected quickly; but if there be debility or disease, then there is more or less disturbance, according to the degree or intensity of that state. The critical changes of denti- tion and puberty are frequently brought about without any dis- turbance or ill health; nevertheless, they are often followed by debility. At critical periods the activity of important apparatus may be too powerful, and disturb other organs, or too feeble to react on others. When the energy of the preponderance-seeking organ is above or below par, health may be impaired. With regard to the influence of critical periods of life, first and second dentition influence both sexes alike and in the same way. Puberty is common to both; but the impulse given to the con- stitution of man, by the perfect development of the sexual appa- ratus, is, in general, fully effective and all-sufficient to insure its permanent activity until extreme old age; whereas, in women the crisis is very liable to be delayed or perverted ; and even when puberty has been fully and effectively established, the health of- woman is dependent on those oscillations of vital force, which render it most uncertain. The chemical activities of a woman cause her to mature early; the inertia of man's nature renders him slow, late in maturing. The same inherent qualities of sex give woman an early change; whereas, man's change is delayed (if not too early precocious) till a good old age, he being capable of begetting children to seventy or eighty; whereas, the moment a woman changes, fecundity ceases. It is true that children begot by very old men are of very feeble vitality. Although most women change at forty-five or forty-seven years of age, it does not follow that sexual appetite is extinct. Sexual congress may not be enjoyed by some, whereas others never have a warmth of feeling until the change of life takes place. The large proportion of women, on cessation taking place, become callous, indifferent, lose their sexual vivacity and vigor. Menstruation, healthy or morbid, marriage, pregnancy, partu- rition and lactation, are critical eventualities in a woman's life, curing some complaints, giving greater activity to others; and when, after having lasted thirty years, the action of the reproduc- tive organs is being withdrawn from the system, then there arises a series of beautifully adapted critical movements, the object of which is to endow a healthy woman with a greater degree of BACTERICIDES. 193 strength than that which she had previously enjoyed. But this will not occur if there are disease-germs lurking in her system, such as cancer, tuberculae, syphilis; then the seeds of those germs, when vital force is low, are liable to become active and destructive; because the very essential of the change, debility, brings them into active growth, and causes them to locate and grow in the very organs in which the change is progressing. The change stimulates their growth; imparts to them fresh activity. So, as a rule, it is at this period we meet with the greatest proportion of cases of cancer of the womb, and breast, adenoma, and other tumors. The change of life is only critical to the diseased. It is only they who need fear the crisis. To the healthy, to those who live according to natural laws, eat healthy food, avoid balls, tight lacing, bad literature, and seden- tary occupations, nothing is to be feared. It is well to make no hap-hazard prediction, but if there is no disease, the process will not be critical. True, the disease may be got rid of; if so, it will mitigate the condition. The change does not cause disease; it detects it, brings it into active existence, and causes an aggra- vation of it. Thus congestion of the womb, chronic inflamma- tion of the ovary, etc., existing at the change, become excessive. Disease has little tendency to leave or become inactive or quies- ceDt during the change. The critical nature of a period is shown by its effects on the health in ensuing years. Thus puberty is not only a crisis of most of the complaints of the preceding years, but it determines the health of the subsequent thirty-two years, for good or evil. In like manner, the change of life, if it can be consummated in a salutary manner, will influence the succeeding period ; nay, it will govern the whole subsequent period of life. So we can prognos- ticate, from the manner of the crisis, whether the after-life shall be good or bad. Five years after a woman ceases tells its own tale in the great additional strength of constitution. The greater sanative change, the greater longevity of woman after the period, her less liability to disease and death, her very remarkable good health, and almost total immunity from the general run of ailments render her last stage of existence a comfort and a blessing. From forty to fifty-five is a general period of invigoration for both sexes—a period in which the daily work of nutrition is very actively carried on in our bodies, rendering them stronger, more vital, healthier, and thereby insuring a more perfect performance of all the functions. The change in man is carried on insensibly, and worked out without disturbance. In woman the passage is often full of danger, if natural laws have been violated; but the 13 i94 DISEASE GERMS. very great improvement that follows the change is so salutary as to compensate for all the suffering. Although the phenomena of change of life are principally due to withering of the ovaries and suspension of their functions, it is aided by and associated with other structural changes, which take place in both sexes, due to coming age, such as the ossifica- tion of the cranial bones; atrophy of spleen, and lymphatics; changes in bone, marrow ; degeneration of some form ; a smooth- ing down of Peyer's patches in the bowels, and some shrinkage of the brain proper. But after cessation a woman's constitution is entirely remodelled ; she takes a new lease of life; decay and suffering have then less hold on her, and she begins life anew. The importance of the change cannot be too highly rated, espe- cially if easily passed; for if it is accomplished without much dis- turbance, so will the future period be healthy; but if gone through with great suffering, then we may expect the subsequent time to be one of long-continued misery. It is a final settlement for good or evil, and it may be reasonably entertained that if it does not excite the activity of some disease-germ in the body which previously existed there in a quiescent state, and the vio- lence of the change be not excessive, it is reasonable to conclude from thousands of pre-existing cases that the rest of life will be passed in uninterrupted good health, and unusual longevity attained. The invigoration of the health which follows is often accompanied with a great improvement in personal appearance— where the thin and emaciated become fat and comely, where the timid become bold and daring ; while another class become mas- culine, and lose their feminine appearance; their cheek bones project, the skin loses its velvety feel, creases show themselves, and stray hairs start on the upper lip or face. The effects of a suspension of ovarian action has a marked in- fluence on all the emotions, desires, affections, passions, as well as on the brain proper, giving rise to debility, prostration, nervous irritability and confusion. Puberty and change of life are caused by physiological and anatomical changes in the same organs : puberty is ovarian evo- lution ; the change of life, involution or stoppage. The true seat of both is in the reproductive centre in the brain ; the one growth, the other death to that special centre; the ovaries being merely the organs to perform the work. When, with proper age and perfect blood development, this co- ordinating reproductive centre in the brain matures (puberty) the seed or egg organs, the ovaries, increase in size, become very vas- cular, and begin to let fall ovula or eggs every twenty-eight days, and cause in modern civilized women menstruation. When the BACTERICIDES. 195 reproductive centre in the brain dries up, which it usually does after thirty-two years of activity, the change has come; the ovary or egg-bed, which, during the active period was smooth and tur- gid, becomes dried up, shrunken into a knot like a peach-stone, and it becomes difficult to trace the cavities of the Graafian vesi- cles, for their walls are pressed together. A few years later they shrink; wither still more; become atrophied, so much as to be no larger than a bean, and latterly completely obliterated, being marked by fibro-cellular tissue. This ovarian atrophy, or shrink- age, or wasting, or withering, comes from a want of germinal influence from the brain ; there being no use for the organs, they wither and die. This change is accompanied with corresponding changes in the fallopian tubes, determined by the same cause; these tubes contract, wither, become impervious and perfectly obliterated. The same condition of non-use, want of stimulus, or enfeebling energy causes the womb to contract, become small, round like an orange ; its neck becomes thinner, and shorter, and obliterated, and in some cases an obliteration of its mouth takes place. The vagina becomes very narrow, short, and there is a shrivelling up of the pampiniform plexus of vessels which pre- viously supplied the organs with blood, which accounts for the remarkable coldness of the parts. Incidental to this general col- lapse, the broad ligaments that retain the womb in its position also shrink and disappear. The breasts, which are a part of the reproductive system, also become cold, small and wasted. During the change they are often seriously affected, being painful and congested, if not otherwise diseased. It would be a matter of infinite surprise how so many phenomena of health and symp- toms of disease could be determined by two little bodies whose structure does not appear complicated, but the fact is unquestiona- ble that not the bodies, but the brain, is the source or seat of change. The ovaries are energized by that nervous centre of sexual power located in the spinal cord, opposite the fourth lum- bar vertebrae, and supplied from the cerebral centre; but although a central act in the brain through the cord, there can be no per- fect exercise of sexual power without well formed and healthy ovaries. The ovaries influence all parts of the body (directly the cord and brain) through the medium of their nerves, for as they have both ganglionic and cerebro-spinal nerves, they can react on both the ganglionic nerves and their centres, and the cerebro- spinal and their central organs. Whether the ganglionic be an independent system of nerves, or an offshoot of the cerebro-spinal nervous system, it is not necessary here to discuss. All are agreed that vaso-motor nerves follow every capillary to their minutest ramification and govern 196 DISEASE GERMS. the nutrition of every part of the body. All organs of nutritive life are supplied with ganglia and a plexus of ganglionic nerves; but they all communicate together, and with a larger plexus and more voluminous ganglia, situated in the viscera of the abdomen. And before those foci of nervous matter were discovered, this region, that is the ganglia on the bowels, liver, spleen, bladder, kidney and reproductive organs, was called the lever of forces by which the body is moved. Sensation and motion are dependent on the cerebro-spinal nerves, nutrition on the ganglionic; but there is a concentration of ganglionic nervous power in the cen- tral ganglia which gives and receives from each viscus a variable impetus. The ganglionic is a centre of nerve force, capable of controlling and disturbing the various parts of the body by its nervous fluid or soul. The human body is so constructed that the various component organs act upon each other in the way most conducive to health, until the age of puberty. At that time health may fail and the whole system languish, unless the reproductive organs come into full activity. From puberty to the change of life, the health of woman cannot be maintained without an energizing influence from the reproductive centre in brain and cord, so as to impart an appropriate amount of ovarian influence. If the ovarian energy reacts under proper nerve stimulus in a healthy way, it will aug- ment, vitalize, energize the visceral centre, or brain, and cause the function of nutrition to be performed with increased energy; give vigor, instinctive consciousness of strength. If the ovarian energy be insufficient, the abdominal brain, the visceral centre of ganglionic action, is half or partially paralyzed, and uneasy sensa- tions are felt at the pit of the stomach, a feeling of sinking, of faintness, goneness, or even actual fainting is sometimes induced; defective nutrition follows, with anaemia of the cord and brain, vulgarly termed hysteria, met with at puberty, during preg- nancy, lactation and change of life. If the brain does not furnish the necessary amount of ovarian stimulus, so that evolution is in- efficient, the menses will come on in an irregular way, off and on and likely scanty; if it be too strong, as under emotion, pas- sion, it will react upon the adjacent viscera and cause violent dis- turbance. All the organs in the chest and abdomen are, on their front part, covered over with the cervical sympathetic, similarly en- dowed with ganglia or little brains. They are knit together by a mysterious net-work of nerves; they sympathize with each other at puberty, menstrual period and change of life, and in this way any disturbance of the ovaries, irrespective of reflex states, will give rise to nausea, sickness, depraved appetite and deranged BACTERICIDES. 197 bowels and kidneys. If the ovarian stimulus be too great for the allied abdominal organs, there may be pain in the ovaries them- selves ; pain, disturbing sensations, irritation which may be trans- mitted to a weakened cord and bulb, then hysteria, tetanus, nervous irritability, restlessness, hysterical convulsions, or there may be a numbness in skin and other parts. The strength or relative weakness of the nervous system may be inferred from the condition of anaemia of brain and cord that is present. The solar ganglia in both sexes form an important centre of nerve force. Insufficient ovarian influence having reached the solar plexus affects the brain chiefly by means of the pneumogastric nerve, so any disturbing influence at puberty, preg- nancy, parturition, change of life, may be shown by the distress- ing headaches, fretfulness, peevishness, irritability, capriciousness, perversion of the moral nature, moral insanity. In other cases, excessive or disturbed ovarian action is manifest by high spirits, or depression, a cloud or a weight on the mental faculties, hazi- ness of mind, brain muddled, memory faithless and an unquenchable desire to sleep during the day, remaining awake all night, almost amounting to coma, or lethargy. From puberty to the change, healthy women, when not preg- nant or nursing, drop ovules every twenty-eight days, and, as a rule, modern civilized women lose about four ounces of blood. But there are women in perfect health, who live according to nature's laws, eat healthy food, avoid modern literature as a destructive ovarian poison, that have perfect ovulation, are easily impregnated, and whose womb does not bleed on the shedding of the egg in the ovary and dropping within its cavity. Those women enjoy the highest possible standard of health. Indian women, in their aboriginal state, seldom lose blood at the monthly period; nothing but a white, glairy discharge. Sexual involution has an ill-defined beginning and end, and only one fixed date, cessation. The activity of the menstrual period is usually thirty-two years, between fourteen and forty- six ; but there are cases, once in a while met with, where the men- ses stop as early as twenty-one, twenty-eight, thirty-five, and at all periods up to sixty-one. The average, however, is forty-six in healthy women, and more cease to menstruate at forty-five than any other period in life. It depends greatly on accidental conditions of life. Blows on the head or back, frights, and other nervous states may prevent its appearance, and arrest it at any time, either when the discharge is on or off, and if the shock is grave, forever. Its continuance depends greatly on the state of the health, the richness and purity of the blood, the freedom from worry, struggle, shocks, jars, and uterine and nervous 198 DISEASE GERMS. disease; but taking all these into account, the average among our ladies is forty-six. Races, being essentially distinct, have each their peculiarities in menstruation. It is said that the Hin- doo women run from twelve to sixty, when free from disease; and the Laplanders and other races have different peculiarities and eccentricities. Ovulation and menstruation stand together, very nearly as cause and effect. Periodicity is an element in woman's nature. Vaginal blood, even if it occurs with periodicity, when late in life may not be menstrual, but may come from congestion, ulcera- tion at the neck, polypi, and other morbid states. Still there are, as we know, rare cases of cessation at sixty-two, or later, in strong constitutions ; so it is well to be guarded. Cases at sixty and seventy menstruating are mostly due to some disease. Out of one-half million women who become mothers from under twenty to above fifty, seven thousand bore children from forty- five to fifty years of age, and one hundred and sixty-seven were mothers after they passed their fiftieth year. Cases of menstrua- tion admit of great variation. Isolated cases are met with at six; more numerous at eight to eleven. Still there are a greater number late, from eighteen to twenty-two; while the general average does not vary from fourteen to forty-six. The Irish, at home in their salubrious atmosphere, with a fish diet, are remarkable for their fecundity. Their nervous systems and their ovaries are endowed with wonderful activity. The fish-eating and oat-meal-consuming races, as the Scotch, Swedes, Danes, Canadians, have strong procreative powers, and reproduce themselves speedily. Ovarian activity, then, is commensurate with constitutional vigor. An unusual prolongation of ovarian life and longevity indicates a healthy condition of the functions of vegetative life, and when prolonged, it implies great vigor, strength, and endu- rance, and means a good old age. During the wear and tear, struggles, hopes, cares, sorrows, vicissitudes of life, the ovaries are often simply paralyzed, and their action suspended; when the difficulty is removed their function will be resumed. Visceral disease has the same effect; when the disease is cured, and better health brought about, their activity is restored. There may be a stoppage for a long time, and then a recurrence. A woman past the age of fifty-three may be regarded beyond the age of child-bearing, except in very rare and exceptional cases. Pregnancy late in life is often mistaken for other diseases; and late labor is dangerous to the mother; indeed, it may be regarded as an extraordinary risk. BACTERICIDES. I99 Cessation is often delayed by morbid blood and affections of the womb and nerves, ulceration of the os. We will again repeat that there may be uterine bleeding without menstruation. It should not be called menstrual unless it occurs between fourteen and forty-six ; comes periodically, or with periodical paroxysms, and the blood has the characteristics subsequently described. On the approach of a fever, or pneumonia, or intense worry, or excitement, the womb of an elderly lady may bleed. Early cessation is very common, and consists in a premature paralysis of the ovaries; and this extinguishment of the repro- ductive force may be caused by hard work, worry, miscarriage, or induced abortions, falls on back, cold, fright, wet, purging, cholera, fever, long trouble, drugs, occupations—all paralyzing influences. It is called early any time before forty-six, whether it be at twenty-one, twenty-eight, thirty-five, or forty-two. This condition runs in families; mothers and daughters resemble each other in this special department only. Women of the same family usually begin to menstruate at the same date; have the same kind of trouble, same eccentricities, same complications; cease at the same time, with the same peculiarities ; and even die under the same conditions. In this alone they resemble the mother; in their mental characteristics and conformation, they are specially the same as the father. Prostitution has a fearfully deteriorating influence on both brain and ovaries, and causes a loss of reproductive power. The vagina of a woman whose sexual act is loose and varied is cold; it has lost its vital vigor and contractility; it has no vivifying influence on the male. Its mucous membrane is purple or livid; it has none of the cherry redness of the virgin, and it is even in a more dilapidated condition than that of the woman after the change. As a consequence, if they live over the three years allotted to their abnormal existence, they change, irrespective of age. Even the conditions of life have a modifying influence on menstruation and change; the former comes on late in the poor and ceases early; whereas in the rich, it is early and holds on longer. Menstruation usually takes place about the period of full moon in about two-thirds of all cases; the other one-third, in the middle of the month. In spite of this disparity, there can be no doubt but that ovulation is regular, inevitable, uninterrupted; but the menstrual function shifts, owing to some special attribute of the nervous system, and this fact shows that it is governed by nervous influence, and explains how strong emotion may repel or alter the time of its appearance. Menstruation is the effect of ovarian action, the shedding of an 200 DISEASE GERMS. ovule; but the menstrual flow, or a discharge of blood can occur without ovulation, just as ovulation may occur without menstru- tion. Nervous emotion, over-exertion, reading sexually exciting literature, passion, hearing disagreeable news, fatigue, quarrel, and jars, will bring on menstruation in some ladies without an ovule being shed. That sudden passion should cause the uterine surface to perspire blood is a well-known effect. Taking all the facts into consideration, it is more than prob- able that the recurring monthly discharge in the human female is a secretion, or rather excretion, from the lining membrane ol the uterus and fallopian tubes, without degenerative change other than that commonly associated with augmented functional activity, and comparable with that occurring in any other organ of the body under similar circumstances. The average duration of the menstrual function is thirty-two years, which is the possible duration of female fecundity, and that of each successive generation. The mode of stoppage in the largest percentage of women is by gradual diminution of the flow; by a sudden stoppage of the usual flow, or by a flooding or successive floodings, or by alternate copious or scanty flow, or at irregular intervals longer or shorter than twenty-one days. The greatest number exhibit a diminution, a gradual decrease in quantity, and also in the time of its duration ; the other class, where it is erratic and the duration irregular; the next class, where there is flooding, the flow growing less and less, and at long intervals apart, till it becomes a mere show. The discharge, at first like blood, becomes blacker and blacker, clotty, then like cinder-dust or dirty-green water; in other cases like a lochial discharge, in smell. The menses, in health, are not to be re- garded as pure blood ; there are certain chemical elements in them induced by the brain, ovarian act, the presence of the ovule, that renders this blood totally different from the blood circulat- ing through the lady's body; so much so if it is absorbed, owing to sudden suppression, it will not mix, but is thrown off at some weak point in the skin, lungs, nose, bowels; it is sweet, not salt- ish like pure blood, but prior to and during the change it is still further altered in quality, whether it be scanty or profuse, at first paler in color, or later, brown or simply green water. As a rule ovarian influence begins to fail before menstruation becomes ir- regular, because when the sexual organs are healthy their loss of power is gradual, the ovarian forces become feebler and feebler until they can no longer determine any influence over the uterus, and the discharge subsides. The Period Before and After Stoppage.—The date of the last regular menstruation is to be taken, and the time calculated dur- BACTERICIDES. 201 ing which the flow became irregular, scanty and the health unset- tled. The length of the premonitory stage of irregularity, off and on, varies from a few months to six or seven years ; the aver- age time being two years and a half before, and two years and a half after. This divides it into two periods of pretty nearly equal length; the period before, with its varied symptoms, is followed by a period after, in which every twenty-eight days there are sen- sations of a peculiar kind, which continue along growing less and less. These monthly occurrences are very varied, embracing lumbar and abdominal pain, leucorrhcea, headache, diarrhea, bleeding piles, hysteria, asthma, debility, sweats, dyspepsia, stoma- titis, swollen gums, legs; usually lasting four or five days. When all is over, the perfect recovery of health, and its re-set- tlement on a new plan takes two or three years, after which women are not liable to debility, floodings, sweats, heats and other un- pleasant symptoms of the change. Diseases, with which a woman may be accidentally affected at the change, may bar the progress of involution, and protract it indefinitely. Fibroid infiltrations in the uterus have been known to delay the change for many years. The ovaries may be shriv- elled and shrunk; reduced to an amorphous mass of fibrous tissue, while the womb is still large, and bleeds promptly every twenty-eight days. These events are of vital importance, espe- pecially when disease-germs have been lurking in the system for years, as it brings them into active existence. The great quicksands and precipices which a woman should avoid during ovarian activity are sexual excesses; the use of drugs; abortions, or miscarriages; and our modern demoralizing literature; these, if indulged in, shipwreck her existence at the change. The removal of the ovaries during the thirty-two years of ac- tivity, induces an artificial, but genuine change. This proceeding is sometimes necessary; this castration of the ovaries is performed when menstruation causes very serious and grave disturbance of the nervous system, as mania, epilepsy, or when they are affected by disease, as interstitial fibroid infiltrations, or tumor, that give rise to flooding, or other very fatal condition. Castration is a grave proceeding; dangerous to life, by inducing peritonitis, and forever renders sterile the woman, and never should be done without the consent of the patient and her friends, and after con- sultation with several other physicians. The question is frequently asked, " Is fecundity possible during the change of life ?" Yes, if there are properly matured eggs evolved; but after the forty-sixth year the chances of fecundity diminishes, becoming less and less every year; but it is possible 202 DISEASE GERMS. just so long as eggs mature and the menstrual flow appears, how- ever irregular the latter may be; cases have occurred under my own observation. Is fecundity possible after cessation ? Most assuredly, no. If the ovaries have ceased to evolve eggs, if they are withered and wasted, shrivelled up and inert, the woman is as barren as a stone. We have already stated that evolution is not indispensable to menstruation ; that with very high vital force, ladies may pass eggs or shed ovules without discharging blood, and become pregnant without ever having the menses. Healthy women never menstruate either during pregnancy or nursing, but there are many nowadays who do. Conception has taken place before menstruation, so it is only possible when the ovaries and brain are healthy, and when ovules are thrown off, irrespective of the numerous eccentricities of the generative function. There is a perfect remodelling of the system at the change of life. For thirty-two years, every twenty-eight days it has been habitual for a healthy, unmarried woman to lose an ovum, and with it four ounces of blood, so that when the great crisis in life, the change comes, there will be numerous efforts on the part of nature to get up various contrivances, compensating discharges and drains, which act as waste-gates, until health is restored or permanently re-established on a new basis. Those compensating agencies are varied and numerous, and embrace the various natural outlets, as the skin, lungs, urine, stool, hemorrhages and obesity. Women at and after the change exhale a much larger quan- tity of carbon than before ; their urine is loaded with brain waste in the form of phosphates and chlorides, which indicates a great revolution in the nerve centres; the lithates are abundant also, which shows that nitrogenized elements are undergoing chemical change. The secretion from the skin is very great; there is great heat, intense radiation,exhalation, evaporation, dry flushes; so much so that the caloric of the elements of chemical change bursts in flushes from the face, neck, chest and other parts of the body. The pulse is not accelerated, nevertheless the generation of heat is indescribable; the patient requiring little clothing, and during the intense cold of winter will have doors and windows open. Those heats are independent of another class, namely, the heats and colds of nervous depression. The heats or flushes of the change are like hot waves, frequently wafted from the surface of the body eight or more times per hour, decreasing after the change has taken place, and disappearing in two or three years. •It is rare for them to continue long, unless the patient is subject to worry or some form of nervous irritation. The face, neck, BACTERICIDES. 203 breast, hands, feet, nails, feel like fire. Florid, sanguine women have a greater power of generating heat than the thin and nervous; in the sanguine temperament there is greater buoyancy, more hopefulness; molecular change is greater than in the dark or bilious; there is less resistance to change; consequently the heat generated is greater, and they suffer terribly from a variety of conditions from which a woman with black hair and eyes is al- most exempt. Sweats, copious and persistent, are also present. Vicarious discharges are very common if there be weakened patches anywhere, as bloody discharges from the nose, mouth, lungs, skin, etc., if these parts are feeble. The effect of the change on all women is to cause a perfect remodelling of their physical and mental traits: the lean become stout; they experience a great improvement in health. The robust or fat do not fight the battle of the change so well; they cannot convert their superabundant blood to other uses rapidly enough; they drag along very slowly; are more liable to hemor- rhages. The breasts in all atrophy, but if women gain flesh or get stout, they usually become quite heavily loaded with fat and become pendulous. Once the change is consummated there is often a grand remodelling of the intellectual faculties, and it is satisfactory to know that the highest grade of intellectual cul- ture, the most profound studies, can now do no harm; so it is at this period of life only that woman should engage in literary and scientific pursuits. Its Cause and Treatment.—Before considering Change this subject in a practical light, it is necessary of Life. to have a proper knowledge of the generative organs of woman: they must be looked at in an anatomical, physiological and pathological condition as the great motive power, the potential lever of the world. It is the nervous system of the female reproductive organs that specially solicits our attention, as it is there, in its deep abyss, in its incomprehensible structure of animated tissue, that the ovum or egg is evolved, before any microscope can detect its organization. In another part of this work, we divided the nervous system into three parts, although essentially one, a unit—the brain proper ; the cerebellum and spinal cord, with the reflex centre, the medulla oblongata; and the great sympathetic or ganglionic nerve centre in the chest and abdomen; those three points, essentially one, work for each other; any damage done to the one injures the other two. The three persons in this trinity are co-equal, but as the uterus, ovaries, etc., are covered on their front part with the sympathetic or ganglionic nerves, we speak of it more 204 DISEASE GERMS. frequently, and as it is the potent instrument of life, a wondrous power, the citadel of the soul, we may have to recur to it again and again. Definition.—Change of life may be defined to be that state in which the brain and cord fail to impart the necessary stimulus to the ovary, so as to enable it to secrete ova. It is a change, a crisis, a critical period, a failure to elaborate ova, and cessation of the menses. Causes.—Although there is but one cause—a failure of the ovaries to shed ovules—still to be more explicit, we will arrange the causes into exciting and real. It is to be understood that it is just as natural for a healthy woman to shed ovules every twenty-eight days for thirty-two years, as for a tree to bear fruit. The exciting causes that bring about a sudden or early change may be any disturbance of the abdominal brain, as violent emotions, intense or unhealthy desires, grovelling affections, degrading passions; hence, fright, grief, worry, struggle, emo- tional or sensational reading, masturbation, promiscuous sexual intercourse, predispose to a change. Deleterious trades, or occupations, in drug or chemical laboratories are productive of ovarian change. The use of such drugs as bromide of potass, belladonna, ergot, opium, chloral, mercury, iodide potass, all acro- narcotics, will in time produce effects analogous to castration- dry, wither, choke the springs of life. Blows on the head or back, poor or diseased blood, disease-germs of typhoid, of syphilis, cancer, tuberculae, etc., are exciting causes. The true exciting cause is when the brain and cord fail to send the stimulus to the ovaries, and as a result they are sterile, barren; then, as there is no further use for the organs, they shrivel up, waste, and disappear. The uterus also becomes inert, its normal waves are gone, even the source of their nutrition; their special plexus of vessels, not being needed, wither and be- come obliterated. Symptoms.—In enumerating the symptoms, it is not our pur- pose to describe the changes that take place in the skin and bones, the vertical wrinkles and hair on the lip, or stray hairs; nor the atrophy of the ovaries; the changes of the womb, the obliteration of its neck and vessels; nor other changes. What we are desirous of doing more especially is to describe a train of symptoms, several of which are present in every case, and imperatively demand medical assistance. We shall begin with those of most frequent occurrence. We have already statedthat there are at all times three millions of women between forty-five and fifty years of age, in the United States, undergoing the change of life. Now, it is fair to presume that one-half have lived in a BACTERICIDES. 205; natural way, in conformity to natural laws, and pass over the change so easily as to seldom require any medical aid. The other half are those that suffer from one or more of the following symptoms: Nervous Debility, with great languor and lassitude, is present in every case to a greater or less degree. It begins with the first indication of a change, grows worse and worse till final cessation ; when that takes place it grows less and less till health is re- established. This is an essential symptom of the critical period, and usually begins to affect most women about forty. Some of # the phases of nervous debility may be due to the ordinary wear and tear of life, and are common to both sexes; but at or about the change they form a special group by themselves, occurring with greater or less aggravation in different ladies, variable in each individual, never two alike, and most marked about three years before the complete stoppage, and continuing three years after the change has been completed and a new basis of life established. Nervous depression, debility, weakness, or some form of nerve tire or trouble, is present in all cases. It is a marked character- istic symptom either in the brain, cerebro-spinal system, or ganglionic. The nerve prostration never slackens its pace, but persists till the change is accomplished, simply modified by location of weakness. It is a perfect revolution; when the stop- page or dropping of eggs ceases every organ supplied with the sympathetic is affected; the spleen, kidneys, liver, larynx, face, bowels, womb. The three brains have worked harmoniously for thirty-two years, and now there is a disturbance. This disturbing influence generally shows itself in a diminution of the flow; in a weariness, a torpor, a lethargy, headaches, and an indescribable feeling of goneness ; the brain and cord fail to give an adequate stimulus to the ovaries, and energy is impaired; the ovarian loss itself gives rise to mild or severe nervous disturbance. If there be disease of the sexual organs the symptoms of ovarian dis- turbance will be more severe, and prolonged beyond their natural termination. If there be something in the nervous system eccentric, the reaction on the ovaries may be analogous to shock or paralysis. We cannot be surprised at the immense train of nervous symptoms so common at the change, when we reflect on the great volume of brain concerned in the evolution of the eggs, and its complicated and artistic structure, rich in gray or intellectual matter; and when we turn to the visceral brain,—the ganglionic nervous system,—that incomprehensible seat of life, of vital force, of good and evil, located, centralized, and congregated into little 206 DISEASE GERMS. lumps of nervous matter, bound together by tangled skeins of nerves, reflected over the viscera, not only the seat of power, but guides nutrition, healthy and morbid, and controls the action of blood-vessels, heart, and lungs. The third brain, the ganglionic system, and great sympathetic, is an offshoot from the cerebro-spinal at the junction of the last cervical with the first dorsal. The ganglia are scattered every- where over the viscera, uterus, ovaries, and contain every kind of nerve matter, but are extremely rich in gray or sentient cells. ,These ganglia must be considered as little brains, each having its own range of power; being very sensitive, through them the brain becomes cognizant of ganglionic impressions. The ganglia serve for a storage of power, of vital force—a source of energy for the sympathetic; the fountain from which ganglionic nerves draw their supply; by the currents of which the capillaries and nutrition is maintained. The centralization of vital force in the solar plexus and sym- pathetic renders the abdominal brain of immense importance at the change of life. To show its intrinsic value and its intensi- fication of power, a blow on the stomach will cause instant death, and yet leave no lesion or mark to explain the cause, not a trace. The ganglionic nervous system furnishes to the human frame a nervous influence, a reservoir of nerve-force, giving to the cerebro- spinal a power of which the human mind only recognizes the force when it fails. In the reproductive organs of women, a prominent symptom, even in health, is occasional nerve prostra- tion at.menstruation, or after connection, parturition, or nursing; many women feel a great loss of energy. Woman cannot pass through any stage that communicates life without a momentary loss of a portion of her own vital energy. She reminds us of those animals that die when they have transmitted life to others. Nervous debility is so constant, and so intense in all women at the change, as to be fairly considered the primary symptom; and it is justly so; and her complicated mechanism readily explains it. Her nerve exhaustion fairly causes her to lose her equilibrium, and some special nervous disease is like to supervene. Flushes of Heat are present in about eighty cases out of one hundred, and slight heats and colds in the balance. This symp- tom is present to some extent in all cases of nervous depression, but the intense heat prior to, during, and subsequent to change, must be explained by the great chemical change going on in the body. The heat is due to molecular action; and the intensity of the heat, as well as its quality, is due to the pathological conditions present, so that women at the change generate more caloric, because there is more change going on. In most cases BACTERICIDES. 207 it is a dry heat, a dry exhalation. If perspiration be present, it is likely cold or clammy. It is to be regarded as a salutary effort at elimination. It usually -has an irregular area of dis- tribution, as flushes of the face, breast, body, hands, and feet, and if not diverted off by the safety-valve, the skin, may manifest itself internally in a burning in some organ. As a general rule, the heat starts from the solar plexus in abdomen, then the chest, and face; the parts are suffused, hot, like a burning stream. They are not preceded with a chill unless there is great nerve- shock. The flushes occupy from a minute to a quarter of an hour or longer in duration, and are repeated six or eight times an hour; usually begin three years before, and continue three years after cessation ; face and neck are most obnoxious to them, but they affect any part of the body, even the nails, which often feel like fire. Stout or plethoric women suffer most intensely in their severity as well as long duration. These heats never affect the pulse, which is usually slowed. These heats must never be confounded with blushing, which is an act of the sympathetic; our women still blush, even at sixty, seventy, and upwards ; and blushing will arouse them afresh. In blushing, heat is also evolved by the shock or emotion of the sympathetic. What this nerve does under emotion, it does also, to a certain extent, on the subsidence of ovarian stimulus, and aids, to an infinitesimal degree, in the production of heat. The heat flushes of the change are like tornadoes of heat, heated waves, which cause patient to discard some of her clothing and keep windows and doors open. Perspirations are the next symptom in the frequency of its occurrence. It may follow the heats, if nerve debility is very great, but it very frequently exists by itself. It is often very great, amounting to twenty or thirty ounces in the twenty-four hours, independent of the insensible perspiration, which is in- creased. The skin is the most easily moved of all the safety- valves of the body, and is much influenced at the change of life. It is of great service in drawing off waste and solid elements not needed, and its active function is desirable. The critical nature of the sweats at this period is of much importance; they are often heavy, saturating body-linen and bed-clothes. As a general rule, these perspirations do not come from the entire body, but are generally restricted to portions, as the brows, face, breast, hands, feet, and pit of stomach. Like the heats, they begin early and continue on to cessation, and subsequently diminish in intensity and duration, and gradually disappear. Leucorrhcea, or the Whites.—Next in frequency, we find this discharge from the vagina, beginning two or three years before 208 DISEASE GERMS. cessation, and continuing the same length of time after. It may occur all the time, or at irregular intervals, or periodic monthly. They are so common at the monthly period at this time that they may be considered as its legacy; especially so, when they come periodically. The critical nature of such discharges shows that they should not be stopped, although it may be proper to restrain them. When it occurs periodically, it usually continues several years after cessation. Hemorrhage occurs in about sixty cases out of every one hundred; two-thirds of all cases from the uterus ; the other third from nose, mouth, lungs, nipple, kidneys, rectum, pubes; skin, in blotches or excoriations. They are all critical, and are to be regarded as the harbingers of serious trouble. Flooding at the change, in some cases, prevents complications, and relieves nature, and affords time for the readjustment of the system to the new order of things. Successive floodings are very common in the robust; but may occur in any temperament as often as there is an overload of blood. The sanguine, with the florid features, are specially prone to it; blondes more obnoxious to it than the dark. A continual dribbling from the womb, at the change, is very undermining to the strength. It does not weaken down so much as when occurring at the regular periods. The best mode of stoppage is one gradual and progressive. Flooding is not always to be laid down to premonitory or existing cancer without the pain in front and back opposite, nor to ulceration of neck or womb. The whole net-work of uterine nerves are con- fused, upset, and a fright, emotion, passion, excitement, bad news, a fit of sneezing, a connection, may bring on a flooding. When floodings occur a few months after cessation, it is dangerous, because the system cannot repair itself fast, and the patient becomes much weakened thereby. Next in the order of frequency of occurrence of symptoms are Headaches. We have no words to describe the dreadful headaches of the change of life. It is a frequent, and often a ruling symptom. The pain, and its location, is very variable; sometimes a dull, heavy pain, with drowsiness; at other times it is frontal, sharp, excruciating; in other cases it is in the temple, or top of the head, or at the occiput; most frequently behind. The nature of the pain may be described as shooting, throbbing, gnawing, boring, or like a nail driven in, or as if the head was in a vise. It varies in intensity from a mere inconvenience, to the most agonizing; sufficient to prostrate the most vigorous. It is often accompanied with nausea, or sickness in the stomach; in some cases there is vomiting. It is purely nervous, and is present in both plethoric and anaemic. It may be associated with pains BACTERICIDES. 209) elsewhere. It is usually off and on, or periodic; and in some cases it is a true neuralgia of the brain, with flushes, per- spirations, hemorrhages, etc. Next in succession comes Drowsiness, Giddiness, like being tipsy, so that when she walks she likes to have something to hold by, or feels like a top. The drowsiness is peculiar; sleeps all night unrefreshed, and falls asleep during the day; sometimes feels stunned and lost for an hour, with hot pain at pit of the stomach. Before the change she was all life and animation; clever, sprightly; but now, stupid; lets things fall out of her hands, and falls down in attempting to pick them up. Such a condition is often present at puberty, and is often bad when the flow is scanty, painful, or absent. The tendency to sleep is great, and often accompanied with an uneasy sensation of weight in the head, a feeling as if there was a cloud or cobweb on the brain that required removal; loss of memory, power of exertion ; heaviness of head ; dulness of intellect. This drowsiness, stupor, is often a precursor of insanity. Mental stupor is often present during pregnancy, but passes off. Catalepsy, Melancholia, Nervous Stupor are due to, and caused by a morbid action of the ganglionic system on the brain,. brought about by the disturbed performance of the reproduc- tive organs. It is a kind of spontaneous narcotism. Hysterical Symptoms are quite common; but they are always? associated with nervous debility, flushes of heat, sweats, ab- dominal pain, piles, or hemorrhages, such as a gush of blood from mouth or nose. Epilepsy is very common at puberty; disappears when the menses are established, and is very liable to reappear at the change. Very frequently the attacks are periodic, corresponding; to the flow; usually go away when the change is well over. Minor symptoms of epilepsy are very common, as vertigo, sensa- tions, or aura, temporary loss of speech and consciousness, twitching of the facial muscles. Aphonia, or loss of voice at puberty, is very likely to recur at change, and then disappear finally; so with stammering or stut- tering, fear or dread. Chorea is very rare at change. Insanity, from the best statistics, is more frequent among women from twenty to forty, while the reproductive organs are endowed with their greatest activity, than between forty and sixty. This latter time, when hope is fading, and physical strength giving out, is the period when men die insane, and when women are most exempt. From sixty to eighty, when the sexes most resemble each other, insanity affects them equally. The 210 DISEASE GERMS. change of life is not prone to insanity; the puerperal state and nursing more frequently give rise to it, which explains the reason of its prevalence between twenty and forty. Delirium, Mania, at puberty, may be expected at change. The two mental states known as Melancholia and Hypochondriasis are very common at the change, particularly the latter, which may be regarded as an exaggeration of other symptoms. There is often blended with it haziness of intellect, self-absorption, love of solitude, distrust of friends, and exaggeration of trifles. There is often associated with those mental states neuralgia and hys- teria. They are most frequently periodic, corresponding to the monthly flow ; at which period she becomes very gloomy, indo- lent ; scarcely speaks, and imagines a fancied evil is about to befall her. This condition generally continues for three or more years after the change. This symptom is a most common one, often well masked and hidden by the lady ; her sensitive and loving nature is disturbed when all is changing around her, and she feels cord after cord snap that anchored her to life; and she, if she has sufficient strength of mind, will conceal her condition. The flame of vitality cannot die without forebodings of decay, and there may spring up doubts about faded charms, failing energy, changed aspect she never before harbored, whether now she may be able to retain the affection of husband, the sympathy of friends, the admiration of the world. Because the strength, the vigor, the vivacity of youth is gone, some women try to convince them- selves that they are useless, and make themselves miserable. If unmarried, this change tells her to put aside long-entertained visions of future bliss. Apathy and sudden change of habits; dislike to exertion, mental or physical, with want of sleep ; melancholy and suicidal tendency. There is often a remarkable perversion of the moral nature; un- controllable impulses to do things which they know to be wrong; often ungovernable, eccentric, reckless, extravagant, and in other cases avaricous. The temper is strange, peevish, snappish, quarrelsome, invari- ably uneven. The nervous system at the change is in a state of pertur- bation ; there is an insatiable desire for alcoholic drinks; a true dipsomania. An Impulse to Deceive.—Women always surpass men in their stupendous powers of deception. When a man has an object to gain he may deceive; but he does not, like a woman, find a pleasure in deceiving for deception's sake. Untruthfulness is very common, and it is not to be wondered at, under the mental BACTERICIDES. 211 perturbation present. Delirium, vertigo, distorted ideas and false notions are crystallized with deception. Kleptomania, or a desire to steal, is very common at puberty, during disordered menstruation, pregnancy, puerperal conditions, and at the change. It is most unaccountable, this impulse to steal, at all risks, at the critical period. Homicidal Mania.—A tendency to kill is a lamentable conse- quence of the change. Suicidal Mania is common at puberty, and recurs at the critical period ; less common in women than in men; one woman to three men being affected. In women it is associated with the notion that they are possessed with the devil. Eromania, or inordinate desire for sexual gratification, is sug- gested, promoted, and intensified by morbid ovarian influences, uterine affections, and brain irritation. Woman, at the change, is an irresponsible being, being afflicted with some form of in- sanity ; the disturbance of the abdominal brain reacts upon the brain proper. Apoplexy, Paralysis, in all their forms, are common at this period. In apoplexy, there is the vertigo, the specks and spots before the eyes, the noises in the ears, the choking. In paraly- sis, the numbness, the feeling of pins and needles, the loss of sen- sation and motion, coming and going in a part, or the whole of the body. Nearly all women suffer from neuralgia, as well as paralytic symptoms, most common about the small of the back; lumbago in the abdomen all the time, or it may be simply monthly ; ovarian pain, colic, numbness, paralysis, sciatica; numbness in the hands, arms, feet and other parts ; neuralgia of the face, loss of voice, deafness, toothache. Nearly every woman, at the change, suffers from one or more of the above symptoms, and an endless variety not enumerated. The pains in the back, or loins, and legs, are the most common, and are generally described as radiating from the back, and an aching, numbing, gnawing, dragging, burning, or grinding. Often a sensation as if the back was broken through entirely. These backaches are often associated with pain in the ovary, or abdom- inal neuralgia; numbness ; pricking sensation in feet and hands ; loss of power of parts are common; burning sensations, with numbness in arms, back, and temporary loss of power; neuralgia of the eyes. There is a whole host of affections that attack the reproductive organs at the change, independent of flooding and leucorrhcea. There is a remittent form of menstruation ; vaginitis; follicular inflammation of the vulva; inflammation of the labia; ulceration 212 DISEASE GERMS. of the neck of the womb ; induration and enlargement of the womb; falling of the womb ; uterine polypus ; cancers; tumors; ovarian disease; irritation of the breasts; milk, or glutinous secretion from the breasts; copious phosphatic deposits in the urine, with often inability to hold it; bloody urine; erectile tumor at the mouth of the urethra; rectal trouble; piles; abscess; burning in womb and rectum. There is not much disposition to acute inflammation, as the general condition of degeneration going on protects the organs. Itcliing about the vulva, or pruritus, is very common, and is due to the sugar in the urine at this period of life, and to that coming in contact with the parts. Eczema on the lips makes the life of a woman unbearable. Prurigo and follicular inflammation begin at the change, and continue, in spite of the best treatment, for several years. Herpes, or tetter is another annoyance. The great prevalence of vaginitis is to be explained by the continuance of" sexual intercourse. Some cases are due to morbid states of the blood. A failure of health, gout, and extension of eczema up the vagina, or acrid'discharges from the womb, which are muco-purulent, greenish, or yellow, or slightly tinged' with blood, and more or less offensive and contagious. Vaginitis gives rise to heat; bearing-down pains; disturbance of bladder and ovaries. The symptoms of change in the reproductive organs are manifold. The ovaries rule supreme over menstruation; and if there is any disease lying quiescent, as a nucleus of a tumor, it will either retard, or give increased activity to the change. From thirty-five to forty-four years of age, when cessation begins to dawn in most women, sexual desire' is less intense ; the married have fewer children, and the unmarried think less of marriage. This diminution of sexual energy accounts for a great decrease in the number and intensity of inflammatory uterine disease. Many women begin the change of life with uterine disease that has been undetected, or imperfectly cured, and all such conditions are likely to be intensified or aggravated by the change. Failing health gives rise to an exfoliation of the glands at the neck of the uterus at the change, so that the neck enlarges; becomes soft, Daggy- Tne change is often suspected by disease in the womb, or other parts; but after the change, the uterus is not liable to the old diseases of its active state. Disease is rare after, and when it does take place, it is a residuary legacy from old times. The obliteration of the neck of the womb, with the altered shape of the womb, vaginal prolapse, falling, uterine tumors, fibroid, fatty, and mineral degeneration, are quite common. BACTERICIDES. 213 Women, with cancerous germs lurking in the system, are extremely apt to have them grow between forty and fifty; although cancer, between thirty and forty, is very common. The influence of the change on cancer is to give it an impetus, a start; to give it a rate of progression. The average duration of cancer here is sixteen months. Swelling and irritation of the breasts commence at the change ; they swell, become painful, nipples sore, ooze out serum or milk, or a gelatinous fluid, or a watery, bloody discharge. Tumors now put in an appearance; cancer, if the germs are present in the blood. When the lacteal ducts and connective tissue are disap- pearing, fatty or adipose tissue becomes very abundant, and there are apt to be lobules of that tissue thrown out. Although disease of the kidneys is rare at the change, still there may be bloody urine, continence or incontinence of urine, and chronic inflamma- tion of bladder. Tzvo- thirds of alltuomen, at the change, suffer from some irritation of the stomach, liver, bowels, as dyspeptic symptoms, toothache, swollen gums, vomiting of mucus, blood; biliousness, jaundice, constipation, diarrhea, inflammation of rectum, and enlarged abdomen. Biliary derangement at puberty, and its recurrence at the change, is the most common of all the disorders of the alimentary tract. A very large number complain of being bilious ; bitter, metallic taste in mouth, with headache, nausea, and vomiting; bile in urine, and jaundice. This liver-irritation gives rise to the burning in the rectum, and piles, which are often so troublesome. That piles should be a common symptom is not to be wondered at, when we see the unrelieved plethora of the liver at the change, and when we bear in mind that the liver, intestines, and repro- ductive organs are covered by ganglionic nerves; that the womb and all the viscera are supplied by nerves from the cord ; that the veins of the liver, uterus, and rectum are identical and con- tinuous ; it is not surprising that when the uterine discharge is arrested, that the nervous energy and sanguineous current should flow by the intestinal surface, and gives us bleeding piles. The swollen gums, dyspepsia, diarrhea, constipation, spitting of blood are generally periodic. A permanently enlarged abdomen is very common at the change, and is accounted for in two ways: (1.) by the increased deposit of fat in the omentum and in the abdominal walls ; (2.) to some extent, by an enlarged, inflated state of the bowels, without either diarrhea or constipation being present. The Skin gives decided, infallible indications of the change in every woman ; it loses its softness, its elasticity, its fulness, and 214 DISEASE GERMS. shrinks, and becomes withered and wrinkled; then there are the heats, the sweats, the local burnings in hands, feet, legs, painfully hot; aching in the finger-nails, just as if they were being pried off, a peeling, a rotting of the nails, Besides these, there are various eruptions often present on the skin, as nettle-rash, ery- sipelas, eczema, blood-spots, tetter, prurigo; swelling of face and legs, either monthly or all the time; varicose veins; ulcers on leg; boils everywhere, but especially about the seat; abscess in the fingers, armpits, neck, groin; sensation of insects in skin are very common ; peculiar exhalations from the skin are not un- common ; chronic rheumatism and gout, enlargement of the heart, chronic peritonitis, dropsy, are common at the change; ulcers, goitre, discharges from the ears, nose, mouth, and nip- ples are very often present; swollen gums, sore mouth, saliva- tion, periostitis of the small bones, and other chronic affections more rare. There is a long list of other symptoms : the long-continued, persistent debility, with regular monthly pain in ovary or womb, with laughing and crying fits, and intense burnings, to which so little attention is paid; the irritable rectum, with tenesmus; habitual oozing of mucus, or pus, or blood, is too often not at- tended to. The most common cause of delay of change, and consequently, prolongation of symptoms, is to be found in congestion and en- largement of the body of the womb, and this uterine enlargement, which delays cessation, is generally the result of sexual excesses, or frequent abortions. This very state, irrespective of hysteria, may give rise to spurious pregnancy at the change. If the patient is free from disease, and has led a temperate life, the rule, " like puberty, like change," will hold good, not other- wise. The change is greatly modified by temperament, by constitu- tional peculiarities or eccentricities, social position; and these modify all symptoms, from the debility and heats, to the pricking sensations in feet, numbness of extremities, trembling of the limbs. Some imagine that the unmarried are more liable to flooding, cancer, ovarian tumors, at the change, but this is not true; the single pass over this critical time with much less trouble than the married, and suffer less. Women of loose habits, given to promiscuous sexual indulgence, prostitutes, those who resort to abortions, suffer immensely—words are inadequate to describe their sufferings. Such states keep up more or less inflammation through life, and predispose to much trouble at the change. Marrying late in life is also bad; those sexual states maintain congestion of the sexual organs, and are eminently calculated to BACTERICIDES. 215 aggravate all the symptoms enumerated, as congestion and ul- ceration of the womb, if it exist. Terminations.—Change of life in woman, at whatever age it occurs, is a final settlement, and exercises its sanative influence on the rest of her life. When it is effected, her mind emerges from a cloud, in which it has for some years been lost. All ladies, while avoiding causes that would be likely to give rise to conges- tion of the womb, should sustain their intellectual faculties well, read history, train their minds to take comfort from the fact that the period is past, which gives them an immunity from the perils of child-bearing, and the tedious annoyance of monthly restraint, thankful to have escaped real suffering. Women should not torture themselves into imaginary woes, but they should feel the ground steadier under them ; they are now less dependent on others, and their mental faculties assume a more vigorous and masculine form. The change of life does not bring talent, but it imparts the power to bring out latent faculties that have been for years in abeyance. The subsidence of ovarian action depresses one form of love,—those emotional impulses which give passion energy; but at last, when the heart becomes capable of listemngto reason, love still rules paramount in the breast of woman, and whether it is called charity, friendship, affection, conjugal or maternal, it is still there. Sound religious ideas often become engrafted, and take a sure hold, covering the evening of life with unanticipated happiness. When once over, and anchored in this new haven, a woman looks back on the time when her health was disturbed by ever-recurring monthly trouble, and her mind distressed by de- lusion and passion. The importance to a woman of the change is great; she is healthier, lives longer, less risks to life, becomes stronger, and enjoys a great freedom from disease. It is said that a woman at the change loses all her personal attractions ; but this is not so. The beauty of childhood appeals for a fostering care; the beauty of youth fascinates ; that of mature age excites ad- miration ; but in most women, after the change, there is an autumnal majesty, so blended with amiability, that it charms all who approach within its magic circle. Her sphere is wider, her social influence greater, her field of usefulness extended, and now is her time for intellectual pursuits and efforts. The cultivation of the mind, and its endowment with scientific lore, usurp the place of faded charms. Now woman becomes the guide, the mainstay, the pillar of strength to man in the difficulties and struggles of life; she harmonizes society, unites its discordant elements, and stimulates the race to great, noble, and laudable ambition. 2l6 DISEASE GERMS. Time may dull the eye, rob the cheek of its bloom, indent fur- rows on the brow, but it cannot smother the seraphic fire burning in the hearts of women, prompting them to console, heal the deep and ever-festering wounds that afflict society. Those who have attained their sunset without having been granted the anxious though desirable vicissitudes of wedded life, destitute of relatives and friends, may find in the philanthropic efforts of allevi- ating suffering humanity a grateful channel for their affection. Some women at the change are perfectly unstrung, unnerved, find themselves solitary and alone in the world, bereft of the sympathy of friends. Travel, occupation, history, religious duties capable of engaging her attention, should be inculcated. The continued friction of sound duties restores peace and harmony, prevents brooding, self-absorption. Isolation causes everything to lose its natural and real appear- ance and to shine with morbid tints, and should be sedulously avoided. Social Position.—The position in life exercises a special influ- ence at the change of life. Women who live in a natural way, keep regular hours, avoid reading trashy or fictitious literature, exercise mode'rately, do not tight lace, and keep their health good, suffer comparatively little, except it be from the flushes and minor symptoms. Women in moderate circumstances get along the best; they are much freer from the symptoms than the spoiled and petulant daughters of the wealthy lords of civilization. The necessity for working hard, the struggle, the anxieties of poverty, the impossibility of escaping these, in our abnormal condition of society, together with insufficient food, insanitary states, increase the sufferings of the poor at the change. Certain occupations have a good or bad effect: thus, sewing- machine operators and washerwomen suffer most; the movement of the leg, in the one, keeps up ovarian irritation; in the other, the changes of temperature to which they are exposed are highly deleterious. The close, damp, heated rooms in which mill-opera- tives, book-folders, catgut-workers, etc., work, increase their suf- ferings at the change. Hard work has its merits, it cures the nervous affections which assail the rich at this period of life; for luxury, ease, lounging on sofas, in shut-up rooms, is the hot-bed of nervous affections; there they grow in profusion and run into extravagant eccentricities. Few ladies are compelled to work in a heated atmosphere so injurious as the heated ball-rooms of the aristocrat. We would say to the rich and poor alike, that the best way to approach the change, is to get right down to a natural base in all things, and thus approach the critical period with a sound constitution. A condition of debility, which is the result BACTERICIDES. 217 of all excess, prevents the regular succession of vital phenomena, by which the critical period is carried out; and as the change is marked by debility, when this is grafted on constitutional weak- ness, loss of power, ill health will be of long continuance with a train of nervous disorders. With those states of urgent debility present, there is not stamina enough left to carry them through the changes successfully. All constitutional affections, all forms of diseased blood, are increased by the change. Prognosis.—Menstruation is a useful guide for the changes; as it is ushered in, so the change; storms at puberty will realize a stormy change. Diseases that preceded menstruation are likely to attend the change. Skin affections, as eruptions of all kinds; hysteria, epilepsy, bleeding at nose, discharges from the ear, boils, diarrhea; erratic pains before puberty, same condition before change; faintings, want of strength, precede the succession of vital phenomena and are likely to re-appear. Puberty does not always bring health; there may be a lack of development, which may produce conditions that incapacitate for exertion; her mental faculties may be lost in dreamy forget- fulness; nervous irritability may give rise to fretfulness of temper, waywardness of disposition, mischievousness. The conduct of some girls at puberty often betrays a dereliction of all principle. There may be some jar or want of harmony between the action of the reproductive organs and the nervous system, so that the flow may come on on the fifteenth or twenty-first, instead of the twenty-eighth ; same troubles at change. Sisters are a fac-simile of each other as a rule ; observe the same date, have the same peculiarities, same crisis, same com- plaints; as biliousness, headaches, mental condition, everything the same at puberty ; same at change. The plethoric and sanguine suffer most; very much more than the bilious and nervous, and chiefly from flooding and heats, and have a hard road to travel. A girl at ten, without any sign of cerebral or gastric disease, may manifest either a sleeplessness, or drowsiness, the result of the premature action of the ovaries on the nervous system; the precocity of the ovaries are very pro- ductive of nerve affections several years before menstruation takes place. Great irregularities and suffering at any period are warn- ing symptoms of a change at any age. If the ovaries work well and smoothly at puberty, and the patient lives naturally, follows physiological laws, the change will be unembarrassing, irre- spective of age. It must ever be borne in mind that it is only the minority of women who suffer those innumerable difficulties and obstacles at the change; the large proportion pass the ordeal with little or no suffering. Well-regulated habits, healthy ex- 218 DISEASE GERMS. ercise, good moral and religious surroundings, and avoidance of tight lacing, of balls, late hours, unhealthy society and literature. Women, from want of instruction suffer much; they are ignorant of what should occur, or form exaggerated notions of the perils that await them, and receive no help from their medical attendant, because he is ignorant of their suffering. Let it, therefore, be clearly understood, that, if in tolerable health, and with ordinary care, they have only blessings to expect from the change of life. We say that the critical period is very dangerous to the tight-lacer, the dime novel reader, to the ailing, to the dancer, to the lazy, to the habitual sufferer at the menstrual period, to those suffering from uterine disease, to epicures, for ices, improper food, sitting on door-steps, sewing- machine operators, and sexual excesses. Very great difficulties are likely to arise from marriages at the change, especially if for the first time. Such a state at the change causes the womb to become congested, and it increases in size four or five times. If marriage is desirable, postpone it, hold it off till after the change has been consummated. Diagnosis.—Have we the means of foretelling the change, and recognizing it when completed ? Assuredly we have. The change can be predicted after forty, if there is a gradual diminution in the quantity of the menstrual flow, a gradual prolongation of the inter-menstrual periods, an occasional flooding, with heats and other symptoms ; but the grand landmarks are not this gradual cessation, or at once, but in the organic changes that take place. The uterine wave disappears ; the ovaries are shrivelled, withered, crumpled up in a peach-stone shape; obliteration of fallopian tubes ; atrophy of the womb, becomes round, its neck grows- shorter, and thinner,and disappears; vagina becomes narrow and short; coldness of the parts, from a shrivelling up of the pampi- niform plexus ; atrophy of the breasts ; hairs on the upper lip, with vertical creases; stray hairs on the face and chin ; and a peculiar, masculine physiognomy. There is a prevailing, all- pervading debility, which cannot be accounted for by disease; the complexion is pale, or sallow, a drowsy look, a sort of stupid astonishment, as of one seeking to raise herself to answer a question ; always some irritation of the brain, which shows itself in a knitting of the brows; the disappearance of the menstrual flow, or its irregularity, or scantiness, or its too great abundance. Cessation is to be looked upon as positive, whatever be the age, when the above conditions are present, unless accounted for by nursing, pregnancy, or uterine disease. At forty-five it is a settled fact; but, in order to complete the diagnosis, it is well to add, the debility, the unusual heats, the sweats, the appearance of BACTERICIDES. 219 discharge dirty brown, its total disappearance, and the other symptoms already enumerated. The sanguine or plethoric exhibit unmistakable indications of a great aggravation of all the leading symptoms; whereas, the nervous, with their white faces, ever-anxious, nervous look, suffer least. Cessation should never be mistaken for chlorosis, inflamma- tion of the womb, uterine polypi, uterine tumors, uterine cancer, pregnancy, either spurious or real, or other eccentricities of the uterus. Some diseases induce early changes in a woman's nervous system, and render her barren or sterile, such as the cholera germ, typhoid germ, the germs of pernicious, malarial, or yellow fever, the germs of diphtheria; under these the ovaries wither, and change takes place. Blows on head and back, fright, etc., we have already alluded to, and they should be weighed in the diagnosis of some cases. Treatment.—As ladies approach the change, it behooves them to prepare for the crisis—to get rid of all little ailments or disease; to observe and carry out a special regimen, and, as far as possible, to so arrange themselves as to be ready for emergencies; eat the best of food, observe hygienic laws, and place themselves upon a course of alteratives and tonics, such as we will subsequently lay down. Those two kinds of remedies are specially useful at the change. Alteratives are particularly indicated, to aid the change, to rouse up all the glands, to relieve the system of all waste, or effete, or waste matter; and tonics, to aid in bracing up. In pre- scribing alteratives, it is necessary to guard against the prejudice, firmly rooted in the minds of many, that the change of life is synonymous with old age, which is not so; for the very prime part of a woman's life is before her, and at the change all ladies are benefited by alteratives which are not suitable for advanced years. Both at puberty and change, which are periods of a new birth, there is strong vital energy; it may be latent, but it is there, and the use of alteratives, which cleanses the blood, de- velops unexpected strength and great vigor, and is strictly in accordance with natural laws and the phenomena of the change. But before calling attention to those, we will lay down, briefly, the essential elements, in a dietetic, hygienic, and medicinal view, that should, as far as possible, be observed at the change in all cases, and then briefly allude to remedies for the predominant symptoms. Diet.—Women, at the change, should eat plain food, as milk, eggs, boiled white-fish, broiled beef-steak or chops, chicken, game, bread, butter, oatmeal porridge and cream, vegetables of all 220 DISEASE GERMS. kinds, and an abundince of ripe fruit; the latter to be used freely, and to an extent not interfering with digestion. All farinaceous, or starchy food, or sweets, as puddings, tapioca, rice, pies, cakes, pastry, tend to load the system with carbon, and thus generate heat; prolong sleep ; cause distaste for exercise, and a tendency to stoutness. Forbid, in all cases, the use of sugar, tea, spices, pepper; all stimulants, together with shellfish, salted fish, or bacon, ham, corned-beef; malt and alcoholic stimulants. Coffee to be used with moderation. Women who have a tendency to become stout, require less food and more exercise than the lean. If there is great languor, weakness, nervousness, the diet should be made very generous, and the tonics increased. With the above diet, women will tide over the change well and have no further unsettlement of health to bear. If, however, women go in for eating heavy meals, stimu- lants, and excess, they will become like men, and have another change to meet after sixty-five. High living and stimulants at the change, give rise to early degeneration, which begins first in the capillaries, and steadily progresses to the larger vessels; then to the heart, spleen, liver, kidneys; and this degeneration is characterized by an increase of fat; a non-vital substance in the omentum, in the abdominal walls ; and, as a result, the belly be- comes large, protuberant, pendulous. Clothing and Bathing.—Whatever the season of the year may be, or locality, or condition in life, flannel should be worn next the skin, at all times, to protect the surface from changes, to ab- sorb perspiration, so as to prevent being chilled. Bathing the entire surface daily cannot be omitted, as it is a great safeguard; its neglect gives rise to great suffering. We might say it is im- perative, for the skin is heavily loaded with waste matter. Warm baths are the best, as they remove from the skin copious saline deposits, and other secretions left there by the heats, or the per- spirations ; besides, being in a warm bath for three-quarters of an hour enables the skin to absorb moisture or water, which allays the cutaneous irritation and dilutes the blood. The warm alka- line bath is like a gigantic poultice, applying its warmth to all the peripheral expansion of nerves, so that it becomes a splendid sedative of nervous irritability. It is perfectly manageable in all cases ; temperature increased or lowered at pleasure ; and even while in the warm bath cold can be applied to the head, or a cold shower bath to the abdomen; or by a long-tubed syringe cold water can be thrown up the vagina or rectum to relieve uterine con- gestion. The alcoholic vapor-bath about twice a week ; on other days the hot, or warm bath for over half an hour, followed by brisk friction, is always of utility, and, and in some cases, it is well to follow up with massage. BACTERICIDES. 221 In a small number of cases cold bathing is useful, provided there is vitality enough for reaction. The mineral water baths, whether of the sulphurous or alkaline kind, are always of the most efficacious character. Sea-water is not of so much benefit unless warm. Exercise of the muscular system relieves the congestion of the internal organs; it depletes, causes the skin to perspire, the kidneys to work actively and eliminate uric acid freely ; it rouses the liver to action. It should be taken in the mornings ; should be moderate, not continued to exhaustion ; long walks are objec- tionable, it should just be enough to carry off the redundant energy, which, when unemployed, or not wrought off, gives rise to fidgets, nervousness, temper. Driving is excellent; but horse- back exercise should never be indulged in at this period. Change is most beneficial in all things. There is nothing that conduces so much to mental and physical vigor as change. It is a great strengthener of the nervous system in particular. Travelling places the patient in a new sphere; new scenes ; new ideas, every one of which makes a call on her attention, solicits her interest, captivates her faculties, completely leads her away into new fields of thought; away from old habits and asso- ciations to which she had been long and painfully chained. Change has a most salutary effect on the brain ; under it the mind is consoled, and resumes peace and tranquillity. Nothing so vitalizing; nothing so serviceable for the cure and prevention of disease at this critical period. Fresh air is indispensable here; there must be an avoidance of close rooms, badly ventilated apartments, insanitary surround- ings ; the bedroom windows open at top and bottom. Amusements.—The ordinary cares of the household are at this period a burden; there should be, if possible, a general easing- up, a lay-off, or rest. The mind could be occupied with reading history, because exciting stories, which are present in novels, induce nervousness of some shade or type; besides, excitement is injurious. For this reason, balls, parties, concerts, operas, theatres, are excitants, and the impure air breathed in those places, in addition to their moral effect, causes them to shock the impressible, susceptible nervous system, and renders the patient sleepless and irritable. All exciting agents are deleterious, being productive of continued irritation and want of sleep, and it must ever be borne in mind that continued sleeplessness is the precursor of insanity. Night after night at theatres habitually subjects the mind to an increased intensity of feeling, which in the silence, solitude, and darkness of the night that follows, destroys its sensibility, and eradicates its typical fissures. All amusements should be of the most stable and healthy kind. 222 DISEASE GERMS. Hygiene of the Reproductive Organs.—This is a most import- ant consideration at the change, when those organs become atro- phied and shrivelled up. Nature emphatically points, by this very condition, that their appropriate stimulus should be avoided, and it is neither wise to marry nor to have congress at this unsettled period of life. Connection at the change brings about uterine disorders and grave complications. Some assert that the sexual appetite is strongest at the change; that the flickering flame of sexual desire gives rise to a final blaze; that there is increased ardency. This no doubt occurs once in a while, but it is rare ; the opposite condition is the natural one, merely a distaste for connection at that period. A marked in- crease of sexual impulse or ardency at the change is a morbid desire, depending on a condition of congestion of the ovaries, spinal cord, or brain. The sexual act aggravates the trouble, and leads to serious complications. No woman should marry at that crisis ; defer it till it is over; because if performed it will result in flooding, uterine disease, the development of uterine cancer, etc. Having regulated the general condition of the patient, she should be placed upon a general alterative and tonic course of remedies for at least five or six years ; she does not want many remedies, only a few, but they should be good ones ; but in all cases she should persevere with them faithfully, changing them at regular intervals of every seven days; and with those breaks the same remedies can be resumed again and again with great efficacy. The best alteratives at this period are the saxifraga ozonized compound, the mother's cordial, the wine of aleteris farinosa, and the ozonized phytolacca. Select two out of the above list and give in the usual dose about two hours after meals, and change weekly. If the patient is in very straightened circum- stances, so that she is unable to procure those invaluable alter- atives, let her do the next best thing, make infusions of blue flag, tag alder, yellow dock, and take them instead, so as to aid the elimination of waste-matter from the body. The best tonics at the change are the Peruvian bark, white mustard seed, the glycerite of ozone, kurchicine, golden seal, gentian, etc. Of these the Peruvian bark and white mustard seed are the most efficacious; the crude bark is better than its finer preparations: one ounce of the bark to one pint of good port wine, to which add one ounce of elixir of vitriol; allow the whole to settle. Dose, one tablespoonful three times a day one hour before meals. In some cases leave the elixir of vitriol out, then it can be given in wineglassfuls three times a day before meals. BACTERICIDES. 223 The compound tincture cinchona and mineral acids is excellent. At all events, don't deceive the patient by worthless and ineffi- cient preparations of the bark, nor delude her with tasteless in- finitesimal sugar globules. There is a gigantic, a grave change to be aided, shattered vital force to be restored, and it must be effected on the principles of common sense. Next in efficacy, as a tonic, is the peroxide of hydrogen. This is one of the valuable remedies at the change. It is particularly useful to meet the symptoms of debility in a worn-out constitu- tion; invaluable if there be indigestion, or liver trouble, with heartburn, pain or cramp, or a numbness, or a failure to sleep, nerve-tire, prostration. The cinchona stimulates the brain; favors the making of red blood, and is slightly astringent; whereas the peroxide of hydrogen operates in a most extraor- dinary manner in disorders of the organs of digestion and assimi- lation ; on the stomach and liver especially; stimulates the gan- glionic nerves lying over the womb and ovaries; corrects all irregularities, and improves the general health. It is a valuable tonic, stimulant and aperient; strengthens all the organs in the abdomen ; imparts activity. The efficacy of the peroxide of hydrogen does not depend on any specific power, but from the vitalizing energy which it imparts. There is no better remedy at the change—not one that can excel it. It relieves that indescribable feeling of debility and languor ; overcomes drowsiness ; soothes the irritable; strengthens; invigorates; increases assimilation one hundred per cent., and aids the vital forces under the terrible prostration, enabling them to hold their own by its effect on the nervous system. To ladies who need constant help it affords great relief; inestimable benefit. It should be taken one hour before meals, three times a day, in 10 to 20 drop doses, always exercising care not to give an overdose. It never fails to afford great amelioration. Its gentle action on the bowels is very salu- tary, as it is always important that bowels and skin should be stimulated. One or two teaspoonfuls of the aleteris farinosa wine should be administered every three hours for five days out of every seven, then on those two days, she should take the comp. syr. partridge berry. Those two remedies should be taken steady for a period of four years, embracing, some time before, during and after that period. The aleteris is a powerful uterine tonic and restorative of the greatest efficacy, in tiding ladies over this, the critical point of life. The glycerite of ozone operates well in all cases, and combines the action of both tonic and alterative. The extract of kurchicine is also a very valuable tonic. Infu- sions of golden seal, gentian, collinsonia, wine bitters are good tonics, but not of much utility at the change. Next to the 224 DISEASE GERMS. Peruvian bark and white mustard seed may be placed the kurchi- cine. All tonics are best given one hour before meals. In or- dinary cases the above simple alteratives and tonics are all that the great proportion of cases require, and can be readily carried out by the patient herself. But in addition to these there are often met a train of symp- toms some of which are present, and require special remedies and management. To these we will now solicit attention. Nervous Debility.—This debility at the change is peculiar; sometimes it depends on an excess of blood, and in other cases upon too little blood. If it depends on an excess, for which there is no drain, it is a good plan on the first appearance of irregular- ities which characterize this period, to curtail rather than augment food. Debility, when in the family way, or nursing, is benefited and often overcome by a very liberal and generous diet; but at the change this surplus blood cannot be utilized. In some cases it is advisable to establish a drain by applying two small blisters, about two inches square, on each side of the nape of the neck for six hours, every second or third day, so as to keep up a slight discharge. These off and on periodic blisters to the nape of the neck are of great utility when disease-germs are suspected to exist in the blood. In debility, with anaemia or poor blood, these must be more and better food, with rest, and a free use of the tonics already laid down. It is almost useless to experiment with others. Preparations of phosphorus, although very strengthening, im- parting keenness and vivacity to the mind, are contra-indicated, because they predispose to fatty degeneration of tissue; of the heart, liver, spleen, kidneys. The same objection is to be urged against malt and spirituous liquors. Iron is not a good tonic at the change, as it increases the heats by retarding the action of the liver. If it is tried, the acetated tincture is to be pre- ferred. Flushes of Heat.—The skin at the change suffers from flushes, heats, sweats, eruptions. They all pass off, as a rule, after the change. The flushes are the most tenacious, often holding on for years. Prurigo, itching, and eczema are the most trouble- some, and are blended with the hot flushes ; have their origin in the latter. In the treatment of them, it should be borne in mind that they are increased by emotion, nerve-shock, external heat, as in cooking, washing, ironing, baking, hot rooms, hot drinks, over-feeding. In arresting diarrhea, leucorrhcea, flooding, over- clothing, all these, as far as possible, should be avoided; the Peruvian bark mixture, the white mustard seed, are to be in- creased in dose ; the bowels to be kept rather open, and the usual BACTERICIDES. 225 daily warm baths scrupulously carried out. Various local appli- cations, "cooling," should be applied, as bay-rum and borax, borax water, and the face, cheeks, neck, breasts, or other parts can be dusted occasionally with puff powders, which are very cooling, and contain no deleterious agent. In some cases the flushes are preceded by a chilly sensation, or coldness; some even tremble with cold before the heats come on ; others have associated with it aching in the nails. When sweats follow, it denotes great debility and congestion of internal organs. Sometimes the flushes are anomalous, preceded by strange sensa- tions in the skin, which in numerous cases resemble a beating, like an animal throbbing in the stomach, or the fluttering of a bird, sensations that disappear when the perspiration comes. Some women are living furnaces, and insist upon the doors and windows being left open in winter time, and woe betide delicate women compelled to live with them. In such cases good results follow the use of salines in alterna- tion with preparations of sulphur, as the tincture, in twenty or sixty-drop doses three times a day; or glycerite of sulphur, or sulphur and cream of tartar; or sulphur, fine flour-sugar, and white resin. In other cases infusions of sassafras or yellow dock are of efficacy. Sweats.—These are simply evidences of great brain prostration, sweat running off the forehead or the entire body, obliging the patient to change linen several times a day, and when in bed liter- ally soaking the bedclothes. To a certain extent sweats are beneficial, they clear the body of superfluous material; but when they are excessive they hinder the insensible perspiration—that exhalation so necessary to health. Besides, when they are excessive they denote a passive permea- bility of the skin, caused by a loss of nerve power. It is not well to check them entirely, as such a proceeding will cause internal congestion. Try such simple remedies as aromatic sulphuric acid and quinine, tincture of sulphur, or in some case a tea of pleurisy root. Leucorrhcea.—This should not be stopped, although it is well to syringe out the vagina three times daily with infusions of white pond-lily, or witch-hazel, or strawberry leaves, and if there is any itching or burning, boroglyceride should be added. As a general rule, the injection should be tepid or cold. All these remedies failing, occasionally packing the vagina with boroglyceride is of immense utility. Hemorrhages from nose, mouth, ears, nipple, navel, ulcers, vagina, are common. If they are not excessive, mitigate them, 15 226 DISEASE GERMS. but do not check altogether, as they are often salutary. The regular treatment by alteratives and tonics should be adhered to, but if they are violent or excessive try ergot, gallic acid, and port wine, digitalis, or the alcohol, turpentine, and sulphuric acid mix- ture. At the same time, if from the vagina, enjoin rest in the recumbent posture, head low, foot of bed'elevated, cold drinks or ice in mouth, small sponges, saturated with vinegar, inserted up vagina, and changed every three hours. Great care and good judg- ment should be exercised in its arrest. Headaches are often promptly relieved by guarana, four tea- spoonfuls of the fluid extract every few minutes, or two or three grains of caffeine, or, that failing, a four-drop capsule or pearl of nitrate of amyl inhaled ; these failing, treat it under the following head : Sleeplessness, Giddiness, Drowsiness, with Headache, or Cerebral Neuralgia.—In those depressing states, hyoscyamus is of great utility ; repeat till it affords relief. Hyoscyamus suits the nervous disturbance of the change in a most excellent manner. The dose and its frequency of administration will depend on the condition. When the pain is very great try either croton chloral, bromo-caf- feine, or guarana If these fail, then bromide of potassa and brom- ide of ammonium are of utility, either alone or combined with chloral hydrate, as follows: Take one ounce of camphor-water, three drachms of bromide of potassa, one drachm of bromide of ammonium, and two drachms of chloral hydrate. Mix. Dose, one teaspoonful every two or three hours till relief is obtained. But if that fail, and nothing will allay the intolerable pain and giddiness, which render existence unbearable, give morphia suf- ficient for the purpose rather than let the patient suffer. Sleep- lessness, with cerebral neuralgia, at the change, often resists our best remedies, and it is necessary to tack around considerably, and only in the event of all remedies failing should the morphia be given, as at no period of life is a habit so easily acquired as at the change, so that with alcohol and opium we should exercise great care. Camphor is a valuable remedy in those cases; it stimulates the nervous system to increased action; it corrects the toxic influence which the reproductive organs have upon the brain of some women; it abates the sexual sting by acting on the cerebro-spinal nerves of the internal organs of generation, not on the ovary or testicle. Large doses of camphor to child-bearing women do not prevent conception, like bromide of potass, nor induce impotence, but simply appeases the excitement of the generative organs at the change. It may be given alone, or with lupuline from the hops. Sambul or musk-root, tincture of green root of gelsemium, operate beneficially. The inhalation of the BACTERICIDES. 227 nitrate of amyl moderates cerebral irritability; sulphonal or ure- than both extremely efficacious. Topical applications to the head are often of great value; as, for instance, take two pints of water, to which add two ounces of liquor ammonia, one ounce of spirits of camphor; mix, and apply to the head for fifteen or thirty minutes, or longer, and then remove and apply vaseline ointment. Or, another good remedy is to take two ounces of olive oil, the same of chloroform, and half an ounce of menthol; mix, and rub into the painful part. The irritability of the brain at the change is caused by and aggravated with ovarian disturb- ance, and it is a good plan to use both rectal and vaginal sup- positories of belladonna and opium. Veratrum viride, and aconite or antipyrine may be given with benefit if there is plethora. The same characteristic symptoms, as headache, giddinesss, drowsiness, are present at puberty, and at that period bromide of potass is inadmissible, and never should be given. During the change the brain is often unhinged, so that cata- lepsy, epilepsy, melancholia, hypochondriasis, insanity, apathy are present, for the management of which see those different heads. Clever women often lose confidence in themselves at the change, and are unable to manage their own affairs, and their moral treat- ment, for a few years, requires great care. The disturbance of this crisis tells heavily upon her. Very frequently her mode of dealing with everyday occurrences of life betrays a want of prin- ciple, strongly contrasting with her previous rectitude, and a return to that untruthfulness that may have existed at puberty. There may also exist every idiosyncrasy—peevishness, irritability, ill-temper, ingratitude, passion, eccentricity. It is no uncommon thing for a high toned Christian lady all through life up to the change to desert her husband and children for a scamp, while others make life intolerable by their tyranny and hate the long- cherished object of their affections. Some become moody, silent, gloomy; neither loving nor hating. Others again, in the midst of wealth talk poverty and indulge in a propensity to steal, while another class feel like committing grave crimes. The nervous system is unhinged, still it will pass away and must not be re- garded and treated as insanity, for all the strangeness of temper, the fitfulness of spirits, the perversion of character will abate and disappear under proper care. But the patient requires judicious care, removal from home excitement, new scenes, the intelligent sympathy of friends, and the support of strong minds. The most amiable at this time become annoyed with trifles, and are often passionate, quarrelsome, fretful, by the slightest worry or excite- ment. Derangements of the stomach and liver are very common. 228 DISEASE GERMS. This disturbance shows itself in every imaginable form of dys- pepsia and biliousness; the kidneys also suffer. The general treatment as laid down for those affections should be carried out. and nitro-muriatic acid and phosphate of soda given. Diuretics are very valuable and deserve attention. Diarrhea is salutary and must not be hastily checked. Some- times useful to encourage by giving small doses of either of the following mixtures, say about ten or twenty grains thrice daily: sulphur, one ounce; calcined magnesia, half an ounce; mix; or equal parts of borax and sulphur. In some cases of diarrhea great benefit accrues from the use of the liquor ammonia acetatis in teaspoonful doses as above. A most painful affection, caused by violent contrac- Colic. tion of the muscular fibres of some portion of the in- testinal tract, generally near the umbilicus, occurring in paroxysms. Pain almost invariably relieved by pressure, never aggravated by it; there may be vomiting, and generally constipa- tion ; an entire absence of either fever or inflammation. During its occurrence pulse is lowered ; surface of the body cold; face white and anxious. There are numerous varieties, as microbial, bilious, nervous, brass, lead, tin and other mineral varieties. Microbial Colic, formerly known as flatulent, due to the pres- ence of bacteria, the degraded bioplasm of mal-nutrition, induced by excess, indigestion, perverted nutrition, improper or deleteri- ous articles of diet, the delicate nerves of the intestine are affected toxically by the ptomaines of the microbe. Best relieved by the administration of an active germicide; if an adult, a teaspoonful of either eucalyptol, or kurchicine, or Warburg's tincture; if a child, some aromatic, as menthol; con- centrated ozone ; peroxide of hydrogen ; resorcin, etc. These means failing, an emetic of lobelia combined with bicarbonate soda, copious draughts of tepid water. Bilious Colic.—The irritation of acid or acrid bile, or other morbid secretions, often irritates the nerves of the bowels, and causes contraction of the muscular coats. In those cases there are usually the dulness, the brown coat on tongue, the yellow tinge on the white of the eye, fetor of breath, etc. This is best relieved by the administration of small doses of the anti-spasmodic tincture, or a warm infusion of the wild yam or dioscorea, followed up with the compound licorice powder, or neutralizing mixture, with leptandra, oil of peppermint and anise, BACTERICIDES. 229 or with more active remedies to stimulate the liver, as phosphate of soda or nitro-muriatic acid. Nervous Colic comes on from fright, cold, hysteria, gout, rheu- matism, or from irritation of adjacent organs, as the bladder, aterus, or morbid conditions of the alimentary canal. This must be promptly relieved by the administration of chlo- roform in sweetened water internally, or belladonna or anti- spasmodic tincture, phosphate of quinine, colchicum, and the cause removed. Tin Colic.—This form of mineral colic has become very com- mon since the introduction of canned vegetables, fruit, beef, fish ; and also caused by cooking soup in tin culinary vessels on petro- leum cook stoves. Relieve the pain and spasm by the usual means, and put pa- tient on the iodide of potassa and carbonate of ammonia. Copper Colic.—A most severe form of twisting or griping; comes on suddenly; pain is intense; nausea, vomiting ; bowels generally loose. The countenance is anxious, of a peculiar sal- low hue; eyes sunken and lips livid ; a purple line around gums. Common among copper-plate printers, brass founders, and from copper cooking vessels. Treatment same as lead colic. Bismuth Colic.—Bismuth introduced into the stomach blunts the sensibility of the gastric nerves, but when extensively used, as it often is by ladies in face powders and cosmetics, gives rise to colic, with a peculiar bluish, shrivelled, or wrinkled appearance of the skin, and after death, the duodenum is black with the debris of the metal. Same treatment as lead colic. Lead Colic.—Due to the absorption of lead ; hence, it is com- mon among operatives in lead works, oil-cloth factories, painters, plumbers; drinking from lead pipes, soda water from lead taps, ^nuff adulterated with lead, claret drinkers, as sugar of lead is often added to wines to render them cooling; and wine casks absorb the lead, and if ever used for carrying water in ship, they re-impregnate the water, and the sailors, or those drinking the water, become affected. Lead, whether inhaled by the skin or bronchial mucous membrane, or absorbed by the glands of the mouth,-or swallowed in water or food, or breathed from a newly painted room, diffuses itself through the body, but seems to spend the force of its poisonous effects on the fine, delicate nerves of the duodenum, giving rise to an irritation which speedily terminates in a spasm or contraction of the muscular coat of the bowel, so that it is usually ushered in by a grinding or twisting near the umbilicus, with retraction of the abdominal muscles to the spine, and pain in the back, vomiting, constipation, metallic aspect of countenance, a blue or slate-gray line round edges of the gums, with general languor and debility. 230 DISEASE GERMS. Treatment.—To prevent absorption of this metal, workmen employed in or about it should exercise great care, resorting to daily baths, wear flannel clothing, keep bowels regular, eat the most nutritious diet and spend a good portion of time in open air. Aromatic sulphuric acid, fifteen drops thrice daily in water, pre- vents absorption, and is undoubtedly the best prophylactic. Alum is not a preventive, but, if given after the lead is in the fluids and solids of the body, it will unite with the metal and form an inno- cent sulphate. Although alum has this remarkable chemical property of changing the lead, it does not prevent its ingress into the body, like the aromatic sulphuric acid. In suffering from an attack, the first thing to be done is to relax the spasm and relieve the patient from pain. The compound lobelia, with capsicum and valerian, should be administered by mouth and rectum in small doses, often repeated, so as not to excite emesis ; and if the spasm does not yield, administer thirty drops of chloroform with it for several times. Relieve pain by hypodermic injection of morphia. As soon as the spasm is relaxed and a free motion of the bowels brought about by oil, begin with iodide of potassa. This drug unites with the lead, sets it free, and also eliminates it by the skin, kidneys and bowels. The dose of the iodide should not be less than five grains, three times daily ; but it is often beneficial to give it in ten-grain doses, and combine it with either bicarbonate of potassa or carbonate of ammonia ; the whole to be given in syrup of stillingia compound. While pursuing this treatment with iodide, an everyday bath of the sulphuret of po- tassium. This should be done in a wooden bath-tub, with tepid water enough to cover the body, to which one pound of carbon- ate of soda and sulphuret of potassium should be added. The patient should remain in bath not less than half an hour, even a little longer. The diet should, while pursuing this treatment, be generous to a fault. Shock, prostration, extremely great depression Collapse, of the vital forces, such as may follow any acci- dent, injury, concussion ; inhalation or absorption of any poison; or even from some depressing passion. The symptoms are very variable, most commonly, however, we find the patient lying on the back, with a cold skin, feeble pulse, sighing respiration, half unconscious. If the force of the shock, or injury, or poison, has fallen upon the vascular system, there will be syncope or fainting, pulse and respiration imperceptible; BACTERICIDES. 231 if upon the nervous system, patient bewildered, incoherent, vomiting, coma, convulsions, paralysis of sphincters. The duration of the stage of prostration is variable, depending on the power of vital resistance inherent in the patient and the amount of violence inflicted, or poison absorbed, or degradation of living matter, commonly from a few to forty-eight hours. The mode or manner of recovery from shock or collapse is termed reaction—everything depending on the nature, degree, or quality of that reaction. If, aided by proper means, it is perfect, we have recovery; if in spite of our best efforts it is altogether wanting, we have death ; if it is imperfect, then it is followed by fever, a salutary effort of vital force for recovery. The indications in treatment are to stimulate vital forces to healthy reaction. If the patient is cold, shivering, respiration and pulse feeble, diffusible stimulants should be administered, such as brandy and water, or capsicum, or some preparation of ammonia; if incapable of swallowing, the same remedies should be administered by the rectum in an emulsion of slippery elm, and spirits of turpentine added. The patient should be bathed all over with ammonia and warm water, after which he should be well dried and rubbed with dry mustard. If no reaction is perceptible, dry cups or scorching hot pillows should be applied to both sides of the spine, and mustard plasters with heat to the feet. Rubbing the skin is of the greatest importance, as we thereby stimulate the periphery of nerves, which stimulus is carried to the brain. Artificial heat by means of bricks wrapped in flannel, or bottles of hot water, should be applied all around the patient's body, especially inside of arms and thighs. Stim- ulation must be persevered with, and other remedies, such as nitro-glycerine in drop doses, or quinine, resorted to, the object being to establish an equilibrium in the body, and the greatest care should be observed not to over-stimulate, as we thereby produce exhaustion with cerebral excitement. What is desired is perfect reaction, so that fever, the condition of imperfect reaction, may be obviated. _______ Insensibility from various causes is worthy of the Coma, most earnest consideration. When an individual has been picked up on the road or street insensible, irrational, or inarticulate, and his ante- cedents unknown, what is the matter ? Is he ill, drunk, drugged, or suffering from some brain concussion, or from coma after an epileptic fit, or otherwise ? Syncope, trance, catalepsy, coma, are names used by medical writers to designate states of insensibility, which the public call fits. ^32 DISEASE GERMS. Syncope is fainting, a condition of the body in which there is a death-like pallor, with loss of muscular power and consciousness; a faint is usually transitory, due to shock. In it the person collapses, rather than falls to the ground; his knees are bent under him, he subsides into the sitting posture, his head drops forward, and by the time his head has thus sunk to the level of the heart, or below it, the circulation of the brain becomes suffi- ciently restored for consciousness to return. In a faint, a person seldom bruises his face. Upon waking, he may feel sick, giddy, or alarmed, but his brain resumes its thinking functions at once, and entirely. Recumbent posture on right side, articles of dress loosened, dashing cold water on face and front of chest, cautious inhalation of ammonia, diffusible stimulants. Trance is a state of death-like faintness, in which some con- sciousness is retained, but inability to speak. In trance, the body appears inanimate, there is no power to move a muscle, the limbs are flexible ; he may hear, see, and remember all that goes on around him. There is no perceptible pulse or respiration; hence trance has been, and often is, mistaken for death, as the temperature is lowered; muscles re-act to galvanic stimulus. There should be no hurried burial alive, or post-mortem unless rigor mortis or signs of putrefaction be present. Treat same as Collapse—artificial heat, enemata of turpentine, cups to both sides of entire spine, over abdomen; and as soon as he can swallow, diffusible stimulants. Catalepsy, a rare inanimate condition ; insensible, stiff, unable to move, or articulate; pulse slow, respirations diminished; ex- tremities cold and flabby. He or she may be pinched, pricked, beat without flinching—statue-like, but perfect muteness. There is neither the lividity of asphyxia, nor the pallor and general flexibility of syncope, nor the stertor of coma, nor the paralysis of epilepsy, nor the movements and dreamy mental automatism of somnambulism. Treat same as neurasthenia. Coma, or deep sleep, may be due to very many causes as pressure exercised upon the brain from effusion within the ventricles, and outside of the membranes; to alteration in the molecular state of brain from concussion, contusion, apoplectic extravasation; to brain-poisoning by insufficiently oxidized blood; to disease germs, to uraemic blood, narcotics, anesthetics, inebriants. It is impossible to give accurately positive landmarks for diagnosing each kind of coma. Profound Coma is present in serous effusion into the ventricles BACTERICIDES. 233 of the brain, such as arises from extensive burns, or from tuber- cular meningitis in later stages. Patient is first sleepy, then drowsy, then stupid, slow of comprehension, difficult to wake, and finally, incapable of being roused at all. The breathing is stertorous; at first he can swallow, then he fails to do so ; pupils are not characteristic, most frequently contracted, and then dilated. Coma, due to fracture or effusion of blood, as in sanguineous apoplexy, is sudden in its advent. The breathing is stertorous, pupils contracted, heat may be normal, skin perspires freely. In fracture of the skull there is oozing of blood or serum from ear and nose; or there may be blueness, humidity, ecchymosis of the eye, neck. In apoplectic cases, face often turgid with blood. Coma, due to molecular death of a portion of the brain, the face is pale, heat lowered, pupils unequal, evidence of hemiplegia, or some form of paralysis. Coma, due to some brain-poisoning, as deficiency of oxygen in pneumonia; nitrous oxide gas; the nose, lips, neck, face, and other parts are livid, often black. If patient has breathed carbonic acid gas, say from a lime- kiln, or sulphuretted hydrogen from some source, those two gases arrest the oxygen-carrying properties of the blood, and this blood-change, or damage, is not recoverable from brain- poisoning ; and coma by anesthetics and inebriants is usually detectable by the breath of the comatose person. Apoplexy and dead-drunkenness are often mixed. In Brain-Poisoning try artificial respiration, abundance of fresh air, cloths out of boiling water over heart; enemata, say one and a quarter pints of cold or warm water, with a table- spoonful of salt; cups to nape of neck; mustard to feet and hands; free purgation, if he can swallow. Fever Coma, due to the presence of disease germs, spores, and ptomaines in blood and brain, loxically affecting the functions of life. Easily recognized by the history of the case, and febrile state. It is an imperative call to push bactericides to destroy the factor of the fever. Urcemic Coma is recognized by oedema of eyelids, or extrem- ities ; wax-like pallor, uriniferous odor of breath and skin, furred tongue, pearly conjunctiva, dilated pupils. Try warm bath, free purgation with salines, and hypodermic injections of pilocarpine. Coma of an epileptic fit is usually recognized by the bruises, torn or soiled clothes; indications as if the tongue were bitten. Patient to be placed on right side, clothes loosened or re- 234 DISEASE GERMS. moved; enemata of lobelia, capsicum, and valerian; or hypo- dermic injection of one-fourth of a grain of sulphate of morphia, if over seventeen years of age ; dashing cold water on the patient, of little service. Alcoholic Coma.—Alcohol, a toxical agent, an arrester of gen- eral metamorphosis, has a special action upon the brain and liver. In large doses it produces insensibility, partial or com- plete. Symptoms vary according to the amount of poison imbibed. There may or may not be stertor; slow or fre- quent pulse, temperature lowered two or three degrees; pupils contracted, more frequently dilated. The odor of the breath chloroform, chromatic spirits of ammonia or liquor ammonia acetatis is the best agent to clear the poisoned brain. Opium Coma.—Profound stupor, closed eyelids, contracted pupils, upturned eyeballs, pale face, cool, clammy skin, forehead beaded with heavy perspiration, limbs lax; breathing slackens, reaching as low an ebb as six per minute; coma profound; no responsive movement to pricking, pinching, or other stimulation. The body will not walk, it is only dragged; lips become livid, surface colder, breathing, at long intervals, and pulse, nearly im- perceptible. This coma may be mistaken for effusion into the pons; so it is well, in all cases of profound coma, with contracted pupil, to exercise care, unless there be collateral evidence, as a laudanum or morphine bottle about, or marks of a hypodermic syringe, lest the case be apoplexy into the pons—a kind of coma that is not benefited by bastinado, beating with wet towels or willow rods, walking about, or all the caffeine, or coffee pumped into the body. In all cases of effusions, fracture, apoplexy, ad- here to cups to nape of neck, stimulants to extremities, open bowels. (See Opium}) A formation of solid, unorganized masses Concretions, within the body, either by chemical prepara- tions from the fluids, or by the accidental aggregation °f solids introduced from without; in the former case it is termed a calculus, in the latter concretion. A concretion may be wholly composed of solids foreign to the body, or there may be a mingling with the elements of secretion, as with mucus or calculous matter. Beans, peas, noodles, and other foreign bodies, introduced into the cavities of the body, often become the nuclei of concretions, by attracting around them mucus, or crystalline deposits. The most remarkable forms of concretions are those found in the stomach and intestines of man, from the more solid and indigestible parts of food or of substances improperly swallowed. BACTERICIDES. 235 Remarkable concretions are formed in the stomach and intes- tines of man and the lower animals, from the solid, undigested part of the food, or of substances imperfectly cooked and swallowed without proper mastication. The swallowing of hair, the use of raw oatmeal, the continual use of animal food, the use of carbonate of magnesia as a laxative, insoluble carbonate of iron, phosphate of lime, pulverized bone are apt, if continued steadily, to give rise to solid concretions, varying in size from a walnut up to that of an orange. They invariably give rise to pain, constipation and obstruction of the bowels, as they are pushed along. They are very apt to lodge above the sigmoid flexure, and thus give rise to backache, derangement of the kidneys and bladder, a wearied sensation or ^sssms*^ in different parts of the body is extremely liable to give rise to concretions. The tubercular bacilli is the most prone to effect this, especially if the deposit is made in the brain, parotid, lungs, stomach, intes- tines, ovaries, testes, pancreas, spleen, female breast, etc. There is an irritation somewhere in a tubercular patient, effusion takes place, the bacilli aggregate together, form a round mass, which by-and-by becomes milky, then cheesy, and latterly calcareous—phosphate of lime; that is, the tubercle takes on the form of degeneration and death. A shock or concussion is usually caused by a Concussion, jar, blow, fall, or some mechanical injury ; and it may also be the result of some depressing passion. No part of the body, no organ or tissue is exempt from a concussion. Thus we have concussion of the brain, stomach, bowels, etc. Concussion of vital organs is much more common in our 236 DISEASE GERMS. highly civilized state, than is generally supposed. For example our improved means of railroad travel and electric lighting, are highly detrimental from the repeated jars and shocks produced thereby. The strain and struggle for existence are greater—the emotions, desires, affections are more intensified, and give rise to shock to vital organs. Certain drugs have a depressing, or jar- ring action, alcohol, opium, quinine, if in large doses, give rise to a cerebral shock—phosphorus, if large dose, irritates, jars the function of the stomach, etc. All concussions are spent upon the brain, whether the cause be direct or indirect. In the treatment of brain shock, or concussion, absolute, per- fect rest in the recumbent posture in bed, so as to enable the vital forces to rally. Sulphonal or hyoscyamus should be admin- istered in sufficient doses to procure sleep; bowels opened, stimulants applied to the extremities, and if need be to the head. A skilled physician should be in immediate attendance, who will prescribe some cerebral sedative, as aconite, or belladonna, sam- bul, valerian, bromide of ammonia, so as to induce sedation, even an excess of sleep. If brain shocks or concussions were more actively treated, there would be fewer cases of cerebral disease. If any people in the world require great precaution against concussion of the brain it is our people, with brains feverishly active and literally starved for a diet of phosphates. There should be an improvement here, better brain nourishment, which our people would find in boiled white fish, oat-meal, whole corn- bread. ______ A retention of faeces beyond the usual Constipation, period, so that when they are passed, it is with difficulty, and in a comparativly hard or indurated state. A normal condition of the body demands a movement of the bowels following the morning meal; if this does not follow there is inertia of the intestinal track. Constipation is a most troublesome and prevalent affection. Causes.—This may be due to some constitutional defect, in- herent weakness of organization, or inertia of the nerve centres, which gives rise to scanty mucous secretion, deficiency of bile, a defective nerve supply, as exists in neurasthenia. Add to these habitual inattention to nature's calls, sedentary habits, use of drastic cathartics, malaria, alcoholic drinks, erroneous drug treat- ment, adulterated food, hasty or insufficient mastication, dys- pepsia, anything which will arrest the peristaltic wave. BACTERICIDES. 237 Symptoms.—Looking at the rectum with its immense supply of spinal nerves, its mucous membrane studded over with the most active absorbents, any retention of the faeces over twenty- four hours will give rise to headache, fetid breath, drowsiness, fever, due to the absorption of deleterious gases, poisons, and disease germs re-entering the circulation, such a state necessary gives rise to a morbid state of the kidneys, bladder, skin, lungs. The pressure of a loaded rectum gives rise to prostatorrhcea, and seminal emissions in the male; ovarian, uterine, and vaginal disturbance in the female. Its reflex effect tells disastrously upon the brain, often giving rise to serious nervous disorder. Treatment.—In the treatment of constipation, the cause if possible should be ascertained, and removed. The patient should be instructed, that there is no rule of health of so much import- ance as a well regulated state of the bowels. It is a very common belief that the rectum is but a receptacle for the faeces, or the refuse matter of the intestinal canal, but this is a mistake. The rectum is not a storage for the faeces, as they are naturaPy stored in and above the sigmoid flexure, just above the rectum, but when habitual constipation is induced, it is often compelled to act that part. As the rectum has a greater supply of nerves, of blood vessels, and its mucous membrane literally studded over with absorbent follicles greater than any other part of the intestines, it clearly explains why persons who suffer from habitual constipation, have dry, hard stools, fetid breath, rough skin, febrile exacerbation. Every individual should be taught a regular habit, a daily evacuation from the rectum, of all matter that approaches it for exit from the body. The great trouble is that all disease germs and ptomaines contained in the faeces, on entering the rectum, if they are not promptly discharged, re-enter the circulation again, rendering the blood germ-laden, irritating, deranging, interfering with the healthful working of every organ. Let this continue from day to day, and it silently but surely produces disease of the rectum itself. The evil results of constipation are not limited to blood poison- ing and nerve irritations. The failure of the bowels to excrete, throws additional work upon the skin, lungs, kidneys; deranges and produces disease of vital organs. Habitual constipation oc- casions great distress and produces grave pathological changes in the brain, heart, lungs, bowels, organs of assimilation, often gives rise to chorea and epilepsy. It is often difficult to ascertain the cause, but a careful exami- nation of the rectum should be made for chronic inflammation or 238 DISEASE GERMS. catarrh, for ulceration or other morbid states. Cathartics for the relief of this difficulty are worse than useless and invariably do more harm than good. Rational attention should be paid to diet, exercise, bathing, massage, accompanied by regularity in going to stool to solicit movements; if the condition does not yield, there is some trouble with the liver, mucous membrane, nervous system. We shall enumerate briefly a few of our best remedies for habitual con- stipation. Kolatina is the best remedy in the materia medica for all forms of constipation. This principle is isolated from the African kola nut by a peculiar process of maceration, and converted into a pleasing palatable paste, and this into a refreshing fruit lozenge, Kolatina has many properties : it rejuvenates the nervous sys- tem in all cases where a poverty of nerve force exists—by this action on the brain the liver is roused into activity, the peristaltic wave heightened, strength augmented. The dose is from a half to a whole lozenge and should be taken at bedtime. It is indicated in all cases of constipation, particularly those dependent on defective or perverted nutrition, combined with in- digestion. It has been used extensively, and ail have been fully satisfied of its wonderful power as a therapeutic agent, and the very best remedy in constipation, producing full, easy stools, without nausea or tenesmus. Another very valuable formula in or among neurotic patients who suffer from constipation, caused by a want of nervous energy, is three drops of the tincture of belladonna and the same amount of the tincture of nux vomica, added to a little water, administered two hours after eating. Tincture of sulphur is also a most effective remedy, in doses ranging from five to fifteen drops added to water. Enemata of one or two ounces of glycerine either alone or medicated with tincture of belladonna or nux. This is a most efficient remedy in habitual constipation, and intestinal ob- struction. Cascara sagrada lozenges, two at bedtime, are most effectual in overcoming this difficulty. Ox-gall, charcoal pulverized, and extract of nux vomica is in- valuable ; thus, ox-gall, thirty grains ; willow charcoal, pulverized, sixty grains ; solid extract nux vomica, five grains. Mix. Make thirty-six pills. One at bedtime ; or the following : solid extract golden seal, sixty grains; comp. solid extract of colocynth, thirty grains; extract hyoscyamus, five grains. Mix. Make thirty pills. One or two at bedtime, as the case may require. BACTERICIDES. 239 Injuries inflicted Contusions, with blunt or obtuse ^-Vi';/, instruments are usually 'ly.'/^i^if^'m followed by an extravasation of blood either into the cellular tissue or skin. Treatment should be active, and should consist of such remedies as rest, the application of the tinctures of mari- gold or arnica, so as to stimulate ab- sorption of the effused blood. If these fail, then take half and half of peroxide of hydrogen and water and _ . r /' '" .". J . r 1 • 1 -n 1 Chains of micrococci found in apply tO the part, Which Will prevent the contusions, followed by ecchy- 1 .. r • • mosis; magnified 1000 diam. evolution of micrococci. Inflammation of the mucous membrane lining the Coryza. nose, frontal sinuses, throat, accompanied with fever. The cause is usually exposure to cold or wet, or dis- ease germs. Symptoms.—Languor, lassitude, debility ; pain in head ; ach- ing in back and limbs ; fever, thirst, loss of appetite, rapid pulse, increased heat, coated tongue, discharge from nostrils; profuse Iachrymation, hoarseness, sore throat. In addition to those symptoms, the discharge from the nose is liable to become acrid, and coming in contact with the lips causes an eruption of fever blisters or herpes. In a few days symptoms will subside and pass into a subacute form, and tonsilitis or bron- chitis may supervene, and the patient recover. If he happens to be feeble, or possess a tubercular habit, it. may pass into ulcera- tion, and a chronic form be set up. In all cases there is a degra- dation of the living matter that supplies the mucous membrane of the nostrils, frontal sinuses, posterior nares and throat, into the disease-germ, amoeba, which, if not speedily relieved, will produce grave changes. The treatment to be promptly effectual must consist of bac- tericides. During the feverish stage jaborandi to diaphoresis, followed by antifebrine and tincture of belladonna till throat be- comes dry, or salicylate soda in liquor ammonia acetatis, alstonia, Pulsatilla, cimicifuga race., alternated with peroxide of hydro- gen, or else quinine; chloride of ammonia. Inhalations of glucozone, benzoin, ammonia, camphor, menthol, nasal bougies, prepared from menthol; benzoin, cocaine, applied locally, will often cut short an attack. 2 JO DISEASE GERMS. This is an indication of the presence of microbe Cough, in or on or near the larynx and bronchi, and is a symptom of various microbial diseases, as catarrh, laryngitis, asthma, croup, pleurisy, pneumonia. The act of coughing consists in first, irritation of these and other germs, and in a deep inspiration, closure of the glottis and violent expiratory effort by which the glottis is forcibly opened by the compressed air, which carries with it, in its exit, mucus or other matters which may have lodged in the lungs or respiratory passages. The nervous centre for this act lies in the medulla oblongata. It is bilateral, and situated on each side of the cen- tral raphe. It is excited into action reflexly by irritation of the respiratory branches of the vagus, distributed to the folds of the epiglottis, to the whole interior of the larynx, to the trachea, espe- cially at its bifurcation, to the bronchi, to the substance of the lung itself, as well as the pleura when it is inflamed. Irritation of the internal auditory canal at the point to which the auricular branches of the vagus are distributed, also causes coughing; and so may irritation of stomach, liver, spleen. As coughing is a reflex act, excited by irritation applied to a sensory nerve, and reacting through a nerve-centre upon the respiratory muscles, it is obvious that it may be lessened either by removing the source of the irritation, that is, destroying the germ, or by diminish- ing the excitability of the nervous mechanism through which it acts. Both methods are employed in practice ; one of the most common being to lessen irritation by the use of mucilaginous, or saccharine, or oleaginous substances which have no action upon the nerve-centres; the other by acting on the nerve-centres. The action of germicides is ever for good ; the wonderful ac- tion of either the tar or creosote syrup; the syrup toluentaine compound cannot be too highly extolled. The probable action of marshmallow, gum licorice, is to soothe irritation at the root of the tongue, around the fauces, as well as the trachea, bronchi or lungs. This probable action in relieving cough depends to a great extent on the mucilaginous coat. Sedatives relieve cough by entering the blood, and being carried to the medulla lessen the excitability of the nerve-centres, such as bromohydric acid with spirits of chloroform and syrup squills, or a mixture of solution of hydrochlorate of morphia; dilute hydrocyanic acid, of each, twenty drops ; glycerine an infu- sion of gentian, of each, two ounces ; chloroform, three drachms. A teaspoonful, as indicated, every three hours. Muriate of am- monia, in five-grain doses in syrup is excellent. Cough, from teething, intestinal irritation, is best relieved in the former by lancing the gums ; in the latter by getting rid of the parasite. BACTERICIDES. 241 Cough from relaxed, or elongated uvula; hypertrophy of the tonsils requires first, a trial of astringent gargles ; that failing, alteratives, iodide and excision. Cough, due to disease of the ear, mullein oil. Nervous cough, avena, kephaline, sambul, coca, pulsatilla, gentle exercise, sea-bathing, shower baths, nutritious food. A devitalized condition of the brain, caused Coup de Soleil, by solar heat and evaporation of the serum or of the blood. Sun-stroke. It gives rise to faintness, a craving for water, heat and dryness of the skin, high temperature of coldness, great nervous depression, vertigo, tight- ness across the chest; pulse variable, often quick and full, at other times thin and feeble, so that it can scarcely be felt. As the case progresses heart's action becomes violent; stupor, so that the patient cannot be roused; face becomes pallid; vomiting, coma, great difficulty of breathing, contracted pupils. While in this state the conjunctiva may become congested, action of heart intermittent, and just prior to death dilatation of pupils, gasping respiration, and it may be vomiting. In some cases symptoms are very insidious : mere listlessness and stupidity, with languor and debility, head feeling strange, yet in a few hours death. In other cases after exposure to the sun, the individual has suddenly fallen down insensible, made one or two gasps, and died in a state of syncope; the brain being enervated, the blood deficient of its serum (clotty), and the secre- tions deranged. If recovery does take place, convalescence is apt to be retarded by a slight fever, some complications of heart, lungs, liver, kidneys, or from paralysis or prostration. Patient not free from danger for some time. A great while after apparent recovery symptoms of paralysis and insanity may be developed. In every case, just like recovery from inflammation of the brain, the patient is easily affected, and never the individual he was before the attack. Treatment.—If one has to be exposed during the hot season to the sun's rays, quinine is our best drug as'a prophylactic; besides, proper care of the dress and an abundance of water not iced. On no account must alcohol be used, but there may be utility in coffee or malto cocoa. The greatest good is to be derived from the judicious use of tepid or even moderately warm water, wrapping the patient in a nude condition up in sheets or blankets saturated with or wrung out of warm water, keeping them moist by pouring it 16 242 DISEASE GERMS. freely over them, so that the skin may imbibe the water, an element essentially needed in the blood, besides the revulsive effects of the water on the periphery of the nerves on the skin The head, also, should be encased in packs, and even copious enemas of tepid water. If the tongue is coated, an emetic of mustard and salt, allowing the patient to drink freely of tepid water and bicarbonate of soda. After it has acted gently, follow with half a teaspoonful of compound licorice powder, in which one drop of croton oil has been rubbed up, and repeat if bowels are not promptly opened. Allow the patient as much water as he may desire to drink, for water is the remedy. As soon as the patient can swallow, half teaspoonful doses of the sesquicarbonate of ammonia freely diluted with water, is a o-ood remedy to liquefy the blood, given as often as indicated by the condition of the heart. If the patient does not react, no im- provement, then cup the nape of neck, shoulders, and apply mustard plasters to feet and hands, still holding on to the water, and an alkali internally. If a stimulant is necessary, carbonate of ammonia, liquor ammonia acetatis and artificial heat; other- wise, the case should be managed like chronic inflammation of the brain. _______ This is the utmost limit of deterioration which Cretinism, can be reached by a human being without death. It may be regarded as defective, or imperfect formation or development of the body, accompanied by a dwarfish stature, malformation of the head, which is usually flat on top and spread out laterally; accompanied with mental im- becility; vacant staring countenance; devoid of intelligence; the physical deformity is variable in degree; in mild cases (sporadic) the shortness of the limbs is most remarkable. The tips of the fingers, instead of reaching well down to the middle of the thighs, only extend as far as the umbilicus in many instances. The arms and hands are very short, the fingers scarcely longer than the toes. The legs are as short in proportion as the arms; in well marked cases (endemic) the mouth is gaping wide, tongue pro- truding, saliva flowing; goitre; brutalized habits; squinting blindness; deaf-mutism. The endemic form is common in valleys, gorges, in which neither sunlight nor purified air enters, where the inhabitants are necessitated to drink ice or snow water deeply impregnated with silicious or calcareous deposits. In addition to impure air, there is usually associated with it bad or meagre diet, extreme poverty, insanitary conditions, sensuality, incompatibility consanguinity. Whenever either endemic or sporadic cretinism is developed, BACTERICIDES. 243 and the cretin survives and reaches the age, say, of 15 or 20 years, its condition is equally remarkable and characteristic. No signs of puberty make their appearance and the mental con- dition is that of iodiocy. Such being the case, cretinism never can be transmitted, an impure sustained breed cannot be pro- duced. A cretin never can beget a cretin, procreation ceases— there is no establishment of a morbid race. Probably a hundred years hence, when our population reaches two or three hundred millions, the population necessarily re- stricted to given areas, this disease may appear in our mountain gorges or valleys. The disease admits of no treatment. Its prevention is important; this embraces legal enactments to restrain marriage among those closely related by blood or temperament, those affected with the tubercular bacilli, or crypta syphilitica—to restriction in the use of alcohol which atrophies and whittles down the brain of the modern Caucasian. Under this term there are usually classed three Croup, distinct pathological states : (1) a spasmodic action of the larynx, usually caused by reflex irritation, as teething, worms and derangements of the digestive tract; (2) a species of laryngitis, due to cold, wet, exposure, often accom- panied with oedema of the glottis; and (3) true croup with the formation of a false membrane on tongue, tonsils, uvula, larynx and trachea. In true membraneous croup, we have a micrococcus very much resembling that of diphtheria and croupous pneumonia, and although not deemed contagious and infectious, nevertheless is so, the microbe being very heavy, the living germs of conta- gion are limited to the patient. The microbe is easily isolated, either from the false membrane or blood, bears cultivation well, the cultures injected into animals produce the identical pathological condition, to with a pale red gelatinous exudation on the mucous membrane of the air passage, giving rise to bronchitis, pneumonia. The bacillus indicum ap- pears, patient dies from exhaustion, suffocation, convulsions, thrombosis. The microbe is pathogenic of the disease, and is associated with a special diathesis. Symptoms in the early stage are very similar to catarrh : slight fever, cough, hoarseness, drowsiness, suffusion of eyes and run- ning at nose. In the course of a few hours wheezing respiration; fits of hoarse coughing; occasional spasm of laryngeal muscles. Then the characteristic symptoms, alteration in cough, which has 244 DISEASE GERMS. now a peculiar ringing sound, rendering it brassy; inspiration* prolonged, accompanied with a crowing or piping noise; redness and swelling of tonsils, uvula, but not so diffused as in tonsillitis; increased fever; breathing becomes more hurried and impeded; cough frequent; great prostration, with irregularity of pulse; great thirst, irritability and restlessness; patient's features ex- pressive of alarm and distress; he grasps at his throat, thrusts his fingers into his mouth,' as if to remove the cause of his suffering; symptoms much worse towards afternoon and evening; a remission towards morning. If vital force properly aided with remedies overcomes the disease, cough loses its peculiar twang, becomes moist, crowing inspirations cease, expectoration takes place. But if all fail, and death is approaching, drowsinesi becomes great, sleep is uneasy, child starts and wakes in terror, breathing becomes gasping and interrupted, suffocation seems impending, congestion of lungs, skin cold, covered with a clammy sweat, asphyxia, coma, convulsions or fatal thrombosis. Treatment.—There is much good to be derived from general management. Patient must be confined to bed in a room with a moist atmosphere, whose temperature is 75° Fahr.; steam atomi- zers kept running near the bed, with either resorcin, creolin, or distillation of jequirity, or iodine, or lime-water, alumina, or lactic acid ; or all failing glucozone. Calcium sulphide alternated with peroxide of hydrogen acts well in hoarseness. If symptoms resemble asthma, give quinine in from one to five grains every four hours; and every half hour 30 drops of the acetic syrup of blood-root, and if there is any tendency to spasmodic action of the muscles, add lobelia. Hot fomentations to the throat, con- sisting of solutions of boroglyceride with cocaine act well. Nasal bougies composed of resorcin, lactic acid, creolin, etc, pushed up the nostrils have an excellent effect. Case must be carefully watched, every point guarded, and germicides pushed. Diet very nourishing; beef tea, cream, milk and lime-water, malted milk ; bowels kept open with enemata; if there is fever give antifebrine, alternated with liquor ammonia acetatis and salicylate of soda. An energetic germicide treatment is essentially curative, prevents complications, as embolism. A term applied to a variety of morbid condi- Cyanosis, tions in which the microbe indicans appears in the blood and all vital organs, as the heart, brain, lungs, etc., its presence is indicated by a gasping, respiration, general coldness and blueness of the cutaneous surface; more especially the nose, lips, ears, fingers. It is a diagnostic symp- BACTERICIDES. 245 torn of asphyxia, pneumonia, Addison's disease, malarial poison- ing, purpura, organic disease of the heart, etc. In asphyxia and pneumonia, non-aeration, or non-oxygenization of the blood; in disease of the suprarenal capsules, the excre- tion of indican is often so great as to stain the underclothing blue; the alkaloid ptomaine from the malarial germ in bad cases, evolves the indican microbe in immense quantities; in purpura, the factor in the production of the germ is pov- erty of the nerve-force; in organic cardiac disease, the presence of this microbe is a precursor of an early termination in death. The presence of the microbe is invariably associated with embol- ism of the blood. Cyanosis at or subsequent to birth is dependent on some defi- ciency or defect in the construction of the heart, as the septum not arriving at its full development at birth; or from permanence of the foramen ovales allowing a passage of blood from the au- ricles; or from the origin of aorta and pulmonary artery from a single ventricle, or from contraction of the pulmonary artery; any state or condition which permits a mixture of venous and arterial blood. In the diagnosis, the history of the case, the blueness and cold- ness, the difficulty of breathing, fainting on movement or excite- ment, violent palpitation. In the congenital form, tips of fingers and toes become bulbous, nails incurvated ; imperfect develop- ment; dropsical effusions, mostly congenital ; if so, patient blue all over, often present at the termination of valvular disease. In the treatment, each individual case, dependent upon some special disease, must be managed according to its own pathology ; asphyxia and pneumonia, liquor ammonia acetatis and salicylate soda, alternated with peroxide of hydrogen and compound oxy- gen ; in purpura, malaria, disease of the suprarenal, eucalyptol is a priceless remedy. If it is a congenital, the best plan is to be very cautious in any opinions of the case, as in one-half the cases the organic mis- chief is irreparable, whilst in the other it is amenable to treat- ment. So it is well to keep the little patient warm by keeping it rolled up in blankets, with external artificial heat; nourish carefully; administer one or two drops of digitalis twice daily; in a large proportion of such cases, the digitalis will contract the orifice and a cure be effected. When it appears as a symptom of other maladies, palliate the condition by the administration of bactericides; plain nourishing food, mild tonics, rest, freedom from mental care or worry. 246 DISEASE GERMS. Cysts. A species of degeneration which may have a con- genital origin, or may be acquired by some degenera- tive action. Properly speaking they are tumors consisting of a sac containing solid or liquid substances. They may arise by the formation of definite cavities in the meshes of the areolar tissue; by the dilatation and growth of obstructed gland-duct or follicles; by the erratic development of nucleated cells, which become exaggerated into cysts. Some contain serum, others a jelly-looking substance; some blood, others solid matter. Cysts in the brain are usually either hydatids or cysticercus—both have been found, solitary or multiple, and may attain considerable size, and cause atrophy of the brain. Cysts in the kidneys are met with in four different forms of degeneration. Two of them follow as a natural sequel from Bright's disease: (1.) Cysts vary- ing in size from a pin's-head to a hazel- nut are common, as a result of inter- stitial breaking down and obstruction. (2.) General cystic degeneration from atrophy and obstruction, and expan- sion or dilatation of uriniferous tubes. (3.) Small cysts are often met with on the surface of the kidney, which do not interfere with its function in any way. Sometimes they attain a great size, and form an appreciable abdominal tumor. (4.) Congenital cysts, complete or incomplete, or kid- neys made up of cysts without any trace of secreting tissue; usually combined with other malformations. If the result of chronic desquamative nephritis, treatment same as for degeneration. In the other forms the symptoms are often obscure. Cysts in the Liver are still more common. There is a variety of views as to their origin and nature; some believe that they are formed by a degenerative process of the hepatic cells ; others that they are due to dilatation of the minute canals; others that they are a new formation of vacuoles in the hepatic cells that these vacuoles are formed by obstruction and dilatation of the biliary of branches. Encysted, knotty tumors, containing a cheese-like substance Cysts in the kidney. Cysts in the liver. ducts, vacuolation BACTERICIDES. 247 are found in the glandular substance, varying in size from a pea to that of a hen's egg. They arise from irritation and inflamma- tion of the hepatic ducts; steatomatous contents composed of irregular granules, free oil globules, and occasionally plates of cholesterin. Simple Serous Cysts, with clear watery contents, are sometimes found scattered over the liver, usually about the size of a small bean. Sacculated Cysts, containing a glairy fluid, are also met with. In some cases they resemble a honey-comb. The liver in some cases is crowded with such cavities. I can suggest no explanation of the fact that such changes in the liver should be so commonly associated with similar changes in the kidneys. We have no means of determining in which or- gan the change commences, though the destruction of the kidney and interference with its functions are the more marked. In some cases the increase in size of the liver is much more obvious than in the kidney, which from its position is accessible to examination. There seems to be no way in which the changes in the one could be secondary to the other. The connection between the organs is functional only; neither anatomically nor by develop- ment are they at all related. Perhaps, to take a broad view, we may look on the changes in both organs as a constructive attempt, possibly making use of embryonic remnants, and in- tended to resist degenerative processes in the organism due to the strain of advancing years and failing powers of excretion and secretion. Cysts in the lungare neither so common nor Cysts of the lung. so numerous as in other organs. They are alto- their origin and gether different pathology from emphysema. Cysts in the mesentery are still less common ; when they do occur, they are found of very peculiar shapes and sizes. Cysts in the pancreas are due to the retention of the pancreatic secretion, from obstruction of the duct by calculi, or from the external pressure of tumors. Hemorrhagic cysts are rare; when the duct is closed near its Cysts in the mesentery. 24*$ DISEASE GERMS. mouth, there is apt to be hemorrhage ; atrophy and cirrhosis of the gland may result from these cysts. Cysts of the uterus, closed sacs, filled with serum or otherwise, are often found developed in the walls of the uterus, or beneath the internal lining membrane or serous covering. Sometimes one part of the uterine walls is invaded with c> sts, or small bladders, while another part is infiltrated with fibrous tissue, or the ordinary fibroid tumor. These cysts give rise to trouble and inconvenience when they attain any size, such as leucorrhcea and hemorrhage. If within reach, they may be punctured. They, like the others, are unaccompanied with pain ; not infrequently give rise to uneasiness. The best treatment is a general alterative and tonic course. In order to avoid those three common forms of uterine disease, there should be a rigid avoidance of irritation of the uterus, either by tight lacing, wearing sponges or pessaries, masturbation, abortions, irritating caustics of doctors, especially nitrate of silver; even certain occupations, as the sewing machine, should be guarded against, or other forms that aid in the production of congestion. _______ The ear with its appendages is a perfect instru- Deafness. ment by which the brain receives the undulations of sound from the external world, through the medium of the auditory nerve reflected upon the membrana tympani. A normal state of the brain and ear is essential to perfect hearing. Loss of hearing may be the result of a great variety of states or conditions, and .supervenes as a sequela of nearly all affections of the middle and inner ear. Every disease germ incidental to the human body, when present in the blood, finds the ear a favorite structure for deposit and growth; the microbes of typhoid and typhus fevers often leave the ear in a state of dilapidation ; tubercle, syphilis, rheu- matism, gout, their spores, germs, and ptomaines are destructive to the ear, arid often cause irreparable deafness; the migratory germs of scarlatina, mumps, diphtheria, measles, nasal catarrh, produce great havoc in the ear by giving rise to points of ulcera- tion (nests), and various inflammatory changes in the ear. Microbes in the nose, fauces, throat, often find their way up the eustachian to the inner ear and give rise to pathological changes and deafness. Besides these and other affections in which the hearing is impaired or permanently lost, there are five other states in which the hearing is either impaired or lost. BACTERICIDES. 249 1. A class of cases due to anezmia of the brain, in which the emotions, desires, affections, passions, play an important part; among these emotional deafness, the death of a friend, fright, news of a painful character; exhausted vital force, by sexual excesses ; shocks; masturbation; want of nutrition in the brain ; action of the sun; railroad jars ; meagre brain food ; isolation ; monotony; sameness; obliterating the typical brain fissures. Best treatment for deafness due to anaemia, is avena sativa; glycerite of kephaline; nitro-glycerine ; coca wine; cerebrin ; peroxide of hydrogen; removal of cause ; nourishing brain food ; every thing possible to create richer blood. 2. Deafness due to congestion, a determination of blood to the brain, as in apoplexy, etc. Best treatment, foot baths ; hot mustard water; free purgations, stimulants to the nape of the neck and shoulders. 3. Reflex, chiefly due to teething, worms; irritation to stomach, liver, bowels, uterus, sexual organs. The chief point is to get rid of cause. 4. Often due to the careless and indiscriminate use of such drugs as quinine, chloral hydrate, opium, belladonna, tobacco. Coca wine; avena sativa; glycerite of kephaline. 5. Organic, due to bankruptcy of the brain ; white softening; atrophy, obliteration of its convolutions ; very hopeless. In all the different varieties an effort at cure should be aimed at by placing the patient upon a general alterative and tonic course of treatment, as all affections of the ear are most amenable to constitutional treatment. The introduction of so many invaluable remedies of late have effected a complete revolution in aural diseases. For example, the internal use of nitro-glycerine alternate with avena sativa operates like a charm in some cases; in others the glycerite of kephaline, in alternation with the peroxide of hydrogen, with the use of mullein oil dropped into the ear. Brain food is essen- tial in all cases, change of air, especially the mountains where the atmosphere is highly rarefied and ozone is abundant. Saccharine diabetes, a complicated chronic Diabetes, malady, characterized by the presence of glucose or or grape sugar in the urine, blood, and all the Mellituria. solids and fluids of the body. The liver is the great sugar-forming gland, and it is to that organ we must look for the grand predisposing cause. Any irritation transmitted to it through the medium of the eighth pair of nerves from the brain, produces an exaggeration of the 250 DISEASE GERMS. hepatic secretion, and an augmentation in the flow of urine. Still, the liver may be irritated reflexly by a diseased stomach, pancreas, spleen, either by the presence of disease germs in the blood; or the abdominal brain, the great sympathetic, may be damaged by worry, struggle, mental depression, depressing passions. This irritation, central in the brain, peripheral in the liver, may be directly due to shocks, falls, blows, concussions, over- work, exposure to the sun, drinking ice-water when heated, or vicissitudes of climate. As a rule it comes on slowly and insidiously, with great mus- cular and nervous debility ; greatly increased flow of saccharine urine, of an apple odor, of a high specific gravity of from 1035 to 1060. Still, cases are often met with in which the specific gravity is lower ; skin invariably very dry and harsh ; obstinate constipation, gradual failure of health and strength, with loss of sexual power, pain in loins ; extreme prostration ; coldness of extremities, with sense of burning in hands and feet. Debility increases, weight diminishes, body shrinks, withers ; oedema of feet; some- times albuminuria ; breath has a chloro- form odor from imperfect combustion of sugar; gums spongy; teeth drop out ; mental depression and irritability; constant sense of sinking at pit of stomach; appetite for food voracious; ThegiucosefungusofDiabe.es, or thirst extreme; strong tendency to Me!1,turia- cataract. After it has lasted months or years, the lower lobe of the right lung, which is so fully covered by branches of the sympathetic, becomes literally invaded with tubercle, colonizing from below and proceeding upward. There may be boils, eczema, psoriasis, lichen, with pruritus of the genitals. The above are the common symptoms, when it originates in the brain, the great co-ordinating chemical centre; but when it starts in gastric intestinal catarrh, from the presence of some poisonous substance, or microbes, with its ptomaines, or morbid material generated in the intestinal tract, there may be in the early stage localized or paroxysmal pain in the upper part of the abdomen, and vomiting of green-colored matter, exceedingly ob- stinate constipation, heart affection, cerebral irritation, somno- lence, great prostration, febrile spells, in which the pulse is fre- quent and small, with very rapid breathing, with remarkably deep inspirations, dry tongue, intense thirst, and no elevation of tem- perature. By-and-by the symptoms coalesce. The whole train of symptoms point to a nervous origin at the BACTERICIDES. 251 base of brain in the fourth ventricle; even the eye-symptoms can be partially explained. The spinal root of the optic blending with the sympathetic and passing the origin of the eighth pair, in the base of the brain, may receive a pathological effect; at all events, this root brings the retina into direct communication with the co-ordinating chemical centre and the medulla. The exist- ence of this branch is interesting, as it throws light on the physiological relation between the parts affected in diabetes, the medulla and retina, and it constitutes the undiscovered link be- tween certain diseases of the spinal cord and eye. There are often wandering, or aching pains in the bones ; hyperasthenia of the soles of the feet; flesh is tender; feel as if they were walk- ing on pebbles; cannot maintain their balance; sciatica is common. Besides, the very common termination; tubercular consump- tion, bronchitis, pneumonia, peritonitis, gangrene, may take place, or the patient die from exhaustion. To constitute the morbid condition, there must be a persistency of sugar in the urine with the symptoms. This can be readily detected by the potash, copper, or fermentation tests. It is clearly to be understood that the liver, under this weak- ened or irritated nerve, can, will secrete, and continue to secrete, sugar, without either sugar or starch being introduced into the stomach. If sugar or starch is taken in, we then are feeding a poison the system cannot get away with. What becomes of the sugar that is taken in, in some cases, even in large quantities, see- ing none of it is ever found in the chyle or portal vein ? It must be transformed somewhere, and this transformation is, no doubt, effected in the duodenum by the agency of the pancreatic juice. If the digestion of sugar does take place in that way, and it should happen that the pancreatic secretion was insufficient, from disease of pancreas itself, from the disturbing and inhibitory in- fluence upon the nerves controlling the secreting function of pa- thological events, or from the constant ingesta of sugar in too large amount, a greater or less quantity of sugar which has escaped transformation must accumulate in the intestines. Of all tissues that keenly absorb sugar the intestinal tract is the most active, especially the small intestines. When the co-ordinating chemical centre in the brain is dam- aged, and the irritation is transmitted, to the liver, grape sugar is elaborated in such quantities that the ozone-forming faculty of the lungs is incapable of burning it up, hence the presence of this agent in all the tissues of the body engenders the formation of a fungus in the blood, which is easily isolated, especially from the urine. 252 DISEASE GERMS. This glucose fungus is pathogenic of diabetes, capable of cul- ture in any starchy or saccharine liquid at a temperature of be- tween 80 and 900 F. Cultures injected into animals give rise to precisely the same symptoms as in man. As a rule animals into which those cultures are injected die before the microbe of boils an'd bacilli of tubercle put in an ap- pearance. There is a pathological alteration of cell-life through- out the organism by virtue of which a greater or less part of the elements have lost the capacity of destroying the sugar secreted in excess. Treatment.—In the general management of the case, daily bathing, flannel clothing, bowels to be opened every morning, for great improvement follows the abundant evacuations of extremely offensive and almost black quantities of excremental matter loaded with ptomaines, so, as a rule, empty the bowels daily; for it is not too far-fetched an idea that the sugar has undergone de- composition or some chemical change in the intestines, and aids in producing that terrible burning and thirst so common in diabetes. The diet is to be highly nutritious, and free from sugar and amylaceous ingredients, for then the pancreatic juice is sufficient to meet the trifling amount of sugar present. How far the pan- creatic juice suffices for the transformation of sugar in different cases, it is not easy to say. It is difficult to prepare a diet list entirely free from sugar, for even flesh, yolk of eggs and most acid wines contain sugar; and with regard to vegetables, the stalks and ribs of salad and leafy herbs all contain sugar. In short, with the exception of cheese and sour milk, there is scarcely any edible to be found that does not contain sugar. If in spite of a diet of flesh, white-fish, game, eggs, beef-tea, cream, cheese, bran-loaf, gluten bread, herbaceous vegetables, the sugar does not disappear, we know that the case is beyond the reach of pan- creatic influence, or the patient may not have adhered strictly to the rules. Rigidly forbid cane sugar, but allow saccharine fruit, confectionery, potatoes, carrots, parsnips, beets, turnips, radishes, rice, sago, arrowroot, tapioca, liver, oysters, lobsters, crabs, beer, whisky, coffee. If able, gentle exercise in open air. Two small irritating plasters, an inch square, should be kept constantly ap- plied to the nape of the neck; one on each side, and stimulation over the region of liver. A persistent alterative and tonic course commenced and persevered with ; vegetable extracts, with iodine and such tonics as cinchona. The appetite for food and drink is best appeased by the administration of the glycerite of kephaline or tincture of oats. After attending to the general management of the case, oar BACTERICIDES. 253 treatment becomes decidedly empirical, and is confined almost exclusively to the use of cerebral tonics and bactericides. These are a few remedies worthy of most serious consideration. Sambul seed finely pulverized, introduced into a capsule or pearl which will hold five grains, to be taken after every meal, has a magical effect in diabetes. The use of five grains of this drug after each meal, corrects the faulty condition of saccharine fungus evolution, and it disappears from the blood and urine while taking this remedy, and the patient may eat anything on the entire list of dietetics, and for years he may prolong his life in comfort, but let the remedy be discontinued, the fungus promptly re-appears in both blood and urine. Although not a curative drug, while taking it its action works wonders. Drugs of any utility in this disease must have a germicidal action. Salicylic acid, combined with the acetate of ammonia, and alternated with the glucoside of the poplar bark is most effectual in old, stubborn cases, and is worthy of a trial. The glycerite of ozone acts very energetically upon the glucose fungus in the blood, and destroys it at the same time ; appeases the appetite for drink and food, brings the specific gravity of the urine down to a normal condition ; patient improves under its use. Chlorate and permanganate of potass, comp. oxygen, ozone water, peroxide of hydrogen, glucozone, etc., all operate most efficaciously in sterilizing the fungus. All the vegetable balsams, such as copaiba, petroleum, oil of sandal wood, pine needles distillation, will, when administered, destroy the fungus, bring the urine to a normal standard. The sulphide and chloride of lime are essentially remedies of great value. Lactic acid, salol, resorcin, iodol, sulphonal, naphthaline and saccharine, with very little benefit except a slight amelioration of the symptoms. Saccharine has probably been more extensively used than any other of the phenol products, but its prolonged use gives rise to gastro-intestinal irritation and a sweet taste in the mouth, which is very disagreeable. Good results have been obtained from full doses of the citrate of lithia in alternation with boroglyceride in from ten to twenty grain doses. Where pains are prominent, either rheumatic or neuralgic, the salicylate soda and liquor ammonia acetatis, afford immediate relief. When the disease can be traced to chronic liver disease, the nitrate of uranium is invaluable. 254 DISEASE GERMS If the attending physician views the case as one of irritation of the visceral brain, he will use opium or codeia, in alternation with white hellebore and quinine, with most satisfactory results. Codeia is undoubtedly the best form, so long as it exercises a salutary effect over the disease ; narcotic symptoms early present themselves. Excellent results follow the exhibition of the cascara sagrada lozenge ; two following each meal often effects a perfect revolution upon the fungus. Exalgine is the most recent remedy, and there is no doubt that by its peculiar action on both liver and brain, it greatly dimin- ishes the amount of sugar in both blood and urine. The dose is from six to twelve grains in the twenty-four hours. Any cutaneous affection that may appear, is due to the sugar fungus, whatever it may be; eczema, lichen, psoriasis, pruritus, must be treated by the application ot bactericides, as resorcin ointment, cerate of the pine needles, iodol ointment, ichthyol lotion, or essence of peppermint. This is usually defined as the discharge of fluid Diarrhea, or semi-fluid faeces from the bowels without pain or tenesmus. It is met with in an acute or chronic form. Both forms are characterized by frequent loose evacuations from the bowels, due to either functional or organic derangement of the small intestines, and produced by either local or constitutional causes. The evacuations vary in consistence and quality, as well as in quantity and frequency; they may be fluid or semi-fluid; sometimes they are watery and serous, at other times they are mixed with mucus and occasionally a little blood. In children diarrhea is readily produced and is often very troublesome to cure; it may be acute or chronic, and in both forms is dangerous to life. Under five years of age the mortality from this cause is greater than at any other period of life, and the greatest liability is shown during the period of teething, from six months to eighteen months or two years of age. In hot climates diarrhea is more common than in cold. As regards the time of year, diarrhea is far more prevalent in the summer and autumn than in spring or winter. | |The causes of diarrhea are numerous and varied, and are divided into local and general; among the former are to be classed indigestible food, impure air and water. Amongst the latter may enumerated disease germs, which induce a diminution of vital power. It is often beneficial and due to an effort of the irritated bowel to throw off its noxious contents, as in cases where decay- BACTERICIDES. 255 ing fruit or vegetables, or tainted meat or fish are taken; in such cases a fatal result may follow from ptomaines being evolved ; hence in order to treat a patient with success, it is always important to make out thoroughly the ,,"" v> vhv' of the subject into a variety of forms, but in each fy'^Cj+fil^ and all of them are to be found the pathogenic *tV%.'»W«' microbe of diarrhea. ^'%'r'i^ This microbe is the factor of all cases, it bears * culture well, and the cultures injected into animals The microbe of " diarrhea. give us the disease. The Summer Diarrhea of Infants.—The factor operating in the causation of the summer diarrhea of children is to be found in the presence of micro-organ- isms in the food, either before or after it entered the body. Putrefactive changes split up complex molecules and form chemical poisons. W SxteBCO '£••• -'lW.: Milk is the natural food of • K£ c*7 >-<•' ?'?&&%'::-~'. 1-V- --•-A'V.',v all young children, and next . ''•j^V>%><-v 'v.fl ":'I-V/'*'-'^ to raw '3ee' ls a great attrac- '*&&&*M¥j£ V**fc-<4 ■*£/£:•'" tor of germs, especially so • ''*"£a&7&V<<1 A-^^.t" when the insanitary sur- x*/ -yy^.y:i,%& - > roundings are bad, an organ- ized ferment is present; this The summer diarrhea of infants. ig ^jj^ ^/ » <* \- Bacilli in putrid fish, showing the protoplasmic threads; the eating of such is not only toxi- cal, but is productive of diarrhea and leprosy. cry/ W Bacillus Alvei, as found in honey, which is eaten by children, is productive of diarrhea. \(»9J' '*<„ %, % 0 ^ <5» ©I o *€> "Vr * a 1 • fro^l 8 o t\» Bacillus Alvei, as found in honey, whick, if used, is not only productive of diar- rhea, but mellituria. \ Bacillus Megatherium on boiled cab- bage half an hour after being cooked, gives rise to irritation ol the bowels, diarrhea. In the treatment of feculent diarrhea, caused by the ingestion of bad or germ-laden water, or by deleterious food, or otherwise, the stomach and bowels should be cleansed out by an efficient cathartic ; rest enjoined; concentrated ozone applied over the entire abdomen ; over and above the flannel roller. Following the action of the cathartic, select some one of the following bacteri- cides and administer in suitable doses every hour, as amelioration takes place at longer intervals between. Peroxide of hydrogen, resorcin, naphthaline, salol, salicylate soda, acetate of ammonia, etc., or fl. ext. stone crop, or collinsonia, or infusions of kaki, jr bayberry, etc. Mucous and Serous Diarrhea, the former where the mucous coat is relaxed; the latter when the serous coat is irritated. BACTERICIDES. 259 Both forrn^, if the tongue is clean, may be successfully treated with rest, the application of a flannel roller over abdomen, and mild vegetable astringnets, such as infusions of kaki, cranesbill, stone crop, collinsonia, or by the mineral acids and quinine. Germicides, as sulphur water, resorcin, naphthaline, creolin. Boiled milk in which cinnamon sticks are incorporated. Biliary diarrhea is most common in the summer months, caused by intense solar heat, carbonaceous food, alcoholic drinks ; malaria, or the damp, faint-smelling emanations from a marshy district, which are very injurious ; in summer time, walking along the banks of the river, where the stream is sluggish and rank vegetation abundant, it may be often noticed that, as evening comes on, a faint, damp smell is present, which is very injurious to those subjected to it. Bad dwellings and cold, damp houses, especially those which are situated low and badly drained, will cause this disease; and so also insufficient clothing will aid in its production. This form of diarrhea is easily recognized by the injected con- junctiva, brown skin, and heavily coated tongue; stools exhibit a great excess of bile. In the treatment, rest, in the recumbent posture, hot fomenta- tions over liver; if there be nausea, vomiting, an emetic of ipecac, cleanse out the bowels with one, two, or more doses of euonymus and caffeine, follow with: Comp. tr. cinchona, four ounces; nitro- muriatic acid, three drachms; simple syrup, two ounces. Mix; a teaspoonful every three hours. Quinine and aromatic sulphuric acid, peroxide of hydrogen. Chronic diarrhea is said to exist when either of the other forms last a long time. There is very apt from the nature of things, to exist some, if not a good deal of ulceration of both the mucous and serous coats. Besides, in chronic diarrhea, we have to con- tend with a perfect loss of tone in the bowel, an inability on the part of the lacteals to absorb the digested products, and on the part of the bowel to hold its contents. In all forms of chronic diarrhea, the diet should be solid, light and of the most nutritious character. Forbid fruit, the flannel roller should be worn and rest inculcated; an alterative and tonic course prescribed. Movements of bowels restricted to one per day with a pill composed of equal parts of pulverized opium and tannin. Sufficient quantity to be taken to insure the result. Then follow with special remedies to vitalize the bowel, such as kaki, bayberry, collinsonia, poplar bark, and stone crop. A strong infusion of one of them should be made every morning and drank freely during the day. The stone crop and collinsonia are best prescribed in the form of a fluid extract—in teaspoonful 260 DISEASE GERMS. doses, thrice daily—using one for a week, then alternating with the other. In the Diarrhea of Typhoid bactericides should be energeti- cally pushed, especially naphthaline, creolin, and resorcin. The diarrhea must be arrested at all hazards, never encouraged on the fallacious idea that the microbe escapes by the stools. True the retention of the germ is bad, but diarrhea is always weaken- ing, and very dangerous as it tends to ^rupture the thin-based ulcers on the bowels. Melcena or black stools in diarrhea, or evacuations like tar, are due to the presence of blood from the stomach and bowels, acted on by the intestinal juices. Degeneration of the liver necessarily gives rise to congestion of the gastric and intestinal vessels, a condition that gives rise to extravasation of blood from the gastro-intestinal membrane. It may be present in enteritis and other morbid conditions of the alimentary canal. A disposition, some constitutional affection of Diathesis, the body, some predisposition to certain diseases more than others. Before the discovery of the germ theory of disease, there was a large variety of diatheses ingrafted on all our medical works, as the tubercular, canceroiH, gouty, rheumatic, etc. More recently the classification has been greatly curtailed, reduced to three, namely : The uric acid diathesis. The phosphatic diathesis. The oxalic acid diathesis. The uric acid diathesis is the most common, and to appreciate it thoroughly we must have a due appreciation of the function of the kidneys. The human kidneys are situated in the region of the loins, on each side of the spine, and are imbedded in a layer of fatty tissue, The average length of each kidney is about four inches, its weight from four to six ounces. The substance of the kidney is dense, extremely fragile, and of a deep red color. A vertical section of the kidneys will show them to con- sist of different substances, which are named from their position, the external or cortica, and the internal, or medullary substance. The cortical substance forms by far the greater portion of the gland, and sends numerous prolongations inwards between the pyramids and medullary substance. It is soft, granular, and con- tains numerous minute, red, globular bodies, diffused throughout it, which are called from their discoverer, the Malpighian bodies. Its substance is made up of uriniferous tubes, capillaries, lym- BACTERICIDES. 26l phatics and nerves, held together by an intermediate parenchyma- tous substance. The medullary substance consists of pale, reddish, conical masses, usually twelve in number, although these often vary from eight to eighteen, their apices point to the hollow space: which is termed the pelvis of the kidney, which occupies the interior of the gland. The medullary substance is firmer than the cortical, and instead of being granular, presents a striated appearance from its being composed of minute, dense, gray, uriniferous tubes, which run in straight lines through the kidneys, after having received a highly convoluted course through the cortical portion. The cavity or pelvis of the kidney is lined by mucous mem- brane through the medium of the ureters, which extend into the tissue of the kidney to meet the uriniferous tubes. The mucous membrane forms cup-like cavities around the termination of each pyramid. The cavity termed the calyx receives the urine from the open termination of the tubes and conveys it towards the pelvis, from whence it passes down the ureters into the bladder. Each kidney is supplied with blood by renal artery, a large trunk which comes off at right angles to the aorta. The blood enters the kidneys and is there subjected to a filtration or separ- ation of the various matters which constitute the urine, after which it is returned into the venous system by the renal or emul- gent vein. The nerves are derived from the renal plexus and belong entirely to the sympathetic system. The respective function of the essential elements of the kidneys is the anatomical arrangement of the tufts, so as to secrete urine from the blood, to separate the various organic constituents and inorganic salts, which collectively form the solid constituents of the urine. The secreting cells do not undergo rapid decay and renewal, they seem impervious to change, but their great faculty is their innate power of selecting certain waste materials from the blood, and eliminating them without the disintegration of their own structure. Their function is secretion of urine, one of extreme importance, for if arrested by any cause, death is inevitable ; the selection, the secretion of waste, effete matter, complex fluids which have played their part in the organism from the blood. They do not eliminate disease germs, although those microbes may aggregate in the kidneys, block up the tubuli, and force themselves through by a laceration of the tufts, as seen in scarlet, malarial and yellow fevers. An ordinary sized man in twenty-four hours will pass fifty-two fluid ounces of urine. This yields, on evaporation, nine hundred 262 IMSEASE GERMS. and thirty-five grains solid constituents ; five hundred and twenty of this is urea ; two hundred and sixty-six chloride and phosphate of soda, lime, ammonia, creatine ; while the remaining one hun- dred and forty-nine grains is uric acid and its salts; depending much on the kind and quality of the food and drink. These constituents in health render the urine very slightly acid, but the acidity of the secretion of the kidneys and stomach stand in an inverse relation to each other, so that the urine loses its acidity and may even become alkaline during stomach digestion. Dis- ease either diminishes or increases certain urinary elements, and tells whether the disease is gaining or losing ground. In all fevers and inflammations, except the nervous, the uric acid is vastly increased owing to the metamorphosis of tissue. In gout and rheumatism, in a state of sameness, isolation or mono- tony, the urea and uric acid is greatest, incidental to a perverted state of nutrition. Just as sexual neurasthenia increases so does the rate of kidney trouble and disease, for the weak back and albuminous urine are present in self abuse, spermatorrhoea, prostatitis, impotency, per- verted sexual appetite, debility. All disease germs, their spores and ptomaines, when in the blood, if not destroyed, have a damaging effect on the kidneys The microbe of scarlet fever, variola, measles, the.bacteria of ery- sipelas, the streptococcus of diphtheria, the bacillus of malaria and numerous others, become impacted in the kidneys, give rise to congestion and passage of albumen.* Properly speaking no disease germs can be eliminated ; they must be destroyed in the blood. In the migration of disease germs, when they are pre- sent in the blood, the liver, spleen, lymphatics, glands, especially the rectum, become the abode of the living, breeding micro- organisms ; the kidneys resist the egress of living germs, although it is a hot-bed of spores and ptomaines. The dead germs of tubercle, cancer, syphilis, of malaria, of fevers, are to be found here. • The presence of the living germs of disease, either alive or dead, in the kidneys, weakens their structure, impairs their secret- ing power, deranges their function, so that the urea is imperfectly separated from the blood, and consequently imperfectly elimin- ated, congestion ensues and exudation of albumen and fibrin is the result. If disease germs could only pass through the kidneys, instead of lodging in their interstitial structure, humanity could be spared a vast deal of Bright's disease. This terrible malady is due in two-thirds of all cases directly or indirectly to microbes in the blood, and the other third to strains, BACTERICIDES. 263 blows, venereal excesses, drugs, drinking, over-indulgence in malt and alcoholic liquors. Disease germs in the blood, their micrococci lodged in the kidneys, give us the languor, the lassitude, the debility, the neuras- thenia, albuminous urine, the drowsy aspect, the bloodless, flabby, uriniferous look of a large percentage of our people. The late increased prevalence of kidney trouble has been attri- buted to drinking of the well-drugged beer of the present day; but although true to a certain extent, it would be more correct to place it to the credit of genital debility in young men whose genito-spinal centre has been unduly excited by excesses in mas- turbation, who have fallen into a state of mental and physical bankruptcy, suffer from albumen in the urine, of nerve origin. Urea is, however, the grand source of nearly all kidney trouble. The sources of urea, besides the ordinary tear and wear of the body, arise from all the vices and defects of civilization; from adulter- ated food and drink, from insanitary states, isolation, monotony, sameness either in habits, food, or otherwise, from disease, espe- cially gout or rheumatism ; a perversion of nutrition takes place and an excess of urea or uric acid, and with it degraded living mat- ter, disease germs. The uric acid diathesis may be recognized by chemical and mi- croscopical examination of the urine, and general languor, las- situde and debility, which is in- variably present, by a damaged state of the co-ordinating chemi- cal centre in the brain, which gives rise to indigestion, and a conversion of all the starchy and saccharine elements of the food into uric acid; that this faulty digestion and imperfect assimi- lation, are greatly aggravated by monotony of life, isolation, confinement indoors; sameness of diet and habits ; that this mal-conversion is aggravated by the sarcinae ventriculi, disease of the liver and pancreas; imperfect aeration of the blood by the skin, lungs ; rapid oxidation as in fevers, or excessive muscular exercise ; its recognition is assured when we find a persistent copious deposit of red gravel, a brick dust sediment, from a few grains to a considerable amount, deposited when the urine cools. Uric acid is most most irritating to the kid- leys, bladder,prostate, giving rise to undefined sensations of irrita- Magnified view of uric acid in different forms. The dumb-bell shaped forms seen in upper part of the figure were formerly supposed to consist of oxalate of lime. It has recently been shown that they are a form of uric acid crystal. 264 DISEASE GERMS. tion in the loins; sometimes excruciating pain in the kidneys; nau- sea, vomiting, aching in the thighs; retraction of the testicles; irri- tation of ovary ; itching at the orifice of the urethra ; irritable bladder, with continence or incontinence of urine. The passage of the urine causes a burning or smarting sensation ; and when the uric acid crystals are large, a cutting, tearing sensation, as if particles, of glass were being passed, with bearing-down and prostration. Treatment.—Special attention should be paid to giving the patient immediate relief, and this can only be done by the admin- istration of alkalies, a class of remedies whose use is likely to be detrimental if administered for any length of time; still, for a few days, they had better be given, say, five or ten grains of bicar- bonate of potassa thrice daily, While thus affording temporary relief, proceed to the removal of cause—sameness, monotony, isolation; inculcate change of habits, diet, of everything that savors of sameness or monotony, for a high grade of mental and physical existence can only be attained by change. The essential element of life is incessant change; and in order that the highest state of existence may be procured, this must be attained. The make-up of the tissues of the body exhibits" that facts ; the fresher they are, the more complete their change; provided construction exceeds destruction, the more serviceable they are. The secre- tions are to be regulated; daily tepid alkaline bathing; flannel clothing ; moderate exercise in the open air ; diet is to be vari- able but nutritious, rigidly forbidding fat, malt and spirituous liquors, sugar, or starchy agents. In the medical treatment, vegetable alteratives and tonics are always of the greatest efficacy. Discontinue the alkali, and substitute benzoic acid in ten-grain doses, with same amount of boroglyceride, for the purpose of changing the uric acid into a non-irritating agent in the body. If for some cause it is not thought best to give the benzoic, sub- stitute the salicylate of soda, with acetate of ammonia which is a remedy of the greatest efficacy. This remedy has the effect of improving or restoring the tone of the co-ordinating chemical centre, and preventing the formation of the acid, and also of chemically causing its disintegration. The uric acid solvent is of the greatest efficacy in all cases. Sulphate and phosphate of quinia are also valuable, but possess none of the chemical properties of the salicylates. Besides the above, a course of alteratives and tonics for a few months, embracing compound extract saxifraga, ozone-water, glycerite of ozone, and kephaline. liACTERlCIDES. 265 The phosphatic diathesis, in which the urine is persistently leaded with phosphates and chlorides, which are deposited in the form of a floury mass, or white, gritty substance, calcareous in its character, called white gravel. The urine may or may not be alkaline but microscopically has this appearance. When human urine becomes alkaline, it is due to one or other of the following condi- tions: To excess of the alkalmj carbonates of potassa and soda, which is apt to occur after a meal, especially of fruit an navmg a flagellum at one or both ends, „,. . u ** with which they perform active spinning or The microbe of dysentery. , J r ,_, _ r , ° . darting movements. They form zooglcea in the corrugations of the bowel, in which the interstitial gelatinous substance is more copious. BACTERICIDES. 28l The microbe is pathogenic of the disease, repeated cultivations in any nourishing broth, even for successive generations ; the cultures injected into animals produce in them the original disease in all its virulence. It is contagious and infectious in the true sense of the term. The presence of this microbe in the rectum, sprouting and breeding spores by millions, gives rise to great constitutional dis- turbance and fever, and the microbe excreting ptomaines gives us the intolerable griping and tenesmus, with bloody mucus. During our heated term this microbe is one of the greatest scourges of our country. The presence of this germ in the rectum and colon is found at all seasons of the year, but it is roused into activity and rapid growth, prodigious spore evolution and ptopaaine excretion by weakness, solar heat, moisture, dampness, hot oppressive atmos- phere, ice water, indigestible articles of food, green fruit, alcoholic drinks, malaria, mental depression. These and numerous other causes do not operate directly upon the rectum and colon, but rather upon the liver. They cause a general condition of congestion, debility, in which area of vital depression the dysenteric microbe puts in an appearance. Symptoms.—Great constitutional disturbance in the acute form; rigors, headache, fever, biliary symptoms, brown tongue, sallow skin, conjunctiva tinged with bile, nausea, perhaps vomiting ; fre- quent evacuations of the bowels, accompanied with pain and uneasiness of a griping or bearing-down character; the inclination to go to stool is frequently accompanied with ptomaine excretion and tenesmus. At first, the stools are dark, ginger-bread color; then mucous, thin, scanty, bloody and often mixed with little hard lumps of faeces. The scanty stools give great distress; the griping and straining, or tenesmus, is most excru- ciating, with evacuation; motions are often dark-colored, and peculiarly fetid, mixed with blood, muco-purulent matter, and shreds of lymph. The bladder sympathizes; micturi- tion is frequent, and a constant desire to urinate; there is strangury, or only a few drops coming at a time; amount of urine scanty and high-colored; in some cases there are violent hemorrhages. It may last a few weeks and terminate in recovery, or run into a chronic form; or recovery may take place with thickening, effusion of lymph, and stricture, or gangrene of the bowel and Appearance of the mucous surface of the rectum in the first stage of dysen- tery; the microbe actively at work. 282 DISEASE GERMS. death; or the patient may succumb to the violence of the fever and inflammation. The pathological appearance of the walls of the rectum are most significant, especially during the first and second stage, if permitted by inefficient treatment to run that way. Every day in which germicide remedies are delayed, more havoc is made by the germ degeneration of the intestinal glands, atrophy of the mucous membrane, indurated cicatrices in both colon and rectum. In the treatment, general principles must guide ; if there be a very irritable state of the stomach, an emetic may be administered with advantage, followed by an alcoholic vapor ?^VW';*:| bath, and it would be well to cleanse out the :.-^f^^^&^\ alimentary with a powder of euonymine and W^t-?~^^ caffeine, say one and a half grains of each, ^ every hour till they had done their work. Appearance of the mucous ._J . , , ... membrane of the rectum Rest in the recumbent posture in bed ; one dVehnetery??hemtcgrob°ef dose of exalgine in the morning, another in making ravages in the ^e evening; during the day tincture of green root of gelsemium should be given, alternated with peroxide of hydrogen, it will completely paralyze the or- ganism. If not it may be noted that this microbe is either sterilized or completely annihilated by the administration of either of the following germicides, which can be used here with brilliant success, one of which could be selected : Naphthaline in five grains, in a capsule, repeated frequently. Resorcin and turpentine, combined in mucilage of acacia, per- fectly annihilates the microbe. Eucalyptol, ten to thirty-drop doses, is excellent. Caffeine, one grain every hour. Stone crop and sulphate of quinine are most efficacious. Resorcin, naphthaline, perfectly annihilate the microbe. Kaki, as an infusion, does effective work in effacing the microbe from the bowel. This is an efficient germicide where we have a specific micro- organism inhabiting the intestinal canal, as in typhoid, diarrhea, dysentery; besides it has a decided action in neutralizing the pto- maines, generated or excreted by the microbe. Its first dose affords relief, fetor disappears from the stools; subsidence of pain; stop- page of the diarrhea or hemorrhage, reduction of temperature and a general return of all the vital functions. The bark of the root of calotropis gigantea is even more power- ful than kaki; like kaki, best administered in infusion of the pow- dered bark. BACTERICIDES. 283 The bisulphide of carbon is much esteemed as a germicide in dysentery, the dose is variable, but when administered it quickly relieves the tenesmus, the motions diminish in frequency, the stools lose their offensive odor, the germs disappear. Enemata of infusion of kaki, green root tincture of gelsemium, creolin and resorcin kill the entire colony of microbes. The method of giving the enemata must be considered ; the patient's buttocks should rest upon a pillow at the edge of the bed, so ele- vated that the natural tendency of the fluid entering the rectum would be to travel down into the colon. A fountain syringe is the best, with a long flexible pipe. An effort should be made to pass this into the sigmoid flexure. One enema is often sufficient to effect a cure. Whatever remedy is selected a cocaine supposi- tory should be inserted up the rectum thrice daily. Difficult or painful menstruation appears Dysmenorrhcea in gynecological practice under three forms, (Neuralgic). the first being due to neurasthenia.— Nervous dysmenorrhcea is very common among highly educated and refined ladies—those who have developed their nervous systems at the expense of the physical, those who have insufficient exercise for body, who lounge, and keep reading our fictitious, debasing, modern literature—that deadly poison which undermines their nervous systems. It may appear at puberty, but more generally it comes on from enervating causes after some years of painless menstruation, especially in the unmarried. In married life it may come on from the irritation of frequent abor- tions, and the use of means to accomplish that act. It may be due to incompatibility in the sexual act. Symptoms.—General languor, lassitude, debility, headache, with pains in the back, sacrum and lower part of abdomen, com- ing on a few days prior to period; an aching soreness of inner and upper part of the thighs; bearing-down, with a sense of weight in the pelvis. As soon as the discharge comes on freely, relief is promptly experienced; if the flow is scanty, and comes on in slight gushes, the suffering is often excruciating; it becomes paroxysmal, pain comes and goes ; often considerable pain in left ovary, sometimes in both; no swelling or heat, or increased sensi- bility in parts. There is flatulence, constipation, hysterical symptoms or convulsions. If the patient is seen during an attack, a warm hip-bath, tea- spoonful doses of comp. tincture of serpentaria and the intro- duction both into the rectum and vagina of an obstetric cone— patient in bed. Usually this affords instantaneous relief. If it 282 DISEASE GERMS. Appearance of the mucous membrane of the rectum in the second stage of dysentery; the microbe making ravages in the ulcers. death ; or the patient may succumb to the violence of the fever and inflammation. The pathological appearance of the walls of the rectum are most significant, especially during the first and second stage, if permitted by inefficient treatment to run that way. Every day in which germicide remedies are delayed, more havoc is made by the germ degeneration of the intestinal glands, atrophy of the mucous membrane, indurated cicatrices in both colon and rectum. In the treatment, general principles must guide ; if there be a very irritable state of the stomach, an emetic may be administered with advantage, followed by an alcoholic vapor bath, and it would be well to cleanse out the alimentary with a powder of euonymine and caffeine, say one and a half grains of each, every hour till they had done their work. Rest in the recumbent posture in bed ; one dose of exalgine in the morning, another in the evening; during the day tincture of green root of gelsemium should be given, alternated with peroxide of hydrogen, it will completely paralyze the or- ganism. If not it may be noted that this microbe is either sterilized or completely annihilated by the administration of either of the following germicides, which can be used here with brilliant success, one of which could be selected: Naphthaline in five grains, in a capsule, repeated frequently. Resorcin and turpentine, combined in mucilage of acacia, per- fectly annihilates the microbe. Eucalyptol, ten to thirty-drop doses, is excellent. Caffeine, one grain every hour. Stone crop and sulphate of quinine are most efficacious. Resorcin, naphthaline, perfectly annihilate the microbe. Kaki, as an infusion, does effective work in effacing the microbe from the bowel. This is an efficient germicide where we have a specific micro- organism inhabiting the' intestinal canal, as in typhoid, diarrhea, dysentery; besides it has a decided action in neutralizing the pto- maines, generated or excreted by the microbe. Its first dose affords relief, fetor disappears from the stools; subsidence of pain; stop- page of the diarrhea or hemorrhage, reduction of temperature and a general return of all the vital functions. The bark of the root of calotropis gigantea is even more power- ful than kaki; like kaki, best administered in infusion of the pow- dered bark. BACTERICIDES. 283 The bisulphide of carbon is much esteemed as a germicide in dysentery, the dose is variable, but when administered it quickly relieves the tenesmus, the motions diminish in frequency, the stools lose their offensive odor, the germs disappear. Enemata of infusion of kaki, green root tincture of gelsemium, creolin and resorcin kill the entire colony of microbes. The method of giving the enemata must be considered ; the patient's buttocks should rest upon a pillow at the edge of the bed, so ele- vated that the natural tendency of the fluid entering the rectum would be to travel down into the colon. A fountain syringe is the best, with a long flexible pipe. An effort should be made to pass this into the sigmoid flexure. One enema is often sufficient to effect a cure. Whatever remedy is selected a cocaine supposi- tory should be inserted up the rectum thrice daily. Difficult or painful menstruation appears Dysmenorrhcea in gynecological practice under three forms, (Neuralgic). the first being due to neurasthenia.— Nervous dysmenorrhcea is very common among highly educated and refined ladies—those who have developed their nervous systems at the expense of the physical, those who have insufficient exercise for body, who lounge, and keep reading our fictitious, debasing, modern literature—that deadly poison which undermines their nervous systems. It may appear at puberty, but more generally it comes on from enervating causes after some years of painless menstruation, especially in the unmarried. In married life it may come on from the irritation of frequent abor- tions, and the use of means to accomplish that act. It may be due to incompatibility in the sexual act. Symptoms.—General languor, lassitude, debility, headache, with pains in the back, sacrum and lower part of abdomen, com- ing on a few days prior to period; an aching soreness of inner and upper part of the thighs; bearing-down, with a sense of weight in the pelvis. As soon as the discharge comes on freely, relief is promptly experienced; if the flow is scanty, and comes on in slight gushes, the suffering is often excruciating; it becomes paroxysmal, pain comes and goes ; often considerable pain in left ovary, sometimes in both; no swelling or heat, or increased sensi- bility in parts. There is flatulence, constipation, hysterical symptoms or convulsions. If the patient is seen during an attack, a warm hip-bath, tea- spoonful doses of comp. tincture of serpentaria and the intro- duction both into the rectum and vagina of an obstetric cone— patient in bed. Usually this affords instantaneous relief. If it .284 DISEASE GERMS. fails, let her inhale twenty to thirty drops of chloroform, and an hypodermic injection of a quarter of a grain of sulphate of mor- phia might be given. She must be tided over the crisis with great care. If aware of the attacks coming on, they often can be prevented by inducing anesthesia of the lumbar plexus of nerves with belladonna, a plaster of this, four inches wide by nine inches longways across the loins; the administration of tincture of belladonna internally, till throat becomes slightly dry and pupil dilated; the introduction of a pastile up vagina, and suppository up rectum, every night at bedtime, each containing one grain of opium and one-quarter grain extract of belladonna. The above to be commenced five days before period. From two to three weeks during the interval, the following treatment should be carried out: Daily, alkaline baths, followed w th friction or massage; flannel or silk under-clothing must be worn next the skin, especially over the loins; most nourishing easily digested food, avoiding tea, coffee and other stimulants. Sleep must be limited to eight hours, abundance of gentle exer- cise, games, moderate work so locomotion is active; if circum- stances permit, horse-back exercise. Rigidly forbidding seden- tary habits, novel reading, and if married, sexual congress. If there is any evidence of indigestion, columbo infusion or some bitter tonic, bowels to be regulated by taking two cascara lozenges after meals. Then the true treatment of the case begins, and select four of the best remedies in the materia medica to vitalize the uterus and overcome this neurasthenia, namely, tincture of oats and kepha- line, with wine of aleteris farinosa and comp. syrup partridge berry. Place the patient upon two of them, oats and aleteris, one week ; kephaline and partridge berry the next, and so repeat till case is cured. All other remedies as pulsatilla, cimicifuga, are greatly inferior to the above. In ladies of a rheumatic and gouty condi- Dysmenorrhcea tion, afflicted with intra-uterine catarrh, (Congestive). there are in the cavity of the uterus quite a conglomeration or heterogeneous number of disease germs in the cavity of the uterus, as the amoeba, yeast-germ, sarcinae and others. Such microbes naturally excite irritation of the internal uterine walls, and when the menstrual function is excited there is great hyperaemia of the entire uterus. Those of a sanguine, plethoric or lymphatic temperament are its victims. Causes.—Aside from the diathesis, gouty or rheumatic, and BACTERICIDES. 285; pelvic irritation, general plethora of the genito-urinary organs, from sedentary habits and occupations, it may be caused by local irritation, as abortion, exposure to cold and moisture; sluggish- ness of the liver, displacement of uterus, and metritis. Symptoms.—Suffering begins four or five days before each period, in a general sense of languor, or weariness, with head- ache, pains in the loins; a feeling of weight in the pelvis; gen- eral restlessness, and irritability of the bladder; there are heats and colds, with other evidences of nervous depression. The weight in the uterus becomes a pain of a throbbing character ; then dragging in the back, aching in the hips and thighs, and bearing-down, especially when pain is on. Discharge, after a few days suffering, makes its appearance, usually slowly and gradually, scanty at first, but subsequently, after the system is. relaxed by the condition of prostra- tion, it comes freely. It may come in small clots, or shreds, or flakes of membranes, or sometimes in the form of a large pear-shaped clot, covered with a false membrane, an exact cast of the cavity of the uterus. This membrane looks like the epi- thelial membrane lining the cavity of the uterus, analogous to the de- cidua. In some cases there is no congestion of the uterus, in others it is much engorged, often displaced; ovaries very tender, with swelling and tenderness of breasts. If the portal circulation is sluggish there will be piles. The treatment, during the period, should consist in ameliorat- ing the condition as far possible, hot vaginal injections of a solu- tion of boroglyceride, warm hip baths; free action of the bowels, the administration of obstetric cones per vaginam and rectum, with warm, relaxing infusions of asclepias, or eupatorium per. When the period is over, and for the next three weeks, patient should be placed upon good food, daily warm alkaline baths, followed by massage; bowels to be kept open with the cascara sagrada lozenge; the patient to be placed upon alteratives and tonics, saxifraga, alternated with the aleteris far.; phytolacca comp. alternated with the partridge berry. With an energetic course of these remedies for four or five months, a cure may be effected. A cure, however, may be effected much more speedily, when The yeast plant and sarcinae present in> all cases of intra-uterine catarrh ; the yeast plant, sarcinae and other germs found in the cavity of the uterus in. congestive dysmenorrhcea. 286 DISEASE GERMS. germicidal bougies are used about every four days. These bougies are composed of thallin, resorcin, naphthaline, creolin, etc., and other bactericides, and are inserted into the cavity of the uterus, patient in the recumbent posture, and permitted to dissolve and come in contact with the internal walls, entirely re- juvenating them, and destroying all germs. If any difficulty is experienced in introducing, the original plant can be dissolved and a four or six catgut bougie can receive a heavy coating and be introduced, say for one-half an hour, until the germicidal sub- stance is dissolved. The method is most successful. This term is applied to a thickening, in- Dysmenorrhcea duration, cartilaginous degeneration, or (Mechanical). stricture of the external and internal os uteri, or neck, or a narrowing of the entire canal of the neck. It may also be due to some tumor, or uterine displacement, as ante or retro-flexion ; these latter we do not in- clude in the following remarks. What we speak of here is either a narrowing of the canal of the neck, or its infiltration with lymph, or cartilage, or a true stricture of the external or internal mouths of the cervical canal—conditions that cause sterility as well as dysmenorrhcea. Causes.—The causes that give rise to this induration, or me- chanical obstruction, are inflammation, such as acute and chronic vaginitis, leucorrhcea, self-abuse, excessive coition; congenital irritation common cause. Symptoms.—Are those indicative of obstruction to the escape of the menstrual fluid. There is the languor, prostration, nausea, vomiting, pain in loins, hips, and thighs, bearing-down; pain in ovaries and uterus, usually some time before a scanty flow makes its appearance. When discharge does come, it is in gushes, each gush preceded by pain, and an aggravation of all the symp- toms. The bladder becomes irritable, and there is often con- siderable tenderness over both uterus and ovaries ; anaemia, con- stipation ; very much resembles labor; uterus struggling to expel its contents. An examination of these cases reveals either a small os uteri, or an orifice of the natural size, but the canal leading to the internal os, thickened, indurated, strictured, or suf- fering cartilaginous degeneration—conditions that can readily be felt with the finger, or the uterine sound. In some cases the ob- literation is confined to the inner os. In nervous or neuralgic dysmenorrhcea, the repeated irritation from month to month often aids in bringing about this condition. In the treatment of these cases, the same plan of treatment BACTERICIDES. 287 should be adopted as in the neuralgic during the flow, comp. serpentaria tinct, the introduction both per vaginam and rectum of the obstetric cones, and all failing hypodermic injections of morphia. During the intermenstrual period, there are various forms of treatment which might be resorted to. In all cases, it is well to place the patient upon an alterative and tonic course, administer- ing either comp. saxifraga, or phytolacca, alternated with aleteris farinosa; relieving the dyspeptic symptoms with bitter tonics and the constipation with cascara sagrada lozenge. Every other night, the vagina should be packed with boroglyceride paste, and permitted to remain over night. During the eight hours of sleep there will ooze away from four to six ounces of serum ; this has a most marvellous effect on an indurated, structured, or hyper- trophied neck, besides it is most vitalizing to the blighted os. Perseverance with this remedy is invariably attended with success. Another method, still more heroic, attended with less trouble, but still most efficacious, is the introduction of one or two jequi- rity wafers or capsules right against the uterine neck, permitting them to remain over night. These if properly applied, will cause a complete exfoliation of all the tissues with which they come in contact. If it is not deemed advisable to use it in that way, the contents of the capsule can be blown on the os and neck of the uterus, and the same result obtained. This procedure will bring away large fibrinous masses, a peeling off without causing any breach of surface. Its use should be followed with mucilaginous injections. Most successful, still there are cases it fails to reach. Dilatation, by means of sponge-tents, sea-tangle, and metallic and rubber dilators are worse than useless, setting up more irrita- tion and additional obstruction. Those expanding instruments may produce no bleeding, but they are very destructive, and if often repeated are most harassing to the patient, and invariably after their use the canal returns to its former size, even a little nar- rower. There is no good in either slow or rapid dilatation, and even the new method of dilating, lacerating, tearing, by divergent blades, is useless ; there is danger of irritation, if not of metritis, pelvic cellulitis, or peritonitis. Incision is the best plan, as it gives rise to no suffering, gives a sure result, and is free from danger if properly performed and rapid. This is best performed by a pair of scissors, made for the purpose, one blade terminating in a probe-pointed end, which enters the os; the other by a hook, which seizes and fixes the vaginal portion at the point desired. One stroke of the scissors divides the intervening tissue in a straight line. The proceeding is then repeated on the other side of the os, and the operation is 288 DISEASE GERMS. then completed. There is a tendency to contract again even after that. To meet this, there should be a slight nick made of the internal os, just sufficient to divide the mucous membrane and some of the superficial circular fibres of the muscular coat. This will allay spasmodic sphincteric action. The incision should be no greater, because it is superfluous, and even dangerous. At the mouth of the inner neck there are blood vessels in pro- fusion, and of considerable size. Large veins, without valves and small arteries, gap at the uterine level, and are apt to bleed very profusely if uterus is cut into. A piece of lint, saturated with the juice or extract of hemlock bark, is to be inserted between the cut edges, and patient kept in bed under opium. If the patient and friends are willing, the best plan, if the suffering is great, is to perform the operation at once, as it is only a waste of valuable time to exhaust the usual list of reme- dies on her first. Indigestion, terms used to express or indicate Dyspepsia, a train of symptoms caused by a functional de- rangement of the digestive processes; when they are confined to the stomach, they constitute gastric dyspepsia; when in the bowels, duodenal dyspepsia. The indigestion, or failure on the part of the stomach to digest, takes place immediately after a meal, and continues for two, four, or more hours, according to the gravity of the disease, or kind or quality of food introduced; whereas, in intestinal or bowel dys- pepsia, the uneasiness or symptoms of indigestion do not com- mence for several hours after eating. In the stomach, the food, after being slowly and perfectly masticated, and incorporated with the secretion of the parotid and other glands of the mouth, is subjected to the action of the gastric juice, a powerful solvent, being made up of a substance called pepsin. In the bowels, the digested food or chyme, is subjected to the action of the pancreatic secretion, (a gland almost immaculate, enjoying a freedom from disease most remarkable,) which emulsifies the fat, starch, and other products, rendering them fit to become proper constituents of nutrition. The process of healthy digestion is easy, speedy, and complete; there can be no excess of it, for food cannot be too quickly and completely converted into blood; whereas, indiges- tion is slow, painful, and imperfect. Painful, from a slight uneasiness, to pain, or actual torture; slozv, when the stomach fails to digest in the ordinary time, and chemical decomposition or change takes place; defective, when the food is either altered, or fermented, or decomposed, or formed" into vegetable germs, like a yeast plant. BACTERICIDES. 289' Indigestion is divided into numerous forms or varieties accord- ing as one or more symptoms predominate. It is called simple, when there is loss of appetite, pain, weight, fullness or oppression about the stomach after meals ; flatulence, nausea, vomiting, constipation or diarrhea, coated tongue and fetid breath, with headache, palpitation, heartburn, water-brash, hypochondriasis. It is called slow digestion, when there is a deficient secretion of gastric juice ; a feeling of fulness and distension at the pit of stomach, with the other symptoms. It is called painful, when gastralgia and heartburn are the pre- vailing indications. Wind Dyspepsia, when flatulence, eructations of gas, and acid water, as water-brash or pyrosis; there is usually gastrodynia, or stomach-ache. It is termed Boulimic Dyspepsia, when, with the ordinary symp- toms, there is an excessive hunger or craving for food, and even not appeased by large quantities of food. Nervous Dyspepsia, when there is a nervous temperament, white face, sharp features, emaciation, phosphates and chlorides in urine; all or most of the symptoms are present, but especially headache, like a band or scalp flying off, and hypochondriasis a decided and prominent symptom, etc. Causes.—The causes are not only numerous but varied, and embrace every derangement and lack of tone in any organ, or of the entire body. Hurried eating, with imperfect mastication from whatever cause; improper food ; drinking of fluids at meals, or the use of iced or cold drinks or food, highly depressing to stom- ach which arrest digestion; want of exercise ; mental anxiety; strain on mental powers by study or struggle for existence; gen- eral debility, or nervous exhaustion ; use of whiskey, beer, tobacco, and drugs; excessive drinking, especially cold drinks; diseases of the blood; and often due to reflex causes, as diseases of the liver, spleen, lungs, heart, kidneys, and to diseases of the nervous system generally. There is, so to speak, an endless chain of sympathetic and other causes. Symptoms.—Are very variable in their nature and severity. Loss of appetite, pain, weight, fulness at or about the stomach after eating; acidity, flatulence, eructations, nausea, vomiting, pyrosis, tightness, heartburn, oppression, wearing cramp, lan- guor, debility, giddiness, with headache, frontal, or like a band round head; a sensation as if there was a movement of the ground; constipation most common; still, there might be diar- rhea; tongue coated white or brown, or if intestinal, buff coat, with transverse fissures; fetid breath; palpitation; pains in loins 19 2Q0 DISEASE GERMS. or limbs ; often cough ; liver very torpid ; eyes tinged with bile; urine scanty, high-colored, and deposits phosphates and chlo- rides; skin dry, contracted; the brain is often seriously affected, both through reflex action, want of nutrition, and otherwise; so that hypochondriasis is always present in either a mild or aggravated form. A look at the physiology of the stomach will satisfy anyone of the existence of an immense nervous connection—the very secretion of the gastric juice being a nervous act—for there is no gastric juice in a healthy stomach until the stimulus of food is impressed upon the gas ric nerves, which is carried to the brain, and if that organ is healthy, gastric juice will be thrown out. The ultimate relation of the stomach with the great sympathetic, and the intimate union that exists between the stomach and other organs, cause non-sentient nerves to become highly sensitive. The abdominal plexuses of sympathetic nerves always play an important part in the production of indigestion. Treatment.—In all its forms, there should be an avoidance of all care, worry, and anxiety, study, or any mental strain. A vigorous brain is of essential importance, and an easy sympa- thetic soul of great moment. PCvery drain upon the nervous system must be blocked off; no over-work, nor care, nor sexual excesses. Pure blood is also important; and active, but not fatiguing exercise in the open air; daily bathing; if the cold douche or shower-bath can be borne, it is best, to be followed by friction and flannel clothing; a diet highly nutritious but light, should be laid down, consisting of broiled tenderloin steak, or chicken, soft-boiled eggs, boiled fish, toast buttered, oatmeal mush, roasted potatoes, ripe fruit, mocha coffee. Veal, pork, salt or corned meats or fish, fried or boiled meat, all slop, as soups, pastry, pies, nuts, sweets, cabbage, tea, tobacco, alcohol, or all fermented liquors, should be carefully avoided. Another important point is slow eating, thorough mastication; no fluids, warm diet, perfect regularity in eating, sleeping, and in a daily movement of the bowels, and in perfect rest to stomach between meals; no nibbling, or odd snaps, or lunches. Not more than three meals per day, with proper intervals between. Bowels to be opened with enemata daily every morning after breakfast. Special symptoms must be relieved or palliated, in order to give relief, until a cure is effected. The most valuable remedy in dyspepsia is a healthy condition of the mouth and teeth, and thorough mastication of the food. We all eat too hurriedly. There is too little mastication, not a BACTERICIDES. 291 proper admixture of the salivary secretion ; so that there is crammed into most stomachs a mass of inadequately crushed or undivided solid matter, which acts as a mechanical irritant, sets up disease. Eating quickly, filling the stomach with indigestible material, unprepared food, renders it incapable of recovering its tone. All animals intended to feed hurriedly have the powers of rumination, or are provided with gizzards. Man is not so furnished, and it is fair to assume he was made to eat slowly. Hurried meals are highly mischievous. Then there should be rest, for a considerable time after meals, of mind and body, but, on no consideration, sleep. To sleep after meals is the worst aggravation a weak stomach can receive. During sleep, digestion in the stomach is, to a certain extent, suspended. For the Relief of Eructations and Vomiting.—One of our best remedies to effectually relieve this condition is either pepsin or papoid. It should be administered with or at the meal. Its use causes little demand to be made upon the stomach for its diges- tive secretion, and artificial digestion, promptly carried out, pre- cludes the possibility of either eructation or vomiting. There is no drug to equal it, as it gives vitality to a weak organ by giving rest. The digestive powers are assisted, and the food which, in other cases, ferments and irritates, because undigested, readily becomes assimilated, because it is now digested. Some think it best to give the pepsin or papoid a little while before meals, so as to afford it some time to combine with the existing condition of the stomach, and produce a more natural effect upon the food when swallowed, after being acted on by the salivary secretion. The idea is to give the stomach rest, and promote the formation of peptone; and as soon as normal vigor is acquired, the organ will soon respond to the production of its natural fluids. The use of alkalies in the treatment of dyspepsia, should as far as possible, be discouraged, as they tend to weaken the mucous coat of the stomach, and give rise to catarrh. Perhaps the most innocent alkali would be one teaspoonful of lime-water to half a tumblerful of milk, or five grains of bicarbonate of potassa to the same quantity of milk, once, twice, or even thrice daily. For the Relief of Gastrodynia or Stomach Cramp.—As a rule this form of pain comes on following a meal. It is of the same character as neuralgia; it is the gastric nerves crying for more nutrition—something to vitalize them. The various preparations of bismuth and cerium will relieve this pain, but their efficacy in other respects is not good. We witness their baneful effects in ladies who use it as- a face powder or in cosmetics, and to introduce this deadening, benumbing drug 292 DISEASE GERMS. directly into the stomach is reprehensible if any other remedy can be procured. Capsicum, or white mustard seeds, especially the former, is an excellent remedy, a good stimulant, does not irritate like black pepper, and its use affords almost instant relief. A good form is the compound tincture of myrrh, from half to one teaspoonful after meals in warm coffee. Half or drop doses of dilute hydro- cyanic acid act well, and being an ingredient of normal gastric juice, it could be added to the pepsin. A solution of quinine in aromatic sulphuric acid is also of utility; mineral acids, carbolic acid and tincture iodine ; warm plasters, as hemlock or belladonna plaster, over stomach. For the Relief of Pyrosis or Water-Brash.—To mention acidity is equivalent to rushing for an alkali, but a bitter will answer better. Still, patients will persist in their use on account of the immediate relief they afford. Glycerine added to milk ; one tablespoonful to half tumblerful,, and taken after meals, relieves flatulence, acidity, pyrosis, or water- brash. Usually it is speedily and completely successful, as it pre- vents fermentation and putrefaction. Although glycerine prevents putrefaction of nitrogenous substances, it does not prevent the digestive action of pepsin and hydrochloric acid; hence, while it prevents the formation of acids, checks fermentation, it in noway hinders digestion. For the Relief of Gastralgia or Heartburn.—Reject alkalies and try nitric acid in compound tincture of cinchona, or dilute nitro- muriatic acid. If these fail, use hydrocyanic acid dilute. If that does not afford relief, steep gentian and horse-radish in good whiskey enough to cover, and use in tablespoonful doses; or nux vomica in fluid extract of columbo or cascarilla. If, however, the dyspepsia has been in existence for some time, the stomach needs such a stimulant as the following: Pepper- mint water, eight ounces; tincture nux vomica, three drachms; tincture belladonna, two drachms; carbonate ammonia, sulphate of magnesia, of each three drachms; tincture of ginger, half an ounce. Mix. One tablespoonful after meals. All microbes in their ingress into the skin ex- Ecthyma. cite irritation, erythema and effusion of lymph, thickening nodules, pustules. Very common on the face of both sexes about or subsequent to puberty. In older subjects they are found on the feet and hands. Ecthyma is com- mon as a result of any ordinary inflammation of the skin, pro- vided the system be somewhat debilitated. BACTERICIDES. 293 In the treatment the general powers of life should be well sus- tained by the best of food. Germicides should be administered : as glycerite of ozone, avena, compound oxygen ; locally, to the affected parts, solutions of boroglyceride, peroxide of hydrogen, creolin, ichthyol should be used. An inflammatory disease of the skin, which Eczema, is not contagious, is polymorphous in charac- Moist Tetter, ter, and may be acute or chronic. Its poly- morphous or multiform character is one of its most marked features. Formerly described as a vesicular affec- tion, but it is erroneous to regard it solely as such. Vesicles, though frequently present, are not the sole elementary lesions met with; in many cases, indeed, none are discoverable. Any one of the following primary lesions may occur : Simple redness (erythema), papules, vesicles, pustules. According to the lesion present the observer might thus be inclined to term the eruption erythematous, papular, vesicular, or pustular. It will have been noted that, in the classification adopted, eczema appears in several classes, but it will be convenient to refer to its variojs forms in the present place. A typical case is described as commencing as a patch of erythema, passing on to the formation of papules ; the latter then develop into vesicles, some becoming pustules. The bursting of the vesicles and pustules (either spontaneously or as the result of scratching) is succeeded by a serous or sero-puru- lent discharge; this is often very copious and thus justifies der- matologists in regarding eczema as a cutaneous catarrh. The drying up of the discharge is succeeded by the formation of scabs. Many cases, however, are far from presenting this regular course. The lesions are often more or less commingled, thus producing extremely varied appearances. The eruption may be also more or less entirely confined to one form of lesion. Thus, it may be mainly erythematous, or vesicular, and so on. These different forms have been named correspondingly. Thus we get E. erythematosum, E. vesiculosum, E. pustulosum, etc. The red and moist condition of skin often seen in infants in the groin or between the nates, and beneath the breasts in stout women, is termed E. intertrigo; in the official nomenclature it is classed as a separate disorder under the heading Intertrigo. In E. rubrum or E. madidans there is intense redness of the skin, which is ex- coriated, largely denuded of epidermis, and exudes a copious watery discharge ; it is generally seen on the lower limbs. E. papulosum is a form of eczema closely resembling lichen, which latter eruption is, indeed, described by some authorities as merely 294 DISEASE GERMS. a form of eczema. Similarly, some writers include impetigo under eczema, regard it as merely a variety of E. pustulosum. When the surface of the skin is red and inflamed, discharge scanty, but scabs formed in abundance, the resulting condition is termed £ squamosum ; the latter term was also employed by dermatologists to describe some varieties of psoriasis. The eruption may also be named according to the part affected, e. g., E. capitis, /•'. facialis, etc. Eczema is an exceedingly common affection. Statistics show- that from one-third to one-fourth of the cases of skin diseases seen in practice come under this heading. It may occur at any age, but is more common in young children—especially at or about the period of teething ; often (generally erroneously) attri- buted to vaccination. More common in males. May be of local or constitutional origin. Inflammation of the skin set up by ex- ternal irritants differentiated by some dermatologists as dermatitis, In most cases, external irritation is an important factor as, when not actually causing, it often materially aggravates the disorder. Eczema is often hereditary. Gout, scrofula, alimentary disorders, and circulatory derangements are said to predispose to it. Preg- nancy, lactation and uterine complaints are enumerated as causes of eczema, and it may also occur as a " trophic lesion" in various nervous disorders. As there are no specifics in medicine, none in cutaneous dis- ease, each case must be managed on its own merits and general principles; so in treatment, we can only draw brief attention to the main indications for treatment. The general condition of the patient demands careful attention; every effort should be made to discover the cause of this trouble- some and frequent skin disease. The diet should be carefully regulated, plain and nutritious, easy of digestion. Shell fish, alcohol, tea and coffee forbidden. Constipation is almost invariably present, and calls for imme- diate attention, as the ptomaines from microbes are always present and greater too if the peristaltic wave is slowed. Kola nut lozenge, better still the cascara sagrada lozenge, which stimulates the liver and aids elimination of excess of uric acid which inva- riably co-exists with eczema. General alteratives and tonics. Tincture of sulphur, alternated with nux vomica, or lycopo- dium do well, better by far than the indiscriminate use of arseni- cal solutions. An excellent formula for .general use is : Comp. tincture cin- chona, four ounces ; acetate of potass, half an ounce ; tincture of nux vomica, two drachms. One teaspoonful in a glass of water after every meal. Another good formula is: Ozonized sulphur BACTERICIDES. 295 water and comp. tincture of gentian, equal parts of each, a tea- spoonful in a little water after meals, alternated with nux vomica. Locally washing to be avoided, but as this must be done, white castile soap should be used and a few drops of the peroxide of hydrogen added to the water. In cases with little secretion, we often meet with great success with a dry dressing, as simply dusting on the anti-microbe powder. To allay itching, a solution of boroglyceride; or an ointment of ozone ointment and resorcin are excellent. Ichthyol, as an external remedy in the form of a solution or ointment, in strength varying from five to fifty per cent. It acts in three ways: (i) As a Protective.—When a solution of it is painted over the skin surface it quickly dries, forming a thin layer somewhat resembling friar's balsam or collodion, and so protects the skin from the air, dust, etc. (2) As a Reliever of Congestion.—When applied to healthy skin its effects seem nil, but where there is an active congestion of the part it acts promptly by causing contraction of the arterioles, and so dimin- ishes the vascularity of the part. (3) As a Desiccant.—As it reduces the vascularity of congested skin, the outward flow ot serum is also reduced, and consequently the part becomes drier. In these three actions are the essentials of the treatment of many skin diseases. Resorcin in glycerine or as a jelly; ointment of iodoform, iodol, oleate of zinc ; oil of boroglyceride ; nitrate of mercury ; caustic potassa ten grains to the ounce of vaseline ; salicylic acid five to ten to the ounce of vaseline ; siegesbeckie cerate most effica- cious ; all internal and local remedies to be of utility should be changed weekly. The tubercular bacilli appears in a great Elephantiasis, variety of forms in the cuticle, true skin and subcutaneous tissue. In certain cases in which the nerve forces are decidedly bankrupt, and the external surroundings of the worse possible kind, the bacillus excites irritation, effusion of lymph, which form germ nests, great hyper- trophy, and induration. Associated with the hardness, there is considerable pain. Sometimes the parts are dry and mealy, in other cases serum exudes. It usually attacks the lower extremities, scrotum and depending parts, and progressively extends upwards. Before the introduction of so many bactericides.it was deemed incurable, now a cure in the earlier stages is looked upon with more hope. 296 DISEASE GERMS. Physicians of undoubted veracity say that the boroglyceride paste during the day, and the resorcin paste during night, are effective in getting rid of the infiltration. The usual internal remedies for the cure of tuberculosis certainly deserve a fair and impartial trial. The presence of the bacillus pyogenes in the Empyema, cavity of the chest—usually the result of pleurisy in debilitated subjects. It is liable to follow scarlet fever in children ; pneumonia and tubercular disease of the lung in adults ; the bursting of a hydatid cyst into the pleura, or the bursting of a tubercular cavity of the lung into the thorax. Often it supervenes without any assignable cause. Symptoms.—There is at first pain of a sharp and shooting character in the affected side, and this is generally confined to one spot; the patient cannot cough or take a deep breath with- out increasing this pain. In a few days, when the fluid is poured out into the pleura, the pain may diminish considerably; but there is more or less distress of breathing, because, from the pressure of the fluid, air cannot enter the lungs on the affected side, and the other lung is called upon to do all the work; hence the patient lies on his back or diagonally towards the diseased side, so as to give the healthy side of the chest all the room he can to expand. From the first there are the usual signs of fever— a furred tongue, quick pulse, loss of appetite, and much thirst. The temperature, too, of the body rises considerably, and is liable to much daily variation, being high at night and perhaps two or three degrees lower in the morning. When the disease is well established, the diseased side of the chest is larger in circumfer- ence than the other, and there is bulging of the intercostal spaces; the veins also are obstructed over the part, and appear as blue lines running over the chest. The dyspnoea is great, and increased on exertion; each respiration is hurried and shallow; the countenance is anxious, and sometimes pale or livid. Gener- ally the patient is worse at night, and becomes hotter and more oppressed ; at times a hectic flush appears on the cheeks, at others there is much perspiration over the head and body; rigors or shivering are very usual in the early stages of the disease, but become less frequent afterwards. /// the treatment, the patient must be kept in bed, in a warm, well ventilated room, the air kept moist, and at a temperature of 65° to 750 F. Food of a highly nutritious character adminis- tered, as malted sterilized milk, beef tea, broth; and a moderate amount of stimulants administered. BACTERICIDES. 297 A course of internal bactericides, as the exhibition of the di- oxide of hydrogen, comp. oxygen, ozonized sulphur water. Jackets of bactericides have been tried, prepared of iodoform, and kindred germicides, occasionally a case seems to yield to them, but their uncertainty of action renders them practically useless. The living microbial mass should be removed either by aspi- ration or tapping the chest, The latter procedure is the best. For this purpose an incision, about an inch long, or rather less, is made through the skin, about the sixth or seventh inter- costal space, and in the line of the axilla or arm-pit. A trocar and canula, about one-fourth or one-fifth of an inch in diameter, is then introduced, and when the trocar is withdrawn the pus will run through the tube most readily. The wound should not be allowed to close, but a piece of tubing of gutta-percha should be kept in, so that any more pus that forms may escape at once, and not accumulate again. Even in very favorable cases pus continues to be secreted and to flow through the tube for days and even weeks after the original puncture. The quantity pro- duced dai'y gradually diminishes until at length it ceases. All this while the patient will be easier; he can breathe more com- fortably ; there is less fever and hectic; he will recover his appe- tite, and rest better at night; but in all cases that recover, conval- escence is a very slow process, and tonics, generous diet, cod-liver oil, a visit to the sea-side or country are indispensable aids for regaining health. If the lung cannot expand after the matter has escaped, the chest-wall of the affected side will be pressed in by the external atmosphere, and so be smaller than the other, and in this way such patients often have lateral curvature of the spine afterwards. In time the healthy lung becomes much increased in size, and does in a great measure the work of both. The mor- tality from this disease is considerable, and it is nearly always fatal when arising from pyaemia, or when the patient's health has been worn down by previous disease. In a few cases the pus has made its way through the skin of the chest, and burst externally of its own accord ; but it is best to tap the chest before such a process has taken place. _______ A morbid state of the blood, in which it has a Embolism, tendency to clot or form fibrinous concretions, which either adhere to the walls of vessels or are carried onward by the current of the circulation, and plug up or impede its normal course. The causes are varied : in-door life, insufficient aeration of blood by skin or lungs; its imperfect decarbonism by the liver in drunkards; the pressure of the gravid uterus on the liver, and 298 DISEASE GERMS. non-ogygenization by pressure on the diaphragm. It is present in ague, typhus and other fevers; also in croup, diphtheria, pneumonia, scarlatina, erysipelas, caused by the ptomaines of the germ of each, respectively. It is also caused by diseased vege- tables, fruit, meat, and cereals, such as ergot of rye, u.stilago maidis, so that ergot during parturition produces it in mother and child, and is one of the most common causes of death to both. In an examination of the blood after death there is usually a large coagulum found in the heart; fibrinous specks, patches, plugs can be seen in brain, lungs, heart, liver, and arteries. On an examination of these clots or plugs by the microscope, they seem, in nearly all cases, to be a mass of bacteria interspersed > with cadaveric alkaloids. It is often difficult to recognize the disease during life as the symptoms are quite variable, but if any of the above causes exist, it is positively present to a greater or less degree, and particu- larly so if the patient complains of strange sensations about the heart, and has a tendency to fainting. In all diseases in which this is present, or where it is suspected, the patient should be kept as quiet as possible in the recumbent posture, never being permitted to sit up, and nothing allowed to disturb him in any way, and have an abundance of fresh air. The diet should consist of milk, eggs, soups; the secretions attended to. In order to meet the pathological condition of blood, tincture of belladonna, alkalies, and peroxide of hydrogen should be administered. All acro-narcotic remedies have a wonderful effect in causing and maintaining a fluid state of the blood. Belladonna has this property in a high degree. A teaspoonful of the tincture in half a tumbler of water, of which a teaspoonful should be given every one or two hours, never administering it so frequently as to cause dryness of throat. In the sesquicarbonate of ammonia we have an excellent alkali. This either alone or combined with a few grains of bicarbonate potassa soon relieves the condition; besides, the ammonia is destructive to living germs in the blood. Bromide of ammonia answers well if a deposit of fibrin has taken place. Salicylate soda in acetate of ammonia. Sulphate of soda is also valuable, so is the permanganate or chlorate of potassa. In dis- eases associated with embolism, iron and mineral acids should be avoided in treatment. The term thrombosis is applied to a clot of fibrinous blood causing a partial or complete closure of a vessel. BACTERICIDES. 299 A pouch or air-sac in the lungs. Two Emphysema, varieties. Vesicular and inter-lobular em- physema. Vesicular Emphysema.—Consists of a debilitation, enlargement and coalescence of air-cells, atrophy of their walls and oblitera- tion of their vessels, may affect one or both lungs, or a part of each, especially anterior edges and apices. Its causes are degeneration, a sort of interstitial death, destroy- ing elasticity and contractility of affected tissues, the air-cells and their surroundings, which conditions may be caused or intensi- fied by running, jumping, hoisting, playing base-ball or wind- instruments, singing, shouting, lifting, digging, rowing, running up stairs, or by anything that would cause the patient to take prolonged deep inspirations, or sudden check to an ex- piration ; a sequel of hoop- ing-cough, asthma, chronic bronchitis. Inter-Lobular.—Consist s of an infiltration of air into the interlobular areolar tis- sue, or into sub-pleural areolar tissue. This form is generally caused by rup- ture of the air-cells by vio- lent strain, or fractured ribs, and is generally met at the corners or abrupt angles ot the lungs. The distincti n is important, as the lobular form is very hopeless, and can only be relieved by antispasmodics. Emphysema is often latent, dates back to early years ; an iso- lated spot of the lung weak, which affords an anatomical substra- tum for its occurrence ; a substantive inherent unhealthiness ot lung tissue, which gradually increases with years. This is the true pathological process, which is easily microscopically demon- strated, and is at the bottom of all cases; gives rise to a predis- position, in an incomplete respiration and retention of air, and in time gives rise to microbiosis of patches in the lung, and lat- terly in the formation of large rarefied air spaces. Symptoms.—The symptoms are the same in both forms. Gene- ral debility, with shortness of breath and difficulty of breathing, increased by slightest exertion, and general distress, that the suf- A beautiful illustration of vesicular emphysema, showing a well-developed air sac in each lung, with two small ones fully formed. 3Q0 DISEASE GERMS. ferer is unfit for any active occupation; feeble cough, expectora- tion of frothy sputa, dusky appearance of countenance, weakness of voice, stooping gait; loss of flesh and strength, lowered tem- perature, 85° Fahr.; very weak and slow pulse, fifty to sixty; re- spiration twelve per minute ; constipation, occasional paroxysms of asthma; chest barrel-shaped, scarcely any movement of the intercostal muscles in breathing; on percussion, an unnatural clearness tympantis can be mapped out, and to be found there at all times. Ausculation reveals indication of vesicular murmurs as must rule us in bronchitis. Heart sounds are very feeble, and that organ is frequently displaced. Disease of the right cavities of the heart, with venous congestion and dropsy. Diseased side bulging, round or prominent in bad cases. Treatment.—Emphysema is generally regarded as an incurable affection, and that is correct in a large proportion of cases; still there are few cases that do not admit of much amelioration, and very many of the vesicular form curable. All conditions that would be likely to cause sudden inspiration or expiration should be avoided, as mental and physical excite- ment, no shouting nor attempts at running, lifting, rowing, etc. Warm flannel clothing, very generous and strengthening diet, and tonics to stimulate the appetite. Some remedies have a re- markable power over the interstitial tissue and stroma of the lungs in atrophy or in sclerosis, such as lobelia, quinine and hyoscyamus; one grain of each thrice daily operates well, and effects some good cures put up in pill form; liquor ammonia, sambul, phosphate of iron and quinine, also, are of great efficacy. The lobelia, quinine and hyoscyamus pill is our best combination; next, bromohydric acid ; warm, moist atmosphere. Quebracho is also a good drug to relieve the difficulty of breathing. It is difficult to define this disease, but it can be Epilepsy, described as a weakness or irritation of a patch of the brain, with an impaired cerebro-spinal centre which leads on the slightest disturbance to an explosion between the positive and negative forces of that organ, which produces the characteristics of sudden loss of consciousness and sensi- bility, power of voluntary motion, with tonic convulsions lasting a few seconds, and followed by clonic spasm of voluntary mus- cles; cessation succeeded by exhaustion and coma. Attacks recurring at intervals. Without a weakened bulb and neighbor- hood epilepsy could not exist. The causes may be embraced under three general heads: (1.) Centric causes. (2.) Reflex. (3.) Blood diseases. BACTERICIDES. 301 I. Hereditary conformation, consanguinity, peculiar shape of skull, depression or excrescence from its walls, tumor, worms ; weakened patches by falls and blows in infantile life. 2. Reflex : caries and overcrowding of teeth, vaulting of the roof of mouth, giving rise to irritation of.the trigeminus, the most reflex nerve in the entire body. Irritation anywhere, espe- cially in the abdomen, for of all the regions of the body none reflect more strongly on the brain than the visceral organs; so we must look well to the stomach and bowels for worms; if there is great mental depression, melancholia, for a loaded or sacculated colon, the kidneys, bladder and irritation of the gen- erative organs in both sexes, etc. 3. The blood, the living germs of tubercle, cancer, syphilis, rabies, and even the ovum of parasites will nestle and form colo- nies in patches of the brain weakened by falls and blows, and thus increase the condition of molecular death. Epilepsy is characterized by general languor, debility, lassi- tude; patient soon acquires a nervous temperament, sharp fea- tures, white skin, with an excess of brain-waste in urine in the shape of phosphates and chlorides. If the fits are about to ap- pear, there are in about two-thirds of all cases what is termed warnings or premonitory symptoms, which consist usually of some nervous sensations, different in duration and character, such as spectral illusion, hallucination of smell, taste, headache, giddiness, vertigo, twitching, confusion of thought, sense of fear, etc. But the aura epileptica occurs in the large propor- tion of cases; some compare this to a current of hot or cold air passing by ; others to a stream of cold water running on the skin, a fulness in head, a sense of burning or tingling or a prick- ing sensation, drawing inwards of the thumbs, a feeling as if insects were creeping, the sensation beginning in some remote part and extending to the head. Usually when aura ceases fit commences. The real symptoms : white or cadaverous appearance or pallor of features, with utterance of a shriek or scream ; and that may not take place, but the patient falls to the ground insensible, with loss of voluntary motion and violently convulsed; convulsive movements continue violent, usually more marked on one side than the other; distortion of face, gnashing of teeth, foaming at the mouth; protrusion of the tongue, which is often bitten ; eyes partly open and suffused; eyeballs rolling and insensible to light; skin cold and clammy ; perhaps involuntary micturition and defecation ; vomiting; breathing laborious, seems about to be suspended; when the limbs are stretched out a deep sigh is drawn and the fit passes off. Patient left insensible and as in a 302 DISEASE GERMS. sound sleep, with stertorous breathing, from which he recovers with a feeling of stupor and exhaustion and headache, but with- out any knowledge of what he has gone through. Some hours subsequently small ecchymosis often detected on face, neck and chest. The fit may be very light or very severe; its duration may be a few minutes or extend to many hours. Fits, when slight, often only consist of giddiness, confusion of mind, loss of conscious- ness, little or no convulsion and stupor, and all over in less than a minute. Seizures occur at variable intervals; often occur at night without being suspected by patient or friends. Repetition of attack impairs memory, may cause cerebral hemorrhage, tem- porary or permanent paralysis, or dementia, idiocy. In all obscure cases, it is well to look for germs and parasites or their spores or eggs. The most hopeless cases are those due to centric causes in the brain or skull, defective nervous organizations, lesions of the meninges. Those due to irritation, reflected or propagated, or to a morbid state of the blood, if not of very old standing, are amenable to treatment. The great increase of epilepsy is due to the vices or defects of civilization, the brain being more susceptible to irritation; abnormal conditions of alimentary canal, uterine irritation, masturbation, venereal excesses, alcoholism, tobacco, syphilis, mercury, etc. Treatment.—The symptoms are those of a sudden explosion of accumulated nervous energy. From the periodical character of the fits, it is inferred that the accumulation of nervous energy goes on for a definite time in the brain and spinal cord until an explosion ensues, which spends itself upon the muscles of voluntary motion, which are thrown into violent action, and by these means the accumulation is exhausted—the explosion being followed by coma or deep sleep. Many measures have been proposed for preventing the gradual accumulation and sudden explosion of the nervous energy con- stituting epilepsy, as improving nutrition, restoring mental and bodily vigor by any possible means, abundance of exercise in open air, daily bathing. Treatment during a fit should be directed chiefly to protecting the patient from violence, and getting him out of the fit. All clothing should be loosened, so that the blood may have free circulation to and from the head and all parts of the body. A piece of pine wood should be placed within the teeth to save the lips and tongue from being wounded by the spasmodic move- ments of the jaws. The patient should be placed on right side BACTERICIDES. 303 on bed or floor, head well elevated, and restrained or guarded, so that no personal injury is inflicted. Cloths wrung out of warm water should be applied to the head; mustard to the feet. Enemas of some broth, or mucilaginous tea, with half a tea- spoonful of spirits of turpentine, operate very favorably. Tying a ligature around the limb in which the aura is experienced prior to the fit, to*ward it off, of doubtful utility. If fit lasts long, a hypodermic injection of one-quarter of a grain of sulphate of morphia in the cellular tissue of nape of neck or over deltoid instantly rouses the patient up. Snuff, inhaling nitrite of amyl, etc., rather to be avoided. During the interval, while the fit is off, there must be a vigorous effort to prevent a recurrence or suspend the explosive tendency of the positive and negative forces of the brain with sufficient doses of bromide of potassa and other remedies to diminish or allay the reflex excitability and force of the cerebro- spinal centres. Such a formula as one of the following is efficient: Fluid extract of sambul, four ounces; tincture of calabar bean, one ounce; bromide of potassa, one ounce; bromide of ammonia, two drachms; bicarbonate potassa, two drachms; tincture ot belladonna, thirty drops. Mix. One teaspoonful or more— sufficient to ward off the fits; or the following: Camphor water, four ounces ; bromide of potassa, one ounce; iodide of potassa, two drachms ; carbonate of ammonia, half an ounce. Mix. Dose, from one to more teaspoonfuls, sufficiently often to ward off attacks. The numerous causes of epilepsy have given rise to a variety of treatment, among which that of the bromides deservedly takes the first rank. For many years, bromide of potassium, sodium, ammonium, lithium, calcium, zinc, arsenic, nickel, camphor, ethyl, have variously been employed, but their action appears less reli- able than the bromide of potassium, or a combination of three— potassium, sodium, and ammonium. Lately the author first used bromide of gold, and encouraged by the results, has established a treatment of remarkable activity. The form preferred is the solution, which is of a dark orange color. The least dose for an adult is eight milligrammes in twenty- four hours; for a child, from three to six milligrammes will suffice. When wishing to obtain a rapid effect in an adult this dose is gradually increased until the effect is obtained. If the dose is increased a persistent headache may occur, which ceases when the dose is lessened. The author has never exceeded a dose of twelve milligrammes. The advantages are the small quantity required, compared to the bromide of sodium or potassium necessary to obtain a good result; and the absence of digestive disturbance renders it pos- 3°4 DISEASE GERMS. sible to continue the treatment for a long time without inter- mission. No phenomena of bromidism have been noticed; no cutaneous accidents, nor loss of memory, or diminution in sexual functions. Every one is familiar with the grave result of the bromide treatment upon the general health of epileptics. Bromide of gold is more rapid in its effects, and gives rise to none of these very disagreeable phenomena. Another point worthy of attention is that the effect is lasting, and remains sometimes for many years without other treatment and with no return of the epileptic attacks. Bromide of potassa is a salt of high diffusive power, readily entering and quickly leaving the blood, it should be given freely diluted with water on an empty stomach, otherwise, part of it escapes from the system without being absorbed. Besides, its well-known power in producing anesthesia of the*medulla oblongata, thus diminishing central irritation, it has a similar effect on the motor and sensory nerves. Bromide of lithium is a more powerful salt than the potassium, containing more bro- mine, but is not efficient in epilepsy. The dose of the bromide of potassa should be from forty to sixty grains per day; not one grain more should be given than the quantity required. The addition of the bicarbonate of potassa in the one prescrip- tion and carbonate of ammonia in the other, increases the action of the bromine materially; besides, they are antacid and pro- tect the stomach against brominism. The rule is, bromine enough to act successfully on the bulb, but not to produce a catarrhal condition of mucous membrane with a train of miserable symp- toms in which the remedy must be stopped. Bromide operates best on the heavy fits; it has less effect on the light. What is really the value of the bromides in chorea and epilepsy due to the germs of tubercle, syphilis, or starved brain areas? We cannot correctly appreciate. A weakened patch in the brain or bulb, with either of those two disease germs in the blood, will give rise to epilepsy. An imperfect nutrition or weakened patch in brain and cord, with impaired nutrition of the nervous ganglia, or group of nerve cells, with the same or other germs present, will give rise to chorea. Besides, there are the ordinary reflex causes. The two affections demand an alterative and tonic course of remedies, —all the time—with repeated small blisters of about the size of a silver dollar, to nape of neck, for six hours daily, twice a week, as there is always a co-existence of spinal tenderness, greater spinal impressibility and other hybrid ailments. In addition nothing should militate against the use of avena sativa day by day, as the tissues are starved. It increases the motor power of BACTERICIDES. 305 the heart, tones the nerves, increases the number of nerve cells, overcomes the want of equilibrium between 'the grey and white matter of the cord ; relieves insomnia, overcomes mental weak- ness, and incoordination of muscles. If, however, the motor phenomena are peculiarly violent, the patient must have rest— rest from excitement, from noise, from harsh words, from taking an active part in the struggle of life. We do not endorse the use of the bromides in either; it is true they suspend the reflex impressibility of the medulla oblon- gata—the seat of reflex action—but it is also too true that they diminish nervous energy ; true vital stamina is lowered; motor and sentient power diminish under their use. They soothe, dis- pose to sleep, but they blunt the intellectual faculties, impair the memory, confuse the ideas, render the individual dull, stupid, apathetic, with a tendency to somnolence. They impede speech, weaken special senses, make the body infirm, feeble, unsteady. Its effects on the ovaries and testes are to destroy, or obliterate the secreting cells ; being analogous to castration, so that sexual power is abolished. The bromides devitalize the mucous mem- brane of the stomach, give rise to gastric catarrh (sarcina ven- triculi) nausea, flatulence, etc. It also slows the heart, covers the skin with acne (the bromine rash). Now none of these symptoms are produced by the ozonized fluid extract sambul. It has precisely the same action upon suspending the fits or the choreaic twitching, but never impairs, nor damages, nor atrophies the sexual apparatus. The bromide craze has had its day. Many brilliant minds have been wrecked, by its indiscriminate use; it has caused impotency to be very general, and sterility exists from its use to a very alarming degree. Simulo, for epilepsy, nervous and hysterical cases, has not realized the anticipations formed of it. Its properties are iden^ tical with the fl. ext. or essence of hyssop. It is a germicide of some power, but not efficient in epilepsy, and cannot cure it. True, if suitable cases are selected, those due to disease germs, it will do work, but never can make the inroad on the weakened bulb which is effected by the sambul. (Enanthe Crocata, or cowbane, is conspicuous as a remedy in epilepsy, it succeeds in warding off fits by arresting the molecular activity of the brain ; it is worthy of a trial. The tincture of cocculus indicus in ten-drop doses, morning and night, and gradually increased until it produces cerebral conges- tion. The drug keeps the cephalic vessels in a state of relaxation and thus prevents the vascular spasm which produces cerebral anaemia, the fundamental condition of the initial stage of an epi- leptic attack. It is most useful in old chronic cases, in which 20 306 DISEASE GERMS. bromine and sambul have failed. The remedy must be carefully guarded. Exalgine possesses some remarkable properties in epilepsy in certain cases; its action resembles the bromides—that to obtain its effects, it must be given in large doses and persevered with. Osmic acid, alternated with nitro-glycerine, has met with success. Other remedies often of utility are the mono-bromide of cam- phor, valerianate of zinc, cannabis indica, conium, Fowler's solution, sclerotinic acid, Chian turpentine; Calabar beans, lobelia. The elucidation of the germ theory of disease with its bac- tericide remedies has clearly shown that many obscure brain lesions are due to disease germs and uric acid in the blood. Many epileptiform seizures are preceded by hemicrania, and are readily kept in check by peroxide of hydrogen, uric acid solvent, etc. The use of these remedies in epilepsy bids fair to bnng this hitherto stubborn affection within the class of diseases amenable to treatment. It is therefore a good plan in all cases, after ward- ing off the fits either with ozonized extract of sambul or some other remedy, to place the patient upon some efficient bacteri- cide ; such a course is attended with most marvellous results. If it is a boy or young man with short hair, an ointment of equal parts of chloral hydrate and camphor dissolved in vaseline should be rubbed into the entire scalp at bedtime; in case of a lady, well up in nape of neck. It is a valuable help, whether it acts by continuity of tissue or by causing some molecular altera- tion in the periphery of the nerves and occasioning the same alteration in the nerve trunks, or in their nuclei, or by reflex ac- tion, it is impossible to say. The liver and colon should be roused into action by compound licorice powder and colocynth. There is a la-ge number of cases where the central irritation is kept up by eccentric causes, as a worm, fistula, tight or elongated prepuce, or clitoris, which latter being removed, the central irritation is easily combated by the application of ice to the sympathetic nerve which issues from the last cervical and upper dorsal vertebrae, and by small doses of the bromine. The value of ice is effective in proportion to the youth of the patient and acuteness of the case. It is rarely bene- ficial in the chronic epilepsy of adults. Young children, from one to six years, sleeping in closed rooms, are subject to frequent attacks at night of screaming, with insensi- bility and semi-convulsions, due to the protracted inhalation of air deficient in oxygen and laden with carbonic acid gas. For this the chlorate of potassa is a sovereign remedy, and for the true convulsion and epileptic attacks in children it often proves curative. It is of no utility in the adult, unless combined with bromide. BACTERICIDES. 307 While warding off attacks, remove the cause if it is admissible. In distinguishing the true epilepsy from the feigned, the follow- ing are good landmarks for a guide. In the feigned, the patient does not fall violently but deliberately, to avoid injury; eyes are closed but pupils contract to the stimulus of the light; "tongue and lips never bitten; face red, congested instead of being pale; skin healthy; blow snuff into the nostrils and patient sneezes. A proposition to apply the actual cautery to the spine effects an in- stant and permanent cure. In infantile epilepsy, we must look for falls, blows, teething, irri- tation of the stomach and bowels, worms, and remove by lancing gums, emetics, cathartics and vermifuge remedies. If caused by fright or mental emotion, aconite, belladonna, hyos- cyamus, citrate of caffeine, etc. If caused by indigestible substances, emetics, compound anti- bilious pills, etc. If by worms, the active principle of pomegranate root, valdivine. If by suppressed menstruation, compound betin pills, warm teas, etc. If by masturbation, large doses of tincture of green root gel- semium, with circumcision and shortening clitoris. If caused by blood disease-germs, as tubercle, syphilis, etc., iodine, glycerite of ozone and water, nitric acid in compound tincture of cinchona, iodide of potassa, phytolacca, general altera- tives and tonics, as laid down under each; and in all cases, either repeated blisters or irritating plasters, or the antimonial plasters below nape of neck, an open sore, so as to attract the germs of disease to another pasture-field, away from the vital organ—the brain. The bioplasm of normal nutrition, changed, Erysipelatas. altered, degraded by adverse conditions preju- dicial to vitality into a disease germ. The mi- crococcus erysipelatous is very small, consisting of minute cocci in chains, found in the mouth, breath, blood, kidneys and in the erysipelatous blush. They occupy the lymphatics of the skin and spread along them as the disease advances or progresses. At the margin of the erysipelatous zone, where the microbes are multiplying by millions, marked by the characteristic redness and swelling, the lymph glands are filled with zooglcea of micro- cocci, and the injection of these vessels keeps pace with microbe growth. Artificial culture of the germ succeeds well in almost any nu- trient fluid; such cultures or even successive cultures inoculated into animals, produce erysipelas. 3o8 DISEASE GERMS. Streptococcus erysipelas. The presence of this germ in the blood of an individual gives rise to languor, lassitude, debility, pain in the head, back, calves of the legs, tongue coated with a heavy brown bacterial coat, usually constipation, albuminuria, rigors on the sprouting of the germ, and a high grade of fever, either prior or subsequent to the chill an inflammatory blush upon some part of the skin which was accidentally weakened. This inflammation of theskin is thus accounted for by micrographers, the streptococcus erysipelatous, having used up in their own growth, nutrition and multiplication all the oxidizable properties in the blood, and are in danger of starvation, becoming weak and attenuated, seek the cutaneous surface to have free access to oxygen. Here they received an infusion of new life and vigor, and have an unprecedented growth, spreading widely, but invariably selecting weak or devitalized parts, where the vessels are weak and patulous. The most successful treatment consists in annihilating the germ, overcoming malnutrition, arresting germ evolution. To sterilize and annihilate the microbe: Internally try either brewers' yeast or ozone water; or resor- cin or compound tincture kurchicine, or lactic acid; sulphide of lime. Locally, try either satu- rated solution of borogly- ceride or ichthyol, one drachm of the latter to the ounce of distilled water; painting it on every four hours, forms a complete protection, under which microbes die. Literally speaking, ichthyol is no antiseptic, in itself it cannot destroy the erysipelatous cocci, but it starves the nutrient soil, so that the skin is no suitable location for their multiplication. But the solution of boroglyceride is the remedy which annihilates, and that speedily ; a remedy one can depend on to wipe out every microbe. Section of the skin in erysipelas. The microbe breeding in the lymphatics in chains; multiplied iooa diameters. This invariably depends on the presence of a Erythema, germ, and is the name given to an eruption of the skin which is attended bya diffuse redness over a larger or smaller tract of skin. This disease is something like BACTERICIDES. 309 a mild attack of erysipelas, and in some cases may shade into it, but it is much less severe in character, and although troublesome, is not dangerous. Unlike erysipelas, it is not confined to the face and head particularly; it is not attended with inflammation of the true skin, nor with any marked pain or fever. When the skin is dry, as in old people, and when it has somewhat lost its elasticity, it is very apt to become erythematous ; the face and neck may become in this condition from walking out in a cold northeast wind. These simple cases may be treated by resting the affected part, keeping it covered up from the air, and bathing it with tepid water several times a day. Another kind, which is more impor- tant, but still very curable, has been styled erythema nodosum. It is generally seen in children, and is found in the form of dirty purplish patches in front of the ankles. These are raised above the surface, and are painful on pressure; they are worse after walking about. This state is due to blood and serum being effused under the skin, and it is thus different from the other va- riety. With rest in bed, plenty of nourishing diet, such as milk, meat, strong beef tea or broth, and a little medicine of a tonic character, such as fluid extract of yellow dock, four ounces; ace- tate potass, half an ounce; tincture nux vomica, two drachms. Mix. Dose, a teaspoonful every three hours. Dusting the erup- tion with the anti-microbe powder, a cure soon takes place. This form is sometimes met with in cases of rheumatic fever. It more frequently affects young women and girls than the male sex ; yet it is met with in feeble boys. There is slight fever with it, and a feeling of languor and discomfort. Red, elevated spots, oval in form, then come out in a few days, and they are generally situated along the length of the limb qr in a vertical direction. The lumps in a short time become purple, as if they were cold, and this in time dies away, leaving no mark behind. The disease, when it occurs, is met with in debilitated persons, and therefore measures should be taken to improve the general health. A cutaneous disorder, affecting chiefly those Erythrasma. regions of the body where exposed surfaces of the skin are in contact, characterized by ery- thema, rose-shaped maculations, and due to the presence of microsporon missitissimum. The growth is in the superficial layers of the epidermis. The fungus to which this disease is attributed is remarkable for the extraordinary delicacy and fineness of its threads and spores. They are cylindrical bodies of variable size, inextricably inter- 3io DISEASE GERMS. woven. Bacteria and heaps of zooglcea are visible among the scales. It is easily recognized by being encountered only when op- posed surfaces of the skin yellow and light or dark orange. The most successful remedies are either the boroglyceride paste or lotion, anti-microbe powder, with improvement of the general health. The elements of nutrition, under adverse Fatty conditions to vitality, can be altered, changed Degeneration, modified or degraded into other living mat- ter, which constitutes a diseased germ, such as cancer, syphilis, tubertula. Independent of this, living matter can be degenerated, the in- fluence of the formative force which builds, maintains existence, and then dies, leaving behind a tissue or structure of an organ, worn out, effete, useless, adds to the general state of general dis- solution. Degeneration is an indicator of advancing age, a necrobrosis, as we begin to live, we begin to die. Another special form of degeneration is the result of disease, slow, certain ; a slight, but continuous failure of nutrition, in which we recognize fibroid, fatty, pigmentary, calcareous, athero- matous degenerations of arteries, glands, nerves, which aggra- vate all maladies. ------- is usually met with in one. or other Fatty Degeneration of two forms ; that is, fatty tissue may of the Heart usurp its muscular structure, or there may be an accumulation of fat upon its surface so great as to interfere with its systolic and diastolic action. BACTERICIDES. 3H The causes of fatty degeneration of the heart are evidently those things which interfere with the nutrition of the heart. It is essentially a disease of middle life, associated or blended with senile decay, predisposed to by the use of tobacco, fast liv- ing, chronic alcoholism, systemic syphilis, gout, rheumatism ; states or conditions which directly enervate the heart, give it a tendency to degenerative changes. In addition a want of nutri- tion may be the result of atheroma, or calcification of the coro- nary arteries; embolism, obstruction, or to the use or absorption of phosphorus; to the action of the yellow fever fungus on the liver. Fatty infiltration of the heart is directly caused by beer drink- ing and various other vices of modern society. In its occurrence, the changes noticed are a want of nutrition; muscular structure becomes pale, loses its contractility, because its nuclei and muscular tissue begin to disappear, become completely granular, anaemic, filled with albuminoid matter; oil globules obliterate normal fibres. As the muscular structure degenerates it assumes a dirty buff brown or yellow color ; loses its elasticity, power of resistance. Breathing is difficult; heart liable to be hypertrophied. The coronary arteries either atheromatous, calcified or obliterated. When the fat accumulates upon the sur- face of the heart, it is liable to cause atropTiy with rupture. Fatty degeneration of the heart may go on unrecognized for quite a number of years, a pressing debility, a gradual inability to endure exertion for any length of time; sud- den fitS Of Suffocation, With Violent palplta- Teased fibres from the heart . ' r r in fatty degeneration. tion not infrequent; skin is pale, pasty, yellow color, extremities cold ; oedema not uncommon, espe- cially in old age ; digestion feeble; perspiration profuse on the slightest exertion; invariably suffering from difficult breathing after exercise; occasional pain about the heart; liver and kid- neys become affected, and as this takes place, respiration becomes irregular and feeble. Cardiac insufficiency is progressive; and simultaneously all the tissues of the body become soft, flabby, affording strong evidence of arterial degeneration; the arcus often present; temper irritable, depression of spirits ; disturbance of vision ; failure of memory, giddiness, vertigo; sudden cerebral anaemia during excitement; syncope, epileptic fits; pulse variable in force, but feeble, yet accelerated. Later on angina pectoris ; the apex heart-beat is indistinct; no impulse can be detected. . 312 DISEASE GERMS. The prognosis is unfavorable, as the usurpation of the muscu- lar structure of the heart by fat has either a fatal termination by rupture or cerebral anaemia. No plan of treatment can be laid down which is positively curative. No drug or combination of drugs can restore degen- erated muscular fibre, but much good can be accomplished in ameliorating and retarding the disease by improving the tissue- making power of the blood, which is best effected by very gentle physical exercise in the open air, by bathing and persistent mas- sage, by good nutritious food. Our best remedies to increase fibrine are comp. tincture cin- chona and mineral acids; comp. tincture marticaria; cardiac stimulants, like digitalis, strophanthus, should be administered with great care. Tobacco, beer, alcohol, worry, care, should be avoided. occurs either as a general or partial Fatty Degeneration infiltration of the liver with fat, or as a of the Liver general metamorphosis of the structure of the gland into adipose tissue. Associated with this in all cases is a gradual, painless, enlarge- ment of the liver. The victims of this disease are generally in the middle period of life ; men who have been large consumers of fat or other hydro- carbons, as beer, alcohol, wine, with little physical exertion. The presence of certain disease germs in the blood give rise to fatty degeneration, such as the tuber- cular bacilli; the fungus of yellow fever, the microbe of typhoid, puer- peral, scarlet fever, variola, malaria, pyaemia. The use of certain drugs, as arsenic, antimony, phosphorus, ether, chloroform, tobacco ; old age, etc., produce certain changes in the blood, which give rise to fatty liver. Once a liver is infiltrated with fat, it increases in size, steadily and persistently, and commences to have a peculiar flattened appearance, a smooth surface; a pale brown or light color; a doughy, flabby feel, pits on pressure. Its capsule is tense, shin- ing, transparent; vessels become enlarged and tortuous. Cutting the liver with a warm knife, the blade is coated with oil globules, BACTERICIDES. 313 very little blood flows from the cut surface. If the patient died in a very early stage, the liver would be reticulated, dotted or mottled, of a dull yellow color. The central veins are intensely congested and pigmented with fat, or the whole substance may present a yellow appearance. It is not uncommon to meet with both fatty and amyloid de- posits in the same liver. An aggregation of fat in the liver varies considerably; small deposits the size of a pea, interspersed through the gland, large nodules or patches in the liver of beer drinkers; seventy-five per cent, of the entire organ is usurped by fat. There is always present in fatty liver, dyspepsia, flatulence, loss of appetite, want of nutrition, splenic enlargement, some pain over the liver, pain in the shoulders, dulness in the apex of right lung. The slightest indiscretion in eating or drinking causes attacks of gastric irritation and diarrhea. Gradually the patient becomes anaemic, moody, suffers a loss of muscular power with a disposition to sleep. The skin is pasty, and smooth, soft, and flabby. Difficult breathing results from loxaema, enlarged liver, ascites. If acholia be present, with pale, clay-colored stools, the hepatic degeneration speedily proceeds to a rapid termination. Fatty and waxy degeneration are often mistaken for each other, the history of the case when in doubt has an important bearing in diagnosis ; in the waxy form, a history of syphilis, disease of bone, suppuration, etc., are, or have been present; whereas in the fatty form, chronic alcoholism, high living, malaria. The blood is watery in fatty liver; an increase of the white corpuscles in the waxy, a fatty liver is soft, flabby; a waxy liver is hard. In waxy liver, faeces are pale, deficient in bile; in fatty liver, faeces are often normal till disease has become well advanced ; with a waxy liver, spleen invariably in same condition; with fatty liver, spleen often normal. Fatty liver is a disease invariably attended with great danger to life; death may take place at any moment from epileptic fits, apoplexy, or other grave lesion. Treatment can effect much in warding off, even if it cannot cure the disease; a restricted diet with no fat, sugar or starch ; regular daily open air exercise, with baths and massage. Resi- dence if possible in a temperate region, free from malaria; stop all alcoholic drinks gradually. A general alterative and tonic course inculcated, as comp. saxifraga, alternate with comp. tincture of matricaria, chionan- thus. 314 DISEASE GERMS. Usually the result of desquamative Fatty Degenerated nephritis, or Bright's disease. If it Kidneys. occurs without the precursory disease, intemperance and bad living may bring it about. Kidneys are usually large, pale, soft, doughy, and fatty. Symptoms.—A recapitulation of all the symptoms enumerated in Bright's disease, but greatly aggravated ; debility increases rapidly; the uriniferous aspect, pallor, and anaemia much intensi- fied ; the pulse is now irritable and frequent; there is general oedema; puffiness of face and hands ; frequent micturition ; dys- pepsia, with attacks of vomiting; a tendency to inflammation of the membranes of brain, pleura, peritonaeum, pericardium, and amaurosis, due to albuminuria, retinitis, and degeneration; anasarca of the limbs and dropsy of the cavities. Indications of uraemic poisoning show themselves often in convulsions, coma, etc. The urine in fatty degeneration from the very commence- ment exhibits oil-globules, is very scanty, low specific gravity, and highly albuminous. There are also cast-cells filled with oil, presenting the appearance of dark, opaque rrfasses, besides the oil-globules. When the urine is highly albuminous and presents a large number of oil-casts and cells, the case is to be regarded as a serious one, as they indicate an intractable form of the malady. In aged persons, especially females, con- Faecal fined to bed or leading very inactive lives, Accumulations, and in whom nervous sensibility is more or less dulled, faecal matter is now and then found to accumulate, and in time to become so hard and large as to resist the natural expulsive action of the bowel. Most liable to occur in the aged or infirm ; still examples of it are often found in young subjects. Enemata of warm glycerine, which is so valuable in constipa- tion, have a most excellent effect in relieving faecal accumulations, a warm thrill is experienced, penetrating through the intestines, followed by vermicular movement which precedes peristalsis, fol- lowed by an urgent call. Enemata form, without doubt, the most efficient means known for dealing with faecal accumulations. The injection should be copious, and should be given, when possible, in the knee-and- head, knee-and-elbow, or lateral abdominal position. The best material is water at a temperature of about ioo°, although some prefer mixtures of soap and water, or of turpentine and water, or of oil. No anesthetic should be used, so that the patient's sensa- BACTERICIDES. 315 tion may afford some test of the amount of pressure employed. If any symptoms are present that raise a suspicion of stercoral ulcers, it is needless to say that the injection should be conducted with the greatest caution. The fluid should be very slowly intro- duced, and should be forcibly retained for ten or fifteen minutes ; and while the colon is well occupied therewith the faecal mass should be gently kneaded. Massage is of great utility, a most potent mechanical tonic and vitalizer. In its application the patient lies upon his back ; the hands of the operator are oiled, and, with the fingers widely opened, both palms are laid upon the abdomen ; the hands are made to pass systematically in various directions; the pressure exercised is steady and deep, and the movements are slow; the manipulation on each occasion should extend over fifteen or twenty minutes, and should be repeated at such intervals as may be considered advisable. It is a mechanical agent, influencing the stercoral mass and modifying its position ; it is a stimulant, an exciter of the peris- taltic wave through the abdominal nerves which contain both excitatory and inhibitory fibres—a therapeutic measure of great value. A condition in which the vital forces have received Fever, a shock and are struggling to regain their supremacy —an effort of impaired vital forces at restoration. The common causes of all fevers are disease germs and their ptomaines. The mode or manner of ingress of microbes into the body is still an unsettled question. The action of heat and cold, mechan- ical injuries of all kinds, poisons, may so degrade, alter, change elementary molecules into other living matter, or simply depress the vital forces and pave the way for the ready ingress of disease germs from without, such as the germs of malaria. The ordinary symptoms of fever are languor, lassitude, debility, pain in the head, back, and calves of the legs, rigors, high heat, frequent pulse and respirations, with derangement of the secretions. The poison or living germinal matter that produces these symptoms may have gained access to the patient's body through the air, or water, or food, or it may be the degraded or changed living matter of his own body. The salivary glands of the mouth are the most eligible channels of a poison gaining access to our bodies. This is apparent by the disturbance of the stomach. Once the poison has gained admission and found its way into the blood, it grows with great rapidity, and is diffused throughout 3 16 DISEASE GERMS. the entire body, disturbing the vitality of organic living matter with which it comes in contact. The destruction caused by fever or germ-disease involves every constituent of the body. General nervous depression is the characteristic of all fevers. The prostration, rigors, headache, with pain in the back and calves of the legs, denote a partial death of the nervous system. Pain exists in every sensient nerve in the body, but is experienced most keenly by the patient in the large superficial sensient nerves of the back and calves of the leg. In fever we have a diminution of evaporation, the dormant skin does not act as a refrigerator, destructive metamorphosis is great, the semi-vital chemical changes raise the temperature,—there is rapid oxidation, the passage of organic into inorganic matter, the blood loaded with germinal matter; and its growth together with the irritation of brain and the eighth pair of nerves that supply the liver, causing an excessive secretion of glucose, all of which go to explain the heat of fever. The controlling action of the brain being impaired, the heart and lungs are irritable, and their action accelerated. The brain needs more vital force to hold them in check. All the secretions and excretions are depraved. The termination of fever is either recovery or death; the former may in some cases be imperfect, terminating in other forms cf disease, as anaemia, paralysis, etc. Some fevers, due to disease germs, a specific contagion, have a definite period of existence in the body, which limits their duration. Nearly all contagious diseases are of this class. Fevers are easily recognized by their symptoms: languor,pain in the head, back, calves of legs, rigors, with high heat, frequent pulse and respirations, with perverted secretions. If the heat of fever does not exceed 1030 Fahr., with favorable surroundings, hygiene, nursing, and no irreparable lesion, good hopes may be entertained of rapid recovery. The treatment of all fevers is based upon certain, well defined rules, viz.: Either sterilize, kill, or annihilate the microbe, the factor of the fever, and to maintain the vitality of the patient. To arrest in all cases, the destructive metamorphosis of the disease germ, bactericides must be administered; these are the true remedies to lower temperature, reduce the action of the heart, diminish the respirations. In the incipient stage of all fevers, very great benefit is derived from an emetic to unload the stomach, an active or gentle cathartic to relieve the bowels, and an alcoholic vapor bath or some form of bathing to start the function of the skin. The utility of an emetic is apparent; the living poison that BACTERICIDES. 3>7 probably caused the fever has been taken in by the salivary glands, swallowed, and lowers the vitality of the stomach. It loathes food, fails to digest, and the symptoms are much ameliorated by an emetic. Before administering this, the patient should drink freely of tepid water with a small amount of bicarbonate of soda, so as to neutralize the acid secretion from the walls of the stom- ach. Following the emetic, the alcoholic vapor bath, then the cathartic. Typhoid fever is the solitary exception among all fevers to the use of purgatives ; in that fever they are not admis- sible, except in some rare instances. If the patient is unable to sit up or very young, or pregnant, instead of the alcoholic vapor bath, sponging the entire body should be resorted to with tepid alkaline water. In some cases vinegar is a good addition. Then the regular treatment for the case should be laid down. The room selected for the* patient during his illness should, if possible, be isolated, well ventilated, no draught, abundance of light, free from carpets, curtains, and paper on the walls, as they retain the seeds of disease. If possible, an open fire-place, and if the season permits, a fire, so as to destroy the disease-germs as they escape from the patient. If convenient, two beds should be placed in the apartment, so that the patient's clothing and bed- clothing can be changed daily, and he lifted from one bed to the other. In all cases the head of the bed should be placed to the north, feet to the south, and insulated from the floor with glass castors or pieces of glass, so that the patient may be in unison with the magnetic law of the earth. The greatest cleanliness should be observed. When clothing and bed-clothing are re- moved, they should at once be immersed in water with an anti- septic. No unused food should be permitted to remain in the room. Antiseptics, such as chloride of lime or carbolic acid, buckets of water with bromine, or iodine, or permanganate of potassa, should be exposed in different corners of the apartment. If a nurse is to be selected, let her be young, strong, vigorous; few attendants except the nurse, so that the contagion be limited as far as possible. All superfluous matter should be kept away from the patient, even books. Magazines and papers should never be permitted to get out; after perusal they should be destroyed. In all cases the hair should be cut short and the cut portion de- stroyed or deodorized. The recumbent posture is the true one, it retains the nervo-vital fluid in the spinal cavity and not in the cranium, and gives a diminution of pulse of at least ten or twelve beats per minute, with a corresponding lowering of heat and re- spirations. The entire body should be sponged three times daily with an alkaline wash, such as castile soap and warm water, or 3i8 DISEASE GERMS. bicarbonate of potash and tepid water, well dried, and then rubbed with the drv hand. It is sometimes beneficial to follow this with vinegar and water, which is cooling and grateful to the patient and 'excites the normal alkaline secretion from the skin. The alkaline bathing removes the disease-germs, opens up the emunc- tories of the skin; the rubbing with the dry hand dislodges the disease-o-erms from the capillaries, removes the stagnation in the microscopical circulation, and the reflex effect of it is highly vita- lizing to the medulla oblongata, the seat of reflex action and life. Besides, the inherent vitality of the nurse is in this manner com- municated to the patient, so that instead of elderly ladies being selected for nurses, we demand the young and healthy. The law of reflex emanation is definite: we assimilate the vital condition of those with whom we are brought in contact. In exhausting fevers, like typhoid, good results are derived from the inunction of warm olive oil after the sponging and dry- ing off. This aids nutrition, supplies the place of arrested seba- ceous follicles, and softens the skin, for exhalation attracts the germs to the surface and smothers it. Oil is perfectly compatible in the living tissues. " Physiological chemistry explains the imperative necessity of drink in fevers. Water requires to be in excess of the demand; acidulated drinks of water, with a few drops of acetic or hydro- chloric acid, enable the albumen to be acted on by the gastric juice. All acid substances have the power of increasing the nor- mal alkaline secretions of the body. Apply heat to the feet in all cases of fever, for though the action of the heart is violent, yet it lacks the stamina or power to send the blood to the capillaries; besides, the nervous system, upon which the circulation depends, is incapable of performing its function in aiding the circulation, and artificial heat aids in a renewal of life. As to the clothing of the patient, cotton and linen should be avoided, and woolen or silk preferred as con- servators of vital force and being impervious to atmospheric changes. In fever the nitrogenous tissues are devitalized, drained away, and it is important that they should be replaced, so that small doses of nitrogenous aliment should be given frequently. These pass over the irritated stomach unconsciously, and are taken up by the iacteals in the intestines, requiring very little to make them fit for absorption. The most suitable food is milk. It forms the most appropriate nourishment for fever patients. Two to three ounces should be given every two hours with half a tea- spoonful of lime-water. If it disagrees, substitute beef tea for the milk. If the patient is properly nourished, it renders the BACTERICIDES. 319 danger much less. Albumen, such as we possess in eggs and oysters, is highly nutritious if quickly absorbed, but if delayed, as they are likely to be by the impaired condition of the stomach, their decomposition is highly injurious—the sulphuretted hydro- gen and other gases evolved are so poisonous that an aggrava- tion of symptoms is the result. A good condition of gastric power is necessary for the digestion of eggs and oysters. Alcohol is a poor stimulant; it has no food or blood-forming faculty; its only property in fever is an arrester of destructive metamorphosis or change, so with reference to its use in fevers we must be guided by the amount of disintegration going on. If there is great prostration, low muttering, delirium, excessive phosphatic elimination by the kidneys, it should be given. It acts well if there is tremor of the muscles, a sharp, weak, un- equal pulse, or rapid respiration. Sleep is most essential in fever. It is only during sleep that the brain picks up its nutrition or pabulum from the blood. There is no nutrition without sleep. In our pathology of fever, we recognized the microbe as its factor, depressed vital force, as the condition or sphere of exist- ence of microbial life. Bactericides must be administered every hour; just as they kill the germ, temperature is lowered, respira- tions and pulse become normal; if indications exist administer either aconite or antipyrine, or veratrum or antifebrine, or gelse- mium or exalgine. Careful nutrition and nursing. The division of fevers, now that the germ origin of disease is thoroughly established, must be as follows : Simple Fever, Dengue, Gastric Fever, Cerebro-spinal Meningitis, Bilious Types of Fever, Puerperal Fever, Malarial Fever, Surgical Fever, Relapsing Fever, Measles, Typhoid Fever, Scarlet Fever, Yellow F^ever, Small-Pox. One-day fever, the simplest type of fever, re- Fever, suiting from a slight shock to the nervous sys- Ephemeral. tern, rigor and a fever, in which the vital forces, aided or otherwise, react in twenty-four hours, or a few days at most. The cause is usually cold, wet, exposure, overwork, mental de- pression. The usual symptoms are: the patient is seized with lassitude, debility, nausea, want of appetite, chilliness, pain in head, back, 320 DISEASE GERMS. limbs. After a few hours rigors and fever, high heat, frequent pulse and respirations, headache, thirst, constipation, dry skin, scanty urine, perhaps slight delirium ; symptoms aggravated at night. After a few days a remission; critical sweating or diar- rhea. Convalescence often somewhat slow. It usually terminates in recovery. It is easily recognized by its cause, mildness, short duration, by its common occurrence in children, persons of feeble vital force, and nursing women. In the treatment general principles are to be followed out; if there be much nausea or disposition to vomit, a very mild emetic may be useful, and open the bowels with some saline. A warm or a Turkish bath, or alcoholic vapor bath, or one or two doses of fluid extract jaborandi should be resorted to to excite the action of the skin and stimulate the periphery of nerves. Patient must remain in bed, recumbent posture, then one or other of the following remedies should be administered: aconite.an- tipyrine or exalgine, in doses sufficient to lower temperature, pulse, respirations. Whichever one is selected, it should be alternated with a bactericide, as a few drops of peroxide of hydrogen or compound oxygen. This latter is essential, as the breath, saliva, tongue, are loaded with a conglomerated mass of micro- organisms. Just as soon as fever abates a good tonic should be adminis- tered, as compound tincture of cinchona or matricaria. As recovery progresses, diet should be more liberal; compli- cations guarded, every symptom promply relieved. So called, because induced by some agent Gastric Fever, which irritates and weakens the stomach, and causes a perversion of normal nutrition, and the appearance in the mouth, saliva, breath and coating of the tongue, the bacteria as seen in this illustration. It is almost exclusively peculiar to children, and its origin can be traced to eating pastry, cabbage, nuts, candies ; alcohol. There is a period of prostration, during which the child suf- fers from languor, lassitude, debility, nausea,.vomiting, followed ' by rigors and a fever, in which the predominating symptoms are nausea, vomiting, pain over the region of the stomach; acid or fetid breath, white-coated tongue are always present. Its duration is from seven to fourteen days, and if properly * treated terminates in recovery. It is easily recognized by its history, derangement of stomach, BACTERICIDES. 321 nausea, vomiting, white coat on tongue, irritation of brain, and the entire absence of any other type of fever, and that it is pe- culiar to children. Treatment.—As soon as recognized, give the little sufferer an emetic. The peculiar shape of a child's stomach enables it to vomit easily and effectively. To very young children the wine of ipecac, to those more advanced in years an infusion of lobelia. In all cases precede the emetic with drinks of tepid water with bicarbonate of soda, so as to neutralize the acid secretions of the stomach and permit of an easy absorption of the emetic, and a thorough washing out of the stomach; follow this with a warm alkaline bath, then give a teaspoonful of the neutralizing mixture with one grain of leptandrin, every hour, until a free movement of the bowels is obtained. While pursuing the above treatment, aconite, veratrum, and sweet spirits of nitre should be given as in the preced- ing fever. Another excellent plan of treatment even better than the above, would be to start in and persevere with one or other of the following germicides. Ten grains of resorcin could be ad- ministered in water every three hours, or a few drops of the peroxide of hydro- gen or salicylate soda in the liquor ammonia acetatis ; or com. oxygen ; or ozonized sulphur water, etc. If there is still a disposition to nausea or vomiting, apply a plaster made of pulverized cloves, allspice and capsicum, moistened with vinegar, over the region of the stomach, and give milk and lime-water in very small quantities every two hours, for diet. Give the stomach all the rest possible ; as a drink, boiled water on toast or crackers, or barley-water. Several days after the fever has entirely disappeared is the proper time for tonics, as the wine bitters, elixir cinchona, sul- phate cinchonine. Otherwise, the treatment should be the same as for fevers generally, especially insisting upon rest in the recumbent posture, and sponging the body thrice daily. 21 The bacteria—the degraded bio- plasm of nutrition—the prevail- ing microbe of mal-nutrition— gastric fever. 322 DISEASE GERMS. A fever induced by some shock to the Simple liver. Bilious Fever. The common causes are blows, articles of dress irritating the liver, microbes in the blood, as syphilis, and mercury, eating and drinking excessively of carbonaceous articles. The ordinary symptoms are prostration, in which we have lan- guor, lassitude, debility, nausea, vomiting, brown-coated tongue, yellow skin, pain perhaps over the region of the liver or in the shoulder, constipation or diarrhea, with rigors and fever, the yellowness of the skin increasing and heavily tinging the white of the eye, with dulness, stupor, coma, and itching of the skin, This simple form of bilious fever should be managed with great care, and a most active treatment in all cases resorted to. Exalgine should be administered in proper doses to lower temperature and equalize the circulation, the surface should be bathed thrice daily; stimulants should be applied over the region of the liver. The bowels should be opened by some remedy calculated to stimulate the liver, as either phosphate of soda and chloride of ammonia; or euonymine and caffeine. Those remedies act well as liver stimulants. As a rule the case progresses well under these mild remedies. Just as febrile action is effectually controlled, the following acts most efficiently: Comp. tincture cinchona and simple syrup, of each two ounces; nitro-muriatic acid, two drachms; water, half pint. Dose, a tablespoonful every three hours. Other cases again can be managed by the administration of exalgine, and small doses of either the kola-nut paste or cas- cara sagrada lozenges. This latter remedy is of great utility in all states in which the liver has suffered damage. Diet, malted sterilized milk, arrow-root, and other simple articles. Intermittent fever or ague, whose chief character- Malarial istics are that it has febrile paroxysms, coming on at Fever. a definite specific time, usually, but not always, ushered in with a chill, followed by a fever, ending in a critical sweat, and during the intermissions or remissions, there is an interval of apparent good health, and at the end of a certain interval, the phenomena of rigor, fever and sweat are repeated again and again, until a cure is effected. The cause of this peculiar type of fever is the spore or germ of decaying vegetable matter, acted on by solar heat exceeding 75 or 8o° F., becomes active. The germ or spores may come from any decaying matter whether it be on the ground, in a marsh, in the soil or ground, stagnant pool, or water we drink. BACTERICIDES. 323 In all countries whose temperature exceeds 8o° F., and decay- ing vegetable matter present, there is a bacillus evolved which, under favorable circumstances, enters the body either by air breathed, or water drank, or by endosmosis through the skin. Once the germ enters the blood, if vital force is normal, it will be repelled, ousted out; but let vitality be depreciated, the bacillus will grow, sprout, seed, evolve spores, cause grave changes in the blood and vital organs. The bacillus is found in the blood of the patient during the rigor, as in the annexed cut, while during the sweat or decline only spores are found. The same microscopic organism is found in malarial sections in a strata of air which floats above the ground. The microbe is pathogenic, capable of cultivation, the cultures injected into animals produce the dis- ease, the microbe being found in the spleen, lymphatics and pink marrow of the bones. The fact that the bacillus and its spores are successively found in the blood explains the intermittent type of the fever. Vegetable decomposition is the source of the germ. From the ponderable character of the spores, they lie close to the ground, so that r ' J . r n 1 1 he bacillus of malaria. those who sleep in the first floor lower rooms of dwellings are easily contaminated with it. Fires destroy them, hence the denizens of large cities, as a rule, are exempt from their attack. Certain trees which evolve ozone, as the willow, magnolia, eucalyptus, pine, are, by the pungent, grateful odor emitted, inimical to germ and spore, causing their destruction. The germ of malarial fevers is an organic germ •floating in the air we breathe, and capable of introduction into our bodies through the food we eat or the water we drink. The pathologi- cal effects of the germ upon the human organism are protean in their forms, varying from the intense saturation of the system to the slightest degree. No organ in the body escapes the influence of the germ. The characteristics of the bacillus are its periodicy, the com- plete evolution may demand twenty-four, forty-eight or seventy- two hours ; the access, the rigor corresponds with the greatest ac- tivity of the bacillus, and which precedes the emission of spores. When the paroxysms occur at the same hour every day, the fever is called quotidian ; when every other day, tertian; and when absent for two whole days and then recur, quartan. In the quotidian, the interval is twenty-four hours ; in the tertian, forty- eight hours, and in the quartan, seventy-two hours. The period between the termination of one paroxysm and the commencement 324 DISEASE GERMS. of the next is the intermission. In the quotidian form, the paroxysms occur for the most part in the morning; in the tertian, at noon ; in the quartan, in the afternoon. Besides these forms, we meet with cases occurring once a week, once a month, once a year. Any type may be double, that is, occurring twice during its specified time. Once the sprouting is effected the newly-formed or full-fledged bacilli imbed themselves in the red corpuscles and cause crescen- tic pigmentation of the blood, with segmentation of the germ; if vital force be high, even normal, they will be repelled. The blood of man and do- mestic animals in whom the micro-organisms of malaria have entered, have the disease germ enter the interior of the red discs, in which they un- dergo changes, sprout, develop, grow. In their first attack upon the red corpuscles, they are of an amoeboid form, cause cres- centic pigmentation, as seen in the annexed wood-cut. As they grow older they assume the flagellated form, which is the adult condition of the germ. Any one can readily verify the fact by drawing a drop of blood from any part of the body; place it in the field of a microscope of 2500 diameters ; take a drop in the cold stage, and the amoeboid pig- mentation will be seen; take a drop in stage of decline, and the flagel- late protozoa are present in millions in a case of ordinary quotidian. The germs crowd the capillary vessels of the brain and the blood- forming glands, as the spleen, suprarenal capsules, pink marrow of bones, lymphatics. These, in chronic cases, are filled with dark granules, flagellate A beautiful microscopic illustration of the microbe of malaria. It is seen as a pigmented proto- plasmic body boring into the red corpuscles of the blood and destroying them in their process of growth, invariably present in all forms or stages of the disease. Truly diagnostic. This illustration exhibits the amrcba pigmented bodiesinthe red corpuscles, numerous free circular forms,a few crescents and several flagellate organisms. The adult form of the germ. BACTERICIDES. 325 organisms, with an undulating fin-like membrane, highly poly- morphic. In the tertian, quartan type, and in the comatose pernicious forms, the germs are most numerous and most destructive to the red corpuscles. An interesting practical point is still unsolved, which is, whether the micro-organism from decaying vegetable matter, when it enters the blood, coalesces with and destroys the red discs, or whether the microbe produces a special degradation of living matter, rriancrpt; it intr> the mirrnhe Typical example of the germ in the blood-forming CnangeS 1L 1UIU UlC IincrOIJC, glands> as the spleen, pink marrow, lymph canals. CaUSinc destructive meta- In the pernicious form the capillaries are literally . b . - , , stuffed with micrococci and microbes. morphosis of the red cor- puscles. One thing is certain, that the micro-organism is patho- genic of the disease, capable of culture ; cultures injected into animals produce the disease. Symptoms.—This fever may set in suddenly, or it may come on gradually with a feeling of general indisposition, which at the end of a few days may culminate in a regular paroxysm. An ague fit is composed of three stages, the cold, hot, and sweating. The cold stage is ushered in with feelings of languor, lassitude, debility, headache, pain in the back and limbs, chilliness. There are sensations as of cold water running down the back ; shiver- ing; the skin is shrivelled and the papillae rendered prominent, the skin assuming the appearance of a plucked goose (cutis anse- rina), resulting from irritation of the nerves that supply the microscopical muscles of that gland, which are called arrectores pilorum. The teeth chatter, the nails turn blue, and the whole body is shaken; there is exhaustion, often urgent thirst; the countenance is anxious; the features contracted; eyes dull and sunken; pulse feeble; respiration hurried or oppressed; mental irritability. The duration of this stage varies from a few minutes to several hours, and is succeeded by the hot or febrile stage. Then all the symptoms of fever are well defined : increased respiration ; more frequent pulse ; elevated temperature; parched mouth; excessive thirst; painful sense of fulness in the head; great restlessness ; irritability ; delirium. This stage may last a short time or for some hours. Then follows the sweating stage, beginning with a slight moisture on the forehead, then over the entire body. After its decline, all the symptoms become ameliorated, and the patient to all intents and purposes seems to be in perfect health until another paroxysm takes place. 326 DISEASE GERMS. Sometimes one or two of the three stages are absent. The general effects of this microbe are: I. More or less irritation of the brain, according to the amount of germs present and power of vital resistance. 2. A blood-disease is engendered ; that fluid is loaded with bacteria and malarial germs, and as they increase in number it becomes fibrinous or clotty, and dark colored. Such blood coagulates readily in the fine, delicate interstitial structure of the brain, in the granulated structure of the liver and kidneys, in the very vascular structure of the spleen, and even adheres in masses to the walls of arteries. When this condition has lasted months or years, a white-cell condition or leucocythemia is brought about. of the by the 3. This white-cell disease stage, and is brought about blood is properly the third malarial germ using up in its own nutrition the ele- ments of the red cor- puscles, aided by the mor- bid condition of an en- larged, indurated, or caked, or hypertrophied state of the spleen or an amyloid degeneration of other glands. This fever is easily recognized by the parox- ysms occurring with pe- riodicity, being ushered in • with rigors, followed with fever and a sweat. During the remissions an interval of apparent good health, but at the end of a cer- tain interval the phenom- ena are repeated. The morbid conditions are irritation of brain, liver, kidneys, spleen, with blood loaded with living disease-germs, creating an embolism of the blood. In all forms of shock there is a deter- mination of the capillary circulation to the internal viscera; the spleen, the safety-valve of the heart, suffers most, as the blood is driven inward. True, the congestion subsides during the inter- mission, but repeated attacks with the peculiar bacterial blood give rise to hypertrophy, induration, thrombosis. In the treatment of all forms of malarial fever, the great object in view is to maintain the vital forces by nourishment, bathing, comfortable clothing, and rest in the recumbent posture in bed. Destruction of the red corpusc les of the blood in the spleen by the microbe of malaria. BACTERICIDES. 327 During the different stages of the fever, the patient should be nursed and tided over as gently as possible—cold stage, diffusable stimulants; febrile stage, aconite ; during the sweat or decline, cooling drinks. During the interval, the bacillus, if possible, must be completely annihilated. There are several preparations of great value, in use for this purpose, they are either Warburg's tincture; or the concentrated tinct. of kurchicine; or eucalyptol. Each of the three remedies is equally good. One is to be selected, and administered according to the following directions: In any given case of malarial fever, of either the quotidian, tertian or quartan type, first open the bowels with an antibilious purge; then, three or four hours before the chill or paroxysm, administer either half an ounce or one large tablespoonful of the tincture, without any water; then follow just a little before the chill with another dose. It should be given undiluted, and no drink allowed between the doses. If the profuse perspiration and disintegration of dead germs prove exhausting, beef essence should be freely given. For ordinary fevers, much smaller doses are admissible. The remedy selected administered in smaller doses for seven consecutive days. (For additional formulae see Cinchona.) This occurs in the form of continued fever Remittent characterized by remissions. There is no cessa- Fever. tion of the fever, simply an abatement or diminu- tion. The period of remission varies from twelve to twenty-four hours, at the end of which time the feverish excitement increases, the exacerbation being often preceded by a chill. • The cause is the malarial germ, acting upon vital forces already exhausted. It varies greatly in its severity, according to the number of microbes present in the blood the peculiarities or type of the patient. Symptoms.—Usually commences with languor, lassitude, de- bility, mental depression, headache, shivering followed by high fever, vomiting, sometimes jaundice, often accompanied with delirium; pulse frequent and full; tongue dry and furred; nausea, vomiting, generally of bilious matter; sense of pain at the epi- gastrium, and tenderness on pressure, with signs of pulmonary congestion, great difficulty of breathing, a feeling of oppression at the chest, cough, and a livid color of the countenance. The urine is usually scanty, high-colored, and loaded with lithates, 328 DISEASE GERMS. but passed in increased quantities during the remission. Length of remission varies from six to twelve hours and from twelve to twenty-four hours; at the end of which time the feverish excite- ment increases and the exacerbation is usually preceded by chilliness and a rigor. Remission usually occurs in the morn- ing; the principal exacerbation is generally towards the evening. The disease may run on for some fourteen or fifteen days and end in an attack of sweating, or merge into typhoid or cerebro- spinal meningitis. The period of convalescence is usually short, except some organic mischief has occurred, in which case con- siderable time may elapse before a restoratiou to health is effected, the debility being kept up by night-sweats, sleeplessness, dyspepsia, neuralgia, jaundice, and dropsy. Complications.—The extreme severity of some cases, the de- pressed condition of the nervous and vascular systems, with defective secretions, the great exhaustion at the termination of a paroxysm, collapse, convulsions, or delirium, passing into drow- siness and coma, cerebro-spinal irritation, with gastric irritability, or with bronchitis, pneumonia, or with hepatitis, jaundice, diarrhea, or typhoid symptoms! The chief causes of the com- plications are great depression of vital power, with epidemic influence and improper treatment- As a rule the fever terminates in two weeks in recovery or some of its numerous complications. The diagnosis is important; a continued fever with remissions, when complications arise, other morbid states taking place, the points of recognition may be varied. In the treatment of remittent fever, general principles must guide us ; the state of the stomach, bowels and skin merit imme- diate attention. It must be borne in mind that the febrile exacer- bation is of longer duration and of greater intensity than in in- termittent, so there is more danger of structural lesion of brain, liver, spleen, stomach and kidneys, and our first great object should be to effectually equalize the circulation and mode- rate the excitement with a mixture composed of four ounces of water, to which is added one teaspoonful of tinctures of vera- trum viride, aconite, green root tincture of gelsemium and sweet spirits of nitre, one teaspoonful every half-hour until all febrile excitement has become ameliorated and the pulse down to seventy. Then begin with remedies to destroy the germ. For this purpose it is best to resort to a combined treatment of the two classes of remedies, so as to break it up. So that it is well to give quinine, either with prussiate of iron, or in the form of a bisulphate, that is, dissolving it with aromatic sulphuric acid in from one grain to several, every four hours. Give the two rerhe- BACTERICIDES. 329 dies alternately; if the above does not meet the indications. Then try either Warburg tincture or concentrated tincture of kurchichine, in half or one-teaspoonful doses every three hours. Bathing the entire body has a magical effect in procuring sleep. The diet should consist of beef tea or farinaceous food. Com- plications looked for and carefully guarded. If there seems to be much cerebral disturbance, active purgation, mustard to feet, head shaved and evaporating lotions of camphor-water and am- monia applied. If there is low delirium or exhaustion, or cere- bro-spinal irritation, dry cups followed by mustard poultices to nape of neck. Haematuria or a hemorrhage of blood from the kidneys is often present in both intermittent and remittent fevers. The general treatment of the fever must not be interfered with, but the patient promptly placed upon as large doses of the green root tincture of gelsemium as he can bsar, with dry heat over the loins, and a few drops of peroxide of hydrogen given. The bilious type of intermittent and remittent requires very nearly the same treatment. In these the force of the malarial and bacterial germs seems to be spent upon the liver, so that in those cases the tongue is heavily coated brown, there is nausea, vomiting, jaundice, diarrhea and other bilious symptoms ; a state that will require special attention in addition to the treatment being carried out for the fever, such as the following : five drops of nitro-muriatic acid every four hours in water, or an infusion of leptandra, drunk freely, or phosphate of soda. Some remedy to act efficiently upon the germs that block up the liver, managing the fever in the manner already indicated. A peculiar type of fever, intermediate be- Remittent tween malignant intermittent and dengue, Bilious Fever, occurring in individuals whose vital force is Malignant. low. The temperature runs high, action of the heart violent, skin jaundiced, stomach very irritable, tongue very heavily coated with a brown coat and black at the root; there is often delirium from the brain suffering from the ingress of microbes. Treatment here must be most energetic, large doses of bacter- icides must be administered, such as resorcin or creolin; the circulation controlled with exalgine, and either Warburg's tinc- ture or concentrated tincture of kurchicine administered freely. The case must be carefully guarded, and general principles will guide the selection of drugs. 330 DISEASE GERMS. Sometimes termed enteric or nervous fever, is Typhoid essentially contagious and infectious, owing to its Fever. origin in a disease germ. Various theories are set forth by nearly all authors, as to the origin of the microbe of typhoid fever. A certain class advocate the idea that its pristine condition is in sewage, that the contamination of our drinking water by sewers is one of the chief means of propagation ; others believe in the theory of the origin being in a low degree, as a spirillum placatile, and that by certain series of progression, passing through various stages of growth and development, it reaches the perfection of a full fledged microbe; others believe that under adverse states, the bioplasm of the nervous system is degraded . into other living matter, a disease germ, that in even very slight nervous depression, or shock, the change in the nutrition of the nervous system into a disease germ can be detected. But when there is great depression of the sympathetic and ganglionic nervous system, typhoid fever by this class of observers is re- garded as the climax of all nervous depression. They assert that the microbe, the factor of the fever, is simply the degraded bioplasm or living matter concerned in the nutrition of the nerve cell; that any condition of nerVe-depression may cause the change from normal nerve bioplasm into a disease germ, which, when once evolved, is capable of prodigious powers of growth and development; that the germ is so light (aerobic) that it will float in the atmosphere long distances, penetrate our wells, springs and brooks ; that the excretions of individuals so affected, passing into the earth either by cesspools or sewage pipes, con- taminate everything within its reach. Milk, raw or even cooked meat of animals or fowls, coming in contact with the germs in the air, may communicate the disease. The microbe of typhoid fever has a power, a potency which is incomprehensible. Whence this microbe originates, it is undecided. The predisposing causes are nervous prostration, mental strain, worry, exhaustion, overwork, depressing climatic states, solar heat, chills, damp exposure. The exciting cause is the microbe in the blood, which gives rise to those mysterious headaches, lassitude, goneness ; which are unclassified, unnamed, often unpitied, which distress the patient, puzzle the physician ; for the microbe only finds its abode in the weak, the feeble, the shattered. Symptoms.—Usually a period of incubation or germ-growth varying from ten to fourteen or even twenty-one days, in which languor, lassitude, debility, insidiously make their appearance, with headache, white face, sharp features, pain in back and calves BACTERICIDES. 33' of the legs, nausea, diarrhea, and chilliness. The rigors recur from time to time at uncertain intervals, with an aching all over. The rigors increase, and the patient is much prostrated. There may be vertigo, deafness, or epistaxis ; great headache ; intoler- ance of light; thirst; loss of appetite ; great nervous irritability ; restlessness; nostrils pinched; often a marked, circumscribed flush on each cheek; tongue at first white, with red edges and tip, later red and glazed, buff dry or brown; sordes on gums, pulse small, wiry, frequent, 100 to 120 or higher; temperature from 1010 to 1040 Fahr., higher in the evening; breath offensive and ammoniacal. These symptoms slowly become aggravated ; emaciation is great from the destructive action of the germ and imperfect renewal of tissue; continuous destruction ; defective supply. The solid constituents of the urine increase ; the ten- dency to diarrhea becomes greater ; great interstitial death ; rapid metamorphosis of the entire body. At the commencement of the second week, or a day or two earlier, the typhoid rash appears ; rose-colored spots on the chest and abdomen, few in number, circular, disappearing on pressure, and fading away to be replaced by a fresh crop. In ten or twelve per cent, of cases, no rash. It is a true petechia. After the mid- dle of the second week, tympanitis, gurgling in the right iliac fossa on pressure, diarrhea, stools alkaline, of a pea-soup appear- ance. If there is extreme debility with profuse sweating there may be sudamina, or small watery blebs on neck, chest, or abdo- men. There may be other symptoms present, as violent delirium, spasmodic contractions of the muscles, picking at the bedclothes, subsultus, hiccough, tinnitus aurium or deafness, muscular pains, prostration, bed-sores, and attacks of hemorrhage from the ulcer- ated patches in the ileum and perforation of the bowel, with fatal hemorrhage and peritonitis. Congestion of the kidney, cerebral or pulmonary complications; the latter is the most common and most to be dreaded, and is easily recognized by the flush on right cheek ; cough, rusty sputa, dulness on percussion at the base of the right lung. During convalescence a venous murmur can be detected in the neck, and an inorganic systolic bruit in the heart, same as in anaemia, which quickly disappears on giv- ing nourishment. Duration should be from two to three weeks; still, some cases are prolonged to the fifth or sixth week. It may terminate in recovery, paralysis, or death. Death is usually due to exhaustion from the protracted fever, or from diarrhea; sometimes to pulmonary and cerebral complications, or to perforation of the bowel and peritonitis, or to hemorrhage ; occasionally to uraemia. In some cases the patient seems to be 332 DISEASE GERMS. overwhelmed by the poison-germ and dies easily with cerebral symptoms, delirium, and coma. When recovery takes place with paralysis, it is generally due to anaemia, which, in nearly all cases, can be overcome with good diet. A persistent rise in temperature over 1050 Fah. is very un- favorable, and several degrees above, an almost fatal result. Typhoid fever is easily recognized by its insidious mode of attack, by the nervous prostration, by the ringing in the ears or deafness, bleeding at the nose, rapid emaciation, white, sharp- pointed features, sunken eyes, and pinched nostrils; dry, buff- leather tongue, red tip or edges, or smooth and glassy; sordes on teeth and gums; small wiry fre- quent pulse, irritation, inflamma- tion, and ulceration of the glands of Brunner and Peyer of the small intestine ; with tympanitis, gurgling in right iliac; diarrhea, petechia, sudamina. It bears no analogy or resem- blance to typhus—in no single point. Pathologists are agreed upon one point, that there is nothing in common. In typhus fever the poison or fever germ is bacteria; in typhoid, the disease-germ vibrios—a specific disease-germ, a true contagium vivum, having properties as dis- tinct and powers of reproduction as perfect as any germ or species known to botanists and zoolo- gists. The most recent observations and experiments show that, owing to adverse conditions in- imical to nerve nutrition and development, such as worry, grief, struggle, disease, insanitary states, the bioplasm of nerve nutri- tion is altered or degraded into other living matter, which is a disease germ—capable in or out of the body of independent existence with prodigious powers of growth and reproduction. The disease germ thus evolved is pathogenic of all nervous diseases, as headache, neuralgia, chorea, epilepsy, brain lesions, insanity and typhoid fever; all contagious and infectious diseases owing to the presence of the microbe. The above diagram represents the vibrios in different stages of growth or evolution. Microscopical diagram of the vibrios, the mi- crobe of typhoid fever, magnified iooo diam- eters ; magnified 2500, they look like feathers. The diagram from the stools, A, bowel threads stage of incubation (germination) prior to chill; B, at the period of rigor; C, the seventh day, now curved ; D, the fourteenth day, germ swollen at the spore-forming end ; E, various stages of the developing germ from the twenty-first to the twenty-eighth day. BACTERICIDES. 333 Feathers, rods, threads bowed or bent. They bear a flagellum at each end; as they grow from the bowed feather rods, or 4i "' "Iv--*^ fe Diagram of the microbe on the mucous coat of the ileum, first week of typhoid ; hype- remia attending the germ, planting itself in a Peyer's patch. The vibros at work, second week of germ evolution, same location, clumps of micro- cocci are seen very extensively on the ulceration of the bowels, and in the mucous membrane surrounding the ulceration, and may even be traced into the mesenteric gland and spleen. threads, they cease to move, become swollen at their extremity and sprout out into spores ; immense spore formation. Provided vital force be low, when this germ is evolved in the blood or re- ceived by contagion and in- fection, it will go through regular stages of sprouting, growth and development, limited by days and weeks. These stages of microbe growth correspond to seven, fourteen, twenty-one and huenty-eight days or four weeks in all. Although the tears, breath, tongue, gums, urine, stool and blood are germ-laden, the natural abode of the germ is beneath the ganglia or little brains of the great sympathetic in the glands of the bowels. Corresponding with the rigor, the germ in localizing excites irritation, inflammation, The germ at work three weeks, shows Peyer's patch deeply ulcerated, loaded with germ ; at D, eats through, causing perforation of the bowel. 334 DISEASE GERMS. a catarrhal state of Peyer's patches; these become soft, spongy, later on hard and smooth. Germ growth is greatest at the ileo- caecal valve. This state of hyperaemia, due to the germ burrowing in the gland follicles, causes the agminated and solitary glands to become more elevated; rapid growth takes place. The various coats of the bowel become infiltrated with germs, necrotic changes are established and ulceration definitely commenced. The third week exhibits the peeling off of the dead germs from each colony, leaving the characteristic typhoid ulcer, which sloughs some in order to remove the necrotic tissue; a loss of tissue which extends to the deeper layer of the mucous mem- brane. In or during the fourth week inflam- matory action ceases, and the process of cicatrization com- mences,which usually with care progresses on until they are entirely healed up. The mesentery,one of that class of blood- forming glands like the pink marrow and spleen, often becomes invaded by the mi- Sketch showing enlargement of the mesenteric lymphatic glands Crobe, and a prOCCSS in typhoid fever; A, A, portion of small intestine; B, mesen- r i m tery; C, glands enlarged; at D a gland is shown in section. Ot analOgOUS germ colonizing and growth takes place same as in the intestine. The enlarged glands vary in size, from a hazel nut to that of an egg, most numerous over the ileo-caecal valve. The habits of the microbe teach us best its mode of annihilation. The evidence as to the poison of typhoid fever being a micro- organism is : all observers have found it in enteric fever, in the mouth, gums, blood, urine, faeces, and after death in the brain, Peyer's patches, mesentery, spleen, suprarenal capsules. It is constantly and exclusively present; it is never found only in bankrupt states of the nervous system; capable of culture in a nutrient fluid. Independent of the bacillus in typhoid fever and grave nervous BACTERICIDES. 335 ^ ~"%s= fever. On the second day the erup- ^V ** 4. ->"►_ 3^' tion appears in the form of innu- ^ ^_^ ~_ a^ merable minute dots of a bright The Bacilli Starlatina aTfoundhTthe scarlet color, which rapidly diffuses the°skinefore the germ migrat"to itself over the entire body. This eruption terminates by desquamation of the cuticle, which takes place on the fifth day. It is merely a scurf on the face and trunk, while on the hands and feet large flakes of denuded cuticle peel off. While, or even before the efflorescence is spreading over the entire body, the mucous membranes of the mouth, fauces, and tonsils become affected ; the tongue at first covered with a thick white fur, through which red, elongated papillae project; as the fur cleans off, the organ presents a strawberry appearance. In Scarlatina Anginosa the symptoms are more violent, very much aggravated, and the languor, rigors, and headache very great; fever high, vomiting, delirium, and prostration. The fauces, palate, and tonsils become greatly swollen and covered with coagulable lymph, the nasal mucous membrane, parotid and other glands severely implicated, swollen, and often suppurating. Sometimes there is a diffuse inflammation of cellular tissue of <36o DISEASE GERMS. •the neck, which is swollen and of a brawny hardness. The erup- tion may be delayed to the third or fourth day, and may then come out in scattered patches. With its fading, on the fifth or sixth day, the fever as well as the inflammation of the throat be- gins to abate. Severe inflammation of the serous and mucous membrane is to be dreaded. In strumous subjects it often as- sumes quite an aggravated form. Cases sometimes occur in which there is no eruption on the skin at all, and still it peels off after recovery. In Malignant Scarlet Fever it assumes a malignant or typhoid form. Great cerebral disturbance, convulsions, urgent prostra- tion, muttering delirium, sordes on teeth, fetid breath, incrusta- tions .of coagulable lymph on tongue, uvula, tonsils, fauces, gan- grene often takes place, and there is suppuration of throat, nose, ears, and eyes. The rash, if any, is purple or livid ; if it comes out it is late ; more generally it never appears. A fatal termina- tion almost invariably takes place on the third or fourth day; few indeed weather the storm. The various forms are liable to terminate in ulceration of the tonsils; inflammation of the eyes and ears, glands of the throat with suppuration. The ear, next to the kidneys, suffers greatly from the bacillus of scarlatina. The microbe penetrates the eus- tachian tube to the inner ear, germs and spores by the million ; their escape is prevented by the drum head; the bacillus rapidly causes destruction of the ossicles, mastoid cells and perforation of the membrana tympani itself. A large percentage of post- scarlatinal deafness, with perforation, is no doubt the result of carelessness. The scarlatinal germ excites synovitis, carditis, vaginitis, irri- tation of all serous membrane, wnich terminate in dropsy, and acute desquamative nephritis, with persistent albuminuria; uraemia is to be feared in some cases. The bacillus scarlatina is one of the most vigorous of all dis- ease germs, a potent spore evolver and ptomaine excretor, most destructive to the red discs of the blood, and deteriorates the general vital elements of the nervous system. The fact, that a patient afflicted with scarlatina is a perfect pest-house of disease eerms should be strongly impressed upon parents, and also the fact that in his skin and hair are millions of spores, capable of propagating the disease for three months to come. There is no doubt that this contagious and infectious fever can, with care, be greatly modified; rendered so mild that none of the usual complications can take place. When the disease is suspected in any locality, all the children not previously affected should be placed at once upon better diet, daily bathing, cleanli- BACTERICIDES. 361 ness, a removal of all insanitary states, and all deemed suscepti- ble should be placed upon a germicidal course of treatment, so as to utterly sterilize the blood, to render it unfit for any disease germ to grow. Select some active bactericide, such as dioxide of hydrogen ; or sulphide of calcium ; or glycerite of sulphur. By resorting to such a procedure, there are few germs, and what there is are usually greatly attenuated. The discovery of the bacillus scarlatina has been the result of much study, accurate observation. The discovery of this bacillus revolutionizes the treatment completely. In the general treatment of a case, the general indications for the correct management of a case of fever must be inculcated. The patient must be confined to bed, in a warm, comfortable room; the entire body should be sponged off thrice daily with a warm alkaline wash until the eruption appears. The diet should consist of beef tea, sterilized milk ; disinfectants should be ex- posed in the apartment. The clothing or covering of the patient should be the finest possible ; bowels and kidneys looked after. The very mo/nent the case is recognized, place the patient at once on a germicide, either glucozone, sulphide of lime or gly- cerite of sulphur ; one of these remedies should be persistently administered, and if so, the case will run very mild. There is no use in waiting for symptoms, apply resorcin jelly to the throat at once. Put it on every three hours. If too late in beginning with bactericides, and fever sets in, keep on with germicides, but at the same time fall back on the old remedies, tinctures of aconite, belladonna and digitalis, with comp. tincture of serpentaria; suitable doses to equalize the cir- culation and lower temperature. Ears carefully covered with laps. Mineral or vegetable sulphur is the natural antidote to kill the germ and sterilize the blood. Glycerite of sulphur, ozonized sulphur water, sulphide of lime are probably the three best forms for internal use, whereas lycopodium can be dusted over the entire skin, and if this is not handy, the anti-microbe powder can be used. Everything in and around the patient must be given and per- formed to kill a most tenacious microbe, even his drink and food should be germicidal. Tartrate of soda and a little lemon juice sweetened is an excellent drink; malted sterilized milk a superb food. In addition to germicides, most cases are benefited with a tonic of aromatic sulphuric acid and quinine, small doses added to water.. 362 DISEASE GERMS. Convulsions, an evidence of ptomaine evolution in the intes- tines, are best treated with resorcin in the syrup of tolu, and ad- ministering salycilate soda in the liquor ammonia acetatis. Forthe mouth and fauces: Water, four ounces; chlorate potassa and hydrochloric acid, of each two drachms. Mix. Dose, one teaspoonful added to sweetened water; boroglyceride solution; zozoiodol and chlorinated soda. If the microbe scarlatina is not either sterilized or annihilated in the blood by the glycerite of sulphur, peroxide of hydrogen, or other germicides, in the ordinary course of its evolution, it will seek the cutaneous surface to secure free oyxgen. In this pro- cess it imbeds itself in the skin and causes desquamation or peel- ing of the cuticle. In this process of shedding, the old microbes die, but leave their spores. These spores represent the seeds, are capable of retaining life and germinating into bacilli, even after the most damaging influences are brought to bear against them, even time, drying, heat, cold and chemical agents. The spores of scarlatina retain their power to ger- minate after long intervals; even the temperature of boiling water, while it kills micrococci, bacteria and the bacilli themselves, does not affect the vitality of the spores. The determination of the thermal death-point of the spores of the mi- crobe of scarlatina has a very impor- a colony of the Bacillus Scarlatina in tant bearing upon humanity at large, the peeling of the cutis; showing , ., ,° i . , .. the spores. and possibly ot curative therapeutics. Clinical experience has established this, that if the entire cutaneous surface is rubbed over with resorcin jelly morning and night, that there are neither microbe nor spores left on the cuticle to cause desquamation. This jelly is easily prepared, thus : add to one pound glycerine heated to a temperature of 3500 Fahr., one ounce of resorcin, three ounces of pulverized starch, and while cooling off, four ounces of per- oxide of hydrogen. This makes an excellent bactericide. As soon as the case is diagnosed, begin inunctions morning and night with warm olive oil, then rub in a portion of this jelly. This procedure is effective. It is almost needless to recapitu- late that all internal treatment should be germicidal; sterilize the blood (kill the microbe), so that no disease germ can live there; resorcin in syrup of tolu, ozonized glycerite of sulphur, ozone water, dioxide of hydrogen are the medicaments of the future. The general principles of treatment all through the case is to BACTERICIDES. 3^5 push bactericides under all and every condition, by doing so, life is saved, complications prevented. Ear complications are about equally as common as dropsical effusions from all the serous membranes. Serous infiltration of the cellular tissue, effusion from the mem- branes of the brain, pleura, peritonaeum, and sometimes the labia and scrotum. These dropsical conditions are due to the destruction of the red discs of the blood by the action of the germ; poverty or anamia ; to heart failure, that organ being imperfectly nourished by the poor blood; to a blocking of the kidneys with the microbe. Very nearly the same treatment should be resorted to as inter- stitial nephritis. Patient should be well nourished and kept warm. Remedies like digitalis and strophanthus to stiffen up action of heart; mild diuretics, as parsely root, hair-cup moss, asparagus tops, with cream of tartar, to flush the tubules of the kidneys ; aided with warm baths and dry heat over the loins. These, with the strictest attention to the weakened heart, are soon effective in promoting a cure. The microbial origin of small-pox is now tho- Variola, roughly elucidated, and the micrococci variola or isolated. The microbe is most abundant in the Small-Pox. blood, mucous membrane and pustules. The microbe is pathogenic of the disease, bears cultivation 'well, and cultures injected, or eaten by animals produce the disease in all its malignancy. That eminent bacteriologist, Prof. James M. Bunn, M. D., of Altoona, Pa., says that the streptococcus of variola appears under the microscope in the form of cocci, singly, in pairs, and in long or short chains or colonies. /?%';.;..... They are found in the fresh lymph of human ^.-:;f ^^itt^ and cow-pox and in the pustules of true small- :T^rM$::'X^. pox. Iney are found most numerous in and -s.>.5;/;r •:;?..■ around the pustules. Successful vaccinations ^V>;v^:'%: result from artificial cultivations. The micro- '" r'y cocci of varicella, variola and confluent small-pox ^man-pox"' ° are identical, thus establishing most conclusively that these are but one morbid state, that the microbe is patho- genic of the disease. Living as we do among distinct races of men, in which every microbial disease is intensified, variola is the great pathogenic and therapeutic question of the day. 364 DISEASE GERMS. The microbe variola can be detected in the atmosphere, for fifty feet around an infected person. All within that radius are exposed to it, and it enters their bodies ; but in order to take hold and mul- tiply, there must be particular conditions of temperature and chemical media, constituting what is termed receptivity. Just as some seeds will germinate only in presence of certain meteorologi- cal conditions and in certain soils, so organic receptivity is re- quisite, that disease germs be followed by their effects. Once the microbe of variola enters our bodies and produces small-pox, the solids and fluids of our bodies are so altered or modified, that all the essential elements for their further nutrition ■.•.■"T^.::^^^ are used up and never appear again. If the germ of variola enters the human body and finds a medium suitable for its existence, it quickly multiplies, with the celerity peculiar to minute bodies, their marvellous facility of reproduction compensating for their micro- scopic size. During the twelve days of incu- bation millions of ova or spores are evolved, so that when the rigors come with the three days of fever, the microphytes, having used up all the oxygenizable material in the body, eager, V - greedy for more, with air and light, accumu- ^V^ late near the surface; scattered in groups in ' \s°.j the skin and mucous membrane, the microbe section of skin in imar- excites suppurative inflammation, which con- pox, showing the mi- stitutes " pustulation." crococci seeking the _, r . surface for free oxy- 1 he cause of the fever is the streptococcus variola. Symptoms.—The period of germination in the blood, or latency or incubation, lasts twelve days, during which time there is lan- guor, lassitude, debility, pain in the head, in the loins, and calves of the legs, with persistent nausea and vomiting, tongue not much coated and white of eye clear, and as early as the ninth day a gritty feel can be detected in the skin. Following these symp- toms a rigor and fever for three days, during which time pains in the head, loins, and muscles continue, but nausea and vomiting usually cease. When vomiting is severe, pains in the loins in- tense, they may be regarded as precursors of a bad attack. Pe- culiar eruptions of pimples or papulae appear at the end of the third day of fever, appearing in the following order : first on the face, then on the neck and wrists; secondly, on the trunk, and lastly, on the lower extremities. The papulae have first a hard, shotty feel, then present vesicles on the summit, which gradually expand laterally to about the diameter of a split pea, are flat or BACTERICIDES. 3^5 depressed in the centre. On the eighth day of the eruption an inflammatory areola or circle forms around the vesicles, and their contents become cloudy and then purulent, the vesicles gradually ripen into pustules, suppuration being complete on the ninth day, at which time finer pustules break and crusts or scabs form. In from five to nine days more, longer or shorter, these scabs fall off. In many instances the rash on the skin is accompanied with a similar one on the mucous membrane of the nose, mouth, throat, eyes, and ears ; in others by a swelling and inflammation of the subjacent areolar tissue; occasionally by marked irritation of the nervous system, delirium, and convulsions. The severity of the disease usually bears a direct relation to quantity of eruption. When pustules are few, and they remain distinct and separate from each other, the disease is not severe ; when very numerous, they run together, coalesce, and lose their regularly circumscribed circular form, it is highly dangerous. This has caused a division of small-pox into variola discreta and variola confluent. Former not near so dangerous as the latter. Eruption on the face may be confluent, while scanty over the body; still if so, the disease is regarded of the confluent kind. Sometimes the pustules are so numerous that they touch each other, but do not coalesce; it is then said to be the semi-conflu- ent form. Sometimes they are grouped in circles or clusters, and the name corymbose applied. If in either case symptoms of malignancy or putrescence are added, the disease is termed ma- lignant small-pox, a most formidable affection. Occasionally after the early symptoms, as pain in the loins, nausea, vomiting, a rubeoloid or measly eruption, and later minute petechia, which increase in number and size, hemorrhage takes place into the conjunctiva and from the bladder, bowels, etc., and death occurs on the fourth or sixth day ; no characteristic rash, only a few scattered papules or vesicles having appeared, it is called hemor- rhagic small-pox, which is almost invariably fatal. The greatest difference between the distinct and confluent form exists from the beginning. All the symptoms in the con- fluent form are very aggravated, intense, often proving fatal from the blood being surcharged with a living destructive poison. During its course, troublesome complications are likely to arise, as erysipelas, swelling of the glands in the groin and axillae, phlebitis, ichoraemia, glossitis, pleurisy, pneumonia, ulceration through the cornea, and suppuration of eyes and ears. No con- tagion so potent as the living germ of small-pox; infection lasts all through the case, from the earliest symptom to a little after the last crust has fallen off. One attack exhausts the suscepti- 366 DISEASE GERMS. bility of the system to future attacks, as a rule. The practice of inoculation with the variolous matter is illegal. Small-pox is easily recognized by the history of the case, the period of incubation, fever, and rash ; in the earliest stage by pain in loins, nausea, vomiting, and a white or clear conjunctiva. The success of treatment in small-pox depends upon the early recognition of the disease. With our present bactericides, we are not able to break it up, but it can be rendered very mild. During the twelve days of incubation of the germ, every pos- sible means to allay the irritability of the stomach should be resorted to, as the recumbent posture, stimulants over stomach, peppermint water, and tincture opii, etc. Then select a ger- micide that will take kindly to the stomach, as either thuja or sulphide of lime, or the bichloride of mercury as follows: 13/ Aqua distilled,............5viii. Bicarbonate of soda,..........5iv. Bichloride of hydrargyrum,.......grs. ii. Mix. One teaspoonful every two or three hours. Either of these three agents—thuja, calcium or bichloride—freely given, and elaborated in the blood, renders the soil unfit for the growth of this microbe. The glycerite of sulphur, with the hydrogen peroxide, has excellent germicidal properties, diffuses itself well through the blood, sterilizes that fluid, combats the invasion of the bacterium of variola. Push germicides as far as possible all through the stage of germination, and when the rigor comes and the three days of fever preceding the eruption, do not suspend their use, but perseveringly administer them. When the rigor takes place and fever sets in, it is likely to be very mild if the antiseptic plan has been carried out. After the rigor the patient must be kept in bed, in a well-ventilated room, free from carpets and curtains, and disinfectants freely distributed around the apartment. After his long fast the patient often has a keen appetite, and the diet should be generous—arrdw-root, beef essence, milk and lime-water, ripe fruits, warm drinks. Sponging the entire body during the three days of fever with warm mustard water and soda must not be neglected. After rash appears it must be discontinued. All through an attack of small-pox, from its incipiency to its termination, no cold article of food or drink, such as iced drinks, cream, or ice, should be given or applied to the patient. Arterial sedatives, as tincture of aconite, veratrum, and bella- BACTERICIDES. 367 donna, one teaspoonful of each to half a tumbler of water, of which a teaspoonful should be given every hour or two. During the febrile stage it is often advantageous to change the germicide to either lycopodium, ozonized tincture, or to gluco- zone or salicylate soda in the acetate of ammonia. The physi- cian in attendance will be the best judge. Warm drinks are always indicated; nourishment and stimulants are always of great utility. Tincture of cimicifuga racemosa has an excellent effect in all cases. Aromatic sulphuric acid and quinine is a good tonic in all cases. Much has been written of the bactericide properties of pitcher plant, wild indigo, siegesbeckie, and other vegetable germicides. We might just say that they are of no utility whatever in the destruction of this micrococcus. When the pustules appear, general principles must guide. The germcides should be admin- istered regularly, till every vestige of the disease has disappeared. With regard to pitting, there can be none, even if that simple thuja alone be given. Far less can it take place when such powerful germicides as sulphide of lime, comp. oxygen and gluco- zone are given. If the physician is weak in faith in the action of bactericides, he can bear in mind that under darkness or a yellow light the microbe becomes sterilized in the pustules. Hence there is no pitting. If his faith is still weaker, resorcin jelly or ointment applied over the face at once destroys every microbe with which it comes in contact. As far as practicable, disinfectants should be exposed all round the apartment; and if it were possible to move the patient on his cot to another apartment, sulphur fumigation for an hour will destroy every germ with which it comes in contact. The factor in small-pox is the germ. The whole aim and object of all treatment is its careful, persistent destruction, and at the same time keep up by every possible means the vital forces of the patient. We must by all means crowd in germicides with- out offending the stomach. All complications are to be treated on general principles; convulsions, delirium, with bromide of potassa, belladonna; restlessness, with sulphonal. If the throat is seriously implicated, antiseptic gargles of boroglyceride. We cannot insist too strongly on the imperative necessity of persistent and careful nutrition all through the case; food often, at proper intervals by day and night. Beef-tea, broths, milk food, cream, finely-chopped meat, chicken, game, are most acceptable. The retrograding action of alcohol on all disease-germs must not be overlooked. This property alone renders it an agent of 368 DISEASE GERMS. infinite value in the form of milk punch. There is no form of fever that bears such an amount of careful nutrition in all forms as small-pox. Does the modern system of vaccination with the cow-pox lymph sterilize the blood of the recipient ? Does it render the soil unsuitable for the growth of the variola microbe ? Does it exhaust the pabulum ? Most assuredly not. Modern vaccination is productive in creating a deterioration of race, as is seen in widespread neurasthenia and tuberculosis. Bovine lymph has in it the oidium albicans from foot diseases of the heifer; the bacillus tuberculosis which affects eighty per cent, of all swill-fed and high-bred animals. Actinomyces is more common than what is really known, and all are familiar with the malignant anthrax which is decimating our cattle, pollu- ting our soil. Does a father or guardian desire to implant in his offspring microbes of disease, factors of crime ? In all tropical countries where solar Filaria Sanguinis heat ranges from 8o° to upwards of ioo° Hominis. F., there are to be found in the human blood during night, millions of ova, of a minute, almost structureless, microscopic parasite, which is the embryonic form of the filaria, which requires the action of the Filaria Sanguinis Hominis in human blood X 280. In this case Irom 25 to 100 were found in every drop of blood between 6 p. m. and 5 A. M. mosquito to effect a transition in its scale of being, a sexually mature worm. The mosquito, ever active during the night, feeds upon human blood when those micro-organisms are present; being a greedy feeder'it gorges itself, and once in its body grows prodigiously. The nature of the mosquito compels it to seek water, into which it liberates the developed spores of a trematode. Free in the water, especially if it be stagnant, it undergoes further changes, progressing onward in the water, in the human stomach, in its Filaria Sanguinis Hominis, taken from a lymphatic in the scrotum, BACTERICIDES. 369 migration from the gastro-intestinal tract to the lymphatic, where it is found in a mature state, measuring usually about three inches long. The passage of this micro-organism into the human body is chiefly by the water as a drink, possibly by the skin in bathing or by the bronchial mucous membrane. Once the embryonic worm is within the body, it has a selective power, to seek out the lymph canals as an abiding place. Its aptitude in choosing the lymphatics, or lymph scrotum is remarkable. Our knowledge of this parasite is very imperfect, so much so that we are unable to give its life history, its original mode of development, its duration of life, its habits, its power of repro- duction, or how myriads do exist in individuals during rest or repose. The embryonic filaria in the blood is a microscopic parasite, and will remain or die such, unless he finds an entrance into the mosquito, thence into water, and finally into the human stomach and lymph channels. The mosquito has a peculiar and special affinity for this micro- organism, and will not suck the blood of those in whom they do not abound. The embryonic filaria are not common in the blood of those who lead an out-door life and enjoy the highest possible standard of health. More is wanting to enlarge our conceptions of the nature of this and other blood parasites. This usually consists of a narrow crack or lacer- Fissure. ation of the mucous membrane, involving the sphincter muscle at its coccygeal border. It is usu- ally situated at the posterior wall, at the external border of the anus, where skin and mucous membrane meet, but it often ex- tends up or across the internal sphincter, and even into the rec- tum. As a rule there is only one, but it is not at all uncommon for two or three to exist simultaneously. The great abundance of sensient nerves in and about the sphincters renders it very sensitive, and when fissured, the pain is indescribable; severe, agonizing, persistent, after a defecation ; the reflex effect of which is most disastrous to the nerve centres, giving rise to collapse, chorea, epilepsy, nervous disease. It may occur at any age, in both sexes, but most frequently met with in adult females. Causes.—Scratches, abrasions, lacerations, due to straining at stool, or to excessive stretching produced by passing dry, hard- ened faeces, or to fish bones, or cherry stones, polypus, piles, 24 370 DISEASE GERMS. eroding tumors, diarrhea, discharges, enlarged prostate, prolapsus of uterus and rectum, rectal ulcers, disease germs eating the tissues, the labor of childbirth. Symptoms.—There is excruciating, intense, sharp, burning pain, at or subsequent to defecation, with mucus or muco-puru- lent matter from the anus, but it needs to be seen, although the pain is an excellent symptom, being of an agonizing character, very de- pressing, owing to the faecal matter lodging in the fissure undergoing chemical changes. Treatment.—The general health must be improved by every possi- ble means, alteratives and tonics. Among the last the following is in- valuable as a rectal tonic: Fl. ext. j uglans; fl. ext. Virginia stone crop; fl. ext. collinsonia, equal parts of each. Mix. One teaspoonful three times daily. The sphincter muscle must be paralyzed by the local application of belladonna ointment, the bowels evacuated by oil. After a thorough movement, wash out rectum with boroglyceride solution, then wipe the parts dry and expose the fissure thoroughly; then sprinkle it all over with iodol or the solution of nitrate of silver, thirty grains to the ounce of water. By keeping the sphincter thorough- ly relaxed; causing copious soft stools with the administration of fl. ext. of juglans, and the introduction of the cocaine suppository, the fissure heals promptly. Another plan is: after the bowels are evacuated, and the parts cleansed, introduce within the fissure a frag- ment of lint, soaked in a solution of chloral hydrate, one to fifty. This should be applied every morning. The action of the chloral is anti- septic, stimulates granulation rapidly. Conium ointment is of great utility in all painful affections of A form of deep rectal fissure commenc- ing two-and-a-half inches above the sphincter muscles, usually met with in persons that suffer from nervous bank- ruptcy, white softening and insanity. m vr;-< Piles, complicated with longitudinal fis- sure, high up as well as low down. BACTERICIDES. 371 the anus and rectum, but it is especially efficacious in fissure with intolerable itching, severe tenesmus, with bleeding; it affords ' marked and speedy relief, after every other remedy has failed. If the case resists treatment, sphincter irritable, stretching the sphincter muscles is of great utility. The office of the sphincter ani is to guard the rectum from in- voluntary discharges of its contents in health ; this it does easily, perfectly, without strain or friction. But let disease supervene, ulcer, fissure, fistula, piles—the irritation incidental to which gives rise to thickening; piles are constantly tending to protru- sion, ceaselessly warring with the muscle, when faeces are passed, they are either protruded, bruised, painful, or agonizing ; whereas in ulcer or fissure the irritation is cumulative. glyceride and resorcin, or stuffing them on alternate days with iodol; the external chronic haemor- rhoidal condition best smoothed down by painting them once a week with a solution of chromic acid. Another excellent remedy is the ozonized distillation of hamamelis virginica; by two thirds of the profession it enjoys absolute precedure over all other drugs. This term is applied to a sinus or channel exist- Fistula in ing in the tissues surrounding the anus or rectum. Ano. Anal fistula is a tube lined with a false membrane, which is a secreting tissue and communicates with a cavity. It is met wjth in three forms ; complete, blind internal, blind external. A complete fistula connects the rectal 372 DISEASE GERMS. cavity with the external skin, by a sinus running outside of or around the sphincters. If the rectal wall be perforated and a sinus extends from the perforation to some point in the tissues, but does not reach the surface, it is called an internal, imperfect External incomplete fistula Internal incomplete fistula. or blind fistula. If the sinus extends from an opening on the outside wall of the rectum, but does not penetrate the rectal wall, it is termed a blind internal. Causes.—Constipation, which distends the lower portion of the bowel to a great extent, and then a weakened patch gives way, or a piece of hardened faeces, fruit seed, fish bone or some other hard body excites irritation, inflammation, ulceration clean through, or otherwise forming a fistulous ulcer. There may be one or more. Fistula does not necessarily co-exist or depend upon the presence of the tubercular bacilli, but may be caused by a germ-eaten rectum, the microbes eating their way through to the external parts. This is frequently the case in ulceration, due to the bacilli of tubercle, or to the vibrios of the insane. The external tissues of such patients are soft, non-vital and disease germs perforate readily. Symptoms.—The external aper- ture is usually small, and in some cases difficult to find. Generally it is near the anus, although it is not uncommon to find it several inches distant; it may be concealed in a furrow, or it will be found in the centre of a button-like eminence. Complete fistula is most annoying, because gas, intestinal mucus, and fluid faeces pass along the tract, causing external irritation and painful spasmodic contractions of the sphincter. The blind internal is easily detected by the introduction of a blunt probe, which does not penetrate through, the discharge from this is mucus; the blind external gives rise to symptoms nearly analo- gous to irritable ulcer. By a careful examination with a bent probe the orifice can readily be detected. BACTERICIDES. 373 Treatment.—Before enumerating our modern method of treat- ment, which is satisfactory, we will simply enumerate the old methods which have fallen into disuse. The old orthodox and approved treatment for many years has been to cut through the fistulous opening into the rectum, divid- ing the sphincter, and permitting it to heal from the bottom, if the patient has vitality enough, otherwise an imperfect or non- union of the sphincters may take place. This cutting may be done with the knife, or crushed by the chain of the ecraseur, or by a ligature. Even cutting the false membrane lining the sinus has been resorted to. Most encouraging success has attended the treatment of this malady, by stimulating, cleansing, germicidal injections into the fistula. Generally we are successful with this method, but once in a great while we meet with a case in which the ligature or knife might be necessary. Whichever of the methods is deemed best for success should be decided on; but before it is resorted to it is well to improve the patient's health by every possible means with tonics, fresh air, best of diet. The bowels should be cleansed with oil. If the injection method is selected, we append a few formulae, with which we have had most gratifying success. Before any of those are used, the sinus and rectum should be washed with an anti- septic wash, such as one grain of chloral hydrate to one ounce of water; or one grain of nitrate potassa to two ounces of water; or one grain of bichloride of mercury to four ounces of water; or a few drops of peroxide of hydrogen in water; or a solution of boroglyceride. After one or other of those washes have been used, the parts dried, then select one of the following formulae to inject, to destroy the sinus and stimulate effusion of lymph to block up the passage. Carbolic acid, three drachms; glycerine, one drachm ;, sperm oil, one-half drachm. Mix. Heat to 3000 F., and evaporate to four drachms; then use as below. Carbolic acid, twenty grains; corrosive sublimate, gr. i.; Mon- sul's solution, one drachm; glycerine, two drachms. Mix. Carbolic acid crystals, forty grains; hydrochlorate of cocaine and of morphia, of each respectively, five grains; glycerine, two drachms. Mix. An excellent radical cure is as follows: First trace fistula with a flexible probe. Wash out the tract with a five per cent, solu- tion of hydrogen peroxide. Then inject a ninety-five-per-cent. solution of carbolic acid, plus an equal quantity of a ten-per-cent. solution of the muriate of cocaine. Draw from ten to fifteen 374 DISEASE GERMS. minims in the syringe. Push the nozzle of the syringe to the depth of the fistula, and then inject slowly as you withdraw the needle. Within two hours afterwards inject a few drops of equal parts of oil of eucalyptus and glycerine. Let the patient rest twenty-four hours. Lock up the bowels for a few days, and the operation is complete. Stricture of the urethra, when old, and not got Fistula rid of by absorption or electrolysis, is very apt in to excite irritation of the urethra and a gleety dis- Urethra. charge ; the obstruction, however small or large, causes a rebounding upon the prostate, and invaria- bly gives rise to irritation and enlargement of that gland. In bad cases of stricture a drop of urine is liable to lodge behind the stricture, which will, in time, excite irritation, in- flammation, ulceration, and ultimately an opening on the inferior aspect of the penis, through which the urine drops or flows in micturition. There is really only one successful method of treatment, namely, placing the patient under the influence of an anesthetic, and carefully dissect out the fistulous tract; then forcibly intro- duce into the urethra, through the stricture, into the bladder, a No. 12 silver catheter; it should be retained for about eight days; the wound should be carefully stitched up. By the time the catheter is withdrawn both stricture and fistula are usually wiped out and a good cure is the result. This may originate from a laceration of the Fistula, perinaeum, which extends back through the Recto-Vaginal, sphincter muscle of the rectum, which has been stitched up, but left an opening between the vagina and rectum ; or it may have arisen from chancre in the vagina perforating through, or from stricture of the lower bowel; foreign bodies ; from the introduction of knitting-needles, whalebones, to induce miscarriage, and like conditions. It is easily recognized by the passage of gas, liquid or solid faeces into the vagina. If very small, and in doubt, empty the bowels from above with castor oil ; after it has operated, put patient on her back, knees drawn up, and a crow-bill speculum into the front part of the vagina; have a good light, and the index finger into the bowel, and examine it all over for an orifice. They are seldom high up, and by bulging the rectum with the finger, can be easily seen. If very small, so that a pea would BACTERICIDES. 375; penetrate through, it can be closed up without an operation if care- fully managed. Every second or third day for five or six weeks it can be touched with nitric acid ; that is, the edges of the fistula and a little beyond; after it is raw, it will begin and throw out granulations that will effectually block up the orifice. It takes time and care, and while it is going on, the patient must keep bowels very soluble and free from gas, by eating a proper diet. If it fails, or if the opening is large, it should be stitched up. Patient's bowels having been well cleansed out, placed under chloroform on her back, a crow-bill speculum should be inserted, and the part exposed to a good light; its edges should be freely pared, so as to have a good raw surface. If the sore is round, like a three-cent silver piece, it has to be lengthened slightly, to prevent puckering when the stitches are introduced ; then sewed up with lead sutures, and the sphincter muscle on both sides of the coccyx must be divided, so that the patient can have no con- trol of the bowels, that gas and solid matter may pass without disturbing the fistula ; bowels locked up for ten days with opium ; and kept perfectly quiet in bed for two weeks. If the patient is strong and vigorous, all may go well; the cut sphincter may unite; if it does not, the patient is a miserable object all her future life, not being able to hold or have control over her bowels. The original fistula, however, unites perfectly, unless there has been some bungling in the paring of the edges or application of the stitches. To obviate the cutting of the sphincter muscle of the rectum, tubes have been tried, with partial success. In all cases the best of nourishment should be given, so that a high standard of health be maintained. A fistulous opening from the bladder Fistula, into the vagina. Vesico-Vaginal. Its common cause is the use of instru- ments during delivery, especially if the bladder has not been emptied. A full or distended bladder, with hurried labor,-or with a bad presentation; or a crooked or de- formed pelvis, may also give rise to it; and various other like conditions. It is often caused by ladies attempting to commit abortion on themselves by knitting-needles, whalebones. The dribbling of the urine through the orifice, night and day, gives rise to irritation, rawness of the vagina and renders the patient very miserable, and an object of great distress. It should be treated by getting her into as good health as pos- sible, and then stitching it up ; placing her upon her arms and 376 DISEASE GERMS. knees, head down, parts well exposed by two crow-bill specu- lums, a catheter in the bladder. The edges of the fistula should be well pared, and then stitched up with lead-wire sutures; patient put to bed, and a catheter kept constantly in the bladder. All cases are successful. Reflex or functional disorders are Functional Disorders extremely common, and embrace of the Heart. many of the principal organs of the body. We have selected two as an illustration of them all. Functional disorders of the heart are usually brought about in this way : the reflex centre, medulla oblongata, is weak from some cause or other, so are the various nerves that supply the heart. With a weakened bulb, any irritation in the body, such as worms, neuralgia, uterine irritation, or irritation of clitoris, penis, kidneys, bladder, stomach, liver, will be easily and promptly transmitted to the centre, from thence to the heart, giving rise to this functional disturbance; nervous exhaustion, over-study, anxiety, sexual excesses, weaken the nervous centre. Tobacco, tea, whiskey not only enfeeble the reflex centre, but devitalize the heart. Gout, rheumatism, syphilis, mercury, act on the weakened cardiac nerves, circulating through them, poisoning them. Symptoms .—--in the so-called functional derangement, we may have every symptom of organic disease, irregular pulse, palpita- tion, fluttering, with a cardiac murmur and subcutaneous anaemia, in anaemic subjects. Dull, weary ache over region of heart; occasionally sharp, lancinating, catching pain ; inability to lie on the affected side, owing to tenderness ; very great mental depres- sion ; often dyspepsia, with heart-burn, flatulence, and eructations of gas or acid secretions; vertigo, faintness, noises in ears, specks or spots before the eyes, flushing of face, violent palpitations, with pulsations in aorta. In women with uterine or ovarian trouble, or young men addicted to masturbation, smothering, difficulty of breathing, globus hystericus. Treatment.—Cases cf this kind require fine judgment, long ex- perience and keen observation. Symptoms must be relieved, for they are real, not imaginary, until the cause can be reached. If patient is intelligent, his case should be fully explained to him. He must be told his nerve centres are feeble from some cause or other; that his cardiac nerves have lost their tone; that there is an irritation carried to the weakened, but now highly impressible bulb, thence transmitted to the heart; or that the nerves of the heart are starved from poor, or poisoned by bad blood. Once the cause can be removed there is usually BACTERICIDES. 377 little difficulty in the case, but that must be done. Investigations as to them embrace not a cursory but careful examination of fungs, stomach, liver, bowels, kidneys, genito-urinary organs, skin, blood, for irritation or disease ; and if no cause can be found, the case should be treated with alteratives and tonics, with irritating plaster over region of heart, and treatment persevered with for months. At the same time every means should be adopted to invigorate the nerve centres with cinchona, avena, matricura, kephaline, coca wine. The terms biliousness and torpid Functional Disorders liver are very common, and are ap- of the Liver. plied to a variety of symptoms, such as constipation, sallow and itching skin, dark urine, headaches, lassitude, furred tongue, bitter taste in mouth. Functional derangement of the liver may be due to structural disease, as chronic inflammation ; abscess, acute yellow atrophy, gastric and intestinal dyspepsia, atony of the bowels, organic dis- ease of the heart, lungs, kidneys, to syphilis, tuberculosis, ma- laria, to a faulty diet, too much hydrocarbon, ale, beer, sedentary habits, a deficient supply of oxygen, insanitary state, breathing sewer and other deleterious gases ; poor ventilation, anxiety, pro- longed mental labor. The prominent symptoms which attract attention are anorexia, a bitter taste in the mouth due to taurocholic acid in the blood ; flatulency, acidity, pyrosis. The tongue is large, pale, flabby, with indentations of the teeth along its edges. It may be white, with elongated papillae. The faeces are pale, unless they have remained a long time in the large bowel, when they are blackish. Constipation and diarrhea may alternate; haemorrhoids very common. There is often a weight, fulness, tightness, burning, or even a sense of actual pain over the liver. There may be obesity, but emaciation is liable to take place from deficient production of bile, or from disarrangement of the glycogenic function of the liver. Bile may saturate the textures of the body, and yet fail to poison, so long as the kidneys are active. A torpid liver, with obstinate constipation, gives rise to a deficient elimination of cholesterin ; lithiates and pigmented bodies in the urine are signs of a dormant liver, and the diathesis lithaemia is usually an ante- cedent state. Renal derangements may be the result of hepatic trouble, and in this way liver disturbance gives rise to congestion of the kidneys. » 378 DISEASE GERMS. After the function of the liver has been interfered with for some time, its granular structure is liable to become diseased. Amyloid and fatty degeneration is the most common. Senile' decay, calcareous, atheromatous arterial changes follow next in order. The lactic and butyric are next, due to the non-de- struction of fibrine in the liver. This modern liver torpor seriously impairs the energies of life. It dwarfs ambition, creates debility, gives rise to pains in the right side, and not infrequently is the cause of numerous diseases, as sciatica, lumbago, vertigo, headache, muscae volitantes, melan- cholia, insomnia, hypochondriasis, irritable temper, moodiness. It often gives rise to functional disorders of the heart, a variety of skin affections. The treatment consists in regulating the diet. Forbid the use of all starchy or saccharine food; also all wines and malt liquors. Recommend fresh air, moderate exercise, attention to daily alka- line bathing, and abandonment of all severe mental strain. The bowels should be kept freely opened. Alkalies, as the phosphate of soda, are always of service. The remedies of real value are those which act directly on the liver. Chionanthus virg. is the most efficacious drug in func- tional hepatic disturbance. It increases the biliary secretions; it influences the disintegration of albumen, and thus relieves a weak or overworked organ. Apocynum, podophyllum and taraxacum make a good liver stimulant. The use of iron, mineral acids, narcotics is contra-indicated. In speaking of disease germs, it is not necessary Germs to describe the origin, the growth, the development Disease, of the human species; neither is it requisite to delineate the process of nutrition, mode of propaga- tion, maturation from the most simple element, a cell, up to the most complex and perfect bodies, nor the ingestion and digestion of food in the stomach, bowels, and its elevation into a vitalizing fluid by the lymph canals and pink marrow of the bones—the blood, which is the life, a complex liquid that nourishes brain, bone, muscle, gland—a fluid in which infinitesimally flows the sparkling, vivifying elements of the soul. In other words, it is not necessary to describe the process of evolution, but suffi- cient it is to say that evolution is simply an ascending develop- ment in a particular order—the passage from the least, the low- est, to the most highly organized; from the most simple to the most complex; from the infinitesimal to the giant species; from a simple cell to the climax of brain development in man's sympa- BACTERICIDES. 370, thetic ganglia. It is a positive process by which the body is built up, put together or constructed; the negative process is dis- solution, one of undevelopment, of taking to pieces, when the organized, the complex, fall asunder, come back to simple original elements. Man originates in a simple cell or germ, and this body, when of sufficient vitality, with a favorable location, evolves, grows, aggregates from its surroundings, and becomes the most com- plex and highly organized of all created beings—reaches the highest level, the top layer of evolution. Partial or complete dis- solution is downwards, retrogressive; it is a process of change, of alteration, of living matter resuming its most simple form, and in this process of dissolution normal living matter is changed, altered into disease germs. Disease may be defined to be any deviation from health, a par- tial death or dissolution—a state or condition in which there invariably takes place a degradation of the bioplasm of the blood of some special tissue or gland. Thus, for example, if the shock affects the nervous system—say grief, worry, anxiety—the mat- ter concerned in the nutrition of the great sympathetic will be degraded into the disease germ, the vibrios, and there will probably be typhoid fever or neurasthenia; if the organs of digestion are impaired or damaged, the nutritive elements con- cerned in its nutrition are degraded into the disease germ bacte- ria ; if the lining membrane of the nose is depressed by colds or otherwise, the nutritive elements concerned in its repair or con- struction are degraded into the disease germ, the amceba. The degradation may be local, but its pristine seat is in the blood—a fluid in which flows the sparkling, vitalizing elements of our being. There can be no dissolution without pain, without altered secretion, without disease germs being present. Pain, by what- ever name it is called, indicates a deficiency of life, a partial death, with its changed secretion and disease germs, calls for remedies to promote a renewal; pain is nature's cry for more stimulus, more pabulum. It disappears the moment a renewal is established. So long a.s pain exists colonies of disease germs are being formed or evolved, which are important factors in dis- ease, being the degraded living elements of special nutrition. Pain, even a neurosis, an increased sensibility, whenever and wherever it exists, exhibits a deficiency of life and the presence of disease germs. Pain follows; nay, is an integer, a factor, in over-work, exhaustion, enfeebled brain, deficient vitality, disease. As a result, the mechanism of the human body is deranged, the appetite leaves ; tongue coats, becomes bulky, dry, indented; 380 DISEASE GERMS. complexion muddy; countenance has the stamp of suffering, of mental depression; urine deposit lithates; the stomach, liver, kidneys work feebly, and the individual feels wretched ; jaundiced in all his acts, thoughts, because he is clogged up with disease germs, True, persons highly and finely organized, feel pain more keenly, more acutely than those of a lower organization; the higher the development, the less reserve of vital force, the less the resistance, the more the susceptibility, and less the capacity to bear it. No standard can be laid down as to the degree of pain. Men and women are variously organized and experience it differently. Disease germs may be thus defined: " The blood contains every element, when properly supplied with food, for the proper nourishment of every tissue in the body, as brain, bone, muscle, gland ; here all find their primary elements of nutrition. If the inherent, innate, vital force, that presides over the evolution of each be degraded by any condition adverse to healthy evolution or normal health, those primary elements become degraded into disease germs." Disease germs then consist in the degradation or change or alteration of the primary elements in the blood, into other living matter which is capable of independent existence, noxious, with prodigious power of reproduction if vital force is low, and if much shattered may destroy the individual in whom they are evolved or from whom the degradation springs, or of being car- ried from the seat of evolution and communicated by contagion and infection. The diseases of this class are very variable, being often differ- ent in one race from another, modified by soil and climate, but in all cases giving rise to epidemics, as plague, cholera, small- pox, diphtheria, catarrh, fevers, hooping cough, cancer, syphilis, tuberculosis. Thus disease germs in their varied forms and aspects, influence the fate of individuals, of cities and empires; they decimate armies, infest the habitations of the poor in our sewage-sodden cities and are direfully fatal to all in feeble health, with insanitary surroundings. They are emphatically the scourges of mankind. The question how microbes act in disease has long been in doubt, but the progress of science tends to clear away obscurity. The first idea was that they were the factors of disease, that when they were evolved or taken in that they acted like parasites, lived upon the blood and tissues of their host. No doubt this is the case to a certain extent, that they swarm in the blood, ab- stract from the red corpuscles the oxygen they require for their nutrition. BACTERICIDES. 381 It often happens that death is so rapid that the bacilli have not time to develop in the blood in sufficient numbers to produce fatal results, such as in tetanus, anthrax, rabies, in cholera ; in the latter especially, death often takes place before the comma- bacillus enters the blood. An explanation of this state of things is necessary. It is this : all disease germs excrete or eliminate in their growth and development a poisonous substance, resembling snake venom, an alkaloid, the ultimate product of putrid fermentation of organic matter, an alkaloid termed ptomaines. The presence of this toxical principle is a natural excretion of all microbes, in the blood, intestines, brain, stomach, etc., gives rise to debility, rigors, fever, pain in sentient nerves, vomiting, diarrhea, hectic, delirium, spasm, collapse. Poisoning by tainted meat, fish, milk, wool, water, is due to the presence of ptomaines. The chief action of all pathogenic microbes, of the most harm- less as well as the most dangerous class, is due to their excretion (in some part of the body) of the ptomaines. This explains the speedy death in snake bite,tetanus, rabies, and cholera; so rapid, so sudden, that the germ has simply localized, never entered the blood. Although the germ has not been absorbed by the intes- tinal mucous membrane, and carried into the blood, the poison- ous alkaloid or ptomaine which it excretes, is certainly present, and it is to its presence that the symptoms must be ascribed. This alkaloid has been extracted from the faeces. The action of pathogenic microbes on and in the human body is complex, and may be thus stated. The action of the germ, the factor of morbid action, which is nourished at the expense of the blood; the formation and excretion by this same germ of a ptomaine, a highly poisonous alkaloid, which acts on the system as an annihilator of vital force. A ptomaine is a chemical compound which is basic in its character, formed either during the putrefaction of animal and vegetable matter, or is an excretion from disease germs, some of which are not very poisonous, whereas others are so highly toxical that they will destroy life almost immediately. Ptomaines are formed in the death of matter, in the transition; in the activity of bacterial life, which is present when structures are passing from the organic to the inorganic; they are formed in all microbial diseases as an excretion of the germ ; they are pure alkaloids, and differ in their poisonous qualities, according to the nature and character of the germ which gave them birth. Whereas Leucomaines are altogether different, being a basic substance found in the living tissues, either as the product offer- 382 DISEASE GERMS. mentative changes or of destructive metamorphosis—all basic substances found in animal tissue during normal life. The term is used in contradistinction to the ptomaine, the basic alkaloid of putrefaction. The leucomaines embrace two groups of waste, uric acid and creatine. The excretions of all living things, plants and animals are poison- ous to the organisms which secrete them. These poisons are formed within the body ; they originate in the changes by which the complex organism is split up into simpler compounds, urea, ammonia, water, carbonic acid gas. It matters little how these changes are effected by organized ferments, germs, or by the un- organized ferments of the gastric juices, or by unknown agencies, which will induce metabolic changes in all the tissues; in all cases poisons are formed. At all times, but especially in warm weather, there is a pro- fusion of both vegetable and animal germs in the atmosphere, of which even the most virulent or active cannot find ingress to the blood through the bronchial mucous membrane; but let the mouth be open, they find ingress there. The human mouth is an excellent culture apparatus, in which too frequently do the broods of microbes enter; for there they find heat, moisture, nutrient fluids, naturally provided for their nourishment and growth. Besides, the mouth is really the receptive focus, by or through which all disease germs enter the body; but if there is a lesion, even infinitesimal in its character, they merge in freely. If a few germs enter, they are apt to perish in the blood, but when a large mass enter, the vitality of the blood has not the power to destroy them. Besides disease germs, the degradation of the primary elements, of our own bodies, we are liable to take into our blood a giant form from animals, most malignant, such as anthrax, rabies, glanders. The vegetable kingdom also furnishes elements, microbes in themselves, which enter the human blood, produce microbic changes, such as malaria, yellow fever. The degraded bioplasm of fruits, cereals, as borne by the wind or dew drops, give rise to fearful ravages. Races are distinct and antagonistic to each other, so are the degradations of living matter into disease germs as distinct as the body in which they originated. The origin of disease in the Negro, Mongolian, etc., are dependent on the same condition as the Caucasian, but the germs are more active, virulent, if they are passed into an antagonistic race. Not infrequently are animals and plants similarly affected; all BACTERICIDES.* 383 the result of a deterioration of original histogenetic elements. Besides, a special degradation in our own bodies, and that of ani- mals and plants, " disease germs " may come into our bodies from other persons, or from animals, or from plants, if our vital force is weakened in any way, as that condition only permits of the ingress of disease germs from any source. Germ diseases are more common in our country than in any other, mainly on account of the high development of the people, their less reserve of vital force, the necessities of a rising civiliza- tion, mixed races living in proximity, mingling with antagonistic races, our intensely oxygenized atmosphere, our sudden extremes of heat and cold, the mental strain or struggle, or worry, etc. The mortality from germ diseases is enormous, especially at the present time. There is a special degradation of living matter corresponding to each disease. The practical difference in the evolution of those germs turn chiefly upon the amount, kind, degree, quality of expenditures of mental or physical force. Enervation, decrepi- tude, altered nutrition of various parts of the body follow a prodigal waste of the mental or corporeal energies. The quan- tum of germ diseases, contagious maladies, falling to our lot as a nation is in direct proportion to the demand upon the tissues, the character of the food, housing, clothing, and absence of sewage. ' Taken in the order of their greatest fatality, " germ diseases " arrange themselves thus: Tuberculosis, typhoid and scarlet fevers. Small-pox, hooping-cough, measles, croup, diphtheria, dysentery, erysipelas are the most common. Germ diseases vary with the density of population, the charac- ter of races, location, sewage. Certain trades are very deterio- rating ; whereas others are remarkable for their healthiness. Life is longer, the freedom from care, worry, excitement; the better the food and clothing, the fresher the air, the more salu- brious and cleanly the house, the less the confinement. Animals and plants, when their vital elements are deteriorated by adverse conditions, have also their vital elements of nutrition degraded into " disease germs," as anthrax or cattle plague among cows is simply a degradation of primary elements into a giant disease germ called bacillus anthrax; and the foot disease of the same animals is analogous to the grape and potato rot, both being identical with the disease germ oidium albicans in the human race. Again, glanders or epizooty (in which we find the giant amoeba) is analogous to the amoeba of nasal catarrh. Every deviation from health, every disease, has its special degradation, its own disease germ, and all are contagious and infectious. As, for example, when nerve nutrition is damaged 384 "DISEASE GERMS. there is a special degradation or alteration of neurine into the dis- ease germ vibrios, the germ of typhoid fever and all nervous dis- eases. When the elementary matter concerned in the nutrition of the air-passages is degraded by adverse conditions we have the amoeba, the disease germ" of catarrh, chronic laryngitis, eustachian deafness, asthma, bronchitis; when the fundamental elements of nutrition are perverted we have the bacteria, the germ of boils, erysipelas, wounds, etc. If the elements concerned in the nutrition of the sexual organs are degraded by promiscuous coition, the syphilic germ is evolved ; if the typical fissures of the brain are partially or completely obliterated by consan- guinity, sameness, isolation, solitariness, reflex irritation or dis- ease, the tubercular germ or bacilli are evolved; if the vital forces are terribly shattered, a dilapidation, a sterility of vital elements, there may be a rot, and the oidium albicans is evolved, and so with other diseases. The discovery of these and other disease germs has done much to alleviate human suffering, prolong human life. It has created a new system of medicine, a new cure, founded on the presence of disease germs in the blood and the employment of antiseptics in the treatment—a class of remedies to kill the germ, which at the same time tone, invigorate, elevate the standard of vital force, and thus prevent further degradation, which enter the blood, and coming in direct contact with the germ, annihi- late it, without in the least diminishing the vitality of the patient. Bacteriology has completely revolutionized the practice of medicine and the treatment of all diseases. What are bacteria or microbes ? simply either the degraded bioplasm of our own or others' bodies, or of animals, or vegetable cells, the lowest forms of existence. All bacteria possess constancy of form, marking its complete development. All bacteria have a cell wall and cell contents, and multiply or reproduce themselves by division or by the formation of spores. The spores are surrounded by a thicker and .stronger cell wall than the bacteria from which they spring, they are con- sequently more vigorous than the original bacteria; can with- stand much greater extremes of heat and cold or vicissitudes of atmospheric influences. In a favorable environment, carefully nurtured, in a proper nutrient material, they grow and multiply with great rapidity, and if introduced into any animal will reproduce the disease to which they are the factor, and in their process of development, in the vital process so resulting, they excrete a chemical product, an alkaloid (a ptomaine), which in the living organism occasions BACTERICIDES. 33 r- pathological changes, characteristic of infectious diseases, and which are antagonistic to the life.of the microbes themselves and any vital fluid or tissue with which they come in contact. These micro-organisms are cellulose, round globular [micro- cocci) ; short rods {bacteria); long rods {bacilli) ; spherical, twisted {spirilla). The atmosphere, water, and even some articles of food, con- tain both animal and vegetable germs, even the mineral world in which we have the debris of perished creatures. From the vegetable world we have micrococci, bacilli and other forms of the great family of bacteria, spores of other fungi, pollen, seed, parts of flowers. The air of cities is rich in mi- crobes of all diseases, from their sewage-laden emanations. The determination of the thermal death point of disease germs has a very important bearing in prophylactic medicine and cura- tive therapeutics. The following table exhibits the death point of a few of the microbial factors of disease : Organism. Thermal Death Pomf. Fahr. Bacillus of typhoid fever..............1320 Cholera-spirillum (comma-bacillus)..........125.6° Cholera-spirillum...................125.6° Cholera-bacillus..................143.6° Anthrax-bacillus (without spores)...........129.2° Tubercle-bacillus in Ircsh sputum...........212° Bacillus of glanders........... .....1310 Bacillus of tubercle | Bacillus of cancer I..............140° Bacillus of syphilis j Bacillus from fasces................143-6° Bacillus of green pus...............!32.8° Bacillus of so-called pneumococcal..........136.40 Bacillus of foul blood...............212° Staphylococcus pyogenes aureus...........136.40 Staphylococcus pyogenes citreus...........143.0° Staphylococcus pyogenes albus............143-6° Micrococcus of osteomyelitis.............136.40 (Identical with Staph, aureus) . ,......... Streptococcus of erys pelas..............129.20 Micrococcus tetragon s...............140° Bacillus variola..................' 212° The spores of all disease germs require a heat nearly fifty per cent, greater to kill, than the mother germ itself; ptomaines, the excretion of microbes, correspond chemically and pathologically with the cadaveric alkaloids, which are indestructible by any known heat, or process of calorification. The germ theory of disease has, and is producing a complete revolution in the treatment; it has created a new system of medi- 25 386 DISEASE GERMS. cine, a new cure founded on the presence of disease germs and their excreta ptomaines in the blood, and the introduction into the materia medica of a class of remedies called germicides. Bactericides are a series of valuable antiseptics and disinfec- tants now becoming of very general use by the highest scientific authorities for the purpose of exerting a detrimental influence on the evolution, growth, and multiplication of disease germs, in either sterilizing or killing them. In order that the remedy be pronounced a germicide, it is ne- cessary to bring it in direct contact with the disease germ for a definite period of time, then remove the germ to a suitable nour- ishing medium; if the germs refuse to grow, the conclusion is, that the exposure has either injured, sterilized or destroyed its life. While thus testing whether the remedy be a germicide or not, we must bear in mind that Pathogenic Microbes do not thrive in an acid medium, neither do they grow well unless there be some degree of warmth about blood heat; a very high heat kills all germs and parasites. In the case of pathogenic microbes, all remedies are to be pro- nounced germicides which have the power, when they are ex- posed or brought in contact with the micro-organism, of perfectly annihilating therm Pathogenic Microbes * either in the human blood or in a suit- able nutrient fluid, acted on by a germicide, are incapable of pro- ducing the disease, which the same organism, unexposed to the substance in question, does produce. A perfect germicide then must be capable not merely of destroy- ing the micro-organisms and their spores, but also of destroying by chemical oxidation the toxic products which they are capable of producing. The great scavenger of diseased blood is ozone. Ozone exists in the atmosphere and is liberated by friction, it is manufactured in the laboratory of the chemist in a method analogous to that of respiration. This, then, is nature's antisep- tic or germicide, the presence of ozone wards off all contagious and infectious diseases, it vitalizes all animated nature; without it there is no higher life, without ozonized phosphorus there is no thought, no longings after immortality. * Pathogenic Microbes.—The pathogenic microbes are those which are capable of generating disease; and the evidence on which their disease-producing powers rest is, it must be admitted, sufficiently satisfactory, for no microbe is regarded as the cause of a disease unless it is, in the first place, found to be constantly present in that dis- ease, either in the blood or in the tissues; secondly, unless when carefully isolated and cultivated, it can, when introduced into the body of a healthy animal, give rise to the original disease, and be again found in quantity in the body. BACTERICIDES. 387 Ozone, then, chemically pure and in an assimilated form, is the most important agent in nature and in medicine. When intro- duced into the human body it does its work efficiently as a scavenger to diseased blood, it also vitalizes the healthy corpuscle and tissue, it kills disease germs and eliminates them when dead from the body; thus the important factor in disease is destroyed and rendered innocuous. All the eminent medical men of this age and country attest the suprising virtues of the ozone preparations, and it is only a question of time as to its general utilization by the profession. It is of the greatest utility in all diseases to which flesh is heir to; good in all maladies, acute and chronic, when disease germs are lurking in the blood. We have many and numerous agents that are active germicides, but none so intrinsically valuable as C. P. ozone. It is a scandal to our civilization if, with a proper knowledge of the uses of ozone, typhoid fever, scarlet fever, diphtheria, small-pox are permitted to remain the scourge of our day, the terror of any parent, and allowed to run their course by succes- sive inoculations or infections from child to child, from man to man, when our increased knowledge teaches us that here we have an agent able to control and destroy any principle of contagion, every disease germ in any location. Microbes differ greatly in their chemical composition, and in their toxical effects upon the nervous system, and the germicide, organic or inorganic, which is prescribed for their complete anni- hilation, must meet the requirements of a positive strength so that when it comes in contact with the organisms, they ever afterwards are incapable of growing or multiplying, even their very existence is wiped out. Some germicides have a special affinity or chemical attraction to certain pathogenic microbes, and will unite with them more readily, combine with them and destroy them, than others. Witness how silently, how efficiently the glycerite of ozone, when administered in pulmonary tuberculosis, annihilates the tu- bercle bacilli; and if additional degradation of bioplasm could only be prevented, how rapid the cure. See the utter annihilation of the streptococcus, oidium albicans of diphtheric, the spherical and cylindrical masses making up the diphtheric membrane, the micrococci in the blood and every gland, and the pathogenic microbe of scarlet fever, if the ozonized glycerite of sulphur be freely administered. The microbe variola in or out of the body refuses to grow in the presence of thuja occidentalis. Such germicides kill the germ ■and eradicate all ideas of contagion and infection. 388 DISEASE GERMS. The comma-bacillus of cholera will not grow in the presence of lobelia, resorcin, lactic acid, ozone water, peroxide of hy- drogen. The cancer germ, of all microbes is undoubtedly the most difficult to reach by a germicide, although the practical experi- ence of a half of the members of our profession in America clearly demonstrates that the prolonged use of Chian turpentine mixture effectually kills it in the blood and also in the tumor. Administer the glycerite of wintergreen in acute rheumatism, fever ceases, all its symptoms disappear, because the microbe, its factor, is killed. Brush over a diphtheric patch or colony with the ozonized distillation of jequirity and the oidium albicans die ; sprinkle or dust or apply in capsule, the ozonized powdered jequirity to an ulcerated neck of the uterus, and the entire brood of bacteria will peel or shell off in the form of a false membrane, leaving normal tissue unaffected. When the bacteria of erysipelas migrate to the skin for free oxygen, if a saturated solution of boroglyceride be applied and kept wet, they entirely disappear. Witness the extraordinary action of sambul on the sugar fungus of diabetes; if administered it thoroughly annihilates it; the re- sult is, the languor, debility, chloroform breath disappear ; every function, appetite, excretion, becomes normal, and the affected in- dividual, with deranged chemical centre in his brain, assumes a new lease of life. Old physicians can scarcely realize the fact that the addition of resorcin to syrup of tolu, and administered in hooping cough, will cause the mycelia to disappear from the breath and blood, that morbid action will cease ; or that resorcin jelly applied over extensive burns, will kill the bacteria; or over the abdomen in peritonitis, inflammatory action ceases the moment the microbe is destroyed. Bring ichthyol close to any vegetable cutaneous parasites, they immediately die. The germicide calculated to do the work most efficiently should be selected; sometimes it is advisable to use one and sometimes another. The one best suited to the pur- pose is one which will retain the largest amount of positive or negative ozone, without causing the decomposition of the remedy, most of all the ozonized remedies contain from five to ten volumes of C. P. ozone, so that they are capable of yielding when taken on the stomach five times their own volume of nascent oxygen. They are all available for internal administration. The more general use of ozonized remedies exhibits a more rapid cure of a class of diseases hitherto deemed incurable, and a greatly diminished mortality among all contagious and infec- tious diseases. BACTERICIDES. 3^9 The following table of bactericides is prepared from the most careful experiments. One part in thirty will annihilate the bac- teria. The highest or germicide of greatest potency at top, weakening as you descend the scale : Peroxide of hydrogen. Corrosive sublimate. Sulphurous acid. Boroglyceride. Chloride of lime. Bisulphate of lime. Chlorine. Iodine and bromine. Chloride of zinc. Menthol. Thymol. Benzoate soda. Creosote. Benzoic acid. Methyl salicylic acid. Salicylic acid, Eucalyptol. Sodium salicylate. Carbolic acid. Oil cloves. Chloral hydrate. Permanganate potass. Wild indigo infusion. Glucozone. Arsenic solutions. Glycerite sulphur. Glycerite ozone. Glycerite wintergreen. Glycerite kephaline. Bisulphate of carbon. Con. ozone. Resorcin. Solol. Chian turpentine. Naphthaline. Quinine. Camphor. Ozone water. Alcohol. Oil of rue. Oil of thyme. Oil of peppermint. Oil of turpentine. Oil of erigeron. Oil of sassafras. Oil of fennel. C. P. ozone. Siegesbeckie. Essence mustard. Pino). Ichthyol. Creolin. Sambul. Iodol. Thallin. Hydrocotyle. Arbor vita. Saccharin. Comp. oxygen. Liquid ozone. Chloride of carbon. Simabicidia. Distillation of jequirity. Distillation of witch hazel. The above list, classified in the order of their activity. Each of the above, as a remedy, has more or less affinity for a special microbe, the factor of some special disease. The dose of a germicide must in all cases be innocuous to the tissue of the body, and still must be sufficient to either arrest their multiplication or sterilize, or destroy them. Amcebee. ^is microscopical vegetable organism, which we find present in all cases of nasal catarrh, ozsena, eustachian deafness,ulcerated sore throat, chronic laryngi- tis, bronchitis, incipient tu- berculosis, has a most won- derful tenacity of life, difficult to sterilize or destroy. Nasal catarrh and its kindred affec- tions are predisposed to by the presence of the microbe of syphilis, the bacillus of tubercle and other disease creating organisms in the blood, but the active exciting microbial factor of nasal catarrh is the amoeba, which is pathogenic of the disease; bears cul- The amoeba of nasal catarrh. 39Q DISEASE GERMS. ture well in any nutrient fluid; the inoculation of the cultures into animals produces the disease. The amoeba looks like o°o0o0 » breed by fusion, distension of their cellulose walls, and a shedding off of their embryonic broods, they are aerobic, take a thermal heat of over 212° F. to destroy them. This microbe is sterilized in the presence of ozone et chlorine, boroglyceride, resorcin, creolin, peroxide of hydrogen, myrtol, glucozone. Bacteria. the stomach. A general term once applied to all disease germs, but now restricted to that present on the tongue in malassimilation, or disordered states of It is identical with the bacillus megatherium, which is found on spoiled vegetables. It consists of large rods, like small sausages, four or five times longer than wide, usually somewhat curved. Transverse division occurs, each seg- ment attaining the length of the original rod. When fresh, they appear non- articulated, but when treated with alcohol, they are seen to be composed of seg- ments. The rods are motile, and form irregular chains of a disjointed appear- ance. They are pathogenic of malassimila- tion, bear cultivation well on nutrient agar and nutrient gelatine. Cultures injected into animals produce profound malnutrition; tongue coating heavily. Spore formation in the usual manner. If not sterilized or annihilated, it becomes an exuberant breeder, giving rise to colic. This microbe bacteria is the most common of all disease germs, being the degraded bioplasm of normal nutrition in man and plants, changed or altered under some adverse state. It is found in all deranged states of the alimentary canal in wounds, ulcers, and all breaches of continuity. Like all other disease germs, it has marvellous powers of re- production under favorable conditions. It is either sterilized or annihilated in the presence of eucalyp- tol, Warburg's tincture, matricaria, sulphur water, peroxide of hydrogen, and other bactericides. The Bacteria—the degraded bio- plasm of nutrition, magnified 600 diameters, in an active state of growth and nutrition. Spore formation is seen beginning in a single cell, spreading in link-like sausages, which vegetate and divide. These protoplasmic bodies are surrounded by a cell wall or cellulose membrane so thin that they are virtually naked; they move either by rotation or oscillation. Present in erysipelas, boil, gastric fever. BACTERICIDES. 391 Bacteria Pneumonica Micrococci of the pathogenic ; microbe of the pneumococcus seen in different stages of growth in the prune juice 01 the sputum prior to the rigor. consist of short, thick rods, almost ellipti- cal cells ; often two to four linked together, forming dark granular colonies. The lanceolate diplococcus represents the only pathogenic microbe or virus of genuine primary pneumo- nia. During the first three or four days of the disease the diplo- coccus is present in the patient's sputa in an almost pure cultivation; but later on there may be found, side by side with it, either the amoeba sub- tilis, or sometimes various pyogenic micro-organisms, such as staphylo- coccus aureus et albus, bacillus of green pus, streptococcus, etc. The lanceolate coccus, however, is in- variably detected in such enormous masses that a pneumonic sputum cannot possibly be mistaken for that of any other kind—bronchitic, etc. Still, in view of the fact that the staphylococci, micrococcus tetragenes, and such like microbes may stimulate to a certain degree the pneumonic cocci, the differential diagnosis in question should be always settled by means of plate preparations and cultivation experiments, in addition to a micro- scopic examination. The diplococcus loses its virulence and vitality with characteristic rapidity, both in the patient's system and on artificial nutritive media. In the former case it becomes less and less virulent day by day, to perish altogether just after the crisis. In artificial media kept at 370 C. the microbe loses its vital- ity in a week; in that at 400 or 40.500 C, even in a few days. How- ever, when the medium is daily renewed, and-invariably kept at 320 C, the coccus may survive about three weeks. In lower animals, on inoculation of its pure cultures ob- tained from the sputa or pulmonary juice (in cases ending fatally before the crisis), the diplococcus gives rise to a typical fibrinous pneumonia. We strenuously insi.st that a bacterioscopic examination of the patient's sputa Perfect adult form of the pneumococcus magnified 2000 diameters ; A and B, thread forms: C, D and E, rod forms; G, diplococci; H, cocci; /, streptococci. The pneumococcus consist of cocci, ellipsoidal or round, single or in pairs (diplococci), rocs and thread forms, all enclosed in a cell membrane or geiatinous capsule. 392 DISEASE GERMS. should be undertaken; possibly early. The latter should be collected always after a preceding thorough disinfection of the oral cavity. The microbe is pathogenic of pneumonia ; grows vigorously in blood serum or beef juice. Cultures injected into any animal will give rise to the disease. The microbe is most abundant in the prune juice sputum, from which it is easily isolated. The microbe is either sterilized or annihilated by inhalations of comp. oxygen, peroxide of hydrogen, glucozone, etc.; locally by concentrated ozone and chloroform over the microbial- smitten lung, followed by linseed-meal poultices and resorcin jelly. Germicides internally, peroxide of hydrogen, alternated with liquor ammonia acetatis and sulphate of quinine; Warburg's tincture, antifebrine, resorcin, creolin. Jaborandi, administered before microbes form a colony (red hepatization), will cause the micro-organism to leave the lungs for the skin ; later on, no good. The microbe excretes ptomaines freely, the alkaloid being pro- ductive of embolism, and cardiac and intestinal paralysis. The microbe of all warts, contagium vivum, a Bacterium minute germ. Porri. Bears culture well in any warm nutrient liquid (is pathogenic), injected into any animal it invariably causes an abundant crop of warts to appear over the entire body. Microbe is at first sterilized, subsequently annihilated, in the presence of thuja occidentalis. Washing them over with salt water twice daily, and then sprinkling them with calomel. The reaction of the residual sodium chloride and calomel produces mercuric chloride, which speedily annihilates the microbe without the slightest pain. Lactic or acetic acid efficacious. The bacillus of butyric acid—the Bacillus Amylobacta. microbe of rheumatism. This micro-organism results as an evolution of fermentation from starchy and saccharine solutions. It takes the form of minute cylindrical rods, rounded at their ex- tremities, usually straight, and either isolated or united in chains of two or more articulations. They have a gliding motion, and are often curved and present slight undulation, they are repro- duced by fission, and like all other germs, excrete ptomaines freely. They are found most abundantly in cheese, convert the lactic acid in milk into butyric acid. BACTERICIDES. 393 This microbe, the evolution of fermentation, is pathogenic of rheumatism, bears cultivation well, and its injection into animals produces the identical condition of rheu- matism which we meet with in the human ^subject. The microbe is anaerobic, in the ripening of cheese, in the fermentation of sauer-kraut, and sour gherkins; in a case of acute rheumatism, the micro-organisms can be detected for at least twenty feet from the ferment. Ptomaines are excreted freely, and are the cause of the intense suffering. This microbe can either be sterilized or completely annihilated in the presence of the glycerite of winter- green ; uric acid solvent; salicylate soda in acetate of ammonia ; manaca, cascara sagrada tablets ; tine, cimicifuga racemosa. Bacillus Amylobacta, spindle shaped forms including oval spores. Bacillus wool-sorters' disease, or malignant pustule, con- sists of rods, long and broad, and threads, with Anthracis, spore formation present and ac- tive ; rods are straight, or some- timse curved, rigid and motionless ; vary in size in different animals. The most tenacious of life of all microbes; and excretes ptomaines in great abundance, so much so that it is probably as fatal a disease germ as rabies. It has a most vigorous growth, literally loads the capillaries all over the body, lungs, liver, kidney, spleen, skin, mucous ->o li> » J 0 ©,-<5 Q <&Q J3* '§■ ■0 0 ©« ?©,Q Kucillus Anthracis, as seen i wool sorter. the blood of a Anthrax, giant bac- teria magnified 6oo diameters ; from foreign wool. Pathogenic 392 DISEASE GERMS. should be undertaken; possibly early. The latter should be collected always after a preceding thorough disinfection of the oral cavity. The microbe is pathogenic of pneumonia; grows vigorously in t blood serum or beef juice. Cultures injected into any animal will give rise to the disease. The microbe is most abundant in the prune juice sputum, from which it is easily isolated. The microbe is either sterilized or annihilated by inhalations of comp. oxygen, peroxide of hydrogen, glucozone, etc.; locally by concentrated ozone and chloroform over the microbial- smitten lung, followed by linseed-meal poultices and resorcin jelly. Germicides internally, peroxide of hydrogen, alternated with liquor ammonia acetatis and sulphate of quinine; Warburg's tincture, antifebrine, resorcin, creolin. Jaborandi, administered before microbes form a colony (red hepatization), will cause the micro-organism to leave the lungs for the skin ; later on, no good. The microbe excretes ptomaines freely, the alkaloid being pro- ductive of embolism, and cardiac and intestinal paralysis. The microbe of all warts, contagium vivum, a Bacterium minute germ. Porri. Bears culture well in any warm nutrient liquid (is pathogenic), injected into any animal it invariably causes an abundant crop of warts to appear over the entire body. Microbe is at first sterilized, subsequently annihilated, in the presence of thuja occidentalis. Washing them over with salt water twice daily, and then sprinkling them with calomel. The reaction of the residual sodium chloride and calomel produces mercuric chloride, which speedily annihilates the microbe without the slightest pain. Lactic or acetic acid efficacious. The bacillus of butyric acid—the Bacillus Amylobacta. microbe of rheumatism. This micro-organism results as an evolution of fermentation from starchy and saccharine solutions. It takes the form of minute cylindrical rods, rounded at their ex- tremities, usually straight, and either isolated or united in chains of two or more articulations. They have a gliding motion, and are often curved and present slight undulation, they are repro- duced by fission, and like all other germs, excrete ptomaines freely. They are found most abundantly in cheese, convert the lactic acid in milk into butyric acid., BACTERICIDES. 393 This microbe, the evolution of fermentation, is pathogenic of rheumatism, bears cultivation well, and its injection into animals produces the identical condition of rheu- matism which we meet with in the human ^subject. The microbe is anaerobic, in the ripening of cheese, in the fermentation of sauer-kraut, and sour gherkins; in a case of acute rheumatism, the micro-organisms can be detected for at least twenty feet from the ferment. Ptomaines are excreted freely, and are the cause of the intense suffering. This microbe can either be sterilized or completely annihilated in the presence of the glycerite of winter- green ; uric acid solvent; salicylate soda in acetate of ammonia ; manaca, cascara sagrada tablets ; tine, cimicifuga racemosa. Bacillus Amylobacta, spindle shaped forms including oval spores. Bacillus Anthracis, wool-sorters' disease, or malignant pustule, con- sists of rods, long and broad, and threads, with spore formation present and ac- tive ; rods are straight, or some- timse curved, rigid and motionless ; vary in size in different animals. The most tenacious of life of ail microbes; and excretes ptomaines in great abundance, so much so that it is probably as fatal a disease germ as rabies. It has a most vigorous growth, literally loads the capillaries all over the body, lungs, liver, kidney, spleen, .. ^ . „ , « skin, mucous '©a-G-^'©^©"^ G> membrane. In a well marked case they are so nu- merous as to cause infraction of the kidneys, and look under a small power as if the kidney was an injected speci- men. One of the most contagious and infectious of all malignant microbic diseases. in the truest sense of the term. The sterilization and destruction of the germ is most difficult, because when a man, woman, or child, or an animal die and are © Bacillus Anthracis, as seen in the blood of £ wool sorter. Anthrax, giant bac- leria magnified 6oo diameters ; from foreign wool. Pathogenic 394 DISEASE GERMS. buried, the worms bring .the germs to the surface and deposit them. The excrementary discharges from infected animals find a nourishing soil in decaying vegetable and animal matter; and their spore formation is active in marshes, rivers, ponds; inhala- tion of spores, ingress by the pulmonary or intestinal mucoid membrane, or direct inoculation are thus being constantly kept up. Various theories have been proposed as to the mode in which the anthrax bacillus causes death—by embolism, by a ferment which decomposes the tissues ; by the evolution of ptomaines. From pure cultures of the bacillus, a most deadly alkaloid is ob- tained. The same in the blood of the affected individual is so toxi- cal that death often takes place before the symptoms of the dis- ease appears. ______ Bacteriological demonstrations on malignant or Bacillus cancerous growths have arrived at the following of conclusions: Cancer. I. The disease is caused by a special pathogenic red-shaped microbe. 2. The bacilli have slightly ovoid outlines, and are arranged mostly in pairs and little heaps, their length amounting to one- fourth of the diameter of a red-blood capsule. 3. In a pure cultivation (§) ^N^ J / 1 the rods grow best on <^ £^^ \ coagulated blood-serum at fa ^/*\T A \ tne bofty temperature. w^ u 4. When inoculated un- der the skin in animals, The microbe of Cancer. ^ mjcrobe giveS HSe tO a cancerous degeneration, commencing in the nearest lymphatic glands, and subsequently spreading to the internal organs, especially to the mesenteric glands, omentum, liver and pericar- dium. In all the organs genuine cancerous nodules are formed. 5. Of the lower animals, rabbits and cats prove to be most sensitive in regard to the bacterium. When inoculated they die in one or two months from cachexy, with generalization of can- cerous foci all over the body. 6. All cancers (of any variety and any organ) seem to be caused by one and the same bacillus. The microbe is pathogenic of all forms of cancerous growth. It is sterilized and annihilated in the presence of Chian turpen- tine, saxifraga, sulphate of lime resorcin, thallin, compound saxi- fraga and phytolacca ozonized ; siegesbeckie, hydrocotyle. BACTERICIDES. 395 This microbe consists of very short rods, with Bacillus rounded ends. They are round, ovoid, or spindled Indicus. shaped, and have characteristic granular margins, having a strong resemblance to the microbes of pneumonia and rhinoscleroma, both of which are capable of giving rise to the formation of indigo blue, and to indigotic fer- mentation. It is pres- ent in Addison's dis- ease. This microbe plays an important part, and determines the forma tion of indigo in vario i: s diseases. Indigo is a fermen- tation product, due to the action of this m - crobe, and not to sim- ple oxidation. This indigo bacillus is pathogenic of various affections, due chiefly to non-aeration of the blood,bears cultivation well. If injected into any animal gives rise to embolism, hepa- tization of lungs, cardiac apoplexy, visceral congestion and fibrinous exudation. This microbe is sterilized in the presence of compound tincture kurchicine, eucalyptol, sulphate of quinine, compound oxygen, ozone water, liquor ammonia acetatis, belladonna and acro-nar- cotics generally; peroxide of hydrogen. A giant form of bacteria trans- Bacillus Mallei: mitted to man from the horse. The Microbe of Glanders The nasal discharge placed in and Farcy : the field of the microscope ex- hibits the micro-organisms in the form of fine rods, about the size of the tubercular bacilli. They appear in the form of minute, transparent drops, consisting en- tirely of characteristic bacilli. When this microbe enters the human blood it takes one or other of two forms, either excites by its presence irritation, in- flammation of the lining membrane of the nose, which speedily passes into ulceration, round, scooped-out ulcers, elevated edges, Microbe of Indicus, as seen in the liver, magnified 1500 di- ameters ; found in pneumonia, Addison's disease, asph) xa, cyanosis, valvular heart disease ; excretes ptomaines frtely. 396 DISEASE GERMS. with a central granulation, profuse micro-purulent discharge (glanders), or the microbe causes a germinal blocking up of the lymph canals, with en- _^__^ **>, gorgement (farcy). The ^•k^-^V^ -^ v^^^^^-^t^C microbe excretes pto- y^'^N^--^-^^* ^/_^^ fj */\ maines freely. \vN^t^^-x,;C[^^^'^C>^-** ^e m'cr°be 'ls thees- f^ Vxi'/N^?; .*— / sential cause of the dis- ^ V^NZ*S ^L^^* J^^~~y ease> an" 1S pathogenic. **-—-' " ** Bears most excellent Bacillus Mallei, .he microbe of Glauders and Farcy. culture m beef tea Of meal extracts. To Sterilize or Annihilate the Germ.—It will not grow in the presence of peroxide of hydrogen, glucozone, sulphate of lime and other bactericides. _______ Rods, very fine, like thread forms, mostly col- Bacillus in lected in irregular masses, with characteristic Tetanus. spore-formation. Inoculation of garden earth subcutaneously into rabbits induces tetanus. The bacilli found in their blood is identical with the microbe in man. The germ is pathogenic of the disease, bears cultivation well, and is as active after several generations of culture as in its primi- tive state. Pre-eminently contagious and infectious, it has an un- certain period of incubation, depending upon the status of vital force of the inoculated. Cases occurring , .„„ twenty-four, thirty-six or forty-eight hours '''**jS\i'i/, after injury rarely survive the third day, but t'ltV^■ '■*$ comparatively few are lost when it comes on the ninth or eleventh day. '*,;;*/9^/ The excretion of ptomaines is most active in and around the medulla, death often takes Microbe of Teunu.. place from them before they have time to enter the blood. Sterilized and annihilated by the administration persistently every few minutes of a combination of lobelia, capsicum, valerian, resorcin and sozoidol, aided with con. ozone and chloroform to nape of neck. Three rod-formed organisms, whicii Caries and Necrosis, give rise to and are invariably asso- Bacillus saprogenes. ciated with a gangrene of bone and putrefactive processes generally. The microbe is readily procurable from necrosed bone or from otitis media, grows very readily on blood serum. All cultivations BACTERICIDES. 397 yield the microbe with the peculiar odor of rotten kitchen refuse. The bacillus bears in- oculation well. The microbe becomes sterilized in the pres- ence of either of the fol- lowing remedies: Peroxide hydrogen; glucozone; chloride of gold et soda; baptisia; siegesbeckie; distillation of jequirity; etc Bacillus Saprogenes, the microbe of Caries and Nf Caries Dentalis. Caused by a tissue-starved brain; hot and cold fluids; indigestion, formation of lactic acid degrades the elementary mole- cules into a polymorphic bacillus, which is pathogenic of the dis- ease, bears cultivation well in beef tea to which some phosphate of lime is added. Inoculation into animals gives rise to tooth caries. So infec- tious is it that one carious tooth will contaminate a mouthful. The microbe becomes sterilized in the presence of the anti-microbe powder ; concentrated ozone; distillation of je- quirity ; solutions of boroglyceride; soap-tree bark and hydrogen peroxide; infusions of wild indigo ; fennel; rue ; and nearly all the aromatics. Microbe of tooth caries. consists of rods, occasionally long, very thin, Bacillus and rounded at the ends. They are both Tuberculosis straight or curved, and frequently beaded ; occur singly, in pairs, or in bundles. They are found in the cells of tubercles, especially in the interior of giant cells. Propagate by spore formation. A tubercle bacillus consists for the most part, of a very deli- cate sheath, with protoplasmic contents which have a great tendency to be broken up, or coagulated into little segments or roundish granules. 400 DISEASE GERMS. To sterilize or annihilate the microbe, a combination of lobelia, stramonium and belladonna (crude) inhaled, or administered in tincture form, will sterilize; glonoin, nitrate of amyl; sulphate sparteine, have the same action ; euphorbia piluliform. The microbe is annihilated in the presence of pyridin. consists of rods, very minute. Two or more Bacillus in ovoid points are visible in the course of the rod, Syphilis which are spores. They are best observed from the secretion or discharge of the indurated chancre, or from the ulcers in the mouth. When the blood is searched for them, they are, when present, found in the interior of the nucleated cells. The microbe is pathogenic of systemic The bacillus in syphilis as seen in the b'ood. syphilis. Bears culture well; reproduces itself in all red-blooded animals when injected subcutaneously. The ptomaines excreted by the syphilitic germ are peculiarly toxical to skin, mucous membrane, bone, brain, lungs, etc. When the atmospheric electrical influences are low, germ breeds most actively. Thence the nocturnal pains in bones, etc. The micro-organism is annihilated in the presence of saxi- fraga, kalmia, phytolacca, stillingia, irisine, sulphur water ozonized, sozoiodol. BACTERICIDES. 401 appears in the form of a rosette of pyriform, The Microbe or club-shaped elements. The little masses Actinomycosis are arborescent, pure white, of a yellowish tinge, visible to the naked eye. The microbe effects an entrance to the mouth through an abrasion, wound or carious tooth. Then the living organism sets up an inflammation, which results in the formation of a neoplasm, composed chiefly of round cells, resembling a tuber- cular nodule. These may break down or go on increasing in size. Fibrous growths may develop between the nodules, and these latter into purulent excavations or cavities. The microbe has a special affinity for the mouth, gums; if it does not localize there, it may select the lungs. There it pro- duces great havoc, destroying tissue, forming fistulae and sinuses, giving rise to fetid expecto- ration ; often causes caries of the spongy bones. The fungus has been detected in the tonsil. The fungus bears cultivation well, pathogenic of the disease; extremely contagious and infec- tious. Cattle drivers are most generally affected. The microbe of Acti- The absence of antiseptic precautions among dentists aids greatly in maintaining and propagating the disease. The microbe is sflerilized and completely annihilated in the presence of concentrated ozone, ozonized jequirity, anti-microbe powder, peroxide of hydrogen, and other germicides ; but before these are applied, free incisions, openings and counter-openings into the diseased parts should be made, so that the remedy may reach the microbe. ______ Bacteria abound in the intestines even in Microbe health, and some have thought that they might of Diarrhea, even aid the digestive juices in breaking up the food. It is quite likely that they aid in breaking up the food, but whether they do so with any advan- tage to the organism may be somewhat questionable. . They tend to split up the products of pancreatic digestion farther than the pancreatic ferment would, and one of the substances to which they give rise \ ;'*:';-;•! £.- is indol. This body has an antiseptic action, i:?.;*/jL and belongs to the aromatic series, members **S * "* of which, as I shall afterwards have to show, Microbe of diarrhea. haye a yery markecJ action upon the liver. In the intestine it becomes converted into indican, which is absorbed and excreted in the urine. Diarrhea may depend either upon special microbes or their A/*.. * *'-•* 402 DISEASE GERMS. ptomaines. These are numerous, but not completely isolated; but that due to cholera and typhoid fever acts to a great extent upon the organism by simply producing poisons in the intestines. To sterilize the entire crowd of germs which produce diar- rhea, intestinal disinfectants have been proposed. Naphtha- line, which has been recommended by eminent authors, is very sparingly soluble; so much so that it passes to a great extent unchanged through the whole of the intestinal canal. It cer- tainly destroys the disagreeable odor of the motions in infantile diarrhea, but it does not appear satisfactorily to check the dis- ease. Salol is the phenyl ether of salicylic acid. It passes through the stomach unchanged, but in the duodenum it is split , up by the pancreatic juice into salicylic and carbolic acids. Although the carbolic acid is set free at the point where its action is wished, yet there is still the dis- advantage of its being poisonous, and so betol has been recommended. The constitution of this sub- stance is similar to that of salol, but it splits up into salicylic acid and beta-naph- thol, which is much more sparingly soluble, and which Microbe of summer diarrhea, magnified 2000 jg 1°SS DOisOnOUS than Car- diameters. .. \ . bohc acid, while it is much more powerfully antiseptic. Resorcin, thymol and benzoate of soda are among the antiseptic remedies which sometimes are useful, but these are either weak or subject to the same objec- tions as carbolic acid. Direction in which to look for Intestinal Disinfectants.—When we consider the enormous number of aromatic compounds which have an antiseptic action, we may expect almost with certainty that amongst them most useful remedies are to be found for diarrhea, and Pellicani has found that substances containing a diphenyl nucleus are less poisonous, and at the same time more powerfully antiseptic, than those containing a single phenyl nucleus. But there is another class of sulpho compounds—the sul- phonic compounds—in which the atom of sulphur, instead of being united by means of oxygen to the aromatic nucleus, is attached directly to one of the, carbon atoms in that nucleus. BACTERICIDES. 403 One such compound—ortho-phenol-sulphonic acid, or aseptol, .as it has been christened—has been introduced both as a local antiseptic and as an intestinal disinfectant. The commercial aseptol is a solution containing one part in three, and it is administered internally, in the same dose as salicylic acid, in cases both of gastric and intestinal catarrh, and apparently with good results. The comma-bacillus. Curved rods Microbe of spirilla and threads. The curved rods Epidemic Cholera, or commas occur isolated or in masses, or attached to each other forming S- shaped organisms or longer screw forms. The commas are actively motile, rapid in development, excrete ptomaines abun- dantly in the superficial necrosed layer of the intestine, in the mucous flakes and liquid con- tents of the intestinal canal of epidemic chol- r\g -^ era, and often cause death before the germ has df** ^J time to enter the blood. It is pathogenic of the disease, bears arti- ficial cultivation well in broth, and reproduces itself by either being injected or fed to animals. The microbe is either sterilized or com- pletely annihilated in the presence of salol, The c°chmoferaa.cillus °f creolin, sozoiodol, lactic acid, naphthaline, tercbene. when isolated from the ordinary excremen- The Microbe of titious matter of the lower bowel, appears Dysentery, in the field of the microscope as a germ, slightly elongated and oval, or short and cylindrical, with rounded ends. They divide by fission ; like the micrococci, the individual elongating and becoming constricted in the middle, capable of spontaneous locomo- tion, having a flagellum at one or both ends, with which they perform active spinning or darting movements. They are capable of forming zooglcea, in which the interstitial gelatinous is more copious. The microbe is pathogenic of the disease, bears cultivation •*■ well in any broth, the cultures when injected The microbe of dysentery. .^ anjmals giye us all the virulence of the original disease. The micro-organism is indigenous to the rec- tum and colon; breeds and multiplies there, excretes ptomaines which give rise to the tenesmus, fever, furred tongue. 404 DISEASE GERMS. The micro-organism is either sterilized or completely annihi- lated in the presence of ozonized stone crop; creolin, peroxide of hydrogen; naphthaline; resorcin; essence of mustard ozonized; salicylic acid in acetate of ammonia. The Microbe of Influenza. Asthmatus Ciliaris. Infusorial catarrh, epidemic influenza, very common during the winter months. The mi- crobe is a flagellated infusoria, with body and cilia. It is pathogenic, bears cultivation well in any nutrient fluid. While in the body it excretes ptomaines so freely that they Micrcbe of ii.fluenza; infusorial catarrh. are to be found in great abundance in the urine, and often cause sudden death. The microbe is sterilized and completely annihilated in the presence of jaborandi, and peroxide of hydrogen internally; inhalation of either glucozone, or menthol, or nascent chloride of ammonia, or ozonized sulphur water, or benzoate of soda. The Microbe of Boils. i3& Identical with that of erysipelas. The pus from a boil contains bac- teria, analogous to those in the lymphatics of erysipelas, bearing culti- vation well. Pathogenic. The local application of equal parts of either ozone ointment and resorcin, or citrine ointment, applied before posi- tive suppuration occurs, kills the mi- crobe. A thick coating applied gives rise to a drawing sensation, followed by complete cessation of pain and tender- ness. Carbuncles may be well treated by applying a cerate made of ichthyol, four parts ; camphorated cerate, fifteen parts. Apply on lint. The pain is relieved and the disease is arrested or modi- fied. Staphylococcus pyogenes aureus ; the miotobe of boils. I BACTERICIDES. 405 Salicylic acid and extract of belladonna; or ichthyol, one drachm to a half ounce of water sterilizes the microbe ; whereas, internally, either brewers' yeast, ozone water, iodol, one-fourth grain doses sulphide calcium, lycopodium and other germicides have a remarkable action in sterilizing the germ. A most excellent method is to inject a few drops of the per- oxide of hydrogen into the centre of the boil. This unpigmented amoeboid body makes The Microbe of its way into a red blood corpuscle, and Malaria. lives and increases in size af the expense of the latter. It becomes pigmented, the pigment-granules being changed to haemoglobin. It has been demonstrated that the granules contain iron. Having come to occupy the entire, or almost the entire, cor- puscle, it enters upon a cyst stage, during which the pigment- granules make their way to the centre, and segmentation of the periphery takes place, thus forming spores, which are subse- quently set free. Each spore then begins again the same life circle. The biological relation of the crescentic and flagellated forms to the others has not been made out. But there are, among the lower animal organisms, many polymorphic varieties, which at different periods of development exist as spores, amoeboid bodies, cysts, and flagellated organisms. Among the protozoa, some forms develop falciform spores which in appearance resemble the crescents. The paroxysm seems to be the period at which the segmenta- tion and setting free of spores takes place. This is now tolerably definitely settled. The discovery in the blood of the segmenting bodies, justifies the positive prediction that the patient will have a chill at some time within two hours. Immediately after the paroxysm one finds free spores and unpigmented amoeboid bodies. During the day of intermission the pigmented amoeboid forms gradually increase in size till six or eight hours before the chill, when the cyst stage is met with. Immediately before and during the chill, one finds the segmenting forms. The germ is pathogenic of the disease, will grow in almost any nutrient fluid. Inoculative experiments on human beings are almost uniformly successful. Intravenous injection of malarial blood into a healthy individual is followed by typical intermittent fever, with 406 DISEASE GERMS. the appearance in the blood of the second person of the various forms of the organism described. The germ is sterilized by the administration of quinine; com- pletely annihilated by comp. tine, kurchicine; Warburg's tincture alternated with green root tincture of gelsemium. The more atoms of carbon a drug contains, the more powerful is its anti-malarial effect, kurchicine and eucalyptol each contain twenty atoms of carbon, and are distinctly germicidal to this germ. Poverty of nerve force invariably gives The Microbe of rise to the evolution of a pathogenic mi- Neurastflenia. crobe, which bears cultivation well in a broth of wheaten grits. It can be readily isolated from the tongue of an insane individual, and can be found in all states of nervous exhaustion, languor, headache, neu- ralgia, spermatorrhea, impotency, suicidal mania; most com- monly met with among males. The presence of this microbe explains why suicide and spermatorrhea are epidemic, impotency endemic, insanity contagious. The first appearance of this microbe in a man strikes at the origin of life, saps his sexual vigor, causes the disappearance of spermatozoa in the prostatic secretion, and in their stead sper- matic crystals appear, which are devoid of all vitalizing or ferti- lizing elements. Kill this microbe with bactericides, languor, headache, suicidal mania disappear, the ravings of the insane will cease, impotency and sexual callousness be wiped out. The remedies to sterilize this microbe and cause its disappear- ance from the nervous system are: cerebin, glycerite of kepha- line, avena sativa, electricity and vitalized massage. Pathogenic of all chronic bronchial The Conferva of affections, found in greatest abundance Chronic Bronchitis, in the slate-colored sputum. Bears cultivation well in liquid gela- tine ; cultures injected into animals give the cadaverous cough, with its decided prostration so peculiar to the disease. The conferva of bronchitis. The micro-organism being difficult to reach, even by inhala- tion, renders the malady essentially very chronic; however, it is sterilized in the presence of creosote, peroxide of hydrogen, BACTERICIDES. 407 glycerite of kephaline, lobelia, senega, ammonia, and completely annihilated by resorcin in syrup of tolu; salicylic acid, and acetate of ammonia. _______ A streptococcus massed upon the thickened Micrococcus valves of the heart, small chains, three or four Endocarditis, linked irregularly together, later on they as- sume the form of zooglcea and are found con- gregated together and form plugs in the vessels of the muscular tissue of the heart. In the detritus of the ulceration which fol- lows, they are found in chains. The micrococci are also found in the spleen, kidneys, liver, lungs, lymphatics, blood. They bear cultivation well in beef tea. This microbe is pathogenic of the disease. The changes in the heart after death give evidence of great microbial growth, the muscular structure is engorged, red; later it assumes a grayish, mottled, opaque, buff color, and finally changes to green. The microscopical appearances vary much, but simply eluci- date different stages of germ proliferation, a degenerative pro- cess, a breaking down of tissue and formation of abscess ; muscu- lar tissue, in chronic cases, is replaced by a new formation or cal- careous deposits. This micrococcus is most difficult to sterilize or annihilate; quinine, strophanthus and other drugs of no avail. The gonococcus, cocci, singly, in pairs, Micrococcus groups. They are found in great abundance WR ft Gonorrhea. in the muco-purulent dis- charge from the urethra, in the pus of a soft chancre and buboes. The microbe bears cultivation well in nutrient broth, and the pathogenic character of the cocci is established beyond all doubt by inocu- lation. The micro-organism is sterilized and com- Micrococcus of gonor- pletely annihilated by the ozonized distillation wL^after"'"^7"^ of eucalyptus, by the introduction of the thai- £ars^n ™*{J fommy lin ozonized bougies into the urethra; inter- of.fissi°"of t.heir nu: nally by germicides which dodge or are un- moving in the proto- affected by the gastric juice, and are excreted plasm (X 00 lam' by the urethra in molecules, which coming in contact with the microbe, kill it. Those embrace balsam copaiba, oleum tere- binth, petroleum, sandal-wood, cubebs, kava kava, etc. 408 DISEASE GERMS. Micrococcus in Haemophilia. Neonatorum, a coccus characteristic of this disease, has been found in hemorrhage of infants and young persons, which is pathogenic. Micrococci Scarlatina. ^-^ -^ Streptocr cuiis of scarlainn and magnified 500 diameters; tound on the mucous membrane ot the mouth, tongue, tonsils, uvula. These, during the fever, prior to 1 heir appearance on the skin, form or grow into large diplococci and cocci in cnains. and thick zooglcea are found on the larynx. The capillaries and inter- lobular spaces are blocked with cocci. Blood germ-laden with the micrococci; mouth and glands of the throat swarming. The germ is minute, seeks the skin for free oxygen, where it will breed (if not smeared over with olive oil and resorcin or ozone ointment) in the scales of the desquamating epi- dermis ; will continue this in colo- nies if not smothered out for two weeks or more. It is the deficiency of vital force, amount of germs present, with their ptomaine excretion, which give rise to the three forms of this fever. Pathogenic—Sterilized and anni- hilated in the presence of glycerite of sulphur, sulphide of lime, per- oxide of hydrogen, sulphur water. These also destroy spores and check the evolution of ptomaines. Micrococcus in Measles. measles. Round cocci and diplococci have been found in the watery discharge from the eyes and, in the sweat, eruption, ca- pillary vessels and blood of patients affected with After the stage of incubation, .vK**'/'•.•»•••". ten days, and of active sprouting, four :v.vj»*£^£v;.-. .;:■;. days, the micrococci leaves the blood and *v-^'^C'!4"4\""":ii':>: migrates to the skin for free oxygen. '•::-.:*^->'::'t. The germ is pathogenic, bears culture "'r;>' , . „11 TU J- • ii- Micrococci of measles. well. I he disease is reproduced in animals by either feeding or injecting the cultures. The germ is easily sterilized and destroyed by either the administration of jaborandi or resorcin. We find, in a small-pox pustule, micrococci, either Variola, isolated or united, which may be seen on a section of the skin. The same microbe may be observed on the pustules of the mucous membrane of the mouth or larynx, in the liver, kidneys and blood. ♦■•.trcv?"* ' BACTERICIDES. 409 The micrococci are pathogenic of the disease, bear cultivation well in any warm, nutrient broth; cultures, injected or fed, will reproduce the disease in either man or animals. .-?.?:.-..•..... The micrococcus, found irt small-pox pustules, <£;/|;/^;:;..^ does not differ in its form from that of the cow- •■p^.^iS^' pox in cows; chemically, morphologically and .^ 'f\ P~.*£F ' microscopically, they are the same; they are "'^>%%? completely sterilized and annihilated by the ,-••'"OS '" same remedies, to wit, thuja, sulphide of lime, The micrococci of dioxide of hydrogen and bichloride of mercury. •This microbe is found in the sputum of pa- Micrococcus tients suffering from pulmonary tuberculosis Tetragonus. and in the walls of the cavities in the germ- eaten lung. They are found in groups of four (tetrads) surrounded by a hyaline capsule.. Present invariably when the actinomyces are in lung structure. They are pathogenic of vomica, caverns in the lung ; bear cultivation well; reproduce the disease in animals. Groups of the charac- teristic tetrad are found in the capillaries, lungs, spleen and kidney after death. When present, urine usually loaded with pto- maines. The presence of Micrococcus tetragonus ; from the walls of a vomica if 1 • 1 1 in the lung. those deadly alkaloids ex- plains the sweats, diarrhea, hectic fever that are present. The microbe is sterilized in the presence of glycerite of ozone, tarsyrup, peroxide of hydrogen; completely annihilated by kepha- line and toluene. '* *<£D< Actively motile, dumb- Micrococcus bell cocci are found in the in blood, lymphatics, in all Typhus. cases of typhus, ship or g6»y^ jail fever. f$£ *^*\ They are isolated from the breath, saliva, sweat, the eruption. They are pathogenic ; easily cultivated in any nutri- ent medium. The microbe of typhus fever. 4io DISEASE GERMS. An injection of the cultures into animals reproduces the disease. A course of ordinary germicides effects a destruction of the micro-organisms in the blood. The same class of remedies, act also as prophylactics, by steril- izing the blood. ____ Micrococcus Urea. ^^es^ The transformation of the urea (the nitro- genous principle of urine) into ammonia and carbonic acid, under the influence of a microbe, appears in the form of free globules of articu- lated filaments, or of chaplets, resembling those of the lactic fer- ments. So long as the bladder is perfectly, empty, that is per- fectly evacuated, no residual urine, there is no microbe in it, but let there be some little retention, probably owing to an enlarged pros- tate, then this microbe is evolved. True it is often carried into the urethra by bougies, catheters, sounds, but very generally found in the bottom of the chamber. This microbe is the true cause of ammoniacal fermentation and intense uriniferous odor. The germ is positively sterilized and anni- hilated by boroglyceride internally and locally. „©<=* (peetfOev *2»a C2>e, Micrococcus urea, mag- nified 1500 diameters, as found in the bladder of all patients wiihpros- tatorrhcea, catarrh or ulceration of the blad- oer, with dribbling urine ; a germ of rapid growth. Micrococcus in Hooping Cough. Elliptical cocci, having a strong resemblance to the oidium albi- cans or its mycelia, are constantly present in the breath, expectora- tion and secretions of all individuals suffer- ing from pertussis. In the sputum of patients affected, in their blood, micrococci resembling figure 8. The microbe bears culture well, and is pathogenic of the malady. Culture in- jected or fed to animals reproduces the original disease in all its virulence and precision. It is an active ptomaine elimi- nator, to whose toxic presence is due the em- bolism of blood, fever, vomiting, convulsions. The micrococcus is either sterilized or annihilated in the presence of either of the following remedies: Syr. tolu, with resorcin and thymol; bromide of sozoiodol; ozonized tar syrup and creolin; tincture of iodine, siegesbeckie, and in all cases the apartment in which the child is domiciled should be fumigated twice a week. Micrococcus of hooping- cough. BACTERICIDES. 411: for half an hour on each occasion, with burning sulphur. Local stimulation to nape of neck of value as a means of raising the standard of vitality, on that part of the cervical portion of the cord upon which the microbe feeds. Cells partly round, oval or cylindrical, Oidium Albicans, all sizes. The bud colonies consist of rows of cylindrical cells; from the ends oval or round cells sprout; spores form singly in roundish cells. They are found on the mucous membrane of the mouth, tonsils, dorsum of the tongue; very common in children in the grayish-white patches, sore mouth and on the nipple. Bears cultivation well in sweetened water and tartrate of ammonia. The cells germinate according to its rich- ness in sugar. The oidium albicans is sterilized, completely annihilated, in the presence of a solution of boro- glyceride, resorcin, creolin, naphthaline. Within a distance of five miles from Spirillum Plicatile. the emptying of any sewer into a river, this microbe is found, few, and at some distance at the five mile point, but more numerous as the point of egress of the sewer is reached. As found it consists of thin threads, with numerous narrow windings. The threads have pri- mary and secondary windings, very irregular; their ends cut off bluntly, and they exhibit rapid Spirillum piicaiiie (Marsh spirochaite). movement. Besides being com- rrom sewage, contaminated water; . . . 1 • 1 magnified 1200. mon in rivers into which sewage empties, they are abundant in marsh water, and can be obtained by allowing algae to decom- pose in water. On cultivation, the threads break up into long rods, short rods, and finally cocci. Progressive cultivations finally produce the microbe of typhoid fever. The spirillum plicatile in water can be sterilized either by the addition of a few drops of dioxide of hydrogen, or comp. oxygen,. 412 DISEASE GERMS. ozone water, aromatic sulphuric acid, sulphur water, or com- pletely annihilated by passing the fumes caused by dropping sul- phuric acid on permanganate of potassa, or by the addition of lime. This germ consists of threads, Spirillum of Relapsing with screw curves. They move Fever. rapidly and exhibit peculiar wave- like undulations. They are' found in the blood of patients suffering from relapsing fever. They are to be found only during the relapses, and are absent during the non-febrile intervals. Their number is usually great, excessive as it nears the fifth or sixth week. They are pathogenic of the disease, bear cultivation well in blood serum or broth highly salted. Cultures are inoculated successfully into all animals near to man in the scale of being; lower grade of quadrupeds, negative results. The prodigious ptomaine excretion occurs every seventh day, at which time the multiplication of the germs are enormous. The microbe is either sterilized or killed in the presence of con. tincture of kurchicine, or Warburg's tinct., avena sativa; euca- lyptol. The cells lie singly or in pairs, or in Streptococcus in rosaries, or in spherical or cylindrical Diphtheria. masses. A microbe of easy cultivation on blood serum, or veal or lamb broth. A small piece of the membrane affords the best bacilli. So far successive generations have not been attained. Its malignancy is due to its very rapid excretion of ptomaines, a very toxical alka- loid. The germ is pathogenic. It may be sterilized in the presence ol tyi/'iyz&A^f the glycerite of suhohur, resorcin, carbolic tococcusofd-^° ' acid and tincture of iodine, and com- pletely annihilated by brushing it over with a distillation of jequirity bean, lactic acid, hydrogen peroxide; solution of salicylate soda. From the cultivations of diphtheria microbe, an exceedingly soluble alkaloid has been obtained, which induces embolism, paralysis and rapid death (ptomaine). BACTERICIDES. 413 The Microbe of Croup resembles that of diphtheria; in well-marked cases the blood and kidneys are thoroughly infiltrated with the micrococci. They often unite or are agglutinated in small masses. Found in all the tissues, even in the marrow of forming zooglcea. bones. They bear cultivation well, and the cultures injected in animals give rise to the disease. The germ is sterilized or annihilated in the presence of acetic or lactic acid ; sulphide of calcium; either of these remedies checks trie evolution of microbes in the blood and tissues. Here, as well as in diphtheria, too much cannot be said against the misuse of emetics. The administration of such an agent may remove the false membrane in which the micrococci are im- bedded, and leave an irritated or bleeding mucous membrane behind, which is a most attractive and luxuriant pasture field for an additional multiplication of the micrococci, which are sown there afresh, and reproduced with fearful rapidity. Streptococcus in Cerebro-spinal Meningitis. Cocci, diplococci and chains are found in the cerebro-spinal fluid, base of brain, around the medulla oblongata, spinal cord; zooglcea in spleen, liver, kid- neys. In all cases excretes ptomaines freely, hence its remarkable fatal character. The microbe is pathogenic of the patho- logical state ; bears cultivation well in bar- ley broth. Difficult to sterilize or annihilate; best remedies are those which induce a quasi- suspension of the activity of the brain and cord, such as scull-cap, lobelia, calabar bean, gelsemium, alter- nated with either peroxide of hydrogen, resorcin, sulphur water. Recent bacteriological investigation reveals a micro-organism morphologically and biologically identical with this streptococcus in inflammation of the brain-substance. Streptococcus in cerebri spinal meningitis. (bpotted fever ) The bioplasm of normal nutrition,. changed, altered, degraded by adverse conditions into other living matter, which acquires an independent form of existence, with prodigious power of growth and multiplication; a disease germ. The micrococcus erysipelas is very small, consisting of Streptococcus Erysipelatosus. 414 DISEASE GERMS. minute cocci in chains, found in the mouth, breath, blood, feces, kidneys, and by millions in the erysipelatous blush. They occupy the lymphatics of the skin, and as they *"'"*• %.. sprout and multiply, spread along these ) .— ? ..• *"•• just at the margin of the erysipelatous Ov' ..... zone, where the microbes are multiplying '•* by millions, marked by the characteristic streptococcus of erysipelas. redness and swelling; the lymph glands are filled with zooglcea of micrococci and the injection of these vessels keep pace with microbe growth ; contagious and infectious. The germ is pathogenic of the disease; artificial culture suc- ceeds well on nutrient base ; inoculation into animals gives us the characteristic. To sterilize or annihilate the microbe, solution of boroglyceride, kept constantly wet, over the microbic patch ; internally emetic of lobelia, followed with either ozone or sulphur water, or resorcin, or sozoiodol; peroxide of hydrogen. Cocci, singly, in dumb-bells, and in curved | Streptococcus chains, essentially identical with the oidium j of albicans or rot, with the exception that they Foot Disease, grow well in milk, in alkaline peptone broth, | in almost any nutrient fluid. Very common among cows which feed on marshy pasture, or insanitary condi- tion; found in their milk, and by or through that fluid give rise to diphtheria, scarlet fever and malignant stomatitis in children. Streptococcus of foot disease, magnified 50 diameters. The microbe is pathogenic of the disease, bears cultivation well for ages. Cultures injected into animals gives rise to diph- theric effusion and death. Same remedies sterilize and annihilate as in diphtheria. BACTERICIDES. 415 Pathogenic, and the cause of amyloid Streptococcus degeneration; microbe can be isolated from Pyogenes. pus or muco-purulent matter, most abundant when greenish colored, whether pure or from bandages. The bacillus consists of slender rods, linked two or three together, or collected in irregular masses. Multiplies rap- idly by spore formation on liquid gelatine. In twenty- four hours culture exhibits a greenish pigment or coloring principle " pyocaninP The germinal mass is soluble in acidulated water, which it colors red; neutral solution is blue. The microbe crys- talizes in chloroform in long needles, and in some cases form lamellar prisms. To sterilize or annihilate the microbe, iodized oil, saxifraga ozonized, phosphated tincture of oats, kephaline, glycerite of ozone, matricaria, comp. siegesbeckie, iodide potass, ozone water, peroxide of hydrogen. Streptococcus pyogenes. Streptococcus in Puerperal Fever. Cocci in zooglcea, and sometimes in chains, have been found in all organs affected in puerperal fever, and espe- cially in the lochial clots or discharge in the blood, brain, heart, lungs, spleen, kidney. The microbe bears cultivation well, and is pathogenic of the fever. It is sterilized and completely annihilated in the presence of either hydrogen peroxide, or resorcin, or creolin internally, with intra-uterine injections of either boro- glyceride, creolin, chlorinated soda, peroxide of hydrogen, and locally over the entire abdomen either ozonized turpentine, followed by resorcin paste, or concentrated ozone, with chloroform and creolin. The production of ptomaines in the blood and tissues plays an important part in the gravity and fatality of the disease. So very great are they in this affection that they can be readily isolated from the urine. a P,y-. The pathogenic microbes of puerperal fever. 416 DISEASE GERMS. Cocci, microscopically minute, are found Streptococcus in in the blood, brain, vomit, stomach, spleen, Yellow Fever. liver, kidneys. They occur in chains, aggregate into masses, distend the capil- laries of the organs enumerated, exciting inflammation, with acute fatty degeneration of liver, kidneys, spleen. The microbe is pathogenic of the disease. Difficult of cultiva- tion so far. Ptomaines cause the vomiting, acute inflammation of stomach, liver, spleen, kidneys ; the intense prostration, fever. It seems to be sterilized in the presence of dilute hydrocyanic acid, comp. tincture of kurchicine, ozone water, Warburg's tincture. The microbe, or fungus of yellow fever, has (up to the present date) not been isolated. A paludal germ, probably originating in the delta of the Mississippi, spread by maritime commerce over the whole inter-tropical zone of the globe. Centres of infection, the sea-boards and mouths of great rivers. The scien- tific researches of Prof. McFall, in Galveston and Jacksonville, show that in the liver, spleen, kidneys, intestinal canal, chaplets of micrococci exist, visible under a high power. New and sus- tained researches are necessary to elucidate the germ. much resembles that of yellow fever, micro- The Microbe scopically. Growth is not so rapid; neither of Dengue has it the faculty of exciting acute fatty degen- eration in the liver, spleen and kidneys. It is / * • •»' ■ • • v. . * £*?■& AW-.*' % /..I'-V. '• .-ST- • • • •• , * .•••. ;»; The appearance of the microbe of The germ as found in the blood Dengue at the time of rigor. seventy-two hours after rigor. much more easily sterilized than the streptococcus of yellow fever. ______ Whitlow, felon; chains of bacteria or micro- Periostitis, cocci are always present prior and subsequent to suppuration. The microbe is pathogenic, an inoculation of the cultures gives rise to periostitis of the small bones. BACTERICIDES. 417 The micro-organism can be sterilized and annihilated by the local application of either of the following remedies : a saturated tincture of lobelia, or citrine ointment, if the tincture is applied it must be kept constantly moist for twenty-four hours or more; if the ointment is applied, a thick layer. Neither application is painful, causes a drawing sensation, followed by a complete cessa- tion of pain and tenderness. The Glucose Fungus of Diabetes. When the co-ordinating chemical centre in the brain is damaged, an irritation is transmitted to the liver, grape sugar is elaborated in such abundance that the ozone-forming faculty of the lungs is incap- able of burning it up, hence the presence of this agent in the blood and tissues necessitates the for- mation of a living breeding fungus, which is pathogenic of the disease. The fungus is m ost easily isolated from the urine, capable of culture in any saccha- rine or starchy liquid at a temperature between 8o° and 900 F. Injected into animals, gives rise to the disease, with all its symptoms of thirst, voracious appetite, prostration, chloroform breath, cataract, etc. This fungus is sterilized and annihilated by the administration of a five-grain pearl of sambul after meals, glycerite of ozone before meals. Antipyrin is often of value. The saccharine fungus of diabetes. as a canine disease, is evolved in dogs by a degrada- Rabies, tion of the primary elements of their nervous sys- tem, under adverse states or conditions, communi- cated to man and other animals by or through the saliva, in some crack or fissure or indentation of a tooth, or bite, so as to reach the true skin. The microbe is essentially an outcome of perverted nerve nu- trition, consisting of small globular cecci, single or united into characteristic colonies; they are most abundant in the brain juices, especially in and around the medulla oblongata and spinal cord. The microbe of rabies must never be confounded with the viru- lent saliva evolved in man under rage, passion. The exceptional virulence of this micro-organism is due to its vital and reproduc- 27 4i8 DISEASE GERMS. tive energy, to the rapidity with which it multiplies, and the ex- cessive amount of ptomaines excreted by the germ. No germicide has yet been discovered that will either sterilize or annihilate the germ. Ptomaines of the most toxical character are found in the brain and medulla oblongata. This germ is round, oval, occasionally The Microbe of elongated. It is pathogenic. In artificial Mumps. cultivations they appear as white dots, and as they grow larger, become of a grayish color. They bear culture well in gruel or any nutrient fluid, and if injected into any mammalia will reproduce the original dis- ease, either in the parotid, mammae, ovaries, testes or cortical substance of the brain. The microbe is sterilized in the presence of either resorcin, thallin, ozone water, aconite, phytolacca, belladonna, or avena. Locally, concentrated ozone, to which a small amount of chlo- roform is added, applied over the parotid, testes, mammae, ovaries, is instant death to the microbe, there is neither contagion nor in- fection left. Cocci, cubes or packets, with rounded off corners in groups of four, or multiplies of four, united in families of eight, sixteen, thirty-two, sixty-four. Contents of the fungus, greenish or It occurs in the stomach of man, and is detected in the vomit, on the fur of the tongue. The germ or fungus bears cultivation well on albumen or liquid gelatine. Pathogenic of catarrh of the stomach communicated to water, thence to poultry and animals. The nervous symptoms which accompany gastric catarrh are due to the peculiar ptomaines excreted by the fungus. Fungus starved out by either drinking freely of bayberry, or stone crop, or by mineral acids, peroxide hydrogen, sulphide of lime, saccharated sulphur, Sarcinae Ventriculi. yellowish red. €0 b Sarcinae ventriculi, in different degrees of development; strongly magnified. collinsonia ; sterilized kaki; annihilated by lactic acid, creolin, sulphur ozonized, sozoiodol. BACTERICIDES. 419 Cocci, or packets, in groups of four or eight, Sarcinae very small in size, but very regular in form, oc- Intestinalis. cur only in the intestines in cases of chronic diarrhea and catarrh of the intestines. Sterilized by the use internally of Virginia stone crop, alter- nated with salol, naphthaline. Sarcinae Urinae. Extremely small cocci united in families of eight to sixty-four, present in the bladder in vesicle catarrh. Sterilized by either boroglyceride or uric acid solvent; the insertion of either a papoid or trypsin bougie into the bladder, permitting them to dissolve. Sarcinae Uterinous. into the uterus. Cocci very small, but forming large packets, common in intra-uterine catarrh. It is sterilized by the aleteris far. comp., and the insertion of papoid or salix-nigra bougies Yeast torula consists of spherical or oval Yeast Fungi, cells, very much larger than the largest micro- cocci ; each cell consists of a membrane and contents. The contents are either homogeneous, or finely granular protoplasm; in the latter case there are generally present one, two or more vacuoles. There are a great many species of torula, varying from one another morphologically, chiefly in their size, and physiologically by their action on different fluids. The cells of ail of them multiply in suitable media by gemmation, a minute knob-like projection ap- pearing on one side of the cell and keeps enlarging till it reaches nearly the size of the original mother cell. It finally becomes con- stricted, or exfoliated off from this latter, or having reached its full size remains fixed to the mother cell, and each cell again producing by gemmation a new cell. In this way, aggregations Torula, or Saccharomyces. In the lower part of the figure an acospore and four isolated spores are shown/ Magnifying power about 700. 420 DISEASE GERMS. of four, six, eight, or more cells are formed, which may be arranged either as a chain, when the production proceeds in a linear manner, or otherwise, or as a group if the gemmata takes place laterally. Under varying conditions of nutrition or growth, yeast cells enlarge twice, thrice, and more times; form in their interior two three, four, or more cells by endogenous formation. These new cells are regarded as spores, the mother cell being an acospore, and finally becomes free by bursting the membrane of the mother cell. Classifying them according to their physiological function, there are various specious of torula or saccharomyces ; all of them possess the power to split up sugar into alcohol and carbonic acid, but this power is not possessed in the same degree. Torula cerevisiae, ordinary brewers' yeast, is found in the human stomach in gastric catarrh; in the bowels in intestinal catarrh; in the uterus and bladder in catarrh of both organs. Their pres- ence in those organs gives rise to intolerable uneasiness and pain, and results of a fatal nature are due to their presence in the hol- low viscera. The yeast fungus, in the uterus in intra-uterine catarrh, grows well as the catarrhal secretion is slightly acid and little saccharine matter present, cells elongate when the case is chronic into cylindrical elements, a linear series, separated from each other by a thin septum, a mass of filaments, resembling a mycelium or elliptical torula cells. Chronic cases of gastric and intra-uterine catarrh thus have the fungus changed or altered into the oidium albicans, hence ulceration of the mouth, stomach, uterus, vagina. Artificial cultures prove the same thing; the fungus after re- peated cultures on and on, becomes spherical or cylindrical, taking on another type in the series of evolution. The yeast fungi is easily sterilized and completely annihilated in the stomach in the presence of peroxide of hydrogen, sulphide of lime, ozone water; in the bowels by the ozonized Virginia stone crop; in the uterus and bladder by the occasional intro- duction of a thallin, iodol, resorcin, creolin bougie. The nervous symptoms which accompany dyspepsia are due to the ptomaines excreted by this germ. This hybrid germ consists of fine slender The Microbe of rods, occasionally pointed at both ends, Leprosy. some clearly motile, others not. In the secretions from the tissues, they have a beaded appearance. They are best cultivated artificially on blood serum or meat juice. BACTERICIDES. 421 The microbe is pathogenic of the disease, just the same as that of syphilis or small-pox. The micro-organism demonstrates the true nature of the disease. Not a single sporadic case has ever occurred in our country. Every case we see here is imported, coming from some portions of the world in which the disease is prevalent. In some cases the microbe is sterilized in the presence of the Chian turpentine mistura ; chaul- moogra and gurjun oil in the form of an emulsion have also been found useful. s£&, The full-fledged bacillus of leprosy, magnified 1500 diameters. are rod shaped, one and one- Bacteria of Rhinoscleroma half times longer than they are broad. Their location is the nose, skin and mucous membrane and contiguous parts, the colo- nies of neoplasm form either flat or elevated dense ivory nodules. The microbe is pathogenic of the disease, they bear cultivation well in any nutrient fluid, the cultures injected into animals give rise to the same ivory nasal deposit. The germ and its broods are sterilized in the presence of the peroxide of hydrogen and Chian turpentine emulsion. Locally, ozone ointment and resorcin; boroglyceride and creolin; benzoated oint- ment and naphthaline. Bacteria of rhinosclero- ma; rods surrounded with their rapsules; group of bacteria sur- rounded by a single capsule; bacteria seen from above and resem- bling a coccus. In the culture of the various Dual, Triple and other pathogenic microbes we have found Complex Organisms. by careful culture that the union or junction of microbes in the culture glass gives us most remarkable results. For example, an equal quantity of the cultures of the bacillus of tubercle and the mi- crobe of syphilis will produce the microbe of lupus; an equal quantity of the micro-organisms of syphilis, tuberculae and scar- coma, will give us the microbe of leprosy. The bacteria of malnu- trition, the germ of erysipelas and the vibrios of typhoid fever, unite to form the microbe of puerperal fever. 422 DISEASE GERMS. If we take a lupus nest, or a scraping from the skin of a leper's face, or a drop of lochial discharge, this statement can be imme- diately verified. In neurasthenia in both sexes there is an evolution from the blighted or weakened embryonic elements, which assume various forms of microscopic life. In gynecological practice in the maladies peculiar to women, as a neurosis of the womb or vagina, either affecting the mucous membrane or body, a damaged uterus is followed by a relaxed or altered state (acid), mucous secretions, yeast fungi and other microbes. This natur- ally gives rise to more microbes in women than men, and explains why those latent discharges are so common in men. From puberty to the cessation of the menses the uterus has a rich, nervous, arterial connection, and the organ is liable, from very slight causes to suffer a neurosis or get out of gear. Can we wonder at the number and variety of female disease when we look at modern society, and our women, with this maundering, wandering activity and great fluctuations of animal spirits, gay, fascinating in society; brisk, orderly, thorough in business, but at home dejected and fretful; a small eater, light sleeper, worn worker, an heir of any true neurosis, from insanity to toothache; perturbations of intermarriage, with great mental power, with eccentricities agonizingly painful, when affected with any disease, instead of single disease germs being present, we have them dual and complex, as in peritonitis we have both the bactarian and vibrios. Microbes of all Cutaneous Diseases. There is no lesion of the skin without a degradation of its living matter into a disease germ. No damage done, no depression of its vital elements, without some fungi, or mould, or vege- table parasite appearing on its sur- face. All skin diseases are indicative of poor health; all have their special microbe, which is pathogenic of each cutaneous affection, which bears cul- ture in some nourishing broth. As an infallible result, all cutaneous affections possess in their innate ele- ments contagion and infection; even the sweat is loaded with microbes. Fungi from Favus.—Patch. BACTERICIDES. *2\ All cutaneous diseases must be treated with bactericides chemically adapted to the utter annihilation of the germ, as thy- mol, menthol, ozone ointment, sulphurous water, creolin, per- oxide of hydrogen, sulphide of lime. Very favorable results have been obtained by creolin, chrysophanic acid, ichthyol, resorcin. All vegetable parasitical skin affections should be treated with a course of internal germicides, such as the peroxide of hydrgen, COmpOUnd Saxifraga and phytO- Photograph of the micrococcus versicolor r °. . *■ ./ —small cocci which are seen form lrides- laCCa, CaSCara Sagrada, lyCOpodlUm. cent colonies—growing in the form ot yellowish beads. jf»f • Cocci, singly or in pairs, seen in the roots of Bacterium the hair in cases of alopecia areata. Microbe is Decalvans. pathogenic; bears cultivation in rich soup; in- jected into animals, reproduces the disease. It is completely sterilized either in the presence of ozone oint- ment or turpeth mineral, gr. i. to xv. gr. benzoated ointment; ozonized boroglyceride. Trichomycosis nodosa, a peculiar condition, nodose in char- acter, affecting the hairs of the axilla and scrotum; due to the evolution, growth and encapsulation in the cortical layers of the shaft of a small, red-shaped bacterium. In the various forms of bacteria occurring in sweat, there exists in the secretion numerous granular bodies, the number of which is increased according to the hairiness of the part, the arm- pit and between the thighs. They are micrococci; they attack the hairs, causing small, knotty swellings. These are composed of bacterial elements, cause clefts, spindle-shaped projections; hairs are friable; affect the hair shaft. of sumac, ivy, poisoned vines, stings of The Microbe wasps, bees, gnats, are pathogenic. or Living Poison The bacterial germs can be annihilated either by solution of chloride of ammonia or concentrated ozone. 424 DISEASE GERMS. The oidium albicans (rot) often atta;ks the Onychonycis. roots of the nails of man as well as the hoofs of animals, as the horse, ass, mule. The par- asite fungus is readily transferred from one person to another, introduced into the cracked, superficial layer of the hoof through the fissures. Pathogenic of the disease; bears culture well in any nourish- ing broth. The cultures injected into any mammal produces the original disease. Germ sterilized and annihilated in the presence of ozone oint- ment and resorcin, or resorcin jelly, hydrogen peroxide, and the use of comp. saxifraga ozonized, avena sativa, glycerite of kepha- line ozonized. In the three different stages of burns, t The Microbe of erythema, vesication, ulceration, we have Burns and Scalds, a degradation of the primary elements of the different coats of the skin in a bacterium, so that whatever application is made to a burn of any degree should be a powerfully stimulating application, as car- bolic acid and olive oil, glucozone, creolin, resorcin, thymol, sul- phide of lime, balsam of fir, tolu, siegesbeckie in ozone ointment, or in olive oil, or oil of boroglyceride, resorcin and cocaine in olive oil. A malignant, very contagious, microbial disease, Glanders, which appears in the nasal organ of the horse, ass, mule, or in the lymphatic glands. It is termed glanders, when in the nose; farcy, when the lymphatics are infil- trated by the microbe. The predisposing cause of glanders in animals is depressed nervous and physical energy, such as is produced by hard work, overcrowding, isolation, sameness of diet, exposure to air cur- rents, privation, depressed and vitiated states of the atmosphere, endemic conditions, air loaded with germs, abnormal meteoro- logical states, dispersion of germs over large areas, very fatal to man and animals, destroying the red discs of the blood, and is death to that fluid ; besides, it causes immense hypertrophy of spleen, starchy degeneration of liver and kidneys and general dropsy. Like all germ diseases, it is propagated by contagion and infec- tion. It is very prevalent in all sections of the country, and it exists to such an alarming extent that it is becoming a serious and growing evil. It makes occasional epidemic attacks under a form named epizooty. BACTERICIDES. 425 The gathering together of several hundred horses in one stable ib not conducive to their health, and the slightest catarrhal condi- tion when present is likely to be disseminated. It is well known that the disease-germs are not only abundant in the nasal dis- charge, but that the breath, sweat, urine and other excreta are loaded; and where have we the least sanitary arrangements made for its suppression ? In the stalls, blankets, feed boxes, water troughs there is the living contagion. The public drinking troughs are a source of danger to animals, as the germs pass into the water and the glandered horses are allowed to quench their thirst at those valuable conveniences. In the act of drinking by the horse, a certain amount of saliva and nasal discharge always escapes into the trough, so that one glandered horse may infect all that drink subsequently from the same trough; for, although the discharge is heavier than water, and as we would naturally suppose, sinks to the bottom, the fact of its being alive and the germ growth increased by water, myriads and millions are grown light enough caused by the presence '~ 3—-^ x—-^ ^-x>—) of a giant bacterium, the BaciUus ofgIanders. degraded bioplasm of nu- trition of the Schneiderian membrane of the horse, evolved by in- sanitary states, exposure, over-crowding, bad or meagre food and other adverse states. The microbe as found either in the dis- charge from the nose (glanders) or from the contents of a lym- phatic (farcy) appears in the form of very fine rods, about the size of the tubercular bacilla. When this germ is cultivated either on blood serum or extract of meat, it affords magnificent results, appearing in the form of minute transparent drops, con- sisting entirely of characteristic bacilli. Pure cultivations, after several generations, when inoculated into horses, asses, rabbits and other animals, give us genuine glanders. It takes place as follows : a spreading ulcer with an indurated base first makes its appearance at the site of inoculation, while a crop of smaller ulcers break out in close proximity. There is a general state of languor, debility, rigors, fever ; lymphatics be- come engorged with the microbe; general infection follows, nodules of microbes are thrown out on all internal organs, and on the inner lining of the nose, these eminences of the nasal sep- tum break, form characteristic ulcers, round, scooped-out, with granulations in the centre. 426 DISEASE GERMS. Glanders is fortunately a very rare disease, and is met with, almost exclusively, among grooms, coachmen and others occu- pied with horses. The salient feature of the disease is the forma- tion of pustules, followed by ulceration of the skin, nasal cartilages and bones. The earliest symptoms are secretion of a thin, tough mucus, followed by swelling and redness. The mucous mem- brane is covered with scabs and ulcerations. There may subse- quently be ulceration of the throat, larynx and tongue. The discharge from the nose, which is sometimes limited to one side, only, becomes, sooner or later, sanious and fetid. The majority of cases go on to perforation of the septum, necrosis, glandular enlargements and death from pyaemia and exhaustion. The com- plaint may run a very chronic course, but in the acute form may terminate life within a week. If the history of the case is clear, the diagnosis is easy; if not the microscopical examination of the nasal discharges will decide it. The ulcerations bear a strong resemblance to those of syphilis, and are apt to be mistaken for them. The microbe is pathogenic of the disease, bears cultivation well; cultures injected into animals reproduces the disease in all its malignancy. It is resident in the nasal secretions of the infected animals and in the ulcers which form upon their mucous membranes,. also in the so-called " farcy buds " and in the large lymphatic glands of the infected animal. There seems some probability, also, that it is occasionally present in the urine. The rod itself bears a strong resemblance to the ordinary tubercle bacillus, but it is more uniform in size. It can be readily seen when stained with fuchsine or methyline blue, and certain appearances have led people to believe that spores are present in the bacilli. The infective material does not appear to be capable of living for any great length of time outside the body, and never develops after the bacilli have been exposed to a temperature of 1300 F. for ten minutes. Exposure for five minutes to a five-per-cent. solution of carbolic acid, or to corrosive sublimate of a strength of one in five thousand, is quite sufficient to destroy all possibility of infection. Practically there seems not the smallest doubt that any suspected article can be readily disinfected by being boiled for, say, a period of half an hour in ordinary water, whilst any article that will not stand boiling can be readily disinfected by carbolic acid or corrosive sublimate. The exposed parts of the stable should be thoroughly disinfected by burning sulphur in them, with all the doors and windows closed, after which the walls should be thoroughly washed down with carbolic acid of BACTERICIDES. 427 the above strength or with perchloride of mercury, and the vari- ous troughs, etc., should be thoroughly scrubbed out, so as to remove all trace of the disinfecting materials. After the walls are carefully lime-washed there seems to be no possibility of in- fection taking place. The treatment of glanders, either in the horse or in man, is the same. Remedies calculated either to sustain the vital powers, or sterilize the blood or allay pain, should be given internally. Either the sterilization or destruction of the germ should be effected by either peroxide of hydrogen or sulphide of calcium in the form of an aqueous solution internally and locally; these two remedies kill the microbe, stimulate the blood currents and have a special vitalizing action upon the mucous membrane and lymphatics. Other bactericides which have met with success are resorcin, creolin, pyridin, creosote, naphthaline. The nostrils should be douched out thrice daily; all enlarged or painful lymphatics immediately opened. Exalgine is a good remedy for both pain and fever. General principles as to bathing, diet, nursing, hygiene, should be carried out. Scrupulous cleanliness, immediate destruction of all dress- ings and discharges. The Epizooty, the epidemic form of glanders, is due to insani- tary states existing in stables, to overcrowding, to a sameness or meagre or insufficient food. Pink Eye is simply the same disease germ colonizing in the eye instead of the nose or lymphatics. A form of blindness, attended with disorgani- Glaucoma. zation of the various tissues of the eyeball, in which objects are surrounded by various colors, especially blue and green. Causes.—It seems to depend upon extravasation of blood in retina and choroid; serous effusion between retina and choroid ; retina raised in folds; and clots in vitreous humor, and changes in the optic nerve. What induces such changes, aside from shocks, jars, concussions, it is impossible to say. Symptoms.—It may be acute or chronic, that is, it may come on suddenly, or more slowly; take months to do so. In both there is a rapid and irreparable loss of vision; begins with in- tense pain in the ball of eye during night, with throbbing in both eye and temple. Pain continues, and the eyes become congested. his of a dusky hue, and motionless ; cornea becomes dim; pupil widely dilated, and sometimes of an oval shape; eyeball 428 DISEASE GERMS. unusually hard. ' Everything looks as if surrounded with pris- matic colors ; often bright flashes of light before eyes ; both eyes are affected. In the chronic form the symptoms are the same; perhaps more congestion of iris and cornea, and more fulness of eyeball. Opacity of the lens is common in chronic form, as a result of deranged nutrition. Treatment.—So far there is no known mode of treatment that avails. The improvement of general health and relief of pain is about'all that can be done. Any depressing treatment, anything that weakens the patient, aggravates the trouble, so that the care- ful administration of sulphate of quinine, ozonized glycerite of kephaline, and other elements to invigorate the brain, should have a trial, with change of scene, and a sea voyage, etc. At the present day, when science is slowly ferreting Gout, out the secrets of nature, both under normal and ab- normal conditions, it is a matter of great interest to trace out the origin of uric acid and the presence of urate of soda in the blood of gouty patients. What gives rise to the liberation of vast quantities of this salt in the blood has never been clearly explained. Special typical conformations of the body which are hereditary give rise to it, and an excess of certain kinds of food, by supply- ing an over-abundance of nitrogenized material, for the blood creates an excess of urea and uric acid. Besides certain special agents as malt liquors, wines, sedentary habits, want of exercise, irregularities, lead poisoning, excessive mental strain, worry, give us urate of soda or uric acid and soda, which exist in the blood in a separate state, but a depression of the nervous system causes their union. The morbid state is aggravated by gastric and intestinal disorder, impaired appetite, furred tongue, acid or bitter eructations. The disease cannot be developed unless the blood contains a considerable quantity of uric acid and soda in some form. They never exist in the blood in combination before an attack of gout, but the moment they combine the disease is produced. Nerve force in health keeps them separate, so that they can be elimi- nated by the skin, kidneys and bowels, but as soon as nerve force is lessened or impaired these two unite. Good nerve force keeps them apart, but in shocks or debility they unite and crystallize as urate of soda. In lessened nerve force the uric acid seizes the urate of soda, and this is deposited in the tissues generally most remote from the heart and brain. This union generally arouses BACTERICIDES. 429 the nervous system, and a febrile effort takes place and it is warded off, but in subsequent attacks the febrile effort fails. In youth, before care, anxiety and disappointment have well-nigh worn out the brain, the nervous system is active, and in spite of dissipation and indulgence, gout is rare, but as soon as age and care stamp their mark upon the great nerve centres, gout too often appears. In the gouty diathesis, without local manifestations, are to be found neuralgia, dyspepsia, palpitation, syncope, congestion of liver, piles, anaemia, pains in head, toothache, tonsillitis and asthma; besides it is a common cause of disease of heart, arte- ries, kidneys, and, indirectly, of apoplexy, etc. Gout presents itself in so many different forms that it is often difficult to recog- nize it when we meet with it, and many cases are overlooked be- cause the disease is not found in its accustomed seat. One patient may suffer from bronchitis, another from psoria- sis; one may have gravel, another asthma, or, again, neuralgia of the face. One may be alarmed by his having to be treated for an apparent gonorrhea, while another may have piles or tenes- mus ; all of which are but local exhibitions of the constitutional affection. The morbid anatomy of gout shows the brain cells to be feeble, exhausted, the red blood discs greatly impaired by the presence of the urate of soda, and the de- posit of that substance on the cartilages of joints, and valves of the heart, or wherever vitality is lowered. This consists of the urate of soda in the form of needle-shaped crystals. In the early stages the articular surfaces are granular, form a thin incrusta tion, which, as the urates increase in the blood, becomes thicke/ and thicker, the deposits becoming large concretions. Symptoms.—The attack may be preceded by debility, heart- hurn, flatulence, dull pain in left side of chest, irregularity in heart's action, dry skin, urticaria, urine loaded with phosphates and urates containing albumen. It may come on suddenly in the night with acute pain in the great toe, heel, instep or wrist; rigors, followed by fever with great irritability and restlessness, The appearance of the cartilages of a gouty subject, showing a .deposit of urates of soda—dense deposits of uric acid. 430 DISEASE GERMS. tenderness and swelling of the affected part. The attack passes off, an interval elapses of length proportionate to the care taken, and then another attack follows. The local affection takes place in weakened parts, then the in- flammation and exudation take place, so there is liable to be a change of location according as the vital forces of a part are strong or feeble. In this manner a metastasis occurs from the joint to some internal part, as the heart, stomach, lungs, brain, etc. When the kidneys act imperfectly, and there is a retention of the urate of soda in the blood, it is taken up and deposited in other structures to which it has an affinity, as cartilage, bones, fibrous tissue, forming topha or chalk formations, or stones con- sisting of urate of soda. They are found in innumerable situa- tions in chronic gout, in the eyes, ears, heart, joints, etc. Treatment.—The general principles of treatment consist in per- fect rest between blankets, attention to the condition of the skin, kidneys and bowels; to the former, warm baths, to the latter, with salines, so as to relieve the overloaded heart and blood vessels. For any irritation about the heart, mustard ap- plied and to be repeated. The following is to be given at re- peated intervals, so that the sensorium experiences no sensation of pain : Pulverized opium, ten grains ; Dover's powder, thirty grains; pulverized nitrate potash, sixty grains. Mix and make twenty powders. Dose, one, as indicated. If there is fever, aconite and veratrum viride. To cut short an attack, nothing excels the phosphate of quinine in alternation with the wine of the root of colchicum. These two remedies act quickly and meet the indications most promptly. As to the dose, from one to three grains of the quinine every three hours, with colchicum enough in alternation to slightly move the bowels, the dose necessary being usually from fifteen to thirty drops. If the evacuations from the bowels are too frequent, diminish the quantity, but do not discontinue. As soon as the acute stage is over, the same remedies may be continued, although it is often advisable to change to some of the following drugs: The uric acid solvent, highly ozonized, has a marked effect in causing the urate of soda to disappear from the blood, and a dis- solution of the incrustations in the joints. This remedy has per- manently cured the most aggravated form of the disease. In the present state of medical science there is no longer obscurity about what gout is ; a bankrupt brain and a perversion or mal- assimilation of the secondary process of digestion, with deficient elimination of waste products through functional disorder of the BACTERICIDES. 431 kidneys ; a disease always attended with danger on account of the tendency to metastasis. In order, therefore, to effect a radical cure, and get rid of the urates in the blood and joints, we must administer this solvent in all cases ; because it never fails to neutralize this morbid product, increases the secretions from the kidneys and skin, and with the elimination, pain and irritation cease. It acts first as a chemical solvent, then as an alterative in absorbing and removing deposits in valvular disease of the heart. It is best used in small doses, frequently repeated, say from ten to thirty drops, added to a glass of cold water. Cascara sagrada lozenges, two after each meal are most effica- cious in preventing the elaboration of the acid ; they are of great utility. Carbonate, or bromide of lithia, possesses remarkable chemi- cal properties, being, next to the uric acid solvent, one of the most soluble salts of uric acid known. Salicylate acid, administered in the acetate of ammonia, is most efficacious in preventing the formation of the urate of soda; best administered in alternation with sulph. quinine. Iodide of potassa, chlorate of carbon are of utility. Benzoic acid administered after meals prevents the formation of the tophaceous deposits. Phosphate of ammonia decomposes the insoluble lithates of soda and leads to absorption of them when deposited. In chronic gout, or a state nearly allied to gout, or half gout, there may be no local inflammation, pain or obvious swellings, or the gouty paroxysms, but it works more silently and is char- acterized by the abundance of lithates in the urine. There is apt to co-exist signs of ill-assimilation of food, with aches and pains, unaccompanied by any perceptible change in the aching part. A very common and prominent symptom in these cases is vertigo, associated with dull headache, occipital pain, occasional irregularity of the heart, oppression about the heart, memory fails and an exercise of the mind is laborious. Frequently the gastric derangement is not well marked, so that the patient is apt to believe that the trouble is all in the head. According to the most recent views on the subject it is due to the liberation of a certain amount of this salt by certain special agencies. Once the urate of soda ceases to circulate in the blood the attack of acute gout passes off, only again to reappear whenever another exciting cause appears to liberate a further amount of the stored- up urate of soda. It is not our purpose at the present moment to go into the various views which have recently been expressed on 432 DISEASE GERMS. the pathology of the uric acid diathesis. Whilst one set of writers put down the formation of uric acid to insufficient oxidation of the various products of digestion, others are inclined to ascribe it to some deficiency in the action of the liver. This much, how- ever, at least, is certain in the treatment of the disease, that all gouty patients do not do well upon a similar diet. It is certainly impossible to say that gout is in all cases the product of a nitrogenous diet, as opposed to one which is formed mainly of starchy food. But in addition to acute gout, which we have considered so far, there is the more chronic form of the disorder which supervenes when the urate of soda is deposited round about the joints and in certain of the other fibrous struc- tures, thus mechanically interfering with the function of those particular parts. Such a condition may go on for a great length of time, interrupted occasionally by an acuter attack of the dis- ease, whilst the same patient will be the subject of various forms of dyspepsia, heartburn, and other similar forms of indigestion. The heart will be very irregular in its action, and chronic inflam- mation may take place later on in the walls of the arteries and veins. There is perhaps nothing which more readily helps us to understand the affections of the circulation of the system than watching the effect of an infinitesimal amount of urate of soda in- troduced into the blood of an excised frog's heart. If the beats of this heart are registered on a revolving drum, they will be seen to be rendered most remarkably irregular when the blood contains certain poisons, such, for example, as uric acid ; whilst they resume with equal speed their regular rhythm when these impurities have been removed, In the case of the respiratory organs, pneumonia, pleurisy, and bronchitis are all affections of the gouty diathesis, and in many instances, as inflammation of the pharynx and the larynx, hardly any of these affections exist without some associated irregularity of the heart's action. It was ascertained years ago by Berthollet that the skin of a part affected with gouty inflammation instantly gave to litmus paper a deep red color, owing to the large quantity of acid which was passing off by exudation from the inflamed surface. A very similar observation may be made in the case of many of the acuter forms of gouty affections of the respiratory organs. The gouty affections of the genito-urinary tract are too well known to need any very lengthy description here ; but those who have had any prolonged opportunities of observing the course of the attacks of gout which are acute or chronic will easily call to mind the large amount of irritability which often exists in the bladder and other portions of the urinary tract in such patients In children occasionally so great is the irritation caused by the BACTERICIDES. .-- highly acid condition of the urine that the interior of the bladder is irritated and caused to secrete an alkaline mucus which makes the urine alkaline when it is voided; whilst if it be drawn off from the bladder with a catheter, and the bladder is washed out, the urine which is drawn off a quarter of an hour later will be found to be strongly acid, owing to the fact that it has not yet had time to be converted into an alkaline condition by the irritable mucus from the surface of the bladder. Of nerve affections it seems certain that we are only just beginning to appreciate the way in which gout is able to affect the various portions of the nervous organization. Opinions are rapidly gaining ground that many forms of epilepsy and other obscure discharging lesions of the brain are due to excess of uric acid in the system. It is curious that in some cases epileptiform seizures are preceded by hemi- crania, and are readily kept in check by those medicines which should be given in the case of the uric acid diathesis. The treatment of a gouty patient in the future must be directed to- wards ascertaining what these particular conditions are, whether mental or bodily, which are liable to provoke the formation of a large amount of uric acid in the body, and to ascertaining how far the formation of this acid is dependent on the particular forms of diet which are ingested, and how far it is brought about by the surroundings of the individual. Until we are in a position to answer these questions it will be quite impossible to arrive at a scientific treatment of the gouty diathesis. Whilst much is to be hoped from a preventive treatment in the early stages, we seem to be as far as ever from the removal of urate of soda from the body, when it has been deposited in large quantities in the vari- ous tissues, and has already set up pathological changes there which are spoiling the tissues in question. On examination of the urine in these cases, we find the lithates in great abundance, urine scanty, highly colored, specific gravity greatly increased, and readily deposits urates of a pink or brick color, and crystals of uric acid. In the treatment of these cases, rest from mental labor, a plain, rather spare diet, free exercise in the open air, and the bowels kept regular with salines once a day. The remedy from which most satisfactory results are obtained is the uric acid sol- vent, in small doses, barely enough to move the bowels. The diet in gout should be nutritious, as milk, arrow-root, tapioca, fish, oatmeal, fruit, vegetables, avoiding animal food as much as possible. Women are comparatively free from gout. This immunity is due to sexual causes, the character of her nervous system, and the rudimentary condition of her great sympathetic. A gouty, 28 „, , DISEASE GERMS. 434 bald-headed woman may be said to have left her sex, cast off the woman and become the man. Among males whose nervous systems are exhausted by any kind of drain, or worry, or study, the gouty diathesis is very prevalent, and it lies at the basis of nearly all cases of Bright's disease of the kidneys._______ Man, endowed with both an instinctive and moral Habits, nature, is easily moulded by habit, more especially by the love of stimulants, which is an inherent ele- ment in the organization of all men, barbarous as well as civilized. The most extensive and devitalizing of all habits is the alcohol habit. In no country in the world doe? the use of whiskey and malt liquors produce such direful results as they do in our climate. Our dry, clear atmosphere is highly oxygenized, vivifying and stimulating, causing great activity of muscular movement and cerebral thought; add to it another fuel, it actually burns up the tissues. The use of alcohol in small quantities produces chronic inflammation of the stomach, arrests normal metamorphosis; that is, checks elimination by liver, kidneys and other excretory glands, and tends to the production of fatty degeneration in muscles and glands. Besides, it coagulates, indurates, atrophies the cineritious or cell-producing structure of the brain; at the same time, it paralyzes the motor elements. Its use in large quantities so coagulates and shrivels up the abode of Deity in man that every vital function is destroyed, or at least impaired. As an illustration: should the drunkard impress his damaged spermatozoa upon the living healthy ovum ; that is, if there be progeny, it will be tubercular, of a brain type, weak-minded, im- becile, idiotic, or the victim of nervous disease. Habitual inebri- ation is not even necessary to produce this result. One dose of this poison will prevent the brain elements from developing in the embryo, fcetus, child or adult. Brain-growth is retarded, and incapable of habitation by the soul; idiocy of a congenital type is impressed; judgment, reason, memory are defective. The tobacco habit is one of great importance to our people, to whom from mere babies to a short old age it is of very general use. It relaxes and enfeebles the muscular system, especially involuntary muscular fibres, like the heart and stomach; it exhausts the base of the brain, gives rise to aphonia or paralysis of the cerebral faculty of speech. Take alcohol and tobacco in their joint action, they dwarf and atrophy the brain, cause tuber- culae in the user and his offspring. They fret, whittle down the ♦ BACTERICIDES. 435 over-stimulated American ; and, under these\two habits, it is diffi- cult to say what new forms of degradation and disease may not be produced. The general method of use is by smoking, chewing, snuffing; ladies are often addicted to it in the form of eating snuff. We are unable to account for so many ladies using it, as it is ruinous to their nature, hostile to their happiness. How disease-creating, nauseous, disgusting tobacco ever became a habit to our ladies is an enigma to be solved; its use constantly indicates degen- eracy and corruption. The use of tobacco in all cases is inimical to health. Snuff-eating is confined to ladies, and they generally begin by using snuff as a tooth powder. The habit gains, and the nervous system craves the stimulant, but it soon destroys the rosy hue of health and subverts and ruins digestion; following that the complexion becomes pale, sickly, yellow; the cheeks lank, faded and hollow; eyes lose their brilliancy, and become jaundiced, sunken, hollow, beamless. It destroys the vital ener- gies, gives rise to languor, debility, tremors, disturbed sleep, and gives the eater the sepulchral shade of death. In the form of minute subdivision of snuff, its action is more destructive than by smoking or chewing, and how young, blooming girls can bear its use is most unaccountable. The opium habit is generally created by the physician prescrib- ing opium or morphia for the relief of pain; but ladies have found out that it gives unusual brilliancy to the eyes, and have got in the way of using it too extensively. Its use at first is not incompatible with great intellectual efforts and brilliant thought, but by and by, when it makes its dreadful ravages into the brain, muscle and gland, it is, without a doubt, the most persistent, irre- sistible and destructive of all habits. It over-stimulates, and thus exhausts, giving rise to the most feeble form of languor and despair; it atrophies the brain, so that the consumer is dull and stupid; it causes sterility, drying up the very fountains of life, and causing a human wreck often fearful to behold. The tea and coffee habit; the characteristics are : anorexia, dis- turbances of sleep, trembling of the lips and tongue, attacks of gastralgia, different kinds of neuralgia, dyspepsia and leucor- rhcea, often profuse. Slaves to tea and coffee suffer from great mental disturbance, vertigo, impaired vision, poor memory, insomnia; their deleterious action upon the brain is bad, but upon the liver and bowels even worse; all the symptoms of functional liver trouble are present, as brown-coated tongue, want of ambi- tion, yellow conjunctiva and skin, with obstinate constipation or diarrhea. The evil effects of coffee are especially observable in •children. The coffee drunkard is described as thin, pinched 436 DISEASE GERMS. features, pale, wrinkled face, and a grayish-yellow complexion, The pulse is weak, frequent and compressible. The sleep is troubled with anxious dreams. No doubt coffee does on the whole far more good than evil. But it is important that the medical profession constantly bear in mind the evils that it is able to produce under favorable circum- stances. In a general way it may be said that indoor brain work- ers do not bear coffee as well as outdoor muscle workers. Per- sons of nervous temperament bear coffee badly. The chloral hydrate is another very destructive cerebral stimu- lant, exhausting more especially the ophthalmic tract and causing impaired vision. Much used. Arsenic, belladonna and other cerebral stimulants are not much used in this country. The arsenic habit is not so common in our country as the others; still, isolated cases are met with now and again. It is generally found in ladies, first inaugurated by ignorant doctors prescribing arsenic for some roughness of the skin. Its use gradually wears on the patient, stimulating both brain and heart until the habit is acquired, when the patient can tolerate large doses of the drug in solution as well as in a crude state. Still, the lady, in order to procure the smooth, enamelled white skin, will persevere, until some day an over-dose is reached, which will terminate the case, and some one else suffer from her reckless indiscretion. Although these and other habits are thus acquired, it must ever be borne in mind that in all cases the working faculty of the brain is thrown out of gear. Brain and nerve tissue are of the highest possible organization ; they play in the organism the part of primary activity. They are the centres of all energy, they generate all force. They do not live for themselves but for the whole body, and when a habit is created, their nutrition is im- paired. We see this well illustrated in the dwarfing and whit- tling down process when any of those habits are acquired by children or young persons in arresting their growing brain. It is positively certain that those habits never strengthen the brain, but it is too true that they impair its activity, retard its progres- sive tendency. That higher organism, the brain of man, certainly requires a better stimulus than what can be supplied with alcohol, tobacco or opium. None of these elements impart nutrition or growth. No ; they are fatal to the growing brain of man ; they cripple its organization ; they do irreparable structural mischief, the effects of which are permanent. A well-fed and properly exercised brain free from those habits works without tension or friction of any kind. The knit brow, straining eyes and fixed BACTERICIDES. 437 attention of the tobacco or opium slave are not a token of power but of weakness. When the brain is not crippled by those debasing, deleterious habits, its intellectual faculties work easily, without tension or jar. Treatment.—In the treatment of one or all of these or other habits, we must bear in mind that the brain is out of gear, bank- rupt, and that all the secretions as well as excretions are vitiated. There must be a new era of existence commenced, a complete change ; moral and physical restraint; daily shower and plunge baths ; secretions stimulated ; massage as laid down in the (arti- cle Neurasthenia) morning and night. General alteratives and tonics are always of utility and should be insisted on. The only two drugs, however, of real permanent value are the erythroxylon coca and the phosphated tincture of oats. They produce an effect which is difficult of explanation, but they are the remedies in opium, alcohol and chloral habit and dipsomania. They are safe, reliable nerve tonics, acting rapidly as diffusible stimulants, leaving no unpleasant effects. They act promptly upon the nerve centres, causing mental quietude and satisfaction, with easy respiration and excellent digestion; acting upon the cord, relieving anaemia of that structure. They have a most wonderful effect in relieving that undefinable sensation of languor, weariness and mental unsteadiness. They are very exhilarating, which is followed by ease and comfort, relieving all mental misery and distress. After using coca alone for five to six weeks it should be alter- nated with the oats. This remedy should be commenced in small doses and gradually increased. The avena seems to correct aiyi deepen the cerebral fissures and imparts tone and vigor to the entire nervous organization. After continuing both remedies for about three months, they should be gradually decreased and by and by discarded. The coca, of all known remedies, is specially adapted to usurp the place of alcohol, tobacco, opium, chloral; the drug habit must be at once discarded and the coca substituted in its place, and ad- ministered at proper intervals. In a few days the patient relishes the substitute well, his appe- tite for food becomes keen, and then he should be fed upon the very best; his sleep also becomes refreshing, and it should be prolonged by the administration of sulphonal. His strength physically and mentally increases, and he is the being of a new existence, free from the.slavish action of the habit and capable of wonderful powers of endurance and fatigue. Its wonderful action on the nervous system in causing its recu- 438 DISEASE GERMS. peration under the most adverse conditions ; its stimulating power in perfectly supplanting the most inveterate habit, the person feeling better with it and having the power of discarding it at any time after six or eight weeks. The best preparation is the orange wine coca. This wine ex- tracts altogether different properties from that extracted by alco- hol. This wine subjected to the dioxide of Hydrogen gives us a remedy of marvellous power in all habits, by appeasing the desire or craving. _______ In individuals of a sanguine tempera- Hemorrhagic ment there exists in the blood, irrespective Temperament, of any special disease, a peculiar constitu- tional defect which gives rise to a micro- coccus haemophilia, which is pathogenic of hemorrhage. This micro-organism impairs the fibrine of the blood, and weakens its cohesive property, so that on the slightest irritation, or wound, there is apt to be hemorrhage, and especially so from mucous membranes, as the nose, bronchi, stomach,'kidneys, uterus. Patients with light hair, white skin, and highly sanguine tem- perament are its victims. It may be hereditary or acquired. It may be suspected if there be debility, vertigo, hemorrhages or ecchymosis. The treatment to overcome this diathesis should consist in the best highly animalized diet, rich in blood elements, beef, poultry, eggs, cream, etc., mineral acids, preparations of cinchona, etc., and all surgical operations on this class of subjects should be carefully avoided. Loss of blood, or the escape of blood from Hemorrhage, the blood-vessels, in which it is naturally con- tained, constitutes a hemorrhage. It is variously classified and designated; as for example, it is termed traumatic, when due to a wound, injury or incision, and if a middling large vessel is cut or torn, it will escape in jets, corresponding to the contractions of the heart; idiopathic, when there exist a peculiar germ in the blood, which destroys the cohe- sive faculty of the blood, as in the sanguine temperament; migra- tion, localization of disease germs, as well as their destructive action on the red discs of the blood, give rise to hemorrhage, as the bleeding from the nose in typhoid fever. It may be active or passive. Active hemorrhage is present in operations or injuries when vessels are torn or cut; passive when it depends on the presence of disease germs in the blood, or poverty of that fluid. Hemorrhage is sometimes periodic, as in cases of vicarious menstruation. BACTERICIDES. 439 The seat of hemorrhage will depend upon the location of the lesion, weakness, or partial death. There are general principles which must be observed in all hemorrhages. The recumbent posture must be rigidly maintained ; perfect freedom from excitement. The circulation must be perfectly regulated by keeping the action of the heart below seventy contractions per minute, this can be effected either by the administration of veratrum viride, or exalgine, or both. Plain, simple, nourishing food ; elevation of the bleeding part; and the application of stimulants and styptics. Remedies to arrest hemorrhage will depend greatly upon its location and cause. All bactericides are active styptics, as car- bolic acid, creosote, creolin, peroxide of hydrogen, mineral acids ; the various preparations containing terebcne, gallic acid, etc. As soon as arrested, great caution is to be observed in diet and movement. Bleeding from the nose or sinuses connected Hemorrhage, with it is quite a common occurrence ; owing to Epistaxis. the exposed position of the nasal organ and its richness in blood-vessels, to its possession of erectile tissue, the organ is liable to severe hemorrhages. These may be either traumatic or idiopathic. Among the commonest traumatic causes are blows, falls, frac- tures, entrance of foreign bodies, violent blowing, catheterizing the eustachian tube, and other surgical operations. Spontaneous or idiopathic hemorrhage is more rare, but may be met with in both sexes at the age of puberty. It may also occur from en- gorgement, hyperaemia, and presence of disease germs during hooping cough ; from diseases of the heart, lungs, and liver; in acute affections, such as scarlatina, measles, typhoid fever or diphtheria, and in recurrent fever. In some of these cases, the primary cause is increased arterial tension, resulting in the rup- ture of small and badly-supported blood-vessels. Habitual hemorrhage is also met with, without disease of the mucous membrane, in unhealthy conoitions of the blood, such as haemo- philia, anaemia, chlorosis, pregnancy, leucaemia, and, according to some authorities, in scurvy, but that nt least appears doubtful. There may also be nasal hemorrhage in cases of general plethora in children or adults. Small varicose vessels, angiomata or ero- sions of the septum, naso-pharyngeal polypi, malignant tumors, and ulcers may also be causes. Vicarious epistaxis occurs at times, and may take the place of habitual discharges from the 440 DISEASE GERMS. anus or uterus. Free hemorrhage occasionally takes place under the mucous membrane, where the blood collects and forms haama- tomata, or blood tumors. The symptoms, apart from the flow of blood, are chiefly those of cephalic congestion, such as giddiness, throbbing, noises in the head and sleeplessness. The actual bleeding may be in a stream, or drop by drop from one or both nostrils. When it comes from the posterior part the blood flows through the nasal fossae into the pharynx, and is swallowed. The quantity lost may vary from a few drops to several quarts. After these severe attacks patients remain pale and anaemic, and if often subjected to them may gradually succumb. Diagnosis.—The.first point is to establish the origin of the hemorrhage, which may come from the lungs, stomach, or pharynx. Sometimes the bleeding point can be seen. The ab- sence of vomiting will preclude haematemesis, and the history of the case, together with physical examination, will eliminate dis- eases of the lungs and heart. Hemorrhage from the pharynx may be recognized on inspection. If the hemorrhage ceases on compressing the nostrils, it comes from the anterior third of the nasal fossa. Treatment.—Epistaxis in some rare cases may be beneficial, as in plethora, hemorrhoids, heart disease, and vicarious menstrua- tion, but must always be looked upon with some degree of sus- picion. In a large proportion of cases the bleeding stops of itself; this of course can be aided by a few simple manoeuvres, such as placing the patient in the erect posture, holding both hands above the head ; the application of cold to the .nape of the neck to cause contraction by stimulating the olfactory at its root in the medulla ; the application of spirits of turpentine over the liver; by snuffing cold, or, better still, very hot water ; the in- sufflation of alum, tannin, matico-leaf, or injections or sprays by a cold atomizer of tannic acid, perchloride of iron. Sometimes these methods fail, and recourse must be had to plugging the nose with cotton or lint saturated with perchloride of iron. In no case should the plug be permitted to remain in over twenty-four hours. Constitutional treatment will often improve the condition of the blood; rid that fluid of microbes, and thus lessen the predisposition to hemorrhage. For this purpose such remedies as iron in the form of syrup of quinine and aromatic sulphuric acid, avena sativa, kephaline, peroxide of hydrogen; whatever may improve health and vitality may be prescribed. Ergot here is a remedy of great value. BACTERICIDES. 441 Bloody urine, hemorrhage from the Hemorrhage mucous membrane of the urinary pas- From the Kidneys, sages, the kidneys, bladder, urethra. Haematuria. It may be a symptom of acute or chronic nephritis; to the presence of the microbe of malaria in the kidneys, or to parasites, or calculi; morbid states of the blood, strains, blows, cancer in the kidney. It is easily recognized by the smoky or port-wine tint of urine ; albumen invariably present. When from the kidney, it is gener- ally diffused through the urine ; when from bladder or urethra, Renal hemorrhage ; illustrating renal Renal hemorrhage ; infarction, as often occurs in mala- diagram showing rial hsemaiuria. hemorrhage from the vascular tults of the glomeruli. blood comes away after passing clear urine. Blood-casts of renal tubes, cancer-cells, or renal calculi. Haematuria very often present in Southern ague ; it may occur paroxysmally with the fit. Strong liability to haematuria in purpura, scurvy, or white cell- blood ; comes on from the slightest cold or exertion; also a symptom ii bilious, remittent, and yellow fevers; and in or among the inhabitants of those localities where such prevail, it is endemic. The treatment must be varied according to cause; but in all cases rest, and stimulants over kidneys. In all inflammatory forms, turpentine ; when passive without inflammation, hama- melis; con. tincture of kurchicine, when due to the malaria mi- crobe; gallic acid in infusion of uva ursa best astringent. 442 DISEASE GERMS. Hemorrhage from the lungs is invari- Hemorrhage ably an essential symptom of bronchia! From the Lungs, tuberculosis ; not at all so common where Haemoptysis. the substance of the lung is infiltrated by tubercle. It is also a common symptom in congestion of the lungs, due to the presence of the pneumo- coccus ; periodic in vicarious menstruation ; lifts, blows, running, jumping. Treatment in all cases, according to cause, common salt, exal- gine, comp. tincture of myrrh, erigeron, iron, are good remedies, when the bleeding is due to the tuberculae bacilli, causing ulceration of small vessels; cannabis indica, if there is much nervous irrita- tion ; turpentine, ipecac, cricus lanceolatus, witch hazel, ergot, sulphur water, peroxide hydrogen, all excellent remedies. At the same time enjoin rest, recumbent posture, cold drinks; keep heart's action under control with exalgine. Hemorrhage from the bowels may Hemorrhage be due to the lesion produced by the From the Rectum, germs of typhoid fever in the glands of Bruner and Peyer ; to the germ-eaten rectum of tuberculosis; or the presence of the vibrios in the insane. It may be due to congestion of inflammation, as in dysentery; to the rupture of the pile sacs (varicose veins); to the eating of the cancer germ through the vessels invaded by it. Foreign bodies, large or hardened masses of faeces, calculi or con- cretions may rupture a vessel and considerable loss of blood may take place ; polypoid growths. From whatever cause it has occurred, it should be promptly checked by rest in the recumbent posture, heat over abdomen; either green root tincture of gelsemium or antipyrine should be administered freely to bring the action of the heart to sixty. Enemata of witch hazel or stone crop, or a teaspoonful of Mon- sul's solution of iron to an ounce of water, or aromatic sulphuric acid and water. Internally, our best styptic is the bursa pastoris, or shepherd purse, a tincture from the green or fresh herb is the best rectal styptic in the materia medica, always reliable, ever efficacious; and the general treatment of the disease which gave rise to it should be carried out. It is well for all individuals who have rectal trouble, or who have had any operative procedure about the rectum which may have rendered them liable to hemorrhage, to avoid all strainings lifting, or violent exertion for some time. BACTERICIDES. 443 The escape of blood-stained fluid Hemorrhage from Skin, from the cutaneous surface is a very or rare disease. Most frequently met Haematidrosis. with in young ladies suffering from vicarious menstruation ; still, it occa- sionally occurs in young men after puberty. The treatment must be upon general principles, chiefly directed to stimulating the uterine function by caulophyllum and uterine tonics. A general course directed to improving the general health by tonics and stimulants. Hemorrhages into the skin may occur Hemorrhages under various conditions. They are not in Skin. uncommon in the specific fevers and allied affections, occurring especially in typhus, measles, variola (hemorrhagic variola), diphtheria and pyaemia. In erythema and urticaria slight hemorrhages may occur. In scurvy, cutaneous and subcutaneous hemorrhages are prominent symptoms, while in one disease (purpura) cutaneous hemorrhage may be said to be the only symptom. Hemorrhagic spots in the skin are variously described, according to their size. Those which do not exceed a line in diameter are termed petecliice; when somewhat larger, they are described as vibices; while large patches are denominated ecchymoses. Purpura, an unclassified affection, doubtless from the difficulty of deciding where to place it. Its cause is not known. Occa- sionally it occurs amongst those depressed in health, or subject to insanitary conditions, but it also attacks those in perfect health. May occur at any age, but more common in children. Sometimes preceded by lassitude, pains in the limbs, etc., but frequently the hemorrhagic macules appear suddenly, without any premonitory signs whatever. They are mostly closely aggre- gated together, and vary in size from mere points to spots a quarter of an inch in diameter. They are circular, purplish in tint, not raised, and not attended with any abnormal sensations whatever. Most common on lower limbs and lower part of trunk, but also occur in other parts. Also seen on mucous mem- branes and beneath conjunctivae. Fade away in the same man- ner as bruises do, but successive crops may appear for weeks. Larger extravasations may also occur; these are generally more deeply seated, and gradually manifest themselves in the same manner as deep-seated bruises. Very often purpura is attended by no symptoms whatever. Sometimes weakness and lassitude accompany the attack, or the temperature may be elevated. In 444 DISEASE GERMS. some cases hemorrhages from the various mucous membranes may occur. If these be severe, symptoms due to loss of blood will be developed. In severe cases death may ensue from asthe- nia or syncope. In fatal cases hemorrhages have been found beneath the mucous and serous membranes and into the substance of various organs, especially the heart, lungs and kidneys. The treatment should consist of rest; digitalis or strophanthus, mineral acids and quinine, with the best blood-forming diet. Scurvy is characterized by cutaneous hemorrhage, caused by a want of vegetables; limited to seamen or people who live on heights. The skin symptoms resemble, to some extent, those of purpura, but the other symptoms should prevent all possibility of a mis- take in the diagnosis. There is marked and rapidly-increasing anaemia, accompanied both by bodily weakness and mental apathy. Hemorrhage is very common, The gums swell and bleed, and the teeth become loose. Ulcers are apt to form on various parts of the body, and old wounds often re-open. In severe cases death may occur from syncope or from some complication. In the treatment rest is of essential importance; digitalis, abundance of fruit, vegetables, speedily effect a cure. Vomiting of blood by the stomach Hemorrhage from the is due to a large variety of causes. Stomach. It is often but a symptom of some Haematemesis. disease, as acute gastritis, of yellow fever, of abdominal disease, as a morbid liver, or cancer, or ulcer of the stomach; morbid states of blood, as purpura and scurvy; or vicarious menstrua- tion. The vomited blood may be either a pure red, or mixed with the gastric juices, or it may be dark, frothy, like coffee grounds, or changed to black by the acids of the stomach. In the treatment enjoin rest, recumbent posture, heat over stomach. Try first green root tincture of gelsemium; that failing, tincture of ipecacuanha, in four to ten drops if there be much vomiting. If the blood is dark, grumous (venous), hama- melis tincture; oil of turpentine if there is great debility; ergot hypodermically; other astringents, as sulphuric acid, iron, tannic and gallic acid, etc. BACTERICIDES. 445 Various terms are used to express the idea Hemorrhage, of uterine hemorrhage at different periods and Uterine. conditions. Fpr example, it is called menor- rhagia, when menstruation is copious or profuse, or prolonged; metrorrhagia, when there is a copious, excessive, continous flow of blood during the interval, not necessarily asso- ciated with menstruation, but more frequently blended with tu- mors, warts, disease germs, polypus, cancers and retained pro- ducts of conception. The uterus is the only organ in the body from which blood flows at stated intervals, and so long, as it does not exceed in quantity over four ounces, and does not occur more frequently than every twenty-eight days, it is to be regarded as normal. Causes.—Among Caucasian ladies, the uterus is very freely supplied, nay, its anterior portion literally covered all over, with branches of the great sympathetic nerve; hence in that class of patients violent emotions, desires, affections, passions, as in- tense grief, sorrow, worry, etc., give rise to relaxation of uterine tissue and congestion; sedentary occupations, repeated abortions, devitalize the uterus, cause it to lose its contractility; wearing sponges, rings, pessaries, excessive sexual congress, all impair its vitality and aid in bringing about an excessive flow. Debility is a common cause, whether it be directly from disease, or the presence of disease germs in the blood; long continued or ex- cessive lactation, over work, lifts, strains, inordinate excitement ; poisons in the blood due to sewer-gas ; defective sanitation. The excessive flow, with debility, anaemia are the symptoms ; and these, outside of the causes enumerated, may be essential landmarks of metritis, uterine or ovarian tumors; of placenta praevia ; uterine cancer ; polypus, moles, etc. Treatment.—During an attack, enjoin rest of body in recum- bent position in bed, head low, foot of bed somewhat elevated. With this horizontal rest, ease of mind, no hot drinks or hot food, and the patient is not to get up for either urination or defeca- tion, for the blood pressure is greatly increased by stooping or straining. Diet to be nourishing: beef essence, milk and lime- water, eggs, toast. The judicious physician will select remedies and administer them according to their indications. In the menorrhage of young ladies, ovarian hyperaemia, no drugs excel fluid extract salix nigra, aleteris farinosa, digitalis, bromide of potassa. These are unfailing remedies. Ergot, ustilago maidis, terebene, are useful in hemorrhage due to chronic metritis, pelvic hyperaemia. These drugs cause con- traction of the pelvic vessels. 446 DISEASE GERMS. Strvchnine is useful when the flow is associated with general debility and loss of muscular tone. Witch hazel is indicated in venous or passive hemorrhage. Sulphuric acid and spirits of turpentine, oil of erigeron, hy- drastin, gallic acid, etc., best adapted to cases of hemorrhage after lingering labor. Ergot in combination with compound oxygen as follows: Fluid extract ergotae, three drops ; compound oxygen, two drachms ; dilute muriatic acid, ten drops ; infusion of gold thread, one ounce. Administer in four doses, half an hour apart. Local treatment of utility, if there be a thick, heavy, congested state of the neck of the uterus, even hypertrophied ; pack the vagina nightly with boroglyceride till removed. The hot vaginal douche is always a valuable auxiliary to treat- ment. One of the most powerful local means of aiding a renewal of life in the uterus, and inducing contractility, is dry heat, in any light vehicle, as camomile flowers, bran, hops in bags or pillows, ap- plied over the uterus and vulva hot. The old doctors swear by cold, but cold water, or ice either, over pubes, or up vagina and rectum, is positively injurious. If these means fail, resort at once to a plug ; in the unmarried it is difficult sometimes to insert, but in married women there is no difficulty. A sponge answers the purpose most admirably, or several small ones; they may be saturated with a solution of carbolic acid, or tincture of iron, or vinegar. Of intra-uterine applications (used with great care and judg- ment), boroglyceride, resorcin, creolin, etc., and the positive pole of the continuous current are of chief importance. Bleeding from a cancer or polypus is always mitigated by rest, brushing the diseased surface with lactic acid; their removal. In all cases, no matter zvhat the origin may be, strengthen the uterus, induce contraction of its vessels by the alternate adminis- tration of the salix nigra ; aleteris farinosa, compound syrup of partridge berry, stylosanthus, etc. Hemorrhoids or piles are terms applied Hemorrhoids, and restricted to small, vascular tumors, or excrescences situated either within or on the verge of the anus. They consist of folds of mucous and sub- mucous membrane in an inflamed, infiltrated or permanently thickened condition, and usually contain enlarged varicose veins. bactericides'. 447 Certain distinctions are admitted, and these are engrafted into all our literature on the subject, as blind and bleeding, according as they are or are not accompanied by hemorrhage; and into external and internal, as they are without or within the sphincter ani. Hemorrhoidal disease is essentially one of debility—a true vari- cose condition of the veins of the rectum, involving altered nutri- tion, with dilated, tortuous vessels, surrounded by tissue thickened by inflammatory products. Those tumors may in some cases consist of erectile tissue, formed by the abnormal condition of the vessels of the mucous membrane. In order to appreciate the subject thoroughly, the anatomy of the rectum must be reviewed. Here we see that it is very freely, nay, largely, sup- plied with blood. The vessels on its outer side are large, and send branches at intervals through the muscular coat, which ramify between it and the mucous membrane. The arrangement of the coats of the bowel is not the same throughout; over the greater part the arteries and veins take the same course, penetrate the muscular coat at short inter- vals, and at once divide into small branches, and go in a trans- verse direction, forming a network by their communication with the subdivisions of other smaller vessels. Towards the lower end of the bowel, for the length of about six inches, the arrange- ment is quite different. Here the vessels have considerable length, and their direction is longitudinal. Penetrating at different lengths, they merge in parallel lines towards the end of the gut. In their progress downwards they communicate with each other at inter- vals, and are still more freely connected near the orifice of the bowel. Here the arteries all join by transverse branches of good size. The veins form loops, inosculate or anastomose with great freedom. internal and external At an early stage of hemorrhoidal disease the blood may circulate through the dilated veins; but as they advance dilatation becomes greater, and they are still further enlarged, and when so, they are found to contain clotted blood or fibrinous matter. From the aggregation of veins, thus dilated in different ways and degrees, loaded with blood or one of its elements, more or less solidified, the hemor- rhoidal tumor is formed. The rounded masses which fringe the < 448 Disease germs. end of the rectum, soft, pulpy, are simply coagulated blood which is confined there. When ravelled out and inspected with a magnifying glass, those swellings are simply varicose veins, loops dilated, enlarged, tortuous, thickened by inflammation. The dilatation of the terminal loops, from their dependent posi- tion, the weight of the column of blood, the want of valves in those rectal vessels, gives us an uninterrupted flow from heart and liver, the large size of the vessels at the lower end of the rectum and of their terminal loops favor varicosity. The predisposing causes are inherent, or acquired debility, or weakness of the veins, which permits of their alteration or This wood cut affords an excellent illustra- tion of both external and internal hemor- rhoids in a full stage of development, three protruding through the external sphincters, three higher up in the bowels. A complete state in which a hemor- rhoid protrudes externally with an erodine ulcer high up Very com- mon in pulmonary consumption. change into a hemorrhoidal tumor. This change takes place in the loops into a species of gradual dilatation, usually in the form of a round pouch, fusiform, or abrupt, or elongated. The exciting causes are any thing that give rise to congestion of the lower bowel, as luxurious living, sedentary habits of life. The use of alcohol, carbonaceous food, overcrowding, solar heat, render the liver sluggish, and this inactivity rebounds upon the rectal plexus of vessels ; causes turgescence. A germ-smitten, malarial liver and spleen retards the formation of bile, embarrasses its function, gives rise to inertia or inactivity of the bowels. Whenever the portal circulation is slowed, vascularity of the rec- tal vessels take place. Constipation is the most common cause; it operates in producing hemorrhoids by pressure of the accumulated and hardened faeces upon the veins; the straining bactericides. 449 and irritation such alvine evacuations produce in their passage; drastic purgatives, as aloes, dysentery; inflammation of the prostate ; uterus ; all persons habituated to diarrhea. The ordinary symptoms of hemorrhoids are very variable, but may be embraced in a few sentences. The patient, after experi- encing for an uncertain length of time a feeling of itching, heat, fulness, throbbing about the lower portion of the bowels, be- comes conscious of a sensation, as if there was a foreign body in the anus. On an examination, after an evacuation of the bowels, he discovers a small tumor, usually about the size of a small marble, which either remains outside or is retracted inside, according as it originated, without or within the sphincter. The tumor gradually increases in size, and others form around it, until a mass of them may form, or the original one remain soli- tary. Whichever be the case, they gradually increase in size, reaching about the bulk of a pigeon's egg or larger. In its ordi- nary indolent state it has little sensibility, and may occasion little annoyance; but when inflamed from strangulation of the sphincter muscle, or any other cause, it is exquisitely tender to the touch, and is the seat of burning and stinging sensations, rendering the evacuation of the bowels, and sometimes the blad- der, difficult and very painful. In men those tumors may give rise to leakages, prostatorrhaea; in women, to irritation of the uterus, ovaries, vagina, with mucous or muco-purulent discharge, anaemia, loss of flesh, debility, and many other anomalous symptoms. In severe cases patient can neither sit nor walk with comfort, and only finds relief in the horizontal position. The reflex symptoms are numerous, as pain in the back, albuminuria, headaches, prostration, chorea, epilepsy, nervous disease, and general derangement of the vital forces. Itching piles, as they are termed, present no distinct elevation, but great irritation of the anus and puffiness of the surrounding parts, often accompanied with an eczematous eruption; usually disappear under an alterative and tonic course of treatment, with a lotion of boroglyceride to the part. Hemorrhoids are liable to be affected by attacks of general ill health, or irregularities of the stomach, liver and bowels. Cold, damp, carelessness in the selection of article for cleansing the parts after defecation, often excite an irritation, a little red- ness, with slight tenderness and oedema. Any thing which irri- tates the delicate integument about the verge of the anus, an obstruction to the circulation, preventing a return of venous blood, high living, alcoholic drinks, mercury, malaria, use of tobacco, act in the production of piles by obstructing the liver. 29 45Q DISEASE GERMS. The diagnosis of piles is very simple; the history of the case, their appearance are most significant. Treatment.—The general management of a case of either ex- ternal or internal piles is simple and most effective. In all cases the patient should be placed upon an alterative and tonic course, generous diet, free from carbonaceous material, daily alkaline or acid baths, and rest in the recumbent posture inculcated; all pre- disposing and exciting causes as far as possible removed. Remedies that will efficiently stimulate the liver should be ad- ministered, and all alcoholic drinks or conditions of life which will cause torpidity of that gland removed. For this purpose the following formulae are excellent: tincture of nux vomica, and tincture of belladonna, of each half an ounce. Mix. Dose, from five to ten drops before each meal, in alternation with fifteen- drop doses of tincture of sulphur, both administered highly di- luted in water. And on retiring to bed every night, the follow- ing is to be injected into the rectum : three drachms of the fluid ext. of hamamelis; two drachms of the fluid ext. of hydrastis cana- densis ; and two ounces of sweet oil. Mix, and if possible, re- tain over night. As a palliation, and often curative remedy for local and internal piles, hamamelis is very superior to all other remedies. The external parts should be bathed thrice daily with warm water and castile soap. After each morning stool, the rectum should be injected with warm water, or if great debility exists, beef tea, and permitted to remain half an hour or longer. When this is passed, a cocaine suppository should be inserted, or a half a drachm of either of the following should be introduced into the rectum : sub-nitrate of bismuth, two drachms ; muriate of hydrastin, thirty grains; butter of coca, one ounce; oil of eucalyptus, twenty drops. Liquefy the butter of coca by heat, then add the bismuth, hydrastin, and eucalyptus; run in moulds so as to give thirty grains to each. Or, the following may be tried: fluid ext. eucalyptus, one drachm ; oxide of zinc, two drachms; butter of coca and vaseline half an ounce. Use as above. Petroleum oint., one ounce; salicylate soda, solid extract elder bark, and burned alum, of each one drachm. Mix. All are excellent, and should be applied to the outside, and inside as far as possible. This treatment will get rid of the inflammation. Small piles, or cutaneous excrescences around the anus should be removed, or absorbed. For this purpose some of the following •mould be tried : Monsul's solution of iron, one ounce and a half; fluid ext. belladonna, three drachms ; fluid ext. hamamelis, three ounces; tinct. calendula, four ounces; sulphate of morphia, thirty grains. Mix. Apply locally around the parts once or BACTERICIDES. 451 twice daily with a camel's hair pencil brush; or a mixture of hamamelis, glycerine, and boroglyceride is excellent. In our treatment of both external and internal piles, whether they be blind or bleeding, protruding or ulcerated, or whatever name may be given to them, a cure can be effected in all cases with- out the use of the knife, ecraseur, clamp, torsion, or burning with caustic, by simply injecting them to coagulate their contents and excite absorption. If it is decided to operate for either external or internal hemor- rhoids by injection, the bowels should be freely opened, and then the rectum washed out. If they are external, the mode of pro- cedure is very simple, simply throwing the injection into the centre of the pile; but if they are internal, the speculum must be inserted, and the tumor brought well into view. Then introduce the needle of the syringe (which is charged with one of the formulae which are given below), into the most dependent part, taking great care not to push the needle into the connective tis- sue underneath the sac. This accident would cause great pain and inflammation, and in some cases produce much trouble. Should this occur, a warm sitz bath should be immediately re- sorted to, to be followed by a cocoaine suppository. This affords instant relief. It is unnecessary to state that there is always less irritation from injecting one, than two or more. In all cases the irritation passes off in from four to eight days, unless an overdose be given. Scarcely any pain follows if the injection is deposited in the centre of the sac. It is a good rule to adopt, never to inject internal piles when they are protruding, they should invariably be returned into the rectum before being injected, and the inflammation, if possible, must be reduced before treatment is carried on, although we have treated piles when protruding from the anus, with our favorite prescription, with no unpleasant results. The following are a few of the formulae in very general use by rectal specialists for the purpose of coagulating the contents of piles, and causing their disappearance or perfect obliteration by absorption: Carbolic acid crystals, fifteen grains; fluid extract thuja occi- dentalis, thirty drops; oil of eucalyptus, sixteen drops ; glycerine, thirty drops; aqua dest., three drops. Mix. Inject from five to fifteen drops into each pile, the quantity injected being governed by the size of the pile to be injected. In using this, and either of the following formulae, no irritation or sloughing will occur, even if a drop or two penetrate into the connective tissue. 452 DISEASE GERMS. In preparing any of the formulae, a very small quantity should be prepared at a time, as it will be fresher, more active. None of them should be exposed to a strong light for any length of time. A variety of formulae for injecting piles : Carbolic acid, glycerine, of each one drachm; fl. ext. ergot, one drachm; water, one and a half drachm. Mix. Three to eight drops to be injected according to the size of the pile. Carbolic acid, thirty-five grains; fl. ext. ergot, twenty drops; glycerine, fifteen drops ; dist. water, fifty drops. Mix. Inject two to ten drops. Carbolic acid, four drachms ; olive oil, three drachms; oil ori- ganum, one drachm ; salol, five drachms. Mix. Inject two to six drops. Olive oil, twelve drachms; carbolic acid, ten drachms; tinct. opii, one drachm. Mix. Heat to 2900 F.; evaporate to two and one-half ounces to drive off the water and alcohol, then in- ject from two to ten drops. Fl. ext. thuja, six drachms; fl. ext. hamamelis, one drachm; fl. ext. horse chestnut, three drachms; water, four drachms. Mix. Inject from five to twelve drops. Carbolic acid, one drachm; sperm oil, three drachms. Mix. Inject from three to fifteen drops. Carbolic acid, one ounce; creosote, twenty drops; olive oil, glycerine, of each one ounce; muriate of cocaine, three grains. Mix. Inject three to six drops. Salol, ten grains; fl. ext. horse chestnut, one drachm; fl. ext. ergot, one drachm. Mix. Inject ten to thirty drops. With those, and like formulae, a good rule to adopt is never to inject more than one pile at once; if small, two can be injected, provided the amount injected did not exceed ten io twelve drops. Better to repeat the operation in eight or ten days, until all have been injected and cured. In some rare cases, very large piles may require two or three treatments. Select one of the following formulae, to apply on cotton or lint continuously for irritable piles : Hydrochlorate of cocaine, five grains; two drachms each of fluid extract of opium, aconite and stramonium ; glycerine, one drachm. Mix. Tannic acid, two drachms; solid extract of belladonna, five grains; pulverized opium, one drachm; ozone ointment, one ounce. Mix. Apply inside and outside. Subnitrate of bismuth, two drachms; hydrarg. chloride mit, forty grains ; sulphate of morphia, three grains; glycerine, three drachms; ozone ointment, one ounce. Mix. Apply in pile syringe. BACTERICIDES. 453 We cannot speak too highly of the utility of curing hemor- rhoids by injecting and dispensing with the old and barbarous methods. It is the most serviceable and requires very little skill, nothing but good common sense; the number of drops in- jected should correspond to the size of the pile. It is best to use a curved needle, it throws and holds the medicament deeper into the base of the tumor than a straight one. The operation is sim- ple with hemorrhoids situated near the anus, a little more diffi- cult higher up. The injections are more painful the nearer they are to the external anal orifice, but this soon subsides. Even in very sensi- tive ladies pain is scarcely appreciable. In is undoubtedly the best plan, after they are injected, to lock up the bowels for a few days by administering a grain of opium thrice daily. Even when the bowels are moved there is no difficulty, no danger of any complications what- ever. The almost freedom from pain per- mits the patient to follow his avoca- tion undisturbed, there is no need of chloroform or ether with their dangers and disagreeable effect. There is every argument in favor of the method. Hemorrhoids and Prolapse of the Rectum often co-exist. In cases of this kind the eminent rectal specialist, Prof. G. W. Powell, M. D., Moriah, New York, gives what he denominates a safe, simple, and effective mode of treating these troublesome affections. He injects into the tissues with a hypodermic syringe an eight-grain solution of muriate of cocaine with an equal vol- ume of phenol sodique. The quantity of this solution injected varies from Uventy minims, in small hemorrhoidal tumors, to one ounce, in prolapsed rectum. One injection is sufficient to cure haemorrhoidal tumors in all his cases, while two to four trials are found necessary to cure prolapsed rectum. The syringe point is introduced at the most prominent point of the tumors—large or small—and thrust boldly to the most vascular part of their base, and a liberal por- tion of the solution deposited, according to the size of the tumor. Then.the balance of the tumor is well saturated with the solu- tion. After injecting hemorrhoids no topical treatment is ap- plied, except a daily wash of dilute solution of boroglyceride as hot as can be borne. After injecting prolapsed rectum a mild Numerous small piles protruding from the anu-, which were all injected at one time with car- bolic acid injection; excellent cure. 454 DISEASE GERMS. antiseptic healing salve is applied. The following formula was found very efficient: Iodoform, in fine powder, balsam Peru, oil of camphor, oil of sassafras, of each half a drachm ; pine tar, castor oil, powdered aloes, of each one drachm; subnitrate of bismuth enough to make a stiff salve. Apply thoroughly twice a day, and cover with a soft cloth. Before applying the salve each time, let the parts be well washed with the syringe; soapsuds from tar soap, as hot as can be borne, being employed for the purpose. In addition to whatever general internal treatment may be indi- cated in any given case, he is in the habit of directing, with ex- cellent results, something like the following: Fl. ext. witch hazel, half an ounce; sat. tinct. horse-chestnut, one drachm; muriate of ammonia, one drachm; glycerine, four ounces. M. ft. sol. Dose. A teaspoonful three times a day, just after meals, on alternate days. Muriate of hydrastin, twenty-four gr.; ergotin, twelve gr.; ext. capsicum, ext. ipecac, aloin, of each six gr. Mix. Make twenty-four pills and silver-coat. Dose. One pill three times a day, just after meals, on alternate days. These last two prescriptions should be administered regularly, on alternate days, as long as the hemorrhoids or prolapse give trouble, and for several weeks after they have ceased to do so. After operation on hemorrhoids, patients are allowed to attend to their ordinary business at pleasure. The cases of prolapsed rectum are confined to bed until cured, which is in the mildest cases about two weeks, and in some severe or complex cases about four weeks. They are then allowed to move gently about the room, but if the patients are parturients, the horizontal posture and quietude are doubly indicated. No general anesthetic is found necessary in any of the cases, as the operations produce but little pain or subse- quent soreness. No# inflammatory reaction follows the injec- tions. Pain indicates a partial death, so here we have, Headache, in the brain, an organ suffering a Joss of its vitality from the wear and tear of civilized life ; this lies at the origin of all headaches; then the presence of disease germs in the blood acts as an exciting cause, so we have the headache of syphilis, gout, rheumatism, malaria, etc. Poisons in the blood, like uric acid; polluted atmospheres, with sewer-gas and other effluvia ; want of nutrition in the brain proper, as starved areas ; reflex causes and organic disease of the brain substance. BACTERICIDES. 455 A division or classification of the various headaches is of great value in the application of remedies for its relief. Of all varieties the nervous is the most common, it is due to debility, exhaustion, poor blood, to the use of a diet deficient in phosphates ; to hemorrhages, over-lactation. When neurasthenic men or women suffer from this headache, it is confined to one spot, resembles the driving of a nail into the part, and is known as the clavus hystericus. The congestive form is due to inherent weakness in brain sub- stance and a determination of blood. There are symptoms of plethora, vertigo, beating in ears, caused by over-stimulation, or it might arise from a sudden suppression of the catamenia. What is termed bilious headache is associated with derange- ment of the stomach and liver. There is usually a coated tongue, fetid breath, flatulence, nausea, constipation, stools clay- colored. In the organic form, there is some well-defined cerebral disease, with vertigo, muscae volitantes, tinnitus aurium, vomiting, con- vulsions. The character of pain will indicate its location, whether it be the membranes or substance of brain. In the treatment of all headaches general principles should guide us. Bowels should be regulated either with cascara sagrada or kolatina lozenge, skin stimulated, rest inculcated; warm mus- tard foot baths and a light nutritious diet given, and above all things breathe pure air. We briefly enumerate a few of the more prominent remedies in the cure of headache : When purely nervous the salicylate soda in the effervescing citrate of caffeine, guarana, fluid extract tonga, simabicidia, one- per-cent. solution of nitro-glycerine. The caffeine in this form of headache is of great efficacy. Nothing can excel it. Menthol also of utility. When bilious, compound extract of colocynth, nux vomica, gelsemium, chloride of ammonia. When due to congestion, bromide of potass, liquor ammonia acetatis, bryonia, exalgine. In ancemic states of the brain, as in cerebral neurasthenia, nitro- glycerine stands unrivalled ; Indian hemp also good ; cimicifuga, caulophyllum, pulsatilla, are three excellent remedies at the climacteric period, with pain at vertex and hot and cold flushes. In headache, due to the inhalation of foul air, sewer-gas, densely populated localities, peroxide hydrogen, compound oxy- gen, chlorate potass. In that due to organic changes in the brain, large doses of solid extract hyoscyamus, alternated with sulphonal; croton chloral hydrate. 456 DISEASE GERMS. An acute affection in which one or more groups Herpes, of vesicles are seen seated on a red and inflamed base. The vesicles are generally small and their contents clear, but sometimes they become opaque ; several may coalesce. The vesicles begin as papules, but these quickly be- come vesicular, and the eruption is at its height in twenty-four hours. In a few days the vesicles dry up and scabs form, which drop off, leaving simply a patch of redness. Two varieties are described in the official nomenclature: H. facialis, (Syn. labialis) and H. prceputialis. Other varieties also receive special names according to the part affected, as H. auricularis, etc. H. labialis is a not uncommon accompaniment of catarrh, espe- cially when accompanied with much fever. It so constantly occurs at the onset of croupous pneumonia as to form a marked' symptom ; it follows the rigors. H. praputialis is a vesicular eruption occurring on the genitals, as implied by its name. It may cause alarm by being mistaken for a venereal affection. It is sometimes exceedingly obstinate, recurring again and again. H. circinatus and H. iris are rare forms which are occasionally seen. The former is the name applied to a ring of vesicles seated on an inflamed base. This gradually enlarges and fresh vesicles form at the periphery while the centre clears. H. iris is a very rare form of eruption, in which vesicles form in con- centric rings upon a reddened base which gradually increases in size. In the treatment of these different forms of herpes, we must always recognize the fact that the serum of the vesicles contains the germ, the factor of the disease; that if this is permitted to ooze around and contaminate sound parts, it will have a perpetual exist- ence. So that whatever dressing is applied, must be powerfully germicidal, wet or dry, to kill the microbe; if a lotion is desired, let it be made of either ichthyol or resorcin, or creolin or bichloride mercury; if a powder, the anti-microbe powder; oint- ments are to be avoided if possible, but if used, must be made of resorcin, ichthyol, creolin, bichloride of mercury, etc. Internally, patient should be placed upon alteratives and tonics, as saxifraga and cinchona ; at the same time the blood must be kept sterilized by the constant administration of either ozonized sulphur water, peroxide hydrogen or compound oxygen. Herpes, zoster, shingles, formerly described as a variety of herpes, but now considered a distinct disease, and named zona in the official nomenclature. In appearance it somewhat resembles ordinary herpes, consisting, as it does, of small vesicles seated on an inflamed base. It has, however, marked differences. The BACTERICIDES. 457 distribution of the vesicles should alone suffice to diagnose it. They usually appear along the course of one of the principal nerves, very commonly one of the intercostal or superficial cervi- cal nerves, though it may also occur on the limbs. The eruption is almost invariably unilateral. It is generally preceded or accom- panied, sometimes followed, by neuralgic pain along the course of the affected nerve, which may be very severe. Zona is regarded as a neurosis. Changes have been found in the adjoining nerves, also in the inter-vertebral ganglia. Hyperaemia and hemorrhage have been found to occur within the ganglion and surrounding cell-infiltration. Peripheral nerves show neuritus or perineuritis. Both motor and stnsory nerves have been fcund affected. Dubler believes that zona is not a neurotrophic disturbance, but a direct extension of inflammation along the nerve to the skini Eruption may occur at any age, but more common in latter half of life. A second attack is rare. In many cases no dis- coverable cause is present. In others, some source of nerve irri- tation may be known to be present, as tumors causing pressure on nerves, caries of vertebrae, locomotor ataxy, etc. Eruption has also been observed after poisoning with carbon monoxide, and has been known to appear during the medicinal administra- tion of arsenic. The vesicles of zona may be few and isolated, but more often occur in groups, the individual vesicles being small, prominent and set rather closely together. Successive crops may come out for a week or more. The vesicles become opaque and then dry up, leaving yellowish scabs which soon drop off. It is not followed by scarring unless ulcers have formed, or the inflammatory pro- cess has proceeded to gangrene. This form is best treated by the local application of powerful stimulating bactericides and the use of such remedies as gly- cerite of kephaline, tincture of oats, and such formulae as the fol- lowing : Glycerite of kephaline, four ounces ; sulphate of quinine, one drachm; tincture of nux vomica, two drachms. Mix. One tea- spoonful thrice daily. Phosphide of zinc and extract of nux vomica, of each, one-third of a grain, added to solid extract of hydrastis, thrice daily. _______ Hiccough is a short, convulsive and noisy inspi- Hiccough. ration, followed immediately by expiration. It is due to the sudden and involuntary and momen- tary contraction of the diaphragm with the simultaneous narrow- ing of the glottis. The cause is either in the brain, at the origin of the pneumo- 458 DISEASE GERMS. gastric and vagus, or at their periphery in the stomach or recur- rent branches in the diaphragm. Occurring in brain irritation or disease, it is to be looked upon as one of great danger when de- pendent on irritation of digestive organs; usually not to be dreaded, but the paroxysms occurring at short intervals, and for days in succession, give rise to pain about the heart and great exhaustion. Young and old are most liable to attacks. In all cases the treatment should be adapted to the cause; but if no acute or dangerous malady is under way, in a mild case it can be checked by patient taking a deep inspiration, and then holding the breath as long as possible, so as to keep diaphragm con- tracted ; the wearing of a belt around epigastrium. In other cases it can be checked by snuffs, a good sneeze. In more severe forms try one of the following remedies by the smell, as inhalation of a few drops of chloroform, ether, nitrate of amyl; by the mouth, ammonia, musk, camphor, menthol, Indian hemp, aconite, belladonna, nux vomica, chloroform. bromohydric acid, hydrocyanic acid; local, dry cups, aconite, belladonna and chloroform; liniment to nape of neck and over diaphragm. If due to dyspepsia, emetics, bitter tonics, cinchona and ammonia. If hysterical, sambul, valerianate of zinc. If intermittent, iodine and quinine. If infantile, a few drops of oil of aniseed, wintergreen, warm bath ; see to the milk. _______ In the United States, with its heteroge- Home-Sickness. neous population of different races of men, all possessing more or less an affinity for that spot of earth on which they each respectively originate, we find this malady very common and in a most aggravated form. Among the Caucasian race the Anglo-Saxon is the most easy to climatize, whereas, the Celt, with all his vivacity and dash, is the most difficult. In the latter race there is often a perfect want of adaptability, especially if there exists a poverty of nerve force in the individual; in the former the acclimatization faculty is per- fect, truly cosmopolitan. Neurasthenia lies at the root of this disorder, and all its varied symptoms are present. Nostalgia shows itself by a fondness for solitude, and an indul- gence in grief and despondency; together with a loss of appetite, constant pain in the stomach, difficulty of breathing upon the least bodily exertion, paleness of the face and palms of the hands, whiteness of the tongue, with an appearance like stains of ink BACTERICIDES. 459 upon it, whiteness of the lips, drowsiness, inactivity, unwhling- ness to attempt and inability to perform motion, and general debility. The tunica adnata is of a glassy whiteness, the skin of an olive complexion and cold to the touch ; the eyelids, face and extremities show evident signs of an extravasation of water in their cellular membrane; and the unhappy sufferer can only breathe in an erect posture, from water being likewise collected in the chest and cavity of the abdomen. The entire lymphatic sys- tem becomes vitiated and fails to raise the standard of the blood to that of red discs. As a sovereign remedy, none can excel the tonic and stimula- ting effects of the coca. It is used with the most gratifying suc- cess for the cure of this form of neurasthenia—it facilitates diges- tion, relieves the depression of spirits and all other attendant symptoms. Added to this the glycerite of kephaline acts well in aiding a restoration of vital force and building up nerve tissue. The avena sativa also is very effective. May be defined to be a contagious and in- Hooping-cough, fectious disease, due to the presence of a [Pertussis) micrococcus in the blood—a disease of great frequency in childhood, and to which a large proportion of infant mortality is due. Indeed no disease germ, except the comma-bacillus of cholera infantum, kills more children under two years of age than this. It exists in all parts of the world, and has been recognized from the most remote times. The cause is the presence of a micro- coccus in the blood, its field of nutrition seems to be in and around the cervical portion of the spinal cord, in which ~"?r«£*> ^ locality it finds a proper pabulum for Micrococci of hooping-cough. growth and reproduction; although the germ is constantly present in the blood, it is also found in the breath, expectoration, saliva*, urine and faeces, and it can be detected within a radius of fifty feet on the furniture, walls, carpets, etc. The germ consists of elliptical cocci or their mycelia, and looks like the annexed cut, with figure 8 interspersed. 460 DISEASE GERMS. Like all other living poisons in the blood, it has a period of incubation, sprouting, fecundation, growth, activity, and death, depending greatly on the vigor of vital force of the patient. The pathological effects produced by the micro-organism are embolism, and as it is a free excretor of ptomaines, toxaemia of the brain—convulsions. Its duration under the old treatment, from six to eight weeks. Symptoms.—The earliest is a common cold or catarrh, accom- panied by a cough; there is also a slight amount of fever, rest- lessness, and sometimes running at the eyes and nose. The cough in a few days becomes more troublesome, and some glairy fluid may be brought up from the chest; in a week or ten days, but oftener later, the child will begin to have the characteristic hoop ; the cough comes on in paroxysms, and is more frequent by night than by day; each paroxysm begins with a deep and loud inspiration, followed by a succession of short and sharp ex- pirations, again followed by a deep inspiration, and the repeated expiration ; this may go on several times, and last one or two minutes, according to the severity of the case. Just before each attack comes on, the child clings to its nurse or mother ; it sits in an erect position ; during the paroxysm the face is flushed, the veins in the head and face prominent, the eyes suffused and watery, and generally there is some glairy fluid expelled from the mouth, or vomiting may come on. After the paroxysm the child will rest for a time and appear pretty well until the next attack comes on. In bad cases there may be twenty and thirty paroxysms a day, and several fits of coughing besides, without the hoop being heard. In ordinary cases there are from four to ten spasmodic attacks in the twenty-four hours. These symp- toms last for three or four weeks, and then the cough abates in severity and frequency, and finally ceases altogether; even when there is no hooping, the child may continue to have a trouble- some cough for some time. In most cases there is some bron- chitis attending this complaint, and this is shown by the hurried breathing, rise of temperature, and by hearing rattling noises over the chest. The more mischief there is in the lungs, the greater is the danger to the child. Convulsions are a sign of ptomaines being liberated, and this is generally the way in which such cases die. Hooping-cough cannot be made out until the characteristic hoop appears, with microbe in breath, and then there can be no difficulty in recognizing the disease. Complications, as measles, small-pox, bronchitis, pneumonia, disordered bowels, as cholera infantum, tubercular meningitis, always render it fatal; cough, accompanied with hemorrhage from nose, mouth, ears, effusion into the conjunctiva are bad BACTERICIDES. 461 complications. It may prove fatal from exhaustion, marasmus, convulsions from embolism, or thrombosis in heart or large arteries. Renal complications are extremely common, if the physician fails to recognize its germicidal origin ; stasis of blood in the kidney, albuminuria, suppression of urine. When disease is permitted to run its course, emphysema, dilatation of ventricles of heart and glucosuria are common. In the treatment, child should be kept as quiet as possible; if the weather is fine, it can be taken out, but if stormy, it must be kept within its room, which should be of an even temperature and protected from draughts. Warm clothing should be worn, nourishing diet given, and well bathed morning and night in an antiseptic bath; all complications; as diarrhea, carefully guarded. In all cases, the reflex impressibility of the medulla oblongata and spinal cord must be diminished by the administration of some one of the following remedies : comp. syr. lobelia, musk root; bromides of potass and ammonia; tinctures of calabar bean; black cohosh; belladonna, etc. Such a formula as the following: comp. syr. lobelia, six ounces; fluid ext. sambul, one ounce; tinctures of belladonna, calabar bean, each one drachm; bromide of potass, half an ounce; bromide of ammonia, two drachms. Mix. Dose, from a few drops to half a teaspoonful or more every three or four hours. The action of this can be aided by applying local stimulants to the back of the neck, as concentrated ozone and chloroform ; or thymol dissolved in chlo- roform ; or an ointment of eucalyptol and iodol. Children, as a rule, do not bear inhalations well, but if they can be used, in an atomizer or otherwise, the best are distillations of jequirity, pine, eucalyptus, creolin, naphthaline, glucozone. The little patient should be taken off some distance, a mile or two, twice a week, and while absent the apartment in which it is domiciled should for one hour be fumigated with burning sul- phur, doors, windows, and every crevice carefully closed; this has a salutary effect in destroying every germ in the apartment, on the walls, floor, playthings, etc., so that when the patient returns it will breathe a sterilized atmosphere. This sulphur fumigation is most beneficial, exercises a marked effect on the future evolution of the germ. Having attended to those preliminaries, then the correct treat- ment of the case should begin. The patient, as far as possible, should be surrounded with an antiseptic atmosphere; tincture of iodine, or distillation of the pine or solution of carbolic acid, etc., should be exposed in the apartment in saucers, so that they mix freely with air breathed,. and thus paralyze the activity of the micrococcus. 462 DISEASE GERMS. Internally, the true curative treatment consists in administering persistently some efficient germicide that will cither completely sterilize or annihilate the germ. For this purpose, one of the fol- lowing formulae may be selected : Syrup of tolu, four ounces; resorcin, half an ounce. Mix. One teaspoonful every three hours while child is awake.. Liquor ammonia acetatis, six ounces; salicylate soda, four drachms. Mix. Dose, as above. Hydro- gen peroxide (ten volumes strength), six drachms; glycerine, four drachms ; distilled water, three ounces. Dose. One table- spoonful thrice daily. Syrup of benzoin, four ounces; drosera rotundifolia tincture, two drachms ; tincture belladonna, thirty drops. Mix. Dose. One teaspoonful every three hours. Other germicides often used. Salicylic acid, pyridin, exalgine, chloral hydrate, benzoic acid, boroglyceride, bromohydric acid, etc. All complications should be carefully guarded and treated on general principles, holding on to germicides as the agents to destroy the factor of the disease. Warm clothing, moderate exercise ; some mild, efficient tonic should be given. are watery vesicles in whose fluid are found the Hydatids larval elements of the tape-worm. These hydatid sacs may occur in any part of the body of man and animals. They are generally enclosed in an external sac, which is attached to the tissue of the organ in which it is situated; they rapidly grow, young broods sprout- ing forth, with distinct envelopes peculiar to each. The fluid in the interior of the hydatid contains millions of larvae, and is almost colorless and limpid, but the fluid in the common cyst in which the hydatids float is often of a yellow color. Two species of echinococcus are usually noted, that which is peculiar to man, met showing the growth and bud- with in the brain, eye, liver, intestines, ding of hydatids. kidneys, and that which is common in animals, but it is by no means certain that they are distinct. Whenever any of the hydatids are swallowed by man or ani- mals they proceed under favorable circumstances to be developed to a higher stage of existence, the tapeworm. These echinococci do not become developed into tapeworms unless they reach the intestinal canal of some animal by being taken in as food or drink. In ordinary cases of hydatids, consisting of echinococci, the cysts and their contents undergo a species of degeneration, be- BACTERICIDES. 4^3 coming changed or altered in some cases into fatty or calcareous matter, while in other cases the contents become granular. The peculiar hooklets which occur in them, and which remain unal- tered for a long time, reveal their true origin. The common globular hydatid or acephalocyst, which sometimes attains quite a large size, is merely a degenerated or abnormally developed echinococcus. Hydatids sometimes oc- casion so little inconvenience that persons in whom they are discovered after death have not even suspected any disease in the organ in which they were found. On other occasions they grow rapidly and cause so much irritation that suppuration occurs in and around the common sac. In such a condition it is very liable to either burst externally or into a mucous canal or serous cavity. When discharged into any of the natural outlets, all is well; recovery may take place, but if it ruptures into a cavity, a shut sac, like the chest, abdomen or brain, fatal inflammation will follow. False hydatids are simple serous cysts, either occurring alone, or in clusters, com- mon in the choroid plexus of the brain; constituting the fluid of ovarian dropsy. These false hydatids are comparatively common in the uterus, where they cause great enlargement of that organ, simulat- ing pregnancy. Most remarkable cases of epilepsy, chorea, might be cited as due to the presence of those larva formations in brain and cord. Even the eye becomes affected by bathing it in water from a pond in which animals have drunk. Hydatids. 1, Coenurus eerebralis, natural size ; 2, one head magnified ; a, oval circlet of hooks ; b, suckers; 3, Cysticercus tenuicollis, natural size; 4, head magnified; a, circlet of hooks; b, suckers. A bright elastic tumor of a translucent appearance on neck of the womb; wheu punctured, its serum yields myriads of echinocerons. 464 DISEASE GERMS. Hydatids of the Brain.—Parasite cysts of the brain are very commonly found in sections of the country in which the inhabi- tants live chiefly upon pork. Chiefly two parasites, the taenia echinococcus and the taenia solium, are found in the human brain in the cyst condition, and it is of some importance to distinguish between them more defi- nitely than has hitherto been done. Where dogs are admitted freely to human dwellings and have access to sources of drink- ing water, the echinococcus will be the more common, as, for instance, in Iceland. In our Western States, the cysticercus cellulosae is the more common parasite, and it has been shown that it has a special tendency to affect the brain in man. Out of eighty-seven patients in Cincinnati, Ohio, who were affected with this parasite, it was found that in no less than seventy-two the cyst was situated in the brain. Two cases have been reported where the cysticercus acanthotrias and the ccenurus respectively were discovered in the brain, but these were isolated instances. It is not surprising, seeing that the male sex is more liable than the female to cerebral tumor, to find that a much larger proportion of men than of women are attacked by hydatids of the brain. The proportion is greater than that of their general tendency to hydatid disease. The echinococcus forms in the brain a much larger tumor than does the cysticercus cellulosae. A case has been recorded which weighed eighteen and CysticercuTlsTee^in the eye. one-half ounces, and contained eighteen ounces of clear fluid. In regard to the anatomy of these cysts, it is curious that in a large number of the cases collected, the tumors consisted of the parasite pure and simple. In other organs, as, for instance, the liver, the echino- coccus cyst has around it a fibrous capsule, derived from the tissues among which it lies. In most cases the brain cysts appear to be devoid of this coating. A consideration of the seat of the parasite brings forth some facts which may become of some practical importance. In more than half of all cases, the cyst was in one or other hemisphere of the brain, and more com- monly in the right than in the left side. Again, in only four out of the ninety-seven cases collected was the cyst situated in the cerebellum, or " the ratio of cerebral to cerebellar echino- cocci was about fourteen to one." One naturally turns to the symptomatology, hoping for further practical guides, but the signs have been so various in different BACTERICIDES. 465 cases as to give no very definite clue. Headache, blindness, and convulsions seem to be the symptoms which is most common to such cases. Hydatids of the Liver.—The essential cause of the development of hydatids is the entrance into the stomach or intestines of the taenia echinococcus. If they remain in the intestines they be- come tape worms; when they pass into the liver they develop hydatids. They are chiefly met with between the ages of thirty and fifty, rare in children and the aged. They are most com- monly met with among the poor, the filthy, and those that are surrounded by insanitary states. The percentage of people affected is quite large. Dogs, sheep, pigs, cats, rats, are victims to tape worms, and as the ova of those parasites are discharged in the excrements of those animals, they can only gain access to the human stomach through polluted drinking water, or un- cooked food. The method of growth is as. follows: an ovum of taenia echi- nococcus, either during mastication, or from the action of the digestive juices, has the envelope containing the echinococcus removed, and then by its hooklets it bores its way from the stomach or intestine into the liver. It there becomes encysted ; the cyst consists of an external laminated cuticular layer, and an internal parenchymatous lining. From the internal layer numer- ous little heads bud forth in the form of vesicles, and these in turn bud out into others, and so on, the mother-sac keeping en- larging to accommodate the young broods. Successive genera- tions or broods of embryonic taenia, immature scolices, form upon the internal surface of the mother-sac, while the young crop cling to the mother, pushing the older ones forward into the fluid of the sac, which keeps on enlarging. Proliferation is excited by pressure of the surrounding tissue, which developes into a cyst. During the process of enlargement, a hydatid tumor loses its spherical shape, and becomes indented, the fibrous capsule be- comes thickened, rough, cartilaginous, and in some cases ossifi- cation takes place. There are various contingencies that may arise that may de- stroy the echinococci, such as, bile may enter the cyst and destroy its living breeding contents; inflammation from numer- ous causes may arise, that may cause the disappearance of the mass. They may suffer fatty degeneration, or they may die from over-growth and other forms of degeneration. They are liable to rupture in every direction, and cause grave organic changes, even death, consequently they are dangerous in proportion to their size and the direction of their growth. The symptoms of hydatid tumor in the liver are those which 30 466 DISEASE GERMS. belong to liver disease. There is the presence of a tumor in the region of the liver, weight, dragging, difficulty of breathing, cough, bronchial catarrh; pain in the right shoulder; brown- coated tongue ; constipation ; jaundice ; ascites ; hemorrhoids. Prophylactic measures consist in preventing the drinking of water contaminated by the evacuations of animals, and in not permitting dogs to feed upon the offal of sheep; chloride of sodium, resorcin, naphthaline, iodide of potass; .■jjJA v * aspiration if the tumor is superficial. ^^vVBtT^* Hydatids are found in every organ of the * ^V^^jSllil* body, and are to be seen in vrrious micro- ^C^T^l^H^ scopical conditions. &^JVo%*«*%^' Hydatids of the Kidney.—Every disease *&L&£^4 germ, and nearly every parasite incidental to "^ * the human body is to be found occasionally Hydatids of the lung; m j-J^ kidneys. the appearance el the J . elements found in the As a rule, when the kidney becomes the seat of hydatids it becomes enormously dis- tended or enlarged. A tumor is usually the first noticeable sign, and an examination of the urine may reveal echinococci hooklets. If the case can be made out Nearly, aspiration should be practiced, and iodine injected into the cyst. Dropsy of the scrotum may be a result of Hydrocele, inflammation, or disease, as enlargement of testis injuries, or dependent on general dropsy. Symptoms.—The scrotum becomes gradually distended with serum, which forms a smooth, pear-shaped, elastic and translucent swelling. The spermatic cord can usually be detected free at its neck, and the testicles can be detected lower down. There is no impulse on coughing. To take patient into a dark room and hold the scrotum between you and a lighted candle is an absurd proceeding ; for the serum in the scrotum is often grumous, turbid, and it may not be transparent, although in a good number of cases it is of a pale straw-color. In quantity, it averages about twelve ounces, less or more. If it is allowed to become chronic it may lose its pear shape, become thick, and almost invariably opaque. In some cases, instead of the water being in one mass or volume in the scrotum, it is found in cysts, resembling a honey- comb ; it is then called encysted. Little boys may be born with this accumulation, and the communication between the peritoneal cavity and scrotum may not have been obliterated; it is called congeyiital. BACTERICIDES. 467 Treatment.—In the early stages or in acute form, such as in scarlet fever or from testitis, try treatment for dropsy—diapho- retics, diuretics, hydragogue cathartics, preceded with digitalis, then iodide potass, and back on those remedies (See Dropsy), using the lotion of muriate of ammonia over scrotum. If medi- cinal means fail, then tap the scrotum about three-fourths of an inch from the median line at the base, boring gently in with tro- car and canula until the serum appears between the fingers; then withdraw the trocar, leaving the canula in, through which the fluid oozes out. After it has been entirely drained away, insert the trocar again, and push it through the walls of the scrotum high up. After perforating, withdraw the trocar, and insert up through the canula a strand of seven threads of saddler's silk, and holding the upper end, withdraw the canula, and then tie the ends of the strand together ; undo this knot every morning, and remove one thread every successive day till they are all withdrawn. By this method the secreting faculty of tunica vaginalis will be destroyed, and a perfect cure is the result. There is no deceiving the patient with this manner of dealing with the case, as the result is always most satisfactory. Some tap without using the seton ; others tap, withdraw the fluid and inject tincture o iodine; while another class aspirate; all such measures are un- certain and inappropriate. In the encysted form each sac must be punctured, one by one, and their contents drained off, and then the seton. In the con- genital form a truss must be worn, so as to irritate a little, and thus close up the vaginal process. Usually the muriate of am- monia lotion to scrotum is sufficient. Tapping the scrotum for hydro- cele. Dropsy of the brain may be congenital, Hydrocephalus, and associated with cerebral malformation. When it does not originate in that way it is a result of tubercular meningitis. It is rarely met with after two years of age. In dropsy or effusion of serum from the membranes of the brain, the head often attains a large size; the unossified sutures yield readily to the pressure of the fluid. It may be equal all round, or one side may be larger than the other ; bones thin and trans- parent; meninges thickened. Serum, in quantity, varies from a few ounces to as many pints ; if in large amounts, the lateral ven- tricles are expanded in one large cavity. 468 DISEASE GERMS. The predisposing cause is tubercle bacilli irritating the mem- branes of the brain, causing the effusion. The exciting causes are falls, blows, cradle rocking, or reflected irritation, as teething, worms, cholera infantum, etc. Symptoms.—General symptoms of tubercular meningitis to a greater or less degree, followed by extreme wasting of the body. Although the child may eat ravenously there is no nutrition. The appearance is remarkable ; skin very white, body emaciated, face small, with a large globular cranium and overhanging fore- head ; head drops helplessly on one side. Th.'re may still exist a little inflammation ; if so, there will be headache, irritability, rest- lessness sleeplessness, and a susceptibility to noise, light, motion. Intelligence very feeble; great prostration and muscular weakness; rolling movement of head, eyeballs, perhaps squinting and blind- ness ; great liability to epileptic convulsions; nausea, constipa- tion, with dark-colored, offensive stools; grinding of teeth,screams on awaking. As the case progresses there is more pallor of the surface, a great deal of stupor, very slow pulse, dilatation or contraction of pupils, picking of nose and lips. In favorable cases the headache and irritability subside ; the skin assumes a better color, there is more energy, appetite becomes more natural and the body nourishes. If there is great prostration, rapid pulse, paralysis, coma or convulsions, it is very apt to end in death. Treatment.—Infants of a tubercular diathesis, with a tendency to any irritation of the brain, should be well cared for, and their constitution strengthened by every possible means. Nourishing food, abundance of good milk, beef juice, country air ; seaside in summer; daily bathing, followed by inunction of iodized oil; and when they become older, great precaution should be used, espe- cially against any mental strain or irritation. To get rid of the effusion, its cause must be removed, that is, all irritation. Then the principles of treatment are the same as effusion of serum or dropsy. Small doses of infusion of digitalis, with infusion of parsley or asparagus, with nitrate potassa. Bowels to be opened freely with leptandra and compound licor- ice powder, given as often as necessary to keep the bowels free. Other diuretics, if it is possible, should be crowded in, as hair- cap moss, squills, etc. In the hospital for the treatment cf children's diseases, lactose or sugar of milk is recognized as a standard and reliable diu- retic, and so administered with great success in hydrocephalus. Whatever remedies are administered to get rid of the effusion, they should invariably be alternated with two grains of the iodide potass in simple syrup thrice daily. Warm alkaline baths invariably do good. BACTERICIDES. 469 A peculiar tubercular form of disease of Hydrocephaloid the brain in children, under two years of Disease. age who suffer from insanitary states, over- crowding in cities, with meagre or insuffi- cient or deleterious food. Often the result of reflex irritation, as teething, worms, summer diarrhea. It has a close resemblance to tuber- cular meningitis, although pathologi- cally different; the surface of the fontan- elles are depressed, instead of being raised as in hydrocephalus. There is great prostration, heavi- ness of head, drowsiness, languor, chop-spinach stools; wakes from sleep in alarm, screams, dread of strangers, freaks of temper, irregular breathing, no fever, skin white and cool. The main point in treatment is to make an effort to destrov the tubercular bacilli by the administration of the Protrsionrfahyd«,ceX'oidbr»in. glycerite of ozone, kephaline and avena internally; locally, into the scalp an ointment of sozoiodol should be rubbed daily. An effusion of serum into the cavity of the Hydrothorax. chest may be either the effect of pleurisy or organic disease of the heart; in pleurisy, a result of the expectorant treatment; in organic disease, obstruc- tion and exosmosis of the serum of the blood takes place. The presence of serum in the cavity of the chest is usually easily recognized, by the history of the case: the great difficulty of breathing when the patient lies down, in which position if the lungs are clear, there will be resonance from top to bottom, as they float on the top of the water; then set the patient up, on percussion, dulness will extend up as far as the water level. .If the patient is of a spare habit, a splashing sound will be detected by shaking the patient in the sitting posture. This form of dropsy admits of removal without operation in the large percentage of cases when due to pleurisy. The microbe of rabies is communicated to Hydrophobia, man by the inoculation ,of the saliva of a {Rabies.) rabid animal. Period of latency or dormancy of the germ varies with the grade of vital force. With strong vital force it may remain quiescent indefi- 470 DISEASE GERMS. nitely, whereas, in a weak and impaired constitution the germ may take on vigorous growth and use up vital force in a few days. In the dog there can be little doubt that the degradation of living matter which gives us the germ rabies, may be due to filth, want of natural grasses and water, over-exhaustion, heat, and probably from other animals. The fact that a dog only per- spires by its. mouth may have something to do with it, in render- ing it more obnoxious to its development. Licking the hand, bites, scratches are the ordinary forms of inoculation. As a latent germ or slightly active one in the human blood, it gives rise to a number of obscure nervous affections, as epilepsy, asthma, neuralgia, hysteria, special conditions of irritation of the brain, chiefly around the pons, spinal cord and great sympathetic. If the germ becomes active, or, in other words, if hydrophobia is about to appear, there is great nervousness and irritability, a mental condition of profound despair, haggard appearance of countenance. If from an old bite or inoculation, the cicatrix be- comes painful, sharp lancing pains radiate along the course of the nerves up the limb, and in a freshly bitten part the same sen- sations. Slight spasms come on, very light at first, and long intervals between, but they gradually become more violent, increase in length, and the interval between grows less and less with each occurrence. During these attacks the features become livid or purple, eyes protrude from their sockets; thick, viscid, ropy saliva is secreted, which keeps him constantly hawking and spitting; spasmodic action of the muscles of the throat and pharynx and diaphragm, and latterly, of the entire body. Dur- ing these paroxysms the patient is wild and delirious. In the interval between, nervous impressibility is intense; thus, dread of movement so great that even the moving of a curtain or door, the undulation of water in a glass, will excite a spasm. Still, there is a real dread of fluids. They are more difficult to swal- low than solids, as they bring all the rings of the oesophagus into active exercise. Great delirium, violent spasm, exhaustion, , death. It is a disease that is easily recognized by the great mental irritability, by a total absence of fever, by the character of the spasm, very light at first with long intervals, by the fits gradu- ally becoming longer and more violent, with less time between; the face, during paroxysm, livid or purple, eyes protruding, hawking and spitting thick, viscid saliva; while paroxysm is off, conscious. The Microbe of Rabies, " canine," consists of small globular cocci, single or united into characteristic colonies. They are not BACTERICIDES. 471 met with in the blood, but are found literally swarming in the cerebral secretion, in and around the medulla oblongata and spinal cord. One hundred and twenty drops of brain juice from about the medulla yields three-fourths of a grain of a distinct crystallizable (ptomaine) alkaloid, one thirty-second of a grain of which injected into a mule, gives rise to all the symptoms of hydrophobia, and in a short time collapse, convulsions and death. The exceptional virulence of this microbe is due to its vital and reproductive energy, to the rapidity with which it multiplies, and the excessive amount of ptomaines excreted by the germ directly in the nerve centres. The microbe is pathogenic of the disease, bears culture well in a neutral menstruum. Inoculations of the cultures, or better still the ptomaines, give rise to the disease. From these cultivations new ones can be made, and carried on through successive generations, all cultures, behaving in the same manner, showing exactly the same changes as in the parent culture. The most minute droplet of any of those cultivations produces the disease in animals. Treatment.—After a bite ligate above the wound, then resort to free incision into it or apply wet cups over it; encourage free bleeding with fomentations of hot water ; then either cauterize the wound freely with caustic potash or wood ashes, or if none of these are handy, chop a number of red onions very fine, and crush or beat into them pulverized muriate of ammonia, and apply for several hours; if a large wound, fresh application every hour, then poultice with lobelia and slippery elm. At once the patient should be placed on small doses of lobelia, and if indica- tions of a spasm, larger doses, just enough to nauseate well, not to vomit. Keep on with it several days. Lobelia has a retro- grading action on the germ rabies; it will not cure, but prevents its activity and development. The living germ will only die under a condition of quasi-suspension of the nervous system. This is to be obtained if commenced early, when the patient can swallow freely, by very large doses of fluid extract of sambul, a strong infusion of skull-cap and sesquicarbonate of ammonia. Administer often; repeat one after the other in as large doses as the stomach will tolerate, and not let up until a condition resembling general paralysis is induced, with a sleep like coma. If this condition can be brought about the germ will die. The rate of growth of the germ rabies is determined solely by the debility of the affected person, and there is no way left, no time for anything but cutting off the pabulum by partially suspend- ,--, » ■ DISEASE GERMS. 4/ - ing nerve force. The power of growth is great, but if this quasi- suspension is induced, there seems to be no nutrient matter for the germ. It must be performed early. None of the remedies are in any way poisonous, so there is no danger from an over dose; and there must be no stopping until the most profound anesthesia is produced. Never be satisfied with a sensation of pins and needles over the entire body, that feeling must be followed by profound narcotism. Anesthetics, chloral hydrate, opium, bromide of potass, are no good, neither are the general run of acro-narcotics, as aconite, belladonna. More recently practitioners of repute and trustworthiness in Asia have introduced hoang-nan (strychnos gautheriana) as a germicide which will destroy the microbe. The effects and physiological action of this drug are, general indisposition, with extreme fatigue, vertigo, tingling of the hands and feet, with involuntary movement of the jaws, and a partial sus- pension of nerve power. If these symptoms are not present while the drug is being administered, it is a certain sign of the presence of a microbe imbibing the remedy. In such cases, the treatment must be continued, the remedy increased every dose, until the microbe is destroyed, which is known when the above symptoms appear. If the remedy acts too violently, either because the microbe or its ptomaine is absent, or to the administration of too large a dose, it is easily counteracted by administering fluid extract licorice. Energetic, repeated doses, either in the stage of sprouting (incuba- tion) or upon segmentation (violent rabid stage) should be the rule. The passion of rage in any animal, even man, evolves a special living principle, a disease germ ; for the bite of an angry man free from the anesthetic influence of alcohol, is highly danger- ous and often fatal, causing bacterial poisoning, erysipelatous in flammation of cellular tissue, and death. The principle might be carried further. Are not there living principles in all our emotions, desires, affections, passions, which render them contagious? Have we not special epidemics which are catching, religious excitement, suicidal mania, seasons when special crimes seem to be propagated ? Enormous enlargement of the breast is often Hypertrophy met with in both single and married women; of sometimes one gland, in other cases both The Breast, glands slowly increase in size. It is not at- tended by inflammatory symptoms ; no heat. pain, induration; nothing but progressive enlargement, which becomes burdensome and unsightly. The affected glands may BACTERICIDES. 47 J point right out, but more generally they hang, loose, flabby and pendulous, reaching, in some cases, well to the navel or knee. Causes.—Rather obscure; in some cases we can see its con- nection with goitre ; in another class with masturbation ; while in still another,.uterine and ovarian irritation, chiefly from imper- fect sexual intercourse; impaired health, etc. Treatment.—Alteratives and tonics; every possible means to improve the general health and activity of the uterine organs should be resorted to. As a rule, however, all means are very unsatisfactory and unavailing. Amputation of breasts is most invariably followed by tetanus. Enlargement of the heart is much more Hypertrophy common than atrophy. The weight of an of adult male heart is about nine and a half, and The Heart. the female eight and a half ounces, but in en- largement it often weighs several pounds. Hypertrophy may take place in various ways. It may be gen- eral, that is, its walls increased in size or thickness without any change in its cavity,—this is called simple hypertrophy; the walls may be thickened and the cavity enlarged,—called eccentric hypertrophy, or enlargement with dilatation; or the increase of thickness of its walls may be accompanied with diminution of cavity,—concentric hypertrophy. In cases of valvular disease and other forms of obstruction, hypertrophy is of utility in over- coming the impediment to a free flow of blood. Hypertrophy of left ventricle is usually due to aortic valvular disease, or to Bright's disease, in which there is resistance to the passage of the blood through the arteries and capillaries. Hypertrophy with dilatation of right ventricle generally due to disease in the mitral valve, causing obstruction to the pulmonary circulation, or to some chronic disease of the lungs. Causes.—Enlargement of the heart may be predisposed to by the use of tobacco, tea, alcoholic stimulants, great mental strain, worry, disease of brain, blood, etc., although the common excit- ing causes are over-stimulation, excitement, violent muscular exercise, as running, jumping, rowing, hoisting, lifting; excess, use of malt liquors, sexual excitement. Symptoms.—There is usually vertigo, muscae volitantes, tin- nitus aurium, redness of face or plethora; heat, respiration and pulse are up. The sounds of the heart are not only frequent but loud, audible at a distance ; there is a fulness or bulging, often a wearing away of the ribs; instead of the area of dulness on per- cussion being four square inches, it is increased to more than 474 DISEASE GERMS. double; there is also numbness in left hand extending up the arm, caused by a distension or stretching of the recurrent branches of the subclavian nerve over the heart reflected to the brachial plexus, thence to the hand. There may be bleeding at the nose, cough, difficulty of breathing from enlarged heart pressing on lungs; often palpitations; difficulty in walking quickly; uneasiness, and sense of fulness and pain about cardiac region. In the treatment of an enlarged heart, all mental and physical excitement must be rigidly avoided; strictly forbid the use of tobacco, tea, coffee, whiskey, ale, sexual congress. Diet very nutritious but as little animal food as possible, unless there is debility, warm flannel clothing, and abundance of fresh air. The action of the heart must be carefully regulated with tinc- ture of digitalis, alternated with strophanthus. Possibly it may be necessary to keep the patient upon those two drugs for two or three years, slightly lessening the dose all the time. As the case improves, begin with a general massage of all the superficial muscles of the body, morning and night. Then other drugs, as dioxide of hydrogen, comp. oxygen fucus vesiculosis, etc., could be administered with advantage. A visit for a month or more to some mountainous region is of great benefit. There are a variety of forms of enlarged Hypertrophy liver; it may be increased in size and weight of in chronic inflammation, with effusion of The Liver. lymph in fatty or starchy degeneration, and from the presence of tumors, but those are not conditions of true enlargement. Hypertrophy of the liver proper is characterized by an increase in size as well as the number of the secreting cells, causing gen- eral enlargement of the gland. It is usually the result of long- continued congestion, such as takes place in all tropical climates from the irritation of malaria, and whiskey. It may be looked for in the indurated spleen, or leucocythaemia, in or after dysen- tery, and very common in the glucose diathesis, or diabetes. It is often met with in a lobe or portion of the liver. It is then said to be partial. It is brought about by the healthy portion having to do the work of a portion diseased; its cells become enlarged, new ones are developed, and in this way the developed part compensates for that which is diseased. It gives rise to gastric catarrh, etc. Treatment same as for chronic inflam- mation. BACTERICIDES. 475 Muscles may suffer enlargement by exces- Hypertrophy sive use. The muscles on the arm of a black- of smith or prize-fighter are enormously devel- Muscles. oped. In the former it is quite common for the right side to measure four or five inches more than the left. This can only go on to a certain extent__to a degree of growth in which there is an adequate nerve-supply ; when that limit is reached, and exercise still continued or per- sisted in, fatty tissue will begin to take the place of muscular fibre, and the muscle will lose its contractility and become use- less, because it has undergone fatty degeneration. The treatment is rest and alteratives. About two-thirds of the male population Hypertrophy of this country, about the middle period of of life, suffer from some unsuspected urinary The Prostate, trouble, as well as partial or complete im- potency, while the other third, from puberty up, are either victims of self-abuse, a perversion of the sexual act, or a neglected or imperfectly cured gonorrhea, etc. These are the most prolific sources of generative weakness, and in themselves are productive of irritation, inflammation^ effusion of lymph, and enlargement of the prostate. It is doubtful, when once this gland is damaged by masturba- tion, by dalliance in the sexual act; by withdrawal in the act of ejaculation; by the wearing of condums ; or by a gonorrhea, if ever it regains its pristine condition of health; and those and other causes plant the foundation of future trouble. Chronic inflammation, brought about by these and other like causes, invariably terminates in enlargement of the gland, with either tubercular or calcareous induration. The degree of trouble from an enlarged or hypertrophied prostate varies greatly. For example, the lateral lobes may be consider- ably enlarged without causing much inconvenience; whereas, if the middle lobe, which forms the floor of the prostate urethra, is only slightly enlarged, there is difficulty in micturition. The symptoms of hypertrophy of the prostrate, even in the slightest degree, are in all cases well marked, and consist in some difficulty in emptying the bladder, dribbling after micturition; inability to pass water, which frequently proceeds along to a state in which he cannot hold his water at all; the irritability becomes intense, the desire to urinate imperative, and still withal partial retention of an ounce or two of urine ; which speedily undergoes decomposition, and there is evolved in its ammonia- 476 DISEASE GERMS. cal products, the micrococcus urea, which gives rise to cystitis. The micrococcus migrates up the uterus to the kidneys, giving rise to grave anatomical changes in those glands. The sufferer from irritable, then enlarged prostate, is an incessant victim of pain, uneasiness, aching in the hips and thighs, a feeling of weight and heat in the perinaeum, and all around ; pains in the limbs, and extreme irritability; besides he is liable to severe complications, even from the slightest indiscretion in diet, or from cold, or wet, and the residual urine in the bladder loaded with the micrococcus urea, excreting ptomaines gives rise to pain and fever. The spasmodic contractions of the bladder to void its germ-laden contents are irresistible. In the early stages, noc- turnal emissions, two or three in a night are not uncommon, with urine very cloudy, with a copious deposit of muco-purulent matter. A thin, transparent discharge at stool invariably pres- ent, or, if not present, a gluing of the lips. This moisture or discharge, if placed in the field of the microscope, will be found to be prostatic, often mistaken for semen. A rectal examination in all such cases, reveals the prostate, large, hot, indurated, tender to the touch. Enlarged prostate means complete physical and nervous bank- ruptcy, as is seen in the partial or complete impotency, in the wasted testes, in the blighted state of the organs, loose and patulous vesiculae seminalis ; in the gleety discharge, or weeping penis ; in the cold, clammy state of the parts. What does modern therapeutics offer for the alleviation of this affection, and anchoring its unhappy victim to the earth a little while longer? One essential element in the treatment of such cases is, the bladder must be emptied; there must be no residual urine in it to give birth to the micrococcus urea and fungus; it must be evacu- ated daily, and either injected with a germicidal fluid like boro- glyceride, or else a bougie of thallin or resorcin used to kill every microbe in the viscus. An effort must be made to control and wipe out all irritation and inflammation of the prostate, and establish a renewal of life in it For this purpose a selection of some of the following methods or modes of treatment should be tried, with some of the special remedies enumerated. It is unnecessary to state that the appetite should be stimu- lated, the diet should be the best and abundant; daily bathing inculcated; the bowels regulated, so as to have one free motion after the morning meal, and an injection every evening, an hour or two before retiring to bed, this should consist either of witch hazel or infusion of uva ursi, or a like remedy, with occasional hip baths. BACTERICIDES. 477 All cases of enlarged prostate are much benefited by a general alterative and tonic course of treatment. The best alteratives being saxifraga and phytolacca ; and preparations of cinchona our best tonics. Then the attending physician will select some special remedy to meet the peculiar outcroppings of each particu- lar case. If there is great irritability in a chronically inflamed and en- larged prostate, with either continence or incontinence of urine, there should be no delay, but large doses of green root tincture of gelsemium should be administered, with belladonna suppositories. The ozonized uric acid solvent is of inestimable value, it con- tains a large percentage of pichi, a most efficacious drug in breaking up fibrinous and calcareous deposits in this gland ; its power of disintegration on this gland is immense, in effacing all conditions of hypertrophy. Once the gland becomes soft, patulous, the action of ergot and damiana are of signal efficacy in inducing contraction. Unquestionably, the most efficient drug in hypertrophy is the salix nigra, being a tonic, vitalizer, sedative and anesthetic. It entirely supersedes the different preparations of bromine upon the prostate, possessing all the good properties, with none of the bad. The ulterior action of a long continued persistent adminis- tration of the black willow has a most marvellous action in de- creasing the size of an enlarged prostate. The introduction daily or every other day of the salix nigra bougie will effectually get rid of all leakages or emissions. This is an important point gained. Besides the black willow bougie those composed of ergotine, quinine, damiana, papoid, iodol, have an excellent effect, their use rouses up the vital energy of the gland ; they diminish its size ; contract the ejaculatory ducts ; change the whole sphere of morbid action. If the bougies fail, then suppositories of the same ingredients should be used. The cocaine suppository; one prepared from ergotine and cocaine; another composed of the glucosides of the black willow and stone crop. All have an excellent action in contracting the motor cells in the vesiculae seminalis and cord. This method of treatment is good, direct, energetic, often effective, but in all cases it must be aided with a course of medical treatment to increase their efficacy. We attach the greatest importance in all cases to a careful rectal examination, as it determines the status of the case. When we feel the prostate soft, yielding to the touch, it indicates that muscle still prevails, that a complete, restoration of function is possible under good treatment, aided by the stimulating ab- sorbent action of electricity; again, when we feel a hard, modu- .-,g DISEASE GERMS. lated prostate, and there is evidence to the touch, that fibrous tissue preponderates largely over the muscular ; the power of the bladder seldom returns, unless electrolysis is resorted to. Electrolysis of late years has been brought to bear upon such cases with wonderful success. The medical electricians of the United States are scientific men of rare culture, arduous study and extensive experience. The plan they adopt in electrolysis of the prostate is, they place the positive electrode in the form of a plate over the region of the bladder, and the index finger guides into the disinfected rectum the negative pole in the form an insu- lated needle, with its point clear for half an inch. This, by a gently rotary motion, is inserted into the prostate. The two electrodes are switched on and the current gradually increased to ten or twelve cells, for five minutes. The needle is then withdrawn and reinserted the same way in another direction. This is repeated three times. Taking in all fifteen-minute sitting. The results in the hands of the following eminent savans have been pre-eminently satisfactory. No dan- ger, no unfavorable symptom, and no doubts can be entertained of its wonderful efficacy.* Every means failing, either to ameliorate or cure, and life being in imminent danger, suprapubic and perineal prostatectomy have been resorted to with great success. There is no gland in the entire body, more frequently the seat of irritation; the tubercu- lar, the syphilitic, the gouty, the lymphatic, the sensualist, the sedentary, the bicycler as well as the rider on horseback are its victims. No matter what the irritation be, it invariably gives rise to fibrous excoriation, calcareous deposits, ulcerations, fistulous openings, ante- rior and posterior, vesical thickening, catarrh, and necessitates special illustration. This cut shows the external appearance of the middle lobe when the vesiculae semi- nales and the vasa deferentia under which it is situated have been removed. Although it is connected firmly on each side with the lateral lobes, it is distinct from them at the posterior part, and evidently a separate lobe of a rounded form. *We would enumerate the names of medical electricians who have met with brill- iant success in electrolysis of the prostate and subsequently effecting a radical cure; C S. Hastings, M. D., Los Angeles, Cal.; R. H. Randolph, M. D., Portland, Ore- gon ; I. C. Hewes, M. D., Omaha, Nebraska; J. J. Jones, M. D., Philadelphia, Pa.; S. M. Piatt, M. D., Waterbury, Conn.; Frank L. Tuttle, M. D., Springfield, Mass.; E. J Skelton, M. D., Bloomfield, Iowa. BACTERICIDES. 479 This in a natural fl®?^ The prostate gland varies more in its size in different men, than many other parts of the human body; and this middle lobe is liable to do so in a still greater degree than the body of the gland, being frequently smaller than it is here re- presented, and sometimes of a larger size. This illustration represents the middle lobe of the prostate gland in an incipient state of its enlargement, putting on a nipple- like appearance, and pushing the internal membrane of the bladder before it, which everywhere adheres to the projecting parts, and forms a covering to it. In this view the fundus of the urinary bladder is removed, so as to expose the orifice of the bladder. state resembles the narrow part of a funnel, but here the pro- jecting middle lobe is so situated that whenever the bladder contracts to expel its contents, the middle lobe is pressed for- wards directly upon the orifice; and although it could not completely shut it up, must form an obstruction to the pas- sage of the urine. This diagram is taken from the same parts, but the enlarged lobe is seen in relation both to the bladder and the ure- thra. The membrane covering it is put so much on the stretch, as to drag down the orifices of the ureters towards the tumor, so that the intermediate space forms a double projecting ridge, instead of a concave surface. In the opposite direction the loose membrane of the ure- thra, as far as the verumontanum, is so much elevated as to form a bridle of some breadth and considerable strength, by which the enlarged lobe and the verumontanum are drawn nearly close to each other, and the hollow between them is rendered much deeper than it is in its natural state; this hollow is considerably increased by the lateral lobes having also become enlarged. In this state of the parts, there is some difficulty in passing a catheter into the bladder, unless it is a large metallic one. The best instrument is a silver No. 12, which should be well warmed and oiled, introduced with the greatest care and gentleness; as it is being inserted it should press against the superior aspect of the urethra; it will thus readily slide into the bladder. With such a sized instrument there is no danger in making a false passage or doing any damage to the parts. It should be inserted at least thrice daily and retained a short time. 4S0 DISEASE GERMS. In this representation the bladder had been for many years disturbed by the passage of the urin.e being obstructed in conse- quence of strictures in the urethra; so that before the enlargement of the middle lobe took place, the muscular coats of the bladder had acquired great strength, and an un- common degree of thickness; the internal membrane had been formed into sacculi, and was so much thick- ened, that its fibres were unusually distinct. The opening of the ureters had become so patulous, as to admit of regurgitation of the urine. Under these circumstances many of the pathological effects had taken place. The stretched state of the mem- brane of the bladder over the middle lobe is remarkably distinct. In this illustration the middle lobe of the prostate is more prominent than the last. The internal membrane of the bladder has a sacculated ap- pearance ; at the fundus there is a sac formed by the internal membrane, protruding between the fasciculi of muscular fibres. There is a cavity be- hind the ridge formed by the enlarged lobe, and the transverse fold of the mem brane; and another on the opposite side between it and the verumontanum. It is evident, that, when the disease has arrived at this stage, the bladder can never empty itself completely, since, before any urine can pass out, the cavity behind the ridge must be full; and the pressure of the liquid which it contains must force the tumor forwards, so as to shut the orifice of the urethra; but when a larger quantity of urine is collected in the bladder, the internal membrane being put upon the stretch, and the tumor pulled backwards from the orifice of the urethra, a certain portion is al- lowed to flow. The same ridge, which prevents the bladder from emptying itself, forms an obstacle to the point of the catheter when an attempt is made to pass it into the bladder to draw off the urine. In the middle line where the lobe itself is BACTERICIDES. 481 situated, there must be great art in directing the end of the in- strument over it; but laterally, where there is only a folded membrane which can be pressed before the instrument, and which does not rise so high, the catheter may be more easily di- rected into the bladder. The bridle extending from the veru- montanum to the lobe being only a narrow band, the end of the catheter cannot rest upon it, but descends into the space on one side of it, and is conducted into the bottom of the cavity before the lobe, where it is very probably entangled, so as with diffi- culty to be extricated, unless the catheter is curved at the point. The middle lobe is in this instance still larger than in the last; the lateral fold of the membrane on each side is very distinct, and as the prostate gland itself is increased to a great size, the cavity before the middle lobe is very deep, and the left portion of the gland having swelled more than the right, it has put on a convex form, towards the urethra while the opposite surface is concave, so that the canal of the urethra through that part, instead of being straight, forms a curved line ; wherever this is the case, there is great difficulty in conducting the point of the catheter into the bladder, for when it arrives at the prostate, the handle of the instrument is always turned round, and the point forced downwards and to one side, and goes on in that direction till it is en- tangled in the fold of the membrane close to the root of the projecting por- tion of the middle lobe. To counteract this it is difficult to insert a catheter. In this cut the middle lobe is not very prominent, but it extends laterally, and the transverse fold of the mem- brane of the bladder is unusually thick, so that they form toge'ther a very com- plete valve to the orifice of the urethra; the lateral portions of the gland are not much elongated but are consider- ably swelled, so that the hollow be- tween the middle lobe and the verumontanum is of unusual depth. The resistance to the passage of the urine was so great in this instance that not a drop could be passed, and the efforts 3i 482 DISEASE GERMS. of the muscular coats of the bladder to expel the contents were so great, that they occasioned the inner membrane to protrude just between the openings of the ureters, and a large cavity or reservoir was formed there capable of containing above half a pint of urine, while the cavity of the bladder became preternaturally con- tracted. In this case every attempt to pass an instrument into the bladder was ineffectual. In this representation, the middle lobe has acquired a larger size than the lateral lobes, so that it appeared at first to be a tumor of an irregular form belonging to the body of the gland taking this par- ticular direction ; but after having been examined more accurately, it was found to be an enlargement of the middle lobe only; the transverse folds of the inner membrane of the bladder connected with it were dis- tinct when the parts were examined in a recent state. In this specimen, the increase in the size of the lateral lobes was more in the direction towards the bladder, which produced an effect the reverse of what has been met with in the former representations, since here the distance between the verumontanum and orifice of the bladder is increased, and the canal of the urethra is lengthened. The appearance of the middle lobe in this illustration is quite hypertrophied and extremely difficult to introduce an instrument. In such cases the use of papoid works in a marvellous manner as a digestive solvent. The difficulty has been to get it in con- tact with it. This has recently been overcome by mixing the papoid with butter of coca into a bougie. An instrument made in all respects like Lallemand's porte caustice, size No. 12 catheter into this ; after it is inserted right up against the prostate, this papoid bougie can be continuously pushed up as it melts ; it dissolves the hypertrophied tissue and makes its way into the bladder. Repeated several times it does most excellent work. BACTERICIDES. 483 In this instance the middle lobe itself has not acquired so great a size as in some of the others, but the left lateral lobe is very much enlarged, and, what is unusual, forms a prominent tumor in the bladder, by which the middle lobe is thrown to- wards the right side. From the mode in which the enlargement has taken place, the orifice of the bladder and urethra is enlarged to an uncommon degree, as is also a portion of the urethra itself, so that instead of being a canal, it has at this part the appearance of an oval cavity. This is a very unusual appearance, and is principally produced by the left lobe in its enlargement having extended itself to the same length in the direction of the membranous part of the urethra, as it has done towards the bladder in the opposite direction, and also in an equal degree laterally. This engraving exhibits great enlarge- ment of the prostate in the middle and lateral lobes; the lateral lobe of the left side projecting into the urethra, and into the bladder, the middle iobe being pushed to the right side, and the left considerably more prominent. In this case the retention of urine was complete, and was only relieved by the introduction of a very large-sized catheter and sub- sequently cured by the persistent use of a papoid bougie. This represents lobe of the prostate ulceration. This is In this instance the left lateral lobe forms so large a tumor, projecting into the bladder, that the mid- dle lobe is pushed on one side, and forms a less complete valve over the orifice of the urethra, than it would otherwise have done, which probably is the reason that the patient was less the middle and left gland in a state of of rare occurrence. 4«4 DISEASE GERMS. liable to retention of urine in the earlier periods of the disorder than in some other instances where the acual enlargement was less, and where there was less difficulty in the introduction of the catheter. The enlargement of the left lobe also extends further into the bladder. This cut represents the substance of the lateral lobes of the prostate gland, in which suppuration and ulceration had taken place with little or no increase of their size, and no apparent affection of the middle lobe. This state of the prostate is very common when the microbe of syphilis localizes itself in the prostate, giving it that germ-eaten appearance. In speaking of the operation for the removal of the hypertrophied prostate, we would say : /. That prostatic enlargements which give rise to urinary symp- tom's are intravesical and not rectal. It has been long recognized that the severity of the symptoms in a case of hypertrophy of the prostate bears little or no relation to its apparent size as felt through the rectum, and it is also well known that a considerable number of men, aged fifty-five and upwards, have prostates of an abnormally large size, though of these only a certain proportion, say fifty per cent., suffer from urinary symptoms. This strange difference depends on the position at which the organ is enlarged. Prostates of immense size which project towards the rectum and perinaeum cause no urinary trouble, while severe symptoms may supervene when the prostate on rectal examination is apparently of normal dimensions. There are many varieties of the intravesical growth. We find (i) a pro- jecting middle lobe, pedunculated or sessile, (2) a middle lobe with lateral lobes forming three distinct projections, (3) the lateral lobes alone, (4) a pedunculated growth springing from a lateral lobe, and (5) " a uniform circular projection surrounding the internal orifice of the urethra." This last variety, described by Brodie, has in recent years escaped notice; it is better seen in situ than in museum specimens, and is of not infrequent occurrence. It surrounds the urethra like a collar, and projects for a variable distance into the bladder. II. That retention is caused by a valve-like action of the intra- vesical prostate, the urethral orifice being closed more or less com- pletely by the contraction of the bladder on its contents. When the bladder contracts on its contents the contained fluid BACTERICIDES. 485 is forced on to the projecting prostate, and the urethral orifice is closed. The mechanism is the same, with one exception, what- ever may be the variety of the enlargement. Whether there is a middle lobe or lateral lobes, or a collar, the same valve-action occurs ; and the more violent contraction the more complete is the action of the valve. A patient finding that he is unable to relieve himself soon ceases his violent efforts ; the pressure on the valve is then lessened, the urethral orifice is released, and the urine flows away in a feeble stream. If he attempt to expel it more quickly the outflow again stops, and it is only after several attempts that he is able to obtain an incomplete relief. A time comes when, though the bladder still contains urine, no more can be forced from it. This residual urine varies much in quantity in dif- ferent cases, sometimes amounting to a pint or more. Its pres- ence, and the consequent frequency of micturition, are accounted for by the fact that a more violent contraction of the wall is re- quired to completely than to partially empty the bladder, and that its muscular coat acts to a greater advantage, and consequently with greater force, in its partially contracted than in its distended con- dition. This greater force, pressing on the outside of the valve, more completely closes the urethra, and the urine that remains is unable to escape. An exception to the general rule is found in cases with a small sessile middle lobe, situated partly in the blad- der and partly occluding the prostatic urethra. When this is the case the passage is blocked by the projection, and no valve action occurs. The urine is expelled by a violent contraction, and the ' bladder wall is much hypertrophied, and its cavity contracted. The cuts show instances of this condition. The explanation I have given of the mechanism of the residual urine is not that generally received, but want of time prevents me from discussing the various hypotheses that have been advanced. III. That in many cases self-catheterism is the only treatment required. This prosposition does not require discussion. We have all seen patients who with little discomfort have, by a passage of a catheter, kept themselves in good health, sometimes for years. We would none of us think under these circumstances of advis- ing a patient to submit to a radical operation. IV. That when the catheter treatment fails, or is unavailable, more radical measures are necessary. I am unable to prove the assertion, but my belief is that a large proportion of the cases treated by the catheter sooner or later break down ; in other words, that evenually the prostatic enlarge- ment is the cause of death. The breakdown may come soon, or it may come late, but in many cases it ultimately supervenes. 486 DISEASE GERMS. The urine becomes thick and ammoniacal, the desire to micturate is continuous, the passage of a catheter relieves but for a few minutes, the suffering and discomfort are constant; day and night • life becomes a burden, and death a happy release. The greatest care cannot prevent this result, and the greatest carelessness does not always induce it. I have seen a patient who daily for years passed a gum-elastic catheter, which he carried in his hat, which he never washed ; the urine was acid, and he was in robust health. I have also seen many in the last stage of prostatic cystitis who had previously taken every care. Not only does catheter treatment fail, but it is not infrequently, especially in hospital patients, unfavorable. The patient has suffered from frequency of micturition and general discomfort for some years; he has probably consumed large quantities of herbs to cure a supposed attack of " the gravel," and has not sought surgical assistance till, from some cause or other, complete retention has occurred. The surgeon passes a catheter with difficulty, there is much hemorrhage, the bladder is full of blood, and the patient's life is in jeopardy. If he gets over the acute attack it is found that he cannot learn to catheterize himself. The constant attend- ance of a surgeon is impossible, and the catheter treatment can- not consequently be tried. Even in cases where there is ap- parently no difficulty it is sometimes impossible to teach a patient to pass a catheter for himself. In these various cases, cases of fre'quent occurrence, it is plain that a radical operation is required. It is, indeed, absolutely necessary. V. That this treatment, to be effectual, should {i) for a time thoroughly drain the bladder, and (2) permanently remove the cause of the obstruction. It is now some ten or twelve years since perineal drainage was introduced for the relief of cystitis in patients suffering from prostatic breakdown. The relief obtained in this way has been most marked, and the practice is well recognized and established. As soon as efficient drainage is effected the bladder ceases to be a receptacle, urine sweet from the kidneys flows through it, pu- trefactive changes are prevented, and acute symptoms cease. The relief is, however, only temporary. Either the patient must sub- mit to the discomfort of permanently wearing a urinal, or the artificial fistulae must be allowed to close, with the probable result of a recurrence of the symptoms. It is necessary, if we desire permanent relief, that our measures should be more radical. We have seen that the cause of the mischief in the intravesical pros- tatic outgrowth must consequently be removed. This can only be done by leaving a raw surface in the prostatic region of the bladder, and as mischief would undoubtedly result from stagnant BACTERICIDES. 487 urine accumulating in this position, another and not less import- ant reason for efficient drainage presents itself. VI. That these two indications are best fulfilled by a suprapubic rather than by a urethral or perineal operation. There are three ways in which it is possible to perform a radi- cal operation for the removal of prostatic obstruction—the ure- thral, the perineal, and the suprapubic. Of these the urethral appear to be in every way unsatisfactory. It is founded on faulty anatomy; it is supposed that the cause of the retention of urine is a bar at the neck of the bladder, and that the division of this bar will effect relief. We must next compare the perineal with the suprapubic operation. I prefer the latter, for the following reasons :— 1. It is more generally applicable. 2. It can be performed with greater precision, and completed with greater certainty. It is, I believe, impossible to diagnose the nature of the intravesical growth till the finger is in the blad- der ; we may suspect an enlarged middle lobe, but we cannot be snre that it exists alone. In no way can a bladder be explored with the same completeness as through a suprapubic wound. All projecting portions can be felt with ease, but often are re- moved with difficulty—a difficulty that has made me certain that attempts at removal through the perinaeum must often of neces- sity fail. 3. It ensures complete and most efficient drainage. It may possibly be argued by some that the position of the suprapubic wound will prevent drainage, and that the urine will naturally escape more readily through a dependent perineal wound than through one above the pubes. Experience shows that this is not so. Drainage takes place more easily through the soft ab- dominal than through the hard perineal tissues. This was shown in a case already published. In a patient with fractured pelvis and ruptured urethra, I opened the bladder above the pubes, and also cut into the infiltrated tissues in the peri- naeum. A tube was passed through the bladder from above, and brought out below. On its removal all the urine escaped above, and continued to do so as long as the wound remained unhealed. 4. It is equally safe. While making this assertion it is right to draw attention to the fact that it is merely an opinion, and does not rest on a statistical foundation, there being no statistics available for the purpose. In looking over a few cases we shall find that the mortality of the suprapubic operation has been lower than might reasonably be expected. Of ten patients, 488 DISEASE GERMS. all old men, three were above sixty, while seven were upwards of seventy. It is unnecessary to describe fully the operation of suprapubic prostatectomy, but a few special points about its technique, founded on an experience of thirty-seven suprapubic cystotomies of various kinds, may not be out of place. i. The quantity of water injected into the rectal bag, espe- cially in cases where the prostate is abnormally hard, should be smaller than is usually recommended. Profuse rectal hemor- rhage may occur. 2. The bladder should be irrigated till the antiseptic borogly- ceride solution used is perfectly clear. The quantity left in the bladder varies much from ten to twenty or more ounces. The hand placed on the hypogastrium will show when the distension is sufficient. 3. In cases where the bladder is contracted with thick non- distensible walls it will usually be unadvisable to perform this operation. 4. It is better to leave a catheter in the bladder till its cavity is opened, as it is a guide that expedites the operation. Care must be taken not to hook the peritoneal fold (superior false ligament) into the wound with the point of the instrument. 5. The linea alba is best divided by incising it immediately above the symphysis, and then dividing upwards on a director. 6. Care must be taken to secure the bladder before proceeding to remove the prostate. This is best done by inserting two sutures through each lip of the wound, and fastening it securely to the deeper part of the abdominal wall. When the operation is completed a third suture, passed through the lower angle of the wound, is an additional security against urinary extravasation into the retropubic space. 7. The prostrate should be removed as far as possible by enu- cleation with the finger, and not by cutting. The mucous mem- brane over the projecting portion having been snipped through, the rest of the operation is completed with finger and forceps. In this way excessive hemorrhage is prevented. A pedunculated middle lobe can, however, be removed by cutting through its base. Hemorrhage is best arrested by irrigation with water so hot as to make it unpleasant for the hand. 8. A large tube should be inserted into the bladder, and the wound united above the tube, by a deep and superficial row of sutures. The tube is to be removed in forty-eight hours. 9. The after treatment consists in keeping the parts clean, and washing the bladder and the wound—in exceptional cases—with a boracic solution. BACTERICIDES. 489 Enlargement of the testicle is comparatively Hypertrophy rare, not by any means so frequent as atrophy. of The same causes which cause the testes to The Testes, wither and die, in two cases out of fifty, will cause them to enlarge; they are sexual excesses, masturbation, germs of syphilis, haematocele. Enlargement without effusion of lymph is rare, still it may take place, owing to obstruction of the seminal or ejaculatory ducts. The internal administration of iodide and bromide of potassa in some convenient vehicle will soon arrest this hypertrophy and diminish or reduce the size of the testes to a mere cypher. The bromide is invariably efficient in wilting the testes. Dropsy of the pericardium is invariably a Hydrops result of pericarditis. It is to be recognized Pericardium, by the history of the case; the cardiac ex- pression of the features; difficulty of breath- ing, cough and general debility; also, by the increased area of dulness on percussion; by the sounds of the heart being muffled; negatively, by the skin of the face being pale; no nnmbness in left hand; by respiration, heart and pulse being low; usually oedema of feet and legs. Treatment, same as for Dropsy, with the addition of the steady application of the irritating plaster over region of the heart, and the persistent use of the hair-cap moss in the form of an infusion. The diet here should be very generous, consisting of articles that can be converted into good, rich bood. A morbid state of the blood, caused by the Ichorrhaemia. introduction of the bacillus pyocyanes and other germs of the pus family into the blood. It is called septicaemia, when it "is fatal without any local for- mation of pus; and pyaemia, when secondary abscess follows. If rigid antiseptic precautions are not enforced in all surgical cases, and among puerperal women, ichorrhaemia may appear. It may manifest itself in a great variety of ways. In some cases where the bacillus pyocyanes enters the blood, it will ex- crete ptomaines so freely, in such great abundance, that he or she will die before any local phenomena are exhibited. In another class of cases, the ptomaine excretion is so prodigiously profuse, that both liver, kidneys, spleen, intestinal track, are saturated ; in another class of cases, there is a copious flow of black bile, in 490 DISEASE GERMS. others, an attack of diarrhea or dysentery. In another class of cases, the serous membrane of the pleura, heart, peritoneal coat or even the cellular tissue bear the brunt of the poison, so that pleurisy, pericarditis, peritonitis, erysipelas and boils may be present. Another class of cases exhibit themselves in profuse suppuration of liver, lungs, joints, glands, eyes and ears. General symptoms are, rigors, sweating, rapid pulse, sallow look, sweet hay-like odor of the breath, diarrhea, dysentery, with inflammation of serous membranes, rapid wasting, feebleness, prostration. The absorption of pus containing the living germs of disease is the most productive of septicaemia, as the lochial products, the punctured wounds in dissection, the streptococcus of erysipe- las, bites of enraged men, rabid animals, venomous reptiles and insects, inoculations from scratches or abrasions from the secre- tions of those affected with contagious diseases. These living poisons multiply rapidly, when in the blood ptomaines are freely evolved. They are taken by the veins, the lymphatic system becomes involved, and the entire blood the field of a living deadly poison. In the treatment of such cases, the powers of life should be well sustained, free incisions made into suspected parts, then washed out with dioxide of hydrogen, followed with poultices of yeast, charcoal, wild indigo. These microbes must be destroyed in the blood; hence the treatment, besides being essentially constructive, must consist of the most powerful bactericides, peroxide of hydrogen; lactic acid; salicylate soda and acetate of ammonia; naphthaline; creolin, etc.; such a germicide as will destroy the living microbe in the blood. Often hereditary and congenital. Ichthyosis Xeroderma Frequently the abnormality es- (Fish-Skin Disease.) capes notice at birth, but its recog- nition is almost certain when the child is about a year old. The treatment is at first directed to the removal of the scales, accomplished by warm alkaline baths, with friction, followed with olive oil and resorcin. Then a selection must be made from some of the following bactericides: sulphur ointment; creolin ointment; napthaline ointment, etc. Whichever is selected must be rubbed into the affected part, morning and night, for some months. The internal remedies should consist of alteratives and tonics, as saxifraga, avena, cinchona. BACTERICIDES. 491 Jaundice is always to be regarded as a symp- Icterus. torn of hepatic disease, an evidence of either con- (Jaundice.) gestion, inflammation, irritation from poisons, microbes, degeneration, tumors, gall-stones, or acute or chronic atrophy, yellow fever and mental excitement. All forms of jaundice may therefore be classed under two heads: (i.) Those in which the functions of the liver are suppressed or will not work, and the coloring matter of bile and cholesterin ac- cumulates in the blood. (2.) When the liver works, perhaps well, bile is secreted in abundance, but cannot get away; there is an obstruction to its exit in the duodenum by gall-stones, or by pressure, or something, and the bile is re-absorbed into the blood. This condition cannot last very long without the liver ceasing to work, for the bile, being dammed back on the gland, becomes a poison to its own structure. If due to disease of liver, there will be oppression, pain, over liver; if due to gall- stones, there will be the nausea and paroxysms of severe pains. Symptoms.—Jaundice, then, a symptom of liver disorder, dis- ease or depression, is characterized by yellowness of skin and conjunctiva, nausea, loathing of food, especially fatty substances, tongue coated brown, usually constipation; stools, if any, pale or clay, or white colored; urine very scanty, and of a saffron color, or dark mahogany color, according to the amount of bile pigment present. Drowsiness, giddiness and peevishness, dyspep- sia, bitter or copper taste in mouth, slow pulse, weakness or ex- haustion ; itching in the skin. In very severe cases the aqueous and vitreous humor of the eye is so heavily tinged with bile that the patient sees everything yellow; very drowsy. If it is severe and allowed to last long, there may be stupor, delirium, and great cerebral disturbance; extreme weakness from mal-nutrition; there may be hemorrhage into the skin, profuse bleeding from nose, gums, stomach or bowels. The most successful treatment of jaundice, consists in the ad- ministration of an emetic of the wine of ipecac; followed by opening the bowels with salines; daily baths; diet to consist of soups or broths; raw eggs ; white fish, boiled; oatmeat, with an abundance of ripe or cooked fruit. An external stimulant over the liver; this might consist in the application of concentrated ozone, followed either by hot packs or the irritating plaster. Then a selection of one or two of the following remedies should be made, and administered persistently to the patient: comp. tincture cinchona, four ounces; nitro-muriatic acid, two drachms. Mix. Dose, one teaspoonful every three hours. With phosphate of soda a sufficient dose to move the bowels. The case might be tried either upon sulphur water, or tincture 492 DISEASE GERMS. of lycopodium, with cascara sagrada lozenge, two after every meal, to move the bowels. Some of the vegetable cholagogues, such as leptandra, euonymine, chionanthus, might be tried. If there be any presumptive evidence of syphilis microbe being the cause of the trouble, place patient upon saxifraga. An eruptive skin disease, with hemispherical Impetigo, pustules surrounded by a red areola, contagious, and auto-inoculable, from the presence of a micro- scopical parasite. The treatment embraces the removal of the crusts by repeated poulticing, and as soon as removed, keep the part encased in ger- micides ; one selected from either of the following answers well: resorcin ointment, ointment of iodol, or creolin, or. napthaline, or any other good germicide. In the treatment it is well to appreciate a Incontinence condition of nervous debility as its origin, of Urine. acidity of urine, worms, as exciting causes. Bathing, good food , sleeping between blan- kets, emptying the bladder before retiring, etc. The selection of remedies should be such as will soothe and tone the irritable sphincter muscle of the bladder, such as— Tincture of iron in alternation with belladonna. Rhus aromatica in alternation with fluid extract ergot. • Strychnine is excellent where there is atony of the walls of the bladder and paralysis of the sphincter. Fluid extract of stone crop in alternation with tincture lyco- podium. As regards continence the same remedies are of utility, to- gether with gelsemium, in alternation with creosote. If the case does not yield after removal of causes, and the use of some of the above, then try cantharides. All remedies failing, better to retrace, and of all remedies give belladonna another trial. The peculiar and sedative action of belladonna upon the lum- bar plexus of nerves and sphincter muscle of the bladder renders it of infinite value in all cases of continence or incontinence of urine. The method of administration is of great importance. A sufficient dose should be given every afternoon about four o'clock, and another at bedtime, so as to insure dilatation of the pupil. If the pupils are well dilated with the first dose, the bed- time dose may be omitted. The essential point is that the pupils BACTERICIDES. 493 be well dilated during the sleeping hours, showing that the sys- tem is under its influence. All exciting causes, as ascarides, acid urine, cold sheets, etc., should be removed. While thus holding the pathological condi- tion, stone crop Virginia should be administered in appropriate doses and persevered with for a sufficient length of time, until a cure is effected. Ozonized Virginia stone crop fluid extract has a most remarkable vitalizing, action upon both rectum and bladder, and is decidedly curative in all cases of incontinence of urine. signifies a closure of the rectum. It may Imperforate exist in various degrees. The anal opening may Anus, be closed by a thin skin, which soon becomes distended with meconium, forming a round swelling. In other cases again the bowel might terminate in a blind pouch, at any point from the sig- moid flexure downwards, and the anal aperture be altogether wanting ; in other cases again, the anus may be open for an inch or two, with an obstruction beyond; or the rectum terminate in the bladder or urethra. The defect is congenital, often overlooked in the first cleansing of the child. Treatment.—If the end of the in- testine can be felt protruding when the child cries, make a free crucial incision into it without delay; if it cannot be felt, an incision of the same kind made, and the parts ex- plored, and an effort made to reach the bowel, which,- if reached, is to be pulled down and opened. Nature is is very provident in those cases. Give her an opening, and she rapidly forms around the descending meconium a wall or tube, which becomes a rectum. The opening at the anus should be large enough to admit the finger—always made crucial. It is recommended, if no bowel can be>tapped per anurn, to make an artificial opening, or anus, in the left groin. Anus and rectum deficient. Anus absent; rec- tum ending high up. Anus communicat- ing with vagina. Rectum opening by fistula, close to urethra. 494 DISEASE GERMS. The hymen or guardian of virginity is differ- ently located, in each particular race, affording distinct anatomical relations, to exhibit the non- unity of races. In the Caucasian, it is over the vaginal entrance, in the negro, it is not over, but from two to Imperforate Hymen. Imperforate hymen. The hymen semilunaris, or normal hymen. The hymen cribriformis, sieve-like. The hymen fimbriatus. Upper and lower opening. Opening divided into two parts. three inches up in the canal; in the Mon- golian, from two to five inches up, etc. We have also the hymen fimbriatus, similar to the fringe-like appendages of the ostium abdominale of the tubae fallopianae. This form is the most important in a forensic point of view, as .it may be taken for the normal hymen which has been torn. In some instances there is a variety in which there exists an upper or anterior and lower or posterior opening, with simply a band lying transversely across the vagina. In rare cases we also find a second hymen existing above the first. There are numerous other forms, named according to their fancied resemblance to things in nature, as the horseshoe hymen, bilobate hymen, etc. Hymen circularis, with small central opening. BACTERICIDES. 495 In rare instances the opening of the hymen is found divided into two parts by a perpendicular bridge from the concave border of the hymen to the meatus urinarius, where it be- comes fast. The hymen imperforatus, in which we have a thickened, rough- ened state entirely blocking up the canal. This usually requires surgical procedure, on account of the retention of the menses, and its preventing copulation. Impotence is a morbid condition in either sex Impotency. that prevents the spermatozoa of the male from coming in contact with the female ovule; in other words it is an inability to consummate the sexual act. Sterility is a condition in which neither spermatozoa nor ovules are either secreted or elaborated; or, if evolved, their vitality is immediately destroyed or possesses no fertilizing power whatever —a perfect want of power to fecundate, or it may be defined an inability to copulate or perform the sexual act. I. Impotence in Man.—Sexual impotence implies the existence of malformation, disease or derangement of the genital organs by which there is either an absence of sexual desire, or power of erection, or the capability of ejaculating the seminal fluid into the vagina, or experiencing pleasure during the act of copulation or emission of semen. Impotence relates to the act of intercourse, and differs from sterility, an inability to beget offspring. Impotency may be either due (i) to an absence of sexual de- sire; or (2) to an inability, owing to certain physical conditions to permit of the entrance of the penis into the vagina; or (3) to the absence of the ability to experience the sexual orgasm. Absence of sexual desire may exist in individuals of apparent good health, who may never have experienced the least inclina- tion for sexual congress. There are a very long array of circum- stances or conditions which exert a governing influence in abolishing the natural sexual appetite, which is necessary for the perpetuation of the species and the happiness of the individual. The genital organs of both sexes in all highly civilized nations are very freely covered by branches of the great sympathetic, hence, depressing emotions, perverted desires, violent passions, and blighted affections, have a remarkable lowering effect on genital vigor, besides, add to these worry, care, struggle, sorrow, mental pre-occupation, a state in which the whole heart and soul are either engaged in scientific pursuits, or discoveries, or in study, or in engrossing business, or in exciting speculations. 496 DISEASE GERMS. Harassing toil, lack of rest, certain occupations, cause sexual indifference or cause, Individuals suffering from neurasthenia often are temporarily impotent either through fear, or anxiety, want of confidence or great love or disgust, and often find it impossible to get an erec- tion, the organ remaining flabby like an old rag. Some men in their eagerness to consummate the sexual act, not infrequently fail, ejaculate prematurely the first time; whereas the repetition of the act corrects the trouble, they acquiring more confidence. Sexual desires may be extinguished, the natural sexual appetite depraved, withered, perverted, and the very soul atrophied by the practice of masturbation, which induces genital debility, impo- tence, and throws the finely-knit mechanism of the nervous system into chaos, with loss of power so great that even the greatest fascinations or lewd imaginations fail to excite libidinous desires, or the slightest power of erection, which, sooner or later, gives way to continued masturbatory excesses. Onanism is degenerative; it destroys the exquisite sensibility of the organs and creates an insuperable aversion to women, Mental masturbation is usually caused by reading obscene books, scanning nude pictures of the opposite sex, witnessing sexually suggestive plays, etc., and, in the near future, gives rise to loss of virile power. Sexual desire is often extinguished by perversion of the sexual act, by abnormal methods of sexual congress, as by the practice of withdrawal in the act of ejaculation, the wearing of condums; dalliance in the act, what is vulgarly known as tasting, in a short time destroys every vestige of erectile power. If any of those or other abnormal methods are indulged in, or persisted in, the power of erection will become weaker, more feeble, until, at last, it is forever gone, leaving, as its legacy, diurnal and nocturnal leakages, with imbecility. All abnormal methods cause natural desire to grow less, or be- come obliterated to such an" extent as to render intercourse im- possible. Congress with women with large vaginas, loose, lax, or with those affected with leucorrhcea, where the sphincter muscle has become non-contractile, causes the erectile power of the male to dwindle, grow feeble; whereas, if the act is consummated in a normal manner with a fitting companion, not in excess, it is a tonic and sedative. Sexual excesses give rise to nervous debility and loss of the power of erection. Erections consist in the augmentation of the volume, stiffness, and rigidity of the penis ; due to an increased flow of blood in the organ, active dilatation of the arterioles of BACTERICIDES. 497 the cavernous and spongy bodies. It is a law of the human or- ganism that over-stimulation produces exhaustion; that any function overworked, or excited, before the organs producing it are fully matured, is certain to lead to derangement or even ex- tinction of the function. Any titillating of the genital organs in infancy, or before or after puberty, often leads to complete impo- tence, or at least, to a loss of power or desire. Young people are usually excessive in sexual matters, and, as a result of the great drain and loss of the nervo-vital fluid, become pale, weak, effeminate, exhausted, have roaring in the ears, specks and spots before the eyes, and are genitally weak. Young married people are given to excesses, and, if persisted in, become incapable of generative enjoyment. The earlier in life the ex- cesses are initiated the greater the impotence in after life, for the generative act absorbs all the physical and moral qualities. Impotence may be imaginary, or there may be at the origin of it a tissue-starved brain which gives rise to peculiarities and idio- syncrasies as to the capability of performing the sexual act. To one person who is really incapable of performing the sexual act, there are two who imagine themselves so. It is, nevertheless, too often a genuine disease, appearing as a slight deficiency of capacity, with increased desire ; profound deficiency of both desire and capacity, with penis cold, benumbed, anesthetic, weeping; power of erection feeble, or erectile power may be increased with no discharge of seminal fluid, due to morbid idio- syncrasies, a tissue-starved brain, and the sexual appetite, the most powerful passion of the human mind, obliterated. Usually, in these cases, the great sympathetic is at fault. This nerve is intimately blended with sexual vigor. In such cases, an avoidance of mental care, worry, of sentimental ideas, of carnal thoughts and the like, which abolish the desire. Impotence may be due to imperfect erection, the erection so feeble that intromission is impossible, the power of erection is completely abolished. There is a certain class of impotent men, with whom the main trouble seems to be a blunting of sensibility, a lack of tone and sensitiveness of the nerves of generation. These nerves come from and go to the spinal cord, ending in small bulbous, and (in health) exquisitely sensitive, points under the mucous membrane of the glans (head of the penis). Here may be found in this small space, some six thousand of these " sensitive bulbs," or " points," as they are called, and hence the acute sensitiveness of this part of the organ. This peculiar arrangement of nerve points in the mucous membrane of the head of the organ has a distinct object. Both man and animal are almost wholly dependent upon this peculiar 32 < • 498 DISEASE GERMS. sensitiveness of the glands to friction for the sensation that oc- curs during connection, and hence it can be plainly seen that if from any cause (former abuse, excesses, debility, overwork, etc.) the sensitiveness of these nerve points is blunted, sensation either before, during or after the act, cannot be natural. Some men are impotent from this cause alone. In others, this is only a part of the difficulty, but requires as careful treatment as if it were the only cause, for it must be overcome before a perfect cure can be effected. Sexual Paralysis, which means loss or decay of the erectile power, sensibility and size of the organs, is really a very advanced stage of impotency, and is usually the result of blows or injuries to the spine, softening of the brain, neglect of ordinary impotency, etc. It is more often found in men well advanced in years, but sometimes in young men and men of middle age. Enlargement of the prostate gland at the neck of the bladder, by pressure on the sexual nerves, sometimes produces it. So, also, does vari- cocele by destroying the testicles. Spermatorrhoea is the most common of all causes. It is more usual in young and middle-aged men. It is usually, but not always, the result of self-abuse, neglected discharges, losses in the urine, and usually ends in complete impotency, shrinking or wasting of the organs, coldness of the parts, stringiness and flab- biness of the testicles, and sooner or later, nervous weakness, brain exhaustion, spinal irritability, and still later, if neglected, paralysis, St. Vitus's dance, insanity, brain softening, etc. There are numerous other factors, besides the above, which are capable of producing a loss of virility, lessen or altogether abolish the power of erection and render the individual impotent, such as obesity, a defect of assimilation and elimination; or to emaciation, a derangement of the nutritive system. Certain shocks, concussions, jars, incidental to railroad travel. Shocks to the brain and spinal cord, or to the lumbar plexus of nerves, are liable to be followed by atrophy of the testicles and impotency. Neuralgia of the testes, varicocele, circocele, scrotal hernia, hydrocele, lead to degenerative changes and irreparable impo- tency. Disease germs in the blood, localizing in.the testes, give rise to wasting of the testes, imperfect development and atrophic changes with loss of virile power. Horseback exercise, bicycle riding, roller skating, give rise to prostatic urethral irritation and exhaustion of spinal nerves, atrophic changes in the cord, with a shrunken penis, a withering of the erectile tissue, a pronounced state of sexual weakness, nervous exhaustion, with paralysis of the erector muscles of the penis. BACTERICIDES. 499 Location influences the sexual appetite, highly oxygenized and rarefied conditions favor a loss of power. Fevers and nervous diseases are most productive of sexual de- bility. Habits, as the use of alcohol, chloral, opium, arsenic, render the individual incapable of copulation, by sapping and dwarfing the springs of life. Some drugs, as nitrate of potassa, tobacco, bromide, ergot, conium, digitalis, camphor, gelsemium, etc., when administered, cause loss of virile powers ; even the operatives in certain chemi- cals, as those by photographers, become impotent. Under one or other of these drugs, or a slave to any of those habits, the natural sexual appetite at the base of the brain be- comes impaired, desire and power both diminish, or entirely fade away, but in a large number of cases desire remains without the ability to accomplish the sexual act, or either erections fail and intromission becomes impossible, or there are imperfect erections and premature emission. A man may possess strong virile power, and still there may be an— Absence of the power of ejaculating seminal fluid into the vagina. This may be due to malforma- tion, disease, other abnormal states of the penis and testes ; also to a poverty of nervo- vital fluid. It is a well demonstrated fact of men who have com- mitted masturbation, or who have been the victim of sexual excesses, or abuse in early life, that prior to or about middle life (forty-five years of age), their semen becomes almost destitute of spermatozoa, pov- erty-stricken, and that instead we find in their so-called semi- nal discharge, dwarfed, dead or infertile germs, the discharge loaded with spermatic crystals; that . the presence of those crystals denote nervous bankruptcy, diminished spermatozoa, or their entire absence, degenerative changes, unproductive semen, decrepitude. The penis may be either absent or a mere stump, or it may be excessively large, or it may suffer a bifurcation, or a suture, or the urethra may have an opening either above or below. There may be a stricture, real or spasmodic, or paralysis of the compressor 5oo DISEASE GERMS. urethra, anomalies of the glands and prepuce which render copu- lation impossible. The glans penis may be the seat of anaesthenia, chancres, warts. The testicles may be absent, or their development ar- rested by blows or falls on the back or head ; atrophy caused by injuries to spine and brain; disease of the spinal cord ; bodily deformity operate disastrously. The essential parts of an act of sexual intercourse are the emis- sion of semen and the experiencing of a pleasurable sensation before, during and after the act. This sensation originates in the glans, being peripheral with an inhibitory action upon the central areas in the base of the brain and cord. Inability to experience sexual pleasure may be due to the cica- trices of chancres, warts, tight prepuce and utter insensibility of the glans from abnormal methods of excitation. The effects of impotency are most disastrous to the brain, in- ducing nervous bankruptcy, lunacy, idiocy, another class of cases are well physically, dead sexually. The last fifty years has brought to the notice of physicians a peculiar condition of the sexual organs, confined chiefly to men past the age of thirty, and most common at from forty to fifty. This consists in a peculiar form of impotency, producing partial or total loss of power and sensibility in the organs, but accom- panied by no very bad effects upon the general system. There seems to be a blight upon the sexual organs, while the general health remains good. There is oftentimes some little dyspepsia, and often great prostration during hot weather. Treatment of Impotency.—The most hopeless cases are those in which organic changes have taken place in the brain or spinal cord, or in some malformation that cannot be rectified, or congenital deficiency, or degenerative change. Nearly all other cases admit of a complete or perfect cure under the improved method of treatment and new remedies. Impotency resulting from an ina- bility to have an erection of the penis, without degenerative changes, is a curable affection, and the means to restore this func- tion are numerous and reliable; positive and efficient. The general management of the case embraces attention to the general health, taking every means to build it up. A most important measure is rest, an absolute cessation of all sexual excitement; a freedom from all lascivious thoughts ; the duration of sleep should be extended to eight or nine hours in the twenty-four hours; the bowels must be kept regular. Daily baths and douches must be resorted to, the ordinary tepid baths followed by the shower bath ; a hip bath of cold water thrice daily. The BACTERICIDES. 501 morning or evening bath, one or both to be followed by persistent massage for a suitable length of time, and this procedure followed by faradization of the whole body, but specially the brain, spinal cord and reproductive organs. Look carefully over all the causes that give rise to impotency and remove them if possible ; if it be due to imperfect develop- ment, retarded growth of the genital organs, that can be pro- moted by electricity; by causing a vacuum, and a determination of blood to the part, by the use of stimulating liniments. If it be due to fear, or rather a weakness of the great sympathetic, let in- difference be practiced, let the heart and sympathetic system be braced up by sparteine ; turn his back to his companion, wait, go to sleep, when probably by the early morning the difficulty will be overcome, confidence restored. Disgust, complete incompatibility, requires a good deal of tact and skill, but with good judgment the patient can be tided into recovery. The effects of masturbation, sexual excesses, perversion of the sexual appetite, are more tardy of recuperation. Digestion and assimilation, all nutritive derangements must be rectified; all shocks, concussion avoided. There must be no study, no care, no worry, no scientific pursuits; avoid intense solar rays, and in all cases forbid the use of tobacco, alcoholic drinks, all acro-narcotic drugs, as digitalis, conium, camphor, gel- semium, chloral, potassa, horseback exercise, or the bicycle. A most important indication in the management of all cases ot impotency is perfect digestibn and assimilation of food. The ap- petite must be stimulated with columbo and nux, or with hydras- tis and stone root, and if necessary pepsin could be added to meals to hasten digestion. The diet should be generous to a fault, and should consist as much as possible of articles that will nourish the brain. Animal food, chiefly of those animals nearest to man in the scale of crea- tion, as broiled tenderloin steaks, roast beef, mutton, poultry, game, milk, cream, boiled white fish, oysters, eggs; and among the cereals oatmeal, corn bread. Active bodily exercise should in all cases be inculcated, but never to fatigue. A mild but efficient alterative and tonic course of remedies may be prescribed with advantage, having a tendency to improve the general health. But it is by a special class of remedies that we obtain the most rapid and efficient results. Phosphorus naturally attracts considerable attention, but it should not be prescribed in impotency either in pill or in water, 502 DISEASE GERMS. or infusion, or tincture, or even in the dilute acid, as when admin- istered to such patients it predisposes the recipient to fatty degen- eration of involuntary muscular fibre, and to a laxity of erectile tissue. The best forms are either hypophosphorous acid dilute or in the form of phosphate of zinc. Best administered in all cases immediately after eating. Electricity, in the form of faradization, galvanism and franklinism is a genital stimulant and tonic of no mean order. Comparing the three forms, faradization is best adapted to the large propor- tion of cases, and when used in cases of impotency, the whole surface of the body from the crown of the head to the soles of the feet should be brought under the influence of the faradic cur- rent. Used in this way, the current acts as a powerful constitu- tional tonic to the nervous system, promotes appetite, improves digestion, gives rise to refreshing sleep, equalizes the circulation, develops the musclar tissue and increases strength. Above all it has an invigorating effect on the genital organs. It influences the whole periphery of nerves, whereas galvanization brings the entire central nervous system, brain, spinal cord and great sympa- thetic under its sway. Local electrization by external and internal applications ot both galvanic and faradic currents, are always of utility. The glycerite of kephaline ozonized, being the natural phos- phate of ox brain, barley, oats, wheat, is a true nervo-vital es- sence, and can be administered in all,cases of impotency with the best success. Neurasthenia, poverty of nerve force, cerebral anaemia, or softening, or paralysis and other states of nervous shock, are too frequently the result of excesses, and thus by draining off the cerebral essence, leave that organ in a state termed starved. A brain in that state soon has its typical fissures of thought obliterated, and granular deposits appear on the arachnoid; ad- hesion of its membranes to the surface of the convolutions; crystalline granulations in the living membrane of the ventricles, with an unusual amount of fluid in the sac of the arachnoid. Besides, a tissue-starved brain gives rise to inflammation of the cortical portion, terminating in degeneration of the nerve cells ol the hemispheres, and these changes give rise to structural change in the organic cell. The brain of man, his brilliancy of thought, his energy, his force of character, are due to the quantity of phosphorus con- tained in the cerebrum. If this is economized, it might sustain him to a good old age in full genital vigor, but let overwork or excess drain it off, health fails, the vital forces can supply no BACTERICIDES. 503 more; then, unless kephaline or oats can be administered, de- generative changes will take place in the gray matter of the brain and spinal cord, simply because the phosphorus in the brain is exhausted. Brain workers, mechanics, professional men, the libertine in his excesses, feel this in their languor, want of energy—victims of ex- cessive brain exhaustion. Nothing can invalidate the assertion that unless our present race obtain more phosphorus, impotency will prevail. Kephaline is an excellent brain food, a reconstructor of shat- tered nerve force, refreshing to the nerves, repairs lost sexual power. Kephaline gives intellectual capacity, a higher stratum of life. It is a stimulant to the molecular growth of the brain, with a special action on the lymphatics and pink marrow and other blood-forming and blood-raising glands, and above all an active energizer of the seat of sexual power of the brain. The phosphated tincture of Scotch oats {Avena sativa) is a remedy of very rare value, great efficacy in all cases, and in every form of impotency, especially when it depends upon a tissue- starved brain. From among all the cereals, oats give us the best stratum of brain growth, one of the greatest vigor; barley, wheat, rye, give us mental delicacy. Oats having a large per cent, of phosphorus in a most assimilable form, renders its use of national importance. The amount of brain matter it contains is immense, and renders it of the greatest value whenever there is a deficiency of life in nerve tissue, in mental depression, insomnia, loss of sexual power. It not only supplies the brain with its own constituents, but aids blood formation, rebuilds, recruits tissues and forces lost in the destructive march of sexual degeneration. This preparation of oats is the most valuable for ail cases of nervous exhaustion, nerve tire, debility, excesses, reconstructs the most delicate, it aids the growth of the brain, the bones, the teeth, the skin, the nails of children; imparts to them a vigorous constitution, it gives to the old the vivacity of youth, and that part of the nervous organism—the sexual appetite in the brain— it rejuvenates it. It is an excellent stimulant to the motor cells, a life-giving tonic. In order to get the full benefit of a phrenic pabulum of the phosphated tincture of oats, sleep should be prolonged to at least nine or ten hours in the twenty-four. This is the remedy when the entire system is sapped and ex- hausted, the blood acid, nerves prostrated, appetite and digestion gone. It is food to the nerves, brain ; also a muscle-strengthen- ing remedy. 504 DISEASE GERMS. The fluid extract of the saw palmetto (Sabal serrulata) is of great utility indirectly in impotency. Its great property is the promotion of grandular growth in the testes, prostate, ovaries, mamma'. It is a most appropriate and active remedy when impotency is associated with degenerative changes in the testes due to sexual excesses, perversion and masturbation. It is a nutritive remedy of much value and of a peculiar kind, especially when there is a deficiency of the nervo-vital fluid. The brain and the important net-work of glands connected with the genito-urinary organs wear out fast in these days of high civilization, and this remedy fills a vacuum long desired to pro- mote glandular growth, restore the testes and prostate, if they happen to be shrivelled or shrunken, to their pristine condition and even to an increased size. Atrophy of the testes is very frequently associated with impotency and varicocele. Atrophy of the prostate is also a prominent symptom of genital debility from the opium habit and sexual perversion, a state the reflex effect of which gives rise to a sense of goneness and suicidal despair. A much greater calamity than enlargement, for with the latter, he may go through the act of coition, but neither semen nor prostatic secretion can be ejaculated if the prostate is withered and atrophied. The exhibition of the fluid extract or ivine of the erythroxylon coca is attended with excellent results. Its best form is the coca et celerina. It arrests the active metamorphosis of the brain, promotes cohesion of the cerebral faculty of thought and vital- izes the central areas of the sexual appetite. This is a remedy'of intrinsic value in all cases of impotency on account of its peculiar action as a powerful nerve excitant, giving great vigor to mind as well as to body. The combination with the celerina acts energetically upon the cineritious substance, and has a most invigorating action upon the sexual sense. There is no doubt that it rejuvenates that sense and wipes out genital and phrenal incapacity. Cocaine Suppositories are of great efficacy in cases of impotency caused by masturbation or excess. Onanism, the modern vice, the bankruptcy of the soul, degrades primary nerve elements into a germ of auto-infection. Millions of vibrios, the signal of brain wreckage, are to be found in all parts of the body, and with it a germ-laden rectum, which gives rise to irritation and leak- age. These suppositories are of great utility, soothing the motor, sensual and urinary centre in the spinal cord, and vitalizing the atonic condition of the prostatic ducts. It is a well-known fact that disease in any part, or even a non- use, causes a decrease in the size and a diminution of its strength, BACTERICIDES. ,0C This is a result of mal-nutrition, an insufficient supply of nerve force and blood to the organ. Tie up a limb, deprive its muscles of exercise, of a full supply of blood or .nerve force; it wastes, shrinks to an indefinite degree ; so with the genital organs when they suffer disease, excesses, congenital defect or abuse, they are deprived of a full amount of nerve force and blood—they shrink to a degree which renders them totally useless for the important function designed for them by nature, and the- sequel is either partial or total impotency and incapacity. Various electrical apparatuses and other instruments, lotions, ointments have been suggested to remove these defects and re- store the sexual organs to their full size and vigor. All such contrivances are both dangerous and useless. What is wanted is something that will supply or impart more vital force and blood, increase nutrition of the marasmic, atro- phied, wasted or shrunken parts. The cocaine suppository acts specifically on the muscular tissue, nerves, arteries, veins and lymph canals of the organ, augmenting the supply or nerve force and rich arterial blood, increasing their nutrition, growth, and restoring to them their natural size, energy and power. They act gently, according to a natural method, and accomplish a natural result. Besides, if the impotency is in any way blended with prostatic trouble, it is a most excellent remedy to relieve vesical tenesmus, senile hyper- trophy. It enables him to sleep at night without disturbance. Damiana is a remedy introduced from Mexico, in which country it is used as a powerful aphrodisiac, of the greatest utility in all cases of sexual atony or lethargy. It is a capital tonic to the nerve centres which preside over erection, it in- creases the flow of blood to the spinal cord and the genitalia. The greatest trouble to be apprehended is in getting the proper plant, the true or genuine damiana, as there are several spurious articles in the market. The true damiana is beyond a doubt a most reliable, useful, and permanent tonic to the genital organs of both sexes. Acting as it does, directly upon the nervous sys- tem, it restores, as it were, the debilitated functions of the gener- ative system; besides, it is an unsurpassed nervine. Its merits are well established, if the proper article is used. A good tinc- ture or fluid extract is the most eligible form, and all nostrums, such as the so-called wafers or tablets, should be avoided. The fluid extract, in medium doses of fifteen to thirty drops, added to water, administered thrice daily, rouses up the vital functions, thoroughly invigorates the brain, and energizes the nerves of the lumbar plexus. It is well adapted to all cases of impotency, but especially those in which the sympathetic system 506 DISEASE GERMS. is at fault; consequently, under its use, there is intellectual brightness, courage strengthened, mental and physical vigor in- creased. Muira puama fl. ext. in very many cases excels the damiana it its action. Apiol is a remedy of considerable power in functional impo- tency, when the erections are feeble, seminal fluid watery, testes soft. It acts speedily. The leaves of the ruta graveolus increases the flow of blood to the genital organs. Gelatine caps, made of avenine, are most efficient in increasing the peripheral sensibility of the nerve fibrils in the corona glandis. Medicated caps act to increase the sensitiveness of the glans. Laid on the part for a short time the effect is marvellous, and by using one or two a day for a few weeks, many weak and impo- tent men have been restored to full power, vigor and sensibility. In cases where this is not the only cause of impotence the use of the medicated tissues with the urethral treatment is certain to re- sult in success. It is by neglecting to restore this part of the organ to the healthy condition that so many cases of impotence and debility have failed to be cured. Middle-aged and old men, and men about to marry, whose organs are weak and debilitated, and whose sexual sensibility is blunted or lost, will find in these cleanly little films a speedy means of relief. They are cut of proper size to fit the glans perfectly, and have simply to be laid on and left for from five minutes to five hours, according to the severity of the case. Wasted and dwindled, as well as misshapen organs, are wonderfully improved by the use of these films. As the nerve sensibility and power improve, so does the strength of the muscles and the circulation, and in nine cases out of ten, weak, wasted and puny organs increase in both size and strength, and erections become firm and satisfactory. Erectile power and 'sensitiveness are results that quickly fol- low their use. They are perfectly cleanly, produce no soreness, and are so made that they can be worn beneath the foreskin, and will not fall off or slip out. The gelatinous film that holds the remedies rapidly dissolves and brings them into direct contact with the membrane of the glans, where they act directly on the nerve ends. By their use, too slow or too rapid ejaculation is properly regu- lated, for these things are directly dependent upon the sensi- bility on non-sensibility of the glans. Of the use of the damiana ozonized soluble gelatine bougies there can be no doubt; the remedy is good, the mode of appli- BACTERICIDES. 507 cation unexcelled in energizing the glands and stimulating the erectile fibres. The application is a modern idea to heal a defect of our present civilization and a gap in our nation's health. For the growth, vigor and future prosperity of a nation de- pends upon the strength and energy of its young men, and if the places of the robust and healthy are to be filled by effeminate, weakened, nervous and physically drained youths, such as the vice of masturbation and sexual excesses is yearly giving us, the result cannot be otherwise than nationally disastrous. Every man suffering from impotency or from disease or dis- order or a leakage should use those bougies once, twice or more frequently weekly. To some, these may be inconveniences or annoyances, but the result is invariably a brilliant success. The value of ozone as a therapeutic agent and of ozonized remedies in the modern treatment of impotency is thoroughly appreciated by every liberal-minded practitioner. It makes little difference whether it be ozone water, peroxide of hydrogen, or comp. oxygen, as the three are analogous as therapeutic agents. Either of these excites a perfect renovation of the sexual appe- tite, removes the lethargy or sexual inability. In administering these remedies it is important to understand that they are the most powerful of all microbe killers; that the blood-discs take up the ozone and are depurated by it without undergoing any change themselves. In any deviation from health there is no fluid or solid in the body exempt from the presence of disease germs. But so long as a metamorphosis is active, and renewal normal, germs are passive or dormant; but when vital action is depressed they become active. The use of ozonized remedies in disease is a step forward, as they are not only death to microscopic life, but to all animated existence, life, vitality. The source of supply of ozone is unquestionably electrical, unceasingly going on in nature, aided by geographical position, as rocks, waves, hill-tops, billows. Its presence or absence modi- fies the denizens of towns, gives rise to peculiar idioms of speech, vigor or weakness of the sexual appetite. Look at the highly vitalized American race, the prototype of the ancient Roman, who inhabit the Eastern States, with their brain clear, perception keen, full of practical utility and magna- nimity, the result of ozone. Compare them with the Jerseyman, the Marylander or Virginian on their sandy beach and malarial swamps, where no ozone can exist. Compare the gigantic 5o8 DISEASE GERMS. ' achievements of the one with the proverbial meanness of the other, and say what ozone does for race and location. Another urgent reason why ozone or ozonized remedies should be admin- istered in impotency is, there is a contagium vivum in all diseases; for example, introduce three or four confirmed mastu rbators into a village where the act is unknown, in six months every young man will be a victim of the habit. So with the genital debility or impotency or effeminacy. II. Impotency in the female may be due to a want of develop- ment of ovaries and uterus, and absolute want of sexual desire; inability by reason of malformation, or other physical conditions to obtain the entrance of the penis into the vagina, such as vagina occlusion, with an excessively developed and ligamentous hymen; obliteration of the vagina; double vagina, or a normal vagina and no uterus; absence of the ability to experience the sexual orgasm. The entire absence of all sexual desire may be the re- sult of abuse or excesses, or arrest of development of the clitoris, or an impairment of the sexual sense by falls or blows on back or head. Inability to permit an entrance into the vagina by a neurosis, as vaginismus, or super-sensitiveness of the surrounding tissues of the vagina, involving its sphincter muscle, forming a complete barrier to coition; tumors, involving the vagina, uterus or ovaries, may mechanically prevent copulation; cancer may or may not be a cause of impotency; hydrocele of the labia, warts, hernial protrusions, hypertrophy of the clitoris, or vagina, catarrh of the uterus, masturbation, as well as sexual excesses, render a woman impotent. The same cases that exist in men; disease of the brain, cord, and certain disease germs in the blood; the use of tobacco, alco- hol, opium, chloral, coca, arsenic, belladonna, conium, gelsemium, the bromides, render women callous and often impotent. The want of ardency or callousness or icicle coldness of some women is not always to be attributed to impotency, but rather to incom- patibility. The interruption of the procreative faculty of the female may be due to many other conditions. This is most apparent when we consider the anatomy of the genital organs of both sexes. They consist chiefly of erectile tissue, a loose, elastic substance, intimately interwoven with nerves, and divided into multitudinous cells, into which, under excitement, blood is forced, filling or congesting them to their utmost capacity. The penis and glans penis of the male, and the clitoris, nymphae, internal labia and a portion of the vagina of the female are largely made up of this tissue, and the nerves in those parts are numerous, and in a healthy state highly impressible. BACTERICIDES. 509 The fallopian tubes of the female, which convey the egg from the ovaries to the uterus, are also composed of erectile tissue, like the penis and clitoris. During coition, if the female is not impotent, the fallopian tubes are erect at climax of the act, the fimbriae grasp the ovaries; if the egg is mature, it is sucked up by them and carried forward to meet the spermatozoa of the male for im- pregnation. III. Sterility in either Sex.—In order to thoroughly grasp the subject of sterility, it is necessary to have a clear idea of the physiology of conception. Several factors are concerned in concep- tion, and these should act in harmony. The woman must pro- duce healthy ovules, and the man must secrete healthy sperma- tozoa. There must exist no condition in either sex to destroy the vitality of the ovule or spermatozoa before they come in con- tact, and this union or junction must take place under proper conditions, to produce impregnation. There must be no con- dition existing which prevents the fastening the impregnated ovule within the uterus. Conception depends upon the combined mat- ter of two individuals, male and female. Sterility is very prevalent among modern men, due to excesses, perversion of the sexual appetite, to gonorrhea, epididymitis, which causes destruction of the vas deferens. A very large per- centage of sterile women are married to men who have had gon- orrhea before or after marriage. Spermatozoa may be secreted, yet in copulation not ejaculated, on account of some congenital or acquired defect, or their vitality may be destroyed by an in- flammatory process with its acid secretions. When secreted or ejaculated, they may be prevented from entering the uterus by contraction of the external or internal os, flexion, or conoid cervix, or their vitality may be destroyed by unhealthy conditions of the mucous membrane lining the uterus, cervical canal or vagina, as intra-uterine catarrh, tumors, preventing fixation or conception of the impregnated ovule. Healthy ovules may not be produced on account of feeble health; sudden or profound shock to the nervous system, caus- ing ovarian incapacity, or from any disease in or about the ovaries, as chronic ovaritis; cystic, sarcomatous, cancerous, or inflamma- tory degeneration, or from peritonitis, or cellulitis. Of course there are no ovules in absence of the ovaries. They may be secreted in a healthy condition, and their en- trance into the uterus may be prevented by displacements, de- tachment or absence of the fallopian tubes, or by any condition which obstructs or contracts, or obliterates their cavity. All forms of dysmenorrhea are causes of sterility. 5io DISEASE GERMS. Some women, while potentially fertile, are actually sterile or may have relative sterility. This is seen in women who marry two or more men, and have children by only one of them, or when a man marries two or more childless widows and has children by each of them. This may be termed sterility from in- compatibility. Sedentery habits, monotony, confinement, absence of sunlight, certain climates, all acro-narcotic drugs, all habits of opium, alcohol, chloral, arsenic, obesity, syphilis, like tempera- ments, in-and-in breeding, are causes of absolute and relative sterility. Most fertile women experience pleasure in sexual congress, and may have strong passions or desire, but women may con- ceive who have neither desire nor pleasure; while others who have both desire and pleasure remain sterile. No woman should be pronounced sterile unless she has some defect to prevent conception, until the semen of her husband is examined to ascertain if it contains living, healthy spermatozoa. One of the greatest wants of the age Infantile Diseases, is health—" a sound mind in a sound body." Without it our national future —the future of families, of races, becomes more a matter of chance than a certainty. Physical degeneracy has blotted out many names from the face of the earth that ought to have been perpetuated to bless and take part in civilization and progress. Many parents bring into the world feeble children, because the laws of life and growth were not understood. Many more have consigned their loved ones to an early grave, or had them afflicted with disease, feebleness, deformity, through a want of a knowl- edge of the natural laws of life. It is a true maxim, that a large and healthy population is the life and strength of a nation, as well as the source of its success in sciences, arts, agriculture, commerce; so that it is a point of momentous importance to secure to the child a perfect state of health. It is true that pure air, cleanliness, suitable clothing, plain, natural food, will do much in preventing disease and prolonging life. Marriage should be prohibited among persons of like temperaments, or diseased, as they produce a diseased offspring. Neither should there be any incompatibility of ages, of blood affinity, or disposition. In order to do her duty to herself, to her country, to her offspring, a pregnant mother should sustain her health in its highest per- fection. This she will accomplish by attention to diet, clothing, cleanliness, exercise, and moral discipline. Her diet should be simple, light, nutritious, with abundance of BACTERICIDES. 5H brain, bone, and flesh-forming elements, adapted to the require- ments of the individual and the condition of the digestive organs. The clothing should be warm, comfortable; all tight lacing, corsets, etc., should be avoided. Keeping the skin in the best of order, by daily tepid sponging, is very conducive to good health during gestation. Gentle, moderate exercise is to be recom- mended, and all violent movements avoided. She should live in well-ventilated rooms, so as to breathe pure air at all times. There should be a perfect state of mental and bodily equilibrium on the part of the mother on all occasions; a well-balanced state of all her emotions, desires, affections, passions; her mind calm, cheerful; there should be no strain either on the intellectual or physical, especially on the former. She should entertain a high sense of her social duties, of her eminent status in nature as the mother of our race, and have implicit trust in Him whose name is honored in His marvellous works. The mother is all in all; her mental condition stamps the character, the calibre of the future man, the future mental condition, sex, and capacity of an immortal being; so that every precaution should be taken to look well to the mother. At the moment of impregnation, both parents, to a certain extent, transmit their qualities to the offspring; and either parent may transmit, to a greater or less degree, their constitutional peculiarities, thus occasioning the greater or less resemblance to one or other parent. But from the moment of conception until birth, and even during lactation, the influences of the mother are constant. She is specially present; to her we owe all, even the determination of the sex. The natural tendency of a healthy mother is to breed a great excess of male births. This she can only do under certain conditions, to wit: saving her mental forces for perfect production. One would naturally think that by education and improvement of mothers in the sciences and arts, that we would improve the stock, and further increase male births, which is true, if the mother does not exercise, or exhaust, or overwork her intellectual powers during the breeding period of life. If a woman, before and during the child-bearing period of married life becomes an astronomer, teacher, preacher, physi- cian, attorney, she exhausts her manhood, and cannot bear male children at all, or if she is capable of giving birth to boys, they will have small heads, weak brains, feeble or meagre intellectual capacity; in other words, they are deteriorated and effeminate. So that if married women crowd the avenues of scientific life, before and during the child-bearing period, we run the risk of becoming a nation of girls. Anything that affects the mother injuriously or depressingly, 512 DISEASE GERMS. to the same extent damages the child. Let the mother partake of gross food, and there is a strong probability that the child will be tubercular ; if she is of sedentary habits, it will be weak and flabby; if she has been dosed with drugs, they will impair the constitution of the child. And so with mental influences— if she has contemplated feticide, the future child will have sui- cidal mania; if she reads trashy novels, they will react on the offspring in some vice; if she is passionate, has an unhappy home, or bad husband, each one, or all, will give rise to some deterioration in the child. So that if we want healthy, buoyant children, free from all diseases or immoral taint, we must have happy, comfortable mothers. To have healthy children, parents should be free from disease, either inherited or acquired; should exercise no deleterious trade, nor should they use alcohol or tobacco—both productive of imbecility and nervous disease in the child—and should have healthy organizations, and conform to all the requirements of hygiene. ( A most important condition to our having healthy children, is to give them abundance of pure air to breathe. Respiration is the first act of independent life; air is a vital necessity. Shut a child up in a close room, or in a crowded city, every breath he takes changes the quality of the atmosphere; it loses oxygen, becomes loaded with carbonic acid gas; besides, there are the emanations from skin and lungs, which are poisonous. Pure air is essential to life, to the blood, and to all the tissues. Next to air comes exercise; the activity of every organ and function. There is not an organ, muscle, faculty, gland, but what was made for use, for movement, exercise. Exercise is necessary to development; without it, anaemia and disease. Good health requires, nay, demands, the regular performance of all the organic and animal functions, secretions, excretions, and all muscular, nervous, intellectual, moral and passional activities. It demands for the entire body, bathing once or twice a day; it demands a temperature neither too warm nor too cold, and easy clothing, so as not to impede motion, aeration and perspiration. As destruction is rapid, and renewal very active, everything about a child should be scrupulously clean. Rest and sleep are important factors in growth. Sleep, during which the brain picks up its pabulum from the blood; the brain must rest for fresh supplies. The child, the microcosm of Deity, with its dawning intelligence, sleeps nearly all the time. Noth- ing so withers and blasts incipient vitality as want of sleep. In childhood, ten to twelve hours in the twenty-four should be devoted to sleep; in maturity, eight hours is sufficient; and in old age we do with less. BACTERICIDES. 513 Management of the Infant at Birth.—The most striking pic- ture of utter helplessness that can be imagined is that of an in- fant at birth ; for if assistance be not speedily afforded it will perish. The first thing to be attended to is the umbilical cord, which should be tied with saddler's silk, about three-fourths or one inch from the abdomen ; then another ligature about an inch further on, and the cord divided between the two with clean- cutting scissors. Any mucus should be removed from the mouth, or ears, and it should be examined to see that it is a per- fect child. After the function of respiration is established, the infant should be wrapped up in a blanket and kept very warm, protected from cold, and the nurse, or other attendant, should bathe it at the earliest opportunity, after the mother has been duly cared for. The first bathing of the infant is of much im- portance, and it should be performed with the greatest care and precision. All children, to a greater or less extent, are covered, either partially or wholly, with a thin or thick sebaceous secre- tion, which will not unite with soap, but readily unites with fat or oil. So, after the nurse has been provided with a low' stool, a basin of tepid water, castile soap, and some olive oil, or lard de- prived of its salt, she sits down and first freely anoints the scalp of the little stranger, rubbing it in gently, efficiently, causing it to unite with the sebaceous secretion, and then takes the soap and washes off; then she goes over the face, ears, and in the same manner, being most careful that not a particle of this mat- ter enters the eye, ear, vagina, axillae, as it causes inflammation ; and being very careful that not a particle of it remains about an ear-lobe, angle of nose, a fold or crevice of the skin. Then she manipulates each arm in the same manner, washing the arms, and watching the armpits and fingers, then the limbs, and look- ing after the corrugations about anus, folds of vagina, groin. The utmost care should be exercised, and if it has been heavily covered, it might not hurt to bathe it in the same manner again in a few hours, lest the smallest particle or patch may have es- caped observation. The perfect removal of this sebaceous secre- tion is all-important, and should receive the most careful atten- tion and scrutiny, so as to prevent ophthalmia and other inflammations. After the child is thus not only bathed but thoroughly cleansed and well dried, a double piece of fine old linen, four inches square, with a hole in the centre to permit the passage of the cord, slightly scorched, should be applied over the navel, bringing the cord through the orifice, and the linen laid flat on the belly. Then another piece of linen the same size, with a hole in the centre, should be applied, into which the end of the 33 514 DISEASE GERMS. cord should be wrapped up and turned over to the right side; and over and above all, a roller or bandage of finest flannel, reaching from the breasts to the groin, should be evenly and neatly pinned; and then the general clothing of the child, which should be easy and warm—flannel or silk. If the mother has been properly cared for, and the labor not too exhausting, she will have milk ; and it is the best plan to put the child to the breast pretty soon,#s the mother's milk' is the true nourishment for the infant, that which nature has provided, a perfect combina- tion for the due elaboration of every tissue in the body. Still, there are cases in which this cannot be done, and the child must be nourished with a little milk and water, or sugar and water. We are, however, most partial to mother's milk, as it cleanses out the bowels of the meconium, gives the nipple a better shape, facilitates a better flow of milk, induces contractions of the uterus by its reflex action, and diminishes all risk of secondary hemor- rhages. The child, for the first fifteen months, should be bathed morn- ing and night—a thorough ablution—followed by gentle friction, and clean, soft clothing, to maintain an active condition of the skin. Tepid bathing for infants is always to be preferred. Very great cleanliness should be observed, diapers changed the mo- ment they are damp ; soiled, and moistened parts sponged off. About the fourth month a child should have sufficient exer- cise in the open air, be occasionally placed in a sitting posture, and be allowed to roll round and kick at its pleasure. All these movements not only afford amusement, but act beneficially, by calling the different muscles of the body into action, and so in- crease their strength. A child should be exercised during the day, so that it may enjoy undisturbed repose at night. The child should be weaned between twelve and fifteen months, provided it has teeth, and the season of the year warrants. No child should be weaned at the approach of summer, not unless the mother be pregnant, then it should not be kept an hour at the breast, irrespective of season or age. In weaning, it should be gradual, less and less daily, gradually substituting milk-food and ordinary solid nourishment. In all cases avoid starchy food, as rice, arrowroot, corn-starch, farinas, as they contain neither brain nor bone; not food for a Caucasian child; besides, the child has no saliva to digest starch. In order to be brief, we shall next direct attention to various peculiarities of the infant, and then to special diseases. Peculiarities of the Infant.—Infancy may be said to extend from birth to the second year, or completion of dentition; and childhood to. the age of puberty. BACTERICIDES. 515 The general appearance of a new-born infant is as follows : It usually measures twenty inches, more or less, and weighs about six or seven pounds, more or less. The skin is very vascular, sensitive, and delicate; of a deep red color. All the prominent parts of the body are well protected by fat and cellular tissue; the tendons and ligaments are imperfect; the muscles soft and gelatinous; the bones are small, chiefly cartilaginous, deficient in earthy matter; the lower extremities are less developed than the upper; the pelvis is small and looks contracted ; the thorax small, flattened at the sides, prominent in front; the head and abdomen large. The digestive organs are perfectly adapted for producing rapid changes in the food introduced into them; indeed, they afford room for a continual supply of the materials for nourish- ment and growth. The mouth is beautifully adapted for extract- ing the food prepared by the mother, and conveying it to the pharynx. The stomach is small and long, which shows that it is not suited for receiving much food at a time, or for retaining it long. The intestines are smaller and shorter than in the adult; their peristaltic action is rapid, so that all excrementitious matters are quickly got rid of, the infant having an evacuation every four or five hours. The mucous membrane of the whole alimentary tract is thick, soft, villous, very vascular, and sensi- tive, and easily irritated by improper food; the salivary glands, the pancreas, the lacteal vessels, the mesenteric glands, are largely developed ; the kidneys are large, the suprarenal capsules of considerable size; the spleen is small, liver very large, oc- cupying one-third of the abdominal cavity, but becomes smaller by changes that take place in its circulation. The respiratory organs undergo a great change ; the lungs, on being permeated with air, increase in size, become light, vesicular in structure, and of a deep rose red; the respirations are nearly double those of an adult. The action of the heart is quick, varying from 120 to 130 beats in a minute. In looking at the nervous system, we find the brain large, soft, imperfect in structure, and weighing about ten ounces; the convolutions are imperfectly marked; intelligence is in direct proportion to their extent, while the gray portion scarcely differs from the white, in color. The meninges are more vascular than in the adult. The structure of the spinal cord and nerves is more perfect than that of the brain; those parts being devoted to functions of sensation and voluntary mo- tion. The organs of the external senses are all present at birth, and the nerves distributed to them are large. Peculiarities of Disease in Children.—During childhood little boys are very delicate, susceptible to disease, whereas little girls 5i6 DISEASE GERMS. are tough and wiry, and resist morbid action. After puberty, the young man is vigorous, and the young lady delicate or tender, thus reversing the conditions. In childhood, in both sexes, there is a predisposition to disease on account of inherent weakness of organization, and the ease with which impressions are made, and disease at that period of life is very apt to be insidious, and run a very rapid course into some organic change. The activity of the vital force, the quick metamorphosis of tissue, predisposes to inflammatory disorders, and the great susceptibility of the nerv- ous system to impressions causes any affection to be keenly felt by the whole system. Hence, the slightest disease, or indisposi- tion in a child should never be regarded with indifference. It is also true that the same activity of the vascular and nervous sys- tem imparts an energetic, reparative power in the child, and es- sentially aids recovery from some severe affections which would be fatal in advanced life. The skin and the mucous membrane of the respiratory and digestive organs are the principal points upon which morbid im- pressions exhibit themselves, although they originate in the stomach, or from outside influences. The mucous membrane of the larynx, trachea, bronchial tubes, is liable to inflammation of various grades, mostly of an acute character. The gastro-intes- tinal mucous membrane is another source of disease in early life, and owing to irritation of these parts, so abundantly supplied with the sympathetic nerve, and the increased sensibility of the reflex centres in modern children, give rise to innumerable brain affections. Hence, the frequency of fits, convulsions and cere- bral disease. The early growth of the lymph canals, or lym- phatics, render them obnoxious to morbid action. Diseases of the urinary organs are not frequent or severe. The diseases of children present many interesting and re- markable features, the peculiarities decreasing as age advances. All affections of children, even the process of dentition, are at- tended with fever of a remittent type, having exacerbations towards evening or during the night. In all cases of disease in the infant the causes are the same as at other periods of life, though they react upon the child with greater severity than the adult. Errors in diet, impure air, inat- tention to the laws cf health, intense cold, heat, damp, filth, meagre or improper food, insufficient clothing, disease-germs, poison; reflex states, as dentition, worms, accidents, act ener- getically upon the feeble constitution. Again, many disorders that exist in early life may not exist at birth : Thus, some are unfortunately born with the germs of syphilis, tubercle, in their blood. The chief causes of death among our children are BACTERICIDES. 517 cholera infantum ; disease of the brain, superinduced by indiges- tion ; acidity, worms, teething, bad food and the like. Diagnosis of Infantile Diseases.—A little good sense is all that is necessary to form a correct diagnosis of the diseases of the child. The chief sources from which our information is derived are the countenance, the gestures, attitude, the sleep, the cry, the mouth and breath, the respiration, circulation, etc. Countenance.—The human face divine is the most interesting and intelligible page in the book of nature. In its calm and smile, we read health, ease, happiness of mind and body; in pain and suffering we discover disease. In general uneasiness, excitement, and fever, the whole expres- sion of the countenance is altered, a flushed and wrinkled condi- tion alternately being remarkable. In affections of the brain and nervous system, the expression of the upper portion of the face, as the forehead, brows and eyes, is especially changed; the skin white, the forehead contracted and heavy; the brows are knit; the eyes wild and vacant, or fixed and staring, partially open; rolling of head; squinting; dropping of eyelids. Morbid conditions of the organs of respiration and circulation affect the features of the middle of the face; the nostrils, in pneumonia, are dilated ; tip of the cheeks red ; sharp, dark cir- cle round the mouth. In cardiac irritation, features are con- tracted. In diseases of the abdomen a peculiar expression is given to the face r cheeks sallow, sunken ; the mouth retracted or drawn; the lips colorless. In irritation of the bowels from worms, the nose and upper lip are tumid, a dark ring below the eyes and round the mouth, and the white of the eye has a pearl-like look. In the exhaustion from diarrhea, the face is alternately flushed and pale, hot and cold ; in extreme cases, pallid, cold, glistening; the eyelids half closed. In jaundice, the countenance is yellow. In measles, the running from eyes and nose, redness of the eye, swelling of eyelids, never can be mistaken. The features are emaciated, and present an appearance of decrepitude, in tabes mesenterica. The peculiar feverish look, sharp features, sunken eyes, pallor, of cerebro-spinal irritation never can be mistaken. Pain in the head causes the brows to contract; in the belly, the upper lip is elevated; in the chest, sharpness of nostrils. Before convulsions come on, the face becomes convulsive; the upper lip is drawn, there is squinting. Suffusion of the face denotes fever; flushes of heat and coldness denote exhaustion. Gestures and Attitude.—The beginning of disease in a child is made apparent by inattention to surrounding objects, by their 5i8 DISEASE GERMS. listlessness and dislike to movement. They then become rest- less, languid. Inflammatory pain may make a child still. In ab- dominal inflammation the child lies quiet; the knees bent, drawn up; twisting about; uttering loud cries on the sudden accession of" pain. Acute spasmodic pain induces immediate contraction of all the muscles, and the infant starts in terror. In convulsions, the head is drawn back, and becomes rigid, or a leg is drawn up- wards, and the child cries violently from pain or fear; the breath- ing is spasmodically affected ; the thumbs and fingers are drawn into the palms of the hands ; the toes are firmly flexed down- wards. In irritation of the brain, the little hand is frequently raised to the head, attempts made to tear off its cap, and perform other movements with the hands, while the head is rolled from side to side on its pillow. In disorders of the mouth, as difficult teething, the child presses its fingers into the mouth, or seizes and presses the nipple roughly and. greedily, or rubs the gums with anything it can get hold of. In croup and other diseases producing difficulty of breathing, it pulls or grasps at the larynx, and tries to compress it laterally, and by its cries indicates the seat of suffering, which is relieved by the sitting posture. During dentition, throwing back the head, grinding of the jaws, or irri- tation of digestive tract, indicates convulsions. The Sleep.—The sleep of a healthy child is deep, tranquil, pro- longed ; the countenance is calm and happy ; the breathing slow and easy; its limbs relaxed ; on awakening, it is lively, and seeks the breast. In disease, the rest is disturbed, broken; the respira- tion is loud, labored; the brow contracted, or the mouth drawn; there is grinding of the teeth, or gums ; sudden startings; the child is fretful, irritable, peevish. Any irritation anywhere, but especially in the brain or bowels, lessens the ability to rest. Rigid extension of the limbs, with a turning in of the great toes and thumbs, is indicative of convulsive movements. In jaundice, there may be deep sleep or coma. The Cry.—The first indication that a new-born infant gives of life is to cry, and the more loudly and lustily it does so, the better, as it thereby inflates the lungs more perfectly, and demon- strates the fact that the vital organs are well and vigorously formed, and the child in good health. But after being bathed, clothed, and warmed, and otherwise seen to, the well-cared for % infant cries but little ; the act of crying being reserved to express pain, distress, hunger. Pain is productive of crying. In affec- tions of the lungs, the cry is more of a groan; in croup, hoarse, muffled, crowing; in cerebral disease, screams, with great irrita- bility at intervals; in diseases of the abdomen, the cry is pro- longed, low, moaning. The sympathetic nerve and lachrymal BACTERICIDES. 519 gland being rudimentary until three or four months; the little sufferer does not shed tears in crying until after that period. After four months, if a child shed tears in the act of crying, it is a most favorable sign ; but if the eyes are dry, sunk in the orbit, great danger to life exists. The Mouth and Breath.—In health, the mouth is moist and pale, the tongue smooth, and partially covered with a layer of whitish mucus ; the gums red. the breath sweet, free from smell or odor, only that of the mother's milk. This is altered by very slight causes ; the mouth may become hot, dry, red; the tongue coated, and the mouth sour, acrid. This is the case in fevers, acute affections of the chest and abdomen, and in retarded, difficult dentition. In the eruptive fevers, torigue often swells, or its papillae project. In scarlet fever, with its strawberry papillae, it sometimes presents a swollen, hot condition. In sore mouth, or aphthae, due to bad milk, indigestion, teething, over- crowding, the breath is fetid, tongue excoriated, and there may be ulceration on various parts. (See Aphtha?.) The Skin and Temperature.—In a healthy skin of an infant we should find it firm, elastic, smooth, of a rosy flesh-color, neither hot nor pale, but moist and cool. A hot skin is present in all febrile diseases; a cold, moist skin in feebleness and pros- tration. Great redness indicates inflammation, or the eruptive fevers ; a pale, doughy skin warns us against tuberculae ; intense blueness, to cyanosis, a mixture of the arterial and venous blood, or some interference with the oxygenation of the blood ; a yellow skin, to some affection of the liver; a dirty, sallow hue, to diar- rhea. Rigors are not common in young children, even suffering from malarial fever, the usual symptoms being a paleness of the face, a discoloration of the lips, a bluish tint beneath the nails. Respiration.—An infant breathes instinctively, without, method, but with regularity. All diseases of the air-passages are attended with noisy, rattling respiration and cough, which is hoarse and spasmodic in inflammation of the glottis ; ringing in laryngitis ; crowing in croup. In catarrh, bronchitis, pleurisy, and pneu- monia, the breathing is merely hurried, the cough hacking and dry, and the expectoration, as it comes up, is swallowed by the child. As the inflammation increases, the rapidity of the breath- ing becomes great, so that in lung congestion it is often panting : at the same time there is rapid dilatation and contraction of the nostrils. In pleurisy, the respiration is restrained ; in peritonitis, the inspirations are short, jerking, difficult. The Circulation.—The heart's action is more variable in infancy than at any other period, and impressions of every kind quicken the pulsations. Pulse, in health, ranging about 130. 520 DISEASE -GERMS. Discharges by Vomiting and Stool.—The first stools after birth are of a black, or dark-green color, called the meconium. Subse- quently they become brown, or of a yellow hue, of a curdy con- sistence. The bowels move frequently in health—about every four hours. Heated milk, or anything that disturbs the digestive organs, may cause vomiting and diarrhea, and reflexly act on the brain. A great many diseases of childhood are ushered in by vomiting, or diarrhea, as cholera infantum, hooping-cough ; and the expectoration swallowed in diseases of the chest is often vomited, or causes diarrhea. Frothy, acid stools, with undi- gested milk, indicate disorder of the stomach and pancreas; green, or chop-spinach stools, irritation of liver and brain ; slimy stools, common in difficult dentition, or when worms are present in bowels ; thin, fetid, dark-brown stools indicate chronic diar- rhea. Constipation is rare among children when they are fed on milk diet, until teeth are present for mastication. The Urine.—Scanty and high-colored in all fevers and inflam- mations; of an intense uriniferous odor in difficult dentition and marasmus; scanty, almost suppressed, in disease of the brain ; complete suppression may follow a fall, shock, jar; in dis- ordered liver, stains diaper a deep orange color. It will be impossible to notice the disease, accidents, deformi- ties, nutrition, dentition, of infants, in anything like order, so we shall isolate them and enumerate singly. Inflammation of the Uikbilicus.—Many ignorant medical at- tendants, self-conceited nurses, and meddling old women, insist upon various applications to the navel, especially rancid and trichinous lard, which softens, irritates, and causes ulceration at this point. The scorched linen rag, which we have recommended, is the best application : it is absorbent and antiseptic, and always procurable. The period of time that elapses before the cord separates is about four days, and in cold weather, perhaps five or six; When it has not been tampered with, a slight oozing of serum takes place, and the part heals ; but owing to some condition of irritation, that instead of healing, it may become in- flamed and ulcerated, suppuration takes place, and very serious nemorrhage may occur. When this takes place resort at once to germicide washes, for in the ulcer the streptococcus pyogenes fs ibundant, and must be immediately destroyed. So bathe it with the boroglyceride or creolin lotion weakened down to suit age, and then dress with vaseline or ozone ointment. Swelling, or Milk in the Breasts.—The breasts of the infant often swell after birth, and become engorged with serum and milk. The best plan is to open the bowels freely with oil ; give a little sweet spirits of nitre, and apply over the breasts a lotion BACTERICIDES. 521 of muriate of ammonia, and if it does not disappear quickly, belladonna in tincture form, or put on the iodide of potass, muriate of ammonia, and belladonna ointment. If still stubborn, iodide of potass, in grain doses, internally, thrice daily. Retention of the Meconium.—The black, or dark-green, viscid matter known by the name of meconium is sometimes retained in the bowels after birth, instead of being discharged freely the first day or so. Its evacuation is promoted by the first milk secreted by the mother, which is of a slightly aperient nature. As a rule, this is sufficient to bring away the meconium, but if it does not, then it should be aided by medicine ; a little castor- oil might be tried ; that not proving satisfactory, a few drops of fluid extract of leptandra in water, in which one or two grains of bicarbonate of potassa has been dissolved. The Yellow Gum.— If the meconium is not discharged promptly, its presence seems to give rise to irritation and obstruc- tion of the biliary ducts, forcing the bile back into the liver; the meconium becomes impacted in the intestines, and a condition of jaundice supervenes ; or the jaundice may be due to the dis- turbance of the hepatic circulation, on the transfer of its chief blood-supply from the umbilical vein ; or, owing to some condi- tion of congestion, there may be difficulty in the bile finding its way into the duodenum. This causes languor, indolence, yellow skin, bilious urine, a tendency to deep sleep, which keeps child from nursing, and may prove fatal. In some cases it assumes the condition of true jaundice. Treatment.—Cleanse out the bowels with oil; follow with a solution of phosphate of soda, one grain every two hours. A few drops of the fluid extract of leptandra, in the neutralizing mixture, should be given morning and night. If liver does not act very promptly, better to put one grain of calomel on the tongue, follow with the breast, and in an hour with a teaspoon- ful of oil. Tb.is may be repeated and followed with bicarbonate of potassa in a little water, the idea being to rouse up the liver, and free the gall-duct from all viscid secretion. Asphyxia, or Still-Born.—The apparent or real cessation of life in a new-born infant may be due to a variety of causes, such as inherent weakness of the vital powers; peculiar conformations ; collections of glairy matter in the bronchi and air-vesicles of the lung; the introduction of a quantity of amnii into the trachea, and congestion of the lungs, arising either from the neck of the child having been tightly encircled by the os uteri, or vulva, or navel string; or from its being long detained in the passage, from pressure of the cord in breech presentation, or where the 522 DISEASE GERMS. cord is prolapsed, or where the mother has been dosed with ergot. From the exhibition of this latter during labor, we have asphyxia, or still-born of a peculiar kind; the blood is coagu- lated in brain, heart; the child bloodless, and rarely manifests a sign of life; its blood dried up, mummified; and no method of reanimation can restore it to life. When unusual weakness of vital power seems to be the cause, and there are active pulsations in the cord, lay the child on right side, keep it warm, rub it gently; but do not slap it on either back or side, and do not ligate the cord as long as pulsations are good ; artificial respira- tion should be tried ; but blowing in the nose, and trying to in- flate the lungs are very unsatisfactory, as the air is frequently blown down into the stomach as well as the lungs. If pulsations have ceased, ligate cord at once, and try the usual means for sus- pended animation. Then cleanse thoroughly ; wrap in flannel; rub gently; use tincture of capsicum down the spine; sprinkle alternately hot and cold water on the chest, so as to get to sigh, and thereby inflate the lungs; blow on face. Try artificial re- spiration, warm bath ; and be careful while pursuing these or all those means, that the child does not lose its heat; keep it in flannel, and rub with tincture of capsicum and whiskey. It there is an electro-galvanic machine about, set it at work, apply- ing the positive pole to spine, negative over stomach and dia- phragm. This is often effectual. If respiration can be estab- lished, give a few drops of brandy in sweetened water, and repeat at intervals. When a portion of the liquor amnii gets into the trachea, and produces asphyxia, or the mouth of the infant is discovered to be filled with glairy matter, rendering the respiration difficult, sono- rous, rattling, we must wash out the mouth and throat; place child over on its belly on the nurse's lap, which will facilitate the discharge of the liquor. Having done that, we must endeavor to reanimate the child in the usual manner. If a congestion of the lungs be the cause, or if you suspect the nurse or physician has been dosing the mother with forcing- powders (ergot), then it is a good plan to untie the cord, and let from a teaspoonful to a tablespoonful or more of blood escape; then follow with warm mustard-bath, friction to surface. Slap- ping the infant is always reprehensible, as its lungs, liver, spleen, kidneys, and other organs, are so soft that they are liable to lacerattion. In all cases adhere to the rules laid down for suspended animation. Medical men are often called upon to give evidence in cases of supposed infanticide; it seems proper to mention that much careful observation and experience is required to discriminate bACTERICIDES. 523 between a child that is still-born, and one that has lived only a short time after its birth. Various appearances, both internal and external, may be mistaken for marks of violence. Even the floating of the lungs in water, a test on which much reliance is placed, is found on many occasions to be fallacious; for they will float if a putrefactive process has commenced, as well as when filled with air by respiration. It may also happen that an unmarried woman, on arriving at the full period, and having con- cealed her condition, may be taken ill alone and be delivered of a live child; but that, either from syncope ensuing speedily, or from a convulsion, or from less of reason, or a distracted state of mind, or some other cause, she may be so far overcome as to be rendered incapable of assisting herself or child, and it may have been suffocated by the bed-clothes. In other instances it may happen that the child is born alive, still, from some injury in the birth, or inherent weakness, or some other obscure cause, it may cease to breathe without receiving any injury from the mother. No doubt cases of this nature are of daily occurrence, and they point out the impropriety of placing any reliance on the floating of the lungs in water as a test of infanticide. The dictates of humanity and reason require a radical change of this method of evidence, as it has been often injudiciously used. Excoriations, Chafing, Ulcerations.—From a want of care, neglect of proper cleanliness, children are very liable to chafe, or excoriate, in the folds of the neck, behind the ears, in the groin, and around the arms. To prevent this, there should be a removal of all damp or soiled linen promptly, the parts dried and exposed to the air. It is a good plan to bathe all excoriated parts in warm milk and water twice or thrice daily, or an infu- sion of sage tea and boroglyceride, and afterwards dust with pulverized starch, or anti-microbe powder, or rub over with vaseline. If the excoriations are of considerable extent and depth, use a solution of boroglyceride for a wash, and apply the ozone ointment for a dressing; this will heal them rapidly. In obviating excoriations, it should be our aim to prevent the secre- tions of the body from mingling with them. In tubercular children, about the time of teething, when the child suffers from malnutrition, bacteria are very abundant in alimentary canal, blood, and they find their way about the skin of the ears and other parts, which gives rise to sores, the secre- tions from which are highly contagious. In these cases, an effort must be made to correct the malassimilation, by sulphate of cinchona and elixir cinchona. The sores should be bathed with a decoction of poppies, and either kept dry by dusting on anti-microbe powder, or applying ozone ointment. 5-M DISEASE GERMS. If the case is stubborn, push better food ; pure air; and alter- atives, as iodide of potass; and use stronger antiseptic washes locally. Non-expansion of the Air-cells of the Lungs.—It often happens from a weakness, or from a long, tedious labor, or from severe compression of the head, or from the little one's blood being coagulated by ergot administered to the mother, that it is unable to inflate its lungs perfectly; that there is a non-expansion of the air-cells, and the infant looks as if about to die. It soon be- comes jaundiced; cry consists of a mere whimper; inability to nurse ; drowsiness, exhaustion, are great; surface cold and livid ; chest but partially dilated by imperfect respiratory movements; the lung condensed, but the consolidation will give way as strength is gained; and good health may be attained, or death may occur from exhaustion and convulsions. To prevent this, bathe the child, wrap up in warm flannel in a room 8o° F.; hot bath twice every twenty-four hours ; massage gently with sweet olive oil, especially about the chest and abdomen; nourish every two hours with juice of raw beef, or milk and lime-water; open bowels with magnesia. Cephala?matoma.—If the labor has been long, tedious, or the head large and pelvis small, or the presentation a difficult one, it is very apt to so compress, or stagnate, or rupture vessels on the scalp as to cause the formation of a bloody tumor after birth between the bones of the skull and pericranium. Long-con- tinued pressure is the cause. Symptoms.—Tumor varies in size from a hen's egg to that of a large orange. It is generally formed on one of the parietal bones; on right more frequently than left, and occasionally on both. Swelling is soft, fluctuating, and circumscribed ; its base often becomes encircled with a hard ring, caused by the coagu- lation of the plasma exudation. Treatment.—Never incise, nor apply compression ; administer a gentle purge, and apply a solution of muriate of ammonia, not very strong. If anxious regarding it, a solution of iodide of potass, five grains to the ounce of lime-water, and apply. Convulsions of Infancy.—There is a very rare form of convul- sions occasionally met with in infants, which is epileptic in its character, and leads to impairment of the intellectual faculties. It consists in a peculiar, involuntary, rapid bowing forward ol the head, and in some cases the whole body. The bowings are repeated in quick succession, one following the other, occurring every day, or less frequent; usually worse in the morning, or when awaking from sleep, After child grows old, regular epi- BACTERICIDES. 525 leptic attacks take their place ; pure epilepsy, or convulsions, or paralysis, and wasting may follow. By attention to bowels, skin, and administration of alteratives, the symptoms will sub- side, and the health be completely restored. Treatment same as for Epilepsy aud Convulsions. Nine-day Fits.—There is a peculiar form of tetanus, or lock- jaw, that occurs in infants about two weeks after birth, and is very fatal. It is supposed by some to be due to cutting the navel-string or cord with blunt scissors, or to the application of irritating agents about the navel. Others imagine it to be due to cold, foul air, improper feeding, imperfect bathing, retention of meconium, ergot to mother. Precautions ought to be taken in the dividing of the cord that it be done by clean-cutting scissors ; that no irritants be applied to navel; that the child be properly seen to by proper bathing, pure air, cleansing out its bowels with oil. Hide-Bound; or, Sclerema.—A peculiar disease of new-born infants, consisting of an induration of the skin and subcutaneous tissue, with serous effusion, occurring at birth, or within ten days subsequently. It seems to depend on the latent elements of syphilis. Symptoms.—The skin, at first is dry, stiff, withered ; then as- sumes a waxy, yellowish appearance, and gradually becomes dis- tended and unyielding; so the babe is said to be skin-bound. It grows cold, prostrated, unhealthy, and often jaundiced. Indi- cations of distress in restless, whining cries ; refuses the breast; feeble pulse and laborious respiration. Gastric and intestinal disturbance sets in, and death is ushered in with prostration and asphyxia. Treatment.—Use warm bath ; inunction of oil; flannel; solu- tion of raw beef, and one-grain doses of iodide of potass ; milk and lime-water ; keep bowels open with neutralizing mixture, and see that kidneys act well. Death is almost inevitable. Hiccoughs.—Some infants are greatly incommoded by hic- coughs. They usually arise from some acidity of the stomach, or from some nervous irritation. If due to acidity, try a few drops of lime-water in milk ; a grain of bicarbonate of potassa, in milk, or the neutralizing mixture. If due to nervous irritation, try one drop of chloroform, in water, sweetened, or tincture of aconite, or belladonna; or a few drops of aromatic spirits of ammonia in water; or some aro- matic tea, as catnip, anise-seed, caraway. In some cases a few drops of vinegar prove very effectual. If persistent, and not relieved, then some stimulant to spine and over stomach, as soap liniment and lobelia. 526 DISEASE GERMS. Our Infantile Mortality.—Our country, noted for every practi- cal improvement, every species of philanthropy, everything cap- able of ameliorating human toil and suffering, suffers the great- est infantile mortality in the world. Much of this k due to solar heat, city life, insanitary conditions, special diseases, but the greatest causes are bad feeding and improper drugging. The practice of not nursing, or weaning early, is now becoming more common, as the struggle for existence becomes greater, so as to enable the mother to work. As a result, the babe is fed on starch, farina, corn-flour, boiled bread, sour, or swill milk; articles it cannot digest; so that it starves—takes marasmus; because it has lost the main factor of nutrition, mother's milk, it sickens, dwindles and dies. Parents cannot be too frequently in- formed of the unsuitability of farinaceous food for children. The practice of an American mother in this land of freedom and wealth being compelled to work during pregnancy and nursing drains away the life and vigor of both mother and child. It makes the mother prematurely old, and stunts the growth and destroys the vitality of the child. A mother's labor, a mother's worry and strain should be minimized by every possible means, and work avoided. As for drugging babes, it is a great wrong, and the immediate and remote cause of much mortality. Think of the millions of bottles of soothing syrups that are annually consumed, all loaded with opium, which whittles down and mummifies our new growth. Introduce a better system of feeding; milk-food free from starch; abolish drugging, and we will save this element of national greatness that is now lost. Infantile Syphilis.—Parents, either father or mother, affected with the syphilitic germ, are liable to transmit it to their off- spring. In the case of a father affected, and the mother free from the disease, the healthy uterus of the mother is likely to repel the diseased fcetus at four or seven months, and cause an abortion; but in some cases the mother may carry her preg- nancy through, and the child may be born, apparently free from disease. But in a period of time, usually inside of six weeks after birth, the original pock of the father will appear on the skin of the child in the shape of blisters about ears, nose, face, body, arms and legs, forming a regular rash, copper-colored. Very soon there is a general shrinkage, or shrivelling of the skin, with general syphilitic ulceration of mouth and throat, and other parts. In other cases, the infant may be born with the withering effects of syphilis visible all over its entire body; its hair may drop off, and general ulceration may occur. In still another class of cases there may be no visible appear- BACTERICIDES. 527 ance on skin, but the disease may exhibit itself in the bones, in a separation of the growing extremities of the ends of the long bones, which leads to the separation of their epiphysis. This affection of the growing bones seems to be painless, and even more amenable to treatment than the skin eruption. Same treatment as for Adult Syphilis. Physicians meeting those cases in every-day practice, see the imperative need of legislative enactment to prevent the marriage of parties afflicted with this malady, entailing disease and death upon their offspring. Syphilis is a contagium vivum just as much as small-pox, and some gigantic effort is necessary to prevent its wide-spread dissemination. Teething.—Of all the occurrences to which children are liable not one is attended with such grievous and distressing symptoms as difficult dentition. With regard to the time of their cutting their teeth, no fixed or exact period can be laid down ; as in rare cases, some are born with teeth, others have them soon, others very late, and others extremely late. As a general rule, dentition commences, in the large majority of children, between the fourth and eighth month, and the pro- cess continues until the seventeenth month, and often later. The two front teeth of the lower jaw are those that usually appear first, and shortly after these are observed two more come out in the upper jaw, exactly opposite the two former. These are suc- ceeded by the four molars, then the canine, and, last of all those of an infant's first teeth, the eye-teeth, make their appearance, making sixteen in all. This is the ordinary number of a child's first teeth, as they are called, but some infants cut four double teeth in each jaw instead of only two, making the number twenty. In children who are healthy and strong, who have a good mother and abundance of milk—a mother who eats a wholesome diet, with daily meal of oatmeal porridge and cream, corn-bread, and boiled fish, the process of dentition goes on with perfect re- gularity, and the teeth are cut early, and without a particle of trouble or pain ; but in the unhealthy and weak infant, who has a mother reckless of her diet, the process of dentition is slow, tardy, uncertain, painful and difficult. So that we meet with children cutting their teeth in a very irregular way; perhaps the teeth appearing in the upper jaw at intervals apart, or overlapping, and the same in the under jaw, and various other condi- tions, which are attendant on tardy, difficult, or painful den- tition. The first two teeth give a pretty good index of what is to follow, the succeeding ones generally making their way in a corresponding manner. This first set is called the milk-teeth, 528 DISEASE GERMS. and are generally shed when the child becomes six or seven yeai> old, according to their diet and health. At six or seven years of age, when the shedding begins, it is followed, in a gradual manner, by a fresh set; and about the age of twenty-one they get one more in the corner of each jaw, which, from their appearance at that period of life, have been named their wisdom-teeth. The following table exhibits a fair average of the eruption of the teeth : DECIDUOUS TEETH. ( The lower generally precede the upper by taw or three months.) Central incisors................5 to 8 months. Lateral "................7 to io 1st molars..................12 to 16 Canines .................15 to 20 2d molars..................20 to 36 PERMANENT TEETH. 1st molars.................5 to 6 years. Central i> ci>or>...............6 to S " Lateral inciM>r>...............7 to 9 " 1st bicuspids................9 to 10 2d " ................ 10 to 11 Canines..................II to 12 " 2(1 molars..................12 to 14 " 3d "..................17 to 21 " Difficult Dentition.—Permature decay of the teeth is in a great measure due to the want of vegetable phosphates in the mother's blood ; to her neglect of the daily use of oatmeal, corn-bread and boiled fresh fish ; and the use of bakers' bread as diet. This also predisposes the mother to nervous diseases, which correlate to the deterioration of the teeth, each influencing, and, in a mea- sure, causing the other ; besides, the modern system of over- stimulating the nervous system by early precocity, causing a defective process of assimilation- and tissue-formation, especially in teeth. Symptoms.—Difficult teething exhibits itself in a variety of ways, but the great bulk of the symptoms are reflex—irritation transmitted to a weakened bulb and cord. The child becomes fretful, its skin white ; nutrition is impaired; the gums swell, spread, become hot, tender; the child is continually working with its mouth, desiring to bite something; irritable, restless, peevish; some fever; increased heat in the head, or pallor, with dilatation of pupils; there is often a hectic flush on the cheeks, with erup- tion on the skin, especially on face and scalp; a looseness of the bowels, with griping stools, of a green, pale or leaden hue, BACTERICIDES. 529 sometimes mucus; and the child becomes very peevish; starts in its sleep ; eyes partially open ; rolls head, and throws its arms about, and seems convulsed in particular parts of the body. It exhibits great indications of brain-irritation; in some cases screaming, throwing head back, thrusting its fingers into mouth; in other cases there is cough, difficulty of breathing, emaciation, marasmus, great fever, thirst, convulsions and a bad train of symptoms. When the child is properly cared for, its secretions and excre- tions kept natural, and elements supplied in its milk from which nature can make teeth, very few of the violent symptoms attend- ant on such a condition occur, and we need not apprehend any bad symptoms from teething. Infants cut their teeth more easily and readily in winter than in summer; boys more difficult than girls. What is to be apprehended is the reflex condition, which affects all children to a greater or less degree. Treatment.—The irritation of teething causes the gums to swell and become tender to the touch ; there is fever, with irritation of nervous system, with occasional convulsions. In such cases, where the gums are considerably swollen, and the child seems to suffer much from the irritation of the tooth in working its way out, and when the tooth is near the surface, it will be exposed by the retraction of the gum, then it may be advisable to relieve it with a lancet; when no such appearances present themselves, and the child is very restless and uneasy, we can do little more than attend to the different symptoms. In the mildest forms of dentition, sedation is very useful; bathing twice daily; put thirty drops of tincture of aconite in half a tumbler of water, and give a teaspoonful every one or two hours ; if there be strong nervous symptoms, with a tendency to convulsions, add a few drops of tincture green root gelsemium. If the breath is very acid, lime- water and milk, or the neutralizing mixture, or ozone-water; if there seems to be griping, open the bowels with cascara, and fol- low with infusion of anise-seed. The above also will relieve the bowels if constipated. In some cases a grain of leptandra rubbed up in pulverized licorice is very efficient. If there is restlessness, violent startings, with screamings and twitchings—precursors of convulsions ; bromide of potass and ammonia in lavender or cinnamon-water. Opium, or laudanum, or paregoric, should not be administered to teething infants for the purpose of keeping them quiet. It is a most injurious practice; dries up their secretions, and whittles down their vital force. Mothers, and especially nurses, are prone to resort to that drug in some soothing syrup, so as to have their own rest undisturbed. The only drugs of real merit are lime- 34 530 DISEASE GERMS. water in milk, compound hypophosphites of lime and soda in juice of raw meat, and ozone-water ; two of which could be given at alternate periods, say, every two hours; otherwise the treat- ment must be upon general principles. If there is fever, aconite and asclepias should be given ; urine scanty and high-colored, parsley-root tea and sweet spirits of nitre. Watch convulsions; let mother have tincture of lobelia on hand, and if she sees twitchings or throwing head back, alternate pallor and redness, administer a few drops as occasion demands. A free action of the bowels during dentition should not be stopped; not unless the motions are very frequent, and then guardedly. Any other symptom that arises should be managed upon general principles. The practice adopted of giving infants toys made of hard rubber or ivory to suck and hold in the mouth, upon which they can press their gums during teething, is highly improper, as it has a tendency to harden the gums. Aphthoe, or Nursing Sore Mouth, is most common in ill-fed children, and the parasite present often makes destructive ulcera- tion of the gums. (See Aphtha?) Pure air, proper exercise, wholesome, nutritious milk; flannel clothing, regular bathing, secretions, and everything that is calculated to promote good health, will greatly contribute to the safety of dentition. At the same time guard the reflex centres, by keeping them well stimu- lated by proper means. In all cases of tardy, difficult, or painful dentition, we must never ignore the main defect—a want of histo-genetic material in the blood; provide in all cases material from which the sys- tem can elaborate teeth. Weaning Brash is a term applied by mothers and nurses to a disorder that takes place upon being suddenly deprived of the mother's milk by disease, pregnancy, or death, or where children are reared artificially with bad milk. The use of the milk-food has stamped this disorder out. It consisted in derangement of the stomach, vomiting and purging, with green stools; and if it occurred during the hot weather, speedily merged into that fatal disease, cholera infantum, with its sequel, tabes mesenterica. A quick transition from one kind of food to another should never take place; it should be progressive, and adapted to the age and condition of the child. Malformations and Deformities.—Some attribute them to im- pressions made upon the mother during pregnancy, and there is no doubt but this is a fruitful source; others attribute them to defects, or deficiencies, or absence of certain histo-genetic mate- rial in the body; and others, to a variety of causes. But there can be little doubt that by far the most prolific causes of deformi- BACTERICIDES. 531 ties are incompatibility of temperament, close consanguinity, in- and-in breeding. Although this is the main source of the trouble, it would be well in our present state of civilization, where the nervous system is developed at the expense of the physical, where the brain is alive, vivid to external impressions, to guard pregnant mothers from theatre scenes, deformities, animal or fowl killing, choreaic movements, fits, appalling accidents, death, or anything of an unfavorable nature that would be likely to impress her keenly or acutely. Defects or mutilations may also be classed under the same causes. Imbecility, an abrogation of the facial angle of forty-five, or idiocy, is likely to be due to the use of whiskey and tobacco by the father, the former causing true imbecility, the latter wiping out the typical convolutions of the brain. As a rule, all extra fingers, and toes, and other malformations, should be rectified at birth. Tongue-Tie.—The tongue may be unnaturally adherent to the sides, or to the under surface of the mouth, so that nursing may be prevented. The adhesions must be carefully and cautiously divided with a bistoury and the bleeding controlled by the perchloride of iron. Genuine tongue-tie is when the bridle of the tongue is so short as to reach nearly to its tip and interfere with its motions. This is to be remedied by dividing the edge of the bridle with the scissors. Hare-Lip.—The simplest degree of this deformity is single hare-lip, in which the lip is fissured on one side ; it may be com- plicated, with partial or complete fissure of the palate. The greatest malforma- tion of this kind is ^ m double hare-lip and Jw^n fissure of the pal- ^jp^ ate. The arrest "-^^F* of development oc- Different foms of hair.lip curs only in the upper lip; the fissure never occurs in the median line, but always under one or both nostrils, and the deformity may vary from a notch to a complete fissure, extending into the nostrils. The only point of interest is the treatment. The operation for the relief of this difficulty should be performed immediately after birth. The child, after being properly nourished, should be wrapped up in a sheet; the edges of the cleft should be liberally pared, and then hare-lip-pins inserted two-thirds the thickness of the lips, from its anterior face. A sufficient number of pins should be used, and over each the figure 8, formed of lead wire, which should have the preference to silk. 532 DISEASE GERMS. Cleft Palate is often associated with hare-lip, and frequently closes when the lips are healed. The operation for this has generally to be delayed till patient becomes ten or fourteen years of age, or even older. Wry-Neck.—A distortion in which the head is drawn to one side, and the face to the opposite; due to contraction of one sterno-mastoid muscle. Paralysis of one muscle allows the other to overpower its fellow. Causes.—Blows on neck ; caries of cervical vertebrae; enlarge- ment of cervical glands on one side; to the cicatrix of a burn or ulcer ; rheumatism ; gout. Treatment varies much, generally embraces alteratives and tonics, with shampooing, friction, electricity of the paralyzed side. Try every means to improve general health ; all failing, the muscle on sound side to be divided. Knock-knees, due to a relaxation of the internal lateral liga- ments of the knee-joints, allowing femur and tibia to become separated, so that an angular obliquity of the bones results. It is common in tubercular children ; may be noticed before beginning to walk. The best plan is to treat for tuberculae, and resort to every means to build up the general health. Massage, locally, twice daily. Bow-legs belong essentially to rickets, and is generally due to starch-feeding of infants. It can be overcome by a better diet, one containing vegetable phosphates, as corn and oatmeal mush, boiled white-fish, animal food, etc.; keeping patient off his feet, and in addition, using locally, massage, salt-water baths, and general treatment for tuberculae. Perseverance is essential, as many months are indispensable for a cure. Club-Foot.—A gradual change in form and positions of tarsal bones, chiefly owing to undue action, or paralysis of certain mus- cles, or their atrophy, or want of development, or to contraction of tendons. Usually congenital, and dependent on same causes as other malformations; or it can be acquired by conditions affecting either the circulation of nerves, or growth of muscles. There are quite a number of varieties, but for all practical pur- poses they may be embraced under four principal heads. (i.) Talipes Equinus: This is the most common form, and consists either in a rigid contraction of the tendo-achillis, of the muscles of the calf of the leg, so that the heel cannot be brought to the ground, and the patient walks on the metatarsal bones. When this is not congenital, it is liable to occur during dentition, from worms, acidity and other reflex causes of irritation. The patient, either from incompatibility or other causes, is very tuber- cular; and the slightest irritation in the body is transmitted to BACTERICIDES. 533 the weakened nerves. A cure is easily effected by a division of the tendo-achillis under the skin. (2.) Talipes Varus: The heel is raised, the inner edge of the foot is drawn upwards, and the outer edge rests on the ground. In extreme cases, patient walks on dorsum of foot and outer ankle. There is contraction of the muscles of the calf and ad- ductors of the foot. Every tendon that aids in producing the deformity should be freely divided under the skin, and, last of all, the tendo-achillis. (3.) Talipes Valgus : This is the direct reverse of the talipes varus. The outer edge of foot drawn upwards, so that patient rests on inside of instep and inner ankle. All the tendons that are concerned in producing the deformity are to be cut under the skin. (4.) Talipes Calcaneus: Elevation of the toes and falling on the heel, so that the patient walks on the latter. This is usually brought about by loss of nerve-power, or degeneration of the muscles of the calf, which affords the opposing muscles a chance of drawing the foot into the abnormal position. Every tendon to be divided subcutaneously, so as to bring the foot into its proper position. The principle upon which the tendons of the various muscles are divided is very simple : A cut, or incision, is made under the skin, so as to prevent any suppuration ; the cut surfaces, or ends, although stretched apart quite a space, heal by connective tissue or lymph, which lengthens the tendon the amount desired. It is necessary to wear a boot if performed at birth, as it ought to be, or a week after. When not congenital, but coming on during childhood, many cases can be cured without operation by the removal of the source of the irritation, by good food, fresh air, sea-bathing, tonics and by shampooing, friction or massage, with oil, and a proper use of bandages, splints, boots, adhesive plasters and the like. Rheumatism and gout should be carefully guarded against. We cannot too strongly insist upon a most constructive treat- ment as the best means of overcoming the true cause of the difficulty. Flat Foot.—A sinking of the sole of the foot from relaxation of the supporting ligaments. Walking is rendered awkward, slow, painful, and in bad cases, lameness and deformity. It is usually the result of debility, and can be remedied by the mother when the child is quite young, by bathing, friction and good nutrition. Webbed Fingers and Toes.—In rectifying this malformation, the best plan is to make a small incision at the junction of fingers 534 DISEASE GERMS. or toes, through which introduce a piece of lead ribbon which should be permitted to remain about ten days, so as to give ample time for healing. Then remove and slit up the web its entire length, and dress with the lead ribbon, or otherwise. If the above method is not observed the webbing often returns. The Nutrition of the Infant.—Milk is the natural food of the infant up to the period when it is supplied with teeth for masti- cation. Its stomach is adapted solely for its digestion, and it is the only proper element for building up the body. Milk, if healthy, supplies everything for the whole organism, from which bone, muscle, brain, gland, etc., can be constructed, repaired and renovated. Milk is pre-eminently suited for the rapid oxidation, increased temperature, accelerated respiration and circulation, the only diet for building up infant organization. The milk taken by the child represents so much potential energy; but before that energy can assume a vital form, the food must be converted into tissue, and in that conversion a large amount of energy must be expended. All the constructing and repairing powers in the in- fant are more active than in the adult. The infant requires, over and above the wants of the man, not only food for flesh laid on, but also for the energy used in making up that living, sculptured flesh out of materials that serve for food. In the growing organ- ism there is a greater instability in the nutritive process, and this instability must be guarded against by having good milk, else we will have defects in blood formation. American mothers have been accused of being bad nurses. Now,this is both true and false; true, she is highly civilized, quick, excitable, and often, in the act of nursing, allows care, worry, to distract her attention; will hastily lay her little one down before it has even partially emptied the breast, which act of all others causes the milk to dry up; true, she is absorbed in lectures, theatres, balls and other frivoli- ties, which engender late hours and irregularity, which has a de- pressing effect upon her; and her literature is not good ; true, her diet is not the proper kind or quality for a nursing mother, her ices, ice-cream, iced drinks, candies, pastry, etc., are pernicious and highly detrimental to the secretion of milk; but let her re move these and other defects, she is as good a nurse as any other mothers of her race. Take the American mother, free from toil, care, struggle for existence; free from the vices and depressing influences of city life, with a good diet of beef, mutton, poultry, game, eggs, milk, oatmeal porridge, corn-bread, carrots, parsnips. fruit and other vegetables, she is a good nurse. Excess of feed- ing, alcoholic or malt liquors, wines and sloppy food, never should be recommended ; neither is tea nor coffee of any utility. The nutrition of the child is of the greatest importance, be- BACTERICIDES. 535 cause in all our large cities we lose two-thirds of our entire infantile population during the first two years of existence, chiefly by bad milk, careless or improper nursing, insufficient food, and insanitary conditions. The mother's milk is too often deteriorated by fashion, theatres, improper food, worry, work, and other causes, and the want never can be supplied by artificial means, for there is no substitute for the life-giving mother's milk. If we could only teach mothers how much suffering they could save, how many valuable lives they could prolong, by seing that their children have proper food, it would be a holy task. Many modern mothers can only nurse their children partially, or not at all. Their milk is often deficient through improper diet, and not emptying the breast properly; besides, the secretion decreases by care, worry, struggle, work, or her health may be feeble or delicate; or her vital energies taxed by some latent condition, that she may have no milk. In this condition the infant must have nourishment; if rich, a wet-nurse could be provided ; if poor, the cow's milk, or milk-food. As regards wet-nurses, there is always great danger to be ap- prehended from them in a moral and physical point of view. They are generally unfortunate women, women with hidden vices, uneducated, full of prejudices and disease, and the irregularity of their past life has a bad influence on the milk and moral well- being of the child; and it is doubtful, rather than run risks of moral and physical degradation, whether artificial nutrition, administered by its own mother, or some other intelligent person, properly adapted to its age and development, is not the best. Artificial nourishment is often better than run the risk of wet- nursing. The great trouble of late years, in this particular, has been that parties, by advertisements and certificates of ignorant physicians, have foisted upon the people an immense array of infant food, all chiefly composed of starch. Indeed, starch-food is forced upon the mother wherever she goes, as a diet for her child. Now, our infants cannot digest starch, their stomachs are not made for it, neither have they the means of converting it into sugar, like an adult; so children fed upon starch, as rice-flour, farina, Liebig's food, arrowroot, starve; they have no teeth; their bones and brain are destitute of phosphates. God never made a Caucasian infant to eat starch; there is not a trace of it in the white mother's milk. A Mongolian or Negro, without cerebral convolutions, may thrive on it, but never the white race. So, if there must be artificial feeding, let us have cow's milk or milk-food; and with greater care, more fresh air, rigid cleanli- ness, abundance of sleep, an avoidance of insanitary states and contagious diseases, we may be able to raise the child. 536 DISEASE GERMS. The proper food, then, of all infants, is milk. That gives everything wanted—development and growth ; on it they arc healthy and thrive. The first two months of life, cow's milk, two-thirds, water, one-third, with very little sugar, comes very near that of mother's milk. There is still a difficulty here: if a cow is fed on pasture alone the milk is very poor ; but if they are fed with corn-meal and bran, in addition to abundance of good pasture, the milk is excellent; and besides, it must be seen that the cow is free from foot-disease, or tuberculosis, and the milker not affected by syphilis. In all our large cities there is much impure milk—milk loaded with diseased germs; besides, nearly all the high-bred cows are affected with tubercle ; so if matters are not of the purest kind, condensed milk should be used : for in the process of manufacturing, the diseased germs are destroyed. About the third month nourishment should be more substan- tial ; for that is the period for true, rational nourishment to be given for the future welfare of the child. The Racine Malted Milk Co., Wis., has placed bef >re the American parents a nour- ishment for children at this period that is unsurpassed, and satis- fies all the physiological and chemical demands. It consists of the best miik, the wheaten phosphates, no starch, best cane-sugar, and a normal quantity of saline matter. The combination is perfect, and the most appropriate for infant-food, and of immense value as an article of general nutrition. It is highly nourish- ing, its composition is pure, fresh, superior to anything ever introduced ; it is very easily digested ; keeps well, never fer- ments or sours; and is better than city milk, because it is free from all diseased germs. Besides, it nourishes brain and bone well, consequently teething is easy ; excellent for debility; chil- dren and invalids never tire of it, but. rapidly increase in flesh and strength upon it. It is so excellent in teething that they come easy, regular, without suffering; no diarrhea, or vomit- ing, or skin eruptions. It supplies a long-felt want, to wit: a per- fect form of artificial nutrition—the best that has ever been offered in the world. The milk-food is intended to be used when the infant is about from two to three months old. Its superiority consists in its containing no starch, which has been so detri- mental to the digestion of children ; and to the fact that bone and brain elements in it are abundant. As soon, as the child has completed its dentition, the mouth, salivary glands, stomach, and pancreas become gradually adapted to digest solid food, and a change or transition from milk food should be very progressively made. Modern children are per- mitted by both parents to take the ordinary course of the house, BACTERICIDES. 537 which is a great wrong on the part of the parents. For exam- ple, the use of tea and coffee by children is very injurious, as it overstimulates and exhausts their nervous systems; gives rise to catarrh of the stomach in their period of infancy, and pre- disposes them to dyspepsia and cancer of stomach in more mature years. The use of sweets, ice-cream, pastry, dumplings, is also improper food, because the gastric juices are not strong enough for their dissolution; so also with pork, veal, cabbage, nuts, salt fish, and corned beef, totally unfit for the diet of a child. Children should be early taught the injurious effects of drinking at meals. Whatever fluids are necessary should consist of milk or water. A new system of dietetics should be inculcated, or rather, an old method revived, among the children. All, irre- spective of sex, or condition in life, should, from weaning, up till twenty-one years of age, have a special diet—one of brain and bone-elements ; one hearty meal daily of oatmeal porridge and milk or cream. This should be a daily meal from September ist to May ist; during the very hot months of the summer, better to discontinue its use, as it is somewhat heating. Corn-bread, made without baking-powder, should be a daily and staple article of diet; boiled white-fish and home-made bread.- Bakers' bread, with its noxious compounds of soda, tartaric acid, alum, sul- phuric acid, etc., is unfit for child-food, as the phosphates are •destroyed in the process of whitening. The oatmeal, corn, and fish diet should be insisted on, as calculated to promote the nutri- tion of brain and bone. No baking-powders should be tolerated in the culinary department of any family, as their use is destruc- tive to the phosphates in all our cereals. To the toothless babe starch diet is starvation, but after dentition is completed they can digest starch; but in our climate, with its highly oxygenized atmosphere, our children do not require much starch-food, such as potatoes, arrowroot, tapioca, rice; there are no brain elements in them—not of thought; they are converted into sugar, and hus into calorification—a process not very essential to the pre- cocious American ; so, as a rule, they should be sparingly fed. Carrots, parsnips, onions, vegetables, and ripe fruit generally are conducive to health and longevity in the child. The Child—its care and culture, warding off and curing its dis- eases, must be carried out on physiological principles. In look- ing at the dawning intellect, we must remember that mind is brain-function, just as locomotion is one form of muscle-function. The brain, as it matures, acts, thinks, reasons, judges, and forms purposes. As the size, weight, form, and development of the bony skeleton, with its muscular apparatus, determine the limits and nature of physical power and activity, so do the size, weight, 538 DISEASE GERMS. form and development of the brain, with its apparatus of sense- organs, determine the limit and nature of intellectual power and activity. Its personal characteristics are passed down from the parents ; so that there are mental and moral qualities offering themselves for care and culture. The aggregate qualities of the parents, embodied in the child, are subject to surrounding influ- ences. It is essential to recognize this initial fact, so as to develop the good, and repress the evil elements of its nature. Every child is charged with potential energies that need to be stimulated for good, trained and taught in a manner and upon a principle peculiar to her or himself; the influences brought to bear upon it; the tasks imposed; the exercise of its body and mind—its regime, selected and graduated to its undetermined nature, and its special needs. A partial death of a portion of the body, Inflammation, and involves a condition of vital depression, and degradation of the bioplasm of the part. The causes are very numerous, and embrace everything that diminishes, damages, or tends to destroy any part of the body, such as heat, cold, wet, poisons, depressing passions, mechanical violence, etc. The permanent symptoms of inflammation are pain, heat, red- ness, swelling^. Pain is a symptom of partial death, of deficient vitality, or vital depression. It differs in structures and tissues according to their physiological function, chemical composition and anatomical structure. The nerve-tissue being intrinsically the most valuable, most highly organized, and vital, is the most resisting, the most diffi- cult to depress, and when once devitalized the most tardy of all structures to regain its vitality. The pain also, when it suffers a partial death, is out of proportion to all other pain, especially so if the brain has suffered the shock; here it is frontal, and aggra- vated by noise, light, heat and motion. If the skin suffers a partial death or inflammation, the pain is burning, tingling; if the cellular tissue, throbbing; if the serous membranes, like pleura, sharp, lancinating; if the mucous mem- branes, sore, raw; if in bone, dull, deep seated; if in cartilage, more intense. Pain may not be experienced in the inflamed part, but reflected by recurrent nerves to a part at a distance, as for in- stance, in inflammation of the liver the pain is in the shoulder; of the kidney, at the orifice of the urethra; of the ovary, in the BACTERICIDES. 539 front of the thigh; of the uterus, in the sacrum; of the hip-joint, at the knee. The heat of inflammation is caused by the semi-vital chemi- cal change, the passage of organic into inorganic matter, the per- version of nutrition, rapid oxidation, molecular excitement and general metamorphosis of structure. The congestion and redness are due to the lost contractility of the walls of the blood-vessels, whereby their walls become loose and lax; the blood rushes in and the minute capillaries being also relaxed, red blood circulates where white only passed through, and the walls being so relaxed the more watery portion passes through their walls. The blood-vessels owe their con- tractility to the nerves that supply them, so the vitality of the part or its nerves being so weakened permits of the changes ; indeed, its chemical character is altered ; in health neutral or alkaline, it is in inflammation intensely acid. Besides a change in secretion, there are important changes in the structure of the part, as degradation of living matter into disease-germs which cause it to spread. Inflammation has but one genuine termination; resolution or recovery; the subsidence of the inflammation and the restoration of the part to its original condition ; but besides this legitimate termination, there may take place from various causes the follow- ing effects, viz.: Effusion of serum, effusion of blood or hemor- rhage ; effusion of lymph; the breaking of lymph and formation of pus ; ulceration ; gangrene, or mortification. Inflammation may be either acute or active, sub-acute or pas sive, and chronic. It is called acute when it sets in and runs its course rapidly, when the symptoms are all well defined and are accompanied with rigors and fever; sub-acute, same as the acute, with the exception that there is no fever. Chronic may be either a sequel of an acute or sub-acute attack, or it may come on per se. It is liable to occur in patients of low vitality. It usually progresses slowly, insidiously; symptoms not well defined; no fever, and has a tendency to terminate in effusion of serum or thickening. Each form of inflammation is characterized by a special microbe of its own, which renders all inflammations to a degree conta- gious and infectious. The permanency of the pain, heat, redness and swelling is the best point by which to recognize inflammation. The correct treatment of all inflammation is powerful local and internal stimulation. A stimulation so powerful and so effective that will run the case in resolution. The local stimulants should be of such a character that they will stimulate to the point de- 540 DISEASE GERMS. sired and still not impair or destroy in any way the future in- tegrity of the tissues ; induce contractility of the blood vessels and overcome partial death. The class of internal stimulants of most utility are exalgine, aconite, veratrum ; these tend to lower tem- perature by checking the chemical metamorphosis, vivifying and toning the vessels. No case of inflammation can be treated with success without the use of bactericides; even ordinary bacteria of malnutrition require to be killed. If the largest dose of an arterial sedative, warranted by the nature of the case and good judgment of the physician, does not ameliorate the pain, then the impressibility of the sensorum must be blunted by anodynes to secure an entire freedom from pain. General attention should be directed to hygiene, rest, diet, sponging and secretions. If it is impossible to secure resolution by these means, then the case will terminate in either one or other of its six termina- tions or effects. Effusion of serum may occur during inflammation of any tissue, but by preference from serous membranes, as the periosteum, membranes of the brain, the pleura and peritoneum ; the cellular tissue is also obnoxious to serous effusions. When effusion of serum takes place, whether it be from membranes of the brain, pleura, peritoneum, or cellular tissue or other structures, it con- stitutes what we term dropsy, not a disease, a mere mechanical effect. Serous effusion, however, often gives rise to much trouble, especially if within the cranium, chest, or abdomen; in the extremities it constitutes what we term oedema or dropsy, pitting upon pressure. Although not a disease, its presence is liable to bring about grave complications, and it must be got rid of at the very earliest moment the inflammation can be overcome. The serum effused in the process of inflammation is a fluid of pathogenic microbes, of which neither the origin, kind, nor quantity can be accurately ascertained. These microbes exercise a morbid effect on the adjacent tissues, and constitute a febrile element in the body. To get rid of serous effusion, the appetite should be stimulated with tonics, as teaspoonful doses of compound tincture of cin- chona, before meals, and the very best of blood-elaborating diet given.' Before making any decided attempt at the removal of the dropsy, place the patient upon an infusion of digitalis for a few days. To half a pint of water, boiling briskly, add one or two grains of fresh pulverized digitalis, boil for five minutes, then cool and administer one wineglassful every two or three hours; continue from day to day till the patient becomes quite BACTERICIDES. 54* melancholy or despondent, then administer less frequently and in smaller doses. Now is the opportune moment to commence with diaphoretics, diuretics, and hydragogue cathartics, just as the digitalis has unlocked the flood-gates of the body. Then take of Pulverized mandrake, thirty grains ^pulverized nitrate of pot- ash, one drachm ; cream of tartar, one ounce. Mix. Make ten powders, and let the patient take two or more daily, so as to cause at least three watery evacuations from the bowels in the twenty-four hours. In addition, a teaspoonful of the fol- lowing mixture should be taken thrice daily, in a glass of water: Camphor water, four ounces ; nitrate of potash, half an ounce ; muriated tincture of iron, one ounce. Mix. At the same time an alcoholic vapor bath should be given every other day. As a drink, to encourage free sweating, an in- fusion of jaborandi or pleurisy-root. Patient kept moderately warm and clothed in flannel. If the above means fail, discontinue the mandrake mixture and substitute a pill, one-twelfth of a grain of elaterium. If the. patient is unable to bear such active remedies, five-grain doses of iodide of potassium should be given in a tablespoonful of fluid extract of saxifraga. Other remedies, as infusion of hair cap moss, buchu. Treat effusion or dropsy in the extremities in the same man- ner, with the addition of rest, elevation, compression by rollers, friction, shampooing, steaming with medicated vapors, elec- tricity. (See Dropsy?) Effusion of Blood.—Hemorrhage, as a result of inflammation, may take place prior to or during its activity; or the inflamma- tion may so terminate. Organs that are freely supplied with blood-vessels, when they suffer a partial death are more liable to have hemorrhage occur in them than others, as the lungs, stomach, bowels, kidneys, bladder, urethra, uterus. In the treatment of hemorrhage as a result of inflammation, the main point is more thorough arterial sedation, more active local stimulation. If from the lungs, large doses of veratrum viride; if from the stomach, rectum, kidneys, or uterus, the green root tincture of gelsemium, and digitalis. If the hemorrhage is violent, styptics may be resorted to, but the true principles of treatment of inflammation should never be lost sight of. Salt, iron, gallic acid, digitalis, matico are useful if from the lungs; capsicum, salt, gelsemium, if from the stomach ; 542 DISEASE GERMS. erigeron, gallic acid, ergot, corn smut, if from the kidneys or uterus. In surgical operations, the vessels should be ligated; still there are often minute capillaries that bleed. Then carbolic acid spray, exposure of the bleeding surface to the air, pressure by bandages, cold, perchloride-of iron, matico, spider web. Effusion of Lymph.—This is a very common termination of chronic inflammation, still there can be little doubt but that it is present in all forms. When it takes place, it causes induration, thickening, adhesions, mechanical obstructions. In surgical practice, the greatest ingenuity has been exercised to procure effusion of lymph for the purpose of cementing or joining parts. For this purpose all foreign bodies are re- moved. Catgut ligatures are used. An antiseptic spray flows upon the wound to destroy degraded matter or bacteria. Me- tallic sutures and antiseptic dressing are extensively employed. Effusion of lymph for the purpose of repair can only take place when there is total absence of pain, and when the vital forces are normal. Lymph is often effused in general inflammations ; in pleurisy, where it forms adhesions; in inflammation of stomach, thicken- ing ; in canals, forming strictures ; in glands and tissues, form- ing swellings. It is highly desirable to get rid of effused lymph, because if permitted to remain it is liable to break down at any time the vital forces of the individual become impaired, and form an abscess. To cause an absorption of effused lymph our best internal remedies are iodide of potassium, iodol, bromide of potassium, saxifraga, phytolacca, blue flag, mandrake. Our local remedies are green plantain leaves, phytolacca, stra- monium, belladonna, ozonized clay, iodide of potassium, iodo- form, potassa, ammonia. Shampooing, friction, and electricity are very doubtful in their utility. When adhesions have taken place, the continuous application of the irritating plaster is a powerful resolvent, and aids in the breaking down or absorption of the adhesions. The effused lymph, like the serum, contains the spores of the pathogenic microbe of pus. The presence of these spores in the effused lymph may for many years be innocuous, but when softening comes they are capable of provoking septicaemia, which may prove fatal. The Formation of Pus.—Lymph or plasma from the blood is effused to a greater or less extent in all forms of inflammation, but especially in the chronic, and is liable, at any moment there BACTERICIDES. 543 is the slightest nervous depression, to break down and become pus—become the bacillus pyocyaneus. This event is invariably ushered in with rigors, but when it occurs during acute inflam- mation, simultaneously with the rigors the pain changes to a tnrobbing or beating, the heat diminishes, congestion and red- ness disappear. When it occurs during chronic inflammation or after inflammation has ceased, it is also invariably preceded by a rigor. The broken-down lymph constitutes pus, an active living deadly microbe, and a collection of pus anywhere forms an ab- scess. The precursor or rigor is followed by the lymph break- ing down in the centre and gradually enlarging, perhaps point- ing, and a sense of fluctuation is experienced to the touch. There are numerous varieties of pus, as, healthy or laudable, when it is thick and creamy; serous, when it contains water; sanious, when it contains blood; curd-like or cheesy, when it contains tubercle; muco-purulent, when it contains mucus mixed with purulent matter; lardaceous, if like lard; specific, when it con- tains a special living germ or poison; and putrid, when dark or offensive. The division of abscess into acute and chronic, superficial and deep-seated, explains itself. The moment pus has formed, there should be an assiduous effort made to aid the vital forces of the part in its further pro- gress by the application of heat and moisture in the form of a well-made poultice, which should be continued until the lymph has entirely broken, when a free opening should be made into the part and the poultices continued for a day or two, then dressed with an ointment of vaseline. Simultaneously with the evacuation of the pus and breaking down of the entire amount of lymph effused, nature begins to throw out lymph anew at the bottom of the abscess or cavity ; this is at once permeated by blood-vessels and nerves; then another layer which becomes similarly organized, and so on un- til she reaches the surface, when around its edges can be seen a white milky scum, which gradually covers the entire surface. The process of effusion of lymph, its organization or permeation with blood-vessels and nerves, is called the process of cicatriza- tion ; when it is covered over with a new skin or cutis it is called a cicatrix. In order that the effused lymph may exhibit vital elements, the process may be devoid of pain, the pus laudable, and the granulations neither pale nor red. During such a pro- cess of repair the vital stamina of the patient should be well sus- tained with good food. Gangrene, or Incipient Mortification.—When the vital forces of a part are so shattered that the salutary effort of nature fails in 544 DISEASE GERMS. obtaining resolution, then the process of dying is liable to set in. If it is an internal vital organ, the sudden cessation of pain fol- lowing a high intensity of symptoms, with a typhoid condition supervening, features becoming small and contracted, breath and extremities cold, intermitting wiry pulse, indicate the approach of mortification or complete death. If the inflammation occurs in an extremity and it is aboul to terminate in gangrene, pain suddenly ceases, the redness be- comes of a livid color, the congestion soft and flaccid. It crepi- tates when pressed upon, from the fact that it contains gases, the productions of putrefaction and a train of typhoid symp- toms. In gangrene, when the parts yet retain a certain degree of vitality, the object should be to arrest the occurrence of morti- fication. Internal stimulants and antiseptics, as brandy and quinine, yeast; and locally poultices of charcoal, yeast, capsicum, wild indigo weed with carbolic acid, changed frequently. If this poultice does nothing in arresting the condition it will at least stimulate a line of demarcation between the living and dying part. Such a line usually makes its appearance in the form of a red blush, which soon rises into a blister; this soon ruptures, forming a line of ulceration with a furrow. In the treatment of all forms of inflammation, the most decidep and energetic measures should be resorted to ; internal and local stimulation should be the rule, in order to-prevent the process of dying (gangrene) or complete death (mortification) from tak- ing place. _______ Partial death of bone may arise from inj uries; Inflammation poisons, as phosphorus; from the microbes of Bone. of rheumatism, syphilis and the tubercular bacilli, etc. The usual termination is effusion of lymph, in which we find the spores or seed of the saprogenes blended with other germs. Spores may be absorbed or break down, giving us caries and necrosis—ulceration of bone. Symptoms.—There is a deep-seated, severe, dull pain, with swelling of the soft parts, rigors and fever ; if acute, the parts slowly enlarge, tenderness increases, with weight and pain. If it proceed to ulceration (caries or necrosis), there are rigors, and pain changes to a throbbing. The treatment embraces rest; control fever with exalgine, keep bowels open, and skin active ; local stimulants in the form of hot packs during the day, and the chloroform liniment at night. As soon as fever is controlled, iodide of potass in compound syrup BACTERICIDES. 545 stillingia; keep patient under it for some months. If rigors and a throbbing have taken place, poultice, and as soon as indica- tions of pus formation are clear, free openings. If an opening, or several openings, have taken place, run them into one, so as to give nature as little work to do as possible. Inject with various solutions of peroxide of hydrogen. Abscess is rare, the condi- tion being a breaking down of lymph in the substances of the bone, giving us caries or necrosis. Either of these conditions can be easily detected by a gritty or sandy feel of the pus. In all cases general alteratives and tonics ; best of diet, with an ex- cess of phosphates, as oatmeal porridge, cream and boiled white- fish. The periosteum being fibrous tissue Inflammation of the is liable to suffer a partial death from Covering of Bone. various microbes, as bacillus of syphi- (Periostitis.) lis, tubercle, rheumatism, and from injuries. Whether it be of microbial origin or not, there is invariably a disease germ present. It is easily recognized by the history of the case, and the sharp, lancinating pain present. By killing the microbe, resolution may be effected before the streptococcus pyogenes appears. Any powerful germicide, which will not destroy the tissues, should be applied, as the oil or'fluid extract of lobelia; resorcin in ozone ointment; iodol. No class of diseases are so interesting as Inflammation the various affections of the brain. The fact of the Brain, that the brain wears out sooner than it used Acute. to do, under what is termed civilization, and that its health and vigor, and even the pro- duction of disease in it, depends on the development and healthy condition of the great sympathetic, are highly suggestive. In women, children and all races outside of the Caucasian, the ab- sence to a great extent of cerebral disease can only be accounted for by the rudimentary condition of the sympathetic. The effects of isolation and sameness, or monotony, in causing contraction of its convolutions, thus causing epilepsy and insanity, and the action of blood poisons, are also of great moment in reducing the angle of longevity of our race. The study of brain diseases is not suffi- ciently advanced to enable us to elucidate all the points clearly ; neither are we yet able to distinguish correctly between inflam- mation of the substance of the brain and that of its membranes. 35 546 DISEASE GERMS. Indeed, they cannot be really separated, although it has been attempted. A partial death of the substance of the brain may depend upon two general conditions. It may be due to causes within the body, such as depressing emotions, desires, affections, passions, the struggle for existence, or excessive mental strain, religious excitement, blood poisons, or it may be due to blows, falls, shocks, concussion of the brain or fracture of the skull. In the former case it is said to be idiopathic ; in the latter, traumatic. As brain substance is intrinsically the most valuable tissue in the body, it is the most difficult to depress and the hardest to establish a re- newal of life in ; so that in the idiopathic form, the stage of Section of brain : horizontal seciion through the brain to show the mode in which the two hemispheres, a, a, are joined together by the transverse band of white m;itter called the Cor- pus Callosum. In front and behind this the longitudinal fissure b sepa- rates the two hemispheres; b, b, is the sect on of the cortical substance; a, a, of the medullary; the section also shows the depth of the suki be- tween the convolutions. The brain : upper surface of the brain of man, showing its subdivision by the longitudinal fissure into two lateral hemispheres, right and left, also the chief sulci and convolutions. The fis- sures of Rolando are the oblique fis- sures which commence near the mid- dle line and proceed outwards and forwards, marking off the frontal lobes, a, a, from the parietal lobes, which lie behind those fissures The occipi- tal lobes forming the posterior extrem- ity of the hemispheres completely con- ceal the cerebellum. shock or incubation is often for a number of years, and in the traumatic form, quite a good while; even in bad fracture, with compression, a week or more often elapses before active symp- toms of inflammation set in. After the brain has received the shock, there is then an inter- vening period before the rigor and active inflammation, and dur- ing that time the patient is irritable, restless, peevish, sleepless, complains of heats and colds, burning in the skin, secretions are arrested, great lassitude, peculiar idiosyncrasies, great disturbance of the mental faculties, and there is a characteristic pain in the head, usually frontal, aggravated by noise, light, heat and motion. There is also intolerance of light, slow pulse, want of appetite, tongue dry, with white and brown coat, skin white. BACTERICIDES. 547 These premonitory symptoms become more intense daily, when, if the inflammation is about to take place, the patient is seized with the most violent rigors and a high fever; pulse hard and frequent, strong pulsations of the carotid and temporal arteries, headache intolerable and throbbing, eyes suffused, face congested, tongue dry and brown, bowels obstinately constipated; stomach rejects everything, secretion and excretion arrested; besides, there is apt to be violent delirium, coma, convulsions, paralysis, pupils contracted to a pin's point, articulation difficult or indistinct. If not relieved at this point, then pupils become dilated, the eyelids drop (ptosis or squinting), or paralysis of muscles of eyelids, frequent twitching of muscles, ghastly coun- tenance, sordes on gums and teeth, cold sweats, relaxation of sphincters, convulsive paroxysms, paralysis, profound coma, which usually soon ends in death. In some cases, the first symptom of an attack is convulsions, preceded by very slight premonitory symptoms that are often unnoticed. Convulsions, strong and severe, may be followed by coma, which is soon fatal; or it may recur frequently at short intervals, and pass into coma at the end of twenty-four hours. When nausea and vomiting are the earliest symptoms, inflamma- tion has its origination in the cerebral pulp. When attacks begin with convulsions, the affection has started from the arach- noid or pia mater ; or, to be more explicit, if the inflammation involves the cortical substance and membranes, early derange- ment of the intellectual faculties, irritability, constant agitation; if the medullary substance, chills, headaches, convulsions, great lassitude. The medullary substance of the brain is merely the passive servant of the cineritious substance, the conductor of its de- mands to the muscles. The gray presides over intellect; the white, over movements. Rigors taking place during the active inflammatory stage, with squinting or dropping of the eyelids, palsy; contraction of one pupil and dilatation of the other, indicate extravasation of blood into the brain and an unfavorable termination. Acute inflammation of the brain may terminate in any of the ordinary results of inflammation, but its common termination is effusion of blood or extravasation of blood on or in its substance, or recovery by the slow process of chronic inflammation. The hemorrhage is termed red ramollissement. In the recognition of acute inflammation of the brain, its his- tory, all the symptoms prior to and after rigor, the fever, intel- lectual condition, eyes, face, arrested secretions, and especially the headache, must be noted. True, there may exist compli- r4g „ DISEASE GERMS. ■ Interstitial pneumonia rods terminating in a cone, are found wi h it. The micrococcus is the early form of the microbe, which becomes a bacillus in the adult form. The presence of a microbe in pneumonia explains many facts which have hitherto remained obscure in this disease, especially epidemics, also the remarkable resemblance between that of man and the contagious pneumonia of cattle. The origin of the microbe of pneumonia in man is no doubt due to intense nervous strain, worry, exhaustion, especially neu- rasthenia of the great sympathetic, which is so freely reflexed on the face, larynx, heart, lungs, spleen and internal viscera of the Caucasian; that owing to some adverse .^-.^r^.. state or condition, the bioplasm, the living matter of nutrition of the great sympathetic is either changed, or altered, or degraded into other living matter, a disease germ, the microbe of pneumonia, which is capable of prodigious growth, and multiplication, an independent existence in or out of the body if warmth and some nutritious pabulum be present. Once it has suffered evolution and become a microbe, it can be propagated by contagion and infection, like all germ diseases. The partial death of the great sym- pathetic induces the evolution. Cultivations of the pneumococcus on boiled potatoes and in meat juice yield immense crops, which if in- jected into or are fed to any animal produce pneumonia. The career of this germ does not differ, when it is the sequel of other maladies, such as typhoid, etc. Later on, when the lungs or lobules have become transformed into a solid structure, gray hepatization, masses of micrococci may be found in the air cells, even growing into the blood vessels, in which stasis had set in. Aside from the pathogenic microbe, we find in the sputa, blood, mucus, epithelial cells, granular protoplasmic masses, elastic fibres, etc. None of these bear cultivation. All cases are ushered in with a rigor less or more violent. Pneumonia is met with in the following forms: Acute, sudden Perfect adult form of the pneumococcus magnified 2000 diameters ; A and B, thread forms ; C, D and E, rod forms ; G, diplococci; H, cocci, I, strepto- cocci. The pneumococcus consist of cocci, ellipsoidal or round, single or in pairs (diplococci), rods and thready forms, all enclosed in a cell membrane or gelatinous capsule. 6o2 DISEASE GERMS. in its seizure, and attended with fever; sub-acute, of the same character, but the vital forces of the patient being vigorous, resist the local irritation, consequently there is no fever; or chronic which may be a sequel of either of the former, or come on of itself from slight irritation in patients whose constitutions are %'°i° Micrococci of the pathogenic; microbe of the pneumococcus seen in differ- ent stages of growth in the prune juice ot the sputum prior to the rigor. The appearance of the pneumococcus prior to the rigor in acute pneumonia. The microbe will disappear from the sputum in less than two hours with concentrated ozone over the germ-smitten lung. Inha- lation of comp. oxygen. feeble. It is called lobular, when confined to one lobe; single, when confined to one lung; double, when both lungs are involved; pleural, when the violence comes from without and proceeds in- ward, affecting the pleura first, then the lungs; and typhoid The micrococci, as seen microscopically in the prune juice sputum of pneumonia; b, d, free or encysted in expectorated lymphatic cells. pneumonia, when the powers of life are low, and the typhoid germ is developed, giving us inflammation of lungs with typhoid fever. A case that is permitted to run its course has three distinct stages, viz.—congestion, red hepatization and gray hepatization. General Symptoms in First Stage.—Great nervous prostration, with pain in the head, back, calves of the legs, with cough, short- ness of breath, rusty, or prune juice sputum, or streaks of blood, or hemorrhatge, restlessness and anxiety, violent rigors and high grade of fever, with aggravation of symptoms; pulse 140 to 160, heat 105° Fahr., respiration 40; flush on cheek or cheeks, nostrils BACTERICIDES. 603 dilated, tongue coats heavily with a brown coat, nausea, great thirst, loss of appetite. Cough becomes worse, sputum viscid and bloody, pain in the affected lung, with frequent but dis- tressed breathing, skin has a dry pungent heat, sometimes delirium. As this is the stage of filling up or engorgement, the affected lung which was clear and resonant gradually becomes dull on percussion, and crepitation to a variable extent is distinctly heard. If the pleura is involved, friction sounds can be detected ; there is exudation into the air-cells and proliferation of their lining epithelium. This stage may last a few hours to a week or longer. General Symptoms in Second Stage.—If the inflammation pro- ceed, it passes into the stage of red hepatization, in which all the symptoms of the first stage are still present and more decided ; there is in addition likely to be blueness or lividity of the skin, delirium or coma from non-aeration of blood. The air-cells are choked by coagulated exudation of blood ^ ** /$ a ^ and lymph; the spongy character &s _ • "^ a O of the lung is quite lost, and it ®^ \») ^^ e a becomes solid as a liver, neither *** ^ . ^ /$ minute crepitation nor vesicular '^ ^' f £%, *** murmur can be heard. There is ft) •**» perfect dulness on percussion and ^ ^ * G* ^ no intercostal movement; bron- o • ^J Chial Or tubular breathing, With Some ot the pneumococcus in the secon.l .... . ° stage, surrounded by a capsule. vocal vibration communicated to the walls of the chest by the solidified lung and felt by the hand over the ribs, unless there be water in the cavity of the chest. The duration of this stage is from a week to a longer period. General Symptoms in the Third Stage.—If the inflammation still progresses, and the patient does not die in the second stage, then the third or gray hepatization supervenes; then we have a complete change of symptoms. Fever abates; heat, pulse and respirations often low; rigors; profuse colliquative sweats are common; the flush .on cheeks and other physical signs disap- pear, and it looks as if amelioration was taking place; whereas, we have the grave process of suppuration of the substance of the lung; diffuse suppuration of pulmonary tissue, with parts re- maining dense and impermeable; it is hard to drag through with incessant cough ; thick, ropy, tenacious pus. In some cases the pus liquefies, and is expectorated, air begins to re-enter the affected lung, and resonance and a healthy vesicular murmur is restored. Often cases will, during the first and second stage, 604 DISEASE GERMS. take on a typhoid condition. The tongue will become of a buff leather appearance, very dry and parchy, or it may become red, like a piece of raw beef, or simply red at tip and edges, with elevation of papillae; the char- acter of the pulse changes to small, wiry and frequent; bowels generally in pneumonia are constipated, but when typhoid symptoms threaten, diarrhea, sordes on the gums, petechia on skin, eyes sunken, nostrils pinched, face white, gurgling in right iliac, and tympanitic state of the abdomen. No definite rule can be laid down as to its duration. About two-thirds of cases run thus: a week of infiltration or filling up, a second week in perfect consolidation, and a third in gray hepatization, which terminates in suppura- tion, extending over a period of months. In any of its stages it is easily recognized; in the early stage its history, flush on cheek or cheeks, the rapid mal-assimilation, the anxiety or distress, the cough, difficulty of breathing, the rusty sputum or blood, pain in side, dul- ness on percussion at base of lung proceeding up, lack of inter- costal movement, tubular breathing, rigors, fever, purple or livid appearance of skin, delirium, coma, etc. As a very vital organ is smitten, pneumonia must be regarded as a grave affection, if it has passed the first stage; imperfect Diagram showing red hepatization of the lung; pneumococcus changing into the streptococcus pyo- genes. '^m^MMzmrQ Capillary net-work in the human lung. Section of lung, showing a single alveolus in red hepatization. oxygenation of the blood gives rise to so many complications, besides delirium, coma and lividity of the lips, nose, hands, face, as embolism in brain and heart, that render all cases very dangerous, and our prognosis must be guarded. In spite of the great improvement in modern therapeutics, the death rate of pneumonia has been steadily on the increase. The pathology of the disease must be better appreciated; we have BACTERICIDES. 605 not only a vital organ smitten by a deadly microbe-infarction of the lung by the micrococci, non-aeration of the blood the result; skin, kidney, and other excretory organs, imperfectly, feverishly perform their work; springs feeding the smaller and larger glands run dry; the feverish nerve centres repel the vital atoms of the great sympathetic, are wrecked by germ evolution. The blood requires aeration, oxygen, ozone: In all cases of acute and chronic pneumonia, there are to be found in the blood, in the infiltrated lung, in the sputum, and all Section of lung in the second stage of lobar Vertical section of the lung as seen in pneumonia, showing the pneumococcus the second stage of pleuro-pneumo- aggregated together in patches. nia. the glands of the body the microbe pathogenic of the disease; even the sputum in the early stages is loaded with the micro- cocci, which gives it the peculiar characteristic brownish prune- juice tint. This is most common the first seven days from the Lobular pneumonia, alveolus from lung; Section of lung, second lobar the capillaries distended with the mi- pneumonia; the pneumo- crobe. coccus actively throwing off spores. rigor, later on they decrease in number, until about the four- teenth day when their presence is usurped by vibrios. Treatment.—Perfect rest in bed in a room whose atmosphere is kept moist by steam, and at a temperature of 700 Fahr. If 6o6 DISEASE GERMS. there be constipation, enemas and a dose of castor oil. Having ascertained the extent of the damaged lung, wet cups should be freely and closely applied over the part, and free bleeding from cups encouraged by hot fomentations, and then followed by hot Section of lung, showing a single alveolus in the first stage of pneumonia, with the pneumo- coccus actively sprouting. poultices of flaxseed meal. This is a better local stimulant than turpentine or mustard. Poultices should be changed every three hours, spread about half an inch thick, and in size to cover a little beyond affected part, so that if both lungs are affected it will form a regular jacket. Poultices should be covered by oiled silk. Over and above all, there should be a firm flannel roller, wide enough to extend from the arm-pit to the bottom of chest. Pyaemia (streptococcus pyogenes); Microbe of croupous pneumonia in mem- abscess in the lung. branous croup. It should be pinned evenly and firmly, beginning at neck, insert- ing a pin every inch, and proceeding down to the bottom, so as to confine the ribs, stop intercostal movement, and cause the pa- tient to breathe by the diaphragm. Outside of all, bladders filled with hot water should, as far as practicable, be placed at Section" of lung, with the streptococcus pyogenes; third stage of pneumo- nia. BACTERICIDES. 607 the sides, so as to keep heat in poultice. Patient must not be permitted to lie too long in one position, as it gives the blood a tendency to gravitate into the weakened lung structure and con- geal ; a change is very beneficial every two or three hours; heat to feet, and general treatment for fever; diet, warm milk, with about five grains of bicarbonate of potassa to the half tum- bler full, instead of lime-water, and warm beef tea, one or other at regular intervals every hour; no other diet of any efficacy; eggs and oysters strictly prohibited; drinks are to be warm, and mucilaginous, as flaxseed, etc. There are, now, three drugs that must be unsparingly and persistently given, and these are, veratrum viride, opium and sulphate of quinine. A. tablespoonful of tincture of veratrum viride, same amount of sweet spirits of nitre in four ounces or half a tumbler of water, of which one teaspoonful should be administered every half hour till pulse reaches sixty-five, and then at intervals of two or three hours, so as to check the current of circulation, so that when it passes through a weakened tissue effusion cannot take place; a balance maintained, a heart controlled, and by its influence on the connective tissue of lungs, prevents inflamma- tory action spreading into fresh parts. In some cases it is advantageous to combine a teaspoonful of tincture of aconite in the mixture; to be continued as long as there is any fever. Opium or its alkaloid should be given in every case of pneu- monia. It aids the action of the veratrum, prevents irritation, and so neutralizes the action of that drug that we are enabled to give it in larger doses. Besides, opium acts as a stimulant to the great sympathetic that so fully covers the lower lobe of the right lung and heart. As soon as the veratrum is commenced, begin with the opium every three hours, and continue at regular inter- vals. The painful oppression of the chest and hacking cough soon disappears ; the noisy and frequent respirations soon become quiet and slower; the cyanosis of the face and lips gives way to flush; the dry, scorching skin becomes cool and moist; the heart regains its normal force and regularity; its impulse, its sounds, its murmurs with the lung difficulty subside almost com- pletely. It also counteracts the abnormal quantity of carbonic acid in the blood, and with the attainment of that object, languor and drowsiness disappear. Whether the crude drug or its alka- loid is selected, it must be borne in mind that the condition of the stomach is such that absorption is slow and imperfect; so to obtain readily the desired effect, it is best to administer it with an alkali; to facilitate its absorption and soften the effused pro- ducts in the lung, such as opium pulverized, ten grains ; Dover's 608 DISEASE GERMS. powder, thirty grains; nitrate of potass, one drachm. Mix. Make twenty powders ; one every three hours ; or if the alkaloid is preferred, take one ounce of lemon juice ; carbonate of potassa, enough to saturate ; add to one ounce of cinnamon-water, to which add one grain and a half of morphia. Dose, one tea- spoonful instead of the opium. The effects of potassa on the lungs is very marked indeed. The next drug is quinine, without which there can be no suc- cessful treatment of pneumonia. Its action on the brain add great sympathetic is good, but in pneumonia the size of the red corpuscles of the blood is diminished. Quinine restores them to their normal shape. Its presence in the blood is most salu- tary, when loaded with carbonic acid, in diminishing tempera- ture. The dose should be such as will give a result, and con- tinued, as it is freely eliminated by the kidneys, in alternation with the opium. To relieve cough, a mixture of equal parts of syrup ipecac, squills, wild cherry and tolu, with muriate of ammonia, in half' teaspoonful doses. If there is tremor of hands, quivering of tongue, or delirium, alcohol in the form of brandy and milk or wine must be given. The important micrographic discovery has been made that a microbe is always present, hence the necessity of a more efficient bactericide treatment, which we hereby submit: Germicidal Remedies which have been demonstrated to cause total dis- appearanck of the pneumococcus from the blood, sputum, lung. Internal Remedies. Exalgine, sufficient doses and frequency to keep pulse at 65 or 70. The glue side baptisin, triturated with an equal quantity of sulphate of qui- nine added to aromatic sulphur and water. Ozonized tar syrup, or the syrup of Tolu with chloride of ammonia, resor- cin, benzoate of soda, opii et ipecac et camphora et resorcin. The combina tion administered in small doses fre- quently repeated, so as to maintain a sort of comatose condition, during which the germ dies. Comp. concentrated tincture of kurchi- cine, no fluids permitted, micro-organ- isms disappear. Kurchicine con. con- tains 20 atoms of carbon and is more powerfully germicidal. Local Remedies over the Germ smitten f.ung. Concentrated ozone painted over the area of dulness and beyond, followed with hot linseed meal poultices in which resorcin and boroglyceride and opium are freely incorporated, changed fre- quently. If this is not applied, ozon- ized turpentine, till an erythema is pro- duced, followed with hop poultices in which resorcin and peroxide of hydro- gen are incorporated. Iodol incorpor- ated in ozone ointment rubbed into the chest, and also spread on leather ap- plied. A jacket of resorcin jelly is most effica- cious. BACTERICIDES. 609 Compound oxygen, administered by the atomizer, is of infinite value, as by this method we bring it into immediate contact with the seat of the disease, thus carrying out the principle of direct medication, and thus sterilizing the micrococcus in the pulmonary tissue. The results obtained by its use are immediate, eminently gratifying and satisfactory to both patient and physician. In the first stage of pneumonia, when the prune-juice sputum is abun- dant, it should be inhaled every half hour or hour, according to the urgency of the case. Do not wait until cyanosis appears. A few inhalations lower heat, quiet the heart, diminish the rapid respirations; thus enabling the patient to breathe easily, promote free and abundant expectoration. To obtain good results in chronic lung affections, as in asthma, bronchitis, tuberculosis, inhalations for twenty minutes, three times a day, are best. The action of the compound oxygen is that of a germicide, by either the sterilization or annihilation of the microbe, sub- stantial results are obtained ; the germs become passive or dead ; the embarrassment in breathing is overcome ; free and abundant expectoration takes place; the cough becomes less and less; the obstructed germ-laden air cells become clear; the cold is cleared up; additional breathing areas are opened up, and respira- tion becomes full and deep. The inhalation of this remedy reddens up the blood, frees it from the presence of all disease germs, even neutralizes the ptomaines of numerous microbes; thus the nervous system becomes rejuvenated; appetite is stimulated in a most re- markable degree. Delirium, coma, blueness or lividity of skin due to deficient aeration of blood; tincture of belladonna with a solution of ace- tate of ammonia to maintain fluidity. With the above treatment, during the stage of congestion and the early part of red hepatization, all signs of consolidation of the lung will give way and become absorbed, leaving the walls of the air cells unimpaired and elastic as before. Re- covery is perfect, the breathing being mechanically and physio- logically performed as in health. Neither is the interlobular structure altered, and there is no permanent thickening of the lung or bronchial tubes. The products of inflammation in a congested lung consist chiefly of exudation of fibrine, with liquor sanguinis, white and red corpuscles, and perfect absorption takes place. But some- times cases have progressed too far, and about the end of the second week a change takes place; temperature goes down; there are rigors and sweats, and there is thick, viscid or muco- 39 > 6io DISEASE GERMS. purulent matter expectorated, and the physical signs tell us that the lung is still solid but undergoing grave changes; the air does not penetrate; bronchial breathing still continues, but changes which indicate softening and ulceration begin to appear. Now our treatment must be changed to an alterative and tonic course, including iodide of pqtassa, tincture of iodine and am- monia ; irritating plaster, so as to keep an open discharging sore over the consolidated part; diet changed to milk, cream, raw eggs, animal food. If during an acute attack there are the slightest indications of typhoid symptoms, antiseptics at once; brewers' yeast in milk, tincture of iodine and carbolic acid, as in typhoid fever, every hour. The degraded living matter in pneumonia is the pneumococcus, which is to be found all through the case in different stages of growth and development. In a large number of cases patients, Inflammation of the when properly cared for, will recover Substance from acute pneumonia apparently of the Lung. well, but with some portion of lung [Chronic Pneumonia) damaged; that is, weakened, or he may recover with a lobe perfectly consolidated, in which condition it may remain for years; or the products of inflammation may break down and recovery take place; whereas, in another class of cases, the non-aeration of blood and local irritation tells badly on the nerve-centres, and a degradation of living matter takes place, and we have the tuber- cular germ, or in other words, the ulcerative process of pneu- monia changes into that of consumption of lungs—tubercular. It makes little difference how the inflammation originally started; its termination, unless managed with the very greatest nicety, i^ apt to take that course. The treatment of chronic pneumonia is the same as should take place following any and every case of acute until the lung clears. Diet nutritious and generous, flannel clothing, daily bathing, followed by inunction of oil; bowels regulated, appetite stimulated with tonics ; irritating plaster to be kept all the time, if possible, over the seat of consolidation. Encourage free suppu- ration. Iodide of potassa, carbonate of potassa in alteratives Expectorants in sufficient quantity to keep down cough. In other words, a tonic and alterative course. BACTERICIDES. 6ll The very great prevalence of purulent Inflammation ophthalmia and stomatitis among the of the Mouth. children of the crowded sections of our large cities and our public schools demand more than a passing notice. Both affections are either directly due to a special degradation of bioplasm, or to contagion and in- fection; in the eye, the normal elements of nutrition are changed or altered into bacteria proper, whereas in the mouth, though the bacteria be abundant, the degraded elements are the oidium albicans. The causes which give rise to a partial death of mucous mem- brane of the mouth are the de- pressing effects of insanitary states, and the crowding of large bodies of children into small areas with meagre or insuffi- cient, bad or deleterious food, bringing about a perversion of nutrition, the degradation, the germ, and then its spread by contagion and infection, espe- cially by the indiscriminate use of drinking vessels. Inflammation of the mouth or stomatitis with its special micro- organism is met with in three forms or stages which are simply degrees of microbe growth. In the primary or first state, the diseased germ aggregates in the follicles of the mucous mem- brane of the lips, cheeks, gums, fauces, and appears in the form of little vesicles or blisters, and is termed follicular; when those vesicles rupture, the germs are let loose and spread in all directions, hence it is termed ulcera- tive; if vital force is decidedly lower, insanitary surroundings wretchedly bad, the ulcerative patches may become gangrenous. The symptoms which attend this degradation and germ evolu- tion in the mouth are general prostration and debility, with in- flammation of the mucous membrane of the oral cavity, tender- ness, the formation of vesicles, on lips, cheek, gums, tongue, Jauces—the encysted germs in the follicles or vesicles rupture The mouth widely opened so as to show the palate; i, i. the upper, 2, the lower lip; 3, 3, hard palate; 4, 4, soft palate; 5, uvula ; 6, 6, the arches of the soft palate; 7, 7, the tonsils ; 8, the tongue. 6l2 DISEASE GERMS. their sacs and spread (if vital force be low, surroundings bad,) in every direction, giving rise to phagedenic ulceration. There is usually a copious flow of saliva, amounting to salivation; great fetor of the breath, mal-assimilation, restlessness, fever, loss of appetite, and as the germs descend into the stomach and bowels, most offensive stools. The patches in the mouth are covered at first with a dirty, yellow slough ; subsequently, the patches of infiltrated mucous membrane are purplish, and the ulcers covered with a layer of pulpy grayish matter; if the disease is permitted to progress, the germs become spongy, teeth loose. As the affection is essentially one of germ evolution, the great- est precautions should be ob- served in isolating the patient, in surrounding him with an at- mosphere of germicides. The essential points in treat- ment are to kill the germ, and by every possible means raise the standard of vital force, so as to prevent its further evolution and growth. The mouth should be washed, throat gargled about every hour with either a teaspoonful of a saturated solution of borogly- ceride, or chlorate of carbon or potassa added to half a tum- bler of tepid water or infusion of sage or thyme, and internally every three hours, five or ten grains of resorcin dissolved in water; or a few drops of peroxide of hydrogen. A good blood-elaborating diet, embracing cream, eggs, beef juice and other nourishment. The oidium albicans present in stomatitis. Onychia, or inflammation of the root Inflammation or matrix of the nails, may arise from me- of the chanical injuries, as contusions, spicula of Matrix of Nails, bodies penetrating the mother of the nail, [Onychia) corns, etc.; or it may arise from greatly broken-down states of the constitution, as in tuberculosis. Symptoms.—Pain, swelling, and suppuration at the root of nail or nails, and about the surrounding texture. Exudation of1 sanious, or purulent discharge, on pressure of the nail; ulcera- I BACTERICIDES. 6I3 tion; nail becomes raised and finally detached, revealing a foul ulcer, with the most intense fetor. The disease-germ, oidium albicans is present,—a true rot. Ulcer becomes glazed, irritable, eating and spreading in all directions, even down to the bone, when the vital forces are at a low ebb. Treatment.—Poultice with linseed and yeast; wash, by drip- ping hot permanganate of potass lotion on the ulcer, by com- pressing a sponge, morning and night. Remove nail as soon as possible; continue cleansing sore, morning and night, with permanganate wash. Dress during the day with either the black salve, vaseline, or ozone ointment, iodoform. Place pa- tient upon a general course of alteratives and tonics with nour- ishing food, fresh air, hygiene, etc., when the difficulty can be traced to tuberculae, glycerite of ozone especially; if to syphilis, ozonized phytolacca, and iodide of potass ; if to mercury, tonics and iodide of potass. The causes of catarrh, or common Inflammation of the cold, may be grouped under two Lining Membrane main divisions—viz., predisposing and of the Nose. exciting. Among the former must be mentioned youth; for it is a well known fact that old persons are practically exempt from this malady. Many individuals appear, moreover, to possess a cer- tain idiosyncrasy as regards the affection. It is not uncommon among the gouty, and in persons whose nervous system is in a condition of unstable equilibrium, and among those with a strumous diathesis, or predisposed to asthma. Hay fever would often appear to be a connecting link between asthma on the one hand, and catarrh on the other. Climatic conditions and sudden changes of temperature, not necessarily from heat to cold, but sometimes the reverse, must also be noted. The most common exciting cause is without doubt the action of damp cold, more particularly if the body be heated and per- spiration active. Sometimes simple transition from warm to cold air will be enough to induce an attack ; at others the prolonged action of cold is required, especially on the feet, and in bald per- sons on the head. Heat, either as solar heat, or the elevated temperature of a warm room, may produce similar results. In the former case it has been suggested that the catarrhal effects mty be due either to direct irritation, or may be of a reflex character, dependent on undue stimulation of the retina. In the latter case the coryza is generally observed in persons in a de- pressed condition of health, and in those who have been the sub- 614 DISEASE CERMS. ject of previous attacks. The influence of irritating vapors, and of certain medicinal substances, such as iodide of potassium, and of the pollen of many plants in producing nasal catarrh, has long been known. The earliest symptom of an attack of acute inflammation of the lining membrane of the nose, is a feeling of chilliness and fever, a sense of weight and pain in the forehead, dryness of the nasal membrane, itchiness, accompanied with sneezing, nasal fossa becomes blocked, an irritating watery discharge appears, which subsequently becomes muco-purulent. Both taste and smell diminish in catarrhal attacks, and may even disappear. The voice becomes distinctly nasal in its tones. This is due to the fact that when the anterior nares are blocked the nasal cavities can no longer act as reverberating chambers. On the other hand, when the stoppage of the nostrils is chiefly posteriorly, articulation becomes defective. The second stage of coryza is marked by an increased secre- tion of alkaline serum, which may cause erosion of the nostrils and upper lip. This discharge may be so copious as to necessi- tate the constant use of the handkerchief, and may even be ac- companied by slight hemorrhage. During sleep the secretion is arrested wholly or in part. The nostril opposed to that of the side on which the patient lies may become dry and free, to be affected in its turn by any change of position. Pathology.—The only actual lesions found in coryza are such as are common to all inflamed mucous membranes, and are superficial and unimportant The initial stage is active conges- tion of the pituitary mucous membrane, followed by serous exu- dation. The exuded fluid contains epithelial cells more or less altered, which increase in number as the catarrh advances, to- gether with blood corpuscles, pus globules, and micrococci. These latter are the real cause of the trouble. It is not quite clear whether the inflammation attacks, exclusively the respiratory tract, or both it and the olfactory region. The latter appears the more probable, seeing that the inflammation not uncommonly extends to the cavities accessory to the nose. Treatment.—In the majority of cases a common cold will cure itself with little aid from medicine, but,at times, whether from the severity or the frequency of the attacks, treatment becomes ad- visable. This may be either stimulant or derivative. Of all stimulants, opium, either in the form of pulv. ipecac, co., or tinct. opii., is the best. Doses of from five to seven drops of the lat- ter, taken at the commencement of an attack, will often cut it short. But this treatment need not be continued after the second or third day. General principles in all cases. BACTERICIDES. 615 A peculiar inflammation of the pituitary Rhinitis, mucous membrane, due to irritating vapors or (Traumatic.) particles of dust. Etiology.—In addition to the generally irri- tating effects of dust on the nasal mucous membrane as seen in millers, sawyers, brushmakers and other trades, there are certain nasal lesions more especially found in connection with workers in chemical manufactories. This is especially the case among workers in bichromate of potash, yellow chromate, arsenical and mercuric preparations, and generally in those exposed to caustic dusts and vapors. Snuff-takers enjoy almost complete immunity from the affection. The earliest symptoms are much akin to those of coryza, but instead of being merely temporary, persist for a varying length of time, in proportion to the rapidity with which the inflamma- tory process is evolved. To the earlier symptoms of pricking and smarting there is gradually added discharge passing from serous into purulent. This dries and forms crusts, which are cast off with more or less hemorrhage. The next and last stage is ulceration of the bone and cartilage, with perforation of the septum; without, however, any offensive odor. The sense of smell is rarely affected. Ulceration of the inferior portion of the turbinated bone may take place, and be followed by perforation. Owing, however, to the fact that the anterior portion of the septum. is not involved, no deformity follows. The immunity enjoyed by snuff-takers may be explained by the excessive activity of the nasal secretion, and by the fact that the nose is so frequently blown. Hence, no irritating matters can long remain in contact with the mucous membrane, which, moreover, by the chronic thickening it undergoes, is rendered less sensible to external irritants. Prognosis.—The portion chiefly affected is the septum, and little practical inconvenience ensues from its perforation. The treatment should be mainly prophylactic. Frequent spray- ing with alkaline solutions will keep the nostrils clean, while wearing plugs of wadding will effectually prevent the entry of irritating particles. When the disease has been fairly established, local detersive treatment with boroglyceride or resorcin injections are useful. To these should be added tonic and hygienic mea- sures for the general health. Our best tonics in rhinitis are the comp. tincture of matricaria, phosphated tincture of oats, glycerite of kephaline. These remedies should be persevered with for a few months, adminis- tered in alternation. 6i6 DISEASE GERMS. Inflammation of the pericardium, or the Inflammation white fibrous tissue, in which the heart is en- of the cased. This is one of the most highly or- Pericardium. ganized of all the white fibrous tissues of the [Pericarditis.) body, and when weakened by any cause, is the favorite location of the bacillus amylo- bacta, the urate of soda of gout; the pus microbe, uric acid, etc. The most common predisposing causes are tobacco, alcohol, tea sexual excesses, nervous exhaustion, diseases of brain, struo-cde for existence, worry. These and like causes weaken the cardiac plexus of nerves, which, if once enfeebled, are very liable to be irritated by morbid states' of the blood. The common exciting cause is the presence of the bacillus amylobacta, the urate of soda and other states in which the living germs of disease appear in the blood. Symptoms.—There may be a general attack of rheumatism or there may not. An acute attack of pericarditis is usually ushered in with all the symptoms of fever; first languor, lassi- tude, debility, with sharp, lancinating pains in the pericardium ; pain in head, back, calves of Themcca'rd.tisf peri" less; rig°rs»and a fever of hish £rade; .tonsue coats heavily, urine loaded with uric acid; the sharp, lancinating pain in the heart darts through to the scapula upward to the left collar bone and shoulder, down the arm; the action of the heart becomes violent, tumultuous; its action ir- regular ; the difficulty of breathing is often extreme ; inability to lie^on affected side ; very much anxiety; features become con- tracted ; there is great giddiness, noises^ in ears, bleeding from nose. As the case progresses there is extreme debility, cough, suffocative paroxysms, fainting fits, (edema of the face and feet; often great restlessness, delirium, distortion of the features, spasms or convulsions. In sub-acute and chronic cases the symptoms are so slight as scarcely to be suspected; just a little pain, sharp, darting to shoulder blades, but effusion of lymph, which causes adhesions between the pericardium and heart, and organic disease; or effu- sion of serum, which, if copious, may fill up the pericardium and compress the heart, impede its movements, completely muffling its sounds to the hand or ear. . __ It is easily recognized in any of its three forms by the: pain sharp, lancinating, darting in acute cases through to the shoulder blades up to the clavicles. In the acute and sub-acute form a BACTERICIDES. 617 friction sound can be felt by the hand and heard by the ear; or if not that, an alternate rubbing to and fro sound; friction sound, attended with valvular murmurs and excitement of heart. In the chronic or declining stage of an acute attack, serous effusion often takes place, when no friction sound can be heard, nor even the sounds of the heart itself, being muffled by the water or fluid, which, if great, may compress the heart, so as to cause weakness or paralysis. The duration of pericarditis depends much upon the treat- ment. With such improved remedies as we now have it should be short. In the acute form, it should be treated in precisely the same manner as a case of acute rheumatism—by rest in bed, between blankets, heat to feet, open bowels with cascara sagrada lozenges; malted sterilized milk and beef essence for diet; local stimulation over the heart with concentrated ozone, subsequently dry heat. Administer at once opium in small but frequently repeated doses until there is a perfect freedom from cardiac pain, such as the fol- lowing : Opium pulverized, 10 grains; Dover's powder, 30 grains; nitrate potass, 60 grains. Mix. Make 20 chart. Give one every hour, till relief is afforded. This is most important. If fever is running high, aconite and veratrum ; or better still would be quinine, administered in small but repeated doses. A selection of some remedy to kill the bacillus amylobacta should at once be made and the patient placed upon it. The special bactericides to completely annihilate that germ are: The glycerite of wintergreen; the salicylate soda in liquor ammonia acetatis; fl. ext. manaca ; salol; and other germicides. Whenever the tongue cleans speedily under any one remedy, that is the one to adho.'t> to and push with vigor. The irritating plaster should be placed over the region of the heart as soon as the more urgent symptoms seemed to be re- lieved and a general course of alteratives and tonics prescribed. On no account is the bactericide to be dropped; that must be persevered with till every vestige of the amylobacta is wiped from the body. In the chronic form, pretty much the same treatment should be carried out, avoiding all causes that would be likely to enfeeble the heart. Here general alteratives and tonics should be administered, until the peculiar diathesis is wiped out. Comp. saxifraga and •Phytolacca are our best alteratives; and for tonics, comp. matri- caria is the most efficient. 6i8 DISEASE GERMS. A partial death of the ovary may Inflammation of the arise from a long, tedious, harassing Ovary. labor; from the use of instruments in [Acute Ovaritis) producing abortion; from the inject- ing of fluids into uterine cavity; from absorption of lochial products, or other debris; from the use of caustic to the neck of uterus ; from dilatation of the os uteri; from violence, falls, blows; also from sudden suppression of the menses from cold, or wet, or shock ; from gonorrhea, excessive sexual intercourse, or sexual intercourse within six weeks after miscarriage; masturbation. Usually left side, unless due to movement of right leg. Symptoms.—There is the shock, with localized pain over the region ot the ovary, aggravated by pressure or movement, with aching or numbness, or pain in the inside of the thighs, with re- peated rigors and a fever. The features are anxious, tongue coated, nausea, vomiting, pulse frequent and wiry; great restless- ness and loathing of food ; bowels constipated ; urine very scanty, scalding, and high-colored; patient lies on back with knees drawn up. In some cases the pain in the ovary is intense, caus- ing a bearing-down like labor pains; in other cases it is of a dull, aching character, with paroxysms of occasional sharp, lancinat- ing attacks. Besides the intense pain in the ovary or gland, there is quite considerable pain in the groin and thigh corre- sponding to affected ovary. Bladder is always irritable. The peritoneal covering always sympathizes and often becomes involved. Passage from bowels gives great distress, the hard- ened faeces passing along in the distended bowel presses hard on the ovary. Besides, the ovary can always be detected exces- sively tender, swollen, or puffed up. If the case is a severe one, or treatment inefficient or shilly-shally, it may terminate in peri- tonitis, or in the breaking down of the effused lymph in the ovary, and suppuration. If the latter, there will be rigors; the pulse will become feeble; there will be great nausea and vomit- ing, tongue will become red and glazed; there is weight and throbbing in the ovary. In favorable cases abscess will burst into vagina or rectum ; in unfavorable cases, into peritoneal cavity, giving rise to peritonitis and death. When openings or sinuses form, the case becomes very tedious, opening and closing again and again. Treatment.—The moment a case is made out, apply turpentine over affected ovary; as soon as redness is bright, hot poultices of linseed meal; as soon as it becomes pale, a reapplica- tion of the turpentine, or else croton oil, and follow with hot poultices and opium. At the same time open the bowels with BACTERICIDES. £, copious enemata of linseed tea and laudanum, and place patient upon opium or morphia and gelsemium, in doses often and re- peated until there is absolute relief from pain. If this does not succeed quickly, introduce pastiles into vagina and suppositories of belladonna and opium into rectum. If skin does not become moist and be considerably better in a few hours, substitute aco- nite for gelsemium, and with it give jaborandi. In addition to the poultices and stimulants over ovary, cushions or small pillows of hops, baked in an oven, hot over pubes, vulva, hips. If in this manner inflammatory symptoms can be held in abeyance for four or five days by establishing a renewal of life in the ovary, then begin with the iodide of potass with bicarbonate very cautiously; by and by iodide of lime, and later on ozonized glycerine. The irritating plaster can be substituted for the more active agents, spreading it fresh every morning and applying. The diet all through the attack should be meagre, and confined to milk and lime-water, and beef tea; bowels opened daily with warm enemata of linseed tea. If there are elements of venereal poison in the case, tepid in- jections of solutions of borax, or permanganate, should be used thrice daily. As the progress of these cases is essentially slow, great cau- tion is to be observed in resuming exercise, diet, and ordinary mode of life. Even a tonic course, so essential for recovery, is best delayed till all pain has ceased. Usual uterine tonics.. One of the most common affections Inflammation of the of modern ladies, during the period Ovary. of sexual vigor. Essentially a very [Chronic Ovaritis) chronic disease, consisting in a low grade of irritation of one ovary orboth. Causes.—Suppression of the menses by cold, damp, fright or passion. Masturbation, use of sewing-machine; violence, exer- cise too great, as dancing; tight lacing; sexual incompatibility; excessive sexual intercourse; producing abortions with sounds, whalebone, knitting-needles; retention of puerperal products, as clots and pieces of placenta; the use of sponges, pessaries, rings, uterine supporters ; sexual congress within six weeks after con- finement ; use of caustics ; gonorrhea; fictitious literature; rheumatism and gout, etc. Symptoms.—There is general languor and debility, an unde- fined sense of weariness; a nerve-tire, with a pale, dry, white, doughy skin, torpid bowels and irritable bladder, with scanty urine, and irritation of stomach, nausea, indigestion, flatulence, 62o DISEASE GERMS. with decided hysteria. There is a dull, continuous pain over the affected ovary, aggravated by pressure, movement. In some cases neuralgic shooting pain in addition ; besides this steady pain in ovary, there is also tenderness in the groin, in the sacral region and in the upper part of the thighs. There is trouble of some kind with the menses, usually scanty and painful. Pain in sexual intercourse; likely to be some puffing or swelling of ovaries; also tumefaction and tenderness of one or both breasts. Nymphomania is a common symptom, and it may even merge into a more decided form of insanity, or peculiar strangeness of conduct. Often in defecation, if stools are hard, pain is great. In all cases the ovary can be detected sensitive or tender, either over ovary, or by vagina or rectum. Treatment.—For three weeks during every month the treat- ment can be carried on with vigor, but during menstrual period ii must be entirely suspended, with the exception of local stimu- lation over affected ovary. The points to observe are: ascer- tain the causes, and remove them by daily bathing, hip-baths; regular evacuation of bowels; gentle walking exercise; warm flannel clothing; excite appetite and give best of food, followed by pepsin ; solid diet of animal food, white-fish, oatmeal por- ridge and cream, eggs, etc.; avoid slops. Then general course of vegetable alteratives and tonics, such as compound syrup phytolacca and iodide of potass, Iodide and bromide of potass in the'viburnum compound, or in stillingia compound; iodide of lime; port wine and Peruvian bark; sulphate quinine and aro- matic sulphuric acid; glycerite of ozone, ozone-water. Besides these, the following acro-narcotics have a remarkable sedative action on the ovaries: tincture digitalis, tincture belladonna, tincture cimicifuga. Those drugs have an effect to soothe and even prevent the evolution of the ova if long continued. Pastiles and supposi- tories every night at bedtime of belladonna and opium, if neces- sary. The above can be so regulated as the tonic can be given before meals, alteratives after, and the other remedies between. The irritating plaster to be kept continuously applied, keeping an open sore about the size of a hen's egg. It will be necessary to keep up this alterative and tonic treatment for some months, and while so taking treatment the vagina should be washed out at least twice a day with tepid water and borax, or an infusion of golden seal and borax or sage tea.. In chronic irritation of the ovary, the marvellous absorbing power of the mucous membrane of the vagina should be taken advantage of for administering remedies; pastiles of cocaine, atropia, boroglyceride do good. BACTERICIDES. 621 The parotid suffers from irritation, Inflammation of the inflammation, from the localizing in Parotid Gland. its substance of a pathogenic microbe [Mumps) of mumps. This very fact renders inflamma- tion of this gland a dangerous and a highly contagious form of inflammation. The microbe is freely distributed on the tongue; mucous membrane of the cheek, gums, saliva, breath; seeks the parotid only when that gland is weakened or devitalized, for if we raise the standard of vitality by applying stimulants, the mi- crobe leaves, seek analogous structures, as the mammae, ovaries, testes, brain. At all periods of the attack the micro-organisms are to be found in the blood. Usually a period of incubation, with the ordinary symptoms of fever, debility, inflammation, with pain in head, back, and limbs; pain and swelling over one or both parotids, stiffness of jaw, some soreness in swallowing. Fever and inflammation reaches its height in four days and then declines, occupying about a week in all. Treatment consists in rest in bed, warm room, open bowels, heat to feet, aconite and belladonna internally, nourish with warm beef tea, malted milk. To destroy germ in the blood and mitigate its severity, administer syrup of tolu with either resorcin, creolin, or naphthaline. No local application over parotid. Inflammation of the parotid may arise from cold, or from the presence of the bacillus of tubercle, scarlatina, syphilis, cancer, etc., and demands a very different form of treatment. If acute, exalgine, followed up with general alteratives, saxi- fraga, phytolacca; locally, concentrated ozone, followed with dry heat to the parotid. _______ Inflammation of the pleura or serous Inflammation of the covering which invests the lungs and Pleura. inner surface of the thorax; is met [Acute Pleuritis) with either in the acute, sub-acute or chronic form ; confined to one side or to both. The cause is usually exposure to wet or damp or cold, or frac- tured ribs. The symptoms in the acute form are languor, debility, pain in head, back and calves of legs, chilliness, rigors and a fever, with hot, dry skin; temperature not so high, unless pneumonia, to a limited extent, exists—1010 to 1030 F.; cheeks flushed; hard ,-,., DISEASE GERMS. and quick pulse; increased frequency of respirations; an acute, lancinating pain in the side, called a stitch or catch, commonly below the nipple, over attachment of diaphragm on front of chest. This stitch or pain is aggravated by expansion of the lung in inspiration, coughing, or moving, or lying on affected side, and by pressure. A harsh, dry cough, with frothy expectoration; anxiety and restlessness; scanty and high-colored urine. Over the seat of stitch or pain can be detected, quite early, a friction sound, caused by the in- flamed, congested and roughened surfaces of the covering of the lung rubbing against the pleura of the ribs. This rubbing resembles the rubbing of two pieces of brown paper or stiff silk against each other; generally best heard and even felt by AcshowrngUrithe the hand forty-eight hours after rigor, often earlier. microbe at jt ceases when inflammatory action is arrested, or when the two surfaces become moist and smooth by effusion of serum, or when adhesions by bands of lymph take place from the affected surfaces, or when effusion is in great abundance. The duration of an attack of pleurisy should bcbut a few days if properly treated; but if mismanaged, it may be run into some of its terminations or effects, or into a chronic form. Effusion of serum may take place, to the amount of a few ounces or of several pints. It may be pure serum, liquor san- guinis, or serum and blood. When excessive it compresses the yielding lung, suspends its functions, displaces the heart, and somewhat distends the thoracic walls. This effusion is called hydrothorax. When" pleurisy terminates in a break- ing down of lymph, or suppuration or pus, which accumulates in the cavity of chest, it is called emphyema. When this occurs constitutional symptoms are more serious—rigors, febrile dis- turbance, often of a hectic character; Acuteinflammationofthepieura, tongue brown, dry and thickly coated; showing the microbe of pieu- ° . - J ii. risyin nests- pus sometimes forms a bulging tumor in intercostal spaces; fluctuation can be detected, or sinuses may form at distant parts, and it may be evacuated; or ulcera- tion of costal pleura may take place, pus finding its way through muscles and skin, and forming a fistula in the chest; or, more rarely, the covering of the lung may be perforated, and the pus find an entrance into the air cells, and be expectorated. BACTERICIDES. 623 Whatever the nature of the effusion, serum, or serum mixed with blood and liquor sanguinis, or lymph broken down (pus), it will cause, according to its extent, dulness on the lower part of the chest, extending upwards. The respiratory murmur of the lung is diminished. The chest may be so filled up that the lung may be compressed, so that little or no air can enter the bronchial tubes, so that no murmur can be heard. The fluid also prevents any intercostal movement. Patient cannot lie down. Treatment.—Acute pleurisy should be treated with great energy, in order to prevent such grave complications. Wet cups or turpentine to redness over the seat of pain, followed with hot, moist linseed poultices, in which tincture of opium is freely in- corporated; changed frequently. A flannel'roller should encase the chest from the axilhe down to the base of ribs over poultice; the latter can be kept hot by bladders of hot water. Patient put to bed, perfect rest, avoidance of talking or full, deep inspiration ; breathe, chiefly by diaphragm, so as to prevent friction between inflamed surfaces. Then one tablespoonful of tincture veratrum viride, tincture of aconite and sweet spirits of nitre in half a tum- bler of water, of which one teaspoonful should be given every hour till pulse reaches 70; then at intervals of two or three hours apart. Give half a grain of pulverized opium, five of Dover's powders in an infusion of pleurisy root every three hours, or double the quantity if there is not a speedy relief. Open bowels if confined; keep heat to feet. If the skin does not perspire well with pleurisy root tea, add compound tincture of serpentaria in half-teaspoonful doses. If symptoms are urgent, inject hypo- dermically one-third of a grain of pilocarpin; when it acts there is immediate relief and a cure; so it is unnecessary to lay down rules for diet or drink, which should be gruel, milk, broths, cream of tartar, water or lemonade. With such new and definite remedies, we have the means of getting rid of all acute and sub-acute cases in twenty-four or forty-eight hours. Tonics, good, nourishing food during conva- lescence; quinine, in alternation with iodide of potass, is espe- cially valuable. _______ Chronic inflammation may follow an Inflammation of acute attack, or it may come on of itself. the Pleura. There is no fever, rarely friction sound, {Chronic Pleuritis) but more generally effusions of lymph, with adhesions in the form of threads, bands, or ribbon-like exudations between the two pleuras, which interfere with respiration, especially if deep, or with movements, 624 DISEASE GERMS. as raising hands to face, turning sideways when the characteristic stitch is experienced. As there is in all cases of chronic pleurisy adhesions going on, the best method of treatment is to build up the general health by good substantial food, well-regulated secretions, woolen clothing, rest for a few months. If that is not practicable, an avoidance of positions in which the catch is experienced; then a general alterative course, with iodide of potassa in alternation with tonics. Over the seat of adhesion, which is readily known by the stitch in certain postures, the irritating plaster should be kept constantly applied, spread fresh every morning, and if sup- puration is not free, occasionally rub over with croton oil. The irritating plaster has a better resolvent action than repeated fly blisters or iodoform ointment. Usually about three or more months are necessary to break down a pretty firm adhesion. The obstacle to free, deep inspiration, and that peculiar retrac- tion of chest will disappear as soon as the adhesion gives way. To Promote the Effusion of Serum in the Cavity of Chest.— The best of diet to raise the standard of blood; tonics to stimu- late appetite. Try first infusion of squills and digitalis, followed with diuretics, diaphoretics and hydragogue cathartics; those failing, alteratives and iodide of potass ; all remedies useless, tap the chest between sixth and seventh ribs, two-thirds the distance from the spinous process of vertebrae to middle of sternum. The old-fashioned trocar and canula is better than the aspiration. In emphyema, aspiration should be performed several times. The thorax to be tapped long before difficulty of breathing, or threat- ened suffocation takes place. A partial death, or inflammation, of the Inflammation serous membrane lining the abdominal cavity of the and investing the viscera ; a white fibrous tissue Peritonaeum, of very low organization. Nothing so likely Acute. to ward off any depressing influence as strong [Peritonitis) vital force, and this is especially true with reference to the peritoneal membrane, for we find in a large per cent, of all cases that it is predisposed to by some depression of the sympathetic system, and that the com- mon exciting causes, such as minor injuries, would be insufficient, were it not on account of this nervous depression. In the condition of partial death of this structure there is also a degradation of its normal living matter into a micro-organism or diseased germ, for we find that if a physician is attending a case of acute peri- tonitis in a male, and by chance becomes the attendant in a case BACTERICIDES. 625 ol parturition, the lady will become affected with peritonitis, severe or mild, according to her vital stamina, so that thus far there seems to be a living poison present. The general causes are injuries, perforation of stomach and bowels, strangulated hernia, damage done to organs in the abdominal cavity, as stomach, uterus, liver, etc. Acute inflammation of the peritonaeum is one of the most grave and serious calamities that can befall a human being. When not due to wounds, it is generally caused by injuries to organs, as the uterus, beginning as a case of metritis, or inflammation of that organ, and spreading over every organ in the visceral cavity. Originating in that manner it is called metro-peritonitis. Symptoms.—Chilliness or. violent rigors, accompanied with severe, sharp, lancinating pain, extending over the entire abdo- men, with high fever, small, hard, wiry pulse, abdomen swells, becomes exquisitely tender on pressure, even sensitive to the slightest pressure, as bed-clothes, or movement of abdominal muscles ; patient lies on back, with knees bent, legs drawn up ; abdomen becomes more enlarged, tense and hot, tympanitic or drummy; motionless in respiration ; features become sharp, ex- pressive of anxiety and suffering; the tongue is sharp-pointed, dry, with a variable coat, according to the location of inflamma- tion ; nausea, vomiting, constipation ; skin very dry and burning; pulse becomes more rapid ; respiration hurried ; often hiccough. If case drags, the abdomen ceases to be tympanitic, but remains enlarged from effusion of serum. If the injury is irreparable, or treatment ineffective, and the case about to terminate fatally, ab- domen becomes more distended, pulse thready and quick, but intermittent; face becomes of a ghastly expression, cold, clammy sweat, pain suddenly ceases. Unless due to perforation of stomach or bowels, the ordinary duration of peritonitis is about one week; when due to perforation, twenty-four or forty-eight hours. After sudden cessation of pain, when about to terminate fatally, patient may live twenty-four to thirty-six hours. Treatment.—The aim of treatment is to establish a renewal of life in the affected membrane. For effecting this purpose narcot- ism with opium, or its alkaloids, is our only resource. The first difficulty we have to contend with is in selecting the form, whether it be crude or pulverized opium alone, or with Dover's powders, or as paregoric, or the sulphate of morphia in cinnamon water. The best plan is to try the crude pulverized alone or with Dover's powder every half hour in half-grain doses. If it an- swers the purpose of causing the patient to sleep, then push it; if it stimulates, try other forms until you find the one that answers the purpose. In conjunction or in alternation, a few 40 626 DISEASE GERMS. drops of tincture of green root gelsemium. If stomach is re- jecting everything introduced, same remedies in suppositories or capsules per rectum, in double doses. At the same time the attending physician or nurse must select one of three remedies and apply over the entire abdomen ; either a fly blister for six hours, or until it causes redness, or turpentine applied until the same effect is produced, or tartar emetic ointment rubbed in over the entire abdomen. There is to be no blistering, as that is injurious, barbarous, draws off the liquor sanguinis of the blood. Whichever is applied, must be followed with large linseed meal poultices made with glycerine and one or more ounces of tincture of opium incorporated in it. Change every two or three hours. If there is any delay in procuring the above articles put on hot poultices of anything that will hold heat and moisture, until proper remedies can be procured. Local stimulants to the entire abdomen are of the greatest value; they promote vitality, create a renewal of life; their use is founded on sound principles, for it is a law of physiology that when two parts are nervously in sympathy with each other, if we excite a greater action in the nerves of one, we distract action from the nerves of the other. The blister or turpentine to erythema is a powerful means, it cures by withdrawing nervous action from the nerves of the part, and followed by hot poultices induces contractility of blood vessels and a renewal of life. Turpentine, of all stimulants, is perhaps the best in puerperal peritonitis, and one which, from its action on the skin and kidneys materially helps in the elimination of the materics morbi from the system in such cases. Moreover, from the rapidity with which in many instances the symptoms of peritonitis may subside under treatment by this drug, it would apparently seem to have some direct germicide effect on whatever micro-organisms may be con- nected with the development of puerperal septicemic fever or metria. In other cases of the same kind muriated tincture of iron, more especially when given in combination with quinine and liquor ergotae, and given in full doses, appears to act in a similar way, and may be tried either with the turpentine, or in its stead, as long as tolerated by the stomach and bowels. It too often happens, however, that vomiting and diarrhea are promi- nent symptoms in these cases ; and, under such circumstances, the remedies just referred to are obviously out of the question, and we must then fall back on the various preparations of opium and its alkaloids, from the administration of which, concurrently with free stimulation and the use of the hot pack—that is, by swathing the patient in mustard or turpentine stupes until reac- tion is established, and gastro-intestinal irritation allayed; re- BACTERICIDES. 627 coveries occur in cases of puerperal peritonitis in which all hope had been previously abandoned. As soon as the skin begins to pour out a copious sweat, and stertorous breath- ing take place, patient must be turned over on right side, carefully watched, and as a rule ten to twelve hours of nar- cotism is sufficient. Then waked up and a little barley-water, or lime-water and milk given. If there are any indications of sink- ing, aromatic spirits of ammonia. The opium, gelsemium and hot poultices should be continued for about a week, the two former in small doses, at intervals of three or four hours apart. Cautiously and carefully begin with a little diet, as milk and water, beef tea, essence of beef. Enemata ot warm castile-soap water daily, to remove all fecal accumulation in colon or rectum. A cradle over abdomen to support bed clothes; most perfect quiet obtained. The best of nursing and care, air of sick room to be kept warm and pure; carry case over seventh day, then treatment for chronic peritonitis should be adopted. Chronic peritonitis may be the Inflammation of the sequela of an acute attack; more Peritonaeum. frequently an independent affection. [Chronic Peritonitis.) It may arise from cold, suppression of menses, miscarriage, mechanical vio- lence, such as blows, rheumatism and gout, ovarian irritation. In children, it is associated with deposit of tubercle. Symptoms.—General languor, lassitude, debility, with abdomi- nal pain, sharp and lancinating, tender to pressure, and con- siderable swelling of abdomen; sometimes slight fever, with obstinate diarrhea, nausea, wasting and prostration. If case progresses, a good deal of abdominal tension ; often effusion of lymph, with adhesions, which give rise to colic. In some cases, effusion of serum or ascites is immense. In chronic tubercular peritonitis in children, there is usually enlargement of mesentery. Treatment.—Patient should go to bed for a few weeks, until every vestige of pain has disappeared ; being treated in the same manner as if the case was acute, with opium, gelsemium and local stimulants. As soon as pain has disappeared, alteratives and tonics, as ozonized saxifraga, iodide of potassa, ozonized glycerine, cinchona and mineral acids, tincture of white bryony. To the abdomen, ozonized clay, if effusion of lymph is suspected, or iodoform ointment, or ozone ointment, iodide of cadmium ointment; and over all a flannel roller; great attention to the bowels and diet; milk and lime-water, raw eggs, raw extract of meat. 628 DISEASE GERMS. Inflammation of the pharynx is a Inflammation of the very rare form of disease. We meet Pharynx. with it occasionally in terribly broken- down conditions, where the vital forces are at a low ebb, mal-nutrition and mal-assimilation ex- treme, as we often find it in the degrading haunts of poverty and vice ; and when it occurs, it is mostly erysipelatous or bacterial, and is attended with great prostration, low fever, and difficulty in swallowing. Death takes place from exhaustion. Our remedies, then, are to get the patient into a better atmos- phere ; abundance of antiseptics or disinfectants around. Ad- minister quinine freely; give brewers' yeast in tepid milk every three hours. Diet, beef tea with barley, raw eggs. A partial death of this gland may Inflammation of the be induced by violence, blows, kicks, Prostate Gland, falls; by gonorrheal inflammation Acute. proceeding upwards; by the use of strong caustic injections into the ure- thra ; excessive venery, masturbation, disease of rectum; a metastasis of the poisons of gout or rheumatism in that class of subjects exposed to cold or wet: to the action of such drugs as cantharides, turpentine, balsam copaiba, etc. Symptoms.—Pain in the perinaeum, very excruciating, with sense of heat; frequent painful micturition, often inability to urinate; great pain and distress in defecation ; a feeling of weight and fulness about perinaeum and rectum; suffering increases; rigors and a fever set in, and difficulty of micturition increases. The insertion of finger up the rectum gives great pain, but by it the gland can be felt, hot, extremely sensitive, and enlarged. The greatest kind of suffering is experienced if a catheter is in- troduced ; aching in hips and thighs, with dragging in back. If case is not actively treated, often progresses on to abscess. Treatment.—Hot hip-baths, followed with suppositories of belladonna and opium, or enemata of the same remedies. Then perfect rest in bed, with either hot poultices or fomentations of lobelia, keeping perinaeum smeared with belladonna. Treat fever with aconite, and as large doses of green root tincture of gelsemium as can be borne, with bromide and bicar- bonate of potassa, every three hours. If there is inability to urinate, draw off with catheter. As soon as fever abates, add iodide of potassa to the bromide and bicarbonate. Infusion of one of the astringent diuretics as a drink, to which sweet spirits of nitre can be added to keep urine alkaline. Lva BACTERICIDES. 629 ursi or hydrangea is the best. As case progresses, alteratives and tonics, iodide of potassa to be the principal. If abscess form, incision over fluctuation, followed with poultices, nourish- ing food, tonics. Forbid, during treatment, all stimulating articles of diet, feather beds, sexual intercourse, liquors, as priapism is often present. If there are elements of gout, colchicum and quinine. In inflammation of the substance of the pros- Prostatitis. tate, besides the symptoms of granular prosta- Sub-Acute. titis, there are aching or stabbing pains in the anus, sacrum, or perinaeum ; pain at the supra- pubic region is a common sign. There are also radiating lum- bar or femoral pains after exercise or long journeys, general languor, malaise, or depressed spirits. Increased frequency of micturition is often absent; when present, it is felt by day, not by night. The flow of urine is altered by delay at the begin- ning, which may amount to retention. Dull pain after micturi- tion^ sometimes spasm at the end of the flow, with a sense of more to come, are complained of. In cases of long standing, micturition during sleep is a symptom,—constipation is almost invariable. When the congestion is great, there is pain during defecation and between the acts a sense of weight at the anus or in the perinaeum. Pain in the testes when it occurs is simply a neuralgia. There is constantly hypersecretion of mucus. In some patients, the organ recovers its natural condition in a few weeks; but usually the disease drags on a course more or less wearisome; thus the termination is very uncertain. Re- lapses are almost sure to follow if the patient exceed in his diet or regime. In relapses small abscesses often collect in obstructed ducts, which usually empty themselves through a duct before accumulating much. Sometimes the inflammation spreads to the parenchyma, and the prostate then becomes unyielding to the touch, hard and sensitive. The enlargement of the organ may last long. The increase in size may be symmetrical, or only affect one part, giving the sensation of irregularity or lobular form when felt by the finger. In course of time, the nodules may disappear, and the organ regain its natural size, or even shrink below it, and feel quite firm and smooth. The treatment of all forms of prostatitis is always obstinate and tedious—of the many remedies in use, few are trustworthy. General treatment assists the local remedies. General alterative and tonic course. Indigestion must be overcome by comp. tinc- ture matricaria; bowels regulated with the cascara lozenge, and 630 DISEASE GERMS. the best tonics, embracing cinchona, mineral acids, nux vomica, gelsemium and belladonna are very valuable, if troublesome micturition be a symptom. Ergotine and damiana are specially useful if there be enlargement, or if there be pain or aching ex- cited by walking or standing. When the organ is enlarged, flabby, soft, or tender, a good remedy is the cold sitz bath, taken at first for a few minutes, then prolonged to fifteen minutes, of cold spring water. The cold douche on perinaeum and rectum are also of utility. Cold enemata are extremely useful; four ounces of cold water and one ounce of distillation of witch hazel" form a good injection ; it should be retained, and used at least twice daily. Among the best recognized remedies are the insertion of a cocaine supposi- tory at bedtime, and we have great faith in its efficacy. An in- jection often or twenty drops of the undiluted distillation of the eucalyptus is a good preparation. This has to be repeated fre- quently. Prostatitis from Masturbation or Excessive Venery.—Masturba- tion is a frequent provocative of prostatitis, sometimes in the acute form, more often in the sub-acute or chronic forms. In the mildest form of prostatitis through masturbation, the prostate bleeds easily, the urine is often tinged with blood, smoky, or even coffee-colored. If felt per rectum, the organ is found but little changed from the natural condition. General malaise, in- appetency, and slight elevation of temperature usually accom- pany the bleeding. Bleeding from the congested prostate may be copious in young men when it follows prolonged venereal ex- citement and excessive copulation. Commonly very copious when thus originated, it may be profuse for an hour or two, and exhausting. * In those affections nothing can excel the glucoside of the black willow in the form of a suppository per rectum, the ozo- nized extract should be given in drachm doses thrice daily. It has a marked effect in checking the involuntary emissions, and thus prevents the irritation, exhaustion, and neuralgia which is often experienced. Sequela of Prostatitis.—Persons who have suffered from a con- gested prostate are liable to too speedy ejaculation during copu- lation. This may be so rapid, and erection so fugitive, that effective coitus is impossible. For such cases the ozonized ex- tract of damiana has sometimes a powerful effect. But cure is almost hopeless if continence is neglected. Some persons give way to the sexual appetite without limit. Then follows a condi- tion of great helplessness. The intense neuralgia of the lower extremities which follows the shortest walk renders exercise im- BACTERICIDES. 631 possible. Pain is rarely absent, even when at rest; it extends from the sacrum along the spinal column to occiput. The diges- tion is deteriorated. Topical treatment, after the mucous catarrh and chronic inflammation of the prostate is quelled, must be laid aside. The best remedy is a life of quiet, absence of exertion of any kind ; a long sea-voyage is one of the best remedies. In rare cases chronic parenchymatous prostatitis excites temporary mania, whichthas erotic irritation for an early or leading symp- tom. It disappears if the patient recovers from the physical affection. We have found in such cases a most excellent cerebral tonic, prepared from the orange wine of Florida Vinum Co., green coca leaves and the peroxide of hydrogen, alternated with avena sativa. Or, as some term it, chronic enlarge- Inflammation of the ment of the prostate, is very common ; Prostate Gland, not as a result of the dignity of a Chronic. hoary age, but rather of the defects and vices of modern civilization. The character of the gland is such that with a slight degree of irrita- tion, its different lobes become rapidly filled up with lymph, and thus become greatly hypertrophied. The enlargement is due to effused lymph, the result of inflammation, which, in old age, undergoes calcareous degeneration. Of the male population of" North America, it is estimated that eighty per cent, of all over thirty-five years of age suffer more or less from chronic prostatitis. Causes.—It may be a sequel of an acute attack, or may come on from the same causes, such as mechanical violence, gonorrhea, irritating injections, diseases of rectum; but by far the most common causes are sexual excesses; masturbation; imperfect copulation, in withdrawing the penis in the act of ejaculation, so as to prevent impregnation; in having sexual congress with women of large or dilated vaginas, or affected with leucorrhea, in whom the contractility or grasping power of vaginal walls is impaired, and the tonic action of the sexual act on the male is destroyed: the wearing of condums; the want of compatibility in the sexes. These, and similar conditions, prevent the secre- tion of the prostate, as well as the semen from the testis, from being thrown off; the result is, it remains in the ejaculatory ducts and excites inflammation ; in other words, they are im- perfectly emptied of their natural secretion ; sedentary habits ; incessantly in the saddle, as in riding; strictures; the debasing or demoralizing effect of our modern sexually exciting literature; 632 DISEASE GERMS. drugs that cause a determination of blood to those parts; over stimulation in eating and drinking. Those are a few of the most common causes of devitalization of this gland, the cause of premature decay, loss of national vigor or manhood. Although we have stated the disease to be of such prevalency and early occurrence, it is usually at a later period of life that decided symptoms make their appearance, although the enlargement begins earl)'. The increase in size is due to a true hypertrophy of the normal structure of the gland. This hypertrophy may affect the whole gland, or only a lobe, or the two lateral lobes alone, or the middle alone may be affected. Again, there may be a separate tumor of prostatic tissue em- bedded in the substance of the gland, or pedunculated growths may spring from the surface of the gland and project forward on the bladder or back to rectum, often mistaken by the ignorant for piles. The effects of chronic prostatitis on the spinal cord are bad; on the brain even worse; and as a mechanical impediment to the bladder, of the gravest kind; alters the course of the ure- thra, lengthens its vesicle end, increases the curve, and dimin- ishes the calibre of the canal; besides, the cavity of the bladder may be intruded on by the size of the gland; its muscular coat thickened by frequent straining to void water, and later on the ureters may, with the kidneys, become affected. Chronic inflam- mation of the bladder may take place, and its capacity be dimin- ished, or it may become sacculated. Although we have stated thirty-five as the period in our country of its appearance, still, as the symptoms are obscure, patients may not seek relief for many years thereafter. It is a slow, insidious, but progressive disease. The production of prostatic inflammation must be regarded as the result of ignorance and wilful violation of natural laws, and not as the calamity of age. Symptoms.—The symptoms of chronic inflammation of the prostate in the early stage are not of a prominent kind ; indeed, the gland may attain considerable size without giving rise to much trouble. But decided when there is weakness in erectile power, or seminal losses, or obstruction to urinating, or urine escaping with the stools, stream weak, more difficulty in turn- ing it on or off, besides increased frequency in micturition, with more irritability of the gland; if unmarried, nocturnal emis- sions, one after the other, or a morbid desire for sexual inter- course ; often a slight gleety discharge, which keeps the urethra red, tender, or sore. The enlargement causes a mechanical impediment to the function of the rectum, as well as the bladder; stools are flattened like a ribbon; constipation ; a feeling as if BACTERICIDES. 633 the bowels were not perfectly evacuated. The frequent calls to make water become a serious item, disturbs the patient at night, and interferes with his comfort during the day. Continence or incontinence is likely to take place; if the latter, the urine drib- bles away. As the case progresses, there is more irritation of the bladder, urinary misery becomes greater, and fits of reten- tion may take place from the slightest exposure to cold, or ex- cess. The reflex symptoms are often distressing—languor, lassitude, debility, nervous prostration, derangement of spinal cord, brain, stomach, liver, and especially in a young patient, a morbid condition of the mind. With all these and other symptoms, there should be an exam- ination per rectum with the forefinger of right hand, and in all cases the gland can be felt, large, hot, tender. The examination should be made with patient on his back, finger-nail filled with soap, and the finger, well oiled, should be introduced very slowly and gently, so as not to excite spasm of the sphincter. Treatment.—As soon as the disease is clearly made out, and the necessary arrangements made, begin with a general vege- table alterative and tonic course, as ozonized phytolacca and iodide potass, ozone-water, glycerite of ozone, gentian, columbo, or some other better tonic. Instruct patient that cure is slow, but positive, unless very old. Inculcate good diet; attend to skin; daily bathing and flannel clothing; bowels to be opened daily; a cold water hip-bath, morning and night, for fifteen minutes each time ; forbid tea, coffee, tobacco, and all kinds of alcoholic drinks; recommend exercise, an avoidance of unhealthy literature, and for a few months at least, a suspension of sexual congress. Patient should sleep on hair mattress, on his right side. While this treatment is being carried out, the special features of the case should be attended to. To Arrest, Check, or Control the Morbid Sexual Desire, or Emis- sions.—Try first thirty drops of tincture of green root gelsemium at bedtime, and increase dose if necessary. Or tincture digitals, drops eight. Or tincture belladonna, drops five ; begin in after- noon, and give three doses before bedtime. Or tincture ery- throxylon coca in sufficient doses. Or lupulin and lactucarium. Or black willow extract. Or, best of all, the spermatorrhea pill. The salts of bromine are efficient, and, if used, let it be for a little while. To Promote Absorption of Effused Lymph in Prostate.—The patient is on iodide potass in his alterative; so, to aid its action, try every night at bedtime a cocaine suppository, with infusion of hydrangea; or cleavers; or uva ursi. Or muriatic acid in 634 DISEASE GERMS. five-drop doses, thrice daily, in water ; and, in addition to either, a suppository of belladonna and iodide of potassa. To Overcome Inflammation of Prostatic Portion op Urethra.— Use every other night a gelatinized bougie of iodol. For Retention of Urine.—The ordinary means, warm hip-bath, belladonna suppositories, and gelsemium internally ; failing, urine should be drawn off daily with a catheter. This is a good plan if there is the least inability to empty the bladder completely, as it is of primary importance that at least once in the twenty-four hours the bladder should be thoroughly emptied. If this is not attended to, it may bring about paralysis of the organ, with the loss of the power of voluntary micturition, and cystitis. For this purpose, a No. 12 silver catheter is better than a smaller instrument; it goes in easier, is less likely to do damage. Keep the point of the instrument on the upper wall of urethra, and, above all things, use no force. In a short time, even in old cases, the patient will be able to get along. An alterative and tonic course should be persevered in. The sequela of this inflammation, if not cured, is enlargement of the prostate. ______ Rectitis, without the 'affection termed Inflammation dysentery being present, is a rare form of of the Rectum, disease, but it may be caused by violence, [Rectitis) or the introduction of foreign bodies into the bowel. The Symptoms are the same as dysentery : rigors, fever, great constitutional disturbance, intense heat and soreness about the anus ; severe shooting pain up the back and sacrum ; spasmodic contraction and excessive tenderness of the sphincter ani; tenes- mus, with passage of muco-purulent matter and blood; irritable bladder, with a train of reflex symptoms, and the same microbe appears as in dysentery. The treatment should consist in the most absolute rest in bed; sthnulants, such as mustard plaster over the entire abdomen; followed with hot poultices of linseed meal, changed frequently; drink, water acidulated with aromatic sulphuric acid ; enemata of starch and tincture of opium every three hours into the bowel; antipyrine, fifteen grains, every four hours for fever, dis- solved in water; a selection of some of the following formula may be made: Iodol, one drachm; solid extract of belladonna, five grains; pulverized opium, twelve grains; butter of coca, a sufficient quantity to make twelve suppositories. Insert one every four hours. BACTERICIDES. 635 Subnitrate of bismuth, sixty grains ; iodoform and resorcin, of each ten grains; muriate of hydrastin, five grains; sweet almond oil, one ounce. Inject at once and repeat. Infusion of slippery-elm, one ounce; add to it twenty grains of resorcin, with one grain pulverized opium. Green root tincture of gelsemium operates like a charm. Follow with small doses of peroxide of hydrogen and mineral acids; stone crop, as the case progresses to recovery. Diet very light and bland, as chicken, toast, arrow-root. Inflammation of the delicate net, or web, or Inflammation membrane, called the retina, is rare, al- of the Retina, though it sympathizes with all the inflam- [Retinitis.) matory conditions of the eye. Causes.—Exposure to vivid light; such as the glare of snow, the white sand in tropical latitudes, large fires in foundries, and molten iron. Symptoms.—Acute, deep-seated pain in the eyeballs, extending to temples and forehead ; great intolerance of light; dimness of vision; frequent sensations of flashes of light; pupil contracted to a pin-point; iris loses its brilliancy and becomes motionless ; some vascularity of sclerotic and conjunctival coats; constitu- tional disturbance ; high fever, and delirium. If not carefully managed irreparable blindness liable to take place. Treatment.—Perfect rest in a dark room; veratrum, aconite, for fever; morphia, or opium, or hyoscyamus for pain, which is to be relieved at all hazards; bowels to be freely opened; skin stimulated by frequent bathing and jaborandi; heat to feet— after mustard. To nape of neck, a four-inch square mustard plaster, followed with croton oil, then poultices, and latterly irritating plaster. To the eye, warm fomentations of opium and tepid water, or infusion of poppies; alteratives and tonics, iodide potass and quinine. As to the great value of stimulating applications to nape«of neck, there can be no doubt in all eye affections. The optic nerve originates in the spinal cord and medulla, so that a good stimulant at root induces contractility and normal vigor in the main trunk, and in its finer mechanism or reflexion in the opti- cal instrument, the eye. In all eye diseases, aside from children, our motto is active stimulation to its origin. We cannot urge too strongly the use of quinine in glycerite of kephaline as our best tonic in retinitis. It should be adminis- tered in half grain doses thrice daily. 636 DISEASE GERMS. Inflammation of the Stomach. Acute. [Gastritis) The stomach being a very vital organ, anything which gives rise to a partial death of that organ is attended with ex- treme danger. Causes.—The ordinary causes are the introduction of irritating agents into the stomach, such as poisons, arsenic, caustics, mercury, acids, emetics, "whiskey, and other irritants; or it may be caused by blood poisons or disease-germs, as in yellow and puerperal fevers ; or by inflammation spreading from other parts, as in in- flammation of the uterus and peritoneal coat; it often spreads to or involves the stomach. Symptoms.—Nausea and vomiting; burning soreness or raw- ness in the stomach, accompanied with a pricking or lancinating pain, very tender to slightest touch, or even pressure of bed- clothes; intense thirst; great desire for cold'drinks, which when swallowed, are almost imme- diately rejected; tongue at first may be furred or coated white, with red tip and edges, or in streaks, and subsequently it assumes a raw-beef appearance, smooth and glassy; and if the blood is affected, dark at the root. The matter vomited at first is usually serous,' or mu- cous, or biliary, then becomes greenish, latterly like coffee grounds, or black, which is simply blood changed by the action of the acids of the stomach. There is a generally tympanitic condition of the abdomen, and patient lies on back with knees drawn up and head and shoulders elevated, so as to keep the abdominal muscles from pressing the stomach. Temperature is very high ; pulse frequent, small and wiry; respiration frequent and short; features pinched and sharp-pointed ; constipation ; loathing of food and disgust of warm drinks; urine scanty, high-colored; its duration, about a week. If not very carefully and energetically managed, death is very liable to take place' from exhaustion, or suddenly from gangrene. The best we can obtain is to run it into chronic gastritis. Treatment.—The patient must be kept as quiet as possible in recumbent posture in bed ; weight of bed-clothes kept off by a cradle; heat to feet; sponging body thrice daily; mustard plaster poultices over stomach, followed by hot poultices of gly- A vertical section of the walls of the stomach in acute gastritis. BACTERICIDES. 6?7 cerine, flaxseed, and opium; no drink allowed ; patient can take water or ice in mouth, but must not swallow much, if any—noth- ing to enable the stomach to contract. Small, but oft-repeated doses of tincture of green root gelsemium, in alternation with a solution of morphia. The two remedies administered on and on every half hour till narcotism is induced, which condition should be continued for ten or twelve hours, and patient kept on right side. If successful with narcotism, then continue same two remedies every three or four hours for a few days ; give no food, a little mucilaginous drink, as gum-arabic water or marshmallow tea; nutritive enemata every three hours. The point to be aimed at is narcotism, during whfch inflammatory action ceases. If a complication of other diseases, still this point holds good. The idiosyncrasy that often exists to the action of opium or morphia, is entirely overcome by the gelsemium. If successful, be very cautious about beginning diet; milk and pepsin, beef tea and pepsin, white of egg and pepsin, juice of raw beef. A low grade of irritation in the vari- Inflammation of the ous coats of the stomach. Stomach It may follow an acute attack, or [Chronic Gastritis) may come on from the introduction of irritants into the stomach, as arsenic, mercury, whiskey, etc.; swallowing immoderately iced drinks ; bolting ice-cream after a hearty meal, thereby suspending diges- tion and devitalizing the stomach. In ladies, belts or other arti- cles of dress irritating stomach; in men, from dispensing with suspenders, wearing belts ; and mechanical t N.-^ occupations, pressing on stomach; also, '•'•:g^^^fe ., direct violence and other like causes. '-':-^^^P^jM|:^■ Symptoms.—The symptoms of chronic '-■•JkJ^^^SS|^'-) inflammation of the stomach involve all m ^^^^^^ that are present in the various forms of ^^f^^BrjJT^^ dyspepsia, as heartburn, water-brash, eruc- ',/^^- tations of gas or liquids, gastrodynia, slow a vertical section of the *tom- or imperfect digestion, with headache ; be- ach ,n chronic gastrit" sides, the tongue is red at the tip and edges, with a white coat in the centre; there are is pain in the stomach, aggravated by pressure or the clothes; disordered bowels; often a craving for food, but only a small portion can be taken without producing oppression and vomiting. Chronic gastritis is essentially stubborn. It may exist many- years, even in a mild or aggravated form, but is very apt to terminate in thickening or induration of its coats, narrowing the pylorus, or ulceration, perhaps going on to perforation. 63S DISEASE GERMS. Treatment.—In this affection, rest, daily bathing, bowels opened by enema of some soup ; flannel clothing. A suppurating sore, about four square inches, should be maintained over region of stomach, until a few months, after recovery. The diet should consist of juice of raw beef, milk, with lime-water or bicarbonate of potassa, arrow root, milk toast, boiled fish, chicken, oatmeal mush; three meals per day, pepsin to follow each in a suitable dose to digest without without making any demand on stomach for digestion; drinking fluids to be forbidden. After attending to those preliminary points, our next and main object is to increase the vitalizing tonicity of the stomach. For this purpose, compound tincture of cinchona, four ounces; aro- matic sulphuric acid, one ounce; one teaspoonful every four hours in water, or if that does not operate well, use infusion of golden seal, from a tablespoonful to three every four hours; col- linsonia, gentian, columbo, or other remedies laid down under the head of dyspepsia. If there is much burning,-soreness, or rawness, use gelsimium and quinine freely, or gelsemium and chlorate of potassa. Once rid of pain, with tenderness on pressure, and the red tip and edged tongue, then a general course of vegetable alteratives and tonics, with more extended and varied diet. Inflammation of the substance of the spinal Inflammation cord is extremely rare, usually a segment or of the a portion involved, seldom the entire length. Spinal Cord. It may be caused by falls, blows, shocks, Myelitis) concussions, or microbial disease of the vertebrae, as the bacillus of tubercle, syphilis, etc. Symptoms will depend almost entirely upon what part of the cord is implicated. If the cranial portion of the cord is affected, there is deep-seated headache ; convulsive movements of head and face ; inarticulate speech ; trismus; difficult deglutition; impeded spasmodic breathing ; irregular action of heart; paralysis. If about to prove fatal in the acute stage, great prostration; greater difficulty of breathing; involuntary excretions. When the entire thickness of the cord above the phrenic nerve is affected, death takes place rapidly from cessation of respiratory move- ments. If the cervical portion suffer inflammation, difficulty in swallowing and breathing; impossibility of raising the head, pain in back of neck; sense of pricking and formication in arms and hands; paralysis of upper extremities. If the dorsal, pain over the* affected part, numbness or pricking sensations in fingers and toes ; paralysis of arms and lower extremities, with great difficulty BACTERICIDES. 639 of, breathing and palpitation. If the lumbar, marked paralysis of lower extremities, at an early period, abdominal pain, and a sensa- tion as if there were a cord tight around the body, convulsions with retention, followed by incontinence of urine, owing to paralysis This plate represents the under surface or base of the brain, little brain, the pons varolii and me- dulla oblongata, also the anterior surface of the spinal cord, to show the mode of origin of the cranial nerves from the base of the brain and that of the spinal nerves from the spinal cord, a, a. Cerebral hemispheres. l\ Right half of cere- bellum, m. Medulla ob- longata. Above this is a transverse white mass, the pons varolii, c, c. The spinal cord, showing its cervical and lumbar enlargements and its pointed termination, e. the Cauda equina. 1 to 9, the several cranial nerves arising from the base of the brain and sides of the medulla ob- longata. Below these, on each side are the roots or origins of the spinal nerves—cervical, dorsal, lumbar and sacral. • In some of these the double root can be seen and the swelling or ganglion on the posterior root, a, x, the axillary or bronchial plexus, formed by the lower four cervical and first dorsal spinal nerves. 1. The lumbar plexus. s. The sacral plexus, formed by the last lum- bar neive and first four sacral nerves, t. Shows a piece of the sheath of the cord cut open and within it a portion of the ligament which supports the cord. Plate A. A transverse section through the cord to show the form of the gray cornua or horns in the midst of the white substance. B. Shows the same parts and also the membranes of the cord and the anterior and pos- terior roots of a pair of spinal nerves springing from its sides. of bladder, involuntary stools followed by paralysis of sphincter ani. Pain in whatever part is increased by heat, pressure or movement. The loss of power in lower limbs and body below the seat of inflammation, and later, of sensation. 640 DISEASE GERMS. In the treatment, the cause should be removed, if possible, and the most powerful of all stimulants, the galvanic cautery ap- plied, followed with poultices of belladonna. Exalgine should be administered in fifteen-grain doses morning and night, more frequent if case does not yield; bowels °l%, should be freely opened, and the patient fjv placed upon bromide and iodide of potassa in compound saxifraga. ;V/ The sole aim of treatment is to cany the patient through an acute attack and *S. run it into a chronic form, which is more v <* V'/Vj'- easily managed. ''■■-O&.-'^'v'VJ'^ Chronic inflammation may be the sequel ^ , « ?>V of an acute attack, but it may arise from , ,_ the same causes which produced an acute Acute myelitis of the «ray . ' . matter dorsal portion of attack. Persons in middle life, suffering Spmai cord. from some chronic disease are apt to suffer a form of reflected irritation, which weakens the cord, and gives rise to myelitis. It is easily recognized by the pain on pressure and movement, on the application of a hot sponge, or the pole of a battery, aching in the back and limbs, gradual loss of power of the lower extremities. Symptoms are much ameliorated after a long rest in the recum- bent posture ; the acute form may terminate in effusion of blood; the chronic, in thickening, with atrophic degeneration. Very likely to be numbness, coldness, loss of sensation and motion in the parts below. If the anterior columns only are affected, motor paralysis prevails ; if the posterior columns, sen- sibility is either impaired or destroyed. If the case has progressed simply to chronic inflammation, an effort should be made to get rid of the inflammation by the ap- plication of external stimulants, like the irritating plaster kept on nearly all the time; by rest in the recumbent posture in bed; by- keeping the secretions active ; by the administration of bromide and iodide of potassa in compound syrup of saxifraga; by the administration of such drugs as will diminish the area of the circulation in the cord, as ergot, belladonna, calabar bean, etc., and a diet rich in phosphates, as oatmeal, wheaten grits, cream, eggs. . Such a plan of treatment is of no avail if white softening nas set in. 1 • r 11 When white softening of the cord takes place, paralysis ot an parts below the lesion is inevitable. All symptoms, however, admit of palliation ; the case should be carefully watched, espe- cially the rectum and bladder. BACTERICIDES. 641 Inflammation of the membranes of Inflammation of the the cord is very rare, as it is well pro- Membranes tected from injuries by the thick, bony of the Spinal Cord. casement. [Spinal Meningitis) Nevertheless, the rheumatic bacillus often excites irritation in its structure. The indiscriminate and careless method of prescribing nux vomica or its alkaloids exercises a most deleterious action upon the membranes of the cord. It is, however, to the pathogenic microbe of cerebro-spinal meningitis that we owe such grave and important changes in the cord membranes. It usually manifests itself in acute burning, or often sharp lan- cinating pains along the spine, extending to the limbs, aggravated by pressure and movement. If this irritation is high up, there may be some fever and a tendency to opisthotonos, with some rigidity of the muscles of the neck and back ; feebleness of the limbs; paralysis and the loss of power increases as the case pro- gresses, sense of suffocation, or constriction in neck, back, abdo- men; lower down still, constipation, retention of urine, priapism, prostration. Acute inflammation of the testes Inflammation of the may be caused by blows, kicks, falls, Testicles. violent exercise; or badly fitting [Acute Testitis) clothing; by a metastasis or exten- sion or migration of the gonococcus from the urethra, by too quickly sterilizing the urethra by such drugs as balsam of copaiba, turpentine, cubebs, kava kava, or aggravated by strong irritating injections, or alcohol, or venereal excesses. In some cases, only a portion of the testicle is affected, such as its body ; or the epididymis and tunica vaginalis are attacked, or the entire gland suffers. Svmptoms.—Pain, and feeling of weight in cord and testicle ; great uneasiness in the loin, groin, and upper part of thigh; fre- quent micturition; diminution or suppression of the urethral discharge; swelling of the epididymis, which embraces and hides the testicle; scrotum firm and tense ; swelling of the cord ; great tenderness; pressure aggravates the pain. There is pain in the head, back, calves of legs ; rigors, and a fever; nausea, vomiting, constipation. The inflammation, if violent, powers of lite feeble, or inefficiently managed or treated, may terminate ln chronic inflammation, with effusion of lymph, induration and enlargement, or abscess; or, if vital force is greatly de- 4i 642 DISEASE GERMS. pressed, and system vitiated with mercury and syphilitic germs, gangrene. Treatment.—As there is nausea and often vomiting, with a depraved condition of the alimentary canal, an emetic of lobe- lia, followed by warm or alcoholic vapor-bath ; then open bowels freely with salines ; administer aconite, veratrum and gelsemium, freely and frequently, till pulse reaches seventy, then in small doses at longer intervals ; opium and Dover's powder, to relieve pain ; apply, in the form of packs, several layers of canton flan- nel, embracing the entire scrotum, saturated with the following: water, one quart; muriate of ammonia, half a pound ; nitrate of potash, quarter of a pound ; common salt, a handful; tincture of iodine, one ounce. Mix. Cover with oiled silk, and moisten again and again. If skin of scrotum becomes tender or sore, or excoriated, keep it off a few hours, and apply cloths wet with hot water and opium. Bowels to be kept freely opened; patient must be confined to his bed ; diet as for fever. Just as soon as the active stage is controlled, place patient upon iodide of potassa in a vegetable alterative, followed by tonics. If the inflammation of the testis be due to the sudden suppression of a gonorrheal discharge, it is unquestionably a good plan to inject the urethra, once or twice, with a solution of the sesqui-carbonate of potass, so as to cause the gonorrhea to re-appear; it has the effect of removing the inflammation from the testis at once. In bad cases, powers of life low, and ignorance of medical attendant gross, where the inflammation has been mal-treated, the testicle enormously swollen and very painful, it is found to be a good plan to puncture the body of the testis, so that by a division of the tunica albuginea, the pressure on lobules and convoluted tubes maybe removed. The incision allows a quantity of serum, lymph, and blood to escape, and affords instant relief in such cases. After such, some resort to compression with adhesive strips, but this is very painful, and the best plan is to apply the hot water and opium. After recovery, patient should wear a suspensory bandage for a few months. In this we have a low grade of irn- Inflammation of the tation, witrj a large quantity of lymph Testicles. effused, which gives rise to very great [Chronic Testitis) enlargement and induration, the testis becoming, in some cases, enormously increased in size. Causes.—It may be a sequel of an acute attack when badly managed, but more generally it is due to a low grade of irrita- BACTERICIDES. 643 tion, as horseback exercise, imperfect coition, strains, condums, stricture, gleet, or the presence of the syphilitic germ in testis. Symptoms.—Testicle hard and swollen ; slightly painful to pressure, but very weighty; the irritation and effusion of lymph usually begins in the epididymis, and extends to the body of the testicle; sometimes effusion of serum takes place into the tunica vaginalis. The syphilitic form is usually accompanied with indi- cations of the presence of that germ elsewhere, as on the tongue, throat, skin, bones or iritis. In the treatment of enlarged testicle, the patient should be placed upon comp. saxifraga and phytolacca internally. Remove all causes that can be ascertained, such as a stricture, or mastur- bation, or any impediment to sexual congress. Patient must wear a suspensory, *witli as much compression as possible. Such local remedies as ointments prepared from iodol; iodide potassa and belladonna ; iodide of cadmium, and the like. Fail- ing all, an absorption of the effused lymph may be effected by electricity. _______ Inflammation of the tonsils is one of Inflammation the most common affections of the mouth. of the Tonsils. One or both the tonsils may become af- [Acute Tonsillitis) fected. The predisposing causes are weakness of organization, a tubercular diathesis or enervation of the glands by mercury, other poisons, etc. The exciting causes are cold, damp, exposure, cold drinks when body is heated, seasons of the year, as winter, spring, vicissitudes of temperature; common in all periods of life. Symptoms.—Those consist in the usual languor, lassitude, de- bility, rigors, and a fever of a pretty high grade. The tonsils and adjacent parts become sore, tender, painful, red, hot, and swollen. There is also great pain and difficulty in deglutition; return of liquids through the nostrils in attempting to swallow; there is pain along the eustachian tube and deafness; glands exude considerable mucus, so that the throat is filled, and gives rise to some hawking and spitting; respiration may be affected; the parotid gland at angle of jaw sympathizes; tonsils can be seen often, if double, almost meeting at the root of tongue. Its duration is from four to ten days. It may terminate in resolution, but apt to return on exposure ; or it may terminate in effusion of lymph, with thickening and induration, or in breaking down of lymph, abscess. If indurated or hypertrophied, will alter the voice. Treatment.—Patient to be kept in bed; warm room; the ad- 644 DISEASE GERMS. ministration of an emetic of lobelia and capsicum is attended with good results; to be followed up with large doses of tincture of aconite and belladonna; mouth and throat washed out every hour with chlorate of potassa and tepid water; heat to feet, and general treatment for fever ; locally to the angle of the jaws, heat and moisture, poultices with mustard. Patient an adult, hypodermic action of pilocarpin might be tried ; it often breaks up most severe attacks. Its diaphoretic action is excellent, but it has a special action on the tonsils in stimulating them, and causing them to disgorge the inflammatory products with which they are loaded. If young, better to use the acetate of ammonia in alternation with compound tincture of serpentaria. Those two remedies act kindly and speedily. Benzoate of sodium is of great utility. Benzoate of sodium, half an ounce ; glycerine and elixir of calisaya, of each one ounce. Dose one teaspoonful every hour. Salicylate of sodium is nearly as effectual. Just as soon as fever abates, begin with doses of iodide of potassa, rang- ing from five grains upwards, every three hours. If suppuration seems to be inevitable from the presence of rigors, pain changed to a throbbing one, and by the appearance of a yellow speck on tonsils to the eye, or sense of fluctuation to the touch, then let the patient inhale hot vapors of ammonia, poultice assiduously, and when ready for evacuation of the pus, administer a good, smart emetic of lobelia. In the straining efforts at emesis, the contents of the tonsil is freely discharged, and a rapid recovery takes place under good diet and such reme- dies as compound tincture cinchona and aromatic sulphuric acid. If any soreness or induration remains, chlorate potassa for a gargle, and iodide internally. Once the tonsil has suffered a partial Inflammation death, it is very liable to become irri- of the Tonsils. tated by very slight causes. This re- [Chronic Tonsillitis) peated, spring and fall, soon tells disas- trously on the medulla oblongata, and the patient, after suffering a few attacks, becomes tubercular; so that in chronic inflammation we usually find tubercular de- posits in the tonsils. In the chronic form there is little soreness or heat or pain, but a vast deal of effused lymph or tubercle thrown out, and as the gland is very vascular, they often become enormously hypertrophied , the enlargement being so great that they meet on tongue, causing thickness of speech and obstruction to swallowing and even to inspiration. In such cases, don't resort to excision, as there is danger in BACTERICIDES. 645 such a proceeding. Place the patient upon saxifraga and phyto- lacca. The one remedy one week, the other the following. An effort should be made to hasten and stimulate absorption by painting the tonsils with equal parts of tincture of iodine and iodide potass, or jequirity in the form of distillation or powder; never irritate; apply about once a week. The jequirity causes a shell- ing or peeling to take place every time it is applied. Soothing mouth washes or gargles of slippery-elm ; benzoate of soda; chlorinated soda, naphthaline. A tonic course, change of scene, best of food. Perfectly developed cocci found in the mouth and throat in aphtha; tonsillitis. Magnified 400 diameters. The tongue is greatly exposed to the in- Inflammation roads and colonization of disease germs. of the Tongue. Either acute or chronic inflammation of [Glossitis.) the substance of the tongue is comparative rare affection, usually dependent upon some constitutional cause, or some caustic.or irritant poison applied to the organ. In either case there is fever, great nervous depression, and debility. The local symptoms are those of pain, heat, redness, swelling. The tongue becomes of a very deep red color, and so swollen that it fills and protrudes out of the mouth. It usually comes on quickly, and is often attended with urgent symptoms, and requires prompt treatment, as active purgatives, followed by hypodermic injections of one-third of a grain of pilocarpin, heat to feet, poultices of slippery-elm to tongue, and suppositories of veratrum viride and gelsemium per rectum. If mercury- is the cause, iodide of potassa, chlorate of potassa gargles, and sulphu- retted potassa baths, or both. Inflammation of the Uterus. [Acute Metritis) Acute inflammation is comparatively rare of the uterus unimpreg- m nated states, but very common asso- ciated with impregnated states. Causes.—The causes of this condi- tion of partial death are, exposure to cold, damp, and excitement when menses are on; shocks of all kinds, falls, blows ; irritation from sponges, rings, and pessaries; abortions ; violence from the 546 DISEASE GERMS. instrument, of a whalebone, knitting-needle, in performing the act, and in the subsequent non-expulsion of all the membranes and clots; lingering labor, tedious, and painful violence from instruments in delivery ; the use of emmenagogue drugs, as savin, tansy, aloes, ergot; the use of injections. It is doubtful whether or not, in very highly civilized women, it may be brought on by grief, worry, passion. Poisons, as the imperfectly-washed hand of an uneducated physician in removing the placenta, or pieces of the placenta ; or in administering ergot erroneously, causing the uterus to contract; or a clot, or coagulum, which excites the inflammation ; gonorrhea, the forcible entry of large hands. Pathology.— i. Incases of puerperal endometritis, the uterine and vaginal discharges contain a streptococcus which is present in pure, or almost pure, cultivation. 2. In cases of puerperal pelvic inflammations associated with exudation, the discharges contain either the streptococcus with a staphylococcus, or the staphylococcus alone. 3. In such cases where the womb or vagina contain some decomposing dead tissues (retained placenta, vesicular mola.etc.j, the extremely fetid uterine and vaginal discharges prove to teem with peculiar rod-shaped microbes, which occur either alone or are accompanied by scanty non-pathogenic bacteria of various species. 4. The puerperal streptococcus is quite identical with the streptococcus of erysipelas. There is no difference whatever in their morphological properties and biological behavior. Besides, the inoculation of the forrner coccus to rabbits and man gives rise to a distinct erysipelatoid attack. BACTERICIDES. 647 5. The puerperal bacilli are fairly thick and |short (almost ovoid). They are, as a rule, arranged in pairs, which form irregular small-sized heaps. They grow well both on jelly and agar, but somewhat less so (especially in the absence of air) in broth. On gelatine they form large circular colonies of a yellow- ish-orange color, without liquefying the medium. When culti- vated in test-tubes, the microbes develop in from four to six days a characteristic offensive putrescent odor, closely resembling that of the puerperal discharges from which they have been obtained. When inoculated to animals they do not produce any local changes, but give rise to fever, the febrile elevation oscillating between a few tenths and 2° C, and lasting from four to eight days, ac- cording to the quantity injected. 6. Hence, mild puer- peral affections may be subdivided into two large '^# Uterus, showing the thickening of its walls by con- gestion. groups, one of which em- braces specific cases caused by the penetration into the patient's genital tracts of certain pathogenic mi- crobes (streptococcus or staphylococcus). The other group consists of non-specific affections determined by the absorption into the patient's circulation of certain ptomaines that are elaborated by the putrefaction bacilli described above, in the presence of putrescent substances (dead particles of animal tissues). Symptoms.—Should the shock come on the uterus during the menstrual period, or during the lochial discharge, the flow is suddenly arrested, and this will also happen in hemorrhagic congestion. Simultaneously there is sharp, lancinating pain in the uterus, followed by rigors, and a fever of a high grade. Patient lies on back, knees drawn up; features sharpen and be- come anxious; eyes look sunken; tongue coated, pulse rising; great tenderness over uterus, a sense of fulness and weight. There is throbbing above pubes, in groin, and perinaeum; great pain in sacrum, irritable bladder and rectum. Either constipa- tion or diarrhea; if the latter, tenesmus, which is troublesome. Usually nausea and vomiting, which is great or persistent if the outside covering or peritoneal coat of uterus is involved. The os uteri, to the finger, is hot, congested, patulous, sensitive; to the eye, it looks of a scarlet redness. The secretions of uterus 648 DISEASE GERMS. acid and acrid; usually after twenty-four hours there is a watery discharge, then bloody, or sanguineous, mucous, and serous; pains become acute and bearing-down, intermittent, cutting, but at all times the uterus is the seat of pain, which is aggravated by pressure of the hand, or bed-clothes. This pain extends to perinaeum and front part of thighs. If case does not ameliorate, symptoms assume a typhoid form. Acute symptoms rarely last over seven days. Recovery may take place when the damage is not great, and the patient's affections not blasted. In unfavorable cases abscesses form in the structure of the uterus, or other tissues, as the pelvic, areolar tissue, peritoneal membrane; substance of liver and stomach becomes involved, and gangrene sets in ; or, in another class of cases, it may leave chronic inflammation, or enlargement, or induration of uterus, labia, and a muco-purulent diarrhea. It may come on at any time if violence is inflicted. After parturition, a lady is not quite safe from an attack until after five or six weeks. It is exceedingly common and very fatal, and with very ordinary care it might be rare. Treatment.—Formidable as metritis generally is, still, if seen early, much can be done to aid recovery. Suffering is much relieved by the recumbent posture and complete repose. Com- mence at once with opium and tincture of green root of gelse- mium—half a grain of opium every half hour, with a few drops of the gelsemium (same as in peritonitis, pushed to narcotism). If we delay, or don't come right up to the mark of energetic treatment, the patient will die ; don't hesitate ; aconite does well, combined with gelsemium; excite an action on the skin with an infusion of asclepias, or boneset, or jaborandi; mustard over pubes for an hour, then followed with hot poultices of linseed and opium; keep patient on back, hips elevated ; enemata of linseed tea, with tincture of opium, irrespective of diarrhea or constipation, twice a day ; injection per vagina, of the same, or else an infusion of camomile and boroglyceride, thrice daily; dry heat to vulva; hop bags. If there is the debris of a placenta in the uterus, then that organ should be washed out with camo- mile and resorcin or creolin injection once a day. The great aim in the treatment of the case is narcotism; the opium relaxes neck of uterus sufficiently to permit the escape of clots or other bodies. If there is much distressing tenesmus, and pain in the sacrum, suppositories of belladonna and opium should be used. Indeed, whatever the cause, from shocks, fright, lingering labor, or violence, or whatever the symptoms may be, they can often be very successfully combated with the opium and gel- semium ; under those drugs the inflammation soon subsides, BACTERICIDES. 649 becomes tractable and manageable. Great care should be exer- cised less abscess takes place, and it is well, as the active indica- tions subside, to begin with small doses of quinine and antiseptic drugs. The period of treatment is so short, that if the patient can be tided over the seventh day, the condition of death, at least, may be obviated. Nourishment must be meagre, and increased as recovery progresses; otherwise, if patient do well, the treat- ment of chronic metritis must be followed out. She must be careful not to get about too soon, as indiscretion may lead to a relapse. ______ Chronic inflammation of the uterus con- Inflammation of sists in a low grade of irritation, either of the Uterus. the neck or entire body of the uterus, with {Chronic Metritis) effusion of lymph, which produces en- largement and induration. Causes.—It may follow an acute attack, or be brought about by masturbation, tight-lacing, which causes local plethora, or engorge- ment, or frequent miscarriages, or abortions; wearing sponges, pessaries; whalebone, knitting-needles, recklessly used; gonor- Thea, excessive coition, cold, fright and a sudden arrest of menses, or suppression; use of irritating injections; emmena- gogue drugs. Symptoms.—There is a languor, lassitude, debility, pain in the head and back, accompanied by a sense of weight at bottom of abdomen; a bearing-down ; aching in thighs and hips, with severe griping pains in uterus, which is very sensitive to external pressure; there are heats and colds, or slight febrile attacks ; loss of appetite, constipation, difficulty of breathing; and the head- ache is often intolerable. To the finger, neck of uterus is very tender, and has more heat than the surrounding parts; to the eye, it is a little redder, but considerably thickened, and there is leucorrhcea. The plethora or congestion of the uterus, with aug- mentation of bulk, causes it to descend, and produces some ab- dominal swelling. This increase in size and weight is due to re- laxation of its tissues, and they being filled up with serum, lymph, blood, now grave changes take place, owing to the lost contractility and engorgement; its functional activity is entirely abolished ; there is inertia, and the organ is predisposed to organic changes. The changes are not uniform, they depend often on condi- tions, as the transition to puberty, confinement, or forced, celibacy in virgins, or mental states; engorgements, indurations, ulcerations, are frequent results. These conditions are much aggravated if the chronic inflammation occur late in life, for then if the germs 650 DISEASE GERMS. of tubercle, or cancer, or any dyscrasia lurk in the system, it will be likely to manifest itself. In chronic metritis there is apt to be bladder trouble, rarely pain in sacrum, but possibly some pain if stools are hard. The entire train of symptoms of hysteria, in addition to the above, may be present. It may last a long num- ber of years. The menstrual flow is usually excessive or may come on several times during the month. Chronic inflammation of the uterus is one of the most common diseases among modern females, and renders their whole life a complete misery; and even if in mild cases they should marry and pregnancy take place, miscarriage at four and a half months will inevitably take place, owing to the stretching of the indurated fibres at neck, as the body expands, the irritation being carried to the fundus, and thus contractions are induced. Trcattnent.—Patients suffering from this very chronic disease are usually able to be about, and are often engaged in their ,i - customed duties, although suffering greatly. If they are un.ibh to rest a month or two, it renders the process of cure very diffi- cult, because rest in the recumbent posture, in bed, with elevation of pelvis, is one of our main stand-bys. The recumbent posture is always to be preferred to sitting, and gentle walking to stand- ing still. When menstruation is absent', daily bathing, shower bath, if possible, with hip-bath thrice daily; the vagina should be syringed out three times a day with demulcents or emollients, as linseed tea, infusion of marsh-mallow, slippery-elm, or camo- mile flowers; and as the case improves, alkaline injections, as soapsuds, borax-water, chlorate and permanganate of potass; the temperature that is best is slightly tepid; both bathing and in- jections to cease during the catamenial state, and when that is over to be resumed. Flannel clothing; bowels to be kept open once a day with cascara ; the appetite to be stimulated with tonics ; the very best of diet; beef, mutton, game, poultry, boiled white-fish, eggs, milk, coffee. If digestion is faulty follow with pepsin. Then place patient upon alteratives and tonics, general course, with a class of remedies bearing more especially upon the uterus. The alteratives should be administered two hours after meals and should consist of one of the following for a week; then another, selecting the two that does the most good, using them alternate . weeks: Iodide of potass in compound syrup of phytolacca, compound viburnum, compound stillingia, iodide and bromide of potass, macrotys in compound yellow dock. Tonics before meals, selecting from the following: Glycerite of ozone, glycerite of kephaline, ozone-water, compound tincture of cinchona and nitro-muriatic, aromatic sulphuric acid and quinine, port wine and Peruvian bark. bACTERICIDES. 65I Inflammation of the different coats of a Inflammation vein with a coagulation of its contents, is of Veins. most likely to occur from the introduction [Phlebitis) into the true skin or cellular tissue of some pathogenic microbe, as the micrococci of metria, in the lochial discharge; the virus of chancres; the dressings of wounds, etc. Physicians, nurses, and especially washerwomen, are liable to have phlebitis, provided they have scratches or abrasions upon the hands, through which the germs might find an ingress. The germs of puerperal fever, erysipelas, the micro-organisms of all forms of pus, venereal germ, are most active and very viru- lent. Symptoms.—The moment these micrographic molecules enter the living tissue, there is pain, veins; these vessels become thick, cordy, swollen, and a streak of redness appears along the entire course of the affected vessel, first extending to the elbow, then up the arm; very prone, if not energetically treated, to terminate in suppu- ration ; if so, there are rigors and flying pains in different parts of the body, with great constitutional disturbance and fever of a nervous or irritative type. When suppuration and abscess take place the coats of the vein ulcerate, and the con- tained clot is discharged by means of an abscess. The bacteria or germ-poison or microbe does not produce coagulation ; it mixes with the blood, rendering that fluid a river of disease- germs, affecting the entire body, and giving rise to bacterial de- posits in weakened parts, with embolism and abscess in vital organs, as the heart, lungs, spleen, liver, kidneys, joints and areolar tissue. In some cases a clot is carried from the vein to the heart, and causes sudden death. Treatment.—The general management of such a case is of great importance; the suction and cauterization of the wound, the application of a solution of muriate of ammonia, and poultices with yeast and creolin. If the vein has become engorged, thick. cordy, the application of a row of leeches along it to empty it of its bacterial contents, and hot fomentation of ammonia or per- radiating in the course of the Section of a lymphatic gland in phlebitis, mag- nifying power, 700. In and around large number of minute bacilli are found at the seat of inoculation; the spleen is large; in the oedematous tissue and in the blood-vessels, large and small, numbers of minute bacilli are found, chiefly contained in the white blood corpuscles, but also free. They are very minute, about o 008 to o.coi mm. long. to 0.0001 to o-ooo2 mm. thick, isolated or in couples, or in chains. <552 DISEASE GERMS. Influenza. Infusorial Catarrh. manganate of potassa; or if the clot in vein is so firm that the diseased:blood cannot be drawn off, then to paint along the course of the entire vein with creosote, and then poultice with alkaline antiseptics, as tincture iodine in lime-water, etc. The creosote permeates the walls of the vein, kills the bacteria, and the blood regains its fluidity. It penetrates better than carbolic acid, and is just as effectual in annihilating the micro-organisms. Internally, acro-narcotics, as opium and belladonna in alterna- tion ; the former to relieve pain, the latter to maintain the fluidity of blood. Otherwise the case should be treated with a free use of antiseptics, those possessing alkaline properties, as ammonia, chlorate or permanganate of potass; sulphide of lime should have a preference. Suitable doses of quinine should also be given. The patient should be well nourished with essence of beef, eggs, cream, lime-water and milk, and a total alleviation from suffering._______ A specific, epidemic, and endemic disease, due to the annexed microbe, which is pathogenic of it, and cultures from which it can reproduce itself again and again. Like all microbial diseases, it has a definite period of incuba- tion—sprouting and full growth. In some respects it is a marvellous germ, aerobic, can multiply in the air and reproduce itself. Race and sex are equally attacked by the microbe. Symptoms.—The symptoms con- sist chiefly of a general and definite febrile disturbance, and of a special affection of the nose and air-passages. The disease commences with shiver- ing or a feeling of coldness down the spine, with a hot, dry skin, quick pulse, thirst, and severe headache. Sometimes these symptoms come on suddenly, sometimes they de- velop slowly in two or three days. If they come on suddenly, intense frontal headache with aching pain over the eyes is generally the first symptom. This feverish state usually lasts four or five days, and then gradually disappears, and its disappearance may be accompanied The microbe present in influenza or infusorial catarrh. BACTERICIDES. 653 by profuse perspiration or a troublesome diarrhea; in some cases the fever may last several days longer, but then some complica- tion has probably arisen and given rise to inflammation of the lungs or some other organ. The peculiar catarrhal affection usually follows the early symptoms of the fever; it begins with swelling and dryness of the lining membrane of the nose, and the tissues or cavities of the forehead, causing great frontal head- ache and frequent sneezing; the mucous membrane of the eyes or the conjunctiva are generally affected in a less degree, and a thin acrid discharge takes place; now and then bleeding occurs from the nose ; this condition then occurs all the way down the air-passages, even down to the smallest branches of the bronchial tubes. This affection may occur in the whole tract of the mem- brane at once, or, beginning in the nose, it may spread down- wards into the lungs. The inside of the mouth and the tongue and pharynx may also become implicated, but in a less degree. The discharge from this inflamed surface is at first thin and acrid, and at times bloody; it then becomes thicker, tenacious, and purulent. The patient sneezes, has a troublesome and violent cough and pains in the side. There is great distress in breath- ing, and the pallor of the face and lividity of the lips show how great is the obstruction to the circulation in the lungs, for the blood becomes in such cases imperfectly aerated, and, owing to •the accumulation of carbonic acid, flows through the vessels with difficulty. In most cases the catarrh is at its height by the third or fourth day, and generally declines from the fifth to the seventh, but in severe cases it may last longer. Coincident with the fever and catarrh, and perhaps in proportion to the severity of the former, is a peculiar state of the nervous system. There is great depression and loss of spirits, with aching pains in the muscles and neuralgic pains in various parts of the body or extremities. The mind is often affected, and the patient may become stupid or delirious. The temperature of the body appears to be raised in most cases, but no exact observations on this point have yet been made. Sweating of the skin often occurs during the defer- vesence of the fever, or at the time when a descent of the temper- ature takes place, but rarely in the early stages. Crops of minute transparent vesicles, or little blisters containing fluid, are often seen on the skin. Meningitis, or inflammation of the membranes of the brain, and otitis, or inflammation of the ear, may come on now and then. Great delirium, as well as intense headache, is a dangerous symptom. Neuralgic pains are met with in many parts of the body, and there is also a remarkable prostration of the muscular strength. The cough comes on in paroxysms, and may be so severe as to bring on a rupture, or 654 DISEASE GERMS. even abortion in pregnant women. There is but slight expec- toration at first, and then the phlegm which is expectorated is string}' and often bloody, then it becomes more consistent, opaque, and purulent. Bronchitis, or inflammation of the bron- chial tubes, pneumonia, or inflammation of the lungs, and pleurisy, or inflammation of the serous covering of the lungs, are present in some cases, and add to the danger; however, the frequency of their occurrence varies much in different epidemics; their presence may be detected by a careful physical examination of the chest, and by the increase in the distress of breathing. Vomiting and nausea often come on at the commencement of an attack; diarrhea, as a rule, occurs later on in the disease, when the fever begins to abate. In some eases the skin assumes a yellow tint, and bilious vomiting comes on. As in most febrile affections, the urine is at first high-colored and scanty, and after- wards it often deposits a pink or reddish sand, made up of lithates. Occasionally there is complete or partial suppression of the urine. Now and then swelling of the glands under the chin or in the neck has been observed. Convalescence is often retarded by rheumatic-like pains in various parts of the body, and by prolonged debility or unusual nervous depression. Treatment.—Consists in general principles, warm bath, rest in bed in a warm room ; administer exalgine to reduce temperature, and comp. serpentaria to excite diaphoresis. Select an efficient bactericide, such as sulphide of lime, or glucozone, or carbolic acid and tincture of iodine, as in typhoid fever; hot steam atomizers charged with iodine, or liquor chlorinated soda should be kept going on at bedside, and disin- fectants exposed in the room in which patient is confined. Naphthaline is excellent for this purpose, as it retards the devel- opment of the spores. Naphthaline finely powdered and well spread, or in solution and continually shaken, has its disinfecting power increased. In a temperature of 980 the effect of naphthaline is much more powerful, which makes it highly probable that it is chiefly in its gaseous state that it destroys the germs. Gaseous naphthaline in solution has more effect on aerobic than on anaerobic bacilli, and more on germs cultivated in a solid medium than on those cultivated in liquid. The conditions for the full effect of naph- thaline are much more favorable in the intestines than in the test- glass. Naphthaline added to faeces decreases their germs by about a half, but, administered internally, it first decreases them to one-third or even a quarter; after this, however, their number rises again almost to its original figure. Against the bacilli of infusorial catarrh, naphthaline is considered still more effective, BACTERICIDES. 655 and decreases the number of the germs even to one-tenth. The administration of naphthaline should be commenced at the very- beginning of influenza, and continued all through the case. Subsequently tonics and nourishing food. Epizootic affections in the horse are identical with influenza in the human being—in causes, symptoms and treatment, the amoeba in animals being of a large or giant micro-organism. But suppose this form peculiar to the horse is communicated to man, we not only have an aggravated form of influenza or catarrh, but the giant amoeba brings about chronic inflammation of liver, spleen, kidneys, giving us haematuria, Bright's disease, leucocythaemia, dropsy and death ; so that in cases of tl is kind our best modes of nutrition, our most powerful antiseptics and tonics, fail either to destroy the germ or maintain vital force. Pink Eye is simply a modified form of the epizooty or giant amoeba, only affecting the mucous membrane of the eye instead of the nose. There is a scarlet redness of the eyes, quite con- siderable swelling, intolerance of light. General health is usually- bad from over-work, over-crowding, sameness of diet, or else poor food, bad ventilation. In all such cases an alterative and tonic treatment should be maintained for some months, and the very best of diet that the circumstances of the patient can afford. These consist in the bruising, laceration, and Injuries. . division of various tissues, with or without wound of the skin and other parts. In all injuries from a simple contusion or bruise up to the most aggravated lacerated wound; from a simple strain up to a perforation of the skin, all are changed, altered into a bacterial mass. Even an ecchymosis, superficial or deep, all is bacteria. When superficial, the ecchymosis of the skin appears speedily as a swelling of a reddish color, which speedily becomes black; on third day, violet, with diffused margin or edges; on fifth or sixth day, green; on seventh or eighth day, yellow; and then gradually disappears about tenth or twelfth day, sooner or later, according to the vital force of the patient, and intensity and depth of contusion. If the contusion is deeper-seated, it may not appear for twenty-four hours, or several days. Ecchymosis may, besides being due to injuries, be a symptom of purpura, scurvy, fevers, or of gangrene in inflammation. The object of all sound treatment is to overcome the condi- tion ot partial death, by checking extravasation of blood, by preventing inflammation, by sterilizing and annihilating all mi- 656 DISEASE GERMS. crobes. For this purpose, the injured part should be placed in an elevated position, and a bactericide applied. To an ecchy- mosis, a lotion of peroxide of hydrogen should be applied; to an incised wound, a solution of boroglyceride; to a laceration, a wash of chlorate of carbon. being a word of negation, is not easy to define. Insanity, Doubtless we may speak of it correctly enough as any condition which is not that of sound mind, but as this soundness of mind cannot be judged absolutely but only relatively, in giving such a definition, we are simply tossing the ball from one hand to the other. Each case, in point of fact, must be considered by itself and as a whole. Nay more, one law which after all defines insanity, lavs down different tests to be applied in different classes of cases. Broadly it may be said that the tests of lunacy, which are com- monly used in exactly the same sense as insanity, are in each case incapacity to manage property or danger to the public, in criminal law; however, it is broadly laid down that the test of sanity- is the knowledge of right from wrong—a test, as has been well said, which, applied to our lunatic asylums, would set at liberty three-fourths of their inmates. It would be useless here to enter into metaphysical speculations as to the connecti.on between mind and brain, or the alterations in brain substance which are most commonly associated with the insane condition ; suffice it to say that the current belief is, that in the great majority of cases of insanity there is a change in the brain substance just as there are changes in the lung in diseases of that organ, or of the heart when that part of the body is affected. For just as the function of the lung is respiration,- and that of the heart circulation, so is the function of the brain the manifestation of mind. As we find in other parts of the body, however, when the self-balancing power is lost or in abeyance, there may be disorder of its func- tions without any marked, or, at all events, protracted signs of local change, so we may have in the case of the brain temporary insanity without any permanent disease of its structure such as give rise to the more permanent form of the malady. The causes of insanity are generally assumed to be of two kinds, as is usual in medicine; predisposing and exciting, but the so-called predis- posing causes mean merely a state in which the individual is more likely to become insane than if the same set of circum- stances were operating on him in any other state. Accordingly, the term predisposing cause may be looked on as synonymous BACTERICIDES. 657 with tendency, and the origin of these tendencies has here to be discussed. By far the most potent of these tendencies is derived from here- ditary transmission, or, as would sometimes seem, transmission from collateral branches of the family. It is of the greatest pos- sible importance to fairly understand and to face the tendency of insanity to become hereditary, for an individual with such an inheritance, if duly guarded, may pass through life fairly able to fulfil its duties, whereas if the fact of this inheri- tance be ignored and the individual left to face the world like men of stronger mental equilibrium, it is more than likely that at some crisis the equilibrium will be upset more or less permanently. The most difficult question arises, however, when marriage comes into play. Too often these things are kept profoundly secret, or even intentionally hidden away, especially where property is concerned ; the result in many cases is un- fortunate, the more so that the consequences of the deception frequently fall on the guiltless. We may, however, lay it down as a rule that if one has once been insane—be the individual male or female, though the rule is more binding on the latter than the former—marriage should determinedly be put out of the question. Much more difficult is it to decide in the case of those who belong to an insane family, but who have not themselves shown any signs whatever of the malady. There is always a certain risk, and this must be fairly faced, but the risk is less the further removed the insanity is from the individual concerned. Thus, an insane uncle or aunt would be a matter of much less moment than an insane father or mother, and an insane father or mother portends less risk than does an insane brother or sister. This here- dity, however, tends to obliterate itself in course of time in two ways. Intermarriage with a healthy stock gradually diminishes the tendency to insanity in the survivors, and there is besides not only a natural but an artificial tendency to put an end to the heredity from the increasing num- bers thereof. Thus, a certain number of those tainted will probably be incapable of propagating the race, and a certain number more being locked up will have no opportunity, and so between the two the insane members of the family tend to die out, whilst the stronger, having intermarried with a more healthy stock, in course of time become like other people. Age has something to do with the liability to insanity. It is greatest between twenty-five and forty, least in the first ten years of life. Then, too, the nature of the insanity varies with the age at which the individual is attacked. In the earlier years 42 658 DISEASE GERMS. of life there is much more violence connected with insanity than there is with the later; if this rule is reversed, the likelihood of recovery is very greatly lessened. Sex, as already hinted, has a good deal to do with the liability to insanity, though not in the way one might have conceived. When men have grown up they are exposed much more to conditions likely to disturb the mental equilibrium than are females; but, on the other hand, if there is a tendency to insanity in married females, it is, especially in the time of childbearing, etc., likely to have full effect. Next come the causes called exciting, which are special to the individual and not to any class or group, though practically it is found that the same causes do operate in a very considerable number of in- stances. Chief among these are the moral causes of insanity, which may operate suddenly in the way of mental shock, or they may act over a number of years. Doubtless the former are the more potent in destroying mental equilibrium, especially in a mind which is badly balanced by heredity or by means of the individual's own habits and training. These last, however, belong rather to the group of physical exciting causes. The most important, according to all accounts, is the inordinate use of alcohol. This is especially to be avoided in those of originally weak mind. The symptoms of insanity differ greatly from the signs of any other disease. They consist in great measure of the sayings and doings of the insane individual, either acquired by the observer from direct inspection or by hearsay. There are certain words used in connection with the mistaken beliefs of the insane, which, though in ordinary parlance used synonymously, yet, strictly speaking, have got totally different significations. These are de- lusion, illusion and hallucination. A delusion is a false belief relating to something which has a real existence, but to which the insane individual supplies attri- butes totally false. Thus he entertains a belief that some one, probably the least likely to do so, desires to swindle him; that he himself is a prince possessed of boundless wealth, etc. An illusion is a -false interpretation of the senses. There is something to be and something to have, but the patient gives them a totally false significance. A few rags are gorgeous robes; pebbles, pearls of great price; a few words spoken in an ordinary tone, a command to an army, etc. A hallucination is, on the other hand, a mistake on the part of the senses. The eye or the ear itself seems to be at fault; the patient hears and sees things where there is nothing to see or hear. The word delusion is that commonly used so as to cover both the other terms ; but should be limited to the mistaken BACTERICIDES. 659 imaginings of one whose brain is disordered. These delusions are sometimes of a gloomy description. The patient is depressed or nervous, and proceeds to account for this feeling in the way most congenial to his fancies. A rich man may imagine himself a beggar; a good and worthy man, damned to all eternity. More- over, everybody knows it, and treats him accordingly, or he has some special tormentor who will never leave him alone. Some patients entertain delusions of a totally different character; these delusions are exalted delusions. They fancy themselves rich and powerful, and they are happy ; and yet the bodily condition of some of these poor patients is most miserable. They very fre- quently indicate a form of brain disease which advances through what to the bystander are exceedingly painful stages to certain death. Such delusions are most frequent in the condition known as general paralysis of the insane. Again, there are patients whose delusions take a different turn; they live in fear and dread, but under which they are not passive; they are prepared to fight, do anything for their life and liberty. Such are amongst the most dangerous class of lunatics. But it is not only by means of ideas, it is also by means of acts founded or not on these, that we judge of man's sanity. Amongst the most notable acts of the insane are indecent ex- posure, which very often occurs in the early stage of general paralysis, and stripping off of clothes, which has a most variable signification. Very frequently the removal of clothes is had re- course to out of revenge for not being allowed to do as the patient pleases. In other cases the patient cannot bear the feeling of clothes on the surface, and so tears them off him to get rid of them forever. In either case it is troublesome and an expensive symptom. In many cases it is hopeless to cope with it. Give the patient the strongest materials, fastened on ever so carefully, by- and-by they will be torn off and torn to pieces; blankets are torn in the same way. For the former class, that is to say those who destroy clothing not knowing what they do, nothing well can be done; but for the others some sort of punishmenthas to be devised; for they know perfectly well what they are about; and if this fails, constant watching, which generally puts a stop to the nuisance. Suicidal acts, or acts of self-mutilation, are frequently com- mitted by the insane. In the form of insanity called suicidal melancholia, where from the depression of mind life has become unbearable, it is frequently hardly possible to prevent the patient from destroying his life. He will watch his opportunity for years, and the first opportunity is sure to be taken advantage of. Very frequently in these patients the homicidal is closely associated with suicidal impulse. The subject of homicide, however, brings 6(3o DISEASE GERMS. us to the consideration of those acts which are directed towards others rather than to the patient himself. Not unfrequently homicide or suicide is the result of over-powering terror. This perhaps is the most frequent form assumed in the insanity of drunkards. The patients in dread of their lives attempt to escape, and are killed in the attempt, or in their desperation and dread of attack turn upon the attendants and kill them. A goodly num- ber of the murders committed by the insane are from delusions. A man thinks his wife and children are going to starve, and so thinks it better to kill them at once; or he fancies he has got a command from on high to sacrifice them, and does so. Yet, again, it may be done from sheer wantonness, as by an imbecile. In all of these cases there is, as a rule, no difficulty in making out the insanity ; it is not concealed, and may otherwise be only too apparent; but there is yet another group of cases, which are of a much more doubtful category. It is well known that the great majority of confirmed epileptics sooner or later become totally insane. These constitute the very worst class of insane patients. Utterly untruthful, not a single word they say can be depended on. Nor is an attendant's life safe with them. Before the onset of the epileptic fits, if they have them at intervals, they generally go through a state of excitement, in which they are exceedingly dangerous. Now the stage is sufficiently well marked long before the minds of the patients are so far gone as to require them to be sent to an asylum, and during these periods they are at any time liable to commit murder, and so it may be said of them just after such an attack. It is, however, with regard to paroxysmal insanity that there is most discrepancy between the opinions of alienists and the public at large. In the latter the idea is not pleasant that a man may go on all his life quietly and decently; yet suddenly an uncontrollable impulse comes on him to murder some individual, after which he returns to his normal state. Yet most physicians, who have studied the subject, are agreed that this is so; and it has now apparently been admitted by the Bench. Homicidal mania, on account of its great importance, is not infrequently elevated into a special form of insanity. So too are certain others, one which, however, we generally hear ot when affecting some of the higher classes of society. These are klep- tomania, entomania, and pyromania. Entomania can hardly be called a special form of insanity; inasmuch as the patient almost invariably labors under other signs of brain weakness. Nevertheless, in some insane patients, the lucid instincts are the most prominent of these symptoms. Such instincts are exceedingly common in many cases of insanity, BACTERICIDES. 661 especially in the early stage of general paralysis. It is, however, in women that the form of the malady is most marked, especially- in young women. So of pyromania. Undoubtedly a good many patients have an inclination to set things on fire, but such a tendency is hardly to be elevated to the rank of a special form of insanity. In many insane people the impulse to destroy everything they can lay their hands on is very great, and a very convenient way of so getting rid of things is to set them on fire. But in all of these patients there are other signs of insanity than a tendency to set a light to everything they can. Roughly, and in such a way as will well suit our purpose, we may divide most cases of insanity into two divisions; those in which there is apparent exaltation, and those in which there is depression, and these two we shall describe as mania and melancJiolia ; but both of these tend in the long run to end in a condition characterized by absolutely no mind—what we term dementia, though there is a condition not inappropriately termed acute dementia. Most forms of insanity are preceded by a period during which the patient is not quite himself; he is odd in his ways ; there is confusion of intellect; bad sleep at night, and the patient is easily excited. The advance of the malady depends a good deal on the amount of sleep taken. His delusions, at first mere mo- mentary fancies, become fixed and insuperable, and drive the patient to acts of insanity. Then most likely the medical prac- titioner is called in, and the patient is probably moved to some place of refuge. At this time the patient w-ill probably complain of headache, very likely with slow pulse and confined bowels; if a woman, the menstrual function is generally impaired, or there may be pregnancy, recent parturition, or nursing. All these may be removed, and yet the patient does not get well ; we can- not restore the mental balance. As a rule, the first thing is to remove the patient from home, and surround him with new at- tendants who will take him duly in charge in every way, when he will be removed from the causes of aggravation, be they what they may. With this change of scene and pursuit there should be a change of diet to a nutritive one, if it has not been so before, and then everything must be done to secure good digestion and a due nutrition. The bowels must be properly looked after, and sleep must be got. Opium is not good ; in such patients it often excites rather than soothes, and increases the headache. Chloral is better, and had better be given in good full doses, thirty grains or so. It does not confine the bowels. If there is a tendency to epileptic fits, bromide of potassium had better be given them too, m full doses of twenty or thirty grains, three times a day. 662 DISEASE GERMS. Tonics, especially strychnine, in careful doses, given so that the patient can never command enough to do himself harm, should be administered. All these things require very careful superintendence, and as it is quite possible that the patient may get worse instead of bet- ter, when constant action may require to be taken, it is always better to select a place for change of air and scene where there is a good practitioner on whom you can rely, not only for medicine but also for what in such cases is more valuable—namely, advice how to act. Most probably, if the case assumes a confused character, it will also assume the phase either of melancholia or of mania. If melancholia, then the utmost depression overpowers the unfortunate individual. Everything that happens round him seems to be connected with his evil fortune. Very likely he thinks he has committed sins too black for him to hope for for- giveness. No argument will get him out of these notions ; it is useless at this stage to attempt it. The appearance of many such patients is very striking. Woe-begone in the extreme he may stand for hours in one spot, never moving, or he may be restless and trying to wander away, so to speak, from his evil fate. Usually such patients suffer a good deal in health ; they be- come thinner from want of food and sleep. The pulse is slow and weak, and the general condition of the patient indicates im- perfect nourishment and bodily change. Suicide is greatly to be apprehended in a good many cases, perhaps the majority; and this tendency may be so suddenly developed as to defy anything save the greatest caution from the commencement. For this reason, skilled attendance is of the first necessity, but it does not greatly matter whether that be carried out at home or in an asylum. Food and sleep are the two great remedies for this state, with absolute mental quiet. For sleep, chloral is best; but if this does not suit, morphia may be given under the skin. The diet should be carefully selected, so that nourishment in abundance may be given. Sometimes these patients refuse their food, and when that is so, they must be made to take it, either by|the stomach pump or through the nose. The bowels must be moved and kept open. First had better be administered a turpentine enema, after which a dose from time to time of castor oil, or a small quantity of aqueous extract of aloes, daily at din- ner time, will suffice to keep them open. The moral treatment of such patients needs to be begun as early as possible. The great thing is to draw their attention from themselves, and that must be done carefully and judiciously. Once they are brought to take an interest in anything outside themselves, they will generally do well; this is the first step towards recovery. At BACTERICIDES. 663 this stage, any sudden event which necessitates, or ought to ne- cessitate exertion, will frequently suffice to complete a cure; but if there has been no improvement, it may do harm. Certain of the peculiarities above alluded to as characteristic of melan- cholia are much better marked in the form of the malady known as acute melancholia. The patient becomes actually frenzied from fright. Such patients have very high suicidal tendencies, and require the most careful watching. These, too, are the patients who most commonly refuse food, and who require to be fed forcibly. They also refuse to lie in bed at night, and espe- cially to be covered by bedclothes. This too must be forcibly combated. Patients, the subjects of this form of disease, gener- ally end badly. They are sure to be badly nourished, and a very little superaddition to their troubles in the way of acute disease, finishes them. The lungs are especially liable to be fatally affected by low forms of inflammation. Mania, accompanied by delirium, is perhaps that form of the malady which is taken as the type of madness by uneducated people. The patient may be suddenly seized with this form of the malady, and may as suddenly become free from it. It is most frequently caused by violent passions, disappointed love, violent grief and the like, especially if the patient be weak-minded or hysterical. The importance of such an attack must depend very greatly on the soil in which the bud is cast; if there be much of an hereditary taint, the attack may be a final and complete one, whereas under more favorable circumstances it may speedily pass away. As a rule, too, the more marked the symptoms of onset, and the longer they have shown themselves before the actual malady bursts forth, the more severe it is likely to be. It is not always desirable to hurry these patients to an asylum, for, as said, they may recover perfectly in a day or two ; but fre- quently it becomes absolutely necessary to do so. Acutely delirious patients generally behave much in the same way. They sing and shout, and will not rest a minute. Com- monly they are utterly incoherent, jumbling their words together, or they repeat one word or phrase like a parrot ad infinitum. They show less delusions than do many other insane patients— their condition is indicated more by gesture and behavior than word. Sometimes they are full of glee, laughing and shouting ; at other times they are angry and outrageous, but not nearly so dangerous as some who are quieter in their demeanor. As in most similar conditions, the great object here is to get sleep and rest, for which chloral is the best medicament. Opium generally does harm. Some prefer digitalis to all other remedies, or give its active principle, digitalin, under the skin. The wet pack is a 664 DISEASE GERMS. means of treatment greatly commended by- some. (See Packing.) It is chiefly with regard to these cases, or to the occasional out- bursts of chronic lunatics, that the question of restraint or non- restraint arises. To some it may seem superfluous to speak of there being nowadays a question between the two. Nevertheless, no asylum can be carried on without some system of restraint. It is itself a system of restraint, and the only question is how best to restrain the patient; if that can best be done by living force, let it be applied in the form of the male or female attend- ant's hand. If such is likely to do more harm than good, or even if it cannot be used with such advantage as can some other form of restraint, let the other, even if it be the strait waistcoat, • be applied. During the very acute attack there will be some- times an entire absence of sleep for days and nights. Women can stand this much better than men ; but both men and women require to be well sustained by food during the sleepless period. Rest, food, and sleep are the great remedies, and the means of procuring the last have once more to be examined. Once more chloral stands at the head of the list; once more opium has only to be mentioned to be forbidden. Indeed, before chloral came in, treatment by baths was relied upon, so general was the dis- trust against opium. No doubt the baths did good by soothing, but they also weakened the patient. The bath, to do any good, must be hot, and a stream of cold water or an ice bag- should at the same time be applied to the head. The best temperature for the bath is about 920 or 93°,F., and the patient must be kept in it for a considerable time—half an hour or so. Shower baths are not to be given. If the bowels be confined a good dose u calomel may be given; but this had better not be repeated. There is still another form of mania, which may be acute, and yet there is no delirium. This insanity may consist of delusions, but more frequently manifests itself in actions usually of a vio- lent and dirty description. Frequently the patients have their wits about them in an almost surprising fashion, quite baffling the medical man who endeavors to examine them, so as to sign a certificate for their admission to an asylum. Yet, as soon as the practitioner is gone, they are dirty and abusive as ever, shameless in their conduct, tear up clothes and sheets, break windows, chairs, and the like—in short, act like the veriest demons. Their incoherence might sometimes be mistaken for delirium ; but it is totally different. The health of these patients is fairly good; they eat well and sleep well apparently when they like. At all events they will have good rest one night, and the next they will disturb the whole ward throughout the whole night. Sometimes they may go on like this for long periods BACTERICIDES. 665 together, and, as they are exceedingly troublesome, care must be taken to get them quieted. This was the class, and they consti- tute a goodly proportion of our asylum folks, who used to be dealt with by bodily punishments. The plan did not succeed. The plan now adopted, which as a rule, but not invariably, answers, is to give to those who are quiet and well-behaved, and who do any work, some trifling reward—extra beer for dinner, tobacco or snuff, which are always greatly relished; the privilege of excursions and the like. Work in the field or garden is the best means of keeping such maniacs out of mischief. Very often these patients are allowed to run on without care or attention until too late, provided they are not especially troublesome, for the malady tends to a chronic course if not speedily cured, and the only hope of cure rests in seclusion. There is a variety of insanity to which the name monomania has been given, and of it kleptomania, entomania, pyromania are commonly adduced as'examples. But it is rare, if indeed such a thing ever happens, to find a man mad on one point and not on others also. At all events this almost invariably happens— one permanent feature of their maladies may for a time be most marked, but by-and-by, as time passes, the madness is seen in other features of the patient's character, and he probably ends by becoming a chronic maniac of the class just described, or a melancholia, but without the characters of either division being very strongly marked. Such are the main divisions of insanity; but there is one other so peculiar that we are fain to give a brief sketch of its history. The malady is commonly called general paralysis of the insane. It is commonly described as constituting three stages, of which the first is such as may give rise to little anxiety on the score of insanity, though the individual is often greatly altered from his former self. The second period is one of acute mania, with ex- alted delusions, and the third one of complete dementia, with complete prostration of mind and body. In the first stage, a general paralytic is usually a prey to exalted notions of his own importance and power. If he has money he scatters it broad- cast, fancying his supply of it is unlimited. He asserts himself as some great dignitary, not unfrequently God Himself; but if this position is denied, he will not take the trouble to argue the * question—he will let the objector go in what seems to him his besotted ignorance. As a rule, too, sexual ideas take hold of him, he exposes himself in any situation, or assaults women in the most unlikely neighborhoods. He is restless, and, above all, forgetful. He takes an interest in nothing, or if he do it is laid aside in a moment, all about it being forgotten. At this period, 666 DISEASE GERMS. too, in some cases, though not in others, there may be observed a tremulousness about the upper lip, and a slowness of speech, which are very characteristic. Both these signs, are, however, much more marked in the second stage, when the patient becomes fairly the subject of delusion. These delusions, as already pointed out, are all of an exalted character. He can do wonders in every way. All his surroundings, though of the most trumpery kind, are interpreted as being of the grandest character; his power is immense, and his bodily strength, though like that of a .child, he thinks incomparable. As to physical signs, as already pointed out, they commonly begin with slowness of speech or rather a kind of interval between each syllable, with a kind of stutter or drawl something like the utterance of an intoxicated man. There is, too, that tremulous motion of the upper lip which is so peculiar; but in some there is a kind of stiffness and swelling instead of the tremulous condition. The tongue, too, trembles when thrust out, and it is thrust out with a jerk, as if the patient had not full command of it. As the malady advances the delusions of these unfortunately get worse. At the same time they are liable to break out in fits of violence of a most dangerous character. They are altogether unreasoning, and as they are generally men in the prime of life, they are not easy to manage when they break out in fits of vio- lence. By-and-by they become subject to fits of a peculiar kind, not seldom resembling the slighter attacks of epilepsy called petit mal. The walk alters, it becomes vacillating about the hips, and the legs are not moved as usual, but are rather thrown forward with a kind of jerk. The hand-writing, too, becomes imperfect both as to mechanism and material. Words or letters are omitted or inserted wrongly, the same word is repeated over and again. The whole is nonsense. The food is eaten voraciously, sometimes bolted, but in other cases, especially as the malady advances, there is difficulty in swallowing from paralysis of the fauces. Such patients are very destructive and very dirty, but they tear up their bedding without knowing what they are doing, and they dirty themselves very frequently for ornament. By-and-by the patient gets worse ; he can hardly walk or shuffle round the room ; he loses power over the bladder and rec- * turn if not constantly attended to. His face has lost all expres- sion, and yet it seems fat and puffy. He can hardly hold any- thing in his hand, and if he is confined to his bed, sores form which are hard to heal. Grinding of the teeth is very often a marked symptom. His appetite is still good, but he has lost the power of swallowing comfortably, so he crams his mouth and throat, and there is a risk of suffocation if this is not seen to. BACTERICIDES. 667 At this time all such patients require to be fed. In point of fact everything must be done for them. But even in this state they- may survive a good long time if care be taken of them, and if they are protected from cold, to which they are very sensitive. The average duration of the disease, from the onset to the end, does not exceed as a rule two years, whilst it may be much less. The causes of the malady are hard to determine. It generally occurs in the prime of life, and most frequently in males. In a certain number of cases it can be traced to overwork of the brain, but as the malady is more common among the laborers than the rich, this will not account for nearly all. Another cause assigned is sexual excess. This, of course, is no easy to make out, but irrregular lives have been noted in a considerable number. As to treatment, that is useless ; we must just do our best to keep the patient quiet, clean and orderly. We must try to feed him well, and as soon as any difficulty in swallowing appears no food must be given in the solid state—the pulpy condition is best. If theyr are confined to bed for a day or two their backs must be care- fully watched, and, if necessary-, washed with some weak spirit with a little corrosive sublimate in it. Stimulants are usually necessary, especially in the latter stages—in the maniacal stage, they must be given with caution. In these cases during a maniacal paroxysm digitalis or digitalin often does good, but only for subduing the paroxysm; nothing does good permanently. Meanwhile, as far as we know, the malady invariably ends in death. Feigned insanity has already been alluded to, but briefly. Often as insanity is assumed the fiction rarely succeeds. The would-be lunatic, as a rule, overdoes his part; most likely he has never seen a lunatic, and his only conception of one is a raving maniac. The means of detecting feigned insanity are not too nu- merous, each case must be dealt with on its own merits; and there are some men known to be sane who have for years succeeded in keeping up an ostensible insanity. Associated with, and dependent on a shal- Kleptomania. low state of the typical fissures of the brain, among the ordinary phenomena of minds not regarded as insane, there is an inordinate tendency to acquire, or collect, or hoard. So long as such an impulse does not inter- fere with the rights of others, or involve a breach of the law, it is readily admitted as an indication of disease, or an absurdity or eccentricity which may consign the individual to an asylum, ot- to contempt. But when the amount of the object appropriated, 668 DISEASE GERMS. or the circumsiances under which it is purloined, bring the mat- ter into a court of justice, the act is treated as a theft and pun- ished. In very many cases this is the result of cerebral disease, in which the typical fissures of the brain are partially wiped out. The inclination to steal is a premonitory indication of many * forms of mental disease, often a characteristic symptom, where violence, delusion, eccentricity, incoherency leave no doubt as to the source from which it springs. • But there are many other cases in which the morbid origin cannot be so clearly demon- strated ; where the mind is clear and cogent, the morals pure, and where the theft is the only proof of insanity. The propensity to steal may be so irresistible that the will is impotent, that the appropriation is involuntary and the perpe- trator irresponsible. The gratification of the impulse is found associated with phy- sical changes and conditions which may be regarded as incom- patible with the healthy discharge of the nervous system, but the connection is not invariable, and the best mode of establishing the reality of such a disease, is to consider marked cases, in rela- tion to the character, interests, and previous development of the individual, to the nature of the articles taken, to the motive which determined the action. The incongruities of some point to the existence of deep-seated cerebral changes. Each case must be tested on its own merits and all its salient points and features well considered. The objects stolen, often ostentatiously, without any adequate precaution to conceal the attempt, or perhaps the article taken may be of no value, even useless to the taker, or the taker quite wealthy. The act is soli- tary, without motive, and promptly and spontaneously avowed and restored. This disease is observed in extreme youth, near puberty in both sexes. It often follows falls, blows on the head or spine, and looms up as a symptom of perverted sexual abuse, and of pregnancy. But it is when the uterus undergoes those critical and crucial changes at the turn of life, that this affection is most prevalent. The interstitial changes in the womb and ovaries is reflected to the brain proper, and produces grave ehanges in the cerebrum —changes which the modern jurist and philanthropist should note. The incarceration of such cases is a blot on the civilization of the age. The therapeutics of insanity are of late years becoming more extensive. Chloral hydrate and bromide of potassa in syrup of orange peel, must be given cautiously lest cardiac syncope be induced. BACTERICIDES. 669 Chloral, bromide potass, conium and hyoscyamus best adapted to procure sleep. The hydro-bromate of hyoscyamus very valuable in melancholia. Amyl nitrate is very useful alternated with morphia. Ergot, combined with hypophosphite of soda, excellent when paralysis is threatened. When insanity is complicated with epilepsy, belladonna, gel- semium and cannabis indica afford most salutary- results. Turpentine of utility when symptoms of an hysterical nature manifest themselves. Strychnine, avena sativa, electricity, calabar bean, used with variable success. For procuring sleep, amylene nitrate, sulphonal, paraldelyde, hydrochlorate hyoscyamus. Insomnia is often an early and premonitory- Insomnia, symptom of a partial death of the brain. [Sleeplessness) It may be caused by passion, mental anx- iety ; dyspepsia; imperfect action of the liver ; constipation; disease of the heart, pregnancy. It is often an aggravated and persistent symptom of chronic inflammation of the brain, insanity, mania, chronic alcoholism. Besides, it is often present in neurasthenia, poverty of nerve force, cerebral softening, paralysis and other states, which are the sequel of exhausted nerve force, whether by mental work or sexual excess; it brings about the state of an organ tissue- starved. Following this, granular deposits on the arachnoid, adhesion of the membranes to the surface of the convolutions, crystalline granulations in the lining membranes of the ventricles, with an unusual amount- of fluid in the sac of the arachnoid and in the lateral ventricles are found in the brain of those who de- vitalize that organ. A tissue-starved brain gives rise to inflam- mation of the cortical part of the brain, ending in its degenera- tion of the nerve cells of the hemispheres, structural change in the convolutions, the cells of which lose their integrity and look like an irregular heap of particles ready to fall asunder. The brain of man owes its healthy existence to the quantity of phosphorus it contains ; if this is enconomized, independent of its scantiness in modern food, it might sustain him probably as long as life lasts and health holds out; but let the brain starve, health fails, nature can supply no more; then, unless the patient can obtain phosphated food, or ozonized tincture of oats, or the animal phosphorus of kephaline, degenerative changes will take place in the gray substance of the cerebrum; the cells of that 670 DISEASE GERMS. part will become granular and deposits of granules scattered through its substance, and these changes take place in all parts of the brain and spinal cord, when the phosphorus in the brain is exhausted. Brain workers, merchants, professional men, know this; they feel it in their languor, tired brain; those are the victims of excessive brain exhaustion. How far this granu- lar change in the nerve cell is compatible with healthy mental action, we cannot yet say. In the treatment, the removal of the cause, whether it be men- tal or physical; the regulation of the secretions; daily baths, with massage; good digestible food; moderate exercise; abundance of fresh air; an avoidance of all stimulants, as tea, coffee, tobacco, are all important. One essential element in the management of all cases of insom- nia is to crowd in more elements containing more phosphorus. In order to accomplish this, without disturbing the organism too much, it is always best to administer a tonic, either wine of cinchona or ozonized coca wine; the latter being essentially the most active, it stimulates the absorption of vitalized phosphatic compounds. The tincture of oats and the glycerite of kephaline are the two best remedies for brain nutrition; and we can pro- cure their absorption by means of the coca. These remedies when thus administered, penetrate the brain, nourish and invigo- rate it. These are our two best brain foods, a nerve-vital essence; they entirely supersede comp. hypophosphorus as a recon- structor of shattered nerve force; invaluable in all forms of loss of brain power, as loss of memory, paralysis, white softening; very refreshing to the nerves when tired by worry, when in neu- ralgia they cry for richer food, purer blood. These are the only true remedies, they cause sleep by promot- ing cerebral nutrition. In order that this point be correctly gained, sulphonal can be administered in doses sufficient to procure sleep, until the remedy has time to act. Sulphonal is the best of all drugs for that purpose, as it does not interfere with the secretions. It is a capital remedy in cases of sleeplessness in brain-starved subjects. Other drugs of value are boldo; glucine; methylal; hydrate of amylene ; somniferin ; antipyrine ; hyoscyamus, etc. All remedies failing, then the case should be placed upon precisely the same treatment as that employed for neurasthenia, namely, vitalized massage, electricity, seclusion, rest, and gener- ous brain diet. This is never-failing, although expensive. BACTERICIDES. 5- j Invagination or intussusception is the most Invagination frequent of .all kinds of interstitial obstruc- of tion. In the case of children, it is the charac- The Bowels, teristic form of obstruction, and any other kind is a rarity. In adults, the affection is far less common, and differs in its locality and in its clinical course. The disease is far more frequent in children than in adults, and in infants at the breast than in older children; it is more common in boys than in girls; in adults, the distribution be- tween the two sexes is more nearly equal, or even. The invagination may take place at any portion of the bowel, but most common at or near the ileo-caecal. In the so-called enteric form, the lesion is in the small intestines ; next the colic variety, in which the large intestines is affected, and the valvular or ileo-colic variety, in which the ileum passes through the valve. Intussusception of the rectum is so rare that it is a pathological curiosity, and still more exceptional is it for the duodenum to be involved. Judging from statistics, the common types are more common, and the rarer forms more rare than is generally supposed. The course of this affection is essentially acute, from a few hours to a few days from the first symptom to the termination in recovery or in death. Symptoms are remarkably constant and even; pain always per- sistently present, severe, and sudden in its accession; then remit- ting, returning again and again. It is of a colicky character. Vomiting is usually an early and very constant symptom. It is a reflex effect. In chronic cases it subsides, or may even be absent at first, and appears in the later stage, when mechanical obstruction has become complete. Tenesmus, which is often mentioned as a characteristic symp- tom of invagination, only appears when the intussuception has reached the rectum. It would seem to be always absent when the small intestine is the seat of the disorder, and is naturally more obvious in adults and older children than in the case of infants. % The bowels are, in 'some of the most acute cases, confined from the first, in others diarrhea appears for a time, and in the more chronic there is often a period of irregular looseness of the bowels, ending in complete obstruction. A more characteristic symptom is the passage of blood, or of blood and mucus, unmixed with fecal matter, containing no pus, and varying from frequent and abundant hemorrhage to the presence of a little blood-stained mucus on the examining finger. We never see the black, tarry stools of melaena, for the blood has *-, DISEASE GERMS. *- / " • not undergone acid digestion in the stomach. Hemorrhage from the bowel is almost invariably present. The characteristic sign of a tumor felt through the abdominal wall was present in sixteen cases out of twenty-four. The only other movable tumors likely to be present in a case of obstruction are a scybalous mass in the colon, a gallstone im- pacted in the small intestine, or a cancerous nodule in the omen- tum. The two latter possibilities would be excluded in the great majority of cases of invagination by the age of the patient. No other tumor moves gradually from the right iliac fossa across the abdomen, and no other contracts under the hand as an invagina- tion sometimes does. If the reflex centre is in any way weak- ened, tetanic symptoms slight or aggravated according to the weakness existing. Abdominal distension is occasionally an early symptom, but more often only appears in the latter stage of chronic cases. It was most marked in a case which lasted three months, and was associated with visible peristalsis, an appearance commonly in- dicative of chronic obstruction in the larger intestine; but in this case the invagination affected the ilium. Infants very early show signs of collapse, with cold extremi- ties, feeble pulse, and sighing respiration. The temperature is often subnormal, but in one case of mine, in a child six months old, it rose to above 1030 F., although the autopsy showed neither peritonitis nor any other morbid condition, but a reduced ileo- caecal invagination. Diagnosis.—When there is no tumor to be felt either in the rectum or through the abdominal walls, the diagnosis of the case depends on the combination of symptoms of acute abdominal disturbance, pain, vomiting, and early or late obstruction, with the passage of blood and mucus. When these occur in a child almost the only condition likely to be confounded with invagina- tion is ulcerative colitis, so-called infantile dysentery. In adults the diagnosis is more difficult. Cancer of the upper part of the rectum may closely simulate the effects of invagination, particu- larly when it leaves diarrhea, instead of, or in addition to, constipation. Prognosis and Treatment.—Invagination is always a grave con- dition. There is little doubt that the bowel occasionally extri- cates itself by a reversed movement, as may be seen in the case of animals dying from asphyxia. This natural reduction hap- pened in three out of twenty-four cases, in one of them under the influence of chloroform. Far more frequently cases left to themselves go from bad to worse ; the invagination extends farther and farther, and the BACTERICIDES. 673 patient dies quickly of abdominal shock, or more slowly from exhaustion or from peritonitis. If the invaginated gut sloughs off speedy death often follows by perforation or by hemorrhage. Probably this event was more frequent formerly than now, when our power of diagnosis and of treatment is better. It has rarely been recorded in the case of children, and is an accident of chronic rather than of acute cases. The part involved is more often the small than the large intestine. The best treatment seems to be to administer chloroform at once, and then to inject air. When the abdominal walls are re- laxed, a tumor before undetected may be readily felt, and the condition is more favorable for inflation. If for any reason, how- ever, it is undesirable to administer chloloroform, or if inflation has to be repeated, there is no need for an anesthetic, since the operation is painless. The hand should be kept upon the ab- dominal tumor while air is being forced into the bowel; the inflation of the colon is then felt, and the tumor disappears from the touch with a characteristic sensation. Moreover, one can thus better appreciate and regulate the force used, which must be gradually and cautiously increased. If with justifiable pres- sure reduction is not effected, the best plan is to desist for two or three hours, put the patient under opium, and try again either by inflation or by an enema. Not infrequently the invagination returns after reduction, but it may be again reduced by a second or even a third inflation. When the invaginated gut has reached the anus, or protrudes therefrom, it must first be replaced by a large, well-oiled bougie, until there is sufficient space in the rec- tum for the nozzle of the inflation-pipe to enter two or three inches. An ordinary pair of bellows is as convenient and efficient as any other means of inflation, and has the great advantage over specially devised apparatus of being always at hand. Some good authors prefer the administration of forcible and copious enemata to inflation as a means of reduction. The water should be warm, plain or medicated with lobelia; and the requi- site power obtained by raising the receptacle from which it flows. Advantage is moreover gained by raising the patient's pelvis, or by more complete inversion of the body, so as to open out the sigmoid flexure and increase the space between the " plug " and the anus. On the whole, the injection of air appears to be the safest and most efficient treatment. Neither method, however, is uniformly successful. Indeed, when the invagination has long existed, adhesions have taken place, so that no safely exerted pressure can reduce it; and if this were effected it is likely that a rupture of the softened or sloughing gut would take place. In one case that lasted only a 43 674 DISEASE GERMS. single day it was found impossible, even after death, to effect re- duction by injection of water into the rectum. In these cases we must, after two or three careful and patient attempts, either keep the patient under opium and hope for a natural cure by the plug sloughing off safely, or else open the abdomen and deal manually with the invagination. In this case we have the great advantage of a diagnosis, so that the surgeon knows what he has to deal with. The seat as well as the nature of the obstruction can usually be ascertained, and there is scarcely ever already existing peritonitis. These are all favorable circumstances, but on the other hand we have the early age of most of the patients, and the fact that they are already exhausted by want of food for hours or days, as well as by pain and vomiting. In the more chronic cases the patient is usually older and stronger, and more nourishment has been taken; but it is likely that adhesions and other local changes may have rendered reduction impossible or dangerous. The results of treatment are not, therefore, very favorable. Of a very large number of cases treated, a very large percentage died. The most recoveries take place under the administration of large doses of opium, hyoscyamus and belladonna, internally; with copious warm lobelia injections into the rectum. In nearly all cases of abdominal section, death follows, not from the operation and peritonitis, but from the damaged state of the invaginated intestine, or from the shock and collapse. This is the name given to a disease of the skin in Keloid, which there is hardening or thickening of that tissue, so that the part very much resembles that seen after a burn. It occurs on the back and upper extremities chiefly, and seems to be an incurable disorder. The word " keloid" or "kelis"is derived from a Greek word signifying a crab's claw. There seems to be two kinds or varieties of this disease. The one appears as hard, shining tubercles or small nodules of a dusky or deep-red color, and generally attended wtth itching, pricking, shooting, or dragging pain in the part. These tuber- cular elevations gradually increase in size until they are as large as a horse-bean or even an almond, and about one-tenth or one- sixth of an inch above the general level of the skin. They are hard, firm, and elastic, but after a while they become broader and more irregular. Some delicate whitish, glistening lines appear on the surface, and from each there is a claw-like process from a quarter of an inch to an inch in length, which appear to cause a puckering of the skin. Growth may go on for months and even BACTERICIDES. 675 years, but they only cause local inconvenience and do not impair the general health. The other form of keloid does not begin with tubercular elevations, but as white, roundish patches of skin, very slightly raised and surrounded by a zone of redness. At first there is no pain nor uneasiness; afterwards there is itch- ing and pain with a feeling of tightness in the part; at length the part becomes hide-bound, and the skin is hard and rigid, so that the movement of the part is impaired. The fingers are very liable to be affected in this way. After a time the skin shrinks, becomes red or yellowish, and may go on to ulceration. If the affected part be extirpated it often returns, and no treatment seems to be of any avail, but a prolonged use of the Chian turpen- tine mistura. Skin diseases in our country have neither the Leprosy, virulence nor malignity of other parts of the world. This is due to our highly oxygenized atmosphere, to the extreme abundance of healthy food, and cleanliness of our people. We look with holy horror at the emigration to our north- western States of nearly all the lepers of Scandinavian Europe and Asia. It is well known to our profession in those States that certain localities are literally packed with individuals having this malignant disease. The time is opportune and no false notions of philanthropy or religion should deter us from insist- ing upon the segregation and isolation of all lepers, and upon forbidding all such entering our country in the general tide of immigration. Lepra is an infectious parasite disease of an exceedingly chronic character, the microbe or parasite in its embryonic state breeding in the blood, when more matured invading every organ and tissue of the body; chiefly characterized by cutaneous pig- ment changes, disordered or abolished sensation—making its chief ravages upon the skin, in either tubercles, bulbae, cicatrices, atrophies, or destruction. The germ creates a cachexia which terminates fatally. There are several varieties as lepra tuberose, maculae, anaesthe- sia, etc. Leprosy is a contagious and infectious parasite disease, produced by the bacillus lepra. Common to both sexes, all ages. After the microbe is once hatched, breeding freely, it produces organic or degenerative changes in the nerves, which explains the anaesthesia, or hyperesthesia, and possibly the pigment altera- tions, so characteristic of the malady. The peculiar inaptitude of the nervous tissue to undergo retro- 676 DISEASE GERMS gressive metamorphosis; the slow growth of the germ, its ten- dency to invade the skin with no involvement of the internal viscera, explain the slow growth of the disease. The bacillus lepra is discernible in no other disease affecting man, although in leprosy, in tuberculus, in syphilis the aggrega- tion of germs often tend to cutaneous and subcutaneous growths or nodes; nodules in the cornea, cartilage, testicle, spleen, liver, bone. In a drop of blood placed under the microscope the germ is visible in lymph spaces, or in any new formation. The microbe consists of fine, slender delicate rods with tapering extremities, some rather long and pointed, some clearly mobile and others not. In the secretions they are recognized sprinkled through the mass, have a beaded appearance. The germ bears artificial culture in blood, serum, and alkaline The full-fledged bacillus of leprosy, mag- nified 1500 diameters. meat extracts. Inoculation on animals nearly allied to man pro- duces the disease. The germ is most prolific in the tubercular form of leprosy; here their growth is prodigious, and as a result they are found in enormous numbers in the mouth, palate, larynx, liver, spleen, kidneys, testes, lymph glands, and in the interstitial tissue of the nerves in anaesthesia form. The recognition of leprosy is very easy; the eruption, its ap- pearance, odor, chronicity, its large, brownish-yellow, glazed bulbous lesions; its leathery, mica-tinted cicatrices are rare in any other contagious disease. As regards treatment we have a most remarkable and exceed- ingly tenacious microbe to deal with. No remedies known to science have thus far had any direct curative effect; that is, we have not yet found the potent germicide. Even the Chian tur- The microbe of leprosy in its embryonic state, magnified 1000 diameters. BACTERICIDES. 6?7 pentine with the ethereal peroxide of hydrogen, with resorcin and thallin, which so effectually annihilates the cancer germ, fails in half the number of cases in which it has been used to destroy the lepra bacillus. Other remedies, as the comp. saxifraga; half-drop doses of creosote; oil cf cashew nut, gurgun balsam, ichthyol, chaulmoogra oil, alvelos milk, siegesbeckie, internally and locally have all been employed with varying success ; they mitigate greatly, but fail to exercise a controlling influence over the disease; that is, they do not kill the germ. The most recent and extensively used remedies to kill the mi- crobe in the connective tissue between the nerves, are chaul- moogra oil and gynocardic acid with glycerine. Both oils are administered internally in increasing doses to one drachm a day. Chaulmoogra oil in emulsion. The adoption of a highly nutritious diet, the exhibition of our best tonics, as iron, cinchona, avena, kephaline, wine and malt liquors are always of good service. Baths are of great advantage in all cases. Those of the high- est potency in germicidal properties, as ozone, sulphur and iodine, should have the preference. Such remedies would be of utility in syphilis and cancer. Every secreting ulcer and open surface in a leper should be attended to by the application of resorcin and ozone ointment, so as to destroy the bacilli that are contained in it. The prominent indications in each case should be met. If the patient happen to reside in a district where the disease prevails, an immediate change of residence and climate is necessary. An essential symptom of all diseases of Leucorrhcea. vagina, uterus, ovaries. It is therefore present in debility of the va- ginal walls; in acute and chronic inflammation of the uterus; uterine catarrh, and ulceration ; in all forms of displacement; in all forms of ovarian irritation, etc. If the original morbid condition can be got rid of, there is little trouble in getting rid of leucorrhcea. General internal treatment consists in the use of tonics and alteratives; pulsatilla and caulophyllum, in alternation with the aleteris cordial and compound tincture cinchona. As the discharge in all cases is loaded with disease-germs the remedies used must be bactericides; as extract hydrastis, dioxide of hydrogen in tepid water; hemlock bark, dioxide of hydrogen in tepid water; acetic acid, solutions of boroglycerides; packing the vagina with boroglyceride; lime-water and tincture of iodine. 678 DISEASE GERMS. Infantile leucorrhcea, as seen in children of three or four years of age, differs altogether from the leucorrhcea of adolescence or maturity. Its location is the vulva; discharge, sero- or muco- purulent. The subjects of this disease are tubercular, and the victims of hereditary syphilis. Exceptional cases are due to the germs of the eruptive fevers and ascarides. There should be an improvement of the general health by all possible means, fresh air, abundance of nutritious food, cleanliness and the affected parts bathed three times daily with a warm solution of borogly- ceride. Internally, compound tincture of matricaria in five- drop doses, in water, is most effectual in overcoming the patho- logical condition of germ evolution which is dependent on debility. _______ A disease in which the number of white Leucocythaemia. corpuscles in the blood is greatly in- creased, with a simultaneous diminution of the red. This state is brought about by chronic, exhausting diseases, exposure to cold, wet, privation, and insanitary condi- tions, and often a sequelae of malaria, typhus, typhoid, puerperal fevers and pneu- monia ; affections of the lymphatic glands or of the spleen, and is attended with a decided train of symptoms. Great weakness and de- bility, anaemic pallor, with all the other symptoms of anaemia; disordered re- spiration, loss of appetite, mental depression, abdomi- nal swelling, with enlarge- ment and induration of the spleen; sometimes diar- rhea, at others, constipa- tion, nausea, jaundice; often hemorrhage from nose, lungs, stomach ; jaundice, anasarca, ascites, prostration, ending in death. Very chronic, lasting usually quite a number of years. The morbid condition is characterized by an excess of white corpuscles in the blood, with great enlargement, induration of the spleen, often as large as a child's head, its proper structure Destruction of the red corpuscles of the blood in the spleen by the microbe of malaria, which gives rise to the white-cell disease of the blood. BACTERICIDES. 679 obliterated, filled with coagulated blood, soft and friable, and a mass of bacteria. Oftentimes we have a peculiar inflammation of the retina. All methods of treatment and our best remedies fail us in this disease. An eruption consisting of small pimples or papules, Lichen, arranged together separately, or in clusters, and oc- curring anywhere on the surface of the body. The term is restricted to inflammatory papules, which undergo no metamorphosis. In the treatment there are three indications, the improvement of the general health, especially as regards the nervous exhaus- tion ; the relief of the itching by local means, which will go far towards the removal of the eruption. The patient should not scratch the heads off the pimples, as . he may produce an irritable sore which may become eczematous. The papules arenot large, but are hard, dry and red in color. They tingle or itch and disappear by scaling off. Numerous varieties are described, according to the cause which gives rise to it; none of them dangerous, but as a rule troublesome or intractable. The employment of general alteratives and tonics, among the latter, avena, mineral acids, nux vomica. Local remedies of most utility are thymol, naphthaline, resor- cin, creolin, rubbed up in lard or vaseline ; in the form of lotions, try oil of cade cut with alcohol; or chrysarobin five to ten per cent, solution; baths of sulphuret potassium. The case must be pushed; nerve tonics, it is essentially chronic, and if untreated may last for years, spreading and leading to grave complications. Various lesions may be occasioned by the local application of many substances; chiefly irritants; but eruptions also some- times follow the internal administration of certain drugs. Amongst the more common thus caused are the following: A scarlatiniform eruption (from belladonna), erythematous patches (from quinine or chloral), a rubeoloid eruption (from copaiba), a vesicular rash (from arsenic), pigmentation (from the prolonged administration of arsenic or silver-salts), an acneiform eruption (from iodides or bromides), and a purpuric rash (from iodide of potassium). By leaving off the drug, those various eruptions will each and all disappear in forty-eight or seventy-two hours, without any treatment whatever. 68o DISEASE GERMS. A hybrid micro-organism produced by the pre- Lupus. sence of the microbe of syphilis and the bacillus tuberculosis. It usually attacks the face and mani- fests itself in a variety of forms. L. erythematosus.—The least severe form. Most common in the female sex and usually attacks face. It is mostly symmetri- cal and makes its appearance as an erythematous patch on either cheek. These generally become joined across the nose, the ar- rangement then somewhat resembling a butterfly with its wings spread out. Sooner or later scabs form which adhere closely to the skin. When removed by the nail, they are seen to extend into the orifices of the sebaceous glands by numerous fine pro- cesses from their under surface. The scabs, in fact, consist of dried sebaceous matter. The disease has, therefore, been con- sidered by some as an affection of the sebaceous glands. Its affinities, however, are more marked with the other affections de- scribed as lupus, and like them it leaves permanent cicatrices. It is a chronic affection and may last for years. L. vulgaris.—The more severe form often causing great de- struction of tissue. Begins mostly in early life—usually before puberty, often in quite young children. May go on for years even if vigorously treated. More common in the female sex. Sometimes hereditary. Said to be frequently associated with struma, but many cases of scrofuloderma were doubtless formerly erroneously regarded as instances of lupus. Any part of the body may be attacked but, as with the erythematous form, the face is the favorite locality. It also attacks the mucous membranes. The characteristic appearance of lupus is that of minute yellowish- brown translucent (" apple jelly") nodules in the substance of the skin. They average a line or two in diameter, are not raised above the surface, and are covered with epidermis. The tuber- cles may occur singly or in groups. The former arrangement is rare and has been termed acne lupus from its superficial resem- blance to the follicular prominences seen in acne. More generally the nodules occur in groups which gradully tend to get larger owing to fresh portions of the skin getting attacked. The older nodules get paler in color. Microscopic examination shows the growth to begin by an aggregation of small round cells in the corium mainly in the coats of the vessels. The growth extends along the vessels until it involves the whole thickness of the corium. It occupies the interspaces of a fine fibrous network in which a few capillaries may be seen. Later, there is marked over- growth of the epidermis, and the cells of the rete malpighii are infiltrated with leucocytes. The two principal varieties of L. vulgaris are L. exedens (or BACTERICIDES. 681 exulcerans) and L. non-exedens, so named according as ulceration does or does not occur. L. tuberculatus is a form in which the new growth forms prominent tubercles, and pustular lupus is a variety having a superficial resemblance to impetigo. In L. non-exedens the new growth does not extend deeply but is limited to the skin itself, a considerable tract of which may become ultimately involved by irregular gradual extension of the disease. As the growth advances in a fresh direction cica- trization takes place in the parts first attacked and grayish-white glistening scars are left. The hair-follicles are destroyed in the process and the hair is therefore not reproduced on the areas attacked. Compared to the next form this is a comparatively benign affection, though deformities may result from the con- traction of the cicatrices. L.exedens is that form in which the process goes on to ulceration. Most common on the face, especially on the nose and cheeks. As a rule the ulceration has more tendency to advance superfi- cially than deeply. When the process has lasted a certain time a fresh patch is attacked, and on the older patches a scab forms, beneath which gradual destruction of the tissues may still go on. More or less cicatrization may ultimately result and disfigure- ment or deformity may ensue. On the face the lower eyelids may be drawn down and everted, the mouth drawn out of place, and incurable nasal deformity be caused. On the limbs the con- traction may limit the movements of the joints. In those rarer cases in which ulceration tends to extend deeply extensive destruction may be caused. Almost the whole of the face may thus be destroyed and even the bones may be attacked. Pustular lupus is an eruption consisting of isolated tubercles (occasionally confluent) which may reach two lines in diameter. They become pustular at their summits, and soon small dark scabs form and adhere firmly. If removed fresh ones form. The tubercles finally disappear, leaving temporary discolora- tions and permanent scars. In lupus we have a hybrid germ ; a microcosm, which ex- ercises a fierce, unrelenting struggle for existence. The hybrid microbe lupus in nests interspersed T :fc fr.rrnci+\r,n \up- havP a with sweat ducts and sebaceous follicles. ln ir-S IOrmatlOn We nave d disappearance of both the bacilli of tubercle and that of syphilis; no doubt these two bacilli, when together, generate a diastase which kills themselves. 682 DISEASE GERMS. The hybrid microbe, the factor of lupoid infiltration and ulcera- tion in all its varied forms, is the direct offspring of the micro- organism of syphilis and tubercle in the blood. The presence of both germs in the lupus nest in the skin, actively proliferating, places the origin of the disease beyond all doubt, as well as the fact that both disease germs can be isolated and cultivated. Simultaneous with the evolution and growth of both mother- germs, the hybrid lupus follows. Both the internal, as well as the external, treatment, must ne- cessarily be, in the highest degree, germicidal. The internal treatment should be constructive and alterative, the best of diet, bathing, clothing and a mode of life calculated to build up vital force, embracing the very same remedies which are of utility in syphilis and tuberculosis, as the iodide of starch, saxifraga, glycerite of ozone, sulphur water, hydrogen, peroxide, phytolacca, have a marked effect in sterilizing the organisms, dwarfing their micrococci and their multinucleated masses cf protoplasm. Constitutional remedies do great good; they sterilize the blood and the lupus-nests fail in their organization. The favorable results obtained by some of the following local remedies have again and again been verified. The favorite are either iodized oil, thymol, ich- thymol, naphthol, chrysarobin, iodol, sozoiodol, creosote, per- oxide of hydrogen, salicylate soda, chromic acid, sulphurous, pyrogallol in ointment form. Equal parts by weight of ozone ointment and resorcin most efficacious; lactic acid. Erosion, scraping by the der- mal curette or spoon, followed by the application of iodoform, has met with fair results. Be- fore any remedy, either in ointment, lotion or in gutta- percha and chloroform be ap- plied, the crusts should be softened by boroglyceride' oil and slippery-elm. If a caustic be deemed indispensable, electrolysis, or nitric acid in which the chloride of gold et soda is dissolved, should have the preference. A mixture of thallin and papoid, made into a paste, of immense value ; sprays of C. P. peroxide of hydrogen, very effectual. Lupus microbes removed with ozone ointment and resorcin. BACTERICIDES. 683 Several most interesting cases of facial lupus have been speedily and permanently cured byjthe local use of one ounce of ozone Lupus exedens before treatment. Lupus exedens after treatment with ozone ointment and resorcin. ointment and one ounce of resorcin. Mix thoroughly and ap- ply over night, during the day sprinkling the part with iodol. This is a term applied to a most pernicious Masturbation, and disastrous habit—the stimulating the or penis with the hand, in order to excite the Self-Abuse. pleasurable sensation of coition and a dis- charge of semen; an act revolting to humanity, destructive to vigorous manhood, and one which depreciates vital stamina, entails degeneration, disease, insanity and death upon all who practice the vice. The causes which give rise to this habit are the defects and vices of modern civilization ; a poverty of nerve force ; isolation, monotony, solitary confinement which wipe out and obliterate the typical fissures of the brain ; isolation of the sexes; the developing the nervous system at the expense of the physical; the moral tone of society is blunted. The symptoms incidental to this habit are insidious languor, lassitude and debility; a want of energy and ambition; a depres- sion of spirits ; a disinclination to society ; a pallor of the face ; weakness of the back and knees; hands and feet are cold and 684 DISEASE GERMS. clammy ; noises in the ears ; specks and spots before the eyes; the circles around the eyes are depressed and darkened; a gen- eral want of nutrition, emaciation; he cannot bear the cold, as he is morbidly sensitive ; morbid thoughts annoy him ; his old pur- suits and amusements have no attraction for him, neither do new ones have any charm for him; his memory becomes imper- fect, so does vision and hearing; the freshness and vigor of health disappear; a general destructive metamorphosis sets in; the skin becomes rough, often of a leaden hue; the eyes lose their brilliancy, and by languor express that of the whole body; the lips lose their vermilion tint; the teeth their whiteness; the hair becomes dry and falls out, and sometimes even the whole body is bent and distorted; his face is shrunken, haggard, pale, unmeaning, soulless, inexpressive; eyes become dull and lack lustre, in other words, the masturbator is a physical, moral and mental wreck. This vice is not confined to the male sex, it is equally com- mon among women. Young and apparently modest ladies are dying by thousands from tuberculosis, uterine complaints, spinal and nervous disease, general debility, prostration caused by this habit. The symptoms and effects are similar to the male. The practice causes a glary, white discharge to pass away, which is very weakening; besides, it gives rise to leucorrhcea, ovarian and uterine irritation, mental aberration, suppression of the menses, and general disorganization and bankruptcy. The effects of masturbation are invariably disastrous, it always gives rise to irritation of the prostate gland and ejaculatory ducts ; damages the testes, the veins of which with those of the spermatic cord, become weak, varicose ; atrophy or wasting set in, or if the practice has begun in early life, they do not attain their full size, lose their power of secreting semen, and the entire body is dwarfed and suffers vital deterioration. As a rule the generative organs suffer first, the penis and tes- ticles resemble those of a boy, they take on interstitial absorp- tion, lose their elasticity and firmness—their proper structure is anaemic—the spermatic cord atrophies, its nerves degenerate and the cremaster muscle disappears. The thin, watery semen that is formed under such a state is entirely destitute of spermatic granules and spermatozoa; its fertilizing power is gone; impo- tency supervenes. When the testicles waste away, as the result of masturbation, the wasting is equal, dwindling to nothingness; whereas if they waste as the result of the localizing of the syphilitic germ, they alter in shape, become uneven, or irregular, or elongated as well as small. BACTERICIDES. 685 In some cases, enlargement of the testes takes place, puff up, insidiously increase in bulk, but diminish in firmness, consistency and elasticity; in others, they become spongy. Whether it be enlargement or atrophy, it is the precursor of degeneration. The reflex effect of the act upon the spinal cord and brain is most disastrous in setting up an irritation, in draining off the nervo- vital fluid, in changing the whole aspect of the cerebral areas. The time when most males and females become addicted to this vice, is usually about puberty, the most critical period of life. The generative propensity, called forth perhaps prematurely and viciously gratified, steps in amidst the natural efforts of growth, with its unnatural train of nervous shocks, and physical pollu- tions, causing our boys and girls to have the appearance of old age, being feeble, pale, effeminate, with perverted tastes, drained out brains, mere wrecks of humanity, victims of nervous disease. It is thus the delicate, the impressible nervous system of the young of both sexes, that most vividly experiences the depress- ing effects, the soul-wrecking ravages of self abuse. Such a habit strikes at the root of society ; the origin of species; dwarfs humanity in its very bud, deforms its features, stunts its growth. Its direct reflex effect on the nerve centres creates an intense tubercular diathesis, and this peculiar nervous defect aids in the creation of this abnormal desire. Fathers, but especially mothers, must not shut their eyes to the fact that their children often, at an early period of life, resort to tickling their sexual organs. Later on, just at the time when all the energies of the system are needed for growth and develop- ment, the practice is most devitalizing, but when puberty sets in with its rapid growth of the organs, the increased power and frequency of erection, the dawn of a new life, the practice is most demoralizing, and its effects more permanent. Man, with his instinctive and moral nature, is often a slave of habit, and if the act of masturbation be but a few times indulged in, this habit is created. The blighting effects of masturbation are not confined or lim- ited to the sexual organs, to wasting or atrophy of the spermatic cord, testicles, spinal cord, but re-acts upon the brain, impover- ishing the nerve centres; so that the semen secreted becomes thin and watery, of a sickly odor, with no living spermatozoa in it, consequently not fertilizing. The effects produced by masturbation may be embraced un- der three heads: 1. A condition of genital debility, in which the seminal ducts will not retain the semen, but it oozes away by day or night or 686 DISEASE GERMS. both, with or without seminal incontinence ; or a chronic prosta- titis may be the result, with emissions often and persistent. 2. Chronic irritation of the lumbar portion of the spinal cord. i. Exhaustion and irritation of the brain. The leading or characteristic symptoms of these three stages are as follows : A general feeling of languor, lassitude, debility; there is vertigo or swimming in the head; specks or spots be- fore the eyes; noises in the ears; skin becomes white; pupils are dilated ; breath fetid ; digestion is feeble ; bowels constipated; the faeces harden in the rectum, and produce irritation of the seminal ducts in their vicinity; the circulation is languid; the extremities cold and clammy; the muscles soft and flabby; by- and-by, the forehead may be dotted over with pimples; the corners of the mouth are lengthened; the nose and features be- come sharp ; eyes sunken and deprived of their brilliancy; there are bluish circles around them; no look of gaiety or animation; he cannot look you in the face; becomes morbidly sensitive ; loses all his vivacity or grit. The case progresses onwards; there is weakness about loins and knees; a crack- ling in the joints; memory fails; percep- tions become dim; desires blunted; dis- traction or absence of mind, which reh- ders him unfit for business; imagination gives birth to the wildest fancies and most groundless fears ; an allusion to the habit, in his presence, causing a twitching, a flush of shame, or even despair. The affected one shuns the face of man, and dreads the observation of women ; then, after a while, there are fainting fits, wandering pains, chorea or convulsions, trembling, epilepsy, and partial paralysis. The debility of masturbation is both local and general, never partial. Persons so affected, in attempting sexual intercourse, may be unable to get an erection; or, if" the act is accomplished, an emission takes place too quickly, and is followed by exhaus- tion ; besides, there are daily as well as nocturnal losses; the semen regurgitates, and finds its way into the bladder, and is passed in the urine ; or it may be passed during an evacuation of the bowels; the patient becomes keenly alive to his weakness; is timid, fearful, careless of everything; his mind becomes ab- sorbed in the consideration of his malady, until the presence, re- currence and persistence of the same train of thought, with the ever-leaking seminal ducts, creates a monomania or premature Healthy spermatozoa from a vigorous man who never committed the act of mas- turbation. BACTERICIDES. 687 old age. There is not a gland or function or movement of the body natural, nor a faculty or organ, nor sense or perception of the brain clear or healthy; all is out of gear ; nothing but dis- integration and disease; incessantly, by night and day, the seminal fluid or brain juice oozing, dribbling away without sensation, erections, or any show of natural ejaculation. This persistent drain of the most vital fluid in the body varies in quantity, according to the state of weakness. Onanism wipes out the deity of manhood. The victim of the solitary vice is repulsive to his fellowman; his very skin emits an odor resembling the smell of the ailanthus blossom in a decaying state, or that of a dog-kennel; his brain softens, insanity super- venes. First Stage.—The main, if not the only trouble, is in involun- tary emissions. The patient, after having practiced masturba- tion, has generally discovered its pernicious nature and aban- doned it, hoping by temperance and frugality to outgrow its evil effects. But the injury once having been done to the delicate sexual apparatus, he is sooner or later surprised and alarmed by the occurrence of involuntary discharges of semen. These, in the first stage, occur at night, sometimes at considerable inter- vals, at others several times a week, usually accompanied by a dream of an obscene nature. These seminal losses are a terrible drain upon the system; they impoverish the blood, and rob the body of the precious elements of manhood. For some time no other serious effect is observed, the general health being good, and the sexual powers vigorous. When these symptoms are present, treatment should be resorted to at once, for if the evil is not remedied it soon passes into the second stage. Second Stage.—The emissions now occur not only at night with dreams, but sometimes without them, the patient knowing nothing of it until he observes the stains on his linen the next day. He also soon learns to know, by a wretched feeling of malaise and depression the next day, that he has suffered a loss of the vital principle. In this stage the weakness of the organs increase so that emissions take place in the daytime, the semen escaping with the urine, or while straining at stool. The sufferer now begins to experience a gradual failure of his usual strength and powers of endurance; in some cases there is loss of flesh, and various abnormal symptoms, headache, dyspepsia, low spirits and melancholy, weak back, gloomy forebodings, etc. And, although from not being married he may not observe it, there is perceptible weakening of the sexual powers. The power of erec- tion may remain comparatively perfect, but the sexual powers are easily exhausted. In such cases, on attempting intercourse, 688 DISEASE GERMS. the emission takes place too soon, thus defeating the end of marriage, and bringing disappointment instead of mutual happi- ness. In an advanced degree of this stage urethral complica- tions set in. The urethra becomes relaxed and weakened, the semen is not ejected with force, and is sometimes thin and watery, producing feeble, unhealthy children. There is a low degree of chronic irritation, which produces uneasy sensations in the passage at times, a burning sensation on passing water, and a driobling of urine afterwards Sometimes there is a kind of oozing of a clear, whitish fluid, like the white of an egg, which may be either mucus, prostatic fluid, or these discharges mixed with semen. These are always bad symptoms, as they denote an advanced stage of the disease, and debilitate the genera- tive organs and impair the health. This is followed by nervous irritation, restlessness, lack of energy and ambition, loss of memory and want of self-confidence. If, from neglect or im- proper treatment the disease has been allowed to reach this stage, appropriate treatment should be adopted at once; as, if not remedied, it gradually passes into the third stage, making a con- siderably longer course of the remedy necessary. Third Stage or impotence and sterility, " Loss of Manhood," as :'t is termed, the sexual powers continue to gradually fail; the emissions are now less frequent, because but little semen is secreted. The nervous energies, however, suffer the fame. Inclination for the opposite sex is irregular and feeble, the secre- tions are slow, weak and imperfect, and no longer under the con- trol of the will, intercourse is often* wholly impracticable, owing to absence of erection, or premature discharge; when the semen escapes it is often accompanied by a burning sensation, owing to the unhealthy state of the urethra. In time all sexual power is wholly lost; occasional erections of mornings may be observed, but they are due to a distended bladder rather than the presence of semen. If married, the patient discovers himself incapable of consummating it, and many under such circumstances have com- mitted suicide in despair. The general health is often still more impaired, although on the gradual extinction of the sexual func- tions, a person will sometimes become fleshier, and to outward appearance look well, the same as eunuchs and castrated animals. No one knows better than himself, however, what a fraud he is to womankind. He is impotent; or if capable of occasional inter- course, his semen is imperfect, containing no spermatozoa, and he is sterile and incapable of transmitting life to posterity. Towards the latter part of the second stage, and during any part of the third stage, the mind is liable to become diseased as well as the body; then comes mania, insanity—a grave consultation BACTERICIDES. 689 of friends and physicians—a hurried removal to the confinement of an asylum—and he is entombed alive—a few months, or at most years, of mad delusion follow—and all is over ! This is the sad end of many a once ambitious and promising life, recklessly sacrificed by vice and ignorance. This is a function performed by women Menstruation, between the age of puberty and middle life; this forms the child-bearing period, and usually lasts about thirty years. Various names have been given to this function ; it is spoken of as the menses, the period, the catamenia, etc. When not performed at all the patient is said to have amenorrhcea, when the function is performed with difficulty or pain it is called dysmenorrhcea, and when the dis- charge is very profuse the individual is suffering from monor- rhagia. The appearance of menstruation is generally accom- panied by more or less pain in the back, headache, and lassitude ; often, also, the patient loses color, and has a dark ring round the eyes. From thirteen to fifteen years of age is the average time when menstruation commences, but it may come on a year or two earlier in some cases, or it may be much delayed in others. The periods are frequently irregular at first, and some months may elapse before the function is carried on with regularity. When well established, an interval of about four weeks elapses between each period, but sometimes only three weeks intervene. The blood that flows differs from ordinary blood in being acid instead of alkaline, and in not clotting unless poured out in large quantities. This function is always suspended during pregnancy, and is, in fact, the chief symptom from which a woman dates the expected time of her confinement. Many things will tend to cause irregularity in the performance of this function during the child-bearing period of life—exposure to cold or wet, mental emotion or worry, acute diseases, consumption, cancer, and many other diseases may either cause menstruation to stop altogether, or be diminished in quantity, or to occur at irregular intervals. The period of life when menstruation ends is known as the climacteric period, and the cessation of the function is often accompanied by more or less distress; the patient becomes nervous and is easily worried, suffers from lowness of spirits, pain in the back and between the shoulders, pain also frequently in the left side, and headache ; the temper may be irritable and the appetite capricious. These symptoms arise in a great measure from a disturbance in the nervous system, giving rise to various neuralgic pains; such symptoms, however, though often 44 690 DISEASE GERMS. troublesome, are not attended by danger, and subside when the function of menstruation has quite ceased. The flow generally ceases gradually, and becomes more and more scanty ; sometimes it is for a short time much increased in quantity. Menstruation has a nerve origin ; not a shedding of mucous membrane. Recent authority points out that this monthly phe- nomenon is the result of changes in the condition of the nerve supply, manifested by symptoms of a general character. With the approach and appearance of the monthly flow the whole frame, as one would naturally expect, participates more or less in the change, and the amount of disturbance experienced as well as manifested is commensurate with the power the organism possesses of adaptation. The true nature of the catamenial dis- charge is still conjectural and theoretical, yet its elimination from the body renders it highly probable that having already served some special end, its detention in the blood may exert some deleterious influence upon the animal economy. Ovula- tion and menstruation are coincident. It is alleged as an estab lished theorem that from the period of puberty to the climacteric age there is, besides a gradual death of the mucous membrane lining the whole uterine cavity—which must ever recur, to be compatible with life—a more or less regularly-recurring and complete death of this coat. In the whole animal kingdom we search in vain for a physiological change truly analogous with this. To maintain the integrity and activity of the menstrual function almost indefinitely, we have two most remarkable rem- edies, namely: avena sativa and ozonized distillation of apiol; the former acts on the origin of the sexual appetite in the brain; the latter upon the uterus. The mesentery is a double fold of Mesenterica, peritonaeum which retains the small in- Tabes Mesenterica. testines in their place in the abdominal [Marasmus) cavity; it is fan-shaped in form, and attached to the front of the spine at its narrow end. Around its longer margin the bowels are arranged, so that perfect freedom of movement upon each other is allowed, while yet each portion keeps in its proper place. Between these two folds run some vessels which take blood to and from the in- testines ; these are called the mesenteric vessels, and consist of arteries and veins; they are also accompanied by various nerves- There are besides a great many glands in the mesentery, called the mesenteric glands, and these are often liable to disease. Through these glands passes an alkaline, opalescent fluid called the chyle; BACTERICIDES. 691 this chyle is collected in the intestinal walls by a vast number of small vessels called lacteals, which are very analogous to the lymphatic vessels in other parts of the body : these lacteals join together and form larger branches, until, having passed through the mesenteric glands, they convey the chyle, altered by that process, to the receptaculum chyli—a dilated tube lying in front of the spine and serving as a kind of reservoir for that fluid, which afterwards passing up the thoracic duct, enters the blood at the lefc side of the root of the neck. The lymphatics of the mesentery belong to the same class of glands as the suprarenal capsules, spleen, pink marrow of bones, lymphatics, active blood raisers. Any irritation in the bowels, as diarrhea, cholera infantum, worms, irritates and weakens the mesentery and renders it a congenial place for the localization of germs, so that the bacillus of typhoid, tubercle and other germs, lodges in its meshes or network; grows with great rapidity, fills up its tissue, destroys the function of the gland; their growth obstructs the passage of chyle through the convo- luted lacteals which traverse the mes- entery in all directions; besides there is a complete failure on the part of the gland in elevating the white discs of the blood, consequently all the tissues of the body starve and waste. The symptoms of tabes mesenterica are very plain, usually some intestinal disturbance, as diarrhea or cholera infantum; when the abdomen becomes hot, tender, swells with less or more pain in the bowels ; in some cases pain severe, griping, causing the legs to be drawn up towards abdomen; deep red color of lips; angles of the mouth covered with small ulcers, in which the oidium albicans abound; the passages from the bowels resemble chopped spinach, and sour smelling; are very irritating; abdo- men continues to swell or bloat; becomes tense and greatly en- larged ; at the same time the emaciation is fearful; the patient gets down to skin and bone; even the marrow in bones wastes; skin white and wrinkled; intense debility, with rapid, increasing weakness. The abdomen, although intensely swollen, soon be- comes irregular to the feel, lumpy in masses like large eggs at first; when tubercle is active and growing, soft; then a cheesy feel, and latterly calcareous; there may be a tubercular condition Inflammation of the omentum; the tubercular bacilli filling up its interstitial structure. 692 DISEASE GERMS. of lungs, bronchi, or membranes of brain. Its duration is un- certain, depending on the condition of vital force and season of the year. If it appear early in June, the little, sufferer, unless taken to the seashore or country, stands a poor chance of recovery before September; whereas, if it appear in August, there is usually little difficulty in tiding the patient into the cool weather. It may occur at any season, but much more common when the vital forces of the child are depressed by solar heat and city life —season when cholera infantum is prevalent. True, the mesentery may be the abode of numerous germs, but none seem to have the power of holding their position, breeding and going through its different stages of growth, like the tuber- cular bacilli. The treatment of tabes mesenterica requires the nicest tact and good judgment. Bathing twice daily, with massage; diet chiefly essence of beef. . The whole aim of treatment is to keep up vital force and kill the microbe; a good plan to begin on is to keep the intestinal tract aseptic. Several remedies have lately been proposed as intestinal disin- fectants. Naphthaline, which has been recommended by Ross- bach, is very sparingly soluble, so much so that it passes to a great extent unchanged through the whole of the intestinal canal. It certainly destroys the disagreeable odor of the motions in infan- tile diarrhea, but it does not appear satisfactorily to check the disease. Salol is the phenyl ether of salicylic acid. It passes through the stomach unchanged, but in the duodenum it is split up by the pancreatic juice into salicylic and carbolic acid. Although the carbolic acid is set free at the point where its action is wished, yet there is still the disadvantage of its being poisonous, and so betol has been recommended. The constitution of this substance is similar to that of salol, but it splits up into salicylic acid and beta-naphthol, which is more sparingly soluble, and which is less poisonous than carbolic acid, while it is much more powerfully antiseptic. Resorcin, thymol and benzoate of soda are among the antiseptic remedies which sometimes are used herewith success. A disease of the skin, characterized by Molluscum. round elevations of the skin, varying in size from a hemp-seed to a hazel-nut, and marked on the summit by a dark point and a depression in the centre. The color of the skin over them is sometimes translucent, or of a pinkish color. Some of the growths have no black mark and no depression. These little tumors may increase slowly in size BACTERICIDES. ^93 without undergoing any change, or they may ulcerate and dis- charge their contents. There seem to be two kinds: (1) Mol- luscum fibrosum, which consists in an increased formation of the fibrous tissues round the hair follicles ; and (2) Molluscurn con- tagiosum, which is due to an increase in the sebaceous .follicles, so that the contents of each tumor have a cheesy appearance. The usual seats of molluscurn are the back or front of the trunk, the neck, face, and scrotum. Its presence is not attended with Microbe of molluscurn. Section of molluscurn (microscopic^ any constitutional disturbance ; it rhay exist at any age, but is most frequent in children. There are generally several of these small tumors present at the same time. The treatment is purely local; the tumor should be laid open, the contents squeezed out, and the inside touched with caustic; if attached by a thin stem to the skin, the growth may be snipped off with a pair of scis- sors, and the cut end touched with caustic. Some cases are benefited by a course of general alteratives and tonics, as saxifraga, phytolacca, in alternation with glycerite of kephaline, tincture of oats; with a local treatment of either resorcin, ichthyol, or creolin in a solution of gutta-percha. The nails may be absent or imperfectly developed Nails, [onychatrophia). Either of these conditions is usually congenital and associated with absence or imperfect development of hair. Hypertrophy of the nail [onychauxis) may occur and be either lateral, causing ingrowing- toe-nails, or be limited to the extremity of the nail. A special form of hyper- trophy, limited to the centre portion of the nail, is termed ony- chogryphosis. Either of these forms of hypertrophy may be treated by scraping away the nail with knife or scissors. In- growing toe-nail may be treated by scrapmg the nail with a piece of glass until it is very thin, or softening it with liquor of potassae. 694 DISEASE GERMS. Inflammation of the nail (onychia) may occur in a limited form from ingrowing toe-nail, or more extensively as the result of injury. Pus forms under the nail and the latter becomes loose. Certain diseases of the skin involve also the nails in some cases. The most important in this connection are eczema, psori- asis, lichen ruber, ringworm and favus. These may not be easy to distinguish one from the other by having regard only to the condition of the nails, but the accompanying eruption will gen- erally guide to a correct diagnosis. Ringworm or favus may, however, attack only the nails, usually by direct contagion in persons who have to attend on patients suffering from these dis- eases. They may be diagnosed by scraping the nails and exam- ining the scrapings under a microscope after soaking them in liquor potassae. The nails become brittle and split when in- volved in eczema, lichen ruber, or psoriasis. The former affec- tion of the nails begins with pitting, the pits gradually extending until the nail splits longitudinally. After febrile diseases shedding of the nails may accompany the desquamation of the skin which goes on; the nails may also be shed in acute eczema and pityriasis rubra. During a severe illness transverse lines form on the nails; one at the root of each nail. As the nail grows they are carried for- ward until they reach the free edge and are cut away. It is hence possible, on seeing a patient several weeks after a severe illness, to calculate the date of his illness by observing the situa- tion of the lines and taking into consideration the known rate of growth of the nails. ______ Violent paroxysmal pain either in the trunk or Neuralgia, branch of a nerve, due either to a want of nutri- tion in the nerve or to the presence of disease germs or their ptomaines, toxically acting on the same. The causes, then, of neuralgia, are disease, germ-laden blood, anaemia, debility, overwork, struggle, worry, defective nutrition. It divides itself in numerous varieties, according to the special nerve affected, and the cause producing it. The primary indication in all cases is to afford immediate relief of the pain, and subsequently remove the cause. The various antithermic drugs, exalgine, phenacetine, solol, are used with success in all neuralgic affection, whatever their loca- tion may be; the best results are obtained from smafl doses, fre- quently repeated. Croton Chloral Hydrate.—This contains two more atoms of hydrogen than the chloral, and is, properly speaking, butyl chloral, which has the property of diminishing sensibility before BACTERICIDES. 695 producing narcosis. It gives instant relief in facial neuralgia in doses of fifteen grains, repeated, if necessary, after meals or largely diluted with water. The syrup of croton chloral is an elegant and efficacious preparation. It gives immediate relief. To combine the croton chloral with quinine we have still a more effective remedy. Citrate of caffeine is a valuable drug in facial neuralgia, the dose to be such as will give relief of pain. It operates better than guarana—not so rapid and effectual as the croton chloral. Bromo-hydric acid, with or without quinine, of which it is a solvent, operates very beneficially, if the neuralgia is due to reflex causes, in doses of half a drachm upward. Tincture of green root gelsemium, being non-poisonous, only in very large doses, is best adapted to malarial cases, in doses of a half drachm upward. Salicylate of quinine, in rheumatic and gouty cases, is so speedy in its action that it is unnecessary to precede it with any of the above remedies, for in six-grain doses it is usually efficacious within a few minutes. While pursuing this course of treatment in relieving pain, the cause must, if possible, be ascertained and removed. In looking over the list of causes, we must scan them carefully as to anaemia, mercury, malaria, gout, rheumatism, syphilis ; and to reflex causes, as teething, worms, liver, kidney, or other forms of chronic disease. The treatment should in all cases be adapted to each, and if no cause can be ascertained, the patient should be put upon an alterative and tonic course; all through relieving the in- tolerable pains. In these cases the condition of the stomach, bowels, skin, kidneys, should be seen to. Local remedies for the relief of pain are of little utility, but if used should, in all cases, be combined with chloroform, to carry the remedy down to deep-seated parts. Aconite and belladonna are especially valuable in neuralgia of facial nerves ; cinchona, iodine and gelsemium, if of a malarial type; coffee, if due to nervous anaemia; phosphate of quinine, if due to gout; and general treatment as to cause. Improvement of the general health in all cases. Diet very nourishing, raw eggs, animal food, milk. Clothing warm, flannel next the skin. Warm tepid or cold salt-water baths. Friction to skin ; change. Indeed, every- thing to improve the nervous system, and give the patient richer and purer blood, pure air night and day, great cleanliness, and avoidance of all causes. The true aim of treatment is to fertilize the brain by the persistent administration of avena sativa and glycerite of kephaline—thorough reconstruction. 696 DISEASE GERMS. The free anastomosing of the uterine Neuralgia of the nerves with those of the mammae, their Breast. blending or junction with the sympathetic {Mastodynia) in the breast of all highly civilized ladies, renders the nerves of the mammae ex- tremely susceptible of irritation and weakness. They are very liable to suffer from the presence of microbes in the blood, from reflex irritation from the uterus or ovaries; from certain other causes, as occupations; corsets; sitting at benches. Neuralgia exists without any structural lesion. Symptoms.—Pain in the breast of a sharp, lancinating charac- ter, or it may be an aching, wearying kind, but usually like neu- ralgia elsewhere, acute and liable to exacerbations. There may or may not exist a slight puffiness, or swelling, or even an in- crease of temperature of the affected gland ; and even the lobules may feel rather firmer than natural. But it is more generally the case that the gland feels healthy to the touch. When due to uterine or ovarian trouble anaemia is generally prominent. In some women the breasts enlarge and become irritable; suffer from neuralgic pains at and during menstruation. In all cases there is some impairment of general health; nervous dyscrasia; loss of appetite; constipation; leucorrhcea; restless nights; anxiety. In the treatment, immediate relief must be afforded from the distressing pain. For this purpose a combination of the sulphate of morphia and atropia is most effectual; or cocaine subcutaneously; iodide and bromide -of potassa ; belladonna plaster over the entire breast followed with dry heat. As soon as pain is relieved, the cure of the disorder upon which the pain depends ; search carefully for malaria, mercury, syphilis, gout, rheumatism, anaemia, chlorosis; but above all for ovarian and uterine irritation, and the greatest attention to diet of the best; proper outdoor exercise; daily bathing; flannel clothing, and regulated bowels. Alteratives and tonics, embracing ozonized phytolacca, or saxi- fraga, iodide potass, iodide of lime, glycerite of ozone, and keph- aline, sulphate of quinia, cinchona. No application to breasts equal to the belladonna; if the plaster does not produce the necessary anesthesia, put on the chloroform, aconite, and belladonna liniment; the chloroform will carry the belladonna down to the deepest nerve. There should be proper support, but no pressure. The uterine trouble should be seen to, and removed, according to its cause. BACTERICIDES. 697 Young infants, boys, and girls about puberty, are liable to slight neuralgia of the breasts. In some cases there are enlarge- ment, tenderness, and secretion of milk. There must be no irri- tating applications applied, no friction, nor any stimulating ap- plication, the belladonna plaster being usually sufficient. Neuralgia of the auditory nerve is Neuralgia of simply the cry of a nerve for better the Auditory Nerve, and purer blood. It may be brought {Otalgia) about by cold, damp, rheumatism, gout, tubercle, syphilis. When an attendant upon some acute disease there may be fever, but more generally it is unaccompanied by any febrile dis- turbance. The intimate connection of the auditory nerve with the various nerves of the face, especially those supplying the upper and lower jaws, the stomach, liver, uterus, render ear-neu- ralgia common where those organs are out of gear. Ear-ache is thus common, as its causes are numerous and varied. It is easily recognized by the sharp, lancinating pain in the ear, very severe; frequently also shooting through the nervous fila- ments distributed over the side of the head and face, causing much suffering and great restlessness. Treatment.—If it is traced to imperfect performance of stom- ach or liver, an emetic of lobelia, and saline purge ; a carious tooth, extraction; or to any special diseased germ, treat for its destruction; drop one or two drops of mullein oil in the ear. In all cases, and at once, relieve pain by resting the head on very hot pillows of hops, or camomile flowers, or bran, or salt; or the roasted bulbs of onions ; or, better still, garlic. In addition, if very severe, the aconite, belladonna and chloroform liniment should be applied to the side of the face ; cotton-wool, saturated with glycerine, tincture of opium and belladonna in ear. Dur- ing the day, aconite and belladonna, in alternation with quinine, are true stimulants to this nerve, and it is well to give pretty large doses; at night either chlorai or morphia, to procure a good night's rest. In the mean time, treat the case according to the cause, with alteratives and tonics ; and bear in mind that in this painful nerve-cry, that brain-food, or nerve-forming diet, is an essential and important element in the cure. Animal food, eggs, milk, boiled white-fish, oatmeal porridge, cream, and those admirable drugs, glycerite of ozone and kephaline. Nutrition is an important indication in the treatment, so as to prevent a re- currence, especially among the little ones. 698 DISEASE GERMS. Pain, tenderness about coccyx; often Neuralgia of the sharp, tearing, lancinating; is a most un- Coccyx. pleasant form of neuralgia. Most com- {Coccyodynia) mon in women, on account of their great development of coccyx, and above all, in women of high civilization, who have as an index of that condi- tion a sacrum at an angle well verging on to 45 °, and a coccyx most perfect. In women of low civilization the sacrum is nearly straight, and the coccyx almost as rudimentary as it is in man. Causes.—Hurried labor, or insufficient support to the peri- naeum, whereby the nerves of the coccyx receive a shock; blows, falls, fractures, and horseback exercise, etc. Symptoms.—Pain in sitting down or in rising, or in walking, or in defecating. Pain is even more than neuralgic, more than sharp and lancinating ; there is a general soreness. In many cases patient can only sit on one hip. Any movement or pres- sure on the surrounding parts give rise to pain. It is aggra- vated by menstruation, or sexual intercourse. It may be reflex, as in chronic inflammation of uterus or ovaries. It is very chronic in its nature. Treatment.—Remove all sources of irritation about uterus, ovaries, rectum. Place patient upon a general alterative and tonic course of treatment, with the best of food. Keep bowels open with cascara; suppositories of cocaine, belladonna and opium at bedtime, or hypodermic injections. To raise the standard of vitality in the nerves of the coccyx, warm hip-baths, quinine, iron, pulsatilla, glycerite of kephaline, and other nervines, such as musk, valerian. Painful Sitting.—In coccyodynia, as a result of fracture of the hinge-joint, after ossification, in having a child after thirty-five years of age, there is apt to be a laceration of the nerves, and neuralgia established, which gives rise to painful sitting. This is also present in deep-seated inflammation of the genital organs, especially in the uterus and ovaries, so very slight, how- ever, that the patient does not experience uneasiness, only in the sitting posture. Relaxation of the great joints of the pelvis towards the end of pregnancy is very natural; they become loose and juicy, and a considerable increase of motion is observed in them. If the labor is long, the presentation not a good one, or the head of the child large, or instrumental delivery, made with force or violence, there may be a low grade of irritation set up in them. So that there is a morbid loosening, which not only gives rise to pain in sitting, but hopeless lameness. Rest, general alterative and tonic treatment will, in time, effect a cure. BACTERICIDES. 699 Facial neuralgia or irritation of the nerves Neuralgia of the face may be due to any of the mi- of the Nerves crobes which infest the human body; to of the Face. cold, damp, exposure ; to the irritation of the microbe of dental caries. In the treatment of all forms the cause must be removed, and the microbe annihilated ; if due to the rheumatic germ, manaca ; salicylate soda in acetate of ammonia; colchicum and quinine; if due to the microbe of syphilis, chloride of gold et soda, saxi- fraga; if due to cancer germ, Chian turpentine; if due to*the malarial germ, com. tincture of kurchicine, etc. To procure anesthesia of facial nerves, aconite, belladonna, ammonia, phosphate of quinine, as a local remedy in all cases, concentrated ozone with chloroform. Often due to gravel, or disease-germs, Neuralgia of the like malaria ;■• to drugs ; to suppression of Kidneys. an eruption ; in the left kidney to poisons {Nephralgia) of rheumatism ; gout, cold, wet. It is attended with most excruciating suffering; sharp lancinating pains, coming on suddenly, violent in intensity, relieved by pressure, never aggravated by it. If due to gravel, it may be continuous, beginning at the time it com- menced to pass into the ureters, and continuing till it reached the bladder. The pain is paroxysmal in its character, not only experienced in the loins, but extends to the groin, thigh, or abdomen, causing retraction of the testicle in the male, and irri- tation of ovary in the female. If the paroxysms are severe, they may be accompanied with nausea and vomiting; a small, wiry, feeble pulse; profuse perspiration ; prostration, with a desire to pass urine, and an inability to do so. When concretion, if due to that, reaches the bladder, pain suddenly ceases ; if due to other causes, it may continue till the cause is removed. Its location (relieved by pressure), character of pain being paroxysmal, with other symptoms of kidney irritation, are always important land- marks. In the treatment, alcoholic vapor-bath ; external warmth over kidneys; if stomach is so irritable as to cause everything to be rejected, apply mustard over it, and give a large dose of tincture of green root of gelsemium ; if vomiting still persists, hypo- dermic injection of morphia, preceded by the inhalation of a few drops of chloroform. Then apply belladonna plaster over kidneys, and depend on quinine and gelsemium internally. In some cases aconite and belladonna answer well, with dry cups 700 DISEASE GERMS. and lobelia fomentations. If due to the retrocession of an erup- tion, compound tincture serpentaria or jaborandi; if due to rheu- matism, alkalies, as nitrate of potassa and cream of tartar, fol- lowed with nitro-glycerine; and acetate of ammonia and salicy- late soda. Each case managed as to its cause. Neuralgia of the nerves of the pleura Neuralgia of and of the intercostal are generally Intercostal Nerves, due to the bacillus amylobacta, more {Pleurodynia) rarely caused by the microbe of syphilis. Associated with the presence of one or both microbes, we find all that class of patients suffering from great impairment of the general health, with mental and physical prostration—phosphates and chlorides in the urine. The recognition of the pain being non-inflammatory coming on, leaving suddenly but intensely sharp and lancinating, fatigue is often an exciting cause. In the treatment, apply either dry cup, or irritating plaster at once—dry heat; then follow with either salol or manaca, or salicylic soda in acetate of ammonia; these three remedies are most efficacious. Follow up with comp. saxifraga and phytolacca, tincture of oats, glycerite of kephaline. Stiffness, soreness, cramp, or pain in the vol- Neuralgia ot untary muscles of the body, may be due to Muscles. various -causes : for example, in young persons {Myalgia) of rapid growth, persons in whom the bones grow faster than the muscles, the muscles and tendons become stretched, and the individual suffers from what is termed growing pains. These are often quite severe, and in- volve both the fleshy part of the muscles as well as its tendons, either the centre, or where it is inserted into the bone, or both. It is often due to a strain, lift, over-exertion, and involves the muscles of back, chest, abdomen, arms, or legs. It is also a symptom of a shock from cold, great nervous prostration, and is thus prominent in certain diseases, as fevers, inflammation, partu- rition, rheumatism, scurvy, tuberculosis, cancer, chlorosis, leuco- cythaemia, dysentery, diarrhea, prolonged lactation, exhausting maladies generally, and spermatorrhoea. Symptoms.—Pain is the chief symptom; and this in its degree and intensity bears a direct ratio to the amount of debility that BACTERICIDES. 70I is present. Where it depends on too rapid growth of bone in young persons, they seldom complain of it in the morning after a good night's rest, but comes on after exertion, and gradually increases till night. In the case of the masturbator, or those suffering from seminal losses, pains in the morning, and rather wear off during the day ; whereas in case of disease, mostly an aching all the time. The pain in all cases, however, is aggra- vated by movement. General health in all cases is poor; skin cool, pulse natural or depressed; appetite good, clean tongue. In bad cases there may be night-sweats, loss of appetite, im- paired digestion, constipation, no vigor or energy, inability for work, severe mental depression. Treatment.—The principles of treatment will be modified by the cause, but all cases require good nourishing diet, as animal food, boiled fish, oatmeal porridge, cream, raw eggs, fruit, vegeta- bles in abundance; tonics, as cinchona and mineral acids ; sul- phate quinine and aromatic sulphuric acid, quinine, iron, hy- drastin, nux pill. Rest for the affected muscles, by splints or otherwise. Massage to be performed twice daily; begin with half-an-hour treatment, and increase length to two hours, if pa- tient has means to carry out treatment. In the massage treat- ment, bathe a limb with soap and water ; dry; use dry hand until there is a glow of warmth ; then shampoo, rub, knead, and otherwise manipulate with warm olive oil; then another limb in same manner until the entire body is massaged. Electricity can follow if case is bad, or in a hurry to get well. An intense form of neuralgia, character- Neuralgia ized by acute pain following the course of the of the great sciatic nerve extending from the sciatic Sciatic Nerve, notch down the posterior surface of the {Sciatica) thigh to the popliteal space, and often along the nerves of the leg to the foot. The causes are a depression of the sheath of the nerve, by cold, damp, sprains, etc., and blood charged with the bacillus amylobacta circulating through the weakened tissue, giving rise to thickening and compression of the nerve. Sciatica, properly speaking, is not an affection of the nerve, but its sheath, which, under the irritation, becomes thickened and contracted, compressing the nerve, and thus causing the excru- ciating pain in movement, or numbness in the leg by compression. Sciatica, then, is not, at least at first, neuralgia of the nerve, but inflammation and thickening of its sheath, and this thickening produces a mechanical condition which presses the nerve, and thus gives rise to the neuralgia. 702 DISEASE GERMS. In the treatment we must pursue a course of treatment very similar to rheumatism. Salicylate soda and acetate of ammonia, salol, manaca, cascara sagrada lozenges, etc. One of those remedies should be admin- istered ; if it fail to .give relief, then try a mixture composed of equal parts of tinctures of aconite root, colchicum seed, bella- donna and actia racemosa. Mix. Six drops every few hours till relief is felt, or use a hypodermic injection of morphia and atropia. Locally, along the course of the nerve, paint on and confine concentrated ozone—its action is prompt, much superior to men- thol, acupuncturater, or dry cups. Exalgine has been very highly recommended. If case resists ordinary treatment remedies then it should be placed upon iodide potass in the compound saxifraga. A temporary irritation of a special Neuralgia of nerve or nerves often gives rise to a Special Nerves, spasmodic and involuntary contraction {Cramps) of one or more muscles, attended with rigidity and great pain ; most common in the muscles of the lower extremities, as the large muscle of the calf of the leg; but it is very apt to affect the muscular fibres of internal organs, as the stomach, intestines, bladder, uterus, pharynx. The true cause is a weakness in the nerves that supply special muscles, and those weakened nerves crying for pure or better blood; so that disease-germs in blood, poverty of blood, gout, rheumatism, metals in blood, the bacteria of dyspepsia, the cholera germ, etc., besides pressure on nerves not infrequently causes it, as the head in labor, etc. Swimmers often attacked, and common cause of drowning. Symptoms.—The nerves of a muscle, weakened, irritated, cause the contraction, which gathers the muscle into a knot, apprecia- ble to the touch and often to vision, when external. Pain is not only severe, but agonizing. The cramp, or contraction, or spasm, may last a few seconds, minutes, hours, and leave the part tender and patient prostrated. The same nerves of a muscle may be affected over and over again, if its vital integrity is not restored; or if due to a poison, it may affect different muscles, as in cholera, where all the muscles of the body are in a cramp. Treatment.—To relieve the cramp immediately, administer either chloroform or the antispasmodic tincture, in twenty or thirty-drop doses, in warm boneset tea, every few minutes till re- BACTERICIDES. 703 lieved. Then search for causes, as debility, anaemia, indigestion, constipation, lead, tin, zinc, gout, rheumatism and other blood diseases, and remove them with alteratives and tonics. Best of food; pure air. To raise the tone of nerves, quinine, glycerite of kephaline, aconite, belladonna, friction, shampoo, massage, stimulating liniments, baths. When the nerves of the testes are irri- Neuralgia of the tated by the microbes of syphilis, rheu- Testes. matism, etc.; or weakened, exhausted, or drained out by venereal excesses; or when the ejaculatory ducts become clogged, or stopped up, affording no outlet for for semen secreted, and the testes suffer compres- sion; or there may be a shock from mechanical irritation— in which condition the nerves suffer a partial death, neuralgia supervenes. If due to rheumatism, acetate of ammonia and salicylic acid ; manaca; colchicum and quinine; tincture black cohosh, etc.; locally, dry heat with camomile flowers or bran. If due to syphilis, iodide and bromide of potassa; saxifraga, phytolacca; chloride of gold et soda. A poverty of nerve force. May be general, Neurasthenia, involving the whole body, or it may be local, affecting an organ. The present work aims to increase our knowledge of the origin and phenomena of disease-germs; how normal living matter, concerned in the nutrition of the body, can be changed, altered, or degraded by conditions adverse to life, into diseased or malig- nant living matter, of a special kind, genera and species, each capable, in a proper medium or fertilizing fluid, of reproduction and independent existence, the powers of growth being prodi- gious; how such diseased living matter is contagious and infec- tious ; that living, breeding, organized germs are no phantom but a living enemy ; how such conditions can be averted by maintain- ing a high standard of health, of vital force and rigid enforcement of the laws of sanitary science; and how all can be obliterated by an antiseptic treatment. In neurasthenia or nervousness, there is a degradation of the primary molecules of nutrition of brain and nerve tissue into the disease germ; in all deviations from health, or mental vigor; in all states of phrenal incapacity; in all nervous affections, even ■in nervous headache; in trance, natural or artificial; in all grades 7°4 DISEASE GERMS. or degrees of insanity, mental aberration; in epilepsy, inebriety, cholera, etc.; evolution and dissolution, or a change of living elements, preside over all the phenomena of nature. For all practical purposes, the definition of neurasthenia may be thus given : It is a condition of nervous debility or nervous- ness ; a chronic morbid condition of the nervous system ; a prac- tical death of that tissue, the basis of which is an impoverish- ment of nerve force; a starved phrenal state, in consequence of which there is a liability to quick exhaustion and an impera- tive necessity for frequent supplies of force; there is beside in this state a lack of inhibitory or controlling power, both physical and mental; a feebleness, an instability •; '#?:.•'•'V?\ (y'ng coiled as to enable the observer with a small mag- nifying glass to determine the sex of the parasite. The number of the larval trichinia that may exist at one time and in one case is enormous, being estimated at twenty millions. 7«2 DISEASE GERMS. Sexually mature female trichinia spiralis magnified. A single trichinous pig, if its flesh is eaten without being sub- jected to a heat of 21 2° F. for some time so as to destroy the vitality of the larval trichinia, may establish a local epidemic of the disease. Suppose an animal was fed with flesh containing the larval worm and is killed a few days afterwards, there will be found in the intes- tines a large number of minute worms ; on closer examination, the larger ones are the female, and the smaller the male. On the second day after being swallowed, the trichinia attain full sexual maturity, and in six days the females contain innumerable perfectly developed and free embryos. The female is a slender worm in length from one-eighth to one twelfth of an inch. The anterior end presents a beaded ap- pearance, from which the intestinal canal proceeds ; the posterior portion three-quarters is mainly occupied by the reproductive organs, which are filled with eggs and free embryos in various stages of development. When the embryos attain maturity they pass out of the genital aperture and begin life on their own account. The ac- companying diagram shows the em- bryo in various stages of develop- ment. The males are less numerous, and shorter lived than the females. How pigs acquire the trichinia is unknown ; beet-root, earth worms, moles, rats, have been suggested as their infectors, but nothing is really known how widely this parasite is diffused through the animal kingdom. By ingestion of food of rare pork, underdone sausages, and flesh in which the larvae of this worm are present, the following symptoms would be likelytoputin an appearance in Sexually mature male trichinia spiralis magnified. fpw hfllirS after being swallowed—loss of appetite, nausea, vomiting, with great languor, lassitude, debility — general undefined prostration. The embryo of the trichini. BACTERICIDES. 783 These symptoms last about a week, when pain, stiffness in all the joints and muscles supervene; then oedema of the face, re- peated rigors, fever, with high temperature, and frequent pulse -y great thirst, nausea and vomiting continue. Constipation with a most offensive diarrhea, copious fetid perspiration. The tongue exhibits great gastro-intestinal irritation. Synchronous with the trichinous brood migrating from the stomach and bowels into the muscles, the second stage com- mences when the patient lies on his back like one paralyzed; pressure or any attempt to move the swollen muscles is attended with most excruciating pain ; sleep is impossible, even respira- tion is difficult and prolonged ; the oedema of the face disappears, which is replaced by a swelling of the feet, which proceeds up- wards to the body. The tongue still presents the appearance of one with gastric fever, and diarrhea often prevails ; urine scanty, loaded with lithates. In about the fourth week of the disease, the trichinia may be regarded as having permanently settled and of having completed their destructive action on the muscles. Now begins what is termed the third stage, which is character- ized by extreme exhaustion, the gastric symptoms abate, appetite returns ; in favorable cases, the muscular pains and swellings gradually diminish and disappear; while in some cases this third stage is the most critical, the diarrhea is often severe, and accom- panied with tenesmus ; involuntary discharges of faeces and urine; pailor of the skin, which becomes enormously distended with fluid. Various complications very apt to set in as aphonia, pleurisy, pneumonia, peritonitis, etc. The fourth and last stage, that of convalescence, takes place about the fifth week, sooner or later, and may last a few weeks or even months: No definite line can be drawn. Death may occur at any time. The diagnosis of the disease rests chiefly on the history of the case, the gastro-intestinal irritation when the parasite burrows through the mucous coat of the stomach and bowels, then it bears a strong resemblance to cholera, or typhoid fever; the muscular pains resemble rheumatism; the oedema or swelling, Bright's disease. No reliable treatment can be laid down, as poor success has attended the use of our best remedies. More recently an effort has been made to destroy or sterilize the parasite by the use of germicidal remedies. Such bactericides as glucozone, naphthaline, salol, would be of some utility if the parasite were located in the bowels ; but when encysted in the muscles, they fail to reach it. 7H DISEASE GERMS. The human body may be infested with Parasite. three different kinds of lice; the head-louse, [Pediculosis, Lice) body-louse and crab-louse. Uncleanliness, insanitary states, perverted nutrition of skin, bad food, filth, etc., give rise to a depraved con- dition of skin, which render it a chosen pasture-field, or seat, for the hatching and breeding of the larvae of those parasites. The three species are oviparous, the eggs being known as nits ; sexes distinct; young are hatched in five days, and in eighteen days are capable of reproduction. The numbers of eggs laid are im- mense. Each of the three has its favorite location or abode. On the head they are very easily got rid of by daily washing and using vaseline or ozone ointment as a hair-dressing; on the body, it should be thoroughly bathed and lightly sponged with tincture of lobelia. The crab-louse, on pubes, axillae, eyebrows, may be got rid of at once, by washing thoroughly, drying off and damping the affected parts with a lotion of two grains of corrosive sublimate to an ounce of water. The stavesacre, or cocculus ointment, is excellent. Peroxide of hydrogen makes an exceedingly efficacious remedy for all varieties. To destroy the larvae on head, body, pubes, warm vinegar is very efficacious, applied morning and night. Bedclothing, and also body-linen, should be boiled and subjected to a strong heat with hot iron, and all due precautions taken for thorough de- struction. Itch or psora, a contagious vesicular dis- Parasite. ease of the skin, attended with great itch- [Acarus Scabiei.) ing, which is increased by warmth and use of stimulants. All parts of the body, ex- cept the head are liable to be affected, but the most common seats of the disease are the wrists and hands and finer portions of the skin between the finger. Commences as a papular, vesicu- lar, or pustular eruption, with an itching sensation, which, upon minute examination is found to proceed from a minute conical vesicle, while the adjacent portions of epidermis present a more scaly appearance than natural. The cause of this condition of the skin is due to the presence of the acarus scabiei, a microscopical animal parasite, which bur- rows within the epidermis and excites the cutaneous vesicular, irritation, and as it is utterly impossible to refrain from scratch- ing, the vesicles get more or less broken, causing patches of ex- coriation. The itch is always communicated by contact, shaking hands, BACTERICIDES.- 7§5 articles of clothing, sheets, blankets, towels, drinking vessels used by a person suffering from the disorder. The female is much larger than the male, and after impregna- tion burrows herself beneath the skin, and forms a furrow or ditch, in which she lays her eggs. The males have itinerant habits and wander about the skin. The diagnosis of the presence of the itch insect is most im- portant. Rupture a vesicle, place the exudation under a micro- scope, and the figures in the annexed cut will be seen. Eczema, prurigo, and lichen are affections most likely to be con- founded with it; but eczema, though a vesi- cular disease, presents round, and not conical vesicles, and at most only a pricking sensation, and nothing like the irritation of the itch ; while pru- rigo and lichen are papu- lar disorders, and are not accompanied by the presence of vesicles, moreover none those disorders are contagious. Different names are applied to it in various sections of the country, as the prairie or lumberman's itch. Treatment.—As it would be somewhat of an expensive cure to resort to vaseline, ozone ointment, glycerine and oil of herga- mot, or the like, which are destructive to the parasite, the cheapest plan is to take two or three pounds of common lard, deprive it of its salt, and stir into it as much sulphur as it will hold, still retaining its properties as an ointment. The patient being bathed all over with an alkaline wash, into, which a handful of lobelia has been introduced, well dried, and the sulphur and lard well rubbed into every part of the body except the head. He must be put in a clean bed, and his contaminated clothes either fumi- gated with sulphur, or else washed with sulphurous acid water. This process is to be repeated every night for three or more nights in succession, on each occasion the body to be thoroughly washed before the application of sulphur and lard. The immer- sion of the body-linen, bedclothes, or ordinary clothing in water, acidulated with sulphurous acid, is sufficient in all cases to de- stroy the larvae and the parasite; so is a heat of 212° Fahr., either in boiling or by hot irons. There need be no detention 50 Itch-mite, i, abdominal view of female itch-mite, magni- fied 65 diameters; 2, one of its manibles, magnified 6s diameters; 3, manible of male sugar-mite, magnified 390 diameters. of 786 DISEASE GERMS. from business ; the first application could be made on a Friday night, and the two succeeding ones on a Saturday or Sunday evening. The following is highly esteemed : Lard, one hundred parts green soap, fifty parts; naphthaline, fifteen parts ; white chalk, ten parts. Mix. The same may be used in acne with success. One of the following formulae may be substituted for the ordinary sulphur ointment: Sulphur flor., twelve drachms; potass, subcarb., six drachms; adipis, nine ounces. Styracis, liq., one fluid drachm ; petrolei, ol. olivae, of each, half fluid ounce; balsam. Peruv., two and a half fluid drachms; spts. sapon. virid., five fluid drachms. Potass, sulphuret, five drachms; sapon. alb., twenty drachms; ol. oliv., four fluid drachms; ol. thym., fifteen drops. Sulphur, sublim., balsam. Peruv., of each, half a fluid drachm; adipis, one ounce. For use especially in the scabies of children: Styracis liquid., one ounce; adipis, two ounces. Melt and strain. Styracis liquid., one fluid ounce; spts. rectificat, two fluid drachms ; ol. olivae, one fluid drachm. Ft. liniment. An affection due to the presence of the Parasite vegetable parasite tricophyton tonsurans. Trichophyton. Most common on hairy parts—especially the [Ringworm.) scalp—but non-hairy parts may be affected; the nails may also suffer. Most common in children, and spreads readily by contagion. Hence common in schools, where it may be conveyed from one to another by means of combs and brushes, hats, towels, etc.; the spores of the psrasite have also been found floating loose in the air of schoolrooms. May last for years if untreated, being especially obstinate when attacking the hairy parts. Ringworm of scalp [T. tonsurans) begins in circumscribed patches, with redness of skin, which becomes covered with slight scales. Tendency to assume crescentic or ringed form. Slight itching. Hairs brittle and break off, leaving bald patches, over which numerous stumps of hair are seen. Ringworm of the beard (7". barbae, T. sycosis) is similar in appearance; often confounded with ordinary sycosis. In many cases of ringworm of scalp diagnosis often obvious at once. The bald patches covered with broken stumps of hair present a marked contrast BACTERICIDES. . 787 Q>=?.o %??o%0c3§ -£,?Op8 to the smooth, perfectly bare " billiard ball " patches of alopecia areata. Absence of discharge or crusts will differentiate from eczema, though either may occur from irritation in long-standing cases. Diagnosis only rendered certain by identification of pa- rasite under microscope. On scalp or beard, extract broken stump with forceps, place on glass slide with a few drops of liquor po- tassae, and examine with quarter- inch—preferably after soaking for a few hours in liquor potassae. Rows of spores of parasites seen on hair and between its fibres, splitting them and making hair appear thicker than normal. Para- site invades the hair bulbs on the one hand and the epidermis on the other, where mycelial filaments may be found between fine epider- mic scales. On the non-hairy parts of the body the affection is known as T. circinata or T. corporis. Slightly raised reddened patches are seen. These are frequently more or less rounded, and may at- tain an inch or more in diameter. Their margin is red and ele- vated ; often papules or vesicles seen on it. The centre becomes yellowish and desquamates. When the eruption attacks the inner side of the thigh, genitals, or perinaeum, it is known as Eczema marginatum, and presents a some- what different appearance. Owing to the natural warmth of the parts and the friction of the opposing sur- faces, the presence of the parasite excites more or less inflammation (eczema), and this may persist even after the parasite has been destroyed. Not merely vesicles, but pustules and crusts are frequently to be seen on the margins of the patches. In T. circinata the presence of the para- site may usually be readily ascertained by scraping with a pen- knife some scales from the inner edge of the outer ring, placing :-; . A microscopical appearance of a section of the skin in which the trichophyton has made its appearance. Tinea capitis. 788 DISEASE GERMS. them in a drop of liquor potassae, and examining them under the microscope. Long slender irregularly-jointed threads ot mycelium are seen and spores occurring singly or grouped. Ringworm of the nails is very intractable and is, fortunately, not very common. The nails become thick, soft, opaque, and assume a yellowish tint. Of all the vegetable parasites of the skin, the trichophyton is the most common; it produces three distinct forms of skin disease, tinea circinata, or ringworm of the body; tinea tonsurans, or ringworm of the scalp; and probably a special form on the face. This parasite gives rise to considerable irritation of the skin, which results in the formation of circular, circumscribed patches of various sizes, slightly elevated above the level of the skin, of a dull red color, and usually covered with brassy scales, while round the edges, there may be found vesicles, and sometimes even pustules. On the scalp, ringworm shows itself as one or more circum- scribed patches of a grayish or slightly ruddy color. The hair of the affected parts is short,. lustreless, easily drawn out, breaks readily, and the extremi- ties are ragged and uneven, the skin is covered with numerous thin white scales, and occasion- ally with crusts. In all these three situations the trichophyton presents simi- lar microscopic appearances. The parasite is frequently met with in both children and adults of both sexes, wherever over- crowding exists, schools, chari- ties, reformatories. It is highly contagious, but yet requires a suitable soil for its growth and development. The most com- mon methods of transmission are close contact, brushes, combs. sponges, towels, clothing, domestic animals, as dogs, cats. The indication for the relief of the disease is the destruction of the parasite, and the improvement of the general health of the individual. Prominent among the parasiticide remedies may be enumer- ated ozonized sulphur water, ozonized boroglyceride; solution ot hyposulphite of soda; tincture of iodine ; iodized oil; ^.solution of thymol in chloroform ; ointments of iodine of sulphur; ozone ointment; ichthyol; chrysarobin ; gutta percha, dissolved in chloroform with resorcin added and painted on ; iodine crystals BACTERICIDES. 789 dissolved in oil of tar. Among the most recent and effective remedies in ringworm is the tincture seigesbeckie orientalis; equal parts of this drug and glycerine rubbed into the affected parts morning and night, immediately kills the spores. The parasite breaks up into isolated dead patches, and these speedily peel off, leaving the skin underneath slightly red, which disap- pears in a few days. Older remedies are chrysophanic acid dissolved in chloroform; may be painted on and will soon prove effectual. In ringworm of hairy parts, difficulty arises from impossibility of reaching seat of disease. Applications to surface of scalp do not reach roots of hair. To facilitate treatment, cut hair short; in severe cases, shave. Then apply some parasiticide regularly once or twice a day, Most authorities recommend frequent washing of head with soap and water ; others oppose. Various opinions of value of epilating broken stumps. Local remedies innumerable. Following amongst most useful:—Unguentum hydrargyri am- moniatum, unguentum hydrargyri oxidurn rubrum, unguentum acidi chrysophani, ten grains to one ounce ; hydrargyri olea- tum, five or ten per cent, solution in oleic acid, sulphurous acid, U. S. P. acid used as a lotion with equal part of water, head being covered with cap to prevent evaporation, salicylic acid as lotion dissolved in rectified spirits, twenty to forty grains to one ounce of acetic acid, painted on with brush. Any or all of these may be tried in succession in severe cases. Spontaneous cure sometimes by formation of kerion, which is the name applied to a boggy swelling formed by inflammation of the hair follicles. Resembles subcutaneous abscess. Parasite perishes in inflamma- tory process, and, not unfrequently, some destruction of hair- bulbs also occurs. In chronic cases it may be desirable to pro- duce kerion artificially by painting scalp with croton oil or other irritant, watching the process carefully. No case of ringworm of scalp must be pronounced cured till absence of the parasite proved by careful and repeated microscopic examination. If am, left it may spread again over the whole scalp and be as bad as ever. After the parasite has been completely removed a scurvy condition of the head is frequently left. This is a cutaneous affection occur- Parasite. ring chiefly upon the trunk, neck, upper Microsporon Furfur, and lower extremities of adults of both Tinea Versicolor) sexes, characterized by irregularly reticulated, macular lesions, yellowish °r brownish in hue, over which the epidermis may exfoliate in delicate scales, owing to the presence of the cryptogamic plant, {he microsporon furfur. 79° DISEASE GERMS. In warm weather it grows most luxuriantly, in beautiful, mot- tled, copper-colored patches over a portion or the entire body, which is covered ; in cold weather it contracts and often disap- pears. This vegetable parasite makes its habitation in the pigmentary gland. Hidden in its recesses, below the cuticle, it is difficult to reach with antiseptics. This also renders its capabilities for con- tagion far inferior to other vegetable parasites. The disease is propagated by scales or spores, prevails in mid- dle life, irrespective of social position and personal cleanliness. It is easily recognized by the microscope, by the history of the case, by the fact that it never invades hairy parts; avoids light and air, its characteristic yellow, or fawn-tinted color, the exfoliation of the epidermis, which it excites by its superficial pene- tration of the outer layer, produc- ing a mealy, brawny, flaky, or roll- like exuvium, will enable any one to diagnose it from chloasma or liver spot. The germ of syphilis upon the skin may be mistaken for this plant, but the microbe of Photograph of the micrococcus versicolor syphilis encroaches anywhere, is —small cocci which are seen form in- J r ,•/-/- , r descent colonies—growing in the form of more diffuse, creeps over the face, yellowish beads. j^^ {^ ^ ^^ js j;^ {q ^ either adenopathy, alopecia, mucous patches, palatine hyperaemia, polymorphic tendency. The nature of the sensations, with its initial growth copper-color patches might be due to liver torpor. The destruction of the microsporon furfur is not invariably as successful as it might be, owing to its location in the pigmentary gland, below the cuticle. In order to be successful this must be either weakened or removed. For this purpose, for three or four successive nights, the patient should be immersed in a hot bran bath, in which abundance of bicarbonate of soda has been dis- solved—he should be thoroughly macerated, and subsequently well rubbed or scrubbed with a flesh brush, then dried and bathed with cider vinegar, in which boroglyceride has been dis- solved. This is often successful in an entire rooting out of the parasite. If this is not efficacious, proceed as above, but try half an onnce of the hypophosphite of sodium dissolved in a quart of water—this also often removes the last vestige of the germ. Other parasiticides, very popular, are ozonized sulphur water, sulphuret of potassium ; boroglyceride combined with resorcin ; iodine, chrysarobin. BACTERICIDES. 791 In all cases the inner clothing should not be worn after the bathing and application, until it has been immersed in water acidulated with sulphuric acid. When untreated, the parasite, after quite a lapse of time, undergoes spontaneous exfoliations, the fungus fails to find in the epidermis the nutriment upon which it thrives. A contagious disease of the scalp, Parasite. due to the presence of the vegetable [Achorion Schonleinii, parasite achorion schonleinii. The Tinea Favosa.) scalp invaded by this parasite presents the characteristic appearance of a honeycomb in the form of small, dry, yellow, cup-like crusts, OuS. racking tne Achorion schonleinii; a, spores ; b, r, sporophores. affected part for a few consecutive nights with boroglyceride paste, or chrysarobin is very effectual in an ointment, or sulphur in almost any form, ozonized sulphur water; or thymol dissolved in ozone ointment, or painting it over every third day with iodine crystals, dis- solved in oil of pitch, or rhinacanthin rubbed up in petroleum ointment; ichthyol also is of great service, naphthaline. Tinea sycosis, or barber's itch, due Parasite. to the presence of the fungus tricho- [Fungus Trichophyton) phyton in the beard of the adult. This parasite is readily recognized by its location, its fig-like appearance, by the irritation or itching. Its presence gives rise to the presence of macula, papula, vesi- cular, pustular or tubercular lesions—it has greatest growth in devitalized individuals and blonds ; extremely contagious. The chin and beard are its favorite locations. 7Q2 DISEASE GERMS. In the destruction of this parasite, the patient should for sev- eral consecutive days macerate the eruption with olive oil, then shampoo it effectively, that is, wash off all crusts, with castile soap and water as hot as can be borne; this tends to reduce the inflammation of the perivascular spaces, removes the incrustation. Beard to be shaved, and a saturated solution of boroglyceride should for several minutes be applied to the entire beard and face, followed by some one or other of the following ointments, to be kept ap- plied over night: either the iodide of sulphur ointment; or thymol; or ichythyol; naphthaline, chrysarobin, resorcin, sul- phuric acid; gunpowder made into a paste by the addition of lemon juice, and applied and reapplied. More recently equal parts of tincture of siegesbeckie orientalis and glycerine, The fungus trichophyton of barber's itch. rubbed Well into the parts affected, have proved wonderfully effective in destroying the germ, and promoting a rapid cure ; although any one of the above is brilliantly effective in destroying the fungus. In the morning, whichever application is used should be washed off and the boroglyceride wash reapplied ; when dry the anti-microbe powder should be freely dusted on during the day, and in the evening a re-application of the hot bathing, borogly- ceride and the selected ointment. This should be repeated for several weeks after all appearances of the parasite has ceased to exist. The following formula.- are used by some: If the beard is not shaven, first wash with an antiseptic soap and apply night and morning. Ung. simp., 20 parts ; resorcin, 2 parts; hydrarg. bichlor., 0.05 part. If the beard is shaven, a zinc paste, viz.: Ung. zinc, benzoat, 90 parts; terras silice;u, 10 parts maybe substituted for the ung. simp, in the above prescription. If the disease is very superficial it may be sufficient to touch the part with sublimate or resorcin pencil, or use a spray of: Resorcin, 5 parts ; hydrarg. bichlor., 0.05 part; aq. cologniensis, spiritus, of each 50 parts; ol. ricini, I part. Wk? BACTERICIDES. 793 When the disease is deeper and nodes have formed, the follow- ing plaster mass should be applied and bound down : Empl. hydrarg., 10 parts; ac. carbolici, 10 parts; sublimate, i part. Epilation should be practiced if pustulation has occurred, but not otherwise. A high standard of health is proof against this and other micro-organisms ; if it were not so the frequenters of our barber shops would be more generally affected. An eruption consisting of bullae (blebs, blis- Pemphigus. ters) of varying size, seated on a more or less erythematous base. Some vesicles may also be present, intermixed with the bullae. The eruption is often preceded by itching and tingling, and may be accompanied by some fever. The bullae are more or less flattened, frequently irregular in contour, and may reach the size of an egg. They contain serum, which, clear at first, soon becomes opaque, and contains pus. The serum is effused into the malpighian layer, where it accu- V ^ fi mulates between the filaments uniting <;>. ^"^ the cells, but finally makes its way to the ^j\^A#nW£ granular layer. The bullae are bounded ^^VXVC^ ^ externally by the horny layer of the epi- dermis. In a few days they begin to bo°J..,:$ lessen in size. Many burst, allowing escape of their contents; the outer epi- Bacteria of pemphigus. dermal coat of bullae then drops off in a few days, leaving reddened patch, on which epidermis soon forms again. The attack may be acute, and terminate in a few days in spontaneous recovery, or successive crops may occur, and the eruption thus be prolonged for days or weeks (chronic pemphigus). Pemphigus may occur on any part of the body; the syphilitic form (syphiloderma bullosum) is more com- monly seen on the palms and soles. It may occur at any age. In new-born children it is termed P. infantilis, and may proceed to gangrene, in which case it is generally rapidly fatal. Repeated attacks are not without danger, especially in old people, or where an extensive portion of the surface is attacked; in such cases patients may emaciate, and be reduced to a very low state. P. foliaceus is a rare and peculiarly obstinate form, which may last for months or years. It is said to be incurable. Successive crops of bullae form and burst, but after the detachment of the epidermis in flaky scabs it is not reformed, but a raw surface 794 DISEASE GERMS. remains, to which fragments of epidermis may be seen adhering In cases of long standing, almost the entire cutaneous surface may be affected, and but little epidermis be seen remaining. The patient passes into a hectic condition, and the eruption usually ends fatally. Another variety of pemphigus occurs on the hands (occasionally on the feet) and is known as cheiro-pomphylyx. It is termed dysidrosis, and is due to obstruction of sweat-ducts. It is now regarded as a neurosis. Consists of vesicles as small as a pin's head, or larger blebs, and makes its appearance on or be- tween the fingers. The vesicles or blebs have a peculiar translu- cent appearance, and burst in a few days. All varieties may be met with in either an acute or chronic form, and all characterized by the production of a series of pea or egg-shaped vesicles, variable in size, the smallest being about a pea, the largest that of a large egg, irregularly distributed over the surface, from a few to some hundreds, filled with serum or blood, loaded with bacteria. The causes which give rise to this rare cutaneous affection are poverty of nerve force, nervous prostration or debility, mental worry, exhaustion from sexual excesses, the presence of syphil- itic germ in the blood, the empirical use of the mercurial preparations, vis- ceral disorders, impairment of nutri- tion, squalor, filth, uncleanliness. The presence of such prodigious herds of the bacteria in the blood and their migration in colonies to the skin is usually attended with either con- tinuous remittent or intermittent py- rexia, appearing with each crop of vesicles. There are always headache, .pains in the back, gastric and intestinal disturbance. The contents of the bullae or blebs consist almost entirely of bacteria ; arranged in chaplets or joints interspersed through it are cocci. Like all morbid states dependent on the presence of a disease- germ, it is highly contagious and infectious. Bacteria are ubiqui- tous, ever present in atmosphere in a range of fifty feet around the patient. The treatment is essentially constructive and germicidal. The stomach and bowels merit attention ; diet should be rich, gener- ous, blood-forming; such remedies as iron, oats, quinine, nux,. Microbe of pemphigus syphiliti ;a. BACTERICIDES. 795 matricaria compound are unexcelled; the latter remedy is deemed the best, as it destroys the micro-organism and stimulates a re- newal of vital force. The sulphide of zinc in alternation with ozonized sulphur water are the best remedies to give internally. The syphilitic form requires the general treatment for syphilis. Locally puncture the vesicles with a fine needle, and with a sponge saturated either with a solution of boroglyceride or resor- cin, wipe up the germs as they exude from the puncture. Then all over the collapsed bleb, dust on the anti-microbe powder. The aim of all treatment is to raise the standard of vital force, so as to prevent further degrada- tion of bioplasm into a disease- germ. When the microbes die in the vesicles, they dry up into black crusts or scabs, become flat- tened, then the affection re- ceives another name—rupia. Those crusts, after a time, may fall off, leaving deep, perforating sores, which may heal, or again fill up. If the case is properly appreciated, by a reconstruction of vital power, they heal up rap- idly. They receive different names, according to their size, consistency, and tendency to eat in, as rupia simplex, when the crusts are thin, small, superficial; if crusts are large and prominent, rupia prominens; if deep, extensive and still penetrating, rupia escharotica. Horse riding causes com- Perineal Pressure. plete impotence in the {The Disease of the Scythians) strongest and most daring men, with wasting of the testes, dropping of the beard, and change in the pitch of the voice. If, then, these sad results are the outcome of immoderate equitation, where there are an extensive seat and a stable foot rest, and where the adductor muscles of the thighs are used, what are we to look for, where our boys of ten and upward spend the greater part of their own time riding bicycles, and get 796 DISEASE GERM>. over thousands of miles in the year, perched upon a saddle no bigger than the hand, which conveys every jolt of the machine to the body; where the jolts are a thousand times more numerous than those experienced by the equestrian, and occurring with- out any approach to rhythm, are conveyed unexpectedly to the person ? Cycling is doubtless a very healthy and pleasant mode of ex- ercise when used in moderation, but now that tens of thousands of our boys ride bicycles daily, and " get up records " of thous- ands of miles in the year, it may not be out of place to point out some alarming evils which are likely to arise from this abuse of an otherwise healthy pastime. Some time ago it was pointed out that obscure nervous complaints would probably be devel- oped by the continual jarring, the succession of shocks conveyed to the spinal column in bicycle riding; and this, I believe, has proved correct in many instances, notwithstanding " Arab springs " and " rubber cushioned " machines. But it is to some- thing much more serious than this that I would now call atten- tion : it is to the amount of pressure brought to bear upon the perinaeum in growing boys, affecting directly the prostate, the muscles of the bulb, etc., and indirectly the whole generative system. The bicycle saddle is now reduced to the smallest possible limit. It is just wide enough at its posterior part to cover the ischial tuberosities, and it tapers off quickly to a long narrow horn in front, upon which the perinaeum rests. Let us consider the position of the body and limbs when the rider is mounted, and we can then appreciate the amount of body weight which must be thrown upon the perinaeum. In bicycle riding the legs are, when extended, vertical, and the pelvis is flexed upon the thighs or rolled forward. This rolling forward of the pelvis is slight in easy riding, and very marked in fast riding and hill climbing. Now, when the body and pelvis are bent forward, the ischial tuber- osities are raised from the saddle, and the whole weight of the body, save what is transmitted to the pedal by the then extend- ing leg, is thrown upon the perinaeum. It is not much of the body's weight that is conveyed to the pedals. In easy riding on the level the weight of the limb from the hip down is sufficient to move the machine, and in hard riding the extra pressure if gained not so much by throwing the body's weight upon the pedals as by pulling upward on the handle-bar, and so further increasing the pressure of the body upon the saddle. But even admitting that the pressure upon the perinaeum be only a few pounds, I hold that it must be injurious in the extreme, for were the pressure nil when riding upon a perfectly plane surface, it BACTERICIDES. 797 must at times be considerable when the machine is ridden over an unequal surface such as is afforded by our best country roads. Let those who talk of " the beautiful gliding motion of the bicycle " try to play a game of billiards after a ride of twenty miles, and then explain where all their " shakiness" comes from if their motion has been that of a skater. Now this pres- sure on the perinaeum, whether it be continuous and increased at every jolt, or whether it be made up of jolts alone and be nil in the almost imperceptible and irregular intervals, must be injuri- ous, more especially to growing boys. It must cause irritation and congestion of the prostate and surrounding parts, tend to exhaust and atrophy the delicate muscles of the perinaeum, and also call attention to the organs of generation, and so lead to a great increase in masturbation in the timid, to early sexual indulgence in the more venturous, and ultimately to impotence in both. The deplorable effects of self-abuse in Perversion of the early life, and excessive indulgence in Sexual Sense. later years, give rise to seminal weak- ness, varicocele, nocturnal and diurnal emissions, impotency, sterility and phrenal bankruptcy. The prevalence of self-abuse, its widespread and destructive effects on mind and body, its degrading and ravaging effect upon the vital elements of nature, render the subject one of vast importance to our well-being as a nation. Its victims are found among the very young, before and after puberty of both sexes, in every vil- lage, town, and city, and, unfortunately, the religious, or so- called virtuous, are most addicted to it. The perversion of the sexual sense is much on the increase. Our entire population, with their nervous constitutions and ex- cessive nervous susceptibility, leading to cerebral debility, tend to induce the habit of mental masturbation, as well as both natu- ral and unnatural excess in sexual indulgence. The creation of a purely nervous temperament in the people of our country, under their special mental strain of tension, operates disastrously upon the procreative faculties; very different indeed from the well-balanced temperaments of those who live out of doors and work with the muscle more than with the mind ; these usually are strong, healthy, and are not, as a rule, tormented with sexual desire in the same degree as the sensitive and nervous. A perversion of the sexual appetite is the result of excessive nervous development. This perversion is a true monomania, a positive insanity, manifested in society under what is termed crankiness. 798 DISEASE GERMS. Some inherit this effeminacy, this deterioration of brain, this wiping out of the typical fissures of thought. Some come into it as soon as the sexual passion dawns ; some acquire it as the result of sexual debility. A perversion of the sexual appetite is usually brought about through excess, or masturbation, partial impotency, with cold- ness or indifference to the opposite sex. Confirmed, long standing masturbators, of either sex, care little for the opposite sex. Excess creates hate for the partners of excess; perverts the sexual sense and the characteristics change ; men become women and women men. When a man suffers from sexual perversion he becomes feminine in his thoughts, ideas, tastes, occupations, dress, even permits his hair to grow, and is silly in his behavior. Disgust follows debauch; repeated excesses create indiffer- ence, fear, and sexual perversion comes on. Many who perish from its effects are supposed to die from other causes, such as consumption, chorea, epilepsy, heart dis- ease, debility and failure of vital powers. It destroys the mind as well as the body. In its milder form, it produces loss of memory, melancholy, evil forebodings, timidity, loss of spirits and loss of energy; tn its worst form, idiocy and insanity. Many maniacs owe their loss of reason to no other cause. In the tabulated reports of every insane asylum are a great number of cases in which the cause of insanity is set down as " Mastur- bation." No affection so completely unfits for either the duties or the pleasures of life. The semen of those who have abused themselves in this way, or who have been guilty of excessive in- dulgence, is like that of old men, often scanty, thin and watery, and when examined under the microscope, the active principle (the spermatozoa) is deficient and imperfectly developed. Such semen cannot propagate healthy offspring. If the spermatozoa are absent, or imperfect, as is always the case if the emissions are frequent, the individual is either sterile, or the offspring is weak puny, deformed and short-lived. It is thus one of those sins which are visited upon the children. This alone is a powerful reason why no masturbator should marry before he has received competent medical advice. But there are other reasons. The sexual powers of such persons are not equal to those duties of marriage which appertain to perfect manhood. Owing to sex- ual debility, connection is imperfect; the emission is premature, so that the wife cannot reciprocate ; or erection is feeble, or will not occur at will, so that connection is impossible. Much do- mestic misery results from this cause, the lives of many a couple are passed in wrangling, misery and discontent from it; many BACTERICIDES. 799 divorces have their origin in it; for if the wife is denied her natural rights, a divorce, or what is worse, unfaithfulness, is a logical sequence; many men have become desperate upon find- ing themselves united to beautiful and lovely women, but in- competent as husbands. It is true, many other conditions or states of the body give rise to emissions—anything that weakens the nervous system, as fevers, affections of the brain and spinal cord. Among some of the other effects of this vice are aversion to so- ciety, love of solitude, specks and spots before the eyes, pain in the back of the head, pain in the back, left side of breast; frightful dreams ; sensations of falling in the sleep ; bashfulness and timidity, especially with ladies; palpitation of the heart ; flushes of heat; chilly sensations; rush of blood to the head; restlessness; cold feet; at times voracious appetite, at others, loss of appetite and indigestion ; dryness of the skin ; pale, sal- low complexion, with dark rings under the eyes; pimply erup- tions and blotches on the skin ; dimness of the eyes ; indisposi- tion to study, exertion, or to concentrate the faculties on one subject for any length of time; a constant dwelling on their disease in the mind ; often causeless anxiety and dread of death ; despair of recovery, etc. Indeed, young men are inclined to worry, fret, become hypochondriacal and mentally depressed. The explanation is, the great sympathetic is at fault, this nerve has been perverted; the genital apparatus, brain and stomach are in constant telegraphic communication. In view of the intricate mechanism of the damaged parts, the habit having the effect of paralyzing and blighting vital organs, self-treatment should in all cases be avoided. This affection, above all others, needs the experience and skill of an honest medical adviser in whom the patient can place perfect confidence. The worst results come when patients treat themselves, and all the time read and worry about their disease. The sexual sense, whose origin is in the base of the brain, is the last (together with the reproductive organs, the power to reproduce species) in the series of development, and it is a rule in the animal economy that when the nervous system is attacked by disease, sameness, isolation, vices of civilization that the late evolved functions suffer first, and suffer before any other function is disturbed, so that a denizen of the United States living under the influence of our highly oxygenized atmosphere, our perni- cious moral area of fictitious literature, exciting food, unrestrained passions, solitary confinement, use of stimulants, tea, coffee, tobacco, whiskey, suffer through the nervous system a perver- sion of the sexual sense. The habit of self-abuse, before and 8oo DISEASE GERMS. after puberty, is often inherited, implanted in children who have been begotten with either parent in a state of inebriation. The philanthropist is eagerly scanning the horizon to see what modern medicine can do to stem this current of irreparable waste and national ruin. The growth, vigor and future prosperity of every nation de- pend upon the strength and energy of its young men, and if thi\ practice is not arrested, effeminate, weak, nervous, and physically drained-out youths are to appear upon the scene. Victims of this, our national vice, need sound religious and moral instruction on their duties and responsibilities ; daily cold water baths ; flannel clothing; avoidance of all insanitary states and isolation ; a liberal dietary ; open air exercise ; a daily pas- sage from the bowels, as a rectum loaded with fcecal matter pressing upon the prostate urethra is an irritant, and anything that would re-invigorate the general health. The first indication in the correct treatment of a perversion ol the sexual sense is to cut off all sexual desire ; let the irritable prostate have the soothing, cooling influence of a genital seda- tive. This is best effected by the administration of large doses of the green root tincture of gelsemium, or the spermatorrhoi pill, or the cocaine suppository, which are infinitely superior to all bromides. These genital sedatives should be continued until the damaged parts regain their pristine strength or vigor. The second indication is to bring remedies to bear upon the sexual sense in the brain, to correct the perversion in or from which the habit originates. The first remedy that should be used is the phosphated tinc- ture of oats, which is of great utility in all cases of nervous bankruptcy as a remedy to feed and vitalize the brain, deepen the typical fissures of thought, to energize and rejuvenate the morbid sense, wipe out the atrophic paralysis and aid in a perfect renewal of nerve tissue. This preparation of oats consists exclusively of avena sativa, which is invaluable. Another invaluable remedy to wipe out this perversion of a natural sense is the ozonized glycerite of kephaline. No class of remedies are so valuable, in all states of perver- sion, as the chemical elements of the brain itself—"cerebnn,' which is of the highest order of vitalized bodies—the true elixir of life. If there be any failure in the absorption of this form ot phosphates, add to it small doses of some bitter tonic, as strych- nine. The damiana is a remedy of priceless value. In the cure of sexual perversion or self-abuse it is a great vitalizer of the urethra, the prostate gland, the seminal vesicles, ejaculatory and BACTERICIDES. 801 the differential ducts and the tubes ; exerts a powerful effect upon the functions of generation, whether that effect be due to the ex- tension of morbid action through continuity of structure, or to reflex action, or to a morbid state of the brain, inherited or acquired. The true damiana must in no case be overlooked in the cure of any given case, as it is of great efficacy in sexual perversion, debility or lethargy, when due to abuse; very effective in partial or complete impotence arising from this source. The comp. damiana soluble gelatine bougies are of great effi- cacy in correcting the perversion of the sexual sense. The in- troduction of one of those twice or three times a week up to the prostatic urethra, allowing it to remain, melt, run over the irri- tated, inflamed or strictured parts, the congested prostate and theorifices of the seminal ducts,absorb the remedy, which corrects the abnormal state of the sexual sense at the base of the brain. This forms the most efficient and successful treatment ever pre- sented for self-abuse, spermatorrhoea and impotency; it has met with universal success, and effected the most astonishing cures of deplorably hopeless cases. It is local; it is direct; it acts reflexly upon the nerve centres, the diseased portions, the urethra, seminal ducts and vesicles; good results are apparent from their very first use. The use of those bougies meets the pathological condition of the deep urethra, into which the seminal ducts open; they soothe, heal, contract all the congested parts, stop the drain of the vital fluid, which by and by becomes thicker and healthier, the parts increase in size and the distressing nervous symptoms are relieved. In the perversion of the sexual sense, which give rise to self- abuse, we have seen that there is a tissue-starved brain; and, in- cidental to that, there is always more or less damage done to the parts. To repair this damage, the saw palmetto fills a gap that has long been needed. In its action it is a nutritive tonic to glands, as the parotid, mammae, ovaries, testes, prostate. When those glands have suffered atrophy and withered into nothing- ness, if administered it will cause them to bud out and grow, often to exceed their normal size and activity. In this class of cases it operates well; it often overcomes the blight of varioco- cele, the atrophy of the testes, the spasm at the neck of the bladder, due to irritable prostate, and, take it all in all, the saw palmetto is of great value in all cases of sexual debility. The coca et celerina is a powerful nerve stimulant, promotes cohesion of cineritious substance of the brain, and exercises a healthy, invigorating action upon the perverted sexual sense, and 51 ?02 DISEASE GERMS. relieves the mind of the depression incidental to the disease. The coca et celerina, internally, and coca suppositories, are very valuable preparations, if isolation has been at work, wiping out the typical fissures of thought, in creating this perversion of the sexual sense, or if mental strain and worry have given rise to genital and phrenal incapacity. A preternatural contraction of the foreskin Phimosis, over the glans of the penis, preventing it being drawn back. In infants, it is congenital, obstructs micturition ; in adults it is acquired by a variety of causes, as the irritation from the presence of sebaceous secretion, by clothing irritating the parts, by mas- turbation, irritating discharges (cocci) from the female, by gonor- rhoea, balanitis. Symptoms.—In children and adults, there is the long, con- tracted foreskin, which gives rise to obstruction in urinating, re- sembling stricture, or stone in the bladder. In some cases, ae inability to urinate. In adults, the swelling, elongation and contraction are generally due to masturbation, gonorrhoea, chancres, and often causes great swelling of the areolar tissue, and balanitis. Treatment.—Warm bathing, hot hip-bath, with tobacco and bel- ladonna ; the local application of lobelia and belladonna; inject- ing a hot infusion under the foreskin. If once back, a thorough ablution with warm water and lobelia; cotton-wool, with ozone ointment, around head and neck ; and then pull foreskin over, and repeat three times a day, inculcating rest, and bowels freely opened with salines. Get rid of cause upon which it depends. If all means fail, circumcision should be performed. This is performed in a variety of ways. As introduced by that great pathologist, Moses, to prevent the dissemination of venereal disease, it consisted in a simple slit- ting up of the entire length of the foreskin to the rim or neck on the upper or dorsal aspect, and excising a small piece like a V. This answers well enough in children or very young persons, be- cause the two bags or ears that are left are easily and quickly absorbed. The better plan in adults, is an entire excision round, only not interfering with the fraenum or bridle on the inferior aspect; first slitting it up, and then clipping it off neatly with the scissors ; inserting eight or nine lead-wire sutures; stitching the edges of the mucous membrane to the skin. Subsequently dressing with some antiseptic lotion, as lime-water, tincture of Jodine, boroglyceride or resorcin, or creolin; keeping all the time moist; changing and destroying dressing twice a day. BACTERICIDES. 803 During parturition, especially if labor Phlegmasia Dolens. be tedious or severe; a condition in [Milk Legs) which the vitality of the uterus suffers; or we could suppose a case in which ergot had been administered; or the uterus had remained for some time contracted upon a placenta, or clot; absorption by the ovarian lymphatics had taken place, and embolism of the blood engendered, thrombosis of the internal iliac and femoral veins taken place, giving rise to obstruction of the veins, radicles and capillary vessels, with implication of the lymphatics, giving rise to a painful, non-cedematous, hard, brawny swelling of the limb, attended with great prostration. Symptoms usually commence from one to six weeks after labor. On its first appearance there are rigors, fevers, thirst, nausea; great pain, swelling, loss of motion of the affected extremity; limb hot, tender, non-cedematous, but swollen and twice its natural size, of a pale white color, tense and elastic, having a glazed and shining appearance; and even after acute symptoms have sub- sided, and limb remains enlarged for many weeks, even months. As there is a micro-organism in the origin of embolism and thrombosis, the same organism is present here, all efforts have failed in its cultivation, hence it is not pathogenic, but it bears a very close relationship to the micrococcus of puerperal peritonitis. The same treatment as for thrombosis, perfect rest, simple diet, anodynes to relieve pain, germicides, sedative and alkaline fomen- tations. An excellent fomentation is made by adding one pound of bicarbonate of soda, half a pound of peroxide of hydrogen and four ounces of poppies to one gallon of tepid water. The flan- nels should changed frequently; applied over the entire limb, over the groin and lower part of the abdomen, whenever there is pain and tenderness. The heat and steam are to be retained by wrapping up the limb in impermeable cloths. Internally dioxide of hydrogen, acetate of ammonia and salicylate soda; sulphide of lime, belladonna, general alteratives and tonics; later on no remedy so efficient and beneficial as bandaging and bitter tonics. The medical press, and the entire profession Phosphorus are unanimous in advocating and urging upon Disease. the people a diet containing more brain ele- ments, as oatmeal, corn meal, flour not de- prived of its phosphates, boiled white-fish, as being more condu- cive to health and longevity, and better calculated to increase the intellectual power of the nation; that in these natural forms, 804 DISEASE CERMS. phosphorus does increase the depth of the typical fissures of thought, and improves the mental, still, we must say that phos- phorus as a remedy, isolated, and in various forms, is too reck- lessly and indiscriminately prescribed. Phosphorus water, tinc- ture of phosphorus, phosphorus et nux pill should not be admin- istered to any one who indulges in alcohol or tobacco, even in small doses, as it is very prone to irritate their stomachs and cause either acute or chronic gastritis; besides in the same class of patients it tends to engender fatty degeneration of the invol- untary muscles, and also of such glands as the spleen, liver, kid- neys, uterus. Operatives in phosphorus in match factories inhale its fumes, which in a very short time produces progressive pernicious ancBinia, with great debility, albuminuria, loss of hair. Later on a peculiar form of necrosis of the bones, especially the superior and inferior maxillary. This form of partial death is due to disordered innervation, a failure on the part of the lymph canals, pink marrow, etc., to raise or elevate the blood discs. There is no known antidote to the presence of this poison in the system ; a change of occupation, a sea voyage, and a most generous diet is about all that can be done. In diabetes, chronic alcoholism, disease of Piarrhaemia. the liver and kidneys, degeneration of the [Fatty Blood) suprarenal capsules, pneumonia and other morbid states in which the microbe " indican" appears in the blood. The presence of free fat and molecular albumen in the blood may be the result of indigestion, pregnancy and lactation. In the process of digestion the lactescence of the serum begins about two hours after the ingestion of food, and continues for a few hours. The serum is found turbid, opalescent and semi-opaque, a condition, however, which is only transitory, and due to the ab- sorption of fatty matter, formed into an emulsion by the pan- creatic juice and absorbed as such in the duodenum. It is en- tirely due to the presence of fat granules, and molecular granules of albumen. The passage of chyle into the blood renders the serum turbid, the turbidity lasting until fatty matters enter in combination with the free soda of the blood. This condition is the result of disease. Various explanations have been offered as to the occurrence of fatty blood in disease. Some attribute it to the passage of un- BACTERICIDES. 805 altered chyle into the circulation ; others declare that the fat is set free in the blood for the want of a free alkali; while another class maintain that it is fatty degeneration of the albumen of the blood; and others insist that it is dependent upon a new combi- nation of fat. It is never found existing as an independent affec- tion, being invariably associated with some other disease, usually of the liver or kidneys. _______ A chronic, non-contagious squamous affection Ptyriasis. of the skin of parts usually covered by hair, [Dandruff) characterized by the exfoliation of minute white scales or scurf in large quantities. Sometimes acute, with a red base ; chronic with a white skin. Relapses and recurrence of the disease not infrequent. In all cases the skin, bowels, and especially the kidneys must be stimulated. The scalp should be washed with a borogly- ceride lotion, and the following mixture used as a hair dressing: Bay rum, one pint; boroglyceride, one ounce : tincture lobelia, half an ounce; tincture of cantharides, one ounce. Mix. Inter- nally, glycerite of kephaline, four ounces; tincture nux vomica, half an ounce ; sulphate of quinine, one drachm. Mix. Dose, thirty drops added to water every three hours. Avena sativa excellent. Food nourishing, not stimulating, rest of mind. Peptone is a hydrated albumen, which nor- Peptonuria. mally, in passing from the gastro-intestinal tract, is mostly dehydrated, becoming the serum and albumen of the blood. Some of it appears to be taken up by the white blood-cells ; and when these are multiplied or broken up, as in acute suppurative processes, or scorbutic and septic affections, the peptone is discharged, and passes away by the kidneys. In gastro-intestinal maladies, it is possible that the peptone is not all dehydrated in its passage into the blood, and hence peptone reaches that fluid and circulates with it. Peptonuria is thus classed by Bourchard as gastro-enteroge- nous, hepatogenous, haematogenous, and phlegmasic. Looked at from another point of view (Ultzmann), it may be said to be present in three conditions : one a general one, including scurvy, typhoid, diphtheria, tertiary syphilis, pernicious anaemia, small- pox, cerebro-spinal fever, phosphorus poisoning, in which it seems to be connected with a general disorganization of leuco- cytes ; the second, a local condition, including pleurisy, croupous pneumonia, pericarditis, acute inflammatory rheumatism, in which "t is connected with absorption of exudates rich in leucocytes ; 8o6 DISEASE GERMS. the third, also a local condition, including gastro-intestinal dis- eases associated with imperfect absorption and dehydration of peptone. It also occurs from local causes in nephritis and genito-urinary catarrh. Peptonuria does not occur in large amount in the urine. The best of ordinary tests is, perhaps, prussic acid with heat and cold. Prussic acid precipitates peptones ; but the fluid if heated cleans up, and then is clouded with peptone again on immersion of the test-tube in cold water._______ These are spots, or dots, which make their ap- Petechia. pearance in various microbial diseases. Chief among these are typhoid fever, typhus, small-pox, purpura, scurvy, but they may appear even from the ordinary bacteria of mal-assimilation. In these spots, whether a mere red spot, or an irregular patch of a dusky hue, indicative of blood lesion and alteration, the special germ is always to be found— the microbe which gives rise to the disease. Petechial spots require no special treatment, simply push mi- crobicides, which are the remedies in every case. The entrance of air into the pleural cavity Pneumothorax, usually gives rise to collapse of the lung. The most common causes are when the microbes of tuberculosis or pneumonia eat their way into the pleura. In additon to the symptoms of the disease under which the patient has been previously suffering, there will be sudden pain on the affected side of the chest, great pallor of the face, much difficulty and distress in breathing, and a general collapse of the vital powers. In most cases such an accident puts an end to the life of the sufferer. Pneumo- thorax may also be produced by external the conditions, as when a man is stabbed between physical signs of pneu- the ribs, or when the chest is perforated by a mothorax. . , _ , , l . t pistol-shot, etc. In both, cases air enters tne cavity, the lung collapses, and the patient breathes with the greatest difficulty. Invariably there is a shock, which must be met by the admin- istration of stimulants and opium, either in the form of pill, or morphia hypodermically. Diffusible stimulants, as ammonia, brandy, with inhalations of BACTERICIDES. 807 iodide of ethyl, or nitrate of amyl. The patient must be care- fully watched for signs of increasing pressure within the chest; should be frequently nourished with small quantities of food of easy assimilation. _______ Mercurial poisoning is very common, as it is Poison. used quite extensively in the arts. Artisans mak- [Mercury) ing barometers, thermometers, looking-glasses,, etc., become thoroughly saturated with mercury. The amalgam used by dentists contains a very large percen- tage of pure quicksilver, which saturates the system of those who have their cavities filled. The finer the preparation, the more highly it is triturated, the more likely it is to be absorbed into the system. There is much less danger from a blue pill, fol- lowed by a saline purge, than from high graded triturations. Physicians are aware of its destructive effects upon the blood, liver, and bones; when it enters the blood it attacks the red discs and impoverishes them, later on, if persevered with, chronic inflammation of the liver, mercurial aphtha, stomatitis, destruc- tion of mucous membrane, especially of the throat, causes inflam- mation of the bones and periosteum; nodes form, necrosis follows. All who imbibe or inhale mercury either by the skin, bron- chial mucous membrane or stomach, for some time exhibit a peculiar metallic color of the skin; emit a pathogenic fcetor of the breath; and have destructive bone pain in climatic changes. It is a bactericide of immense power, being co-equal with the dioxide of hydrogen, it will destroy, if it is administered, the syphilitic microbe, but unless it is given conjointly with the iodide of potass, it will create a mercuric diathesis, making the taker < living barometer. The practice recently of introducing the bichloride of mercury into lotions, washes, dressings for parturients, for all classes of wounds, should be discouraged by all Christian physicians, as we now have so many superior germicides for those purposes. So long as no organic changes have taken place, either in the liver or bones, from the use of mercury, it can be eliminated from the system by the administration of iodide of potass; elec- trical baths, medicated with sulphuret of potassium. The chlorate and iodide of potass have a remarkable affinity for mercury in the body, they unite with it and eliminate it Whether the human blood can be sterilized by the exhibi- tion of mercury, so as to resist the ingress of the syphilitic microbe, it is unnecessary to discuss ; true it is, that, it operate- that way in variola, and why not in syphilis ? 8o8 DISEASE GERMS. This is a term applied to all pear-shaped excres- Polypus. cences, or tumors, which grow from a cavity lined with a mucous membrane, such as the nasal fossae, ear, pharynx, uterus, vagina, bladder, more rarely in the stomach, intestines, bronchial tubes. The predisposing cause is a peculiar modification of the tuber- cular diathesis, the exciting causes being in all cases, irritation. Microscopic appearance of the polypoid growth Irom a deep section in its embryonic state. Microscopic appearance still later on, showing the too type form. The two conditions, co-existing do not produce a disease- germ, but a neoplasm, properly speaking a zoophyte, whose com- Exiernal appearances, magnified 250 diameters, from a shred of a polypus. Microscopical appearances, magnified 25° diameters, from the interior of a pf 7 poid growth. ponent parts or elements form a hybrid, a transition between the animal and vegetable kingdoms. This is true, whether the mass be gelatinous, or fibroid, pale or fleshy. BACTERICIDES. 809 Polypoid growths, mixed in their microbial constituents, be- long really to that class of tumors which we have designated papilloma, in which the living germs, bacterium porri, tubercle bacillus, with minute vegetable organisms, form the neo- plasm. This conglomer- ated or mixed organism is pathogenic of all poly- poid growths, bears cul- ture, and if eaten by or in- jected into animals will reproduce the disease. They are completely annihilated in the presence of peroxide of hydrogen, ozone et chlorine, naph- thaline, nitrate of sangui- naria, and other bacteri- cides. The prevention or eradication of the polypoid diathesis requires the same treatment as for tuberculosis, and the careful maintenance of a high state of vital force. Microscopical appearance of a perfect polypoid pro- tuberance. Polypi are found growing from the tympanum, Polypus, more especially its posterior wall, from the meatus, [Aural) and from the tympanic membrane. Pathology.—They are either mucous, fibrous, or myxomatous. The first named is composed mainly of a homogenous stroma, in which are round cells enclosed in a fibrous framework (Politzer.) In their interior may be found cystic spaces lined with epithe- lium. They are rich in vessels. The density of the growth depends on its gradual conversion of the round cells into fibrous elements. The fibrillar nature of the fibrous polypus distin- guishes it, and it is not so vascular as the mucous. True myxo- matous polypi are exceedingly rare. Those polypi which grow from the membrane and tympanic cavities are very vascular. They occur as the result of otitis media and chronic suppurative states of the middle ear. Polypi vary in size from that of a large mass which completely fills the meatus, and protrudes from it to a small growth, which it is diffi- cult to seize with the forceps. Sio DISEASE GERMS. Polypi may be multiple, several existing in one ear, and we may find them in both ears. There is often a considerable discharge of pus, which obscures the polypus, on the removal of which with a syringe the polypus comes into view. There is not neces- sarily pain during their formation, and the characteristic symp- toms are deafness with a discharge, which is occasionally mingled with blood. Those springing from the deeper portion of the meatus, or just in front of the membrane, frequently conceal a perforation of the latter. The dangers arising from the neglect of aural polypus are elsewhere referred to. Treatment.—\f the polypus is of larger size, globular or pyri- form in shape, of the fibrous or fibro-gelatinous kind, we must resort to other means of removing the mass. It is well in these cases to determine as carefully as possible before operating, the size, mobility and seat of attachment of the polypus. This, as a rule, can be readily done with a probe. Most of the globular polypi which fill up the meatus are easily removed, with the ordinary small curved polypus forceps; but the best instru- ment is the polypus snare of Wilde—the only difficulty which we meet with is the careful noosing of the polypus close to its at- tachment This, however, is seldom a matter of difficulty, and will be found less so if wire strong enough for the removal of the polypus, at the same time that it can be easily moulded so as to encircle the mass, is used. I have tried various wires for the removal of polypi. I prefer thin copper or iron wire if the growth is large and hard. Thin wire or fishing gimp can be used in ordinary cases. For operating on small vascular growths, either the rectangular ring forceps or the lever ring forceps is the best to use. This latter instrument is admirably adapted for this purpose. Free syringing will bring away any loose portions of polypus not removed by the forceps. I have never had any hemorrhage to speak of after removal of any kind of polypus. I generally use a little very hot water if the bleeding is severe, and this is, as a rule, sufficient to control it. Occasionally it is not possible to remove the entire of one of these vascular polypi at one time, and we have to operate three or four times before the growth is cleanly extirpated. But the mere removal of these troublesome growths is only the first step in the process of cure. It requires often considerable forbearance on the part both of the patient and surgeon to follow up the treatment. Periodical touching of the exposed surface with some caustic is required, as well as the thorough cleansing out of the canal. Having wiped the raw surface with cotton-wool, used with the armed aural probe, then the site of the polypus must be lightly touched with a fine pencil BACTERICIDES. 8ll of wool rolled on the point of the probe, and moistened with chloro-acetic acid. The crystallized acid is readily converted into a fluid state by the addition of a little water. We may also use the mullein oil with great success ; it entirely gets away with the root or pedicle, prevents the growth ; or perchloride of iron. But after a fair trial of many agents, I prefer the chloro-acetic acid to any for this purpose. One rule should be adopted in every case; no one should be satisfied as to the cure of the disease until all dis- charge has ceased, and the surface from which the polypus has sprung presents a healthy appearance. Illustration of the cases of aural polypi which had been erroneously diagnosed as otorrhcea, otitis media, ulceration of membrana tympani, etc. All springing or growing from the membrana tympani ; all were crude, polypi withered, died and disappeared by dropping ozonized mullein oil into the ear. A crescentic gelatinous, with central fibroid. Conglomerated mass, fibroid in centre, with gelatinous terminations. Small red gelatinous polypi growing from the membrana tympani. Entire membrana tympani covered with a gelatinous membrane of some thick- ness. Four distinct nodules; tubercle contents, with mucous covering. Three distinct growths, two large and one small pale fibroid. Three fibroid spring from the same source. Large mixed polypus, central elevation, firm, fibroid, with fibres running into gela- tinous edges. This and No. 16 are alike, single fibroid, with mucous covering. One distinct fibroid could be distinctly visible sprouting towards external meatus. Soft slate-colored excrescence covering the entire membrane. Two large lateral polypi; three small central; total deafness, which was com- pletely restored when they were removed. One large gelatinous mass, covering the membrane—perfectly deaf—hearing re- stored when it disappeared. Crescentic fibroid. One distinct irregularly shaped fibroid. The neglect of polypi may lead to the most serious conse- quences. On two occasions I have seen death with brain com- plications following on aural disease that was associated with the presence of a large polypus in the meatus. In both cases the symptoms of cerebral abscess were present. I saw the cases when the removal of the polypus was too late to avert the mis- chief. # Such cases should act as a warning to practitioners not to simply pull away a polypus with a forceps or snare, and then Ni 2 DISEASE GERMS. send the patient home with the idea that he is cured, only giving him some simple lotion to keep the ear clean with. The polypus re-grows, perhaps the patient has the growth again torn away, or partially torn, as happens in many cases, and he now thinks it useless to apply for relief for that which is certain to return And so he is satisfied to let things as they are until some formid- able symptoms are induced by the growth and the discharge. All this is the result of want of subsequent attention to the re- mains of the pedicle of the polypus or the granulations that re- main after its removal. Whenever a polypus is removed the patient should have im- pressed on him the necessity of a prolonged attendance or an occasional inspection of the ear subsequently, in order to prevent its re-growth, and also to get the meatus or other seat of the dis- ease into a healthy condition. These neoplasms in the nasal fossa are Polypus in either benign or malignant, they are met with Nasal Fossa, as mucous, gelatinous slate-colored or red; fibroid, pale, or red; and either form may have the microbe of cancer interspersed through it. They are all of mycomatous structure, pedunculated. The causes of these pear-shaped growths, or nasal polypi are confessedly obscure, evidently identified with tuberculae and hereditary syphilis. They are much more common among men than women. They may be of traumatic origin, but are also probably often due to any causes which induce or maintain in- flammation of the pituitary mucous membrane. From this point of view they may be a pathological derivative of hypertrophic rhinitis. But mere chronic inflammation can scarcely be alone sufficient to produce them, seeing that children, who are more subject to persistent catarrh than adults, are yet not nearly so liable to polypi. Pathology.—Mucous polypi are composed in part of the ele- ments of the mucous membrane, from which they spring. They are invested with ciliated epithelium, contain a few small blood- vessels, and are destitute of nerves. They consist chiefly of em- bryonic connective tissue. According to recent authorities, the cells composing their mass are first rounded, but subsequently become fusiform and stellate. The intercellular tissue is formed of stout and fine fibres, among which either connective or glan- dular tissue may predominate. In the former case, the polypi will appear as soft fibromata, in the latter as adenomata. They may occasionally be cystic and contain glands, but the cysts, if BACTERICIDES. 813 such, have no true walls. The contents of the cavities are, as a rule, serous, but may become colloid, fatty, or mucous. Polypi in most cases exist as globular ovoid tumors, gray, semi-trans- lucent and jelly-like. They vary in size from that of a mustard seed to a walnut The smaller ones are pear-shaped, but the larger take the form of the cavity in which they have been developed. They are attached to the mucous membrane by a pedicle of varying size and consistency, which is often pearlv and fibrous in appearance. They may, however, have a broader base and even become sessile and immovable. The number of polypi present may be variable. Threy are seldom single and are often very numerous. I have frequently removed from thirty to forty from the nostrils of patients, but this number has in some recorded instances been much sur- passed. Thus, cases are mentioned in which sixty-five and even eighty have been removed. Generally, both nostrils are affected simultaneously, and may be completely obstructed from front to back. Polypi, on a cursory examination, appear to spring from the middle turbinated body, but it has been shown that they often have a deeper origin, viz., from the superior meatus or superior turbinated body. They may occasionally grow from the septum, or from the inferior turbinated body, or from the nasal roof, or from the outer wall, or from the floor of the nose; but such positions are unusual. Symptoms.—The earliest symptoms of polypus are increased secretion from the nose, together with a sense of fulness and stuffiness and -pain over the brow. As the neoplasm increases in size, interference with respiration becomes more marked. There is a constant desire to blow the nose, but though this may be done frequently, and even violently, it gives no relief. It feels like a constant cold in the head, with a sensation of something mov- ing up and down in the nose. In proportion as the nasal fossa becomes blocked up the symptoms increase in severity, espe- cially in cold or damp weather. Later on breathing is carried on entirely by the mouth. If they are large and numerous they often cause atrophy of the bones of the nose by pressure, the septum being displaced, aspect of nose altered occasionally, they protrude externally. Naso-pharyngeal polypi give rise to an alteration in the voice and the sensation of a foreign body in the pharynx. Smell, taste are completely abolished. The Jachrymeal duct is blocked. If the polypi occupy only one nostril, or do not completely fill both, many of the above symptoms may be absent altogether or present in a minor degree. In most cases of polypus there is a remarkable train of symp- si4 DISEASE GERMS. toms referable directly to the nervous system. These are head- ache, giddiness, failure of memory, migraine, neuralgia, asthma and even epilepsy. They may not all be present in any given case, and will, of course, vary in degree in each. It is probable that the presence of these symptoms depends in a great measure on deficient aeration of the blood, owing to the absence of nasal respiration. Carbonic acid poisoning is in fact taking place slowly but surely, and causing a condition of vital depression and mal-nutrition. It has been observed that asthma occurs more frequently in cases where polypi only partially obstruct the nostrils. The occurrence of the attacks during sleep, and their absence in complete obstruction, when patients necessarily sleep with their mouths open, is an argument in favor of insufficient oxygenation. External examination may in many cases suggest the* presence of a polypus. The alae of the nose may be dilated, and the nasal bones forced outwards. On examining the nostrils with a good light, one or more tumors will be seen occupying the nasal fossae, and having a gray gelatinous appearance. During forcible expi- ration and inspiration the tumors will be displaced. The probe will show their mobility, elongated form and pedunculated attach- ment. The progress of nasal polypi is slow but progressive, and they gradually fill up the nose, displacing the septum and forcing the nasal bones outwards. They may also protrude beyond the nostrils, and extend posteriorly into the pharynx. Rare cases have occurred in which the pedicle has been ruptured by some sudden effort of sneezing or blowing the nose, and a polypus has been expelled. But as these tumors are almost always multiple, no real alleviation is obtained from the removal of a single one. When of long standing cystic cavities may form, and these as they rupture from time to time give some little relief to the patient. Diagnosis.—When polypi are sufficiently large to fill one or both nasal fossae the diagnosis is easy; indeed, it is sufficient to see the tumors in order to recognize them. But the case is dif- ferent when the neoplasm is only partially developed. Care is then required in order not to confound polypus with hypertrophy of the mucous membrane, with deviations of the septum, with foreign bodies in the nasal fossae, and more particularly with thickening of the membrane covering the inferior turbinated bodies. This latter error is by far the most common, and is not unfrequently made. Attention to the following points are there- fore important. Polypi though often bilateral are seldom sym- metrical. The turbinated bodies form only one or two promi- BACTERICIDES. 8l- nences, and are situated anteriorly and laterally. Again, the mucous membrane pits under pressure with a probe, while a polypus moves as one solid mass. If any doubts still remain, they may be set at rest by the application of a ten-per-cent solu- tion of cocaine. This will not affect the polypus, but relieve all the congestion, and admit of seeing the polypus. The prognosis is good for a cure in all cases with bactericides. The treatment is quite elaborate, consisting either of interstitial injections, or perchloride ferri, or by snuffs of bayberry, blood root and sulphate of zinc, or better still, by injecting each one with a few drops of ozone et chlorine or peroxide of hydrogen, by inserting the-nozzle of the hypodermic syringe well into the centre of the polypus and depositing the remedy. This at once causes it to wither and die, without pain, hemorrhage, or any constitutional disturbance whatever. No force is necessary, sim- ply inserting the syringe with a rotary motion. Otherwise, excision, ligation, torsion may be tried. Each method has its advocates, its advantages and disadvantages. The disadvantages of the excision are, that they are painful to the patient, that they cause bleeding, and so obscure the field of operation, that they seldom remove the polypus as a whole, and that if used Injudiciously they may inflict irreparable damages on the nasal tissues. It is, however, but fair to add, that many operators of large clinical experience and undoubted skill prefer excision to any other method. In my own practice I reserve excision for two classes of cases, the first where the polypi are situated very anteriorly and are easily grasped, and where the movements of the instrument can be kept in sight; the second, where the polypi are very large, and situated so far back that they cannot be snared. But generally in these latter cases ope- ration through the mouth, with the retro-nasal forceps is pre- ferable. For ordinary cases of polypi I do not hesitate to say that the wire snare, either cold or heated by electricity, offers the best means of removal. I generally operate in the following manner: The patient being seated on a low chair, the nostrils are dilated with the speculum and well illuminated by means of a frontal mirror. The polypi are then carefully examined with a probe and an estimate formed of their number and connections. A ten-per-cent. solution of cocaine is next applied by means of a fine nasal spray. By this not only is a better view of the growths obtained, but all pain to the patient is completely guarded against. The wire snare is then very carefully intro- duced into the nose in a vertical direction, and made to grasp the most anterior and perhaps smallest of the polypi. Traction 8i6 DISEASE GERMS. is made and the polypus removed slowly and gently, the sank* process being repeated until either the nostril has been cleared or until hemorrhage so far obscures the view that a little delay is advisable. But very often, with care, only slight bleeding will take place. It thus becomes possible to work backwards, re- moving small polypi, until a large one is met with. This latter, when removed, will often give immediate relief, and restore the patency of the nostril. It is sometimes advisable after the re- moval of several polypi from one nostril to syringe it with an astringent solution, and to operate on the other side, returning to the former when the bleeding has ceased. A good deal may thus be done at one sitting. If the pedicle is narrow bleeding is slight, but more considerable when the attachment is extensive. Several operations will generally be necessary. The longer the time over which they are spread, the less trying will it be for the patient, and the less chance will there be of recurrence. Etiology.—Sex and age have an im- Polypus, portant influence on the growth of these Naso-Pharyngeal. neoplasms. They are almost, if not ab- solutely unknown in women, or beyond the age of thirty. They are met with chiefly in growing lads, between the ages of fifteen and twenty-five, and are fortunately excessively rare. Symptoms.—The earliest symptom is a sensation of fulness in the nose, with perhaps slight bleeding, and more or less interfer- ence with respiration. The constitutional symptoms are a dull headache, localized in one spot, and marked drowsiness, with an overpowering desire for sleep. Later on there is a mucous dis- charge, an alteration in the voice, deafness with partial or com- plete loss of smell, and difficulty of swallowing, At this period the tumor may be felt in the pharynx, or seen with the rhinoscope. The third and last stage is that of deformity, which is pathogenic of this terrible malady. As the neoplasm grows, it may, like a wedge, open up the bones of the face and base of the skull, the eye may be projected outwards, the palatine arch depressed into the mouth, the soft palate thrown forward, the temporal and zygomatic fossae filled, and the whole countenance assume the hideous deformity known as " frog face." The cranial cavities may gradually be invaded, and the brain itself compressed or forced out in the form of a hernia. There may be profuse hemorrhages, endangering the life of the patient. When death occurs it arises from exhaustion, or from compression of the brain. BACTERICIDES. 8l7 The point of implantation of these tumors is still uncertain, but they probably spring from the basilar arch or pterygoid process. Attached to the mucous membrane by a broad base, are usually solitary, with rough, uneven surfaces, often attain a considerable size, and are very vascular. If a very large polypus occupy the whole of the posterior nasal fossae, it may be impossible to grasp it through the anterior nares. I have met with a similar difficulty in a case where, together with the polypus, there was also a bony growth in a nasal passage. In such cases it is best to pass the finger into the naso-pharynx, behind the soft palate, and endeavor to hitch the wire round the tumor, a procedure of some difficulty, or the polypus may be grasped by a forceps introduced post-nasally, or again by a snare of wire rendered incandescent by the galvanic current Such cases are among the most difficult to deal with. No strict rules can be laid down for operating, as so much must be left to the necessities of each case, and the inventive skill and dexterity of the surgeon. The galvanic cautery has much to recommend it, and will probably, in the hands of specialists, at any rate, gradually super- sede all other methods. It requires, however, not only con- siderable skill to use, but also special apparatus, and this will prevent its becoming popular in general surgery. With the elec- tric wire the operation is conducted much as with the cold snare. Cocaine should be used freely before operation, and the wire not heated till it has grasped the polypus. The current must then be passed slowly, so as to sever the tumor at a dull red heat. In this way bleeding will be prevented. A platinum wire, which is always expensive and troublesome to procure, is not ab- solutely necessary, the ordinary iron or steel wire answering all purposes. ______ Polypus, a peculiar pear-shaped growth, Polypus of the either gelatinous, fibroid or malignant, corn- Rectum, mon in the various orifices of the body in those of a tubercular diathesis, .who suffer from local irritation. When met with in the rectum, it is usually attached to the mucous membrane by a tendinous cord, smaller than the body of the tumor, but of the same substance as the main mass. We say that it is pear-shaped, but as those growths are usually inside the internal sphincter, and even very high up, their shape is apt to be elongated by pressure. But there is no other name that can be applied to them, they seldom, if ever have the same jelly-like consistence which belongs to those of the nose, but growths of a firmer nature are by no means uncom- 52 8i8 DISEASE GERMS. mon. Rectal polypi are unyielding under pressure with the finger, commonly pale red in color, and fibrous, or fibro-cellular in texture. In size they are very variable, as small as a pea, prominent on the surface of the bowel, and in length from one-half to two inches or more, nearly cylindrical, of the thickness of a quill. Those little sessile bodies often detected when the bowel is ex- amined for other diseases, often give no trouble, but some reflex irritation. Polypi and polypoid growths of the rectum, whatever their texture may be, soft or firm, spongy or vascular, when they are not protruded from the bowel, and not attended with hemorrhage, produce very little inconvenience, unless they attain a large size, but if it is prolapsed it becomes the source of much annoyance, even of pain, and the alarming intensity of the reflex symptoms call for its immediate removal. Vi'lous polypus in rectum, Section of rectal polypus, a very common form. The general symptoms are frequent desire to go to stool, and violent straining in the act of defecation; protru-ion of a fleshy mass frequently takes place with a discharge of blood and mucus. No symptom to be depended on unless it can be seen. The reflex symptoms, as aching in the back, numbness of the hips and posterior portion of the thighs, vertigo, pain in the back of the head, coated tongue, general derangement of the nervous system. The favorite methods of removal are by the knife, ligature, ecraseur, torsion and by caustics. More recently, papoid, trypsin, etc., have been introduced into bougies and inserted, with most remarkable success. Polypus and stricture of the rectum intensify the predisposition to cancer, so does an exudation or exfoliation of the papillae and all other morbid states. Pockets, fringes, pimples of the mucous membrane of the rec- tum, or thickened elongations or prolongations of mucous mem- BACTERICIDES. gl branes, cone shaped, very pointed and sensitive at the apex, which is free; very broad and thick at the attached base. These papillae vary in number from one to five or six, and in length from one line to half an inch, are not unlike in appearance the broken relics of a hymen. These papillae are always sources of irritation and should be at once removed. Transfix them one by one with a tenaculum and snip them off with the scissors. They are not found in every rectum, but are common. We also find pockets from one-eighth to an inch in depth, and their num- ber varies from one to eight. Their direction is always to the anus. The bottom of the pockets are usually very sensitive and contain an ulcer. You enter the pocket with a probe bent in the with in tubercular subjects. Section of a rectal polypus. shape of a fish-hook, raise it up slightly and snip it off with the scissors. The operation is simple and does not need ether, ex- cept in very nervous patients. Now anoint your fingers with soap and water and introduce two of each hand into the rectum and stretch it for one or two minutes, or until the sphincter is par- tially paralyzed. Any one can guess as to the cause ot these pockets, papillae and fringes. They are not a normal condition, as is proved by their absence in a healthy rectum. They provoke irritation by reflex action in various portions of the body. By their re- removal you can cure a chronically-coated tongue in a short bme. Their removal rapidly and permanently cures acne of the lips and tip of the nose, restores color to pallid lips and face, and it will relieve obstinate constipation, cure headache, spas- modic urethral stricture, cough, uterine congestion and other « 820 DISEASE GERMS. troubles too numerous to mention. Rectal conditions influence waste and repair more than any other single point of the system. If not attended to cancer, is the inevitable result. Polypus originating from the navel are very Polypus, rare, but once in a great while we meet with one. Umbilical. The drawing below gives a very faithful ap- pearance of the microscopical characters of the growth in the case we have described. The section is taken transeversely to the long axis of the growth, and shows that the surface is covered with columnar epithelial cells of one-cell thickness. Opening out on this are the orifices of many glands. These glands are of the tubular variety, and reach towards the nucleus of the growth to the ex- tent perhaps, of one-third the diameter of the poly: pus or less. Many are seen in transverse or oblique sections, others are cut in the direction of their long axis. They , end blindly, are not branched at their extremities, and are lined throughout with a single layer of columnar epithelial cells, many of which are beautifully goblet-shaped. Supporting these is a fine and very bountifully nucle- ated connective tissue. Lying under the investing layer of columnar epithelium, and supported by the connective-tissue growth just mentioned, are many vessels, chiefly cut longitudi- nally, which are intensely gorged with blood, and during life gave the scarlet hue characteristic of the tumor. The centre of the growth consists in large measure of bundles of involuntary muscle-fibre, here seen for the most part in longi- tudinal sections, but some of them are cut transversely to their long axis. A few muscle filaments appear to entwine in the con- nective tissue round the glands at their central terminations. In addition, in the central area, many vessels of large size are seen cut in various directions. Umbilical polypus with a large base may be obliterated or re- moved by electrolysis ; if the pedicle is small, ligation, torsion, excision may be resorted to, according to the ideas of the surgeon. Umbilical polypus. BACTERICIDES. 821 Polypus of the Uterus. We find those pear-shaped excrescences growing from all parts of the mucous mem- brane of the uterus, such as the cavity, neck, os, or in any part of the vagina, by a root, pedicle, or stem. Three varieties are common: (1.) gelatinous, or mucous; (2.) fibroid, pale, covered with mucous membrane; (3.) fibroid, fleshy or placental. The predisposing cause is the tubercular diathesis ; the excit- ing causes, any kind of irritation, such as sexual incompatibility, frequent abortions, masturbation. Symptoms.—Either profuse menstruation or irregular attacks of uterine hemorrhage, or a dribbling all the time, or often ex- cessive bleeding; profuse leucorrhcea. It must be borne in mind that hemorrhage or flooding, may result from an alteration of uterus, and an examination as to determine the the cause. in all cases Profuse dis- Gelatinous polypus, hanging from the fundus of the uterus, pro- truding a little beyond the plane of the orifice—hemor- rhages very threatening. the structure of should be made, so charges from the uterus are the pre- cursors of abortion; some arise from scirrhus; others from polypi. If a hemorrhage comes on suddenly, with pain in the back, abdomen, thighs, bearing down, it resembles an abortion. But if the discharge of blood has continued for weeks, giving rise to cerebral anaemia, pasty complexion, lancinating pain in the uterus, with a fetid discharge, the cancer germ has probably localized itself. But if there are recurrent hemorrhages, unattended with pain, anterior and pos- terior, it would be well to examine for polypus; if this hypo- thesis is correct, instead of finding an empty vagina, there will probably be found a tumor, varying in size from that of a walnut, apple, or child's head. As a general rule, the polypus, if present, is easily detected in the uterus by the sound, or if on the neck or vagina, by the speculum and finger. Treatment.—If the polypus is in vagina, or on the neck, or os, any of the following methods of treatment can be resorted to : It can be excised, and bleeding arrested with a sponge, proper size, saturated with perchloride of iron; it can be ligatcd, and allowed to slough off; torsion can be used, that is, it can be 822 DISEASE GERMS. turned a little every day, thus impeding its circulation, strangu- lating it, and allowing it to slough off; or the chain of the ecraseur can be applied round it, and crushed ; or, if it can be brought into a speculum handy, the ozonized chloride of chro- mium can be applied, and cause its in- stant death without a particle of pain. If in the cavity of the uterus, the os uteri must be dilated, and it may then either be snipped off or ligated. If in the cavity of the uterus, gelatin- ized bougies, prepared with papoid or trypsin, introduced daily into the cavity of the uterus, causes those excrescences to wither and die. To those in the vagina, touching them with lactic or chromic acid, has a marked effect in their destruction. This cut illustrates a case of polypus of the uterus, with an infiltration of the neck and body with the cancer microbe; the polypus hanging from the os uteri; with a cancerous nodule on the posterior vaginal wall. The cachexia well marked, pain anterior and posterior, diurnal hem- orrhages, followed by fetid discharges. The vagina was first packed with boroglyceride paste for twenty-four hours, which produced a marked withering of the polypus, so much so that it admitted of an easy exploration, permitting the pedicle of the polypus being freely painted with a strong lactic acid. The packing of the vagina with borogly- ceride was performed every night for four consecutive times, wnen the polypus was expelled and the hem- orrhages in a great measure ceased. The vagina and neck of the uterus were syringed three times daily, after each a boroglyceride pastile was inserted up against the neck of the uterus and permitted to dissolve. This diagram represents the dual microbe of polypus and can- Diagram of polypus. Polypus, with infiltration of the neck with cancer germ. BACTERICIDES. 823 cer on the cervix uteri; a nodular growth just rupturing, with a most offensive discharge, tinged with blood. Occasionally hemorrhages. In this case there was the diathesis, anterior and Internal polypus, with epithelium of the neck, encroaching upon the cavity. posterior pain, infiltration of the lymphatic glands of the groin; the body of the uterus was considerably infiltrated. A micro- scopical examination of the vaginal discharge revealed the fact that it consisted almost entirely of liv- ing and dead germs. The local appli- cation in this case was the application of the contents of half a dozen jequi- rity wafers to the ulcerated surface, which caused a large mass to exfoliate, then following with the boroglyceride injections and pastiles. Twice a week painted the germ-laden parts as far as it was possible to reach with lactic acid. This illustration shows an internal polypus of the uterus, with epithelium of the neck ; the internal polypus was first diagnosed and neglected; the daily hemorrhages became exhaust- ing, and latterly carcinoma appeared. This latter commenced as an indura- tion. The local treatment consisted in painting the parts affected with lactic acid, using the boroglyceride injections and pastiles. As the cancer microbe has a remarkable tenacity of life, and A large mixed polypus, fibroid and red, gelatinous, growing from the neck of uterus, cured by injecting with peroxide of hydrogen. 824 DISEASE GERMS. as the Chian turpentine mistura is antagonistic to its existence, nearly all cases may be readily cured with this remedy. The Chian turpentine mistura is composed of the best selected Chian turpentine, ethereal peroxide of hydrogen, resorcin, thal- lin and other germicides, which, when they enter the blood, come like an avalanche upon the germ, and destroy it. Urethral polypi, usually of the fibroid Polypus of the variety, are occasionally found protruding Urethra. from the male urethra, causing occlusion of the canal. Pathological products are sometimes met with in the fossa navicularis, which present a structure absolutely analogous to that of the vegetations seen on the surface of the prepuce and glands. They are slowly developed in the interior of the canal, where they preserve an elongated shape, but spread as soon as they have passed outside of the meatus. Polypoid growths in the urethra being of the character of papilloma (bacterium porri), are readily got rid of by the inter- nal and local use of thuja, filling the urethra, or inserting a gela- tinized bougie of the same. By the use of this remedy, all irrita- tion is avoided; the oil is the best form. In all deviations from health, all Poison of Subjects, states of vital depression, bacteria [Cadaveric Alkaloids) evolved from the normal living matter, and the microbes of disease from without are present and play an important part in the transition from life to death. When life, or the soul element, leaves our bodies, the corpo- real part enters a new sphere of existence in the form of micro- bial life. All forms of micrococci, streptococcus, bacterium and bacilli are evolved, they eat up all the pabulum obtainable for their growth and development, and either die or are converted into other living organisms, dual, triple or quadruple germs, and this process continues until our bodies are reduced to their original constituents, water, carbonic acid gas, ammonia, and earthy salts. During this stage of microbial existence, of chemical change, of prodigious growth, we have every known micro-organism with its deadly alkaloid (ptomaine), present. If, at any stage of bacterial existence, the most minute particle be introduce into the living blood of man, it will breed with most extraordinary rapidity; the germs indeed have their vitality augmented and BACTERICIDES. 825 produce in the living organism precisely the identical state of decomposition, which they were pushing forward in the dead. The olfactory nerve also, of an educated physician, recognizes in the odors of the cadaver the various micro-organisms present, even the one which caused the. death of the subject. The micro- organisms of the dead are keenly active in the subject, so much so that in the atmosphere for one hundred feet around it they can be detected, and within that radius they can also be found in mouth, eyes, hair and clothing of the attendants. With an open mouth, they enter the salivary glands of the oral cavity and descend to the stomach, giving rise to gastro- intestinal irritation. With regard to dissection wounds, we must bear in mind the following facts: that all subjects are but one mass of disease- germs, being more or less virulent according to the disease, or species of bacteria which induced the separation between soul and body. Injecting the subject with either chloride of zinc or arseniate of soda solutions, or even the oil of cloves, or peroxide of hydrogen, does not destroy the germs and its spores, they simply for the time being induce a latency. There is no bacteri- cide which will destroy the comma-bacillus of epidemic cholera, or the streptococcus of diphtheria, or erysipelas, etc. It is also well to bear in mind that the more highly developed the dissector, the more finely organized the brain and muscle, the greater is his affinity or inhibitory power to take in germs. This is true of all animal matter. Inoculation, through a scratch, abrasion, indentation of or from the microbial mass, a subject will produce in the living the same growth of micro-organisms; but if the subject has slid off his immortal through the agency of the microbe of phlebitis, erysipelas, typhoid fever, pneumonia, etc., then the case is bad, and an inoculation is followed by grave results. In the management of such wounds or inoculations, the per- oxide of hydrogen stands first among all remedies—applied locally, administered internally. No well-conducted dissecting room can afford to be without this bactericide. Its use supersedes all our old remedies ; students, nurses, washerwomen, should have it handy, C. P., and medicinally pure. Polyuria always indicates some affection of the Polyuria, parts of the brain situated in or near the posterior fossae, the cerebellum, pons, and medulla oblon- gata, but that the material on hand does not permit a more ex- act localization. It is a symptom showing an irritation of the cerebral parts 826 DISEASE GERMS. concerned, but it is never only a functional disturbance. Poly- uria, especially if not permanent, might, therefore, indicate a pass- ing hyperaemia, or an otherwise transiently irritated state of the portions of brain-tissue mentioned, but if continuous and not amenable to treatment, the same symptom would be an evidence of some organic lesion of the same cerebral parts. This theory is confirmed by the empirical observation, that ergot is the only remedy which has thus far resulted in a cure of polyuria. This drug has been tried in cases of that kind, where it has been suc- cessful. Ergot, as well known, causes a contraction of the capillaries and, therefore, a diminished blood supply mainly in regions specially rich in capillaries, as the brain and spinal cord. A transient hyperaemia will thus be relieved, and the polyuria, when due to the latter, disappear under the influence of ergot. But when the prolonged administration of this remedy does not diminish the flow of urine, the suspicion is warranted of an or- ganic change in the parts mentioned of the brain being respon- sible for polyuria. In such cases the symptom is of grave import, and usually predicts the fatal issue of the case. The fact that polyuria, if of long duration, occasionally ends in diabetes, also is explained by the statements above made. This is normal in old age and is Porrigo Decalvans. usually preceded and accompanied by [Baldness.) grayness [canities). Premature bald- ness may occur from failure of general health, as a consequence of eczema, seborrhceaor other disease of the hairy scalp, or without apparent cause. It often seems to be hereditary and is most common in males. It generally begins at the top of the head and tends to spread from thence. The hair gets thin before any patch becomes completely bald. Treatment.—Senile baldness is not very amenable to treatment. Premature baldness may be treated with more hope of benefit. Any disorder of the general health should be attended to, and any cutaneous disease present on the hairy scalp should be treated. When any obvious general or local affection has been attended to, local stimulants may to some extent promote the growth of hair. Various preparations of cantharides are often employed, and lotions containing ammonia have been recommended. The following formula may prove useful: Bay rum, one pint; tincture of lobelia; tincture of cantharides, of each one ounce; boroglyceride, two ounces. Mix. BACTERICIDES 827 Wash scalp with castile soap, dry well. Use the above for a hair dressing. Alopecia ar. differs from the ordinary form in several important particulars. As implied by the name it occurs in isolated patches, not as a general thinning and falling of hair. Rest of hair often grows with great vigor. It is not preceded by grayness. The patches attacked get perfectly bald and as smooth as the surface of a billiard-ball. It may attack the beard and whiskers as well as the scalp; also the eyebrows and other hairy parts. The dis- ease is not one of old age, but of early life. Children are more often attacked than adults, and women more commonly than men. (Ordinary alopecia is more common in men.) Distinguished from ringworm by the absolute baldness and smoothness of the patches which present a marked contrast to the broken stumps seen m ringworm. A characteristic feature is the presence of short clubbed hairs at the margin of the patches. Recovery in in some cases spontaneous, but disease is apt to recur. It often tends to run in families. Often found associated with excessive brain-work (school children) and worry. Has hence been re- garded as a neurosis. Also been considered a vaso-motor, or trophic lesion, but a microscopical observation shows a parasite. Treatment.—The general health should be attended to and tonics given if needful. Glycerite of kephaline and tincture of oats internally often gives good results if persevered in for some time. Local stimulation may do some good. The patches may be painted at intervals with jaborandi fluid extract, or equal parts of the liniment and tincture of iodine. An ointment or lotion containing cantharides may also be of service. Canities, or Acquired Whiteness of the Hair.—Grayness of the hair is a common precursor and accompaniment of baldness as already mentioned. It is due to deficiency of pigment. In those rare cases in which sudden blanching of the hair has fol- lowed great emotion it is said to be due to the-formation of air- bubbles in the shaft of the air. Treatment.—Not very effectual. Tonics (especially oats) may be given and local stimulants used, such as cantharides. Kaposi recommends the use of fatty oils, as those of mace, walnut, or cassia. Persons wishing to conceal it very generally consult their hair-dresser and use some form of hair dye, which he finds it profitable to sell to them. Lead is a frequent ingredient in the popular nostrums sold and darkens the hair by chemically com- bining with the sulphur in it to form a sulphide. A lead comb is often used. 828 DISEASE GERMS. • Conception consists in the fertilization of Pregnancy and the ovum or egg of the female, by the sper- Parturition. matozoa of the male in the ovaria; then fecundation takes takes place. There must be a union of the two materials furnished by both sexes; that is, the spermatozoa must unite with the egg in the ovary and fertilize Side view of viscera, female pelvis : i, vagina; 2, bladder; 3, Interior of rectum; 4, uterus; a, fundus ; 6. cervix : , c, c, os uteri; d, posterior portion ; e. anterior portion; 5, rectum, here cov red by peritoneum ; 6, 6, 6, sacrum; 7, coccyx; 8, labia minora ; o.labianiajora; 10,urethra; 11, symphysis pur>is ; 12, clitoris; 13, mnns veneris ; 14, urachu* ; 15, section of peritoneum; 16, last lumbar vertebra; 17, broad ligament; 18, ovary. it; and the embryo results from this union. The spermatozoa is ejaculated into the vagina; the uterus, by inhibitory action and vermicular movements, takes it into its cavity, and passes it along the fallopian tubes to the ovaries. It may occur without the patient being conscious of its occurrence, or against her will. BACTERICIDES. 829 The most favorable period for conception to take place is either before or after a menstruation. After the ovum is impregnated, it increases in size and becomes prominent on the ovarium ; then absorption of the peritoneal coat takes place; and when free, is seized by the fimbriated extremities of the fallopian tube, and carried into the cavity of the.uterus. The ovum, as a general rule, is found in the uterus twenty days after impregnation, sooner or later. After the exfoliation of the ovum from the ovary, an effusion of blood takes place into the cavity in which the egg was em- bedded, and this is followed by a corpus luteum. The human impregnated egg is very small, about the size of a dwarf pea. When impregnation takes place, the internal os uteri becomes closed by a soft, gelatinous substance, and the internal lining membrane of the uterus throws out a flocculent A fair standard specimen of a Interior view of the same Uterine .cavity. virgin uterus; 2J4 inches in uterus. length, \yl inches in width, and 2% ounces in weight. or downy substance, which fills its cavity entirely. This is called the membrana decidua, and into this downy bed the ovum drops when it makes its exit from the fallopian tube, and, if not disturbed, will form its attachment near the point of ingress, and cause a growth of that part with which it comes in contact, and is called the decidua reflexa. So that the decidua is now divided into that portion lining and in contact with the uterus, called the decidua vera, and the other portion called the decidua reflexa. The embryo then becomes covered with two membranes— the chorion and amnion. The amnion is an internal lining of the serous membrane, which furnishes a fluid for the protection ot the embryo; allows space, facilitates motion and development of the fcetus, and wards off shocks, jars, concussions. The chorion, or outside covering, furnishes a means of communication with the uterus 330 DISEASE GERMS. The ovum, after its establishment within the uterus, consists of the decidua, decidua reflexa, chorion, amnion, liquor amnii, fcetus, and umbilical chord, with one extremity attached to the child, the other to the membranes at the point of attachment in the after-birth. The after-birth, or placenta, is a plexus of vessels by which the circulation is maintained between mother and child, and by which the latter is nourished. When of full size, it is from six to eight inches in diameter, and in thickness varies from a line to one inch, or more, at its centre. It has two surfaces: one attached to the uterus, which is rough, spongy, traversed by ditches; and the foetal side, which is lined by the amnion, which is smooth. For the first three months of intra-uterine existence, this twig of humanity is termed an embryo; the latter six, a fcetus. As soon as impregnation takes place, the walls of the uterus become greatly infiltrated with blood, which increases the size of the vessels from being very small and convoluted, to that of large and straight; the muscular fibres grow with perfect regularity. This increase of growth and development for the first three months is very great, so much so that the specific gravity of the uterus is such that its broad ligaments are unable to hold it up, and it descends very low into the cavity of the pelvis, often nearly protruding. After the fourth or fifth month this difficulty is entirely obviated, by the uterus floating above the pubes; and at six months it is still higher. After the fifth month there is a gradual distension of the body of the uterus, which en- croaches upon the neck, distending it, merging it into the body, and causing it to become shorter and shorter, until, from the eighth to the ninth month, it is entirely obliterated; that is merged into the body. Signs and symptoms of pregnancy are divided into rational and sensible signs. The rational signs embrace : First and Second Months.—A stoppage of the menses, nausea, vomiting, flatness of the abdomen, depression of the umbilical ring, tumefaction and tenderness of the breasts. Third and Fourth Months.—In addition to the above, there is now a slight fulness of the abdomen, augmented swelling of the breasts, prominence of the nipple, and discoloration around areolae. Fifth and Sixth Months.—The disturbance of the digestive organs usually disappears ; abdomen becomes well rounded and full, and the uterus can be detected above the pubes; fluctuation can be detected; and the color around the nipples becomes brown. Seventh and Eighth Months.—Abdominal tumor large; dis- BACTERICIDES. 831 coloration of the skin of the abdomen common; often varicose veins of the leg, labia, vulva ; vaginal granulations; leucorrhcea, pruritus, and real copper-color around nipple; and suppression of the menses through the entire nine months. First Half of the Ninth Month.—Vomitings liable to re-appear; the abdominal swelling is so great that the skin of the abdomen is stretched, tense; there is difficulty of breathing; oedema of feet. Last Half of Ninth Month.—Vomiting ceases; abdomen re- laxes; uterus descends; there is less difficulty in breathing, but more in walking; often difficulty of urinating—sometimes sup- pression, in other cases an inability to hold it; often piles; vari- cose veins of the leg ; pains in the loins; cramps in the legs; colic, etc. The sensible signs embrace : First and Second Months.—Augmentation in the size and weight of the uterus causes that organ to descend low down in the pelvis; it cannot be moved easily ; its walls touch the neck, which is directed downwards; the orifice or mouth is rounded, swollen, and a slight softening of the lips. Third and Fourth Months.—The fundus of the uterus rises above the pubes, and a rounded swelling can be detected by palpa- tion. Making the patient stand up, and putting the finger on the os uteri, and lifting it up, it drops suddenly down on the finger. Fifth aud Sixth Months.—The fundus can now be detected below the umbilicus; there are active movements of the fcetus ; foetal heart can be detected distinctly, indeed, it is very percep- tible. The uterus can be mapped out, fluctuating, rounded; and the lower half of the neck of the uterus is softened, and the neck now begins to lose itself in the distension of the body. Seventh and Eighth Months.—The increased size of the uterus and abdomen ; the fundus of the uterus is three finger-breadths above the umbilicus at the seventh month, four or five at the eighth; movements of fcetus stronger; foetal heart very clear; neck disappearing in the body. First Two Weeks of Ninth Month.—The fundus of the uterus reaches the borders of the false ribs, clear up to the stomach; foetal heart very strong; neck of the uterus gone entirely into the body; the mouth of the uterus open. Last Fortnight.—Fundus sunk low down ; movements active; mouth of uterus open, soft, dilatable; the whole cavity of the neck becomes confounded with that of the body. The entire period of pregnancy occupies nine calendar months, or forty weeks. Time varies somewhat, as to whether concep- tion took place immediately before or after menstruation. 832 DISEASE GERMS. Pregnancy may be protracted in some rare cases; that is, carried out beyond two hundred and seventy-eight days, the interval between the last day of the menstruation and the ex- pected confinement, and at least a fortnight more than this. There is no very exact time, or number of days, to which preg- nancy may be protracted; still, it would be safe to maintain that in no case can it be prolonged over three weeks beyond the natural period. Development of the Foetus.—Fifteen days after the ovum or egg appears in the uterus, it is a gelatinous, semi-transparent, floccu- lent, grayish mess ; at thirty days, the size of a large ant, and from three to five lines in length; at six weeks, ten lines in length, about the size of a bee, but some of the organs, in a very rudimentary state, visible; at two months, two inches long, weighs two ounces, and ossification has commenced at some points; at three months, three and-a-half inches long, weighs three ounces; umbilical cord well formed, and genital organs Ovum and embryo at the sixth week. A fcetus at fortv-five days and at two months. distinct; at four months, five or six inches long, weighs from four to five ounces ; at four and-a half months, quickening, or motion, is felt by the mother, or by placing the cold hand on the abdomen, and it is now from seven to nine inches in length, and weighs from nine to ten ounces ; at six months, parts pretty fully developed, and weigh from • one to two pounds, and its length from nine to twelve inches ; at seven months, all parts are per- fectly developed; weighs from two to three pounds, and in length from twelve to fourteen inches, or more, and perfectly de- veloped ; at nine months, usually twenty inches long and average weight seven pounds ; bones of head firm; ossification more \ complete, and all the organs capable of performing their natural function. Some variations in the above, but it gives the general average. There may be several eggs fertilized, so that there may be twins, triplets, or quartlets. Pregnancy may occur outside of the uterus, extra-uterine; it may take place in the ovary, and the embryo develop there ; or it may be developed in the fallopian BACTERICIDES. 833 tube, or in the abdomen, or the ovum may find its way into the muscular coat of the uterus and be developed. The conse- • quences of such are usually serious, causing inflammation, ulceration, suppuration, internal hemorrhage, and death to the mother. When pregnancy takes place, and the woman knows she is in that state, she should eat the best of food, take moderate exer- cise, but avoid hard work or any strain, and above all, keep her bowels regular by eating sufficient fruit, or using enemata of milk and water. She should make a regular habit of either sponging or bathing the entire body once a day. All gloomy or idle fears should be banished ; no tales of woe or sorrow told in her pres- ence; her surroundings should be of the most agreeable kind, and she should place her trust in the benevolence, mercy, and wisdom of her Creator. Her clothing should be flannel, next the skin, at all seasons ; she should have abundance of sleep, and all symptoms in this state should be managed with as few drugs Diagram of the fcetus and membranes about the sixth week : a, chorion; b, the larger absorbent extremities, the site of the placenta; c, allantois ; d, amnion; e, urachus; e. bladder ; f, vesi- cular umbilical is; g, communicating canal between the vesicular umbilicalis and intestine; h, vena umbilicalis.; 1, i, arenas umbilicalis; k, arteria omphalo-meseraica ; /, vena omphalo- meseraica; «, heart; o, rudiment of superior extremity; p, rudiment of lower extremity. as possible. The sickness of the stomach is one of the earliest of all symptoms, and should be treated with the plainest bitter tonics. General symptoms of pregnancy are reflex; that is, they are de- pendent in a great measure upon some loss of tone, or weakness of the reflex centres, the medulla oblongata and spinal cord ; so that when pregnancy or any condition of molecular activity of the uterus takes place, the excitement or hyperaemia is trans- mitted to the cord and bulb ; directly from the uterus to those centres, and thence along any weakened nerve, hence we have facial neuroses, toothache, salivation, if the nerves supplying those nerves are weak; nausea, vomiting, headache, heartburn, water- brash, constipation, diarrhea, if the nerves of the stomach have suffered a partial loss of vitality; or there may be syncope, fyhonia, difficulty of breathing, insomnia, hypochondriasis, con- 53 834 DISEASE GERMS. vulsions, abnormal states of sensation, sight, and hearing; vari- ous neuroses, even chorea, epilepsy, catalepsy. Now with reference to these and numerous other symptoms, we would say: palliate them in the best manner possible, and above all things avoid medication during pregnancy. It is well to forbid the use of all malt or alcoholic drinks, as they dwarf and whittle down the elements of humanity; predis- pose to fatty degeneration of the uterine fibres, and hemorrhage, give rise to miscarriage and brain failure in the infant; forbid all impressive sights; and the inhalation of all anesthetics, espe- cially nitrous oxide gas for the painless extraction of teeth, be- cause the nitrate of ammonia, of which it is composed, increases the alkaline constituents of the blood, and is very liable to cause an exfoliation of the uterine contents. The pain of toothache is due to the microbe of dental caries eating the nerve of the tooth. Kill it with resorcin paste, or concentrated ozone, and relief is afforded. Symptoms of indigestion can be relieved with papoid; ozon- ized pepsine, and bitter tonics; diarrhea arrested with opium and tannin pill; constipation relieved by fruit; loss of voice by inhaling the nascent chloride of ammonia and a glass of coca wine; fainting or difficulty of breathing relieved by some diffusible stimulant; insomnia or hypochondriasis by extract of of hop, or coca et celerina ; and neuralgic pains in the breast by heat. With regard to chorea, epileptic fits, or other nervous states, they must, if possible, be suspended, as their continuance is most disastrous ; so extract of sumbul should be tried first, in the event of a failure, bromide of potass, blue cohosh, and simulo next. Morning Sickness of Pregnancy.—Many theories have been adduced regarding the cause of morning sickness during preg- nancy. All, however, appear to have been too speculative, and no one has met with anything like a universal opinion. Evolu- tion may aid us in arriving at a just and feasible interpretation. From the earliest period of existence every organism has been endowed with two distinct qualifications : I, that of maintaining self; 2, that of perpetuating its species. At first the double function was performed by a uniform mass, free from any sem- blance of structural differentiation. Habitual localization of function, however, produces eventually a specialization of struc- ture, and with it the evolution of a nerve tract whereby the inter- dependence is maintained. It is therefore feasible to suppose that the nerve centre which regulates the process of assimilation is either in opposition or at least in direct communication with BACTERICIDES. 835 that which presides over the organs of generation. All the visceral functions are now performed automatically, and are regu- lated by nerve centres located in the medulla oblongata; the uterine, by inference, being no exception. Considering the close relationship that exists throughout life between the two processes of assimilation and reproduction, there can be no doubt that the representative nerve centres act and react upon each other. When the uterus becomes the nidus for a developing germinal mass, the molecular disturbances radiated therefrom to the reproduc- tive centre are liable to be transmitted to the pneumogastric as well, and induce either a feeling of nausea or actual emesis. Usually, however, in the course of a few months, through habit, the pneumogastric centre becomes tolerant, and the symptom evidencing disturbance at the same time disappears. It is diffi- cult to understand why the sickness should be experienced more especially in the morning, unless it be that the change from the recumbent to the erect position after sleep renders the whole nervous system more liable to explosive disturbances. Fre- quently we find patients who only suffer from disturbances asso- ciated with epilepsy on assuming the erect position after sleep. The more highly unstable the nervous system is generally, the more likely is a woman who becomes pregnant to suffer markedly and for a lengthened time from sickness, whether matutinal or more or less constant. It is well, however, to remember that the molecular radiations from the uterus itself may, for some reason or other, be materially augmented; and such, acting on a nerv- ous system otherwise apparently healthy, may induce an aggra- vated train of events. The neurasthenic are most liable to it, whether it be due to a morbid innervation or a reflex condition. The sickness is often bad, even fatal, but in the large proportion of cases ceases at four and a half months, but may continue ail the time. It is arrested if the fcetus dies, or if miscarriage, abortion, occurs, or when the patient is delivered at full time. Some cases can be directly traced to a general catarrhal state of the salivary glands of the mouth, with great salivation, catarrh of the stomach and bowels, with liver irritation. Other cases are due to a degeneration of the liver, spleen, kidneys—a sort of passive usurpation of their proper structure with fatty granules, a common condition in both pregnancy and lactation. Such conditions induce persistent anaemia, often jaundice, and uraemia. These symptoms are very dangerous, as there is apt to exist a structural granular lesion. Even slight vomiting, when accom- panied with jaundice and albuminuria, is unfavorable. Decided yellow atrophy of the liver is only present once in 836 DISEASE GERMS. iooo cases of pregnancy, whereas uraemia is common one in 500 cases. Still it is well to look upon nearly all cases with suspi- cion. The theory of pressure is untenable, for the worse cases are in the early months long before the gravid uterus could either affect the kidneys, or liver, or spleen. No definite line of treatment could be laid down for any one case. Remedies must be tried, and if found successful, persevered with. A few of the best remedies for the purpose of trial are the following: Confine the patient to bed for one or two hours after the morning meal. Bowels to be kept well regulated. A cup of good strong mocha coffee, without milk or sugar; or citrate of caffeine; or guarana could be tried; when either operates beneficially, usually from the first dose. Liquor cerii ozonized is a splendid gastric sedative, tried in teaspoonful doses repeated; the oxalate in five-grain doses; ipecac in one-eighth or one-quarter of a grain dose. Dioxide of hydro- gen worthy of a trial. Carbonic acid gas operates as a sedative upon the base of the brain, and medulla oblongata, it could be tried in the form of a glass of champagne, vichy, apollinaris, and other effervescing drinks. Papoid, pepsin, ingluvin and other digestive agents, as pan- creatine, maltine, before or after meals, are often of great utility in arresting the vomiting. They should have a fair trial, as they often operate like a charm. Milk and lime water. Peppermint water, bitter tonics, camo- mile, columbo. Ozone tablets are excellent. Tablets of nitro-glycerine. Cocaine suppositories, one at bedtime, of great efficacy in nu- merous cases. Hot applications over the abdomen. Menstruation during pregnancy and lactation should not take place ; indeed the presence of ovulation during these states is to be regarded in a most serious light, calculated to impair the vitality of both child and mother, causing both to acquire a tubercular diathesis. The causes which have brought about this uterine, ovarian, and spinal neurosis, are obscure, some attribute it to a high state of nerve-strain, worry, struggle incidental to civilization; others assert that our modern, sexually exciting literature has much to do with it in producing this special neurosis, and wrecking the female organism; another class attribute it to the sewing ma- BACTERICIDES. 837 chine; while others claim that sexual excesses and over- stimu- lating diet are the cause. Whatever the cause may be, one thing is very certain, that it did not exist thirty years ago. Occurring during pregnancy, it is to be carefully distinguished from those cases where the after-birth is over the mouth of the womb, when after the fifth or sixth month of pregnancy there is a dribbling from the uterus daily. The appearance of the menses during pregnancy and nursing is to be looked upon as a weakness, or neurosis of the sexual appetite, brain cord, ovaries, uterus; and every possible means seould be taken to arrest it by strengthening the whole system, and parts implicated. There must, in the management of such cases, be an entire avoidance of all excitement; no use of the sewing-machine; an avoidance of shows, theatres, balls; no light or fictitious read- ing ; a perfect freedom from care, worry, taking life easy with a good deal of rest. The best remedies are hip-baths, wine of aleteris farinosa; and erythroxylon coca; comp. syrup partridge berry and fl. ext. of stylosanthus. Two of these remedies should be used one week; next week the other two, and so on for a period of some months, as each one has a most remarkable vitalizing action on the uterus. Avena sativa might be administered occasionally. A morbid appetite, a perverted or depraved longing, or craving, or insatiable desire for peculiar substances, as sand, chalk, clay, sponge, and other articles. We have often the same state existing in uterine irritation, chlorosis, masturbation, ascarides, an abnormal hyperaemia or neurosis transmitted to the co-ordinating chemical centre in the brain; the same state is induced during the first four and-a-half months of pregnancy. To correct this state, and appease the craving or hungering, rest in the recumbent posture, and a per- sistent use of coca wine are most effective. The coca wine is also the best remedy for the pallor, anaemia, mental depression, colicky pains, diarrhea, debility and other symptoms of nerve tire. To increase the efficiency of the coca wine, it could be alter- nated with kephaline or avena with advantage. An irritable bladder is present as a symptom of pregnancy, chiefly among neurotic females, in quite a number of cases. Some few cases are due to the presence of an excess of uric acid; if such be the case, a change of diet, more fresh air, will probably overcome it without resorting to drugs. Still, if no improvement takes place, it might be well to look 838 DISEASE GERMS. for some adjacent irritation, as some caruncle, or vascular excres- cence, lupoid, or other ulcer on a follicle of the vagina; sym- pathy from a rectal abrasion or pocket, or fissure, or neurosis. If the irritability of the bladder is great, ordinary treatment must be resorted to, irrespective of the condition of pregnancy. Passive chronic interstitial nephritis is quite a common condi- tion during pregnancy, especially after the fourth month. The peculiar protoplasmic changes in the blood-forming and blood-raising glands; the intimate nervous connection of the uterus and kidneys; possibly pressure; albuminuria during pregnancy is to be looked upon as a most grave affection, often involving the death of the fcetus by a peculiar degeneration of the placenta, and later on the mother succumbs to the inevitable. The same course of treatment should be pursued as in chronic interstitial nephritis. Our two best remedies are nitro-gly- cerine and benzoic acid, which, when carefully administered, cause a rapid disappearance of both albuminuria and dropsy. Mellituria, the sugar fungus in the blood, is becoming more and more common as a symptom of pregnancy. No doubt this is due to a neurosis of the sympathetic system, as it occurs most frequently among ladies of high culture, with excessive mental development. The peculiar change in the hepatic structure, or else in the eighth, pair of nerves which supply the liver, or in the brain, inci- dental to this condition, is probably the cause. Few of the essen- tial symptoms of diabetes are present, there is usually no exces- sive appetite for either food or drink; no chloroform breath, and although the urine is loaded with the sugar fungus, it is neither excessive in quantity nor of a high specific gravity. It is this saccharine fungus-laden urine, coming in contact with the fine sensitive mucous membrane of the vulva, which excites a neurosis, a pruritus, with its intolerable itching. The best remedies are: administer five grains of jambul after each meal till pregnancy is completed, when the fungus at once disappears. Solutions of boroglyceride, either in an infusion of elder flowers or poppies, are most effective in relieving the intolerable itching. Pure cocaine, dissolved in coca butter, is also most efficacious. Eruptions and excoriations are also quite common around the labia, entrance to the vulva, also on the perinaeum extending back to and around the rectum; often partaking of the nature of an eczema. As a general rule it originates from some local irritant, as sac- charine urine; in other cases from neglect of diurnal ablutions BACTERICIDES. with castile soap and tepid water, followed by boroglyceride solutions. The best treatment is great cleanliness, followed with ozone or resorcin ointment. Cracks, abrasions, ulcers, apply resorcin ointment. A serous, or watery discharge from the vagina, loaded with cocci, best relieved by the boroglyceride wash locally, and inter- nally by the use of the aleteris farinosa. Piles are often present, and usually the result of the passive changes in the liver, incidental to pregnancy, all that can be done is to palliate the condition by keeping the bowels regular by taking fruit, use of baths, bathing the anus with distillation of witch hazel and boroglyceride. Swelling of the labia, best relieved with rest, bathing the parts with distillation of witch hazel. Varicose veins of the limbs should be palliated by first bathing the limb with castile soap and tepid water, drying well, then bathing with distillation of hamamelis, and either wearing an elastic stocking or bandage during the day. Cramps in the limbs, best relieved with rest, rubbing. Inability to hold the urine or retention of urine, best relieved by rest, change of diet, and a persistent use of the aleteris cordial in alternation with the compound syrup of partridge berry. Undue tightness of the abdomen is best relieved by rubbing warm olive oil into the abdomen before retiring. General Rules to be Observed.—Daily tepid sponge bathing to be observed, so as to permit free aeration of blood by the skin; no drugging, but what is absolutely necessary; a good deal of rest, with a fair amount of open-air exercise; change very salu- tary ; abundance of good food; tea and coffee restricted; she should never feel exhausted by any labor, nor be fretted or wor- ried by care ; mental and physical vigor of the highest calibre; the higher and holier attributes of her being should be brought permanently forward; she must positively avoid literary pursuits, as they arrest brain evolution in the fcetus. Deformities and mutilations are becoming more common as the nervous system is being developed at the expense of the physical. There are some causes which are known, others which are latent. A child begotten by a father in a state of alco- holic intoxication, either suffers from idiocy, or brain shrinkage, feebe-mindedness, imbecility or epilepsy; some brain disease of the insane group. All children born with deformities, such as hair-lip, cleft palate, club-foot, imperforate anus, are the result of incompati- bility of temperament, close consanguinity, or in-and-in breeding; 840 DISEASE GERMS. whereas, mutilations, monstrosities, are due to shocks, frights, impressions made upon the mother during the first two or three months of embryonic life. Probably amputations of the limbs come later. The prevention of brain disease and deformities is in the hands of the parents, and should be regulated by the most stringent laws ; whereas, the prevention of mutilations is in the hands of the mother alone; she should avoid reading all dime novels, fictitious literature, or attending theatres, or excursions, or the killing of animals or poultry, or seeing, hearing, or feeling any strange or abnormal thing that would be likely to vividly impress her. All physicians deprecate the practice of the administration of drugs during pregnancy, still there are exceptions to the rule in our present conditions of civilization. The use of the wine of Showing the vessels of the gravid uterus at The appearance of the uterus and child the beginning of labor. at full period of pregnancy, weight from seven pounds upwards. the aleteris farinosa, comp. syrup of partridge, fl. ext. stylosan- thus, either one alternately, should be recommended in, and dur- ing all pregnant states, as they are most invaluable remedies for strengthening the uterus and its appendages, and rendering labor easy and natural. These remedies have a most salutary action in obviating all complications, as false pains, hemorrhages, etc. The bowels must be kept regular by the use of fruit and vegetables, and once a week, for eight weeks prior to the event, the coming mother should take a dose of castor oil, in order to favor a secretion of milk. Parturition or labor may be defined to be the expulsive efforts of the uterus and mother to evacuate the contents of the womb, the fcetus being a mere passive body. Violent passion, mental excitement or impressions may excite or suspend labor, but cannot prevent it. Symptoms of labor may be briefly enumerated: When the BACTERICIDES. 841 fortieth week has expired, there is likely to be some nervous de- pression, which is manifested by a rigor or chill of more or less intensity; a frequent inclination to make water, or else a sup- pression of it, bearing-down ; subsidence of the abdominal tumor ; secretion of mucus, often streaked with blood, called the show; aching in the hips or thighs; sometimes cramps, and a dilatable condition of the mouth of the womb, with alternate contractions, accompanied with pain. In some cases the pains are false or spurious. They are said to be such when the mouth of the uterus remains unaffected by them. These pains in some ladies are apt to come on several days before the genuine, and are apt to worry or annoy the patient; and in all cases in which you are satisfied that they are false, they should be stopped by an injec- tion of starch and laudanum into the rectum. The following are the measurements of a fcetal head, of ordi- nary dimensions, at the full period of utero-gestation : The longitudinal diameter of its head is from 4 to 4^ inches. The transverse,............3^ to 4 " The occipilo-mental or oblique,..... 5 " The cervico bregmatic,........4 to 4^ " The trachelo-bregmatic.........3^ to 4 " The inter-auricular........... 3 " The fronto mental,.......... 3^ " The transverse diameter of the shoulders, . 4^ to 5^ " " " " " hips, ... 4 to 5 " True pains are produced by contraction and drawing up of the womb, which first expels the slimy matter, mixed with blood, called a " show." As soon as this appears, the mouth of the womb at each pain begins to open and widen itself, so as to per- mit the contents of the womb to pass. When labor begins, the mouth of the womb is opened by the longitudinal fibres which are opposed to the circular. Labor is very correctly divided into three stages: the first is the period of dilating of the mouth of womb sufficient to let the head of the child pass, and occupies more than two-thirds of the time of a labor; the second is the expulsion of the child from the uterus, and occupies much less than a third; vaginal examination. and the third stage is a complete expulsion of the membranes and placenta. The first pains are short, come on at long intervals; the patient is restless under them, first hot, then cold, and not infrequently sick at the stomach. She may be griped, belches wind, or passes it from the bowels, which should not be restrained by false deli- 842 DISEASE GERMS. cacy. By and by pain passes to the back and then to the bottom of the belly, and there is usually a desire to urinate or to go to stools, calls that are to be obeyed, never neglected. Just at this time she is likely to become fretful, uneasy, and may ask for something to hurry up pains ; but be patient, wait a little, don't force nature to premature efforts; let her rest while nature rallies, and the womb gradually opens. The duties of the nurse, midwife, or physician, if the presenta- tion is all right, consists in aiding, if needed, giving consola- tion and encouragement; warm drinks ; watching the case care- fully and closely, and rendering assistance when necessary. During the First Stage.—At this stage it is unnecessary for the patient to go to bed, only once in a while, for examination. She is better during the greater part of the first stage, moving gently about the bed- room, and when a pain comes on, be in a position to get hold of something. During such pains a doubled-up position, either sitting on a low stool, or kneeling, answers well. When this first stage is nearly over— that is, dilating the neck of the womb com- pleted, the patient must go to bed. The best position for American women is the left side, near the foot of the bed, so that she can fix her feet firmly against the bed-post; her hips from ten to twenty- four inches from the edge of the bed. If attendants are few she could have a sheet attached to the bed-post, so she could hold on to something from below; her legs bent, a pillow between her knees, and her head also supported by a pillow. The bed for about a yard and-a-half square should be protected with a gum or oil-cloth spread, and two or three quilts doubled up over the same, so as to take up the discharge. Irish or German women, with straight sacrums, do fully as well on their backs, or even on their knees, in the bed, or on the floor, until they are well over and into the second stage. Once it is ascertained that the presentation is a good one, it is unnecessary to annoy her by repeated examinations. All examinations should be made during a pain, and continued when a pain is off If the pains are good, efficient, and the mouth of the womb well dilated, parts well lubricated and the mem- branes seem to act as a retarding element, they can be ruptured by roughening the nail of the index finger; but if they do not seem to retard the labor, they may be let alone, until they almost protrude externally, as they act as a good dilator. The bag of waters differs in size in different cases, according BACTERICIDES. 843 to the amount of water present, and is, always, large or small, a good dilating body, continuing to force open and widen the mouth of the womb, until it is open sufficiently to permit the head of the child to pass. It also distends or dilates the vagina. In some cases, ladies, by excessive or violent movements, cause a rupture of the membranes, a week or more before labor; then labor is dry, and is not nearly so easy; in other cases of sudden or hurried labor, the membranes, water, child and after- birth are expelled in a mass, then the child is said to be born with a caul. When they burst at the proper time the pains con- tinue, and the child gradually enters the world. If the mouth of womb is dry and rigid, so that the pains are inefficient and the first stage prolonged, this rigidity must be overcome in various ways; enemata of tepid water and lobelia into the rectum, steam- ing the vulva, perinaeum, and anus, by causing the patient to sit on a chamber partially filled with boiling water in which a plug of tobacco has been cut up ; or by smearing the rigid mouth with belladonna ointment, or introducing a pastile of belladonna and opium into the vagina; and if it does not yield, these means may be repeated, or they can all be used. A decided nausea has an excellent effect. When the head is emerging under the arch of the pubes, the perinaeum should be supported with the palm of the left hand, and retained there till the head is free from the vulva. If the perinaeum is tough, rigid, not easily distended, and thus obstructs the exit of the head, it may be well oiled, and Forehead under the arch of hot towels—as hot as can be borne—ap- thepeivis. plied, one after the other, so as to relax it. If this is unavailing, wring the towels out of hot lobelia or tobacco water. When the head has made its exit, do not pull or drag it, but simply hold it in the hand until the next pain, and, when it occurs, have the patient hold her breath well and bear down, when the body will be expelled. Indeed, all through the case the patient must exercise great fortitude, patience, and for- bearance; be quiet and docile, and on no account must she throw up her arms, stretch herself, or let go her breath in the middle of a good bearing-down pain or effort. Some ladies are remarkably sensitive, and the greatest delicacy and kindness should be observed towards her in all things. Her person must not be exposed. Cool, firm determination, a cheerful disposition, with the use 844 DISEASE GERMS. of warm stimulating drinks, are of more utility than a lot of humbug. We must guard against too sudden a delivery, with membranes, water, and after-birth altogether, as that is very apt to be followed by hemorrhage. After the delivery of the child, lay it on the right side, remove any mucus from its mouth, and give it a very gentle beat on the back with the open hand. Usually this is sufficient to establish respiration ; if not, artificial respiration, or otherwise, should be resorted to. (See Asphyxia) Respiration may be suspended for over forty minutes, and resus- citation may take place ; so our efforts should continue as long, As soon as the child cries lustily, and there is evidence of a proper supply of arterial blood, that is the time to ligate the cord, applying the first ligature from three-fourths to one inch from the belly, the other one two inches further on, and then dividing or cutting it between the two. As soon as this is done, wrap or roll up the child in a blanket, and hand it to the nurse; then attend to the mother, and the removal of the after- birth. On placing your hand over the abdomen, you will find the uterus either contracted or relaxed. If contracted, the after- birth may be in the vagina, and a cough, or sneeze, or blowing with some force into the palms of both hands, or a gentle bear- ing-down effort, or slight traction on the cord, may cause it to come away. As soon as it approaches the vulva, it should be grasped and twisted round several times, so as to twist the mem- branes, and have them come easily and entirely away. If the uterus is relaxed, and after-birth attached, resort to fric- tions with oil over the abdomen, so as to cause contraction; allow a little rest till the vital forces rally. Administer a little capsicum in warm sweet milk, or a little quinine, or a little hot punch, so as to establish permanent tonic contraction of the uterus. If there is retention of the after-birth after tonic con- tractions have taken place, use friction, sham- pooing, dry heat to the abdomen, enemata of tepid water into the rectum, and administer stimulants. These means failing, after waiting perhaps one or two hours, introduce the hand in the form of a cone—the back of it well Extraction of a re- oiled—into the cavity of the uterus, and gently grasp the placenta, or after-birth. It is very probable that the presence of the hand will cause such violent con- tractions, with expulsive pains, as to cause it to be thrown off. « not, detach it carefully, and leave no portion behind; wait until a pain comes, when withdraw the hand in harmony with the bearing-down effort. This is best effected with the patient on her back, knees drawn up, and I will repeat, let it be done with BACTERICIDES. 845 great kindness and gentleness. After it is removed, the patient should be carefully bandaged, from the middle of the thighs to the bottom of the sternum, with a thin compress over the uterus. In applying this bandage, it should be pinned from below up; a pin every inch, and free from all wrinkles. Then a dry, warm diaper should be pressed against the vulva. This, or a similar bandage, should be applied daily, and seen to by the physician or nurse for ten days, and it should be worn for at least two or three months. On the re-application of the bandage, it is well to sponge the abdomen with a little hartshorn and tepid water; dry off well, and then use either bay rum or cologne-water. By this means all the cracks, fissures, crevices, of the abdomen are avoided ; also enlarged or pendulous abdomen. A woman can be well preserved if due care is taken of her, even after she has had a dozen children. After the bandage is applied, the patient should be moved up to her proper place in bed, and a doubled quilt placed underneath her. The use of the bandage after delivery has many advan- tages. Besides maintaining the natural condition of the abdo- men, //stimulates the uterus to contraction, and thus prevents hemorrhage; it rests the broad ligaments, and gives*support, and prevents falling of the womb; it is, besides, a great safeguard and comfort to the woman, and on no account can it be dispensed with. Always pin from below up, firm at first, but always easier as you progress upwards. If there is any disposition to hemorrhage, in addition to the roller put the child to the breast at once, or as soon as possible after the mother has rested. The first cathartic should be given after the mother has had a sleep ; and it should be oil, on account of its influence in secreting milk. All through, during and after labor, the bladder should be carefully watched, especially if there is any retention of urine. The diet of the mother, if not very feeble, should, for about nine days, consist of plain oatmeal gruel, sago, arrowroot, rice, tea and toast, beef-tea. As a rule, beef, mutton, chicken, game, or highly-seasoned food, or stimulants, should be avoided ; but after the ninth day, a generous and nutritious diet may be allowed, even as liberal as the patient may desire, avoiding all indigestible articles, as veal, pork, salt meat and fish, pie-paste, cabbage, etc. The discharge that comes, or takes place from the uterus after delivery, is called the lochia, or cleansing, and should continue from two to three weeks; If longer than three or four, means should be taken to tone up the uterus by port wine and Peru- van bark, mother's cordial. If it should suddenly cease inside 846 DISEASE GERMS. of the first two weeks, measures should be taken to re-estab- lish it. The most common causes that are likely to* cause its arrest, are cold, cold drinks, ice; sudden mental emotion, or excitement, or worry, or passion. To cause its re-appearance, try heat to the vulva, over the uterus, and to the feet, with infusion of catnip, and a few drops of the tincture of aconite. If that fail, try serpentaria compound, in half-teaspoonful doses, in some warm tea, and administer enemata of flaxseed tea, with laudanum. If that fails let patient drink linseed tea, warm, with tincture of snake-root. If the stoppage, or arrest of the lochia takes place inside of the first ten days, we may entertain apprehension of its absorption into the blood, and puerperal fever; later than that it is not likely to be attended with such grave results. The prevention of its disap- pearance, by keeping the patient quiet, free from all care or anx- iety, by a strict avoidance of all cold drinks, and inculcating other elements of comfort, which are of great consequence, will almost infallibly ward off this complication. The early and often indiscreet use of ergot is most disastrous in parturition, by energetically stimulating the lumbar portion of the cord, and often causing rapid contraction of the entire uterus, neck and all. This is most liable to occur if the drug has been administered freely early on the expulsion of the child, causing a retention of the placenta. If this should occur, opium should be administered in small but repeated doses, to relax the neck of the uterus; inject hot water copiously into both rectum and vagina, following with one or two obstetric cones into each ; apply scorching hot pillows to loins and over uterus. If not successful, in a short time in get- ting the fingers and hand into the uterus, after it, inhalation of a few drops of chloroform on the towel, never enough to produce anaesthesia, because the blood is embolized and heart feeble. If this fails, try enemata of lobelia, and administer the same inter- nally in small doses, just enough to nauseate well, but not to cause emesis. In connection with the lobelia, insert a cocaine suppository into both rectum and vagina every three hours. These means failing, insert a No. 12 cat-gut bougie, well up to the fundus of the uterus, and leave it there for a few hours to try and excite or originate pains or contractions. If all these means fail, then inject the uterus thrice daily with either tepid solutions of creolin, or boroglyceride and being care- ful that it all escapes, keeping the patient under the influence of opium and the uterus under bactericides. Retention of the placenta must invariably be regarded as a BACTERICIDES. 847 most grave complication, there being great danger of metria, septicaemia. Owing to the nervous, impressible condition of the reflex nerve centres in American ladies, they do not bear uterine injections well, and they in themselves are dangerous from the fluids finding their way into the uterine sinuses, thence into the circulation. The emerging of the fcetus from the uterine cavity in some one of its six vertex positions, head downwards, a position the necessary and ultimate consequence of its own specific gravity; extension and impaction of the child's lower limbs against the resisting parts of the uterine cavity, is the normal state. The breach, or the feet, knees, buttocks, are regarded as natural, and are next in frequency to the head, but they are not such good points for dilatation ; consequently, the labor is very slow or prolonged, and even when the feet, knees, buttocks and body are expelled there is danger to the child, if the head is not delivered, by pressure upon the cord. If hemorrhage should occur during natural labor, enjoin rest, recumbent position and a plug. This latter is uncomfortable, and really does not hasten evacuation much, and scarcely pre- vents hemorrhage. If these means fail, endeavor to excite uterine contractions with quinine, capsicum, corn-smut, mistletoe. If still persistent, and the os uteri dilatable, rupture the membranes and introduce the hand into the cavity of the uterus, seize the feet and bring them down with their toes pointing to either thigh of the mother, so as to bring the long diameter of the head into the long diame- ter of the pelvis. In convulsions during natural labor, if the mouth of the womb is rigid, administer opium and lobelia, by the mouth and by enemata; if they recur, inhalation of chloroform; and as soon as the mouth is dilated sufficiently to admit the hand, insert it, seize the feet, and bring down, with the toes pointing to either thigh; and deliver under chloroform and hypodermic injection of morphia. If fainting fits should occur, and they are due to debility, or some peculiarity of the nervous system, diffusible stimulants should be given; but if they are due to internal hemorrhage (concealed), turn and deliver. If there is a rupture, and danger of strangulation, and the mouth of the womb is dilatable, turn and deliver. In case of presentation at the shoulder-joint, it is easily recog- nized by the child lying crossways in the abdomen, head at one side, buttocks at the other, by the sharp point of the shoulder 848 DISEASE GERMS. or the descent of the arm. In cases of this kind, delivery can- not take place, and it is necessary in all cases to turn. So wait until the mouth is sufficiently dilated to admit the hand; then rupture the membranes, *if still entire, and proceed to turn. In doing this, the patient should be placed upon her back, knees drawn up; the back of the hand of the operator well oiled; hand in the form of a cone, gently introduced into the cavity of Arm presentation, first position. Compound presentation, head, feet and cord. the womb; seize the feet and bring down, with the toes pointing to either thigh of the mother. If the hand of the child has de- scended, the palm will either point to the front or the back; this forms an excellent guide to where the feet are to be found. If it points to the front, insert the hand up in front, and there the feet are to be found; if to the back, then in that direction. This saves groping round after the feet In all cases of turning, or when it is necessary to introduce the hand into the uterus, it should be done during the absence of a pain ; and if a contrac- tion or pain comes on when it is so introduced, let it lie flat until the pain subsides, and then proceed and bring down the feet After-Pains.—After the first confinement there is usually no after-pains, as the uterus does its work well and with energy; that is, effects a perfect evacuation of its contents, leaves nothing behind, but in all subsequent deliveries, there is liable to be a slight inertia, or sluggishness, and there is apt to be an imperfect closure of the uterine vessels, an oozing, or clot, or shred of the secundaries, a something which the uterus tries to expel. It is simply due to a want of tone, and it is greater with each subsequent delivery. The pains are due to contraction of the uterus upon something, which if large, the pains are severe; if small, less annoying. Ladies affected with neurasthenia of the spinal cord, after labor, often have the recently emptied uterus brought into a most vio- lent and painful contraction, without any discernible object in view; and a severe case of this kind is bad; much more painful BACTERICIDES. g than ordinary after-pains, that come on to expel a clot or piece of membrane. In all cases of after-pains, whether mild or severe, the roller should be kept applied, but not too tight, as it acts as a stimu- lant to contraction. A solution of sulphate of morphia, thus : sulphate of morphia, four grains; bicarbonate potass, twenty grains; cinnamon water, four ounces. Mix. Dose, one teaspoon- ful, as indicated, relaxes the neck of the uterus, and by adminis- tering gradually just enough to permit the egress of the clots, discharge or cleansing, and discontinuing as soon as relief is afforded. If in spite of this, pains persist, evacuate the bowels with a dose of castor oil, and insert one, two or more obstetric cones. Ftom extensive observations of the bacteriology of the genital canal in the non-puerperal condition, it has been found that the uterus, its tubes and crevices, upper part of vagina, when in a normal condition contain no micro-organisms, but all below the external os, in the cervix and lower portion of vagina, organisms are numerous. They consist of cocci, pathogenic in appearance and behavior, but in an attenuated condition, incapable of culture. The lochial discharge is simply a myriad of disease germs, but they contain no power of inoculating till they reach the vagina, when patients are affected by their own secretions. The lochial organisms are intimately associated with the microbes of suppuration and septicaemia, hence the indispensable necessity of obtaining aseptis in obstetrical practice. The hands of the physician, all instruments, cloths, as well as those of the nurse, should be carefully disinfected by solutions of boroglyceride, resorcin, creolin, iodine. A closure of all lacerations at the earliest possible moment after delivery, to render them impervious to the entrance of germs. Boroglyceride, acetic acid, creolin, resorcin, iodine, etc., are excellent disinfectants, styptics, non-poison- ous, produce no unpleasant effects, and are fatal to all micro-organisms in the puerperal state ; the bo- roglyceride and creolin in solution are superb, leave the mucous membrane smooth and healthy. Hour-glass contraction of the uterus and retention of the placenta or after-birth, is not at all uncom- Hour.gl. mon, and most cases noted can be traced to the traction of the early and persistent use of ergot. Hour-glass con- traction is a condition in which some nerve that supplies the centre of the uterus is weak, which receives an undue amount of stimulation from the cord, irritated by the ergot, which causes it to contract in the middle, with the after-birth in the upper half. This is not nearly so grave an affection as contraction of the 54 850 DISEASE GERMS. neck, for when some degree of relaxation is induced by either chloroform or lobelia, it usually yields readily to gentle manipu- lation, first one finger being inserted then another, and so on, latterly the whole hand gets through the obstruction, seizing the after-birth, gently withdrawing it. Placenta prazvia, a condition in which, instead of the after- birth being adherent to the fundus, it is implanted over the mouth of the uterus. This is usually recognized sometime between the fourth and sixth month, by an almost daily dribbling or oozing of blood, which increases in quan- tity and frequency as the neck merges into the body, and during the later months the loss is quite considerable. On making a digital examination, a soft, spongy mass can be de- tected over the mouth of the womb. In all such cases it is well to have another physician in attendance besides the regular one, not for aid, but to share the grave responsibilities of such a case. Wait until labor sets in; if there should happen to Placenta praevia ; the child's head firmly imbedded in be hemorrhage, USe the the after-birth. pjug made Qf severa] fine sponges until the mouth of the womb is sufficiently dilated to admit the hand ; then push away the after-birth on one side, whichever yields most readily ; then insert the hand, rupture membranes, and bring the feet down, toes to the thigh of the mother. Before resorting to this, either brandy or capsicum should be given, with infusion of good, fresh ergot; the abdomen rubbed with warm oil; and every means taken to facilitate de- livery. Promptness of action and a clear head are necessary in this crisis, in order to save either mother or child. When turn- ing is once consummated, there is little of further hemorrhage, because the head of the child eff-Ctually blocks the mouths of the bleeding vessels. If no physician is near, the nurse or mid- wife must pursue the above course, without aid, for if she wait, death will inevitably take place. There should be no inter- BACTERICIDES. 85I ference until the mouth is dilated to admit the hand, only by the plug, but everything be in readiness. Inducing, exciting, stimulating uterine contractions during labor is often necessary, and we have many valuable agents for effect- ing this purpose. The drug in common use is ergot, which when administered freely, produces continuous contraction of the uterus, and embolism of the blood. In all cases, every possible means of increasing the vital action of the uterus should be tried before risking the life of both mother and child upon this drug. Ustilago maidis, corn smut, is rapidly taking the place of ergot. It is a uterine excitant of the highest order; when administered in parturition, it gives rise to intermittent contractions and does not create embolism. Sulphate quinine is an efficient parturient, stimulates contrac- tions, cleanses the uterus of retained clots, membranes and pla- cental debris. Its action as an oxytocic has long been known ; it acts upon the body of the uterus alone, leaving the cervix un- touched, thus being superior to ergot, which acts upon both body and neck and occasionally occludes pieces of membrane. Painless labor is the great desideratum of ladies of the present age, and is effected in a variety of ways ; anesthetics are not to be recommended, except in some rare cases. Smearing the loins and entire abdomen with the following acts well: Concentrated ozone, four ounces ; chloroform, two ounces; sulphate of mor- phia, ten grains. Mix. Before applying the above, insert two obstetric cones up the rectum and the same number up the vagina. These cones being composed of cocah.e, peroxide of hydrogen and boroglyceride, render all parts to which they are applied aseptic and completely blunt the sensory nerves, aid dilatation, facilitate a speedy, painless delivery. If, from any cause, labor be prolonged, their administration can be repeated, as the attending accoucheur may direct. Various complications or accidents may arise, as extravasation of blood into the labia; this is usually either caused by the presence of the head or instruments. After the labor is over, apply cloths saturated with either dis- tillation of witch hazel or arnica or marigold ; these failing to excite absorption, use tincture of iodine in lime-water. Convulsions appearing during the progress of labor, belong to a state characterized by anaemia or congestion. In both forms, turn, and deliver with all speed, if the mouth of the womb is dilatable. If due to anosmia, hypodermic injections of morphia ; lobelia enemata, and very nourishing drinks; or use inhalations of chloroform or chloral hydrate, with the hypodermic injections. If due to congestion, enemata of lobelia, active purgation, hy- 852 DISEASE GERMS. oscyamus, bromide of potass ; heat to feet, stimulants to nape of neck, cups ; all failing, administer either by mouth or rectum the antispasmodic mixture, which is a safe and always efficacious remedy. A division of the class thus enables you to meet them with great promptness. Rupture of the uterus is very apt to take place if there is any obstruction, hardened faeces, an exostosis of the promonotory of the sacrum, deformed pelvis, a bad presentation, turning during a pain, or the use of ergot during the first stage, and such like causes. Some think fatty degeneration of the muscular fibres of the uterus has much to do with it, and thinning of its walls. It is easily recognized by the sudden cessation of pain, fainting, pallor, death-like coldness, and, on placing the hand over the abdomen, the child can be detected in the cavity of the abdomen out of the uterus. If such an event should take place, the abdomen should be slit up, its cavity exposed, the child, after-birth, blood, clots and water carefully sponged out, the cavity of the uterus cleansed, the whole stitched up and bandaged. An effort should be made to rouse up the patient by administering diffusible stimulants; and if she rallies, treat for peritonitis. Unnatural Labor.—-Unnatural labor may arise from defective uterine power, and abnormal states of the pelvis, and by some Face presentation, Face presentation, Passage of the head through ist position. 2d position. the external parts in face presentation. peculiarity on the part of the child. Of this latter the most common malposition is presentation of the face. The face usually presents in two positions—the first is when the forehead is to the left ilium, and the chin toward the right ilium. This is the most common. Treatment.—If the pelvis be not smaller than usual, assistance will rarely be necessary, but if the delays be great, interference is justifiable. If there is an impediment, we must decide whether there is room for the application of the forceps, or whether craniotomy is the only alternative. The time for operating must be determined by the symptoms. BACTERICIDES. 853 Malpresentations.—The head is the type of natural labor, so that any presentation of any other part of the body may be classed under the head of malpresentations. Presentation of the breech.—This presentation in the statistics of my practice occurred about one in sixty. The breech may Breech presentation, ist position. Breech presentation, ist position. Breech presentation, 2d position. present at the brim in different positions, but as it enters it usually arranges itself, so that, either first, the back of the child shall be turned anteriorly toward the abdomen of the mother; or, second, the back of the child shall look posteriorly toward the back of the mother, not directly anterior or pos- terior, but obliquely, the transverse diameters of the child's hips corresponding to one or Breech presentation, extraction of the head. Presentation of the inferior extremities other of the oblique di- ameters of the brim. In the first and most frequent position the left ischium corresponds to the left acetabulum, and, being anterior, it is de- pressed, and presents at the os uteri, so that the finger impinges upon it if it be passed into the centre of the os uteri. In this oblique position the breech descends into the cavity. On examination, we discover the absence of the head, blocking up the passages. Presentation of the inferior extremities.—In my practice, I have met with this position but once in one hundred and ten cases. By this presentation I include both of the knees and feet. There 854 DISEASE GERMS. are but two forms of malpresentation. When the toes are di- rected backward, and when they are directed forward, they correspond exactly to breech presentations. The first thing that excites our suspicion of its being unnatural is very often the early rupture of the membranes and the large quantity of liquor amnii that escapes. Presentation of the superior extremities.—I have met with this presentation once on an average in every 230 cases. In almost all cases, it is the shoulder with primarily presents, and after- Arm presentation ; position for Arm presentation, turning ; ist position. 2d posiiion. wards the arm prolapses, but sometimes we find the arm, or hand, or elbow, at the beginning of labor, at the os uteri. In all cases the back of the child either looks toward the abdo- men of the mother, or backward toward her spine. Version, or turning; seizing the feet. Turning; bringing down the feet. The delivery of a child so placed is impracticable, unless assisted by art. Although cases of spontaneous evolution have been met with, yet they are very rare. Symptoms—Labor with this presentation is extremely danger- ous to the mother, being about one lost in every ten, and of chil- dren more than one-half. After the membranes have burst, and discharged more liquor amnii than in general, when the head or nates present, the uterus contracts tighter around the child, and BACTERICIDES. 855 the shoulder is gradually pressed deeper in the pelvis, while the pains increase considerably in violence from the child being unable, from its faulty position, to yield to the expulsive efforts of nature. Drained of its liquor amnii, the uterus remains in a state of contraction even during the intervals of the pain ; the consequence of this general and continued pressure is, that the child is destroyed from the circulation in the placenta being interrupted, the mother becomes exhausted ; inflammation or rupture of the uterus or vagina are unavoidable results. Treatment.—The labor is impracticable; there is nothing to expect from natural efforts, except an increase of the difficulty, so that it is our duty to interfere in every case with promptness and energy. If the malpresentation is detected before the rup- ture of the membranes, and the liquor amnii has not escaped, there is seldom any difficulty, but, after its escape, the uterus contracts firmly upon the child, and, in proportion to this con- traction, is the difficulty. If the uterine action be very intense, the operation may be impossible; if so, give opium in solution, alternately with lobelia, to perfectly and thoroughly suspend uterine contraction. After suspension, turn the child; if the front of the head points anteriorly, slip the hand up in front, seize the feet gently and firmly, and bring down the feet in such a manner as to have the great toe pointing to the inner part of the left thigh ; if the anterior portion of the arm points to the coccyx, insert the hand behind and bring down the feet, with the great toe pointing to the inner portion of the right thigh. Then the management of the labor will be the same as breech presentation. Prolapse of the umbilical cord.—Natural Complex Labor, labor, we have seen, is where the agents or elements of parturition are equally bal- anced. Unnatural labor, where some abnormal deviation has occurred from some deficiency or irregularity in the power, in the passage of the child. We have now to consider another element in parturition ; an accidental complication, which renders a labor complex. The labor may be natural or unnatural, but this complication renders it complex. Prolapse of the cord.—The first and most common complica- tion is, prolapse of the umbilical cord, either above or with the presenting part of the child; and it may occur at the beginning of labor or during its course. The accident, or complication, has no bearing upon the progress of labor, but a most disastrous 856 DISEASE GERMS. Prolapse of the cord. effect upon the child, and any interference that the physician re- sorts to should have this one object in view. More than half the children are lost, which gives us a large mortality indeed. Causes.—This accident occurs about once in 230 cases, and is caused by various circumstances, as the malposition of the child; a small child with a large quantity of the liquor amnii; the sudden rupture of the membranes; the forcible rush of a large quantity of the liquor amnii; pre- sentation by the feet or knees; irregular shape or irregular action of the uterus; where the placenta was situated low down, near the cervix uteri, etc. The child is in the greatest possible danger in all cases of dropping of the cord. Treatment.—The means to be adopted will depend entirely upon the state of the prolapsed cord. If it exhibits marks of putrefaction, or is flaccid, without pulsation, it is useless to inter- fere, because hopeless, as regards the life of the child; but if pulsation be good, there are various modes of management. Push up the cord, beyond the brim of the pelvis, and there retain it with one or two fingers, until the upper outlet is filled by the descending head. Labor may be obstructed by mechanical impediments in the passages, which are numerous, and varied in their character. One, formerly rare, but now becoming common, is tumor of the ovary. The enlargement is sometimes solid, more frequently fluid, or containing a substance of the consistence of honey. If the dis- ease progresses slowly, the uterus, with the ovaries by its side, will have emerged from the pelvic cavity in time to remove the obstacle, which will then be in the abdominal cavity; but, in some cases, either from the situation or rapid increase of the ovarian tumor, or by adhesions between it and the neighboring parts, it is retained in the pelvis, and may offer a serious obstruc- tion to labor in the second stage. There are several forms of ovarian tumors which thus obstruct the passage of the child. It may be a cyst or a real enlargement of the ovarium; but, gener- ally, an ovarian tumor is much more likely to be moved out of the way of the child at the time of labor than any other form of tumor. Ovarian tumor. BACTERICIDES. 857 The diagnosis is usually difficult. If the tumor within the recto-vaginal septum be movable, elastic, and communicates to the finger a sense of fluctuation, it is probably ovarian, but it is not always so ; it may be hard, not fluctuating, and, to the touch, solid. The only practical test is puncture. Treatment.—Give ample time to see whether the tumor be not displaced by an effort of nature ; carefully estimate the effects of pressure upon it before bad symptoms supervene. If it be insur- mountable by the natural powers, if it cannot be raised above the brim of the pelvis by the hand, then we must puncture the cyst through the vagina; nor are we to be deterred by the apparent solidity of the tumor, as they mostly all contain fluid. A long trocar and canula should be used, and plunged quite through the parietes of the tumor. If fluid be freely evacuated we shall have no further trouble with the labor; if it be viscid, and ^does not pass freely through the canula, enlarge the opening. Vaginalcystocele.—The necessity of keep- ing the bladder empty during labor is clearly pointed out, as, if it is distended, it is apt to be caught by the head of the child in its descent and pushed before it into the cavity. The patient complains of fulness, tension, pressing down and dragging, a desire to vaginal cystocele. evacuate frequently, and inability to do so. On examination, we detect a tumor in front of the pelvis, par- tially covering the head and containing fluid. The fiuger passes easily posterior to the tumor, but not anteriorly, and the catheter cannot be passed in the usual direction, clearly indicating its nature. This, if it exists, occasions delay in the second stage, and danger to the mother from rupture of the organ. We should be active here, whenever we are aware of the im- pediment A gum bougie should be at once introduced, the point directed backwards, and we shall very probably be suc- cessful in emptying the bladder; if necessary, raise the head a little with the finger, during an interval, to facilitate the intro- duction. We usually succeed, but, if we fail, the labor will be arrested by the obstacle, or pressure threaten a rupture. I have always been able to draw it off, therefore, I cannot, from experience, recommend tapping the bladder with a trocar, through the vagina, which is often done. If the quantity of urine be moderate, pres- sure not excessive, the head of the child not large, we may leave the case to nature. But, after the labor is over, we must imme- diately evacuate the bladder, and watch the patient. 858 DISEASE GERMS. Various minor operative procedures are in use for the purpose of aiding parturition. The vectis or lever.—The great variety of levers in use have only led to confusion and misunderstanding. The nature of the aid afforded by this in- strument is threefold: First.—To correct malpositions, or aid the natural rotations of the head at the brim, or in the cavity of the pelvis. Second.—As a lever, making a fulcrum of the pelvis, or the left hand of the opera- tor, external to the pelvis. Its employ- ment in making a fulcrum of the soft parts of the pelvis is extremely dangerous, besides the chance of injuring the soft parts, or the child's head. The vectis applied. . • , , Third.—As a tractor, it should not be em- ployed to wrench, but to hook or draw down. The cases in which the use of this instrument is indicated are: Those in which the head, having descended into the pelvic cavity, is arrested in its progress by the inefficiency of the pains, when the patient is beginning to exhibit symptoms of constitu- tional or local disturbance. This^ does not take place until the second stage of labor has advanced some hours. There is supposed to be space enough, but pains feeble, and a slight additional force will often succeed in bringing the infant into the world ; and as there is nothing in the nature of the operation to add to the danger, and more par- ticularly since the tractile force will be sufficient, it seems pecu- liarly adapted to these cases. , In cases of convulsions, resulting from the head pressing upon the sacral nerves, the use of the vectis is specially indicated; provided the pains continue, the aid of the lever may consum- mate the labor. Respecting the time when the instrument ought to be used. This is regulated somewhat by the object sought to be attained. If to assist the head in passing through the upper outlet, or to change its position there, then operate whenever the os uteri is dilated or dilatable ; but never use this extractive power during the interval of contraction, but during its continuance; and it is only as the result of considerable experience that the practitioner can, nearly always perceive whether or not a woman still retains the power of assisting her labor. Of course, in cases where serious constitutional disturbance exists, the vectis ought to be applied as early as possible. BACTERICIDES. 859 The forceps are invaluable in cases of inertia of the uterus powerless labor. The object of the operation with the forceps is to facilitate delivery when its progress is arrested by certain malpositions of the head at the brim, or in the cavity of the pelvis. To supply the want of uterine action, or to render it effective for the expulsion of the child. To save the mother from the evil results of too long a labor. To save the child, or at least afford it a chance of escape from certain destruction. These objects are attainable by the nature of the aid afforded by the forceps, and that they have attained most brilliant results, experience has proved. The forceps possesses a twofold power : First.—It grasps and compresses the head of the child. Second.—It acts as a lever of the first kind and as an extractor. The compression exercised by it must be limited within the degree the head can bear without injury. The extracting force will be in propor- Application of the forceps. tion to the firmness of the grasp, limited by the resistance, by the danger of injury to the mother. If there be sufficient space, we may so grasp the child's head, without injury to it, as to enable us to extract it, and the ex- tracting force is not sufficient to injure the mother. Numerous cases occur where the transverse diameter of the child's head is rather larger than the antero-posterior diameter of the brim, or the transverse diameter of the lower outlet; but, if this does not exceed the amount of compression that the head will safely bear, and the force required safe to the mother, such extracting force may be supplied by the forceps, which will likely render the uterine action effective. In inexperienced hands this might fail, but with ordinary care no mischief will be done. A sufficient grasp will almost always be obtained, where the head is not impacted, to enable us to alter the position of the child. There can be no doubt of the propriety of using these valuable instruments, as compressors within natural limits, if early used and properly applied. They are extremely valuable in tedious labors, for abnormal or diseased action of the uterus. In these cases they should be freely used, and the best period for their use is early in labor—as soon as the os permits—before the maternal system suffers. 86o DISEASE GERMS. It is a well recognized rule in obstetrics, that the forceps are not to be applied until we are satisfied that the obstacle cannot be overcome by the natural powers with safety to mother and child. In craniotomy our object is to secure the safety of the mother, by the destruction of the child, where both would be lost were no interference attempted. Cases of rickets, deformity, a dispro- portion between the foetal head and the pelvis, whereby a living child cannot be expelled by the natural powers; distortion so great as to prevent its extraction. In distortion of the pelvis, when the antero-posterior of the brim is less than three inches, where we have no chance of delivery by other means; also, if the transverse diameter of the lower outlet is diminished to three inches. No approximation of the tuber ischii, if the forceps are applied antero-posteriorly, Use of the perforator. Application of the crotchet. Application of the crotchet is sufficient to move the head. We must have recourse to craniotomy. If the calibre of the pelvis is diminished to a certain degree by a fixed obstacle, as a fibrous tumor, exostosis, etc., it is neces- sary to diminish the head. It is also necessary, in certain cases of ovarian disease, where the tumor has formed adhesions within the pelvis, so as to prevent its being pushed above the brim, it has been found necessary to lessen the head before the child could be extracted ; but we must first ascertain whether the con- tents of the tumor may not be drawn off, in order to save the child. If the child be hydrocephalic to such an extent as to prevent its entering or passing through the pelvis, whether dis- torted or of the natural size, there can be no doubt about the propriety of opening the head. Mode of operating.—It is not necessary for the operation that the os uteri should be fully dilated, though it is an advantage, BACTERICIDES. 86! for greater care is necessary when it has not taken place. The rectum and bladder are first to be evacuated; then place the pa- tient upon her left side, with the hips over the edge of the bed, and an assistant to keep his hand expanded over the abdomen. Then make an examination, and find the part of the head for perforation, which is best at the sutures, for the bones will col- lapse more readily. Having decided upon the part or position, take the perforator, passing it along close to the palm of the hand, and inside of the fingers, so as to avoid injury to the soft parts of the mother. Once arrived at the point of insertion into the skull, carefully guided and guarded by the fingers, the perforator is to be pressed firmly forward, in a semi-rotating manner, until it pierces the bone; it is then to be passed in, the handles opened, the brain thoroughly broken up, the medulla oblongata thoroughly cut across. The perinaeum should be carefully guarded, and the greatest care exercised that the soft parts be not injured. Phantom tumors are among medical curiosi- Pregnancy, ties. They commonly occur in females, who, [Black) examined one day, might seem to have a large abdominal tumor, examined next day, nothing is felt. The size of these tumors varies much; in some it amounts only to the size of a fist, in another it may amount to that of a fully distended uterus, near the full term of pregnancy. These tumors have not unfrequently been mistaken for a true pregnancy, and everything been prepared for the birth of a child. Nay, the woman herself has been apparently in labor, and yet there have been neither conception nor even enlargement of the womb. The shape of the tumor may remain long unchanged, or may vary from day to day. Sometimes the patient complains of acute pain on examination, at other times, she is completely insensible. Again, and perhaps most frequently, these tumors seem to disap- pear under prolonged and gentle pressure, but they return next day or the day after. Now as to the cause of such tumors, or rather perhaps we ought to say their natures. In a goodly number of instances, they consist of flatus, limited to one particular portion of the bowel by contraction of the gut above and below. In other cases it is said that the muscular wall of the abdomen is concerned in their production, but the cases we have seen, have been of the former kind, especially if the walls of the abdomen and the omentum were loaded with fat. The diagnosis of these tumors is more a curious problem to 852 DISEASE GERMS. the physicians than of practical interest to the public. Their ex- istence is a fact, which, however, should never be forgotten. The same treatment as for neurasthenia. Constant and distressing erection of the penis, Priapism, may be caused by shocks, concussions, blows fractures, injuries of the lower portion of the spinal cord, occurring at the lower portion of the lower dorsal or upper lumbar of vertebrae: or at the origin of the nerves sup- plying the sexual organs in the brain. The gonococcus in the urethra often penetrates deeply into the corpus cavernosa, breeds rapidly, excites an inflammatory process, with effusion of lymph or blood into that structure. The damaging effects of masturbation and of abnormal and excessive coition, upon the same parts, the reflected irritation to the spinal cord and brain, is productive of this difficulty. The treatment of such cases will depend entirely upon the cause. In all cases of shocks, concussions, injuries of the spinal cord, general principles must guide. When due to sexual excesses, or masturbation, our chief de- pendence must be placed upon the frequent administration of large doses of tincture of the green root of gelsemium in alternation with as large doses of the bromide of potassa as the patient can bear. From thirty to sixty drops of the gelsemium every three hours, in small, but often-repeated doses, watching it carefully, with from thirty to sixty grains of the bromide of potass, to which a little bicarbonate potassa is added every three hours. Enemata of a solution of boroglyceride, to which a few drops of the tincture of belladonna is added. Persistently repeat,and repeat the gelsemium and bromide until the erections are overcome. If the case is one dependent upon the microbe of gonorrhea, the same plan of treatment should be pursued, with the addition of belladonna suppositories. The various affections which are associated Prolapse of the with prolapse of the mesentery are a clue Mesentery. to its pathology. Given in the order of their frequency, they are prolapse of the transverse mesocolon, prolapse of the hepatic flexure of the colon, and prolapse of the right kidney, prolapse of the splenic flexure of the colon, and prolapse of the left kidney. The pylorus and duodenum are at times also prolapsed, with elongation of the BACTERICIDES. 863 lesser omentum; but a mobile pylorus is such an ordinary oc- currence that it hardly deserves to be enumerated amongst the other complications. The co-existence of these affections has just been adduced as an argument to prove that when acquired hernia is associated with prolapse of the mesentery the prolapse is a cause of the hernia, and not an effect; and now it may be argued that their co-existence proves that, with rare exceptions, prolapse of the mesentery is not due to a local and accidental condition, but that there is, except, perhaps, in simple prolapse, a more general deterioration, in which the suspensory apparatus of the mesentery merely participates. The nature of the lesion which permits the displacement of the kidneys is pointed out by Landau, in his excellent work on movable kidney. In my opinion that author clearly establishes that the prolapse of those organs is due to elongation of the fascia which descends from the diaphragm for their support. The cases in which I have seen prolapse of the kidneys, either with or without hernia, show that the displacement of the kidney is nearly always associated with descent of the hepatic or splenic flexure of the colon. * Analogy would lead us to infer that prolapse of the mesentery was of the same nature as prolapse of the kidney, and was due to a failure in the suspensory apparatus. The question, how- ever, can be placed upon a surer basis, because there is no diffi- culty in ascertaining that when the mesentery is prolapsed its root becomes excessively movable and capable of being pulled downwards with significant ease; and moreover, dissection shows that under these circumstances the tissues which compose its root are thin and scattered and inadequate to resist displacement. The I suspensory muscle is one of the chief constituents of the root of the mesentery, and is, I think, mainly at fault. But there are other circumstances, which suggest that the peritonaeum ought not to be ignored ; for instance, I am not aware that either the hepatic or splenic flexures or the colon, or the transverse mesocolon, have other support than the serous membrane, and yet, as we have seen, prolapse of one or more of those structures is a common accompaniment of prolapse of the mesentery; also when the pylorus is displaced the elongation of the gastro-hepatic ligament is very obvious. All of these circumstances point to the import- ance of the peritonaeum as a factor in these displacements, in- cluding that of the mesentery. With regard to the other struc- tures which are involved in this affection, namely, the mesenteric artery, vein, nerves and lacteals, we can only infer that they play a minor part, although, as in prolapse of the kidney, they are noticeably elongated. The causes of the deterioration of the suspensory apparatuses and peritonaeum which permits these 864 DISEASE GERMS. various displace ments are not clearly indicated by my investiga- tions, but age has without doubt an important influence, and it seems quite safe to add other debilitating influences, such as poverty, wasting diseases, certain occupations, and the like. Prolapsus of the rectum, or falling of the Prolapse of 'the fundament, or a protrusion of the lower Rectum. bowel, may exist in various degrees; it may be simply a protrusion of the mucous mem- brane near the anus, or the various coats of the bowel, or the bowel itself may be protruded several inches. The chief causes of these displacements in children are: in- herent weakness of the parts, diarrhea, straining at stool, worms and any irritating disease of the rectum, or genito-urinary organs. The same causes may produce like results in adults, also chronic diarrhea, catarrh, dysentery, internal hemorrhoids, polypus, impacted faeces, diseases of the urinary organs, as irrit- able prostate and bladder, calculi, ulcer. Symptoms. — Usually in the early stages the prolapse takes place after the bowel acts. Insidiously, and pro- gressively the descent of the bowel or its coats follow any exertion, as running, Prolapse of rectum, with its mucous membrane. jumping, COUghing, Strain- ing, laughing, crying, etc. A fold of the mucous coat at first, by and by the inverted bowel may be protruded to the extent of four or five inches. This usually follows defecation, and is easily returned ; but if not cured speedily, the sphincter ani becomes relaxed, and the pro- lapsus becomes permanent; the intestinal mucous membrane being exposed to the air and subjected to various forms of irrita- tion, becomes thickened, indurated, often ulcerated; discharge of mucus tinged with blood; general distress, about the hips, back, with severe pain in defecating. The reflex symptoms are numerous, headache, mal-assimilation, nervous twitching, convul- sions, general impairment of the vital force. Treatment.—In the prolapsus of both children and adults, much good can be effected by improving the general health in every possible manner. Daily bathing, massage, flannel clothing and the very best of diet, abundance of fresh air. The patient BACTERICIDES. 865 should in all cases pursue an alterative and tonic course of treat- ment for some months. The best remedies for internal exhibition are Virginia stone-crop, collinsonia, bayberry, aromatic sulphuric acid and quinine; compound tincture of cinchona and nitro-mu- riatic acid, and for an alterative compound, saxifraga. The bowel, if possible, should never be permitted to remain protruded, if it can be returned; if this is difficult,make a hot poul- tice of pulverized slippery elm, in which are incorporated some powdered lobelia and belladonna leaves. After this has remained a short time the bowel is usually very easily replaced by oiling the back of the hand and pressing it gently, but firmly, against the boweX and replacing it. In some obstinate cases, it may be necessary to administer an anesthetic or place the patient under the influ- ence of a relaxant, as the compound lobelia. When the bowel is returned every precaution must be taken to prevent a recurrence or even a slight pro- trusion by applying a pad of lint firmly against the anus and a T- bandage. The bowels should be moved by a mixture pf castor oil and glycerine ; a sufficient quantity administered to cause one evacuation of the bowels; or fluid extract of butternut, or cas- cara sagrada lozenges might be tried for the same purpose. The patient for a few weeks should defecate in the recumbent posture so as to avoid straining. Immediately after the bowels have moved, a cold water hip bath should be used, parts well dried, and a teaspoonful of either the fluid extract of Virginia stone-crop, or collinsonia, or oak bark, or matico, or bayberry, added to one or two tablespoonfuls of water injected into the bowel, or if a mineral acid is deemed best, the following is of great efficacy: aromatic sulphuric acid, one ounce; water, six- teen ounces. Mix. Inject one ounce. The best suppository to use instead of the enemata is one made of the Virginia stone-crop, pulverized opium and butter of coca. If these means fail,, after a fair and prolonged trial, administer a large dose of castor oil before retiring to bed ; next morning, after the bowels are thoroughly emptied of their contents, the protruded portion should be well cleansed with warm water and 55 Prolapsus of three folds of the rectum with posterior tubercular ulcer — a most common condition in the diar- rhea of phthisis. 866 DISEASE GERMS. castile soap, and returned, then an ordinary anal speculum with a window its entire length, well warmed and oiled should be in- inserted its entire length, the vertical portion of the bowel ex- posed in the window of the speculum should be wiped dry, then C. P. nitric acid should be painted down its entire length. This should be repeated thrice, so as to be effectual. Then the speculum should be turned about three-quarters of an inch and another vertical streak made with the nitric acid, and this should be repeated so as either to make five or seven vertical streaks around the bowel. An interval of time should elapse between each turn of the speculum so as to permit the nitric acid to penetrate to the erectile fibres. Following this, one grain of pulverized opium should be ad- ministered every three or four hours to allay peristaltic action; patient confined in the recumbent posture for about seven or nine days. Underneath each of the vertical streaks of nitric acid, a species of plastic inflammation is set up, lymph is effused, thickening takes place and vertical pillars, usually strong enough to keep the bowel erect, are established. Food must be taken in a concentrated form, as it is not desira- ble to have the bowels move for over a week. At which time they should be acted on with castor oil. This is the most effective method of affording a radical cure. The uterus may be displaced in various ways, Prolapse, the most common forms being simple displace- [Uterus) ment in which it descends down and protrudes beyond the vulva; anteflexion, where the fundus of the uterus is bent over on the bladder; and retroversion, in which the fundus is bent over on the rectum; besides it may be displaced laterally. The predisposing causes are inherent weakness of organization, or debility. The exciting causes are a relaxed state of the vaginal walls, debility of the broad ligaments, added to which there is either tight lacing, lifting, jumping, strains, fall, standing occupations, constipation, indefinite retention of urine, congestion, tumors. Prolapsus and procidentia are two terms employed to designate a descent or falling of the womb, as it exists in two different degrees, or grades. Prolapsus means that condition in which the uterus falls below its natural level in the pelvic cavity. The term procidentia is used when the uterus slides down and pro- trudes beyond the vulva. It is simply prolapse or falling, ex- tended in degree, both conditions being the same. BACTERICIDES. 867 Symptoms.—Leucorrhcea, pain in the back, sense of weight or fulness about pelvis, bearing-down pains. Usually no impedi- ment to menstruation, or conception, as uterus is generally re- placed when in the recumbent posture in bed; irritation of blad- der and rectum. In prolapsus, uterus found depressed, resting on upper floor of perinaeum; in procidentia, a round or pear- shaped tumor, with os uteri visible at its centre, is seen project- ing beyond the vulva. Labia of os uteri, from exposure to air and clothing, often becomes excoriated; vaginal walls dry, harsh, cracked or ulcerated. Treatment.—As far as possible remove all predisposing and exciting causes, as debility, tight lacing, coughing, constipation, standing occupation, congestion ; carefully regulate bowels with either cascara sagrada or kola nut, so that the stools will be soft, and easy; place the patient upon the best of food and a tonic course of remedies, embracing such medicines as wine of aleteris farinosa; and coca erythroxylon, in alternation with comp. syrup of partridge berry and comp. tincture cinchona. A two-quart fountain syringe is an essential requisite of every lady's toilet. This must be used morning and night; The first thing in the morning, before getting up, it should be used in conjunction with a bed-pan, so as to keep patient strictly in recumbent posture. A selection from some of the following agents should be made for the purpose Prolapse of uterus (procidentia). of injecting: boroylyceride, resorcin, creolin, lime water and tincture of iodine, matico, oak bark, dis- tillation of witch hazel. A full quart or more be permitted to pass through—of a strength adapted to each particular case. Before the patient is permitted to get up, some form of mechani- cal support should be applied. This may consist of a silver, or gutta-percha cup, or it may be a fine silk sponge, cut in the shape of a small pear, with a silk cord fastened to it, which saturate with the last wash used, and then insert up the vagina, the broad base upwards and point or pedicle downwards, from which the cord hangs. Then patient to get up. The size of this pear-shaped sponge will depend on the capacity of the vagina; it must be large enough to prop the uterus up in its proper place. This process of injection is to be repeated at noon and at bedtime. The patient can easily draw the sponge out herself, which should be thoroughly washed every time. After the night injection the sponge need not be 868 DISEASE GERMS. inserted, but should be laid to steep in a solution of boroglyce- ride. This is to be repeated every day, changing remedies every three or four days, and keeping the patient lying down as much as possible. Cold water hip-bath, morning and night, to give tone to the pelvis and its organs, especially the broad liga- ment. All treatment, except the tonics, to be discontinued during menstruation. If the case is an aggravated one of procidentia, the uterus must be returned, and the same plan pursued. Now, if this fails in eight or ten weeks, which is seldom the case if patient is faithful, and the injections cold and of proper strength, return the uterus, and resort to the radical operation of painting seven vertical streaks on the vaginal walls, as described under Vaginal Prolapsus. This is better than humbugging with belts, supporters, plates, pessaries, rings, and other trash that irretrievably ruin a woman. Any lady, with a very little in- struction, may cure herself in a short space of time. It will aid matters much if she is freed from all domestic care, or toil, or worry, so that when about she can either walk gently, or ride, for the improvement of general health. A most excellent plan in old chronic cases, with considerable irritation and thickening of the neck of the uterus, is to pack the vagina with boroglyceride every night on retiring to bed. This exercises a most beneficial effect, as it stimulates absorp- tion of the effused lymph, and exercises a highly vitalizing action upon the parts; it gets rid of the induration, drains off the super- fluous products of inflammation. If this does not operate speedily, or efficiently enough, the in- sertion of two or three jequirity capsules, say about once a week, will cause a complete exfoliation of dead tissue to take place, and lighten to a considerable extent the specific gravity of the uterus. The body or fundus of the uterus may be thrown forward on the bladder, or backward on the rectum, constituting anteflexion, or retroflexion. If the displacement backward or forward is not very great, there may be very few symptoms present. If the flexion is quite considerable, there is much suffering; the uterine ligaments are unduly stretched, the circulation through the body of the uterus is interfered with, impeded, and the fundus immovably fixed on either the bladder or rectum. . , The leading features of those cases are great languor, lassitude, debility ; dull, wearing, aching pain in back; tenderness about tfte groin and inside of the thighs; sense of fulness or obstruction in either rectum or bladder; pain in coition; fecundation prevented, BACTERICIDES. 869 severe dysmenorrhcea; nausea, gastric irritation, loss of appetite. Great mental depression, reflex irritation, etc. The displacement is readily made out in all cases by the uterus sound. Antiflexion of the uterus gives rise, in addition to pressure on the bladder, to sterility, dysuria, dysmenorrhaea, dyspermasia. The kink produced in the cervical canal by the flexion of the cervix prevents the ingress of the seminal fluid into the uterine cavity. Until this obstruction is removed by straightening the canal, the sterility will persist. To effect this the introduction of an intra-uterine stem is the only certain remedy. Slight flexions may be relieved by the occasional passage of the uterine sound. Backzvard displacement, and uterus freely movable, the bladder should be emptied and the uterus fully replaced by bimanual manipulation in a position of complete anteversion, the fundus being directed to the pubes and'the cervix to the sacrum. A Hodge pessary of sufficient size is to be now inserted to keep the cervix in this position. The use of the pessary in the posterior cul-de-sac is not to support the body of the uterus, but to sling the cervix upwards and backwards. When adhesions prevent reposition, and no active disease exists, stretching and loosening the adhesions is to be recom- mended. Cases of this kind are not by any means Prolapsus rare. It#is met with in women who have of the Vagina, practiced masturbation, or borne many children, or had numerous miscarriages. Tight-lacing, strains, lifts, coughing may produce it. When the front part alone is affected it draws down the back portion of the bladder and is called vaginal cystocele ; if the back wall of the vaginal falls down it is called vaginal rectocele. In the former case, urine is apt to accumulate tn a pouch formed by the bladder; in the latter, a pocket forms in which hardened faeces are retained, causing a sense of weight and irritation. In the treatment of prolapsus of the walls of the vagina there should be an avoidance of coughing, straining, lifting, and above all things, tight-lacing. The patient should be placed upon a general tonic and alterative course of treatment: the wine of the aleteris farinosa and coca erythroxylon in alternation with compound partridge berry, compound tincture of cinchona, avena sativa. Vaginal injections, with fountain syringe thrice daily, very copious, consisting of boroglyceride, matico, oak bark, glucozone, distillation of witch hazel. Pastiles are also of great utility. 870 DISEASE GERMS. An effort of cure should be tried by these and like means. All failing, then a radical cure should be tried, as follows : In diminishing the calibre of the canal, in exciting seven pillars of plastic inflammation, or effused lymph to prop it up. It is performed as follows: Bladder to be evacuated, rectum thoroughly syringed; the vagina to be washed out with a quart of soapsuds; the protrusion returned; then introduce a proper-sized speculum, with a window; wipe dry the part of the vaginal walls opposite window; then take chemically pure nitric acid and paint a vertical streak one-quarter of an inch wide and two and a half inches long; paint it neatly and carefully seven or eight times; when finished, turn speculum half an inch and repeat the same process by making another, and another, until seven good streaks are made. Before re- moving speculum, fill it with a piece of lint, saturated with olive oil, which, hold firmly with a ramrod; then withdraw the specu- lum, leaving the oiled lint in vagina. Administer one grain of opium every three hours, to lock up the bowels; keep patient in bed ten days, with a catheter in bladder; permit no straining, laughing, or lifting for some time; bowels to be opened with enemata or cascara sagrada. This is the most effectual method, if well performed. The oiled lint need not be disturbed for a week, unless there is some uterine difficulty above; if there is, it may be necessary to remove it inside of twenty-four hours. On the removal of lint, injections of cold linseed tea or slippery- elm-water ; all through, pushing tonics and good diet. A more recent method is contraction of the calibre of the vagina by the use of the jequirity wafers, and occasionally pack- ing the vagina with boroglyceride. One of the most common of all maladies, a Prostatorrhcea. hyper-secretion of the tubular glands of the prostate, due to any irritation, such as mas- turbation, extension of the gonorrheal germ, to marital sexual excesses,sedentary habits; bicycle riding, etc., morbid sensibility of the prostate, aggravated by stricture, riding, alcoholic and malt liquors, with contraction of the perineal and other muscles during the micturition and defecation. Such an irritation, with sufficient discharge to barely cause a gluing of the lips up to several drachms, invariably depreciates the quantity and quality of the semen, so that under the micro- scope, the discharge is found to consist of cylindrical epithelial cells, countless refractory and colorless granules of lecithen, and minute, yellowish concentric, amyloid concretions, phosphate of BACTERICIDES. 871 magnesium, watery and colloid semen. When the secretion de- pends upon chronic inflammation of the glands of the prostate, it thickens, and contains in addition, pus, mucus, corpuscles, muco- purulent casts of the follicles and ducts. In addition, the local signs, urgent desire to relieve the blad- der, scalding in urinating, a sense of weight, fulness, even dull pain in the perinaeum. Aching, with darting pain in the hips, ex- tending down to the knees; unsteadiness of gait; and reflexly the irritation is carried to the medulla oblongata; brain suffers, as we see by the vertigo, tinnitus aurium, haziness of vision and unbal- anced state of the sufferer. In all cases, it is an obstinate affection to treat. All causes that tend to produce or aggravate the trouble must be interdicted, and attention to the diet and secretions duly attended to. The oozing or leakage is owing to a swollen and irritable state of the pros- tate gland and a debilitated condition of the seminal vessels allowing that fluid to escape; consequently a general alterative and tonic course is indicated. This enlarged prostate is exceedingly common, and the older methods of treat- ment are of no utility wdiatever. The introduction of a seven-inch bougie, A Diagram 01 the Bladder, . - . . . . . 1 showing the prostrate gland prepared from the glucoside ot the black willow, stimulates absorption in the gland, reduces its size, and restores it to a healthy condition. The pro- cedure possesses many advantages over all other methods. In old chronic cases experience has satisfied me of the utility of this remedy in this form; it has very many advantages, it does its work well, its use is not attended with pain, it does not require the patient to leave off his usual avocation, it has a peculiar and astringent action on the parts. Among the medicaments lately brought into very general use for restoring the integrity of the sexual organs, none can excel the fluid extract of black willow; it is a drug which is both sedative, tonic and astringent to the nerves and vascular structure. When the reproductive organs of both sexes are damaged in any way, it is the drug from which the most decided tonic action is to be obtained. By its use all leakages, great or small, are effectually checked. Its introduction at the present time may stem the current which is dwarfing humanity in its very essence. Every man or woman who has practiced self-abuse; every one g-2 DISEASE GERMS. who has had a gonorrhea, or suffered from sexual perversion, or ridden a bicycle, needs the vivifying influence of the salix niger. For a more elaborate descriptive article, the reader is referred to article Hypertrophy of the Prostate, page 475, of present volume. The most prevailing affection of American males, in all ages. A condition of heightened sensibility, with Pruritus, altered nutrition, with microbe evolution, in which the main symptom is an indescribable itching, affecting the whole or a portion of the body. Generally local, not infrequently a most troublesome, obstinate malady. Pruritus of the vulva frequently depends on uterine disease, and all remedies prove useless till that is removed. After vaginal injections of either lotions of boroglyceride or resorcin, try some of the following remedies: Carbolate of sodium in equal parts of cologne spirits and glycerine; or the sozoiodol of mercury; or strong peppermint water and borogly- ceride. Pruritus ani, lime water and fluid extract of belladonna, or ozone ointment with atropia; salicylate of soda, with creosote and camphor, is most efficacious; tincture benzoin, peroxide ot hydrogen, oil of rue, etc., painted on the part are of immense utility. A selection of one of the following formulae may be tried in pruritus: Saponis viridis; oil cadini; alcohol, of each one ounce; resorcin, two drachms. Mix. Sodae borate, two drachms; chloride of morphia, sixteen grains; dilute hydrocyanic acid, half an ounce; glycerine, two ounces; water, eight ounces. Mix. Add one ounce concentrated ozone to two ounces of ozone ointment. Mix. Muriate of cocaine, fifteen grains; muriate of morphia, ten grains; carbolic acid crystals, twenty grains ; tincture of aconite rad., three drachms ; rub the whole up in one ounce of ozone ointment. Apply lightly over the affected surface. Menthol, thymol, of each one drachm ; oil of sweet almonds, one ounce; benzoated zinc ointment, half an ounce; muriate cocaine, ten grains. Mix. Conium cerate, one ounce; resorcin and salicylic acid, of each two drachms. Mix and apply. The local treatment should be BACTERICIDES. 873 commenced by the institution of the most perfect cleanliness The patient should be instructed to wash his anus well with a cloth and cold water after each action of the bowels, and then to bathe his anus with the following wash: Hyposulphite of soda, half an ounce; carbolic acid, two scruples; aqua destil., four ounces; glycerine, two drachms Mix. Sig— Shake the wash well, and use freely after first thoroughly washing the anus with cold water. In addition to this treatment, the patient must every night or two, after undressing for bed and washing and drying his anus lie upon his face, and with his hands behind him separate his nates as widely as possible, and be instructed to strain as at stool, and while thus straining the anus will protrude, and while the anus is protruding in consequence of the strong effort five or ten grains of pulv. iodoform must be sprinkled upon the 'anus from a knife or spatula by an assistant The minute eruption which causes this most distressing itching will be found most abundant at the junction of the mucous membrane of the rec- tum and the skin of the anus, and it is at this situation that the application does the most good. The patient should allow the iodoform to remain in the position of its application during the night, repeating during the day his ablutions of the anus after each action. The probability is that after two or three nightly applications of the iodoform all pruritus will disappear; but the patient should be directed to have the application of the iodoform continued three or four times a week until he is entirely relieved. Frequently we have occasion to try many medicaments in succession before we hit the right one suited to the case. The disease is always stubborn in pregnant women. External appli- cations are not always of permanent utility, constitutional treat- ment is often required, even then we have our hands full, for medicaments soon lose their effect. Gelsemium in full doses has done best for us of any single remedy. Skull-cap is often of eminent benefit in some cases. A combination of chloral and bromide of soda occasionally does wonders. In some cases euonymus and helonius act well. In one severe case, lady-slipper tea, made from the recent root, one ounce to a pint of boiling water, a wineglassful every two hours worked like magic. . ' Among local agents, balsam of peru stands first in our ex- perience, apply it full strength. Some cases will require it di- luted, then use vaseline as the diluent. When it fails, try an ointment made of balsam peru, two drachms; quinine sulphate, one drachm; extract belladonna solid, one drachm. Rub on ne parts. Borax, two drachms, water, eight ounces; oil of 874 DISEASE GERMS. peppermint, ten drops. Apply often to the parts. Nitric acid, ten drops; water, eight ounces Apply to the parts. Bismuth subnit, apply dry to the parts. Iodoform, bismuth subnit, boric acid, equal parts. Apply dry to the parts. Boroglyceride and resorcin a most excellent application. In some cases, local applications to the os uteri will be needed to effect a cure. But few things are equal to carbolic acid di- luted with glycerine, applied at first moderately strong, then stronger. You may add solid extract belladonna with good re- sults. In one case we made a strong solution of salicylic acid in glycerine, applied to the os and cervix with a small swab. A second application was needed a week after, after which no more trouble was experienced. A medical friend says he has the best results from dry sulphur, rubbed on the parts and small doses taken internally twice a day. Keep the bowels soluble with mild cholagogues. There is often an intimate relation between pruritus in preg- nant women and liver inactivity, hence the benefit of such reme- dies as chionanthus, The causes of general pruritus is obscure, it is met with chiefly in elderly people, and is but very little amenable to treatment When present in the middle-aged, it is generally associated with some other malady, especially jaundice, glycosuria, and albumi- nuria. In women, pregnancy and disturbance of the menstrual functions may also give rise to it. The disease, however, is more commonly met with as a senile change of an obscure kind, and as such is incurable. Treatment.—When the neurosis arises from, or is associated with, some other malady, such as jaundice, glycosuria, or dis- turbed menstrual functions, a rational and often successful mode of treatment is at once suggested. The cause of the disease should as far as possible be removed, and in addition, local reme- dies of a soothing kind may be used to give a little temporary relief from the intolerable itching. Amongst these, tepid gela- tine, and bran and alkaline baths are the most generally useful, some soothing ointment being always applied to the skin after the bath, to prevent it from becoming too dry and cracked. In senile pruritus the same plan of local treatment may be adopted, but the relief at best is only temporary. In all cases of pruritus, whether local or general, the microbe of neurasthenia is ever present, and all cases are greatly benefited, nay, cured by glycerite of kephaline and tincture of oats. Great cleanliness is essential. Stimulating food, hot, fiery drinks avoided. BACTERICIDES. 875 A peculiar form of skin disease, characterized by Prurigo, itching especially when the body is heated, due to an altered state of nutrition of the skin. Generally no eruption visible. There are numerous varieties, depending upon the cause. Any remedy which will promote nutrition of the skin is the one to administer, as quinine, iron, sulphur, arsenic, oxygen. Locally, sulphur baths, naphthaline. A term applied to a condition, in which the Psilosis. leading features are bareness or rawness of the tongue and entire intestinal mucous membrane. The most prominent symptoms are remitting inflammation of the mucous membrane of the mouth and alimentary canal; diar- rhea, irregular, action of the bowels, anaemia, general atrophy. During the exacerbation, tongue swells, papillae become elevated and red, shallow ulcers appear on the cheeks, tongue, lips, accom- panied with salivation, swelling and tenderness, with a tendency to bleed; articulation is difficult. The acute stage passes off, and the tongue becomes small, glazed or shining, looks as if it was denuded of its epithelium. Taste and smell usually in abey- ance. The evacuations from the bowels are usually a gray pultaceous mass deficient in bile; albumen, excessive debility. The pathology of the disease is obscure. What few cases have been seen have been amenable to an in- fusion of the Japanese persimmon with resorcin, and arrow root and beef tea for diet. This is a dry scaly disease of the skin; it is Psoriasis, chronic in its course and characterized by slightly raised red patches covered by white, shining, opaque scales; these scales often come off in great numbers, so that on waking iu a morning, the patient finds his bed full of little branny particles. Sometimes the spots are cir- cular, small and numerous, and scattered over the skin; some- times they are ring-shaped and the centre is healthy, while the disease spreads at the circumference ; sometimes large patches of irregular shape occur, and most often they are seen at the knees and elbows; at other times the patches assume a figure- of-eight form. The edges are always well defined and with a tendency to be circular; when the scales are rubbed off, a dry and red surface is left. The name lepra was formerly given to 876 DISEASE GERMS. the ring-shaped variety of psoriasis, but the term has now fallen into disuse. Psoriasis in all its forms runs a very chronic course, lasting not unfrequently for many years. When cured it is prone to come back again. Some persons have an attack of psoriasis every year; spring and autumn are the seasons when it most frequently appears. The red patches of psoriasis are due to inflammation of the skin ; the scales are due to excessive for- mation of epithelium on the inflamed surface. The rash is often accompanied by much itching; it occurs on the coarse and dry parts of the skin, and not where the sweat-glands are abundant. The disease is never communicated from one person to another, although a tendency to it is certainly hereditary; it may come on as a consequence of syphilis. On the palms of the hands and soles of the feet it may be mistaken for eczema. The peculiar defect which gives rise to this form of skin dis- ease, is to be found in the presence of the bacilLus of tubercle, syphilis, rheumatism, gout; in the surroundings and general health of the patient; in states or conditions of depressed vitality, overwork, relaxing climate, sexual excesses, or any excessive drain upon the system. In the treatment, the essential points are to build up the gen- eral health by every possible means, by a most nutritious diet, daily hot alkaline baths ; flannel clothing. General alteratives and tonics, as saxifraga, phytolacca; alter- nated with avena sativa, kephaline. A selection of some of the following remedies are worthy of a trial. Large doses of Fowler's solution might be tried, and in order to facilitate its toleration. Oil of cadi is a most efficacious remedy as in the following formula. Glycerite ; starch ; oil of cadi, and green soap. This in suitable strength, is applied over the eruption. An ointment of thymol, or salicylate soda, or chrysarobin. Red, circumscribed, hyperaemic Psoriasis Linguae, patches on the tongue, and inner sur- [Leucoplacia) face of the lips and cheeks, may exist for a few days, weeks, or months, and then spontaneously subside, or become developed into circum- scribed grayish or white discolorations. There are many micro-organisms present, the oidium albicans usually taking the lead. Irritation has much to do with its pro- duction, especially smoking, which favors the development of epithelioma. The numerous micro-organisms are met with in nests, which BACTERICIDES. o 877 bore their way into the epithelium, and deeper tissue, giving a thickened and fissured aspect to the patches. The whole pro- cess is characterized by infiltration and cell-proliferation of the corium, which explains the obstinate persistence of the patches and the readiness with which they undergo conversion into other processes. The early or hyperaemic stage of leucoplacia, as described by Professor Schwimmer, is not often seen • the disease usually presents the appearance of milky white patches on the dorsum of the tongue; sometimes these patches are slightly raised and rough, and have a sodden appearance; in other cases they are quite smooth. Leucoplacia is not confined to the dorsum of the tongue; it is occasionally met with on the mucous membrane of the cheek and lower lip. Diagnosis.—Leucoplacia should be distinguished from a some- what similar condition produced by syphilis, and also from superficial scars of the tongue, which sometimes have a white appearance; and, if I am right, it should also be distinguished from psoriasis of the tongue, which, like the syphilitic affection, is more amenable to treatment than ordinary leucoplacia ; but on this point I should be very unwilling to dogmatize. In the treatment, all irritation, including smoking, should be removed. The most favorable local treatment is the application of a saturated solution of boroglyceride. Many kinds of stomatitis have been described, but it is only necessary to refer to three : 1. Aphthous stomatitis, which is the commonest of all forms, begins as little yellowish spots of exudation ; these subsequently form into small, very superficial ulcers with a red areola. When these ulcers are of larger size than usual, and the attendant in- flammation considerable, the disease becomes both very painful and troublesome, and the ulceration difficult to cure ; but under ordinary circumstances, when it does not assume this severe form, it yields readily to local and general treatment with boro- glyceride. The affection is very apt to recur. In all severe forms of ulcerating stomatitis the internal administration of opium is all-important. 2. Parasitic stomatitis, or thrush, is chiefly met with in un- healthy children, and in those suffering from exhaustive diseases. It is due to the micro-organism oidium albicans. The white patches seen on the buccal mucous membrane are found to con- sist of epithelium permeated by the spores and mycelium of the parasite. A weak resorcin lotion is useful as a wash for the mouth, and in addition the spots may be painted with glyceri- num boracis, applied with a small camel's-hair brush. Wandering rash on the tongue. It is usually seen as small 878 DISEASE GERMS. rings and fine serpiginous lines of a bright red eruption. The peculiar character of the rash is the quickness wito which it spreads centrifugally, so that it is appropriately described as wandering over the dorsum of the tongue; the rings will some- times disappear and new ones appear in the course of a few hours. Subjective sensations of itching are always present. It has been compared in appearance to ringworm, but has no re- lationship to that disease. A varicose condition of the vessels of the inner Pterygium, canthus of the eye, giving rise to a triangular excrescence, usually the result of inflammation. The generally accepted theory of all authors is that pterygium has its origin in a marginal corneal ulcer, to which a tag of con- junctiva has become attached; it is thought to be untenable, because if this were its usual mode of origin, pterygium would be found approaching the cornea from every possible direction, since marginal corneal ulcers are not apparently more frequent in one position than in another. It is known, however, that such is not the case, but that pterygium is almost always situated directly over the recti muscles, and that in a very large proportion of cases it is over the rectus internus. The more recently proposed theory of Poncet, that pterygium is due to the presence of mi- crobia, which tunnel their way under the corneal epithelium, is open to the same objection, for this also assumes the existence of a precedent corneal ulcer. The view long held, that con- ditions which tend to induce chronic hyperaemia of the conjunc- tiva favor the formation of pterygium, is thought to be well es- tablished. Assuming that this view is correct, are there reasons why a localized hyperaemia of the conjunctiva should be of frequent occurrence where pterygium usually forms to the nasal side of the cornea ? This is answered as follows: The close connec- tion between the vessels of the recti muscles and those of the anterior portion of the conjunctiva, were referred to, and it was pointed out that the determination of blood to these muscles might influence the blood-supply of the overlying conjunctiva, and that this would be the case especially with the recti interni, since they were the largest of the straight muscles and in close relationship with the conjunctiva, because attached to the scle- rotic nearer to the corneal border than any of the others. Ab- normality in the distribution of the blood-supply of the internal recti muscles, and of the overlying conjunctiva, and, more fre- quently still, disturbance in the normal relationship between BACTERICIDES. 879 convergence and accommodation, such as insufficiency of the of the internal recti muscles, the different varieties of ametropia ; these were regarded as the usual causes of pterygium through the localized hyperaemia of the conjunctiva, to which they give rise. Brushing it over with a solution of nitrate of silver, thirty grains to the ounce of water, repeating a few times with proper intervals apart, is usually successful in effacing it; if not, then it must be hooked up and snipped off. All chemical compounds, basic in character, Ptomaines, formed during the putrefaction of organic mat- ter. They bear the closest possible resemblance to vegetable alkaloids, but they are not all poisonous. All putrefaction is due to the action of bacteria; ptomaines are the result of the growth and activity of disease germs. The poisonous or non-poisonous character of ptomaines de- pends a great deal upon the individual bacteria engaged in their production, upon the temperature, amount of oxygen present, electrical states, etc. Each disease germ excretes or generates its own ptomaine. The bacillus of typhoid produces the ptomaine typhotoxine; tetanus, tetanine; which if injected into animals gives rise to tetanic convulsions; the bacillus amylobacta, by its action on carbohydrates, gives rise to butyric. Bacteria are either aerobic or anaerobic ; the one thrives by the presence of air, the other by its exclusion. This quality in itself causes a difference in the chemical character of a. ptomaine, besides there is a decided difference in the various stages of putrefaction. Ptomaines are transition products in the progress of putrefac- tion—temporary forms through which matter passes in its change from the organic into the inorganic state—complex organic sub- stances, as brain, gland, muscle, etc., are broken up into less complicated molecules—their original elements. Countless myriads of minute organisms are thus constantly engaged in transforming matter from the organic to the inorganic state. Besides being abundant in all putrefactive states, ptomaines abound in all forms of shell-fish, in decaying sausages; in im- perfectly cured ham; in all canned meats; in a large amount of imperfectly cured cheese; tyroxicon is found in all milk partially frozen, then thawed, and re-frozen and used; in ice cream ; in the mould of meal, flour or bread, ptomaines are found like in ap- pearance to the crystals of urea. 88o DISEASE GERMS. Specific micro-organism are the cause of special disease. Each must be pathogenic of that disease and conform to definite rules. In order to be able to state definitely that any disease is due to the action of a microbe it is necessary to fulfil certain conditions as formulated thus: i. The microbe must be found in the body of the manor animal suffering from or dead of the disease. 2. The microbe must be isolated and cultivated in suitable media outside the body of the animal. The cultivations should be carried on through successive generations of the organism in order to insure its purity. 3. A pure cultivation when introduced into the body of a suitable healthy animal, must produce the disease in question. 4. In the inoculated animal the same microbe must again be found. The cultivation of microbes.—In the examination of air, water, and the fluids and tissues of the body many kinds of microbes may be seen under the microscope, but it is possible to distin- guish them from one another only by comparing their reactions to staining fluids and their appearance and mode of growth in certain media. The media which are used are both solid and fluid; potatoes, peptone-gelatine, agar-agar (Japan isinglass), bread-paste, chicken-broth, milk, blood serum, urine, various chemical solutions, most of which contain sugar and phosphates. These media, as well as all apparatus with which either the mi- crobes or the media come in contact, must be thoroughly sterilized. It is found that some organisms grow better in one kind of soil, others in another, thus pathogenic germs grow best in an alkaline medium, putrefactive in an acid one : and at least twelve pathogenic forms will not grow in nutrient animal jelly. It is not every acid, however, which interferes with the growth of pathogenic germs, as the acid surface of a potato affords a favor- able nidus. Besides these points, their growth is influenced by temperature, by the presence of mineral matter (amount and kind), and by the presence or absence of oxygen (aerobic or anaerobic). Germs grow in nutrient jellies in a manner varying with the way in which they are planted, the usual methods in tubes are surface, depth, and streak cultivations. Gelatine jelly is used when the required temperature at which the tubes have to be kept is under 250 C, at which point it liquefies; agar-agar liquefies at 350 C. When microbes are cultivated in this man- ner, under favorable circumstances, they rapidly grow and mul- tiply ; this is done by simply dividing in two (fission), or by the BACTERICIDES. 88l production of spores, or by both means. The vitality of many of the spores is so great that if circumstances favorable for im- mediate growth are not present, they will survive for very long periods; outbreaks of diseases which seem spontaneous in their origin may be thus explained. The special bacterium must be present in all forms of the disease; special micro-organisms freed from all extraneous matter. The micro-organisms themselves may be poisonous, or the poison may be an integral part of them, or the germ may pro- duce a poison, by splitting up pre-existing compounds in the body, or it may be intimately associated with or produce a solu- ble, chemical ferment. Ptomaines excreted from the microbes of anthrax, cholera, puerperal and typhoid fevers, often kill before the germ enters the blood. Ptomaines resemble, in all essentials, the vegetable alkaloids, poisons, conine, nicotine, strychnine, morphia, atropia, digitaline, veratrine, delphine, colchicum, curare, aconitine. Besides the presence of disease-germs, with their alkaloids, ptomaines, there are another class of basic substances which are found in the living, either as the product of fermentative changes or of retrograde metamorphosis, alkaloidal products of physiologi- cal change found in the animal tissues during life, termed leuco- maines, in contradistinction to the ptomaine, a basic product of putrefaction. The leucomaines are derived from the urea and creatine group, and are called autogenous. The excretion of all living things, plants and animals are poisonous to the organism which excrete them. An individual may drink only pure water; eat food of the best; free from all adulteration, breathe the purest atmosphere, and yet his excretions will contain the most deadly alkaloid poisons, which are formed in the body, ^originate in the metabolic changes by which com- plex molecules are split up into simpler compounds. These woe-be-gone states of languor, lassitude, debility ; states in which there are headache, brown-coated tongue, termed biliousness, are due to the formation of alkaloids, shocks to the system from cold or wet or otherwise, retain effete matter, which poison the nervous system, which is speedily relieved by a Turkish bath, opening the bowels with a bactericide. Some febrile states are autogenous, due to the retention in the body of products which should be eliminated. Urine excreted during the hours of activity is much more toxic man during the hours of repose. Physical and mental work give rise to the formation of numerous poisonous substances; lengthen the hours of labor, shorten those of rest, and we have 56 DISEASE GERMS. toxical agents formed, which give rise to insomnia and fretfulness; brain excited and refused to rest. Fever from fatigue, from pro- longed excretion due to like causes, often mistaken for malaria. The following is a list of ptomaines discovered, with their formula, up to the date of publication of this work: Name. Melhylamine,.... Dimethylamine,. . . Trimethylamine, . . Ethyl amine, .... Diethylamine, . . . Triethylamine, . . . Propylamine, .... Amylamine, .... Hexylamine..... Tetanotoxine,.... Collidine (?), .... Hydrocollidine (?), . Parvoline (?), .... Unnamed,..... Ethylidenediamine (?), Trimethylenediamine, Putrescine,..... Cadaverine, .... Neuridine,..... Saprine,...... Unnamed..... Methyl-guanidine, . . Unnamed,..... Mydine, . . Neurine,. . Unnamed, . Choline, . . Betaine, . . Muscarine, . Mydatoxine, Mytilotoxine, Gadinine, . Typhotoxine, Unnamed, . Tetanine, . . Unnamed, . . Tyrotoxicon, . Mydaleine,. . Spasmotoxine, Peptotoxine, . Formula. Physiological Action. C H5 N . . . Non-poisonous. C2 H7 N . " " C3 H9 N . « « C2 H7 N . << (i C4 H^N . .« « C6 H15N . << 11 C3 H9 N . t C5 H13N . C6 H15N . C5 HX1N(?) . . Poisonous. C, H„N . C8 H13N . . . Poisonous. C9 H13N . C10H15N . . . Poisonous. C2 H8 N2 . . " C8 H8 Na . . « C4 H12N2 . . Non-poisonous. C5 H14N2 <* 11 C, H14N2 a 11 C5 H16N2 t< ii C7 HinN2 « 11 C2 H7 N3 . . " " C13H20N4 C17H88N4 C8 HX1N 0 . . Xon-poisonous. C5 H13NO . . Poisonous. C6 H„N 02 . . Non-poisonous. C5 H15N 02 . . Poisonous. C5 H13N 03 . . Non-poisonous. C5 H15N Oa . . Poisonous. C6 H13N Oa C6 H15N 02 -■. v.■. ■■•V'-,ftcv!kc/ Asperated air from a sewer in close proximity to a vinegar factory. Deposite seen on the microscope Mycoder- ma aceti still young, and older ones. £(*K *a Air aspirated near a beer brewery, showing microbes which produce disease. Young Bacillus Anthrax, mingling with the young broods of the malarial germ in a sewer. Bacil'us of Typhoid Fever, aspirated from a sewer; cultivated, injected into animals, reproduced the original disease (pathogenic typhoid fever). Various other micro-organisms which the our large cities are compelled to breathe. inhabitants of all - BACTERICIDES. 937 ' Sanitary science says most emphatically, that typhoid fever is becoming more prevalent, being epidemic and endemic all over the world. By the light of modern investigation, and with our modern knowledge of the influence of bacteria in the production of vari- ous forms of disease, it is not at all difficult to , -, - $**- understand the way in which the surface water * "- ?^^_ _s in its rise and fall may influence the spread of a .4.^'-^' disease of this nature. As we have seen by the M^^^^S^ considerations to which we have drawn atten- ~'~~" tion, the excreta from typhoid patients find Comma-Baciiius in their way into cesspools or into defective drains, and are thus dispersed into the surrounding damp soil. Both the rise and fall of the surface water, with the amount of air which it must necessarily displace from the interstices of the soil, must be a potent factor in the circulation of typhoid germs. In the one case, when the water falls, air enters the soil to a greater depth, from which it can be sucked into the lower floors of dwelling-houses, whilst (he rise of the water in the soil displaces the air upwards, which taking with it the typhoid germ, distributes it over certain localities. It seems probable that a wider study of the phenomena of this nature would afford a very adequate explanation of how it is that at certain periods of the year typhoid fever is so much more prevalent than it is at others. Furthermore, the infection process requires special conditions. The germs will not flourish in every human being. They re- quire a soil suitable to their growth. And such a suitable soil, such specially favorable conditions are found in nearly all per- sons who have been exposed to insanitary influences, such as bad drainage, foul air, or unwholesome surroundings of any sort, or who are in poor health or have suffered from any complaint of a weakening character. All these things tend to depress the strength and lower the vitality, and thus a fertile soil for the pro- pagation of typhoid germs is at once produced. There is no doubt that the typhoid poison may enter many healthy and well- nourished bodies, and pass harmlessly away. But let the vitality be lowered by the inhalation of sewer gas or other foul air, by exposure to any insanitary conditions, or by any other cause, and then the entrance of the poison into the system is almost certain to involve the communication of the actual disease. Every fresh patient is a new source of further danger. Yet the peril may be reduced to a minimum by the thorough disin- fection of the evacuations before these are thrown away. This ought to be an invariable rule. Supposing, however, that some germs nevertheless escape, then the risk of contagion may fur- 938 DISEASE GERMS. ther be minimized by good drainage, by rigid care as to drink- ing-water and milk, and by the observance of sanitary rules generally. All water and milk as to which the slightest suspi- cion can exist should be boiled before being used, and a strict inspection of dairies is imperative. If typhoid fever is to be arrested or abolished in this or any other part of the world the greatest care must be taken to avoid all exciting, as well as pre- disposing causes, and to study the way in which it is introduced and in which it spreads in every part of a locality. The terms endemic and epidemic are used in connection with preventible diseases, the former to imply that the disease is re- stricted within certain areas and depends on local or localized causes, and has a tendency to persist in the district; the latter to describe a disease which suddenly appears and spreads widely and rapidly, but its prevalence is usually of limited duration. The two conditions, however, may pass into one another, e. g., plague, yellow fever. The term sporadic is applied to diseases which occur in isolated cases, and appear sometimes as if of spontaneous origin, as typhus fever. Such cases are to be explained either by the sud- den development of spores which have been waiting for a favor- able set of circumstances, or, possibly, it may be that those con- ditions of overcrowding and filth may so aggravate the virulence of some organism (existing usually in the body without danger),. that absorption of its products occurs and produces the symp- toms known as typhus fever. Action of the microbes in the body.—Microbes affect the body in one or more of three ways: (i) By rapid development and aggregation in the blood vessels, producing embolism, as in anthrax. (2) By producing a ferment which acts on the tissues, as, perhaps, in diphtheria. (3) By producing one or more defi- nite chemical poisons (toxines), as in tetanus. There is, for a longer or shorter time, a period of quiescence,, , latency, or incubation; the period of invasion which follows is ' characterized by increased temperature, rigors, etc. When the distinctive features of the disease appear the stage of advance or \ eruption has begun; these special features appear to be due to the fact that, after undergoing development in the invasion stage, ' the microbes and their products tend to accumulate in particular organs, as in the throat, bowels, nervous system, skin, etc. From these parts they are discharged from the body ready to propagate the disease, or they die out from causes unknown, producing the stage called decline, defervescence, or resolution, suddenly (crisis), or slowly (lysis). Various theories are suggested to explain why the microbes tend so often to die out in each case, as that BACTERICIDES. g^ the high temperature of the body kills them, that the multiplica- tion of the poison interferes with their growth. Convalescence is the period in which the body gets rid of the effete products, and restoration of the various functions is re established. Sequela, however, sometimes occur after the disease appears to have been cured; these are probably due to the action on the tissues of poisonous products which have not been eliminated or destroyed—perhaps on account of their late production. Deathr however, may occur before a disease has run its course. The great aim of sanitary science is the prevention of disease. The infecting nature of the tubercular bacilli is causing consider- able alarm ; strenuous efforts are being put forth by the various health boards to disinfect all suspected localities, and radical pre- cautions so as to prevent its dissemination. Pulmonary tuberculosis (consumption) is directly communi- cated from one person to another. The germ of the disease ex- ists in the expectoration of persons afflicted with it. The follow- ing explains the means by which the disease may be transmitted : Tuberculosis is commonly produced in the lungs (which are the organs most frequently affected) by breathing air in which living germs are suspended as dust. The material which is coughed up, sometimes in large quantities, by persons suffering from con- sumption, contains these germs often in enormous numbers. This material when expectorated frequently, lodges in places where it dries, as on the street, floors, carpets, handkerchiefs, etc. After drying in one way or another, it is very apt to become pulverized and float in the air as dust. By observing the follow- ing rules the danger of catching the disease will be reduced to a Tubercle Bacillus__ Sputum of a tubercular from a In the sputum patient in a Pullman sleeper found on the floor suffering from lung-syphilis. of a Pullman sleep- ing-car. minimum: i. Do not permit persons suspected to have con- sumption to spit on the floor, or on cloths, unless the latter be im- mediately burned. The spittle of persons suspected to have con- Pneumonia in c roupo n s, magnified icoo diam., found and isolated from the spu- tum found in a Pullman sleep- ing-car. 940 DISEASE GERMS. sumption should be caught in earthen or glass dishes, containing a solution of the sulphate of iron. 2. Do not sleep in a room occupied by a person suspected of having consumption. The living rooms of a consumptive patient should have as little furni- ture as practicable. Hangings should be especially avoided, The use of carpets, rugs, etc., ought always to be avoided. 3. Do not fail to wash thoroughly the eating utensils of a person suspected of having consumption as soon after eating as possible,' using boiling water for the purpose. 4. Do not mingle the un- washed clothing of consumptive patients with similar clothing of other persons. 5. Do not fail to catch the bowel-discharges of consumptive patients, with diarrhea, in a vessel containing cor- rosive sublimate, I part; water, 1000. 6. Do not fail to consult the family physician regarding the social relations of persons auffering from suspected consumption. 7. Do not permit mothers suspected of having consumption to nurse their offspring. 8. Household pets (animals or birds) are quite susceptible to tuber- culosis ; therefore, do not expose them to persons afflicted with consumption ; also do not keep, but destroy at once, all house- hold pets suspected of having consumption, otherwise, they may give it to human beings. 9. Do not fail to thoroughly cleanse the floors, walls and ceilings ot the living and sleeping rooms of persons suffering from consumption at least once in two weeks. Sanitary science has demonstrated beyond all dispute that pathogenic micro-organisms do exist in distinct and definite entity, that they show themselves as distinct, specific germs, begetting special disease. The micrococci of measles is the same to-day as it existed thousands of years ago ; the same period of incubation, the same prodromata, the same eruption, the same complications and terminations. That the essential nature of a pathogenic microbe is not changed by an alteration in the soil or other surroundings. The microbe may be shrivelled, dwarfed, or reproduction checked by lack of oxygen, unsuitable nutrition, improper tem- perature, but never changed in nature. Up to the present time it has been found impossible to deprive pathogenic microbes of their pathogenic properties. We lack as yet a sufficient or satisfactory explanation of the immunity conferred, though three plausible hypotheses have been proposed. The first is the theory of exhaustion, which assumes that the germs of the disease exhaust the elements in the blood necessary to their nutrition. Something analogous to this is seen in vegetation of higher structure, which cannot be made to grow indefinitely in the same soil. The second is the BACTERICIDES. 941 antidote theory, or the theory of antagonism, which supposes that certain products evolved from the soil in the multiplication or growth of germs react upon them fatally. The analogy here is found in the process of fermentation, whereby the torulae cease to produce themselves, become quiescent and sink to the bottom of the vessel as soon as the proportion of alcohol reaches twenty per-cent. There is reason to think that the fever evoked by micro-organisms is in some cases fatal to their growth and life. The third is the theory of accommodation, which main- tains that the tissues in their first struggle with the micro-organ- isms acquire a higher degree of energy or vitality, whereby they are enabled to endure or resist future attacks. Perhaps a simile may be found for this hypothesis in the process known as accli- matization. The question now arises, How do Pathogenic Micro-organisms produce the Phenomena of Disease ? From the rapidity of their multiplications it might be inferred that the symptoms and lesions of the infectious maladies were caused by the mere pres- ence of these organisms as foreign bodies. But it has been ob- served that the bacilli of milzbrand alone multiply in the body in such number as to produce extensive occlusions of vessels. Further, it has been shown that no mere mechanical presence, no mere foreign bodies, aniline particles, or granules of cinnabar, ever induce the signs of fever or toxicemia. The micro-organ- isms of disease live in the body, and must therefore be nourished at its expense, whereby they withdraw from the blood or tissues elements essential for their nutrition. Pathogenic micro-organ- isms require oxygen. In processes of fermentation, outside air is excluded, that the germs of fermentation may be compelled to withdraw oxygen from its soil. Pathogenic micro-organisms multiplying in great abundance seize upon the oxygen of the bloo'd with such avidity as to develop in fulminant forms the symptoms simulated by prussic acid poisoning. But the other symptoms mentioned do not correspond either to deficient oxy- genation or carbonic acid poisoning. These symptoms indicate toxicaemia, and since the injections of fluids from which bacteria have been separated by porcelain filters remain innocuous, it follows that the toxic agent inheres with the bacteria. Then, inasmuch as blood-corpuscles show their reaction against bacteria on simple contact, it follows that the poison must lie upon or issue from their surface. The only hitherto known poisons which may in such minute quantities induce such grave toxic signs are the poisons result- ing from the action of the bacteria of decomposition upon organic matter. As these intensely virulent poisons were first 942 DISEASE GERMS, observed only in dead organic matter, they were called ptomaines. These matters, the ptomaines, though so newly known, have re- ceived so much attention in the past year as to form a subject in themselves. It may be said here that some cadavers develop no ptomaines, that ptomaines are developed as putrefaction advances in the course of weeks, next that they are also found sometimes in animal products, as in cheese, urine, faeces, etc., and lastly, that many ptomaines are perfectly innocent. Then it might be added that many phenomena attributed to their action have been found due to simpler causes. Sanitary science teaches us that sewage should not run into our lakes and rivers, as the microbial product is a factor of disease and tends to poison all the fish in those waters. Take for example the shell-fish and others in all our bays and rivers where sewage enters, there is to be observed with an ordinary glass a red-dotted discoloration, in which there is a bacillus of a deadly sewage enters, found at thirty miles from the Vibrios and comma-baciilus in water opening. contaminated with sewage on which our modern fish and oysters subsist. character. In order to test whether this bacillus is toxical, eating a few of the infected oysters or clams, or some fish, give rise to bowel spasms, or inject into the tissue from the red spots, into some animal, a condition of disease analogous to cholera was produced, and the comrna-bacillus found in the stools, together with other organisms of a virulent type. Sanitary science teaches us that the air we breathe at all sea- sons of the year is highly impregnated with disease germs or their spores. In the summer season especially, we, in addition to microbes, breathe ^he pollen from grasses, flowers, vines, and trees, which BACTERICIDES. 943 give rise to different forms of hay fever, or summer catarrh Fungoid spores are more abundant in the atmosphere in hot weather than cold. Cities being comparatively destitute of ozone ^^-\^ 6>" '<'t««il$V °<">o0 v^i-^ <<- 00 V. Bacillus Alvei as found in honey, young brjods, passing into a higher grade, as seen in next diagtam. Bacillus Alvei, showing stages of transition between rod and fully developed spores, foul brood on bees giving rise to flower, clover and buckwheat rot. Another transi- tion converts the microbe into the bacillus subtilis of hay fever. %^§ too«»v. %■ q> ox&dO H 'RfeCDO =£> \$ '<* ^\ and loaded with the living organisms of sewers, have an atmo- sphere loaded with bacteria ; at an altitude of 2000 feet no microbes are found. The largest percentage of microbes are to be found in the atmospheres of hospi- tals, or adjacent to them, whereas the reverse condition exists in the air of the country. In this country the presence of microbes in houses, schools, etc., has been demonstrated by actual experiment of eminent bacteriolo- gists ; and they have shown the im- provement that can be produced by proper ventilation. In houses the numbers of microbes increases in proportion as the living rooms de- crease in size, and according to how many rooms constitute a house; thus, a one-roomed house contains more microbes than a two- roomed house, and sickness and mortality go pari passu. That the following diseases attack the person through the medium of the air cannot be doubted, viz., scarlet fever, small- pox, measles, typhus, enteric fever, plague, pertussis, yellow 'ever, diphtheria, influenza, purulent and granular ophthalmia, erysipelas, hospital gangrene. Bacillus Alvei as found in honey, which, if eaten by individuals, give rise to in- testinal irritation; and the transition of the microbe in the body gives rise to the fungus of diabetes. 944 DISEASE GERMS. Sanitary science teaches us that the prevention of endemic ma- laria by extensive drainage is a sanitary fact. The mortality caused by the malarial germ does not indicate the amount of misery caused by it. It usually takes from twenty to thirty at- tacks before the germ, with attendant fever, produces a fatal re- s^'P's. sult, and then its sequelae, its anaemia, leucocythemia, diabetes, dropsy, enlarge- ment of spleen and liver, and other conditions which ultimately terminate the existence of the patient. In malarial sections, the number of yellow, sallow a bacillus found in stagnant water; wretches, inhabitants of such districts, ^b.y tfi^SSi'SSSi with their limbs shrunken, their muscles 8erm- wasted, nervous and physical wrecks, can have the microbe of all their ills blotted out by a drainage of the soil; a perfect system of drainage will get rid of this microbe, and localities decimated with ague become perfectly healthy. Sanitary science teaches us that nearly all our domestic animals in and near our large cities are saturated with the bacillus an- thrax and actinomycosis ; that milk and meat poisoning are very common, cases being daily recorded. The inhibition of these microbes often cause immediate death from the reflex presence of the microbe, or from its spore, or the toxical effect of the pto- maine. So prevalent and fatal are those cases becoming, that efforts are being made to stem the evil, but with poor results. Death before these germs can enter the blood is deplorable, and worse still when pustules, abscess in lymphatic, and pyaemia occur. The microbe actinomycosis is a denizen, in its early stages, of the jaws; just how far it has spread among the human family cannot be correctly stated, but its prevalence is in a great measure due to the imperfect cleansing of the dentist's hands, forceps and other tools. We cannot always tell, until the microscope reveals its presence or absence. That pus from an alveolar abscess is necessarily septic we cannot be sure ; but there are three facts worthy of notice: I. Pus from an alveolar abscess is often of foul odor. 2. As a consequence of alveolar abscess, necrosis of a por- tion of the jaw-bone is not at all uncommon. 3. There are cases recorded of patients who have died from pyaemia and septicaemia, as the result of alveolar abscess, with or without the actinomycosis. In a case of anthrax, from eating diseased meat from an infected animal, the pus from the lymphatics was extremely fetid, and BACTERICIDES. 945 when examined showed abundant presence of micrococci. Agar-agar plate cultivations were made on two consecutive days, but no development ensued. Thus, while the microscope re- vealed the presence of crowds of micro-organisms, the cultiva- tion experiment showed that they were all dead. It would seem as if the microbes had been the cause of their own death; that is to say, they had multiplied so rapidly as to exhaust the soil upon which they had to live, and had produced products which were poi- sonous to themselves. The result of the investigation struck one with some little surprise. It is, perhaps, hardly what one would expect, that a patient should survive with such a quantity of putrid material in his body, in which even mi- crobes were unable to live. Sanitary science teaches us that from our drinking water we are suf- fering unconscious suicide, and this exists all over the land. A number of cemeteries drain into Brooklyn's sources of water supply. Long IsJand City pumps its water out of an underground frog pond. Jersey City, Newark, Elizabeth and Hoboken secure their water from the dirty Passaic river. Albany and Kingston have muddy supplies of water. Phi.-adelphia pumps up Schuylkill sewage and drainage of graveyards. St. Louis is burdened with mud and filth from the Mississippi, which has rotted its water pipes. The same is true of cities de- riving their water supplies from the Mississippi, Missouri and Ohio to an alarming extent, such as Louisville, Memphis and New Orleans. Boston's water system is polluted by a poisonous vegetable growth. Chicago sewage so completely invests lower Lake Michigan mat in summer time the hydrant water actually smells of the 60 Section through a Kidney of a Cask that died after meat-poisoning. The figure represents part of a glomerulus of a Malpighian corpuscle, in which some of the capllary blood-vessels are filled with the bacilli Magnifying power 700. 1. Capsule of Malpighian corpuscle. 2 Ca pillaries filled with bacilli. 3 Capillaries empty. 4. Bacilli contained between ca- pillaries. 946 DISEASE GERM>. filth. In winter, the water, being taken from a considemble depth, is void of oxygen, the life-giving gas, and under the high pressure of the pumps, remains a dead liquid, injurious to the health and productive of malaria and winter cholera. New York might have tapped Lake George for le.'-s monev than the total expense attending Croton water, which has cost Ophidonnnas sanguinea of stag- nant water (slightly magnified), often present in our drinking water of all our large cities. Crenothrix Kuhniana.— This micro-organi>.m, magnified 600, is taken from waier pipes, rendering drinking water very foul. Comma-rJacilla.—Spirillum as found in sewage, as it enteis the river. " w •< "" -vX -H* '■ The Comma Bacillus as si en in liver water into which sewers enter. The drinking of such water, even five miles below where the sewers enter,givel rise to dianhoea. upward of $8o,ocx),ooo. Croton water, politically and physically, is probably the most corrupt supply extant. Mineral matter is always visible in it; in the summer it is impregnated with a green and poisonous vegetable matter. Grand Rapids, Michigan ; Waukesha, Wisconsin, and a few other and small places are probably the only ones known having perfectly pure water supplies. At Grand Rapids, the Hydraulic Company's works, and those at Waukesha, are fed by enormous springs, cases exceptional and singular in the water-works history of this continent. Nearly all farm wells in the rural districts receive the drainage of the barns. Not long ago, nearly all the wells and water-works supplies in our State were found laden with germs, which if corrected would decrease the mortality of our country. I As a general rule, the water which supplies all our large citie?, contains a large number of microbes in a perfect state of vitality The rivers and lakes receive most of them directly from sewerv which discharge into them ; even most of the wells in the rura Spirillum volitans which is met with in marshes. BACTERICIDES. 947 districts receive them by infiltration through the soil. During epidemics of measles, scarlet fever, variola, typhoid fever cholera, etc., the microbes of each of those diseases are to be found in all running and stagnant water, in close proximity, and therefore they often become sources of contagion and infection. Well-water near a barn, a cess-pool close to a dwelling, owino- to its stagnant nature, and to the infiltration of microbial matter, is much more dangerous than running water. Aquatic saprophytes as found in marshes, wells, drains, stagnant pools, from decaying organic matter. Magnified 500 limes. Germ-laden well-water used in bread-making is dangerous to health, because the internal temperature of the loaf in the hot- test oven is seldom sufficient to destroy the microbe, far less its spores. In testing well-water, we almost invariably find ova of a [arge number of parasites, spores of disease germs, and bacteria innumerable. As a general rule, well-water should be con- demned for drinking purposes and making bread. Rain, spring, or river water is more free from microbes than well-water. It is true boiling water will destroy all the disease 94 S DISEASE GERMS. crerms it may contain, but in the act of boiling, the natural gases of the water are destroyed, it is rendered heavy, indigestible. Filtering, if correctly performed, seems to be the only method of clearing it of the ova of ascarides, and larger germs. Mineral waters, such as apollinaris, vichy, if genuine, are ex- cellent table waters, but their use is costly. Ice yields its mi- crobes to any fluid or solid with which it is brought in contact, besides the use of iced waters, and other drinks is highly detri- mental to digestion and productive of a tubercular habit. Sanitary science teaches us that the modern methods of pre- serving meat and vegetables are erroneous—productive of bac- terial evolution and disease—factors which increase the mortality of the nation. To prevent chemical change, the evolution of fungi and mi- crobes, in organic substances ; to preserve them fit for alimentary use and the nourishment of the body for an indefinite period of time, they must be protected from the microbes and germs of the air, and germicides, as chloride of sodium, aromatic spices and salines ; and when smoked, the aromatic principle of carbolic acid and creosote, contained in the smoke destroys the microbes and prevents all chemical change. \ ' /' \ Bacillus megatherium as seen in decaying cab Fungi, or Moulds, found Moulds, or Fungi, found bage, canned tomatoes, in hermetically sealed in hermetically sealed peas, etc. cans fi|]ed wjth sai. peas mon. The preservation of meat, fish, fruit, vegetables, in hermeti- cally sealed cans, with or without certain fluids, heated to a tem- perature of uo° Fahr., to insure the destruction of germs, ap- pears to be correct in principle, but most pernicious, nay toxical, to the user. The preservation of meat in fat, or by drying, or evaporation by heat, refrigeration by ice, is extensively used to preserve beef, mutton, poultry, fish, etc. When congelation occurs in the fluids of the subcutaneous tissue, important cadaveric changes begin; these changes con- sist in the formation of the most deadly poisons, which may be held in perfect abeyance so long as the freezing point is main- BACTERICIDES. 949 tained, but let the temperature rise, putrefactive changes occur in which ptomaines appear. As the temperature rises, and these changes occur, the meat becomes soft and mucky, and if cooked at this point has a sweetish taste. All animal food kept on ice, in the process of thawing, evolves toxical agents. Cream or milk, acted upon by ice, so as to perfectly freeze it, if freezing be maintained, all is well, but let a thawing take place, and again freezing the same can, ptomaines or tyrotoxicon are evolved. Sanitary science teaches us that all cooked meats, cold articles of food which have been cooked some time before eating, pro- duce toxic properties, ptomaines or alkaloids, which are indestruc- tible; these dangerous poisons are generated in cabbage, pies, hams, and all canned meat or vegetables. That re-heating or cooking over does not destroy them. These poisons are known as ptomaines when formed by the decomposition of albumen by the microbes of putrefaction in the dead body ; the more poisonous bases produced by pathogenic germs have been named toxines, while those formed in the bacillus Figurans found in garden earth and on green vegetables, parsley, salads, which gives rise to choleraic symptoms. Bacil us Megatherium found on cab- bage, after standing one hour, being productive of intestinal irritation. The microbe effects a transition in the bowels, and becomes a patho- genic bacteria. healthy living body by the breaking down of albuminous matter in the course of functional activity are called leucomaines. Fa- tigue-fever may be explained by the production of leucomaines being more rapid than the excretory organs of the body can keep up with ; a similar explanation may also serve for uraemia. , Microbes in order to produce disease must obtain admission into the body, and when they gain an entrance there must be a lowered vital force, so as to enable them to grow. For with a high graded vital force no microbes can grow—the body is insusceptible. 950 DISEASE GERMS. Insusceptibility is a condition which is due to the absence of a proper soil, in which the microbes can grow. As it is believed that epithelial cells have normally the power to resist the attacks of bacteria, which may then be destroyed by the white blood- corpuscles ; a lowered vitality, either hereditary or acquired, would, therefore, constitute a predisposition to infectious disease. As age advances this power of the cells probably increases, so that the susceptibility is greatest in infancy and childhood. (See article, Disease Germs) Moreover it appears that germs will not develop in the blood unless it contains at first suitable food in the shape of effete matter. Another important cause of insusceptibility to some diseases is the (in a measure) protective influence of a previous attack. In the cultivation of micro- organisms in artificial media, it has been found that the presence or absence of very minute quantities of certain salts was essen- tial for growth; this suggests that the first attack of a disease may use up some essential body which may not be reproducible, or only so after a long interval, or some product may be left behind which would be inimical to a second successful growth of the germ. Microbes in their passage from race to race, from one animal to another, increase, diminish, or destroy their pathogenic proper- ties. See the remarkable increase in virulence of all microbial disease in the passage of the germ from one race to another.- Sanitary science is strongly in favor of contagious or micro- bial disease hospitals, for diphtheria, small-pox, typhoid and other fevers. That priceless object, human health, is best secured by an iso- lation of any case of germ disease; that bacterial-smitten pa- tients in the ordinary currents of life do not receive the care so indispensable to their welfare; that no ordinary dwelling can be of utility as a means of stamping out germs; that a poor man's house does not afford the means of properly isolating a case of infectious sickness, neither can the natural affection of the pa- tient's relatives provide all that is needed for the recovery of the sufferer. In a well-ordered hospital, however, the patient is sure to receive careful nursing, good treatment, and proper food. Recovery is thus much facilitated, and if the hospital is, as it should be, free for the use of the inhabitants of the district, no expense whatever is imposed on the patient or his family. More- over, the other members of the family are relieved from the risk of contracting the disease, and are left free to pursue their ordi- nary avocations without endangering the public health. It is satisfactory to find from the reports of medical officers of health BACTERICIDES 951 and others that there is a growing inclination on the part of the public, both rich and poor, to avail themselves of the benefits of the sanitary hospital where the local authorities have been suffi- ciently far-sighted to provide such a building. Without a proper infectious disease hospital a district is without one of the most effective defences against epidemics. Sanitary science has clearly demonstrated that the activity, growth and virulence of microbes are greatly intensified by their entrance into sewers ; that the germs in sewers are most conta- gious, giving rise to the disease of which they are pathogenic, but more virulent; all fevers, cholera, pneumonia, dysentery are apt to be communicated through 5ewer air. The symptoms of chronic sewer-air poisoning are of two kinds —the specific and the non-specific. The specific symptoms are those which result from pathogenic micro-organisms of various kinds suspended in the sewer air, and causing the various infec- tious-diseases described. Among the symptoms, where no specific disease-germs are at work, are malaise, headache, loss of appetite, with dyspeptic symptoms, drowsiness, and slight feverishness. There is a marked tendency to anaemia and general debility. These symp- toms are frequently grouped under the name of " malaria." In children, to these phenomena may be added a smooth or glazed, broad, flabby tongue, with a marked tendency to digestive trouble, as vomiting, diarrhea, dysentery, and attacks of gastric catarrh and catarrhal tonsillitis. The tendency of sewer-air poisoning is to derange the organs of primary assimilation rather than the lungs ; as, for example, gastric catarrh, duodenitis, hepatitis, splenitis, diarrhea, enteritis, and colitis. Besides these effects, the debilitating influences of the polluted air render the persons so affected an easy prey to an intercurrent malady. Sewer air is more like to affect weakly and anaemic persons. Sanitary science teaches us that diarrhea is a prominent symp- tom of different complaints, and is frequently due to the presence of some irritant in the intestinal canal. Children are specially liable to be attacked with diarrhea, when changes are made in regard to diet, as at the time of weaning, or when improper food •s given, but in summer this tendency is so greatly increased (adults also being affected) that such names as epidemic, chol- eraic or infantile diarrhea have been given it. While this disease prevails quite as much (if not more so) among adults as among young children, yet the mortality is almost exclusively confined to the latter, and equals one-tenth of all other causes put together. 952 DISEASE GERMS. While it is true that improper feeding of children, and putre- factive changes occur more rapidly in food in warm than in cold weather, and might be sufficient to set up diarrhea, yet it is now believed to be chiefly due to bacteria, and it is probable that they act in this as well as in epidemic cholera by producing poisons in the intestine. Probably much of the diarrhea which occurs, especially in children, after the use of milk, is due to the formation of tyro- toxin, or other more or less poisonous products by decomposi- tion of the milk in the intestine itself; and as milk appears to be an excellent breeding ground for septic and other organisms, it is easy to explain the reason why infants, who are breast fed, have a much greater chance of escaping diarrhea than those who are fed by hand. That the risk of bacterial inoculation is prac- tically small in the former. That the essential cause of diarrhea resides ordinarily in the superficial layers of the earth, where it is intimately associated with the life processes of some micro-organism not yet detected, captured or isolated. That the vital manifestations of such organism are dependent, among other things, perhaps principally, upon conditions of sea- son, and on the presence of dead organic matter, which is its pabulum. That, on occasion, such micro-organism is capable of getting abroad from its primary habitat, the earth, and having become air-borne, obtains opportunity for fastening on non-living organic material, and of using such organic material both as nidus and as pabulum in undergoing various phases of its life history. That in food, inside of as well as outside of the human body, such micro-organism finds, especially at certain seasons, nidus and pabulum convenient for its development, multiplication, or evolution. That from food, as also from the contained organic matter of particular soils, such micro-organism can manufacture, by the chemical changes wrought therein through certain of its life pro- cesses, a substance which is a virulent chemical poison ; and that this chemical substance is in the human body the material cause of epidemic diarrhea. Certain factors have been noted as having an important bear- ing upon the development of diarrhea, the chief of these being the nature and temperature of the soil. i. Nature of the soil:—A high mortality occurs on loose soils, such as those composed of sand, gravel, marl, or marl with clay, which are easily permeated by water and air, and especially when such soils are contaminated with organic animal matter. BACTERICIDES. 953 Excessive dryness or wetness of the soil is unfavorable to diarrhea. 2. Temperature of the soil:—The atmospheric temperature has very great influence, but it is exerted indirectly, as the mor- tality does not increase until the mean temperature recorded by an earth thermometer at a depth of four feet from the surface has attained to about 56° F.—no matter what the temperature pre- viously attained by the atmosphere, or recorded by a thermome- ter at a depth of only one foot from the surface, may have been. The mortality rises and falls with the four-foot thermometer. It usually begins to rise rapidly in the middle of June, attains a maximum towards the beginning of August, the fall begins slowly in August, becomes more rapid in September, and re- covers its ordinary rate by the end of October. Minor influence on the mortality is exerted by the amount of rainfall, rise or fall of ground-water, wind or comparative calm, and by elevation above sea-level according to the way in which they hasten or retard the rise of temperature, or affect the wet or dry condition of the soil. 3. Density of population. 4. Density of buildings upon any given area. c. Restricted circulation of air about or within dwellings. 6. Domestic darkness, and general dirtiness and mustiness of dwellings. 7. Emanations from sewers, cesspools, privies, and dust bins. 8. Filthy accumulations. 9. Polluted drinking water and food supplies, especially milk, and everything about a house which tends to lower health and vitality, exert a baneful influence, and should be remedied. We recommend subsoil drainage, concreted sites for dwellings, free ventilation, daily scavenging, proper drainage, and special pre- cautions to protect the milk supplies from contamination, aerial or otherwise, both before and after it reaches the consumer. Sanitary science has clearly demonstrated that the disease germ which induces the greatest mortality among the human race is the tubercle bacillus. This is the most important of all microbes. A nation tainted to its core with this micro-organism would quickly cease to be a nation at all. The presence of this disease germ entails sickness, infirmity, an actual, definite, national loss, in consequence of which we are weaker and poorer. We do not properly appreciate the influence of disease germs on national prosperity, although we realize it in the individual. ff our national rulers could only realize the extent to which it is impoverished by preventible disease, rendered poorer by the loss 954 DISEASE GERMS. of that wealth of which money is the token, they would soon devise means to wipe out glaring insanitary conditions and take meas- ures to instruct the masses in sanitary science, so that each one would have a sound mind in a sound body. The greatest possible amount of money spent by our govern- ment for efficient sanitary measures will always prove an actual and great economy, and result in a saving of human life and an increase of national wealth. Nothing is so costly as disease, excepting death ; no waste is so extravagant as the waste of human life. i. Tuberculosis is the most important of diseases. As it affords the highest percentage of deaths, it is the most important from an economical point of view, as the sufferers from it gener- ally die after prolonged illness with diminished or altogether abolished power of production. 2. The war against tuberculosis is to be carried on vigorously by the state, the profession and the community; it promises very considerable diminution, if not total stamping out. 3. The cause of tuberculosis is the bacillus; its existence outside the animal economy is not yet proved, but, it has the power of long preserving its infective qualities. 4. The bacillus of tuberculosis is obtained (a) by heredity—this is of slight importance; (b), by direct or indirect transmission from other tuberculous individuals ; (c), by direct or indirect transmis- sion from tuberculous animals, particularly by their milk and the parts serving as food. 5. Measures against the spread of tuber- culosis—ad 4A, certain regulations impracticable; ad 415, school hygiene (disinfection of the expectoration of teachers and children, regular wet cleansing and frequent disinfection of school-rooms); erection of disinfecting offices by the community, and the instruc- tion of people in the technique of disinfection; repeated disinfection of dwellings and articles used by tuberculous individuals, obliga- tory disinfection of the dwellings and utensils of persons dying of tuberculosis ; supervision of the health of nursemaids, midwives and hospital attendants ; supervision of persons engaged in the preparation and sale of foods, exclusive of such as are coughing. Careful hygiene of hospitals, prisons, orphanages and similar in- stitutions. Ad 4c, instruction of the people, strict compulsory meat inspection. Determination of all animals found to be tuber- culous as regards breed. Veterinary superintendence of shippons from which tuberculous animals have come. Destruction ol animals found to be tuberculous (with at most partial compensa- tion), supervision of the milk trade. BACTERICIDES. 955 A most complex disease of the blood in which Scurvy, the essential elements of anaemia, purpura are prominent factors, with a deficiency of the alkaline salts in the blood. Monotony, sameness, isolation, together with the use of food deficient in the salts of potash, as fresh meat, fruit, vegetables, are the usual causes. Symptoms.—The earliest and best marked symptoms are observed in the countenance; the face is pale, and may be bloated; the eyes and lips have a dirty hue; the features are somewhat depressed ; the gums are spongy, livid, and bleed when slightly irritated; teeth loose, breath very offensive. There is great lassitude and debility, pains in the legs, limbs very feeble, joints stiff, unable for any exertion. There is great difficulty of breathing, skin dry and harsh, sometimes rough and scaly, espe- cially around joints, oftentimes puckered ; although more gen- erally it is shining, with patches or spots of brown, blue, black or livid blue. These patches are first seen on the legs or thighs, but generally extend over the entire body, except the face, and the disease continuing, the feet and legs become cedematous. If not arrested at this point, the symptoms increase in severity, the gums become more livid and swollen, the breath more offen- sive, the pains more severe, and so with the other symptoms. In the latter stages there is often hemorrhage from the mucous canals, and the loss of blood is often so great as to prostrate the vital power of the patient. In these stages, the evacuations from the bowels are often fre- quent and offensive, and we often have scorbutic dysentery, albu- men in urine. The pulse is jerking, appetite impaired, intellectual faculties slightly affected. In nearly all cases there is a tendency to faint on the slightest motion or exercise, which is often fatal. In distinguishing purpura from scurvy, to ascertain the cause is of the first importance. The latter disease can always be traced to hardships and the absence of fresh meat, fruit and vege- tables ; and it is readily amenable to treatment by proper diet and lemon juice. Purpura, on the other hand, never depends on the above-mentioned causes, and does not yield to treat- ment. The following additional points of distinction may be mentioned: i. Scurvy does not usually appear in isolated cases ; all those exposed to the unfavorable influences above indicated suffer from 't more or less. 2. Debility, want of energy, depression of spirits and pains in the limbs are always present as an early symptom in scurvy, 956 DISEASE GERMS. while in purpura these symptoms are generally absent, especially at the commencement of the disease. 3. In scurvy painful swellings and ulcerations are apt to occur, especially in the legs ; these are not present in purpura. 4. In purpura hemorrhagica the bleeding is more general, copious and continuous than in scurvy. v There is generally a high temperature in the later stages of purpura hemorrhagica. Treatment.—Rest in the recumbent posture ; attention to liver, skin, kidneys, fresh air, generous diet, wholesome animal and vegetable food ; fresh meat and boiled fish; juicy, rare meat; all kinds of vegetables, with fresh fruit in abundance. Precisely the same treatment as for purpura, with the exception that five grains of chlorate of potassa in water should be given three times a day, in order to supply the deficiency of alkalies in the blood. Cin- chona and mineral acids are of great efficacy. In land-scurvy, change of diet is of the greatest importance, and an avoidance of salted meats and fish. More recently scurvy has appeared among the ill-fed children of large cities who reside in crowded insanitary localities. It yields readily to fresh air, meat-juice and abundance of food. Pellagra, or scurvy of the hills, used to be confined exclusively to the Alps, but several well-marked cases have taken place in Montana and Arizona. It is a species of scurvy; blood disease, with an altered state of skin, the eruption being symptomatic of the blood disease. The cause is a want of variated food, or in- sufficient nourishment. It ends in mania, imbecility and slow death with softening of brain and spinal cord. When first seen patient should be removed to better quarters and have a variated diet, because when once established all reme- dies fail. The best success has attended the use of a highly animated diet, with vegetables. The glycerite of ozone and kephaline operate most favorably in aiding blood formation, their use being pre-eminently constructional to brain and blood. Or motion sickness, as it may be termed, Sea-Sickness, for it occurs on lakes, rivers, or other turbu- lent motions, and by riding backwards, is a disturbance of a special sense, whose function is to determine the position of the head of man in space, and to govern and direct the mechanism by which the body is maintained in the erect posture and in equilibrium. This special sense is highly devel- BACTERICIDES. 957 oped in the highly civilized Caucasian, and is his peculiar pre- rogative; by it the grandeur of the heavens, the beauties of nature, are realized; by it, man's mind is endowed with divine energy, and he can better appreciate his divine origin. This faculty of equilibrium is connected or seated in the brain, the optic lobes, the nervo-vital fluid or bed-plate of cerebrum and cerebellum, and other parts of the nervous organism, but its principal seat is in the semi-circular canals of the internal ear, which may be called the sense of equilibrium. Motion produces sickness by disturbing the endo-lymph in those semi-circular canals, the viscera of the abdomen, the bed- plate of brain, or the nervo-vital fluid upon which the brain rests. The motion may be either backward, forward, downward or os- cillating, and should be continued for a certain length of time. A combination of these conditions is the most effective, espe- cially if there be an element of irregularity or uncertainty. There are three varieties or forms of sea-sickness, which can be clearly distinguished from each other, and each of which is susceptible of relief by appropriate treatment. Nausea and vomiting is a prominent feature of all the forms. They may be classed as follows: i. The Endo-lymph, flowing freely in the semi-circular canals of the inner ear, is subject to all the laws of fluids, inertia, gravi- tation, friction. It flows in a straight horizontal current, follows the motion of head and ship. The plane of the canals corre- sponds most nearly to the direction ot the motion, face forwards; reverse the motion, and the endo-iymph continues to flow on, until it is arrested by friction, this causes undue pressure in one or more of the ampullae which causes a wrong impression to be carried to the sensorium, and insubordination and giddiness is the result; the fluid in the canals is agitated, rocked or washed about, the finer nerve filaments are irritated and abused, and when this process is repeated a number of times, nausea and vomiting take place. In the recumbent position, head low, feet to the stern of boat, in which position nature has some beautiful anatomical contriv- ances to prevent sickness. She has made provision for the equilibrium of the body in the horizontal position, by the change in position of the fluid at the base of the brain into the spinal cavity, in the position of the semi-circular canals on their present extremities. In consequence of these, when the body is recum- bent or thrown back, the endo-lymph gravitates to the least sensitive part, and disturbance of them will not have that tend- ency to alter pressure. This explains why the backward motion in carriages causes nausea. In auditory vertigo we have pre- 958 DISEASE GERMS. cisely the same condition by pressure within the inner ear, de- cided vertigo, headache, nausea, etc. Motion sickness is a semi- physiological prototype of sea-sickness. All authorities are agreed on the point that a reversion of the movement in the semi-circular canals is a cause of nausea, vomiting. This form is most common in all steamships, with sea motion and vibration of the engine. Second class.—Visceral vomiting, due to mechanical disturb- ance of the viscera; contusion of the abdominal viscera, pro- duced by the violent heaving of the ship in a heavy sea, has a tendency to cause mechanical disturbance. Here, again, we are compelled to go back to the brain. The endo-lymph in canals follows the motion of the head, and after that motion is stopped, continues on its course for a second or two, and then moves on in its original direction. During this change erroneous impres- sions are conveyed to the brain, which in turn sends a mistaken message to the abdominal muscles and viscera, and they are brought into action, and complete abdominal contusion is the result. This is of the greatest importance to the viscera, altering their basis of support, and causes them to thump on each other. Besides, there can be little doubt, as the viscera are all covered by the sympathetic and the pacinian corpuscles, that their move- ment causes a disturbance of the centre of equilibrium. In this form vomiting is very violent. Third class.—A mechanical disturbance of the fluid contents of the stomach gives rise to paleness, goneness and vomiting. Sea-sickness exists independent of visual impression, although it may exercise an important influence in some cases. Visual ver- tigo depends upon an exhaustion of the optic mechanism; but in the visual vertigo of sea-sickness there is a discord between the immediate impressions and a visceral sense of the fitness of things, which passes into a feeling of uncertainty, dizziness and nausea. All the phenomena of sea-sickness have a rapid tendency to pass away. Nature has so constructed the organ of equilibrium that it is eminently fitted to receive impressions through the physical behavior of the contents and habit taught that organ, to convey to the sensorium within, correct information of the ex- perience of those impressions. The ocean habit teaches the canals to adapt therrj^elves to the new condition of things, and to pass over erroneous impressions unheeded, which were noticed at first. In fact, the new habit becomes so strong that a disturb- ance of it by return to land will be marked by a peculiar phe- nomenon, as is witnessed in the unsteady gait of a sailor, and others. BACTERICIDES. 959 Sea-sickness teaches us that there is within us a sense of pas- sive motion. We see it in the child being lulled to sleep in the rocking-horse, rocking-chair ; horseback exercise, vehicular mo- tion of all kinds, passive movements of the body. It is agreeable, when mild, and when in a line with the semi-circular canals; disagreeable, when the natural harmony is broken. The feeling of goneness is due in a great measure to the subsidence of the abdominal visceia in the erect posture, and irritation of the nerve centres by ceaseless movement of the ship. Best remedies to act on canals, sulphate quinine, nitrite of amyl, pills of nitroglycerine, bromohydric acid, cocaine tablets, or coca wine. Bandage round abdomen, recumbent posture, and, when about, face to the front of ship, etc' The vesiculae seminales are two mem- Seminal Vesicles, branous receptacles, situated one on each side, beneath the base of the blad- der between it and the rectum. Their length is usually about two inches, and their greatest breadth from four to six lines ; but they vary both in size and shape in different individuals. Their poste- rior extremities are separated widely from each other, but ante- riorly they converge so as to approach the two vasa deferentia, which run forwards to the prostate between them. With the vasa deferentia thus interposed, they occupy the two diverging sides of the triangular portion of the base of the bladder, which lies upon the rectum, and is bounded behind by the line of re- flection of the recto-vesical fold of the peritonaeum. The semi- nal vesicles themselves rest upon the rectum, but are separated from it by a layer of the recto-vesical fascia which attaches them to the base of the bladder. Their posterior ends lie beneath the openings of the ureters. The common seminal or ejaculatory ducts, two in number, are formed .on each side by the junction of the narrowed extremities of the corresponding vas deferens and vesicula seminalis, close to the base of the prostate. From this point they pass side by side through the prostate between its middle and lateral lobes. After a course of nearly an inch they "end in the floor of the prostatic portion of the urethra by two valve-like slits placed in the veru- montanum, one on each prominent margin of the opening of the prostatic sinus. Seminal vesiculitis is usually secondary to mischief in the urethra. It is a common accompaniment of gonorrheal epididy- mitis, and originates in a precisely similar manner. When the 960 DISEASE GERMS. inflammatory process has crept from the urethra along the com- mon ejaculatory duct to its termination, it is as likely to proceed along the short seminal tube to the vesicle as along the twenty- four inch vas deferens to the epididymis. I believe it commonly extends along both these structures. I have seen the vesicles inflame secondarily to urethritis, set up by the passage of a bougie, by the presence of a stricture, by masturbation after coitus with a leucorrheal woman, and by the elongated front of a bicycle saddle. I have seen both vesicles suppurate in one case where their inflammation appeared to be primary ; at least there was no antecedent cause discoverable in the urethra. When acute inflammation attacks a vesicle it gives rise to a swelling at the side of the base of the bladder, the greater part of which is due rather to effusion of inflammatory products into the perivesicular connective tissue than into the cavity of the vesicle itself, just as we see that in epididymitis the bulk of the enlargement depends upon inflammatory infiltration into the con- nective tissue between the tubules of the epididymis. Seminal vesiculitis, like acute epididymitis, most frequently terminates in resolution. It sometimes ends, however, in suppu- ration, and, when this occurs, pus may make its way laterally into the ischio-rectal fossa, or may diffuse itself deeply around the rectum (constituting one of the varieties of peri-rectal suppu- ration), or may discharge itself by the ejaculatory duct, or may open either into the bladder or rectum, but never into both cavi- ties together. Some cases pursue a chronic course, distend the cavity of the vesicle, cause permanent choking of the ejaculatory duct, giving rise to a cystic swelling behind and beneath the bladder and blighting the spermatozoa. . ._ The symptoms of vesicular r *>" ,__ ' —e> „~> disease are essentially those of ^J\* ^\ "^'/Jf \ vesical irritability, resemble f9 "*) C * \'* oA./ » prostatitis, consist in uneasiness <~ , c J V\ ^ ^t_- v~ about the perinaeum, painful de- "M r\°>i "^.V \s/T fecation, frequent painful mic- '■" ^ - turition or retention, nocturnal Perfect Spermatozoa. Imperfect Spermatozoa, emissions, persistent moisture Or Sprightly, active. as^seen in inflamma- weeping peniS( with SOme ptiap- vesicies, opaque, mo- jsrn. All the symptoms are easily explained: The distended vesicle produces a degree of pressure upon the back of the bladder in the neighborhood of the trigone, and this gives the frequent desire to urinate. Pain or uneasiness increases as the bladder BACTERICIDES. 961 fills: nocturnal emissions, undue erections are always present owing to the irritation or hyperaemia produced by the distended vesicle, and reflected irritation to the deep urethra and its connections. Prolonged or ill-treated gonorrhea, masturbation, perversion of the sexual act, bicycle riding, etc., are frequent common origina- tors of this malady, which is affecting a very large proportion of our male population. Modern therapeutics, which rests upon a scientific basis, has crystallized a treatment of infinite value, one in which definite results are obtained. In all cases an efficient alterative and tonic course, with atten- tion to secretions, bathing, diet, etc., should be pursued. Specially the green-root tincture of gelsemium in doses rang- ing from five to fifty drops, three times daily is a genital sedative of the highest order ; alternated with the ozonized extract of the black willow in doses of from a half to one teaspoonful thrice daily, acts as a true sedative, astringent and vitalizer of the ejacu- latory ducts, and the entire reproductive area. In the entire materia medica there are no two things which can excel these in allaying irritation of the seminal vesicles— directly sedative, nay, anaesthetic to this part of the organism. They not only control inflammatory action, but effectually check all leakages and emissions. Their activity can also be greatly increased, and the deep- seated urethra entirely rejuvenated, by the introduction every other night into the urethra, well up to the prostate, of a bougie prepared from the glucoside of the salix niger. Still further, a cocaine suppository could be introduced into the rectum, to render treatment still more effective. There is a great variation of sight among the dif- Sight. ferent races of men; the sense of sight, like that of hearing, is much greater and keener among all colored races than the white. Vision, or sight, is performed by the brain, through the most perfect optical apparatus, the eye, by or through which the brain looks at the exterior world. In normal vision in the Caucasian, between fifteen and forty- five, with a healthy brain and eye, he can distinguish an object the six-one hundreth part of an inch in size, at a distance of six inches. Myopia, short or near-sightedness, may be said to exist when the distance at which ordinary type can be read is less than 61 962 DISEASE GERMS. twelve inches, and when near objects can be seen distinctly, bright light aggravating the condition. Near vision may be hereditary, a typical type of conformation; usuallvtoo great a convexity of the cornea or crystalline lens,or both. It may also be due to lengthening of the eye-ball, to an undue density of its refractive media. The rays of light from objects at usual distances are brought to a focus before reaching the retina, instead of being concentrated upon it. Overcrowding in our public schools in large cities is most pro- ductive of myopia. It is brought about by a low form of puru- lent ophthalmia, which is always present where density of popu- lation, insanitary conditions prevail. Want of phosphates in children's food is a common cause. This is often caused by the introduction into bread of alum, to whiten, but which destroys the elements of brain and bone nutrition. Adulterated food (cerebral starvation) and overcrowded schools are manufacturing a myopic race of children. Masturbation in both sexes is a cause. Permitting lights in sleeping apartments deprives the eye of its natural rest in dark- ness, hence this is a common cause. Overwork, excesses, read- ing by gas-light and oil lamps, etc., are causes. Long-sightedness ; an alteration in the refractive power of the eye, producing presbyopia. It is always associated with weak- ness of vision, an indication of cerebral atrophy, of approaching old age, often a precursor of glaucoma, vision imperfect for near objects ; distant ones clearly seen. Weakness of vision, asthenopia, eyes weak, but appear normal; inability to read or write for any length of time, usually asso- ciated with headache and muscae volitantes. Color-blindness, an inability to discriminate between certain colors, an affection of vision of the greatest interest to the gen- eral public, as regards the exclusion of affected individuals from the position of engineers on railroads, signal-men, pilots. Quakers and Jews are most affected with it; in the former it is brought about by a marked characteristic, a general coalescence of the typical fissures of the brain, induced by monotony, same- ness, isolation; a condition often present in insanity, epilepsy and other low types of the human brain ; in the latter class relation- ship or consanguinity wipes out the mental characteristics and obliterates the convolutions. This in-and-in breeding, as well as solitariness, predisposes to suicidal mania and causes color- blindness. The average per cent, of color-blindness among any given peo- ple will depend upon the preponderance among them of Friends and Jews, or persons who possess the same characteristics. It BACTERICIDES. 9^3 always diminishes as we ascend the social or educational scale. Among deaf mutes the percentage is even greater than the two classes mentioned. Intermarriage is not only a great factor, but the same law extends to temperament and races. Intermarriage not only creates the defect, but aggravates it, causing the most intractable form, which is red blindness. There is also to be found an unusually high average of color defects among the children of either fathers or mothers who work among colors. Trades requiring great concentration of sight, as engraving and watchmaking, seem to bring it about. Women are equally affected with men. The average percentage in people of low civilization or culture is great; among deaf mutes, ten per cent, and among Friends and Jews, about six per cent. Color-blindness is a defect which is quite compatible with perfect vision in other respects. Color-blindness is found to exist in three forms: 1. Inability to distinguish any color, properly so called ; black or white, or light and shade. 2. Inability to distinguish between nicer shades of more com- posite colors, as brown, gray and neutral tints. 3. Inability to distinguish between primary colors; red, blue, yellow; or secondary and tertiary colors, as green, pur- ple, orange. In the latter form there is a defective appreciation of all colors. Little good results from any treatment; and as there is about one per cent, of the entire population affected, care should be exercised by railroad officials, pilot boards, etc., that no affected person be employed, so as to avoid serious accidents. Convexity of the cornea from above downwards, or from side to side, gives rise to an inequality of the refractive power of the several meridians of the eye (astigmatism). It is often con- siderable, and interferes with the sharpness of sight. Oversight; a condition in which the refractive power of the eye is too low, or the optic axis too short; consequently when the eye is in a state of rest, parallel rays are united upon the retina, but behind it, and only convergent rays are brought to a focus upon the latter. Distant objects are not seen clearly ; eyes look smaller and flatter than in health; likely to be head- ache, dull pains in the eyes, with heat and fulness ; when reading words run into each other. There are a very large variety of drugs which affect the brain disastrously" and cause weakness of the optic nerve, " amblyopia," such as morphia, tobacco, chloral, and the long list of hair washes and dyes. Double vision may be due to the use of drugs, such as gelse- 9t'4 DISEASE GERMS. mium, or to some irregularity of density, or paralysis of the muscles of the eye-ball. Night blindness, or day vision, hemeralopia, is common among travellers, soldiers, sailors, in tropical countries, brought about by long exposure to intense sunlight, or to the reflection of the sun's rays on the white sand of the desert; this exhausts the sensibility of the retina. It is occasionally a symptom of scurvy, of sexual excesses, masturbation, and organic changes in the brain. Intolerance of light, photophobia, is a constant prevailing symp- tom of all inflammatory conditions of the eye and brain. A dilated pupil, mydriasis, is invariably present in all states of cerebral anaemia, and gives rise to imperfect vision. It may be induced by the use of acro-narcotic drugs, especially belladonna. A contracted state of the pupil is present in all states of conges- tion of the brain (myosis), and it can also be induced by the use of calabar bean. Certain trades, in which they are compelled to look at minute objects, as watchmakers, wood engravers, acquire it. Great obscurity of vision in a weak light. Vision is often most powerful or acute during twilight, myc- talopia. Specks or spots before the eyes—musca volitantes are present. When the vital integrity of the brain is lowered or depressed, and either anaemia or hyperaemia is present, the nerve filaments that supply the aqueous humor and vessels of choroid are re- laxed. If the debility be great, vessels take on varicosity; and when the brain looks through the eye at the external world, it sees the varicose vessels, tortuous, and anastomosing in every conceivable form, and it then compares them with objects seen or described in the external world; if depression be not very great they will be compared to small objects, as flies, specks, spots ; if depression be great, the vessels are greatly engorged; then the patient will compare them to large objects, as men, devils; they are real, no hallucination, as the patient sees them ; in his own eye. It indicates brain exhaustion, in a mild or aggravated form. Protuberant eye-balls are present as a symptom in tuberculosis, in all its varied forms. Why we sleep, and how we sleep, are questions Sleep, still awaiting solution. The periodic suspension of the activity of the superior nerve centres is the domi- nant character of sleep ; even the automatic centres for the re- spiration and circulation are less energetic, so that the breathing is slower, pulse quieter. BACTERICIDES. 965 The variations of the cerebral circulation present a certain re- lation with the alternation of sleep and wakefulness, but these variations require an explanation, they do not suffice for any theory of sleep. The great, nay vital, importance of oxygen in keeping up the activity of the tissues once recognized, its less absorption, giving rise to anaemic states of the brain. An active state of the brain cells necessarily gives rise to waste, a sensation of fatigue; and those fatigue substances ope- rate by monopolizing the oxygen, sleep follows* by default of this agent. The products of exhaustion are continually forming within the brain when active ; that their accumulation brings on sleep, and that during that process they are eliminated by the blood which passes through that organ. All organic activity gives rise to products of exhaustion, to the formation of a substance termed "ponegenes," which accu- mulates in the brain during wakefulness, and being very oxidiz- able, terminate, by diverting to their own profit, the oxygen destined to keep up the activity of the different glands, muscles and brain, in such a fashion as that the mental acts and voluntary movements are depressed, the organism falls asleep. Among the ponogenic substances are lactic and uric acid, and a group of bodies closely allied to them. In would thus appear that there is a sort of self-regulating mechanism in the body, by which sleeping and waking are made to alternate. During the waking hours soporific products are formed, and these, gradually accumulating, will by-and-by induce sleep, while during sleep stimulating products are formed which, after a certain number of hours, will stimulate the brain to wake- fulness. • Microbes in the throat are common in all Sore-Throat, diseases. From breathing microbe-laden air, from re- laxing and damp weather, or living badly and working hard, will in the end produce a relaxed condition of the throat. For this, pure air, better food, and swabbing or gargling the throat with a solution of tannic acid and chlorate of potassa, to which a few drops of peroxide of hydrogen is added, is the best remedy. Sore throat is common among those exposed to the vicissitudes of weather. It is a common, universal symptom or indication of the presence of the micrococci of scarlet fever or the streptococcus of diphtheria; it may follow a shock from cold, damp, or excessive talking. It is common in 99 cases out of 100 in all persons who have had syphilis or tubercle; in 966 DISEASE GERMS. all individuals who are close to or near by any syphilitic or tubercular individuals. The hoarseness, or soreness, or the ulceration are due to the inroad or deposit of those two bacilli. It is preposterous in this microbial age to look for anything else. Look for the brown copper-colored mucous membrane, with yellow flakes of pus; the impress, the stamp of syphilis ; or the pale mottled mucous membrane, with cheesy specks or particles, the insignia of the tubercle bacilli. Those microbes work silently, there is neither pain, nor rawness, nor redness. Inhalations of glucozone are most effectual in killing and loot- ing out those microbes. Its daily use sterilizes the mucous membrane, renders it unfit for their deposit and growth. Convulsions in young children, subject to laryn- Spasms. gitis (spasmodic laryngitis); they are respiratory convulsions, but may become universal. I suggest that the age of the patients, the fact that there is a manifest im- pediment to respiration at the gateway of the respiratory appa- ratus, and the occurrence of the attacks mostly at night (in sleep), point to an over-stimulation of the respiratory centres by too great venosity. If so, the hypothesis that attacks of laryn- gismus are similarly caused is favored. " Spasmodic " laryngitis usually occurs in children under two or three years of age; the attacks usually occur suddenly during sleep, and the next day the child may be seemingly well, except for a little hoarseness and cough ; the attacks are sometimes mistaken for laryngitis. Treatment of Inward Fits.—Let us now see if the results of treatment favor the hypothesis put forward. It is good practice not to let the child who is the subject of laryngitis sleep too long at a time; not to let it remain too long in a condition favoring venosity ; I suppose the same applies to laryngismus stridulus, to which morbid affection I confine further remarks on treat- ment. It is understood, of course, that attention is given to diet, di- gestion, and state of the bowels. No one fails to treat the rick- ets, the approved medicine being kephaline. The good effect of the highly valued remedy, cold sponging, favors my hypo- thesis ; manifestly it will stimulate the respiratory centres. So do the good results of carrying the child out, even in cold weather, and change from town to country air. The several remedies will tend to reduce venosity. Now for drugs, more especially in the treatment of what we BACTERICIDES. 967 call laryngismus itself. The best remedies should, on,the hy- pothesis, be those which stimulate the respiratory centres. Of special drugs fl. ext. musk-root and belladonna are most useful in laryngismus stridulus. The former can be given to a child of twelve months old in doses of one-half teaspoonful every six hours, and will be found to have a powerful influence in check- ing the tendency to spasm. Belladonna, to be of service, must be given in sufficient doses. The comp. tincture of lobelia is a never-failing remedy; it should be administered in small doses, frequently repeated ; con. ozone applied to the throat and chest is good. Musk is a stimulant to the respiratory centres, as is also belladonna. It is well known that children tolerate large doses of belladonna; bearing in mind Soltmann's researches, this may be because in them it acts more as a stimulant, or rather that the parts it can render negative (inhibitory and secretory nervous arrangements) are not largely present in the infant to be para- lyzed. Chloral is a remedy for fits of laryngismus lauded by high authorities. It is the best remedy for a rapid succession of fits of any kind ; for putting an end to the seizures, that is. It is not, I presume, actually curative of the morbid condition induc- ing them. It may be given when fits of laryngismus are frequent. Now for treatment after the paroxysm. When the fit is over, the child usually comes round spontaneously. But supposing that after a severe attack respiration no longer goes on. The respiratory centres are exhausted, or what remains of them un- exhausted is not enough to produce respiratory movements; the child is seemingly dead. There is paralysis of the respiratory apparatus after respiratory convulsions, just as there may be of a limb after an epileptiform convulsion which had affected that limb first and most. Here we must bear in mind that after asphyxia fits produced in lower animals, the heart, as a rule, con- tinues to beat for a short time after respiration has stopped. Hence if luckily present when a child is seemingly dead after a fit, we should give him a chance of recovery by artificial respir- ation. We should not waste time to see whether the heart has or has not stopped. means the violent and uncontrollable action Spasm of the of some particular set of muscles. Spasms Bladder are generally described as of two sorts, viz., tonic and clonic. In tonic spasms the muscles of a part contract violently, and remain rigid and im- movable by the will of the patient for a greater or less length of 968 DISEASE GERMS. time. .Such contractions occur in tetanus and in ordinary cramp. Clonic spasms again consist in sudden contraction and relaxations regularly alternating. The jumping of the legs and arms, which occur under certain conditions, are examples of this. All muscular structures are liable to attacks of spasmodic action; the bladder having such a coat is frequently affected with spasm. Spasmodic attacks are accompanied with great pain, as well as contraction. Causes.—The presence of a stone in the bladder ; disease of the rectum or uterus; abscess of kidney ; an inordinated amount of uric acid ; ulceration of the walls of bladder; disease of pros- tate gland ; excessive sexual congress; hysteria; the use of drastic diuretics or emmenagogues, as oil of turpentine, juniper, cantharides, savin. Symptoms.—Severe pain in the lower part of the abdomen, extending to urethra. There is either continence or inconti- nence, or dribbling of urine. The difficulty is not so great when the urine flows involuntary; when there is retention, with urgent desire to micturate, and tenesmus, with inability to do so, suffering is great. If allowed to continue, may terminate fatally. Treatment.—If patient is seen during the attack, hot baths, enemata of warm water and lobelia; fomentations or poultices, with belladonna, linseed poultices, with lobelia and belladonna; suppositories of opium and belladonna. Internally, mucilaginous drinks, with cream of tartar and nitrate of potass; either the compound of lobelia, valerian and capsicum, or else sumbul and tincture of green root gelsemium. When attack is over, removal of cause, alteratives and tonics, iodide potass and sulphate of quinine. Diet regulated, an avoidance of all stimulants; tea, coffee, warm clothing ; forbid horseback exercise, or sexual intercourse; use appropriate remedies as to cause. Spasm of the rectum ; contraction of the Spasm of sphincter muscle accompanies ulcer of the mucous Rectum. membrane that covers it. The spasmodic condition is distinguished by the absence of pain after defecation, and an examination of the bowel will show no stricture. The treatment of spasmodic contraction of the bowel is best effected by a general course of nerve tonics to remove the nerv- ous irritability of the system, and the use of the cocaine sup- positories. BACTERICIDES. 969 There is very frequently met with in highly developed and intellectual ladies and in neurasthenic males a neurosis of the nerves of the rectum, which gives rise to frequent spasm, with painful defecation, and constipation; a state which is either brought about or aggravated by emotional states, without any ulcer or breach of surface. This state yields to alteratives and tonics with the use of the cocaine suppository. If this treatment fail, seclusion, rest, forced feeding, massage and electricity. Some of those cases are very troublesome. Lack of nervous co-ordination of the sphincters and irritable bladder; painful coition, asthma, difficulty of breathing, aphonia. In strict neu- rosis the sphincter develops chronic spasm as well as neuralgia, which gives rise to great exhaustion after any motion of the bowels. This term is applied to the flowing away Spermatorrhoea, of the seminal fluid, and designates all varieties and forms of spermatic losses, which occur beyond the limits of health. True spermatorrhoea, or seminal incontinence, the flowing away of the spermatic fluid, is primarily dependent upon weakness, or exhaustion, or neurasthenia, with increased impressibility, mobility, or excitability of the genito-urinary spinal centre, phe- nomena usually induced and perpetuated by hyperaesthenia of the nerves which supply the prostatic portion of the urethra, induced in nine cases of out of ten by masturbation. In seminal incontinence there are three conditions which may exist separately or be blended together. 1. Nocturnal emissions, which occur during sleep, attended with an erection, pleasurable sensation, erotic dream. 2. Emissions during the day, excited by slight mechanical or physical causes; incomplete erections, diminished sensation, and no erection. 3. Spermatorrhea proper, in which there is a continual flow of semen from the urethra, without erection, sensation, or during urination or defecation. In the first form, namely, involuntarily nocturnal seminal dis- charges, we have the bulk of the affection. This is common to all men after the epoch of puberty, especially if they lead a chaste and virtuous life. Their frequency may vary with the con- dition of life, age, climate, habits, constitution, temperament, diet, precocity. Their frequency varies greatly. Single men, who live a moral '"e of contentment and possess an inherent vitality, sound 9/0 DISEASE GERM nervous system, healthy occupation, mental and physical, strictly avoiding all the unhealthy literature and debasing amusements, may have no emissions, no leakages of any kind, still, if he had an emission not more frequent than one every two or three weeks, it might not be inconsistent with a high standard of health. If such were the case, it would merely exhibit a slight weakness, or merely a reflex sign of fulness or distension of the seminal ducts. Ungratified sexual instinct in those whose nervous systems are slightly impaired is apt to be followed by emissions, but if these are not any more frequent than what has been stated and are not followed by languor, headache, backache, dimness of vision, and noises in the ears, with mental depression, etc., they are not regarded as very materially wrong, although we see in them a precursor or indication of an impairment of the sexual appetite at the base of the brain. In the second form, where the afflicted individual has emis- sions, or ejaculations, or leakages during the day, we have a clear case of nervous bankruptcy, combined with weakness of the genital organs and of the reflex nerve centres. In such cases, the slightest degree of peripheral irritation, as the friction of the clothes, the crossing of the legs, horse-back or bicycle riding, driving on rough roads, reading libidinous dime novels, attending variety theatres; looking at indecent pictures ; or the full bust of a beautiful woman excites in their mind lascivious ideas, and emissions. In such a case, if there is an erection, it is but partial, as the penis is flabby and flaccid. In the third form there is a true condition of seminal incon- tinence ; there is a moisture, or leakage all the time, a passive loss, without the concurrence of the organism, and this oozing, leakage or partial ejaculation is associated with positive physical symptoms, such as a dilatation of the orifices of the ejaculatory ducts, from atony of their muscular fibres ; great and unconsciois discharge of semen at stool and in urinating; an irritable weak- ness of the seminal vessels and dilatation, with atony of the ejac- ulatory ducts. Spermatic fluid escaping all the time, and the spermatozoa are so feeble, so infertile, that. they die in their escape, and we have azoospermorrhagia, or the passive loss of barren semen. Inflammation of the prostate urethra invariably exists, which leaves the mouths of the ejaculatory ducts open, patulous ; this is very frequently a result of masturbation, or chronic inflamma- tion from gonorrhea, or bicycle riding, or from lifting heavy weights, the seminal vesicles are injured, and the semen oozes out. Any of those three forms may exist separately, or they may be BACTERICIDES. ' gy T blended together, or the one pass into the other, beginning with the mild form and proceeding from bad to worse, giving rise to a general train of symptoms. Emissions increase in frequency and severity, erections become most feeble, ejaculation on coition is precipitate, general nervous debility, pain in the back of the head, dilated pupils, muscular languor, mental incapacity, slight paresis of the brain, dulness of perception ; impairment of memory; vertigo, mental dejection; weakness of vision ; trembling of the limbs; palpitation of the heart; shortness of breath ; a sense of oppression in the chest; flatulence, constipation, dyspeptic symptoms. Daily losses, due to mechanical or psychical causes, are soon followed with leak- ages all the time, with no erections, no pleasurable sensations whatever, sexual intercourse is impossible, being impracticable either from the flabby or feeble premature erection ; or the wasted state of the parts, or the general nervous bankruptcy present. The patient becomes progressively worse, he broods over his lost virility, great mental depression, which passes into hypo- chondriasis. His gait becomes unsteady, he is erratic, he suffers from neuralgic, rheumatic pains; headache; hands and feet habitually cold and clammy ; insomnia; shuns society ; fears to look any one in the face; utterly incapacitated for mental and physical exertion; thinks of nothing but his genital organs, dejected, vertigo, noises in the ears, specks and spots before the eyes, muscular weakness, trembling of the limbs, crackling of the joints, chilliness, indigestion. There is increased irritability of the prostate urethra, and brain and spinal cord ; these suffer fearful exhaustion from the persistent and constant oozing, which daily becomes augmented. His mental status merges silently into epilepsy, chorea, ataxia, insanity, or other nervous disorders. Spermatorrhea then or the flowing away of semen, however, induced, terminates in a functional derangement of the nervous system, which is apparent from the increased sensibility of the brain and cord, or feebleness of the powers of life. No one can shut their eyes to the fact that our literature, amusements, exciting erotic ideas, are powerful factors in the production of an irritable state of the genital organs. Seminal incontinence is usually ac- quired by those erotic ideas, superadded to which masturbation, sexual excesses, or unsatisfied sexual decire, produced by toying with females, or sexual perversion if the act of coition can be consummated, and like conditions, give rise to exaggerated irri- tability of the genital organs, which is soon followed by inflam- mation of the prostate, patulous, dilated, or relaxed state of the ejaculatory ducts, with the nerves of the part morbidly sensitive, and out of gear. 972 DISEASE GERMS. In addition there are numerous local exciting causes, as phy- mosis, retention of the sebaceous secretion around the corona glandis, tetter, narrowness of the meatus, diseases of the rectum, especially ascarides, or fissure, or pruritus, or piles. The rectum being supplied with the same nerves there is the finest degree of sympathy between it and the seminal vesicles. Promiscuous sexual intercourse debilitates the sexual organs and inevitably brings about an oozing of semen. Certain trades, as photographers. The only correct method of diagnosis in all cases of sperma- torrhea is to make a microscopical examination of the discharge which constantly oozes from the urethra. A microscope of five hundred diameters is sufficient. Their urine, if there is no moisture apparent, will demonstrate or exhibit a class of objects devoid of living spermatozoa, but will show numerous dead or vari- ously deformed small, motionless bodies, incapable of fertilizing any ovum, how- ever vigorous that may be, or a No. 12 catheter could be inserted up to the prostate urethra and enough of fluid obtained to exhibit an exhausted, watery fluid, devoid of living elements. If not cured insanity is the termination. A chemical examination of his urine will demonstrate the state of his brain, and very likely show that instead of there being six per cent, of vitalized phosphates that it is reduced to two and a half, a state of things which exist only in incur- able cases of insanity.* Self-abuse is an etiological factor in a large number of cases of insanity, but only those cases should be designated as insanity of masturbation in which the connection between the excesses and the symptoms is direct. Self-abuse, to produce insanity, must have been carried very far, or the subject must be predisposed. Often onanism can be traced in other members of the family, and very often it is found that the maternal ancestry is a weak one. Mania, melancholia and epilepsy occasionally occur in young masturbators, the former two usually having a favorable prog- nosis. Stuporous insanity and katatonia are both common, and the former presents good prospects. The forms thus far mem *The chemical constituents of the average brain of man, in health, is in one hun- dred parts : Water, seventy-five and a half; albumen, seven; fat, eleven and a hall; various salts containing phosphoric acid, six. Spermatozoa as seen in the urine of patients suffering from seminal weakness. BACTERICIDES. 973 tioned when occurring in masturbators present no essential differ- ence from the typical psychoses. They should therefore be desig- nated as mania, melancholia, stupor, etc., from masturbation, and not as masturbational insanity. There is a chronic delusion of in- sanity in grown persons who have been devotees of self-abuse, and it is usually a hypochondriachal paranoia. Clinically, it is very like typical paranoia, and etiologicariy it is not the direct result of self-abuse, but rather of an intermediate neurosis, a cerebro- spinal irritation which is due to self-abuse. Finally, there is a form of insanity developing about or after the period of puberty which does merit the name "masturbational insanity;" it is chronic, has a tendency to agitated dementia, is characterized in its early period by anxiety, timidity, suspicion, fear and a cow- ardly, mean disposition. Later there are confusion, meddlesome, aggressive behavior, vague delusions, loss of memory and de- terioration. After these are observed spells of fury or destruc- tiveness. This form is never due to any other cause, and resembles no other form of insanity than the one already alluded to. In forming an accurate prognosis of the case it is not by any means so unfavorable as many would think, as a rule they yield readily to treatment, provided the prostate is not hypertrophied, or there is no stricture, haemorrhoids or no chronic inflamma- tion of the seminal vesicles, or sexual hypochondriasis. Cases brought on by bicycle riding, the use of chemicals, as in pho- tography or gonorrhea, or sedentary habits ; any cause but mas- turbation. Spermatorrhoea from onanism, sexual perversion, are more intractable than from any other cause, as the brain waste is greater. We give a synopsis of the treatment of spermatorrhoea. In all cases of involuntary seminal emissions there are certain rules which must be observed, such as bathing the entire body daily, followed by brisk friction or massage, the shower bath ; the diet should be light but very nutritious and easily digested ; all stimu- lating articles of food carefully avoided, as well as alcoholic and malt liquors. Before retiring at night the bladder should be com- pletely emptied, and the patient should sleep upon the right side, on a hair or straw mattress with as little covering as possible. An alarm clock should be set, so as to awake the patient at an early hour, so as to empty his bladder, as a full bladder induces erections. Interdict sedentary habits, horse or bicycle riding, or driving over rough roads, or toying with ladies, or reading sex- ually exciting literature or shows. Everything calculated to excite erotic thoughts or dreams avoided, mind and body should 974 DISEASE GERMS. be occupied with healthy exercise. Causes, as far as ascertained, should be removed, the corona glandis should be bathed two or three times a day, the anus and rectum should be be thoroughly syringed out with a solution of boroglyceride or infusion of Vir- ginia stciie crop. Remove all sorts of irritation ; even an elon- gated prepuce keeps the sensitive glands of the penis constantly moist, and favors the collection of sebaceous secretion. Herpes of the prepuce, stricture, piles and fissure, puritus, habitual con- stipation, variocele should if possible be speedily cured. True, of all the exciting causes, the most common is an inflamed or irritated prostate, urethra. In all cases of seminal incontinence the remedies to commence with are those which would be the most likely to overcome the sensibility of the mucous membrane of the urethra, the ejacula- tory ducts and seminal vesicles—to diminish the reflex excita- bility of the genito-urinary spinal centre. To accomplish this, a sitz-bath morning and night, drying the parts well and then bathing them with a distillation of hamame- lis, wearing a suspensory during the day. The remedies which have a calming, sedative effect are to be selected from some of the following, which we arrange according to our idea of their efficacy: The green root tincture of gelsemium in doses from a few drops up to such a dose as will give its peculiar physiological action, administered on retiring, diminishes the sensibility, the reflex mobility of the genito-spinal centre, paralyzes the move- ments of the cells of the acinous glands, and checks their secre- tion, so it can on no account be dispensed with. It is an invaluable remedy. Numerous acro-narcotic drugs have a very similar action, such as digitalis, belladonna, hyoscyamus, coca erythroxylon. Another invaluable remedy for the cure of spermatorrhoea, and the arrest of diurnal or nocturnal emissions, is the salix nigra, or the fluid extract of black willow bark. This is a sexual sedative of the first order, superior in its action to the bromides, but with- out their depressing or deteriorating qualities. This drug is a tonic, carminative, stimulant and germicide, with a special action upon the sexual appetite in the brain, and when this centre of inhibition gets out of gear, it gives excellent results. It is a remedy of great value in all forms of prostration and spermatorrhoea, controls emissions most effectually. The appropriate dose is about half a teaspoonful thrice daily. The resinoid of the black willow bark is also made into a ure- thral bougie and applied, and into a suppository, and used with marked success. BACTERICIDES. 975 The use of the ozonized extract of black willow bark is indi- cated in every case of spermatorrhea whatever other remedies are being used, a mixed treatment is always the most salutary. The cocaine suppository is a preparation especially adapted to weak, nervous debilitated men, who have suffered from those dis- charges for an indefinite time. The very celebrated spermatorrhoea pill which is composed of the following abstractae: Cocaina, jerubalum, hypophosphite of lime, gelsemium, and extracts of ignatia and leptandra. Tonics should follow the sedative plan of treatment. A gen- eral tonic course, embracing such as columbo, stone crop, cin- chona and mineral acids, coca. Oats in the form of a phosphated tincture is an admirable tonic for those cases ; alone its action is unsurpassed, but better still when alternated with damiana and ignatia. Of local remedies, the organized soluble gelatine bougies are the best; they hold the first rank, especially if there is a limited or circumscribed area of inflammation and tenderness including the openings of the ejaculatory ducts. Those bougies have entirely superseded all the older methods of treatment—they are most efficient especially when prepared fresh, from thallin, beberine, brucine, arbutin. Under good management recovery is the rule, but in some few rare cases, it may happen that the reflex genital centre is still impressible, in which case a few doses of the ozonized sumbul will prove highly serviceable. If there is reason to suspect dilatation and atony of the ducts, the bougie should be run right up to the prostate-urethra and retained there, and permitted to dissolve and be absorbed. Spermatorrhoea, if not cured, will give rise to wasting, and atrophy of the generative organs; to white softening of the spinal cord and brain ; to suicide, insanity, and death. A healthy man, who never masturbated, may have unnaturally small or atrophied organs of generation, and be able to perform the duties of married life, although rarely in a satisfactory man- ner. Very different however with the masturbator, he not only has seminal disease, or impotence with either dwarfed sperma- tozoa, or none at all, with wasting and stringiness of the testicles and smallness of the organs. It is true some cases of smallness of the genital organs may be congenital, but its common origin is the damaged inflicted by masturbation, by unnatural excitement without gratification ; by withdrawal, non-completion of the act; by wearing condums ; mumps; gleet; stricture; paralysis; blows on the head and spine. These, and numerous like causes, produce wasting and 976 DISEASE GERMS. imperfect development. No one can be surprised that it is very prevalent, as nine-tenths of all patients suffering from sperma- torrhoea are its victims. This is an appalling truth, visible in marital infelicity, quarrels, dissension, desertion, suicide, or else a life of shame and disaster. Eminent chemists, scientific physicians of all schools, men of profound intellectual calibre, are earnestly and vigorously at work in the discovery of remedies to destroy the germs of dis- ease, and to some extent have succeeded in revolutionizing the art of medicine by their discoveries. The time is ripe for important discoveries in new remedies to vitalize the genito-urinary tract. Spermatorrhea and impotence are now being cured by eminent specialists, who bring to bear on their cases a class of powerful drugs which wipe out every symptom of lost vigor, and cause the weak, debilitated victim to become strong, healthy, and vig- orous. The vitalized principle of the brain, " cerebrin " in keph- aline ; the "avena" in oats; the vital element of thought; the glucoside of the saw-palmetto and damiana are growth-fostering remedies to the genital system, to the ganglia and plexus of both penis and testicle, and do good work in sexual atrophy. Elec- tricity must not be despised. Cold water hip-baths, retracting the prepuce, and bathing the corona-glandis with castile soap, thrice daily, and then drying. After each bath, the following developing powder should be applied; rubbed all over the penis and scrotum, and kept constantly in close approximation by means of a suspensory bandage. The formula for this developing powder is: Take the oil of saw-palmetto, and digest it in peroxide of hydrogen for two weeks, then evaporated to a resinoid, which is triturated in pul- verized boroglyceride until it makes a fine powder. How well, how efficiently this powder acts is proven by ex- perience in a large number of cases. It causes a determination of blood to the penis and testes ; promotes molecular growth in a large number of cases ; it is rapidly absorbed by the vessels, and would almost seem to furnish nourishment to the parts. Although it is a powder, the moment it touches the skin it is taken up by the absorbents, permeates every cell and fibre of the part, acts with increased force and rapidity on the wasted vessels and tissues; fostering growth, imparting power and vigor, with acuteness of sensation; in short, restoring the weak and wasted muscles to tone, vigor, strength and size. The practical application of this principle and the internal use of vitalized kephaline and oats, meet the wants of a large class of men, helpless and useless (sexually), and the attention of the mem- bers of our profession to this subject is a step in the right direction. BACTERICIDES. 977 Human semen (healthy), as seen in the Spermatozoa, field of the microscope, magnified 600 diame- [Healthy.) ters, five minutes after ejaculation. The seed of a Caucasian, the fertilizing agent secreted in the epithelial lining of the tortuous seminal tubes of the testes. At puberty in man, the seminal tubes are filled with cells, from which the sper- matozoa are developed, they are set free by the bursting of the cell walls, and arrange themselves in parcels, symmet- rically placed, with the so-called heads in one direction, and the tails in the opposite. The spermatozoa are clear hyaloid bodies, each of which consists of a dilated portion (the head or body), from which a long tail or filament issues. The head is flattened from side to side, and of a conical form, the pointed ex- tremity being anterior, terminating in a long tapering tail which is in rapid undulating motion, and which propels the head di- rectly forwards. These movements may continue for twelve hours or longer, after they are ejaculated into a healthy vagina, but if they are exposed to cold or acidity, they seldom live over thirty minutes. Spermatozoa. A,the bladder; B, B, the lower bowel; C, the spermatic chord which conveys the seminal fluid from the testicle to D, the vesiculae seminales or seminal reservoirs; D, the vesiculae seminales; E, the seminal ducts entering the urethra through the prostate gland; F, the urethra; G, a part of the penis showing the urethra cut open; I, the prostate gland. Fig. i, shows the prostate gland and the seminal ducts in their healthy state. The recognition of different discharges from the urethra is of vital importance. Spermatorrhoea, or the flowing away of semen, is readily dis- tinguished, although complicated, by the general bankrupt state of the nervous system, the careworn, haggard appearance, the withered, wasted, pendulous state of the testicle, the indurated 62 978 DISEASE GERMS. epididymis; besides, there is always a slight, almost impercep- tible discharge from the urethra, most frequently seen after uri- nating, or defecating, or when in the society of females. A, the body of the testicle; B, B, the tubuli testis; C, the rete testis; D, the vasa de- ferentia; E, E, the epididymis; F, the vas deferens; G, the ducts which convey (he seminal fluid to the prostatic portion of the urethra, and when open allow the seminal fluid to escape with the urine, and on going to stool; H, the vesicuk seminales, showing the spermatozoa conveyed by the vas deferens from the testicles; I, I. I, the rectum ; J, J, the division of the vertebrae; K, K, the skin divided; L, the bladder; M, the bulbous portion of the urethra; N, the corpus spongiosum; 0, O, the urethra; P, P, the corpora cavernosa; Q, the body of the penis; S, the sym- physis pubis ; T, the anus ; U, the epididymis indurated, which explains how impo- tency is produced by preventing the seminal fluid passing to the vesiculae seminales. Seminal discharges are frequently mistaken for gleet and pros- tatorrhoea, especially if the patient has had repeated attacks of gonorrhea, or indurated chancres in the urethra, whereby the urethra has become thickened, or if the prostate has lost its tone. It is a matter of great importance to know in all cases what we have to deal with, to distinguish the gonococcus of gonor- rhea ; the spermatozoa of the seminal secretion; the discharge present in gleet, or that peculiar to catarrh of the prostate; or to a concealed urethra chancre, as each requires a different mode of treatment. To the microscope we are indebted for the means of unequivo- cally being able to discriminate between the different discharges. It may, however, be remembered, that the gonococcus is never present in the urethra without some pain, heat, redness, swell- ing, due chiefly to the micrococci burrowing in the follicles ol the mucous membrane; when the discharge is chiefly spermatid it is glairy, starchy, like the white of an egg, glueing the lips 0( the orifice of the urethra together; whereas, when from ulcerx either in the urethra or prostate, or stricture, usually greenishi As we have just stated, no reliable diagnosis can be effected without the microscope, aided by urinary analysis. BACTERICIDES. 979 The annexed diagram shows the appearance and the location of the three principal discharges. A, C, and D, represent the appearance of the discharges in spermatorrhoea, gonor- rhea, and syphilis. The dotted lines on each side of F point to the seminal ducts. True, the spermatorrhoea are often mutilated and mixed with the other secretions, and are difficult to detect. This may be looked upon as a prolongation Spinal Cord, of the brain downwards. It lies within the spinal column in the vertebral canal safe from any external violence, unless the injury be very severe. It sends off on each side numerous nerves which supply every part of the D°dy. Like the brain, it is covered by three membranes, and it consists of two portions, a gray matter, where various nerve-cells are met with, and a white portion, which is formed of nerve- 980 DISEASE GERMS. fibres, which convey motion and sensation. Any injury to the cord will cause more or less loss of motion and sensation in the parts below, and then paraplegia is said to occur. The cord is liable to inflammation, and the patient is said to have myelitis; to chronic degeneration, causing progressive locomotor ataxy; to cancerous and other tumors, causing paraplegia; to destruc- tion, through fracture or dislocation of the vertebrae surrounding it; to concussion, as in a railway accident, and to inflammation of its membranes, or spinal meningitis. The medulla oblongata, the seat of reflex action, is the con- necting link between the brain and the cord, and all nerves of the body, have more or less a common connection with the medulla, the bulb of which is the common centre or fountain of nerve supply, the spinal cord being but its prolongation, not so highly organized as the medulla, but nevertheless a reflex centre from bulb to sacrum. All irritations from organs are transmitted here by the gray or efferent nerves to the root or origin of the nerves that supply that organ, in other words, the same kind, quality, or intensity of irritation is transmitted to the origin of the nerve which sup- plies it; the same irritation exists in the cord as is present in the periphery or terminal end; that when the disease in an organ is removed, it is still necessary to wipe out the irritation at its central origin in the cord. Like the brain proper, the cord is covered with serous tissue which secretes a nervo-vital fluid for its protection, when the structures are so devitalized that they fail to secrete this fluid, and the brain and cord rest against their bony casement, there is trouble and often a puzzling problem to the physician. There are thousands of weak, nerveless men, who do not know what ails them; thousands of invalids, whose physicians are puzzled and perplexed by their symptoms and cannot account for the rapid waste of strength, energy and vitality, much less check it; and thousands of others, on the street, in the pulpit, on the bench, in the counting room, whose nervo-vital troubles, illness and misery are due to losses of vital fluid. Some know it, many more do not. Some are being properly or improperly treated for it, many are being dosed and drugged for malaria, neurasthenia, consumption, overwork, brain troubles, paralysis, etc. They sicken, die, destroy themselves in hopeless despair of ever getting well and strong again, verge into hopeless idiocy or go raving mad, simply because their trouble is not understood; because day by day and hour by hour there is draining from them in their urine, at stool and otherwise, that precious nervo- vital fluid that represents life, health and energy to them. BACTERICIDES. 93J And is it surprising that the continual losses do drain away strength and vitality ? This fluid is the most vital, intrinsically, the most valuable in all nature ; is the only one charged with life —acjual life ; capable of producing life ; of creating offspring ; of impregnating and developing into perfect being with thinking and reasoning brain and mind, pulsating heart, expanding lungs, sentient nerves, motive muscle, and all that beautiful, minute, and co-ordinate mechanism that forms a perfect human being; the only secretion in the body capable of propagating species; carrying life within life. Surely this was not meant for waste. Surely the influence of its loss upon the system, especially of a boy or young man (growing and not fully developed) must be great, and it is. Many and many a young man thus wastes away before the eyes of his friends from no other cause. How much better if all this false modesty, social hypocrisy, and blundering medical dosing and drugging, without thorough examination and full under- standing, were wholly done away with, and the young men and old men too, were brought to understand two cardinal facts: The causes of spinal irritation, poverty of the nervo-vital fluid, spinal bankruptcy, are to be found in both sexes in irritation transmitted to the cord. The recognition of spinal irritation, or exhaustion, or neuras- thenia is, as we have said, often difficult. The acquisition of strong nervous temperament, with great prostration, persistent headache, dyspepsia, constipation, phos- phates and chlorides in the urine are significant. Then by pass- ing a sponge electrode from a good running battery, we are al- most invariably assured of the seat of the irritation. This may be complicated with neuralgia or spasmodic affection involving the organs supplied with spinal nerves. If the irrita- tion is on the dorsal portion it is generally referred to one side, frequently the left, and is only felt below the mammae, often complained of as a constriction, or tightness, or suffocation, with accelerated action of the heart, with spasmodic cough. If the irritation is in the lumbar, there will be spasmodic action of the viscera; numbness, cramps and excessive tenderness, with im- paired motion and sensation in the lower extremities, with con- stipation, retention of urine, irritable bladder and uterus, with disturbed menstruation. It is not common in the cervical portion, still if it took place there it would give rise to neuralgic pains in the neck and face, difficulty of swallowing, loss or impairment of voice and affec- tion of speech, cough and altered sensibility; partial paralysis; coldness and numbness of both hands, or a pricking sensation. 982 DISEASE GERMS. In the treatment of spinal irritation, we must endeavor to ap- preciate the immensely destructive effects of an impairment of this nerve centre, it tells upon every organ, every secretion, so that the bowels are constipated, and require the action of the cascara sagrada lozenge; daily bathing followed by brisk fric- tion ; massage; gentle exercise in open air if strength permits, and when not exercising, rest in the recumbent position. Comp. tincture matricaria to stimulate the stomach, improve the appe- tite ; diet to be very generous, consisting of the elements of the blood. Local stimulation the entire length of the spine by keeping applied two strips of irritating plaster, or the application of the electrical brush, or some other convenient stimulant. The internal medicaments are of two classes, green-root tincture of gelsemium, belladonna; ozonized fl. ext. musk root, to induce sedation; glycerite of kephaline, tincture of oats, cerebrin, to vitalize and reconstruct the cord. The materia medica affords an abundant class of remedies which operate directly on the cord, as rhus rad., ergot, nux, calabar bean, atropia, ignatia, etc. The simple stretching of parts is often attended Sprains, with much suffering. Of the back.—Commonly caused by a fall from a height, or from a weight coming down suddenly on neck and shoulders. The structures suffering are the fibrous ones generally, such as the muscular fascia, tendons and ligaments. There is con- siderable swelling in the loins soon after the accident, and great pain on any attempt at motion. The inconvenience arising from a severe sprain in the back lasts a long time; so that a person may be confined to his bed or sofa for a fortnight, and it may be many weeks or even months before he completely loses pain. There may be some transient effect produced on the kidneys, and blood may be found mixed with the urine for a few days, but rarely any bad effects ensue. The treatment consists in perfect rest in the recumbent pos- ture ; the application of either the arnica or marigold lotion, or ozonized iodine to the stretched muscles Pain must be relieved by large doses of hyoscyamus. Knee.—Sprains, or twists of the knee joint are very common, often setting up great irritation, inflammation, and the damaged part is slow in recovering. Having had considerable experience with the older methods BACTERICIDES. 9^3 of treatment, clay is now the favorite local remedy. The ozon- ized clay is simply mixed with water to form a paste of a thick and moist consistence. This is spread on muslin to the depth of a quarter of an inch thick, and applied entirely around the part. Over this a rubber roller bandage, just light enough to keep the dressing from shifting, and to retain the peroxide. At the end of a few hours the joint and all its structures is com- pletely saturated with a powerful bactericide, microbe evolution prevented, resolution is perfect. Rest is all important. Ankle.—The lower extremity is the most frequent seat of sprain of all the limbs, and particularly the ankle joint, and the ridiculous fashion of wearing high-heeled boots, whereby the base of support for the body is diminished, is a frequent cause of the accident. In the slighter sprains of the ankle the liga- ments are stretched, or, perhaps, a little lacerated; but in the severe ones they are completely torn. Severe sprains are often mistaken for fractures, and should the case be one, when from swelling and pain there be any doubt, it should be treated as a fracture, bearing in mind that proper treatment of fracture is the best that could be adopted for a sprain. Impediment of speech (stuttering) in nearly Stammering, all cases is a nervous affection ; having as its origin a want of equilibrium of the gray and white matter of the cervical portion of the cord, resembling chorea. The vocal apparatus is usually perfect. It may be con- genital, but more likely to be the result of some shock in a fright, blow, or reflex condition, or follow some fever, worms, masturbation. White skin, dilated pupils, soft muscles, debility, point to a neurasthenic condition of the nerve centres; or when it appears as a sequel of microbial disease, the spores of the germ cause the difficulty. The treatment consists in the removal of the cause ; improv- ing the general health by bathing, clothing, frictions to the eervical portion of the spine, thus raising its standard of vitality. Same remedies as for chorea. Make the child speak slowly and distinctly. Let him fill his chest well before he articulates a word, and then enunciate one word after another. If unable to do that, let him beat time for every word he utters in talking or reading. A persistent course of measuring the words until the stammerer can read and talk straightforward for an hour, daily, will soon overcome the habit. Let the diet be brain-food, boiled fish, oatmeal porridge and massage. 984 DISEASE GERMS. By this term is meant an unnatural protru- Staphyloma, sion of the tunics of the eye-ball. It occurs in the cornea and sclerotic. Staphyloma of the Cornea.—Of this condition there are two varieties. In one the cornea, rendered soft and weak in conse- quence of a slow inflammatory process, yields to the pressure of the clear aqueous fluid collected in the anterior chamber of the eye, and forms a rounded or conical prominence in front of the globe which presses upon and, in some cases, protrudes between the eyelids. This condition is usually associated with more or less marked corneal opacity. In cases where the cornea remains clear the patient complains of impairment of vision and is often short-sighted. In the other variety of staphyloma a portion of the cornea has been destroyed by ulceration; the gap thus formed is filled up by portions of protruded iris, which become adherent to its margins. The protruded and exposed iris is sub- sequently thickened by the formation of delicate scar tissue on its surface, but still yields to the pressure of the aqueous fluid and forms a projection in front of the globe. The most marked instances of this kind of staphyloma may be observed in patients who have had an attaek of purulent ophthalmia, which has caused sloughing, and removal of nearly the whole of the cornea. Patients afflicted with the latter form of staphyloma usually suffer from frequent attacks of ophthalmia, and of pains and in- flammation in the displaced iris. Distension of the staphyloma by accumulation causes much pain and irritation, which is gen- erally relieved for a time by rupture of the protruded membrane. This, however, is always followed by closing of the orifice and reaccumulation of the aqueous humor. Sympathetic inflamma- tion often attacks the opposite eye. The palliative treatment consists in guarding the eye against possible causes of irritation, and in applying the ordinary means of relief during the recurrent attacks of ophthalmia. When there is painful distension of the staphylomatous cornea and iris in consequence of a great accu- mulation of aqueous humor, considerable though temporary relief may be effected by making a small puncture into the thin- nest and most prominent part of the projection. When the oppo- site eye is affected with sympathetic inflammation it becomes necessary to remove a part or the whole of the damaged globe. Staphyloma of the Sclerotic.—This term is applied to protrusion of a portion of the sclerotic, due either to thinning of the mem- brane itself, or to thinning or rupture of the subjacent tunics—- the choroid and retina. This condition may be caused by wounds of the sclerotic, blows on the eye-ball, or slow inflam- matory changes, resulting in a loss of firmness and diminished BACTERICIDES. 9«5 resistance in, the tunics of the eye. Staphyloma may affect the anterior, lateral, or posterior portions of the globe of the eye. In cases of anterior or ciliary staphyloma, may be perceived one or more bluish, small and irregular-shaped prominences, which con- trast strongly with the surrounding portions of white and smooth sound sclerotic. The cornea and the walls of the anterior chamber generally remain healthy. The same changes occur in staphyloma of the lateral portions of the sclerotic. This affec- tion, which is called equatorial staphyloma, is often associated with much impairment of vision and severe recurrent attacks of ophthalmia. Posterior staphyloma generally occurs at that part of the sclerotic which corresponds to the optic nerve and yellow spot. «This is frequently a congenital condition, and is the cause of that defect of vision known as myopia, or short-sightedness. The generative act on the part of the male im- Sterility. plies the completion of sexual congress, with an ejaculation of fertile semen, and its deposit in the upper part of the vagina. The capacity for copulation depends upon the perfect erection of the penis, the failure of which renders man impotent. Sterility includes certain distinct states, or conditions : As one in which no semen whatever, or unproductive or infertile semen is secreted, termed, azoospermism. Another in which the spermatic fluid is secreted but not ejacu- lated, termed aspermatism ; Aud still another, in which there is a failure to deposit fertile semen in the upper portion of the vagina, called mis-emission. In the first form, intercourse and ejaculation are natural, but the essential elements of life, of fecundation, are dead ; in the second form, the power to ejaculate is prevented by an impedi- ment, and in the third variety, coition and emission are perfect, but fruitful semen, fails to reach its destination, in consequence of some congenital or acquired deficiencies of the urethra. 1 A man having no semen at all, or at the best unproduc- tive semen, may be due to malformation or disease of the testes, obstruction of the vas deferentia, and abnormal conditions of the semen; with no testes, and the accessory organs rudimentary, is unable to ejaculate a drop of semen. If the parts are mutilated in early life, the individual may have an erection but is absolutely impotent and sterile. When the testes are retained in the abdo- men, that is have not descended in intra-uterine life, they may have erections and perform the sexual act but they emit a fluid, thin, watery, devoid of spermatozoa; other abnormal deficiencies 986 DISEASE GERMS. which obstruct secretion, as atrophy of the seminal vesicles, vari- cocele and morbid states of the blood in which disease germs are present, more especially the microbe of syphilis, or the bacilli of tuberculae; the lithiate of soda of gout and the like, are prone to set up in the testes a process of interstitial disorganization and degeneration, which destroys the secreting cells, causes oblitera- tion of the excretory ducts of the testes, and abrogates their func- tional activity. Besides, the quantity, quality and composition of the ejaculated semen, may be altered or poverty-struck by sexual excesses, masturbation, exhausting diseases, inflammation of the seminal vesicles, and prostate urethra. There may be an entire absence of spermatozoa in the'ejacu- lated fluid, induced by grief, worry, struggle, excesses, nervous bankruptcy. Neurasthenic masturbators suffer from emissions, seminal and prostatic discharges, the result of their violation of divine law, venereal excesses, or ungratified desires, with no spermatozoa, or if any be pres- ent they are motionless. The vitality of the spermatozoa is dependent up a healthy secre- tion of the prostate, when ex- cess or pollutions damage that gland, overstep a natural limit, the spermatozoa are liable to suffer, become few, small, and their place is usurped by sper- matic crystals. Among our physically drained young men various diseases of the spermatozoa are met with, such as fatty degeneration, abnormal density of the semen or purulent state of that fluid, watery or colloid. In masturbators, or men who have committed excesses, or prac- ticed sexual perversion, the semen is thin, watery, and the sper- matozoa few and motionless, incapable of impregnating the ovum. When their semen is permitted to dry and placed under a 300 diameter power a considerable number of transparent, variously modified, rhombic prisms, with their bases in apposition, the ends of these terminating in fine points, composed of ammonio-mag- nesium phosphate. The more numerous those crystals are they denote a diminu- tion of the spermatozoa or their entire absence. Among the same class of patients the semen is often watery, 69 V. ^-^^^ Spermatic crystals. BACTERICIDES. 987 kaving a whey-like appearance, destitute of all spermatozoa, except a few deformed and motionless, but a few spermatic crystals, lymph corpuscles. Disease, acute or chronic, impairs the vitality of the semen, renders the spermatozoa scarce, small, motionless, infertile. The semen of men, after fifty years of age, becomes gradually less and less charged with spermatozoa, until about eighty, when few are visible, hence their inability to procreate arises more from impotence than sterility. Sterility in the male is far more frequently the cause of barren marriage than is generally believed to be the case. Asper- matism is associated with complete impotence, but azoospermia or absence of spermatozoa in the semen, a condition by no means rare, may exist with perfect potency, and on that account is very easily overlooked. With few exceptions, azoospermia is caused by obliteration of part of the seminal ducts. This condition is generally caused by double gonorrheal epididymitis, or inflam- mation of the vas. After that malady, the chances are nine to one that azoospermia will follow. Prognosis appears to be hope- less when the condition in question is not discovered until three or four months after the onset of the local inflammation. The chief importance of the management of the case lies in accurate diag- nosis. True aspermatism is traced to arrested development of the ejaculatory ducts. In several cases of sterile marriages under our own observation the unfortunate wife had been sent from physician to physician, or from hospital to hospital, and her cervix divided, or her endometrium scraped, until a glance at the microscope proved that nothing was wanting to insure the bless- ing of children, except spermatozoa. No doubt the increase of intemperance involves the relatively greater frequency of those forms of gonorrhea where the earlier symptoms are very mild. Hence the first stages may now be as much neglected by patients as they have ever been wont to neglect later stages. The more a case of gonorrhea is neglected the greater will be the chance of serious secondary complications. Of all germ diseases that of syphilis is the most destructive to spermatozoa. Of all drugs which will annihilate it, the use of morphia and bromide of potassa stand pre-eminent; of all morbid states, catarrh of the prostate; the micrococci and cryptococci of fever kills the most vigorous semen. The correct diagnosis of sterility must in all cases be made by the microscope, or by a bulbous sound. It must always be borne •nmind that sterility does not include impotence, but is often met *ith in vigorous subjects, who ejaculate a fluid which presents a'l the visible properties of normal semen, hence it is difficult for toem to realize that they are the result of a barren marriage. 988 DISEASE GERMS. Semen is the mixed product of the secretion of the testes, vasa deferentia, seminal vesicles, sinus pocularis, prostate, Cowper's glands, mucous follicles of the urethra, etc., presided over by the brain. The thick, white, pasty secretion of the seminiferous tubes con- sist mainly of seminal cells, out of which the spermatozoa or fertilizing elements are developed; but the spermatozoa first make their appearance in the rete testis and constitute nine-tenths of the glutinous mass. In the epididymus and vasa deferentia, the zoosperms are per- fectly motionless, from the density of the medium in which they are contained, but when they reach the seminal vesicles they are in active undulating motion. 2. When sexual intercourse is not finished by the ejaculation of semen, that is, does not enter the urethra, because its ex- pulsion is prevented by some obstruction, or obstacle in the ejaculatory ducts; or perverted sexual appetite in the brain, or deficient excitation of the spinal centre, or a blunting of the nerves of the glans, congenital occlusion of the ejaculatory ducts is rare, but a damaged condition of these ducts, brought about by wearing condums, or the act of withdrawal during ejaculation to avoid impregnation, retards an emission; acts most disas- trously on the entire force of erection and ejaculation. Tight or adherent foreskin, stricture, induration of the corpus spongiosum. Lethargy, loss of passion through fear, disgust, suspicion of infidelity. 3. A failure to deposit fertile semen in the upper portion of the vagina may be due to mechanical obstruction, owing to which it regurgitates into the bladder, or slowly oozes away from the urethra as the erection subsides. Ejaculation may have a faulty direction, owing to malformation of the urethra, although de- formity does not always involve sterility. Fistulous openings above or below, congenital or acquired, malposition of the urethra, or its orifice located far back, will prevent the ejaculated semen from reaching its destination. Again, all depressing emotions, desires, affections, passions; all acro-narcotic drugs; alcohol, gout, syphilis, impair the ejacu- latory power. What is meant here by " atonic sterility " is a state of prostra- tion of the nerve-centres which preside over the genital functions, so that the sexual act is not performed naturally and completely. There may not be an absence of spermatozoa in the testicles or the fluid ejected, but they fail, on account of the incomplete sexual act to reach their destination. BACTERICIDES. 989 Now, assuming that an inflamed prostate urethra will produce the class of symptoms described above, and finally atonic sterility, if is well to look for the cause of the local inflammation and irri- tation of that portion of the urethra. The cause that I have usually found was stricture; often not a close one, but a con- striction sufficient to retain behind it a few drops of urine at each time the bladder is emptied. These few drops of urine decom- pose and act as an irritant. This irritation constantly kept up soon excites an inflammation which extends to, and often into, the bladder. This inflammation of the bladder is often the first symptom that calls the attention of the patient to his urinary ap- paratus. Constant excitement of the genitals by over-indulgence in sexual intercourse or masturbation may cause a state of hyperaesthesia of the urethra. No doubt that strictures are often caused by masturbation, an inflammation being excited and kept up by free indulgence, and eventually the same results are obtained as arise from a gonorrheal inflammation. Sometimes congenital discrepancies serve as an exciting cause. The treatment of the first form Is as a rule most unsatisfactory. Nevertheless, much can often be accomplished if the cause can be removed and the patient placed upon a prolonged alterative and tonic course, together with daily massage, followed by faradiza- tion of the entire body, and the administration of the glycerite of kephaline and tincture of avena sativa. The treatment of the second form is much more hopeful; in- variably good is to be derived from the use of alteratives and tonics, massage, baths. If the ejaculatory ducts are obstructed, a No. 12 silver catheter may be introduced into the bladder, and retained there for ten days, so as to excite a dissolution and effusion of the lymph in their mouths. Add to this introduction a No. 12 rectal silver bougie, its presence may possibly squeeze out the coagulated lymph. If stricture be a cause, then it must be dilated and absorbed. ■ If the chemical secretion of the prostate be changed through inflammation, or the prostate urethra sensitive, then urethral bougies of thallin. The cocaine suppository per rectum, and internally such drugs as nux, saw palmetto, ctemiana, should have a trial. The treatment of the third form is chiefly by surgical proce- dure; faulty or mal-formed states of the urethra; fistulous open- 'ngs above and below, adherent prepuce, all admit of prompt relief. Even atrophy of the organ admits of a cure by judicious management. 990 DISEASE GERMS. Sterility is rapidly increasing and it is important that a clear idea of the physiology of reproduction should be disseminated. AU the factors concerned in the process of conception must operate in harmony, the woman must produce healthy ovules and the man normal spermatozoa. These products must unite there must be no abnormal condition that will destroy their vi- tality before or after they come in contact, nor after fixation to the uterine mucous membrane. Many women are potentially fertile, yet practically sterile, as a result of the prevention of conception; a practice common in all stations of society which is undermining the health, morals and our very national existence. All means of prevention are prejudicial to the mental and phy- sical health of husband and wife, and the moral effect of with- drawal before emission is nearly identical with that of masturba- tion, and the physical disturbance may be greater, as the vasa deferentia remain partially filled, producing an irritation that causes a more frequent desired for sexual connection than is healthful. When the semen is not deposited in the vagina, and the connection is imperfect or unfinished, the active congestion of the female pelvic organs finally become passive, resulting in engorgement, hyperplasia, displacement, etc., entailing various local and reflex disturbances, or even insanity. Women in so-called refined, religious, and cultivated society, being controlled by a desire for social pleasure, and for position and wealth for their children, practice prevention more than women in the ob- scure walks of life. Their daughters are taught nothing about the anatomy or the physiology of their generative organs, but are trained to abhor offspring, and are told how to avoid becom- ing pregnant. The higher education or brain-cramming, of girls nowadays, with the absence of exercise, and other hygienic measures, and the reading of sensational or love novels, destroy their power to bear well-developed and healthy children, or to supply them with enough nutritious milk for the natural period. As woman ascends in the scale of education and refinement,. child-bearing becomes more difficult. She is more sensitive to pain, and bears children with greater cranial development. Her mode of dress distorts or displaces her thoracic, abdominal and pelvic viscera, and so weakens the abdominal muscles that the auxiliary forces in parturition are very much impaired. Sterility may be absolute or relative, congenital or acquired. In absolute or congenital sterility, the ovule is not impregnated, or if impregnated, conception does not follow, the ovule being destroyed in the tubes or uterus ; or conception may occur, but the woman aborts before the child is viable. In relative or ac- BACTERICIDES. 99I quired sterility, the woman has had one or more living children, but in number not according to the duration of married life. A woman may marry successively, two or more men, and have children by only one of them ; or a man may marry two or more childless widows, and have children by each of them. This is sterility from incompatibility, these women being potentially fer- tile. One-child sterility exists in one out of thirteen marriages. The average time from marriage to the birth of the first child is seventeen months, and between the birth of children nineteen months, and women, upon an average, bear children from twenty- five to thirty-eight years of age; less than fifteen years. As one in thirteen women bear their first child after having been married three years, no woman should be considered sterile until the fourth year of married life. Sterility may result from mechanical obstruction, from uterine or pelvic diseases, or from constitutional disturbances, or from some defect in the husband. The spermatozoa may be prevented from entering into the uterus by any congenital or acquired de- fect that interferes with sexual connection, such as imperforate hymen, vaginismus, atresia vaginae, etc., or by constriction or obliteration by stenoses or flexure of any part of the cervical canal, or by an elongated cervix. The vitality of the spermato- zoa may be destroyed by secretions from diseased mucous mem- branes of the vagina, cervical canal or uterus, but the most poisonous secretions result from glandular cervical endometritis, and from latent gonorrhea. Tumors connected to the uterus, and in the parenchyma of the uterus, or any disease of the mu- cous membrane and walls of the vagina. Difficult breathing may be due to Stertorous Breathing, a number of causes, as inflammation of the fauces and tonsils; from the presence of the microbes of croup, diphtheria, tubercle, syphilis, cancer, irritating the nerves of the larynx; also from the presence of foreign bodies ; growths in the same locality ; to ulceration ; narrowing or pressure of the trachea; to bronchitis; asthma, emphysema, and consolidation of the lung; to organic disease of the heart; to the presence of ptomaines in tetanus, cholera, typhoid, whereas, stertor, or stertorous breathing is due to one or other of three states: Nasal or Palatine Stertor, when the air is rushing through the nose or mouth, causing a vibration of the soft palate. Pharyngeal Stertor, when the air passes through the narrowed interval between the base of the tongue and the posterior wall of the pharynx. 992 DISEASE GERMS. Mucus Stertor, when there is mucus in the air tubes, and the air in breathing bubbles through it. Stertorous breathing is a mere mechanical condition, and in a large number of cases can be got rid of. Mucus stertor, when unaccompanied or unconnected by Jiving engorgement, may occur in serious cases, when the nutritive process of the lungs are interfered with by some injury to the seat of life in the medulla oblongatata, injuries to the brain, con- vulsions, poisoning with opium, drowning, epilepsy, apoplexy, and the so-called death rattles of profound prostration, whether there be fluids in the bronchi or not. Snoring in these and other states shows that there is an impediment to the ingress of air, so that the blood and tissues fail to be oxygenized; a condi- tion of non-aeration of blood and embolism; a failure of the heart's action and death. It is very doubtful whether a large percentage of death does not really occur from this cause, and most of those mysterious deaths that occur during sleep. When snoring or stertor forms a symptom it should be treated by placing the patient on either side, and keeping him there. This seldom fails to give instant relief to this distressing and danger- ous symptom with its consequences, and death in many cases can often be obviated. Squinting, or strabismus, is a want of har- Strabismus. mony in the muscles of the eye. The common form met with in young persons is where the eye is turned inward, or, convergent; the other form, in which the eye is turned outward, or divergent, is more rare, and is chiefly met with in elderly persons, from paralysis of the internal muscles. Both eyes may be affected, but this is not common. The causes of squinting are very numerous. It may be con- genital, or induced by bad habits, by imitation, by looking at pimples on the nose; or it may come on from a stye, which often interferes with the motion of the eye; by the use of one eye to the neglect of the other, or by shading one; it may also result from slight opacities of the cornea; from a variety of nervous causes, and it is often the result of reflex irritation in morbid conditions of the stomach, worms, teething and constipa- tion; disorders of the sympathetic system, as fright, passion, etc., and also to disorders of the brain, as convulsions, congestion, effusion, hydrocephalus, etc. Treatment.—If it be recent, that is, not over a few weeks standing, the difficulty can be frequently overcome by the re- moval of the causes, as teething, worms, disorders of the stom- BACTERICIDES. 993 ach and bowels, by the proper remedies ; by avoidance of study and reading; by proper exercise to the eyes, and by wearing glasses for the purpose. But if the squint be of long stand-in! and is habitual, and above all, if there is the slightest disparity in vision of the two eyes, very little good can be effected unless the internal rectus muscle be divided. This is a very simple pro- ceeding, consisting in placing the patient under chloroform and placing a blunt hook under the muscle and raising it, and then dividing it. If the squint depends on some opacity of the cornea or organic disease of the brain, no interference should be per- mitted. ^ The orthopcedic treatment of paralyzed muscles has been re- cently tried in strabismus with marked success; this treatment consists in seizing the conjunctiva over the affected muscles by a pair of forceps, the eye being under cocaine, and moving the globe in the line of action of the paralyzed muscle and its antag- onist. s Protrusion of the eye-ball is a general symptom of wasting disease, as consumption, anaemia, but it may be due to aneurisms tumors, fatty deposits, osseous and encysted growths. The danger of tumors are twofold : destruction of the eye from con- tinued pressure; and protrusion through the roof of the orbit into the cavity of the skull, with compression of the brain. The diagnosis is most important. Tnis may be met with in either a spasmodic Stricture or organic form. In the former it comes and of the goes ; in the latter there is effusion of lymph (Esophagus, which forms a permanent obstruction. The , -, oesophagus being made up of circular muscu- lar nbres, or rings, each of which is supplied with both sensient and motor nerves, renders it susceptible of the slightest irritation which gives rise to contraction, and repeated contractions give nse to effusion of lymph ; thickening. Spasmodic stricture is that which is not permanent, but comes and goes away. This may originate in two ways. There may be some weakness or irritation of the cervical nerves, issuing Tom the spinal cord, which supply the circular muscular fibres °t the oesophagus, a sort of neurosis, or extreme sensibility, when m hastily swallowing a cold fluid, like ice water or beer, it acts as an instantaneous depressant to the weakened nerves, which causes contraction of the circular muscular, a sort of spasm, wnich prevents deglutition. It is more apt to come on in swal- lowing a cold fluid than otherwise, for fluids are much more diffi- 994 DISEASE GERMS. cult to swallow than solids. In the act of swallowing a liquid all the rings of the oesophagus are brought into active exercise; whereas in swallowing a well masticated solid, it will slip down without a movement. In the other class of cases the integrity of the nerves are normal, no neurosis, no nervous irritation, but it may come on from decided carelessness in the hurried drinking or suddenly gulping down large draughts of ice water, cold beer and other cold drinks in hot weather. The pungent coldness and haste produces the shock, followed by contraction, which once induced is liable to be repeated, if the same cause is brought to bear on it. It is most generally met with in beer drinkers and among young ladies who bolt large quantities of ice- cream. Symptoms.—Difficulty in swallowing; at first confined to fluids, usually cold ; then it extends to warm drinks and solid food; but the difficulty is not always; it comes on by spells ; often a sense of fulness and choking under the influence of excitement. It cannot be confounded with permanent stricture, because the difficulty of swallow- ing is only now and again, and a bougie will pass down without a particle of obstruc- tion. In the treatment of spasmodic stricture the greatest possible care should be exer- cised in eating and drinking; food should be bland, soft, nutritious; well masticated and swallowed slowly. All liquids taken should be warm and sipped with caution. Forbid strictly cold or iced drinks, iced lemonade, beer, ice-cream. The medical treatment should consist in daily baths, massage, electricity, sumbul, kephaline, avena, matricaria. Organic stricture is a condition in which lymph is effused in or on the circular muscular fibres of the oesophagus; thickening produced; it may involve the entire ring clear round, or only a part, and forms a permanent obstruction to the descent of solids, and often liquids. The effusion may be mere lymph, or even cartilage. The cause is some irritation, as spasmodic stricture or the swallowing of some irritant, which gives rise to the effusion of lymph. Stricture'of the oesophagus and human alimentary canal: /, oesophagus; b. stomach ; c, cardiac orifice; d, pylorus ; e, small intes- tine ;_/*, biliary duct ;g, pan- creatic duct; h, ascending colon; i, transverse colon ; j, descending colon; k, rec- tum. BACTERICIDES. 995 Symptoms.—Vomiting after taking food which descends to a point, and apparently sticks, and is thus rejected ; or if the diet is very bland or soft, or the drink mucilaginous, it may pass through the obstruction. If case is seen here, and proper treatment in- culcated, a cure may be effected. But if neglected, after the end of six or eight months the inability to swallow becomes greater, until little can be swallowed. Then emaciation, debility, takes place, and increases rapidly. The stricture can be felt, its size and shape well made out by bougie. If not cured, starvation takes place in spite of nutrient enemata. In the treatment of organic stricture there must be great care exercised, in order to maintain the nutrition of the patient. The diet should be of the most nutritious and blandest character, such as the juice of meat, raw eggs, cream, with enemata of the same. The seat or location of the stricture can be easily made out by the introduction of a bougie and feeling for the stricture. Once its location is determined, put an irritating plaster four inches square over the seat of stricture on sternum, another on the spine; spread fresh every morning and applied. The patient must be placed upon an alterative and tonic course of treatment, such as compound saxifraga and phytolacca, alternated with matricaria. Three times a week the patient should swallow a bolus of thirty grains of papoid, large enough to be stopped by the obstruction; while so obstructed a bougie should be intro- duced which should push the papoid closely against the obstruc- tion of the effused lymph. On this the papoid acts as a solvent, a digestive agent. By this is meant a narrowing, or a dimin- Stricture of the ished calibre of the canal. It may be so Rectum. slight as not to attract attention, or do ap- preciable harm, or it may be so complete as to close the canal and prevent the passage of any substance whatever. It may involve the entire ring, or a half, or a part of it. Causes.—Usually an effect of acute or chronic inflammation; lymph is effused, generally about two and a half inches from the verge of the anus, or more properly speaking, at the spot where the tenesmus is experienced. It rarely exists without ulceration, and this alone may cause stricture. Congestion around an ulcer- ating surface, and the constant effusion of lymph in attempts to heal the ulcer, very soon form an undue deposit of lymph in the rectal walls, whereby they become thickened and hardened. In 996 DISEASE GERMS. patients of feeble health this process goes on till the elasticity and contractility of the muscular coat is lost, and the rectum be- comes passive, a steadily narrowing tube through which faeces 'pass when liquefied or semi liquefied, forced through by the stimulus of cathartics and spasmodic effort of the intestines. Symptoms.—These vary considerably in the early stage, but, as the stricture becomes more marked, there is constipation often alternated with diarrhea. Stools if solid are passed with great difficulty, in small, flattened, chopped pieces, usually about two and a half inches in length; in other cases they are long, slim and cord like; severe straining efforts in voiding the motions if solid; pain in the loins and sacrum'; flatulence; often mucous discharges stained with blood ; if there is ulceration above the stricture, burning pain and ten- derness about sacrum and funda- ment ; discharges of blood and pus. The reflex symptoms are often very decided and severe, languor, lassi- tude, debility, headache, constitu- tional disturbance, burning in hands and feet, brain disorder, vertigo, fits, impairment of the general health, depression of spirits, hypochon- driasis. The diagnosis is easy, the history of the case, the constriction of the bowel can be felt by the finger about two and a half inches from the anus, so that it cannot be confounded with spasmodic constriction caused by spinal irritation. Treatment.—This necessarily varies according to the state of the stricture, the condition and circumstances of the patient. In all cases one thing is essential, every possible means should be resorted to to build up, improve and maintain the highest standard of health possible; to effect this the patient should resort to daily bathing, flannel clothing, a most generous diet, an alterative and tonic course of remedies. The most appropriate alterative is the saxifraga comp.; as a tonic no remedy can excel the Vir- ginia stone crop, collinsonia, mineral acids. The stools should be kept soft and liquid by a dose of kola- tina ; or olive oil and glycerine; or juglandine before retiring at night. Then an absorbent action must be excited in and around the Stricture of the rectum, usually found 2j^ inches from the verge of the anus; the effusion of lymph may be all round or only partial. BACTERICIDES. 997 stricture by some one or more of the following methods: The introduction of a metallic bougie, well warmed and gelatinized, with belladonna and salicylate soda, a size that will pass easily through the stricture should be inserted first, and permitted to remain at least a half an hour. These bougies should in length be twelve inches long, and inserted gently up for eight inches. From week to week they should be gradually increased in diam- eter, until the largest size pass easily. This method will take from three to four months. To aid this treatment, various sup- positories should be used, as the cocaine ; belladonna and opium; salol. The idea which must be rigidly carried out is absorption of the effused lymph, which constitutes the stricture, never dilata- tion. It is useless to experiment with sponge tents, sea tangle, or to torture the patient by cauterization, incisions, forcible rupture or tearing, for they may be for a week or two of utility, but the stricture returns under those methods. We might enumerate other methods by which absorption of the lymph can with some degree of success be effected, such as electroysis; suppositories or bougies six inches long, in which papoid, trypsin, boroglyceride, salicylate soda, salol, creolin, are incorporated. The development of blenorrhagia takes Stricture of the place in the following order: The micro- Urethra, coccus deposited on the anterior portion of the mucous membrane of the urethra encounter there a very thick epithelium, upon which they fer- tilize. Perhaps here we have an explanation of the theory of incubation, for the micrococcus only develops well in the globules of pus. The epithelial cells desquamate, allowing the germ to penetrate into the chorion and thence into the lymphatics; then true suppuration commences, propagating itself little by little to the deep parts of the urethra, always following the course of the lymphatics. At the close of the malady, either because the soil is exhausted or the pathological modifications of the tissues ren- der them unsuitable to the growth of the germ, the latter returns to the superficial parts of the mucous membrane, and localizes itself on the surface. This is found to be done in nests, on the inferior aspect of the canal, and signalize the points where lymph is effused to form Stricture. Stricture in the urethra is essentially due to rapid microbe 998 DISEASE GERMS. evolution, in points with foliaceous colonies, which present them- selves in the form of diplococci, forming masses of greater or less extent, render the canal narrower than what it is by nature, and incapable of resuming its ordinary capacity. When the urethra contains the micro-organisms of morbid action, they produce one or other of three conditions, either a weakness of some of the circular rings, which give rise to spasmodic contraction, or when the germs are freely elaborated in urethral pus; inflamma- tory or when the cultures have given rise to a permanent effusion of lymph. All forms of stricture, whether they be spasmodic, inflammatory or permanent, arise either from microbe growth, a specific cause, and capable of being removed by one uniform and easy treatment. As a rule, few persons take little notice of a stricture till some inconvenience arises therefrom. A man may have a slight moisture, or gleety discharge, or a diminished flow of urine, from which he experiences little or no inconvenience, he may not even suspect the existence of any other complaint, and therefore gives the matter no thought, till at length prostatitis, inability to micturate drives him to seek professional advice, and an exami- nation of the urethra being submitted to, the presence of a stric- ture is detected, which may have existed for a length of time. Spasmodic stricture arises from the circular muscular fibres of of the urethra being weakened in times gone by or by the sapro- phylic bacteria of masturbation or the gonococcus, the slightest stimulus will cause the weakened part to contract, and thus cause the stream of urine to be suddenly obstructed, or if able to pass it, it will be spiral, corkscrew, or split; cold, damp, exposure, microbes in the canal may act as exciting causes. The difficulty micturition comes on suddenly. In, or during inflammation, nests of micrococci weaken the nerves and circular fibres by burrowing in the follicles and lacuna. Permanent strictures are always due to effusion of lymph, and its organization either into a band across the inferior aspect of the canal, or a flattened exudation. The cause of this effusion is due to a microbial nest, and effusion of lymph over the germ colony, which gradually diminishes the calibre of the canal. Among the earliest symptoms of permanent stricture is the retention of a few drops of urine in the urethra, which drops soon escape and slightly wet the linen; the bladder becomes irritable, necessitates frequent efforts to urinate, as the lymph in- filtration increases, there is a discharge of mucous from the urethra, attended with a sensation of itching, heat and pain in making water; the steam of urine becomes forked,, spiral, flat- BACTERICIDES. 999 tened, or scattered, which, if let alone, eventually grows worse, until the urine is voided drop by drop. At this period the slightest irritation, cold or wet, intemperance in diet or otherwise, may be immediately followed by a complete stoppage of urine. Stricture of the urethra may arise from any form of irritation, but ninety-nine cases out of one hundred are due to the micro- organisms of gonorrhea. Independent of the symptoms enumerated, the stricture must be felt by a metallic bougie. Two urethral strictures, the posterior one in the deep urethra. Three urethal strictures. Treatment.—The general treatment should consist in placing the patient upon a general alterative and tonic course, saxifraga in alternation with cinchona. The local management of the stricture is somewhat varied; some believe in burning them out; others in cutting them with the stilleto ; while another class ad- vocate forcible dilatation ; some are believers in their dissolution by electrolysis ; while others again believe in the old and best method, exciting absorption in them by the persistent introduc- tion and retention of graded metallic medicated bougies ; three days in the week for ten or twelve weeks. The merits and demerits of all other methods, it is unneces- sary to discuss, suffice it to say, that after its removal by those methods, they invariably return. This method is the best as there is no recurrence; by the other methods, the disposition to recur after removal, originates in the stricture itself; thence to the bladder and contiguous parts IOOO DISEASE GERMS. and anteriorly in a less degree in the urethra; smearing the bougie, or using bougies of thallin, belladonna, papoid, trypsin, operates like a charm. In the management of the case, the simple bougie should be increased in size weekly, according to the facility with which it is absorbed. A little and little is gained by its passage every other day or twice a week. Following the use of the bougie, an iodol gelatinized bougie should be inserted and permitted to dissolve. The good effects of frequently and gently stretching a con- stricted part, is the true successful method of cure ; a perfect cure can be effected, without pain or inconvenience; and no re- currence demonstrates the superiority of the simple metallic overall other forms of treatment. The treatment of stricture of the urethra by electrolysis has, within the last few years, been brought before the profession, and from its success, we may fairly conclude that in the near future, it will occupy an important - place. In the application of electrolysis to the urethra, a battery of thirty cells, and a gal- vanometer to measure the strength of the current, together with filiform bougies and electrodes of various shapes and sizes, are required. The bougie electrode used for passage into the urethra has a metal point, usually of olive shape; its stem is covered with isolating material, and is connected with the negative pole of the battery. The other electrode, connected with the positive pole, is of a convenient shape to hold in the hand or apply to the back. In all cases it is absolutely essential that a galvanometer should be in the circuit of the electrical current, so that its strength may be known and regulated. The usual current strength employed is five milliamperes, though it may sometimes be increased to ten milliamperes without the patient feeling any discomfort. The time occupied at a sitting varies from about five minutes to half an hour. The modus operandi of electrolysis on the stricture does not seem to be clear; hydrogen gas is dis- engaged during the operation, and a thick, granulous discharge comes from the urethra. That electrolysis produces a change on the tissue forming the stricture, seems to be proved without doubt, from the alteration which is found to occur after the elec- trode has passed through the stricture, as compared to what ob- tains after the passage of an ordinary metallic bougie. If a metal instrument be pushed through a stricture which grasps it tightly, and is immediately withdrawn, it will be found that about the same amount of force is required to withdraw the instrument as was required to pass it. With the electrode the case is different. Although a considerable time may have been taken and some pressure needed to pass through the stricture, it can always be BACTERICIDES. IOOI withdrawn with ease, being no longer grasped firmly like the metallic instrument. With it, with care, a permanent cure can be effected, but too often it is neglected, and the stricture will re- turn, unless an instrument is passed and retained for some time. By weekly electrolysis, resiliant or non-dilatable stricture, or those which are impassable, can be successfully got rid of. Follicular irritation, effusion of lymph, with sup- Styes, puration in one or more of the sebaceous follicles, at edge of eyelids. The cause is invariably mal-assimilation, perversion of nutri- tion, which gives rise to the same micrococci that we have in boils. In hordeolum or stye, there is great fetor of the breath, brown- coated tongue, constipation, slight pyrexia. These cases are benefited by an emetic, opening the bowels, and administering some germicide. Locally, to the lids, if it is just about to appear, painting the lids with saturated solution of boroglyceride ; if it has progressed to near the point of suppuration, pack the lids with the same. Boroglyceride solution is death to the microbe in all cases and under all conditions. Suicidal mania is a peculiar morbid state of the Suicide, brain of civilized man in which its typical fissures coa- lesce. A deviation from the normal type takes place, termed atypic, which is present in hereditary insanity, and in the boy children of mothers who have exhausted their mental powers in literary pursuits, over-stimulating their nerve-power a^»d thus causing a defective power of brain assimilation in their offspring. It is a low state of human brain in which the facial angle is lowered. Maternal impressions also give rise to it, as the witnessing of the slaughtering of cattle and killing of fowls; the insatiable desire of some mothers during pregnancy to have criminal abor- tion performed, or in taking emmenagogue drugs to destroy and evacuate the contents of the uterus, thus impressing a suicidal disposition in her child. The true influence of our present trashy, demoralizing literature can scarcely be adequately appreciated as a prolific cause; besides, we have most important factors in isola- tion, solitary confinement, masturbation and supposed loss of sexual power. The worry, the struggle for existence, is supposed to be a prominent cause; but this is not correct, because suicide 1002 DISEASE GERMS. is more prevalent among the unmarried and the widowed than among the married, in whom the struggle is greatest. The anaemia of the brain and cord induced by excess of study and sexual losses is an important factor. Infidelity, Darwinism have an important bearing in its production. It is also to be regarded as epidemic. There is a singular regularity of the law which governs the return of suicides. The regularity is conclusive. There is a perfect uniformity with which the numbers of suicides are repeated from year to year in each country, especially in those countries in which the rate of suicides is high, such as France, Germany, England, the United States. Side by side with this remarkable regularity is a progressive in- crease of this morbid condition during recent years in the above- named countries. It has, besides, a seasonal distribution, the first months of the year, being few, but a steady increase to June, when it is at its height, and from its maximum there is a steady decline to the end of the year. The variations in the prevalence of suicide in dif- ferent localities depends a good deal on their moral, social and religious status and absence of monotony. The influence of sound, honest Christianity (no sham) retards it. In Scotland, where the rigid Presbyterian has a hold ; in Ireland, Spain and Portugal, where Catholicism is pure, the affection is rare. The number of suicides increase in countries where religion is a mere show or trade-mark. The proportion of suicides to the popula- tion is less where the tenets of the Bible are absolute, whereas the largest proportion occur where infidelity is rampant, as in Germany and the United States. In Europe the pure Germanic race shows the highest proportion of suicides, followed closely by the Scandinavian races ; whereas, among the Latin race, all except France, the rate is low, in Russia seldom known. In the present state of pathological anatomy, the old theory of suicide being the effect of the struggle for existence and of human selection, which works according to the laws of evolution among civilized people, will not stand good. The proportionate relation between male and female suicides is pretty constantly from three to four males to one female. The proportion of suicides is largest between forty-five and fifty-five, very few taking place later in life. The humanizing effects of an implicit faith in God, of man being part and parcel of that immortal existence, and of endless immortality well grounded into a people, seems to be the best prophylactic. When the malady is suspected, rest to the brain, freedom from care, worry; liberal administration of cerebral tonics of great utility. BACTERICIDES. IOO3 Micrographic germs are to be found in both the Sweat, insensible as well as the sensible perspiration of the skin, probably most numerous when the sweat glands are devitalized, as in— Hyperidrosis, in which we have an excessive effusion of sweat. In this we make no reference to normal sweat, the physiological result of active exercise or excessive heat, but to general or par- tial pathological sweating. The latter is common in the adipose, the feeble, the victims of microbial disease, as in the tubercular, syphilitic rheumatism, fevers, etc.; partial sweating in hands and feet due to neuras- thenia, or where it may follow the course of a special class of nerves, and may or may not be accompanied with fcetor. In all cases the integument is weakened, its nu- _.:..s trition impaired, being constantly mace- y±r*'*£?4&&;; rated, it becomes painful, tender, exfoliates , j£^^^S»jk?>.. and becomes loaded with disease germs. <^^S^*^'^ Sudamina, confluent or discrete, superfi- f~0>&£jt&i(iffi\':'? daily seated, of the size of a millet seed, or \*)i&\k£$'*-ffi? larger, translucent vesicles, each one contain- *.:>**^ »^S»/-'"■? : ing a droplet of sweat, with a germ lurking • .1 r. , ,1 The bacillus of feet-sweat. in the serum, often due to the same causes. No localized centre in the brain for excito-sudoral or inhibi- tory effects has yet been recognized, although we have very posi- tive evidence that a bankrupt, nervous system, especially the sympathetic branches, give rise to it. When the sweat centre is weakened, sweating all over is usually mitigated by either the tincture of oats, or mineral acids, or nux vomica, matricaria, quinine, belladonna, agaric, ergot, jaborandi. Localized sweating, in which a pathogenic microbe is present, such germicides as lycopodium, boroglyceride, quinine lotion, ichthyol, naphthol, microbe powder in socks, etc. Anidrosis, a state in which there is no sweat secreted, owing to some pathological condition of special nerves, or to destructive changes in the skin, produced by burns, blisters, cicatrices, keloid and other growths. Bromidrosis, fetid or stinking sweat is invariably due to microbes, as the brood of syphilitic germs in an ulcer, or swarms of the micrococci in small-pox, but in a sweaty foot, the odor of which is so offensive, there is a specific microbe which is pathogenic. It consists chiefly of short rods, which are aerobic, and anaero- bic, develop rapidly in beef tea or broth; will retain its offensive odor even after numerous cultivations and inoculations. Any one of one of the following germicides brought in con- 1004 DISEASE GERMS. tact with the microbe will cause its instant death: Solutions of boroglyceride, peroxide of hydrogen, ozone ointment, microbe powder, resorcin jelly. Other antiseptic precautions are bathing the feet, twice daily, with solution of boroglycide, washing the socks, saturating them before drying with some germicide. Chromidrosis.—Sweat of an abnormal color, is often attributed to the presence of drugs, as antifebrin, antipyrine, indican, pre- parations of phosphorous and of iron, vegetable parasites or vegetations. The red, malodorous, sweat of the arm-pit is due to the presence which is found in the sweat, or massed in the form of zooglcea and adherent to the hair of the skin, which it causes to become brittle. This microbe bears cultivation well at blood heat, on white of egg. In its growth it retains its original color, odor and microscopic appearance. In excessive and odorous perspiration of the feet and axillae, a variety of remedies will either sterilize or kill the microbe, almost incredible relief is at once experienced, and both the odor and sweating gradually disappear by bathing the parts with boro- glyceride solution, or a wash of peroxide of hydrogen. Sudden prostration from some shock; a partial Syncope, suspension of vital power. [Fainting) Best treatment recumbent posture, one-drop doses of nitro-glycerine on tongue, head low, cold air; cold water dashed over the face and chest; smart beating hands, feet; friction ; mustard plasters over the region of heart; aromatic spirits of ammonia or brandy. If the syncope be due to or associated with anaemia or chlo- rosis it must be cautiously, treated with brandy, ammonia and beef-juice, administered both by mouth and rectum. The recum- bent posture should be maintained until the action of the heart is nearly normal. consists of water, albumen, soda, chloride of sodium, Synovia phosphate of lime, a fluid to lubricate the joints, but one of the very best culture fluids for very many disease germs, especially the micrococci of scarlatina; amylo- bacta of rheumatism; bacillus of tubercle; the syphilitic germ. and others. This joint-fluid is a most nutritious pasture field for those germs, affording them all elements suitable for growth and repro- duction. BACTERICIDES. IOO5 The micrococci of scarlet fever, when oxygen is deficient in the blood, take to the joint water, where they can receive nourishment and protection more frequently than is generally supposed ■ it goes there alone and has neither identity nor affinity for any other microbe; it may possess eccentricities, but it alone is the cause of the joint-lesion. It is impossible to describe or state the time of migration, or joints affected, but smaller joints, as the fingers, wrists, etc., in which the synovia is richest, and pink marrow abundant, are those generally affected. The synovitis caused by the presence of the micrococcus of scarlatina in the synovial sacs, and other white fibrous tissue, in which it breeds, evolve spores and ptomaines, should invariably be treated by the local application of bactericides, as concentrated ozone, sulphur, ozonized tincture of iodine, iodoform, iodized oil or,"some of the essential oils, menthol, thymol, etc. The bacillus amylobacta of rheumatism germinates most actively in the larger joints; it is an active germ, leads to an accumula- tion of effete material in the system. Occupies joints in which pink marrow is not so abundant, therefore in its immediate results is not so productive of anaemia ; the excretion of ptomaines are considerable, hence the joint pain is usually great. The treatment same as rheumatism, with local bactericides. The favorite location of the tubercular bacilli in joints is around the cartilaginous ends of the bones, and the joints selected are the knee, hip, wrist. (See Tuberculosis) The syphilitic and other germs often localize in the joints. A term used to distinguish peculiar or- Temperaments. ganizations of the body in different indi- viduals. It is customary to arrange them in four principle groups. 1. The sanguine temperament, characterized by plumpness of body, fair or red hair, blue eyes, a soft, thin skin, active circula- tion, and a full, quick pulse. 2. The phlegmatic temperament is distinguished by a round body, soft muscles, fair hair, pallid skin, and slow, languid circu- lation and pulse. All the functions, mentally and bodily, are torpid. 3. The bilious temperament, known by firmness of muscle and nesh, defined sharp features, black hair and dark complexion, a lull, firm, and moderately quick pulse. 4- The nervous temperament, characterized by a small spare frame, quick, impulsive movements, and a delicate constitution ; the pulse is small and weak, and easily excited ; the whole nerv- ioo6 DISEASE GERMS. ous system is susceptible, the thoughts quick and imagination lively. Some physicians place great reliance on the indications of temperament in the treatment of disease, and find that those who possess a sanguine temperament are most liable to acute inflam- matory diseases; the phlegmatic inclining to scrofulous com- plaints; the bilious to affections of the liver and digestive organs- and the nervous to mental disorders and diseases of the nervous system generally. A microbial disease of great intensity, capable of Tetanus, destroying life in either a few hours or from three to five days, patient conscious but in a state of rigid spasm, said to be idiopathic or traumatic, whichever it is a spe- cific contagious disease, due to the action of a specific virus, which exists in the tissues at the seat of infection in the blood and in the central cerebro-spinal nervous system. The conclusions arrived at with reference to the origin of tetanus, is that it is an earth poison, or microbe. i. Tetanus is transmissible, not only between animals of the same or different species, but also from man to man and from man to animals, and vice versa. 2. The demonstration is estab- lished as regards solipedes. 3. The contagion from horse to man may be made directly or indirectly, the latter being most frequent. 4. Intermediate agencies, whether in prolonged or slight contact with a tetanic horse, receive without destroying the poisonous element, consequently enlarging the sphere of infec- tion. 5. Living beings may serve as the means of transmission without being themselves affected, but are constantly in danger of traumatic auto-inoculation. 6. A wounded man may receive infection of tetanus from surrounding objects, but of all these the horse and all his belongings are the most dangerous. Next in order is cultivated ground and its products. 7. The earth case acquires tetanic virus when contaminated by a tetanic horse. 8. Statistics show that tetanus occurs most frequently among those persons whose calling brings them in contact with horses—that human tetanus is parallel with equine. 9. The equine theory is confirmed by a majority of facts. In view of the experimental evidence which we possess at present and of numerous unassailable observations of many sur- geons and veterinarians, there seems to be ample warrant for the admission that not infrequently tetanus in man is acquired di- rectly and indirectly from some of the domestic animals which surround him, notably the horse, and also from newly cultivated ground. BACTERICIDES. I0O7 When this microbe enters the body, it is by the nerves, and makes directly, as if by magic, for the medulla oblongata and its membranes, where it breeds with amazing rapidity. The germ is contained in the medulla and spinal marrow, and spreads along the cord, being strengthened in its progress, and grows more intense all the time. Such an active microbe breeding freely, with a deadly ptomaine excreta, even greater than rabies, runs along and implicates all nerves in connection with the medulla and cord ; first the micro- bial chain traverses the nerves that supply the muscles of the jaws and throat, they become rigid, fixed with the mouth firmly closed, giving what is termed trismus, or lock-jaw. As the microbial colony spreads, descends the spinal cord, the muscles of the face, throat trunk and extremities become involved in the spasmodic contraction. Angles of mouth drawn outward and upward; muscles of neck, back and abdomen, hard, tense, con- tracted, and from time to time violent contractions occur. Spasms never entirely cease, except in some cases during sleep; aggra- vated every quarter of an hour or so, increased, cramps lasting for a few minutes and then partially subsiding. When the nerves that supply the strong muscles of the back are most implicated or affected, they draw or bind the body in the shape of an arch, the patient resting on the occiput and heels, which is called opis- thotonos. If the nerves that supply the anterior or front muscles of the body are weakened by any cause, the irritation may ex- hibit or spend itself there and thus bend the body forward by strong contractions of the muscles of the neck and abdomen ; this is called emprosthotonos. If the nerves that supply the mus- cles on either side be affected or weakened, the irritation may spend itself there and the body be drawn sideways, which has been designated pleurosthotonos. By and by, the nerves that supply the involuntary muscles become affected. Frightful suf- fering, caused by tetanic spasms ; face pale or as white as snow ; brows contracted ; skin covering forehead corrugated ; eyes fixed and prominent, sometimes suffused with tears ; nostrils dilated ; corners of mouth drawn back ; teeth exposed and features fixed in a grin—risus sardonicus. Respiration performed with diffi- culty and anguish; severe pain at the sternum or pit of the stomach; great thirst, but agony increased by attempts at deglu- tition; pulse feeble and frequent; temperature very slightly raised; skin covered with perspiration ; patient cannot sleep, or ii he does, it is only for a few minutes at a time. In spite of all the suffering the patient's intellect remains clear and unaffected. It terminates either in death or recovery, or by a breaking up of the spasm into chronic, from which, with proper management, recovery is almost certain. ioo8 DISEASE GERMS. The duration of an acute attack is usually between three and five days, death taking place partly from suffocation, partly from exhaustion. It is very easily recognized by its history and symptoms, the absence of fever, the clearness of intellect and the continued spasm. No other disease like it. The appearances after death are great serous effusion in ventricles of brain, around the spinal cord ; the whiteness of skin and laceration of muscles by the spasm is also present. In the serous effusion around the medulla oblongata and spinal are to be found the bacillus of tetanus. Rods, very fine, like thread forms, mostly collected in irregular masses, with characteristic spore-formation. Inoculation of garden earth subcutaneously into rabbits in- duces tetanus. The bacilli found in their blood is Identical with the microbe in man. The germ is pathogenic of the disease, bears cultivation well, and is as active after several generations of culture as in its primi- tive state. Pre-eminently contagious and in- , f$» '%"•*• fectious, it has an uncertain period of incuba- ftfox^Ai**'!'-'1 ti°n> depending upon the status of vital force ••*l'» ? "alii?'? °f the inoculated. Cases occurring twenty- ' $1 *fl~3*i f°ur» thirty-six or forty-eight hours after injury Jr» v * rarely survive the third day, but comparatively ... . , rj. . few are lost when it comes on the ninth or Microbe ol letanus. eleventh day. The excretion of ptomaines is most active in and around the medulla, death often takes place from them before they have time to enter the blood. As tetanus has thus been clearly shown to be a disease due to the presence ox a pathogenic bacillus, its curative treatment de- pends almost exclusively upon the administration of bacteri- cides, but before any drugs can be given the spasm must be relaxed. For this purpose move the bowels freely with com- pound powder of jalap and senna with one drop of croton oil. Apply at once the galvanic cautery at a white heat every three quarters of an inch on both sides of the spine, from the nape of the neck down about ten inches. After its thorough application, poultices, composed of equal parts of flaxseed meal, pulverized lobelia and stramonium should be applied as hot as can be borne and changed every three hours. While this is being done, an effort must be made to relax the spasm, as the recovery of the patient depends upon that. For that purpose, take one heaped teaspoonful of lobelia seed, fresh crushed, one teaspoonful of the BACTERICIDES. IOO9 fresh plant of lobelia, one tablespoonful of American valerian, and one tablespoonful of pulverized capsicum ; place all in half a pint of brandy, shake well, let it settle a few minutes, then begin to give a teaspoonful every few minutes until the spasm relaxes. If there is a hot bath handy, put the patient in it (97° Fahr.) Throw in the bath a pound of lobelia, and while in the bath enemas of a strong infusion of lobelia should be given. The lobelia, by the stomach, bath and rectum should be pushed to thorough relaxation of spasm, avoiding emesis if possible. If there are no facilities for a hot bath, then cloths wrung out of a decoction of lobelia should be applied to chest, abdomen, thighs. Half an hour is sufficient for the bath, but if cloths are applied they should be constantly used, keeping them hot and moist. If spasm breaks, the case may be considered pretty safe, if well managed, and the proper bactericide administered. The dioxide of hydrogen is the germicide combined and alternated with sumbul and bromide of potassa. Other germi- cides might the tried, as resorcin, sozoiodol, concentrated ozone, etc.; sulphur water ozoned; par-aldehyd, etc. The lobelia, antispasmodic, must be still persevered with in small does, and small doses' of calabar bean added to it. If there be a wound, a scratch, an abrasion, or laceration, from a rusty nail, with the microbe from the earth or from something in use near a horse, it should be attended to ; all irritating parti- cles should be removed and the wound sterilized; the nerve, if lacerated or torn, might be divided, and poultices of either creoline or naphthaline, or ozonized jequirity applied. Otherwise, treat on general principles. It is folly to think either of dividing the nerve high up in the limb, or amputation, for once the microbe reaches the medulla (vital force slightly impaired) it will breed in the nervo-vital fluid and cause the disease. Spasm well broken, and microbicides administered, acro-nar- cotics, like belladonna, conium, might be tried. Inhalation of ether, chloroform, hypodermic injections, alka- loids of opium, chloral, are decidedly hurtful and likely to cause death. Infantile tetanus, or as they are sometimes termed, nine-day fits, occur in infants after birth, from cutting of the cord with scissors which had been on the ground or earth, or old linen fags, trichinous lard, etc. Great care is necessary to guard the new-born from cold, foul air, poisoned lard to skin, imperfect cleaning of sebaceous secretion, retention of the meconium. Cord should in all cases be properly cared for, never left in the hands °f an ignorant nurse. Puerperal tetanus often makes its appearance during and subse- 64 IOIO DISEASE GERMS. quent to labor. Pressure of the fcetal head on the sacral plexus of nerves is said to be the common cause, true of an irritation transmitted to the medulla oblongata, but the disease is most common in spring and fall, when the accoucheur for pleasure is occasionally working in his garden or with his horse. Here we have all the symptoms of the disease; the peculiar germ-laden medulla; the germ excreting ptomaines, the tetanine irritating motor nerves, which supply the muscles, causing rigid spasm. In our diagnosis it must not be confounded with anaemia or hyperaemia of the brain, which are very common. The mode* of management here is to deliver quickly and pur- sue precisely the same treatment as one of general tetanus. The coagulation of blood in the heart or Thrombosis, blood vessels during life, is predisposed to by malaria, carbonaceous food and drinks, in- door life, sedentary habits, non-aeration of the blood, breathing deleterious gases, germ-laden air with sewage, pregnancy; such drugs as ergot. The blood thick, clotty, is prone to attach itself to some neo- plasm, some calcareous body on its inner lining of the vessel, some atheroma, or some weakened or inflamed patch, or dilated vessel; agents that will slow the heart's action, hasten the co- agulation. The nature of the clot is most variable ; the coagulated fibrine may fill the vessel, and the thrombosis may be uniform; the blood may coagulate along the inner walls of the vessel only, flowing freely in its centre. When once formed it may organize or undergo shrinking, softening or suppuration. The symptoms will depend upon its location, the size of the vessel and the amount of clot; for example, when the blood in ' the femoral vein is clotted it gives rise to phlegmasia dolens; thrombosis of the cerebral vessels gives rise to special phrenic symptoms ; clotting of the blood in the vessels of. the lower ex- tremities gives rise to anaemia, necrosis, hemorrhagic infarction, dry or moist gangrene. In the treatment of thrombosis, rest, abundance of fresh air, alkaline bathing, friction or massage, with stimulating liniments ; internally a judicious use of alkalies in alternation with belladonna and general treatment for embolism. Precautions.—As nearly all the new coal tar preparations, as exalgine, antipyrine, antifebrin, salol, etc., cause thrombosis, great care must be exercised in their administration. BACTERICIDES. IOII In structure the tongue consists essentially of Tongue, muscular tissue covered by mucous membrane. The muscular fibres, omitting those of muscles inserted into the organ, are arranged in two horizontal and several verti- cal layers, the former set lying immediately underneath the mu- cous membrane, and the latter passing vertically from between the horizontal layers, leaving intervals which are occupied by gland structure. The mucous membrane is furnished with pa- pillae, i. The circumvallate, which are a dozen or so in number, and are arranged at the base of the tongue like an inverted V; these papillae are greatly concerned in taste, and are supplied by the glosso-pharyngeal nerve. 2. The fungiform ; these are scat- tered over the tongue, and are specially observed at the sides and tip. 3. The conical or filiform, are distributed all over the tongue. The tongue is divided into two symmetrical halves by a fibrous septum, the existence of which is marked by a raphe in the median line. Diseases.—Tongue-tie is a condition in which the fraenum, or fold, seen on the under surface, extends to the tip, and ap- pears to tie the organ down to the un- derlying structures ; its division, by means of a pair of blunt-pointed scissors, readily remedies the defect. Inflammation of the tongue (glossitis) may be caused by wounds, or stings, or by the application of some acrid substance ; occa- sionally it comes on without any apparent cause. If the symptoms are not peculiarly urgent—i. e., if there be no great pain or swelling, or threatening of occlusion of the fauces, a leech or two under the jaw, and a smart purgative, usually afford relief. If the inflammation be very sudden, its pro- gress rapid, and suffocation threaten, then a few longitudinal incisions should be made on its surface to allow of the escape of fluids. In very severe cases, where these measures afford no relief, and the symptoms are very urgent, tracheotomy must be performed. Glossitis is sometimes brought on by the excessive use of mercury; the trealment in such cases consists of purga- tives, astringent lotions, and careful bandaging of the organ, and full doses of chlorate of potash internally. Ulceration. Ulcers of the tongue may have their origin from several causes, either from local irritation, such as decayed teeth, The upper surface of the tongue showing the papilla, and the dorsum on which disease germs localize. 1012 DISEASE GERMS. or from some derangement of the digestive organs, in fevers, or from syphilis, or from the prolonged and mal-administration of mercury. In all cases there is a marked foulness of breath. The constitutional treatment of course varies with the case, and re- moval of all obvious irritation, attention to the bowels, and lo- cally the application of a solid stick of lunar caustic, the sucking a few crystals of chlorate of potash, and in syphilitic ulceration, the application of a little calomel powder diluted with flour, are about the best remedies. Those connected with microbe of syph- ilis are the most intractable, and frequently defy all treatment. Malignant ulcers of the tongue are epithelial in their character, and their development is frequently ascribed to local irritation, such as a sharp stump of a tooth, the habit of smoking short clay pipes, etc., but such causes are very questionable. The margins of such ulcers are composed of hard granulating masses, impli- cating the substance of the tongue, and ultimately involving the glands at its base; under the jaw and in the neck they are at- tended with great pain, and are usually deeply excavated. The prognosis in these cases is very unfavorable. The treatment is very unsatisfactory, and consists in removal as the only chance for the sufferer. Enlargement (hypertrophy) occurs in young persons, and is nearly always congenital. The tongue pro- Organisms found in the human mouth, trudes from the mouth, becomes almost invariably present. • i i i ulcerated from contact with the lower teeth, and there is a constant dribbling of saliva. The treatment consists in attention to the state of the digestive system, ban- daging the organ, and astringent lotions. In cases where this treatment is of no use, removal of a portion, or the whole of the protruded part, must be performed. Tumors in connection with the tongue are sometimes met with. Of the most frequent occurrence is ranula, to which a special article is devoted. (See Ranula) Encysted tumors, closely resembling ranula, fatty tumors, and naevi. The ducts of the salivary glands, the parotid, and submaxil- lary, are sometimes the seats of concretions composed of phos- phate of lime and animal matter, oval in shape, of a brownish or yellowish color, and of variable size, sometimes being as large as a small egg. Occasionally they come away of their own accord by ulcerating through their confines, but their treatment consists in their removal by the knife and forceps. Wounds of the tongue almost always bleed very freely; in slight cases, iced water, or styptics, will arrest the hemorrhage or occa- BACTERICIDES. IOI3 sionally a vessel may be tied, or pressure may be kept up by a pair of common forceps, the blades of which are kept together by an elastic band. The edges of a severe cut or laceration should be approximated with sutures. All pain, swelling, etc., should be allayed by iced drinks, and astringent and disinfecting gargles or washes. The tongue is a most valuable index of the state of the stom- ach, bowels, liver, kidneys, etc. In the mouth, but especially on the tongue, are to be found al- most every pathogenic microbe. By taking the mucus, or coat, and placing it under a micro- scope, we see the sarcina? ventriculi of gastric catarrh; the bacillus of typhoid fever; the micrococcus of measles, scarlet fever and variola, are all 'to be found on the tongue. The bacillus of tubercle and amylobacta of rheumatic syphilis, cancer, are invariably found on the dor- sum or root of the organ. Even simple mal-assimilation can be detected in the myriads of bacteria and oidium albicans present. The physician of the future will not only tell that transverse cracks and fis- sures mean intestinal irritation from Different forms of the bacillus microbes or parasites, but what those mouth Ind tongue in"rheu* really are; that elongated papillae at matisra- root or edge, are the starved-out crepta syphilitica seeking nu- trition. The frequency with which bullous erythema and hydroa at- tack the mucous membrane of the mouth, especially the lower lip and cheek, is one of the characteristics of these diseases; whether they ever also attack the mucous membrane of other parts of the alimentary canal is, I think, doubtful. No doubt, however, exists on this point with regard to pemphigus, for the disease not only attacks the mouth and vagina, but also the whole of the large bowel except the lower part of the rectum; this has been placed beyond doubt, not only by general symp- toms and dysenteric diarrhea, but also by the results of post- mortem examination. (See Pemphigus). Urticaria is especially liable to attack the mucous membrane of the throat, producing sometimes most alarming symptoms, with great dyspnoea and difficulty in swallowing. Violent symptoms of gastric irritation are also not very uncommon in cases of acute urticaria. In our present state of microbial surroundings, the human 1014 DISEASE GERMS. mouth should be kept aseptic by washing it out with a few drops of the tincture of the soap tree bark, and dioxide of hydrogen; or some anti-microbe powder, added to a little water; boro- glyceride also is excellent mouth wash. A very favorite anti- septic gargle consists of thymol; benzoic acid; eucalyptus, added to water. In quinsy, so called in various Tonsils, the forms of irritation of the tonsils, from abode of Pathogenic inflammation to hypertrophy, there Microbes. is found in addition to the ordinary bacteria of mal-nutrition, the bacillus of tubercle and syphilis, the streptococcus of diphtheria, the mi- crococci of scarlatina and variola, a special pathogenic microbe of quinsy. Requires bactericides ; exalgine for fever. Chlorate of potash alone, or in combination with hydrochloric acid in the form of gargles, or taken internally, is so often disap- pointing in the treatment of enlarged tonsils that better means are desirable. The disease is of parasitic origin. Whilst the harmless, if not very active boroglyceride has pretty well dis- placed the chlorate in domestic practice. Then salicylic acid was used, and with excellent results when applied judiciously. In the form of gargle it is least satisfactory, and often fails to reach the affected surface ; a spray of glucozone is better, but to use that effectually trained hands are needed. The best and simplest mode is to apply the powdered acid directly by means of a rather large camel's hair pencil, which may be slightly moistened. In this way it is brought directly in contact with the diseased surface, and but few applications are necessary. And it may be used with very young children after a little coaxing. When the tonsils are covered with a thick mucous coating, which may be diphtheritic, it is necessary to previously remove it, and the following liquid, to be also applied with a brush, acts extremely well: Pepsine, thirty grains ; dilute hydrochloric acid, one drachm; water, five drachms ; glycerine, four drachms. The coating is quickly dissolved (digested) in this solution. Besides applying the acid locally, it is advisable to give it in- ternally at the same time, thus : Salicylic acid, thirty grains; mucilage of acacia, one ounce; simple syrup, half an ounce; water, four and one-half ounces. Mix. A tablespoonful every two hours. In the more chronic forms it is well to pencil the tonsils over BACTERICIDES. IOI5 with tannin, fifteen grains; ozonized iodine, two drops; glycer- ine, five drachms; water, one pint; or it may be used as a gargle still more diluted. For the prompt dispersal of threatened quinsy, apply with a brush three times a day, the following solution : Tannin, fifteen grains ; ozonized iodine, three drops; carbolic acid, half a drachm , glycerine, five drachms; water, two and one-half ounces. Toothache. Invariably the result of disease germs, either the microbe of dental caries, or the amylobacta of rheumatism, the former going for the body of the tooth, the latter for the fang. There are numerous others, one especially which forms lactic acid in a substratum containing sugar or starch. The salts of calcium in the sub- 00, « * Q, » "' s • t 2> lungs, in two ways : first, as the result of anaemia, in which case the marginal and apical regions are primarily attacked ; secondly, as the result of an inflammation frequently induced by functional abuse, in which case the vocal chords and ventricular bands are situations in which the disease is not infrequently first manifested. Erosions, non-tuberculous in character, may appear in the larynx of a tuberculous patient; doubtless some of those that heal are of this nature. Clinical evidence has long warranted the supposition that a laryngeal may precede a pulmonary tuberculosis. Recent facts have proved the truth of this hypothesis. Fauces and Pharynx.—A nidus may be formed in this region by absorption of the contaminated fluids of pulmonary, laryngeal, and oral secretion, and the bacilli be conveyed through the general system. In the case of a primary faucial tuberculosis there is probably a previous breach of continuity. Clinical evidence would show that there is a possibility of a primary faucial tuberculosis, but the fact has not yet been verified by post-mortem evidence. Tonsils.—While faucial and pharyngeal tuberculosis are acutely painful, the tonsils may be attacked without symptoms, provided the other portions are free from ulceration. Treatment.—Considerations under this heading are limited to cases in which the disease, though well established,. is not advanced. i. The first indication is, by climate, hygiene and general measures, to place the patient in the most favorable position for resisting the baneful influence of the bacilli and rendering their life impossible; preference is given in early cases to sea voyages and mountain air over hot or moist climates. 2. Inhalations containing oxygenating elements, peroxide of hydrogen and administered by oro-nasal inhalers are preferable to those of steam. 3. Medicines include, first, atropine as a probable alkalojdal antidote to symptoms of the septicaemic process indicating a ptomaine toxaemia; secondly, kephaline, of which that of calcium is preferred as most favorable to rapid (calcareous) degenera- tion of the tuberc'e ; thirdly, glycerite of ozone, which it is sug- gested may act as a specific in the tuberculous disease, though not to the same extent as other drugs. 4. Germicides are of two classes : (a) those which may power- fully affect the general system ; [b) those of a more purely local character. Of the first may be mentioned peroxide of hydrogen. The use of sulphuretted hydrogen and carbonic-acid gas per BACTERICIDES. 1041: rectum is a method of treatment which is still on its trial, and so far as can be judged, it is more favorable in cases of chronic bronchitis than in tuberculosis. The microbicidal effect of the gas is very feeble. Conclusion.—That, while throat symptoms may be greatly relieved even in cases of advanced pulmonary disease, there is seldom any true cure, but that each year there is a greater hope of such a happy result. There can be no doubt that ulcers in the regions under con- sideration can be healed, and success in this direction is in pro- portion to the accessibility of their site. Treatment.—In its early stages the treatment of phthisis laryngea ought not to be of an active and meddlesome charac- ter; and general advice as to avoiding changes of temperature, damp and cold atmosphere, hot and irritating food and drink, and tobacco smoking, combined with tonics and drugs by inhala- tion, etc., to relieve the cough, is of more importance than any local throat treatment. When, however, ulceration of tubercular deposits has taken place, and there is much pain on taking food, along with hoarseness and irritating cough, then we must adopt systematic local treatment in the shape of spraying or brushing the affected parts with solutions of cocaine in glycerine in borax, 5 to 10 per cent.; cocaine pastiles ; insufflations of iodoform or iodol; lactic acid carefully applied with the brush, and varying in strength from 20 to 60 or even 80 per cent; gradually increas- ing the concentration as the parts become tolerant of it. Solutions of menthol in olive oil to allay pain, and insufflations of morphia and bismuth for the same purpose, are good. All these measures must be combined with the usual cough mixtures, tonics, tar syrup, glycerite of ozone, which are used in cases of pulmonary phthisis. The question of climate is most important if the patient can afford it. Mountainous locations in Pennsylvania are excellent. When the system is heavily The Tubercular Bacillus loaded with the microbe tuber- in the culae, if some irritation exists in Stomach and Bowels. the stomach, it will infiltrate its walls, and in some cases, if not arrested by building up the constitutional powers and killing the germ with bactericides, the germ-tubercular colony often as- sumes an immense size. At first an active germ mass, by-and- by caseous, and latterly calcareous. There may be simply one nodule, or several. 66 1042 DISEASE GERMS. In any stage, it may either slowly or suddenly break down and pass by the bowels, leaving an ulcer behind, or it may cause perforation of the stomach and death. In the walls of the intestines the same course is pursued, an irritation, an exudation of plasma from the germ-laden blood, in which the microbe is present, its deposit in or on the walls of the bowel, either in one or several colonies. The very same degenerative changes are liable to occur in the bowels, as in the stomach, congestion, caseous consolidation, calcareous degeneration, either ulceration or perforation of the bowels. Throughout the ileum, but especially, as in typhoid fever, in the solitary and Peyer's glands and those structures at the lower part of the small intestine and in the caecum, there are large patches of ulceration at variable intervals, commencing as small. round, discrete ulcers at the upper part of the canal, and becom- ing confluent below into irregular patches, which extend through- out the entire circumference of the canal. Each ulcer is of an irregularly circular form, and bounded by a thick, raised, round, and inflammatory border. Internally, the margin is irregular and continuous, with coarse granulations, between which are scattered little yellow masses of tuberculous matter, firmly adherent to the base of the ulcer. Some of the ulcers may extend to the peritoneal coat, and their existence may be known, before the intestines are opened, by an irregular thickening and a corresponding irregularity of the peritonaeum. The points of difference between the tubercular ulcer and the typhoid ulcer are the following: The ulceration in the tubercu- lar ulcer extends transversely round the whole surface of the intestine; the edges and base of the ulcer are thickened and in- durated. This form of ulcer very rarely heals, and perforation is also very rare. Some contraction and narrowing of the gut fre- quently occur. The presence of the tubercular microbe in either the stomach or bowels, is usually recognized by the gastritis or enteritis present, diarrhea, or constipation ; the presence of the tubercular bacilli in stools, some, but very little pain; in the later stages, the caseous and calcareous masses can be readily felt through the abdominal walls, the emaciation is usually immense. The same constitutional, hygienic, and medicinal treatment as for tuberculosis, build up the vital force by every possible means; destroy the bacillus with the most powerful bactericides. Special treatment for the germ in stomach, administer dioxide of hydrogen ; fl. ext. stone crop ; kephaline and quinine; hy- drastis and avena sativa. BACTERICIDES. IO43 Diarrhea occurring during the progress of the tubercular bacilla in any part of the body, would be strongly presumptive that the bacillus would emerge on or in the coats of the bowel, and if the microbe could be detected in the stools, the diagnosis would be perfect. In this event, bactericides must at once be applied to the en- tire abdomen, as concentrated ozone, with chloroform ; ozonized iodine with chloroform ; or aromatic pinol, over and above all, a flannel roller. & £■«!$...,•, .^v*^ Internally, glycerite of ozone, alternated i^ii^iaf^l with ozonized stone crop. i^^M'^l^"^ But if there are any evidence of ulceration |$p^ \$& 'i by the presence of the streptococcus pyo- ^'^^^f^*^ genes in the stools, then in addition to those \v0^^^0i remedies, intestinal disinfectants, as naph- Ili'^vW^^ thaline, salol, salicylate soda, creolin. >-^W\...;,-. fr With regard to intestinal disinfectants, we Tubercular ulcers of the must carefully consider the effects those will produce on the organism. When the contents of the stomach and bowels are undergoing decomposition, either from yeast, sarcinae, bacteria, or tubercle, we may get good results by the use of creosote, or salol, or naphthaline, because these substances come directly into contact with the microbes in the stomach, and a quantity of them which is too small to be injurious to the patient, will be sufficient to act as a disinfectant. If the intestine is to be disinfected, these drugs will not produce this effect so readily, because they will be partly absorbed in the stomach, and one has to look either for some remedy, which, on account of its sparing solubility, will pass through the stomach into the intestine without being absorbed, or else one which will not have much poisonous action. Such we have in the stone crop ; an invaluable drug in all states of ulceration, it tends to promote a renewal of life in that structure. Of all parts of the intestinal tract, the microbe seems to have a special affinity to the posterior part of the rectum; here the tubercular bacilli deposits itself in nodules upon the surface of the bowel, hard to the feel, smooth and round. If the germ is permitted to establish itself, and undergo caseous, calcareous de- generation, it gives rise to ulceration, and a germ-eaten rectum ; often with fistulous openings, or crescentic thickening. If such a state of things exist, germicide treatment must be pushed, and locally to the rectum, microbicides, as rectal bqugies of either resorcin, or thallin, or papoid, or creolin, or naphthal- ene, or iodol. irtJIA DISEASE GERMS. IO44 Enemata of boroglyceride, ozonized pine tree, witch hazel, etc., will do much to effect a cure. Tubercle bacilli in liver. The tubercular bacillus sometimes migrates into the liver, creates considerable irritation, and often jaundice. In such cases, small doses of the peroxide of hydrogen, alter- nated with the phosphate of soda, speedily remove the symp- toms. Depression of the perito- The Tubercular Bacilli neal membrane offers a favor- in the Peritoneal Membrane, able location for the localiz- [Tubercular Peritonitis). ing of the bacilli; it may ex- ist alone, or be complicated with the microbe in the lung. Tubercular deposit on the peritonaeum is accompanied with some fever, acute pain in the abdomen, increased by pressure, loss of flesh and strength, thirst, loss of appetite, and continuous diarrhea, or diarrhea alternating with constipation. The diseases with which we are most apt to confound acute tubercular peritonitis are typhoid fever and acute non-tubercu- lar peritonitis, and in some instances the resemblance is so close that it is only by great care and watchfulness that we can avoid falling into error. As a general rule tubercular peritonitis of this kind begins suddenly, whilst typhoid is usually preceded by a period in which the patient has been weak, feeble, and feverish, In the former, pain in the abdomen is more marked, and there is BACTERICIDES. 1045 tenderness over different parts ; whilst pain in the latter is rarely severe, and any tenderness that may be present is confined to the iliac region. In tubercular peritonitis the temperature rises at once, and not regularly, as in enteric fever, and the pulse is usu- ally more rapid. As the case proceeds the temperature varies more in peritonitis, spots are rarely observed, and the stools have not generally the typical appearance of those passed in typhoid; whilst at a later period the persistence or frequent returns of ab- dominal pain and tenderness, and of vomiting, the variations of the temperature, the alterations of constipation with diarrhea, and the increasing prostration, will in most instances, enable you to distinguish between these diseases. In addition to these differ- ences, you will in many cases be able to render your diagnosis more certain by the discovery of fluid in the peritonaeum, or by the detection of a tumor in the abdomen; or you may find the signs of effusion in the pleura, or of a consolidation in the apex of one or both lungs. Still more difficult is it to distinguish be- tween acute tubercular peritonitis and ordinary peritonitis when the former does not assume from the first the typhoid form. In many cases I believe it is impossible to arrive at a certain con- clusion in the early stage, for both may attack persons previously healthy, both may be ushered in by similar abdominal symptoms, and it is only by watching the progress of the disease that you can form an accurate opinion. As a general rule the pain, ten- derness, and vomiting are less distressing in the tubercular form, the temperature is lower, and there is more usually diarrhea than constipation. As the disease progresses the abdominal symp- toms recur from time to time, instead of slowly subsiding the temperature remains high, emaciation becomes more marked, the effusion into the peritonaeum is very slowly absorbed, and you may discover signs indicating effusion into the pleurae or pulmo- nary consolidation. A child under two years of Tubercular Bacilli in age with either an hereditary or Mesentery. acquired tubercular constitution, [Tabes Mesenterica, or may be subjected to some irrita- Marasmus) tion of the bowels, either from worms, diarrhea, cholera infan- tum, which necessarily weakens the mesentery, into which the bacillus of tubercle enters, and lodges in its meshes or net-work, breeds, grows with great rapidity, destroys its proper function as a blood-raising gland; obstructs the passage of chyle through the convoluted lacteals, which traverse the mesentery in all direc- 1046 DISEASE GERMS. tions, and give rise to anaemia and leucocythemia, and as a result all the tissues of the body starve and waste away. The spongy net-work of the mesentery becomes enormously engorged with the bacilli. Prior to, or more generally associated with it, there is either diarrhea or cholera infantum. About the earliest premonitory is, the abdomen becomes hot and tender, bloats, more or less con- stant pain in the bowels, sometimes so severe as to cause the lit- tle sufferer to instinctively draw up its knees towards the ab- domen ; deep red color of lips ; angles of mouth covered with small ulcers, or lips fissured ; passages from the bowels resemble chopped spinach, and very acid. Later on, they are very fetid, more frequent, and distressing; abdomen rapidly grows large, child more pale and anaemic, the emaciation greater, until he gets down to skin and bone; even the marrow in bones wastes; skin white and wrinkled; intense debility, with rapid, increasing weakness. The abdomen, al- though intensely swollen, soon be- comes irregular to the feel, lumpy in masses like large eggs at first; when tubercle is active and growing, soft; then a cheesy feel, and latterly, cal- careous ; there may be a tubercular condition of lungs, bronchi, or mem- branes of brain. Its duration is un- certain, depending on the condition of vital force and season of the year. If it appear early in June, the little sufferer, unless taken to the seashore or country, stands a poor chance of recovery before September; whereas, if it appears in August, there is usually little difficulty in tiding the patient into the cool weather. It may occur at any season, but much more common when the vital forces of the child are depressed by solar heat and city life—a season when cholera infantum is prevalent. In the treatment of these cases, the first thing to do is to disin- fect the intestinal tract and kill the microbes of cholera infantum, and those of the green diarrhea; this can be effected either by the administration of naphthaline, or resorcin, or calomel. The diet should either consist of mother's milk, or sterilized malted milk, or beef juice; the entire body should be bathed morning and night with castile soap and cold water, followed by a salt water bath; kept in a quiet, cool place, with abun- dance of fresh air. To the entire abdomen, some bactericide, such as con. ozone The tut ercle bacilli in the omentum in tabes mesenterica. BACTERICIDES. IO47 to erythema, followed with ozone ointment; or if con. ozone is not procurable, apply spices ; say a mixture of pulverized cloves, allspice, cinnamon, and cinchona, equal parts of each, saturated with vinegar or acetic acid ; spread between folds of book muslin, and apply all over, then above a roller ; when it cakes it can be crumbled up, moistened, and re-applied ; or, the peroxide itself could be applied. The germicide principle of either penetrates by endosmosis to the tubercular bacilli in the mesentery, either kills or sterilizes them ; it also decapitates the comma-bacillus in the bowels. At all events, the nausea, the vomiting, diarrhea, cease; microbes disappear from the stools. Whatever germicide remedy is used, it must be powerful enough to kill, or at least sterilize the various microbes present; general principles must guide. But in all cases the general treatment for the destruction of the tubercular bacilli must be enforced. Individuals with a strong tuber- The Tubercular Bacilli cular cachexia, are liable, if any on the part of the body be weakened, to Walls of the Bladder, have the bacillus deposited on the [Tubercular Cystitis.) devitalized part. When the bladder becomes af- fected, deposits of tubercle occur in its mucous lining, especially about the trigone; these, after a time, softening and breaking down, are succeeded by distinct ulcerations with punched-out edges, which, when they remain separate from one another, are usually of small size and often very numerous ; in other cases they run together, and, becoming confluent, form ulcers of con- siderable dimensions, e.g., as large as the palm of the hand. The muscular coat subsequently becomes thickened from inflam- mation, and at the same time contracts, so that the capacity of the bladder is often considerably diminished ; occasionally per- foration of its walls ensues, and under these circumstances, sec- ondary abscesses may form in its vicinity. Tubercular cystitis may manifest itself in three different ways. In the most common form, the testicle is the part primarily at- tacked by tubercle ; this is frequently followed by suppuration, and after a while the prostate and vesiculae seminales become similarly affected ; eventually the disease spreads further onward, involving next the bladder, and then the kidneys. Under these circumstances, the affection is very slow in its course, often con- tinuing for as long as ten or fifteen years. In the second form, the bladder is first involved ; the prostate and kidneys may after- 1048 DISEASE GERMS. ward become affected, but the testicles usually escape. In the third form, the implication of the genito-urinary organs is sec- ondary to the development of tubercle in the lungs. One of the earliest evidences of tubercular cystitis is slight haematuria, the blood coming from the mucous lining of the bladder, and in many cases this continues for a considerable pe- riod, sometimes for several years, before the more severe symp- toms manifest themselves. Sooner or later, severe pain is usu- ally felt, but it differs from that met with in cases of cystitis due to calculus, inasmuch as it is almost constantly present, not being relieved by rest or sleep. Micturition is increased in frequency, and accompanied by tenesmus and a burning sensation, owing to the fact that the trigone is the part of the bladder which is usually the chief seat of ulceration ; the urine contains pus, and the deposit is more floc- culent and less of a gelatinous character than is usually met with in cases of chronic cystitis due to other causes. The position of the patient is often characteristic. He fre- quently lies crouched up in bed, so as to relax the abdominal muscles, for in this way, by taking all pressure off the bladder, slight relief is often obtained. The prognosis is always very unfavorable, most cases eventu- ally terminating fatally, either from the local affection, or occa- sionally, if the kidneys become affected, from the supervention of uraemia. Unfortunately, very little can be done in the way of treatment. Washing out the bladder with some germicide ano- dyne solution, suppositories, fomentations, etc., sometimes afford slight relief; but in most instances the severe pain, which is doubtless due to the constant irritation of the urine as it flows over the ulcerated surfaces, continues unabated, and it is the very intractable nature of this symptom which in many cases of pain- ful cystitis is of assistance in helping us to recognize the tubercu- lar origin of the affection. General treatment for tuberculosis, including glycerite of ozone, ozonized stone crop, uric acid solvent, often retards the disease and prolongs life. The tubercular bacilli in the kidneys. In all diseases due to the presence of a microbe in the blood, we almost invariably find the germs blocking up and breeding in the organs of excretion. This is specially so in the rectum and kidneys of young persons, who are the host of the germ. Males are more prone to this affection than females. The right kidney more seriously implicated than the left. When the germ is thus deposited, they are usually most abundant in the cortex, in the arterioles, and other parts. The BACTERICIDES. IO49 tubercle undergoes its^various stages of growth and degenera- tion. The symptoms are those of tuberculosis, pulmonary or intesti- nal hectic, night sweats, etc., pain in the loins, irritable bladder, scalding urine, with casts of the bacilli ; invariably tubercle in lungs, prostate, lymphatics. General treatment for the diathesis. We have seen that simple in- The Tubercular Bacilli flammation and ulceration of the in the Rectum. rectal mucous membrane and [Tubercular Ulceration) deeper tissues are more fre- r^quently present than what is generally supposed, and is often treated for disease of the liver and dyspepsia. Tubercular ulceration is generally in the posterior portion of the bowel, a weakened patch in which the tubercular bacilli have localized and where they are in an active state of growth, the walls of the rectum pre- senting a worm-eaten appear- ance. The annexed cut is a form of rectal ulcer, almost inva- riably present in the last stages of pulmonary tuber- culosis ; the posterior portion of the rectum is germ eaten ; in that riddled structure the tubercular bacilli are seen in their albuminoid, cheesy and calcareous stages. This ulcer, with its per- forating fistula is always amenable to a cure by the local appli- cation of resorcin or naphthaline ; with glycerite of ozone in- ternally. The symptoms are nearly identical with the simple form: diar- rhea, followed by constipation ; severe pain in the coccyx, radiat- ing through the hip and down the thighs, passing of mucous and bloody matter during stool; burning, itching, great uneasiness in the bowel from the presence of the microbes ; inclination to strain at stool, and after movement a burning sensation after stool, but usually pain is slight, neither is there much local disturbance, but the reflex symptoms are vertigo or giddiness; loss of memory, 1050 DISEASE GERMS. pain in the back of the head, indigestion, bloating of the abdomen, with order of the bladder and kidneys. The great prevalence of tubercular ulceration of the rectum may be gathered from the fact that 90 per cent, of all cases of pulmonary tuberculosis have a worm-eaten rectum. A species of ulceration of the rectum, very nearly analogous to the above, is met with among the insane. In our large, over-crowded cities, among prostitutes, with broken-down constitutions, aggravated by poor or insufficient food, alcoholic drinks, insanitary surroundings, we meet with gangrenous, or phagedenic ulceration of the rectum ; skin adjacent to the sphincter, often extending to the nates, the germ present being the oidium albicans, the evidence of squalor and rot. For the destruction of this we require our most powerful antiseptics and germicides, with the best of internal nourishment and tonics, to reconstruct the shattered vital force. Gonorrhea of the rectum, venereal warts, condylomata or mucous patches near the verge of the anus must be treated on general principles. This frequently follows gonorrhoea. Tubercular Bacilli in In the early stages the symptoms, be- the Prostate. ing those of catarrh, escape notice, and the tubercle in the prostate can- not be detected by the finger until it has become considerably de- veloped. The catarrhal condition of the prostate, with slight ir- ritation of the bladder, lasts an indefinite time ; eventually atten- tion is directed to the prostate by the occurrence of other symp- toms, such as frequent seminal emissions, or by weight in the perineum and pain in the sacrum. In other cases the patient notices increased frequency of call to micturate, but a slowness in starting the stream of urine ; then he feels a burning or cutting pain during the flow. As soon as the shape and consistence of the prostate are altered, the finger in the rectum finds the pros- tate irregular, perhaps larger than natural, tender, particularly at the posterior part near the trigone. The disposition of these irregular thickenings is variable. When cystitis is developed, copious viscid pus, mixed with shreds and blood-clot, form the urinary sediment, and the urine contains albumen in considerable quantity. The further progress of the case is accompanied by gradual participation of the ureters and kidneys in the septic in- flammation, and the patient is gradually exhausted. Acute gen- eral tuberculosis may terminate his sufferings. The ages of the patients usually range between nineteen and forty years. Numerous BACTERICIDES. 1051 and highly instructive cases of advanced disease have been de- tected by the cystoscope, in which the surface was irregular, with pits at the uvula vesicae or neighboring part of the floor of the blad- der, partly filled with shreds of tissue, muco-pus, and blood-clot, though in those cases cystitis, ulceration, burrowing abscess in the floor and walls of the bladder are usually superadded before death. ■The differential diagnosis of tubercle in the prostate. In early cases the presence of tubercle elsewhere may be wanting, as the prostate is often affected before other organs. The disease most commonly suspected when tubercle is irritating the prostate is stone in the bladder. The urine is at first only moderately tur- bid in both. In prostatic tubercle there is often a gleet or history of such having continued since an attack of gonorrhea; a little shreddy mucus may be washed out with the first portion of urine voided, the remainder being only slightly turbid. In stone, on the other hand, a drop of blood often comes at the end of the stream, instead of pus at the beginning. When blood comes from the prostate, it is usually washed out first as coagula mixed with curdy pus. If the patient be sounded, and stone be there, it can be generally detected. Sounding does not always discover any alteration in the shape of the prostate or trigone, unless the tuberculous disease be far advanced. The distinction of vesicle tumor from prostatic tubercle is so great that confusion is not likely to occur. Tuberculous pyelo-nephritis creates symptoms which often suggest disease of the neck of the bladder. In these cases the absence of change in the condition of the prostate and the presence of tenderness in the renal regions indicate the real seat of the disease. The treatment of tuberculous prostatitis.— In the early stages the catarrh must be cured, and the general treatment for tubercle ap- plied. In the later stages, the ragged cavities must be carefully washed out. A good antiseptic solution is two grains to the ounce of sulphate of quinine, two ounces being injected and left in the bladder after the pus and urine are well cleared out by re- peated small injections of boric-acid solution. Still more anti- septic is an emulsion of iodoform. In cases of chronic cystitis, if the bladder, is well washed out, and a couple of drachms of this emulsion injected, the most fetid-ammoniacal urine is replaced by acid urine ; fetor disappears, and the pus rapidly diminishes. Again, in cases of cystitis caused by neglect of prostatic reten- tion, the urine in ten days becomes quite free from deposit, and even when calculus, or tumor, or malignant ulceration coexists, the improvement is enormous. Tubercular deposits, nodules, ulcers, on the floor of the bladder are readily made out by the use of the cystoscope. 3052 DISEASE GERMS. Cases might be cited, in which the various coats were literally eaten with the bacilli. These were cured by washing out the blad- der, and then injecting iodoform emulsion, so that in a fortnight the patient—a man with advancing pulmonary tubercle—was cured of his bladder trouble. When the pain of washing the bladder is severe, cocaine previously injected often renders the operation bearable. When things are too far gone for this, ether should be given while the bladder is thoroughly washed with a large silver catheter, and Clover's extracting bottle, then a drachm of iodoform emulsion is injected and left in. The subsequent washings may then be carried out with very little suffering. The formula for the emulsion is—iodoform, two parts ; mucilage, four parts ; glycerine, two parts ; water, twenty parts. The microbe of tubercle when The Bacillus Tubercle in the blood has a great affinity to in the Testes. deposit itself in weakened parts and • there breed, but of all structures in the body the parotid gland and testes are decidedly favorable locations. Masturbation, sexual excesses, gonorrhea, stricture, sexual in- compatibility, are common causes, which damage the testes, and afford a location for the germ to run in ; once there, the tendency is to cause a general infection before suppuration takes place. A resection of the tubercular deposit in the epididymitis at the earliest possible moment is advised, but this is really unnecessary in the face of such valuable remedies as we now possess for the destruction of tubercle. The tubercular microbe, when The Tubercular Bacillus the blood is over-crowded with in the Eye and Ear. the germ, often appears in the eye, in and upon the conjunctiva and cornea. (See Tubercular Ophthalmia) The microbe can be isolated from the serous discharge from the eye. The ear is still more obnoxious to inflammation of a tuber- cular kind than the eye. It is very doubtful if we can isolate any one case of otitis media or otorrhea without the germ of pus and tubercle. In otitis, from the micrococci of scarlatina, running up the eustachian tube to the inner ear, this germ is present; in per- foration of the membrana tympani, and in all forms of dis- charges from the outer ear, this microbe is present. Such cases even existing for years, should be placed upon the usual bactericide treatment of tuberculosis. BACTERICIDES. »053 The Tubercular Bacilli in the Skin and Mucous Membrane. The microbe of tubercle in ter- ribly broken-down cases, often appears upon the skin as well as the mucous membrane of the mouth. disease appears with the some mysterious manner into round or crescentic Almost every variety of cutaneous germ, but the pathogenic bacillus in has the ascendancy and runs them forms, even erythemia, roseola, lichen, lepra ; psoriasis all appear- in circles, and may be called any name corresponding to the nomenclature of skin disease. The bacilli can be isolated by scraping off the surface of the ulcer. The bacilli are short, straight, or curved rods, with irregular, undulating and slightly notched contours, of a deep blue color, and contain from two to four spores. They are never free, but are invariably included in wandering cells, in groups of from two to nine. The cells themselves are rarely found at the centre of the infiltration, but exist in pretty large numbers at its edges, and in the adjacent apparently healthy tissues. Lustgarten has also demonstrated the presence of these bacilli in the spinous cells of the rete Malpighi in papular eruptions, through which he explains the clinical fact that moist papules become contagious when they are deprived of their epithelial investment. The Bacilli of Tubercle in the Skin.— Individuals possessing the tubercular diathesis are lia- ble at all times, if any weakness be induced (either by a mechan- ical or chemical irritant) in any part of the skin, to have the bacilli effused from the blood in the devitalized part. A dam- aged part is a vulnerable one for germ deposit, spore breeding. The annexed diagram is a photograph of a tubercular infil- tration following a burn on the elbow, which healed kindly un- der ordinary remedies, but a lew months later became a tu- bercular colony of great growth. The germs are seen in indolent, circular or oval superficial patches, having caused some loss of substance, which is covered by crusts of tubercle. Here and there throughout its centre could be seen dissemin- ated miliary nodules, transparent or of a light yellow color. -m ■5^ \ *&*-„ The tubercular bacilli actively breeding on the cutaneous surface above and below jj the elbow. 1054 DISEASE GERMS. Such an incrustation is not common, but when met with can only be cured by the destruction of the bacilli of tubercle. So far the glycerite of ozone is the only remedy that will kill the o-erm and prevent its reproduction by a fresh degradation of living matter. It is our best germicide in tuberculosis, and superior to all known remedies, except the glycerite of kepha- line or tincture of oats in constructing a dilapidated brain. The very fact that it "^^%'rl%^'■'$$}?'' contains a very large percentage of com- J'^i^f^S^^^- pound hypophosphite of lime, soda, iron ^\^'^^^u^'"^ m a ^ne state °f subdivision, ready for 'd j?>$i*^:"?[ty»^f assimilation, renders it invaluable as a The bacillus of tubercle mag- constructor of shattered nerve force. nificd 950 diameters, from Ozone tablets might also be adminis- the above arm. 111 tered so as to cause the dead germs to exfoliate rapidly. Locally to the germ colony on the arm, a lotion of the per- oxide of hydrogen should be applied over night, and the oil of boroglyceride during the day. Other remedies, as thymol, ichthyol, ozone ointment, ozonized sulphur water are of utility. The general management of a case of tuberculosis should be enforced. The nails also may suffer onychia maligna, the matrix of a single nail may be infiltrated by the bacillus, or several, or all, and the severity of the case will depend upon the amount of germs present; in every case there is inflammation, which begins under the free edge of the nail; the pain increases so that sleep is disturbed; the part is red and the nail-bed swollen ; an ulcer develops that creeps along the side of the nail till it reaches the lunula or root, and at last the nail falls off. The ulcer is usually covered with bloody pus, and resembles a diphtheritic ulcer without its phagedenic character. The ulcer remains stationary for an indefinite time in spite of in- ternal and external treatment; it may be for three or more years; without attacking the periosteum and bone, or spreading beyond the ungual phalanx." The treatment should be active, glycerite of ozone and saxi- fraga ; locally bactericides, solutions of boroglyceride, creolin, sozoidol; build up the constitution of the patient by every possi- ble means. In the mouth, the bacillus tubercular appears in round, scooped out ulcers [tubercular aphtha), in deep ragged, eating ulcers (tubercular stomatitis). Such cases are pre-eminently contagious and infectious, each BACTERICIDES. 1055 ulcer, however small, contains millions of cocci, oidium albicans and the bacillus tubercular. These are readily seen by micro- scopes of low power, indeed the bacillus can be seen in the centre, in the form of cheesy flakes. In the treatment of such cases every possible means must be taken to improve the general health of the patient, the most liberal diet, fresh air of the country, salt-water bathing and mouth bactericides. The gums, cheek, tongue, throat must be washed out or gargled with lotions of boroglyceride three times a day, and also before eating, and then pickled down in either resorcin or thymol, or naphthaline, or creolin jelly. The microbe of tuberculosis lodges Tubercular Bacilli frequently in the bones and produces in the Bone. great havoc, ulceration (necrosis or caries). In these circumstances, the medulla contained in the cancellous tissue of the bone undergoes fatty degeneration, and, as in other parts of the body, this de- generated tissue disintegrates, and so cavities are formed in the head of the femur, containing a quantity of oily matter and bone-earth. It is this bone-earth or grit that sets up, not only a rarefying ostitis, but also the formation of the florid granulations characteristic of caries. The same changes occur as a conse- quence of tuberculosis of the medulla. On making a microscopic examination of a bone affected with tuberculosis in its early stages, we find nodules composed of an aggregation of round cells (among which are usually one or more giant-cells), which compress and so occlude the vessels in the affected area; but the blood-channels surrounding the nodule and the spaces through which the round cells escape are choked with corpuscles. With the exception of increased cell-growth from the brood-cells, the surrounding tissues appear healthy. I have already referred to the changes which occur in the tubercles, the caseous degeneration of which, in the greater number of cases, ends in destruction, not only of the osseous tissue, but also of the joints, and the soft parts in their proximity. Symptoms.—There can be no question as to the fact that tuber- culosis of bone is in its early stages easy of cure, but most diffi- cult to recognize; in the course of time, however, there is no difficulty as to our diagnosis; but the cure of the disease is a'most impossible without extensive damage to the affected tissues. It requires no stretch of imagination to understand that the pro- duction of cell growth in a structure like the medulla, only sparingly supplied with nerves, may progress to a considerable 1056 DISEASE GERMS. extent without causing pain. There is one symptom, however, referable to nerve-irritation, almost always present in cases of this kind; and that is a certain amount of stiffness in the mus- cles surrounding the diseased bone. This is especially the case in tuberculosis of the bodies of the vertebrae and of the hip-joint. The stiff back or neck, and the occasional days of stumbling in the early stages of morbus coxarius are well known, but too often disregarded symptoms of diseased bone. From the com- mencement of tubercular disease of the medulla, however, imme- diate and forcible pressure on the bone generally causes marked pain; otherwise, the pain is often felt at the distribution of one of the nerves connected with the diseased bone or joint. Subse- quently, the pain becomes more marked, and is greatly increased if the diseased part be moved or jarred; suppuration occurs, and sinuses form leading to dead bone, with all the long-continued and well-known consequences. Treatment.—We must bear in mind the fact that, supposing the exciting cause of tubercle be a bacillus, it is certain that an hereditary predisposition, and other recognized circumstances, prepare the soil in which any such influence can take root and. grow. Pure air, sunlight, and plenty of wholesome food, are essential to the building up, or fortifying tissues against the action of any causes which provoke the growth of tubercles. If tuber- cles have formed in the bone, means tending to invigorate the patient's health must be enforced, and at the same time the dis- eased tissue should be protected from concussion or injury. Rest to the diseased bone is useful, and it should be employed so as to relieve pain caused by the pressure of the extremities of tender parts against one another. But, in my opinion, it is a mis- take to suppose that rest or confinement to a couch or bed for. weeks and months, particularly in young children, is a judicious method of treating cases of this kind, especially in the early stages of the disease. I am convinced that the actual cautery, applied judiciously, near the seat of the disease, and repeated if necessary, is of great service in many of these cases. In more advanced instances, good hygienic conditions, great patience on the part of the patient, his friends, and the medical attendant, and the removal of diseased bone, together with free drainage,. will bring about results more favorable than could otherwise be attained. Superiosteal excision of the diseased extremities of the bones is sometimes attended with most favorable results. Internally, comp. saxifraga and phytolacca should be adminis- tered alternately; the small but active quantity of iodide of pot- ass, which they contain, rouses up the vital energies which throw off the microbe, while at the same time, kephaline, avena sativa, aid in the reconstruction of osseous tissue. BACTERICIDES. 1057 Tubercular bacilli in the various Tubercular Bacilli in bones of the body, or, as it is termed, Bone. rickets, is one of the most common [Rickets.) diseases of children, and it is an affec- tion, with regard to its etiology, na- ture, and treatment, of which we know too little. The manifes- tations which attract attention are the intense tubercular habit, the malformation of bones, due to the bacillus eating up their os- teogenetic tissue, and deposition of lime salts—the presence of the bacillus in the blood being the cause of the osseous lesion. Rickets may be defined as a chronic tubercular disease in chil- dren, which deprives growing bones of their nutrition, accompa- nied by functional disturbances of various organs, more especially the nervous, respiratory, and digestive organs. The age at which rickets commences during the first three years of life varies considerably, but almost all statistics place the age whe.i the greatest number of cases come under notice as from twelve to eighteen months, and the next most frequent as from six to twelve months ; or taken in years about forty-seven per cent, come under observation during the first year of life, and forty-two per cent, during the second year, after which the numbers rapidly decrease. There seems also good reason to brieve that rickets may run its course during fcetal life, the dis- ease having ceased when the children are born (fcetal rickets), while the existence of congenital rickets, i. e., of children born suffering from the disease, is generally admitted. In all large cities, with adulterated food and insanitary condi- tions, it is generally admitted that about ten per cent, of all the children are affected. The bacillus of tubercle strikes at the nutrition of bone; it may affect different organs, although not always to the same ex- tent. There is invariably an increase in the number of the white corpuscles of the blood. Excessive sweating of the head is a typical symptom of tuber- culosis, due to an irritation of the nerves by the ptomaines of the bacillus; the febrile exacerbations, the general irritability, the restlessness at night, together with the skin eruptions, all indi- cate an irritation of the central nervous system by either the microbe or its ptomaine. It is this same irritation which gives rise to the occurrence of laryngismus stridulus, which is gener- ally associated with rickets, and more especially with cranio- tabes. Other causes will produce this laryngeal spasm. (1) Pres- sure on the brain through the soft cranial bones ; (2) reflex from ^e digestive tract; (3) anaemia of the brain in rickety children ; 67 1058 DISEASE GERMS. (4) the presence of noxious substances in the circulating blood, ir- ritating the vagus centre. All tubercular children suffer from disturbances of the digestive apparatus. These vary in severity from slight dyspepsia to severe gastro-intestinal catarrh, anomalies of dentition. The frequency with which the various parts of the skeleton are affected varies with the age of the patient, in children below six months the bones of the skull being most frequently attacked, while in the following six months the thorax is the chief seat of the disease, the rule apparently being that the bones in which growth is most rapid (these varying with the age of the patient) are most readily and markedly affected. As regards the anoma- lies in dentition, dentition is delayed, the teeth erupt irregularly, and not in groups, as is normally the case, and they are not so good as in healthy children. The presence of the tubercular bacilli in the blood is the pri- mary cause of rickets, derangements of the digestive organs; erroneous feeding, excess of farinaceous food, and other lowering conditions tend to increase it. No doubt, imperfect aeration of the blood, due to living in badly ventilated apartments, has much to do with it. In support of this view we would remark that this disease is extremely rare in warm climates, and chiefly occurs where, owing to the cold climate, there is much in-door life, or in crowded cities where the general hygienic conditions are bad. That it is not merely a question of bad feeding or poverty is also shown by the fact that it is very rare in gypsy children. Further, the number of cases of rickets is much greater in spring, after a winter spent in-doors, than in autumn, after a summer spent out of doors. Result of imperfect aeration of the blood—carbonic acid and water accumulate in it and in the juices of the body gen- erally. Further, as the result of the imperfect oxidation, numer- ous by-products accumulate in the blood, and it is these pro- ducts and the excess of carbonic acid that lead to the irritation of the central nervous system, with the consequent symptoms. A similar irritation is also exerted on the ossifying bone, leading to increase in the amount of new material, while by these products the alkalinity of the blood is diminished, and thus the lime in it enters into combination, and its deposit in the bone is prevented. Rickets is a bone disease, dependent upon the presence of the tubercular bacillus in the blood. Either the microbe or its pto- maine, or some unknown irritant acting on the bone, leads to in- complete deposit of lime salts in place of true ossification ; to the formation of an incomplete form of bone, devoid of lime, and to increased absorption of already existing bone. BACTERICIDES. IO59 The real essence of rickets consists in a tubercular diathesis the germ giving rise to inflammatory hyperaemia, and increased new formation of vessels in the osteogenitic tissue, the ptomaine of the germ, a chemical irritant ending in the softening. Rickets, then, is a name applied to the presence of the tubercle bacilli in bone. The disease may appear at birth ; most generally the impair- ment begins between the fourth and twelfth month. Most commonly the rickety condition is not noticed until the child begins to walk, or is affected by his first teething. appeared in the first year. second year. " third year. " fourth year. " fifth year. " sixth year. Of these 147 were males and 196 were females. At first the most ordinary symptoms are those which indicate irritation of the intestinal canal; there may be diarrhea alternately with con- stipation, enlargement of the abdomen and more or less emacia- tion. The child is dull and languid, peevish and fretful; the appetite is bad, and the sleep disturbed at night. If it tries to walk it is "taken off its legs ; " it is thirsty and will drink plenty of water; it has pain in the bones ; a pale face and flabby skin ; the hair on the head is thin, and blue veins marble the surface by their prominence; the fontanelle remains open. In the next stage there are three symptoms to be chiefly noticed. (1) A profuse perspiration of the head, neck, and upper part of chest. This sweating is worse at night, beads of sweat may be noticed on the head, while the lower part of the body is dry and hot. {2) There is a desire to kick the clothes off on the part of the child, as if with a wish to be cool; so that the little patient lies with its naked legs on the counterpane. (3) There is general tenderness, so that the child cries when it is moved about. The urine is thick, and deposits a pale sediment of phosphates on cooling. The next set of phenomena are those connected with the deformity of the skeleton. With the increasing paleness and flabbiness of the skin, the wrists and ankles enlarge, and the ends of the ribs are knuckled. The long bones of the extremi- ties, and chiefly those of the legs, begin to yield, not being strong enough to bear the weight of the child. The deformity is very great in some cases, and such children are called knock- kneed or bow-legged. The spine is curved forwards ; the head falls backwards, and the face looks upwards; lateral curvature of the spine is not so common, and with this curvature there is generally the deformity known as pigeon-breast. Of 343 collected cases 98 " 176 (< 35 " I9 " " 10 M 5 io6o DISEASE GERMS. The back is flattened, there is a hollow under the arm-pit, the ribs are pressed in and the breast-bone or sternum is more prominent than usual. At each inspiration the softened ribs are sucked in, and the space for the lungs and heart is much en- croached upon. In this way also the bones of the arms become distorted, and the more so if the child tries to support itself by its arms and hands. The forehead is square and projecting. The head is generally unusually large and the top flattened. The process of teething is generally delayed, and those that are through, decay and soon fall out. The bones forming the pel- vis are sometimes distorted, and add to the general mischief. Such children are generally of an inferior intellect, although sometimes thought by their mothers to be very precocious; this seems due to the fact that such patients are more in the society of their elders, and have an old-fashioned way about them, be- cause they cannot play with other children. After this the child may gradually get worse ; the emaciation goes on, the abdomen is more tumid, the softening of the bones, and the deformity in- creases, and generally disease of the liver, kidneys, or spleen comes on. Death may occur from bronchitis or congestion of the lungs, or from diarrhea, or from waxy degeneration of differ- ent internal organs, or from general dropsy. Children affected with rickets are liable to attacks of spasmodic croup, convulsions, and chronic hydrocephalus. So death may end a life, which to the unfortunate child has been one of unabated misery. Yet many cases do recover and grow up to adult life, but the de- formity remains, and they are never so healthy as other people. The favorable symptoms will be, an increase in weight, an ani- mated expression, and less pain in the limb; the pulse is less frequent, and the stools not so pale; the urine will return to its natural color, and the appetite is more natural. The growth of the limbs then goes on with great rapidity, and the muscles ac- quire a powerful development. Many of the dwarfs are examples of recovery from rickets ; they may possess plenty of strength in spite of their deformity; they are generally irritable and sulky, keeping aloof from their fellow-creatures, in consequence of their misfortune, being the subject of derision and mockery by their more fortunate brethren. The sooner the disease comes on after birth, the more likely is it to be fatal; as a rule, if the disease be not far advanced, and if the deformity have not much affected the spine and chest, a favorable result may be looked for. Treatment.—Improvement of the general health is the first i thing to be sought after. The child should be placed in a warm and dry atmosphere, with due ventilation and pure air. The greatest possible attention paid to bathing. These twice a day BACTERICIDES. I06l baths should consist of bactericides ; iodine, glucozone, p;ne, etc.; clothing flannel. The very best of diet, including malted milk sterilized. General treatment for the annihilation, and preventing the evolution of the bacillus. The conclusions arrived at by the most profound bacteriolo- gists in the United States, are that in the glycerite of kephaline and ozone; in the tincture of oats, and glucozone, in the treat- ment of rachitis, we find remedies giving the most brilliant re- sults. Not only afford amelioration, but are curative and pre- ventive. Whenever the tubercular bacilli Tubercle Bacilli exists in the blood of children, all in the the tissues, glands, bones of the body Vertebral Column, are weak, deficient in their natural ele- ments. This is esoecially true of the vertebrae which possess this inherent weakness in a high degree, rendering it soft and flexible. A child possessing this tubercular organization, placed in some avocation which causes the muscles on one side to become unduly developed and powerful, such as the habitual use of the right arm in a dressmaker or black- smith; constant assumption of an unnatural attitude, or in hitching one shoulder in wearing a low-necked dress; nurses or mothers carrying children always on one arm ; repeated standing on right leg, left knee bent; a tubercular diathesis, in which the the muscles are weak, relaxed, flabby, or where there is a predis- position to rickets, or a deficiency of earthy salts in the bones, so that there results a loss of equilibrium between the resistance of spinal column and weight of upper part of the body where the vertebrae are soft, spongy; rickety diathesis strong, even amount- ing to inflammation, ulceration, or caries of the vertebrae or their inter-vertebral spaces. There are three varieties: Lateral curvature, the convexity being to one side, usually the right. Posterior curvature, or excurvation. Anterior curvature, or incurvation. 1. Lateral Curvature.—This is the most common form. Ap- pears chiefly in young girls from four to eighteen years of age, of a weak, tubercular habit, whose bones and muscles are defi- cient in vital elements ; who have been nursed and pampered, not supplied with the proper kind of food, nor had abundance of 1062 DISEASE GERMS. sunlight, or sufficient amount of exercise in open air; and where there has been an inattention to a natural position in standing or walking, or in wearing low-necked dresses, or high-heeled gaiters, corsets and tight-lacing. Its recurrence is much favored by myopia, which is so prolific in our large school-houses from over-crowding and forced strains of the eyes, which leads to a constrained position in writing, walking or in ordinary duties. Symptoms.—One shoulder is observed to be higher than the other, with a growing-out of the scapula. While one shoulder is high, the other is unduly depressed. So one hip projects, while the opposite curves inwards. On an examination, the ver- tebral column is found to be curved; in double lateral curvature it is twisted like the letter S. As the thoracic and abdominal cavities are more or less depressed, the movement of the lungs and heart are interfered with, and the play or peristaltic action of bowels, liver, uterus are impeded. The general health suffers greatly; difficulty of breathing, dyspeptic and other indications of derangement; pain in side from pressure exerted on the nerves. If it is dependent directly on a rickety diathesis, there are the usual cachexia and distortion of the limbs. In the treatment we must bear in mind that the bones which form it are made almost entirely of the spongy or cancellous tissue, and for that reason are specially liable to disease, which sometimes burrows a good distance into the bone before any one, not even the owner of the spine, guesses what is going on. Another trouble to which the spine is liable is curvature, which usually appears first between the ages of twelve and eighteen, just when delicate girls are grow- ing very fast, and probably out-growing their strength. It is very unfortunate that in these cases the spine does not keep pace with the other parts of the body; the head and chest grow, the shoulders broaden, but the strength of the spine does not increase fast enough to bear this extra weight, and so it bends. It is as if you were to try and balance a heavy stone on the end of a thin stick; the stick would bend, and the spine does just the same and for the same reason. There is no real disease, simply the bacillus, which gives rise to weakness, and this trouble is usually laid upon girls; about nine cases of it in girls to one in boys. And another thing is, it is usually due to the occupations followed by girls,'as distinct from that followed by boys, and besides, a boy will go and join some healthy game after his work is over. That there need be little, if any, difference between most men and women, in the matter of muscular strength, is proved by what goes on amongst some barbarous tribes, where the men BACTERICIDES. IO63 lead idle lives, and the women do all the work and carry the heavy weights, and their muscles grow very strong; and you certainly will not find spinal curvature amongst them; that is a trouble of civilized life. You must clearly understand that curvature of the spine is due to tubercle, and is entirely the fault of a child's up-bringing, and her friends do her a grievous harm if they do not take measures in time to correct it, for in time it crushes the other organs in the body, and may shorten life. What ought to be attempted is: (1) to feed the child better; (2) to give her as much fresh air as you can possibly get for her; (3) not to let her sit up at a table or any work for many hours together without support to her back, but place her in a chair with a back, and prop her up well with pillows, so that the poor weak back does not get over-tired and yield; (4) if you can possibly avoid it, do not choose for a delicate over-grown girl work at which she must sit bolt upright, or in a stooping position; (5) whenever she can do so let her lie on a couch; (6) if she is short-sighted take her to the eye department and get her spectacles. A child with spinal mischief will have a sharp pain in the back if it jumps off ever so little a height, and if this happens once he will not be in a hurry to do it again, but you will notice that he moves about carefully, and will not hurry himself, and have the sprightliness of a healthy child. The position which a child will choose as the most comfortable in spinal disease should also warn an experienced eye: he will lean forward, and often grasp the thighs very firmly—a position very much like that which boys assume when playing leap-frog. Of course the child finds this position the least painful because, to some extent, it takes the weight of the body off the diseased spinal bones and throws it on the upper part of the legs. Another point to remember is that a child will often, when the disease has attacked the upper part of the spinal bones, complain of pain at the back of the head. Of course this may be merely a headache, but if it is repeated often this warning must not be overlooked. Again, if the disease is in the upper part of the spine, the child's neck may be stiff, so that when he wants to turn his head he will turn all his body round, and to look up- wards he will bend the lower part of his back, and also a child will often make a habit of resting his chin on the top of the breast-bone, or of supporting it on the hand. Children with dis- ease of the spine will lose flesh. The diet therefore should be generous, consisting of animal food, milk, eggs, boiled white-fish, oatmeal, corn cake. The remedies used internally should consist of glycerite of ozone to annihilate the tubercular germ; glycerite of kephaline 1064 DISEASE GERMS. and tincture of oats ; comp. tincture matricaria to stimulate an appetite. When not exercising for the benefit of her health, the recum- bent posture, with head low. Once, twice, or even thrice daily, strengthen the muscles of the back with vitalized massage; follow with either a stimulating liniment or faradization. Clothing should be light but warm, so that there be as little weight on vertebrae as possible. Unless the case is bad, can be better treated more successfully without than with an apparatus. Posterior curvature prevails among the same class of children, and chiefly affects the cervical and dorsal regions. It is caused in infancy by the frequent practice of mothers and nurses, in raising the child, by placing their hands under the arm pits, and so compressing the ribs, and forcing back the sternum and spine. Under this common custom, the muscles and ligaments, which keep the vertebrae erect, become weakened and relaxed. In other cases it may depend on rickets. Anterior curvature, the tubercular bacilli are literally swarming in the blood, the nervous system is bankrupt, and the bacilli are being evolved in myriads ; all the bones of the body are soft, spongy, devoid of vital stamina, tubercular deposit, evolution of spores, germs, inflammation, destructive ulceration, caries of the bodies of the vertebrae; the intervertrebral spaces tumble in, owing to interstitial softening, and absorption of calcareous ele- ment of bony tissue. As the bodies are destroyed or absorbed, ; the spine projects backward, forming an angle. In bad cases, where the tuberculosis is very aggravated, as many as five or six vertebrae may be implicated, with their intervertebral spaces. It is most frequently met with at the middle of the dorsal vertebrae. Symptoms.—Intense tubercular diatheris ; weakness; coldness; numbness of legs, with twitching and spasm. Subsequently, paraplegia, with paralysis of bladder and rectum ; tenderness, or dull, aching pain in back; tightness of chest, with more or less difficulty of breathing; rigors; formation of abscess in back, the pus of which finds its way along the course of the psoas muscle in the groin ; exhaustion, sweats, hectic. Under favorable treat- ment, the disease gets arrested; bones collapse; anchylosis occurs ; patient recovering with incurable deformity. Sometimes sudden death, owing to diseased bodies of the vertebrae giving way and crushing the spinal cord, or from discoloration, with ulceration and destruction of its ligaments. In the treatment push the bactericide treatment of tuberculosis as far as practical. Perfect rest in the recumbent position is in- dispensably requisite; the use of a reclining couch, so shaped as BACTERICIDES. IO65 to keep the trunk perfectly quiet; a stiff bandage of paraffine, extending from the occiput to hips, to insure rest; no attempt to be made to rectify the deformity; pain to be relieved. As soon as the streptococcus pyogenes appears, the abscess should be aspirated and a few drops of peroxide of hydrogen in- jected. For mechanical support, the best application in all cases is a paraffine jacket, made after the manner of the plaster of Paris bandage. To make this jacket, take a large sheet of cotton- wool, long enough to reach from the nape of neck to beyond the buttocks. The thickness of the sheet is sufficient, but if the physician desires to have it thicker, he can double it or use two. It is then to be submerged in the liquid paraffine for five minutes. Have the patient in a nude condition, in the precise position in which it is desired to be retained; then turn out the cotton, saturated with the paraffine, on a piece of oil-cloth, or any smooth body, oiled to prevent it adhering; spread it out to its original size; and after it has cooled sufficient so that you can place the back of the hand on it without inconvenience, it is ready for applying to the back. This cooling process will occupy three or four minutes. The sheet of cotton, so saturated, is applied to the back, from neck to hips, and well round the body. Its adaptability is perfect, filling every curve or crease. Then apply a bandage over all, pressing the cotton firmly. This pressure causes a cohesion of the cotton and paraffine. Then have a piece of ice handy, which will cause the paraffine to be- come as hard as a block of marble. If it is desirable to prevent the hardening, refrain from applying the ice; the paraffine in that case will take at least twenty minutes to cool. Spina bifida, or cleft spine, is also due to the presence of the tubercular bacilli in -the vertebrae during fcetal life, which gives rise to an arrest ot development or growth of the posterior arches of one or more vertebral bones: the membranes which loosely envelop the spinal cord become distended with fluid, and are bulged out through the tissues in the walls of the canal, and form under the skin a soft and rounded tumor. When the mal- formation affects several of the vertebral bones the base of this tumor is broad, but when only one or two of the arches are defi- cient, or merely fissured, there is more or less of a pedicle or stalk. The size, conformation, and appearance of the tumor, and the symptoms caused by the malformation, differ very much in different cases. The state of things is usually as follows: in the lumbar region, just above the sacrum, and in the middle line of the back, is a large fluctuating and rounded tumor, evidently containing fluid, and the surface of which is covered by thin and io66 DISEASE GERMS. distended skin. At the base of this tumor a fissure, or large hole, can generally be felt in the posterior part of the spinal col- umn. When the child is placed upon its belly the tumor shrinks to a slight extent, and the skin becomes flaccid; in the erect position of the child the . tumor swells and the skin becomes stretched and smooth. As the child grows, serious nervous symptoms, such as convulsions and palsy of the lower extremi- ties, make their appearance. In most cases spina bifida termi- nates fatally, and the patient dies in convulsions, which in some instances are immediately preceded by giving way of the walls of the tumor. The affection, however, does not always cause death; several cases have been recorded in which the patient at- tained an advanced age without suffering any ill effects from the tumor, which continued to grow, though not out of proportion to the rest of the body. A more favorable and occasional termi- nation of cases of this kind is a closure, through adhesive inflam- mation, of the walls of the orifice between the spinal canal and the tumor. A closed and comparatively harmless cyst is thus formed, which is called a false spina bifida. The walls of the tumor formed in cases of spina bifida are composed of the skin and extended membranes of the cord, and sometimes a portion of the cord itself spreads out into a thin membrane. The con- tents of the tumor are a thin clear fluid, a portion of the cord and some of the spinal nerves. In consequence of the close connection between the tumor in spina bifida and the contents of the spinal canal, all surgical at- tempts at a radical cure of this affection are extremely hazardous. The too frequent result of such interference is acute inflamma- tion of the cord and its membranes, causing convulsions, palsy, and finally death. Symptoms.—A tumor, varying in size from a walnut to a child's head. There is fluctuation, swelling, most tense when the child is in erect posture. The tumor may be transparent, or the skin may be unaffected, or it may be congested, purple, or blue. If only one or more lumbar vertebrae are affected, spinal cord does not deviate from its course, and only the pos- terior spinal nerves have any connection with the sac. If the tumor occupy part of the lumbar and part of the sacral region, the cord itself, and all its nerves will almost always be found in close contact with the sac. Not necessarily fatal, but likely to be if there is hydrocephalus, or paralysis of the bladder or rec- tum and lower extremities, or if the tumor bursts. The general treatment for tuberculosis should be pushed with care and energy. The glycerite of kephaline, tincture of oats, salt water and iodine baths; most nutritious diet, avoiding BACTERICIDES IO67 starch. Every means which the nature of the case will admit of for to overcome the tubercular condition. To prevent further protrusion, a compress of some kind might be applied with great care. The collection of cerebro-spinal fluid is first due to the want of the normal support of the vertebrae; its increase due to the irritation and unravelling of the serous fibres, causing exudation. The collection is termed hydrorachitis. Irritation, shocks to the cartilagi- Tubercular Bacilli nous extremities of the ends of bones, in the from falls, jumping, or other mechani- Hip-Joint. cal irritation, depreciate the nerve [Coxalgia) centres, liable, if the tubercular condi- tion does not exist, to create it. The knee, hip, and wrist, are most obnoxious to the, ingress of that bacillus. The greater tendency for the germ to appear in those three joints, is accounted for by the presence of pink mar- row in the concellous structure, which dischrages the function of ordinary lymphatic gland, namely the elevation of the blood discs; so that when weakened in any way, they become invaded with myriads of the bacilli. Most common among children between the ages of seven and fourteen; met with up to thirty years age; boys, from their stir- ring habits, are its victims. The first symptom which is observed in the child, is the dragging of the affected limb after the sound one, a flattening of the nates; pain at first confined to the knee, and in standing, the patient advances the foot a little, slightly everting the toes, and does not rest his weight upon it. After a while pain comes on in the hip-joint itself, and generally conntinues chronic for sev- eral months. At length the symptoms may disappear, and be- come far more serious; thus the affected limb becomes shorter than the sound one, the motion in the joint being impaired or destroyed, and permanent dislocation taking place. To assist in making an early diagnosis, a careful study should be made in a difficult and doubtful case of those limitations in the motions of the joint which become apparent only when the extremes of normal motion are approached. This may be done m various ways. I have found two methods easy in practice and certain in revelations. The first method applies to rotation, which is a direction in which limitation of motion first takes place. Let the patient lie supine with the feet slightly apart. With the hand placed lightly on the knee of the unsuspected io68 DISEASE GERMS. limb, a rocking or oscillating motion is given to the whole limb, outward and inward rotation following each other, while the toe sweeps through an arc of nearly 1800, the inner border of the foot striking the table, and the outer border nearly reaching that level. This occurs in the sound limb. A similar manipulation of the suspected limb may reveal a slight limitation of rotation, the result of hip disease. The other simple procedure relates to flexion. Let the patient, still on the table, sit up and kiss the knee. By flexing the neck and back, and drawing the limb up with the hands, this can be easily done with the unaffected limb, while an attempt to do it with the suspected limb may reveal a slight limitation of flexion indicative of incipient hip disease. Another diagnostic sign, too little thought of, perhaps, but of importance in the very early stage, a brawny thickening about the joint in front of the capsule or behind the trochanter. There will in some cases be found a condensation of the soft tissues, due apparently to the vicinity of osteitis, not visible perhaps, but recognizable by palpation or pinching with the thumb and finger, and then often not detected except by comparing the two sides. It will be found that a smaller pinch of the skin and un- derlying tissues can be made on the sound than on the affected side. These tests are to be used, of course, in connection with other diagnostic helps, and with due regard to other conditions which have the power to produce similar phenomena. Properly used they may betray the presence of hip disease in a patient entirely free from pain and lameness at the time of the examina- tion. Later on, the bacillus destroys the cartilage lining, the ace- tabulum, and covering the head of the femur ; the microbe of pus puts in appearance, and forms large masses in the cavity of the joint, ptomaines are excreted by both germs, hectic appears, and if nature or art does not effect an opening into the joint, the pa- tient may die or recover with anchylosed joint and a wasted use- less limb. The treatment in the earliest stage consists in maintaining the limb at perfect rest (the patient in the recumbent posture), in a straight position, which is best effected by putting on the limb a counter extension apparatus, and placing two sand bags, one on each side of the limb, the external one reaching as high as the arm-pit. Local stimulation over the germ-infiltrated tissues, with powerful bactericides, the irritating plaster; if sinuses form, run them in one, and use injections of peroxide of hydrogen, somewhat diluted, into and around the joint cavity; otherwise general treatment for tuberculosis. Aspiration of the joint, and injecting eight vol. peroxide has been tried with success. BACTERICIDES. I069 Tubercular Bacilli in the Knee-joint. [White Swelling) The knee-joint is the largest in the body, and is composed of three bones ; the thigh-bone (femur); shin- bone (tibia), and knee-cap (patella). These bones are held together by a great number of strong ligaments, and the movements of the joint are controlled by numerous muscles. Like all movable joints, the articular surfaces are covered over with cartilage, and a large and complex synovial membrane is insinuated between the structures forming the joint. A remarkable feature about the articulation, it has in common with one or two more in the body, viz., the inter-articular fibro-cartilages, or as they are here called semilunar; their office is to defend the joint from severe and sudden concussions, and their mechanism is so adjusted, they are always between the ends of the bones when, and at the point at which the greatest pressure is experienced. From the complex nature of this joint, their size, and exposed situation, it is obvious that it must come in for a large share of injury, and it is peculiarly subject to disease. The natural movements of which this joint is capable are flexion, extension, and partial rotation outwards and inwards. The tubercular diathesis is intense, the joint and all its struc- tures badly damaged, before the bacillus can enter. More common among children than adults. It commences with slight lameness, swelling of the joint, and from the pain or stiffness of the articulation, the muscles are not brought into play, and so waste and atrophy. The gtneral train of symptoms is as follows: Tubercular habit, some exciting irritation ; occasional pains in the joint, be- coming gradually worse; swelling so slight at fir>t that it is scarcely recognizable, gradually becomes a globular enlargement, owing to infiltration of the synovia with the bacilli, and latterly in and around the joint. If the disease proceeds unchecked the bacillus dies, and undergoes cheesy and calcareous degeneration, anchylosis, disor- ganization of the joint ensues. The same rule holds good with reference to the knee, as the hip ; the same pathology and germicide treatment. This illustration is a microscopical appearance from a •ymphatic in the groin of a patient, aged seventeen years, who The bacilli of tuvercle infiltrating one of the lymphatics of the groin. 1070 DISEASE GERMS. had suffered for eight months with tubercular synovitis of the knee joint. The patient was much emaciated, terribly anaemic and broken up in all the essentials of life. He was placed upon the glycerite of ozone in alternation with the concentrated tinc- ture of kurchicine in half teaspoonful doses, thrice daily. Improvement was perceptible the second day of treatment, which continued on for three months, when he was perfectly cured. The tubercular effusion in and around the joint was somewhat troublesome; ozonized clay effected most excellent results, but after using it about ten days lost its effect altogether; liquid ozone operated well; this was followed by iodol, which also did good work ; hot fomentation of wormwood, one ounce resorcin to the pint were efficient, iodized oil was most effective. The effusion of tubercle into the synovial fluid of the knee joint must not be confounded with enlargement of the bursa mucosa, situated in front of the patella, and of the tendon imme- diately below it. It is frequently noticed in those who have much kneeling, as household servants, carpenters, plumbers, carpet-layers, etc. Enlarged bursas of the patella are frequently attacked by inflammation and suppuration, and usually there is extensive inflammation of the surrounding cellular tissue. Some- times troublesome burrowing ulcers remain after these abscesses, : which are singularly obstinate, attended with fungus growths, the surrounding skin being dark and unhealthy, with deep burrow- ings under the integuments of the knee, and a foul offensive dis- ; charge. In severe instances the bone (patella) may become ne- ! crosed. The treatment consists in the first place of complete rest, and a well-fitting splint must be applied, and all motion of the joint prevented. If a recent enlargement, a stimulating lotion of acetic acid and hydrochlorate of ammonia, or a small blister, will often cause it to subside. If there is considerable thicken- ing, as there always is if the tumor has been of long duration, evacuation of the sac and subsequent counter-irritants will often effect a cure. Some surgeons use a seton, which is composed of a few threads of silk passed through the cyst, and by setting up suppuration and the consequent contraction and granulation the cavity becomes obliterated. When the tumor has become a solid, gristly mass, there is no other treatment th^n dissecting it completely out. In the cases most commonly ought under observation, rest, leeching, hot fomentations, ana ^ -gatives, and failing these a free incision, usually effect a cure. Efforts have been made, by various remedies, to cause a disin- tegration of the calcareous mass in and around the joint, either by the ozonized clay or dioxide of hydrogen, with electricity, but with no satisfactory results. BACTERICIDES. IO71 Next in order to the knee and hip- Tubercular Bacilli in joint comes the wrist, here the same the Wrist-Joint. microbes often lurk, and here the amount of lymph glands are numer- ous, pink marrow abundant, consequently the anaemia is great. Treatment same as in the other joints ; locally, try the ozonized clay, if suppuration has not taken place; or better still the gal- vanic cautery, followed with concentrated ozone; if suppuration has taken place remove matter by aspiration, and inject eight- vol. solution of peroxide to destroy the microbe. Curative treatment has chiefly been attempted by stomach medication, and by the local application of bactericides. Local destruction of the bacillus tubercle by inspiring bacteri- cides, has been effectual and is worthy of a trial, breathing the germicide it often strikes the germ. There are various forms in which remedies employed for inha- lation can be administered, and several methods by which their direct application can be accomplished. All inhalations may be divided into two principal groups—the moist and the dry. In the first group, or moist inhalations, we have— 1. Warm vapors arising from water heated to various degrees of temperature, and charged with medicinal substances properly prepared for vaporization. 2. Medicated spray, produced by mechanical force. In the second group, or dry inhalations, we have— [a) Gases or vapors produced by heat or chemical action, and mingled with the air. [b) Minutely divided solid substances, or impalpable powders. Each of these forms requires special apparatus for their pro- duction and administration, such as the inhaler, the atomizer, the evaporating dish, properly contrived syringes. For inhalation, important gases, as oxygen, chlorine, and nitrous oxide are of great utility. The use of oxygen is of utility—a valuable remedy in those cases of lung diseases which arise from imperfect decarboniza- tion of the blood. In some forms of asthma it is also exceed- ingly h 'ix-ficial, relieving the difficulty of breathing and restoring the patie."t to a healthy condition. It must, of course, be used with caution and only under proper professional advice. Chlorine also has been highly spoken of by many writers on con- sumption, and has been even supposed by some to cure every stage of this affection. Numerous physicians have mentioned several severe cases of consumption that were perfectly cured by 1072 DISEASE GERMS. this gas, and I am fully convinced that there are certain advanced stages of this disease in which its inhalation is extremely benefi- cial. In chronic catarrh, and those affections of the lungs and air-passages in which direct stimulation of the mucous membrane is advisable, this gas, properly diluted with atmospheric air, may be applied with the greatest advantage. Like all other forms of remedial agents it must be used with caution and judgment, and when it is so administered it is perfectly free from danger, un- pleasant sensation or inconvenience. This gas may be easily obtained by placing a teaspoonful of peroxide of manganese in an earthenware saucer, floating in a basin of boiling water, and pouring upon it about fifty drops of hydrochloric acid. This will disengage a sufficient quantity of the gas to medicate a room of moderate size. The fumes which arise will rapidly diffuse themselves through the atmosphere, and be inhaled in the natural act of respiration. It will be necessary to keep the doors and windows of the apartment closed during its use, and indeed, if possible, it is better to appropriate a small room for the purpose, into which the patient may go for a few minutes several times a day, otherwise it will be necessary to pre- pare the vapor freshly as required. Nitrous gas has also been found very effective in many forms of lung disease, its action upon the system doubtless depending in a great measure upon the amount of oxygen which it contains. This gas may be obtained by pouring about half an ounce of sulphuric acid into a saucer, and adding to it, at short intervals, small quantities of pure nitrate of potash. By this means the air of an apartment will be quickly charged with the gas. When judiciously applied it speedily relieves violent parox- ysms of coughing, soothes the irritation of the mucous mem- brane, and promotes expectoration. In ash ma and chronic bronchitis also it is very efficacious in overcoming the sense of oppression ot the chest and difficulty of breathing which always accompany these distressing complaints. The vapor of creosote may be obtained by mixing ten drops of this substance with half an ounce of water, and allowing it to evaporate in the fumigator and slowly diffuse itself through the atmosphere of the apartment. This quantity will be sufficient to medicate the air of an ordinary-sized room. This vapor has been found very useful in the advanced or ulcerative stages of consumptive disease. It should not be admin- istered whilst any inflammatory action is present, but when used with due caution it is attended with the best results. In the early stage of tuberculosis, before the bacillus has made much of an inroad, the microbe can often be sterilized, and a complete restoration of general health effected by inhalations. BACTERICIDES. IO73 When the germ has effected an entrance and become localized in the lung, softening of the tubercle and its expulsion by expec- toration is much aidid by inhaled vapors. When the greater portion of the lung is microbe-eaten, an ulcerous cavity formed, the possibility of a cure depends a great deal on the energy of the treatment. If the microbe, on the contrary, involves the whole of one lung, the prospects of recovery are greatly diminished; but still cure is possible so long as the other lung retains its integrity and is unobstructed in its functions. Life may be preserved even after the destruction of one lung. A person in this condition cannot have the same power of endurance in pursuit of his ordinary occupations, but he may still live and enjoy comparative freedom from suffering for many years. In such cases, which have hitherto been considered hopeless, a properly conducted course of inhala- tion has produced the following marked effects : the cough and expectoration have been controlled, and the constitutional dis- turbances greatly modified. In this condition the patient may remain stationary as regards flesh, although this will be, of course, below the former standard. When both lungs are involved in extensive disease, cure is im- possible, and it is folly ever to hope for so great an improvement in the healing art as to embrace these cases among the list of curable. The most that can be accomplished is to afford relief by cleansing the lungs from mucus and pus which obstruct the bronchial tubes ; to soothe the cough and allay the irritation of the lung, so as to promote sleep, and make the patient com- paratively comfortable. But, in defiance of any skill within the power of man, the duration of life is a question of weeks or months. This, however, is no reason why some well-directed effort should not be made to procure the greatest amount of relief possible, and this can be more confidently looked for from the aid of inhalation than from any other mode of treatment. From the above remarks it will be seen how necessary it is for those who are predisposed to pulmonary disease to keep a close watch over the earliest perceptible signs of its approach. All authorities agree that in its first stage consumption is as amena- ble to treatment and as curable as any other form of disease. It cannot be known too soon who are the subjects of it, and it is impossible to ascertain this but by a most thorough, careful and frequent examination into the constitutional and local symptoms of the disease. Every one ought to be examined regularly at stated periods during the year, and there are no seasons better suited for this than the autumn and spring. If the lungs are healthy, an examination cannot produce the complaint, and if 68 1074 DISEASE GERMS. any evidence of the malady be detected, the sooner the patient comes under treatment the better chance there will be of his deriving benefit, and the greater probability of an ultimate cure being effected. The treatment should in any case be persevered in so long as the least vestige of the disease remains. To kill bacteria is one thing, to kill germs is quite another. It has been proved that they can stand a short boiling, that they can be floated in air-bubbles through strong vitriol, that they can be washed with a carbolic solution of any strength short of five- per-cent. without being killed, or losing their power of self-multi- plication. Is it likely, then, that) any vapor which could possi bly be inhaled would be capable of destroying organisms which are so retentive of their vitality ? I think it is quite obvious that all evidence shows that it is impossible, either to keep germs out of the body, or by antiseptics to kill them. What else, then, can inhalations do ? Simply ameliorate. While Prof. McFall was performing experiments on the living matter in the atmosphere, it became necessary very frequently to prepare sterile solutions, and he was much troubled by the pro- longed boiling which was necessary to destroy with any certainty their contained vitality. But he found that if, instead of giving his solutions one long boil, he heated them several times for quite a short period, leaving them at the ordinary temperature in the intervals, he could quite readily devitalize them. This method he described as sterilization by discontinuous heating. He dis- covered, in fact, that however hard and resisting the germ may be, there is, in the life-history of every bacterium, a period when it is very soft, tender and easily destroyed ; and that, although he could not touch the germs themselves, he could let them hatch, and, by repeated slight heatings, kill their offspring as they came out, while they were too young to produce a fresh generation; and thus he was able, without ever reaching the point of ebulli- tion, completely to devitalize the fluids which he had found most resisting, even to very prolonged boiling. The recognition of this difference between germs and bacteria, as regards the action of destructive agents, explains many things otherwise difficult of comprehension, and enables one to understand how organic sub- stances can often be protected from decomposition by the addi- tion of very minute quantities of antiseptics, in proportions quite too small to be in any way considered germicidal. The modus operandi is probably in all cases the same: the germ is allowed to hatch, the young is killed by an antiseptic far too weak to touch its parent, and thus the race dies out. Now, it seems to me that this is the explanation of antiseptic inhala- tions. The materials which have been found most useful are not BACTERICIDES. IO75 mere gases which intermingle with the inspired air and then pass out again with it, but are vapors, gaseous forms of soluble bodies which are deposited wherever their penetrating vapor comes in contact with water. On every moist bronchial tube, on the walls of every cavity, and even in every congested spot in the lung, the inhaled carbolic vapor condenses and carbolizes the tissues; and we are, I think, forced to believe that the benefits derived from the use of antiseptic inhalations are due to this infiltration of the lungs with this antiseptic material rather than to any action upon the floating germs. It must, however, be granted at once that this impregnation of the tissues never goes to any great extent, and the question arises whether so mild a dose can have any effect in preventing bacterial growth. There is plenty of evidence to show that antiseptic inhalations diminish the irritating qualities of the expectoration, and lessen the number of bacteria in it; but there is no proof at all that it can be rendered entirely free from bacteria by any amount of antiseptic vapor; in fact, all evidence goes the other way. Now, it has often been assumed that, if we cannot stop the growth of micro-organism in fluids lying in the tubes and cavities, we certainly must not expect to check the development when embedded in the substance of the lung. But the cases are dif- ferent ; the one is a question of dead matter, the other of living tissue. Decomposition of expectoration obeys the same laws as experiments in test tubes ; but the growth of bacilli in the living substance of the lung is resisted by the vitality of the tissues themselves. Life is the great antiseptic. There are few points in which the difference between things living and things dead is more markedly shown than in the power live bodies possess of resisting, by virtue of their own vitality, the growth within them- selves of those lower organic forms which, in dead tissue, readily take root and grow, and by their development, rapidly reduce the lifeless elements to their lowest chemical affinities. For scores of years man's body resists decay, and then, when life departs, he rapidly swarms with myriads of bacteria; not that there is any chemical change making his body more suitable food for them, but because they are able at last to take possession, now that the resisting power of vitality has departed. As it is with the germs of decomposition, so it is with those of tuberculosis. When they attack the lung, they do not usually at first affect those parts which are most actively performing their functions; the very parts into which they are most freely carried by the air are least susceptible to their attacks ; their active vitality is their protection ; but, in the apices and parts injured by pre- vious inflammations, they settle and breed disease. And, even 1076 DISEASE GERMS. when phthisis is well established, and when the air in the chest mu.-t be crowded with its germs, large portions of the lung remain for long untouched ; showing on the one hand, how great is the resistance to the disease inherent in the tissues themselves, and, on the other, giving a rough measure of the amount of help required from treatment. For, if the difference between a soil fit and one unfit for bacterial growth is to be measured, for example, by the difference between the functional activity and resulting vital resistance of an upper and lower lobe of the lung, surely it is not unreasonable to hope that, by impregnating the pulmonary tissues with antiseptic material, which, we know, renders them less fitted for the cultivation of bacilli, we may be able to make up the lacking resistance, and so prevent the access of disease. The inhalation of bactericides certainly has a tendency to steri- lize the bacillus, and thus aid in at least arresting the disease. First, the material used ought to be capable of absorption by moist surfaces ; it should be a vapor, not a gas ; and a dry vapor, not an atomized solution. Second, as no attempt to filter or steri- lize the air is required, all complex forms of respirator may be discarded. The freest possible access of air should be allowed, the vapor being breathed with it as constantly as possible; so that the simplest and most open respirator is always the best, the mere diffusion of the vapor in the room sometimes being suf- ficient. Thirdly, we must combine with the treatment by inhala- tion, all medicinal, dietetic, and hygienic measures which tend to improve the general condition of the patient, and thus increase his vital resistance. It is worth bearing in mind that the view of the matter, which I have so imperfectly brought before your notice, shows the har- mony and unity of purpose which exist among the various means which we make use of in the treatment of consumption. If we accept the germ-theory of the origin of tuberculosis, all treatment, both local and general alike, must aim at preventing the growth of certain bacteria in the body ; the struggle is be- tween one great life and myriads of small ones; and while all general treatment tries, by providing healthy work, good food, and pure air, and by attention to all the details of a bactericide treatment, the treatment by inhalants should consist in a selection of a few of our best germicides, as eucalyptus, menthol, creosote, iodine, ozonized sulphur water, comp. oxygen. There is really no cessation of attempts to attack the microbe by inhaling or through the stomach. The baneful parasite brood of bacilli are hard to kill, and it requires tact, and good remedies to drench the germs, and cause their departure from the pulmonary cells. BACTERICIDES. IO77 Ozonized sulphur water or ozonized iodine, are most obnoxious to the tubercular bacilli; their anti-parasite and disinfectant properties are great, and their use is of real benefit in pulmonary phthisis, in thoroughly rooting out the germ. More recently, inhalation of hydrofluoric has met with success. Where a special inhaling chamber can be contrived, the vapor may be driven into it by means of atmospheric air forced through a mixture of the acid and water in various degrees of dilution. Simpler portable contrivances have been employed, consisting of a bottle containing the mixture of acid and water, through which the air may be drawn by means of an india-rubber tube, and in- haled direct; or of a bag containing a definite quantity of air, which is connected by tubing with the acid bottle, two wash-bot- tles being interposed between the acid bottle and the inhaler. A definite volume of air is thus drawn through the whole appa- ratus until the air-bag is exhausted. The strength of the acid solution varies from fifteen to twenty or thirty per cent. An eminent physician contributes a note on the action of hydro- fluoric acid in the treatment of phthisis, in which after a full recognition of preceding work, he advocates the careful trial of the remedy as one which is, at any rate, simple and innocuous, and may greatly contribute to the recovery of early cases. He points out, that in this, as in every other form of inhalant, the strength must be so graduated, that long-continued inhalations can be practiced without discomfort. Inhalations that are pain- ful, or in any way distressing to the patient, are of very little value in practice, as they can never be long continued. Hence no positive standard can be laid down for the strength of the acid to be used in each case. The first sensations on inhaling the vapor are always somewhat irritating to the nose and fauces, but toleration is quickly established, and patients are soon able to inhale the vapor continuously. The remedy has been most successful in the early cases, and the first notable improvement is always in the appetite. He also notes that night-sweating is diminished, but that the fever is not always reduced in propor- tion to the improvement in other directions, nor do the number of bacilli diminish to any material extent. The same may be said of the local physical signs. Cough is not very much af- fected, but the sputa, as a rule, becomes less profuse. Diarrhea and laryngitis are not much affected, being generally met with in the case of advanced disease. The inhalation, after the first few moments, is attended with pleasant sensations, and patients al- ways express themselves as being better for it at the time. The hygienic management of all cases of tuberculosis is im- portant, it includes proper directions as to ventilation, diet, cloth- lng, exercise, bathing, etc. 1078 DISEASE GERMS. Ventilation is most important, as a very large proportion of microbial diseases are due to germ-laden atmospheric areas; thus it is bad in quality, often charged with noxious vapors, or irritating impurities, variable in temperature, liable to transitions in electrical conditions ; all these sources affect health. In some the effect is a direct, and in others an indirect, cause of disease. The changes in the temperature of the air are less serious than those in its purity. The former produces active inflammation; the latter is the parent of low fevers and consumption. The former is the most speedy in its influence on the health, the lat- ter the most fatal in its effects. The influence of pure air is seen in those who live active lives in the open air; riding, walking, or working. The effects of im- pure air, on the contrary, are seen in the pallid visage of the in- door mechanic, in the fragile form and hectic-tinted cheek of the seamstress, everywhere, in fact, when great numbers of human beings are crowded together without the means of sufficient ventilation. Germ-laden air is most depressing to the one affected. Air must be considered in the light of food, the amount of supply, the mode or manner in which it is introduced, as well as the equality of its distribution, are essential considerations in every well ventilated-apartment. With respect to the purity of the air as a preventive or curative agent, there are some curious facts which appeal to our judg- ments in rather a circuitous, but yet cogent way, and which would seem to militate against many of our proconceived notions, and make us reverse much of what we have hitherto enforced in practice. Some physicians have held the view that an excess of fibrine (hyperinosis) in the system predisposed to, if not favored, the development of tubercle. In pregnant women, the disease, if already present, is held in abeyance during the period of gesta- tion, owing to the fact that the arterial blood assumes, in a large measure, the venous character, from the excess of carbonic acid in the system in general, but in the circulating fluid in particu- lar; and as venous blood contains a less proportion of fibrin (hypinosis) than does the arterial, the arrest, or prevention, of the development of phthisis in the gravid state is thus rationally and physiologically explained. The bright carnation or vermilion hue of the skin of consumptive patients furnishes additional proof of the excess of oxygen over carbonic acid in such cases, and would seem to indicate the most rational remedy for the prophylaxis or cure of the disease, which, under the circum- stances, would necessarily be the very opposite of that recom- mended by so many writes and authorities on consumption. BACTERICIDES. IO79 The solvent action of venous blood on fibrin prevents materially the deposition and development of tubercle, and goes far to strengthen the significance of the foregoing views, so that we are forced to infer that air contaminated to a certain extent by car- bonic acid is not after all, so deleterious to phthisical patients as we have been led to suppose. The well-known anesthetic action of carbonic acid upon the terminal branches of the sensory nerves in general may not only allay " formative irritability," which, according to Virchow, plays such an important part in the genesis of tubercle and other morbid growths of tubercle, but also effectually calm the incessant, hacking cough which accomr panies phthisis in all its stages, and thus become a potent pre- ventive, as well as a curative agent, in the disease. The effect of climate upon the tubercular bacilli is remarkable, some climates rich in ozone will often completely sterilize the germ, whereas others bring it into amazing activity. It is difficult to suggest a climate adapted to all constitutions, and in recommending special localities a fearful risk is incurred, as the whole matter is involved in uncertainty. To parties who have ample means there are to be found locali- ties suitable everywhere for their special case. Within the limits of our native land there are differences of climate which can be made available according to season. In winter there are shel- tered nooks on our southern and Pacific coasts; in the heat of summer there are the cool and bracing places of the north. Even in our homes it is practicable to secure a temperate yet in- vigorating air, with all the personal comforts to which we have been habituated, in which we can enjoy the charms of a con- genial and social intercourse with friends, and in which the domestic ties are preserved intact to the latest moment of exist- ence. The diet of those suffering from the tubercular bacilli in their bodies should be of the best, and liberal to the utmost degree, as the condition of the patient will permit. Clothing, summer and winter, should be woolen, light as con- sistent with sufficient warmth. Exercise, moderate, is invaluable. In our day too little atten- tion is given to this subject, and the most erroneous notions pre- vail among the people; some of the evil results are forcibly illus- trated in the case of the invalid. Do we not daily see those who are able to walk without any considerable fatigue shut up in close over-heated rooms, lest a breath of pure air should reach them; whilst others, reduced to the last extremity of emaciation by dis- organization of the lungs, are made to undergo long and tedious journeys on their way to a warm climate? io8o DISEASE GERMS. Proper exercise is that physical exertion which calls into use the greatest number of muscles, and should be carried to that amount which the patient can bear without fatigue. A walk of a quarter of a mile in disease may be equal to thirty miles in health. Every invalid should take regular exercise daily, which must be apportioned in quantity and in kind to the nature of the disease and the strength of the patient, and should always be determined by the physician, in accordance with the condition of the invalid. This particularly applies to cases of consumption, and also to other diseases affecting the breath, as asthma and those of the heart. In addition to these outdoor exercises there are many kinds of passive exercise, such as swinging, rocking, inflating the chest, and the use ot dumb-bells, which may be resorted to indoors when the state of the weather prevents the patient from going out. Much misapprehension exists in regard to the influence of the weather, and, as a consequence, few invalids take half the exer- tion they should and can take with perfect safety in the open air. Rain is an insuperable objection; and a raw, damp, windy day should never be braved under any circumstances. Snow, on the contrary, when unaccompanied by wind or sleet, offers no obsta- cle to exercise in a covered carriage. The influence of a dull, cloudy day is felt almost as much in the house as in the open air, and the necessity for exercise is quite as imperative as on a fine clear day. With a clear sky overhead—though there may have been recent rain—the invalid may drive out with entire safety. During the autumn and winter", dry cold days are the best for outdoor exercise, and with the protection of a respirator, invalids may go out in the coldest weather, not only with safety, but with comfort to their feelings and benefit to their health. Bathing is an essential element in the treatment of all suffer- ing from the presence of the microbe in any part; its tempera- ture, period of use become a matter of regulation by the attend- ing physician. There are, however, certain general maxims which ought to be clearly understood : i. The use of cold water should be particularly avoided by those suffering from the bacillus tuberculosis. The quantity of blood circulating in the superficial blood-vessels at the surface of the body is very considerable, and the action of cold water ap- plied to the skin is certain to disturb the equilibrium of the circulation, and to drive back a large proportion of the blood on the internal organs, especially when these are already the seat of disease, thus producing a liability to congestion. BACTERICIDES. I08l 2. The use of hot water should be avoided, as being very de- pressing in its effects upon the system, and, from the increased circulation which it causes on the surface of the body, rendering the patient more susceptible to change of temperature and conse- quent risk of " taking cold." 3. Plunge-baths and shower-baths are also to be avoided by consumptives, as necessarily exposing the whole surface at once to the action of the atmosphere, and the sudden shock to the nervous system is equally prejudicial, being a frequent cause of disturbance to the proper action of the heart. In all cases where the bacillus of tubercle is present I recom- mend, as most beneficial, the use of water as nearly as possible the temperature of the blood (980 Fahr.). I also give the prefer- ence to sponging over every other form of bathing, recornmending as a precautionary measure to uncover only a portion of the body at a time, and to regulate the temperature of the room by pre- venting draughts of air, and by having it sufficiently heated. As the perspiration is apt to be acid, and charged with oily secretion, the use of a small quantity of an alkaline substance in the water, such as carbonate of soda, will assist the cleansing of the skin more thoroughly and removal of dead microbes. In the more acute forms of disease gentle frictions of the skin after the bath will be beneficial, but in chronic complaints this will not be so essen- tial. Great care should be taken not to expose the person to the open air immediately after bathing, but to allow the equilibrium of the circulation to be fully re-established before venturing forth, for it will be found that with every precaution an amount of con- stitutional excitement will always be produced. It will readily be seen that I attach great importance to the act of bathing; not that I regard it as a specific or directly curative agency, but simply as forming a portion of the general hygienic management which cannot be too rigidly enforced by the physi- cian, or too faithfully put in practice by all who seek relief from pulmonary tuberculosis. As our readers would naturally like to hear what the most illus- trious, leading and learned members of the medical profession in the United States think and say regarding the " tubercular ba- eilli," we hereby append extracts from their published essays on the subject. A very prominent, highly scientific, and most suc- cessful practitioner, H. S. Lane, M. D., Philadelphia, Jefferson Co., New York, says: "Tubercle, the degraded bioplasm or living matter of our own bodies, caused by conditions adverse to vitality, and when once present the bacilli being always abundant, whether there be formations or not, renders this diathesis pre-eminently conta- 1082 DISEASE GERMS. gious and infectious. If vital force be low, germs very active In the deposits in the periphery of the nodules, isolated or grouped, and the bacilli or young swarms are found in the sputum, sweat, saliva, stool. Spores producing bacilli are found in every tissue, but breeding is carried on actively in parts that are weak and feeble. Indeed their mode of evolution is the same as other germs—a weakened part, a station suited to the growth of germs; incubation follows, the seed undergoes changes, same as a grain of oats in the soil. That particular germ may die, but in dying multiplies itself indefinitely ; new germs are let loose into the cir- culation and another colony is formed in another part or soil, during the incubation of which there is a pause, a febrile excite- ment, a growth. The disease germ in the blood may multiply, but the chances are that if the individual has high vital force and normal physi- ological activity that growth will be retarded until there is a weak, vulnerable point,' a locality, a zone where germs can grow. The transmissibility of the micrococci of tubercle may take place from man to man in apparent health; from husband to wife, or vice versa; or from tubercular disease or from domestic animals, especially from the milk of tubercular cows, but there is, properly speaking, no fructification unless vital force is shat- tered. The diversity of disease-germs, aside from tuberculae, is easily explained, and harmonizes with physiological laws ; the germ is originally an elementary element of nutrition of some special tissue, and in that condition it is degraded by mechanical violence, ill health, depressing causes, as poor food, insanitary states, which accounts for their difference when the condition of de- pressed vital force exists; still there must be a receptivity of soil as an essential requisite to reproduction—a vulnerable point for their deposit or reception and fructification. These facts teach us that consumptives should in all cases be placed in an invigor- ating residence, with ozone-generating atmosphere, where no dis- ease-germ can live, for where ozone is, tuberculae cannot exist; a diet rich in blood elements, surroundings free from all insani- tary states, body properly protected with flannel, and daily in- vigorated with bathing and massage. It must be born in mind that the lung at some point has suf- fered a partial death ; it is devitalized, passive, there is a stagna- tion, a lowness, a want of contractile power; the nerve power, the tone of the blood vessels is lowered, circulation is feeble, all is delicate, and the working capacity of the lymphatics and pink marrow is greatly impaired." BACTERICIDES. IO83 E. S. Pixley, M. D., Pittsfield, Massachusetts, a most experi- enced and highly scientific practitioner, who has added much to the dissemination of the germ theory of disease, in a recent printed essay on chronic disease, says : "Tuberculosis originates in one or other of two ways, the microbe is either the changed, altered, degraded bioplasm o'f our own bodies, by living under conditions inimical to vitality; or it is the product of others. Whether it is acquired, or the product of an invasion, the recovery or destruction of the patient depends upon the relative vital power of the microbe and the integrity or strength of his own vital force. In the struggle it is the object of remedies to weaken the one and strengthen the other. This can only be effected by selecting and administering such germi- cides as are innocuous to the human body, whilst they are as inimical as possible to the microbe. If the microbe is not anni- hilated in the blood and tissues it will excrete ptomaines, a chemi- cal substance disastrous to living matter. Numerous attempts have been made to destroy the bacillus in the lung, blood and other tissues by means of germicides, either inhaled through the bronchial mucous membrane; or by the stomach, or by endosmosis through the skin or rectum; to destroy the bacillus without interfering with the delicate structure of an organ. The principle is a good one ; the glycerite of ozone is the remedy, which, when taken into the stomach- eliminates ozone; this, the great scavenger of nature, enters the blood, in which it either sterilizes or annihilates all microbial life. By the persistent administration of half a teaspoonful thrice daily, well diluted in water, the tubercular bacilli is constantly exposed to its action. The remedy is volatile; permeates all the areas of living matter, circulates in the blood ; vitalizes that fluid ; has a specific power to destroy tubercle without injuring any tissue, even deli- cate lung structure. From its first dose, the microbes are para- lyzed, they fail to excrete ptomaines; hence hectic, diarrhea, fever, states in which ptomaines play an important part, are wiped out orally or otherwise. Over the germ colony, or desposit or infiltration, an active bactericide should be applied either constantly or at suitable in- tervals. Such a germicide as ozonized turpentine, if the tubercle is localized on the peritoneal coat; if in the lung, the concentrated ozone with chloroform; if in the knee-joint, glucozone; such local applications are found to destroy tubercle when kept in close contact. Indeed the tubercle bacillus speedily disappears." The observations of Prof. IV. V. Rutledge, M. D., of St. Louis, Mo., who is one of the foremost workers in the field of bacteri- ology, has developed the significant fact that the bacillus of tuber- 1084 DISEASE GERMS. cle may co-exist with numerous other microbes, as those of lepra, syphilis, rheumatism; that the evolution of the microbe can be prevented by a high standard of health. " The tubercular germ is undoubtedly the most common, one to which the human race owes more mortality during the working period of life, between fifteen and fifty-five, than any other, and it is the duty of the individual, as well as the government, that a systematic attempt should be made to diminish, and when possi- ble, remove the preventable cause of this scourge. The evolution of the microbe can be prevented by a rigid ob- servance of sanitary science, by abundance of the best of food, good clothing, a high moral atmosphere, and everything which tends to ennoble man. The reception of the germ from other bodies is more difficult to control. Amongst the various modes by which the infecting bacillus has been shown to enter the body, there are two which are of special importance in connection with the subject of this paper. Com- munication by means of the mucous membrane of the alimentary canal is of interest because of the prevalence of tuberculosis in cattle, and from the experimental proof of the infectiveness of the milk of tuberculous cows. As animals which are crowded together in sheds with deficient ventilation, etc., are most liable to tubercu- losis, an efficient inspection of cattle kept for dairy purposes is necessary. Although the injurious properties of the milk of diseased animals may be destroyed by boiling, precautions are required as to the selling of milk for food; and even though the bacilli are rarely found in the muscles, it has been suggested that tuberculosis should be included amongst the contagious and infectious diseases of animals. Infection through the respiratory system is, however, the most frequent starting point of phthisis; and as the risk is intensified by close contact and by the crowd- ing together of sick and healthy, the necessity for ventilation and the prevention of overcrowding is apparent, and becomes more marked when the predisposing causes are considered. Wherever tuberculous persons or animals are congregated, the air must contain large numbers of the tubercle bacilli, which must be taken in with the inspired air by many individuals, of whom only a proportion become phthisical. It is probable that even if the bacilli escape expulsion by the expiratory effort, the healthy tissues do not afford them a suitable habitat; but a lowered vitality of the tissues, whether local or general, places them in a more favorable condition for the development of the micro-organism, and thus constitutes in the individual a predis- position to tubercular disease. Speaking generally, a suscepti- BACTERICIDES. IO85 bility to tubercle may be produced by diseases of the respiratory system, or by constitutional enfeeblement. Amongst the predisposing causes, some of the most important result from the aggregation of persons in a crowded population, or from the industries which mark an advancing civilization. Indoor and sedentary occupations, as well as those in which dust is inhaled, influence largely the prevalence of phthisis ; and much of this disease amongst those who follow these occupations is preventable. Here, again, the basis of all preventive measures is to be found in efficient ventilation of mines and work-places. Printers, tailors, and dressmakers afford sufficient example of the effect of employment in crowded and ill-ventilated rooms, and the prevalence of phthisis amongst these classes is shown to be very considerable. The home-workers are more difficult to deal with than those who are working in large establishments, but the provision of public work-rooms, in which conveniences for various occupations could be found, might lessen the evils of the present state of things. With regard to climate, its influence in the causation of phthisis is probably infinitesimal as compared with the effects of density of population. The dampness of the soil has been shown to have some influence on the prevalence of the disease, and this can be remedied by drainage. Damp in houses may be pre- vented by concrete foundations and the insertion of a damp- proof course in the brickwork above the level of the ground. Overcrowding is of two kinds—the aggregation of buildings on a confined area, with insufficient open space around and be- tween houses; and the crowding together of the inmates within the house. Both are unfortunately too common, and are potent factors in the development and spread of tubercular disease. By-laws should be enforced regulating the width of streets, the amount of open space around houses, the minimum height of rooms and size of windows ; and efficient inspection of new houses should be carried out before they are allowed to be occu- pied. Tenement houses should be licensed to hold a certain number of inmates, and be liable to inspection. In considering the number of inmates to be allowed to a house, attention should be paid to the means of ventilation as well as to the num- ber and size of the rooms. As many diseases which produce a general debility thereby predispose to tuberculosis, sanitary and hygienic measures, framed for the control of these, tend to di- minish the amount of phthisis in a community: and seeing that insufficiency of food, of fresh air, and of exercise, continued anx- iety and mental depression, and dissipation must be reckoned amongst the predisposing causes, the philanthropist may assist io86 DISEASE GERMS. the sanitarian in the fight against this widespread disease. How many cases of consumption will result from the present epi- demic of measles in this city, which might have been checked by the timely closing of schools ! The fundamental principles which must form the basis of any successful attempt to diminish the prevalence of phthisis are : (i) to provide a sufficiency of fresh air in and around dwellings, and work-places and (2) to endeavor to improve the resisting power of the individual by all possible means, as physical training dur- ing the period of growth and development, by exercise and recreation, and good food. As the effects of the tubercular microbe in the individual are not confined to his generation, but handed down from parent to child, any causes that tend to increase tubercular disease among a people must be regarded as tending to produce progressive vital deterioration of race. We owe it, therefore, to humanity, to succeeding generations, to allow no time to be lost in com- mencing a systematic attack upon everything productive of this germ." Tuberculosis is a most contagious and infectious disease. We copy the following which is part of a report made to the Health Board by the eminent R. H. Randolph, M. D., Portland, on the prophylaxis of tuberculosis: " That the terrible mortality due to tuberculosis must not be reckoned only from the cases of phthisis, but that a large num- ber of examples of bronchitis, pleurisy, meningitis, peritonitis, enteritis, diseases of bones and their articulations, indolent abscess and others, are due to the same fatal and protean source. Tuberculosis is an infectious, parasitic malady, caused by a microbe, but can only be conveyed to healthy individuals under special circumstances. Besides its transmission by descent, the microbes can gain entrance aerially by the organs of respiration, by the stomach mixed with food, by the mucous membranes, and by the skin through wounds, scratches, or punctures. The most common and active source of contagion is to be found in the sputum of consumptives. In its liquid state, this has little activity, and can only very rarely do mischief; it is when dried and reduced to powder by attrition that it is most dangerous. When expectorated on the ground, the floor, or the surface of walls, on one's clothes, carpets, bed coverings and cur- tains, even in handkerchiefs or napkins, it may readily be re- duced to this pulverulent form, and then be distributed by the air, to be absorbed by the lungs, settle on one's skin, on mucous surfaces, or become mixed with food. In the faeces, also, of the phthisical, the microbe exists, and may be disseminated by simi- BACTERICIDES. IO87 lar means. Therefore the utmost care should be taken in the reception and disposal of the sputa; the spittoon should always contain water or some antiseptic liquid ; never sand, sawdust, or ashes. The contents {should be thrown daily into the fire, and the vessel well washed with boiling water. It should never be emptied into drains, on dunghills, or on the soil of gardens. Handkerchiefs should never be allowed to become dry before washing, but be put into water as soon as possible after use. But the best plan is to use some cheap material and burn it. A healthy person should not sleep in the same bed as a con- sumptive, nor, if it can be avoided, in the same room. In hotels and establishments devoted to the use of consump- tives, the furniture should be of the simplest kind, and readily washed; and all textile fabrics should be disinfected before a change of occupancy by heating in steam under pressure. Besides the chances of human contamination, there is the ever-present danger of infection by tuberculous animals. The fatal microbe may be found in the milk, the flesh, and the blood of those used for the food of man; in beef, in cows', goats', and asses' milk, the flesh of rabbits and fowls. Cows' milk is most frequently infected, that ot the goat and ass much more rarely. But it is safer to boil them all before used as infants' food. The carcasses of all animals slaughtered for food should be jealously examined before the meat is per- mitted to be sold. There is a horrible practice, common in France, of people frequenting the abattoirs for the sake of drink- ing the warm blood; one is glad to hear that it is exceedingly dangerous; and meat should not be cooked in large joints, since the bacillus can stand a high temperature with impunity. The children of tubercular parents are most inimical to the disease, and this is obviously true, apart from the possibility of congeni- tal infection." The presence of the tubercular bacilli in Tubercle Bacilli the sputa, or in any other discharge of a in Sputum. patient is a sure proof of the tubercular in- .fection of the individual. It might thus appear very easy to discover the tubercular taint in a person. Such really is the case, but the naked truth remains that it is occasionally exceedingly difficult to prove the presence of tubercle bacilli, especially because of their close resemblance to the bacilli of lupus and lepra. Prof McFall, M. D., of Dallas, Texas, however, seems to have discovered a procedure which-promises the long-desired aid. This procedure is as follows : io88 DISEASE GERMS. " After the sputum or the pus has been treated in the usual man- ner on the watch-glass, it is allowed to dry thoroughly in the at- mosphere, and the glass then drawn in the well-known way through an alcohol flame. The glass is then taken hold of by brass pincers, or, still better, glass pincers, and dipped quitt slowly into the strongest undiluted nitric acid, /'. e., the acidura nitricum fumens of 145 to 150 specific gravity; it is then taken out just as slowly, and at once dipped into a vessel containing pure water, and there rinsed. The thus prepared material is then dried and afterward placed into the coloring fluid, according to the usual method, and in this the floating glass is permitted to remain for twenty-four hours, when the color is removed with diluted nitric acid. For the first coloring process fuchsin, for the second a solution of malachit, is employed by him. The fuming nitric acid used must each time be a fresh preparation, as it at once attracts the water from the atmosphere, and by giving off nitrous vapor changes to common nitric acid, which no longer retains the property of the fuming acid. Tubercle bacilli thus treated perfectly retain their form, shape and color; only their contents have undergone* an alteration; their interior appears as little nodules attached to each other like a chain of pearls. The bacilli, therefore, seem to consist of a hyaline wall and coagulable contents. Neither the bacilli of lupus nor those of lepra show the same changes. This "chain-of-pearls" appearance, being characteristic of tubercle bacilli alone, may well serve, therefore, for the differ- ential diagnosis of the three kinds of micro-organisms mentioned, while the method will permit us, henceforth, at once to establish the presence of tubercle bacilli without having to await the results of inoculation or of pure culture. The present methods of detection often fail, he says, on ac- count of the frequent scarcity of the bacillus in any given speci- men, and the tenacious character of the latter renders it difficult to get the film on the cover-glass sufficiently thin and uniform. We advise that the whole sputa for the twenty-four hours should be placed in a conical vessel, very like a urine deposit glass, and that it should be subjected for another twenty-four hours to a uniform heat of 36-390 C. (95-1030 Fahr.). This temperature he considers to fairly represent the temperature existing in the lung— the habitat, for the time being, of the parasite. At the end of the above time the thicker portions of the sputa will have settled to the bottom of the glass, and will have lost much of their tenacity. The supernatant fluid can be easily decanted, or a drop of the thickened portion can be spread upon the cover-glass with uniformity, and, of course, is much more BACTERICIDES. I089 liable to show bacilli, if present, than a drop of sputum before concentration. They are often five times as abundant. C. L. Souder, M. D., Burrows, Indiana, has made a specialty of the treatment and cure of tuberculosis. His high scientific at- tainments, together with his profound erudition, have made him a standard authority on the subject. In a recent essay on the subject we read": "The bacilli of tubercle, a degradation of the living matter of the patient's own body, which takes place under unfavorable condition to existence, or is received by weakened bodies in the form of contagion or infection—whichever.it colonizes in devi- talized parts, on or in the bronchial or pulmonary tissue, and is usually accompanied with great emaciation and debility, because the pink marrow and other lymph canals are germ-laden, blocked up; difficulty of breathing after exercise, and a cough, which is always troublesome, and annoying expectoration, hectic fever, diarrhea. Under states or conditions prejudicial to a high state of life, the bacilli of tubercle may appear at any age, but poverty, hardships, colds, catarrh, pneumonia, and many other states of vital deteriora- tion bring it on, as certain deleterious trades, confinement, mo- notony, insanitary states, alcohol, excesses. Of all diseases, probably the presence of the malarial germ in our bodies has much to do with the greater prevalence of the disease in our country, but a very large per cent, of all cases are due to the sudden changes in our climate, to insanitary states in- cidental to modern sewage, and heating of dwelling; to deleteri- ous food and perverted habits. Like all germ diseases, it is essen- tially contagious and infectious—a damaged part is its seat of deposit. It is there it breeds ; if lung substance is weak from any cause, it imbeds itself there ; if the lining membrane of the bronchi is impaired, there. It is always dangerous from the growth and development of tubercles. A vital organ smitten— a deposit on the bronchi is much more dangerous than when in the substance of the lung—the danger is in proportion to the amount. of germs present, and their activity, which depends wholly on the amount of vital depression. The only cure for tuberculosis is the destruction of the bacilli tuberculae in the blood, and in the part where they have colo- nized, and the maintaining and building up of vital force. If there is cough, emaciation, haemoptysis, hectic fever, night sweats, etc., administer the glycerite of ozone, the only remedy 10 far discovered that will positively destroy the germ, the factor of disease. Under its persistent use, there will be strength,, greatly diminished cough ; he will gain flesh ; every dose will 69 1090 DISEASE GERMS. reduce pulse, respirations, and abolish hectic, it will arrest night sweats and bleeding from the lungs. If there are great prostration, great and grave lesions in lung structure, or on bronchia ; if the patient, and even physician, is hopeless of a cure, we say give it; administer it persistently when the bacilli are active in an albumin )id state, for it will annihilate the germs : give it when the germ is merging from a caseous to a calcareous mass; an inorganic body ; give, for it will then cause a chemical dissolution." /. F. Bcckner. M. D., Kentland, Ind., may also be regarded as standard authority on the tubercle bacillus. In his recent scien- tific and brilliant essay on the subject, he says : " The discovery of the tubercle-bacillus is a scientific fact; all, with the same facilities, may see what others have seen. It is the one thing tangible, describable, known by its peculiarities among entities as readily as one individual is known from another. To doubt its existence in tuberculosis is to doubt the utility of scientific medical research, and to abandon further progress to the unstable dreams of theorists. The sputa of the phthisical contain these germs ; the air they exhale is loaded with them or their spores, and their introduction into the system of animals will always produce tuberculosis, while nothing else ivill. These are not speculations, but demonstrable facts! Further- more, clinical observations go to prove conclusively that healthy individuals, living in an atmosphere contaminated by the phthisi- cal, will contract this disease, and not any other which might be due to a lowered vitality, from being in close quarters and breath- ing a vitiated air. On the general question, as to how far it is possible to con- tract tubercular disease by contagion, we certainly have at the present time no sufficient evidence to warrant us in arriving at any satisfactory conclusion. All that is certain, or even probable, is that when a large number of human beings are herded together in a small space one of the diseases which make themselves most commonly felt is tuberculosis, whilst in the presence of abun- dance of fresh air it can almost with certainty be banished. It is equally certain that under such favorable conditions that poison may be communicated from one individual to another, a fact which is abundantly demonstrated, both by general clinical evi- dence and likewise by experimentation of animals allied to man. We have before drawn attention to the disadvantages that arise from the intimate association of healthy and tubercular individu- als, but it by no means follows from these facts that any real danger exists of contagion from one person to another, provided that the most ordinary precautions are taken. We have yet to BACTERICIDES. 1091 appreciate and to understand what it is that makes an individual more prone at one period of his existence than at another to be- come infected with the poison of disease, and until it can be shown-that infection from one individual to another takes place on a far larger scale than anything that has hitherto been demon- strated, it is certainly premature to conjure up dangers in the mind of the public which are purely hypothetical. With a rea- sonable supply of fresh air, and with our meat and milk thor- oughly cooked, there is but slight fear, if any at all, of tuber- cular infection, and certainly to attempt to lead people to believe that it is dangerous to inhabit any room which has been occu- pied by a consumptive person, unless it is furnished and uphol- stered in such a manner that disinfection can be easily and com- pletely carried out after the departure of each patient, by means of washing and sulphuring the rooms, is to frighten people un- necessarily, and to conjure up ideas in their minds which have no real basis for their existence." Oscar N. Snow, M. D., St. Albans, South Carolina, another eminent specialist on pulmonary phthisis, and who has achieved brilliant results with bactericides, in its treatment and cure. He says: "The gaseous treatment of pulmonary tuberculosis is a total, nay, a glaring failure. Eminent savans are now pushing forward an old but valuable remedy, lime water and phosphate of lime, not with the view of killing the microbe, but in the hope, in the far future, of creating calcification and fibroid changes in the neo- plasm—thus retrogressing or sterilizing the bacilli. The action of the phosphate of lime and lime water, or infu- sion of burned oyster-shells, is too well-known to need recapitu- lation at this late day, of their value in dentition, in small-pox, and even carcinoma no one can doubt, but in tuberculosis their use is powerless to arrest germ evolution. The glycerite of ozone is prepared chiefly from the hypophos- phite of lime and soda added to C. P. glycerine, ozone being added until it is thoroughly charged. This very fine chemical preparation of lime is easily and quickly assimilated, and has a much more rapid action in build- iug up vital force—in aiding a renewal of life, than the crude phosphate. The only chance of ever checking, or arresting, or curing, pulmonary tuberculosis, is by germicides, by building up vital force, by the administration of a microbe destroyer, like the gly- cerite of ozone, a remedy that enters the blood—coming in con- tact with the germ annihilates it. The microbicidal effect of the glycerite of ozone is thoroughly established, as is illustrated by 1092 DISEASE GERMS. over six thousand physicians, who prescribe it daily and in their remarkable success in the management of the most hopeless cases of the malady." The leading scientific savan, and undoubtedly the most distin- guished and successful physician in Tennessee, her only bacteri- ologist, Prof. IV. J. Heacker, M. D., Boon's Station, Tennessee, says: " Pulmpniry tuberculous miy hi dafin^d t> be the deposit or presence of the tubercular bacilli, either in- the substance of the lung or the mucous membrane of the bronchi; the localization of the germ, its growth, its multiplication, its tendency to degen- eration, excavation of the parts in which it is situated, with wasting of the body, and other evidences of germ evolution. The bacilli must exist in the blood. The lung must be smitten, or damaged, or weakened, and the contractility of its blood vessels impaired so as to permit of the exosmosis of the bacilli from the germ- laden blood. The onward progress of the microbe depends altogether on the state of vital force, and how great the state of partial death in a portion of the lung. Degeneration and destruction mark the different stages of growth. The progress of all cases varies according to the state of vital force and the nature of the lung lesion. The more of neurasthenia, the greater the amount of germs in the blood ; lung congestion ; capillary infiltration ; the progress of the germ is irresistibly rapid ; uninterrupted, harassing cough; opaque, cheesy, clotty expectoration; increasing shortness of breath, profuse sweats, frequent chills, rapid loss of flesh and strength; germ-eaten rectum, aphthous alimentary canal. If vital force is not so depressed the degradation is less marked and the germs in the lung less abundant; slower in its metamorphosis; fewer tubercles, little cough, less fever and wasting. The bacilli of tubercle may deposit themselves either on the mucous membrane of the larynx and bronchi, or in the substance of the lung, the selection invariably being a weakened part or tis- sue for growth and reproduction. The localization of tubercle in the apex of the left lung is the most common ; here it may re- main latent for many years ; the lower lobe of the right lung, if congested or damaged by repeated attacks of cold, offers another favorable location for the lodgment of these micro- organisms. To effect a renewal of life in the germ-smitten lung and destroy the germ in the affected part, and in the blood, is the most efficacious method of treatment. The administration of BACTERICIDES. IO93 that positive therapeutic, glycerite of ozone, annihilates the germs, checks the tissue waste, while it increases the quality and number of the red corpuscles of the blood. It thus lowers tem- perature, decreases the heart's action, alleviates cough, checks night sweats, and aids in the maintenance of the appetite better than all the bitter tonics, and is a more effective arrester of meta- morphosis than brandy. Tumors, or new growths, are divided by patholo- Tumors. gists into two main groups ; one of innocent or benign growths, the other of malignant growths. The latter are distinguished by the following common characters : rapidity of growth, tendency to infiltrate and to replace the tissues of the affected part, tendency to recur after removal by operation, tendency to multiply locally and to infect other and remote parts of the body; a tendency to destructive and progressive ulcera- tion, inducing fatal exhaustion through pain, continuous dis- charges and occasional loss of blood. To any tumor presenting these so-called characters of malignancy, the term cancer was applied by pathologists of a past generation, but at the present time, in consequence of the extensive use of the microscope in pathological research, there is a tendency to classify tumors with regard more to minute structure than to clinical characters. The tumors constituting the maglignant differ much in consistency and in minute structure, but the great majority of them have been referred to one of the following two great divisions: that in which the growth is composed of some form of connective tissues, and that in which it is made up in great part of cells re- sembling in character those found in the epidermis, on mucous membranes, and in the ultimate lobules of secreting glands. To the former division belong tumors that are called sarcomata or fleshy growths, to the latter belong the true cancers or carcino- mata. Structurally the two are distinct; with regard to clinical characters and malignancy, their resemblance is very close, the chief distinction in these respects being the facts that cancer almost invariably, and sarcoma seldom, affects secondarily the lymphatic glands, and that the latter usually appears at an earlier period of life. Innocent or benign tumors may occur in almost any part of the body, and they may vary in character from so simple a growth as a wart up to formations which may endanger life or require some serious surgical operation for their removal. It would be useless to attempt in a work like this any useful classification of tumors, as any properly devised system would be unintelligible to 1094 DISEASE GERMS the ordinary reader. The question with most people who find a tumor is forming is as to its being of a cancerous nature or not, and this can only be answered by obtaining the advice of a medi- cal man. Much harm is done by the reckless way in which patients, to get rid of their malady, fall into the hands of those who pretend to cure them, while too often they only hasten on the fatal termination. The great majority of small tumors are harmless in character, and often cause inconvenience rather than any other distress, but in ail cases proper surgical advice must be taken before recourse is had to removal. Tumors then are swellings, prominences of greater or less size, developed by irritation, from either normal or adventitious matter upon any part of the body. The following division is a most excellent one, the best which can be devised under our present light of science : They are classified as follows : I. Type of fully-developed Connective Tissues— Fibroma................^ype °f fibrous tissue. Myxoma................ " mucous Lipoma................ " adipose Chondroma ............ •" cartilage Osteoma................ " bone Lymphoma j „ , hoid Lymphangioma j J r 2. Type of Embryonic Connective Tissue. Sarcoma................its different varieties. 3. Type of higher Tissues. Myoma................Type of muscle. Neuroma............... " nerve. Angioma................ " blood-vessels. 4. Type of Epithelial Tissues. Papilloma...............Papillae of skin or mucous * membrane. Adenoma ~| ^, , „ ■ \.............Glands. Carcinoma j "5. Mixed Tumors, or Teratomata. Fibrous tumors are growths of Tumors. mature connective tissue. Both the [Pibroma—Fibrous Tissue) cell and intercellular substance are in a state uf complete development, and they resemble normal connective tissue. There is usually a constitutional predisposition, an excess of over nutrition of these elements in the system; prolonged irritation operates as an exciting BACTERICIDES. IO95 cause, still a simple hyperaemia is often sufficient when lymph channels are gorged or blocked. Three varieties are met with, the solid, soft, and cavernous. These tumors may originate from connective tissue in any situation, at first consisting of embryonic tissue, cells being abun- dant and intercellular substances scanty. As they develop the number of cells de- creases, and the intercellular substances in- creases enormously, fibrillated and hardened. The cells are smal1 and spindle-shaped, and hidden amongst the fibres which run irreg- ularly in all directions; the fibres form the ra0st embryonic type- greater portion of the growths, being closely usually a vigorous grower. interlaced and often concentrically arranged around the blood vessels. The growth of these tumors are slow, gradual, central, they are always encapsulated. They are liable to inflammation, hemorrhage, mucoid, fatty and calcareous degeneration. They vary in consistence from being very dense to that of succulent, areolar tissue, and vary in size from that of a pea to a massive growth. Innocuous, painless, usually single, unless originating from the skin, sheaths of nerves; and harmless, unless their size interferes with the func- tions of parts. Usually they are non-recurrent after removal. Found in all parts of the body. Some contain more blood vessels than others, and are pinkish in color, but the majority of them are destitute of vessels. This class of tumors is found in the womb, breast, bone. They are firm to the feel, free from ten- derness, smooth, oval, or lobulated ; of slow growth, lasting an indefinite number of years. It often degenerates into a stony mass, or earthy salts. When no larger than an orange, the application of the o2onized clay should be tried, keeping it steadily applied if no erythema is produced, and administering comp. saxifraga and phytolacca in- ternally. That failing, extirpation is the only remedy. Besides the above, there are often found, (1) a subcutaneous tumor about the size of a pea, composed of fibrous tissue, which affects women, and gives rise to neuralgic pains; (2) a fibro- cellular tumor, made up of bands of firm, white, fibrous tissue, infiltrated with serum ; (3) fibro-plastic tumor, made up of fibrous tissue and lymph ; (4) fibrous tumor, composed of filaments of fibrous tissue, with naked nuclei. Fibrous tissue in the female breast is usually effused in a nodule, or mass, in the breast, constituting a tumor of irregular shape, hard, dense and fibrous ; it may become large. No pain or lymphatic enlargement. General health good. In some cases IOg5 DISEASE GERMS. they assume a cartilaginous or bony consistency. They, as well as the fatty, depend, the one upon an excess of adipose tissue, and the other upon a superabundance of fibrous tissue in the blood, owing to some constitutional defect. Treatment.—If not very dense or hard, the same treatment as for the fatty; but here alteratives as compound phytolacca, Fibroid tumor, where the tubules have Fibroid tumor of the breast. undergone some proliferation into cysts. iodide of potass, glycerite of ozone, play a most important part in procuring their absorption. So those remedies should be persevered with, and the clay kept on, alternately with bella- donna, iodide of potass and muriate of ammonia. Even in cases Fibroid in the female breast. Fibroma of the cerebellum. as dense as bone, they can often be absorped with the above remedies. Never tamper with electricity, unless under the care of a scientific pnysician. Fibrous tissue is often effused in the brain and cerebellum, more especially the latter. The annexed diagram is taken from the cerebellum of K. Jones, who died in Beverly, N. J, 1878, whose case puzzled the entire medical profession of the Untea States as no symptom existed during life upon which to base a diagnosis, but intense po^t-cervical pain, which by its agonizing vibrations literally caused the death of the patient. BACTERICIDES. IO97 Fibrous tiesue is often found in nodules on the spinal cord, first lymph which becomes organized. Irritation of all kinds, falls, blows, strains, lifts, anything we can imagine that would weaken any portion of the cord or its membranes, may permit of effusion of lymph which produces thickening, or if the blood of the patient is highly loaded with the germs of the tubercle, cancer, syphilis, rabies, they may form a nidus or seat of deposit, and grow and multiply, giving rise to a nodule of tubercle, an exostosis of syphilis, a cancerous infiltration, and may thus, by causing pressure or producing atrophy, cause paralysis. Symptoms come on slowly but progressively. Paralysis of motion precedes that of sensation, often not very decided till growth or infiltration is some size. Apt to be pain over seat of induration, cramps and convulsive movements of the extremities. Nature of tumor or thickening is to. be inferred from the history of case and diathesis of patient. Treatment.—General health to be well cared for; nutritious brain diet; bathing with frictions and inunctions of oil into paralyzed limbs ^attention to secretions. Persistent use of altera- tives and tonics, iodide potassa, tincture iodine, iodide of starch and lime, with vegetable alteratives, as phytolacca compound, and such tonics, as quinine, mineral acids, occasionally ergot; bitter tonics, as kurchicine, gentian, and above all things the unremitting application of a two-inch-wide strip irritating plas- ter on both sides of the spine, changed every morning; keeping up a free, copious discharge of pus. Firm, determined perse- verance will often get rid of the difficulty. These tumors consist of muCous tis- Tumors. sue, the intercellular substance of which [Myxoma—Mucous is homogeneous, translucent, and jelly- Tissue) like, containing much fluid, and yielding mucia. Pathologically mucous tumors contain one or two distinct nuclei. The cells are oval, stillated, fusiform, or spherical, and distributed scantily, in which case the growth is translucent, but if the cells are very abundant, and packed closely, a whitish, brain-like opacity is imparted to the growths. The growth as a whole is gelatinous, soft, trembling, of a grayish white or pinkish color. The cut surface yields a muci- laginous, tenacious liquid, in which the cellular elements may be seen. These tumors are usually encapsulated, and are met with in 1098 DISEASE GERMS. the later periods of life, being most common in sub-serous and sub-cutaneous fat, inter-muscular, and sub-serous tissue. A pure myxoma is rare, met with usually mixed or combined with lipoma. This class of tumors are liable, when they arrive at some size, to rupture of their capilla- ries and hemorrhages, or the growth may be- come inflamed, ulcerated or necrosed. The myxomata are mostly benign tumors, but they often attain an enormous size. They never reproduce themselves after complete re- moval. Often associated with sarcoma in the female breast. Mucous cysts consist of dilated and expanded gland ducts filled with mucus and epithelium. There may be one, or several cysts, in one or both breasts. They seldom grow larger than a Hyaline Myxoma. (Mucous tumor.) Inter-cvstic E'Owth, suirounded with fatty molecules. Cvstic tumor of the breast. Cystx tumors of the breast. hazel-nut. Most common after change of life. They give rise to no pain or inconvenience, but when detected should be re- moved by a simple incision. If allowed to remain they simply become the seat of cancerous deposits. Under the head are classed cystic tumors, which consist of a sac containing solid or liquid substances. They may arise by the formation of definite cavities in the meshes of the areolar tissue ; by the dilatation and growth of obstructed gland-duct or folli- cles ; by the erratic development of nu- cleated cells, which become exaggerated into cysts. Some contain serum ; others a jelly-looking substance, some blood, others solid matter. Wens, or encysted tumors, are most common on the head, face, and shoulders, and consist of obstructed sebaceous glands, Cystic tumor on neck, BACTERICIDES. IO99 or else of erratically formed cutaneous cysts. In examining them with a small glass, the orifice, or mouth of the gland can be seen in the centre in the form of a black spot or crust. They are all lined internally with a serous membrane, which secretes water, epidermis, scales, hairs, nails, oil-globules, and crystals of cholesterine, which cause the contents of the sac to resemble gruel or suet. The cyst is liable to accidents, which give rise to distension, suppuration, ulceration. Treatment.—The cause that engenders them is irritation • so they never should be irritated or tampered with, and, as a rule not interfered with if patient is out of health. In all cases they should be removed by the knife only by making an incision through their centre, and carefully dissecting out their sac, for if the smallest portion be permitted to remain, it will give rise to a sinus and weeping. Such tumors are common in the breast prostate, parotid, and thyroid glands. As a rule, they are pain- less, not tender, moderately soft, elastic, and lobulated. Extir- pation is the only cure. The liver is often the seat of myxoma. Encysted, knotty tumors, containing a cheese-like substance are found in the glandular substance, varying in size from a pea to that of a hen's egg. They arise from irritation and inflammation of the hepatic ducts; steatomatous contents composed of irregular granules, free oil globules, and occasionally plates of cholesterine. Simple serous cysts, with clear watery contents, are sometimes found scattered over the liver, usually about the size of a small bean. Sacculated cysts, containing a glairy fluid, are also met with. In some cases they resemble a honey-comb. The liver in some cases is crowded with such cavities. Ovarian tumors are very generally of this class. Those are an invariable result of chronic inflammation of the ovary when that condition is not seen to promptly, and managed properly. Irritation is the cause of those growths. This irrita- tion may spend itself upon the serous membrane and give rise to dropsy of the ovary, or on the fibrous tissue, or upon the seba- ceous glands, or other tissues of the ovary, thus giving rise to different kinds of effusions or tumors. Ovarian dropsy is the most common of cystic disease of the ovary. There are three forms met with : the simple cyst or bladder, filled with a fluid; then there are the proliferous cysts, in which there are a number; and the dermoid cysts, the lining membrane of which is capable of secreting hair, nails, teeth, sebaceous matter, or any substance of the body. Causes.—It is unnecessary to recapitulate the causes, suffice it I IOO DISEASE GERMS. to say that they are to be embraced under all those of chronic inflammation of the womb and ovaries, acute and chronic— which see—and placed under one term, irritation. Symptoms.—Most cases, if carefully scrutinized, will exhibit well-marked symptoms of chronic inflammation of ovary; still the irritation seems to be even a little less, so the uneasiness or pain of that condition is often not well marked, and may, if the patient is of a cheerful, sanguine temperament, escape detection until the abdomen begins to enlarge. In other cases, the pain in the ovary is well marked, and when the ovary fills up, it gives rise not only to an appreciable tumor in the affected side, but gives rise to some irritation of the bladder and rectum ; a sense Pedunculated dermoid tumors from the rectum—removed or rather exfoliated entire by the introduction of a je- quirity capsule. of weight and oppression in the abdomen; pain and numbness down the thigh of the affected side. Besides, there is the usual lassitude, weariness, backache, constipation, irritable bladder. Menstruation at first may be regular, but scanty or abundant. After tumor has attained some considerable size, the symp- toms become aggravated; there is greater pain and tenderness, as well as distension of the abdomen. Menstruation now is in- terfered with greatly, usually it is disordered, frequent or sup- An ovarian dermoid with a spurious mamma and a nipple growing from its wall. BACTERICIDES. I 101 pressed. There is loss of appetite, indigestion, constipation, loss of flesh ; frequent micturition ; urine scanty, often suppressed. Strength diminishes ; emaciation becomes greater ; hectic spells ; no sleep, sense of smothering, cannot go to bed, sits up. Mean- time the abdomen increases in size, becomes enormously en- A lock of hair, twenty inches long, from an Ovarian Dermoid. larged. The swelling is one-sided, it may lay over to the other side in the recumbent posture; the pain is only in front, if it is simple, but if it contains cancer germs, the pain will radiate from the front to the back ; if it contains a fluid, a sense of fluctuation can be detected even if the cysts are like a honeycomb, whereas, if it contains any solid constituent of the body, hair, nails, bone, teeth, or cheesy matter, it is solid, dull on percussion. As the tumor grows it fills up the abdomen, and may cause dropsy of the abdomen by unravelling its peritoneal fibres ; oedema of the legs and thighs. As it progresses, patient's movements become impeded from the bulk of the tumor, suffering is augmented, all the symptoms grow worse, the nights are wretched, the difficulty of breathing is very great; the swelling or dropsy, becomes con- siderable, often suppression of urine and fasces ; uraemic poison- ing or fatal prostration is very apt to take place. Treatment.—When tumor is smaller than the two closed fists of the patient, an effort at absorption is to be tried, which, with our new remedies, is often successful; and if it fails, it will be no barrier to ovariotomy. Every point must be well guarded and seen to, as the best of food; regular evacuations; good, com- fortable sleep ; flannel clothing; a perfect alleviation of all pain, and the best of hopes encouraged for a cure. Then selecting a tonic and alterative from the list for a week, then change, and so on for another week. Among our best alteratives are comp. saxifraga and phyto- lacca, alternated with wine of aleteris farinosa, comp. syrup partridge berry, and elixir of apiol. In addition, pastiles of cocaine and boroglyceride, might with advantage be inserted far up the vagina several times a day. Locally, the ozonized clay over the entire tumor, bound on with a firm roller and T bandage. If the clay causes no redness, it can be put on fresh every morning; but if there is the least redness, it can be taken off and broken up fine, and water added I 102 DISEASE GERMS. to it and reapplied for four or five days. The action of this clay on this class of growths is most extraordinary; causes their thorough, positive dissolution and disintegration. As this pro- cess goes on, the bowels must be kept open with cascara, and kidneys stimulated with cream of tartar lemonade. Cover entire tumor with the clay, and no more, and as this process goes on, push diet, alteratives, and tonics. All other methods of treatment are simply a loss of valuable time, such as tapping, aspirating. If the absorption plan with the clay, and other drugs fail, then there is only one thing left, and that is ovariotomy. In larger tumors than those mentioned, the clay will reduce their bulk, and in some rare cases cause their disappearance; but in very large ones we cannot speak with the same precision as we do of those of a smaller class. In ovariotomy, that is in making an abdominal section in the median line of the abdomen, ligating the pedicle of the tumor, then dividing it, removing tumor and returning the ligated stump into the abdomen, stitching up abdomen, etc., and treat- ing for peritonitis, do not wait too long, until there is no recup- erative power left in the patient. Fatty tumors are growths of adipose Tumors. tissue; a general and diffused infiltration of [Lipoma—Adipose fat is obesity; a fatty tumor or lipoma is a Tissue) localized and circumscribed formation. Lipomata originate wherever fat exists normally, being produced by fatty infiltration of existing tissues. Their growth is central, encapsulated and lobulated, and at first it increases slowly. The cells of a lipoma are larger, and the fat they contain is more fluid than normal adipose tissue. Fatty tumors are liable to glide out from the deepest structures and show themselves under the skin. They are all sizes and forms. They generally grow in the cutaneous tissue, between the skin and the muscles. They are most frequently met with below the collar-bone, back, neck, inside of the thighs and some- times in or among the muscles. In number there is generally one; it grows slowly, may attain an immense bulk, seldom degenerates, is free from pain and is easily recognized by its soft, lobulated, doughy feel, which never can be mistaken for anything else. If the tumor is not large, in some cases (not always), the ap- plication of the ozonized clay has a most marvellous effect in causing a dissolution. It is worthy of a trial. It may be kept BACTERICIDES. IIO3 constantly applied, if it induces no redness of the skin • if it causes any redness, off and on at proper intervals. Internally, fucus vesiculosus ozonized might be tried that is the fluid extract combined with peroxide of hydrogen, alternated with ten or fifteen drops of liquor potassa, as they are the only remedies which disorganize the fatty cells. Adipose tissue or masses of fat may be freely and evenly dis- tributed throughout the entire connective tissue of the gland, or in nodules, or aggregation at different points. Its doughy, ine- lastic feel and perfect freedom from pain will be good points by which to recognize it. They grow slowly, give rise to immense bulk and considerable inconvenience. Treatment.—Ozonized clay is the only known remedy that will cause a dissolution of those growths. Kept on the breast or tumor constantly, if no redness of skin is produced; if redness is caused, to be removed, and lotions of peroxide of hydrogen, and then the clay reapplied again and again. Internally, altera- tives, as in lacteal tumor. Cartilaginous growths or tu- Tumors. mors are often met with and [Chondroma—Cartilaginous exist in three forms [a) as cells Tissue.) embedded in a hyaline basic sub- stance (hyaline cartilage); [b) as cells embedded in fibrillated basic sub- stance (fibro-cartilage); [c) as cells emb- edded in a mucoid basic substance (gela- tinoid or mucoid cartilage). To these may be added an osteoid form. The growth in nearly all cases leading to ossification. To be found most among near joints and on white fibrous tissue. Cartilaginous tumors are common in the neighborhood Of iointS. Calcified cartilage, showing the 0 J calcification of the intercel- lular substance, x 300. Bony tumors consist of connective tissue Tumors. in which the bone corpuscle or cell pre- [Osteoma—Bony dominates. Bone is originally from car- Tissue.) tilaginous or fibrous membrane, and event- ually from periosteum. Osteomata are produced by mechanical or microbial irritation of the periosteum or medulla of bone. They are usually divided 1104 DISEASE GERMS. into two classes, viz., an exostosis and osteophytes; the former, from proceeding from the bone or periosteum ; the latter, more or less remote from the bone. A compact osteoma, which grows from the surface of the bone or its periosteum, usually exhibits a line of demarcation, although covered by the ordinary periosteum. Osteophytes, found in the common connective tissue, tendons, cartilage in the interstitial connective tissue of muscles, glands and organs, any part subject to chronic irritation ; tumors formed by the irregular hypertrophy of bone. Such tumors are hard, pain- less and globular, and mostly situated on the long bones. Their N structure is that of ordinary bone, but usually more dense and compact. In some cases they are porous, in others of an ivory consistence. They cause no pain unless they press on nerves. On the inside of the skull they press upon the brain, and give rise to epilepsy ; in the orbit they cause the eye to protrude. Their cause is irritation, and effusion of lymph, which becomes organized into bone. Treatment.—If not too dense, they can often be got rid of by absorption, by alterativ es and by iodide of potassa, with the local application of ozonized clay; when hard, of the consistence of ivory, they can be cut down upon and chiselled off. These tumors are growths of lym- Tumors. phatic or adenoid tissue, and are [Lymphoma—Lymphatic divided into soft lymphomata, in Tissue) which there is a preponderance of lymph corpuscles and indurated, lymphomata, with preponderance of stroma and microbes. The causes of lymphomata are numerous and varied; irrita- tion, the microbes of syphilis, tubercle, cancer and other disease germs. These tumors are to the physician a sort of barometer or index of the state of the blood of the patient; enlarged lymphatics, soft or indurated, indicate feeble vital force, and excessive micro- bial growth. Soft lymphomata begins with a proliferation of the lymph cor- puscles, and a migration of the disease germ with the white cor- puscles. The growth is pultaceous and soft, resembling brain substance in color and consistency. Trj,e growth of soft lytftDhp- ma is rapid; becomes very large, often breaks through strufxirws in which it is infiltrated. The indurated lymphomata are characterized by an entirely op- posite condition of things—being marked by induration with a tendency to calcareous degeneration. BACTERICIDES. 1105 In what is termed Hodgkiri's Disease, there is a progressive en- largement of all the lymphatic glands of the body—gradual, painless enlargement. Glands of neck, axilla, groin symmetrically enlarged, not in- flamed or fused together; thoracic and abdominal glands also affected. Patient has all the symptoms of anaemia and leucocy- thaemia ; is very weak, loses flesh and suffers from great exhaus- tion on the slightest exertion. The white corpuscles in blood are greatly increased; tightness or constriction of chest and abdomen ; progressive increasing debility. The spleen is enlarged, filled with spores of tubercular bacilli. The glands, when cut into, are uniform in structure, translucent and filled with various microbes, the contents appearing to the naked eye as albuminous or lardaceous matter, and precisely the same in the spleen, mesentery and pink marrow. It is this blocking up of those blood-raising glands that gives us the ex- treme anaemia, dropsy, exhaustion and death. In all cases, tuber- cle is present, whether the syphilitic or cancer germ is present or not. * Sarcomatous, or fleshy tu- Tumors. mors consist of embryonic con- [Sarcoma—Fleshy or Embry- nective tissue, and retain their onic Connective Tissue) embryonic type throughout the whole period of their growth. They are classified, and thus named : fibro-plastic, fibro-nucleated, recurrent-fibroid, and myeloid tumors. Many growths, which A thin section of Another section of Round-celled sarcoma in its Round-celled sarcoma lymphomata. the same growth incipient stage. more advanced. were formerly described as cancerous, are now to be classified under this head. Cells constitute nearly the entire bulk of the growth, and pre- sent great variety of shape, form, and colon They are round,, fusiform, myeloid, and pigmented. All the sarcoma present an intercellular substance, small in amount, but their blood vessels are numerous. Sarcoma may be found in the brain, spinal cord, in or among 70 no6 DISEASE GERMS. all the muscles of the body; in the orbit, parotid, lungs, liver, kidney, spleen, and in all parts of the body. Sarcoma.—The term sarcoma, a fleshy tumor characterized by the appearance of one or several, usually at first isolated ; pea to nut sized and even larger ; smooth, spherical, irregular, as lobu- lated, cutaneous or subcutaneous neoplasms, as tumors, pig- -^^f*m Sections of sarcoma. Sarcoma ; spindle-cells visible in sections of a cutaneous nodule removed from one of the author's patients. About x 300. mented and non-pigmented, having a marked inaptitude for ul- ceration, but malignant in character, recurring speedily after re- moval, and usually terminating fatally by involvement of the viscera. These tumors may be free, movable, but eventually they become adherent, both above and below. • Their characteristics are their white color, rapid growth and development, with systemic tainting of the entire blood. Their predisposing cause, a hybrid microbe produced by the mingling of the proto- plasmic elements of the cancer germ, and the bacilli of tuber- cle in the lymph spaces of the blood. Once these hybrid germs are effused from the blood by some irritation in the skin, cellular tissue, or elsewhere, the weakened patch, the lesion becomes swollen, infiltrated, painful, germ proliferation active, enormous, skin reddens, ulcerates, often attains an enormous size. In a short time, weeks not years, if there are several nodules, they aggregate together, the nodules or neoplasms coalesce, degenerations by ulceration, and participates in the process of destructive metamorphosis going on. Death speedily results, exhausting fever, with sarcomatous involvement of the viscera. gection of a sarcomatous nodule wirh the spindle cancer germ interspersed throughout its sub- stance, magnified 300 diameters. BACTERICIDES. I I07 This germ deposit may take place in any weakened parts of the body. All tumors of this class are abundantly supplied with blood vessels, lymph canals, and the germ with mottled tubercles inter- spersed through it, exhibits a net-work of spindle-shaped, spher- oidal, branched, with one or more nuclei, with connective tissue and basement membrane. Its correct diagnosis rests upon the microscopical examina- tion of the growth. Up until a very recent period, the treatment was very unsatisfactory, even its surgical ablation, is followed by a speedy return of the tumor, so far as germicide remedies are concerned. The Chian turpentine mistura has effected most wonderful re- sults in the cure of this form of growth. This preparation differs from all others in the molecules of the turpentine, being in a fine state of subdivision, being dissolved by the ethereal peroxide of hydrogen, resorcin, thallin, and other germicides being added. In some cases the glycerite of ozone, or the comp. saxifraga, or the glycerite of sulphur, were used in alternation. Sarcoma found in the bladder. Sarcoma in the liver. The general symptoms of sarcoma of the bladder are very similar to those met with in other varieties of vesical growths, consisting of haematuria with signs of irritability of the bladder, viz., pain arid increased frequency in micturition ; in most cases evidences of obstruction to the escape of urine are sooner or later produced, micturition becoming difficult and attended by straining efforts. In addition, attacks of retention and inconti- nence of urine are sometimes present in the later stages, and in some instances distinct evidences of the existence of the growth can be detected upon a physical examination of the bladder. Haematuria is usually a prominent and often an early symp- tom. It frequently precedes the signs of irritability of the blad- der, so that in this respect sarcoma resembles papilloma—a pain- uo8 DISEASE GERMS. less hemorrhage often continuing for a considerable period, sometimes for several years, without any other symptoms, is generally characteristic of the latter affection. As in papilloma, the bleeding at first occurs in attacks separated by intervals of varying duration, during which the urine is quite clear. As the disease progresses the attacks last longer and become more fre- quent, until, after a certain time, there are frequent, excessive attacks, which speedily undermine the vital forces of the sufferer. Numerous cases of different forms of sarcoma have been diag- nosed cystoscopically during the last year. Embryonic connec- tive tissue, or sarcoma, is also met with in the liver. The Chian turpentine mistura is really the only remedy of value in sarcoma of the bladder; it certainly, by its microbicide action, has a decided effect in arresting germ evolution. The pipssisewa is a drug of intrinsic value, has a specific influ- ence upon the walls of the bladder; it not only checks the ravages of the microbe of sarcoma, but prevents the ingress of the cancer germ. Muscular tumors, consisting of Tumors. non-striated muscular fibres, always [Myoma—Muscle Tissue.) arise from muscular tissue, espe- cially from the walls of the uterus. In this organ as they enlarge, they push aside the normal tissue and protrude into the cavity of the perinaeum or uterus. View of tumor, showing the adventitious tissue, muscular, glandular, from walls of the uterns. Becoming pedunculated in the latter organ form fibroid poly pus of the uterus. They are often found in the prostate, cesopri agus, stomach, intestines. Their growth is slow, central, ofte: multiple or compound. The myoma form the great bulk of a uterine growths, very liable to become calcified, forming in tn uterus a hard, stony lump, the so-called womb stone. Myoma ot the walls of the uterui. BACTERICIDES. IIO9 As a general rule, the myoma are elastic, pear-shaped and spheroidal. Their firmness depends upon the age and amount of connective tissue present. Their color varies from muscular redness to pinkish or grayish white. Their presence gives rise to exhaustive hemorrhages. Mucoid degeneration often takes place leading to a cyst-like formation in the growth. As a rule, these tumors are innocent. General Treatment.—Improve general health by every possible means—tonics, alteratives, as comp. saxifraga and phytolacca, alternated with distillation of aleteris farinosa, and comp. syrup partridge berry. Where the myoma involve the walls of the uterus, the use of the ozonized clay is often of great utility. The best local treatment is by electricity, mild uninterrupted currents, so as to stimulate absorption, not growth. This must be performed by one having the highest scientific attainments, and who thoroughly appreciates the subject.* These tumors are growths of Tumors. nerve tissue, very rare outside of [Neuroma.—Nerve Tissue) stumps. Their substance re- sembles the cerebro-spinal nerves. With the nerve fibres there is usually associated a certain amount of connective tissue. Their growth is slow, seldom become of large size, usually exist in single nodules, they are quite innocent, although very painful. They always spring from a cut or lacerated nerve. Solid or cystic. The solid growths have a deal of fibrous tissue inter- spersed through them, making them dense and plastic, implicat- ing the neurilemma of the nerve. Occasionally nerve fibres merely spread over tumor without being involued in its texture. A nerve, when divided, if its two |nds are placed in apposition, will unite like bone, and sensibility *nd motion be restored. If not placed in apposition, their ex- Semities will become bulbous, or may aid in the formation of these growths : so they are common after lacerations, wounds, *In 1870, Prof. John J. Siggins, M. D., of Philadelphia, Pa., introduced a chemico- "ectncal method of exciting absorption, and thus curing a large percentage of these tumors. Indeed it was a brilliant success. This same modus operandi in all its varied details and with numerous improvements, is carried out by the following scientific Physicians: A Park, M. D., 517 W. Twenty-third street, N. Y.; F. L. Tuttle, M. D., % Main street, Springfield, Mass.; J. J. Jones, M. D., Philadelphia, Pa.; S. H. *M, M. D., Watefbury, Conn., and numerous others. It consists essentially in keep- lngone electrode over the tumor moist with specially prepared peroxide of hydrogen. II 10 DISEASE GERMS. injuries, amputations. There may be one or several, and vary in size from a grain of barley to a melon. Symptoms.—These growths are found in the course of a nerve; grow slowly but steadily; of an oval or oblong form; long axis in the course of the nerve ; darting, lancinating pains in paroxysms. Treatment.—Excision is the only hope of cure ; tumor to be carefully dissected out, and, if possible, the ends of the divided nerve to be brought into appo- sition, and an effort at least, made to keep up continuity, so that the function of the nerve be, if possible, restored. We meet with tumors of nerve tissue on both brain and cerebellum, also on the cord, which give rise to grave or- ganic lesions. This diagram represents a true neuroma of the skin, cov- ering the shoulder and arm. Cases similar to this, have been recently cured by the application of the ozonized je- quirity powder made into a paste with butter of coca, and glycerine ; a perfect exfoliation was effected. Neuroma in the skin. Tumors. Angioma—Made up of Blood Vessels) The angiomata are a class of tumors or growths, consisting of blood vessels held together by a small amount of connec- tive tissue. ■ Under this heading are included naevi, aneurism by anasto: mosis. They are usually divided into two varieties. The simple, or capillary angiomata, and the cavernous, or venous. * All the angiomata Originate from blood vessels, and occur chiefly on the skin and mucous membrane. Their growth is slow, rarely large, very liable to ulceration. Usually they are of a bluish hue, pulsate. Occur in skin, sub- cutaneous tissue, and are found in the orbit, muscles, liver, spleen, kidneys, and are usually what is termed mother's mark. Where abnormal conditions, such as naevi, or angiomata, exist, which are of large dimensions or lie in situations that are not BACTERICIDE^. ]U] readily within reach of the knife, there can be little doubt that few plans afford us such an effective mode of treatment as a gal- vanic battery. To work such a plan successfully the operator must thoroughly understand the construction of his instrument, so as to able in a minute to rectify any temporary stoppage of - the current. Almost equally essential is the need for a galvano- meter, without which it is difficult to detect the variations in in- tensity of the current, and sometimes quite impossible to ascer- tain whether the current is passing or not. A neglect of these two precautions is almost certain sooner or later to result in a disastrous failure, which is ascribed to a fault in the process, and not to its true source, the neglect of proper precautions by the op- erator. Without a galvanometer, it is perfectly true that an ex- perienced operator will form a shrewd guess what is going on in his patient, by the visible signs of the procedure, viz , the bub- / Dilated capillaries fiiled with red corpuscles Capillary angioma at the umbilicus, containing at umbilicus, known as capillary angioma a few leucocytes. of umbilicus. bles of gas and fluid that emanate from the growth. In a similar manner an experienced physician will predict the course of a disease from the symptoms that he can observe without the aid of a thermometer, but with instruments of exactitude at hand, the treatment proceeds with greater ease and a readier precision. Most galvanometers which are to be employed in such operations are graduated in milleamperes, so as to determine exactly the strength of the current to be employed. With some simple battery at hand, the patient is placed under an anesthetic, for the process is often a prolonged one, and by no means devoid of pain. If the naevus is a large one, and placed in a situation where the presence of a scar is of no importance, as for example, in the middle of the back, half a dozen needles from each pole are introduced at various points of the growth, care heing taken that they do not touch one another, and in determin- ing that no contact arises during the procedure, a galvanometer is of the greatest value, for if they do touch the current at once chooses the easiest route through the needles, and no longer subjected to the resisting action of the tissues of the body, 111J DISEASE GERMS. causes a rapid deflection of the galvanometer needle. If the gal- vanometer is doing its work satisfactorily, the naevus soon com- mences to swell up, and gas exudes from the small punctures made by the needles, while no perceptible rise in temperature takes place in the part. The gas issuing from the negative pole is hydrogen, and that from the positive oxygen. By these mani- festations of chemical decomposition it is rendered abundantly clear that the process in question is a true electrolysis, and not of the nature of burning as it has been often wrongly termed. If the process of destruction is carried far enough, the tissues are so far destroyed and undermined that death of the part ensues, and a true slough separates a few days later, quite as extensive in character as if the galvano-cautery had been employed, and quite indistinguishable from a slough so produced. It is, however, quite possible, and by the aid of the galvano- meter very easy, to modify and restrict the process of tissue-de- struction with so much nicety and exactitude that no more tis- sue need be destroyed than is absolutely necessary to effect a cure ; but if this result is to be obtained a weaker current and a shorter sitting must be employed, and the process of destruction can be still further minimized by using only negative needles in the nerves, and placing the positive pole on a distant portion of the body. The novice will very soon determine how far it is de- sirable to go on making his first attempt with diffidence, and by gradually increasing the length of his sitting, will at length suc- ceed in removing the growth without leaving more than a slight discoloration of the skin, where before lay an unsightly and ex- tending mass of veins and capillaries. There are other plans by which the scarring is reduced almost absolutely to a vanishing- point ; the needles should be insulated to within an eighth of an inch of their point with gutta-percha, and they can be introduced, say, a quarter of an inch into the growth to be destroyed, so that the skin at the seat of puncture is protected from the action of the current, and the electrolytic process is limited to the subcutane- ous tissues. When the first operation is over due time must elapse before a second is attempted, in order to insure that full contraction of the cicatrix has taken place; five or six weeks, or two months, when it can be given, is not too long a time to allow. On a subse- quent occasion, should it be advisable to produce a small slough in any portion of the growth, the positive pole, with a stronger current, can be employed, and all the needles concentrated in the one situation. Such methods as these are capable of almost in- definite application, whilst they can be employed in situations where no other plan of treatment is possible, and with results which cannot be equalled for precision by any other method. BACTERICIDES. III3 Tumors. [Papilloma—made up of Papilla of Skin and Mucous Membrane) of or Papilloma, tumors resembling or- dinary papillae. Irritation may cause existing papillae to sprout out, from either the mucous, serous, or cuta- neous surface. The simple papillae are usually small and conical. Papillary growths are not infrequent in the bladder, uterus, urethra and intestines. Under this head are to be classed all warts and horny growths. A simple papilloma may become an epithelioma. A large number of growths are developed from the walls the bladder; warty, or polypoid fibrous bodies; villous, vascular growths, and cancerous deposits. Whatever the nature of the growths, they give rise to symp- toms that resemble calculi—frequent micturition, a painful sense of inability to empty the bladder ; urine may be bloody, or purulent, or ammoniacal, or loaded with mucus. Cancerous deposits are the most numerous; medullary, epithelium, more common than scirrhus ; suffer- ing great; easily recognized by the pain anterior and posterior, the cachexia, and germs in urine. Papilloma in the urethra is often mistaken for stricture. Tumors or growths resembling in their struc- ture ordinary papilla, springing from the ordinary papilla of the mucous, serous, or cutaneous surface. They may also arise from the sub-epi- thelial connective tissue, as that of the stomach and larynx. Even in its simplest form there is present the bacterium porri, a pathogenic microbe, in and around the vessels of the connec- tive tissue—most numerous where the vessel turns, or ascends to the apices, or turns to form a plexus. These papilloma owe their origin to irritation, and gradually, as the bacterium become active, give rise to ulceration and hemorrhage. Papillary growths upon the skin include horny growths and warts. Larger and more vascular papillary growths are formed A bladder fungus; present in chronic catarrh of the bladder, and in condi- tions where the micrococci urinarii are found, also in papilloma of the bladder. 1114 DISEASE GERMS. when the bacterium porri unite or mingle with other microbes, as the venereal, in the formation of venereal warts. Clinically, the papillomata, accompanied with their pathogenic microbe bacterium porri, are innocent growths, but often prove fatal by ulceration and hemorrhage. Papilloma of the bladder presents nothing special at the outsit, unless it be a little undue frequency of micturition, which is probably the only sign which excites suspicion. But early in the progress of the papilloma, or all villous growths, there in an im- portant sign, characteristic of it, throughout its entire course, and common to most other tumors at a later period, namely, the appearance of blood in the urine. Hemorrhage occurs after exer- cise, much more abundant than what would come from the pres- ence of a calculus, and it is -unaccompanied with pain and irrita- Papilloma as seen by the endoscope on the walls of the bladder, cured by per- oxide of hydrogen and salicylate soda. Papilloma as seen by the endoscope on the walls of the bladder, radically cured by injections of thuja and peroxide of hydrogen, alternately— very weak injections. Papilloma as seen by the endoscope on _the w;.lli of the bladder, radically cured by injections of peroxide of hydrogen twice a week, and daily inserting a thallin gela- tinized bougie into the bladder and retaining it one hour. tion of the bladder. As the papilloma increases in size, hemor- rhage becomes more profuse; still pain is absent. A microscopic examination of the urine will reveal the characteristic appearance of papillomatous structure and the presence of a fungus. The bladder should, in all cases, be washed out with a tepid solution of boroglyceride; an examination made with a sound, which reveals a soft, flimsy tissue, springing from a thick base. On those outgrowths, papoid or trypsin has a well-defined action as solvents, and much better adapted to the location than either lactic or acetic acid. Oil of thuja answers well, both locally and internally, and probably is our best drug. As an injection into the bladder it is of great efficacy, diluted half an ounce to four of tepid water. Probably thuja internally to sterilize the blood, and papoid as a digestive agent for injecting the bladder. BACTERICIDES. - Adenomata are tumors or growths Tumors. of gland tissue, and they usually re- [Adenoma—made up or semble tubular or racemose glands Glandular Tissue) in consisting of saccules or acini, lined by epithelial cells. The adenoma proper is an innocent tumor, its favorite seat is the female breast and lung, in pulmonary phthisis. Adenoma of the Breast.—Irritation of various kinds, as corset- bones, dress ; mechanical violence, as blows, contusions, etc., The female breast, dissected back to show adeno-fibroma of the nipple, showing the racemose arrangement of the acini or saccules lined with epithelial cells. often cause a sort of glandular growth in the interstitial structure of the breast. In one variety of partial hypertrophy of gland structure, we find the tumor dense, compact, lobulated, and pro- vided with a fibrous capsule; with ducts and sinuses developed. In another class, there are cysts with growths attached to their walls and floating in a fluid; while, in still another class, dilated ducts are converted into cysts, with growth of gland springing from their sides. These glandular tumors, made up of the substance or out- growths of the breasts, occur in healthy women, between puberty and the thirtieth year of age; and single women are much more liable to them than the married. Their growth is slow, pro- ii i6 DISEASE GERMS. gressive, and an enormous size may be attained. In some cases they grow considerable, then cease, and often disappear; in Section of an adenoma of the breast, magnified 750 diameters. other cases, after growing to a certain size, they remain station- ary and breasts disappear. There is never pain nor lymphatic enlargement. Symptoms.—The tumor begins as a small, movable growth; seems to be isolated from gland tissue; never painful; nor does 'M£t. Adenoma of the breast. Gummy growth in the kidney, with an adenoid formation. it involve the skin nor cause enlargement of the lymphatics of the axillary space. As it grows, breast may atrophy. Rate of growth depends on irritation. If it becomes very large the coverings might ulcerate, and the tumor protrude through. Treatment.—The application of the ozonized clay during the day, and the belladonna ointment during the night, with a general vegetable alterative and tonic course, is the best treat- ment. If the case is stubborn and resists these remedies, then apply a complete casing or covering of iodol in gelatine and gly- cerine, and internally administer ozonized iodine. BACTERICIDES I I \y During its activity, that is, Tumors. secreting milk, the female breast [Mixed Cancer Germs and is most obnoxious to what is other Microbes) termed a milk or lacteal tumor, generally due to violence or blows, which cause a rupture of a lacteal tube, which permits of the escape of the milk into the surrounding connective tissue ; or it may take place from an occlusion of the orifice of a milk- duct, by inflammation cf the nipple, and various other mechani- cal conditions. It occurs only during the activity of gland in lactation. Symptoms.—A round, oval, or cystic swelling, varying in size from a walnut to that of a large orange or pear, can be felt, which, when recent, is elastic and fluctuating, but as its watery portion becomes absorbed, it becomes firm and solid. There is an absence of pain, and the general health is unaffected. So very little annoyance does it give rise to, that the patient may not discern the enlargement for quite a while, or by accident, and, when she does so, becomes greatly alarmed, fearing cancer. If the patient is tubercular, the coagulated caseine in the lobule, or in connective tissue, sometimes become a concretion, like chalk. Treatment.—If infant is old enough, or not near the approach, or during the summer heat, wean the child ; arrest secretion of milk by belladonna; administer saline purgatives ; and subse- quently apply ozonized clay to the breast, and place patient upon an active course of alteratives, as compound phytolacca ozonized, iodide in stillingia compound, glycerite of ozone. If there is suppuration, incision and same treatment as for abscess. As a rule, there should be no interference with the coagulation until gland-tissue becomes inactive. Mixed class of tumors are found in the antrum. They consist of bony matter, exostosis, and fibro-plastic tumors of the con- sistence and form of brain or liver; often the color of the latter, and difficult to recognize from cancer. Others have the color and consistence of kidney. We meet with fibrous tumors, very dense and encysted tumors, and other deformities, that may be mistaken for enlarged antrum. With all diseases of the teeth and nose, the antrum has much to do. The incessant tinkering about old stumps; filling with amalgam loaded with mercury, sets up irritation and effusion. The ignorant extraction of teeth has also much to do with it. Catarrh, and its diseased germ, amoeba, often block up the nasal opening. The trouble seems to be that when its lining mem- brane becomes irritated, that it will secrete an endless variety of substances, which, when liquid, semi-liquid, and glandular, are 1118 DISEASE GERMS. easily got rid of by an opening, stirring up the contents, and washing out the antrum daily with a stimulating wash. The kidney or liver deposits are often mistaken for cancer by the great pain they occasion. In all cases, besides the removal of contents, an alterative and tonic course. From the number of Adenona-fibrom; ignorant men entering the dental profession, it is highly prob- able the diseases of the antrum will be much increased. We respectfully direct attention to the fact that the tissues, which are the seat of malignant neoplasms (cancers, sarcomas, epitheliomas, etc.), may, at a given moment, be invaded by divers microbes, the origin, species and nature of which, it has, so far, been impossible to determine. This invasion, the causes and mechanism of which are alike unknown, may remain latent for an indefinite period, but in certain cases, in the evolution and nutrition of the tumor, it may lead to several modifications, such as the rapid enlargement, the softening, or the ulceration of the part affected. Microbes are not to be found in all neoplasms, or even in all neoplasms of the same kind, nor yet in every portion Adeno-fibroma, where the secretions from the glandular tubules have collected in them and given rise to numerous small cysts. of the neoplasm invaded. They are not to be found, for instance, in lipomas or in pure fibromas; they cannot be found in the early stages of sarcoma or cancer, in which the progress is slow, and Adeno-fibro-sarcoma. Adeno-fibroma, having a dense fibrous stroma, which includes newly-formed glandular or ad- enomatous matter, with increased prolifera- tion. BACTERICIDES. I I 19 the growth is covered by healthy skin ; on the other hand they are nearly always to be found in softened and ulcerated tumors. These microbes, besides their irritant, phlogogenic and pyrogenic action, which they exercise locally even on the diseased tissue possess other pathogenic properties, which may affect the whole system. Thus so far as an opinion can be found, they may give rise to a more or less intense and irregular febrile condition, whilst they are pent up in a tumor about to grow rapidly or to soften. Moreover, during the removal of a tumor, they may im- pregnate the fluids contained in the softened parts, infect the operative wound, and so inoculate it as to develop septicaemia, which may lead even to death. The knowledge of this last fact pleads strongly in favor of the removal of malignant neoplasms, so desirable from every point of view, and suggests forcibly to surgeons the necessity of adopting preventive measures, both during and after operations, for the extirpation of tumors infected with microbes. Any form of tumor may have black pigment matter in its in- terstitial tissue to which the term melanosis has been indiscrimin- ately applied to all tumors or deposits containing black pigment matter. Pigment is of frequent occurrence in the human body, and consists in a deposit in the form of the minutest sepia-colored granules, of a dark-brown or black appearance. These granules may be free, or collected into masses, with a cell membrane around them, or they maybe added to any morbid growth whatever. The chemical composition is not accurately settled, but nearly all forms contain from eighty to ninety per cent. of pure carbon. The division into true and false is a good one—the true being an animal matter, the spurious, carbonaceous matter from without that has found its way into the body, or the action of chemicals on the blood, or the stagnation of blood. [A) True melanosis is a diathesis or cachexia, in which large quantities of pigment may be deposited or infiltrated through many organs in the same individual, either alone or in conjunc- tion with other elements. The primary growth is likely to arise from some pigmentary tissue, as the choroid, or a cutaneous mole. The secondary desposits are mostly found disseminated in the connective and adipose tissue, in muscles, tendons, mu- cous membrane and bone. The bones of the cranium, ribs and sternum, most frequently affected. The organs which it generally affects are the spleen, liver, lungs, pancreas, lymphatics, brain, eye, kidneys, testicles, uterus, ovaries, rectum, mammae. It may be associated with cancer. When melanotic tumors, or nodules, are on the surface there is no difficulty in their recognition. When deposited on or in I 120 DISEASE GERMS. internal organs, symptoms are obscure. In all cases there is great languor and sinking of vital power. The cachectic appear- ance is a dusky, or ash-colored countenance; emaciation, dropsy, night-sweats, exhaustion. Treatment.—Same as for tuberculosis. [B) Spurious forms: inhalation of coal dust in miners, in bronchi and lungs. From the action of chemical agents on the blood, and also from the stagnation of that fluid. It may not appear for twenty-four hours, or several days. Ecchymosis may, besides being due to injuries, be a symptom of purpura, scurvy, fevers, or of gangrene in inflammation. Treatment.—The object in treatment is to check extravasation of blood, prevent inflammation and procure absorption of the effused blood. For this purpose the bruised part should be placed in a raised position, and if about the eye, a few leeches might be applied, and then a poultice of Solomon seal. If it occurs on other parts of the body, tincture of arnica or mari- gold should be used. Arnica or marigold has the property of astringing and contracting the walls of the capillaries, and also "promoting the absorption of the effused blood. The ordinary garden marigold is an unexcelled agent. This should be taken when in full-bloom, flowers, leaves and stem, and put to steep in common whiskey for a month, pressed well down with whiskey enough to cover. It is much ^V^^-v " _ ~_ . r,"f~f^ superior to arnica. Either of the two may be administered internally, but their effects are very doubtful in that way. Pigmented or black cancer, usually begins as hempseed, to pea-sized, single or numerous, soft or dense nodules, which develop in time to tumors of considerable size, and are stain- ed in various shades of color, Black pigment matter as found in a rare (rt\m i rrriiricU Um\*m nr a «larf> form of epithelioma on the lip. lrom a grayisn Drown, or a siaie color to a dead black ; the pig- ment being occasionally displayed irregularly in streaks or bands, over the suiface of the growth. They occur anywhere, the eye, skin, etc., starting as moles, marks, naevi. The pigment is deposited in the protoplasm of the cancer mi- crobe in the epithelium, and connective tissue frame work of the cancer. All melanotic cancers are remarkable for their speedy growth, malignant career and noteworthy tendency to degenerate into BACTERICIDES. 11 21 ulcers. Often such verrucous masses are surrounded by grayish or blackish papules or by diffuse cancerous infiltration of the in- tegument, exhibiting irregular pigmentation of the surface. The local application of lactic acid about twice a week and the internal administration of the Chian turpentine mistura are our best remedies. Breaches of continuity of the surface are either Ulcers. the result of inflammation# or some unrepaired [Cutaneous) injury. Ulceration consists in the gradual disin tegration and separation of tissues, the healthy nutrition of which has been disturbed by local inflammatory changes, by impoverishment or poisoning of the blood, or by an injury to one or more of the nerves of the affected region. In this process the destroyed tissues break down into minute parti- cles, or undergo liquefaction ; in gangrene, to which ulceration is closely connected, the open sore is formed by the separation of the dead tissues in sloughs or large and visible masses. Ulcera- tion may attack any organ or tissue ; it is often met with in bone, and sometimes in teeth ; the tissues most disposed to it are the skin, mucous membrane, and connective or areolar tissue. Nerves and blood vessels resist longer than other tissues the ulcerative process, and may, in cases of rapidly-increasing and sloughing ulcers, be seen isolated in the midst of discharge and slough. The cornea is a frequent seat of ulceration, which too often causes blindness or serious impairment of vision, by resulting in opacity or perforation of the membrane. Within the body ulceration very frequently occurs in some part of the alimentary canal. Ulcer of the stomach, ulcer of the duodenum, after severe burn, typhoid and tubercular ulceration of the small intestine, syphilitic and dysenteric ulceration of the colon and rectum, and fissure or painful ulcer of the rectum are all well-known affections. The pathological process of ulceration occurs in many different diseases of the skin, but for the presence of special microbes and application of remedies, it is best to keep them apart from all other cutaneous diseases. In ulceration there is always a loss of substance, a molecular death, disintegration and discharge of tissue. Asa rule, ulcers heal slowly, for in all breaches of continuity, there are disease germs present, and the molecular destruction hinder the formation of granulations. The nomenclature of ulcers is exceptionally bad ; we have the healthy or simple ulcer, the fungous uher, the weak ulcer, the inflammatory ulcer, the irritable ulcer, the varicose ulcer, the ec- 71 1 122 DISEASE GERMS. zematous ulcer, and many others. These names are little better than jargon, but are nevertheless in common use, and are likely to remain so. Such names as varicose ulcer, eczematous ulcer, and gouty ulcer may be regarded as a kind of conventional short- hand writing, and may possibly be justified on that ground. Etiology and Pathology.—Simple ulcers of the leg always arise from some previous inflammation of the skin ; they are, as it were, a pathological accident of the inflammatory process. There are many causes which may give rise to them, but three only re- quire especial mention • (i) varicose veins ; (2) chronic eczema; (3) blows or other injuries to the skin. Ulcers of the leg are sel- dom met with in the young ; they are most common in middle and advanced life, and their production is much favored by any occupation that involves much standing. With regard to heal- ing chronic ulcers of the leg, a prejudice exists among the pub- lic, and even amongst some members of the profession, against stopping a discharge, on the supposition that the ulcer gets rid of some morbid material out of the system, and that if the ulcer ceases to discharge, this will be retained, and the patient's health suffer in consequence. But the pathological changes which sometimes occur in other parts of the body coincidently with the healing of a chronic ulcer of the leg, cannot possibly be ex- plained in this way; the morbid discharge from the ulcer is cer- tainly not drawn as such from the body generally, but is simply morbid in connection with the ulcer itself; its morbidity is en- tirely local. All ulcers, or breaches of continuity, are germ depots, and must be treated with microbicides. All cases, no matter the cause, should be placed upon a general alterative and tonic course of remedies, with the best of diet, and regulated secretions. With a breach of continuity existing, no matter whether it be superficial or deep-seated, it invariably creates a neurosis of the nervous syst*rn at large; consequently an essential point in the treatment of all u'ers is sedation, a tranquillized nervous sys- tem; nothing aids a local treatment so much as the regular ad- ministration of opiates in all cases. This is not incompatible with any form of treatment. The local treatment of ulcer must depend on the amount ofir- 'ritation present in the surrounding tissues; when this is great, the parts must be kept as quiet as possible, and lotions of boroglycer- ide or creolin applied on lint, changed often, covered with oiled silk, never permitted to become dry. As soon as the inflamma- tion has subsided, a bandage, if the parts admit of it, should be applied from the extremity upwards. Taken off every night and re-applied in the morning; this is always of utility. Strapping BACTERICIDES. 1123 with salicylate rubber adhesive plaster above and below the ulcer, sometimes strips over it, so as partly to cover it, drawing the edges toward each other, allowing open spaces for pus to dis- charge ; over and above this a bandage. Those most liable to ulceration are the debilitated, the intem- perate, mdrcurialized, or those whose blood is loaded with the ba- cillus of tubercle and syphilis. Healthy Ulcer.—In constitutions, or parts predisposed to it, the slightest irritation may be sufficient to excite ulceration. In the vigorous it requires more irritation ; but when produced, it may be what is termed a healthy ulcer, and present a sore free from pain with a fine granulating surface, with smooth, white, milky edges, and its pus thick and creamy. A healthy sore is smooth, covered with a transparent pellicle, or scum, which is lost on the margins of the granulations. Treatment.—In all ulcers or breaches of continuity we must recognize a degradation of healthy, living matter, or diseased germs. In a healthy sore we find nothing but the bacteria, and streptococcus pyogenes, and those in very small numbers, so that it is important that all dressings exclude air completely, be somewhat stimulating, and invariably antiseptic. Ozone oint- ment, or black salve, should therefore be kept constantly applied, Bacteria as seen in simple ulceration. Living mass of working germs in irritable ulcer. spread on fine old linen or lint, about one-sixteenth of an inch thick, a little larger than the sore, changed twice or thrice daily. The dressing on each occasion to be fresh. Before any dressing is applied, the limb should be bandaged from the extremity up, leaving a space for the application of the ointment, and over and above that a few turns of the bandage. The limb should, if possible, be kept at rest, and in an ele- vated position. The constitutional treatment required here is tonics, cinchona, and a liberal, generous, blood-forming food. Irritable Ulcer.—This term is applied to an ulcer when it is hot, tender, very red and painful; bleeds easily, and the discharge is thin, irritating; in some cases foul and copious, and heavily loaded with bacteria. The cause of this is some malassimilation, perverted nutrition, or derangement of the general health. The treatment should consist in opening the bowels, correcting 1124 DISEASE GERMS. the malnutrition with tonics, as comp. tincture of matricaria; plain, unstimulating food. After a free action of the bowels, the irritability of the sore should be removed by applying a saturated solution of boroglyceride covered over with oiled silk, this will speedily exhaust the irritability and reduce it to the condition of a simple ulcer. If not, the ulcer might be sprinkled\over with ozonized jequirity pulv. which will cause a complete exfoliation to take place, and stimulate it into a healthy condition. Then it might be healed up with ozone ointment. In the case of irritable ulcer it is indispensable that anodynes be administered freely, tonics and alteratives pushed. Indolent Ulcers.—Old ulcers of ten or twenty years' standing have generally a smooth, uneven surface, of a pale ashy color, like a mucous membrane. In some cases it may display a crop of weak fungus granulations. The edges are raised, thick, white insensible, either inverted or everted ; discharge scanty and thin and contains a few bacteria. Those ulcers may remain stationary for years, or take on at attack of irritability, and become in- flamed ; or may heal, and then suddenly give way. An irritation Bacteria in indo- Tubercular ulcer. Another form of tubercle lent ulcer. bacilli in an ulcer, in the body existing for years gives rise to a cachexia which is essentially tubercular. Treatment.—Before interfering at all with the ulcer, the patient should be placed upon a very active alterative and tonic treat- ment, with a varied diet, rich in blood elements, for a month or two. If the patient is feeble, the stramonium ointment and iodide of potass should be applied to the ulcer to soften and absorb the granulations and indurated edges. If he is in average health, the powdered or distillation jequirity might be applied to cause an exfoliation of its surface. Ointments made either of hydrastin, lycopodium, or pinol, or naphthaline, or aromatic sulphuric acid, or resorcin. Tubercular Ulcer.—The microbe of tubercle often blocks up the lymphatics in the neck, axilla, groin. Usually the bacilli crowd into the chain of lymphatics, two, three, or more; they aggregate together in nests, first in an albuminous form, then as they die in the lymphatics, they become milky, cheesy, and lastly calcareous; generally inflammation is excited at several BACTERICIDES. 1125 points in the lymph canals, cellular tissue, skin, giving rise to numerous openings, through which the curdy or cheesy matter exudes. These perforations communicate with each other in the cellular tissue, forming ugly puckered cicatrices on the neck or elsewhere, where they discharge and heal up. In all cases, the general treatment for tuberculosis should be enforced : glycerite of ozone, iodized oil, or ozonized iodine, sul- phur water, avena sativa. Locally to the sores, ozone ointment, sozoiodol, iodol, per- oxide of hydrogen, benzoin ointment. Varicose Ulcer.—An ulcer dependent upon a varicose condi- tion of the veins of the limb. The consequent venous conges- tion weakens the already debilitated parts, and renders them prone to ulceration. The ulcers are generally three or four in number, situated above the ankle. Oval in shape, indolent in their progress, neither extensive nor deep, but attended with considerable pain of an aching character. Treatment.—Get the general health into good order by tonics and alteratives, with abundance of good food and fresh air. Keep bowels regular, and attend to the skin by daily sponging. The internal and local exhibition of the witch hazel to tone up the veins ; an infusion answers the purpuse. The patient should wear an elastic stocking or bandage during the day. Before it is applied in the morning, limb to be bathed first with soap and water; then either tincture or infusion, or ozonized distillation of witch hazel applied; sore dressed with either black salve, vaseline or ozone ointment; over the dressing a piece of oiled silk; then an ordinary stocking, and, above all, the elastic stock- ing. The same should be repeated in the evening, but the elastic stocking need Hot be kept on during night, unless case is very bad one. Infusion of oak bark, alcohol, and salt, and other remedies are of no importance when we have the witch hazel. A cerate of calendula, or pinus, or of hazeline, are most effectual. Fistulous Ulcer.—Consists of a tube or narrow channel, lined by a false membrane, which is a secreting membrane, and which may, or may not, lead to a suppurating cavity. In old cases, the walls of the tube are dense and semi-cartilaginous. Fistula may be produced by a deep-seated abscess, not healed from the bottom, or by caries, or necrosis of bone ; or by the perforation of tissue by a mechanical irritant or obstruction, as a foreign body perforating through the walls of the rectum to the external parts. If there are several openings, or fistulae communicating with dead bone, it is folly to try to heal them. If the parts permit, they should be run into one opening, so as to give nature as little I I 26 DISEASE GERMS. work as possible in throwing off the dead bone ; or if due to the imperfect healing of an abscess, it should be slit up from the bottom and injected with peroxide of hydrogen. (See Fistula in Ano.) Phagedenic Ulcer.—This term is used to express a variety of ulceration which destroys the tissues more rapidly and to a greater extent than ordinary forms of ulcer. The subjects of this local affection are usually individuals who have been debili- tated by some severe febrile disorder of a typhoid character, or who have been subjected to the influence of cold and wet, foul air, bad and insufficient food, fatigue, and excessive indulgence in spirits. It is generally preceded by some sore or wound, and its local causes a»*e irritation of the open surface, and gross neg- lect of cleanliness. A very superficial sore, such as that formed by the application of a blister, may under the above-mentioned constitutional and local influences, rapidly become phagedenic and produce much destruction of the soft parts. It has been most frequently met with in connection with venereal ulcers, especially in those cases in which the parents have been submit- ted to a prolonged and excessive use of mercury. Phagedena varies in intensity in different cases ; it is somes so mild as to be scarcely distinguishable from ordinary ulceration, and in other instances it spreads with so much rapidity and destroys so great an extent of the surface of the body, that there seems to be very little difference between it and the affection xoyrsi^ known as hospital gangrene. This latter form 't^H'SifcM °f phagedena is met with in noma, can- ***§$&&£§$ crum oris, and the sloughing throat of scar- ^■HPsr latina. It is believed by some surgeons that %PrTngeeandbpfigedengaan" phagedenic ulceration is caused by poison- in^ of the blood, in consequence of the ab- sorption of putrid matter. In phagedena there is a' large and rapidly spreading ulcer, the edges of which are formed of sharply-cut, indented and undermined skin. The surface of this ulcer is uneven and of grayish color, and is covered by a dark-colored, thin and very fetid discharge, which is often marked by streaks of blood. The integument surrounding the ulcer is swollen, and of a dusky-red color. The ulcerative process is attended with severe gnawing pain. In the treatment of this affection it is necessary that the patient be supplied with good nourishment, and that alcoholic stimulants be given freely, but at regular intervals. Opium is generally ad- ministered for the purpose of relieving the severe pain, and of allaying nervous irritation. The patient should kept in bed in a BACTERICIDES. 1127 large and well-ventilated room. The bowels should be kept open by mild purgatives, but great care must be taken to avoid diar- rhea, as the subjects of phagedena may rapidly sink under any excessive drain upon the system. The local treatment consists in cleansing the surface of the ulcer by frequently syringing it with some disinfectant lotion, as a solution of carbolic acid, of per- manganate of potass, boroglyceride, or peroxide of hydrogen, and in relieving the pain by the application of poultices or poppy fomentations. In severe cases, where the ulceration, in spite of this treatment, is spreading with rapidity and attacking important parts of the body, the surgeon often finds it necessary to apply the actual cautery, or some strong caustic. Of caustic applica- tions, fuming nitric acid seems to be the most in favor. Bed-sores are large unhealthy ulcers formed over the hips, but- tocks and the lower part of the back of bedridden persons. They are due to long-continued pressure on these parts, to a vitiated state of blood, and to general debility, and are met with in the subjects of fever, paralysis, broken back and in very old people who have been in bed for a long time. In cases of paraplegia bed-sores are very large and deep and spread with rapidity. A' bed-sore commences as a dusky-red patch on the skin, which be- comes excoriated. After the separation of the cuticle the sur- rounding soft parts become swollen, and the inflamed integu- ment is converted into a gray or black slough, from the under surface of which there is a discharge of thin matter, and the mi- crobe of phagedena. This sloughing process extends both su- perficially and deeply until a large cavity is formed, which, in some instances, exposes bone. In old or very debilitated sub- jects death is frequently the result of this affection. Except in cases of palsy and broken back the existence of a bed-sore bears witness to the incompetence or carelessness of the nurse. In cases of long continued illness and confinement to bed injurious pressure on the back and hips may be prevented by the use of soft pillows and air and water cushions, and by a constant atten- tion to cleanliness. Same treatment as phagedena. Gangrenous Ulcer—Hospital Gangrene.—Gangrenous and ul- cerative processes which attack wounds and stumps after ampu- tation, when the patients are collected together in great numbers and are placed under faulty hygienic conditions. Hospital gan- grene in all its forms is both contagious and infectious, and seems in some instances to be due to epidemic influences. It is very prevalent among armies during military operations, and when 'arge numbers of wounded soldiers are collected together in buildings unsuitable in size and internal arrangements for hos- 1128 DISEASE GERMS. pital purposes. The disease has often made its appearance with- out any known cause in one or more American hospitals. It at- tacks small as well as large wounds, and even blisters and leech- bites, but is never met with in perfectly sound individuals. In the most severe form of hospital gangrene a small livid spot or bleb makes its appearance on a stump, or near the margins of a wound, which had previously been closing favorably. This bleb increases rapidly in size, and converts the extremity of the stump or the whole of the wound, with the surrounding healthy skin, into a black and swollen gangrenous mass. The disease spreads rapidly, and is associated with constitutional symptoms of a low typhoid character. At other times a stump swells and becomes hard and very pale, and its surface is marked by large blue veins. This form is also attended with severe general symptoms and much pain. Like the preceding one, it is generally fatal. In the less severe forms the surface of a wound is covered by a thick, yellow, and adherent crust, which increases rapidly both in depth and superficial extent. This disease has been met with chiefly in Europe, and is there known by the name of diphtheria of wounds. The constitutional symptoms are not so severe as those of the strictly gangrenous forms, and the fever, if it be present, is gen- erally high and of an inflammatory kind. The general treatment should consist in supporting the strength of the patient by tonics, stimulants, germicides and nourishing diet. In the diphtheritic form, however, the diet should be moderate, so long as there is high fever, and alcoholic drinks should not be given freely. The local treatment is generally directed towards arresting the spread of the gangrene by the application of bactericides of great power, charcoal, yeast, resorcin, chlorinated soda, boroglyceride. Syphilitic Ulcer.—A breach of continuity in which the venereal bacillus appears. When not due to a specific inoculation, they The venereal bacillus eating the dorsum of the Pus from syphilitic ulcer »'ith the hand—forming a duplicating ulcer—which venereal bacillus and streptococ- healed kindly under resorcin and ozone cus pyogenes, magnified u5° ointment. diameters. are usually met with on the legs, occasionally on the thighs and arms. The annexed diagram was photographed from a living subject, made a rapid cure under saxifraga and resorcin oint- ment. BACTERICIDES. II2 Malignant Pustule (Anthrax).—Becoming very common, from importation of foreign wool, hides ; and the operatives in such are often fatally affected. It begins as a little _,_N \ ^ \ ~> dark red spot, with stinging or pricking pain, J \ N,vN . on which a vesicle and then a pustule, seated " V V|L^ on a hard, inflamed base. When this is opened \ V"*; \M it is found to contain a slough as black as c r .„ , . i . , . r ° . , . Spores of the bacillus charcoal, which is a mass of giant bacteria. anthrax from a pustule There are likely to be more than one, and to Zle^J^t spread with great rapidity, and the system ^meters. becomes affected; or there may be systemic poisoning first, from the workers breathing in air loaded with the diseased germs. Butchers are often affected. The stomach, from its important functions, con- Ulcer, trolling the whole system of nutrition, merits [Gastric) greater consideration than it is apt to receive at the hands of many. Any disease of such an organ implies so much interference with all other functions as to pre- clude, in great measure, their proper fulfilment. Even the func- tions of the brain are intimately dependent on those of this organ. Common acute inflammation, such as often affects other organs, is rare in the stomach, except when excited by some powerful ir- ritant swallowed. On the other hand, the slighter form of irrita- tion, commonly called gastric catarrh, is much more common than is supposed, and is, indeed, the ordinary form in which the stomach resents ill-treatment; ordinarily, this form of malady is reckoned as indigestion merely. Dyspepsia, as well as inflammation, is productive of ulcer. The two most important maladies of the stomach are simple and malignant ulceration, the latter commonly going by the name of cancer. Cancer of the stomach—a painful and intract- able malady—commonly affects one or other of the orifices of that organ, and of the two, by far the most frequently that next the bowel called the pyiorus. Disease in this region interferes sadly with nutrition, prevents the half-digested food from passing on- wards in the digastric tract, and so starves the patient. As a consequence of this obstruction, too, the organ commonly be- comes dilated, the food, only half digested, collects and putrefies, and so vegetable organisms form in it. After being retained in the stomach for a time, giving off foul-smelling gases, the whole contents are ejected—a foul-smelling, black-looking mass, often resembling coffee grounds. The pain at these times is severe, but not at others, the great want felt being really a want of 1130 DISEASE GERMS. food. In the simple ulcer of the stomach there is also, as a rule, vomiting, but the part most frequently affected being the poste- rior wall at some distance from either orifice, there is not that regularity in its occurrence there is in cancer. In simple ulcera- tion of the stomach there is one serious danger always possible, that arises from bleeding. The shape of the gastric ulcer is mostly round; if several make their appearance and coalesce, it is irregular, and occasion- ally belt shaped. The shape at first is nearlv always round ; after existing for a time the ulcer becomes elliptic or gets small notches, and thereby becomes irregular. The ulcer spreads mostly in an oblique direction, there- by occasionally encircling the whole stomach like a belt. Perforating ulcer of the if tne ulcerated process goes on until siomach. i , f 11 11. the ulcer reaches the deeper and larger blood vessels of this organ, it is quite possible for one of these to give way before it is closed at either extremity, and so the blood is poured out from it so rapidly that life is endan- gered. Most frequently under such circumstances the blood is vomited, and this vomiting of blood may be the first symp- tom of danger. At the same time, however, the blood will in part pass into the bowels, and being there partly altered and blackened, is so discharged. This constitutes melaena, vomiting being termed haematemesis, Often it is not easy to diagnose between the simple and malignant variety of ulceration, though this is important, the simple form being tolerably amenable to sound treatment, the malignant not at all so. When bleeding does occur it constitutes a danger so serious as to demand instant attention, for if the bleeding does not stop the patient will die. Frequently, too, it will be found that the bleeding recurs again and again, tasking the resources of the physician and the strength of the patient to the uttermost. Here are the rules to be adopted. The patient must be kept at absolute rest, and ice given freely. Let the patient crush the ice roughly with the teeth, and swallow it in lumps. Let ice be placed outside the body over the stomach. The best thing to give is dry cham- pagne, in small quantities, well iced ; if that is not to be had, iced brandy and soda, only the smallest quantity of brandy. The best medicine is gallic acid, made into a paste with water, twenty or thirty grains for a dose, with perhaps ten or twenty drops of dilute sulphuric acid. There are a score of other remedies, but these are the best, and as a rule will succeed if any will. But as regards food—there is the real difficulty. Well, it is best to face BACTERICIDES. 1>3' it from the beginning, and give no food by the mouth, but only nutrient enemata. If the case is severe, that is the best plan ; in slight cases a little milk, iced, is best to be given. But in all cases of real difficulty, there is nothing like nutrient enemata— strong beef-tea. The bowels ought, however, to be well washed out with soap and water before administering the injection. Disease germs are productive of ulceration of the stomach, and it is quite certain that by lavage of the stomach thev can either be discharged or washed out. This is a valuable aid to medical treatment. It is well to bear in mind that the symptoms of gastric ulcer in middle-aged persons, differ very considerably from those which have occurred early in life, though the symptoms consist chiefly of pain, tenderness, vomiting, and haematemesis. The individuals are no longer simply anaemic, but are often cachectic and wasted. The pain is often much less acute, and the sickness much more frequent and distressing. There is generally great tenderness over the region of the stomach, and the matter which is brought up is intensely acid, and contains quantities of blood, sometimes in the form of clots, but more often presenting the coffee-grounds form. In such cases there is often great difficulty in distinguishing between gastric ulcer and malignant tumor of the stomach, and indeed the diagnosis can only be arrived at with certainty after the case has been for some time under treat- ment, and the absence of a tumor has afforded further indications of the non-malignant character of the disease. At the present time it is rare to find death occurring from perforation in cases of gastric ulcer, and yet it has been estimated that the propor- tions of death by perforation is something like fifteen per cent. Largely, this result is due to improved methods of treatment, and to early recognition of the disease, but it may be doubted, even at the present day, whether as much is done in the shape of treatment, as might possibly be accomplished. One of the most important points to be borne in mind is to insist on the importance of simple physical rest. A physician is very com- monly called upon to deal with two very distinct classes of in- dividuals; those occupying a bed in hospitals, and those who either go to his out-patient room, or consult him at his own house. The greatest rapidity of recovery is always to be found amongst those who are kept quietly in their own beds. It is extremely difficult to convince people that this is really an advantage. So long as individuals can move about at all, and more especially if they can move about with any ease and comfort to themselves, they are extremely loath to lie quietly in bed. It is only a very few who will place such complete reli- 1132 DISEASE GERMS. ance on the instructions of their physician, as to allow him to carry out to his heart's content, treatment by rest. It is ex- tremely difficult to lay down what particular forms of food should be taken or rejected, but most experience shows, though of course many instances to the contrary might be quoted, that all forms of uncooked food, meat, stimulants, and things generally known to be indigestible, must be prohibited. Some can take milk, some eggs, some farinaceous foods, whilst some seem to be specially irritated by them. As far as possible, it is desir- able to insist on rectal alimentation. The value of the treatment of drugs depends largely upon the amount of an accompanying gastric catarrh. It is very much the fashion at the present day to give alkalies, usually in the form of carbonate of soda, com- bined with a little iodide of potassium, and. possibly some opium, If symptoms of hemorrhage supervene, it is obvious that all the more need exists for care in treatment; but the subject of treatment is so large a one that we must briefly epitomize it. First, as to the alimentary canal. In their abnormal conditions, the digestive organs present a nidus peculiarly favor- able to the development of the lower or- ganisms, and 1 believe that many, if not most, of the annoying phenomena of in- digestion depend on fermentation and putrefaction of their contents. An in- digestion originally dependent either on some passing condition of the primae viae, or on some solitary indiscretion in diet, is often indefi- nitely prolonged by the development of torulae, sarcinae, and other {microphytes. The acids and gases evolved by their baneful activity confirm a condition that otherwise would be evanescent, The delayed digestion of the so-called atonic dvspepsia, I am convinced, is often due to the excessive acid- ity of the stomach contents, which, in its turn, is due to the growth and activity of torulae and sarcinae. By the destruction of these microphytes, or even by the temporary inhibition of their activity, we greatly relieve, if we do not cure, the dyspeptic; and certainly in those cases not dependent on incurable organic lesions, we make a long stride towards cure. But how destroy these microphytes, or inhibit their activity? Chiefly by the internal use of germicides. Those best adapted to this purpose are, so far as my observation extends, peroxide of hydrogen in the fluid ext. of hydrastis or columbo, or liquor cerii. Ducts and acini similar to the pyloric glands and the fine, richly cellular connective tis- sues forming the inter-tubular stroma in microbes. BACTERICIDES. "33 Of these, the liquor cerii is probably the most suitable in the majority of cases. It is efficient. It is a digestive as well as a general tonic. By its gradual solution, its action is prolonged, and even extended into the intestine. It is easy of administra- tion. Thus we see that it answers a number of indications most admirably. It should be administered in about thirty-drop doses, three times a day, and always after meals. Hand in hand with this, of course, should go the proper se- lection of foods, their thorough mastication, and the use of di- gestive and general tonics, such as pepsin, the vegetable bitters, and especially moderate quantities of alcoholic stimulants. In dilatation of the stomach, the administration of the appro- priate germicide should be preceded by a thorough washing-out of that viscus. Authorities recommend the use, before meals, of the mineral acids in cases of excessive acidity, and of the alkalies, in deficient acidity, of the stomach contents. This advice, as they say, is based on the physiological fact that alkalies increase the secre- tion of the stomach acids, while, on the contrary, acids diminish it. This explanation has always seemed to me a little strained, and especially so, since the demonstration of the germicidal power of the mineral acids. Were it the true one, excessive acidity should be its own remedy. The excessive presence of the normal acid, I believe, is very rarely a cause of acid indiges- tion; on the contrary, the acid of acid indigestion is the acid ot fermentation. With this view, the explanation of the efficacy of the mineral acids before meals, and of their failure after, is very simple. Administered on an empty stomach, their degree of concentration is sufficient to be germicidal, while on a full stom- ach, it is insufficient, and so the would-be remedy aggravates the trouble by adding its own acidity to that already existing. The value of the mineral acids in this condition is not solely dependent on their germicidal powers; muriatic acid and nitric acid in a less degree assist in the digestion of the albuminoids, and by their astringency give tone to the debilitated mucous membranes. Muriatic acid before meals, therefore, is one of our most valu- able resources in the treatment of acid dyspepsia. The bisulphite of sodium in full doses or in divided doses, re- peated as necessary, is especially adapted to the treatment of those cases of acute septic indigestion, otherwise known as bilious attacks. It occurs to me that perhaps in these very cases it was, that calomel, as an unsuspected germicide, acquired its false reputation as a cholagogue. If administered in the very outset, both experience and observa'tion assure me that bisulphite i'34 DISEASE GERMS. of sodium will often abort these distressing attacks. Here it is best given in drachm doses, dissolved in mint-water to mask its abominable taste. It must be fresh so as to contain an excess of sulphurous acid which is liberated in the stomach, and on which its efficiency depends. Lavage is an important element in the treatment of gastric ulcer. Lavage is thus performed. An oesophageal tube, with a blunt double-eyed extremity, made of flexible-rubber, 28 inches in length, and from a % to ]/2 an inch in diameter, is attached to a small section of glass tubing, which is also attached to a yard of soft rubber tubing, into the free extremity of which, a glass funnel capable of holding eight ounces should be inserted. This oesophageal tube well-warmed and oil, should be passed down the oesophagus in the usual manner, the patient aiding all he can by attempts at deglutition. When the stomach has been reached the funnel is raised above the patient's head, and from a pint to a quart of the lavage solution is slowly poured in, ob- struction or regurgitation being noticed by the glass tube joining the two tubes. When sufficient of the lavage solution has been introduced, the funnel is lowered and inverted over a basin. While making this change compress the tube ; when the change is made, relax it; freed from the pressure, the tube becomes a syphon, and the contents of the stomach is rapidly removed. If there be irritability to the passage of the tube, smear its edges with cocaine ointment, and if patient be very nervous, ex- tract of musk-root to be given. With regard to the solutions used; as simple lavements, infu- sion of slippery elm and resorcin; boroglyceride; creosote, one- per-cent. ; carbon bisulphide; charcoal; creolin ; naphthaline. The strength of the various solutions must be carefully regu- lated. In some cases, as with slippery elm, or wild indigo infusion, they may be permitted to remain. Any irritability must be over- come by painting the fauces and throat with cocaine. The different forms of ulcer of the larynx Ulcers of the may be embraced under the following heads: Larynx. Catarrhal; follicular; diphtheric; tubercular; syphilitic, and other forms due to the micro- organisms of the eruptive fevers. The tubercular and syphilitic are the most common. Catarrhal ulcers are not infrequently associated with nasal ca- BACTERICIDES. "35 tarrh, and are usually superficial, as they are round, then oval and gradually, as the germs burrow (amaeba), become more exten- sive in size, and more numerous ; often coalesce, become large with irregular outline. The follicular ulcer as a rule, is superficial with a limited area of extension. The tubercular ulcers are either superficial or deep ; most com- monly met with at the inter-arytenoid commissure, generally associated with laryngeal tuberculosis. The deficient vascularity of the pale and thickened arytenoids favors the occurrence of those ulcers. They have their inception in a neurosis, a general bankrupt state of the nervous system, the evolution of'the bacil- lus tuberculi which causes deep destruction, calcification and ne- crcsis of the laryngeal structures, which is usually aggravated by discharges from the bronchi or lung, independent of degenera- tive changes and tubercular nodules. Syphilitic ulcers of the larynx depend greatly on the general health, if vital energies are greatly exhausted, the mucous mem- .^^^S& Syphilitic microbe as found in the scooped-out copper-coiored ul- cers on the larynx. i"€». The albumen in the urine in certain cases may be derived from the blood from the presence of disease germs in the kidneys. Urinary Sugar.—When the urine contains much glucose or grape sugar it is of a pale, yellow color, sweetish taste, and vast in quantity. Its specific gravity is nearly always high, generally between 1030 to 1065, an isolated case, one in a thousand, where it is as low as 1010. When persis- tent, large in quantity, it indicates a grave pathological lesion, diabetes mellitus. It is often met with temporarily in nervous shock, chronic alcoholism, eczema. In normal urine a minute quantity of grape sugar is present, but it is so very small that none of the ordinary tests can detect it. Sugar in an abnormal amount constitutes the pathological condition termed glycosuria. The qualitative tests for urine containing sugar depend upon the coloration caused by boiling with caustic potassa; upon the power grape sugar possesses of reducing hydrated oxide of cop- per; and upon the evolution of carbonic ac»d gas, when fermen- tation is set up by the yeast plant. In all cases, if albumen be present, it must be got rid off by coagulation by heat and filtration, before any other test is applied. /. The Caustic Potash Test.—Mix one ounce of urine with the same quantity of caustic potassa, boil the mixed fluids in a test-tube over the flame of a spirit lamp. If sugar is present it will assume a dark brown color. 2. Sulphate of Copper Test.—Take a certain quantity of urine in a test-tube, add to it one-third of its volume of liquor potassa, and then a drop or two of a saturated solution of the sulphate of copper, the precipitate which falls will re-dissolve if sugar be present, and more of the copper solution must be added, until a small quantity of the hydrated oxide remains as a precipitate. On boiling this mixture, a yellow color will show itself if sugar be present, and will pass into a reddish yellow granular precipi- tate of the sub-oxide of copper. j. Fermentation Test.—Under the influence of yeast, grape sugar breaks up into alcohol and carbonic acid, and this evolution of carbonic acid has been made the basis of a test for sugar. It is readily performed. Take two test of equal size, fill one with the suspected urine and the other with water, adding to each a s-nall piece of yeast, cover them with saucers, and then invert tium. If sugar be present in the urine, carbonic acid gas will BACTERICIDES. "55 collect at the upper part of that test-tube. A few bubbles of gas may come from the yeast itself, but the second test-tube contain- ing water, will show these also, so that any mistake is hardly po-^ible. This test is not very sensitive, as it only shows sugar, when it is largely in excess of two grains to the ounce. 4. Fehling s Test Solution for Sugar in Urine.—It is prepared in two solutions No. 1. Dissolve 17.32 grams (267 grains) pure crystals copper sulphate; water 250 c. c. (6 fl. ozs.) No. 2. Dissolve 86.5 grams (1328 grains) pure crystals Rochelle salts; sodium hydrate solution sp. gr. 1.12 250 c. c. (3 fl. ozs.) These two solu- tions are mixed in equal volume when used. This is the most delicate and reliable test for sugar in urine, being quantitative and qualitative. The copper in 100 c. c. (25 5) is precipitated as cuprous oxide by 0.5 grams (7^4 grains) of glucose. How to Use It.—About 20 c. c. (5 5) of Fehling's solution are put in « test-tube of four or five times this capacity, heat it slowly over spirit lamp to the boiling point, then gradually add the sus- pected urine slowly in quantities often to fifteen minims, let boil after each addition. If sugar is present the following changes in the color of fluid takes place: it first becomes slowly yellow, turns to red, the beautiful green of the normal fluid is rapidly disappearing, during the whole the red cuproits oxide is being •formed and precipitated; after standing half an hour when the heat is discontinued the precipitate falls to the bottom of the tube, and the fluid is nearly colorless if the reactions have been so com- plete as to have converted all the copper and all the sugar in the urine has been used up in the process. These reactions are de- veloped in fulness in proportion to the quantity of sugar in the urine. If the quantity is very considerable it is advisable to dilute the urine with an equal volume of water. It is best to test this urine for albumen, which, if present must be taken out by precipitation and filtration, then the-clear urine is tested for sugar. It is always in order to test Fehling's solution by heating to the boiling point; if it remains clear and free from any precipi- tate it may be trusted. It is well to recollect the worst cases we have to treat are those in which the quantity of sugar continues considerable while the patient is on a pure nitrogenous diet ex- clusively. Those cases in which the quantity of sugar daily passed in the urine is decreased in proportion as amylaceous and saccharine food are withheld, and the effect of medicaments is satisfactory, are curable. Never lose sight of the vast import- ance muscular exercise, and plenty of it, is to such patients. Take a small quantity of that solution in a test-tube, heat it to boiling, and then add a few drops of the suspected urine. If sugar be present, reduction of the copper in Fehling's solution 1156 DISEASE GERMS. will at once take place, giving rise to a red precipitate. If the solution be always boiled previous to the addition of the urine, no error can occur as to the result. It is somewhat difficult to estimate the quantity of grape-sugar in a given amount of urine either by any method of analysis or even by the polarimeter. Bile.—Urine containing bile varies in color from a deep red- dish brown to a dark green, acid reaction, high specific gravity. The coloring matter of the bile, such as bilirubin, biliverbin, biliverdin are the portions which appear in the urine in disease. It is found in jaundice and all morbid states of the liver or gall-duct. Its presence is very easily detected when the urine, which con- tains the pigment bile, comes in contact with nitric acid in a play of colors. Place some of the pigmented urine in a conical glass, permit it to stand a little while to settle, then drop gently down the edge of the glass a little nitric acid, when a series of colored rings will form in the following order: Yellow, violet, blue, green. Bile acids are found in the urine in considerable quantity in hepatogenic icterus. In a small quantity of this urine dissolve a little sugar, then dip in it a strip of filter paper and permit it to dry. If now a drop of sulphuric acid be allowed to fall on the paper a purple ring will appear round it. Lactic acid is found in the urine in diabetes, yellow atrophy of the liver, trichinosis, osteomalacia. Fat.—Fat is occasionally met with in the urine, when present it gives that fluid a milky appearance; as it is generally associated with abumen it forms an emulsion, a sort of coagu- lation, and in a short time standing it rises to the top Q C^)^^0k and disappears by the ad- ^ O / y (S$B dition of ether. Under the A/5°°^n VJil^kJA^^ microscope minute globules ^ O °Q W^MzM^/tiS of fat are seen, usually in- 000 -n S^^^&Smgt terspersed with lymph and r\ ° rf^^^lw> blood corpuscles. Fat glohules from Leuc.n and Tyrosin. LeilCVl Mid 1yrOSm.—fW chylous urine. A, globules of leuctn; Substances found in the urine, often in large quanti- ties, due to the prolonged action of the pancreatic ferment upon the nitrogenous elements of the food. Leucin appears either in the form of white crystalline scales, BACTERICIDES. "57 freely soluble in water, or as small round yellow bodies, looking like fat cells. Tyrosin is in the form of white masses consisting of long shiny needles arranged in star-shaped groups. Leucin and tyrosin ap- pear in those diseases in which oxidation is very greatly impaired, such as acute yellow atrophy of the liver, typhoid fever, small-pox and in hepatic diseases generally. Urates.—The amorphous deposit of'urates which is so fre- quently met with even in healthy urine, consists chiefly of urates A '\n-:-.-;:-r- -is ' ^v- Urate of soda. A, amorphous gran- ules in clusters, resembling moss : B, granules in strings, sometimes mistaken for granular casts x 250. Urate of ammunia. of soda, of potassa, magnesia, ammonia. To the naked eye the deposits of amorphous urates has a reddish brick dust color, due to pigmentation with uroerythrin. When the urine has been allowed to stand in a glass for some time, and deposits those urates, a peculiar bloom may be seen on the sides of the glass when it is bent over at an angle of 45 degrees, which is a characteristic, and un- mistakable sign of the presence of urates. Microscopically this deposit appears amor- phous and finely granular. On warming the microscopic slide, the sediment be- comes dissolved, and it separates out again on cooling and the same reaction can be seen in a test tube. In health, a deposit of urates often oc- curs afer profuse perspiration and violent exercise. It is abundant in all febrile and inflammatory affec- tions, in organic disease of the heart and liver. Oxalate of Calcium.—Calcium oxalate is often held in so- lution in the urine, but when it is precipitated it takes one of Oxalate of Calcium ; the oc- tahedra, most frequently present, are seen on the left. The comparatively rare form of dumb-bells is also shown, x 250. 1158 DISEASE GERMS. two forms, either a small, colorless, sharp-edged octahedra crys- tals, or dumb-bell shaped crystals. To the naked eye the deposit appears as a white, undulating, clearly defined layer, resting upon a grayer deposit beneath. Oxalic acid is much increased by the consumption of sugar and of such vegetables as contain it, as rhubarb. It is the last stage of the decomposition of effete tissue, the result of impeded metamorphosis. Oxaluria or oxalate of lime in the urine is accompanied with a well marked train of symp- toms. The affected individual is emaciated, very nervous, ex- tremely hypochondriacal and irritable—pain in the loins, irritability of bladder, muscular weakness. The crystals of oxalate of lime are found in cases of disturbed respiration, emphysema of the lungs, rachitis, epileptic convul- sions. Cystine.—A white crystalline body derived from the liver, is not often found in the urine, but when it is present, it presents itself in the form of hexagonal plates, which are of a neutral re- action and can be dissolved by caustic mineral alkalies. When this substance appears in the urine it is apt to give rise to cal- culus. The pathology of cystinuria is very obscure. Mucus.—A small quantity of mucus is present in normal urine ; but in such affections as catarrh of the bladder, prostrate, urethra, it is greatly increased. It is of importance always to distinguish between mucus and pus in the urine. This is readily done by eg, filtration, when, if pus be present, the fil- ja. tte. ® mt^ trate will give the reactions of albumen; but if it contain mucus, it will give that which is characteristic of mucin, that when acidulated with acetic acid a precipitate of mucin separates out in the cold. @ Pus corpuscles when present in urine ^B (*), give it the appearance of having a deposit (♦) ® (D © °^ white yellow flocculent substance, ga easily recognizable to the naked eye; mi- ^ croscopically, as a rule, present their normal ^rii^seen^rur^r^'rhe appearance; but if the urine be strongly same, treated with acetic alkaline, they tend to run together and acid, x 300. - , J ™° . ■ form a homogeneous mass, lo ascertain whether it is pus or not, it is only necessary to add either a small piece of caustic potass or liquor potass, stir with a glass rod; if the sediment be formed of pus it will become tenacious, glassy, and semi-solid. Another test for pus is, bring a few drops of peroxide of hy- drogen into contact with the pus, an effervescence will take place. BACTERICIDES. "59 This action continues till all the pus is destroyed so that it cannot be recognized microscopically. The presence of pus in the urine is a sure sign that there exists either an acute or chronic inflammation at some part of the uri- nary tract, as a stone in kidney with renal abscess, pyelitis, cystitis, or urethritis. Earthy Phosphates.—The earthy phosphates are the most com- mon sediment met with in the urine, when the urine is alkaline they are never absent; they present themselves as the ammonio- magnesium, or triple phosphates, or as the phosphate of lime. During the stage of alkaline fermentation the ammonia produced combines with the phosphate of magnesium present, and the result is that the crystals of the triple phosphates, being insoluble in an alkaline fluid, are thrown down in large quantities, as are also the crystals of the phosphate of lime ; the separation of the latter de- pending upon the presence of the fixed alkalies as the carbonate of soda. The crystals of the triple phosphate vary according as they are the result of rapid or slow crystallization ; in the former they assume a feathery form, looking like two crystals crossing each other at acute angles ; in the latter they appear as triangular prisms with bevelled edges. The phosphate of lime forms a whitish flocculent deposit, which is not dissolved bv heat, but passes into solution by the addition of a drop or two of nitric or acetic acid. Under the microscope this deposit is seen to consist of phosphate of lime. fine granules, usually arranged in irregular groups. In microscopical appearance they closely resemble amorphous urates, but the reaction of the urine will at once in- dicate their nature. A sediment of the earthy phosphates does not of necessity show that there is an abnormal amount in the urine, but it shows an alkaline state of the urine, and points out in most emphatic tones a too rapid metamorphosis of brain and bone, and the pos- sible danger of the formation of phosphatic calculi. Chlorides.—The chlorine which is contained in urine exists in combination with potassium, sodium, ammonium, magnesium or calcium. The presence of these chlorides may be detected by adding to a small quantity of urine in a test tube, a few drops of nitric acid, and then a small quantity of a solution of nitrate of silver. A white flocculent precipitate at once falls, containing mainly chloride of silver, but also containing combinations of silver, with uric acid, creatinin, xanthin, and urinary pigments. 1160 DISEASE GERMS. The average quantity of chlorine excreted in the urine in 24 hours is about 100 grains. It is increased by the consumption of salt and copious drinking of water. The diseases in which we have the largest diminution of chlor- ides are all fevers and inflammations, except those caused by malaria. Sulphates.—The sulphates which are found in the urine are derived from the breaking up of albumen, either that of the tis- sues, or that which is contained in the food. Sulphuric acid ex- ists in the urine in two fornix; either in combination with the alkalies, or in the form of aromatic ether-sulphuric acid. Both of these aromatic bodies, when heated with hydrochloric acid, break up into phenol or indigo and sulphuric acid. Acetic acid does not cause this decomposition. To detect sulphates, acidulate a portion of urine strongly with acetic acid, then add the chloride of barium in solution, then there will be immediately precipitated the sulphate of barium, representing the sulphuric acid, which was combined with the alkalies. The amount of sulphuric acid passed daily is about 30 grains, It is increased and diminished according as more or less albumen is broken up, and therefore corresponds with the quantity of urea and uric acid, both in health and disease. Phosphates.—In normal acid urine phosphoric acid is met with in the form of phosphates of the alkalies, sodium and potassium, and calcium and magnesium. It may appear in the form of glycerin-phosphoric acid and lecethin. About 50 grains of this acid are elimi- nated in the urine every 24 hours. It is enormously increased in all nervous dis- eases and also in morbid states of bones; much diminished in all fevers and inflam- mations, and excessively so in pneumonia and interstitial nephritis. When the urine loses its carbonic acid by being heated, the earthy phosphates separate out as a white flocculent precipi- tate, which becomes re-dissolved on the addition of acid. The addition of am- monia to urine causes an amorphous pre- cipitate of the phosphate of lime, while the phosphate of magnesium unites with the ammonia-magnesium-phosphate (triple phosphate), which appears in a crystallizable form. Phosphates in the urine represent the precise amount of tissue Triple phosphate. BACTERICIDES. I 161 change or waste of brain and bone ; in other words, they are but the ashes of the nervous and osseous system. In chronic bone and nervous diseases the phosphates are increased excessively. The food consumed has a marked effect, an animal diet giving rise to more excretion than vegetable. In constipation the earthy phosphates are much increased. To estimate the quantity of phosphates, take a given quantity of boiled urine, say four ounces, then add a solution of nitrate of silver, which will precipitate the phosphates. Then either per- colate through blotting paper, or evaporate the watery portion ; the remaining powder, well dried, and weighed, will give the phosphates. Epithelium.—The epithelial cells in the urine are best seen when stained with eosin or fuchsin. They may be derived from any portion of the urinary tract. The epithelium of the urinary tubules consist of round or polygonal cells, each having a large and sharply defined nucleus. Those of the pelvis of the kidney are conical, with one, or sometimes two tail-like processes. The large irregular pavement epithelial cells, which are often seen in the urine, come from the bladder or vagina. Peptone.—The presence of peptone in the urine is in yellow atrophy of the liver, en- teric fever, pheumonia, systemic syphilis, phosphorus poisoning, cancer of the stom- mach, and in abscess, phthisis. The appearance of peptone in the urine is to be explained on the supposition that when it passes into the blood it does not undergo the usual change, and so reaching the kidneys as peptone, it is excreted as Epithelium from urinary such. deposits- To detect peptone in albuminous urine, the albumen must be completely separated by means of acetic acid, boiling and filtra- tion, and then by the addition of hydrated oxide of lead, the lead being subsequently removed by sulphuretted hydrogen. This process must be repeated until no trace of albumen can be detected by the ferrocyanide test. The peptone in the filtrate is then precipitated by means of a solution of tannin, the precipi- tate collected and washed, the tannin removed by means of the hydrate of baryta, and the baryta by means of dilute sulphuric acid. ! io2 DISEASE GERMS. Renal Tube Casts.—Before examining the urine for tube casts, a specimen should be allowed to stand in a conical glass for t.wenty-four hours, at the end of which time, a few drops of the sediment may be raised by means of a pipette, and examined microscopically. Staining with eosin will make the tube casts more distinct. Renal tube casts are almost always associated with albumi- nuria, or Bright's disease, although they often appear when no albumen can be detected in the urine. They are, as their name implies, casts of the renal tubules, in the majority of cases of the convoluted tubules of the cortex. The chief forms of tube casts are the follow- ing: i. Epithelial Casts.—In these the fibrin- ous cylinder has become covered over with epithelial cells, which have been de- tached or exfoliated from the lining mem- brane of the tubule. These cells may be more or less cloudy and swollen. Such tube casts are peculiar to Bright's disease. 2. Pus Casts.—Casts containing in them pus corpuscles, are diagnostic of glomerulo-nephritis. 3. Fatty Casts.—Very frequently in fatty degeneration of the kidneys, do we find oil globules studded in the casts. Epithelial casts. Fatty casts, x 25c Grai.ular casts. A, large granular casts; B,small finely granular cast'. 4. Granular Casts:-—Dark opaque granular casts are also the result of epithelial degeneration in the renal tubules. 5. Blood Casts?— Many consist wholly or partially of blood; the corpuscles being closely adheient to one another, or fibrinous casts may be seen containing one or two blood corpuscles im- bedded in them ; such casts point to capillary rupture, as in acute nepritis. 6. Hyaline Casts, are structureless, transparent cylinders, having a tendency to fracture transversely, and are derived from BACTERICIDES. H63 the fibrinous exudation which has passed through the degene- rated walls of the renal vessels and coagulated in the tubules ot Blood casts. A, collecting tube blood casts; B, mu- cous casts. Hyaline casts. A, delicate hyaline casts ; B, < ense, so-called waxy casts. the kidneys. Small hyaline casts are present in the incipient degenerative stage of Bright's disease, whereas, the larger casts are to be seen in the chronic form. Occasionally hyaline casts may be found, which exhibit the amyloid reaction, becoming reddish brown on the addition of iodine, and dirty violet on the further addition of sulphuric acid ; and giving a beautiful violet, with methyl green. Waxy and amyloid casts are more strongly refractive than the ordinary hyaline variety, and being less flexible, they ex- hibit deep fissures where they have been torn asunder in passing through the straight tubules. Blood.—Blood may be found in the urine as such (haematuria) or blood corpuscles, or blood pigment may be present (haemoglobinuria), and these two conditions are readily distinguished by the fact that in the former case blood cor- puscles are found on microscopical examination, while in the latter they are absent. A very small quantity of blood in the urine gives it a peculiar smoky appearance. When blood is present in a larger quantity the urine becomes bright red or dark brown. Small quantities of blood are best detected by the microscope, but when no corpuscles or crystals of haematin are present, recourse should be* had to the spec- troscope. In cases of haematuria it is important to ascertain from what point in the urinary tract the blood comes, and this is not usually difficult. The hemorrhage may come : 1. From the urethra.—The blood is mixed with the first por- tion of the urine voided—often being expelled as a long clot, and it continues to flow in the intervals of micturition. Blood. A, Swollen red corpuscles seen in urine of low specific gravity; B. Crena- ted corpuscles from dense urine, x 2=0. 1164 DISEASE GERMS. 2. From the neck of the bladder, or prostatic portion of the urethra. In this case, the blood usually appears at the very end of micturition, when the sphincter vesicae begins to contract. 3. From the bladder.—The biood is usually coagulated, and is passed in clots as large as the calibre of the urethra will allow to escape. 4. From the ureters.—In this case, the blood often appears in the form of long worm-like clots, which are casts of the ureters, 5. From the kidneys.—When the blood comes from the kid- neys, it is generally equally diffused through the urine, very rarely in large quantities ; when the urinary sediment is exam- ined, there are found tube casts, usually containing blood-corpus- cles. Hemoglobinuria appears in the urine in such diseases as pur- pura, scurvy, pyaemia, typhus, small-pox, etc. Results from a breaking down of the red corpuscles in the bloodstream, and the consequent liberation of the hemoglobin they contain, when it escapes into the urine. In malarial germ-laden blood it is often periodic, its appearance ushered in with a chill. Micro-organisms.—Living matter, degraded bioplasm, disease germs, or microbes, lower class of organism are found in the urine; passed in the urine as it leaves the body. In all diseases due to the presence of a micro-organism, as measles, scarlatina, variola, cancer, tuberculosis, syphilis, typhoid and other fevers, etc., the urine has a peculiar condition, termed bacilluria, in which it is opalescent when passed, from the enormous number of bacilli present. The reaction is acid, and when the urine has stood for some time, the microbes sink to the bottom of the glass, leaving the supernatant fluid clear. Very rarely do we find the embryonic form of parasites which infest the blood present in the urine. Fully-developed hydatids and echino- coccus, or only portions of these, may appear in the urine, having been devel- oped at some portion of the genito- urinary tract. The microbe of malaria, the sarcinae and yeast plant of gastric catarrh, the former in the haematuria of malaria, the latter in fungous sugar urine. Spermatozoa are occasionally found in urine. They preserve their normal appearance for a long time. If the urine be very alkaline, they may even be seen in active motion, but those movements are soon lost. Urine which contains spermatozoa becomes alkaline very rapidly. BACTERICIDES. I 165 Urticaria may be defined as an acute non- Urticaria, contagious affection of the skin, characterized [Nett/erash) by the development of wheals, and accompanied by sensations of stinging, itching and burning, like those produced by the stinging of a nettle. In the wheals of the eruption can be detected a bacterium, re- markable for its easy culture in acidulated beef-tea ; so far it has not been proved to be pathogenic. Nettlerash is remarkable for its variable and fugitive character, and for the great variety of circumstances and conditions under which it is developed. In all cases, however, the presence of wheals or some equivalent eruption is pathognomonic of the disease. The size, form and general appearance of the wheals vary greatly; sometimes they are no larger than a split pea, while at other times they may occupy a considerable extent of surface and cause much swelling of the skin. In typical ex- amples they are round, raised and circumscribed spots, with a white centre and a reddish border, closely resembling the erup- tion produced by a nettle sting. In other cases they may take the form of streaks, ovals, or irregularly shaped patches ; some- times the only eruption consists of a diffuse erythematous-looking bright red blush; but whatever be its form, it is very evanescent and liable to appear and disappear almost suddenly, leaving no trace behind. In all cases the subjective phenomena are nearly the same, and consist in excessive itching, tingling, stinging, and burning sensations ; sometimes the itching preponderates; at other times perhaps the stinging or burning sensations are the most marked, for like the eruption itself, they are subject to constant changes. The rash often appears with a sudden burst all over the body, while at other times it is developed more slow- ly and appears successively on different parts. The subjective sensations invariably cause the sufferer to scratch and rub the skin; this greatly aggravates the symptoms, and brings out fresh wheals wherever the finger-nails are applied, and in severe cases small excoriations and little spots of coagulated blood may be seen scattered about the skin as the result of scratching. The eruption is roughly symmetrical and may appear on any part of the body, but is most common on the trunk, face and upper ex- tremity. An ordinary attack of urticaria may last from a few hours to several days, but always with partial remissions and ex- acerbations ; it is usually associated with very slight febrile dis- turbance. It must not be forgotten that the mucous membrane sometimes participates in the changes which occur in the skin; this is especially the case about the fauces and throat, which become suddenly swollen, so as even to threaten suffocation. n66 DISEASE GERMS. The circumstances under which urticaria is most likely to oc- cur require a brief notice, as having some bearing on diagnosis. (i) It is extremely apt to complicate other irritable affections of the skin, such as scabies, phthiriasis, prurigo, and eczema; this is especially the case in children, who are more liable than adults to this affection ; the production of nettlerash under these circumstances is due to a reflex nervous action set up by scratch- ing. (2) Urticaria produced by the irritation of some part of the mucous tract is not uncommon, and belongs also to the group of reflex nervous actions. We often meet with examples of this kind dependent on uterine irritation from pregnancy and other causes ; also in children who suffer from worms. (3) The bites and stings of poisonous insects and the hairs of stinging plants will produce in some people pretty severe local attacks of urti- caria, so that the face or arms become much swollen and very painful. (4) Certain kinds of food are apt to produce nettlerash; amongst these may be specially mentioned shell fish, mushrooms and many kinds of fruit; but in these cases much depends on the idiosyncrasy of the-individual. (5) There is a nervous form which occurs in individuals whose nervous systems are utterly broken down. (6) Certain drugs give rise to it as copaiba, cap- sicum, turpentine, cubebs. In its diagnosis great care must be exercised so as to assign it its proper type—a great variety of forms, as urticaria papulosa, lichen urticatus, purpura urticans, urticaria vesiculosus. Uricaria may take the form of simple, roundish, red patches, or it may be white, or a buff copper color. Urticuria is undoubtedly associated with a weak digestion and mal-assimilation of food ; in its treatment therefore, our attention should be specially directed to a suitable diet. As a rule, fruit, vegetables, pastry and sugar should be avoided, together with any other food that seems to produce indigestion ; the sufferer should, in fact, adopt the simplest form of a plain and nutritious diet, such as milk, meat (once cooked), toast or bread, light pud- dings and cocoa. Wine, beer, coffee and most other stimulants should be avoided, but in some cases a little weak brandy and water may be required, and is the form of stimulant which is generally the most suitable. No rules as to diet can be laid down which are applicable to all cases ; it is only possible to in- dicate the general plan of dietetic treatment ; the idiosyncrasy of the individual must, of course, be studied. For example, with some people milk always disagrees, and it would be the height of foll\- under these circumstances to insist on a milk diet with ;t view to improve a weak digestion. The conditions of the teeth and the proper mastication of food, regular and suitable exercise BACTERICIDES. I 167 and a sufficient amount of rest, are all points that demand atten- tion. With regard to medicines, those are most useful that pro- mote the processes of digestion, correct an excessive secretion of acid, and prevent an unhealthy decomposition of the food. By far the most generally useful is a mixture containing bismuth, carbonate of magnesia, bicarbonate of soda, and small doses of nux vomica taken before each meal. Sometimes small doses of Fowler's solution with alkalies do great good, chiefly by im- proving the powers of digestion. Nux vomica and carbolic acid pills are occasionally useful. A large proportion of the cases of urticaria are distinctly of neurotic origin, indicated by other disturbances of the nervous system. This especially applies to that form which recurs at a fixed hour in the day, and which sometimes replaces an attack of neuralgia. Quinine and tonics are both useful in dealing with urticaria of this kind, but thorough change of air is of all re- medies the one which is most certainly beneficial. The malady is, however, often very obstinate. Acute urticaria of the ordinary kind is generally produced by poisoning from shell-fish, fungi, or some other poisonous food. Under these circumstances it is often associated with vomiting and diarrhea, which relieve the most serious symptoms. The best treatment in these cases is free purging and a. simple emetic, if the latter can be administered soon enough to remove any of" the offending matter from the stomach ; this treatment is particu- larly applicable to children, who usually bear emetics well; fol- lowed with resorcin, or naphthaline, or with 24-grain doses of salicylate of sodium, every two hours. Acute febrile urticaria is a rare affection, and occurs without any assignable cause except perhaps some severe shock to the nervous system ; it should be treated by rest in bed, a light un- stimulating diet, mild saline purgatives, followed by tonics, espe- cially quinine. As the suffering is very considerable, soothing external treatment must be adopted ; warm alkaline or bran baths, and alkaline and sedative lotions are the most useful. Very severe symptoms sometimes occur in consequence of the sudden swelling of the mucous membrane of the throat ; when this happens, a sharp quickly acting purgative is always indi- cated. Lichen urticatus, which is a form of urticaria almost confined to children, is a most troublesome affection to deal with. In Many cases it does not in any way yield to treatment; the af- fection, however, usually dies out in a few years. The most generally useful medicine, I find, is carbonate of magnesia and soda with a little bromide of potassium ; the bowels should be 1168 DISEASE GERMS. kept open and the diet carefully regulated ; soothing lotions should be applied to the skin, and amongst the many that have been tried, one containing bicarbonate of soda and hydrocyanic acid dilute is excellent. Among the myriad of remedies for those troublesome af- fections, we have no other which affords such complete and in- stantaneous relief as a solution of menthol. Not only is the itching relieved for a time, but a cure seems to be effected. In pruritus and in eczema, moistening the parts with menthol solu- tion causes an immediate cessation of the pain. The solution should contain from two to ten grains of menthol to the ounce of water. Vaginal alimentation has been thoroughly Vaginal tested, and the absorbing powers of that canal Medication, have been proven to equal that of the rectum. Suppositories containing various animal and vegetable foods have been used, capsules containing peptonized foods have been introduced into the vagina at regular intervals, and it is asserted by the experimenters that the results were bet- ter than when the same foods were introduced into the rectum, Moreover, the vagina has many advantages over the rectum. The necessity of an alvine evacuation every day, a tight sphincter ani, the presence of hemorrhoids, an irritable rectum, render the vagina less objectionable as a receptacle for food or medicine than the rectum. The absorbents of the vagina are much nearer the uterus, ovaries, and other tissues connected with the genital apparatus than the stomach. Physiologically, all medicinal substances ought to act more promptly on the pelvic organs when placed in the vagina. In my gynecological practice for nearly tw?enty-five years, 1 have practiced applying to the uterus and vagina the remedy indicated by the symptoms and condition of the organs affected. Whenever I could induce the patient to allow the proper appli- cation of such remedies, or apply them herself, I have found the curative process to proceed much more rapidly then when medi- cines were given by the stomach. Some medicines when applied in the vagina to the os and cervix, will act as quickly as when given hypodermically. To those not accustomed to observe the action of medicines applied per vagina, I will say that I have repeatedly observed the general temperature to fall 2° in as many hours after the appli- cation to the os uteri of a tampon wet with aconite 2x dil. I BACTERICIDES. I 169 have seen severe uterine pain relieved quickly by the local use of belladonna 3X dil., and uterine spasm by the use of cannabis indica, ergotin, hamamelis and sabina. Cinnamonum will ar- rest chronic hemorrhage as soon or sooner when topically applied. I have arrested the violent vomiting of pregnancy with tampons moistened with ipecac, cocaine, bromide of soda and ozonized iodine, when they had failed otherwise. Every gynecologist has observed when applying iodine, carbolic acid, iodoform, argentum nitrate and mercurial agents to the os and cervix, that the woman has complained or observed the taste of these agents immediately. I have known the mouth and tongue to become dry and the pupils dilate in one minute after the application of a too strong lotion of belladonna or atropia to the cervix. Innumerable instances could be mentioned proving the rapid absorption of medicinal agents into the general system, when placed in the vagina. By this method we can sooner get the tonic and haematic effects of iron, manganese, aurum, argentum, hydrastin, cinchona and quinine as* well as cod liver oil, cocoa and other nutrients. This consists in dilatation and a convoluted state Varix. of the veins, due in most instances to an obstruction of the current of blood towards the heart. It occurs very often in the lower part of the rectum, where it constitutes haemorrhoids ; and in the affliction known as varicocele, the veins of the testicle are thus affected. The most frequent seats of varix, however, are the lower extremities, a condition being there established which is commonly termed that of " varicose veins." In a well-marked case of "varicose veins " the inner stirface of of the lower limb, from foot to groin, is studded with a number of soft, bluish swellings, varying in size and shape, and which are formed by a tortuous and dilated condition of the large saphena vein, which extends along the whole length of the limb. These swellings become more prominent when the patient stands up, or after constriction of the knee or thigh. The skin covering the tumors is generally thin and distended. This condition gives rise to stiffness and aching pain in the affected limbs, and even slight exercise is soon followed by a sense of fatigue. The skin about the ankles is puffy and is marked by purple patches of small veins, arranged in an arborescent form, etc. The feet are generally cold, and the toes of a bluish color. The skin of the leg is generally dry and itches very much; it is very often red and inflamed, and the seat of an eczematous eruption. In old people, and in cases where the varicose condition is of long stand- 74 1170 DISEASE GERMS. ing, large ulcers may form on the lower third of the leg, consti- tuting the so-called varicose ulcers. An occasional serious result of varix is thinning and giving way of the skin over a distended vein and hemorrhage, which, so long as the patient remains in the erect position or allows the leg to hang down, continues, and may speedily become fatal, but which may be readily arrested by placing the patient on his back, elevating the limb, and ap- plying slight pressure with a pad of lint and a bandage over the bleeding point. The predisposing causes of varix are an inherited tendency and debility, due to old age, over-work, or long illness. It is believed by some that the distension of the veins is occasionally preceded by a gouty condition of the blood. The chief exciting cause is obstruction to the venous circulation applied either directly to the lower limb, as in the case of wearing fight garters, or indi- rectly, as in disease of the heart, congestion of the liver, or con- stipation, with overloading and distension of the large intestine. Varix may be caused by the pressure upon the veins of the pelvis of tumors, or of the pregnant uterus. Pursuits necessitating much standing or walking very often give rise to the affection. It has been stated that cooks and soldiers are the people most especially prone to the formation of varicose veins. In all cases of varicose veins, an effort should be made to strengthen the whole body ; tonics, best of diet, rest. The patient should avoid as far as possible the standing posture. • When the veins of the limbs are affected, they should be bathed every night, well rubbed and then the ozonized extract of witch hazel rubbed well in and permitted to dry. In the morning the same proceeding is gone through, and before tfie affected individual is permitted to get up, either the limb should be bandaged from the toe to the groin, or else an • Ml elastic stocking should be applied. If this does not cure it will at least prevent such complications, as eczema, ulceration. The essential elements of all sound treatment are to strengthen the various tissues of the body by every possible means; the most generous diet, massage, electricity, change. The internal as well as the local exhibition of hamamelis is of great utility. Indeed the witch hazel in alternation with cinchona and avena sativa form about all the reliable remedies for varix, and they should be perseveringly given. Many operations have been recommended for the purpose of producing permanent obliteration ot the distended veins. Of these none of them can be recommended as safe or reliable. Neither ligation nor sutures are of any real permanent benefit. BACTERICIDES. I 171 A condition of varicosity of the veins of Varicocele, the spermatic cord, usually of congenital origin, resulting in or associated with deficient development, or functional imperfection of the corresponding testes in the majority of cases. The varicose condition is al- ways well marked, and is altogether, from that temporary ful- ness which may from to time occur in the spermatic veins of any healthy individual from intro-abdomi- nal pressure. In the large majority of cases the affec- T||^. jjf ti\ tion is only on the right side ; in a certain- Jfip M ,'jj| fa number of cases both sides are affected. 6§ M^mm (( When limited to the left side, the disease may be the only evidence of varicosity in the body, when it occurs on both sides, there is USUally more Or leSS Vai'icO.sitV Of External appearance of the the veins of both lower extremities. parts inva,icocele- The causes then of varicocele may be inherent weakness of organization, direct or from maternal impressions during intra- uterine life, or masturbation pr^or to and subsequent to puber- ty, or for indiscretion of the newly married, or men ad- vanced in years who push their failing powers too far. The sexual appetite—the faculty to perpetuate the species is impaired by work, by suffering, confinement, sedentary habits, worry and care—anything that tends to wipe out the typical fissures of thought—as alco- hol, tobacco, opium and chlo- ral ; any element of partial death will give us varicocele, with undeveloped or wasted or mis-shapen parts, as twist- ing or curving, with a per- fect avalanche of nervous symptoms. Varicocele, a dilated, tortuous, relaxed, knotty, hard condition of the veins of the cord, feeling like a bag of worms, dilate on coughing, diminishes or disappears when the afflicted individual lies down, gives rise to burning, aching in and along the cord and testicle, great dragging in the back with partial or total im- potency, great nerve prostration. Natural testicle. Section of healthy testicle. 1172 DISEASE GERMS. sues. The habit of masturbation is very damaging, of most dis- astrous effect upon mind and body, producing a mental and physical wreck, must be discarded before any treatment can be effective or a debilitated organ restored to its integrity. Varicocele invariably gives rise to seminal weakness, nervous exhaustion, shattered mind and body, wasting of testes, and latent spermatorrhoea, as weeping, draining of life (without erection or pleasure) in the urine. This very loss, this abnormal waste causes the organs to waste still further, until perfect atrophy en- One testicle, generally the left, at first becomes soft and flabby, and both become similarly affected. A tes- ticular waste or atrophy soon becomes identical with castration, but more disastrous to tlv mind. The reflex state of dwarf- age of the genital or- gans gives rise to greater despondency, deeper de- spair, more profound gloom and mental dis- order. In the cure of varico- cele, the irritable condi- tion of the seminal vesi- cles, and seminal losses, must be got rid of, sexual vigor restored, and a speedy positive cure es- tablished. There must be a general appreciation of the true physiology of the reproductive organs. The entire profession keenly appreciate the tincture of the green root of gelsemium and the ozonized extract of black wil- low in the cure of varicocele—the former a genital sedative of the highest order ; the latter, one of the most profound sedatives and astringents to the spermatic ducts and veins of the cord, it contracts, soothes. For varix within the range of the genito- urinary organs the black willow operates well. All members of the profession are agreed on the utility of well-regulated secretions, local baths, local application of witch- Varicocele, the result of mas- turbation after puberty. Varicocele, the result of masturbation be- fore puberty. BACTERICIDES. "73 hazel, and mechanical support with a suspensory bandage, bath- ing with the ozonized extract of witch-hazel, and a general al- terative and tonic course of remedies. No remedy ever presented has been so favorably received by all members of the profession for the cure of all weaknesses of the generative organs as the saw palmetto—the sales of this drug have been immense, and the most satisfactory, unprecedent- ed success has attended its exhibition, It has been thoroughly tested and extensively used, and as an exciter of glandular growth found to be unexcelled. Nearly all cases of varicocele are associated with seminal weak- ness, emissions or leakages, due to irritation of the prostatic por- tion of the urethra and an inflamed or relaxed state of the ejaculatory ducts ; these must be checked, blotted out by use of the cocaine suppository or a urethral bougie. Physiological rest should be obtained, so as to allow the parts to regain their tone and normal strength, and all unnatural losses of leakages arrested before a cure can be effected. As soon as this is accomplished, the patient, dilapidated and a wreck, should be placed upon those great brain essences or fertilizers kephaline and phosphated tincture of oats ; then the dilated and sagging veins become emptied, the testes begin to grow larger, the parts regain their tone, strength, contractility. Relief is prompt with such remedies. Vascular Excrescences and Erectile Tumors of the Female Urethra.—These are mostly composed of bunches of capillaries, distended and varicose, covered with a highly sensitive mucous membrane, are essentially warts. They are generally met with at the orifice of the urethra, and extend back a little distance. Thev grow in size, extend in numbers, become exquisitely sensi- tive, cause great untold agony to many ladies, so much so that the reflex effect of it breaks down and shatters their nervous system. Severe, often acute and prolonged pain accompanies micturi- tion ; the suffering is often protracted after the act. Pains pass back into the rectum, cause straining and bearing down, so that hemorrhoids soon appear. The uterus suffers; there is often a constant congestion of the organ, owing to reflex irritation. The. bladder symptoms are apt to overtop all others. The irritation extends up from the urethra, causing bladder tenesmus, sometimes retention, then frequent desire to pass urine, of which but a few drops are passed. The pain attending the act is often fearful. Treatment.—The first thing to be done is to quiet the irrita- bility of the urethra and anesthetize the mucous membrane and 1174 DISEASE GERMS. the growths. This is best accomplished by applying a 10 or 20 per cent, solution of hydrochlorate of cocaine, then apply the thuja occidentalis. Give the same remedy internally. This is superior to all known agents as a local and internal remedy to those painful erectile tumors at the orifice of the urethra. Whenever sexual intercourse is loose and varied, Venereal few women among many men, there takes place a Disease, change, an alteration or degradation of the living elements concerned in the nutrition of the genital organs of both sexes into a diseased germ. This change in the embryonic cell or primary elements of nutrition is the direct result of a violation of natural and divine law. This degrada- tion of biophasm mayr result in the evolution of an immature or perfect germ. This naturally leads to the description of the venereal disease under two distinct divisions—the immature, im- perfectly developed germ, which, when applied or deposited on any mucous membrane, especially that of the urethra or vagina, will give rise to a specific form of inflammation, with a profuse muco-purulent discharge, or if applied to a crack, or fissure, or abrasion, will cause follicular inflammation, or soft, non-infecting chancre or sore; whereas the mature germ, the perfectly formed microbe, may localize, by aggregation, in the urethra, or vagina, and give rise to a very slight inflammation with a scanty muco- purulent discharge, or if there be a crack or a fissure on the external parts, and the germ-laden pus applied to it, will produce a sore or chancre, with a hardened base, from which focus, the point of induration, a germ-breeding colony, the germs will enter the blood, causing a disastrous destruction of the red corpuscles, the life of that fluid, and grow there with less or more vigor according to the degree of vital force. • The immature germ is a microbe of low potency, and although capable of exciting violent inflammation in the urethra or vagina, and causing a non-infecting chancre, which, in conditions of filth and insanitary states, may assume a phagedenic state; still, the germ never enters the blood, even if the individual has it a hun- dred times. The germ is so immature that it will not grow in an alkaline fluid like the human blood; and if it is not interfered with, will die out in a few weeks ; whereas the mature germ, the microbe of syphilis, the perfectly developed germ, whether it finds access to the urethra, and there gives rise to a pock, or a crack, fissure or abrasion anywhere on the skin, invariably enters the blood. The growth of the true syphilitic germ in the blood depends BACTERICIDES. "75 altogether on the degree of vital force he possesses ; if vital force is good, its fecundation and growth may be retarded—that is, it will remain latent; but if vital force be slightly deteriorated, it will grow; and if vigor be low, it will grow with rapidity. No- thing can be more disastrous than the contraction of the disease from an opposite and distinct race of men or women. As the venereal disease has been described and spoken of under the terms primary, secondary and tertiary stages, these terms must now be discarded, for the discovery and elucidation of" the disease, as being due to a living microbe, renders the use of such terms absurd and meaningless under the science of modern medicine. The living syphilitic germ can enter the body in many ways, as byr towels, drinking vessels, breath, sweat, saliva, kissing, close contact, as in sleeping; through air, water, milk, clothing, cushions, articles handled in ordinary use, from parent to child, neither primary nor secondary states existing. Just let the germ enter the blood in any way, so it reaches the true skin, and it will grow and multiply in weakened tissues or gland with a slowness or rapidity according to the status of vitality of the individual. Gonorrhea.—This is essentially a specific form of inflammation of the mucus membrane of the urethra of the male, or vagina The Micrococcus of Gonorrhea, 12 hours after sexual congress with a woman afflicted with gonorrhea, magni- fied 750 diameters. Microscopical diagram of the gonococcus and the germ sy- philitic in the same patient. The cocci are the gonococcus of a soft chancre ; the rods in section, the embryonic germ about to split up in curved microbes, true cryplica syphi- litica. Taken from the dis- charge of an infected female. Magnified 750 diameters. The Micrococcus of simple Gonorrhea, due to the immature germ of a soft chancre, from 24 tr> 48 hours after coition, magnified 750 diameters. Within may be seen seve- ral forms of fission cf their nuclei, and micrococci moving in the protoplasm. (magnified 600 diam.) of the female, caused by the gonococcus, or immature germ. It usually makes its appearance in from forty-eight to seventy-two hours, sooner or later, after a suspicious connection or exposure to the germ-laden virus. As men and women have numerous other discharges, the mi- croscope should be brought to bear upon all doubtful cases. The above beautiful microscopic diagrams of the gono- coccus in different stages of microbial existence are worthy of IT76 DISEASE GERMS. serious attention. Interspersed through those germs we have the streptococcus pyogenes, pus germ, which has been completely isolated and removed. The gonococcus, cocci, singly, in pairs, groups. They are found in great abundance in the muco-purulent discharge from the urethra, in the pus of a soft chancre and buboes. The mi- crobe bears cultivation well in nutrient broth, and the patho- genic character of the cocci is established beyond all doubt by inoculation. Symptoms.—The presence of the gonococcus in a healthy urethra or vagina gives rise to the following: The first manifes- tation which attracts attention is a tickling, burning or smarting sensation at the orifice or at about three-quarters of an inch within, upon its under surface. On examination, the meatus is found to be of a pinkish color, slightly swollen, and between its lips ma)' be seen a drop or two of mucus, as the germs multiply rapidly. Pain and smarting in urinating become decided, dis- charges increase in quantity, become thicker, muco-purulent, change to milky hue, then yellowish or greenish, often streaked with blood. The pain in urinating increases, the meatus becomes highly inflamed, swollen, contracted in calibre, the glans penis, and the whole extremity of the organ becomes reddened and enlarged. The prepuce may become affected, swollen, puffed up by infiltration of the products of inflammation into its cellular tissue, that it may be impossible to cover the glans, or it may be swollen over the head and it may be impossible to retract it, Pain is experienced all along the urethra, sensitive to pressure. An increased desire to urinate is felt at all times, and the act is accompanied with difficulty and extreme suffering owing to the swelling of the urethra. The act of micturition is described as if molten lead was passing. Extremely likely to be attended with chordee, a bent or crooked condition of the penis during an erection ; painful erections along the urethral canal; pain in the back, groin, perinaeum, fever, aching in the testicles. In four or five weeks, without treatment, there is a gradual subsidence of the acute symptoms. In order to constitute a gonorrhea, the characteristic microbe must be present and detected in or on the mucous membrane, in the discharge. In the male this is never difficult, but in woman there are numerous bacilli and cocci which are satellites of that micro-organism which render a diagnosis more obscure. There is, so to speak, a conglomeration of germs usually present in the female vagina when the gonococcus is present. Indeed, the female genital tube is a true, natural incubator, favor- able to the most luxuriant growth of germs. A bacterioscopic . BACTERICIDES. llj- examination is imperative in both sexes, so as to detect the mi- crobe. Such a proceeding aids diagnosis, prognosis and treat- ment. Although the gonococcus is an immature germ,—never enters the blood,—still its presence either in the acute or chronic form operates disastrously upon the genitals of both sexes, giving rise to impotency and sterility. The formidable prevalence of the gonococcus demands the strictest surveillance over prostitution. Diagnosis of a gonorrhea in a woman, the gonococcus must be present, and there must be pelvic trouble, her general health suffering to an extent not explainable by the slight changes ob- served in the sexual organs. She has a purulent discharge, not depending upon the presence of an existing erosion, sarcoma, or carcinoma; or there may be a scanty glairy discharge from the bright red, eroded cervix. There is a catarrh of the ducts of the vulvo-vaginal glands. Small acuminated condylomata are seen around the vaginal outlet; there may be a ring of them just above the anal orifice. Granular vaginitis is present. Evidences of peri-salpingitis, or ovaritis, the latter being of the glandular variety. It is essentially important, that several or all of these symptoms should be combined ; a single one has no diag- nostic value whatever. Of all forms of venereal disease, originating in sexual inter- course, the above is the most common. In the other form of gonorrhea, the infecting form, that due to the microbe of syphilis, the mature germ, there are few of the above symptoms present,—usually a slight muco-purulent dis- charge in the morning. The entire uretha is not affected, simply a small area, in the lower aspect of the canal—an ulcer or chancre at the neck. In this form there are few complications, except chordee. The great trouble with this form is syphilitic germ disease of the entire blood. Treatment of Gonorrhea.—Since the recent discovery of the germ origin of gonorrhea, the treatment has been somewhat modified. If a case is seen early before the discharge has become muco-purulent, an effort should be made to abort the germ evolution in the urethra. Eor this purpose the patient should be instructed, after every urination, to inject the urethra with the ozonized distillation of the eucalyptus, in the proportion of one ounce to four of water. This might be repeated for twenty-four hours after every micturition, and at night before retiring, a solu- ble gelatinized germicidal bougie, composed of either thallin, or three grains of iodol to each bougie inserted. If this is performed early enough, the gonococcus is killed; .even if it i.s the true syphilitic germ it i.s likely to be sterilized. II78 DISEASE GERMS. The aborting or stamping out of a gonorrhea may be effected as follows: It consists in irrigating the urethra with large quantities of a tepid solution of boroglyceride or creolin, and repeating the procedure three times a day. It is best effected by a fountain syringe ; patient seated upon the edge of a chair ; syringe elevated four feet above the pelvis, rubber tube same size as number six catheter, passed to the deep urethra, and let current flow, it passes out outside of the catheter, causes no irritation whatever, In nearly every case in which this is tried, the microscope has shown no micrococci to be present, but it is best to continue the irrigation, as the germ is often imbedded in the lymph spaces of the mucous membrane. In some cases it is worth)' of a trial. If this abortive treatment is not successful, in arresting the entire germ colony in the urethra or vagina, then a regular sys- tematic course must be resorted to and persistently pursued. In beginning this treatment, the patient must be carefully in- structed to have his bowels opened every morning with some saline, such as the following mixture; sulphate of magnesia, one ounce; bitartrate potassa, two ounces; nitrate potassa, one drachm ; water, six ounces. Mix. A tablespoonful or more added to a glass of water first in the morning. This will keep the urine alkaline, obviate the presence of an overloaded rectum, overcome the local congestion, lessen the pain in urinating. He should also be cautioned to avoid all active exercise, such as prolonged walking or riding on horse- back, dancing, etc., and as much as possible to sit or lie down. No doubt the best position is the bed, in the recumbent posture, as the erect posture favors congestion of the parts. This may be impossible, but a partial compliance may be effected. All sexual excitement while suffering from the disease must be avoided. The diet should consist of articles, that will not en- gender acidity ; salads, hot dressing, mustard, pepper, asparagus, gross food like pork, together with all alcoholic and malt liquors, must be positively forbidden. Frequent ablutions, are an important part in the management. The patient should be directed to bath the parts morning and night, or more frequently, in hot water, and to immerse the penis and testicles in it for five or ten minutes at a time. If the parts are much swollen and painful, the patient should be instructed to wear a T bandage, and by means of that and a handkerchief keep the organs properly supported, so that they do not hang loosely. Various methods of treatment are resorted to and pushed with less or more activity, all having but one object in view the de- struction of the germ. BACTERICIDES. "79 This being so, all remedies used, internal or local, should in the highest degree be of the most germicidal character, and the in- ternal ones of utility are those not used up in the process of diges- tion, such as kava kava, copaiba, oil of sandal wood, resorcin, petroleum ; these exert an antiseptic action on the mucous mem- brane of the urethra, in the urine in form of infinitesimal molecules come in contact with the germ, unite with it and destroy it. Formulae for killing the gonococcus in gonorrhea. Comp. syrup stillingia, four ounces; tincture of kalmia, one ounce; balsam capaiba, one ounce; oil of sandal wood, two drachms ; oil of peppermint, thirty drops. Mix. Shake well be- fore taking. Dose, one teaspoonful every four hours. Balsam copaiba; sweet spirits of nitre, of each one ounce; mucilage of acacia, two ounces; tincture of opium; tincture of iodine and tincture of lavender comp., of each two drachms. Mix. Dose as above. Mucilage acacia, four ounces; oil of cubebs; oil of sandal wood, of each one ounce. Mix. Dose as above. Comp. syr. of tolu, four ounces ; oil of sandal wood, one ounce; spts. nit. ether dulc. Mix. Dose as above. Kava kava paste or pill. Comp. syr. tolu, fl. ext. kava, oil of sandal wood, equal parts. Mix. Dose as above. One of the above should be selected, the one which the physi- cian deems best suited to destroy the germ ; have the best healing and modifying action Upon the irritated or ulcerated mucous mem- brane. The use of some such remedy in all stages of the disease is attended with advantage. They are useful remedies, and should not be omitted. The use of the gelatinized urethral bougies, highly ozonized, is to be recommended in all cases. They are prepared from various ingredients all of a powerful antiseptic character, capable of killing the gonococcus and healing the abraded mucous mem- brane. They are prepared from hydrastis canadensis, iodol, resorcin, thallin, and numerous other agents, incorporated in a plant of glycerine and gelatine. When a bougie made of any of the above ingredients is inserted into a germ-laden urethra, it imme- diately commences to dissolve, and the medicating ingredient with rts peroxide of hydrogen causes the microbe to die, and heals the abraded surface. As time—from twenty minutes to three- quarters of an hour—is required for the complete solution of the bougie, a gradual prolonged and continuous action of the remedy is maintained, and during that time it does its work well. It causes no pain in its introduction, it separates and distends the walls of the urethra, penetrates into every sinus, every follicle or H80 DISEASE GERMS. fold. As the germicidal properties of the bougie penetrate in all and every direction, killing the germs as fast as evolved, and healing. The advantages of these bougies, are, they are thorough in their action, prompt in their effect, affording a speed)- cure in all cases. They prevent the formation of stricture, relieve chordee, and will effect a cure without any other treatment, in all stages of the disease. Gleet.—In this we have great debility of the mucous mem- brane of the urethra, either from long-continued inflammation or inherent weakness, with a glairy, weakening discharge, like the white of an egg, or it may be milky or watery, without any symptoms of inflammation. The discharge may be quite little, a drop or two, or even very profuse. It is most important in all cases of so-called gleet to be sure that there be no stricture, no prostatorrhcea. Then pursue a tonic course of treatment, either administer in- ternally compound tincture matricaria alternated with ozonized iodine, or iron and quinine alternated with salix nigra. Urethral bougies of iodol, hydrastis, have an excellent effect. Urethral Catarrh.—Patients will sometimes return after a sub- sidence of all tne symptoms, when the are apparently well, com- plaining that the discharge has returned, probably owing to some indiscretion, as prematurely, having sexual congress, or causing their urine to become acid by the use of malt liquors, etc. On examination of these cases there is'found a slight watery discharge, probably most in the morning, or merely a drop or two, once or twice a day; no pain in urinating, simply due to de- bility, a sort of lack of tone in the capillaries of the mucous membrane of the urethra. General tonic and alterative course ; compound saxifraga and phytolacca, compound tincture matricaria, avena sativa. Stricture.—When the case is permitted to run along for several weeks or months there is very apt to be deep-seated damage done by the inflammation or by the remedy administered; lymph is often effused from localized patches of inflammation that may exist; this lymph is generally effused on the inferior aspect of the urethra; it is thrown out either in a flattened piece, or in membranous bands across the canal, and if not promptly re- moved will form an impediment to micturition, cause the stream of urine to be twisted like a cork-screw, or forked, or like a thread or in drops. This continued obstruction gives rise to a leak- age or discharge; if they are old, ulceration is liable to take place behind them; they invariably produce congestion of the prostate and prostatorrhcea, with functional impotence, invariably some leakage. BACTERICIDES. Il8l The correct treatment—gradual dilatation and absorption. Chordee.—This is perhaps the most common complication of a gonorrhea, when it is permitted to run its course; the gono- coccus eats through the tissue, usually the inferior aspect. When the patient becomes warm at night in bed, owing to the existing inflammation, a great determination of blood takes place in the organ, powerful, painful erections; when these erections take place the penis becomes crooked or bent, in the form of a bow or arch. The complication gives rise to gieat suffering. The best remedy for the purpose of paralyzing the erectile fibres of the penis is the green root tincture of gelsemium in the following mixture: Camphor water, four ounces; bromide of potassa, half an ounce; nitrate potassa, two drachms ; green root tincture of gelse- mium, one ounce. Mix. This mixture should be given in the afternoon, after supper and before retiring, in teaspoonful-doses, added to a little water. The rectum should be washed out with ozone distillation of hamamelis, followed by a cocaine suppository. Sleep on hard mattress, in a cool room, avoiding all sexual thoughts. Chronic Gonorrhea.—As a rule, the gonoccocus dies in from five to six weeks in an acute attack of gonorrhea without treat- ment ; with treatment, of a germicidal kind, a few days, or at least from a week to ten days, should be ample time to kill the germ and cure the patient. True, there are cases in which the germ may hold on, the discharge quite a good deal, re-aggravated by the slightest provocation. Even indigestion, the slightest sexual excess, or ungratified sexual desire, the use of alcohol, cold, wet, over-exertion, will re- surrect the gonoccocus, give rise to more or less pain in urinat- ing, with a rather profuse creamy discharge and other inflam- matory symptoms. The patient should be placed upon a general alterative and tonic course of remedies, embracing compound saxifraga and sandal wood, kava-kava paste. The most common lesions occurring in chronic gonorrhea are these: 1. A catarrhal inflammation localized in deeper parts of the urethra. 2. Papillary granulations resulting from hyper- plasia of the mucous membrane. 3. Granular vegetations, or peculiar bloodless (or rather vesselless) protrusions, the degener- ation ending in atrophy of the tissues. Every one of the three forms is accompanied by a mucoid or muco-purulent discharge, and may lead in course of time to the formation of strictures of varying size. The stenoses of extreme degrees are usually recog- !* 1182 DISEASE GERMS. nized fairly easily. It is otherwise in cases of milder strictures, which frequently do not give rise to any marked symptoms beyond the so-called goutte militairc—that is, a morning drop of discharge arising from inflammation caused by stagnation of the urine behind a narrowed spot. Without a careful examination, such slight strictures may be easily overlooked, and our treat- ment accordingly prove a failure, since such means as routinary injections are powerless to remove the lesions of this kind. In view of the facts, Dr. Hobensack recommends the examination of every patient suffering from urethral discharge by means of a large- sized catheter. If the latter failed to pass into the bladder, a stricture is present. If the instrument passes with some diffi- culty, one of the three lesions mentioned above must be sus- pected. The best means for establishing a differential diagnosis between the forms is undoubtedly afforded by an endoscopic ex- amination. The latter, however, requires a considerable skill and experience. In the absence of the conditions, the endoscope may be, to a certain extent, substituted by a bulbous catheter. In such cases, where the introduction of the instrument causes a strictly localized pain, and is followed by a few drops of blood, either the 1 form or the 2 must be thought of. In the absence of the pain, and bleeding, the cause of the urethral discharge is constituted, probably, in granular vegetations (the form 3). The treatment varies according to the nature of the cases. In those mentioned under 1 and 2, excellent results may be obtained from injections of ozonized distillation of eucalyptus. In cases of granular vegetations, soluble bougies of papoid. Strictures are best treated by a systematic dilatation of the urethra with metallic bougies. Besides the two forms of gonorrhea, men are liable to have numerous other discharges, all due to micro-organisms; sexual congress with females who suffer from intra-uterine catarrh, in which both the yeast plant amoeba and • sarcinae are present, will contract a discharge in which these germs appear. Congress with ladies during their menstrual flow, or with those affected with ulceration, will be likely to give rise to a dis- charge in which the bacteria, the factors of the irritation, are present, so with cancer, the bacilli of tubercle, etc. Both forms of gonorrhea are liable to have a train of compli- cations or sequelae in their acute and chronic stages; they ex- hibit features and characteristics of inflammation of mucous membrane, whatever germ be present. The germs travel back gradually, extending by continuity of surface, to the deep urethra, bladder, ureters, kidneys. U BACTERICIDES. Il83 The venereal disease consists of The Venereal Bacillus, two distinct germs, one immature [The Pathogenic Microbe the other a full-fledged microbe. of Syphilis) The immature germ gives rise to a gonorrhea, and a soft, non-infecting chancre, but is too feeble to enter the blood and produce any havoc there. The immature germ gives rise to specific suppurative inflammation on both mucous membrane and skin; on the latter a well defined pock or pustule, with scooped-out edges, and an abundant secretion, and when you take it between your finger and thumb, it is soft to the feel. In the treatment of this form of sore, since the introduction of so many germicides, caustics are avoided, and instead, this class of sores are promptly destroyed and healed by sprinkling on them iodol, or applying a wash of lime water and tincture of iodine, or any other good antiseptic, like the peroxide of hydrogen lotion. Whichever of these be used, they should be applied fresh every morning and night,'until the sore is healed. When this immature germ is inoculated on the prepuce or glans of an individual of a tubercular diathesis, the sore in which the germs are breeding take on a serpiginous or horseshoe ap- pearance, owing to the tubercular bacilli and the venereal germ mingling, which gives us a true hybrid ; one which cannot pro- create, but is nevertheless most intractable to get rid of. The iodine salts are the best remedies, painting the sore with a mixture of tincture of iodine and iodide of potass, in the pro- portion of half an ounce of the former to three drachms of the latter, about once a week; keeping iodol applied in the interim. Keeping the patient upon the comp. saxifraga, internally. The non-infecting sores have a great tendency to suffer adr ditional degradation if exposed to, or in close proximity to, insanitary states, such as overcrowding, filth, meagre, or un- healthy food, mercury, imperfect drainage, absence of sunlight, etc., the oidium albicans, evidence of the human rot, mingles with the immature, and gives us phagedena, eating, sloughing condition. Such cases call for prompt attention: apartments should be disinfected by the fumes of burning sulphur, greater cleanliness observed, removal of all nuisances, germicidal applications, as lotions of peroxide of hydrogen,.boroglyceride, sulphur-water, fresh air, nourishing food, thorough hygiene. ,The bacillus of syphilis consists of rods, very minute. Two or more ovoid points are visible in the course of the rod, which are spores. They are best observed from the secretion or dis- charge of the indurated chancre, or from the ulcers in the mouth. 1184 DISEASE GERMS. When the blood is searched for them, they are, when present, found in the interior of the nucleated cells. The microbe is pathogenic of systemic syphilis. Bears culture well; reproduces itself in all red-blooded animals when injected subcutaneously. The ptomaines excreted by the syphilitic germ are peculiarly toxical to skin, mucous membrane, bone, brain, lungs, etc. When the atmospheric electrical influences are low, germ breeds most actively. Thence the nocturnal pains in bones, etc. The bacillus in syphilis as seen in the blood; the full-fledged microbe. The mature, full-fledged germ, the true syphilitic microbe, wherever it reaches the true skin, a true secreting membrane, through a breach of mucous tissue, or cuticle, finds ingress to the human blood, its genuine pasture field, where it remains latent or breeds according to the degree of vital force present in the individual. There are numerous other channels of ingress into the blood for this germ, besides cracks, fissures, abrasions on the genital organs of either sex. It may come into our bodies from the germ-laden tissue of the affected by close contact, breath, kissing, clothes, bathing dresses; through food, espe- cially milk and raw beef, and we might cite the case of profes- sional tattooers, who often contaminate thousands of persons by their saliva. In ordinary everyday life, the spread of this germ, either in the urethra, vagina, male genital organs, is generally through a scratch, or abrasion, or fissure of the cuticle or mucous mem- BACTERICIDES. U85 brane; in this crack, or fissure, the microbe breeds, forms a nestT or reservoir, from which the veins carry the germ to the nearest lymphatics, or blood-forming glands ; so fast, so energetically does the microbe breed, that the veins are unable to carry off the germs, so entire colonies remain at the point of inoculation, forming a ridge, or eminence, or induration of the sore. It is simply a mass of germs, an aggregation which feeds the blood. When those microbes enter the blood they are safe, their living particles find protection and nutrition there. If vital force be maintained at a high standard, it will resist or retard germ evolution, and the microbe can be held dormant, although the individual can at all times be trans- mitting the disease to others, especially to his offspring. Let vitality be low, depressed by any cause, then growth, ac- tive multiplication of the germ takes place; the rate of germ growth and destructive metamor- phosis being in propor- tion to the deviation from the standard of health; and if there be any localized weakness in any part of the body, the microbes will congregate there and grow, giving rise, through the germ-laden blood, and reflex irritation, to ob- scure chronic disease of vital organs, as the brain, heart, lungs, bones, mucous membrane, skin. From the moment that the germ enters the body, till its death or destruction in the body, for it must die there, systemic syphilis is a contagious and infectious disease, whether it be latent or active. Suppose, then, that vital force is depreciated and the germ merges into activity and growth. Simultaneously with the entrance of the germ into the body, if vital force is feeble, or six months later, if somewhat stronger, or even years, subsequently, an indescribable train of symptoms make their appearance in no definite order. There may be languor, lassi- tude, debility, even fever. If the skin is feeble, the germ may appear there in some form or grade corresponding to the con- dition of vital force; if mucous membrane be feeble, colonies of germs will settle there, giving us various forms of ulceration, but it has now blended with it the oidium albicans of aphthae ; but on skin and mucous membrane it is easily recognizable in Indurated chancre on the lip, the result of a kiss. 75 u86 DISEASE GERMS. the Caucasian by its copper-colored appearance and lack of sen- sibility ; if the bones are feeble, the germs will lodge there, giv- ing us periostitis with nodes; ostitis with necrosis and caries; they often find their way into the most delicate parts ; one even can estimate or approximate their growth and their destructive action on the blood, by the degree of nocturnal pain in the bones, the tenderness of the sternum and enlargement of the post-cervical glands of the neck; they are never-failing cri- terions ; the matrix of hair suffers an invasion, and the hair drops out. Tuberculae are created, mucous tubercles or patches be- come common at points where skin and mucous membrane meet, lips, vulva, anus; often iritis, if vital force is greatly shattered, with deafness, and brain affections; in some cases, the onyx of nails are copper-colored, and often rot or crumble ; ulceration of tongue, hard and soft palate, perforating ulcers, larynx, trachea; elevations and gummy deposits ; caries and, necrosis of the cartilage and bones of the nose, and in a large per cent, of cases the germ invades various vital organs, as the brain, spinal cord, lungs, heart, liver, kidneys, never appearing on skin or mucous membrane at all. Treatment.—The first and most important consideration in the management of these cases is the care of the general health. The bathing of the entire body daily is a matter of great importance. Cold or tepid baths, either by sponging or immersion, followed by shampooing or massage, are of great utility. The clothing should be woolen, adapted to the season of the year, so as to give warmth. The diet should be generous, consisting of the most easily digested and nutritious articles possible. The mouth, gums, and teeth should be well cleansed before and after meals, with a solution of boroglyceride, or comp. tinc- ture cinchona, tincture of myrrh, or resorcin, added to water. To- bacco in all its forms must be rigidly forbidden, as it is decidedly injurious. The patient should sleep in a well-ventilated apart- ment, and alone, as bis disease is pre-eminently contagious and capable of transmission to sound persons by close contact or by drinking vessels. Gentle exercise in the open air, selecting healthy locations, elevating amusements, the regular routine of business, unless it proves too exhausting, then change of scene. The mind should be kept cheerful, free from needless worry or anxiety, and all thoughts of their disease as much as possible avoided. Malt and alcoholic drinks should be employed solely under the explicit directions of a physician. Infection.—The question of the possibility of several attacks of syphilis has long been settled. It admits of no discussion. An BACTERICIDES. 1187 Venereal Microbe in the breast, caused by nursing a syphilitic ch'ld. individual may have attack after attack ; his blood never becomes sterilized to the ingress of brood after brood ; there is no im- munity ; re-infection after re-infection is the rule. A man or woman may each have an indurated chancre ninety-nine times, and each time it is a fresh syphilitic re- infection. The germs are there until they are absolutely annihilated. Turning to the use of remedies em- ployed in systemic syphilis, we may re- mark that there is no routine plan of treatment, no specific which can be advantageously used in every case. The remedies which are to be employed must be powerful germicides, and on the part of the physician, he must have experience, fine discrimination, good judgment, unusual professional skill to manage those cases. The success in curing venereal cases, that is, destroying the microbe in the blood, does not depend on the largest amount or varied assortment of drugs, but in the tact and skill in their ap- plication in combating a most most formidable disease. Prepa- rations of mercury, iodide of potass, nitric acid, iron, quinine, are the great remedial agents for the destruction of the syphilitic microbe; these may be used to no purpose by one physician, whereas another, with greater tact, achieves the most bril- liant results with them. The vegetable prepara- tions, stillingia, saxifraga, phytolacca, kalmia, dul- camara, iris versicolor, are slower, but fully as effective as the mineral agents. But a microscopical inspection of the blood in syphilis is the best for diagnosis. This is posi- tive, and demonstrates clearly to us that the germ is there, and how numerous or how scanty they are. During a course of treatment under saxifraga, phytolacca, and other germicides, it emphatically The microbe of syp spaces, from the bfc diameters. rhilis as seen in the inter-corpuscular ood of an affected individual, 1200 u88 DISEASE GERMS. tells us how fast the disappearance of the germ takes place. The preceding diagram exhibits the syphilitic germs in the blood, active with life, hurrying hither and whither with the ceaseless motions of protoplasmic life. They appear as copper-colored bacilli in the blood. Before proceeding to lay down a course of treatment for the destruction of the microbe syphilitica with remedies of acknowl- edged value, it must be borne in mind that no two cases are alike ; that there is the widest range between the most benignant forms of private practice to the most malignant type as seen in hospitals. Mercury as a germicide stands to-day unrivalled as a remedy for the destruction of the syphilitic germ. Administered wfth skill, in a properly graded dose, immense advantage is often gained by its use, provided the patient gains in health, strength, and vigor; but if salivation, stomatitis, fetor of the breath, spongy state of the gums, with inappetence, gastro-intestinal disturbance, be produced, more harm than good may be produced. The least hurtful, and a form of great energy is the protochlo- ride in the following : Comp. saxifraga, four ounces . tincture of kalmia, one ounce; iodide potass, two drachms; bichloride of mercury, two grains. Mix. Dose, one teaspoonful every three hours. The hypodermic injection of mercury is very popular and effec- tive. The following is the formula in general use. Hydrarg. bichloride, eighteen grains; chloride of ammonia, eighteen grains; chloride of sodium, one drachm ; distilled water, four ounces. Dissolve and filter, and add the white of one e£g- Our professional brothers should test the "action of the com- pound saxifraga or the compound phytolacca, ozonized, or either combined, or as follows : Compound saxifraga, ozonized, four ouaces ; tincture of kal- mia, one ounce ; iodide potassium, three drachms ; resorcin, one- half ounce. Mix. Dose, a teaspoonful thrice daily. Watch the blood changes on the^syphilitic germ, and later on the total disappearance of the germ from the blood, under this germicide. :% Since the discovery of the venereal bacillus, there has been inaugurated a change from the older methods of treatment to one essentially of a bactericide character; the change has been gradual and progressive, and to-day it is as simple and sensible as formerly it was complicated and senseless. The very moment it is detected, treatment should be begun, and continued for some time after all symptoms have disappeared BACTERICIDES. I 189 In this way it can be cured. It is not necessary to have an ini- tial, as the microbe can enter the body in many ways without, as by close contact, breath, saliva, sweat. If there is a sore, or pock, excision is regarded with favor by a few syphilographers as capable of preventing general infection. Others regard the initial lesion as a sign of general infection. The former position is hard to establish, as it is open to two ob- jections : first, that it is impossible for the diagnosis of the initial lesion to be certain until later manifestations appear ; and second, that it is impossible to be sure that the disease may not manifest itself after the usual period of observation. This part of the treat- ment of syphilis cannot, therefore, be considered as yet accepted. Again, as to the proper time to begin treatment, we say at once, Treatment early diminishes the intensity of the disease. There must be no inaction where this germ exists, as we have abundant means for combating it. The bacillus of syphilis frequent- The Venereal Bacillus, ly localizes itself in the eye and [The Pathogenic Syphilitic on the lids. On the lids the mi- Microbe in the Eye) crobe appears in three forms, pri- mary lesion from a towel, or a finger, with the virus, initial sclerosis, exanthem, and gumma. Ophthal- mia due to the mature germ is very rare. Still occasionally we meet with ulcers on the cornea, following corneal abscesses in which spores of the syphillic germ can be isolated. Iritis is undoubtedly the most common of all eye affections. In broken down states of the body associated with poor or meagre food and insanitary conditions. In such cases, general treatment must be energetically pushed, with stimulation to the nape of the neck, quinine internally, never neglecting atropia in the eye. The tendency to corneal ulceration often lies in a diminished vitality of the cornea, which debilitates it for the battle against the ever present pyogenic microbes. One essential portion of the treatment must, therefore, ever be the fortification of the gen- eral system and improvement of its condition. In many cases in which ulceration of the cornea is found to frequently recur, it will be found that there is a chronic condition of trachoma, or a neg- lected inflammation of the lachrymal sac, or obstruction of the duct, causing the cornea to be constantly bathed in stagnant tears. These collateral relations should ever be borne in mind, for no treatment can be successful which does not include a rational at- tention to the general physical, as well as the local health of the cornea and its adjoining tissues. 1190 DISEASE GERMS. Civilization with its varied im- The Venereal Bacillus, provements is unfavorable to brain [Phrenal Syphilis. longevity, much more so than the The Pathogenic Microbe in intellectual torpor of a semi-civilized the Brain?) condition. Modern thought with its neurasthenia of the cerebrum, renders the brain proper a favorite site for the location and evo- lution of the germ syphilitica. But over and above the well-recognized forms of nervous and mental disease, there are certain groups of symptoms which may fairly be regarded as indicative of specific infection, although the proof may not be greater than that to which the lawyers give the name of" prima facie"—i. e., proof amounting to a presumption, which may, however, be rebutted by adequate testimony to the contrary. These symptom-groups, if I may be allowed to formu- late from my own experience, are as follows : (1) Quasi-periodical cephalalgia of a peculiar kind. (Nocturnal.) (2) Hemiplegia under forty years of age, with or without preced- ing cephalalgia of the aforesaid type. (3) Cephalalgia followed by hemiplegia, which bear a singular relationship to one another in that the cephalalgia ceases immediately upon the supervention of the hemiplegia, and does not recur. (4) Convulsions in the adult, which have not been preceded by convulsions in infancy, and are not of traumatic or nephritic origin, or due to pregnancy, or in an individual subject to migraine. (5) Symptoms indicative of a lesion at the base of the brain. (6) A comatose condition ex- tending over days or weeks, not traumatic, meningitic, diabetic, nephritic, or from typhoid fever. (7) Tabes dorsalis. (8) Gen- eral paresis. (9) Spinal lesions in a subject who has had intra- cranial syphilis. I have very pronounced ideas with regard to treatment. I have no faith whatsoever in mercury. I am quite prepared to say, that unless the iodides with their proper adjuvants—of which I shall speak in a moment—can cure a case of nervous syphilis, it cannot be cured at all. But the dose of the iodides which is administered by the Germans and French will often be entirely inadequate. I give the iodides until the symptoms yield, or until iodism is produced. Should iodism ensue before the symptoms yield, I pursue one of two methods. I first increase the dose of the iodide by about one-third, and rapidly increase each succeeding day. Singular to say, in some cases this increased dosage will cause the iodism to disappear, and the larger doses will be borne very well. Should, however, these larger doses still more increase the iodism, I decrease to one-half of the dose at which the iodism had begun, and continue BACTERICIDES. I I91 this decreased dose until the iodism diminishes or disappears, when I again rapidly increase the dose, and am usually able to go on without further trouble. In some few individuals, however, no amount of care will cause more than a certain amount of the iodide to be borne, and such cases, as I have said, are usually of unfavorable prognosis. In some cases, too—fortunately they are rare—even small doses of the iodide will produce a cardiac dis- turbance that prohibits its administration. I am perfectly well aware that the medical chemist will object that these large doses of the iodide pass through the body and are quickly excreted by the urine; but I am equally well aware, in the face of this fact, that these large doses of the iodide will cause symptoms to yield that cannot be made to yield by lesser doses. I have given as much as several hundred grains of the iodide of potash in the twenty-four hours, and have seen symptoms disappear with these enormous doses that would not yield to minor ones. I admin- ister the iodide after meals, and either in a full tumbler of ice- Softening of the cerebral pulp in Sclerosis of the brain. phrenal syphilis. Cerebral sclerosis in chronic intersti- tial inflammation from the presence of the syphilitic germ. water, or in a glass of Vichy, or in a glass of Bohemian spring water, the Giesshubler. But he who expects to cure his patients with the iodides alone, unless the case be so grave as to call for immediate relief, will be disappointed. The human organism must be put 'in the best possible condition. A generous diet should be employed. Free- dom from care and worry, where possible, should be enjoined, and all strenuous exertion of body or mind avoided. The germ syphilitica frequently localizes itself on the circum- ference and base of the brain, in the form of an exosmosis from the blood vessels, and appears in the form of thickenings, adhe- sions, contractions, puckerings, with a germ-eaten state of the blood vessels. Cerebral softening. Small blood-ves- sel from a focus of yellow soften- ing in phrenal syphillis. 1192 DISEASE GERMS. Microscopically throughout the effused lymph, there appears soft jelly like masses, irregular in form, blended intimately with brain structure, the pathogenic micrococci appear as spindle and stellated cells imbedded in an alveolar frame work. It is needless to emphasize the fact that cerebral syphilis is very common—true the brain resists with tenacity the localization of the germ—but epileptic seizures, paralysis, as hemiplegia, or eye neurotis, aphasia, etc., occurring in middle life, are most significant, especially if there are symptoms of nocturnal headaches, numb- ness, formication, heats and colds, etc. If those exist look for syphilis, because tumors, abscesses, organic lesion are rare at that time of life. By placing the patient on specific treatment for syphilis,- when in doubt, is the safest. The repeated application of two small fly blisters to the nape of the neck for six hours at a time, twice weekly, often diverts the germ to other pasture fields. It is safe, salutary. The internal administration of comp. saxifraga ozon- ized is a treatment calculated* to be invariably beneficial; its use for months is the only probable means of cure. The origination and use of this remedy is the outcome of a national necessity, an agent that never fails to give satisfactory results. Good authority says, the profession must depart from their usual course in the treatment of syphilis—the initial lesion affects the whole system—disseminates the germs through every tissue. Our people, more than any other nation, suffer from phrenal syphilis. Syphilitic growths, gummata, will, if formed on the brain, disappear as speedily as any other lesion ; and when their mi- crobial growth gives rise to pressure, the resulting damage to the nerve structure is recovered from in the most complete degree. When there is reason to suspect inflammation of the cranial nerves—syphilitic neuritis—the prognosis is chiefly influenced by the duration of the morbid process. If the inflammatory pro- ducts are in such a stage that they can be removed, the progno- sis is good if the damaged nerve fibres will recover conducting power. If, however, there is reason to suspect cicatricial trans- formation of the new formation into fibroid tissue, it is improbable that the degree of improvement will be sufficient to permit severe symptoms to pass away entirely. The same general prognosis is true also of infiltrating growths. In true acute inflammation that is treated early and arrested early, the prognosis is the same as in similar inflammations that are not specific. The recovery or persistence of the symptoms depends on the recovery or per- sistence of the changes in the nerve elements which are pro- duced by an intense inflammation, and effusion of germs. BACTERICIDES. 1 193 The clinical history of the neurotic form of syphilide has an individuality of its own. In the very, early months of the di- athesis, either in the stationary period of an early syphilide or at its decline, generally preceded or accompanied by severe neural- gic symptoms involving the facial or cranial, intercostal, anterior crural, or, in fact, in any cutaneous nerve, by severe cephalalgia, continuous or nocturnal; by rheumatoid pains in muscles or joints, and by general malaise and debility, this eruption makes its appearance with more or less promptitude and develops quite rapidly. In some instances the invasion is very acute, so that at the end of a week, we may find fully developed tumors an inch or two long, in others and in the majority of instances the de- velopment is slower and nearly two weeks elapse. Besides the general neuralgic symptoms, local pains on the site of the lesions or in the whole territory on which they are developed are ex- perienced. These may be continuous or intermittent, and in some cases are excruciating as in severe herpes zoster. There are two points in the treatment of syphilitic diseases of the nervous system on which I think a word of caution is ur- gently needed. The first is regarding the prolonged adminis- tration of anti-syphilitic drugs, especially of iodide of potassium. By " prolonged " I mean exceeding from six to ten weeks. I believe that full doses in this time will effect all it can achieve in the removal of the syphilitic process. Here, as I have just said, we want facts that are visible, numerous, and carefully observed, to guide us in our conclusion. I do not say that the symptoms will have disappeared. It cannot be too firmly remembered that symptoms are due to changes that are not syphilitic, changes in the nerve elements secondary to the syphilitic disease, but so far independent in course that they may persist long after the speci- fic lesion is at an end. Hence the fact that the symptoms have not yet ceased is no indication that the specific lesion is not en- tirely'removed. If iodide be continued, as it often is, during many months (and much more, as it sometimes is, during years), there is a danger that the normal tissues of the patient may be- come so accustomed to its presence that the drug may no longer hold in check the syphilitic processes. Probably we may still influence the lesions by increasing the dose, but this process must have limits in practice, if not in theory. Such prolonged and augmented treatment may do definite injury to the patient's health, and even then fail to effect the desired object. If the poison is in an organized virus we might a priori expect this re- sult. By long-continued, gradual alteration in the conditions, •ow organisms, as has been shown in remarkable experiments, can be made to endure influences that would at first be fatal to 1194 DISEASE GERMS. them. By slowly raising the temperature they will not only live but flourish at a degree of heat which, had it not been for their acclimatization, would have killed them in a few minutes. But the question is not one in which we can be guided by theory, far less by analogy, possibly remote. There is, moreover, a positive danger in this method. It is also great in the practice to which I referred, that of repeated courses of energetic treat- ment to remove residuary symptoms that cannot be thus re- moved, because they do not depend on any residual specific process. A very eminent authority says : Inherent weakness of certain parts or structures of the brain permits of the deposit and locali- zation of the syphilitic germ if present in the blood. The mi- crobe is here found in the form of gummatous tumors, composed of small, round, oval and pyriform cells, with basement sub- stance. These masses may undergo a variety of changes and degenerations, and often migrate from bone to brain and vice versa. The history of the case, persistent localized nocturnal head- ache, impaired intellect, dull, stupid, apathetic; impairment of the senses, often facial paralysis, and, if energetic treatment i.s not pursued, unconsciousness, stertorous breathing, dilated pupils and death. The diagnosis rests chiefly on the presence of the syphilitic germ in the blood. The treatment consists in the use of the most energetic remedies to kill the germ, with persistent repeated blisters to the nape of the neck to attract the germ away from this vital organ. The venereal disease, both con- The Venereal Bacillus, tagious and infectious, is to a great [Pathogenic Microbe extent a preventable disease, if Syphilitica) licensed and put under restraint by the State. The microbe, when once in the body, is generally carried to every nook and corner of the tissues. The ingress of the germ is silent—effected without a sore, coming in by the breath or contact, or through the translucent lymph of vaccine pustule. Of all forms of venereal infection, lung syphilis is. the most potent and effective. The microbe is generally scattered through- out the entire body of the blood vessels and lymph canals. It is to be freely found in all the secretions and excretions—in the synovia, bone, periosteum, brain, skin, etc., but in no form is the infection so great and pungent as in pulmonary syphilis. BACTERICIDES. I I95 So, it is well in all cases, especially those with a cough and expectoration, to resort to rigid antiseptic precautions. The room in which a lung syphilitic affected individual sleeps or lives in should be disinfected at least every two weeks, thoroughly fumigated with burning sul- phur; that his sputum, faeces, urine, should be destroyed; that the individual should be isolated from his fellows. He should not be permitted to sleep with or come in contact with healthy persons. All workshops in which venereal pa- tients congregate should be frequently dis- infected. It must ever be remembered that both in tuberculosis and syphilis, that domestic animals play an important part in carry- ing these germs from one individual to another. Syphilitic germ in the kidney, found forty-eight hours after death actively evolving spores ; ihey were detected in the urine several months before death took place. The Venereal Bacillus. [The Pathogenic Microbe of Syphilis passing from Parents to their Offspring) The microbe passing either in the spermatozoa of the male, or ovum of the female, or both, is a frequent cause of either blighting the fcetus, caus- ing its death, or, if the uterus is healthy, it often repels the germ- smitten fcetus, and miscarriage results. The child may be born with unmistakable signs of the disease, or may be born apparently healthy and in. a few weeks the symptoms develop. Emaciation or great sleeplessness may sug- gest the taint. The symptoms resemble the secondaries in the adult, and appear about the same time as the acquired after inoculation. When markedly present the child has a peculiar "old man" look, a prematurely old appearance, is very ema- ciated, simply skin and bone, these children being frequently premature. The cry is shrill and hoarse, compared to the sound of a penny trumpet, and the child has a hard cough, often sick- ness and diarrhea, coryza, and snuffling due to inflammation and ulceration of the mucous membrane of the nose causing it to become blocked, the child therefore refusing the breast on account of it only being able to breathe properly by the mouth. The skin is hard, dry, dirty looking and wrinkled ; soon acquires patches of a light brown color, and the nails are often cracked. «The skin and mucous membranes are the first to show the symp- toms, gummata being met with later in the skin, mucous mem- 1196 DISEASE GERMS. branes, periosteum, bone and lymphatic glands. The usual history helps in the diagnosis, as rash, throat, bones, miscar- riages, or children dying soon after birth, etc. The eyes seem weak, the eyelids sore. The parts about the mouth, nostrils, buttocks, anus, flexures of joints get copper-colored, fissured and excoriated. A dermatitis about the pelvic region is not always specific, and may be due to wet napkins, etc., although if reaching beyond the limits enclosed by the napkin i. e., down the legs and up on the abdomen, it is syphilitic. A detachment of the epidermis from the palms and soles is an almost certain sign of the disease. In the various systems the following lesions are met with : Skin.—Dermatitis and detachment of the epidermis as stated. Deep red or copper-colored blotches on palms, soles and pelvic region (gluteal folds and genitals). Mucous tubercles about the anus and flexure of the groin, condylomata about scrotum, and on neck, thigh and arms. Mucous Membranes.—Condylomata and mucous tubercles about the mouth and anus, bucco-pharyngeal mucous membrane, and in larynx. A chronic inflammation and ulceration of the mucous membrane of nose causing " snuffles." At the angles of the mouth we get ulcers leaving cicatrices (specific stomatitis). Bones.—Periostitis leading to formation of nodes; Diffuse ostitis, causing hypertrophy and sclerosis. Ulceration, causing caries and necrosis (in the case of the nose causing the bridge to fall in). Cranio-tabes from atrophy (often not specific as is rickets). Cranial bosses (often not specific as is rickets). Separation of the epiphyses. Stoppage of ossification. Eye.—Acute iritis, interstitial keratitis. Ear.—Otitis. The disease in question is the most common cause of double deafness in children. Voice.—Laryngitis. Teeth.—Notched (the permanent ones). Visceral.—Congestion and fibroid enlargement of liver and spleen. Peri-hepatitis is one cause of infantile jaundice and ascites. Chronic inflammation of cerebral arteries. Meningitis, hydrocephalus, pulmonary affections, etc. With regard to infantile syphilis, this is either hereditary or acquired. If the former, it is transmitted from one or both parents, and the infected fcetus may be expelled with a clean skin and the characteristic rash not displayed for six weeks after birth; if the latter, the immediate contagion may be from the nipple of the nurse, or from kissing, or from some article of dress. BACTERICIDES. I I97 The presence of the syphilitic germ in an infant gives rise to a shrivelled or emaciated appearance. Some cutaneous manifesta^- tion appears near the sixth week. Defective nutrition, in the form of emaciation or marasmus. Emaciation progresses rapidly; the skin seems to stretch unnaturally over the facial bones; the expression is one of distress; the cry becomes a fretful moan; the skin loses its natural hue, and acquires a sallow or muddy tint; and very peculiar wrinkles or puckered lines radiate from the angles of the lips. The faces of those germ-eaten creatures have the appearance of age. In the recognition of the disease, the history of the case, the copper-colored appearance of the rash, together with syphilitic coryza, give a clew to the presence of the germ. The discharge from the nose, at first serous, later purulent, desiccating suffi- ciently to obstruct the nasal passage. Crusts form about the nose and angles of the mouth, giving rise to the snuffles, obstruct respiration. The mouth, larynx, vulva, anus are often the seat of mucous patches or condylomata. The liver in our country is The Venereal Bacillus. naturally weak, being exposed to [The Pathogenic Microbe of the malarial germ> the irritating Syphilis in the Liver. action of carbonaceous food and Syphilitic Hepatitis) drink, and to this organ the bacil- lus often migrates. Let the germ enter the body of a person with a weak or devitalized liver, the first thing we often observe is syphilitic hepatitis. As a rule, Fatty liver, interspersed with Microbe of syphilis in the liver. the syphilitic germ. the syphilitic germ does not manifest any special preference for the liver, like the skin or mucous membrane; it does not seem to be a pleasant or congenial pasture field. When it takes that organ for its abode, it colonizes in three forms: (1) germs gen- erally diffused through interstitial structure ; (2) a large congre- gation of germs, colonies varying in size from a linseed to a bean ; (3) in large irregular patches. 1198 DISEASE GERMS. Symptoms.—Sometimes there are all the indications of chronic inflammation of the liver; in other cases, there are few, if any, symptoms present but jaundice, a coppered-colored appearance of mucous membrane, with other marks of syphilitic cachexia, enlargement of spleen and albuminuria. When the microbe migrates to the liver, there is usually all the symptoms of jaundice present; nausea, vomiting, brown-coated tongue, yellow skin and conjunctiva, itching in the skin, clay-col- Syphilitic microbe in the liver. Another form of syphilitic microbe in the hver. ored stools. The usual treatment for the destruction of the syphilitic germ must be persevered with, to wit, saxifraga, phyto- lacca, comp. dioxide of hydrogen, etc. In addition, local stimulants over the liver, as either the irri- tating plaster, or take iodoform, one ounce; ether sulphuric, suf- ficient quantity to dissolve it. Mix. Paint freely over the region of the liver twice daily; or ozonized iodine. Internally, such remedies as phosphate of soda, nitro-muriatic acid, fringe tree, with chloride of ammonia. These remedies exercise a most salutary action on the liver. In all cases, it is most important to attend to this germ migra- tion and at the same time take care of the mother germ and its brood of spores in the blood. All individuals who have the The Venereal Bacillus, pathogenic microbe in their blood, [The Microbe in the Lungs) if their lungs be weakened in any way or from any cause, are liable to have a migration of that bacillus to that weakened point, when it passes by the name of syphilitic phthisis. There can be no question, that in the majority of instances in which phthisis has been produced through acquired syphilis —and syphilitic phthisis is more prevalent than is generally be- lieved—the symptoms, physical signs, and course of the disease are peculiar and characteristic, and distinguish it somewhat from other forms of phthisis. There is no doubt, too, that many cases which are regarded as examples of ordinary phthisis possess a BACTERICIDES. IIQg congenital element of syphilis, and that this disturbs the normal course of the disease. Just to what extent this factor is opera- tive we are not prepared to say, but it is very certain that some cases of ordinary phthisis are more readily influenced by micro- bicides than others. Although syphilitic phthisis is a well-reorganized disease, so far as its pathology goes, I am convinced that clinically it is not understood as well as it should be; and in order to aid as much as I possibly can in determining it from other diseases, I shall endeavor to lay before you the salient points of the disease as they occur in its clinical course. The characteristic signs and symptoms which distinguish the syphilitic from the non-syphilitic form of the disease are chiefly an absence of well-defined physical features in its earlier stages, frequently the only evidence of the presence or the disease being a wavy respiration, or an impaired respiratory sound. However, when crepitation appears it commences suddenly, and is usually The sputum in syphilitic phthisis. of a loud, moist character, and may diffuse itself very rapidly over the whole side of the chest. Haemoptysis is generally a prominent factor; there are no persistent, well-defined fever and night-sweats; the expectoration is frequently tough, white, stringy, and abundant; the patient, as a rule, is anaemic, subject to diarrhea and vomiting; the marked anorexia and wasting do not appear early; and every change which occurs in the course of the disease, either toward recovery or death, is generally more marked and sudden than in the ordinary form. The absence of fever, or the tendency of the fever to assume an irregular or abnormal course, I regard as one of the most valuable symptoms in differentiating this form of phthisis. When- ever I meet with a constant low temperature in such cases, my suspicion of infection is always aroused, in spite of the absence of other satisfactory evidence. The presence of fever is deter- mined, I think, in a great degree by the rapidity of the destruc- tive process. If this assumes a gangrenous form, as it does oc- casionally, the fever, as a rule, runs high. In addition, there may be aching pains in the sternal region, over the crest of the tibia, as well as in some of the articulations. Micrococci in the sputum in syphilitic bronchitis. Mould of bronchial twigs expectorated in a case of syphilitic bronchitis. The venereal bacillus in lung structure, found forty-eight hours after death in a case of syphilitic phthisll HACTERICIDES 1201 Also enlargement of the post-cervical glands, with nocturnal pains in the bones. There is a great difference between the behavior of microbe of syphilis and the tubercle bacilli in the lung, an interstitial as well as an anatomical difference. The anatomical changes in the lung chargeable to syphilis are cicatrices, connective-tissue growth, gummata, and chronic in- duration of the pulmonary tissue in the form of peri-bronchial growths, nodular formations, and diffuse lobular condensation, which generally start from the bronchus of the part (diffuse syphilitic infiltration). The diagnosis of these changes during life may be made with •a certain degree of probability at times, but can never be made amth certainty. The shortness of breath, cough, scanty and r*«metimes bloody expectoration, and other signs, rational as well as physical, are so wanting in characteristic peculiarities that the syphilitic nature of the affection cannot be made out from them. The diagnosis is to be based rather on the history of the case, the presence of well-known symptoms of general syphilitic infec- tion, and laryngoscopic examination, which will reveal in nearly all cases of pulmonary syphilis old lesions of the upper air-pas- l sages. The tubercular and syphilitic bacilli may co-exist in the same lung, and both can be detected and isolated in the sputum. The most common form in which the syphilitic germ appears in the lung is the gummata. These vary in size from a pea to an?gg, and are either single or in groups, appearing in the lungs as well-defined rounded tumors, surrounded by a fibrous capsule, and usual I v d;ep seated. The microbe in its eating operations on the lung has fibrous tissue thrown out with it. The presence of the gummata in the lung'causes it to be more weighty, larger, more dense. White, dry specks are seen on a section of it. There is also thickening of the alveolar walls, and minute bronchi, thick- ening and obliteration of pulmonary areas. 76 1202 DISEASE GERMS. Any irritation in the lungs of a syphilitic patient may cause gummata to form, and abscesses are quite common. There may be masses, nests of the tubercle bacilli, right alongside of the gummata in the same lung. There is also in syphilitic cases a deposit of the germ on the bronchial mucous membrane, which gives rise to the syphilitic asthma or bronchitis, or both. In some cases there is great ulceration, with copious expectoration, with the microbe in sputum. Lung and bronchial syphilis resemble in their symptoms tuber- cular affections of the same organs. Lung syphilis more generally follows inhalation of the germ by sleeping with an individual affected, or by berthing in a Pull- man with germ-saturated persons, or by kissing, or from the use of drinking vessels, than when the germ enters through a pock on the genital organs. Still, if the lungs are weak, we may have bronchial and lung syphilis before the germ appears in any other location. The weaker the affected individual or organ, the more virulent and active the germ. There are no stages—microbial infection calls for none. There is no protection from one or a dozen attacks ; every time the germ enters, a fresh attack. At whatever point the syph- The Venereal Bacillus. ilitic microbe enters the body, ( The Pathogenic Syphilitic whether it be by a hard chan- Microbe in the Lymphatics— ere on the penis, or on the Syphilitic Bubo) lip, or on the nipple, or through the endosmosis of a kiss, or contact by a drinking vessel or a towel, the lymphatics in the vicinity convey the microbe into the blood; in this process they themselves become contaminated by the deadly microbe, and suffer a partial death in the presence of the germ ; inflam- mation of the lymphatics takes place; they become clogged up with germs and products of inflammation, and form what is termed buboes. The seat and virulence of the sore determines in a great measure the kind or quality of the bubo. All the muscles of the The Venereal Bacillus. body may become the seat (The Syphilitic Germ of the syphilitic germ. The Entering Muscular Structure— muscle most frequently af- Myositis Syphilitica) fected is the sphincter ani. The localizing of the germ on this muscle gives rise to great pain, tenesmus before and after BACTERICIDES 1203 defecation, which often lasts for hours. The pain is a^^ravated by pressure from without. Women are more subjecUo it than men. The whole muscle is not affected ; sound bundles of fibres may be found among the diseased ones. Both the blood vessels of the perimysium and the nuclei of the sarcolemma are involved in the inflammatory process. As the affection of the sphincter may last long after the other symp- toms of syphilis have disappeared, we may have to treat the con- traction of the muscle and the consequent pain by sphincter- otomy. The Venereal Bacillus. ( The Pathogenic Microbe of Syphilis in the Male Urethra; or the Female Vagina) Hard, indurated in- fecting chancres are met with in both locations, and require tact and good judgment, with re- liable remedies, to effect their destruction. In the male, gelatinized bougies of iodol can be introduced, and the germ colony gradually killed off. In the female, the task is much easier, as the capacity of the vagina will admit of copious vaginal injections of either boroglycende or resorcin, or creolin, or even packing the vagina with borogly- ceride, are usually successful in wiping out the sore, together with bactericides internally. Another form of location, but much less frequent, is the ap- pearance in the form of papillomata, or warts, or condylomata. In ihe male urethra these are not infre- quently mistaken for organic strictures,and very foolishly dilated, curetted, even burned out with electrolysis with no result what- ever but a return of the afifection. In the vagina of the female, they also appear as papilloma, warts, con- dylomata, and unless a very careful examination is made, the leucorrheal discharge is often mistaken for some other affection. In all cases of supposed stricture of the urethra, the endoscope should be used for the purpose of making a diagnosis. If warts are present they are readily seen in the form of gelatinous V' Vegetating condylomata of the vulva. 1204 DISEASE GERMS. growths of various sizes, studded over the canal. In the female the same procedure should be adopted, although here they can be readily felt. In the form of papilloma, either in the male urethra or the fe- male vagina, the introduction of the oil of thuja speedily steri- lizes the germs and causes them in all cases to peel off—effects a cure. Frequently around the corona glandis, on the penis, or on the vulva, orifice of the urethra, or on the internal labia, these papil- loma make their appearance, and are most annoying. It is well to bear in mind that cleansing off by a lotion of per- oxide of hydrogen, and subsequently applying oil of thuja sev- eral times, they readily disappear. Chancres in and around the The Venereal Bacillus, nose are rare. The slightest ab- (The Pathogenic Syphilitic rasion at the entrance of the nos- Microbe in the Nasal trils and the application of the . Cavity) microbe by an infected towel, in- strument, etc., may be the exciting cause. Later on, especially if mercury or debilitating .treatment be used, the region of the nasal fossa is often the abode of the germ. Symptoms vary according to the period of germ growth and number of spores and germs present; ulcers surrounded by a bor- der of inflammatory tissue are seen on the anterior portion of the septum and inferior turbinated bone, while posteriorly they are localized behind the uvula and soft palate. The symptoms com- plained of by patients vary with the position of the lesions. Thus, if the latter be situated anteriorly there will be a sensation of heat and discomfort, with slight muco-purulent discharge; if posteriorly, the disturbances will affect swallowing and hearing, and impart a nasal twang to the voice. Examination reveals the characteristic patches on the mucous membrane, with, later on, ulcerations. Along with these appearances there will be the usual constitutional manifestations in other parts of the* body. Syphilitic condylomata occasionally make their appearance on the border between the skin and nasal mucous membrane. It is, however, in the later or tertiary stages that the ravages of nasal syphilis are most clearly manifest, The most wide- spread destruction of the nose, externally and internally, is by no means uncommon. Ulceration of the integuments may spread from without inwards, or from within outwards, destroying the tissues and forming ashy colored open sores, with the character- BACTERICIDES. 1205 istic indented edges and indurations. These ulcerations spread in depth and width and, unless arrested, permanently destroy the shape of the nose. Flattening and collapse of the bridge, and partial disappearance of the whole organ, are not unfrequently met with. The internal lesions are, however, the more common. The earliest symptom is a gummatous infiltration of the mucous membrane, which is at first apparently harmless, and may readi- ly be mistaken for chronic rhinitis. Obstruction of the nose, disturbances of smell, increased mucous discharge and a change in the timbre of the voice are at first the only diagnostic symptoms. Gradually, however, the discharge becomes thicker and more purulent, but not fetid. About this period examination will reveal ulcers on the septum and turbinated bones, The next stage is the presence of fetid discharge, sinking of the bridge of the nose, perforation of the septum, and caries and necrosis of the turbinated bones. The diseased bones can be seen as dark masses projecting into the nasal cavities and emitting a sickening stench (syphilitic ozsena). In these cases the discharge from the nose is generally abundant, and no amount of syringing with disinfectants can remove its fcetor. If the vomer be attacked the bridge of the nose will fall in and become characteristically flattened ; on the contrary, if the cartilage of the septum only is destroyed the tip of the nose will collapse. The ravages of the disease do not, however, in the worst cases stop here, for they may extend to the lachrymal canal, or the ethmoid and sphenoid bones, and large pieces of these may be thrown off. Even the brain has been occasionally laid bare, and this has been followed by meningeal inflammation and death. The odor from syphilitic ozaena is peculiarly repulsive and dis- gusting, and cannot be removed by disinfectants. In its char- acter and obstinacy in this respect it differs very distinctly from true ozaena, and should not be confounded with it. The diagnosis of nasal syphilis during the early stage of gum- matous rhinitis, may be difficult; later on the collateral symp- toms will be a good guide. The prognosis, provided bactericides are pursued with vigor, is good. General remedies.—Nose must be cleaned out with lotions of creolin, resorcin, permanganate potass, which are of a stimulating, detergent, deodorizing character. Stimulating, antiseptic inhalation of distillation of the pine, eucalyptus, jequirity, are of great value. Push general treatment, which will consist of iodide of potass in comp. saxifraga and phytolacca. 1206 DISEASE GERMS. The venereal bacillus is The Venereal Bacilius. dualistic, consisting of two {The Pathogenic Microbe on the microbes, one immature, Skin—Dcrmato-Syphihs.) the other full-fledged. The immature gives rise to soft, non-infecting sores (soft chancres), and a gonorrhea, but the germ is too feeble to enter the blood, hence there are no blood or tissue lesions ; the mature germ, if inoculated on any part of the body, gives us an indurated chancre, in which resides the true syphilitic germ, which enters the blood and produces the gravest form of blood changes. This, the true syphilitic germ, may appear in the urethra or vagina and give rise to some dis- charge. It is not at all necessary for this microbe to have an inoculation, a breeding place, a focus from which the blood can be saturated, hence the entire body, for it can be communicated from individual to individual by breath, by close contact, by kisring, drinking cups, towels, seats, cars, etc. This is the pathogenic germ of syphilis; the immature germ of a soft chancre can do no more harm than excite local inflam- mation ; it has not advanced in the scale of microbial existence to enter the blood. The true microbe syphilitica, once in the blood, seeks the weakest part, and there either grows, or if vital force is moder- ately good, may remain latent. Suppose a depreciation has occurred and the cutaneous surface weakened, then the microbe will make his appearance in any or all of the numerous forms of skin affections. The diagnosis of these are important, that is, the difference between simple skin eruptions and those that contain the patho- genic microbe of syphilis. In making this, the history of the case is fallacious, as the germ can effect an entrance without a pock or primary sore; the history of the case has no bearing in diagnosis, neither have such terms as primary, secondary or ter- tiary ; the germ will, if present, show itself microscopically and the appearance of the syphilitic eruption must be taken as it exists; without a history of the case. The appearance of the complexion of a microbe-syphilitic patient is remarkable. More prevalent in a chronic case than in one which the microbe has recently effected an entrance; also influenced by the number of germs present in the blood and the constitution of the individual. We must not, for example, expect to meet with it at the begin- ning of an outbreak of secondary specific roseola; but if the dis- ease has lasted for some months, we shall almost surely find that it has produced a peculiar change in complexion, which is best BACTERICIDES. I 207 described as a pale and dirty opaque appearance. This change in color is due to two causes. (1) The paleness is the result of general anaemia from an impoverished condition of the blood, which may often be demonstrated by placing a little blood under The venereal bacillus on the skin in the Micrococcus furfur—with groups ot f.inn of a lichcnons rash, aruiip-> of 1 he mii:r coccu- furfur. case. A splendid photograph of a living case. the microscope, when many pale corpuscles will be seen. (2) The muddy, opaque or dirty look is due to an abnormal increase in the pigmentation of the skin. I know of no disease that pro- duces an exactly similar appearance. It is scarcely necessary to add that it is general and quite inde- pendent of the " coppery hue" of syphilitic erup- tions. The bacillus of tubercle and the microbe of syph- ilis united on the face, forming indolent, circular or crescentic losses of skin substance, covered with crusts. The floor of each is a granulating, pale red- dish surface, with a cop- per-colored ring around, in which the syphilitic microbe is found; the edges are notched from The bacinus 0f tubercle and the microbe of syph'.U. the occurrence of succes- sive crops of the two bacil'i. Those microbes grow slowdy, coa'esce, but isolate themcelves in nutrient fluid. We note that the syphilitic eruptions develop with remarkabl r208 DISEASE GERMS. slowness and run a protracted course as compared with the simple inflammatory diseases of the skin which they closely resemble, Th-y also have an especial tendency to recur. This rule does not apply to syphilitic ulcers, which, compared with non-syphilitic ones, often run a rapid course, but nevertheless, taking a general view, the rule holds good, and is especially applicable in distin- guishing syphilitic eruptions resembling varicella or varioloid from those diseases, and syphilitic rose rashes from urticaria, erythema and measles. The color of syphilitic eruptions is often remarkable and highly characteristic; it is described as coppery. This peculiarity of color varies with the age of the eruption and other attendant circumstances. It is of the first importance to recollect that the typical color is rarely met with in recent syphilitic roseola, which follows closely on the primary sore; on the contrary, this rose rash is at first quite bright, and of a clear red or pink, and without the slightest trace of anything syphilitic in its appearance; when, however, it has lasted for some time, an irregular increase in the pigment of the skin occurs, and then we have the dirty brown maculae characteristic of the dis- Tenia Tonsurans in a svphiiitic ease. In practice we meet with various su^grlltVy^S shades of color, from the pale dirty brown micr-'be0' the pa,hogemc to the typical copper-colored blotch, and from this again to the deep purplish-brown, or almost black pigment stain, which is sometimes left after a syphilitic sore has healed. Indeed there is no other disease of the skin which leads to more remarkable changes in the rete Malpighii. Of all the characters which distinguish dermato-syphilis, per- haps polymoiyhism, or the appearance of several forms of erup- tion at the same time, is most important, because in no simple disease is this peculiarity developed to anything like the same extent or with equal frequency. It is, in fact, the exception to find a syphilitic eruption assuming a uniform appearance in dif- ferent parts of the body. For example, we may find maculae in one part, and mucous tubercles in another, or ulcers in one part, and nodes in another ; or we may even find four or five different forms of eruption on one and the same individual. Hence the great importance of examining every part of the eruption in doubtful cases. A red patch on the chest may present none of the characters of syphilis, but if we find also a typical ulcer on the arm, there will be no difficulty in arriving at a diagnosis. Locality, as' a means of diagnosis, is sometimes of value. BACTERICIDES. 1209 Secondary eruptions which follow closely on the sore, are com- monly symmetrical; but remote eruptions are, on the contrary, generally unsymmctrical, though frequently both-sided. The rea- son of this difference is, that recent eruptions occur while the microbe is still in the blood, while remote eruptions occur after the germ has migrated everywhere, when all the tissues of the body have probably undergone some obscure change, which is manifest by the development of syphilitic growths. Ulcers often appear en the arm, abdomen, without any apparent cause. Certain forms of alopecia, seborrhcei, appear on the scalp, and sometimes on the pubis ; syphilitica roseo'a, maculae, pemphigus, on the palms of the hands and soles of the fett. In all forms there is a per- fect lack of sensibility and copper-colored appearance of the emotion. If the affected individual be tubercular, or acquire that condi- tion during the progress of syphilitic germ life, all forms of the eruptions will be either round, crescentic, or serpiginous, but copper-colored, with lack of sensibility. Irritation, pain, itching, are at a minimum in all syphilitic eruptions. The microbe can be found in the crusts of the sores, hence thev are typical syphilitic. The frequent development of tubercles in the-skin, in conjunc- tion with other changes, is extremely characteristic, as those are never found in any other skin affection. Gummata and tubercles never can be confounded with any other affection. The occurrence of ulcers of a round, serpiginous, crescentic, or horseshoe shape, with sharply cut edges, and of the character- istic copper-color, or ash-gray, is an important sign of the pres- ence of the microbe. The presence of white, flatfish scars on different parts of the body is sometimes an aid to diagnosis. It will generally be possible to obtain a history of these scars, and if they have been produced by sores which occurred without any such apparent cause as bu*-ns, injuries, or bed-sores, there will be presumptive evidence of a former attack of syphilis, and this will be all the stronger if they are pretty numerous, and found on the trunk, thighs, arms, or scalp. • We must be very careful, however, in drawing conclusions with regard to a single scar found on the lace or shin. The chronic indurated enlargement of the lymphatic glands in different parts of the body, without any apparent local cause, is a diagnostic sign of syphilis of the first importance. The foregoing remarks apply more or less to dermato-syphilis generally. It will now be necessary to enumerate in detail the 1210 DISEASE GERMS. principal forms assumed by syphilitic eruptions, and also to point out briefly the peculiarities that distinguish each variety. The common recent secondary eruption are the following: (i) Roseola, or rose rash. (2) Maculae. (3) Papular eruptions (svphilitic lichen, so called). (4) Mucous tubercles and patches. \Je also meet with alopecia, pustules and ulcers, but of these the The venereal bacillus. Aluot syphilitic The venertal bacillus Dry syphiliticecxema. eczema ot the lace. Painless, copper Devoid of pain, and copper colored. Colored. two latter are less common on the skin as recent secondary forms, and usually occur only in severe cases. There is no well- defined line of demarcation between the recent and the rcmoti secondary eruptions, of which latter the following are the most The venereal bacillus. Syphilitic Lepra. The venereal bacillus. Lepra syphi- Scattered sp.trs. ly over the fore-arms. litica, wilh naralvsis of the exitnsoi Painless, copper colored. muscles of the fingers. common: (5) Pustules, particularly ecthymatous and acne- form. (6) Seborrhoea and alopecia. (7) Squamous patches. (8) - Tubercles. (9) Ulcers. (10) Rupia. (n) Onychia. There are many other varieties of syphilitic eruptions, but they hardly require any special description. Congenital syphilides correspond very closely with secondary eruptions, but coppery blotches and mucous tubercles are the prevailing forms. Bullae, though rare, are more common in con- genital syphilis than in the acquired disease. Rose rash or roseola syphilitica, when it first appears, may be very easily mistaken for other red rashes if we trust alone to it* BACTERICIDES. 1211 appearance, which is often identical with simple erythema. It is in this form of the disease that the history of a primary sore and other symptoms are of the greatest value for the purposes of dif- ferential diagnosis. Syphilitic roseo'a always follows closely on the primary disease (inoculation) ; indeed it often develops be- fore that has disappeared. It is frequently accompanied by the characteristic sore-throat, and other well-known symptoms, and at the outset of the eruption, these general symptoms are our chief means of diagnosis. A little later on, when pigmentation pecurs, the diagnosis is easy. Syphilitic roseola may. in the first instance, be readily distinguished from measles and German measles, by the febrile and catarrhal symptoms of those ma'a- dies. Pigmented syphilitis rose-spots become more defined by exposure to cold; the reverse is the case with the simple red rashes. Again, the subjective sen- sations are more marked in the latter than in the former. Syphilitic macula are among the commonest manifestations of the disease. They may be red, livid,copper-colored, dirty brown, purple, or almost black, the tint of color being produced by the varying combinations of local hyperaemia and abnormal pig- mentation. They may occur as recent or remote secondary erup- tions; in the former, the hy- peraemia usually preponderates over the pigmentation, and therefore the red or bright copper- colored maculae are the most common. The yellowish syphilitic pigment spots, especially about the forehead, may be easily mis- taken for chloasma or freckles. The pigmentary syphilide which is sometimes met with on the back of the neck in women, is generally a remote secondary eruption. Papular dermato-syphilis for the most part follows quickly on roseola ; mucous tubercles, and patches, are the most character- istic evidence of the germ. Pustular-dermato-syphilis may assume many forms. It may closely resemble acne, variola, ecthyma. Pustular-syphilitic rash on face, back and body, very common in broken-down subjects. Syphilitic alopecia very common. It takes the form of a thinning of the hair of the whole of the head, and is not at all confined to the parts usually affected with bald- less. It commonly occurs as a secondary affection, and is often Syphilitic microbe attacking the tuberosities. of v.tri in bonis. The nodules if germs on tne elbows and knees were thick y net. 12 I 2 DISEASE GERMS. associated with seborrhea. The head becomes covered with dirty yellow scales, and the hair harsh and brittle, so that \t breaks off and also combs out easily. Sometimes alopecia is associated with a distinct active, syphilitic inflammation of th,e Syphilitic papulae, with germ-laden blood. Syphilitic psori.isis, covering The genuin; syphil lie iiiicn be appear. chrst an > back I he dead ing in the form ot coppei-coloied pawn's veneieal bacillus could be on the face. Tht re was no original pock isolated from the scales; —the system was saturated with the spore could bear cultivation microbe through washing the clothes of an infected brother. scalp resembling eczema, and producing a discharge which forms dirty unhealthy-looking crusts ; as these are removed the hairs come out. It may be distinguished from simple eczema by the absence of itching and irritation, by the character of the crusts, later stage of some papular, mascular or rose ash, and as such are not difficult to recognize; the scales are thin, there is on itching, and the skin is more or less abnormally pigmented, which gives it the peculiar dirty look to which I have so often referred. In short, scaly affections of this kind are little more than a chronic desquamative stage of previous eruptions. BACTERICIDES 1213 % The circumscribed forms of scaly dermato-syphilis are more Important, and may be easily confounded with dry eczema or psoriasis vulgaris, particularly the latter, which often leaves be- hind brown pigment-spots. The syphilitic scaly eruptions, how- ever, do not especially attack the point of the elbow and the skin below the knee-pan, though they may oc- casionally appear there as elsewhere. The scales are thinner and dirtier than those of psoriasis and more diffi- cult to remove, and the corium does not blend readily on their re- moval, as is the case in psoriasis; pigmenta- tion is usually well maiksd and of typical color. Itching is rarely present. Moreover the scalp is often affected, and this is invariably attended with loss of hair, whereas simple psoriasis, when it attacks the scalp, has but little effect on the hair. Listly, the complexion of those who suffer from the latter disease is clear and fresh, and contrasts remarkably with that of the constitutionally syphilitic patient. Psoriasis palmaris and plantaris, as it is miscalled, is always either of syphilitic origin or a dry eczema of the palm. It differs in apparance and nature from true psoriasis, which, moreover, never occurs as simply a palmar eruption. It usually shows itself as a small copper-colored spot; this gradually becomes scaly, with a desquamation of epithelium, leaving a somewhat thickened, raised, or dhty ragged edge. The tendency of these patches is Ao spread at the circumference. Sometimes the cuticle becomes thickened, brittle, and fissured. The affection is very chronic, and often very inveterate. It may be confounded with dry cracked abortive eczema of the palm, but the appearance is different, the itching and pain are much less, the history of the commencement is also different, and lastly, eczema rarely occurs on the palm without being, or having been also "present else- where. Syphilitic g?rm papulae (lichen), has the diagnostic character- istics—coppsr-coloretl, lack of sensibility. 1214 DISEASE GERMS. Syphilitic squamous patches are not uncommon about the peri- naeum, scrotum, and penis. They usually present a rounded, well-defined border, and from their situation are apt to become red, inflamed, and very chronic. They may be easily mistaken for old patches of psoriasis or eczema; the latter disease, how- ever, especially in this region, is attended with intolerable itching, and although this form of syphilis is also often irritable, yet the Syphi itic lupia almost Molluscum epiiheha, ass<-c;ated with inherited covering the entire syphilis,showing the coppti-colored eruption body. on neck. itching is far less than in simple eczema. The previous general history is here a valuable guide, but it must be admitted that the diagnosis is sometimes difficult. ^Syphilitic tubercles.—I have already referred to tubercles, and therefore will only add that the remote ones are of two kinds, gummy tubercles and tubercles of the connective tissue. Rupia is a rare eruption, typical of syphilis. It consists of pe- culiar hard, conical, laminated crusts of a limpet-shell shape. The removal of the crust exposes a specific sore. Onychia maligna is also frequently met with, which give rise to a brittle or rotten condition of the nails. The syphilitic germ modifies all cutaneous diseases, by the microbe altering the nutrition of the tissues ; the normal re si sting power is weakened, so that the change in the tissues usu- ally produced by syphilis is impressed upon it; it is altered by being made more chronic, there is greater pigmentary deposit, less scaling, more crusting, and more infiltration, especially at the margin of the lesion. In the treatment of all forms of cutaneous syphilis, there should be no deviation from the general line of remedies. Anni- BACTERICIDES. [215 hilate the microbe and build up the vital forces of the patient. Saxifraga and phytolacca are the remedies. If mercury is deemed advisable, let it be the proto-iodide, in pill form, with one grain of opium. If this is administered, it is a good plan not to exceed one twelfth of a grain, and to follow it up with larger doses of iodide of potass than what is contained in the saxifraga syrup. The special indications for the administration of this salt in dermato-syphilis are (i) the existence of periosteal affections ; (2) a low constitutional condition ; (3) the co-existence of albuminu- ria, other than that due to syphilis, in which case mercury is gener- ally contra-indicated. The most important point in connection with Syphilitic microbe in pustules The venereal bacillus. The germ syphilt- (rupia). tica in pustules on the hand, with moist gangrene ol the fingers. the use of iodide of potassium is the fact that it soon loses its effect unless the dose be from time to time steadily increased. This should be done about once a week, otherwise the result of the treatment will be often disappointing. In those cases in which the constitutional condition is low, iodide of potassium should be given in combination with carbonate of ammonia and cinchona, and the dose gradually increased from five grains up to half a drachm (or more if required) three times a day. Under these circumstances, if there is no indication to the contrary, a I2l6 DISEASE GERMS. dose of opium every night is of the greatest possible value. When there is much anaemia or albuminuria, the iodide of po- tassium should be combined with iron, or with the citrate of iron and quinine, The great use of opium in the treat- ment of all syphilitic sores is too much forgotten. I have seen cases in which all remedies seemed to irritate, and had little or no effect until the nervous sys- tem was soothed by the action of opium. The use of sulphur, iodine, and ozone baths is attended with good results in the severest forms of syphilitic eruption. They are especially useful to aid the action of internal remedies, and used about twice a week. Local treatment of syphilitic eruption is not of much utility, but they should be covered with ozone ointment, or sprinkled with iodol or iodide of starch, or the anti-microbe powder. Sozoiodol is the best remedy for indolent ulcers; the ulcers should .first be washed with a solution of boroglyceride, then Syphilitic Ichthyosis Dry pangrene. etif. < f the«ffecTsof the venereal bacillus. This Mate is usually uhertd in with intense nocturnal tan in the I alt of the gn-at toe. After this lasts a tew weeks the luberof-iiy becomes "f a bluish color, gradu. ally Hack, dry, cold, and spreads up the foot. Dry rprg-rne of thr tees, the venrre.il I acilln- fnM aiiinkiip il.r ni.-iitix ci lh«- nail-, aril v-throxyion coca. ing increased vigor to the muscles, as well as to the intellect, with an indescribable feeling of satisfaction." In small doses it increases appetite and promotes digestion. In cases of sleeplessness from exhaustion and fatigue, it is in- valuable, producing a sound and refreshing sleep without the distressing sensations so common after opiates, bromides, and hydrate of chloral. One wineglassful is equal to one drachm of the leaves. Dose, as a tonic: one wineglassful before or with each meal. Children, half or quarter of a wineglassful. For sleeplessness from nervous exhaustion : place a wineglass- ful at the bedside, and take a sip about every half hour until asleep, or take the whole at one dose, and repeat during the night if wakeful. J288 DISEASE GERMS The spermatorrhea pill which has acquired such a celebrity in the cure of seminal weakness, is prepared as follows: Cocaine, one drachm ; jerubelin, fifteen grains ; hypophosphate of lime, thirty grains; gelsemium, six grains ; extract ignatia, three grains; leptandra, thirty grains ; glycerin, q. s. Mix, Ft. sixty pills. Millions of pills from the above have been sold for arrest of spermatorrhoea with most gratifying results. Cocaine in that formula being a mere abstracta. The Cocaine Suppository from the divine plant is prepared as follows: Butter of cocoa, six ounces ; cocaine hydrochlorate, two to four grains ; solid ext. hyoscyamus (English), one and one half ounces ; Ft. 100 suppositories. Mix. The addition of either the hyoscyamus or conium, modifies the action of the cocaine. This suppository positively cures spermatorrhoea, impotence and sterility, continence or incontinence of urine, inflammation and enlargement of prostate, piles, stricture of rectum; also cures coccydynia, dysmenorrhcea, or painful menstruation, cancer of the rectum. is the common name for a berry of a Cocculus Indicus climbing shrub, which grows in Cey- lon. It is used in large quantities by brewers for increasing the bitterness and intoxicating power of malt liquors. It is also used to destroy fish. As a microbicide, its power is immense, but its use demands great care and caution. Picrotoxicon, its alkaloid, a most irritant poison, is used in the form of a cerate to kill parasites on the skin. It has also been used with some success in epilepsy. Best to try it in pill form. 'igy^ The whole herb is Cochlearia Officinalis, officinal. The bac- [Scurvy Grass) tericide properties are most abundant in the green plant. This resides in an oil which is obtained by distillation from both the green and dried plant, most abundant in the former; this oil is identical in germicide properties with the oil of mustard. The tincture of either the green or dried plant, best made with dilute alcohol. It is, take it all in all, an excellent energetic stimulating alterative and germicide, very useful in dormant liver or spleen ; often suc- cessful in paralysis; of great utility locally in ulcers, sores in the mouth, and spots upon the skin. BACTERICIDES. 1289 Cocoa Theobromo. The fruit of the gods, is from a tree which is extensively cultivated in the tropical parts of Asia, Africa and Amer- ica. It is a tree which rises with a bare stem to the height of six or seven feet, dividing into many branches, and attaining a height of from sixteen to twenty feet; oftentimes twice that height. It attains its full growth in seven years. The fruit has the appearance of a cucumber in shape, six or eight inches long, yellow, but red on the side next the sun. The rind is thick and wart}r, the pulp sweetish, not unpleasant, the seeds quite numer- ous, easily compressed, with a thin, pale, reddish brown, fragile skin or shell, covering a dark brown, oily, aromatic bitter kernel, which con- sists mostly of wrinkled cotyledons. These seeds are the beans of com- merce ; the larger seeds decorticated, bruised, ground, yield that delicious, nutritious beverage—cocoa. The Theobroma Cacao. principle constituent of the bean, aside from this more solid constituent, is the oil or butter of cocoa, which forms fifty per cent. of their weight, a glucoside, theo- broma, which is identical with caffeine, slightly more nitrogenous. The butter is extracted by com- pression of the seeds, or by de- coction, or by the action of a sol- vent; the method of expression is preferable. The butter is an ex- cellent germicide ; useful for mak- ing bougies, cones, pastiles, sup- positories and ointments. Coffee. The important con- stituents of the coffee bean is caffeine, a sub- stance to which it, tea, kola nut, guarana, cocoa nut, owe their ex- hilarating and refreshing properties. The effect of caffeine is not Coffee; a, a branchlet with leaves, flowers and fruit; b, section of fruit. 1290 DISEASE GERMS. identical with tea or coffee, or the other drugs containing it • all possess a germicidal action. Extensive clinical experience have demonstrated caffeine to stimulate the heart and respiratory movements; increase the peristaltic wave; excite the brain and spinal cord; retard tissue change, and augment the flow of urine. It is the remedy which excels all others in the so-called nervous headache, or in that due to fatigue or overwork, or the abuse of intoxicating li- quors. It is used as an antidote to opium poison- ing; as a diuretic in drop- sical effusions due to cardiac disease. Dose: from two to five grains. Of the various salts of caffeine, the citrate and bromide have met with most favor, being soluble and not deliques- cent. The caffeine soda salts are the best germicides, because they are per- fectly soluble in water, and make permanent solutions, and will, if brought in contact with the amoeba of catarrh, the bacteria of erysipelas, kill those micro-organisms. The an- American nexed wood Columbo. cut is an il- lustration of the columbo or frasera, which grows so abun- dantly in our Southern States. Frasera is a mild, bitter tonic, of a rather fine order. In many particulars it re- sembles columbo in its medical properties as well as in its appearance, and experience in American Columbo. BACTERICIDES. 1291 its use has given us a high opinion of its virtues. It neither astringes nor stimulates, and is a bitter above all others that is most acceptable to the stomach. It answers admirably as a remedy in simple dyspepsia and in all enfeebled states of the alimentary canal. Its very mildness and absence of all irritating properties render it a tonic of great value in the convalescing stages of all acute diseases. Even in inflammation of the stom- ach it will be tolerated when all other remedies will be rejected. The article termed fraserin is simply a solid extract in a state of trituration. Columbo is regarded as next to collinsonia as a tonic to the stomach and bowels. There are many preparations of it, all of great excellence. The following formula is very efficient: an ounce of columbo, half an ounce of ginger, the same of leptandra, and thirty grains of capsicum, to one pint of boiling water. Dose, a wineglass three times a day. Colchicum, rectly termed a meadow saffron. as employed in medicine, is either the bulbous under- ground portion (more cor- corm) or the seeds of the From the corm are pre- pared an extract and a wine of colchicum, and from the seed a tincture. Colchicum seems to have the effect of increasing the flow of bile, of diminishing the force and rapidity of the heart's action, and if large doses are used, causes vomiting and purg- ing. The specific action of colchicum is, however, on the pain of the gouty par- oxysm, which it relieves in a marvellous manner. Its use is followed by some pros- tration, and a tendency to faintness which is far from agreeable, even though the pain has gone. It is sometimes used in acute rheumatism, but does not produce the same wonderful effects as in gout. There is, how- ever, one fact which is of vital interest to those who suffer from gout, they may kill the pain with colchicum, but they do not cure the disease, and in all probability this will return sooner or more violently after being chocked off with colchicum, than had it been allowed to exhaust itself, or other remedies, as alkaline purgatives, employed. Of the ordinary extract, about a grain Colchicum. 1292 DISEASE GERMS. should be given for a dose; of the wine and tincture ten or fifteen drops every four hours. Its bactericide action is exerted chiefly on amylobacta and urate of soda of gout. Indicated where there is a rheumatism of joints, worse by motion. Dysentery of a bloody mucous character, with loathing of food, and nausea. Dose, one-half to one drachm of the wine, or twenty-five to thirty drops of the normal tinctbre. In small doses it is valuable in pericarditis, gout and rheumatism of the small joints. It may be used in any heart affection connected with rheumatism. In dysentery, with stools like the scrapings of flesh, colchicum is a good remedy. In tympanitis, three drops of the tincture every half hour is a very positive relief. And where there is a pain after urinating, twenty drops three times a day gives relief. In dropsy after scarlet fever small doses, say three to five drops with thirty to fifty drops of the tincture of asclepias syriaca is apt to be followed by a cure. Colchicum with apocynum androsem, in doses of ten to thirty drops, ac- cording to age, cures dropsy or rheumatism. Commonly known as " stone Collinsonia Canadensis, root," or " knob root," is one of the most valuable of indigenous American medicinal plants. It is widely distributed, being found in richly-wooded soils from April to October in all sections of the United States. It possesses a rank aromatic odor, and is hot and somewhat pungent to the taste. Its principal medicinal con- stituent appears to be a volatile oil, which is driven off by boiling or drying. All parts of the plant may be used in medicine ; but the root is the most powerful, and the portion usually employed. As it yields its virtues to water and alcohol, it may be administered in the form of a powder, or as the tincture, the fluid extract, or the infusion. The dose of the powdered root varies from ten to sixty grains, that of the tincture from twenty drops to two drachms ; the fluid extract from fifteen minims to a drachm; the infusion from one to four ounces. The physiological action of collinsonia, very much resembles bayberry and stone crop, intermediate between the two. It is an astringent to mucous surfaces and a bactericide of consider- able power, besides equalizing chaotic nerve centres. It is very highly esteemed in all disordered states of the ali- mentary canal, starves out both gastric and intestinal sarcinae. Its action upon all organs contained in the pelvic region is BACTERICIDES. 1293 good, relaxes the ureters, promotes an increased, flow of urine, facilitates the expulsion of calculi, diminishes the irritability and general sensitiveness of the bladder. Acute cystitis is most effi- ciently treated with collin- sonia in alternation with gel- semium. So is constipation, hemorrhoids, rectal neuralgia. Again in chaotic nervous affections, like chorea, it is equal to cimicifuga in its ac- tion; very valuable in neuroses of the vagina. Its germicidal action is best seen in its sterilizing the mi- crobe of hooping-cough. Upon the urethra, prostate and rectum its action is very similar to the stone crop. It has some peculiar action upon ptomaines, as when it is being used, all odors of the body disappear. Collinsonia is of great utility in piles, as follows: Tincture hamamelis, tincture collinsonia, tincture euonymus of each equal parts. Teaspoonful in water four times daily. Take the first daily dose early in the morning in a tumbler of water in which ten grains of soda bicarbonate are dissolved, collinsonia. then at night just before retiring; remaining two doses between meals. The product of gun-cotton dissolved in ether Collodion, and alcohol, when exposed to the air, the ether speedily evaporates, leaving it in such a state that when painted on it leaves a thin film on the surface to Avhich it is applied. This film is impervious to the air and is very useful for cuts. Steeping gauze in collodion and applying in gaping wounds, supersedes the use of sutures. Tannic acid and collo- dion are useful for sterilizing the microbe of corns. 1294 DISEASE GERMS. A preparation called flexible collodion, made by adding Cana- da balsam and castor oil to ordinary collodion, is however much more useful in many instances than ordinary collodion, as it does not crack on being bent or stretched. To this various germicidal remedies can be introduced and painted over parasite skin affections—creolin, resorcin, ichthyol, creosote, naphthaline, added render it an application of the most powerful germicidal character. The com- Colt's-Foot, mon name of a British plant, known to botanists as tussilago farfara. 11 i s a com- positous plant, and has had a good reputation as a remedy in diseases of the lftngs. Colt's-foot contains an en- ergetic active principle, a glucoside, which is a most valuable germicide. This principle sterilizes the microbe present in asthma, bronchitis, and incipient pulmonary dis- ease. Cigars made of the leaves and smoked afford prompt relief in the violent paroxysms of asthma. Infusion excellent for colds. Coltsfoot. The root of this plant Comfrey. yields to water a peculiar mucilaginous substance, highly antiseptic, which renders it of great value in the treatment of all bronchial affections. It has a sterilizing action on the amoeba of chronic catarrh, and on the conferva of longstanding bronchitis. It yields its properties to hot water; hence an infusion is the best form for administration. It makes a most admirable tonic for female weakness as follows : Take one ounce each of the fluid extract comfrey, Solomon's seal, uni- corn root; half an ounce each of fluid extract camomile, compound gentian, Common Comlrey. sassafras, cardamom; BACTERICIDES. 1295 alcohol, four ounces; sherry wine, one pint and a half. Mix. Dose : A tablespoonful every three hours. Common name, Indian Convulvus Turnip, man of the earth. Panduratus. Its properties are that of a most active bactericide, mild but efficient alterative, without pro- ducing any drastic action either on the bowels or kidneys. The milky juice of the fresh root is so powerful a germicide that it will, if applied to the part freshly bitten by a rabid animal or venomous reptile, kill or antidote the poison. _______ One or two drops in a carious - Concentrated Ozone, tooth will instantly relieve most vio- lent toothache; rubbed over a painful nerve the pain of neuralgia ceases ; two to twenty drops in sweet- ened water will afford most refreshing sleep; cloths saturated with it and applied (covered with oiled silk) over any portion of the body suffering from inflammation, will instantly arrest it and cause a renewal of life; to the abdomen in cholera and typhoid; to the throat in diphtheria and scarlatina. Successfully used in parturition to alleviate its pains by rubbing it over the abdomen and lumbar plexus of nerves ; if applied over the mammae when secreting the lactiferous fluid it is a more efficient arrestor of secretion than belladonna. Dose : For internal use five to ten drops; for local use rub freely over the painful part; repeat as indicated. has been chemically examined. It con- Condurango Bark tains two or three glucosides and a resin, all of them manifesting the same action. These substances form collectively the condurangin. It coagu- lates when heated in an aqueous solution, even at 400 C. and, like albumen, is precipitated from an aqueous solution by sodium , chloride. Its action on the central nervous system is decidedly a poisonous one. In small doses it produces symptoms like those of tabes dorsalis in ataxic change of gait. It also appears to act on the peripheral nerves and muscles, at first increasing and then depressing their electric excitability. Loss of appetite, and in the earlier stages a plentiful flow of saliva, as well as Indian Turnip. 1296 DISEASE GERMS. vomiting, are constant symptoms in mammals. The poisonous dose of condurangin is about 0.02 gramme per kilogramme of the body weight for carnivorous animals, and about three times as much for herbivorous animals. It was brought forward as a remedy calculated to destroy the microbe of cancer, but'for this purpose it is utterly useless. An'ozonized extract prepared from the conium Conium. maculatum is one of the most valuable remedies when the blood is germ- laden with the micrococci of cancer. From one to three grains should be given every four hours. It sterilizes the cancer germ, it aids in rectifying the defect in nutrition upon which the degradation of bioplasm takes place so as to give us the germ. So valuable is this remedy that no case of cancer can be successfully treated with- out it. Excellent results are ob- Conium Maculatum. . tained from the administra- tion of conium in the cure of chorea with violent movements. Large doses at first are best, until the system is thoroughly under its influence, when smaller doses, more frequently repeated, will keep up its action. The uncertainty of action of certain preparations necessitates care in its administration. An ointment prepared from the green leaves is an admirable remedy in rectal irritability and fissure. Two glucosides from the Convallamarin—Convallarin. flowers of convallaria maja- lis, or lily of the valley, con- vallamarin and convallarin, whose physiological effects were determined by Marme, in 1866. Convallamarin is of a persistent bitter taste, readily soluble in water, insoluble in ether and chlo- roform. Upon boiling it with diluted acids, it is split up into BACTERICIDES. 1297 convallamaretin and sugar. According to Marme, it is emetic in small doses, and affects the heart similarly to digitalin, arrest- ing its action in systole. The commercial pro- ducts vary widely in strength. Merck's con- vallamarin may be ad- ministered hypodermi- cally in doses of .005 to .02 grammes several times daily. Given by the mouth, .05 to .06 grammes every hour or two up to .1 gramme per diem, produce the full effects Of the drug. Lily of the Valley. Convallamarin is indicated in weakness of the heart, oedema from myocarditis and other cardiac diseases, as well as in exudative pleurisy and Bright's disease. Convallarin has a scratchy taste, sparingly soluble in water, insoluble in ether, but readily soluble in alcohol. It is also separated into convallamaretin and sugar upon being boiled with diluted acids. In action, it is purgative only. Dose : About one-fiftieth grain. An alkaloid from the coto bark ; of great utility Cotoin. in diarrhea and cholera. Cotoin is insoluble in the gastric juice of the stomach, and passes unchanged into the intestines, where it is dissolved. It is specially indi- cated in the diarrhea of those affected with ulcer of the bowels, as in the insane, in phthisis, in the diarrhea of detention. It is contra indicated if there be congestion. Dose: One grain for adults ; half grain for children, in powder or emulsion ; several times a day. A leafless herb, sending up Corallorhiza Odontorhiza. from a coral-like rhizome, a [Coral-Root.) simple flower, from six to six- teen inches high, furnished with sheaths, instead of leaves, of a light brown or purplish color, and bearing small, greenish-brown flowers in a long spike. i It is a parasite plant, growing from the roots of trees, and 82 1298 DISEASE GERMS. nourished by them. The root is the part used. It is much branched, toothed, of a brown color, and from its resemblance to coral in appearance, has derived its name. Like numerous other parasite plants, it has a peculiar action in morbid states in which micro-organisms play an important part. Administered in doses of thirty grains, every three hours, either in powder or in jelly, it acts precisely like exalgine, lowers heat, respirations, pulse. Corallina. Ustilago, fl. extract, ten Corn Smut, to sixty drops in uterine hemorrhage, bleeding piles, epistaxis; aids parturition when uterine contractions are feeble. Useful in e nlarged prostate; spermator- rhoea, im- potence. The re- putation of stigmata maidis, as a diuretic, demulcent, and anti- septic in all affections of the genito-urinary tract, is well established. In order to obtain a most efficacious preparation, the fluid extract should be prepared from freshly-gathered silk. The bark cotton punt. Cotton Root. of the root of this plant is emmenagogue, parturient, abortive and diuretic. As it causes a condition of engorgement, in true congestion, it is very apt to Maize, or Indian Corn. (Zea mays). BACTERICIDES 1299 be followed by hemorrhage in patients of a sanguine tem- perament. The bark of the green root is the most active, the so-called active principle gossypium, is worthless, perfectly inert. Those desirous of procuring a reliable article of cotton root, must procure it from some one who will dig the root, slice off the bark, and at once put it into alcohol. To imagine that it can.be prepared otherwise is absurd. Dried root preparations are all worthless. This is the active volatile constituent of the Coumarin. tonka bean, a germicide of great power, capable when administered in hooping-cough of killing the microbe of that disease. This active principle is sometimes found in a crystallizable state, between the two lobes of the kernel, but more commonly it is thus prepared : The beans are coarsely ground, heated for some days with twice their bulk of alcohol. This tincture is poured off, set aside, and the tinctured mass subjected to the same process. After this is completed, the two tinctures are mixed together, the alcohol distilled off until it appears turbid, when twice its bulk of water is added, which precipitates the coumarin and fatty matter. This precipitate is then heated to the boiling point and passed slowly through a wet cloth, which attracts all the fatty matter, and the coumarin passes through. The fluid extract may be used with great advantage. is a substance composed of carbon, hydrogen, Creatine, nitrogen, and oxygen, and is found in the juice of the flesh of all animals. A pound of flesh yields upon an average about five grains. The quantity varies in dif- ferent animals. The flesh of fowl yields the largest quantity. The flesh of fish contains it in larger quantities than beef or mut- ton. Creatine is obtained in colorless, transparent crystals, and, dissolved in water, it has a slightly bitter taste. It unites with the various acids forming salts. If creatine is boiled with 1300 DISEASE GERMS. alkalies, a new alkaloid is produced called sarkosine. If boiled with hydrochloric acid, it produces creatinine. This substance also forms salts with the various acids, and is found normally in flesh. These alkaloids are probably the result of the decompo- sition of the flesh of animals. They are found with the extract of meat, but whether they exert any power on the system is not known. B. F. Shepherd, M. D., Frankford, Ind., in an able and elabo- rate article on creatine, entertains a most favorable action of it and recommends its use in doses of two grains, four times a day, as a remedy of great value, as an excitant of muscular action in atonic conditions of the general muscular system, especially of the heart. The remedy is placed dry on. the tongue, and fol- lowed by a draught of water. A bactericide of the very highest order, pro- Creosote, duced in the destructive distillation of wood for the purpose of obtaining acetic acid. It is a colorless, transparent liquid, with a peculiar odor and burning taste. It is an invaluable drug in medicine, its germicidal action is prompt, decisive. It completely annihilates the bacillus of tubercle, the sarcinae ventriculi of gastric catarrh, the microbe of diarrhea and dysentery. Inhaled through hot spray atomizer, it kills the germs in the bronchial tubes. It is not well to use it in lotions or gargles, as it does not mix with water. It is freely soluble in alcohol and acetic acid. On account of its remarkable property in coagulating albumen, it has acquired quite a reputation in coagulating aneurisms. Externally applied to the germ-laden veins in phlebitis, its power of penetration is so great by endosmosis, that it kills the entire bacterial colony; of great value in destroying the microbe of dental caries; com- bined in various proportions with salicylic acid, it is capable of destroying the microbe of lupus, and other forms of skin germs and parasites. Internally, in all affections where the tubercular bacilli are present in the blood, it has the power of sterilizing and partially annihilating that germ. It should be given internally in syrup of tolu or some emulsion in drop doses, and by inhala- tion of various strengths. This well-known germicide has been demonstrated by Pro- fessor Bigger, M. D., of Atlanta, Ga., to be fatal to micrococci in the strength of I to 200. While he admits that it may not be from its antiseptic or germicidal powers that it benefits, but that BACTERICIDES. 1301 it may be simply from its favorable action upon digestion, still he advises that it be pushed to its utmost limit of toleration, as here is where so many fail in its use. Pushing it to this extent would be unnecessary if its beneficial action was expended only upon the process of digestion and assimilation ; for experience with the drug plainly shows that it is the small doses, and not the large, which assist digestion, and that the large ones which he advises, occasionally irritate the stomach. He says that dis- appointment arises through timidity. " The more creosote that can be borne the better the effect," is his dictum. He claims to have treated 500 cases during the past nine years, and of those treated by this formula, twenty-seven per cent, recovered. Others were treated by the following formula, which gave the best results: Creosoti, fifteen minims; tr. gentian, forty-five minims; spir. vini recti, six and one-half fluid-drachms ; vini xerici, q. s. ad three fluid ounces. Of this, one ounce was taken three times a day. The creosote was gradually increased to thirty grains. He obtained the best results by following treatment for from three months to a year. The most benefit was seen in the young, and in the first stages of the disease, when the symptoms were not well defined. Good results were always secured when tubercular glands were pres- ent. It generally relieved irritation and cough, and secretion and expectoration diminished, so that narcotics could be dis- pensed with. Dr. T. E. Quick, of Carrollton, N. Y., after trying various formulae, settled upon the following as the best: Creosoti purissimi, two parts ; alcoholis, thirty parts; tr. gen- tianae; ext. caffeae, aa ten parts; aquae destillatae one hundred parts. M. Sig.—Shake well and take a tablespoonful in half a glass of milk twice daily. From most extensive experience, and merited success, he formulated the following pill: Creosote, one-half minim ; iodoform, one-tenth grain ; ext. of opium, one-quarter grain; balsam of tolu, turpentine, of each, one-third minim. Mix. Of these, from three to ten may be taken daily. is a product of the dry distillation of coal, and is an Creolin. oily, dark-brown, fluid, smelling of tar, but differing from carbolic acid in being easily and completely miscible with water, forming a milky solution which tends to become brown. We have tested its action on several 1302 DISEASE GERMS. varieties of organisms. A two per thousand mixture of creolin killed the cholera bacillus and the streptococcus of pus and of erysipelas in two minutes, the bacillus anthracis in five minutes; but the typhoid bacillus, the staphylococcus Pyogenes, was not affected in an hour's treatment. A two-per- cent, mixture, however, killed the staphylococcus and tertragenes in about fifteen minutes. Creolin is a more powerful germicide than carbolic acid; a three-per-cent. mixture killed the spores of bacillus anthracis in two days, a six-per-cent. in twenty-four hours, whereas a carbolic acid mixture up to eight per cent, did not affect the spores in seven days. Many other experiments con- firmed the superiority of creolin over carbolic acid. Given in large doses to animals, creolin is not found to be poisonous. It is eliminated by the kidneys, and the urine is not discolored, although tribromophenal may be separated from it by the addition of bromine water and of hydrochloric acid. Creolin has been used therapeutically both for external and internal ad- ministration. Externally, we have used a one-per-cent. mixture in a severe case of puerperal joint affection, in ulcers of the leg, in old operation wounds, and also in recent wounds. Good re- sults were obtained in all these cases; the growth of granulations was stimulated, and the excessive discharge was stopped. Ulcers may be treated with a gauze-compress soaked in a one-to-two- per-cent. solution and bandaged up for about four days. We strongly recommend the employment of creolin in gauze or as an emulsion in surgical practice, in conditions similar to those indicated above. We have employed it with good results in otitis media. We use an injection of the strength of ten drops to one- half pint of warm water in acute otitis. It relieves the pain, and owing to its innocuousness, it may be used as an injection in leu- corrhcea. As regards its administration, it effects big results in gastric catarrh, in diseases of the stomach and intestines. It was found free from poisonous effect and non-irritant. It may be given in doses of three to fifteen grains, in gelatine capsules, three times daily, and relieves meteorism and catarrh, and is serviceable in the severer forms of local inflammation of the in- testines, such as typhlitis. In simple dilatation of the stomach, in flatulence and in diarrhea, it i.s of great service. It is of great utility as an injection in cystitis. It is always well to be a little cautious of taking too rose-colored a view of the action and effects of a newly-introduced drug. If all that has been stated about creolin be correct, we have in it a drug of great import- ance, a powerful antiseptic with no poisonous qualities. Experi- ence will determine the extent of its utility. The germicidal properties of creolin has been thoroughly in- BACTERICIDES. 1303 vestigated by Pennsylvania's great bacteriologist, James M. Bunn, M. D., of Altoona, Pa., who pronounces it a non-toxic disin- fectant bactericide. The experiments were performed by mixing a certain per- centage of the antiseptic with bouillon-cultures of the organism, from which mixture, after a certain time, the presence of living bacteria was tested by a fresh cultivation free from creolin. It was found that a two-per-1000 mixture of creolin killed the cholera bacillus and the streptococcus of pus and of erysipelas within two minutes; the bacillus of anthrax was killed in five minutes, while the typhoid bacillus and the staphylococcus of pus were still alive after one hour. The last organism, as well as tetragenes, was killed in ten to fifteen minutes by a two-per-cent. mixture. Compared with carbolic acid, it was found that a two- per-cent. mixture of creolin killed the spores of the anthrax bacillus in two days, a six-per-cent. mixture within twenty-four hours, while a carbolic acid mixture up to eight per cent, had no effect on the spores within seven days. A similar comparative result was obtained with the hay bacillus, and the superiority of creolin over acid was further shown by its great power of pre- venting the growth of organism in culture. Creolin is not poison- ous, as it may be given in large doses to dogs without deleterious effect. Bunn earnestly recommends its use in surgery in place of corrosive sublimate, carbolic acid, and iodoform. He has strongly recommended its use. He has applied it in the form of emulsion or a creolin gauze, and found that it stimulates the growth of granulations, and aids in separating sloughs without the pro- duction of any toxic symptoms. The urine does not present the green color of carbolic acid urine, but tri- bromophenol may be separated from it on the addition of hydrochloric acid and bromine water. Curarin Curarin is found in Sulphate, the form of a sul- phate in the arrow poison of the South American In- dians, the so-called curari or woorari which is derived from a number of plants of the strychnos Woorari Poison family. Curari was first brought to Europe by the celebrated traveller, Waterton. It has long been used as a remedy in the treatment of convulsive affections, I3Q4 DISEASE GERMS. tetanus, hydrophobia, etc., with more or less success. The dose of the curari is one-tenth grain. Great care must be exercised in its use. The sulphate of curarin is used for the same disease but as it is more powerful than curari, the dose must be propor- tionately smaller. From one-twentieth to one-sixtieth of a grain has been given. The remedy is worthy of trial in cases of tetanus, when the combination of lobelia, capsicum and valerian cannot be procured. This is a glu- Cyclamen. coside isolated from cyclamen europaeum, a powerful germicide, capable of destroying the microbe of tetanus, producing effects on the animal system analogous to those of curari. This prepara- tion is soluble in water, sparingly so in alcohol. Upon shaking an aqueous solution it assumes a frothy appearance. Besides being destructive to the germ of tetanus, it has the same action on the red corpuscles of the blood. Either orally or hypodermi- cally, its administration must not be prolonged or carried to the point of an emetic cathartic, small doses frequently repeated until the spasm, gives way; then at longer intervals, until the Gferm dies. Cyclamen Europjeum; a, b, the fruit the whole plant; Turnera aphrodisiaca, is used in renal and vesi- Damiana. cal diseases, nephritic albuminuria, diabetes, and has proved successful as a nervine tonic in a case of blindness from tobacco amaurosis; also as a tonic for the genito-urinary tract. The fluid extract when ozonized is indicated in all cases of sexual debility in young or old of both sexes. It is a true sexual invigorator, its merits are sustained by extensive experience, and it is of the greatest efficacy in every case of genital debility. Dose: From ten to thirty drops added to water; every three hours. BACTERICIDES. I'3<>5 Foxglove, a powerful car- Digitalis, diac tonic in small doses in enfeebled heart action, a stim- ulant which gives permanent improvement by increasing the nutrition of the heart. It exerts a contractile or tonic action upon the capillaries, unlocks the absorbents, and sterilizes disease germs. Where the heart is feeble, there is no more direct remedy than digitalis. In all forms of serous effusion, the infu- sion of digitalis is a drug of great efficacy, and can always be relied upon in the gravest cases of dropsy. The tincture is the best form for general administration. In all cases it exercises a special influence on the circulation; a sedative, calming in- fluence, which can only be explained by its excitant action on the ultimate branches of the sympathetic system. Foxglove or Digitalis. The bark of the ' Dogwood, cornus Florida forms one of our best ozonized fluid extracts and may be prescribed with great certainty as a tonic, germicide, stimulant. It acts chiefly upon the brain and spinal cord as a stimulant. Some think that it is a good substitute for quinine; in this they are mistaken. It is much inferior to cinchona preparations. Still it is an excellent tonic in dyspeptic cases. Its internal use increases the strength and frequency of the pulse, and elevates normal, while it depresses abnormal tempera- ture. Dose of the bark from thirty to sixty grains. A fluid extract in doses of from a half to one teaspoonful every four hours is a good form in which to administer it. Dogwood. 1306 DISEASE GERMS. Sundew (Drosera rotundifolia). patient relief from bronchial irritation. This plant is highly Drosera. germicidal and has a wide range of action. Its effects are best exhibited when administered in diseases of the re- spiratory organs, as in nasal catarrh, laryngitis, hooping cough, asthma, bronchitis, pulmonary phthisis. It promotes a renewal of vitality, bet- ter innervation of the lungs, at the same time it sterilizes all germs in the air passages. The special action of this drug is upon the great nerve centres, having a special action in getting rid of congestion. Its action is mild, but invariably effective, affording the Eggs.—In addition to eggs being a nutritious food, they are also of value as a medicine. The albumen, beat up in water and salted, is an excellent remedy in diarrhea, also very useful in the vomiting of cholera infantum. Elaterium. Or squirting cucumber, in its mature state, is a plant rough all over with stiff hairs, has a trailing branch stem without tendrils; the leaves are heart-shaped, bevelled and tooth- ed on long stalks; the flowers axillary, yellow; the male-flcw- ers in small racemes; the fruit oblong, about an inch and one- half long, grayish green, covered with soft prickles and finally parting from the stalk and ex- pelling its seeds along with a thick mucus, through the aper- ture, where the stalks are in- serted. This remarkable phenomenon is ascribed to osmotic action within the fruit; a thin membrane separating a mucus Wild Cucumber (Ecbalium agrtste). BACTERICIDES. 1307 which immediately surrounds the seeds from a less dense juice, which abounds in the succulent part of the fruit, and the quality of the former being gradually increased at the expense of the latter, till on the perfect ripening of the fruit, the much-distended central cell is open to permit its ejection. It is this mucus surrounding the seeds—a thick green mucus of a very peculiar character which contains the elaterin. To collect this the juice of the ripe fruit is allowed to stand a short time and become turbid, when it deposits a sediment. This sediment, carefully collected and dried, is elaterium, from which the crystalline principle elaterin is prepared, one of the most powerful of all drastic cathartics, but invaluable in certain forms of dropsy. The patient should be, in all cases, suitably prepared for the remedy by drinking rather freely of an infusion of digitalis for a few days, and then the elaterin in one-twelfth of a grain, in a fine state of trituration, should be given every few hours until copi- ous evacuations of serous fluid takes place. Elaterin.—Indicated in all dropsies—the most active agent known to remove large serous accumulations. Its use should be preceded by infusions of digitalis. Dose : one-twelfth to one- twentieth of a grain triturated in sugar of milk, as indicated. A bac- Elecampane. tericide of great pow- er, exercising a peculiar ster- ilizing action on all microbes ; has a most remarkable action on the bacillus of tubercle. It is worthy of further inves- tigation. It is a good remedy, of in- trinsic value in rabies ; it has a powerful germicidal action, faint aromatic odor, a bitter, acrid and a somewhat cam- phor-like taste. It is a stimu- lant to the organs of secre ° . Elecampane {Inula Helemum). tion, promotes expectoration, and is a diuretic and soporific. It contains two active principles, one called inulin, which resembles starch, but is deposited un- changed. An old author speaks of it thus : " Elecampane root, taken with honey made in an electuary, cleanseth the breath, ripeneth the « 1308 DISEASE GERMS. tough phlegm and maketh it easier to be spit forth, and prevaileth mightily against the cough and shortness of the breath, com- forteth the stomach and helpeth digestion." The bark, leaves, shoots, flowers and berries of the Elder, common elder are highly antiseptic, diuretic and slightly narcotic. These properties reside in a vola- tile oil which is present in the entire plant, but most abundant in the flowers. A decoction of the leaves is so strongly antiseptic that if ap- plied to the bacterial blush of erysipelas, it will in a few hours' destroy the germs. Elder water is unexcelled as a local antiseptic in skin affec- tions. An ointment prepared by simmering the inner bark, flowers and leaves, in lard, is very highly esteemed by rectal specialists as a local application to rectal ulcers of a tubercular character. The following is their for- mula: Unguentujn sambucus, one ounce; hydrargyrum mur. sub., thirty grains; pulverized opium, solid ex- tract belladonna, of each, seventeen grains. Mix. The bowel is first washed out with castile soap and tepid water, subsequently the ointment is brushed over the ulcer. This repeated several times at intervals of a week apart until the germ colony is destroyed and the ulcer heals. Elder flower soap excels in therapeutic value all other germi- cidal soaps. The berries make an agreeable sub-acid wine, con- taining much malic and citric acid, sugar and glucose. Flower-stock, leaves, and cluster of berries of com- mon elder (Sambucus nigra). Elm Bark. The pulverized bark makes an excellent ger- micide poultice, to which bicarbonate of soda in any given quantity can be added. An infusion of the bark is one of our best remedies in gastritis and gastric ulcer. BACTERICIDES. I309 Slippery Elm Bark in the successful treatment of tapeworm is well presented by recent authors. Pulverized slippery elm bark, four ounces ; water, one pint. A tenacious mucilaginous fluid is thus obtained. The following directions for use are given : The patient to fast two days; the evening of the second day to take a purgative dose of castor oil sufficient to move the bowels the following morning, and while still fasting take one-half the medicine, and in half an hour the remaining half along with the full dose of castor oil. In a case so treated the entire parasite in a mass was expelled in one hour after the last dose of medicine, measuring forty feet in length. _______ Epilobium Angustifolium. (Willotv Herb) This indigenous plant has very nearly identical properties with the willow tree, and even yields sali- cine, hence it is germicidal, bracing, se- dative, astringent action. It yields its properties freely to both water and alcohol. It seems to have a special affinity to unite with and destroy the micro-organ- isms of diarrhea and dysentery. Its sphere of action is best exhibited upon all organs in the genito-urinary organs, hence it is valuable in catarrh of the vagina, bladder, ^V^ prostate. \ r\^ The tincture is the most eligible form W^T for administration. Willow Herb. Erigeron Canadensis. The oil is equally effi- cacious as terebene, and as powerful a germicide, also astringent, styptic. Five drops of the oil on sugar repeated as indicated, exerts a well-marked influence over the heart and arteries, and is a most efficient remedy in chronic bronchitis. Re- Engeron. cent ext-ensive clinical experience with this drug confirms its ancient reputation as an invaluable haema- static to the uterus, bladder and rectum. Its chief sphere of action 1310 DISEASE GERMS. is upon the genito-urinary organs, it is essentially a uterine styp. tic, stops the flow, lessens the irritability; it is also of great effi- cacy in haemoptysis. It acts well upon the kidneys, checks haematuria ; greatly lessens the flow of albumen in chronic inter- stitial nephritis, and in chronic cystitis it exerts a good effect in lessening the mucous exfoliation from the coats ot the bladder. If the oil dropped on sugar and administered excites any heart- burn, administer in mucilage or syrup of tolu. Ergot. The degradation of the primary elements of nutri- tion of certain grasses, cereals, fruits, vegetables, by adverse states, as poverty of soil and aosence of nutritive pabulum, into a fungus or microbe, has nothing in com- mon with the normal gland. The principal use of this fungus, up to a recent period, has been its efficacy in parturition. When administered during labor, it produces a constant, unremit- ting contraction and rigidity of the pregnant uterus. Consequently, un- less the os uteri and external parts, are sufficiently relaxed, it is apt to prove disastrous to the mother and child. The indiscriminate use of this .fun- gus gives rise to thrombosis or em- bolism, hence sudden deaths during its use is the rule from clot and rup- ture of the heart. It is, however, a spinal stimulant of great efficacy, and this, together with its faculty of causing a coagulum to form in the blood, renders its use of rare value in all hemorrhages from or- gans in chest and abdomen. So great are its properties as a spinal stimulant, that hypodermic injections of ergotine, will, in short time, reduce an enlarged prostate, or cause absorption of a uterine fibroid; so with en- largement of the thyroid. The Glucoside Ergotine.—By stimulating the spinal cord (lum- bar portion) it causes contractions of the uterus ; used in paraly- sis of the sphincters; enuresis; incontinence of urine; impot- , ency; to absorb uterine fibroids; diminish enlarged prostate. Dose: one-fourth to one grain every four hours. Ergot ef Rye. BACTERICIDES. I3U or adder's-tongue. All parts Erythronium Americanum, of this plant are active in the destruction of microbe. The plant in its green state is most energetic, its activity is much diminished by drying. The crushed leaves and bulbs, added to diluted alcohol, macerated four weeks, percolated, make an elegant preparation for emetic purposes, as an alterative and germicide; in very small doses it is often of advantage in the cure of chronic eczema and herpes. In the form of a preparation made from the green plant we derive the most effi- cient results. Cerate is of great utility in nearly all skin affections. Eryngium. This is a most effect- ive germicide, valuable tonic, active stimulant and restorative. Its special action is upon the genito- urinary organs, being a diuretic and , aphrodisiac (Eryngi , a petal maritintum); a, a a stamen ; d, the Adder's-Tongue (Ophioglos- sum vulgatum). In its action it re- sembles apiol, allays vesical and urethral irritation from what- ever cause. Some claim that it will destroy the microbe of snake bite, but this is not correct. It acts well in some cases of dropsy, dependent upon conges- tion or obstruction of the kidneys with uric acid. Its use in alternation with the saw palmetto, has a most excel- lent effect in atrophy of the testes. It has been used with great success in dropsical effusions. It acts well in all such cases, in alternation with strophanthus. 1312 DISEASE GERMS. This plant has been thoroughly Eschohltzia Californica. investigated, and three distinct products have been isolated: a glucoside, a new alkaloid, resembling codia, and a very small percentage of morphia. Two pounds of the dried plant yielded about six grains of morphia. The tincture, or fluid extract of the entire plant is a most ex- cellent, efficient germicide, and entirely well adapted to combat the various diseases of infancy, especially the green diarrhea of the summer season. From a large number of cases in which the remedy was used in cholera infantum during the heated term of July, August, and September, in crowded-up abodes, devoid of all sanitary precau- tions, and among a class of cases, with great vital disorder, pain, fever, spasm, prostration, it has demonstrated itself to be a rem- edy of vast importance, and one destined to supersede lactic acid, salicylate soda, resorcin, in the treatment of those formidable af- fections. It can be administered with safety to the youngest child in any stage of the disease, and always with the most satis- factory results. In infantile diarrhea, when the common bacillus are liberating ptomaines, as is manifested by the symptoms of utter goneness, pallor, distress, tense abdomen, drawing up of knees, screaming or crying, etc., with green stools, in this stage the action of the ramedy is seen to the best advantage, for when administered right here, a complete change to the better at once takes place, and if persevered with, the green stools, with the bacillus and ptomaines, disappear and recovery is rapid. the name applied to an extensive genus of Eucalyptus, trees of the myrtle family, natives of Australia and Tasmania, all possessing great germicidal properties. The eucalyptus globulus, or blue gum, one of the species, has come into high esteem and deserved repute as a sanitary tree, and has exercised in regions of the warm temper- ate zone, a greater influence, scienic, industrial, hygienic, bacteri- ological, than any other species of arboraceous vegetation, even the pine not excepted. It is a great ozone generator, liberates that agent in great abundance. The planting of this tree in the most pernicious paludal and malarial marsh, where ozone never penetrated, and human life could not exist, rendered them perfectly habitable and healthy. There are numerous preparations made from the selected leaves, such as a fluid extract, which is almost inert, as in the mode of extraction, the essential oil is virtually lost. BACTERICIDES. 1313 All the bactericidal properties of the leaves are in this essen- tial oil, which can readily be prepared in the form of a glycerite, and five volumes of hydrogen dioxide added, in this form we have a germicide of great efficiency in sterilizing and annihilat- ing the microbes of croup, diphtheria, catarrh; and is capable of neutralizing offensive discharges from the vagina, or ulcers. An ozonized distillation from the leaves is the most efficient remedy ever discovered for promptly killing the gonococcus of gonorrhea; one ounce of the distillation, added to four ounces water, gives us an injection of intrinsic value in gonorrhea, leu- corrhea, ophthalmia. Suppositories prepared from the fresh leaves kill the tuber- culae bacilli of a germ-eaten rectum. A cerate prepared from the oil is valuable in erysipelas. Eucalyptus honey, contains all the ozone-generating properties found in the tree, and to the presence of which are due all its wonderful germicidal properties. This honey plays an important part in the cure of all laryngeal, bronchial, pulmonary diseases, as well as in hooping-cough and influenza. Eucalyptol, active principle in solution.—In the administration of this remedy for malarial fever, open the bowels freely. Three hours before the chill, Folia Eucaiypt™. give two tablespoonfuls of the extract undiluted; drink of all kinds to be strictly forbidden; twenty minutes before the rigor, another half-ounce. In place of the chill, a violent perspiration sets in, which has the peculiar odor of a marshy swamp, which is due to the dead germs on the skin. Dose : from ten to fifteen drops on sugar thrice daily. Utterly insufficient to destroy the tubercular bacilli, but acts powerfully on the bacteria. Eucalyptus Folia.—(A distillation from the fresh leaves, ozon- ized.) In gonorrhea, use as an infection after urinating, or three times a day; for leucorrhea, use as an injection by fountain syringe morning and night; for ophthalmia, keep a cloth con- stantly wet with it, loosely applied to the eye. An energetic agent to destroy the germs of gonorrhea and leucorrhea. It not only destroys the germ, the factor of gonorrhea, but its use be- fore a suspicious connection acts as a prophylactic. In the various forms of purulent or gonorrheal ophthalmia, it com- 83 I3H DfSEASE GERMS. pletely kills the bacteria or gonococcus present. Dose : add one fluid ounce to four fluid ounces of water. For external use only. This new drug has proved most Euphorbia Pilulifera. successful in cases of asthma, bron- chitis, coughs, influenza, affections of the chest, and is now being tried for hay-fever. Preparations.—As this plant is a poison, great care should be taken not to make too strong a decoction, or ill instead of good results may be expected. The decoction is prepared as follows: Place one ounce of the weed in an enamelled saucepan contain- ing two quarts of cold water, boil, and then allow it to simmer for a couple of hours, or until the quantity of water is reduced to one quart; strain it, allow it to cool, and bottle for use, adding a teaspoonful of alcohol and chloroform to fortify and prevent fermentation ; also a tincture. Doses: Decoction, two fluid ounces to be taken at night be- fore going to bed, on rising in the morning, and an hour before dinner. Tincture: one-half to one teaspoonful, two or three times a day in water. ||Most favorable reports reach us from all quarters, of the prompt beneficial results in asthma, promoting easy breathing and soothing the irritation of bronchial tubes. It succeeds when all other remedies fail. This decoction has, from Euphrasia, time immemorial been famous [Eye Bright) as a remedy for dimness of vision. On account of its astringent and antiseptic action, it is invaluable in all forms of ophthal- mia. Add to one pint infusion one ounce of boroglyceride, and we have an eye lotion of great efficacy, one which will purge the visual organ of all microbes, and in granular con- junctivitis act as an absorbent to effused lymph. Besides its utility in eye effections, it is often of great service as a diuretic. The in- fusion to be taken freely. An excellent extract may be prepared by macerating the coarsely ground plant with equal parts of water and glycerine for fourteen days, and then percolating. Euphrasia Officinalis (com- mon Eye Bright). BACTERICIDES. 1315 The extract may be administered in all acute and painful af- fections of the eyes; it is even successful in opacity of the cornea, in twitching and paralysis of the lids. Eupatorium Queen of the mead- Purpureum. ows, or gravel root, is a decided tonic to the granular structure of the kidneys; an infusion of the root is very valuable in alternation with nitro-glycerine in Bright's disease of the kidneys. There are few remedies so beneficial as this one in affording relief wherever there is painful suppression of the urine, either from inflammation or from calcareous accumulations. It is of great benefit in the treatment of almost all affec- tions of the kidneys and bladder. In dropsy, strangury, haematuria, gout and rheumatism, it is a valuable auxiliary agent, and of decided benefit in dropsy, on account of its stimulating influence on the vessels, as well as its diuretic powers. _________ Queen of the Meadows, or Gravel Root. The name {ex, privative, and algos, pain) is sig- Exalgine. nificant of its qualities. The formula is C9HnNO (or C6H5.02H3O.NCH3), and the substance is one of the three isomeric (para, meta and ortho) methyl derivatives of acetanilid. It occurs either in fine acicular or long tablet-like crystals, accordingly as it is obtained by evaporation from solu- tion, or by fusion thereafter. It is sparingly soluble in cold water, more soluble in hot water, and extremely soluble in very dilute alcohol, or in water slightly alcoholated. Physiologically it acts very much like analgesine, having, however, more effect upon the sensory and less upon the thermogenic centres than this substance. Its therapeutic effects are obtained in doses of from four to six grains, administered at once, or from six to twelve grains taken in two doses in the course of twenty-four hours, and are powerfully analgesic, subduing the element of pain in all forms of neuralgia, including visceral. Like all new remedies of this sort, it is at present on trial. It is claimed by 1316 DISEASE GERMS. eminent authority that it has in their hands up to the present exhibited no evil sequelae, being free from the rash, cyanosis, etc., so frequently observed after the ingestion of antipyrine and ace- tanilid. Exalgine is eliminated by the urine, upon the quantity of which it exercises a marked effect, acting like the antipyretics of the same group, diminishing the quantity of the secretion. In diabetes it also diminishes the quantity of sugar eliminated. Like all of the derivatives of the aromatic series, it is antiseptic and antithermic, as well as analgesic, and possesses the latter quality in a comparatively superlative degree, being more effi- cient, in doses less than half so great, than antipyrine. The following is an excellent formula for its administration: Dissolve two drachms of exalgine in two ounces of diluted alcohol, 45 per cent.; add the same to either two ounces of the syrup of tolu or fluid extract of licorice, and administer in tea- spoonful doses as indicated. Nearly all our essen- Fennel. tial oils are germicides of the first order, and their use is sadly neglected in practice. For example, the oil of pepper- mint has an antiseptic property in it, a potency for good, a field of therapeutic utility, vast in extent and importance, greater than yet known or suspected. The greatest of all desiderata in diphtheria is a germicide like this, which can be fearlessly applied, in the greatest quantity and frequency, which is innocuous, whether it be absorbed or swallowed. The oil of fennel has not such active germicide properties, although a grateful aromatic and carminative. Fennel seed exercises an important action on the broad liga- ments of the uterus, and is utilized with rare success in all cases of prolapsus. An infusion of the powdered seeds, twenty grains to a drachm to a pint of water, is an excellent form for administration. BACTERICIDES. 1317 A glucoside from fumarina officinalis or fumi- Fumarine. tory; a most remarkable vegetable bactericide. A simple decoction used as a mouthwash or gargle kills the oidium albicans. As an eye lotion, completely sterilizes all bacteria and other micro- organisms in ophthalmia. A fluid extract is exceedingly useful in congestion of the liver and spleen. It is a very valuable remedy in sterilizing the micrococci of the eruptive fevers. The general properties of this remedy are tonic, alterative, and, in large doses, laxative and diuretic. Its pro- longed use diminishes plethora and will Fumitory. produce anaemia; so it should be administered for about days, left off for four or five days, and then resumed. ten The whole plant has an agreeable, aromatic Gaultheria. odor and taste, owing to the presence of a vola- tile oil, which is stimulant and highly germi- cidal. An ordinary fluid extract of the plant has in ordinary doses a direct sedative action upon the genito-urinary organs of both sexes. It is an anaphrodisiac, allays irritation and inflammation of the bladder, prostrate urethra ; ovaries, uterus and vagina. The oil of partridge-berry yields salicylic acid in great abundance. • The glycerite of wintergreen is prepared from the oil, and is with- out a doubt the most valuable of all its preparations, being a cerebral stimulant and vitalizer, and when administered in proper doses, in acute rheumatism, having such a chemical affinity for the lactic, buty- ric ferment or germ in the blood and tissues, completely neutralizes and annihilates it. It lowers tempera- ture, equalizes the circulation. It is a perfect substitute for salicylic acid and its salts, the latter being a chemical derivative of the former. In its use in rheumatism, it has many advantages; it is prompt and efficient in action—few relapses when used; no cardiac complications. It is best to administer it in frequent Procumbent Gaultheria ig.iultheria procumbens); a, fruit; i, flower. 1318 DISEASE GERMS. doses, till temperature is lowered. It is a local anodyne to inflamed joints. The best method of administration is in frequently repeated doses, continued in diminished doses throughout convalescence. Its use possesses the advantages of being unattended with any toxic effect or gastric disturbance. Glycerite of Wintergreen.—In acute rheumatism this remedy supersedes its derivatives, salicin, or salicylate, in neutraliz- ing the lactic and butyric acid; besides, it is a great promoter of nutrition. Salicylate of ammonia is useful when we desire ammonia administered; salicylate of potash is an excellent substitute for the soda salt; it is to be preferred whenever we desire to introduce potash into the system, as in the gouty dia- thesis ; salicylate of lithia is the ne plus ultra of all drugs in gout; salicylate of quinine is used with considerable success in neuralgia and rheumatic pains; and the salicylate of cinchonidia is very useful as a tonic and anti-periodic in neuralgia, gout, rheumatism. Cinchonidia (CaH^NaO) is an isomer of cinchonia, but possesses left instead of right polarization and is more soluble. In chronic rheumatism, as a stimulant to the appetite and general tonic, it is of great utility. Glycerite of Wintergreen [Ozonized), Gaultheria.—Indicated in all cases of acute or chronic rheumatism. When administered it unites with the lactic and butyric acids, and renders them inert, at the same time its tonic and antiseptic action upon the organs of digestion and assimilation prevents the formation of those acids; hence its use stamps and starves out the disease. A perfect substitute for salicylic acid and soda. The superi- ority of this preparation is seen in the rapid cure of both acute and chronic cases, the infrequency of relapses, and the prevention of cardiac complications. All physicians who use this prefer it to the various compounds produced by artificial means. Perfectly annihilates the bacillus amylobacta of rheumatism. Dose: From one-half to one teaspoonful every two hours. The bark of the root of the yellow jessamine Gelsemium. is a nervine, antispasmodic and an energetic genital sedative. A pure nerve tonic of the highest order and a germicide of great power, being capable of destroying the malarial germ, so that it is used either alone or combined with quinine with the greatest success in all malarial fevers. It has a powerful influence on the sympathetic nervous system, BACTERICIDES. 13*9 allays nervous irritability, as may be seen by its use in all nervous diseases, neuralgia, headache, tetanus, epilepsy, delirium tremens, hysteria and convulsions. It is invaluable in all forms of reflex irritation, arresting the symptoms so produced. As a genital sedative, exceedingly valuable in gonorrhoea, allays urethral irritation, and is of the greatest efficacy in nocturnal emissions when they are dependent on irritation of the prostatic portion of the urethra, or if there is an inflamed prostate or rectal ulcer. In all cases of sperma- torrhoea it is invaluable, soothing to the damaged parts, cuts off for the time being all sexual desire which, when its use is discon- tinued, are restored to their full vigor. To secure its full phy- siological action it should be given in large doses at bed- time ; a tincture of the fresh root is the best form. The active principle is unfit for use, being toxical and unreliable in its action. In puerperal eclampsia lobelia and gelsemium combined are excellent. In severe cases ad- minister a teaspoonful by the rectum,first emptying the lower bowel by enema. The dose maybe repeated in half an hour, and so on till the convulsions are abated. When given by the mouth half teaspoonful doses are in order. Very useful when a person is under the influence of an alcoholic stimulant or is men- tally excited, the face is flushed and the eyes have the appear- ance of being bright. The excitement is in the base of the brain and the vaso-motor tract at the same time is in a state bordering on paresis. Here are found the centres for respiration, circulation and secretion. Here are points wherefrom emanate controlling influences that either stimulate or inhibit ganglia and their nerves. It is in this state that gelsemium is remarkably valuable. Vasomotor dilator excitation prevails. There are vaso-dilator centres through the medulla and cord. When these are excited we have full capillaries and veins, and low arterial 1320 DISEASE GERMS. pressure, dilated pupils. Pulse soft and temperature high, func- tional excitement and the vital energies of the centres are being depressed. Gelsemium is a wonderful medicament in all these conditions. The irritation of nerve centres, restlessness, fever, bright eye and flushed face, soft pulse, low blood pressure, weak heart sounds, pains of that kind that indicate irritation of centres and not of nerves. Gelsemium must be fitted to the case in each person. Some require larger doses than others to be of value; too small a dose is worthless, too big a dose is paralyzing. Remember gelsemium is a stimulant. This remedy possesses in a high degree the Gentian, tonic properties which characterize simple bitters. It excites the appetite, invigorates digestion, in- creases the vital forces of the body. It may be used when- ever a tonic is indicated in all conditions of debility, but it is the condition of the stomach and of the system generally, not the name of the disease, which must be taken into considera- tion in prescribing it. It is a germicide of some value, destroying the bacteria and oidium albicans in malig- nant and sloughing ulcers. It can either be sprinkled on or in- corporated in a poultice and applied to the sore. It kills the germ streptococ- cus, or chain of micrococci, which is present in impetigo. The powdered gentian is incorporated in ozone ointment, and applied to the scalp morning and night. The same ointment, as a hair dressing, is a prophylactic to thjs disease, which has been epidemic in our public schools and certain streets. Common Gentian; a, capsule ; b, capsule cut across, c, vertical section ol seed, magnified. The root of the cranesbill, or spotted geranium, Geranium, is an astringent and antiseptic ; a decided tonic, bracing to all mucous surfaces. It is a vitalizing and restorative agent, promotes instead of suppressing the normal mucous secretion. It is most efficacious in cholera infantum and BACTERICIDES. T-2I the summer diarrhea of children; peculiarly serviceable if there is much pain, griping or flatulency. On account of its pleasant taste and efficient action, it is par- ticularly suitable for administration to children and persons of a delicate constitution. It is of great service alone to check the vomiting of cholera, and can be combined with salicylate soda when a powerful antiseptic action is needed. It cannot be valued top highly as a safe and efficient astringent, and it is indicated in all forms of infantile diarrhea. In fissure, ulcer of the rec- tum, it is of the greatest effi- cacy. A tincture is the most eligi- ble form for administration. Probably one of the most profound of our physicians and certainly one who is a keen ob- server of morbid action, says : " There are few remedies which possess a wider range of .usefulness than geranium ma- culatum, and which are so de- void of harmful properties. In all forms of hemorrhage, whether internal or external, it is without a superior. Haemop- tysis can usually be promptly arrested by drachm doses of the fluid extract given hourly until the attack subsides. Re- lapses may be prevented by continuing the same dose at longer intervals for three or four days. Haematemesis may be effectually controlled in the same manner after ergot, matico, sulphuric acid, iron, ice and other styptics have failed. In hemorrhage from the kidneys and the intestinal canal better results can be obtained from the adminis- tration of smaller doses twenty drops four times' daily, for an extended period. Epistaxis may be speedily checked by plug- ging the nostrils with cotton dipped in a solution composed of one part of the fluid extract of geranium and three parts of water; or by syringing the nasal passages with the same solution. Hemorrhage resulting from the extraction of a tooth is occasion- ally obstinate in character, persisting for days, defying the cau- 1322 DISEASE GERMS. tery and other methods, enfeebling the patient and alarming the family ; but it can invariably be promptly arrested by filling the socket with a piece of cotton saturated with the undiluted extract of geranium maculatum, and applying firm pressure for a few minutes. Hemorrhagia can be most effectually abated by the internal administration of geranium combined with vaginal injec- tions of the same remedy." Ginger. A well-known root, indi- genous to both the E^ist and West Indies and China, but the best is grown in Jamaica. It is a diffusible stimulant, and aromatic and an- tiseptic. To weak, germ-laden stomachs it is a remedy of rare value. It makes an excellent tea, which should be taken either warm or cold, as desired. In the preparation of an infusion of ginger it should never be boiled, as that impairs its antiseptic properties very much; valuable carminative, useful in colic, de- bility and laxity of the stomach and uterus. It is invaluable combined with quinine in uterine hemorrhage, either in infusion, say half an ounce of pulverized ginger to a pint of water; or, syrup of ginger, three ounces; sulphate quinia, twenty grains. Mix. A teaspoonful as indicated. Common Ginger (Zingiber offici- nale) ; a, flower, detached; b, perfect anther. Gillenia Trifoliata. Bark of the root of the gillenia tri- foliata is a safe and mild emetic; a most reliable and effica- cious agent in diseases where emetics are indicated. Besides it can be employed with great benefit in all dropsical conditions. It is of most value in gastric catarrh, where the sarcinae ventriculi and yeast plant are on the stomach. It might fairly be named an emeto- hydragogue, cathartic and antiseptic. For an alterative action, best to administer doses, and continue for some time. Indian Physic. in very small BACTERICIDES. 1323 The fluid extract is the best form for general use. When it is desirable to administer it in large doses, it should be combined with fluid extract of collinsonia, which entirely mitigates its irri- tating effects. An invaluable germicide and parasiticide. Glycerine. Glycerine is a sweet substance, the basis of fats, being combined in them with the peculiar fatty acid characteristic of each. Accordingly, when these fats are decomposed by the addition of an alkali, as is done in making soap, the glycerine is set free, and the new combination of fatty acid and alkali constitutes soap. It is also obtained by distilling the fats by means of superheated steam. Thus obtained, the glycerine is a sweet liquid, colorless, and syrupy, oily to the touch, yet mixing readily with water. The solution of it in water does not ferment with yeast, and it does not dry up on ex- posure to heat of a moderate temperature. Its properties are very valuable, it readily dissolves many substances, and not drying up readily, it constitutes an excellent basis for applying them to the skin. It is chiefly as an adjunct to lotions that glycerine is pf use. Lotions containing it do not dry up, and so the skin is kept soft and moist, and the bad effect of drying in forming scabs is avoided. It has been tried internally instead of cod liver oil, and it is used as a basis for some remedies, as gallic acid and tannic acid, when they are applied to the throat. In this way, too, borax may be made of use in aphthae with advantage. Dose: one drachm, locally applied, in the proportion of a desert-spoonful to eight ounces of water, and taken internally, in doses of one to two drachms, is curative of impetigo, prurigo, pruritis, lupus, and herpis exedens. It is a good application to fetid ulcers, skin scurf, dandruff, chapped hands, chilblains, acne, rosacea, eczema, and to prevent pitting in small-pox. It is a good application, alternated with boroglyceride, for cracked nip- ples, cracked lips, and hands, burns, scalds, wounds, and erysipe- las. It is valuable in dry eczema of the ear, alternated with boric acid. It prevents fermentation of the stomach, and given with nux, is a tonic. Glycerine has been lauded in constipation; glycerine when brought into contact with the mucous membrane of the rectum, withdraws water from it, thus causing hyperaemia and irritation of the sentient nerves of the rectum, which in its turn leads re- flexly to powerful peristaltic contraction, ending in defecation. The larger the accumulation of faeces, the greater is the effect There is no discomfort or pain, but the action takes place at 13 24 DISEASE GERMS. once. Sometimes, however, a little throbbing is felt in the rec- tum for a few minutes afterwards. This repeated exhausting of the serous coat of the rectum renders it weak, liable to prolapse or deposit of the cancer germ, so that the so-calied " glycerine suppository " so freely adver- tised, is productive of great damage. Internal use of Glycerine.—Prof. C L. Souder, M. D\, Burrows, Ind., prescribes it as a stimulant to the digestive organs in the non-febrile stage of phthisis, when for any reason cod-liver oil ceases to be tolerated. The following mixture is given daily in two or three doses: glycerine, forty grammes, and rum or cog- nac, ten grammes, with one drop of essence of mint. This aro- matic alcoholized compound, of agreeable flavor, is well tolerated by the stomach, and even after long uninterrupted use, it causes neither satiety nor disgust. The addition of the rum or brandy has simply in view the modification of the insipid taste of the glycerine, and to assist its digestion. The amount of the gly- cerine may be raised to fifty or sixty grammes, but only in per- sons who do not exhibit any signs of abnormal excitability of the heart or nervous system ; and restlessness, unusual loquacity, obstinate insomnia, or an increase of temperature, announces that the proper dose has been exceeded. It diminishes constipation in almost all cases, and yet moderates diarrhea when it is pres- ent ; and under its use sleep becomes calmer. It has an evident effect on nutrition, its employment in most cases, leading to an increase in weight after the first fortnight. In tuberculous cases it induces a considerable amendment in the functional manifesta- tions of the disease, such as dyspnoea, cough, and sweating. The expectoration is the symptom which is least influenced. The local condition of the lung also remains stationary, and the physical signs undergo no change. The action of glycerine on the liver is exhibited by the increase of its size, and by the more abundant flow of bile. With respect to its action on the kid- neys, there are observed a more abundant diuresis and an absolute and relative increase of the urea, chlorides, and phos- phates eliminated by the urine. In affections of the genito- urinary organs, it has been found that under the use of glycerine the alkalescence of the urine seems to diminish, while purulence, when present, becomes considerably lessened. Glycerine-Gelatine Preparations.— Their use in Skin Diseases.— The glycerine gelatines are distinguished above all the agents used for promoting the absorption of secretions, and especially in comparison with the pastes, by their adhesiveness, which con- stitutes a most useful addition to their other valuable character- istics. The most important of them is the germicide preparation, BACTERICIDES. 1325 which finds a very extensive field of utility, no less as indepen- dent therapeutic agents than as auxiliaries to the use of other agents. Slight superficial eczemas and erythemata, especially such as occupy the flexor surfaces of the joints, or are distributed over large tracts of the body-surface, can be treated by means of it both quickly, safely, and pleasantly. The preparation is ren- dered fluid in a water-bath, then painted on to the skin whilst still warm with a broad bristle brush, after which the layer is dabbed over with a flock of cotton-wool. By this means the layer is soon dried, and takes on the nature of a fabric. From places which are free from hair, it can be stripped off in a single sheet on the following day, but from places which are covered with lanugo, it must be washed off with warm water. A gelatine covering does not interfere with the perspiration of the skin, but rather tends to increase it, so that there need be no hesitancy in painting the patient all over with it, if the case de- manded it. Glycerite of Kephaline, (ozonized).—Indications. As this is a true brain essence, it is of the greatest efficiency in all nervous dis- eases, as mental and physical exhaustion, wasting diseases, loss of memory, vertigo, worry, struggle, nervous debility, decay of brain power, premature and otherwise, nervous prostration, neu- ralgia, loss of vital power, general vital deterioration, sleepless- ness, paralysis, white softening, typhoid, effectual and permanent cure in all cases of nerve debility; builds up the brain, restores lost energy, refreshes the nerves, stimulates the sexual appetite and supplies it with nervo-vital fluid. It thus is a positive cure for seminal weakness, impotency, or loss of power in the genera- tive organs. It is also of great efficacy in leucorrhcea, female weakness, and change of life. Gives intellectual vigor and vivacity. / J. Tempest, M. D., D. C. L., 32 Bank st, Bradford, England, Europe, a close clinical observer, and eminent physician, when speaking of kephaline, says : " I regard it as an excellent brain food, a nervo-vital essence ; when administered, it will repair, or reconstruct chaotic nerve force, deepen the typical fissures of thought, refresh the nerves when tired by worry or study; re- pair lost energy, stimulate and supply the elements of the molecular growth of brain tissue, by its vitalizing action on the lymph glands, or blood raisers. "It is of pre-eminent utility in this age of cerebral exhaustion, and anaemia; every man and woman should use it." More recently, this great English physician has used kepha- line in paralysis, white softening, and various other so-called in- curable conditions, with great success. 1326 DISEASE GERMS. Whenever the tubercular bacilli ap- Glycerite of Ozone, pear in the blood or any weakened part, it annihilates the microbe in all the fluids and solids of the body; the factor of pulmonary con- sumption being destroyed—wasting; debility; cough ; loss of voice; expectoration ; night sweats; haemoptysis, and difficult breathing cease ; under its use the pulse slows ; heat, respirations diminish; phosphates and chlorides in urine become normal. The remedy either in stomach or rectum liberates its ozone, which enters the blood, acts as a scavenger and vitalizer to germ-laden blood, cleansing it. It is very efficacious in tubercular menin- gitis, tabes mesenterica, diabetes, pink marrow engorgement, typhoid fever, Bright's disease, and in all diseases due to the presence of micrococci in the blood. Dose: fifteen to thirty drops for the first fourteen days, then increase it slowly to sixty drops every three hours. foseph Redman, M. D., Carson City, Nevada, an eminent bacte- riologist and excellent physician, one who' is regarded as standard authority, says: " Of all germicides the glycerite of ozone stands unrivalled in tuberculosis, for both annihilating and sterilizing the germ, in the following manner : Beginning with ten drops three times daily, the dose is run up rapidly to twenty, twenty-five, or even thirty drops. Short interruptions were allowed, and this remedy was universally well borne and exhibited no toxic effects. In cases of laryngeal phthisis, in addition to the glycerite of ozone inter- nally, resorcin was used locally in substance with the best results. Even in advanced cases the treatment was carried out, not so much in the hope of curing as for the reason that it seemed equal to any other in alleviating the symptoms of the later stages. Even in such cases real benefit often followed. Con- trary to expectation, in intestinal tuberculosis and the diarrheas referred to it, glycerite of ozone was of benefit. In general miliary tuberculosis it is efficacious, and the forms of disease most benefited have been those with hemorrhages, or with caseous or fibroid degeneration. During actual haemoptysis the use of the remedy is suspended. The author thinks the most decided value of the treatment results from improvement of the gastric and intestinal digestion, the immediate cause of which he leaves undecided. The rapid improvement of appetite and assimi- lation soon appears manifest in increased weight and renewed vigor, and through the latter the patient is rendered more capa- ble of withstanding fresh inroads of disease. So evident was the effect on the alimentary tract that the author was led to use glycerite of ozone with benefit in ordinary cases of dyspepsia and gastric catarrh. In bronchitis it was used with satisfaction.' BACTERICIDES. 1327 Though not a germicide, is an invaluable Gutta-Percha. agent for the purpose of holding germicidal and parasiticide remedies in direct contact with a microbe, fungi or parasite, in order to insure their destruc- tion. The method of preparing and applying it is as follows: Take of purified gutta-percha, in thin slices, one ounce; chloro- form, eight ounces ; carbonate of lead, in fine powder, one ounce. Add the one ounce of gutta-percha to six ounces of the chloro- form in one bottle. Shake frequently till a solution is effected. Add the carbonate of lead to the remaining two ounces of chloro- form. Shake; after both have become thoroughly incorporated, mix the two together. This is a most elegant menstruum for the exhibition of germi- cides in cutaneous disease ; it is applied by painting it on the skin with a brush, and allowing it to dry. This forms a delicate neu- tral, durable dressing, perfectly elastic, and exceedingly,well adapt- ed for the treatment of chronic skin diseases. Nothing so convenient, so effective, as the preparation itself to protect the skin in light burns; the rapidity with which the chloro- form evaporates, leaving a thin elastic, nearly colorless coating, is astonishing. It does not shrink, but is soft, and abraded parts heal almost immediately under it. The following germicides are added to it and used with brilliant success: Resorcin, thallin, chry- sarobin, iodol, naphthol, ichthyol, oil of cade, salicylic acid, siegesbeckie. In the large proportion of skin affections, as eczema, psoriasis, lepra, scabies, the different forms of tenia, they prove most efficacious. Traumaticine consists of a solution of one part of purified gutta-percha in ten parts of chloroform. This forms an admirable adhesive, and continues unchanged and adherent to the skin for two or three days, or even longer. On the contrary, in his expe- rience, the layer of gelatine is apt to separate in a few hours, in consequence of friction by the clothes or movements of the limbs, and needs frequent renewal. Again, the traumaticine pro- duces' a much thinner and more delicate film than does either collodion or gelatine, and therefore occasions neither tension nor pain The traumaticine is more readily applied than gelatine ; GuttaPercha. 1, a flower ; 2,apistil; 3, a branch with leaves and flowers;_ 4, transverse section of ovary ; 5, vertical section of ovary; 6, transverse section of fruit; 7, fruit, scarcely mature ; 8, anther. 1328 DISEASE GERMS. it does not stiffen so quickly, and the brush does not become matted into a stiff mass. The solution in traumaticine is perma- nent ; the gelatine tends to become mouldy, even with the addi- tion of salicylic acid. Psoriasis can be admirably treated with a solution of chrysarobine in traumaticine as follows : After the chief part of the scales have been removed by means of a simple bath of soap and water, a ten-per-cent. solution is not only painted on, but rubbed in, with a narrow, short-haired painter's brush, to the patches. The application can be repeated every day, or every second or third day, in proportion to the extent of the disease. A bath is taken after each three or four applications. After at most twelve paintings the infiltration and scales will have disappeared, and in place of them are visible white patches bounded by a red or violet-brown areola. Neither in children nor in adults did any untoward results follow even a very exten- sive application to the body and face of the chrysarobine- traumaticine. A bactericide of some power in Gold Chloride et Soda, the destruction of the bacillus of tubercle and syphilis ; it acts best when the microbes are on the bones. Dose, i-iooth grain of muriate doses, is especially called for in the treatment of chronic bone and glandular affections, and attended with mental gloom. It is also of value in hypertrophy of the liver. In ozaena, especially, where the nasal bones are affected, it is a very positive remedy. In chronic nasal catarrh it acts well, but is only applicable in this form. In chronic otorrhcea it is also used with benefit, as also in syphilitic bone affection. resembles hydras- Gold tis in all its varied Thread properties, only more feeble, yields the same alkaloids. Borogly- ceride and an infusion of gold thread make a valuable remedy in nasal catarrh. The fluid extract is prepared in the same manner as that of hydrastis. Makes an excellent combination with peroxide of hydrogen. BACTERICIDES. •329 This remedy has become well estab- Grindelia Robusta. lished in cases of asthma and kindred diseases ; in asthma and hay fever ten to twenty drops of the fluid extract may be given in sweetened water or milk every half hour until the microbe is killed and relief is obtained. Preparations: Fluid extract (one drachm represents one ounce of the plant) and tincture. Doses: Fluid extract, one half to one fluid drachm, repeated every three or four hours, as required. Tincture, one half drachm every one or two hours in hooping-cough. An excellent formula for asthma is the following: Fluid ex- tract grindelia robusta, one ounce; fluid extract lobelia, three drachms; fluid extract belladonna, one and a half drachms; iodide potassium, two and a half drachms; syrup tolu, q. s. ad four ounces. Teaspoonful as needed to keep down the attacks. from which the resin is obtained, grows in the West Guaiacum, Indies. The wood is known as lignum vitae, and is excessively hard. The wood is employed for various purposes, and the chips and turn- ings obtained in preparing it for these are saved and made use of in medicine. The resin is also got by boring a hole in the log, and putting one end of it in the fire; as it burns the resin melts and runs from the hole. More commonly it is obtained by boiling the chips already referred to in salt and water, when the resin floats on the top. The resin is insoluble in water, but soluble in alcohol. The preparation commonly em- ployed is the ammoniated tincture, con- sisting of the resin dissolved in aromatic spirit of ammonia, and an ordinary alcoholic tincture. Either taken internally is a powerful stimulant and bactericide. It steri- lizes the bacillus amylobacta of rheumatism; the venereal bacil- lus and sterilizes the tubercular microbe. By steeping ordinary blotting paper in the alcoholic tincture and drying, then placing it beneath the leaves of a book for preservation, it affords one of the best characteristic tests for ozone, being colored blue by that and all oxidizing agents. It contains guaiacic acid which closely resembles benzoic acid, and yields, on distillation, certain definite compounds known as guaiacine, pyroguaiacine and hydride of guaiacyl. 84 DISEASE GERMS. Common sun- Helianthus. flower; is an in- valuable germicide and ozone generator. Planted in the vicinity of a deadly malarial marsh, they yield, if properly cared for, enough of ozone to destroy the ma- larial germ as fast as it is evolved from the decaying vegetable matter. Its ozone generating properties or faculty is even greater than the eucalyptus, although its antiseptic properties are much less. The seeds yield a fixed oil which is a valuable article of diet in all sunflower (Hetianthu* annuus) bronchial complaints, and as a local application to the chest in infantile pneumonia. A syrup from the seeds is of great efficacy in colds, influenza, catarrh. A glucoside has been isolated, but its medicinal properties are feeble. The entire plant yields to Hepatica. boiling water a peculiar ac- [Liverwort) tive cholagogue, which effects remarkable results in chronic hepatitis. The formulas in use are either drinking ad libitum a decoction of equal parts of liverwort and chionanthus Virginia, c*' fluid extract of hepatica and chionanthus Virginia, equal parts of each. Mix. A tablespoonful thrice daily. An effective and most powerful Hoang-Nan. germicide, sterilizes and kills the [Strychnos Gaultheriana) microbes of rabies or hydrophobia, elephantiasis, leprosy, cancer, snake- bite, malignant ulcers. Its physiological effects are most potent on the nerve-centres; moderated doses produce a feeling of intense fatigue, general in- disposition, vertigo, tingling in the hands and feet, involuntary movements of the jaws. This remedy effectually annihilates the microbes above enu- merated; when administered, the microbes imbibe this poison and die. *fe#%^ BACTERICIDES. '33* The remedy should be boldly and energetically given in all suspicious cases, until its physiological action is experienced. As soon as this takes place the microbe is killed. Dose is very variable. Hound's Tongue. [Cynoglossum.) The root of this plant is highly germi- cidal and as- an excellent Hound's Tongue {Cynoglossum officinale). tringent; it is thus alterative wherever there are disease germs in the blood, and its astringent mucilaginous properties are of great utility in diarrhea, dysentery, coughs, catarrh and haemoptysis ; locally to burns, ulcers, tumors, infiltrations and goitre. Administered internally or applied locally, it sterilizes and kills numer- ous of the disease germs. An inspissated extract, or the juice, or succus of the green root, applied to a snake-bite or the bite of a rabid animal, effec- tually kills the poisonous breeding germs, and at the same time paralyzes the motor and sensual nerves of the part to which it is applied. It is an herb which merits further investigation. The action Hops, of the hop, when admin- istered in almost any form, is tonic, soothing, anodyne, germicidal. The infusion is thus prepared : To one pint of boiling water add six drachms of hops, mace- rate for four hours in a loosely covered vessel and strain. Dose, from one to two ounces. The tincture is pre- pared thus: Six ounces of hops are added to two pints of alcohol; mace- rate for fourteen days Hop (Humulus Lu/ulus). 1332 DISEASE GERMS and percolate. Dose, from one to two ounces, or ten drops of the fluid extract. These are tonic and vermifuge. Hop-bitters are made thus : Haifa pound of hops, two ounces of buchu, boiled in five quarts of water, and two ounces of the essence of wintergreen, added to flavor. A pillow stuffed with hops is valuable in insomnia. A glucoside is prepared from the hop. Lupuline, combined with equal parts of the glucoside from the black willow is invaluable in seminal emissions. A poultice of hops relieves pain and prevents suppuration. Horse-Chestnut. The fruit of this tree is an antiseptic, astringent, narcotic, cholagogue, etc., and is often successfully used in intermittent; locally in the form of ointment to ulcers, swell- ings ; also of great utility in hemorrhoids. To the latter it relieves the rec- tal congestion by its stim- ulant and depurant action on the liver, and applied to the piles in any con- venient form, its astrin- gent action causes them to disappear. Its stimulant and anti- septic action renders it of great utility in nasal ca- tarrh, relieving the con- gestion of the sinuses of the head, and often bringing away masses of germs that are blocking up the nasal fossa. The oil of horse-chestnuts on the painful joints of rheumatism affords almost instant relief. An excellent liniment may be made of it, thus: To eight ounces of alcohol add one ounce each of the oil of horse-chestnuts, menthol, oil of cajeput, and oil of wintergreen. Mix well. Apply three times a day. Horse- Chestnut fluid extract.—Useful in piles, by relieving the portal circulation ; also in ointment form. Dose, fifteen to thirty drops, added to water, every three hours. The powdered kernel of the nut is a sternutatory of utility in Horse-Chestnut—Leaves, flowers, fruit. BACTERICIDES. 1333 nasal catarrh. The fixed oil which the nuts contain is very use- ful as a local application in rheumatism. The flowering summit Hyssop, and leaves are the parts used. They have an agree- able, aromatic odor, and a warm, pun- gent, bitterish taste, which is due to the presence of a volatile oil, which is highly germicidal. Its infusion has been much employed in chronic nasal catarrh, as it retards germ evolution, facilitates ex- pectoration. It is a most excellent drug in hoarseness and bronchial obstruction. An acetic syrup makes an excellent remedy for difficult breathing and or- dinary colds. It is a drug specially indicated for the aged or debilitated suffering from any affection of the respiratory organs. The leaves, crowded in and simmered in olive oil, make one of the finest ger- micides for local use to the throat in diphtheria and scarlet fever, and to old, germ-eaten ulcers. Common Hyssop (Hyssopus officinalis). Hydrastis Canadensis. [Golden Seal) Hydrastis Canadensis. The fluid hydrastis, made by digesting the root in water or glycerine, or by displacement with this vehicle, is the best medicament in the treatment of gastric and duodenal catarrh. Hydrastis is a powerful local remedy ; acting on the blood supply of parts it is app1ied to in virtue of its vaso- constrictor action on the arterioles. A decoction of the ground root, made by boiling four ounces of the root in a mixture of sixteen fluid ounces each of water and glycerine for two or three hours, adding water from time to time as the fluid boils away; at the end of the boiling process the quantity of fluid 1334 DISEASE GERMS. must measure thirty two fluid ounces. This is the most univer- sally successful local application known in the treatment of gon- orrhea, chronic inflammations of mucous membranes, diseases of the uterus of a catarrhal and leucorrhceal nature, ophthal- mia, etc. The influence of hydrastis over inflamed parts locally used, is well known to eclectics, and has been used for years by them as a local medicament in lieu of other astringents and local stimulants. The white principle of hydrastis, in my experience, is nearly worthless; so is the sulphate of hydrastine. The combination of fluid hydrastis and hamamelis forms a valuable medicament in the treatment of menorrhagia. Flydrastis and pulsatilla combined is one of our best prepara- tions in the pains and nervous troubles, and the hemorrhagic gushes often encountered in women entering the climacteric of life. Pulsatilla and belladonna combined afford us a fine heart sedative in nervous excitement of women in the menopausis. Hydrastis canadensis is indicated where there are thick, ropy discharges from mucous membranes, loss of appetite and feeble digestion. Dose : twenty to sixty drops of the tincture, twenty to thirty drops of the fluid extract. In small doses, this article acts well in all cases of feeble digestion, especially if from catarrh of the mucous membranes. It is recommended in jaundice, chronic bronchitis, constipation, if given in drop doses. In chronic oph- thalmia, or for granulated lids, a solution in water, of the sul- phate of hydrastia two grains, in distilled water one ounce, applied three times a day, often cures this trouble. The fluid extract of hydrastis canadensis is indicated as a tonic in all weakened states of the digestive organs; its obviates constipation by stimulating a free flow of bile from the liver; added to water, makes an excellent wash for ulcerated sore throat or in ophthalmia. Dose: ten to thirty drops, added to water, every four hours. Hydrastine sulphate is indicated as a stomach tonic and to increase the flow of bile; in atonic dyspepsia, tubercular diar- rhea and enlarged spleen. Valuable astringent, antiseptic gargle in syphilitic sore throat. Dose: two to five grains, in pill or powder, every four hours. A most valuable bactericide, hav- Hydrocotyle Asiatica. ing the power, when administered persistently in small doses, of utterly annihilating the venereal bacillus. BACTERICIDES. 1335 It is extensively used in Hindostan, and is being gradually introduced into this country. The dose is from five to ten drops of the tincture, added to a little water. This valuable derivative of coal tar is no Hydronaphthol. longer an experiment, but has fairly won a permanent place high up in the list of niodern antiseptics. After severest tests and experiments in both hospital and private practice, it has been accorded a place second only to mercuric bichloride in point of germicidal power, rand being non-poisonous and non-corrosive, it is preferable to that well-known agent for all the purposes for which it is recom- mended. Hydronaphthol is free from the odor and escharotic properties of carbolic acid and other phenols, hence it is a pleas- ant and valuable internal antiseptic. Therefore, aside from its value as a general antiseptic, disinfectant, germicide and pre- servative, it is being used with great satisfaction as an internal remedy in cancer of the stomach, chronic dyspepsia, gastritis, typhoid fever and in other diseases of the alimentary canal; also in enuresis, cystitis, rheumatism and gout. The very learned 5". H. Holbrook, M. D., of Salem, and other eminent dermatologists of Massachusetts, have found hydro- naphthol an excellent remedy in ulcers, eczema, scabies, all forms of tinea. It is a most excellent bactericide for the preservation of ana- tomical preparations without shrinkage or decay. Hydronaphthol is a secondary compound of betanaphthol, differing from it in having a molecule of hydrogen displaced by an equivalent of hydroxide. Considered as a germicide, it is one of the highest rank, sufficiently powerful to destroy the bacillus of anthrax, subtilis, variola, leprosy. Administered in- ternally in small doses as an antiseptic; but it is found to be of the greatest service in washing out septic or germ-laden cavities or wounds. It is most convenient either to make use of a solu- tion in alcohol, in which it is soluble to the amount of 1 in 2 parts, or with glycerine added to the alcoholic solution, so as to make it of the strength of 1 in 10. It is soluble in oil to the ex- tent of 1 in 20, but it is only dissolved in cold water to the amount of 1 in 1100. In making this last solution it is best to see that the water is tepid. A solution of 1 in 300 in warm water possesses very great germicidal powers. '336 DISEASE GERMS. is a peculiar product obtained from a bituminous Ichthyol rock found in the Tyrol. It occurs in the form ol a reddish brown liquid, clear and syrupy, of a peculiar herb-like odor, and of a faintly alkaline reaction. It is soluble in water, partially so in alcohol and ether, but more soluble in a mixture of alcohol and ether. From its aqueous solution it is precipitated by hydrochloric acid. It is a remedy of intrinsic value in all parasite skin affections, as in impetigo, eczema, sycosis and other forms of tinea, where fatty agents in- crease their growth. A most reliable formula consists in three parts of ichthyol to glycerine and dextrine each ten parts, ' mix. Equal parts of ichthyol and spirits of turpentine, a mixture of great efficacy in dry and moist chilblains; the burning and itch- ing passing away the moment it is applied. Three parts ichthyol to one of chloroform is a never-failing remedy for toothache. In burns and scalds, psoriasis, in prurigo, pruritus, ichthyol has been used both internally and externally with success. As a germicide it stands unrivalled, being even efficacious in nasal catarrh, chronic bronchitis, and chronic rheumatism.. Our best dermatologists regard ichthyol as a cutaneous germi- cide, most efficient, superior to many other remedies ; painted over the affected part it protects it from the air and dust by forming a coating over it; relieves congestion by causing con- traction of the arterioles, thus diminishing the vascularity of the part. In eczema, one drachm of ichthyol to one ounce of distilled water, when painted over the affected part with a camel's hair brush, relieves the itching and tingling. For squamous eczema, an ointment made of one drachm of ichthyol added to one ounce of ozone ointment. The same ointment applied over affected parts in rheumatism has a sterilizing action on the micrococci of that affection, for it unquestionably relieves the fever ; the swelling and the joint- pain leave—thus killing the germ where it was localized. Ichthyol has found a rival in thiol, a new product of chemical synthesis, obtained by artificially sulphuretting unsaturated hydro-carbons, and charging these with ten per cent, of sulphur. Chemical and therapeutical researches prove its exact identity with ichthyol. Thiol consists of a brown fluid of the consistency of syrup; it is completely soluble in water, is totally inodorous, and has therefore a decided advantage over ichthyol. There exists also a dry thiol, which has two and a half times the strength of fluid thiol, otherwise having the same properties as BACTERICIDES. [337 the latter. Thiol is used like ichthyol in the following diseases: Acne, acute and chronic rheumatic arthritis, other rheumatic affections, contusions, decubitus, eczema, erysipelas, neuralgia, ischia, leprosy, frost-bites, prurigo, pruritus, ulcus cruris, burns and scalds. Thiol and ichthyol are identically alike; thiol will replace the latter when the natural sources of that remedy are exhausted. is a remedial agent which, since its comparatively Ingluvin recent introduction to the medical profession of the United States and Europe, has gained for itself a repuation perhaps hardly equalled in so brief a period in the case of any other preparation known in pharmacy. It is prepared from the ventriculus callosus gallinaceus ; the gizzard of the do- mestic fowl—pullus gallinaceus. Since its introduction no remedy of modern times has excited more attention among physicians far and near, or received a higher endorsement, than ingluvin. As the source of its manufacture and the substance from which it is derived are made public, the profession has not hesitated to prescribe it in all cases where pepsin is indicated as a remedy, and its use has been attended with more uniform bene- ficial results than that afforded by pepsin, which has been found so variable, perhaps on account of its various strengths and dif- ferent modes of preparation. Ingluvin, unlike pepsin, is riot in- compatible with alkalies. The diseases in which the use of ingluvin is indicated are indigestion in its various forms, known as dyspepsia, and sick stomach or nausea caused by debility of that organ. It was originally discovered to be a remedy, indeed a specific, for vomiting in pregnancy ; in this respect it stands above all other medicinal agents. In all that is here set forth the manufacturers claim no more than is sustained by medical authority of the highest standing. The practitioner is especially cautioned to avoid fraudulent substitutes and imitations, which the manufacturers are aware have been offered, and which are but the crude powdered gizzards of the fowl. Ingluvin differs from this by its extreme refinement, and its association with simple substances for its preservation as animal matter. It is therefore essential to his success, and for the welfare of the patient, that the practitioner should be guarded against unscrupulous competition that would offer powdered gtzzards, and seek to profit by the success of the true prepara- tion. Dose : From five to ten grains. '33« DISEASE GERMS. Indigo. A substance derived from a great variety of plants; many compounds of great chemical and medicinal value have been derived from it. Indigo, itself, and all its alkaloids and glucosides, are potent germicides, it was from this agent that aniline was first derived, from which such a host of invaluable antipyretics have been prepared. The wild indigo, or its gluco- side baptisin, is of great efficacy in the destruction of microscopic life; one ounce of the crude plant (root) to a pint of boiling water, infuse over night, and drink freely the following day, will kill the germs of typhoid fever, epidemic dysentery, chronic diarrhea, sore throat. The glucoside baptisin has been effectually used in epileptic and nervous cases. It is also a valuable remedy in chronic irritation of the liver, with albuminuria. Indigo Plant {Indigo Tinctoria); a, pod ; b, block of indigo. The bark of the root of this plant yields an active Ipecac, principle of great value called emetine. This vege- table alkaloid in very small doses is an active stimu- lant to the mucous membrance of the bronchi. All preparations of this bark are of great value. In large doses it is a mild and efficient emetic; whereas in small doses it allays ir- ritation of the gastric nerves. In medium doses it does good work either alone or combined with muriate of ammonia in bron- chitis. Also a good remedy in the treat- ment of infantile pneumonia. It is an excellent remedy in small doses for nausea and vomiting, and exer- cises a sedative action on the mucous membrane, whether diar- rhea or dysentery be present. I p< cac. BACTERICIDES. •339 All preparations of iodine are highly germicidal. Iodine. Its use is indicated wherever there are disease germs in the human blood. Dose, ten to fifteen drops of the officinal tincture, five to seven drops of Lugal's solution. Iodol in pills, one to two grains. Dose of iodide of soda, five to six grains. Uses.—Iodine is a remedy for croup, of the membranous variety, or spasm of the glottis. It is a good remedy for cancer. It is a good injection in a corrosive leucorrhcea, diluted to pre- vent irritation. One part to ten or fifteen of water at first. Lugal's solution in doses of six to eight drops, three times a day, is a good remedy for Chronic malarial poisoning, where there is induration of the liver and spleen or other glands. It is a good inhalation in the early stage of pneumonia. It prevents suppuration, if used in time, especially if iodoform is used on the ulcer. For tubercular and skin affections, iodine, in doses of one to six drops three times a day, is almost a specific, and it is valuable in syphilis. It is a positive remedy for leucorrhcea. Alternated with diluted bromine, the inhalation of iodine is a remedy in hay asthma and hay fever, bronchitis and catarrh. Iodine is a good mouth wash, as it removes tartar from the teeth, and cures diseased gums, and heals ulcers of the mouth and gums. Iodine (tincture) kept applied, cures orchitis. Iodoform lotion, one part to fifteen of water, constantly applied, re- moves abnormal growths of the mam- mary glands. It also cures house-maid's knee, and also purulent ophthalmia. An ointment of iodoform, applied fre- quently, cures enlargement of the prostate. In powder it is the best antiseptic dressing for ulcerations of the external surface. Iodol, containing as it does nearly eighty nine per cent, of iodine, is next to iodoform, the strongest iodine preparation extant; and is much superior to iodoform in germicidal power, and its ab- sence of odor and of toxic properties makes it preferable to iodoform. An iodol jacket in consolidated lung either with the bacilli of tubercle, or the pneumococcus of pneumonia, is most effective in the annihilation of the germs, thus clearing up lungs partially dead. Iodol sprinkled on chancres, specific. Iodol as a snuff in nasal catarrh and ozaena, destroys the amoeba in the former, and the oidium albicans in the latter. f&^m§' Diagram showing the lower lobe of thr. right lung engorged with the pneumococcus; an iodol jacket was applied for 24 hours, every microbe disappeared, leaving the iung clear on percussion. 1340 DISEASE GERMS. It destroys the tubercle in the thyroid, and thus cures goitre; annihilates the bacteria of erysipelas and boils ; kills all fungi, as the different forms of tinea. It is destructive to all microscopic life, vitalizing to the higher grades of animated existence. Iodized oil for external application has numerous advantages, it is readily absorbed; does not stain; may be applied to the most delicate skin without irritation; it is of immense value in pulmonary consumption and in tubercular disease of joints. Dr. W. H. Flesher, Green Ridge, Mo., a physician of great culture and experience, says: "Iodol, or tetraiodopyrol, has a light-brown color, and#is almost odorless, in which respect it offers a decided advantage 'over iodoform. Unfortunately, it is not very soluble in water, only in a proportion of I to 5000. In alcohol it dissolves in three times its weight. The drug is employed in the following manner: 1. As a powder, in the same manner as iodoform. Being a finer powder, it enters and covers the part more com- pletely than the former. It forms no scurf (in opposition with iodoform) on the wound, renders the secretion odorless, favors the formation of healthy granulation, and has a general salutary influence on the nutrition of the affected parts. 2. As solution, in sixteen parts of alcohol and thirty-four parts of glycerine, for the saturation of uterine or rectal tampons. It is also injected in this form into empty or scraped-out abscesses. 3. As gauze. 4. In combination with vaseline and collodium. In no instance, in spite of its extensive use, were any symptoms of intoxication observed, nor was ever any iodine after its use discoverable in the urine. It is probable that its action depends on the genera- tion of free iodine, though we have no definite data yet regarding this point. At all events, its action is prompt and harmless, and offers no small advantage over the iodoform in the absence of any odor, though its poor solubility and its (at present) high price are equally great objections." Its special advantages are: when applied, the iodine which it contains is set free by lung bioplasm, kills microbes; when sprinkled on a wound, movements of leucocytes, renders the sur- face dry, prevents suppuration, and encourages granulation. while at the same time its local anesthetic action lessens pain, It seems to have a special destructive action on the tubercle bacillus, and is therefore employed with advantage as a local application for tubercular disease of the larynx and tubercular abscesses. One great convenience of iodoform consists in the fact that it can be applied as a powder over any surface, and will there exercise its antiseptic action for a long time without the necessity of any dressing being applied over it, but as I have BACTERICIDES. 134' said, it is not without its dangers, and, although sparingly solu- ble, it may yet be absorbed from wounds or cavities to such an extent as to produce poisoning. The symptoms of poisoning are particularly interesting, as nation of the action of iodine itself with that of an alkyl. Like an iodide, it may pro- duce unpleasant taste and smell, running at the nose, and gastric disturbance, but it behaves also like a mem- ber of the alcoholic series in causing special symptoms of poisoning which are connect- ed with the nervous system, and consisting of loss of memory, variable temper, headache, sleeplessness, and especially mental distur- bances, sometimes amount- ing to furious mania, alter- nating with coma. Fatty de- generation of the heart and other organs is usually found after death. Ozonized iodine is a remarkable active form, and has acquired a big reputation, which it justly deserves in sterilizing the blood. During a recent epidemic of influenza, it was administered with remarkable success in getting rid of the microbe, and re- lieving the intense pain in the muscles and bones. Sozoiodol is a compound of such well-known Sozoiodol. antiseptics as iodine, carbolic acid, and sulphur, and is chemically described under the name Di- iodoparaphenolsulphonic acid. It is destined to act as an odor- less substitute for iodoform. Sodium-sozoiodol occurs in colorless tubular crystals, which dissolve easily in water or glycerine at an ordinary temperature, to the extent of about one in twelve. The glycerine solution remains quite unchanged when exposed to sunlight, but the aqueous solution slowly alters its color on exposure. Potassium-sozoiodol dissolves only to a slight extent in water and glycerine, these fluids dissolving only about a fiftieth part of their weight of the salt. This property makes the potassium they consist of a peculiar combi- The microbe of epidemic influenza, which appeared in ihe U. S, 1-90; whicn was completely ster- ilized by the administration of ozonized iodine in alteination with the sulphate of quinine. Every Case yields to these remedies. 1342 DISEASE GERMS. salt preferable to the sodium salt in the treatment of cases which require the application of dusting powders, etc., because of the greater duration of their efficacy ; the effects of both salts are, however, the same. Sozoiodol has been applied not only in the solution, but in combination with talc, lanolin, sugar of milk, and with much success, in the pure state. It is perfectly odor- less, and experience has shown that it is without any injurious after-effects whatever, so that it seems to be entitled to promi- nent rank among antiseptics. Its chemical nature permits of combinations with almost every metal, opening thus a vast field for therapeutic treatment, and enabling the physician to combine the action of certain me- tallic bodies with that of the antiseptic substance proper, such as aluminum, magnesium, lead and zinc, which compounds are easily soluble. Also the ammonium, barium, mercury, and sil- ver salts, which are difficultly soluble. The sozoiodol salts have been used in skin diseases of a para- sitic character: eczema, even of long standing. Dry eczema may be treated with sodium-sozoiodol; damp eczema with zinc, either as a powder or with talc (I to 10), and in very obstinate cases of syphilitic eruption, mercury-sozoiodol has been used with great success. In diseases of the ear, nose, larynx, and pharynx, potassium- and sodium-sozoiodol, either pure or mixed with an equal weight of powdered talc, yield good results. For conjunctivitis, five to ten per cent, solution of sodium-sozoiodol forms an excellent lotion, and for gonorrhea, zinc-sozoiodol in one to three per cent, solution, and it can be applied to ulcera- tive cancer surfaces with advantage. Their application is indi- cated everywhere in the place of iodoform, and the fact that here the long-looked-for desideratum, an odorless substitute for iodo- form, has been found, should induce all medical men to give them a fair trial. a remedy of decided value in the treatment of a Jaborandi, large number of febrile and inflammatory dis- eases, is not a germicide, but possesses the most extraordinary faculty, when the blood is germ-laden, of driving the entire brood of bacilli and micrococci to the cutan- eous surface and salivary glands of the mouth, where they can be readily annihilated with bactericides. It does this by its potent diaphoretic and sialagogue action, consequently in a large percentage of fevers, and inflammations, as in oedema of the glottis, laryngitis, bronchitis, pleurisy, pneumonia, rheumatism, erysipelas, diabetes, malarial fever, etc., it is of signal efficacy in the management of the cases. BACTERICIDES. i 343 A good form to administer is to take of the fluid extract one drachm, and add to it a cup of hot water, and if free salivation and diaphoresis does not occur in half an hour, give a second dose; it is rarely necessary to repeat. The saliva in all cases must be spit out as fast as it accumulates in the mouth, as it is invariably loaded with the micro-organisms of disease. Another formula is the fol- lowing : Fluid extract of jaborandi, four drachms ; aromatic spirits of ammonia, one drachm; sim- ple syrup, one ounce. Mix. One teaspoonful to be given every ten minutes till free per- spiration is induced. The alkaloid pilocarpin hy- drochlorate, one-fourth grain in solution, injected hypoder- mically, has been extremely efficacious in dropsical effu- jaborandi. sions, as the result of interstitial obstruction of the kidneys. Tetanus has been successfully treated by subcutaneous injection of the same alkaloid, but the dose used has been very large. The purport of treatment is to drive the microbe from the cerebro- spinal centres -to the skin. The hypodermic use of the same alkaloid has been well spoken of in alopecia. Pilocarpin removes the urgent symp- toms of asthma. Jalap. Jalup. The therapeutic action of this remedy is so well known that it seems superfluous to enumerate it; but as it has such a de- cided action in relieving modern cere- bral congestion, it is worthy of notice. It is of unquestionable utility, a most valuable cathartic in disease of the I344 DISEASE GERMS. brain ; its derivative action is unexcelled. The best combination for use is one part of powdered jalap, two parts bitartrate potassa, and sufficient pulverized ginger to keep it from griping. It is also of value in dropsical effusions. With all our new remedies, this very frequently comes into excellent service. In small doses, combined with leptandra, it does excellent work in torpid states of the liver. A fluid extract prepared from the Jamaica Dogwood, bark of the root is a powerful narcotic, germicide and parasiticide—annihilates many species of germs when brought in contact with them—the root thrown into water will stupefy fish. In five to eight-drop doses, it will sterilize and destroy the mycelia of hooping-cough, the germs of toothache, erysipelas, and of bron- chial catarrh. Extremely valuable in insomnia, affords in all cases most refreshing sleep. It possesses all the desirable effects of chloral, bromide of potass, opium, urethan. If administered dur- ing parturition, it will lessen the pains of labor without interfering with uter- ine contractions. It is of great utility in all forms of neuralgia. The following is an excellent for- mula in gastralgia: Fluid extract of Jamaica Dogwood. Jamaica dogwood, fluid extract of American columbae, comp. tincture of matricaria—of each one ounce. Mix. Dose: from fifteen to thirty drops, added to a little water, as indicated. The seeds and bark are power- Jambul. fully germicidal, stomachic, carmi- [Syzygium Jambulanum) native, diuretic, astringent. When introduced into the human stomach, and passed into the process of secondary digestion, thence into the blood, they have a specially destructive action upon the glucose or sugar fungus, not only annihilating it, but preventing its formation by some peculiar action upon the starch formed in BACTERICIDES. 1345 the liver. In this way it controls the disease, and all its promi- nent symptoms disappear under its use, such as prostration, debility, emaciation, thirst, ravenous appetite, extreme restless- ness, excessive secretion of urine of high specific gravity. While taking jambul, there need be no restriction of diet, the urine becomes normal. For easy administration, and better to preserve the properties of the drug, two and one-half grains are encased in a capsule; two of these should be taken three or even six times a day, according to the indications of each particular case. By taking these, pearls in diabetes thrice daily, the specific gravity, the percentage of sugar and the quantity of water passed are astonishingly reduced. _______ The berries are stimu- Juniper. lant, antiseptic, diuretic; chiefly used in dropsical affections. Its antiseptic properties causes it to be a drug of great value. Whenever we desire to impregnate the body with a natural ozone scavenger, juniperus is indicated; valuable in dropsy, in blood and cutaneous affec- tions, and in those states where there is a bleeding fungus in the bladder associated with retention of urine and catarrh of that organ. The compound spirits of juniper is thus prepared : take of juniper berries, well bruised, one pound; caraway and fennel seeds, pul- verized, one ounce and a half of each; dilute alcohol, one gallon; macerate two weeks, then add half a gallon of water and distill off one gallon. The infusion is an excellent one for administration, prepared by adding one ounce of crushed berries to one pint of boiling water. The whole of this is to be taken in the twenty-four hours. All extracts are worthless. _____ Common Juniper. {J comtnunis), a, branchlet with male flowers; 6, part of branchlet with female. flowers ; c, unripe fruit. Kaki, [Pulverized Root Japanese Persimmon) It is indicated in gastric catarrh, chronic diarrhea, typhoid fever, dysentery, ulceration of the bowels, catarrh of the colon and rectum. Decidedly one of the best reme- 85 '346 DISEASE GERMS. dies ever introduced, as it excites a renewal of life in the various coats of the entire intestinal tract; a sovereign remedy in the diseases enumerated. Dose: One to two teaspoonfuls to a half pint of boiling water • when cool, permit patient to drink freely. Fluid extract; a bactericide of great efficacy in Kalmia, sterilizing the syphilitic bacillus. Dose for that [Laurel.) purpose, twenty to thirty drops thrice daily. Kalmia, in one-drop doses, has proved valuable in albuminuria, curing twenty-five per cent. It mitigates the pain of rheumatism very quickly, and acts positively in neuralgia. It wards off rheumatism of the heart. In headache, coming on in the morning and going off at night, this remedy acts like a charm. In influenza, with watery eyes, sore throat and much aching in the bones, the kalmia gives quick relief. In all aches and pains, think of the kalmia. It may be given in drop doses, with two to five drops of gelsemium, every hour or for five or six hours, then lessen. Dose : fluid extract, twenty to thirty Kava-Kava, drops; tincture, thirty to sixty drops {Piper Methysticum.) three times a day. A remedy for tooth- ache, neuralgia, small doses of this drug will give relief quickly. In painful urination, this is a remedy, in doses of eight to ten drops every three hours, or in extreme cases give twenty-five drops. It may be combined with pareira brava, one drop at a dose. These remedies may also alternate benzoate of lithia in gravel, cystitis and catarrh of the bladder. It may be combined with hydrangea in gravel, or with liatris spicata in cystitis. These remedies often give relief, where there is excess of acid in the urine, then it will require lithia in addition. In gonorrhea, kava-kava paste entirely replaces the old reme- dies. It does not cause gastro-intestinal irritation ; neither does it impart any odor to the breath, but it kills the gonococcus, the discharge is very speedily reduced to a slight oozing. In chronic catarrh and suppurating nephritis, it very soon diminishes the amount of muco-purulent matter. Cures very obstinate cases of cystitis. The tincture and fluid extract are worthless, have no germicidal action. The paste invariably does its work well. Dose: A piece the size of a bean every three hours. BACTERICIDES. '347 The nut of Cola acuminata, or sterculia, a native Kola Nut. of the tropical parts of the western coast of Africa, and cultivated in other tropical countries. The natives value the nuts very highly, and often take a portion of them before meals, believing that they improve the appetite and destroy all microbes in what they eat and drink, even render- ing putrid meat and stagnant water fresh. The nuts are the size of eggs and possess identical properties with the coca erythroxy- lon and caffeine. In all its forms it is a germicide ; it has marked aphrodisiac properties and retards tissue waste. It has a most decided action in heart disease with renal obstruction, promotes diuresis by increasing the general vascular tension. It acts as a nutrient and tonic, an aperient and gastric stimulant. It cannot be too highly extolled in chronic alcoholism, appeases the appetite, removes stupefaction, prevents dis- agreeable after-effects. It has a remarkable prophylactic action— or rather guarding effect to the liberation of large doses of iodide of potassium in the blood in cases where the blood is germ-laden with the syphilitic microbe. The Liberia kola nut is the best, and it is from this that a laxative and refreshing fruit lozenge has been prepared for the relief and cure of constipation and its attend- ant maladies, as headache, conges- tion of the liver and spleen, piles, dyspepsia, and all disorders of the alimentary canal. With Americans, who consume a highly concentrated diet, and possess a normal condition of the brain, liver and digestive organs, one evacuation of the bowels in the twenty-four hours, following the morning meal, is to be regarded as a healthy standard. When defecation is less frequent, slow, prolonged or retarded, it constitutes constipation. Habitual constipation is one of the most common affections incidental to young or old, in all sections ot our country, due to neurasthenia in nearly all cases, and this poverty of nerve force is aggravated by our highly ozonized atmosphere, by malaria, by the use of stimulants; erroneous drug treatments, adulterated food hasty mastication, nerve strain, worry, struggle for existence. Branch and nut of the Kola Sterculia. 1348 DISEASE GERMS. brain exhaustion ; chronic disease, sedentary habits, etc., give rise to inertia or sluggishness, deficiency of bile, which give rise to arrested perisaltic action, a faulty condition of the intestinal secretions and constipation. Assuming, then, that a lack of nerve force is the source of this widespread affection, it would seem to be most erroneous and pernicious to treat this affection with purgatives, and still further increase the debility. Constipation, or faecal accumulation, is a fearful source of headache, fetid breath, dyspepsia, torpidity of the liver and spleen ; piles, insomnia, mental depression, apoplexy, neivous disorders of all kinds—the brain and rectum suffer most in all cases. The poisonous activity of human faeces even in a healthy indi- vidual is very gi eat. There are formed in the intestines of an adult in twenty-four hours a quantity of cadaveric alkaloids, which, if excretion were stopped and all were absorbed, would be sufficient to destroy life. No one can doubt the seriousness of retained faeces and the injurious effects of constipation, for when it exists those poisons are absorbed at the rate of diminished perisaltic action. The only true method of curing constipation is by increasing the vital force of the affected individual, and the removal of all apparent causes. The remedy must not be either a pur- gative or laxative; it must increase the vital stamina; by this means procure a free flow of bile, remove congestion and unload the bowels. For this purpose the active nerve-stimulating principle of the kola nut has been isolated and made into a pleasing, palatable form which, when taken, relieves this difficulty. This active, isolated principle is free from all bitter and astringent properties, incidental to the drug, while the nerve-cell elaborating principle is even more energetic by this elimination. This principle is one of immense power; it not only stimulates the brain by its action in generating more gray matter, but in some mysterious manner vivifies the great sympathetic which covers the bowels and energies the eighth pair that supply the liver. Such a remedy speedily affects the liver, restores that gland to its pristine activity, the bowels become regular, the complexion clear, the breath sweet, and the whole body seems rejuvenated and pervaded by a feeling of buoyancy, which shows that the liver has resumed its normal function. The remedy is indispensable, not only in constipation, but in all diseases of the liver and bowels, as it increases cerebral force, acts upon the sympathetic which supplies the intestines and pro- BACTERICIDES. 1349 motes the nutritive assimilative forces, rouses up the secretion of the liver. It never causes any pain or griping, or nausea, no de- rangement or inconvenience, but in all cases constipation dis- appears. The individual taking the remedy must be the judge of the dose. Enough should be taken before retiring to cause only one comfortable, free, copious evacuation after the morning meal. It is a gentle and effective aperient for the most debilitated as well as the strong, affording agreeable and effective relief from constipation. Its use, unlike other medicines, does not necessi- tate continuous repetition, and, however frequently taken, its action being so gentle, no evil effects can arise therefrom. A native of Abyssinia. The panicles are uni- Kousso. sexual. Both the male and the female flowers, but chiefly the latter, are collected and exposed to the sun to dry. As they reach this country, they are in com- pressed clusters, entire or more or less broken, or in subcylindrical rolls, bound to- gether with transverse bands, or in small fragments. The clusters or rolls vary from ten to twelve inches, of a green- ish-brown color, and have a pleasant, herby, tea-like odor, but very acrid and disagree- able. There is found in the entire plant a volatile oil. a bitter acrid resin, and the alkaloid koussin, which is inert. A.n infusion is the only form which is eligible for use. Two ounces to a pint of water, simmered down to half a pint. The usual precautions being observed, as to diet, it should be drank freely and is most effectual in destroying all forms of tape-worm. Kousso. prepared from the kurchicine, are most Hindoo Bitters, efficacious. These bitters excel all others in point of real merit, and their fine bitter orange flavor makes them as pleasant as they are useful. They are a reliable remedy for dys- pepsia, indigestion, constipation, ague, and diseases of *he stom- 1350 DISEASE GERMS. ach, bowels, liver, and kidneys. They purify and enrich the blood, tone and impart strength to the system, stimulate the di- gestion, regulate the bowels, promote a healthy appetite, dispel nervous exhaustion, cure general debility, give buoyancy to the spirits, and are especially recommended as a true tonic and restorer for invalids, females and delicate persons. They will be found extremely beneficial in regulating the various functions of the body, and a reliable antidote and preventive for chills and fever and all malarial diseases. The Hindoo Bitters are not an intoxicating beverage, nor can they be used as such by reason of their cathartic properties, and being purely vegetable, they are classed strictly as a medical agent, and can be given at all times with beneficial results. When taken after meals they aid digestion ; when taken before meals, they produce a healthy appetite, and as a morning tonic they have a charming effjct. In cases of dipsomania, or for persons having an unnatural desire for liquor, they will be found peculiarly suitable, as the use of these bitters will enable them to free themselves of the pernicious habit, by acquiring a strong and healthy appetite for solid food. The same remedy is put up in pill form, and there is also an alkaloid extracted from the same—sulphate of kurchicine. Concentrated tincture of kurchicine highly ozonized is of im- mense utility in the quotidian, tertian and quartan types of mala- rial fever, as it destroys the micro organisms which give rise to that class of pernicious fevers. So definite and potent is its ac- tion that after the first dose the odoriferous character of the dead germs can be detected in the sweat, saliva, urine. The bowels must be opened ; all fluids strictly forbidden, either with the remedy or for several hours subsequently, or between doses, as watery fluids supply a pabulum to germ evolution in the blood. The remedy causes the malarial germ to speedily disappear from the blood and tissues. It is valuable in small doses in all fevers or states of debility. It changes the electrical forces of the body from a negative to a positive state. This is a most efficient germicide in certain Lactic Acid, forms of dyspepsia, and for the removal of phosphatic deposits in the urine. From one to two drachms is added to a half or a pint of sweetened water and drank like lemonade, this being the dose for twenty-four hours; in one-half drachm to the pint of water, taken daily, of utility in diabetes. A solution of one part of the acid to five of water has been BACTERICIDES. 1351 efficacious in dissolving the false membrane of croup and diphtheria. A small amount of the acid added to pepsin increases its sol- vent powers in a most remarkable degree. An eighty-per-cent. solution painted over ulcerating lupus is most effectual in the destruction of the tubercular bacilli. Obsti- nate cases of ulceration of a phagedenic or cancerous type are successfully treated with this acid. More recently it has done good work in the removal of large patches of epithelioma in, around and on the os uteri. The acid locally, and Chian turpen- tine internally in cancer of the uterus often effjct radical cure. The application of the acid in all cases should be limited to the diseased parts. The great value of lactic acid in the diarrhea of infants is well established, especially in cholera infantum. The best result is obtained from small doses, frequency repeated. The following formula operates well : Lactic acid C. P., half a drachm; simple syrup, one ounce; water, three ounces. Mix. In teaspoonful doses, repeated as occasion requires. For corns, acid salicylic, ten parts; acid lactic, ten parts; col- lodion, eight parts; carbolic acid, two parts; apply to the corn several coats, allowing each previous one to dry. E. D. Reed, M. D.. FYederick, Md., in a recent essay read before the Society in that State, says : " Lactic acid has been found to possess some very remarkable properties. It has no corrosive action upon healthy mucous membrane, but attacks and destroys unhealthy and sloughing tissues. The diseased tissues turn a dark, diity brown under its application, and quickly slough off, leaving a healthy appearing surface which tends to granulate and heal. It is a valuable remedy when the pain is severe and the discharge very offensive and flooding frequent. These symptoms are greatly relieved by the application of the acid twice a week. It does not produce pain when applied, and when used freely twice a week relief is almost immediately experienced. The manner of application is as follows: An ordinary Furgeson speculum is introduced, the cervix cleansed; then a mop made of absorbent cotton and saturated with the acid is freely applied to the sloughing mass; water is then thrown in, and the acid again applied, after which a tampon of cotton is placed, and the patient allowed to go. The treatment should be practiced once or twice a week, according to the gravity of the case." Disappointment in the use of lactic acid is frequently experi- enced on account of the poor quality of the drug. Hence the necessity of procuring, the article of a reliable chemist. •352 DISEASE GERMS. E. Sr Pixley, M. D., Pittsfield, Mass., has had most extensive experience with dilute lactic acid in the treatment of summer diarrhea and cholera infantum; he has also found it useful in headache and rheumatism, having the effect of clearing the in- testinal tract of all microbes. Children take the remedy easily, as it forms an agreeable beverage, and its continuous use does not in any way interfere with digestion. Lachnanthes Tinctoria. {Red Root) The whole herb in the form of a saturated tincture, is a bactericide of considerable power; administered in pneumonia, typhoid, and other fevers, it kills the spores, and the full fledged microbes. It also has a most remarkable action in sterilizing the tuber- cle bacillus, hence it is of great utility in the cough of bron- chitis and phthisis. The tinc- ture is prepared as follows: Coarsely ground herb, one pound, cover with alcohol of a seventy-five per cent. strength. Let it macerate one month. Then percolate. A few drops of this tincture is excellent in hoarseness, laryn- geal cough, and for our hay- fever cough of spring and fall. In the recent epidemic, influenza, the physicians of New Jersey have been using the tincture of the red root with salicy- late soda with wonderful success. It certainly is a valuable addi- tion to our respiratory antiseptics. Red Root. Lactose. There seems to be a considerable future before lactose as a diuretic. Milk itself can be used as a diuretic, but it tends to produce a temporary gly- cosuria Lactose has none of these disadvantages. Very con- siderable diuresis is produced by the administration of one hun- dred grammes of lactose, that is to say, the amount contained in two litres of milk. The diuretic effect produced by a potion containing that amount of lactose is greater than any produced by drugs ; it quickly re iches two and a half litres of urine a day, BACTERICIDES. 1353 almost always rising to three and a half and even four and a half litres on the third day. During this period dropsical effu- sions disappear, and the blood is dehydrated Its effect is cer- tain in cardiac dropsy; in renal dropsy, on the other hand, its action is much more doubtful. In cardiac cases it fails only when the complication of Bright's disease exists, and when the albumi- nuria amounts to from sixty to ninety centigrammes per litre of urine. Diarrhea or copious perspiration may also lessen the diuretic effect of lactose by dehydrating the blood. The remedy is, as a rule, well borne. It should be continued for eight or teR days, when the administration should be interrupted for a few days, and afterwards resumed. The blood-pressure is not raised by lactose. It is far superior in this respect to strophanthus and digitaline.______ The milky juice of the lettuce, added to Lactucarium. the ozonized syrup of tolu, is a most valuable preparation. Possesses the hypnotic, sedative, and calming properties of the opiate preparations, without provoking constipation, cerebral congestion, want of appetite, etc. It is one of the very few preparations that can be efficaciously employed for children without any inconvenience. In con- sumption it moderates the cough and expectoration, destroys the bacillus. A shrub of the mint Lavender, family, possessing all the germicidal properties of its class; besides being an aromatic stimulant and tonic, it is much esteemed in the form of a decoction in nervous debility; as a tonic to the stomach ; a gargle to the mouth and throat; in cases of aphonia. Vinous tincture of the flowers make an excellent aromatic wine for colic, and where ptomaines are irri- tating the bowels Its oil is obtained by distillation, forms a pleasant and invigorating per- fume, and the amount of ozone devel- oped in the atmosphere by this volatile antiseptic is immense. Thus it may be used in an atomizer for laryngeal irritation, or in the form of a cerate. l354 DISEASE GERMS. Oil of lavender, two ounces ; vaseline, two ounces; oil of sweet almonds, one ounce; oxide of zinc, two ounces ; carbolic acid, thirty grains. Mix. Apply to the nostrils in catarrh. Lemon. All the fruit germicidal, the rind stomachic. Lemon juice specific for the cure and prevention of scurvy. Administered in large doses in rheumatism it annihilates the lactic ferment, but not essentially curative. It greatly intensifies the action of some alkaloids; lemon juice and quinine added to strong mocha coffee is pre-eminently de- structive to the malarial germ. Citric acid or lemon juice added to caffeine affords us a reliable remedy for the headaches incidental to breathing sewer gas. As a local application, with a small amount of cocaine added, never-failing in pru- ritis of the scrotum; for freckles equal parts of lemon juice and glycerine, say two ounces of each, and one grain of bichloride of hydrargyrum added; for painting over the diphtheritic patch. Take ft all in all, it is a remedial agent of much potency. Citric acid has powerful germicidal action. It is cooling and refreshing to the taste, and is decomposed in the system, acting, probably, in the same manner as sugar. When taken in the form of lemon juice, or in the fruits of the orange family of plants, it is eminently antiscorbutic. On this account ships going a voyage of more than six weeks are com- pelled to take a supply of lemon or lime juice, and sailors should take at least half-an-ounce a day. The crystallized citric acid does not appear to act as an antiscorbutic. Citric acid and the juices which contain it are employed for making effervescing draughts, when mixed with atka'ies. Fourteen grains »of citric acid, or ha'f-an-ounce of lemon juice, mixed with twenty grains of bicarbonate of potash, makes, with one ounce of water, an ex- cellent effervescing draught. Lemon (Citrus Lemonuni). BACTERICIDES. '355 Black root or Culver's Physic, the rOot of Leptandra. leptandra virg., is a mild alterative, cholagogue and tonic. It is a slow acting remedy, but effi- cient, reliable and powerful in stimulating the granular structure of the liver, cor- recting the hepatic secretions and pro- moting a free flow of bile. It is an effi- cacious remedy in all diseases of the liver: if combined with phosphate of soda, it operates efficiently in jaundice or whenever the liver needs the aid of a remedy to promote biliary secretion. The fluid extract from the fresh root is the most reliable and best for ordi- nary use. The so-called leptandrin is simply a solid extract in a state of trituration, not entirely useless but nearly so. The glucoside leptandra (American preparation) is reliable, as it is prepared from the fresh root. It forms some f)\/l splendid compounds. Glucoside leptan- dra, two drachms ; citrate of caffeine, one . ^ggfilffir* 1 drachm; strychnine, half a grain. Mix. IkJlvl^^i Make sixty pills, one thrice daily of great efficiency in constipation of Bright's disease. Leptandra, hydrastin, quinine, of each thirty grains; solid extract of nux- vomica, grains seven. Mix. Make thirty pills. One thrice daily, good tonic. \xrv Licorice root contains a Licorice, valuable substance called glycyrrhizine, closely allied to sugar; yellow, transparent, uncrys- tallizable; soluble in both water and alcohol, forming compounds with acids and their bases. It is much used, not only for its antiseptic properties, but for a vehicle to disguise the taste of bitter drugs. Fluid extract of licorice, for quinine mixtures, is very generally used by physicians, but all may riot be aware how effectually it disguises the bitterness of quinine. The desired dose of the Leptandra. J 356 DISEASE GERMS. quinine in powder should be added to a teaspoonful of the licor- ice and thoroughly mixed before being swallowed. An aromatic elixir of licorice should be used like the fluid extract. Common Licorice (Glycyrrhiza glabra). Ammoniated Glycyrrhiza.—The sweet principle of licorice, glycyrrhiza, in combination with ammonia. Used to blunt the gustatory nerve and to mask the bitterness of quinine. Dose: One grain every three hours. Instead of obtaining this by decomposing Liquid Ozone, the atmosphere, we can now more effectually obtain it in greater abundance and purity by compressing strongly ozonized oxygen to the extent of 125 at- mospheres at a temperature of—102.50 C(—153.5° F-)- We have practically dispensed with pressure and employed cold alone. At a degree of heat—or shall we say cold?—represented by— i8i.4°C. (—194.5° F.), the temperature now known as that of the boiling-point of fluid oxygen, ozone condensed to a deep, purple-blue liquid, the color of which is so intense that a layer of it about two and a half mm. is to all intents and purposes opaque. The ozone remained liquid as the temperature was al- lowed to rise gradually (controlled by fluid ethylene), until at about—1060 C (—168.8° F.), as indicated by a " hydrogen ther- mometer," the ozone begins to boil. The boiling-point of ethy- lene itself is not very different, being—102.50 C. (—I52.5°F.). Very great care must be taken in order that the ethylene and the ozone do not come into actual contact with each other, as if they do so. an explosion of terrific violence immediately occurs. Re- cent chemical manipulations have led to the discovery and intro- Cocardus. (Magnified 225 diam.) A highly polymorphic species of mould which is very prone to appear upon aqueous ex- tracts of Glycyrrhiza, and renders them worthless. BACTERICIDES. •357 duction of apparatus by the aid of which those wonderful products of modern science—liquid oxygen, hydrogen, nitrogen.. etc., and even the solid form of these So-called " permanent'' gases—were made. Carbonate of lithia, valuable in relieving cystis; Lithia. affords relief in irritable states of the prostate. The' bromide of lithia acts efficiently in all cases of gout or rheumatism. Benzoate of lithia neutralizes uric acid in the blood and overcomes the uric acid diathesis; it is also a remarka- ble solvent to calculi in the bladder. The benzoate of lithia in five-grain doses alternated with salicylate soda in the acetate of ammonia does good work in chronic rheumatism. The carbonate of lithia rendered soluble by the peroxide of hydrogen is one of the chief ingredients of the uric acid solvent ozonized. The salicylate of lithia is an excellent bactericide, has a destructive effect upon the bacillus amylobacta. Lobelia. Indian tobacco, the leaves and seeds are used medically for a variety of diseases, as it is an emetic, expectorant, sedative, antispasmodic, and. has the invaluable property of sterilizing all disease germs. It is a most powerful and active emetic, provided its administration is pre- ceded by copious warm alkaline drinks, as it is not absorbed in an acid menstruum. It is very useful in all fevers, as it keeps the germs, the factor of fever, quiescent; it relaxes the system, produces diaphoresis. As a relaxant and sedative, it is a most efficient agent in the treatment of epilepsy, hysteria, spasm, cramp, convulsions, tetanus. It acts well upon the motor nerves of respiration, hence it is often of the greatest utility in asthma, bronchitis, laryngitis. The immense resources of modern thera- peutics have not been able to supersede it. The vast future of medicine will require lobelia. Noses may wither with the amoeba of catarrh; eyes fail from steady use; ears becomedull by excesses; tissued-starved teeth may vanish and drop out; but the cleansing of the stomach from the fungus Lobelia. i35« DISEASE GERMS. sarcinae needs lobelia. We do not claim it to be an antiseptic, it .cannot destroy micrococci, it sterilizes them and also the nutrient soil upon which they live. No drug has superseded it in teta- nus ; its action cannot be explained; meets the etiological and vital condition, renders the germs of this fatal disease quiescent in the blood, and retards organic changes. Lycopodium Vegetable sulphur, is an invaluable germi- . cide. The plant, moss or fern, possesses properties of a high anti-bacterial character, for a oecoction of it kills that terrible parasite malady the plica polonica. It is extremely useful in that peculiar burning of the cutaneous suiface when it is loaded with the germs of disease, in painful boils; in 'that aggiegation of the germ syph- ilitica on the bones called nodes ; in all tu- bercular skin af- fections ; it ope- rates like ordi- nary sulphur upon the liver, stimulating that gland, removing that dirty, yellow hue of the skin, which is so common in torpid liver. Besides it is invaluable in relieving irritable bladder, espe- cially in the enuresis of children. Lycopus. Bugleweed, the herb either in de- coction, tincture or fluid extract, is astringent, tonic, sedative and narcotic. It is so soothing when admin istered that it diminishes heat, pulse, respirations, and its action is incomparable in incipient pul- monary tuberculosis, in retarding germ evolution and growth—in preventing bacterial development in diarrhea and dysentery. Bugleweed. BACTERICIDES. 1359 It is this peculiar germicidal action that renders this plant so efficient, so highly prized in all haemorrhages from the lungs and stomach. Its action upon the heart resembles that of bromide of soda. Besides, it is valuable in toning up and promoting digestion, and allaying all uneasiness or irritability of the alimentary canal. The best preparation for use is either the tincture or fluid extract, in doses according to the effect desired. The physiological action of bugleweed is directly on the nerve. The combination of this property and its germicidal properties is what renders it of so much value in pulmonary and intestinal tuberculosis. This invaluable anthelmintic consists of an Male Fern, ethereal extract or oleoresin extracted from the rhizome. This is the only preparation fit for medicinal use; it is a thick, dark green liquid, has the odor of the fern, nauseous bitterish acrid to the taste. On standing, a granular, crystalline substance ap- pears on the surface, which is the active ingredient, and should not be sepa- rated. Dose from thirty to sixty grains is the proper quantity, administered in capsules. If capsules are not ac- ceptable, it may be ad- Common Male Fern. ministered conveniently in the following combination : Ethereal extract male fern sixty grains, rubbed up in mucilage of gum acacia one ounce. To be taken at one dose, followed by copious drinks of slippery elm. Castor oil to be taken two hours after- ward. is a powerful germicide, having a special affinity to Manaca destroy the microbe of syphilis, the bacilli of tubercle and the germs of rheumatism. It excites the action of the lymphatic system most energetically, and eli- minates morbid or waste material from the system. In alterna- 1360 DISEASE GERMS. Manaca. tion with the saxifraga, it is the ne plus ultra of all drugs in syphilis. Prof. Day, M. D., of America, and £. Mather, M. D., of England, have had undoubtedly the most experience with this drug. They state, and both agree that, if very carefully guarded in its administra- tion, it will destroy the bacillus of syphilis and amylobacta of rheuma- tism. It is of special utility in phrenal syphilis, affording relief in all cases from the noctur nal pain. A perennial plant, with a stem about a foot Marjoram, high; ovate leaves; roundish, panicled, crowded heads of purple flowers, with large bracts. Its properties are germicidal, used in cooking for seasoning. Stimulat- ing and diaphoretic in the eruptive fevers, has a sterilizing action on germ evolution. The powder is nearly equal in antiseptic proper- ties to the horse-chestnut in nasal catarrh. An infusion is the best method of administering. Drink- ing it cold it warms, invigorates and soothes the nervous system. The essential oil of sweet marjoram mixed with olive oil in various proportions, is an excellent remedy for baldness, as it is inimical to the different forms of tinea of the scalp. 1. Sweet Marjoram (Origanum Marjo- rana); 2, Common Marjoram (Ori- gziium vulture). Horehound is a' most efficacious germicide Marrubium. upon all micro-organisms on the mucous mem- brane of bronchi and larynx, and also upon germ-laden sputum from the substance of the lungs, as we have BACTERICIDES. 136l in pulmonary tuberculosis and pneumonia; consequently, al- though entirely ignorant of its annihilating action upon the germs of catarrh and bronchitis, and its sterilizing action upon the tubercular bacilli, and the pneumo- coccus, the remedy has been em- pirically prescribed with the best results in chronic catarrh and bron- chitis, attended with very copious germ-laden expectoration. Besides its action as a bronchial stimulant and antiseptic, it is a safe and efficacious tonic, acting as a most efficient stimulant to the kid- neys, skin, but especially the liver, giving US COpioUS biliary Secretion. Horehound (Marrubiutn vulgare). An infusion of one ounce to the pint of boiling water. Dose: a wineglassful, either warm or cold, as desired, answers well; but better still is the tincture, which holds its aromatic properties in a more perfect state. Japanese peppermint, a camphoraceous body, Menthol, having the same bactericide properties as thymol. Menthol is somewhat soluble in water, as shown by its taste being imparted to water, and by the slug-like move- ments of the crystals when covered with water, and placed under the microscope. Sometimes the movements in the water to- wards and from the dissolving crystals, are as rapid as those formed by an active rotifer or vorticel. These movements are rendered visible by minute objects floating in the water, as infu- soria and algae. They approach the crystals of menthol with ve- locity, and are ejected with violent electric motion. Menthol left exposed, will evaporate and disappear at the ordi- nary temperatures of the rooms. Its smell is like peppermint, but less pungent. Taste is somewhat sharp, and penetrates the whole mouth. It looks like the sulphate of magnesia to the naked eye, but more talc-like. It is rather bulky, one ounce filling a two-fluid ounce bottle. From what I can judge, it is a very agreeable medicine, and would make an acceptable substi- tute for the smelling-salts of elderly ladies. There is nothing unclean about it. Its volatility renders it easy to administer in diseases of the air passages, even to infants and very feeble persons. Menthol is a bactericide, has the remarkable property when 86 1362 DISEASE GERMS. administered, of sterilizing the blood to many disease-germs. The following are a few of the formulae in general use: For internal administration.—Menthol, one drachm ; three ounces each of fl. ext. licorice, water, alcohol ; twenty drops each of oil of cajeput and carbolic acid. Mix. Four drops every two hours. For applying to the nostrils in hay fever.—Menthol, one drachm; ozone ointment, two ounces; hydrochlorate of cocaine, one grain. Mix. For piles, eczema, pruritus of the genitals, fistula?, rectal excoria- tions.—Menthol, one drachm ; ozone ointment, two ounces: chaulmugra oil, half an ounce; cocaine hydrochlorate, two grains. Mix. As a gargle for sore mouth, scarlet fever, syphilitic and tubercular ulceration.—Take of each menthol and carbolic acid, twenty grains; two ounces each of fluid extract of licorice and glycer- ine; peroxide of hydrogen, one drachm; one pint of water. Mix. In pruritus.—Take one drachm menthol ; two ounces of alco- hol ; thirty grains carbolic acid ; the same of the benzoate of soda; add the whole to six ounces of rose water. This drug is used by the natives as Mudar Bark. a remedy for epilepsy, paralysis, bites [Calotropis Gigantea) of poisonous animals, worms, etc. In cutaneous affections, especially lep- rosy, it is frequently employed. Its active principle, discovered by the late Dr. Duncan, of Edinburgh, called mudarine, pos- sesses the extraordinary property of congealing by heat and be- coming again fluid when cooled. Dr. G. Playfair found the milkly juice to be very efficacious in leprosy, lues venerea, herpes, dropsy, rheumatism, hectic and intermittent fevers; and Dr. Duncan considered that it agreed in many respects with ipecacuanha, and that it might eventually supersede the latter. (See Major Heber Drury's "Useful Plants of India.") in the form of a tincture of the green plant, that Marigold is, flowers, leaves and stem, i.s a bactericide of [Calendula), the first order ; hence it is of intrinsic value in all cuts, bruises, wounds, and contusions. It is altogether superior to arnica in ecchymosis. The mother tincture diluted one-half with water and applied to a wound or ulcer, pro- motes rapid cicatrization by destroying the bacteria. BACTERICIDES. 1363 As a germicide its range of action is large; it sterilizes the oidium albicans of aphthae and sore nipples. It combines well with peroxide of hydrogen, and when four volumes of that invaluable agent are added, it is of the greatest possible utility in threatened gangrene, purulent ophthalmia, abscess, carbuncle, etc. _______ A most intense- Menyanthis Trifoliata. ly bitter tonic and [Buck Bean) germicide. In some sections of the country it is used quite extensively in the treatment of our indigenous fevers, rheuma- tism, jaundice and parasite cutaneous diseases. It is alterative and purgative. It is often administered in infusion—half an ounce of the pulverized plant to a pint of boil- ing water. Dose, a wineglassful repeated fre- quently. Also in the form of a fluid extract in doses of thirty to sixty drops. This ointment is in very general use Mexican Ointment, in Mexico as an ointment for, hernia. [For Rupture) Its true composition has as yet not been definitely settled. It is applied externally over the hernial aperture, and has the remarkable faculty of contracting the orifice, and at the same time, without the slightest irritation, causes thickening of the parts, and forever after prevents the rupture from taking place. It is a most excellent remedy to prevent the occurrence of rupture. It is spread on a piece of leather morning and night and ap- plied. It is a most excellent local bactericide when applied to the skin in any form, of either vegetable or animal parasitic disease, it al- most immediately kills it. Its action is perfectly painless. The whole plant is germicidal, and is a Mitchella Repens. remarkable agent to render labor easy, [Partridge Berry) it is also diuretic, tonic and astringent. It resembles the aleteris farinosa. The comp. syrup of partridge berry is the most important agent ever presented to the profession in the treatment of dis- Buck Bean. 1364 DISEASE GERMS. eases of the female reproductive organs. This syrup is emmena- gogue, parturient, antispasmodic, diuretic and tonic, and is par- ticularly efficacious in the treatment of engorgement, inflamma- tion and induration of the uterus, dysmenorrhcea, menorrhagia, leucorrhcea, amenorrhcea, prolapsus uteri, hysteria, melancholia, pruritus vulvae, impaired vitality, vomiting of pregnancy, habitual abortion and uraemic eclampsia. It being a powerful uterine sedative, is the remedy par excellence in dysmenorrhcea or threat- ened abortion. Mulberry. Some of the most common affections, spring and fall, when the vicissitudes of temperature are great, are inflammatory affections of the glands of the mouth and larynx, chilliness, fever, pain in de- glutition, and as it progresses, swallowing becomes exceed- ingly difficult, if not imprac- tible. The tongue coated white or brown, mouth dry, and if the inflammation is not promptly checked by the use of antipyrine, small vesi- cles make their exit: in these the oidium albicans make their appearance. In such cases the glycerite of sul- phur, one teaspoonful every hour, and the throat packed from ear to ear, with a strong infusion of the inner bark of the white mulberry. As a gargle and mouth wash, the same infusion is unexcelled, as it destroys all germs in the mouth. It is also an infallible remedy in nursing sore mouth and ulceration of the nipple. The root has considerable reputation as a vermifuge. Common Mulberry (Aforus nigra) female flower. fruit, leaf, and Arrowroot, is a variety of starch, extracted from Maranta, the roots of certain plants which grow only in tropical countries, and is much valued as a deli- cacy, a light, nutritious and easily digested food for children and invalids. The tuberous roots contain a large percentage of farina. That growing in the ozoniferous atmosphere of Bermuda BACTERICIDES. •3^5 is a foot long when a year old, and when reduced to a pulp, by repeated raspings and washings, yields one of the finest antisep- tics in medicine. A small quantity of this extract in- troduced into albuminoid bodies preserves them for many months, without de- terioration or chemical change. The use of this antiseptic in all fevers, and in all diseases in which albu- minoid changes take place, is worthy of serious consid- eration. The amount of fecula or starch present in the root of the maranta varies ac- cording to age and soil, runs from eight to twenty-six per cent. The latter stage is reached when the plant is about a year old. A green tincture prepared from the fresh root is highly germicidal, and is an antidote to the stings and bites of venom- ous insects and reptiles. Arrowroot; a, tubers ; b, leaf and flowers ; ;and style. c, stamen Mistletoe (Viscum Album). This parasitical Mistletoe. shrub, which de- (Viscum Album) rives its nourish- ment from the liv- ing tissue of the tree upon which it grows, and from which it seems to spring, has been held in high repute by both German and British Druids as a germicide in sterilizing the microbe of hooping-cough and the bacillus of hay- fever. It has a decided medicinal pro- perty in chorea, epilepsy, convulsions, and stands high as a pain-alleviating remedy. It is used most extensively in this country as a uterine tonic and vitalizer. The very best results are obtained by administering the elixir of the mistletoe during the last four months of preg- 1366 DISEASE GERMS. nancy, equal to the wine of the aleteris farinosa. Sure to relieve pregnancy and parturition of many complications, and insure ease and safety; and still more, when its action in labor is aided by the uterine cones, we bring about the phenomenon in midwifery practice of "painless parturition." Mura Puama.—Fluid extract more powerful than damiana as an aphrodisiac. It forms the chief ingredients of the sexual invigorating fluid and pills. The fluid extract of mullein leaves is indicated Mullein, in pulmonary phthisis ; efficacious to relieve cough and ulcerated bowels ; obviates phthisical diarrhea. The smoke of the burnt leaves relieves irritation of the bronchial mucous membrane. Mullein oil, valuable in all cases of aural disease, as deafness otitis media, otorrhea, otalgia. This oil is prepared by polarised light and by peroxide of hydrogen. One to three drops in the ear. Dr. Mather, the celebrated English physician says: Mullein oil was worth a trial in bad cases of deafness, especially when labyrinthine mischief was suspected. I commenced its use in a large number of cases, with most satisfactory results. In nearly all cases complaining of pains and presenting signs of hyperaemia of the middle ear, the instillation every two or three hours of two or three drops of this oil rapidly arrested the pain, and prevented suppuration and perforation of the membrana tympani. In every case of otorrhea or otitis media, after the ear was washed out with tepid water and castile soap, it was dropped; following its use there was no more odor, no muco-purulent dis- charge, not a vestige of the streptococcus pyogenes could be seen. In cases of labyrinthine deafness the result was extremely satis- factory. In some instance the cure was gradual; in others at once. The mullein oil treatment of aural diseases excels all others, especially of an otalgic or suppurative character. BACTERICIDES. I367 This is a substance Myrrh, which exudes from the bark of the balsamoden- dron myrrha, a tree peculiar to the tropics, in oily yellow tears, which gradually thickens, and finally be- comes hard, and darker in color. It is an invaluable germicide, was ex- tensively used by the Egyptians for embalming, and by the moderns as a remedy to destroy micro-organisms in the mouth and alimentary canal; hence useful in all forms of oral ulcer- ation, spongy gums, fetid breath; it destroys the bacteria of ulcers, hence if sprinkled on them promotes heal- ing ; of value to sterilize the amoeba of catarrh and bronchitis. A tinc- ture is good form for general use. Myrrh (Balsamoiiendroji myrrha). Myrtle. Ten drops of ozone et chlorine were added to six- teen ounces of tepid water, and when used an ounce of myrtol was added. Used as a mouth wash and douche by the nose. Most excellent results followed, a general improvement took place, a complete change from worse to better, so much so that I dete- rmined to try the myrtol inter- nally. The preparation I used was an ozonized distillation of the leaves and flowers of the common myrtle; being a liquid possessing all the perfume of the plant. It is of less density than water, and evaporates at ordinary temperature. It has a slightly acrid, astringent taste, followed by a sensation of freshness. It is a powerful germicide, stimulates all the vital functions of life, inimical to microscopic Myrtle. 1, Myrtle Flower. Flower. Myrtle in life. It is a great appetizer, a sedative i368 DISEASE GERMS. to the nervous system, enters the blood, acts as a scavenger to that fluid, and after disinfecting the entire body is freely elimi- nated by the breath, skin, and kidneys. It has a decided affinity to disinfect the respiratory mucous membrane, completely anni- hilates the amoeba of catarrh, laryngitis, bronchitis, asthma; also of glanders; changes the opaque, gangrenous, purulent secretion, at the same time inducing a healthy condition. It is an unsur- passed remedy in chronic fetid bronchitis, complicated with paroxysmal asthma and emphysema. (C10H8) is a derivative of benzol, and allied to Naphthaline phenol. It appears as thin white shining rhombic crystals, with a strong pungent odor and burning taste. It is insoluble in water, but readily dissolves in alcohol, ether and fatty and ethereal oils. Externally it has been found of value in the treatment of venereal ulcers, of wounds and of scabies. This substance was recommended for certain intestinal affec- tions by Dr. H. Warner, Springfield, Mass. The purest naphthaline alone should be used, and he found it invaluable incase of chronic intestinal catarrh and cholera morbus in children, as well as in typhoid fever. In intestinal tuberculosis he found that it caused some improvement, but no radical change, and for acute diarrhea it was no better than opium and suitable diet. Dr. Warner's success was not attained by others who used naphthaline according to his directions, and they reported that it produced hypogastric pain, strangury, tenesmus, and urinary appearances suggestive of carbolic acid poisoning. Moderate success was reported, however, by a few writers. The author, after extensive and careful use during a sufficiently lon'^ period of time to warrant conclusions, decided : I. That naphthaline is ineffective in the so-called dyspepsias which are characterized by frequent movements of the bowels, and usually by the vomiting of coagulated milk, and is inferior to other medicaments which are in general use for such con- ditions. 2. In all other forms of intestinal catarrh in children naphtha- line should be preferred to all other known means of medication. In simple acute diarrhea the preparations of opium would be pre- ferable, but for the fact that naphthaline checks fermentation pro- cesses, and in this way prevents an acute intestinal catarrh from developing into a chronic one. Naphthaline is a powerful antiseptic, insoluble in water, alkalies, BACTERICIDES. '3^9 and acids ; may be administered in capsules two to eight-grain doses without any noteworthy absorption by the stomach and in- testines. Excellent results are obtained from the use of this germicide in acute and chronic intestinal diseases, tubercular affections, diarrhea, dysentery, infantile diarrhea and cholera. It kills the germs of disease in the alimentary tract; besides it dis- infects the entire passages of the germ-laden, green stools, so common among children in crowded cities during the hot season of the year. In cholera infantum it has achieved most-wonder- ful results. An excellent formula for all cases, to destroy the bacteria and disinfect the entire alimentary tract, is the following: Naphthaline, sacch. lac, of each, two ounces; oil peppermint, one drop. Ft. twenty chart. One every hour, and less frequent, according to the evacuations. Externally in a pure form, or in an ointment, it is useful in scabies, herpes tonsurans, eczema. Prof. Fuchs, M. D., New York City, N. Y., several years ago, called attention to the value of this agent in the treatment of cer- tain diseases of the skin, and particularly of scabies. He em- ploys naphthol in a ten-per-cent. alcoholic solution, or in the form of ointment, and says that one or two applications will cure the most inveterate cases of common itch. He has had equal suc- cess with naphthol in psoriasis, eczema and ichthyosis, and there is nothing better, he says, to allay tormenting itching of prurigo. Dr. Fuchs speak in high praise of naphthol as an external agent (alcoholic lotion or pomade) in the skin diseases mentioned above. Van Harlingen, moreover, has seen favorable results from naphthol in obstinate cutaneous affections. The experiments to which allusions has been made, have led Bouchard to regard naphthol as one of the best and safest of antiseptics. According to these a three-per-cent. solution markedly retards the development of the typhoid bacillus, as well as that of the bacillus tuberculosis. The same solution is fatal to the microbes of several of the parasitic diseases of ani- mals, and prevents fermentations. Bouchard gives naphthol internally in typhoid fever, and believes that, if it does not abort this disease, it certainly renders its course milder. He regards a dose of forty-five grains (2.50 grammes) a day as realizing the conditions of intestinal antisepsis, and affirms that in such doses there is no antiseptic agent which is more innocuous. This use of naphthol in typhoid fever has been followed to some extent in this country with apparently favorable results. 1370 DISEASE GERMS. Indicated as a powerful stimulant to the Nitrite of Amyl. pneumogastric and vagus in angina pec- toris, asthma, epilepsy, syncope. Its action is instantaneous and certain, as it lowers vascular tension by dilating the arterioles ; stiffens up a weak heart, breaks or wards off the spasm. Dose: One, two, three, four, five, ten drops in pearls or glass shells. Crush a pearl in a handkerchief and inhale on the approach of a paroxysm. One of the most valuable stimulants in Nitro-Glycerine. the Materia Medica. Indicated in all conditions of prostration or collapse, in headache, asthma, angina pectoris, albuminuria, neuralgia, ner- vous anaemia. The best form for administration is a one-per-cent. solution. This is the handiest and least liable to change or become worthless. The average dose is one drop, but patients are not all alike in the amount required to produce an effect—some requiring less than one drop, others requiring three or four or more drops to produce the same effect. The effects usually last two to three hours. It is wisdom for the physician in all cases to call the remedy by a less terrorizing name—glonoin, or trinitrin. Physiological Effects.—Dropped on the tongue, the effect is the more rapid, as there is no dilution. Byway of the stomach, unless greatly diluted, the effect is apparent in a few minutes, the pulse being increased from ten to twenty beats, and becoming fill and regular. In a few cases there is a slight headache, last- ing for a few minutes. In larger doses the face becomes flushed, a severe headache is experienced, accompanied with a feeling of fulness, singing in the ears, flashes before the eyes, and all the symptoms of an increased supply of blood to the brain. On account of this effect on the cerebral circulation, care should be taken in administering the remedy to the aged, as the sudden expansion of the cerebral vessels might cause a rupture of their weakened calcareous walls. Its action on the heart is through the sympathetic nervous system. The vagus nerve and the vaso-contractor nerves of the vaso-motor nervous system are depressed, partially paralyzed. This allows the extensive system of arterioles to dilate, and thus give room within their walls for a greater amount of blood to flow. Thus this enlarged reservoir of tubes relieves the heart of the work of forcing the current through narrow contracted tubes. This and the vagus nerve BACTERICIDES. 1371 being depressed permits the heart to beat freer, fuller and more rapidly. Of great value in asphyxia.. Best administered by adding the prescribed dose to a little water, or in the form of pill, The antidotes to an overdose are either ergot, strychnine or belladonna. Two of our oldest physicians speak of it thus : /. H Moon, M. D., Montpelier, Idaho, a physician of the high- est scientific attainments, gives his experience on nitro-glycerine in tinnitus aurium, as follows : " After the usual experience in ear-work, and a gradual accu- mulation of unimproving cases of tinnitus aurium, I began to study the general effects of nitro-glycerine, and to use it in these cases. In some cases there was an improvement; in others there was none. In the patients where improvement had occurred, there was found to be present a similarity of conditions, and I soon satis- fied myself that there was a class of patients in which the nitro- glycerine treatment was valuable. I found it most serviceable in patients having the tinnitus aurium, without much impairment of hearing, and where but little change had occurred in the naso- pharynx and where it was found on examination that some abnormal condition of the heart existed, either functional or organic. The tinnitus was generally constant, or nearly so. It was not, as a rule, more marked when the patient was in a recumbent position ; occasionally there was some remission in that position. The thermometric and barometric conditions of the atmosphere influenced the tinnitus; damp weather, with low barometer, usually increased it. Dull, heavy headache, more or less per- sistent, and most frequently located in the parietal regions, though sometimes located in the frontal region, was of frequent occurrence." Wm. McMillen, M. D., Sugar Branch, Ind., one of the most eminent physicians in the United States, and a close clinical ob- server, points out the value of this drug in various affections —angina pectoris, migraine, and neuralgia, (which he describes as angioneuroses), as also in sea-sickness, some forms of anaemia, faintness, palpitation, and other diseases; depends upon the ex- istence of an irregular distribution of blood,, which condition may be inferred from a certain degree of pallor of the skin, es- pecially of the face, often co-existent with a weak pulse and a small rigid radial artery, which frequently is situated at some depth When on the other hand, headache and neuralgia occur in patients with chronic congestion of the subcutaneous veins of 1372 DISEASE GERMS. the face, nitro-glycerine is to be avoided; and similarly it is of no use in asthma, when the face is reddened in consequence of emphysema. If, however, a pale face exists with angina pectoris migraine, giddiness, shock, toothace, or sea-sickness, the best re- sults may be looked for by giving nitro-glycerine. The regulat- ing effect of the drug exercises an influence over the congestion of internal organs similar to that brought about by blood-letting; and in these congestions, whether of lung, brain, or kidney' when they are of a temporary character, the pulse is generally found to be slow and of low tension; a fact which, as the author remarks, is sufficiently well known in reference to the fever-free periods of acute hyperaemia of the lung and kidney. He lays down as a rule, that the condition of the pulse is the best indica- tion for the employment of nitro-glycerine, and the most trust- worthy guide as to the dose with which to commence the treat- ment. The smaller the radial artery is, the more rapidly it dilates under the action of the drug, and the less the secondary effects proceed; on the other hand, the fuller the pulse with a distended radial artery, the less it is affected; and finally, the softer the artery, with a weak pulse, the greater the secondary, and the less the general effects. Single-drop doses of the one- per-cent. solution are sufficient in cases of small pulse, but with a full pulse, it will be found that the full effects cannot be pro- duced with less than two-drop doses. When there is a soft artery with a weak pulse, subnormal doses only should be given; a quarter to half a drop. After the trial dose is given, the patient's sensations of pulsation and pain in the head, as well as the distension of trie radial artery under the finger of the physi- cian, will be the guides for increasing the dose. An aromatic ger- Nutmeg. micide of some power, and in large doses produces alarming senso- rial disturbance and stupefaction. It is chiefly used as a spice, for its carminative and stimulant proper- ties. Its action is identical with mace, and in both, their virtues depend upon the presence of a volatile oil, which has a remark- able affinity for oxygen. When the oil myristicae is distilled at a temperature 347° F., there are marked traces of comp. oxygen, Nutmeg (Myristica moschata). A branch showing fruit, and section of rfruit, with nutmeg enclosed. \ 2Z. BACTERICIDES. 1373 and the pure colorless hydrocarbon, which remains after distil- lation, is identical in composition with the pure oil of turpentine. The extract which is thus prepared, is available for internal use Mix two drachms of the oil with one ounce of pulverized mace; macerate for a few days in one quart of deodorized alco- hol, then filter. Dose from five to ten drops, thrice daily. Nux Vomica. The tincture prepared from the seeds of the strychnos nux vomica, when administered in small doses, is an excitant or stimulant to the vaso-motor and motor-centres of the spinal, and thereby in- creases the activity of the circu- lation and general tone of the system. It is one of the most valuable of all tonics, and inimi- cal to microscopic life. In anaemia of the brain and spinal cord, in all forms of paraly- sis due to that pathological con- dition, this drug is invaluable, stimulating the cord and rousing up the inertia of the muscular system.' It increases the activity of striated as well as non-striated muscular fibres—valuable in in- ertia, in a relaxed state of the stomach and bowels, which give rise to loathing of food, nausea, vomiting, colic, atony of the stomach and liver. Its general action as a stimulant to the ner- vous and vascular systems renders it a valuable tonic to aid digestion, to overcome a sluggish liver, habitual constipation. The dose is variable from a few drops up to fifteen of the com- mon tincture, added to water, thrice daily, before meals. Nux Vomica. Branchlet, leaves and flowers. Nymphae Odorata. The root of the white pond lily has been in use for several hundred years, pulverized and incorporated into poul- tices, and ointments for an antiseptic in gangrenous and phage- denic sores; an infusion has been very generally used as a wash in leuchorrhcea. The root has been recently subjected to a rigid chemical ana- lysis, and a very peculiar astringent, different from tannic and »374 DISEASE GERMS. gallic acid isolated, which contracts connective, muscular and mucous tissue. Its action is most energetic on sphincteric fibres. If the urine is kept neutral or alkaline in incontinence, and this remedy administer- ed, it causes the sphincter to contract; locally it con- tracts the walls of the vagina or rectum, if relaxed, and restores them to their pris- tine condition. To those suffering from prolapsus of the rectum, it is invaluable; to ladies suffer- ing from falling of the womb, or lost contractility of the vaginal walls; whose gener- ative system has lost its tone and vigor, and has become callous, inoperative to sexual white Pond Liiy. enjoyment, it is the remedy par excellence; to all who suffer from catarrh and leucorrhcea it is of great utility. Take it all in all, it is a great vaginal con- tractor and rejuvenator. F"or the convenience of the profession it is put up in the form of pastiles. One to be used every night at bedtime. The glucoside isolated from this old and reliable remedy is attracting well-merited attentiori. This glucoside has an ex- tremely bitter astringent taste, is very hygroscopic and not well adapted for internal use, but as a local remedy in all relaxed, devitilized states of the vagina it has no equal. Added to the butter of coca, it forms a most elegant pastile, tonic and astrin- gent to the vagina and uterus. One of these inserted every other night produces a complete revolution in the tissue, and causes contraction and vital tonicity. They are specially indicated in prolapsus uteri, leucorrhcea, sexual lethargy, sterility, and when- ever the reproductive organs are worn out by frequent parturi- tion or exhausted by sexual excesses. Water hemlock, water drop-wort, or CEnanthe Crocata. cowbane, a European aquatic plant, grows in ditches and margins of ponds. In Scotland it grows to a considerable height with a very large, fleshy white root. BACTERICIDES. 1375 The entire plant is a virulent, narcotic, acrid poison to man and the inferior animals, and produces in them when inadver- tently eaten, giddiness, convulsions, coma, and profound cerebral disturb- ance analogous to a violent epilep- tic fit. The believers in the law of similia similibus curantitr, with their apostate brethren the specific medicationist, therefore deem this plant a specific in all epileptic seizures. By repercolation, an alcoholic extract of great power and efficacy has been prepared from a recent importation. The dose is small, a few drops in water, repeated at intervals of every three hours and increased with great care, so as to ward off the fits, stem the current of cerebral explosions. It is worthy of a fair trial. Wa'.er Drop {Oinanthe croc at a). These " cones" are prepared from the Obstetric Cones, finest butter of coca ; boroglyceride, hydro- chlorate of cocaine and hydrogen per- oxide. Their use is indicated in every case of parturition. Simultaneously with the first pain, one should be inserted as far up the vagina as the finger can push it, and at the same "time one up the rectum. These speedily melt, thoroughly lubricate the parts and produce anaesthesia of the uterine plexus of nerves, rendering the parts soft, moist, easily dilated. In a short time two more should be inserted, and thus repeated every half hour, in accordance with the judgment of the ac- coucheur. At the same time the abdomen over the uterus and lumbar portion of the back should be rubbed with a mixture of concentrated ozone and chloroform. By these procedures the pangs of paturition are either totally obliterated or reduced to a cipher, the vagina rendered aseptic. The use of these cones in all cases of parturition at full time or miscarriage, is far-reaching. When thus used there is no tedious labor ; no inertia of the uterus ; no hour-glass contraction ; no retained placenta ; no post uterine hemorrhage; no metria; no puerperal convulsions ; a speedy convalescence. 1376 DISEASE GERMS. These cones have numerous other valuable properties: they cure the three forms of dysmenorrhea, specific inflammations, in- duration of the neck, leucorrhcea, pruritis, piles, irritable and ulcerated rectum, ascarides. Compound oxygen, or oxygenized water, Oxygen Comp. is a germicide of immense power, destruc- tive to all micro-organisms, completely annihilating the bacilli of tubercle, syphilis, cancer, fungus of diabetes, germs of scarlatina, etc. Vitalizes the blood, promotes the activity of the pink marrow and entire lymphatic system. Very efficacious in general nervous debility, nerve tire, and in debility of the respiratory organs, as in asthma, bronchitis, con- sumption, pneumonia, hooping cough. An invaluable remedy for impure, impoverished, germ-laden blood, or where the blood is literally swarming with myriads ot disease germs from over- crowding, sewer gas; in embolism, bacteria-laden blood from imperfect action of the heart, lungs, liver, spleen or skin. Dose: Internally. One teaspoonful three or four times daily, in a glass of cold water, is sufficient to supply the blood with oxygen—at least with all that it will imbibe, or in any form of blood disease, as chlorosis, anaemia, etc. As a Gargle.-r-ln scarlet fever, syphilitic, tubercular, malignant sore throat, one teaspoonful in half a tumbler of tepid water, every three hours. For inhalation use in full strength in a hot or steam atomizer. Prof. McFall, M. D., in his report to the Board of Health, Nashville, Tenn., says: " When pure atmospheric oxygen is exposed to the action of electricity, it is transformed into ozone, which is an allotropic modification. Ozone, at ordinary temperature, is being con- stantly generated in the atmosphere by the natural electric forces. The health of all animated nature is influenced by its presence; all diseases, in which disease germs are the factor, are greatly aggravated by its absence. A locality or home in which ozone is freely evolved, is one in which contagious diseases cannot exist, while if only a small percentage exists morbid action is rampant. Oxygen gas is inadmissible as a remedy, as it oxidizes the tissues too rapidly and hastens metamorphosis. This is true, whether the pure gas is used or its combination with nitrous oxide gas. As a medicament, compound oxygen, ozone water, peroxide of hydrogen, are remedies of intrinsic value; they are germicides; their use keeps the blood pure and stimulates all the BACTERICIDES. 1377 vital functions of the body ; they restore lost vitality, stimulate the hepatic and renal organs ; a cardiac respiratory tonic. The remedy in one or other of its three forms, if added to a little water, and swallowed, enters the blood, first acts as a scavenger, then as a vitalizing tonic- Oxygen is respirable to a limited extent, but when greatly in excess, hastens destructive metamorphosis. It is essential to the support of apimal and vegetable life, and is the most widely distributed of all the elements. It constitutes more than a fifth of the bulk and more than a fifth of the weight of the atmo- sphere. In combination with hydrogen it forms eight-ninths of all the water on the globe, and enters largely into combination with all the solid constituents of the globe, and is found largely in the tissue and fluids of all forms of plants and animals, none of which could maintain existence without this element. Although a great vitalizer and a potent remedy to increase the red corpuscles of the blood, by promoting the activity of the lymphatics, and destructive to all micro-organisms in the blood, it is totally inadmissible for inhaling or breathing, as it hastens destructive metamorphosis in the lungs and other vital *organs. It is very different when introduced into^he alimentary canal;; there nature will absorb just what it requires to vivify and renew. Ozone water, which is simply negative oxygen, is one of our best vehicles for the administration of oxygen, as that gas libe- rates itself when taken into the stomach, is speedily absorbed,, and does its work in cleansing the blood and tissues of all disease germs and increasing vital power. Comp. oxygen, or oxygenized water, is also a germicide of immense power, destroys all micro-organisms, an antidote to narcotic poisons. It destroys the bacilli of tubercle, syphilis, cancer, hooping-cough, but is not powerful enough to kill the oidium albicans of diphtheria, although it completely annihilates the fungus of diabetes with great promptness ; of great utility in in all our fevers. Its action upon the stomach in small doses is that of a tonic and appetizer, will destroy cancer on that viscus; it cleanses the blood, imparts oxygen to the tissues, and has a radical effect upon the lymph canals and pink marrow." This compound is prepared from Ozonized Uric Acid the active principles of hydrangea ; Solvent. cleavers ; triticum repens ; iris versi- [Antilithic) color; fringe tree; liverwort; juniper berries ; pichi; salts of lithia; acetate of soda; nitrate of potassa, with peroxide of hydrogen. 87 1378 DISEASE GERMS. This compound is valuable in sterilizing and destroying the bacillus amylobacta of rheumatism; neutralizing the urate of soda of gout; disintegrading uric acid crystals. Dose : from a half to one teaspoonful, added to water every two or three hours. Most efficacious in dissolving uric acid concretions or formations, in both liver and kidneys. No remedy so effectually relieves a crippled kidney as this, it dissolves and washes the debris away, and renders the kidney able to act as depurators of the blood. It relieves renal inadequacy by its sol- vent action, flushes the tubules and obviates the state of intersti- tial obstruction. The great catarrh annihilator. One Ozone et Chlorine, thorough application not to be repeated sooner than three or four weeks. Pre- cautions while using the remedy by the douche : No sneezing or blowing of the nose, because the moment the amoeba comes in contact with the ozone, it paralyzes them and they aggregate together into masses or colonies, leaving their abode in the head in a thick, ropy mass. Indicated in chronic nasal catarrh, ozaena, eustachian deafness, chronic laryngitis, asthma, bronchitis, and in incipient consump- tion. Before using the remedy paint with a camel's hair brush dipped in the fluid in its original strength, the tonsils, uvula, fauces. Then use the douche in the following manner: From one to two and a half ounces of the compound should be added to six- teen ounces of tepid water, and for the purpose of giving a bril- liant microscopical exhibition of the contents of the nasal cavity in catarrh, with its millions of disease germs, five to ten grains of permanganate of potassa should be added to each sixteen ounces, simply to color. If no microscopical examination is to be made, it can be omitted. The douche or cup for the fluid should be made of maple wood, and placed on a stand eight or nine feet high. The cup is better to hold twenty ounces. The bottom of this receptacle should be perforated large enough to admit a piece of pine wood, which should protrude outwards. This, also, should be perforated, to which a fine rubber hose is attached, long enough to stretch to the ground, to the end of which a nose piece of pine wood, large enough to completely fill the nos- tril, of an oblong shape, and this is to be perforated by burning a hole through it with an ordinary knitting needle. In applying this douche, first put in the water, then the ozone et chlorine mixture, and add the permanganate. Patient is to be BACTERICIDES. r379 seated in a chair, with a newspaper pinned under his chin, secur- ing the end, and a square slop Basin between his knees, head slightly stooping, then run about two ounces or so through one nostril, which, if there is no obstruction, will find its way down the other ; then change the nose-piece to the other nostril, and run through about the same quantity, changing from nostril to nostril, till it all passes through. While the fluid is running up and then down, patient must hold breath well, so as to keep it from passing down the larynx. Continue in this manner till it all passes. If there is any difficulty with the ear, and it is desir- able to run the fluid up the eustachian tube to the inner ear, for the relief of deafness, then the patient must hold breath very firm, then suddenly, while the fluid is running through the nose, close the open nostril with the finger and thumb. This will draw up the fluid in the sinuses of the head ; breath held well, none can go down the throat, and the superincumbent pressure in the douche will force it up the eustachian tube to the ears. In this manipulation, the nose-piece must fit accurately, so as to permit none of it running down its sides. The presence of the fluid in the ear is readily recognized by the pain in that organ. The eustachian tube maybe closed by disease-germs, by lymph, or it may not be pervious from collapse of its walls, and on the first effort it may not be successful; if this should be the case, rest a few minutes, and try again, raising the douche higher and telling patient to hold breath still more firmly. If not successful at all, give it up for about a week and make another more deter- mined effort, and still another, before pronouncing it a hopeless case of deafness. The permeation of the tube by the fluid indi- cates recovery of hearing. It may have to be repeated every month for a few times. If the fluid reaches the inner ear, and the pain or distress is intolerable, an effort at emesis should be made by tickling the throat with a feather, the gagging efforts will cause the fluid to descend. If there is chronic laryngitis, with ulceration of the fauces, the back portion of the throat should be painted, or brushed over, or smeared with the catarrh fluid, in its original strength, or slightly diluted, before it is ap- plied by the douche. During the interval of changing nostrils, and after it is completed, for several hours patient should breathe by the mouth exclusively, and sit in a stooping posture, head bent forward so as to permit a free gravitation for the discharge with its millions of amoeba from the sinuses of the head. Dose : One application of from one to two and a half to sixteen ounces of tepid water sufficient to cure the worst case of nasal catarrh. i38o DISEASE GERMS. Indicated wherever there are Ozonized Syrup of Tar. bacilli or microbes or micrococci irritating the periphery of nerves imbedded in the highly sensitive and exquisitely organized mucous membrane of the larynx; thus it promptly relieves the cough of phthisis, by either sterilizing or destroying the bacilli of tubercle. Dose : From a half to one teaspoonful every three hours or more frequently, so as to relieve cough. Ozone Tablet.—Indicated in all diseases of the skin, and is a beautifier of the complexion, an aid to nutrition, a tonic to the whole intestinal tract. Triturated, added to a little water. After meals. The only remedy so far discovered that Ozonized Clay, will absorb internal fibroid tumors in either chest or abdomen or external infiltration; it causes absorption of effused lymph in true and false anchylosis ; it has most marvellous power of absorption, it penetrates to internal parts by endosmosis, and softens and disintegrates. It is efficacious in all simple or malignant growths, tumors or swell- ings, of great utility in infiltrated breasts, goitre, consolidation of lungs, thickening of the walls of the stomach, ovarian and uterine tumors, enlarged liver; very large tumors disappear under its in- fluence with remarkable celerity, no matter where located. Dose: Take sufficient quantity of the clay, add to it cold water, and while pouring on the water, keep constantly stirring until a paste suitable for a poultice is formed, then spread on fine muslin the size of the tumor or growth. Apply for a few hours every day, not long enough to cause erythema of the cutaneous surface. It should be bandaged or strapped over the part. It is invaluable in destroying all micro- Ozone Water, organisms or disease-producing germs in the human blood, annihilates the germs of typhoid fever, of erysipelas, of diphtheria, scarlet fever, small- pox and other contagium vivum. It is of great value in all nervous diseases, cleansing, purifying, vivifying, vitalizing and increasing renewed molecular growth of the entire nervous sys- tem. It is true brain or nerve food, vitalizing and feeding, by promoting good blood for healthy brain. It is of great utility in all derangements of the stomach; it annihilates the sarcinae of BACTERICIDES. I38l gastric catarrh, corrects faulty nutrition, the outcome of indiges- tion and mal-assimilation of food, promotes gestation and lacta- tion and is a true physical restorer in all cases of sexual debility. See peroxide of hydrogen, with which it is identical in chemical composition. Dose: From half to one teaspoonful in half a tumbler of water every three or four hours. Map out the cancer. Cover sound parts Ozone Paste, with several layers of adhesive plaster, cut a piece of table oil cloth somewhat larger than the size of the cancer, spread it over with ozone paste one-fourth inch thick, then apply. It may remain twenty-four, forty-eight, or even seventy-two hours, but best to renew every morning till it is completely killed, or drops out, then poultice and dress as an ordinary ulcer. Paste can be charged with ozone to any degree of strength, prepared to suit all and any special case. This paste is the most powerful germicide ever prepared, being simply ozone gas condensed by immense pressure into an inert powder, forming a paste of marvellous oxidizing power, which has a special and peculiar affinity to unite with and chemically annihilate all disease germs or microbes or micro-organisms without pain or loss of blood. Although it has a special affinity for the cancer germ, and will effectually destroy it by a process of oxidation, and convert the germ or tumor into an ozonoid or an inert body, nevertheless it is destructive to healthy tissue. What is claimed for this paste is, that it is the most powerful and least painful of all remedies ever discovered for the cure of cancer. For external use only. Indicated in all breaches of continuity Ozone Ointment, as a dressing to protect, heal and kill disease germs. The best application for wounds, cuts, bruises, burns, piles, ulcers and cutaneous erup- tions. Its action is unexcelled in the bites of insects, ivy and sumach poisoning, boils and erysipelas. It annihilates the germs of variola on the face, nose, mouth and throat; sterilizes diph- theric and aphthous patches in the mouth or on the nipple. When the tubercular bacilli have invaded lung structures, it can be spread on chamois or linen and applied over the germ colony, aiding the internal remedies in promoting the dissolution 1382 DISEASE GERMS. of the germs. The range of action of this ointment is immense, from the most malignant cancerous phagedenic or syphilis ulcer, to the simple form of abrasion. Ozone ointment is a most efficient remedy in tinea capitis. A species of epidemic of this parasite recently occurred in one of our reformatories, which resisted ordinary remedies, when this was successfully applied. The disease was accompanied with severe itching and irritation, which at times became so intoler- able as to make the patients lose all control, and in five minutes undo the effect of a fortnight's treatment. All the usual reme- dies, including internal sedative treatment, were tried without avail for over two months. Ozone ointment was then resorted to, and the result was most satisfactory. The disease soon passed out of the acute stage, the itching was relieved, the red papules speedily disappeared, arid the discharge ceased. In a very short time the patients became convalescent. Dose: The most efficacious ointment ever introduced. To be spread on linen and applied twice or three times daily. This tree grows in all tropical and sub- Papoid. tropical countries to a height of from fifteen (Carica Papaya.) to twenty feet, with leaves only at the top, where also the fruit grows close to the stem. The leaves are from twenty to thirty inches long. The fruit is of a green color, very similar in appearance, flavor, and odor to a small melon. By the natives it is eaten raw or boiled. The seeds are round and black, and when chewed they have the odor of cresses, bitterish to the taste. The pow- dered seeds and juices of the unripe fruit are most powerful anthelmintics. The juice of the fruit and the sap of the tree have power- ful germicidal properties : even the exhala- tions of the tree will preserve beef, mutton, poultry, game, keep them fresh for an in- definite time if hung up near to it, or on it; besides, it renders the toughest meat tender in a short time. It is a tree of rapid growth, exceedingly prolific, bearing fruit all the year round. The juice of the fruit contains a principle called papoid, a peculiar soluble digestive ferment, which is des- tined to supersede pepsin, as it will dissolve fibrine in the pre- sence of acids and alkalies, and in neutral solutions. Papaw Tree (Carica Papaya). BACTERICIDES. T~g, The juice of this remarkable fruit has a tendency to undergo butyric fermentation, which is prevented by adding glycerine to it. The active principle is worthy of universal use, as a drug to displace pepsin, very valuable in chronic gastric catarrh; all forms of dyspepsia. Papoid digests better in the presence of a small quantity of fluid than when much diluted, thus possessing a greater advan- tage over pepsin and pancreatin, which in order that they digest well, require a large amount of fluid. It is a remarkable solvent to the false membrane of croup and diphtheria, more recently it has been used as a solvent for fib- rous growths in the bladder, stricture of the rectum, cutaneous cancer, epithelioma of the lip. Still more recently, it has, by continuous administration, opened an oesophagus closed by car- cinoma, by its powerful dissolving action. Intestinal indigestion may be greatly relieved, and in many cases practically cured, by the judicious exhibition of papoid. It is useful in all forms, but its value is more especially notice- able in those cases where constipation is a prominent factor, ac- companied by distension within a couple of hours after taking food. The method I have adopted, consists in the administra- tion of two grains of papoid powder in capsule before meals, the dose to be repeated two hours later, if flatus occurs. One par- ticularly valuable application which should not be overlooked, is its use in the treatment of attacks of a dull, disagreeable head- ache, depending upon indigestion ; a common affection amongst literary persons. Two grains of papoid pov^er, dry in capsule, will disperse it generally in from three to five days. It converts five times as much albumen into peptone as the best animal pepsin. It increases the flow of gastric juice by stimulating the peptic glands, acts as well with an acid as an alkali. With ozonized boroglyceride gives excellent results in gastric catarrh, as it kills the sarcinae. It is the greatest galacta- gogue known in medicine, also an abortifacient. Dissolves the germ colony or false membrane of diphtheria. This is comparatively a new hypnotic, and Paraldehyde, one that promises to be of much interest and value in the treatment of the various causes of wakefulness. It stands in the same rank as chloral, but is much safer, acts quicker and gives a more natural sleep. Several have written in high terms of its utility and safety. Like all new remedies, it is somewhat expensive. This dose is from one to 1384 DISEASE GERMS. two drachms. The name indicates its oily nature, and this is a difficulty which has to be met in prescribing. It is usually made into a draught by suspending in tragacanth powder, sweetened with syrup. I generally give it with whiskey or brandy in the proportion of one to three. The oiliness disappears when mixed with the stimulant, which is, I am convinced, a most useful ad- junct to every hypnotic. In its action it is gradual, and should it fail to produce sleep, it does not excite. Its use is not followed by headache or gastric disturbance, but it continues to be excreted by the lungs for many hours afterwards. This is by some con- sidered a great objection. Now it may be, and no doubt is, an objection, but as one writer very truly says : " Should we not rather look upon the disagreeable breath as a safeguard against the clandestine use of the drug, and not in the light of an objec- tion?" There is no accumulative principle in paraldehyde, and I have not met with a case of intolerance. It, however, is a much more valuable hynotic than sulfonal. Probably the best American authority on this subject is Prof. W. H. H. Crandall, M. D., of Des Moines City, Iowa, who says : < " Aldehydes have a strongly irritant action upon mucous mem- branes, and this is a great objection to their use as hypnotics. But they have a power of uniting with themselves, or polymeris- ing, as it is termed, and these polymeric forms are less irritant. Ethylic aldehyde unites with itself, and when three molecules of it combine it forms a paraldehyde. When several molecules, the number of which is unknown, combine, it forms metaldehyde. Paraldehyde is a useful hypnotic, which does not depress the action of the hearfclike chloral, and does not give rise to discom- fort next day. The chief objection to it is the unpleasant smell, which it imparts to the breath and which hangs about the patient for many hours." This medicament is excellent to Passiflora Incarnata. relieve the nervousness and insomnia in convalescence from fevers. We have been employing it in some cases of spinal meningitis after the acute symptoms had subsided, when the patients were unabie to sleep either day or night, could not endure the bed, and were unable to maintain the sitting posture, with highly satisfactory results. It is administered in small doses. Add ten drops of the mother tincture to half a tumbler of water, teaspoonful every two hours. BACTERICIDES. 1385 They are of the greatest efficacy in all uterine Pastiles. diseases, and are an invaluable boon to both [Ozonized) single and married ladies, if they are suffering from any disease of the womb. They positively cure whites, falling and ulceration of the womb, induration, granular erosions and catarrh of its 'neck, all forms of painful menstruation, neuralgia, dragging in the back, and every morbid condition incidental to that potent organ, the motive power of the universe. They also overcome the condition of sterility and impotency, impart great tone, strength and vigor to the sexual organs. They should be inserted when in the recumbent posture. It should be inserted up the vagina as far as possible with the finger and allowed to remain; shortly after its introduction it will dis- solve and come in contact with the diseased parts. The vagina should the following morning be washed out. Discontinue the use of the pastiles during the menstrual period ; when they disappear resume their use again, until the affection is cured for which they were originally used. Extensively cultivated for its fragrant, Peppermint. bactericide oil, which is obtained by dis- [M&iitha Piperita) tillation. The oil of mentha piperita is one of the most valuable germicides. The pure oil painted ^% on the diphtheric membrane instantly kills the strep- M| tococcus, causes it to shrivel up, completely annihi- $£$fe lating the micrococci and spores ; the membrane ^wp^ peeling off eventually, leaving a healthy, healing S^&krx surface behind. , /Sj7A<^ All varieties possess the same invaluable pro- v^\\i perties. It has a wide range of action, being a stimulant Water Mint. and carminative. A fluid extract of the common pellitory is a Pellitory. bactericide of considerable power. In doses of from ten to twenty drops it is very efficient in clearing the alimentary canal of all forms of microbial life. Two species of streptococcus have been found in the pulp of decayed teeth, both agents of lactic acid fermentation. They are in the form of cocci, diplococci and chains, and are the cause of toothache. The old germicide remedies, creosote, cloves and 1386 DISEASE GERMS. arsenic are entirely superseded by a saturated or mother tincture of the common pellitory. This is a germicide of great power, in all cases it destroys the micro- organism in the cavity of the tooth. Besides the internal use of the drug, it is of great value as a diuretic, re- frigerant and lithontriptic. Pellitory. This is a grate- Pennyroyal, ful aromatic, car- minative and dia- phoretic—stimulating the stomach, bowels and kidneys, and an elegant efficient diaphoretic. The greatest care should be exercised in prepar- ing the infusion so as to retain its volatile oil, which escapes altogether if permitted to boil. The essential oil is inimical to microscopic life. So the remedy may be used in mucilage of gum arabic as a powerful germicide. The oil possesses all the antiseptic properties of the pepper- mint and eucalyptus, and hence will destroy fungous growths. It is an antidote to the stings of the mosquito and other insects. Pennyroyal. A digestive solvent of great Pepsin, value in all forms of dyspep- sia, as it supplies a direct de- ficency in the animal economy. A most eligible form is the wine of pepsin, made by cutting up a cleaned call's stomach and covering with good sherry wine, macerating for two weeks, then percolating, and to every pint of it add half a pint of brandy to preserve. A teaspoonful after meals. The ozonized pepsin prepared by peroxide of hydrogen is the best for general use. The field for the use of pepsin seems constantly extending BACTERICIDES. 1387 with the improvements made in the quality of this agent, and it may now be employed with greater certainty as to results than ever before. The application of pepsin to digest away the mem- brane in diphtheria and membranous croup is not new, and is more or less commended and resorted to by physicians in the treatment of these diseases. Naturally, however, its utility depends entirely upon its diges- tive activity, and on account of the many preparations of pepsin of feeble or no digestive power heretofore at the disposal of physicians the results obtained have been in some cases dis- couraging. As to the value of pepsin, however, in these affections when of proper purity and strength there can be no question. It is to be hoped, and it is certainly highly probable, that the further study of digestive ferments will lead to a pepsin still more active. If the false membrane could be easily digested, and there seems no reason why it might not be with a pepsin of high diges- tive power, we could expect to have fewer grave cases of interfer- ence with respiration and blood poisoning from absorption of septic material, now alas so frequent. The three agents which have been most extensively used as local solvents for the false membrane of croup and diphtheria are papayotin, trypsin and pepsin. Papayotin is a vegetable agent recently introduced, claiming to have the same digestive properties as pepsin. Dr. Cannon treated forty cases of diphtheria with papayotin and gives the following conclusion : First. It exercises a feeble solvent action when the membrane begins to decompose. Second. The deli- cate new membrane is not affected by it. Third. It exerts no effect on the mortality of the disease. Its present high price is also somewhat against it. In the use of trypsin it is necessary to maintain an alkaline condition of the throat, as trypsin acts only in alkaline solutions. The secretions of the mouth and throat in these diseases is strongly acid, and tend to neutralize and destroy the power of the alkaline solution of trypsin. Permanganate Potass.—Emmenagogue, kills microbe of snake bites and the fungus of diabetes. The best preparation of manganese. Dose: One-half to one grain in water. i388 DISEASE GERMS. The fluid extract of pichi is indicated in all affec- Pichi. tions of the urinary organs; especially useful in all catarrhal states of the bladder and prostate. It is the primary agent in the uric acid solvent. In that formula it allays irritation, causes the disintegration and expulsion of calculi in the uric acid diathesis. Dose: From a half to one teaspoonful every three hours. The great value of this very ex- Peroxide of Hydrogen, cellent remedy is being seriously injured by its indiscriminate manu- facture by irresponsible parties who have been supplying the drug trade with a highly impure article. To such an extent has this been done as to render its employment in medical and sur- gical practice extremely dangerous. A remedy like this, which is indicated in all microbial dis- eases, should invariably be of the highest possible standard of purity. There is no morbid state, acute or chronic, in which this remedy is not indicated ; in all fevers its use is indispensable; in mumps, hooping-cough, cholera, dysentery, by killing the mi- crobe, diseased action ceases; in burns, boils, cuts, wounds, and gangrene, it destroys every vestige of germs. Physicians would do well to keep it in every family who are under their professional care, its employment is safe, its applica- tion never can injure, and it can always be depended on to kill the microbe of membranous croup, and thus save human life. Mothers can readily be intrusted in its use. Aphtha, follicular sore throat, oedema of the glottis, a gargle of from two to four volumes rapidly effects a cure by the de- struction of the germs. In nasal catarrh, after the mass of germs have either been an- nihilated or caused to migrate by a douche of the ozone et chlo- rine, following in a few days with a douche of one ounce of a fif- teen-volume strength of the peroxide of hydrogen to seven ounces of tepid water, and repeating this occasionally, a most excellent cure is the result. In epistaxis, an eight-volume solution immediately arrests hemorrhage by coagulating the blood, and causing contraction of the blood vessels. The eruptive fevers are deprived of all their malignancy and danger by their treatment with germicides. What a saving of human life is effected in diphtheria and scarlet fever by the use of the glycerite of sulphur internally; what a destruction of BACTERICIDES. I389 germs, what a speedy recovery if the child is daily bathed with peroxide of hydrogen. It destroys the germs on the skin, pre- vents the peeling, which is the most infectious media. A ten or fifteen-volume solution applied to any venereal sore or chancre, instantly kills the microbe syphilitica. For inhalation it excels all known bactericides, sterilizes speedily all the tissues with which it comes in contact, stimulates the reproduction of healthy epithelium. The peroxide in an atomizer by the bedside of the patient, yields good results in all cases of diphtheria and malignant sore throat. In addition to other forms of microbic disease, the result of sewer gas poisoning, numerous cases of diarrhea and albumi- nuria are clearly traceable to that cause, sewage poisoning, intes- tinal irritation, nephritic congestion. An epidemic of typhoid, or diphtheria, or metria, or erysipelas, naturally excites attention to the drainage, but no attention is paid to that terrible feeling of goneness experienced by eighty per cent, of the population of our large cities, who are suffering from exposure to its morbific agency. Diarrhea and albuminuria having such an origin, are the result of a physiological effort by the bowels and kidneys to eject the germs and their noxious pro- ducts from the system. Such states are promptly relieved by the internal exhibition of the dioxide of hydrogen, which acts as a scavenger to diseased blood. The injecting of boils, abscesses, with a few drops of the per- oxide, instantly kills the streptococcus pyogenes; healing the abscess by one application. Dose: half a drachm of the solution mixed with an ounce of distilled water, every four hours. There is a brilliant future for peroxide of hydrogen. In addi- tion to its great bactericide properties, it has a most remarkable property of aiding the absorption of fibroid tumors by a chemico- electric process—by simply keeping the electrode over the tumor constantly moist with C. P. medicinally pure peroxide of hydro- gen ; by endosmosis it enters the tumor, excites an absorptive ac- tion, by a withdrawal of its water and oxygen, at the same time liberating positive ozone, a bacterial destroyer. Electricity is thus a medicament of ponderous value. After each treatment there is a feelino- of great comfort and freedom from pain, and eventually compTete recovery. The method was first brought to the attention of the profession by Prof. John J. Siggins. M. D., of Philadelphia, aad more elaborately carried out by his pupils, A. Parks, M. D., 517 W. Twenty-third street, New York, and F. A. Tuttle, M. D.,' 2^3 Main street, Springfield, Mass. 1390 DISEASE GERMS. is the acetyl of phenetine, /. e., of the ethyl- Phenacetine ether of the paramidophenal. Its crystals have a great resemblance to those of antipyrine; they are white, odorless and tasteless. This absolute tasteless- ness renders the administration of the drug very easy. Similar to antifebrine it is very slightly soluble only in water, more so in hot water, but on cooling it is precipitated again. It is more readily soluble in glycerine, most readily in alcohol. The physi- ological action of the drug is that of a powerful cerebral stimu- lant ; as such it acts as a reliable antipyretic in all fevers and in- flammation ; as such it soothes the pain of neuralgia, as head- ache, angina pectoris, sciatica, ovarian irritation ; as such it is of great value in vasomotor neuroses, in the lancinating pains of locomotor ataxia; it is a strong analgesic, does not produce cyanosis, like antifebrine; acts very rapidly in spite of its insolu- bility in the gastric juice, and its administration is free from all untoward or depressing influence whatever. As it has a direct action upon the central nervous system, it exercises a powerful effect upon the circulatory system, its use being followed by a copious sweat. _______ a glucoside, prepared from the root of the apple Phlorizin, tree, is a peculiar germicide, sterilizing the blood for quite a number of microbes. It should be administered in small doses, in a high state of trituration. It is most efficacious wherever ordinary bacteria are present in mal- assimilation. It, in a most remarkable manner, increases the transformation of sugar in the liver, and will produce glycosuria. It does this by lessening the normal process of oxidation, by which it should be converted into carbonic acid. Phytolacca.—Next to saxifraga the best vegetable alterative in the Materia Medica; when ozonized it destroys the microbes of syphilis, cancer and tubercle. Dose : One teaspoonful every three hours. Platinum Chloride.—Useful in syphilis. Dose : One-thir- tieth of a grain triturated in sugar of milk, thrice daily. A germicide, warm, aromatic stimulant, used as Pimento, an adjuvant to tonic and purgative medicine, the taste of which it serves to disguise, while it in- creases their warm, their antiseptic properties, and renders them more acceptable to the stomach. It is specially indicated in dys- pepsia with flatulence. It is an excellent remedy in feeble heart, gives it tone, strengthens its contractions; valuable in all cases of heart failure with passive hepatic engorgements. The tincture of pimento is of great efficacy in chilblains. The resinoid is a most useful auxiliary to sulphate of quine in the treatment of rebellious paludal fev- ers, and even in paludal dyscrasia. Useful also combined with solid ex- tract of black willow in leucorrhea, gonorrhea, and in constipation due to torpidity of the liver. This is really the only genuine prepara- Phosphated tion of oats, differing from all others in Tincture of Oats, containing the entire amount of the glu- [Avena Sativa) coside " avena " in a given portion of the grain; it is prepared from the genuine Scotch oats, and before being tinctured and ozonized, is made to undergo acetous fermentation, so as to evolve its entire phos- phatic elements; this mode of preparation gives it a strong acid reaction, and holds in it unimpaired, and in a concentrated form, the avena or phosphates. This preparation retains the full amount of nitrogen of the grain, which is the best criterion of its quality. In this form, it is the most nutritious of all agents prepared from the cereals, being strength-giving and sustaining, as well as flesh-forming, besides being the great brain and bone fertilizer. From among all cereals, oats give us the most perfect and highest stratum of brain growth and development. The amount of brain matter in this preparation excels all known com- pounds of the phosphates or hydrophosphites, and in a most assimilable form. This, the true essence of the grain, is a brain fertilizer, supplying that organ with its own constituents ; besides it has a most mar- vellous action in blood formation, stimulates the lymph canals, rebuilds, recruits tissues and forces lost in the destructive meta- morphosis of the body. Our entire nation is neurasthenic. This poverty of the nerve force, this tissue-starved nervous system is chiefly due to !39! 1392 DISEASE GERMS. mental work, to sexual excesses, to the destruction of the phosphates in our food, etc. Retarded and difficult dentition, nearly all the cerebral diseases of childhood, are due to those causes and are promptly relieved by the administration of avena. That mysterious languor, that depressing lassitude, undefin- able headache and neuralgia, wandering pains, that feeling of goneness and dyspepsia, are traceable to defective phrenal nutri- tion, and are speedily relieved and cured by the administration of avena. The immense area of nervous diseases—the brain wearing out sooner than of old, civilization being unfavorable for healthy brain growth, and the like—is untrue, for it is to the vices, the excesses of our present state, to the improved methods of adul- terating food, destroying its phosphates, which is aiding in the production of cerebral starvation, and pushing upon us an off- spring with dwarfed brains and paucity of intellect; all this can be rectified by the use of " avena." The decided increase of all nervous diseases is plainly trace- able in the large proportion of cases to defective cerebral nutri- tion, such as epilepsy, chorea, insomnia, brain softening. When no organic lesion exists, the use of avena is curative, because it is reconstructive. The phosphated tincture of oats is a direct stimulant, perma- nent tonic to the sexual appetite at the base of the brain, increases virile power, and more too, its use promptly replaces the drained- off nervo-vital fluid upon which the brain rests (which is frequently exhausted by great mental effort or sexual excesses), it is the antidote to that terrible base of the brain pain, peculiar to libertines. A tissue-starved brain gives rise in all cases to nervous bank- ruptcy, to depravity eccentricities, suicidal mania, crime, mastur- bation, the creation of habits. It is doubtful whether or not all vice, immorality, or crookedness of life, may not be due to a condition of tissue-starved brains; all our nation needs the use of avena sativa. This preparation, being a reliable brain food, may be presented in paralysis, epilepsy, chorea, nerve exhaustion, insomnia, cephalalgia, in the alcohol, chloral and morphia habits, with the best results. The tincture, or fluid extract, prepared from the freshly crushed oats, is not nearly so active a brain fertilizer as that prepared by permitting the grain to undergo acetous fermentation. All who have been disappointed in the use of the remedy should try the phosphated tincture. BACTERICIDES. 1393 All varieties are ger- Plantain. micidal. This property resides in all parts of the plant. The fresh leaves applied to wounds, ulcers, buboes, germinal swell- ings, by their anti-bacterial, antiseptic properties, discuss or heal them. A saturated tincture destroys the ordinary microbe in the mouth, and thus relieves toothache. It is prescribed internally in incipient phthisis, bronchitis, leucorrhcea and hemorrhages, but its action is too feeble to be of much efficacy. The seeds of the plantago ispaghula, two drachms to the dose, taken in an uncomminuted form, in a little jelly, passing through the intestinal tract, de- stroy the bacteria and sarcinae of intes- tinal catarrh, and heal ulcerations. One of the best and most powerful of the Pomegranate, vegetable germicides and parasiticides, much cultivated in warm climates for its fruit and bark of the root. In its wild state it is a thorny bush; when cultivated it is a low tree with twiggy branches. The fruit is as large as an orange, with a thick leathery rind of a golden yellow color, with a rosy tinge on one side. The fruit consists of in- numerable berries densely packed to- gether in the orange-sized globe, the juice of which is highly germicidal, pressed with hot water forms a cooling antiseptic, a decoction of which is of the greatest efficacy when the oidium Section of the fruit of the albicans is evolved or deposited on the Pomegranate. fauces or tonsils, or the bacterial mala- rial germ of dysentery. The bark of the root is used as an anthelmintic in tape worm. A decoction four ounces of the pulverized bark to one pint of boiling water, reduced to one-half pint. Very efficacious taken in two doses, half an hour apart; some add calomel,ten to twenty grains, to stimulate the biliary secretion. 88 Greater Plantain (Plantago major) 1394 DISEASE GERMS. Sulphate and Tannate Pelleterin.—The alkaloid pelleterin, sul- phate and tannate (the latter is usually preferred, as being most active) is administered in doses of five grains, more or less, accord- ing to the constitution of the patient, observing the precaution of a sweet-milk diet the day before, with no food the day of adminis- tration. Thirty minutes after administering the pelleterin a brisk cathartic should be given, as an ounce of the comp. tincture of jalap, and the same quantity in another half hour. The worm usually follows. Valdivine is a glucoside from the same root, equally efficacious. Another popular formula is: pulverized pomegranate red bark, half an ounce; crushed fresh pumpkin seeds, one ounce; ethereal extract male fern, one drachm; powdered ergot, half a drachm ; powdered gum arabic, two drachms; croton oil, two drops; add to the whole one pint of boiling water. Simmer down to half a pint, which is to be taken in two divided doses, one hour apart. Valdivine, a glucoside from pomegranate root bark, pump- kin seed, male fern, koussa, kanula and other taenicides. This preparation is identical with the alkaloid " pelleturin;" put in extract of gentian and capsules, ready for administration. The patient should take very little food for two days, and that little should be of a fluid nature. On the evening of the second day, he should take a purgative (castor oil is best) of sufficient strength to cause an evacuation of the bowels ; in the morning, after the castor oil given the previous evening has operated, and while still fasting, the patient should take seven or eight capsules along with a full dose of castor oil, or other purgative ; follow that with another eight capsules to another dose of castor oil. The worm generally comes away within two hours after taking the second dose of capsules. The ozoniferous properties of the buds and bark Poplar.' of this tree are too well known to require a descrip- tion. The leaf-buds are covered with a resinous exudation, which has a peculiar ozoniferous balsamic odor, with a bitter pungent taste. This exudation is highly antiseptic, is present in all species of the poplar and is most abundant in the buds. Poplar buds are as ozoniferous as turpentine, and make a most valuable tincture, liniment and ointment. The formula for the poplar ointment which is so popular is by simmering1 the leaves and buds for twenty-four hours in lard; then removing BACTERICIDES. 1395 the crisped leaves and buds and adding more, and so on till the lard becomes saturated. This is to be done over a gentle fire. To this same ointment some add poppy heads, belladonna and hen- bane leaves, and digest them for twenty-four hours. It makes an excellent anodyne ointment for irritable or painful ulcers. The poplar bark makes a very superior tonic, very valuable in indigestion and all debilitated states of the system. It has a special tonic action on the liver and kidneys and corrects their deficient action. It is one of the most serviceable remedies in the Materia Medica. The bark yields largely of sali- Popiar Buds. cm) benzoic and other antiseptics. This remedy is indicated in all states of nervous Protagon. bankruptcy. It is both in liquid and crystalline form, containing nitrogen and phosphorus. It does not differ chemically from kephaline. It is called protagon, as it was the first definitely ascertained specific constituent of brain. Dose: ten to thirty drops of the liquid, one to three grains of the crystals, after meals, every three hours. An invaluable non-alcoholic compound, contain- Prunia. ing all the tonic, vitalizing properties of the wild cherry bark, with its innate hydrocyanic acid unim- paired, and four volumes of the dioxide of hydrogen. The preparation is of great efficiency in some cases of pulmo- nary tuberculosis, being a bactericide of average power and operating most actively upon the bronchi, pneumogastric and ™ It has been found of utility in pneumonia, pulmonary tubercu- losis bronchitis and other forms of microbial affections. The average dose is a teaspoonful every three hours. One of the leading physicians of Iowa, R. Small, M D., of Decorah,in speaking of prunia says: "The compound known as prunia is the most perfect sedative and lung tonic ever intro- duced to the profession; mitigates the intensity of all pulmonary affections, and aids the action of other bactericides. 1396 DISEASE GERMS. Pulsatilla. This plant, in the form of a mother tincture, or an alcoholic extract by percolation, yields a most efficient germicide, alterative and cerebral seda- tive of considerable power. Alone or combined or alternated with the tincture of kalmia, it is most efficient in destroying the syphilitic germ in the blood, and is a remedy of great value in chronic cutaneous affections. It was first brought to the notice of the profession as a therapeutic agent to calm the re- flex centres, in uterine and genital irri- tation transmitted, which gives rise to morbid states termed hysteria, mel- ancholia. Take it all in all, it fills a gap to which the bromides do not reach. In order to illustrate the remarkable action of this drug on the genito- urinary system, a trial of two-drop doses every three hours is suggested in spermatorrhoea, metritis, epididymitis. It exerts a special influence upon the reproductive organs of both sexes, restores normal menstruation, relieves the wander- ing pains incidental to gestation, and even exceedingly useful in neuralgia of the testes. Pulsatilla. is a colorless liquid, of a peculiar odor, readily Pyriden soluble in water and of a strong alkaline reaction when in solution. It is a product of the dry distil- lation of organic substances containing nitrogen and carbon, such as coal, bones. It absorbs water rapidly on exposure to the air. This is ah invaluable remedy for inhalation in asthma and dyspepsia associated with disease of the heart. A few drops poured upon a plate, the patient with down-turned face inhales it for a few minutes. This can be repeated three or four times daily; it affords prompt relief, and continued persistently for a few weeks effects a cure. is an antipyretic drug, the active ingredient of Pyrodin which is acetyl-phenyl-hydrazin. It is in the form of a powder, sparingly soluble in cold water; having neither an unpleasant taste nor smell, causing no irritation of the stomach. When administered it acts promptly and powerfully BACTERICIDES. 1397 in reducing temperature by destroying the germ, the factor of fever; hence it is of great utility in all fevers in which a disease germ or microbe is present. It acts well in all cases, but it must be carefully watched. It neither causes nausea nor vomiting, acts quickly and more powerfully than antipyrine, antifebrine, phenacetin. _______ The leaves of this plant Raspberry, yield their medicinal pro- perties freely to water. They contain a large amount of tannin and gallic acid; a decoction, used tepid, pos- sesses in a most remarkable degree, one of the finest astringents in the Materia Medica. It is an excellent vehicle for the admin- istration of bactericides, thus: add some boroglyceride to it, it is an infallible eye lotion in all forms of ophthalmia; add a small quantity of the eucalyptus distilla- tion to it, most efficacious in gonorrhea and leucorrhea. --------- Raspberry. One of the derivatives of benzol, a germicide of Resorcin. the highest rank : a one-per-cent. solution will re- tard, and a two-per-cent. solution will arrest fer- mentation and coagulate albumen. These strengths do not irritate the skin, but stronger solutions might. Internally, five-grain doses may be readily taken three times a day in any simple vehicle; but in larger doses, say from ten to thirty, it produces a striking resemblance to the effect of • alcohol and other stimulants, quickening the pulse, causing flush- ing, giddiness, tinnitus, sweating, increasing the secretion of tears and saliva. It is an invaluable germicide, being specially inimi- cal to all microbes on the mucous membrane of the mouth, stom- ach, intestines, and bladder. If administered in aphthae, or sar- cinae ventriculi, or cholera infantum, or typhoid fever, or injected into a tubercular rectum or bladder loaded with fungus growths, it annihilates colony after colony of the germs, with a brilliant precision. By killing microbes it reduces heat. You can watch the physiological effects more plainly than of other drugs of this class. When the temperature is down, you can keep it there by re- duced doses, one or two hours apart. 1398 DISEASE GERMS. Being a valuable antiseptic, it would seem to be especially in- dicated in fevers of septic origin. It will be particularly valuable if proved clearly, as circum- stances now tend to show, that it deranges the organs of digestion less than the other antipyretics. Its great solubility renders it of intrinsic value in otorrhcea and purulent ophthalmia, nearly as active a microbe killer as the ozonized boroglyceride. In various skin affections, put up in ozone ointment, or oil of boroglyceride, it gives great satisfaction, being more energetic than the best mercurial preparations. Gelatinized bougies of resorcin and boroglyceride will kill the gonococcus of gonorrhea, and one of them introduced into the uterus in a chronic case of intra-uterine catarrh, will effect in a few minutes what years of treatment could not effect. Most gratifying results can be relied on in cholera infantum and typhoid fever, and in ophthalmic and aural cases ; but its great anti-microbe properties fail before the giant germ of syphilis. The doses of resorcin may vary from ten to fifteen grains a day in light attacks, up to seventy-five grains as a maximum. It should be dissolved in about twenty parts of water or any other excipient, for which orange syrups, glycerine, brandy, etc., are suitable. It will also form good emulsions with almond, etc., or may be given in wafers. Used as a cleansing agent, it produces neither rust, nor does it affect the edges of knives. The odor of iodoform is almost entirely destroyed by it. Resorcin is used with much success in the treatment of epithe- lioma, and other cancerous diseases. Mix resorcin and ozone ointment in equal parts, and use locally to the diseased part, after a day or two, apply a milder ointment of two parts of re- sorcin and three parts ozone ointment. After the eschar is formed, then clean and dust over with iodoform; boric acid, equal parts. Dress the wound with an ointment, one part resor- cin to ten parts ozone ointment. Resorcin rubbed up in ozone ointment, by its reducing or withdrawing oxygen power, applied in eczema, coagulates the serum and produces a firm germicidal covering, under which a rapid healing takes place. Thio-Resorcin is a combination of sulphur with resorcin, in the form of a powder, without smell and entirely non-poisonous. It is used as a substitute for iodoform, and usually applied as a dusting powder and often made into an ointment with ung. petro- leum of the strength of from ten to twenty per cent., for eczema, psoriasis, scabies, and other vegetable or parasitical skin diseases. BACTERICIDES !399. For barber s itch, etc.—Resorsin, one drachm ; glycerine, water, of each one ounce; lac sulphur, one and a half ounces ; cologne, a half ounce; alcohol, four ounces. Mix. Apply to the af- fected parts several times a day, using a soft sponge. Bath the parts every morning in hot water. Ether, half ounce, to dis- solve the sulphur before adding the latter, makes the prescription more pleasant to use. Reduced by the most careful trituration and sifting to an im- palpable powder, it is highly recommended by the most eminent dermatologists as superior to any other germicide in eczema or irritation of the skin. It is insoluble in water and very sparingly soluble in ether or alcohol. Rhigolene.—This is the impure hydride of amyl, and is the lightest fluid of the petroleum series, and is well adapted for pro- ducing local anesthesia, and its bactericide properties render it very useful as a local application wherever a germicide is indi- cated. in incontinence of urine has passed into Rhus Aromatica household words. In Europe the medi- cament is becoming a well-known agent in the treatment of this affection, and its greatest success is in children. A great deal of trashy stuff is put on the market and sold under this name. When made of the recent article the medicament is well-nigh specific in enuresis and diabetes insipi- dus. It is also a grand heart tonic and valuable in chronic cystitis of old men who suffer from enlarged prostate and chronic catarrh of the bladder. Rhus tox. in incontinence of urine is said by Dr. J. H. Moon, M. D., of Montpelier, Idaho, to be a reliable medicine. He gives several cases of this disease cured with the remedy. In a simple uncomplicated case the following was prescribed: Rhus tox. three drachms; glycerine, two ounces; water, q. s. ad four ounces. Mix. Teaspoonful four times a day. Iron was given for the anaemia. The rhus and iron treatment was continued three months, a complete cure was effected. Rhus tox. is also a very valuable medicament in cases when patients (mostly women) complain of the urine scalding the urethra and meatus. It is often a really curative medicament in the severe back ache some women are so much tormented with. 1400 DISEASE GERMS. one of the oldest germicides, was Rue, held in high favor as a great ozone liberator, and preventive to contagion. It is also a tonic, diuretic, laxa- tive and vermifuge, but its real intrinsic value in fluid extract, decoction, essential oil, or emulsion is as a bactericide; it kills the oidium albicans, neutralizes, or checks the chemical action of the ptomaines in cholera infantum. A decoction, sweetened for children, cleanses the entire intestinal tract of mi- crobes, thus wards off convulsions or fits, epilepsy due to reflex irritation. Rue Graveoius. Although but a simple herb it is a valu- able stimulant and antispasmodic. Still it must not be administered in large doses, as it produces gastro- intestinal irritation, cerebral derangement, and acts energetically on the uterus. A sweetening substance two Saccharin, hundred and eighty times [Sulphinide of Benzoic Acid) greater than cane sugar. A white crystalline powder solu- ble in two hundred and thirty parts of water, but very soluble in alcohol or ether. It has a faint odor of bitter almonds, which is more perceptible on heating. Chemically and physiologically totally different from cane sugar, being a powerful bactericide and unfernlentable. It is indigestible, inert, non-toxical; passes out by the urine unchanged. Its chemical reaction is that of a weak acid. In diabetes, where cane sugar, starch and other products feed the glucose fungus, it may afford the patient sweet nutriment, but in all other respects, that is as a dietary and medicinal agent, it is worthless. The eminent T. H. Goodman, M. D., of East Saginaw, Michigan, says on this subject: " Saccharin i.s not a food in any sense ; but it is recognized that there are many circumstances under which it is necessaryto have a sweetening agent to take the place of sugar. As to the non- toxic nature of saccharin the experimenters have no doubt, since their experiments confirm those of reliable investigators on the Continent. Saccharin has decided antiseptic properties, and in sufficient quantities is capable of stopping the action of organ- BACTERICIDES I4OI ized ferments. As regards its extra-corporeal action on the solu- ble ferments, as regards the peptic digestion of fibrin 0.1 per cent, of saccharin has no retarding influence, while 0.25 per cent. slows the process decidedly, and 1 per cent, greatly retards it; 0.1 per cent, of saccharin is equivalent to 30 per cent, of sugar, which may be said to be a dietetic impossibility. The diastastic solution of starch is not hindered by two per cent, of saccharin. The addition of saccharin to urine hinders ammoniacal fermenta- tion, as does ingestion of saccharin." As regards the intra-corporeal action of saccharin, it was found that a gramme of the substance, equal to more than eight ounces of sugar, did not interfere in the least with the gastric digestion of the dog. The article used in the experiments was " soluble saccharin," equal to about nine-tenths its weight of pure sac- charin. In is as soluble in water as table salt, and when properly diluted is scarcely to be distinguished from cane sugar. Dr. Goodman concludes that (1) saccharin is quite innocuous when taken in ordinary dietary; (2) it does not interfere with nor im- pede the digestive processes when taken in any practicable quantity; (3) it may be taken during an extended period without interfering with the digestive and other bodily functions. There is, then, no reason to think that its continual use may be in any way harmful. Dose : Thirty to seventy-five grains in water every three hours. The syrup is thus made : Dissolve ten parts saccharin, twelve bicarbonate soda in one thousand parts of water, at a tempera- ture of 8o° Fahr. Useful in diabetes. The compound, as is well known, consists of 40 per Salol. cent, carbolic and 60 per cent, salicylic acid, and is decomposed into its components by the action of the pancreatic ferment. This is a germicide of immense potency. It is a white crys- talline coarse powder, rather like damp table salt. The odor is very marked, and is identical with that of glycerite of winter- green, which is chiefly salicylate of methyl. When taken into the mouth a fainter impression of the smell is received on the palate, and the taste of carbolic acid is just suggested. The internal administration of salol is certainly devoid of many of the objections that may justly be urged against the salicylic acid. It is well borne by the stomach, is tasteless and devoid oi odor, readily administered in water, and but seldom gives rise to the troublesome tinnitus that constitutes one of the drawbacks to salicylic acid. 1402 DISEASE GERMS. It is eliminated from the body very largely by the kidneys, the urine assuming, however, the characteristic appearance and reaction of carbolic acid urines, being dark green or almost black in color. Its reaction remains acid, it is free from albumen, and it deposits no sediment. The characteristic alteration in the color of the urine is manifest after a single dose of ten grains, and persists for a long time, so that when salol has been given for some time, the color of the urine remains black five days or more after the remedy has been discontinued, showing that it accumulates in the system and is eliminated very slowly. The salicylic acid of its composition appears first as salicylic acid, the carbolic acid being responsible for the changed color of this fluid. The advantages which are claimed for salol over salicylate of soda, for which it is prepared as a substitute, are dependent first of all on its insolubility in water and the juices of the stomach, and secondly on the ease and completeness with .which it is de- composed after passing the pylorus. Being insoluble in water, it is free from the repellant and nauseating effects of salicylate of soda, which some patients find so objectionable that even syncope has sometimes supervened on ingestion. Passing through the stomach unaltered, it undergoes decomposition in the duodenum, where it comes into contact with the pancreatic juice and is broken up into salicylic acid and phenol. Salol can be used with good effects in all rheumatic affections, in chronic urticaria, in sub-orbital neuralgia, as an antipyretic, in diabetes, in intestinal catarrh, in typhoid fever, in cholera, against intestinal parasites, in catarrh of the bladder, in ozaena, in otorrhea, as a local application in gonorrhea, and as a mouth wash. It is insoluble in the gastric juices, and consequently better borne by weak or irritable stomachs; its soiubility is obtained by the action of the pancreatic secretion, and hence its more pronounced local effects upon the intestinal tract, chiefly upon the duodenum. The buzzing and ringing of the ears, produced by salicylic acid and salicylate of soda, are hardly noticeable with the use of salol. In articular rheumatism it allays both fever and pains better than the respective amount of salicylic acid that it contains. In neuralgia it succeeds fully as well as salicylic acid. Salol will kill the cholera bacillus, and thus prevent the for- mation of a poisonous ptomaine. The ordinary dose is five grains every hour, and decrease in frequency as an improvement takes place. BACTERICIDES. 1403 in uric acid diathesis is to be considered, Salicylate of Soda and often is prompt in bringing about a cure. Many cases of persistent pruritus, resisting all other approved treatment, yield to ten grain doses of salicylate of soda, and repeated every two to four hours. These are cases in which uric acid abounds in the urine, and often there are manifested other nervous symptoms. The excellence of this medicament in sick headache is now well known. The fact of most of these cases being complicated with uric acid in excess, or rather the former, may be taken as resulting from the latter. It will be found a valuable remedy, administered in decoction of black cohosh in many cases of chronic rheumatism, uric acid in marked excess in the urine in many of these cases. Recently a case of dry pleurisy came under my care, the urine contained much uric acid. Salicylate of soda, ten grains, dissolved in ammonia acetate, one and one-half drachms, and repeated every two hours. The pain was relieved completely in six hours. Before the second dose was taken, marked relief of pain was obtained. In acute tonsillitis, ten-grain doses of salicylate, repeated every hour, are almost sure to give rapid relief to all the acute symp- toms in a few hours, and a cure promptly brought about. Added to the liquor ammonia acetatis it is a most effective remedy to sterilize and destroy the bacillus amylobacta, the microbe of rheumatism, and protect the heart from the ravages of the micro-organism. Valuable in diphtheria to sterilize the germs in the throat. is a crystalline substance, neutral in reaction, Santonin obtainable from the unexpanded flower-heads of certain species of artemisia. The flower-heads, which can, at first sight, hardly be distinguished from seeds, have a strong odor and bitter taste. To obtain santonin, these are bruised and boiled for a time with water and lime. To this fluid hydrochloric acid is added till the whole becomes curd, when it is set aside for the santonin to subside. The precipitate is weil washed and otherwise purified till it is brilliantly white and crystalline. It must be kept away from the light. The crystals have but little taste and no smell, insoluble in cold water but soluble and subliming with a moderate heat. These brilliantly white crystals become yellow by exposure to light. Nitric acid converts it into succinic acid Santonin if given in any quantity, colors the field of vision yellow, so that the patient sees everything of that color. Some- times green takes its place. 1404 DISEASE GERMS. Being tasteless, energetic in the destruction of the round worm, it is easily and readily taken by children. The crystals in trituration with sugar and milk. Lozenges and a glycerite are most eligible forms. Dose: one to two grains. is the product of a tree growing in India and Sandal Wood Ceylon, and also in the South Sea Islands. It occurs in billets of a dark brown color externally ; internally the rings are well marked. The powder is blood red, and has a slightly astringent taste. It is mainly used for the coloring matter, which may be extracted by alcohol or ether, and by alkaline solutions. It is sandal wood which gives the red color to the compound tincture of lavender and to Fowler's solution of arsenic. An oil of sandal wood has recently come into use as a remedy for gonorrhea. Fifteen or twenty drops are usually given for a dose: but a good many people it does not suit; many cases are not benefited by it. In all instances it gives rise to a good deal of pain. Often it is very effectual. The mistura santal comp., highly ozonized, a combination of pure sandal oil, oil of cubebs, copaiba, kava kava, terebene, with tincture of hyoscyamus, with peroxide of hydrogen. A useful, reliable preparation for the destruction of the gonococcus. It forms, when diluted, an elegant and pleasant mixture, which does not interfere with the digestive organs, and may be given without producing the offensive eructations which follow the administration of copaiba. Its use is especially indicated in the advanced stages of gonor- rhea, and in protracted or chronic gleet, though it may be given with equally good effect in the earlier symptoms, unless contra- indicated by an inflammatory condition. If given as soon as possible after the appearance of the dis- charge, the effect is usually most gratifying both to patient and doctor. The discharge disappears, the scalding ceases, and by continuing the medicine, with attention to collateral treatment, a cure may generally be effected in from two to five days. This remedy has been in use Saponaria Officinalis, throughout Europe and America as [Soap- Wort) a bactericide, chiefly for killing the venereal bacillus, and parasite affec- tions of the skin. It is nearly as powerful a remedy as comp. saxifraga and phytolacca. BACTERICIDES. 1405 For its alterative and germicidal properties, best given as a decoction, or in the form of a fluid extract. It does kill the gonococcus by slow degrees, in about two weeks. Saponin,'a proximate principle obtained from the root in large quantities, is extremely poisonous; although a glucoside, it unites with acids and forms crystals. A germicide and parasiticide, belonging to the Savin, cypress section of the fir family, has an extended sphere of action, both externally and internally. A cerate prepared in the usual manner is most efficacious in tinea capitis; applied to indolent gangrenous ulcers, destroys the microbes present, and they heal promptly, the savin cerate being equally germicidal to ichthyol. It is all efficient as a lotion, fomentation or powder. The fluid extract internally adminis- tered in small doses, frequently repeated, annihilates the microbe of rheumatism ; rouses up the dormant functions of the torpid liver. In cases of tape-worm, the oil, with a little chloroform added, rubbed over the abdomen for a few minutes, by endos- mosis so paralyzes the parasite that it is expelled. Its action on the uterus is that of a drastic stimulant. The berries contain diuretic, sedative, Saw Palmetto. nutritive, and gland-stimulant properties; _ [Sabal Serrulata) and in the form of a fluid extract are in- valuable, and have a special and decided action upon the glands of the reproductive organs, as the mammae, ovaries, prostate, testes, etc. Its action is that of a great vitalizer, tending to increase their activity, to promote their secreting faculty, and add greatly to their size. . It is specially indicated in all cases of wasting of the testes, such as follows varicocele, or is induced by masturbation, or which is often present in sexual impotency. In atrophy of the prostate, so very common in cases of sexual perversion, this drug operates in a most remarkable manner, in overcoming the withered, blighted state of the gland; so*in 1406 DISEASE GERMS. uterine atropy dependent upon ovarian blight, its action is unex- celled. In gynecological practice it is much used to promote the growth of the mammae. But it is on the prostate gland that this remedy exercises its best effects. Great medical authority states, that when " the hair becomes gray and scanty .... the prostate gland be- comes increased in size," and this, irrespective of age. Nine men out of every ten have enlarged prostate, and one atrophy, ages varying from thirty-five to seventy-five, respectively, the result either of early indiscretion, as masturbation, or excess, or perver- sion of the sexual act, or sedentary habits, or from improperly cured gonorrhea. The prostate is Composed of two lobes and a median portion. Sometimes one portion or all may be enlarged ; the part affected influences the function of micturition, whether it be wasted or enlarged. A patient may have enlargement as great as a small cocoanut, and no obstruction to micturition, provided the. median portion is only but slightly enlarged. A man with prostatic trouble has always impaired sexual power, verging on partial or complete impotency, with wasting testes ; with urinary trouble, either a frequency, or a dribbling, a lack of power of propulsion. The dribbling, or lack of power of retention is altogether different from stricture, for in the latter the power is good, strong; although it maybe as fine as a thread, or split, or twisted like a cork-screw. Prostatic disease, acting reflexly on the brain, gives rise to in- numerable cerebral affections. Indicated in syphilis, cancer and tuberculosis; Saxifraga. one of the most powerful vegetable alteratives known to medical science; stands in the front rank of therapeutics as a great vegetable germicide. It would be impossible to successfully combat syphilis, cancer and tuber- culosis without this remedy. Saxifraga, Comp. Oz.—This preparation is purely vegetable, composed of the active principles of saxifraga, blue flag, tag alder, dulcamara, kalmia, corydalis, phytolacca and yellow parilla, prepared by a process of distillation and highly ozonized, after which five grains of iodide of potass and five grains of chlorate of carbon are added to each drachm. The preparation is en- dorsed by the entire medical profession, as the best of all altera- tives. It is not only the best of alteratives, but a potent germicide' when it enters the human blood. It annihilates all disease germs, BACTERICIDES. I407 sterilizes their micrococci and thus cleanses germ-laden blood, while it has the faculty of stimulating the springs of life, the vital elements of nutrition in aiding in the formation of pure and more vitalized blood. It is a true blood scavenger and tonic, strength- ening the system in a remarkable degree. It has a special faculty when it enters the blood, lymph canals and pink marrow of destroying the microbes of cancer and syph- ilis and the bacilli of tubercle. It completely supplants the use of mercury, antimony, arsenic, the iodides and other deleterious mineral agents in the removal of morbid action, destruction of myriads of germs which are always present in chronic maladies. As a great blood purifier and germicide, (the most efficacious in the whole range of therapeutics), it acts as a stimulant to the skin, liver, kidneys and every gland in the body. Dose : One teaspoonful every three hours. As a remedy to sterilize all disease germs or Skullcap, microbes, this one is too much neglected by the profession, especially in the treatment of all ner- vous diseases. It is a remedy of rare value, being a tonic, diuretic, anti- spasmodic. It has been used chiefly in convulsions, chorea, epilepsy, dys- menorrhcea and debility. It allays all irritation of the nerve centres, im- parts tone and quiets cerebral ex- citement. It is esteemed as our best remedy in hydrophobia. In this disease, to be effectual, it must be given in large doses until it produces a sort of paralysis or suspension, and if this is effected the germ dies or is sterilized. The remedy has also the same effect on the vibrios of nervous disease. It yields its properties freely to water, and in the form of an infusion it should be drunk freely, until there is a feeling of pins and needles ex- perienced over the entire body. 1408 DISEASE GERMS. Senega Root Polygala Vulgaris oxide pound reputation in all renal diseases aris- ing from defective assimilation and an excess of uric acid. Physicians using it should see that they have the genuine ozonized. is a famous germicide, possesses important medicinal properties, being a stimulant, diuretic, diaphoretic, and in large doses emetic and purgative. Its administration in catarrh, bronchitis, rheumatism, has a most sterilizing effect upon the germs of those respective ma- ladies. Even the mycelia of hooping- cough are thoroughly paralyzed in its presence. The following for- mula is effective : Syrup senega, syrup of tolu, of each one ounce; resorcin, half an ounce. Mix. Dose, from a half to one teaspoonful every two hours. A most wonderful remedy in the cure of diabetes, Bright's dis- ease, cystitis, sciatica, gout, rheu- matism, dropsy, neuralgia and carditis is the ozonized uric acid solvent. The addition of pichi and di- of hydrogen to the corn- has given it a world-wide Virginia snake Serpentaria. root is a stimu- lant tonic, acting also as a diaphoretic and diuretic. On'account of its peculiar stimulat- ing action on the skin, its use is extremely beneficial in all forms of eruptive fevers ; it has the peculiar faculty of driving all the micro- organisms of those fevers to the surface, thus relieving cerebral and visceral congestion. Of great effi- cacy when the kidneys are blocked up by solid bodies, as the urates ' Virginia Snake Root. or triple phosphates. It BACTERICIDES. I409 promptly relieves that sensation of weight and dragging in the loins, fulness in the chest, difficult respiration incidental to nephritic congestion. It augments vital force, increases the power of vital resistance. The comp. tincture and fluid extract are the most eligible forms for administration. Undoubtedly the most powerful Siegesbeckia Orientalis. and valuable of all vegetable germi- cides. Administered internally or applied locally, it either completely annihilates or sterilizes all micro-organisms. For internal administration, a syrup is pre- pared by pounding the green plant, adding sugar and straining, or by adding one drachm of the tincture to two ounces of simple syrup. This is the best form for prescribing in syphilis and cancer, and in cases where any microbes inhabit the human blood. It acts most efficiently upon the syphilitic germ, even exceeding in its germicidal ac- tion bichloride of mercury, iodide potass., saxifraga, kalmia, etc. As a spinal stimulant it ex- cels nux vomica, ignatia, rhus; hence its value in aphasia, stam- mering, and in incontinence of urine or irritable bladder. As a local remedy to ulcers or sores, syphilitic, gangrenous, it promptly destroys the germs present, then stimulates rapid cicatrization. A very small quantity of the tincture'added to a jelly, pre- pared from glycerine of starch, destroys the oidium aphthae and sore nipples. The tincture is a valuable cure, locally, for all forms of tinea, and can be prescribed with invariable success. Apply it in ring-worm, tinea circinata, tinea sycosis (tinea ton- surans), tinea versicolor, typical, well-marked cases, even of the mpst aggravated form in broken-down subjects; the result is marvellous in the extreme. The drug acts as a stimulant and a parasiticide, and the mode of cure, after it is applied, is that the diseased patch becomes broken up into a series of small patches, with sound skin intervening. Then the re-application of the drug causes it to break up into still smaller pieces, when it dis- 89 Siegesbeckia.—The great vegetable Bactericide. 1410 DISEASE GERMS appears altogether, and in their place a small red blush. This only remains for a day or two, and the most stubborn case is thus cured. The prescription in all forms, even the most aggravated and stubborn, is: equal parts of the tincture of siegesbeckia and glycerine, well rubbed into the affected area morning and night. At present it is a high-priced drug, but the dose is small, and its use, if indicated, brings colossal results. The learned leading physicians of Canada are adopting the germ theory of disease with great avidity. Dr. Cannon, of Sharbot Lake, is pushing bactericides with great energy in his extensive practice. In one of his recent essays, he says : " The siegesbeckia orientalis in typhoid has not received the attention it merits. The time has arrived to lay before the pro- fession the results of an experience in its use extending over two years, comprising a series of seventy-nine cases. The general management of all those cases was: the patient was confined to bed in the recumbent posture, in a well venti- lated room, rigid hygiene, and every effort made to maintain the nutrition of the patient by fresh milk alternated with beef tea, etc. In the entire number of cases, no matter what time I was called, I ordered one-drop dose of a saturated tincture of sieges- beckia orientalis in a tablespoonful of water in which a teaspoon- ful of the syrup of orange peel had been dissolved. The good effect of the remedy was immediate; the pulse slowed, tempera- ture fell, tongue cleaned, diarrhea ceased, and the general condi- tion of all the patients improved so much that, as a rule, all anxiety as to the future of the cases was at an end, as they all proceeded to speedy recovery. What induced me to try this drug in typhoid fever was that, in my experiments in the cultivation of the typhoid bacilli and the effect produced upon the micro-organisms when the sieges- beckia tincture was introduced into the cultivating media, perfect annihilation of microbe growth took place. So internally in typhoid. Another reason was, I had applied this tincture in gangrenous ulcers (oidium albicans) with most marvellous results, and had demonstrated most clearly the destruction of the germs and the establishment of healthy, healing action, so I obtained similar results upon the germ-eaten bowels, so much so that I noted over half the cases were aborted on the second week. My seventy-five cases were treated all alike, the prevailing idea being to destroy the germ, and heal the ulcers on the bowels; just as BACTERICIDES. 14II this great vegetable germicide was administered, so febrile dis- turbance ceased. This remedy owes its antipyretic action directly to its germi- cidal power, to its power over the germ before destroying it— that the germ being destroyed, no ulcers form on the intestines; recovery from the fever is certain provided no accidental or adventitious cause arises." This is a strong bactericide, non-poison- Silico-Fluoride ous, unirritating to the tissues, inodorous, of Soda. non-volatile, non-corrosive, and not de- stroyed by oxidation. ' This remedy is very useful for washing out the peritoneal cavity after laparotomy, here using ten grains to the pint; in cases of strangulated hernia ; in the radical cure for hernia; in excision of joints ; in amputation of the arm, leg, and thigh ; in washing out the pleural cavity; in the removal of tumors; in excision of veins ; in ligature of blood vessels; in compound fractures ; in osteotomies ; in washing out the bladder ; in wash- ing out the uterus after curetting the interior, and after the re- moval of septic retained membranes ; as a vaginal douche before and after Apostoli's operation for fibroid ; in the irrigation of ex- tensive ulceration in the rectum, where a poisonous antiseptic could not have been employed ; in washing out the stomach ; as an injection in gonorrhea (ten grains to the pint); as an injec- tion in otorrhcea; in syringing out large pelvic abscesses; as a gargle in hospital and in diphtheritic sore throat; as a nasal douche after removing polypi; for syringing out empyema of antrum ; and in many other cases. an invaluable ozonized compound, composed Simabicidia, of cedron seed, coto bark, Jamaica dogwood, manaca, tonga and black cohosh, a specific for neuralgia. These remedies are a special combination of peculiar efficacy and highly germicidal. The preparation was first intro- duced by us, and on submitting it to the profession, it was found to possess extraordinary power in relieving neuralgic pain. Neu- ralgia is caused by the presence of living microbes in the blood, impoverishing the nerves. The theory of pain, caused by mi- crobes, or their poisons, was anaemia. Cedron seeds have obtained quite a reputation in the treat- ment of snake bites and other venomous reptiles. They are of undoubted utility in headaches and neuralgias due to the pres- 1412 DISEASE GERMS. ence of sewer gas, foul emanations, or microbe-laden atmo- spheres. A tincture or fluid extract of the coarsely ground seeds may be used, but for general use the simabicidia answers the purpose best. There is still another explanation which on many grounds has recommended itself, as accounting more satisfactorily for the phenomena observed, both to chemists and biologists. It is that the injurious effects produced by microbes on special nerves are due, not to what they take or to what they excrete, but to what they leave, and this is closely associated with the imperious de- mand they make for oxygen. Being in many instances anacrotic —that is, living and multiplying without direct exposure to air—they must obtain the oxygen they require for the process of life from the tissues by which they are surrounded; but when oxygen is withdrawn from such complex chemical compounds as those of which our bodies are constructed, the elements enter into new combinations, and then, under the name of ptomaines, are believed to be the really poisonous agents. Attempts have been made to isolate these com- pounds ; and it has been shown that they are of the nature of alkaloids, and resemble, both in their constitution and in their effects, those deadly poisons that may be extracted from digitalis, conium, tobacco, delphinum, and other noxious plants, and that it is its action upon those poisons, in neutralizing or antidoting them, that is effectual and invaluable in all nerve pain. Dose : From half to one teaspoonful in water, three times a day. Relief generally follows the third or fourth dose. No ill effects from larger doses. Seeds of Simaba Cedron. Quarter natural size. This drug has been highly extolled as a remedy Simulo. to sterilize the microbe of neurasthenia and epilepsy. In the estimation of one of our best and most suc- cessful physicians in the treatment and cure of nervous diseases, Thomas L. Barnes, M. D., of Jamestown, N. Y., simulo is entirely worthless. The learned Doctor has tried this much-lauded remedy, and in no single instance does it control any, nay, even the mildest epileptic seizures. BACTERICIDES. HI3 Solidago. [Sweet-Scented Golden Root) A germicide, aromatic, stimu- lant. An infusion of the herb, administered warm, is an excel- lent diaphoretic and carminative; a fluid extract is valuable to cover the taste of nauseous drugs. Its medicinal properties depend entirely upon the presence of a volatile oil which contains all the bactericide properties. It is of great utility to sterilize or destroy all micro-organisms in the alimentary canal; by doing this it relieves pain in the stomach and bowels, flatulence. It is also of great value for inhaling in all microbial diseases of the respiratory organs. Dose : From two to five drops, triturated with sugar, or cut with alcohol, every three minutes, until relief is experienced. A bitter, astringent tonic, sudorific, diuretic, Speedwell, expectorant, nerve stimulant. Employed in some (Veronica) countries as a substitute for tea, makes a pleasant beverage, restores the functions of the digestive organs, strengthens the mental and physical powers. Adminis- tered with great benefit in all cases of depression or over fatigue or exertion, it entirely wipes out that feeling of exhaustion and is unquestionably one of the most powerful tonics to the muscu- lar system that we possess. The remedy can be specially re- commended to medi- cal men and nurses, and all who require to keep awake and be on the alert, and Speedwell (Veronica). enabling them to do a vast amount of work with ease. Although of great efficacy in combating fatigue and drowsiness, no antidotal properties are claimed for it in any of the habits. 1414 DISEASE GERMS. Solanin. A glucoside derived from the leaves and berries of the solanum nigrum and other plants. It has an acrid, nauseous taste ; is insoluble in water, but freely soluble in ether or alcohol. It has a powerful germi- cidal action upon all the fluids and solids of the body, has an anesthetic action upon the base of the brain, influencing chiefly the pulmonary plexus, and diminishing the sensibility of the bronchial mucous mem- brane. Its peculiar action upon the respira- tory centre of the brain causes it to slow the pulse, diminish respirations and lower temperature. In large doses it is an irritant and paraly- zer; in small doses it is of the greatest efficacy in destroying the micro-organisms of hooping-cough, bronchitis, carditis, asthma, emphysema, rheumatism, gout, sciatica and cystitis. By its peculiar seda- tive action on the pneumogastric, it relieves Administered in doses of a quarter to one For subcutaneous injection the hydrochlo- Common or Black Nightshade. (Solanum nigrum.) gastralgia, vertigo. grain thrice daily. rate of solanin is used in an aqueous solution. is closely allied Spikenard to the valerian family, but has a much stronger odor and is more powerfully germicide. Simmering the sliced roots in oil or vaseline makes an embro- cation of the greatest utility in the successful cure of old fetid ulcers. It is an old remedy, but one of great value, and likely to regain its place in modern therapeutics. •A tincture is the most eligible form for exhibition; being a good nerve stimulant, it affords almost instant relief in innumerable painful affections. BACTERICIDES. 1415 consists of the bulb of the sea onion [Urginea scilla Squill or Scilla maratimd) sliced and dried. It grows along the shores of the Mediterranean, partly in the water. The bulb is pear-shaped, and often of considerable size. It is covered with brown scales overlapping like those of the lily. The outer ones are membranous, the inner white and fleshy, these being cut across. Squill is commonly seen in small white pieces, consisting of transverse sections of those scales. Squill has a bitter taste and not easily powdered until well dried; in that state they may easily be converted into powder, but if allowed, the powder speedily absorbs moisture from the atmo- sphere, so that the powder becomes a solid adherent mass. Squill seems to owe its efficacy to a resinous substance, which is not, however, separated for use. Its pre- parations are, vinegar of squill, oxymel of squill, made by mixing squill vinegar with honey, a syrup and a tincture. It is a bactericide of no mean order, and as it yields its properties to acetic acid dilute, we have the advantage of two germicides in one. It is also an excellent remedy to facili- tate expectoration, and for rousing up the action of the kidneys, and to promote the absorption of fluids; hence its value in dropsy. As an expec- torant, use it alone, or combined with syrup of tolu, senega, wild cherry, ipecac. It is one of our best remedies in stubborn dropsical cases in alternation with strophanthus. Common broom, which grows so Sulphate of Sparteine, abundantly in the temperate lati- tudes of Europe, yields by decoction and alcoholic extract an invaluable cardiac tonic and vitalizer. This property resides in the whole plant, leaves, stem and flowers, but specially in the young tops and seeds. Besides its decided action on the muscular structure of the heart, it is an efficient diuretic and laxative. These are the ordinary properties of the scoparius, but the alkaloid is sulphate of sparteine, which is obtained freely from 1416 DISEASE GERMS. the tops, takes its place in the front rank as a most extraordinary heart tonic. The constant physiological and therapeutic effect of this drug is to strengthen the heart's action, improve its pulsations, increase its growth. The sulphate of sparteine is most effective administered hypo- dermically in the morphia and other habits ; the injection should be given when the craving comes on. Invaluable in asthma. The fluid extract, in small doses, exerts a favorable action upon the reproductive organs of both sexes. It quiets irritation of the testes, strengthens their secreting faculty, lessens irritation of the piostate-urethra, arrests leakages; often of utility in catarrh of the bladder. An ointment, made by digesting over a vapor bath for twenty- four hours, three parts of stavesacre seeds, in powder, with five parts of vaseline, and then straining, may be used for the destruc- tion of all cutaneous parasites. It is most effectual when applied in destroying the entire crop of parasites present, what- ever they may be. BACTERICIDES. 1417 The alkaloid principle, delphinine, is extremely acrid; but administered in small doses it is often effectual in overcoming paralysis caused by the action of the lactic acid of rheumatism or general nervous prostration. A microbicide of some power. Its Stillingia Sylvatica. bactericide properties are present only [Queen's Root) in the oil, which is very volatile, hence there is none in our fluid extracts if made by heat or compression. Alcohol extracts this oil. All comp. syrups of stillingia are entirely worthless when made with fluid extracts. Alcoholic syrups made by re-percola- tion contain the oil in great abundance. The use of this syrup kills the bacillus of tubercle, cancer, syphilis ; besides it is a general alterative, tonic, diuretic. The stillingia is worthless if the oil is extracted. The compound syrup, which consists of stillingia, corydalis, phytolacca, iris versicolor, prickly-ash, chimaphila, umbellata, and cardamom seed, made by maceration, is a powerful and effi- cient alterative. The oil of stillingia, dissolved in alcohol, is invaluable as a liniment in or over joints loaded with the bacillus amylobacta. This invaluable remedy has a wide Virginia Stone Crop, range of action, and can be used with marvellous efficacy in a large number of diseases, but specially in nervous affections, morbid states of the alimentary canal, and in genito-urinary affections. It stands pre-eminent and alone as a great rectal tonic and vitalizer ; operates exceedingly well in all feeble or relaxed condi- tions, as catarrh, prolapsus, spasmodic and refractory states of the sphincter ani, and in neuralgia; of great utility in ulceration of the rectum and piles. Ascarides are effectually destroyed with it in the form of an injection. No remedy can excel this in all diseases of the genito-urinary organs of both sexes; it operates like a charm in relieving irri- table bladder and prostate ; has a most beneficial action in pros- tatorrhea, checks all leakages, or any o6zing, even the exudation of chronic gonorrhea or gleet; in the female, its use cures leu- corrhea, dysmenorrhea, and that neurosis, termed vaginismus, spasm of the sphincter muscle of the vagina, and uterine neu- ralgia. . . It exercises a most extraordinary sedative action on the kid- 1418 DISEASE GERMS. neys and bladder; of great efficacy in the expulsion of calculi; in acute and chronic cystitis; in vesical tenesmus, and in incon- tinence of urine of all ages. It is of great value in dyspepsia, gastric and gastro-intestinal catarrh, gastralgia, and flatulent, biliary and infantile colic. It restores the tone of the alimentary canal by its peculiar tonic ac- tion ; increases the appetite, promotes digestion ; gently stimu- lating the organs of excretion. It vitalizes the respiratory organs; good in colds, hoarseness, or in elongation of the uvula, chronic laryngitis and pharyngitis, aphonia, and the lack of tonicity of the vocal chords. It is of great efficacy in all nervous disease, as chorea, epilepsy, lumbago, nervous cough, hooping-cough ; its use overcomes all habits, as the desire for liquor, morphia, etc., and it may be given with decided benefit in anaemia, chlorosis, incipient con- sumption, convalescence from fevers. As a local remedy in contusions, ecchymosis, incised wounds, indolent ulcers, it has no superior. Dose : Internally from twenty to sixty drops added to water, three times a day; for local use, one ounce to four ounces of water; as an ointment, one ounce of the extract to three ounces of vaseline. J. J. Crider, M. Z>.>.Ottumwa, Iowa, in an elaborate disserta- tion on our indigenous remedies, says of stone crop: " The most highly vitalizing of all tonics for the gastro-intes- tinal mucous membrane, operates efficiently from the tip of the tongue to the verge of the anus. The most effective remedy we possess in an ulcerated, germ-eaten rectum. Stone crop is an effective remedy in relaxation of the uvula, chronic pharyngitis and hoarseness, dependent upon a lack of tonicity of the vocal chords. The fluid extract may be given in these affections in half-drachm doses, four times dally, and em- ployed also as a gargle when diluted with four times its volume of water. It is also of value in gastro-intestinal catarrh, and the catarrhal gastritis of beer and alcohol drinkers. It lessens the desire for liquor, restrains the secretion of mucus, and restores the normal tone of the alimentary canal, and re-invigorates the depressed nervous system. Constipation, hemorrhoids, rectal neuralgia, vague pelvic pain, are cured by inserting a suppository made of the glucoside prepared from the stone crop. Add half an ounce of resorcin to four ounces of fluid extract stone crop, and we have an invaluable remedy for chronic gon- orrhea, leucorrhea, prostatorrhea, infantile and biliary colic. As a general tonic, increasing the appetite, promoting diges- bACTERICIDES. 1419 tion, and gently stimulating the fountain of life, it is useful in very many diseases." When taken either in small or large doses, Stramonium, produces symptoms, analogous to those pro- duced by the use of belladonna. It is used with some suc- cess in puerperal mania; be- neficial in neuralgia. It has acquired quite a reputation in spasmodic asthma. It is only employed during the paroxysm, which it either alleviates or subverts. It may be used either in a pipe or cigarette. Externally, stramonium is used advantageously as an ointment or cataplasm in irrit- able ulcers, inflamed tumors, swelling of the mammae, and painful hemorrhoidal affec- tions. The green leaves simmered Common Tho™-aPPle (^'«™ stramonium). in lard, until saturation, form an ointment of rare value in para- sitic affections of the skin. It, like belladonna, sterilizes all disease germs. _______ or styrax, is a kind of liquid balsam obtained from Storax, the bark of a tree, liquidambar orientate, growing in Asia Minor. This balsam is afterwards purified. It occurs in two forms ; a thick liquid of the consistence of honey, and brownish red, nearly solid masses, softening with heat. Storax contains, as do all balsams, cinnamic acid, which, when pure, occurs in flat crystals ; also styracin and styrol. Styracin is a compound containing cinnamic acid and styrone. It is crys- talline when pure, and insoluble in water. Styrol is a colorless oil which by oxidation may be converted into benzoic acid. Its odor is aromatic. Storax if pure should be soluble in alcohol or ether, and is by chemical means capable of being broken up into a variety of pro- ducts. Storax is not nowadays much used in medicine, but belongs to a group which the bacteriologists highly esteem. The whole family of balsams are active germicides, killing the various forms of germs. t 1^20 DISEASE GERMS. Styrone, prepared from liquid storax and balsam of Peru, has intense germicidal properties. It possesses several excellent ad- vantages, it is efficient, non-poisonous, and its odor is agreeable. It may be used to an ulcerating surface in the form of a spray, styrone one drachm to one ounce of water, and one of glycerine, or applied to raw surfaces in the form of an emulsion, with olive oil, petrolina. From experiments made by us, the germicidal properties of styrone are considerable, completely annihilating the micro-organisms of putrefactive bacteria ; comma-bacilli; streptococcus pyogenes, and staphylococcus pyogenes aureus. is a reliable hypnotic, possessing none of the pecu- Sulfonal liar effects of the narcotics on the nervous and cir- culatory systems; it has no injurious secondary effects, and may be taken in proper doses with impunity, to pro- duce the most quiet, uninterrupted, refreshing natural sleep for eight or ten hours. It possesses neither taste nor odor. It has a decided action upon the insomnia of the inebriate; upon the delirium of the typhoid, and upon the raving mania of the insane. The drug can be administered in wafers or capsules, or if the patient refuses the remedy, it can be mixed with soup, wine, water, coffee, or strewn on bread, or any dish the patient may be eating. The dose is from thirty to forty-five grains. Paralysis from phrenal anaemia, cerebral softening, and other grave pathological brain lesions, are becoming amenable to reme- dies. By the use of sulfonal we can prolong sleep in the raving maniac to twelve or sixteen hours in the twenty-four; by the use of the glycerite of kephaline we can supply the blood with adequate brain matter, from which even the bankrupt cerebrum of the insane can, during prolonged repose, recuperate. The two remedies are being tested in several of our insane asylums with brilliant results. Nervous affections are essentially infectious and contagious; all lesions, whether inflammatory or not, are but a mass of mi- crobes. In sulfonal we have a drug which produces a quasi suspension, during which germs either die or become sterilized ; in the glycerite of kephaline we have a true brain essence and germicide. The pulse, temperature, and digestion are unaffected by the remedy. Indicated in the prevention Sulpho-Carbolate Sodium, of ingress and destruction of the oidium albicans of diph- theria, the microbes of small-pox, the bacteria-vibrio of puerperal BACTERICIDES. 14^1 fever, the bacteria of erysipelas and boils and all forms of rectal ulcer caused by eroding germs. It renders the blood aseptic, making that fluid a habitat into which no disease germ will enter while the patient is taking that drug. Dose: For children, one to two grains; for adults, three to four grains, added to water or dry on the tongue or rectum, every four hours. The antiseptic and antifermentative Sulpho-Carbol, properties of this compound are re- the New Antiseptic, markable, and it has the advantage over carbolic acid of being soluble in water in all proportions, and of being neither poisonous nor caustic. It is a syrupy, rose-colored liquid, of a pungent odor, but no wise disagreeable in solution. It is volatilized in a water- bath, and may be used for fumigation. It may be given inter- nally also, in syrup and water, in doses of from one to five grammes daily. Indeed, being an inoffensive product, its doses may be increased ad libitum, which of course is not the case with carbolic or salicylic acids. Three varieties serviceable: First, to Soluble Gelatine kill the gonococcus; second, to arrest Urethral Bougies, seminal leakages; third, to rouse up erections in profound impotency. To insert one after urinating and allowing it to dissolve direct, im- mediate cure of a recent gonorrhea; of marvellous efficacy in checking all leakages or seminal losses ; as a remedy in impotency they have no equal; imparts to the virile organ all the force and ardor of youth. Insert in urethra every night. This plant is very widely distributed over Strophanthus. equatorial Africa. It produces pods or fol- licles from nine to twelve inches in length, in which are contained from 100 to 200, or even 300, oval seeds, characterized by bearing beautiful comose appendices, which eive it an arrow-like appearance. The active or medicinal part of the plant is in the seeds, which are generally used in the form of a tincture which contains about S}4 per cent of a crystalliz- able principle termed " strophanthin," which has an intensely bitter taste and an acid reaction, readily soluble in water and 1422 DISEASE GERMS. alcohol, but insoluble in ether, benzol, etc. This substance is found also in smaller proportions in the leaves and bark. The action of this very remarkable drug in medicinal doses, when introduced into the human stomach, is to increase the contrac- tile power of the heart, and to render its contractions more com- plete and prolonged—a true cardiac tonic and strengthened By the regulation of the dose, a most distinct physiological influence may be produced on the heart, while the other muscles remain unaffected. It is a most valuable cardiac tonic-invigora- tor of the heart muscle, accompanied by a rise in blood pressure, increased secretion of urine and reduction of temperature. In its action it bears a strong resemblance to digitalis, but it is a much more effective and safer drug for a much-weak- ened heart, whatever the , cause of that$^p| be. As an arte- rial sedative, reducing the frequency of pulse, lowering temperature" and diminishing respira- tions, it is of rare value; also in the stage of col- lapse of cholera, typhoid fever, and all cases of heart failure, it is of unexcelled «♦, efficiency. It is a true heart * tonic in enfeebled heart; in- <% creases both the first and ^ second sounds of the heart, both in length and volume ; increases the radial pulse. In oedema of the legs, the result of cardiac ob- struction, great diminution of the swelling is obtained, the water-logged extremi- ties are cleared; and in car- diac obstruction, with diffi- cult breathing, much relief is afforded to the laboring heart. It is the Ex- celsior drug in heart failure due to the use of tobacco or exces sive study. It will not cure a fat- ty heart, but it will steady its action, dimin- ish its irregularity. It is a true tonic of great utility in all states of dam- aged or weakened heart. It does its work well, relieves the difficult breathing, and the system never becomes habituated to its use. On the contrary, its action from first to last is uniform in increasing cardiac muscular impulse. It encourages the action of the kidneys. In anaemia, with weak heart, it is of great value. The best and safest prepa- ration for general use is a tincture prepared from the BACTERICIDES. 1423 seeds alone, and in doses varying from two to ten drops, added to a little water. The method of preparing the tincture adopted by us is as follows: Strophanthus seeds, deprived of their comose appendices, reduced to powder, and dried, one ounce or one part. Ether, freed from spirit and from water, ten fluid ounces, or ten fluid parts. Alcohol, a sufficiency to obtain one pint, or twenty fluid parts. Remove entirely the stalks and comose appendices from the seeds, reduce the seeds to a moderately fine powder, dry the powder by exposing for twelve hours to a temperature of ioo0" or 1200 F., and weigh. Pack ,in a percolator (the percolator being furnished with air valves, or being otherwise so constructed that the percolation may be arrested when desired), add ether until the whole of the powder is saturated, and a small quantity of the ether has dropped into the percolator; arrest the perco- lation for twenty-four hours, and then continue oercolating slowly until the whole of the ether has been used. If the last ether percolate should not be almost colorless, use more ether. Remove the powder from the percolator ; expose to the air, and break up any lumps after the ether has sufficiently evapo- rated ; and continue the exposure, heating the powder, if neces- sary, to 1000 or 1200 F., until all the ether has evaporated, when a uniform, nearly white, dry powder may easily be obtained. Repack the powder in the percolator, add enough alcohol to moisten it thoroughly; arrest the further flow of the alcohol, and macerate for forty-eight hours, and pass alcohol slowly through until twenty fluid parts of tincture have been obtained. In this process, the preliminary extraction with ether is for the purpose of removing the large quantity of inert oil contained in the seeds, which, if present in the tincture, would cause it to become opalescent on the addition of water. The dose of this tincture is from five to ten minims. It may also be used in doses of half a minim to two minims, frequently repeated. is employed in medicine in two forms—sublimed Sulphur sulphur and precipitated sulphur, or milk of sul- phur. Sublimed sulphur is commonly used. It is prepared by fusing virgin sulphur, and conducting the vapor into a cool chamber, where it consolidates into bright yellow powder without taste or smell. It burns with a blue flame, and produces the unpleasant fumes of sulphurous acid. The precipi- 1424 DISEASE GERMS. tated sulphur is pale yellow, and its powder is much finer. The preparations of sulphur are a confection and an ointment. The confection contains sulphur, cream of tartar, and syrup of orange- peel. It is a valuable laxative in piles, or where it is not desired to do more than gently open the bowels, as in fissure of the anus, or in stricture of the rectum. It is mainly, however, as an exter- nal application that sulphur is employed. Sulphur ointment still remains the great remedy for the itch, but it is useful in other forms of skin disease. Itch is due to a small acarus which burrows in the skin and gives rise to the intolerable itching. By rubbing the skin thoroughly with any unguent, these bur- rows may be broken down ; but something more is required— the acarus and its eggs must be destroyed ; this the sulphur or the ointment seems to do. It is important before using the sul- phur that these burrows should be exposed, and nothing does that so well as a good hot bath and an effectual rubbing with soft soap. After that a single application of sulphur ointment, if well rubbed in, may cure. With delicate skins this plan will not do, as a good deal of irritation may be produced. Frequently it is enough to use this treatment to certain parts of the body, especially the hands, arms and inside of the thighs, where usually the crop of eruption is richest. Simple cleanliness may suffice for other parts, but usually the ointment should be applied every night for a night or two, and only Washed off in the morning. The clothing must subsequently be disinfected by heat, or the malady is prone to return. If there has been much inflamma- tion round the spots, a little carbolic acid lotion or ointment may be applied. Burning sulphur is our great disinfectant and bactericide. Its effects in hooping-cough are marvellous. It is also highly recommended in tuberculosis by Prof.R. King, of Georgia. He recommends the following treatment in the case of tuberculous patients. "They should be brought into a room into which small quantities of sulphur (one or two drachms) are burnt every hour over a spirit lamp or on a stove. At first coughing of a more or less aggravated character takes place, and after eight or twelve days the bacteria gradually disappears and cease to irritate the lung tissue. To complete the cure, the patients should be brought into rooms which contain some aro- matic vapors." Sulphuric Acid is the most powerful of all the acids. It is made by burning sulphur, and afterwards oxidizing the sulphur- ous acid by the fumes of nitre. Sulphuric acid thus prepared is a heavy oily-looking fluid, commonly known as oil of vitriol. It is intensely acid, and speedily chars any vegetable substance BACTERICIDES. I425 added to it. Commercial oil of vitriol often contains arsenic from the use of impure sulphur. The diluted acid is used in two forms—as aromatic sulphuric acid, which is flavored by cinna mon and ginger, and dilute sulphuric acid, in which water alone has been added. The strong sulphuric acid is rarely employed, even as a caustic ; it is unmanageable, and less powerful reagents are preferred. Internally the aromatic or dilute sulphuric acid is mainly used as an astringent. In this way it is of much service in the wasting sweats of consumption ; and it may be of service where there is a chronic mucous discharge from the bowels. It is also of importance as an astringent in diarrhea, especially if combined with opium. The ordinary dose of dilute or aromatic sulphuric acid is about ten or fifteen drops, well diluted with water, or some such vehicle. In diarrhea that quantity ought to be given with as much laudanum, if irritating substances have been expelled. Sulphurous Acid is a remedy of some importance. It may be prepared in a variety of ways, but it is most commonly obtained by reducing sulphuric acids by means of charcoal. It is most easily prepared by burning sulphur in the open air. It has the well-known odor of burning sulphur. Sulphurous acid is a pow- erful deoxidizing reagent, and is powerfully destructive of vege- table life. Applied to the skin it causes some reddening; and if any vegetable parasite is present, as is not unfrequently the case in skin disease, it is destroyed. Hence arises its value in such maladies. Internally, if there is any tendency to fermenta- tion, and if fungi are present in the stomach, it does great good. Used as spray in certain forms of sore throat, sulphurous acid is also of great use. It may be freely applied, and subsequent ly used somewhat diluted as a gargle. Sulphates and hydro-sul- phates, especially of soda, are frequently given internally in its stead. Glycerite of Sulphur ozonized.—This combination of sulphur with ozone possesses most remarkable, energetic germicidal pro- perties, so much so that when administered internally it is most destructive to all microbes in the blood and tissues. Its use is specially indicated in diphtheria, hooping-cough, cerebro-spinal meningitis, small-pox/ scarlet fever, erysipelas, rheumatism, etc., whenever disease germs are present in the Vitiated secretions of the body. To the streptococcus of diphtheria it is a decided specific, kill- ing and sterilizing the germ and its micrococci. ' Dose • From one-half to one teaspoonful to be taken every hour or more frequent. The dose varies with the age of the patient and the intensity of germ development. As microbes are 90 I A26 DISEASE GERMS. killed off or sterilized, which will be known by the amelioration of symptoms, the size and frequency of dose should be gradually less. Comp. Sulphur Lozenges Ozonized.—(i.)' The results obtained from large clinical practice are derived from the administra- tion of very small doses of sulphur continued for a lengthened period of time, the dose being much smaller than those hitherto employed, often not exceeding five grains each day, and the time of exhibition much longer, namely : weeks, months, and in some cases, years. (2.) A lozenge named the Compound Sulphur Lozenge, containing five grains of sulphur, and one of cream of tartar, was usually prescribed, as being very convenient, and by no means unpleasant in taste, and it was found that patients could be readily induced to persevere in using them for an almost indefinite time. (3.) The physiological effects of these minute doses of sulphur are observed upon the alimentary canal and the organs connected with it, also on-the pulmonary mucous mem- brane and the skin. (4.) Sulphur is not an element foreign to the system, as it is contained in the most important proximate principles of the blood and flesh, and likewise of the bile and saliva. Dose : one or two at bed-time. , Sulphur water, has been recognized as a valuable 0 4 germicide, disinfectant and parasiticide. As a local ij iiif remedy in all skin affection it is unexcelled, being I I flls inimical to all microbe existence. It is essentially ■ | '|| destructive to the micro-organisms present in i ! R^ malignant and sore throat, scarlet fever, laryngeal diphtheria, croup, influenza, tonsillitis, either in- The Bacillus of ternally or locally applied ; while in typhoid and other fevers, by its use, we diminish both their severity and duration. Recognizing its potent germicidal action upon nearly every form of microscopic life, it has a most extensive range of action, If administered in gastric catarrh (sarcinae ventriculi), it ef- fectually kills the fungus or microbe, provided fluids entering the stomach are limited. Concentration of fluids hinder, and dilu- tion favors the growth of the sarcinae. Because dilution favors movement of molecules, hence promotes the catalytic action of the germ. Concentration of fluids retard mobility; all germs in a state of activity are endowed with motion; whatever hinders motion re- tards germ evolution. The hybrid microbe of tuberculae in all forms of lupus is para-1 lyzed in the presence of sulphur water, nay, further, it is rendered incapable of existence. BACTERICIDES. I427 In all cryptogamic affections of the skin, as the different forms of tenia; as well as in those obstinate squamous forms lepra, psoriasis, it is of the greatest efficacy. Even in those giant forms of microbial disease, syphilis, can- cer, tubercle, its occasional use is of great service. Besides its innate germicidal properties, it has a powerful stimu- lating action upon the powers of life. In the preparation of sulphur water, before and after it is ozo- nized, there is a remarkable bacillus found in it and the more numerous they are, in it, the more energetic it is as a microbi- cide. The leading physician in Wilmington, Delaware, speaking of sulphur water in the treatment of epidemic typhoid fever which is so common in that city, says : " Nearly all the physicians made use of sulphur water in alternation with an infusion of kaki. All were much impressed with the success of the remedies. During their administration, heat, respirations and pulse were lowered and the onward progress of definite germ evolution cut short. All were well marked, typical cases of typhoid. The sulphur water was administered in half teaspoonful doses every hour or two hours in water. It is as.-imilated rapidly, improvement is progressive, the growth, sprouting, or multiplication of the germ is checked by its germicide action. The drink, infusion of kaki, as well as the sulphur water, should v *. be continued to convalescence." By the use of germicides in typhoid we stamp out its very existence, and its formidable sequelae, besides saving the patient and sterilizing his blood. No nurse, no washerwoman, no dear friend can suffer from the perform- ance of their duties, as the contagium vivum is wiped out. The mother tincture Sumach, of the green leaves and ripe berries of this sim- ple herb are most powerful germi- cides, and also parasiticides. It has the potency of killing the crypto- gamic growths which embrace the entire family of tinea, and thus cures those obstinate skin affec- tions • it is destructive to the bacteria of boils and erysipelas, and to the vibrios of nervous affections; hence its utility in cases of paralysis, amaurosis, chronic rheumatism. . 1428 DISEASE GERMS. The dried leaves and berries, ground, made into a decoction, sweetened, make an excellent drink in fevers ; lower heat, pulse, and diminish the respirations by annihilating the germ, the contagium vivum; useful also in all forms of aphthae, as it destroys the oidium albicans on the tongue, gums, lips; espe- cially useful if the germ is active, as will be seen by the diffused redness of the parts.______ is the root of a plant growing somewhere in Sumbul, Central Asia. It reaches us mostly by way of [Musk Root) Russia, partly also by way of Bombay. Its odor resembles that of musk, and at one time was supposed likely to become a valuable remedy. Subsequent experience has confirmed this view, and it is now regarded the standard remedy in epileptic attacks. The peculiar character of the ozonized fluid extract renders it a most invaluable preparation of immense utility in both chorea and epilepsy if they are in any way associated with disease germs. Dose: One teaspoonful every three hours or more frequent. Thomas L. Barnes, M. D., of Jamestown, N. Y., who is an authority on epilepsy, says : " Musk root, ozonized extract, is our best remedy in epilepsy ; its pro- longed use is curative ; at first dimin- ishes the force and frequency of the convulsive seizures, and latterly ob- literating the pathological condition. In order to cleanse the blood of all microbes ; while administering the musk root, it is invariably a good plan to alternate it with small doses of ozone water; later on, avena or glycerite of kephaline." A tincture of the Sweet Flag. root of the acorus calamus is a car- minative, stimulant, diaphoretic, tonic, alterative and antiseptic. It forms a very valuable adjunct to all prescriptions, such as the following: Fluid extract saw palmetto, three ounces ; fluid extract damiana, one ounce; fluid extract nux vomica, one drachm ; fluid extract calamus, one ounce. Mix. Dose : Half a tablespoonful every four hours, added to water. Excellent in genital debility. BACTERICIDES. I429 Fluid extract bayberry, three ounces; fluid extract calamus, one ounce. Mix. Dose : One teaspoonful every four hours, added to warm water. Of great efficacy in intestinal catarrh. This remedy has acquired quite a reputation Tag Alder, as an alterative. Next to the comp. saxifraga, it is excellent, prepared as follows : Tag alder, vellow dock, bittersweet, comfrey, dandelion—of each two pounds.; mandrake, blue flag, of each one pound. Let all the herbs be good and fresh. (1) Then grind fine and mix the articles together; place the whole twelve pounds in a convenient vessel, cover them with alcohol of j6 per cent and macerate for four weeks. Then transfer the whole to a displacement appa- ratus, and gradually add alcohol, until five pints of the alcoholic tincture has been obtained, which retain and set aside. (2) Then continue the percolation with water as long as it ex- hibits a sensible amount of medicinal properties with an alcoholic taste. (3) Con- tinue the displacement with water until it has no taste. Boil down these two solutions (all except the alcoholic tincture), so that it will make thirty-two pints. (4) To these two solutions combined, add thirty-two pounds of refined sugar and dissolve it by heat, carefully removing any scum which arises as it comes to the point of boiling; and if it exceeds thirty-six pints, evapo- rate to that quantity with constant stirring. Then remove from the fire, and when nearly cold add the four pints of reserved alcoholic tincture. To the above, when it cools, add two ounces of the chlorate of carbon. It is then ready for use. AUer Tree. A valuable diuretic, tonic, stimulant and parasiti- cide. The whole plant possesses strong antiseptic properties, the pulverized flowers being the part penerallv used. In suppression of urine, due to the presence of Tansy. 1430 DISEASE GERMS. micro-organism and funguses in the bladder, it is of great utility. It is a drug extremely destructive to worms, especially the lumbricoides; but its use most be carefully guarded, as it is an irritant narcotic. The microbicide action of the oil of tansy in parasite affections of the skin is too much overlooked. Its addition to ozone ointment makes it an efficient remedy in all forms of tinea. The pine tree in all Terebintha. its different species, ( Turpentine) and in every country on the. globe, is a great natural ozone generator. The tree itself, and its oils, extracts, resins, all liberate ozone in great abundance. The ozonized turpentine for peritonitis has no equal as a local ozone generator. Spirits of turpentine applied' .,v.-.^- externally, or administered inter- Tansy. ( Tanacetum vulgare.) ■Mi: nally, is a great ozone generator —germicide. There is no organic body that can absorb so much chemically pure ozone gas and retain it as turpentine. There is no physi- cian that should be without this agent. It should be incorpor- ated in all poultices where theie is no breach of continuity, to destroy disease germs, and as a local stimulant it is never-failing in its action. Ozonized turpentine excels in therapeutic power, tartar emetic ointment in peritonitis. Ozonized Tar Syrup.—This i.s one of those medicaments con- cerning whose curative powers 11^-' all physicians, irrespective of Pine. school, are in full agreement. Its action upon all microbes is direct and decided—either in BACTERICIDES. 1431 destroying or sterilizing them. All preparations of tar, such as antipyrine, antifebrine, kairine, thallin are stable, easily assimilable, do their work promptly, and are reliable, effective preparations— can be used with precision, and nothing can excel them in practical utility in a very large percentage of all diseases. Recent modern pathological discoveries have suggested its more extended use, oh etiological grounds, based upon its action( a pure ozone-generating germicide with a clearly defined action peculiar to itself. The present era in the history of medicine will, as some one has aptly expressed it, be known as the antiseptic or germicide epoch, and experimental therapeutists everywhere are employed in starting " cultures " and testing the anti-microbe power of the articles of our Materia Medica. Not satisfied with these, how- ever, investigators go still further, and attempt to discover not only the drugs which are active, but those whose effects' are vir- tually negative. An example of this is well represented by a recent article from the pen of that brilliant author and scientist, Enoch Mather, M. D., of England, in which he calls attention to the effect of the oil of turpentine on germs of various kinds. His method consisted of taking fresh colonies of the micrococcus prodigiosus and staphylococcus aureus. The vessels used were carefully sterilized, and agar-agar and gelatine were used as cul- ture beds. After some hours, oil of turpentine was applied, and its effects on the life and growth of the germs noted. Under these circumstances it was soon evident that the turpentine, unless applied in large amounts and for a considerable time, pro- duced no effect of sufficient force to enable one to use the drug in ordinary everyday life for the purposes of antisepsis. Its irri- tant properties, when concentrated, and its loss of the little retard- ing power which it possesses on micro-organisms, as regards their growth, on dilution, exclude it from use on the tissues of the patient, and confine its sphere of value to the instruments employed. Certainly, from our present knowledge of the drug, we may rest assured that it is only proper to use it as an anti- septic when nothing better can be obtained. Distillation of the needles of the pine tree, highly ozonized, is decidedly an efficient bactericide. The needles of the pine tree, teeming with natural ozone, has yielded up its properties to the resources of modern chemistry. Its powerful vitalizing and germicidal principle has been isolated from the highly ozonifer- ous buds, young shoots and needles, suitable for internal admin- istration. ' This elegant preparation has been distilled with the greatest care, so that its rich ozoniferous principle is preserved 3 An eminent practitioner, J? A. Hendricks, M. D., Summ.r I432 DISEASE GERMS. Hill, Pa., in speaking of this distillation, says: "It is a clear ethereal liquid, carefully distilled from the American pine, very fragrant, a powerful bactericide; it is administered internally by dropping it on sugar ; used as an inhalant in pulmonary tubercu- losis ; for frictions and massage. It does not irritate; a valuable remedy in microbial diseases." Equal parts of white rosin, sulphur and cream of tartar. Mix. Dose: One tablespoonful in some jelly is a great intestinal disinfectant. Terebenc.—Pure terebene is strongly recommended in " winter cough," chronic bronchitis, emphysema, phthisis, bronchorrh, etc.; in those cases aggravated with a dyspeptic element it con- trols the complication at once. It checks the formation of flatus so quickly, and i.s so efficacious in expelling any that may remain in the stomach or intestines, that I constantly employ it in cases of dyspepsia when flatulence is a prominent symptom. Patients like it, and often continue taking it for months or years. It acts as an antiseptic, probably much in the same way as glycerine, oil of cajeput and oil of eucalyptus. I am surprised that it-has not come more largely into use in the treatment of flatulence. Pure terebene is of such value in winter cough that I rarely ex- perience the necessity of resorting to other remedies. It is a powerful expectorant, and if inhaled the first thing in the morn- ing, when the mucous membranes are covered with thick viscid secretion, will give very great relief. Pure terebene is a valuable remedy, and will in time come largely into use. Terebene i.s pleasant to take, and has the agreeable odor of fresh-sawn pine. The dose is ten drops on a piece of sugar three or. four times a day. It is so effective that its remedial value is apparent in a day or two. Dose: Fifteen to thirty drops during the course of the day. As it does not mix with water, five or ten drops can be dropped on sugar at proper intervals. C. Collin, M. D., Middletown, New York, an eminent and leading bacteriologist, in his essay on the subject, says that he has used terebene for seven years, both internally and as an inhalant in phthisis, bronchiectasis, chronic bronchitis, and other pulmonary complaints characterized by profuse purulent expec- toration. " In cases where the trouble has not been of long standing, and the symptoms are slight cough, more especially at night; expectoration moderate in quantity and easily voided; no fetl'ng of rawness in the chest, and little or no disturbance of the general health, I consider that pure terebene is almost to be nuked as a specific, so quickly is a cure effected." Terpin Hydrate.—Colorless, inodorous, rhombic crystals, BACTERICIDES. H33 soluble in hot water, alcohol, chloroform and ether; of neutral reaction. A bactericide of great power, used with great success in all microbial disorders of the respirator)' organs, kidneys and nervous system. Terpin hydrate covers all that class of cases in which turpen- tine used to be prescribed. Dose : Two grains every three hours. Specific for bronchitis. Dr. Collin also speaks highly of terpin hydrate. He gives the case of a lady suffering from obstinate bronchitis, and says: "After two doses (of three grains each) there was already an amelioration in my patient's condition; the cough began to loosen; expectoration became free and easy in consequence of elimination by the bronchial mucous membrane; the skin be- came soft, moist and natural on palpation; and there was a marked diminution in the bronchial whistling and rales." In another case—one of catarrhal congestion of the larger bronchi —treated as in the preceding case, " there was a notable decrease ...f the mucous rales ab initio, and normal vesicular murmur could be distinctly heard in a very few days after." Other cases, «uch as nasal and pharyngo-laryngeal catarrh from cold, have been treated with equal success. In night cough from habit, two grains of hydrate of terpin exhibited at bedtime had a good effect. Terpinol is prepared from terpin, used in diseases of the bladder, and by rectal injection in the same class of diseases A very highly ozonized cerate or ointment is prepared from the needles, which is one of the most healing agents in the Materia Medica. It is an ointment which, being prepared with very great care and skill, is pharmaceutically perfect. It pos- sesses the curative and antiseptic properties of the pine essence in a form suitable for toilet requisite, or as a soothing and heal- ing application to excoriated and irritated surfaces. Its efficacy in obstinate cases of eczema is testified to by hundreds of un- solicited testimonials from medical men. As an application to ulcers and raw or weeping surfaces generally it is probably without a rival. It is highly spoken of as an adjunct to the massage treatment, lubricating the skin and facilitating the necessary manipulation. Pine ointment is always well received by patients on account of its agreeable odor. All preparations of the pine tree may be utilized for inhala- tion- they are valuable microbicides in bronchitis, pulmonary tuberculosis, asthma, catarrh. Valuable remedies to sterilize the blood. H34 DISEASE GERMS. is an antipyretic and germicide of rare value. It is Thallin generally employed in the form of a sulphate or tartrate, both of which occur in the form of white crystalline powder, possessing an aromatic taste and odor, and readily soluble in wine or water. A very small dose causes a marked reduction in temperature, lasting several hours. It is adapted to all ages and degrees of strength, may be administered in syrup of prunus virg. The urine of all individuals taking thallin assumes a green or brown yellow tint. Thallin, either in the form of an injection, or, better still, incor- porated into a gelatine bougie and inserted into the urethra laden with the gonococcus of gonorrhea, annihilates it at once. One application effects in a few minutes what requires weeks, often months, to cure. By means of these bougies the remedy is carried to the farthest part of the urethra; the germicide mass adheres to the germ-laden urethra, slowly dissolves, and by unin- terrupted and immediate contact with the germs destroys them most effectually. Thallin, combined with papoid, has proved itself efficient in digfestingf cancers. ■£*%? SM&- The Tea Plant. nitrogenized crystalline An alkaloid analogous Theine. to caffeine, of weak* basic properties, variable quan- tities, being found in different grades of tea, two to four per cent, in ordinary qualities ; very rarely does it exceed six per cent, in the best grades. The physiological action of theine is it diminishes waste or disintegration of all the tissues of the body ; under its administration metamorphosis is les- sened, vital force increased. The use of tea is prejudicial to every young or middle-aged American; in some cases it is beneficial to the old or infirm, but never to people in ordinary health. The frequent use of strong tea in a highly oxygenized atmosphere like ours leads to utter destruction of bodily and mental vigor. The important alka- loid in tea is caffeine, which is the highly principle, occurring in colorless silky needles. Caffeine is a stimulant of the medulla and cardiac centres, BACTERICIDES. !435 quickens the puhe and respiration, and raises the blood-pressure when given in moderate doses. The effects of caffeine " are identical with those of digitalis ; slowing of the heart pulsation; augmenta- tion of its force of contraction ; diuresis ; no nauseous effects ; no cumulative action. This drug, therefore, does not necessitate an incessant watchfulness. You can employ it in cardiac cases where the kidneys are affected." As to mode of administration. Pure caffeine is soluble in from eighty to one hundred parts of water; its solubility is increased by acids. I have generally employed the citrate, which is freely soluble. It has been objected that it is a doubtful salt, but this objection is of small importance if the proportions of caffeine and citric acid used in its manufacture are definite, the only important function of the acid being to render the salt easy of solution. I employ it in from three-grain to five- grain doses, dissolved in the ordinary saline mixture ; diluted liq. ammonia acetatis. The dose is generally administered three times in the day, but in some cases once only. Instead of the citrate, the pure caffeine may be employed dissolved in solutions of benzoate or salicylate of sodium : in these it dissolves freely, and thus a concentrated solution may be made for hypodermic injection. The following is a good formula for internal adminis- tration : Pure caffeine and benzoate of sodium, of each one drachm ; distilled water, six fluid ounces. Half an ounce con- tains five grains of pure caffeine. Thymol. A camphoraceous, power- ful bactericide, derived from the oil and resin of various plants of the thyme family. The thymus serpyllum of America and Europe and the ptychotis ajowan of India, yield this prin- ciple in greatest abundance. The germicidal properties of the oil and camphor of thyrre are equal if not superior to carbolic acid, creosote, peppermint. As a bactericide, it has an extensive field of action ; its use in all fevers quietens the pulse, lowers temperature by killing the germ, the factor of the disease; its use sterilizes the sarcinae of dyspepsia, the mi- crobe of diarrhea, and dysentery; locally, in skin affections, it is equal to resorcin, ichthyol, creolin, naphthaline; dissolved in alcohol and applied to rheumatic germ-laden joints, it instantly kills the amylobacta, and relief is immediate. Thymus Serpyllum. '436 DISEASE GERMS. Compound thymol jelly, an infallible bactericide as a dressing for wounds, ulcers, most valuable in scarlet fever, suiall-pox, and all other contagious diseases. As a disinfectant for the hands, this jelly excels in bactericide power, all known remedies. An elegant agent in obstetrical practice, and bound to come into very general use by all. Couch Grass. From among the class Triticum Repens. of remedies designated astringent diuretics, there is none that can compare with couch grass; its action upon the kidneys and bladder is much more efficient than buchu, uva ursi, queen of the meadow, pipsissewa. In papilloma of the bladder, with frequent mic- turition, it rarely fails to afford immediate relief, and in alternation with the oil of thuja, is essen- tially curative. It is to this remedy, combined with the pichi, that the uric acid solvent owes its most valuable properties. ______ This is the Tobacco, most power- ful antispas- modic, sedative, and germ sterilizer in the Materia Medica. Its good and bad effects may be briefly enumer- ated : In either smoking or chewing, there is no doubt whatever, that its moderate daily use disgorges the salivary glands of the mouth of all disease germs which may have deposited themselves in that region, or sterilizes those factors, of disease ; it has a most disastrous depressing action upon the heart muscles, causing cardiac failure ; its use paralyzes the base of the brain, im- pairing the cerebral faculty of speech, giv- ing rise to vertigo, amaurosis, color-blind- ness, faintness, prostration. In the drain- ing of and vitiating the saliva, it gives rise to indigestion ; it prevents salivary secre- tion, and the continual blunting of the gustatory nerves, which is the predisposing cause of cancer of the tongue. Virginian Tobacco. {hicoticina tabacum.) BACTERICIDES. '437 Tobacco smoke prevents the development of some micro- organisms, and retards or sterilizes others. Nicotine (C20H14N2) is one of the natural volatile oily bases destitute of oxygen, and constitutes the active principle of the tobacco plant, in the leaves, roots, and seeds of which it occurs in combination with malic and citric acids. It is likewise con- tained in the smoke of the burning leaves. It is a colorless, in- intensely poisonous liquid, of specific gravity 1.027 at 66°, which boils at 4800; evolves a very irritating odor of tobacco, especially on the application of heat, is very inflammable, and burns with a smoky flame. It is moderately soluble in water, and dissolves readily in alcohol and ether. If exposed to the air, it absorbs oxygen, and becomes brown, and ultimately solid. The quan- tity of nicotine in tobacco varies from two to eight per cent.; the coarser kinds containing the larger quantity, while the best Havannah cigars seldom contain more than two per cent, and often less. or arbor vitae, Thuja Occidentalis, a highly ozon- iferous tree, yields a peculiar balsamic resin, which has an agreeable smell and high germicidal properties. The fluid extract retains all those properties in a high degree, but the ozonized oil is extremely powerful. It has a specially destructive action upon the micrococci of warts of all kinds, and its use in those affections entirely obviates the practice of burning with chromic acid or any other caustic. It is quite imma- terial what the kind of wart may be, ven- ereal warts, single or double, or in masses, or those upon the hand, all wither and die the moment it is brushed over them—it kills the spores or germs in all cases. Arbor vn*. Large masses of venereal warts in the vagina disappear after half a dozen applications of this remedy. It is a good practice to administer it internally, as well as apply it locally. The dose is from twenty to thirty drops in water 'thrice daily. The arbor vitae, fluid'extract, in six to ten drops, more or less, is destructive also to the microbe of variola. It should be admin- istered every two or three hours in water. Commence the moment the diagnosis is made. U38 DISEASE GERMS. Thuja is one of our best remedies in chronic inflammation of the pharyngeal mucous membrane, especially if dark colored. _______ • The bark of this Tulip Tree, beautiful tree yields a bitter antiseptic aroma- tic, and a glucoside tulipine, which a few years ago was quite extensively used f >r Peruvian bark. More recently tulipine has been used in the uric acid diathesis and rheuma- tism instead of colchicum, and with marvellous success. This is accounted for by its action on the liver ; the latter organ being the chief one concerned in the formation of urea. The tissues in their oxidation or disintegration con- tribute but little. The chief source is the red blood cells, which are broken up in the liver; the coloring matter goes to form bile and urea. The glucoside is definite and positive in its action. The nitrate of uranium is of utility in diabetes. Uranium. Dose: One-sixth to one-half grain every three • hours. Urethan. From fifteen to twenty grains sel- dom fail in producing the most profound refreshing sleep. This is one Uva Ursi. of the best of the astringent diuretics. Its specific action is upon the genito-urinary tract as a vitalizer, a bracing tonic. It is an antilithic, very serviceable in all forms of gravel, dissolving and washing away from the kidneys and bladder small concretions. It is of great utility in chronic nephritis and diabetes; of great efficacy in enlarged prostate with continence or incontinence of urine; and of appreciable value in BACTERICIDES. '439 gleet and leucorrrueal discharges. So energizing on the genital organs of the female is the remedy, that many physicians use it in labor to induce stronger-, more active uterine contractions A crystalline principle is extracted from the leaves, termed " arbu- tin," which has a bitter taste, and when placed under the influ- ence of dilute acids, separates into glucose and hydrochinon. It is soluble in warm water. Arbutin is considered a valuable astringent diuretic, and has all the properties of the uva ursi in an increased degree—positive, definite in action in restoring tone to the bladder and kidneys. The dose of the arbutin is from thirty to sixty grains. Valerian. The root imparts its pro- perties to water, alcohol and ammonia. It owes its medicinal properties to a volatile oil and valerianic acid. It is of great efficacy in all conditions of reflex irritation, in anae- mia of the brain or cord, as witnessed in the widespread state of melancholia, inci- dental to neurasthenia or nerve exhaus- tion. In this affection the triple valerian- ates operates like a charm, as in the fol- lowing : Valerianate of quinine, of zinc, of iron, of each twenty grains. Make twenty pills ; one every three hours. The American valerian is equal, if not superior to the European. It is free from the disagreeable odor of the latter; very soothing, allays pain, promotes sleep. The so-called cypripedin is an inert, worthless preparation. The recent importation of a so-called glucoside of valerian from a German house is also of no therapeutic value whatever. Valerian. American hellebore, in the form of a Veratrum Viride. tincture, administered in all fevers and inflammations, was the most powerful cardiac and cerebral sedative in the Materia Medica. It was of special utility in inflammation of the brain and lungs. Modern scientists have entirely superseded the use of veratrum viride in the practice of medicine by the discovery of such rare remedies as antipyrine, antifebrine, kairine, thallin—remedies definite in 1440 DISEASE GERMS their action, positive in their effects, will lower heat, pulse, respiration, and hold the posi- tion gained for several hours in succession. Much more effi- cient in ameliorating suffering and curingdisease than veratrum viride, each and all of them be- ing potent active germicides. The veratrum viride is a valu- able germicide, but as a local remedy in erysipelas is entirely superseded by the ozonized boro- glyceride, still it is a most valu- able local remedy to the throat in diphtheria. atrum Viride. A glucoside Veronica has been re- Beccabunga. cently extract- [Brooklime.) ed from this plant, which has proved itself to be invalu- able as a bactericide in all lung, kidney, and bladder affections. The fluid extract has the same properties. As the plant is extremely succulent, it yields by expression a large quantity of juice, which in its fresh state is a remarkable efficient alter- ative. When administered in this state it com- pletely annihilates the bacillus of syphilis and leprosy. a most excellent bactericide, also Vervain, sudorific, tonic, expectorant, dia- Brookiime phoretic, and in large doses emetic. V The juice of the green plant is as effective in expelling tape worm as the tannate pelleterin. It is an excellent drug in all the eruptive fevers. A few drops of the fluid extract added to warm water, make a most excellent drink ; by its sterilizing action on the germs, it lowers heat, diminishes respiration and pulse. Vervain, an invaluable germicide, having a very wide range of action, being of great utility, both locally and internally—in the former to wounds, bruises, ulcers, up to even the aggravated BACTERICIDES. I44I forms of snake bites; in the latter to malarial fever, disorders of the stom- ach and bowels, and urinary organs. For Malarial Fevers.—Fluid ex- tract vervain and concentrated tinc- ture of kurchicine of each two ounces. Mix. One teaspoonful every three hours. Fluid extract vervain, two ounces ; fluid extract stone crop, three ounces; fluid extract leptandra, one ounce. Mix. One teaspoonful every three hours in gastric debility and intes- tinal catarrh. Fluid extract vervain, one ounce ; uric acid solvent, three ounces. One teaspoonful every four hours; good in all bladder and kidney trouble. Warburg's Tincture. Vervain. then half another half an ounce ; no drink must be allowed, not a drop, as it is a pabulum for the germ. The formula for this tincture is : aloes soc. one pound; rhubarb, ange- lica fruit, confection of democra- tis, of each four ounces; elecam- pane, saffron, fennel, prepared chalk, of each two ounces; gen- tian, zedoary, cubebs, myrrh, camphor, agaric, of each one ounce. Digest the whole in five hundred ounces of alcohol for fourteen days, then percolate, after which ten ounces of quinine is added and dissolved. Dose : half an ounce undiluted, every three hours. ______ three an Indicated in mala- ria ; its administra- tion must be pre- ceded by a purge; hours before the chill, ounce; prior to the chill Water Plantain. Water Plaintain.—The leaves in the green state are highly germicidal and, applied to engbrged lymphatic glands, sterilize 91 144^ DISEASE GERMS. or^ kill the microbes, and thus relieve the engorgement. A tincture prepared from the green root is of utility in intestinal catarrh, it being destructive to both the gastrc and intestinal sarcinae. Witch Hazel [Hamamelis Virginica), an indigenous shrub, from five to fif- teen feet high, growing usually on hills and stony places, flowers late in September, bears a fruit, a nut-like capsule, like a hazel nut. The bark has a bitter, sweetish astringent taste. Marvellous results have been obtained from a distillation of the bark, leaves, and twigs; ten parts of them to a mixtuie of ten of alcohol and ninety of water. All parts of this shrub pos- sess similar pro- perties. Of great efficacy in all hem- orrhages, from lungs, stomach and bowels; a splendid remedy in all rectal affections prepared from equal parts of witch hazel, white oak bark and apple tree, in ointment form. An infusion is often valuable in incipient phthisis. This' famous remedy, as an astringent and antiseptic, has ac- quired great and deserving repute in all diseases dependent upon a relaxed or devitalized condition of the mucous membrane of nose, vagina, uterus, bladder, and rectum. As a topical applica- tion it destroys germs and promotes healing; it makes an excel- lent wash for sore mouth, ophthalmia, or rectal fissure, or ulcer; Witch Hazel. BACTERICIDES. 1443 of rare value in the radical cure of all varicose veins, whether they be on the extremities or be varicocele, or piles, etc. The internal and local use of the remedy is indicated in all diseases of veins and mucous membrane, and in those it effects a cure in the most stubborn cases. The leaves are the part Wormwood, used; a tincture or fluid extract administered has a well marked influence upon the digestive organs, increasing the appetite, promoting assimilation. It is also of great value in hepatic torpor and in all states of debility dependent upon imperfect digestion or de- bility of the stomach. It is an anthelmintic, being antagonistic to the lumbricoides and ascarides. Fluid extract wormwood, fluid extract collinsonia, of each two ounces ; fluid extract nux vom- ica, tincture capsicum, of each two drachms. Mix. From a half to one teaspoonful be- fore meals. Invaluable in indigestion and torpidity of the liver.______ Fluid Extract of the Black Willow. [Salix Nigra), The properties of the black willow bark are tonic, carminative, stimulant, sedative, anaphrodisiac, astringent, germ- icide. Its special properties in both sexes are a powerful sexual sedative—of very decided value in prostatorrhea and spermator- rhea—used with marked benefit in all cases of nocturnal emis- sions, or seminal losses. Its action is very similar to that of the bromides, without their de- pressing or debilitating proper- ties. By its peculiar sedative and astringent action, it arrests semi- nal emissions entirely, but it does not, in any way, diminish virile power or passion. Its action is direct upon the genito-urinary organs, upon which it'exercises a benign influence, so much so that menstrual pain The Black Willow (Salix Nigra). The great sexual sedative. 1444 DISEASE GERMS. and uterine irritability are entirely relieved with it; 'ovarian hyperaesthesia overcome. No case of failure when it is used; it always brings about speedy and lasting relief. It is indicated specially in spermatorrhea and prostatorrhea whenever the seminal or ejaculatory ducts have lost their tone in all leakages. Dose: From a half to one teaspoonful of salix nigra should be taken thrice daily. One of England's most celebrated physicians and a specialist in genito-urinary diseases, E. Mather, M. D., of Masbro, Rother- ham, says of the black willow: " A sexual sedative of the highest order, administered in from half to one drachm doses, three times a day, exceeds in thera- peutic power the action of the green root tincture of gelsemium and the bromides combined, without any deleterious effect what- ever. In nocturnal emissions of our drained-out young men, the drug is used with the most marked benefit. The pollutions cease en- tirely, virile power and passion are not in the least diminished." Xanthoxylum. The prickly ash is a low deciduous tree common from Canada to Virginia. It is in high repute, both as a diffusible stimulant, as a diaphoretic, diuretic and antiseptic. Both bark and berries are used. It sterilizes the sarcinae, vitalizes the stomach ; has a most decided action on the gonococcus in the urethra, and if its use is persisted in the micro-organism will disappear. Of utility in flatulent colic; cholera mor- bus ; Asiatic cholera; tympanitis and chronic disease of the mucous membrane. Xanthoxylum frax. is a powerful vaso- motor stimulant. It slows the heart beats and strengthens them in a remarkable manner. Its action is not confined to the vasomotor centre, but extends to the cardiac also. It seems to regulate the rhythm of a feeble heart as much through the pres- sor nerve. It acts well in adynamic fevers, etc., when the heart beats are fast, weak, and the rhythm irregular. Its value in some forms of dropsy, especially that originating in heart weak- ness and attended with passive hepatic engorgements, is often remarkable and when combined with collinsonia does excellent service. Xanthoxylum Fraxineum. INDEX. Abdomen, 17. Abortion, 18. Abscess, 20. Acarus foil., 21. Acholin, 21. Acne, 22. Actinomycosis, 22. Addison's disease, 25. Adenoma, 27. Adenitis, 28. Adipose tissue, 30. Albuminuria, 31. Alcoholism. 32. Alopecia, 34. Amaurosis, 34. Amoeba, 3J1'9. Amenorrhea, 37. Ammonsemia, 39. Amyloid degeneration, 41. Anasarca, 45. Anaemia, 45. Anchylosis, 48. Aneurism, 49. cardiac, 51- thoracic, 51. abdominal, 52. nervous, 53. Angina pectoris, 53. Anthrax, 57, 1129. Aphasia 60. Aphonia, 61. Aphthae, 62. Apoplexy, brain, 64. spinal, 67. pulmonary, 68. Ascaris, 69. Ascarides, 69. Ascites, 70. Asphyxia, 71, 521. Asthma, 77. Ataxia. 81. Atalectasis, 83. Atheroma, 84 Atrophy, 85. Bacterium porri, 392. decalvans, 423- Bacillus amylobacta, 39: anthracis, 393. cancer, 394. indicus, 395. mallei, 395. tetanus, 396. saprogenes, 396. dental caries, 397. tuberculosis, 397. typhoid fever, 398. subtilis, 399. syphilis, 4c o. Bacteria, 390. Balanitis, 89. Bites, 91. Boils, 92. Brass disease, 94. Burns, 95. Bronchitis 96. chronic, 98. senile, 141. infant's, 101. plastic, 102. mechanical, 102. microbial, 103, hay, 103. Bronchocele, 104. Bursal swellings, 105, Bubo, 105. Bullae, 106. Calculus, 107. biliary, 107. prostatic, 109. renal, 111, Carcinoma, 114. Cancer of anthrax, 121. lip, 121. breast, 123. liver, 129. rectum, 130. oesophagus, 133. palate, 13 . pancreas, 134. penis, 137. stomach, 138. tongue, 139. 1446 INDEX. Cancer of uterus, 144. vulv.i, 151. Caries. 151. Catalepsy, 152. Cataract, 154. t Catarrh, bile duct, 153. bladder, 157. bronchial, 158. gastric, 160. intestinal, 166. nasal, 167. prostate, 170. rectum, 172. urethral, 1180. uterine 174. utrine cervix, I7*>- vagina, 177. Chancre, 1185. Chilblain, 17S. Chlorosis, 178. Cholera, 179. infantum, 180. morbus, 183. epidemic, 184. Chordee, n 81. Chorea, 188. Chyluria, 191. Climacteric descites, 191. Colic, 228. Collapse, 230. Coma, 231. Concretions, 23). Concussions, 235. Constipation, 236. Contusions, 239. Coryza, 239. Coup de soleil, 241 Cretinism, 242. Croup, 243. . Cyanosis, 244. Cysts, 246. Deafness, 248. Dentition, 527. Diabetes, 249. Diarrhea, 254. Diathesis, 260. Diphtheria, 267. Dropsy, 279. Dysentery, 280. Dysmenorrhea, 283. Dyspepsia, 288. Ecthyma, 292. Eczema, 293. Elephantiasis, 295. Empyema, 296. Embolism, 297 Emphysema, 299. Epilepsy, 300. Erysipelas, 307. Erythema, 308, Erythrasma, 300 Fatty degeneration, 310. heart, 310. liver, 312. kidney, 314. Fitcal accumulation, 314. Fever, 315 ephemeral, 519. gastric, 320. bilious, 322. malarial, 322. remittent, 327. malignant biliou-, 329. typhoid, 330. surgical, 338. typhus 339. relapsing, 341 dengue, 342. yellow, 343. puerperal, 34O. hay. 350. cerebro-spinal, 354. eruptive, 355. measles, 356. scarlet, 359. small-pox, 363. Filaria sanguinis hominis, 308. Fissure, 369. Fistula in ano, 371. recto-vaginal, 374. vesico-vaginal, 375. Frost bite, 178. Functional disorders, 37M. Fungus, aural, 755. ; diabetes, 417. i yeast, 41K. | Germ diseases, 378. Glanders, 424. , Glaucoma, 427. Gleet, 1180. Gonorrhea, 1175. Gout, 428. Hair lip, 531. Habits, 434. tobacco, 434. opium, 435. caffeine, 435. chloral, 436. arsenic, 436. Hemorrhagic temperament, 438. Hemorrhage, 438. nose, 439. kidn.ys, 441. INDEX. 1447 Hemorrhage, lungs. 442 rectum, 412. skin, 443- stomach, 444. uterine, 445. Hemorrhojds, 447 Headache, 454- Hemiplegia, 761. Hiccough, 457. Home-sickness, 458. Hooping-cough, 459- Hydatids, 462. Hydrocele, 466. Hydrocephalus, 467. Hydrocephaloid disease, 409. Hydrothorax. 469. Hydrophobia, 469. Hypertrophy, breast, 472. heart, 473, livtr, 474. muscles, 475 prostate, 475. testes, 489. Hydrops pericardium, 489. Ichorrhaemia, 489. Ichthyosis, 49°- Icterus, 491. Impetigo, 492. Incontinence of urine, 492. Incubus, 746. Imperforate anus, 493. hymen, 494 Impotency, 495- Infantile diseases, 510. Inflammation 538. bone, 544- periosteum, 545- brain, 545. membrane of brain, 553. bowels, 556. r bladder, 558. 'breast, 560. cellular tissue, 562. cornea, 5°4- ear, 564. eye, 567. heart, 573- heart covering, 574- iris, 576. kidneys, 577- larynx, 592. liver, 595' lungs, 600. mouth, 611. nails, 612. nose, 613. rhinitis, 615. pericardium, 616. Inflammation, ovary, f>iS. parotid, 621. pleura, 621. peritonaeum, 624. prostate gland, 628. . rectum 634. retina, 635. stomach, 636. spinal cord, 638. lesticles, 641. tonsils, 643. tongue, 645. uterus, 645. veins, 651- Influenza, 652. Injuries, 655. Insanity, 656. Insomnia, 669. Invagination of bowels, 671. Keloid, 674. Labor, 840. Leprosy, 675. | Leucorrhcea. 677. Leucocythema, 678. Lichen, 679. Lupus, 680. Masturbation, 683. Mellituria, 249 Menstruation, 689. Mesenterica, 690. Microbe actinomyces, 401. dengue, 416. diarrhea, 401. epidemic cholera, 403. leprosy, 420. dysentery, 403. influenza, 404. boils, 404. malaria, 405. mumps, 418. neurasthenia, 406. rhinoscleroma, 421. bronchitis, 406. croup, 4T3- Micrococcus endocarditis, 407. gonorrhea, 407. haemophilia, 408. measles, 408. variola, 408. tetragonos, 409. typhus, 409. urea, 410. hooping-cough, 410. Moist tetter,0293. Molluscurn, 692 1448 Nails, 693. Neuralgia, 694. breast, 696. ear, 697. coccyx, 698. face, 699. kidneys, 099. intercostal nerves, 700. muscles, 700. sciatic, 701. testes, 703. Neurasthenia, 708. brain, 710. sexual, 719. Neurosis, anus, 731. aorta, 733. bowels, 734. brain, 734. clitoris, 735. genitals, 735. heart, 736. larynx, 736. nose, 738. penis. 739. prostate, 740. sexual sense, 740. skin, 742. spinal cord, 742. vagina, 744. general, 745. Nightmare, 746. Obesity, 747. Oidium albicans, 411. Old age, 747. Olfaction, 751. Ophthalmia, 567. infantile, 568. common, 569. purulent, 569. gonorrheal, 571. tnhercular, 571. rheumatic, 571- Othaematoma, 753. Otomycosis, 755. Otorrhcea, 756. Ozaena, 757. Papulae, 759. Paralysis, 761. paraplegia, 762. amyloid, 766. mercuric, 766. lead, 767. agitans, 768. infantile, 768. wasting, 770. rheumatic, 770. • diphtheric, 770. INDEX. I Paralysis, local, 772. I bladder, 772. Paraphimosis, 773. Parasites, 774. intestinal, 775. ascarides, 776. lumbricoides, 776. taenia solum, 777. trichiniae spiralis, 7X1. lice, 784. itch, 784 ringworm, 786. liver spot, 789. baldness, 791. barbers' itch, 791. Pemphigus, 793. Perineal pressure, 795. Perversion of sexual sense, 797. Phimosis, 802. Phlegmasia, dolens, 803. Phosphorus disease, 803. Piarrhaemia, 804. Pityriasis, 805. Peptonuria, 805. Petechia, 806. Phrenal syphilis, 1190. Pneumococcus, 391. Pneumothorax, 806. Poison, 807, 824. Polypus, 808. aural, 809. nasal, 812. pharyngeal, 816. rectal, 817. umbilical, 820. uterus, 821. urethra, 824. Polyuria, 825. Porrigi decalvans, 826. Pregnancy, 828, Presentations in labor, 840. Priapism, 862. Prolapse of mesentery, 862. rectum, 864. uterus, 8c6. vagina, 869. Prostatorrhcea, 870. Pruritis, 872. • Prurigo, 875. Psilosis, 875. Psoriasis, 875. lingua, 876. Pterygium, 878. Ptomaines, 879. Purpura, 883. Pyaemia, 884. Rabies, 886. Races, 888. INDEX. 1449 Railway, 896. Ranula, 897. Rectum, 897. Rectal medical, 898. Reflex irritation, 899. Respiration, 899. Rigor mortis, 904. Retching, 905. Rheumatism, 906, Rhinoscleroma, 917. Roseola, 918. Rupia 919. Rupture of heart, 919. muscle, 919. hernia, 920. inguinal, 927. femoral, 928 umbilical, 929. uterus, 929. Sanitary science, 930. Sarcina ventriculi, 418. intestinal, 419. uterine, 419. Scurvy, 955. Scythianas, 795. S«a sickness, 956. Seminal vesicles, 959. Sight, 961. Sleep, 964. Sore throat, 965. Spasms. 966. bladder, 967. rectum, 968. Spermatorrhoea, 969. Spermatozoa, 977. Spinal, 979. Spirillum plicatile, 411. relapsing fever, 412. Sprains, 982. Stammering, 983. Staphyloma, 984. Sterility, 985. Stertorous breathing, 991. Strabismus, 992. Stryptococcus of diphtheria, 412. cerebro-spinal meningitis, 413. erysipelas, 413. foot disease, 414. pyogenes, 415. puerperal fever, 415. yellow, 416. periostitis, 416. rabies, 417. Stricture of oesophagus, 995. rectum, 995. urethra, 997. Styes, 1001. Suicide. 1001. Sweat, 1003. Syncope, 1004. Synovia, 1004. Syphilis, phrenal, 1190. Temperaments, 1005. Tetanus, 1006. Thrombosis, 1010. Tongue, ion. Tonsils, 1014. Toothache, 1015. Tuberculosis, 1016. Tubercle in lung, 1021. nose, 1039. larynx, 1039. bowels, 1041. peritoneum, 1044. mesentery, 1045. bladder, 1047. rectum, 1049. prostate, 1051. testes, 1052. eye and ear, 1052. skin, 1053. bone, 1055, 1057. spine, 1061. hip-joint, 1067. knee-joint, 1069. wrist-joint, 1071. Tumors, 1093. fibroma, 1094. myxoma, 1097. chondroma, 1103. osteoma, 1103. lymphoma, 1104. sarcoma, 1105. myoma, 1108. neuroma, 1109. angioma, 1110. papilloma, 1113. adenoma, 1115. mixed, n 17. Ulcers, 1121. cutaneous, 1121. healthy, 1123. irritable, 1123. indolent, 1124. tubercular, 1124. varicose, 1125. fistulous, 1125. phagedenic, 1126. bed sores, 1127. gangrenous, 1127. hospital gangrene, 1127. syphilitic, 1128. malignant, anthrax, 1129. gastric, 1129. of the larynx, 1134. diphtheric, 1135. on the rectum, 1136, 1141. lA^O 1NDKX. Ulcers on the neck of uterus, 1142. on the vulva. 1148. Uraemia, 1149. Urine, 1150. Urticaria, 1165. Vaginal medication, 1168. Varix, 1169 Varicocele, 1171. Venereal disease, 1174. bacillus, 1183. in the eye, 1189. in the brain, 1190. in offspring, 1195. in the liver. 1197- Venereal bacillus in the lungs, 1198. in the lymphatics, 1202. in urethra and vagina, 1202. in nasal cavity, 1204. in the skin, I20f>. in the trachea, 1217 on the tongue, 1219. Vertigo, 1219. Vasico-urethral erethism, 1222. Vulva, shrinking, 1224. Warts, 1225. Wasting disease, 1227. Xeroderma, I 227 BACTERICIDES. Abrus Precatorius. 1 229. Acacia, 1231. Acetic Acid, 1231. Achillea, 1232. Aconitine, 1232. Acta Racemosa, 1233. Adahatoda Vasica. r 234. Adonidin, 1234 Agaric Acid, 1234. Agrimony, 1235. Aleteris Farinosa, 12 ;'>, Alkanet, 1237. Alnus Niger, 1237. Althaea, 1238. Aloe, 1238. Alum, 1238. Aluminum, 1239. Acetate of Aluminum, 12 V*. Alvelos Milk, 1239 Amaranthus, 1240. Ammonia, 1240. Amylene Hydrate, 1241 Anagallis Arvensis, 1241 Andromeda Polyfolia, 1242. Anemone Nemorosa 1242. Angelica, 1242. Antefebrine, 1243. Antimicrobe Powder. 1244. Antipyretics, 1245. Apocynum, 1247. Apiol, 1247. Arnica, 1247. Arnotto, 1248. Arsenic, 1248. Arum Triphyllum. 1249 Asclepias, 1249 Aseptol, 1241, Asparagus, 1250. Aspidospermine, 1250. American Ash, 1251. Balsam Copaiba, 1251. Balsam of Peru, 1252. Balm Melissa, 1252. Bayberry, 1253 Benzoin, 1253. Berberis Vulgaris, 1254. Belladonna, 1255. Betin, 1255. Bismuth, 1256. Bistort, 1257. Bittersweet, 1257. Bladder-Wrack, 1258. Bloodroot, 1258. Blue Cohosh, 1259. Boldo, 1259. Boroglyceride, 1260. Bryonia, 1263. Burdock, 1264. Cadmium, 1264. Calabar Bean, 1264. Cajeput Oil, 1264. Calcium, 1265. Camphor, 1266. Campho-Phenique, 1267 Cannabis Sativa, 1267. Capsicum, 1268. Cardamom Seeds, 1269. Carbolic Acid, 1270. Caraway, 1270. Carbonic Acid Gas, 1271 Caroba, 1271. Carrageen. 1272. INDEX. 1451 Cascara Sagrada, 1272. Cassia Alata, 1273. Celona Glabra, 1274. Centaury, 1274. Cerastinum Vulgatum, 1275. Cerebrin, 1275. Cerium, 1275. Cinchona, 1275. Cinnamon, 1276. Camomile, 1277. Chelidonium, 1278. Charcoal, 1278. Chaulmogra Oil, 1279. Chrysarobin, 1280. Chian Turpentine, 1281. Chinoline Salicylate Tartrate, 1281. Chionanthus Virginica. 1281. Chloral Hydrate, 1282. Croton Chloral Hydrate, 1282. Chloralamid, 1282. Chlorine Water, 1283. Chloride of Chromium, 1283. Clover, 1284. Coca Erythroxylon, 1285. Cocculus Indicus, 1288. Cochlearia Officinalis, 1288. Coca Theobroma, 1289. Coffee, 1289. Columbo, American, 1290. Colchicum, 1291. Collinsonia Canadensis, 1292. Collodion, 1293. Colt's-Foot, 1294. Comfrey, 1294. Convolvulus Panduratus, 1295. Concentrated Ozone, 1295. Cendurango Bark, 1295. Conium, 1296. Convallamarin, 1296. Croton, 1297. Corallorhiza Odontorhiza, 1297. Corn Smut, 1298. Cotton Root, 1298. Coumarin, 1299. } Creatine, 1299. Creosote, 1300. Creolin, 1301. Cuphea Viscasissima, 1268, Curare Sulphate, 1303. Cyclamen, 1304. Damiana, 1304. Digitalis, 1305. Dogwood, 1305. Drosera, 1306. Eggs, 13°6. Elaterium, 1306. Elecampane, 1307. I Elder, 1308. Elm Bark, 1308. Ephilobium Angustifolium, i3og Erigeron Canadensis, 130c) Ergot, 1310. Erythronium Americanum, 1311 Eryngium, 1311. Eschohltzia Califomica, 1312. Eucalyptus, 1312. Euphorbia Pilulifera, 1314 Euphrasia, 1314. Eupatoreum Purpureum, 1315 Exalgine, 1315. Fennel, 1316. Fumarine, 1317. Gaultheria, 1317. Gelsemium, 1318. Gentian, 1320. Geranium, 1320. Ginger, 1322. Gillenia Trifoliata, 1322. Glycerine, 1323. Glycerite of Ozone, 1326. Guttapercha, 1327. Gold Chloride et Soda, 1328 Grindelia Robusta, 1329. Guiacum, ^329. Helianthus, 1330. Hepatica, J 330. Hindoo Bitters, 1349. Hoang Nan, 1330. Hound's Tongue, 1331 Hops, 1331. Horse-Chestnut, 1332. Hyssop, 1333. Hydrastis Canadensis, 1333. Hydrocotyle Asiatica, 1334 Hydronapthol, 1335 Ichthyol, 1336. Ingluvin, 1337. Indigo, 1338. Ipecac, 1338. Iodine, 13-39. Jaborandi, 1342. Jalap, 1343- Jamaica Dogwood, 1345 Jambul, 1344- Juniper, 1345 Kaki, 1345. Kalmia, 1346. Kava-Kava, 1346. Kola Nut, 1347. 1452 INDEX Koussa, 1349. Kurchicine, 1349. Lactic Acid, 1350. Lochnantes Tinctoria, 1352. Lactose, 1352. Lactucarium, 1353. Lavender, 1353. Lemon, 1354. Leptandra, 1355. Licorice, 1355. Liquid Ozone, 1356. Lithia, 1357. Lobelia, 1357. Lycopodium, 1358. Lycopus, 1358. Male Fern, 1359. Manaca, 1359. Marjoram, 1360. Marrubium, 1360. Menthol, 1361. Mudar Bark, 1362. Marigold, 1362. Menyanthis Trifohata, 1363. Mexican Ointment, 1363. Mitchella Repens, 1363. Mulberry, 1364. Maranta, 1354- Mistletoe, 1365. Muira Puama, 1366. Mullein. 1366. Myrrh, 1367. Myrtle, 1367. Napththaline, 1368. Nitrite of Amyl, 1370. Nutmeg, 1372. Nux Vomica, 1373. Nymphae Odorata, 1373. CEnanthe Crocata, 1374. Obstetric Cones, 1375. Oxygen, Compound, 1376. Ozonized Uric Acid Solvent, 1377. Ozone et Chlorine, 1378. Ozonized Syrup of Tar, 1380. Ozone Tablet, 1380. Ozonized Clay, 1380. Ozone Water, 1380. Ozone Paste, 1381. Ozone Ointment, 1381. Papoid, 1382. Paraldehyde, 1383. Passiflora Incarnata, 1384. Pa-tiles, 1385. Peppermint, 1385. Pellitory, 1385. Pennyroyal, 1386. Pepsin, 1386. Permanganate Potassa, 1387. Pichi, 1388. Peroxide of Hydrogen, 1388. Phenacetine, 1390. Phlorizin, 1390. Phytolacca, 1390. Platinum Chloride, 1390. Pimento, 1390. Phospi ated Tincture of Oats, 1391. Plantain, 1393. Pomegranate, 1393. Pelleterin, 1394. Poplar, 1394. Protagon, 1395. Prunia, 1395. Pulsatilla, 1396. Pyriden, 1396. Pyrodin, 1396. Raspberry, 1397. Resorcin, 1397. Rhigolene, 1399. Rhus Aromatica, 1399. Rue, 1400. Saccharin, 1400. Salol, 1401. Salicylate of Soda, 1403. Santonin, 1403. Sandal Wood, 1404. Saponaria Officinalis, 1404. Savin, 1405. Saw Palmetto, 1405. Saxifraga, 1406. Skullcap, 1407. Senega Root, 1408. Serpentaria, 1408. Siegesbeckie Orientalis, 1409. Silico-Fluoride of Soda, 1411. Simibicidia, 1411. Simulo, 1412. Soldago, 1413. Sozoidol, 1341. Speedwell, 1413. Solanin, 1414. Spikenard, 1414. Sulphate Sparteine, 1415. Staphisagria, 1416. Stillingia Sylvatica, 1417. | Stramonium, 1419. Storax, 1419. Sulfonal, 1420. Sulpho-Carbolate of Sodium, 1420. Sulpho-Carbol, 1421. Soluble Gelatine Urethral Bougies, 1421. Strophanthus, 1421. Sulphur, 1423. INDEX. 1453 Sumach, 1427. Sumbul, 1428. Sweet Flag, 1428. Tag Alder, 1429. Tansy, 1429. Terebintha, 1430. Terpin Hydrate, 1432. Terpinol, 1433. Thallin, 1434. Theine. 1434 Thymol, 1435. Thio-Resorcin, 1398. Triticum Repens, 1436. Tobacco, 1436. Thuja Occidentalis, 1437. Tulip Tree, 1438. Uranium, 1438. Urethran, 1438. Uva Ursi, 1438. Valerian, 1439. Veratrum Viride, 1439. Veronica Beccabunga, 1440. Vervain, 1440. Virginia Stone Crop, 1417. Warburg's Tincture, 1441. Water Plantain, 1441. Witch Hazel, 1442. Wormwood, 1443. Willow, Black, Fluid Extract, 1443 Xanthoxylum, 1444. • <3 NE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE S«a NATIONAL LIBRARY OF M V. IVN 3NIDI03W JO AaVaSIT IVNOIIVN INE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE XI NATIONAL LIBRARY OF M j IVN 3NIDIQ3W JO AaV»9n IVNOIIVN :iNE NATIONAL LIBRARY OF MEDICINE ■^\"%y\ T r IVN NATIONAL LIBRARY OF MEDICINE j v^ jo Aavaan ivnoiivn \ ^4 * NATIONAL LIBRARY OF M 3NOia3w jo Aavaan r r-tAilUNAL LIBRARY OF MEDICINE r^\ : \A i A/ DJivaan tvnouvn 3nidio3w jo Aavaan tvnouvn NATIONAL LIBRARY OF MEDICINE S. 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